Iron deficiency in infants and children

Iron deficiency anemia afflicts an estimated two billion people and iron deficiency approximately 4 billion people in developed countries and is even more common in developing countries. In Brazil, depending on the region and age, studies point to high prevalences of iron-deficiency anemia in children. The high growth speed, which requires a greater amount of iron, connected with an inadequate iron diet and early weaning contribute to the high prevalence, mainly within the first 2 years of life. Other risk factors, such as prematurity, low birth weight, early umbilical cord clamping and weaning from exclusive breastfeeding may contribute. The impact of iron deficiency on growth is controversial as several other variables contribute to improve or worsen the nutritional status. Alterations in the psychomotor and neural-cognitive development of infants with iron deficiency have been reported in various studies with the catch-up growth rate after treatment being controversial. Additionally, some studies have demonstrated a decrease in the intellectual development and cognitive acquisition in school age children and adolescents that is reverted after iron therapy. The best preventive measure is nutritional education, however due to the high prevalence of iron deficiency anemia, other measures should also be used as iron supplementation and food fortification with iron.Estima-se que dois bilhões de indivíduos sejam anêmicos e que a deficiência de ferro ocorra em cerca de quatro bilhões de indivíduos, afetando a população de países desenvolvidos e, com mais intensidade, a dos países em desenvolvimento. No Brasil, estudos apontam elevada prevalência de anemia ferropriva em crianças dependendo da região e da faixa etária. A velocidade de crescimento aumentada, determinando maior necessidade de ferro, aliada a dieta inadequada em ferro e ao desmame precoce, contribuem para a elevada prevalência de anemia, principalmente nos dois primeiros anos de vida. Outros fatores de risco são apontados, como a prematuridade, o baixo peso ao nascer, a ligadura precoce do cordão umbilical e o abandono do aleitamento materno exclusivo. O impacto da deficiência de ferro no crescimento permanece controverso, uma vez que inúmeras outras variáveis poderiam contribuir para melhora ou piora do estado nutricional. Alterações no desenvolvimento psicomotor e neurocognitivo, nos lactentes deficientes com ferro, têm sido relatadas em diversos estudos, sendo controversa a recuperação após o tratamento. Há trabalhos que demonstram queda no rendimento intelectual e nas aquisições cognitivas também no período escolar e adolescência, com reversão após a terapia marcial. Entre as medidas preventivas, a educação nutricional é a forma ideal; entretanto, frente à elevada prevalência, outras formas de prevenção devem ser também utilizadas, como a suplementação com ferro e a fortificação de alimentos com ferro.Universidade Federal de São Paulo (UNIFESP) EPM Departamento de PediatriaUniversidade Federal de São Paulo (UNIFESP) EPM Depto. de PediatraUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPM, Depto. de PediatraSciEL

Avaliação dos processos de secagem e da qualidade do sorgo granifero (Sorghum bicolor L. Moench)

Orientador: João Domingos BiagiDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia AgricolaResumo: Verificou-se, neste trabalho, a influência de tratamentos térmicos, grau de umidade e presença de ar ambiente, no fenômeno de endurecimentodos grãos de feijão (Phaseolus vulgaris L.) armazenados, visando identificar as condiçôes de armazenagem que minimizem a perda de qualidade de textura do produto. Os grãos foram submetidos a dois tratamentos térmicos (Vapor a 9SoC por 10 minutos e Autoclave a 121°C por 2 minutos) e em seguida armazenados em vidros herméticos com 7, 10 e 13% de umidade, por um período de oito meses à temperatura ambiente (15 a 27°C), sob duas condições: aeração quinzenal e sem aeração. A cada dois meses foi avaliada a qualidade de textura dos feijões, aqui representada pela cozinhabilidade dos grãos detectada através do "Penetrômetro de Mattson" e pela resistência à compressão dos grãos "in natura". A qualidade de textura dos grãos cozidos foi melhor preservada quando armazenados com níveis de umidade de 7 ou 10%, sem aplicação de tratamento térmico e independente da presença ou não de ar ambiente. Os resultados demonstraram que os tratamentos térmicos vapor e autoclave foram prejudiciais à cozinhabilidade do feijão. O tempo de armazenamento exerceu uma influência diretamente proporcional ao endurecimentodo produto, com relação a todos os outros fatores analisados. Constatou-se que, na faixa de umidade investigada, a textura dos feijões "in natura" é influenciada pelo seu teor de umidade, de modo que a conteúdos de umidade mais altos correspondem grãos de menor dureza. Observou-se, também, que amostras de feijão não podem ser diferenciadas, quanto a sua cozinhabilidade,através da textura dos grãos "in natura"Abstract: The purpose of this work was to verify the influence of heat treatments, moisture content and ambient air on the hardening phenomenon of stored dry beans (Phaseolus vulgaris L.) in order to identify the storage conditions that minimizes the textural quality loss of theproduct. Two heat treatments were applied: 2 minutes in an autoclave at 121°C and 10 minutes under steam at 98°C followed by eight months period storage in hermetic glass jars. The beans moisture contents were 7, 10 and 13%, during storage at ambient temperature at two conditions: fortnightly aeration and no aeration at alI. Every two months the beans textural quality were evaluated by determining the cookability through the "Mattson Penetrometer"device and by testing the resistance against compression force of the raw beans. Cooked beans textural quaIity were better maintained when stored at moisture contents of 7% or 10%, without pre-storage heat treatments and independent of the ambient air presence. Both heat 94 treatments autoclave and steam were proven to be detrimental to the beans cookability. The storage time was directly proportional to the beans hardening process, with respect to all analysed factors. It was verified that, for the investigatedmoisture content range, raw beans texture was influenced by its moisture content, so that higher moisture levels meant grains of lower hardness. It was also observed that beans cookability cannot be predicted by its raw characteristic of hardnessMestradoPre-Processamento de Produtos AgropecuariosMestre em Engenharia Agrícol

Idiopathic thrombocytopenic purpura as initial manifestation of juvenile systemic lupus erythematosus

Patients with Idiopathic Thrombocytopenic Purpura (ITP) present a high trend to develop Systemic Lupus Erythematosus (SLE), especially those with chronic presentation. Some authors observed that female gender, older patients and familial history of autoimmune disease in patients with Idiopathic Thrombocytopenic Purpura are factors that lead to increased susceptibility for the development of Systemic Lupus Erythematosus. Based on these facts, we decided to study 5 children with chronic Idiopathic Thrombocytopenic Purpura and late Systemic Lupus Erythematosus. In this paper, we describe the clinical and laboratorial features of 5 female children with Idiopathic Thrombocytopenic Purpura that later developed Systemic Lupus Erythematosus. All patients were girls, 3 Caucasian, with Idiopathic Thrombocytopenic Purpura onset age ranged between 6 years and 3 months and 12 years and 1 month (mean - 9 years and 2 months). The age at Systemic Lupus Erythematosus diagnosis ranged between 8 years and 13 years and 8 months (mean - 10 years and 10 months). Though, the gap between Idiopathic Thrombocytopenic Purpura and Systemic Lupus Erythematosus diagnosis ranged between 11 months and 2 years and 9 months (mean - 1 year and 10 months). All patients presented chronic Idiopathic Thrombocytopenic Purpura (thrombocytopenia lasts longer than 6 months). The Systemic Lupus Erythematosus classification criteria were (in decreasing frequency): malar erythema and positivity of ANA in 5 patients; arthritis, hematological (thrombocytopenia) and immunological alterations (positivity of anti-DNA) in 4 patients; photosensitivity and positivity of anti-cardiolipin in 3 patients. Other manifestations included oral ulcers, renal involvement, leukopenia and auto-immune hemolytic anemia, serositis (pericarditis), neurological involvement and positivity of anti-Sm antibody. We would like to emphasize this form of presentation of Systemic Lupus Erythematosus, in which the Idiopathic Thrombocytopenic Purpura was the first manifestation and that the auto-antibody determination in every children with chronic form of this disease is very important.Os pacientes com púrpura trombocitopênica imunológica apresentam risco aumentado para desenvolver lúpus eritematoso sistêmico, principalmente quando a doença evolui de forma crônica. Alguns autores observaram que o sexo feminino, a idade mais avançada, a história familiar para lúpus eritematoso sistêmico podem ser fatores indicadores de maior risco para desenvolver lúpus em pacientes com púrpura trombocitopênica imunológica. Com base nestes fatos, resolvemos estudar cinco crianças nas quais a púrpura trombocitopênica imunológica foi o primeiro sintoma do lúpus eritematoso sistêmico. Neste artigo descrevemos as características clínicas e laboratoriais de cinco crianças com púrpura trombocitopênica imunológica que desenvolveram lúpus eritematoso sistêmico juvenil. Todas as crianças eram do sexo feminino - três caucasóides e duas pardas, com idade do início das manifestações de PTI variando entre 6 anos e 3 meses a 12 anos e 1 mês (média de 9 anos e 2 meses). A idade do diagnóstico de LESJ variou de 8 a 13 anos e 8 meses (média de 10 anos e 10 meses). Portanto, o intervalo de tempo entre o quadro de PTI e o diagnóstico de LESJ foi de 11 meses a 2 anos e 9meses (média de 1 ano e 10 meses). Todas as crianças apresentavam quadro de PTI crônica (plaquetopenia por mais de 6 meses). Os critérios de classificação para LESJ foram, em ordem de freqüência: rash malar e FAN positivo em 5 pacientes; artrite, alterações hematológica (plaquetopenia) e imunológica (anticorpo anti-DNA nativo) em 4; fotossensibilidade e ACL positivo em 3. Outras manifestações associadas foram úlceras orais, alterações renal e hematológica (leucopenia e AHAI com TCD positivo); serosite (pericardite), acometimento neurológico e alteração imunológica (anticorpo anti-Sm). Gostaríamos de alertar para esta forma de apresentação do lúpus eritematoso sistêmico em que o primeiro sintoma foi a púrpura trombocitopênica imunológica e salientar a importância da determinação de auto-anticorpos para lúpus eritematoso sistêmico nas crianças com a forma crônica desta patologia.UNIFESP-EPMUNIFESP, EPMSciEL

Retardo en la erupción dental en adolescentes con hipotiroidismo

OBJECTIVE: To report the case of an adolescent with undiagnosed hypothyroidism who sought dental clinic care due to delayed tooth eruption. Multiprofessionalwork enabled the diagnosis. CASE DESCRIPTION: This is a 16 years and 4 month-old patient whose initial complaint was delayed tooth eruption. Dental evaluation drew attention to the significant delay in tooth eruption as it could be related to organic diseases. This has prompted the intervention of medical professionals who diagnosed hypothyroidism in the follow-up. COMMENTS: Teenagers typically value acceptance by their peers and may have aesthetic concerns that lead them to seek health services for seemingly trivial complaints. A high degree of surveillance in these cases can detect more serious underlying organic problems. We highlight the importance of the multidisciplinary team in this approach.OBJETIVO: Relatar caso de adolescente que buscó servicio odontológico de un ambulatorio de medicina del adolescente, por presentar retardo en la erupción dental y cuya actuación multiprofesional permitió llegar al diagnóstico de hipotiroidismo. DESCRIPCIÓN DEL CASO: Se describe la historia de una paciente de 16 años y 4 meses de edad cuya queja fue retardo en la erupción dental. En la evaluación odontológica, llamaba la atención el importante retardo en la erupción dental, lo que podría estar relacionado a alguna enfermedad orgánica. De este modo, se solicitó la intervención del equipo médico que, en el seguimiento, constató tratarse de hipotiroidismo. COMENTARIOS: Se llama la atención para el hecho de que adolescentes estiman mucho la aceptación por sus pares y las cuestiones estéticas y, muchas veces, la búsqueda por un servicio de salud implica quejas que pueden parecer comunes, pero una mirada atenta no dejará que problemas orgánicos más graves pasen desapercibidos. Se subraya además la importancia de la actuación del equipo multiprofesional.OBJETIVO: Relatar o caso de adolescente que procurou serviço odontológico de um ambulatório de medicina do adolescente por apresentar atraso de erupção dentária. A atuação multiprofissional permitiu chegar ao diagnóstico de hipotireoidismo. DESCRIÇÃO DO CASO: Paciente de 16 anos e 4 meses cuja queixa inicial foi atraso na erupção dentária. Na avaliação odontológica, chamava atenção o importante atraso na erupção dentária, o que poderia estar relacionado a alguma moléstia orgânica. Desta forma, solicitou-se a intervenção da equipe médica, que, no acompanhamento, constatou se tratar de hipotireoidismo. COMENTÁRIOS: Chama-se a atenção o fato de que adolescentes prezam a aceitação pelos seus pares e as questões estéticas e, muitas vezes, a procura por um serviço de saúde envolve queixas que podem parecer triviais. Porém, o olhar atento não deixará que problemas orgânicos mais graves passem despercebidos. Salienta-se ainda a importância da atuação da equipe multiprofissional.UNIFESP Centro de Atendimento e Apoio ao Adolescente Departamento de PediatriaUNIFESP Departamento de PediatriaUNIFESP CAAAUNIFESP Departamento de Pediatria Setor de Hematologia InfantilUNIFESP, Centro de Atendimento e Apoio ao Adolescente Depto. de PediatriaUNIFESP, Depto. de PediatriaUNIFESP, CAAAUNIFESP, Depto. de Pediatria Setor de Hematologia InfantilSciEL

INVENTÁRIO DE PEQUENOS MAMÍFEROS (RODENTIA E DIDELPHIMORPHIA) DA SERRA DE OURO BRANCO: PORÇÃO SUL DA CADEIA DO ESPINHAÇO, MINAS GERAIS, BRASIL

Serra do Ouro Branco is located at the south portion of Espinhaço Range, at a transition area between Cerrado and Atlantic Forest biomes, in Minas Gerais state, Brazil. Here, we surveyed small mammals communities from Parque Estadual Serra do Ouro Branco and Monumento Natural Estadual do Itatiaia, two protected areas, and compared them with the diversity recorded in the remaining Espinhaço mountain range. Sampling occurred over 24 months (2009-2010) using pitfall traps. Nineteen species, 13 rodents and six marsupials, were recorded in 6,664 traps /night. The study area has low similarity with other areas of Espinhaço Range; high dissimilarity was the main pattern found, as revealed by the large number of singletons (40%) and few species found at least in half of the areas (17%). Thus, the elevated richness and diversity registered allied to the singularity in composition of species in each area and the scarcity of data for the north and mainly for the central region of Espinhaço, reinforce the importance and urgency of more studies and inventories of small mammals in all mountain range extension.Serra do Ouro Branco is located at the south portion of Espinhaço Range, at a transition area between Cerrado and Atlantic Forest biomes, in Minas Gerais state, Brazil. Here, we surveyed small mammals communities from Parque Estadual Serra do Ouro Branco and Monumento Natural Estadual do Itatiaia, two protected areas, and compared them with the diversity recorded in the remaining Espinhaço mountain range. Sampling occurred over 24 months (2009-2010) using pitfall traps. Nineteen species, 13 rodents and six marsupials, were recorded in 6,664 traps /night. The study area has low similarity with other areas of Espinhaço Range; high dissimilarity was the main pattern found, as revealed by the large number of singletons (40%) and few species found at least in half of the areas (17%). Thus, the elevated richness and diversity registered allied to the singularity in composition of species in each area and the scarcity of data for the north and mainly for the central region of Espinhaço, reinforce the importance and urgency of more studies and inventories of small mammals in all mountain range extension.Serra do Ouro Branco is located at the south portion of Espinhaço Range, at a transition area between Cerrado and Atlantic Forest biomes, in Minas Gerais state, Brazil. Here, we surveyed small mammals communities from Parque Estadual Serra do Ouro Branco and Monumento Natural Estadual do Itatiaia, two protected areas, and compared them with the diversity recorded in the remaining Espinhaço mountain range. Sampling occurred over 24 months (2009-2010) using pitfall traps. Nineteen species, 13 rodents and six marsupials, were recorded in 6,664 traps /night. The study area has low similarity with other areas of Espinhaço Range; high dissimilarity was the main pattern found, as revealed by the large number of singletons (40%) and few species found at least in half of the areas (17%). Thus, the elevated richness and diversity registered allied to the singularity in composition of species in each area and the scarcity of data for the north and mainly for the central region of Espinhaço, reinforce the importance and urgency of more studies and inventories of small mammals in all mountain range extension

Factors Associated With Early Weaning

To identify the factors that influenced early weaning and its incidence among children from six months old in five public hospitals of two states - Minas Gerais and Bahia, Brazil. Material and Methods: The sample (N = 104) was of convenience type composed of mothers of six-month-old infants from five public hospitals. Mothers answered a personal interview by phone when the child was six months old. Data analysis was performed by the association between the dependent variable, early weaning, and independents variables, maternal age, mother's marital status, education and job, family income, maternal belief about the amount of milk produced to be or not enough to feed her baby and breastfeeding interruption reason, through the chi-square test in SPSS software version 17.0 (p< 0.05). Results: Among the relationships found, only maternal belief in milk failure was significantly associated with early weaning (p < 0.001). Most mothers who did not perform early weaning believed they had satisfactory amount of milk (66.7%). The general weaning rate was. 30%. Conclusion: Early weaning was related to maternal belief that the amount of milk was insufficient to meet the needs of the newborn and its incidence was high in the study population.16149149

O planejamento e as relações federativas no Plano de Ações Articuladas: assimetrias nas ações de formação de professores

Neste artigo, analisam-se as relações federativas: intergovernamentais, descentralização e regime de colaboração entre a União e o Município de Mossoró/RN, nas ações de formação de professores no PAR (2007-2011). A análise teórica, documental e os dados empíricos emanam de tese inscrita na pesquisa de avaliação do PAR do Observatório da Educação/Capes. Constatam-se aproximações dos entes federados, mantendo-se assimetrias no planejamento e financiamento nas ações, com centralidade na União

Molecular analysis and association with clinical and laboratory manifestations in children with sickle cell anemia

Objectives: To analyze the frequency of βS-globin haplotypes and alpha-thalassemia, and their influence on clinical manifestations and the hematological profile of children with sickle cell anemia.Method: The frequency of βS-globin haplotypes and alpha-thalassemia and any association with clinical and laboratorial manifestations were determined in 117 sickle cell anemia children aged 3–71 months. The confirmation of hemoglobin SS and determination of the haplotypes were achieved by polymerase chain reaction-restriction fragment length polymorphism, and alpha-thalassemia genotyping was by multiplex polymerase chain reaction (single-tube multiplex-polymerase chain reaction).Results: The genotype distribution of haplotypes was 43 (36.7%) Central African Republic/Benin, 41 (35.0%) Central African Republic/Central African Republic, 20 (17.0%) Rare/atypical, and 13 (11.1%) Benin/Benin. The frequency of the α3.7 deletion was 1.71% as homozygous (−α3.7/−α3.7) and 11.9% as heterozygous (−α3.7/αα). The only significant association in respect to haplotypes was related to the mean corpuscular volume. The presence of alpha-thalassemia was significantly associated to decreases in mean corpuscular volume, mean corpuscular hemoglobin and reticulocyte count and to an increase in the red blood cell count. There were no significant associations of βS-globin haplotypes and alpha-thalassemia with clinical manifestations.Conclusions: In the study population, the frequency of alpha-thalassemia was similar to published data in Brazil with the Central African Republic haplotype being the most common, followed by the Benin haplotype. βS-globin haplotypes and interaction between alpha-thalassemia and sickle cell anemia did not influence fetal hemoglobin concentrations or the number of clinical manifestations.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Intervenciones del enfermero en las personas con obesidad en la Atención Primaria de Salud: revisión integrativa

Objective: Identify the knowledge produced on nursing interventions with people suffering from obesity in Primary Health Care. Method: Integrative literature review of publications indexed in the databases: CINAHL, LILACS, MEDLINE, SciELO, SCOPUS and WEB OF SCIENCE, between 2011 and 2016. Results: Thirty-three articles were selected. The knowledge produced covered two themes: “Counseling aimed at weight control and promotion of healthy lifestyle habits” and “Perception of Primary Health Care nurses regarding interventions with people with obesity.” Conclusion: The results may help prompt reflections on professional training, management, and health services in terms of the relevance of nurses working with people suffering from obesity, with the support of digital technologies, motivational techniques, and nursing consultations. This could enhance their activities in the multiprofessional teams in which they participate at this healthcare level.ObjetivoIdentificar el conocimiento producido acerca de las intervenciones del enfermero en las personas con obesidad en la Atención Primaria de Salud. Método Revisión integrativa de la literatura de publicaciones indexadas en las bases de datos: CINAHL, LILACS, MEDLINE, SciELO, SCOPUS y WEB OF SCIENCE, entre 2011 y 2016. Resultado Fueron seleccionados 33 artículos. El conocimiento producido congregó dos temas: “Aconsejamiento con vistas al control del peso corporal y la promoción de hábitos sanos de vida” y “Percepción del enfermero acerca de las intervenciones en las personas con obesidad en la Atención Primaria de Salud”. Conclusión Los resultados podrán contribuir a la reflexión en el marco de la formación profesional, gestión de servicios sanitarios acerca de la relevancia de la actuación del enfermero junto a las personas con obesidad, con el aporte de tecnologías digitales, técnicas motivacionales y la consulta de enfermería. Eso podrá estimular la valoración de sus acciones en el equipo multiprofesional del que es integrante en ese nivel de atención sanitaria