Dietary patterns of children living in slums and their associated factors: a cross-sectional study, 2019-2022 / Patrones dietéticos de niños que viven en barrios marginales y factores asociados: un estudio transversal, 2019-2022 / Padrões alimentares de crianças moradoras de favelas e fatores associados: um estudo transversal, 2019-2022

ABSTRACT Objective To identify dietary patterns and analyze factors associated with the consumption profile of socially vulnerable children, Maceió, state of Alagoas, Brazil, August 2019 to December 2021. Methods This was a cross-sectional study; sociodemographic, anthropometric and food consumption variables were collected, factor analysis was used to identify dietary patterns; associations were analyzed using Poisson regression. Results Among the 567 children studied, two dietary patterns were identified, healthy and unhealthy; age ≥ 24 months (PR = 2.75; 95%CI 1.83;4.14), male gender (PR = 0.66; 95%CI 0.49;0.87) and maternal schooling ≤ 9 years (PR = 0.61; 95%CI 0.46;0.81) was higher in the healthy pattern; the unhealthy pattern was associated with age ≥ 24 months (PR = 1.02; 95%CI 1.01;1.03) and male gender (PR = 1.46; 95%CI 1.08;1.98). Conclusion The healthy pattern was more frequent in children aged ≥ 24 months, less frequent in male children and mothers with low level of schooling; children aged ≥ 24 months and males showed a higher prevalence of the unhealthy pattern.

RESUMEN Objetivo Identificar hábitos alimentarios de niños socialmente vulnerables y analizar su relación con factores vinculados al perfil de consumo de Maceió, Alagoas, Brasil. Métodos Estudio transversal de base poblacional llevado a cabo de agosto de 2019 a diciembre de 2021; se recogieron variables sociodemográficas, antropométricas y de consumo de alimentos, los patrones alimenticios se identificaron mediante análisis factorial; las asociaciones se analizaron mediante regresión de Poisson. Resultados De los 567 niños estudiados se identificaron dos hábitos de alimentación, "saludable" y "no saludable"; edad ≥ 24 meses (RP = 2,75; IC95% 1,83;4,14), sexo masculino (RP = 0,66; IC95% 0,49;0,87) y educación materna ≤ 9 años (RP = 0,61; IC95% 0,46;0,81) se asociaron al patrón "saludable"; el patrón "no saludable" se asoció con la edad ≥ 24 meses (RP = 1,02; IC95% 1,01;1,03) y el sexo masculino (RP = 1,46; IC95% 1,08;1,98). Conclusión El patrón "saludable" fue más frecuente en niños ≥ 24 meses y menos frecuente en niños varones y madres con menor educación; los niños de ≥ 24 meses y los varones tuvieron una mayor prevalencia del patrón "no saludable".

RESUMO Objetivo Identificar padrões alimentares e analisar fatores associados ao perfil de consumo de crianças em vulnerabilidade social, Maceió, Alagoas, Brasil, agosto/2019-dezembro/2021. Métodos Estudo transversal; coletaram-se variáveis sociodemográficas, antropométricas e de consumo alimentar, identificaram-se padrões alimentares por análise fatorial; analisaram-se associações mediante regressão de Poisson. Resultados Das 567 crianças estudadas, identificaram-se dois padrões alimentares, saudável e não saudável; idade ≥ 24 meses (RP = 2,75; IC95% 1,83;4,14), sexo masculino (RP = 0,66; IC95% 0,49;0,87) e escolaridade materna ≤ 9 anos (RP = 0,61; IC95% 0,46;0,81) associaram-se ao padrão saudável; o padrão não saudável foi maior em idade ≥ 24 meses (RP = 1,02; IC95% 1,01;1,03) e sexo masculino (RP = 1,46; IC95% 1,08;1,98). Conclusão Padrão saudável mais frequente em crianças ≥ 24 meses, menos frequente no sexo masculino e em mães de menor escolaridade; crianças ≥ 24 meses e do sexo masculino apresentaram maior prevalência do padrão não saudável.

Determining factors of child linear growth from the viewpoint of Bronfenbrenner's Bioecological Theory

Abstract Objective To analyze the factors associated with children's linear growth, according to the different subsystems of the 6Cs model and Bronfenbrenner's Bioecological Theory. Data sources Narrative review, carried out in the Scielo, Lilacs, Pubmed, and Science Direct databases, based on research using the terms Bioecological Theory, child growth, and risk factors, combined with the use of Boolean operators. Summary of findings According to the 6Cs model, proposed based on Bronfenbrenner's Bioecological Theory, the determining factors of children's linear growth are in six interrelated subsystems - cell, child, clan, community, country/state and culture. The empirical studies included in this review made it possible to analyze protection and risk factors within the subsystems. Among the protective factors: are adequate birth weight and satisfactory weight gain, breastfeeding for six months or more; proper hygienic habit of hand washing, proper elimination of feces, and access to clean water. As risk factors: low, birth weight and size, prematurity, multiple deliveries, short interval between deliveries, non-exclusive breastfeeding until the 3rd month, frequency and severity of infectious processes and anemia, little parental education, short maternal statur, inadequate maternal nutritional status, domestic violence, family poverty, food, and nutritional insecurity, living in rural areas or at high altitudes. Conclusion Children's linear growth is determined by interrelated factors that encompass aspects prior to the child's birth, as well as socioeconomic, political, family and community issues.

Serum and genetic markers related to rapid clinical progression of coronary artery disease.

INTRODUCTION AND OBJECTIVES: Patients with clinically evident coronary artery disease differ in their rate of progression, which impacts prognosis. We aimed to characterize serum and genetic markers in patients with rapid clinical progression (RCP) of coronary artery disease vs those with long standing stable (LSS) disease. METHODS: Retrospective study of cases (RCP) and controls (LSS) (1:2). Patients requiring ≥ 2 revascularizations due to atherosclerotic progression in the 10 years after a first angioplasty were considered to be RCP and those without events during the same period after the first angioplasty were considered to have LSS disease. After patient selection, we analyzed serum values, mRNA expression and genetic polymorphisms of inflammatory markers, including interleukin-6, C-reactive protein, and tumor necrosis factor (TNF)-a, and atherogenic markers consisted of proprotein convertase subtilisin/kexin type 9 (PCSK9), low-density lipoprotein receptor, sterol regulatory element binding transcription factor 2, and apolipoprotein-B. RESULTS: The study included 180 patients (58 RCP and 122 LSS). Demographic characteristics, classic risk factors and the extent of coronary disease were similar in the 2 groups. Patients with RCP showed higher serum levels of interleukin-6 and PCSK9 and higher TNF mRNA expression. Interleukin-6 rs180075C, TNF rs3093664 non-G and PCSK9 rs2483205 T alleles conferred a risk of RCP (P<.05 in all cases). Among patients with RCP, 51.7% had all 3 risk alleles vs 18% of those with LSS (P<.001). CONCLUSIONS: We suggest the existence of specific phenotypic and genotypic markers associated with RCP of coronary artery disease that could help to individualize the type and intensity of treatment.

Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease.

OBJECTIVES: The aim of this study was to compare, in a cohort of patients with complex coronary artery disease (CAD) and severe aortic stenosis (AS), the clinical outcomes associated with transfemoral transcatheter aortic valve replacement (TAVR) (plus percutaneous coronary intervention [PCI]) versus surgical aortic valve replacement (SAVR) (plus coronary artery bypass grafting [CABG]). BACKGROUND: Patients with complex CAD were excluded from the main randomized trials comparing TAVR with SAVR, and no data exist comparing TAVR + PCI vs SAVR + CABG in such patients. METHODS: A multicenter study was conducted including consecutive patients with severe AS and complex CAD (SYNTAX [Synergy Between PCI with Taxus and Cardiac Surgery] score >22 or unprotected left main disease). A 1:1 propensity-matched analysis was performed to account for unbalanced covariates. The rates of major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, nonprocedural myocardial infarction, need for new coronary revascularization, and stroke, were evaluated. RESULTS: A total of 800 patients (598 undergoing SAVR + CABG and 202 undergoing transfemoral TAVR + PCI) were included, and after propensity matching, a total of 156 pairs of patients were generated. After a median follow-up period of 3 years (interquartile range: 1-6 years), there were no significant differences between groups for MACCE (HR for transfemoral TAVR vs SAVR: 1.33; 95% CI: 0.89-1.98), all-cause mortality (HR: 1.25; 95% CI: 0.81-1.94), myocardial infarction (HR: 1.16; 95% CI: 0.41-3.27), and stroke (HR: 0.42; 95% CI: 0.13-1.32), but there was a higher rate of new coronary revascularization in the TAVR + PCI group (HR: 5.38; 95% CI: 1.73-16.7). CONCLUSIONS: In patients with severe AS and complex CAD, TAVR + PCI and SAVR + CABG were associated with similar rates of MACCE after a median follow-up period of 3 years, but TAVR + PCI recipients exhibited a higher risk for repeat coronary revascularization. Future trials are warranted.

Acral Calcified Vascular Leiomyoma: Report of 3 Cases and Literature Review.

ABSTRACT: Angioleiomyomas are benign neoplasms, which usually present as solitary, slow-growing nodules on the skin of lower extremities, but acral location on the hands or feet is unusual. Yet, microscopically, they may show many histopathological variants, focal calcification is uncommon. Extensive calcification masquerading the real nature of the tumor has been rarely reported, the term acral calcified leiomyoma having been proposed for this entity. This change is more often in distal locations and has been interpreted as degenerative in nature, probably related to repetitive minor trauma. We report 3 examples of this unusual condition on the feet of 2 male and one female subjects (aged, 68, 69, and 80 years) and make a review of the 31 cases available in the literature. Two of our cases are associated with highly uncommon features, such as transepidermal calcium elimination and concomitant calcaneal spur.

ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement.

BACKGROUND: Among patients with acute coronary syndrome following transcatheter aortic valve replacement (TAVR), those presenting with ST-segment elevation myocardial infarction (STEMI) are at highest risk. OBJECTIVES: The goal of this study was to determine the clinical characteristics, management, and outcomes of STEMI after TAVR. METHODS: This was a multicenter study including 118 patients presenting with STEMI at a median of 255 days (interquartile range: 9 to 680 days) after TAVR. Procedural features of STEMI after TAVR managed with primary percutaneous coronary intervention (PCI) were compared with all-comer STEMI: 439 non-TAVR patients who had primary PCI within the 2 weeks before and after each post-TAVR STEMI case in 5 participating centers from different countries. RESULTS: Median door-to-balloon time was higher in TAVR patients (40 min [interquartile range: 25 to 57 min] vs. 30 min [interquartile range: 25 to 35 min]; p = 0.003). Procedural time, fluoroscopy time, dose-area product, and contrast volume were also higher in TAVR patients (p < 0.01 for all). PCI failure occurred more frequently in patients with previous TAVR (16.5% vs. 3.9%; p < 0.001), including 5 patients in whom the culprit lesion was not revascularized owing to coronary ostia cannulation failure. In-hospital and late (median of 7 months [interquartile range: 1 to 21 months]) mortality rates were 25.4% and 42.4%, respectively (20.6% and 38.2% in primary PCI patients), and estimated glomerular filtration rate <60 ml/min (hazard ratio [HR]: 3.02; 95% confidence interval [CI]: 1.42 to 6.43; p = 0.004), Killip class ≥2 (HR: 2.74; 95% CI: 1.37 to 5.49; p = 0.004), and PCI failure (HR: 3.23; 95% CI: 1.42 to 7.31; p = 0.005) determined an increased risk. CONCLUSIONS: STEMI after TAVR was associated with very high in-hospital and mid-term mortality. Longer door-to-balloon times and a higher PCI failure rate were observed in TAVR patients, partially due to coronary access issues specific to the TAVR population, and this was associated with poorer outcomes.

Sweet's syndrome triggered by ultraviolet light.

Sweet's syndrome is a neutrophilic dermatosis associated with many different underlying conditions but only rarely is it triggered by environmental factors such as ultraviolet (UV) exposure. We present two cases of photoinduced Sweet syndrome. Our first patient, who was taking hydrochlorothiazide, presented photodistributed lesions, pathological phototest and neutrophilic dermatosis histopathology. The phototest normalized after drug withdrawal, suggesting that both UV light and hydrochlorothiazide were necessary to cause the lesions. Our second case presented lesions clearly induced by UV light and histologically consistent with Sweet's syndrome. The MED was decreased and the lesions were reproduced with nbUVB, suggesting the diagnosis of photoinduced Sweet's syndrome. In conclusion, we report a case of neutrophilic dermatosis induced by hydrochlorothiazide and UV light and a case of photoinduced Sweet's syndrome with reproduction of the lesions after nbUVB. Both patients had a pathologic photobiological study. Our report emphasizes the need to perform phototests in patients with photodistributed Sweet's syndrome.

Procedural Characteristics and Late Outcomes of Percutaneous Coronary Intervention in the Workup Pre-TAVR.

OBJECTIVES: This study sought to determine, in patients undergoing percutaneous coronary intervention (PCI) during the work-up pre-transcatheter aortic valve replacement (TAVR): 1) the clinical and peri-procedural PCI characteristics; 2) the long-term outcomes; and 3) the clinical events in those patients with complex coronary features. BACKGROUND: A PCI is performed in about 25% of TAVR candidates, but procedural features and late outcomes of pre-TAVR PCI remain largely unknown. METHODS: Multicenter study including 1197 consecutive patients who had PCI in the work-up pre-TAVR. A total of 1,705 lesions (1.5 ± 0.7 lesions per patient) were included. Death, stroke, myocardial infarction, and major adverse cardiovascular and cerebrovascular events (MACCE) were recorded, as well as target lesion failure (TLF) and target vessel failure (TVF). RESULTS: One-half of patients exhibited a multivessel disease and the mean SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) score was 12.1 ± 9.1. The lesions were of B2/C type, calcified, bifurcation, and ostial in 49.9%, 45.8%, 21.4%, and 19.3% of cases, respectively. After a median follow-up of 2 (interquartile range: 1 to 3) years, a total of 444 (37.1%) patients presented an MACCE. Forty patients exhibited TVF (3.3%), with TLF identified in 32 (2.7%) patients. By multivariable analysis, previous peripheral artery disease (p < 0.001), chronic obstructive pulmonary disease (p = 0.002), atrial fibrillation (p = 0.003), diabetes mellitus (p = 0.012), and incomplete revascularization (p = 0.014) determined an increased risk of MACCE. In patients with unprotected left main or SYNTAX score >32 (n = 128), TLF, TVF, and MACCE rates were 3.9%, 6.3%, and 35.9%, respectively (p = 0.378; p = 0.065, and p = 0.847, respectively, vs. the rest of the population). CONCLUSIONS: Patients undergoing PCI in the work-up pre-TAVR frequently exhibited complex coronary lesions and multivessel disease. PCI was successful in most cases, and TLF and TVF rates at 2-year follow-up were low, also among patients with high-risk coronary features. However, overall MACCE occurred in about one-third of patients, with incomplete revascularization determining an increased risk. These results should inform future studies to better determine the optimal revascularization strategy pre-TAVR.

Metodologia ativa no estágio supervisionado de enfermagem: inovação na atenção primária à saúde / Metodología activa en la pasantía supervisada en enfermería: innovación en la atención primaria de salud / Active methodology in nursing supervised internship: innovation in primary health care

Objetivo relatar a experiência do uso de uma metodologia ativa no estágio supervisionado na Atenção Primária à Saúde. Método trata-se de um relato de experiência sobre o uso de uma metodologia ativa no estágio supervisionado, realizado entre março e junho de 2019, baseado nos pressupostos da educação problematizadora de Paulo Freire. Como estratégia pedagógica utilizou-se a Metodologia da Problematização, apoiada no Arco de Maguerez. Resultados o Arco de Maguerez possibilitou implantar ações de educação em saúde na sala de vacina da unidade de saúde. Este processo de ensino-aprendizagem viabilizou uma postura ativa das acadêmicas envolvidas, convergiu para o propósito de facilitação da professora e resultou na efetiva implementação das estratégias planejadas durante a execução do Arco. Conclusão o presente relato expôs uma experiência exitosa no âmbito do ensino-aprendizagem, de forma a protagonizar o papel das acadêmicas, em consonância com as diretrizes curriculares que indicam prática pedagógica ética, reflexiva e transformadora.

Objetivo reportar la experiencia de utilización de una metodología activa en la pasantía supervisada en la Atención Primaria de Salud. Método se trata de un relato de experiencia en el uso de una metodología activa en la pasantía supervisada, realizado entre marzo y junio de 2019, con base en supuestos de educación basada en problemas de Paulo Freire. Como estrategia pedagógica, se utilizó la Metodología Basada en Problemas, con base en el Arco de Maguerez. Resultados el Arco de Maguerez permitió implementar acciones en educación para la salud en la sala de vacunación de la unidad de salud. Este proceso de enseñanza-aprendizaje posibilitó una postura activa de las estudiantes involucradas, convergió con el propósito de facilitación del profesor y se tradujo en la aplicación eficaz de estrategias planeadas durante la ejecución del Arco. Conclusión el presente informe reporta una experiencia exitosa en el contexto del proceso de enseñanza-aprendizaje, con el fin de protagonizar el papel de las estudiantes, en línea con las directrices curriculares que indican las prácticas pedagógicas éticas, reflexivas y transformadoras.

Objective to report the experience of using an active methodology in the supervised internship in Primary Health Care. Method this is an experience report on the use of an active methodology in the supervised internship, conducted between March and June 2019, based on assumptions of problem-based education of Paulo Freire. The pedagogical strategy used was the Problem-Based Methodology, supported by the Arch of Maguerez. Results the Arch of Maguerez enabled deploying health education actions in the vaccination room of the health unit. This teaching-learning process allowed for an active behavior of the students involved, converged to the professor's facilitation and resulted in the effective implementation of planned strategies during the implementation of the Arch. Conclusion the present report outlined a successful experience in the context of the teaching-learning process, in order to provide the students the main role, in line with the curricular guidelines that indicate ethical, reflective and transformative pedagogical practices.

Clinical Outcomes and Prognosis Markers of Patients With Liver Disease Undergoing Transcatheter Aortic Valve Replacement: A Propensity Score-Matched Analysis.

BACKGROUND: Chronic liver disease is a known risk factor for perioperative morbidity and mortality in patients undergoing cardiac surgery. Very little data exist about such patients treated with transcatheter aortic valve replacement (TAVR). Our objective was to evaluate early and late clinical outcomes in a large cohort of patients with liver disease undergoing TAVR and to determine predictive factors of mortality among these patients. METHODS AND RESULTS: This multicenter study collected data from 114 patients with chronic liver disease who underwent TAVR in 12 institutions. Perioperative and long-term outcomes were compared with a cohort of 1118 patients without liver disease after a propensity score-matching analysis (114 matched pairs). In-hospital mortality and vascular and bleeding complications were similar between matched groups. Acute kidney injury was more common in liver disease group (30.8% versus 13.5%; P=0.010). Although cardiovascular mortality was similar between groups (9.4% versus 6.5%; P=0.433) at 2-year follow-up, noncardiac mortality was higher in the liver group (26.4% versus 14.8%; P=0.034). Lower glomerular filtration rate (hazard ratio, 1.10, for each decrease of 5 mL/min in estimated glomerular filtration rate; 95% confidence interval, 1.03-1.17; P=0.005) and Child-Pugh class B or C (hazard ratio, 3.11; 95% confidence interval, 1.47-6.56; P=0.003) were the predictors of mortality in patients with chronic liver disease, with a mortality rate of 83.2% at 2-year follow-up in patients with both factors (estimated glomerular filtration rate <60 mL/min and Child-Pugh B or C). CONCLUSIONS: These findings suggested that TAVR is a feasible treatment for severe aortic stenosis in patients with early-stage liver disease or as bridge therapy before a curative treatment of the hepatic condition. Patients with Child-Pugh class B-C, especially in combination with renal impairment, had a very low survival rate, and TAVR should be carefully considered to avoid a futile treatment. These results may contribute to improve the clinical decision-making process and management in patients with liver disease.

Effectiveness of mussels (Mytella falcata) in malnourished children's recovery living in the slums in Maceió, Alagoas / Eficácia do sururu (Mytella falcata) na recuperação de crianças desnutridas, moradoras de favelas de Maceió, Alagoas

Abstract Objectives: to assess the efficacy of mussels (Mytella falcata) in malnourished children's recovery. Methods: 64 chronically malnourished children were accompanied for 12 months and attended at the Centro Recuperação e Educação Nutricional (Recovery Center and Educational Nutrition). The children were paired by age and malnutrition level forming three groups, which they received a balanced diet for nutritional recovery differing only on protein source. The group was offered (1) preparation of red meat, group (2) preparation of mussels and group (3) preparation of mussels in coconut milk. Results: the anthropometric assessment revealed that the children obtained a mean increase in the Z score in A-I indice of 0.70 for the group who red meat, 0.62 for the group who had mussels and 0.57 the group who had mussels cooked in coconut milk (p<0,05). An observation was made on a reduction in the prevalence of anemia with 22,8% (p=0,002), 27.8% (p=0.,007) and 42.4% (p 0.001) in groups 1, 2 and 3, respectively. Conclusion: the preparation of mussels cooked in or not in coconut milk can be an effective substitution for meat in combating child malnutrition and anemia and may be included in the children's institutions menus and in the programs that aim for children's nutritional recovery.

Resumo Objetivos: avaliar a eficácia do sururu (Mytella falcata) na recuperação de crianças desnutridas. Métodos: foram acompanhadas por 12 meses 64 crianças desnutridas crônicas atendidas no Centro Recuperação e Educação Nutricional. As crianças foram pareadas por idade e grau de desnutrição formando 3 grupos, os quais receberam dieta balanceada para a recuperação nutricional diferindo apenas na fonte de proteína. Foi ofertada ao grupo (1) preparação de carne bovina, ao grupo (2) preparação de sururu e ao grupo (3) uma preparação de sururu com leite de coco. Resultados: a avaliação antropométrica revelou que as crianças obtiveram um incremento médio em escore Z no índice A-I de 0,70 para o grupo da carne, 0,62 no grupo que recebeu sururu e 0,57 no grupo que recebeu sururu com leite de coco (pD0,05). Constatou-se ainda redução da prevalência da anemia nos grupos com percentual de redução de 22,8% (p=0,002), 27,8% (p=0,007) e 42,4% (pD0,001) nos grupos 1, 2 e 3, respectivamente. Conclusões: a preparação sururu com ou sem leite de coco pode ser um substituto eficaz da carne bovina no combate a desnutrição infantil e da anemia, podendo ser incluída no cardápio de instituições infantis e em programas que visem à recuperação nutricional de crianças.