Analysis of heart rate as a predictor of changes in heart rate variability in children / Análise da frequência cardíaca como preditor de alterações na variabilidade da frequência cardíaca em crianças

ABSTRACT Objective: To evaluate the predictive validity and cut-off point of heart rate and blood pressure on heart rate variability (HRV) changes in children with and without obesity. Methods: This study included 125 children, of whom 41 were normal weight and 84 were obese. Anthropometry, blood pressure, heart rate, and HRV were measured using an electronic scale and stadiometer, a sphygmomanometer, and HRV monitor. In addition, the receiver operating characteristic (ROC) curve was obtained by statistical analysis of the data. Results: Heart rate proved to be a good predictor for changes in the square root of the mean of the square of the differences between consecutive NN intervals (RMSSD) parameter in students of both sexes for the normal-weight group (ROC 0.89; 95%CI 0.77-1.00) and obesity (ROC 0.90; 95%CI 0.83-0.97). In addition, the heart rate cut-off point for alterations in the RMSSD parameter for normal-weight boys was 93 bpm (sensitivity 100.00% and specificity 87.50%) and for boys with obesity, the established cut-off point was 91 bpm (sensitivity 94.74% and specificity 63.64%). Heart rate also proved to be a good predictor considering low-frequency/high-frequency ratio (LF/HF) and standard deviation of long-term continuous NN intervals /standard deviation of the instantaneous variability of continuous NN intervals in the Poincaré graph ratio (SD2/SD1). Systolic and diastolic blood pressures were good predictors in more specific stratifications and, therefore, can be used in some cases. Conclusions: The predictive validity of heart rate was shown to be at a good level, with high sensitivity and acceptable specificity for the cut-off points according to the different analyses stratified by gender and nutritional status. In this sense, health professionals will be able to use heart rate to estimate cardiovascular risk in children of different sexes and nutritional status.

RESUMO Objetivo: Avaliar a validade preditiva e o ponto de corte da frequência cardíaca e da pressão arterial nas alterações da variabilidade da frequência cardíaca (VFC) em crianças com e sem obesidade. Métodos: Foram incluídas 125 crianças neste estudo, sendo 41 com peso normal e 84 com obesidade. Antropometria, pressão arterial, frequência cardíaca e VFC foram medidas por meio de balança eletrônica e estadiômetro, esfigmomanômetro e monitor de VFC. Além disso, a curva característica de operação do receptor (ROC) foi obtida pela análise estatística dos dados. Resultados: A frequência cardíaca mostrou-se um bom preditor de alterações no parâmetro de raiz quadrada da média do quadrado das diferenças entre os intervalos NN consecutivos (RMSSD) em escolares de ambos os sexos para o grupo de peso normal (ROC 0,89; IC95% 0,77-1,00) e obesidade (ROC 0,90; IC95% 0,83-0,97). Além disso, o ponto de corte da frequência cardíaca para alterações no parâmetro RMSSD para meninos com peso normal foi de 93 bpm (sensibilidade 100,00% e especificidade 87,50%), e para meninos com obesidade, o ponto de corte estabelecido foi de 91 bpm (sensibilidade 94,74% e especificidade 63,64%). A frequência cardíaca também se mostrou um bom preditor considerando os índices da relação baixa frequência/alta frequência (LF/HF) e razão desvio padrão de intervalos NN contínuos de longo prazo/desvio padrão da variabilidade instantânea de intervalos NN contínuos na relação gráfica de Poincaré (SD2/SD1). As pressões arteriais sistólicas e diastólicas foram bons preditores em estratificações mais específicas e, portanto, podem ser utilizadas em alguns casos. Conclusões: A validade preditiva da frequência cardíaca mostrou-se em bom nível, com alta sensibilidade e especificidade aceitável para os pontos de corte, conforme as diferentes análises estratificadas por sexo e estado nutricional. Desta forma, os profissionais de saúde poderão utilizar a frequência cardíaca para estimar o risco cardiovascular em crianças de diferentes sexos e estado nutricional.

How did previously obese children and adolescents behave during the SARS-CoV-2 pandemic in relation to weight gain? / Como crianças e adolescentes previamente obesos se comportaram durante a pandemia de SARS-CoV-2 com relação ao ganho de peso?

ABSTRACT Objective: The objective of this study was to analyze the implications of social contingency measures and interruption of outpatient follow-up on weight gain in children and adolescents with a previous diagnosis of obesity. Methods: This is an observational study with data from electronic medical records of children and adolescents followed up at a specialized outpatient clinic from 2019 to 2023. Weight gain, height, BMI variation, BMI z-score, laboratory tests, and associated comorbidities were analyzed. The data were computed and analyzed using the Statistical Package for the Social Sciences (SPSS), and the results were considered statistically significant when p<0.05. Results: There was a weight gain of approximately 17.66% in the total set of participants, corresponding to a median increase of 14 kg. When analyzing between genders, we observed an approximate increase of 21.38% in body weight for men, while for women, it was 21.45%. Conclusions: The COVID-19 pandemic has led to significant weight gain among previously obese children and adolescents in follow-up at a specialized outpatient clinic.

RESUMO Objetivo: Analisar as implicações das medidas de contingenciamento social e interrupção do acompanhamento ambulatorial sobre o ganho de peso de crianças e adolescentes com diagnóstico prévio de obesidade. Métodos: Estudo observacional com dados proveniente de prontuários eletrônicos de crianças e adolescentes acompanhadas no Ambulatório de Obesidade na Criança e no Adolescente do Hospital de Clínicas da Universidade Estadual de Campinas, no período de 2019 a 2023. Analisaram-se ganho ponderal, altura, variação do índice de massa corporal (IMC), escore Z de IMC, exames laboratoriais e comorbidade associadas. Os dados foram computados e analisados pelo programa StatisticalPackage for the Social Sciences (SPSS). Os resultados foram considerados estatisticamente significativos quando p<0,05. Resultados: Constatou-se aumento ponderal de aproximadamente 17,6% no conjunto total de participantes, correspondendo ao acréscimo mediano de 14 kg. Ao analisarmos os gêneros, observamos elevação aproximada de 21,38% no peso corporal do sexo masculino, enquanto a do sexo feminino foi de 21,4%. Conclusões: A pandemia de COVID-19 levou a ganho peso significante entre crianças e adolescentes previamente obesos, que estavam em seguimento em ambulatório especializado.

Clinical, epidemiological, and care profile of hospitalized patients with retinoblastoma in Brazil

ABSTRACT Purpose: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil. Methods: Using data from the Hospital Cancer Registry of the Instituto Nacional de Câncer, patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0-19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20-75, >75 cases). Results: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1-14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals. Conclusions: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services.

Brazilian children's quality of life during the COVID-19 pandemic: analysis of contextual factors and dimensions / Qualidade de vida de crianças brasileiras durante a pandemia de COVID-19: análise de fatores e dimensões contextuais

ABSTRACT Objective: The aim of this study was to investigate the contextual factors associated with the quality of life (QOL) of Brazilian children aged 0-12 years during the strict period of social isolation. Methods: This observational cross-sectional study was conducted between July and September 2020 using an online questionnaire on QOL-related family factors and the Pediatric Quality of Life Inventory (PedsQL™). Results were analyzed by multinomial logistic regression analysis. Results: The sample had 849 children, mostly from the South Region of Brazil (75%), white (83%), with typical development (79%), sedentary (68%), using screen (85%) for >3 h/day (44%). Their mothers were their main caregivers (90%). The following variables were significantly associated with high scores of QOL: typical health status (OR 2.38; 95%CI 1.60-3.55; screen time ≤2 h/day (OR 1.62; 95%CI 1.17-2.24); social distancing considered as "easy" (OR 1.67; 95%CI 1.20-2.32), and stimulation of the child by the family (OR 1.93; 95%CI 1.08-3.45). Conclusions: This study indicates that the family context can influence children's QOL, especially during the COVID-19 pandemic and home environment reorganization.

RESUMO Objetivo: Investigar os fatores contextuais associados à qualidade de vida (QV) de crianças brasileiras de zero a 12 anos, em momento de ápice de distanciamento social. Métodos: Estudo observacional, transversal, online, de julho a setembro de 2020, com questionário sobre fatores do contexto familiar associados à QV e Inventário Pediátrico sobre QV — PedsQL™. A análise dos dados foi feita por de regressão logística multinomial. Resultados: A amostra foi de 849 crianças, na maioria da Região Sul (75%), brancas (83%), com desenvolvimento típico (79%), sedentárias (68%), com uso de telas (85%) em tempo >3h/dia (44%). As mães eram as cuidadoras principais (90%). Foram significativamente associadas a escores mais elevados de QV: a condição de saúde típica (odds ratio — OR 2,38; intervalo de confiança de 95% — IC95% 1,60-3,55), o tempo de tela ≤2h/dia (OR 1,62; IC95% 1,17-2,24), o distanciamento social considerado "fácil" (OR 1,67; IC95% 1,20-2,32) e a família afirmar estimular a criança (OR 1,93; IC95% 1,08-3,45). Conclusões: Este estudo mostra que o contexto familiar pode influenciar a QV de crianças, especialmente no período de pandemia e de reorganização do ambiente domiciliar.

The role of parental stress on emotional and behavioral problems in offspring: a systematic review with meta-analysis

Abstract Objective Empirical evidence underscores an association between parental stress and emotional and behavioral problems in offspring. However, a comprehensive systematic review or meta-analysis on this topic is lacking. Thus, this study aims to address the scientific inquiry: Is there a relationship between parental stress and emotional/behavioral problems in children? Sources This systematic review with a meta-analysis surveyed PubMed, PsycINFO, and the Biblioteca Virtual em Saúde between August and September 2021. The present search combined terms (school-age children) AND (parental stress OR parenting stress OR family stress) AND (emotional and behavioral problems OR internalizing and externalizing problems). Eligibility criteria encompassed cross-sectional, cohort, and case-control studies published within the last five years, exploring the association between parental stress (stressful life events and parenthood-related stress disorders) and emotional/behavioral problems in school-age children. PROSPERO ID CRD42022274034. Summary of the findings Of the 24 studies meeting all inclusion criteria (n = 31,183) for the systematic review, nine were eligible for inclusion in the meta-analysis. The meta-analysis revealed an association between parental stress and emotional problems (COR: 0.46 [95 % CI: 0.27 - 0.61], p < 0.001, Heterogeneity = 89 %) as well as behavioral problems (COR: 0.37 [95 % CI: 0.27 - 0.46], p < 0.001, Heterogeneity = 76 %). Conclusions These findings indicate that parental stress predicts emotional/behavioral problems in school-age children. Since these problems are related to long-term negative effects in adulthood, these results are crucial for preventing mental health problems in offspring and for screening and managing parental stress.

Estimation of standing height in spina bifida: model development and validation

Abstract Objective Childhood standing height has been estimated from arm span-related (heightAS) models. The authors aimed to develop and cross-validate a heightAS model in individuals with spina bifida (SB) and examine the accuracy of existing heightAS models. Methods Participants were individuals with sacral and low-lumbar SB (n = 14) and non-SB (n = 83), 7-16 years old. Arm span, age, sex, and group (SB vs. non-SB) were candidate height predictors. Sequential regression and leave-one-out cross-validation approaches were used for the model development (M1) and cross-validation (M1-M5). Existing models were: an SB-specific model from Polfuss et al. (M2) and non-SB specific models from Gauld et al. (M3), Mulu et al. (M4), and Zverev et al. (M5) studies. Results Arm span and group explained 95 % of the variance in height (R2 = 0.95; p < 0.001; SEE = 3.666 cm) and were included in the M1. Mean differences between actual and estimated height were 0.0 cm (M1), 0.4 cm (M2), and 0.5 cm (M5), all not significant (p > 0.05). However, Bland-Altman analysis revealed some variability in the predictability of the models across participants with limits of agreement ranging from 7.4 to 10.9 cm. Considerable errors were observed with M3 (mean diff: −5.58 cm, 95 % CI: −1.6, −20.2 cm), and M4 (mean diff: 10.5 cm, 95 % CI: −13.8, −27.3 cm). Conclusions Models (M1, M2 and M5) may accurately estimate standing height in groups of children with SB. However, due to the wide limits of agreement, caution is recommended when applying these models for individual height estimations.

Cardiorespiratory fitness and socioeconomic influences in Chilean schoolchildren: a cross-sectional study

Abstract Objective To compare the cardiovascular risk and physical fitness, according to type of school in a national sample of Chilean school students. Methods A total of 7,218 students participated, who completed all the national tests of the National System for Measuring the Quality of Education, which included physical fitness and anthropometric tests. The results were compared according to the type of educational establishment and anthropometric indicators were considered. Physical fitness was measured by lower extremity strength, abdominal strength, upper extremity strength, trunk flexibility, exertional heart rate, and cardiorespiratory fitness. Body mass index, heart rate, and waist-to-height ratio were analyzed as predictors of cardiovascular risk. Results There were differences according to the type of establishment in the predictors of cardiovascular risk (p < 0.05). Differences were also found in the physical fitness tests evaluated (p < 0.01). Students in private schools (PSC) and subsidized schools (SC) had lower levels of cardiovascular risk and higher levels of physical fitness than public schools (PS) and schools with delegated administration (DA). Conclusions In conclusion, students in educational establishments with a higher socioeconomic level have lower levels of cardiovascular risk and better physical fitness than students in public establishments. The authors suggest considering specific school interventions to mitigate cardiovascular risk and improve physical fitness among this vulnerable population. To this end, future studies should analyze the characteristics of physical activity and nutritional habits in schools to determine the factors that affect the results.

Comparing the clinical characteristics and outcomes of septic shock children with and without malignancies: a retrospective cohort study

Abstract Objective There is an amelioration in mortality rates of septic shock patients with malignancies over time, but it remains uncertain in children. Therefore, the authors endeavored to compare the clinical characteristics, treatment needs, and outcomes of septic shock children with or without malignancies. Methods The authors retrospectively analyzed the data of children admitted to the PICU due to septic shock from January 2015 to December 2022 in a tertiary pediatric hospital. The main outcome was in-hospital mortality. Results A total of 508 patients were enrolled. The proportion of Gram-negative bacteria and fungal infections in children with malignancies was significantly higher than those without malignancies. Septic shock children with malignancies had a longer length of stay (LOS) in the hospital (21 vs. 11 days, p<0.001). However, there were no statistically significant differences in the LOS of PICU (5 vs. 5 days, p = 0.591), in-hospital mortality (43.0 % vs. 49.4 %, p = 0.276), and 28-day mortality (49.2 % vs. 44.7 %, p = 0.452). The 28-day survival analysis (p = 0.314) also showed no significant differences. Conclusion Although there are significant differences in the bacterial spectrum of infections, the septic shock children with or without malignancies showed a similar mortality rate. The septic shock children with malignancies had longer LOS of the hospital.

Eficacia y seguridad de ceftazidima­avibactam en pediatría: revisión sistemática / Efficacy and safety of ceftazidime-avibactam in pediatrics: A systematic review

Los datos sobre eficacia y seguridad de ceftazidima-avibactam (CAZ/AVI) en niños son limitados; por lo tanto, se llevó a cabo una revisión sistemática para responder a la siguiente pregunta: La combinación CAZ/AVI es más eficaz y más segura que otros antibióticos comparadores en el tratamiento de infecciones graves por bacilos gram negativos en niños?. Procedimiento: Se realizaron búsquedas bibliográficas en Medline, Embase, The Cochrane Library, Cinahl, SCI-EXPANDED y Scopus. Se incluyeron solo estudios aleatorizados randomizados controlados, en sujetos ≤18 años de edad que recibieran tratamiento empírico o de infección documentada por microorganismos sensibles que fueran tratados con CAZ/AVI o un comparador y que informaran su evolución y efectos adversos. Se realizó un metaanálisis con el método de Der Simonian-Laird. Se calculó la heterogeneidad mediante el indicador I2. Resultados: De un total de 1673 artículos hallados, solamente dos cumplimentaban los criterios de inclusión exigidos por lo que se procedió a la lectura del texto completo. Ambos son estudios primarios experimentales de fase II, uno en pacientes con infecciones intraabdominales y el otro, con infecciones renales. La estimación de la heterogeneidad estadística de la eficacia resultó en una alta heterogeneidad que estimamos que estaría generada en los diferentes diagnósticos (infecciones intraabdominales y pielonefritis) pero no llegó a ser tan elevada como para desaconsejar realizar el metaanálisis. Con respecto a la evaluación de los eventos adversos, el valor I2 es de signo negativo, lo que sugiere la inexistencia de heterogeneidad. La probabilidad de sesgo de publicación es inevitablemente elevada, puesto que solamente hubo dos estudios aptos para ser incluidos. Interpretación: Esta revisión sistemática, concluye que no fue posible establecer superioridad del CAZ/AVI frente al comparador meropenem en el tratamiento de infecciones intraabdominales y frente a cefepime en pielonefritis. Ambas intervenciones mostraron un aceptable perfil de seguridad en niños. La incidencia de eventos adversos fue semejante en ambos grupos y ninguno de los relacionados con las drogas fue grave (AU)

Data on the efficacy and safety of ceftazidimeavibactam (CAZ/AVI) in children are limited. Therefore, a systematic review was conducted to address the following question: Is the CAZ/AVI combination more effective and safer than other comparator antibiotics for the treatment of severe gramnegative bacilli infections in children? Procedure: Literature searches were performed in Medline, Embase, The Cochrane Library, CINAHL, SCI-EXPANDED, and Scopus. Only randomized controlled trials involving subjects aged ≤18 years were included. Studies had to report on patients receiving empirical treatment or treatment for documented infections caused by susceptible microorganisms with CAZ/AVI or a comparator antibiotic, as well as their outcomes and adverse effects. A meta-analysis was conducted using the DerSimonian-Laird method, and heterogeneity was assessed with the I2 indicator. Results: Out of 1,673 articles identified, only two met the inclusion criteria and were subsequently reviewed in full. Both studies were primary experimental phase II trials: one focused on patients with intra-abdominal infections, and the other on patients with renal infections. The estimation of statistical heterogeneity for efficacy indicated high heterogeneity, which was attributed to the differing diagnoses (intra-abdominal infections and pyelonephritis). However, the heterogeneity was not excessive enough to preclude a meta-analysis. For the evaluation of adverse events, the I2 value was negative, indicating an absence of heterogeneity. The probability of publication bias was inevitably high due to the limited number of eligible studies. Interpretation: This systematic review concludes that it was not possible to establish the superiority of CAZ/AVI over the comparator antibiotics, meropenem for intra-abdominal infections and cefepime for pyelonephritis. Both treatments demonstrated an acceptable safety profile in children. The incidence of adverse events was comparable between groups, and none of the drug-related events were serious (AU)

Certezas e incertidumbres en el manejo de la candidemia en niños con patología oncohematológica / Certainties and uncertainties in the management of candidemia in children with oncohematological conditions

Los niños con patología oncohematológica suelen presentar candidemia como complicación del tratamiento de su patología de base. El manejo de la misma presenta certezas e incertidumbres que abordaremos en este artículo como la remoción o no del catéter, la búsqueda de focos secundarios de infección, el tratamiento y la evolución (AU)

Children with oncohematologic disease often experience candidemia as a complication of the treatment of their underlying disease. The management of candidemia presents certainties and uncertainties that we will address in this article, including whether or not to remove the catheter, investigation of secondary infection foci, treatment strategies, and patient outcomes (AU)

Tratamiento funcional de las fracturas diafisarias de pierna en edad pediátrica: cohorte única prospectiva y consecutiva de casos / Functional fracture-bracing of tibial shaft fractures in children: single prospective, consecutive cohort of cases / Tratamento funcional das fracturas diafisárias da perna em idade pediátrica: uma coorte de casos única, prospetiva e consecutiva

Introducción: Las fracturas de tibia son lesiones frecuentes. En los niños existe una mayor capacidad de curación debido al mayor grosor y mejor vascularización que presenta su periostio. Como resultado, la mayoría pueden tratarse de manera exitosa de forma no quirúrgica. Está descrito el tratamiento funcional para estas fracturas, siguiendo los principios desarrollados por Sarmiento. Dada la falta de evidencia actual acerca del tratamiento funcional en este grupo etario, realizamos el análisis del mismo mediante una serie de casos tratados siguiendo este método. Materiales y métodos: Se incluyeron pacientes que cumplieron con los criterios de inclusión y exclusión, tratados mediante tratamiento funcional siguiendo los principios desarrollados por Sarmiento. Se evaluaron clínica y radiográficamente. Se evaluó la técnica registrando tiempos para cada período en este grupo etario, así como la satisfacción con el tratamiento de los pacientes y padres y/o tutores. Todas las complicaciones relacionadas fueron documentadas. Resultados: Evaluamos un total de 15 pacientes, con al menos 6 meses de seguimiento. La edad promedio fue de 11.7 años. Todas las fracturas consolidaron, el tiempo promedio hasta la consolidación fue de 7.6 semanas. El período agudo de 3.4 semanas y el período funcional de 4.2 semanas promedio respectivamente. Todas las fracturas consolidaron con una reducción aceptable. Existió un 100% de satisfacción tanto de los pacientes como de los padres ó tutores con el tratamiento implementado. Dos pacientes presentaron complicaciones menores. Conclusión: El tratamiento funcional para las fracturas de pierna en niños entre 10 y 15 años es una técnica segura, reproducible, con buenos resultados funcionales, que le permite tanto a los pacientes y a sus cuidadores gran independencia durante el período de curación.

Introduction: Tibial fractures are frequent injuries. In children there is a greater healing capacity due to the greater thickness and better vascularization of their periosteum. As a result, most of them can be successfully treated non-surgically. Functional treatment for these fractures is described, following the principles developed by Sarmiento. Given the lack of current evidence on functional treatment in this age group, we analyzed a series of cases treated following this method. Materials and methods: We included patients who met the inclusion and exclusion criteria, treated by functional treatment following the principles developed by Sarmiento. They were evaluated clinically and radiographically. The technique was evaluated by recording times for each period in this age group, as well as the satisfaction with the treatment of the patients and parents and/or guardians. All related complications were documented. Results: We evaluated a total of 15 patients, with at least 6 months of follow-up. The average age was 11.7 years. All fractures consolidated, the average time to consolidation was 7.6 weeks. The acute period of 3.4 weeks and the functional period of 4.2 weeks average respectively. All fractures healed with acceptable reduction. There was 100% satisfaction of both patients and parents or guardians with the treatment implemented. Two patients presented minor complications. Conclusion: Functional treatment for leg fractures in children between 10 and 15 years of age is a safe, reproducible technique, with good functional results, which allows both patients and their caregivers great independence during the healing period.

Introdução: As fracturas da tíbia são lesões comuns. Nas crianças existe uma maior capacidade de cicatrização devido à maior espessura e melhor vascularização do periósteo. Como resultado, a maioria pode ser tratada com sucesso de forma não cirúrgica. É descrito o tratamento funcional destas fracturas, seguindo os princípios desenvolvidos por Sarmiento. Dada a falta de evidência atual sobre o tratamento funcional neste grupo etário, procedeu-se à análise de uma série de casos tratados por este método. Material e métodos: Foram incluídos pacientes que preencheram os critérios de inclusão e exclusão, tratados por tratamento funcional seguindo os princípios desenvolvidos por Sarmiento. Foram avaliados clínica e radiograficamente. A técnica foi avaliada através do registro dos tempos para cada período nessa faixa etária, bem como a satisfação com o tratamento por parte dos pacientes e dos pais e/ou responsáveis. Todas as complicações relacionadas foram documentadas. Resultados: Avaliámos um total de 15 doentes, com pelo menos 6 meses de seguimento. A idade média foi de 11,7 anos. Todas as fracturas cicatrizaram, sendo o tempo médio de cicatrização de 7,6 semanas. O período agudo foi de 3,4 semanas e o período funcional de 4,2 semanas, em média, respetivamente. Todas as fracturas foram curadas com uma redução aceitável. Os doentes e os pais/encarregados de educação ficaram 100% satisfeitos com o tratamento efectuado. Dois doentes tiveram complicações ligeiras. Conclusão: O tratamento funcional das fracturas da perna em crianças com idades compreendidas entre os 10 e os 15 anos é uma técnica segura, reprodutível e com bons resultados funcionais, que permite aos doentes e aos seus cuidadores uma grande independência durante o período de cura.

Perfiles de funcionamiento en un grupo de niños con parálisis cerebral en Argentina: datos preliminares del primer estudio nacional / Profiles of functioning of a group of children with cerebral palsy in Argentina: Preliminary data from the first national study

La parálisis cerebral (PC) afecta la postura y la coordinación del movimiento, y es la causa más común de discapacidad grave en la población pediátrica. El diagnóstico de PC no describe el funcionamiento ni la interacción de la persona con el contexto en el cual se desarrolla. Por lo tanto, el diagnóstico se debe complementar con una descripción del funcionamiento, utilizando herramientas basadas en el modelo biopsicosocial de la Clasificación del Funcionamiento (CIF) de la Organización Mundial de la Salud (OMS). En esta comunicación, describimos los datos preliminares de un estudio multicéntrico en Argentina destinado a estandarizar la descripción del perfil de funcionamiento en niños y adolescentes con PC. Estos datos mostraron que los participantes tienen algunas habilidades en las funciones del sueño, las funciones mentales del lenguaje y las visuales, así como en algunas relacionadas con el contexto. Presentan dificultades importantes en categorías tales como mantener la posición del cuerpo, el andar y la higiene.

Cerebral palsy (CP) affects body posture and movement coordination and is the most common cause of severe disability in the pediatric population. The diagnosis of CP is not a description of a person's functioning or interaction with their environment. Therefore, the diagnosis should be complemented with a description of functioning, using tools based on the biopsychosocial model proposed by the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This report describes the preliminary data from a multicenter study conducted in Argentina with the aim of standardizing the description of the profiles of functioning of children and adolescents with CP. These data showed that the participants had some skills in sleep functions, mental functions of language, seeing functions, and in some environmental factors. They showed significant difficulties in categories such as maintaining body position, walking, and toileting.

Habilidades ejecutivas: actualización, cambio entre conjuntos mentales e inhibición en niños no mapuche urbanos, mapuche urbanos y mapuche rurales de La Araucanía, Chile

Las habilidades cognitivas de los niños varían conforme a los contextos de desarrollo cultural en los que se desenvuelven. Asumiendo la variabilidad cultural, este estudio tuvo por objetivo comparar las habilidades ejecutivas en 110 niños, entre 9 y 11 años, pertenecientes a tres grupos: no mapuche urbanos, mapuche urbanos y mapuche rurales, de comunas de la región de La Araucanía, Chile. Se usó un diseño descriptivo y correlacional para contrastar el desempeño de los niños en las variables de interés. La batería de instrumentos estuvo formada por tres pruebas que evaluaron: actualización, cambio entre conjuntos mentales e inhibición, respectivamente. Los resultados indican que no hubo diferencias estadísticamente significativas en actualización y cambio entre conjuntos mentales, pero sí hubo significancia estadística para las diferencias en inhibición; siendo los niños no mapuche quienes tuvieron mayor inhibición respecto de los otros dos grupos. Se discuten los hallazgos según la hipótesis de que el desarrollo de habilidades se relaciona con las prácticas cotidianas, demandas y características sociodemográficas de los contextos en los que los niños se desarrollan.

As habilidades cognitivas das crianças variam conforme os contextos de desenvolvimento cultural em que elas se desenvolvem. Partindo do pressuposto da variabilidade cultural, este estudo teve como objetivo comparar as habilidades executivas de 110 crianças, com idades entre 9 e 11 anos, pertencentes a três grupos: não mapuche urbanas, mapuche urbanas e mapuche rurais, de municípios da região de La Araucanía, Chile. Foi utilizado um desenho descritivo e correlacional para comparar o desempenho das crianças nas variáveis de interesse. A bateria de instrumentos foi composta por três testes que avaliaram: atualização, mudança entre conjuntos mentais e inibição, respectivamente. Os resultados indicam que não houve diferença estatisticamente significativa em atualização e mudança entre conjuntos mentais, mas houve significância estatística para as diferenças em inibição, com as crianças não mapuches apresentando maior inibição do que os outros dois grupos. Os resultados são discutidos de acordo com a hipótese de que o desenvolvimento de habilidades está relacionado às práticas cotidianas, demandas e características sociodemográficas dos contextos em que as crianças se desenvolvem.

Children's cognitive abilities differ according to the cultural development settings in which they are raised. Assuming cultural variability, this study compared the executive functions in 110 children, aged 9 to 11 years, belonging to three groups: urban non-Mapuche, urban Mapuche, and rural Mapuche, from communes in the Araucanía region, Chile. A descriptive and correlational design was used to contrast children's performance on the variables of interest. The battery of instruments comprised three tests that assessed updating, set-shifting, and inhibition, respectively. The results indicate no statistically significant differences in updating and set-shifting, but there was a statistical significance for differences in inhibition, with non-Mapuche children having greater inhibition than the other two groups. The findings are discussed according to the hypothesis that skill development is related to the daily practices, demands, and sociodemographic characteristics of the settings in which children are raised.

Spinal anesthesia in children: an educational review / Anestesia raquídea en niños: una revisión educativa

Abstract Despite the well-known benefits of spinal anesthesia (SA), this technique remains underutilized among pediatric anesthesiologists. According to the data from the Pediatric Regional Anesthesia Network, SA accounted for less than 5% of all neuraxial techniques. Some of the factors for underutilization of SA include: Limited duration, unfamiliarity with the technique in younger children, and surgeon preference for general anesthesia. The safe and successful use of SA in children involves recognition of anatomical and physiological differences between adults and children owing to differences in bony structures, spinal cord growth and cerebrospinal fluid physiology. Reports on successful use of SA in children for various surgeries have increased. This educational review summarizes what is known about SA in children, reviews the literature from the last decade and provides suggestions for development of SA in children. Technical considerations, role of ultrasound, guidance on dosing, physiological effects, unexplained aspects of the mechanism of action and combined caudal/SA are discussed.

Resumen A pesar de los beneficios bien conocidos de la anestesia raquídea (AR), esta técnica sigue siendo subutilizada entre los anestesiólogos pediátricos. De acuerdo con los datos de la Red Regional de Anestesia Pediátrica, la AR representó menos del 5% de todas las técnicas neuroaxiales. Algunos de los factores a los que se atribuye dicha subutilización son: su duración limitada, la falta de familiaridad con la técnica en niños de menor edad, y la preferencia del anestesiólogo por la anestesia general. El uso seguro y exitoso de la AR en niños implica el claro conocimiento de las diferencias anatómicas y fisiológicas entre adultos y niños, en virtud de las diferencias en las estructuras óseas, el crecimiento de la médula espinal y la fisiología del líquido cefalorraquídeo. Los reportes sobre el uso exitoso de la AR en niños para diferentes cirugías ha aumentado. La presente revisión educativa resumen la información conocida sobre AR en niños, revisiones de la literatura de la última década y ofrece sugerencias para el desarrollo de la AR en población pediátrica. Se discuten consideraciones técnicas, el papel de la ecografía, orientación sobre la dosificación, los efectos fisiológicos, aspectos no explicados del mecanismo de acción y la combinación de anestesia raquídea/caudal.

Prevalence Of Malnutrition Among Pre-School Children Of Nine Indian States

Introduction: In developing countries, undernutrition is a major health concern among children. Besides this, the coexistence of undernutrition and overnutrition, which is referred to as double burden of malnutrition is well observed among children. This paper investigates the total prevalence of malnutrition (undernutrition+overnutrtion) among preschool childrenObjective: of Empowered Action Group (EAG) states in India using the secondary data, which was extracted from Clinical, Anthropometric and Biochemical (CAB) Survey. A total of 92444 (43655 females; 48789 males) under 5 years preschool children wereMaterials and Methods: included from 165 districts of EAG states and Assam in India. To assess the nutritional status, Z scores for weight-for-height (WHZ), height-for- age (HAZ), weight-for-age (WAZ) were calculated by following WHO standards using AnthroPlus software. Double burden of malnutrition was evaluated using categorical components of rCIAF (revised Composite Index Anthropometric Failure). The overall prevalence of UF andResults: OF were 50.48% (47.34% female; 53.29% male) and 3.76% (3.95% females and 3.60% males), respectively. The highest prevalence of UF was observed in Madhya Pradesh (54.47%). Sex-specific highest prevalence in females and males were observed in Jharkhand (51.76%) and Madhya Pradesh (58.91%). The outcomes from this study may help the policymakers in ameliorating the problem of malnutrition.

A Study Of Prevalence Of Refractive Errors In The Catchment Area Of A Tertiary Care Hospital In Northern India

Aim: Early detection and correction of Refractive Errors in children can improve probable visual outcomes in the future and also have a positive impact on the education and overall development of the child. The aim of this study was to establish the prevalence of refractive errors in school going children. An observational cross-Materials And Methods: sectional study was conducted among 864 school going children in the catchment area of a tertiary healthcare centre in Northern India. Children between ages of 5-16 years were assessed for ocular complaints; recording of visual acuity with Snellen's chart at 6 meters was followed by subjective refraction and a general torchlight examination. Results: The study reports that the overall prevalence of refractive errors is 21.9%. The prevalence of Myopia was 21.1%; Hypermetropia was 0.8% and Astigmatism was 4.7%. Only 10.9% of the children reported having any vision related complaints. 16.1% of the children with no ocular complaints had reduced visual acuity. 17.5% of the children were prescribed spectacles for the first time. School screening programmes are a cost effective and sensitive method of unearthing theConclusion: hidden burden of visual impairment amongst school children. The need for proactive measures in uncovering and correcting refractive errors is underscored by the low reporting of problems by children, especially with the rise in prevalence of refractive errors witnessed after the global coronavirus pandemic.

Tratamiento no quirúrgico de la epilepsia refractaria en niños / Non-surgical treatment of refractory epilepsy in children

Resumen Aproximadamente el 30% de las personas con epilep sia será refractaria. Este manuscrito revisa las modalida des actuales y basadas en la evidencia de tratamientos no quirúrgicos para la epilepsia refractaria pediátrica, incluyendo estrategias farmacológicas y dietéticas.

Abstract Approximately 30% of people with epilepsy will be refractory. This manuscript reviews current evidence-based non-surgical treatment modalities for pediatric refractory epilepsy, including pharmacological and di etary strategies.

Challenges in Feeding Children with Autism Spectrum Disorder: the Role of Nurses in Research and Interventions

The prevalence of autism spectrum disorder (ASD) has increased significantly in every continent in the world. Research findings suggest that nearly 1 in every 100 children is diagnosed with ASD globally.(1) In the United States, more recent data from the Centers for Disease Control and Prevention (CDC) indicate an even higher prevalence, with 1 in every 36 children, or close to 2.0% being diagnosed with the disorder.(2) (Zeiddan et al., 2022; CDC, 2023). The prevalence distribution varies among different regions. In Latin American countries, like Brazil, data is limited, but it is estimated that approximately 1.5- to 2-million children could be affected by ASD. In Africa, prevalence rates are lower, with significant variations among countries due to differences in data collection methods and the diagnostics resources available.

Infant Food Flours Made from Local Products to Combat Acute Malnutrition in Children Under 5 Years Old in Côte D’ivoire

In Côte d'Ivoire, recurring stock shortages and difficulties in accessing specialized food products compromise nutritional treatment. This study proposes food formulas of flours composed of locally available products capable of meeting the protein-energy needs of children aged 6 to 59 months diagnosed with moderate acute malnutrition. The methodological approach consists of formulating and determining the physicochemical, nutrient, and functional characteristics of four new formulations (1F, 2F, 3F, 4F, and 5F). The results indicate that the formulated foods have high levels of calcium (215.60-252,29 mg/100g MS), potassium (555,70-789,29 mg/100 g MS), magnesium (261,26-200,63 mg/100g MS), iron (4,86-7,03 mg/100g MS) and phosphorus (392,36 -469,36 mg/100g MS). The fat content varies from 9.66% to 23.86%. The energy value determined for all flours corresponds well to the Codex. The food formulas developed would also be able to meet more than 100% of the daily requirement of vitamins E and B1. The phytate (180.26 - 227.05 mg/100 g) and oxalate (66.00 - 88.00 mg/100 g) contents are low. The presence of phenolic compounds, including flavonoids (7.78-15.44 mg/100 g) and antioxidant activity (31.09-32.84%) would be a significant asset. The levels of deoxynivalenol (62 ?g/kg) recorded in flours are below 200 ?g/kg recommended for infants and young children. The proposed formulations have high-water absorption capacity (136.15 -252.94%) and high solubility index (56.84 -59.2%). The wettability time ranges from 3.66 ± 0.16 s to 33.71 ± 0.23 s. Flours (1F, 2F, 3F, 5F) have a better absorption capacity for refined palm oil (132 %, 139 %, 121 %; 115 %). The proposed new formulations have nutritional characteristics close to standard data and could therefore be recommended for children aged 6 to 59 months for complementary feeding in the context of the fight against moderate acute malnutrition.

Clinical Manifestations of Vernal Keratoconjunctivitis and Its Effects on School Attendance and Access to Medical Care in School Children of Western Uttar Pradesh

Introduction: Vernal Keratoconjunctivitis (VKC) is a chronic ocular condition affecting school-age children, particularly in hot, allergen-rich regions. It presents with symptoms such as intense itching, tearing, foreign body sensation, and sticky discharge, causing discomfort and management challenges in resource-limited settings. VKC impacts public health significantly due to its high prevalence and effect on academic performance and school attendance. Method: This cross-sectional study included 1521 school children aged 6 to 16 years in Western Uttar Pradesh. Comprehensive eye examinations were conducted, and VKC was diagnosed based on conjunctival and limbal papillae. A structured questionnaire collected data on socio-demographic factors, medical care access, and VKC's impact on daily life and school attendance. Descriptive statistics and Pearson chi-square tests were used for analysis. Result: Of the participants, 242 (15.9%) had VKC, with a higher prevalence among boys (56.2%). Most cases were mild (66%), with 34% severe. Symptoms included itching, stinging, tearing, photophobia, and discharge. Severe VKC resulted in higher rates of constant eye rubbing and tear production. School absenteeism was significantly higher in severe cases (78%) compared to mild cases (47%) (P<0.001). Severe VKC also led to more frequent medical consultations (52% vs. 22%, P=0.01). Conclusion: VKC significantly affects school attendance and medical care utilization among children in Western Uttar Pradesh. Improved management practices, better access to medical care, and enhanced support systems are essential for affected children and families.