Adequate tetanus but poor diphtheria and pertussis response to a Tdap booster in adolescents with juvenile systemic lupus erythematosus.

BACKGROUND: Reports on vaccine responses in immunocompromised patients, such as juvenile systemic lupus erythematosus (jSLE), have shown highly variable results. OBJECTIVE: To compare the immune response and safety after a Tdap booster in 26 jSLE patients and 26 matched healthy adolescents.Methodology: Adverse events and disease activity were evaluated. Lymphocyte immunophenotyping was performed by flow cytometry. Tetanus, diphtheria and pertussis toxin antibodies were assessed by ELISA; whole blood was stimulated with whole cell pertussis and supernatants were assessed for cytokines by xMAP. RESULTS: Both groups showed a similar frequency of adverse events. There was no evidence of disease reactivation after Tdap booster in the jSLE cohort. Both groups showed a significant increase in antibody titers for all three antigens on D14 and D28 (p < 0.001). jSLE patients had a significantly lower increase in diphtheria titers than the control group (p = 0.007). jSLE patients had a distinct titer increase of tetanus and pertussis antibodies when compared to controls (p = 0.004 and p < 0.001, respectively). There was a lower frequency of pertussis seroconversion in the jSLE group on D14 (p = 0.009), D28 (p = 0.023), D12m (p = 0.015) and D24m (p = 0.004). Cellular immune response to Bordetella pertussis showed significantly lower levels of IFNγ (p < 0.001) and higher levels of IL10, IL12, IL21 and TNFα in jSLE patients than controls. CONCLUSIONS: jSLE patients had good response to Tdap booster dose for the tetanus antigen, but not for diphtheria and pertussis. This vaccine was safe in relation to adverse events and absence of disease reactivation.

Anthropometric Evaluation and Assessment of Food Intake of Parents of Pediatric Patients with Chronic Rheumatic Diseases.

INTRODUCTION: Parents' eating behavior, lifestyle, and food choices can interfere with their children's eating habits, bringing new perspectives for the development of beneficial interventions in the context of chronic rheumatic diseases. OBJECTIVES: The objective is to evaluate BMI, dietary intake, physical activity, and biomarkers of lipid metabolism in parents of children and adolescents with chronic rheumatic diseases and to verify the association with those of their children. METHODS: This is a cross-sectional study with 91 parents, and their respective children diagnosed with juvenile idiopathic arthritis (n = 30, 33.0%), juvenile systemic lupus erythematosus (n = 41, 45.0%), and juvenile dermatomyositis (n = 20, 22.0%). Anthropometric and dietary data, physical activity, lipid profile, and apolipoproteins A-I and B were evaluated. RESULTS: In total, 67% of parents and 27.5% of children were overweight; 80% of overweight children/adolescents also had parents with the same nutritional diagnosis. We found a moderate association of total fat intake (Cramer's V test = 0.254; p = 0.037), and a weak association of saturated fat intake (Cramer's V test = 0.219; p = 0.050) and cholesterol intake (Cramer's V test = 0.234; p = 0.025) between parents and their children. A high prevalence of dyslipidemia was observed for parents (82.4%) and children (83.5%), however, with no association between both. A weak association was found between parents and children (Cramer's V test = 0.238; p = 0.024) for triglycerides, and no association was found between parents and children concerning physical activity. CONCLUSION: The high frequency of overweight and dyslipidemia observed in parents, combined with the association between the fat intake by parents and their children with chronic rheumatic diseases, points to the importance of intervention strategies with the engagement and participation of families.

Nutritional intervention in patients with juvenile systemic lupus erythematosus: protective effect against the increase in fat mass.

Patients with juvenile systemic lupus erythematosus (JSLE) usually have an increase in fat mass and decrease in lean body mass. The purpose of this study was to assess the effect of a nutritional intervention on changes in body composition and food consumption of adolescents with JSLE compared with a control group and its variation over time and to assess the association of total fat mass with clinical parameters. This randomized controlled study evaluated 31 girls. Body composition and food intake were evaluated at baseline. The patients were randomly allocated into a nutritional intervention group and a control group. The intervention group received monthly nutritional guidelines for 9 months. After this period, evaluations were repeated. The carbohydrates intake decreased in the intervention group compared with the control group (p = 0.031) at the end of the study period. Additionally, a significant decrease was observed in the intake of energy (p = 0.023), carbohydrates (p = 0.031), protein (p = 0.024), total fat (p = 0.027), saturated fat (p = 0.012), and trans fat (p = 0.029) in the intervention group between baseline and the end of the study. There was an average increase of 3.7 kg (95% CI 0.8-6.5) in the total fat mass (p = 0.013) and 0.36 kg/m2 (95% CI 0.10-0.62) in the appendicular fat mass (p = 0.007) in the control group during the study period; this finding was not observed in the intervention group. A 9-month nutritional intervention in JSLE patients improved their eating habits and protected against the excessive gain of weight and body fat.

Sleep, quality of life and mood of nursing professionals of pediatric intensive care units.

OBJECTIVE: To assess sleep, quality of life and mood of nursing professionals of pediatric intensive care units. METHOD: Quantitative, cross-sectional and descriptive study. Professionals grouped by morning, afternoon and evening shifts were assessed by means of the instruments: Morningness-Eveningness Questionnaire; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Generic questionnaire for the assessment of quality of life (SF-36); Beck Depression Inventory; Beck Anxiety Inventory; State-Trait Anxiety Inventory. RESULTS: Sample consisted of 168 professionals, with prevalence of neutral typology (57.49%). There was no statistical significance regarding sleep, despite scores showing a poor quality of sleep and excessive daytime sleepiness for the three shifts. Quality of life did not reveal any statistical significance, but in the field "social role functioning" of the evening shift, a lower score was observed (p<0.007). There was no statistical significance regarding levels of anxiety and depression. CONCLUSION: The results suggest that these professionals may present sleeping problems, but they do not have lower scores of quality of life or mood disorders. Likely explanations for these findings may include an adaptation to their work type over time and the fact that working with children is rewarding. OBJETIVO: Avaliar sono, qualidade de vida e humor em profissionais de enfermagem em Unidades de Terapia Intensiva Infantil. MÉTODO: Estudo quantitativo, transversal e descritivo. Profissionais agrupados por turnos matutino, vespertino e noturno foram avaliados pelos instrumentos: Questionário de identificação Matutinidade-Vespertinidade; Índice de qualidade do sono de Pittsburgh; Escala de sonolência Epworth; Questionário genérico de avaliação de qualidade de vida - SF-36; Inventário de depressão de Beck; Inventário de ansiedade de Beck; Inventário de ansiedade Traço-Estado. RESULTADOS: Amostra composta por 168 profissionais, predominando tipologia neutra, 57,49%. Não houve significância estatística quanto ao sono, apesar dos escores mostrarem qualidade ruim e sonolência diurna excessiva para os três turnos. A qualidade de vida não denotou diferença estatística, mas no domínio "aspecto social" do turno noturno, observou-se escore pior (p<0,007). Não houve significância estatística nos níveis de ansiedade e depressão. CONCLUSÃO: Os resultados sugerem que estes profissionais podem apresentar problemas no sono, entretanto não apresentam escores mais baixos de qualidade de vida ou transtornos do humor. Possíveis explicações para estes achados são que haja uma adaptação ao regime de trabalho ao longo do tempo e que trabalhar com crianças seja recompensador.

Chronic Spontaneous Urticaria: A Survey of 852 Cases of Childhood-Onset Systemic Lupus Erythematosus.

BACKGROUND: Data regarding the prevalence of chronic spontaneous urticaria (CSU) in childhood-onset systemic lupus erythematosus (cSLE) patients and possible associated factors are limited to a few case reports. The objectives of this study were to assess CSU in a large cSLE population, in order to evaluate the demographic data, clinical manifestations, disease activity/damage, laboratory abnormalities and treatment. METHODS: A retrospective multicenter cohort study (Brazilian cSLE group) was performed in 10 Pediatric Rheumatology services and included 852 cSLE patients. CSU was diagnosed according to the guidelines of the European Academy of Allergy and Clinical Immunology, the Global Allergy and Asthma European Network, the European Dermatology Forum and the World Allergy Organization. Patients with CSU (evaluated at urticaria diagnosis) and patients without CSU (evaluated at the last visit) were assessed for lupus clinical/laboratory features and treatment. RESULTS: CSU was observed in 10/852 cSLE patients (1.17%). The median of cSLE duration at urticaria diagnosis was 0 (-3 to 5) years. Comparison of cSLE patients with and without CSU revealed a greater frequency of constitutional symptoms (40 vs. 8%, p = 0.006), reticuloendothelial system involvement (30 vs. 3%, p = 0.003), mucocutaneous (90 vs. 28%, p < 0.0001) and musculoskeletal manifestations (50 vs. 6%, p < 0.0001) and methylprednisolone pulse therapy use (60 vs. 9%, p < 0.0001) in the former group. The frequency of immunosuppressive treatment was lower in patients with CSU (p = 0.018). The median SLE Disease Activity Index 2000 (12 vs. 2, p < 0.0001) and erythrocyte sedimentation rate (40 vs. 19 mm/1st hour, p = 0.024), was higher in patients with CSU. CONCLUSIONS: To our knowledge, this is the first study with evidence that CSU may be linked to cSLE. We also demonstrated that this particular skin manifestation occurs predominantly at disease onset and is associated with lupus moderate/high disease activity without major organ involvement.

Acupuncture for pediatric chronic pain: A systematic review.

OBJECTIVES: To survey, analyze and discuss the scientific evidence supporting the use of acupuncture and related techniques in the management of chronic pain in the pediatric population. SOURCES: A survey of databases (MEDLINE, Scopus and Scielo) was carried out with search strategies, following the PRISMA statement, without limits on publication dates and languages. Clinical studies (clinical trials, single-arm, and case series) were accepted for review if they included participants aged up to 22 years. Study quality was assessed by MMAT, and the randomized clinical trial was analyzed under the STRICTA criteria. SUMMARY OF THE FINDINGS: 2369 articles were retrieved. After excluding repetitions, 1335 underwent the initial selection. Only 16 articles were selected for full reading, of which 5 were included in the review, being two case series, two single-arm studies, and one randomized clinical trial. The articles were considered of good quality by the adopted criteria. CONCLUSION: The analyzed studies showed important clinical results such as the reduction of pain intensity, and improvement in school attendance and social life. However, there are many limitations in study design and sample size. Therefore, there is weak evidence to support the use of acupuncture in the context of pediatric chronic pain, but the positive results reinforce the need for further investigation of the topic with the conduct of larger and well-designed studies, to obtain more data and greater scientific conviction of the findings.

Enrichment of Rare Variants of Hemophagocytic Lymphohistiocytosis Genes in Systemic Juvenile Idiopathic Arthritis.

Objective: To evaluate whether there is an enrichment of rare variants in familial hemophagocytic lymphohistiocytosis (HLH) genes and systemic juvenile idiopathic arthritis (sJIA) with or without macrophage activation syndrome (MAS). Methods: Targeted sequencing of HLH genes (LYST, PRF1, RAB27A, STX11, STXBP2, UNC13D) was performed in sJIA subjects from an established cohort. Sequence data from control subjects were obtained in silico (dbGaP:phs000280.v8.p2). Rare variant association testing (RVT) was performed with sequence kernel association test (SKAT) package. Significance was defined as p<0.05 after 100,000 permutations. Results: Sequencing data from 524 sJIA cases were jointly called and harmonized with exome-derived target data from 3000 controls. Quality control operations produced a set of 481 cases and 2924 ancestrally-matched control subjects. RVT of sJIA cases and controls revealed a significant association with rare protein-altering variants (minor allele frequency [MAF]<0.01) of STXBP2 (p=0.020), and ultra-rare variants (MAF<0.001) of STXBP2 (p=0.007) and UNC13D (p=0.045). A subanalysis of 32 cases with known MAS and 90 without revealed significant association of rare UNC13D variants (p=0.0047). Additionally, sJIA patients more often carried ≥2 HLH variants than did controls (p=0.007), driven largely by digenic combinations involving LYST. Conclusion: We identified an enrichment of rare HLH variants in sJIA patients compared with healthy controls, driven by STXBP2 and UNC13D. Biallelic variation in HLH genes was associated with sJIA, driven by LYST. Only UNC13D displayed enrichment in patients with MAS. This suggests that HLH variants may contribute to the pathophysiology of sJIA, even without MAS.

Health related quality of life of children with rheumatic heart diseases: reliability of the Brazilian version of the Pediatric Quality of Life Inventory™ Cardiac Module scale.

BACKGROUND: This study aimed to translate the 'Pediatric Quality of Life Inventory™ (PedsQL™ 3.0) Cardiac Module' into Portuguese, adapt it to Brazilian culture, and assess its psychometric properties (validity and reproducibility), and to calculate health-related quality of life scores on the PedsQL 4.0 and PedsQL™ 3.0 Cardiac Module Scales for a group of patients 5 to 18 years old with rheumatic heart disease. METHODS: The methods suggested by the authors of the original version of the questionnaire included 1) translation by an expert panel; 2) translation back into English and revision by the authors of the original version; 3) pilot study with seven children and parents in each of three age ranges (5 to 7, 8 to 12, and 13 to 18 years old); and 4) assessment of the measurement properties. In this stage, the PedsQL™ 3.0 Cardiac Module and the PedsQL 4.0 Generic Scale were applied to a sample comprising 109 children and adolescents with rheumatic heart disease and their parents or caregivers. The version for parents or caregivers was administered separately on the same day. RESULTS: The values of Cronbach's alpha for all scales assessed in the questionnaire (heart problems and treatment [symptoms], problems with perceived physical appearance, treatment anxiety, cognitive problems, and communication problems) varied from 0.6 to 0.8, indicating good internal consistency. Correlation was found between the scores for the Cardiac Module and the Generic Scale (0.36-0.86), demonstrating convergent validity (Spearman's correlation coefficient, p < 0.01). The symptoms, problems with perceived physical appearance, and cognitive and communication problem domains were able to distinguish between groups of patients with mild and moderate/severe heart disease (Student's t-test, p < 0.05). The intraclass correlation of the interobserver reproducibility was adequate (0.76 to 0.94 among the patients [children/adolescents] and 0.76 to 0.84 among their caregivers). The correlation between the patients' scores and their parents' scores varied from 0.50 to 0.86 (Pearson's correlation coefficient, p < 0.01). CONCLUSIONS: The Brazilian version of the PedsQL™ 3.0 Cardiac Module was shown to be reliable. The application of this questionnaire in practice will be very useful for all professionals charged with the care of children and adolescents with heart diseases.

Adherence to treatment of children and adolescents recently diagnosed with auto-immune Rheumatic Diseases during the COVID-19 pandemic.

OBJECTIVES: Adherence problems have a great impact on auto-immune Rheumatic Diseases (AIRD). The COVID-19 pandemic may have worsened treatment adherence. The aims of this study were to measure treatment adherence to identify an earlier risk of poor adherence and measure families' satisfaction with the health service during the pandemic. METHODS: Prospective observational study with 50 parents/children and adolescents with recent AIRD diagnosis. Initially, they answered questions (demographic data, disease) and completed the Pediatric Rheumatology Adherence Questionnaire (PRAQ), after 6 months they completed the Morisky-Green Test (MGT), Brief Medication Questionnaire (BMQ), Compliance Questionnaire for Rheumatology (CQR-19) and Pediatric Quality of Life Inventory Questionnaire 3.0 (PedsQlTM-SSS). The patient's medical records from the previous 12 weeks were reviewed for global and medication adherence data. RESULTS: The mean global adherence score was 94.3 ± 10.0, for medication adherence 97.3 ± 9.3, and for PRAQ questionnaire 5.2 ± 1.5. The authors observed agreement between MGT, BMQ, CQR-19, PedsQLTM-SSS scores and medication adherence rate, but not with global adherence rate. There were no associations between demographic characteristics, disease diagnosis, and adherence. No associations between PRAQ scores and values and global/medication adherence rates were observed. No variables were shown to be predictors of good adherence. The mean PedsQLTM-SSS rate was 92.1 ± 6.8. CONCLUSION: The high values of MGT, BMQ, CQR-19 questionnaire scores were in agreement with the medication adherence rate. Despite the pandemic, the global and medication adherence rates were good. It was not possible to demonstrate the PRAQ's predictive power. The authors weren't able to establish an association between families' satisfaction and treatment adherence rates.

Factors related to the readiness of Brazilian chronic pediatric patients to transition to care in adult clinics.

OBJECTIVE: Advances in medicine have increased the life expectancy of pediatric patients with chronic illnesses, and challenges with the guided transition of adolescents and young adults from pediatric clinics to adult clinics have grown. The aim of this study was to better understand readiness and factors related to this transition process in Brazil. METHOD: In this cross-sectional study of 308 patients aged from 16 to 21 years under follow-up in pediatric specialties, the degree of readiness for transition was assessed using the Transition Readiness Assessment Questionnaire (TRAQ) and its domains. Associations with demographic data, clinical data, socio-economic level, medication adherence, family functionality, and parental satisfaction with health care were evaluated. RESULTS: The median TRAQ score was 3.7 (3.2 - 4.2). Better readiness was associated with female patients, socio-economic class A-B, current active employment, higher level of education, not failing any school year, attending medical appointments alone, functional family, and a good knowledge of disease and medications. A low correlation was observed between TRAQ and age. TRAQ presented good internal consistency (alpha-Cronbach 0.86). In the multiple linear regression, TRAQ score showed a significant association with female gender, advanced age, socio-economic class A-B, better knowledge of disease and medications, and independence to attend appointments alone. CONCLUSION: TRAQ instrument can guide healthcare professionals to identify specific areas of approach, in order to support adolescents with chronic disease to set goals for their own personal development and improve their readiness to enter into the adult healthcare system. In this study, some factors were related to better TRAQ scores.

[Health-related quality of life of the children of health professionals]. / Qualidade de vida relacionada à saúde de filhos de profissionais da área de saúde.

In this study, we measured the health-related quality of life (HRQOL) and fatigue of the children of health professionals, aged between two and eleven years, and assessed the daytime and sleep habits of these children and their parents. The study included children from a public school. Data regarding demographics and daily habits were collected. The HRQOL, sleep habits and fatigue were measured using questionnaires. A total of 249 parents participated - 63.5% reported getting an adequate amount of sleep, while 47.4% woke up feeling tired. The children's mean age was 5.6 years - 62.2% watched television in their rooms, 50% used the computer (> 4 hours/day) and 27.8% engaged in extracurricular physical exercise. The sleep score was 45.8 ± 12.2. The HRQOL scores were higher in the physical and lower in the emotional aspects. We found that poorer sleep on the part of both children and parents may be related to the children's lower HRQOL. We conclude that the inadequate habits of parents as well as children, are related to a decrease in HRQOL, particularly regarding the emotional aspect.

Biomarkers of lipid metabolism in patients with juvenile idiopathic arthritis: relationship with disease subtype and inflammatory activity.

BACKGROUND: To describe the biomarkers of lipid metabolism in children and adolescents with polyarticular and systemic JIA and to relate them to diseases subtypes, diseases activity markers, and nutritional status. METHODS: A cross-sectional study including 62 JIA patients was performed. The following variables were evaluated: disease activity and medications used, body mass index, height for age (z-score), skin folds (bicipital, tricipital, subscapular and suprailiac), food intake based on three 24-h food recalls, lipid profile (total cholesterol (CT), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG) and non-HDL (N-HDLc), glycemia and insulin, erythrocyte sedimentation rate (ESR), ultrasensitive C-reactive protein (us-CRP) and apolipoproteins A-I and B (Apo A-I and Apo B). RESULTS: Dyslipidemia was observed in 83.3% of the patients. Based on classical lipid profile, low HDL-c levels was the most frequently alteration observed. Inadequate levels of LDL-c, Apo B and NHDL-c were significantly more frequent in the systemic JIA subtype when compared to the polyarticular subtype (p = 0.017, 0.001 and 0.042 respectively). Patients on biological therapy had a better adequacy of Apo A-I concentrations. The ESR showed a negative correlation with Apo A-I level (r = - 0.25, p = 0.047). CONCLUSION: We concluded that dyslipidemia is common in patients with JIA, especially in systemic subtype. The systemic subtype and an elevated ESR were associated with lower concentrations of Apo A-I, suggesting the participation of the inflammatory process.

Duration of inactive disease while off disease-modifying anti-rheumatic drugs seems to influence flare rates in juvenile idiopathic arthritis: an observational retrospective study.

BACKGROUND: many Juvenile Idiopathic Arthritis (JIA) patients reach inactivity while medicated, but there are no guidelines to determine the moment or method for discontinuing medications. We present the flare rates and remission and possible influencing factors after therapy discontinuation in children with JIA. METHODS: data was collected from charts of JIA patients (n=70) in remission on medication, who had their drugs withdrawn. RESULTS: Seventy patients fulfilled inclusion criteria and were included for analysis. The mean time of inactive disease on medication until tapering or withdrawal was 15.6±6.7 months; 45 (64.3%) patients remained in remission and 25 (35.7%) flared. There was no difference between groups regarding sex, age, JIA subtype, disease duration, time in remission on medication and scheme of therapy withdrawal. Patients who fulfilled Wallace criteria for remission off medication had lower flare rates than those who did not achieve 12 months of remission after the medication withdrawal (p<0.0001). Patients who used biologic DMARDs plus synthetic DMARDs appeared to flare more (77.8% vs 29.5% respectively, p=0.008) and presented shorter periods of inactivity off medication (15.3±24.7 vs 32.3 ± 31.7 months respectively, p=0.049) compared to those who used only synthetic DMARDs. CONCLUSION: It is possible that gradual drug tapering is not necessary for JIA patients, but caution must be exerted in those patients using biologic DMARDs, weighing carefully the decision to withdraw medication, due to their higher flare rates and shorter times of inactive disease after the medication withdrawal.

VIRTUAL LEARNING ENVIRONMENT IN PEDIATRIC RHEUMATOLOGY FOR PEDIATRIC RESIDENTS.

OBJECTIVE: To develop, implement and evaluate an online virtual learning environment (VLE) on pediatric rheumatology, aimed at pediatric residents, analyzing its effectiveness and satisfaction rates. METHODS: A total of 92 first and second year pediatric residents at two pediatric reference centers were invited to participate in the study. Residents were randomized into a case group (that answered the pre-course test, attended the six virtual pediatric rheumatology modules, and then responded to the post-course test and a satisfaction questionnaire) and a control group (that only answered the pre-course test and, after 4 weeks, the post-course test). RESULTS: Forty-seven residents (51%) completed their participation. In the case group (n=24), the mean percentage of correct answers was 14% higher on the post-course test (p<0.001). The number of correct answers was larger in the case group than in the control one (n=23) in the post-course test (p=0.045). In the assessment of satisfaction with VLE use, residents considered the site easy to navigate (91%), suitable as a learning tool (91%), and attractive in design (79%). They reported poor prior knowledge in pediatric rheumatology (91%) and agreed that there was good learning with the methodology (75%). CONCLUSIONS: The virtual learning environment in pediatric rheumatology proved to be an effective teaching tool with high satisfaction rates, providing pediatrician residents with adequate knowledge regarding the initial assessment and management of children with rheumatic diseases.

Evaluation of the measurement properties of the Brazilian version of two quality-of-life questionnaires in food allergy - for children and their parents.

OBJECTIVE: To evaluate the psychometric properties of the Brazilian version of health-related quality-of-life questionnaires of children with food allergy and their parents. METHODS: The translation and cultural adaptation processes were previously performed, according to the method proposed by the World Health Organization. After this stage, the questionnaires were applied to 201 parents of children under 6 years of age with food allergy. The assessment of the psychometric properties included: evaluation of the internal consistency by Cronbach's alpha coefficient; of the reproducibility by the intraclass correlation coefficient between test and retest; and of the construct, using Spearman's correlation coefficient, comparing the obtained scores with those of generic questionnaires that evaluate health-related quality of life. RESULTS: The means of the obtained scores were 2.44 and 3.35, for the children and their parents, respectively. Cronbach's alpha coefficients were 0.85 and 0.91, respectively, which showed good internal consistency of the tools. The intraclass correlation coefficients between test and retest were 0.87 and 0.84 for children and their parents, respectively, showing good reproducibility for both questionnaires. The correlation between the specific and the generic questionnaires was significant (-0.27 for the children, -0.64 for their parents, p<0.05). CONCLUSIONS: The specific questionnaires to evaluate the health-related quality of life of children with food allergy and of their parents were satisfactorily validated to be used in Brazil.

Yogic meditation improves objective and subjective sleep quality of healthcare professionals.

OBJECTIVE: Our aim was to evaluate the impact of yogic meditation in sleep quality of healthy pediatric healthcare professionals. METHOD: Subjects were randomized into a meditation group (MG, n = 32), who attended a yogic meditation class held for eight weeks, or a control group (CG, n = 32). Polysomnography (PSG) and Pittsburgh Sleep Quality Index (PSQI) scores were determined at baseline and after eight weeks. RESULTS: The PSQI overall score was lower (p = 0.024) in the MG. Reported sleep latency (p = 0.046) and MG sleep latency (p = 0.028) were lower in the MG at eight weeks. PSG showed a time effect (p = 0.020) on decreasing minutes of wake after sleep onset in the MG. There were strong and significant correlations between PSG and PSQI variables. There was a significant time effect on heart rate (p = 0.001) in the MG. CONCLUSION: Yogic meditation may be used as an integrative health tool to foster improvements in the health-related aspects of healthcare professionals' lives. TRIAL REGISTRATION: CinicalTrials.gov identifier: NCT02947074; trial registry name: Meditation Practice in Pediatric Healthcare Professionals: A Randomized Controlled Clinical Trial.

Adverse drug reactions associated with treatment in patients with chronic rheumatic diseases in childhood: a retrospective real life review of a single center cohort.

BACKGROUND: Adverse drug reactions (ADRs) are the sixth leading causes of death worldwide; monitoring them is fundamental, especially in patients with disorders like chronic rheumatic diseases (CRDs). The study aimed to describe the ADRs investigating their severity and associated factors and resulting interventions in pediatric patients with CRDs. METHODS: A retrospective, descriptive and analytical study was conducted on a cohort of children and adolescents with juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM). The study evaluated medical records of the patients to determine the causality and the management of ADRs. In order to investigate the risk factors that would increase the risk of ADRs, a logistic regression model was carried out on a group of patients treated with the main used drug. RESULTS: We observed 949 ADRs in 547 patients studied. Methotrexate (MTX) was the most frequently used medication and also the cause of the most ADRs, which occurred in 63.3% of patients, followed by glucocorticoids (GCs). Comparing synthetic disease-modifying anti-rheumatic drugs (sDMARDs) vs biologic disease-modifying anti-rheumatic drugs (bDMARDs), the ADRs attributed to the former were by far higher than the latter. In general, the severity of ADRs was moderate and manageable. Drug withdrawal occurred in almost a quarter of the cases. In terms of risk factors, most patients who experienced ADRs due to MTX, were 16 years old or younger and received MTX in doses equal or higher than 0.6 mg/kg/week. Patients with JIA and JDM had a lower risk of ADRs than patients with JSLE. In the multiple regression model, the use of GCs for over 6 months led to an increase of 0.5% in the number of ADRs. CONCLUSIONS: Although the ADRs highly likely affect a wide range of children and adolescents with CRDs they were considered moderate and manageable cases mostly. However, triggers of ADRs need further investigations.

Lipid profile of pediatric patients with chronic rheumatic diseases - a retrospective analysis.

AIM: To describe the prevalence of dyslipidemia in children and adolescents with autoimmune rheumatic diseases (ARDs), particularly juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (jSLE), and juvenile dermatomyositis (JDM). METHODS: Retrospective cross-sectional study conducted in the pediatric rheumatology outpatient clinic. We evaluated 186 children and adolescents between the ages of 5 and 19 years. The medical records were reviewed for the following data: demographic and clinical features, disease activity, and lipid profile (triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C) and very low density lipoprotein (VLDL-C)). In addition, non-HDL cholesterol was calculated as TC minus HDL-C. The cut-off points proposed by the American Academy of Pediatrics were used to classify the lipid profile. RESULTS: Dyslipidemia was observed in 128 patients (68.8%), the most common being decreased HDL-C (74 patients, 39.8%). In the JIA group there was an association between the systemic subtype and altered LDL-C and NHDL-C, which demonstrated a more atherogenic profile in this subtype (p=0.027 and p=0.017, respectively). Among patients with jSLE, the cumulative corticosteroid dose was associated with an increase in LDL-C (p=0.013) and with a decrease in HDL-C (p=0.022). CONCLUSION: Dyslipidemia is common in children and adolescents with ARDs, especially JIA, jSLE, and JDM, and the main alteration in the lipid profile of these patients was decreased HDL-C.

Sleep and restless legs syndrome in female adolescents with idiopathic musculoskeletal pain.

OBJECTIVES: To assess the presence of restless legs syndrome, periodic leg movement, and sleep disorders in female adolescents with idiopathic musculoskeletal pain through a sleep scale and polysomnography, and to compare these data in adolescents without pain history. METHOD: Twenty-six adolescents diagnosed with idiopathic musculoskeletal pain followed in a pain outpatient clinic and 25 healthy controls matched by age and education were recruited. The restless legs syndrome criteria were evaluated according to the International Restless Legs Syndrome Study Group, the Sleep Disturbance Scale for Children was completed, nocturnal polysomnography was performed, and anxiety symptoms were recorded. RESULTS: The mean age of idiopathic musculoskeletal pain adolescents was 13.9±1.6 years; in controls, it was 14.4±1.4 years. One adolescent in the control group (4 %) and nine patients with idiopathic musculoskeletal pain (34.6 %) fulfilled the restless legs syndrome criteria (p=0.011). The authors did not observe significant differences in Sleep Disturbance Scale for Children scores between the groups in all components: disorders of initiating and maintaining sleep (p=0.290), sleep breathing disorders (p=0.576), disorders of arousal (p=0.162), sleep-wake transition disorders (p=0.258), disorder of excessive daytime somnolence (p=0.594), and sleep hyperhidrosis (p=0.797). The neurophysiological, respiratory, and periodic leg movement parameters were similar in both groups. Having anxiety was not associated with restless legs syndrome (p=0.11). Three patients with idiopathic musculoskeletal pain (11.5 %) presented restless legs syndrome and periodic leg movement simultaneously, which was absent in the control group. CONCLUSION: Female adolescents with idiopathic musculoskeletal pain present criteria for RLS more frequently than healthy adolescents. However, this study did not observe relevant changes in objective and subject sleep variables.

Prevalence of juvenile idiopathic arthritis in schoolchildren from the city of São Paulo, the largest city in Latin America.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that affects children and adolescents. Its prevalence varies greatly from one study to another according to the population and methodology. Some tools may be helpful in screening for suspected cases. The aim of this study is determine the prevalence of JIA in children and adolescent students in the city of São Paulo, Brazil. METHODS: This cross-sectional study was conducted from March 2016 to November 2017. It was based on a populational study envolving school children and adolescents from São Paulo, the largest city of Brazil. We randomly selected students under 16 years old from private schools with more than 1000 students who were evaluated through a specific questionnaire for screening suspected cases of chronic arthropathy (Early Diagnosis of Chronic Arthritis - 12 items - EDA-12) and subsequent anamnesis and rheumatologic physical examination for diagnostic confirmation. RESULTS: We contacted all 79 schools in the universe, of which 12(15, 18%) agreed to participate in the study. A total of 21,119 questionnaires were handed out to the parents. We obtained a response of 5,710 (27%). In 108 cases the EDA-12 score was considered positive (≥ 5). We examined all these 108 "suspicious" children. In 10 cases, the rheumatologic evaluation confirmed the diagnosis of arthritis, since the subjects presented a history and physical examination compatible with JIA. The prevalence of JIA in children and adolescents was 0.196% (95% CI = 0.104-0.371%). CONCLUSION: In this first Brazilian population study to evaluate the prevalence of JIA, we observed that the disease is relatively prevalent in our country (196 / 100.000 children), which is similar to that observed in other studies involving children from urban centers.