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1.
J Pediatr (Rio J) ; 2021 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-33567270

RESUMEN

OBJECTIVE: Identify associated factors for recurrent wheezing (RW) in male and female infants. METHODS: Cross-sectional multicentric study using the standardized questionnaire from the Estudio Internacional sobre Sibilancias en Lactantes (EISL). The questionnaire was applied to parents of 9345 infants aged 12-15 months at the time of immunization/routine visits. RESULTS: One thousand two hundred and sixty-one (13.5%) males and nine hundred sixty-three (10.3%) females have had RW (≥3 episodes), respectively (p10 colds episodes (OR = 3.46; IC 95% 2.35-5.07), air pollution (OR = 1.33; IC 95% 1.12-1.59), molds at home (OR = 1.23; IC 95% 1.03-1.47), Afro-descendants (OR = 1.42; IC 95% 1.20-1.69), bronchopneumonia (OR = 1.41; IC; 1.11-1.78), severe episodes of wheezing in the first year (OR = 1.56; IC 95% 1.29-1.89), treatment with bronchodilators (OR = 1.60; IC 95% 1.22-2,1) and treatment with oral corticosteroids (OR = 1,23; IC 95% 0.99-1,52). Associated factors for RW for females were passive smoking (OR = 1.24; IC 95% 1.01-1,51), parents diagnosed with asthma (OR = 1.32; IC 95% 1,08-1,62), parents with allergic rhinitis (OR = 1.26; IC 95% 1.04-1.53), daycare attendance (OR = 1.48; IC 95% 1.17-1,88), colds in the first 6 months of life (OR = 2.19; IC 95% 1.69-2.82), personal diagnosis of asthma (OR = 1.84; IC 95% 1.39-2.44), emergency room visits (OR = 1.78; IC 95% 1.44-2.21), nighttime symptoms (OR = 2.89; IC 95% 2.34-3.53) and updated immunization (OR = 0.62; IC 95% 0.41-0.96). CONCLUSION: There are differences in associated factors for RW between genders. Identification of these differences could be useful to the approach and management of RW between boys and girls.

2.
Pediatr Clin North Am ; 68(1): 293-304, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33228939

RESUMEN

Social inequality refers to disparities in society that have the effect of limiting a group's socioeconomic, educational, and intellectual potential. Inequity in health means any limitation to access comprehensive health services that also hinders the achievement of well-being and favorable health outcomes. Strategies for more equitable growth to eradicate global poverty would contribute to reducing health inequities and improve health care outcomes. Coordinated efforts between governments, private sector, families, and interested stakeholders are needed. This article discusses inequality and inequity in pediatric respiratory diseases, the challenges confronted, and the strategies needed to mitigate these disparities.

3.
Braz J Microbiol ; 51(4): 1729-1735, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32862400

RESUMEN

Acute respiratory infection (ARI) is a major cause of morbidity and mortality worldwide. Most of these infections are caused by viruses. Infections pose as important triggers of acute episodes of chronic respiratory diseases (CRD). This study sought to evaluate the frequency and circulation profile of respiratory viruses among ARI symptomatic patients and completely asymptomatic children in Midwest Brazil. The study enrolled symptomatic children with and without ARI symptoms. During 1 year, 225 nasal respiratory samples were obtained from patients aged 4-14 years old. The samples were screened by multiplex nested-PCR for 16 common respiratory viruses. From 225 samples, 42 had at least one virus detected. Samples from four different patients had multiple viruses detected. The viral detection rate in symptomatic (20.1%) and asymptomatic patients (14.8%) showed no significant difference. The most frequent viruses detected were rhinovirus (28.6%), FLUA (11.9%), adenovirus (11.9%), human bocavirus (HBoV) (11.9%), and respiratory syncytial virus (RSV) antigenic group A (9.5%). Monthly detection rate was higher during the rainy season. RSVs were detected during the months with higher rainfall indexes and higher air humidity, while FLU and HBoV were detected during the winter months. The obtained results reinforce the importance of viral pathogens in pediatric population, emphasizing similar viral occurrence in symptomatic and asymptomatic children.

4.
Hum Vaccin Immunother ; : 1-9, 2020 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-32730135

RESUMEN

There is a well-known inverse association between mortality rate from infectious diseases and improvements in socioeconomic status, even though longer time-series are required to demonstrate this relationship. This general rule seems to apply to mortality from pneumonia in children in the pneumococcal conjugate vaccine (PCV) era. Two recent published secular trend studies spanning from about 30 years among Brazilians under the age of five show either no effect of PCV - not even death rate decline from pneumococcal meningitis - or a modest one (8% reduction). Time-series mortality studies from pneumonia are needed for both, developed and developing countries, those who have implemented PCV or not. Results from these studies would provide critical input and feedback to public health policy makers.

5.
Pediatr Pulmonol ; 55(8): 2115-2127, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32519809

RESUMEN

AIM: To summarize what we know so far about coronavirus disease (COVID-19) in children. METHOD: We searched PubMed, Scientific Electronic Library Online, and Latin American and Caribbean Center on Health Sciences Information from 1 January 2020 to 4 May 2020. We selected randomized trials, observational studies, case series or case reports, and research letters of children ages birth to 18 years with laboratory-confirmed COVID-19. We conducted random-effects meta-analyses to calculate the weighted mean prevalence and 95% confidence interval (CI) or the weighted average means and 95% CI. RESULT: Forty-six articles reporting 551 cases of COVID-19 in children (aged 1 day-17.5 years) were included. Eighty-seven percent (95% CI: 77%-95%) of patients had household exposure to COVID-19. The most common symptoms and signs were fever (53%, 95% CI: 45%-61%), cough (39%, 95% CI: 30%-47%), and sore throat/pharyngeal erythema (14%, 95% CI: 4%-28%); however, 18% (95% CI: 11%-27%) of cases were asymptomatic. The most common radiographic and computed tomography (CT) findings were patchy consolidations (33%, 95% CI: 23%-43%) and ground glass opacities (28%, 95% CI: 18%-39%), but 36% (95% CI: 28%-45%) of patients had normal CT images. Antiviral agents were given to 74% of patients (95% CI: 52%-92%). Six patients, all with major underlying medical conditions, needed invasive mechanical ventilation, and one of them died. CONCLUSION: Previously healthy children with COVID-19 have mild symptoms. The diagnosis is generally suspected from history of household exposure to COVID-19 case. Children with COVID-19 and major underlying condition are more likely to have severe/critical disease and poor prognosis, even death.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Adolescente , Antivirales/uso terapéutico , Infecciones Asintomáticas , Niño , Preescolar , Comorbilidad , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/mortalidad , Tos/etiología , Eritema/etiología , Femenino , Fiebre/etiología , Humanos , Lactante , Recién Nacido , Estudios Observacionales como Asunto , Pandemias , Faringitis , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/mortalidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Respiración Artificial/efectos adversos , Tomografía Computarizada por Rayos X
8.
Infect Control Hosp Epidemiol ; 41(7): 854-856, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32299517

RESUMEN

Catheter-drawn blood sampling is an efficient method of diagnosing catheter-related bloodstream infection (CRBSI) in neonates; it has greater sensitivity and accuracy than methods using catheter-tip cultures. No association was detected between catheter-drawn blood sampling and the occurrence of adverse events with central venous catheters.

9.
Vaccine ; 38(11): 2559-2565, 2020 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-32033849

RESUMEN

BACKGROUND: Studies on the impact of pneumococcal conjugate vaccines (PCV) on mortality, especially among preschoolers are scarce. We aimed to assess time trend mortality from lower respiratory infections (LRI), taken as a proxy of pneumonia, from 1990 to 2017. METHODS: This ecological study assessed the mortality rate among Brazilians under-five before and after the national PCV-10 implementation in 2010. Pneumococcal meningitis (PM) and diarrheal diseases (DD) were included as a "positive and negative controls", respectively. Trend analysis was performed through Global Burden of Disease estimates. Joinpoint regression modeling was used to describe trends in mortality and to identify time points of its statistically significant decreases throughout the study period. RESULTS: There was a sustainable reduction in mortality rates for these three diseases, with no relevant changes in the secular trends for LRI and PM after the PCV-10 implementation. For LRI, PM, and DD the higher and statistically significant (p < 0.05) annual percent change reduction occurred between 2000 and 2003, (-8.3%), 1997-2000 (-11.9%), and 1990-1994. (-13.8%), respectively, i.e., several years before the nationwide implementation of PCV-10. Moreover, for LRI the annual percent change (from -5.9 to -8.8) verified from 1990 to 2009, i.e., 20 years before countrywide vaccination, was comparable to that observed during the PCV era, that is, from minus 5.8 to minus 7.8, between 2010 and 2017. CONCLUSION: Mortality from LRI, PM, and DD decreased over time, irrespective of national PCV-10 implementation in Brazil. Other factors such as healthcare delivery, socioeconomic status improvement, and health interventions may have impacted this secular trend.

10.
Am J Infect Control ; 48(9): 1102-1103, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-31926756

RESUMEN

We found that low birth weight and type of central venous catheter were associated with catheter-related bloodstream infection in neonates. In the multivariate analysis, only central venous catheter type (dissected veins, tunneled catheters, and short-term nontunneled catheters) remained significantly associated with catheter-related bloodstream infection.

11.
Clin Transl Allergy ; 9: 57, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31695865

RESUMEN

Background: The Nature Step to Respiratory Health was the overarching theme of the 12th General Meeting of the Global Alliance against Chronic Respiratory Diseases (GARD) in Helsinki, August 2018. New approaches are needed to improve respiratory health and reduce premature mortality of chronic diseases by 30% till 2030 (UN Sustainable Development Goals, SDGs). Planetary health is defined as the health of human civilization and the state of the natural systems on which it depends. Planetary health and human health are interconnected, and both need to be considered by individuals and governments while addressing several SDGs. Results: The concept of the Nature Step has evolved from innovative research indicating, how changed lifestyle in urban surroundings reduces contact with biodiverse environments, impoverishes microbiota, affects immune regulation and increases risk of NCDs. The Nature Step calls for strengthening connections to nature. Physical activity in natural environments should be promoted, use of fresh vegetables, fruits and water increased, and consumption of sugary drinks, tobacco and alcohol restricted. Nature relatedness should be part of everyday life and especially emphasized in the care of children and the elderly. Taking "nature" to modern cities in a controlled way is possible but a challenge for urban planning, nature conservation, housing, traffic arrangements, energy production, and importantly for supplying and distributing food. Actions against the well-known respiratory risk factors, air pollution and smoking, should be taken simultaneously. Conclusions: In Finland and elsewhere in Europe, successful programmes have been implemented to reduce the burden of respiratory disorders and other NCDs. Unhealthy behaviour can be changed by well-coordinated actions involving all stakeholders. The growing public health concern caused by NCDs in urban surroundings cannot be solved by health care alone; a multidisciplinary approach is mandatory.

12.
Am J Trop Med Hyg ; 101(5): 1077-1082, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31482780

RESUMEN

This follow-up cross-sectional study aimed to analyze the prevalence rate and risk factors related to latent tuberculosis infection (LTBI) and active tuberculosis (TB) in children aged < 15 years in contact with adults with smear-positive pulmonary TB (PTB) in a Brazilian municipality. Data were collected from interviews, clinical evaluations, chest X-rays, tuberculin skin tests, and interferon gamma release assays. The median time elapsed between diagnosis of the index case (IC) and inclusion in the study was 2.5 years (interquartile range [IQR] = 1.5-4.4) and 7.4 years (IQR = 3.8-9.7) when we reassessed the development (or not) of active TB. The median age at the time of exposure to the IC was 6.6 years (IQR = 3.3-9.4) and 14.1 years (IQR = 8.9-17.7) at the last follow-up. Of the 99 children and adolescents in contact with smear-positive PTB, 21.2% (95% CI = 14.0-29.9) were diagnosed with LTBI, and none developed active TB. There was no statistically significant difference between the LTBI and non-LTBI groups regarding demographic, socioeconomic, and epidemiological characteristics. Unlike national and international scenarios, we found a lower frequency of LTBI and no active TB among our studied patients. For better understanding of these findings, further studies might add, among other factors, host and Mycobacterium tuberculosis genetic features.


Asunto(s)
Tuberculosis Latente/diagnóstico , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Trazado de Contacto , Femenino , Humanos , Tuberculosis Latente/epidemiología , Tuberculosis Latente/patología , Masculino , Prevalencia , Radiografía Torácica , Prueba de Tuberculina
13.
Paediatr Respir Rev ; 31: 52-57, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30987798

RESUMEN

Pediatric asthma has been increasing in LMICs (Low Middle-Income Countries), leading to an important burden for both children and national health systems. Implementing measures to achieve control are influenced by the degree of organization health systems have, the availability and affordability of essential asthma medications, and the effective implementation of asthma programs and asthma guidelines. In this review authors give an updated view of the current situation of these components of asthma management in LMICs.


Asunto(s)
Antiasmáticos/uso terapéutico , Asma/terapia , Países en Desarrollo , Política de Salud , Educación del Paciente como Asunto , Antiasmáticos/economía , Antiasmáticos/provisión & distribución , Asma/epidemiología , Costos y Análisis de Costo , Accesibilidad a los Servicios de Salud , Humanos , Guías de Práctica Clínica como Asunto
14.
J. pediatr. (Rio J.) ; 95(1): 69-75, Jan.-Feb. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-984657

RESUMEN

Abstract Objective: There is a scarcity of studies that assessed the association between adherence to combination therapy and asthma control in pediatric patients. The authors investigated the association between adherence to fluticasone propionate/salmeterol xinafoate combination-metered aerosol and the level of asthma control in children. Methods: This was a prospective observational study of 84 patients aged 5-16 years with moderate persistent asthma, who remained uncontrolled despite the use of 1000 µg/day of inhaled nonextrafine-hydrofluoric alkane-beclomethasone dipropionate in the three months prior to study enrollment. Participants were prescribed two daily doses of FP (125 µg)/salmeterol xinafoate (25 µg) combination by metered aerosol/spacer for six months. Adherence rates were assessed using the device's dose counter after the 2nd, 4th, and 6th months of follow up. Asthma control was assessed using a simplified Global Initiative for Asthma 2014 Report classification. Results: Mean adherence rates after the second, fourth, and sixth months were 87.8%, 74.9%, and 62.1% respectively, for controlled asthma, and 71.7%, 56.0%, and 47.6% respectively, for uncontrolled asthma (all p-values ≤ 0.03). The proportion of children achieving asthma control increased to 42.9%, 67.9% and 89.3% after the 2nd, 4th and 6th months of follow-up, respectively (p ≤ 0.001). Conclusion: Adherence rates between 87.8% in the 2nd month and 62.1% in the 6th month were strong determinants of asthma control.


Resumo Objetivo: São escassos os estudos que avaliaram a relação entre a taxa de adesão à combinação de proprionato de fluticasona/xinafoato de salmeterol e o nível de controle da asma na infância. O presente estudo teve como objetivo avaliar essa relação. Métodos: Estudo prospectivo observacional com 84 participantes, de 5 a 16 anos, todos eles com asma persistente moderada que permaneceram não controlados apesar do uso de 1.000 µg/dia de dipropionato de beclometasona em partículas não extrafinas nos três meses que antecederam a admissão no estudo. Os participantes receberam prescrição de 125 µg de propionato de fluticasona e 25 µg xinafoato de salmeterol através de inalador pressurizado, duas vezes ao dia, e foram avaliados após o 2°, 4° e 6° meses de tratamento. A taxa de adesão foi obtida por meio do contador analógico de doses incorporado ao inalador. A classificação do nível de controle da asma foi baseada numa simplificação das recomendações da Global Initiative for Asthma. Resultados: As taxas de adesão aos 2, 4 e 6 meses para a asma controlada foram 87,8%, 74,9% e 62,1% e para a asma não controlada de 71,7%, 56,0% e 47,6% (p ≤ 0,03), respectivamente. A proporção de pacientes com asma controlada elevou- se para 42,9%, 67,9% e 89,3% nas três avaliações subsequentes (p ≤ 0,001). Conclusões: Taxas de adesão entre 87,8% no 2° mês e de 62,1% no 6° mês foram determinantes para o nível de controle da asma.


Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Asma/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Xinafoato de Salmeterol/administración & dosificación , Fluticasona/administración & dosificación , Cumplimiento y Adherencia al Tratamiento , Estudios Prospectivos , Estudios de Seguimiento , Resultado del Tratamiento , Quimioterapia Combinada
15.
J Pediatr (Rio J) ; 95(1): 69-75, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-29274305

RESUMEN

OBJECTIVE: There is a scarcity of studies that assessed the association between adherence to combination therapy and asthma control in pediatric patients. The authors investigated the association between adherence to fluticasone propionate/salmeterol xinafoate combination-metered aerosol and the level of asthma control in children. METHODS: This was a prospective observational study of 84 patients aged 5-16 years with moderate persistent asthma, who remained uncontrolled despite the use of 1000µg/day of inhaled nonextrafine-hydrofluoric alkane-beclomethasone dipropionate in the three months prior to study enrollment. Participants were prescribed two daily doses of FP (125µg)/salmeterol xinafoate (25µg) combination by metered aerosol/spacer for six months. Adherence rates were assessed using the device's dose counter after the 2nd, 4th, and 6th months of follow up. Asthma control was assessed using a simplified Global Initiative for Asthma 2014 Report classification. RESULTS: Mean adherence rates after the second, fourth, and sixth months were 87.8%, 74.9%, and 62.1% respectively, for controlled asthma, and 71.7%, 56.0%, and 47.6% respectively, for uncontrolled asthma (all p-values≤0.03). The proportion of children achieving asthma control increased to 42.9%, 67.9% and 89.3% after the 2nd, 4th and 6th months of follow-up, respectively (p≤0.001). CONCLUSION: Adherence rates between 87.8% in the 2nd month and 62.1% in the 6th month were strong determinants of asthma control.


Asunto(s)
Asma/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Fluticasona/administración & dosificación , Xinafoato de Salmeterol/administración & dosificación , Cumplimiento y Adherencia al Tratamiento , Administración por Inhalación , Adolescente , Niño , Preescolar , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Resultado del Tratamiento
17.
BMC Pulm Med ; 18(1): 109, 2018 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-29970066

RESUMEN

BACKGROUND: Multiple factors are involved in asthma exacerbations, including environmental exposure and viral infections. We aimed to assess the association between severe asthma exacerbations, acute respiratory viral infections and other potential risk factors. METHODS: Asthmatic children aged 4-14 years were enrolled for a period of 12 months and divided into two groups: those with exacerbated asthma (group 1) and non-exacerbated asthma (group 2). Clinical data were obtained and nasopharyngeal samples were collected through nasopharyngeal aspirate or swab and analysed via indirect fluorescent immunoassays to detect influenza A and B viruses, parainfluenza 1-3, adenovirus and respiratory syncytial virus. Rhinovirus was detected via molecular assays. Potential risk factors for asthma exacerbation were identified in univariate and multivariate analyses. RESULTS: In 153 children (group 1: 92; group 2: 61), median age 7 and 8 years, respectively, the rate of virus detection was 87.7%. There was no difference between groups regarding the frequency of virus detection (p = 0.68); however, group 1 showed a lower frequency (19.2%) of inhaled corticosteroid use (91.4%, p < 0.01) and evidence of inadequate disease control. In the multivariate analysis, the occurrence of three or more visits to the emergency room in the past 12 months (IRR = 1.40; p = 0.04) and nonadherence to inhaled corticosteroid (IRR = 4.87; p < 0.01) were the only factors associated with exacerbation. CONCLUSION: Our results suggest an association between asthma exacerbations, poor disease control and nonadherence to asthma medication, suggesting that viruses may not be the only culprits for asthma exacerbations in this population.


Asunto(s)
Asma/fisiopatología , Asma/virología , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/virología , Virosis/complicaciones , Adolescente , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Asma/tratamiento farmacológico , Brasil , Niño , Preescolar , Estudios Transversales , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Análisis Multivariante , Análisis de Regresión , Sistema Respiratorio/virología
18.
Clin Exp Allergy ; 48(12): 1640-1653, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29999223

RESUMEN

BACKGROUND: Allergic rhinitis (AR) management has changed in recent years following the switch from the concept of disease severity to the concept of disease control, publication of the AR clinical decision support system (CDSS) and development of mobile health (m-health) tools for patients (eg Allergy Diary). The Allergy Diary Companion app for healthcare providers is currently being developed and will be launched in 2018. It incorporates the AR CDSS to provide evidence-based treatment recommendations, linking all key stakeholders in AR management. OBJECTIVE: To produce an electronic version of the AR CDSS (e-CDSS) for incorporation into the Allergy Diary Companion, to describe the app interfaces used to collect information necessary to inform the e-CDSS and to summarize some key features of the Allergy Diary Companion. METHODS: The steps involved in producing the e-CDSS and incorporating it into the Allergy Diary Companion were (a) generation of treatment management scenarios; (b) expert consensus on treatment recommendations; (c) generation of electronic decisional algorithms to describe all AR CDSS scenarios; (d) digitization of these algorithms to form the e-CDSS; and (e) embedding the e-CDSS into the app to permit easy user e-CDSS interfacing. RESULTS: Key experts in the AR field agreed on the AR CDSS approach to AR management and on specific treatment recommendations provided by Allergy Diary Companion. Based on this consensus, decision processes were developed and programmed into the Allergy Diary Companion using Titanium Appcelerator (JavaScript) for IOS tablets. To our knowledge, this is the first time the development of any m-health tool has been described in this transparent and detailed way, providing confidence, not only in the app, but also in the provided management recommendations. CONCLUSION: The Allergy Diary Companion for providers provides guideline and expert-endorsed AR management recommendations. [MASK paper No 32].


Asunto(s)
Sistemas de Apoyo a Decisiones Clínicas , Aplicaciones Móviles , Rinitis Alérgica/diagnóstico , Sistemas de Apoyo a Decisiones Clínicas/normas , Manejo de la Enfermedad , Práctica Clínica Basada en la Evidencia , Humanos , Rinitis Alérgica/inmunología , Rinitis Alérgica/terapia , Teléfono Inteligente , Telemedicina , Interfaz Usuario-Computador
19.
Sci. med. (Porto Alegre, Online) ; 28(2): ID29566, abr-jun 2018.
Artículo en Portugués | LILACS | ID: biblio-909633

RESUMEN

OBJETIVOS: Comparar dados clínicos, laboratoriais e espirométricos de pacientes pré-escolares (idade entre três e seis anos) com fibrose cística, identificados pela alteração do tripsinogênio imunorreativo no teste de triagem neonatal (grupo IRT) com os dados de pacientes cuja suspeita diagnóstica ocorreu a partir de sinais e sintomas clínicos (grupo DC). MÉTODOS: Estudo do tipo coorte retrospectiva, com amostra obtida a partir dos prontuários dos pacientes que faziam acompanhamento ambulatorial especializado e multidisciplinar. Todas as crianças incluídas tinham diagnóstico confirmado de fibrose cística por teste de eletrólitos no suor e/ou sequenciamento genético. Como variáveis incluíram-se sexo, peso, altura, índice de massa corporal, número de internações por ano, colonização por Pseudomonas aeruginosa, presença de insuficiência pancreática e escore de Shwachman. Este escore abrange quatro domínios: atividade geral, nutrição, exame radiológico e avaliação física, cada um pontuado entre 5 e 25 pontos, sendo que o escore ≤40 pontos indica estado grave e ≥86 pontos excelente estado. Para comparação da função pulmonar utilizaram-se os dados da última espirometria realizada antes dos seis anos de idade. Os desfechos foram comparados por qui-quadrado ou teste t de Student, com limite de significância de 0,05. RESULTADOS: Foram incluídos no estudo 24 pacientes, sete no grupo IRT e 17 no grupo DC. As crianças do grupo IRT iniciaram acompanhamento com média de idade de 1,51±2,04 meses e as do grupo DC com 3,77±1,80 meses (p=0,014). A média do escore de Shwachman foi 94,40±2,19 nos pacientes do grupo IRT vs. 87,67±8,00 no grupo DC (p=0,018). A média do escore Z para o índice de massa corporal foi 0,95±1,02 no grupo IRT vs. 0,51±1,05 no grupo DC (p=0,051). Foram encontrados valores ligeiramente superiores nas variáveis espirométricas no grupo IRT, sem diferença estatisticamente significativa entre os grupos. CONCLUSÕES: Os resultados sugerem que os pacientes diagnosticados com fibrose cística a partir da suspeita pelo teste de triagem neonatal beneficiaram-se de uma intervenção precoce, podendo iniciar os testes de função pulmonar e receber tratamento e orientações mais cedo. A avaliação de parâmetros clínicos com o escore de Shwachman mostrou que os benefícios puderam ser observados já na idade pré-escolar.


AIMS: To compare clinical, laboratory and spirometric parameters of preschoolers (ages from three to six years old) with cystic fibrosis identified by abnormal newborn screening test (NS group), with data of patients whose diagnostic suspicion arose from characteristic clinical signs and symptoms (CS group). METHODS: Retrospective cohort study, with a sample obtained from the medical charts of patients who received specialized and multidisciplinary outpatient follow-up. All the included children had a confirmed diagnosis of cystic fibrosis by sweat electrolyte testing and/ or genetic sequencing. Variables included sex, weight, height, body mass index, number of hospitalizations per year, Pseudomonas aeruginosa colonization, presence of pancreatic insufficiency and Shwachman score, which covers four domains: general activity, nutrition, radiological examination and physical evaluation, each one scored between 5 and 25 points. A total score ≤40 points indicates severe state, and ≥86 points indicates excellent state. For comparison of pulmonary function, data from the last spirometry performed before the age of six years were used. Outcomes were compared by chi-square or Student's t test, with a significance limit of 0.05. RESULTS: Twenty-four patients were included in the study, seven children in the NS group and 17 children in the CS group. The children of the NS group started follow-up with a mean age of 1.51±2.04 months, and those of the CS group started with 3.77±1.80 months (p=0.014). The mean Shwachman score was 94.40±2.19 in the NS vs. 87.67±8.00 in the CS group (p=0.018). The mean Z score for body mass index was 0.95±1.02 in the NS group vs. 0.51±1.05 in the CS group (p=0.051). Spirometric variables had slightly higher values in the NS group, with no statistically significant difference between groups. CONCLUSIONS: The results suggest that those patients diagnosed with cystic fibrosis from the neonatal screening test suspicion benefited from an early intervention, being able to initiate pulmonary function tests and receive treatment and counseling earlier. Evaluation of clinical parameters with the Shwachman score showed that benefits could be already observed at the preschool age.


Asunto(s)
Fibrosis Quística , Fibrosis Quística/diagnóstico , Tamizaje Neonatal , Niño , Nutrición del Niño , Espirometría
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