Antibioticoterapia em crianças indígenas e não indígenas desnutridas / Antibiotic therapy in indigenous and non-indigenous undernourished children

INTRODUÇÃO: A prevalência da desnutrição infantil vem diminuindo em todo o mundo, mas ainda acomete milhões de crianças, especialmente indígenas. Devido ao elevado número de doenças infecciosas associadas à desnutrição, a antibioticoterapia faz parte da terapêutica recomendada. OBJETIVO: Observar os casos de desnutrição entre crianças indígenas e não indígenas hospitalizadas e a terapêutica empregada durante o tratamento. MÉTODOS: Estudo de coorte retrospectivo, farmacoepidemiológico, realizado com informações extraídas de prontuários arquivados do período de janeiro de 2012 a dezembro de 2014 de um hospital público. RESULTADOS: Participaram 166 crianças, sendo o número de crianças indígenas aproximadamente seis vezes maior do que não indígenas. Houve maior prevalência entre lactentes e crianças com idade inferior a um ano apresentaram mais chances de serem internadas por desnutrição. Os diagnósticos de desnutrição mais vistos foram os inespecíficos, com uma proporção significativa de óbitos relacionados ao diagnóstico E43. As infecções mais comuns foram do sistema digestório e respiratório. Crianças indígenas tiveram quase cinco vezes mais chances de apresentarem infecção respiratória. A maior proporção recebeu até três antibióticos, havendo crianças que receberam mais que sete antibióticos diferentes durante o período de internação. CONCLUSÃO: A população infantil deve ser acompanhada por meio de inquéritos que possam subsidiar políticas de saúde que atendam suas necessidades. É necessária a capacitação dos profissionais envolvidos no cuidado da criança desnutrida, recursos materiais e financeiros, a fim diminuir o número de diagnósticos inespecíficos e evitar o uso indiscriminado de antibióticos, sendo imprescindível uma política de controle efetiva no uso da politerapia antimicrobiana.

INTRODUCTION: The prevalence of child malnutrition is declining worldwide, but still affects millions of children, especially indigenous people. Due to the high number of infectious diseases associated with malnutrition, antibiotic therapy is part of the recommended therapy. OBJECTIVE: To observe the cases of malnutrition among hospitalized indigenous and non-indigenous children and the therapy used during treatment. METHODS: Retrospective cohort study, pharmacoepidemiological, carried out with information extracted from medical records filed from January 2012 to December 2014 of a public hospital. RESULTS: 166 children participated, with the number of indigenous children being approximately six times higher than that of nonindigenous children. There was a higher prevalence among infants and children under one year of age who were more likely to be hospitalized for malnutrition. The most frequent diagnoses of malnutrition were nonspecific, with a significant proportion of deaths related to diagnosis E43. The most common infections were of the digestive and respiratory system. Indigenous children were almost five times more likely to have respiratory infection. The highest proportion received up to three antibiotics, with children receiving more than seven different antibiotics during the hospitalization period. CONCLUSION: The child population must be accompanied by surveys that can subsidize health policies that meet their needs. It is necessary to train the professionals involved in the care of malnourished children, material and financial resources, in order to reduce the number of non-specific diagnoses and to avoid the indiscriminate use of antibiotics, a policy of effective control in the use of antimicrobial polytherapy is essential.

Clinical significance of neuropsychological improvement after supplementation with omega-3 in 8-12 years old malnourished Mexican children: a randomized, double-blind, placebo and treatment clinical trial.

It has been shown that supplementation with omega-3 improves cognitive performance, especially in infants and toddlers, but it is unknown whether these results are effective in older malnourished children. The aims of this study, therefore, were to investigate the omega-3 supplementation effects in 8- to 12-year-old children and to know which neuropsychological functions improve after three months of intervention in a sample of Mexican children with mild to moderate malnutrition. This study was a randomized, double-blind, treatment and placebo study of 59 children aged 8-12 years who were individually allocated to 2 groups. The duration of the intervention lasted 3 months. Neuropsychological performance was measured at baseline and at 3 months. Results show that more than 50% of children in the treatment group had greater improvement in 11 of the 18 neuropsychological variables studied. Processing speed, visual-motor coordination, perceptual integration, attention and executive function showed improvement in more than 70% of the omega-3 supplemented children. This trial was registered at clinicaltrials.gov as NCT01199120.

Exceso de peso y preguntas frecuentes sobre la alimentación del niño con cáncer / Overweight and frequently asked questions about feeding the child with cancer

Durante el tratamiento del niño con cáncer, es posible requerir el uso de corticoides, los cuales como efecto adverso tienen el aumento en el apetito, que unido al sedentarismo de estos niños, incrementan de peso y pueden concurrir en sobrepeso y obesidad, malnutrición que es tan dañina como la desnutrición. Es necesario un control y seguimiento estricto por parte del pediatra y nutricionista infantil en estos niños con malnutrición.

During the treatment of children with cancer, may require the use of corticosteroids, which have the adverse effect of increased appetite, which together with the inactivity of theses children, increased weight and may attend overweight and obesity, malnutrition that is as harmful as malnutrition. It is necessary to control and closely monitored by the pediatrician and infant nutritionist in these children with malnutrition.

Clinical manifestations of nutritional copper deficiency in infants and children.

A series of reports in the 1960s highlighted nutritional copper deficiencies in infants and children recovering from malnutrition in Peru; since that time, a cascade of additional cases in premature infants, in patients receiving total parenteral nutrition, and in those receiving special diets or unmodified cow milk have been reported. The identification by Danks that Menkes syndrome, a genetically determined defect in copper absorption and utilization, is responsible for the observed clinical manifestations provided further insight into the physiopathologic effects of copper deficiency. New information on the metabolism and physiologic role of copper, plus the identification of additional copper metalloenzymes and improvement in how to determine copper status, has fueled interpretation and speculation on how and why the classic signs of copper deficiency occur, as well as on the possible effects of mild deficiencies. Also under scrutiny are potential interactions between other elements and the effects of other elements, even when given in acceptable amounts, on copper status. There should be no constraints in thinking on other possible effects of impaired copper status in humans. I review some of the history of nutritional copper deficiency in infants and children and attempt to interpret some of the clinical manifestations in light of newly acquired information.

Hierro, infección y nutrición

El hierro cumple un papel esencial en el organismo como componente de moléculas encargadas del transporte y almacenamiento de oxígeno, sistemas de transferencia de electrones y diversas enzimas. La relación entre infección y utilización de hierro ha sido estudiada en los últimos años, en esta revisión se analizan los tópicos de más controversia al respecto: 1) la deficiencia crónica de hierro aumenta en el huésped la susceptibilidad a infección; 2) la deficiencia de hierro para su supervivencia, lo que se llama "inmunidad nutricional"; y 3) cuál es el comportamiento del hierro en el paciente críticamente enfermo.

National vitamin A survey in Panama.

The prevalence of vitamin A deficiency in a nationally representative sample of children 12-59 months old in Panama was assessed using serum retinol levels and dietary indicators. The median serum retinol level found was 1.27 +/- 0.42 mumol/L (38 micrograms/dL); 6.0% of the study sample providing adequate blood specimens had levels below 0.7 mumol/L (20 micrograms/dL), indicating deficient vitamin A intake. The Panama City Metropolitan Area and the country's western region had the highest prevalences of low serum retinol levels (below 0.7 mumol/L in 9% and 6% of the study children, respectively), as compared to overall prevalences of 5% in the two other regions studied. Low serum retinol levels were significantly more prevalent among Indians in the study group (primarily Guaymí Indians) than among non-Indians (13% versus 5%). Dietary information provided by the study children's mothers showed that high risk of inadequate dietary vitamin A intake closely paralleled low serum retinol levels; specifically, the highest prevalence of dietary inadequacy was found in the western region, especially among the Indians. The Panamanian Government is currently increasing distribution of high-dose vitamin A capsules to Indian preschoolers in Chiriquí and Bocas del Toro Provinces.

Effects of short-term zinc supplementation on cellular immunity, respiratory symptoms, and growth of malnourished Equadorian children.

OBJECTIVE: To assess the effect of zinc supplementation on respiratory tract disease, immunity and growth in malnourished children. DESIGN: A randomized double-blind placebo-controlled trial. SETTING: A day-care center in Quito, Ecuador. SUBJECTS: Fifty children (12-59 months old) recruited by height-for-age and weight-for-age deficit. INTERVENTIONS: Twenty-five children (supplemented, S group) received 10 mg/day of zinc as zinc sulfate, and 25 (nonsupplemented, NS group) received a placebo during 60 days. All were also observed during a 60-day postsupplementation period. Two children of the S group dropped out. Daily the clinical presence of cough, respiratory tract secretions, and fever, was recorded. On days 0,60 and 120, the cutaneous delayed-type hypersensitivity (DTH) to multiple antigens, and anthropometric parameters were assessed. On days 0 and 60 serum zinc levels were also measured. RESULTS: On day 60, DTH was significantly larger (20.8 +/- 7.1 vs 16.1 +/- 9.7 mm), and serum zinc levels were significantly higher (118.6 +/- 47.1 vs 83.1 +/- 24.5 micrograms/dl) in the S group than in the NS group (P <0.05 for each). The incidence of fever [relative risk (RR): 0.30, c.i. = 0.08- 0.95, P =0.02], cough (RR): 0.52, c.i. = 0.32-0.84, P = 0.004) and upper respiratory tract secretions (RR):0.72, c.i. = 0.59-0.88, P = 0.001) was lower in the S group than in the NS group at day 60. At the end of the postsupplementation observation period (day 120), the incidence of fever and upper respiratory tract secretions was the same in both the S and NS groups. The incidence of cough was higher at day 120 in the S group than in the NS group (RR): 2.28, c.i. = 1.37-3.83, P = 0.001). CONCLUSIONS: This study supports a role for zinc in immunity, and immunity to respiratory infections, while pointing out the need for larger studies.