Association between acanthosis nigricans and overweight with hypertension in children and adolescents from low-income families.

OBJECTIVE: This study aimed to describe the prevalence of acanthosis nigricans and high blood pressure in children and adolescents from low-income families, and to verify the association of elevated blood pressure with nutritional status and the presence of acanthosis nigricans. METHODS: This is a cross-sectional and controlled study with 232 children and adolescents from an institution for low-income families. Pubertal stage, body mass index Z-score, waist-to-height circumference ratio (increased waist-to-height circumference ratio >0.5), the presence of acanthosis nigricans, and blood pressure were assessed. RESULTS: The prevalence of excess weight and the change in waist-to-height circumference ratio was 37.9%. Acanthosis nigricans and increased blood pressure occurred in 20.3 and 34.8%, respectively. The prevalence of acanthosis nigricans and hypertension was higher in individuals with excess weight (p<0.001; p<0.001) and with an increased waist-to-height circumference ratio (p=0.009; p<0.001). Logistic regression showed a significant and independent association of body mass index Z-score (OR 2.35; 95%CI 1.52-3.65; p<0.001) and the presence of acanthosis nigricans (OR 2.43; 95%CI 1.12-5.23; p=0.023) with elevated blood pressure. CONCLUSION: Acanthosis nigricans and elevated blood pressure occurred in one-fifth and one-third of the individuals in an institution for children from low-income families. Overweight and the presence of acanthosis nigricans increased the risk of high blood pressure more than twofold.

Association between acanthosis nigricans and overweight with hypertension in children and adolescents from low-income families

SUMMARY OBJECTIVE: This study aimed to describe the prevalence of acanthosis nigricans and high blood pressure in children and adolescents from low-income families, and to verify the association of elevated blood pressure with nutritional status and the presence of acanthosis nigricans. METHODS: This is a cross-sectional and controlled study with 232 children and adolescents from an institution for low-income families. Pubertal stage, body mass index Z-score, waist-to-height circumference ratio (increased waist-to-height circumference ratio >0.5), the presence of acanthosis nigricans, and blood pressure were assessed. RESULTS: The prevalence of excess weight and the change in waist-to-height circumference ratio was 37.9%. Acanthosis nigricans and increased blood pressure occurred in 20.3 and 34.8%, respectively. The prevalence of acanthosis nigricans and hypertension was higher in individuals with excess weight (p<0.001; p<0.001) and with an increased waist-to-height circumference ratio (p=0.009; p<0.001). Logistic regression showed a significant and independent association of body mass index Z-score (OR 2.35; 95%CI 1.52-3.65; p<0.001) and the presence of acanthosis nigricans (OR 2.43; 95%CI 1.12-5.23; p=0.023) with elevated blood pressure. CONCLUSION: Acanthosis nigricans and elevated blood pressure occurred in one-fifth and one-third of the individuals in an institution for children from low-income families. Overweight and the presence of acanthosis nigricans increased the risk of high blood pressure more than twofold.

Relationship between body mass index and waist-to-height ratio in childhood.

OBJECTIVE: To evaluate whether there is an association between the body mass index z-score and waist-to-height ratio of children and adolescents. METHODS: This was a cross-sectional study conducted in a school in Santo André, SP, between June and August 2019. Body mass index was measured for all participants, adopting the z-score cutoff of +2 recommended by the World Health Organization. The waist-to-height ratio was determined in children over two years of age and considered abnormal when ≥0.5. The qualitative variables are presented as absolute numbers and percentages. To compare qualitative data, we used the χ2 test or Fisher's exact test. Pearson's test was applied to assess the correlation between BMI and waist-to-height ratio. The level of significance adopted was 5%. RESULTS: The body mass index was calculated for 518 children and the waist-to-height ratio for 473 children. Regarding body mass index, 60.6% of the participants had normal weight, 3.1% were underweight, and 36.3% were overweight. overweight (24.7%) and obesity (22.7%) were more prevalent in adolescents. The waist-to-height ratio was abnormal in 50.5% of the sample. There was an increasing association between body mass index and waist-to-height ratio with age, according to the Pearson correlation coefficients for the age groups <5 years (r=0.459; p<0.001), 5 to 10 years (r=0.687; p<0.001) and >10 years (r=0.805; p<0.001). CONCLUSION: There was a significant correlation between body mass index and waist-to-height ratio. This association was higher in adolescents. The waist-to-height ratio is easy to apply and may be useful as a predictor of cardiometabolic risk.

Relationship between body mass index and waist-to-height ratio in childhood

SUMMARY OBJECTIVE: To evaluate whether there is an association between the body mass index z-score and waist-to-height ratio of children and adolescents. METHODS: This was a cross-sectional study conducted in a school in Santo André, SP, between June and August 2019. Body mass index was measured for all participants, adopting the z-score cutoff of +2 recommended by the World Health Organization. The waist-to-height ratio was determined in children over two years of age and considered abnormal when ≥0.5. The qualitative variables are presented as absolute numbers and percentages. To compare qualitative data, we used the χ2 test or Fisher's exact test. Pearson's test was applied to assess the correlation between BMI and waist-to-height ratio. The level of significance adopted was 5%. RESULTS: The body mass index was calculated for 518 children and the waist-to-height ratio for 473 children. Regarding body mass index, 60.6% of the participants had normal weight, 3.1% were underweight, and 36.3% were overweight. overweight (24.7%) and obesity (22.7%) were more prevalent in adolescents. The waist-to-height ratio was abnormal in 50.5% of the sample. There was an increasing association between body mass index and waist-to-height ratio with age, according to the Pearson correlation coefficients for the age groups <5 years (r=0.459; p<0.001), 5 to 10 years (r=0.687; p<0.001) and >10 years (r=0.805; p<0.001). CONCLUSION: There was a significant correlation between body mass index and waist-to-height ratio. This association was higher in adolescents. The waist-to-height ratio is easy to apply and may be useful as a predictor of cardiometabolic risk.

Prescription of red cell concentrates by emergency physicians.

OBJECTIVE: To evaluate the adequacy of the prescription of red cell concentrates by emergency physicians. METHODS: A cross-sectional study based on the survey of transfusion requests records completed by emergency physicians, from May/2018 to April/2019, in an emergency hospital. Adequacy in the indication, volume, and subtype (filtered, irradiated, and washed) of prescribed erythrocytes were evaluated. To compare the qualitative data, we used the χ2 test. The significance level adopted was 5%. RESULTS: One thousand and twenty-two transfusions were evaluated. The indication, volume, and subtypes were correct in 72.7%, 45.9%, and 81.6% respectively. Transfusion in symptomatic patients presented superior adequacy when compared to asymptomatic individuals with significant statistical difference (indication: 79,6% vs 67.2%, p <0.001; Volume: 63.5% vs 31.7%, p <0.001; subtype: 85.3% vs 78.7%, p 0.006). Among clinical situations, there were more errors in sepsis (39.7%) and pneumonia (36.3%). More than half of the prescriptions presented excessive volume, raising the risk of circulatory overload, observing that the mean age was 60.6 years. The specific analysis of the prescribed subtypes showed adequacy of 17.9% in the filtered, 1.7% in the irradiated, and none in the washed. Thirty transfusions should have been filtered, but the prescriber did not request the subtype. CONCLUSION: One hypothesis for the observed inaccuracies is inadequate medical training on the subject, both in undergraduate and medical residency, associated with a lack of continuing education on transfusion protocols. The transfusion Committee received the results of this study with a proposal for continuing education measures on transfusion hemotherapy.

Epinephrine in pediatric cardiorespiratory arrest: when and how much?

The objective of the present study was to assess the efficacy of different doses, times for infusion of the first dose, intervals of administration of subsequent doses, and number of epinephrine doses in the survival of children and adolescents who went into cardiorespiratory arrest. It is a review study with data from the PubMedⓇ/MEDLINEⓇdatabase. The search was for articles published from January 1st, 2000 to February 10, 2019, with a sample of patients aged under 18 years, published in English, Portuguese and Spanish. We found 222 articles, of which 16 met the inclusion criteria of the study. The first dose should be given as soon as possible. The standard dose (0.01mg/kg) has a better outcome when compared to the higher dose (0.1mg/kg). There is an iⓇverse relation between the number of epinephrine doses and survival. The interval currently recommended between doses has lower survival when compared to larger intervals. The dosage recommended by the American Heart Association presents a better outcome for survival, but the interval between doses and the maximum number of doses should be better assessed.

Epinephrine in pediatric cardiorespiratory arrest: when and how much? / Epinefrina na parada cardiorrespiratória pediátrica: quando e quanto?

ABSTRACT The objective of the present study was to assess the efficacy of different doses, times for infusion of the first dose, intervals of administration of subsequent doses, and number of epinephrine doses in the survival of children and adolescents who went into cardiorespiratory arrest. It is a review study with data from the PubMedⓇ/MEDLINEⓇdatabase. The search was for articles published from January 1st, 2000 to February 10, 2019, with a sample of patients aged under 18 years, published in English, Portuguese and Spanish. We found 222 articles, of which 16 met the inclusion criteria of the study. The first dose should be given as soon as possible. The standard dose (0.01mg/kg) has a better outcome when compared to the higher dose (0.1mg/kg). There is an iⓇverse relation between the number of epinephrine doses and survival. The interval currently recommended between doses has lower survival when compared to larger intervals. The dosage recommended by the American Heart Association presents a better outcome for survival, but the interval between doses and the maximum number of doses should be better assessed.

RESUMO O objetivo deste estudo foi avaliar a eficácia de diferentes doses, tempos para infusão da primeira dose, intervalos de administração de doses subsequentes e número de doses de epinefrina na sobrevida de crianças e adolescentes que sofreram parada cardiorrespiratória. Trata-se de estudo de revisão, cujas buscas foram feitas na base de dados PubMedⓇ /MEDLINEⓇ. Foram selecionados artigos publicados de 1° de janeiro de 2000 até 10 de fevereiro de 2019, realizados em menores de 18 anos de idade, publicados em inglês, português e espanhol. Foram encontrados 222 artigos, dos quais 16 atenderam os critérios de inclusão no estudo. A primeira dose deve ser aplicada o mais rápido possível. A dose padrão (0,01mg/kg) apresenta melhor desfecho quando comparada à dose alta (0,1mg/kg). Houve relação inversa entre número de doses de epinefrina e sobrevida. O intervalo entre doses recomendado atualmente apresenta menor sobrevida quando comparado a intervalos maiores. A dose recomendada pela American Heart Association apresenta melhor desfecho para sobrevida, porém o intervalo entre doses e o número máximo de doses devem ser melhor avaliados.

Prescription of red cell concentrates by emergency physicians

SUMMARY OBJECTIVE To evaluate the adequacy of the prescription of red cell concentrates by emergency physicians. METHODS A cross-sectional study based on the survey of transfusion requests records completed by emergency physicians, from May/2018 to April/2019, in an emergency hospital. Adequacy in the indication, volume, and subtype (filtered, irradiated, and washed) of prescribed erythrocytes were evaluated. To compare the qualitative data, we used the χ2 test. The significance level adopted was 5%. RESULTS One thousand and twenty-two transfusions were evaluated. The indication, volume, and subtypes were correct in 72.7%, 45.9%, and 81.6% respectively. Transfusion in symptomatic patients presented superior adequacy when compared to asymptomatic individuals with significant statistical difference (indication: 79,6% vs 67.2%, p <0.001; Volume: 63.5% vs 31.7%, p <0.001; subtype: 85.3% vs 78.7%, p 0.006). Among clinical situations, there were more errors in sepsis (39.7%) and pneumonia (36.3%). More than half of the prescriptions presented excessive volume, raising the risk of circulatory overload, observing that the mean age was 60.6 years. The specific analysis of the prescribed subtypes showed adequacy of 17.9% in the filtered, 1.7% in the irradiated, and none in the washed. Thirty transfusions should have been filtered, but the prescriber did not request the subtype. CONCLUSION One hypothesis for the observed inaccuracies is inadequate medical training on the subject, both in undergraduate and medical residency, associated with a lack of continuing education on transfusion protocols. The transfusion Committee received the results of this study with a proposal for continuing education measures on transfusion hemotherapy.

RESUMO OBJETIVO Avaliar a adequação da prescrição de concentrados de hemácias por médicos emergencistas. MÉTODOS Estudo transversal por levantamento de fichas de requisição de transfusões preenchidas por médicos emergencistas, no período de maio de 2018 a abril de 2019, em um hospital de emergências. Foram avaliadas as adequações na indicação, volume e subtipo (filtradas, irradiadas e lavadas) de hemácias prescritas. Para comparação dos dados qualitativos, utilizamos o teste de χ2. O nível de significância adotado foi de 5%. RESULTADOS Foram avaliadas 1.022 transfusões. A indicação, o volume e os subtipos estavam corretos em 72,7%, 45,9% e 81,6%, respectivamente. A transfusão prescrita em pacientes sintomáticos apresentou adequação superior quando comparada aos assintomáticos, com diferença estatística significativa (indicação: 79,6% vs 67,2% - p<0,001; volume: 63,5% vs 31,7% - p<0,001; subtipo: 85,3% vs 78,7% - p 0,006). Entre as situações clínicas, ocorreram mais erros na sepse (39,7%) e pneumonia (36,3%). Mais da metade das prescrições apresentavam volume excessivo, elevando o risco de sobrecarga circulatória, observando-se que a média da idade foi 60,6 anos. A análise específica dos subtipos prescritos apresentou adequação de 17,9% nas filtradas, 1,7% nas irradiadas e nenhuma das lavadas. Trinta transfusões deveriam ter sido filtradas, porém o prescritor não solicitou o subtipo. CONCLUSÃO Uma hipótese para as incorreções observadas é a formação médica inadequada sobre o assunto, tanto na graduação como na residência médica, associada à falta de atualização nos protocolos transfusionais. O comitê transfusional recebeu os resultados deste estudo com proposta de medidas de educação permanente sobre hemoterapia transfusional.

Evaluation of platelet concentrate prescription in pediatric patients at a tertiary care hospital.

OBJECTIVE: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. METHODS: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. RESULTS: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. CONCLUSION: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.

Evaluation of platelet concentrate prescription in pediatric patients at a tertiary care hospital / Avaliação da prescrição de concentrado de plaquetas em pacientes pediátricos em hospital terciário

ABSTRACT Objective: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. Methods: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. Results: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. Conclusion: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.

RESUMO Objetivo: Verificar a adequação na prescrição de concentrado de plaquetas por pediatras em diferentes setores da pediatria de um hospital geral. Métodos: Estudo transversal avaliando 218/227 fichas de requisição de concentrado de plaquetas de crianças e adolescentes (zero a 13 anos), de janeiro de 2007 a abril de 2015 pelos pediatras do pronto-socorro, enfermaria e unidade de terapia intensiva. Excluíram-se as requisições em portadores de doenças hematológicas e aquelas sem o número de plaquetas. Resultados: Crianças com menos de 12 meses receberam 98 prescrições de concentrado de plaquetas (45,2%). A maioria das transfusões foi profiláticas (165; 79%). Em relação ao local da transfusão, 39 (18%) foram no pronto-socorro, 27 (12,4%) na enfermaria e 151 (69,6%) na unidade de terapia intensiva. O gatilho, o volume prescrito e o subtipo de concentrado de plaquetas foram adequados em 59 (28,2%), 116 (53,5%) e 209 (96,3%) das transfusões, respectivamente. Prescrições para pacientes com hemorragia apresentaram adequação em 42 (95,5%) transfusões, enquanto para crianças sem hemorragia houve adequação em 17 (10,3%) vezes. A inadequação mais comum em relação ao volume foi a prescrição acima da recomendação (95; 43,8%). Foram prescritos oito concentrados de plaquetas sem indicação de solicitação de subtipos. Conclusão: Os resultados obtidos nesse estudo mostraram que a prescrição de transfusão de concentrado de plaquetas foi mais adequada em crianças com hemorragia ativa em comparação com a transfusão profilática. Houve tendência à prescrição de volumes elevados e de subtipos de plaquetas, o que não se justifica segundo os protocolos atuais. O ensino da medicina transfusional deve ser mais valorizado na graduação e na residência médica.

Assessment of the prescription of red blood cell concentrates in the pediatric age group.

OBJECTIVE: To verify the adequacy of red blood cell (RBC) prescription to pediatric patients in different sectors of a pediatric hospital. METHOD: A retrospective study was conducted including 837/990 RBC transfusion requisition forms for children and adolescents (0 to 13 years old) filed in between January 2007 and April 2015 by the pediatricians of the emergency room (ER), infirmary ward and intensive care unit (pICU). Transfusion requisition forms belonging to patients with chronic anemia or acute hemorrhage, as well as incompletes requisition forms, were excluded. RESULTS: Trigger, prescribed volume and subtype of RBC concentrates were adequate in 532 (65.3%), 460 (58.8%) and 805 (96.2%) of the transfusions, respectively. When the clinical picture was considered, prescription adequacy was higher compared to the use of the hemoglobin level alone (70.9% vs. 41%). The pICU had the highest correct trigger percentage (343 [71.6%]; p<0.001) while the ER showed more often adequate prescribed volumes (119 [66.1%]; p=0.020). The most common inadequacy regarding volume was that of prescriptions above the recommendation > 15 mL/kg found in 309 cases (36.9%). Thirty-two (32) RBC subtypes were requested and none were consistent with current recommendations. CONCLUSION: The results obtained in our study showed that RBC transfusion occurred more appropriately when the clinical picture was taken into account at request. There was a tendency to prescribe higher volumes and RBC subtypes without the justification of current protocols. Hemotherapic teachings at undergraduate level and medical residency must be improved.

Assessment of the prescription of red blood cell concentrates in the pediatric age group / Avaliação da prescrição de concentrados de hemácias na faixa etária pediátrica

Summary Objective: To verify the adequacy of red blood cell (RBC) prescription to pediatric patients in different sectors of a pediatric hospital. Method: A retrospective study was conducted including 837/990 RBC transfusion requisition forms for children and adolescents (0 to 13 years old) filed in between January 2007 and April 2015 by the pediatricians of the emergency room (ER), infirmary ward and intensive care unit (pICU). Transfusion requisition forms belonging to patients with chronic anemia or acute hemorrhage, as well as incompletes requisition forms, were excluded. Results: Trigger, prescribed volume and subtype of RBC concentrates were adequate in 532 (65.3%), 460 (58.8%) and 805 (96.2%) of the transfusions, respectively. When the clinical picture was considered, prescription adequacy was higher compared to the use of the hemoglobin level alone (70.9% vs. 41%). The pICU had the highest correct trigger percentage (343 [71.6%]; p<0.001) while the ER showed more often adequate prescribed volumes (119 [66.1%]; p=0.020). The most common inadequacy regarding volume was that of prescriptions above the recommendation > 15 mL/kg found in 309 cases (36.9%). Thirty-two (32) RBC subtypes were requested and none were consistent with current recommendations. Conclusion: The results obtained in our study showed that RBC transfusion occurred more appropriately when the clinical picture was taken into account at request. There was a tendency to prescribe higher volumes and RBC subtypes without the justification of current protocols. Hemotherapic teachings at undergraduate level and medical residency must be improved.

Resumo Objetivo: Verificar a adequação na prescrição de concentrado de hemácias (CH) por pediatras em diferentes setores de um hospital pediátrico. Método: Realizou-se estudo retrospectivo onde avaliamos 837/990 fichas de requisição de CH para crianças e adolescentes (0 a 13 anos), preenchidas entre janeiro de 2007 e abril de 2015 pelos médicos pediatras do pronto-socorro (PS), da enfermaria e da unidade de terapia intensiva (UTI). Excluíram-se as transfusões realizadas em portadores de anemia crônica, crianças com hemorragia aguda e requisições incompletas. Resultados: Gatilho, volume prescrito e subtipo de concentrado de hemácias foram adequados em 532 (65,3%), 460 (58,8%) e 805 (96,2%) das transfusões, respectivamente. Quando foi considerado o quadro clínico, a adequação foi maior em comparação à prescrição pelo valor isolado da hemoglobina (70,9% vs. 41%). A UTI teve o maior percentual de acerto no gatilho (343 [71,6%]; p<0,001) e o PS, no volume prescrito (119 [66,1%]; p=0,020). A inadequação mais comum, em relação ao volume, foi a prescrição acima da recomendação (> 15 mL/kg, 309 [36,9%]). Foram solicitados 32 subtipos de CH e nenhum estava de acordo com as indicações atuais. Conclusão: Os resultados obtidos mostram que a transfusão de CH aconteceu de forma mais adequada quando a situação clínica era levada em conta na solicitação. Houve uma tendência à prescrição de volumes elevados e de subtipos de hemácias não justificados segundo os protocolos atuais. É necessário melhorar o ensino de hemoterapia na graduação e residência médica.

Síndrome de Ogilvie: relato de dois casos tratados com cecostomia / Ogilvie’s syndrome: report of two cases treated with cecostomy

Acute colonic pseudo-obstruction or Ogilvie’s Syndrome is characterized by signs and symptoms of large bowel obstruction without evidence of mechanical cause. The authors report two cases of patients with acute obstructive abdomen who were previously submitted to clinical treatment with no sucess. Later on one of them was submitted to laparoscopic cecostomy and the other to colonoscopic cecostomy The results showed that only the interventionist methods were successful.

Histoplasmose pulmonar crônica em Alfenas, MG / Chronic pulmonary histoplasmosis in Alfenas, MG

A histoplasmose é uma micose sistêmica causada por um fungo dimórfico, o Histoplasma capsulatum var. capsulatum. A histoplasmose pulmonar crônica (HPC) afeta usualmente homens, com mais de 50 anos de idade e com história de doença broncopulmonar obstrutiva crônica (DPOC). As lesões são limitadas aos pulmões, cujos sintomas são clínica e radiologicamente similares à tuberculose pulmonar crônica. Neste trabalho, os autores tecem considerações sobre um caso de HPC afetando um morador da cidade de Alfenas, simulando metástases e/ou tuberculose pulmonar. O diagnóstico foi feito através do exame histopatológico de biópsias pulmonar videoassistida sendo o paciente posteriormente tratado oralmente com itraconazol apresentando evolução favorável.