Quality of life of former preterm adolescents / Qualidade de vida de adolescentes nascidos prematuros

ABSTRACT Objectives: To compare the quality of life of adolescents born prematurely with very-low-birth-weight, reported by adolescents themselves and their caregivers, and analyze associated factors perceived by both. Methods: This cross-sectional study included former preterm adolescents born with gestational age < 37 weeks and birth weigh < 1,500 g, who were being followed up at the premature outpatient clinic of a university institution, from birth to adolescence, and their caregivers. Quality of life was assessed by the WHOQOL-BREF questionnaire. Factors associated with quality of life were analyzed by linear regression. Results: Of 91 eligible adolescents, 73 (80.2%) were included, being 38 (52.1%) male. The mean gestational age was 30.1 ± 2.4 weeks and birth weight was 1134 ± 239 g. Adolescents reported better quality of life than their caregivers (p = 0.011), being respectively: dissatisfied (1.4 vs. 4.1%), neither satisfied nor dissatisfied (20.5 vs. 20.5%), satisfied (56.2 vs. 71.2%) and very satisfied (21.9 vs. 4.1%). Scores attributed by adolescents and caregivers were, respectively: overall quality of life (4.0 ± 0.7 vs. 3.8 ± 0.6, p = 0.032), physical domain (3.6 ± 0.6 vs. 3.5 ± 0.6, p = 0.685), psychological domain (3.4 ± 0.6 vs. 3.6 ± 0.6, p = 0.116), social relationships (3.7 ± 0.7 vs. 3.6 ± 0.8, p = 0.371) and environment (3.4 ± 0.7 vs. 3.2 ± 0.6, p = 0.037). For caregivers, absence of fixed partner and hospitalization in childhood decreased the overall quality of life score; furthermore, the occurrence of respiratory distress syndrome increased this score. In the adolescents' view, leukomalacia reduced this score. Conclusions: Adolescents reported better quality of life than caregivers. For adolescents, only biological factors were associated with quality of life scores; for caregivers, biological and social factors were associated this scores.

RESUMO Objetivos: Comparar a qualidade de vida de adolescentes nascidos prematuros com muito baixo peso na percepção do adolescente e de seu cuidador e analisar os fatores associados na visão de ambos. Métodos: Estudo transversal com adolescentes nascidos com idade gestacional < 37 semanas e peso < 1.500 g, em acompanhamento no ambulatório de prematuros de uma instituição universitária, do nascimento à adolescência, e seus cuidadores. Pesquisou-se a qualidade de vida com o questionário WHOQOL-BREF. Fatores associados à qualidade de vida foram analisados por regressão linear. Resultados: Dos 91 adolescentes elegíveis, 73 (80,2%) foram incluídos, sendo 38 (52,1%) masculinos, nascidos com 30,1 ± 2,4 semanas de gestação e peso de 1.134 ± 239 g. Adolescentes referiram melhor qualidade de vida que seus cuidadores (p = 0,01), sendo, respectivamente: insatisfeitos (1,4 vs. 4,1%), nem satisfeitos, nem insatisfeitos (20,5 vs. 20,5%), satisfeitos (56,2 vs. 71,2%) e muito satisfeitos (21,9 vs. 4,1%). Os escores atribuídos pelos adolescentes e cuidadores foram, respectivamente, qualidade de vida geral (4,0 ± 0,7 vs. 3,8 ± 0,6, p = 0,032), domínio físico (3,6 ± 0,6 vs. 3,5 ± 0,6, p = 0,685), domínio psicológico (3,4 ± 0,6 vs. 3,6 ± 0,6, p = 0,116), relações sociais (3,7 ± 0,7 vs. 3,6 ± 0,8, p = 0,371) e ambiente (3,4 ± 0,7 vs. 3,2 ± 0,6, p = 0,037). Para cuidadores, ausência de parceiro fixo e hospitalização na infância diminuíram os escores de qualidade de vida geral, já a síndrome de desconforto respiratório aumentou esse escore. Na percepção dos adolescentes, a leucomalácia reduziu esse escore. Conclusões: Adolescentes referiram melhor qualidade de vida que seus cuidadores. Para adolescentes, apenas fatores biológicos se associaram aos escores de qualidade de vida; para cuidadores, fatores biológicos e sociais se associaram a esse escore.

Análise da prevalência de vírus respiratórios em crianças atendidas em um hospital universitário do sul de Minas Gerais / Analysis of respiratory virus prevalence in assisted children in a university hospital of southern of minas gerais

INTRODUÇÃO: As infecções respiratórias virais são doenças de alta incidência no nosso meio. Os vírus circulam durante todo ano, todavia, a incidência destas infeccões aumentam com a sazonalidade. Grande parte destas infecções ocorrem em crianças por serem mais susceptíveis do ponto de vista imunológico. OBJETIVO: Analisar a prevalência dos patógenos virais nas infecções respiratórias em crianças de 0 a 9 anos no Hospital das Clinicas Samuel Libanio(HCSL), Pouso Alegre - MG. MÉTODOS: Foi realizada uma revisão sistemática dos dados coletados a partir de aspirados de orofaringe, para pesquisa de vírus pela equipe da Comissão de Controle de Infecções Hospitalares (CCIH), entre os anos de 2010 e 2014. RESULTADOS: Foram analisados 310 amostras e cerca de 26,4% foram positivas para algum vírus. O vírus sincicial respiratório (VSR) foi o mais prevalente nas crianças menores de um e também na faixa etária de 1 a 4 anos (25,3% e 11,1 %, respectivamente), estatisticamente significante (p<0,001). Já no grupo entre 5 a 9 anos prevaleceu o virus Influenza A H1N1 com 13,8%. CONCLUSÃO: As infecções virais contribuem para um alto número de hospitalizações que oneram o serviço público de saúde, principalmente na faica etária pediátrica. Deste modo, medidas preventiva como campanhas de vacinação devem continuar a ser incentivadas, de preferência abrangendo os vírus mais prevalentes para uma determinada faixa etária. (AU)

Introduction: Viral respiratory infections are of high incidence diseases in our midst. Viruses circulate throughout the year, however, the incidence of these infections increase with seasonality. Most of these infections occur in children because they are more likely immunologically. Objective: To analyze the prevalence of viral pathogens in respiratory infections in children aged 0 to 9 years old at the Samuel Libânio Clinical Hospital, Pouso Alegre-MG. Methods: A systematic review of data collected from aspirates oropharynx was performed to search for viruses by the Commission's Team of Nosocomial Infection Control between the years 2010 and 2014. Results: 310 samples were analyzed and about 26.4% of the samples were positive for a virus. Respiratory syncytial virus (RSV) was the most prevalent in children under one year old and also in the age group 1-4 years (25.3% and 11.1%, respectively), statistically significant (p<0.001). In the group between 5 and 9 years prevailed the virus Influenza A H1N1 with 13.8%. Conclusions: Viral infections contribute to a high number of hospitalizations that burden the public health system, especially in the pediatric age group. Thus, preventive measures such as vaccination campaigns should continue to be encouraged, preferably covering the most prevalent virus for a certain age group (AU)

Características epidemiológicas dos asmáticos atendidos no Ambulatório de Pneumologia de um hospital universitário do Sul de Minas Gerais / Epidemiological characteristics of asthmatics treated in outpatient Pulmonology at a university hospital in southern Minas Gerais, Brazil

Objetivo: Avaliar as características clínicas, socioeconômicas e epidemiológicas dos asmáticos atendidos no ambulatório de um hospital universitário. Métodos: Aplicou-se um questionário com questões referentes à asma no período correspondido entre janeiro e dezembro de 2012, em 83 pacientes asmáticos atendidos no ambulatório de Pneumologia Pediátrica do Hospital das Clínicas da Universidade do Vale do Sapucaí (UNIVAS), em Pouso Alegre - MG, com idade entre 0 e 14 anos. Resultados: A maioria dos pacientes era do sexo masculino, residentes de zona urbana e da raça branca. Pequena parcela dos pais era fumante e apenas um terço tinha historia familiar de asma. A doença predominou no inverno e mais da metade da amostra tinha quadro intermitente ou leve. A maior parte dos pacientes usava corticoide inalado associado a beta-2 agonista de longa duração, sendo que 50% destes usaram medicação de alívio pelo menos cinco vezes no último ano. Conclusão: Observou-se que a maioria dos pacientes utilizava a associação de corticoide inalado com beta-2 de longa duração, mesmo predominando quadros leves de asma. Diante disso, sugere-se a revisão da terapêutica.

Tuberculose pleural na criança / Pleural tuberculosis in children

Objetivo: relatar um caso de tuberculose pleural em uma criança.Descrição do caso: Apresenta-se o caso de um escolar de 12 anos,gênero feminino, com dor em hipocôndrio esquerdo e picos febrisnão aferidos com duração de 6 dias, alem de perda de peso, adinamiae hiporexia, negando tosse e dispneia. Na radiografia de tóraxapresentou derrame pleural à esquerda, sendo realizada toracocentesecom retirada de liquido amarelo-citrino e coletado materialpara biópsia. O teste tuberculínico foi reagente, a baciloscopia negativaem 3 amostras e a dosagem de adenosina deaminase (ADA)foi acima de 200 U/l. No anátomo patológico havia infiltradolinfocítico-granulomatoso com áreas de necrose de caseificação ecélulas gigantes tipo Langhans, compatível com o diagnostico detuberculose pleural.Conclusões: Tb pleural é um diagnóstico que deve ser consideradoem crianças não toxemiadas que apresentam derrames pleurais. Érara, sendo mais comum em adolescentes. O diagnóstico em crianças,devido a sua característica paucibacilar, deve ser realizado pormeio de critérios epidemiológicos e clínico-radiológicos, baseando--se em quatro pilares: a clínica do paciente, o contágio com algumgrupo de risco, a radiografia de tórax e o teste tuberculínico, estandopresente três destes critérios pode-se confirmar o diagnóstico.Nos últimos anos, a dosagem de ADA vem sendo uma alternativapara o diagnóstico de tuberculose pleural. Os autores discutem queos sinais e sintomas da tuberculose na infância são inespecíficos, oque dificulta a suspeição clínica e retarda o diagnóstico da doença.

Objective: To report a case of pleural tuberculosis in a child.Case description: We present the case of a school girl 12 years old,female gender, with pain in the left upper quadrant and fever spikesnot measured lasting 6 days, besides weight loss, lethargy andappetite loss, denying cough and dyspnea. Chest radiographs showedleft pleural effusion, thoracentesis was performed with removalof citrus-yellow liquid and samples for biopsy. The tuberculintest was positive, a negative smear in 3 samples and determinationof adenosine deaminase was above 200 U/ l. Pathology had granulomatous-lymphocytic infiltrate with areas of caseous necrosis andLanghans giant cells, reaching the diagnosis of pleural tuberculosis.Conclusions: Pleural TB is a diagnosis that should be consideredin children who have not toxemiadas pleural effusions. It is rareand is more common in adolescents. The diagnosis in children, dueto its characteristic paucibacillary, must be accomplished throughepidemiological and clinical criteria, radiological, based on fourpillars: clinical signs, with some contagion risk group, the chest radiographand tuberculin skin test being present three of these criteriacan confirm the diagnosis. In recent years, the dosage of ADAhas been an alternative for the diagnosis of pleural tuberculosis.The authors discuss the signs and symptoms of childhood tuberculosisare nonspecific, which makes the clinical suspicion and slowsdisease diagnosis.

Pneumonia lipídica em um lactente / Lipid pneumonia in an infant

Lactente de seis meses apresentava pneumonia refratária a diferentes antimicrobianos previamente utilizados. Houve melhora clínica, mas havia persistência de lesão pulmonar no radiograma de tórax. Obteve-se a informação do uso prévio de óleo mineral devido à constipação eventual. Realizou-se broncoscopia, lavado bronquíolo-alveolar e exame anatomopatológico definindo o diagnóstico como Pneumonia Lipídica. A pneumonia lipídica deverá sempre ser considerada no diagnóstico diferencial de pneumonia de evolução prolongada sem resposta ao tratamento com antimicrobianos para germes comuns e naquelescasos suspeitos de tuberculose. É importante que os pais sejam orientados sobre o uso de óleo mineral em lactentes e crianças previamente constipadas, devido ao risco de aspiração e posterior pneumonia.

A six-month old infant had pneumonia and a resistance to previously-used antimicrobials. There was clinical improvement, but a radiogram discovered a persistent pulmonary lesion in the chest. We discovered a previous use of mineral oil to combat a bout of suspected constipation. This revelation led us to performing a bronchoscopy, a bronchoalveolar lavage-alveolar procedure,and other pathological examinations, all of which led us to conclude that the condition was a form of lipid pneumonia. Thus, lipid pneumonia should always be considered in the differential diagnosis of prolonged evolving pneumonia when not responding to treatment with antimicrobials for common germs. It should also be considered in those cases of suspected tuberculosis. Because of the risk of aspiration and subsequent pneumonia, it is important that parents with infants and children be instructed on the use of mineral oil when addressingconstipation in their offspring.

Predictive score for clinical complications during intra-hospital transports of infants treated in a neonatal unit.

OBJECTIVE: To develop and validate a predictive score for clinical complications during intra-hospital transport of infants treated in neonatal units. METHODS: This was a cross-sectional study nested in a prospective cohort of infants transported within a public university hospital from January 2001 to December 2008. Transports during even (n=301) and odd (n = 394) years were compared to develop and validate a predictive score. The points attributed to each score variable were derived from multiple logistic regression analysis. The predictive performance and the score calibration were analyzed by a receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test, respectively. RESULTS: Infants with a mean gestational age of 35 ± 4 weeks and a birth weight of 2457 ± 841 g were studied. In the derivation cohort, clinical complications occurred in 74 (24.6%) transports. Logistic regression analysis identified five variables associated with these complications and assigned corresponding point values: gestation at birth [<28 weeks (6 pts); 28-34 weeks (3 pts); >34 weeks (2 pts)]; pre-transport temperature [<36.3°Cor >37°C(3pts); 36.3-37.0°C (2 pts)]; underlying pathological condition [CNS malformation (4 pts); other (2 pts)]; transport destination [surgery (5 pts); magnetic resonance or computed tomography imaging (3 pts); other (2 pts)]; and pre-transport respiratory support [mechanical ventilation (8 pts); supplemental oxygen (7 pts); no oxygen (2 pts)]. For the derivation and validation cohorts, the areas under the ROC curve were 0.770 and 0.712, respectively. Expected and observed frequencies of complications were similar between the two cohorts. CONCLUSION: The predictive score developed and validated in this study presented adequate discriminative power and calibration. This score can help identify infants at risk of clinical complications during intra-hospital transports.

Predictive score for clinical complications during intra-hospital transports of infants treated in a neonatal unit

OBJECTIVE: To develop and validate a predictive score for clinical complications during intra-hospital transport of infants treated in neonatal units. METHODS: This was a cross-sectional study nested in a prospective cohort of infants transported within a public university hospital from January 2001 to December 2008. Transports during even (n=301) and odd (n = 394) years were compared to develop and validate a predictive score. The points attributed to each score variable were derived from multiple logistic regression analysis. The predictive performance and the score calibration were analyzed by a receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test, respectively. RESULTS: Infants with a mean gestational age of 35 + 4 weeks and a birth weight of 2457 + 841 g were studied. In the derivation cohort, clinical complications occurred in 74 (24.6 percent) transports. Logistic regression analysis identified five variables associated with these complications and assigned corresponding point values: gestation at birth [<28 weeks (6 pts); 28-34 weeks (3 pts); >34 weeks (2 pts)]; pre-transport temperature [<36.3°Cor >37°C(3pts); 36.3-37.0°C (2 pts)]; underlying pathological condition [CNS malformation (4 pts); other (2 pts)]; transport destination [surgery (5 pts); magnetic resonance or computed tomography imaging (3 pts); other (2 pts)]; and pre-transport respiratory support [mechanical ventilation (8 pts); supplemental oxygen (7 pts); no oxygen (2 pts)]. For the derivation and validation cohorts, the areas under the ROC curve were 0.770 and 0.712, respectively. Expected and observed frequencies of complications were similar between the two cohorts. CONCLUSION: The predictive score developed and validated in this study presented adequate discriminative power and calibration. This score can help identify infants at risk of clinical complications during intra-hospital transports.