Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.328
Filtrar
2.
Medicine (Baltimore) ; 98(39): e17305, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574858

RESUMO

Until now, the recognition of sodium taurocholate cotransporting polypeptide (NTCP) deficiency has been mainly based on sporadic case reports. It was previously believed to be mildly symptomatic and resulting in mild liver dysfunction. However, to our knowledge, there have been no reports about the histopathologic and ultrastructural pathologic characteristics of the disease. The aim of the study was to analyze the clinical, histopathologic and ultrastructural pathologic characteristics of NTCP deficiency in 13 pediatric patients.From August 2012 to October 2018, this retrospective study conducted in the Department of Pediatrics of Tongji Hospital, China analyzed the data of 13 NTCP deficient patients with an SLC10A1 gene mutation. Except for NTCP deficiency, no other liver diseases were present in the patients, which was determined by both a genetic testing panel for jaundice and by reviewing medical records. The laboratory results, imaging, histopathologic, and ultrastructural pathologic information were recorded for analysis.The serum level of total bile acid was high in all 13 patients. All patients had adequate growth and development. Eight of the patients (8/13) presented with visible jaundice and 12 (12/13) were found to have hyperbilirubinemia. A needle liver biopsy was performed in 11 cases, which revealed slightly chronic inflammation in all 11 patients. One of the patients (1/13) was found to be suffering from gallstones.The data showed that although NTCP deficiency was often asymptomatic, some of the patients showed obvious clinical expressions, such as jaundice. Among the 13 pediatric patients with NTCP deficiency, both the biochemical and histopathologic features were similar to those of mild hepatocellular jaundice. In addition, it was determined that the clinical features in the patient with gallstones may have been caused by NTCP deficiency.


Assuntos
Ácidos e Sais Biliares/sangue , Icterícia , Hepatopatias , Fígado , Transportadores de Ânions Orgânicos Dependentes de Sódio , Simportadores , Desenvolvimento Infantil , Pré-Escolar , China/epidemiologia , Testes Genéticos/métodos , Humanos , Biópsia Guiada por Imagem/métodos , Lactente , Icterícia/diagnóstico , Icterícia/etiologia , Fígado/metabolismo , Fígado/patologia , Hepatopatias/diagnóstico , Hepatopatias/genética , Hepatopatias/fisiopatologia , Hepatopatias/terapia , Testes de Função Hepática/métodos , Glicoproteínas de Membrana/metabolismo , Mutação , Transportadores de Ânions Orgânicos Dependentes de Sódio/deficiência , Transportadores de Ânions Orgânicos Dependentes de Sódio/genética , Pediatria/métodos , Estudos Retrospectivos , Simportadores/deficiência , Simportadores/genética
3.
Top Magn Reson Imaging ; 28(4): 197-204, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385899

RESUMO

Functional MRI is a reliable, noninvasive technique which allows spatial mapping of the various functions like sensorimotor, language and vision in the brain. This is of immense help to the neurosurgeon in presurgical planning and intraoperative navigation in order to identify and preserve eloquent areas of the brain and minimize post-surgical neurological deficits. Using this technique in children pose unique challenges. This article discusses some of these challenges and how they can be overcome in successful application of this technique in pediatric patients.


Assuntos
Encéfalo/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/cirurgia , Criança , Pré-Escolar , Humanos , Pediatria/métodos , Cuidados Pré-Operatórios/métodos
4.
J Pediatr Orthop ; 39(8): e572-e577, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393291

RESUMO

BACKGROUND: Tibial spine fractures are rare, complex injuries. Management remains varied given a lack of consensus about the optimal approach. Thus, the purpose of this study is to determine prevailing strategies among pediatric orthopaedists and establish areas of agreement and ongoing controversy in the management of tibial spine fractures. METHODS: An electronic survey was distributed to the Pediatric Orthopaedic Society of North America (POSNA) membership. Surgeon demographics, experience, and responses to clinical vignettes were collected. Surgeons were grouped according to how frequently they treat tibial spine fractures and responses were compared. RESULTS: Of the 180 POSNA members who completed the survey, all were attending surgeons and nearly all (90.4%) had academic affiliations, treated mostly skeletally immature patients (88.5%), and 3 or fewer fractures per year (62.4%). In younger patients, respondents were more likely to treat type II fractures closed and less likely to cross the physis. Arthrofibrosis was the most commonly reported complication and postoperative duration of immobilization was identified as a risk factor by most. However, high-frequency surgeons identified this risk factor more often (P=0.015) and recommended immobilization for <2 weeks more frequently (P=0.018). There was, however, considerable discrepancy regarding the duration of immobilization. Although there were areas of agreement on general principles, there continues to be disagreement regarding specific treatment strategies. CONCLUSIONS: Surgeons within POSNA agree on general principles of treatment for tibial spine fractures. Members, regardless of high-volume or low-volume caseload, are all less likely to pursue surgical options when treating younger patients and treating arthrofibrosis during the first 2 postoperative months. The most commonly reported adverse outcome after treatment was arthrofibrosis, for which high-frequency surgeons identified length of immobilization as a significant risk factor more often and thus, recommended shorter periods of immobilization. Although surgeons may agree on general principles in some cases, there continues to be disagreement regarding specific strategies suggesting that a prospective multicenter study of this topic is warranted. LEVEL OF EVIDENCE: Level V.


Assuntos
Fraturas Intra-Articulares/cirurgia , Articulação do Joelho/patologia , Ortopedia/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Fraturas da Tíbia/cirurgia , Adolescente , Criança , Fibrose , Humanos , Fraturas Intra-Articulares/complicações , Ortopedia/métodos , Pediatria/métodos , Estudos Prospectivos , Inquéritos e Questionários , Fraturas da Tíbia/complicações
5.
J Pediatr Orthop ; 39(8): e592-e596, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393295

RESUMO

BACKGROUND: Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures. METHODS: A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making. RESULTS: Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (ß=-0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making. CONCLUSIONS: There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes. LEVEL OF EVIDENCE: Level V.


Assuntos
Fraturas do Úmero/terapia , Luxações Articulares/terapia , Ortopedia/métodos , Pediatria/métodos , Adulto , Pré-Escolar , Tomada de Decisão Clínica , Articulação do Cotovelo/lesões , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/diagnóstico por imagem , Imobilização , Luxações Articulares/etiologia , Masculino , Pessoa de Meia-Idade , Redução Aberta , Padrões de Prática Médica , Radiografia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(31): e16562, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374022

RESUMO

BACKGROUND: Distal radius fractures (DRFs) is one of the most common bone injuries in children, which may lead to deformity and other complications if the treatment is not prompt or appropriate. Splints external fixation is a common conservative treatment for such fractures. Therefore, we conducted a systematic review and meta-analysis to explore the efficacy, safety and cost benefits of splints in the treatment of DRFs in children. METHODS: PubMed, Web of Science, Embase, Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov, Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Database, and VIP Database were searched for eligible randomized controlled trials (RCTs). The methodological quality of the included studies and the level of evidence for results were assessed, respectively, using the risk bias assessment tool of Cochrane and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Statistical analysis was conducted with Revman 5.3. RESULTS: This study will analyze and integrate the existing evidence for effectiveness, safety and cost benefits of splints on DRFs in children. CONCLUSION: The conclusion of this study will provide evidence to effectiveness, safety and cost benefits of splints on DRFs in children, which can further guide the selection of appropriate interventions. PROSPERO REGISTRATION NUMBER: CRD42019123429.


Assuntos
Fraturas do Rádio/terapia , Contenções/efeitos adversos , Contenções/normas , Adolescente , Criança , Pré-Escolar , Humanos , Segurança do Paciente/normas , Pediatria/instrumentação , Pediatria/métodos , Fraturas do Rádio/economia , Contenções/economia
7.
Isr Med Assoc J ; 21(6): 369-375, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31280503

RESUMO

BACKGROUND: In Israel, coronary heart disease mortality rates are significantly higher among the Arab population than the Jewish population. Dyslipidemia prevention should begin in childhood. OBJECTIVES: To identify sociodemographic disparities in the preventive health measurement of lipid profile testing and lipoprotein levels among Israeli children and adolescents. METHODS: A cross-sectional analysis of 1.2 million children and adolescents insured by Clalit Health Services between 2007 and 2011 was conducted using sociodemographic data and serum lipid concentrations. RESULTS: Overall, 10.1% individuals had undergone lipid testing. Those with male sex (odds ratio [OR] = 0.813, 95% confidence interval [95%CI] 0.809-0.816), Arab ethnicity (OR = 0.952, 95%CI 0.941-0.963), and low socioeconomic status (SES) (OR = 0.740, 95%CI 0.728-0.752) were less likely to be tested. By 2010, differences among economic sectors narrowed and Arab children were more likely to be tested (OR = 1.039, 95%CI 1.035-1.044). Girls had higher total cholesterol, triglyceride, low-density lipoprotein-cholesterol, and non-high-density lipoprotein-cholesterol levels compared to boys (P < 0.001). Jewish children had higher cholesterol and low-density and high-density lipoprotein-cholesterol, as well as lower triglyceride levels than Arabs (P < 0.001). Children with low SES had lower cholesterol, low-density and high-density lipoprotein-cholesterol, and non-high-density lipoprotein-cholesterol levels (P < 0.001). CONCLUSIONS: We found that boys, Arab children, and those with low SES were less likely to be tested. Over time there was a gradual reduction in these disparities. Publicly sponsored healthcare services can diminish disparities in the provision of preventive health among diverse socioeconomic groups that comprise the national population.


Assuntos
Árabes/estatística & dados numéricos , Dislipidemias/diagnóstico , Disparidades em Assistência à Saúde , Judeus/estatística & dados numéricos , Programas Nacionais de Saúde , Classe Social , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Dislipidemias/sangue , Feminino , Humanos , Israel , Lipídeos/sangue , Masculino , Pediatria/métodos , Fatores Sexuais
8.
Int J Mol Sci ; 20(13)2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31261877

RESUMO

In the pharmaceutical technology, paediatric population still presents the greatest challenge in terms of developing flexible and appropriate drug dosage forms. As for many medicines, there is a lack of paediatric dosage forms adequate for a child's age; it is a prevailing practice to use off label formulations. Children need balanced and personalized treatment, patient-friendly preparations, as well as therapy that facilitates dosing and thus eliminates frequent drug administration, which can be ensured by modified release (MR) forms. MR formulations are commonly used in adult therapy, while rarely available for children. The aim of this article is to elucidate how to modify drug release in paediatric oral dosage forms, discuss the already accessible technologies and to introduce novel approaches of manufacturing with regard to paediatric population.


Assuntos
Composição de Medicamentos/métodos , Liberação Controlada de Fármacos , Pediatria/métodos , Criança , Excipientes/efeitos adversos , Excipientes/química , Excipientes/farmacocinética , Humanos , Impressão Tridimensional
9.
J Grad Med Educ ; 11(3): 301-306, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31210861

RESUMO

Background: A formal handoff process, such as the I-PASS handoff program, can improve communication about patients among residents. Faculty observation of resident handoffs has served as the primary method for documenting adherence to I-PASS, and little is known about residents' use when they are not being observed. Objective: We determined how frequently pediatric residents use I-PASS when not being observed. Methods: We implemented I-PASS in the 2016-2017 academic year and anonymously surveyed residents (December 2016 and June 2017), asking them how they perceive the effectiveness of I-PASS at enhancing patient safety, their frequency of I-PASS use when not observed, co-residents' frequency of use, and open-ended questions regarding factors affecting use. Results: Fifty-one (52%) and 50 (51%) of 99 eligible residents completed the December and June surveys, respectively. All respondents thought I-PASS had some effectiveness in enhancing patient safety. In December, only 6 (12%) residents stated they used I-PASS more than 75% of the time and reported providing a synthesis statement during handoffs more than 75% of the time. The results were similar for both surveys. Commonly cited reasons for not using I-PASS included time (n = 30), prior knowledge of patients (n = 20), and patients with limited complexity (n = 9). Conclusions: While most residents thought I-PASS was effective at enhancing patient safety, many reported that they do not use all 5 elements in most of their handoffs when not being observed. Barriers reported included time, familiarity with patients, and limited patient complexity.


Assuntos
Transferência da Responsabilidade pelo Paciente/normas , Segurança do Paciente , Continuidade da Assistência ao Paciente/organização & administração , Hospitais Pediátricos , Humanos , Internato e Residência/métodos , Maryland , Pediatria/educação , Pediatria/métodos , Inquéritos e Questionários
10.
J Laparoendosc Adv Surg Tech A ; 29(8): 1046-1051, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31241404

RESUMO

Background: Despite the lack of randomized or controlled trials for minimally invasive surgery (MIS) in pediatric surgical oncology, the integration of MIS into the surgical practice of pediatric oncology has become increasingly popular. The aim of this study was to evaluate the implementation of MIS in a pediatric tertiary cancer center and compare present use of MIS to that in a previous analysis at our center. Methods: We retrospectively reviewed the medical records of patients with pediatric cancer treated with MIS at a single institution between 2000 and 2014. Results: A total of 252 MIS procedures were performed: 73 laparoscopic (29%) and 179 thoracoscopic (71%). MIS was used for diagnostic purposes in 59% (146 thoracoscopic and 34 laparoscopic) and the therapeutic resection in 24% (39 laparoscopic cases and 33 thoracoscopic cases). Conversion to an open procedure occurred in 18 tumor resections (6%) and in 22 diagnostic biopsies (7%), mostly due to technical challenges in identifying or mobilizing tumors. Complications occurred in seven tumor resections (2%) and included three pneumothoraces, two bleeding complications, one bowel injury, and one wound infection. Complications occurred in 10 diagnostic biopsies (3%), mostly pneumothoraces. No tumor upstaging or trocar site recurrences occurred (follow-up time, 1-15 years). Conclusions: Over the last decade, we demonstrate the evolution of MIS in the management of solid tumors in children. We encourage surgeons and oncologists to join the call to arms to establish prospective trials evaluating MIS in pediatric surgical oncology.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neoplasias/cirurgia , Pediatria/métodos , Oncologia Cirúrgica/métodos , Biópsia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Laparoscopia , Masculino , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Toracoscopia
11.
AAPS PharmSciTech ; 20(5): 208, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31161450

RESUMO

Individualized medicines for pediatrics are a useful alternative if there is no correct dosage marketed for this segment (easy to swallow, adequate volume and content, correct composition for pediatrics, good organoleptic properties, etc.). Its validation process must ensure quality testing: its content uniformity, physical (homogeneity after shaking), chemical, and microbiological stability. Some of these attributes are checked by the recommendations of European Pharmacopoeia (Ph. Eur.), International Conference of Harmonization (ICH), and National Formularies but others are not. The aim of this study is to develop a general high-demanding strategy to ensure the final quality of liquid dosage forms testing and developing standard operating processes (SOPs) for the elaboration of individualized oral liquid medicines for pediatric use. Furosemide was used as an example of the validation of an individualized liquid solution for pediatric use. Three SOPs were selected according to their composition and the recommendations of liquid dosage forms for pediatric use. Quality attributes according to National Formularies, Ph. Eur., and ICH were tested: pH, organoleptic properties, uniformity of mass of delivered dose from multidose containers, and chemical stability. In this study, a general high-demanding strategy was elaborated to validate oral liquid dosage forms, including validation of the analytical method used to test their quality. A second part focuses on the elaboration of liquid formulations for pediatrics with the highest standards of quality taking into account CQAs that were not contemplated by official compendial such as content uniformity and physical stability.


Assuntos
Excipientes/normas , Furosemida/normas , Pediatria/normas , Medicina de Precisão/normas , Administração Oral , Criança , Diuréticos/administração & dosagem , Diuréticos/normas , Composição de Medicamentos/métodos , Composição de Medicamentos/normas , Excipientes/administração & dosagem , Furosemida/administração & dosagem , Humanos , Pediatria/métodos , Soluções Farmacêuticas/administração & dosagem , Soluções Farmacêuticas/normas , Medicina de Precisão/métodos
12.
BMC Infect Dis ; 19(1): 495, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164085

RESUMO

BACKGROUND: There is currently no research on the diagnostic value of metagenomic next-generation sequencing (mNGS) for a single pathogens in CSF. The aim of this study was to analyse the value of mNGS for identifying Streptococcus pneumoniae (S. pneumoniae) in paediatric bacterial meningitis. METHODS: Bacterial meningitis (BM) cases from October 23, 2014, to December 31, 2016, and December 1, 2017, to July 31, 2018 at Beijing Children's Hospital were reviewed. Clinical features and pathogens were analysed. RESULTS: We diagnosed 135 patients with BM in this study. A total of 43 S. pneumoniae were identified by combination methods. 26/135 (19.3%) patients had positive results in S. pneumoniae by blood and/or cerebrospinal fluid (CSF) culture. Alere BinaxNow®Streptococcus pneumoniae Antigen test was positive in 35/135(25.9%) cases. 32/135 (23.7%) S. pneumoniae were identified by mNGS. Six CSF samples were identified as S. pneumoniae only by mNGS technology. Taking culture as the gold standard, the sensitivity and specificity of mNGS for diagnosing S. pneumoniae meningitis were 73.1 and 88.1%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of diagnosing S. pneumoniae meningitis by mNGS were 59.4 and 93.2%, respectively. When comparison between mNGS and combined tests (culture and Alere BinaxNow®Streptococcus pneumoniae Antigen test), the sensitivity and specificity of mNGS for S. pneumoniae identification were 70.3 and 93.9%, the PPV and NPV in the identification of S. pneumoniae by mNGS were 81.4 and 89.3%, respectively. The difference in number of unique reads of S. pneumoniaein from CSF sample (< 14 days onset) and CSF sample (> 14 days from onset) was statistically significant (170.5 VS. 13, P = 0.019). The difference in the collected time of CSF for culture and mNGS was statistically significant (4 days VS. 14 days, P < 0.001). CONCLUSIONS: mNGS has high sensitivity and specificity for S. pneumoniae identification. The pathogen load (number of unique reads) of S. pneumonia is related to the CSF collection time. mNGS was less affected than culture by the use of antibiotics before CSF collection.


Assuntos
Sequenciamento de Nucleotídeos em Larga Escala , Meningites Bacterianas/diagnóstico , Metagenômica/métodos , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Fatores Etários , Antígenos de Bactérias/análise , Antígenos de Bactérias/sangue , Antígenos de Bactérias/líquido cefalorraquidiano , Antígenos de Bactérias/genética , Criança , Pré-Escolar , Testes Diagnósticos de Rotina , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Meningites Bacterianas/sangue , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/microbiologia , Pediatria/métodos , Reação em Cadeia da Polimerase/métodos , Valor Preditivo dos Testes , Sensibilidade e Especificidade
13.
Cien Saude Colet ; 24(5): 1743-1752, 2019 May 30.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31166509

RESUMO

Based on interviews with physiotherapists, we explored the arguments produced by them about their actions and the relationships of a change that has been taking place in the profile of illness in children, where an increased prevalence of complex chronic conditions has been observed. Structured in a qualitative approach, data were generated based on two provocative affirmations that generated arguments by the professionals. Data analysis revealed statements that can be referred to as results of power struggles over the performance in this new field of knowledge. Physiotherapists seek to affirm themselves through their knowledge and by approaching other professional categories, especially Medicine, in order to feel recognized and valued. However, we see that these professionals use a simpler discourse with family and caregivers, creating a bond of trust and identification with them, which facilitates their care and access to children. We point out the need for the hospital environment to be recognized as a place for the action of other categories, besides Medicine and Nursing, and the valuation in pediatric physiotherapy.


Assuntos
Doença Crônica/terapia , Conhecimentos, Atitudes e Prática em Saúde , Fisioterapeutas/organização & administração , Modalidades de Fisioterapia , Criança , Dissidências e Disputas , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pediatria/métodos
15.
Medicina (Kaunas) ; 55(5)2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31117308

RESUMO

Background and objectives: To identify the relationship between neck circumference (NC) and cardiometabolic risk factors in children. Materials and Methods: Children and adolescents 6-18 years old (n = 548) from five counties of San Luis Potosí, México were included. Data was collected for biological markers (glucose and lipid profile) and anthropometric and clinical measurements-weight, height, NC, waist circumference (WC), and blood pressure (BP). Body mass index (BMI) was calculated using Quetelet formula (kg/m2). Descriptive analysis, correlation tests, and receiver operating characteristic (ROC) analysis were performed. Results: NC was highly correlated with BMI and WC in both genders (p <0.0001). The most frequent risk factor was high BMI (38.7%). Sensitivity and specificity analysis of NC and high BMI showed an area under the ROC curve of 0.887. Conclusions: According to our findings, NC is a simple, low-cost, and non-invasive measurement, which has a high association with high BMI and increased WC.


Assuntos
Antropometria/métodos , Doenças Metabólicas/classificação , Pescoço , Pesos e Medidas/normas , Adolescente , Antropometria/instrumentação , Índice de Massa Corporal , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Doenças Metabólicas/fisiopatologia , México , Pediatria/instrumentação , Pediatria/métodos , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Risco , Pesos e Medidas/instrumentação
18.
Anesthesiol Clin ; 37(2): 289-300, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047130

RESUMO

Ambulatory surgery in the pediatric population can be similar to adult ambulatory with a few different challenges. Success is best determined by appropriate preoperative screening. Issues common in pediatrics are the respiratory infection, asthma, congenital heart disease and syndromes, as well as sleep apnea. Risk factors for adverse respiratory events and patient transfer differ from adults as do data for rapid discharge.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia/métodos , Pediatria/métodos , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Cuidados Pré-Operatórios , Fatores de Risco
19.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31138666

RESUMO

The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of appropriately trained staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.


Assuntos
Academias e Institutos/normas , Hipnóticos e Sedativos/administração & dosagem , Monitorização Intraoperatória/normas , Pediatria/normas , Guias de Prática Clínica como Assunto/normas , Humanos , Hipnóticos e Sedativos/efeitos adversos , Monitorização Intraoperatória/métodos , Pediatria/métodos
20.
Indian Pediatr ; 56(4): 317-321, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-31064903

RESUMO

Childhood hypertension has become a significant health concern. There have been a slew of important new findings in this field over the last decade. This has led to an update by the American Academy of Pediatrics of the original recommendation of United States Fourth Working Group on blood pressure. We herein describe the important changes in the guideline, which include an updated normative data, change in blood pressure classification, strong endorsement of ambulatory blood pressure measurement and the reduction in the blood pressure target for both chronic kidney disease and non-chronic kidney disease hypertensive children.


Assuntos
Determinação da Pressão Arterial , Hipertensão , Adolescente , Criança , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Hipertensão/terapia , Pediatria/métodos , Pediatria/organização & administração , Guias de Prática Clínica como Assunto , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA