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BACKGROUND: Erythropoietic protoporphyria (EPP) is a rare inherited disease of heme biosynthesis resulting in the accumulation of protoporphyrin, characterized by liver failure in a minority of cases. Although liver transplant (LT) is the therapeutic strategy for advanced hepatic disease, it does not correct the primary defect, which leads to recurrence in liver graft. Thus, hematopoietic stem cell transplantation (HSCT) is an approach for treating EPP. METHODS: We aim to describe the first sequential LT and HSCT for EPP performed in Latin America, besides reviewing the present-day literature. RESULTS: The patient, a 13-year-old female with a history of photosensitivity, presented with symptoms of cholestatic and hepatopulmonary syndrome and was diagnosed with EPP. Liver biopsy demonstrated cirrhosis. She was submitted to a successful LT and showed improvement of respiratory symptoms. However, she had disease recurrence on the liver graft. She underwent a myeloablative HSCT using a matched unrelated donor, conditioning with BuCy (busulfan and cyclophosphamide), and GvHD (graft vs. host disease) prophylaxis with ATG (thymoglobulin), tacrolimus and methotrexate. Neutrophil engraftment occurred on D+18. She has presented mixed chimerism, but normalization of PP levels, being 300 days after HSCT, in good state of health and normal liver function. CONCLUSIONS: Consecutive LT and HSCT for EPP is a procedure that has been described in 10 cases in the literature and, even though these patients are a highly diversified population, studies have shown favorable results. This concept of treatment should be considered in patients with established liver disease.
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Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Hepatopatias , Transplante de Fígado , Protoporfiria Eritropoética , Feminino , Humanos , Adolescente , Transplante de Medula Óssea , Protoporfiria Eritropoética/terapia , Protoporfiria Eritropoética/patologia , Transplante de Células-Tronco Hematopoéticas/métodos , Transplante de Fígado/métodos , Condicionamento Pré-TransplanteRESUMO
Patients with acute myeloid leukaemia (AML) have a five-year survival rate of 28·7%. Natural killer (NK)-cell have anti-leukaemic activity. Here, we report on a series of 13 patients with high-risk R/R AML, treated with repeated infusions of double-bright (CD56bright /CD16bright ) expanded NK cells at an academic centre in Brazil. NK cells from HLA-haploidentical donors were expanded using K562 feeder cells, modified to express membrane-bound interleukin-21. Patients received FLAG, after which cryopreserved NK cells were thawed and infused thrice weekly for six infusions in three dose cohorts (106 -107 cells/kg/infusion). Primary objectives were safety and feasibility. Secondary endpoints included overall response (OR) and complete response (CR) rates at 28-30 days after the first infusion. Patients received a median of five prior lines of therapy, seven with intermediate or adverse cytogenetics, three with concurrent central nervous system (CNS) leukaemia, and one with concurrent CNS mycetoma. No dose-limiting toxicities, infusion-related fever, or cytokine release syndrome were observed. An OR of 78·6% and CR of 50·0% were observed, including responses in three patients with CNS disease and clearance of a CNS mycetoma. Multiple infusions of expanded, cryopreserved NK cells were safely administered after intensive chemotherapy in high-risk patients with R/R AML and demonstrated encouraging outcomes.
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Antígeno CD56/análise , Imunoterapia Adotiva/métodos , Células Matadoras Naturais/transplante , Leucemia Mieloide Aguda/terapia , Receptores de IgG/análise , Adolescente , Adulto , Brasil/epidemiologia , Antígeno CD56/imunologia , Criança , Feminino , Proteínas Ligadas por GPI/análise , Proteínas Ligadas por GPI/imunologia , Doença Enxerto-Hospedeiro/etiologia , Humanos , Imunoterapia Adotiva/efeitos adversos , Células Matadoras Naturais/imunologia , Leucemia Mieloide Aguda/epidemiologia , Leucemia Mieloide Aguda/imunologia , Masculino , Pessoa de Meia-Idade , Estudo de Prova de Conceito , Receptores de IgG/imunologia , Adulto JovemRESUMO
Acute lymphoblastic leukemia is the most common childhood malignancy. One of the drugs used in the treatment is Asparaginase, and monitoring of its activity levels enables better outcomes. Since 2018, our laboratory has been working to establish a regular analysis of activity. This implementation allowed to qualify care by detecting silent inactivation and also establishing desensitization as a safe way to overcome the lack of Erwinia. We were able to monitor children aged 0 to 18 years who were being treated with PEG-ASNase. The activity was assessed on days 7 (90 samples) and 14 (52 samples) after ASNase infusions. 142 samples were analyzed. 95.7% reached an adequate activity level (≥ 0.1 IU/mL). Patients treated with ASNase can develop allergic reactions. With the activity monitoring, is possible to circumvent situations like these and implement desensitization protocols for patients who had clinical hypersensitivity without inactivation. Desensitization induces temporary unresponsiveness to drug antigens, allowing the patients to proceed with the prescribed chemotherapy. We have received samples from four patients being treated with different desensitization protocols. Patients tolerated the protocols well. Only one had a grade 2 reaction during the infusion and activity < 0.1 IU/mL, which resulted in the switch to Erwinia. The dose adaptation is a possible and more recent use of ASNase monitoring and we were able to confirm the feasibility of PEG-ASNase desensitization protocols.
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OBJECTIVE: This study aims to describe the epidemiological characteristics and survival rates of children with acute myeloid leukemia treated in hospitals in southern Brazil and compare them with international data. METHODS: A multicenter cohort study was conducted with retrospective data collection of all new patients with acute myeloid leukemia under 18 treated at five referral centers in pediatric hematology-oncology in southern Brazil between January 2005 and December 2015. RESULTS: Of the 149 patients with acute myeloid leukemia, 63.0% (n=94) were male. The median age at diagnosis was 10.5 years (range 0-18 years) and 40.3% (n=60) had a white blood cell count below 50,000/mm2. The most common Franco-American-British (FAB) subtype was M3 (n=43, 28.9%). Nine (6.0%) patients had central nervous system disease. In M3 patients, overall survival (OS) was 69.2% and 3-year event-free survival was 67.7%; in non-M3 patients, these rates were 45.3% and 36.7%, respectively. In non-M3 patients, OS was significantly different between transplanted (61.8%) and non-transplanted (38.2%) patients (p=0.031). CONCLUSIONS: These results show a higher prevalence of the Franco-American-British M3 subtype than that reported in the international literature, as well as a decreased OS compared with that of developed countries. Further multicenter Brazilian studies with a larger sample size are encouraged to better understand the characteristics of acute myeloid leukemia, and to improve the treatment and prognosis in this population.
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Leucemia Mieloide Aguda , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Humanos , Lactente , Recém-Nascido , Leucemia Mieloide Aguda/epidemiologia , Masculino , Prognóstico , Estudos RetrospectivosRESUMO
Abstract Objective: This study aims to describe the epidemiological characteristics and survival rates of children with acute myeloid leukemia treated in hospitals in southern Brazil and compare them with international data. Methods: A multicenter cohort study was conducted with retrospective data collection of all new patients with acute myeloid leukemia under 18 treated at five referral centers in pediatric hematology-oncology in southern Brazil between January 2005 and December 2015. Results: Of the 149 patients with acute myeloid leukemia, 63.0% (n = 94) were male. The median age at diagnosis was 10.5 years (range 0-18 years) and 40.3% (n = 60) had a white blood cell count below 50,000/mm2. The most common Franco-American-British (FAB) subtype was M3 (n = 43, 28.9%). Nine (6.0%) patients had central nervous system disease. In M3 patients, overall survival (OS) was 69.2% and 3-year event-free survival was 67.7%; in non-M3 patients, these rates were 45.3% and 36.7%, respectively. In non-M3 patients, OS was significantly different between transplanted (61.8%) and non-transplanted (38.2%) patients (p = 0.031). Conclusions: These results show a higher prevalence of the Franco-American-British M3 subtype than that reported in the international literature, as well as a decreased OS compared with that of developed countries. Further multicenter Brazilian studies with a larger sample size are encouraged to better understand the characteristics of acute myeloid leukemia, and to improve the treatment and prognosis in this population.
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Humanos , Masculino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Leucemia Mieloide Aguda/epidemiologia , Prognóstico , Brasil/epidemiologia , Estudos Retrospectivos , Estudos de CoortesRESUMO
Objetivo: O objetivo deste estudo foi estimar os custos do tratamento do transplante de células--tronco hematopoéticas (TCTH) em um centro de referência no Brasil. Métodos: A população do estudo foi composta por pacientes provenientes da lista de TCTH do Sistema Único de Saúde submetidos ao TCTH em um hospital do sul do Brasil, entre 2016 e 2019. A avaliação de custos foi realizada por meio de um estudo de microcusteio, baseado no Time-Driven Activity-based Costing (TDABC) adaptado para estudos econômicos em saúde e incluiu as seguintes etapas: definição da questão de pesquisa, coleta de dados estruturada e análise estatística dos resultados. Resultados: O custo total do TCTH foi de $ 155.110 ($ 92.794 $ 249.146 USD). O TCTH de doador não aparentado compatível foi mais caro do que o TCTH de doador aparentado compatível. Os principais fatores de custo envolvem complicações pós-transplante, principalmente a ocorrência de infecções. Em relação à composição dos custos, exames e procedimentos representam o maior custo em TCTH (45%). Conclusão: Essas estimativas podem ser aplicáveis a novas avaliações de custo-efetividade do TCTH e ajudar os gestores na tomada de decisão em saúde, especialmente em países de média renda
Objective: The objective of this study was to estimate treatment costs of Hematopoietic stem cell transplantation (HSCT) at a reference center in Brazil. Methods: The study population consisted of patients from the Unified Health System HSCT who underwent HSCT in southern Brazil between 2016 and 2019. Costs were measured using a micro-costing approach, based on Time-Driven Activity-based Costing (TDABC) adapted for economic studies in health and included the following steps: definition of the research question, structured data collection, and statistical analysis of results. Results: The total cost of HSCT was $155,110 ($92,794 $249,146 USD). Matched unrelated donor HSCT was more expensive than matched related donor HSCT. The major cost factors involve post- -transplant complications, mainly the occurrence of infections. Concerning cost composition, exams and procedures represent the largest expense in HSCT (45%). Conclusion: These estimates could be applicable to further evaluations for HSCT cost-effectiveness and help healthcare decision-makers in middle-income countries
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Transplante de Células-Tronco Hematopoéticas , Custos e Análise de CustoRESUMO
INTRODUCTION: Fasting in the night before elective surgery has been established to prevent pulmonary complications, vomiting, regurgitation and aspiration of gastric contents. The year of 2005 was developed the project ACERTO. It consists in a multidisciplinary team that aims to recover the surgical patient by administering two our six hours before surgery, a carbohydrate-rich beverage (12.5% dextrinomaltose). The multidisciplinary team consists of anesthesiologists, surgeons, nutritionists, nurses and physiotherapists. METHODS: Literature review of preoperative fasting conducted during September and October of 2011 in Scielo and PubMed. CONCLUSION: Reducing the time of preoperative fasting with high carbohydrate solution until two hours before the operation as early feeding postoperatively, bring numerous benefits to the patient. The ACERTO project has shown good results and these new behaviors should be encouraged, thereby reducing the recovery time of the surgical patient.
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Jejum , Métodos de Alimentação , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Jejum/efeitos adversos , Métodos de Alimentação/efeitos adversos , Humanos , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pré-Operatórios/efeitos adversos , Fatores de TempoRESUMO
Objective : Constipation is a frequent motility disorder and while a common complaint among the overall population, is particularly prevalent among the elderly. The increase of this population group is creating a growing demand for long term care institutions. The present study aims to investigate the prevalence of and factors associated with constipation in elderly residents of long stay care institutions. Method : The study involved 87 individuals. The data collected from each participant included gender, daily intake of water and fiber, physical activity, family history of constipation and nutritional status. The diagnosis of constipation was based on Roma III criteria. Statistical analysis was performed with the SPSS software program (version 18.0) with a level of significance of 5% (p≤0.05). The Student t, Mann-Whitney, Pearson's chi-square or Fischer's exact tests were employed. Results : The sample was predominantly female (80.5%), with a mean age of 79.4(±9.6) years. A 42.52% prevalence of constipation was observed. Among affected individuals, the condition was more frequent among women (89.2%), those aged over 80 years (67.6%), those who did not engage in physical activity (56.8%), those with below the recommended intake of water and fiber, those who had a family history of constipation, and those who were diagnosed with eutrophia (56.3%). Among the factors analyzed, only age (p=0.049) and low fiber intake (p=0.019) were significantly linked to constipation. Conclusion : The results show that constipation is a multifactorial disease that is significantly related to age and low fiber intake.
Objetivo : Investigar a prevalência e fatores associados à constipação intestinal em idosos institucionalizados. Método : Trata-se de um estudo do tipo transversal. A amostra foi composta por 87 idosos e os dados coletados foram referentes à idade, sexo, ingestão diária de água e fibras, prática de atividade física, histórico familiar de constipação, além de dados referentes ao estado nutricional. O diagnóstico de constipação foi baseado nos critérios de Roma III. Para realização das análises estatísticas foi utilizado o softwareSPSS, versão 18.0, considerando o nível de significância de 5% (p≤0,05) e os testes estatísticos feitos foram:t Student, Mann-Whitney, Qui-quadrado de Pearson ou Exato de Fischer. Resultados : A amostra foi predominantemente do sexo feminino (80,5%), apresentando idade média de 79,4 (±9,6) anos. Observou-se que a prevalência de constipação intestinal foi de 42,52%, sendo mais frequente nas mulheres (89,2%), naqueles com idade igual ou superior a 80 anos (67,6%), nos que não praticavam atividade física (56,8%), nos que possuíam uma ingestão hídrica e consumo de fibras abaixo do recomendado, nos que possuíam histórico familiar de constipação, e também se mostrou mais prevalente naqueles que apresentaram diagnóstico nutricional de eutrofia (56,3%). Quando relacionadas à constipação, verificou-se que apenas a idade (p=0,049) e o baixo consumo de fibras (p=0,019) se associaram significativamente. Conclusão : Os resultados obtidos evidenciaram que a constipação intestinal é uma queixa digestiva de etiologia multifatorial, com a qual a idade avançada e o baixo consumo de fibras se associaram significativamente.
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INTRODUÇÃO: O jejum noturno praticado antes de operações eletivas foi instituído para prevenir complicações pulmonares, vômitos, regurgitação e aspiração do conteúdo gástrico. No ano de 2005 foi desenvolvido o projeto de Aceleração da Recuperação Total Pós-operatória, denominado ACERTO. O projeto é composto por uma equipe multidisciplinar que visa à recuperação do paciente cirúrgico administrando de duas a seis horas antes da operação uma bebida rica em carboidratos (12,5% de dextrinomaltose). A equipe multidisciplinar é composta por anestesistas, cirurgiões, nutricionistas, enfermeiros e fisioterapeutas. OBJETIVO: Frente aos novos métodos de controle no pré-operatório verificar a qual a necessidade de jejum antes de procedimentos cirúrgicos. MÉTODOS: Revisão sobre jejum pré-operatório realizada nos meses de setembro e outubro de 2011, nos sites de busca Scielo e PubMed. Foram selecionados 24 artigos. CONCLUSÃO: Reduzir o tempo de jejum pré-operatório com solução rica em carboidratos até duas horas antes da operação, tal como alimentação precoce no pós-operatório, trazem inúmeros benefícios ao paciente. O projeto ACERTO tem demonstrado bons resultados e estas novas condutas devem ser encorajadas, diminuindo assim o tempo de recuperação do paciente cirúrgico.
INTRODUCTION: Fasting in the night before elective surgery has been established to prevent pulmonary complications, vomiting, regurgitation and aspiration of gastric contents. The year of 2005 was developed the project ACERTO. It consists in a multidisciplinary team that aims to recover the surgical patient by administering two our six hours before surgery, a carbohydrate-rich beverage (12.5% dextrinomaltose). The multidisciplinary team consists of anesthesiologists, surgeons, nutritionists, nurses and physiotherapists. METHODS: Literature review of preoperative fasting conducted during September and October of 2011 in Scielo and PubMed. CONCLUSION: Reducing the time of preoperative fasting with high carbohydrate solution until two hours before the operation as early feeding postoperatively, bring numerous benefits to the patient. The ACERTO project has shown good results and these new behaviors should be encouraged, thereby reducing the recovery time of the surgical patient.
Assuntos
Humanos , Jejum , Métodos de Alimentação , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Jejum/efeitos adversos , Métodos de Alimentação/efeitos adversos , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pré-Operatórios/efeitos adversos , Fatores de TempoRESUMO
OBJETIVO: Analisar fatores associados à Hipertensão Arterial Sistêmica (HAS) e sua relação com o estado nutricional de indivíduos hipertensos cadastrados no programa Hiperdia em um município do Rio Grande do Sul. MÉTODOS: Foram avaliados indivíduos hipertensos cadastrados no Hiperdia. Os dados referentes aos fatores associados à hipertensão foram coletados por meio de um questionário semiestruturado composto pelas seguintes variáveis: idade, escolaridade, exercício físico, tabagismo, medicamentos consumidos, herança genética, doenças crônicas, peso, altura e circunferência da cintura. RESULTADOS: Entre os 402 hipertensos estudados, 138 (34,3%) eram adultos e 264 (65,7%) eram idosos, sendo que a maioria era do gênero feminino. A prevalência de excesso de peso foi de 76,8% em adultos enquanto 35% dos idosos apresentaram peso normal. Quando comparadas as faixas etárias, 11% dos idosos estavam significativamente associados ao analfabetismo. Os adultos e idosos apresentaram média de circunferência da cintura e classificação do IMC acima dos níveis desejados. CONCLUSÃO: Neste estudo, a HAS foi associada a níveis pressóricos aumentados com o avanço da idade, excesso de peso, circunferência da cintura elevada, baixa escolaridade, fumo e consumo de bebida alcoólica. O excesso de peso configurou-se como um dos fatores mais agravantes nessa população.
OBJECTIVE: To analyze factors associated with hypertension and its relation with nutritional status of hypertensive subjects enrolled in the program Hiperdia in a municipality of Rio Grande do Sul. METHODS: We evaluated patients with hypertension enrolled in Hiperdia. The data related with risk factors for hypertension were collected through a semi structured questionnaire composed of the following variables: age, education, exercise, smoking, drugs consumed, genetics, chronic diseases, weight, height and waist circumference. RESULTS: Among the 402 hypertensive patients studied, 138 (34.3%) were adults and 264 (65.7%) were elderly, and the majority were female. The prevalence of overweight was 76.8% in adults, while 35% of them were normal weight. When compared the ages, 11% of the elderly were significantly associated with illiteracy. The adults and the elderly presented waist circumference and BMI classification above desired levels. CONCLUSION: In this study, hypertension was associated with increase of age, excess of weight, waist circumference, low education, smoking and alcohol consumption. Excess of weight was configured as one of the most aggravating factors in this population.
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OBJETIVO: Verificar os fatores de risco que interferem no estado nutricional dos idosos socialmente ativos de um município do interior do Estado do Rio Grande do Sul. MÉTODOS: Estudo do tipo transversal, do qual participaram voluntariamente 284 idosos. Foi aplicado questionário individual estruturado contendo questões relativas aos hábitos alimentares e foram coletados os dados antropométricos (peso, altura, circunferência da cintura). RESULTADOS: 60,3% dos homens e 62,5% das mulheres estavam com sobrepeso. Com base na avaliação da circunferência da cintura, verificou-se um risco muito aumentado para o desenvolvimento de doenças cardiovasculares em 98,5% dos homens e 92,5% das mulheres. A maioria das mulheres (56,9%) informou usar algum medicamento contínuo, enquanto que entre os homens (52,5%), a maioria respondeu não consumir nenhum medicamento. Não se observou diferença significativa entre os diferentes estados nutricionais e os hábitos alimentares investigados. Entre os casados, o sobrepeso foi encontrado em 47,1% dos homens e em 35,6% das mulheres. CONCLUSÃO: A maioria da população idosa estudada apresentou sobrepeso e circunferência da cintura elevada entre homens e mulheres. Não se observou associação entre o estado nutricional e o número de refeições, ingestão de água, consumo diário de frutas e verduras, tipo de leite ingerido, consumo semanal de carnes, doces, frituras e leguminosas. .
OBJECTIVE: To investigate the factors affecting the nutritional status of socially active elderly in a municipality in the countryside of Rio Grande do Sul state, Brazil. METHODS: A cross-sectional study where 284 subjects participated voluntarily. A structured individual questionnaire containing questions relating to eating habits was administered and anthropometric data (weight, height, waist circumference) were collected. RESULTS: 60.3% of men and 62.5% of women were overweight. Based on the assessment of waist circumference (WC) there was increased risk for developing cardiovascular disease (CVD) in 98.5% of men and 92.5% women. Most women (56.9%) reported some solid drug use, whereas among men (52.5%), most reported no medicine consumption. No significant difference between the different nutritional status and dietary habits investigated was observed. Among married, overweight was found in 47.1% of men and 35.6% of women. CONCLUSION: The majority of the elderly population was overweight and waist circumference was large among men and women. No association between nutritional status and the number of meals, water intake, daily intake of fruits and vegetables, type of milk consumed, weekly consumption of meat, candies, fried foods and legumes was observed. .
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As leucemias são o tipo mais frequente de câncer em crianças e adolescentes. A leucemia linfocítica aguda é a forma mais comum de leucemia na infância. A doença surge normalmente entre dois e quatro anos de idade, sendo incomum antes de um ano de vida. As manifestações mais comuns incluem febre, fadiga, letargia, dor óssea e articular. Em 50% dos casos, há hepato e/ou esplenomegalia e linfonodomegalias. Este relato de caso fala sobre uma menina de nove meses que foi levada à emergência do hospital por distensão abdominal, fraqueza em membros inferiores e constipação duas semanas antes. Apresentava massas abdominais endurecidas em flancos, abaulamento em região fronto-temporal direita e linfonodomegalias cervicais. A primeira impressão foi de nefroblastoma bilateral (Tumor de Wilms). A ecografia abdominal e a tTC de abdome mostraram aumento de volume renal bilateral e descartaram nefroblastoma. Em setor de oncologia pediátrica, foi realizada imunofenotipagem compatível com leucemia/linfoma linfoblástico B. No líquor havia 400 células p/uL com 81% de blastos. A avaliação neurológica e a RNM de crânio e neuro-eixo descartaram alteração que justificasse a paresia de membros inferiores. No décimo dia de tratamento, os rins já haviam reduzido até o limite superior da normalidade. O abaulamento da face já havia desaparecido. A paciente apresentou anemia, neutropenia, plaquetopenia e hipoalbuminemia severas. Ao final da indução, apresentou sepse fúngica e bacteriana evoluindo para choque séptico e parada cardiorrespiratória não responsiva às manobras de reanimação. Não foi realizado medulograma no final da indução por piora do quadro clínico e posterior óbito (AU)
Leukemias are the most frequent type of cancer in children and adolescents. Acute lymphocytic leukemia is the most common form of childhood leukemia. The disease usually arises between two and four years of age, being uncommon before one year of life. The most common manifestations include fever, fatigue, lethargy, bone and joint pain. In 50% of cases, there is hepatomegaly and/or splenomegaly and lymph node enlargement. This case report tells of a nine-month old girl who was taken to the hospital emergency room due to abdominal distension, weakness in the lower limbs, and constipation for two weeks. She had abdominal masses that were hardened on the flanks, bulging in the right fronto-temporal region and cervical lymph node enlargements. The first impression was bilateral nephroblastoma (Wilms tumor). Abdominal ultrasound and abdominal CT showed bilateral renal volume increase and ruled out nephroblastoma. In the pediatric oncology sector, immunophenotyping compatible with lymphoblastic leukemia/lymphoma was performed. In the CSF there were 400 cells/L with 81% blasts. Neurological evaluation and MRI of the skull and neuro-axis ruled out alterations justifying lower limb paresis. By the tenth day of treatment, the kidneys had already reduced to the upper limit of normal. The bulging of the face was gone. The patient presented severe anemia, neutropenia, thrombocytopenia and hypoalbuminemia. At the end of the induction, she presented fungal and bacterial sepsis evolving to septic shock and cardiorespiratory arrest unresponsive to resuscitation maneuvers. No myelogram was performed at the end of the induction due to worsening of the clinical picture and subsequent death (AU)
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Humanos , Feminino , Lactente , Leucemia-Linfoma Linfoblástico de Células Precursoras B/diagnóstico , Neoplasias Renais/etiologia , Diagnóstico DiferencialRESUMO
Introdução: A assistência pré-natal é importantíssima tanto para a evolução da gravidez quanto para o bem-estar da mãe, sendo o cuidado nutricional um promissor aliado para a otimização do crescimento fetal. Objetivo: Nesse estudo, objetivou-se analisar características maternas, gestacionais e do parto e relacioná-las com o estado nutricional pré-gestacional e com o peso da criança ao nascer, de mães usuárias do SUS. Métodos: Foi realizado um estudo transversal retrospectivo com 173 nascidos vivos de gravidez única. Resultados: Os resultados mostraram elevada prevalência de sobrepeso/obesidade pré-gestacional e sua associação com nascimento de recém-nascidos macrossômicos e maior número de partos cesáreos. Conclusão: A idade materna elevada e o grande número de filhos tidos em gestações anteriores contribuíram para essa prevalência, reforçando a importância da realização do pré-natal e da avaliação do estado nutricional pré-gestacional.
Introduction: The prenatal managing is important both for the development of pregnancy as the mother?s well being, being the nutritional care a promising ally to optimize fetal growth. Objective: This study aimed to examine maternal characteristics, pregnancy and childbirth and correlate them with nutritional status before pregnancy and the child?s weight at birth of mothers from SUS. Methods: This is a retrospective cross-sectional study with 173 live born in singleton pregnancies. Results: The results showed high prevalence of pre-pregnancy overweight / obesity and its relation with the birth of macrosomic newborns and greater number of cesarean deliveries. Conclusion: The increased maternal age and the high number of children from former pregnancies contributed to this prevalence, reinforcing the importance of prenatal exam and the nutritional evaluation before pregnancy.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Adulto , Adulto Jovem , Peso ao Nascer , Macrossomia Fetal/epidemiologia , Cesárea/estatística & dados numéricos , Estudos Transversais , Estudos Retrospectivos , Número de Gestações , Sobrepeso/epidemiologiaRESUMO
OBJETIVO: Caracterizar o estado nutricional de uma população de idosos e verificar sua associação com fatores de risco cardiovascular e síndrome metabólica. MÉTODOS: Foram avaliados o estado nutricional e prevalências de fatores de risco cardiovascular de síndrome metabólica em amostra de idosos em município da região central do Rio Grande do Sul. O estado nutricional foi determinado por meio de índice de massa corporal, conforme classificação de Lipschitz/1994. O diagnóstico de síndrome metabólica foi obtido por meio dos critérios da International Diabetes Federation. RESULTADOS: Entre os idosos avaliados, a prevalência de excesso de peso foi de 42 por cento entre os homens e de 50 por cento entre as mulheres. As prevalências de hipertensão arterial sistêmica, diabetes mellitus, síndrome metabólica, obesidade central, lipoproteína de alta densidade - colesterol baixo e triglicerídeos elevados foram maiores naqueles com excesso de peso de ambos os sexos. Usando como referência os com estado nutricional normal, os portadores de excesso de peso apresentaram aumento no risco de hipertensão arterial sistêmica, diabetes mellitus e síndrome metabólica, com razão de chances de, respectivamente, 3,3 (IC95 por cento: 1,7 a 6,4), 3,3 (IC95 por cento: 1,48 a 7,11) e 6,9 (IC95 por cento: 3,2 a 14,6), enquanto aqueles com magreza tiveram tendência à razão de chances reduzidas para essas doenças. CONCLUSÃO: As razões de chances de apresentar hipertensão arterial sistêmica, diabetes mellitus e síndrome metabólica na população de idosos da pesquisa estão associadas ao estado nutricional definido pelo índice de massa corporal, sendo progressivamente maiores naqueles com excesso de peso e menores nos com magreza, independente de gênero e idade.
OBJECTIVE: This study aimed to characterize the nutritional status of an elderly population and verify its relationship with cardiovascular risk factors and metabolic syndrome. METHODS: Nutritional status and prevalence of cardiovascular risk factors and metabolic syndrome were assessed in an elderly population from a city in the state of Rio Grande do Sul, in the South of Brazil. Body mass index, according to the Lipschitz classification of 1994, was used to determine their nutritional status. Metabolic syndrome diagnosis was based on the International Diabetes Federation criteria. RESULTS: Among the studied elderly, 42 percent of the males and 50 percent of the females were overweight. Hypertension, diabetes mellitus, metabolic syndrome, central obesity, low high density lipoprotein-cholesterol levels and high triglyceride levels were more common in overweight individuals than in normal weight individuals of both genders. Using the normal weight individuals as reference, the overweight were at greater risk of systemic hypertension, diabetes mellitus and metabolic syndrome, with an odds ratio of 3.3 (CI95 percent: 1.7 to 6.4), 3.3 (CI95 percent: 1.48 to 7.1) and 6.9 (CI95 percent: 3.2 to 14.6) respectively, while the underweight tended towards a lower odds ratio for the same diseases. CONCLUSION: The odds ratios for the presence of hypertension, diabetes mellitus and metabolic syndrome were associated with nutritional status determined by body mass index. The odds ratios are progressively higher in the overweight and lower in the underweight, regardless of age and gender.
RESUMO
O aumento da prevalência de sobrepeso na população infantil tem repercussão sobre o quadro de saúde das crianças. Nesse sentido, o acompanhamento da situação nutricional constitui um instrumento importante para aferição das condições de saúde e qualidade de vida da população em geral. A presente pesquisa objetivou verificar o estado nutricional de escolares de 6 a 10 anos, das escolas municipais da cidade de Chapada, Rio Grande do Sul. É um estudo descritivo transversal, composto por crianças de 6 a 10 anos de idade, matriculadas na rede municipal de ensino de Chapada (RS). As coletas de dados ocorreram de outubro a dezembro de 2009. Foram avaliados 214 escolares, sendo 53% do sexo feminino. Os frequentadores das escolas rurais totalizaram 54% da amostra. Excesso de peso foi encontrado em 30% dos avaliados, sendo mais frequente em meninas e com maior prevalência na zona rural. Alunos com peso excessivo demonstraram maior ingestão de doces e refrigerantes que os eutróficos. O padrão alimentar brasileiro sofreu modificações, até mesmo nas áreas rurais. Faz-se necessário o diagnóstico precoce do desequilíbrio dietético infantil, como medida preventiva da instalação da obesidade desde essa faixa etária.
The increasing prevalence of overweight children has repercussions on the framework for children?s health. In this sense, the monitoring of nutritional status is an important tool for gauging the health and quality of life in general. This research aimed to determine the nutritional status of schoolchildren 6 to 10 years of the municipal schools of the city of Chapada, Rio Grande do Sul, Brasil. This is a cross-sectional study, comprising children aged 6 to 10 years of age enrolled in municipal schools in Chapada, RS, Brasil. Data collection occurred from October to December 2009. We studied 214 schoolchildren and 53% female. Regulars of rural schools totaled 54% of the sample. Overweight was found in 30% and it was more common in girls and with a higher prevalence in rural areas. Students with excessive weight showed a higher intake of sweets and soft drinks that eutrophic. The Brazilian food standard has changed, even in rural areas. Early diagnosis is necessary for infant dietary imbalance as a preventive measure of obesity since the installation of this age group.