Jornal de Pediatria (Vers?o em Português)最新文献

英文中文

Infections in children with diabetes 糖尿病儿童的感染

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-03-01 DOI: 10.1016/j.jpedp.2019.09.004

Luis Eduardo Calliari , Flávia J. Almeida , Renata Maria Noronha

Objective

The association between diabetes mellitus and infections is very common. These infections, even when mild, interfere with blood glucose control. The aim of this review is to describe infections that occur in children and adolescents with DM, as well as to provide recommendations on glycemia management during these episodes.

Source of data

A non‐systematic review was carried out in the PubMed database, using the terms “diabetes mellitus,” “infection,” “children,” and “adolescents.” The most relevant publications were selected.

Synthesis of data

In addition to the usual community diseases, some infections may occur predominantly in diabetic patients, especially when there is inadequate glycemic control, and common infections can be more severe in these patients. Alterations caused by the disease itself and the immune response are responsible for the risk of higher frequency and severity of infections. During infections, an increase in blood glucose occurs and usually an increase in insulin dose is required.

Conclusions

Pediatric patients with diabetes have some immune system disorders that, when associated with high glycemia, increase the risk of infections and their severity, and should be promptly identified and treated. The presence of an infectious condition, in turn, raises blood glucose and increases the risk of decompensation, and pediatricians should be cautioned to intensify monitoring and insulin therapy, and to avoid the risk of DKA. It should also be noted that many infections are preventable and can be avoided with adequate vaccine coverage.

目的糖尿病与感染的关系是非常普遍的。这些感染，即使是轻微的，也会干扰血糖控制。本综述的目的是描述发生在儿童和青少年糖尿病患者中的感染，并在这些发作期间提供血糖管理建议。在PubMed数据库中使用“糖尿病”、“感染”、“儿童”和“青少年”等术语进行了非系统评价。选出了最相关的出版物。除了常见的社区疾病外，一些感染可能主要发生在糖尿病患者中，特别是在血糖控制不充分的情况下，这些患者的常见感染可能更严重。由疾病本身和免疫反应引起的改变是导致感染频率和严重程度更高的风险的原因。在感染期间，血糖升高，通常需要增加胰岛素剂量。结论儿科糖尿病患者存在一些免疫系统疾病，当伴有高血糖时，会增加感染的风险和严重程度，应及时发现和治疗。感染性疾病的存在，反过来又会升高血糖，增加代偿失调的风险，儿科医生应加强监测和胰岛素治疗，并避免DKA的风险。还应该指出，许多感染是可以预防的，并且可以通过充分的疫苗接种来避免。

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引用次数: 0

Opportunistic infections in pediatrics: when to suspect and how to approach 儿科机会性感染:何时怀疑及如何处理

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-03-01 DOI: 10.1016/j.jpedp.2019.09.007

Maria Isabel de Moraes-Pinto, Maria Aparecida Gadiani Ferrarini

Objectives

To describe the characteristics of opportunistic infections in pediatrics regarding their clinical aspects, as well as the diagnostic strategy and treatment.

Source of data

Non‐systematic review of literature studies in the PubMed database.

Synthesis of data

Opportunistic infections caused by non‐tuberculous mycobacteria, fungi, Herpesvirae, and infections affecting individuals using immunobiological agents are analyzed. Because these are severe diseases with a rapid evolution, diagnostic suspicion should be early, associated with the patient's clinical assessment and history pointing to opportunistic infections. Whenever possible, samples of secretions, blood, and other fluids and tissues should be collected, with early therapy implementation.

Conclusions

Despite the improved diagnosis of opportunistic infections in recent years, they remain a challenge for pediatricians who are not used to these infections. They should raise the suspicion and start treating the case, but should also resort to specialists in the management of these infections to provide a better outcome for these patients, who still have high mortality.

目的探讨儿科机会性感染的临床特点、诊断策略和治疗方法。数据来源-对PubMed数据库中文献研究的系统综述。分析了由非结核分枝杆菌、真菌、疱疹病毒引起的机会性感染，以及使用免疫生物学药物影响个体的感染。由于这些都是发展迅速的严重疾病，因此应及早进行诊断怀疑，并结合患者的临床评估和指出机会性感染的病史。只要可能，应收集分泌物、血液和其他液体和组织样本，并尽早进行治疗。结论尽管近年来机会性感染的诊断有所改善，但对于不习惯这些感染的儿科医生来说，它们仍然是一个挑战。他们应该提出怀疑并开始治疗该病例，但也应该求助于管理这些感染的专家，为这些仍然具有高死亡率的患者提供更好的结果。

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引用次数: 0

Tuberculosis in childhood and adolescence: a view from different perspectives 儿童和青少年结核病:从不同角度看

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-03-01 DOI: 10.1016/j.jpedp.2019.11.002

Tony T. Tahan , Betina M.A. Gabardo , Andrea M.O. Rossoni

Objective

To describe the epidemiological situation of tuberculosis in children under 19 years of age in Brazil and to review the latest publications on disease risk, diagnosis, treatment, and prevention.

Source of data

Notifiable Diseases Information System (2018), World Health Organization estimates, and PubMed articles selected using the descriptor “Tuberculosis,” delimited by type of study, period, age, and language.

Synthesis of data

In 2018, in Brazil, 9.4% of notifications were in children under 19 years. The pulmonary form predominated in 80.1% of the cases. The cure rate was 76.8%, lethality was 0.8%, and abandonment was 10.4%. The prevalence of drug‐resistant tuberculosis (2011 to 2016) was 0.5%.It has been found that the risk of disease can reach up to 56% in children under 5 years, influenced by helminth co‐infections, malaria, chronic viral infections, live attenuated virus vaccines, and hypovitaminosis D. Exposure to a bacilliferous patient for periods shorter than 30 minutes is sufficient for the development of infection and/or disease. In Brazil, microbiological screening is recommended, but the use of the scoring system, modified in 2019, has been maintained. Studies on infection detection have supported the use of the tuberculin skin test. In the treatment, the great advance was the introduction of dispersible formulations, adjustment of the recommended doses, and shortened regimens for latent infection. Several vaccine studies (stages 1–3) are ongoing, but no BCG‐licensed substitute has been implemented yet.

Conclusions

There has been progress in treatment, but major challenges need to be overcome to improve diagnosis, monitoring, and outcome of cases, aiming to eliminate tuberculosis.

目的了解巴西19岁以下儿童结核病的流行病学情况，并回顾有关疾病风险、诊断、治疗和预防的最新出版物。数据来源:法定疾病信息系统(2018)、世界卫生组织的估计数据，以及使用描述符“结核病”选择的PubMed文章，按研究类型、时期、年龄和语言划分。2018年，在巴西，9.4%的通报是19岁以下儿童。80.1%的病例以肺型为主。治愈率76.8%，致死率0.8%，遗弃率10.4%。耐药结核病的患病率(2011 - 2016年)为0.5%。研究发现，受寄生虫共感染、疟疾、慢性病毒感染、减毒活疫苗和维生素d缺乏症的影响，5岁以下儿童患病的风险可高达56%。与细菌患者接触不到30分钟就足以导致感染和/或疾病的发生。在巴西，建议进行微生物筛查，但仍保留了2019年修改的评分系统。关于感染检测的研究支持结核菌素皮肤试验的使用。在治疗方面，最大的进步是引入了分散制剂，调整了推荐剂量，缩短了潜伏感染的治疗方案。几项疫苗研究(1-3期)正在进行中，但尚未实施获得卡介苗许可的替代品。结论在治疗方面取得了进展，但在改善诊断、监测和病例转归方面仍需克服重大挑战，以消除结核病。

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引用次数: 0

Blood pressure reference values for Brazilian adolescents: data from the Study of Cardiovascular Risk in Adolescents (ERICA Study) 巴西青少年血压参考值:来自青少年心血管风险研究(ERICA研究)的数据

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-03-01 DOI: 10.1016/j.jpedp.2018.09.002

Thiago Veiga Jardim , Bernard Rosner , Katia Vergetti Bloch , Maria Cristina Caetano Kuschnir , Moyses Szklo , Paulo César Veiga Jardim

Objective

Blood pressure (BP) references for Brazilian adolescents are lacking in the literature. This study aims to investigate the normal range of office BP in a healthy, non‐overweight Brazilian population of adolescents.

Method

The Brazilian Study of Cardiovascular Risks in Adolescents (Portuguese acronym “ERICA”) is a national school‐based study that included adolescents (aged 12 through 17 years), enrolled in public and private schools, in cities with over 100,000 inhabitants, from all five Brazilian macro‐regions. Adolescents’ height and body mass index (BMI) were classified in percentiles according to age and gender, and reference curves from the World Health Organization were adopted. Three consecutive office BP measurements were taken with a validated oscillometric device using the appropriate cuff size. The mean values of the last two readings were used for analysis. Polynomial regression models relating BP, age, and height were applied.

Results

Among 73,999 adolescents, non‐overweight individuals represented 74.5% (95% CI: 73.3–75.6) of the total, with similar distribution across ages. The majority of the non‐overweight sample was from public schools 84.2% (95% CI: 79.9–87.7) and sedentary 54.8% (95% CI: 53.7–55.8). Adolescents reporting their skin color as brown (48.8% [95% CI: 47.4–50.1]) or white (37.8% [95% CI: 36.1–39.5]) were most frequently represented. BP increased by both age and height percentile. Systolic BP growth patterns were more marked in males when compared to females, along all height percentiles. The same pattern was not observed for diastolic BP.

Conclusions

Blood pressure references by sex, age, and height percentiles for Brazilian adolescents are provided.

目的:巴西青少年血压(BP)相关文献缺乏。本研究旨在调查巴西健康、非超重青少年的正常血压范围。巴西青少年心血管风险研究(葡萄牙语首字母缩略词“ERICA”)是一项以学校为基础的全国性研究，研究对象包括来自巴西所有五个宏观区域、人口超过10万的城市中公立和私立学校就读的青少年(12至17岁)。青少年身高和体质指数(BMI)按年龄和性别按百分位数分类，采用世界卫生组织的参考曲线。使用经过验证的振荡测量装置，使用合适的袖带尺寸，连续进行三次办公室血压测量。最后两次读数的平均值用于分析。采用BP、年龄和身高相关的多项式回归模型。结果在73999名青少年中，非超重个体占总数的74.5% (95% CI: 73.3-75.6)，各年龄段分布相似。大多数非超重样本来自公立学校84.2% (95% CI: 79.9-87.7)和久坐54.8% (95% CI: 53.7-55.8)。报告自己肤色为棕色(48.8% [95% CI: 47.4-50.1])或白色(37.8% [95% CI: 36.1-39.5])的青少年最为常见。血压随年龄和身高的增加而增加。男性的收缩压增长模式比女性更明显，在所有身高百分位数上都是如此。舒张压没有观察到相同的模式。结论提供了巴西青少年按性别、年龄和身高百分位数的血压参考。

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引用次数: 0

Effects of intrauterine latent iron deficiency on auditory neural maturation in full‐term newborns 宫内潜伏性缺铁对足月新生儿听神经成熟的影响

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-03-01 DOI: 10.1016/j.jpedp.2018.11.006

Leticia Valerio Pallone, Felipe Alves de Jesus, Gleice Aline Gonçalves, Laura Carvalho Navarra, Débora Gusmão Melo, Rodrigo Alves Ferreira, Carla Maria Ramos Germano

Objective

This study analyzed the relationship between latent iron deficiency evaluated by ferritin, and the myelination of the central nervous system evaluated through the brainstem evoked response audiometry test.

Method

A total of 109 full‐term newborns, born without anemia and risk factor for hearing deficiency, were enrolled. After delivery, umbilical cord blood was collected to determine ferritin and hematocrit levels. The brainstem evoked response audiometry test was carried out in the first 28 days of life. Analysis was performed between the control group (n = 71) with ferritin greater than 75 ng/mL, and the latent iron deficiency group (n = 38) with ferritin between 11 and 75 ng/mL. Results were presented as mean ± standard deviation. Statistical analysis was performed using GraphPad prism7 and SPSS with a significance level of 5%.

Results

A significant higher V‐wave (p = 0.02) and interpeak intervals I–III (p = 0.014), I–V (p = 0.0003), and III‐V (p = 0.0002) latencies were found in the latent iron deficiency group, as well as a significant inversely proportional correlation between ferritin and the same wave and intervals (p = 0.003, p = 0.0013, p = 0.0002, p = 0.009, respectively). Multiple correlation analysis showed a significant correlation of latent iron deficiency with all interpeak intervals, even taking into account newborn gestational age.

Conclusion

Iron deficiency anemia is a prevalent pathology; this study showed auditory delayed maturation associated to intrauterine iron deficiency, even in its latent form. This reinforces the importance of adopting effective measures, on a global scale, to prevent and treat this pathology in different life periods, especially in the most vulnerable population.

目的分析铁蛋白评价的潜伏性缺铁与脑干诱发反应听力学评价的中枢神经系统髓鞘形成的关系。方法入选109例足月新生儿，出生时无贫血和听力缺陷危险因素。分娩后，采集脐带血测定铁蛋白和红细胞压积水平。在出生后28天进行脑干诱发反应听力学测试。对铁蛋白≥75 ng/mL的对照组(n = 71)和铁蛋白≥11 ~ 75 ng/mL的潜伏性缺铁组(n = 38)进行分析。结果以均数±标准差表示。采用GraphPad prism7和SPSS进行统计学分析，显著性水平为5%。结果潜伏性缺铁组的V -波潜伏期(p = 0.02)、I-III峰间期(p = 0.014)、I-V峰间期(p = 0.0003)、III - V峰间期(p = 0.0002)显著增高，铁蛋白与V -波潜伏期、峰间期(p = 0.003、p = 0.0013、p = 0.0002、p = 0.009)呈显著负相关。多重相关分析显示，即使将新生儿胎龄考虑在内，潜伏性缺铁与所有峰间间隔均有显著相关性。结论缺铁性贫血是常见病;这项研究表明，听觉延迟成熟与宫内铁缺乏有关，甚至在其潜伏形式。这加强了在全球范围内采取有效措施，在不同生命阶段，特别是在最脆弱人群中预防和治疗这种病理的重要性。

{"title":"Effects of intrauterine latent iron deficiency on auditory neural maturation in full‐term newborns","authors":"Leticia Valerio Pallone, Felipe Alves de Jesus, Gleice Aline Gonçalves, Laura Carvalho Navarra, Débora Gusmão Melo, Rodrigo Alves Ferreira, Carla Maria Ramos Germano","doi":"10.1016/j.jpedp.2018.11.006","DOIUrl":"https://doi.org/10.1016/j.jpedp.2018.11.006","url":null,"abstract":"<div><h3>Objective</h3><p>This study analyzed the relationship between latent iron deficiency evaluated by ferritin, and the myelination of the central nervous system evaluated through the brainstem evoked response audiometry test.</p></div><div><h3>Method</h3><p>A total of 109 full‐term newborns, born without anemia and risk factor for hearing deficiency, were enrolled. After delivery, umbilical cord blood was collected to determine ferritin and hematocrit levels. The brainstem evoked response audiometry test was carried out in the first 28 days of life. Analysis was performed between the control group (<em>n</em>   =38) with ferritin between 11 and 75ng/mL. Results were presented as mean±standard deviation. Statistical analysis was performed using GraphPad prism7 and SPSS with a significance level of 5%.</p></div><div><h3>Results</h3><p>A significant higher V‐wave (<em>p</em>  =0.014), I–V (<em>p</em>  =0.0002) latencies were found in the latent iron deficiency group, as well as a significant inversely proportional correlation between ferritin and the same wave and intervals (<em>p</em>  =0.0013, <em>p</em>  =0.009, respectively). Multiple correlation analysis showed a significant correlation of latent iron deficiency with all interpeak intervals, even taking into account newborn gestational age.</p></div><div><h3>Conclusion</h3><p>Iron deficiency anemia is a prevalent pathology; this study showed auditory delayed maturation associated to intrauterine iron deficiency, even in its latent form. This reinforces the importance of adopting effective measures, on a global scale, to prevent and treat this pathology in different life periods, especially in the most vulnerable population.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 2","pages":"Pages 202-209"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2018.11.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137162114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Septic shock in pediatrics: the state‐of‐the‐art 儿科感染性休克:最新进展

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-03-01 DOI: 10.1016/j.jpedp.2019.10.007

Pedro Celiny Ramos Garcia , Cristian Tedesco Tonial , Jefferson Pedro Piva

Objective

Review the main aspects of the definition, diagnosis, and management of pediatric patients with sepsis and septic shock.

Source of data

A search was carried out in the MEDLINE and Embase databases. The articles were chosen according to the authors’ interest, prioritizing those published in the last five years.

Synthesis of data

Sepsis remains a major cause of mortality in pediatric patients. The variability of clinical presentations makes it difficult to attain a precise definition in pediatrics. Airway stabilization with adequate oxygenation and ventilation if necessary, initial volume resuscitation, antibiotic administration, and cardiovascular support are the basis of sepsis treatment. In resource‐poor settings, attention should be paid to the risks of fluid overload when administrating fluids. Administration of vasoactive drugs such as epinephrine or norepinephrine is necessary in the absence of volume response within the first hour. Follow‐up of shock treatment should adhere to targets such as restoring vital and clinical signs of shock and controlling the focus of infection. A multimodal evaluation with bedside ultrasound for management after the first hours is recommended. In refractory shock, attention should be given to situations such as cardiac tamponade, hypothyroidism, adrenal insufficiency, abdominal catastrophe, and focus of uncontrolled infection.

Conclusions

The implementation of protocols and advanced technologies have reduced sepsis mortality. In resource‐poor settings, good practices such as early sepsis identification, antibiotic administration, and careful fluid infusion are the cornerstones of sepsis management.

目的探讨小儿脓毒症及感染性休克的定义、诊断及处理要点。数据来源在MEDLINE和Embase数据库中进行检索。这些文章是根据作者的兴趣选择的，优先考虑最近五年发表的文章。数据的合成仍然是儿科患者死亡的主要原因。临床表现的可变性使得在儿科很难获得精确的定义。气道稳定，适当的氧合和通气，如有必要，初始容量复苏，抗生素治疗和心血管支持是败血症治疗的基础。在资源贫乏的环境中，在给药时应注意液体超载的风险。在第一个小时内没有容积反应时，需要使用血管活性药物，如肾上腺素或去甲肾上腺素。休克治疗的随访应坚持恢复休克的生命体征和临床体征、控制感染病灶等目标。建议在头几个小时后进行床边超声多模式评估。在难治性休克中，应注意诸如心包填塞、甲状腺功能减退、肾上腺功能不全、腹部灾难和未控制的感染焦点等情况。结论方案的实施和先进的技术降低了脓毒症的死亡率。在资源贫乏的环境中，良好的做法，如早期败血症识别、抗生素给药和仔细输液是败血症管理的基石。

{"title":"Septic shock in pediatrics: the state‐of‐the‐art","authors":"Pedro Celiny Ramos Garcia , Cristian Tedesco Tonial , Jefferson Pedro Piva","doi":"10.1016/j.jpedp.2019.10.007","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.10.007","url":null,"abstract":"<div><h3>Objective</h3><p>Review the main aspects of the definition, diagnosis, and management of pediatric patients with sepsis and septic shock.</p></div><div><h3>Source of data</h3><p>A search was carried out in the MEDLINE and Embase databases. The articles were chosen according to the authors’ interest, prioritizing those published in the last five years.</p></div><div><h3>Synthesis of data</h3><p>Sepsis remains a major cause of mortality in pediatric patients. The variability of clinical presentations makes it difficult to attain a precise definition in pediatrics. Airway stabilization with adequate oxygenation and ventilation if necessary, initial volume resuscitation, antibiotic administration, and cardiovascular support are the basis of sepsis treatment. In resource‐poor settings, attention should be paid to the risks of fluid overload when administrating fluids. Administration of vasoactive drugs such as epinephrine or norepinephrine is necessary in the absence of volume response within the first hour. Follow‐up of shock treatment should adhere to targets such as restoring vital and clinical signs of shock and controlling the focus of infection. A multimodal evaluation with bedside ultrasound for management after the first hours is recommended. In refractory shock, attention should be given to situations such as cardiac tamponade, hypothyroidism, adrenal insufficiency, abdominal catastrophe, and focus of uncontrolled infection.</p></div><div><h3>Conclusions</h3><p>The implementation of protocols and advanced technologies have reduced sepsis mortality. In resource‐poor settings, good practices such as early sepsis identification, antibiotic administration, and careful fluid infusion are the cornerstones of sepsis management.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 ","pages":"Pages 87-98"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.10.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137132045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rational use of antimicrobials in the treatment of upper airway infections 抗菌药物在上呼吸道感染治疗中的合理应用

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-03-01 DOI: 10.1016/j.jpedp.2019.11.003

Santiago Alfayate Miguélez , Luis Garcia‐Marcos

Objective

To analyze the main cause of the irresponsible use of antibiotics at the pediatric level in a very frequent, usually self‐limited, and typically viral condition: upper airway respiratory infections.

Sources

Different databases were searched using specific terms related to resistance to antibiotics, upper airway respiratory infections, and pediatrics patients.

Summary of the findings

Effectiveness varies depending on the place, the form of intervention, and the resources used. Multiple interventions appear to be more effective. The foundations of treatment are training in technical aspects and in communication skills for the prescribers, and having enough time for each patient; and training through the health clinic and the media for patients/parents. Deferred prescription and the use of rapid diagnostic tests in the primary care setting have been shown to be effective. A fluid relationship based on trust between clinicians and parents/guardians is one of the keystones.

Conclusions

Any project that seeks to be totally effective must include a health authority, which in addition to helping implement these measures, has the firm intention of drastically reducing the use of antibiotics in animals and in the environment, as well as favoring research into new antimicrobials.

目的分析儿童在一种非常频繁的、通常是自限性的、典型的病毒性疾病:上呼吸道感染中不负责任使用抗生素的主要原因。使用与抗生素耐药性、上呼吸道感染和儿科患者相关的特定术语搜索不同的数据库。研究结果总结:效果因地点、干预形式和使用的资源而异。多重干预似乎更为有效。治疗的基础是对开处方者进行技术方面和沟通技巧方面的培训，并为每个病人提供足够的时间;通过健康诊所和媒体对病人/家长进行培训。在初级保健环境中推迟处方和使用快速诊断测试已被证明是有效的。临床医生和家长/监护人之间基于信任的流动关系是关键之一。任何寻求完全有效的项目都必须包括一个卫生当局，该当局除了帮助实施这些措施外，还坚定地打算大幅减少在动物和环境中使用抗生素，并支持研究新的抗菌素。

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引用次数: 0

Sex and age disparities in physical activity among Brazilian adolescents: nature or nurture? 巴西青少年体育活动的性别和年龄差异:先天还是后天?

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-01-01 DOI: 10.1016/j.jpedp.2019.04.010

Deborah Salvo , Nicolas Aguilar‐Farias , Alejandra Jauregui , Andrea Ramirez Varela

引用次数: 0

TyG in insulin resistance prediction TyG在胰岛素抵抗预测中的作用

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-01-01 DOI: 10.1016/j.jpedp.2019.09.003

Wendell Arthur Lopes, Gustavo Henrique de Oliveira, João Carlos Locateli, Caroline Ferraz Simões

引用次数: 0

Answer to the Letter “TyG in insulin resistance prediction” 对“TyG在胰岛素抵抗预测中的应用”的答复

Jornal de Pediatria (Vers?o em Português)

Pub Date : 2020-01-01 DOI: 10.1016/j.jpedp.2019.10.002

Sarah A. Vieira‐Ribeiro , Poliana C.A. Fonseca , Cristiana S. Andreoli , Andréia Q. Ribeiro , Helen H.M. Hermsdorff , Patrícia F. Pereira , Silvia E. Priore , Sylvia C.C. Franceschini

引用次数: 0

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