Pub Date : 2016-03-01DOI: 10.1016/j.rppede.2015.09.002
Rodrigo Wiltgen Ferreira , Airton José Rombaldi , Luiza Isnardi Cardoso Ricardo , Pedro Curi Hallal , Mario Renato Azevedo
Objective
To determine the students’ exposure to four different sedentary behavior (SB) indicators and their associations with gender, grade, age, economic status and physical activity level.
Methods
A cross-sectional study was conducted in 2013. The SB was collected using the HELENA instrument, composed by screen time questions (TV, video games and internet) and sitting activities on school opposite shift. The cut point of ≥2h/day was used to categorize the outcome. The Poisson regression was used for associations between the outcome and the independent variables (95% significance level), controlling for confounding variables and the possible design effect.
Results
The sample was composed by 8661 students. The overall prevalence of SB was 69.2% (CI95% 68.1–70.2) on weekdays, and 79.6% (CI95% 78.7–80.5) on weekends. Females were more associated with the outcome, except to electronic games. Advanced grades students were more involved in sitting tasks when compared to the early grades. Older students were more likely to surf on net for ≥2h/day. Higher economic level students were more likely to engage in video games and internet. Active individuals were less likely to engage in SB on weekdays.
Conclusions
The prevalence of SB was high, mainly on weekends. The associations with sex, age, grade and physical activity level should be considered into elaboration of more efficient interventions on SB control.
{"title":"Prevalence of sedentary behavior and its correlates among primary and secondary school students","authors":"Rodrigo Wiltgen Ferreira , Airton José Rombaldi , Luiza Isnardi Cardoso Ricardo , Pedro Curi Hallal , Mario Renato Azevedo","doi":"10.1016/j.rppede.2015.09.002","DOIUrl":"10.1016/j.rppede.2015.09.002","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the students’ exposure to four different sedentary behavior (SB) indicators and their associations with gender, grade, age, economic status and physical activity level.</p></div><div><h3>Methods</h3><p>A cross-sectional study was conducted in 2013. The SB was collected using the HELENA instrument, composed by screen time questions (TV, video games and internet) and sitting activities on school opposite shift. The cut point of ≥2h/day was used to categorize the outcome. The Poisson regression was used for associations between the outcome and the independent variables (95% significance level), controlling for confounding variables and the possible design effect.</p></div><div><h3>Results</h3><p>The sample was composed by 8661 students. The overall prevalence of SB was 69.2% (CI95% 68.1–70.2) on weekdays, and 79.6% (CI95% 78.7–80.5) on weekends. Females were more associated with the outcome, except to electronic games. Advanced grades students were more involved in sitting tasks when compared to the early grades. Older students were more likely to surf on net for ≥2h/day. Higher economic level students were more likely to engage in video games and internet. Active individuals were less likely to engage in SB on weekdays.</p></div><div><h3>Conclusions</h3><p>The prevalence of SB was high, mainly on weekends. The associations with sex, age, grade and physical activity level should be considered into elaboration of more efficient interventions on SB control.</p></div>","PeriodicalId":101120,"journal":{"name":"Revista Paulista de Pediatria (English Edition)","volume":"34 1","pages":"Pages 56-63"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rppede.2015.09.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55270557","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}
Pub Date : 2016-03-01DOI: 10.1016/j.rppede.2015.12.001
Julie R. Ingelfinger , Kamyar Kalantar-Zadeh , Franz Schaefer , on behalf of the World Kidney Day Steering Committee
{"title":"In time: averting the legacy of kidney disease – focus on childhood","authors":"Julie R. Ingelfinger , Kamyar Kalantar-Zadeh , Franz Schaefer , on behalf of the World Kidney Day Steering Committee","doi":"10.1016/j.rppede.2015.12.001","DOIUrl":"10.1016/j.rppede.2015.12.001","url":null,"abstract":"","PeriodicalId":101120,"journal":{"name":"Revista Paulista de Pediatria (English Edition)","volume":"34 1","pages":"Pages 5-10"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rppede.2015.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55271505","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}
Pub Date : 2016-03-01DOI: 10.1016/j.rppede.2015.12.003
Pedro Paulo do Prado Junior , Franciane Rocha de Faria , Eliane Rodrigues de Faria , Sylvia do Carmo Castro Franceschini , Silvia Eloiza Priore
Objective
To evaluate the correlation between the number of leukocytes and cardiovascular risks associated with birth characteristics, nutritional status and biochemical tests.
Methods
Cross-sectional study developed with 475 adolescents, born between 1992 and 2001, in the municipality of Viçosa (MG). Maternal medical records were analyzed in the hospital units, and the following was recorded: birth weight and length, head circumference, chest circumference, Apgar score, gestational age. In adolescents, body mass index, skinfold thickness, body composition, blood count, biochemical tests and clinical variables were also assessed. The statistical analyses was carried out using Statistical Package for Social Sciences (SPSS) version 20.0 and Data Analysis and Statistical Software (STATA) with Kruskal–Wallis, Mann–Whitney, chi-square or Fisher's exact tests and Linear Regression. Significance level was set at α<0.05. The study was approved by the Research Ethics Committee of UFV for studies with human subjects.
Results
Weight and birth length, head and chest circumference were higher among boys. In adolescents, the number of leukocytes was higher in individuals with excess weight and body fat and high adiposity index, waist-to-height ratio and waist circumference. Only altered triglycerides showed differences between leukocyte medians. Regardless of the anthropometric variable of the final regression model, the stage of adolescence, number of platelets, eosinophils, monocytes and lymphocytes were associated with the increase in leukocytes.
Conclusions
The birth variables were not associated with changes in leukocyte numbers, whereas the anthropometric variables were good indicators for a higher leukocyte count, regardless of the stage of adolescence and gender.
{"title":"Leukocytes as risk markers for cardiovascular disease in adolescents: association with birth characteristics, nutritional status and biochemical tests","authors":"Pedro Paulo do Prado Junior , Franciane Rocha de Faria , Eliane Rodrigues de Faria , Sylvia do Carmo Castro Franceschini , Silvia Eloiza Priore","doi":"10.1016/j.rppede.2015.12.003","DOIUrl":"10.1016/j.rppede.2015.12.003","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the correlation between the number of leukocytes and cardiovascular risks associated with birth characteristics, nutritional status and biochemical tests.</p></div><div><h3>Methods</h3><p>Cross-sectional study developed with 475 adolescents, born between 1992 and 2001, in the municipality of Viçosa (MG). Maternal medical records were analyzed in the hospital units, and the following was recorded: birth weight and length, head circumference, chest circumference, Apgar score, gestational age. In adolescents, body mass index, skinfold thickness, body composition, blood count, biochemical tests and clinical variables were also assessed. The statistical analyses was carried out using Statistical Package for Social Sciences (SPSS) version 20.0 and Data Analysis and Statistical Software (STATA) with Kruskal–Wallis, Mann–Whitney, chi-square or Fisher's exact tests and Linear Regression. Significance level was set at <em>α</em><0.05. The study was approved by the Research Ethics Committee of UFV for studies with human subjects.</p></div><div><h3>Results</h3><p>Weight and birth length, head and chest circumference were higher among boys. In adolescents, the number of leukocytes was higher in individuals with excess weight and body fat and high adiposity index, waist-to-height ratio and waist circumference. Only altered triglycerides showed differences between leukocyte medians. Regardless of the anthropometric variable of the final regression model, the stage of adolescence, number of platelets, eosinophils, monocytes and lymphocytes were associated with the increase in leukocytes.</p></div><div><h3>Conclusions</h3><p>The birth variables were not associated with changes in leukocyte numbers, whereas the anthropometric variables were good indicators for a higher leukocyte count, regardless of the stage of adolescence and gender.</p></div>","PeriodicalId":101120,"journal":{"name":"Revista Paulista de Pediatria (English Edition)","volume":"34 1","pages":"Pages 38-46"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rppede.2015.12.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55271533","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}
Pub Date : 2016-03-01DOI: 10.1016/j.rppede.2015.10.001
Lílian de Fátima Dornelas , Lívia de Castro Magalhães
Objective
To compare the functional performance of students diagnosed with developmental delay (DD) up to two years of age with peers exhibiting typical development.
Methods
Cross-sectional study with functional performance assessment of children diagnosed with DD up to two years of age compared to those with typical development at seven to eight years of age. Each group consisted of 45 children, selected by non-random sampling, evaluated for motor skills, quality of home environment, school participation and performance. ANOVA and the Binomial test for two proportions were used to assess differences between groups.
Results
The group with DD had lower motor skills when compared to the typical group. While 66.7% of children in the typical group showed adequate school participation, receiving aid in cognitive and behavioral tasks similar to that offered to other children at the same level, only 22.2% of children with DD showed the same performance. Although 53.3% of the children with DD achieved an academic performance expected for the school level, there were limitations in some activities. Only two indicators of family environment, diversity and activities with parents at home, showed statistically significant difference between the groups, with advantage being shown for the typical group.
Conclusions
Children with DD have persistent difficulties at school age, with motor deficit, restrictions in school activity performance and low participation in the school context, as well as significantly lower functional performance when compared to children without DD. A systematic monitoring of this population is recommended to identify needs and minimize future problems.
{"title":"Functional performance of school children diagnosed with developmental delay up to two years of age","authors":"Lílian de Fátima Dornelas , Lívia de Castro Magalhães","doi":"10.1016/j.rppede.2015.10.001","DOIUrl":"10.1016/j.rppede.2015.10.001","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the functional performance of students diagnosed with developmental delay (DD) up to two years of age with peers exhibiting typical development.</p></div><div><h3>Methods</h3><p>Cross-sectional study with functional performance assessment of children diagnosed with DD up to two years of age compared to those with typical development at seven to eight years of age. Each group consisted of 45 children, selected by non-random sampling, evaluated for motor skills, quality of home environment, school participation and performance. ANOVA and the Binomial test for two proportions were used to assess differences between groups.</p></div><div><h3>Results</h3><p>The group with DD had lower motor skills when compared to the typical group. While 66.7% of children in the typical group showed adequate school participation, receiving aid in cognitive and behavioral tasks similar to that offered to other children at the same level, only 22.2% of children with DD showed the same performance. Although 53.3% of the children with DD achieved an academic performance expected for the school level, there were limitations in some activities. Only two indicators of family environment, diversity and activities with parents at home, showed statistically significant difference between the groups, with advantage being shown for the typical group.</p></div><div><h3>Conclusions</h3><p>Children with DD have persistent difficulties at school age, with motor deficit, restrictions in school activity performance and low participation in the school context, as well as significantly lower functional performance when compared to children without DD. A systematic monitoring of this population is recommended to identify needs and minimize future problems.</p></div>","PeriodicalId":101120,"journal":{"name":"Revista Paulista de Pediatria (English Edition)","volume":"34 1","pages":"Pages 78-85"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rppede.2015.10.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55270807","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}
Pub Date : 2016-03-01DOI: 10.1016/j.rppede.2015.12.004
Alessandra Bernadete Trovó de Marqui, Roseane Lopes da Silva-Grecco, Marly Aparecida Spadotto Balarin
Objective
To assess the prevalence of Y-chromosome sequences and gonadoblastoma in patients with Turner syndrome (TS) using molecular techniques.
Data source
A literature search was performed in Pubmed, limiting the period of time to the years 2005–2014 and using the descriptors: TS and Y sequences (n=26), and TS and Y-chromosome material (n=27). The inclusion criteria were: articles directly related to the subject and published in English or Portuguese. Articles which did not meet these criteria and review articles were excluded. After applying these criteria, 14 papers were left.
Data synthesis
The main results regarding the prevalence of Y-chromosome sequences in TS were: (1) about 60% of the studies were conducted by Brazilian researchers; (2) the prevalence varied from 4.6 to 60%; (3) the most frequently investigated genes were SRY, DYZ3 and TSPY; (4) seven studies used only polymerase chain reaction, while in the remaining seven it was associated with FISH. Nine of the 14 studies reported gonadectomy and gonadoblastoma. The highest prevalence of gonadoblastoma (33%) was found in two studies. In five out of the nine papers evaluated the prevalence of gonadoblastoma was 10–25%; in two of them it was zero.
Conclusions
According to these data, molecular analysis to detect Y-chromosome sequences in TS patients is indicated, regardless of their karyotype. In patients who test positive for these sequences, gonadoblastoma needs to be investigated.
{"title":"Prevalence of Y-chromosome sequences and gonadoblastoma in Turner syndrome","authors":"Alessandra Bernadete Trovó de Marqui, Roseane Lopes da Silva-Grecco, Marly Aparecida Spadotto Balarin","doi":"10.1016/j.rppede.2015.12.004","DOIUrl":"10.1016/j.rppede.2015.12.004","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the prevalence of Y-chromosome sequences and gonadoblastoma in patients with Turner syndrome (TS) using molecular techniques.</p></div><div><h3>Data source</h3><p>A literature search was performed in Pubmed, limiting the period of time to the years 2005–2014 and using the descriptors: TS and Y sequences (n=26), and TS and Y-chromosome material (n=27). The inclusion criteria were: articles directly related to the subject and published in English or Portuguese. Articles which did not meet these criteria and review articles were excluded. After applying these criteria, 14 papers were left.</p></div><div><h3>Data synthesis</h3><p>The main results regarding the prevalence of Y-chromosome sequences in TS were: (1) about 60% of the studies were conducted by Brazilian researchers; (2) the prevalence varied from 4.6 to 60%; (3) the most frequently investigated genes were <em>SRY</em>, <em>DYZ3</em> and <em>TSPY</em>; (4) seven studies used only polymerase chain reaction, while in the remaining seven it was associated with FISH. Nine of the 14 studies reported gonadectomy and gonadoblastoma. The highest prevalence of gonadoblastoma (33%) was found in two studies. In five out of the nine papers evaluated the prevalence of gonadoblastoma was 10–25%; in two of them it was zero.</p></div><div><h3>Conclusions</h3><p>According to these data, molecular analysis to detect Y-chromosome sequences in TS patients is indicated, regardless of their karyotype. In patients who test positive for these sequences, gonadoblastoma needs to be investigated.</p></div>","PeriodicalId":101120,"journal":{"name":"Revista Paulista de Pediatria (English Edition)","volume":"34 1","pages":"Pages 114-121"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rppede.2015.12.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55271134","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}
Pub Date : 2016-03-01DOI: 10.1016/j.rppede.2015.12.006
Arthur Kummer , Izabela Guimarães Barbosa , David Henrique Rodrigues , Natália Pessoa Rocha , Marianna da Silva Rafael , Larissa Pfeilsticker , Ana Cristina Simões e Silva , Antônio Lúcio Teixeira
Objective
To assess the frequency of overweight and obesity in children and adolescents with autism spectrum disorder (ASD) and with attention deficit/hyperactivity disorder (ADHD) and their parents, in comparison with children and adolescents without developmental disorders.
Methods
Anthropometric measures were obtained in 69 outpatients with ASD (8.4±4.2 years old), 23 with ADHD (8.5±2.4) and 19 controls without developmental disorders (8.6±2.9) between August and November 2014. Parents of patients with ASD and ADHD also had their anthropometric parameters taken. Overweight was defined as a percentile ≥85; obesity as a percentile ≥95; and underweight as a percentile ≤5. For adults, overweight was defined as a BMI between 25 and 30kg/m2 and obesity as a BMI higher than 30kg/m2.
Results
Children and adolescents with ASD and ADHD had higher BMI percentile (p<0.01) and z-score (p<0.01) than controls, and increased frequency of overweight and obesity (p=0.04). Patients with ASD and ADHD did not differ between them in these variables, nor regarding abdominal circumference. Parents of children with ASD and ADHD did not differ between themselves.
Conclusions
Children and adolescents with ASD and ADHD are at a higher risk of overweight and obesity than children without developmental problems in the community.
{"title":"Frequency of overweight and obesity in children and adolescents with autism and attention deficit/hyperactivity disorder","authors":"Arthur Kummer , Izabela Guimarães Barbosa , David Henrique Rodrigues , Natália Pessoa Rocha , Marianna da Silva Rafael , Larissa Pfeilsticker , Ana Cristina Simões e Silva , Antônio Lúcio Teixeira","doi":"10.1016/j.rppede.2015.12.006","DOIUrl":"10.1016/j.rppede.2015.12.006","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the frequency of overweight and obesity in children and adolescents with autism spectrum disorder (ASD) and with attention deficit/hyperactivity disorder (ADHD) and their parents, in comparison with children and adolescents without developmental disorders.</p></div><div><h3>Methods</h3><p>Anthropometric measures were obtained in 69 outpatients with ASD (8.4±4.2 years old), 23 with ADHD (8.5±2.4) and 19 controls without developmental disorders (8.6±2.9) between August and November 2014. Parents of patients with ASD and ADHD also had their anthropometric parameters taken. Overweight was defined as a percentile ≥85; obesity as a percentile ≥95; and underweight as a percentile ≤5. For adults, overweight was defined as a BMI between 25 and 30kg/m<sup>2</sup> and obesity as a BMI higher than 30kg/m<sup>2</sup>.</p></div><div><h3>Results</h3><p>Children and adolescents with ASD and ADHD had higher BMI percentile (<em>p</em><0.01) and <em>z</em>-score (<em>p</em><0.01) than controls, and increased frequency of overweight and obesity (<em>p</em>=0.04). Patients with ASD and ADHD did not differ between them in these variables, nor regarding abdominal circumference. Parents of children with ASD and ADHD did not differ between themselves.</p></div><div><h3>Conclusions</h3><p>Children and adolescents with ASD and ADHD are at a higher risk of overweight and obesity than children without developmental problems in the community.</p></div>","PeriodicalId":101120,"journal":{"name":"Revista Paulista de Pediatria (English Edition)","volume":"34 1","pages":"Pages 71-77"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rppede.2015.12.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55271631","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}
Pub Date : 2016-03-01DOI: 10.1016/j.rppede.2015.12.007
Marisa Lima Carvalho
{"title":"Challenges on off label medicine use","authors":"Marisa Lima Carvalho","doi":"10.1016/j.rppede.2015.12.007","DOIUrl":"10.1016/j.rppede.2015.12.007","url":null,"abstract":"","PeriodicalId":101120,"journal":{"name":"Revista Paulista de Pediatria (English Edition)","volume":"34 1","pages":"Pages 1-2"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rppede.2015.12.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55271718","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}
Pub Date : 2016-03-01DOI: 10.1016/j.rppede.2015.06.019
Maria Estela Bellini Ribeiro, Raphael Del Roio Liberatore Junior, Rodrigo Custodio, Carlos Eduardo Martinelli Junior
Objective
To compare multiple doses of insulin and continuous insulin infusion therapy as treatment for type 1 diabetes mellitus.
Methods
40 patients with type 1 diabetes mellitus (21 female) with ages between 10 and 20 years (mean=14.2) and mean duration of diabetes of 7 years used multiple doses of insulin for at least 6 months and after that, continuous insulin infusion therapy for at least 6 months. Each one of the patients has used multiple doses of insulin and continuous insulin infusion therapy. For analysis of HbA1c, mean glycated hemoglobin levels (mHbA1c) were obtained during each treatment period (multiple doses of insulin and continuous insulin infusion therapy period).
Results
Although mHbA1c levels were lower during continuous insulin infusion therapy the difference was not statistically significant. During multiple doses of insulin, 14.2% had mHbA1c values below 7.5% vs. 35.71% while on continuous insulin infusion therapy; demonstrating better glycemic control with the use of continuous insulin infusion therapy. During multiple doses of insulin, 15–40 patients have severe hypoglycemic events versus 5–40 continuous insulin infusion therapy. No episodes of ketoacidosis events were recorded.
Conclusions
This is the first study with this design comparing multiple doses of insulin and continuous insulin infusion therapy in Brazil showing no significant difference in HbA1c; hypoglycemic events were less frequent during continuous insulin infusion therapy than during multiple doses of insulin and the percentage of patients who achieved a HbA1c less than 7.5% was greater during continuous insulin infusion therapy than multiple doses of insulin therapy.
{"title":"Continuous insulin therapy versus multiple insulin injections in the management of type 1 diabetes: a longitutinal study","authors":"Maria Estela Bellini Ribeiro, Raphael Del Roio Liberatore Junior, Rodrigo Custodio, Carlos Eduardo Martinelli Junior","doi":"10.1016/j.rppede.2015.06.019","DOIUrl":"10.1016/j.rppede.2015.06.019","url":null,"abstract":"<div><h3>Objective</h3><p>To compare multiple doses of insulin and continuous insulin infusion therapy as treatment for type 1 diabetes mellitus.</p></div><div><h3>Methods</h3><p>40 patients with type 1 diabetes mellitus (21 female) with ages between 10 and 20 years (mean=14.2) and mean duration of diabetes of 7 years used multiple doses of insulin for at least 6 months and after that, continuous insulin infusion therapy for at least 6 months. Each one of the patients has used multiple doses of insulin and continuous insulin infusion therapy. For analysis of HbA1c, mean glycated hemoglobin levels (mHbA1c) were obtained during each treatment period (multiple doses of insulin and continuous insulin infusion therapy period).</p></div><div><h3>Results</h3><p>Although mHbA1c levels were lower during continuous insulin infusion therapy the difference was not statistically significant. During multiple doses of insulin, 14.2% had mHbA1c values below 7.5% <em>vs</em>. 35.71% while on continuous insulin infusion therapy; demonstrating better glycemic control with the use of continuous insulin infusion therapy. During multiple doses of insulin, 15–40 patients have severe hypoglycemic events <em>versus</em> 5–40 continuous insulin infusion therapy. No episodes of ketoacidosis events were recorded.</p></div><div><h3>Conclusions</h3><p>This is the first study with this design comparing multiple doses of insulin and continuous insulin infusion therapy in Brazil showing no significant difference in HbA1c; hypoglycemic events were less frequent during continuous insulin infusion therapy than during multiple doses of insulin and the percentage of patients who achieved a HbA1c less than 7.5% was greater during continuous insulin infusion therapy than multiple doses of insulin therapy.</p></div>","PeriodicalId":101120,"journal":{"name":"Revista Paulista de Pediatria (English Edition)","volume":"34 1","pages":"Pages 86-90"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rppede.2015.06.019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55269179","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}
Pub Date : 2016-03-01DOI: 10.1016/j.rppede.2015.10.002
Marcos Moura de Almeida, Wládia Gislaynne de Sousa Tavares, Maria Mônica Alencar Araripe Furtado, Maria Marcia Farias Trajano Fontenele
Objective
To describe a case of neonatal atrial flutter after the insertion of an intracardiac umbilical venous catheter, reporting the clinical presentation and reviewing the literature on this subject.
Case description
A late-preterm newborn, born at 35 weeks of gestational age to a diabetic mother and large for gestational age, with respiratory distress and rule-out sepsis, required an umbilical venous access. After the insertion of the umbilical venous catheter, the patient presented with tachycardia. Chest radiography showed that the catheter was placed in the position that corresponds to the left atrium, and traction was applied. The patient persisted with tachycardia, and an electrocardiogram showed atrial flutter. As the patient was hemodynamically unstable, electric cardioversion was successfully applied.
Comments
The association between atrial arrhythmias and misplaced umbilical catheters has been described in the literature, but in this case, it is noteworthy that the patient was an infant born to a diabetic mother, which consists in another risk factor for heart arrhythmias. Isolated atrial flutter is a rare tachyarrhythmia in the neonatal period and its identification is essential to establish early treatment and prevent systemic complications and even death.
{"title":"Neonatal atrial flutter after insertion of an intracardiac umbilical venous catheter","authors":"Marcos Moura de Almeida, Wládia Gislaynne de Sousa Tavares, Maria Mônica Alencar Araripe Furtado, Maria Marcia Farias Trajano Fontenele","doi":"10.1016/j.rppede.2015.10.002","DOIUrl":"10.1016/j.rppede.2015.10.002","url":null,"abstract":"<div><h3>Objective</h3><p>To describe a case of neonatal atrial flutter after the insertion of an intracardiac umbilical venous catheter, reporting the clinical presentation and reviewing the literature on this subject.</p></div><div><h3>Case description</h3><p>A late-preterm newborn, born at 35 weeks of gestational age to a diabetic mother and large for gestational age, with respiratory distress and rule-out sepsis, required an umbilical venous access. After the insertion of the umbilical venous catheter, the patient presented with tachycardia. Chest radiography showed that the catheter was placed in the position that corresponds to the left atrium, and traction was applied. The patient persisted with tachycardia, and an electrocardiogram showed atrial flutter. As the patient was hemodynamically unstable, electric cardioversion was successfully applied.</p></div><div><h3>Comments</h3><p>The association between atrial arrhythmias and misplaced umbilical catheters has been described in the literature, but in this case, it is noteworthy that the patient was an infant born to a diabetic mother, which consists in another risk factor for heart arrhythmias. Isolated atrial flutter is a rare tachyarrhythmia in the neonatal period and its identification is essential to establish early treatment and prevent systemic complications and even death.</p></div>","PeriodicalId":101120,"journal":{"name":"Revista Paulista de Pediatria (English Edition)","volume":"34 1","pages":"Pages 132-135"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rppede.2015.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55270948","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}
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