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OBJECTIVES: To define disease activity measures, muscle strength and functional assessments in new-onset juvenile dermatomyositis (JDM) patients, at disease onset and follow up. METHODS: A registry was set up in 18 hospitals, enrolling patients over 3-years (2015-2018). Clinical assessments were performed at baseline, and at 6, 12, 18 and 24 months after diagnosis. Disease Activity Score (DAS20), skin and musculoskeletal DAS sub-scales; Manual Muscle Test (MMT8); Childhood Myositis Assessment Scale (CMAS); Childhood Health Assessment Questionnaire disability index (CHAQ_DI 0-3) and 10 cm Visual Analog Scale (VAS) for overall wellbeing scores were compared by Poisson Model and Wald post-test for repeated measures. RESULTS: Ninety-six cases, being 61 (64%) females, median age 10 years had JDM diagnosis and 12 (13%) onset calcinosis. Mean ±SD scores at diagnosis and 6 months intervals for DAS20 (0-20) were 7.8±5, 6.3 ±4.8, 5±4, 4.9 ±5 and 0.5 ±2.3; with significant difference from baseline (p<0.01). Skin DAS subscales were 2.8±3.3, 1.8±2.9, 1,1±2.2, 0.6±1.8, 0.4±1.5. MMT (0-80) 62.6±20.4, 70.2±13.5, 73.3±11, 75.7±7.9 and 74.8±7.8, with significant difference from baseline up to 6 months (p=0.016); CMAS (0-53) 29.5±11.4, 33.1±8.3, 34.2±5.8, 34±6 and 33.3±5.4. CHAQ-DI (0-3) 1±0.9, 0.6±0.7, 0.8±0.8, 1±0.8 and 1±0.3; parents VAS 4.1±2.5, 2±2.1; 1.3±2.8, 4.1±3.1, 1.7±2.2. There was no significant difference for CMAS, CHAQ-DI and parents VAS from baseline up to 24-month assessment. CONCLUSIONS: DAS20 scores improved gradually during follow up, MMT8 improved significantly during the first 6 months and CMAS, CHAQ-DI and parents VAS scores had no significant improvement with persistent functional impairment over 2-years.
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BACKGROUND: Juvenile idiopathic arthritis (JIA) comprises a whole spectrum of chronic arthritis starting before 16 years of age. The study aims to explore the clinical and demographic descriptors, treatment, and disease progression of enthesitis-related arthritis (ERA) in comparison with juvenile-onset spondyloarthritis (SpA). METHODS: Cross-sectional analysis of consecutive patients in two dedicated clinics, with a single visit and retrospective case-notes review. Arthritis, enthesitis and sacroiliitis were evaluated by scoring disease activity and damage. Continuous variables were reported by median, interquartile range; categorical variables were reported by the frequency comparison of the two groups. RESULTS: Thirty-three cases were included, being 23 (69.7%) with ERA. The median age at diagnosis was 12.5 y (SpA) vs. 9 y (ERA) (p < 0.01); the time from symptom onset to diagnosis was 5.5 y (SpA) vs. 1.5 y (ERA) (p < 0.03). In both groups, the predominant presentation was a single joint or < 5 lower limb joints and asymmetric involvement, with a high frequency of enthesitis. There was a higher frequency of mid-tarsal and ankle synovitis in the ERA group and hip involvement in those with SpA. The comparison of the frequency of spine symptoms at presentation, 30% SpA vs. 21.7% ERA (p = 0.7), was not significant, and radiographic progression to spinal involvement occurred in 43.5% of ERA patients. The median time for spinal progression and age at onset was 2.2 and 12 y for ERA, and 4 and 16.5 y for SpA, respectively. Activity and damage scores were not significantly different between the groups. Treatment comparison resulted in 91.3% of ERA and 100% SpA being treated, predominantly with NSAIDs in both groups, followed by DMARDs and biologics, with a higher frequency of biologics in SpA. CONCLUSION: The main differences were the late diagnoses of SpA, and the hip and spine involvement, with higher frequency of biologic treatment in juvenile-onset SpA compared to ERA.
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Antirreumáticos , Artritis Juvenil , Progresión de la Enfermedad , Espondiloartritis , Humanos , Estudios Transversales , Artritis Juvenil/complicaciones , Artritis Juvenil/tratamiento farmacológico , Artritis Juvenil/diagnóstico , Niño , Adolescente , Femenino , Masculino , Estudios Retrospectivos , Espondiloartritis/complicaciones , Espondiloartritis/tratamiento farmacológico , Espondiloartritis/diagnóstico , Antirreumáticos/uso terapéutico , Entesopatía/etiología , Entesopatía/diagnóstico por imagen , Sacroileítis/diagnóstico por imagen , Edad de Inicio , AdultoRESUMEN
BACKGROUND: Increased malignancy frequency is well documented in adult-systemic lupus erythematosus (SLE), but with limited reports in childhood-onset SLE (cSLE) series. We explored the frequency of malignancy associated with cSLE, describing clinical and demographic characteristics, disease activity and cumulative damage, by the time of malignancy diagnosis. METHOD: A retrospective case-notes review, in a nationwide cohort from 27 Pediatric Rheumatology centres, with descriptive biopsy-proven malignancy, disease activity/damage accrual, and immunosuppressive treatment were compiled in each participating centre, using a standard protocol. RESULTS: Of the 1757 cSLE cases in the updated cohort, 12 (0.7%) developed malignancy with median time 10 years after cSLE diagnosis. There were 91% females, median age at cSLE diagnosis 12 years, median age at malignancy diagnosis 23 years. Of all diagnosed malignancies, 11 were single-site, and a single case with concomitant multiple sites; four had haematological (0.22%) and 8 solid malignancy (0.45%). Median (min-max) SLEDAI-2 K scores were 9 (0-38), median (min-max) SLICC/ACR-DI (SDI) score were 1 (1-5) Histopathology defined 1 Hodgkin's lymphoma, 2 non-Hodgkin's lymphoma, 1 acute lymphoblastic leukaemia; 4 gastrointestinal carcinoma, 1 squamous cell carcinoma of the tongue and 1 anal carcinoma; 1 had sigmoid adenocarcinoma and 1 stomach carcinoid; 3 had genital malignancy, being 1 vulvae, 1 cervix and 1 vulvae and cervix carcinomas; 1 had central nervous system oligodendroglioma; and 1 testicle germ cell teratoma. CONCLUSION: Estimated malignancy frequency of 0.7% was reported during cSLE follow up in a multicentric series. Median disease activity and cumulative damage scores, by the time of malignancy diagnoses, were high; considering that reported in adult series.
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Carcinoma , Lupus Eritematoso Sistémico , Niño , Femenino , Humanos , Masculino , Adulto Joven , Edad de Inicio , Carcinoma/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Estudios RetrospectivosRESUMEN
ABSTRACT Objective: To evaluate autoinflammatory diseases (AID) according to age at diagnosis and sex, and response to therapy in a large population. Methods: This is a cross-sectional observational study of a Latin American registry using a designed web system for data storage, collected between 2015 and 2018. Any altered findings during follow-up were recorded. The forms were translated into Portuguese and Spanish, including demographic, clinical, laboratory, genetic and treatment characteristics. Results: We included 152 patients, 51.3% male and 75% Caucasian. The median age at disease onset was 2.1 years (0-15.6 years) and median age at diagnosis 6.9 years (0-21.9 years); 111 (73%) were children (0-9 years old), and 41 (27%) were adolescents and young adults (AYA) (10-21 years old). Periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome (PFAPA) occurred in 46/152 (30%), chronic non-bacterial osteomyelitis (CNO) in 32/152 (21%), and familial Mediterranean fever (FMF) in 24/152 (15.7%). PFAPA was significantly higher in young children than in AYA (38.7% vs. 7.3%, p<0.001), while CNO were lower (13.5% vs. 41.5%, p<0.001). The frequency of females was significantly higher in CNO (28.4% vs. 14.1%, p=0.031) and lower in FMF (8.1% vs. 23.1%, p=0.011). The most used drugs were glucocorticoids, non-steroidal anti-inflammatory drugs (NSAID), and colchicine. Glucocorticoids and colchicine treatment were used in all AID with good to moderate response. However, cryopyrin-associated periodic syndromes (CAPS) seemed unresponsive to glucocorticoids. NSAIDs and methotrexate were the main medications used to treat CNO. Conclusions: Differences among AID patients were observed in the LA population regarding sex and age at disease diagnosis.
RESUMO Objetivo: Avaliar as doenças autoinflamatórias (DAI) de acordo com sexo e idade no momento do diagnóstico e a resposta terapêutica em uma grande população. Métodos: Este é um estudo observacional transversal de um registro latino-americano que usou um sistema de dados coletados entre 2015 e 2018. Quaisquer achados alterados ao longo do acompanhamento foram registrados. Os formulários foram traduzidos para os idiomas português e espanhol, incluindo características demográficas, clínicas, laboratoriais, genéticas e de tratamento. Resultados: Incluímos 152 pacientes, sendo 51,3% do sexo masculino e 75% da raça branca. A média de idade de início da doença foi de 2,1 anos (0-15,6 anos) e a média de idade de diagnóstico 6,9 anos (0-21,9 anos); 111 (73%) eram crianças (0-9 anos) e 41 (27%) adolescentes/adultos jovens (10-21 anos). A síndrome de febre periódica, estomatite aftosa, faringite e adenite (PFAPA) ocorreu em 46/152 (30%), osteomielite não bacteriana crônica (CNO) em 32/152 (21%) e febre familiar do Mediterrâneo (FMF) em 24/152 (15,7%). A PFAPA foi significativamente maior em crianças pequenas (38,7 vs. 7,3%, p<0,001), e a CNO, em adolescentes/adultos jovens (13,5 vs. 41,5%, p<0,001). A frequência do sexo feminino foi significativamente maior na CNO (28,4 vs. 14,1%, p=0,031) e menor na FMF (8,1 vs. 23,1%, p=0,011). Os medicamentos mais utilizados foram glicocorticoides, anti-inflamatórios não esteroidais (AINE) e colchicina. O tratamento com glicocorticoides e colchicina foi usado em todas as DAI com resposta boa a moderada. No entanto, as síndromes periódicas associadas à criopirina (CAPS) pareciam não responder aos glicocorticoides. AINE e metotrexato foram os principais medicamentos utilizados no tratamento da CNO. Conclusões: Diferenças de pacientes com DAI foram observadas na população latino-americana em pacientes agrupados por sexo e idade ao diagnóstico da doença.
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Abstract Background Increased malignancy frequency is well documented in adult-systemic lupus erythematosus (SLE), but with limited reports in childhood-onset SLE (cSLE) series. We explored the frequency of malignancy associated with cSLE, describing clinical and demographic characteristics, disease activity and cumulative damage, by the time of malignancy diagnosis. Method A retrospective case-notes review, in a nationwide cohort from 27 Pediatric Rheumatology centres, with descriptive biopsy-proven malignancy, disease activity/damage accrual, and immunosuppressive treatment were compiled in each participating centre, using a standard protocol. Results Of the 1757 cSLE cases in the updated cohort, 12 (0.7%) developed malignancy with median time 10 years after cSLE diagnosis. There were 91% females, median age at cSLE diagnosis 12 years, median age at malignancy diagnosis 23 years. Of all diagnosed malignancies, 11 were single-site, and a single case with concomitant multiple sites; four had haematological (0.22%) and 8 solid malignancy (0.45%). Median (min-max) SLEDAI-2 K scores were 9 (0-38), median (min-max) SLICC/ACR-DI (SDI) score were 1 (1-5) Histopathology defined 1 Hodgkin's lymphoma, 2 non-Hodgkin's lymphoma, 1 acute lymphoblastic leukaemia; 4 gastrointestinal carcinoma, 1 squamous cell carcinoma of the tongue and 1 anal carcinoma; 1 had sigmoid adenocarcinoma and 1 stomach carcinoid; 3 had genital malignancy, being 1 vulvae, 1 cervix and 1 vulvae and cervix carcinomas; 1 had central nervous system oligodendroglioma; and 1 testicle germ cell teratoma. Conclusion Estimated malignancy frequency of 0.7% was reported during cSLE follow up in a multicentric series. Median disease activity and cumulative damage scores, by the time of malignancy diagnoses, were high; considering that reported in adult series.
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The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Brazilian Portuguese language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability, and construct validity (convergent and discriminant validity). A total of 231 JIA patients (14.7% systemic, 43.3% oligoarticular, 22.5% RF negative polyarthritis, 19.5% other categories) and 72 healthy children, were enrolled in three centres. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed good psychometric performances. In conclusion, the Brazilian Portuguese version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.
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Artritis Juvenil/diagnóstico , Evaluación de la Discapacidad , Medición de Resultados Informados por el Paciente , Reumatología/métodos , Adolescente , Edad de Inicio , Artritis Juvenil/fisiopatología , Artritis Juvenil/psicología , Artritis Juvenil/terapia , Brasil , Estudios de Casos y Controles , Niño , Preescolar , Características Culturales , Femenino , Estado de Salud , Humanos , Masculino , Padres/psicología , Pacientes/psicología , Valor Predictivo de las Pruebas , Pronóstico , Psicometría , Calidad de Vida , Reproducibilidad de los Resultados , TraducciónRESUMEN
OBJECTIVE: To evaluate prevalence, clinical manifestations, laboratory abnormalities and treatment in a multicenter cohort study including 847 childhood-onset systemic lupus erythematosus (cSLE) patients with and without diffuse alveolar hemorrhage (DAH), as well as concomitant parameters of severity. METHODS: DAH was defined as the presence of at least three respiratory symptoms/signs associated with diffuse interstitial/alveolar infiltrates on chest x-ray or high-resolution computer tomography and sudden drop in hemoglobin levels. Statistical analysis was performed using Bonferroni correction (p < 0.0022). RESULTS: DAH was observed in 19/847 (2.2%) cSLE patients. Cough/dyspnea/tachycardia/hypoxemia occurred in all cSLE patients with DAH. Concomitant parameters of severity observed were: mechanical ventilation in 14/19 (74%), hemoptysis 12/19 (63%), macrophage activation syndrome 2/19 (10%) and death 9/19 (47%). Further analysis of cSLE patients at DAH diagnosis compared to 76 cSLE control patients without DAH with same disease duration [3 (1-151) vs. 4 (1-151) months, p = 0.335], showed higher frequencies of constitutional involvement (74% vs. 10%, p < 0.0001), serositis (63% vs. 6%, p < 0.0001) and sepsis (53% vs. 9%, p < 0.0001) in the DAH group. The median of disease activity score(SLEDAI-2 K) was significantly higher in cSLE patients with DAH [18 (5-40) vs. 6 (0-44), p < 0.0001]. The frequencies of thrombocytopenia (53% vs. 12%, p < 0.0001), intravenous methylprednisolone (95% vs. 16%, p < 0.0001) and intravenous cyclophosphamide (47% vs. 8%, p < 0.0001) were also significantly higher in DAH patients. CONCLUSIONS: This was the first study to demonstrate that DAH, although not a disease activity score descriptor, occurred in the context of significant moderate/severe cSLE flare. Importantly, we identified that this condition was associated with serious disease flare complicated by sepsis with high mortality rate.
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Hemorragia/etiología , Enfermedades Pulmonares/etiología , Lupus Eritematoso Sistémico/complicaciones , Alveolos Pulmonares , Edad de Inicio , Niño , Ciclofosfamida/uso terapéutico , Glucocorticoides/uso terapéutico , Hemoglobina A/análisis , Hemoptisis/etiología , Hemorragia/sangre , Hemorragia/diagnóstico por imagen , Humanos , Enfermedades Pulmonares/sangre , Enfermedades Pulmonares/diagnóstico por imagen , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/tratamiento farmacológico , Activación de Macrófagos , Metilprednisolona/uso terapéutico , Alveolos Pulmonares/diagnóstico por imagen , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Brote de los Síntomas , Trombocitopenia/etiologíaRESUMEN
Background: Wild animals bred in captivity may develop steatosis due to unbalanced dietary intake and obesity caused by sedentary behaviour. In some rural areas, six-banded armadillos are raised in captivity inside some metal barrels, with restricted space, and are often overfeed. After getting fattening, armadillos they are slaughtered and used as food. The unfavorable conditions may somehow contribute to likely underlie the development of many diseases, among them we can including hepatic steatosis. The present report aims to describe the pathological findings of hepatic lipidosis in banded armadillos (Euphractus sexcinctus), bred in captivity. Case: The animals were three female adult six-banded armadillos (Euphractus sexcinctus), caught in the native forest of the city of Natal, Rio Grande do Norte, Brazil and raised in domestic environment in a small enclosure and fed with human food leftovers. After eight months kept in these conditions armadillos had severe obesity and then were donated to the city zoo, where they were quarantined and presented clinical symptoms of anorexia for two weeks, weight loss and exhaustion. After being found dead during daily inspection carried out by the veterinarian zoo, the six-banded armadillos were sent to the Animal Pathology Laboratory of Federal Rural University of the Semi-Arid (UFERSA) for pathological examination. The animals [...]
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Animales , Hígado Graso/veterinaria , Hepatopatías/patología , Lipidosis/patología , Lipidosis/veterinaria , Armadillos , Lipólisis , Obesidad/veterinaria , Ácidos GrasosRESUMEN
Background: Wild animals bred in captivity may develop steatosis due to unbalanced dietary intake and obesity caused by sedentary behaviour. In some rural areas, six-banded armadillos are raised in captivity inside some metal barrels, with restricted space, and are often overfeed. After getting fattening, armadillos they are slaughtered and used as food. The unfavorable conditions may somehow contribute to likely underlie the development of many diseases, among them we can including hepatic steatosis. The present report aims to describe the pathological findings of hepatic lipidosis in banded armadillos (Euphractus sexcinctus), bred in captivity. Case: The animals were three female adult six-banded armadillos (Euphractus sexcinctus), caught in the native forest of the city of Natal, Rio Grande do Norte, Brazil and raised in domestic environment in a small enclosure and fed with human food leftovers. After eight months kept in these conditions armadillos had severe obesity and then were donated to the city zoo, where they were quarantined and presented clinical symptoms of anorexia for two weeks, weight loss and exhaustion. After being found dead during daily inspection carried out by the veterinarian zoo, the six-banded armadillos were sent to the Animal Pathology Laboratory of Federal Rural University of the Semi-Arid (UFERSA) for pathological examination. The animals [...](AU)
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Animales , Lipidosis/patología , Lipidosis/veterinaria , Hepatopatías/patología , Armadillos , Hígado Graso/veterinaria , Obesidad/veterinaria , Lipólisis , Ácidos GrasosRESUMEN
Leishmaniose Tegumentar Americana (LTA) constitui um problema de saúde pública emergente no Rio Grande do Norte, com relatos de casos humanos principalmente na Região Serrana do Alto Oeste do estado, uma vez que o cão tem um importante papel na manutenção da doença neste ambiente. O presente estudo teve por objetivo analisar prevalência da LTA canina em quatro localidades localizadas na Zona Rural do município de São Miguel, RN. Foram realizados exames clínicos e diagnóstico sorológico através das técnicas de ELISA e RIFI em 100 cães de diferentes sexo, idade e categorias companhia e de caça. Todas as localidades apresentaram cães soropositivos com resultados de 21% de positividade para a técnica de ELISA e 10% para a de RIFI. Maiores prevalências foram observadas em cães machos, assintomáticos, na faixa etária de dois anos de idade e de caça. O presente estudo confirma a importância epidemiológica como reservatório da infecção e poderá auxiliar nas medidas de prevenção e controle da doença no município. .
American Cutaneous Leishmaniasis ( ACL) is an emerging public health problem in Rio Grande do Norte , with reports of human cases mainly in the mountainous region of the Upper Midwest state . Once the dog has an important role in maintaining the disease in this environment the present study aimed to evaluate the prevalence of canine ACL at four sites located in the Rural Area of São Miguel , RN . Clinical and serological diagnosis through ELISA and IFA in 100 dogs of different sex, age and company categories and hunting were performed . All towns had seropositive dogs with results of 21 % positivity for ELISA and 10 % for the IFA. Highest prevalence rates were observed in males , healthy dogs aged two years old and hunting . The present study confirms the epidemiological importance as a reservoir of infection and may assist in the prevention and control of disease in the city.
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Animales , Pruebas Serológicas , Prevalencia , Leishmaniasis Cutánea , Perros , EpidemiologíaRESUMEN
A alimentação escolar tem a função de suprir parte das exigências nutricionais para o crescimento e o desenvolvimento do organismo, bem como a de proporcionar modelos de refeição de qualidade nutricional adequada e promover a formação de bons hábitos alimentares. O presente estudo objetivou avaliar a adequação da alimentação escolar de uma instituição de ensino do município de Bezerros, Pernambuco, frente às recomendações do Programa Nacional de Alimentação Escolar (PNAE) para os adolescentes. Foram analisadas 13 amostras e os dados observados foram comparados com os padrões estabelecidos pelo PNAE. Foram avaliados macronutrientes (carboidratos, proteínas, lipídios, gorduras saturadas e açúcares), energia, vitaminas A e C, ferro e sódio. Foi verificado que as calorias, os lipídios, as vitaminas A e C e o ferro atingiram valores abaixo do recomendado; já os teores de carboidratos, proteínas, gorduras saturadas e açúcares alcançaram valores acima do recomendado, ou seja, nenhum item verificado esteve adequado ao recomendado. Os resultados evidenciam a necessidade de adequações no conteúdo nutricional das preparações oferecidas aos escolares, uma vez que estas representam significativo complemento na alimentação diária para a população em questão.
School feeding has the function of supplying the nutritional requirements of organic growth and maintenance, as well as to provide models of appropriate nutritional meal quality and to promote the development of good eating habits. The present study aimed to evaluate the adequacy of school feeding in an educational institution in the city of Bezerros, Pernambuco, Brazil, regarding the recommendations of the National School Nutrition Program (PNAE) for teens. We analyzed 13 samples and the observed data were compared with the standards established by PNAE. We evaluated the macronutrients (carbohydrates, proteins, lipids, saturated fats and sugars), energy, vitamins A and C, iron and sodium. It was found that the calories, fats, vitamin A, vitamin C and iron reached values below the recommended, while carbohydrates, proteins, saturated fats and sugars reached values above recommended, that is, none of the items was in accordance with recommendations. The results highlight the need for adjustments in the nutritional content of preparations offered to students, since they represent a significant supplement to the daily diet for the population in question.
La alimentación escolar tiene la función de suministrar los requerimientos nutricionales de crecimiento orgánico y el mantenimiento, así como la de proporcionar modelos de calidad de comida nutritiva adecuada y promover el desarrollo de buenos hábitos de alimentación; por lo tanto, la adecuación de la comida dada al alumnado debe cumplir con tales funciones. El presente estudio tuvo como objetivo evaluar la adecuación de la alimentación escolar a una institución educativa en la ciudad de Bezerros, Pernambuco, Brazil. frente a las recomendaciones del Programa Nacional de Alimentación Escolar (PNAE) para los adolescentes. Se analizaron 13 muestras y los datos observados se compararon con las normas establecidas por el PNAE. Se evaluaron los macronutrientes (hidratos de carbono, proteínas, lípidos, grasas saturadas y azúcares), la energía, las vitaminas A y C, hierro y sodio. Se encontró que las calorías, grasas, vitamina A, vitamina C y hierro alcanzaron valores inferiores a lo recomendado, mientras que los hidratos de carbono, proteínas, grasas saturadas y azúcares alcanzaron valores superiores a lo recomendado, es decir, ningún ítem estuvo adecuado a lo recomendado. Los resultados destacan la necesidad de ajustes en el contenido nutricional de las preparaciones que se ofrecen a los estudiantes, ya que representan un complemento importante de la dieta diaria de la población en cuestión.
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Humanos , Alimentación Escolar , Adolescente , Composición de AlimentosRESUMEN
Leishmaniose Tegumentar Americana (LTA) constitui um problema de saúde pública emergente no Rio Grande do Norte, com relatos de casos humanos principalmente na Região Serrana do Alto Oeste do Estado. Uma vez que o cão tem um importante papel na manutenção da doença neste ambiente. O presente estudo teve por objetivo analisar prevalência da LTA canina em quatro localidades localizadas na Zona Rural do município de São Miguel, RN. Foram realizados exames clínicos e diagnóstico sorológico através das técnicas de ELISA e RIFI em 100 cães de diferentes sexo, idade e categorias companhia e de caça. Todas as localidades apresentaram cães soropositivos com resultados de 21% de positividade para a técnica de ELISA e 10% para a de RIFI. Maiores prevalências foram observadas em cães machos, assintomáticos, na faixa etária de dois anos de idade e de caça. O presente estudo confirma a importância epidemiológica como reservatório da infecção e poderá auxiliar nas medidas de prevenção e controle da doença no município.(AU)
American Cutaneous Leishmaniasis ( ACL) is an emerging public health problem in Rio Grande do Norte , with reports of humancases mainly in the mountainous region of the Upper Midwest state . Once the dog has an important role in maintaining the diseasein this environment the present study aimed to evaluate the prevalence of canine ACL at four sites located in the Rural Area of SãoMiguel , RN . Clinical and serological diagnosis through ELISA and IFA in 100 dogs of different sex, age and company categoriesand hunting were performed . All towns had seropositive dogs with results of 21 % positivity for ELISA and 10 % for the IFA.Highest prevalence rates were observed in males , healthy dogs aged two years old and hunting . The present study confirms theepidemiological importance as a reservoir of infection and may assist in the prevention and control of disease in the city.(AU)
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Animales , Perros , Leishmaniasis Cutánea/diagnóstico , Leishmaniasis Cutánea/veterinaria , Infecciones Protozoarias en Animales , Pruebas Serológicas/veterinaria , BrasilRESUMEN
Leishmaniose Tegumentar Americana (LTA) constitui um problema de saúde pública emergente no Rio Grande do Norte, com relatos de casos humanos principalmente na Região Serrana do Alto Oeste do Estado. Uma vez que o cão tem um importante papel na manutenção da doença neste ambiente. O presente estudo teve por objetivo analisar prevalência da LTA canina em quatro localidades localizadas na Zona Rural do município de São Miguel, RN. Foram realizados exames clínicos e diagnóstico sorológico através das técnicas de ELISA e RIFI em 100 cães de diferentes sexo, idade e categorias companhia e de caça. Todas as localidades apresentaram cães soropositivos com resultados de 21% de positividade para a técnica de ELISA e 10% para a de RIFI. Maiores prevalências foram observadas em cães machos, assintomáticos, na faixa etária de dois anos de idade e de caça. O presente estudo confirma a importância epidemiológica como reservatório da infecção e poderá auxiliar nas medidas de prevenção e controle da doença no município.
American Cutaneous Leishmaniasis ( ACL) is an emerging public health problem in Rio Grande do Norte , with reports of humancases mainly in the mountainous region of the Upper Midwest state . Once the dog has an important role in maintaining the diseasein this environment the present study aimed to evaluate the prevalence of canine ACL at four sites located in the Rural Area of SãoMiguel , RN . Clinical and serological diagnosis through ELISA and IFA in 100 dogs of different sex, age and company categoriesand hunting were performed . All towns had seropositive dogs with results of 21 % positivity for ELISA and 10 % for the IFA.Highest prevalence rates were observed in males , healthy dogs aged two years old and hunting . The present study confirms theepidemiological importance as a reservoir of infection and may assist in the prevention and control of disease in the city.
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Animales , Perros , Infecciones Protozoarias en Animales , Leishmaniasis Cutánea/diagnóstico , Leishmaniasis Cutánea/veterinaria , Brasil , Pruebas Serológicas/veterinariaRESUMEN
BACKGROUND: Muscle atrophy and asymmetric extremity growth is a common feature of linear scleroderma (LS). Extra-cutaneous features are also common and primary neurologic involvement, with sympathetic dysfunction, may have a pathogenic role in subcutaneous and muscle atrophy. The aim was investigate nerve conduction and muscle involvement by electromyography in pediatric patients with LS. METHODS: We conducted a retrospective review of LS pediatric patients who had regular follow up at a single pediatric center from 1997-2013. We selected participants if they had consistently good follow up and enrolled consecutive patients in the study. We examined LS photos as well as clinical, serological and imaging findings. Electromyograms (EMG) were performed with bilateral symmetric technique, using surface and needle electrodes, comparing the affected side with the contralateral side. Abnormal muscle activity was categorized as a myopathic or neurogenic pattern. RESULTS: Nine LS subjects were selected for EMG, 2 with Parry-Romberg/Hemifacial Atrophy Syndrome, 7 linear scleroderma of an extremity and 2 with mixed forms (linear and morphea). Electromyogram analysis indicated that all but one had asymmetric myopathic pattern in muscles underlying the linear streaks. Motor and sensory nerve conduction was also evaluated in upper and lower limbs and one presented a neurogenic pattern. Masticatory muscle testing showed a myopathic pattern in the atrophic face of 2 cases with head and face involvement. CONCLUSION: In our small series of LS patients, we found a surprising amount of muscle dysfunction by EMG. The muscle involvement may be possibly related to a secondary peripheral nerve involvement due to LS inflammation and fibrosis. Further collaborative studies to confirm these findings are needed.
Asunto(s)
Deformidades Adquiridas del Pie/prevención & control , Deformidades Adquiridas de la Mano/prevención & control , Músculo Esquelético , Atrofia Muscular , Esclerodermia Localizada , Preescolar , Estudios Transversales , Diagnóstico Precoz , Intervención Médica Temprana , Electromiografía/métodos , Femenino , Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas de la Mano/etiología , Humanos , Masculino , Músculo Esquelético/inervación , Músculo Esquelético/patología , Músculo Esquelético/fisiopatología , Atrofia Muscular/diagnóstico , Atrofia Muscular/etiología , Atrofia Muscular/fisiopatología , Conducción Nerviosa/fisiología , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Esclerodermia Localizada/complicaciones , Esclerodermia Localizada/diagnóstico , Esclerodermia Localizada/fisiopatología , Esclerodermia Localizada/terapiaRESUMEN
Serum retinol concentrations were compared in a consecutive series of 65 mother-newborn pairs at delivery in a public maternity hospital in Recife, Brazil, from January to August 2008 and examined their association with biological, socioeconomic, environmental and obstetrical characteristics. Serum retinol concentrations of the newborns (umbilical cord) and mothers (brachial venipuncture) were analyzed by high-performance liquid chromatography. Prevalence of low (< 0.70 micromol/L) and inadequate (< 1.05 micromol/L) serum retinol concentrations were observed in 23.1% (95% CI 13.9-35.5) and 23.0% (95% CI 13.5-35.8) among newborns and mothers respectively. The serum retinol distribution was lower in male than female infants (-0.4 micromol/L, p = 0.01) and, across both sexes, concentrations in paired newborn and mother were correlated (r = 0.27, p = 0.04). Further, maternal status explains only 7% of the variance in retinol concentrations in newborn's cord plasma. Among mothers delivering in public facilities in Recife, hypovitaminosis may exist.
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Maternidades , Hospitales Públicos , Madres/estadística & datos numéricos , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/epidemiología , Vitamina A/sangre , Adulto , Brasil/epidemiología , Cromatografía Líquida de Alta Presión/métodos , Femenino , Humanos , Recién Nacido , Masculino , Estado Nutricional , Prevalencia , Distribución por Sexo , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
INTRODUCTION: Paediatric rheumatology (PR) is an emerging specialty, practised by a limited number of specialists. Currently, there is neither a record of the profile of rheumatology patients being treated in Brazil nor data on the training of qualified rheumatology professionals in the country. OBJECTIVE: To investigate the profile of PR specialists and services, as well as the characteristics of paediatric patients with rheumatic diseases, for estimating the current state of rheumatology in the state of São Paulo. PATIENTS AND METHODS: In 2010, the scientific department of PR of the Paediatric Society of São Paulo administered a questionnaire that was answered by 24/31 accredited specialists in PR practising in state of São Paulo and by 8/21 institutions that provide PR care. RESULTS: Most (91%) of the surveyed professionals practise in public institutions. Private clinics (28.6%) and public institutions (37.5%) reported not having access to nailfold capillaroscopy, and 50% of the private clinics reported not having access to acupuncture. The average duration of professional practise in PR was 9.4 years, and 67% of the physicians had attended postgraduate programmes. Seven (87.5%) public institutions perform teaching activities, in which new paediatric rheumatologists are trained, and five (62.5%) offer postgraduate programmes. Two-thirds of the surveyed specialists use immunosuppressants and biological agents classified as "restricted use" by the Health Secretariat. The disease most frequently reported was juvenile idiopathic arthritis (29.1-34.5%), followed by juvenile systemic lupus erythematosus (JSLE) (11.6-12.3%) and rheumatic fever (9.1-15.9%). The incidence of vasculitis (including Henoch-Schönlein purpura, Wegener's granulomatosis, and Takayasu's arteritis) and autoinflammatory syndromes was higher in public institutions compared to other institutions (P = 0.03, P = 0.04, P = 0.002, and P < 0.0001, respectively). Patients with JSLE had the highest mortality rate (68% of deaths), mainly due to infection. CONCLUSION: The field of PR in the state of São Paulo has a significant number of specialists with postgraduate degrees who mostly practise at teaching institutions with infrastructures appropriate for the care of high-complexity patients.
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Pediatría/estadística & datos numéricos , Reumatología/estadística & datos numéricos , Brasil , Niño , Humanos , Estudios Retrospectivos , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/terapia , Encuestas y CuestionariosRESUMEN
INTRODUÇÃO: A reumatologia pediátrica (RP) é uma especialidade emergente, com número restrito de especialistas, e ainda não conta com uma casuística brasileira sobre o perfil dos pacientes atendidos e as informações sobre a formação de profissionais capacitados. OBJETIVO: Estudar o perfil dos especialistas e dos serviços em RP e as características dos pacientes com doenças reumáticas nessa faixa etária a fim de estimar a situação atual no estado de São Paulo (ESP). PACIENTES E MÉTODOS: No ano de 2010 o departamento científico de RP da Sociedade de Pediatria de São Paulo encaminhou um questionário respondido por 24/31 especialistas com título de especialização em RP que atuam no ESP e por 8/12 instituições com atendimento nesta especialidade. RESULTADOS: A maioria (91%) dos profissionais exerce suas atividades em instituições públicas. Clínicas privadas (28,6%) e instituições (37,5%) relataram não ter acesso ao exame de capilaroscopia e 50% das clínicas privadas não tem acesso à acupuntura. A média de tempo de prática profissional na especialidade foi de 9,4 anos, sendo 67% deles pós-graduados. Sete (87,5%) instituições públicas atuam na área de ensino, formando novos reumatologistas pediátricos. Cinco (62,5%) delas têm pós-graduação. Dois terços dos especialistas utilizam imunossupressores e agentes biológicos de uso restrito pela Secretaria da Saúde. A doença mais atendida foi artrite idiopática juvenil (29,1%-34,5%), seguida de lúpus eritematoso sistêmico juvenil (LESJ) (11,6%-12,3%) e febre reumática (9,1%-15,9%). Vasculites (púrpura de Henoch Schönlein, Wegener, Takayasu) e síndromes autoinflamatórias foram mais incidentes nas instituições públicas (P = 0,03; P = 0,04; P = 0,002 e P < 0,0001, respectivamente). O LESJ foi a doença com maior mortalidade (68% dos óbitos), principalmente por infecção. CONCLUSÃO: A RP no ESP conta com um número expressivo de especialistas pós-graduados, que atuam especialmente em instituições de ensino, com infraestrutura adequada ao atendimento de pacientes de alta complexidade.
INTRODUCTION: Paediatric rheumatology (PR) is an emerging specialty, practised by a limited number of specialists. Currently, there is neither a record of the profile of rheumatology patients being treated in Brazil nor data on the training of qualified rheumatology professionals in the country. OBJECTIVE: To investigate the profile of PR specialists and services, as well as the characteristics of paediatric patients with rheumatic diseases, for estimating the current state of rheumatology in the state of São Paulo. PATIENTS AND METHODS: In 2010, the scientific department of PR of the Paediatric Society of São Paulo administered a questionnaire that was answered by 24/31 accredited specialists in PR practising in state of São Paulo and by 8/21 institutions that provide PR care. RESULTS: Most (91%) of the surveyed professionals practise in public institutions. Private clinics (28.6%) and public institutions (37.5%) reported not having access to nailfold capillaroscopy, and 50% of the private clinics reported not having access to acupuncture. The average duration of professional practise in PR was 9.4 years, and 67% of the physicians had attended postgraduate programmes. Seven (87.5%) public institutions perform teaching activities, in which new paediatric rheumatologists are trained, and five (62.5%) offer postgraduate programmes. Two-thirds of the surveyed specialists use immunosuppressants and biological agents classified as "restricted use" by the Health Secretariat. The disease most frequently reported was juvenile idiopathic arthritis (29.1-34.5%), followed by juvenile systemic lupus erythematosus (JSLE) (11.6-12.3%) and rheumatic fever (9.1-15.9%). The incidence of vasculitis (including Henoch-Schönlein purpura, Wegener's granulomatosis, and Takayasu's arteritis) and autoinflammatory syndromes was higher in public institutions compared to other institutions (P = 0.03, P = 0.04, P = 0.002, and P < 0.0001, respectively). Patients with JSLE had the highest mortality rate (68% of deaths), mainly due to infection. CONCLUSION: The field of PR in the state of São Paulo has a significant number of specialists with postgraduate degrees who mostly practise at teaching institutions with infrastructures appropriate for the care of high-complexity patients.
Asunto(s)
Niño , Humanos , Pediatría/estadística & datos numéricos , Reumatología/estadística & datos numéricos , Brasil , Estudios Retrospectivos , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/terapia , Encuestas y CuestionariosRESUMEN
Objective. To measure concentrations of serum retinol in children after the use of maternal vitamin A double megadose supplements. Design. Randomized controlled clinical trial. Setting. The study was conducted at two maternity hospitals in the city of Recife, in the northeast region of Brazil between August 2007 and June 2009. Subjects and Methods. 276 children/mothers were recruited after birth and the women received a 200,000 IU capsule of vitamin A. After ten days they were randomly assigned to two treatment groups. One group received a second 200.000 IU capsule, while the other received a placebo. The concentrations of retinol in the serum of the children from each group were measured at 2, 4, and 6 months. Results. 173 children completed the study. There was no difference between the two treatment groups (P = 0.514). The mean base retinol level was lower than that at four and six months (P < 0.001). Conclusions. The maternal double megadose supplement had no additional effect on the serum retinol levels of the children, although concentrations of retinol in the children rose in the first six months of life. This trial is registered with NCT00742937.
RESUMEN
BACKGROUND AND OBJECTIVE: Postpartum vitamin A supplementation is a strategy used to combat vitamin A deficiency and seems to reduce maternal/infant morbidity and mortality. However, studies have shown that a dose of 200 000 IU (World Health Organization [WHO] protocol) does not seem to provide adequate retinol levels in maternal breast milk, infant serum, and infant tissue. The objective of this study was to compare the effect of postpartum maternal supplementation with 400 000 IU (International Vitamin A Consultative Group protocol) compared with 200 000 IU of vitamin A on infant morbidity. METHODS: This was a randomized controlled, triple-blinded clinical trial conducted at 2 public maternity hospitals in Recife in northeastern Brazil. There were 276 mother-child pairs that were allocated to 2 treatment groups: 400 000 IU or 200 000 IU of vitamin A. They were followed up for >6 months to evaluate infant morbidity. RESULTS: Fever (rate ratio [RR]: 0.92 [95% confidence interval (CI): 0.75-1.14]), diarrhea (RR: 0.96 [95% CI: 0.72-1.28]), otitis (RR: 0.94 [95% CI: 0.48-1.85]), acute respiratory infection (RR: 1.03 [95% CI: 0.88-1.21]), the need for intravenous rehydration (RR: 2.08 [95% CI: 0.64-2.07]), and the use of antibiotic treatment (RR: 0.80 [95% CI: 0.43-1.47]) did not differ significantly between the 2 treatment groups. CONCLUSIONS: Our findings suggest that postpartum maternal supplementation with 400 000 IU of vitamin A does not provide any additional benefits in the reduction of illness in children aged <6 months; therefore, we do not support the proposal to increase the standard vitamin A dose in the existing WHO protocol.
Asunto(s)
Diarrea Infantil/prevención & control , Suplementos Dietéticos , Deficiencia de Vitamina A/tratamiento farmacológico , Vitamina A/administración & dosificación , Administración Oral , Adulto , Brasil/epidemiología , Diarrea Infantil/epidemiología , Diarrea Infantil/metabolismo , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Leche Humana/química , Morbilidad/tendencias , Periodo Posparto , Resultado del Tratamiento , Vitamina A/farmacocinética , Deficiencia de Vitamina A/epidemiología , Vitaminas/administración & dosificación , Vitaminas/farmacocinética , Adulto JovenRESUMEN
Realizou-se revisão sistemática de estudos avaliativos da aplicação de megadoses de vitamina A nas concentrações de retinol no sangue e no leite maternos como medida de curto prazo para a prevenção de hipovitaminose A. Com base na estratégia do Centro Cochrane do Brasil para ensaios clínicos aleatórios foram identificadas 115 publicações no PubMed, entre as quais, por um conjunto de critérios de inclusão/exclusão, foram selecionados 14 artigos publicados entre 1993 a 2007. O efeito das intervenções com três esquemas posológicos (200.000, 300.000 e 400.000 UI) de vitamina A foram analisados. Dos 11 experimentos realizados em leite materno, nove apresentaram elevação dos níveis de retinol em comparação com o grupo controle; dos nove que avaliaram sangue materno, quatro mostraram elevação após tempos variados de aplicação de megadoses de vitamina A. Conclui-se que a administração de vitamina A em elevadas doses foi positiva em 82 por cento dos ensaios com leite materno, mas menos notáveis em comparação ao sangue materno. Não foram observadas diferenças significativas quanto à posologia aplicada.
A systematic review on studies evaluating the effect of applying megadoses of vitamin A on the retinol concentrations in maternal milk and blood, as a short-term measure for preventing hypovitaminosis A, was conducted. Based on the strategy of the Brazilian Cochrane Center for randomized trials, 115 published papers were identified in PubMed. From these, through a set of inclusion/exclusion criteria, 14 articles published between 1993 and 2007 were selected. The effects of interventions with three posological regimens (200,000, 300,000 and 400,000 IU) of vitamin A were analyzed. Out of 11 experiments conducted on maternal milk, nine presented elevation of the retinol levels in comparison with the control group; out of nine that evaluated maternal blood, four showed elevation at varying times after applying megadoses of vitamin A. It was concluded that the results from administration of vitamin A at high doses were positive in 82 percent of the trials on maternal milk, but less notable in relation to maternal blood. No significant differences regarding the posological regimens applied were observed.
Se realizó revisión sistemática de estudios evaluativos de la aplicación de megadosis de vitamina A en las concentraciones de retinol en la sangre y en la leche maternos como medida de corto plazo para la prevención de hipovitaminosis A. Con base en la estratégia del Centro Cochrane de Brasil para ensayos clínicos aleatorios fueron identificadas 115 publicaciones en el PubMed, entre las cuales, por un conjunto de criterios de inclusión/exclusión, fueron seleccionados 14 artículos publicados entre 1993 a 2007. El efecto de las intervenciones con tres esquemas posológicos (200.000. 300.000 y 400.000 UI) de vitamina A fueron analizados. De los 11 experimentos realizados en leche materna, nueve presentaron elevación de los niveles de retinol en comparación con el grupo control; de los nueve que evaluaron sangre materna, cuatro mostraron elevación posterior a tiempos variados de aplicación de megadosis de vitamina A. Se concluye que la administración de vitamina A en elevadas dosis fue positiva en 82 por ciento de los ensayos con leche materna, pero menos notables en comparación a la sangre materna. No fueron observadas diferencias significativas con relación a la posología aplicada.