Adriana de Oliveira Mukai

Análise espacial das internações por pneumonia na região do Vale do Paraíba (SP)

OBJECTIVE To identify spatial patterns in hospitalizations for pneumonia in infants under one year of age in the Vale do Paraíba region of Brazil. METHODS This was an ecological exploratory study using a georeferencing technique based on data from the Information Technology Department of the Brazilian Unified Health Care System on the number of hospitalizations for pneumonia among infants under one year of age in the Vale do Paraíba region between 2004 and 2005. Based on the distribution of the rates of hospitalizations for pneumonia per 1,000 live births, thematic maps were created. Morans spatial autocorrelation coefficient was estimated, and the cities with the highest rates were identified using box maps. RESULTS During the study period, 2,227 infants under one year of age were hospitalized for pneumonia. Morans coefficient was 0.37 (p = 0.02), demonstrating a spatial autocorrelation for these hospitalizations. Eight cities deserving special attention for future interventions were identified. CONCLUSIONS The spatial analysis was successful in determining the spatial autocorrelation, as well as in identifying the cities in which an intervention is necessary regarding the number of hospitalizations for pneumonia in infants under one year of age.

Chronic granulomatous disease (CGD): an immunodeficiency diagnosed in pediatric ICU

Background This paper aims at showing a severe case of a patient with Chronic Granulomatous Disease (CGD), an immunodeficiency which is not so uncommon, affecting 1/ 250000 born alive, and which is due to phagocytic dysfunction. It is characterized by inability of phagocytic cells to produce hydrogen peroxide and other oxidants needed to eliminate microorganisms, in addition there is excessive accumulation of immune cells into aggregates, known as granulomas, at sites of infection or inflammation. The patient may experience fungal or bacterial infections affecting the skin, lungs (Aspergillus pneumonias), lymph nodes, liver (liver abscesses 90% caused by Staphylococcus), bones (osteomyelitis), and granulomas which may lead to obstruction of gastrointestinal and urinary tracts.

Crescimento de lactentes durante o primeiro ano de vida

The aim of this study was to describe and analyse the profile of growth in normal infants during the first year of life, including their patterns of weight and length, and the duration of breastfeeding METHODS: This is a retrospective cohort study conducted based on 85 records of infants who met the inclusion criteria. The total duration of breastfeeding was recorded along with weight and length at three ages: birth, 6 and 12 months. The data were analysed as Z-scores based on WHO (2006) using the software products MedCalc 12.0 and GraphPad Prism 6.0 RESULTS: Although 76.5% of the infants showed a growth pattern compatible with WHO references at 12 months of age, the others presented as overweight as at risk of being overweight. A significant correlation was observed between birth weight and BMI Z-score at two ages: 6 months (r = 0.26; p = 0.01) and 12 months (r = 0.32; p = 0.002). A correlation between birth weight and length Z-score was also found at 6 months (r = 0.4034; p = 0.0001) and 12 months (r = 0.3309; p = 0.002). Birth length was also correlated with length Z-score at 6 months (r = 0.4829; p Analisar o perfil do crescimento durante o primeiro ano de vida em lactentes normais e suas relacoes com o peso e o comprimento ao nascer e com o aleitamento materno METODO: Estudo de coorte retrospectiva com levantamento de dados de prontuarios de 85 criancas que preencheram os criterios de inclusao. Registrou-se com peso e comprimento ao nascer, aos 6 e 12 meses de vida, e o tempo total de aleitamento materno. Os dados de crescimento foram analisados em escores z com base na referencia da OMS (2006), utilizando os softwares MedCalc 12.0 e GraphPad Prism 6.0 RESULTADOS: Aos 12 meses de vida 76,5% dos lactentes apresentavam valores de crescimento compativeis com o referencial da OMS, enquanto os demais estavam em risco de sobrepeso e sobrepeso. Observou-se correlacao entre o peso de nascimento e o escore z do Indice de Massa Corporal aos 6 meses (r = 0,26; p= 0,01) e aos 12 meses (r = 0,32; p = 0,002) e tambem com o escore z do comprimento para idade aos 6 (r = 0,4034; p = 0,0001) e 12 meses (r = 0,3309; p = 0,0020). O comprimento ao nascer tambem mostrou correlacao com o escore z de comprimento aos 6 (r = 0,4829; p

Relato de um caso de neutropenia congênita grave em um lactente jovem

OBJECTIVE: To report a case of severe congenital neutropenia and alert pediatricians about its diagnosis in young patients with recurrent infectious diseases. CASE DESCRIPTION: Young infant with 45 days of life, with a history of high fever, lethargy, poor feeding and repeated blood counts showing significant leucopenia due to a significant decrease of polymorphonuclear cells. The diagnosis was confirmed by bone marrow aspirate showing hypoplasia of the granulocytic series and complete absence of mature neutrophils. Treatment was started with broad-spectrum antibiotic therapy and granulocyte colony-stimulating factor, but the patient died due to infectious complications 21 days after hospital admission. COMMENTS: This is a young infant with a rare congenital disorder that leads to severe neutropenia and, therefore, susceptible to potentially fatal infections. In the hospital the infant showed signs and symptoms of sepsis. The diagnosis was based on the clinical history and the presence of repeated altered white cell counts and it was confirmed by bone marrow aspirate. Granulocyte colony-stimulating factor is generally effective, but, in this case, the patient died with a severe infection.

Hemangioendotelioma kaposiforme e síndrome de Kasabach-Merritt

To describe the clinical presentation of kaposiform hemangioendothelioma that was complicated by Kasabach-Merritt syndrome. CASE DESCRIPTION: A 45-day-old male infant presented fever, irritability and crying associated with the eruption of nodules in trunk and members. Soon after admission, the patient developed a consumptive coagulopathy, requiring admission in the Pediatric Intensive Care Unit (PICU). Computed tomography scans showed intra and extrapulmonary condensations suggestive of multiple thoracic hemangiomas, without the central nervous system and abdominal lesions. The diagnosis of Kasabach-Merritt syndrome in consequence of kaposiform hemagioendothelioma was established. Treatment option was conservative, including red blood cells, cryoprecipited, fresh frozen plasma and platelets transfusions associated to tranexamic acid and dexamethasone. After 20 days, patient recovered and he was discharged from PICU with significant remission of the hemangiomas. The child continued to receive tranexamic acid and prednisone at home, with weekly follow-up. COMMENTS: The disease presents quick and severe clinical course. Therefore, early diagnosis and treatment are needed to improve the outcome.