Antonio Geraldo Cidrão de Carvalho

Diagnosis of iron deficiency anemia in children of Northeast Brazil

OBJECTIVE To diagnose iron deficiency anemia in children. METHODS The study was conducted with a sample of 301 children aged six to 30 months attending public daycare centers in the city of Recife, Northeast Brazil, in 2004. The diagnoses of anemia were based on a combination of different hematological and biochemical parameters: hemoglobin, mean corpuscular volume, ferritin, C-reactive protein, transferrin saturation and transferrin receptor. The chi-square test and ANOVA were used in the statistical analysis. RESULTS Of all children studied, 92.4% had anemia (Hb<110 g/L) and 28.9% had moderate/severe anemia (Hb<90 g/L). Lower levels of hemoglobin were found in children aged 6-17 months. Iron deficiency was found in 51.5% of children using ferritin (<12 microg/L) as parameter. Taking into consideration the combination of hemoglobin level, ferritin and transferrin receptor, 58.1% had anemia with iron deficiency, 34.2% had anemia without iron deficiency and 2.3% had iron deficiency without anemia. Mean ferritin concentration was significantly higher in children with high C-reactive protein when compared with those with normal levels (22.1 vs. 14.8 microg/L). CONCLUSIONS The use of several biochemical and hematological parameters allowed to diagnosing iron deficiency anemia in two thirds of children, suggesting a need to identify other determinants of anemia without iron deficiency.OBJETIVO: Diagnosticar anemia por deficiencia de ferro em criancas. METODOS: O estudo foi desenvolvido com uma amostra de 301 criancas com idade entre seis e 30 meses, usuarias de creches publicas de Recife, PE, em 2004. Para o diagnostico da anemia utilizou-se a combinacao de diferentes parâmetros hematologicos e bioquimicos: hemoglobina, volume corpuscular medio, ferritina, proteina C-reativa, saturacao da transferrina e receptor da transferrina. Para a analise estatistica empregou-se o teste do qui-quadrado e ANOVA. RESULTADOS: Do total de criancas, 92,4% tinha anemia (Hb < 110g/L) e 28,9% apresentou anemia moderada/grave (Hb<90g/L). Niveis mais baixos de hemoglobina foram observados em criancas de seis a 17 meses. Encontrou-se deficiencia de ferro em 51,5% das criancas, utilizando-se a ferritina (< 12µg/L) como parâmetro. Considerando a combinacao da concentracao de hemoglobina, ferritina e do receptor de transferrina, 58,1% tinha anemia com deficiencia de ferro, 34,2% anemia sem deficit de ferro e 2,3% deficiencia de ferro sem anemia. A concentracao media de ferritina foi significativamente maior em criancas com proteina C-reativa aumentada quando comparada com aqueles com niveis normais (22,1 versus 14,8 µg/L). CONCLUSOES: A utilizacao de diversos parâmetros bioquimicos e hematologicos possibilitou diagnosticar anemia por deficiencia de ferro em dois tercos das criancas, revelando a necessidade de identificar outros determinantes de anemia sem deficiencia de ferro.

Fatores associados ao estado nutricional em criancas de creches publicas do municipio de Recife, PE, Brasil

OBJECTIVE To evaluate the nutritional status of infants attending daycare centers in the Municipality of Recife and to verify its association with potential determinant factors. METHODS This is a cross sectional study conducted with 321 infants in the age group of 6 to 30 months from August to October 2004. The nutritional status was assessed through length-for-age, weight-for-age, weight-for-length and body mass index-for-age using as reference pattern that of the World Health Organization. Multivariable linear regression analysis assessed the effect of maternal socioeconomic and demographical indicators, and child related variables on infant length-for-age. RESULTS The percentages of malnutrition (Z score < -2) were found in 13.4%, 2.8%, 0.6% and 0.6% for length-for-age, weight-for-age, weight-for-length and body mass index-for-age, respectively. The final model of the linear multivariable regression analysis showed that the socioeconomic (type of roof and water supply) and child biological conditions (birthweight, age and hemoglobin concentration) were the variables that significantly influenced the variation of length-for-age, explaining 3.8% and 12.8%, respectively. CONCLUSION Among the studied variables, child biological factors had a higher influence in the variation of length-for-age than the socioeconomic ones.

Diagnóstico de anemia por deficiência de ferro em crianças do Nordeste do Brasil

OBJECTIVE To diagnose iron deficiency anemia in children. METHODS The study was conducted with a sample of 301 children aged six to 30 months attending public daycare centers in the city of Recife, Northeast Brazil, in 2004. The diagnoses of anemia were based on a combination of different hematological and biochemical parameters: hemoglobin, mean corpuscular volume, ferritin, C-reactive protein, transferrin saturation and transferrin receptor. The chi-square test and ANOVA were used in the statistical analysis. RESULTS Of all children studied, 92.4% had anemia (Hb<110 g/L) and 28.9% had moderate/severe anemia (Hb<90 g/L). Lower levels of hemoglobin were found in children aged 6-17 months. Iron deficiency was found in 51.5% of children using ferritin (<12 microg/L) as parameter. Taking into consideration the combination of hemoglobin level, ferritin and transferrin receptor, 58.1% had anemia with iron deficiency, 34.2% had anemia without iron deficiency and 2.3% had iron deficiency without anemia. Mean ferritin concentration was significantly higher in children with high C-reactive protein when compared with those with normal levels (22.1 vs. 14.8 microg/L). CONCLUSIONS The use of several biochemical and hematological parameters allowed to diagnosing iron deficiency anemia in two thirds of children, suggesting a need to identify other determinants of anemia without iron deficiency.OBJETIVO: Diagnosticar anemia por deficiencia de ferro em criancas. METODOS: O estudo foi desenvolvido com uma amostra de 301 criancas com idade entre seis e 30 meses, usuarias de creches publicas de Recife, PE, em 2004. Para o diagnostico da anemia utilizou-se a combinacao de diferentes parâmetros hematologicos e bioquimicos: hemoglobina, volume corpuscular medio, ferritina, proteina C-reativa, saturacao da transferrina e receptor da transferrina. Para a analise estatistica empregou-se o teste do qui-quadrado e ANOVA. RESULTADOS: Do total de criancas, 92,4% tinha anemia (Hb < 110g/L) e 28,9% apresentou anemia moderada/grave (Hb<90g/L). Niveis mais baixos de hemoglobina foram observados em criancas de seis a 17 meses. Encontrou-se deficiencia de ferro em 51,5% das criancas, utilizando-se a ferritina (< 12µg/L) como parâmetro. Considerando a combinacao da concentracao de hemoglobina, ferritina e do receptor de transferrina, 58,1% tinha anemia com deficiencia de ferro, 34,2% anemia sem deficit de ferro e 2,3% deficiencia de ferro sem anemia. A concentracao media de ferritina foi significativamente maior em criancas com proteina C-reativa aumentada quando comparada com aqueles com niveis normais (22,1 versus 14,8 µg/L). CONCLUSOES: A utilizacao de diversos parâmetros bioquimicos e hematologicos possibilitou diagnosticar anemia por deficiencia de ferro em dois tercos das criancas, revelando a necessidade de identificar outros determinantes de anemia sem deficiencia de ferro.

Constraint-Induced Movement Therapy Combined with Transcranial Direct Current Stimulation over Premotor Cortex Improves Motor Function in Severe Stroke: A Pilot Randomized Controlled Trial

Objective. We compared the effects of transcranial direct current stimulation at different cortical sites (premotor and motor primary cortex) combined with constraint-induced movement therapy for treatment of stroke patients. Design. Sixty patients were randomly distributed into 3 groups: Group A, anodal stimulation on premotor cortex and constraint-induced movement therapy; Group B, anodal stimulation on primary motor cortex and constraint-induced movement therapy; Group C, sham stimulation and constraint-induced movement therapy. Evaluations involved analysis of functional independence, motor recovery, spasticity, gross motor function, and muscle strength. Results. A significant improvement in primary outcome (functional independence) after treatment in the premotor group followed by primary motor group and sham group was observed. The same pattern of improvement was highlighted among all secondary outcome measures regarding the superior performance of the premotor group over primary motor and sham groups. Conclusions. Premotor cortex can contribute to motor function in patients with severe functional disabilities in early stages of stroke. This study was registered in ClinicalTrials.gov database (NCT 02628561).

Sociodemographic indicators and quality of life of caregivers of children with neuromotor changes.

Introduction: Children with neuromotor changes are challenged daily, and such challenges may be faced with the help of a caregiver. Thus, the functional dependence of these children lead to the daily demands, causing physical and emotional distress, which affect the quality of life of their caregiver. Objective: Analyze the sociodemographic indicators that interfere with the level of life quality of the caregivers of children with neuromotor changes. Method: 50 caregivers of children with neuromotor changes were interviewed at the Association of Parents and Friends of the Exceptional (APAE) of Paraiba, on the city of Joao Pessoa. To evaluate the quality of life, the questionnaire SF-36 was used, in addition to collecting demographic data (sex, age, degree of kinship, marital status, number of children, school level and religion). For the data analysis, a descriptive study was developed, the normality test of Shapiro-Wilk was realized, followed by the inferential analysis with non-parametric correlation of Spearman, considering the significant value α = 0,05. Results: There was a predominance of the female sex (96%) with medium age of ≥ 39 years old. Correlating the sociodemographic indicators with the level of life quality of the SF-36 of the caregivers, only the vitality domain presented significance with the variables: number of children (p=0,012), benefits (p=0,044), and how the transfer of the child is done (p=0,044). There was no significant difference relating the sociodemographic indicators on the other domains. Conclusion: The knowledge of sociodemographic indicators that interfere with the quality of life shows the importance of preventive measures, such as guidance and, if needed, treatment for improvement of possible grievances.

Musculoskeletal disorders in manual therapistis.

Introduction : Musculoskeletal Disorders (MDEs) are inflammatories and degenerative diseases that are a public health problem. In recent years among registered occupational diseases worldwide are the most prevalent, affecting the quality of life of individuals. Objective: To investigate the occurrence and characteristics of MDEs on physiotherapists who use manual therapy techniques in Recife-Pernambuco. Method: 34 therapists of both genders responded standardized questionnaire (demographic characteristics and complaints of musculoskeletal diseases) in regular time and in the workplace (public and private health services). Data were analyzed by chi-square test ((c 2 ), a significance level of 95% (p <0.05), BioEstat program version 3.0. Results: It was found that 88.2% of the sample refers to any type of MDEs, but the spine (76.6%) and upper (70.6%) were most often affected, especially wrists and hands (56,7% ).There were no significant correlations between MDEs and gender of the therapist and not with the playing time (years) profession, however the occurrence of these disturbances was correlated to the age of the professional. There was a direct relationship between workload and the presence of DMEs. Conclusion: The results indicate that the manual therapists in the performance of intense activity partners have high percentages of involvement by musculoskeletal disorders, requiring preventive ergonomic measures.

Diagnóstico de anemia por deficiencia de hierro en niños del Noreste de Brasil

OBJECTIVE To diagnose iron deficiency anemia in children. METHODS The study was conducted with a sample of 301 children aged six to 30 months attending public daycare centers in the city of Recife, Northeast Brazil, in 2004. The diagnoses of anemia were based on a combination of different hematological and biochemical parameters: hemoglobin, mean corpuscular volume, ferritin, C-reactive protein, transferrin saturation and transferrin receptor. The chi-square test and ANOVA were used in the statistical analysis. RESULTS Of all children studied, 92.4% had anemia (Hb<110 g/L) and 28.9% had moderate/severe anemia (Hb<90 g/L). Lower levels of hemoglobin were found in children aged 6-17 months. Iron deficiency was found in 51.5% of children using ferritin (<12 microg/L) as parameter. Taking into consideration the combination of hemoglobin level, ferritin and transferrin receptor, 58.1% had anemia with iron deficiency, 34.2% had anemia without iron deficiency and 2.3% had iron deficiency without anemia. Mean ferritin concentration was significantly higher in children with high C-reactive protein when compared with those with normal levels (22.1 vs. 14.8 microg/L). CONCLUSIONS The use of several biochemical and hematological parameters allowed to diagnosing iron deficiency anemia in two thirds of children, suggesting a need to identify other determinants of anemia without iron deficiency.OBJETIVO: Diagnosticar anemia por deficiencia de ferro em criancas. METODOS: O estudo foi desenvolvido com uma amostra de 301 criancas com idade entre seis e 30 meses, usuarias de creches publicas de Recife, PE, em 2004. Para o diagnostico da anemia utilizou-se a combinacao de diferentes parâmetros hematologicos e bioquimicos: hemoglobina, volume corpuscular medio, ferritina, proteina C-reativa, saturacao da transferrina e receptor da transferrina. Para a analise estatistica empregou-se o teste do qui-quadrado e ANOVA. RESULTADOS: Do total de criancas, 92,4% tinha anemia (Hb < 110g/L) e 28,9% apresentou anemia moderada/grave (Hb<90g/L). Niveis mais baixos de hemoglobina foram observados em criancas de seis a 17 meses. Encontrou-se deficiencia de ferro em 51,5% das criancas, utilizando-se a ferritina (< 12µg/L) como parâmetro. Considerando a combinacao da concentracao de hemoglobina, ferritina e do receptor de transferrina, 58,1% tinha anemia com deficiencia de ferro, 34,2% anemia sem deficit de ferro e 2,3% deficiencia de ferro sem anemia. A concentracao media de ferritina foi significativamente maior em criancas com proteina C-reativa aumentada quando comparada com aqueles com niveis normais (22,1 versus 14,8 µg/L). CONCLUSOES: A utilizacao de diversos parâmetros bioquimicos e hematologicos possibilitou diagnosticar anemia por deficiencia de ferro em dois tercos das criancas, revelando a necessidade de identificar outros determinantes de anemia sem deficiencia de ferro.