Joaquim Antônio César Mota

Is dilution of cows'milk formula necessary for dietary management of acute diarrhoea in infants aged less than 6 months?

There is concern that feeding full-strength animal milk to infants aged less than 6 months with diarrhoea may have adverse consequences. We assessed the effects on clinical course of two feeding regimens in 159 Guatemalan and Brazilian infants aged 2 weeks to 6 months who had had acute diarrhoea for 120 h or less, showed signs of mild to moderate dehydration, and had no complications. After correction of dehydration, infants were assigned randomly to receive continued full-strength milk feeding or initial feeding with diluted milk with regrading to full-strength milk over 48 h. There were no significant differences between feeding groups in rate of treatment failures (-1%, 95% Cl -14 to 12%) or mean (SD) total stool output (full-strength milk 335 [268] g/kg, diluted milk 338 [354] g/kg) and duration of diarrhoea (92 [50] vs 92 [44] h). A significant association was found between presence of reducing substances in stools and treatment failure (OR 4.3, 95% CI 1.1 to 16.8), but reducing substances in stools were common both in treatment successes (61%) and in failures (87%). Our study supports the conclusion that, for infants under 6 months of age with diarrhoea whose only food is animal milk or formula, the milk or formula normally given should be provided in full strength as soon as dehydration has been corrected.

Concomitant prescribing and dispensing errors at a Brazilian hospital: a descriptive study

OBJECTIVE: To analyze the prevalence and types of prescribing and dispensing errors occurring with high-alert medications and to propose preventive measures to avoid errors with these medications. INTRODUCTION: The prevalence of adverse events in health care has increased, and medication errors are probably the most common cause of these events. Pediatric patients are known to be a high-risk group and are an important target in medication error prevention. METHODS: Observers collected data on prescribing and dispensing errors occurring with high-alert medications for pediatric inpatients in a university hospital. In addition to classifying the types of error that occurred, we identified cases of concomitant prescribing and dispensing errors. RESULTS: One or more prescribing errors, totaling 1,632 errors, were found in 632 (89.6%) of the 705 high-alert medications that were prescribed and dispensed. We also identified at least one dispensing error in each high-alert medication dispensed, totaling 1,707 errors. Among these dispensing errors, 723 (42.4%) content errors occurred concomitantly with the prescribing errors. A subset of dispensing errors may have occurred because of poor prescription quality. The observed concomitancy should be examined carefully because improvements in the prescribing process could potentially prevent these problems. CONCLUSION: The system of drug prescribing and dispensing at the hospital investigated in this study should be improved by incorporating the best practices of medication safety and preventing medication errors. High-alert medications may be used as triggers for improving the safety of the drug-utilization system.

O cotidiano no alojamento materno, das mães de crianças internadas em uma Unidade de Terapia Intensiva Neonatal

OBJECTIVES: to investigate the daily routine of mothers rooming-in at the Neonatal Intensive Care Unit. METHODS: qualitative research carried out at the Sofia Feldman Hospital in Belo Horizonte, in the State of Minas Gerais, Brazil. The data was obtained by way of participant observation and a focus group and the instruments used to record the data were field diaries, recorders and tapes. Content analysis was used to analyze the data. RESULTS: when deciding to room in, the mothers feel divided between meeting the needs of the hospitalized child, the demands of the family and their own needs. Living in a hospital environment requires that mothers become detached from her daily routine and adapt to a new pattern which is determined by the institutional routines and norms. Rooming presents mothers with the opportunity to establish relationships of friendship and solidarity, but it is also a time of conflicting relations for them. CONCLUSIONS: the relationships between the mothers, and with their families and health workers were shown to be important for adaptation to the rooming-in process. The study showed the importance for health workers to get more involved in the real-life situation of the mothers in order to facilitate their adaptation to the new daily routine.

Perfil das condutas médicas que antecedem ao óbito de crianças em um hospital terciário

OBJECTIVE: To study the profile of care provided to pediatric patients suffering fatal outcomes at a university hospital, including: description of models, comparisons between units, associated factors, participants involved and records of decisions made. METHODS: Cross-sectional study. One of the investigators reviewed the medical and nursing records of deceased patients. Interviews were held and questionnaires filled out with the care team members over a period of 12 months (May 1, 2002 to April 30, 2003). RESULTS: The study included 106 cases. The most frequent treatment patterns at the hospital were: withholding advanced life support (51.9%) and unsuccessful cardiopulmonary resuscitation (44.3%). The decision to make a do-not-resuscitate order occurred later in the intensive care unit (p < 0.05). The restricted care category was more prevalent in the neonatal unit and among patients with chronic diseases that limit survival (p < 0.05). The professionals that most often participated in the decision-making process were the units treating physician and resident (52.8%) and the medical team (31.1%). Parents or guardians were observed to have been involved in 20.8% of cases. For the entire hospital, seven cases (6.6%) of ambiguous or discordant cardiopulmonary resuscitation procedures were found. CONCLUSIONS: Procedures involving limitation of therapy are frequent, especially in the neonatal unit. Diagnosis of brain death and withdrawal of advanced life support are, nevertheless, rare. Decisions to grant do-not-resuscitate orders are generally mate late, especially in the intensive care unit. In this sample procedures for full participation in decisions and for recording decisions were imperfect.

Coeliac disease in identical twins.

Coeliac disease occurred at the same age in MZ twins. The diagnosis was confirmed by histology of the small intestine, rapid response to a gluten-free diet, and relapse after reintroduction of gluten.

A perspectiva dos pais sobre a obtenção do diagnóstico de leucemia linfóide aguda em crianças e adolescentes: uma experiência no Brasil

Objectives: to investigate how parents perceive a diagnosis of lymphoid leukemia in their children. Methods: qualitative research based on the sociological theory of social representations was used. Data was gathered by way of semi-structured interviews. Twenty parents of children diagnosed as having acute lymphoid leukemia (ALL). The content analysis technique was used to analyze data. Data analysis was guided by the principles of bioethics and humane care. Results: the parents clearly recalled the progression of symptoms up to diagnosis. The word leukemia was associated with cancer and death. Difficulties related to listening to the symptoms, the specific clinical features of leukemia and the referral system were the main reasons for delay in arriving at a final diagnosis. The parents highlighted the need to move about a lot from one place to another, the lack of resolution, unnecessary costs, emotional strain and the slowness of the health services. Conclusions: cancer brings with out cultural values concerning death and these bear greater weight when a child is involved. The search for a diagnosis of leukemia by parents is a good example of the tortuous path they have to tread when what is wrong with their children is not something that bears the label of a “common” disease.

Cuidados paliativos em pediatria: uma revisão

The technological expansion in recent decades changed the profile of the patients in pediatrics, with assistance to children with chronic and life-threatening conditions more frequent each time. Palliative care involves an active and full assistance provided to these children, in the context of their body, mind and spirit as well as the support offered to their entire family. This study provides a review of relevant aspects in palliative approach: the prevalence and approach of symptoms, the participation of a multidisciplinary team, communication with family, care at end of life and limitation of invasive therapies. Despite recognition of the importance of pallia tive medicine, our universities still give priority to curative medicine. Introducing this theme in the process of medical education is a real and absolute need, aiming to provide dignified life and death to our patients.A expansao tecnologica das ultimas decadas modificou o perfil dos pacientes na pediatria, tornando cada vez mais frequente a assistencia a criancas com doencas cronicas e ameacadoras a vida. Cuidados paliativos envolvem a assistencia ativa e total prestada a essas criancas, nas dimensoes de seu corpo, mente e espirito, bem como o suporte oferecido a sua familia. O presente estudo revisa aspectos relevantes na abordagem paliativa: a prevalencia e abordagem dos sintomas, a participacao de equipe multiprofissional, a comunicacao com a familia, os cuidados ao final da vida e a limitacao de terapeuticas invasivas. A despeito do reconhecimento da importância da medicina paliativa, nossas universidades ainda priorizam a medicina curativa. Instituir esse tema no processo de formacao do medico e uma necessidade real e absoluta, visando proporcionar vida e morte dignas aos nossos pacientes.

A infância sem segredos: a noticiabilidade jornalística do crime de exploração sexual de crianças e adolescentes

Ao selecionar os acontecimentos ordinarios que a sociedade deve conhecer e os que ela deve ignorar, e ao codificar esses acontecimentos sob a forma de noticia, o jornalismo disponibiliza para a coletividade um tipo de experiencia com o mundo que a cerca. Cada vez mais, os dispositivos comunicativos sao os meios de experiencia do homem civilizado. Conhecer a natureza dessa experiencia e uma forma de a sociedade se apropriar do seu proprio funcionamento e de sua propria condicao. Esta pesquisa trabalha com 15 reportagens publicadas pelo Jornal Estado de Minas, em 2004, especialmente com a grande reportagem Infância Roubada. Por meio da estrategia de desconstrucao estetica e da narrativa noticiosa de Infância Roubada, bem como da analise de conteudo do material, fica evidenciado que o valornoticia da transgressao e o que justifica a noticiabilidade jornalistica dos crimes sexuais cometidos contra criancas e adolescentes.

Palliative care in pediatric hematological oncology patients: experience of a tertiary hospital

Objective To evaluate the approach to palliative care for hematological oncology patients in the pediatric ward of a tertiary hospital. Methods This was a retrospective, descriptive study of 29 hematological oncology patients who died between 2009 and 2011. Data regarding the approach and prevalence of pain, prevalence of other symptoms, multidisciplinary team participation, communication between staff and family and limited invasive therapy were collected from the medical records. Results Twenty-seven (93.1%) patients displayed disease progression unresponsive to curative treatment. The median age at death was ten years old. Pain was the most prevalent symptom with all patients who reported pain receiving analgesic medications. The majority took weak (55.2%) and/or strong (65.5%) opioids. The patients were followed by pediatricians and a pediatric hematologist/oncologist. Participation of other professionals was also documented: 86.2% were followed by social services and 69% by psychologists, among others. There were explicit descriptions of limitation of invasive therapy in the medical records of 26 patients who died with disease progression. All these decisions were shared with the families. Conclusion Although the hospital where this study was conducted does not have a specialized team in pediatric palliative care, it meets all the requirements for developing a specific program. The importance of approaching pain and other prevalent symptoms in children with cancer involving a comprehensive multidisciplinary team is evident. Discussions were had with most of the families on limiting invasive therapy, but no record of a well-defined and coordinated treatment plan for palliative care was found.

Public primary oral health care: a bioethical reflection

In Brazil, a reduction in the prevalence of tooth decay has been observed recently. However, the distribution pattern of oral diseases still reflects widespread inequality in the access to public preventive and dental care. The oral health status of certain populations highlights the differences in the availability, accessibility and acceptability of education and oral health care. In this context, bioethics can be used as a concrete tool for the discussion, improvement and consolidation of citizenship, human rights and social justice. The purpose of this review is to reflect on Brazilian public primary oral health care from a bioethical standpoint. To do so, it is necessary to start with an analysis of the role of bioethics in public health in Brazil and to approach some of the ethical issues surrounding dental care in the Brazilian public health system.