Marco Antônio Duarte

Treatment of Nonorganic Recurrent Abdominal Pain: Cognitive-behavioral Family Intervention

Objectives: We evaluated the efficacy of cognitive-behavioral family intervention in the treatment of crises of pain in children with nonorganic recurrent abdominal pain (RAP) and the thresholds of pain for 17 body surface areas in these children. Methods: A randomized clinical trial was undertaken with 32 children between the ages of 5.1 and 13.9 years with nonorganic RAP. A group of 15 patients, aged 9.9 ± 2.2 years (11 girls), received standard pediatric care and cognitive-behavioral family intervention for treatment of pain crises. The control group of 17 children, aged 8.4 ± 2.0 years (11 girls), received only standard pediatric care. These procedures were undertaken by general pediatricians over 4 monthly sessions. An analog visual scale was used to measure the frequency and intensity of the pain crises per month and a mechanical pressure algometer for the measurement of pain threshold. Results: The median frequency of pain crises per month reported by patients at the 3 monthly cognitive-behavioral family intervention sessions was 15, 5, 2 and 2, respectively. In contrast, the median frequency for pain crises per month reported by the control group was 12, 8, 10 and 8, respectively. The difference between the intervention group and the controls was statistically significant for frequency of pain at the second, third and fourth visits. There was no statistical difference for intensity of pain or for measured pain thresholds between the control and the intervention group. Conclusions: The cognitive-behavioral family intervention reduced the frequency of pain crises of children with nonorganic RAP. This successful intervention was carried out by the intervention of general pediatricians.

Pressure pain threshold in children with recurrent abdominal pain.

Background Experimental studies on humans have shown that recurrent pain is associated with altered pain perception. We measured the pressure pain threshold in regions of the body surface in a group of children who had recurrent abdominal pain and in a group of children with chronic or recurrent disease but with no pain. Methods Each group consisted of 45 boys and 55 girls ranging in age from 5 to 15.8 years. The regions of the body were the trapezius, deltoid, and supraspinous muscles, nine areas on the abdominal wall, and the median part of the tibias. Using an algometer, pressure was applied through a rubber disc with a surface area of 1 cm2 at a rate of 0.5 kg/cm2/s. The pressure values recorded with the algometer when the children communicated that they started to feel pain were considered as pressure pain thresholds. Results The pain thresholds were reduced in all regions investigated in children with recurrent pain. The median thresholds for all regions of the patients with and without pain were 1.60 and 2.2 kg/cm2, respectively. The diseases of children with pain did not influence the pain thresholds. Conclusion There was an association between recurrent abdominal pain and a lower pressure pain threshold, with no influence of the type of disease, and there was a central nervous system alteration in the perception of pain in these patients.

Comparison of the effectiveness of polyethylene glycol 4000 without electrolytes and magnesium hydroxide in the treatment of chronic functional constipation in children

OBJECTIVE To compare the effectiveness of two drugs, polyethylene glycol 4000 without electrolytes and magnesium hydroxide, in the treatment of chronic functional constipation in children. METHODS Thirty-eight children were randomly assigned to either of two groups, polyethylene glycol 4000 without electrolytes or magnesium hydroxide. The children were followed through periodic appointments until they reached 6 months of treatment. In each medical appointment the following aspects were evaluated: stool consistency, frequency of bowel movements, fecal incontinence, abdominal pain, straining and acceptance of the drugs. RESULTS Seventeen children made use of polyethylene glycol and twenty-one received magnesium hydroxide. All variables analyzed improved for both groups, with no statistically significant differences. All children accepted polyethylene glycol, while 42.9% refused magnesium hydroxide. CONCLUSION The two laxatives showed no difference in effectiveness for the treatment of constipation. However, due to its better acceptance, because it is odorless and tasteless, polyethylene glycol proved to be a better option for treating chronic functional constipation.

Comparação da efetividade entre polietilenoglicol 4000 sem eletrólitos e hidróxido de magnésio no tratamento da constipação intestinal crônica funcional em crianças

OBJECTIVE: To compare the effectiveness of two drugs, polyethylene glycol 4000 without electrolytes and magnesium hydroxide, in the treatment of chronic functional constipation in children. METHODS: Thirty-eight children were randomly assigned to either of two groups, polyethylene glycol 4000 without electrolytes or magnesium hydroxide. The children were followed through periodic appointments until they reached 6 months of treatment. In each medical appointment the following aspects were evaluated: stool consistency, frequency of bowel movements, fecal incontinence, abdominal pain, straining and acceptance of the drugs. RESULTS: Seventeen children made use of polyethylene glycol and twenty-one received magnesium hydroxide. All variables analyzed improved for both groups, with no statistically significant differences. All children accepted polyethylene glycol, while 42.9% refused magnesium hydroxide. CONCLUSION: The two laxatives showed no difference in effectiveness for the treatment of constipation. However, due to its better acceptance, because it is odorless and tasteless, polyethylene glycol proved to be a better option for treating chronic functional constipation.

Comparação entre três equações de referência para a espirometria em crianças e adolescentes com diferentes índices de massa corpórea

OBJECTIVE To compare FEV1 and FVC, calculated using three sets of reference equations (devised by Polgar & Promadhat, Hsu et al. and Mallozi in 1971, 1979 and 1995, respectively) and to determine whether the three are similar in predicting lung function in children and adolescents with distinct body mass indices (BMIs). METHODS The individuals were separated into four groups in accordance with the reference standards of the National Center for Health Statistics: underweight (UW), normal weight (NW), overweight (OW), and obese (OB). All were then submitted to spirometry. RESULTS We evaluated 122 healthy children and adolescents, aged 7-14 years. The FVC values predicted for NW females and UW males through the use of the Hsu et al. equation were significantly higher than the measured values, as were the FEV1 values for UW females and males predicted via the Polgar & Promadhat and Hsu et al. equations. In NW females, the FEV1 values predicted via the Polgar & Promadhat equation were significantly higher than were the measured values. CONCLUSIONS In individuals with distinct BMIs, the measured FVC and FEV1 values were not equivalent to those predicted via the Polgar & Promadhat and Hsu et al. equations. The same was not true for the Mallozi equations. The BMI was not a relevant factor for the predictive index of these equations; therefore, the Mallozi equations can be used without alteration for children and adolescents with distinct BMIs.

Pain threshold and age in childhood and adolescence

OBJECTIVE: The few investigations about pressure pain threshold in corporeal surface areas and children age showed no correlation between these parameters in all areas. In this research the existence of correlation between age and pressure pain threshold in seventeen areas of the corporeal surface of children was investigated. METHODS: A descriptive research was made with one hundred children from the Clinical Hospital of the Federal University of Minas Gerais. The selection of patients was made by directed search. There were forty five boys and fifty five girls with ages varying between 5.3 and 15.8 years old, and a mean (-/+ standard deviation) of 9.6 (-/+ 2.7) years old. The seventeen corporeal areas studied were regions of the trapezium, deltoid and supraspinal muscles, nine areas of the abdomen and the median part of the tibias. The pressure of 0.5 kg/cm(2)/s was made using a mechanical algometer. The pressure values that were recorded in the equipment when the children started to complain about the pain, by verbal communication, were considered as pressure pain thresholds. RESULTS: Positive correlations with significant statistic values were found between pressure pain threshold and age in every area investigated: trapezium, r = 0.36; deltoid, r = 0.34; supraspinal, r=0.42; hypochondrium, r=0.41; epigastrium, r=0.41; flank, r = 0.48; periumbilical, r = 0,40; iliac fossa, r = 0.49; hypogastrium, r = 0.45 and tibia, r = 0,29. CONCLUSIONS: Since correlations between age and pressure pain threshold were found in all areas studied, the age of a patient must be taken into consideration during clinical investigations and pain evaluations in children and adolescents. The younger the patient, the lower the pain thresholds.

Comparação dos valores medidos e previstos de pressões respiratórias máximas em escolares saudáveis

Correspondence to: Lídia Miranda Barreto – Avenida Alfredo Balena, 190, 2o andar, sala 202 – CEP: 30130-100 – Belo Horizonte (MG), Brasil – E-mail: lidia.mbarreto@gmail.com Presentation: Nov. 2012 – Accepted for publication: Aug. 2013 – Financing source: none – Conflict of interests: nothing to declare – Approval at the Ethics Committee n. 0063.0.203.000-10. AbstrAct | Respiratory Muscle Strength is an important tool to diagnose different disorders. Reference equations considered different populations and methodologies. However, there is no agreement on what is the ideal equation to use. The aim of this study was to compare and correlate the measured values of maximal respiratory pressures with those demonstrated by equations described in literature. The sample consisted of 90 healthy individuals aged from 6 to 12 years old. Anthropometric, spirometric and manometric measurements were performed. The comparison between measured and predicted values was significantly different, showing the mean male maximum inspiratory pressure (MIP) (80.65±26.78) to be higher than that predicted by Wilson et al. (67.40±5.65, p<0.001) and Schmidt et al. (70.69±21.70, p<0.05). The mean male maximum expiratory pressure (MEP) (84.35±23.16) was lower than the one predicted by Domènech-Clar et al. (92.25±16.90, p<0.01) and higher than the one predicted by Schmidt et al. (72.78±13.62 p<0.001). The mean of female individuals’ MIP (76.14±26.08) was higher than that predicted by Wilson et al. (57.96±6.04, p<0.001), Schmidt et al. (68.54±7.08, p<0.01), and Domènech-Clar et al. (67.61±11.17, p<0.01). The mean female MEP (74.55±20.05) was higher than the ones predicted by Wilson et al. (66.65±9.55, p<0.001) and lower than the one predicted by Comparison of measured and predicted values for maximum respiratory pressures in healthy students Comparação dos valores medidos e previstos de pressões respiratórias máximas em escolares saudáveis Comparación de los valores medidos y previstos de presiones respiratorias máximas en escolares sanos. Lídia Miranda Barreto, Marco Antônio Duarte, Sarah Costa Drumond de Oliveira Moura, Betânia Luiza Alexandre, Leonardo Silva Augusto, Maria Jussara Fernandes FontesLa Fuerza Muscular Respiratoria es una herramienta capaz de diagnosticar diferentes desordenes. Las ecuaciones de referencia hasta hoy descritas consideran diferentes poblaciones y metodologias. Entre tanto, no hay consenso en cuanto a que ecuacion es ideal para utilizar. El objetivo de este estudio fue comparar y correlacionar valores medidos de presiones respiratorias maximas con aquellos previstos por las ecuaciones descritas en la literatura. La muestra fue de 90 individuos sanos de 6 a 12 anos. Fueron realizadas antropometria, espirometria y manovacuometria. La comparacion de los valores medidos y previstos difirio significativamente, presentando presion inspiratoria maxima (PImax) media (80,65±26,78) , en el sexo masculino, mayor que la prevista por Wilson et al. (67,40±5,65; p<0,001) y Schmidt et al. (70,69±21,70; p<0,05). Presion expiratoria maxima (PEmax) masculina media (84,35±23,16) menor que la prevista por Domenech-Clar et al. (92,25±16,90; p<0,01) y mayor que Schmidt et al. (72,78±13,62; p<0,001). Presion inspiratoria maxima femenina media (76,14±26,08) mayor que la prevista por Wilson et al. (57,96±6,04; p<0,001), Schmidt et al. (68,54±7,08; p<0,01) y Domenech-Clar et al. (67,61±11,17; p<0,01). Presion expiratoria maxima femenina media (74,55±20,05) mayor que la prevista por Wilson et al. (66,65±9,55; p<0,001) y menor que Domenech-Clar et al. (81,16±14,37; p<0,01). Las correlaciones entre valores medidos y previstos fueron de baja a media magnitud (variacion entre r=0,1 y 0,5) siendo significativas para el sexo masculino cuando la PImax fue correlacionada a la prevista por Wilson et al. (p<0,01) y Domenech-Clar et al. (p<0,05). Para el sexo femenino, ambas correlaciones fueron significativas (PImax p<0,01; PEmax p<0,05). Se concluyo que las ecuaciones no consiguieron predecir los valores de presiones respiratorias maximas, reforzando la necesidad de nuevas ecuaciones de fuerza muscular respiratoria.

Polietilenoglicol na constipação intestinal crônica funcional em crianças

OBJECTIVE: To review the literature about the use of the polyethylene glycol in the treatment of chronic functional constipation in children. DATA SOURCE: Articles published between 1998 and 2009 were selected from Medline and SciELO databases. Relevant articles concerning constipation, the use of polyethylene glycol in adults, the recent NASPGHAN guideline and the ROMA III criteria were also included. DATA SYNTHESIS: The treatment of functional constipa-tion in children is composed of several stages, among which is the long-term use of laxative drugs. The therapeutic options are limited and they carry problems related to long-term use, especially due to the adverse effects and childs low adherence to the treatment. Polyethylene glycol is an odorless, tasteless and minimally absorbed osmotic agent, available in 3350 and 4000 molecular weights, with or without electrolytes. Good results have been reported in controlled and randomized studies regarding the improve-ment of symptoms of constipation. It is considered safe, without significant side effects. CONCLUSIONS: Polyethylene glycol is superior to other osmotic agents as far as taste and childrens acceptance are concerned. Low daily doses are safe and effective. It is a good treatment option for chronic functional constipation in children.

Apresentação da técnica de estudo do tempo de esvaziamento gástrico por meio da ultra-sonografia

OBJECTIVE: To describe a technique for measuring gastric emptying in children. MATERIALS AND METHODS: Gastric emptying time was measured in 14 healthy volunteer children aged between 2 to 11. The children were asked to drink modified milk in proportion of 200 ml/m² of body surface. The antral area was measured before the injection of contrast media and at 60, 90, 120 and 150 minutes after the injection. RESULTS: The diet was well tolerated by most patients. In the majority (85%) of the children total gastric emptying occurred 150 minutes after the ingestion of the solution. CONCLUSION: Ultrasound is a safe and low cost alternative for the assessment of gastric emptying.

Comparación de los valores medidos y previstos de presiones respiratorias máximas en escolares sanos

Correspondence to: Lídia Miranda Barreto – Avenida Alfredo Balena, 190, 2o andar, sala 202 – CEP: 30130-100 – Belo Horizonte (MG), Brasil – E-mail: lidia.mbarreto@gmail.com Presentation: Nov. 2012 – Accepted for publication: Aug. 2013 – Financing source: none – Conflict of interests: nothing to declare – Approval at the Ethics Committee n. 0063.0.203.000-10. AbstrAct | Respiratory Muscle Strength is an important tool to diagnose different disorders. Reference equations considered different populations and methodologies. However, there is no agreement on what is the ideal equation to use. The aim of this study was to compare and correlate the measured values of maximal respiratory pressures with those demonstrated by equations described in literature. The sample consisted of 90 healthy individuals aged from 6 to 12 years old. Anthropometric, spirometric and manometric measurements were performed. The comparison between measured and predicted values was significantly different, showing the mean male maximum inspiratory pressure (MIP) (80.65±26.78) to be higher than that predicted by Wilson et al. (67.40±5.65, p<0.001) and Schmidt et al. (70.69±21.70, p<0.05). The mean male maximum expiratory pressure (MEP) (84.35±23.16) was lower than the one predicted by Domènech-Clar et al. (92.25±16.90, p<0.01) and higher than the one predicted by Schmidt et al. (72.78±13.62 p<0.001). The mean of female individuals’ MIP (76.14±26.08) was higher than that predicted by Wilson et al. (57.96±6.04, p<0.001), Schmidt et al. (68.54±7.08, p<0.01), and Domènech-Clar et al. (67.61±11.17, p<0.01). The mean female MEP (74.55±20.05) was higher than the ones predicted by Wilson et al. (66.65±9.55, p<0.001) and lower than the one predicted by Comparison of measured and predicted values for maximum respiratory pressures in healthy students Comparação dos valores medidos e previstos de pressões respiratórias máximas em escolares saudáveis Comparación de los valores medidos y previstos de presiones respiratorias máximas en escolares sanos. Lídia Miranda Barreto, Marco Antônio Duarte, Sarah Costa Drumond de Oliveira Moura, Betânia Luiza Alexandre, Leonardo Silva Augusto, Maria Jussara Fernandes FontesLa Fuerza Muscular Respiratoria es una herramienta capaz de diagnosticar diferentes desordenes. Las ecuaciones de referencia hasta hoy descritas consideran diferentes poblaciones y metodologias. Entre tanto, no hay consenso en cuanto a que ecuacion es ideal para utilizar. El objetivo de este estudio fue comparar y correlacionar valores medidos de presiones respiratorias maximas con aquellos previstos por las ecuaciones descritas en la literatura. La muestra fue de 90 individuos sanos de 6 a 12 anos. Fueron realizadas antropometria, espirometria y manovacuometria. La comparacion de los valores medidos y previstos difirio significativamente, presentando presion inspiratoria maxima (PImax) media (80,65±26,78) , en el sexo masculino, mayor que la prevista por Wilson et al. (67,40±5,65; p<0,001) y Schmidt et al. (70,69±21,70; p<0,05). Presion expiratoria maxima (PEmax) masculina media (84,35±23,16) menor que la prevista por Domenech-Clar et al. (92,25±16,90; p<0,01) y mayor que Schmidt et al. (72,78±13,62; p<0,001). Presion inspiratoria maxima femenina media (76,14±26,08) mayor que la prevista por Wilson et al. (57,96±6,04; p<0,001), Schmidt et al. (68,54±7,08; p<0,01) y Domenech-Clar et al. (67,61±11,17; p<0,01). Presion expiratoria maxima femenina media (74,55±20,05) mayor que la prevista por Wilson et al. (66,65±9,55; p<0,001) y menor que Domenech-Clar et al. (81,16±14,37; p<0,01). Las correlaciones entre valores medidos y previstos fueron de baja a media magnitud (variacion entre r=0,1 y 0,5) siendo significativas para el sexo masculino cuando la PImax fue correlacionada a la prevista por Wilson et al. (p<0,01) y Domenech-Clar et al. (p<0,05). Para el sexo femenino, ambas correlaciones fueron significativas (PImax p<0,01; PEmax p<0,05). Se concluyo que las ecuaciones no consiguieron predecir los valores de presiones respiratorias maximas, reforzando la necesidad de nuevas ecuaciones de fuerza muscular respiratoria.