Mariana Porto Zambon

Aspiração de corpo estranho em crianças: aspectos clínicos, radiológicos e tratamento broncoscópico

OBJECTIVE To describe the clinical manifestations and bronchoscopic treatment of foreign body aspiration in children under 14 years of age, correlating the clinical aspects with the bronchoscopic findings. METHODS A retrospective, descriptive study analyzing data related to children under 14 years of age undergoing bronchoscopy due to clinical suspicion of foreign body aspiration at the State University at Campinas Hospital das Clinicas from January of 2000 to December of 2005. RESULTS The sample consisted of 69 patients, ranging in age from 8 months to 12 years/7 months (75.4% under 3 years of age), 62.3% of whom were male. The principal complaint was sudden-onset cough (75.4%), auscultation was abnormal in 74%, and dyspnea was observed in 29%. Radiological abnormalities were seen in 88% of the cases. Aspirations were primarily into the right lung (54.8%), and 30.7% of the foreign bodies were of vegetal origin (principally beans and peanuts). In the follow-up period, 29% presented complications (most commonly pneumonia), which were found to be associated with longer aspiration time (p = 0.03). Mechanical ventilation was required in 7 children (10.1%), and multiple bronchoscopies were performed in 5 (7.2%). CONCLUSION A history of sudden-onset choking and cough, plus abnormal auscultation and radiological findings, characterizes the profile of foreign body aspiration. In such cases, bronchoscopy is indicated. Longer aspiration time translates to a higher the risk of complications. The high prevalence of foreign bodies of vegetal origin underscores the relevance of prevention programs aimed at children younger than 3 years of age.

Obesidade e fatores de risco cardiovascular em estudantes de Sorocaba, SP

OBJETIVO: Verificar a prevalencia de obesidade, hipertensao arterial sistemica (HAS), aumento de cintura e acanthosis nigricans em estudantes da cidade paulistana de Sorocaba em 2009, associando aos fatores de risco. METODOS: Amostra probabilistica com 680 criancas (7-11 anos) de 13 escolas municipais de Sorocaba. Um questionario avaliou a pratica de atividade fisica, tempo com televisao, videogame e computador (TV/VG/PC), antecedentes do aluno e dos pais para hipertensao arterial, doenca renal e cardiaca e nivel economico. Foram realizadas medidas de peso, altura, cintura, pressao arterial (PA) e verificado acanthosis nigricans. Determinou-se a prevalencia de alteracao nutricional, HAS, aumento da cintura e acanthosis nigricans. Para a associacao do indice de massa corporea (IMC) IMC > P85 e da PA > P90 com outras variaveis, empregou-se o teste do qui-quadrado ou exato de Fisher (p P85 foi 22,1% [IC 95%: 19,0-25,3%], de PA > P90 10,9% [IC 95%: 8,6-13,5%], aumento da cintura 15,4% [IC 95%: 12,9-17,9%] e acanthosis nigricans 3,8% [IC 95%: 2,6-5,6%]. Foi encontrada associacao do excesso de peso com antecedentes do pai (RCP: 1,76; IC 95%:1,05-2,95; p = 0,02) em ambas as analises. A elevacao de PA associou-se ao sexo feminino (RCP: 1,90; IC 95%:1,12-3,23; p = 0,010), ao maior tempo na TV/VG/PC (RCP: 1,82; IC 95%:1,00-3,36; p = 0,030), a presenca de acanthosis nigricans (RCP: 8,18; IC 95%:3,37-19,80; p < 0,00), a obesidade (RCP: 4,09; IC 95%:2,416,94; p < 0,00) e a cintura (RCP: 4,83; IC 95%:2,77-8,41; p < 0,00). Apos analise multivariada, permaneceram como fatores associados o sexo feminino (RCP ajustada = 2,15; IC 95%:1,17-3,93) e a obesidade (RCP ajustada = 9,51; IC 95%: 4,77-18,97). CONCLUSAO: A prevalencia de excesso de peso, HAS, aumento da cintura e acanthosis nigricans foi relevante, o que justifica a realizacao dessas medidas.

Association of Sleep Deprivation With Reduction in Insulin Sensitivity as Assessed by the Hyperglycemic Clamp Technique in Adolescents

IMPORTANCE The association between short sleep duration and decreased insulin sensitivity in adolescents has been described. However, to our knowledge, no studies have investigated this association measuring insulin sensitivity by the hyperglycemic clamp technique. OBJECTIVES To compare the distributions of parameters of insulin resistance in adolescents with sleep deprivation vs adequate sleep, and to investigate the association between sleep deprivation and insulin sensitivity. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional multicenter study using data from the Brazilian Metabolic Syndrome Study conducted from June 29, 2011, to December 3, 2014, at an obesity outpatient clinic at the University of Campinas and public schools, with a convenience sample of 615 adolescents aged 10 to 19.9 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) for age and sex at the fifth percentile or higher. A subsample of 81 adolescents underwent the hyperglycemic clamp technique. MAIN OUTCOMES AND MEASURES The self-reported sleep duration was used to classify the population into 2 groups: adolescents with sleep deprivation (<8 hours/night) and adolescents with adequate sleep (≥8 hours/night). Insulin sensitivity was assessed using the hyperglycemic clamp technique. RESULTS Among the 615 adolescents (56.3% female; median age, 15.9 years [interquartile range, 12.9-17.8 years]) included in the sample, the mean (SD) sleep duration was 7.9 (1.7) hours/night. The adolescents with sleep deprivation (n = 257) compared with those with adequate sleep (n = 358) had a higher median (interquartile range) age (17.0 [15.4-18.3] vs 14.1 [11.8-16.9] years), BMI (25.0 [21.2-29.3] vs 23.1 [19.5-27.6]), waist circumference (83.0 [73.5-95.4] vs 79.0 [68.5-91.0] cm), sagittal abdominal diameter (17.9 [15.8-20.8] vs 17.0 [15.0-19.8] cm), neck circumference (35.2 [33.0-38.0] vs 33.0 [30.0-35.5] cm), uric acid level (4.9 [4.0-5.8] vs 4.5 [3.7-5.5] mg/dL), and white blood cell count (7000 [5900-8200] vs 6600 [5600-7800] cells/μL) (all P < .05). Moreover, the adolescents with sleep deprivation had a lower median (interquartile range) insulin sensitivity index compared with those with adequate sleep (0.10 [0.05-0.21] vs 0.21 [0.09-0.33] mg · kgfat-free mass-1 · min-1 · mU/L × 100, respectively; difference, -0.01; 95% CI, -0.01 to -0.00; P = .02). After controlling for age and sex in the multivariate regression model, sleep deprivation remained an independent predictor for those variables. In the sleep deprivation group, BMI and central distribution of fat were higher in all categories of adiposity. CONCLUSIONS AND RELEVANCE Sleep deprivation (<8 hours of sleep per night) is associated with centripetal distribution of fat and decreased insulin sensitivity in adolescents. Therefore, investigations of sleep duration and sleep quality in adolescents should be included in clinical practice to promote, through health education, the eradication of the health risks associated with sleep restriction.

Metabolic syndrome and insulin resistance in obese adolescents

Objetivo: Verificar a prevalencia da sindrome metabolica e da resistencia a insulina em adolescentes obesos e sua relacao com diferentes indicadores de composicao corporal.Metodos: Estudo transversal com 79 adolescentes de dez a 18 anos. Os indicadores de composicao corporal foram: indice de massa corporea (IMC), porcentagem de gordura corporal, circunferencia abdominal e gordura subcutânea. A sindrome metabolica foi diagnosticada segundo os criterios de Cook et al. A resistencia a insulina foi determinada pelo indice de Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) para valores acima de 3,16. Utilizou-se a analise de curvas ROC para avaliar o IMC e a circunferencia abdominal, identificando-se os individuos com resistencia a insulina e sindrome metabolica. O ponto de corte correspondeu ao percentual acima do valor de referencia para o diagnostico de obesidade.Resultados: A sindrome metabolica foi diagnosticada em 45,5% dos pacientes e a resistencia a insulina, em 29,1%. A resistencia a insulina apresentou associacao com o HDL-colesterol (p=0,032) e com a sindrome metabolica (p=0,006). Todos os indicadores de composicao corporal avaliados apresentaram correlacao com a resistencia a insulina (p<0,01). Na avaliacao dos pontos de corte, os valores de 23,5 e 36,3% acima do valor de referencia do IMC permitiram identificar a resistencia a insulina e a sindrome metabolica. O melhor ponto de corte da circunferencia abdominal para identificar a resistencia a insulina foi de 40%.Conclusoes: Todos os indicadores de composicao corporal, o HDL-colesterol e a sindrome metabolica apresentaram correlacao com a resistencia a insulina. O IMC mostrou-se o indicador antropometrico mais eficaz para identificar a resistencia a insulina.Objective: To verify the prevalence of metabolic syndrome and insulin resistance in obese adolescents and its relationship with different body composition indicators. Methods: A cross-sectional study comprising 79 adolescents aged ten to 18 years old. The assessed body composition indicators were: body mass index (BMI), body fat percentage, abdominal circumference, and subcutaneous fat. The metabolic syndrome was diagnosed according to the criteria proposed by Cook et al. The insulin resistance was determined by the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) index for values above 3.16. The analysis of ROC curves was used to assess the BMI and the abdominal circumference, aiming to identify the subjects with metabolic syndrome and insulin resistance. The cutoff point corresponded to the percentage above the reference value used to diagnose obesity. Results: The metabolic syndrome was diagnosed in 45.5% of the patients and insulin resistance, in 29.1%. Insulin resistance showed association with HDL-cholesterol (p=0.032) and with metabolic syndrome (p=0.006). All body composition indicators were correlated with insulin resistance (p<0.01). In relation to the cutoff point evaluation, the values of 23.5 and 36.3% above the BMI reference point allowed the identification of insulin resistance and metabolic syndrome. The best cutoff point for abdominal circumference to identify insulin resistance was 40%. Conclusions: All body composition indicators, HDL-cholesterol and metabolic syndrome showed correlation with insulin resistance. The BMI was the most effective anthropometric indicator to identify insulin resistance.

Violência doméstica contra crianças e adolescentes: um desafio

OBJECTIVE: To study children and adolescents victims of domestic violence treated at the Referenced Pediatric Emergency Unit of the Hospital de Clinicas of the Universidade Estadual de Campinas and its specialized outpatient clinic between January 2003 and December 2007, emphasizing sexual abuse. METHODS: The variables gender, age, origin, and classification were studied. For victims of sexual abuse, the following variables were also studied: type of abuse (rape), location (domestic/urban), duration (acute/chronic), perpetrator (known, incestuous), alterations at medical examination, notification to child protection agencies, and antiretroviral medication and serology (HIV, syphilis, hepatitis B and C). Patients were divided into two groups according to the type of abuse and type of perpertrator and they were associated with gender, age, and duration. For the comparison, chi-squared or Fishers exact test were performed (significance p < 0.05), as well as raw prevalence odds ratio. RESULTS: Of the total cases of abuse (551), neglect (33.9%) and sexual abuse (31.9%) predominated; the victims were female in 55.9% of the cases, and 50% were up to 5 years of age. Of the sexual abuse cases (95), 80% were female, and 58.9% were between 5 and 10 years of age. Rape was observed in 39% and indecent assault in 59.6%; 72.6% occurred in the domestic area, 81.1% by known perpetrator; 31.6% were incestuous, 47.4% were chronic, and 76.5% had no clinical alterations. 81.1% were referred to child protection agencies. Antiretroviral medication was prescribed to 49.1% of patients, and serological tests (HIV in 46 [48.4%], syphilis in 42 [44.2%], hepatitis B in 44 [46.3%] and hepatitis C in 45 [47.4%]%), all of which were negative, were more frequent in rape victims (p = 0.00). There was an association between rape and age (10 and 15 years, p = 0.01) and between incestuous perpetrator and chronic duration (p = 0.01). CONCLUSION: Although this study does not reflect reality, it can be used as a warning to pediatricians.

Neck circumference as a new anthropometric indicator for prediction of insulin resistance and components of metabolic syndrome in adolescents: Brazilian Metabolic Syndrome Study

OBJECTIVE: To evaluate the correlation between neck circumference and insulin resistance and components of metabolic syndrome in adolescents with different adiposity levels and pubertal stages, as well as to determine the usefulness of neck circumference to predict insulin resistance in adolescents. METHODS: Cross-sectional study with 388 adolescents of both genders from ten to 19 years old. The adolescents underwent anthropometric and body composition assessment, including neck and waist circumferences, and biochemical evaluation. The pubertal stage was obtained by self-assessment, and the blood pressure, by auscultation. Insulin resistance was evaluated by the Homeostasis Model Assessment-Insulin Resistance. The correlation between two variables was evaluated by partial correlation coefficient adjusted for the percentage of body fat and pubertal stage. The performance of neck circumference to identify insulin resistance was tested by Receiver Operating Characteristic Curve. RESULTS: After the adjustment for percentage body fat and pubertal stage, neck circumference correlated with waist circumference, blood pressure, triglycerides and markers of insulin resistance in both genders. CONCLUSIONS: The results showed that the neck circumference is a useful tool for the detection of insulin resistance and changes in the indicators of metabolic syndrome in adolescents. The easiness of application and low cost of this measure may allow its use in Public Health services.OBJETIVO: Avaliar a correlacao da circunferencia do pescoco com resistencia a insulina e com os componentes da sindrome metabolica em adolescentes com diferentes niveis de adiposidade e estadios puberais, bem como determinar a utilidade da circunferencia do pescoco como um parâmetro na predicao de resistencia a insulina em adolescentes.METODOS:Estudo transversal no qual se avaliaram 388 adolescentes de ambos os sexos, de dez a 19 anos. Os adolescentes foram submetidos a avaliacao antropometrica e de composicao corporal, incluindo circunferencias do pescoco e da cintura, e a avaliacao bioquimica. O estadio puberal foi obtido por meio de autoavaliacao e a pressao arterial, pelo metodo auscultatorio. Analisou-se a resistencia a insulina pelo Homeostasis Model Assessment-Insulin Resistance. A correlacao entre duas variaveis foi verificada com o coeficiente de correlacao parcial ajustado para o percentual de gordura corporal e o estadio puberal. O desempenho da circunferencia do pescoco para identificar resistencia a insulina foi testado pela Receiver Operating Characteristic Curve.RESULTADOS: Apos ajuste para o percentual de gordura corporal e estadio puberal, a circunferencia do pescoco correlacionou-se com circunferencia da cintura, pressao arterial, triglicerides e marcadores de resistencia a insulina em ambos os sexos.CONCLUSOES:Os resultados demonstraram que a circunferencia do pescoco e uma ferramenta util para detectar a resistencia a insulina e a alteracao nos indicadores de sindrome metabolica em adolescentes. A facilidade de aplicacao e o baixo custo podem viabilizar sua utilizacao em servicos de Saude Publica.

Tendência secular de crescimento em escolares de Paulínia, São Paulo-Brasil (1979/80 - 1993/94)

BACKGROUND: The purpose of this study was to evaluate the secular trends in height, weight and weight/height of schoolchildren from the city of Paulinia, Sao Paulo, Brazil between 1979/80 and 1993/94. METHODS: Anthropometric measurements (height, weight and weight/height) of 1,903 children (6.5-12.5y); 51.5% M: 48.5% F, from Paulinia public schools were compared with data from a previous study carried out in the same city 15 years earlier. Decade increments were calculated and data was smoothed by the technique of means and medians (3H3H3). RESULTS: Height and weight mean values were always greater than those of the previous study, with positive increments. Height increments ranged from 1.13 to 5.0 cm in boys and from 1.2 to 4.33cm in girls. Weight increments ranged from 0.53 to 4.13kg in males and from 0.87 to 3.0kg in females. In the two studies, weight/height means were very similar for both genders. CONCLUSIONS: Increments in height and weight during this period are an indicator of development on the economical and health levels. A positive secular trend was also observed in developed countries after the 2nd World War and in the Brazilian people.

Crianças e adolescentes obesos: dois anos de acompanhamento interdisciplinar

OBJECTIVE: To study two years follow-up of obese children and adolescents from a specialized out-patient clinic. METHODS: This cohort study with retrospective collection of data enrolled 150 patients (1 to 19 years old, 53% males, 63% from Campinas, Sao Paulo, Brazil, and at mean age of 4.3 years when they started the weight gain). All patients were followed at the Obesity Out-Patient Clinic of the Clinical Hospital of Campinas University. Out of the 150 patients, 128 returned once and weight, height, body mass index (BMI) measurements and Z scores were obtained. Laboratory exams were colleted: hemoglobin, lipids, fasting glucose and fasting insulin. Glucose/insulin ratio was calculated. Patients were divided in two groups, if they returned or not to the clinic. Difference between both groups were analyzed regarding age, gender, city of origin, age when the weight gain started, acanthosis nigricans, weight, height, BMI Z score and proportion of altered laboratory exams. The difference in BMI Z score in relation to the first visit was also analyzed. RESULTS: Among the 128 patients, 57% continued to be followed in the clinic and 114 returned at least once. Comparing groups, patients from Campinas fail more to return. There were no differences in the clinical, anthropometric and laboratory variables. Both groups showed lower mean BMI Z score in the return visit compared to the first visit. CONCLUSIONS: The obese children and adolescents from the follow-up clinic showed a reduction in the mean BMI Z score similar to published data. The rate of dropping follow-up was high, but no variable could explain it, except for the patient origin.

Obesity and cardiovascular risk factors in school children from Sorocaba, SP.

OBJECTIVE To verify the prevalence of obesity, systemic arterial hypertension (SAH), waist circumference and acanthosis nigricans (AN) in school children from Sorocaba, in 2009 and associate them with risk factors. METHODS A probabilistic sample study was carried out with 680 children (7-11 years) from 13 public schools from the city of Sorocaba, SP. A questionnaire containing questions on physical activity, time spent watching television, playing with video games and computers (TV/VG/PC), student and parental antecedents of arterial hypertension, renal or cardiac disease, and economic level was applied. On physical examination, weight, height, waist circumference (WC) and blood pressure (BP) were measured; presence of AN was observed. The prevalence of nutritional disorders, SAH, WC increase and presence of AN were calculated. To associate body mass index (BMI) > P85 and BP > P90 with the other variables, chi square or Fishers exact test (significance p < 0.05) and crude and adjusted prevalence odds ratio (POR) were used. RESULTS The prevalence of BMI > P85 was 22.1% [95% CI: 19.0-25.3%], of BP > P90 10.9% [95% CI: 8.6- 13.5%], increased WC 15.4% [95% CI: 12.9-17.9%] and AN 3.8% [95% CI: 2.6-5.6%]. Paternal antecedents were associated with weight excess in both analysis (POR: 1.76; 95% CI: 1.05-2.95; p = 0.02). High blood pressure was associated with female sex (POR: 1.90; 95% CI: 1.12-3.23; p = 0.01), more time spent with TV/VG/PC (POR: 1.82; 95% CI: 1.00-3.36; p = 0.03), AN (POR: 8.18; 95% CI: 3.37-19.80; p < 0.00), obesity (POR: 4.09; 95% CI: 2.41-6.94; p < 0.00) and WC (POR: 4.83; 95% CI: 2.77-8.41; p < 0.00). After the multivariate analysis, the female sex (adjusted POR = 2.15; 95% CI: 1.17-3.93) and obesity (adjusted POR = 9.51; 95% CI: 4.77-18.97) remained. CONCLUSION The prevalence of weight excess, SAH, increased WC and AN in these school children was relevant. This fact justifies the use of these measurements.

Correlação entre o índice de massa corporal e a prega cutânea tricipital em crianças da cidade de Paulínia, São Paulo, SP

UNLABELLED Body mass index (BMI) has been considered a criterion to define and analyse obesity in adults and children. BACKGROUND the purpose of this study was to evaluate the correlation between BMI and triceps skinfold (TSF). METHODS there were studied 4,236 children (3.1-10.9y); 48.3%M:51.6%F, from four studies made in Paul nia, SP-Brazil. Height, weight and TSF (Holtain caliper) were measured. For each children BMI was calculated and transformed in SDS, according to North American data (Frisancho, 1993). Multiple linear regression analysis (stepwise) was used for the whole population and in three groups according to BMI: A) SDS < or = -1.0; B) -1.0 < SDS< 1.0) SDS(3) 1.0. Data were processed with SPSS software. RESULTS in group A, the TSF (7.8 +/- 2.3) variability was lower when compared with the groups B (10.1 +/- 4.0) and C (17.8 +/- 6.2). In multiple linear regression with the whole population, R = 0.478 for TSF. In groups B and C, R = 0.364 and 0.368 respectively for TSF, and in group A it was only 0.032. CONCLUSIONS these observations demonstrated a height correlation between BMI and TSF in children with obesity risk (group C). Therefore, we conclude that, in Brazil BMI can be used for childrens research of obesity in population studies, instead of TSF.