Patricia Gomes de Souza

Prevalência de sibilância e fatores associados em crianças indígenas Guarani hospitalizadas por doença respiratória aguda no Sul e Sudeste do Brasil

Prevalence of wheezing was studied in Guarani indigenous children hospitalized for acute lower respiratory tract infections in Southern and Southeastern Brazil, recruited by a surveillance routine established in villages from May 2007 to June 2008. Data were obtained from hospital records. Crude and adjusted prevalence ratios for wheezing were estimated according to categories of target variables, using Poisson regression with robust variance. Prevalence of wheezing was 58.1% (136/234). Risk factors that remained significantly associated with wheezing in the final model were: age bracket, inversely associated (0-11 months: reference; 24-35 months: 0.63, 95%CI: 0.40-0.99); hospitalization in the autumn (summer: reference; autumn: 1.58, 95%CI: 1.05-2.40); dyspnea (1.41, 95%CI: 1.09-1.83); chest indrawing (1.42, 95%CI: 1.16-1.73); crackles (1.43, 95%CI: 1.09-1.87). The results show a high disease burden related to wheezing and suggest the phenotype of early-onset persistent wheezing related to recurrence of viral respiratory infections.Realizou-se estudo de prevalencia de sibilância em criancas indigenas Guarani hospitalizadas por infeccao respiratoria aguda baixa no Sul e Sudeste do Brasil, recrutadas a partir de um sistema de vigilância implantado nas aldeias entre maio de 2007 e junho de 2008. Os dados foram extraidos por revisao dos prontuarios hospitalares. Estimaram-se razoes de prevalencia de sibilância brutas e ajustadas segundo categorias das variaveis exploratorias, por regressao de Poisson com ajuste para variância robusta. A prevalencia de sibilância foi de 58,1% (136/234). Permaneceram significativamente associadas a sibilância no modelo final: faixa etaria, inversamente associada (0-11 meses: referencia; 24-35 meses: 0,63, IC95%: 0,40-0,99); internacao no outono (verao: referencia; outono: 1,58, IC95%: 1,05-2,40); e sinais clinicos de dispneia (1,41, IC95%: 1,09-1,83), tiragem (1,42, IC95%: 1,16-1,73) e estertor (1,43, IC95%: 1,09-1,87). Os resultados revelam elevada carga de morbidade por sibilância e sugerem o fenotipo de sibilância persistente de inicio precoce, relacionada a recorrencia de infeccoes respiratorias virais.

INFECÇÃO RESPIRATÓRIA AGUDA BAIXA EM CRIANÇAS INDÍGENAS GUARANI, BRASIL

ABSTRACT Objective: To describe the clinical profile and treatment of Brazilian Guarani indigenous children aged less than five years hospitalized for acute lower respiratory infection (ALRI), living in villages in the states from Rio de Janeiro to Rio Grande do Sul. Methods: Of the 234 children, 23 were excluded (incomplete data). The analysis was conducted in 211 children. Data were extracted from charts by a form. Based on record of wheezing and x-ray findings, ALRI was classified as bacterial, viral and viral-bacterial. A bivariate analysis was conducted using multinomial regression. Results: Median age was 11 months. From the total sample, the ALRI cases were classified as viral (40.8%), bacterial (35.1%) and viral-bacterial (24.1%). It was verified that 53.1% of hospitalizations did not have clinical-radiological-laboratorial evidence to justify them. In the multinomial regression analysis, the comparison of bacterial and viral-bacterial showed the likelihood of having a cough was 3.1 times higher in the former (95%CI 1.11-8.70), whereas having chest retractions was 61.0% lower (OR 0.39, 95%CI 0.16-0.92). Comparing viral with viral-bacterial, the likelihood of being male was 2.2 times higher in the viral (95%CI 1.05-4.69), and of having tachypnea 58.0% lower (OR 0.42, 95%CI 0.19-0.92). Conclusions: Higher proportion of viral processes was identified, as well as viral-bacterial co-infections. Coughing was a symptom indicative of bacterial infection, whereas chest retractions and tachypnea showed viral-bacterial ALRI. Part of the resolution of non-severe ALRI still occurs at hospital level; therefore, we concluded that health services need to implement their programs in order to improve indigenous primary care.

Prevalence of wheezing and associated factors in Guarani indigenous children hospitalized for acute respiratory infections in Southern and Southeastern Brazil

Prevalence of wheezing was studied in Guarani indigenous children hospitalized for acute lower respiratory tract infections in Southern and Southeastern Brazil, recruited by a surveillance routine established in villages from May 2007 to June 2008. Data were obtained from hospital records. Crude and adjusted prevalence ratios for wheezing were estimated according to categories of target variables, using Poisson regression with robust variance. Prevalence of wheezing was 58.1% (136/234). Risk factors that remained significantly associated with wheezing in the final model were: age bracket, inversely associated (0-11 months: reference; 24-35 months: 0.63, 95%CI: 0.40-0.99); hospitalization in the autumn (summer: reference; autumn: 1.58, 95%CI: 1.05-2.40); dyspnea (1.41, 95%CI: 1.09-1.83); chest indrawing (1.42, 95%CI: 1.16-1.73); crackles (1.43, 95%CI: 1.09-1.87). The results show a high disease burden related to wheezing and suggest the phenotype of early-onset persistent wheezing related to recurrence of viral respiratory infections.Realizou-se estudo de prevalencia de sibilância em criancas indigenas Guarani hospitalizadas por infeccao respiratoria aguda baixa no Sul e Sudeste do Brasil, recrutadas a partir de um sistema de vigilância implantado nas aldeias entre maio de 2007 e junho de 2008. Os dados foram extraidos por revisao dos prontuarios hospitalares. Estimaram-se razoes de prevalencia de sibilância brutas e ajustadas segundo categorias das variaveis exploratorias, por regressao de Poisson com ajuste para variância robusta. A prevalencia de sibilância foi de 58,1% (136/234). Permaneceram significativamente associadas a sibilância no modelo final: faixa etaria, inversamente associada (0-11 meses: referencia; 24-35 meses: 0,63, IC95%: 0,40-0,99); internacao no outono (verao: referencia; outono: 1,58, IC95%: 1,05-2,40); e sinais clinicos de dispneia (1,41, IC95%: 1,09-1,83), tiragem (1,42, IC95%: 1,16-1,73) e estertor (1,43, IC95%: 1,09-1,87). Os resultados revelam elevada carga de morbidade por sibilância e sugerem o fenotipo de sibilância persistente de inicio precoce, relacionada a recorrencia de infeccoes respiratorias virais.

Prevalencia de sibilancia y factores asociados en niños indígenas guaraníes hospitalizados por enfermedad respiratoria aguda en el sur y sureste de Brasil

Prevalence of wheezing was studied in Guarani indigenous children hospitalized for acute lower respiratory tract infections in Southern and Southeastern Brazil, recruited by a surveillance routine established in villages from May 2007 to June 2008. Data were obtained from hospital records. Crude and adjusted prevalence ratios for wheezing were estimated according to categories of target variables, using Poisson regression with robust variance. Prevalence of wheezing was 58.1% (136/234). Risk factors that remained significantly associated with wheezing in the final model were: age bracket, inversely associated (0-11 months: reference; 24-35 months: 0.63, 95%CI: 0.40-0.99); hospitalization in the autumn (summer: reference; autumn: 1.58, 95%CI: 1.05-2.40); dyspnea (1.41, 95%CI: 1.09-1.83); chest indrawing (1.42, 95%CI: 1.16-1.73); crackles (1.43, 95%CI: 1.09-1.87). The results show a high disease burden related to wheezing and suggest the phenotype of early-onset persistent wheezing related to recurrence of viral respiratory infections.Realizou-se estudo de prevalencia de sibilância em criancas indigenas Guarani hospitalizadas por infeccao respiratoria aguda baixa no Sul e Sudeste do Brasil, recrutadas a partir de um sistema de vigilância implantado nas aldeias entre maio de 2007 e junho de 2008. Os dados foram extraidos por revisao dos prontuarios hospitalares. Estimaram-se razoes de prevalencia de sibilância brutas e ajustadas segundo categorias das variaveis exploratorias, por regressao de Poisson com ajuste para variância robusta. A prevalencia de sibilância foi de 58,1% (136/234). Permaneceram significativamente associadas a sibilância no modelo final: faixa etaria, inversamente associada (0-11 meses: referencia; 24-35 meses: 0,63, IC95%: 0,40-0,99); internacao no outono (verao: referencia; outono: 1,58, IC95%: 1,05-2,40); e sinais clinicos de dispneia (1,41, IC95%: 1,09-1,83), tiragem (1,42, IC95%: 1,16-1,73) e estertor (1,43, IC95%: 1,09-1,87). Os resultados revelam elevada carga de morbidade por sibilância e sugerem o fenotipo de sibilância persistente de inicio precoce, relacionada a recorrencia de infeccoes respiratorias virais.

Acute abdominal pain as a manifestation of physical violence in an infant: alert to pediatricians

ABSTRACT Objective : To alert pediatricians and pediatric residents on the possibility of child abuse by reporting a clinical case. Case description : An 18 month-old infant was brought to the Emergency Department due to abdominal pain and vomit -ing for 48 hours. Abdominal examination revealed two holes and a small hardened mass. An abdominal X-ray showed three metallic objects. Two sewing needles and one nail without a head were removed from the abdominal cavity by laparotomy. Comments : Diagnosis was performed in the second medi -cal care, probably because the intentional injury had not been considered in the first visit. Physical violence is a differential diagnosis to be considered in the presence of abdominal pain in children. It is worth noting the importance of improv-ing pediatric resident training, and also of pediatricians in general, in relation to the approach of child abuse, enabling them to use adequate care in cases of violence. Key-words : battered child syndrome; abdominal pain; internship and residency; education, medical.OBJETIVO: Alertar a los pediatras y medicos internos en Pediatria respecto a la posibilidad de ocurrencia de violencia contra el nino por medio del relato de un caso clinico. DESCRIPCION DEL CASO: Paciente con 18 meses llevado a la emergencia por dolor abdominal y vomitos hace 48 horas. El examen abdominal revelo dos agujeros y masa pequena endurecida. Rayo-X abdominal mostro imagen compatible con tres objetos metalicos. Dos agujas y un clavo sin cabeza fueron removidos de la cavidad abdominal mediante laparotomia. COMENTARIOS: El diagnostico se realizo en la segunda atencion medica, probablemente por no haber sido aventada la posibilidad de lesion intencional en la primera atencion. La violencia fisica es un diagnostico diferencial que se debe tener en cuenta en los cuadros de dolor abdominal en ninos. Se subraya la importancia de perfeccionar la formacion del medico interno en Pediatria y de los pediatras en general para el acercamiento a la violencia contra el nino, para que esten mas preparados para accionar la linea de cuidados en situaciones de violencia.

Dolor abdominal agudo como manifestación de violencia física en lactante: alerta a los pediatras

ABSTRACT Objective : To alert pediatricians and pediatric residents on the possibility of child abuse by reporting a clinical case. Case description : An 18 month-old infant was brought to the Emergency Department due to abdominal pain and vomit -ing for 48 hours. Abdominal examination revealed two holes and a small hardened mass. An abdominal X-ray showed three metallic objects. Two sewing needles and one nail without a head were removed from the abdominal cavity by laparotomy. Comments : Diagnosis was performed in the second medi -cal care, probably because the intentional injury had not been considered in the first visit. Physical violence is a differential diagnosis to be considered in the presence of abdominal pain in children. It is worth noting the importance of improv-ing pediatric resident training, and also of pediatricians in general, in relation to the approach of child abuse, enabling them to use adequate care in cases of violence. Key-words : battered child syndrome; abdominal pain; internship and residency; education, medical.OBJETIVO: Alertar a los pediatras y medicos internos en Pediatria respecto a la posibilidad de ocurrencia de violencia contra el nino por medio del relato de un caso clinico. DESCRIPCION DEL CASO: Paciente con 18 meses llevado a la emergencia por dolor abdominal y vomitos hace 48 horas. El examen abdominal revelo dos agujeros y masa pequena endurecida. Rayo-X abdominal mostro imagen compatible con tres objetos metalicos. Dos agujas y un clavo sin cabeza fueron removidos de la cavidad abdominal mediante laparotomia. COMENTARIOS: El diagnostico se realizo en la segunda atencion medica, probablemente por no haber sido aventada la posibilidad de lesion intencional en la primera atencion. La violencia fisica es un diagnostico diferencial que se debe tener en cuenta en los cuadros de dolor abdominal en ninos. Se subraya la importancia de perfeccionar la formacion del medico interno en Pediatria y de los pediatras en general para el acercamiento a la violencia contra el nino, para que esten mas preparados para accionar la linea de cuidados en situaciones de violencia.