Sidnei Ferreira

Idiopathic pulmonary hemosiderosis treated with azathioprine in a child

Idiopathic pulmonary hemosiderosis (IPH), the main cause of pulmonary hemosiderosis in children, is characterized by intermittent alveolar bleeding and hemosiderin-laden macrophages in sputum and in gastric lavage. The treatment is based on corticosteroids and cytotoxic drugs, under special conditions. We describe the case of a 7-year-old girl with IPH who achieved partial clinical remission with high doses of corticosteroids. However, the treatment had to be discontinued because the patient developed Cushings syndrome. Treatment was started with an azathioprine-corticosteroid combination and then changed to azathioprine alone, which was maintained for four years, with excellent results.

Preoperative pulmonary assessment of children for liver transplantation

Abstract:  Pulmonary assessment should be part of the preoperative investigation of pediatric patients with chronic liver disease undergoing liver transplantation, as it allows the identification of pulmonary alterations that influence candidacy for transplantation and survival. To describe pulmonary changes found in pediatric patients who were candidates for liver transplantation. Retrospective study of 17 pediatric liver transplant candidates undergoing preoperative pulmonary evaluation assessing pulmonary clinical data, arterial blood gas analysis, CXR, respiratory function test by spirometry, pulmonary scintigraphy, and CEE. Ten patients presented normal chest roentgenograms. The most common radiographic change was interstitial infiltrate in the lung bases. Of the five patients with PaO2 <70 mmHg, four had cyanosis and dyspnea and two were diagnosed with HPS with intrapulmonary shunt evidenced by contrast echocardiogram. Two patients presented with intrapulmonary shunt but without hypoxemia. Spirometry was normal in six patients, restrictive disturbance was evidenced in one patient, obstructive in three, and combined in two. The most common scintigraphic change was heterogeneous pulmonary perfusion. Pulmonary assessment should be performed routinely in pediatric patients prior to liver transplantation, even in asymptomatic patients. Pulmonary assessment may indicate changes such as HPS that can increase postoperative morbidity/mortality.

Lethality by pneumonia and factors associated to death

OBJECTIVE To describe the case-fatality rate (CFR) and risk factors of death in children with community-acquired acute pneumonia (CAP) in a pediatric university hospital. METHOD A longitudinal study was developed with prospective data collected from 1996 to 2011. Patients aged 1 month to 12 years were included in the study. Those who left the hospital against medical orders and those transferred to ICU or other units were excluded. Demographic and clinical-etiological characteristics and the initial treatment were studied. Variables associated to death were determined by bivariate and multivariate analysis using logistic regression. RESULTS A total of 871 patients were selected, of whom 11 were excluded; thus 860 children were included in the study. There were 26 deaths, with a CFR of 3%; in 58.7% of these, penicillin G was the initial treatment. Pneumococcus was the most common pathogen (50.4%). From 1996 to 2000, there were 24 deaths (93%), with a CFR of 5.8% (24/413). From 2001 to 2011, the age group of hospitalized patients was older (p = 0.03), and the number of deaths (p = 0.02) and the percentage of disease severity were lower (p = 0.06). Only disease severity remained associated to death in the multivariate analysis (OR = 3.2; 95%CI: 1.2-8.9; p = 0.02). CONCLUSION When the 1996-2000 and 2001-2011 periods were compared, a significant reduction in CFR was observed in the latter, as well as a change in the clinical profile of the pediatric inpatients at the institute. These findings may be related to the improvement in the socio-economical status of the population. Penicillin use did not influence CFR.

Pleuropulmonary manifestations of dengue fever in children and adolescents

From November 2007 to April 2008, 196 patients were admitted to the Short Stay Unit and/or Intensive Care Unit of the Instituto de Puericultura e Pediatria Martagao Gesteira with clinical presentations suggesting dengue fever. Included in this retrospective case series are 181 patients who had laboratory confirmation of dengue fever; 51.9% (94/181) had classical dengue fever and 48.1% (87/181) had dengue hemorrhagic fever. Patients ranged from 4 months to 15 years of age; the median age being 9 years (mean ± SD; 8.5 ± 3.6 years). There were 90 cases with pleuropulmonary manifestations: 30 of 94 cases with classical dengue fever and 60 of 87 cases with dengue hemorrhagic fever. In descending order, the changes found were pleural effusion, elevation of the diaphragm, and pleural opacity. Radiological manifestations appeared a median of 6 days after hospitalization (range, 3 to 11 days). In 89/90 (98.9%) cases with pleuropulmonary manifestations, early therapeutic approaches resulted in resolution of clinical and radiologic findings.

Combate à violência contra crianças e adolescentes: desafio para a sociedade brasileira

The idea of childhood has varied over the centuries and between cultures. According to Narodowski, childhood is a historical phenomenon and not merely a natural one, and in the West its primary characteristics can be classified as heteronomy, dependence and obedience to an adult in exchange for protection 1 . This perspective is in line with Philippe Aries’s proposition, which suggests that we must accept that childhood, as it is understood today, did not exist before the sixteenth century 2 .

Deficiência e acessibilidade: a discussão nacional é indispensável

Estudar, pesquisar, discutir, falar e escrever sobre um tema dos mais importantes e que faz parte das nossas preocupacoes social e humana e desafio que deve ser enfrentado no âmbito mais apropriado: a bioetica. Questoes de deficiencia e acessibilidade remetem aos direitos fundamentais da pessoa, a Constituicao brasileira, a legislacao vigente no pais, ao Sistema Unico de Saude (SUS) e a conceitos, teorias eticas e principios de justica como autonomia, equidade, exclusao social, moral, utilitarismo e vulnerabilidade, entre outras questoes, discutidas por bioeticistas e filosofos, contemporâneos ou nao.

USE OF CACTUS WOOD CEREUS JAMACARU AS AGGREGATE IN LIGHTWEIGHT BIOCONCRETE PRODUCTION

It is constant, especially in the civil construction sector, the search for new material sources that meet the assumptions of sustainable development. In this way, the cacti are pointed as a good alternative. Therefore, the objective of the present research was to develop and characterize physically and mechanically lightweight bioconcretes produced with Cereus wood from this lignocellulosic source. Cereus jamacaru wood was used after washing in hot water (at 80° C). In the studied matrix, Portland Cement CP V-ARI was used and a water-to-cement ratio of 0.4. To accelerate the cement hydration reactions 3% (relative to the cement mass) of calcium chloride was added. Mixtures with two types of wood particles classified as green and brown were produced and for both cases varying the percentage of compensation water (100 and 200%), cement-to-wood ratio (3,4 and 7) and moulding method (compacting with metal rod or not). A flow table test was used to characterize the fresh mixtures. The mechanical characterization was performed through uniaxial compression test. The density of the composites with the brown particles varied from 892 to 1452 kg/m3 and the compressive strength from 3.38 to 10.51 MPa. The blends with green particles reached between 872 and 1347 kg/m3 of density and between 1.72 and 8.94 MPa of compressive strength. The mixtures with higher cement-to-wood proportions and lower amount of compensating water reached higher compressive strength. The results show that Cactus Wood can be used in the production of bioconcretes with good properties and varied applications in civil construction.