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  • ItemArtigo
    Electrocardiogram as Part of the Evaluation of Children and Adolescents Before Starting Physical Exercise
    (2023-01-01) Silva, Diego Lineker Marquetto [UNESP]; Bonatto, Rossano Cesar [UNESP]; Padovani, [UNESP]; Fioretto, José Roberto [UNESP]; Bonatto, Celia de Paula Pimenta [UNESP]; Roberto, Carlos; Universidade Estadual Paulista (UNESP)
    Background: Children and adolescents should be encouraged to participate in sports; however, physicians should screen for cardiac abnormalities that can lead to sudden death. The European Society of Cardiology, the Brazilian Society of Cardiology and the Brazilian Society of Sports Medicine indicate performing an electrocardiogram (ECG) in evaluating athletes, while the American Heart Association indicates complementary exams only when there is a personal or family history of cardiovascular diseases or changes in clinical examination. Objectives: To evaluate the need for an ECG in evaluating children and adolescents before starting physical activities. Methods: We recruited 983 children and adolescents who practiced physical activities for anthropometric assessment, clinical examination and conventional ECG at rest. Variables were analysed using the Goodman test with a significance level of 5%. Results: Participants had a higher incidence of overweight, obesity and severe obesity compared to standard World Health Organization (WHO) values. The most common finding in clinical examination was heart murmur (18.5% of participants). Electrocardiographic changes were found in 3.3% of participants, including paroxysmal supraventricular tachycardia and pre-excitation syndrome, which may be responsible for sudden death, even in asymptomatic individuals with no personal or family history of heart disease and no abnormality on clinical examination. Conclusions: ECG revealed arrhythmias that were not detected by clinical examination and may precede sudden death in individuals subjected to physical exertion, indicating its role in the assessment of children and adolescents before starting regular physical exercise .
  • ItemArtigo
    Attitudes, hesitancy, concerns, and inconsistencies regarding vaccines reported by parents of preschool children
    (2023-01-01) Neto, Jaime Olbrich [UNESP]; Olbrich, Sandra Regina Leite Rosa [UNESP]; Universidade Estadual Paulista (UNESP)
    Objective: This study aimed to assess attitudes, concerns, information and knowledge about vaccines among parents of preschool children attending kindergartens in a city in the interior of São Paulo, Brazil, using a self-administered questionnaire. Methods: Cross-sectional, questionnaire-based study of knowledge and attitudes regarding vaccination among parents of children aged up to 72 months from public and private schools, between 2018 and 2019. Results: Among the 2, 528 questionnaires, 1, 261 were answered and grouped by respondents’ educational level. According to information, 96.6% of the children were up to date with vaccines. The prevalence of vaccine hesitancy was 5.0%. The lower the educational level, the lower was the income, the larger the number of household members, and the greater the lack of knowledge about vaccines. The higher the educational level, the lower was the vaccine hesitancy, and the greater the dissatisfaction with the information received. Conclusions: Generally, parents consider vaccines to be important for preventing diseases and to be safe, with their benefits outweighing the risks. Positive comments were accompanied by doubts, concerns, hesitancy, and inconsistencies. The level of educational attainment makes a difference in the access to information, medical care provided by pediatricians, and the feeling of obligation to vaccinate. Parents have vaccinated and still intend to vaccinate their children, but ensuring adequate levels of vaccination coverage will be a post-pandemic challenge.
  • ItemArtigo
    Use of laryngeal mask for neonatal resuscitation in Brazil: A national survey
    (2023-03-01) Lyra, João Cesar [UNESP]; Guinsburg, Ruth; de Almeida, Maria Fernanda Branco; Variane, Gabriel Fernando Todeschi; Souza Rugolo, Ligia Maria Suppo de [UNESP]; Universidade Estadual Paulista (UNESP); Universidade Federal de São Paulo (UNIFESP); Irmandade de Misericordia da Santa Casa de São Paulo
    Background: The International Liaison Committee on Resuscitation suggests using the laryngeal mask airway (LMA) as an alternative to the face mask for performing positive pressure ventilation (PPV) in the delivery room in newborns ≥34 weeks. Because not much is known about the health professionals’ familiarity in using LMA in Brazil, this study aimed to describe the health professionals’ knowledge and practice of using LMA, who provide neonatal care in the country. Methods: An online questionnaire containing 29 questions was sent to multi-healthcare professionals from different regions in the country through email and social media groups (WhatsApp®, Instagram®, Facebook®, and LinkedIn®). The participants anonymously answered the questions regarding their knowledge and expertise in using LMA to ventilate newborns in the delivery room. Results: We obtained 749 responses from all the regions in Brazil, with 80% from health professionals working in public hospitals. Most respondents were neonatologists (73%) having > 15 years of clinical practice. Among the respondents, 92% recognized the usefulness of LMA for performing PPV in newborns, 59% did not have specific training in LMA insertion, and only 8% reported that they have already used LMA in the delivery room. In 90% of the hospitals, no written protocol was available to use LMA; and in 68% of the hospitals, LMA was not available for immediate use. Conclusion: This nationwide survey showed that most professionals recognize the usefulness of LMA. However, the device is scarcely available and underused in the routine of ventilatory assistance for newborns in delivery rooms in Brazil.
  • ItemArtigo
    PTEN Immunohistochemistry: A New Approach for Diagnosis of Intestinal Neuronal Dysplasia Type B
    (2023-05-01) Terra, Simone Antunes [UNESP]; de Arruda Lourenção, Pedro Luiz Toledo [UNESP]; Rodrigues, Maria Aparecida Marchesan [UNESP]; Universidade Estadual Paulista (UNESP)
    Context.—Intestinal neuronal dysplasia type B (IND B) is a complex entity involving the enteric nervous system, clinically manifested with constipation in infancy. Diagnosis has been established by histopathologic analysis of rectal biopsies. However, the criteria for the diagnosis have been questioned and modified, hindering diagnostic practice. Objective.—To analyze the applicability of PTEN immunohistochemistry in the diagnosis of IND B and to compare with control cases and cases of Hirschsprung disease (HD). Design.—PTEN immunohistochemical expression was analyzed in colorectal samples from 29 cases of IND B and compared with 4 control cases and 6 cases of HD. The pattern of PTEN immunoexpression was analyzed in glial cells of the submucosal and myenteric nerve plexuses and in neural fibrils of the muscularis propria using a scoring system. Results.—Marked reduction or absence of PTEN expression was observed in glial cells of the submucosal nerve plexuses in all cases of the IND B group and in the myenteric nerve plexuses in 28 of 29 cases (96.5%). Lack of PTEN expression was detected in neural fibrils within the muscularis propria in 21 of 29 cases (72%) of the IND B group. PTEN expression was positive in the same neural structures of the control and HD groups. Conclusions.—PTEN immunohistochemistry may be a valuable tool in the diagnostic evaluation of IND B. Lack of or reduction of PTEN expression in neural fibrils within the muscularis propria suggests that involvement of the neuromuscular junction may be a key event in the pathogenesis of the motility disturbance occurring in IND B.
  • ItemArtigo
    Factors of a social nature associated with prematurity risk in a city in São Paulo
    (2023-01-01) da Cruz, Aline Adryane Morishigue Bássiga [UNESP]; dos Santos, Lucas Cardoso [UNESP]; de Oliveira Minharro, Michelle Cristine; Romanholi, Renata Maria Zanardo [UNESP]; Prearo, Alice Yamashita [UNESP]; Alencar, Rúbia Aguiar [UNESP]; Universidade Estadual Paulista (UNESP); Universidade Nove de Julho
    Objective: To identify the associations of factors of a social nature with prematurity. Methos: This is a cross-sectional study with a correlational method, carried out from a database of a medium-sized municipality in the countryside of São Paulo, containing information on all newborns from January 2018 to July 2020, aimed at the identification of social and biological risks after birth. Results: The analysis included 4,480 newborns, of which 78.9% were classified as usual-risk babies and 21.1% as at-risk babies. Among the risk factors of a social nature for newborns analyzed in the present study, there was a higher prevalence of newborns whose head of household had no income, had mothers under 16 years of age, a dead sibling aged less than 5 years and mothers who did not undergo prenatal care, with the last two having association with prematurity. Conclusion: Factors of a social nature were associated with prematurity. This study made it possible to improve the newborn surveillance database, facilitating the elaboration and planning of health care.
  • ItemArtigo
    Risk factors for mortality in 1528 Brazilian childhood-onset systemic lupus erythematosus patients
    (2023-05-01) Sakamoto, Ana P; Silva, Clovis A; Pita, Ana C; Trindade, Vitor C; Islabao, Aline G; Fiorot, Fernanda J; Lopes, Sandra RM; Pereira, Rosa MR; Saad-Magalhaes, Claudia [UNESP]; Russo, Gleice CS; Len, Claudio A; Prado, Rogerio do; Campos, Lucia MA; Aikawa, Nadia E; Appenzeller, Simone; Ferriani, Virginia PL; Silva, Marco F; Felix, Marta; Fonseca, Adriana R; Assad, Ana PL; Sztajnbok, Flavio R; Santos, Maria C; Bica, Blanca E; Sena, Evaldo G; Moraes, Ana J; Fraga, Melissa M; Robazzi, Teresa C; Spelling, Paulo F; Scheibel, Iloite M; Cavalcanti, Andre S; Matos, Erica N; Guimaraes, Luciano J; Santos, Flavia P; Mota, Licia MH; Bonfa, Eloisa; Terreri, Maria T; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Hospital da Crianca de Brasilia Jose Alencar; Universidade Estadual Paulista (UNESP); Universidade Estadual de Campinas (UNICAMP); Hospital Geral de Fortaleza; Universidade Federal do Rio de Janeiro (UFRJ); Ernesto University Hospital; Irmandade da Santa Casa de Misericordia de Sao Paulo; Joao Pessoa; Federal University of Para; Hospital Darcy Vargas; Universidade Federal da Bahia (UFBA); Hospital Evangelico de Curitiba; Hospital Criança Conceição; Universidade Federal de Pernambuco (UFPE); Federal University of Mato Grosso do Sul; University of Brasilia; Universidade Federal de Minas Gerais (UFMG)
    Objectives: To identify associations between mortality in cSLE patients and their characteristics: clinical and laboratory features, disease activity and damage scores, and treatment; to evaluate risk factors associated with mortality in cSLE; and to determine the most frequent causes of death in this group of patients. Methods: We performed a multicenter retrospective cohort using data from 1,528 cSLE patients followed in 27 pediatric rheumatology tertiary centers in Brazil. Patients’ medical records were reviewed according to a standardized protocol, in which information regarding demographic and clinical features, disease activity and damage scores, and treatment were collected and compared between deceased cSLE patients and survivors. Univariate and multivariate analyses by Cox regression model were used to calculate risk factors for mortality, whereas survival rates were analyzed by Kaplan–Meier plots. Results: A total of 63/1,528 (4.1%) patients deceased, 53/63 were female (84.1%), median age at death was 11.9 (9.4–13.1) years and median time interval between cSLE diagnosis and death was 3.2 (0.5–5.3) years. Sepsis was the main cause of death in 27/63 (42.8%) patients, followed by opportunistic infections in 7/63 (11.1%), and alveolar hemorrhage in 6/63 (9.5%) patients. The regression models resulted in neuropsychiatric lupus (NP-SLE) (HR = 2.56, 95% CI = 1.48–4.42) and chronic kidney disease (CKD) (HR = 4.33, 95% CI = 2.33–4.72), as risk factors significantly associated with mortality. Overall patient survival after cSLE diagnosis at 5, 10, and 15 years were 97%, 95.4%, and 93.8%, respectively. Conclusions: This study confirmed that the recent mortality rate in cSLE in Brazil is low, but still of concern. NP-SLE and CKD were the main risk factors for mortality, indicating that the magnitude of these manifestations was significantly high.
  • ItemArtigo
    Operational Definitions Related to Pediatric Ventilator Liberation
    (2023-05-01) Abu-Sultaneh, Samer; Iyer, Narayan Prabhu; Fernández, Analía; Gaies, Michael; González-Dambrauskas, Sebastián; Hotz, Justin Christian; Kneyber, Martin C.J.; López-Fernández, Yolanda M.; Rotta, Alexandre T.; Werho, David K.; Baranwal, Arun Kumar; Blackwood, Bronagh; Craven, Hannah J.; Curley, Martha A.Q.; Essouri, Sandrine; Fioretto, Jose Roberto [UNESP]; Hartmann, Silvia M.M.; Jouvet, Philippe; Korang, Steven Kwasi; Rafferty, Gerrard F.; Ramnarayan, Padmanabhan; Rose, Louise; Tume, Lyvonne N.; Whipple, Elizabeth C.; Wong, Judith Ju Ming; Emeriaud, Guillaume; Mastropietro, Christopher W.; Napolitano, Natalie; Newth, Christopher J.L.; Khemani, Robinder G.; Indiana University School of Medicine; University of Southern California; Hospital General de Agudos “C. Durand” Ciudad Autónoma de Buenos Aires; Cincinnati Children's Hospital Medical Center Heart Institute; Universidad de la República; Children's Hospital Los Angeles; University of Groningen; Biocruces-Bizkaia Health Research Institute; Duke University; Rady Children's Hospital; Postgraduate Institute of Medical Education and Research; Queen's University Belfast; University of Pennsylvania School of Nursing; Children's Hospital of Philadelphia; Université de Montréal; Universidade Estadual Paulista (UNESP); Seattle Children's Hospital and University of Washington; Copenhagen University Hospital; King's College London; Imperial College London; Edge Hill University Health Research Institute; KK Women's and Children's Hospital; University of Southern California Keck School of Medicine
    Background: Common, operational definitions are crucial to assess interventions and outcomes related to pediatric mechanical ventilation. These definitions can reduce unnecessary variability among research and quality improvement efforts, to ensure findings are generalizable, and can be pooled to establish best practices. Research Question: Can we establish operational definitions for key elements related to pediatric ventilator liberation using a combination of detailed literature review and consensus-based approaches? Study Design and Methods: A panel of 26 international experts in pediatric ventilator liberation, two methodologists, and two librarians conducted systematic reviews on eight topic areas related to pediatric ventilator liberation. Through a series of virtual meetings, we established draft definitions that were voted upon using an anonymous web-based process. Definitions were revised by incorporating extracted data gathered during the systematic review and discussed in another consensus meeting. A second round of voting was conducted to confirm the final definitions. Results: In eight topic areas identified by the experts, 16 preliminary definitions were established. Based on initial discussion and the first round of voting, modifications were suggested for 11 of the 16 definitions. There was significant variability in how these items were defined in the literature reviewed. The final round of voting achieved ≥ 80% agreement for all 16 definitions in the following areas: what constitutes respiratory support (invasive mechanical ventilation and noninvasive respiratory support), liberation and failed attempts to liberate from invasive mechanical ventilation, liberation from respiratory support, duration of noninvasive respiratory support, total duration of invasive mechanical ventilation, spontaneous breathing trials, extubation readiness testing, 28 ventilator-free days, and planned vs rescue use of post-extubation noninvasive respiratory support. Interpretation: We propose that these consensus-based definitions for elements of pediatric ventilator liberation, informed by evidence, be used for future quality improvement initiatives and research studies to improve generalizability and facilitate comparison.
  • ItemArtigo
    Towards development of treat to target (T2T) in childhood-onset systemic lupus erythematosus: PReS-endorsed overarching principles and points-to-consider from an international task force
    (2023-06-01) Smith, Eve Mary Dorothy; Aggarwal, Amita; Ainsworth, Jenny; Al-Abadi, Eslam; Avcin, Tadej; Bortey, Lynette; Burnham, Jon; Ciurtin, Coziana; Hedrich, Christian M; Kamphuis, Sylvia; Levy, Deborah M; Lewandowski, Laura B; Maxwell, Naomi; Morand, Eric F; Ozen, Seza; Pain, Clare E; Ravelli, Angelo; Saad Magalhaes, Claudia [UNESP]; Pilkington, Clarissa A; Schonenberg-Meinema, Dieneke; Scott, Christiaan; Tullus, Kjell; Beresford, Michael William; University of Liverpool Faculty of Health and Life Sciences; Alder Hey Children's Nhs Foundation Trust; Sanjay Gandhi Post Graduate Institute of Medical Sciences; Birmingham Children's Hospital Nhs Foundation Trust; Division of Paediatrics; The Children's Hospital of Philadelphia; University College London; Erasmus Medical Center; The Hospital for Sick Children; University of Toronto; National Institute of Arthritis and Musculoskeletal and Skin Diseases Systemic Autoimmunity Branch; Monash University; Hacettepe University Faculty of Medicine; Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura A Carattere Scientifico; Università Degli Studi di Genova; Universidade Estadual Paulista (UNESP); Great Ormond Street Hospital for Children; University of Amsterdam; Amsterdam University Medical Centres; University of Cape Town
    Objectives Application of 'treat-to-target' (T2T) in childhood-onset systemic lupus erythematosus (cSLE) may improve care and health outcomes. This initiative aimed to harmonise existing evidence and expert opinion regarding T2T for cSLE. Methods An international T2T Task Force was formed of specialists in paediatric rheumatology, paediatric nephrology, adult rheumatology, patient and parent representatives. A steering committee formulated a set of draft overarching principles and points-to-consider, based on evidence from systematic literature review. Two on-line preconsensus meeting Delphi surveys explored healthcare professionals' views on these provisional overarching principles and points-to-consider. A virtual consensus meeting employed a modified nominal group technique to discuss, modify and vote on each overarching principle/point-to-consider. Agreement of >80% of Task Force members was considered consensus. Results The Task Force agreed on four overarching principles and fourteen points-to-consider. It was agreed that both treatment targets and therapeutic strategies should be subject to shared decision making with the patient/caregivers, with full remission the preferred target, and low disease activity acceptable where remission cannot be achieved. Important elements of the points-to-consider included: aiming for prevention of flare and organ damage; glucocorticoid sparing; proactively addressing factors that impact health-related quality of life (fatigue, pain, mental health, educational challenges, medication side effects); and aiming for maintenance of the target over the long-term. An extensive research agenda was also formulated. Conclusions These international, consensus agreed overarching principles and points-to-consider for T2T in cSLE lay the foundation for future T2T approaches in cSLE, endorsed by the Paediatric Rheumatology European Society.
  • ItemArtigo
    PReS-endorsed international childhood lupus T2T task force definition of childhood lupus low disease activity state (cLLDAS)
    (2023-05-01) Smith, E. M.D.; Aggarwal, A.; Ainsworth, J.; Al-Abadi, E.; Avcin, T.; Bortey, L.; Burnham, J.; Ciurtin, C.; Hedrich, C. M.; Kamphuis, S.; Lambert, L.; Levy, D. M.; Lewandowski, L.; Maxwell, N.; Morand, E.; Ozen, S.; Pain, C. E.; Ravelli, A.; Saad Magalhaes, C. [UNESP]; Pilkington, C.; Schonenberg-Meinema, D.; Scott, C.; Tullus, K.; Beresford, M. W.; Goilav, B.; Marks, S.; Oni, L.; University of Liverpool; Alder Hey Children's NHS Foundation Trust; Sanjay Gandhi Postgraduate Institute of Medical Sciences; Birmingham Women's and Children's Hospital NHS Foundation Trust; University Medical Center Ljubljana; Children's Hospital of Philadelphia; University College London; Erasmus University Medical Center; The Hospital for Sick Children and University of Toronto; National Institutes of Health; Monash University; Hacettepe University; IRCCS Istituto Giannina Gaslini; Università degli Studi di Genova; Universidade Estadual Paulista (UNESP); Great Ormond Street Hospital for Children NHS Foundation Trust; University of Amsterdam; University of Cape Town; Albert Einstein College of Medicine; Great Ormond Street Hospital for Children NHS Foundation Trust and the NIHR Great Ormond Street Hospital Biomedical Research Centre
    Objective: To achieve a consensus-based definition of Low Disease Activity (LDA) for use in cSLE trials. Methods: The International cSLE T2T Task Force, comprising of paediatric rheumatologists/nephrologists, and adult rheumatologists undertook a series of Delphi surveys/consensus meetings to discuss, refine, and vote upon cSLE LDA criteria. Results: The Task Force agreed that LDA should be based upon the adult-SLE Lupus Low Disease Activity State definition (LLDAS), with modifications to make it applicable to cSLE (cLLDAS). They agreed upon five cLLDAS criteria: (1) SLE Disease Activity Index (SLEDAI)-2 K ≤4, with no activity in major organ systems; (2) no new features of lupus disease activity compared with the last assessment; (3) Physician Global Assessment score of ≤1 (0–3 scale); (4) prednisolone dose of ≤0.15 mg/kg/day, 7.5 mg/day/maximum; while on (5) stable antimalarials, immunosuppressives, and biologics. Conclusions: A cSLE-appropriate definition of cLLDAS has been generated, maintaining alignment with the adult-SLE definition to promote life-course research.
  • ItemArtigo
    Impaired Health-Related Quality of Life in Brazilian Children with Chronic Abdominal Pain: A Cross-Sectional Study
    (2022-01-01) de Jesus, Carine Dias Ferreira [UNESP]; de Assis Carvalho, Mary [UNESP]; Machado, Nilton Carlos [UNESP]; Universidade Estadual Paulista (UNESP)
    Purpose: We compared the health-related quality of life (HRQOL) of children and adolescents with functional abdominal pain disorders (FAPDs) and organic abdominal pain disorders (ORGDs). Methods: This was a single-center, cross-sectional, observational study. The PedsQL 4.0 generic cores scales parent proxy-report was administered to parents/caregivers of 130 and 56 pediatric patients with FAPDs and ORGDs respectively on their first visit. The self-reported pain intensity in the patients was assessed using a visual analog scale (VAS) and facial affective scale (FAS). Results: Irritable bowel syndrome was the most prevalent FAPDs, and the most prevalent ORGDs were reflux esophagitis (41.1%) and gastritis associated with Helicobacter pylori (21.4%). There was no difference in HRQOL among patients diagnosed with ORGDs and FAPDs (p>0.05). Patients with ORGDs and FAPDs had lower HRQOL Scale scores than healthy Brazilian and American children’s references, with a high proportion of children at risk for impaired HRQOL (p<0.0001). There was no difference in the VAS and the FAS scores between the ORGDs and the FAPDs. FAPDs had a higher prevalence of girls’ and couples’ disagreement (p<0.02), although poor school performance (p<0.0007) and bullying (p<0.01) were higher in patients with ORGD. Conclusion: This study revealed that there was a difference in impaired HRQOL between patients with ORGDs and FAPDs. Thus, considering the high prevalence of chronic abdominal pain in children, a well-founded treatment plan is necessary for a multidisciplinary cognitive-behavioral Pain management program.
  • ItemCarta
    Addressing expectations of therapeutic options for children with hydrocephalus—A comment on “Fetal Cerebral Ventriculomegaly. What do we tell the prospective parents?”
    (2023-03-01) Poliseli, Gianfelipe Belini [UNESP]; Hamamoto, Juliana Fattori [UNESP]; Rugolo, Ligia Maria Suppo de Souza [UNESP]; Zanini, Marco Antonio [UNESP]; Hamamoto Filho, Pedro Tadao [UNESP]; Universidade Estadual Paulista (UNESP)
  • ItemArtigo
    Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document
    (2023-01-01) Abu-Sultaneh, Samer; Iyer, Narayan Prabhu; Fernández, Analía; Gaies, Michael; González-Dambrauskas, Sebastián; Hotz, Justin Christian; Kneyber, Martin C.J.; Lopez-Fernández, Yolanda M.; Rotta, Alexandre T.; Werho, David K.; Baranwal, Arun Kumar; Blackwood, Bronagh; Craven, Hannah J.; Curley, Martha A.Q.; Essouri, Sandrine; Fioretto, Jose Roberto [UNESP]; Hartmann, Silvia M.M.; Jouvet, Philippe; Korang, Steven Kwasi; Rafferty, Gerrard F.; Ramnarayan, Padmanabhan; Rose, Louise; Tume, Lyvonne N.; Whipple, Elizabeth C.; Wong, Judith J.M.; Emeriaud, Guillaume; Mastropietro, Christopher W.; Napolitano, Natalie; Newth, Christopher J.L.; Khemani, Robinder G.; Indiana University School of Medicine; Indiana University Health; Children’s Hospital Los Angeles; University of Southern California; Acute Care General Hospital “Carlos G. Durand; University of Cincinnati College of Medicine; Universidad de la Republica; University of Groningen; Cruces University Hospital; Duke University; San Diego; Postgraduate Institute of Medical Education and Research; Queen’s University Belfast; Children’s Hospital of Philadelphia; University of Montreal; Universidade Estadual Paulista (UNESP); University of Washington; Copenhagen University Hospital; Imperial College London; King’s College London; Edge Hill University Health Research Institute; KK Women’s and Children’s Hospital
    Rationale: Pediatric-specific ventilator liberation guidelines are lacking despite the many studies exploring elements of extubation readiness testing. The lack of clinical practice guidelines has led to significant and unnecessary variation in methods used to assess pediatric patients’ readiness for extubation. Methods: Twenty-six international experts comprised a multiprofessional panel to establish pediatrics-specific ventilator liberation clinical practice guidelines, focusing on acutely hospitalized children receiving invasive mechanical ventilation for more than 24 hours. Eleven key questions were identified and first prioritized using the Modified Convergence of Opinion on Recommendations and Evidence. A systematic review was conducted for questions that did not meet an a priori threshold of >80% agreement, with Grading of Recommendations, Assessment, Development, and Evaluation methodologies applied to develop the guidelines. The panel evaluated the evidence and drafted and voted on the recommendations. Measurements and Main Results: Three questions related to systematic screening using an extubation readiness testing bundle and a spontaneous breathing trial as part of the bundle met Modified Convergence of Opinion on Recommendations criteria of >80% agreement. For the remaining eight questions, five systematic reviews yielded 12 recommendations related to the methods and duration of spontaneous breathing trials, measures of respiratory muscle strength, assessment of risk of postextubation upper airway obstruction and its prevention, use of postextubation noninvasive respiratory support, and sedation. Most recommendations were conditional and based on low to very low certainty of evidence. Conclusions: This clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation.
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    Chronic kidney disease in patients with childhood-onset systemic lupus erythematosus
    (2023-06-01) Sakamoto, Ana P.; Silva, Clovis A.; Islabão, Aline G.; Novak, Glaucia V.; Molinari, Beatriz; Nogueira, Paulo K.; Pereira, Rosa M. R.; Saad-Magalhães, Claudia [UNESP]; Clemente, Gleice; Piotto, Daniela P.; Aikawa, Nadia E.; Pitta, Ana C.; Trindade, Vitor C.; Appenzeller, Simone; Carvalho, Luciana M.; Rabelo-Junior, Carlos N.; Fonseca, Adriana R.; Sztajnbok, Flavio R.; Santos, Maria C.; Bica, Blanca E.; Sena, Evaldo G.; Moraes, Ana J.; Fraga, Melissa M.; Robazzi, Teresa C.; Spelling, Paulo F.; Scheibel, Iloite M.; Cavalcanti, Andre S.; Matos, Erica N.; Guimarães, Luciano J.; Santos, Flavia P.; Mota, Licia M. H.; Bonfá, Eloisa; Terreri, Maria T.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Hospital da Crianca de Brasilia Jose Alencar; Universidade Estadual Paulista (UNESP); Universidade Estadual de Campinas (UNICAMP); Hospital Geral de Fortaleza; Universidade Federal do Rio de Janeiro (UFRJ); Pedro Ernesto University Hospital; Irmandade da Santa Casa de Misericordia de Sao Paulo; Universidade Federal da Paraiba; Federal University of Para; Hospital Infantil Darcy Vargas; Universidade Federal da Bahia (UFBA); Hospital Evangelico de Curitiba; Hospital Crianca Conceicao; Universidade Federal de Pernambuco (UFPE); Federal University of Mato Grosso do Sul; University of Brasilia; Universidade Federal de Minas Gerais (UFMG)
    Background: Lupus nephritis (LN) is a frequent manifestation of childhood-onset systemic lupus erythematosus (cSLE) with a potential risk for kidney failure and poor outcomes. This study aimed to evaluate stages III, IV, and V of chronic kidney disease (CKD) and investigate risk factors for CKD in cSLE patients. Methods: We performed a nationwide observational cohort study in 27 pediatric rheumatology centers, including medical charts of 1528 cSLE patients. Data were collected at cSLE diagnosis, during follow-up, and at last visit or death, between September 2016 and May 2019. Results: Of 1077 patients with LN, 59 (5.4%) presented with CKD, 36/59 (61%) needed dialysis, and 7/59 (11.8%) were submitted for kidney transplantation. After Bonferroni’s correction for multiple comparisons (p < 0.0013), determinants associated with CKD were higher age at last visit, urinary biomarker abnormalities, neuropsychiatric involvement, higher scores of disease activity at last visit and damage index, and more frequent use of methylprednisolone, cyclosporine, cyclophosphamide, and rituximab. In the regression model analysis, arterial hypertension (HR = 15.42, 95% CI = 6.12–38.83, p ≤ 0.001) and biopsy-proven proliferative nephritis (HR = 2.83, 95%CI = 1.70–4.72, p ≤ 0.001) increased the risk of CKD, while children using antimalarials had 71.0% lower CKD risk ((1.00–0.29) × 100%) than children not using them. The Kaplan–Meier comparison showed lower survival in cSLE patients with biopsy-proven proliferative nephritis (p = 0.02) and CKD (p ≤ 0.001). Conclusions: A small number of patients manifested CKD; however, frequencies of dialysis and kidney transplantation were relevant. This study reveals that patients with cSLE with hypertension, proliferative nephritis, and absence of use of antimalarials exhibited higher hazard rates of progression to CKD. Graphical Abstract: [Figure not available: see fulltext.]
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    Accuracy of pulmonary ultrasound versus chest radiography for detecting pulmonary congestion resulting from increased pulmonary blood flow in children with congenital heart disease and left-to-right shunting
    (2022-12-01) de Carvalho, Haroldo Teófilo [UNESP]; Bonatto, Rossano César [UNESP]; Campos, Fábio Joly [UNESP]; Martin, Joelma Gonçalves [UNESP]; Fioretto, José Roberto [UNESP]; Universidade Estadual Paulista (UNESP)
    Introduction: Congenital heart diseases are a set of simple or complex dynamic heterogeneous malformations that originate in the embryo, progress through the pregnancy, and considerably change throughout the course of extrauterine life. They are the most common congenital defect, with a global prevalence estimated at 1.8 cases per 100 live births. These diseases can be classified by the cardiovascular segment affected and the impact on blood oxygenation and pulmonary flow. One of their most feared repercussions is pulmonary hypertension, which can result from lung exposure to increased blood flow, which changes vascular tone and causes medial hypertrophy and vascular remodeling. The advent of echocardiography has revolutionized healthcare for these children; however, chest radiography is still the most commonly used method for detecting increased blood flow and pulmonary edema. Objectives: Thus, this study compared the accuracy of ultrasound and chest radiography in detecting congestion resulting from increased pulmonary blood flow in children with congenital heart disease and left-to-right shunting. Methods: This is an observational longitudinal analytical prospective study comparing lung ultrasounds and chest radiographs of patients with congenital heart disease. Results: Our results suggest that ultrasound, which is a noninvasive diagnostic method that emits no radiation, has a discriminatory capacity similar to that of radiography, and has 92.59 % accuracy, 89.47 % sensitivity, and 100 % specificity. Conclusions: Pulmonary ultrasound is highly accurate, sensitive, and specific, and can be used to assess pulmonary congestion and edema resulting from increased blood flow in patients with heart disease.
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    Cross-cultural adaptation and initial validation of the Brazilian-Portuguese version of the pediatric automated neuropsychological assessment metrics
    (2022-09-16) de Amorim, Jaqueline Cristina; Kishimoto, Simone Thiemi; Elorza, Cibele Longobardi Cutinhola; Cavaletti, Flávia Alegretti; Marini, Roberto; Silva, Clovis Artur; Saad-Magalhães, Claudia [UNESP]; Fernandes, Paula Teixeira; Brunner, Hermine I.; Appenzeller, Simone; Universidade Estadual de Campinas (UNICAMP); Universidade de São Paulo (USP); Universidade Estadual Paulista (UNESP); University of Cincinnati
    Automated neuropsychiatric batteries have been used in research and clinical practice, including for chronic diseases, such as Systemic Lupus Erythematosus. The Pediatric Automated Neuropsychological Assessment Metrics battery (Ped-ANAM), originally developed for use in American-English speaking individuals, allows tracking of cognitive functions. It can be applied to people over 9 years old. The aim of this study was to translate and present initial validation data from the Ped-ANAM into Brazilian-Portuguese. We translated the battery according to Beaton’s guidelines. Psychometric properties were tested, internal consistency was analyzed by Cronbach’s alpha coefficient, test-retest reliability by the intraclass correlation coefficient (ICC). Further, we measured the test execution speed at both times as a temporal stability. Principal component analysis (PCA) was used for structural validity. Evidence of construct validity was assessed through assessment of the relationships with the Wechsler Intelligence Scales. All participants prior to the start of study related activities signed an informed consent form approved by the local ethics committee. A sample of 230 individuals [mean (range) of age: 23 (9 to 60) years; 65% females] was included; a subset of 51 individuals [mean (range) of age: 18 (9 to 57) years, 59% female] completed the Ped-ANAM twice to assess test-retest reliability, and another subset of 54 individuals [mean (range) of age: 20.4 (7 to 62) years; 67% female] completed the Wechsler Intelligence Scales for Children and Adult for assessment of the Ped-ANAM’s construct validity. Our results suggest that the internal consistency of the Ped-ANAM (Cronbach’s α = 0.890) and its subtest test-retest reliability were excellent (ICC: 0.59 to 0.94). There was no clustering in the Principal Components Analysis, suggestive of non-grouping of the evaluated variables. Construct validity assessment to the Wechsler Scales showed expected ranges of low to strong correlations (Spearman correlations: ρ = 0.40 to ρ = 0.69). We concluded that, based on the results of this study, a cross-culturally validated Brazilian-Portuguese version of the Ped-ANAM has been developed and it is a reliable tool for the screening cognitive function.
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    Factors of a social nature associated with prematurity risk in a city in Sao Paulo
    (Univ Fed Sao Paulo, Dept Enfermagen, 2023-01-01) Cruz, Aline Adryane Morishigue Bassiga da [UNESP]; Santos, Lucas Cardoso dos [UNESP]; Oliveira Minharro, Michelle Cristine de; Romanholi, Renata Maria Zanardo [UNESP]; Prearo, Alice Yamashita [UNESP]; Alencar, Rubia Aguiar [UNESP]; Universidade Estadual Paulista (UNESP); Univ Nove Julho
    Objective: To identify the associations of factors of a social nature with prematurity.Methos: This is a cross-sectional study with a correlational method, carried out from a database of a medium-sized municipality in the countryside of Sao Paulo, containing information on all newborns from January 2018 to July 2020, aimed at the identification of social and biological risks after birth.Results: The analysis included 4,480 newborns, of which 78.9% were classified as usual-risk babies and 21.1% as at-risk babies. Among the risk factors of a social nature for newborns analyzed in the present study, there was a higher prevalence of newborns whose head of household had no income, had mothers under 16 years of age, a dead sibling aged less than 5 years and mothers who did not undergo prenatal care, with the last two having association with prematurity.Conclusion: Factors of a social nature were associated with prematurity. This study made it possible to improve the newborn surveillance database, facilitating the elaboration and planning of health care.
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    Risk Factors for Malfunction of Ventriculoperitoneal Shunts Performed by Medical Residents in Children: an Exploratory Study
    (Georg Thieme Verlag Kg, 2022-09-01) Teixeira de Oliveira, Italo Cardoso [UNESP]; Cardoso da Silva, Douglas Inomata [UNESP]; Matilde, Jamille Duran [UNESP]; Botta, Fabio Pires [UNESP]; Hamamoto, Juliana Fattori [UNESP]; Garcia de Avila, Marla Andreia [UNESP]; Suppo de Souza Rugolo, Ligia Maria [UNESP]; Zanini, Marco Antonio [UNESP]; Hamamoto Filho, Pedro Tadao [UNESP]; Universidade Estadual Paulista (UNESP)
    Introduction Ventriculoperitoneal shunts (VPSs) are common neurosurgical procedures, and in educational centers, they are often performed by residents. However, shunts have high rates of malfunction due to obstruction and infection, especially in pediatric patients. Monitoring the outcomes of shunts performed by trainee neurosurgeons is important to incorporate optimal practices and avoid complications. Methods In the present study, we analyzed the malfunction rates of VPSs performed in children by residents as well as the risk factors for shunt malfunction. Results The study included 37 patients aged between 0 and 1.93 years old at the time of surgery. Congenital hydrocephalus was observed in 70.3% of the patients, while 29.7% showed acquired hydrocephalus. The malfunction rate was 54.1%, and the median time to dysfunction was 28 days. Infections occurred in 16.2% of the cases. Cerebrospinal fluid leukocyte number and glucose content sampled at the time of shunt insertion were significantly different between the groups (p = 0.013 and p = 0.007, respectively), but did not have a predictive value for shunt malfunction. In a multivariate analysis, the etiology of hydrocephalus (acquired) and the academic semester (1st) in which the surgery was performed were independently associated with lower shunt survival (p = 0.009 and p = 0.026, respectively). Conclusion Ventriculoperitoneal shunts performed in children by medical residents were at a higher risk of malfunction depending on the etiology of hydrocephalus and the academic semester in which the surgery was performed.
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    Labeling food allergens in the packaged food pyramid groups in Brazil: analysis of descriptions, ambiguities, and risks
    (2022-01-01) Lopes, Joice Ferreira [UNESP]; de Assis Carvalho, Mary [UNESP]; Machado, Nilton Carlos [UNESP]; Universidade Estadual Paulista (UNESP)
    Objective: The aim of this study was to evaluate allergenic labeling components of packaged foods for What is the quality of food labels? and What is the group of Brazilian Food Pyramid that 'May contain' is predominant?. Methods: The photographs of 916 products were obtained, of which 518 were analyzed. Data from each label were evaluated according to Brazilian Food Pyramid Groups (i.e., Cereals, Fruits, & Vegetables; Soybean & products; Milk & dairy products; Meat & eggs; Fats & oils; and Sugars & sweets). Ten items were analyzed in each label, namely, the presence of a list of ingredients, alert phrase for allergy sufferers, grouping of the alert phrase, phrase location, uppercase phrase, the phrase in bold, the color of alert phrase contrasting to the background, adequate font size, do not claim the absence for any allergen with the ingredients, and others factors that make it difficult to read. For the second question, a structured questionnaire was completed, and products were classified into two categories, namely, Contain and May contain. Results: The quality of the label was appropriate, and 69% of packaged foods had at least one allergen. The information May contain were higher in cow's milk (Cereals and Meat & eggs), soy (Soybean & products), and egg protein (Cereals). Soybean & products were the highest insecurity group. Conclusions: Brazilian health professionals can count on goodquality labeling of packaged products. Consequently, they could promote patients' and parents/caregivers' education to consult the labels and manage the risks in processed foods about precautionary allergen labeling. Soybean & products were the most significant insecurity for food choices between Brazilian Pyramid Groups.
  • ItemArtigo
    Labeling food allergens in the packaged food pyramid groups in Brazil: analysis of descriptions, ambiguities, and risks
    (2022-01-01) Lopes, Joice Ferreira [UNESP]; de Assis Carvalho, Mary [UNESP]; Machado, Nilton Carlos [UNESP]; Universidade Estadual Paulista (UNESP)
    Objective: The aim of this study was to evaluate allergenic labeling components of packaged foods for What is the quality of food labels? and What is the group of Brazilian Food Pyramid that 'May contain' is predominant?. Methods: The photographs of 916 products were obtained, of which 518 were analyzed. Data from each label were evaluated according to Brazilian Food Pyramid Groups (i.e., Cereals, Fruits, & Vegetables; Soybean & products; Milk & dairy products; Meat & eggs; Fats & oils; and Sugars & sweets). Ten items were analyzed in each label, namely, the presence of a list of ingredients, alert phrase for allergy sufferers, grouping of the alert phrase, phrase location, uppercase phrase, the phrase in bold, the color of alert phrase contrasting to the background, adequate font size, do not claim the absence for any allergen with the ingredients, and others factors that make it difficult to read. For the second question, a structured questionnaire was completed, and products were classified into two categories, namely, Contain and May contain. Results: The quality of the label was appropriate, and 69% of packaged foods had at least one allergen. The information May contain were higher in cow's milk (Cereals and Meat & eggs), soy (Soybean & products), and egg protein (Cereals). Soybean & products were the highest insecurity group. Conclusions: Brazilian health professionals can count on goodquality labeling of packaged products. Consequently, they could promote patients' and parents/caregivers' education to consult the labels and manage the risks in processed foods about precautionary allergen labeling. Soybean & products were the most significant insecurity for food choices between Brazilian Pyramid Groups.
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    Translating Neonatal Resuscitation Guidelines Into Practice in Brazil
    (2022-06-01) de Almeida, Maria Fernanda B; Guinsburg, Ruth; Weiner, Gary M.; Penido, Marcia G.; Ferreira, Daniela M L M; Alves, José Mariano S; Embrizi, Laís F; Gimenes, Carolina B.; Mello E Silva, Nathalia M.; Ferrari, Lígia L; Venzon, Paulyne S.; Gomez, Dafne B.; do Vale, Marynéa S; Bentlin, Maria Regina [UNESP]; Sadeck, Lilian R.; Diniz, Edna M A; Fiori, Humberto H.; Caldas, Jamil P S; de Almeida, João Henrique C L; Duarte, José Luis M B; Gonçalves-Ferri, Walusa A.; Procianoy, Renato S.; Lopes, José Maria A; Universidade Federal de São Paulo (UNIFESP); University of Michigan; Universidade Federal de Minas Gerais (UFMG); Universidade Federal de Uberlândia (UFU); Faculdade de Ciências Médicas de Minas Gerais; Hospital Estadual de Sumaré; Hospital Geral de Pirajussara; Hospital Estadual de Diadema; Universidade Estadual de Londrina (UEL); Universidade Federal do Paraná (UFPR); Instituto de Medicina Integral Prof Fernando Figueira; Universidade Federal do Maranhão; Universidade Estadual Paulista (UNESP); Universidade de São Paulo (USP); Pontifícia Universidade Católica do Rio Grande do Sul; Universidade Estadual de Campinas (UNICAMP); da Criança e do Adolescente Fernandes Figueira; Universidade do Estado do Rio de Janeiro (UERJ); Universidade Federal do Rio Grande do Sul
    BACKGROUND AND OBJECTIVES: The Brazilian Neonatal Resuscitation Program releases guidelines based on local interpretation of international consensus on science and treatment recommendations. We aimed to analyze whether guidelines for preterm newborns were applied to practice in the 20 Brazilian Network on Neonatal Research centers of this middle-income country. METHODS: Prospectively collected data from 2014 to 2020 were analyzed for 8514 infants born at 230/7 to 316/7 weeks' gestation. The frequency of procedures was evaluated by gestational age (GA) category, including use of a thermal care bundle, positive pressure ventilation (PPV), PPV with a T-piece resuscitator, maximum fraction of inspired oxygen (Fio2) concentration during PPV, tracheal intubation, chest compressions and medications, and use of continuous positive airway pressure in the delivery room. Logistic regression, adjusted by center and year, was used to estimate the probability of receiving recommended treatment. RESULTS: For 3644 infants 23 to 27 weeks' GA and 4870 infants 28 to 31 weeks' GA, respectively, the probability of receiving care consistent with guidelines per year increased, including thermal care (odds ratio [OR], 1.52 [95% confidence interval (CI) 1.44-1.61] and 1.45 [1.38-1.52]) and PPV with a T-piece (OR, 1.45 [95% CI 1.37-1.55] and 1.41 [1.32-1.51]). The probability of receiving PPV with Fio2 1.00 decreased equally in both GA groups (OR, 0.89; 95% CI, 0.86-0.93). CONCLUSIONS: Between 2014 and 2020, the resuscitation guidelines for newborns <32 weeks' GA on thermal care, PPV with a T-piece resuscitator, and decreased use of Fio2 1.00 were translated into clinical practice.