Made available in DSpace on 2015-04-14T13:33:03Z (GMT). No. of bitstreams: 1 446510.pdf: 17222028 bytes, checksum: 91c5883f67ca4db80d44ff4a6092aa1c (MD5) Previous issue date: 2013-03-01 / Objectives: to investigate separately the therapeutic potential of neuropeptide NAP and the intra-arterial (IA) transplantation of human umbilical cord blood (HUCB) mononuclear cells in an animal model of neonatal hypoxia-ischemia (HI). Methods: male Wistar rats at postnatal day 7 were subjected to an HI model by permanent occlusion of right common carotid artery and systemic hypoxia (8% O2 for 2 h). The animals were randomly assigned to groups receiving an intraperitoneal injection of NAP (3 μg/g) immediately (0 h) and 24 h after HI. Other animals received HUCB mononuclear cells (1 x 106 or 1 x 107 cells/50 μL) into the left common carotid artery 24 h after HI insult by using the microneedle technique. Only for NAP study, brain DNA damage, lipid peroxidation and reduced glutathione (GSH) content were determined 48 h post-HI insult. The spatial version of the Morris water maze learning task and the stereological volume assessment were performed in adult animals that received both therapies. The accelerated rotarod test and cerebral and body weight determination were applied only for cellular therapy study. The HUCB mononuclear cells migration was monitored through nested-PCR analysis in the brain and systemic organs of transplanted-HI rats. Results: we observed that NAP prevented the acute HI-induced DNA and lipid membrane damage and also recovered the GSH levels in the injured hemisphere of the HI rat pups. Further, NAP was able to hinder impairments in learning and long-term spatial memory and to significantly reduce brain damage in adult animals previously subjected to neonatal HI. The IA transplantation in neonatal HI rat seemed to be a feasible and safe delivery route for HUCB mononuclear cells. The intra-arterially delivered cells hindered dose-dependently the learning and spatial memory impairments without brain damage recovery in adult rats. Additionally we further showed that HI insult or IA cell transplantation had no long-term impact in the body weight and motor function in rodents. The HUCB mononuclear cells could be promptly identified in the ischemic brain after IA transplantation and also in some peripheral organs until at least 30 days later. Conclusions: the viability and long-lasting beneficial effects of neuropeptide NAP and IA transplantation of HUCB mononuclear cells support its translational characteristic for neonatal HI management. Therefore, NAP and intracarotid delivery of cells became promising candidates for the treatment of HI-induced brain damage and life-long disabilities / Objetivos: investigar, separadamente, o potencial terap?utico do neuropept?deo NAP e do transplante intra-arterial de c?lulas mononucleares de sangue de cord?o umbilical humano (CMSCUH) em um modelo experimental de hip?xia-isquemia (HI) neonatal. M?todos: ratos Wistar machos com 7 dias de vida foram submetidos ao modelo de HI neonatal atrav?s da oclus?o permanente da art?ria car?tida comum direita e hip?xia sist?mica (8% O2 por 2 h). A administra??o do neuropept?deo NAP (3 μg/g, i.p.) ocorreu imediatamente (0 h) e 24 h ap?s a aplica??o do modelo. J? o transplante de CMSCUH (1 x 106 ou 1 x 107 c?lulas/50 μL) foi realizado 24 h p?s-HI atrav?s de t?cnica de microagulha na art?ria car?tida comum esquerda. Somente no estudo do NAP, ensaio cometa alcalino, peroxida??o lip?dica e n?veis de glutationa reduzida foram determinados no hipocampo e c?rtex cerebral 48 h p?s-HI. Para ambas as terapias empregaram-se a vers?o espacial do labirinto aqu?tico de Morris (LAM) e determina??o estereol?gica da volumetria hemisf?rica cerebral na fase adulta destes animais. Utilizou-se o teste do rotarod acelerado e pesagem corporal e cerebral dos animais adultos apenas no estudo do transplante intra-arterial de CMSCUH. A migra??o das CMSCUH foi monitorada atrav?s da t?cnica de nested-PCR no c?rebro e ?rg?os sist?micos. Resultados: o tratamento com NAP restabeleceu a integridade hipocampal e cortical do DNA e membranas lip?dicas, junto ao incremento do sistema glutationa. Al?m disso, o NAP impediu o desenvolvimento de d?ficits do aprendizado e da mem?ria espacial juntamente ? redu??o da atrofia cerebral em ratos adultos. O transplante intracarot?dico de CMSCHU em ratos neonatos HI demonstrou-se fact?vel e seguro. Este tratamento preveniu, de maneira dose-dependente, o desenvolvimento de preju?zo cognitivo de ratos adultos previamente expostos ? HI neonatal, sem influ?ncia sobre a atrofia cerebral. A fun??o motora e peso corporal de ratos adultos n?o sofreram influ?ncia da HI neonatal ou da administra??o intra-arterial de CMSCHU. As CMSCHU puderam ser detectadas tanto logo ap?s o transplante como tardiamente (30 dias) no c?rebro e ?rg?os sist?micos dos animais transplantados. Conclus?es: os efeitos ben?ficos e duradouros do neuropept?deo NAP e do transplante intra-arterial de CMSCHU, assim como sua viabilidade, fornecem evid?ncias de uma poss?vel translacionalidade destas duas terapias inovadoras para o tratamento da HI neonatal. Desta forma, o neuropept?deo NAP e a via intracarot?dica para o transplante de CMSCHU tornam-se candidatos potenciais para a preven??o do dano HI cerebral e decorrentes sequelas

Made available in DSpace on 2015-04-14T13:33:03Z (GMT). No. of bitstreams: 1 447158.pdf: 1221668 bytes, checksum: ba93f5bf3638499b30c10ce8d65f2c0c (MD5) Previous issue date: 2013-03-04 / Background: Elective cesarean section is a common procedure. However, the consequences of this procedure to the baby are not well known. Objective: to evaluate in-hospital clinical outcome of full-term newborn according to the delivery method. Methods: this is a retrospective cohort conducted at Moinhos de Vento Hospital a private hospital with opened clinical staff between January 2010 and April 2011. The study included 2014 newborns with gestational age &#8805;38 weeks. The babies were grouped as: Group I elective cesarean section and group II vaginal delivery. Newborns with severe malformation and diabetic mothers were excluded. Results: the study included 1671 newborns delivered by cesarean section and 343 by vaginal delivery. There was no significant difference between the groups as far hospitalization in the special care unit was analyzed. Transient tachypnea of the newborn was more frequent in group I: 29 (40.8% of those admitted in the special care unit) and 22 of these 29 (75,9%) had 38 gestational weeks. Apgar proportions less than seven in the first minute. The < 2.5 percentile was 4.4% for group II and 1.7% for group I (OR 2.58 (1.35-4.92). The difference in Apgar score was not significant between the groups at 5 minutes of life. Conclusion: it was not observed negative effects in in-hospital clinical results in babies delivered by elective C-section except for the increase in the occurrence of transient tachypnea. The highest incidence of low Apgar in the group of vaginal delivery and should be further investigated. / Introdu??o: A cesariana eletiva ? um procedimento comum. Entretanto, as consequ?ncias deste procedimento para o beb? ainda n?o s?o claramente conhecidas. Objetivo: Avaliar o desfecho cl?nico intra-hospitalar de rec?m-nascidos a termo, conforme a via de nascimento. M?todos: Estudo de coorte retrospectivo, realizado no Hospital Moinhos de Vento, hospital privado, com corpo cl?nico aberto, entre janeiro de 2010 a abril de 2011. Foram inclu?dos no estudo 2014 rec?m-nascidos com idade gestacional &#8805; 38 semanas. Os beb?s foram divididos em dois grupos: Grupo I - Cesariana eletiva e Grupo II - Parto vaginal. Foram exclu?dos rec?m-nascidos com malforma??o grave e filhos de m?e diab?tica. Resultados: Foram inclu?dos 1671 nascidos de cesariana eletiva e 343 de parto vaginal. N?o houve diferen?a significativa entre os dois grupos quando analisadas a interna??o em unidade de cuidados especiais. A taquipn?ia transit?ria do rec?m-nascido foi mais frequente no Grupo I: 29 (40,8% dos internados na unidade de cuidados especiais) sendo que 22 (75,9%) destes tinham idade gestacional de 38 semanas. A ocorr?ncia de Apgar abaixo do percentil < 2,5 foi de 4,4% para o Grupo II e de 1,7% para o Grupo I - OR 2,58 (1,35-4,92). A diferen?a no Apgar n?o foi significativa aos 5 minutos de vida. Conclus?o: N?o foram observados efeitos negativos no resultado clinico intra-hospitalar em beb?s nascidos por cesariana eletiva, exceto pelo aumento de ocorr?ncia de taquipn?ia transit?ria. A maior ocorr?ncia de Apgar baixo no grupo II parto vaginal deve ser investigado posteriormente.

Made available in DSpace on 2015-04-14T13:33:04Z (GMT). No. of bitstreams: 1 448016.pdf: 452471 bytes, checksum: 1fc9475d7f40d9aa0613d308b60b2c94 (MD5) Previous issue date: 2013-03-25 / Introduction: the main causes of hospitalization in infants are wheezing episodes caused by seasonal viruses. The impact of infection by two or more viruses is not well established in the literature, especially the relationship between coinfection and clinical severity of the disease. Methods: In the present study, we evaluated the occurrence of infections and coinfections by respiratory viruses in infants with wheezing, as well as the association between coinfection and outcomes related to disease severity. This was a cross-sectional study with infants up to 12 months of age with acute wheezing, who were admitted to a pediatric unit. The study was conducted between September 2009 and September 2011. For identification of respiratory viruses, nasopharyngeal secretions were collected and, the samples were analyzed using the immunofluorescence and PCR for respiratory viruses. Results: 35.3% (42/119) of patients were negative for virus; 48.7% (58/119) were positive for one virus and 11.8% (14/119) for two viruses. The association of coinfection and severity measured by different periods of hospitalization, use of oxygen therapy and wheezing showed significant results. The higher were the number of virus identified; the higher the markers of severity. Conclusion: In this study, the coinfection with respiratory viruses in infants with wheezing influenced the severity of the clinical condition. In addition, rates of coinfection in infants admitted to the emergency hospital suggests that crowding of people in the same environment as well as the short distance between beds in emergency can be factors contributing to coinfection with respiratory viruses. / Introdu??o: as principais causas de interna??es de lactentes s?o as crises de sibil?ncia causadas por v?rus sazonais. O impacto da infec??o por dois ou mais v?rus n?o est? bem esclarecida na literatura, especialmente a rela??o entre a coinfec??o e a gravidade cl?nica da doen?a. M?todos: no presente estudo, foram avaliadas a ocorr?ncia de infec??es e coinfec??es por v?rus respirat?rios em lactentes com sibil?ncia, bem como a associa??o entre coinfec??o e desfechos relacionados ? gravidade da doen?a. Este foi um estudo transversal, com lactentes de at? 12 meses de idade, com crise de sibil?ncia, que estavam internados em uma unidade pedi?trica. O estudo foi realizado no per?odo entre setembro de 2009 e setembro de 2011. Para identifica??o dos v?rus respirat?rios foi coletada secre??o de nasofaringe e ap?s o per?odo de coleta as amostras foram analisadas atrav?s da t?cnica do imunofluoresc?ncia e PCR em tempo real para v?rus respirat?rios. Resultados: No presente estudo foram selecionados 127 pacientes, sendo que 122 completaram todos os crit?rios de inclus?o. A m?dia de idade foi de 2,9 meses, sendo 54,9% (67/122) dos pacientes do sexo masculino. Com rela??o ?s vari?veis cl?nicas, observamos que 99,2% (121/122) necessitaram oxigenioterapia, com tempo de dura??o m?dio de 5,3 dias de tratamento com O2. O tempo m?dio de interna??o foi de 5,9 dias e o tempo de sibil?ncia durante a interna??o hospitalar foi de 4,0 dias. A identifica??o dos v?rus por imunofluoresc?ncia demonstrou 42 (34%) amostras negativas e positividade de 101 (71,7%). O VSR foi o v?rus mais frequente com 65 (51,2%) da amostra positivas, seguido por influenza 15 (11,8%), parainfluenza 10 (7,9%) e adenov?rus 3 (2,4%). Os pacientes infectados com um maior n?mero de v?rus tiveram um maior tempo de interna??o e de uso de oxigenioterapia. Conclus?o: Neste estudo, a coinfec??o com v?rus respirat?rios nos lactentes com sibil?ncia foi um fator de risco relacionado com a gravidade do quadro cl?nico dos pacientes. Em adi??o, as taxas de coinfec??o em lactentes internados na emerg?ncia deste hospital sugerem que a aglomera??o de pessoas no mesmo ambiente, bem como a pequena dist?ncia entre os leitos na emerg?ncia podem ser fatores importantes para as elevadas taxas de coinfec??o por v?rus respirat?rios.

Made available in DSpace on 2015-04-14T13:33:05Z (GMT). No. of bitstreams: 1 448602.pdf: 5444949 bytes, checksum: 5f077f7aa23c0ec642d7726b401ada78 (MD5) Previous issue date: 2013-03-04 / OBJECTIVE: To calculate the frequencies of acute pyelonephritis and renal scarring in youngers than two years old through scintigraphy with 99mTcDMSA with first episode of UTI in a Brazilian university hospital and comparing with international literature. MATERIALS AND METHODS: We reviewed reports scintigraphy of youngers than two years old who underwent scintigraphy with 99mTcDMSA in a university hospital in Rio Grande do Sul, between 2006 and 2009 to search for APN and renal scarring. It was also revised the presence of vesicoureteral reflux, early use of antibiotics, and comorbidities that were recorded in e lectronic records. The sample size calculation was based on a systematic review study and obtained a minimum of 147 patients. We excluded patients with no electronic record. RESULTS: 157 children met the inclusion criteria, where 48 had APN and 8 of these had renal scars. There was no statistical difference in the association of VUR and APN (p=1.0) as well as among all comorbidities (p=0.470). There was no significance relation to early use of antibiotics and APN (p=0.130) and renal scarring (p=0.720). CONCLUSION: The frequency of renal scarring and APN obtained agree with the results of most studies. / OBJETIVO: Calcular as frequ?ncias de pielonefrite aguda (PNA) e cicatriz renal em pacientes menores de dois anos com cintilografia renal com 99mTcDMSA com primeiro quadro de ITU em hospital universit?rio brasileiro comparando com dados da literatura internacional. MATERIAIS E M?TODOS: Foram revisados laudos cintilogr?ficos de crian?as menores de dois anos de idade que realizaram cintilografia renal com 99mTcDMSA em um hospital universit?rio de no Rio Grande do Sul, entre 2006 e 2009 para pesquisa de PNA/cicatriz renal. Revisouse a presen?a de refluxo v?sicoureteral (RVU), uso precoce de antibi?tico, e presen?a de comorbidades que constassem nos prontu?rios eletr?nicos. Calculouse a amostra baseado num estudo de revis?o sistem?tica e obtevese um m?nimo de 147 pacientes. Excluiu-se pacientes sem registro eletr?nico. RESULTADOS: 157 crian?as preencheram crit?rios de inclus?o do estudo, 48 tiveram PNA e 8 destes apresentaram cicatriz renal. Nem a idade e g?nero dos pacientes apresentaram associa??o significativa com PNA (p=0,405&#894; p=0,124 respectivamente). N?o houve diferen?a estat?stica nas associa??es de RVU e PNA (p=1,0) e outras comorbidades (p=0,470)&#894; e em rela??o ao uso precoce de antibi?tico com PNA (p=0,130) e cicatriz renal (p=0,720). CONCLUS?O: As frequ?ncias de PNA e cicatriz renal obtidas concordam com os resultados da maioria dos estudos publicados

Made available in DSpace on 2015-04-14T13:33:07Z (GMT). No. of bitstreams: 1 451171.pdf: 1444213 bytes, checksum: 3fb4ef51b183abf4e6c68c00f1039133 (MD5) Previous issue date: 2013-08-28 / Objective: To determine factors associated with the length of exclusive breastfeeding at two hospitals, a baby-friendly hospital and one general hospital, and relate them to the scores of the Breastfeeding Self Efficacy Scale and the Edinburgh Postnatal Depression Scale. Methods: We conducted a descriptive and analytical cohort study of 300 binomials of mother-babies that were born in two hospitals: one at the general hospital and the other at a baby-friendly hospital. The inclusion criteria were: children with birth weight of 2,500 g or less, gestational age above 36 weeks and residents in urban areas. At the hospitals maternities, data were collected from medical records, questions to mothers were asked and the Breastfeeding Self-Efficacy Scale was applied. Every 15 days, the mother was contacted and asked if she was still exclusively breastfeeding and the Edinburgh Postnatal Depression Scale-EPDS was applied four months after giving birth. Results: Among the births, 53% were male, 52% were at a baby-friendly hospital and 55% were normal deliveries. The mothers had a mean age of 26 years and a mean gestational age of 39 weeks. The average maternal breastfeed score was 36 points while the score for the Edinburgh Scale was that 36% of the mothers had a tendency of depression. Only 34% of the mothers had up to eight years of education, 57% of them worked outside the home, 13% of them were single and 61% had 7-13 prenatal consultations. At 30 days, the frequency of exclusive breastfeeding was of 86% while only 49% of the babies were breastfed exclusively at 120 days of life. In the multivariate analysis, the variables of exclusive breastfeeding at 60 days showing risk factors were the hospital not being baby friendly (p=0,002), the mother's schooling (up to 8 years of study) (p=0,004) and a working mother (p=0,013). The highest Breastfeeding test score (p=0,016) was for the protection factor of exclusive breastfeeding. At 120 days, it was evaluated that the variables shown as protection factors were the mother's age (p=0,039) and the Breastfeed test score (p=0,046). Conclusions: The risk factors associated with exclusive breastfeeding during the 60 days at a hospital that is not baby friendly are the mother's schooling (up to 8 years) and whether she works or not. The highest Breastfeed score was the exclusive breastfeeding protection factor. At 120 days, the variables shown as exclusive breastfeeding protection factors were the mother's age and the Breastfeed test score. / Objetivo: Determinar os fatores relacionados com o tempo de aleitamento materno exclusivo em dois hospitais, um amigo da crian?a e outro hospital geral, e relacionar com os escores da Breastfeeding Self Efficacy Scale e a Edinburgh Postnatal Depression Scale. M?todos: Foi realizado um estudo de coorte descritiva e anal?tica, com 300 bin?mios m?e-beb?, cujos beb?s nasceram em dois hospitais: um hospital geral e o outro amigo da crian?a. Os crit?rios de inclus?o foram: crian?as com peso de nascimento >2.500 gramas, idade gestacional acima de 36 semanas, residentes em zonas urbanas. Na maternidade, foram coletados dados do prontu?rio foram aplicados um question?rio ?s m?es e a Breastfeeding Self Efficacy Scale. A cada 15 dias, contatava-se a m?e, perguntando-lhe se ainda estava em aleitamento materno exclusivo e, ao chegar aos quatro meses p?s-parto, foi aplicada a Edinburgh Postnatal Depression Scale. Resultados: Dentre os nascimentos, 53% era masculino, 52% foi em hospital amigo da crian?a, 55% foi parto normal. A idade m?dia das m?es era de 26 anos e a idade gestacional m?dia foi de 39 semanas. A m?dia materna de escore de Breastfeed foi de 36 pontos. Quanto ao escore de Edinburgh, 36% das m?es apresentava tend?ncia ? depress?o. Apenas 34% das m?es tinha at? oito anos de estudo, 57% trabalhava fora, 13% era solteira, 61% realizou de 7 a 13 consultas de pr?-natal. Avaliando-se a frequ?ncia de amamenta??o exclusiva (AME) aos 30 dias foi de 86%,enquanto apenas 49% das crian?as recebeu amamenta??o exclusiva aos 120 dias de vida. Na an?lise multivari?vel o aleitamento materno exclusivo aos 60 dias, as vari?veis que se mostraram como fatores de risco para a amamenta??o foram, o Hospital N?o amigo da Crian?a (p=0,002),a escolaridade (at? oito anos de estudo) (p=0,004) e a m?e que trabalha ( p= 0,013). J? a maior pontua??o no teste de Breastfeed (p=0,016) foi um fator de prote??o para amamenta??o exclusivo. Ao avaliar o aleitamento materno aos 120 dias, as vari?veis que se mostraram como fatores de prote??o para a amamenta??o foram a maior idade materna (p=0,039) e a pontua??o no teste de Breastfeed (p=0,046). Conclus?es: Os fatores de risco associados com aleitamento materno exclusivo aos 60 dias foram o Hospital N?o credenciado como amigo da Crian?a, a escolaridade (at? oito anos de estudo) e a m?e que trabalha. J? a maior pontua??o no teste de Breastfeed foi um fator de prote??o para amamenta??o exclusiva. Aos120 dias, as vari?veis que se mostraram como fatores de prote??o para a amamenta??o exclusiva foram a maior idade materna e a pontua??o no teste de Breastfeed.

Made available in DSpace on 2015-04-14T13:33:07Z (GMT). No. of bitstreams: 1 451398.pdf: 671181 bytes, checksum: 9b2ce376bc2dfdff2a7a720c916e7210 (MD5) Previous issue date: 2012-04-27 / Introduction: In children, hearing loss can be a complication of Adenotonsillar Hypertrophy (ATH) due to upper airway obstruction with a corresponding middle ear effusion. Nonetheles, it is not clear if ATH can also lead to impairment of the inner ear. Objective: to detect and characterize hearing impairment in children with Adenotonsillar Hypertrophy.Methods: A case-control study in children with and without Adenotonsillar Hypertrophy. All subjects underwent tonal audiometry, impedance, transient otoacoustic emissions and distortion product otoacoustic emissions. Results: The study involved 32 children with ATH and 37 controls, from 5 to 13 years of age. There were no significant differences between groups regarding gender (p=0.763), age (p=0.349), weight (p=0,653) and race (0.285). Tonal audiometry was normal for both groups in both ears, although the ATH showed slight falls at high frequencies. Transient otoacoustic emissions (TOE) and distortion product otoacoustic emissions (DPOE) were present in both ears of the control group. In the ATH group, TOE were present in the right ear of all children but only in 30% in the left ear; DPOE were present in only 12%, but in 68% of the right ear. Conclusion: There is an association between Adeno-tonsillar Hypertrophy and hearing neurosensory impairment, identified in otoacoustic emissions but not in tonal audiometry / Introdu??o: Em crian?as, a perda auditiva pode ser uma das complica??es da Hipertrofia Adenotonsilar (HAT) devido ? obstru??o de vias a?reas superiores com consequente ac?mulo de secre??o na orelha m?dia (efus?o). Contudo, desconhecemos se a HAT tamb?m compromete a orelha interna. Objetivos: Identificar e caracterizar poss?veis altera??es auditivas em crian?as portadoras de Hipertrofia Adenotonsilar. M?todos: Trata-se de um estudo caso-controle no qual foram recrutadas crian?as com hipertrofia adenotonsilar e seus respectivos controles. Todos os sujeitos realizaram exames de audiometria tonal, impedanciometria, emiss?es otoac?sticas transientes e emiss?es otoac?sticas por produto de distor??o. Resultados: Participaram do estudo 32 crian?as com HAT e 37 controles com idades entre cinco e 13 anos, de ambos os sexos. N?o houveram diferen?as significativas entre os grupos em rela??o a g?nero (p=0,763), idade (p=0,349), peso (p=0,653) e ra?a (p=0,285). Em rela??o ? audiometria tonal, o grupo HAT n?o apresentou diferen?a entre o grupo controle em ambas as orelhas, por?m, o grupo com HAT apresentava discretas quedas nas altas frequ?ncias. As emiss?es otoac?sticas transientes (EOAT) e por produto de distor??o (EOAPD) estavam presentes no grupo controle e em estudo em ambas orelhas. No grupo HAT, as EOAT estavam presentes na orelha direita 100% das crian?as, mas apenas em 30% na orelha esquerda; as EOAPD estavam presentes na orelha direita de apenas 12% das crian?as, mas em 68% delas na orelha esquerda. Conclus?es: H? uma associa??o entre hipertrofia adenotonsilar e altera??es sens?rio-neurais da audi??o, identificadas nas emiss?es otoac?sticas, mas n?o na audiometria tonal

Made available in DSpace on 2015-04-14T13:33:07Z (GMT). No. of bitstreams: 1 451397.pdf: 387615 bytes, checksum: 9ab7f900fdf963b0dd282f824f916d6a (MD5) Previous issue date: 2013-08-20 / Introduction: pain is a fairly recent topic in the field of neonatology, because until recently it was believed that the newborn was not able to feel pain. With the research progress we could not only to know that neonates feel pain, but also the important consequences arising from that. The aim of this study was to investigate how pain is assessed and treated in neonatal intensive care units in the city of Porto Alegre (RS). Methods: it is a descriptive study, done in the neonatal intensive care units of Porto Alegre (RS), from September/2012 to December/2012. The study was conducted in two phases: in the first, a structured interview was answered by the nurse coordinator of the neonatal intensive care unit to know if the neonatal pain is evaluated/treated and, if so, how the pain is managed; in a second moment observations were performed in loco to evaluate pain management to complement the data obtained through the interview. The observed procedures were venipuncture, gastric tube insertion, endotracheal tube aspiration, oral and nasal aspiration, heel stick and administration of medication subcutaneous/intramuscular. Results: were included in the study 9 of 10 neonatal intensive care units situated in the city of Porto Alegre (RS). Regarding the assessment of pain, 7 of 9 hospitals included in the study have established pain as the 5th vital sign, but only three have written protocol for evaluation of pain. The pain scale used by majority was the NIPS and the professionals who routinely perform pain assessment are the technical of nursing and/or nurse. Regarding pain management, of 269 procedures observed, only 31% was done with some form of analgesia. Conclusion: pain is undertreated during the procedures routinely performed by nursing staff of neonatal intensive care units of Porto Alegre. / Introdu??o: a dor ? um tema bastante recente na ?rea de neonatologia, pois at? bem pouco tempo acreditava-se que o rec?m-nascido n?o era capaz de sentir dor. Com o avan?o das pesquisas conseguiu-se n?o apenas saber que o neonato sente dor, como tamb?m, conhecer consequ?ncias importantes decorrentes desta. O objetivo do presente estudo foi verificar como a dor ? avaliada e tratada nas unidades de tratamento intensivo neonatais da cidade de Porto Alegre (RS). M?todos: trata-se de um estudo descritivo, realizado nas unidades de tratamento intensivo neonatais localizadas em Porto Alegre (RS), no per?odo de Setembro/2012 a Dezembro/2012. O estudo foi realizado em duas fases: na primeira, foi realizada uma entrevista estruturada junto ? enfermeira coordenadora da unidade de tratamento intensivo neonatal para saber se a dor neonatal ? avaliada/tratada e, em caso positivo, como a dor ? manejada; em um segundo momento foram realizadas observa??es in loco do manejo da dor para complementa??o dos dados obtidos atrav?s da entrevista. Os procedimentos observados foram pun??o venosa, passagem de sonda g?strica, aspira??o de tubo endotraqueal, aspira??o de vias a?reas, pun??o de calc?neo e administra??o de medica??o subcut?nea/intramuscular. Resultados: foram inclu?das no estudo 9 das 10 unidades de tratamento intensivo neonatais localizadas na cidade de Porto Alegre. Em rela??o a avalia??o da dor, 7 dos 9 hospitais inclu?dos no estudo tem institu?do a dor como o 5? sinal vital, por?m apenas 3 possuem protocolo escrito para avalia??o da dor. A escala de dor utilizada pela maioria foi a escala NIPS e os profissionais que realizam rotineiramente a avalia??o da dor s?o os t?cnicos de enfermagem e/ou enfermeira. Em rela??o ao manejo da dor, no total dos 269 procedimentos observados, apenas 31% foi realizado com algum tipo de medida analg?sica. Conclus?o: os procedimentos realizados rotineiramente pela equipe de enfermagem s?o subtratados em rela??o ? dor nas unidades de tratamento intensivo neonatais de Porto Alegre.

Made available in DSpace on 2015-04-14T13:33:08Z (GMT). No. of bitstreams: 1 451920.pdf: 503995 bytes, checksum: 18877f49594a02c1abdbc2ab1583ecfb (MD5) Previous issue date: 2013-08-30 / Objective : to evaluate the effects of positive fluid balance in infants under one year with bronchiolitis undergoing mechanical ventilation. Methodos : retrospective cohort study based on analysis of medical records of infants under one year admitted from April 2008 to September 2011 with bronchiolitis requiring mechanical ventilation in a tertiary Pediatric Intensive Care Unit (PICU) in southern of Brazil. We excluded patients with chronic lung disease, tracheostomy and previous use of mechanical ventilation due to acute pulmonary disease. We calculated the cumulative fluid balance within the first 3 days of the onset of mechanical ventilation. The outcomes assessed were ventilator-free days, length of stay in PICU, ventilator parameters used on the third day. Results : eighty-one patients were included in the study, 49 males (60.5%). The mean cumulative fluid balance on the third day of mechanical ventilation was 139 ? 68 ml/kg, the ventilator-free days was 19.7 ? 5.7 and the length of stay in PICU was 10.4 ? 5 6 days. In multivariate analysis, increasing cumulative fluid balance on the third day of mechanical ventilation was associated with a lower number of ventilatorfree days (&#946; -.03; 95% CI -.05, -.01; p <.001). The increasing cumulative fluid balance on the third day was also associated with higher PEEP and higher FiO2 used on the same day (&#946; .01; 95% CI.006, .019; p <.001 and &#946; .09; 95% CI .053, .136; p <.001 respectively). There was no relationship between cumulative fluid balance and length of stay in PICU (p = .950). Conclusion : cumulative fluid balance on the third day of mechanical ventilation is an independent risk factor for a lower number of ventilator-free days in infants under one year with bronchiolitis. There is also an association between higher cumulative fluid balance on the third day of mechanical ventilation and higher PEEP and higher FiO2 on the same day. / Objetivo : avaliar os efeitos do balan?o h?drico positivo em lactentes menores de um ano com bronquiolite viral aguda submetidos ? ventila??o mec?nica. Material e m?todo : estudo de coorte retrospectivo baseado na an?lise de prontu?rios de lactentes menores de um ano admitidos no per?odo de abril de 2008 a setembro de 2011 por bronquiolite viral aguda e submetidos ? ventila??o mec?nica em uma Unidade de Terapia Intensiva Pedi?trica (UTIP) terci?ria no sul do Brasil. Foram exclu?dos os pacientes com doen?a pulmonar cr?nica, traqueostomizados e com uso pr?vio de ventila??o mec?nica devido ? doen?a pulmonar aguda. Foi calculado o balan?o h?drico cumulativo nos primeiros 3 dias do in?cio da ventila??o mec?nica. Os desfechos avaliados foram: dias livres de ventila??o mec?nica, tempo de interna??o na UTIP e par?metros de ventila??o mec?nica utilizados no terceiro dia. Resultados : oitenta e um pacientes foram inclu?dos no estudo, sendo 49 meninos (60,5%). A m?dia do balan?o h?drico cumulativo no terceiro dia de ventila??o mec?nica foi de 139 ? 68 ml/kg, de dias livres de ventila??o mec?nica foi 19,7 ? 5,7 e do tempo de interna??o na UTIP foi 10,4 ? 5,6 dias. Na an?lise multivari?vel, um maior balan?o h?drico cumulativo no terceiro dia de ventila??o mec?nica apresentou associa??o com um menor n?mero de dias livres de ventila??o mec?nica (&#946; -0,03; IC 95% -0,05 a -0,01; p <0,001). O balan?o h?drico cumulativo no terceiro dia tamb?m apresentou associa??o com a utiliza??o de maior PEEP e FiO2 neste mesmo dia (&#946; 0,01; IC 95% 0,006 a 0,019; p <0,001 e &#946; 0,09; IC 95% 0,053 a 0,136; p <0,001 respectivamente). N?o houve rela??o entre balan?o h?drico cumulativo e tempo de interna??o na UTIP (p=0,950). Conclus?o : o balan?o h?drico cumulativo no terceiro dia de ventila??o mec?nica constitui fator de risco independente para um menor n?mero de dias livres de ventila??o mec?nica em lactentes menores do um ano com bronquiolite viral aguda. Existe, tamb?m, associa??o entre um maior balan?o h?drico cumulativo no terceiro dia de ventila??o mec?nica e a utiliza??o de maior PEEP e maior FiO2 neste mesmo dia.

Made available in DSpace on 2015-04-14T13:33:08Z (GMT). No. of bitstreams: 1 451963.pdf: 1054634 bytes, checksum: 22a1a79881824872b314b26c9cf9ec20 (MD5) Previous issue date: 2013-03-04 / Introduction: Asthma is a disease with predominant presence of CD4 Th2 cells that affects children. The disease main characteristics is inflammation and airway hyperreactivity. Asthma has two main phenotypes depending on the presence of atopy. It was not yet fully described in asthmatic children of school age the presence of different profiles of Th1, Th2, Th17 and Treg cells in peripheral blood, which may be related to the pathogenesis of the disease. Aims: To analyze the phenotypic of CD4 T cells in asthmatics children in Porto Alegre/RS. Methods: This was a croos-sectional study when it was recruited children between 9 to 15 years old, asthmatics and controls. The PBMCs were isolated using Ficoll and the cells were cultured with anti-CD3/CD28antibodies, Derp1 or left unstimulated. After 24hs the cells were stained with antibodies specifics for transcription factors in order to analyze Th1, Th2, Treg and Th17 cells by flow cytometry and the supernatant was collected for cytokine analysis by CBA assay. Plasma was used to perform analysis of specific IgE. Results: It was analyzed 104 patients, 12 controls and 92 asthmatics. Atopic asthmatic patients presented higher frequency of Th2 cells compared with non-atopic and atopic controls. When we analyzed cells expressing more than one transcription factor it was observed that atopic asthmatics patients have a higher frequency of CD4+GATA3+FOXP3+, CD4+ROR&#947;T+GATA3+ and CD4+GATA3+Tbet+ compared with non-atopic patients and controls atopic. Analyzing the asthma severity it was seen a higher frequency of CD4+ROR&#947;T+GATA3+ in patients with moderate asthma compared with patients with mild asthma. Stimulating the cells from atopic asthma patients with anti-CD3 and anti-CD28 induced more Th1 profile while stimulating with DerP1 protein changed the profile of the cells mainly to Th17 and Treg cells. Conclusion: This is the first study in children that analyzes Th1, Th2, Treg and Th17 cells using the tag transcription factor by flow cytometry in asthmatic or atopic and non-atopic controls. We found a Th2 profile in atopic asthmatic children according to the literature. Interestingly non-atopic children showed no predominant profile. Children with moderate asthma have a profile that expresses both the transcription factor GATA3 and ROR&#947;T. Depending on the stimulus used it was induced different phenotypes in the cells of this group of patients with asthma. / Introdu??o: A asma ? uma doen?a com predomin?ncia da presen?a das c?lulas T CD4 do tipo Th2, que afeta das crian?as e tem como principais caracter?sticas a inflama??o e hiperreatividade das vias a?reas. A asma apresenta dois fen?tipos principais dependendo da presen?a de atopia. Ainda n?o foi totalmente descrito em crian?as asm?ticas com idade escolar a presen?a dos diferentes perfis de c?lulas Th1, Th2, Th17 e Treg no sangue perif?rico, que podem estar relacionados com a patog?nese da doen?a. Objetivo: Avaliar o perfil fenot?pico de c?lulas T CD4 em pacientes asm?ticos escolares do munic?pio de Porto Alegre/RS. M?todos: Este foi um estudo transversal realizado com o recrutamento de crian?as com 09 a 15 anos de idade, asm?ticas e controles. O sangue perif?rico foi coletado e as c?lulas mononucleares foram separadas utilizando Ficoll e colocadas em cultura com anticorpos anti-CD3/CD28. Ap?s 24hs as c?lulas foram marcadas com anticorpos espec?ficos para fatores de transcri??o para an?lise do perfil Th1, Th2, Th17 e Treg por citometria de fluxo e o sobrenadante foi recolhido para analise de citocinas por CBA. No plasma foi realizada a an?lise de IgE espec?ficas. Resultados: Foram analisados 104 pacientes, sendo 12 controles e 92 asm?ticos. Os pacientes asm?ticos at?picos apresentaram um perfil Th2 mais acentuado, comparado com os n?o-at?picos e controles at?picos. Quando analisamos as c?lulas que expressam mais de um fator de transcri??o foi observado que os pacientes asm?ticos at?picos apresentam maior frequ?ncia de c?lulas T CD4 positivas GATA3+FOXP3+, ROR&#947;T+GATA3+, GATA3+Tbet+ comparada com pacientes n?o-at?picos e controles at?picos. Analisando a severidade foi observado uma frequencia maior de c?lulas T CD4+ ROR&#947;T+ GATA3+ em pacientes com asma moderada comparado com pacientes com asma leve. O est?mulo com anti-CD3 e anti-CD28 nas c?lulas dos pacientes asm?ticos at?picos induziu mais um perfil Th1 enquanto que est?mulo com DerP1 mudou o perfil de algumas c?lulas principalmente de c?lulas Tregs e Th17. Conclus?o: Este ? o primeiro estudo em crian?as que analisa o perfil Th1, Th2, Th17 e Treg utilizando a marca??o de fatores de transcri??o por citometria de fluxo em crian?as asm?ticas at?picas ou n?o-at?picas e controles. Encontramos um perfil mais Th2 em crian?as asm?ticas at?picas de acordo com a literatura. Interessantemente as crian?as n?o-at?picas n?o apresentaram nenhum perfil predominante. As crian?as com asma moderadas apresentam um perfil que expressa ao mesmo tempo o fator de transcri??o RORgT e GATA3. Dependendo do estimulo s?o induzidas diferentes fen?tipos nas c?lulas deste grupo de pacientes com asma.

Made available in DSpace on 2015-04-14T13:33:08Z (GMT). No. of bitstreams: 1 457124.pdf: 593064 bytes, checksum: 3d608aeef8635bc4754492396d116824 (MD5) Previous issue date: 2014-03-31 / Objectives : To assess if lung function could be used to predict risk of viral lower respiratory tract infections in prematurely born infants. In addition, we want to assess the impact of number and severity of LRTI episodes on lung growth. Methods : Longitudinal measurements of lung function by raised volume rapid thoracic compression technique were obtained in the first 6 months of life and after one year of follow-up in preterm infants. Number and severity of LRTI were recorded prospectively. The main outcome is an association between lung function measurements and number and severity of LRTI episodes. Results : Lung function tests were obtained in 71 preterm infants. There was a negative association between lung function and LRTI. Compared with infants with one or no LRTI episode (n=41), those with two or more episodes of LRTI (n=30) had significantly lower expiratory flows at first test (p<0.05 for zVEF0.5 zFEF50, zFEF75, zFEF25-75 and zFEFV0.5/FVC). No significant differences in gender distribution, gestational age, birth weight, school age siblings and smoke exposure were detected in relation to number or severity of LRTI. In the multivariate analysis, lung function and respiratory support in the neonatal intensive care unit was associated with higher number of LRTI. Severe LRTI was predicted by passive smoking and reduced zFEV0.5. In the longitudinal analysis, the change in lung function, adjusted for length, sex and smoke exposure during pregnancy was not affected by the number and severity of LRTI. Lung growth in this preterm birth cohort was not significantly different from a reference control group composed of full term babies. Conclusion : Our data suggest that lung function is a direct factor that mediates respiratory morbidity in premature infants. Lung function was a better predictor of number of LRTI than gestational age, sex and social demographics factors. The findings suggest that prenatal factors, particularly those that promote premature birth, determine lung development early in life. Postnatal events, like viral LRTI, do not have a detectable effect on lung growth. / Objetivos : Avaliar se a fun??o pulmonar (FP) pode ser usada para predizer o risco de infec??o viral da via a?rea inferior (IVAI) em lactentes prematuros. Avaliar o impacto do n?mero e da gravidade das IVAI no crescimento pulmonar. M?todos : Medidas longitudinais da FP pela t?cnica de compress?o tor?cica r?pida a partir de volumes pulmonares elevados foram obtidas nos primeiros seis meses de vida e ap?s um ano de seguimento. N?mero e gravidade das infec??es das IVAI foram registrados prospectivamente. O desfecho principal foi a associa??o entre as medidas de FP e o n?mero e a gravidade das IVAI. Resultados : Testes de FP foram obtidos em 71 lactentes. Houve uma associa??o negativa entre FP e IVAI. Comparados com lactentes que tiveram um ou nenhum epis?dio de infec??o (n=41), aqueles com dois ou mais epis?dios (n=30) tiveram fluxos expirat?rios mais baixos (p < 0.05 para zVEF0.5, zFEF50, zFEF75, zFEF25-75 and zFEFV0.5/FVC) no primeiro teste (n=71). N?o houve diferen?as significativas quanto a sexo, idade gestacional, peso ao nascimento, irm?os na idade escolar e exposi??o ao tabaco em rela??o ao n?mero e gravidade da IVAI. Na an?lise multivariada, recebimento de suporte respirat?rio na unidade neonatal e FP estiveram associadas a maior frequ?ncia de infec??es. Hospitaliza??o por IVAI pode ser predita por tabagismo passivo e zFEV0.5 reduzido. Na an?lise longitudinal, a mudan?a na FP ajustada para comprimento, sexo e tabagismo gestacional n?o foi afetada pelo n?mero e pela gravidade de IVAI. O crescimento pulmonar dessa coorte de prematuros n?o foi significativamente diferente do crescimento do grupo controle de refer?ncia composto de beb?s a termo. Conclus?o : Nossos resultados sugerem que a fun??o pulmonar ? um fator que medeia diretamente a morbidade respirat?ria em lactentes. A FP foi um melhor preditor do n?mero de IVAI do que fatores perinatais e s?cio-demogr?ficos. Esses achados sugerem que fatores pr?-natais, principalmente aqueles que promovem o parto prematuro, determinam o desenvolvimento pulmonar no in?cio da vida. Eventos p?s-natais, como IVAI virais, n?o apresentam um efeito detect?vel no crescimento pulmonar.