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Made available in DSpace on 2015-12-06T23:05:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2005 / O objetivo deste estudo é conhecer, analisar e refletir sobre como vem ocorrendo o Ensino da Pediatria na Graduação das Escolas Médicas do Rio de Janeiro, delineando algumas características dos docentes responsáveis por este ensino e correlacionando os dados obtidos com a literatura pertinente. A investigação destas questões se deu a partir de 15 Coordenadores, responsáveis pelo Ensino da Pediatria nos 16 Cursos de Graduação em Medicina em funcionamento no Estado. Optamos por desenvolver uma pesquisa de caráter exploratório, descritiva, realizada através de um estudo do tipo corte transversal e construída a partir de abordagem quantitativa e qualitativa. Os dados foram obtidos a partir de entrevistas semi-estruturadas e de documentos institucionais . Na organização do ensino entre os cursos investigados, observa-se que a inserção da pediatria, os cenários de aprendizagem utilizados, os critérios para seleção dos conteúdos divergem pouco entre si. As dificuldades mais referidas estão afeitas à infraestrutura e ao projeto pedagógico do curso, principalmente a questão da integração intra e inter disciplinas, a articulação docente assistencial e o sistema de avaliação que, para a maioria, encontra-se focado no processo avaliativo do aluno. Discutem-se alguns traços do perfil docente, além de se verificar que os atributos considerados mais significativos para o exercício da docência de pediatria estão baseados na perspectiva humanística, no gostar do que faz, no domínio do assunto, na capacidade de ensinar, na dedicação e na disponibilidade do docente. O percentual de titulação acadêmica encontrado revela a busca docente e institucional pela capacitação profissional. Acreditamos, com este estudo, estar contribuindo para a melhor compreensão do ensino da pediatria como parte fundamental para a formação geral do médico na graduação além de incentivar a busca de novos caminhos que apontem para a melhor qualidade e aperfeiçoamento deste ensino. / The aim of this study is understand, analyze and reflect about how the Pediatric’s Teaching in Undergraduated in Medical Schools of Rio de Janeiro, has been occuring, outlining some characteristics of the responsible professors for this teaching and correlating the obtained data with the pertinent literature. The research of this question was given to 15 coordinators, responsible for Pediatrics teaching at the 16 open undergraduated courses in the state. We opted to develop a research of investigative and descriptive character, carried through a crossover study and built from a quantitative and qualitative approach. The dada were obtained from semi-structured interviews and from institucional documents. Concerning the teaching organization among the investigated courses, it was observed that the insertion of pediatrics, the utilized scenes of learning, the criteria for the selection of the contents diverge a little bit between each other. The majority mentioned difficulties are related to the infrastructure and the pedagogical project of the course, mainly the intra and inter discipline integration questions, the assistencial teaching articulation and the evaluation system that, for the majority, has been focused in the scholar’s evaluation process. Some traces of the teaching profile have been debated, besides it has been verified that the attributes considered more significant for the exercise of Pediatrics teaching are based on the humanistic perspective, in being pleased to what one makes, in the domain of the subject, in the capacity for teaching, in the devotion and availability of the professor. The percentage of titled academic found, reveals the teaching and the institucional search for the professional qualification. We believe, with this study, to be contributing for a better understanding of the pediatrics teaching as a fundamental part for the doctor’s general formation in the undergraduated, besides stimulating the search of new ways that lead to a better quality and improvement of this teaching. / BV UNIFESP: Teses e dissertações

Research suggests that infants with poor neck and upper torso muscle tone experience lateral slouching and a compromised airway when placed in the semi-upright seating position. Studies reveal that 4-60% of premature infants (born at less than 3-7 weeks gestation) may experience oxygen desaturation events when in their child safety seats (CSS), potentially resulting in adverse neurodevelopmental outcomes. Therefore, the American Academy of Pediatrics recommends that premature infants be tested in their CSS prior to hospital discharge. However, neonatal healthcare providers are concerned that this method of testing might not be reliable. No formal studies have investigated the outcomes of repeat testing of premature infants, and little is known about the risk factors for oxygen desaturation events. Therefore, the purpose of this descriptive, non-experimental, observational study was to explore the stability of the one-point Infant Car Seat Challenge (ICSC) and risk factors that may be associated with oxygen desaturation events. A sample of 49 premature infants was used to explore the following variables: 1) pass/fail rates following two (ICSC) observation points, 2) oxygen saturation and desaturation patterns, sleep/wake activity, and a measure of head lag (using the pull-to-sit maneuver) during two ICSCs, and 3) the association between head lag, chronological age, time spent sleeping in the CSS and oxygen desaturation events. Data were analyzed by descriptive and nonparametric statistical tests. This study's findings indicated that 86% of premature infants had stable results, 8% passed rcsc 1 but not ICSC 2, and 6% failed ICSC l and passed ICSC 2. In addition the odds for oxygen desaturation events increased in infants that are born at a gestational age ≤ 34 weeks, were discharged home at a chronological age of > 7 days and had a corrected gestational age of ≤ 37 weeks. Neither head lag or sleep time influenced the ICSC outcomes. Furthermore the ICSC success rate for identifying at risk infants was equal to or better than that of other screening tests for newborn medical conditions. These findings will assist neonatal healthcare providers in making appropriate recommendations for safe travel.

OBJECTIVES: 1) To measure the prevalence of precipitating events in pediatric chronic pain patients and 2) to compare pain and functional disability outcomes at evaluation and 4-month follow-up by presence and type of precipitating event. METHODS: Precipitating events (e.g., injury) were coded from the medical record for 401 youth (6-19) who presented to a tertiary care chronic pain clinic. Four-month follow-up disability and pain were collected for 187 patients. In addition to frequency of events, we examined differences in pain and disability measures by event type at evaluation and follow-up using multiple statistical analysis strategies. RESULTS: Two-thirds of patients had a precipitating event prior to pain onset. Injury was the most common (55%), followed by chronic disease (23%), infection/illness (12.8%), and surgery (7.5%). Patients whose pain was triggered by injury reported the highest average pain levels, F(3, 340)=2.67, p<.05 and functional disability, F(3, 295)=3.54, p<.05. There were multiple cases of event groups that had significantly different baseline and follow-up psychological measures when compared to the rest of the patient population. Trajectories of pain and disability did not differ between patients with and without a precipitating event. Patients with injuries reported greater improvement in functional disability at follow-up (time x injury) F(1, 183)=4.88, p<.05 whereas patients with chronic disease reported less improvement in disability (time x chronic disease), F(1, 183)=5.49, p<.05. No other interactions were significant for disability or pain. CONCLUSIONS: A majority of patients had experienced some form of precipitating event prior to their pain onset, and the presence of a precipitating event had varied effects on the treatment outcomes of patients at four-month follow-up. Although patients with injuries presented with greater disability and pain, they had significantly more improvement, while chronic disease patients were less likely to improve in terms of functional disability. Type of precipitating event appears to be associated with treatment response and can inform clinical prognoses.

Exogenous surfactant therapy has dramatically improved survival in extremely preterm infants, however the turnover of exogenous and synthesis of endogenous surfactant components are still poorly understood in this group. Additionally there is evidence for this patient group that improving nutrition improves long-term outcomes in respiratory function, growth and neurodevelopment. Phosphatidylcholine (PC) is the dominant phospholipid in both surfactant and in plasma and can be synthesised from choline by one of two pathways: the CDPcholine pathway, which is present in all nucleated cells, or by three sequential methylations of phosphatidylethanolamine in the PEMT pathway, which is localised to hepatocytes and is the primary source of polyunsaturated PC species and de novo synthesis of choline. This study quantified choline phospholipid metabolism and pulmonary surfactant kinetics in preterm infants in vivo. Children aged between 23 and 28 weeks gestation and in receipt of exogenous surfactant were intravenously infused with [methyl-D9]choline chloride within 48 hours of birth. Lipid extracts from sequential plasma and endotracheal aspirate samples were then analysed by electrospray ionisation tandem mass spectrometry (ESIMS/ MS). Fractional incorporation into newly synthesised PC species is demonstrated rapidly in plasma samples at a higher rate than previously reported in adults, indicating a high level of hepatic activity for CDP-choline. Analysis of the PC species derived from the PEMT pathway shows significantly lower flux in this pathway than reported in adults. Finally incorporation into surfactant PC species is very low initially before rising slowly over several days and with the rapid changes in other acidic phospholipids suggests a rapid recycling of components of the exogenous surfactant not equilibrating with the CDP-choline pathway thereby providing evidence for the first time of differing rates of exogenous surfactant recycling versus de novo synthesis in the human preterm infant. This study proves that the technique works in the clinical environment, is sensitive and rapid enough to provide data in a clinically relevant timeframe, opening the possibility for translational use to identify biomarkers for disease progression.

This thesis represents an attempt to further our knowledge of the ophthalmic complications of spina bifida and hydrocephalus by means of literature review and a long term clinical study, and to determine whether regular ophthalmic supervision can assist in the general management of affected children. The ophthalmic complications of spina bifida have often been reported in the literature and thought to merit regular supervision of affected children, yet few centres currently offer this service. In this study 322 children attending one regional centre were examined repeatedly over a six year period by one ophthalmologist. Ophthalmic complications were found to be very common. They frequently provided evidence of raised intracranial pressure due to shunt dysfunction even when other objective evidence was lacking. Every spina bifida and hydrocephalus clinic should have an ophthalmalogist in its medical team. Preservation of visual function and early diagnosis of raised intracranial pressure in these children should result from this arrangement.

The use of the oral route of administration for the treatment of young children with antibiotics can at times be problematic since, factors such as nausea, vomiting, taste and/or smell, in addition to the challenges associated with the administration of suspensions, may contribute to poor patient compliance. In such cases, the use of the rectal route of administration may be appropriate. Therefore, suppositories containing 250 mg azithromycin (AZI) were manufactured and assessed for potential as an antibiotic suppository dosage form. Suppositories, containing AZI dihydrate were manufactured by the fusion method, using different grades of PEG, Witepsol® and Suppocire® bases. The rate and extent of AZI release was evaluated using USP apparatus I, and samples were analyzed using a validated HPLC method. Differences in the rate and extent of AZI release were observed with the greatest amount of AZI being released from PEG formulations. The rate and extent of AZI release from formulations manufactured using fatty bases were influenced by physicochemical properties, such as melting rate and hydroxyl value, of the bases. In addition drug partitioning appeared to favor the lipid phase and had a negative impact on AZI release characteristics. Two different formulation approaches were used in an attempt to increase the rate and extent of AZI release from fatty base formulations. The use of surfactants significantly increased AZI release from formulations manufactured with fatty bases with high hydroxyl values. The use of urea or Povidone K25 in combination with AZI as a physical mixture or solid dispersion did not increase the rate and extent of AZI release from the fatty suppositories, to any significant extent. The mechanism of drug release was evaluated using several mathematical models, including the Higuchi, Korsmeyer- eppas, Zero and, First order models. In addition, in vitro dissolution profiles were characterized by the difference and similarity factors, f1 and f2 and by use of the Gohel similarity factor, Sd. AZI release kinetics were best described by the Higuchi and Korsmeyer-Peppas models and the values of the release exponent, n, revealed that drug release was a consequence of the combined effects of AZI diffusion, rate of melting of the base and partitioning of the drug which can be considered to be anomalous release.

Crianças frequentemente realizam atividades físicas em ambientes quentes. O calor pode afetar o desempenho, conforto subjetivo, tolerância ao exercício e ser preocupante para a saúde. Além disso, parece que crianças obesas, comparadas com as magras, apresentam desvantagens ao se exercitarem no calor. Devido à importância do exercício aeróbio para o manejo da obesidade e promoção da saúde, essas diferenças merecem ser elucidadas, principalmente em meninas, devido à escassez de informações. Objetivo: Comparar as respostas termorregulatórias e perceptivas de meninas pré-púberes magras e obesas durante e após uma sessão de exercício, de similar intensidade relativa, em condição ambiental termoneutra e de calor. Métodos: Para a revisão da literatura, foram selecionados artigos com as palavras chaves: thermoregulation, obesity, children, girls, sweating, exercise, heat, hydration e acclimatization. No estudo experimental, vinte e sete meninas ativas e aclimatizadas, alocadas nos grupos magras e obesas conforme a adiposidade (≤ 25% para as magras e  30% para as obesas) medida pelo DXA, participaram do estudo. Elas pedalaram (carga de 55% do VO2pico) e recuperaram (sentadas) por 30 minutos numa condição termoneutra e outra de calor, com água disponível para ser ingerida à vontade. A temperatura retal (Tre), frequência cardíaca (FC), taxa de percepção de esforço (TPE), sensação térmica, conforto térmico e irritabilidade foram avaliados periodicamente. A sudorese foi avaliada, e durante o exercício no calor foi coletada uma amostra de suor para análise da concentração de eletrólitos (Na+, Cl- e K+). Resultados: Revisão — estudos com meninos indicam que os obesos parecem ser prejudicados nas respostas termorregulatórias durante exercício no calor relacionado: prejuízos na dissipação por convecção devido à menor área de superfície corporal (ASC) pela massa corporal; a menor taxa de sudorese, condicionamento físico, tolerância ao exercício e capacidade de aclimatação ao calor; ao maior custo metabólico para locomoção; e prejuízo na dissipação de calor pela maior gordura subcutânea. Não foram encontrados estudos comparando as respostas termorregulatórias de meninas magras e obesas no calor; e os estudos com o sexo feminino apresentam resultados parcialmente contraditórios ao masculino. Experimento — a Tre inicial foi maior nas obesas nas duas sessões (no calor 37,5 ± 0,3 vs. 37,3 ± 0,3 ºC, e na termoneutra 37,6 ± 0,3 vs. 37,3 ± 0,2 ºC; p = 0,03) e se manteve durante o exercício; e a magnitude do aumento foi maior nas magras, sendo que no calor a Tre final ultrapassou a das obesas (37,8 ± 0,2 vs. 38,0 ± 0,2 ºC; p = 0,04). As magras relataram diminuição do conforto térmico (p = 0,009) e aumento da irritação (p = 0,02) no decorrer do exercício. A FC, respostas perceptivas de TPE e sensação térmica foram semelhantes entre os grupos, assim como as respostas de sudorese. Observou-se maior concentração de Na+ no suor nas obesas (78,7 ± 47,5 vs. 50,5 ± 12,1 mEql-1; p = 0,04). Conclusão: Meninas obesas apresentaram maior Tre inicial, e as magras apresentaram uma maior magnitude de aumento na Tre, principalmente no calor, acompanhada de maior desconforto térmico e irritabilidade. / Children often perform physical activities in hot environments. The heat can affect performance, subjective comfort, exercise tolerance and cause concern for health. Moreover, it seems that obese children, compared with the lean, have disadvantages while exercising in the heat. Given the importance of aerobic exercise for obesity management and health promotion, these differences should be elucidated, especially in girls due to the information lack. Aim: To compare the thermoregulatory responses and perceptual between lean and obese pre-pubertal girls during and after an exercise session, at similar relative effort intensity in the thermoneutral environmental and heat. Methods: For the literature review, articles were selected using the keywords: thermoregulation, obesity, children, girls, sweating, exercise, heat, hydration and acclimatization. In the experimental trial, twenty-seven active and acclimatized girls, placed in groups lean and obese according to fat percentage (≤ 25% for lean and  30% for the obese) measured by DXA, participated in this study. They cycled (charge 55% of VO2peak) and recovered (seated) for 30 minutes in a thermoneutral condition and in the heat, with hydration ad libitum. Rectal temperature (Tre), heart rate (HR), rate of perceived exertion (RPE), thermal sensation, thermal comfort and irritability were assessed periodically. Sweating was evaluated, and during exercise in the heat a sample sweat was collected to electrolytes concentration (Na+, Cl- and K+) analysis. Results: Review — obese children appear to be impaired in thermoregulatory responses during exercise in the heat related to: the convection damage dissipation due to less body surface area (BSA) by body mass, the lower sweating rate, fitness, exercise tolerance and to heat acclimation ability, the higher locomotion metabolic cost, and heat dissipation loss for greater subcutaneous fat. Any study had compared the thermoregulatory responses between lean and obese girls in heat. Trial — the initial Tre was higher in obese in both sessions (in the heat 37.5 ± 0.3 vs 37.3 ± 0.3 ºC and in thermoneutral 37.6 ± 0.3 vs. 37.3 ± 0 2 º C, p = 0.03) and was maintained during exercise, and magnitude of the increase was greater in lean, mainly in the heat when the final Tre surpassed the obese (37.8 ± 0.2 vs. 38.0 ±0.2 ºC, p = 0.04). The thermal comfort has decreased (p = 0.009) and irritation has increased (p = 0.02) in the lean during the exercise. HR, sweating responses and perceptual responses of TPE and thermal sensation were similar between groups. A higher concentration of Na+ in sweat was observed in obese (78.7 ± 47.5 vs 50.5 ± 12.1 mEql-1, p = 0.04). Conclusion: Initial Tre were higher in obese group, and lean had a greater magnitude of increase in Tre, especially during exercise in the heat, accompanied by thermal discomfort and irritability increased.