ABSTRACT Objective: To evaluate whether a model of a daily fitness checklist for spontaneous breathing tests is able to identify predictive variables of extubation failure in pediatric patients admitted to a Brazilian intensive care unit. Methods: This was a single-center, cross-sectional study with prospective data collection. The checklist model comprised 20 items and was applied to assess the ability to perform spontaneous breathing tests. Results: The sample consisted of 126 pediatric patients (85 males (67.5%)) on invasive mechanical ventilation, for whom 1,217 daily assessments were applied at the bedside. The weighted total score of the prediction model showed the highest discriminatory power for the spontaneous breathing test, with sensitivity and specificity indices for fitness failure of 89.7% or success of 84.6%. The cutoff point suggested by the checklist was 8, with a probability of extubation failure less than 5%. Failure increased progressively with increasing score, with a maximum probability of predicting extubation failure of 85%. Conclusion: The extubation failure rate with the use of this model was within what is acceptable in the literature. The daily checklist model for the spontaneous breathing test was able to identify predictive variables of failure in the extubation process in pediatric patients.

RESUMO Objetivo: Avaliar se um modelo de checklist diário de aptidão para o teste de respiração espontânea é capaz de identificar variáveis preditivas de falha no processo de extubação em pacientes pediátricos internados em uma unidade de terapia intensiva brasileira. Métodos: Estudo unicêntricotransversal, com coleta prospectiva de dados. O modelo de checklist foi elaborado com 20 itens e aplicado para avaliação de aptidão para o teste de respiração espontânea. Resultados: A amostra foi composta de 126 pacientes pediátricos em ventilação mecânica invasiva, 85 do sexo masculino (67,5%), para os quais foram aplicadas 1.217 avaliações diárias à beira do leito. A pontuação total ponderada do modelo de predição apresentou o maior poder de discriminação para a realização do teste de respiração espontânea, com índices de sensibilidade e especificidade para a falha de aptidão de 89,7% ou sucesso de 84,6%. O ponto de corte sugerido pelo checklist foi 8, com probabilidade de falha de extubação inferior a 5%. Observou-se que a falha aumentou progressivamente com o aumento da pontuação obtida, com probabilidade máxima de predição de falha de extubação de 85%. Conclusão: A taxa de falha de extubação com a utilização desse modelo ficou dentro do que é aceitável na literatura. O modelo de checklist diário para aptidão do teste de respiração espontânea foi capaz de identificar variáveis preditivas de falha no processo de extubação em pacientes pediátricos.

RESUMO Objetivo: Embora a necropsia seja considerada o exame padrão-ouro de diagnóstico, observa-se declínio em sua realização, enquanto cresce o número de eventos adversos na saúde, dos quais 17% são erros diagnósticos. O estudo objetivou estimar a prevalência do erro de diagnóstico, com base no diagnóstico anatomopatológico, em uma Unidade de Terapia Intensiva Pediátrica (UTIP). Métodos: Estudo de corte transversal, retrospectivo, de 31pacientes que foram a óbito entre 2004 e 2014. Os diagnósticos foram comparados para verificar se houve concordância de diagnóstico principal (CDP) e diagnóstico da causa da morte (DCM), classificados de acordo com os critérios de Goldman. Resultados: De 3.117 pacientes, 263 foram a óbito. Em 38 casos foi realizada autopsia (14,4%) e 31 foram incluídos no estudo. Observou-se decréscimo de 67% no número de autopsias em dez anos. Concordância absoluta entre os diagnósticos (classe V) foi observada em 18 casos (58,0%) e discordância (classe I), em 11 (35,4%). Observou-se maior dificuldade no diagnóstico de doenças agudas e de evolução fatal rápida, como as miocardites. Sete pacientes foram admitidos em estado geral grave, indo a óbito nas primeiras 24 horas de internação. Conclusões: A necropsia não só permite a identificação de erros diagnósticos, como também a oportunidade de se aprender com o erro. Os resultados enfatizam a importância desse exame para a elucidação diagnóstica e a construção de uma base de informações sobre os principais diagnósticos envolvidos em pacientes que evoluem rapidamente para o óbito em UTIP, aumentando o grau de suspeição pela equipe da Unidade.

ABSTRACT Objective: Although autopsy is deemed the gold standard for diagnosis, its performance has been decreasing while adverse events have been increasing, of which 17% consist in diagnostic errors. The purpose of this study was to estimate the prevalence of diagnostic errors based on anatomopathological diagnosis in a Pediatric Intensive Care Unit (PICU). Methods: This is a cross-sectional, retrospective study on 31patients who died between 2004 and 2014. Diagnoses were compared in order to assess whether there was agreement between clinical major diagnosis (CMD) and the cause of death as described in the autopsy record (CDAR), which were classified according to the Goldman Criteria. Results: Of 3,117 patients, 263 died (8.4%). Autopsy was conducted in 38 cases (14.4%), and 31 were included in the study. Therewas a 67% decrease in the number of autopsies over the last 10years. Absolute agreement between the diagnoses (class V) was observed in 18 cases (58.0%), and disagreement (class I), in 11 (35.4%). Therewas greater difficulty in diagnosing acute diseases and diseases of rapid fatal evolution such as myocarditis. Sevenpatients were admitted in critical health conditions and died within the first 24 hours of hospitalization. Conclusions: Autopsy not only enables to identify diagnostic errors, but also provides the opportunity to learn from mistakes. The results emphasize the relevance of the autopsy examination for diagnostic elucidation and the creation of an information database concerning the main diagnoses of patients who rapidly progress to death in PICU, increasing the index of clinical suspicion of the team working at this unit.

Abstract Background The severity of nail disease, the presence of arthralgia and fatigue are predictors of development of psoriatic arthritis (PsA) in patients with psoriasis (Pso). In children, little is known about the musculoskeletal (MSK) impairment in patients with Pso and its effect on health-related quality of life (HRQoL). Objectives To determine the frequencies of pain and MSK inflammation (i.e., arthritis, enthesitis, and sacroiliitis) among children and adolescents with Pso and its relationship to HRQoL and fatigue. Methods Pediatric patients with Pso underwent a rheumatologic physical examination to evaluate synovitis, enthesalgia, sacroiliac joint (SIJ) pain and tender points of fibromyalgia. The core set of domains recommended by the GRAPPA - OMERACT to be measured in PsA studies was assessed. Ultrasound (US) was performed in clinical cases of enthesitis, and magnetic resonance imaging (MRI) was performed in cases of SIJ pain. Results Forty-three participants (10 ± 2.9 years old) were evaluated. Pain on palpation of the entheses was observed in 10 (23.2%) patients and pain on SIJ palpation was observed in 3 (7%). No patient presented with synovitis; one presented with enthesitis on US, but MRI did not confirm sacroiliitis in any case. Patients with MSK pain had greater skin disease severity (PASI 5.4 vs. 2, p < 0.01), worse fatigue, and lower HRQoL scores on all instruments used. The estimated risk of HRQoL impairment was eight times higher in the presence of MSK pain, which was an independent predictive factor. With a NAPSI greater than 30, the probability of pain was greater than 80%. Conclusion MSK pain is frequent among children with Pso, related to the severity of skin and nail disease, and negatively affects HRQoL. The typically used complementary exams might not detect the inflammatory process caused by Pso.

ABSTRACT Objective: compare the rates of complications, infections and obstruction of single-lumen peripherally-inserted central catheters to those of double-lumen catheters in extremely premature infants. Method: randomized clinical trial with 30 newborns with gestational age between 24 and 32 weeks. The variables collected were period of use, complications, handling of catheters and obtaining peripheral venous accesses. Analysis was performed using descriptive statistics. Results: there were differences in rates regarding handling catheters (p=0.001) and obtaining concomitant venous accesses (p=0.01). However, there was no difference in complication (p=0.14), obstruction (p=0.55) and infection rates (p=0.47). Despite being more frequently handled, double-lumen catheters do not increase the risk of complications. They reduce the need for obtaining new peripheral accesses and, consequently, the pain of premature infants. Conclusion: the use of double-lumen peripherally-inserted central catheters is beneficial for newborns that need multi-infusion therapy.

RESUMEN: Objetivo: comparar las tasas de complicaciones, infección y obstrucción del catéter central de inserción periférica mono lumen con las del doble lumen en bebés prematuros extremos. Método: ensayo clínico aleatorizado con 30 recién nacidos en edad gestacional entre 24 y 32 semanas. Las variables recogidas fueron la duración, las complicaciones, la manipulación del catéter y la obtención del acceso venoso periférico. El análisis fue realizado por estadísticas descriptivas. Resultados: una diferencia fue observada en las tasas de manipulación del catéter (p=0,001) y obtención de accesos venosos concomitantes (p=0,01). Sin embargo, no se observó diferencia en las tasas de complicaciones (p=0,14), obstrucción (p=0,55) e infección (p=0,47). El catéter doble lumen no aumenta el riesgo de complicaciones, pero es más manipulado. También reduce la obtención de nuevos accesos periféricos y, en consecuencia, el dolor de los bebés prematuros. Conclusión: el uso del catéter central de inserción periférica doble lumen es beneficioso para los recién nacidos que requieren terapia de infusión múltiple.

RESUMO Objetivo: comparar as taxas de complicações, infecção e obstrução do cateter central de inserção periférica mono lúmen com o duplo lúmen em prematuros extremos. Método: ensaio clínico randomizado, com 30 recém-nascidos de idade gestacional entre 24 e 32 semanas. As variáveis coletadas foram tempo de duração, complicações, manipulação dos cateteres e obtenção de acessos venosos periféricos. A análise foi realizada por estatística descritiva. Resultados: houve diferença nas taxas de manipulação do cateter (p=0,001) e obtenção de acessos venosos concomitantes (p=0,01). Contudo, não houve diferença nas taxas de complicações (p=0,14), obstrução (p=0,55) e infecção (p=0,47). O cateter duplo lúmen não eleva os riscos de complicações, porém é mais manipulado. Entretanto, reduz a obtenção de novos acessos periféricos, e consequentemente a dor dos prematuros. Conclusão: a utilização do cateter central de inserção periférica duplo lúmen é benéfica para os recém-nascidos que necessitam de terapia infusional múltipla.

RESUMO Objetivo: Avaliar as variáveis associadas ao diagnóstico de diabetes melito tipo 1 (DM1) na vigência de cetoacidose diabética e seu impacto na evolução da doença. Métodos: Foram avaliadas 274 crianças e adolescentes com idade até 15 anos acompanhados em um ambulatório de endocrinologia pediátrica de um hospital universitário de Curitiba, Paraná, cuja primeira consulta ocorreu entre janeiro de 2005 e abril de 2015. Resultados: A maioria dos pacientes teve diagnóstico de DM1 na vigência de cetoacidose diabética. Os fatores associados foram: menor idade e maior número de consultas prévias ao diagnóstico; a cetoacidose diabética foi menos frequente quando havia um irmão com DM1 e quando o diagnóstico foi feito na primeira consulta médica. Náuseas ou vômitos, dor abdominal, taquidispneia e alteração do nível de consciência foram mais frequentes no grupo com cetoacidose diabética ao diagnóstico. Não se observou associação com nível socioeconômico, tempo de sintomas antes do diagnóstico e duração do período de lua de mel. Conclusões: São necessários estudos prospectivos para definir melhor o impacto desses fatores no diagnóstico e no controle da doença. Campanhas de conscientização dos profissionais de saúde e da população são necessárias para que haja diagnóstico precoce e tratamento adequado do diabetes melito em crianças e adolescentes.

ABSTRACT Objective: To analyze the variables associated with the presence of diabetic ketoacidosis in type 1 diabetes mellitus (T1DM) diagnosis and its impact on the progression of the disease. Methods: We reviewed the records of 274 children and adolescents under 15 years, followed in a Pediatric Endocrinology clinic of a university hospital in Curitiba-PR. They had their first appointment between January 2005 and April 2015. Results: Most patients received their T1DM diagnosis during a diabetic ketoacidosis episode. The associated factors were: lower age and greater number of visits to a physician’s office prior to diagnosis; diabetic ketoacidosis was less frequent in patients who had siblings with T1DM and those diagnosed at the first appointment. Nausea and vomiting, abdominal pain, tachydyspnea, and altered level of consciousness were more common in the diabetic ketoacidosis group. There was no association with socioeconomic status, duration of symptoms before diagnosis, and length of the honeymoon period. Conclusions: Prospective studies are necessary to better define the impact of these factors on diagnosis and disease control. Campaigns to raise awareness among health professionals and the general population are essential to promote early diagnosis and proper treatment of diabetes mellitus in children and adolescents.

Resumo Objetivo Determinar a prevalência, as características e possíveis fatores de risco para as lesões ocorridas durante as partidas do Campeonato Brasileiro de Futebol. Métodos Realizou-se um estudo prospectivo com coleta dos dados referentes às lesões ocorridas durante o Campeonato Brasileiro de Futebol de 2016. O registro das lesões foi realizado pelo médico responsável de cada equipe, por meio de um sistema online de mapeamento de lesões. Resultados Dentre os 864 atletas que foram incluídos no estudo, 231 (26,7%) dos jogadores apresentaram alguma lesão durante o torneio. No total, foram registradas 312 lesões durante o Campeonato Brasileiro, com média de 0,82 lesões por partida. A incidência de lesões foi de 24,9 lesões para cada 1.000 horas de jogo. Meias e atacantes apresentaram, respectivamente, risco 3,6 e 2,4 vezes maior de sofrer lesão do que os goleiros. Conclusão A prevalência e a incidência de lesões foram, respectivamente, 26,7% e 24,9 lesões/1.000 horas de partida. O segmento corporal mais frequentemente afetado foram os membros inferiores (76,3%),sendo que os atletas que atuaram nas posições meia e atacante foram os mais acometidos. Observou-se também maior predomínio de lesões no primeiro turno do campeonato.

Abstract Objective To identify the incidence, the prevalence, the characteristics, and the possible risk factors for injuries occurring during the matches of the Brazilian Soccer Championship. Methods A prospective study was carried out to collect data on the injuries that occurred during the 2016 Brazilian Soccer Championship. Lesions were recorded by the physician responsible for each team through an online software. Results Among the 864 athletes included in the study, 231 (26.7%) of the players presented some injury during the tournament. In total, 312 injuries were recorded during the Brazilian Soccer Championship, with an average of 0.82injuries pergame. Theincidence of injuries was 24.9 injuries per 1,000 match hours. Midfielders and forwards presented, respectively, an injury risk 3.6 and 2.4 times higher than goalkeepers. Conclusion The prevalence and incidence of lesions were, respectively, 26.7% and 24.9 injuries per 1,000 match hours. The most frequently affected body segment was the lower limbs (76.3%), and the athletes acting in midfield and forward positions were themost affected. Moreover, the greater prevalence of injuries occurred in the first part of the championship.

RESUMO A qualidade de vida relacionada à saúde (HRQOL) no diabetes mellitus tipo 1 (T1DM) tem sido amplamente estudada. Os objetivos deste estudo foram avaliar e identificar os fatores que influenciam a HRQOL de crianças e adolescentes com T1DM. MATERIAL E MÉTODOS: No total, 59 pacientes (9-16 anos, T1DM por ≥1 ano) responderam a uma versão do Instrumento de Qualidade de Vida para Jovens com Diabetes (DQOLY) adaptada aos pacientes brasileiros (IQVJD). Esse instrumento compreende satisfação, impacto e preocupações de domínios, com os menores índices correspondentes a uma melhor HRQOL, e um questionário que reúne parâmetros sociais, demográficos e clínicos. RESULTADOS: A idade média foi de 13,6 anos e 57,6% eram meninas. A idade mediana no diagnóstico foi de 7,16 anos, 63% apresentaram cetoacidose diabética (DKA) no diagnóstico e 29% durante o seguimento. A hemoglobina glicada média (HbA1c) no ano anterior foi de 10%. Todos os pacientes receberam doses múltiplas de insulina (média de 4,2 aplicações/ dia), 74,5% utilizavam análogos de insulina de ação rápida e de ação intermediária e 67,8% usavam canetas para aplicação de insulina. Os resultados do DQOLY estavam dentro do limite de corte para melhor HRQOL. Uma análise isolada de cada domínio e os resultados do questionário mostraram que os seguintes fatores estavam associados a uma maior HRQOL: score z de altura, HbA1c menor, prática de atividade física, uso de caneta, menos hospitalizações e residência em uma área rural. Houve uma alta taxa de cetoacidose diabética no diagnóstico, e o controle metabólico foi inadequado na maioria dos pacientes. Apesar de serem provenientes de famílias de baixa renda, a maioria dos pacientes teve acesso ao tratamento recomendado. CONCLUSÃO: Entre pacientes com T1DM, 71% tinham escores IQVJD compatíveis com melhor HRQOL.

SUMMARY Health-related quality of life (HRQOL) in type 1 diabetes mellitus (T1DM) has been widely studied. The objectives of this study were to evaluate and identify the factors influencing the HRQOL of children and adolescents with T1DM. MATERIAL AND METHODS: In total, 59 patients (9–16 years, T1DM for ≥1 year) responded to a version of the Diabetes Quality of Life Instrument for Youth (DQOLY) adapted to adapted to Brazilian patients, the Instrumento de Qualidade de Vida para Jovens com Diabetes (IQVJD). This instrument comprises 50 items (domains satisfaction, impact, and concerns, with the lowest scores corresponding to better HRQOL) and a questionnaire gathering social, demographic, and clinical parameters. RESULTS: The mean age of the patients was 13.6 years, and 57.6% were girls. The median age at diagnosis was 7.16 years, 63% presented diabetic ketoacidosis (DKA) at diagnosis and 29% during follow-up. Mean glycated hemoglobin (HbA1c) in the previous year was 10%. All patients administered multiple insulin doses (mean 4.2 applications/day), 74.5% used rapid-acting and intermediate-acting insulin analogs, and 67.8% used pens for insulin application. The results of the DQOLY were within the cutoff limit for better HRQOL. An isolated analysis of each domain and the questionnaire results showed that the following factors were associated with better HRQOL: height Z-score, lower HbA1c, practice of physical activity, use of pen, fewer hospitalizations, and residence in a rural area. There was a high DKA rate at diagnosis, and the metabolic control was inappropriate in most patients. Despite coming from low-income households, most patients had access to the recommended treatment. CONCLUSION: Among T1DM patients, 71% had IQVJD scores compatible with better HRQOL.

Abstract Introduction Pitch-matching refers to the ability to vocally reproduce an acoustic model in a corresponding tone to the presented sound. This ability, which is dependent on pitch perception ability, can vary among individuals, and some are not able to sing in the correct tune or discriminate differences between tones. Objective To correlate pitch-matching accuracy and auditory processing in individuals without musical training. Methods A Pitch-Matching Test (vocal reproduction of synthesized and human voice sounds) and two commercially available tests of auditory temporal processing (the Pitch Pattern Sequence Test and the Random Gap DetectionTest) were administered to all participants. A total of 62 college students of both genders, aged between 18 and 35 years old, were divided into 2 groups, according to their performances in the Pitch- Matching Test (the accurate match group and the inaccurate match group). Results In the Pitch-Matching Test, both groups achieved better results when reproducing vocalized sounds. The accurate match group achieved a significantly higher pitch pattern sequence test performance. In the Random Gap Detection Test analysis, there were no differences between the two groups. The Pearson’s chi-squared test showed a direct correlation between the Pitch-Matching Test and the Pitch Pattern Sequence Test. Conclusion The findings of this study suggest the existence of a significant relationship between temporal auditory processing and pitch-matching, through which accurate pitch-matching individuals perform better in the Pitch Pattern Sequence Test. Inaccurate pitch-matching individuals may be skilled at discriminating pitch, despite their poor performance in the Pitch-Matching Test.

RESUMO Objetivo Avaliar a prevalência da dependência de internet entre adolescentes, assim como caracterizar comportamentos de risco nessa população em relação ao uso e à dependência de internet. Métodos Estudo transversal analítico realizado em dois colégios, um público e um particular, com 91 adolescentes de idade entre 12 e 16 anos, que responderam aos questionários Internet Addiction Test – versão brasileira (IAT) e Child Behavior Checklist (CBCL). Resultados Entre a população estudada, a prevalência de dependência de internet encontrada foi de 21%, não havendo diferença entre as escolas pública e particular. No grupo dependente de internet, houve relação estatisticamente significativa com os sintomas Ansiedade/Depressão, Isolamento/Depressão e Comportamento Agressivo e de Quebrar Regras. As escalas Problemas Sociais, Problemas de Pensamento e Problemas de Atenção também se correlacionam à dependência de internet. Conclusão O presente estudo demonstra evidência de correlação entre a dependência de internet e sintomas comportamentais entre adolescentes. Por se tratar de um estudo transversal, contudo, esses dados devem ser vistos com cautela e pesquisas futuras são necessárias para corroborar nossos resultados.

ABSTRACT Objective Evaluate the prevalence of internet addiction (IA) among adolescents, as well as characterize behaviors that are considered to be a risk in this population regarding the use and addiction of the Internet. Methods In this cross-sectional study conducted in one public and one private school 91 adolescents, aged 12 to 16 years old, responded the Internet Addiction Test – Brazilian version (IAT) and Child Behavior Checklist (CBCL). Results The prevalence of internet addiction found was 21%, with no difference between private and public schools. On the group dependent on the Internet, there was a statistically significant correlation with Anxiety/Depression, Withdrawn/Depression, Rule Breaking Behavior and Aggressive Behavior, as well as the syndrome scales Social Problems, Thought Problems and Attention Problems. Conclusion Our study provides evidence of a relationship between internet addiction and behavioral problems among adolescents. As this is a cross-sectional study, we consider that future research is necessary to corroborate our results.

Abstract: Background: The greatest sun exposure occurs until adolescence and this is the only factor involved in photocarcinogenesis subject to modification with photoprotection. Objective: The objective of this study was to evaluate the habits and knowledge of adolescents regarding photoprotection. Method: Cross-sectional study that included 512 students from primary and high school. Data were collected by questionnaires with questions about habits and knowledge on sun protection. For data analysis, Pearson's Chi-square test and Yates test were applied, with 5% level of significance. Results: We evaluated 512 students, with a mean age of 14 years old. The teenagers agreed that ultraviolet rays cause skin cancer and aging (96% and 70%, respectively). Knowledge about the occurrence of burns even on cloudy days was recorded in 68% of cases, as well as the need for photoprotection for sports in 72%. The source of information about sun protection were by parents in 55%. In 70% was observed previous occurrence of sunburn, the daily use of sunscreens was found in 15% and 67% used only at the beach. of sunscreens with SPF higher than 30 was reported by 70% of students and 57% reported going to the beach between 10h and 16h. In 68% of cases it was registered insufficient sun protection, attributed, in 57% of the time to forgetfulness. Study limitations: The sample refers to two schools of Curitiba (PR), Brazil. Conclusion: Teenagers know the risks of sun exposure, but they do not adopt the practices for adequate protection.

Resumo Objetivou-se investigar o impacto da atividade física (AF) e níveis da aptidão cardiorrespiratória (APCR) na prevalência de excesso de peso e níveis hipertensivos em adolescentes. Estudo observacional, transversal, com 614 meninos de 10 a 14 anos, que foram avaliados quanto à estatura, massa corporal, índice de massa corporal (IMC), circunferência abdominal (CA) e pressão arterial (PA). Utilizou-se teste de corrida (Léger Test) para avaliar a APCR. O nível de AF foi avaliado por questionário (The Three Day Physical Activity Recall), classificando-os conforme prática < ou ≥ 300 minutos/semana. Estágio maturacional foi autoavaliado de acordo com o desenvolvimento dos pelos pubianos, proposto por Tanner. Testes estatísticos de análises descritivas, bivariada e multivariada foram utilizados. Do total, 50% dos escolares apresentaram AF < 300 minutos/semana e 67,6% com APCR insatisfatória. Indivíduos com alterações no IMC (excesso de peso), CA (obesidade abdominal) ou PA (valores hipertensivos) apresentaram maiores frequências de APCR insatisfatória em todas as faixas etárias, enquanto que o histórico de AF não se mostrou significativo. A APCR insatisfatória apresentou-se como melhor parâmetro para o diagnóstico de fatores de risco para doenças cardiovasculares (CV) do que o histórico de AF, independente da faixa etária.

Abstract The aim of this study was to investigate the impact of physical activity (PA) and cardiorespiratory fitness (CRF) levels on the prevalence of overweight and high blood pressure levels in adolescents. In this observational, cross-sectional study, 614 boys aged 10-14 years were assessed for height, body mass, body mass index (BMI), waist circumference (WC) and blood pressure (BP). CRF was assessed using a run test (Léger Test) and subjects were then grouped according to their CRF level. PA level was assessed through a questionnaire (The Three Day Physical Activity Recall) and classified into two groups, namely ≥ 300 minutes of PA/week and < 300 minutes of PA/week. Maturational stage was evaluated according to the development of pubic hair (self-assessment) as proposed by Tanner. We used statistical descriptive analysis, univariate and multivariate analyses in the total participants and subjects were divided by age. Fifty percent of the sample performed < 300 minutes of PA/week and 67.6% had unsatisfactory CRF levels. There was a higher prevalence of unsatisfactory CRF levels among subjects with altered BMI (overweight), WC (abdominal obesity) or BP (high blood pressure) for all age groups. PA history, however, did not show any significance. A total of 31% of participants were overweight, 24.8% had abdominal obesity and 15.4% had increased BP. Unsatisfactory CRF levels were found to be a better predictor for the diagnosis of cardiovascular diseases (CV) risk factors than PA history, regardless of age group.

Resumo Objetivo Comparar os resultados obtidos no teste do suor pelo método da condutividade e a dosagem coulométrica de cloreto no suor em recém0nascidos (RN) suspeitos da triagem neonatal para fibrose cística (FC). Métodos O teste do suor foi feito simultaneamente pelos dois métodos em crianças com e sem FC. Os valores de corte para confirmar FC foram na condutividade > 50 mmol/L e no teste coulométrico > 60 mmol/L. Resultados Fizeram o teste do suor por condutividade e dosagem coulométrica simultaneamente 444 RN sem FC (185 do sexo masculino, 234 do feminino e 24 não informado) e obtiveram resultado mediano de 32 mmol/L e 12 mmol/L respectivamente. Para os noventa RN com FC os valores medianos de condutividade e dosagem coulométrica foram 108 mmol/L e 97 mmol/L respectivamente. O índice de falso positivo para condutividade foi de 16,7% e em todos os pacientes FC foi superior a 50 mmol/L, o que confere ao método 100% de sensibilidade (IC 95% = 93,8 a 97,8), especificidade de 96,2% (IC 95% = 93,8 a 97,8), valor preditivo positivo 83,3 (IC 95% = 74,4 a 91,1), valor preditivo negativo 100% (IC 95% = 90,5 a 109,4) e acurácia 9,8%. A correlação entre os métodos foi de r = 0,97 (p > 0,001).O melhor valor de corte sugerido foi de 69,0 mmol/L, coeficiente de kappa = 0,89. Conclusão O teste da condutividade apresentou excelente correlação com o quantitativo coulométrico, alta sensibilidade e especificidade e pode ser usado no diagnóstico da FC em crianças detectadas pela triagem neonatal.

Abstract Objective To compare the results obtained with the sweat test using the conductivity method and coulometric measurement of sweat chloride in newborns (NBs) with suspected cystic fibrosis (CF) in the neonatal screening program. Methods The sweat test was performed simultaneously by both methods in children with and without CF. The cutoff values to confirm CF were >50 mmol/L in the conductivity and >60 mmol/L in the coulometric test. Results There were 444 infants without CF (185 males, 234 females, and 24 unreported) submitted to the sweat test through conductivity and coulometric measurement simultaneously, obtaining median results of 32 mmol/L and 12 mmol/L, respectively. For 90 infants with CF, the median values of conductivity and coulometric measurement were 108 mmol/L and 97 mmol/L, respectively. The false positive rate for conductivity was 16.7%, and was higher than 50 mmol/L in all patients with CF, which gives this method a sensitivity of 100% (95% CI: 93.8-97.8), specificity of 96.2% (95% CI: 93.8-97.8), positive predictive value of 83.3% (95% CI: 74.4-91.1), negative predictive value of 100% (95% CI: 90.5-109.4), and 9.8% accuracy. The correlation between the methods was r = 0.97 (p > 0.001). The best suggested cutoff value was 69.0 mmol/L, with a kappa coefficient = 0.89. Conclusion The conductivity test showed excellent correlation with the quantitative coulometric test, high sensitivity and specificity, and can be used in the diagnosis of CF in children detected through newborn screening.

RACIONAL: Anormalidades na função sexual e reprodutiva são comuns em pacientes com hepatopatia crônica avançada e podem ser revertidas após transplante hepático bem-sucedido. OBJETIVO: Avaliar aspectos da função sexual e reprodutiva em mulheres submetidas a transplante de fígado no Serviço de Transplante Hepático do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR. PACIENTES E MÉTODOS: Entre setembro de 1991 e dezembro de 2001, 94 mulheres foram submetidas a transplante hepático. Vinte e oito delas (idade média 44,17 ± 13,60 anos) preencheram os seguintes critérios de inclusão: idade > 16 anos na época do transplante, sobrevida pós-transplante > 6 meses, estar em acompanhamento regular no Serviço na época do estudo e concordância em participar do mesmo. Os prontuários médicos foram revisados e as pacientes responderam a um questionário abordando padrão dos ciclos menstruais no pré e pós-transplante, gravidez no pós-transplante, métodos contraceptivos no pré e pós-transplante, freqüência de realização de citologia oncótica cervical no pré e pós-transplante, ocorrência de neoplasia ginecológica pós-transplante, além de questionário específico para o domínio da sexualidade no período pós-transplante. RESULTADOS: A mediana do tempo de seguimento pós-transplante das 28 pacientes foi de 36,5 meses (6-110 meses) e a principal indicação para o transplante foi cirrose associada à hepatite C (25%). Todas as pacientes apresentavam função normal do enxerto. Excluindo-se 6 pacientes em menopausa (natural ou cirúrgica), 13 das 22 pacientes (59,1%) com potencial de menstruar apresentavam amenorréia no ano anterior ao transplante. Dezenove dessas 22 pacientes (86,4%) reassumiram os ciclos menstruais após o transplante, com mediana de 1 mês pós-transplante (1 a 7 meses). Todas as pacientes com idade inferior a 45 anos voltaram a menstruar após o transplante. Quatro gestações bem-sucedidas ocorreram em três pacientes, sendo uma gestação gemelar. Cerca de 70% das transplantadas realizavam exame de citologia oncótica cervical pelo menos uma vez ao ano. Um caso de carcinoma adenoescamoso de endométrio foi identificado em uma paciente de 64 anos, 36 meses após o transplante, tratado cirurgicamente com sucesso. Cerca de 71,4% das pacientes referiram vida sexual ativa pós-transplante, sendo que 70% delas consideravam-na satisfatória. CONCLUSÕES: Após transplante hepático bem-sucedido, a maioria das mulheres em idade fértil reassumem os ciclos menstruais poucos meses após o transplante, tornando possível a ocorrência de gestações. Devido ao rápido retorno da libido e da fertilidade, as pacientes devem ser esclarecidas sobre métodos contraceptivos seguros após o transplante. A maioria das pacientes apresenta vida sexual ativa e satisfatória e realiza regularmente citologia oncótica cervical.

BACKGROUND: Abnormalities in sexual and reproductive functions are common in women with end-stage liver disease and may be reversible after liver transplantation. AIM: Evaluate sexual and reproductive function in female recipients of liver transplantation at the Federal University of Parana, Curitiba, PR, Brazil. PATIENTS AND METHODS: Between September 1991 and December 2001 94 women underwent liver transplantation at "Hospital de Clínicas" of the Federal University of Paraná. Twenty-eight female recipients (mean age 44,17 ± 13,60 years old) fulfilled the following inclusion criteria: age > 16 years at liver transplant, post-transplant survival > 6 months, be alive and in regular follow-up at our Institution during the period of the study, and agreed to participate of the study. Medical records were reviewed and all subjects were answered by a questionnaire covering the following issues: timing and pattern of menstruation before and after transplant, sexual activity and contraceptive practices before and after transplant, pregnancy after transplant, frequency of cervical cytology and occurrence of gynecological malignant neoplasia after transplant, and aspects of sexuality domain after liver transplantation. RESULTS: The median post-transplant follow-up was 36,5 months (range, 6 to 110 months) and the main indication for liver transplantation was hepatitis C (25%). All patients had normal liver function tests. Excluding six patients who underwent hysterectomy or were in postmenopausal period, 13 of 22 women (59,1%) reported amenorrhea in the year before transplantation. After liver transplantation, 19 of 22 patients (86,4%) promptly recovered menstrual function, after a median period of 1 month (range, 1 to 7 months). Normalization of menstrual function occurred in all women with age 45 or younger. About 71,4% of 28 women were sexually active after transplantation and 70% indicated satisfaction with their relationship. Four successful pregnancies (one gemelar) occurred in three patients and five healthy live-born infants have been delivered, all full term. Most of the patients had cervical cytology at least annually in the post-transplant period. One case of endometrial carcinoma was diagnosed in a 64 year old woman, three years after transplantation and was successfully treated by panhysterectomy. CONCLUSIONS: Most of female liver transplant recipients of child-bearing age recover menstrual function a few months after transplantation and successful pregnancy may occur. As libido and fertility return promptly after liver transplantation, patients should be counseled on safe contraception practices. Most of liver transplant recipients are sexually active and feel satisfied about their relationship. There is a good compliance of patients regarding screening for cervical neoplasm.