Hospital De Clínicas De Porto Alegre Research Articles

Grupo de pais da unidade de terapia intensiva pediátrica: percepção dos familiares

The Parents Group of the Pediatric Intensive Care Unit (PICU) from the Hospital de Clínicas de Porto Alegre (HCPA) takes part on the Family Support Program of the Pediatric Nursing Service. The objective of the study is to know the perception of the family members of hospitalized children regarding the Group of Parents. It is an exploratory and descriptive study with qualitative approach. It was developed within the HCPA after the approval of both the Nursing School Research Commission and the Ethics Commission of the institution. Data was collected in the second semester of 2008 through semi-structured interview with nine family members that participated in the Group. Data was analyzed through content analysis comprising pre-analysis, management of the material, treatment of the results and interpretation. Two categories have emerged: “Talking about the Group” regarding the perception of the family member on his participation and dynamics of the activity that provided freedom of expression, appreciation of the family and the multidisciplinary team, and humanization; yet, the “Group as a Space of the Family” which approaches possibilities, facilities, and exchange of experiences, among others. The research provided new sources of knowledge, possibility of better interventions, new ideas, making the inter-relation among the research and caregiving to the child and his/her family.

Association between medication use and adverse gastroenterologic events in patients receiving enteral nutrition therapy at a University Hospital

Enteral Nutrition Therapy (ENT) is considered an important tool for the appropriate maintenance of nutritional conditions. ENT tolerance may be limited due to gastrointestinal (GI) events resulting from formula composition and/or simultaneously administered drug therapies. To verify the possible association between GI events and drug therapies being administered to patients receiving ENT at a university hospital. A prospective observational cohort study was conducted. Medical records from 95 patients requiring ENT at the Hospital de Clínicas de Porto Alegre (HCPA) were randomly evaluated until discharge, death, or initiation of oral or parenteral diet occurred. Details of the administered medications and enteral formula, together with the presenting patient disease and digestive manifestations, were recorded by the medical team. Three experienced gastroenterologists evaluated the possible association between the digestive symptoms and the medications employed. The study protocol was approved by the HCPA Research Ethics Committee and patient consent forms were signed. Mean patient age: 65±17 (24-95) years; 94.70% presented with GI events: constipation 70.50%, diarrhea 38.90%, abdominal distension 18.90%, vomiting 16.80%, and pulmonary aspiration 1.10%. ENT was most indicated in neurologic (50.50%) and neoplastic (25.30%) disease. Medications given to the patients showed a positive relation: 63.20% to 86.70% of GI symptoms could be attributed to the drugs being administered. GI complications during ENT are common; they are frequently linked to administered drug therapy. Health care teams should consider all risk factors present, specifically those related to prescribed medication, before modifying/suspending ENT.

Group B Streptococcus detection: comparison of PCR assay and culture as a screening method for pregnant women

Streptococcus agalactiae or group B Streptococcus (GBS) is one of the most important causal agents of serious neonatal infections. Numerous assays have been evaluated for GBS screening in order to validate a fast and efficient method. The aim of this study was to compare the culture technique (established as the gold standard) with the molecular method of polymerase chain reaction (PCR) with specific primers (atr gene). Two hundred and sixty-three samples were analyzed. Vaginal samples were collected, according to the Centers for Disease Control and Prevention (CDC) recommendations, from women over 35 weeks of pregnancy at Hospital de Clínicas de Porto Alegre (HCPA). Two different extraction methods were tested in all samples collected. PCR technique yielded 71 (26.99%) positive results. Sensitivity and specificity for PCR were 100% and 86.88%, respectively. PCR demonstrated a shorter turnaround time than the culture. The molecular methodology proved to be a useful screening for GBS, allowing effective treatment to be initiated in shorter time to prevent newborn infection.

Group B Streptococcus detection: comparison of PCR assay and culture as a screening method for pregnant women

Streptococcus agalactiae or group B Streptococcus (GBS) is one of the most important causal agents of serious neonatal infections. Numerous assays have been evaluated for GBS screening in order to validate a fast and efficient method. The aim of this study was to compare the culture technique (established as the gold standard) with the molecular method of polymerase chain reaction (PCR) with specific primers (atr gene). Two hundred and sixty-three samples were analyzed. Vaginal samples were collected, according to the Centers for Disease Control and Prevention (CDC) recommendations, from women over 35 weeks of pregnancy at Hospital de Clínicas de Porto Alegre (HCPA). Two different extraction methods were tested in all samples collected. PCR technique yielded 71 (26.99%) positive results. Sensitivity and specificity for PCR were 100% and 86.88%, respectively. PCR demonstrated a shorter turnaround time than the culture. The molecular methodology proved to be a useful screening for GBS, allowing effective treatment to be initiated in shorter time to prevent newborn infection.

Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index

IntroductionThe Pittsburgh Sleep Quality Index (PSQI) is a questionnaire that assesses sleep quality and disturbances over a 1-month period. It is a valuable tool for research purposes. The aim of this study was to validate a Brazilian Portuguese version of the PSQI. MethodsThe Brazilian Portuguese version (PSQI-BR) was developed according to the following steps: (a) translation, (b) back-translation, (c) comparison between translation and back-translation performed by a group of experts, and (d) pretest in bilingual individuals. Between January 2006 and September 2007, the PSQI-BR was applied to a group of consecutive patients who were submitted to overnight polysomnography with clinical suspicion of obstructive sleep apnea syndrome (OSAS) or insomnia. As in the original article, a group of patients with depression and a control group were included. The depression group was composed of patients from the Mood Disorders Unit of the Psychiatry Department of Hospital de Clínicas de Porto Alegre (HCPA), Brazil. The control group was composed of subjects with a history of normal sleep habits, without noticed snoring. ResultsA total of 83 patients and 21 controls completed the questionnaire and were submitted to overnight polysomnography. The seven-component scores of the PSQI-BR had an overall reliability coefficient (Cronbach’s α) of 0.82, indicating a high degree of internal consistency. The groups included 43 patients with OSAS, 21 with insomnia, 19 with depression and 21 controls. The mean (±SD) PSQI-BR score was 8.1±4.0 for patients with OSAS, 12.8±3.7 for insomnia patients, 14.5±3.7 for those with depression and 2.5±2.0 for control subjects. The one-way ANOVA demonstrated significant differences in PSQI-BR scores across the four diagnostic groups (p<0.001). Post hoc tests between paired groups showed that scores for OSAS, depression and insomnia were significantly higher than for controls (p<0.05). PSQI-BR scores for insomnia did not differ from those obtained for depression (p>0.05), but both were higher than for OSAS (p<0.05). ConclusionsThe results of the present study demonstrate that the PSQI-BR is a valid and reliable instrument for the assessment of sleep quality and equivalent to its original version when applied to individuals who speak the Brazilian Portuguese language. Despite relevant influences of language and cultural background, no major cultural adaptations were necessary during the validation process. The PSQI-BR can be a tool either for clinical management or research.

Body mass index, cognitive deficit and depressive symptoms in high cardiovascular risk patients.

To evaluate the relationship of obesity, cognitive impairment and depressive symptoms in patients with high cardiovascular risk.MethodsA sample of 93 patients aged 50 years or older was selected from the Center of Dyslipidemia and High Cardiovascular Risk from Hospital de Clínicas de Porto Alegre (HCPA). Patients with stroke were excluded. For cognitive evaluation, the MMSE (Mini Mental State Examination) was used. A score of 24 or less was considered as cognitive impairment, and for those who had 4 years or less of education, the cutoff point was 17. The GDS-15 (Geriatric Depression Scale) was also used, with the cutoff of 6 for presence of depressive symptoms.ResultsObese patients showed lower mean MMSE scores compared to non-obese patients (p=0.0012). Additionally, for every one point increase in BMI above 30 there was a 27% increase in the chances of the patient having cognitive impairment. The obese patients presented 31% chance of having cognitive impairment compared with overweight subjects.ConclusionsOur findings corroborated the association between obesity and cognitive impairment in high cardiovascular risk patients. This association however, was not observed for depressive symptoms.

Effects of Velopharyngeal Dysfunction on Middle Ear of Repaired Cleft Palate Patients

Cleft palates are strongly associated with the development of otitis media due to the anatomic and functional defect of the soft palate musculature and the associated alterations of velopharyngeal muscle insertion on tubal cartilage, or even intrinsic alterations of the cartilage, which affects eustachian tube function. This study will assess velopharyngeal muscle adequacy after palatoplasty through videonasoendoscopy and verify if there is a correlation with otologic status. Transversal study. Otorhinolaryngology and cleft palate outpatient service of the Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. Seventy-three patients with cleft palate or cleft lip and palate between the ages of 6 and 12 years who had already undergone palatoplasty. Videonasoendoscopy for evaluation of velopharyngeal function and videotoscopy to assess middle ear status. Severity scale for videonasoendoscopic and videotoscopic findings. There was no significant correlation between the videonasoendoscopic and the videotoscopic scores in the population studied. Intrinsic defects of the eustachian tube cartilage and of the insertion of the velopharyngeal muscles seem to contribute to the evolution of otitis media in patients with cleft palate, in addition to the actual defect of the soft palate. There was no correlation between the severity of the otoscopic findings and the degree of velopharyngeal dysfunction.

The influence of playful activities on children’s anxiety during the preoperative period at the outpatient surgical center

To verify the influence of playful activities during the preoperative period on the anxiety of children participating in the therapeutic recreation project conducted at the outpatient surgical center of Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. The modified Yale Preoperative Anxiety Scale (mYPAS) was administered to 50 children between 5 and 12 years of age undergoing medical procedures at the outpatient surgical center. The children were divided in two groups: recreation group (individuals who participated in playful interventions in the recreation room) and control group (individuals who did not participate in playful interventions). Anxiety was measured using the mYPAS at two different moments: soon after the individuals arrived at the outpatient surgical center (minute 0) and 15 minutes after the first measurement. The results showed that soon after arriving at the outpatient surgical center, the patients did not have significant differences regarding anxiety, showing high values. However, after 15 minutes waiting or undergoing intervention, the children in the recreation group had reduced anxiety levels and those in the control group remained anxious. During the preoperative period, children who participate in playful activities in the recreation room have their anxiety reduced in comparison with those that only stay in the preoperative holding area for at least 15 minutes.

Clinical and demographic characteristics of elderly patients with dementia assisted at an outpatient clinic in Southern Brazil.

The aging of the population is a worldwide phenomenon, where 60% of elders live in developing areas of the world such as Brazil, regions in which few studies have been carried out.ObjectivesThe goal of this study was to evaluate the clinical and demographic profile of patients with dementing disorders seen at a specialized outpatient clinic in South Brazil.MethodsA sample of 105 demented patients seen at the Dementia Outpatient Clinic from Hospital de Clínicas de Porto Alegre (HCPA), Brazil between June 2004 and June 2008. Evaluation of patients consisted of medical history, cognitive testing, assessment of functional status (Activities of Daily Living Scale - ADL; Instrumental Activities Daily Living - IADL) and application of the Neuropsychiatry Inventory (NPI) for behavioral symptoms. Severity of dementia was evaluated based on the CDR scale. All patients underwent laboratory screening tests and brain imaging exams to define etiology of dementia.ResultsOf the whole sample, 71% were female. Age was 79±8 years (mean±SD). Educational level was 4±3 years (mean±SD). Sixty-four patients (60%) presented the diagnosis of Alzheimer’s disease. Of the whole sample, 26.7% were classified as CDR=1, 44% as CDR=2 and 29. 3% as CDR=3. A significant difference on the Mini Mental State Examination (MMSE) and functional status scores was observed among the CDR categories (severity). No significant association was found between severity and impairment on memory tests and behavioral symptoms.ConclusionsAlzheimer’s disease was the most common etiology, followed by vascular dementia. At diagnosis, most patients presented mild to moderate severity of dementia, independent of cause.

Risk factors for cardiovascular disease ten years after preeclampsia.

Preeclampsia is a gestational disease that occurs mainly among nulliparous women after the 20th week of gestation, and frequently close to delivery. The effects of preeclampsia on women's blood pressure over the long term are still controversial. Patients with recurrent preeclampsia or preeclampsia in the early stages of pregnancy appear to present higher risk of hypertension. The aim of this study was to determine the risk factors for cardiovascular disease among women with preeclampsia 10 years earlier. Cross-sectional study at Hospital de Clínicas de Porto Alegre (HCPA). Forty women with preeclampsia and 14 normotensive pregnant women followed up 10 or more years earlier at HCPA underwent clinical and laboratory examinations. Spearman's correlation coefficient was used to correlate body mass index (BMI) and systolic and diastolic pressures. The risk of developing hypertension was measured using the chi-square test. P < 0.05 was considered significant. The patients with preeclampsia 10 or more years earlier had significantly higher diastolic blood pressure (P = 0.047), BMI (P = 0.019) and abdominal circumference (P = 0.026). They presented positive correlations between BMI and diastolic blood pressure (0.341; P = 0.031) and between BMI and systolic blood pressure (0.407; P = 0.009). The patients with preeclampsia 10 or more years earlier had significantly higher diastolic blood pressure, BMI and abdominal circumference than did the control group. This emphasizes the importance of long-term follow-up assessment for cardiovascular risk factors among patients with preeclampsia.

Antibiotic Prophylaxis in Cholecystectomies in a Teaching Hospital in Brazil

Medical literature reports that adequate prophylaxis with antibiotics can reduce the incidence of postoperative infections. To investigate the impact of adopting multiple practices for improving the rational use of antibiotic prophylaxis in patients undergoing cholecystectomy and evaluate, during 2 periods, compliance with the hospital Drug Committee's recommendation and guidelines published in the medical literature. Data were collected from patients' medical records at the Hospital de Clínicas de Porto Alegre (HCPA), Brazil, in 2003. We evaluated 222 procedures as set by guidelines published in the literature and the hospital's recommendation. In 24.5% of the cases, the choice of whether to use the prophylactic antibiotic was not made according to the guidelines. The choice of the antibiotic agent, prophylaxis duration, dose administered, and time for administration was appropriate in 95%, 80.5%, 100%, and 81.8% of cases, respectively. A significant improvement in guideline compliance was observed since multiple practices were adopted to improve the rational use of antibiotic prophylaxis. Compliance with the guidelines for antibiotic prophylaxis for cholecystectomy, in combination with a greater integration among the professionals involved in the HCPA Infection Control Service, resulted in a more appropriate use of these prophylactic agents. Improving physicians' awareness of the importance of meeting guidelines is critical and will benefit patients and the hospital as a whole.

High Prevalence of Extrathyroid Malformations in a Cohort of Brazilian Patients with Permanent Primary Congenital Hypothyroidism

The objective of this study was to evaluate the prevalence of major congenital malformations in a cohort of children with permanent primary congenital hypothyroidism (PCH). This cross-sectional study was conducted in 76 consecutive, unselected children with PCH recruited from a district hospital outpatient clinic. Malformations were identified by clinical examination. The prevalence of major congenital malformations in these patients was compared with the prevalence of malformations in children born at Hospital de Clínicas de Porto Alegre (HCPA). The etiology of hypothyroidism was established by scintigraphy and ultrasonography. Hypothyroidism was caused by thyroid dysgenesis in 67 patients (one case of hemiagenesis, 24 of ectopia, and 42 of agenesis); the gland was normally located and shaped in nine patients. Ten patients (13.2%) had major congenital malformations (1,316/10,000 patients), mostly cardiac. Malformations were observed only in patients with dysgenesis: thyroid agenesis (n = 7) and sub-lingual ectopic thyroid (n = 3). The prevalence of malformations was significantly higher (RR = 2.6; CI 95%: 1.3-4.8; p = 0.005) in this group than in HCPA newborns (509/10,000 patients). In conclusion, a high rate of extrathyroid congenital malformations, mostly cardiac, was found for patients with permanent PCH, especially thyroid dysgenesis. The present data support the existence of an association between CH and increased prevalence of congenital malformations.

Cerebrovascular disease in pediatric patients.

Although rare in childhood, stroke may have a serious impact when it happens in this stage of life. Also, it may be the first sign of a systemic disease. We report 12 cases of patients with stroke treated in the Neuropediatrics Unit of Hospital de Clínicas de Porto Alegre (HCPA) from March 1997 to March 2000. All patients, from term infants to 12-year-old children hospitalized in the Pediatrics Unit of HCPA, had clinical suspicion of stroke, which was later confirmed by radiological studies. Patient follow up ranged from 1 to 6 years (mean = 3.4 years). Presenting symptoms were hemiparesis in 9 patients, seizures in 7, deviation of labial commissure in 3, and loss of consciousness in 1. The increase in the number of cases of childhood stroke identified and later confirmed by noninvasive methods had helped in the determination of different ethiologies of stroke: the most frequent being hematologic, cardiac and genetic diseases. However, our study included 6 newborns with stroke whose ethiology was not identified. Seven children with seizures received phenobarbital. Six term infants had neonatal seizures secondary to stroke and restricted to the first 72 hours of life.

Hiperecogenicidade dos vasos talâmicos no recém-nascido prematuro

The aim of this study is to evaluate possible pathologies associated with hyperechogenicity of thalamic vessels (HETV), which are found on brain ultrasounds (BUS), as well as to observe the frequency of their occurrence. The sample was composed of 206 preterm newborn infants at Hospital de Clínicas de Porto Alegre (HCPA) from July 1998 to May 1999. All of them were submitted to BUS in the first week of life. Preterm children who needed hospital admission and had a term of informed consent signed up by their guardians were included in this study. Preterm newborn children with BUS showing intracranial hemorrhage and/or associated congenital malformation were excluded from this study. Through BUS it was possible to identify 65 preterm newborn children with HETV and 141 preterm newborn children without HETV. We identified the following risk factors for HETV: pelvic presentation, longer gestational period, increased birthweight and big for gestational age classification. On the other hand, mothers hypertension during the gestational period tended to protect infants from HETV. The newborn infants that presented convulsive crises during hospitalization had a 3.2-fold higher risk of having HETV when compared to the ones who did not go through any convulsive crises.