OBJETIVOS: determinar a acurácia do escore de Alvarado para o diagnóstico de apendicite aguda em crianças e adolescentes admitidos na emergência do Instituto Materno Infantil de Pernambuco (IMIP). MÉTODOS: foi realizado um estudo de validação de método diagnóstico (escore clínico-laboratorial para diagnóstico de apendicite aguda) tendo o exame histopatológico como padrão ouro. A amostra estudada consistiu de 81 crianças e adolescentes, admitidas na emergência pediátrica do IMIP com dor abdominal suspeita de apendicite aguda, no período de março a outubro de 2002. Os pacientes foram atendidos na emergência pediátrica e avaliados quanto ao escore de Alvarado. Entretanto a decisão cirúrgica foi tomada pelo cirurgião responsável. RESULTADOS: tomando como ponto de corte o valor >5 pontos, encontramos uma sensibilidade de 92,6%, especificidade 63,6%, valor preditivo positivo de 86,2% e valor preditivo negativo de 77,8%. CONCLUSÕES: o escore de Alvarado é um procedimento pouco invasivo, simples, rápido, reprodutível, que utilizando o ponto de corte >5 pontos apresenta-se como instrumento de alto valor na triagem de crianças e adolescentes com suspeita diagnóstica de apendicite aguda.

BackgroundGestational diabetes mellitus (GDM) is increasing worldwide and has been associated with adverse perinatal outcomes and high risk for chronic disease both for the mother and for the child. Physical exercise is feasible for diabetic pregnant women and contributes to better glycemic control and to a decrease in adverse perinatal outcomes. However, there are no randomized controlled trials (RCT) assessing the effects of aquatic physical exercise on GDM control and adverse maternal and fetal outcomes.Methods/DesignAn RCT will be conducted at Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Brazil. A total of 72 pregnant women will be studied; 36 gestational diabetics will undergo an aquatic physical exercise program in a thermal pool, 3 times per week over 2 months. The primary endpoint will be glucose level control and use of insulin; secondary endpoints will be the following maternal and fetal outcomes: weight gain during pregnancy, blood pressure, pre-eclampsia diagnosis, intrauterus growth restriction, preterm birth, Cesarean section, macrosomia and maternal or neonatal intensive care admission. Endpoints between intervention and control group will analyzed by t test for unpaired data and χ2 test, and the level of significance will set at <0.05.DiscussionThe physical proprieties of water make aquatic exercises ideal for pregnant women. An aquatic physical exercise program developed for GDM women will be trialed in a thermal pool and under the supervision of physiotherapist to ensure compliance. It is expected that this study will provide evidence as to the effect of aquatic physical exercise on GDM control.Trial registrationClinicalTrial.gov, NCT01940003.

Background: Ethanol lock therapy (ELT) has been reported as being effective in preventing central line-associated bloodstream infection (CLABSI) in tunneled (or long-term) central venous catheters (CVCs). To the best of our knowledge, no studies have evaluated this therapy in relation to nontunneled (or short-term) CVCs. Objective: To evaluate the effectiveness of ELT in preventing CLABSI in nontunneled CVC in pediatric patients. Methods: This randomized clinical trial was conducted with children aged 0-5 years and >2 kg in weight, in whom a double-lumen polyurethane nontunneled CVC had been inserted. Patients with catheters inserted in an emergency situation, critically ill patients, and/or those with a history of hypersensitivity or allergic reactions to ethanol were excluded from the study. The variables evaluated were CLABSI, etiological agents, adverse events, and the mechanical effects of ethanol on the catheter (breakage and obstruction). Results: The CLABSI rate was lower in the ELT group compared with the control group (P = 0.0177). However, when the occurrence of CLABSI was evaluated per 1000 catheter-days, no significant difference was found between the groups (P = 0.077). The frequency of side effects and catheter breakage was greater in the ELT group (P = 0.0001 and P = 0.0005, respectively). Conclusions: The CLABSI rate was statistically significantly reduced in the ELT group compared with the controls, but the analysis of frequency per catheter-day showed no significant difference between the groups. Thus, we should not recommend ELT for CLABSI prophylaxis in nontunneled polyurethane CVC, which requires further clinical trials. (JPEN J Parenter Enteral Nutr. 2019;43:1044-1052

The prophylactic use of antiemetic drugs failed to reduce the incidence of POV in pediatric outpatient surgery with a low emetic potential; therefore, routine prophylaxis may be unnecessary.

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