VERA HERMINA KALIKA KOCH
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
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conferenceObject The postural alignment in enuretic children and teenagers(2013) PEREIRA, Rita Pavione Rodrigues; KOCH, Vera HerminaKalika; FAGUNDES, Simone Nascimento; KARIYA, Larissa Tiaki; ARAJO, Talita Souza de; SAKIMA, Thaisa Mayumi; TANAKA, Clarice- Non-REM Sleep Instability in Children With Primary Monosymptomatic Sleep Enuresis(2017) SOSTER, Leticia Azevedo; ALVES, Rosana Cardoso; FAGUNDES, Simone Nascimento; LEBL, Adrienne; GARZON, Eliana; KOCH, Vera H.; FERRI, Raffaele; BRUNI, OlivieroStudy Objectives: Sleep enuresis is one of the most common sleep disturbances in childhood. Parental perception of deeper sleep in children with sleep enuresis is not confirmed by objective studies. However, evidence of disturbed sleep has been demonstrated by questionnaire, actigraphy, and polysomnographic studies, but no neurophysiological correlation with low arousability has been found. The goal of this study was to analyze the sleep microstructure of children with sleep enuresis using cyclic alternating pattern (CAP) analysis. Methods: Forty-nine children were recruited, 27 with enuresis (19 males and 8 females, mean age 9.78 years, 2.52 standard deviation) and 22 normal control patients (11 males and 11 females, mean age 10.7 years, 3.43 standard deviation); all subjects underwent clinical evaluation followed by a full-night polysomnographic recording. Psychiatric, neurological, respiratory, and renal diseases were excluded. Results: No differences in sex, age, and apnea-hypopnea index were noted in the patients with enuresis and the control patients. Sleep stage architecture in children with sleep enuresis showed a decrease in percentage of stage N3 sleep. CAP analysis showed an increase in CAP rate in stage N3 sleep and in phase A1 index during stage N3 sleep in the sleep enuresis group, but also a significant reduction of A2% and A3% and of phases A2 and A3 indexes, supporting the concept of decreased arousability in patients with sleep enuresis. The decrease of phase A2 and A3 indexes in our patients might reflect the impaired arousal threshold of children with sleep enuresis. Sleep fragmentation might result in a compensatory increase of slow wave activity (indicated by the increase of CAP rate in stage N3 sleep) and may explain the higher arousal threshold (indicated by a decrease of phase A2 and A3 indexes) linked to an increased sleep pressure. Conclusions: The findings of this study indicate the presence of a significant disruption of sleep microstructure (CAP) in children with sleep enuresis, supporting the hypothesis of a higher arousal threshold.
- Clinical course of a cohort of children with non-neurogenic daytime urinary incontinence symptoms followed at a tertiary center(2016) LEBL, Adrienne; FAGUNDES, Simone Nascimento; KOCH, Vera Hermina KalikaObjective: To characterize a cohort of children with non-neurogenic daytime urinary incontinence followed-up in a tertiary center. Methods: Retrospective analysis of 50 medical records of children who had attained bladder control or minimum age of 5 years, using a structured protocol that included lower urinary tract dysfunction symptoms, comorbidities, associated manifestations, physical examination, voiding diary, complementary tests, therapeutic options, and clinical outcome, in accordance with the 2006 and 2014 International Children's Continence Society standardizations. Results: Female patients represented 86.0% of this sample. Mean age was 7.9 years and mean follow-up was 4.7 years. Urgency (56.0%), urgency incontinence (56.0%), urinary retention (8.0%), nocturnal enuresis (70.0%), urinary tract infections (62.0%), constipation (62.0%), and fecal incontinence (16.0%) were the most prevalent symptoms and comorbidities. Ultrasound examinations showed alterations in 53.0% of the cases; the urodynamic study showed alterations in 94.7%. At the last follow-up, 32.0% of patients persisted with urinary incontinence. When assessing the diagnostic methods, 85% concordance was observed between the predictive diagnosis of overactive bladder attained through medical history plus non-invasive exams and the diagnosis of detrusor overactivity achieved through the invasive urodynamic study. Conclusions: This subgroup of patients with clinical characteristics of an overactive bladder, with no history of urinary tract infection, and normal urinary tract ultrasound and uroflowmetry, could start treatment without invasive studies even at a tertiary center. Approximately one-third of the patients treated at the tertiary level remained refractory to treatment.
conferenceObject PATIENTS WITH ENURESIS MAY HAVE BALANCE DISORDERS(2015) PAVIONE, Rita; PEREIRA, Rodrigues; MACHADO, Marcos Giannetti; FAGUNDES, Simone Nascimento; LEBL, Adriene; AZEVEDO, Leticia; KOCK, Vera Hermina; TANAKA, ClariceconferenceObject POSTURE AND MOBILITY CHANGES IN PATIENTS WITH NOCTURNAL ENURESIS(2015) PEREIRA, Rita Pavione Rodrigues; MACHADO, Marcos Giannetti; FAGUNDES, Simone Nascimento; LEBL, Adriene; AZEVEDO, Leticia; KOCK, Vera Hermina; TANAKA, ClaricebookPart Enurese noturna: avaliação multidisciplinar(2016) FAGUNDES, Simone Nascimento; KOCK, Vera Herminia Kalika- Impact of a multidisciplinary evaluation in pediatric patients with nocturnal monosymptomatic enuresis(2016) FAGUNDES, Simone Nascimento; SOSTER, Leticia Azevedo; LEBL, Adrienne Surri; PEREIRA, Rita Pavione Rodrigues; TANAKA, Clarice; PEREIRA, Rodrigo Fernando; SILVARES, Edwiges Ferreira de Mattos; KOCH, Vera H.Background Enuresis (NE) is a clinical condition of multifactorial etiology that leads to difficulties in child/adolescent social interaction. This was a prospective study on the impact of multidisciplinary assessment of 6- to 17-year-old patients with monosymptomatic nocturnal enuresis (MNE), including a structured history, clinical/neurological examination, bladder and bowel diaries, sleep diary and questionnaires, psychological evaluation [Child Behavior Checklist (CBCL) and PedsQL 4.0 questionnaires], urinary sonography, blood and urine laboratory tests, polysonography (PSG), and balance evaluation. A total of 140 enuretic participants were evaluated, of whom 27 were diagnosed with NE complicated by urinary disorder, four with hypercalciuria, three with nephropathy and one with attention-deficit hyperactivity disorder. Among the 87 participants who underwent PSG, six were diagnosed with severe apnea. Of the 82 MNE patients who underwent full assessment, 62 were male (75.6 %), and the mean age was 9.5 (+/- 2.6) years. A family history of NE was diagnosed in 91.1 % of first- and second-degree relatives, constipation in 89.3 % and mild/moderate apnea in 40.7 %. Balance control alteration was identified by physical therapy evaluation of MNE patients. Participants' quality of life evaluation scores were significantly lower than those of their parents. Enuresis is a multifactorial disorder that requires a structured diagnostic approach.
conferenceObject POSTURAL CONTROL IN CHILDREN AND TEENAGERS WITH ENURESIS(2013) PEREIRA, Rita Pavione Rodrigues; KOCH, Vera HerminaKalika; FAGUNDES, Simone Nascimento; ROSSI, Aline; VIEIRA, Juliane de Oliveira Marques; TANAKA, Clarice