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 Quality of life of patients with MNE and the perception of their caregivers(2016) FAGUNDES, S. N.; LEBL, A. S.; SOSTER, L. M.; KOCH, V. H.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- Children with nocturnal enuresis have posture and balance disorders(2016) PEREIRA, R. Pavione Rodrigues; FAGUNDES, S. Nascimento; LEBL, A. Surry; SOSTER, L. Azevedo; MACHADO, M. G.; KOCH, V. H.; TANAKA, C.Introduction Integration of the neuromuscular system is required for maintaining balance and adequate voiding function. Children with enuresis have delayed maturation of the motor cortex, with changes in the sensory and motor systems. Along with various alterations, including the genetic, hormonal, behavioral, and sleep disturbances, and neuromotor and sensory deficits associated with nocturnal enuresis (NE) in children and adults, a consistent alteration in the posture of children with NE has been observed in the current practice. Because posture and the balance control system are strongly connected, this study aimed to investigate posture and balance in children and teenagers with NE. Material and methods A total of 111 children with enuresis were recruited to the enuretic group (EG) and 60 asymptomatic children made up the control group (CG). The participants were divided into two age subgroups: (A) 7-11 years old, N = 77 for EG/A, N = 38 for CG/A; and (B) 12-16 years old, N = 34 for EG/B, N = 22 for CG/B. Balance was assessed using an electronic force plate (100 Hz) to calculate the area of the center of pressure (COP) displacement. The COP is the point that results from the action of vertical forces projected onto the force plate. Sensory integration was analyzed using a 60-s trial with the subject standing under four conditions: (1) eyes open, stable surface; (2) eyes closed, stable surface; (3) eyes open, unstable surface; (4) eyes closed, unstable surface. Posture was assessed by placing reflective anatomical landmarks on the anterior superior iliac spine, the posterior superior iliac spine, the greater trochanter, and lateral malleolus. A photograph was taken while the subject stood quietly. The angles were obtained from landmark connections using software to assess the following posture variables: pelvic ante/retroversion and pelvic ante/retropulsion. Results The EG showed a greater area of COP displacement compared with the CG under all four sensory conditions and both subgroups, except for EG/B in condition 3. Regarding posture, EG showed higher pelvic anteversion angles than CG. Conclusions Enuretic children showed forward inclination of the pelvis and had worse balance compared with control children.
- Monosymptomatic nocturnal enuresis in pediatric patients: multidisciplinary assessment and effects of therapeutic intervention(2017) FAGUNDES, Simone N.; LEBL, Adrienne Surri; SOSTER, Leticia Azevedo; SILVA, Guilherme Jorge Sousa e; SILVARES, Edwiges Ferreira de Mattos; KOCH, Vera H.Few studies manage patients with isolated monosymptomatic enuresis (MNE) with multidisciplinary evaluation and pre- and long-term post-intervention monitoring. This was a prospective study of MNE patients, aged 6-16 years, diagnosed by multidisciplinary assessment. Of the 140 initial applicants (58.6%) with MNE, 82 were included in the study and randomized for therapeutic intervention in three treatment groups, namely: alarm, desmopressin and alarm + desmopressin. Therapeutic response was evaluated 12 months after treatment withdrawal. Of the 82 patients [mean age 9.5 (SD +/- 2.6) years, n = 62 males (75.6%)], 91.1% had a family history of nocturnal enuresis (NE) in first-/second-degree relatives, 81.7% had constipation and 40.7% had mild-to-moderate apnea. Prior to randomization, management of constipation and urotherapy led to remission in seven of the 82 patients; 75 patients were randomized to intervention. There were 14/75 (18.7%) dropouts during the intervention, especially in the alarm group (p = 0.00). Initial complete/partial response was achieved in 56.6% of the alarm group, 70% of the desmopressin group and 64% in the combined group (p = 0.26). Continued success occurred in 70% of the alarm group, 84.2% of the desmopressin group and 100% of the combined group (p = 0.21). Recurrence occurred in 3/20 (15%) patients in the alarm group and 1/19 (5.2 %) patients of the desmopressin group. Post-intervention Child Behavior Checklist (CBCL) and PedsQL 4.0 scores showed significant improvement. The three therapeutic modalities were effective in managing MNE with low relapse rates; the alarm group showed the highest dropout rate. Therapeutic success was associated with improvement of behavioral problems and quality of life scores.
conferenceObject Prevalence of constipation in patients with nocturnal enuresis, clinical and pelvic ultrasound scores.(2016) FAGUNDES, S. N.; LEBL, A. S.; SOSTER, L. M.; RIBEIRO, E.; ZUNCHER, I.; SUSUKI, L.; KOCH, V. H.