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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- Hypertension and cardiovascular disease in developing countries(2013) KOCH, V. H.Hypertension is a major global chronic noncommunicable disease (NCD). One-quarter of the world's adult population has hypertension, and this is likely to increase to 29 % by 2025. Due to epidemiologic shifts, the absolute numbers of patients affected by hypertension in low- and middleincome countries are likely to grow, as increased globalization and economic improvement lead to urbanization and longer life expectancy. Increasing longevity provides longer periods of exposure to the risk factors of cardiovascular disease (CVD), resulting in a greater probability of clinically manifest CVD events. Compounding this high burden of hypertension is a lack of awareness and insufficient treatment in those with hypertension. The survivors of an economic transition period are more likely to present the phenotype of lower birth weight coupled with either stunting or a higher body mass index in childhood or adulthood which appears to be associated with the highest risks of morbid cardiovascular, renal, and metabolic outcomes into adulthood. The combination of population-wide and individual interventions may save millions of lives and considerably reduce human suffering from NCDs. © Springer Science+Business Media New York 2013.
- IPEX syndrome with Dent's disease manifestations - Case Report(2013) KOSTIC, Dusan; BRASIL, Saulo Couto; JACOB, Cristina Miuki Abe; SAMPAIO, Magda Carneiro; KOCH, Vera Hermina KalikaObjective: IPEX syndrome, a hereditary (X-linked) immune dysregulation with autoimmune polyendocrinopathy and enteropathy, as the basic manifestations, presents a rare and severe disease. The objective of this case report is to highlight the pleomorphism of the syndrome. Methods: The authors report the case of a male infant, with a family history of three male siblings affected by IPEX syndrome. The patients’ medical records were reviewed in order to describe the case of the youngest one. Results: During the follow-up of the youngest of three siblings, who presented eczema and intestinal manifestation, without compromised pancreatic and thyroid function, different from other two siblings, it was noticed the pattern of Dent’s disease. We registered hypophosphatemia, hypercalciuria, glycosuria, low molecular weight proteinuria and ultrasound revealed second stage bilateral nephrocalcinosis. In this child there was no apparent glomerular involvement, as it was seen in the eldest sibling. Conclusion: Dent’s disease is an X-linked renal proximal tubulopathy associated with mutations in the chloride channel gene CLCN5 (Xp11.22), which is next to FOXP3 gene on the X chromosome (Xp11.23-q13.3). It seems that in this sibling mutations occurred inexons of both of these genes. This case is to remind on pleomorphic potential of mutations that occur near the coding regions of the FOXP3 gene.
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, ClariceconferenceObject The hip and spine mobility is diminished in enuretic children and teenagers(2013) PEREIRA, Rita Pavione Rodrigues; KOCH, Vera Herminakalika; GONCALVES, Monica Maria Ribeiro; MILHORATTI, Thais de Souza; PACHECO, Daniela Castro; TANAKA, ClaricebookPart Triagem geniturinária(2013) KOCH, Vera Herminia Kalika- Infecção urinária comunitária: etiologia segundo idade e sexo(2013) LO, Denise Swei; SHIEH, Huei Hsin; RAGAZZI, Selma Lopes Betta; KOCH, Vera Hermina Kalika; MARTINEZ, Marina Baquerizo; GILIO, Alfredo EliasINTRODUCTION: Choosing the antimicrobial agent for initial therapy of urinary tract infection (UTI) is usually empirical and should consider the prevalence of uropathogens in different age groups and gender. OBJECTIVE: To establish prevalence rates of uropathogens in community-acquired UTI in relation to age and gender. METHODS: Crosssectional study conducted in the emergency department (ED) of a general hospital, from January to December, 2010, in patients younger than 15 years old who had clinical suspicion of UTI and collected quantitative urine culture. UTI was defined as urine culture with growth of a single agent > 100.000 colony forming units (cfu)/mL in a midstream collection or > 50.000 cfu/mL in urethral catheterization. RESULTS: There were 63.464 visits to ED. 2577 urine cultures were obtained, of whom 291 were positive for UTI (prevalence = 11.3% of clinical suspicion and 0.46% of visits), 212 cases (72.8%) in females, median age = 2.6 years. The predominant uropathogen was E. coli (76.6%), followed by Proteus mirabilis (10.3%) and Staphylococcus saprophyticus (4.1%). Among infants < 3 months, prevalence rates of E. coli were significantly lower (50% vs 78.4%; OR = 0.276; p = 0.006). Higher prevalences of Staphylococcus saprophyticus occurred among patients > 10 years (24.4% vs 0.4%; OR = 79.265; p < 0.0001). Proteus mirabilis was significantly more prevalent in boys than girls (24.0% vs 5.2%; OR = 5.786; p < 0.001). CONCLUSIONS: E. coli was the most prevalent community-acquired uropathogen. Nevertheless, initial empiric antimicrobial treatment of UTI should consider the significant prevalence of other agents different from E. coli in infants < 3 months, the high prevalence of Staphylococcus saprophyticus in patients > 10 years and Proteus mirabilis in males.
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, ClariceconferenceObject One year experience of a multidisciplinary investigation on Nocturnal Enuresis in a Brazilian Tertiary Care Facility(2013) FAGUNDES, Simone N.; SOSTER, Leticia A.; LEBL, Adrienne S.; PAVIONE, Rita; TANAKA, Clarice; SILVA, Guilherme Souza e; PORTO, Paula; FERRARI, Rafaela; SILVARES, Edwiges; KOCH, Vera H.Objective: To characterize a cohort of children, 6–16 yrs old, with nocturnal enuresis, defined by 2010 ICCS criteria on the basis of a multidisciplinary evaluation including renal, neurological, psychological and physical therapy approaches. Chronic clinical conditions and genetic disorders constituted exclusion criteria. Methods: After IRB approval, families were invited to participate in the project through press releases, 130 children completed quality of life evaluation through clinically validated questionnaires, followed by a one -day multidisciplinary clinical evaluation. Sleep, urinary and intestinal diaries were evaluated. Urinary sonography, nocturnal polysomnography, urinary and blood analysis were scheduled. Results: 96/130 participants (pts)were male (73,8%), mean age 8 ±1 yrs. Twenty two children were excluded due to noncompliance/chronic clinical conditions. 118/130 pts were evaluated. 93/130 parents of children/adolescents, answered the CBCL questionnaire, 25/93 (27%) of which resulted in scores compatible with clinical psychological conditions. Monosymptomatic enuresis (MoE) was diagnosed in 89/118 children (75.4%). In the MoE group, 67/89 pts were diagnosed with intestinal constipation; 7/89 pts with obstructive sleep apnea, 2/89 pts with hipercalciuria and 2/89 were characterized with ADHD. Area and velocity of center or pressure displacement (VM) were used for postural control evaluation and resulted in 3,67±2,95 cm 2 and 20,35±13,04 cm.s-1, respectively; 22/89 pts were also assessed for postural alignment exhibiting pelvic anteversion (10,27±3,71 grades) and head protusion (0,40±1,86 grades). These results corroborate with a smaller range of motion found for hip flexion (94,86±17,14 grades) and hip extension (2±3,89 grades) assessed using a goniometer. Conclusion: Multidisciplinary evaluation of enuretic children may be the key to optimize therapy on the basis of the underlying etiology of the process.conferenceObject Six- minute walk test (6MWT) in children and teenages with chronic kidney disease: tolerance, reproducibility and comparison with normal reference values(2013) KOCH, Vera; WATANABE, Flavia T.; CUNHA, Maristela; FERRARO, Alexandre; JULIANI, ReginaObjective: To evaluate exercise tolerance using the six-minute walk test (6MWT) in children and adolescents with stage 5 chronic kidney disease (CKD, to assess the reproducibility of the 6MWT and compare the performance of these children with reference values. Methods: Children and adolescents aged 6 to 16 years with stage 5 CKD were evaluated prospectively using 6MWT, according to the American Thoracic Society methodology. Measurement of Heart rate (HR), respiratory rate (RR), pulse oxygen saturation (SpO2), blood pressure (BP) and dyspnea scale (Borg) at rest (pre) and posttest (post) was performed. The test with the larger walked distance was considered for analysis. Reproducibility was evaluated by t-test and the Bland-Altman methods. Brazilian population reference values were used for comparison with normal children. Results: We studied 38 children and adolescents (14F:24M), 4 on peritoneal dialysis, 12 hemodialysis and 22 post renal transplantation with a mean age of 11.3 ± 2.9 years, mean weight of 32.3 ± 11.7 kg, mean height of 131 ± 17cm and mean BMI of 18.3 ± 3.1 kg/m2. There were no adverse events observed during or after the tests. The 6MWT was found to be reproducible, second walk walked distances were greater than first walk ones (p <0.001). Children with CKD performed significantly poorer (548.9 ± 71.4 m) than reference values of children with similar height (576.46 ±39.76 m) (p <0.001). HR, SpO2, systolic BP (pre), diastolic BP were significantly higherin children with CKD. Conclusion: The 6MWT proved to be safe, reproducible and well tolerated. A learning effect was observed between the first and second test. CKD patients performed significantly poorer than reference values.