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.- 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.
bookPart 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.
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.conferenceObject Nutritional status of pediatric patients on hemodialysis after changing the dietary protocol(2016) WATANABE, A.; SATIVO, C.; KOCH, V.; OHTA, M.; GANDOLFO, A.; ZAMBERLAN, P.article 7TH BRAZILIAN GUIDELINE OF ARTERIAL HYPERTENSION(2016) MALACHIAS, Marcus Vinicius Bolivar; SOUZA, Weimar Kunz Sebba Barroso de; PLAVNIK, Frida Liane; RODRIGUES, Cibele Isaac Saad; BRANDAO, Andrea Araujo; NEVES, Mario Fritsch Toros; BORTOLOTTO, Luiz Aparecido; FRANCO, Roberto Jorge da Silva; FIGUEIREDO, Carlos Eduardo Poli de; JARDIM, Paulo Cesar Brandao Veiga; AMODEO, Celso; BARBOSA, Eduardo Costa Duarte; KOCH, Vera; GOMES, Marco Antonio Mota; PAULA, Rogerio Baumgratz de; PAVOA, Rui Manuel dos Santos; COLOMBO, Fernanda Consolim; FERREIRA FILHO, Sebastiao; MIRANDA, Roberto Dischinger; MACHADO, Carlos Alberto; NOBRE, Fernando; NOGUEIRA, Armando da Rocha; MION JUNIOR, Decio; KAISER, Sergio; FORJAZ, Claudia Lucia de Moraes; ALMEIDA, Fernando Antonio; MARTIM, Jose Fernando Vilela; SASS, Nelson; DRAGER, Luciano Ferreira; MUXFELDT, Elizabeth; BODANESE, Luiz Carlos; FEITOSA, Audes Diogenes; MALTA, Deborah; FUCHS, Sandra; MAGALHAES, Maria Eliane; OIGMAN, Wille; MOREIRA FILHO, Osni; PIERIN, Angela Maria Geraldo; FEITOSA, Gilson Soares; BORTOLOTTO, Maria Rita de Figueiredo Lemos; MAGALHAES, Lucelia Batista Neves Cunha; SILVA, Ana Cristina Simoes e; RIBEIRO, Jose Marcio; BORELLI, Flavio Antonio de Oliveira; GUS, Miguel; PASSARELLI JUNIOR, Oswaldo; TOLEDO, Juan Yugar; SALLES, Gil Fernando; MARTINS, Luis Cuadrado; JARDIM, Thiago de Souza Veiga; GUIMARAES, Isabel Cristina Britto; ANTONELLO, Ivan Carlos; LIMA JUNIOR, Emilton; MATSUDO, Victor; SILVA, Giovanio Vieira da; COSTA, Lilian Soares da; ALESSI, Alexandre; SCALA, Luiz Cezar Nazario; COELHO, Eduardo Barbosa; SOUZA, Dilma de; LOPES, Heno Ferreira; GOWDAK, Marcia Maria Godoy; CORDEIRO JUNIOR, Antonio Carlos; TORLONI, Maria Regina; KLEIN, Marcia Regina Simas Torres; NOGUEIRA, Paulo Koch; LOTAIF, Leda Aparecida Daud; ROSITO, Guido Bernardo Aranha; MORENO JUNIOR, Heitor- Six-minute walk test in children and adolescents with renal diseases: tolerance, reproducibility and comparison with healthy subjects(2016) WATANABE, Flavia Tieme; KOCH, Vera Herminia Kalika; JULIANI, Regina Celia Turola Passos; CUNHA, Maristela TrevisanOBJECTIVES: To evaluate exercise tolerance and the reproducibility of the six-minute walk test in Brazilian children and adolescents with chronic kidney disease and to compare their functional exercise capacities with reference values for healthy children. METHODS: This cross-sectional study assessed the use of the six-minute walk test in children and adolescents aged 6-16 with stage V chronic kidney disease. For statistical analysis of exercise tolerance, including examinations of correlations and comparisons with reference values, the longest walked distances were considered. The reproducibility of the six-minute walk test was assessed using intraclass correlation coefficients. RESULTS: A total of 38 patients (14 females and 24 males) were evaluated, including 5 on peritoneal dialysis, 12 on hemodialysis and 21 who had undergone renal transplantation, with a median age of 11.2 years (6.5-16). The median walked distance was 538.5 meters (413-685) and the six-minute walk test was found to be reproducible. The walked distance was significantly correlated with age (r=0.66), weight (r=0.76), height (r=0.82), the height Z score (r=0.41), hemoglobin (r=0.46), hematocrit (r=0.47) and post-test systolic blood pressure (r=0.39). The chronic kidney disease patients predicted walked distance was 84.1% of the reference value according to age, 90.6% according to age-corrected height and 87.4% according to a predictive equation. CONCLUSIONS: The stage V chronic kidney disease patients had a significantly decreased functional exercise capacity, as measured by the six-minute walk test, compared with the healthy pediatric reference values. In addition, the six-minute walk test was shown to be well tolerated, reliable and applicable as a low-cost tool to monitor functional exercise capacity in patients with renal disease.
- 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.
bookPart Lesão renal aguda no recém-nascido(2016) COUTO, Saulo Brasil do; KOCH, Vera Herminia Kalika