ABSTRACT
Introducción. Las malformaciones vasculares cerebrales de alto flujo son poco comunes en la edad pediátrica. El objetivo del trabajo es diferenciar y agrupar estas enfermedades según edad de debut, manifestaciones clínicas y angioarquitectura.Población y método. Se realizó un estudio retrospectivo y observacional. Se analizaron las historias clínicas, los estudios por imágenes y los protocolos de procedimientos de pacientes del Hospital J. P. Garrahan con diagnóstico de malformaciones vasculares cerebrales desde enero de 2010 hasta enero de 2020.Resultados. Ciento ochenta y tres pacientes cumplieron los criterios de inclusión. Se identificaron 131 pacientes con malformaciones arteriovenosas con nido (MAV) y 52 con fístulas directas (sin nido), entre los que se hallaron 19 malformaciones aneurismáticas de vena de Galeno, 23 fístulas piales y 10 fístulas durales. La edad promedio fue de 105 meses para las MAV, 1,7 meses para las malformaciones aneurismáticas de vena de Galeno, 60,5 meses para fístulas piales y 41 meses para fístulas durales.Conclusión. Según su angioarquitectura, las malformaciones vasculares cerebrales de alto flujo tuvieron nido (MAV) o fueron fístulas directas (malformaciones aneurismáticas de vena de Galeno, fístulas piales y fístulas durales). Las MAV se manifestaron a partir de la primera infancia, sobre todo, por hemorragia intracraneana. Las fístulas directas se expresaron en la primera etapa de la vida, frecuentemente, con insuficiencia cardíaca.
Introduction. High-flow vascular malformations of the brain are uncommon in pediatrics. The objective of this study is to establish the differences among these pathologies and group them by age at onset, clinical manifestations, and angioarchitecture.Population and method. This was a retrospective and observational study. The medical records, imaging studies, and procedure protocols of patients seen at Hospital J. P. Garrahan diagnosed with vascular malformations of the brain between January 2010 and January 2020 were analyzed.Results. A total of 183 patients met the inclusion criteria. It was possible to identify 131 patients with arteriovenous malformations with a nidus (AVMs) and 52 with direct fistulas (without a nidus), including 19 vein of Galen aneurysmal malformations, 23 pial fistulas, and 10 dural fistulas. The average age of patients was 105 months for AVMs, 1.7 months for vein of Galen aneurysmal malformations, 60.5 months for pial fistulas, and 41 months for dural fistulas.Conclusion. Based on their angioarchitecture, high-flow vascular malformations of the brain presented a nidus (AVMs) or direct fistulas (vein of Galen aneurysmal malformations, pial fistulas, and dural fistulas). AVMs were observed in early childhood, especially due to intracranial hemorrhage. Direct fistulas occurred in the first stage of life, commonly with heart failure.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Arteriovenous Malformations/therapy , Arteriovenous Malformations/diagnostic imaging , Retrospective Studies , Arteriovenous Fistula/therapy , Arteriovenous Fistula/diagnostic imaging , Intracranial Hemorrhages , Vein of Galen Malformations/therapy , Vein of Galen Malformations/diagnostic imaging , Heart FailureABSTRACT
Several studies have focused on the heart rate variability (HRV) of murine species, while studies discussing HRV in murine neonates and infants remain scarce, since recording hemodynamic signals through invasive methods in small animals has been found to be quite challenging. Thus, this study aimed at describing and validating a novel method to assess HRV in newborn rats. An electrocardiogram (ECG) system was used to determine RR intervals in awake newborns and evaluate HRV in normotensive (Wistar) and hypertensive (SHR) neonate rats. After birth, ECG was recorded in the awake newborns, and they were allowed to rest on a heated surface, restricted only by the weight of the adhesive ECG electrodes. The electrodes were cut and adapted to provide more comfort to the animal, and gently placed on the newborn's skin. RR intervals were recorded over a 30-min period using an ECG system together with LabChart software (4 KHz). Three sequences of 5 min each from the ECG recording period were analyzed in time and frequency domains, using CardioSeries software. ECG data resulted in a clearly interpretable signal that was used to generate an RR interval sequence through time for the analysis of HRV. SHR neonates presented increased cardiac sympathovagal balance compared to Wistar neonates (low frequency/high frequency: 3.85±0.71 vs 0.90±0.09). In conclusion, the ECG setup here described may be used to record RR intervals to assess HRV in neonate rats, thus detecting early impairment of HRV in hypertensive newborns.
Subject(s)
Animals , Rabbits , Rats , Software , Electrocardiography , Rats, Inbred SHR , Rats, Wistar , Heart Rate , HypertensionABSTRACT
There is no definite recommendation for testing platelet aggregation (PA) in acute coronary syndromes (ACS) due to inconclusive evidence on the usefulness of platelet function tests to guide therapy and improve clinical outcomes. The evaluation of PA with multiple electrode impedance platelet aggregometry (MEA) may be useful to manage antiplatelet therapy and possibly influence patient outcome. The primary aim of this study was to measure PA with MEA in Brazilian patients with ACS and evaluate the association between PA and adverse clinical outcomes. Forty-seven consecutive patients admitted with ACS to a Brazilian tertiary-care public hospital were studied and PA was evaluated using MEA. Patients were followed for six months for the occurrence of all-cause death, acute myocardial infarction, or stroke. Suboptimal inhibition of PA was found in 7 patients (14.9%); 5 (10.6%) in response to ASA (acetylsalicylic acid), 2 (5.0%) to clopidogrel, and none to ticagrelor. Inadequate PA inhibition in response to ASA was significantly associated with the composite end point, but there was no significant association for insufficient PA inhibition in response to clopidogrel. This study suggested that the evaluation of PA in ACS using MEA may identify non-responders to ASA. Larger studies are necessary to define, in a public health scenario, the value of MEA in the management of ACS.
Subject(s)
Platelet Aggregation/drug effects , Electric Impedance/therapeutic use , Acute Coronary Syndrome/blood , Platelet Count , Platelet Function Tests , Platelet Aggregation Inhibitors/therapeutic use , Adenosine/therapeutic use , Pilot Projects , Aspirin/therapeutic use , Prospective Studies , Acute Coronary Syndrome/drug therapy , Receptors, Purinergic P2Y12/blood , Tertiary Care Centers , Hospitals, PublicABSTRACT
The attention deficit hyperactivity disorder (ADHD), considered a common cause of disorders in children and adolescents, is a neurobiological condition characterized by inattention and disorganization, hyperactivity and impulsivity. The first reports emerged in the sixteenth century and since then a process that extends to the present time to establish the best nomenclature, process diagnosis, etiology and its clinical characteristics has started. As this is a long and fragmented process, it becomes necessary to conduct a review of the main topics related to the subject, including its historical context. The aim of this study is to present, through the literature review, an over view of the main historical aspects, diagnosis and clinical of ADHD. To do so, we conducted a search of the databases with the following keywords: "ADHD", "prevalence", "etiology", "diagnosis", "clinical manifestation" and "comorbidities", combined or not, in native and not native languages (English). The articles were selected according to the objectives of the study. As it is considered a complex and heterogeneous disorder, as well as for not having a welldefined etiological process, and for suffering diagnostic tendencies, more studies are needed
O transtorno de déficit de atenção e hiperatividade (TDAH), considerado uma causa comum de doenças em crianças e adolescentes, é uma condição neurobiológica caracterizada pela desatenção e desorganização, hiperatividade e impulsividade. Os primeiros relatos surgiram no século XVI, e desde então um processo que se estende até o presente momento para estabelecer a melhor nomenclatura, o diagnóstico de processos, a etiologia e suas características clínicas teve início. Como esse é um processo longo e fragmentado, tornase necessário proceder com revisão dos principais temas relacionados ao assunto, incluindo seu contexto histórico. O objetivo deste estudo é apresentar, por meio de revisão de literatura, uma visão geral dos principais aspectos histórico, diagnóstico e clínico de TDAH. Para isso, foi realizada uma pesquisa dos bancos de dados com as seguintes palavraschave: "TDAH", "prevalência", "etiologia", "diagnóstico", "manifestações clínicas" e "comorbidades", combinadas ou não, em línguas nativas e não (inglês). Os artigos foram selecionados de acordo com os objetivos do estudo. Como ele é considerado um distúrbio complexo e heterogêneo, bem como por não ter um processo etiológico bem definido, e por sofrer tendências de diagnóstico, são necessários mais estudos
Subject(s)
Humans , Child , Adolescent , History, 20th Century , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/history , Attention Deficit Disorder with Hyperactivity/epidemiology , Attention Deficit Disorder with Hyperactivity/etiology , Comorbidity , Prevalence , Executive FunctionABSTRACT
É proposto um modelo simples, fazendo uso do método da máxima verossimilhança, para estimar as freqüências de malformaçöes em grupos raciais, baseado em dados obtidos em serviços hospitalares. Este modelo usa as proporçöes de mistura racial e a freqüência observada da malformaçäo. O método foi aplicado a dois defeitos: polidactilia pós-axial e lábio leporino, cujas freqüências säo reconhecidamente heterogêneas entre grupos raciais. As estimativas obtidas em cada grupo racial foram as esperadas para estas malformaçöes, o que prova a aplicabilidade do método.
Subject(s)
Humans , Cleft Lip/genetics , Racial Groups/genetics , Polydactyly/genetics , Congenital Abnormalities , Residence Characteristics , Environment , Polymorphism, GeneticABSTRACT
La infiltracion del musculo cardiaco que se observa en la amiloidosis sistematica primaria, se manifiesta clinicamente como una miocardiopatia restrictiva. Se presentan dos casos en los que los diferentes hallazgos del ecocardiograma-Doppler cardiaco decisivo para el diagnostico que posteriormente se confirmo con la anatomia patologica realizada a las muestras obtenidas mediante biopsia
Subject(s)
Humans , Female , Male , Middle Aged , Amyloidosis/diagnosis , Cardiomyopathy, Restrictive/diagnosis , Echocardiography, DopplerSubject(s)
Infant, Newborn , Humans , Male , Female , Clubfoot/epidemiology , Birth Intervals , Birth Order , Ethnicity , Labor Presentation , Risk , Sex FactorsABSTRACT
La frecuencia de nevos pigmentados congenitos (NPC) en una serie de nacimientos consecutivos, entre los anos 1967 y 1979, fue 283/30.091 = 0,94%, sin existir diferencias por sexo. Esta frecuencia registrada esta viciada por subregistro, estimandose que la frecuencia real de los NPC debe estar entre 1,5 y 2,0%. Este subregistro afecta principalmente a los NPC leves (unicos, menores de 10 mm, de textura normal), por lo que la proporcion de nevos "graves" debe ser interpretado de acuerdo a la tasa global de incidencia esta 12 veces mayor que la de la poblacion en general. Esta agregacion familiar parece deberse a un mecanismo de herencia multifactorial de alta heredabilidad (H2 = 83,5%), sin indicacion de efectos de dominancia