Comprehensive neuropsychological evaluation of children and adolescents with sickle cell anemia: a hospital-based sample

Abstract Background: Individuals with sickle cell anemia may suffer symptomatic or silent cerebral infarcts leading to neurocognitive complications. This study investigated the cognitive and intellectual performance of children and adolescents with sickle cell anemia. Methods: The socioeconomic status, clinical aspects and behavioral profile of 15 young individuals with sickle cell anemia were evaluated. The Wechsler Intelligence Scale for Children, the Developmental Neuropsychological Assessment Test, and the Child Behavior Checklist were applied. Results: Participants with a history of stroke had lower intelligence quotient (IQ) scores. Alterations were found in attention and executive functioning, language, verbal and visual memory, visuospatial processing and sensorimotor skills. These alterations were found both in the children and adolescents who had had a cerebral infarction and in those who apparently had not. In the majority of cases, there were learning difficulties, a history of repeating school years and a need for specialist educational support. The most common additional diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders IV were depressive disorder, anxiety disorder and somatic disorder, as well as conditions associated with physical and psychosocial repercussions of sickle cell anemia. Conclusion: As sickle cell anemia is considered a progressive cerebral vasculopathy, it is a potential risk factor for neurocognitive and psychosocial development. Therefore, periodic neuropsychological and behavioral evaluations of children and adolescents with sickle cell anemia may represent a useful measure to reduce long-term biopsychosocial repercussions.

Prevalence of clliac disease in children with epilesyy / Prevalencia de doenca celiaca em criancas com epilepsia

Context Neurological symptoms have been well-documented in patients with celiac disease, nevertheless, the presumption of a greater prevalence of epilepsy in celiac patients remains controversial. Objectives To determine the frequency of celiac disease in children and adolescents with idiopathic or cryptogenic epilepsy. Methods A cross-sectional study. One hundred pediatric patients with non-symptomatic epilepsy were followed-up at two public pediatric neurology clinics in Salvador, Bahia, Brazil. Screening for celiac disease was performed by serial measurements of IgA anti-transglutaminase and IgA anti-endomysium antibodies, followed by bowel biopsy in positive cases. HLA DQ02 and DQ08 were investigated in seropositive individuals, assessing the type of seizures, the number of antiepileptic drugs used and the presence gastrointestinal symptoms. Results Three (3.0%) patients tested anti-tTG-positive, two with normal duodenal mucosa (Marsh 0) and one with intraepithelial infiltrate (Marsh I). No villous atrophy of the duodenal mucosa (Marsh III) celiac disease was found. Two patients tested positive for HLA DQ02; none were DQ08 positive. Conclusion The present study failed to prove the association between celiac disease and epilepsy. .

Contexto Os sintomas neurológicos têm sido bem documentados em pacientes com doença celíaca, no entanto, a presunção de uma maior prevalência de epilepsia em pacientes celíacos permanece controverso. Objetivos Determinar a frequência de Doença Celíaca em crianças e adolescentes portadores de epilepsia idiopática ou criptogênica. Métodos Estudo transversal. Cem pacientes pediátricos com epilepsia não-sintomática foram acompanhados em dois ambulatórios públicos de neurologia pediátrica em Salvador, Bahia, Brasil. Triagem para doença celíaca foi feita por dosagem sérica de IgA anti-transglutaminase e anti-endomísio IgA, seguido por biópsia de intestino nos casos positivos. HLA DQ02 e DQ08 foram investigadas em indivíduos soropositivos, avaliando o tipo de crise epiléptica, o número de medicamentos anti-epilépticos utilizados e a presença de sintomas gastrointestinais. Resultados Três (3,0%) pacientes apresentaram anti-transglutaminase positivo, dois com mucosa normal duodenal (Marsh 0) e um com infiltrado intraepitelial (Marsh I). Não foi encontrada atrofia das vilosidades da mucosa do duodeno (Marsh III). Dois deles foram positivos para o HLA DQ02; nenhum foi DQ08 positivo. Conclusão O presente estudo não conseguiu provar a associação entre doença celíaca e epilepsia. .

Incidence of diarrhea in children living in urban slums in Salvador, Brazil

Diarrhea remains a major health issue in developing countries, with high morbidity and mortality rates. Determining the incidence of acute diarrhea in children and its associated factors is crucial to the planning of preventive approaches. The objective of this study was to determine the incidence of diarrhea and to assess some relevant associated factors to it in children younger than 40 months living in two slums of Salvador, Brazil. This is the first prospective cohort, community-based study that was performed in two periurban slums of Salvador, Brazil. Eighty-four children younger than 40 months were randomly selected and visited every other day for one year. The chi-square test was used to evaluate the occurrence of diarrhea and its associated factors. During the surveillance period, 232 diarrhea episodes were identified, resulting in an incidence rate of 2.8 episodes/child/year. In average (mean value of 84 children),each child suffered 11.1 days of diarrhea per year, yielding an average duration of 3.9 days per episode. The highest incidence rates were found among children under one year old. Early weaning, male sex, malnutrition, having a mother younger than 25 years or who considered her child malnourished, missed immunizations and previous pneumonia were associated factors for suffering diarrheal episodes. The rates of incidence and duration of diarrhea that we found are in accordance to those reported by others. Additionally, our results reinforce the importance of environmental and health-related associated factors to the onset of diarrhea.