Assessment of Pathological Personality traits in Meditation Practitioners and Non-practitioners / Avaliação das Características Patológicas da Personalidade em Praticantes e não Praticantes de Meditação / Evaluación de las Características Patológicas de la Personalidad en Practicantes y no Practicantes de Meditación

Abstract This study aimed to evaluate and compare pathological personality traits in meditation practitioners and non-practitioners. Therefore, data were collected from 104 participants of both sexes aged over 18 years, including 53 practitioners of concentrative and mindfulness meditation styles, and 51 non-practitioners. Participants responded to the Dimensional Clinical Personality Inventory (IDCP), the Brazilian version of the Personality Inventory for DSM-5 (PID-5), and an anamnesis questionnaire about the practice of meditation; we proceeded to repeated ANOVA measures and logistic regression analysis to verify the study's goals. Overall, higher means were observed for non-practitioners in the dimensions/factors of the tests, and specific pathological traits as best predictors of the participating groups (practitioners versus non-practitioners). The results indicated that the meditators tended to have lower intensity of pathological personality traits.

Resumo O presente estudo tem como objetivo avaliar e comparar características patológicas da personalidade em praticantes e não praticantes de meditação. Para tanto, os dados foram coletados com 104 participantes, de ambos os sexos e com idade igual ou superior a 18 anos, sendo 53 praticantes de escolas de meditação de estilos concentrativo e mindfulness, e 51 participantes não praticantes. Os participantes responderam ao Inventário Dimensional Clínico da Personalidade (IDCP), ao Personality Inventory for DSM-5 (PID-5) e a um questionário de anamnese sobre prática da meditação. Procedeu-se à ANOVA por medidas repetidas e análise de regressão logística para verificação dos objetivos da pesquisa. No geral, foram observadas médias mais elevadas pelos não praticantes nas dimensões/fatores dos instrumentos aplicados, além de traços patológicos específicos como melhores preditores dos grupos de participantes (praticantes versus não-praticantes). Os resultados indicaram que os praticantes de meditação tendem a apresentar menor intensidade de características patológicas da personalidade.

Resumen Este estudio tiene como objetivo evaluar y comparar las características patológicas de la personalidad en los practicantes y no practicantes de meditación. Los datos fueron recolectados en una muestra de 104 sujetos de ambos sexos mayores de 18 años, de los cuales 53 eran practicantes de escuelas de meditación de estilos concentrativos y mindfulness, mientras que los restantes 51 eran no practicantes. Los sujetos respondieron el Inventario Dimensional Clínico de Personalidad (IDCP), la versión brasileña del Personality Inventory for DSM-5 (PID-5) y un cuestionario de anamnesis sobre la práctica de la meditación. Igualmente, se procedió al ANOVA por medidas repetidas y al análisis de regresión logística para verificar los objetivos de la investigación. En general, fueron observadas medias más elevadas por los sujetos no practicantes en las dimensiones/factores de los instrumentos aplicados, además de trazos patológicos específicos como mejores predictores de los grupos de participantes (practicantes versus no practicantes). Los resultados indicaron que los practicantes de meditación tienden a presentar menor intensidad de características patológicas de la personalidad.

Smartphone Fundus Photography in an Infant with Abusive Head Trauma

PURPOSE: To report fundus photography using a smartphone in an infant with abusive head trauma. CASE SUMMARY: An 8-month-old male infant presented to the emergency room with decreased consciousness and epileptic seizures that the parents attributed to a fall from a chair. He had no external wounds or fractures to the skull or elsewhere. However, computerized tomography of the brain revealed an acute subdural hematoma in the right cranial convexity and diffuse cerebral edema, leading to a midline shift to the left and effacement of the right lateral ventricle and basal cistern. The attending neurosurgeon promptly administered a decompressive craniectomy. Immediately after the emergency surgery, a fundus examination revealed numerous multi-layered retinal hemorrhages in the posterior pole extending to the periphery in each eye. He also had white retinal ridges with cherry hemorrhages in both eyes. We acquired retinal photographs using the native camera of a smartphone in video mode. The photographer held the smartphone with one hand, facing the patient's eye at 15–20 cm, and held a 20 diopter condensing lens at 5 cm from the eye in the other hand. Our documentation using a smartphone led to a diagnosis of abusive head trauma and to obtain the criminal's confession, because the findings were specific for repetitive acceleration-deceleration forces to an infant`s eye with a strong vitreoretinal attachment. CONCLUSIONS: This ophthalmic finding had a key role in the diagnosis of abusive head trauma. This case presented the diagnostic use of a smartphone for fundus photography in this important medicolegal case.

Abusive Head Trauma: Epidemiological Aspects and Diagnosis / Trauma Craniano por abuso: aspectos epidemiológicos e diagnostico

Objective Abusive head trauma (AHT) is defined as a severe, non-accidental traumatic brain injury. Early recognition and treatment are instrumental in limiting the immediate complications and long-term disabilities. The goal of this study was to describe our experience with traumatic head injuries in children younger than 2 years of age. Methods We reviewed the medical records of 195 children aged under 2 years with suspected AHTwho presented with a head injury without witnessed accidental trauma, between January 2008 and June 2013. Results AHT was considered in 145 children. Familial problems (ρ » 0.008), cutaneous hematoma/bruising (ρ < 0.001), retinal hemorrhages (ρ < 0.001), and bone fractures (ρ » 0.04), were significantly more frequent in the AHT group. Conclusions The association between the subdural hematoma and retinal hemorrhage, resulting from an unwitnessed and incoherent history of trauma, is a strong argument for AHT, particularly when associated lesions and socioeconomic risk factors are evident.

Objetivo O traumatismo craniano por abuso (AHT) é definido como uma grave lesão cerebral traumática não acidental. O reconhecimento e tratamento precoce são fundamentais para limitar as complicações imediatas e sequelas tardias. O objetivo deste estudo foi descrever a nossa experiência em crianças menores de 2 anos de idade, vítimas de trauma craniano. Métodos Foram revisados os prontuários de 195 crianças com idade inferior a 2 anos com suspeita de AHT, sem trauma acidental testemunhado e com diagnostico de hematoma subdural, entre janeiro de 2008 e junho de 2013. Resultados AHT foi considerado em 145 crianças. Problemas socioeconômicos familiares (ρ » 0,008), hematomas e lesões cutâneas (ρ <0,001), hemorragias retinianas (ρ <0,001), e fraturas em ossos longos (ρ » 0,04), foram significativamente mais frequentes no grupo de crianças com suspeita de AHT. Conclusões A associação entre hematomas subdurais e hemorragia retiniana, resultante de uma história incoerente de trauma sem testemunhas, é um forte argumento para a AHT, particularmente quando lesões cutâneas e fatores de risco socioeconômicos forem identificados.

Síndrome del niño sacudido o Shaken Baby Syndrome: Lesiones oculares / Shaken Baby Syndrome: Eye lesions

Introducción: el síndrome del niño sacudido se incluye en la clasificación del maltrato físico. Las lesiones oculares se deben a la tracción producida sobre la retina a partir del vítreo del niño, fuertemente unido a ella, con desgarro de las capas retinales y colección de sangre en la cavidad resultante (retinosquisis hemorrágica). Objetivo: describir las manifestaciones oftalmológicas iniciales y la evolución del síndrome del bebé sacudido. Materiales y métodos: se realiza un estudio descriptivo y retrospectivo de cuatro pacientes con el síndrome del niño sacudido. Las variables analizadas son: sexo, edad, fondo de ojos, ecografía ocular, tratamiento y evolución visual. Resultados: los casos 1 y 2 eran gemelos, uno de ellos presentó manifestaciones a nivel del fondo de ojos y el segundo no, ambos requirieron intervención neuroquirúrgica. El tercero presentaba lesiones a nivel ocular con opacidad de medios por lo cual se le realizó en ambos ojos vitrectomía exploradora. El cuarto caso se trataba de una paciente de 6 meses con hemovítreo en ojo derecho y retinosquisis hemorrágica en ojo izquierdo, y requirió vitrectomía para la resolución del hemovítreo, aunque el resultado visual fue desfavorable. Conclusión: el examen oftalmológico contribuye al diagnóstico del síndrome del bebé sacudido por lo que es necesario en la evaluación de los niños pequeños que presenten lesiones sospechosas de abuso (AU)

Introduction: Shaken baby syndrome is included in the classification of physical abuse. Ocular lesions in the infant are due to traction to the retina from the adjacent vitreous causing with tears of the retinal layers and blood collection in the resulting cavity (hemorrhagic retinoschisis). Objective: To describe early ocular manifestations and outcome of shaken baby syndrome. Material and methods: A retrospective, descriptive study was conducted in four patients with shaken baby syndrome. Sex, age, ocular fundus, ultrasonography, treatment, and visual outcome were analyzed. Results: Cases 1 and 2 were twins, one of them presented with fundus manifestations, the other did not; both required neurosurgical intervention. The third infant had eye lesions with media opacities and therefore exploratory vitrectomy was performed in both eyes. The fourth was a 6-month-old baby girl with hemovitreous in the right and hemorrhagic retinoschisis in the left eye. She required vitrectomy to resolve the hemovitreous, but the result was poor. Conclusion: Ophthalmological examination was useful in the diagnosis of shaken baby syndrome and should therefore be performed in little children in whom child abuse is suspected (AU)

Síndrome del niño sacudido / Shaken baby syndrome

El síndrome del niño sacudido (SNS) es una forma de abuso físico caracterizada por ciertos hallazgos clínicos entre los que se encuentran presencia de hematoma subdural o subaracnoideo, edema cerebral difuso, y hemorragias retinianas, en ausencia de otras muestras físicas de lesión traumática, los cuales se producen al sacudir fuertemente al niño tomado del tórax o las extremidades. La aceleración-desaceleracion producida por dicho movimiento constituye el mecanismo de lesión. El cuadro clínico se puede manifestar con hallazgos inespecíficos como vómitos, somnolencia, irritabilidad hasta signos como los mencionados anteriormente, estos niños suelen presentar secuelas a corto y largo plazo. En Costa Rica la legislación ampara al menor contra los maltratos y da al sistema de salud la labor de salvaguardar la integridad y vida del mismo.

The shaken baby syndrome (SBS) is a form of physical abuse characterized for some clinical findings including the presence of a subdural or subarachnoid haematoma, diffuse cerebral edema and retinal haemorrhages and absence of other physical signs of traumatic injury which are produced when the victim is held by the torso or the extremities and violently shaken. The acceleration - deceleration produced by the movement is thought to be the production mechanism of the injury. The clinical findings could be as unspecific as vomits, sleepiness, irritability or signs like the ones listed above, this children often presents short and long term complications. In Costa Rica the legislation protects the children against abuses and give the health system the responsibility of taking care of children’s integrity and life.

Trauma craniano violento pediátrico: uma revisão da literatura / Abusive head trauma in children: a literature review

OBJETIVO: Fornecer uma revisão de literatura científica sobre trauma craniano violento pediátrico enquanto forma de maus-tratos físicos contra bebês e crianças, ressaltando prevalência, sinais e sintomas, consequências, fatores de risco para sua ocorrência e, principalmente, estratégias de prevenção. FONTES DOS DADOS: Revisão nas bases de dados MEDLINE, SciELO, LILACS e Web of Science no período de 2001 a 2012 utilizando os termos "síndrome do bebê sacudido" e "trauma craniano violento" em inglês, espanhol e português. SÍNTESE DOS DADOS: O trauma craniano violento é definido como a lesão ao crânio ou ao conteúdo intracraniano de um bebê ou criança menor de cinco anos devido a um impacto brusco intencional e/ou a uma sacudida violenta. Ocorre principalmente com bebês e crianças menores de um ano de idade, e pode resultar em consequências graves, desde deficiências físicas ou mentais até a morte. Apesar de haver sinais específicos para esta forma de maus-tratos, eles podem se confundir com doenças comuns em crianças ou traumas cranianos acidentais, sendo imprescindível o preparo clínico dos profissionais envolvidos na avaliação dos casos para o diagnóstico correto. As estratégias de prevenção devem incluir tanto a identificação precoce dos casos, como a educação parental sobre o desenvolvimento infantil, especialmente sobre o padrão de choro do bebê. CONCLUSÕES: Considerando a gravidade do trauma craniano violento pediátrico, é fundamental que estratégias de prevenção sejam implementadas e avaliadas no contexto brasileiro. Sugere-se que indicadores de sua incidência sejam pesquisados nacionalmente.

OBJECTIVE: To review the scientific literature on pediatric abusive head trauma as a form of physical abuse against infants and young children, highlighting the prevalence, signs and symptoms, consequences, risk factors for its occurrence, and prevention strategies. DATA SOURCE: The MEDLINE, SciELO, LILACS, and Web of Science databases from 2001 to 2012 were reviewed, using the terms "shaken baby syndrome" and "abusive head trauma" in English, Spanish, and Portuguese. DATA SYNTHESIS: Pediatric abusive head trauma is defined as injury to the skull or intracranial contents of a infant or child younger than 5 years due to intentional abrupt impact and/or violent shaking. It occurs mainly in infants and children under 1 year of age, and may result in severe consequences, from physical or mental disabilities to death. Although there are specific signs for this form of abuse, they can be mistaken for common illnesses in children or accidental head injury; thus, clinical training of professionals involved in the assessment of cases to attain the correct diagnosis is crucial. Prevention strategies should include early identification of cases, as well as parental education on child development, especially on the infant's crying pattern. CONCLUSIONS: Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level.

Prevención del traumatismo cefálico por abuso en los niños / Preventive abusive head trauma in children

El abuso infantil es la causa más común de lesión cefálica grave en los niños de corta edad. A pesar de ello, el traumatismo cefálico abusivo con frecuencia es subdiagnosticado y subinformado. Esto se relaciona parcialmente con el entrenamiento inadecuado que los profesionales de la salud reciben en el reconocimiento y enfoque del abuso infantil. Actualmente, está disponible el contenido curricular para las universidades médicas y programas de residencia. Dadas las altas tasas de muerte y deterioro neurológico grave asociado con el traumatismo cefálico abusivo, la prevención se ha convertido en el centro de atención. Algunas estrategias de prevención mostraron resultados promisorios en mejorar la educación de los padres y en reducir la incidencia de lesiones. Este artículo revisa la epidemiología, las características clínicas y el desenlace del traumatismo cefálico abusivo en los niños de corta edad. También analiza las estrategias de prevención, como la educación y el contenido curricular para los profesionales de la salud.

Child abuse is the most common cause of serious head injury in young children. Despite this, abusive headtrauma is often under-recognized and under-reported. This is partly related to the inadequate trainingthat health professionals receive in child abuse recognition and management. Published curricula are nowavailable for medical school and residency education. Given the high rates of death and serious neurolo-gical impairment associated with abusive head trauma, prevention has become a focus. Some preventionstrategies show promising results in improving parent education and reducing the incidence of injury. Thisarticle reviews the epidemiology, clinical characteristics, and outcomes of abusive head trauma in youngchildren. It also discusses prevention strategies, including education and curricula for health professionals.

Shaken baby syndrome as a form of abusive head trauma

Shaken baby syndrome [SBS] is a form of abuse that is characterised by brain injury. Because of the subtle and yet debilitating neurobehavioural impairment which ensues, SBS represents a diagnostic dilemma for attending clinicians. The situation is made worse by the young age of the affected child who may not be capable of explaining what happened. SBS has been reported in many parts of the world. To our knowledge, there is a dearth of literature on the topic from Arab/Islamic countries. This article attempts to shed light on the syndrome by reviewing information on the aetiology of SBS, as well as on its diagnosis and the reasons for delayed diagnosis. The central aim of this review is to increase awareness of SBS so that enlightened policies for prevention and intervention could be developed in the region and particularly in Oman

Prevenção da Síndrome do Bebê Sacudido: conhecimento da equipe de saúde da família / Prevention of Shaken Baby Syndrome: knowledge of the family health team

Trata-se de um estudo exploratório-descritivo, de abordagem quantitativa que objetiva investigar o conhecimento da equipe de Saúde da Família sobre a prevenção da Síndrome do Bebê Sacudido. A coleta de dados ocorreu mediante aplicação de questionário com 142 profissionais das Unidades de Saúde da Família na cidade de Surubim-PE. Os resultados revelaram que 97% não conheciam a síndrome, impossibilitando então, a correlação com o hábito cultural da comunidade em sacudir ou balançar uma criança ou bebê e a ocorrência da síndrome.

Inflicted neuro-trauma in infancy.

Two infants with non-accidental inflicted neuro-trauma are reported. One presented with sudden onset lethargy, respiratory difficulty and unexplained seizures. There were bilateral retinal bleeds and extradural hemmorage. Other was a well thriving child who had 2 seizures and was noted to lack visual fixation. Retinal hemorrhages and chronic subdural and intraparenchymal hemorrhages were subsequently discovered. We highlight the importance of suspecting child abuse in infants with sudden unexplained unresponsiveness, seizures or respiratory difficulty and the unusual occurrence of extradual hemorrhage.

Shaken baby syndrome.

A 35-day-old male infant with presumed shaken baby syndrome is reported. This first born child to mother educated upto middle school and father tailor by occupation was brought from a remote village 180 kms away from JIPMER. Poor feeding, focal clonic seizures were the initial symptoms. The fundus examination revealed fresh preretinal and vitreous hemorrhages. CT Brain showed right sided subdural hemorrhage with subarachnoid extension and midline shift. He had a normal platelet count and coagulation profile. The sensorium deteriorated and infant expired despite adequate ventilatory support.

Infantile colic and EEG changes

Infantile colic is one of the most common problems in the first few months of life affecting up to 20% of newborns and young infants. It is unclear exactly the aetio-pathogenesis of this condition with unsatisfactory response to different modalities of therapy. We had studied the EEG changes occurring in colicky infants, comparing them with normal healthy non-colicky infants. This study was performed upon 50 infants attending Pediatric department, El-Minia University hospital as a case group according to Wassel's criteria and 25 healthy non colicky infants with normal growth and development who were age and sex matched as a control group. An EEG was done at the onset of presentation and repeated again six months later to all infants. Data were analyzed wit h Pearson Chi-Square and Fisher tests. There was a significant difference between the two groups as regarding EEG changes with significant abnormal EEG changes in colicky infants [p=0.007] before three months of age, but no significant difference between the two groups was present six months later. Significant positive correlations was found between these abnormal EEG changes and shaking baby vigorously during first two weeks of life [p=0.0001, t=9.9]. Most colicky infants were males [56% Vs 44% females],with the first baby was the mostly affected [80% of cases] but no significant statistical difference was present as regarding mode of delivery or maternal age. Infants complaining of infantile colic [according to Wassel's criteria] had abnormal EEG changes as compared to non colicky infants before three months of age. More studies are needed to know if these abnormal changes have a role in aetio-pathogenesis of infantile colic or they occur as consequence of the cause of colic

Síndrome del niño sacudido: artículo de revisión / Shaken baby syndrome: review article

El maltrato infantil es un tema que permanece vigente en nuestro país. En el último tiempo hemos sido testigos de una forma infrecuente, pero no menos grave de maltrato; se trata del síndrome del niño sacudido. Esta entidad descrita ya en la década de los setenta ha sido objeto de numerosos estudios que han permitido una mejor comprensión de su patogenia. Las lesiones frecuentemente encontradas son el hematoma subdural y las hemorragias retinianas, en general sin otras lesiones externas y habitualmente en el contexto de una historia clínica inconsistente o variable en el tiempo. Los Tribunales de Familia, recién implementados en Chile, pretenden resolver de manera oportuna y eficiente ciertas materias, entre las cuales el maltrato infantil es tema prioritario. El objetivo del presente documento es revisar los aspectos médicos fundamentales de esta modalidad de agresión, además de orientar la conducta legal ante un niño maltratado.

Shaken baby syndrome masquerading as apparent life threatening event.

A variety of diseases and disorders can present as an acute life-threatening event among which shaken baby syndrome has been recently recognized. A high index of suspicion along with an ophthalmologic evaluation and cranial imaging helps to identify this form of child abuse, which needs multidisciplinary management.

Shaken Baby Syndrome: A Case Report

Shaken baby syndrome (SBS) is an extremely serious form of abusive head trauma that occurs when infants are subjected to rapid acceleration, deceleration, and rotational forces, with or without impact, resulting in a unique constellation of fractures, intracranial hemorrhages, and intraocular hemorrhages. Presenting complaints are often nonspecific; hence, it is important that all health care providers be able to recognize the clinical features that constitute SBS. Infants who have been shaken and injured have a high mortality rate. Approximately 25% of shaken babies die from their traumatic brain injuries. The infants who do not die may have permanent, often severe damage to their vision, hearing, thinking, and learning capabilities. They may be blind, have seizures, have spasticity, have small heads with lack of growth of brain tissues, and may be severely mentally retarded. Prevention is the best care for SBS, and community education of parents and guardians may reduce the incidence of SBS. We report a case of SBS without external signs of trauma.

Maltrato infantil físico en pacientes diagnosticados en el Hospital Pediátrico Juan M. Márquez, 1996-1998 / Physical child abuse in patients diagnosed at Juan M. Márquez Pediatric Hospital, 1996-1998

Se realizó un estudio descriptivo en el período de octubre de 1996 a octubre de 1998 en el Hospital Pediátrico “Juan M. Márquez” para identificar el comportamiento del maltrato físico en una muestra de 81 niños con diagnóstico de maltrato físico intencional o no. Predominó el maltrato infantil en el menor de un año (38,2 por ciento) y la madre estuvo vinculada al maltrato en los lactantes el 71,0 por ciento. Lesiones en la cabeza el 49,4 por ciento y fueron severas en 27 pacientes (33,3 por ciento). En 21 casos la explicación de cómo ocurrió la lesión no fue consecuente con los signos encontrados (25,9 por ciento) y el abuso fue reportado por 15 niños (18,5 por ciento). Las equimosis en 33 niños para el 40,7 por ciento. Requirió de hospitalización el 60,4 por ciento y 4 niños fallecieron (1,4 por 10 000 niños ingresados). En este estudio, los lactantes fueron vulnerables al maltrato físico por la madre y cuando las lesiones clínicas no están en el rango previsible para la edad sugiere sospecha de maltrato, por lo que el interrogatorio adecuado es importante

Shaken baby syndrome.

A 5-month-old infant with Shaken Baby Syndrome is reported. This form of physical child abuse is often overlooked. It should be suspected in infant who present with drowsiness, coma, seizures or apnea.

Clinical Progress of Three Cases of Shaken Baby Syndrome

Shaken baby syndrome develop as a form of child abuse, with the majority of cases occurring during the first year of life. It results from extreme rotational cranial acceleration and deceleration effects induced by violent shaking of an infant. The characteristic injuries include subdural and subarachnoid hemorrhages, and retinal hemorrhages. We experienced three cases of shaken baby syndrome. Although the history of trauma was little known, all of these cases had subdural hemorrhages. We present the cases with a review of related literature.

Five Cases of Shaken Baby Syndrome

Shaken baby syndrome is a serious form of child abuse, mostly involving children younger than 2 years. It results from extreme rotational cranial acceleration induced by violent shaking. The characteristic injuries include subdural hemorrhage, retinal hemorrhage, and fracture of ribs or long bones. If physicians have no recognition of, or suspicion about, shaken baby syndrome, this syndome is difficult to diagnosis because of a lack of obvious external signs and failure of the abuser to admit his or her actions. In addition to the high mortality, 60% of survivors have significant long term neurologic and developmental abnormality. The authors experienced five cases of shaken baby syndrome presented with seizures or vomiting, without external signs of trauma. All of these cases had subdural hemorrhages, and four cases had retinal hemorrahges. In our follow up, two children were found to have sequelae such as quadriplegia, monoplegia, and developmental delay. We emphasize that early recognition and prompt treament are key to overall success of case management. The incidence of shaken baby syndrome can be reduced through public awareness and education of parents not to shake a babies.