P3 Cognitive Potential in Cochlear Implant Users

Abstract Introduction The P3 cognitive evoked potential is recorded when a subject correctly identifies, evaluates and processes two different auditory stimuli. Objective to evaluate the latency and amplitude of the P3 evoked potential in 26 cochlear implant users with post-lingual deafness with good or poor speech recognition scores as compared with normal hearing subjects matched for age and educational level. Methods In this prospective cohort study, auditory cortical responses were recorded from 26 post-lingual deaf adult cochlear implant users (19 with good and 7 with poor speech recognition scores) and 26 control subjects. Results There was a significant difference in the P3 latency between cochlear implant users with poor speech recognition scores (G-) and their control group (CG) (p= 0.04), and between G- and cochlear implant users with good speech discrimination (G+) (p= 0.01). We found no significant difference in the P3 latency between the CG and G+. In this study, all G- patients had deafness due to meningitis, which suggests that higher auditory function was impaired too. Conclusion Post-lingual deaf adult cochlear implant users in the G- group had prolonged P3 latencies as compared with the CG and the cochlear implant users in the G+ group. The amplitudes were similar between patients and controls. All G- subjects were deaf due to meningitis. These findings suggest that meningitis may have deleterious effects not only on the peripheral auditory system but on the central auditory processing as well.

Ocular involvement in idiopathic hypertrophic pachymeningitis associated with eosinophilic angiocentric fibrosis: a case report / Envolvimento ocular na paquimeningite hipertrófica idiopática associada à fibrose angiocêntrica eosinofílica: relato de caso

ABSTRACT A 43-year-old male with a history of eosinophilic angiocentric fibrosis presented with headache and double vision since 48 h. Idiopathic hypertrophic pachymeningitis was diagnosed based on nuclear magnetic resonance and comprehensive systemic study findings. Eosinophilic angiocentric fibrosis and idiopathic hypertrophic pachymeningitis have been associated with IgG4-related diseases, but this was the first case in which they coexisted in the same patient. After steroid treatment failure, rituximab was used with excellent results.

RESUMO Um homem de 43 anos, com história de fibrose angiocêntrica eosinofílica, apresentou cefaléia e visão dupla com 48 horas. A paquimeningite hipertrófica idiopática foi diagnosticada com base na ressonância magnética nuclear e em achados sistêmicos abrangentes no estudo. A fibrose angiocêntrica eosinofílica e a paquimeningite hipertrófica idiopática foram associadas a doenças relacionadas à IgG4, mas este foi o primeiro caso em que elas coexistiram no mesmo paciente. Após a falha do tratamento com esteroides, o rituximabe foi usado com excelentes resultados.

Impacto da vacina pneumocócica conjugada 10-valente na meningite pneumocócica na região metropolitana de Salvador, Bahia / Impact of pneumococcal conjugate vaccine 10-valent pneumococcal meningitis in the metropolitan region of Salvador, Bahia

INTRODUÇÃO: Em 2010, a vacina conjugada 10-valente (PCV10) foi incorporada ao programa nacional de imunizações (PNI) brasileiro. Este imunobiológico confere imunização contra os dez principais tipos capsulares de Streptococcus pneumoniae, patógeno responsável por diversas manifestações clínicas e com elevada contribuição nas taxas de incidência e mortalidade por meningite, que é a condição clínica mais grave. OBJETIVO: O presente estudo teve como objetivo avaliar o impacto da PCV10 na epidemiologia da meningite pneumocócica na região metropolitana de Salvador (RMS) Bahia, comparando o período anterior (2008-2010) e posterior (2011-2013) a sua utilização, bem como realizar uma caracterização molecular minuciosa a partir de uma série histórica (1996-2012) entre os isolados resistentes a enicilina (PNSSP com CIM≥ 0,125 μg/mL) e para os sorotipos não-vacinais (2008-2012). MATERIAL E MÉTODOS: Foram incluídos todos casos de meningite pneumocócica confirmados laboratorialmente no período entre 1996 a 2013. Taxas de incidência para a Salvador e RMS foram calculadas com base nos dados populacionais do IBGE/2010. A determinação do tipo capsular foi realizada através da técnica de Multiplex-PCR e/ou reação de Quellung. A sensibilidade a nove antimicrobianos foi testada através das técnicas disco-difusão,microdiluição e E-test. Para caracterizar o perfil molecular foram aplicadas as técnicas de genotipagem de PFGE e MLST. RESULTADOS: Um total de 939 casos de meningite pneumocócica foram identificados no período de 1996-2013, sendo que 70 casos ocorrem entre 2011 a 2013 (período pós-vacinal). A incidência de meningite pneumocócica em todas as faixas etárias na RMS reduziu de 0,70 casos/100.000 habitantes para 0,59 casos/100.000 habitantes considerando o período de três anos antes e após a vacinação com PCV10 [p<0,05; RR IC 95%: 1,46 (1,03-2,05)]. Esta redução foi significativa na faixa etária de 0-2 anos e nos casos por sorotipos relacionados à PCV10. Não houve aumento significativo de casos por sorotipos não vacinais nesta casuística,apesar do surgimento de casos por sorotipos não-vacinais não detectados anteriormente na série histórica de MP (10F, 21, 22F, 15A e 24F). Os isolados resistentes à penicilina analisados na série histórica se restringiram a 13 sorotipos, entre os quais: 14 (45,1 %; 78/173), 23F (19,1%; 33/173), 6B (14,4 %; 25/173), 19F (9,2 %; 16/173) e 19A (5,2 %; 9/173). 94% dos casos nãosusceptíveis à penicilina (PNSSP) foram de sorotipos vacinais. Os grupos clonais caracterizados pelo PFGE/MLST predominantes ao longo dos anos foram representados pelo sorotipo 14, denominado grupo A/ST 66 [35,3 %(61/173)] e grupo GK/ST 156 [4.6 % (8/173)], este último associado com níveis elevados de resistência a penicilina e ceftriaxona. Não foram detectados grupos clonais emergentes associados a tipos capsulares não-vacinais.CONCLUSÕES: Estes achados sugerem que a introdução da PCV10 modificou a epidemiologia da meningite pneumocócica na população estudada.

INTRODUCTION: In 2010, the 10-valent pneumococcal conjugate vaccine (PCV10) was introduced into the Brazilian national immunization program (NIP). This immunobiological provides immunization against the main ten capsular types of Streptococcus pneumoniae, the pathogen responsible for different clinical manifestations and high contribution in the incidence and mortality from meningitis, which is the most severe clinical condition. OBJECTIVE: This study aimed to evaluate the impact of PCV10 in the epidemiology of pneumococcal meningitis in the metropolitan area of Salvador (RMS) Bahia, comparing the previous (2008-2010) and after (2011-2013) periods its use, as well as conduct a thorough molecular characterization from a historical series (1996-2012) among isolates resistant to penicillin (PNSSP with CIM≥ 0.125 g / ml) and nonvaccine serotypes (2008-2012). MATERIAL AND METHODS: We included all cases of pneumococcal meningitis laboratory confirmed for the period 1996 to 2013. Incidence rates for Salvador and RMS were calculated based on population data from IBGE/2010. The capsular type determination was performed by multiplex PCR and/or Quellung reaction. Isolates Nine antibiotics were tested by disk-diffusion test, broth micro-dilution and E-test. To characterize the molecular profiling techniques were applied genotyping PFGE and MLST...

Cluster of Serogroup W-135 Meningococcal Disease in 3 Military Recruits

We describe a group of 3 cases of invasive meningococcal disease that occurred in a military training camp in April 2011. All three patients were hospitalized. Ultimately, two patients recovered and one died. One patient had meningitis, one patient had septicemia and meningitis, and the other had no definite septicemia or meningitis. Neisseria meningitidis serogroup W-135 was detected in the serum and cerebrospinal fluid (CSF) of all patients by real-time polymerase chain reaction. In the one case of mortality, two strains were isolated from the patient's blood and CSF. Using multilocus sequence typing analysis, these strains were identified as a novel sequence type, ST-8912. Special attention is required for the meningococcal disease in military camp because the military personnels are in high risk of contact transmission.

Meningocele sacral anterior associada a fístula retotecal e meningite polimicrobiana: relato de caso / Anterior sacral meningocele associated with polymicrobial meningitis and rectothecal fistula: case report

Meningoceles sacrais anteriores são exemplos raros de disrafismo espinhal, originados da herniação do saco dural, através de um defeito ósseo na parede anterior sacrococcígea. Essa condição foi descrita pela primeira vez em 1837 por Bryant, e existem, aproximadamente, 250 casos relatados até os dias atuais. A tríade defeito ósseo, malformação anorretal e massa pré-sacral configura a síndrome de Currarino, e tal massa pode consistir de um tumor, de uma meningocele sacral anterior ou da associação de ambos. Tal síndrome apresenta incidência desconhecida, e acredita-se que seja uma desordem de transmissão autossômica dominante. O diagnóstico ainda é desafiador, apesar da evolução dos exames de imagem. Tomografia computadorizada (TC) e ressonância magnética (RNM) são primordiais, sendo a última o melhor exame para caracterização. A radiografia simples pode ajudar demonstrando o defeito ósseo sacral e o sacro em ?cimitarra?, sendo indicada para triagem de transmissão familiar. A maioria dos pacientes apresenta constipação e sintomas vesicais compressivos. A meningite é uma complicação rara e séria da meningocele sacral anterior, e a associação entre fístula retotecal e pneumoencéfalo foi relatada em apenas dois artigos de língua inglesa. O tratamento deve ser cirúrgico, uma vez que não há possibilidade de fechamento espontâneo. Em casos não tratados ou com atraso diagnóstico, a mortalidade é superior a 30% quando associados à infecção. Descrevemos um caso de meningocele sacral anterior acometendo uma jovem de 17 anos, assintomática até então, que apresentou meningite polimicrobiana como quadro inicial devido a uma fístula retotecal...

Anterior sacral meningoceles are rare examples of spinal dysraphism, originated from the dural sac herniation through a bone defect in the anterior wall of the sacrococcygeal bone. This condition was first described in 1837, by Bryant, and there are, approximately, 250 cases reported until today. The triad bone defect, anorectal malformation and presacral mass configure the Currarino syndrome, and such mass may consist of a tumor, an anterior sacral meningocele or combination of both. The incidence is unknown and it is believed to be an autosomal dominant disorder. The diagnosis is still challenging, despite the evolution of imaging. CT and MRI are essential, although the MRI is the best test for characterization. Plain radiographs can help demonstrate the sacral bone defect and the ?scimitar? sacrum, and they are suitable for familial transmission screening. Most patients have constipation and compressive bladder symptoms. Meningitis is a rare and severe complication of anterior sacral meningocele and association of rectothecal fistula and pneumocephalus was reported in only two articles in the English language. The surgical treatment must be performed, since there is no possibility of spontaneous closure. In cases not treated or with late diagnose, mortality is higher than 30% when associated with infection. We describe a case of anterior sacral meningocele, involving a 17-year-old girl, asymptomatic until then, with polymicrobial meningitis as initial clinical feature due to a rectothecal fistula...

Horner's Syndrome and Contralateral Abducens Nerve Palsy Associated with Zoster Meningitis

A 55-year-old woman presented with diplopia following painful skin eruptions on the right upper extremity. On presentation, she was found to have 35 prism diopters of esotropia and an abduction limitation in the left eye. Two weeks later, she developed blepharoptosis and anisocoria with a smaller pupil in the right eye, which increased in the darkness. Cerebrospinal fluid analysis showed pleocytosis and a positive result for immunoglobulin G antibody to varicella zoster virus. She was diagnosed to have zoster meningitis with Horner's syndrome and contralateral abducens nerve palsy. After intravenous antiviral and steroid treatments, the vesicular eruptions and abducens nerve palsy improved. Horner's syndrome and diplopia resolved after six months. Here we present the first report of Horner's syndrome and contralateral abducens nerve palsy associated with zoster meningitis.

Clinical Manifestations of Eosinophilic Meningitis Due to Infection with Angiostrongylus cantonensis in Children

Eosinophilic meningitis, caused by the nematode Angiostrongylus cantonensis, is prevalent in northeastern Thailand, most commonly in adults. Data regarding clinical manifestations of this condition in children is limited and may be different those in adults. A chart review was done on 19 eosinophilic meningitis patients aged less than 15 years in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Clinical manifestations and outcomes were reported using descriptive statistics. All patients had presented with severe headache. Most patients were males, had fever, nausea or vomiting, stiffness of the neck, and a history of snail ingestion. Six patients had papilledema or cranial nerve palsies. It was shown that the clinical manifestations of eosinophilic meningitis due to A. cantonensis in children are different from those in adult patients. Fever, nausea, vomiting, hepatomegaly, neck stiffness, and cranial nerve palsies were all more common in children than in adults.

Risk factors associated with development of post-meningitic hydrocephalus

To determine the frequency and risk factors associated with the development of post-meningitic hydrocephalus in children suffering from pyogenic meningitis. A descriptive as well as case control study. Children admintted with the diagnosis of pyogenic menigits from December 2010 to July 2011 in the Pediatric unit-2 of Bolan Medical Complex Hospital Quetta. All the children admitted to the Pediatric Unit-2 of Bolan Medical Complex Hospital [BMCH] from December 2009 to July 2011 with the diagnosis of bacterial meningitis. The diagnosis of bacterial meningitis was based on history and examination suggestive of meningitis with at least one of the following items be present, positive CSF culture or positive gram stain [for hemophilus influenza, Streptococus Pneumonae, or Neisseria meningitides], or CSF TLC10/ML and positive blood culture for above mentioned organism or CSF culture and gram stain negative for the organism but CSF WBC100/ML with >50%polymorphonuclear cells. Patients below 2 month of age and patient with Tuberculous meningitis were excluded from the study. The data collected on a specific Performa having different variables such as age, sex, seizure, duration of treatment ect. Then the data was analyzed on Epi info version 6 simple frequencies were calculated for each variable. Chi square analysis was done to see any correlation between the risk factors and post-meningitic hydrocephalus. Odds ratio was calculated for the risk factors. The mean age of study subjects was 7.2 years with 60% males and 40% females. Gram stains were positive in 37.5% of patients, CSF culture was positive in 27.5% of the patients, in 17.5% of the patients hydrocephalus was the main complication of bacterial meningitis and 25% had other type of sequelae including seizures, hearing loss, hemiparesis etc. significant association was found between seizure at admission [p-value<0.040], duration of illness [p-value<0.01%], age and admission [p-value<0.01]. 68.8% patients came for follow up 2.5% patients left against medical advice [LAMA] and 2.5% expired. The association was found between the development of post-meningitic hydrocephalus and variables such as seizure, duration of illness [patients having duration of symptoms like fever, headache, vomiting, cerebrospinal fluid leukocyte count and duration of antibiotic treatment

Causas de sorderas profundas en niños chilenos asistentes a escuelas especiales para sordos / Causes of severe deafness in Chilean children enrolled in special schools for the deaf

La relación entre la audición y el desarrollo del lenguaje ha sido ampliamente demostrada, se aprende a hablar imitando los sonidos oídos y dándole la interpretación que oralmente los padres enseñan. Por ello, todos los países se están esforzando por realizar un tamizado universal en neonatos. El Estado de Chile, en un primer esfuerzo por detectar tempranamente las sorderas, está aplicando un tamizado auditivo a neonatos de alto riesgo. No hay en Chile estudio sobre las causas de sorderas, por lo cual se decidió investigar sobre esta materia en un grupo de niños sordos que estudia en alguna de las 4 escuelas especiales de Santiago. Conociendo las causas de sorderas congénitas y las de instalación en la infancia temprana, posibilita su prevención en el control del embarazo y de niño sano. Objetivo: Establecer las causas de sorderas profundas, según los conocimientos de sus padres o tutor legal y ficha escolar, en niños y jóvenes estudiantes de escuelas especiales para sordos. Material y método: En este estudio observacional, el universo fueron todos los niños que asisten a 4 escuelas especiales para sordos en Santiago. La muestra estuvo constituida por 315 casos que representan al 92 por ciento del universo. Se revisaron las fichas escolares de estos niños y la información se contrastó y completó con una entrevista a los padres o tutores. Conclusiones: El 63 por ciento de los niños presentaba sordera congénita, entre ellos el 9 por ciento fue por infección materna. Del total de la población, el 41.5 por ciento presentó sordera congénita de causa desconocida; el 13 por ciento fue adquirida por meningitis y en el 5.8 por ciento de los casos por prematurez.

The relationship between hearing and language development has been widely demonstrated, as children learn to speak by imitating sounds and interpreting them as they are orally taught by their parents. Because of this, countries are trying to put more emphasis on universal screening of newborns. In Chile, the first efforts of early detection of deafness have been in screening high risk newborns. En Chile there are no studies on the causes of deafness, and for this reason the present study seeks to investigate this issue in a group of Deaf children in special schools in Santiago. Understanding the causes of congenital and early childhood deafness allows for better prevention during pregnancy and early childhood. Objective: Establish the causes of severe deafness, according to the knowledge of parents or legal guardians and school records, in young students in special schools for the Deaf. Materials and Methods: In this observational study, the universe consisted of all children that attend 4 special schools for the Deaf in Santiago. The sample consisted of 315 cases, which represent 92 percent of the universe. School records were examined and information was contrasted and completed with and interview with parents or guardians. Conclusions: 63 percent of children suffered from congenital deafness, 9 percent of those due to infection during pregnancy. In 41.5 percent of all cases the cause of deafness was unknown. 13 percent was due to meningitis, and 5.8 percent was due to prematurity.

[Brain computed tomography scan in meningitis patients with deterioration of consciousness]

Due to life-threatening complication of LP in patients with deterioration of consciousness due to meningitis [=brain herniation] the LP procedure safety without brain CT scan is debated. This descriptive cross-sectional study was done on patients suspected of meningitis with decreased consciousness referred to the infectious emergency of Emam Reza Hospital, Mashhad, Iran from April 2006 to March 2008. All patients underwent physical examination [neurologic and ophthalmoscopic] of the patients by residents of infectious diseases. Data [results of physical examination, neurologic, ophtalmoscopic, brain CT scan and LP] were collected. Then statistical analysis was performed with SPSS software and descriptive statistical methods. 136 patients were evaluated. The mean age of patients was 43.88 +/- 21.185 years and 58.5% [24] of the cases were male. The result of brain CT was normal in 53.7%. The most frequent abnormal brain CT results were hypodencity lesions [12%]. 2.4% [1] of patients had abnormal CT-Scan with space occupying lesion with mass effect and midline shift, and final diagnosis was brain abscess due to chronic mastoiditis. This study showed that abnormal finding of brain CT-Scan in adult meningitis with loss of consciousness is approximately 50% and mass effect was seen in 2.4% of patients

Generalidades / General aspects

La meningitis se define como la inflamación de las membranas que rodean al cerebro y a la médula espinal, que involucra la aracnoides, piamadre y el líquido cefalorraquídeo. Puede ocurrir a cualquier edad y es una emergencia, ya que si no se diagnostica precozmente y se indica tratamiento, puede ocasionar una mortalidad que varía del 2% al 30%, de acuerdo a la edad, o dejar secuelas permanentes tales como hidrocefalia, infarto cerebral, parálisis de pares craneales, alteraciones neuroendocrinas, colecciones intracraneales, hipertensión endocraneana, sordera neurosensorial, retraso psicomotor y parálisis cerebral. Se clasifica, de acuerdo a su tiempo de evolución en: aguda, crónica, recurrente; de acuerdo a su etiología en: infecciosas y no infecciosas. Las infecciosas pueden ser: virales, bacterianas, por hongos y por parásitos. Las no infecciosas pueden ser: tumorales, por enfermedades sistémicas y tóxicas. Los agentes infecciosos que invaden al Sistema Nervioso Central y causan meningitis, lo hacen a través de tres mecanismos: primero colonizan e infectan al huésped a través de la piel, nasofaringe, tracto respiratorio (la mayoría), genitourinario o gastrointestinal. Invaden la submucosa, vencen las barreras del huésped (física e inmunidad) y penetran al Sistema Nervioso Central por 3 vías: torrente sanguíneo, acceso retrógrado neuronal e inoculación directa, produciendo inflamación de las meninges

Meningitis is defined as the inflammation of the membranes that surround the brain and the spinal marrow, which involves the aracnoides, the pia mater and the spinal fluid. It can occur at any age, and it constitutes an emergency, since it may cause a mortality rate between 2 and 30 % or lead to permanent sequela as: brain edema, cerebral infarction, cranial nerve paralysis, neuroendocrine disorders, intracranial collections or hypertension, neurosensorial deafness, psychomotor delay, and cerebral palsy. According to the length of its evolution it is classified in acute, chronic and recurrent; according to its etiology, in infectious and non infectious. Infectious etiologies are viral, bacterial, fungic and parasitic. Non infectious etiologies are tumoral, toxic and systemic diseases. Infectious agents that invade the Central Nervous System (CNS) may cause meningitis by three mechanisms: first they colonize and infect the guest via skin, respiratory, genitourinary or gastrointestinal systems. They invade the submucosa, overcome the guest’s physical and immune barriers, and penetrate the CNS through 3 routes: blood, neuronal retrograde access and direct inoculation

A atuação do psicólogo durante o processo de implante coclear: relato de caso / The psychologist´s action during a cochlear implant process: report of case

Quando uma criança é submetida ao programa de implante coclear, a avaliação psicológica faz parte do processo. Especialmente quando se trata de um caso de surdez adquirida, a criança e seus familiares necessitam adaptar-se a uma nova situação, a partir das limitações decorrentes da doença e das necessárias alterações na vida. O presente estudo realizou um relato de caso de uma criança que foi submetida ao implante coclear pós-meningite, com o intuito de evidenciar a importância da atuação psicológica com a criança e seus pais, antes, durante e após a cirurgia. Foi possível perceber que o acompanhamento psicológico é fundamental, especialmente porque as informações e orientações não são suficientes para favorecer a adaptação tanto da criança quanto da família, se suas reações emocionais e dificuldades não forem abordadas.

Comparison of the frequency and complications of inappropriate antidiuretic hormone secretion in patients with septic and aseptic meningitis

Due to the high prevalence of syndrome of Inappropriate Antidiuretic Hormone Secretion [SIADH]. This study was carried out to evaluate the prevalence and relevant parameters of SIADH in children with septic and aseptic meningitis hospitalized at Kashan Shahid Beheshti Hospital between 1996 and 2006. This descriptive study was conducted on 230 patients with meningitis hospitalized in the pediatric wards of Kashan Shahid Beheshti Hospital between 1996 and 2006. Relevant information [age, gender, type of meningitis, serum sodium and potassium, urine specific gravity [USG], blood sugar, blood urea nitrogen, serum creatinin, hydration condition] was collected from patients' records. Data was analyzed using Mann-Whitney and Kappa [2] tests. Out of 230 patients with meningitis, 33 had incomplete records and only 197 patients were recruited for this study. Sixty eight cases [34.5%] suffered from SIADH. It was more frequent among 1-2 year old children. According to this research, SIADH was diagnosed in 57% of the 121 patients with hyponatremia, 58.7% of the 167 patients with USG> 1.004, 74% of the 93 patients with serum osmolity <280 mOs/l and 100% of the patients with BUN <10 mg%. Due to the high prevalence of SIADH in septic and aseptic meningitis and its complication, it is recommended to restrict fluid therapy and monitor serum sodium, urine specific gravity and other diagnostic tests for SIADH

Acute Shunt Malfunction after Cesarean Section Delivery: A Case Report

Shunt malfunctions that require surgical intervention during pregnancy and the postpartum period are rare. Furthermore, no study has reported on an acute shunt malfunction immediately after cesarean section. Here, we describe the case of a 32-yr-old woman who became drowsy 12 hr after cesarean section delivery of her second child. She had a ventriculoperitoneal shunt placed to treat hydrocephalus associated with meningitis at 26 yr of age. Marked ventriculomegaly was seen on brain computed tomography and her consciousness recovered temporarily after aspirating cerebrospinal fluid from the flushing device. At surgery, the distal catheter tip was plugged by a blood clot. We believe that the blood spilled over during the cesarean section. The clogged catheter end was simply cut off and the remaining catheter was repositioned in the peritoneal cavity. Her consciousness recovered fully.

Subdural effusion complicating neonatal meningitis: successful treatment with acetazolamide.

Postmeningitis subdural effusion is rare in neonates when compared to infants and children. For treatment, various modalities are described. Serial subdural punctures and surgical drain placement are advised for cases having a mass effect on imaging. We report a neonate with symptomatic postmeningitis subdural effusion, who failed to respond to serial subdural punctures, but subsequently managed successfully with acetazolamide. He had no recurrence further. His development was normal at 18 months of age.

Prevalência de sequelas auditivas pós meningite piogênica em crianças / Prevalence of auditory sequelae after pyogenic meningitis in children

OBJETIVO: Analisar a prevalência de déficit auditivo e caracterizar as principais sequelas auditivas e neurológicas pós-meningite, correlacionando o tipo de antibiótico utilizado durante o período de internação e a frequência de surdez, além do tipo de meningite mais prevalente como causa de déficit auditivo. MÉTODOS: Trata-se de um estudo de coorte transversal. Foram enviadas 289 cartas para os responsáveis pelas crianças que apresentaram meningite piogênica entre 28 dias e 24 meses, admitidas no Hospital Couto Maia (HC Maia) entre janeiro de 2002 a dezembro de 2003. A amostra foi constituída por 55 crianças que sobreviveram com ou sem sequelas evidentes, que compareceram para as avaliações audiológica e neurológica. Foi realizada avaliação audiológica completa, incluindo a bateria subjetiva e objetiva de avaliação, com utilização de instrumentos validados para investigação da audição da criança. RESULTADOS: A faixa etária, no momento da avaliação audiológica, variou de dois a cinco anos. A deficiência auditiva foi encontrada em 29 por cento da amostra, sendo a maioria do tipo neurossensorial, bilateral e de grau profundo. As principais sequelas neurológicas encontradas foram epilepsia, hemiparesia, hidrocefalia, disfasia e hiperatividade. CONCLUSÃO: Os resultados destacam a necessidade de monitoramento audiológico e acompanhamento neurológico nas crianças com história prévia de meningite piogênica, especialmente aquelas infectadas em idade precoce, buscando, desta forma, detectar as possíveis alterações auditivas e intervir o mais precocemente possível, por meio de intervenção especializada, protetização e reabilitação da linguagem oral.

PURPOSE: To analyze the prevalence of hearing impairment and to characterize the main auditory and neurological sequelae after meningitis, correlating the type of antibiotic used during the hospitali66zation period and the frequency of deafness, as well as the most prevalent type of meningitis as cause of hearing impairment. METHODS: Two hundred and eighty nine caregivers of children who were diagnosed with pyogenic meningitis between 28 days and 24 months, and had been admitted at Hospital Couto Maia (HC Maia) between January 2002 and December 2003 were contacted. The sample was composed of 55 children that survived with or without evident sequelae, who attended audiological and neurological evaluation. A complete audiological evaluation was carried out, including a subjective and objective battery of evaluation tests, using standardized instruments for investigation of children's hearing. RESULTS: The age range of the subjects when the audiological evaluation was carried out varied from two to five years. Hearing impairment was detected in 29 percent of the sample, characterizing, mostly, a profound bilateral neurosensory hearing loss. The main neurological sequelae found were: epilepsy, hemiparesy, hydrocephaly, dysphasia, and hyperactivity. CONCLUSION: The results indicate the need for audiological monitoring and neurological follow-up in children with previous history of pyogenic meningitis, especially those infected in early ages, seeking to identify possible hearing impairments and to intervene as soon as possible, through specialized intervention, prothetization, and oral language rehabilitation.

Etiology and outcome of non-traumatic coma in children admitted to pediatric intensive care unit

Non-traumatic coma is a relatively common condition in children that may cause considerable mortality and morbidity. The purpose of this study was to determine clinical presentation, etiology and outcome of non-traumatic coma in children. In a retrospective cross sectional study over a period of 5 years, files of 150 children aged between 1 month and 14 years admitted with non-traumatic coma to pediatric intensive care unit of Rasool Akram hospital were reviewed. Historical, presenting symptoms, clinical and laboratory data were collected. Etiology of coma was determined on the basis of clinical history and relevant investigations. The outcome was recorded as died or neurological condition at discharge as normal, mild or sever disability. Chi-square test was used to test the differences in categorical variables. There were 63 [42%] boys and 87 [58%] girls. The mean +/- SD age of patients was 2.7 +/- 2.35 years. Systemic presentations including nausea, vomiting, fever, lethargy and poor I feeding were more prominent in children under 2 years. Etiology of coma in 49 patients [32.7%] was infectious [meningitis, encephalitis, respiratory and systemic]. Other causes were status epilepticus 44 [29.4%], metabolic [diabetic ketoacidosis, inborn errors of metabolism] 11 [7.3%], intoxications 10 [6.7%], accidental [drowning, electrical shock, suffocation] 9 [6%], shunt dysfunction [secondary to congenital brain malformations] 7 [4.6%], others [acute disseminated encephalomyelitis, vasculitis, hypertensive encephalopathy] 11 [7.3%], unknown 9 [6%]. Infection occurred significantly [P=0.002] in children under 2 years of age, whereas accidents and intoxications were more prominent [P=0.004] in those between 2 and 6 years. Overall 25 children [16.6%] died. Of those survived 16 became severely disabled. Accidents and infections had higher mortality compared to other groups [P<0.001 and P=0.02 respectively]. Our results showed that infection was the most common cause of non-traumatic coma in childhood. Accidents and infection had higher mortality than other causes