Aplicações dos potenciais evocados miogênicos vestibulares: revisão sistemática de literatura / Applications of vestibular-evoked myogenic potentials: a systematic literature review

RESUMO Objetivos Revisar a literatura científica sobre as principais técnicas usadas para gerar o potencial evocado miogênico vestibular (VEMP) e suas aplicações clínicas. Estratégia de pesquisa Os artigos que descrevem os métodos de registro e as aplicações do VEMP foram localizados nas bases de dados PubMed, Web of Science, MEDLINE, Scopus, LILACS e SciELO. O levantamento realizado limitou-se aos artigos publicados nos idiomas Inglês, Português e Espanhol, entre janeiro de 2012 e maio de 2018. Critérios de seleção Artigos sobre os aspectos técnicos para a realização do VEMP ocular, cervical ou do músculo sóleo, com estimulação auditiva ou galvânica e artigos sobre as aplicações clínicas do VEMP foram incluídos; artigos repetidos nas bases de dados, artigos de revisão de literatura, relato de casos, cartas e editoriais foram excluídos. Resultados A estratégia de busca resultou na seleção de 28 artigos. Os estudos evidenciaram três métodos de registro do VEMP: cervical, ocular e no músculo sóleo. As aplicações clínicas do VEMP incluíram doença de Ménière, neurite vestibular, síndrome da deiscência do canal semicircular superior, doença de Parkinson, lesões centrais isquêmicas e mielopatias motoras. Conclusão Independentemente da técnica de registro, o VEMP mostrou-se útil como ferramenta complementar para o diagnóstico de doenças vestibulares periféricas e centrais.

ABSTRACT Purpose To review the scientific literature on the main techniques used to generate vestibular-evoked myogenic potential (VEMP) and its clinical applications. Research strategy A search for articles describing VEMP recording methods and applications was conducted in the PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The search was limited to articles published in English, Portuguese, and Spanish between January 2012 and May 2018. Selection criteria Articles addressing the technical aspects for performing ocular, cervical or soleus VEMP with auditory or galvanic stimulation and articles on the clinical applications of VEMP were included in this review, whereas articles repeated in the databases, literature reviews, case reports, letters, and editorials were excluded. Results The search strategy resulted in the selection of 28 articles. The studies evidenced three methods of VEMP recording: responses from the cervical, ocular and soleus muscle. Clinical applications of VEMP included Meniere's disease, vestibular neuritis, superior semicircular canal dehiscence syndrome, Parkinson's disease, central ischemic lesions, and motor myelopathies. Conclusion Regardless of the recording technique, VEMP has proved to be useful as a complementary tool for the diagnosis of peripheral and central vestibular diseases.

Prevalence of low bone mass and changes in vitamin D levels in human immunodeficiency virus-infected adults unexposed to antiretrovirals

Abstract INTRODUCTION: The prevalence of low bone mass is 3 times higher in people living with human immunodeficiency virus (PLWH) and using antiretrovirals than in the HIV-unaffected population. Changes in vitamin D levels is one of the factors associated with decreased bone mass. The objective of this study is to evaluate the low bone mass and altered vitamin D levels in PLWH who have not been exposed to antiretrovirals. METHODS: A cross-sectional study was carried out with HIV-infected individuals between the ages of 18 and 55 years immediately prior to the start of antiretroviral therapy in a specialized reference center focusing on infectious and parasitic diseases. Results of clinical examination (patient's weight, height, blood pressure, and clinical history), laboratory tests, and X-ray absorptiometry, were collected. RESULTS: Sixty patients were included, with a mean age of 34 years. Nine (16.7%) patients presented with low bone mass and 4 (7.1%) patients showed low total femur BMD. Analysis revealed that 23.3% and 36.7% of the patients had deficient and insufficient levels of 25-hydroxyvitamin D3, respectively. CONCLUSIONS: Our study population presented with compromised bone health and with low bone mineral density and 25-(OH)-vitamin D levels.

Evaluation of inflammatory biomarkers, carotid intima-media thickness and cardiovascular risk in HIV-1 treatment-naive patients

Abstract INTRODUCTION Mortality among HIV patients is 3-15 times higher than that among the general population. Currently, most deaths are due to non-infectious diseases. Chronic inflammation and adverse events due to antiretroviral therapy play crucial roles in increasing cardiovascular risk (CVR). METHODS: This cross-sectional study aimed to evaluate carotid intima-media thickness (CIMT) and inflammatory biomarkers (D-dimer, ADAMTS13, GDF-15, sICAM-1, MPO, myoglobin, NGAL, SAA, sVCAM-1, and p-selectin) among naïve patients. RESULTS: Sixty-seven participants were included: median age, 32 years; males, 82.1%; non-white, 61.1%; higher education level, 62.7%; and exposed to HIV through sexual relationship (men who have sex with men), 68.7%. The median viral load and LTCD4+ value were 42,033 copies/mL and 426 cells/mm³. The prevalence of arterial hypertension was 16.4%; those of diabetes mellitus and dyslipidemia were 3% and 70.1%, respectively. The CIMT was 494.08 (± 96.84mm). The mean vascular age was 33.2 ± 18.9 years, one year longer than the chronological age, without statistical significance. CONCLUSIONS The majority of participants had a low CVR (94%). After reclassification, considering the CIMT percentiles, 13 (19.4%) patients had medium/ high CVR, while 54 (80.6%) patients had low CVR. The difference between the proportions of CVR when considering the CIMT and its corresponding percentile was statistically relevant. Body mass index was the only predictor of higher CVR (p = 0.03). No biomarker was found to predict CVR. People living with HIV have a high prevalence of dyslipidemia before ARV therapy.

Alterações metabólicas e estimativa de risco cardiovascular em pessoas vivendo com HIV/AIDS doze meses após o início da TARV / Metabolic changes and estimating cardiovascular risk of people living with HIV/AIDS twelve months after the start of HAART

A incidência de doenças cardiovasculares (DCV) chega a ser duas vezes maior em pessoas vivendo com HIV/AIDS (PVHA) devido aos danos pró-inflamatório causado pelo vírus e efeitos tóxicos de antirretrovirais incluindo as dislipidemias. O objetivo deste trabalho foi acompanhar o risco de DCV e marcadores metabólicos em PVHA. Trata-se de estudo longitudinal realizado antes e após 12 meses de inicio de antirretrovirais. Coletou-se variáveis socioeconômicas, clínicas, antropométricas e laboratoriais, e calculou-se escores de Framingham e PROCAM. Utilizaram-se os testes de Wilcoxon, T-Student e Qui-Quadrado na comparação das variáveis. A amostra basal deste estudo foi composta por 91 PVHA. Desses, 85% eram homens com mediana de idade igual a 31 anos e 94,5% declararam não ter história pregressa de dislipidemias. Foi observado aumento nos níveis de colesterol total (p0,05). Portanto, para a definição de risco real de DCV nesta população temos que considerar a inclusão de outras variáveis como alguns biomarcadores e, ainda, a mensuração ultrassonográfica da camada íntima carotídeas. Sendo assim, o cuidado compartilhado com outras áreas da saúde como nutricionistas e educadores físicos visando estimular a mudança de estilo de vida, pode qualificar o acompanhamento de PVHA reduzindo a incidência de eventos não infecciosos. (AU)

The incidence of cardiovascular disease (CVD) is up to twice as high in people living with HIV / AIDS (PLWHA) because of the proinflammatory damage caused by the virus and antiretroviral toxicities including dyslipidemias. The objective of this study was to monitor the risk of CVD and metabolic markers in PLWHA. This is a longitudinal study before and after 12 months of antiretroviral beginning. They were collected socioeconomic, clinical, anthropometric and laboratory variables, and calculated scores of Framingham and PROCAM. They used the Wilcoxon paired tests, T-Student and Chi-square partition in the comparison of variables. The baseline sample was composed of 91 PLWHA. Of these, 85% were male with median age 31 years and 94.5% did not have a history of dyslipidemia. There was an increase in total cholesterol levels (p 0.05). Therefore, to define real risk of CVD in this population we have to consider the inclusion of other variables as some biomarkers, and also ultrasound measurement of carotid intima layer. Thus, the shared care with other health areas as physical nutritionists and educators to stimulate the change of lifestyle, can qualify PLWHA monitoring reducing the incidence of non-infectious events. (AU)

Cetoacidose diabética em crianças e adolescentes / Diabetic ketoacidosis in children and adolescents

A cetoacidose diabética (CAD) constitui um distúrbio endócrino caracterizado por acidose metabólica, cetose (pH arterial < 7,3 ou venoso < 7,25 e/ou HCO3- < 15mEq/L), hiperglicemia (> 200 mg/dL) e graus variados de desidratação em portadores de diabetes mellitus (DM). É motivo habitual de admissão em emergência ou Unidade de Terapia Intensiva pediátrica. É a causa mais frequente de morte em crianças e adolescentes com DM tipo 1. Resulta da deficiência de insulina e aumento dos níveis circulantes de hormônios contrarreguladores. A abordagem da CAD em pediatria não deve prescindir das particularidades existentes nessa população quando comparada à de adultos. Os principais fatores desencadeantes são as infecções e a omissão de insulina. A terapêutica na emergência visa a: corrigir a desidratação e os distúrbios eletrolíticos; reverter a cetose e a acidose; restabelecer a glicemia normal; evitar complicações; identificar e tratar a causa precipitante; e prevenir novos episódios. Este artigo atualiza sobre a CAD, tratando, em especial, sobre seus aspectos da fisiopatologia, diagnóstico, classificação, manifestações clínicas, abordagem terapêutica, complicações e profilaxia.

The diabetic ketoacidosis (DK) is an endocrine disorder characterized by metabolic acidosis and ketosis (arterial pH < 7,3 or venous pH < 7,25 and HCO3- < 15 mEq/L), hyperglycemia (higher than 200 mg/dL) and different degrees of dehydration in patients with Diabetes Mellitus (DM). It is a usual reason for admission in emergency services or pediatric ICU, as well as the most frequent cause of death in children and teenagers with type 1 DM. This pathology results from lack of insulin and elevation of counter-regulatory hormone levels. The DK’s approach in pediatric patients must consider the singular characteristics of this age group. The main trigger factors are infections and omission of insulin. The therapeutic at the emergency aims to: correct the dehydration and electrolyte disturbances, ketosis, acidosis and hyperglycemia; avoid complications; identify and treat the trigger factors; and prevent new events. The aim of this review is to present updates on DK, dealing in particular with aspects of physiopathology, diagnosis, classification, clinical findings, therapeutic approach, complications and prophylaxis.

Cetoacidose diabética em pediatria: relato de caso / Diabetic ketoacidosis in children: case report

A cetoacidose diabética é a principal complicação aguda do Diabetes Mellitus (DM) e responsável por importante causa de morte, principalmente devido ao desenvolvimento de edema cerebral. É discutida neste trabalho a evolução clínica de um jovem de 10 anos de idade, diabético tipo I, admitido no Pronto Socorro do Hospital das Clínicas da UFMG com sintomatologia compatível com cetoacidose diabética, com melhora inicial dos padrões laboratoriais não acompanhada de melhora clínica.

The diabetic ketoacidosis is the main Diabetes Mellitus (DM) acute complication and responsible for an important cause of death, mainly due to the development of cerebral edema. This article reports a case of a 10 year old boy, previously diagnosed with DM I, admitted to the pediatric emergency of Hospital das Clínicas da UFMG with signs and symptoms compatible with diabetic ketoacidosis. Despite the initial improvement of laboratorial findings, there was not a significant clinical recovery. This scenery required new arrangements, like the use of sodium bicarbonate, which is not recommended by current consensus guidelines, considering that the patient’s venous pH was higher than 6,9.