ABSTRACT
OBJECTIVE: To assess acute neurological complications and neurological sequelae of childhood acute bacterial meningitis in order to determine possible warning signs. METHODS: This retrospective study evaluated children with acute bacterial meningitis (between 1 month and 14 years of age) admitted between 2003 and 2006. RESULTS: Of the 44 patients studied, 17 (38.6%) had acute neurological complications. Seizure was the most frequent (31.8%) complication. Patients with acute neurological complications showed a higher frequency of lower neutrophil count (p = 0.03), seizure at admission (p < 0.01), and S. pneumoniae as the etiologic agent (p = 0.01). Risk factors for the development of acute neurological complications were S. pneumoniae (odds ratio [OR] = 6.4, confidence interval [CI] 1.7-24.7) and neutrophil count < 60% (p < 0.01). Of the 35 patients who were followed up, 14 had neurological sequelae (40%). Behavioral change (22.9%) was the most frequent sequela. Seizures at admission (OR = 5.6, CI 1.2-25.9), cerebrospinal fluid protein concentration > 200 mg/dL (p < 0.01), and cerebrospinal fluid glucose concentration/glycemia ratio (p < 0.01) were identified as risk variables for sequelae. CONCLUSION: Neutrophil count < 60%, seizure at admission, and S. pneumoniae as the etiologic agent were identified as warning signs for acute neurological complications, while protein levels, cerebrospinal fluid glucose concentration/glycemia ratio, and seizure at admission were seen as risk factors for neurological sequelae.
Subject(s)
Behavioral Symptoms/etiology , Glucose/cerebrospinal fluid , Meningitis, Pneumococcal/complications , Neutrophils/pathology , Seizures, Febrile/etiology , Acute Disease , Adolescent , Child , Child, Preschool , Epidemiologic Methods , Female , Humans , Infant , Male , Meningitis, Pneumococcal/microbiology , Meningitis, Pneumococcal/pathology , Risk FactorsABSTRACT
OBJETIVO: Estudo retrospectivo que visa avaliar as complicações neurológicas agudas e sequelas neurológicas das meningites bacterianas agudas na infância, a fim de determinar possíveis sinais de alerta. MÉTODOS: Foram avaliadas crianças (entre 1 mês e 14 anos) internadas entre 2003 e 2006, com meningite bacteriana aguda. RESULTADOS: Dos 44 pacientes incluídos, 17 (38,6%) apresentaram complicações neurológicas agudas, sendo crise convulsiva a mais frequente (31,8%). Os pacientes com complicações neurológicas agudas apresentaram com mais frequência: menor contagem de neutrófilos (p = 0,03), crise convulsiva na admissão (p < 0,01) e S. pneumoniae como agente etiológico (p = 0,01). Os fatores de risco para o desenvolvimento de complicações neurológicas agudas foram: S. pneumoniae [razão de chances (odds ratio, OR) = 6,4; intervalo de confiança (IC) 1,7-24,7] e contagem de neutrófilos < 60% (p < 0,01). De 35 pacientes seguidos ambulatorialmente, 14 apresentaram sequelas neurológicas (40%), sendo alteração comportamental a mais frequente. A ocorrência de crise convulsiva na internação (OR = 5,6; IC 1.2-25,9), proteinorraquia > 200 mg/dL (p < 0,01) e menor relação glicorraquia/glicemia (p < 0,01) foram identificadas como variáveis de risco para sequelas. CONCLUSÃO: Contagem de neutrófilos < 60%, crise convulsiva na admissão e S. pneumoniae como agente etiológico foram identificados como sinais de alerta para a ocorrência de complicação neurológica aguda, enquanto que proteinorraquia, menor relação glicorraquia/glicemia e crise convulsiva na internação foram observados como fatores de risco para a ocorrência de sequelas neurológicas.
OBJECTIVE: To assess acute neurological complications and neurological sequelae of childhood acute bacterial meningitis in order to determine possible warning signs. METHODS: This retrospective study evaluated children with acute bacterial meningitis (between 1 month and 14 years of age) admitted between 2003 and 2006. RESULTS: Of the 44 patients studied, 17 (38.6%) had acute neurological complications. Seizure was the most frequent (31.8%) complication. Patients with acute neurological complications showed a higher frequency of lower neutrophil count (p = 0.03), seizure at admission (p < 0.01), and S. pneumoniae as the etiologic agent (p = 0.01). Risk factors for the development of acute neurological complications were S. pneumoniae (odds ratio [OR] = 6.4, confidence interval [CI] 1.7-24.7) and neutrophil count < 60% (p < 0.01). Of the 35 patients who were followed up, 14 had neurological sequelae (40%). Behavioral change (22.9%) was the most frequent sequela. Seizures at admission (OR = 5.6, CI 1.2-25.9), cerebrospinal fluid protein concentration > 200 mg/dL (p < 0.01), and cerebrospinal fluid glucose concentration/glycemia ratio (p < 0.01) were identified as risk variables for sequelae. CONCLUSION: Neutrophil count < 60%, seizure at admission, and S. pneumoniae as the etiologic agent were identified as warning signs for acute neurological complications, while protein levels, cerebrospinal fluid glucose concentration/glycemia ratio, and seizure at admission were seen as risk factors for neurological sequelae.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Behavioral Symptoms/etiology , Glucose/cerebrospinal fluid , Meningitis, Pneumococcal/complications , Neutrophils/pathology , Seizures, Febrile/etiology , Acute Disease , Epidemiologic Methods , Meningitis, Pneumococcal/microbiology , Meningitis, Pneumococcal/pathology , Risk FactorsABSTRACT
UNLABELLED: A cross sectional study was made on 60 patients (9.9 +/- 1.8 yr-old) with congenital hypothyroidism (CH) (group A): 40 girls (23 prepubertal) and 20 boys (18 prepubertal). Control group (group B) was constituted of 28 healthy children (10.4 +/- 2.1 yr-old): 18 girls (8 prepubertal) and 10 boys (9 prepubertal). AIMS: To evaluate bone mineral density (BMD) and content (BMC) and to correlate them with chronological and bone age (BA), sex, sexual maturation, l-T4 dose, TSH, TT4, FT4, and CH etiology. BA, total body BMD, and BMC (DXA) were obtained of both groups. TSH, TT4, and FT4 were measured in patients only. BMD was lower in group A (0.795 +/- 0.075 g/cm(2) vs. 0.832 +/- 0.092; p = 0.04) and higher in pubertal than in prepubertal girls (p = 0.004). There was no significant difference between BMD and BMC related to sex and CH etiology. Our data demonstrated that BMD was significantly lower in children with CH, different from what has been published in the literature.
Subject(s)
Bone Density/physiology , Congenital Hypothyroidism/physiopathology , Adolescent , Anthropometry , Bone Density/drug effects , Calcium/blood , Calcium/therapeutic use , Child , Congenital Hypothyroidism/blood , Congenital Hypothyroidism/drug therapy , Densitometry/methods , Epidemiologic Methods , Female , Humans , Male , Sexual Maturation/physiology , Socioeconomic Factors , Thyrotropin/blood , Thyroxine/blood , Time FactorsABSTRACT
Realizou-se estudo transversal com 60 pacientes (9,9 ± 1,8 anos) com hipotireoidismo congênito (HC) (grupo A): 40 meninas (23 pré-púberes) e 20 meninos (18 pré-púberes), com grupo controle (grupo B) constituído por 28 indivíduos (10,4 ± 2,1 anos): 18 meninas (8 pré-púberes) e 10 meninos (9 pré-púberes). OBJETIVOS: Avaliar a densidade (DMO) e o conteúdo mineral ósseo (CMO) e correlacioná-los com idade cronológica e óssea (IO), sexo, maturação sexual, dose de l-T4, TSH, TT4, FT4, e etiologia do HC. IO, DMO e CMO de corpo total (DXA) foram obtidos dos 2 grupos; TSH, TT4 e FT4, apenas dos pacientes. DMO foi menor no grupo A (0,795 ± 0,075 g/cm² vs. 0,832 ± 0,092; p = 0,04) e maior nas meninas púberes do que nas pré-púberes (p = 0,004). Não houve diferença significativa de DMO e CMO quanto ao sexo e etiologia do HC. Nosso estudo mostra que a DMO foi significativamente menor no grupo com HC, diferente dos dados da literatura.
A cross sectional study was made on 60 patients (9.9 ± 1.8 yr-old) with congenital hypothyroidism (CH) (group A): 40 girls (23 prepubertal) and 20 boys (18 prepubertal). Control group (group B) was constituted of 28 healthy children (10.4 ± 2.1 yr-old): 18 girls (8 prepubertal) and 10 boys (9 prepubertal). AIMS: To evaluate bone mineral density (BMD) and content (BMC) and to correlate them with chronological and bone age (BA), sex, sexual maturation, l-T4 dose, TSH, TT4, FT4, and CH etiology. BA, total body BMD, and BMC (DXA) were obtained of both groups. TSH, TT4, and FT4 were measured in patients only. BMD was lower in group A (0.795 ± 0.075 g/cm² vs. 0.832 ± 0.092; p = 0.04) and higher in pubertal than in prepubertal girls (p = 0.004). There was no significant difference between BMD and BMC related to sex and CH etiology. Our data demonstrated that BMD was significantly lower in children with CH, different from what has been published in the literature.
Subject(s)
Adolescent , Child , Female , Humans , Male , Bone Density/physiology , Congenital Hypothyroidism/physiopathology , Anthropometry , Bone Density/drug effects , Calcium/blood , Calcium/therapeutic use , Congenital Hypothyroidism/blood , Congenital Hypothyroidism/drug therapy , Densitometry/methods , Epidemiologic Methods , Socioeconomic Factors , Sexual Maturation/physiology , Time Factors , Thyrotropin/blood , Thyroxine/bloodABSTRACT
Objetivos: 1) avaliar o valor preditivo do Clinical Risk lndexfor Babies (CRIB) para óbito hospitalar; 2) identificar a variável do escore com melhor valor preditivo; e 3) comparar a capacidade do escore CRIB para predizer mortalidade hospitalar com a do peso de nascimento, da idade gestacional e do excesso de base isolados.Métodos: o escore CRIB foi aplicado de forma prospectiva em 100 recém-nascidos admitidos consecutivamente na Unidade Neo-natal do HC-UFPR, que tinham peso de nascimento igualou inferior a 1.500 g ou idade gestacional menor que 31 semanas. Resultados: cinqüenta e cinco recém-nascidos eram do sexo feminino e 45, do masculino, a média do peso de nascimento foi de 1.078,0 Ý 277,0 g, e da idade gestacional de 29,2 Ý 2,8 semanas. Vinte e um pacientes foram a óbito. A mortalidade nos graus 1, 2, 3 e 4 do CRIB foi, respectivamente, de 6,6por cento; 46,2por cento, 85,7por cento e 100,0por cento. A precisão do escore para mortalidade foi confirmada (área sob a curva ROC = 0,877), e a melhor variável do escore para prognosticar o óbito hospitalar foi o excesso de base máximo (área sob a curva ROC = 0, 795). Comparado com peso de nascimento e idade gestacio- nal, o CRIB foi significativamente melhor para predizer mortalidade. Conclusões: além de ser útil no prognóstico do óbito hospitalar, o CRIB mostrou-se um escore de aplicação simples. Com base nos resultados encontrados, recomenda-se sua incorporação na rotina das unidades neonatais
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant Mortality , Infant, Premature , Intensive Care Units, NeonatalABSTRACT
OBJECTIVE: To examine the clinical risk index for babies (CRIB) predictive value for hospital death; to identify the score variable with the best predictive value and to compare CRIB score capability to predict hospital mortality to birth weight, gestational age and base excess. METHODS: CRIB score was obtained through a prospective way from 100 newborns with birthweight of 1,500 g or less or gestational age less than 31 weeks, who were admitted consecutively to the Neonatal Unit of Hospital das Clínicas, Universidade Federal do Paraná. RESULTS: Fifty-five newborns were females and 45 were males, the average birthweight was 1,078 +/- 0.277 g and gestational age was 29.2 +/- 2.8 weeks. Twenty-one patients died. The mortality rate in the CRIB groups 1, 2, 3 and 4 was, respectively 6.6%; 46.2%; 87.5% and 100.0%. The score accuracy for mortality was confirmed (area under the ROC curve=0.877) and the best score variable to predict hospital death was maximum base excess (area under the ROC curve=0.795). Compared with birthweight and gestational age, CRIB was significantly better to predict mortality. CONCLUSIONS: Besides being useful to predict hospital death, CRIB was a simple score to be applied. Based on these results, we recommend its inclusion in the routine of neonatal units.
ABSTRACT
Objetivos : chamar atencao para o quilotorax congenito, uma causa rara de insuficiencia respiratoria no recem nascido e a forma mais comum de fusao pleural no periodo neonatal...