Análise da ocorrência de hipertensão intracraniana refratária e da resposta ao tratamento de crianças com traumatismo crânio-encefálico grave / Analysis of the incidence of refractory intracranial hypertension and the response of children with severe head trauma to the treatment

Introdução: o traumatismo crânio-encefálico (TCE) grave é frequente em pediatria, mas as recomendações para seu tratamento têm baixo nível de evidência. Objetivo: analisar a ocorrência de hipertensão intracraniana (HIC) refratária e a resposta ao tratamento em crianças com TCE grave. Métodos: coorte incluindo pacientes com pontuação abaixo de nove na Escala de Coma de Glasgow (ECG) entre setembro de 2005 e agosto de 2008. Aprovado pelo Comitê de Ética em Pesquisa da Fhemig. Resultados: analisados 156 pacientes, 116 masculinos (74,4%), idades entre três meses e 18 anos, média nove, mediana 11. Mediana da pontuação na ECG: 6. Atropelamento: 54 pacientes (34,6%); lesões em ocupantes de veículos: 34 (21,8%); queda: 21 (13,5%); e lesões em ciclistas: 18 (11,5%). Tomografia alterada: 133 pacientes (85,3%); hemorragia intracraniana: 105 (67,3%); swelling: 66 (42,3%); lesão axonal difusa: (28,8%). A monitorização da pressão intracraniana foi realizada em 73 pacientes (46,8%). Foi encontrada HIC com necessidade de tratamento em 56 (76,7%) e refratária em 30 (41%) pacientes. Destes pacientes, 10 receberam barbitúrico e sete morreram. A craniectomia descompressiva foi realizada em nove pacientes, sendo que dois faleceram. O risco relativo de morte com barbitú- rico: 3,9 (IC 95%: 1,1 a 14,1; p=0,02), com significância estatística. O risco relativo de morte com craniectomia descompressiva: 0,3 (IC95%: 0,1 a 1,0, p=0,02). Ocorreram 33 óbitos (21,1%), 59% de redução em relação a estudo anterior da Instituição. Conclusões: HIC refratária foi muito frequente em crianças com TCE grave. O uso de coma barbitúrico para seu tratamento aumentou o risco de morte em quatro vezes.(AU)

Background: Severe head trauma is common in children, but there is a lack of evidence for the intracranial hypertension treatment in the literature. Objectives: To analyze the occurrence of refractory intracranial hypertension and the response of children and adolescents with severe head trauma to the treatment. Method: Cohort study between September 2005 and August 2008 involving pediatric patients with Glasgow coma scale (GCS) from 3 to 8 points. This study was approved by the ethical committee of FHEMIG. Results: From the 156 patients, 116 were male (74,4%). The range of age varied from tree months to 18 years, mean age 9, and median 11. Median of GCS score: 6. Running over crash: 54 patients (34,6%), car occupants injuries: 34 (21,8%), falls: 21 (13,5%) e cyclist´s injuries: 18 (11,5%). Abnormalities in computed tomography: 133 patients (85,3%), intracranial hemorrhage: 105 (67,3%), swelling: 66 (42,3%), diffuse axonal injury: (28,8%). Seventy three patients received intracranial pressure monitoring (46,3%); 56 had had intracranial hypertension that needed treatment (76,7%), and 30 had had refractory intracranial hypertension (41%). From the patients with refractory hypertension, 10 received barbiturates as treatment, seven died. Nine underwent decompressive craniectomy, two died. Relative risk of death with barbiturates: 3,9 (CI 95%: 1,1 a 14,1; p=0,02). Relative risk of death with decompressive craniectomy: 0,3 (IC95%: 0,1 a 1,0, p=0,02). Total mortality rate was 21,1% (33 patients). This showed a decrease of 59% in mortality comparing to previous study done in the same hospital. Conclusion: refractory intracranial hypertension were very common in pediatric patients with severe head injury. The use of barbiturates for its treatment increased the risk of death four times.(AU)

Antifungal activity of extracts of some plants used in Brazilian traditional medicine against the pathogenic fungus Paracoccidioides brasiliensis.

Paracoccidioidomycosis (PCM) is a systemic granulomatous disease caused by Paracoccidioides brasiliensis Almeida (Onygenales) that requires 1-2 years of treatment. In the absence of drug therapy, the disease is usually fatal, highlighting the need for the identification of safer, novel, and more effective antifungal compounds. With this need in mind, several plants employed in Brazilian traditional medicine were assayed on P. brasiliensis and murine macrophages. Extracts were prepared from 10 plant species: Inga spp. Mill. (Leguminosae), Schinus terebinthifolius Raddi (Anacardiaceae), Punica granatum L. (Punicaceae), Alternanthera brasiliana Kuntze (Amaranthaceae), Piper regnellii CDC. (Piperaceae), P. abutiloides Kunth (Piperaceae), Herissantia crispa L. Briz. (Malvaceae), Rubus urticaefolius Poir (Rosaceae), Rumex acetosa L. (Polygonaceae), and Baccharis dracunculifolia DC. (Asteraceae). Hexane fractions from hydroalcoholic extracts of Piper regnellii and Baccharis dracunculifolia were the most active against the fungus, displaying minimum inhibitory concentration (MIC) values of 7.8 microg/mL and 7.8-30 mug/mL, respectively. Additionally, neither of the extracts exhibited any apparent cytotoxic effects on murine macrophages at 20 microg/mL. Analyses of these fractions using gas chromatography-mass spectrometry (GC-MS) showed that the major components of B. dracunculifolia were ethyl hydrocinnamate (14.35%) and spathulenol (16.02%), while the major components of the hexane fraction of Piper regnellii were 1-methoxy-4-(1-propenyl) benzene (21.94%) and apiol (21.29%). The activities of these fractions against P. brasiliensis without evidence of cytotoxicity to macrophages justify their investigation as a potential source of new chemical agents for the treatment of PCM.