Evaluation of sublingual microcirculation in children with dengue shock

OBJECTIVE: To report the sublingual microcirculation observed using Sidestream Dark Field imaging in two children with dengue shock. METHOD: Two children, aged 9 and 10 years, were admitted to the pediatric intensive care unit with dengue shock and multiple organ dysfunction. Sublingual microcirculation was assessed in each patient on the first and second days of shock and was assessed a final time when the patients were no longer in shock (on the day prior to extubation) using Sidestream Dark Field technology. The De Backer score and microvascular flow index were used for the analyses. RESULTS: Both patients had reduced perfused small vessel density in the first two days and showed predominantly intermittent or no microcirculation flow, as demonstrated by a low microvascular flow index. The blood flow in the large vessels was not affected. Prior to the extubation, the microvascular flow index had increased, although the perfused small vessel density remained diminished, suggesting persistent endothelial dysfunction. CONCLUSIONS: Severe microcirculation changes may be involved in the pathophysiological mechanisms that lead to the final stages of dengue shock, which is frequently irreversible and associated with high mortality rates. Microcirculatory monitoring may help elucidate the physiopathology of dengue shock and prove useful as a prognostic tool or therapeutic target

Caracterização dos distúrbios cognitivos na Doença de Parkinson Characterizing cognitive disorders in Parkinson's disease

TEMA: comprometimentos cognitivos na doença de Parkinson. OBJETIVO: ressaltar a existência do déficit cognitivo na Doença de Parkinson, descrevendo as características dos comprometimentos cognitivos. CONCLUSÕES: as alterações cognitivas na Doença de Parkinson (referentes a memória, linguagem, capacidade visuo-espacial e funções executivas) são constatadas na literatura, no entanto, há uma carência de informações quanto à reabilitação fonoaudiológica de pacientes nessa área específica da linguagem.<br>BACKGROUND: cognitive commitments in Parkinson's disease. PURPOSE: to point out the existence of cognitive deficit in Parkinson's disease, describing its characteristics. CONCLUSIONS: cognitive alterations in Parkinson's disease (such as memory, language, visual-spatial capacity and execution functions) are found in the literature, however, there is a lack of information such as the speech therapist rehabilitation of patients in such -specific language-related area