Neurologic examination of a group of children attending first grade of a elementary school

We evaluated children in the first grade of a elementary school using neurological examination. With no previous knowledgement of their educational performance, were invited all children attending five classes of the first grade of an elementary public school chosen randomly, in Itatiba / Sao Paulo / Brazil, whose parents assigned a Commitment Term for participation in this research. Children who missed three evaluations in different days or whose parents did not assigned the Commitment Term were excluded. The Traditional Neurological Examination (ENT) (Lefevre, 1972) was applied. It was considered for normal the measurement of the skull circumference, proposed by Diament & Rodrigues (1976), and the application of all ENT items. The data were stored in a database of the Epi6 Program (Epidemiologic Information), and analyzed by percentage calculation and by the c2 test. The significance level was 0.05. Children evaluated were 124. The ENT results were normal in 87 (70.16%) and altered in 37 (29.83%). Among the alterations, there were observed: light tremor, light muscular hypotonia, speech acquisition delay, macrocephaly, microcephaly, hyperactivity, cranial nerve syndrome, central facial paralysis. One child presented corticospinal tract impairment syndrome of the distal lower extremities.Avaliamos escolares de primeira série do ensino fundamental, utilizando semiologia neurológica. Foram convidados, sem o conhecimento prévio do desempenho escolar, todos os alunos que frequentavam 5 classes de primeira série do primeiro grau de uma escola pública escolhida ao acaso, no município de Itatiba / São Paulo, cujos pais assinaram o Termo de Consentimento Livre e Esclarecido. Foram excluídos aqueles cujos pais não assinaram esse termo ou não compareceram a 3 consultas agendadas em dias diferentes. Utilizou-se o Exame Neurológico Tradicional (ENT) (Lefèvre, 1972). Considerou-se como normal a realização de todas as provas do ENT e as medidas do perímetro craniano propostas por Diament & Rodrigues (1976). Os dados foram armazenados em banco de dados do programa Epi6 (Epidemiologic Information). Os resultados foram analisados pelo cálculo de porcentagem e pelo teste c2. O nível de significância foi 0,05. Foram avaliados 124 alunos. O ENT foi normal em 87 (70,16%) e alterado em 37 (29,83%) escolares. Entre as alterações, foram observados: leve tremor, leve hipotonia muscular, atraso na aquisição da fala, macrocefalia, microcefalia, hiperatividade, síndrome de nervo craniano e paresia facial central. Um escolar apresentou síndrome de liberação piramidal nos membros inferiores11211

Visual Function And Fine-motor Control In Small-for-gestational Age Infants.

To compare visual function and fine-motor control of full-term infants small-for-gestational age (SGA) and appropriate for gestational age (AGA), in the first three months. We evaluated prospectively 31 infants in the 1st month; 33 in the 2nd and 34 infants in the 3rd month, categorized as full-term; birth weight less than 10th percentile for SGA and 25th to 90th percentile for the AGA group. Genetic syndromes, infections, multiple congenital malformations were excluded. The Bayley Scales of Infant Development-II were used, especially items related to visual function and to fine-motor control outcomes. The Motor Index Score (IS) was significantly lower in the SGA group in the 2nd month. The items attempts to bring hands to mouth, in the 1st month and reaches for suspended ring, in the 3rd month showed higher frequency in the SGA group. The Motor IS was lower in the 2nd month and items of fine-motor control in the 1st month and in the 3rd month showed higher frequency in the SGA group.62955-6

[a Method To Evaluate Visual Ability In Infants].

The purpose of this study is to introduce a method to evaluate visual functions in infants in the first three months of life. An adaptation of the Guide for the Assessment of Visual Ability in Infants (Gagliardo, 1997) was used. The instrument was a ring with string. It was implemented a pilot study with 33 infants, selected according to the following criteria: neonates well enough to go home within two days of birth; 1 to 3 months of chronological age; monthly evaluation with no absence; subjects living in Campinas/SP metropolitan area. In the first month we observed: visual fixation (93,9%); eye contact (90,9%); horizontal tracking (72,7%); inspects surroundings (97,0%). In the third month, we observed: inspects own hands (42,4%) and increased movements of arms (36,4%). This method allowed the evaluation of visual functions in infants, according to the chronological age. Alterations in this function will facilitate immediate referral to medical services for diagnoses.62300-

Neurologic semiology in a sample of hearing impaired children

A random sample of 42 sensorioneural hearing impaired children (severe and bilateral) was studied, from special classes in Campinas, with chronological ages varying between 4 and 7 years old. The children of this sample were compared with two control groups of 42 children of the same chronological age, from regular classes of private and public schools. All of them were submitted to the traditional neurological examination. Hearing impaired children showed differences as to head circumference and muscle tonus. In the other examined items we found motor hyperactivity, cerebellar and ocular syndromes although there were no significant differences between the groups.Foi constituída uma amostra aleatória de 42 crianças deficientes auditivas neuros-sensoriaís congênitas, profundas e bilaterais, com idade cronológica variando entre 4 e 7 anos, que frequentavam classes de habilitação da cidade de Campinas. As crianças propostas foram comparadas com dois grupos controles de 42 crianças, da mesma faixa etária, de classe comum. Todas foram submetidas ao exame neurológico tradicional. Verificou-se que os aspectos que demonstraram diferenças foram o perímetro craniano e o tono muscular. Nos demais itens avaliados, mostrou-se hiperatividade motora, síndrome cerebelar e síndrome ocular, porém não houve diferença significativa entre os dois grupos.34134

Evaluation of the static equilibrium in a sample of hearing impaired children

A random sample was organized with 42 children with congenital sensorineural auditory deficit (severe and bilateral) from special education schools in Campinas. Chronological ages ranged from 4 to 7 years of age. This sample was compared with two control groups of 42 children of the same chronological age but attending normal classes. All were submitted to 9 tests of the set of static equilibrium of the Evolutive Neurologic Examination. It was observed that in the position of equilibrium with opened eyes (test 8) there were no differences between the groups. In the Romberg position, the hearing impaired children of 4, 5 and 6 years of age showed a significant decrease in the ability to do the test (test 9); those of 7 years of age had equal ability whether of the control or the deficient groups. Hearing impaired children were less able to do other static equilibrium tests (heel-toe or one foot or tip-toe standing tests, with opened or closed eyes: tests 10, 12, 16, 20, 24, 25 and 26). The use of detailed neurological semiology allowed us to support the alteration of the static equilibrium in this group of hearing impaired children.Foi constituída amostra aleatória de 42 crianças deficientes auditivas neurossen-soriais congênitas, profundas e bilaterais, com idade cronológica variando entre 4 e 7 anos, que frequentavam classes de habilitação da cidade de Campinas. As crianças propostas foram comparadas) às de dois grupos controles de 42 crianças, da mesma faixa etária, que apresentavam bom rendimento escolar em classe comum. Todas foram submetidas a 9 provas do setor de equilíbrio estático do Exame Neurológico Evolutivo. Verificou-se que, na posição de equilíbrio com olhos abertos, não houve diferença entre os grupos. Na posição de Romberg, foi significativamente menor o número de deficientes auditivos que a realizaram aos 4, 5 e 6 anos; aos 7 anos foi executada por igual número de controles e deficientes auditivos. As demais provas foram realizadas por número significativamente menor de deficientes auditivos nas seguintes posturas: artelho-calcâneo com olhos abertos ou fechados (provas 24 e 25), permanecer num pé só (provas 12 e 16) ou nas pontas dos pés (provas 10 e 16). O uso de semiologia neurológica detalhada permitiu documentar as alterações do equilíbrio estático nesse grupo de crianças deficientes auditivas.34635

Serum sclerostin is an independent predictor of mortality in hemodialysis patients

Background\ud Sclerostin (Scl) has recently emerged as a novel marker of bone remodeling and vascular calcification. However, whether high circulating Scl is also a risk factor for death is not well established. The purpose of this study was to test whether serum Scl would be associated with mortality.\ud \ud \ud Methods\ud we measured serum Scl in a hemodialysis patients’ cohort, which was followed during a ten-year period. Competing risk regression models were applied, as during the follow-up, patients were exposed to both events kidney transplant and death.\ud \ud \ud Results\ud Ninety-one patients aged 42.3 ± 18.8 years (55% of male gender, 15% of diabetes) were included. During the follow-up, 32 patients underwent kidney transplant and 26 patients died. Non-survivals presented higher FGF23, higher Scl and lower creatinine. There was an association between all-cause mortality and higher Scl (HR = 2.2), higher age (HR = 1.04) and presence of diabetes (HR = 2.27), by competing risk analyses. Even including potential markers of mortality, as creatinine, FGF 23, and gender, Scl, age and diabetes remained significantly related to higher mortality.\ud \ud \ud Conclusion\ud Serum Scl is an independent predictor of mortality in dialysis patients. However, whether clinical interventions to modulate Scl would be able to improve these patients survival needs to be determined.Fapes

Agreement between scales for screening and diagnosis of motor development at 6 months

OBJECTIVE: To ascertain the degree of agreement between a score for screening and another for diagnosis of motor development in 6-month old infants and to define the most appropriate cutoff point for screening. METHODS: A sectional study, enrolling asymptomatic full term newborns with gestational ages from 37 to 41 weeks, who were discharged from the maternity unit 2 days after birth and are resident in the Campinas area. Infants were excluded if they presented genetic syndromes, malformations, congenital infections, intensive care admission or low birth weight. The assessment instruments investigated were the Alberta Infant Motor Scale (AIMS) and the Bayley Scales of Infant Development II (BSID-II). Two cutoff points were evaluated for the AIMS, the 5th and 10th percentiles, and for the BSID-II infants were classified according to its motor index score (IS) as having inadequate (IS 85, above the mean minus 1 standard deviation). RESULTS: The study sample comprised 43 infants. Six infants (14.00%) exhibited inadequate motor performance. Using the BSID-II motor classification and the 5th percentile AIMS cutoff, sensitivity was 100%, specificity 78.37%, accuracy 81.39%, kappa index 0.50 and p 85, maior ou igual a menos 1 desvio padrão da média). RESULTADOS: A amostra foi constituída por 43 lactentes. Seis lactentes (14,00%) apresentaram desempenho motor inadequado. Considerando a classificação motora das BSID-II e o percentil 5 da AIMS, obteve-se sensibilidade = 100%, especificidade = 78,37%, acurácia = 81,39%, índice kappa = 0,50 e p < 0,001; considerando a classificação motora das BSID-II e o percentil 10 da AIMS, obteve-se sensibilidade = 100%, especificidade = 48,64%, acurácia = 55,81%, índice kappa = 0,20 e p = 0,025. CONCLUSÕES: Os resultados sugerem boa concordância entre os instrumentos de avaliação no sexto mês. A melhor combinação para os parâmetros analisados é a utilização do percentil 5 da AIMS.47047

Concordância entre escalas de triagem e diagnóstico do desenvolvimento motor no sexto mês de vida

OBJETIVO: Verificar o grau de concordância entre uma escala de triagem e uma de diagnóstico do desenvolvimento motor de lactentes no sexto mês de vida, estabelecendo o ponto de corte mais apropriado para triagem. MÉTODOS: Estudo seccional, incluindo recém-nascidos a termo, com idade gestacional entre 37 e 41 semanas, assintomáticos, que receberam alta da maternidade 2 dias após o nascimento, residentes na região de Campinas. Foram excluídas síndromes genéticas, malformações, infecções congênitas, internações em unidade de terapia intensiva e baixo peso ao nascimento. Os instrumentos de avaliação foram: Alberta Infant Motor Scale (AIMS) e Bayley Scales of Infant Development II (BSID-II). Para a AIMS, foram utilizados dois pontos de corte, percentil 5 ou 10 e, para as BSID-II, foi utilizada a classificação dos lactentes na escala motora conforme a pontuação do index score (IS): desempenho inadequado (IS < 85, abaixo de menos 1 desvio padrão da média) ou desempenho adequado (IS > 85, maior ou igual a menos 1 desvio padrão da média). RESULTADOS: A amostra foi constituída por 43 lactentes. Seis lactentes (14,00%) apresentaram desempenho motor inadequado. Considerando a classificação motora das BSID-II e o percentil 5 da AIMS, obteve-se sensibilidade = 100%, especificidade = 78,37%, acurácia = 81,39%, índice kappa = 0,50 e p < 0,001; considerando a classificação motora das BSID-II e o percentil 10 da AIMS, obteve-se sensibilidade = 100%, especificidade = 48,64%, acurácia = 55,81%, índice kappa = 0,20 e p = 0,025. CONCLUSÕES: Os resultados sugerem boa concordância entre os instrumentos de avaliação no sexto mês. A melhor combinação para os parâmetros analisados é a utilização do percentil 5 da AIMS