Hiperglicemia em pacientes pediátricos com traumatismo craniencefálico: estudo de corte transversal

OBJECTIVE: To verify the prevalence of acute hyperglycemia in children with head trauma stratified by the Glasgow coma scale (GCS). METHOD: A prospective cross-sectional study carried out with information from medical records of pediatric patients presenting with head injury in the emergency room of a referral emergency hospital during a one year period. We considered the cut-off value of 150 mg/dL to define hyperglycemia. RESULTS: A total of 340 children were included and 60 (17.6%) had admission hyperglycemia. Hyperglycemia was present in 9% of mild head trauma cases; 30.4% of those with moderate head trauma and 49% of severe head trauma. We observed that among children with higher blood glucose levels, 85% had abnormal findings on cranial computed tomography scans. CONCLUSION: Hyperglycemia was more prevalent in patients with severe head trauma (GCS <8), regardless if they had or not multiple traumas and in children with abnormal findings on head computed tomography scans.OBJETIVO: Verificar a prevalência de hiperglicemia aguda em crianças vítimas de trauma craniencefálico, de acordo com a escala de coma de Glasgow (GCS). MÉTODO: Estudo prospectivo, de corte transversal realizado por meio do acompanhamento de prontuários médicos de pacientes na faixa etária pediátrica admitidos na unidade de urgência de um hospital de referência vítimas de traumatismo craniencefálico, durante um ano. Consideramos o valor de corte em 150 mg/dL para definição de hiperglicemia. RESULTADOS: 340 crianças foram incluídas no estudo e 60 (17,6%) apresentaram hiperglicemia na admissão. Hiperglicemia esteve presente em 9% dos casos de trauma craniano leve, 30,4% daqueles com trauma craniano moderado e em 49% dos pacientes com trauma craniano grave. Verificamos que, entre as crianças com níveis elevados de glicemia, 85% apresentavam alterações radiológicas verificadas na tomografia computadorizada do crânio. CONCLUSÃO: A hiperglicemia foi mais prevalente em pacientes com traumatismo craniano grave (GCS <8), assim como naqueles com alterações identificadas na tomografia computadorizada do crânio, independente da presença de politraumatismo

I SONARÍADE: Debatendo música, linguagem e cérebro

The present work is the result of an initiative by Sonare - Center for Production, Documentation and Music Studies which, with the support of the Federal University of Bahia, mainly through its Music School, managed to materialize the 1st Sonaríade, the first of the series of online events dedicated to debating topics of interest to the music field in a multidisciplinary way, with the participation of invited experts in the various fields of knowledge involved in each opportunity. Thus, welcoming a thematic provocation proposed by Manoel Veiga, the other authors responded accordingly, based on their respective specialties. The text presented here only includes the provocation sent in advance, as well as the presentation sent to the event by Dean Veiga. In order not to betray the spontaneity of the participants and other resources used, the answers presented, as well as the other parts of the online event, were kept in the original audiovisual format and are available through the corresponding links.El presente trabajo es fruto de una iniciativa de Sonare - Centro de Producción, Documentación y Estudios Musicales que, con el apoyo de la Universidad Federal de Bahía, principalmente a través de su Escuela de Música, logró materializar la 1a Sonaríade, la primera de la serie. de eventos online dedicados a debatir temas de interés para el campo de la música de forma multidisciplinar, con la participación de expertos invitados en los distintos campos del conocimiento involucrados en cada oportunidad. Así, acogiendo con satisfacción una provocación temática propuesta por Manoel Veiga, los otros autores respondieron en consecuencia, en función de sus respectivas especialidades. El texto aquí presentado solo incluye la provocación enviada con anticipación, así como la presentación enviada al evento por Dean Veiga. Para no traicionar la espontaneidad de los participantes y demás recursos utilizados, las respuestas presentadas, así como el resto de partes del evento online, se mantuvieron en el formato audiovisual original y están disponibles a través de los enlaces correspondientes. &nbsp;O presente trabalho é resultado da iniciativa do Sonare - Centro de Produção, Documentação e Estudos de Música que, com o apoio da Universidade Federal da Bahia, principalmente através da sua Escola de Música, conseguiu materializar a I Sonaríade, primeiro evento online do SONARE dedicados a debater temas de interesse à área de música de forma multidisciplinar com participação de convidados especialistas nos diversos campos do conhecimento envolvidos em cada oportunidade. Assim, acolhendo uma provocação temática proposta por Manoel Veiga, os demais autores responderam à altura, a partir de suas respectivas especialidades. O texto aqui presente inclui apenas a provocação enviada com antecedência, assim como a apresentação encaminhada ao evento pelo decano Veiga. Visando não trair a espontaneidade dos participantes e demais recursos utilizados, as respostas apresentadas, assim como as outras partes do evento online foram mantidas no formato audiovisual original e se encontram disponíveis através dos links correspondentes

Radiografia simples e tomografia computadorizada do crânio em crianças e adolescentes vítimas de traumatismo craniano leve

OBJECTIVE: To identify which pediatric patients with mild head trauma are candidates for skull radiographs or cranial computed tomography (CCT) scans. METHOD: Patients with mild head trauma aged from 0 to 19 years presenting to the Emergency Department of a trauma centre from Salvador City, Brazil, between May 2007 and May 2008. RESULTS: A total of 1888 mild head trauma patients were admitted; mean age was 7.4 (±5.5) years. A total of 1956 skull radiographs and 734 CCT scans were performed. About 44.4% patients with Glasgow coma score (GCS) 13 and 55.4% with GCS 14 had abnormal CCT scans. In patients with multiple traumas, 16% had abnormal findings on CCT scans. CONCLUSION: We strongly recommend routine CCT studies to patients with GCS of 13 and 14 or to multiple trauma victims, independently of score. Routine screening skull radiographs were not useful in the evaluation of mild head trauma patients in this study.OBJETIVO: Identificar quais os pacientes na faixa pediátrica com trauma craniencefálico leve são candidatos para a realização de radiografia simples ou tomografia computadorizada do crânio (TCC). MÉTODO: Pacientes com trauma craniano leve, entre 0 e 19 anos, admitidos em um centro de referência em traumatologia, na cidade do Salvador, Brasil, entre maio 2007 e maio 2008. RESULTADOS: Foram atendidos 1888 pacientes com trauma craniano leve, com idade média de 7,4 (±5,5) anos. Um total de 1956 radiografias simples e 734 TCC foram realizadas. Em 44,4% dos pacientes com escala de coma de Glasgow (GCS) 13 e 55.4% com GCS 14, tiveram TCC com achados anormais. Em pacientes com múltiplos traumas, 16% possuíam alterações na TCC. CONCLUSÃO: Recomendamos TCC em pacientes com GCS 13 e 14 ou naqueles com traumas múltiplos, independente do GCS. Radiografias simples do crânio como rotina, não foram identificadas como úteis, no presente estudo

Differential aspects of stroke and congestive heart failure in quality of life reduction: a case series with three comparison groups

<p>Abstract</p> <p>Background</p> <p>To assess QOL of patients with stroke in comparison to other groups (caregivers and CHF patients), to identify which items of QOL are more affected on each group and what is the functional profile of patients with stroke.</p> <p>Methods</p> <p>Consecutive stroke or congestive heart failure (CHF) patients were evaluated and compared to their caregivers (caregivers). The NIH Stroke Scale (NIHSS) and EuroQoL-5D (EQ-5D) scale were applied.</p> <p>Results</p> <p>We evaluated 67 patients with stroke, 62 with CHF and 67 caregivers. For stroke patients, median NIHSS score was four. EQ-5D score was significantly worse in stroke, as compared to CHF and caregivers (0.52, 0.69 and 0.65, respectively). Mobility and usual activity domains were significantly affected in stroke and CHF patients as compared to caregivers; and self-care was more affected in stroke as compared with the other two groups.</p> <p>Conclusions</p> <p>Despite a mild neurological deficit, there was a significantly worse QOL perception in stroke as compared to CHF patients, mostly in their perception of self-care.</p

Latin American Consensus Statement for the Use of Contrast-Enhanced Transcranial Ultrasound as a Diagnostic Test for Detection of Right-to-Left Shunt

Background: The role of patent foramen ovale is a field of debate and current publications have increasing controversies about the patients' management in young undetermined stroke. Work up with echocardiography and transcranial Doppler (TCD) can aid the decision with better anatomical and functional characterization of right-to-left shunt (RLS). Medical and interventional strategy may benefit from this information. Summary: a group of experts from the Latin American participants of the Neurosonology Research Group (NSRG) of World Federation of Neurology created a task force to review literature and describe the better methodology of contrast TCD (c-TCD). All signatories of the present consensus statement have published at least one study on TCD as an author or co-author in an indexed journal. Two meetings were held while the consensus statement was being drafted, during which controversial issues were discussed and voted on by the statement signatories. The statement paper was reviewed and approved by the Executive Committee of the NSRG of the World Federation of Neurology. The main objective of this consensus statement is to establish a standardization of the c-TCD technique and its interpretation, in order to improve the informative quality of the method, resulting in expanding the application of TCD in the clinical setting. These recommendations optimize the comparison of different diagnostic methods and encourage the use of c-TCD for RLS screening and complementary diagnosis in multicenter studies