Upper Arm Anthropometry Is Not a Valid Predictor of Regional Body Composition in Preterm Infants

Background: Upper arm anthropometry has been used in the nutritional assessment of small infants, but it has not yet been validated as a predictor of regional body composition in this population. Objective: Validation of measured and derived upper arm anthropometry as a predictor of arm fat and fat-free compartments in preterm infants. Methods: Upper arm anthropometry, including the upper arm cross-sectional areas, was compared individually or in combination with other anthropometric measurements, with the cross-sectional arm areas measured by magnetic resonance imaging, in a cohort of consecutive preterm appropriate-for-gestationalage neonates, just before discharge. Results: Thirty infants born with (mean 8 SD) a gestational age of 30.7 8 1.9 weeks and birth weight of 1,380 8 325 g, were assessed at 35.4 8 1.1 weeks of corrected gestational age, weighing 1,785 8 93 g. None of the anthropometric measurements are reliable predictors (r 2 ! 0.56) of the measurements obtained by magnetic resonance imaging, individually or in combination with other anthropometric measurements. Conclusion: Both measured anthropometry and derived upper arm anthropometry are inaccurate predictors of regional body composition in preterm appropriate-for-gestational-age infants.

Intercorrências da Anestesia Regional em Obstetrícia. Avaliação Retrospectiva

Os autores fizeram uma revisão retrospectiva de 1902 grávidas submetidas a analgesia/anestesia regional no período decorrente de Julho a Dezembro de 2001. Foram detectadas 21 intercorrências relacionadas com a execução da técnica e complicações posteriores. Destaca-se a Punção acidental da dura-mater como intercorrência mais frequente (66%), obrigando a intervenção terapêutica e maior tempo de internamento hospitalar.

Syncope and Intermittent Brugada ECG Pattern

A síndrome de Brugada é uma síndrome rara, com uma prevalência aproximada na Europa de 1-5/10 000 habitantes, mas cuja apresentação clínica inicial pode ser morte súbita. Embora com um padrão eletrocardiográfico típico, este é por vezes intermitente. Os autores apresentam o caso clínico de um doente de sexo masculino, de 32 anos, sem fatores de risco pessoais conhecidos e história familiar de morte súbita, que recorre ao Serviço de Urgência por síncope sem pródromos. O primeiro eletrocardiograma (ECG) em ritmo sinusal documenta a presença de uma elevação isolada e inespecífica do segmento ST em V2. Da restante investigação diagnóstica realizada, salienta-se a repetição do ECG, que revelou a presença de padrão de Brugada tipo 1. Este mesmo padrão é exacerbado posteriormente numa situação de infeção respiratória. O doente foi submetido a estudo eletrofisiológico, seguido de implantação de cardiodesfibrilhador (CDI), tendo tido um episódio de fibrilhação ventricular convertido com choque via CDI 2 meses após a implantação.

Anti-Tumor Necrosis Factor Alpha-Induced Drug Eruptions: One Patient, More Than a Pattern

Background: Tumor necrosis factor alpha (TNFα) antagonists are effective in treating several immune-inflammatory diseases, including psoriasis and inflammatory bowel disease. The paradoxical and unpredictable induction of psoriasis and psoriasiform skin lesions is a recognized adverse event, although of unclear aetiology. However, histological analysis of these eruptions remains insufficient, yet suggesting that some might constitute a new pattern of adverse drug reaction, rather than true psoriasis. Case report: The authors report the case of a 43-year-old woman with severe recalcitrant Crohn disease who started treatment with infliximab. There was also a personal history of mild plaque psoriasis without clinical expression for the past eight years. She developed a heterogeneous cutaneous eruption of psoriasiform morphology with pustules and crusts after the third infliximab infusion. The histopathological diagnosis was of a Sweet-like dermatosis. The patient was successfully treated with cyclosporine in association with both topical corticosteroid and vitamin D3 analogue. Three weeks after switching to adalimumab a new psoriasiform eruption was observed, histologically compatible with a psoriasiform drug eruption. Despite this, and considering the beneficial effect on the inflammatory bowel disease, it was decided to maintain treatment with adalimumab and to treat through with topicals, with progressive control of skin disease. Discussion: Not much is known about the pathogenesis of psoriasiform eruptions induced by biological therapies, but genetic predisposition and Koebner phenomenon may contribute to it. Histopathology can add new facets to the comprehension of psoriasiform reactions. In fact, histopathologic patterns of such skin lesions appear to be varied, in a clear asymmetry with clinical findings. Conclusion: The sequential identification in the same patient of two clinical and histopathologic patterns of drug reaction to TNFα antagonists is rare. Additionally, to the authors’ knowledge, there is only one other description in literature of a TNFα antagonist-induced Sweet-like dermatosis, emphasizing the singularity of this case report.

Técnicas de Anestesia Regional em Cirurgia Ortopédica Pediátrica - Estudo Retrospectivo de 2012

A anestesia regional em ortopedia apresenta vantagens claras na estabilidade hemodinâmica, perfusão do território cirúrgico e analgesia de qualidade superior. o objectivo deste estudo foi avaliar o tipo e frequência de técnicas realizadas no ano de 2012 em anestesia para cirurgia ortopédica pediátrica. Um total de 662 crianças agendadas para cirurgia electiva foram retrospectivamente estudadas no que diz respeito às técnicas regionais utilizadas. Foram realizadas 248 técnicas regionais em 2012. Houve urn predominio de bloqueios do neuro-eixo (63%) em relação aos bloqueios dos nervos periféricos (BNP) (37%). A ultrassonografia foi essencial nos BNP realizados, correspondendoa 75% dos casos. Na anestesia do membro superior os bloqueios mais frequentes foram o bloqueio do plexo braquialvia supra-clavicular (61%) e os BNP na fossa antecubital (23%). No membro inferior os bloqueios mais comuns foram o bloqueio do nervo ciciticopopliteo (41%) e o bloqueio de nervo femoral (35%). Colocaram-se cateteres contínuos de bloqueio de nervo periférico em 5 bloqueios do nervo ciático popliteo. o uso de ecografo tornou-se preponderante para a realização de bloqueios dos nervos periféricos dos membros com as vantagens já amplamente descritas na literatura. Parece haver margem para diminuir o número de técnicas do neuro-eixo em relação a realização de BNP com uma maior taxa de colocação de cateteres contínuos de bloqueio de nervo periférico, diminuindo deste modo a invasibilidade do neuro-eixo. 0 número total de BNP realizados parece claramente satisfatório embora careça de estudos comparativos com outras instituições que o comprove.

Regulatory Cells, Cytokine Pattern and Clinical Risk Factors for Asthma in Infants and Young Children with Recurrent Wheeze

Several risk factors for asthma have been identified in infants and young children with recurrent wheeze. However, published literature has reported contradictory findings regarding the underlying immunological mechanisms. OBJECTIVES: This study was designed to assess and compare the immunological status during the first 2 years in steroid-naive young children with >or= three episodes of physician-confirmed wheeze (n=50), with and without clinical risk factors for developing subsequent asthma (i.e. parental asthma or a personal history of eczema and/or two of the following: wheezing without colds, a personal history of allergic rhinitis and peripheral blood eosinophilia >4%), with age-matched healthy controls (n=30). METHODS: Peripheral blood CD4(+)CD25(+) and CD4(+)CD25(high) T cells and their cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), GITR and Foxp3 expression were analysed by flow cytometry. Cytokine (IFN-gamma, TGF-beta and IL-10), CTLA-4 and Foxp3 mRNA expression were evaluated (real-time PCR) after peripheral blood mononuclear cell stimulation with phorbol 12-myristate 13-acetate (PMA) (24 h) and house dust mite (HDM) extracts (7th day). RESULTS: Flow cytometry results showed a significant reduction in the absolute number of CD4(+)CD25(high) and the absolute and percentage numbers of CD4(+)CD25(+)CTLA-4(+) in wheezy children compared with healthy controls. Wheezy children at a high risk of developing asthma had a significantly lower absolute number of CD4(+)CD25(+) (P=0.01) and CD4(+)CD25(high) (P=0.04), compared with those at a low risk. After PMA stimulation, CTLA-4 (P=0.03) and Foxp3 (P=0.02) expression was diminished in wheezy children compared with the healthy children. After HDM stimulation, CTLA-4 (P=0.03) and IFN-gamma (P=0.04) expression was diminished in wheezy children compared with healthy children. High-risk children had lower expression of IFN-gamma (P=0.03) compared with low-risk and healthy children and lower expression of CTLA-4 (P=0.01) compared with healthy children. CONCLUSIONS: Although our findings suggest that some immunological parameters are impaired in children with recurrent wheeze, particularly with a high risk for asthma, further studies are needed in order to assess their potential as surrogate predictor factors for asthma in early life.