RESUMO
BACKGROUND: Acute central nervous system (CNS) complications are common and well described among pediatric patients undergoing haematopoietic cell transplantation (HCT). However, their long-term outcomes are not known. The aim of this study is to describe the incidence, characteristics, and risk factors of long-term epilepsy in pediatric patients with acute CNS complications of HCT. METHODS: This retrospective study included pediatric patients who developed acute CNS complications from autologous or allogeneic HCT between 2000 and 2022. Clinical, therapeutic and prognostic data including long-term outcomes were analyzed. A diagnosis of epilepsy was provided if unprovoked seizures occurred during follow-up. RESULTS: Ninety-four patients (63 males, 31 females, median age 10 years, range 1-21 years) were included. The most common acute CNS complications were posterior reversible encephalopathy syndrome (n = 43, 46 %) and infections (n = 15, 16 %). Sixty-five patients (69 %) had acute symptomatic seizures, with 14 (16 %) having one or more episodes of status epilepticus (SE). Nine patients (9.6 %) were diagnosed with long-term focal epilepsy during the follow-up (5-year cumulative incidence from the acute complication, 13.3 %). Acute symptomatic SE during neurological complications of HCT was associated with an increased risk of long-term epilepsy (OR=14, 95 % CI 2.87-68.97). CONCLUSIONS: A higher occurrence of epilepsy has been observed in our cohort compared to the general population. Acute symptomatic SE during HCT was associated with a higher risk of long-term epilepsy. Pediatric patients with CNS complications during HCT could benefit from specific neurological follow-up. Further studies are needed to characterize mechanisms of epileptogenesis in pediatric patients undergoing HCT.
RESUMO
Dysphonia, characterized by disturbances in voice quality and modulation, has been sporadically observed in individuals with Anorexia Nervosa (AN), potentially stemming from both organic and psychopathological factors. This study seeks to employ software-based voice analysis to compare the voices of girls with AN to those of female healthy controls (HC). Case-control study adopting "Praat" software to assess voices. Various parameters, including Acoustic Voice Quality Index (AVQI), Fundamental Frequency (F0), Yanagihara's Spectrographic Dysphonia Classifications, and "GIRBAS" perceptual qualitative voice rating, were investigated. Participants completed questionnaires for Vocal Fatigue Index (VFI) and the Reflux Symptoms Index (RSI). Puberty-related voice spectrum changes were considered, and Bonferroni-corrected BMI-adjusted Analyses of Covariance (ANCOVAs) were conducted. The study enrolled 15 girls with AN and 23 girls with HC. AN patients demonstrated greater impairment in voice tiredness/voice avoidance (VFI-1, p < 0.001), vocal physical discomfort (VIF-2, p = 0.002), and rest as alleviation (VFI-3, p = 0.012). Reflux-related scores were higher in AN (p < 0.001). Differences were observed in voice quality (AVQI) (p = 0.001), and GIRBAS scales showed alterations in multiple parameters. Spectrograms documented more frequent pathological findings in AN patients (p = 0.021). No difference was observed in Fundamental Frequency. These group (AN/HC) differences were independent of weight measures. This study is the first to connect voice irregularities in AN by employing standardized, non-invasive tools and accounting for weight-related factors. Young AN patients demonstrated substantial voice quality changes and heightened self-reported symptoms. Future research should expand on these findings with prospective designs and invasive investigations.