Teleconsultations at a Pediatrics Outpatient Service in COVID-19 Pandemic: First Results.

Objective: Describe our experiences using teleconsultation approach to care for pediatric subspecialty follow-up patients during pandemic period. Methods: Synchronous teleconsultation solution was developed and implemented as a multiplatform/multimodality service, capable or running on desktop browsers and smartphones, and capable to handle chat, audio, and video. Term of consent was applied. Absolute number and percentage of patients assisted, as well as the form of consultation and the mean of attendance per patient were presented. Results: A telemedicine service was started using tools provided by The Santa Catarina State Integrated Telemedicine and Telehealth System offering real-time chat, through an online-based teleconsultation service. We assisted 75 patients in 109 consultations in 3 months, of which 69.7% were performed by chat. Mean of consultations per patient was 1.45. Conclusion: To our knowledge this is the first service in offering this modality of medicine for Brazilian public health care system. Patients and health care personnel reported satisfaction.

Differential Activation of Mitogen-Activated Protein Kinases, ERK 1/2, p38(MAPK) and JNK p54/p46 During Postnatal Development of Rat Hippocampus.

Mitogen-activated protein kinases (MAPKs) are a group of serine-threonine kinases, including p38(MAPK), ERK 1/2 and JNK p54/p46, activated by phosphorylation in response to extracellular stimuli. The early postnatal period is characterized by significant changes in brain structure as well as intracellular signaling. In the hippocampus MAPKs have been involved in the modulation of development and neural plasticity. However, the temporal profile of MAPK activation throughout the early postnatal development is incomplete. An understanding of this profile is important since slight changes in the activity of these enzymes, in response to environmental stress in specific developmental windows, might alter the course of development. The present study was undertaken to investigate the hippocampal differential activation of MAPK during postnatal period. MAPK activation and total content were evaluated by Western blotting of hippocampal tissue obtained from male Wistar rats at postnatal days (P) 1, 4, 7, 10, 14, 21, 30 and 60. The total content and phosphorylation of each MAPK was expressed as mean ± SEM and then calculates as a percentile compared to P1 (set at 100 %). The results showed: (1) phosphorylation peaks of p38(MAPK) at PN4 (p = 0.036) and PN10 to PN60; (2) phosphorylation of ERK1 and ERK2 were increased with age (ERK1 p = 0.0000005 and ERK2 p = 0.003); (3) phosphorylation profile of JNK p54/p46 was not changed during the period analyzed (JNKp56 p = 0.716 and JNKp46 p = 0.192). Therefore, the activity profile of ERK 1/2 and p38(MAPK) during postnatal development of rat hippocampus are differentially regulated. Our results demonstrate that ERK 1/2 and p38(MAPK) are dynamically regulated during postnatal neurodevelopment, suggesting temporal correlation of MAPK activity with critical periods when programmed cell death and synaptogenesis are occurring. This suggests an important role for these MAPKs in postnatal development of rat hippocampus.

Evaluation of the quality of life of children with celiac disease and their parents: a case-control study.

PURPOSE: The purpose of the present study was to evaluate the quality of life (QoL) of children with CD and of their parents and to compare it with that of children without CD and of their parents. METHODS: A case-control study was conducted to evaluate the quality of life of children (5-12 years) with CD and one of their parents, compared to the QoL of children without CD (and their parents as their caregivers ). The QoL was assessed by applying the following questionnaires: AUQUEI (children) and WHOQOL-BREF (parents). RESULTS: QoL was evaluated in 33 children with CD, 63 children without CD, and of their respective parents as their parent caregivers (96 adults). QoL total scores were similar between the groups of children with and without CD. However, in the Leisure dimension, the scores of children with CD were significantly lower than those of the controls (P = 0.029). Similarly, when assessing the QoL of the parents, we found scores significantly lower in the social dimension (P = 0.0196) for parents of children with CD compared to parents of children without CD. Family income presented an impact on the QoL in adults, but did not affect children. In CD group, children of mothers who had lower educational levels presented better scores in the function dimension, regarding self-care and autonomy. CONCLUSIONS: There is an impairment of the QoL of children with CD and of their parents, with regard to social life, particularly in the leisure (children) and social (adults) dimensions.

Fetal ultrasound estimated weight and correlation to Brazilian newborn weight.

Background: To compare the best fetal weight formula with different biometric tables on the weight of Brazilian newborns. Methods: This observational study has tested the performance of different common fetal weight formulas and biometric tables. Weight estimates were performed by the methods of Warsof et al. (1977), Shepard et al. (1982), Hadlock et al. (1985), Furlan et al. (2012) and Stirnemann et al. (2017). The biometric tables selected were the following: Snijders and Nicolaides (1994), Hadlock et al. (1984), Papageorghiou et al. (2014) and Kiserud et al. (2016) and correlated to Pedreira et al. (2011) database, which was considered the gold standard. Statistical analyses were performed using the mean relative error, average absolute error and the Pearson correlation coefficient (r). Results: The best r was found when using the Snijders and Nicolaides (1994) biometric table with weight formula by Stirnemann et al. (2017). The average relative error was lower when using weight formula by Shepard et al. (1982) with biometric tables by Snijders and Nicolaides (1994), Papageorghiou et al. (2014) or Kiserud et al. (2016). On average, absolute error, the lowest r was obtained for the Furlan et al. (2012) weight formula and the Papageorghiou et al. (2014) biometric table. Conclusions: The best correlation was found for biometric table by Snijders and Nicolaides (1994) and fetal weight formula calculation for the estimation of Brazilian newborn weight by Stirnemann et al. (2017).Background: To compare the best fetal weight formula with different biometric tables on the weight of Brazilian newborns. Methods: This observational study has tested the performance of different common fetal weight formulas and biometric tables. Weight estimates were performed by the methods of Warsof et al. (1977), Shepard et al. (1982), Hadlock et al. (1985), Furlan et al. (2012) and Stirnemann et al. (2017). The biometric tables selected were the following: Snijders and Nicolaides (1994), Hadlock et al. (1984), Papageorghiou et al. (2014) and Kiserud et al. (2016) and correlated to Pedreira et al. (2011) database, which was considered the gold standard. Statistical analyses were performed using the mean relative error, average absolute error and the Pearson correlation coefficient (r). Results: The best r was found when using the Snijders and Nicolaides (1994) biometric table with weight formula by Stirnemann et al. (2017). The average relative error was lower when using weight formula by Shepard et al. (1982) with biometric tables by Snijders and Nicolaides (1994), Papageorghiou et al. (2014) or Kiserud et al. (2016). On average, absolute error, the lowest r was obtained for the Furlan et al. (2012) weight formula and the Papageorghiou et al. (2014) biometric table. Conclusions: The best correlation was found for biometric table by Snijders and Nicolaides (1994) and fetal weight formula calculation for the estimation of Brazilian newborn weight by Stirnemann et al. (2017).

Atenção auditiva sustentada em crianças com transtorno de déficit de atenção e hiperatividade: o efeito da medicação / Sustained auditory attention in children with attention deficit hyperactivity disorder: the effects of medication

RESUMO Objetivo Comparar a habilidade atencional auditiva em crianças portadoras de transtorno de déficit de atenção e hiperatividade/impulsividade (TDAH) antes e após o uso da medicação psicoestimulante. Métodos Participaram do estudo oito crianças do gênero masculino, com TDAH, entre 8 e 10 anos de idade. Todas faziam uso de medicamentos psicoestimulantes. Para avaliar o comportamento auditivo, foi aplicado o questionário Scale of Auditory Behaviors (SAB) e para identificar possíveis sintomas de desatenção, o Swanson, Nolan e Pelham (SNAP-IV). A habilidade auditiva atencional foi avaliada pelo Teste de Habilidade de Atenção Auditiva Sustentada (THAAS) pré e pós-uso do medicamento psicoestimulante. Neste teste, foram analisados os erros de desatenção, de impulsividade e de decréscimo de vigilância. A análise dos dados foi feita com base nos testes Wilcoxon e Correlação de Spearman. Resultados O questionário SAB mostrou-se alterado na maior parte das crianças, as quais também apresentaram sinais de desatenção e/ou impulsividade no questionário SNAP-IV. No THASS, observou-se diferença nos quesitos desatenção (p=0,017) e pontuação total de erros pré e pós-medicação (p=0,025). Conclusão Houve melhora no desempenho do teste que avaliou a habilidade atencional auditiva após o uso da medicação psicoestimulante, com destaque para o item desatenção.

ABSTRACT Purpose To compare the auditory attention ability in children with Attention Deficit Hyperactivity Disorder (ADHD) before and after the use of psychostimulant medication. Methods Eight male children with ADHD participated in the study, between eight and ten years old. All participants used psychostimulant drugs. To assess auditory behavior, the Scale of Auditory Behaviors (SAB) and SNAP-IV questionnaires were applied to identify possible symptoms of inattention and/or impulsivity. To assess auditory attention ability, the Sustained Auditory Attention Ability Test (SAAAT) was applied before and after the use of the psychostimulant medication. In this test, the errors of inattention, impulsiveness and decreased vigilance were analyzed. For data analysis, the Wilcoxon and Spearman correlation tests were used. Results The SAB questionnaire showed changes in most children, who also showed signs of inattention and/or impulsivity in the SNAP-IV questionnaire. In the SAAAT, a difference was observed in the item inattention (p=0.017) and in total score of errors before and after medication (p=0.025). Conclusion There was an improvement in the test performance assessing the auditory attention ability after the use of psychostimulant medication, with emphasis on the item inattention.

Dose-dependent sickness behavior, abortion and inflammation induced by systemic LPS injection in pregnant mice.

OBJECTIVE: Clinical and experimental evidences indicate that intrauterine inflammation during pregnancy is associated to brain damage. The objective of this study is to determine the effects of lipopolysaccharide in temperature, cytokine production and sickness behavior of pregnant dams. METHODS: A single i.p. injection of lipopolysaccharide (LPS) (50, 150 or 300 µg/kg) was administered on E18. Controls received isotonic saline. Body temperature was controlled before and 3 h after injections. Animals' behavior was assessed by the OF test 3 h following treatment. Animals were sacrificed for leukocyte, IL-1ß and TNF-α determination. Placental tissue and abortion were also examined. RESULTS: LPS administration elicited hypothermia. Abortion was observed in LPS 150 and 300 µg/kg. Leukocyte levels were significantly lower with LPS 300 µg/kg than in controls. LPS induced dose-dependent impairment in animals' locomotion. IL-1ß serum and amniotic fluid were higher than the saline, and TNF-α serum and amniotic fluid increased when compared to controls. Placental histopathologic abnormality was not found. CONCLUSION: LPS induces dose-dependent sickness behavior and hypothermia in pregnant mice. Our findings suggest that the presence of inflammation may be a causative factor for premature labor and that Escherichia coli antigens modify the concentration of pro-inflammatory agents in circulatory system and intra-uterine environment.

Effects of lifestyle modifications on cognitive impairments in a mouse model of hypercholesterolemia.

Epidemiological studies indicate that high midlife plasma cholesterol levels increases the risk of Alzheimer's disease. Moreover, middle-aged familial hypercholesterolemia (FH) subjects show a particularly high incidence of mild cognitive impairments (MCI). These evidence points to hypercholesterolemia as one of the modifiable risk factors focused on prevention/treatment of cognitive deterioration. The present study draws a comparison between pharmacological (lipid-lowering drug probucol) and non-pharmacological (voluntary running wheel, RW) approaches for the management of hypercholesterolemia and cognitive impairments associated with the low-density lipoprotein receptor-deficient (LDLr(-/-)) mice, a well-established rodent model of FH. We also investigated whether exposure to environmental enrichment (EE), a feasible option to increase physical activity in young mice cohort, from birth to adolescence (PN45) yields long-term behavioral changes in adult LDLr(-/-) mice (PN90). We observed that both probucol and RW significantly decreased total and non-HDL plasma cholesterol levels in LDLr(-/-) mice. Notably, only physical exercise mitigated the spatial memory deficits of LDLr(-/-) mice. In addition, we showed that exposure to EE from birth until the adolescence did not mitigate the spatial memory deficits of adult LDLr(-/-) mice in the object location task, although it induced persistent anxyolitic-like effects in the open field arena. Collectively, our results emphasize the advantages physical exercise, in comparison to lipid-lowering drugs, for the management of cognitive deficits associated with FH.

Epilepsy perception amongst education professionals / Percepção de epilepsia entre profissionais da educação

INTRODUCTION: Epilepsy is a prevalent neurological disorder that may cause school failure due to several factors such as seizure severity, lack of information about the condition and stigma. This study aimed to evaluate the degree of perceived stigma and knowledge towards epilepsy among education professionals, and additionally, provide them correct information about epilepsy to reduce stigma through a training course. METHODS: Social and demographic data, as well as the degree of stigma were obtained through the Stigma Scale of Epilepsy. To estimate the level of educational professionals' knowledge about epilepsy we used the Questionnaire about Epilepsy. Statistical analysis consisted of Pearson's or Spearman's correlation tests for numerical parametric or non-parametric variables were used to determine potential significant associations. A p <0.05 was considered significant. RESULTS: Two hundred and twenty-five education professionals were interviewed in three different cities in Southern Brazil. Approximately 65% of subjects would attempt to open the mouth of a student during a seizure and the stigma measured by Stigma Scale of Epilepsy before the course was 45.4±16.61. CONCLUSION: The data indicate that education professionals have partial knowledge about epilepsy and a short duration course would be able to improve it and reduce its stigma in this population.

INTRODUÇÃO: A epilepsia é uma doença neurológica prevalente que pode causar fracasso escolar devido a fatores como severidade das crises, pouca informação sobre a doença e estigma. Este estudo teve como objetivo avaliar a percepção do estigma e conhecimento em epilepsia pelos profissionais de educação, fornecer informações corretas sobre epilepsia e reduzir o estigma através de um curso de curta duração. METODOLOGIA: Os dados sociodemográficos e o grau de estigma foram obtidos através da Escala de Estigma em Epilepsia. O grau de conhecimento em epilepsia foi obtido através da adaptação do Questionário Sobre Epilepsia. O teste de correlação de Pearson ou Spearman foi utilizado para análise das variáveis numéricas contínuas paramétricas ou não-paramétricas. O valor de p<0,05 foi considerado significante. RESULTADOS: Duzentos e vinte e cinco sujeitos foram entrevistados em três cidades do Sul do Brasil. Aproximadamente 65% deles abriria a boca do estudante durante uma crise e o grau do estigma avaliado com a Escala de Estigma em Epilepsia pré-curso foi de 45.4±16.61. CONCLUSÃO: Os dados indicam que os profissionais da educação têm um conhecimento pacial sobre epilepsia e que um curso de curta duração foi capaz de aumentar o conhecimento e reduzir o estigma na população estudada.

Diagnostico de demanda em servico de atencao primaria a saude / Diagnosis of spontaneous demand of primary health care

Os autores estudaram a demanda espontanea dos Postos de Saude do Corrego Grande, com uma amostra n=10 por 12 meses, encontrando uma populacao atendida com predominancia do sexo feminino de 20 a 50 anos de idade e habitante do local. A populacao demonstrou ainda contentamento em relacao ao tempo de espera e de consulta e sugeriu a ampliacao do servico.