RESUMO
Friedreich ataxia (FA) is caused by GAA repeat expansions in the first intron of FXN, the gene encoding frataxin, which results in decreased gene expression. Thanks to the high degree of frataxin conservation, the Drosophila melanogaster fruitfly appears as an adequate animal model to study this disease and to evaluate therapeutic interventions. Here, we generated a Drosophila model of FA with CRISPR/Cas9 insertion of approximately 200 GAA in the intron of the fly frataxin gene fh. These flies exhibit a developmental delay and lethality associated with decreased frataxin expression. We were able to bypass preadult lethality using genetic tools to overexpress frataxin only during the developmental period. These frataxin-deficient adults are short-lived and present strong locomotor defects. RNA-Seq analysis identified deregulation of genes involved in amino-acid metabolism and transcriptomic signatures of oxidative stress. In particular, we observed a progressive increase of Tspo expression, fully rescued by adult frataxin expression. Thus, Tspo expression constitutes a molecular marker of the disease progression in our fly model and might be of interest in other animal models or in patients. Finally, in a candidate drug screening, we observed that N-acetyl cysteine improved the survival, locomotor function, resistance to oxidative stress and aconitase activity of frataxin-deficient flies. Therefore, our model provides the opportunity to elucidate in vivo, the protective mechanisms of this molecule of therapeutic potential. This study also highlights the strength of the CRISPR/Cas9 technology to introduce human mutations in endogenous orthologous genes, leading to Drosophila models of human diseases with improved physiological relevance.
Assuntos
Acetilcisteína/farmacologia , Sistemas CRISPR-Cas/genética , Ataxia de Friedreich/genética , Proteínas de Ligação ao Ferro/genética , Animais , Modelos Animais de Doenças , Drosophila melanogaster/genética , Ataxia de Friedreich/tratamento farmacológico , Ataxia de Friedreich/patologia , Humanos , Íntrons/genética , Estresse Oxidativo/genética , RNA-Seq , Expansão das Repetições de Trinucleotídeos/genética , FrataxinaRESUMO
Drug binding to human serum albumin (HSA) significantly affects in vivo drug transport and biological activity. To gain insight into the binding mechanism of the two B-Raf tyrosine kinase inhibitors dabrafenib and vemurafenib to HSA, in this work, we adopted a combined strategy based on fluorescence spectroscopy, isothermal titration calorimetry (ITC), circular dichroism (CD), and molecular simulations. Both anticancer drugs are found to bind spontaneously and with a 1:1 stoichiometry within the same binding pocket, located in Sudlow's site II (subdomain IIIA) of the protein with comparable affinity and without substantially perturbing the protein secondary structure. However, the nature of each drug-protein interactions is distinct: whereas the formation of the dabrafenib/HSA complex is more entropically driven, the formation of the alternative vemurafenib/HSA assembly is prevalently enthalpic in nature. Kinetic analysis also indicates that the association rate is similar for the two drugs, whereas the residence time of vemurafenib within the HSA binding pocket is somewhat higher than that determined for the alternative B-Raf inhibitor.
Assuntos
Inibidores de Proteínas Quinases , Albumina Sérica Humana , Sítios de Ligação , Dicroísmo Circular , Humanos , Imidazóis , Cinética , Simulação de Acoplamento Molecular , Oximas , Ligação Proteica , Inibidores de Proteínas Quinases/química , Inibidores de Proteínas Quinases/farmacologia , Albumina Sérica Humana/química , Espectrometria de Fluorescência , Termodinâmica , VemurafenibRESUMO
The translocator protein TSPO is an evolutionary conserved mitochondrial protein overexpressed in various contexts of neurodegeneration. Friedreich Ataxia (FA) is a neurodegenerative disease due to GAA expansions in the FXN gene leading to decreased expression of frataxin, a mitochondrial protein involved in the biosynthesis of iron-sulfur clusters. We previously reported that Tspo was overexpressed in a Drosophila model of this disease generated by CRISPR/Cas9 insertion of approximately 200 GAA in the intron of fh, the fly frataxin gene. Here, we describe a new Drosophila model of FA with 42 GAA repeats, called fh-GAAs. The smaller expansion size allowed to obtain adults exhibiting hallmarks of the FA disease, including short lifespan, locomotory defects and hypersensitivity to oxidative stress. The reduced lifespan was fully rescued by ubiquitous expression of human FXN, confirming that both frataxins share conserved functions. We observed that Tspo was overexpressed in heads and decreased in intestines of these fh-GAAs flies. Then, we further overexpressed Tspo specifically in glial cells and observed improved survival. Finally, we investigated the effects of Tspo overexpression in healthy flies. Increased longevity was conferred by glial-specific overexpression, with opposite effects in neurons. Overall, this study highlights protective effects of glial TSPO in Drosophila both in a neurodegenerative and a healthy context.
Assuntos
Proteínas de Drosophila , Drosophila melanogaster , Frataxina , Proteínas de Ligação ao Ferro , Longevidade , Neuroglia , Animais , Proteínas de Ligação ao Ferro/genética , Proteínas de Ligação ao Ferro/metabolismo , Neuroglia/metabolismo , Proteínas de Drosophila/genética , Proteínas de Drosophila/metabolismo , Drosophila melanogaster/genética , Drosophila melanogaster/metabolismo , Humanos , Modelos Animais de Doenças , Ataxia de Friedreich/genética , Ataxia de Friedreich/metabolismo , Receptores de GABA/genética , Receptores de GABA/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Drosophila/genética , Animais Geneticamente ModificadosRESUMO
BACKGROUND: Although many studies analyse gender differences in the clinical expression of Attention-Deficit Hyperactivity Disorder (ADHD) and prevalence studies show that girls with ADHD are underdiagnosed, there are no instruments that are sensitive to the detection of girls with ADHD. OBJECTIVE: The objective of this study is to develop a self-report early detection instrument for boys and girls with ADHD aged 7 to 16, which includes the gender perspective and is sensitive to the detection of girls with ADHD. METHODS: The scale was developed and the items that comprised it were created from the thematic analysis of ADHD and its evaluation in children based on the diagnostic criteria of the DSM-5-TR. A modified e-Delphi method involving a three-round web survey was used to establish a consensus on the content of the scale. Ten experts were recruited to form a professional panel. The panel members were asked to assess the differential symptomatology of ADHD in boys and girls, the dimensions to be evaluated, and the importance of scale items to evaluate the content. RESULTS: A consensus was reached regarding 13 total items distributed in three dimensions: inattention; hyperactivity/impulsivity; and, a third dimension, internalisation, which includes symptoms most present in the expression of ADHD in girls. CONCLUSIONS: To the best of our knowledge, the development of this scale using the Delphi method is the first specific scale used for identifying ADHD that also addresses the gender perspective and the differential symptomatology between boys and girls. However, we must proceed to the analysis of psychometric properties, as the scale requires an exhaustive study of its reliability and validity. We can anticipate that this scale will provide relevant and reliable information that can be used for the identification of ADHD in both boys and girls.
RESUMO
Two clinically approved anticancer drugs targeting BRAF in melanoma patients - dabrafenib (DAB) and vemurafenib (VEM) - have been successfully encapsulated into nanomicelles formed upon self-assembly of an amphiphilic dendrimer AD based on two C18 aliphatic chains and a G2 PAMAM head. The process resulted in the formation of well-defined (â¼10 nm) core-shell nanomicelles (NMs) with excellent encapsulation efficiency (â¼70% for DAB and â¼60% for VEM) and good drug loading capacity (â¼27% and â¼24% for DAB and VEM, respectively). Dynamic light scattering (DLS), transmission electron microscopy (TEM), small-angle x-ray scattering (SAXS), nuclear magnetic resonance (NMR), isothermal titration calorimetry (ITC), and molecular simulation (MS) experiments were used, respectively, to determine the size and structure of the empty and drug-loaded nanomicelles (DLNMs), along with the interactions between the NMs and their cargoes. The in vitro release data revealed profiles governed by Fickian diffusion; moreover, for both anticancer molecules, an acidic environment (pH = 5.0) facilitated drug release with respect to physiological pH conditions (pH = 7.4). Finally, both DAB- and VEM-loaded NMs elicited enhanced response with respect to free drug treatments in 4 different melanoma cell lines.
Assuntos
Melanoma , Micelas , Humanos , Vemurafenib , Espalhamento a Baixo Ângulo , Difração de Raios X , Melanoma/tratamento farmacológico , Melanoma/patologiaRESUMO
PURPOSE: The aim of this research was to determine whether rigid internal fixation interferes with mandibular growth and development in growing New Zealand white rabbits with induced mandibular fractures. MATERIALS AND METHODS: Ten 3-month-old New Zealand white rabbits were included in the study. Surgical fractures were performed in the right mandibular bodies of the 10 rabbits. These fractures were reduced with internal rigid fixation by use of a 1.0-mm titanium system, taking the contralateral left mandibular bodies as the control group. We obtained radiographs preoperatively and at 1, 2, and 3 months postoperatively. Predetermined cephalometric points were used to measure and compare jaw growth. The protocol was approved by the Bioethics Committee of Universidad El Bosque, Bogotá, Colombia. RESULTS: There were no statistically significant differences between the experimental and control groups (P = .95). Mandibular growth in the studied rabbits was not affected by the use of internal rigid fixation. CONCLUSIONS: The use of internal rigid fixation for the treatment of induced mandibular fractures in growing rabbits did not alter the normal process of growth and development. The findings of this study should lead to investigations using larger samples and to long-term prospective follow-up studies of children who have undergone open reduction and internal rigid fixation.
Assuntos
Fixação Interna de Fraturas/métodos , Mandíbula/crescimento & desenvolvimento , Fraturas Mandibulares/cirurgia , Animais , Materiais Biocompatíveis/química , Placas Ósseas , Parafusos Ósseos , Cefalometria/métodos , Fixação Interna de Fraturas/instrumentação , Mandíbula/diagnóstico por imagem , Fraturas Mandibulares/fisiopatologia , Coelhos , Radiografia , Fatores de Tempo , Titânio/químicaRESUMO
The breast cancer type 1 susceptibility protein (BRCA1) and its partner - the BRCA1-associated RING domain protein 1 (BARD1) - are key players in a plethora of fundamental biological functions including, among others, DNA repair, replication fork protection, cell cycle progression, telomere maintenance, chromatin remodeling, apoptosis and tumor suppression. However, mutations in their encoding genes transform them into dangerous threats, and substantially increase the risk of developing cancer and other malignancies during the lifetime of the affected individuals. Understanding how BRCA1 and BARD1 perform their biological activities therefore not only provides a powerful mean to prevent such fatal occurrences but can also pave the way to the development of new targeted therapeutics. Thus, through this review work we aim at presenting the major efforts focused on the functional characterization and structural insights of BRCA1 and BARD1, per se and in combination with all their principal mediators and regulators, and on the multifaceted roles these proteins play in the maintenance of human genome integrity.
Assuntos
Proteína BRCA1 , Neoplasias , Proteína BRCA1/genética , Proteína BRCA1/metabolismo , Reparo do DNA , Bolsas de Estudo , Humanos , Neoplasias/genética , Proteínas Supressoras de Tumor/genética , Proteínas Supressoras de Tumor/metabolismo , Ubiquitina-Proteína Ligases/genética , Ubiquitina-Proteína Ligases/metabolismoRESUMO
Filamins are large proteins with actin-binding properties. Mutations in FLNC, one of the three filamin genes in humans, have recently been implicated in dominant cardiomyopathies, but the underlying mechanisms are not well understood. Here, we aimed to use Drosophila melanogaster as a new in vivo model to study these diseases. First, we show that adult-specific cardiac RNAi-induced depletion of Drosophila Filamin (dFil) induced cardiac dilatation, impaired systolic function and sarcomeric alterations, highlighting its requirement for cardiac function and maintenance of sarcomere integrity in the adult stage. Next, we introduced in the cheerio gene, using CRISPR/Cas9 gene editing, three missense variants, previously identified in patients with hypertrophic cardiomyopathy. Flies carrying these variants did not exhibit cardiac defects or increased propensity to form filamin aggregates, arguing against their pathogenicity. Finally, we show that deletions of the C-term part of dFil carrying the last four Ig-like domains are dispensable for cardiac function. Collectively, these results highlight the relevance of this model to explore the cardiac function of filamins and increase our understanding of physio-pathological mechanisms involved in FLNC-related cardiomyopathies. This article has an associated First Person interview with the first author of the paper.
Assuntos
Cardiomiopatias , Drosophila , Actinas/metabolismo , Animais , Sistemas CRISPR-Cas , Cardiomiopatias/genética , Cardiomiopatias/metabolismo , Drosophila/metabolismo , Proteínas de Drosophila , Drosophila melanogaster/genética , Drosophila melanogaster/metabolismo , Filaminas/química , Filaminas/genética , Filaminas/metabolismo , Humanos , VirulênciaRESUMO
AIM: To comprehensively describe intellectual and executive functioning (EF) in people with dyskinetic cerebral palsy (DCP), by comparing their performance with that of: 1) age- and sex-matched typically developing controls (TDC); and 2) participants with spastic cerebral palsy (SCP) matched for age, sex, term/preterm and gross motor function classification system (GMFCS). METHOD: This cross-sectional study was conducted by the University of Barcelona in collaboration with five institutions. Participants were people with DCP (n = 52; 24 females, median age 20.5 y: 5mo, interquartile range [IQR] = 13.75 y: 7mo; GMFCS I-V). As comparison groups, participants with SCP (n = 20; 10 females, median age = 20.5 y: 5.5mo, IQR = 13.75 y 9mo; GMFCS I-V) and TDC (n = 52; 24 females, median age = 20 y: 4mo, IQR = 12 y 7mo) were included. Intelligence and EF were assessed using common tests in all participants. RESULTS: Both CP groups had lower intelligence than TDC and performed poorer in almost all EF tasks. Intelligence was higher in DCP than SCP (z = -2.51, p = 0.01). Participants with DCP also performed significantly better in goal-setting tasks (z = 2.27, p = 0.03) and information processing (z = -2.54, p = 0.01) than those with SCP. CONCLUSION: People with DCP present lower general intellectual functioning and poorer EF across multiple domains than typically developing controls. People with DCP have higher general intellectual functioning and better EF than people with SCP when levels of motor severity are similar.
Assuntos
Paralisia Cerebral/psicologia , Função Executiva , Inteligência , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Comportamento Social , Adulto JovemRESUMO
Recently characterized as an immune-mediated channelopaty, Isaacs' syndrome (also known as acquired neuromyotonia) was first described in 1961 in two men with persistent, generalized muscle stiffness, in addition to spontaneous, rapid discharges of motor-unit potentials on electromyography. In the peripheral nervous system, antibodies targeted to voltage-gated potassium channels induce hyperexcitability of motor axons, resulting in signs of muscle stiffness or of pseudomyotonia. A spontaneous burst of single motor-unit activity, and myokymic and neuromyotonic discharges, are the most characteristic features found in electromyography studies. This report describes Isaacs' syndrome in a child, in whom the diagnosis was made by clinical features of acquired, spontaneous muscle overactivity and typical electromyographic findings.
Assuntos
Autoanticorpos/imunologia , Síndrome de Isaacs/diagnóstico , Síndrome de Isaacs/fisiopatologia , Músculo Esquelético/fisiopatologia , Canais de Potássio de Abertura Dependente da Tensão da Membrana/imunologia , Espasmo/etiologia , Adolescente , Fatores Etários , Anticonvulsivantes/uso terapêutico , Carbamazepina/análogos & derivados , Carbamazepina/uso terapêutico , Diagnóstico Diferencial , Eletromiografia , Humanos , Síndrome de Isaacs/imunologia , Masculino , Doença dos Neurônios Motores/imunologia , Doença dos Neurônios Motores/fisiopatologia , Neurônios Motores/imunologia , Músculo Esquelético/imunologia , Músculo Esquelético/inervação , Condução Nervosa/imunologia , Junção Neuromuscular/imunologia , Junção Neuromuscular/fisiopatologia , Espasmo/fisiopatologia , Resultado do TratamentoRESUMO
Friedreich's ataxia (FA) is caused by reduced levels of frataxin, a highly conserved mitochondrial protein. There is currently no effective treatment for this disease, which is characterized by progressive neurodegeneration and cardiomyopathy, the latter being the most common cause of death in patients. We previously developed a Drosophila melanogaster cardiac model of FA, in which the fly frataxin is inactivated specifically in the heart, leading to heart dilatation and impaired systolic function. Methylene Blue (MB) was highly efficient to prevent these cardiac dysfunctions. Here, we used this model to screen in vivo the Prestwick Chemical Library, comprising 1280 compounds. Eleven drugs significantly reduced the cardiac dilatation, some of which may possibly lead to therapeutic applications in the future. The one with the strongest protective effects was paclitaxel, a microtubule-stabilizing drug. In parallel, we characterized the histological defects induced by frataxin deficiency in cardiomyocytes and observed strong sarcomere alterations with loss of striation of actin fibers, along with full disruption of the microtubule network. Paclitaxel and MB both improved these structural defects. Therefore, we propose that frataxin inactivation induces cardiac dysfunction through impaired sarcomere assembly or renewal due to microtubule destabilization, without excluding additional mechanisms. This study is the first drug screening of this extent performed in vivo on a Drosophila model of cardiac disease. Thus, it also brings the proof of concept that cardiac functional imaging in adult Drosophila flies is usable for medium-scale in vivo pharmacological screening, with potent identification of cardioprotective drugs in various contexts of cardiac diseases.
Assuntos
Cardiotônicos/análise , Cardiotônicos/uso terapêutico , Drosophila melanogaster/fisiologia , Avaliação Pré-Clínica de Medicamentos , Ataxia de Friedreich/tratamento farmacológico , Actinas/metabolismo , Animais , Cardiotônicos/farmacologia , Modelos Animais de Doenças , Ataxia de Friedreich/patologia , Proteínas de Ligação ao Ferro/metabolismo , Azul de Metileno/farmacologia , Azul de Metileno/uso terapêutico , Microtúbulos/efeitos dos fármacos , Microtúbulos/metabolismo , Contração Miocárdica/efeitos dos fármacos , Miocárdio/patologia , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/metabolismo , Miosinas/metabolismo , Paclitaxel/farmacologia , Paclitaxel/uso terapêutico , Reprodutibilidade dos Testes , Sarcômeros/metabolismo , Bibliotecas de Moléculas Pequenas , FrataxinaRESUMO
Bilateral segmental neurofibromatosis is a rare condition characterized by the occurrence of neurofibromas and/or café-au-lait spots limited to an area or segment of the body bilaterally. It is caused by a postzygotic mutation in the neurofibromatosis type I gene, resulting in a phenotype of genetic mosaicism. This report describes a case of bilateral segmental neurofibromatosis with multiple nodules sitting on a café-au-lait spot.
Assuntos
Manchas Café com Leite/patologia , Neurofibromatose 1/patologia , Manchas Café com Leite/genética , Criança , Genes da Neurofibromatose 1 , Humanos , Masculino , Mosaicismo , Neurofibromatose 1/genética , FenótipoRESUMO
El cáncer de piel es la neoplasia maligna más frecuente en Uruguay así como a nivel mundial, donde muere una persona cada menos de cuatro días por ésta causa. La medida de prevención primaria más efectiva es tener hábitos de fotoprotección, lo cual se consigue mediante la educación en salud y campañas preventivas. En el presente trabajo se resumen los resultados del examen físico realizado a funcionarios del Hospital de Clínicas en el contexto de la Campaña de Prevención de Cáncer de Piel 2017 y los hábitos y conocimientos de fotoprotección de los mismos. La amplia mayoría de los asistentes considera que cuenta con información suficiente sobre cómo protegerse del sol, que proviene, en un 39% de los casos de la televisión. Aún asi, el 41% de ellos, sólo se protege en ocasiones especiales como viajes y verano y únicamente 3 de los participantes emplea medidas adecuadas. Con respecto a campañas previas, 94% no recordaba otra campaña de prevención de cáncer de piel y era la primera vez que concurría a una el 99% de los individuos, lo que pone en manifiesto la necesidad de reforzar la planificación y ejecución de campañas y medidas efectivas para la promoción y prevención del cáncer de piel en los próximos años a fin de lograr disminuir la incidencia de cáncer de piel que continúa en aumento.
O câncer de pele é a neoplasia maligna mais frequente no Uruguai e no mundo, onde uma pessoa morre a cada menos de quatro dias por essa causa. A medida de prevenção primária mais eficaz é ter hábitos fotoprotetores, o que é alcançado por meio de educação em saúde e campanhas preventivas. Este artigo sintetiza os resultados do exame físico realizado em funcionários do Hospital de Clínicas no contexto da Campanha de Prevenção do Câncer de Pele 2017 e seus hábitos e conhecimentos sobre fotoproteção. A grande maioria das pessoas considera que possui informações suficientes sobre como se proteger do sol, o que ocorre em 39% dos casos de televisão. Ainda assim, 41% deles são protegidos apenas em ocasiões especiais, como viagens e verão, e apenas 3 dos participantes usam medidas adequadas. Com relação às campanhas anteriores, 94% não se lembraram de outra campanha de prevenção do câncer de pele e foi a primeira vez que 99% dos indivíduos compareceram, o que evidencia a necessidade de reforçar o planejamento e a execução de campanhas e medidas eficazes para a promoção e prevenção do câncer de pele nos próximos anos, a fim de reduzir a incidência de câncer de pele que continua a aumentar.
Skin cancer is the most frequent malignancy in Uruguay as well as worldwide, where a person dies every less than four days for this cause. The most effective prevention measure is to have photoprotective habits, which is achieved through health education and preventive campaigns. This paper summarizes the results of the physical examination performed on officials of the Hospital de Clínicas in the context of the 2017 Skin Cancer Prevention Campaign and their habits and knowledge of photoprotection. The vast majority of individuals consider that they have enough information on how to protect themselves from the sun, which comes in 39% of television cases. Still, 41% of them are only protected on special occasions such as trips and summer and only 3 of the participants use adequate measures. With respect to previous campaigns, 94% did not remember another skin cancer prevention campaign and it was the first time that 99% of the individuals attended, which highlights the need to reinforce the planning and execution of campaigns and effective measures for the promotion and prevention of skin cancer in the coming years in order to reduce the incidence of skin cancer that continues to increase.
Assuntos
Humanos , Masculino , Feminino , Adulto , Neoplasias Cutâneas/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Hábitos , Roupa de Proteção/estatística & dados numéricos , Protetores Solares , Uruguai/epidemiologia , Estudos Transversais , Inquéritos Epidemiológicos , Acesso à InformaçãoRESUMO
We report the clinical, biochemical and molecular findings on the first documented patient with 4-hydroxybutyric aciduria (4-HBA, McKusick 271980) from Uruguay. The patient displayed a severe picture and turned out to be homozygous for a mutation (c.1226G < A) previously shown to be associated with null enzyme activity.
Assuntos
Erros Inatos do Metabolismo dos Aminoácidos/genética , Hidroxibutiratos/urina , Succinato-Semialdeído Desidrogenase/deficiência , Succinato-Semialdeído Desidrogenase/genética , Erros Inatos do Metabolismo dos Aminoácidos/diagnóstico , Erros Inatos do Metabolismo dos Aminoácidos/metabolismo , Homozigoto , Humanos , Lactente , Masculino , Mutação de Sentido Incorreto , UruguaiRESUMO
Standard intelligence scales require both verbal and manipulative responses, making it difficult to use in cerebral palsy and leading to underestimate their actual performance. This study aims to compare three intelligence tests suitable for the heterogeneity of cerebral palsy in order to identify which one(s) could be more appropriate to use. Forty-four subjects with bilateral dyskinetic cerebral palsy (26 male, mean age 23 years) conducted the Raven's Coloured Progressive Matrices (RCPM), the Peabody Picture Vocabulary Test-3rd (PPVT-III) and the Wechsler Nonverbal Scale of Ability (WNV). Furthermore, a comprehensive neuropsychological battery and magnetic resonance imaging were assessed. The results show that PPVT-III gives limited information on cognitive performance and brain correlates, getting lower intelligence quotient scores. The WNV provides similar outcomes as RCPM, but cases with severe motor impairment were unable to perform it. Finally, the RCPM gives more comprehensive information on cognitive performance, comprising not only visual but also verbal functions. It is also sensitive to the structural state of the brain, being related to basal ganglia, thalamus and white matter areas such as superior longitudinal fasciculus. So, the RCPM may be considered a standardized easy-to-administer tool with great potential in both clinical and research fields of bilateral cerebral palsy.
Assuntos
Encéfalo/diagnóstico por imagem , Paralisia Cerebral/psicologia , Deficiência Intelectual/psicologia , Adolescente , Adulto , Gânglios da Base/diagnóstico por imagem , Paralisia Cerebral/diagnóstico por imagem , Criança , Feminino , Humanos , Deficiência Intelectual/diagnóstico por imagem , Testes de Inteligência , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Testes Neuropsicológicos , Tálamo/diagnóstico por imagem , Escalas de Wechsler , Substância Branca/diagnóstico por imagem , Adulto JovemRESUMO
INTRODUCTION: Cranio-cervical arterial dissections are a recognized cause of ischemic stroke in childhood, with an approximate incidence of 0.4 to 20%. AIM. To describe a population of children with cranio-cervical arterial dissections, analyzing clinical presentation, risk factors, angiographic findings, evolution and treatment. PATIENTS AND METHODS: A descriptive, retrospective, longitudinal collaborative review (Sant Joan de Deu and Pereira Rossell Children's Hospital), of children one month to 17 years old of age was conducted, during the period of time between 2000 to 2009. RESULTS: Ten cases with arterial dissection were identified, 7 of them were boys and 3 girls. Nine had a traumatism preceding neurological symptoms. Clinical presentation included 5 patients with hemiparesis, 3 with hemicerebelus syndrome, 1 with VI cranial nerve palsy and 1 with intracranial soplus as the only symptom at physical examination. Three of them had seizures, while headache preceding the onset of cerebral ischemic symptoms was founded in 6 of them. Dissection involved anterior circulation in 5 patients and posterior circulation in the other 5. In reference to the localization of arterial compromise 4 patients had intracranial dissections and 6 had extracranial dissections. Anticoagulation therapy was done in 5, antiagregation in 3, and treatment abstention in two. None of them suffered neither complications due to anticoagulation therapy nor dead or recurrent dissections in long term follow up (2 months to 8 years). CONCLUSIONS: Cranio-cervical dissections are a frequent cause of stroke in childhood. Clinical suspicious related to cranio-cervical traumatisms and subsequent neurological symptoms should be high.
Assuntos
Dissecação da Artéria Carótida Interna/complicações , Dissecação da Artéria Carótida Interna/patologia , Acidente Vascular Cerebral/etiologia , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/patologia , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Dissecação da Artéria Carótida Interna/etiologia , Angiografia Cerebral , Criança , Pré-Escolar , Traumatismos Craniocerebrais/complicações , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/etiologiaRESUMO
Se presentan los casos clínicos de dos niños previamente sanos con hemoptisis sin repercusión hemodinámica, en quienes se arribó al diagnóstico de malformación arteriovenosa mediante arteriografía. Se realizó tratamiento médico mediante embolización del lecho vascular patológico, siendo favorable la evolución clínica, con resolución de la enfermedad subyacente y alta temprana a domicilio, sin complicaciones. La arteriografía permitió realizar un diagnóstico temprano, así como la prevención de nuevas complicaciones.
Two cases of previously healthy children who suffered hemoptysis without hemodynamic compromise are presented. An underlying arteriovenous malformation by arteriography was identified in both cases. Endovascular treatment was performed using selective bronchial artery embolectomy of the anomalous vessels with an excellent recovery of both patients with no further complications. Arteriography played a vital role in early diagnosis and treatment avoiding new complications.
Assuntos
Humanos , Masculino , Feminino , Criança , Embolização Terapêutica , Hemoptise/etiologia , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/terapia , AngiografiaRESUMO
Resumen El déficit de succínico semialdehído deshidrogenasa es una enfermedad rara cuya alteración en la vía catabólica del ácido aminobutírico (principal neurotransmisor del sistema nervioso central) impide el paso de ácido succínico semialdehído a ácido succínico, condicionando un aumento de ácido 4 hidroxibutírico en líquido cefalorraquídeo y plasma, lo que permite la detección de la enfermedad. La clínica es muy inespecífica, pudiendo presentar desde retraso psicomotor, hipotonía, convulsiones y ataxia no progresiva, hasta trastornos de conducta con crisis de ansiedad y rasgos autistas. Los hallazgos a nivel electroencefalográfico incluyen enlentecimiento del ritmo de base, con descargas epileptiformes focales o generalizadas. En la neuroimagen, en tanto, pueden hallarse frecuentemente hiperintensidades bilaterales y simétricas en T2, a nivel del núcleo pálido. Si bien el tratamiento con vigabatrina teóricamente inhibe la formación de succínico semialdehído con la consecuente reducción de los niveles de ácido 4 hidroxibutírico, no existe al momento actual un tratamiento efectivo para todos los casos. El principal objetivo de este artículo es presentar un paciente con deficiencia de succínico semialdehído deshidrogenasa, debido a su excepcionalidad, con solamente 350 casos identificados en el mundo, siendo el primer caso diagnosticado en Uruguay.
Summary Succinic semialdehyde dehydrogenase deficiency is a rare disorder of the catabolic pathway of gamma-aminobutyric acid, the major central nervous system inhibitory neurotransmitter. Because of such deficiency, transamination of gamma-aminobutyric acid to succinic semialdehyde is shunted towards the production of 4-hydroxybutyric acid, a neurotoxic metabolite which becomes abundant in physiologic fluids which allows the detection of the disorder. Clinical features are not specific and consist of psychomotor retardation, seizures, hypotonia and non progressive ataxia. Electroencephalographic finding include background slowing and generalized or focal epileptiform discharges. Magnetic resonance imaging reveals in most of the cases, increased T2-weighted signal of the globus pallidi bilaterally and symmetrically. Eventhough vigabatrin should theoretically inhibit the formation of succinic semialdehyde and therefore 4-hydroxybutyric acid, to date there is no effective treatment for succinic semialdehyde dehydrogenase deficiency. Due to its uniqueness, the main objective of this article is to present a patient with succinic semialdehyde dehydrogenase deficiency, with only 350 cases identified worldwide.
RESUMO
En la odontología moderna el uso de un material de obturación implica, que éste proporcione características que convenzan tanto al odontólogo como al paciente. Son estas , la estética, funcionalidad, fácil manejo, durabilidad, biocompatibilidad y prevención. Por estos se han desarrollado varios materiales de obturación a partir de la amalgama, pasando por resinas y ionómeros y, finalmente logrando un compómero. Este último, se realizó después de haber analizado las características benéficas de las resinas y los ionómeros como son la resistencia y la liberación de fluor principalmente. Es mercado bajo la marca comercial de (DYRACT). El propósito de este estudio, fue comparar la efectividad de los compómeros y de la amalgama en detención temporal en cuanto a retención, microfiltración y tiempo operativo. Se realizó un estudio longitudinal controlado a 6 meses en 18 pacientes en edad escolar. Los procedimientos de operatoria se diseñaron en el maxilar superior e inferior en molares temporales que requerían obturaciones clase I y II en el mismo paciente. Se controlaron todas las variables mensualmente, durante seis meses. Los resultados mostrados que no hay diferencia estadísticamente significativa en cuanto a la retención y el tiempo operativo, entre el compómero y la amalgama, pero sí se presentaron diferencias estadísticamente significativas en cuanto a microfiltración, observando un mejor comportamiento del compómero frente a la amalgama.
Assuntos
Compômeros , Materiais Dentários , Estudos LongitudinaisRESUMO
En la odontología moderna, el uso del material de obturación implica, que éste proporcione características que convenzan tanto al odontólogo como al paciente. Son estas, la estética, funcionalidad, fácil manejo, durabilidad, biocompatibilidad y prevención. Por esto se han desarrollado varios materiales de obturación a partir de la amalgama, pasando por ionómeros y resinas y finalmente logrando un compómero. Este último, se realizó después de haber analizado las características benéficas de las resinas y los ionómeros como son la resistencia y la liberación de fluor principalmente. El propósito de este estudio, fue comparar la efectividad de los compomeros y de la amalgama en dentición temporal en cuanto a retención, microfiltración y tiempo operatorio. Se realizó un estudio longitudinal controlado a 6 meses en 18 pacientes en edad escolar. Los procedimientos de operatoria se diseñaron en el maxilar superior e inferior en molares temporales que requieran obturaciones clase I y 11 en un mismo paciente. Se controlaron todas las variables mensualmente, durante seis meses. Los resultados mostraron que no hay diferencia estadísticamente significativa en cuanto a retención y tiempo operatorio, entre el compómero y la amalgama, pero si presentaron diferencias estadísticamente significativas en cuanto a microfiltración, observando un mejor comportamiento del compómero frente a la amalgama