RESUMO
Traumatic brain injury (TBI) is the main cause of pediatric trauma death and disability worldwide. Recent studies have sought to identify biomarkers of TBI for the purpose of assessing functional outcomes. The aim of this systematic review was to evaluate the utility of TBI biomarkers in the pediatric population by summarizing recent findings in the medical literature. A total of 303 articles were retrieved from our search. An initial screening to remove duplicate studies yielded 162 articles. After excluding all articles that did not meet the inclusion criteria, 56 studies were gathered. Among the 56 studies, 36 analyzed serum biomarkers; 11, neuroimaging biomarkers; and 9, cerebrospinal fluid (CSF) biomarkers. Most studies assessed biomarkers in the serum, reflecting the feasibility of obtaining blood samples compared to obtaining CSF or performing neuroimaging. S100B was the most studied serum biomarker in TBI, followed by SNE and UCH-L1, whereas in CSF analysis, there was no unanimity. Among the different neuroimaging techniques employed, diffusion tensor imaging (DTI) was the most common, seemingly holding diagnostic power in the pediatric TBI clinical setting. The number of cross-sectional studies was similar to the number of longitudinal studies. Our data suggest that S100B measurement has high sensitivity and great promise in diagnosing pediatric TBI, ideally when associated with head CT examination and clinical decision protocols. Further large-scale longitudinal studies addressing TBI biomarkers in children are required to establish more accurate diagnostic protocols and prognostic tools.
Assuntos
Lesões Encefálicas Traumáticas , Imagem de Tensor de Difusão , Biomarcadores , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Criança , Estudos Transversais , Humanos , PrognósticoRESUMO
INTRODUCTION: Adverse childhood experiences (ACEs) can negatively affect children's current and future health. OBJECTIVES: This study aims to analyse the impact of ACE on the health of 12-month-old infants assessed by a Physical Health and Maternal Care Indicator (ISCM). METHODS: We conducted a retrospective cohort including 170 infants born in two public services for high-risk births in Brazil. ISCM gathers information that reflects maternal care and the child's health throughout the first year of life, such as vaccination, nutrition, growth, illnesses and accidents. The ACE impact on ISCM was analysed by multiple linear regression, and the d-Cohen test estimated its effect size. Spearman's correlation was used to analyse the cumulative ACE effect, measured by a score reflecting events such as family dysfunction, maternal mental health, poverty and exposure to violence. RESULTS: Most infants were born prematurely (71.7%), had low birthweight (64.7%) and were exposed to three ACEs on average. The ISCM was lower in children exposed to maternal depression (P < 0.001, d-Cohen = 0.08), substance abuse by family members (P = 0.02, d-Cohen = 0.6) and marital conflicts (P = 0.03, d-Cohen = 0.7). The Spearman's correlation showed that the greater the exposure to ACEs, the lower the ISCM (r = -0.40, P < 0.0001). CONCLUSION: Exposure to ACE, especially in the family environment, had negative effect on maternal care and child health. The impact could be detected in the first year of life and had cumulative effect. Our findings indicate the need for a broader approach to child health to minimize ACE's impacts.
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Experiências Adversas da Infância , Maus-Tratos Infantis , Criança , Maus-Tratos Infantis/psicologia , Saúde da Criança , Família , Humanos , Lactente , Saúde Mental , Estudos RetrospectivosRESUMO
BACKGROUND: In adult chronic kidney disease (CKD) patients, there is a positive association between inflammation and progressive renal dysfunction. Higher levels of soluble receptors of tumor necrosis factor (sTNFR) have been related to worst prognosis of adult CKD patients. Therefore, the present study aimed to evaluate soluble TNF receptors in children and adolescents with CKD and to search for an association with clinical and laboratory features. METHODS: Demographic, clinical, anthropometric, and laboratory data were evaluated in 34 pediatric patients with CKD and in 34 healthy sex- and age-matched controls. Blood samples were collected in both groups to measure sTNFR by enzyme-linked immunosorbent assay. The modified Schwartz formula was used to estimate glomerular filtration rate (GFR). RESULTS: Pediatric patients with CKD had significantly higher plasma concentrations of soluble TNF receptors types 1 and 2 (sTNFR1 and sTNFR2) in comparison to sex- and age-matched healthy controls. Plasma levels of sTNFR1 and sTNFR2 increased progressively as renal function worsened, being inversely and significantly correlated with GFR (r = - 0.853 for sTNFR1 and GFR, r = - 0.729 for sTNFR2 and GFR). CONCLUSIONS: Children and adolescents with CKD exhibited higher plasma levels of sTNFR1 and sTNFR2 than healthy controls, which increased in relation to renal function deterioration. Plasma levels of sTNFR1 and sTNFR2 emerge as markers of progressive CKD in pediatric patients.
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Rim/fisiopatologia , Receptores Tipo II do Fator de Necrose Tumoral/sangue , Receptores Tipo I de Fatores de Necrose Tumoral/sangue , Insuficiência Renal Crônica/diagnóstico , Índice de Gravidade de Doença , Adolescente , Biomarcadores/sangue , Criança , Estudos Transversais , Progressão da Doença , Feminino , Taxa de Filtração Glomerular/fisiologia , Voluntários Saudáveis , Humanos , Masculino , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/fisiopatologiaRESUMO
Objectives. To evaluate the association between inflammatory biomarkers, neurotrophic factors, birth conditions, and the presence of motor development abnormalities in preterm neonates. Methods. Plasma and urinary levels of cytokines (IL-1ß, IL-6, IL-10, TNF, and IL-12p70), chemokines (CXCL8/IL-8, CCL2/MCP-1, CCL5/RANTES, CXCL10/IP-10, and CXCL9/MIG), and neurotrophic factors (BDNF and GDNF) were evaluated in 40 preterm neonates born between 28 and 32 incomplete weeks of gestation, at four distinct time points: at birth (umbilical cord blood) (T0), at 48 (T1), at 72 hours (T2), and at 3 weeks after birth (T3). Biomarkers levels were compared between different time points and then associated with Test of Infant Motor Performance (TIMP) percentiles. Results. Maternal age, plasma, and urinary concentrations of inflammatory molecules and neurotrophic factors were significantly different between groups with normal versus lower than expected motor development. Higher levels of GDNF were found in the group with lower than expected motor development, while IL-1ß and CXCL8/IL-8 values were higher in the group with typical motor development. Conclusion. Measurements of cytokines and neurotrophic factors in spot urine may be useful in the follow-up of motor development in preterm neonates.
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Biomarcadores/urina , Fator Neurotrófico Derivado de Linhagem de Célula Glial/urina , Recém-Nascido Prematuro , Interleucina-1beta/urina , Adolescente , Adulto , Biomarcadores/sangue , Quimiocinas/sangue , Quimiocinas/urina , Citocinas/sangue , Citocinas/urina , Feminino , Idade Gestacional , Fator Neurotrófico Derivado de Linhagem de Célula Glial/sangue , Humanos , Recém-Nascido , Inflamação , Interleucina-1beta/sangue , Interleucina-8/sangue , Interleucina-8/urina , Masculino , Idade Materna , Fatores de Crescimento Neural/sangue , Fatores de Crescimento Neural/urina , Gravidez , Estudos Prospectivos , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Chronic kidney disease (CKD) is a risk factor for psychosocial impairment and psychiatric symptoms. Children and adolescents on dialysis frequently have compromised daily life activities and a worse quality of life (QoL) compared with healthy peers. However, few studies have investigated these aspects of CKD in pediatric pre-dialysis CKD patients. Therefore, we have analyzed resilience, QoL and anxiety and depressive symptoms in children and adolescents with pre-dialysis CKD and compared these to the values of healthy controls. METHODS: Demographic and clinical data were collected from 28 children and adolescents with pre-dialysis CKD and 28 healthy sex- and age-matched controls. Psychological assessment of the participants was performed using the Wagnild and Young Resilience Scale, Pediatric Quality of Life (QoL) Inventory 4.0 , Child Depression Inventory and Self-report for Childhood Anxiety Related Disorders scales. RESULTS: Of the 56 children enrolled in our study, the CKD patients were referred to mental health professionals more frequently than the controls. Patients exhibited higher scores for separation anxiety and a higher frequency of clinically significant depressive symptoms. They also had lower overall QoL scores, as well as poorer scores for the psychological, educational and psychosocial subdomains of QoL instruments. There was a negative correlation between anxiety and depressive symptoms and all domains of QoL. Resilience was similar in both groups, but lower in patients with significant depressive symptoms. No significant association was found between clinical or laboratory findings and psychological variables in CKD patients. CONCLUSION: Although patients and controls exhibited similar scores of resilience, CKD negatively impacted the QoL of pediatric patients, contributing to a higher frequency of depression and separation anxiety.
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Transtornos de Ansiedade/psicologia , Transtorno Depressivo/psicologia , Qualidade de Vida/psicologia , Diálise Renal/psicologia , Insuficiência Renal Crônica/psicologia , Resiliência Psicológica , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Insuficiência Renal Crônica/terapia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Enuresis is associated with attentional and emotional comorbidities in 20 to 30 % of cases. The Short Screening Instrument for Psychological Problems in Enuresis (SSIPPE) is a questionnaire that allows the initial screening of these comorbidities. This study aimed to translate, culturally adapt, and validate the SSIPPE for Brazilian children and adolescents (SSIPPE-Br). METHODS: Six steps were performed for translation and cross-cultural adaptation: translation, synthesis of translations, back-translation, preparation of the pre-final version of the translated instrument, test of comprehensibility of the pre-final version of the tool, and elaboration of the instrument cross-culturally adapted for Brazil, named 13-itens version SSIPPE-Br. To validate the SSIPPE-Br, a cross-sectional study was carried out, in which the validated Brazilian version of the Child and Adolescent Behavior Inventory (CABI) was used. RESULTS: Validation was performed on 127 children and adolescents with a mean age of 9.7 ± 2.8 years, 48 % male. The reliability was estimated using Cronbach's alpha, ranging from 0.86 to 0.89, indicating good internal consistency. The factorial analysis had a good agreement adjustment (KMO 0.755, Bartlett's test < 0.001) and explained 70.5 % of the data variability. In the reproducibility analysis, the Kappa coefficient ranged from 0.94 to 1, which can be considered almost perfect. A highly significant (p-value < 0.001) and direct correlation existed between the three SSIPPE-Br domains and all evaluated CABI domains. CONCLUSION: The SSIPPE-Br is a valid and reliable tool for emotional problems screening and ADHD symptoms in children and adolescents with enuresis whose first language is Brazilian Portuguese.
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Comparação Transcultural , Enurese Noturna , Criança , Adolescente , Humanos , Masculino , Feminino , Brasil , Reprodutibilidade dos Testes , Estudos Transversais , Inquéritos e Questionários , Traduções , PsicometriaRESUMO
BACKGROUND: An exacerbated systemic inflammatory response has been associated with the occurrence of central nervous system injuries that may determine, in long term, motor, sensorial and cognitive disabilities. Persistence of this exacerbated inflammatory response seems to be involved in the pathophysiology of cerebral palsy (CP). METHODS: A systematic search was conducted in Bireme, Embase, PubMed and Scopus including studies that were published until August 2019. The key words used were "cerebral palsy", "brain injury", "inflammation", "oxidative stress", "cytokines", "chemokines", "neuropsychomotor development", "neurodevelopment outcomes" and "child". The quality of the eligible studies was determined according to the criteria suggested by the Newcastle-Ottawa Scale (NOS). RESULTS: Fourteen eligible studies aimed to investigate the association between peripheral inflammatory molecules and neurodevelopment in infants. The studies differed regarding CP-related risk factors and its classification. Inflammatory proteins were measured in blood, plasma, serum, cerebrospinal fluid or urine. In ten studies, higher circulating levels of cytokines, including IL-1ß, IL-6, TNF and CXCL8/IL-8, were associated with abnormal neurological findings. CONCLUSION: The investigation of the potential association between inflammatory molecules and neurological development in children with CP requires further original studies in order to clarify the influence of prenatal and perinatal inflammation on neurological outcomes.
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Paralisia Cerebral/metabolismo , Citocinas/metabolismo , Inflamação/metabolismo , Biomarcadores , Humanos , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Interleucina-8/metabolismo , Estresse Oxidativo , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Abstract Objective: Enuresis is associated with attentional and emotional comorbidities in 20 to 30 % of cases. The Short Screening Instrument for Psychological Problems in Enuresis (SSIPPE) is a questionnaire that allows the initial screening of these comorbidities. This study aimed to translate, culturally adapt, and validate the SSIPPE for Brazilian children and adolescents (SSIPPE-Br). Methods: Six steps were performed for translation and cross-cultural adaptation: translation, synthesis of translations, back-translation, preparation of the pre-final version of the translated instrument, test of comprehensibility of the pre-final version of the tool, and elaboration of the instrument cross-culturally adapted for Brazil, named 13-itens version SSIPPE-Br. To validate the SSIPPE-Br, a cross-sectional study was carried out, in which the validated Brazilian version of the Child and Adolescent Behavior Inventory (CABI) was used. Results: Validation was performed on 127 children and adolescents with a mean age of 9.7 ± 2.8 years, 48 % male. The reliability was estimated using Cronbach's alpha, ranging from 0.86 to 0.89, indicating good internal consistency. The factorial analysis had a good agreement adjustment (KMO 0.755, Bartlett's test < 0.001) and explained 70.5 % of the data variability. In the reproducibility analysis, the Kappa coefficient ranged from 0.94 to 1, which can be considered almost perfect. A highly significant (p-value < 0.001) and direct correlation existed between the three SSIPPE-Br domains and all evaluated CABI domains. Conclusion: The SSIPPE-Br is a valid and reliable tool for emotional problems screening and ADHD symptoms in children and adolescents with enuresis whose first language is Brazilian Portuguese.
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Before 2007, Zika virus (ZIKV) was generally considered as an arbovirus of low clinical relevance, causing a mild self-limiting febrile illness in tropical Africa and Southeast Asia. Currently, a large, ongoing outbreak of ZIKV that started in Brazil in 2015 is spreading across the Americas. Virus infection during pregnancy has been potentially linked to congenital malformations, including microcephaly. In addition to congenital malformations, a temporal association between ZIKV infection and an increase in cases of Guillain-Barré syndrome is currently being observed in several countries. The mechanisms underlying these neurological complications are still unknown. Emerging evidence, mainly from in vitro studies, suggests that ZIKV may have direct effects on neuronal cells. The aim of this study was to critically review the literature available regarding the neurobiology of ZIKV and its potential neuropsychiatric manifestations.
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Ataxia/induzido quimicamente , Cannabis/efeitos adversos , Cocaína Crack/efeitos adversos , Demência/induzido quimicamente , Transtornos Relacionados ao Uso de Substâncias/complicações , Ataxia/patologia , Encéfalo/patologia , Demência/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Adulto JovemRESUMO
Neuropsychiatric symptoms are frequently associated to renal dysfunction and may compromise negatively the clinical course as well as the quality of life, and the functional status of the patients. The neuropsychiatric disorders associated with renal disease may present various forms according to the natural history of the disease, and remain underdiagnosed and undertreated. There are few data in the literature regarding the treatment of these patients, and a lot of controversies still exist. The objective of this paper is to describe the most frequent neuropsychiatric disorders in patients with renal diseases.