Electrocardiographic and Autonomic Nervous System Changes after Changes in the Posture of Children and Adolescents with Duchenne Muscular Dystrophy. / Alterações Eletrocardiográficas e do Sistema Nervoso Autônomo com a Mudança de Postura em Crianças e Adolescentes com Distrofia Muscular de Duchenne.

BACKGROUND: Duchenne Muscular Dystrophy (DMD) is a rare inherited neuromuscular disease. At first, cardiac involvement may be asymptomatic. Therefore, assessing patients using non-invasive methods can help detect any changes. OBJECTIVES: Analyze the electrocardiogram (ECG) test and heart rate variability (HRV) of the DMD group and compare the information with that of the age-matched control group. METHODS: A prospective study with 27 male patients with DMD (11.9 years old), who underwent clinical evaluation, ECG, echocardiogram, and Holter monitoring. ECG (200% increase) was assessed by two independent observers. HRV was measured over time (24 h) and in the frequency domain, in the supine and sitting positions. The healthy group consisted of nine patients (11.0 years old). A value of p < 0.05 was considered statistically significant. RESULTS: The mean ejection fraction (EF) was 60% (34 to 71%). The Kappa coefficient for ECG measurements ranged from 0.64 to 1.00. An increase in the R/S ratio in V1 was observed in 25.9% of the subjects, pathological Q wave in 29.6%, and fragmented QRS in 22.2% in inferior/high lateral regions, with a negative correlation with EF (p = 0.006). There was low HRV, without the influence of any variable, including treatment. With the change in position, there was an increase in HR (p = 0.004), but there was no change in HRV. The LF/HF ratio was 2.7 in the DMD group and 0.7 in the control group (p = 0.002). CONCLUSIONS: In DMD subjects, prominent R waves in V1 and changes in the inferior/high lateral regions occurred in almost 30% of the cases. Lower vagal tone was observed without the influence of the variables age, ejection fraction, QT dispersion, and treatment. Despite the increase in HR, there was no adequate HRV response to the change in position.

FUNDAMENTO: Distrofia Muscular de Duchenne (DMD) é uma doença neuromuscular hereditária rara. O acometimento cardíaco inicial pode ser assintomático. Portanto, a avaliação por métodos não invasivos pode auxiliar sua abordagem. OBJETIVOS: Analisar o eletrocardiograma (ECG) e a variabilidade da frequência cardíaca (VFC) do grupo com DMD, e comparar com a do grupo controle pareado por idade. MÉTODOS: Estudo prospectivo com 27 pacientes masculinos com DMD (idade de 11,9 anos) que foram submetidos à avaliação clínica, ECG, ecocardiograma e Holter. ECG (aumento de 200%) foi avaliado por dois observadores independentes. VFC foi feita no domínio do tempo (24 h) e da frequência na posição supina e sentada. O grupo saudável foi de nove pacientes (11,0 anos). Um valor de p < 0,05 foi considerado estatisticamente significante. RESULTADOS: A média da fração de ejeção (FE) foi de 60% (34 a 71%). O coeficiente de Kappa para as medidas do ECG variou de 0,64 a 1,00. Foram verificados aumento da relação R/S em V1 em 25,9%, onda Q patológica em 29,6% e QRS fragmentado em 22,2% em regiões inferior/lateral alta, este com correlação negativa com FE (p = 0,006). Houve baixa VFC, sem influência de nenhuma variável, inclusive tratamento. Com a mudança da posição, houve aumento da FC (p = 0,004), porém não houve alteração da VFC. A relação LF/HF foi de 2,7 na DMD e de 0,7 no controle (p = 0,002). CONCLUSÕES: Nos participantes com DMD, as ondas R proeminentes em V1 e alterações nas regiões inferior/lateral alta ocorreram em quase 30% dos casos. Houve menor tônus vagal sem influência das variáveis idade, fração de ejeção, dispersão do QT e tratamento. Apesar do aumento da FC, não houve resposta adequada da VFC com a mudança de posição.

Double-lumen Aortic Arch: Persistence of the Fifth Aortic Arch?

Abstract Double-lumen aortic arch is a rare congenital anomaly related to persistence of the fifth aortic arch. It may be found alone or in association with other anatomical changes of the heart. We report a case of double-lumen aortic arch associated with coarctation of the aorta and patent ductus arteriosus in a child with a congenital malformation known as the VACTERL association (vertebral defects, imperforate anus, cardiopathy, tracheoesophageal fistula, renal abnormalities and limb anomalies).

Fibroadenoma in axillary accessory breast: a case report

The mass are among the possible alterations observed in the axilla. When found, the most frequent differential diagnosis are lymphadenopathy, metastatic lymphadenomegaly, lymphoma, lipoma or tumors in the apocrine glands. Besides that, the presence of accessory breast tissue must also be considered and, as the topical breast tissue, can be the target of breast diseases, either benign or malignant. Female patient, 23 years old, with the presence of hardened palpable node in the right axilla. At the ultrasound, it presented characteristics that classified it as Bi-Rads® 4. An aspiration biopsy of the node was performed with fine-needle, which resulted in unsatisfying material. After the explanation of the therapeutic choices, the patient opted for the excision of the axillary node. The anatomical pathological result showed a nodular formation compatible with fibroadenoma. The occurrence of a node in the axillary region is common. However, in the vast majority of times, it is merely an inflammatory response, manifested as a lymphadenomegaly. In case of chronic mass with suspicious characteristics, it is convenient to suspect the presence of lymphoid neoplasms, locoregional metastasis of breast cancer or melanoma and alterations in accessory breast tissue. In young patients, it is important to evaluate the existence of accessory breast tissue with the presence of suspicious axillary node, because, although controversial, some authors believe that such alterations occur more frequently in these patients. Additionally, in cases of inconclusive imaging, an excision of the lesion must be performed for a definite diagnosis.

Routine mammography: an opportunity for the diagnosis of chronic degenerative diseases? A cross-sectional study.

OBJECTIVE: The aim of this study was to evaluate breast arterial calcification (BAC) detected on routine mammography, analyzing its association with chronic degenerative disease. MATERIALS AND METHODS: This was a cross-sectional study involving women treated at a specialized outpatient clinic for high-risk hypertension, diabetes, or chronic kidney disease, as well as volunteers who participated in a study to validate a method of screening for occult renal disease. A total of 312 patients between 40 and 69 years of age, with no history of breast cancer, all of whom had undergone routine mammography in the last two years, were included. The mammograms were analyzed by researchers who were unaware of the risk factors for BAC in each case. RESULTS: The mean age was 55.9 ± 7.4 years, and 64.3% of the patients were white. The mean glomerular filtration rate was 41.87 ± 6.23 mL/min/1.73 m2. Seventy-one patients (22.8%) had BAC. We found that BAC was associated with advanced age, hypertension, diabetes, chronic kidney disease, and low glomerular filtration rate. In the multivariate analysis, advanced age and diabetes continued to be associated with BAC. The odds ratio for BAC was higher for all chronic diseases. CONCLUSION: The association of BAC with advanced age, hypertension, diabetes, chronic kidney disease, and low glomerular filtration rate should call the attention of radiologists. Therefore, the presence of BAC should be reported, and patients with BAC should be screened for those diseases.

OBJETIVO: O objetivo deste estudo foi avaliar calcificações arteriais mamárias (CAMs) detectadas em mamografia de rotina e analisar sua associação com doenças crônicas degenerativas. MATERIAIS E MÉTODOS: Estudo transversal com mulheres atendidas em um ambulatório especializado para tratamento de hipertensão de alto risco, diabetes ou doença renal crônica, bem como as voluntárias que participaram de um estudo para validar um escore para triagem de doença renal crônica oculta. Trezentas e doze pacientes entre 40 e 69 anos de idade, sem histórico de câncer de mama, com mamografia realizada nos últimos dois anos foram incluídas. Os pesquisadores, que desconheciam os fatores de risco para CAMs, analisaram as mamografias de rotina. RESULTADOS: A média de idade foi 55,9 ± 7,4 anos, 64,3% brancas. A média da taxa de filtração glomerular foi 41,87 ± 6,23 mL/min/1,73 m2. Setenta e uma participantes (22,8%) apresentavam CAMs. Houve associação entre CAMs e idade, hipertensão, diabetes, doença renal crônica e taxa de filtração glomerular. Na análise multivariada, idade e diabetes persistiram associadas a CAMs. O odds ratio entre CAMs versus doenças crônicas foi elevado. CONCLUSÃO: Houve associação entre CAMs com a idade, hipertensão, diabetes, doença renal crônica e taxa de filtração glomerular. Esta associação chama a atenção do radiologista/clínico, para que a presença dessas alterações deva ser relatada, e essas doenças devam ser triadas nestes pacientes.

Routine mammography: an opportunity for the diagnosis of chronic degenerative diseases? A cross-sectional study / Mamografia de rotina: oportunidade para o diagnóstico de doenças crônicas degenerativas? Um estudo transversal

Abstract Objective: The aim of this study was to evaluate breast arterial calcification (BAC) detected on routine mammography, analyzing its association with chronic degenerative disease. Materials and Methods: This was a cross-sectional study involving women treated at a specialized outpatient clinic for high-risk hypertension, diabetes, or chronic kidney disease, as well as volunteers who participated in a study to validate a method of screening for occult renal disease. A total of 312 patients between 40 and 69 years of age, with no history of breast cancer, all of whom had undergone routine mammography in the last two years, were included. The mammograms were analyzed by researchers who were unaware of the risk factors for BAC in each case. Results: The mean age was 55.9 ± 7.4 years, and 64.3% of the patients were white. The mean glomerular filtration rate was 41.87 ± 6.23 mL/min/1.73 m2. Seventy-one patients (22.8%) had BAC. We found that BAC was associated with advanced age, hypertension, diabetes, chronic kidney disease, and low glomerular filtration rate. In the multivariate analysis, advanced age and diabetes continued to be associated with BAC. The odds ratio for BAC was higher for all chronic diseases. Conclusion: The association of BAC with advanced age, hypertension, diabetes, chronic kidney disease, and low glomerular filtration rate should call the attention of radiologists. Therefore, the presence of BAC should be reported, and patients with BAC should be screened for those diseases.

Resumo Objetivo: O objetivo deste estudo foi avaliar calcificações arteriais mamárias (CAMs) detectadas em mamografia de rotina e analisar sua associação com doenças crônicas degenerativas. Materiais e Métodos: Estudo transversal com mulheres atendidas em um ambulatório especializado para tratamento de hipertensão de alto risco, diabetes ou doença renal crônica, bem como as voluntárias que participaram de um estudo para validar um escore para triagem de doença renal crônica oculta. Trezentas e doze pacientes entre 40 e 69 anos de idade, sem histórico de câncer de mama, com mamografia realizada nos últimos dois anos foram incluídas. Os pesquisadores, que desconheciam os fatores de risco para CAMs, analisaram as mamografias de rotina. Resultados: A média de idade foi 55,9 ± 7,4 anos, 64,3% brancas. A média da taxa de filtração glomerular foi 41,87 ± 6,23 mL/min/ 1,73 m2. Setenta e uma participantes (22,8%) apresentavam CAMs. Houve associação entre CAMs e idade, hipertensão, diabetes, doença renal crônica e taxa de filtração glomerular. Na análise multivariada, idade e diabetes persistiram associadas a CAMs. O odds ratio entre CAMs versus doenças crônicas foi elevado. Conclusão: Houve associação entre CAMs com a idade, hipertensão, diabetes, doença renal crônica e taxa de filtração glomerular. Esta associação chama a atenção do radiologista/clínico, para que a presença dessas alterações deva ser relatada, e essas doenças devam ser triadas nestes pacientes.

Perfil das usuárias de um banco de leite humano, em Juiz de Fora, MG / Characteristics of mothers attended at a human milk bank, in Juiz de Fora, MG

Com objetivo de conhecer o perfil socioeconômico das mães usuárias do Banco de Leite Humano (BLH) de Juiz de Fora, MG, assim como suas motivações e demandas, quando na busca pelos serviços oferecidos pela institui- ção, realizou-se uma pesquisa transversal, aplicada, de objetivo exploratório, realizada no BLH, na qual foram avaliados 47 binômios mãe-filhos que buscaram o serviço. A maioria das mães era casada, possuía nível médio ou superior, emprego com direitos trabalhistas e realizou o pré- -natal, em serviço de saúde privado. O aleitamento materno exclusivo foi adotado pela maioria dos binômios (62%) e orientado por profissionais de saúde em 66%. Houve baixa prevalência de procura pelo BLH por usuárias de serviço público (23%). A procura ao BLH foi motivada por problemas associados ao aleitamento, em sua maioria (85,1%). Assim, o estudo indica como ação importante para as equipes das unidades de Atenção Primária intensificar a orientação à população de gestantes e puérperas em direção à busca aos serviços do BLH, tanto como forma de promoção do aleitamento materno e apoio ao mesmo nessa população, quanto para possível captação de doadoras.

To identify the socioeconomic profile of the mothers who sought care at the Human Milk Bank, in Juiz de Fora, MG, as well as their motivations and needs when seeking the services offered by the institution. A cross-sectional, applied, exploratory study was conducted at the milk bank, where 47 mother-child pairs who sought the Milk bank services were assessed. It was noted that the majority of the mothers were married, had a secondary or higher level of education, had a job with labor rights, and had done prenatal care in a private health service. Exclusive breastfeeding was adopted by most of the motherchild pairs analyzed (62%), mostly guided by health care professionals (66%). There was a low prevalence of mothers seeking milk bank care by users of the public service (23%). The demand for the milk bank was mostly motivated by problems associated with breastfeeding (85.1%). Thus the study shows that teams of primary care units should intensify their guidance to expectant and post-partum mothers to seek out the milk bank services, both to promote breastfeeding in this population and to identify potential human milk donors.