Reversible posterior encephalopathy syndrome in a 10-year-old child / Síndrome da encefalopatia reversível posterior em uma criança de 10 anos

Abstract Introduction: The posterior reversible encephalopathy (PRES) syndrome encompasses a set of clinical-radiological findings associated with severe systemic arterial hypertension. This case report proposes to discuss the identification, diagnosis, and management of PRES in the pediatric population. Case presentation: Female patient, 10 years old, admitted to the emergency room with complaint of oliguria and generalized edema. At the initial physical exam, the only alteration present was anasarca. The diagnostic investigation revealed nephrotic syndrome, and clinical treatment was started. She evolved on the 8th day of hospitalization with peak hypertension, sudden visual loss, reduced level of consciousness, nystagmus, and focal seizures requiring intubation. She was transferred to the Intensive Care Unit, with neurological improvement, after the established therapy. CT scan revealed a discrete hypodense area in the white matter of the occipital lobe and anteroposterior groove asymmetry, compatible with PRES. Discussion: PRES is due to vasogenic cerebral edema of acute or subacute installation. Symptoms include headache and altered consciousness, stupor, coma, neurological deficits, seizures and cortical blindness. Nephropathies are the main cause of PRES in pediatrics. Magnetic resonance imaging with diffusion of molecules is the gold standard for diagnosis. The initial treatment objectives are the reduction of blood pressure, antiepileptic therapy, correction of hydroelectrolytic and acid-base disorders and management of intracranial hypertension. Conclusion: PRES is associated with acute hypertension. Early diagnosis and proper management may determine a better prognosis and minimize the severity of the clinical course.

Resumo Introdução: A Síndrome de Encefalopatia Posterior Reversível (SEPR) engloba um conjunto de achados clínico-radiológicos, associados a hipertensão arterial sistêmica grave. Este relato de caso propõe discutir a identificação, o diagnóstico e o manejo de SEPR na população pediátrica. Apresentação do caso: Paciente do sexo feminino, 10 anos, admitida em pronto-atendimento com queixa de oligúria e edema generalizado. Ao exame físico inicial, a única alteração presente era anasarca. A investigação diagnóstica revelou síndrome nefrótica, iniciando-se tratamento clínico. Evoluiu no 8º dia de internação com pico hipertensivo, perda visual súbita, redução do nível de consciência, nistagmo e crises convulsivas focais, demandando intubação. Foi transferida para Unidade de Terapia Intensiva, com melhora neurológica, após a terapêutica instituída. Tomografia de crânio evidenciou área de hipodensidade discreta em substância branca do lobo occipital e assimetria anteroposterior de sulcos, compatível com SEPR. Discussão: A SEPR decorre de edema cerebral vasogênico de instalação aguda ou subaguda. Sintomas descritos incluem cefaleia e alteração de consciência, estupor, coma, déficits neurológicos, convulsões e cegueira cortical. As nefropatias constituem as principais causas de SEPR em pediatria. A ressonância magnética com difusão de moléculas é o padrão-ouro para o diagnóstico. Os objetivos iniciais são a redução dos níveis pressóricos, terapia antiepiléptica, correção de distúrbios hidroeletrolíticos e do equilíbrio ácido-básico, e manejo da hipertensão intracraniana. Conclusão: A SEPR ocorre associada à hipertensão aguda. O diagnóstico precoce e manejo adequado podem determinar melhor prognóstico e minimizar a gravidade do curso clínico.

Reversible posterior encephalopathy syndrome in a 10-year-old child.

INTRODUCTION: The posterior reversible encephalopathy (PRES) syndrome encompasses a set of clinical-radiological findings associated with severe systemic arterial hypertension. This case report proposes to discuss the identification, diagnosis, and management of PRES in the pediatric population. CASE PRESENTATION: Female patient, 10 years old, admitted to the emergency room with complaint of oliguria and generalized edema. At the initial physical exam, the only alteration present was anasarca. The diagnostic investigation revealed nephrotic syndrome, and clinical treatment was started. She evolved on the 8th day of hospitalization with peak hypertension, sudden visual loss, reduced level of consciousness, nystagmus, and focal seizures requiring intubation. She was transferred to the Intensive Care Unit, with neurological improvement, after the established therapy. CT scan revealed a discrete hypodense area in the white matter of the occipital lobe and anteroposterior groove asymmetry, compatible with PRES. DISCUSSION: PRES is due to vasogenic cerebral edema of acute or subacute installation. Symptoms include headache and altered consciousness, stupor, coma, neurological deficits, seizures and cortical blindness. Nephropathies are the main cause of PRES in pediatrics. Magnetic resonance imaging with diffusion of molecules is the gold standard for diagnosis. The initial treatment objectives are the reduction of blood pressure, antiepileptic therapy, correction of hydroelectrolytic and acid-base disorders and management of intracranial hypertension. CONCLUSION: PRES is associated with acute hypertension. Early diagnosis and proper management may determine a better prognosis and minimize the severity of the clinical course.

O vírus Epstein-Barr e a mononucleose infecciosa / Epstein-Barr virus and infectious mononucleosis

JUSTIFICATIVA E OBJETIVOS: A mononucleose infecciosa (MI) é uma doença viral, contagiosa, causada pelo vírus Epstein-Barr (EBV). Apresenta distribuição universal e pode ocorrer em qualquer faixa etária. O presente estudo teve como objetivo descrever a interação entre o EBV e o Homo sapiens sapiens, no que diz respeito especialmente à MI. Para isso, realizou busca no Pubmed e no Scielo, bem como em livros-textos. Os artigos selecionados foram lidos e as informações organizadas de forma a contemplar os aspectos patogênicos - enfatizando o papel do EBV na doença -, epidemiológicos e diagnósticos dessa entidade. CONTEÚDO: A infecção do epitélio da orofaringe permite a replicação do vírus, o qual passa a ser eliminado na saliva, o que explica a transmissão pelo contato com tal fluido biológico. O período de incubação é de quatro a seis semanas. Manifesta-se do ponto de vista clínico, usualmente, com febre, faringite e linfadenomegalia generalizada de caráter agudo ou subagudo. As alterações laboratoriais incluem leucocitose, reações leucemoides, trombocitopenia e anemia hemolítica autoimune, além de aminotransferases elevadas e bilirrubina aumentada, destacando-se que a linfocitose atípica é habitualmente observada. O diagnóstico diferencial da MI abrange as demais causas de síndrome de mononucleose. O tratamento é sintomático, não havendo fármaco antiviral específico. Analgésicos habituais podem ser usados para a terapêutica da dor. CONCLUSÃO: Díspares grupos têm trabalhando no desenvolvimento de vacinas para o EBV, porém, a possibilidade de tumorigênese pelo vírus tem trazido inúmeras dificuldades para a confecção de imunoprofilaxia efetiva.

BACKGROUND AND OBJECTIVES: Infectious mononucleosis (IM) is a widespread viral disease caused by Epstein-Barr virus (EBV). It occurs worldwide and can reach any age group. This article aims at describing the interaction between EBV and Homo sapiens sapiens, regarding especially IM. Thus, a research on PubMed and Scielo was performed, as well as on books. The selected articles were read and the information was organized inorder to contain the pathological - emphasizing the role of EBV on the disease -, epidemiological aspects and its diagnosis. CONTENTS: The infection of the epithelium of the oropharynx leads to the replication of the virus, which is eliminated via saliva, and accounts for the transmission through contact with this biological fluid. The incubation period lasts from four to six weeks. Clinically, the classic symptoms are usually fever, faryngitis and generalized lymphadenopathy, which can be acute or subacute. The laboratorial changes include leukocytosis, leukemoid reactions, thrombocytopenia and severe autoimmune hemolytic anemia, besides high levels of transaminases and bilirubin; atypical lymphocytosis is usually observed. The differential diagnosis of IM includes the other causes of mononucleosis syndrome. Treatment is symptomatic and there is not a specific antiviral medicine. Common analgesics can be used to treat pain. CONCLUSION: Diverse groups have worked on the development of a vaccine for EBV; however, the possibility of tumorigenesis by the virus has brought up several difficulties to the production of an effective immunoprophylaxis.

Infecção por Clostridium tetani no recém-nascido: revisão sobre o tétano neonatorum / Clostridium tetani infections in newborn infants: a tetanus neonatorum review

A despeito de ser uma doença imunoprevenível, o tétano permanece ceifando vidas em diferentes regiões do planeta. Se para a doença de origem acidental a ocorrência de novos casos reflete a insuficiente imunização da população, no caso do tétano neonatorum o problema tem dupla natureza: a precária cobertura vacinal dos adultos e as dificuldades de acesso ao pré-natal de qualidade, situação agudizada pela extrema gravidade da moléstia nesta faixa etária, cuja letalidade pode chegar a 80 por cento. Deste modo, ainda que seja importante o reconhecimento precoce do tétano no recém-nato para seu pronto e adequado tratamento, o aspecto de maior relevância é, indubitavelmente, a implementação de adequadas medidas de profilaxia e controle. Com base nestas premissas, propõe-se, neste artigo, uma atualização sobre o tétano neonatorum, enfatizando-se, com mais vigor, o tratamento e a prevenção da moléstia.

Although tetanus is a preventable disease by vaccination, it continues to claim lives around the world. Whereas cases of accidental origin reflect insufficient population immunization, tetanus neonatorum reveals a double-nature fault-poor vaccination coverage of adults coupled with difficulties accessing appropriate prenatal care; this situation is aggravated by the extreme severity of tetanus in this age group in which the mortality rate can reach up to 80 percent. The early detection of tetanus in neonates is essential for immediately initiating the proper therapy. Therefore, although reaching an early diagnosis of tetanus is important, the most relevant aspect is related to the appropriate management and prophylaxis of this disease. Consequently, the aim of this article is to review neonatorum tetanus with an emphasis on its therapy and prevention.

Clostridium tetani infections in newborn infants: a tetanus neonatorum review. / Infecção por Clostridium tetani no recém-nascido: revisão sobre o tétano neonatorum.

Although tetanus is a preventable disease by vaccination, it continues to claim lives around the world. Whereas cases of accidental origin reflect insufficient population immunization, tetanus neonatorum reveals a double-nature fault-poor vaccination coverage of adults coupled with difficulties accessing appropriate prenatal care; this situation is aggravated by the extreme severity of tetanus in this age group in which the mortality rate can reach up to 80%. The early detection of tetanus in neonates is essential for immediately initiating the proper therapy. Therefore, although reaching an early diagnosis of tetanus is important, the most relevant aspect is related to the appropriate management and prophylaxis of this disease. Consequently, the aim of this article is to review neonatorum tetanus with an emphasis on its therapy and prevention.

Regioselectivity in aromatic Claisen rearrangements.

Theoretical calculations and the isomeric product composition for a series of eight meta-substituted allyl aryl ethers confirm the reliability of a new (1)H NMR methodology used to predict aromatic Claisen regioselectivity from ground-state conformational preference of the reactant allyloxy group. Frontier HOMO-LUMO intramolecular orbital interactions, a classical approach in predicting reactivity and selectivity for Claisen rearrangements of allyl vinyl ethers, is shown to fail to mimic transition-state orbital interactions for aromatic Claisen rearrangements of meta-substituted allyl aryl ethers. B3LYP/6-31G(d,p) calculations on reactants and transition states are shown, however, to correctly predict the outcome of such aromatic Claisen rearrangements from either the preferential reactant ground-state conformation (theoretical predictions that agree with the NMR measurements) or the less energetic transition state, or both.