The demographic and epidemiologic transition observed over the past 20 years in several countries, as well as the magnitude of the incidence and prevalence of childhood leukemia, have attracted the interest of various researchers and been the subject of extensive epidemiological studies. In Brazil, however, childhood cancer statistics have not been analyzed in much depth in the literature, even though data are available, such as those collected in the Mortality Information System (Sistema de Informação sobre Mortalidade, SIM) maintained by the Brazilian Ministry of Health (Departamento de Informática do Sistema Único de Saúde – DATASUS, 1998) 11 .
4. Adair LS, Fall CHD, Osmond C, Stein AD, Mar- torell R, Ramirez-Zea M, et al. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet 2013; 382:525-34.
Acute ataxia is a relatively common presentation to pediatric emergency departments or pediatric neurology clinics. It is characterized by motor incoordination of fewer than 72-hours duration in a previously healthy child and is usually most prominently seen in the child’s movements, such as walking and picking up objects. . Acute cerebellar ataxia is the most common cause of acute ataxia inchildhood, accounting for 30- 50% of all cases . It is characterized by the sudden onset of ataxia following a viral infection, usually varicella [2,3]. How- ever, other infectious agents including Epstein Barr virus (EBV), mumps, Legionella pneumophila, hepatitis A, inluenza, herpes simplex, enterovirus, parvovirus B19, rubeola, and mycoplasma pneumoniae are also associated with acute cerebellar ataxia [1,4]. Acute cerebellar ataxia usually results from postinfectious cerebellar demyelination; it less commonly occurs as a result of direct infection of the cerebellum. Postinfectious cerebellar demyelination is thought to be an autoimmune phenomenon in- cited by infection or immunization . The diferential diagnosis of acute cerebellar ataxia is broad. It is a diagnosis of exclusion ater other serious conditions including posterior fossa tumors, neuroblastoma (opsoclonus-myoclonus syndrome), acute hem- orrhage, drug intoxications, acute labyrinthitis, and metabolic diseases (Hartnup disease, Maple syrup urine disease) have been ruled out . In this study, we aim to analyze all cases of acute cerebellar ataxia presented to our pediatric neurology clinic in order to characterize the clinical features, etiology, and prognosis of the disease and to propose a diagnostic approach to acute ataxia in children.
In 2013 approximately 6.2 million children under the age of five died worldwide, and 3 million of these deaths occurred in Sub-Saharan Africa (SSA) . In 2009, the World Health Organiza- tion (WHO) estimated that if global vaccine coverage increased to 90% by 2015, then approxi- mately two million deaths of children under the age of five would be prevented . In the Sub- Saharan African country Uganda, vaccine coverage rates remain well below the WHO goal of 90%, with 82% of children receiving the measles vaccine and 78% completing the three dose series of pentavalent vaccine providing protection against diphtheria, tetanus, pertussis, hepati- tis B, and Haemophilis influenza type B (DPT-HB-Hib) in 2013 . One recent study demon- strated that the western region of Uganda, where this study was conducted, has the lowest rate of complete childhood vaccination in the country . Immunizations are a key strategy for reducing the prevalence of infectious diseases, and especially in under-resourced areas, immu- nizations are a highly cost-effective foundation for developing health systems to invest in .
Children may have difficulty verbalizing their feelings or may even deny that they are depressed. Thus, special attention should be given to observable manifestations such as changes in sleep patterns, irritability, poor academic performance, and social withdrawal. 13 For the longitudinal assessment of mood symptoms, it may be useful to adopt a mood diary or timelines, and use special dates like birthdays, holidays or school holidays as anchors. Mood is recorded ranging from very happy to very sad/angry; in addition, stressful events and possible treatments should also be registered. The use of time- lines can be extremely valuable in identifying triggers, in assessing treatment response, and in the identification of possible manic or hypomanic episodes (especially in the differentiation of these in relation to return to euthymia). 13 The diagnostic assessment of depressive disorders can make use of formal procedures such as structured/ semi-structured interviews or rating scales. In addition to general interviews to assess mental disorders in child- hood and adolescence (e.g., the Schedule for Affective Disorders and Schizophrenia for School-Age Children [K- SADS] and the Development and Well-Being Assessment [DAWBA]), specific instruments have been developed for the assessment of depressive symptoms in children and adolescents. Among the specific scales more frequently used worldwide and available in Brazilian versions are the Children’s Depression Rating Scale (CDRS), the Children’s Depression Inventory (CDI), and the Kutcher Adolescent Depression Scale (KADS).
Benign acute childhood myositis should be part of the broad differential diagnosis of a child unable to walk/bear weight. Although potentially alarming, it is self-limited with an excellent prognosis. Recognition of this rare clinical entity by the emergency physician is essential to prevent unnecessary invasive testing and hospital admission.
Despite its relevance, the third axis, the fantasy of real, was not targeted by the two teachers for investment in educational activities, as was evidenced in the first interview with them. Teacher Sonia only worked with this axis when she told the children stories, and Beatrice claimed to sometimes work with fantasy and imagination, however, could not specify exactly how she did this. At the beginning of the activities, we observed that in the context of the proposed tasks the children had dif- ficulties in entering the world of fantasy and imagination. One situation illustrates this reality particularly well: Leo, a student at Unesp, dressed up as Santa Claus to develop an activity, and Peter, a student in Beatrice’s room, turned to him and said: “What are you doing? Are you crazy? Why are you dressed as a woman?” In order to address these difficulties, the lessons were planned carefully, seeking strategies to better work with this axis.
To date, over 87 chromosome partners of MLL have been described with diverse func- tions and variable function domains, and 51 of the presumptive gene partners of MLL have been cloned and analyzed at the molec- ular level (11). This marked promiscuity raises the question of whether the diverse partners contribute with common functions or have different effects in leukemogenesis. MLL partners can be divided into two groups. First, the nuclear fusion partners, including AF4, AF9, AF10, ENL, ELL, AF17, and others, which are associated with different aspects of transcriptional regulation. The other group is mainly cytoplasmic and fre- quently associated with cytoskeleton-de- pendent signal transduction, including AF6, Septin 6, ABI-1, EEN, and so on (17). Al- though the fusion partners display many dif- ferent features, all of them delete a large 3' portion of the MLL gene and connect the remaining part with the corresponding part- ner and, regardless of whether the fusion partner itself is nuclear or cytoplasmic, the MLL chimeric proteins consistently form punctuated patterns in the nucleus (18), indi- cating that the localization of the fusion
Though used occasionally, systemic therapies in severe childhood psoriasis have not been systematically investigated. Cyclosporin A (CysA) is effective in adults with severe psoriasis but there are no extensive data regarding the efficacy and safety of its use inchildhood psoriasis. In this paper, we describe six children aged between 11 months and 13 years (average: 7.6 years) treated with CysA microemulsion formulation for severe psoriasis, who had been unresponsive to other treatments. The CysA dose ranged from 2 to 4 mg/kg/day, for periods varying from 8 to 105 weeks (mean: 54 weeks). Dose tapering was gradual after lesion improvement and adjusted according to clinical response. Adjuvant therapy with topical steroids, vitamin D3 ointments, coal tar preparations or anthralin was used in all children. Acitretin was used in three patients for short periods. The children were regularly monitored for serum renal and liver function and blood pressure. Improvement of skin lesions was achieved after between 4 and 30 (mean: 12) weeks of treatment, with complete remission in three children. Relapse of lesions occurred in the other children during CysA reduction, but they responded to a dose increase. The treatment was found to be well tolerated and with no significant side-effects. CysA can be used in carefully selected and monitored patients and may represent an alternative tool for severe episodes of psoriasis in children, when other therapies are unsuccessful.
The authors show that, despite the advances in cancer therapies, alarming short and long-term side effects associated with radiation exposure have been observed in association with treatments and diagnostic tests. Survivors were exposed to several late effects, such as hypothyroidism, GH deficiency, obesity, diabetes mellitus, infertility, hearing loss, different organ dysfunctions, such as lung, heart, kidney and bladder, in addition to development of a second neoplasm. Thus, we emphasize the importance of early and regular follow-up of patients exposed to radiation during childhood, even at low doses, in order to enable diagnosis and treatment of these side effects, leading to better quality of life.
Results : More than 50% reduction in the seizure frequency was observed in 62 of the 86 (72.1%) patients; 44 patients (51.1%) became seizure free, while the seizure frequency increased in 5.8% patients. The associations between seizure reduction rate and age, associated diseases, seizure types, and seizure frequency before treatment were not significant. However, the duration of disease, dose of levetiracetam, duration and frequency of anticonvulsant administration before levetiracetam therapy were significantly correlated. Electroencephalogram findings and the cause of epilepsy showed partial correlation. Forty (46%) patients showed adverse symptoms; the symptoms in the order of their frequency were somnolence, hyperactivity, irritability, aggressiveness, tiredness, etc.
Results: The questionnaires were performed to 150 students and 60 % of them were female. The mean age was 19.04±1.28 (17-26 years). The emotional (p=0.025), physical (p=0.004) and sexual (p=0.001) abuse of male students were signiicantly higher than female students. The emotional (p=0.009) and total (p=0.026) abuse of students who had families with lower income levels were signiicantly high. Also the frequency of emotional abuse in students with divorced parents was signiicantly in- creased (p=0.012).
The association of obesity with low SES is less pronounced than with that of high SHR. Low SES (manual parental-occupation) inchildhood was associated with an increased risk of obesity in adulthood among Portuguese women, but this is not independent of other factors and is explained by women’s education level. Parents with manual occupations may have fewer material resources to offer a better education and offer less stimuli compared with those with non-manual occupations. Inversely, the non- manual parental occupation may lead to more years of schooling of children. In contrast, age explains the association between early life SES and adiposity among men. Since this is a cross-sectional study we are not able to disentangle age from birth cohort. Older birth cohorts are more likely to have had low SES in early life due to historical reasons, and are more likely to be obese at present due to the trend for adiposity to increase with age.
Large Vestibular Aqueduct (LVA) is known as the most common form of inner ear anomaly and it may be radiologically diagnosed using temporal bone computed tomography (CT scan) and inner ear Magnetic Resonance Imaging (MRI). Non-syndromic sensorineural hearing loss (NSSHL) associated with LVA has been a source of interest because it is associated with future clinical characteristics, including hearing fluctuation, many cases of progressive sensorineural hearing loss, sometimes mixed loss, which normally starts inchildhood and may also be associated with vestibular symptoms. Large Vestibular Aqueduct Syndrome (LVAS) was described for the first time by Valvassori and Clemis 1 in 1978 in a retrospective study