Ana Guardiola

Prevalence of attention-deficit hyperactivity disorders in students: comparison between DSM-IV and neuropsychological criteria

Attention-deficit hyperactivity disorder (ADHD) is a common childhood condition, recognized as an important social-medical problem. The syndrome is characterized by motor system, perception, cognition and behavioral disturbances, compromising the learning of children with adequate intellectual potential. To investigate its prevalence in first grade pupils 484 children with DSM-IV diagnostic criteria and neuropsychological criteria were examined. The prevalence of ADHD was 18% when the diagnosis was made using DSM-IV criteria; 3.5% when neuropsychological criteria was used, including, in addition to behavioral and psychometric aspects, a discrepancy in the evolutionary neurological examination, and 3.9% when motor persistence was taken into account. The prevalence of ADHD was higher among older children (92.4 months) only when DSM-IV criteria were used. We conclude that the use of DSM-IV criteria probably overestimates the prevalence of ADHD, since it detects another behavioral disorders. In this context, they may be useful as screening, since they have adequate pre-testing performance.

Associação entre desempenho das funções corticais e alfabetização em uma amostra de escolares de primeira série de Porto Alegre

Cortical brain functions are the basis of the learning process and evolutionary neurological examination (ENE) provides the level of development of the brain. The purpose of this work was to study by means of the ENE the brain functions in a representative sample of first grade students of Porto Alegre, to investigate the learning performance. An observation, analytical and transversal delineated study was performed. The random sample had 484 children. It was observed: sex, age, race, weight, height, neurological examination, ENE, performance in the number sub-tests, completing figures and codes from WISC scale and literacy learning. The items of ENE were below the expected for the age in 11.4% and 38.2% of the children: the most affected ones were the sensitivity activity and gnosias (38.2%) and the least one was motor persistence (11.4%). In psychometric tests, 40.5% of the subjects had their development in numbers below the espected, 39.0% in accomplishing figures, 71.5% in codes. Concerning literacy, 94.4% of the children learned to read and write. The neuropsychological dysfunction and malestablished laterality were a risk factor for the learning process.

Avaliação do desenvolvimento neuropsicomotor em escolares de primeira série e sua relação com o estado nutricional

OBJECTIVE: to investigate the neurological performance of elementary school students from the city of Porto Alegre, state of Rio Grande do Sul, Brazil, in order to assess the association of neurological development and nutritional status. METHODS: we carried out an observational, analytical, and crosssectional study on a random and proportional population sample selected out of all first-grade students (n=35,521) in the city of Porto Alegre for a total of 484 children, out of which 64.7% were enrolled in state public schools, 11.9% in city public schools, and 23.4% in private schools. Our sample size allowed for a precision of ± 3% (95% confidence interval) for an estimated prevalence of 10% of cortical dysfunction. Children were submitted to individual examinations at the school. We collected data regarding sex, age, color of skin, nutritional status, and school of origin. An informed consent was obtained from the State and City Departments of Education and from the principals of the private schools. Statistical analysis was carried out using the chi-square test and ANOVA.. RESULTS: from 11.4% to 38.2% of children presented ENE results lower than expected according to their age. The most affected factors were sensory activity and gnosia (38.2%), and the least affected factor was motor persistence (11.4%). There were no statistically significant differences between boys and girls. We observed an association of children with low height-for-age and weight-for-age and cortical dysfunction. CONCLUSION: chronic malnutrition is a risk factor for brain function performance.

Comorbidades do transtorno de déficit de atenção e hiperatividade em crianças escolares

RESUMO - O b j e t i v o: Avaliar a frequencia de transtorno de conduta (TC), transtorno desafiador opositivo ( T D O ) e transtorno obsessivo-compulsivo (TOC) em criancas com transtorno de deficit de atencao e hiperatividade ( T D A H ) .M e t o d o: Estudo realizado em criancas de 7 a 11 anos com TDAH conforme criterios do DSM-IV ( n = 3 5 ) , exame neurologico normal e exame neurologico evolutivo (ENE) segundo Lefevre alterado. Os re s p o n s a v e i s responderam a questionarios contendo os criterios do DSM-IV para TDAH e para comorbidades.R e s u l t a d o s: TDAH do tipo combinado foi o mais prevalente (51,4%). Quatorze criancas (40,0%) apresentaram TC, incluindo duas que apresentaram TC e TOC. Cinco (14,2%) apresentaram apenas TDO e uma (2,8%) apresentou apenas TOC. Onze das quatorze criancas (78,5%) com TC tinham TDAH do tipo combinado (p<0,05). Onze das quinze criancas (73,3%) sem comorbidades eram do tipo desatentas ou hiperativas (p<0,05).Conc l u s a o: O TDAH a p resenta alta frequencia de comorbidade com TC, que parece estar pre f e rencialmente associado ao TDAH combinado. PALAVRAS-CHAVE: transtorno de deficit de atencao e hiperatividade, comorbidades, criancas. Attention-deficit hyperactivity disorder comorbidity in a school sample of children

Avaliação da idade gestacional de recém-nascidos pré-termo através do exame neurolÓgico e das escalas neonatais e obstétrica

Perinatal mortality and the incidence of neurological sequelae in preterm infants have diminished owing to advances in perinatology. The accurate assessment of gestational age is a very important component of the medical practice and for the newborns management. Herein we provide a study to evaluate the neurological examination in comparison to the obstetrics dating criteria and pediatrics scales (Dubowitz and Capurro) to determine the gestational age as well as to compare the gestational age obtained with the different methods. We studied 35 preterm newborns leaving out those ones with any pathologies. The different scales to determine the gestational age were administered to each infant, beyond the neurological examination. We conclude that Andre-Thomas method is an appropriate clinical tool for reliable determining for gestational age in preterm newborns.

Neurological congenital malformations in a tertiary hospital in south Brazil

BACKGROUND Congenital anomalies are one of the main causes of morbidity and mortality among infants. The involvement of the central nervous system (CNS) occurs in 21% of cases. OBJECTIVE To identify incidence of CNS malformations and associated factors in newborns at a Terciary Hospital of Porto Alegre. METHOD Case-control study conducted between 2000 and 2005 based on the Latin American Collaborative Study of Congenital Malformations database. RESULTS Among 26,588 births registered in this period, 3.67% presented with malformations (IC=95%; 3.44-3.9), being 0.36% of the CNS (IC=95%,(0.29-0.43)). The most common CNS malformation was meningomielocele (10.4%). Young maternal age (p=0.005); low birth weight (p=0.015); large cephalic perimeter (p=0.003); post term birth (p=0.000) and low APGAR indexes at the 1st and 5th minutes were associated with CNS malformations. CONCLUSION We found an incidence of CNS malformations similar as compared to literature.

Importância dos aspectos nutricionais como fator associado à síndrome de hiperatividade com déficit de atenção

O disturbio de hiperatividade com deficit de atencao constitui sindrome comum na infância, pelo que e reconhecido como problema medico-social importante, sendo objeto de extensa investigacao quanto aos seus determinantes, abordagens diagnosticas e formas de prevencao e tratamento. Dentro dos fatores que podem alterar a funcao cerebral, encontra-se a desnutricao. Os autores discutem a associacao da sindrome com o estado nutricional de uma populacao de escolares.The attention deficit hyperactivity disorder is a common childhood syndrome that is recognized as an important medical-social problem, being the object of an exhaustive investigation related to its etiology, diagnostic approach and prevention, and treatment forms. Among the factors that can alter the cerebral function, is the malnutrition. The authors discuss the association of the syndrome with the nutritional condition of students from elementary schools.

Neuropsychomotor development in schoolchildren and its relationship with nutritional status

Objective: to determine ASO titer profile by establishing ARF differential diagnoses of other diseases with high levels of ASO antibodies. Methods: we investigated 78 patients with ARF at onset and follow-up, 22 with isolated chorea at onset, 45 with recurrent oropharyngeal tonsillitis, and 23 with recent flare of juvenile idiopathic arthritis. We tested ASO with automated particle-enhanced immunonephelometric assay (Behring ® -Germany). The ASO (IU/ml) titers were assessed at the following time intervals: 0-7 days, 1-2 weeks, 2-4 weeks, 1-2 months, 2-4 months, 4-6 months, 6-12 months, 1-2 years, 2-3 years, 3-4 years, and 4-5 years after onset of ARF. Results: ASO titers in patients diagnosed with ARF had a significant increase up to the 2-4-month time interval (P<0.0001). Baseline levels were observed afterwards in patients under regular penicillin prophylaxis. The levels of ASO in ARF were also significantly higher than in patients with isolated chorea, recurrent oropharyngeal infections or juvenile idiopathic arthritis (P=0.0025), when age-matched samples of these groups were compared. The test’s sensitivity was 73.3% and the specificity was 57.6%, and it was calculated taking into account the upper limit of normality at 320 IU/ml, as well as the established diagnosis of ARF. The test’s specificity and positive predictive value increased with rising or higher titers, being higher with titers above 960 UI/ml. Conclusion: this reappraisal of ASO profile in ARF patients indicates a remarkable response during the acute phase, and that points to the extent to which ASO levels may differentiate ARF from other diseases with high levels of ASO antibodies, as coincidental but unrelated streptococcal infection or chronic arthritis flareup.

Uso de amitriptilina na síndrome de hiperatividade com déficit de atenção

We studied the action of amitriptyline (AMI) in the attention deficit hyperactivity disorder (ADHD). Twenty-five children who came to consultantion for ADHD were analized, in two groups: the group which used AMI (n=18) at 1.6 mg/kg/day and the group which used placebo (n=7). Both groups were submitted to two assessments in a 30 days interval, which consisted of the evolutive neurological evolution examination (ENE) and the WISC scale subtests on numbers, drawings to be completed and the code. The results showed that the AMI produced an improvement in performance in the motor persistence tests.

Síndrome de cockayne: relato de caso

We describe a girl with Cockayne syndrome (CS), the diagnostic criteria and the complications of this syndrome. The required criteria for the diagnosis include: prenatal poor growth failure, congenital structural eye anomalies, cataracts, pigmentary retinopathy, severe neurologic dysfunction from birth, sensorineural hearing loss, cutaneous photosensitivity and dental caries. CS is a rare autosomal recessive and biochemical disorder.