Felipe Alves Mourato

A Modified Blood Pressure to Height Ratio Improves Accuracy for Hypertension in Childhood

BACKGROUND The blood pressure to height ratio (BP:HT) has been proposed as a simple method for identifying children with elevated BP. This procedure shows good accuracy for the screening of hypertension in adolescents but less so in younger children. Our aim in this study was to modify the BP:HT ratio and determine if this change would increase accuracy when measuring hypertension during childhood. METHODS BP levels of 4,327 children (aged 5-12 years) were retrospectively obtained from medical charts. The modified ratio (BT:eHT13) was calculated as: BP/(HT + 7 × (13 - age in years)). Receiver operating characteristic curves were used to estimate cutoff points and the accuracy of the conventional and modified ratio to detect prehypertension and hypertension. RESULTS The prevalences of prehypertension and hypertension were 3.91% and 5.44%, respectively. In general, BP:eHT13 showed higher sensitivity (ranging from 0.95 to 1.00) and specificity (ranging from 0.80 to 0.98) in detecting prehypertension, level I hypertension, and level II hypertension than BP:HT (sensitivity ranging from 0.91 to 1.00; specificity ranging from 0.59 to 0.89). CONCLUSIONS The modified BP:eHT13 ratio showed better sensitivity and specificity for the screening of BP abnormalities in children aged 5-12 years.

Prevalence and profile of congenital heart disease and pulmonary hypertension in Down syndrome in a pediatric cardiology service

OBJETIVO: Determinar a frequencia e o perfil das cardiopatias congenitas em portadores de sindrome de Down atendidos em servico de referencia de cardiologia pediatrica, considerando-se a idade do encaminhamento, o sexo, o tipo de cardiopatia diagnosticada ao ecocardiograma transtoracico e sua associacao com hipertensao pulmonar ao diagnostico inicial.METODOS:Estudo de corte transversal com coleta retrospectiva de dados de 138 pacientes portadores de sindrome de Down de um total de 17.873 prontuarios. Os dados foram submetidos a analise descritiva, utilizando-se o programa Epi-Info, versao 7.RESULTADOS: Entre os 138 pacientes com sindrome de Down, houve maior prevalencia do sexo feminino (56,1%) e 112 (81,2%) foram diagnosticados com cardiopatia congenita. Entre as cardiopatias, a mais comum foi a comunicacao interatrial ostium secundum, com frequencia de 51,8%, seguida pelo defeito do septo atrioventricular, com 46,4%. A comunicacao interventricular estava presente em 27,7%, enquanto a tetralogia de Fallot representou 6,3% dos casos. Outras cardiopatias totalizaram 12,5%. A hipertensao pulmonar associou-se a 37,5% das cardiopatias. Apenas 35,5% dos pacientes foram encaminhados ao servico ate os seis meses de idade.CONCLUSOES: O baixo percentual de encaminhamento ate os seis meses chama atencao para a necessidade de um melhor rastreamento dos portadores da sindrome no contexto das cardiopatias congenitas, tendo em vista a alta frequencia e a progressao da hipertensao pulmonar.OBJECTIVE: To determine the frequence and profile of congenital heart defects in Down syndrome patients referred to a pediatric cardiologic center, considering the age of referral, gender, type of heart disease diagnosed by transthoracic echocardiography and its association with pulmonary hypertension at the initial diagnosis. METHODS: Cross-sectional study with retrospective data collection of 138 patients with Down syndrome from a total of 17,873 records. Descriptive analysis of the data was performed, using Epi-Info version 7. RESULTS: Among the 138 patients with Down syndrome, females prevailed (56.1%) and 112 (81.2%) were diagnosed with congenital heart disease. The most common lesion was ostium secundum atrial septal defect, present in 51.8%, followed by atrioventricular septal defect, in 46.4%. Ventricular septal defects were present in 27.7%, while tetralogy of Fallot represented 6.3% of the cases. Other cardiac malformations corresponded to 12.5%. Pulmonary hypertension was associated with 37.5% of the heart diseases. Only 35.5% of the patients were referred before six months of age. CONCLUSIONS: The low percentage of referral until six months of age highlights the need for a better tracking of patients with Down syndrome in the context of congenital heart disease, due to the high frequency and progression of pulmonary hypertension.

A telemedicine network for remote paediatric cardiology services in north-east Brazil

Abstract Problem Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. Approach In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. Local setting Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. Relevant changes From 2012 to 2014, 73 751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. Lessons learnt Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.

Comparison of different screening methods for blood pressure disorders in children and adolescents

OBJECTIVE To compare different methods of screening for blood pressure disorders in children and adolescents. METHOD A database with 17,083 medical records of patients from a pediatric cardiology clinic was used. After analyzing the inclusion and exclusion criteria, 5,650 were selected. These were divided into two age groups: between 5 and 13 years and between 13 and 18 years. The blood pressure measurement was classified as normal, pre-hypertensive, or hypertensive, consistent with recent guidelines and the selected screening methods. Sensitivity, specificity, and accuracy were then calculated according to gender and age range. RESULTS The formulas proposed by Somu and Ardissinos table showed low sensitivity in identifying pre-hypertension in all age groups, whereas the table proposed by Kaelber showed the best results. The ratio between blood pressure and height showed low specificity in the younger age group, but showed good performance in adolescents. CONCLUSION Screening tools used for the assessment of blood pressure disorders in children and adolescents may be useful to decrease the current rate of underdiagnosis of this condition. The table proposed by Kaelber showed the best results; however, the ratio between BP and height demonstrated specific advantages, as it does not require tables.

Learning echocardiography and changing realities through telemedicine

the map as an image file and using that instead of the program itself. As the map was static, there was no distraction caused by expanding or collapsing nodes. In addition, the entire map was projected at the beginning and end of the class. This helped to establish the relationships between various topics and sub-topics. This approach engaged the students better. It seemed to address the needs of most students: those who are visual learners benefit from seeing the topic as an image; global learners see the ‘big picture’; sequential learners see the points and sequence of presentation, and verbal learners benefit from both the text in the map, as well as the description provided by the lecturer. However, students still exhibit a strong urge to convert the non-linear maps into a linear format, although they now note only the most important points in class. PowerPoint slides are easily stuffed with the tiniest detail. Mind maps require brevity. Therefore, the teacher is required to handpick points for inclusion. This liberates more time for discussion and returns the spotlight to the teacher. The focused teaching–learning paradigm has seemingly resulted in better retention of material presented during class. As this has not been scientifically evaluated, it is difficult to say if the ‘improvement’ is attributable to the new technique or is merely the result of reinforcement.

Diagnosis and management of Transposition of great arteries within a pediatric cardiology network with the aid of telemedicine: A case report from Brazil.

We present a case of a newborn from a remote, underserved area in the inland of Paraíba, a state from Northeast Brazil. She presented with clinical cyanosis at birth. With the aid of telemedicine, a neonatologist under online cardiology supervision performed a screening echocardiogram. The session established the diagnosis of simple transposition of the great vessels in the baby’s first few hours of life. During the same telemedicine session, the necessary arrangements for transferal to a larger maternity center took place. The baby was maintained stable on prostaglandins and was subsequently transferred to a tertiary cardiac center in the neighboring State, Pernambuco. She underwent anatomical correction at day 10, presented no surgical or postoperative complications, and was discharged home at the age of 21 days. She is now over three years old and continues her follow-up care mostly at her hometown, with local pediatricians under online supervision by a cardiologist in a virtual outpatient clinic. The establishment of a Pediatric Cardiology Network, with the aid of telemedicine, can produce a major impact on the access to specialized health care for poor regions of developing countries.

Impact of a virtual clinic in a paediatric cardiology network on northeast Brazil

Introduction. Congenital heart diseases (CHD) affect approximately 1% of live births and is an important cause of neonatal morbidity and mortality. Despite that, there is a shortage of paediatric cardiologists in Brazil, mainly in the northern and northeastern regions. In this context, the implementation of virtual outpatient clinics with the aid of different telemedicine resources may help in the care of children with heart defects. Methods. Patients under 18 years of age treated in virtual outpatient clinics between January 2013 and May 2014 were selected. They were divided into 2 groups: those who had and those who had not undergone a screening process for CHD in the neonatal period. Clinical and demographic characteristics were collected for further statistical analysis. Results. A total of 653 children and teenagers were treated in the virtual outpatient clinics. From these, 229 had undergone a neonatal screening process. Fewer abnormalities were observed on the physical examination of the screened patients. Conclusion. The implementation of pediatric cardiology virtual outpatient clinics can have a positive impact in the care provided to people in areas with lack of skilled professionals.

A new modified blood pressure-to-height ratio also simplifies the identification of high blood pressure in American children

A new modified blood pressure-to-height ratio also simplifies the identification of high blood pressure in American children

Gender differences in the prevalence of congenital heart disease in Down’s syndrome: a brief meta-analysis

BackgroundDown’s syndrome (DS) affects one per 700 live births and congenital heart disease (CHD) occurs in 40–60% of these patients. Contributing factors to the association between DS and CHD are being unraveled. Gender could be one of them.MethodsWe performed a meta-analysis of CHD prevalence in DS, separated by gender. Three search engines were used and 578 articles were reviewed. Twelve articles were included.ResultsQuantitative analysis showed a higher prevalence of CHD, particularly atrioventricular septal defects (AVSD), in female patients. No differences were found in others forms of CHD.ConclusionCHD, particularly AVSD, are more common in the female gender of Down’s syndrome patients.

Knowledge on heart condition of children based on demographic and physiological features

We evaluated a population of 7199 children between 2 and 19 years old to study the relations between the observed demographic and physiological features in the occurrence of a pathological/non-pathological heart condition. The data was collected at the Real Hospital Português, Pernambuco, Brazil. We performed a feature importance study, with the aim of categorizing the most relevant variables, indicative of abnormalities. Results show that second heart sound, weight, heart rate, height and secondary reason for consultation are important features, but not nearly as decisive as the presence of heart murmurs. Quantitatively speaking, systolic murmurs and a hyperphonetic second heart sound increase the odds of having a pathology by a factor of 320 and 6, respectively.