Abstract Hygrothermal computer simulations consider transient and simultaneous exchanges of heat and moisture between the building elements and the environment. They are an important tool to support the design and performance assessment of buildings. These simulations require the description of the building element, the environmental conditions to which it is exposed, and the hygrothermal characteristics of the materials that compose it as input data. This paper presents an exploratory analysis of the results of the hygrothermal simulation of a concrete wall varying the hygrothermal characteristics of the material. The internal environmental conditions were obtained using EnergyPlus ® and the hygrothermal simulation was done in WUFI ® Pro, with post-processing in WUFI ® Bio to evaluate the risk of mold occurrence. The hygrothermal behavior of the walls varied significantly with the variation in hygrothermal characteristics of the materials, especially for one type of concrete that had a very different capillary transport function. The results indicate the importance of analyzing hygrothermal characteristics and functions for hygrothermal simulations and the need to experimentally determine such characteristics for Brazilian building materials.

Resumo Simulações computacionais higrotérmicas consideram trocas transientes e simultâneas de calor e umidade entre os elementos construtivos e o ambiente, sendo uma ferramenta importante de apoio ao projeto e à avaliação de desempenho de edifícios. Essas simulações requerem como dados de entrada a descrição do elemento construtivo, as condições ambientais às quais ele está exposto e as características higrotérmicas dos materiais. Este artigo apresenta uma análise exploratória dos resultados da simulação higrotérmica de uma parede de concreto variando-se as características higrotérmicas do material. As condições ambientais internas foram obtidas utilizando o EnergyPlus™ e a simulação higrotérmica foi feita no WUFI® Pro, com pós-processamento no WUFI® Bio para avaliar o risco de ocorrência de fungos emboloradores. Houve diferenças significativas no comportamento higrotérmico das paredes em função da variação das características higrotérmicas dos materiais, sobretudo para o tipo de concreto cuja função de transporte capilar mostrou-se diferente dos demais. Os resultados indicam a importância de analisar as características e funções higrotérmicas para simulações higrotérmicas e a necessidade de sua determinação experimental para os materiais de construção brasileiros.

Abstract Cardiovascular diseases are among the leading causes of mortality and morbidity in the world. In different cardiac diseases, the neuronal function of the heart is impaired. Nevertheless, the development of a simple method to assess the autonomic effects on the heart and/or autonomic dysfunction is a challenge. The evaluation of autonomic innervation in cardiac diseases has helped to improve the knowledge of the pathophysiology of these conditions, as well as to provide information on their prognosis. Single photon emission computed tomography (SPECT) and positron emission tomography (PET) are currently the only imaging methods that allow in vivo assessment of cardiac innervation. The majority of SPECT and PET radiotracers evaluate sympathetic neuronal integrity using presynaptic imaging agents that are either labeled as endogenous transmitters or analogues. Postsynaptic imaging agents have also been developed to study sympathetic neuronal integrity, as well as tracers to investigate the parasympathetic nervous system. These methods may be used to analyze the innervation of the heart and allow for early detection of abnormalities caused by, for example, ischemia, heart failure, cardiomyopathies, cardiotoxicity, and arrhythmogenic disorders. This review provides an overview of cardiac innervation evaluation and their application in the assessment of heart disease. world impaired Nevertheless andor challenge conditions prognosis (SPECT (PET analogues system by example ischemia failure cardiomyopathies cardiotoxicity disorders disease

Abstract Objective: To describe the effect of prednisolone on language in children with autism spectrum disorder. This study is based upon two hypotheses: autism etiology may be closely related to neuroinflammation; and, an effective treatment should restore the individual's language skills. Method: This is a prospective, double-blinded, randomized, placebo-controlled clinical trial, carried out in a federal university hospital. The initial patient sample consisted of 40 subjects, which were randomized into two parallel groups. Inclusion criteria were: male gender, 3-7 years of age, and meeting the Diagnostic and Statistical Manual of Mental Disorders - 4th edition (DSM-IV) diagnostic criteria. The final sample consisted of 38 patients, of whom 20 were randomized to the placebo group and 18 to the active group. The latter received prednisolone for 24 weeks, at an initial dose of 1 mg/kg/day and a tapering dose from the ninth week onward. Language was measured on four occasions over a 12-month period by applying two Brazilian tools: the Language Development Assessment (ADL) and the Child Language Test in Phonology, Vocabulary, Fluency, and Pragmatics (ABFW). Results: The side effects were mild: two patients had hypertension, five had hyperglycemia, and two had varicella. Prednisolone increased the global ADL score in children younger than 5 years of age who had developmental regression (p = 0.0057). The ABFW's total of communicative acts also responded favorably in those participants with regression (p = 0.054). The ABFW's total of vocal acts showed the most significant results, especially in children younger than 5 years (p = 0.004, power = 0.913). Conclusions: The benefit of prednisolone for language scores was more evident in participants who were younger than five years, with a history of developmental regression, but the trial's low dose may have limited this benefit. The observed side effects do not contraindicate corticosteroid use in autism.

RESUMO A consorciação de culturas é uma prática que permite a maximização dos recursos disponíveis, sobretudo na pequena propriedade agrícola. Objetivou-se verificar a viabilidade agroeconômica do consórcio do mangarito com milho verde. Dois experimentos foram realizados com as variedades de mangarito ‘Gigante’ e ‘Pequeno’, cada um constituído de nove tratamentos envolvendo os consórcios do mangarito com milho verde, em quatro épocas da associação após a emergência das plantas de mangarito (DAE = 0, 21, 42 e 63), assim como suas respectivas monoculturas. O delineamento experimental foi o de blocos casualizados, com cinco repetições. Avaliaram-se, além dos dados produtivos das culturas, indicadores agroeconômicos de eficiência. Os resultados foram submetidos à análise de variância e as médias de comparadas pelo teste Tukey, além de realizados contrastes (teste F) entre monocultivos solteiro e consórcios para as variáveis medidas no milho verde. Concluiu-se que é viável, agronômica e economicamente, a consorciação dos mangaritos ‘Gigante’ e ‘Pequeno’ com milho verde. Em termos econômicos, a associação do milho verde com mangarito ‘Gigante’ deve ser instalada, preferencialmente, aos 21 DAE das plantas do mangarito e, para o mangarito ‘Pequeno’, ao 0 DAE.

ABSTRACT Intercropping is a practice that allows the maximization of resources available in the agricultural property. The objective was to verify the agroeconomic viability of the mangarito intercropped with green corn. There were two experiments, conducted with the “Gigante” and “Pequeno” mangarito varieties, each one constituted of nine treatments, resulting from the intercropping of mangarito with green corn in four seasons of the association after the emergence of the mangarito plants (DAE = 0, 21, 42, and 63), as well as their respective monocultures. The experimental design was a randomized block design, with five replications. In addition to crop production data, agroeconomic efficiency indicators were evaluated. Data were subjected to analysis of variance, and the means of mangarito production and of agroeconomic indicators compared by the Tukey's test, and contrasts were performed (F test) between single and intercropped crops for characteristics evaluated in green corn. It is concluded that the intercropping of Gigante and Pequeno mangarito varieties with green corn is viable, both agronomically and economically. In economic terms, the association of green corn with Gigante mangarito should be installed, preferably, at 21 DAE of the mangarito plants and, for the Pequeno variety, at 0 DAE.

Resumo Materiais de mudança de fase - Phase Change Materials (PCMs) apresentam uma capacidade de armazenamento térmico substancialmente maior que os materiais convencionais. PCMs aplicados na envoltória de edificações contribuem para o aumento da inércia térmica de ambientes, proporcionando recintos com melhor desempenho térmico, dependendo do clima. Atualmente, há PCMs utilizados em edificações do hemisfério norte, especialmente, havendo poucas informações sobre seu uso em edificações em países tropicais. Neste artigo são apresentadas as características térmicas essenciais que estes materiais precisam ter, quanto à sua capacidade de armazenamento térmico latente e ponto de fusão, para contribuir para a melhoria do desempenho térmico de edificações brasileiras. Foram efetuadas simulações da resposta térmica de edificações com o programa EnergyPlus® em duas etapas: a) reproduziu-se o comportamento térmico de um modelo existente com PCMs verificando-se a similaridade entre dados medidos e simulados para indicar a confiabilidade das simulações; b) foram feitas simulações de modelos com fechamentos leves e pesados, com e sem PCMs em cidades brasileiras, variando-se as características do PCM original, quanto à capacidade de armazenamento térmico latente e o ponto de fusão. Os resultados apontam os intervalos dessas grandezas que proporcionaram melhor desempenho térmico dos recintos em função dos fechamentos e do clima do local, sendo uma referência inicial para o desenvolvimento de produtos mais adequados ao clima de regiões brasileiras.

Abstract Phase Change Materials (PCMs) have significantly higher thermal capacity than traditional materials. PCMs increase the thermal inertia of buildings and improve their thermal performance depending on the climate conditions. PCMs are generally used in buildings exposed to the Northern Hemisphere's climate conditions; however, there is very little information about the effect of these materials in buildings located in tropical areas. This paper presents the essential thermal characteristics that these materials require (latent heat and melting point) to be able to contribute to improve the thermal performance of Brazilian buildings. Simulations of the thermal response of buildings with and without PCMs were carried out. The first stage aimed to reproduce the thermal behaviour of a real prototype - with PCMs available in the market in order to validate the simulations. The second stage included parametric simulations of the thermal response of a prototype with hypothetical PCMs. The characteristics of these hypothetical materials were obtained from variations of the original ones. The results show the values of the latent heat and melting point most appropriate to Brazilian buildings.

Resumo Objetivos: Apresentar uma abordagem clínica, enfatizar a investigação diagnóstica, voltada para crianças e adolescentes no pronto-socorro com fraqueza muscular de surgimento agudo. Fontes: Foi feita uma pesquisa sistemática na base de dados PubMed entre abril e maio de 2017, com os seguintes termos de pesquisa em várias combinações: “agudo”, “fraqueza”, “déficit motor”, “paralisia flácida”, “criança”, “pediátrico” e “emergência”. Os trabalhos escolhidos para esta revisão foram publicados nos últimos dez anos, de 1997 a 2017. Este trabalho aborda a faixa etária pediátrica, até 18 anos. Resumo dos dados: O déficit motor agudo é uma causa razoavelmente comum para crianças e adolescentes procurarem o pronto-socorro. Os pacientes podem ser classificados como com deficiência motora localizada ou difusa e uma descrição precisa das características clínicas é essencial para possibilitar um diagnóstico diferenciado completo. As duas causas mais comuns de paralisia flácida aguda no pronto-socorro pediátrico são síndrome de Guillain-Barré e mielite transversa, independentemente de outras etiologias serem consideradas, como encefalomielite disseminada aguda, mielite infecciosa, miastenia grave, derrame, hemiplegia alternante da infância, paralisia periódica, encefalite do tronco encefálico e fraqueza muscular funcional. Os algoritmos da investigação de fraqueza aguda localizada ou difusa na configuração de emergência também são apresentados. Conclusões: São enfatizadas as habilidades clínicas para obter um histórico completo e fazer um exame físico detalhado. Um manejo diagnóstico e terapêutico organizado, lógico e por etapas é essencial para eventualmente restaurar o bem-estar e a saúde total do paciente.

Abstract Objectives: This review article aimed to present a clinical approach, emphasizing the diagnostic investigation, to children and adolescents who present in the emergency room with acute-onset muscle weakness. Sources: A systematic search was performed in PubMed database during April and May 2017, using the following search terms in various combinations: “acute,” “weakness,” “motor deficit,” “flaccid paralysis,” “child,” “pediatric,” and “emergency”. The articles chosen for this review were published over the past ten years, from 1997 through 2017. This study assessed the pediatric age range, from 0 to 18 years. Summary of the data: Acute motor deficit is a fairly common presentation in the pediatric emergency room. Patients may be categorized as having localized or diffuse motor impairment, and a precise description of clinical features is essential in order to allow a complete differential diagnosis. The two most common causes of acute flaccid paralysis in the pediatric emergency room are Guillain-Barré syndrome and transverse myelitis; notwithstanding, other etiologies should be considered, such as acute disseminated encephalomyelitis, infectious myelitis, myasthenia gravis, stroke, alternating hemiplegia of childhood, periodic paralyses, brainstem encephalitis, and functional muscle weakness. Algorithms for acute localized or diffuse weakness investigation in the emergency setting are also presented. Conclusions: The clinical skills to obtain a complete history and to perform a detailed physical examination are emphasized. An organized, logical, and stepwise diagnostic and therapeutic management is essential to eventually restore patient's well-being and full health.

Introduction: the worldwide trend, particularly in South American countries, is the increase in the casuistry of morbidity Helicobacter pylori that causes chronic gastritis so severe that fertile ground for the development of malignancies, this unfavorable situation for the population increase adds inconclusive reports on the effectiveness of conventional and sequential main therapy options for treating H. pylori. Objective: to determine, in a first approach, from a sample of the Venezuelan population, the efficacy of sequential therapy and standard in the treatment of H. pylori in an attempt to provide information to help answer the question about which therapy is most effective. Methods: a descriptive and retrospective study, based on a review of medical records was performed. The sample consisted of 84 individuals with a diagnosis of H. pylori infection in people gender, diagnosis of infection, diagnosis and therapy used post-treatment was determined. Results: 67.9% were patients without post infection treatment, 50.9% of these subjects had received standard therapy and 49.1% sequential, without significant differences between the two. Conclusions: in the studied sample and standard sequential therapy were equally effective in moderate proportion and in the treatment of H. pylori infection and also that this work is the first study in Venezuelan population.

Introducción: la tendencia mundial, especialmente en países suramericanos, es al incremento de la casuística de morbilidad por Helicobacter pylori que causa gastritis crónica tan severas que abonan el terreno para el desarrollo de neoplasias, a esta situación desfavorable para la población se suma el aumento de reportes no concluyente sobre eficacia de la terapia convencional y secuencial, principales opciones para tratar esta bacteria. Objetivo: determinar en una muestra de la población venezolana, la eficacia de la terapia secuencial y estándar en el tratamiento de Helicobacter pylori. Método: se realizó un estudio de tipo descriptivo y retrospectivo, basado en la revisión de registros clínicos. La muestra estuvo constituida por 84 individuos con diagnóstico de infección con estabacteria, en quienes se determinó género, diagnóstico de infección, terapia utilizada y diagnóstico pos-tratamiento. Resultados: el 67,9% de los pacientes no tuvo infección post tratamiento, de estos el 50,9% habían recibido terapia estándar y 49,1% secuencial, sin diferencias significativas entre ambas. Conclusiones: en la muestra estudiada la terapia estándar y secuencial resultaron igualmente efectivas y en moderada proporción en el tratamiento de la infección por este microorganismo. Este trabajo constituye el primero realizado en población venezolana.

Carbon Dioxide (co2) Emissions by Visitors to the Delta do Parnaíba Conservation Area (Piauí State, Brazil). Climate change represents the focal point of the contemporary crisis between society and nature, and will soon come to affect all human activities. In light of this critical new situation, the planning and administration of protected areas must take into account actions that can lower anthropogenic carbon emissions. The present work evaluated the impacts of tourism on the APA do Delta do Parnaíba Conservation Area in Piauí State, with emphasis on inventorying carbon dioxide (CO2) emissions from visitors and examining the principles of low-carbon tourism through bibliographic studies and field research. Our results indicated that the average rate of CO2 emission per visitor to the Conservation Area was 39.2 kg per day, with the consumption of fossil fuels being responsible for 91.3% of that production. In this away, it was found that the inventory of CO2 emissions was essential for assessment of the impacts of visitation, based on low-carbon tourism model. Under this scenario, it recognized the need for research in other tourist destinations and specific segments in order to expand the scientific knowledge on this subject.

El cambio climático resulta el exponente principal de la crisis contemporánea en la relación entre sociedad y naturaleza y afecta a todas las actividades humanas. En función de este escenario, deben surgir nuevos acuerdos de planificación y gestión basados en acciones contextualizadas en los principios del desarrollo de bajo carbono. Así, este artículo evaluó los impactos del turismo en la Unidad de Conservación (UC) APA del Delta de Parnaíba (PI), en base al inventario de las fuentes de emisión de dióxido de carbono (CO2) de los visitantes y los principios del turismo de bajo carbono. Se utilizó la investigación bibliográfica y de campo y se constató que la media de las emisiones per cápita de los visitantes en la UC fue de 39,2 kgCO2 por día, teniendo como principal vector el consumo de combustibles (91,3% de las emisiones). De esta forma, se verificó que el inventario de las emisiones de CO2 fue esencial para evaluar los impactos de la visita en la UC en base al modelo de turismo de bajo carbono. Así, se reconoció la necesidad de investigar otros destinos turísticos y segmentos específicos con la finalidad de ampliar el conocimiento científico sobre esta temática.

En algunos campos de producción de crudos pesados y extrapesados de Venezuela la producción de dichos hidrocarburos ocurre debido al gas en solución, el cual tiende a formar una espuma, constituida por una dispersión de gas y agua en el crudo. El comportamiento del crudo espumante a condiciones de yacimiento y su transporte en el medio poroso ha sido estudiado por múltiples investigadores en el área de flujo multifásico. Sin embargo, pocos estudios se han enfocado en su comportamiento a condiciones de superficie, donde la viscosidad del crudo aumenta y las burbujas que se encuentran dispersas incrementan su tamaño debido a los cambios en presión y temperatura. El transporte de crudo espumante es un reto en Venezuela debido a los altos volúmenes de gas producidos con el crudo, en el cual el gas fluye parte disperso en el crudo formando una espuma y otra fracción de gas separada, promoviendo la formación de diferentes patrones de flujos en las líneas de producción. Las condiciones evaluadas en este estudio corresponden a un 8.5% p/p de agua de, 1.5%p/p de surfactante y 90%p/p de aceite mineral de alta viscosidad, con presiones de hasta 255 kPa, temperaturas de aproximadamente 20°C, velocidades superficiales del gas entre 0.92 y 17.56 m/s, velocidades superficiales del líquido entre 0.04 y 1.07 m/s, en tuberías de 0.0243 y 0.0508 m de diámetro, obteniendo tres patrones de flujos diferentes: espuma-estratificada, espuma-tapón y espuma-anular. Adicionalmente, se encontró que la espumabilidad incrementa con el aumento del flujo de gas y líquido y la estabilidad de la espuma tiende a decrecer cuando el flujo de líquido aumenta y el de gas disminuye.

In some heavy and extra heavy oil production fields in Venezuela the oil production occurs due to the gas in solution, which tends to form a foam, consisting of a dispersion of gas and water in oil. Foamy oil behavior at reservoir conditions and its transport process through porous media have been the focus of many multiphase flow researches. However, few studies have been developed at surface conditions, in which the oil viscosity increases considerably and the gas bubbles that are trapped in the foamy oil are expanded due to the change in pressure and temperature. Transportation of foamy oil through pipelines is a challenge in Venezuelan fields due to the relatively high gas volumes produced with oil. Part of this gas is dispersed as foam and the rest flows as a separate phase generating different flow patterns in the pipelines. This experimental study is focused on the behavior of a multiphase mixture composed by foamed emulsion, with high oil viscosity flowing through horizontal pipelines. The evaluated conditions correspond to 8.5 wt.% water, 1.5 wt.% surfactant and 90 wt.% mineral oil, pressures up to 255 kPa, temperature of 20°C, superficial gas velocities between 0.92 - 17.56 m/s and superficial liquid velocities between 0.04 - 1.07 m/s, with pipeline diameters of 0.0243 and 0.0508 m. Three different flow patterns were obtained: foamy stratified, foamy slug and foamy annular. Foaminess and foam stability were found to be dependent on the operational conditions. Foamability increases with the increment of the gas and liquid flow rates, while foam stability tends to decrease when the liquid flow rate increases and the gas flow rate decreases.

A cintilografia miocárdica com meta-iodo-benzil-guanidina (123I cMIBG) foi estudada na doença de Parkinson (DP), especialmente nos países asiáticos, mas não na América Latina. A quase totalidade desses estudos inclui indivíduos com DP com disautonomia definida. Nosso objetivo é relatar a neurotransmissão simpática cardíaca em doentes brasileiros com DP de novo esporádica, sem disautonomia clinicamente definida. Foi avaliada retrospectivamente uma série de 21 casos consecutivos com DP sem sintomas ou sinais de disautonomia observáveis pelos testes de beira-de-leito. Com a aplicação dos critérios de exclusão, este número foi reduzido para 14. A captação do 123I MIBG pelo SPECT foi baixa ou ausente em todos os pacientese; a relação coração / mediastino foi baixa em 12 dos 14. Concluímos que a 123c MIBG é capaz de identificar alteração da neurotransmissão simpática cardíaca em doentes com DP de novo sem disautonomia clinicamente definida.

Myocardial scintigraphy with meta-iodo-benzyl-guanidine (123I cMIBG) has been studied in Parkinson's disease (PD), especially in Asian countries, but not in Latin America. Most of these studies include individuals with PD associated to a defined dysautonomia. Our goal is to report the cardiac sympathetic neurotransmission in de novo Brazilian patients with sporadic PD, without clinically defined dysautonomia. We evaluated retrospectively a series of 21 consecutive cases with PD without symptoms or signs of dysautonomia assessed by the standard bedside tests. This number was reduced to 14 with the application of exclusion criteria. 123I cMIBG SPECT up-take was low or absent in all of them and the heart/mediastinum ratio was low in 12 of 14. We concluded that 123I cMIBG has been able to identify cardiac sympathetic neurotransmission disorder in Brazilian de novo PD patients without clinically defined dysautonomia.

A associação entre anemia falciforme (AF) e síndrome de Evans (SE) parece ser rara. Esse estudo objetivou relatar o caso de uma criança com AF e SE. A paciente R. M. S. S., 2 anos de idade, foi admitida em um centro hematológico apresentando hemorragia de mucosa, leucometria 20,3 × 10(9)/l, hemoglobina 4,6 g/dl e plaquetas 28 × 10(9)/l. Posteriormente, realizou-se mielograma, que evidenciou hipercelularidade eritroide, sugerindo hemólise. Teste positivo da antiglobulina direcionou o diagnóstico para SE. Iniciou-se pulsoterapia com corticoide até regularização da plaquetometria. Hemácias em foice foram visualizadas no esfregaço sanguíneo; eletroforese de hemoglobina revelou fenótipo SS. A associação parece ter sido fortuita e gerou quadro grave, que deve ser reconhecido prontamente.

The association of sickle cell anemia (SCA) and Evans syndrome (ES) seems to be uncommon. This study aimed to report a case of a child with SCA and SE. 2 year-old R. M. S. S. was admitted into a hematologic center with mucosal bleedings. Exam results revealed leucocyte 20.3 × 10(9)/l, hemoglobin 4.6 g/dl, and platelets 28 × 10(9)/l. Subsequently, myelogram was performed and showed erythroid-hypercellularity, which suggested hemolysis. Positive antiglobulin test corroborated the diagnosis of ES. Corticosteroid pulse therapies were conducted until normalization of platelet count. Sickle cells were detected in blood smears and hemoglobin electrophoresis revealed SS phenotype. Despite the fact the association appears to occur randomly, it causes severe clinical symptoms, which must be promptly recognized.

OBJETIVO: Analisar a composição metabólica de áreas encefálicas através da espectroscopia de prótons por ressonância magnética em crianças com transtornos do espectro alcoólico fetal e crianças normais. MÉTODO: A amostra deste estudo de casos-controles incluiu 8 meninos com história epidemiológica de exposição fetal ao álcool (idade mediana 13,6±3,8 anos), diagnosticados com transtorno do espectro alcoólico fetal, e 8 controles (idade mediana 12,1±3,4 anos). Utilizou-se voxel único de 8 cm³, tempo de eco 30 ms, tempo de repetição 1.500 ms, 128 aquisições, em scanner de 1,5T para as seguintes áreas: cíngulo anterior, lobo frontal esquerdo, estriado esquerdo e hemisfério cerebelar esquerdo. Estudaram-se os picos e as razões dos metabólitos N-acetilaspartato, colina, creatina e o mio-inositol. RESULTADOS: As crianças acometidas apresentaram diminuição da razão colina/creatina (p=0,020) no estriado esquerdo, e aumento da razão mio-inositol/creatina (p=0,048) no cerebelo esquerdo. Não houve diferença estatisticamente significativa nos valores encontrados no cíngulo anterior e lobo frontal entre os dois grupos. CONCLUSÃO: Este estudo encontrou evidências de que o estriado e o cerebelo esquerdos são acometidos pela exposição intra-uterina ao álcool. Estudos adicionais com amostras maiores são essenciais para expandir nosso conhecimento dos efeitos da exposição fetal ao álcool.

OBJECTIVE: To analyze the metabolic constitution of brain areas through proton magnetic resonance spectroscopy in children affected with fetal alcohol spectrum disorder compared with normal children. METHOD: The sample of this case-control study included eight boys with epidemiologic history of in utero exposure to alcohol (median age 13.6±3.8 years) who were diagnosed with fetal alcohol spectrum disorder, and eight controls (median age 12.1±3,4 years). An 8 cm³ single voxel approach was used, with echo time 30 ms, repetition time 1500 ms, and 128 acquisitions in a 1.5T scanner, and four brain areas were analyzed: anterior cingulate, left frontal lobe, left striatum, and left cerebellar hemisphere. Peaks and ratios of metabolites N-acetylaspartate, choline, creatine, and myo-inositol were measured. RESULTS: Children with fetal alcohol spectrum disorder showed a decrease in choline/creatine ratio (p=0.020) in left striatum and an increase in myo-inositol/creatine ratio (p=0.048) in left cerebellum compared with controls. There was no statistically significant difference in all peaks and ratios from the anterior cingulate and frontal lobe between the two groups. CONCLUSION: This study found evidence that the left striatum and left cerebellum are affected by intrauterine exposure to alcohol. Additional studies with larger samples are necessary to expand our knowledge of the effects of fetal exposure to alcohol.

OBJETIVO: Relatar um caso pediátrico de mielinólise pontina central e extrapontina, rara doença neurológica freqüentemente relacionada com a rápida correção da hiponatremia. DESCRIÇÃO: Adolescente de 15 anos de idade apresentou a síndrome do encarceramento no contexto de hiponatremia grave. Os achados na ressonância magnética cerebral foram compatíveis com o diagnóstico de mielinólise pontina central e extrapontina. COMENTÁRIOS: A correção do sódio sérico deve ser realizada de forma cuidadosa e lenta, respaldada em cálculo meticuloso do déficit de sódio, para minimizar o estresse metabólico e evitar a ocorrência dessa complicação em potencial, a qual, na grande maioria das vezes, cursa com evolução catastrófica. Não existe tratamento eficaz comprovado da mielinólise e, nos casos graves, o prognóstico geralmente é reservado.

OBJECTIVE: To report a pediatric case of central pontine and extrapontine myelinolysis, a rare neurological disease often associated with rapid correction of hyponatremia. DESCRIPTION: A 15 year-old female adolescent developed locked-in syndrome during severe hyponatremia. Brain magnetic resonance imaging was consistent with the diagnosis of central pontine and extrapontine myelinolysis. COMMENTS: Serum sodium correction should proceed slowly and cautiously, based upon a careful calculation of sodium deficit, in order to minimize metabolic stress and avoid the occurrence of this dreadful complication, which has a tragic outcome in most cases. There is no scientifically proved effective treatment for myelinolysis, and severe cases usually have a dismal prognosis.

O pseudotumor cerebral é uma síndrome neurológica relativamente comum na adolescência. Na maioria dos casos, a etiologia é idiopática, mas pode haver complicações graves, como cegueira, relacionadas com a hipertensão intracraniana. O objetivo deste artigo é enfatizar o diagnóstico diferencial do pseudotumor cerebral, com atenção especial às etiologias tratáveis. Relatamos o caso de um adolescente de 12 anos que se apresentou com diplopia e cefaléia 9 dias após otite média e mastoidite à direita. A tomografia computadorizada do crânio foi normal, mas a ressonância magnética do encéfalo detectou trombose dos seios transverso e sigmóideo ipsilaterais, a qual respondeu à anticoagulação precoce. A conclusão é que a ressonância magnética do encéfalo é essencial nos pacientes com diagnóstico clínico de pseudotumor cerebral para exclusão de causas tratáveis, como a trombose venosa dural.

Pseudotumor cerebri is a relatively common neurologic syndrome in adolescence. In most cases, etiology is idiopathic, but it may have serious complications, such as blindness, that are related to increased intracranial pressure. The aim of this article is to emphasize the differential diagnosis of pseudotumor cerebri, with special attention to treatable etiologies. We report a case of an 12 year-old adolescent who presented with diplopia and headache 9 days after right-sided otitis media and mastoiditis. Head computerized tomography was normal, but brain magnetic resonance imaging demonstrated thrombosis of ipsilateral transverse and sigmoid sinuses, which responded promptly to early anticoagulation. The conclusion is that magnetic resonance imaging is essential for patients with a clinical diagnosis of pseudotumor cerebri in order to exclude treatable causes, such as dural sinus thrombosis.