Abstract Background: Fontan circulation can be associated with significant morbidity, especially Protein-Losing Enteropathy (PLE). Echocardiographic parameters can provide valuable diagnostic information about a patient's risk of developing PLE after Fontan surgery. Objectives: To describe echocardiographic/ultrasonographic parameters associated with PLE in patients after Fontan surgery through a systematic review with meta-analysis. Methods: A literature search was performed in electronic databases to identify relevant studies about echocardiographic parameters and PLE prediction in children after Fontan surgery. The search terms used were: “echocardiography”, “ultrasonography”, “Fontan,” and “protein-losing enteropathy”. A p < 0.05 was considered statistically significant. Results: A total of 653 abstracts were obtained from electronic databases and bibliographic references. From these, six articles met criteria to be included in the qualitative analysis and three in the quantitative (meta-analysis). The resistance index in the superior mesenteric artery was described in three studies, and the quantitative analysis showed statistical significance (p < 0.001). Other echocardiographic and ultrasonographic parameters were also described, albeit in single studies not allowing a meta-analysis. Conclusion: This systematic review with meta-analysis identified echocardiographic and ultrasonographic parameters related to PLE in patients with Fontan physiology. Vascular ultrasonography seems to play a prominent role in this aspect, but additional studies are needed to increase the degree of evidence.

Resumo Objetivo: Determinar a frequência em que a PET/CT com FDG-18F muda a classificação de probabilidade de malignidade do nódulo pulmonar solitário. Materiais e Métodos: Foi realizada análise retrospectiva de todas as PET/CTs com FDG-18F realizadas entre maio/2016 e maio/2017 num serviço de medicina nuclear, cuja indicação era a avaliação de nódulo pulmonar solitário. Foram analisados os prontuários e os exames de PET/CT para coleta das informações necessárias para o cálculo da probabilidade pré-teste de malignidade pelo modelo de Swensen e pelo modelo de Herder. Probabilidade menor que 5% foi considerada como baixa, maior que 65% foi definida como alta, e os casos restantes, como intermediária. Os casos classificados como intermediários pelo modelo de Swensen foram reclassificados de acordo com o modelo de Herder. Resultados: Trinta e três pacientes foram incluídos neste estudo, 17 (51,5%) deles eram do gênero masculino, e a média de idade foi 68,63 anos (± 12,20 anos). Em relação à classificação da probabilidade de malignidade pelo modelo de Swensen, 23 (69,7%) apresentaram probabilidade intermediária de malignidade. Destes, o modelo de Herder classificou 6 casos (26,1%) como probabilidade baixa e 8 casos (34,8%) como probabilidade alta de malignidade. Conclusão: A PET/CT com FDG-18F foi capaz de modificar a classificação probabilística do nódulo pulmonar solitário em mais da metade dos casos.

Abstract Objective: To determine the frequency with which 18F-FDG-PET/CT findings change the probability of malignancy classification of solitary pulmonary nodules. Materials and Methods: This was a retrospective analysis of all 18F-FDG-PET/CT examinations performed for the investigation of a solitary pulmonary nodule between May 2016 and May 2017. We reviewed medical records and PET/CT images to collect the data necessary to calculate the pre-test probability of malignancy using the Swensen model and the Herder model. The probability of malignancy was classified as low if < 5%, intermediate if 5-65%, and high if > 65%. Cases classified as intermediate in the Swensen model were reclassified by the Herder model. Results: We reviewed the records for 33 patients, of whom 17 (51.5%) were male. The mean age was 68.63 ± 12.20 years. According to the Swensen model, the probability of malignancy was intermediate in 23 cases (69.7%). Among those, the application of the Herder model resulted in the probability of malignancy being reclassified as low in 6 (26.1%) and as high in 8 (34.8%). Conclusion: 18F-FDG-PET/CT was able to modify the probability of malignancy classification of a solitary pulmonary nodule in more than 50% of the cases evaluated.

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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.

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OBJETIVO: Comparar diferentes métodos de rastreamento para distúrbios da pressão arterial em crianças e adolescentes. MÉTODO: Foi usado um banco de dados com 17.083 prontuários de pacientes de uma clínica de cardiologia pediátrica. Após análise dos critérios de inclusão e exclusão, 5.650 foram selecionados. Esses foram divididos em duas faixas etárias: entre cinco e 13 anos e entre 13 e 18 anos De acordo com a aferição, a pressão arterial era classificada como normal, pré-hipertensiva ou hipertensiva de acordo com guidelines recentes e os métodos de rastreamento selecionados. Posteriormente, foram calculadas a sensibilidade, especificidade e acurácia de cada um de acordo com o gênero e faixa etária. RESULTADOS: As fórmulas de Somu e a tabela proposta por Ardissino apresentaram baixa sensibilidade na identificação de pré-hipertensão em todas as faixas etárias, enquanto a tabela proposta por Kaelber apresentou os melhores resultados. A razão entre pressão arterial e altura apresentou baixa especificidade na faixa etária menor, mas apresentou bom desempenho em adolescentes. CONCLUSÃO: As ferramentas de rastreamento para distúrbios da pressão arterial em crianças e adolescentes podem ser úteis para diminuir o subdiagnóstico que ocorre atualmente nessa condição. A tabela proposta por Kaelber apresentou os melhores resultados, entretanto a razão entre PA e altura apresenta vantagens específicas, como a não necessidade de tabelas.

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 Ardissino's 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.

OBJETIVO: Determinar a frequência e o perfil das cardiopatias congênitas em portadores de síndrome de Down atendidos em serviço de referência de cardiologia pediátrica, considerando-se a idade do encaminhamento, o sexo, o tipo de cardiopatia diagnosticada ao ecocardiograma transtorácico e sua associação com hipertensão pulmonar ao diagnóstico inicial.MÉTODOS:Estudo de corte transversal com coleta retrospectiva de dados de 138 pacientes portadores de síndrome de Down de um total de 17.873 prontuários. Os dados foram submetidos à análise descritiva, utilizando-se o programa Epi-Info, versão 7.RESULTADOS: Entre os 138 pacientes com síndrome de Down, houve maior prevalência do sexo feminino (56,1%) e 112 (81,2%) foram diagnosticados com cardiopatia congênita. Entre as cardiopatias, a mais comum foi a comunicação interatrial ostium secundum, com frequência de 51,8%, seguida pelo defeito do septo atrioventricular, com 46,4%. A comunicação interventricular estava presente em 27,7%, enquanto a tetralogia de Fallot representou 6,3% dos casos. Outras cardiopatias totalizaram 12,5%. A hipertensão pulmonar associou-se a 37,5% das cardiopatias. Apenas 35,5% dos pacientes foram encaminhados ao serviço até os seis meses de idade.CONCLUSÕES: O baixo percentual de encaminhamento até os seis meses chama atenção para a necessidade de um melhor rastreamento dos portadores da síndrome no contexto das cardiopatias congênitas, tendo em vista a alta frequência e a progressão da hipertensão 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.

OBJETIVO: Determinar la frecuencia y el perfil de las cardiopatías congénitas en portadores de síndrome de Down atendidos en servicio de referencia de cardiología pediátrica, considerándose la edad del encaminamiento, el sexo, el tipo de cardiopatía diagnosticada al ecocardiografía transtorácica y su asociación con hipertensión pulmonar al diagnóstico inicial.MÉTODOS: Estudio de cohorte transversal con recolección retrospectiva de datos de 138 pacientes portadores de síndrome de Down de un total de 17.873 prontuarios. Los datos fueron sometidos al análisis descriptivo, utilizando el programa Epi-Info, versión 7.RESULTADOS: Entre los 138 pacientes con síndrome de Down, hubo mayor prevalencia del sexo femenino (56,1%) y 112 (81,2%) fueron diagnosticados con cardiopatía congénita. Entre las cardiopatías, la más común fue la comunicación interatrial ostium secundum, con frecuencia del 51,8%, seguida por el defecto del septo atrioventricular, con 46,4%. La comunicación interventricular estaba presente en el 27,7%, mientras que la tetralogía de Fallot representó solamente un 6,3% de los casos. Otras cardiopatías totalizaron 12,5%. La hipertensión pulmonar se asoció al 37,5% de las cardiopatías. Sólo un 35,5% de pacientes fueron encaminados al servicio hasta los seis meses de edad.CONCLUSIONES: La proporción de cardiopatías congénitas en portadores de síndrome de Down fue mayor en el servicio estudiado respecto a lo descripto en la literatura. Aún así, el bajo porcentaje de encaminamiento hasta los seis meses llama la atención para la necesidad de un mejor rastreo de los portadores de la síndrome en el contexto de las cardiopatías congénitas, teniendo en vista la alta frecuencia y la progresión de la hipertensión pulmonar.