Neurologists
7 years of experience

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2799 W Grand Blvd
Detroit, MI 48202
313-916-2585
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Medical School Score Rankings
Ohio University (2003)
  • Currently 3 of 4 apples
Top 50%

Publications & Research

Dr. Garcia has contributed to 64 publications.
Title Evaluating End of Life Practices in Ten Brazilian Paediatric and Adult Intensive Care Units.
Date November 2010
Journal Journal of Medical Ethics
Excerpt

To evaluate the modes of death and treatment offered in the last 24 h of life to patients dying in 10 Brazilian intensive care units (ICUs) over a period of 2 years.

Title Nursing Workload and Staff Allocation in an Intensive Care Unit: a Pilot Study According to Nursing Activities Score (nas).
Date June 2010
Journal Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses
Excerpt

The objectives of the study were to identify the daily nursing workload in an intensive care unit (ICU) and to analyse the adequacy of nursing staff in a six hour shift according to the Nursing Activities Score (NAS).

Title Risk Factors for Extubation Failure in Infants with Severe Acute Bronchiolitis.
Date May 2010
Journal Respiratory Care
Excerpt

To evaluate demographic characteristics, mechanical-ventilation parameters, blood gas values, and ventilatory indexes as predictors of extubation failure in infants with severe acute bronchiolitis.

Title External Validation of the Paediatric Logistic Organ Dysfunction Score.
Date April 2010
Journal Intensive Care Medicine
Excerpt

External validation of the paediatric logistic organ dysfunction (PELOD) score in two paediatric intensive care units (PICU) in South America.

Title Cytogenetic Comparison of Tree Frogs of the Genus Aplastodiscus and the Hypsiboas Faber Group (anura, Hylidae).
Date March 2010
Journal Genetics and Molecular Research : Gmr
Excerpt

Four species of Aplastodiscus and two species of Hypsiboas were cytogenetically compared. Aplastodiscus perviridis, A. cochranae, H. albomarginaus, and H. faber had 2n = 24 chromosomes, while A. albosignatus and A. leucopygius had 2n = 20 and 2n = 18 chromosomes, respectively. Aplastodiscus perviridis and A. cochranae had identical karyotypes, as indicated by their chromosomal morphology, the location of the nucleolus organizer region (NOR) on chromosome pair 12, and the heterochromatin pattern. The NOR-bearing chromosomes of A. albosignatus and A. leucopygius (pair 9) were very similar in size and morphology (metacentric) when compared to A. perviridis and A. cochranae (pair 12) and to H. faber (pair 11); the NOR of these chromosomes also occurred in the same region, suggesting that these chromosomes are homologous. Although H. albomarginatus differs from the other species with regard to the location of its NOR on pair 2, this species had the same diploid number and a chromosomal morphology similar to that of A. perviridis and A. cochranae. Chromosomal differentiation among the species appears to have occurred by reduction in chromosome number.

Title Nor Dispersion, Telomeric Sequence Detection in Centromeric Regions and Meiotic Multivalent Configurations in Species of the Aplastodiscus Albofrenatus Group (anura, Hylidae).
Date February 2010
Journal Cytogenetic and Genome Research
Excerpt

In the present study, we examined the chromosome number and morphology, heterochromatin pattern, and location of the nucleolar organizer region (NOR) and telomeric sequences in Aplastodiscus albofrenatus, A. arildae, A. ehrhardti and A. eugenioi in order to cytogenetically characterize the Aplastodiscus albofrenatus group. The 4 species analyzed in this study had diploid numbers of 2n = 22 and very similar chromosome morphology. These species could be differentiated based on the distribution and amount of heterochromatin and the location of the nucleolar organizer region (NOR). Six of the 8 A. albofrenatus individuals had an NOR polymorphism previously unknown in anurans since only one of the homologs of pairs 1 and 7 was stained. In the other 2 specimens, the NOR occurred on both homologs of pair 7. In A. ehrhardti, pairs 6 and 10 were stained by the AgNOR technique, but only pair 6 was confirmed by in situ hybridization. The NOR was located on pair 10 in A. arildae and on pair 7 in A. eugenioi. In A. albofrenatus and A. arildae, multivalent rings involving NOR-containing chromosomes were observed during prophase I of meiosis. The telomeric probe identified the telomeres in all species and also centromeric regions in the chromosomes of A. albofrenatus and A. arildae, which were coincident with centromeric heterochromatin. The conserved chromosomal morphology seen mainly in the first 7 pairs among species of the A. albofrenatus group suggests that all of these species probably originated from a common ancestral karyotype and that chromosomal rearrangements resulted in karyotype differentiation, with changes in NOR location, as well as telomeric and heterochromatin dispersal.

Title Adult Partner Preference and Sexual Behavior of Male Rats Exposed Prenatally to Betamethasone.
Date September 2009
Journal Physiology & Behavior
Excerpt

The aim of this study was to investigate long-term effects of prenatal betamethasone exposure on sexual partner preference, testosterone level, and sexual behavior. Pregnant rats received 0.1 mg/kg of betamethasone or saline on the 12th, 13th, 18th, and 19th days of pregnancy. Parameters in male offspring were evaluated at 90 days of age. Male rats from the betamethasone group did not show any difference in sexual partner preference as expressed by the total number of visits to the female or male zone. However, these males spent significantly less total time and shorter duration per visit in the female zone than their controls. Therefore, prenatal exposure to betamethasone led to a significantly lower sexual female partner preference score compared to the control group. These animals also presented diminished testosterone levels in adulthood. Prenatal exposure to betamethasone induced a delay in the latency to first ejaculation, as well as a decrease in the numbers of postejaculatory intromissions, total intromissions and total ejaculations. Although 80% of the betamethasone-treated animals exhibited male sexual behavior, when they were castrated and pretreated with estrogen, 50% of them showed lordosis and accepted mounts of another sexually experienced male. These results suggest that the prenatal treatment with betamethasone, by increasing maternal corticosteroid level, may have diminished testosterone peak in male pups, a peak crucial to brain sexual differentiation. As a consequence, the prenatal betamethasone treatment reduced the testosterone level in adulthood and altered partner preference and sexual behavior.

Title Profile and Consequences of Children Requiring Prolonged Mechanical Ventilation in Three Brazilian Pediatric Intensive Care Units.
Date August 2009
Journal Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Excerpt

To describe the characteristics of children submitted to prolonged mechanical ventilation (MV), and evaluate their mortality, and associated factors as well as the potential impact at admissions to the pediatric intensive care unit (PICU).

Title Semen Parameters, Fertility and Testosterone Levels in Male Rats Exposed Prenatally to Betamethasone.
Date August 2009
Journal Reproduction, Fertility, and Development
Excerpt

The present study investigated the long-term effects of prenatal betamethasone exposure on sperm quality and count, fertility and plasma testosterone levels in adult male rats. Pregnant rats received 0.1 mg kg(-1) betamethasone on Days 12, 13, 18 and 19 of pregnancy. This treatment impaired sperm quality, sperm production, fertility and plasma testosterone levels in adult male offspring compared to the control group. Thus, the results of the present study indicate that the long-term effects of prenatal betamethasone exposure may be deleterious to offspring. The consequent decrease in testosterone production during adulthood, in association with damaged semen parameters, may explain for the observed decrease in the capacity of adult male offspring to themselves generate viable descendants.

Title Pilot Safety Study of Low-dose Vasopressin in Non-septic Critically Ill Children.
Date August 2009
Journal Intensive Care Medicine
Excerpt

To assess the safety of low-dose vasopressin infusion in critically ill children requiring prolonged mechanical ventilation (MV) at risk of developing sedation/analgesia-related hypotension.

Title Dexmedetomidine in Anesthesia of Children Submitted to Videolaparoscopic Appendectomy: a Double-blind, Randomized and Placebo-controlled Study.
Date June 2009
Journal Revista Da Associação Médica Brasileira (1992)
Excerpt

To evaluate the hemodynamic responses to nociceptive stimuli in children submitted to videolaparoscopic appendectomy under balanced anesthesia with isoflurane and dexmedetomidine.

Title Effects of Maternal Exposure to an Aromatase Inhibitor on Sexual Behaviour and Neurochemical and Endocrine Aspects of Adult Male Rat.
Date September 2008
Journal Reproduction, Fertility, and Development
Excerpt

The present study examined the effects of letrozole exposure during brain sexual differentiation on endocrine, behavioural and neurochemical parameters in male rat descendants. Pregnant female rats received 1 mg kg(-1) day(-1) letrozole or vehicle by oral gavage on gestational Days 21 and 22. Exposure to letrozole reduced anogenital distance in males on postnatal Day (PND) 22. At adulthood (PND 75), plasma testosterone levels and hypothalamic dopaminergic activity were increased, but sexual competence was impaired, because fewer successful sexual behaviours (mount, intromission and principally ejaculation) were observed. The impairment of reproductive function by prenatal exposure to an aromatase inhibitor reinforces the importance of adequate oestrogenic activity during perinatal sexual differentiation for complete masculinisation of the hypothalamus.

Title Current Perspectives for Treating Children with Diabetic Ketoacidosis.
Date September 2008
Journal Jornal De Pediatria
Excerpt

To review current concepts of physiopathology, diagnosis and treatment of diabetic ketoacidosis (DKA) in childhood, as well as preventive measures to avoid cerebral edema.

Title End-of-life Practices in Seven Brazilian Pediatric Intensive Care Units.
Date June 2008
Journal Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Excerpt

To evaluate the incidence of life support limitation and medical practices in the last 48 hrs of life of children in seven Brazilian pediatric intensive care units (PICUs).

Title Pharmacologic Support of Infants and Children in Septic Shock.
Date March 2008
Journal Jornal De Pediatria
Excerpt

OBJECTIVES: Septic shock (SS) is a frequent cause for admission to the pediatric intensive care unit, requiring prompt recognition and intervention to improve outcome. Our aim is to review the relevant literature related to the diagnosis and management of SS and present a sequential management for its treatment. SOURCES: Non-systematic review of medical literature using the MEDLINE database. Articles were selected according to their relevance to the objective and according to the authors' opinions. SUMMARY OF THE FINDINGS: The outcome of sepsis and SS is dependent on the early recognition and implementation of time-sensitive goal-directed therapies. These include rapid aggressive fluid resuscitation followed by a well-designed pharmacotherapy. The goals of the resuscitation are the restoration of microcirculation and improved organ tissue perfusion. Clinical and laboratory markers are needed to assess the adequacy of the treatments. Altered pharmacokinetic and pharmacodynamic responses dictate that vasoactive agents should be adjusted to achieve the predetermined goals. In initial resuscitation with isotonic solutions (> 60 mL/kg), either crystalloid (normal saline) or colloid infusion could be used. Despite adequate fluid resuscitation, if: (a) wide pulse pressure, low blood pressure, or bounding pulses (high cardiac output, low systemic vascular resistance--SVR) are present, norepinephrine should be considered; (b) prolonged capillary refill, weak pulses, narrow pulse pressure, normotensive (low cardiac output, high SVR), dopamine, epinephrine or dobutamine should be considered. Adjunctive therapy with stress dose of corticosteroid is indicated in selected populations. CONCLUSIONS: Septic shock hemodynamics is a changing process that requires frequent assessment and therapeutic adjustments.

Title Brain Death: Medical Management in Seven Brazilian Pediatric Intensive Care Units.
Date February 2008
Journal Jornal De Pediatria
Excerpt

To assess the incidence of brain death (BD) and its medical management and adopted protocols after its diagnosis in seven pediatric intensive care units (PICUs) located in three Brazilian regions.

Title Adrenal Response in Children with Septic Shock.
Date February 2008
Journal Intensive Care Medicine
Excerpt

To describe the serum cortisol profile and evaluate the adrenal response in children with septic shock, and determine the influence of these factors on the outcome and mortality in this group.

Title Ferritin Levels in Children with Severe Sepsis and Septic Shock.
Date February 2008
Journal Acta Paediatrica (oslo, Norway : 1992)
Excerpt

To evaluate serum ferritin level in children with severe sepsis and septic shock and its association with mortality.

Title Atypical Presentation of Leber's Hereditary Optic Neuropathy Associated to Mtdna 11778g>a Point Mutation--a Case Report.
Date May 2007
Journal European Journal of Paediatric Neurology : Ejpn : Official Journal of the European Paediatric Neurology Society
Excerpt

Leber's hereditary optic neuropathy (LHON) is a maternally inherited mitochondrial disorder characterized by bilateral loss of central vision, most frequently found in young adult males. In most patients there are no other neurological manifestations and cerebral neuroimaging is normal, but some rare cases of "LHON plus" have been described. Classical LHON is mainly associated to mitochondrial DNA (mtDNA) mutations 11778G>A, 3460G>A and 14484T>C, localized in the coding regions for ND4, ND1 and ND6 of the complex I subunits of mitochondrial respiratory chain (MRC), respectively. We report a 12-year-old girl who presented with reduced visual acuity secondary to optic atrophy at 8 months of age, which led to a clinical diagnosis of LHON. Psychomotor regression, refractory epilepsy and progressive neurological abnormalities developed subsequently. Skeletal muscle histology and biochemical MRC function were normal (evaluated by dual wavelength spectrophotometry). A 11778G>A mtDNA point mutation (investigated by standard PCR and automatic sequencing methods) was identified in lymphocytes isolated from peripheral blood, muscle biopsy and cultured skin fibroblasts. The mother and other maternal relatives are carriers for the same mutation. This case is unusual for age of onset, gender, associated neurological findings and evolution.

Title Pediatric Index of Mortality 2 (pim2)--a Prognostic Tool for Developing Countries: Easy, Efficient, and Free!
Date April 2007
Journal Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Title [the Need for Nursing Care in Intensive Care Units: Daily Patient Assessment According to the Nursing Activities Score (nas)].
Date December 2006
Journal Revista Brasileira De Enfermagem
Excerpt

This study aimed to characterize patients admitted to ICU according to their bio-social factors and admissions and verify the daily needs for nursing care according to NAS. The sample was composed by 50 adult patients who were consecutively admitted to the ICU of a University Hospital in São Paulo city. It was concluded that most patients were older than 60 with an average of 3.5-day stay in the ICU; they came from the Emergency Room and were referred to the Semi-Intensive Care Unit. NAS average was 66.5% (+/- 9.1) with a score higher than 50.0% during their stay in the ICU.

Title Limitation in Paediatric Logistic Organ Dysfunction Score.
Date October 2006
Journal Lancet
Title [plastic Bronchitis in a Child with Thalassemia Alpha].
Date June 2006
Journal Jornal De Pediatria
Excerpt

Plastic bronchitis is an unusual condition in children, associated with formation of mucofibrinous casts and mucous plugging of the tracheobronchial tree. Given that this illness is part of the differential diagnosis of acute respiratory failure, early treatment is important for improved prognosis. The aim of this report is to describe a case of plastic bronchitis in a child with alpha-thalassemia that was treated successfully with endoscopy.

Title Accidental Asphyxia Due to Closing of a Motor Vehicle Power Window.
Date April 2006
Journal Emergency Medicine Journal : Emj
Excerpt

Injuries and deaths among children left unattended in motor vehicles are frequent and the rates are increasing. Injuries associated with motor vehicle power windows usually affect children, in particular children under 6 years of age. This case report is about a child who was asphyxiated because of a motor vehicle power window closing. She was rapidly resuscitated and recovered fully. A brief review of the literature, epidemiology, and preventive measures to avoid this type of injury is also presented.

Title [therapeutic Interventions in Intensive Care Units: Analysis According to Therapeutic Intervention Scoring System-28 (tiss-28)].
Date February 2006
Journal Revista Brasileira De Enfermagem
Excerpt

The present study aimed to identify the therapeutic interventions categories carried out in Intensive Care Units (ICU), finding out their prevalence and identifying their components according to TISS-28. The sample was composed of 89 adult patients who were consecutively admitted to the ICU of a university hospital in São Paulo city. Basic and Supportive Activities, Ventilatory, Cardiovascular and Renal were the TISS-28 that prevailed with a frequency of 73.0% and 100%. The frequency of the items considered Basic Activities were prevalent, that is, higher than 90.0%. The quantitative average of urinary debt was 98.2% concerning Renal Support. The results may mean quality of assistance provided to the clients, as they contribute to the human resources estimative and materials in the ICU as well.

Title Interactions of Sepsis, Organ Dysfunction, and Outcome of Critically Ill Children.
Date February 2006
Journal American Journal of Respiratory and Critical Care Medicine
Title [comparison of Two Prognostic Scores (prism and Pim) at a Pediatric Intensive Care Unit].
Date January 2006
Journal Jornal De Pediatria
Excerpt

To compare the performance of the PRISM (Pediatric Risk of Mortality) and the PIM (Pediatric Index of Mortality) scores at a general pediatric intensive care unit, investigating the relation between observed mortality and survival and predicted mortality and survival.

Title [life Support Limitation at Three Pediatric Intensive Care Units in Southern Brazil].
Date December 2005
Journal Jornal De Pediatria
Excerpt

To describe causes of death and factors involved in the decision-making process related to life support limitation at three university-affiliated pediatric intensive care units in the south of Brazil.

Title The Burden of Paediatric Intensive Care: a South American Perspective.
Date November 2005
Journal Paediatric Respiratory Reviews
Excerpt

Paediatric intensive care is a relatively new medical specialty that has shown a marked growing up around the world over the last three decades. The limits and the development of this new specialty are not uniform from country to country. Original articles relating to paediatric intensive care and some South American data bases of health care were evaluated and relevant results were selected. Using these data, we describe the main characteristics of paediatric intensive care in South America and discuss some associated factors (e.g. economic aspects, health systems, ethical aspects) that could interfere with the quality and extent of care. A strong relationship between the financial stability of each region and the complexity and quality of paediatric intensive care was seen. A better coverage and more sophisticated paediatric intensive care units (PICUs) are concentrated in the more developed countries (Brazil, Chile and Argentina). Compared to the northern hemisphere, children admitted to the South American PICUs have higher mortality and higher rates of intervention (mechanical ventilation and indwelling catheters). Medical paternalism has a strong influence in the decision-making process offered to terminally ill patients. This phenomenon increases the length of stay, reduces the number of available beds and increases costs. In conclusion, during the last 20 years PICUs have developed and increased their coverage in South America. However, the most sophisticated and well equipped PICUs are preferentially located in the more developed areas whereas those areas with higher infant mortality rates have few PICU beds. Improvements in the economical stability, regional health organisation as well as the rationale for PICU localisation are some of the important goals to be reached in the near future.

Title Prone Positioning in Children with Acute Lung Injury.
Date November 2005
Journal Jama : the Journal of the American Medical Association
Title Glucose Level and Risk of Mortality in Pediatric Septic Shock.
Date November 2005
Journal Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Excerpt

To study the relationship between serum glucose level and mortality in children with septic shock.

Title Evolution of the Medical Practices and Modes of Death on Pediatric Intensive Care Units in Southern Brazil.
Date October 2005
Journal Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Excerpt

To study the possible change on mode of deaths, medical decision practices, and family participation on decisions for limiting life-sustaining treatments (L-LST) over a period of 13 yrs in three pediatric intensive care units (PICUs) located in southern Brazil. Methods: A cross-sectional study based on a retrospective chart review (1988 and 1998) and on prospective data collection (from May 1999 to May 2000).

Title Risk Factors for Extubation Failure in Mechanically Ventilated Pediatric Patients.
Date September 2005
Journal Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Excerpt

To describe the incidence of extubation failure and its associated risk factors among mechanically ventilated children.

Title [assessment of Intubation Procedures at Reference Pediatric and Neonatal Intensive Care Units].
Date August 2005
Journal Jornal De Pediatria
Excerpt

To describe intubation procedures in two pediatric and two neonatal intensive care units in the city of Porto Alegre.

Title Csf Ferritin As a Marker for Bacterial Meningitis.
Date February 2005
Journal Pediatric Neurology
Title Conserved Karyotypes in the Hyla Pulchella Species Group (anura, Hylidae).
Date June 2004
Journal Hereditas
Excerpt

Cytogenetic analyses were done on specimens of Hyla marginata and on three populations of H. semiguttata differing in morphology and in the physical parameters of their advertisement call, as well as in individuals of Hyla sp. (aff. semiguttata). All specimens had 2n=24 chromosomes with a morphology very similar to that of other 24-chromosome Hyla species. Hyla semiguttata and H. marginata showed the same C-banding pattern but were distinguished by the location of the NOR on pair 1 in H. semiguttata (in the three populations) and Hyla sp. (aff. semiguttata), and on pair 10 in H. marginata. The H. semiguttata populations did not differ cytogenetically, despite variations in their morphology and advertisement calls. Similarly, H. semiguttata and H. p. joaquini studied previously had identical C-banding patterns and NOR locations, suggesting that they are very closely related.

Title [sedation and Analgesia in Children Submitted to Mechanical Ventilation Could Be Overestimated?].
Date March 2004
Journal Jornal De Pediatria
Excerpt

To describe the pattern of analgesic and sedative infusions in children submitted to mechanical ventilation in a regional pediatric intensive care unit during a 12-month period. To compare the use of these drugs among clinical and surgical patients, as well evaluate the influence of the length of use on the average daily doses and on the incidence of abstinence syndrome.

Title [the Influence of Poor Nutrition on the Necessity of Mechanical Ventilation Among Children Admitted to the Pediatric Intensive Care Unit].
Date February 2004
Journal Jornal De Pediatria
Excerpt

To determine the relation between children's nutritional status when they are admitted to the Pediatric Intensive Care Unit, the necessity and length of mechanical ventilation and the mortality rate.

Title [controversies in the Pharmacological Management of Acute Asthma in Children].
Date February 2004
Journal Jornal De Pediatria
Excerpt

To present a review of controversial issues related to the pharmacological management of the treatment of acute asthma in children.

Title [new Treatments for Critically Ill Children].
Date February 2004
Journal Jornal De Pediatria
Title [rapid Airway Access].
Date February 2004
Journal Jornal De Pediatria
Excerpt

To review the steps involved in safe airway management in critically ill children.

Title [adrenal Insufficiency in Children with Septic Shock].
Date February 2004
Journal Jornal De Pediatria
Excerpt

To review the criteria for diagnosing and treating adrenal insufficiency in patients with septic shock.

Title [analgesia and Sedation in Emergency Situations and in the Pediatric Intensive Care Unit]
Date February 2004
Journal Jornal De Pediatria
Excerpt

OBJECTIVE: To review the current strategies for use of sedatives and analgesics in emergency rooms and intensive care units. SOURCE OF DATA: Original data from our emergency rooms and intensive care units; Medline literature review focused on sedatives and analgesic drugs; textbooks. SUMMARY OF THE FINDINGS: Despite the advances in understanding pain in children, in many critical care units the misguided treatment of pain and anxiety still results in significant morbidity. Difficulties in communication, invasive procedures and the belief that children do not have sufficient neurologic development to process noxious sensations are still a challenge in intensive care units. CONCLUSIONS: The last decade was marked by significant advances in understanding pediatric pain. Treating intensive care unit-related pain and anxiety has clear benefits which may influence the course of disease.

Title [autonomic Dysfunction in Guillain-barré Syndrome: a 13 Year Experience in Pediatric Intensive Care Unit].
Date February 2004
Journal Jornal De Pediatria
Excerpt

The acute inflammatory demyelinating polyneuropathy (Guillain-Barré Syndrome) might have a severe presentation but a good prognosis in children. It is an immune-mediated and inflammatory disorder of the peripheral nervous system. This retrospective study observed that GBS is frequently complicated by hypertension and other autonomic disorders. Cardiovascular instability is due to the involvement of the autonomic nervous system and results in labile blood pressure, cardiac dysrhythmias and hypovolemia. During a 13-year period (1982-1995), 21 children were admitted to the Pediatric Intensive Care Unit of São Lucas Hospital, Porto Alegre, south of Brazil. Eight patients were mechanically ventilated. Symptoms of autonomic disturbance were frequently seen, especially in patients with severe clinical evolution. Previous investigations of the mechanism of hypertension associated with GBS did not evaluate the etiology of these phenomena. With modern pediatric intensive care support the deaths are rare. There is no death in this studied group.

Title [decision Making About the Child in Ciu--participation of the Family].
Date January 2004
Journal Jornal De Pediatria
Excerpt

This paper focuses attention on the moral and ethical principles in the treatment of a very sick newborn infant and child. Special attention is given to the risk benefit balance of the employment of sophisticated technology with the purpose of prolonging the survival of a possible handicapped child. The authors analyzed the different ways of facing this problem according to different cultural backgrounds. The concept of a terminal patient is not applied to the neonatal period. The principle of autonomy is discussed, and the familiar feelings are analyzed.

Title [survival Evaluation of Children with Acute Lymphoblastic Leukemia Treated with Berlin-frankfurt-munich Trial].
Date December 2003
Journal Jornal De Pediatria
Excerpt

To determine the survival rate of children with acute lymphoblastic leukemia treated in Hospital São Lucas - Pontifícia Universidade Católica - Rio Grande do Sul during the past 10 years. To evaluate well known prognostic factors and to compare results of BFM 90 and 95 trials.

Title More, More, and Even More Beta2-adrenergic Agents for Treating Acute Asthma in Children: is the "adrenergic Approach" the Only Way?
Date November 2003
Journal Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Title [a Sixteen-year Epidemiological Profile of a Pediatric Intensive Care Unit, Brazil].
Date April 2003
Journal Revista De Saúde Pública
Excerpt

To review epidemiological data from patients admitted to a Pediatric Intensive Care Unit (PICU), Brazil, and to compare them to medical aspects associated to disease severity and mortality. Also, to profile these patients, including demographic data, disease prevalence, mortality rates and associated factors.

Title Cytogenetics of Two Species of Paratelmatobius (anura: Leptodactylidae), with Phylogenetic Comments.
Date July 2001
Journal Hereditas
Excerpt

In this paper we provide a cytogenetic analysis of Paratelmatobius cardosoi and Paratelmatobius poecilogaster. The karyotypes of both species showed a diploid number of 24 chromosomes and shared some similarity in the morphology of some pairs. On the other hand, pairs 4 and 6 widely differed between these complements. These karyotypes also differed in their NOR number and location. Size heteromorphism was seen in all NOR-bearing chromosomes of the two karyotypes. In addition, both karyotypes showed small centromeric C-bands and a conspicuous heterochromatic band in the short arm of chromosome 1, although with a different size in each species. The P. cardosoi complement also showed other strongly stained non-centromeric C-bands, with no counterparts in the P. cardosoi karyotype. Chromosome staining with fluorochromes revealed heterogeneity in the base composition of two of the non-centromeric C-bands of P. cardosoi. Comparison of the chromosomal morphology of these Paratelmatobius karyotypes with that of P. lutzii showed that the P. poecilogaster karyotype is more similar to that of P. lutzii than P. cardosoi. These cytogenetic results agree with the proposed species arrangements in the P. cardosoi and P. lutzii groups based on morphological and ecological data.

Title Direct Action of the Biocide Carbendazim on Phenolic Metabolism in Tobacco Plants.
Date June 2001
Journal Journal of Agricultural and Food Chemistry
Excerpt

In view of the essential role of phenolic compounds in the development of pathogen resistance in plants, and given the influence that fungicides exert over phenolic metabolism, the aim of the present study was to determine the effect of the application of different rates of fungicide on the metabolism of phenolic compounds in tobacco plants (Nicotiana tabacum L. cv. Tennessee 86). The fungicide applied was carbendazim, with a purity of 100%, at three different rates: 1.3 mM (carb(1)), 2.6 mM (this being the recommended concentration, carb(2)), and 5.2 mM (carb(3)). The control treatment was without carbendazim. The results in relation to control plants indicate that the application of carb(1) in tobacco plants not afflicted by damaging biotic and abiotic agents boosts phenolic accumulation. Therefore, in the case of carbendazim, the application of 50% less (carb(1), 1.3 mM) than the recommended dosage (carb(2), 2.6 mM) of this fungicide could be more effective, because the foliar accumulation of phenolics presented at carb(1) may imply an increased resistance of plants to pathogen infection. On the other hand, we found an inhibition of the phenolic oxidation by the application of carbendazim, principally at carb(3). These results suggest that the excessive application of carbendazim (5.2 mM) could be harmful for healthy plants, because, on inhibiting phenolic metabolism (biosynthesis and oxidation), such treatment would also sharply reduce the capacity of these plants to respond against pathogen attack.

Title International Standard of Quality in the Pediatric Intensive Care Unit: a Model for Pediatric Intensive Care Units in South America.
Date October 1993
Journal Critical Care Medicine
Title [exogenous Surfactant Treatment for Severe Acute Viral Bronchiolitis: Case Report]
Date
Journal Jornal De Pediatria
Excerpt

OBJECTIVE: To describe the possible clinical and laboratory effects of exogenous surfactant instillation into the tracheal tube of a child with severe acute bronchiolitis undergoing mechanical ventilation. CASE REPORT: a 2-month-old girl with clinical diagnosis of acute viral bronchiolitis underwent mechanical ventilation. She required high positive inspiratory peak pressure (35 to 45 cmH(2)O) and high inspiratory fraction of oxygen (FiO(2) = 0.9), but showed no clinical response or improvement in the arterial blood gas analysis. An exogenous surfactant (Exosurf(R), Glaxo - 50 mg/kg) was used to facilitate the use of a less aggressive ventilatory strategy. RESULTS: Four hours after surfactant administration, it was possible to reduce the positive peak inspiratory pressure (PIP) from 35 to 30 cmH(2)O, and FiO(2) from 0.9 to 0.6; and to increase the positive end-expiratory pressure (PEEP) from 6 to 9 cmH(2)O. During this period the paO(2)/FiO(2) ratio increased from 120 to 266. At the end of 24 hours, FiO(2) could be reduced to 0.4. DISCUSSION: Surfactant inactivation may be a decisive factor in the unfavorable evolution of some severe cases of acute bronchiolitis. The tracheal instillation of exogenous surfactant, in these cases, allows us to adopt less aggressive ventilatory strategies, and promotes rapid clinical responses.

Title [eyes on the Present and Looking into the Future]
Date
Journal Jornal De Pediatria
Title [congenital Syphilis: an Emerging Emergency Also in Brazil]
Date
Journal Jornal De Pediatria
Excerpt

OBJECTIVE: To highlight to the fact that some newborns are not identified as having congenital syphilis, and will present to an emergency room within a few months with a severe disease. METHOD: Review of the charts concerning 3 patients with congenital syphilis, as well as review of the literature using Medline and Lilacs databases, covering the period from 1988 to 1999. RESULTS: We describe the case of 3 infants whose diagnosis of congenital syphilis was only established after the neonatal period, when they presented to the emergency room and were admitted to the pediatric intensive care unit. The first patient had neurosyphilis and nephrotic syndrome, the second had neurosyphilis, and the third had hepatitis. We discuss the clinical aspects of the cases, and comment on other clinical manifestations of congenital syphilis that should be within the purview of pediatric emergency medicine. We analyze the reasons for the failure to diagnose syphilis at birth, and describe some risk factors for gestational syphilis. CONCLUSIONS: Considering the rising incidence of syphilis in Brazil, and the possibility that the congenital infections are not recognized at birth, emergency physicians must keep a high degree of suspicion and an awareness of maternal risk factors, prenatal serology pitfalls, as well as of the several clinical presentations of congenital syphilis that can develop in the first months of life.

Title [the Challenges and Consolidation of a Scientific Journal]
Date
Journal Jornal De Pediatria
Title [prognostic Indicators in Neonatology]
Date
Journal Jornal De Pediatria
Title [short-term Effects of Prone Positioning on the Oxygenation of Pediatric Patients Submitted to Mechanical Ventilation]
Date
Journal Jornal De Pediatria
Excerpt

OBJECTIVE: To analyze the short-term effects of prone positioning on the oxygenation of mechanically-ventilated children suffering from severe hypoxemia. MATERIALS AND METHODS: A prospective, nonrandomized trial (each patient as his/her own control) was conducted between July 1998 and July 1999. Mechanically-ventilated children with peak inspiratory pressure greater than or equal to 30 cm H(2)O, FiO(2) greater than or equal to 0.5, and PaO(2)/FiO(2) ratio less than or equal to 200 were included in the study. Each patient was kept in the prone position for two hours, returning to the supine position after this period. Oxygenation was assessed by means of PaO(2)/FiO(2) in the supine position (one hour before prone positioning), one hour after prone positioning, and one hour after returning to the supine position. Patients who presented an increase of at least 20 in PaO(2)/FiO(2) were considered responsive. The results were compared by Student t-test, Friedman test, chi-square test, Fishers exact test, and confidence interval. RESULTS: Eighteen children (10 males), whose mean age was 11.5 -/+11.5 months, with initial PaO(2)/FiO(2) of 96.06 -/+ 41.78, participated in the study. After one hour in the prone position, 27.7% of the patients (5/18) improved their PaO(2)/FiO(2) ratio (P=0.045). Six of these patients presented reduced lung compliance (four of them had acute respiratory distress syndrome); and twelve patients showed increased airway resistance (six of them presented bronchiolitis). No significant difference was observed between these two groups (reduced lung compliance x increased airway resistance) in terms of age, sex, duration of ventilation prior to change in position, peak inspiratory pressure, FiO(2), severity of hypoxemia, and outcome. CONCLUSION: Prone positioning during mechanical ventilation of children with severe hypoxemia may improve the PaO(2)/FiO(2) ratio in the first hour.

Title [jornal De Pediatria On-line: First Impressions]
Date
Journal Jornal De Pediatria
Title [randomized Clinical Trial of Intravenous Magnesium Sulfate Versus Salbutamol in Early Management of Severe Acute Asthma in Children]
Date
Journal Jornal De Pediatria
Excerpt

OBJECTIVE: To study the efficacy of intravenous magnesium sulfate and intravenous salbutamol in the treatment of severe asthma in children. METHODS: Randomized, double-blind, placebo-controlled clinical trial, including children above 2 years of age with severe acute asthma admitted to the observation ward of the Pediatric Intensive Care Unit of Hospital São Lucas. All patients received conventional treatment (oxygen, corticoids, beta-adrenergics) on admission, and later received one of the following solutions: a) IVMg (50 mg/kg); b) intravenous salbutamol (1 micro g/kg); c) saline solution. Clinical assessments, electrolyte concentration, and arterial blood gas analyses were recorded before intravenous infusion and one hour after that. RESULTS: Fifty patients participated in this study (of whom 53% were females, mean age = 4.5 years). There were no significant differences among the three groups. The group that received IVMg presented lower blood pressure during administration, which reached normal levels one hour afterwards, along with an increase in serum magnesium (P<0,001) and serum pH, and reduction of PaCO(2). The group that received intravenous salbutamol had lower respiratory rate (P=0.05) and higher blood pressure (P=0.01), and one hour after administration, these patients showed decreased respiratory rate (P=0.02); lower levels of serum potassium (P=0.009); higher pH, and reduced PaCO(2). This group required fewer nebulizations (P=0.009), fewer nebulizations per day (P<0.001) and less oxygen therapy than the IVMg and placebo groups. Acidosis was more persistent (P<0.01) in the placebo group. No difference as to the length of hospital stay was observed in any of the three groups. Artificial ventilation was necessary in 10% of the patients. CONCLUSIONS: The early intravenous administration of magnesium sulfate, especially salbutamol, achieved a rapid clinical response with excellent prognosis and no significant side effects.

Title [shock Therapy in Children]
Date
Journal Jornal De Pediatria
Excerpt

OBJECTIVE: Review the theoretical bases of the therapeutic approach for volumetric resuscitation of the infant in shock and the evolutionary process that take to the pharmacological support to the circulationMETHODS: References were obtained from computerized searches on the National Library of Medicine (Medline), recent review articles and personal files. RESULTS: Shock and septic shock is the leading cause of mortality in critically ill patients. The septic shock is an extremely complex disease process leading to progressive multiple organ failure. Its presentation may be subtle or catastrophic. Successful management depends on an understanding of the pathophysiology of the syndrome, allowing rapid, appropriate resuscitation. Treatment often requires aggressive correction of volume deficit, maintenance of adequate perfusion pressure with inotropic and vasopressor, mechanical ventilation and others therapies. CONCLUSIONS: The management of the shock in children presents a challenge for the pediatrician. Hemodynamic and respiratory instability should be anticipated. Management requires multisystemic and careful intervention.

Title [acid-base Balance Disorders]
Date
Journal Jornal De Pediatria
Excerpt

OBJECTIVE: Review the theoretical bases on the maintenance of the acid-basic balance, the pathophysiology of the disturbances and its therapeutics in the child.METHODS: References were obtained from computerized searches on the National Library of Medicine (Medline), recent review articles and personal files.RESULTS: Acid-basic disturbances are frequently found in critical ill children. Their pathophysiology and main causes are a complex and multifactorial process. The management depends on precocious diagnosis and of the understanding of the base cause. The treatment should be adjusted for each disturbance and its base cause. Frequently it requests an aggressive correction and continuous monitoring.CONCLUSIONS: The knowledge of the physiology of the acid-basic balance as well as the understanding of the pathophysiology of the main disturbances associated to the clinical situations represent a challenge for the pediatrician. The management of acid-basic balance demands appropriate and careful intervention.

Title [respiratory Failure in the Child]
Date
Journal Jornal De Pediatria
Excerpt

OBJECTIVE: To describe the main physiopathologic mechanism of the respiratory failure in the child, as well as to discuss some aspects of the differential diagnosis and treatment. SOURCE OF DATA: The main national and international textbooks and articles about respiratory failure in the child were used as sources of data for this research. RESULTS: Respiratory failure is defined as the incapacity to maintain a paO(2) over 50 mmHg associated or not to a paCO(2) over 50 mmHg in children breathing ambient air at sea level. This failure may be classified as hypoxemic or hypercapnic, or even as acute or chronic. The main alterations may be hypoventilation, ventilation perfusion mismatch and diffusion defect. It may be secondary to a central origin, upper or lower airway compromise, parenchyma disease, or due to pleural or thorax wall affection. The hypoxemia evaluation may be done by hemoglobin saturation, alveolar capillary gradient of oxygen (D[A-a]O(2)) or by the paO(2) / FiO(2) index. COMMENTS: The knowledge of the physiopathologic mechanisms that cause respiratory failure in the child is important to define the more efficient therapeutic strategy for each cause.

Title [anaphylatic Reactions to Ant Stings]
Date
Journal Jornal De Pediatria
Excerpt

OBJECTIVE: Relate the occurrence of severe anaphylactic reactions caused by ant stings.METHODS: Case report of severe anaphylactic reaction caused by multiple ant stings, and revision of the literature (Medline and Lilacs). RESULTS: A male patient, white, 2 years-old, suffered multiple stings of small red ants of the species Solenopsis invictas, with the occurrence of severe anaphylactic reactions, and resulting in cortical blindness as a neurological sequel. CONCLUSIONS: The occurrence of such events, not very rare, should be taken in consideration by physicians, once such insects are common in our environment, and their sting can result, sometimes, in severe anaphylactic reactions.

Title Copulatory Efficiency and Fertility in Male Rats Exposed Perinatally to Flutamide.
Date
Journal Reproductive Toxicology (elmsford, N.y.)
Excerpt

This study investigated the effects of perinatal treatment with flutamide on male sexual behavior, semen parameters, and fertility in adult male rats. Pregnant rats received 15mg/kg of flutamide or peanut oil, s.c., at days 19 and 22 of pregnancy and for the first five postnatal days. Treated male offspring showed increases in latency to copulatory behavior, number of mounts without penis intromission, number of intromissions until ejaculation, latency to ejaculation, and reduced number of ejaculations. Flutamide treated rats presented reductions in weight of testes and prostate, percentage of normal spermatozoa, spermatozoa concentration, testicular sperm production, and testosterone level. Normal females mated with treated males presented more pre-implantation losses, reduced implantation rates, and consequently reduced offspring size. The results indicated that perinatal flutamide treatment damaged organizational processes of sexual differentiation, which led to inefficiency in copulatory behavior and reductions in sperm quality and count, resulting in low capacity for producing descendants.


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