Para avaliar os níveis de exposição e a dose absorvida em pacientes submetidos a exames de tomografia computadorizada, TC, é necessário calcular os índices de dose em medições com um simulador de PMMA, ou cheio de água. O simulador deve ser capaz de reproduzir as características de absorção e espalhamento do corpo ou parte do corpo humano em um campo de radiação. As grandezas específicas em TC: índice de kerma livre no ar (Ca,100), índice de kerma no ar ponderado (CW), índice de kerma no volume total (Cvol) e produto kerma no ar-comprimento (PKL) devem ser determinadas e comparadas com os níveis de referência já existentes na literatura. Neste trabalho foi desenvolvido um simulador pediátrico craniano, já que no Brasil os níveis de referência para diagnósticos (NRDs) disponíveis foram determinados baseados em um simulador padrão adulto. O simulador desenvolvido inovou em sua construção apresentando materiais que simulam a calota craniana em osso cortical (alumínio) e osso esponjoso (PVC). O seu interior foi preenchido com água destilada. As dimensões foram escolhidas de acordo com as recomendações da Organização Mundial da Saúde e do International Commission on Radiation Units, para o tamanho da cabeça de uma criança de 0 a 5 anos: 160 mm de diâmetro e 155 mm de altura. A calota craniana tem uma espessura de 4 mm e diâmetro interno de 111,9 mm. Para avaliar seu comportamento foram realizados testes em laboratórios e em feixes clínicos. Os resultados apresentaram uma atenuação de até 23% na utilização dos materiais que simulam a calota craniana evidenciando que os valores adotados para os cálculos de NRD podem estar superestimando a dose recebida por pacientes pediátricos. Percebe-se que a dose recebida em exames de crânio apresenta uma distribuição diferente por ser parcialmente atenuada e/ou retroespalhada pela calota craniana, o que não é considerado ao se utilizar o simulador constituído apenas de PMMA. / To determine the exposure levels and the absorbed dose in patients undergoing CT scans, is necessary to calculate the CT dose index in measurements with a PMMA or water phantom. The phantom must be enough to simulate the attenuation and scattering characteristics of a human body or parts in a radiation field. The CT specific quantities : CT air kerma index (Ca,100) , weighted CT air kerma index (CW ), a total volume CT air kerma index (Cvol) and the CT air kerma-lenght product (PKL) must be determined and compared to literature reference levels. In this work a head pediatric phantom was developed, considering that the Brazilian published Diagnostic Reference Levels (DRL) are based on adult phantom measurements. This developed phantom shows a construction innovation using materials to simulate the skullcap, cortical bone (aluminum) and cancellous bone (PVC), and it was filled with distilled water. The phantom dimension follows the recommendations of the World Health Organization and the International Commission on Radiation Units for children from 0 to 5 years old head size: diameter of 160 mm and height of 155 mm. The skullcap has 4 mm of thickness and 111.9 mm of internal diameter. In order to evaluate its behavior, tests were carried out in calibration laboratories and in clinical beams. The results showed attenuation up to 23% when different materials are used as skullcap, demonstrating that the DRLs adopted could be overestimating the dose received by pediatric patients. It is observed that the dose received by CT skull scans presents different distribution, due to the skullcap partially attenuation and/or backscattering which is not considered when the PMMA phantom is used.

Introdução: O schwannoma vestibular (SV) é um tumor benigno que se origina na bainha de schwann de um dos nervos vestibulares. De acordo com sua topografia lesões nos nervos cranianos facial, trigêmeo, coclear e bulbares podem estar presentes. Apesar do conhecimento da possibilidade de lesão nos nervos cranianos bulbares, a condução de estudos com o intuito de identificar alterações funcionais relacionadas raramente é estudada. Objetivos: Analisar fatores prognósticos de resultados funcionais relacionados aos nervos cranianos facial, trigêmeo, coclear e bulbares e correlacionar o prognóstico fonoaudiológico com os resultados de escalas funcionais finais dos nervos cranianos avaliados. Metodologia: Trata-se de um estudo de coorte com coleta de dados parcialmente retrospectiva que analisa a incidência de déficits funcionais de nervos cranianos em pacientes submetidos à exérese de SV, por meio de um protocolo de avaliação clínica estruturado (PAEC) especificamente para este estudo. O PAEC foi constituído de 2 sessões, sendo a primeira referente aos fatores prognósticos de sequelas e a segunda com dados funcionais referentes à deficiência auditiva (DA), comprometimento neurológico global (CNG), paralisia facial periférica (PFP), disfagia (DG) e fonação (DF). A coleta de dados foi realizada durante os meses de janeiro a junho do ano de 2016 no ambulatório de tumores da divisão de neurologia funcional do instituto de psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A análise dos dados foi realizada por meio do software SPSS de modo inferencial univariado e multivariado adotando um p valor inferior a 0.05. Resultados: A amostra foi composta por 101 sujeitos, sendo 77,2% do sexo feminino e 22,8% do sexo masculino. A média de idade correspondeu à 47,1 anos. Foram identificados 20,8% pacientes portadores de neurofibromatose do tipo 2 (NTFII). A via de acesso cirúrgico preferencial foi a retrossigmoidea (92,1%) com média tumoral igual a 3,4cm.70% dos pacientes apresentaram ressecção total do tumor com uma única abordagem. Na análise univariada foram identificados os fatores preditivos de sequela por desfecho estatisticamente significantes tamanho tumoral, presença de neurofibromatose e ressecção total respectivamente- CNG ( < 0,001; 0,023; 0,010), DG (pvalor < 0,001; pvalor 0,007; pvalor < 0,001), DF (pvalor 0,013; pvalor 0,002), confirmados pela análise multivariada respectiva - CNG (Odds Ratio (OD) 1,5 - pvalor 0,07; OR 3,5 - pvalor 0,036; OR 2,4- pvalor 0,08), DG (OR 2,3 - pvalor 0,006; OR 5,7 - pvalor 0,015; OR 3,9 - pvalor 0,018) e DF (OR 1,6 -pvalor 0,062; OR 5,5 - pvalor 0,006). Para o desfecho PFP a análise univariada foi estatisticamente significante para NTFII (pvalor 0,009) e PFP prévia (pvalor < 0,001) confirmados pela análise multivariada (OR 24,6 - pvalor 0,009; OR 0,3 - pvalor < 0,001), neste desfecho foi realizado estudo correlacional entre as escalas funcionais de DG (pvalor < 0,001) e CNG (pvalor < 0,001) com resultados estatisticamente significantes para a correlação entre os desfechos. Os sinais clínicos da deglutição estatisticamente relevantes corresponderam em 44,4% fase preparatória oral e oral e 66,6% fase faríngea. Conclusões: Os fatores prognósticos significativos relacionados aos déficits funcionais encontrados neste trabalho foram o tamanho do tumor e presença de NFT II em todos os desfechos estudados. Para CNG e DG foi evidenciado ainda o fator preditor de tipo de ressecção estatisticamente significante. Os déficits funcionais de paralisia facial periférica se correlacionaram aos déficits da deglutição em fase oral e fase faríngea e de incapacidade funcional / Introduction: Vestibular schwannoma (VS) is a benign tumor that originates in the schwann sheath of one of the vestibular nerves. According to their topography lesions in the cranial, facial, trigeminal, cochlear and bulbar pairs may be present. Although knowledge of the possibility of injury in the lower cranial nerves, the conduction of studies with the purpose of identifying related functional alterations are rarely studied. Objectives: To analyze prognostic factors of functional results related to facial, trigeminal, cochlear and bulbary cranial nerves and to correlate the final functional prognosis of the cranial nerves with each other. Methodology: This is a cohort study with partial retrospective data collection that analyzes the incidence of functional deficits of cranial nerves in patients submitted to SV excision, using a structured clinical evaluation protocol (PAEC) specifically for this study . The PAEC consisted of 2 sessions, the first one referring to prognostic factors of sequelae and the second with functional data regarding hearing loss (DA), global neurological impairment (CNG), peripheral facial paralysis (PFP), dysphagia (DG) and Phonation (DF). The data collection was performed during the months of January to June of the year 2016 in the ambulatory of acoustic neurinoma of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo. Data analysis was performed using univariate and multivariate inferential mode SPSS software, adopting a value of less than 0.05. Results: The sample consisted of 101 subjects, being 77.2% female and 22.8% male. The mean age was 47.1 years. 20.8% of patients with neurofibromatosis type 2 (NTFII) were identified. The preferred surgical access route was retrossigmoid (92.1%) with a mean tumor equal to 3.4cm.70% of the patients presented total tumor resection with a single approach. In the univariate analysis, the predictive sequelae factors were identified by statistically significant tumor size, presence of neurofibromatosis and total resection, respectively - CNG ( < 0.001; 0.023; 0.010), DG (pvalor < 0.001, pvalor 0.007, pvalor < 0.001), DF (Odds ratio 0.05, pvalor 0.013, pvalor 0.002), confirmed by the respective multivariate analysis - CNG (Odds Ratio (OD) 1.5 - pvalor 0.07, OR 3.5 - pvalor 0.036, OR 2.4 - pvalor 0.08), DG (OR 2.3 - pvalor 0.006; OR 5.7 - Pvalor 0.015, OR 3.9 - pvalor 0.018) and DF (OR 1.6 -value 0.062, OR 5.5 - pvalor 0.006). For the PFP endpoint, the univariate analysis was statistically significant for NTFII (pvalor 0.009) and previous PFP (pvalor < 0.001) confirmed by the multivariate analysis (OR 24.6 - pvalor 0.009; OR 0.3 - pvalor < 0.001). The functional scales of DG (pvalor < 0.001) and CNG (pvalor < 0.001) with statistically significant results for the correlation between the outcomes. Significant clinical signs of swallowing corresponded in 44.4% oral and oral preparatory phase and 66.6% pharyngeal phase. Conclusions: The significant prognostic factors related to the functional deficits found in this study were tumor size, NFT II presence and resection type in all the outcomes studied. Functional deficits of peripheral facial paralysis were correlated with oral and pharyngeal deglutition deficits and functional disability

Os objetivos do estudo consistiram em verificar o impacto da infecção congênita por CMV ao nascer e avaliar potenciais preditores prognósticos de anormalidades tardias em uma coorte de criança s com esta infecção. Métodos: Por meio de uma triagem neonatal, 66 de 11.957 crianças foram identificadas como portadoras de infecção congênita por CMV. Todas as crianças infectadas sintomáticas e assintomáticas foram avaliadas ao nascimento por meio de exame físico detalhado, avaliação auditiva, fundoscopia ocular, neurossonografia transfontanelar (NTF) realizada por neurorradiologista infantil e quando alterada, foram submetidas à ressonância magnética de encéfalo (RMc). Análise de regressão logística foi realizada para verificar a associação de potenciais fatores de risco para ocorrência de surdez neurossensorial relacionada ao CMV e/ou presença de achados anormais em NTF e/ou RMc. A análise da Curva ROC foi utilizada para avaliar a associação da carga do DNA do CMV expresso em log10, com a presença de sintomas ao nascer, achados anormais em NTF e/ou RMc e ocorrência de surdez neurosensorial. Resultados: Em 66 crianças infectadas, os sinais clínicos sugestivos de infecção congênita ao nascer foram observados em 8/66 (12,12%; IC95%: 5,74-23,03), sendo considerados sintomáticos. As 58 crianças restantes foram considerados assintomáticos. A surdez neurossensorial foi observada em 8/66 (12,12%; IC95%: 5,74-23,03%) das crianças. Destas, 4/58 (6,9%; IC95%: 2,23- 17,54%) e 4/8 (50%; IC95%: 17,44-82,55%) crianças eram assintomáticas e sintomáticas, respectivamente. Achados de NTF e/ou RMc sugestivas de infecção congênita foram observadas em 7 de 8 crianças sintomáticas (87,5%; IC95%: 46,67-99,34%). Dentre as 58 assintomáticas, 53 (92,4%) completaram todas as avaliações e destas 29/52 apresentaram alterações sugestivas de infecção congênita em NTF e/ou RMc (55,7%; IC95%: 41,41 - 69,27%). O achado mais comum foi a vasculopatia lenticuloestriada acompanhado ou não de cistos subpendimários (13/29: 43.3%). Outros achados anormais foram os cistos subpendimários como achado isolado (11/29: 37.9%), calcificação única ou periventricular com ou sem áreas de gliose (4/29: 13,8%) e ventriculomegalia (4/29: 13,8%). Análise de regressão logística mostrou que apenas a presença de sintomas clínicos ao nascer foi preditivo para a ocorrência de surdez neurossensorial. Achados de neuroimagens (NTF e/ou RMc) foram observados em 3 de 4 crianças assintomáticas (75%) enquanto 26 (54,2%) de 48 crianças sem surdez tinham avaliações normais de NTF e/ou RMc (p=0,42; RR:2,38: IC95%: 0,26-21,39). Nenhum dos outros fatores de risco foram independentemente associados com surdez. A presença de plaquetopenia e/ou níveis altos de gama glutamil transferase (?GT) foi associado com a presença de achados anormais em NTF e/ou RMc uma análise univariada. O poder discriminatório pela determinação do ponto de corte do valor da carga do DNA do CMV foi avaliada pela área abaixo da curva ROC (AUC) e não houve associação entre a carga viral e a ocorrência de surdez e/ou achados anormais de NTF e/ou RMc. Conclusões: Embora a triagem neonatal da infecção congênita por CMV permita identificar a maioria das crianças infectadas que são clinicamente assintomáticas ao nascer, uma proporção significante destas crianças poderá ser beneficiada por uma avaliação do sistema nervoso central através de NTF, uma vez que, achados anormais são muito frequentes. Embora não tenha sido possível determinar fatores independentemente preditivos de ocorrência de surdez neurossensorial, os achados de NTF podem ser potenciais fatores preditivos de anormalidades tardias em crianças assintomáticas. / The objectives of this study were to verify the impact of congenital cytomegalovirus (CMV) infection at birth and to evaluate potential prognostic predictors of late abnormalities in a cohort of children with this infection. Methods: By means of a CMV neonatal screening, 66 of 11.957 infants were identified as congenitally infected. Infants with and without clinical abnormalities detectable at birth underwent physical examination, cranial ultrasound performed by a paediatric radiologist and/or cranial magnetic resonance imaging, ocular fundoscopy, and hearing evaluation using evoked otoacoustic emissions and auditory brainstem response. Logistic regression analysis was carried out to verify the association between the risk factors for occurrence of hearing loss related to CMV and/ or abnormal cranial ultrasound findings. ROC curve was plotted using the log10 value of CMV DNA load to evaluate the association between viral load and clinical symptoms at birth, abnormal cranial ultrasound findings and hearing loss. Results: Of all 66 infected children, the clinical signs suggestive of congenital infection at birth were observed in 8/66 (12.12%; IC95%: 5.74- 23.03) symptomatic infants. Sensorineural hearing loss was observed in 8/66 (12,12%; IC95%: 5.74-23.03%) children. Of these, 4/58 (6,9%; IC95%: 2.23-17.54%) and 4/8 (50%; IC95%: 17,44-82.55%) children were asymptomatic and symptomatic, respectively. Cranial ultrasound findings suggestive of congenital infection were observed in 7 of the 8 symptomatic children (87.5%; IC95%: 46.67-99.34%). Among the 58 asymptomatic infants, 53 underwent complete evaluation and 29/52 had abnormal cranial ultrasound results (55,7%; IC95%: 41.41 - 69,27%). The most prevalent findings was lenticulostriate vasculopathy with subependymal pseudocysts present in 13 of the /29 (43.3%) infants with cranial ultrasound. Other abnormal findings were isolated subependymal pseudocysts (11/29: 37.9%); single or periventricular calcifications and/or gliosis (4/29: 13.8%); and ventriculomegaly (4/29: 13,8%). Logistic regression analysis showed that only the presence of clinical findings predicted the occurrence of hearing loss. Cranial ultrasound findings were observed in 3 of asymptomatic infants (75.0%) while 26 (54.2%) of 48 infants with no hearing loss had abnormal imaging features (p=0,42; RR:2,38: IC95%: 0,26-21,39). None of the other factors risk were independely associated with development of hearing loss. The presence of thrombocytopenia and/or high level of gamma-glutamyltranspeptidase (?GT) was associated with cranial ultrasound findings on univariated analysis. No discrimination power was achieved using the area under the ROC curve to verify the association between CMV DNA load in the urine of the infected children and the developing of hearing loss, presence of cranial ultrasound findings and clinical signs at birth. Conclusions: Although a neonatal screening of cCMV will identify the majority of infected infants who are clinically asymptomatic, a significant proportion of them could benefit from a central nervous system image evaluation, since abnormal findings are frequent. Althoug it was not possible to determine risk factors that are independently associated to development of sensorineural hearing loss, cranial ultrasound findings could be a potential prognostic markers of adverse outcomes of congenital CMV in asymptomatic infants.

Research on the estimation of age at death, sex and stature from skeletal remains has received more attention than methods used to evaluate ancestry. While this may be due to the stigma attached to classifying people into groups, the application, interpretation and precision of non-metric methods used to predict ancestry need to be examined; as these variables are routinely applied to forensic case work in South Africa. The aim of this study was to score fifteen non-metric cranial traits, namely nasal bone structure, nasal breadth, nasal overgrowth, anterior nasal spine, inferior nasal margin, interorbital breadth, zygomaxillary suture shape, malar tubercle, alveolar prognathism, mandibular and palatine tori, shovelshaped incisors, Carabelli’s cusps and the transverse palatine suture shape on a South African sample, with the intent to assess the influence of sex, ancestry and age at death on these facial features. A total of 520 crania were obtained from the Pretoria Bone, Raymond A. Dart and Kirsten Collections in South Africa and included 237 (135 males, 102 females) Africans, 158 (94 males, 63 females) Europeans and 125 (87 males, 38 females) persons of Coloured origin. Data were analyzed using SPSS v.11.5 for Windows. Ordinal regression was used to evaluate the effect the independent variables (age, sex and ancestry) had on the dependent variable (non-metric traits). Results showed that all the variables were associated with ancestral differences among and within groups. Interorbital breadth, nasal bone structure, nasal breadth and shovel-shaped incisors exhibited statistically significant interactions with sex and ancestry, whereas the appearance of the anterior nasal spine, alveolar prognathism, incisor shovelling of the upper incisors, and Carabelli’s cusp morphology were correlated with age at death. If traditional classification methods are used, then these non-metric traits are not a valid prediction of ancestry in South African populations. Future research is to focus on several statistical approaches, including multi-variate analysis, for the classification of non-metric traits. Copyright / Dissertation (MSc)--University of Pretoria, 2010. / Anatomy / unrestricted

The study of skeletal differences between males and females has rarely taken into account the physical change in hard tissue characteristics with the onset of advanced age. Anatomical change through degenerative modification may pose a challenge when diagnosing the sex of an unknown individual, especially if age is unknown. The aim of this study was to establish whether sexual dimorphism changes with age. This issue was addressed by using three types of procedural analyses. Firstly, standard measuring techniques were utilized to determine sex from 593 individuals. Visual (morphological) assessment was then performed on 608 individuals using sexually dimorphic traits in the distal humerus and pelvis. Lastly, over 300 individuals were analyzed with geometric morphometries using four locations on the postcranial skeleton. Younger females and males (50 years of age and younger) were then compared to older individuals (over 50 years of age) to determine if sexual dimorphism was increasing or decreasing with the onset of age. Long bone measurements of the postcranial skeleton increased with the onset of age in the most osteoporotic sample (South African white females). Males exhibited an increase in size, mainly in the knee and elbow joints, and black females remained static in their measurements with age. Older white females especially can sometimes incorrectly be misclassified as males. Visual techniques indicated that all populations have similar non-metric morphology in the distal humerus and pelvis. Classification accuracies in females decreased when viewing the distal humerus, indicating a decrease in sexual dimorphism at this location. Females appeared static in their pelvic morphology with the onset of age. Males remained sexually dimorphic throughout life in the humerus and pelvis. Geometric morphometries showed that the morphology of the distal humerus is sexually dimorphic, and does not change with age. Morphometries also confirmed the marked sexual dimorphism in the pelvis, and showed virtually no change in sexual dimorphism when comparing young to old groups. / Thesis (PhD)--University of Pretoria, 2009. / Anatomy / Unrestricted

M.Tech. / According to the “Lovett Reactor” as explained by Walther (2000), the Atlas and the 5th lumbar vertebrae rotate in the same direction when a person walks. This relationship continues throughout the spinal column as 3rd cervical vertebrae (C3) rotates in the same direction as 3rd lumbar vertebrae (L3). From this point the movement changes to counter-rotation as 4th cervical vertebrae (C4) counter-rotates to 2nd lumbar vertebrae (L2) and 5th cervical vertebrae (C5) to 1st lumbar vertebrae (L1). According to Inman, Ralston and Todd (1981) this correlation extends as the Sacrum reacts with the Occiput. Thus, there is clinical verification demonstrating that the Lovett Reactor vertebrae are often interrelated to primary and compensatory subluxations. The aim of this study was to determine the effect of Chiropractic Occipital adjustments versus Chiropractic Sacroiliac adjustments in the treatment of chronic Lumbar Sacral pain.

Os objetivos do estudo consistiram em verificar o impacto da infecção congênita por CMV ao nascer e avaliar potenciais preditores prognósticos de anormalidades tardias em uma coorte de criança s com esta infecção. Métodos: Por meio de uma triagem neonatal, 66 de 11.957 crianças foram identificadas como portadoras de infecção congênita por CMV. Todas as crianças infectadas sintomáticas e assintomáticas foram avaliadas ao nascimento por meio de exame físico detalhado, avaliação auditiva, fundoscopia ocular, neurossonografia transfontanelar (NTF) realizada por neurorradiologista infantil e quando alterada, foram submetidas à ressonância magnética de encéfalo (RMc). Análise de regressão logística foi realizada para verificar a associação de potenciais fatores de risco para ocorrência de surdez neurossensorial relacionada ao CMV e/ou presença de achados anormais em NTF e/ou RMc. A análise da Curva ROC foi utilizada para avaliar a associação da carga do DNA do CMV expresso em log10, com a presença de sintomas ao nascer, achados anormais em NTF e/ou RMc e ocorrência de surdez neurosensorial. Resultados: Em 66 crianças infectadas, os sinais clínicos sugestivos de infecção congênita ao nascer foram observados em 8/66 (12,12%; IC95%: 5,74-23,03), sendo considerados sintomáticos. As 58 crianças restantes foram considerados assintomáticos. A surdez neurossensorial foi observada em 8/66 (12,12%; IC95%: 5,74-23,03%) das crianças. Destas, 4/58 (6,9%; IC95%: 2,23- 17,54%) e 4/8 (50%; IC95%: 17,44-82,55%) crianças eram assintomáticas e sintomáticas, respectivamente. Achados de NTF e/ou RMc sugestivas de infecção congênita foram observadas em 7 de 8 crianças sintomáticas (87,5%; IC95%: 46,67-99,34%). Dentre as 58 assintomáticas, 53 (92,4%) completaram todas as avaliações e destas 29/52 apresentaram alterações sugestivas de infecção congênita em NTF e/ou RMc (55,7%; IC95%: 41,41 - 69,27%). O achado mais comum foi a vasculopatia lenticuloestriada acompanhado ou não de cistos subpendimários (13/29: 43.3%). Outros achados anormais foram os cistos subpendimários como achado isolado (11/29: 37.9%), calcificação única ou periventricular com ou sem áreas de gliose (4/29: 13,8%) e ventriculomegalia (4/29: 13,8%). Análise de regressão logística mostrou que apenas a presença de sintomas clínicos ao nascer foi preditivo para a ocorrência de surdez neurossensorial. Achados de neuroimagens (NTF e/ou RMc) foram observados em 3 de 4 crianças assintomáticas (75%) enquanto 26 (54,2%) de 48 crianças sem surdez tinham avaliações normais de NTF e/ou RMc (p=0,42; RR:2,38: IC95%: 0,26-21,39). Nenhum dos outros fatores de risco foram independentemente associados com surdez. A presença de plaquetopenia e/ou níveis altos de gama glutamil transferase (?GT) foi associado com a presença de achados anormais em NTF e/ou RMc uma análise univariada. O poder discriminatório pela determinação do ponto de corte do valor da carga do DNA do CMV foi avaliada pela área abaixo da curva ROC (AUC) e não houve associação entre a carga viral e a ocorrência de surdez e/ou achados anormais de NTF e/ou RMc. Conclusões: Embora a triagem neonatal da infecção congênita por CMV permita identificar a maioria das crianças infectadas que são clinicamente assintomáticas ao nascer, uma proporção significante destas crianças poderá ser beneficiada por uma avaliação do sistema nervoso central através de NTF, uma vez que, achados anormais são muito frequentes. Embora não tenha sido possível determinar fatores independentemente preditivos de ocorrência de surdez neurossensorial, os achados de NTF podem ser potenciais fatores preditivos de anormalidades tardias em crianças assintomáticas. / The objectives of this study were to verify the impact of congenital cytomegalovirus (CMV) infection at birth and to evaluate potential prognostic predictors of late abnormalities in a cohort of children with this infection. Methods: By means of a CMV neonatal screening, 66 of 11.957 infants were identified as congenitally infected. Infants with and without clinical abnormalities detectable at birth underwent physical examination, cranial ultrasound performed by a paediatric radiologist and/or cranial magnetic resonance imaging, ocular fundoscopy, and hearing evaluation using evoked otoacoustic emissions and auditory brainstem response. Logistic regression analysis was carried out to verify the association between the risk factors for occurrence of hearing loss related to CMV and/ or abnormal cranial ultrasound findings. ROC curve was plotted using the log10 value of CMV DNA load to evaluate the association between viral load and clinical symptoms at birth, abnormal cranial ultrasound findings and hearing loss. Results: Of all 66 infected children, the clinical signs suggestive of congenital infection at birth were observed in 8/66 (12.12%; IC95%: 5.74- 23.03) symptomatic infants. Sensorineural hearing loss was observed in 8/66 (12,12%; IC95%: 5.74-23.03%) children. Of these, 4/58 (6,9%; IC95%: 2.23-17.54%) and 4/8 (50%; IC95%: 17,44-82.55%) children were asymptomatic and symptomatic, respectively. Cranial ultrasound findings suggestive of congenital infection were observed in 7 of the 8 symptomatic children (87.5%; IC95%: 46.67-99.34%). Among the 58 asymptomatic infants, 53 underwent complete evaluation and 29/52 had abnormal cranial ultrasound results (55,7%; IC95%: 41.41 - 69,27%). The most prevalent findings was lenticulostriate vasculopathy with subependymal pseudocysts present in 13 of the /29 (43.3%) infants with cranial ultrasound. Other abnormal findings were isolated subependymal pseudocysts (11/29: 37.9%); single or periventricular calcifications and/or gliosis (4/29: 13.8%); and ventriculomegaly (4/29: 13,8%). Logistic regression analysis showed that only the presence of clinical findings predicted the occurrence of hearing loss. Cranial ultrasound findings were observed in 3 of asymptomatic infants (75.0%) while 26 (54.2%) of 48 infants with no hearing loss had abnormal imaging features (p=0,42; RR:2,38: IC95%: 0,26-21,39). None of the other factors risk were independely associated with development of hearing loss. The presence of thrombocytopenia and/or high level of gamma-glutamyltranspeptidase (?GT) was associated with cranial ultrasound findings on univariated analysis. No discrimination power was achieved using the area under the ROC curve to verify the association between CMV DNA load in the urine of the infected children and the developing of hearing loss, presence of cranial ultrasound findings and clinical signs at birth. Conclusions: Although a neonatal screening of cCMV will identify the majority of infected infants who are clinically asymptomatic, a significant proportion of them could benefit from a central nervous system image evaluation, since abnormal findings are frequent. Althoug it was not possible to determine risk factors that are independently associated to development of sensorineural hearing loss, cranial ultrasound findings could be a potential prognostic markers of adverse outcomes of congenital CMV in asymptomatic infants.

The occipital bun, a distinctive convexity of the occipital squama, is often considered to be a uniquely derived Neandertal trait. Some scholars, however, consider the occipital morphology found in some early modern and extant human crania (often described as “hemi-buns”) to be homologous with Neandertal occipital buns. A number of hypotheses have been proposed to explain occipital bun/hemi-bun development, including neck muscle function, head carriage, brain growth timing, and cranial base cartilage growth timing, as well as braincase and facial integration. The feature, however, has never before been metrically quantified in a large subadult sample or studied in a well-documented growth series. The primary goal of this dissertation, therefore, was to assess hemi-bun growth and development in a combined comparative sample of extant humans amassed from the following growth series: the University of Toronto Burlington Growth Study, the Iowa Facial Growth Study, the Oregon Growth Study, the University of Oklahoma Denver Growth Study, the Wright State University Fels Longitudinal Study, and the Michigan Growth Study. Cephalograms from these studies facilitated the collection of longitudinal cranial growth and development data. In total, measurements were collected from 468 cephalograms representing 16 males and 10 females. Measured subjects represented the ends of the range of variation in adult midsagittal occipital bone shape, including subjects with defined hemi-buns, as well as subjects lacking all evidence of hemi-bun morphology. Frontal and lateral cephalograms were measured for each subject at 9 age points, spanning from 3.0 to 20.4 years of age. A total of 16 landmarks and 153 sliding semi-landmarks were digitized at each age point. Geometric morphometric analyses, including relative warps analysis and two-block partial least squares analysis, were conducted to assess patterns of cranial covariation and sexual dimorphism in occipital bone growth and possible attendant variation in occipital bun development or absence. In both bunned and non-bunned subjects, midsagittal occipital shape was found to be established very early in ontogeny, and then to remain largely unchanged between 3 years of age and adulthood. This result contradicts previous developmental hypotheses, which posit that occipital bunning results from a pattern of late posteriorly-directed brain growth. No evidence of sexual dimorphism in hemi-bun shape was found to exist in this extant human sample; however, defined hemi-buns were found to covary significantly with an elongated and low midsagittal neurocranial vault in both sexes. Other aspects of cranial morphology, including cranial and basicranial breadth, midcoronal vault shape, and basicranial angle, did not covary significantly with occipital bun morphology at any of the sampled age points. These results reveal that occipital bunning, at least in this sample, is not a discrete trait, but instead develops along a continuum in association with a distinct pattern of neurocranial elongation. Previous studies have suggested that Neandertal occipital buns are similarly associated with elongated cranial vaults. While more work must be done to quantify occipital bun morphology in fossil subadults, this study finds no evidence to disprove the developmental homology of the feature in modern humans and Neandertals, and therefore further undermines the idea that occipital bunning is a unique Neandertal trait.

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