bluuebunny/crossref_metadata_2025 huggingface dataset:
The digital solution development process in health about the stroke
Authors: Silva Nickolas Souza , Silva Maria Luisa Damasceno , Freitas Ana Rebeca Sousa de , Torres Antonia Cristiane Ferreira , Paiva Erislândia Maria Campos , Silva Francisco Gabriel Santos da , Moraes Raimundo Luan da Silva , Gomes Robson Mesquita , Andrade Luiz Odorico Monteiro de
Published: December 2021

Background: Stroke is one of main causes of morbimortality in Brazil, even though it has prevention and care strategies, showing need to improve strategies1 . Digital Health Solutions (DHS) can implement stroke prevention strategies, strengthening patient care and management2 . Objective: To describe initial process of developing DHS with stroke theme (ST) based on public research. Methodology: Cross-sectional study based on form with 12 questions, which outline a profile of users about DHS with ST. Form was aimed at people over 18 year-old who did not have an academic background in human health. Study carried out by the Google Forms® between January and April 2021. Results: With 80 participants, 51.2% women and 48.8% men. 20% under 20 years, 73.8% between 20 and 40, 2.5% between 40 and 60, and 3.7% over 60 years. 62.4% seek knowledge about health from unofficial sources. 62.5% report they rarely seek health information. 67.5% do not have knowledge to detect stroke. Although 32.5% have a DHS on their phones, 97.5% consider it important to learn about stroke in DHS, and 83.8% are interested in it. 55% would use it to recognize a stroke, 25% to have prevention information, 8.8% to use it in urgency, and 11.2% marked three items. 85% never used DHS with ST. Conclusion: Findings shows DHS with ST would educate in health and help people with suspected stroke. DHS would assist in creation of health promotion and stroke prevention.
Clinical manifestations of chronic subdural hematoma in the elderly: Literature Review
Authors: Kalkmann Gabriela Ferreira , Pereira Carlos Umberto , Pereira Francisco de Assis , Oliveira Débora Moura da Paixão , Rabelo Nicollas Nunes
Published: December 2021

Introduction: The clinical manifestations of chronic subdural hematoma (CSDH) are often confused with other medical entities in the elderly, making their early diagnosis difficult or difficult. Early diagnosis is important, since its prognosis is directly associated with the preoperative neurological state, thus resulting in a worse vital and functional prognosis. Objectives: Report through a literature review the clinical manifestations of CSDH in the elderly population. Methods: Literature review, with the search terms: “Signs and Symptoms”, “Chronic Subdural Hematoma”, Aged, Diagnosis and Prognosis. In which PubMed, Lilacs, Scielo, Cochrane and TripDataBase data platforms were used. The inclusion criteria were: original studies published in any language. Articles in which full reading was prevented were excluded. With the application of the inclusion and exclusion criteria, 110 articles were included in the study. Results: Clinical presentation depends on the location, volume of the hematoma, rapid growth, the location of the CSDH, whether unilateral or bilateral, and the clinical conditions of the patient. Because the forms of clinical presentation of CSDH are variable, it is necessary that health professionals linked to the elderly (geriatrician, psychiatrist, general practitioner) have knowledge of this clinical entity. Conclusions: The recognition of classic forms as well as the identification of risk factors in the elderly favors the timely diagnosis and treatment of CSDH in the elderly population.
The Covid-19 pandemic as a trigger for depression
Authors: Schmitt Natália Murad , Andrade Gabriel Costa Ferreira , Rodrigues Maria Arlete da Silva , Sampaio Myrela Murad
Published: December 2021

Background: In the last years, a high number of people with depression have been found and it’s estimated that 5% of the world population lives with this disease. However, since the Covid-19 pandemic, there was a significant increase, which is justify by the fear of the virus, boredom of isolation and the uncertainty of the future due to the difficulties caused by the situation. In this scenario, understand this disease considered a public health problem is important, because health professionals may need to deal with a possible imminent new pandemic: the depression one. Objective: To understand the impact of depression during the Covid-19 pandemic. Methods: An integrative review was performed, through a virtual scenario, selecting articles from the last five years in the Pubmed, Scielo and Google Scholar platforms. Results: Depression brings desmotivation, lack of energy and loss of pleasure in routine activities, besides feeling deep sadness, low self-esteem and a recurrent feeling of guilt. It’s natural the population suffers from mood swings and that’s why it’s important to take care of mental health during the pandemic, like how to create a new routine and make it work, because the atypical situation has been the trigger for the first contact with psychiatric symptoms of many. Conclusion: Fear, financial crisis and the lack of routine are risk factors, which may reflect on the behavior of the population. Understanding the trigger and being able to live with it’s essential for the mental health.
Fahr’s syndrome as a differential diagnosis amid parkinsonian syndromes: a case report
Authors: Mikael Luana de Rezende , Silveira Coralia Gabrielle Vieira , Ribeiro Camilla Duarte , Damiani Daniel , Leite Pedro Henrique de Lara , Oliveira Helton Benevides Santana de , Faria Danilo Donizete de , Pinto Roberta Arb Saba Rodrigues , Silva Sonia Maria Cesar de Azevedo
Published: December 2021

Context: Parkinsonian syndromes are routinely identified by neurologists. However, the differential diagnosis among probable etiologies can be challenging and complex. In Fahr’s syndrome, calcifications of the basal ganglia secondary to disorders of calcium metabolism are observed. A possible clinical presentation associated with this entity is the presence of a parkinsonian syndrome. Case report: A 54-years-old female patient presented with a progressive tremor in the right upper and lower limbs associated with bradykinesia. Seizures were observed during the course of the disease. After extensive clinical workup, primary hypoparathyroidism was diagnosticated along with the recognition of a mutation in the calcium activator gene. Computed tomography and magnetic resonance imaging of the head showed bilateral coarse calcifications in thalami and basal ganglia compatible with Fahr’s syndrome. We began treatment for control of the underlying disease, as well as for symptomatic control of parkinsonism. Conclusions: Different pathologies could justify the parkinsonian syndrome observed initially in the case described. Among them: Iidiopathic Parkinson’s Disease, Multiple System Atrophy, Progressive Supranuclear Palsy. In our patient, the atypical evolution in a young woman led to the research of possible secondary treatable causes. A diagnosis of Fahr’s syndrome related to hypoparathyroidism was unveiled. The differential diagnosis of Parkinson’s Syndrome is broad and difficult. We must be aware of the possible atypical presentations due to the possibility of a secondary condition whose etiology could be effectively treated.
The effects of virtual reality on functional capacity at different stages of Parkison’s disease
Authors: Melo Yuri Sena , Miranda Wesley Anderson de Souza , Bezerra João Lucas De Morais , Teixeira Thaís Bel de Oliveira
Published: December 2021

Introduction: the use of virtual reality in Parkinson’s disease is a very effective therapy, as it promotes important actions for the knowledge of the motor, stimulating neuroplasticity, through visual feedback. Study design: This is a systematic review of the literature. Objective: The objective of this study was to analyze the use of reality in the rehabilitation of functional capacity in the different stages of Parkinson’s disease. Methods: this is a systematic review, carried out from January to August 2017, by means of electronic search in the databases: Pubmed, Scielo, Lilacs, Science Direct and Medline. The descriptors used were: virtual, video game, Parkinson’s, physiotherapy and rehabilitation and all the words in English. They were defined as inclusion criteria for studies that used virtual reality as treatment for patients with Parkinson’s, classifying patients in stages (I, II, III, IV and V) according to the Hoehn & Yahr scale. Literature review articles, description of virtual reality without showing the sample of statistical results and case study were excluded. Results: 7 articles were selected. After analyzing them, it was possible to observe that patients in the early stages showed improvement in perception, gait and balance. However, patients who were in other more advanced stages of the disease only improved their perception. Conclusion: patients in the early stages of clinical Parkinson’s disease have satisfactory results when compared to the advanced stages.
Syndrome of one and middle of the vertical look: possible clinical entity associated with percheron artery ischemia: semiological and neuroanatomic aspects
Authors: Barreira Raphael Palomo , Rossette Vanessa Moraes , Torres Thomas Zurga Markus , Correa Beatriz Medeiros , Marques Thiago da Cruz , Miyahira Clara Kimie , Miranda Natalia Figueiredo , Cutolo Natasha Soares , Costa Fernando Pierini , Mendes Euldes , Santos Júlio Cesar Claudino
Published: December 2021

Context: The acute paralysis of the vertical gaze is usually caused by a mesencephalic lesion because the control of the vertical conjugated gaze is found there; there are three main structures: the rostral interstitial nucleus of the medial longitudinal fascicle (riFLM), the Cajal interstitial nucleus and the posterior commissure (CP). The riFLM, contains burst neurons responsible for the saccades, projecting to the subnuclei of the upper rectum and inferior oblique to look upwards and subnuclei of the lower rectum and superior oblique to look downwards. The projections for the elevators appear to be bilateral, with axons probably crossing within the oculomotor nuclear complex and apparently not via CP; depressors, on the other hand, are ipsilateral. Case report: Female, 78 years old, hypertensive and diabetic, suddenly started with vertical diplopia and vertigo. Examination: Bilateral hypoactive photomotor reflex, bilateral paralysis of the vertical gaze upward, monocular paralysis downward and torsional nystagmus in the left eye. Resonance with restriction the diffusion of water molecules in both thalamus and in the right rostral midbrain. Conclusions: riFLM is vascularized by the posterior thalamus-subthalamic paramedian artery. A single artery, Percheron’s, provides both riFLM in 20% of the population and allows bilateral lesions from a single infarction. Unilateral infarction can also cause saccadic paralysis of the bilateral vertical gaze. The disjunctive disorders of the vertical gaze have two variants of the one and a half syndrome. One consists of bilateral paralysis of the gaze upwards and monocular paresis of the gaze downwards with an ipsilateral or contralateral lesion, described in thalamomesencephalic lesions, explanation for the exposed case. The other is due to bilateral mesodiencephalic infarctions. It is difficult to understand the relationship between topography and the vertical gaze circuit, showing that it is more complex than we imagine. It is probably an association of topographies, little described, but of paramount importance to be discussed and researched.
Epidemiological analysis of traumatic brain injury in the Northeast region of Brazil
Authors: Figueiredo Thaylon Fernando Bonatti , Martins Hilca Mariano , Lima Valnia Vanderlei Nepomuceno , Melo Livia Helena Moreira da Silva
Published: December 2021

Introduction: Traumatic brain injury (TBI) is characterized as an injury or functional damage to the brain caused by traumatic aggression, and is still considered a public health problem. Objectives: To analyze the epidemiological profile of patients hospitalized due to TBI in the Northeast region of the country. Methodology: This is a descriptive, epidemiological study, from January 2009 to December 2019, with data from DATASUS - Ministry of Health. Results: Between 2009 and 2019 there were 299,001 hospitalizations and 30,257 deaths. With 73,133, a presentation from Bahia the highest number of hospitalizations and Pernambuco the highest number of deaths with 6,903 cases. The male gender had the highest number of hospitalizations (78.9%) and deaths (82.6%). Young adults, between 20 and 39 years old, accounted for 40% of hospitalizations and 37.5% of deaths, possibly due to sociocultural and behavioral characteristics. The highest mortality rate was registered in the elderly (21.5%). There was a predominance of brown race in hospitalizations (84.6%) and in deaths (85.5%). In the eleven-year period, there was an increase of 28% in the number of admissions by the TBI, and an increase of 94.7% in hospital costs. Only the state of Paraíba registered a reduction in hospitalizations and deaths due to TBI in the referred period. Conclusion: There is a general worsening in the region, and it is important to formulate education and health policies to reduce TBI morbidity and mortality in the Northeast region of Brazil.
Leprosy: a view of the molecular interaction of Mycobacterium leprae with Schwann Cells
Authors: Santos Ronaldi Gonçalves dos , Nunes Bhenise Vitória Santos , Domiciano Gabriela Santos , Santos Humberto Gessinger Nascimento dos , Silva Jean Cardek Paulino , Martins Mariana Goulart de Souza , Delfino Pedro Henrique , Mesquita Júnior Fernando
Published: December 2021

Introduction: Leprosy is an infectious disease whose etiologic agent is Mycobacterium leprae. Despite its notoriety, there are mechanisms of molecular interaction that have not been elucidated. Therefore, it was carried out a literary review about the molecular interaction between M. leprae and the Schwann cell (SC), characterizing the mechanisms of endocytosis and cellular damage. Methods: It was delimited a 10-year timeframe (2010 to 2020). The research bases used were Portal de Periódicos CAPES/MEC, National Library of Medicine - PubMed, World Health Organization (WHO) Statistical Data, Pan American Health Organization (PAHO), Ministry of Health of Brazil Data, Scielo, Fundação Oswaldo Cruz (ARCA-FIOCRUZ) and UpToDate Inc. Results: M. Leprae is endocitized through interactions with basal lamina of the SC, whose α-laminin 2 enables the formation of the dystrophin-dystroglycan complex. Moreover, the activity of the pathogen in the SC is associated with direct, indirect and additional damage. It was verified the need for continuous studies due to the complexity of this molecular biointeraction, given the cellular reprogramming of SC and its neuronal impact. Conclusion: There are still many scientific gaps, requiring further clarification in the area, which results in uncertainties in the tropism of the pathogen with the peripheral nerves.
Ischemic stroke with agraphestesia signal focus
Authors: Reis Ana Luísa Lopes Espínola da Costa , Souza Leonardo Henrique Gandolfi de , Marques Vitor Roberto Pugliesi
Published: December 2021

Introduction: The ischemic stroke is one of the main causes of death and disability in Brazil. Among the main risk factors are age, atrial fibrillation (AF), diabetes, dyslipidemia and physical inactivity. The main etiology of stroke is cardioembolic, resulting in obstruction of the cerebral arteries by a thrombus of cardiac origin. The artery most affected in ischemic strokes is the middle cerebral artery. The stroke has main characteristics, with emphasis on the sudden onset of symptoms, involvement of a focal area, ischemia caused by obstruction of a vessel and neurological deficits depending on the affected area. Graphesthesia is defined as a cutaneous sensory ability to recognize letters or numbers traced on the skin. The loss of this sensory ability is known as agraphesthesia. Case Report: M.A.F.O. female, 78a, arrived at the UPA complaining of mental confusion. Patient denies previous stroke. Personal history of systemic arterial hypertension. Upon physical examination, the patient was conscious, self and disoriented and inattentive. He was able to repeat and evoke words, without measurable motor déficits. Left upper limb with agraphestesia. Computed tomography was requested, which showed an extensive hypodense area in the right parietoccipital region, which leads to the erasure of the furrows between the adjacent gyres, which may correspond to a recent ischemic event. Magnetic resonance imaging, diffusion-restricted area with correspondence on the ADC map, located in the right temporoparietal region inferring an acute ischemic event. An electrocardiogram was also requested, which showed an irregular rhythm, characteristic of atrial fibrillation, resulting in a diagnostic hypothesis of cardioembolic ischemic stroke. Discussion: The involvement of post-central ischemic gyrus lesions may correspond to paresthesia, anesthesia, hypoesthesia; the involvement of secondary and terciary areas of sensitivity in the upper parietal lobe, especially in the active movements of the hand and in the modalities of integrated sensitivity, their lesions may be clinically affected by: apraxias, dysgraphias, hemineglect, agraphestesia, stereoagnosia and spacial disorientation.
Evaluation of suicidal ideation in adult people with epilepsy and caregivers in a tertiary center
Authors: João Rafael Batista , Nogueira Mateus Henrique , Silva Lucas Scárdua , Brioschi Ricardo , Baltazar Gabriel Ferri , Morita Márcia Elisabete , Alvim Marina Koutsodontis Machado , Cendes Fernando , Yasuda Clarissa Lin
Published: December 2021

Background: Epilepsy is a risk factor for suicidal ideation (SI). SI still poorly investigated in caregivers of people with epilepsy (PWE). Aim: We aimed to analyze the prevalence and predictors of SI in adults PWE and caregivers. Methods: We analyzed 548 consecutive PWE (60% women; median age 41 [18-83]) and 191 caregivers (72% women; median age 47 [18-82]) followed at Outpatients’ epilepsy clinics from a tertiary center. We used “item nine” (item scores ≥1) of the BDI-II to determine the SI presence. The presence of symptoms of anxiety (with BAI) and depression (with BDI-II) was defined with scores ≥14 (for both PWE and caregivers). The presence of anti-seizure drugs (ASDs) adverse effects was defined with the “Liverpool Adverse Events Profile” score≥46. Epidemiological factors and anxiety were investigated as predictors of SI in caregivers and PWE (along with seizure frequency, epilepsy-type, and ASDs’ adverse events). Results: Depression was present in 41% of the PWE and 32% of the caregivers (p=0.04). Anxiety was observed in 37% of PWE and 33% of caregivers (p=0.32). The SI frequency was higher in PWE (19%) compared to the caregivers (11%; p=0.02). Logistic regression analyses were performed for both groups separately. For the PWE (model accounted for 17%-27%), the most significant predictors were anxiety (OR 4.4, p<0.001), presence of ASDs’ adverse effects (OR 2, p=0.021), recurrent seizures (OR 3, p<0.004), and younger age (OR 0.98, p<0.037). For the caregivers (model accounted for 18-37%), only anxiety (OR 43, p<0.001) predicted SI. Conclusion: Identifying SI predictors is equally necessary for PWE and caregivers.
Postoperative migration of motor activity in low-grade glioma resection: a systematic review
Authors: Monteiro Lucas Nascimento , Braz Marcella
Published: December 2021

Introduction: Compensatory mechanisms resulting from the phenomenon of neuroplasticity are present in patients with neuroepithelial tumors, such as lowgrade gliomas (LGG). In the case of tumors located in the primary motor cortex, neural reorganization of motor activity to other areas of the brain may favor the maintenance of motor activity and avoid neurological deficits. Thus, this study sought to assess the movement of motor activity in patients with LGG. Materials and Methods: The search strategy used medical subject headings and text words related to neuroplasticity, LGG, and primary motor cortex. The PubMed and Biblioteca Virtual em Saúde databases were used. The search of articles was conducted from November 2020 to January 2021, and there was no time limit regarding article eligibility. Results: Four studies were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The contralateral motor and supplementary areas were the most active areas reported in the postoperative period. Given that this was a retrospective study, it did not demonstrate migration of motor activity, making surgical resection unfeasible. Conclusion: Knowing where motor function migration frequently occurs in patients with LGG is useful to optimize the resection of these tumors without inducing neurological deficits, thereby increasing the quality of resection in critical areas, such as the primary motor cortex.
Prediction model to delirium in hospitalized elderly people
Authors: Azevedo Wylson , Schutz Eduardo Augusto , Attuy Mayara Menezes , Flores Thamara Graziela , Lampert Melissa Agostini
Published: December 2021

Introduction: Delirium has a high prevalence in hospitalized elderly patients. This is due to low hospital detection and the absence of a screening instrument. Objective: evaluate predictive variables in the development of delirium in na in-hospital environment. Methods: Cross-sectional study. Data collection was carried out between 2015-2016, with a sample of 493 elderly people. The variables used were age, sex, the reason for hospitalization, Identification of Elderly at Risk (ISAR), delirium during hospitalization using the Confusion Assessment Method, frailty using the Edmonton Scale, the impact of comorbidities by the Charlson Index and hospital immobility. Predictive variables were identified through logistic regression. Results: 469 elderly people were taken. The presence of delirium during hospitalization was mostly observed between 80 and 89 years old (n = 12), female (n = 16), with the most common reasons for hospitalization due to fractures (n = 6) and accident brain vascular (n = 11), 79% chance of surviving in one year using the Charlson Index (n = 11) and with ISAR> 2 (n = 26). There are important associations for the development of delirium for patients who have a 98% chance of surviving in one year (p = 0.05) and with ISAR <2 (p = 0.027), with a 34% increased chance and 38%, respectively. Conclusion: It is observed that, by the results, the predictive variables of inhospital delirium are patients with a 98% chance of survival and with ISAR <2.
Fatigue presence in amiotrophic lateral sclerosis and related clinical and functional aspects
Authors: Costa Maria Alice Dias da , Sousa Danielle Antoniazzi Costa , Paula Igor Roque de , Rangel Marcela Ferreira de Andrade , Alencar Mariana Asmar
Published: December 2021

Background: Some symptoms are reported in Amyotrophic Lateral Sclerosis (ALS), such as fatigue, which, despite having an impact on the individual, is still poorly investigated, seeming to have a multifactorial cause and manifesting itself as tiredness. Therefore, it is necessary to investigate this symptom and check the factors associated with this condition. Objective: To investigate the presence of ALS fatigue and the correlated clinical and functional factors. Objectives: 65 people with ALS attended at the Neuromuscular Diseases Clinic of HC / UFMG participated. Demographic, clinical, functional aspects were assessed and the Fatigue Severity Scale (FSS), Functional Scale (ALSRFSR), Quality of Life Questionnaire (ALSAQ-40) and mobility were used. Results: Participants (56.6 ± 11.0 years), about 44.6% (n = 29) presented fatigue. The average intensity was 5.4 ± 1.2 and 10.4% used specific medication. The fatigue group differed from the fatigue group in terms of: gender (male n = 48.3% vs female n = 72.2% (p = 0.049)); the presentation of greater pain intensity (p= 0.026); the worst results in functionality and independence in ALSFRS-R (p =0.004); worse perception of Quality of Life (QOL) (p = 0.000). Fatigue correlated with pain (r = 0.425; p = 0.001), overall muscle strength (r = -0.356; p = 0.004), functionality (r = -0.363; p = 0.003) and QOL (r = 0.481; p = 0.000). Conclusions: Fatigue is a symptom that is correlated with worse functionality and QOL, therefore, it is necessary to investigate this symptom and adopt treatment.
Lessons of a multicenter noninvasive brain stimulation trial in patients with unilateral spatial neglect after stroke: barriers to trial participation from a developing country
Authors: Borges Guilherme Ferreira , Nunes Hélio Rubens de Carvalho , Luvizutto Gustavo José , Silva Taís Regina da , Bazan Rodrigo
Published: December 2021

Background: There is a high demand for stroke rehabilitation in the Brazilian public health system, however most studies that addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in highincome countries. Objectives: Analyze the USN patient recruitment in a multicenter non-invasive brain stimulation clinical trial performed in Brazil. Design and setting: Observation study of reasons for exclusion of patients in a multicenter, randomized, double-blinded clinical trial performed at Botucatu Medical School. Methods: We evaluated reasons for exclusion of patients in a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Results: 173 of 1956 potential neglect patients (8.8%) passed initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to exclusion of 21/87 patients (24.1%). Low socioeconomic status led to exclusion of 37/173 patients (21.4%). Difficulty in transportation to access treatment was the most common reason (16/37 patients, 43.3%). Conclusions: The analyzed Brazilian institutions have potential for conducting studies in USN. Recruitment of stroke survivors with USN was restricted by the study design and limited financial support. Cognitive impairment, presence of stent or craniectomy and lack of transportation was the most common barriers to participate in a multicenter non-invasive brain stimulation trial in patients with unilateral spatial neglect after stroke.
Management of patients with spinal cord trauma in the hospital environment and life quality
Authors: Pereira Sarah Joanny da Silva , Vieira Natália Barros Salgado , Castro Ana Flavia Silva
Published: December 2021

Background: Spinal cord trauma has a negative prognosis, with low life quality. Management procedures increase chances of survival and a better life quality. Objectives: Review in the scientific literature which treatments are recommended to spinal cord trauma in the hospital and how it affects life quality. Methods: A literature review was carried out in the MEDLINE/Pubmed, Scientific Electronic Library Online (SciELO) and LILACS databases, using the terms “spinal trauma”, “recovery”, “patient management”, “accessibility” and “life quality”, in Portuguese, English and Spanish. 87 articles were found and 15 followed for complete analysis. This exclusion criteria were used: (a) articles published before 2015; (b) articles that did not fit the proposed theme. Results: At the hospital, treatment to spinal cord trauma is supportive, reducing secondary damage. Respiratory disorders are treated with intubation. Management of the respiratory tract should also include physiotherapy of the pectoral region, secretion clearance, mucolytic and bronchodilators. High-risk patients may need tracheostomy. The more complex the injury and the higher the level, the more aggressive the neurogenic shock. The first treatment should be fluid resuscitation, to maintain euvolemia. The second, vasopressors and inotropes. MAP should be above 85-90 mmHg during the first week to avoid neurological damage. Conclusions: The treatments are extremely important, but the prognosis is usually negative, given the limitations that reduce the life quality of these people, who suffer from a lack of accessibility.
A novel mutation in the RRM2 domain of TDP-43 in a Brazilian sporadic ALS patient.
Authors: Cambraia Amanda , Campos Junior Mario , Gubert Fernanda , Vasques Juliana Ferreira , Loureiro Marli Pernes da Silva , Gress Claudio Heitor , Lima José Mauro Bráz de , Otero Rosalia Mendez , Zembrzuski Verônica Marques
Published: December 2021

Introduction: Amyotrophic Lateral Sclerosis (ALS) is an adult-onset progressive and fatal neurodegenerative disease that selectively affects upper and lower motor neurons. Death occurs within 3 to 5 years of onset, usually from respiratory complications. Most cases of ALS are sporadic (SALS), but familial forms of the disease (FALS) represent approximately 10% of the cases. More than 30 genes have been associated with ALS and mutations in these genes account for more than a half of all familial cases and about 10% of sporadic cases. One of the most prevalent genes is TARDBP, responsible for approximately 4-6% of FALS and nearly 1-2% of SALS cases. The aim of this study was to perform the screening of known ALS genes, to increase the knowledge of the mutations that circulate in the population from Rio de Janeiro. Methods: The screening of mutations was performed through the Illumina Next Generation Sequencing (NGS) platform with the use of a sequencing panel that contained the TARDBP, SOD1, FUS, VAPB, SMN1 and SMN2 genes. Results: A novel missense mutation (p.Phe194Leu) in exon 5 of the TARDBP gene was found in a sporadic male patient who died at the age of 58 (2018). The mutation, a TTT/CTT substitution, was not detected in any mutation databases and in the literature. In silico analysis of this variant with different algorithms were performed and the results pointed to a probably damaging impact and that the mutation is disease causing. Conclusion: Through the study of the ALS genes by the NGS, we were able to identify a novel TARDBP mutation in a non-familial ALS patient. In addition, this study also increases the number of known TARDBP mutations in ALS patients and our knowledge of the mutations that affect the patients from of population from Rio de Janeiro.
Clinical effects of nonpharmacological treatment of ADHD
Authors: Cunha Matheus Almeida Ribeiro da , Oliveira João Gustavo dos Anjos Morais , Brandão Gabriela Sarno , Assis Ana Flávia Paiva Bandeira , Santos Leonardo Mattos , Purificação Isaac Rêgo , Alves Isabella Trindade Lopes , Cruz Mariana Portella Lopes , Fernandes Raimundo Nonato Ribeiro
Published: December 2021

Background: Though pharmacotherapy of Attention Deficit Hyperactivity Disorder (ADHD) is widespread, some patients suffer with side effects or do not improve with it. Objectives: Evaluate clinical outcomes of non-pharmacological therapy on ADHD. Design and Setting: This is a literature review, produced in Bahiana School of Medicine and Public Health. Methods: Articles published between 2011 and 2021 were taken from PubMed, using the following search: (“Non-pharmacological treatment” OR “Non- pharmacological therapy” OR “Non-pharmacological intervention” OR “Non-drug treatment” OR “Non-drug therapy” OR “Adjuvant treatment” OR “Adjuvant therapy”) AND (“ADHD” OR “Attention Deficit-Hyperactivity Disorder”). Studies that did not match this review’s objectives were excluded. Results: 20 of the 57 articles found, were selected. Reviews that approach treatment in general indicate non-pharmacological therapy specially when there are obstacles to use of drugs, but highlight the lack of studies with methodological quality in this field. Clinical studies indicate reduction of symptoms through neurofeedback, transcranial magnetic stimulation, and aerobic exercises. One of the interventions with the most articles was nutritional supplementation, though most of them did not find significant improvement. Conclusions: Non-pharmacological treatment of ADHD is a relevant alternative, especially when there is no response to medication, but studies with better methodological quality are necessary.
Vestibular rehabilitation by telemonitoring
Authors: Castro Isabella Moraes de , Aquino Leticia Moraes de
Published: December 2021

Introduction: Dizziness is one of the main symptoms of vestibular disorders, with high prevalence and functional impact. Vestibular Physiotherapy (VP) is a part of the treatment in these disorders, targeting functional improvement. Currently, telehealth (TH) appears to expand access, being an immediate solution for COVID-19 pandemic. Objective: To seek evidence of the benefits of VP via TH regarding assessment and interventions for patients with VD. Design and settings: Study carried out at São Camilo University. Methodology: Integrative review of clinical studies, Key words: “Vestibular disorders” and “TH”, in the PubMED and PeDRO databases, with no language or year limit. Results: 10 articles were found, 5 were included after review. Of these, 80% had a TH care protocol guiding adaptations to assessments for acute/ subacute symptoms, considering the severity and need for referrals. 60% of the works highlight the barriers found: devices and the patient’s ability to manage them, data and internet security; but also raise the possibility of greater reach to specialized professionals. One article adapted the Dix-Hallpike test from a distance. Only one study proposed remote interventions by exercise, comparing with face-to-face assistance, demonstrating similar results. Conclusion: Evidence suggests viable use of TH in dizziness, with better evidence in the evaluation processes, considering the barriers to be controlled. Only one study showed results on VF and exercises, showing that it is a possibility to be further investigated.
Diagnosis and treatment of Multiple sclerosis: Brazilian and global overview
Authors: Moreira Lorrane de Moura , Françozo Bruna Stefany Alves , Pereira Bruno Barcelos , Sardinha Camila Almeida , Alves Débora Pimenta , Godoi Filipe Henrique Almeida Barbosa , Ferreira Katherine Oliveira , Dourado Silvia Oliveira
Published: December 2021

Introduction: Multiple sclerosis (MS) is a neurodegenerative autoimmune disease of the central nervous system with a chronic, progressive and inflammatory character. In addition, it presents itself in a heterogeneous way, and can be as an isolated syndrome or as a recurrent remitter, in the first stage, or as progressive, in the second stage. The present work was developed with the objective of determining which is the best form of diagnosis and therapy for multiple sclerosis in Brazil. Methods: The review was performed in PubMed platform, with the descriptors: “multiple sclerosis”, “diagnosis”, “therapy” and “research”. Results: The research result in 148 articles. After a criterious reading and the application of the used criteria, was selected 20 articles. Conclusion: For the diagnosis of this chronic neurological disease, magnetic resonance imaging is used to assess myelination of the different regions of the central nervous system, which is the most suitable for the diagnosis of MS. Μoreover, as a complement, cerebrospinal fluid extraction and blood tests are performed in order to ascertain the concentration of B cells. Regarding therapeutics, this is diversified, including drugs, diets and therapies that stimulate cognition and motor action, such as the use of virtual reality programs and motor images. In relation to drugs, it is of importance that SUS makes natalizumab and ocrelizumab available because they are more efficient and enable users to have a better quality of life. Finally, nutritional monitoring is also suggested to establish a ketogenic or fasting diet in a balanced way
Adalimumab treatment in a patient with severe presentation of VogtKoyanagi-Harada
Authors: Teixeira Rebecca Vieira , Queiroz André Luiz Guimarães de , Almeida Louis Fernando Marques de , Borges Érico Induzzi , Soares Neto Herval Ribeiro , Silva Sônia Maria Cesar de Azevedo
Published: December 2021

Context: Vogt-Koyanagi-Harada syndrome (VKH) is a rare, multisystemic, autoimmune disease mediated by a Th1 response against melanocytes in the eye, inner ear, central nervous system, skin and hair. In this article, we report a case of VKH with severe visual impairment and discuss the therapeutic response to corticotherapy followed by the use of Adalimumab, a tumor necrosis factor (TNFα) inhibitor. Case report: A 61-year-old black woman started bilateral frontal headache of severe intensity, associated with bilateral eye pain, hyperemia and watery eyes, progressing with visual turbidity with gradual worsening, seeing only figures after eight days. After ten days bilateral hypoacusis started, also progressive. She denied eye movement pain, diplopy, dizziness, fever, joint pain or skin injuries. On examination, visual acuity (VA) in RE: hand movement for 30 cm, LE: light perception, fundus of the eye with serous bilateral retinal detachment. CSF with 155 lymphomonocyte predominance cells, proteins: 73, negative bacterioscopy and cultures. Pulsotherapy was performed for 7 days followed by 1g of cyclophosphamide and maintenance therapy with fortnightly Adalimumab. Two months after discharge, she presented VA in RE: 20/200 and LE: counting fingers at 1 meter. Conclusions: Aggressive and early treatment with immunosuppression is key to the effective treatment of VKH. Immunotherapy can be used in patients who are unresponsive to corticosteroid doses. Biological agents that target TNFα have effective results in non-infectious uveitis. Adalimumab is a safe and effective option, which also reduces the need for chronic corticosteroid therapy. The prognosis depends on the early diagnosis and treatment.
Scientific production on the effects of COVID-19 on the central nervous system: a systematic review
Authors: Silva Eluan Joel Rodrigues da , Souza Cristiano de Bem Torquato de , Chappuis Raphael Henrique , Fernandes Sarah Evelyn Silva , Pereira Kleber Fernando
Published: December 2021

Background: The presence of COVID-19 in the world has brought changes to our society. The research groups around the world started an analysis of how the SARS-CoV-2 virus interacts pathophysiologically with biological systems. Objectives: Quantify, based on the literature, the scientific production by Institution and country of origin, which related the damage of COVID-19 in the Central Nervous System (CNS). Design and setting: We conducted a literature review. It was use the databases of PubMed, LILACS (Latin American and Caribbean Literature on Health Sciences), SciElo and The Lancet. Results: 91 articles were included. The Institutions with the most publications were: University of California (United States), All India Institute Of Medical Sciences (India) and Qingdao University (China), with May 2020 being the period with the most publications. The most frequent symptoms caused by COVID-19 in the CNS were: Anosmia, Headache, Vomiting, Nausea and Hyposmia. Conclusions: United States, India and China were the countries with an expressive, even small, number of publications relating the effects of COVID-19 on the CNS. The largest number of publications in May 2020 shows that studies were rapidly developed shortly after the disease was raised to the level of a pandemic in March of the same year. The symptomatic effects of the disease show the primary involvement of the respiratory system with effects on the CNS.
Non-pharmacological therapy in the management of behavioral and cognitive symptoms of dementia: a literature review
Authors: Baltazar Ana Catarini Lopes , Rosa Amanda Mansur , Almeida Ana Luiza Soares Henriques de , Guedes Isabela , Silva Luciana Maria Campos e , Vieira Suelen Darlane , Rodrigues Rafael Felipe Silva , Diniz Maíssa Ferreira
Published: December 2021

Background: Pharmacological treatments for dementia, such as antipsychotics and benzodiazepines, cause significant side effects. Therefore, the search for non-pharmacological alternatives for relieving behavioral and psychological symptoms of dementia is increasing. Up to 90% of patients with dementia are affected by one or more symptoms: behavior change, disturbing vocalization, restlessness, rambling, apathy, among others. Objectives: Analyze the effectiveness of non-pharmacological measures in the management of dementia. Design and Setting: Review of the literature. Methods: The PubMed database was used with the descriptors “non pharmacological interventions”, and “dementia”. From the 450 found, 9 articles published between 2015 and 2019 were selected. Results: Some non-pharmacological measures reported were art therapy, music therapy, aromatherapy, behavioral therapy and physical exercises. However, intervention methods varied between studies as they used different teoric bases and investigated individually the effect of personalized activities. The best results were found when the treatment was adapted to the interests and skills of the participants, mainly regarding apathy and agitation. In addition, a study has shown that an organized non-pharmacological intervention program was also effective in controlling external and intrinsic symptoms, including hallucination and delirium. Conclusion: Studies focusing on alternative approaches reveal that different non-pharmacological interventions are able to reduce psychological symptoms and behavioral disorders. Therefore, they should be considered as first option interventions for treatment. In addition, these variants of precise treatment for greater visibility and more comprehensive studies.
Analysis of hospitalization rates for epilepsy in children between 2014 and 2020 in Bahia
Authors: Gois Maria Grasiele dos Anjos , Lins Layne Nunes , Fonseca Daniele Santos , Muniz Camila Osterne , Mucci Marina Behne , Fernandes Bruna Araújo , Oliveira Beatriz Murta Melo , Paiva Raquel Rebouças , Amorim Gardênia Ellen Almeida de , Oliveira Emanuelle de Lima , Martins Talita Tourinho Barbosa , Oliveira Cinthia Nascimento , Sena Paula Fonseca de , Paz Larissa Neves da , Machado Thaís Mudadu Carmona , Lima Diana Castro de Jesus , Silva Júnior Wilson da
Published: December 2021

Background: Epilepsy is a neurological disease characterized by abnormal and excessive electrical discharges in the brain, with the occurrence of two or more seizures during 12 months, without causing fever, traumatic brain injury, hydroelectrolytic alteration or concomitant disease. Knowing the panorama of hospitalizations makes it possible to manage and direct resources in order to adapt to the needs of the age group. Objectives: Compare the age groups in relation to the number of hospitalizations for Epilepsy in Bahia between 2014 and 2020. Methods: Work carried out based on secondary data through public consultation to the DataSUS platform, through the Hospital Production System of the Unified Health System (SIH- SUS). All cases of hospitalization for epilepsy in children between January 2014 and December 2020, in the state of Bahia, were included. Results: The age group that presented the highest rate of hospitalization was 1-4 years old with an average of 39.49%, followed by the age group between 5-9 years old with 20.16%, in addition to those younger than 1 year old with 16, 70%, with the age groups between 10-14 years old and 15-19 being the last with 13.65% and 10% respectively. Conclusions: It is observed that there is a higher incidence rate of hospitalizations in children under 9 years of age, explained by the high rate of epilepsy that evolve, most of the time, with the disappearance in adolescence, elucidating the lowest rates in the age group over 10 years.
Motor neuronic disease starting in the elderly and young adults
Authors: Paula Igor Roque de , Costa Maria Alice Dias da , Sousa Danielle Antoniazzi Kirscht Auermann D'Allembert Costa , Gonçalves Julia Magalhães Waybe , Rangel Marcela Ferreira de Andrade , Mattos Kamila Silva de , Alencar Mariana Asmar
Published: December 2021

Introduction: Motor neuron diseases (MND) are degenerative disorders that affect motor neurons, leading to disability and dependence throughout their course. The onset of symptoms is variable and can occur in adults(A) and elderly(E), however little is known about the characteristics of the disease in different age groups. Objective: To investigate the characteristics and the difference between clinical and functional factors considering the onset of MND in the elderly and young adults. Method: There were 26 young adults and 26 elderly (≥60 years) evaluated, matched by gender and length of disease, treated at HC/UFMG. The following were investigated: demographic and clinical, using specific instruments (ALSFRS-R/BR and ALSAQ-40); fatigue (FSS); manual muscle strength; mobility and balance (SPPB). Analysis was performed descriptive and comparison (student t test, Mann-Whitney or X2), using SPSS, significance level of 0.05. Results: Differences were observed significant as to the place of onset of symptoms (p=0.034), presence of pain (p=0.034) and use of ambu (p=0.023). No significant differences were verified for the others: occurrence of falls (p=0.254), presence of comorbidities (p=0.158) and use of Riluzole (p=0.548), sit and stand (p=0.931), turn over in bed (p=0.402) and walk (p=0.740), total ALSFRS-R (p=0.656), MND severity level (p=0.307)strength muscular (p=0.940), SPPB (p=0.296), quality of life (p=0.686). Conclusion: The clinical and functional characteristics were similar between individuals who started the disease in the elderly and adult phase. However, it was observed a higher prevalence among the elderly with bulbar onset, which is thebeginning of the worst prognosis of disease progression.
Morphometric analysis of the sella turcica in Northeastern Brazil
Authors: Oliveira Pablo Mariz de , Carneiro Amanda do Nascimento Oliveira e , Lima Júnior Fábio Antônio Serra de , Silva Daniel Dantas da , Cavalcante Leticia Leite , Magalhães Desiré Dominique Diniz de , Oliveira André de Braga Sá de
Published: December 2021

Introduction: The sella turcica is a structure of the median region of the sphenoid bone. Variations in its morphology are relevant as it is a region subjected to several surgical procedures, mainly related to the pituitary gland. Objective: To analyze the morphology of the sella turcica and its sexual dimorphism in Northeastern Brazil. Methods: Fifteen human skulls from the Federal University of Paraíba (UFPB) were used. The qualitative analysis was performed by classifying the shape of the sella turcica into three types: U, J and flattened. Morphometric data was collected and statistically analyzed to evaluate the relationship between sella morphometry and gender, and between sella and skull measurements. Values of p< 0.05) in the sella turcica length (STL) and skull length (SL), with male skulls being larger in both cases. The other linear measurements didn’t show differences between the sexes (p>0.05). There was a positive linear correlation between STL and SL, and a negative linear correlation between sella turcica width (STW) and sella turcica height (STH) and between STH and bitemporal width (BTW). Conclusion: The results point to important differences in the morphometric parameters evaluated with original findings for this population. Knowledge of the morphology of the sella is essential to plan safer surgical approaches in the pituitary gland or related anatomical structures.