bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlates of the Wiesbaden Scale for Positive Psychotherapy and Family Therapy 2.0 in 93 Polish Female Students of Psychotherapy
Authors: Zarek Aleksandra
Published: July 2023

The article presents correlational analysis of the concepts used in PPT in the context of social competences, attachment styles and stress-coping strategies in 93 female students of psychotherapy. Polish translation of WIPPF2.0, together with Profile of Social Competencies (PROKOS), Questionnaire of Attachment Styles (KSP) and Polish adaptation of the COPE Inventory were used as measuring tools. Minor to moderate correlations were found between social competences and four Secondary capabilities (Openness, Politeness, Orderliness, Cleanliness) as well as attachment styles and two Primary capabilities (Trust, Sexuality/Tenderness) and three Model dimensions ( I-mother, I-father, YOU). Social Contact was moderately (and positively) correlated with Seeking of Instrumental Social Support and Seeking of Emotional Social Support, whereas Body/Senses, Activity/Achievement and Future/Fantasy were positively correlated with Mental Disengagement.
An Interdisciplinary and Multidisciplinary Approach Between Medical Education and Positive Transcultural Psychotherapy to Lead Suicide Prevention Strategy for Healthcare Students and Healthcare Workers
Authors: Galli Fabio
Published: July 2023

Suicidal ideation (SI), suicide attempts (SA), and completed suicides (CS), seem to be phenomena present globally and in heterogeneous growth. The objectives of this manuscript are to offer an overview of these phenomena related to mental health and mental well-being, focusing on the prevention of SI, SA, and CS, with multidisciplinary team (MDT) and interdisciplinary team (IDT) interventions that can be integrated into the daily activities of healthcare workers (HWs) and medical/healthcare students (MHSs). The role of medical education (MedEd) and counselling/psychotherapy, with particular interest in the PPT (Positive and Transcultural Psychotherapy), can become fundamental in intervention, identification, prevention activities, for MHSs and HWs.
Positive Group Therapy Through Traditional Games with a Positum MGS Approach for Building Resilience Against Trauma in Times of Pandemics, War and Earthquakes: Theoretical Considerations and Practical Applications of “The Witches” Game
Authors: Parruca Etion
Published: July 2023

Why traditional games and how to transform them into powerful psycho-social and holistic instruments in Positive Group Therapy? The paper aims at looking at the space that Positive Transcultural Psychotherapy [PPT after N. Peseschkian, since 1977]TM can provide for the Positum MGS approach in utilizing traditional and transcultural games with a psycho-social aim in groups. Pandemics, wars and natural disasters such as earthquakes – among many other traumatic events – can result in forced displacement and migration for masses of populations, including children, and have severe consequences in the holistic health of affected people. The paper looks at the foundations of Positive Group Therapy, its interaction with the Positum MGS approach within it, and the value they can create for healing trauma in groups when integrating such tools as traditional games. The paper analised the research and practice in the field, demonstrating the great value of traditional and transcultural games in strengthening the identity and sense of belonging, as key resources for building resilience for individuals in groups and through group work sparked by traditional games transformed into psycho-social ones. The features, principles and strategies of the Positum MGS approach within the framework of PPT are further explained, and cases of practical application from recent years are discussed in the light of theoretical concepts of Positum MGS and PPT.
Evaluation Criteria for Psychosomatic Practice
Authors: Kirillov Ivan
Published: July 2023

To diagnose and treat somatic disorders while considering psychosocial factors, medical and psychological practices require a comprehensive and operationalized list of criteria. The Evaluation Criteria for Psychosomatic Practice (ECPP) has been developed to address this need. It builds upon the updated version of the Diagnostic Criteria for Psychosomatic Research (DCPR) by incorporating significant psychodynamic factors and restructuring its framework to better cater to the practical demands of clinical assessment, diagnosis, treatment planning, and outcome monitoring. It offers four axes for clinical evaluation that can be used together or separately, depending on the needs of diagnostic process, treatment, informing the patient, or research: psychosomatic symptoms and complaints, risk factors related to personality structure, triggers, and secondary risk factors. By utilizing the ECPP’s four axes, clinicians can gain a deeper understanding of how psychosocial factors impact the clinical picture and dynamics of somatic disorders and then effectively communicate this knowledge to patients, improving compliance and collaboration in treatment. Additionally, the ECPP’s framework allows for a balance of psychological, physical, and social treatment interventions that can be tailored to the specific needs of the patient, ultimately leading to better treatment outcomes.
Application of VR-Technology Methods in Psychology and Psychotherapy
Authors: Olenichenko Igor
Published: July 2023

We shall consider the possibility of using virtual reality (VR) technologies in the treatment of phobias, psychosomatic disorders, and other psychophysical conditions. The challenge of augmenting patients’ mental treatment by means of VR technologies is quite relevant in the field of psychology. A new way is quickly developing in the search for better methods of diagnosis, amelioration of anxiety and other conditions, as well as the identification of human characteristics. This new method can be characterized as deep immersion in virtual reality. This provides an opportunity to work with psychosomatics and phobias through virtual reality.
Positive Psychotherapy and Art
Authors: Franzen Georg
Published: July 2023

Art therapy and positive psychotherapy have common points of contact, but differ significantly in their respective theoretical and practical concepts. Both are independent therapeutic methods that require extensive training or further education. Art therapy works preferably with artistic media, whereby psychodynamic processes are integrated depending on the therapeutic orientation. Conversely, Positive Psychotherapy has related approaches in a distinct form to art therapy. This applies above all to the creative process of the procedure. Both methods overlap at the point where psychological conflicts are expressed through artistic means or stories. While artistic therapies focus on this process, Positive Psychotherapy is a psychotherapeutic procedure in its own right. In this article, the approach to art therapy is presented against the background of the resource-oriented practice and theoretical approaches of Positive Psychotherapy.
Феноменологічні аспекти психотерапевтичної роботи із актуальною здібністю «Надія» у часі війни
Authors: Кітчак Тетяна
Published: July 2023

В час динамічного та непередбачуваного характеру війни, психотерапевтичний процес зазнає великих викликів та потребує особливо пильної уваги до первинної актуальної здібності надія. У статті представлено опис, спостереження та перспективи психотерапевтичної роботи із дослідження та активації надії, робота із клієнтом у цій темі за п’ятикроковою моделлю Пезешкіана. Також акцентовано важливість самоспостереження психотерапевта та його потенційна роль як зразка для наслідування.
Транскультуральный аспект построения профессиональных отношений психолога и клиента с видимым отличием
Authors: Чебарыкова Светлана , Куклина Ирина , Гарднер Анна
Published: July 2023

В статье обосновывается правомерность использования идеи транскультуральности для понимания природы психологического барьера, с которым сталкиваются психологи при построении профессиональных отношений с клиентами, имеющими видимые отличия во внешности. Авторы аргументируют использование понятия «видимое отличие» для корректного обозначения людей с особенностями внешности, природа которых напрямую связана с нездоровьем. Клиент с видимым отличием рассмотрен как принадлежащий к особой культуре – «культуре инвалидности», так как его образ жизни вызван или поддерживается физической или психической инвалидностью. Результаты исследования, проведенного с участием практических психологов профессионального сообщества г. Хабаровска (Россия), позволяют подтвердить предположение о наличии специфического барьера, ощущаемого и психологом, и клиентом как противопоставление «Я – Другой». Природа упомянутого барьера связана с культурными особенностями современного социума, так как в обществе сильны установки «культуры полезности» – концепции, при которой ценность человека определяется его способностями к исполнению полезных функций. Транскультуральный подход при построении профессиональных отношений является наиболее адекватным методом, использующим различия как ресурс оказания помощи клиентам.
Patients Encounter with Diagnoses and Illness in Transcultural Perspective
Authors: Okoro John
Published: July 2023

The world of today is full of diversity. With migration problems, religious groups and many conflicts in this world it is important to bring into our focus the different world-views of understanding illness and treatment in different cultural and religious settings. In my article three cases are presented to explain exactly how different Traditions treat patients with diverse sicknesses and their approach to establish the diagnosis of organic and psychic problems. The object of this expose is to explain the way and manner of encounter when one visits a country with some sort of illness. These cases are experiences of my clients in interaction with Therapists in their cultural settings. Importantly, as a Positive Psychotherapist, this information helps to accommodate all aspects of interaction needed to give a safe background for clients. My method is more or less analytic and descriptive. Many illustrations in this work portrays my many years of experience working with people of different cultures and clients. Moreover, it is very important for our understanding of our clients always to see beyond our horizon.
Once Upon a Time there was a Gray Chameleon: A Documented Treatment of a Patient with Borderline Personality Disorder with Positive Psychotherapy from the Perspective of the Patient and the Therapist
Authors: Peseschkian Hamid
Published: July 2023

Even though the borderline personality disorder (BPD) belongs to the most common personality disorders, its treatment is still a great therapeutic challenge. The different approaches have one thing in common – the request for a flexible setting depending on to meet the patient’s needs. After a brief introduction, we report about a 27-year-old female patient who was treated successfully in a 33-hour-session individual therapy. The applied method was positive psychotherapy, a humanistic psychodynamic method. Additional techniques are explained. The patient wrote more than 500 pages as homework during the treatment period of 10 months. This material gives an insight into the therapeutic process and its transference phenomena from the perspective of the patient. The therapist´s comments conclude this and give an insight into the countertransference. The applied therapeutic techniques, especially the writing, homework, tales and bibliotherapy are discussed. Finally, in conclusion, a more innovative approach for the treatment of borderline disorders is called for.
POLYVINYLIDENE FLUORIDE MEMBRANES WITH TIN (IV) DIOXIDE (SNO2) ADDITIVES: ENHANCING WATER TREATMENT FOR AIRPORT ECO GREEN
Authors: Fazal Muhammad Rafli , Mataram Agung
Published: July 2023

Water treatment is a major process of realizing Eco Airport in airport development that does not cause environmental damage, protects the environment, and seeks to minimize the impact of environmental pollution due to airport operations. The growth and development of the global economy make a significant contribution resulting in increasingly uncontrolled disposal of wastewater, resulting in a series of environmental problems related to the provision of clean water at airports. This study discusses water filtration using membrane technology with Polyvinylidene Fluoride (PVDF) polymer mixed with Tin (IV) Dioxide (SnO2). This study aims to analyze the microstructure formed through Scanning Electron Microscopy (SEM) testing and determine the mechanical properties and performance in water treatment of mixed PVDF and Tin (IV) Dioxide (SnO2) membranes. This research is a new method in water treatment. The research method used was quantitative with initial membrane specimen formation, membrane preparation, flat sheet method, and testing methods (tensile testing, Scanning Electron Microscopy (SEM) observations, and Clean Water Permeability (CWP) testing. The results of this study, namely the formation of mixed membranes, showed the corresponding results as an alternative to water filter membranes. PVDF and SnO2 mixed membranes subjected to tensile tests using ASTM D638 standards, the surface structure of mixed membranes using SEM showed significant differences at each concentration, and the performance of water treatment performed with CWP showed an increase with increasing PVDF concentration and SnO2 for the airport. The conclusion is that water treatment performance using Clean Water Permeability (CWP) increases with increasing concentrations of PVDF and SnO2, which are suitable for airports.
SLIP HANDLING ON CONVEYORS TO EXTEND THE LIFE OF CONVEYORS AT THE DEPARTURES TERMINAL
Authors: Harahap Arka Alrora , Handayani Ni Putu Heni
Published: July 2023

The departure terminal’s Abdulrachman Saleh Malang Airport has facilities as an improvement in services for airplane passengers, such as aviobridges, escalators, travelators, elevators, and conveyors. Conveyors are mechanical systems that transfer luggage considerably from one location to another. To facilitate routing procedures, an effective model for conveyor operations must be developed, as well as the maintenance operation. This study aims to determine the consequences of lack of maintenance on the conveyor belt, namely the occurrence of slack in the belt so that it continues to experience abrasions on the sides of the conveyor and tears on the edges of the belt. The tear causes the fibers to unravel so that slip occurs between the belt and the upper idler shaft (carry idler) so that the idler cannot rotate. This causes the conveyor belt to run and malfunction. This research uses a qualitative method of conducting an exploratory study of the conveyor belt using experimental description research by describing and analyzing the existing conditions on the conveyor. The result is that there are belt fibers that cause slippage on the conveyor. Handling that can be done is cutting the fiber belt. The conclusion is that many factors can cause slippage on the conveyor belt, such as too heavy a load, old belt age, and the distance between the collecting belt conveyor and the transfer line conveyor. Maintenance can be done on the equipment to avoid slippage on the conveyor. Conveyor maintenance activities consist of two types, namely unplanned maintenance and planned maintenance. Unplanned maintenance is also called reactive maintenance or emergency maintenance.
STUDY OF GROUND FAULT PROTECTION SYSTEM IN THE MEDIUM VOLTAGE PANEL OF THE MAIN POWERHOUSE AT THE AIRPORT
Authors: Isdy Muhammad Zaky , Basak Tamal , Nina Fadhilla
Published: July 2023

The protection system is a system for securing electrical equipment caused by abnormal conditions such as short circuits (phase contact with the ground), human error, and others and detecting disturbances that occur and overcoming these disturbances in a short time. The ground fault protection system has not been activated at Juanda Airport Surabaya. This research aims to avoid problems that cause ground faults that spread throughout the MV. The Medium Voltage (MV) panel ground fault protection system used by MPH, namely MPH M-03, for voltage distribution to Air Field Lighting (AFL) substation and Airport Operation Building (AOB) substation, and Pump House 4 (PH 4) has not been activated. This study assesses the impact of activating the ground fault protection system for the MV MPH M-03 panel using the SEPAM protection relay. The research method is an exploratory study of the ground fault protection system in the M-03 main powerhouse medium voltage panel. The results showed that using a ground fault protection system for the MV MPH M-03 panel using the SEPAM protection relay is safer due to the ground fault indicator on the equipment. The Ground Fault panel helps protect electrical equipment and supplies from damage caused by ground faults. Quickly shutting off power in the event of a fault prevents excessive current flow that can damage or destroy sensitive equipment. This benefit is significant in industrial environments or areas with valuable equipment where downtime and repairs can be costly. The conclusion is that these systems should be used for safety in voltage transmission and distribution operations. Activating the ground fault protection system, operational safety at Juanda Airport Surabaya will be guaranteed, and it will be safer for the MV panel equipment and safety for the technicians working.
DESIGNING OF OPEN CHANNELS AND CLOSED CHANNELS FOR DRAINAGE FACILITIES IN AIRSIDE
Authors: Avandha Ajeng Teralina Listya , Ramadhani Shabrina
Published: July 2023

Drainage facilities are one part of the airside facilities that are important to ensure the safety of the airside area when weather changes occur. This study aims to make drainage that can be carried out to ensure the safety of the airside area from stagnant water. The calculation of airside drainage refers to the planned drainage calculation rules so that the drainage channels can design accordingly so as not to interfere with the operation of other facilities. In the design of drainage work, the material requirements for making open and closed channels at Dewadaru Karimun Jawa Airport must be precisely designed so that the work takes place by the specified planning and quality standards. The research uses a mixed methodology that the exploratory study by conducting a literature study that compares observation. The analysis starts by finding the volume for each work item based on Standar Nasional Indonesia (SNI) 2052-2017, a national iron and concrete standard. The result shows the excavation of soil for making channels, the total volume required is 880.24 m3, the importance of sand is 40.76 m3, the book of substantial rebates of a mixture ratio of 1: 2: 3 is 23.82 m3, and the book of K300 Concrete works for U-Ditch type C channels (100 x 100) is 116.29 m3. For the needs of the required iron volume of 16,415.09 kg, formwork of 1,408.45 m2, stone river masonry size 100 x 100 by 139 m3, stone river masonry size 50x50 amounted to 42.05 m3, and the volume of plastering work of the channel amounted to 192.46 m2. The conclusion of this study is the accuracy of design required to calculate each work item's volume.
Prevalence of Pregnancy Induced Hypertension among Women Attending Antenatal Clinic at Wenchi Methodist Hospital, Ghana
Authors:   College of Health, Yamfo, Barimah Barimah Antwi Joseph , Achiaa Frimpong Ophelia ,   Kokofu Nursing and Midwifery Training School, Gyamea Helina ,   College of Health, Yamfo
Published: July 2023

Pregnancy-induced hypertension is the most prevalent medical problem associated with pregnancy, affecting 6-10% of all pregnancies worldwide. It is the second leading cause of maternal death worldwide. A systolic blood pressure of 140 or a diastolic blood pressure of 90mmHg or both is considered hypertension in pregnancy. In order to diagnose hypertension disorder of pregnancy, both systolic and diastolic blood pressure rises are necessary. Pregnancy-induced hypertension develops after 20 weeks of pregnancy in women who had previously had normal blood pressure. The study’s objective was to determine the prevalence of pregnancy-induced hypertension by assessing the risk factors associated with Pregnancy-induced Hypertension; knowledge level of pregnancy-induced hypertension and further examined how women with Pregnancy Induced Hypertension are managed at the facility. A descriptive cross-sectional study was conducted among health workers and pregnant mothers attending antenatal clinics at Wenchi Methodist Hospital. 240 pregnant women were chosen using a simple random sampling method. 12 health workers were chosen using a purposive sampling technique. For the analysis, STATA version 14.0 was employed. The results indicate that out of 240 women recruited, the prevalence of pregnancy-induced hypertension was 8.8%. Less than half (37.5%) of pregnant women had good knowledge of pregnancy-induced hypertension and its complications. 25% of health workers stated checking urine protein and 3.33% stated fasting blood sugar was the test done to check whether pregnant mothers had pregnancy-induced hypertension. Despite the low prevalence of pregnancy-induced hypertension, most of these women lacked knowledge of the condition and its complications. According to the study, women who have never had the disorder are at lesser risk of getting it. Pregnant older women were more likely to experience the disease; those who do not eat fatty foods have a lesser risk of developing pregnancy-induced hypertension.
Diagnostic yield of a NGS panel in Brazilian patients with sporadic peripheral neuropathy
Authors: Lamas Gustavo Manginelli , Santos Yves Glauber Silva dos , França Jr Marcondes Cavalcante
Published: July 2023

Introduction: The etiology of sporadic peripheral neuropathy (PN) remains unclear in a significant proportion of patients. In European and North American surveys, genetic causes have been increasingly recognized in these patients. Little is known about Latin American populations. Objective: We assessed the diagnostic yield of a comprehensive next generation sequencing (NGS) panel in a cohort of Brazilian patients with PN without family history. Potential predictors of genetic etiology in this group were further explored. Methods: We evaluated 41 consecutive adult patients regularly followed with PN and 1. Negative family history of PN or other neurological disorders and 2. Unclear etiology despite extensive laboratorial/neurophysiological (Nerve Conduction Study+Electromyography [NCS+EMG]) workup. All patients then underwent genetic testing using a comprehensive (NGS) panel that included 72 genes known to cause PN. Only pathogenic or likely pathogenic variants according to American College of Medical Genetics and Genomics criteria were retrieved. For each subject, we recorded demographic, clinical and NCS+EMG data. Such variables were then compared between positive vs negative NGS subgroups using Fisher exact test (P < 0.05). Results: Fifteen patients had diagnostic NGS results (8 men, median age = 43 years old), whereas 26 patients (15 men, median age = 47 years old) had negative or unconclusive results. Diagnostic yield of the PN panel was 15/41 = 36.5%. Seventeen distinct variants were found in 5 different genes; PMP22 and SH3TC2 were the most frequently identified. Earlier age of PN onset (P = 0.013), demyelinating pattern on NCS+EMG (P = 0.021) and presence of distal atrophy on clinical examination (P= 0.043) were associated with positive NGS results. Conclusion: A significant proportion of Brazilian patients with sporadic PN has genetic etiology. NGS emerges as a diagnostically useful tool for idiopathic PN, particularly when there is earlier age at onset and demyelinating features.
Prognostic factors related to mortality in motor neuron disease at an outpatient care center in Salvador (BA)
Authors: Andrade Isabela Mascarenhas de , Viriato Adriele Ribeiro França
Published: July 2023

Introduction: Motor neuron disease is neurodegenerative and the understanding of its prognostic factors is crucial promoting better quality of life for patients. Epidemiological, clinical and nutritional factors have been described as influencing disease progression. Objectives: To describe prognostic factors in patients with Motor Neuron Disease at a specialized outpacient care center in Bahia. Methods: This is an observational, and cross-sectional study, carried out by collecting data from medical records of patients with diagnosis of amyotrophic lateral sclerosis (ALS), using forms to acess epidemiology data, clinical characteristics, and nutritional assessment in the beginning of treatment and the time of assessment. The time from the first symptoms until the application of palliative measures was also recorded. Results: 27 patients were enrolled in the study, 51.8% men and 41.8% women, with an average age of 55±11.1 years at diagnosis. No patients were diagnosed with frontotemporal dementia (FTD) and 3.7% had family history of ALS. Weight loss was observed in 95.8% of patients. Among the elderly population, 9% were classified as low weight at the first evaluation, and 81% were classified as such during data collection. Among the adult population, 8.3% were classified as malnourished at their first evaluation, and 27% during data collection. About 81% of the population used some palliative measure. The time between symptoms these measures were of 32 ± 18.6 months for gastrostomy, 38 ± 41.1 months for AMBU use and 49 ± 43.9 months for BiPAP use. Conclusion: A similar distribution of prognostic factors compared with literature was observed, with some particularities such as earlier age of onset, low prevalence of familial ALS and absence of FTD. Significant weight loss was observed, especially in those with bulbar ALS and in the elderly population, which is associated with a poor prognosis. Time from symptoms to palliative measures varied, but was shorter on average in patients with the bulbar form of the disease.
In vivo assessment of striatal compartments in patients with idiopathic upper limb dystonia
Authors: Paulo Artur José Marques , Waugh Jeff , Paiva Joselisa Queirzos de , Sato João Ricardo , Faria Danilo Donizete de , Borges Vanderci , Silva Sonia Maria Azevedo , Ferraz Henrique Ballalai de , Aguiar Patrícia Maria de Carvalho
Published: July 2023

Introduction: The striatum is an essential hub in the motor system associated with dystonia and other movement disorders. The function of the striosomes and matrix in motor control is not clear. A recently developed method using diffusion tensor imaging (DTI) enables us to distinguish compartments of the striatum, namely matrixes-like and striosomes-like voxels. Objectives: To access striatal matrix and striosome compartments in patients with idiopathic upper limb dystonia using diffusion tensor imaging. Methods: We analyzed 3T magnetic resonance imaging (MRI) images from 26 patients with idiopathic upper limb dystonia aged 43.88 ± 11.32 years (standard deviation, SD; range 19–60) with a mean disease duration of 12.55 ± 10.25 years (SD; range 1–25) and healthy controls aged 39.42 ±1 1.42 years (SD; range 19–58). The striatum was parcellated by targeting cortical regions that favored striosomes and matrix-favoring areas. The bilateral striatum was assessed for changes in volume and mean fractional anisotropy value. Results: Patients show significant reductions of left Matrix-like voxels volume relative to controls (P = 0.022), with a moderate effect size (Cohen’s d = 0.640). No difference was observed in the right striatum compartments. Conclusion: By parcellating the striatum into striosome and matrix-like voxels, we showed that patients with idiopathic dystonia have a reduced volume in matrix-like voxels in agreement with anatomopathological findings of some genetic types of dystonia. Even in non-degenerative dystonias, volume differences may reflect an imbalance between matrix and striosome signaling, ultimately favoring the direct pathway.
Bilateral thalamic ischemic lesion mimicking bickerstaff brainstem encephalitis – a potential pitfall
Authors: Fraiman Pedro Henrique Almeida , Maffei Rafael Tuzino Leite Neves , Lima Marcio Pinheiro , Azevedo Ruan Gambardella Rosalina de , Ferrer João Victor Cabral Correia , Barbosa Adriel Rêgo , Faria Victor Cardoso de , Souza Gabriel Pinheiro Martins de Almeida e , Silva Gisele Sampaio
Published: July 2023

Introduction: Bickerstaff Brainstem Encephalitis (BBE) is a rare immunologic disorder that often occurs after an infection and is characterized by ataxia, external ophthalmoplegia, and consciousness impairment. While it is a known differential diagnosis for posterior circulation syndromes, this case report highlights the potential pitfall of misdiagnosing a bilateral thalamic ischemic lesion as BBE. Methods: Herein we report a single case based on a retrospective analysis of the patient’s medical records. Results: A 58-year-old man was admitted due to progressive incoordination, unsteadiness, and walking difficulty for seven days. His relatives reported drowsiness and horizontal bilateral diplopia three days before admission. His medical past was relevant for mild coronavirus disease 2019 (COVID-19) infection 40 days before neurological symptoms onset, arterial hypertension, obesity, and untreated obstructive sleep apnea. Neurological examination revealed global deep tendon areflexia, axial ataxia, right eye exotropia, and drowsiness. An initial computed tomography brain scan was normal, and cerebrospinal fluid analysis revealed cytoalbuminologic dissociation (cell count: 2.6/mcL and protein 0.82 g/L). A diagnosis of suspected BBE was made due to clinical and laboratory findings, and COVID-19 was identified as a possible trigger. Intravenous Human Immunoglobulin (0.4 g/kg.day) for five days was administered. The patient worsened despite the treatment. Alternative causes were therefore evaluated. Elevated troponin and echocardiogram were compatible with perimyocarditis. Brain magnetic resonance imaging revealed a bilateral thalamic lesion suggesting a ischemic lesion. Percheron artery infarct was suspected; however, digital angiography was not done due to the patient’s deteriorating clinical condition. Conclusion: BBE is a rare condition that may be mimicked by stroke, especially in the posterior circulation. As observed in this case, minor laboratory abnormalities could be a potential pitfall. The presence of risk factors for cerebrovascular disorders should be considered, even if the onset is gradual and subacute.
Mild cognitive impairment and early onset Parkinson’s disease: an observational study
Authors: Veiga Beatriz Anjos , Candeias Carolina , Barcelos Lorena , Saba Roberta , Silva Sonia de Azevedo , Ferraz Henrique , Borges Vanderci
Published: July 2023

Introduction: Early Onset Parkinson´s Disease (EOPD) is defined as an onset of motor symptoms of Parkinson´s disease (PD) after age 21 years and before 50 years. According to the Movement Disorder Society, PD Mild Cognitive Impairment (PD-MCI) can be defined as performing 1–2 standard deviations (SD) below appropriate norms in at least two neuropsychological tests within the commonly affected domains in PD (i.e., attention and working memory, language, executive function, visuospatial, and memory) in the absence of significant interference with functional independence. People with EOPD face unique challenges compared with those with late-onset PD since they potentially have more active roles in society and a longer time horizon of disease. Objectives: We aimed to establish the PD-MCI frequency in EOPD patients and to define which subdomains were compromised in our patients. Methods: 69 EOPD patients underwent an assessment including Mini-Mental State Examination, Frontal Assessment Battery, Clock Drawing Test, Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test A and B, Forward Digit Span and Backward Digit Span, Stroop Test, Beck Depressive Inventory, UPDRS-3, UPDRS-4, HY and UDysRS. Results: The median (interquartile range [IQR]) age at PD onset was 43 years (23–49), the median (IQR) PD duration was 7 years (2–27), the median (IQR) LEDD was 800 mg (100–2430). The MCI frequency in this group was 40.6%. Patients were distributed in two groups (with and without MCI) and the scores between the groups had significant difference in most cognitive scales except HVLT-R. Conclusion: Our study described a high frequency and a profile of MCI in EOPD patients (attention/working memory and executive function). We suggest that clinicians must search for neuropsychological impairments in EOPD in order to provide a more comprehensive treatment that includes multidisciplinary interventions.
Guillain-Barré syndrome associated with froin syndrome: case report
Authors: Favaro Mateus Gustavo , Vieira Caroline Darold , Lopes Renan Barros , Verdi Giulia Ximenes , Maranhão Neto Túlio , Haes Tissiana Marques de
Published: July 2023

Case report: A 31-year-old man was referred to our service after experiencing paresthesia, followed by distal weakness in both his feet and hands. These symptoms occurred 20 days after the administration of the fourth dose of the ChAdOx-1 COVID vaccine. A lumbar puncture was performed, which showed remarkably thick cerebrospinal fluid (CSF). Biochemical analysis of the CSF revealed 920 mg/dL of protein and a white cell count of 7.3/mm3 . An electromyography (EMG) was performed, which was compatible with the diagnosis of Guillain-Barré Syndrome (GBS). The patient was treated with intravenous immune globulin and showed clinical improvement. One month later, he experienced a recurrence of symptoms and underwent a new EMG, which again showed motor nerve conduction blocks. A new lumbar puncture was performed, and a thick fluid was obtained, with a protein concentration of 804 mg/dL. CSF flow blockage was suspected and the patient underwent a suboccipital puncture, which showed a more watery CSF, with a protein concentration of 227 mg/dL. A spinal magnetic resonance was performed, revealing an arachnoid web at the T3–T4 level. GBS relapse was presumed and the patient was treated with five sessions of therapeutic apheresis, which improved his strength and sensory symptoms. Discussion: Blockage of CSF circulation at the spinal level can produce fluid with abnormally high levels of protein, which in this case was a confounding factor during the clinical investigation. Conclusion: We report a case of concurrent GBS and spinal block, which led to abnormally high CSF protein levels during lumbar puncture, causing diagnostic ambiguity during the investigation.
Case report: ischemic stroke in a young woman
Authors: Gurian Jordana Gaudie , Diniz Maria Ondina Machado , Bispo Amanda Nascimento , Ferreira Aline Boaventura , Borges Fernando Elias , Pedatella Marco Túlio Araújo
Published: July 2023

Introduction: Ischemic stroke is responsible for about 62% of all stroke cases. The lifetime risk of having a stroke is approximately 25%. Worldwide, stroke is one of the leading causes of mortality and disability. The causes are diverse, and the etiology must always be investigated in order to initiate specific treatment and adequate prophylaxis. Objectives: To report a case of ischemic stroke in a young woman after bronchoscopy with endotracheal tube replacement on an elective basis. Methods: Information was obtained through clinical follow-up in a neurology ward. Results: Patient, female, 27 years old, married, brown, with a history of polytrauma in 2015, after a bicycle accident, with the need for hospitalization in the intensive care unit, remaining intubated for nine days. Neurosurgical intervention was not necessary. The patient was discharged without any device, remaining functional, but two months later, she evolved with dyspnea, being diagnosed with tracheal stenosis, thus, a tracheostomy was necessary. In an outpatient routine, she was hospitalized for endotracheal tube replacement in October 2022. In the immediate postoperative period, she presented desaturation, requiring orotracheal intubation, sedation and breathing on mechanical ventilation. As she woke up weakly after ceasing sedation, a neurological investigation was initiated, being diagnosed with multiple areas of ischemic infarcts and identifying patent foramen ovale (PFO), moderate-grade paradoxical transseptal shunt as the most likely cause of the ischemic stroke. Conclusion: Young patient with PFO submitted to mechanical ventilation, after an elective procedure, evolving with worsening of the right-to-left shunt, resulting in ischemic stroke with a high degree of disability.
Epidemiologic review: an analysis of the incidence of botulism in southeast Brazil from 2011-2021
Authors: Rodrigues Pedro Vitor Ferreira , Pinheiro Amanda Pereira Sindeaux , Domingues Raoni de Oliveira da Silva , Melo Leonardo José Rodrigues de Araújo , Ponte Cássia Caroline Aguiar da
Published: July 2023

Introduction: Botulism is a rare life-threatening condition caused by Clostridium Botulinum bacteria toxins, which attack the various parts of the nervous system, like nerves, spinal cord and brain, causing symptoms, like dry mouth, facial weakness, trouble breathing and, in the worst cases, even paralysis. Being, for all the risks that this disease represents, a very important object of study and observation. Objectives: Analyze the epidemiological profile of confirmed cases of botulism in the Southeast region of the country during the years 2011–2021. Methods: This work was made using the data, from the Information System for Notifiable Diseases of the Information Department of the Unified Health System of Brazil, about the botulism. The data has been selected to represent only the 4 states, São Paulo (SP), Rio de Janeiro (RJ), Minas Gerais (MG) and Espírito Santo (ES), of the southeast region. Results: The Brazil had 60 cases of botulism in the analyzed period, with 41.5% of them being in the Southeast region. SP had the most cases in the region with 56% of them, followed by MG with 24% and by RJ with 20%. No cases have been reported in ES. 92% of the reports were foodborne botulism showing an absolute prevalence of this spread form. With a deviation of ±1.35 in the botulism cases over the years. Among those diagnosed, 48% were women and 52% men. Still, 56% of the people were white. Conclusion: With the data collected, it is possible to perceive a stable wave of incidence throughout the entire period, with major regional distortions. In addition, the overwhelming prevalence of the foodborne form of the disease is noticeable. however, due to the small number of cases, much of the data suffer from poor sampling and therefore may be biased, such as gender and race data, thus requiring more longitudinal studies to reach relevant numbers for this type of analysis.
Case report: stiff Person syndrome
Authors: Gurian Jordana Gaudie , Diniz Maria Ondina Machado , Bispo Amanda Nascimento , Ferreira Aline Boaventura , Borges Fernando Elias , Dunck Ane Cristina
Published: July 2023

Introduction: The rigid person syndrome is rare, characterized by blockade of the GAD enzyme, responsible for inhibiting muscle contraction. Although it is not mandatory for the diagnosis, most patients are positive for Anti-GAD. Objectives: To report a case of rigid person syndrome seen at Hospital Geral de Goiânia. Methods: Information was obtained through clinical follow-up in a neurology ward and outpatient clinic. Results: Patient, female, 32 years old, complaining of paresthesia ascending to upper limbs, worsening over a period of six months with paresis with gait impairment, increased tone and muscle spasms. Patient with multiple consultations with a neurologist and psychiatrist, using polypharmacy. During hospitalization, the patient reported severe pain in the limbs. On examination, she had grade 3 strength and quadrisegmental hypertonia with intermittent periods of generalized spasm, exacerbated during periods of greater anxiety. Hypothesis of rigid person syndrome was raised and anti-GAD 1,680 results were obtained. The patient responded well with high doses of diazepam, baclofen and pregabalin. Conclusion: The case represents a definitive diagnosis of rigid person syndrome, a rare pathology that affects 1–2 patients per 1,000,000, mainly females. This study contributes to future research in this area since knowledge in this area is still scarce.
Literature review: the efficacy of mirror therapy in patients with phantom limb pain
Authors: Rodrigues Pedro Vitor Ferreira , Pinheiro Amanda Pereira Sindeaux , Domingues Raoni de Oliveira da Silva , Melo Leonardo José Rodrigues de Araújo , Cavalcante Francisco Luciano Honório Barreto
Published: July 2023

Introduction: Phantom Limb Pain (PLP) is a common symptom after an amputation, affecting more than 80% of the people who experience this procedure. The mirror therapy, based on a reflective illusion is a hopeful possible treatment for this condition, as it tricks the brain to believe that the amputated member is still there, allowing for pain management. Objectives: The objective of this literature review is to search through clinical trials in order to collect data to relate the efficacy of Mirror Therapy in the treatment of the pain condition on PLP, establishing the possible reduction of the pain and the duration of the improvements caused by the procedure. Methods: This review was made using the descriptors “Phantom Limb pain”, “Mirror Therapy” and “Phantom Limb Syndrome” on the PubMed and New England Journal of Medicine advanced search mechanisms. The selected randomized Controlled trials totaled in 10, composed of articles from the last 16 years that fit the research’s purpose. Results: 9 out of the 10 trials used on this research showed improvement in the subjective pain of the patients on short term with the use of Mirror Therapy in both arms or legs. Some studies had even 100% of the patients with reductions on pain intensity, among a total pain reduction in the Visual Analogue Scale between 30% to 87% of improvement in all the trials. However, was not possible to determine the maintenance of this effect on a long term. Conclusion: As the first experiments of mirror therapy demonstrate, the treatment seems to have good efficacy in the reduction of the pain on the PLP condition, but there is still a need for more research to determine the extent of the improvements on a longer schedule and it was not possible to create a consensus over the total efficacy of the procedure due to the different types of amputation and the low number of patients in each trial.
Cerebral watershed infarct as the first manifestation of systemic lupus erythematosus and antiphospholipid syndrome
Authors: Lima Izadora Vieira Bolzani Lopes , Montoya Marco Tulio Medina , Santos Nadson Bruno , Gouvêa Sabrina Vechini , Jorge Rodrigo da Rocha , Pugliesi Allison , Mendes Lucas Castro , Appenzeller Simone , Avelar Wagner Mauad
Published: July 2023

Introduction: Cerebral watershed infarcts are strokes that affect regions supplied by two main arterial territories. It is usually related to hemodynamic compromise or hypercoagulable state as noted in antiphospholipid syndrome. We present a case of a young patient, who developed this type of stroke as the initial manifestation of antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). Objectives: To report an unusual case of watershed zone stroke in the context of APS and SLE. Case report: A previously healthy 15-year-old male patient presented fever and myalgia followed by dropped head and quadriparesis, which progressively worsened in the next five days. Initial neurological examination revealed quadriparesis, predominantly in the proximal muscles MRC grade II with hypertonia and pyramidal signs. Brain magnetic resonance imaging evidenced acute internal borderzone infarct in the territories of the anterior cerebral artery, and middle cerebral artery, bilaterally. Vessel wall imaging and cerebrospinal fluid showed no evidence of vasculitis. Computed tomography angiography revealed no large vessel occlusion, aneurysm or dissection, but showed right sigmoid sinus thrombosis. Laboratory tests revealed pancytopenia(hemoglobin 8,9; white blood cell 3510, 580 lymphocytes and 71.000 platelets) with positive direct Coombs, complement consumption, elevated erythrocyte sedimentation rate ( 47 mm/1st hour), positive anti-dsDNA (>1:1280), anti-SSA and anti-SM-RNP. The Lupus anticoagulant, anti-beta2GPI and anticardiolipin antibodies were positive, filling laboratorial criteria for SLE and APS. Transthoracic and transesophagic echocardiography were unremarkable. The patient was treated with high-dose corticosteroids (1.5 g methylprednisolone in three days) and anticoagulants, presenting a progressive recovery of strength. Conclusion: This case report reasures the important correlation between borderzone infarcts and hypercoagulable states. Antiphospholipid syndrome must be always remembered in these patients.
Atypical case of Wilson’s disease presenting with unusual neuroimage features
Authors: Santiago Mayhara Rosany da Silva , Simeão Ana Caroline Paiva , Galvão Heloisy Maria Nunes , Soares Miriam Carvalho , Oliveira Igor de , Fontana Pedro Nogueira , Andrade Renata Amaral
Published: July 2023

Introduction: Wilson’s disease (WD) is a rare autosomal recessive disorder resulting in hepatic and neurological symptoms. Uncommon presentations are prone to diagnostic and treatment delay. Objectives: Describe an atypical case of WD and improve clinicians awareness. Case report: A 19 years-old male presented to us with seizures and upper limb tremor in the past three years, evolving to torsion-like movements in limbs and trunk. He was unable to open his eyes and had severe dysphagia. There was no consanguinity, perinatal complications or neurodevelopmental delay. Examination revealed generalized dystonia, blepharospasm, retrocollis, dysarthria, trismus, right hemiparesis and marked muscle wasting; there was a gray halo around both irises. The patient was bedridden and severely dependent. Magnetic resonance imaging (MRI) showed T2/FLAIR (T2-weightedFluid-Attenuated Inversion Recovery) hyperintense lesions in the left hemisphere, basal ganglia and cerebellar peduncles. Laboratory workup revealed low ceruloplasmin levels (< 8 mg/dL; range: 16–45), serum copper of 44.2 mcg/dL (range: 70–140). A diffuse increased echogenicity was described in liver ultrasound. The patient had no clinical or laboratorial evidence of liver damage. Due to presumed Kayser-Fleisher rings, movement disorders and MRI findings, WD was suspected. Genetic test revealed two variants in the ATB7B gene, probably a compound heterozygosity. Having a final Leipzig score of 7, WD diagnosis was established. Conclusion: WD may present with cortico-subcortical involvement. Hepatic subclinical involvement may delay WD diagnosis. It is important to have a high index of suspicion for WD in any movement disorder in young people. In order to prevent treatment delay and severe neurologic sequel, neurologists should be aware about atypical clinical and radiological presentations of this treatable disease.