bluuebunny/crossref_metadata_2025 huggingface dataset:
Catharsis by the Bug River. Przewóz [The Carriage] (2021) by Andrzej Stasiuk as a ‘Cleansing’ Novel
Authors: Janiec-Nyitrai Agnieszka
Published: August 2022

The main goal of this paper is to analyze, depict, and characterize the semantic construction of the latest novel Przewóz [The Carriage] (2021) written by one of the most significant contemporary Polish writers Andrzej Stasiuk. A key way of organizing Stasiuk’s novel is juxtaposing semantically distant wholes, which creates strong tensions not only at the level of language but above all at the level of meaning. Categories of different meaning interpenetrate in the novel, creating a conglomerate of new meanings, showing the fractures of the world described by the novelist, the incoherence of a reality infected by war.

Such construction of the novel, based on contrasts and the tensions resulting from their occurrence, allows Stasiuk to reflect the tragedy of wartime experience. War is a catalyst that makes us aware of the uncertain anchoring of concepts and categories, hitherto considered unchanging and permanent, it allows us to capture the illusory nature of human beliefs, the incoherence of human actions, and the naivety of human recognition. The marginal comes to the fore, becoming a model of the world under a microscope, a theatre of history, revealing the nakedness of human existence. Such basic and key concepts as strength, courage, beauty, sacrifice, patriotism, culture, universality, boundary, and truth are questioned.

Stasiuk’s ontology is based upon a constant play of tensions between particular categories that make up reality. Nonetheless, the writer does not propose a coherent, unambiguous assessment of reality but rather draws attention to its complexity, impossibility of complete cognition, elusiveness, and delusion. These tensions, so pronounced in Stasiuk’s novel, reveal the illusory nature of the concepts in which a human is immersed, and at the same time, as one of the fundamental elements determining the artistic value of artwork, they are expected to lead to a catharsis, to a release of emotions, they also help to understand better the situation into which a person is thrown at the border moments. Thus, works designed in this way – as cleansing and releasing, and saturated with tension and contrasts – become, as it were, automatically universal, going far beyond transient vogues.

The goal of the paper is also to focus on these aspects of Stasiuk’s novel, to demonstrate how war as a border situation can lead to a relativization of concepts, how it can introduce confusion and chaos into a well-established, as it would seem, axiological system, which the writer demonstrates precisely by creating clear tensions. In his novel, Stasiuk does not offer a zero-one vision of the world, tensions are not created mechanically, and the writer uses contrasts and paradox, but what is really important for him are halftones, ambiguities, multivocalities, and a smooth transition in between categories. This is what sets Stasiuk’s world in motion.
Silica-coated superparamagnetic iron oxide nanoparticles: New insights into the influence of coating thickness on the particle properties and lasioglossin binding
Authors: Turrina Chiara , Oppelt Anne , Mitzkus Michaela , Berensmeier Sonja , Schwaminger Sebastian P.
Published: August 2022

Silica-coated iron oxide nanoparticles are of enormous importance in biotechnology, nanomedicine, and catalysis. The study demonstrates the significant influence of the coating thickness on the particle properties. Though slow magnetophoresis, a thinner shell leads to higher surface areas, lower isoelectric points, and higher magnetizations. However, thick layers prevent oxidation and lead to stabilization. The coating thickness influenced the binding of the cationic peptide lasioglossin, with a maximal loading of 0.23 g g−1 for the smallest particles. This knowledge can be used to specifically design particles for usage with a cationic tag system in biotechnology or drug delivery with antimicrobial peptides.

Graphical abstract
Optimization of heat-moisture treatment on potato starch and study on its physicochemical properties
Authors: Deng Chunli , Melnyk Oksana , Luo Yanghe
Published: August 2022

The object of research is the technology of modified potato starch obtained by heat-moisture treatment. Heat-moisture treatment (HMT) of starch is a hydrothermal treatment technique to modify their functional properties. Setback viscosity of potato starch gelatinization characteristic is the key factor that influences the quality of potato starch noodle. In order to obtain a green, safe and highly efficient potato starch product for vermicelli production, this study take setback viscosity as response value, a Box-Behnken model was established on the basis of single factor experiment results to optimize the modify technique. A response surface analysis was used to investigate the effects of moisture content of starch, heat-moisture treatment temperature and heat-moisture treatment time on setback viscosity of heat-moisture treatment modified potato starch. The viscosity properties, textural properties and retrogradation characteristics of HMT starch gel were estimated.
The results of response surface methodology showed the optimal parameters of HMT were that moisture content of potato starch was 23.56 %, heat-moisture treatment temperature was 90 °C, and heat-moisture treatment time was 1.5 h. Under such conditions, setback viscosity of heat-moisture treatment modified potato starch (HMTS) paste was 3677 cP, which was higher than native starch (496 cP) obviously, indicating that the gel strength and hardness of potato starch was improved significantly. Compared with native potato starch (NS), HMTS had lower peak viscosity (2966 cP), lower hold viscosity (2882 cP) and lower breakdown viscosity (84.50 cP), but higher paste temperature (71.08 °C), higher final viscosity (6559 cP) and setback viscosity(3677 cP). The results of retrogradation was consistent with the viscosity properties, all of which indicating that potato starch modified by heat-moisture treatment was more prone to retrogradation. TPA tests demonstrated that HMT can enhance the textural properties of starch gel. Compared with native starch (NS) gel, the hardness, cohesiveness, gumminess, chewiness and resilience of heat-moisture treatment starch (HMTS) gel were increased significantly, and there was no significant difference in springiness. Compared with native starch gel, heat-moisture treatment starch gel had better functional properties.
Analysis of methodical approaches to employer brand management and evaluation
Authors: Dzhulai Maryna
Published: August 2022

The object of research is the models of management and evaluation of the employer's brand as components of the effectiveness of the enterprise. One of the problematic points is that there is no universal model for employer brand management. Employer brand assessments are often subjective and untrue. The target audience of the employer brand requires new approaches to management from the employer. This is due to a change in the generation of candidates in the labor market. One third of applicants are Generation Z (born 1995–2010). Companies are losing potential employees due to value proposition mismatch, employer brand immaturity.
During the study, the following scientific methods were used as a method of theoretical analysis in the study of employer brand management models. As well as methods of theoretical analysis, comparison and generalization for a general analysis of the issue and the determination of generalized characteristics of brand management and evaluation models.
In the proposed work, the issues of modern employer brand management are considered. The best models have been identified that consider an integrated approach and form a separate ecosystem within the enterprise. Conclusions are drawn about the need for further search for the most appropriate assessment of the employer's brand. The importance of a flexible approach to employer brand management has been studied. It also summarizes the main methods for assessing the employer brand, which will become the basis for further analysis.
Thanks to the results of the study, company managers will be able to choose a modern employer brand management model, its components and main characteristics. The employer's value proposition needs to be reviewed through the hiddenness of components that may be important to the candidate. Also, the assessment of the employer brand will be comprehensive: internal and external. The relationship between employer brand maturity and company performance is direct. The higher the level, the less losses the company incurs in the selection, training and development of employees.
Marketing solutions to promote branding in eSports
Authors: Kalynets Kateryna , Krykavskyy Viktor
Published: August 2022

This study aims to identify marketing solutions that contribute to the improvement of brand image as a result of sponsorship participation in eSports. Since eSports is an activity that attracts millions of viewers worldwide, its development involves attracting sponsors and donors for its development. That is why marketing is a special tool that can promote this sport's endemic and non-endemic goods and services. The research aims to determine the special importance of eSports for promoting and selling goods and services advertised on virtual sports grounds. The object of the study is the influence of the brand's sponsorship participation in eSports tournaments on its image.
A conceptual framework for the study was created and then refined with empirical data. This quantitative study analyzed 110 eSports fans who were selected using a non-probability heterogeneous method. Empirical data were collected through an online and closed-ended survey. Thus, more accurate and updated empirical data were collected to increase the conceptual framework's quality, reliability, and detail. In particular, special attention was paid to determining the subtleties that contribute to the improvement of the sponsors' brand image by the above-mentioned elements.
The data showed that eSports sponsorship provides several main elements that enhance the sponsor's brand image. These elements include brand recognition, brand trust, building loyalty, referrals, willingness to try a new product, association with famous athletes. The field of eSports sponsorship is largely ignored by academia. As such, this study is first step in better understanding the benefits of eSports sponsorship and lays the groundwork for future research. Knowing the main brand image benefits of eSports sponsorship will help build confidence for brands that are still reluctant to enter this new market.
Research has shown that the use of marketing strategy in eSports for brands of any scale corresponds to the stages of marketing strategy in traditional sports, in particular defining the target audience, and searching for channels of communication with the target audience, collaborating with celebrities, team sponsorship, holding an event with a white label.
Methods of Dialect Vocabulary Semantization in Regional Fiction and Converse of Dialect Speakers
Authors:   Volgograd State University, Tupikova Nataliya , Starodubtseva Nataliya ,   Volgograd State University
Published: August 2022

The semantics of geographically limited vocabulary is considered in the aspect of the actual problem of interaction and interpenetration of lexical systems of literary language and dialects. The material extracted from literary texts (prose by Volgograd writers) and the converse of the Don Cossack dialects speakers living in the Volgograd region (records made by the expeditionary method and direct interview of informants at the points of dialectological survey of territories within the program of the Lexical Atlas of Russian Folk Dialects) is compared. Contextual and graphical methods of dialectisms semantization are described. The linguistic techniques of revealing the meanings of dialect words with the help of literary analogues, as well as various markers signalling the inclusion of an element that is not commonly used in the utterance, are determined. The models of using the appropriate language means formed on the basis of the constructive principle of their organization for the disclosure of the ideological and artistic intent of the work are characterized. It can serve as a means of updating and enriching the expressive fund of the Russian language, or for the purpose of adequate understanding in communication of different speech culture representatives the subject-conceptual correspondences of linguistic units. The general and special techniques of direct and indirect semantization of lexical units are revealed. They reflect the artistic-figurative and visual-symbolic concretization of reality in the perception of the world. The functional role of the vocabulary under consideration as a resource-forming element of the modern Russian literary language is substantiated.
Criteria for Selecting Key Elements of a Compound Commercial Name in the Linguistic Expert Examination of a Trademark
Authors:   Voronezh State University, Novichihina Marina
Published: August 2022

The paper is devoted to the problem of linguistic expertise of verbal trademarks, as well as to the search for ways to optimize this procedure. It is shown that one of the most difficult cases of such expertise is the analysis of similarity to the extent of mixing one-word and compound trademarks. In this case, the existing algorithms prescribe to compare the strong elements of such marks for similarity / dissimilarity. However, there are currently no clear and undisputed criteria for determining a strong (or weak) element in a composite designation. This article aims to find criteria based on which a linguist-expert could clearly identify the strong (weak) elements of a composite designation in the process of linguistic examination of a trademark. The article summarizes various approaches to understanding the strong (weak) element in a composite notation. A list of possible criteria for selecting such elements is provided. Examples of specific expertise are used to highlight the possibility of their usage. It is argued that the objective result will be achieved by overcoming the narrow framework of both purely legal and purely linguistic approaches and by synthetic, complex consideration of the problem of comparing single-word and compound trademarks in the process of linguistic expertise.
Updates on aneurysmal subarachnoid hemorrhage: is there anything really new?
Authors: Marazzi Thire Baggio Machado , Mendes Pedro Vitale
Published: August 2022

Abstract Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a severe disease, with systemic involvement and complex diagnosis and treatment. Since the current guidelines were published by the AHA/ASA, Neurocritical Care Society and the European Stroke Organization in 2012-2013,there has been an evolution in the comprehension of SAH-associated brain injury and its multiple underlying mechanisms. As a result, several clinical and translational trials were developed or are underway. Objective: The aim of this article is to review some updates in the diagnosis and treatment of neurological complications of SAH. Methods: A review of PubMed (May, 2010 to February, 2022) was performed. Data was summarized. Results: Content of five meta-analyses, nine review articles and 23 new clinical trials, including pilots, were summarized. Conclusions:Advances in the comprehension of pathophysiology and improvements in critical care have been reflected in the reduction of mortality in SAH. However, despite the number of publications, the only treatments shown to be effective in adequate, well-controlled clinical trials are nimodipine and repair of the ruptured aneurysm. Thus, doubts about the optimal management of SAH still persist.
Atherosclerosis risk factor management - what's new for the neurologist?
Authors: Bichuette Luciana Dornfeld , Lottenberg Marcos Pita , Cardozo Francisco Akira Malta , Calderaro Daniela
Published: August 2022

ABSTRACT Stroke is the second leading cause of death worldwide and the vast majority can be attributed to modifiable risk factors, mainly behavioral and metabolic. The top six risk factors responsible for cardiovascular mortality in Brazil in 2019 were high systolic blood pressure, inadequate dietary exposure, high body mass index, high LDL cholesterol, high fasting blood glucose levels, and tobacco. We intend to discuss in this paper the evidence and recommendations in the approach of three essential risk factors for patients with a history of stroke: dyslipidemia, hypertension and diabetes.
Genetic investigation of dementias in clinical practice
Authors: Takada Leonel Tadao
Published: August 2022

Abstract Background: The field of neurodegenerative dementia genetics has advanced significantly over the past two decades, but there are still more to be discovered (such as the gene mutation in some familial forms of dementia). Objective: to provide a brief review of the most recent discoveries regarding monogenic dementia, and covering the most frequent genetic diseases that can cause dementia (neurodegenerative or not). Methods: a review of the literature will be carried out. Results: neurodegenerative dementias, vascular dementias and leukoencephalopathies caused by single pathogenic variants are presented. Conclusion: The spectrum of clinical presentations for most of the genes discussed is wide, and hence genetic testing in clinic should try to cover as many genes as possible.
Training of neurologists for the 21st century: cultural and professional skills
Authors: Nitrini Ricardo
Published: August 2022

Abstract Training of neurologists for the near future is a challenge due to the likely advances in neuroscientific methods, which will change much of our knowledge on diagnosis and treatment of neurological diseases. Objective: to comment on what may be more likely to be a constant in the very near future and to recommend how to prepare the neurologist for the 21st century. Methods: through a critical review of recent articles on the teaching of Neurology, to present a personal view on the subject. Results: Diagnostic methods and therapeutic resources in Neurology will be greatly improved, but the central core of teaching young neurologists will continue to be the clinical/anatomical correlation. The neurologist must be prepared to be the primary physician in the care of patients with neurological disorders, although the roles of consultant and clinical neuroscientist must also be considered. In addition to technical knowledge, the neurologist must be prepared to discuss not only distressing issues related to the specialty, such as the risks of genetic diseases for family members of their patients, the inexorable progression of some diseases and the need for palliative care, but also problems not directly related to Neurology that cause anxiety and depression in the patient or that are the main reason for the initial consultation. Conclusion: neurology will be an even more important area of medicine and the neurologist must be well prepared to be the primary doctor to diagnose, treat and follow the patient with neurological disorders. In addition to technical knowledge, training in doctor-patient relations should be highlighted.
Myasthenia gravis in clinical practice
Authors: Estephan Eduardo de Paula , Baima José Pedro Soares , Zambon Antonio Alberto
Published: August 2022

ABSTRACT Background: Myasthenia gravis is largely a treatable disease, but it can result in significant morbidity and even mortality, which can usually be avoided, or at least mitigated, with timely diagnosis and appropriate treatment of the disease. Objective: this review aims to summarize the main practical aspects of the diagnostic approach, treatment and care of myasthenic patients. Methods: The authors performed a non-systematic critical review summarizing the main practical aspects of myasthenia gravis. Results: Most patients with myasthenia have autoantibodies targeted at acetylcholine receptors or, less commonly, muscle-specific kinase - MuSK. Electrophysiology plays an important role in the diagnosis of neuromuscular junction dysfunction. The central clinical manifestation of myasthenia gravis is fatigable muscle weakness, which can affect eye, bulbar, respiratory, and limb muscles. With rare exceptions, patients have a good response to symptomatic treatment, but corticosteroids and/or immunosuppressants are usually also necessary to obtain good control of the manifestations of the disease. Conclusion: Knowledge of the peculiar aspects of their clinical and electrophysiological presentations is important for the diagnosis. Likewise, specific treatment and response time to each drug are crucial for proper care.
Headaches and obesity
Authors: Fortini Ida , Felsenfeld Junior Bernardo Dror
Published: August 2022

ABSTRACT Obesity and headache disorders are two very common conditions in the general population that have been increasing in incidence over the last decades. Recent studies have shown a significant relationship between obesity and headaches, particularly migraine, with an important role in whether the disease is chronic. On the other hand, no such association was found with tension-type headaches. Studies showing an overlapping of hunger-control pathways and those involved in the pathophysiology of migraine may justify the close association between obesity and migraine. Moreover, a secondary headache for which obesity is a strong risk factor is idiopathic Intracranial Hypertension (pseudotumor cerebri), with several studies showing the impact of weight reduction/bariatric surgery in the treatment of the disease. In conclusion, since obesity is a modifiable risk factor, it is important for physicians treating patients with headaches, and particularly migraine, to be aware of the association between these two disorders.
Falls in older adults: a practical approach
Authors: Pereira Cristiana Borges , Kanashiro Aline Mizuta Kozoroski
Published: August 2022

ABSTRACT Background: Falls are a major problem in public health since they are an important cause of morbidity and mortality. To evaluate the risk of fall and prescribe preventive interventions may be a challenging task. Objectives: The objectives of this study are to summarize the most relevant information on the topic “falls in the elderly” and to give a critical view and practical clinical approach on this topic. Methods: In March 2022, a search of Pubmed database was performed, using the terms “fall elderly”, fall prevention”, “fall risk”, with the following parameters: five years, review, systematic review, meta-analysis, practice guidelines. Results: There are several risk factors for falls that can be grouped in different areas (psychosocial, demographic, medical, medication, behavioral, environmental). The clinical evaluation of an older adult prone to falls must include identification of risk factors through history and examination and identification of risk of falls through an assessment tool such as gait velocity, functional reach test, timed up and go, Berg balance test, and miniBEST test. Fall prevention strategies can be single or multiple, and physical activity is the most cited. Technology can be used to detect and prevent falls. Conclusion: A systematic approach to the older patient in risk of falls is feasible and may impact fall prevention.
Cerebral venous thrombosis
Authors: Moraes Junior Anisio Adalio de Azevedo , Conforto Adriana Bastos
Published: August 2022

ABSTRACT Cerebral venous sinus thrombosis (CVT) consists of partial or complete occlusion of a sinus or a cerebral vein. CVT represents 0.5-1% of all strokes and is more frequent in young women. This review discusses particular aspects of CVT diagnosis and management: decompressive craniectomy (DC), anticoagulation with direct oral anticoagulants (DOACs), CVT after coronavirus-disease 19 (COVID-19) and Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT).
Differential diagnosis of demyelinating diseases: what's new?
Authors: Gomes Ana Beatriz Ayroza Galvão Ribeiro , Adoni Tarso
Published: August 2022

ABSTRACT Background: Acquired demyelinating disorders lead to overlapping visual, pyramidal, sensory, autonomic, and cerebellar deficits and may lead to severe disability. Early diagnosis and start of treatment are fundamental towards preventing further attacks and halting disability. Objective: In this paper we provide an updated overview of the differential diagnoses of acquired demyelinating disorders. Methods: We performed a critical targeted review of the diagnoses of the most prevalent demyelinating disorders: multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD). Results: We discuss the workup, diagnostic criteria and new biomarkers currently being used for the diagnosis of these disease entities taking into account the particularities of the Brazilian population and healthcare system. Conclusion: A comprehensive analysis of medical history, physical examination, biomedical and imaging data should be performed to obtain differential diagnosis. Diagnostic criteria should be mindfully employed considering ethnic and environmental particularities of each patient.
Update on Idiopathic Intracranial Hypertension Management
Authors: Souza Marcio Nattan Portes , Costa Barbara de Alencar Leite , Santos Felipe Reinaldo Deus Ramos , Fortini Ida
Published: August 2022

ABSTRACT Background: Idiopathic Intracranial Hypertension (IIH) is a secondary headache with a steadily growing incidence. Currently, there is little evidence to guide the treatment of IIH. Objective: To review the pathophysiology of IIH, with focus on the role of obesity as a risk factor, and the implications for new therapeutic perspectives. Methods: in this narrative review, we summarized the current knowledge on treatment options highlighting available evidence for managing intracranial hypertension, obesity, and headache. Results: Clinical Presentation: headache is the most common symptom and a significant cause of quality-of-life impairment. Visual loss is common in the diagnosis. Pathophysiology: there is no unified theory able to explain all symptoms and the evolution of the disease. There is growing data pointing to metabolic changes and obesity with a central role in IIH pathophysiology. Treatment: most published data on IIH treatment is related to pressure control and protection from visual loss. Acetazolamide and cerebrospinal fluid diversion are the best options available. Optic nerve sheath fenestration might be useful to temporally control the pressure over the optic nerve and thus protect from visual deterioration. Recently, venous sinus stenting has proven to be a safe option in selected cases. Finally, bariatric surgery has proven to effectively control elevated intracranial pressure. Conclusion: IIH is a potential cause of high disability. Early recognition is important, and treatment should be tailored to the needs of each case. There is a lack of research on headache management, which might persist after ICP control.
It is time anti-CGRP monoclonal antibodies be considered first-line prophylaxis for migraine
Authors: Kubota Gabriel Taricani
Published: August 2022

ABSTRACT The result of more than thirty years of research, anti-CGRP monoclonal antibodies are currently the state of the art for migraine preventive therapy. Their efficacy and safety, supported by an already large and growing body of evidence, are added by many other advantages: an early onset of action, favorable posology, negligible pharmacological interaction, and a broad-reaching efficacy in many challenging clinical contexts. When compared to standard prophylactics, these novel medications seem at least as efficacious, clearly more tolerable and, consequently, with a superior adherence profile. Furthermore, recently published analyses indicate that they are cost-effective, especially among those with chronic migraine. Yet, current guidelines endorse their use only after multiple other preventives have failed or have been deemed not tolerable. Although this recommendation may have been sensible at first, the now available data strongly point that time has come for anti-CGRP monoclonal antibodies to be acknowledged as first-line treatments for migraine patients with severe disability. For these individuals, delaying treatment until several other alternatives have failed incurs in significant losses, both economically and to many relevant aspects of their lives.
Cerebrospinal fluid analysis: current diagnostic methods in central nervous system infectious diseases
Authors: Gomes Hélio Rodrigues
Published: August 2022

ABSTRACT Cerebrospinal fluid (CSF) analysis is an important diagnostic tool for many conditions affecting the central nervous system (CNS), especially CNS infectious diseases. Despite its low specificity, CSF white blood cell counts, CSF protein levels, CSF serum glucose ratio and CSF lactate measurement are useful in differentiating infections caused by distinct groups of pathogens. CSF direct examination and cultures can identify causative organisms and antibiotic sensitivities as well. Adjunctive tests such as latex agglutination, different immunological assays and molecular reactions have great specificities and increasing sensitivities. In this article, some recent diagnostic methods applied to CSF analysis for frequent CNS infections are presented.
Are we ready to use anti-amyloid therapy in Alzheimer's disease?
Authors: Brucki Sonia Maria Dozzi , César-Freitas Karolina Gouveia , Spera Raphael Ribeiro , Borges Conrado Regis , Smid Jerusa
Published: August 2022

ABSTRACT Alzheimer’s disease (AD) is the most common neurodegenerative disease. Biomarkers have demonstrated that AD pathology exists over the disease continuum from a stage preceding symptoms over 15-25 years to the progressively more impaired symptomatic states, mild cognitive impairment (MCI), and dementia. Biomarkers include: amyloid (Aß), phosphorylated tau, and neurodegeneration. The plasma assays for Aß and tau show great promise for clinical and research use. This review has aimed not only to present the ATN diagnostic classification and the preclinical AD concepts in addressing some possibilities of cognitive assessment instruments, but also to briefly summarize the main anti-amyloid monoclonal antibodies studied in clinical trials. In addition, this paper presents a critical analysis by experts in cognitive neurology while addressing the question as to whether we are prepared for the anti-amyloid therapy era or not.
Palliative care and neurology: a path to neuropalliativism
Authors: Silveira Mariana Ribeiro Marcondes da , Forte Daniel Neves
Published: August 2022

ABSTRACT This article aims to expand the understanding of how it is possible to alleviate suffering and enable a dignified life trajectory for patients with progressive neurological diseases or with severe and permanent neurological impairment. The four most common disease trajectories described for people with chronic and progressive disease used to advance care planning, Brazilian normative ethical resolutions, evidence-based benefits of palliative care (PC), as well as particularities of PC in neurology, such as neurological symptom control, caring for existential and psychological suffering, care provider’s needs and particularities of pediatric neurologic PC are reviewed.
Diagnostic pitfalls in functional neurological disorders
Authors: Pimentel Filho Lucio Huebra , Mutarelli Eduardo Genaro
Published: August 2022

ABSTRACT The diagnosis of functional neurological disorders is a major challenge in neurologist practice. Some clinical strategies can facilitate the recognition of functional disorders, but several pitfalls make their diagnosis difficult. Here we highlight the following points of attention during evaluation of patients with functional disorder: not all bizarre behavior is functional; not every event triggered by an emotional factor is a functional disorder; not every topographic incongruity is a functional disorder; patients may present functional and organic symptoms at the same time; psychiatric comorbid condition is not always evident in the history of a functional disorder; problematic communication at the time of diagnosis can compromise treatment and prognosis. In conclusion, we emphasize that special attention to these possible pitfalls facilitate the correct diagnosis and management of functional neurological disorders.
How I treat Parkinson's disease
Authors: Barbosa Egberto Reis , Limongi João Carlos Papaterra , Chien Hsin Fen , Barbosa Pedro Melo , Torres Marcela Reuter Carréra
Published: August 2022

ABSTRACT Background: Parkinson’s disease (PD) is a complex neurodegenerative condition. Treatment strategies through all stages of disease progression could affect quality of life and influence the development of future complications, making it crucial for the clinician to be on top of the literature. Objective: This paper reviews the current treatment of PD, from early to advanced stages. Methods: A literature review was conducted focusing on the treatment of PD, in the different stages of progression. Results: Every individual with a new diagnosis of PD should be encouraged to start exercising regularly. In the early stage, treatment should focus on using the lowest dose of levodopa or combination therapy that provides maximum functional capacity, and does not increase the risk of complications, such as peak dose dyskinesias and impulse control disorders. At the moderate and advanced stages, motor fluctuations and complications of treatment dominate the picture, making quality of life one important issue. Rehabilitation programs can improve motor symptoms and should be offered to all patients at any stage of disease progression. Conclusion: Many factors need to be considered when deciding on the best treatment strategy for PD, such as disease progression, presence of risk factors for motor and behavioral complications, potential side effects from dopaminergic therapy and phenotypical variabilities. Treatment should focus on functional capacity and quality of life throughout the whole disease course.
How to choose initial treatment in multiple sclerosis patients: a case-based approach
Authors: Apóstolos Samira Luisa Pereira , Boaventura Mateus , Mendes Natalia Trombini , Teixeira Larissa Silva , Campana Igor Gusmão
Published: August 2022

ABSTRACT Background: Immunotherapy dramatically changed the natural history of multiple sclerosis (MS), which was classically associated with severe disability. Treatment strategies advocate that early control of disease activity is crucial to avoid progressive disability, and the use of high efficacy drugs may be beneficial, but safety is a concern. Choosing the disease-modifying therapy is challenging in clinical practice and should be further discussed. Objective: To discuss the state of art of selecting the initial therapy for relapsing MS patients. Methods: We used a case-based approach followed by clinical discussion, exploring therapeutic options in different MS settings. Results: We presented clinical cases profile compatible with the use of MS therapies, classified into moderate and high efficacy. In the moderate efficacy group, we discussed interferons, glatiramer acetate, teriflunomide and dimethyl fumarate, while in the high efficacy group we discussed fingolimod, cladribine, natalizumab, ocrelizumab, alemtuzumab and ofatumumab. Conclusion: Advances in MS treatment are remarkable. Strong evidence supports the use of early high efficacy therapy. However, biomarkers, clinical and radiologic prognostic factors, as well as patients' individual issues, should be valued and considered for a personalized treatment decision.
Deep brain stimulation in Parkinson’s disease: state of the art and future perspectives
Authors: França Carina , Carra Rafael Bernhart , Diniz Juliete Melo , Munhoz Renato Puppi , Cury Rubens Gisbert
Published: August 2022

ABSTRACT For more than 30 years, Deep Brain Stimulation (DBS) has been a therapeutic option for Parkinson’s disease (PD) treatment. However, this therapy is still underutilized mainly due to misinformation regarding risks and clinical outcomes. DBS can ameliorate several motor and non-motor symptoms, improving patients’ quality of life. Furthermore, most of the improvement after DBS is long-lasting and present even in advanced PD. Adequate patient selection, precise electric leads placement, and correct DBS programming are paramount for good surgical outcomes. Nonetheless, DBS still has many limitations: axial symptoms and signs, such as speech, balance and gait, do not improve to the same extent as appendicular symptoms and can even be worsened as a direct or indirect consequence of surgery and stimulation. In addition, there are still unanswered questions regarding patient’s selection, surgical planning and programming techniques, such as the role of surgicogenomics, more precise imaging-based lead placement, new brain targets, advanced programming strategies and hardware features. The net effect of these innovations should not only be to refine the beneficial effect we currently observe on selected symptoms and signs but also to improve treatment resistant facets of PD, such as axial and non-motor features. In this review, we discuss the current state of the art regarding DBS selection, implant, and programming, and explore new advances in the DBS field.
Gene therapy in neuromuscular disorders
Authors: Mendonça Rodrigo Holanda , Zanoteli Edmar
Published: August 2022

Abstract Monogenic neuromuscular disorders are potentially treatable through gene therapy. Using viral vectors, a therapeutic transgene aims to restore normal levels of a protein not produced by the defective gene, or to silence a gene whose expression leads to toxic effects. Spinal Muscular Atrophy (SMA) is a good example of a monogenic disease that currently has an AAV9-based vector gene therapy as a therapeutic option. In this review, we intend to discuss the viral vectors and their mechanisms of action, in addition to reviewing the clinical trials that supported the approval of gene therapy (AVXS-101) for SMA as well as neuromuscular diseases that are potentially treatable with gene replacement therapy.
NeuroCOVID-19: a critical review
Authors: Guedes Bruno Fukelmann
Published: August 2022

ABSTRACT Background: The COVID-19 pandemic has challenged neurologists since its early days. Neurology consultation services were then overloaded by emergency department and intensive-care patients with acute neurological syndromes. These complications are better explained today, but the growing number of patients with reported longstanding neurological symptoms constitute an emerging, complex, and still poorly understood phenomenon. Objective: This review summarizes data on relevant neurological manifestations of acute SARS-CoV-2 infection and lasting post-infectious disease, also known as Long COVID. The complex history of Long COVID is examined to illustrate the upsides and challenges imposed by the active participation of patient communities in the production of medical knowledge. Methods: Narrative review. Results: Infection with the severe acute respiratory syndrome coronavirus 2 is associated with encephalopathy/delirium, cerebrovascular disease, headache, and peripheral nervous system involvement. Long COVID is a living concept jointly defined by patient communities, physicians and scientists, including neurologists. Conclusion: Co-production of Long COVID knowledge between scientists and patients has initiated an era of patient-led research and evidence-based activism that acts as a two-edged sword - putting patient’s suffering in the spotlight, but with a tradeoff in methodological consistency.
Cannabidiol and epilepsy in Brazil: a current review
Authors: Oshiro Carlos André , Castro Luiz Henrique Martins
Published: August 2022

ABSTRACT Background: Cannabidiol (CBD) has become a promising therapeutic option in the treatment of epilepsy. Recent studies provide robust evidence that CBD is effective and safe. Limitations in current knowledge and regulatory issues still limit CBD use. CBD use regarding epilepsy types still lacks clear guidelines. Objective: To critically review the main current pharmacological features and clinical issues regarding CBD use in epilepsy, to provide current regulatory background regarding CBD use in Brazil, and to suggest a practical CBD therapeutic guide in Brazil. Methods: Non-systematic literature review (up to February 2022) of current concepts of CBD and epilepsy, including the authors’ personal experience. Results: Five pivotal trials have led to CBD approval as an adjunctive treatment for Dravet and Lennox-Gastaut syndromes, and for the tuberous sclerosis complex. Efficacy of CBD in other drug-resistant epilepsies remains not completely understood. CBD adverse event profile and drug interactions are better understood. CBD is well tolerated. In Brazil, CBD is not classified as a medication, but as a product subject to a distinct regulatory legislation. CBD is still not offered by the National Brazilian health system, but can be purchased in authorized pharmacies or imported under prescription and signed informed consent. Conclusion: CBD is a recognized novel treatment for epilepsy. Future well-designed studies and public health strategies are needed to offer widespread access to CBD, and to improve the quality of life of people living with epilepsy in Brazil.
Bancos públicos e política monetária: teoria e alguns resultados com base em projeções locais dependentes de estado
Authors: MODENESI ANDRÉ DE MELO , PASSOS NIKOLAS
Published: August 2022

Resumo Os efeitos dos bancos públicos sobre a política monetária é um tema central para o fortalecimento das instituições financeiras de desenvolvimento. Reformas recentes na atuação de bancos de desenvolvimento se basearam no argumento de que os bancos públicos reduzem a potência da política monetária. Tais reformas foram realizadas a despeito da escassa literatura empírica apontando os efeitos negativos dos bancos públicos. Alguns estudos evidenciaram que empresas com acesso a crédito de bancos públicos ou a crédito direcionado apresentam menores quedas no investimento e na produção após um choque de política monetária. Contudo, tais estudos utilizam dados microeconômicos e ignoram possíveis efeitos de custo decorrentes de variações na taxa básica de juros. Neste artigo explicitam-se as questões teóricas envolvidas neste debate e evidencia-se empiricamente o efeito do canal de custos da política monetária. Quando se compara os efeitos macroeconômicos dos ciclos de crédito guiados por bancos públicos ou privados não são encontradas evidências de que a política monetária é menos potente nos períodos de alto crédito dos bancos públicos. Mesmo que em períodos de alto crédito dos bancos públicos a política monetária apresente menor efeito sobre a produção, nestes períodos os enigmas dos preços se mostram menos persistentes. A maior estabilidade dos juros dos bancos públicos acarreta menor transmissão de custos financeiros, menor redução no estoque de capital e menor puzzle no câmbio contribuindo, assim, para a condução da política monetária.
Globalização, desglobalização e o Brasil
Authors: BAUMANN RENATO
Published: August 2022

RESUMO As últimas três décadas testemunharam mudanças importantes nas facilidades de transporte, comunicações e processamento de dados, com efeitos sobre os processos produtivos, os fluxos comerciais e a movimentação internacional de capitais. Do ponto de vista das economias em desenvolvimento a recomendação passou a ser que aderir a esse processo poderia ser instrumento fundamental para estimular o desenvolvimento econômico e social. No caso da economia brasileira, a participação no processo de globalização foi limitada até aqui, exceto no tocante ao movimento de capitais. A participação no comércio de mercadorias permanece baixa, e o número de acordos preferenciais ainda é comparativamente reduzido. Não foi possível reduzir a “distância econômica” em relação às economias de alta renda.
Managing Contagion: COVID-19, public health, and reflexive behavior
Authors: DAVIS JOHN B.
Published: August 2022

ABSTRACT This paper characterizes a pandemic as a kind of contagion, and describes a contagion as a two-level, two-direction, reflexive feedback loop system. In such a system, expert opinions for managing a pandemic can act as self-fulfilling prophecies due to how they influence collective belief formation. However, when multiple experts produce multiple expert opinions that act as self-fulfilling prophecies, this can fragment a society’s response to a pandemic, worsening rather than ameliorating it. This paper models this possible outcome by distinguishing two competing expert opinions, appealing respectively to people in club good and common pool types of employment/health insurance situations, and argues that to combat fragmentation of opinion about how to address a pandemic, public health policy needs to attend to the nature of public reasoning. It argues this entails asking how just and legitimate deliberative institutions can function in an ‘inclusive and noncoercive’ way that allows society to reconcile competing visions regarding how to combat system-wide crises such as pandemics.
Effect of nurse-performed enhanced patient education on colonoscopy bowel preparation quality
Authors: Arslanca Gamze , Aygün Mahmure
Published: August 2022

Abstract Objective: to evaluate the effect of nurse-performed enhanced patient education sessions on adequate bowel preparation and cecal intubation rates. Method: a prospective, quasi-experimental, comparative study with a quantitative approach. The intervention group (n=150) received education enhanced by a visual presentation and reminder calls. The control group (n=156) received the clinic’s standard written instructions. Adequate bowel preparation rates and other colonoscopy quality indicators were compared between the groups. Results: Boston Bowel Preparation scale scores and adequate bowel preparation rates were higher in the intervention group than in the control group (respectively, 6.76±2.1 vs. 5.56±2.4, p=0.000, and 80% vs. 69.2%, p=0.031). The cecal intubation rates were higher in the intervention group (80% vs. 67.3%, p=0.012). Due to inadequate bowel preparation, unsuccessful cecal intubation rates were 0% in the intervention group and 17.6% in the control group. Biopsy rates were higher in the intervention group (28% vs. 13.3%, p=0.002). Conclusion: the nurse-performed enhanced patient education sessions increase adequate bowel preparation rates and, in parallel, cecal intubation rates. To reach the colonoscopy quality standards recommended in the guidelines, it is suggested that patient education be supported by different training tools and given by health professionals.