bluuebunny/crossref_metadata_2025 huggingface dataset:
Inflammatory Myofibroblastic Tumor of Gallbladder Mimicking Gallbladder Cancer: A Case Report
Authors: Choi Seo-Youn , Chin Susie
Published: July 2023

A primary inflammatory myofibroblastic tumor (IMT) of gallbladder is an extremely rare. Clinical and radiologic features of IMTs are nonspecific and can mimic malignant neoplasm. Herein, we present a case of gallbladder IMT, which was initially suspected to be gallbladder cancer preoperatively.
Porto-sinusoidal Vascular Disease: What Radiologists Should Know
Authors: Kang Ji Hun
Published: July 2023

Porto-sinusoidal vascular disease (PSVD) is a rare hepatic vascular disorder that can cause portal hypertension. Its diagnosis can be challenging, as its clinical manifestations can overlap with those of liver cirrhosis. However, radiological imaging can provide valuable clues to differentiate PSVD from liver cirrhosis. This review aims to identify imaging findings that suggest PSVD in cross-sectional imaging and ultrasound elastography, enabling the suggestion of a liver biopsy that is essential for diagnosis of PSVD.
Primer consenso centroamericano y del Caribe del síndrome de intestino irritable
Authors: Galdámez Estrada Jorge Antonio , Aguilar Paiz Luis , Minerva Blanco Gianna , Chaves Monge Sandra , De Mezerville Cantillo León , Navarro Castillo Pablo , Quintero Isaac , Del Pilar Rivas Polanco Eliam , Sánchez Hernández Marco Antonio , Sandoval Edder , Suazo Barahona Jorge , Vicente Pérez Edwin , Mejía Mariel , Portillo Silvia María , Jerez González Luis Enrique , Remes Troche José María , Schmulson Wasserman Max Julio
Published: July 2023

El síndrome de intestino irritable sigue siendo uno de los trastornos gastrointestinales más comunes observados por los médicos, tanto en la atención primaria como en la secundaria. Se han logrado avances significativos en la comprensión de su compleja fisiopatología, lo que resulta en su reclasificación como un trastorno de la interacción intestino-cerebro, en lugar de un trastorno gastrointestinal funcional. La condición afecta a entre el 5% y el 10% de la población y, en la mayoría de los casos, se caracteriza por tener una evolución con recaídas y remisiones. El diagnóstico se puede hacer sobre la base de la historia clínica con un uso limitado y juicioso de las investigaciones, a menos que se presenten síntomas de alarma, como pérdida de peso o sangrado rectal, o que haya antecedentes familiares de enfermedad inflamatoria intestinal o enfermedad celíaca. Los pilares del tratamiento incluyen la educación del paciente sobre la afección, los cambios en la dieta, la fibra soluble y los medicamentos antiespasmódicos. Otros tratamientos tienden a estar reservados para personas con síntomas refractarios e incluyen neuromoduladores centrales, secretagogos intestinales, medicamentos que actúan sobre los receptores opioides o 5-hidroxitriptamina o serotonina (5-HT), o antibióticos mínimamente absorbidos (todos los cuales se seleccionan de acuerdo con el hábito intestinal predominante), así como terapias psicológicas. Este consenso es el resultado del trabajo en conjunto de representantes de la Asociación Centroamericana y del Caribe de Gastroenterología, desarrollado de forma virtual, con el objetivo de presentar una serie de recomendaciones adaptadas a la realidad de la región y que sirvan de referencia en la práctica clínica.
Endoscopic Capsule Retention: Frequency, Causes and Risk Factors Analysis in 244 Consecutive Procedures
Authors: Saul Carlos , Pereira Lima Guilherme , Pacurucu Merchan Abdon , Pereira-Lima Julio C
Published: July 2023

Introduction. Endoscopic capsule is central to the study of the small bowel. Retention is its main complication.
Objective. To analyze the frequency and risk factors associated with capsule retention. Methods. 244 consecutive examinations were analyzed. The event was defined as “definitive retention” if the capsule remained in the small bowel for 3 weeks after the procedure, and as “temporary retention” if the capsule remained in the small bowel at the end of the procedure but was eliminated spontaneously in the following days. Risk factors associated with retention were inflammatory small bowel strictures, tumours and large diverticula.
Result. Of 244 procedures, lesions were found in 164 (67.2%), 130 of which were in the small bowel. There were 5 and 2 patients with definitive and temporary retention, respectively. Forty-four cases had risk factors. In 7 (15.9%) there was retention of the endoscopic capsule, with definitive retention in 5 cases. The 2 cases of temporary retention occurred in Meckel's diverticulum and in peptic ulcer scar. The 5 cases of definitive retention occurred in 2 patients with Crohn’s disease, 2 patients with stenosis related with anti-inflammatory drugs use and 1 patient with actinic stenosis. None of the 11 cases of small bowel neoplasia had capsule retention.
Conclusions. There was no endoscopic capsule retention inpatients without risk factors. Definitive retention was observed in approximately one-tenth of all patients with small bowel risk factors. Recognition of risk factors and their identification prior to the procedure is of utmost importance, especially in patients with suspected inflammatory strictures.
El microbio: Camino biológico a través de la especie humana
Authors: Soria Villanes Jessica Maria
Published: July 2023

Microbes are small organisms including bacteria, viruses, fungi, and other single-celled organisms that play important roles in ecosystems and human health. Over billions of years, microbes have evolved and filled virtually every ecological niche on the planet. They can be beneficial or detrimental, and their interaction with humans has led to pandemics and serious diseases from the Antonine Plague to the COVID-19 pandemic, the interactions between microorganisms and humans, as well as the mechanisms of transmission, have played a crucial role in the spread of diseases, understanding their epidemiology and transmission is essential for their control. The epidemiological chain describes the transmission process of an infectious disease and involves elements such as the infectious agent, the susceptible host, the reservoir, the exit door, the door of entry, and the vulnerability of the host. The study of epidemiology and microbiology makes it possible to identify the risk factors associated with the transmission of microorganisms, develop infection control strategies, as well as design and evaluate interventions to prevent the spread of diseases and promote public health. Understanding the biological path of the microbe in the human species is essential for the diagnosis, treatment and prevention of infectious diseases, knowing in depth the infectivity, pathogenicity, virulence, lethality, antigenic power and mutation capacity of infectious agents. This review emphasizes the microbe and its biological pathway through the human species.
Peculiarities of the US Policy of “Democracy Promotion” Under George W. Bush
Authors: Hayrapetyan Astghik S.
Published: July 2023

After the terrorist attacks of September 11, 2001, the United States launched a global campaign against terrorism characterized by nation-building beyond its borders through "hard power" and an attempt was taken to reshape the regional order through democracy promotion. 2001 թվականի սեպտեմբերի 11-ի ահաբեկչությունից հետո ԱՄՆ-ը նախաձեռնեց ահաբեկչության դեմ համաշխարհային արշավ, որին բնորոշ էր «կոշտ ուժի» կիրառմամբ սեփական սահմաններից դուրս ազգաշինությունը, ինչպես նաև տարածաշրջանային կարգի վերաձևակերպման փորձը՝ ժողովրդավարության ներդրմամբ և խթանմամբ: После терактов 11 сентября 2001 г. Соединенные Штаты начали глобальную кампанию против терроризма, характеризующуюся формированием нации за пределами своих границ с помощью «жесткой силы» и попыткой изменить региональный порядок путем продвижения демократии.
Peculiarities of Verse Translation (with Special Reference to H. Toumanyan's Quatrains)
Authors: Matikyan Hasmik H. , Sahakyan Silva H.
Published: July 2023

Verse translation is the most controversial field in Translation Science. It is considered the hardest of all literary genres to translate because the features of sound, rhyme and rhythm are difficult to reproduce in the target language.
Բանաստեղծական տեքստերի թարգմանությունը մարտահրավեր է թարգմանական գիտության ոլորտում. չափածո տեքստի հնչյունային առանձնահատկությունները, հանգն ու ռիթմը դժվար է վերարտադրել թարգմանվող լեզվում։
Стихотворный перевод — самая противоречивая область переводоведения. Он считается самым трудным для перевода из всех литературных жанров, потому что особенности звука, рифмы и ритма трудно воспроизвести на языке перевода.
Cocaine abuse and risk of induced carotid artery dissection
Authors: Rodrigues Ketteny de Lima , Mendonça Alda Maria de Sousa , Dias Amanda Selvátici dos Santos , Cunha Vinícius Gonçalves Portilho , Oliveira João Ricardo Leão , Paiva Gabriel Pina
Published: July 2023

Introduction: Cocaine is among the most commonly used illicit recreational drugs worldwide, and its abuse significantly increases the risk of ischemic stroke. Preclinical studies have indicated that cocaine may stimulate arterial dissection, during which blood enters the arterial wall through an intimal tear and activates the coagulation cascade at the site of endothelial damage. This is a case report of a patient, who presented an ischemic stroke, with a history of cocaine abuse in the last 24 hours. The article was developed from data collection through literature review on the subject, as well as analysis of the patient’s medical records. Case report: A 28-year-old man with a history of previously healthy, with a report of cocaine abuse in the last 24 hours, found unconscious on a public road and upon waking up he had aphasia and right hemiplegia, scoring NIHSS 18. Patient was investigated with brain resonance which showed an extensive acute ischemic infarction compromising the frontal, temporal, insula and basal ganglia regions on the left. The etiological investigation discarded the hypothesis of a cardioembolic and/or autoimmunity phenomenon. The arteriography showed an occlusion of the internal carotid artery at its origin with an aspect of arterial dissection. Conclusion: Cocaine-induced dissection of various arteries has been described in the literature, leading to cardiac and neurological complications. The combination of hypertension and intense vasoconstriction result in shear stress on the arterial wall, which may lead to atherosclerotic plaque rupture in those with vascular disease, and an increased risk of dissection even in those with normal arteries, as was the case with our patient. Therefore, public policies against drugs are also means of preventing strokes, especially in the younger population.
Analysis of the distribution of neurologist among Brazilian regions
Authors: Trindade Emmanuel Santos , Miranda Erica Otoni Pereira , Cardoso Guilherme Rocha , Freire Lukas Santos , Vilares Victor Santos , Costa Davi Tanajura
Published: July 2023

Introduction: Brazil has 490,077 active physicians, but these professionals are concentrated in large urban centers, following a historical trend. However, there is a lack of data related to whether neurologists (1.81% of physicians) also follow such disproportion. Objectives: To analyze the distribution of neurologists in Brazil in December 2022. Methods: This is a descriptive analytical ecological study using data obtained from the IBGE 2022 Demographic Census and the National Register of Health Establishments (CNES) provided by DATASUS, regarding the number of neurologists in December 2022, using the variables: number by region, number by capital and works in SUS. Results: In December 2022, there were 8841 neurologists in Brazil, representing a ratio of 0.043 neurologists/1000 inhabitants. The North (N) and Northeast (NE) regions had the lowest proportions, with 0.017 and 0.027 neurologists/1000 inhabitants, respectively. Of the total number of neurologists, 54% were located in the Southeast (SE) region, while only 3.38% were in the N region. Of these physicians, 63.60% worked in the SUS, with higher prevalence in the NE (76.02%) and N (73.58%) regions. In addition, 40.89% of neurologists were located in state capitals. This concentration ranged from 30.72% in the South (S) region — next to SE (36.09%), the only regions with less than half of their neurologists in capital cities — to 65.57% in the Midwest (SW) region. Conclusion: The data presented point to an inequality in the distribution of neurologists in Brazil. The SE region concentrates the majority of professionals, while the N and NE regions have a relative deficit. Moreover, an even greater shortage was observed within these regions, along with the SW region. In the N and NE regions, most neurologists work in the SUS, ensuring access to health care to a historically neglected population.
Long thoracic nerve paralysis as a rare complication of anterior spinal surgery
Authors: Silva Gabriella Louise Constantino , Samper Isabela Corrêa , Oliveira Ana Clara Gondim , Vitorino João Augusto Nunes , Neres Agnes Laura Silva , Silva Laura de Lourdes Cardoso e , Canto Fabiano Ricardo Tavares , Alves Alex Pereira , Santos Diogo Fernandes dos
Published: July 2023

Introduction: Isolated long thoracic nerve paralysis causes weakness of the serratus anterior muscle and winging of the scapula. Several traumatic and non-traumatic causes of damage have been reported and should be considered for diagnosis. Case: 53-year-old woman with neck pain and sensory symptoms, with irradiation to the upper limbs. She was then submitted to an anterior spinal release at levels C5-C6 e C6-C7. In this procedure the patient was positioned in the dorsal decubitus position with a rolled towel under her scapulae bilaterally. After two weeks she complained of weakness of the right upper limb during overhead activities, mild fatigue and pain in the right periscapular region. The right upper limb was intact for both sensory and motor innervation, but the right scapula was winged and she was not able to flex her arm forward over 60°. An electrodiagnostic study carried out and revealed an isolated acute axonal long thoracic nerve lesion. Discussion: The long thoracic nerve innervates the serratus anterior muscle. When this muscle is paralyzed, the scapula’s medial border, and especially its lower angle, stands out prominently and the patient cannot raise the arm fully or push. Due to its long and superficial course, the long thoracic nerve is vulnerable to damage at various levels. Several causes of its damage have been reported, including trauma, compression, and improper surgical technique. In this case, despite the operation was not that long it appears that external compression on the nerve during surgery was the most probable cause of the nerve palsy. Conclusion: To avoid this injury during positioning of patients the course of the long thoracic nerve must be attended to carefully and the nerve should be protected from any external pressure.
Prevalence and impact on the quality of life of urinary incontinence in patients with ischemic stroke: a cross-sectional study
Authors: Assunção Darah Fontes da Silva , Gonzaga Bruno Pissolati Mattos , Freitas Luiza Ramos de , Prado Marcelle Sanjuan Ganem , Kormanski Matheus Kohama , Mendes Natalia Trombini , Lopes Rônney Pinto , Marcusso Rosa Maria Nascimento , Albuquerque Tamara Melissa Zavadzki , Gagliardi Rubens José
Published: July 2023

Introduction: Acute stroke is the second most prevalent cause of death in the world and an important cause of disability in adults. Urinary incontinence (UI) is a complication present in the acute and chronic phases of stroke and is a strong predictor of mortality and need for institutional care. Objectives and methods: Cross-sectional study that aimed to evaluate the presence of UI through the International Consultation Questionnaire on Incontinence - Short Form (ICIQ-UI SF) in patients with ischemic stroke followed in the neurovascular outpatient clinic of a tertiary hospital in São Paulo, Brazil. The ICIQ-SF assesses the impact of UI on quality of life and qualifies degrees of urinary loss. The final score ranges from 0 to 21, with higher values representing greater impact. Casuistics and results: A total of 141 patients adequately answered the questionnaire, among which 75 were female and 66 were male. As for symptoms, 36.87% reported some degree of UI, 40.00% among women and 33.33% among men. The mean ICIQ-UI SF score across all patients was 9.90. For males the mean score was 10.36 and for females it was 9.56. Among symptomatic patients, only 9.21% reported urinary symptoms before the stroke. Discussion: Almost 40% of the patients in the study acquired UI after stroke. This condition prevailed in women, but with less impact compared to men. Urinary incontinence can affect the quality of life of patients, causing psychological, social, physical, economic, personal and sexual relationships. Conclusion: New studies are needed to evaluate prevention and treatment strategies for incontinence in these patients.
History and evolution of the neurological hammer: an integrative review
Authors: Medeiros Matheus Araújo de , Benvenuto Brendo Bezerra , Lucena Renner Cassio Nunes de , Araujo Ana Luiza Bezerra de , Almeida Fabricia dos Santos , Beserra Eric Cymon do Vale , Melo Neto Fernando de Paiva , Dantas Iury Hélder Santos
Published: July 2023

Introduction: The neurological hammer has been a fundamental tool in neurological assessment for over a century. However, its history and evolution are still little known. Objective: This study aims to investigate the history and evolution of the neurological hammer, based on an integrative review of the literature. Methods: A Integrative review was conducted in the Scielo, PubMed, and Cambridge Core databases using the keywords “neurological hammer”, “history of neurology”, and “clinical neurology”. Were analyzed seven articles, and selected one book with historical content to compose the review, published between 1998 and 2021. The analysis included the materials used in the construction of the hammer, its use, and the changes that occurred over time. The aim of this study was to investigate the history and evolution of the neurological hammer. Results: The neurological hammer was invented by Ernst L.O. Oppenheim in 1888, with the aim of creating a softer tool to test reflexes in animals. The original instrument was made of wood and had a soft rubber end. Over the years, the hammer has evolved into a variety of shapes. New materials were introduced in its construction, such as metal, plastic, and harder rubber. In addition, the shape of the hammer’s tip also changed, with the introduction of triangular tips, star-shaped tips, and pin-shaped tips. Conclusion: The history and evolution of the neurological hammer is an important part of the history of medicine and the evolution of diagnostic tools. Knowledge of the evolution of the neurological hammer can help to better understand the origin and development of modern medical practice. In addition, the integrative review presented here can contribute to improving the construction and usage of the neurological hammer in neurological assessments, for the benefit of the patient’s health.
Prevalence of sexual dysfunction in women with ischemic stroke: a cross-sectional study
Authors: Prado Marcelle Sanjuan Ganem , Assunção Darah Fontes da Silva , Freitas Luiza Ramos de , Freitas Paulo Henrique Maia de , Silva Lohana Santana Almeida da , Albuquerque Tamara Melissa Zavadzki , Mendes Natalia Trombini , Lopes Rônney Pinto , Marcusso Rosa Maria Nascimento , Gagliardi Rubens José
Published: July 2023

Introduction: Stroke is characterized by the acute onset of one or more neurologic deficits that persist for at least 24 hours, and is the result of a vascular disorder in a defined territory, being the leading cause of disability. Late complications, such as sexual dysfunction, have a direct impact on psychological and emotional aspects and directly affect the quality of life of these patients. Objectives and methods: Cross-sectional study that aimed to determine the prevalence of sexual dysfunction in patients with ischemic stroke followed in the neurovascular outpatient clinic of a tertiary hospital in São Paulo, Brazil, using the Female Sexual Quotient (FSQ) questionnaire. The FSQ can range from 0-100 points. Higher values indicate better sexual performance/satisfaction and a score of 60 points or less was considered as having sexual dysfunction. Casuistics and results: Sixty-five questionnaires were analyzed and classified according to the FSQ score. Mean age was 52 years and median FSQ score was 54 points. Of the interviewees, 30.7% had their sexual performance classified as poor-null, 13.85% of patients had poor-unfavorable sexual performance, 15.38% as unfavorable-regular. Regular-good and good-great sexual performance were found in 21.54% and 18.46%, respectively. Discussion: In this study, only 40% of post-stroke women have regular-good and good-great sexual performance. The impact of the stroke on the sexual life of these patients is high, because most of the interviewees had sexual dysfunction according to FSQ. Conclusion: The health professional must be aware of the non-motor sequelae caused by the stroke and be prepared to help these patients in coping with sexual dysfunctions.
Ventilatory support and telemonitoring in patients with neuromuscular disease: a prospective study.
Authors: Almeida Ana Elizabeth Cunha Guimarães de , Silva William Nicoleti Turazza da , Almeida Isabella Cristina Guimarães de , Carvalho Iago Resende , Vitorino João Augusto Nunes , Pinheiro Beatriz Iolanda de Sene Ferregutti , Pennisi Elisa Santos , Samper Isabela Corrêa , Silva Gabriella Louise Constantino , Rosa Maria Fernanda Prado , Santos Diogo Fernandes dos
Published: July 2023

Introduction: Neuromuscular disorders (NMD) are diseases of the peripheral nervous system with systemic manifestations. The ventilatory impairment could be one of the most serious complications and can lead to respiratory failure, either chronically or acutely. Objectives: To describe the effects of non-invasive ventilation (NIV) associated with telemonitoring in patients with NMD. Methods: A prospective study of patients with NMD and indication for NIV due to a reduced FVC on spirometry or respiratory symptoms was done. These patients were followed up with periodic exams, telemonitoring and adjustments of ventilatory parameters for six months. Results: 37 patients were included, 56.7% male, average age 49.7 years (±12.6). 69.5% reported dyspnea before the indication of NIV and 10% needed medical attention. The average forced vital capacity (FVC) at inclusion was 67.7 (±14.9) and 72.4 (±15.7) after six months, with average diurnal oxygen arterial saturation of 95.22 (±5.4) at inclusion and 95.7 (±5.1) after 6 months. Throughout the study, 4 (10.8%) patients died and 2 (5.4%) underwent tracheostomy. Between inclusion and after 6 months, according to telemonitoring, there was an increase in the average daily use in hours from 5.5 (±2.2) to 5.6 (±2.0), with a drop in leakage (L/min) from 1.9 (±6. 6) to 1.0 (±7.0) and in the AHI from 3.15 (±4.9) to 2.2 (±4.3). Conclusion: Diurnal oxygen arterial saturation was not a good parameter for indicating NIV, as well as FVC < 70, since most patients already had respiratory manifestation. Regular follow-up of patients associated with telemonitoring showed an improvement in ventilatory parameters, maintaining stability in adherence to therapy over the six months.
Ehlers-Danlos syndrome: an important differential diagnosis for congenital myopathies
Authors: Proença Bruna Moreira de Souza , Moreno Cristiane de Araújo Martins , Albuquerque Marco Antônio Veloso de , Silva André Macedo Serafim da , Camelo Clara Gontijo , Almeida Roberta Diniz de , Sindeaux Raquel Diógenes Alencar , Silva Beatriz Carneiro Gondim , Buarque Lucas Marenga , Zanoteli Edmar
Published: July 2023

Kyphoscoliotic Ehlers-Danlos syndrome (kEDS) is a genetic collagen disorder, with early onset hypotonia, weakness, progressive kyphoscoliosis, joint hypermobility, and other features underlying connective tissue involvement. On the other hand, congenital myopathies (CMs) are genetic muscle disorders, with hypotonia and weakness usually from birth which can associate with skeletal deformities. Case 1: RSS, 2-year-old, male. At birth, hip dysplasia and global hypotonia. On examination, proximal tetraparesis, global hyporeflexia and hypotonia, joint hypermobility, ogival palate, umbilical hernia, scoliosis and clubfoot. Genetic testing: Homozygous pathogenic variant in the FKBP14 gene (ENST0000000222803- c.362_363insC, p.Glu122Argfs*7), associated with kEDS type II. Case 2: RRO, 37-year-old, female. Global hypotonia at birth with congenital hip dislocation. On examination, mild proximal weakness, global hyporeflexia, joint hypermobility, scoliosis and ogival palate. Absence of marfanoid habitus. Genetic testing: Homozygous pathogenic variant in the PLOD1 gene (ENST00000196061-c.2032G>A, p.Gly678Arg), associated with kEDS type I. Conclusion: Uncommon clinical features in CMs should alert for an alternative diagnosis. Extreme joint laxity is more often a sign of a connective tissue disease, and can be associated with Marfanoid habitus, arterial dissection, bluish sclerae, umbilical hernia. Both patients presented nonspecific findings like neonatal skeletal deformities, hypermobility and mild weakness. A wide genetic test was definitive for the correct diagnosis. EDS must be included in the differential diagnosis of congenital myopathies, especially when associated with involvement of connective tissue. This is very relevant in the management care of the patients.
Cerebral cryptococcoma successfully treated by isavuconazole in an immunocompetent patient: a case report
Authors: Furtado Lucas Cruz , Silva Alexandre Almeida da , Santos Júlio César Claudino dos
Published: July 2023

Introduction: Cryptococcosis has been recognized as an increasing cause of severe systemic mycosis in immunocompetent patients in recent years. Radial cryptococcomas are a more uncommon manifestation of cryptococcal meningitis, which are usually not included in the differential air masses. Thus, transmission of the disease occurs by inhalation of cryptococcus spores, initially infecting the lungs. Infectious propagules may also be restricted to the central nervous system, causing cryptococcal meningitis, meningoencephalitis, and respiratory cryptococcomas. Case report: We report the case of a young immunocompetent woman who rapidly evolved with severe neurological deficits. She was finally diagnosed with cerebral cryptococcoma caused by cryptococcus neoformans and Cryptococcus gattii, and was treated with amphotericin B and isavuconazole. This is a case report on antifungal drug treatment in immunocompetent patients with cerebral cryptocoma. After several complications during hospitalization, including hydrocephalus and cerebellitis, she was discharged on isavuconazole. At follow-up, he complained only of anosmia. We reviewed the clinical and radiological findings of similar cases. It is the first time that this form of cryptococcal meningitis is favorably treated with isavuconazole and is caused by two species of Cryptococcus. Conclusion: We emphasize that respiratory cryptococcomas should be suspected in immunocompetent patients who have brain masses or whose symptoms can progress rapidly, sometimes with a lethal outcome.
Clinical utility of FilmArray® in the diagnosis of nervous system infections
Authors: Senne Carlos , Giafferi Carlos , Vega Marcio , Salomão Daiane , Domingues Renan
Published: July 2023

Introduction: The FilmArray® meningitis/encephalitis is a multiplex polymerase chain reaction for identifying 14 agents of central nervous system (CNS) infections, including bacteria, Cryptococcus and viruses. In this study, we retrospectively evaluated the clinical utility of using this method. Methods: We retrospectively evaluated data from 101 patients with suspected CNS infection in which cerebrospinal fluid (CSF) was submitted to FilmArray® and its diagnostic usefulness was evaluated. Results: Thirty-six CSF samples (35.6%) had a positive FilmArray® result. Twenty-six (72.2%) cases were positive for enterovirus, six (16.67%) were positive for HHV-6, two were positive for Parechovirus (5.56%), HSV-1, HSV-2, Haemophilus and Listeria=1 (2.78%). Of these 36 CSF samples, 34 (94.44%) had altered cytobiochemical CSF findings and 2 (5.56%) had no CSF abnormalities. None of these etiological agents were identified by other methods. Conclusion: FilmArray® was able to identify neuroinfection etiology in cases in which other etiological identification methods did not reveal the causative agent. In two cases with positive FilmArray® the CSF general analysis was normal. Therefore, this method increases diagnostic sensitivity and allows an early identification of the etiological agent, contributing to the clinical management of CNS infections.
Neurodegeneration with brain iron accumulation associated with late-onset psychiatric symptoms
Authors: Silva Alexandre Almeida da , Furtado Lucas Cruz , Santos Júlio César Claudino dos
Published: July 2023

Introduction: The neurodegeneration with brain iron accumulation (NBIA) is a heterogeneous group of rare genetic disorders that lead to accumulation of iron in the basal nuclei, which leads to numerous neurologic disorders. This condition has been associated with many genes, PKAN2 being the most common. The treatment remains mostly symptomatic and the approach based on a multidisciplinary team is recommended. Objectives: The aim is to discuss a clinical case of a rare genetic disease that causes neurodegeneration with brain iron accumulation in the individual. Methods: The case presented is from a 67-year-old male with iron accumulation bilaterally in the pale globes and has been having delirium for eight months, as well as visuospatial and executive dysfunction and behavioral alterations. The patient’s magnetic resonance imaging (MRI) showed abnormalities and the “eye of the tiger” sign. Furthemore, the treatment of choice was the administration of atypical antipsychotic medication, which partially controlled the patient’s condition. Results: The most recurrent location of brain iron accumulation is in the basal ganglia and it is mainly linked with mutations in the pantothenate kinase 2 (PKAN2), which leads to psychiatric manifestations of insidious progression and can be inferred when the “eye of the tiger” sign is found in a MRI. Conclusion: The patient was diagnosed with late onset psychotic disorder, mild cognitive deficit and parkisonian syndrome. Genetic tests were not performed to diagnose the etiology. Therefore, the case is considered a NBIA of unknown cause with atypical characteristics and probable mutation linked to PANK2.
Multisegmental ultrasonography of peripheral nerves in leprosy neuropathy
Authors: Luppi Andrea de Martino , Antunes Douglas Eulálio , Silva Gabriella Louise Constantino , Pena Vinícius Moura Abbud , Pennisi Elisa Santos , Silva Laura de Lourdes Cardoso e , Carvalho Iago Resende , Vitorino João Augusto Nunes , Nogueira-Barbosa Marcello Henrique , Santos Diogo Fernandes dos , Goulart Isabela Maria Bernardes
Published: July 2023

Introduction: Leprosy is the most common treatable peripheral neuropathy worldwide. The detection of peripheral nerve impairment is essential for its diagnosis and treatment. Objectives: To identify neural thickening through multisegmental ultrasonography (US). Methods: US measurements of cross-sectional areas (CSAs) of ulnar, median and tibial nerves at two points (in the osteofibrous tunnel and proximal to the tunnel), and also of the common fibular nerve at the fibular head. CSA index (ΔCSA) was calculated as the absolute difference between CSAs from the contralateral side. This is a cross-sectional study composed of 53 leprosy patients (LP) and 53 healthy volunteers (HV). Results: US evaluation detected a total of 138 enlarged nerves, implying neural impairment in 71.7% (38/53) of LP (3.6 enlarged nerves/LP). We detected only mononeuropathy on patient in 23.7% (9/38), and multiple mononeuropathy in 76.3% (29/53). The ulnar and tibial were the most frequently affected nerves. The mean values of CSA of all nerves were significantly higher in LP. We also observed higher ΔCSA measurements for all nerves in LP, with significantly higher values for the ulnar and tibial nerves, both in the tunnel and proximal to the tunnel points. All clinical forms of leprosy evaluated showed neural enlargement through US. Conclusion: The multisegmental US is a useful method for diagnosing leprosy neuropathy, revealing that asymmetry and irregular thickening are characteristics of the disease. Furthermore, that neural involvement is common in different clinical forms of leprosy, reinforcing the importance of including US evaluation of peripheral nerves in the investigation of all leprosy patients.
Clear and colorless cerebrospinal fluid among suspected central nervous system infections
Authors: Senne Carlos , Giafferi Carlos , Vega Márcio , Salomão Daiane , Domingues Renan
Published: July 2023

Introduction: The physical examination of the cerebrospinal fluid (CSF) is part of its routine evaluation and is easily performed as soon as CSF is obtained. However, its predictive value of CSF abnormalities is poorly known. Objective: In this study we evaluated the predictive value for CSF abnormalities leukocytes count among clear and colorless CSF in cases of suspected central nervous system (CNS) infection. Methods: We retrospectively evaluated data from CSF samples collected from suspected CNS infection that were classified as clear and colorless. This visual categorization was performed by the collector physician and by biomedical staff experienced in CSF analysis. The CSF cell count were considered normal when CSF white blood cells were up to 3 cells/mm3 , protein was below 45 mg/dL, glucose above 50 mg/dL, and lactate bellow 19.6 mg/ dL. The proportion of normal CSF and normal CSF parameters were recorded. Results: 34,434 CSF samples from suspected CNS infection were included. Of those, 22,960 were classified as clear and colorless (66.7%). Among clear and colorless CSF samples 13,137 (57.2%) had normal CSF cytology and biochemical findings. The probability of CSF abnormalities in the cytological and/ or biochemical examination in clear and colorless CSF samples obtained from patients with suspected CNS infection was 42.8%. Discussion: In this study, we showed a high frequency of cytological and/or biochemical abnormalities in clear and colorless CSF obtained from patients with suspected CNS infection. Conclusions: Viral infections and other inflammatory CNS diseases are among the conditions that may present with clear and colorless CSF. Therefore, a clear and colorless CSF in suspected CNS infections has a little predictive value for CSF abnormalities.
Comparative analysis between cure without sequelae and cure with sequelae in the therapeutic approach of acute flaccid paralysis in Brazil
Authors: Medeiros Matheus Araújo , Benvenuto Brendo Bezerra , Silva Tiago Lameque de Sousa e , Martins Maria Eduarda Medeiros , Lucena Renner Cassio Nunes de , Dantas Iury Hélder Santos
Published: July 2023

Introduction: Acute Flaccid Paralysis (AFP) is a serious condition that causes sudden muscle weakness and loss of deep reflexes. It is important to note that there are various causes of AFP, and one of them is the Guillain-Barré Syndrome (GBS), an autoimmune disorder that affects the nervous system, causing muscle weakness and sometimes paralysis. Objectives: The objective of this study is to compare the cases of cure without sequelae with the cases of cure with sequelae of AFP, based on data obtained between 2007 and 2021, using the records of Notifiable Diseases Information System (SINAN). Methods: A descriptive ecological study was conducted. Data on cure without sequelae and cure with sequelae of AFP were collected from all Brazilian regions between 2007 and 2021. The data were statistically analyzed and compared between the regions. Results: The data obtained indicated a total of 4,784 cases of AFP during the analyzed period, with 3,476 cases (72.6%) resulting in cure without sequelae, while 1,308 cases (27.3%) resulted in cure with sequelae. The Northeast region presented the highest number of cases of cure without sequelae (1,355), while the Southeast region presented the highest number of cases of cure with sequelae (408). The statistical analysis showed a higher proportion of cases of cure without sequelae in all regions. Conclusion: The results of this study demonstrate that cure without sequelae is more frequent than cure with sequelae in the therapeutic approach of AFP in Brazil. The Northeast region presented the highest number of cases of cure without sequelae, while the Southeast region presented the highest number of cases of cure with sequelae. These results highlight the importance of immunization and appropriate treatment of AFP to prevent sequelae and improve the quality of life of patients.
Elderly man presenting with focal seizures, encephalopathy and tumefactive lesion on imaging scans
Authors: Morais Gabriela Lopes de , Carvalho Ellen Silva de , Nogueira Anny Karoliny de Santana , Ribeiro Sarah Lima , Moura Elisa Coutinho , Camilo Millene Rodrigues , Zotin Maria Clara Zanon , Pontes-Neto Octávio Marques
Published: July 2023

An 84-year-old man with cardiomyopathy and a pacemaker was admitted to our hospital due to a focal impaired awareness seizure. Computed tomography (CT) scan on admittance evidenced right parieto-occipital hypodensity with mild mass effect. A non-contrast CT scan realized in an outer institution seven months earlier showed that such hypodensity, considered then as a stroke, was present, but slowly progressing. He was submitted to therapy with phenytoin upon entry and his electroencephalogram showed increased slow-wave activity. Cerebrospinal fluid showed hyperproteinrachia, normal cell count and slightly reduced glycorrhachia. With such findings, the main hypothesis of neoplasm and neuroinfection emerged. Magnetic resonance imaging (MRI) could not be realized at first due to his pacemaker. Empiric treatment with acyclovir was initiated but, in spite of that, he maintained somnolence and left hemiparesis. The cardiology team was activated, and his pacemaker was set to do an MRI. His scan evidenced a T2/FLAIR hyperintense mass lesion on the right parieto-occipital area. SWI sequences showed microbleeds along the cerebral cortex and chronic lobar hematoma simulating cortical superficial siderosis. Hence, Cerebral Amyloid AngiopathyRelated Inflammation (CAA-ri) was diagnosed and pulse therapy with methylprednisolone was indicated. By closure of this report, he was started on antibiotics for urinary tract infection, and would be initiated on corticosteroids after 48 hours. CAA-ri is a rare yet reversible etiology of seizures, encephalopathy and focal neurological signs in patients with amyloid angiopathy, an entity that occurs mainly in the elderly as a deposit of amyloid protein on vessel walls. MRI is essential as it shows characteristic cortical-subcortical hemorrhagic lesions. Suggestive findings allows treatment with corticosteroids, optimizing neurological recovery and minimizing future deficits.
Neuro-Behçet as a cause of acute onset cerebellar ataxia: a case report
Authors: Ribeiro Giovana Barros e Silva , Corrêa Vítor Guimarães , Lima Izadora Vieira Bolzani Lopes , Gouvêa Sabrina Vechini , Min Li Li
Published: July 2023

Case presentation: A 37-year-old woman, current smoker and previously addicted to cocaine, was brought to the emergency department with complaints of “imbalance and altered speech” that started eight days prior to admission, acutely. The patient, who was previously asymptomatic, also reported fever, headache and myalgia during the same period. Emotional lability was reported by the family members. At the initial evaluation, the patient was somnolent but reactive. Scanning speech, left-sided central facial palsy, sings of bilateral pyramidal involvement, axial and appendicular cerebellar ataxia were also observed. After a thorough examination, cicatricial lesions of previous genital ulcers were observed and the patient reported the presence of recurrent orogenital ulcers in the previous three months. Also, sporadic episodes of conjunctival hyperemia and hematuria were reported. CSF analysis demonstrated a cellularity of 63 leukocytes/mm3 (100% lymphocytes), increased total protein (105 mg/dL) and a low glucose level (cerebrospinal fluid/plasma ratio of 53%). The magnetic resonance imaging showed FLAIR hyperintensity at the midbrain, left cerebral peduncle, pons (base and tegmentum), posterior limbs of both internal capsules and left posterior thalamus. A pontine lesion with peripheral contrast enhancement, leptomeningeal enhancement at the level of the prepontine cistern and enhancement of the VII and VIII complexes were also observed. High-dose steroid therapy with methylprednisolone 1 g/day was initiated (total of five days of therapy) and the patient presented significant improvement of the symptoms, returned to walk independently and no longer presented emotional lability. At the time of discharge, a mild cerebellar ataxia was still observed. The pathergy test was positive and the diagnosis of Neuro-Behçet was confirmed. The steroid treatment was transitioned to oral prednisolone and, later, immunosuppressive therapy with infliximab was started.
Ultrasound detection of carotid web in a recurrent stroke patient: a case report
Authors: Marques Marina Trombin , Reges Zally Siqueira , Barão Felipe Trajano de Freitas , Matos Priscilla , Reges Danyelle Sadala
Published: July 2023

Introduction: Carotid web is an intimal variant of fibromuscular dysplasia, leading to a shelf-like linear defect in the internal carotid bulb. It is a rare, but important embolic etiology for stroke in young patients without conventional cardiovascular risk factors, with a high recurrence rate. Carotid ultrasound is a low-cost, widely available tool in stroke investigation and can be useful as a diagnostic tool for carotid web, as described in this case. Methods: Case report of a patient with recurrent stroke secondary to carotid web, detected by ultrasound, obtained by medical records. Case report: A 57-year-old female patient, with a history of obesity treated with bariatric surgery 7 years ago, presented three episodes of stroke, all in the right anterior circulation. In all of them she presented left side weakness and paresthesia. She remained only with left side paresthesia after those events. The recurrent events happened despite using aspirin and double antiplatelet treatment. A carotid ultrasound was performed and detected a shelf-like, thin band of intima in the posterior wall of the right internal carotid artery. Endarterectomy treatment was performed, and she has been stable ever since with aspirin. Conclusion: Ultrasound is an increasingly available, non-invasive method performed bedside. Although it is a useful diagnostic tool to detect carotid web, it is still a challenging diagnosis, probably due to the lack of awareness among examiners. Given the high rates of stroke recurrence related to carotid web, a careful ultrasound examination and meticulous imaging analysis probably allows earlier diagnosis and appropriate treatment.
Early non-invasive ventilation indication in amyotrophic lateral sclerosis and other neuromuscular disorders: a prospective study
Authors: Almeida Ana Elizabeth Cunha Guimarães de , Silva William Nicoleti Turazza da , Rosa Maria Fernanda Prado , Almeida Isabella Cristina Guimarães de , Oliveira Ana Clara Gondim , Pinheiro Beatriz Iolanda de Sene Ferregutti , Pennisi Elisa Santos , Samper Isabela Correa , Vitorino João Augusto Nunes , Silva Laura de Lourdes Cardoso e , Santos Diogo Fernandes dos
Published: July 2023

Introduction: Neuromuscular diseases (NMD) affect the peripheral nervous system and may lead to progressive respiratory failure. Ventilatory assistance reduces dyspnea and improves quality of life. Objectives: The aim of this study is to compare patients with amyotrophic lateral sclerosis (ALS) or other NMD and the effects of early indication of noninvasive ventilation (NIV) (FVC > 70). Methods: A study was carried out in patients with NMD and indication for NIV, accompanied by periodic examinations, weekly telemonitoring and adjustments of ventilatory parameters for six months. Results: The study found that ALS patients had greater adherence to NIV, with mean daily use increasing from 4.7 to 6.0 hours and a decrease in leakage (L/min) from 2.5 to 1.5 and in the apnea-hypopnea index (AHI) from 5.85 to 4.85. Patients with other NMDs had a decrease in mean daily use from 6.1 to 5.3 hours, with a decrease in leakage from 1.2 to 0.5 and AHI from 3.1 to 1.9. Patients with early indication for NIV had a lower rate of deaths and noncompliance compared to those with late indication. Patients with early indication had 6 hours (±2.0) of average daily use and maintained it after 6 months (±1.3) with a decrease in leakage from 1.9 to 0.2 and AHI from 3.1 to 2, two. In the late indication group, there were 4 deaths and 2 dropouts, with an increase in daily use from 4.7 to 5.5 hours, a decrease in leakage from 1.9 to 1.5 and AHI from 3.2 to 2.2. Conclusion: This study suggests that early NIV indication can improve ventilatory parameters and outcomes in patients with NMDs, especially ALS, and should be considered for patients with FVC > 70%.
Rezension von: Schiersner, Dietmar (Hrsg.), Zeiten und Räume – Rhythmus und Region
Authors: Wettengel Michael , Schiersner Dietmar
Published: July 2023

Dietmar Schiersner (Hg.): Zeiten und Räume – Rhythmus und Region (Forum Suevicum. Beiträge zur Geschichte Ostschwabens und der benachbarten Regionen 11). Im Auftrag des Memminger Forums für schwäbische Regionalgeschichte e. V. Konstanz/München: UVK Verlagsgesellschaft 2016; 385 S., 23, teils farbige Abb., geb., 44,00 EUR
Rezension von: Ernst, Albrecht; Grünert, Regina (Bearb.), Gelebte Utopie
Authors: Wettengel Michael , Ernst Albrecht , Grünert Regina
Published: July 2023

Albrecht Ernst/Regina Grünert (Bearb.): Gelebte Utopie. Auf den Spuren der Freimaurer in Württemberg. Begleitbuch zur Ausstellung des Landesarchivs Baden-Württemberg im Hauptstaatsarchiv Stuttgart vom 24. Mai bis 22. September 2017. Stuttgart: Verlag W. Kohlhammer GmbH 2017; 158 S., 155 farb. Abb., brosch., 16,00 EUR
Rezension von: Histoire de la vie de la Princesse Amélie Zéphyrine de Hohenzollern-Sigmaringen, née Princesse de Salm-Kyrburg, ma mère, écrite par elle-même, rec̨ue après sa mort
Authors: Mayer Bernd M. , Amalie Zephyrine Hohenzollern-Sigmaringen
Published: July 2023

Lebensgeschichte der Fürstin Amalie Zephyrine von Hohenzollern-Sigmaringen, geborene Prinzessin von Salm-Kyrburg, meiner Mutter, von ihr eigenhändig verfasst, nach ihrem Tod erhalten 1760–1831. Herausgegeben von Edwin Ernst Weber/Bernhard Rüth. Bearb. von Christina Egli unter Mitwirkung von Doris Muth. Eggingen: Edition Isele 2015; 402 S., geb., 25,00 EUR
Rezension von: Braun, Karl-Heinz; Ott, Hugo; Schöntag, Wilfried (Hrsg.): Mittelalterliches Mönchtum in der Moderne?
Authors: Schiersner Dietmar , Braun Karl-Heinz , Ott Hugo , Schöntag Wilfried
Published: July 2023

Karl-Heinz Braun/Hugo Ott/Wilfried Schöntag (Hg.): Mittelalterliches Mönchtum in der Moderne. Die Neugründung der Benediktinerabtei Beuron 1863 und deren kulturelle Ausstrahlung im 19. und 20. Jahrhundert (Veröffentlichungen der Kommission für geschichtliche Landeskunde in Baden-Württemberg, Reihe B: Forschungen 205). Stuttgart: W. Kohlhammer Verlag 2015; 237 S., 37 sw-Abbildungen, 7 Farbtafeln, Register, 28,00 EUR