bluuebunny/crossref_metadata_2025 huggingface dataset:
HUBUNGAN DUKUNGAN BAPAK DENGAN STATUS GASTROENTERITIS PADA BALITA DI UPTD PUSKESMAS LUAHAGUNDRE
Authors: Magdalena Tampubolon Cristina
Published: December 2021

Gastroenteritis merupakan proses peradangan yang terjadi pada daerah lambung dan usus yang biasanya disertai dengan gejala diare secara terus menerus dan paling sering sering terjadi pada balita. Perawatan kesehatan balita dalam keadaan gastroenteritis merupakan salah satu aspek perawatan orang tua (ibu dan bapak) yang dapat mempengaruhi status gizi balita dalam penyembuhan penyakitnya sehingga memperbaiki status gastroenteritis yang harus sangat diperhatikan oleh keluarga khususnya ibu yang memiliki balita. Rumusan masalah penelitian adalah bagaimana hubungan dukungan bapak dengan status gastroenteritis. Tujuan penelitian untuk menguji hubungan dukungan bapak dengan status gastroenteritis pada ibu yang memiliki balita yang mengalami gastroenteritis.Jenis penelitian adalah korelasi dengan pendekatan cross sectional. Penelitian dilaksanakan di UPTD Puskesmas Luahagundre, Sampel adalah seluruh ibu yang memiliki balita yang mengalami gastroenteritis tahun 2018 sebesar 51 orang. Alat pengumpulan data menggunakan kuesioner dukungan bapak dan lembar observasi status gastroenteritis. Uji yang digunakan adalah chi-square.Hasil penelitian menunjukkan Ada hubungan yang signifikan antara dukungan bapak dengan sattus gastroenteritis (p value< 0,05) dengan Rasio Prevalensi (RP) = 9,6 artinya dukungan bapak buruk kepada ibu yang memiliki balita yang mengalami gastroenteritis mempunyai risiko 9,6 kali balita yang gastroenteritis mengalami dehidrasi berat dibandingkan dengan dukungan bapak yang diterima ibu baik.Kesimpulan penelitian adalah ada hubungan yang signifikan antara dukungan bapak dengan status gastroenteritis (p value< 0,05) dengan Rasio Prevalensi (RP) = 9,6. Disarankan kepada keluarga lebih aktif dalam mencari informasi tentang pentingnya dukungan bapak kepada ibu dalam melakukan perawatan bagi balita yang sedang mengalami penyakit gastroenteritis untuk mencegah terjadinya dehidrasi berat.
HUBUNGAN IKLIM ORGANISASI TERHADAP KINERJA PERAWAT DI RUMAH SAKIT IMELDA
Authors: Damanik Hamonangan
Published: December 2021

Rumah sakit adalah suatu organisasi yang memilki tenaga kesehatan professional yang terorganisir serta sarana kedokteran yang permanen. Rumah sakit menyelenggarakan pelayanan kedokteran, asuhan keperawatan yang berkesinambungan, diagnosis serta pengobatan penyajit yang diderita pasien. Pada dasarnya upaya pencapaian mutu pelayanan dirumah sakit terfokuskan kepada mutu pelayanan medik. Mutu pelayanan medik diidentik dengan mutu pelayanan yang diberikan dokter dan perawat. Penelitian ini lebih menfokuskan pada kinerja perawat, karena mutu pelayanan keperawatan merupakan persoalan yang mendasar dalam organisasi rumah sakit saat ini. Salah satu faktor yang mempengaruhi pencapaian mutu pelayanan keperawatan adalah kinerja perawat. Tujuan penelitian ini adalah untuk mengetahui hubungan iklim organisasi terhadap kinerja perawat di Rumah Sakit Imelda. Penelitian ini bersifat deskriptif korelasi, populasi dalam penelitian ini berjumlah 340 perawat sedangkan sampelnya berjumlah 51 perawat dengan menggunakan Simple random sampling. Hasil penelitian mengenai hubungan iklim organisasi (P=<0,05), struktur (P=<0.05), standar (P=<0.05), tanggung jawab (P=<0.05),  pengakuan (P=<0,05), tim kerja (P=<0,05), komitmen (P=<0,05) dengan kinerja perawat.
ANALISIS MUTU LAYANAN UNIT REKAM MEDIS BERDASARKAN KEPUASAN PELANGGAN INTERNAL DENGAN MENGGUNAKAN METODE SERVICE QUALITY DAN QUALITY FUNCTION DEPLOYMEN DI RSU IPI MEDAN TAHUN 2018
Authors: Permata Sari Lubis Siti , Zebua Putri
Published: December 2021

Penyelenggaraan rekam medis yang menjadi salah satu indikator mutu pelayanan rumah sakit. Untuk meningkatkan kualitas layanan, yaitu kepuasan konsumen maka dilakukan analisa dengan menggunakan metode Service Quality dengan teknik Quality Function Deployment (QFD). Tujuan penelitian ini Untuk menganalisis mutu layanan Unit rekam medis di RSU IPI Medan berdasarkan kepuasan pelanggan internal dengan metode service quality dan quality function deploymen. Penelitian ini menggunakan jenis penelitian deskriptif yang dilakukan pada bulan juni-juli 2018 dengan sampel 44 pelanggan internal dari 220 pelanggan internal RS. Hasil gab Ruang Penyimpanan yang luas (-136), Jumlah Pegawai (-97), Keamanan penyimpanan berkas rekam medis (-94),  Letak gedung (URM) yang strategis dari rawat inap (-83), Kesesuai informasi (-57). Berdasarkan House of Quality tool dari Quality Function Deployment, perbaikan yang direkomendasikan  berdasarkan gab terbesar. Kepada pihak rumah sakit diharapkan memenuhi kebutuhan pelanggan internal untuk meningkatkan mutu layanan unit rekam medis.
HUBUNGAN FUNGSI MANAJEMEN KEPALA RUANGAN DENGAN KEPATUHAN PERAWAT PELAKSANA DALAM PENERAPAN PATIENT SAFETY DI RUMAH SAKIT UMUM IMELDA PEKERJA INDONESIA MEDAN
Authors: Putra Ritonga Edisyah , Kristian Gulo Eka
Published: December 2021

Keselamatan pasien merupakan prioritas utama untuk dilaksanakan dan hal tersebut terkait dengan isu mutu dan citra perumahsakitan (Depkes RI, 2006). Patient  safety  culture  dapat  dimulai  dari  pemimpin, Kepala  ruang merupakan manajer keperawatan yang langsung berhubungan dengan kegiatan pelayanan kesehatan pada pasien. Tujuan penelitian ini adalah untuk mengetahui hubungan fungsi manajemen kepala ruangan terhadap perawat pelaksana dalam penerapan patient safety di Rumah Sakit Umum Imelda Pekerja Indonesia Medan. Jenis penelitian ini adalah penelitian kuantitatif dengan desain penelitian  adalah deskriptif korelasi, Populasi dalam penelitian ini adalah seluruh perawat pelaksana yang berada di salah satu rumah sakit di Medan yang berjumlah 134 orang dengan jumlah sampel sebanyak 57 dengan random sampling sistematis. Berdasarkan hasil penelitian menunjukkan bahwa ada hubungan antara fungsi manajemen kepala ruangan dengan kepatuhan perawat pelaksana dalam penerapan patient safety dengan nilai p 0.000 < 0.05 yang berarti ada hubungan yang positif yaitu jika fungsi manajemen kepala ruangan semakin baik maka kepatuhan perawat pelaksana dalam penerapan patient safety semakin baik. Diharapkan bagi rumah sakit agar dapat membekali kepada perawat yang ada dirumah sakit dengan pengetahuan yang baru tentang patient safety dengan melakukan sosialisasi atau pelatihan terkait dengan patient safety agar dapat malukukan asuhan keperawatan dengan optimal kepada semua pasien.
PENGARUH JALAN CEPAT (BRISK WALKING) TERHADAP PENURUNAN GLUKOSA DARAH PADA PASIEN DIABETES MELLITUS TIPE II YANG BEROBAT JALAN DI RUMAH SAKIT UMUM IMELDA PEKERJA INDONESIA MEDAN
Authors: Damanik Hamonangan , Rina Situmorang Paskah
Published: December 2021

Diabetes Mellitus (DM) merupakan suatu penyakit menahun yang ditandai oleh kadar kadar glukosa darah melebihi normal dan gangguan metabolisme karbohidrat, lemak dan protein yang disebabkan oleh kekurangan hormon insulin secara relatif maupun absolut. Penelitian ini bertujuan untuk mengetahui pengaruh jalan cepat terhadap penurunan gula darah pada pasien DM tipe 2 yang berobat jalan di Rumah Sakit Umum Imelda Pekerja Indonesia (RSU IPI) Medan. Jenis penelitian ini menggunakan quasi experiment dengan desain penelitian “one group pretest and posttest”. Penelitian ini dilakukan pada pasien diabetes melitus tipe II yang berobat jalan di Rumah Sakit Umum Imelda Pekerja Indonesia (RSU IPI) Medan. Populasi pada penelitian ini adalah 109 orang. Tehnik sampling pada penelitian ini adalah accidental sampling (responden yang tersedia sewaktu dilakukan penelitian) dengan demikian jumlah sampel adalah 19 orang. Analisis statistik yang digunakan uji wilcoxon test. Setelah sampel ditentukan, maka peneliti akan melakukan penelitian dari rumah ke rumah pasien. Proses penelitian dilakukan yaitu dengan melakukan tes gula darah kemudian melakukan jalan cepat bersama pasien selama 30 menit kemudian dilakukan pengecekan kembali gula darah. Hasil penelitian menunjukkan bahwa mayoritas pendetita DM mengalami penurunan kadar gula darah. Hasil analisis data menggunakan wilcoxon test diperoleh nilai p hitung 0,002 < 0,05. Disarankan kepada responden agar tetap menjaga kadar gula darah dengan melakukan latihan jasmani seperti jalan cepat.
PENGARUH TERAPI MUSIK SUARA ALAM TERHADAP KUALITAS TIDUR PASIEN KRITIS DI RUANG ICU RSU ROYAL PRIMA MEDAN TAHUN 2019
Authors: Iman Waruwu Nur , Novalinda Ginting Chrismis , Telaumbanua Devis , Amazihono Darwisman , Putra Alfrain Laia Getzemane
Published: December 2021

Musik suara alam merupakan suara alam seperti suara burung, gelombang laut, angin, air mengalir dll, sebagai terapi kesehatan yang mencapai hasil yang sangat memuaskan antara lain peningkatan kualitas tidur, kondisi fisik, mental bagi individu  diberbagai tingkat umur. Tujuan dari penelitian ini mendeskripsikan perbedaan kualitas tidur pasien sebelum dan setelah pemberian terapi musik suara alam.Desain penelitian menggunakan teknik purposive sampling yang memiliki kriteria inklusi dan eksklusi. hasil uji normalitas Shapiro-wilk  dimana data responden pada data pre-test memiliki nilai sig 0,002 < 0,05, data post-test terdapat nilai sig 0,000 < 0,05. Uji Wilcoxon Signed Rank Tes memiliki nilai Mean Rank pretest-posttest sebesar 6,00-0,00 dengan p- value 0,002 pada pasien kritis di ruang RSU Royal Prima Medan Tahun 2019.
DUKUNGAN KELUARGA DALAM UPAYA MENINGKATKAN KUALITAS HIDUP PASIEN GAGAL GINJAL KRONIK YANG MENJALANI HEMODIALISA DI RSU ROYAL PRIMA MEDAN TAHUN 2019
Authors: Harapan Septiyandi , Ruthnita Elmy , Fanny Agnes , Silaban Nita , Novalinda Crismis
Published: December 2021

Hemodialisa dapat secara tidak langsung mempengaruhi kualitas hidup pasien GGK. Kualitas hidup sangat erat kaitannya dengan adanya dukungan keluarga. Dukungan keluarga yang dapat diberikan oleh keluarga antara lain penghargaan, informasi instrumental, dan emosional. GGK disebabkan oleh beberapa  penyakit seperti kelainan ginjal, DM, kelainan autoimun, sedangkan komplikasi GGK adalah: edema, hipertensi, penyakit tulang dan anemia. Komplikasi GGK dapat diantisipasi dengan tindakan mengontrol tekanan darah ( hipertensi), dan menjaga pola hidup Dan biasanya bila seseorang yang telah  divonis penyakit GGK akan disarankan untuk  menjalani terapi hemodialisa. Tujuan penelitian ini dilakukan supaya untuk mengetahui dukungan keluarga dalam upaya meningkatkan kualitas pasien GGK yang menjalani hemodialisa di RSU Royal Prima Medan. Metode penelitian ini adalah survey analitik dengan pendekatan cross sectional(dengan memberikan sebuah kuesioner) dan menggunakan accidental sampling. Sampel yang terdapat dalam penelitian ini adalah pasien yang telah menjalani terapi hemodialisa di RSU Royal Prima Medan yang berjumlah 30 orang. Pengambilan data yang dilakukan peneliti dengan menggunakan teknik  kuesioner dan diolah dengan menggunakan uji chi-square.  Makah didapatkan hasil penelitian menunjukkan bahwa dukungan keluarga yang  mayoritasnya baik yaitu sebanyak 20jiwa (66,7%) dan dukungan keluarga yang minoritas tidak baik sebanyak 10 jiwa (33,3%). Kualitas hidup mayoritas ketegori yang baik sebanyak 18 jiwa (60%) dan kualitas hidup minoritas kurang sebanyak 5 jiwa (16,7%). Hasil statistik dengan uji chi-square di dapatkan pvalue = 0,020 < 0,05.
CROSSFIT: FEATURES OF APPLICATION IN ATHLETIC TRAINING SYSTEM
Authors: Avetisyan Arman
Published: December 2021

CrossFit trainings tend to have a noticeably positive impact on the physical and functional preparedness of athletes, as well as on the harmonious development of motor abilities which are endurance, strength, flexibility, agility and coordination. Considered one of the best training systems for improving general physical preparation, CrossFit exercises carry noticeable benefits in the harmonious development of athletes' physical and functional preparedness comprising several motor skills. Along with the obvious advantages, CrossFit also has its drawbacks necessary to take into account when drawing up training plans.
CURRENT ISSUES OF MILITARY PHYSICAL TRAINING OF HIGH

SCHOOL STUDENTS
Authors: Aghanyan Gevorg
Published: December 2021

The observations and survey data entail issues pertaining to efficient and high quality organization and teaching of physical education and initial military training subjects. Assessment of teachers brought to the absence of up-to-date material, technical
technical and scientific base, incomplete level of high school curricula, absence of specialized methodic literature, etc.
Thus, in order to enhance high school student engagement in the mentioned subjects, teachers have made a variety of practical suggestions. They have emphasized the need to increase learning hours, to conduct qualification improving courses, to develop adequate high school curricula including extracurricular military-applied activities.
Pavlo Apollonovich Tutkovsky. The 155th anniversary
Authors: Panchenko V. , Yakovleva V.
Published: December 2021

Tutkovsky P.A. is a famous geographer and geologist, who foresaw the discovery of deposits of amber in Ukraine.
Dynamic and kinematic conditions of late phases of Paleoproterozoic graniteformation and tectogenesis within the Pervomaysk fault zone
Authors: Shevchuk V. , Kravchenko D. , Mazko A.
Published: December 2021

Oh the basis of primary c-avis of late singenetic quartz in blastomilonites of granitic composition, which from granite- gneissic monocline in Pervomaisk fault zone, it is demonstrated that bifeldspaort granite formation occurred in the conditions of tension followed by transtension and transpression with realization of translation and recrystallization mechanism is demonstrated.
Conditions of sedimentation of miocene in the central part of Volyn-Podillia region
Authors: Usminska O.
Published: December 2021

Conditions of sedimentation of miocene in the central part of Volhyn’-Podhillia region are described and description facies types are given. As a result lithofacies maps of new generation were compiled.
Main biostratigraphic stages in the Earth history. Technogenic scenarios
Authors: Rudko G. , Zagorodnyuk P.
Published: December 2021

The biostratigraphic history of the Earth as a process of continuous transformation and adaptation from the primary forms of life and till its current state had been considered in the present article.

 The development of life on the Earth had started due to the changes of geological processes, changes of the chemical composition of the atmosphere and the aquatic environment, within the period of global catastrophe. As a result of more than 3.8 billion years the anthropogenic system «human – geological and related environment» was formed; it transformed the biosphere in accordance with the needs of human, creating the precedent of inconsistency between human needs and biosphere resources.

 The basic scenarios of human and biosphere development within the technogene were defined. The results of studies helped to identify the biostratigraphic conditions of the Earth life. The article investigates scenarios of technogene development as well as the role of human under the conditions of intensive biosphere transformation due to the anthropogenic activities.
The Rand Transcript Revealed
Authors: Sciabarra Chris Matthew , Solovyev Pavel
Published: December 2021

In this essay, the authors analyze and interpret facsimiles of important original documents—published here for the first time—that are deeply relevant to the education of the young Ayn Rand at the University of Petrograd. This definitive reading of source material provides significant documentation of Rand’s courses, teachers, and textbooks—and what she might have learned from them. Other original source materials are revealed to advance further investigations of this key period in Rand’s life. Recent commentary on Rand’s education in Gary H. Merrill’s book, False Wisdom, is also considered.
Selected Italian Introductions to Works by Thornton Wilder
Authors: Pickens Dianna
Published: December 2021

At the beginning of the twentieth century, several influential Italian writers, critics, and translators turned their attention to American literature as a source of inspiration during a time of great turbulence that came with the rise of fascism and World War II. The new world as it was depicted in American literature seemed to be worth considering as an alternative to the model that was being proposed in Italy. Because of this growing interest, the publishing industry decided to translate works from both America and other foreign countries—despite growing resistance from the fascist state—and publish them in inexpensive series. The first editions of Thornton Wilder's novels and plays were published in the midst of that difficult period, and selected introductions to those works, translated here for the first time, can help us understand both the enthusiasm for Wilder's work and why his works were so often chosen to be a part of new literary collections created by the Italian publishing industry during that period.
The Rivers Under the Earth: Wilder's Psychoanalytic Primer for the Stage
Authors: Konkle Lincoln
Published: December 2021

One of Thornton Wilder's most famous acquaintances was Sigmund Freud. Allusions to Freud or psychoanalytical concepts can be found in Wilder's plays and novels up to the end of his career. Perhaps the work most indebted to Freud's theorizing about the human psyche and behavior is the little-known one-act play The Rivers Under the Earth, first published in The Collected Short Plays of Thornton Wilder, Volume One, in 1997. The play depicts Wilder's typical nuclear family: a middle-class husband and wife with their teenage son and daughter. But in this play, Wilder goes beyond hints of the Oedipus and Electra complexes that appear in his more famous works to show his understanding of Freud's theory of the unconscious processes of the mind. During one night of the family's annual summer vacation, the parents realize the childhood events responsible for particular quirks of their son's and daughter's personality and actions. Thus, Wilder demonstrates what Freud called condensation and displacement, mental operations in which powerful repressed emotional experiences are associated with sensory phenomena or abstractions of them. Although scholars such as David Castronovo have noted Freudian influences in the one-act plays Wilder wrote in the late 1950s and early 1960s that were intended to be part of two seven-play cycles, The Seven Deadly Sins and The Seven Ages of Man, this article gives a more in-depth and technical reading of Wilder's dramatization of Freud's psychoanalytic theory of human behavior in the one-act play written during this same period.
Treatment satisfaction for gene silencing pharmacotherapies for the treatment of hereditary transthyretin amyloidosis with polyneuropathy
Authors: Gonzalez Deilys , Brown Duncan , Llonch Montserrat Vera , Yarlas Aaron , McCausland Kristen , Kessler Asia Sikora
Published: December 2021

Background and Aims: Hereditary transthyretin amyloidosis (hATTR) is a rare, progressive, systemic, fatal condition in which misfolded transthyretin proteins form amyloid in tissues and organs, often manifesting in polyneuropathy (hATTR-PN). The FDA has approved 2 gene-silencing pharmacotherapies for hATTR-PN: inotersen, administered subcutaneously; and patisiran, administered intravenously. Patient satisfaction for each treatment was examined during a period overlapping with the COVID-19 pandemic. Methods: Patients with hATTR-PN (with and without accompanying cardiomyopathy) in the United States participated in an observational, online survey between January 1 and October 25, 2020. The Treatment Satisfaction Questionnaire for Medication, version II (TSQMvII), was administered to 29 patients currently being treated with inotersen (n=11) or patisiran (n=18). TSQMvII produces 4 scale scores—Effectiveness, Side Effects, Convenience, and Global Satisfaction—ranging from 0 to 100. Higher scores indicate greater satisfaction. TSQMvII scores were descriptively compared between treatment groups. Results: Patients receiving inotersen indicated greater satisfaction with convenience than patients receiving patisiran (mean, 76.3 [SD=19.4] vs 58.6 [15.3], respectively), and less dissatisfaction with treatment side effects (86.1 [16.4] vs 68.3 [19.0]). Ratings were comparable between treatments with respect to effectiveness (72.0 [21.5] vs 67.1 [19.7]) and global satisfaction (78.0 [20.0] vs 74.5 [21.7]). Conclusions: While inotersen and patisiran were rated similarly in effectiveness and overall treatment satisfaction, inotersen was associated with less dissatisfaction with side effects and greater convenience, with the latter possibly reflecting differences in mode of administration (ie, at home vs visit to a clinical site), which may be particularly important during a pandemic.
Antibiotic therapy as a risk factor in Parkinson’s disease
Authors: Maia Lucas Henrique , Diniz Thaís Galdino , Caetano Vitor Carvalho , Diniz Marina Gomes , Reis Pedro Lucas Bessa dos , Leão Gabriela Vieira Marques da Costa , Nunes Vitor Moreira , Reis Helton José dos
Published: December 2021

Background: Antibiotics exposure is related to gastrointestinal tract dysbiosis and appearance of systemic repercussions. Due to the correlation between Enteric Nervous System (ENS) and Central Nervous System (CNS), abnormalities in the gut microbiota have been associated with neurological disorders including Parkinson’s Disease (PD). Objectives: Search evidence in the scientific literature relating antibiotic therapy and Parkinson’s disease. Methods: A systematic review has been done using the descriptors “Parkinson’s disease”, “antibiotics” and “gut microbiota” in PubMed’s database. The research was conducted in april 2021, without temporal limitations, in english and portuguese. Results: Studies suggest that PD begins with intestinal inflammation and abnormal alpha-synuclein deposition in the ENS that follows, through nerves, to the CNS. Results show that leaky gut and dysbiosis preceded 5-10 years PD’s initial symptoms, while the intense exposure to antibiotics preceded 10-15 years the diagnostic. On average, PD patients received larger amounts of antibiotics than controls (p=0.021). Dysbiosis post-antibiotics presented reduced diversity of Bacteroidetes, Firmicutes and Prevotellaceae and growthing of Enterobacteriaceae, resulting in higher risk of gastrointestinal infections, higher rates of pro-inflammatory cytokines, increased permeability of gastrointestinal and brain-blood barriers and hyperexpression of the alpha-synuclein protein in the colon. Conclusion: Poorly controlled antibiotic therapy and its subsequent damage to gut microbiota anticipates PD’s early symptoms.
Repetitive peripheral sensory stimulation (RPSS)
Authors: Conforto Adriana Bastos , Machado André , Plow Ela , Leite Claudia da Costa , Menezes Isabella , Ribeiro Nathalia , Anjos Sarah M. , Peckham Paul Hunter , Cohen Leonardo G.
Published: December 2021

Background: Repetitive peripheral sensory stimulation (RPSS) followed by 4- hour task-specific training improves upper limb motor function in subjects with stroke who experience moderate to severe motor upper limb impairments. Obectives: Here, we compared effects of RPSS versus sham followed by a shorter duration of training in subjects with moderate to severe motor impairments in the chronic phase after stroke. Design and setting: Single-center, randomized, placebo-controlled, parallelgroup clinical trial. Methods: We compared effects of 18 sessions of either 1.5 hours of active RPSS or sham followed by a supervised session of 30-minutes of functional electrical stimulation (FES) and 45-minutes of task-specific training (TST) of the paretic upper limb. In both groups, subjects were instructed to perform functional tasks at home, without supervision. The primary outcome measure was the Wolf Motor Function Test (WMFT) after six weeks of treatment. Grasp and pinch strength were secondary outcomes. Results: In intention-to-treat analysis, WMFT improved significantly in both active and sham groups at 3 and 6 weeks of treatment. Grasp strength improved significantly in the active, but not in the sham group, at 3 and 6 weeks. Pinch strength improved significantly in both groups at 3 weeks, and only in the active group at 6 weeks. Conclusions: RPSS enhanced hand strength in chronic stroke. Despite the short duration of supervised training (2.75 hours/session), changes in WMFT in both groups were comparable to those reported after longer, more intensive training protocols. These findings are relevant to settings that impose constraints in duration of direct contact between therapists and patients.
Relevance about the use of dexametasone in a patient with chronic suddural hematoma: a literature review
Authors: Araújo Louisy Carvalho , Sarmento Marina Crispim , Queiroga Nicole Sarmento , Figueiredo Lucas Vinicius Rafael , Aguiar Michelle Salles Barros de
Published: December 2021

Introduction: The use of corticosteroids, especially dexamethasone, for the treatment of Chronic Subdural Hematoma (CSDH), is a secular conduct protocol. However, recent studies contradict this recommendation in some points. Objectives: To score the use of dexamethasone in patients with Chronic Subdural Hematoma. Methodology: Literature review, based on PubMed database using the descriptors “Desamethasone”, “Chronic Subdural Hematoma” and “Treatment”, using a time filter from the years 2020-2021. Results: In a study with 443 neurosurgeons, 26.2% of respondents estimate that corticosteroids are highly effective in CSDH, with 46.2% using dexamethasone as monotherapy in conservative treatment. According to a randomized study conducted by The New England Journal, 375 people diagnosed with CSDH were treated with dexamethasone while 373 received the placebo, where 94% had undergone surgical treatment previously. At the end of the study, only 680 candidate patients continued to be analyzed, of which a favorable outcome was seen in 286 of 341 (83.9%) in the dexamethasone group and in 306 of 339 patients (90.30) in the placebo group, where there is a difference of 6.4 percentage points in favor of the placebo. In addition, in the same study, more adverse effects occurred in the dexamethasone group, however, 1.7% of the patients in this group needed surgery for hematoma recurrence compared to 7.1% in the group that used the placebo. Conclusion: It is possible to say that treatment with dexamethasone caused more adverse effects and resulted in less favorable outcomes, however, the recurrence for the number of surgeries was lower.
Post-COVID-19 multiple mononeuritis in a patient from a city in São Paulo
Authors: Marcomini Pedro Gabriel , Reis Ana Luísa Lopes Espínola da Costa , Hernandes Mauro Esteves , Macedo Pedro Henrique de Abreu
Published: December 2021

Context: COVID-19 is a disease capable of harming the entire organism, especially the lungs. It may lead to hospitalization in Intensive Care Units (ICU) and neurological conditions due to the possibility of development of myopathy in critically ill patients (MCIP) and even Multiple Mononeuritis (MM). That disorder presents itself with symmetrical lesions, significant disability, and no evidence of myopathy or demyelination in the electroneuromyography (ENM). Case report: We bring the case of a 57-year-old man with diabetes, systemic arterial hypertension, and dyslipidemia without previous neurological alterations. He was interned in ICU for 31 days because of a COVID-19 infection requiring mechanical ventilation and developed MM proven by ENM after hospital discharge. He presented as symptoms of incoordination, weakness, and gait ataxia. The patient’s ENM exam showed evidence of a reduction in the amplitude of the sensory potentials of all researched nerves and reductions in the values of sensitive nerve conduction on both median and sural nerves. It also exhibited an absence of sensitive response of the left superficial peroneal nerve, bilateral increase in the latency times of the H reflex, and absence of distal responses from both peroneal nerves. Conclusions: COVID-19 is a new entity, and it can cause neurological sequels. Even though MCIP is the primary neurological complication in ICU COVID patients, it is necessary to investigate the possibility of differentials like MM.
Guillain-Barre related to Covid-19
Authors: Coppetti Liara Eickhoff , Dall’Ago Lana Caroline Palaver Dall’Ago , Wierzbicki Andressa
Published: December 2021

Background: COVID-19 is a disease that affects the nervous system as proven by the presence of symptoms such as headache, nausea, dizziness, myalgia, anosmia and ageusia - and can cause numerous neurological complications. These complications include Guillain-Barré Syndrome, an autoimmune polyneuropathy usually caused by a previous infectious process. Its main clinical manifestation is asthenia in the limbs, in an ascending form. Objectives: Review studies that suggest relation between COVID-19 infection and Guillain-Barré Syndrome. Methods: A systematic review was carried out in April of 2021 of studies published in the scientific database PubMed. The key words used were: “GuillainBarré syndrome” and “COVID-19”. 345 articles were found, of which 12 were selected and 5 were used for review. Results: The reviewed articles demonstrated an association between cases of Guillain-Barré Syndrome after infection by the COVID-19 virus. The symptoms are asthenia and paresis of the members in an ascending way. The onset of neurological symptoms related to Guillain-Barré Syndrome was about 1 to 4 weeks after the diagnosis of COVID-19. Conclusions: The reviewed articles suggest an association between GuillainBarré Syndrome and COVID-19. It is expected that there will be an increase in the number of Guillain-Barré cases compared to years before the pandemic. In patients with active infection, as well as in those post-COVID, attention should be paid to any manifestation of asthenia that may suggest GuillainBarré syndrome. Further studies are needed to understand the effects of COVID-19 infection on the nervous system and which relate to the development of Guillain-Barré Syndrome.
Mortality of chronic-degenerative and infectious neurological disorders from 2009 to 2019: follow-up of epidemiological transition
Authors: Oliveira Leonardo Santana Ramos , Alves Lucca Ribeiro , Neves Rodrigo Bartolomeu Sobral
Published: December 2021

Background: The epidemiological transition states that degenerative diseases are the main responsible for morbidity and mortality, assuming infectious diseases place. This trend can be explained by interaction between socio- environmental and demographic factors. Understand where Brazil is it’s important in the planning of cost-effective health policies and in reduction of morbidity and mortality. Objectives: Describe the number of deaths from infectious and degenerative neurological diseases between 2009 and 2019 in Brazil. Design and setting: This is an descriptive study considering brazilian deaths for neurological disorders. Methods: Using Ministry of Health database (DATASUS) from 2009 to 2019, mortality of following diseases were analyzed: Meningitis and Encephalitis, as infectous disorders; and Parkinson’s, Alzheimer’s and Epilepsy as degenerative disorders. Data from Human Development Index (HDI) were taken from the United Nations Development Program (UNDP). Proportions were calculated to simplify analysis and correlation between variables were verified using simple linear regression. Results: In the period, HDI increased by 6.4%, while mortality from infectious diseases decreased by 25% and from degenerative disordes grew 132%. Considering infectous disorders, Meningitis decreased by 33%, while Encephalitis increased 64%. In chronic-degenerative diseases, deaths due to Alzheimer’s disease increased by 158%, in Parkinson’s disease 90%, and 63% in Epilepsy. Correlation analysis using simple linear regression revealed a Pearson coefficient (r) of 0.924 and -0.967 for the relation between HDI and mortality from degenerative and infectious diseases, respectively. Conclusion: Brazil has followed the trend of epidemiological transition, with increase in mortality from chronic-degenerative diseases and reduction in infectious disorders.
Mutation in the Codon V180i in Familial Creutzfeldt-Jakob Disease with Diffuse Cortical Hyperintensity, in Brazil
Authors: Melo Neto Fernando de Paiva , Dias Artêmio José Araruna , Viana Marinna Karla da Cunha Lima , Valadares Neto Maurício Vasconcelos , Espínola Paulo Francisco Lucena de Araújo , Silva Bruna Nadiely Victor da , Fernandes Isabella Araújo Mota , Andrade Rafael de Souza
Published: December 2021

Context: Familial Creutzfeldt-Jakob Disease (fCJD) represents 10 to 15% of CJD. Among its subtypes there is a mutation in codon V180I, in which, in complementary exams are observed an absence of specific findings in the electroencephalogram, low concentration of proteins in the CSF and a pattern of diffuse cortical hyperintensity (DCH) in the diffusion sequence identified by MRI. The fCJD with mutation in the V180I codon is predominant in females, presenting symptoms at an advanced age, slow progression, marked by important cognitive decline and low presence of myoclonus. Regarding therapeutic management, there is still no curative or modifying treatment, although the multidisciplinary approach plays a fundamental role in control and quality of life. Case report: A 72 years old male patient reported a history of recent progressive memory loss for three months. It evolved with difficulty in recognizing family members, repetitive behavior, global aphasia, instability when walking until reaching akinetic mutism. The diffusion sequence of MRI revealed areas of diffuse hyperintensity throughout the cerebral cortex. In view of this and after ruling out other etiologies, a mutation in the V180I codon related to fCJD was found. Conclusion: Given the rarity of this form of the disease, a rapid suspicion is essential, with imaging tests, especially skull MRI, and genetic tests, aiming at the proper diagnosis of CJD and its genetic form, with its correct therapeutic management.
Parallels between neurologist training in Brazil and in other countries
Authors: Moura Ludmila Sandy Alves , Arruda André Taumaturgo Cavalcanti , Silva Júnior Mário Luciano de Melo
Published: December 2021

Introduction: Neurology training involves practice in infirmaries and outpatient clinics in several subspecialties, as well as training in procedures and examinations. The analysis of Medical Residency Programs (MRPs) in Neurology in other countries is important to identify points of contrast and similarities as a way to keep the national training equivalent to other countries. Objectives: To analyze the duration and characteristics of the training of neurology physicians in Brazil and other countries. Methods: Cross-sectional study by active search on official web pages of governments and organizations/entities representing neurologists from 12 countries: Australia, Portugal, Italy, Greece, India, USA, Canada, Puerto Rico, Argentina, Chile, Uruguay, and Colombia. Information was obtained on the duration of medical school and residency, as well as the characteristics of this. Results: The duration of medical school was 4 to 7 years (median: 6; IIQ: 0.5). Duration in neurology was 3 to 6 years (median: 4; IIQ:1). Developed countries have a median duration of residency of 4.83 years ± 0.68 years, whereas in developing countries it was 3.66 ±0.47 years. Regarding access, 25% of the countries require a prerequisite. Regarding rotations, those present in most of the programs studied were: neurology outpatient clinic (100%), neuroradiology (83%), neuropediatrics (75%) clinical medicine (58%), psychiatry (58%). Conclusion: We identified differences in the standardization of PRM in Neurology among the countries studied. The duration of Brazilian residency is below the average of the other countries studied, but it includes the required rotations in developed countries.
Analytical Study of the Evolution of Hospitalizations for Traumatic Brain Injury In Brazil, In Comparison With Region, Race, Gender, Age Range and Death, Between January 2011 and December 2020
Authors: Esteves Daniel de Christo , Santos Antônio Henrique Roberti dos , Araújo Guilherme Neumann de , Sena Mylena Sobreira , Lopes Giovanna Amaral , Teixeira Adrianny Freitas
Published: December 2021

Background: Traumatic brain injury (TBI) consists of an damage to the brain tissue by an external agent, whether due to falls, car accidents or aggressions. It is a situation that often requires emergency care, due to possible sequelae and the imminent risk of death. Thus, TCE is one of the main causes of death worldwide, especially in children and young adults, translating into an important public health problem with a high socioeconomic impact. Objectives: To report the number of hospitalizations for TBI, in order to clarify the relationship between it and the variables studied. Methods: Analytical epidemiological study carried out by research at DATASUS based on data on head trauma in Brazil, with patients aged less than 1 year to 80 years or more, between January 2011 and December 2020, associating the location according to the age group, region, race, gender, mortality rate, year and number of deaths in the country. Results: Observing the cases of intracranial trauma, in the last 10 years (2011- 2020), 1,033,512 cases were noted, 787,480 (76.19%) of which were male. As for the regional proportion, there is a higher incidence in the southeastern region, with 431,785 (43.02%) cases, with São Paulo being 236,653 (54.80%) the state with the largest number, followed by the northeast region, in which it occupies the second position with the highest number of cases, with 274,781 (26.58%) and Ceará the most relevant state with 65,602 (23.87%) cases. Regarding race, browns with 348,581 (33.72%) cases had the highest rate. Evaluating an age group, 17.23% of the cases are between 20 and 29 years old, followed by 14.88% between 30 and 39 years old. In relation to deaths, there is a total of 98,537, with the age group between 20 and 29 years with the highest incidence with 14,814 (15.03%), with a highlight in the male gender with 13,152 (88.78%). With regard to the mortality rate, a higher rate was observed in males aged over 80 years. Conclusion: Traumatic brain injury often requires an early diagnosis for a better prognosis. Judging from the large number of cases, it is worth investing in methods for early diagnosis, seeking to improve the prognosis and reduce the total number of deaths. In addition, it is necessary to look at the causes of TBI and to emphasize the prevention of causes that can be avoided, especially among the youngest who are the most affected group.
Health education in physiotherapy for spinocerebelar ataxia
Authors: Cleto Isabela Virgílio , Guimarães Guilherme Silva , Santos Leticia Poloni dos , Nôga Carolina Miguel , Aquino Leticia Moraes
Published: December 2021

Introduction: Ataxia is a symptom of several degenerative medical conditions; the most common in Brazil being Spinocerebelar ataxia (SCA). These patients have difficulty performing fine coordination motors activities, altered body balance and gait. The treatment is based on multidisciplinar rehabilitation, to improve quality of life and mantain general health. Health education (HE) can benefit these patients, but there are few reports about it, especially in SCA patients. Objectives: To search the literature for evidence of the use of HE in phyisiotherapy for SCA patients in Brazil. Design and settings: Study carried out at Centro Universitario São Camilo. Methodology: Literature review in the databases: Scielo, UNIFESP and LILACS, Key words: “SCA”, ”rehabilitation”, “HE” and “physiotherapy”, in Portuguese, English or Spanish . Results: 27 articles were found, of which 16 were eligible. Studies demonstrates the need for more evidence for HE to be part of the physiotherapist’s routine, encouraging the participation and autonomy of the patient and family in the rehabilitation process. It is possible to develop educational materials that complement the health guidelines for these patients. Conclusion: There is a literary gap about the direct role of the physiotherapist as a HE agent, with responsibilities beyond rehabilitation; within the scope of prevention, health promotion and self-management of the patient and family.
Scientific production of an online monitoring in neurology and neuroemergency as the construction of knowledge in academic training: experience report
Authors: Paula Larissa Ottoni Estevanin de , Souza Felipe dos Santos , Valente Maria Clara de Oliveira , Machado Vitor Pereira
Published: December 2021

Introduction: Monitoring comprises a contribution tool in the teachinglearning process. It is an instrument that helps in the understanding, production and improvement of university knowledge, in addition to stimulating scientific initiation and university extension. The present work brings an innovative proposal of the modality, in which medical specialists guide students in the production of materials on themes in the area with virtual later dissemination, allowing an interaction of students from different regions. Objectives: Report on the experience of virtual monitoring during the COVID-19 pandemic and to evaluate the effectiveness of active methodologies for the digital use of resources. Experience report: The monitoring consisted of weekly online meetings, for three months, with clinical cases related to eight themes that were distributed and rotated among the monitors for the production of digital materials containing sub-themes within major touches, which is available for free on the networks monitoring. The following topics were discussed with: headache, ischemic and hemorrhagic stroke, seizures, vertigo, lowering of the sensory, neuroinfections and traumatic brain injury. Reflections on the experience: The active production process, as it is an effective learning method, reinforces the monitors’ knowledge on the themes and consolidates important skills. Conclusion: Online monitoring, in addition to being an alternative to the traditional face-to-face model, contributed to medical training in teaching, research and extension and in the development of other qualities, such as: interpersonal relationships, didactic language, encouraging teaching and improving the search and filtering data from the scientific literature.
Progressive disseminated histoplasmosis with pulmonary and central nervous system involvement: a case report
Authors: Souza Matheus Fellipe Nascimento de , Silva Ana Paula Teixeira da , Bianchin Gabriela Santos , Fileti Maria Eduarda Angelo de Mendonça , Oliveira Raddib Eduardo Noleto da Nóbrega de , Guimarães Rafael Pereira , Nunes Thábata Emanuelle Martins , Ribas Gustavo da Cunha , Moro Carla Heloísa Cabral , Longo Alexandre Luiz
Published: December 2021

Context: Histoplasmosis (Histoplasma capsulatum) is a systemic disease that affects the lung and immune system1. The severity of histoplasmosis is directly related to the individual’s immune response since it is an opportunistic pathogen2. It is one of the most prevalent infections in immunocompromised patients due to the use of tumor necrosis factor-alpha (TNF-alpha) inhibitors, resulting in a mortality rate of 20%. The evolution to CNS occurs in 5-10% of patients with disseminated symptoms3. Case Report: M.G.M, a woman, 67 years, was admitted with bilateral tonicclonic seizure with focal onset in the right upper limb. The patient had hypertension, diabetes and rheumatoid arthritis, and was use ASA, glibenclamide, hydrochlorothiazide, losartan, amlodipine, adalimumab and methotrexate. Complementary exams were performed that showed lesions suggestive of microangiopathy on cranial CT; nodular lesions in the pulmonary right upper lobe and prominent lymph nodes in the hilum and mediastinum on chest CT; CSF with increased cytology (monomorphonuclear predominance), without glucose consumption. The biopsy of lung lesions identified Histoplasma capsulatum, confirming the diagnosis of progressive disseminated histoplasmosis with pulmonary and CNS involvement. Thus, treatment with amphotericin B was started, however, the patient died. Conclusions: Histoplasmosis is the most prevalent invasive fungal infection in users of TNF-alpha inhibitors. In these cases, the disease can be more aggressive and have a rapid evolution, with CNS involvement - which confers a worse prognosis. Early diagnosis, suspension of the immunomodulator and adequate treatment for infection control are required.
Epidemiological study on hospitalizations for viral encephalitis in Brazil between january 2010 to december 2020
Authors: Lessa Ruan Teixeira , Cassiano Daniel Pedrosa , Silva Yasmin Jawhari da , Almeida Júnior Sebastião José de , Teixeira Adrianny Freitas , Silveira Ana Luíza Paes da , Santos Antônio Henrique Roberti dos , Esteves Daniel de Christo , Rocha Gabriela Almeida , Lopes Giovanna Amaral , Paula Julia Goulart Tavares de , Sena Mylena Sobreira , Cândido Pedro Afonso Monteiro de Barros , Espósito Thais Sette , Araujo Guilherme Neumann de
Published: December 2021

Introduction: Viral encephalitis (VE) is an inflammation of the brain parenchyma that progresses to neurological dysfunction of infectious origin. It occurs after hematogenous dissemination into the Central Nervous System and the most common agents are herpes virus, influenza, enterovirus, arbovirus, cytomegalovirus and Epstein-Barr. The signs and symptoms are headache, fever, decreased level of consciousness, seizures, focal deficits and behavioral changes. Objective: Recognize the epidemiological pattern of hospitalizations for VE in Brazil, between 2010 and 2020. Methods: A search for original articles and statistical information was performed in the databases Scielo, PUBMED, Medline and DATASUS, the latter related hospitalizations for VE with region, age, gender and year. Results: Hospitalizations are greater between 0 and 14 Y.O. (59.6%) in both genders, being 1.38M: 1F. The data indicate: <1 Y.O. (15%), 1-4 Y.O. (18.1%), 5-9 Y.O. (16.2%), 10-14 Y.O. (10.2%), totalizing 59.5% (21,004) of hospitalizations (35,188) in these groups, also intensified, between 20-29 Y.O., with 3,956 cases (11.2%). Comparing 2010 and 2020 there was a 63.4% reduction in hospitalizations for VE and the Southeast had the highest rate of the disease (42.1%). Conclusion: The epidemiological pattern of VE in the last decade represented higher prevalence in the interval between 0 and 14 Y.O.; mainly from 1 to 4. The decrease in the last 11 years may be due to adherence to vaccination campaigns and increased vector control, while the hypothesis for the higher incidence in the Southeast is because it is the most populous region, with favorable geographical areas for viral dissemination.