bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital device use and primary headache in college students in the pandemic context
Authors: Freitas Lara Maria de Oliveira Paiva , Oliveira Isadora Mônica Ponte de , Araújo Victor Oliveira , Santos Júlio
Published: December 2021

Introduction: The increased use of devices during the SARS-CoV-2 pandemic is noteworthy. The democratization of technological products caused a significant increase an its use by the population across the globe. This has caused a consistent increase in the appearance of some diseases among users of those devices. Thus, a concern arises about the student context and its high workload online during the pandemic. Objective: Analyze the association between the use of digital devices and the incidence of headache among students during the pandemic. Design and setting: A literature review was conducted on the topic. Methods: We included 15 original articles in English and Portuguese from MEDLINE, Pubmed, and Google Academic databases, selected from 2011 to 2021. Results: In cross-sectional studies, reports of headache were higher in individuals who use digital devices frequently compared to those who do not use them, and migraine attacks with aura and use of analgesics were more recurrent in the first group. Several causal mechanisms between headache and the use of digital devices have already been proposed, such as exposure to electromagnetic fields, neck posture, stress and sleep alterations without, however, having any evidence. Conclusion: We conclude that the excessive use of electronic devices can increase the incidence and duration of headache. However, the literature on the subject is still limited. Therefore, there is an urgent need for research that controls exposure to digital devices in order to analyze the causal relationship between electronic devices and headache.
Phonoaudiological profile of patients in post-operative research of intracranial tumor
Authors: Silva Ianne Melo da , Ribeiro Francieli Goulart
Published: December 2021

Introduction: Primary intracranial tumors have increased the incidence and mortality rate in recent years. The speech-language disorders found in patients with intracranial tumor vary according to the histological type and anatomical location. Objective: To characterize the population of post-surgical patients with resection of intracranial tumors treated by the Speech-Language Pathology Service from January 2015 to January 2018. Methods: This is a cross-sectional retrospective study, carried out at the University Hospital of the Maranhão Federal Unit-Presidente Dutra Unit, with a sample by convenience, based on the data collected in the medical records and speech therapy protocols. The data were treated using the Stata software, version 14.0. The normality of continuous variables was verified by the Shapiro Wilk test. Student’s t-tests were used for continuous variables and Fisher’s exact or Chi-square tests for categorical ones. Results: 22 speech therapy protocols were analyzed. Gender equality was observed (50% men and 50% women). Average age of 48.77. Meningioma was the most prevalent type of tumor (41.0%). As for location, most tumors were located in the left frontal region (22.7%), but it was observed that tumors in the posterior fossa were more severe. Changes in speech articulation (p=0.002), vocal quality (p=0.007), mobility (p=0.001), sensitivity (p=0.020), tonicity (p=0.003), altered oropharyngeal dynamics (p=0.048) and wet vocal quality (p=0.034) were associated with a worse speech-language profile. Conclusion: The speech-language disorders found and the degree of dysphagia were directly associated with the location of the tumor in the posterior fossa.
Screening for post-stroke depression in a Brazilian stroke center
Authors: Lopes Rônney Pinto , Silva Lohana Santana Almeida da , Freitas Luiza Ramos de , Mendes Natalia Trombini , Freitas Paulo Henrique Maia de , Albuquerque Tamara Melissa Zavadzki , Gagliardi Vivian Dias Baptista , Gagliardi Rubens José
Published: December 2021

Background: Depression is the most common psychiatric complication in stroke patients. Its impact is relevant and implies greater functional impairment, delays in the rehabilitation process and recurrence of cardiovascular events. Objectives: To investigate the prevalence of depression and its association with other comorbidities in post-stroke patients. Design and setting: A cross-sectional, observational study conducted at a specialized outpatient clinic in Sao Paulo, Brazil. Methods: The Patient Health Questionnaire-9 (PHQ-9), a 9-item summed scale, with scores ranging from 0 (no depressive symptoms) to 27 (all symptoms occurring daily), was applied to 134 stroke survivors between September 2019 and February 2020. Demographic and clinical data were obtained using the same structured questionnaire by neurologists. Results: Moderate to severe depression (PHQ-9 ≥10) was present in 40 (29.9%) patients, of whom 55% were female, 70% were overweight or obese (BMI ≥25) and only 27.5% were over 60 years. 80% of patients had some comorbidity: systemic arterial hypertension in 57.5%, diabetes in 32.5%, cardiac arrhythmias in 22.5% and history of heart attack in 5%. Current and past tobacco smoking was found in 67.5% of patients and half of them were current smokers. Conclusions: The prevalence of depression among stroke patients was high in our study and mostly associated with other comorbidities. Our data show the need to actively search for symptoms related to this condition, aiming for early diagnosis and appropriate treatment.
Relationship between sodium disturbances on admission, stroke severity (NIHSS) and functional outcome (mRs)
Authors: Fontes Juliana de Alencar , Freire Gabriel Praxedes , Nascimento Gabriel , Jesus Pedro Antônio Pereira de
Published: December 2021

Background: Hyponatremia is the most common electrolyte disturbance in hospitalized patients and is associated with several unfavorable outcomes, as it promotes cerebral edema and consequent intracranial hypertension. As isn’t clear if there is a causal relationship or if it is only a marker of severity, we described and analyzed the association between sodium disorders, especially hyponatremia, with the severity level of the stroke and the functional condition of discharge of these patients. Methods: We did a cross-sectional study with patients admitted to a stroke unit of a reference hospital in Salvador-Ba between 11/2017 and 03/2020 included in the DISPASS cohort. We classify hyponatremia as serum sodium 145mEq / L. To analyze the association between the variables, Fisher’s exact test was performed. Results: We analyzed 399 patients whose mean age was 62. The mean sodium on admission was 138.2 mEq / L, with 56 patients (14%) with hyponatremia and 11 (3%) with hypernatremia. Among those who had sodium disorders at admission (67), 32 had moderate NIHSS, 24 severe / very severe NIHSS and 11 had mild NIHSS. X² = 2.48, p = 0.443. In addition, of these 67 patients, 13 were discharged and still needed help in daily activities and to walk (mRs 4), 15 were discharged restricted to bed (mRs 5) and 6 died during hospitalization (mRs 6). Therefore, of the 17% who had sodium disorder at admission, more than half had a poor functional outcome. Among those who had hyponatremia (56), 35.7% (20) had severe / very severe stroke, 46.4% (26) had a moderate degree, while only 10 had a mild degree. X² = 1.91, p = 0.53. Conclusions: Although the Fisher Test did not show a significant association (p> 0.05), the frequencies of patients with sodium disorders at admission and classified as having high stroke severity were presented with relevant values, so it is important to carry out further studies to investigate the relationship of these variables.
“EMtenda” University Extension Project: A Health Education Experience on the Experiences of Patients with Multiple Sclerosis
Authors: Paula Larissa Ottoni Estevanin de , Caser Lorenza Carvalho , Almeida Iago Ferreira Pinto , Lemos Vinícius Cunha , Teixeira Lisandra Alves , Tavares Fabíola Cristina Santos
Published: December 2021

Introduction: Multiple sclerosis (MS) is a chronic demyelinating disease of the Central Nervous System (CNS). The clinical manifestations of the disease have a negative impact on the patients’ quality of life, and may affect its functionality due to physical and psychosocial losses. From there, it is understood the need to seek ways to guide health professionals, as well as raise awareness among the general population about the experiences of patients with MS. Objective: this work reports the experience of a tent set up in public spaces in the city of Divinópolis-MG, through the “EMtenda” Extension Project. The project discusses the importance of health education as an active learning tool for participants, through the dissemination of information about the limitations experienced by people with the diagnosis of MS. Experience report: The project took place from 2019 to 2020 and had the support of a multidisciplinary team formed by doctors, physiotherapists, nurses and psychologists. Actions were taken in public spaces in Divinópolis-MG, in which a tent was installed and divided into three stations. Each station simulates neurological symptoms such as paresthesia, diplopia, spasticity, loss of strength in the limbs and ataxia. The simulation is performed through the interaction of the participant with various objects, in which simple activities are tested, such as walking with weight on the lower limbs, palpating objects of different textures with closed eyes, wearing glasses that distort the vision, among others. Each station lasts two to three minutes, allowing the visitor to enter subsequent stations or leave the tent. At the end, the participant receives a brief verbal explanation of the disease by the facilitator and/or through banners installed next to the tent. Conclusion: The project enabled health education for students, professionals and for the general population of Divinópolis-MG, in order to improve the empathy of the participants towards the experiences and limitations of patients with MS regarding the neurological symptoms they experience in their daily life.
Secondary parkinsonism and normal pressure hydrocephaly because of cranioencephalic trauma: a case report
Authors: Pinheiro Renato Serquiz Elias , Soares Emanuelly da Costa Nobre , Figueiredo Maria Eduarda Bezerra , Cicco Stella Mandu , Zuza Anna Beatriz Graciano
Published: December 2021

Context: Normal Pressure Hydrocephalus (NPH) occurs due to the quantitative imbalance of cerebrospinal fluid (CSF), changes in absorption or drainage. It shows idiopathic or secondary etiology. Head trauma (TBI) — which causes brain and/or arachnoid granulations fibrosis and inflammation — impairs CSF reabsorption and induces accumulation in the ventricular system. The diagnosis of sNPH was based on a conjunction of symptoms (e.g.: urinary incontinence, dementia, and gait impairment) and imaging studies. Among the treatments with significant clinical improvement, there are ventriculoperitoneal shunt (VP) and tap test. Case report: FAR, a 74-year old man who was diagnosed with parkinsonian syndrome after 6 months of TBI, showed stiffness, bradykinesia and tremor at rest. In addition, he had CT and Skull MRI. Previous studies suggested PNH. Drug therapy with an optimized dose of Levodopa + Benserazide was established. However, it has shown an unsatisfactory response to antiparkinsonian drugs. Hence, he was submitted to the tap test, obtaining functionality and gait reversion as well as cognitive deficits regression. Those results still remained four weeks after the medical procedure. Conclusions: The work aims to emphasize the importance of a positive tap test response as well as early diagnosis and treatment in the outcome of the morbidity.
Chronic traumatic encephalopathy in practitioners of high- impact sports: a systematic literature review
Authors: Leite Lara Lopardi de Souza , Mendonça Bárbara Gazolla de , Amorim Carolina Falconi , Cruz Flávio Welinton Martins , Portes Gustavo Cosendey
Published: December 2021

Background: The chronic traumatic encephalopathy (CTE) is a neurodegenerative disease, in the class of the tauopathies, related to a repetitive exposure to minor head traumas. Manifests severe behavioural changes and cognitive decline, however it is diagnosed posthumously. Researches demonstrate the frequent occurence of the disease in practitioners of high-impact sports such as boxing and american football. Objectives: The review aims to relate the incidence of CTE in practitioners of high-impact sports. Design and setting: Systematic literature review based on neuropathological findings of sports practitioners in the USA. Methods: Systematic literature review based on quantitative and qualitative data from articles found in the Scielo and PubMed plataforms. Results: In boxing 66% of serious injuries are caused by cranioencephalic impacts and the manifestation of symptoms of CTE often appears in retired professionals with more than 50 years. Furthermore, there is na important correlation between the number of matches and tomographic findings from neuropsychological evaluations. As for the american football, a study published in 2017, with a sample of 93 participants, inferred that the risk of neurodeterioration increases with every 1000 impacts (a game season is equivalent to 545 impacts). Conclusion: The studies demonstrated a direct association between CTE and regular concussions in boxing and american football athlets. Considering the relevance of the theme, it is necessary to expand the studies to support care and preventive measures of this disease or even delay the neurodegeneration, ensuring a better life quality for the athletes.
Vasculitis of the central nervous system secondary to amiopathic dermatomyositis: A case report
Authors: Rolindo Saullo José Silva , Silva Isabela Louise Caldeira , Silva Samuel Campos , Diniz Denise Sisterolli
Published: December 2021

Context: Dermatomyositis (DM) is an idiopathic inflammatory myopathy, characterized by proximal skeletal muscle weakness, associated with a variety of characteristic skin manifestations. A form called Amiopathic Dermatomyositis (AD) is a condition that patients have cutaneous findings characteristic of DM without weakness and/or normal muscle enzymes. In turn, central nervous system (CNS) vasculitis refers to a wide spectrum of diseases that result in inflammation and destruction of the blood vessels of the brain, spinal cord and meninges. Case report: Female, 54 years old, reports for 3 months a progressive myalgia, paraparesis and edema in the proximal region of the lower limbs, evolving in the last weeks with erythematous and itchy lesions on the trunk (in shawl), feet and hands, with subsequent peeling of these (mechanic’s hands). During diagnostic investigation she presented epileptic seizures with behavioral arrest, right hemiparesis and motor aphasia. It evolved with a new stroke in the left frontoparietal region. Bilateral angiography showed points of constriction of segments of the middle cerebral artery bilaterally, compatible with CNS vasculitis. Therefore, with the exclusion of other secondary causes of arteritis, associated with the marker of positive inflammatory myopathy (Anti-Jo1) and CPK within the serum levels of normality, the diagnosis of the stroke secondary to AD was closed. Conclusions: Both CNS vasculitis and AD are rare conditions, characteristically diagnoses of exclusion, deserving to be remembered in clinical cases with singular manifestations, as reported in this case.
myoMIR and gene expression in myofibrillar myopathy
Authors: Perez Matheus Moreira , Alves David Feder, Beatriz da Costa Aguiar , Fonseca Fernando Luiz Affonso , Carvalho Alzira Alves de Siqueira
Published: December 2021

Background: Myofibrillar myopathies (MFM) represent a heterogeneous group of muscle disorders caused by mutations in different genes. It has been identified a group of microRNAs present in muscles named myoMIR. Objective: Evaluate the diagnostic value of these myoMIRs and mRNA expression in skeletal tissue from muscle biopsy of patients with MFM. Design and Setting: Muscle biopsies from 16 MFM patients with mutations in Desmin (DES), Myotilin (MYOT), ZASP, or Filamin C (FLNC) genes, and 18 donors (patients with minimal non- specific changes in muscle biopsy) were included. Study were conducted at FMABC. Methods: mRNA and myoMIR expression from both groups were assessed. The target myoMIRs were MIR1, MIR133a, MIR133b, MIR206, MIR208a, MIR208b, MIR486, and MIR499. Anova and Student’s t-test were performed. Results: Six patients presented mutations in DES, five in ZASP, three in FLNC, and two in MYOT. MIR133b (p=0.05), MIR499 (p=0.027), and mRNA expression was up-regulated in patients with MFM. MIR208a (p=0.042) was higher in the control group. We found an association between MIR133a and the presence of mutations in all genes studied (p=0.006). A relation between MIR486 and mutations in ZASP and DES (p=0.035) was also noted. Conclusions: • MIR208a seems to have a protective function in the muscle fiber; • Heterogeneity could be related to the concentration of gene expression in each patient; • Expression of myoMIRs influences several aspects in the muscle function through genes modulation which are important to myogenesis control;
Impact of pharmacogenetics on aspirin resistance: a systematic review
Authors: Silva Gustavo Figueiredo da , Lopes Bruno Mattei , Moser Vinicius , Ferreira Leslie Ecker
Published: December 2021

Background: Pharmacogenetics promises better control of diseases, such as Cardiovascular disease (CVD). Acetylsalicylic acid, aspirin, prevents the formation of an activating agent of platelet aggregation and vasoconstriction, and it is used to prevent CVD. Nevertheless, patients may have treatment failure, causing recurrence and increased mortality, due to medication adherence, drug- drug interactions, aspirin-independent thromboxane A2 synthesis or genetic variants. In this sense, genetic variants have been related with aspirin resistance (AR). Objective: To evaluate the evidence of impact of genetic variants on AR through systematic literature review. Design and setting: Systematic review. Methods: Articles published since 2009 in MEDLINE/PubMed, Cochrane, Scopus, LILACS and SCIELO were systematically screened. Results: The genetic variants rs1126643 (ITGA2), rs3842787 (PTGS1), rs20417 (PTGS2) and rs5918 (ITGB3) were the most studied. As for the relevance of the genetic variants studied, of the 64 evaluated, 14 had statistical significance (p <0.05, 95% CI) in at least one article. Among them, the following have had unanimous. Results: rs1371097 (P2RY1), rs1045642 (MDR1), rs1051931 and rs7756935 (PLA2G7), rs2071746 (HO1), rs1131882 and rs4523 (TBXA2R), rs434473 (ALOX12), rs9315042 (ALOX5AP) and rs662 (PON1). While these differ in real interference in AR: rs5918 (ITGB3), rs2243093 (GP1BA), rs1330344 (PTGS1) and rs20417 (PTGS2). Conclusion: As limitations of our study, we highlight the non-uniform methodologies of the analyzed articles, as well as population differences. It is also noteworthy that pharmacogenetics is an expanding area. Therefore, further studies are needed to better understand the association between genetic variants and AR, as well as the practical application.
Association between religious practices impact on cerebral neurophysiology and radiological expression: a systematic review
Authors: Sodre Maria Eduarda Japyassu , Bezerra Maria Izabel Wanderley , Costa Juliana Oliveira , Amaral Diego Shelman de souza Rosado , Bahia Vinicius Guedes Lima , Lyra Maria Isabel Dantas Bezerra
Published: December 2021

Introduction: Debates around the correlation between neurophysiological processes and religious habits have gained ground in the research in neuroscience. Objective: To evaluate the impact of religious practices on brain physiology and correlate such behaviors and neuroimaging. Design and setting: It’s a systematic review without metanalysis in PUBMED database. Method: Data carried out in the period 2009 and 2020. Descriptors used: “neural correlates of religious, mystical experience” and “religious belief and neuroimaging”, combined with the Boolean operator “and”. Results: It was noted that the belief is associated with a greater signal in the ventromedial prefrontal cortex, important place for self-representation, emotional associations, reward and goal-directed behavior. Neuroimaging indicated regions associated with these behaviors: pre-cuneiform, anterior insula, ventral striatum, anterior cingulate cortex and posterior medial cortex; nonreligious belief, conversely, registers more signs of memory in the left cerebral hemisphere. Additionally, there is an association between absence of religious practices and depression, anxiety, psychosis, pain disorders; it may have a beneficial impact on the pathogenesis and treatment of these conditions. Conclusion: Although it can be said that the impact exists, more research on the topic is necessary for interventions to have scientific plausibility. The results suggest brain regions involved in religious experience and the phenomenon must be perceived from a multidimensional perspective.
Association between Human Development Index and Delay on Arrival to Stroke Unit
Authors: Suzart Gabriel Souza , Sanchez Ingrid , Guimarães Daniel , Lopes Pedro Augusto Assis , Jesus Pedro Antonio Pereira de
Published: December 2021

Background: Stroke outcomes depend somehow on the time taken from the symptoms onset until arrival to the specialized service. However, as it lacks literature exploring the impact of socio-demographics factors on this time, we investigated the association between Human Development Index and delay on arrival to specialized service. Design and setting: Cross-sectional study from a prospective cohort (PMID=33719516) at Hospital Geral Roberto Santos. Methods: From a total of 454 stroke patients, 156 were included in this study because they had registered address, time of admission and of symptoms onset. Patients had HDI defined by their address and were grouped into HDI categories. Results: In our sample, 57 (36,5%) individuals had medium HDI, 70 (44,9%) high HDI and 29 (18,6%) very high HDI. Very high HDI patients’ delay (2:01; 1:22-2:57) was lower than high HDI (3:05; 2:05-5:26) and medium HDI (2:25;1:45-4:04) patients. There was statistical significance comparing these groups (X²=11,41;p<0,05), but a post-hoc test revealed statistical difference just between the very high HDI and high HDI groups (p<0.05). Conclusions: We expected to find a direct relation between delay on arrival to the stroke service and HDI categories. However, this was not observed. *Authors contributed equally.
Machiafava-Bigmami and Wernicke’s Encephalopathy: Association of two rare conditions
Authors: Salman Dan Mohamed , Barreira Raphael Palomo , Ximenes Marcelo Tognato , Ghisleri Lucas , Gagliardi Vivian , Rocha Antonio Jose da , Gagliardi Rubens Jose
Published: December 2021

Introduction: Both Machiafava-Bigmami disease (MBD) and Wernicke’s encephalopathy (WE) result from hypovitaminosis mainly associated with chronic alcoholism. The former affects the corpus callosum while the latter affects mostly the mammillary bodies. There are two main clinical subtypes for MBD in Heinrich’s classification. In type A the entire corpus callosum is affected and is characterized by acute or subacute lowering of consciousness and pyramidal deficits. A poor outcome is expected even with initial, prompt therapy. Methods: Case study with medical record review. Case report: Female patient, 53 years old, with subacute monoparesis in the right lower limb, progressing to generalized paresis, altered mental status and communication impairment. She reported smoking and chronic alcohol addiction for 30 years. She was emaciated, dehydrated, drowsy, sometimes agitated; she had eye opening to speech, dysarthric, bradypsychic, hypoactive pupils, bilateral evoked horizontal nystagmus, proximal paresis with dystonic posture. Impaired coordination and gait, with no other positive findings. Head-CT showed hypodensity in the corpus callosum, more pronounced in the splenium. Head- MRI indicated signs of abnormal impregnation in the mammillary bodies, cerebellar atrophy in the anterior vermis, diffuse cytotoxic lesion in the corpus callosum compatible with toxic demyelination. Conclusion: Although rare, such conditions must be recognized and treated promptly in order to delay progress and improve prognosis.
Biomarkers in Alzheimer’s disease
Authors: Costa Larissa Maria de Paula Rebouças da , Torres Gabriel de Souza , Madruga Kauan Alves Sousa , Santos Poliana Rafaela dos
Published: December 2021

Background: Alzheimer’s disease (AD) is the most common cause of dementia and cognitive dysfunction in old ages. AD is characterised by beta- amyloid (Aβ) plaques and neurofibrillary tangles of the hyper-phosphorylated Tau protein. It has an extensive preclinical stage, which emphasizes the importance of the biological components related to an early diagnostic: biomarkers. Objectives: After critical analysis of the selected literature, this review has the goal of describing the main biomarkers in AD and discussing different ways of detecting it. Methods: This review was elaborated after a literature review in the PubMed database, with 15 articles published between 2016 and 2021. The keywords were used with the boolean operator “AND”. Articles of meta-analysis, review and systematic review were selected. Results: It was found central biomarkers for the AD diagnostic, such as Tau and Aβ. The following tests were used: CSF puncture; blood tests; neuroimaging; saliva and mucosa samples. Aβ and Tau can be collected by CSF or PET-TC. Conclusions: Biomarkers play an important role in early AD diagnostic, even with limitations in the tests. The CSF and PET-TC are expensive methods, only used in atypical cases of AD. Reliable blood tests remain in development. In conclusion, there’s the need for more studies about alternative diagnostic tests, that are non-invasive and have low cost. Those developments can be beneficial for health plans, helping early diagnosis of AD.
Effects of using cannabidiol on a patient with difficult- tocontrol epilepsy
Authors: Moreira Maria Eduarda , Lira Ana Carolina Soares de , Aragão Bárbara Letícia Barreto Ramos , Suassuna Amuriama , Farias Kelly
Published: December 2021

Introduction: Epilepsies are chronic neurological syndromes, characterized by spontaneous and recurrent crises. It is estimated that there is a worldwide prevalence of 1.0% and that around 30% of patients remain refractory to drug treatment. The active Cannabis plant has been used for medicinal purposes. Extracts with a high CBD content have been shown to be effective in reducing the frequency and severity of epileptic seizures. Objective: To expose the therapeutic effects of CBD and its consequences in a patient with crises that are difficult to control. Methodology: Case study. Results: Male patient, 18 years old, has epileptic seizures that are difficult to control since he was 7 months old. Progressively, he presented loss of motor functions, social and environmental interaction, and even with the combination of antiepileptic drugs, the crises remained uncontrolled. Magnetic resonance examinations indicate hypogenesis of the corpus callosum, volumetric reduction of the cerebellar vermis, increase of the cerebrospinal fluid space, posteriorly displaced brain stem, with volumetric loss. The diagnosis suggests Dandy-Walker and West syndrome. In 2017, it started using CBD and currently has an 85% reduction in crises. There was an increase in personal and environmental interaction, improved levels of concentration and bimanual skills, and began to express emotions and feelings more clearly. Conclusion: CBD represents a promising alternative for epileptic refractory patients to drug treatment, which can prevent the occurrence of brain damage and modify the natural history of the disease and the quality of life.
Simultaneous anterior and posterior circulation stroke secondary to large-vessel atherosclerotic disease associated with persistent trigeminal artery: a case report
Authors: Falcão Fernando Benevides , Silva Guilherme Diogo , Lopes Cesar Castello Branco , Midon Aston Marques , Oshiro Carlos André
Published: December 2021

Context: Cardioembolic events are the main cause of simultaneous anterior and posterior circulation stroke. Anatomical variants of the circle of Willis represent another rare mecanism. Persistent trigeminal artery is a carotid–vertebrobasilar anastomosis related to an increased risk of aneurysms, vascular malformations and stroke. Case report: A 67-year-old diabetic man was brought to the emergency department with a history of sudden onset of left hemiparesis. Neurologic finginds showed a hemiparesis, hemianesthesia and heminegligence (all left sided), right hemiataxia and a dysarthria. Brain Magnetic Resonance study revealed a isquemic stroke in right middle cerebral artery, right posterior cerebral artery (PCA) and bilateral superior cerebellar arteries (SUCA). Computed tomography angiography showed a right internal carotid artery oclusion and a persistent trigeminal artery. Causitive Classification System (CCS) revealed a large-vessel atherosclerotic stroke. A non-habitual simultaneous affection of PCA and SUCA resulted from a carotid artery embolization associated with anterior and posterior territories anostomosis by the persistent trigeminal artery. Secondary prevention consisted of aspirin 100mg/day and cardiovascular risk factor control. The patient remained free from others cardiovascular events, in rehabilitation, at the moment, in category 3 from the Ranking Modified Scale. Conclusions: The presence of a persistent trigeminal artery, in the context of a internal carotid oclusion, can chance our stroke-mecanism interpretation. Simultaneous anterior and posterior circulation stroke are compatible with large-vessel aterosclerotic disease.
Lethality rate in children with meningitis in 2019 and associated risk factors
Authors: Lima Thayane Araújo , Santos Filho Cláudio Brandão dos
Published: December 2021

Background: Early diagnosis, identification of the pathogen and time until the start of adequate antibiotic therapy are important variables that improve the clinical outcomes of meningitis in children. However, even with an early approach and adequate treatment with effective antibiotics, death and neurological sequelae may occur as a result of the infection. Objectives: Determine the lethality rate of meningitis among children aged 0 to 9 years and define the factors associated with mortality. Design and setting: Case-control study based on secondary data from the Notifiable Diseases Information System (SINAN). Methods: It covers the notifications registered in 2019 and includes the variables: deaths, age group, sex, residence in the Legal Amazon or in the Semi-Arid. Statistical analysis - Odds-Ratio (OR) - was performed using Microsoft Excel for Windows®. Results: The deaths of children due to meningitis, in the studied period, totaled 316, which corresponds to a lethality rate of 4.2%. The associated risk factors were: residence in the Legal Amazon (OR = 3.7) and in the Semi-Arid (OR = 2.2). The age group (OR = 1.6) and sex (OR = 1.0) were not associated with death from meningitis. Conclusions: Reside in the Legal Amazon and the Semi-Arid are risk factors justified by the scarcity of resources and the isolation of these regions, resulting in precarious and more delayed health care. This factor culminates in deaths due to the need for early intervention and treatment of meningitis. The low educational rates found in these areas, culminates in poor access to information regarding the importance of vaccination.
Studies across subspecialties of neurology (SON) report noninferiority of telemedicine (TM) compared with face-to-face intervention (FTF-I)
Authors: Fernandez Paulo Eduardo Lahoz , Silva Guilherme Diogo , Mutarelli Eduardo Genaro
Published: December 2021

Background: Studies across subspecialties of neurology (SON) report noninferiority of telemedicine (TM) compared with face-to-face intervention (FTF-I). Clinical scales (CS) are important tools for outcome measures in clinical care. However, which CS in FTF-I can be used in teleneurology is unclear. Objectives: Define the most used CS in studies comparing TM with FTF-I in different SON. Design and Setting/Methods: We searched PubMed and Embase for randomized controlled trials, published from 2011 to April 2021, with Key words ‘’telemedicine’’ cross-referenced with ‘’neurology’’ or neurological diseases, considering the synonyms. Results: 43 eligible studies in 400 records, from 12 countries, with 5600 patients and 8 SON: stroke (10), headache (4), epilepsy (6), cognitive disorders (7), demyelinating diseases (8), movement disorders (3), neuromuscular diseases (3), and vestibular diseases (2). The most used CS: National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) for stroke impairment and limitation; Headache Impact Test (HIT-6) and Migraine Disability Assessment Scale (MIDAS) for headache disability; Quality Of Life in Epilepsy Inventory (QOL-31) for seizure burden; Mini-Mental State Exam (MMSE) and Zarit Burden Interview (ZBI) for cognitive function and caregiver burden in dementia care; Expanded Disability Status Scale (EDSS) and Fatigue Impact Scale (FIS) for disability and fatigue in Multiple Sclerosis; Parkinson’s disease Questionnaire (PDQ-39) and Unified Parkinson’s Disease Rating Scale (UPDRS) for QOL and disability in PD; Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R) for severity in ALS; and Vertigo Symptom Scale Short form (VSS-SF) for vertigo. Conclusions: We present feasible CS usually applied in teleneurology that can be used as important tools for future findings in TM research and practice.
“Brain fog” in the post-acute phase of Covid-19
Authors: Araújo Victor Oliveira , Oliveira Isadora Mônica Ponte de , Freitas Lara Maria de Oliveira Paiva , Santos Júlio César Claudino dos
Published: December 2021

Introduction: Covid-19 infection can affect not only the airways but also other organs such as the brain. Individuals that tested positive for SARSCoV-2 may be asymptomatic, but can also have symptoms - such as “brain fog” - during the acute phase and/or the post-acute phase (being the last ones defined as long haulers). “Brain fog” is a set of symptoms characterized by cognitive dysfunction that includes the inability to concentrate, executive function deficits, anterograde and retrograde amnesia. Objective: Review the pathophysiology of individuals with Covid-19 post-acute phase brain fog. Design and setting: A literature review was conducted on the topic. Methods: 12 original selected articles in English and Portuguese from PubMed and Google Academic databases dated from 2017 to 2021. Results: Research evidenced that 18-36% of the patients hospitalized for Covid-19 that had neurological symptoms also experienced brain fog in the post-acute phase. Although not completely elucidated, there are hypothesized mechanisms to clarify the neurological symptoms in the “long haulers’’ patients, such as the release of pro-inflammatory substances that reduce synaptic fidelity due to dysregulation in the levels of neurotransmitters which are fundamental for brain function. In addition, SARS-CoV-2 provides microthrombus formation and possible small cerebral ischemia. Conclusion: The pathophysiology of brain fog is not yet fully proven, since the literature on the subject is limited. Therefore, more robust research in patients who developed neurological symptoms after infection by the new coronavirus is needed to clarify the pathophysiology, clinical management and most appropriate treatment for individuals with brain fog.
Cognitive repercussions of social isolation in children
Authors: Avelar João Victor Miranda , Castro Gabriela Basílio de , Ferreira Natalia Resende , Castro Bruno Basilio de , Lala Joao Victor Cançado , Duarte Rafael Mourao Dolabella
Published: December 2021

Background: In view of the pandemic of COVID-19, sedentary behavior was increased, especially in the pediatric public, with an increase in the use of digital technology in addition to a reduced practice of physical activities. Recent studies confirm the relationship between sedentary and structural damage to brain mass, with a direct association with an increased time spent in front of a screen. Several regions of the brain were shown to be affected, which can cause functional visual lags, interfere in the patient’s state of attention and verbal memory. Objectives: Review the current aspects of the literature regarding the cognitive repercussions of social isolation in pediatric patients. Methodology: Was performed an integrative bibliographic review in March 2021, in English and Portuguese, using the Scielo and PubMed databases. Results: The brain structure and its functionalism are the result of synchronized genetic and environmental factors. Thus, sedentary behavior can interfere with neuronal function, which, in children, can have irreversible repercussions. This way, the increase in screen time is directly associated with the decrease in the volume of gray matter of the brain in children. The main affected areas are the frontal, parietal, occipital, temporal and cerebellum regions. The use of the internet also showed a relationship with brain atrophy in subcortical regions. In addition, sedentarism reduces cerebral blood flow and synaptic plasticity, culminating in cognitive deficits. Conclusions: Social isolation, aggravated by the COVID-19 pandemic, has the potential to generate serious cognitive repercussions for the sedentary population, especially for children, where injuries can be definitive.
Frequency of arboviruses antibodies in patients with autoimmune encephalitis: data from the BrAIN network (Brazilian Autoimmune Encephalitis Network) Bruna de Freitas Dias, Fábio Fieni Toso, Rene de Araújo Gleizer, Maria Eduarda
Authors: Dias Bruna de Freitas
Published: December 2021

Background: Autoimmune encephalitis (AIE) is the main cause of non-infectious encephalitis and results from the peripheral immune response against cell surface antigens in the central nervous system. The clinical presentations are varied and known triggers are tumors and herpetic infections. Arboviruses Zika (ZIKV), Dengue (DENGV) and Chikungunya (CHIKV) are neurotropic infections that present neurological manifestations whose mechanism is unknown. Objective: Verify the frequency of arboviruses antibodies in patients with autoimmune encephalitis in a Brazilian cohort Design and setting: It is a transversal study performed by Hospital Israelita Albert Einstein in Brazil Methods: Patients who met the criteria for probable AIE (Graus 2016) evaluated at the 18 centers of the BrAIN network were included. Clinical, epidemiological and laboratory data were compiled. Antineuronal antibodies were detected using TBA, CBA and immunoblot in serum and CSF; antibodies against ZIKV, DENGV and CHIKV were detected by ELISA. The cohort was divided into two groups: seropositive encephalitic (SPE) and non-encephalitic (NE) and the frequencies of viral serologies were compared. Results: Among 619 patients included in the BrAIN cohort, serology for arboviruses was performed in 482 patients, being 79 SPE and 99 NE. The SPEgroup showed the following frequency of antibodies: 58.2% anti-NMDA, 7.6% antiLGI1, 6.3% anti-Caspr2, 2.5% anti-GABA B, 1.3% anti-GABA A, 3.8% anti-AMPAr, 1.3% anti-AQ4, 8.9% anti-MOG, 1.3% anti-IgLON5, 7.6% anti-GlyR and 5.1% others. The frequency of serology was IgG DENG (SPE 42.3% X NP 43.4%, p = 0.82); IgG CHIK (SPE 16.5% X 3.1% NP, p = 0.001); IgG ZIKV (SPE31.6% X NP 28.3%, p = 0.62). The frequency of triple positive serology (IgG DENG, ZIKV, CHIK) was 11.39% (SPE X 2.02% NP, p = 0.009). Conclusions: Patients with SPE have IgG CHIKV antibodies most commonly. In addition, they present a higher frequency of positivity for IgG CHIKV, ZIKV, DENGV simultaneously. Future studies should assess the association between arboviruses as a trigger for AIE or as a marker of susceptibility to immunological alteration.
Modulation of the expression of the SLC12A2 gene that encodes the cationic co- transporter NKCC1 in epileptic animals treated with mesenchymal stem cells
Authors: Pinzetta Giulia , Ghilardi Allan Alcará, Isadora , Pimentel Vitoria , Becker Nicole , Provenzi Laura , Leal Gabriel , Zocche Giovani , Rodrigues Felipe , Zanatta Ângela , Marinowic Daniel , Zanirati Gabriele , Costa Jaderson Costa da
Published: December 2021

Introduction: Temporal Lobe Epilepsy (TLE) can be identified by synchronized and rhythmic firing of neuronal populations that results in spontaneous and recurrent seizures in individuals affected by it1 . This type of epilepsy is clinically relevant because of its high incidence and refractoriness rate2,3. Thus, the search for therapeutic alternatives becomes important. Due to its benefits and less invasive administration, the mesenchymal stem cells (MSCs)4 appears as a possible therapeutic alternative, because can stimulate and provide a favorable niche for recovery based on their paracrine activities5 . Objectives: The present work aim to highlight the effect promoted by MSCs on the transcription of mRNA of the NKCC1 gene in the TLE induced by pilocarpine model in rats. NKCC1 plays a role in controlling the potential reversal of current and voltage signals executed by Gamma-aminobutyric acid receptors, contributing to inhibitory GABAergic efficacy6 . Design and setting: Experimental design was held at the Pontifical Catholic University of Rio Grande do Sul. Methods: Bone marrow cells were extracted from donor rats, then cultured and transplanted intranasally in animals induced to status epilepticus by pilocarpine7,11. Results: It was observed the ability of the MSCs to alter the amount of transcripts in the brain of the animals. When analyzing the stratified areas of the brain, an increase in NKCC1 expression12 was observed directly to the amygdalas and hippocampi, which are limbic lobe structures affected in epilepsy. Conclusion: MSCs had a modulatory function in the levels of gene expression of cation- chloride co-transporter NKCC1 during acute phase of epilepsy.
Disordered migration processes and global health: impacts of the displacement of Venezuelans in the midst of the syphilis epidemic in Brazil
Authors: Dantas Jane Francinete , Costa Rosângela Maria Morais da , Oliveira Aliete Cunha , Alcoforado Joaquim Luís Medeiros
Published: December 2021

Introduction: Various territorial crises have marked humanity, causing precarious and irregular population displacements with an impact on the health of the population assigned to the waiting territories. Objective: This study sought to assess the impacts of the recent displacement of Venezuelans, amid the syphilis epidemic in Brazil, in the period from 2016 to 2019. Methods: This was a qualitative study with bibliographic design, in which searches were carried out in the Notifiable Disease Information System (SINAN), in the Virtual Health Library (VHL), in Google Scholar, also going through databases referenced in the health area, such as Latin American Literature in Health Sciences (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Nursing Database (BDENF). Results: The study showed that the disorderly displacement of Venezuelans had an international and local impact, culminating in the precariousness and overload of essential health services, shortage of medicines and supplies, an increase in the number of patients, resurgence of the measles outbreak in Brazil and an increase in the incidence of sexually transmitted infections such as syphilis. It was found that in the SINAN compulsory notification forms, there is no specific field for nationality, which makes it difficult to identify foreigners with syphilis, as well as the planning and monitoring of coping measures. Conclusion: As this is a challenging, conflicting theme, perceived as transversal, with micro-territorial, macro-regional, national and international implications, there is a need for more studies from a transdisciplinary approach to understand, analyze, prospect and provide a structured proposal for confronting the problematic evidenced in this work.
Hospitalizations of the elderly for reasons related to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection, Rondônia, Brazil, 2010-2018
Authors: Burgarelli Welliton Repiso , Serigiolli Luan Acas , Marmentini Gabriel Pandolfo , Gomes Luciano Teixeira , Fontes Cor Jesus Fernandes
Published: December 2021

Introduction: For the elderly, cultural factors and social paradigms predispose to the rejection of condom use, which favors human immunodeficiency virus (HIV) transmission. The North region was the last area for the spread of HIV in Brazil. Rondônia, although with a slight decline in the HIV detection rate in recent years, is still among the states with high mortality rate due to HIV/acquired immunodeficiency syndrome (AIDS) in Brazil. Objective: To describe the demographic and clinical characteristics of the elderly patients who were hospitalized for reasons related to HIV infection in the state of Rondônia, Brazil. Methods: Descriptive study of secondary data recorded from 2010 to 2018. The cause of hospitalization was identified in the field referring to the main and secondary diagnoses of the hospitalization authorization form. Results: Between 2010 and 2018, Rondônia recorded 1,073,932 hospitalizations for any cause in the state’s public hospitals. Out of these, 183,803 (17.1%) were of elderly patients over 60 years of age and 249 (0.13%) were due to HIV/AIDS. There was a progressive increase in the number of hospitalizations during the study period, as well as a predominance of younger elderly men (67.1±6.0 years old). The mean length of hospitalizations was 21.3±21.1 days and 57 (24.1%) elderly patients died. Conclusion: Despite all the progress made in HIV prevention and treatment, the state of Rondônia still has a progressive increase in hospitalizations of elderly people for reasons related to HIV/AIDS. HIV transmission prevention strategies should be emphasized in the elderly population in the state.
Implementación de diferentes técnicas de aprendizaje en temas prioritarios de salud en médicos internos de pregrado
Authors:   Hospital General de Zona No. 58, IMSS, Bautista de Anda Rocío , García Campos Sandra Grissel ,   Hospital General de Zona No. 58, IMSS
Published: December 2021

El internado de pregrado es un ciclo académico donde los alumnos consolidan los conocimientos adquiridos durante su estancia universitaria. Los estudiantes de medicina deben estar preparados para tratar las patologías con mayor incidencia en nuestro país. Sin embargo, las estrategias monótonas de enseñanza no siempre son significativas en su aprendizaje, por lo que se busca incorporar otras más. Entonces, el objetivo de este escrito es analizar si estas técnicas implementadas ayudarán a los médicos internos de pregrado a obtener aprendizajes significativos. Por lo anterior, se llevó a cabo un estudio cuasiexperimental, de 6 técnicas didácticas con 19 estudiantes universitarios, durante 2 meses. El tipo de aprendizaje que predomina en cada uno de los participantes se midió con un cuestionario, este sirvió para identificar al alumno visual, auditivo o kinestésico. Para medir el conocimiento se aplicaron otros más, al inicio y al final del estudio; al finalizar, se identificó que los estudiantes incrementaron sus conocimientos y promedios basales. Por lo anterior, se propone continuar con dinámicas del mismo estilo que contribuyan en el aprendizaje continuo de los médicos en formación.