bluuebunny/crossref_metadata_2025 huggingface dataset:
Early detection and Advanced Targeted Drug Therapies for HER2 positive breast cancer
Authors: Bishoyi Baishakhee , Jaiswal Harshita , Shah Yash , Dikkatwar Manoj , Bindu Radhika
Published: July 2023

HER 2 positive breast cancers are the aggressive subtype of breast cancer which can be treated completely if early detected. According to the National Cancer Institute, localized or stage 1 female breast cancer patients have a relative survival rate of 99% and they can survive for more than 5 years after diagnosis but only 63.1% cases are diagnosed at this stage. In later stages when it's diagnosed, the relative survival rate becomes 29%. The overexpression of HER2 proteins can be detected by early diagnosis and screening through advanced technologies like 3D mammography, Positron Emission Mammography, Molecular breast imaging, Contrast-enhanced mammography. The specific diagnosis can be done by Immunohistochemistry (IHC) and Fluorescence in situ hybridization (FISH) for confirmation of this type of breast cancer. Biomarkers such as Her2 heterogenicity, Her2 expression, Her2 mutations, Hormone receptor (ER positivity, PR positivity), PIK3CA mutation, PTEN, PD-L1, TIL, BRCA, miRNA can be used for detection of breast cancer. With successful early detection, which will be used to diagnose early and start the treatment as early as possible. Recently FDA has approved various individual and combination medications for treating the HER2 positive breast cancer and there are further research studies and clinical trials are going on to get more impactful treatment for providing complete cure of the deadly disease.
Role of Fungal Species Distribution in the Chilli and sesame crop production
Authors: M. D. Manoj , Nanda Anima , Nayak B. K.
Published: July 2023

Fungi are heterotrophic microorganisms; provide very valuable support for the crop production. Especially, soil fungi play a significant role as one of the key decomposers in the soil environments. During our recent work, soil samples of two vegetable crop grounds viz., Green chilli and Sesame were analyzed for the enumeration and isolation of fungal community based on their accessibility apart from the soil texture and nutrient. Altogether 141 colony forming units (CFUs) of fungi were sequestered from the soil sample of both the cultivated crop fields. In fungal composition, total 16 species belonged to 9 genera were documented from the soils of both crop fields. Soil of green chilli field contributed (77%), the maximum fungal inhabitants followed by sesame field soil (23%). Among the isolated fungi, Aspergillus terreus was established as the dominant fungus in green chilli soil but Aspergillus niger was the dominant fungus in sesame field soil. Result clearly specified that in both the crop fields, Populospora and Trichoderma spp were recorded in negligible, which is recognized as a negative sign for the plant growth and in their production rate due to the affect by fungal diseases. The study was further repeated in keeping the seeds of sesame and chilli in the broth culture of Trichoderma sp. for 72 hours to form a mycelial form over the seed and then the seeds were sown and checked the production rate and growth period. Diversity of soil fungi was found higher in the green chilli field as compared to the sesame field which enhances the production rate up to 1.5 fold.
Formulation and Evaluation of Transdermal Gel loaded with Atenolol
Authors: Loya Ankit , K Latha , Basha Shaik Naseeb , Rahman Aisha , Tamkeen Javeria
Published: July 2023

The purpose of this work was to study iontophoretic transport of atenolol from transdermal gel formulations through rat skin. Atenolol transdermal gels were prepared by dispersion method using natural and synthetic polymers and were evaluated for ex-vivo penetration of drug through rat skin using Franz diffusion cell. The optimized formulations F10 and F14 permeability of atenolol at 12 hours was found to be 12.52% and 13.4% respectively whereas the using iontophoresis technique drug release observed were 98.52% at 8 hours and 96.44% at 7 hours for F10 and F14 respectively. Therefore, it can be concluded that iontophoresis showed higher release when compared the gels with or without permeation enhancer (solvents). The skin irritation studies proved that there was no observed edema or erythema. In conclusion, iontophoresis is used to increase the permeation of drugs the skin.
Evaluation of Efficacy and Side Effects of Impairement Liver Function in Psoriasis Vulgaris Patients Treated with Methotrexate in Dr. Soetomo General Academic Hospital Surabaya: A Retrospective Study
Authors: Yunita Ira , Nurul Hidayati Afif , Yulianto Listiawan Muhammad , Ervianti Evy , Utomo Budi , Damayanti Damayanti , Anggraeni Sylvia , Ayu Umborowati Menul , Sigit Prakoeswa Cita Rosita
Published: July 2023

Background: Psoriasis is a chronic inflammatory skin disease that involves several factors, genetic, immunity defects, hormones, and environmental factors. Psoriasis vulgaris is often characterized by a thick, erythematous, well-defined, rough, layered, silvery white plaque. Methotrexate is a first-line systemic therapy in the management of psoriasis vulgaris. This drug effective to reduce the severity of the disease by at least 50% in more than 75% of patients. Unfortunately, methotrexate also has the potential to cause adverse effects, this drug is considered one of the main causes of increased liver enzymes in psoriasis patients for several years so special consideration is needed when prescribing methotrexate to patients. Therefore, periodic evaluation during the use of this drug is needed to find out the side effects that can be caused. Purpose: The aim was to to evaluate PASI, SGOT and SGPT score of psoriasis vulgaris patients who received methotrexate therapy at Dermatology and Venerology Outpatient and Inpatient Clinic Dr. Soetomo General Academic Hospital Surabaya. Methods: This was a observational analytical study with retrospective data through one shot case study pre-experimental study approach, but was conducted pre and post treatment that aimed to evaluate PASI, SGOT and SGPT score of psoriasis vulgaris patients who received methotrexate therapy at Dermatology and Venerology Outpatient and Inpatient Clinic Dr. Soetomo General Academic Hospital Surabaya for the period January 2018-December 2020. Results: The results of this study were 51 psoriasis patients who received methotrexate that include in inclusion criteria. The number of male patients was more than women, 30(58,8%) for men and 21(41.2%) for women. There was a statistically significant difference in the reduction in PASI score of psoriasis vulgaris patients before and after methotrexate therapy (p = 0.001). However, the results of statistical analysis SGOT score of psoriasis vulgaris patients before methotrexate therapy were no different than after receiving methotrexate therapy (p = 0.286). In contrast, the results of statistical analysis SGPT score of psoriasis vulgaris patients after receiving methotrexate therapy increased significantly compared to before receiving methotrexate therapy (p = 0.001). Conclusion: there was significant decrease in PASI scores and significant increase in SGPT scores before and after receiving methorexate therapy. However, for SGOT scores statistically there was no significant difference before and after receiving methorexate therapy.
Analysis of polarization in lifelong education participation and attainment
Authors:   The Korean Society for Lifelong Education, Lee Jeongwoo
Published: July 2023

In this article, patterns of polarization were empirically analyzed in relation to the field of lifelong education by applying the calculation formula suggested by Kim et al. (2020) that can be used to measure degrees of educational polarization. More specifically, this article analyzed patterns of polarization focusing on educational participation and outcomes. Educational participation was analyzed by examining the amount of participation time (average weekly hours), and educational outcomes were analyzed by exploring lifelong learning attainment, lifelong learning competencies, and changes in social awareness, For the analyses, this article used the results of a survey conducted on 2,200 adult males and females between the ages of 25 and 65. Specifically, the differences in the averages of educational participation and outcomes were first analyzed according to the subjects' parents’ monthly income and own income levels. Next, polarization index values for ‘increases in gaps between groups’ and ‘decreases in mobility’ were calculated considering the subjects' parents’ income and own income levels. Based on this, the degree of polarization was explored. An overall degree of polarization was confirmed in both educational participation and outcomes, though there were some differences by sub-components. In particular, it was found that the degree of polarization was stronger in educational outcomes than in educational participation, when analyzed according to own income levels rather than parents’ income levels.
Characterization of Babassu Mesocarp Flour as Potential Bio-Reinforcement for Poly(Lactic Acid)
Authors: Carneiro da Silva Lucas Rafael , Soares Alves Tatianny , Barbosa Renata , Dal Pont Morisso Fernando , Rios Alessandro de Oliveira , Campomanes Santana Ruth Marlene
Published: July 2023

Growing environmental concern has resulted in a strong trend towards using green materials, and the efficient use of by-products reduces resource waste and environmental pollution. Using Babassu Mesocarp Flour (BMF), a by-product of the babassu oil extraction industry, as bio-reinforcement for polymers, such as Poly (Lactic Acid) (PLA), is a promising alternative. Before any attempt to develop composite films, the industrially extracted BMF was characterized to know its chemical composition, particle size distribution, specific surface area, morphology, and structure, which is the main objective of this manuscript. The elemental analysis showed that the BMF is predominantly organic and also showed contents of inorganic elements by XRF. Its particles had an average diameter of 38.82 µm and a specific surface area of 3.02 m2/g. Through microscopic techniques, mainly SEM, starch granules in different shapes and sizes were observed. XRD and FTIR showed structure and functional groups typical of starchy materials, evidencing the ecological character of BMF. Progress is necessary to achieve the continuous and comprehensive use of babassu coconut by-products, mainly BMF, allowing greater appreciation. The characteristics of BMF are of great interest in PLA-based films, as they are green materials and non-toxic to the environment.
A sertéságazat helyzetének bemutatása (jövedelmezőség, hatékonyság)
Authors: Marczin Tamás , Kovács Krisztián , Nagy Adrián szilárd , Vida Viktória
Published: July 2023

Jelen tanulmányban a sertéságazat piaci helyzetét és jövedelemtermelő képességét vizsgáltuk, ehhez kapcsolódóan jártuk körbe az ágazatot. Az ágazati körkép után a sertéstartás jövedelemtermelő képességének bemutatására egy „jó színvonalú termelési gyakorlatot” kívántunk modellezni. Az Eredmények között bemutatásra került, hogy mi jellemzi a naturális ráfordításokat, a termelési költségeket, valamint ezek szerkezetét és összetételét. Megállapításra került, hogy a sertéshús előállítás összes költségének körülbelül kétharmadát a takarmányozási költségek teszik ki, így itt a költséghatékonyság javítása alapvető gazdasági cél. A termelés legfőbb nehézsége a folyamatosan változó felvásárlási ár, amely alapvetően meghatározza, hogy az adott vállalkozás nyereséget vagy veszteséget realizál. Az adatokból levezettük, hogy adott körülmények között hogyan alakulna egy virtuális üzem árbevétele, és megállapításra került, hogy a jelenlegi piaci árak mellett támogatás nélkül nem lehet a sertéságazatban jövedelmet elérni, a virtuális üzem kizárólag az ágazati támogatásnak köszönhetően tudott nyereséget realizálni. Végezetül kereszttábla elemzésekkel szemléltettük, hogyan befolyásolja a termelés hatékonyságát és gazdaságosságát a takarmány ára és a hízó értékesítési ára, illetve a takarmány ára és a takarmányozási együttható. Azt a megállapítást tehetjük, hogy a virtuális üzemünk nehéz helyzetben van, ugyanis ha a fajlagos takarmányhasznosítás minimálisan emelkedik (cp), vagy a takarmányárak növekednek (cp), mindkét esetben veszteséget realizál az üzem külön-külön is. A jelenlegi takarmányárak mellett érdemes fontolóra venni, hogy milyen kompromisszumot kötünk azzal kapcsolatban, hogy teljes mértékben az adott genetika igényeit kívánjuk kielégíteni, ezzel akár magas színvonalú takarmányhasznosulási és jó húsminőségi mutatókat elérve, vagy olcsóbb takarmányokat etetünk, amely a naturális mutatókat ronthatja, azonban költséghatékonyságban kedvezőbb szintet tudunk elérni.
L’ascolto e la partecipazione di bambini e ragazzi come valore aggiunto nelle politiche pubbliche
Authors: Giuliano Giovannina Assunta , Marucci Marco , Piesco Anna Rita , Porcarelli Cristiana , Baldassarre Laura
Published: July 2023

Coinvolgere i bambini e gli adolescenti nelle decisioni che riguardano la loro vita, il loro contesto familiare, la comunità nella quale vivono è fondamentale per poter esprimere il diritto di essere partecipi all’interno di un processo realmente democratico come sancito dalla stessa Convenzione ONU sui diritti dell’infanzia e dell’adolescenza, ribadito dall’Agenda 2030 per lo Sviluppo Sostenibile e dalla Youth2030. Il lavoro, presentato a un anno dal protocollo siglato tra UNICEF Italia e Inapp, è una desk review aggiornata e quanto più possibile esplicativa dei principali indicatori e degli indirizzi sulla materia. Nel testo sono esaminati i più recenti esercizi a livello internazionale, europeo e nazionale che hanno coinvolto o stanno coinvolgendo i bambini e gli adolescenti, alla luce delle strategie europee e nazionali, tra cui la Child Guarantee, delle linee guida e degli atti di programmazione in corso di attuazione. Lo studio, inoltre, intende qualificarsi come propedeutico alla formulazione di una più approfondita analisi che possa dare una lettura dei processi che, su diversi territori del nostro Paese, si stanno implementando con lo sviluppo di politiche pubbliche per/con i bambini e gli adolescenti
The Context of Sir Orfeo in a Miniature Library, Harley 3810, Section I
Authors: Boffey Julia
Published: July 2023

Derek Pearsall wrote influentially about the contexts in which Middle English romances were transmitted, paying particular attention to large manuscript “libraries” offering mixed edification and diversion. Two copies of Sir Orfeo, a romance in which he was especially interested, survive in just such contexts, in capacious anthologies. The third copy, however, in London, British Library MS Harley 3810, section I, is rather different, and has attracted less attention. This article discusses the features of this section of Harley 3810, its relationship to the other sections of the manuscript, and what can be hypothesized about its early readership and circulation. Unlike the other manuscripts in which Sir Orfeo appears, this small-format anthology has the characteristics of a pocket-book.
Texts and the City: William Caxton, Richard Hill, and Metropolitan Conjury
Authors: Thompson John J.
Published: July 2023

Shortly after William Caxton had established his printer’s shop in Westminster, he described himself as a citizen and conjury—the latter a term he seems to have coined in order to describe how seriously he viewed his role and activities as a sworn member of the London Company of Mercers. A generation later, the London Grocer and copyist Richard Hill demonstrated an affinity with the Caxton view on metropolitan citizenship and mercantile values. The survival of a varied collection of Hill’s transcriptions in a single manuscript provides a range of evidence to support this conclusion. Across a thirty-year career as copyist, Hill retained an interest in preserving material he had begun transcribing as a London apprentice and young man. As his career progressed, he augmented his collection with songs, carols, and other miscellaneous informational, didactic, and polite reading materials. Such varied texts represented (for Caxton, Hill, and many of their contemporaries) the metropolitan mercantile tastes and values that Hill wished to preserve, as a citizen and conjury in his own right.
Neurosyphilis - atypical presentation
Authors: Warmling Marine , Alves Emily Tainara Miranda , Vieira Marcella Beghini Mendes , Gomes Lessandra Esper Abdala
Published: July 2023

Neurosyphilis is a disease with high morbidity, whose incidence is alarming. We present a case of syphilis with an atypical neurological presentation, as tabes dorsalis was the most common form in the pre-antibiotic era and is currently uncommon in the antibiotic era. Neurosyphilis can be classified into early and late forms. Early forms usually affect the cerebrospinal fluid, meninges, and vasculature, while late forms affect the brain and spinal cord parenchyma This case demonstrates the great variability of clinical manifestations of syphilis and the importance of maintaining a high degree of suspicion of the diagnosis. MLC, female, 64-year-old. She reports abdominal pain in the lower floor, followed by constipation, urinary retention, hypoesthesia in the right lower limb, being worse in the sella region. Physical examination on admission showed hypopalesthesia in lower limbs, saddle anesthesia, tactile sensory level at T4. In the investigation exams, she presented magnetic resonance imaging of the spine with an image suggesting extensive longitudinal transverse myelitis, with a more central involvement and discreet contrast enhancement. It features VDRL 1:16 and electrochemiluminescence reagent for syphilis, AntiHIV nonreactive. Clear and colorless cerebrospinal fluid with 24 erythrocytes, 94 mm³ leukocytes with a predominance of mononuclear cells (98%) and proteinorrhachia (72.6 mg/dl) and glucose 46 mg/dl, with HGT 86 mg/dl. Once the diagnosis of neurosyphilis is made, the patient is treated with crystalline penicillin for 14 days, and at the end of the treatment there was an improvement in the condition of saddle anesthesia, urinary retention, no longer needing a bladder catheter for relief and improvement in constipation. Thus, since Neurosyphilis is a prevalent disease, its screening should be part of the routine investigation of neurological conditions with a possible infectious etiology.
Neurosyphilis causing bilateral optic perineuritis
Authors: Maffei Rafael Tuzino Leite Neves , Barbosa Adriel Rêgo , Amorim Andre Felipe Candeas , Souza Gabriel Pinheiro Martins de Almeida e , Fraiman Pedro Henrique Almeida , Férrer João Victor Cabral Correia , Faria Victor Cardoso de , Lima Márcio Pinheiro , Azevedo Ruan Gambardella Rosalina de , Matas Sandro Luiz de Andrade
Published: July 2023

Introduction: Optic perineuritis is a rare disorder with multiple possible etiologies, including systemic autoimmune or infectious syndromes and, more rarely, neurosyphilis. The aim of this report is to describe an uncommon manifestation of this reemerging infectious disease. Case report based on a retrospective analysis of the medical records of the patient. Case report: A previously healthy 35-year-old female presented to the hospital with a seven-day history of progressive right eye vision loss and pain on extraocular movement, with development of a pink maculopapular rash on the trunk. On the sixth day of her disease, similar symptoms appeared in the contralateral eye. Physical examination showed reduced fotomotor reflex and finger counting at 50 cm in both eyes. Magnetic resonance imaging revealed bilateral and circumferential thickening with enhancement of the optic nerve sheath, suggesting bilateral optic nerve perineuritis. Serum Venereal Disease Research Laboratory (VDRL) was 1/64 and cerebrospinal fluid (CSF) showed 440 cells (86% lymphocytes), proteins 97 mg/dL, glucose 47 mg/dL, lactate 21 mg/dL and VDRL 1/4. She was treated with IV crystalline penicillin for 21 days and had partial improvement of bilateral vision within two months. At follow-up, her visual acuity was 20/40 in the right eye and 20/100 in the left; her CSF normalized, with nonreactive VDRL. Conclusion: Neurosyphilis is a treatable cause of optic perineuritis, and its recognition is important to establish the right antibiotic treatment.
Effects of transcranial magnetic stimulation on the working memory of people with multiple sclerosis
Authors: Bando Mauricio Ossamu , Dias Alice Estevo , Telles Juliana Aparecida Rhein , Sciarini Bruna Helena , Agourakis Demetrios Chiuratto , Vidigal Giovanna de Paula , Caetano Andre Virgilio dos Santos , Monteiro Carlos Bandeira de Mello , Silva Talita Dias da
Published: July 2023

Introduction: Multiple sclerosis (MS) causes various cognitive symptoms. Transcranial magnetic stimulation (TMS) is a resource used for stimulation. Objectives: To evaluate the effects of TMS on the working memory of people with MS. Methods: A double-blind crossover study was carried out with 29 people diagnosed with MS (18 relapsing-remitting, 6 primary progressive and 5 secondary progressive), aged between 29 and 68 years (mean = 47.2, standard deviation [SD] = 10.9 years), 9 men (31%) and 20 women (69%), with EDSS from 0 to 6.5 (mean = 4.3 and SD = 1.85) and diagnosis time between 1 and 24 years (mean = 9.5 and SD = 6.57 years). The active group received 10 TMS interventions (primary motor cortex (Cz): 10Hz, 50 pulses per time, 30 trains, 20 seconds apart, totaling 1,500 pulses at 90% of the resting motor threshold and pre -left dorsolateral front (F3): 10 Hz, 50 pulses per train, 40 trains, 20 second interval, totaling 2,000 pulses at 110% of resting threshold) for 10 consecutive working days. The sham group received the inactive TMS and participated in the physical activities. After 30 days, there was an inversion of the active and sham groups for a new sequence of 10 days. For evaluation, an interview was conducted for data collection and the subtest Digits of the Wechsler Intelligence Scale (WAIS-III) was applied at the beginning and end of the stimulations. The chi-square test was used for statistical analysis. Results: 55.2% of people who received active TMS improved, against only 27.6% of people who received sham TMS. This difference was significant with P = 0.033. Conclusion: TMS appears to be an important resource for treating the working memory of people with MS. This result may encourage further research.
Super-refractory status epilepticus after intoxication by quetiapine and carbamate
Authors: Lima Márcio Pinheiro , Maffei Rafael Tuzino Leite Neves , Fraiman Pedro Henrique Almeida , Férrer João Victor Cabral Correia , Barbosa Adriel Rêgo , Faria Victor Cardoso de , Souza Gabriel Pinheiro Martins de Almeida e , Azevedo Ruan Gambardella Rosalina de , Uenishi Lucas Toshio , Silva Gisele Sampaio
Published: July 2023

Introduction: Quetiapine, an atypical antipsychotic, works through the agonism of multiple brain receptors, including dopaminergic, serotonergic, and adrenergic receptors. Compared to typical antipsychotics, quetiapine has a more favorable profile of adverse reactions. Myoclonus is infrequent. However, there have been reports of quetiapine overdose associated with generalized myoclonus. Electroencephalogram (EEG) modifications linked to the use of quetiapine are unusual. Aldicarb, commonly known as ‘chumbinho’ in Brazil, is a carbamate used as a rodenticide. Its toxicity is caused by the inhibition of acetylcholinesterase. A few reported cases of myoclonus related to its use may be due to the anticholinesterase effect causing hyperactivity. This is a case report based on retrospective analysis of the patient’s records. Case report: A 23-year-old woman was admitted after a suicide attempt by ingesting carbamate and quetiapine 36 hours after the attempt. Her initial symptoms were vomiting and sialorrhea, followed by generalized tonic-clonic seizures and coma. At admission, she was already sedated with midazolam, with her last tonic-clonic generalized seizure two hours earlier. Her pupils were myotic, with persistent tachycardia and diffuse muscular hyperexcitability – clonic movements were evoked with minimal stimuli. Brain imaging and cerebrospinal fluid analysis showed no alterations. A loading dose of 20 mg/kg of phenytoin was administered. Upon admission, an EEG showed status myoclonus. Midazolam was then titrated to 0.8 mg/kg/h, and clobazam (30 mg/day) and levetiracetam (1.500 mg/day) were added, with resolution of the status epilepticus after three days. Conclusion: Status epilepticus should be considered a possible presentation of quetiapine and carbamate intoxication.
Gradenigo’s syndrome: an old, but still alive, cause of sixth nerve palsy
Authors: Fraiman Pedro Henrique Almeida , Maffei Rafael Tuzino Leite Neves , Lima Marcio Pinheiro , Ferrer João Victor Cabral Correia , Barbosa Adriel Rêgo , Faria Victor Cardoso de , Souza Gabriel Pinheiro Martins de Almeida e , Azevedo Ruan Gambardella Rosalina de , Ferraz Maria Elisabeth Matta de Rezende
Published: July 2023

Introduction: Gradenigo Syndrome is characterized by suppurative otitis media, pain in the distribution of the trigeminal nerve, and abducens nerve palsy. Sixth nerve palsy is secondary to nerve entrapment through the Dorello canal, petroclinoid ligament and petrous apex of the temporal bone. It is a report of a single case based on a retrospective analysis of the patient’s medical records. Case report: A 12-year-old girl was admitted due to new-onset binocular horizontal diplopia, worse with far vision, and right-side headache. She also complained of otalgia and fever for one week before admission. She has an unremarkable past medical history and up-to-date vaccination. On her neurological examination, she was alert and oriented, there was right eye abduction palsy, reduced right corneal-palpebral reflex and pain in the distribution of the right ophthalmic branch of the trigeminal nerve; meningeal irritation signs were absent. Otoscopy revealed a tender right tympanic membrane. Brain and ear computed tomography revealed abnormal right temporal petrous apex aeration and opacification of the petromastoid air cells. Brain and ear magnetic resonance imaging show abnormal hyperintensity compatible with right petrous apicitis. Gradenigo syndrome secondary to otitis diagnosis was made. An empirically-guided intravenous antibiotic was started and a myringotomy tube was placed by the ENT team. The culture of the middle ear revealed a Streptococcus pneumoniae infection. The patient was discharged after 14 days with an improvement in neurological symptoms. Conclusion: Gradenigo syndrome is a cause of sixth nerve palsy. The syndrome is classically described after suppurative otitis media, but it has already been described after complications of trauma and skull-base metastases. Nowadays, it is more uncommon due to early and widespread treatment with antibiotics to avoid complications of otitis media.
Case report: motor neurone symptoms as initial clinical manifestation in a patient with Creutzfeldt-Jakob disease
Authors: Pereira Camila Alves , Barbosa Alana Strucker , Moreira Vanessa de Freitas , Farias Igor Braga , Serrano Paulo de Lima , Badia Bruno de Mattos Lombardi , Oliveira Hélvia Bertoldo de , Chieia Marco Antônio Troccoli , Pinto Wladimir Bocca Vieira de Rezende , Souza Paulo Victor Sgobbi de , Oliveira Acary Souza Bulle
Published: July 2023

Female, 54-year-old, began with weakness in her right hand and loss of dexterity. Four months after initial symptoms, patient developed sudden onset vertigo. She progressed with difficulties in coordination, dystonic posture and involuntary movements in her right arm. Family also reported insomnia and cognitive impairment. Ten days later, she had no recognition of family members, and developed myoclonia. After two weeks, progression of ataxia rendered her unable to walk and she also had urinary incontinence. Neurological examination revealed perseveration of speech, oculomotor apraxia, severe gait and limb ataxia, intention tremors and generalized hiperrreflexia. She had marked tenar, first dorsal and palmar interosseus amyotrophy. Video-EEG showed markedly disorganized activity and generalized periodic complexes. Neuroimaging had no signs of spinal cord suffering. Electroneuromyography showed preganglionic chronic neurogenic involvement in cervical and lumbosacral myotomes, and acute denervation bilateral of C5–C7. Cerebrospinal fluid examination showed discrete hyperproteinorraquia and positivity for protein research 14-3-3. Genetic testing showed M129M variant in the PRNP gene. Brain tissue neuropathology revealed histologic spongiform encephalopathy associated with reactional gliosis and neuronal loss. Creutzfeldt-Jakob disease is a rare neurodegenerative disease caused by prion propagation. It has been mainly associated with central nervous system involvement, but lower neuron signs have been described. We report a case of motor neurone symptoms as initial clinical manifestation of Creutzfeldt-Jakob disease.
Prolactinoma compromising visual acuity and causing adrenal insufficiency in a young male patient: case report and literature review
Authors: Santos Vanessa Gil Humberto dos , Bastos Rafaella Antunes , Dumas Nathalia Brito , Carvalho Luiza Lopes , Moreira Laís Bornéo , Ribeiro Vitória de Sousa Cardoso
Published: July 2023

This article reports on a case study of a 27-year-old male patient with prolactinoma, a pituitary adenoma that secretes prolactin, leading to a loss of visual acuity. The data were obtained from the patient’s clinical history, as well as complementary exams and procedures. The article emphasizes the importance of correct and early diagnosis, particularly in young patients, as the patient in this case had a relevant family history of brain tumors and experienced a year of symptoms before diagnosis. The patient was diagnosed with prolactinoma after a canon magnetic resonance imaging revealed a macroadenoma pressing on the optic chiasm, causing visual complaints, weight gain, milk production, and erectile dysfunction. The patient’s serum prolactin level was higher than 200 ng/mL, and he began treatment with Cabergoline after discovering adrenal insufficiency. While the patient reported an improvement in symptoms after two months of medication, his vision did not return. The report highlights the importance of proper screening and thorough evaluation, including atypical patients who may not fit the typical epidemiology of the disease. It took a year of research in the ophthalmological area to realize that the patient’s symptoms were neurological, and this delay in diagnosis may have allowed complete blindness in the left eye and progression with mild symptoms in the right eye. However, proper treatment led to significant improvement in symptoms. In conclusion, the article emphasizes the importance of early and assertive diagnosis, particularly in young patients, whose complaints are often neglected. The case study illustrates the consequences of delayed diagnosis and the need for a complete anamnesis and correct screening.
Sleep disorders and degree of disability in patients with multiple sclerosis
Authors: Dias Tereza Cristina Batista , Neres Maria Julimere Alexandre , Almeida Fabricia dos Santos , Dunga Lucas Medeiros , Araujo Ana Luiza Bezerra de , Beserra Eric Cymon do Vale , Melo Neto Fernando de Paiva , Dantas Iury Hélder Santos , Oliveira Bianca Etelvina Santos de
Published: July 2023

Introduction: Multiple sclerosis (MS) is a chronic disease that manifests through neuronal inflammation and demyelination. Patients exhibit symptoms that can reduce their physical and mental well-being, including worsened sleep quality. Objectives: To verify if there is a relationship between the level of Expanded Disability Status Scale (EDSS) and sleep quality in patients with MS. Methods: This is an observational, field and documentary study with a crosssectional, descriptive, and quantitative approach. Sociodemographic parameters were evaluated, as well as the relationship between chronic use of Interferon Beta 1a and sleep disorders assessed by the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Results: A hundred and twenty nine people were observed, subjected to inclusion and exclusion criteria, and 90 patients were selected. After analysis, a predominance of women (78.78%) was noted. The most commonly used drug was Interferon Beta 1a, which showed excessive daytime sleepiness in 5% of patients when compared to the control group. When sleep pattern was investigated through PSQI, the score was 9.1, with a prevalence of poor sleep reaching 67.78%. No correlation was observed between EDSS and poor sleep quality, with EDSS values ranging from 0 to 6, totaling an average of 2.4. In addition, EDSS was observed in 21% of patients, but a negative relationship between EDSS and ESS was found. Conclusion: The prevalence of poor sleep and excessive daytime sleepiness in the studied population was evidenced. The research was limited by the target audience with recurrent-intermittent MS, which may explain the lack of correlation between variables. This opens up space for possible investigations of other progressive forms of MS and their relationship with sleep disorders.
Multiple sclerosis associated with adalimumab treatment in psoriatic arthritis: a case report
Authors: Fernandes Lucca Ferdinando Queiroz , Guimarães Matheus Procópio , Silva Diógenes Emanuel Dantas da , Carvalho Pedro Henrick Guimarães , Dantas Iury Hélder Santos , Lima Junior Daniel Vicente de Siqueira , Villarim Luíza Alves Monteiro Torreão , Oliveira Bianca Etelvina Santos de
Published: July 2023

Introduction: Tumor necrosis factor (TNF) antagonists have emerged as one of the most effective treatment options for patients with autoimmune diseases, including psoriatic arthritis. However, these agents carry a risk of severe adverse effects, including demyelinating disorders. The aim to report a case of multiple sclerosis associated with the use of adalimumab. This is a case report study. The information of this work was obtained through review of the medical record. Case report: A 40-year-old female with psoriatic arthritis on adalimumab (ADM) treatment. She developed paresthesia in her lower limbs, which was initially attributed to anxiety. Six months later, she presented with decreased visual acuity in her left eye, which was diagnosed as optic neuritis. She received pulse therapy with methylprednisolone and underwent investigation for multiple sclerosis (MS). Magnetic resonance imaging (MRI) of the brain revealed multiple lesions with high signal intensity in T2/FLAIR on periventricular regions bilaterally. Furthermore, MRI of the thoracic spine showed high signal intensity on posterolateral cords at levels T5 to T9. These findings fulfilled the revised McDonald Criteria for MS and suggested a link to ADM treatment. On neurological examination, mild left lower limb paresis, bilateral plantar-cutaneous reflex, hyperreflexia in the lower limbs, and mild hypopalesthesia in her right leg. ADM treatment was discontinued, and although she reported a slight worsening of her skin condition, there were no further signs of psoriatic arthritis. Conclusion: Neurological adverse events associated with TNF antagonists are rare but must be considered. If neurological disorders develop during therapy, prompt discontinuation of the drug is recommended.
Melatonin: a safe and effective treatment for rem sleep disorder in an elderly patient - a case report
Authors: Fernandes Lucca Ferdinando Queiroz , Nóbrega Rafael Palmeira Araújo Medeiros , Pereira João Victor Gregório de Azevedo , Jales Maria Clara de Araújo , Araújo Maria Clara Medeiros , Dunga Lucas Medeiros , Medeiros Neto Francisco Belisio de , Dantas Iury Hélder Santos
Published: July 2023

Introduction: REM sleep disorder is a parasomnia characterized by the loss of atonia during REM sleep, resulting in dream enactment behavior. It is commonly associated with dementia with Lewy bodies (DLB) and is prevalent in up to 90% of individuals with this condition. Treatment for REM sleep disorder typically involves a combination of antipsychotics and melatonin, which can regulate sleep and reduce symptoms. The aim is to report a case of using melatonin for REM sleep disorder in an elderly patient. This is a case report study. The information of this work was obtained through review of the medical record. Case report: A 87-years-old female with DLB. After 36 months of dementia onset, the patient experienced dysregulation of the sleep-wake cycle, with nocturnal awakenings, visual hallucinations, and vocalizations and complex motor behaviors during REM sleep. The patient was initially prescribed olanzapine 5 mg once a day, which led to three episodes of dysregulation per week. Clonazepam 0.5 mg was added to the treatment, in combination with environmental measures and maintenance treatment for DLB, resulting in two episodes per week. After three months, clonazepam was replaced by melatonin 3 mg, which led to a reduction in episodes to five per month. The dosage of melatonin was later increased to 6 mg, which reduced the frequency of dysregulation to three episodes per month. Olanzapine was eventually replaced by quetiapine 25 mg once daily, leading to only one episode per month. Conclusion: Melatonin was found to be effective in reducing agitation and other symptoms without causing any side effects in the patient. It is important for healthcare professionals to consider the use of melatonin in the treatment of REM sleep disorder, particularly in elderly patients.
Impact of obstructive sleep apnea in imediate outcomes of stroke patients: a transversal study
Authors: Novais Aurea Maria Lago , Rogério Beatriz Santos , Branco Renan Carvalho Castello
Published: July 2023

Introduction: Obstructive sleep apnea (OSA) is a disease of upper airways, diagnosed with polisomnography, that is well associated with stroke through diverse mechanisms. Despite this, it still is not clear about the impact of this disease in the prognosis of the patients, especially in immediate outcomes. Objectives: This study aims to elucidate the impact of high risk of obstructive sleep apnea in immediate outcomes of stroke patients. Methods: We performed a transversal study, part of a cohort of stroke patients. Patients were evaluated of risk of OSA with STOP-BANG and SOS scores. We compared hospitalization time, CTI time, hemorragic transformation, type of hemorragic transformation, infection, delirium, new stroke and death during hospitalization between high/moderate risk and low risk of OSA using T test, Mann-Whitney or chi-square. Results: We obtained 190 patients. Considering STOP-Bang, we obtained significance with delirium (P < 0.001), infection (P < 0.001) and death during hospitalization (P = 0.04). Considering SOS score, we obtained CTI time (P < 0.001). Conclusion: The important role of OSA in death during internment was clear with the results of this study. Other outcomes that can lead to death or increase the risk of death, such as the infection itself and CTI time, were essential. Thus, it is imperative that we need to be aware of these questions, in order to reduce CTI time in adequate condition, so we can have better outcomes in this type of patient.
Extraction and nutritional characterization of baru almond (Dipteryx alata Vog.) water-soluble extract
Authors: SILVA Herberth Diego Martins da , SANTOS Fabrício Carrião dos , ANDRADE Bruna Ribeiro Pontes de , PERFEITO Danielle Godinho de Araújo , SIQUEIRA Ana Paula Silva
Published: July 2023

This study aimed to evaluate different techniques to obtain the baru water-soluble extract and characterize the most advantageous extract in the production stage. The first part of the experiment was carried out in a factorial scheme (3 × 2) for 24 h. The almonds were used under three physical conditions: A1) raw skin; A2) toast with film; and A3) toast without film, evaluated at two absorption temperatures (25 and 80 °C). The almonds were assessed regarding the percentage of water absorption and water absorption time. After weight stabilization, the extract was obtained and evaluated. The best treatment in this productive stage, considering technological aspects, was nutritionally evaluated in macronutrients and micronutrients. The baru water-soluble extract obtained showed characteristics similar to cow’s milk in physical terms. Regarding macronutrients, about 90% of the product is water. The other 10%, in descending order of quantity, are lipids, proteins, carbohydrates, and mineral matter. The mineral composition that deserves to be highlighted in the extract is copper, iron, and zinc. Therefore, it is possible to obtain water-soluble baru extract with a good yield and good physical and nutritional aspects using roasted baru almonds without skin.
Bir İlçedeki Sağlık Çalışanlarının Otizm Spektrum Bozukluğu Hakkındaki Bilgi Düzeylerinin İncelenmesi
Authors: AKDAĞ Berhan
Published: July 2023

Amaç: Otizm spektrum bozukluğu küresel boyutta önemli bir halk sağlığı sorunu hâline gelmiştir. Otizm spektrum bozukluğunun klinik seyri, sağlık çalışanlarının erken teşhis koyma ve müdahale etme becerisine bağlıdır. Bu nedenle sağlık alanında çalışan profesyoneller, otizm spektrum bozukluğunun semptomlarını tanıma ve gerektiğinde sevk etme bilgi ve yeterliliğine sahip olmalıdır. Bu çalışma, sağlık çalışanlarının çocuklarda otizm spektrum bozukluğuna ilişkin bilgi düzeylerini ve bilgi düzeylerini etkileyen faktörleri belirlemeyi amaçlamaktadır.
Yöntem: Çalışma, kesitsel ve tanımlayıcı tiptedir. Çalışmanın örneklemini Silifke ilçesinde görev yapmakta olan sağlık çalışanları (n=269) oluşturmaktadır. Veriler, sosyodemografik veri formu ve Sağlık Çalışanlarının Çocukluk Çağı Otizmi Hakkında Bilgisi Anketi yoluyla toplanmıştır. Tanımlayıcı istatistikler; ortalama, standart sapma ve yüzde olarak verilmiştir. Ölçek puanlarının demografik verilere göre farklılıkları Student’s t-testi ve tek yön ANOVA testi ile değerlendirilmiştir.
Bulgular: Sağlık çalışanlarının ölçek puan ortalaması 12.36 ± 4.14’tür. Hekim, hemşire ve ebelerin puan ortalamaları diğer sağlık çalışanlarından anlamlı derecede yüksektir. Ayrıca otizm hakkında eğitime katılmış ve daha önce otizm şüphesiyle yönlendirme yapmış olan sağlık çalışanlarının ölçek puanları diğerlerinden anlamlı derecede yüksektir.
Sonuç: Mevcut çalışma, sağlık çalışanlarının otizm spektrum bozukluğu hakkındaki bilgilerinin istenen düzeyde olmadığını göstermektedir. Bu nedenle sağlık çalışanlarının lisans eğitimi sürecinde otizm spektrum bozukluğuna daha geniş yer ayrılmalı, sağlık çalışanlarına yönelik farkındalık artırıcı eğitimler düzenli aralıklarla tekrarlanmalıdır.
INTERACTIONS BETWEEN SUBSTANTIVE AND PROCEDURAL OBLIGATIONS IN PREVENTING ENVIRONMENTAL HARM
Authors: WU YANGFAN
Published: July 2023

I examine the preventionprinciple- one of the most important principles in international environmental law,in its internal structure and interaction mechanisms. I analyze respectively therequirements of the substantive and procedural obligations of the principle, as well as their connections throughrelevant environmental disputations such as the ‘Pulp Mills’and‘Certain Activities’case and international environmental conventions like the CBD and UNFCC.I conclude that substantive obligations act as guidance, while procedural obligations play an indispensable complementary role. Through the interactions, the prevention principle can thus provide clear instruction for courts tomake decisions inenvironmental pollution cases and for countries to perform their obligations in relevant affairs.
O ENFERMEIRO DIANTE DA CONSULTA DE PRÉ-NATAL: ATENDIMENTO A GESTANTE PORTADORA DE SÍFILIS
Authors: Vieira da Silva Ana Cristina , Alves Ribeiro Wanderson , De Paula Enimar
Published: July 2023

A sífilis em gestantes é considerada um elevado problema de saúde pública, requerendo diagnóstico e tratamento adequado. A qualidade da assistência prestada no pré-natal pelo enfermeiro, durante a gravidez e o parto, é considerada um importante determinante da redução da transmissão da sífilis. O trabalho tem como objetivo geral descrever a assistência, conhecimento e prática do enfermeiro a gestante portadora de sífilis durante o acompanhamento pré-natal. Trata-se de uma revisão bibliográfica de caráter descritivo e abordagem qualitativa, com análise de literaturas científicas que nos remetam ao objeto de pesquisa. Utilizamos como critérios de seleção da literatura, artigos completos, publicados em português, no período de 2018-2022. A partir dessa leitura preliminar, foram selecionados 11 artigos que mantinham coerência com os descritores acima apresentados e com objetivo do estudo. Os resultados dividiram-se em 2 categorias: desafios enfrentados pelo enfermeiro durante o pré-natal da gestante com sífilis; plano estratégico para prevenir e reduzir um agravamento ou avanço dos casos de sífilis durante o pré-natal. Portanto, é fundamental que os enfermeiros se dediquem integralmente aos cuidados com a gestante, durante o pré-natal, no que diz respeito à sífilis, incluindo medicação e conscientização, informando-a da importância de iniciar o tratamento o mais cedo possível para evitar a evolução negativa que a sífilis pode provocar durante a gravidez, tire todas as suas dúvidas e converse com a participação do seu parceiro, pois se o parceiro também for portador da doença, pode causar reinfecção na gestante e tornar ineficazes todos os tratamentos dados a ela.
IDIOMATIC EXPRESSIONS IN TAYLOR SWIFT’S SONGS ON THE ALBUM EVERMORE
Authors: Kondoalumang Siti R , Olii Sanerita T. , Sanger Maikel B. G.
Published: July 2023

This study aims at identifying and describing the idiomatic expressions found in Taylor Swift’s songs on the Evermore album. This study was a descriptive qualitative study that used note-taking and literature review as the means of collecting the data. The primary data of this study were taken from the lyrics of 4 songs in Taylor Swift’s Evermore album. The researcher also used secondary data such as academic articles, books, and various websites in conducting this study. The data were then analyzed using the content analysis technique proposed by Miles and Huberman. The result showed that there are 21 idioms found in Swift’s song lyrics in the Evermore album. Based on its types, there are 2 proverb idioms, 8 phrasal compound idioms, 9 tournures idioms, and 2 simile idioms. Those idiomatic expressions are used to express the problem in life and the problems in love faced by the character in the songs.