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RESUMO Introdução: A rabdomiólise é uma síndrome resultante da desintegração do músculo estriado que cursa com mialgia, astenia e colúria, sua tríade clássica. Tem como causas mais comuns o estresse muscular excessivo. Na base de dados Scielo e Pubmed não foi encontrado literatura que compare o trabalho de parto ao exercício físico, mas considerando fatores inerentes ao trabalho de partoassociados ao esforço físico, podemos inferir e caracterizá-lo como um exercício físico, visto que este também provoca estresse muscular. Objetivo: Relatar caso de rabdomiólise após trabalho de parto extenuante, com intuito de alertar sobre a prevenção, sintomas e seus fatores de risco, visando diagnóstico e tratamento precoces, melhorando o prognóstico das pacientes. Descrição do caso: Primigesta, 30 anos, 41 semanas e 5 dias, sem comorbidades, deu entrada no Hospital Unimed na cidade de Macaé/RJ com quadro de amniorrexe prematura. Após dezoito horas de trabalho de parto foi indicado cesariana por exaustão física, a pedido da paciente e de seu esposo. Durante sondagem vesical foi observada colúria, sendo realizada hidratação vigorosa com cristaloides e furosemida venosa, tendo o procedimento ocorrido sem intercorrências. Solicitados exames para elucidação diagnóstica, apresentou alterações que confirmouquadro de rabdomiólise. No pós-operatório apresentou quadro de intensa mialgia e astenia, tendo alta hospitalar no quinto dia pós-parto após melhora progressiva. Conclusão: A rabdomiólise deve ser considerada no diagnóstico diferencial de quadros de mialgia, astenia e colúria no pós-parto, permitindo seu tratamento imediato, reduzindo assim complicações renais e a comorbidade materna. Palavras-chave: Rabdomiólise, Trabalho de parto extenuante, Colúria

Background Mobility restrictions and overloaded health services during the COVID-19 pandemic compromised services dedicated to the prevention and care of HIV and other sexually transmitted infections (STI). In this study, we present client’s responses to standardized questionnaires applied during the COVID-19 pandemic period as part of the strategy to measure impacts on social and sexual vulnerability, access to STI prevention services, and access to STI care. Methods: The questionnaires included variables on sociodemographics, behavior, risk perception, prevention attitudes, barriers to service-based HIV rapid test, reasons for taking an HIV self-test, and access to health services for STI diagnosis and treatment. We explored demographic variables associated with income reduction, reduced access to HIV/STI testing/treatment and increased vulnerability to HIV/STI. Results: 847 participants responded to the study questionnaire between May 2020 and January 2021. Most were young, cisgender male, and 63% self-reported as men who have sex with men. Income reductions were reported by 50%, with 30% reporting a decline over 50% of total income. An increase in heavy episodic drinking (>5 doses) was reported by 18%; 7% reported more sexual partners and 6% reported using condoms less often. Difficulties in obtaining HIV tests, tests for other STI and treatment for STI were reported by 5%, 6% and 6%, respectively. Lower schooling was significantly associated with income reduction (p = 0.004) and with reduced access to HIV/STI testing or STI treatment (p = 0.024); employment status was associated with income reduction (p < 0.001) and increased vulnerability to HIV/STI (p = 0.027). Having access to an expedite test result, avoiding physical attendance in health units during the pandemic, and undertaking the test with privacy with a trusted person were reported as motivators for HIV self-test. Conclusions: Our findings are relevant to promote service improvements tailored to subgroups more likely to struggle with detrimental effects during and after the COVID-19 pandemic.

Summary Background Temperature and rainfall patterns are known to influence seasonal patterns of dengue transmission. However, the effect of severe drought and extremely wet conditions on the timing and intensity of dengue epidemics is poorly understood. In this study, we aimed to quantify the non-linear and delayed effects of extreme hydrometeorological hazards on dengue risk by level of urbanisation in Brazil using a spatiotemporal model. Methods We combined distributed lag non-linear models with a spatiotemporal Bayesian hierarchical model framework to determine the exposure-lag-response association between the relative risk (RR) of dengue and a drought severity index. We fit the model to monthly dengue case data for the 558 microregions of Brazil between January, 2001, and January, 2019, accounting for unobserved confounding factors, spatial autocorrelation, seasonality, and interannual variability. We assessed the variation in RR by level of urbanisation through an interaction between the drought severity index and urbanisation. We also assessed the effect of hydrometeorological hazards on dengue risk in areas with a high frequency of water supply shortages. Findings The dataset included 12 895 293 dengue cases reported between 2001 and 2019 in Brazil. Overall, the risk of dengue increased between 0–3 months after extremely wet conditions (maximum RR at 1 month lag 1·56 [95% CI 1·41–1·73]) and 3–5 months after drought conditions (maximum RR at 4 months lag 1·43 [1·22–1·67]). Including a linear interaction between the drought severity index and level of urbanisation improved the model fit and showed the risk of dengue was higher in more rural areas than highly urbanised areas during extremely wet conditions (maximum RR 1·77 [1·32–2·37] at 0 months lag vs maximum RR 1·58 [1·39–1·81] at 2 months lag), but higher in highly urbanised areas than rural areas after extreme drought (maximum RR 1·60 [1·33–1·92] vs 1·15 [1·08–1·22], both at 4 months lag). We also found the dengue risk following extreme drought was higher in areas that had a higher frequency of water supply shortages. Interpretation Wet conditions and extreme drought can increase the risk of dengue with different delays. The risk associated with extremely wet conditions was higher in more rural areas and the risk associated with extreme drought was exacerbated in highly urbanised areas, which have water shortages and intermittent water supply during droughts. These findings have implications for targeting mosquito control activities in poorly serviced urban areas, not only during the wet and warm season, but also during drought periods. Funding Royal Society, Medical Research Council, Wellcome Trust, National Institutes of Health, Fundacao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro, and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico. Translation For the Portuguese translation of the abstract see Supplementary Materials section.

Made available in DSpace on 2020-12-12T02:49:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-08-18 Different countries have adopted strategies for the early detection of SARS-CoV-2 since the declaration of community transmission by the World Health Organization (WHO) and timely diagnosis has been considered one of the major obstacles for surveillance and healthcare. Here, we report the increase of the number of laboratories to COVID-19 diagnosis in Brazil. Our results demonstrate an increase and decentralisation of certified laboratories, which does not match the much higher increase in the number of COVID-19 cases. Also, it becomes clear that laboratories are irregularly distributed over the country, with a concentration in the most developed state, São Paulo. School of Agriculture São Paulo State University (Unesp) Botucatu Medical School São Paulo State University (Unesp) Clinical Hospital of Botucatu Medical School (HCFMB) Institute of Biosciences São Paulo State University (Unesp) School of Technology and Sciences São Paulo State University (Unesp) Federal University of Espirito Santo (UFES) School of Agriculture São Paulo State University (Unesp) Botucatu Medical School São Paulo State University (Unesp) Clinical Hospital of Botucatu Medical School (HCFMB) Institute of Biosciences São Paulo State University (Unesp) School of Technology and Sciences São Paulo State University (Unesp)

Objective To perform spatial distribution analysis of reported cases of Zika virus and congenital Zika syndrome (CZS) in the state of Espírito Santo, Brazil, by neighborhood, and relate the results to sociodemographic indicators and implications for the health process. Methods An ecological study using data from the 2016 National Notifiable Diseases Surveillance System, epidemiological records, and information on neighborhoods of families confirmed with CZS from qualitative field research. Results Sociodemographic indicators were analyzed in three distinct groups: general population with Zika virus, pregnant women with Zika virus, and cases of CZS visited. For the three groups, average literacy rates were 71.1%, 71.0%, and 68.3%; the average income per minimum wage was 1.4, 1.1, and 1.4; sanitary sewage coverage was 75.6%, 76.1%, and 71.4%; garbage coverage was 90.8%, 91.2%, and 89.2%; and water supply was 93.8%, 94.1% and 93.8%, respectively. Socioeconomic indicators showed no significant differences between groups, although they were above the national average. A nonsignificant variation of 68.3%–71.1% was seen in the average literacy level above 15 years of age. Conclusion Socioeconomic and demographic indicators of cases of Zika virus infection and CZS may indicate that the outbreak had different impacts according to class, social group, or gender, reflecting the persistence and social geography of inequality in Brazil., The sociodemographic profile of cases of Zika virus and congenital Zika virus syndrome reveals different impacts on social strata and reflects the social geography of inequality in Brazil.

Introdução: O Ministério da Saúde incluiu a vacina contra o Papilomavírus Humano (HPV) no calendário básico de imunizações em 2014 com a meta vacinar pelo menos 80% das adolescentes entre 11 e 13 anos de idade. Objetivos: Frente à baixa adesão à campanha nacional de vacinação contra o HPV no município de Maringá, PR, em 2014, o presente estudo teve como objetivos: 1) identificar o nível de conhecimento das adolescentes acerca do vírus e da vacina; e 2) descrever os motivos pelos quais elas não se vacinaram. Métodos: Trata-se de um estudo observacional transversal, do tipo inquérito domiciliar com delineamento descritivo, conduzido com 58 adolescentes que não tomaram a 1ª e/ou a 2ª dose da vacina dentro do prazo estipulado pela campanha vacinal de 2014. Para coleta de dados, foi aplicado questionário por meio de entrevistas face a face. Resultados: 86% das adolescentes já ouviram falar do vírus, 74% sabe que sua transmissão é sexual, 49% conhece sua relação com o câncer de colo de útero e 88% já ouviu falar da vacina. A maior parte das meninas entrevistadas não se vacinou por recusa por parte dos pais. Conclusão: Os resultados do presente estudo sugerem que o desconhecimento sobre a infecção pelo HPV e sobre a campanha de vacinação entre as entrevistadas e seus responsáveis, bem como o medo de efeitos colaterais da vacina, como apontado pela população do estudo, interferiram negativamente na tomada de decisão.

This paper presents an omnidirectional RGB-D (RGB + Distance fusion) sensor prototype using an actuated LIDAR (Light Detection and Ranging) and an RGB camera. Besides the sensor, a novel mapping strategy is developed considering sensor scanning characteristics. The sensor can gather RGB and 3D data from any direction by toppling in 90 degrees a laser scan sensor and rotating it about its central axis. The mapping strategy is based on two environment maps, a local map for instantaneous perception, and a global map for perception memory. The 2D local map represents the surface in front of the robot and may contain RGB data, allowing environment reconstruction and human detection, similar to a sliding window that moves with a robot and stores surface data.

Software Defined Networks (SDN) provide a high simplification of the network management by decoupling the control plane from the data plane through the use of controllers. Distributed-Denial-of-Service (DDoS) attacks can make SDN controllers unavailable to process legitimate flow requests from switches. The main approaches to protect controllers against DDoS attacks are essentially based on the attack detection, that still yield high rates of false negatives and/or false positives, highlighting the importance of mitigating DDoS attacks. Existing mitigation techniques are fundamentally based on external and additional resources or on the network traffic analysis, increasing computational cost or being prone to high rates of false negatives and/or false positives. This work presents PATMOS, a novel Protocol for DDoS Attack miTigation in Multi-contrOller SDN networkS through controller's clustering. PATMOS procedures are organized in three phases. The first one exchanges control messages to identify overloaded controllers, eliminating the dependence on the network traffic analysis. The second phase elects the best performance level controller to coordinate the mitigation process. The third phase minimizes the DDoS attacks effects using operational controllers in the network, differently from the works that employ external resources. Simulations results show PATMOS reducing 52.39% of CPU usage rate, increasing 192.74 fold more the throughput and decreasing 2.5 fold less the latency of flow requests to a target controller.

Technology has enabled significant advances in the distribution of information for education. With the Internet the information was available to the global context immediately through computer networks. To treat the contents and structure the information for education groups of researchers and developers worked to create groups of information entitled Learning Objects. This paper demonstrates the re-design of a learning object, in order to adjust it to criteria of gamification and accessibility. The methodological process consisted of: defining the project requirements and the structuring of a storyboard for the collaborative development of learning objects (Braga 2015b; Kethure 2010). Thus, the proposed interface incorporates playful elements for presentation of immersive and interactive content, so as to encourage learning also to people with disabilities, related to low vision, blind and deaf. In this sense, the objective of this paper is to present the process of developing a new interface for content learning about “Triangles and its characteristics” content, this treaty in Descriptive Geometry Course in the Graduate Graphic Design and Product. At the end of this document, we present the resulting learning object of this process, designed from gamification elements and affordability. The methodological procedure used as a base, collaboration in the development of learning objects, and includes: Concept Map, Navigational maps and Storyboard. Besides this, a Storyboard created to meet the needs of this collaborative development is presented. The paper presents a case study focusing on the use of Learning Objects to the teaching content of triangles in the university. The collaborative development process to redesign this platform featured a master’s degree and two doctoral students of the Graduate Program in Design at the Federal University of Parana, and the project was prepared during the course of accessibility and gamification.

OBJETIVO: Determinar a acurácia diagnóstica da positron emission tomography (tomografia por emissão de pósitrons)/tomografia computadorizada (PET/TC) com deoxiglicose marcada com flúor-18, conhecida como fluorodeoxiglicose (FDG[18F]), na avaliação de nódulo pulmonar solitário (NPS). MÉTODOS: Análise prospectiva de 53 pacientes consecutivos que realizaram PET/TC para avaliação de NPS, entre março de 2005 e maio de 2007. Destes 32 preencheram os critérios de inclusão. As lesões foram avaliadas quanto a sua localização e tamanho, grau de captação do radiofármaco e o standardized uptake value (SUV, valor padronizado de captação) máximo das lesões. Os achados dos estudos de FDG-PET/TC foram correlacionados com outros preditores de malignidade (idade, sexo, tabagismo, tamanho e localização do nódulo). O diagnóstico definitivo foi estabelecido por confirmação histopatológica ou acompanhamento clínico-radiológico por um período mínimo de um ano. RESULTADOS: Encontrados 14 NPS malignos. Após análise da curva ROC, o SUV de 2,5 foi considerado o melhor ponto de corte que identificou corretamente 13 dos 14 NPS malignos. Os resultados abaixo deste ponto de corte mostraram um exame falso positivo para neoplasia num total de 14. O método semiquantitativo apresentou sensibilidade de 92,9%, especificidade de 72,2%, valor preditivo positivo de 72,2%, valor preditivo negativo de 92,9% e acurácia de 81,2%. Na análise multivariada, apenas a localização do nódulo nos lobos superiores (p = 0,048) e o SUV (p = 0,007) demonstraram significância estatística para malignidade no NPS. CONCLUSÕES: Os dados do estudo mostram que o SUV da FDG[18F] é um bom preditor de neoplasia em nódulos pulmonares e com alto valor preditivo negativo, o que oferece grande segurança em afastar presença de malignidade, indicando sua importância na abordagem diagnóstica do nódulo pulmonar. OBJECTIVE: To determine the diagnostic accuracy of positron emission tomography/computed tomography (PET/CT) using fluorine-18-deoxyglucose ([18F]-FDG) for the evaluation of a solitary pulmonary nodule (SPN). METHODS: Prospective analysis of 53 consecutive patients submitted to PET/CT between March 2005 and May 2007 for the evaluation of an SPN. Of those, 32 met the criteria for inclusion in the present study. The lesions were evaluated for location, size, radiotracer uptake and maximum standardized uptake value (SUV). The FDG-PET/TC results were correlated with other predictors of malignance (age, gender, smoking status, nodule size and nodule location). The definitive diagnosis was established through histopathology or through clinical/radiological follow-up for at least one year. RESULTS: Fourteen malignant SPNs were found. Through analysis of the ROC curve, we established an SUV of 2.5 as the most appropriate cut-off point, since it correctly identified 13 of the 14 malignant SPNs. The results below that point revealed one false positive for neoplasia out of a total of 14. The semiquantitative method presented a sensitivity of 92.9%, specificity of 72.2%, positive predictive value of 72.2%, negative predictive value of 92.9% and accuracy of 81.2%. The multivariate analysis showed a statistically significant association with SPN malignancy only for nodule location in the upper lobes (p = 0.048) and SUV (p = 0.07). CONCLUSIONS: The results obtained suggest that the SUV of [18F]-FDG is a useful predictor of neoplasia in SPN, with a high negative predictive value, which allows malignancy to be safely ruled out, showing its relevance in the diagnostic approach to pulmonary nodules.

OBJECTIVE: to evaluate the outcome of abdominal wall integrity of both techniques. METHODS: a retrospective study was carried out at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, identifying the patients undergoing temporary abdominal closure (TAC) from January 2005 to December 2011. Data were collected through the review of clinical charts. Inclusion criteria were indication of TAC and survival to definitive abdominal closure. In the post-operative period only a group of three surgeons followed all patients and performed the reoperations. RESULTS: Twenty eightpatients were included. The difference in primary closure rates and mean time for fascial closure did not reach statistical significance (p=0.98 and p=0.23, respectively). CONCLUSION: VAC and Bogota Bag do not differ significantly regarding the outcome of abdominal wall integrity, due to the monitoring of a specific team and the adoption of progressive closure OBJETIVO: avaliar o resultado da integridade da parede abdominal após utilização do fechamento assistido a vácuo e da bolsa de Bogotá. MÉTODOS: um estudo retrospectivo foi realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), identificando os pacientes submetidos à técnica de fechamento abdominal temporário (FAT) entre janeiro de 2005 e dezembro de 2011. Os dados foram coletados por meio de revisão de prontuários. Os critérios de inclusão foram indicação de FAT e sobrevivência até o fechamento definitivo da parede abdominal. No período pós-operatório, apenas um grupo de três cirurgiões, seguiu todos os pacientes e realizou as reoperações. Além disso, independente da técnica de FAT utilizada, foi aplicada a tática de fechamento fascial progressivo durante as reoperações. RESULTADOS: Vinte e oito pacientes foram incluídos. Não houve diferença estatística nas taxas de fechamento primário e tempo médio de fechamento fascial. CONCLUSÃO: O fechamento assistido a vácuo e a bolsa de Bogotá não diferem significativamente em relação ao resultado da integridade da parede abdominal após as reoperações. Isso se deve ao acompanhamento de uma equipe específica e a adoção de técnica de fechamento fascial progressivo.

We report a patient with longstanding Behçet disease who presented sudden onset of headache and facial paresis. The magnetic resonance imaging (MRI) showed a mass in the right thalamus, extending to the lentiform nucleus, subthalamic area, right cerebral peduncle and deep subcortical white matter. Stereotactic brain biopsy disclosed gliosis with no signs of malignancy. The diagnosis of a pseudotumoral form of neuro-Behçet disease was done and she was treated with pulse methylpredinisolone and intravenous cyclophosphamide. After 8 weeks she had improved and a new MRI showed disappearance of the tumor-like lesion. The differential diagnosis, especially with central nervous system tumor is emphasized.

Introdução: A presença de escorpiões em um município e o seu convívio com as populações humanas são fatores que apresentam riscos à saúde pública. A partir disso, é viável que haja um controle adequado destes animais, tendo em vista que a erradicação dos mesmos não seria possível. No Brasil há certa seletividade de localidades que apresentam ocorrências de acidentes com escorpiões, principalmente nos estados de Minas Gerais, Bahia e São Paulo. Dessa maneira, a tomada de certas medidas de prevenção pode contribuir para a redução do número de acidentes. Metodologia/Desenvolvimento: Este projeto busca analisar características da distribuição dos escorpiões no município de Presidente Prudente, interior de São Paulo no período de 2010 à 2012, relacionando aspectos socioambientais com o intuito de contribuir para o entendimento desse agravo, dando subsídio aos órgãos responsáveis pelo combate aos problemas de saúde pública do município, tais como o Centro de Controle de Zoonoses (CCZ), Secretaria Municipal de saúde de Presidente Prudente e a população de uma maneira geral. Os processos metodológicos componentes desta pesquisa consistem em um levantamento bibliográfico sobre o assunto, de modo que auxilie no embasamento do tema ao longo do trabalho; digitalizar os dados fornecidos pela CCZ referentes às ocorrências de escorpiões no município de Presidente Prudente durante o período de 2010 à 2012; a geração de um banco de dados a partir dos dados coletados; elaboração de mapa da distribuição espacial das ocorrências de aparição dos escorpiões pelo município por meio da ferramenta de geocodificação no Software ArcGIS 10. Considerações Finais: Como resultado da pesquisa, espera-se compreender: Quais os grupos sociais mais expostos aos acidentes? Quais as condições socioambientais responsáveis por permitir tais acidentes? Quais os bairros mais atingidos e os menos atingidos, por quê? O que pode ser feito para que haja um controle adequado? O que pode ser feito para que a população tenha acesso às devidas informações?

In this article we make a critical assessment of the relation between online and print design, focusing on the graphic language of newspaper infographics. A lot of the work done in this area consists in adapting print newspaper infographics to online versions. The problem with many of these adaptations is that there are losses in reading strategy and structure of their online versions, offering readers a mainly linear reading experience. To understand this fact, we compare print infographics and their digital versions through the analysis of layout and cognitive load. In a time when the knowledge of computer programming seems to be crucial to editorial design, we reflect on the importance of layout, which is the principle design structure to help readers access and understand information.

Pilonidal cysts and sinuses are described as dermoid cysts which contain follicles of hairs and sebaceous glands. They clinically present as a classic case of inflammation which comes with pain, local infection and redness. The origin of pilonidal disease remains controverse. There are many hypothesis as lack of hygiene on the affected area and a penetration and growth of a hair in the subcutaneus tissue caused by constant friction or direct trauma on the damaged area. The option for clinical treatment is very frequent. However, taking into consideration the incidence and the possibility of recidive, surgical treatment is presently recommended. Complications include cellulitis and abscess formation. Pilonidal cysts are mostly found on the sacral region. In the literature is found description of pilonidal cysts on the penis, interdigital region on the hands as well as on the cervical region. We present a case of pilonidal cyst located on the vault biparietal region, without malignant degeneration.

The group comprises episodic and chronic clus-ter headache, chronic and episodic paroxysmal hemicra-nia, and SUNCT syndrome. SUNA syndrome (short-lasting unilateral neuralgiform headache attacks with cranial au-tonomic symptoms), although not classified as a TAC, also shares some common characteristics with this group and may include the SUNCT definition. Despite their common elements, the TACs differ in response to therapy, frequen-cy and duration of attacks. They must be differentiated from secundary TACs because of the possible serious and treatable underlying causes, like mass lesions, subarach-noid hemorrhage, pathology in the base of the skull and others

There are few papers devoted to geriatric Guillain-Barré (GBS) and many related issues remain unanswered. OBJECTIVE: To describe clinical, electrophysiological and therapeutic features in this age. METHOD: Clinico-epidemiological data and therapy of GBS patients older than 60 years were reviewed. Hughes scores were used to quantify neurological deficit and define outcome. RESULTS: Among 18 patients (mean age 64.8 years), 9 had evident prodrome and 80% noticed initially sensory-motor deficit. Demyelinating GBS was found in 8 and axonal in 6 subjects. There was one Miller-Fisher and 3 unclassified cases. Plasmapheresis (PFX) was single therapy in 12 patients and intravenous immunoglobulin (IVIg) in 2. Disability scores just before therapy were similar in both groups, so as short and long term outcome. CONCLUSION: Axonal GBS seems to be more frequent in the elderly and this may have prognostic implications. PFX and IVIg were suitable options, but complications were noticed with PFX. Prospective studies are needed to better understand and manage GBS in the elderly. Publicações sobre a síndrome de Guillain-Barré (SGB) no idoso são escassas e várias questões sobre o tema estão abertas. OBJETIVO: Descrever aspectos clínico-eletrofisiológicos, terapêuticos e prognóstico no idoso. MÉTODO:Revisamos os prontuários de pacientes acima de 60 anos com SGB. A escala de Hughes foi usada para quantificar os déficits iniciais e finais. RESULTADOS: No total de 18 pacientes (média de idade 64,8 anos), 50% tiveram pródromo e 80% tiveram déficit sensitivo-motor no início. SGB desmielinizante foi encontrada em 8 pacientes, axonal em 6 e uma síndrome de Miller-Fisher. Três casos não puderam ser classificados. Plasmaférese (PFX) foi empregada isoladamente em 12 pacientes e imunoglobulina endovenosa (IVIg) em 2. A disfunção inicial nos dois grupos tratados era semelhante, assim como a evolução a curto e longo prazo. CONCLUSÃO: A forma axonal da SGB parece ser mais freqüente no idoso e isto pode ter implicações prognósticas. PFX e IVIg foram eficazes, mas complicações ocorreram apenas no grupo tratado com PFX. Estudos prospectivos são necessários para um melhor entendimento e manejo da SGB no idoso.

Whipple's disease (WD) is an uncommon multisystem condition caused by the bacillus Tropheryma whipplei. Central nervous system involvement is a classical feature of the disease observed in 20 to 40% of the patients. We report the case of a 62 yeards old man with WD that developed neurological manifestations during its course, and discuss the most usual signs and symptoms focusing on recent diagnostic criteria and novel treatment regimens.