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In about a third of the patients with epilepsy the seizures are not drug-controlled. The current limitation of the antiepileptic drug therapy derives from an insufficient understanding of epilepsy pathophysiology. In order to overcome this situation, it is necessary to consider epilepsy as a disturbed network of interactions, instead of just looking for changes in single molecular components. Here, we studied CA3 transcriptional signatures and dentate gyrus histopathologic alterations in hippocampal explants surgically obtained from 57 RMTLE patients submitted to corticoamygdalohippocampectomy. By adopting a systems biology approach, integrating clinical, histopathological, and transcriptomic data (weighted gene co-expression network analysis), we were able to identify transcriptional modules highly correlated with age of disease onset, cognitive dysfunctions, and granule cell alterations. The enrichment analysis of transcriptional modules and the functional characterization of the highly connected genes in each trait-correlated module allowed us to unveil the modules’ main biological functions, paving the way for further investigations on their roles in RMTLE pathophysiology. Moreover, we found 15 genes with high gene significance values which have the potential to become novel biomarkers and/or therapeutic targets in RMTLE.

The authors describe the case of a 71-year-old female patient who initially went to the dermatologist to assess a scalp skin tumor. This lesion was submitted to an incisional biopsy, performed by dermatologist herself, and the result of the anatomopathological examination and immunohistochemical study showed a preliminary diagnosis of metastasis of breast carcinoma. The patient had no history of breast cancer and, in view of this result, she was referred to consult with the mastologist, who carried out an investigation of breast nodules in search of the possible primary focus of the carcinoma, through imaging exams, biopsies and mammotomy, without finding any possible primary focus on the breasts. Finally, the lesion on the scalp was removed in its entirety by the plastic surgeon and a new exam of pathological anatomy and an immunohistochemical study confirmed the diagnosis of metastasis of breast carcinoma. In view of these results, the authors discuss the difficulty in diagnosing differentiation from primary or metastatic neoplasm of the scalp, with the resources currently available, until the conclusion that it was a primary carcinoma of the sweat gland.

O HIV é um vírus do gênero Lentivirinae e da família Retroviridae, envelopado de RNA que, uma vez no hospedeiro, transcreve este material em DNA, infecta linfócitos e macrófagos que tem em sua superfície o marcador CD4. Atualmente houve uma progressiva feminização da infecção, decorrente da transmissão heterossexual. Segundo o Relatório Global do Programa Conjunto das Nações Unidas sobre HIV/AIDS (UNAIDS), cerca de 200 milhões de mulheres ficam grávidas a cada ano, das quais 2,5 milhões são infectadas pelo HIV. Identificar o perfil epidemiológico das gestantes HIV positivo é de grande relevância, para a possibilidade de estabelecer estratégias de prevenção e assistência no pré-natal e puerpério. O objetivo do estudo foi estimar a prevalência de infecção por HIV, das gestantes triadas pelo programa de proteção à gestante do Estado de Goiás. Trata-se de um estudo ecológico, retrospectivo, compreendendo série histórica de dez anos, a partir de janeiro de 2005 a setembro de 2016. A triagem é realizada usando sangue seco em papel filtro e analisado pelo método ELISA. Do total de 834.155 gestantes, 1254 foram diagnosticadas com HIV positivo, obtendo prevalência de 1,50 para cada 1000 mulheres (IC95% 1,42-1,58), sendo observado variações de 1,42 para cada 1000 mulheres em 2005 e 1,49 em 2016.

IntroductionThe clitoris is partially responsible for sexual arousal. The integrity of the extracellular matrix is essential for clitoral erection. Sexual dysfunction is a phenomenon associated with age.Material and methodsThe clitoris of cadavers of 20- to 80-year-old women was excised and histologically processed. Stereological analysis was performed to quantify the volumetric density of collagen, elastic fibers, and smooth muscle.ResultsA significant increase in collagen and a decrease in smooth muscle and elastic fibers were observed in older women.ConclusionsIn short, these changes caused by aging could contribute to female sexual dysfunction concerning clitoral orgasm.

Objetivo: Estimar a prevalência da toxoplasmose em gestantes triadas pelo Programa de Proteção à Gestante do Distrito Federal e identificar fatores associados à infecção. Método: Trata-se de um estudo ecológico e retrospectivo, incluindo uma série histórica de mulheres grávidas rastreadas pelo programa de proteção à gestante (PPG) no Distrito Federal no ano de 2018. A triagem é realizada usando sangue seco em papel filtro e analisado pelo método ELISA. Resultados: Do total de 32.288 gestantes triadas, 12.480 foram diagnosticadas com Toxoplasmose, estimando uma prevalência geral de 38,65 (IC 95%: 38,12-39,18). Conclusão: a prevalência encontrada é semelhante as de outras regiões, é importante destacar o grande número de gestantes susceptíveis a infecção da toxoplasmose o que pode possibilitar a infecção aguda durante a gestação. Sendo assim o acompanhamento das gestantes é fundamental para que se tenha uma adequada prevenção da toxoplasmose.

Background Psychogenic nonepileptic seizures (PNES) are a common and debilitating problem in patients with epilepsy. They can be virtually indistinguishable from epileptic seizures, demanding video-electroencaphalogram monitoring, which is costly and not widely available, for differential diagnosis. Specific functional brain correlates of PNES have not been demonstrated so far. We hypothesized that PNES and epileptic seizures have distinct brain activation patterns, assessed by functional neuroimaging during ictal events of both conditions. Objective: Compare ictal brain activation patterns of PNES and epileptic seizures using single-photon emission computerized tomography. Methods We prospectively assessed brain functional activation using single-photon emission computerized tomography 99mTc-ethyl cysteinate dimer in 26 patients with PNES, confirmed by trained psychiatrists in epileptology, who had their seizures induced by provocative tests compared with 22 age- and sex-matched subjects with temporal lobe epilepsy who underwent prolonged intensive video-electroencaphalogram monitoring. Results In PNES patients compared with temporal lobe epilepsy group, we found a consistent increase in regional cerebral blood flow in the right precuneus (Brodmann area 7; P = 0.003) and right posterior cingulate cortex (Brodmann area 31; P = 0.001), as well as a decrease in regional cerebral blood flow in the right amygdala (P = 0.027). Conclusions Activation of default mode network brain areas and temporoparietal junction may be a distinct feature of ictal PNES and could be explained by a disruption between movement prediction input and sensory outcome. Such information mismatch might be the neurobiological underpinning of dissociative episodes.

Background: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. Objective: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. Methods: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. Results: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). Conclusions: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.

AIM: To describe different modalities to record and transfer natural head position (NHP) to 3D facial imaging by using the virtual surgical planning software in three facial asymmetry patients. CASE REPORTS: Three patients with facial asymmetries (A, B, and C) were evaluated by means of dental and facial analysis, photographs, cone-beam computed tomography (CBCT) and digitized dental arches. Before starting the VSP workflow with Dolphin Imaging, NHP was recorded by three modalities and transferred to three-dimensional (3D) facial images as follows: (a) facial photographs taken with digital camera and the estimated NHP was transferred to 3D images by comparing lines and planes from both images; (b) cross-line level laser was used to place radiopaque markers on the face skin for recording the estimated NHP, which was transferred to 3D images by alignment of planes and markers in the software; and (c) photographs of the face were processed to generate facial surface mesh by using the Agisoft PhotoScan software, which maintained the same position of the estimated NHP in 3D for aligning the images of the soft tissue with the facial surface mesh by using superimposition. All the three patients underwent bi-maxillary orthognathic surgery. CONCLUSION: There are different modalities using simple and available technologies in the clinical routine, but whose reproducibility, reliability and validation could not be assessed nor compared to each other. There was no trend for better predictability, feasibility and efficiency because the postoperative outcomes were adequate regarding the patients’ satisfaction and facial symmetry.

Myasthenia gravis and thymoma are often presented in association with ∼10% of myasthenic cases having concomitant thymoma. Thymic carcinoma is one of the rarest/aggressive human epithelial tumors and has no correlation with myasthenia gravis hitherto. Here is provided a clinical case and review of literature on a very rare association of thymic carcinoma (with no sign of thymoma) and myasthenia gravis (antiacetylcholine receptor antibody positive). Two years after thymectomy, clinical evolution was satisfactory. This clinical case elicits hypothesis that thymic carcinoma may be related with myasthenia gravis, what may have good prognostic from oncologic and neurologic perspectives.

Conservative treatment is the most common clinical management for the proper rehabilitation of patients with chronic neck pain, and there is a trend towards the use of therapeutic exercise. However, some uncertainty about the efficacy of therapeutic exercises remains, and it is necessary to conduct more studies with high methodological rigor, especially in regard to multimodal treatment, as in the combination of therapeutic exercises with electrotherapy. Thus, the objective of this study will be to evaluate the clinical effects of adding high- and low-frequency transcutaneous electrical nerve stimulation (TENS) in a program of specific therapeutic exercises for the treatment of patients with chronic neck pain. Sixty participants will be randomized into three groups: therapeutic exercise + placebo TENS group (n = 20), therapeutic exercise + high-frequency TENS group (n = 20), and therapeutic exercise + low-frequency TENS group (n = 20). Eight treatment sessions will be performed, and participants will be evaluated before and after the eight sessions and four weeks after the end of treatment. The Numerical Rating Pain Scale, Neck Disability Index, Pain-Related Catastrophizing Thoughts Scale, and Tampa Scale for Kinesiophobia will be used for participant evaluations. In the statistical analysis, a linear mixed model will be applied considering interaction between time and group factors. The addition of this electrotherapeutic modality to a therapeutic exercise program is expected to generate clinical improvements for patients with chronic neck pain, and if the results demonstrate benefits in the treatment group, this form of care could be used.

Introducao: A desnutricao proteico-calorica e frequente em pacientes com doencas que acometem o sistema respiratorio, devido a ingesta alimentar apresentar-se diminuida, secundaria a anorexia, e ao aumento da taxa metabolica de repouso em decorrencia do esforco respiratorio aumentado Pacientes com doencas pulmonares devem ser submetidos a avaliacao nutricional cuidadosa e monitoramento constante. Objetivos: Sendo assim, o objetivo do estudo foi descrever a recuperacao nutricional em um hospital de retaguarda, apos internacao em Unidade de Terapia Intensiva. Resultados: Durante as primeiras 24h da admissao, foi aplicada anamnese nutricional e observado peso de 46 Kg, altura de 1,52m, IMC de 19,9kg/m² considerado eutrofico. Contudo, ao analisar o peso pregresso, foi relatado peso habitual de 52 Kg, que demonstrou perda involuntaria grave de peso no periodo de tres meses (11,5%). Ao se avaliar as demais medidas antropometrica, como CP de 25cm, CB de 23,5cm, adequacao de CB de 79% (desnutricao moderada), CMB de 19,04 cm e adequacao de 87% (desnutricao leve), PCT de 14,2mm e adequacao de PCT de 61% (desnutricao grave), foi possivel observar que a perda de peso foi decorrente da perda de massa muscular e perda de tecido adiposo. Com relacao aos exames bioquimicos, observou-se anemia por doenca cronica, hiperglicemia e deplecao de massa muscular. Mediante aplicacao do protocolo de desmame de dieta enteral do proprio hospital, sendo tres horarios de dieta enteral no periodo da noite e restante dos horarios na consistencia pastosa cinco vezes ao dia, a dieta via oral foi gradualmente inserida, conforme tolerância da paciente ate atingir a consistencia livre, que ocorreu no periodo de um mes. Conclusao: O caso relatado mostra a importância de uma adequada terapia nutricional na recuperacao do estado nutricional do paciente que transita pelos diferentes ambientes de assistencia hospitalar.

The purpose of this exhibit is to discuss different imaging patterns of central nervous system (CNS) metastasis based on their primary cancer site and to review the recent literature of the particularities of CNS metastasis distribution in the era of molecular advancement in oncology. Selected cases extracted from our institutions database will be presented. The cases will be didactically organized to illustrate the most common imaging characteristics and distribution of brain metastasis based on their organ of origin, such as lung, breast, renal, skin, testicle and gastrointestinal tract. (SCHROEDER T. et al., J Neurooncol. 2020). We will also discuss the correlation between tumor imaging findings and genetic profile. We intend to review well-known CNS metastasis imaging patterns, as preferential involvement of the posterior fossa and anatomic watershed areas in cases of lung cancer (TAKANO, K. et al. Neuro-Oncology, 2016) and the rarity of parenchyma metastasis from prostate cancer (HATZOGLOU V. et al, J Neuroimaging. 2014). We will also demonstrate newly described imaging findings in correlation with primary tumors genetic mutations, such as higher incidence of leptomeningeal involvement in triple negative breast cancer and increase in the number of brain lesions in cases of EGFR positive lung cancer. Familiarity with the most prevalent imaging characteristics of central nervous system metastasis helps oncologists and radiologists not to miss out a CNS progression in case of a known tumor, and also helps to direct systemic investigation of a primary tumor when brain metastasis is the initial presentation. The correlation between molecular profile and the most common sites of CNS involvement can help on treatment planning, including brain radiation (Yanagihara TK,et al., Tomography. 2017), and also bring to discussion the mechanisms of tumor dissemination, which can be targets for future treatments.

PurposeThe main aim of the present study was to describe the development of a non-commercial biomechanical system designed for the simultaneous measurement of kinematic and kinetic parameters during a lower limb pointing task. The task was performed by two groups of soccer players (10 novices and 10 experts, aged 16-19 years) and the differences between the two groups, in terms of these parameters, were also assessed. MethodsThe calibration procedure of the combined system is presented in this paper. The system measured the Centre of Pressure (CoP) and body Center of Mass (CoM) displacements, kicking duration and the acceleration of the kicking leg. ResultsThe margin of error found for kinematic and kinetic calibration was less than 1%. Furthermore, the expert players presented decreased CoP and CoM displacements and kicking duration and acceleration of the kicking leg compared to the novices. ConclusionThe combined system provides an effective method for the simultaneous measurement of kinematic and kinetic parameters associated with kicking and may contribute to the development of intervention studies for the improvement of balance and kicking performance in sports.

O transtorno de déficit de atenção e hiperatividade é um transtorno neuropsiquiátrico com agitação, impulsividade e maior tendência à distração. Trata-se de uma doença de importante prevalência na infância, acometendo 4 a 10% das crianças, e que se perpetua ao longo da vida adulta, causando importantes prejuízos sociais, financeiros e emocionais. O diagnóstico é feito por entrevista, sendo necessário a presença insistente de sintomas antes dos doze anos de idade e pelo menos cinco critérios de desatenção e cinco de hiperatividade. Por ser um diagnóstico sem auxílio de propedêutica complementar, pode sofrer interferências da diversidade de variáveis sintomatológicas, inclusive pela possível interferência de terceiros - como pais, professores ou a indústria farmacêutica - em querer medicalizar desnecessariamente o paciente. O tratamento ideal envolve tanto o uso de medicação, sendo o metilfenidato o padrão-ouro, quanto o auxílio psicoterápico, principalmente por meio da terapia cognitiva comportamental, sendo ambos utilizados em longo prazo. A associação da psicoterapia permite à criança o aprendizado de técnicas de autocontrole para que possa lidar melhor com sua sintomatologia, enquanto o tratamento farmacológico atua por meio da interferência na dopamina e recaptação de noradrenalina, diminuindo a inquietação e distração e melhorando a memória e a regulação do humor.

Background The condition of advanced oncological disorders demands a complete health care, although attention has been predominant on physical aspects. To consider personal positioning entails other aspects when dealing with patients’ diseases – such as their existential aspects – expanding forms of care. This study aims to comprehend the personal positioning of oncology patients receiving palliative care. Methods This is a cross-sectional, convergent parallel mixed-methods study. Seventy-one oncology patients in palliative care cooperated with this study, 14 of whom participated in a qualitative approach and 56 in a quantitative approach only. In the former approach, we conducted a phenomenological interview and, in the latter, we used tools to measure meaning of life (PIL-Test), quality of life (EORTC QLQ C-30), anxiety and depression (HADS), and to collect sociodemographic data. Data obtained through the interview were analyzed according to the principles of Classical Phenomenology, and the quantitative data were analyzed through generalized structural equation models. Results Our results showed that patients regained their focus on life, accentuating its possibilities and distancing themselves from the impact of their condition, such as imminent death, which was associated with giving up fighting depression. These signs were observed in 21% of the participants. This demands a tenacious fight that supports a positioning nurtured by sensitivity. Related to such position is the religious belief in life continuation, together with their awareness of the meaning of their own lives. Additionally, we found a direct association between purpose in life and an increase in the scores of functional scales (p

Introduction Chagas disease (CD) is classically reported as a neglected disease of vectorial transmission and is endemic in 21 Latin America countries. While it has long been stigmatized as a mere tropical pathology, CD has recently gained prominence, since new means of infection have become more common, including blood transmission and consumption of food contaminated with feces from a given vector. Taking immigration into account, the disease is currently spreading beyond the limits of endemic areas and has become a [...]

IntroductionCOVID-19 may lead to persistent and potentially incapacitating clinical manifestations (post-acute sequelae of SARS-CoV-2 infection (PASC)). Using easy-to-apply questionnaires and scales (often by telephone interviewing), several studies evaluated samples of COVID-19 inpatients from 4 weeks to several months after discharge. However, studies conducting systematic multidisciplinary assessments of PASC manifestations are scarce, with thorough in-person objective evaluations restricted to modestly sized subsamples presenting greatest disease severity.Methods and analysesWe will conduct a prospective observational study of surviving individuals (above 18 years of age) from a cohort of over 3000 subjects with laboratory-confirmed COVID-19 who were treated as inpatients at the largest academic health centre in Sao Paulo, Brazil (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo). All eligible subjects will be consecutively invited to undergo a 1–2-day series of multidisciplinary assessments at 2 time-points, respectively, at 6–9 months and 12–15 months after discharge. Assessment schedules will include detailed multidomain questionnaires applied by medical research staff, self-report scales, objective evaluations of cardiopulmonary functioning, physical functionality and olfactory status, standardised neurological, psychiatric and cognitive examinations, as well as diagnostic laboratory, muscle ultrasound and chest imaging exams. Remaining material from blood tests will be incorporated by a local biobank for use in future investigations on inflammatory markers, genomics, transcriptomics, peptidomics and metabolomics.Ethics and disseminationAll components of this programme have been approved by local research ethics committees. We aim to provide insights into the frequency and severity of chronic/post-COVID multiorgan symptoms, as well as their interrelationships and associations with acute disease features, sociodemographic variables and environmental exposures. Findings will be disseminated in peer-reviewed journals and at scientific meetings. Additionally, we aim to provide a data repository to allow future pathophysiological investigations relating clinical PASC features to biomarker data extracted from blood samples.Trial registration numberRBR-8z7v5wc; Pre-results.

BACKGROUND: We assessed whether COVID-19 is associated with de novo pain and de novo chronic pain (CP). METHODS: This controlled cross-sectional study was based on phone interviews of patients discharged from hospital after COVID-19 compared to the control group composed of individuals hospitalized during the same period due to non-COVID-19 causes. Patients were classified as having previous CP based on the ICD-11/IASP criteria, de novo pain (i.e. any new type of pain, irrespective of the pain status before hospital stay), and de novo CP (i.e. persistent or recurring de novo pain, lasting more than 3 months) after COVID-19. We assessed pain prevalence and its characteristics, including headache profile, pain location, intensity, interference, and its relationship with fatigue, and persistent anosmia. Forty-six COVID-19 and 73 control patients were included. Both groups had similar sociodemographic characteristics and past medical history. RESULTS: Length of in-hospital-stay and ICU admission rates were significantly higher amongst COVID-19 survivours, while mechanical ventilation requirement was similar between groups. Pre-hospitalisation pain was lower in COVID-19 compared to control group (10.9% vs. 42.5%; p = 0.001). However, the COVID-19 group had a significantly higher prevalence of de novo pain (65.2% vs. 11.0%, p = 0.001), as well as more de novo headache (39.1%) compared to controls (2.7%, p = 0.001). New-onset CP was 19.6% in COVID-19 patients and 1.4% (p = 0.002) in controls. These differences remained significant (p = 0.001) even after analysing exclusively (COVID: n = 40; controls: n = 34) patients who did not report previous pain before the hospital stay. No statistically significant differences were found for mean new-onset pain intensity and interference with daily activities between both groups. COVID-19 pain was more frequently located in the head/neck and lower limbs (p

Maintaining appropriate home rehabilitation programs after stroke, with proper adherence and remote monitoring is a challenging task. Virtual reality (VR) - based serious games could be a strategy used in telerehabilitation (TR) to engage patients in an enjoyable and therapeutic approach. The aim of this review was to analyze the background and quality of clinical research on this matter to guide future research. The review was based on research material obtained from PubMed and Cochrane up to April 2020 using the PRISMA approach. The use of VR serious games has shown evidence of efficacy on upper limb TR after stroke, but the evidence strength is still low due to a limited number of randomized controlled trials (RCT), a small number of participants involved, and heterogeneous samples. Although this is a promising strategy to complement conventional rehabilitation, further investigation is needed to strengthen the evidence of effectiveness and support the dissemination of the developed solutions.

ObjectiveTo describe the clinical, neurological, neuroimaging and cerebrospinal fluid (CSF) findings associated with encephalopathy in patients admitted to a COVID-19 tertiary reference center.MethodsWe retrospectively reviewed records of consecutive patients with COVID-19 evaluated by a consulting neurology team from March 30, 2020 through May 15, 2020.ResultsFifty-five patients with confirmed SARS-CoV-2 were included, 43 of whom showed encephalopathy, and were further divided into mild, moderate and severe encephalopathy groups. Nineteen patients (44%) had undergone mechanical ventilation and received intravenous sedatives. Eleven (26%) patients were on dialysis. Laboratory markers of COVID-19 severity were very common in encephalopathy patients, but did not correlate with the severity of encephalopathy. Thirty-nine patients underwent neuroimaging studies, which showed mostly non-specific changes. One patient showed lesions possibly related to CNS demyelination. Four had suffered an acute stroke. SARS-CoV-2 was detected by RT-PCR in only one of 21 CSF samples. Two CSF samples showed elevated white blood cell count and all were negative for oligoclonal bands. In our case series the severity of encephalopathy correlated with higher probability of death during hospitalization (OR = 5.5 for each increment in the degree of encephalopathy, from absent (0) to mild (1), moderate (2) or severe (3), pConclusionIn our consecutive series with 43 encephalopathy cases, neuroimaging and CSF analysis did not support the role of direct viral CNS invasion or CNS inflammation as the cause of encephalopathy.

The occurrence of calcifying odontogenic cyst (COC) in the posterior maxillary region is uncommon, with few cases described in literature. We report a case of a 13-year-old female patient presenting a large lesion in the left maxilla (> 7.5 cm). Panoramic radiograph showed a well-delimited radiolucent unilocular lesion extending from the posterior left maxilla to the maxillary sinus. The patient was submitted to decompression followed by conservative surgical removal of the lesion. Histological analysis of the surgical specimen confirmed the diagnosis of COC. After one year, no local recurrence has been observed and the patient remains under follow-up on a regular basis.

Technical advances currently allow recording and monitoring continuous electroencephalogram (cEEG) of critically ill patients. Continuous EEG monitoring provides real-time information regarding brain function, and allows detection of changes in the neurologic status, particularly in stuporous and comatose patients, where neurological examination is limited. Nonconvulsive seizures occur commonly in stuporous and in comatose patients, and usually cannot be detected without cEEG. cEEG monitoring is therefore crucial to detect and guide treatment of nonconvulsive seizures. Additionally, cEEG can be used as a tool to manage pharmacological coma in the treatment of increased intracranial pressure and to detect early signs of brain ischemia in patients with subarachnoid hemorrhage (SAH). Quantitative EEG softwares generate continuous information regarding cerebral function in real time and may allow detection of acute brain events, such as seizures and ischemia. Intracranial EEG recording is being performed in a few centers to better detect seizures, ischemia, and peri-injury depolarizations, all of which may contribute to secondary brain injury. In addition, intracranial EEG recording may allow intervention before permanent injury ensues. The exact use of cEEG in different clinical scenarios requires further studies, that should also evaluate the role of cEEG to support clinical decisions that guide therapeutic interventions in critically ill patients, and to evaluate the role of cEEG in improving neurologic outcomes in different clinical of settings. Additionally, cost-effectiveness of cEEG remains currently unclear, and further studies should better delineate cEEG use in a cost-effective way.

Background: Although neurological complications are well recognized in sickle cell disease (SCD), myelopathy has been rarely described. We present the first case report of longitudinally extensive myelitis (LETM) in SCD and review the differential diagnosis of myelopathy in these patients. Design and setting: case-oriented review. Methods: We report the case of a 29-year-old African-Brazilian man with SCD, who experienced a subacute flaccid paraparesis, with T2 sensory level and urinary retention. CSF analysis showed a lymphocytic pleocytosis and increased protein levels. MRI disclosed a longitudinally extensive spinal cord lesion, with a high T2/STIR signal extending from C2 to T12. Serum anti-aquaporin-4 antibody was negative. We searched Medline/ PubMed, Embase, Scopus, and Google Scholar databases for myelopathy in SCD patients. Results: Spinal cord compression by vertebral fractures, extramedullary hematopoietic tissue, and Salmonella epidural abscess have been reported in SCD. We found only three case reports of spinal cord infarction, which is unexpectedly infrequent compared to the prevalence of cerebral infarction in SCD. We found only one case report of varicella-zoster myelitis and no previous report of LETM in SCD patients. Conclusion: Specific and time-sensitive causes of myelopathy should be considered in SCD patients. In addition to compression and ischemia, LETM should be considered as a possible mechanism of spinal cord involvement in SCD.

© 2020 Mary Ann Liebert, Inc., publishers., The objective of this communication is to offer a better understanding of the value of telemedicine in health care, particularly its role in creating opportunities for continuity of care to patients in a complex and novel setting as were the circumstances of the early COVID-19 pandemic times. Crisis time is also a time for opportunities. With regard to telehealth, all players (providers, staff, and patients) should be informed about its benefits and should also become familiar with the use of the various telehealth options and this will only be achieved through large information campaigns necessary enriched by local teaching and training programs in both public and private institutions. The final aim is to launch the debate and foster ideas useful throughout the pandemic. This article covers the experiences of physicians as well as health professionals in the Iberian Peninsula (Spain and Portugal), to provide a clearer idea of what has happened and how we can improve it with the possibilities provided by telemedicine, while at the same time to put in evidence that public health systems need to be rethought to provide solutions to situations such as that we are experiencing.

The pandemic status of the Novel Coronavirus 2019 has affected many countries around the world, due to the high virulence of the SARS-CoV-2, the recommended protocol to prevent infection is social isolation. The purpose of this study was to compare the number of patients admitted and their epidemiological data on a Level 1 Trauma Hospital after the declaration of the pandemic status and the first week of mandatory lockdown, with the same period of time in the last year. This was a retrospective study of medical records from the patients admitted in the Oral and Maxillofacial Surgery of the Joao XXIII Hospital, between the March 24 and March 31 of 2020 and the same period of the last year. There was a 52.27% decrease in the total number of patients and 76.34% decrease in the total consultations of the service of oral and maxillofacial surgery during the lockdown. All the groups presented a decrease in significance with motor vehicle accidents events, the group 11 to 20 years old presented an increase on the correlation with violence (P = 0.019) and falls (P = 0.002). When comparing both sex with the etiologies, the male one presented an increase in the correlation with violence and falls. The female sex presented correlations only with the minor causes. No valid significance was observed when comparing females with violence events. The lockdown is an effective way to reduce the transmission of the COVID-19, the hospital usage and occupation.

Background: Neurological manifestations of COVID-19 are still incompletely understood. Neurological manifestations may be due to direct viral effect on neurons and glial cells, to an immune-mediated response to the virus, or to a hypercoagulable state and associated endothelial damage, as well as to severe systemic disease with prolonged intensive care unit stay. Objective: To describe two patients with severe SARS-CoV-2 infection and delayed recovery of consciousness after sedation withdrawal, in whom MRI disclosed multifocal white matter brain lesions, compatible with the diagnosis of acute disseminated encephalomyelitis. Methods: Observational report of two cases of severe COVID-19 infection in patients from two tertiary hospitals in São Paulo, Brazil. Results: These patients underwent neurologic and systemic evaluation for delayed awakening after sedation withdrawal. MRI displayed multifocal centrum semiovale lesions, suggestive of demyelinating inflammation. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for SARS-CoV-2 was negative in both cases. Conclusion: A recurrent pattern of multifocal white matter lesions can occur in COVID-19 patients, possibly associated with delayed awakening. Additional studies are necessary to elucidate the role of the viral infection and of inflammatory and immune-mediated associated changes in neurological manifestations of COVID-19.

Objective: Describe a minimally invasive surgical technique for acute repair of Achilles tendon injuries, and evaluate outcomes. Methods: Nine subjects with primary Achilles tendon injury who underwent the minimally invasive repair technique between July and October 2018 were assessed. All subjects were followed up, and the SF-36 quality of life questionnaire was applied after the first postoperative year to evaluate treatment outcomes. Results: The participants had average scores greater than 90 points in the SF-36 questionnaire, with widespread treatment adherence. Only one subject had an infectious complication in the postoperative period. Conclusion: The technique described for acute Achilles tendon repair is simple, uses basic materials, is a low-cost method and, in this series, produced good clinical outcomes measured by the SF-36 Questionnaire. Level of Evidence IV; Therapeutic Study; Case Series.

The anterior vaginal wall is subject to many diseases, such as pelvic organ prolapse. The pathophysiology of this illness is multifactorial, and as such, structural components of the vagina are involved. Furthermore, it is more prevalent in older women. There is a lack of data in the literature regarding the extracellular matrix components of the vaginal wall and its changes with aging. The work presented herein aims to perform a stereological study of the extracellular matrix in young and old women. It was observed a decrease of the volumetric density of smooth muscle (45.5 ± 3.2 % and 32.8 ± 5.8 % for the G1 and G2 samples, respectively) and an increase of collagen and elastic fibers with age (35.9 ± 2.1 % and 54.1 ± 5.9 % for the G1 and G2, respectively) in the mucosa of the vaginal wall. These results could help to better understand the pathophysiology of pelvic organ prolapse concerning the aging process.

Neoplastic musculoskeletal lesions are heterogeneous tumors with variable outcomes that require a precise diagnosis and delivery of optimal, specific treatment. Advanced MR imaging techniques can help differentiate and characterize musculoskeletal soft tissue tumors and are the method of choice for detection, evaluation, local staging, and surgical planning. MR imaging-ultrasound fusion is the process of combining relevant information from 2 methods into a single image that is more informative than the images obtained separately. This article assesses the potential of fusing real-time ultrasound spatial registration with previously acquired musculoskeletal MR imaging to guide tumor tissue biopsies and procedures.

Objectives: To translate and culturally adapt the Pediatric Eosinophilic Esophagitis Symptom Score (version 2.0), a tool used to assess pediatric eosinophilic esophagitis symptoms reported by patients and/or their parents/caregivers. Methods: The Pediatric Eosinophilic Esophagitis Symptom Score was translated through the following stages: initial translation, back-translation, and consensus of independent reviewers through the Delphi technique. The pre-final version of the Pediatric Eosinophilic Esophagitis Symptom Score was applied to five 8-to-18-year-old patients and to ten parents of two-to-18-year-old patients from an outpatient pediatric gastroenterology service (pre-test). Results: During the translation process, no translations presenting with difficult consensus in the review process or grammar inconsistencies were observed. During the pre-test, difficulties in comprehension of some unconventional terms, e.g., “náusea”, were observed. Adverbs of frequency, such as “quase nunca” were also identified as being of difficult understanding by patients and parents, and the substitution by the term “raramente” was suggested. Such difficulties may be inherent to the pediatric age group. Age 8 years or above should be considered adequate for the self-reporting of symptoms. Conclusions: The study presents the Brazilian version of the Pediatric Eosinophilic Esophagitis Symptom Score, which is adapted to the Brazilian culture. This version may be introduced as a clinical and research tool for the assessment of patients with esophagic disease symptoms. The Pediatric Eosinophilic Esophagitis Symptom Score is a breakthrough in the evaluation of symptoms of pediatric eosinophilic esophagitis, since it reinforces the importance of self-reporting by patients who experience this disease. Resumo: Objetivo: Traduzir e adaptar culturalmente a Pediatric Eosinophilic Esophagitis Symptom Score (versão 2.0), um instrumento usado para identificar os sintomas relatados pelos pacientes ou seus pais/responsáveis para a avaliação da esofagite eosinofílica pediátrica. Método: Realizamos o processo de tradução a partir da tradução inicial, retrotradução, seguida da etapa de obtenção de consenso por revisores independentes por meio da técnica Delphi. Aplicamos a versão pré-final a cinco pacientes de 8 a 18 anos e dez pais de pacientes de 2 a 18 anos, no Serviço de Gastroenterologia Pediátrica (pré-teste). Resultados: No processo de tradução, não encontramos traduções de difícil consenso no processo de revisão ou discordâncias gramaticais. No pré-teste, identificamos dificuldades de entendimento de termos pouco convencionais, como “náusea”, com sugestão de substituição para o termo “enjoo”. Outra dificuldade encontrada relacionou-se aos advérbios de frequência da escala, como, por exemplo, “quase nunca”, sendo sugerida a substituição pelo termo “raramente”. Essas dificuldades podem ser inerentes à faixa etária pediátrica. A idade dos pacientes a partir de oito anos deve ser considerada adequada para o uso de escores de autorrelato. Conclusões: A tradução do escore de sintomas da esofagite eosinofílica pediátrica produziu uma escala adaptada à cultura brasileira, que poderá ser introduzida como instrumento de investigação clínica e de pesquisa em pacientes com sintomas sugestivos de doenças esofágicas. É um importante avanço na avaliação dos sintomas, já que valoriza o relato dos próprios pacientes que convivem com essa doença. Keywords: Eosinophilic esophagitis, Translations, Self-report, Child, Adolescent, Palavras-chave: Esofagite eosinofílica, Traduções, Autorrelato, Criança, Adolescente

A coccidiose é uma das principais enfermidades do trato gastrointestinal dos ruminantes, manifestada por alterações sutis como redução de ganho de peso até quadros de diarreia aquosaà sanguinolenta. Na sua forma clínica, ocomprometimento damucosa intestinal prejudica a absorção de nutrientes provindos da dieta, culminando em atrasos na recuperação clínica dos animais. Desta maneira o presente trabalho pretendeu avaliar a eficácia de dois tratamentos na recuperação clínica da coccidiose em bezerros leiteiros em fase de crescimento por meio de avaliação de hematócrito, proteína e fibrinogênio plasmático, leucograma, contagem de ovos por gramas de fezes, inspeção visual do pelame e incidência de diarreia. Para tanto, sete bezerros da raça Jersey entre 2 a 6 meses de idade, com coccidiose foram divididos em dois grupos conforme o tratamento. O grupo antibiótico mais catofós (C), com quatro bezerros, foi tratado com sulfametoxazol + trimetoprim e com o imunoestimulante butafosfan+ vitamina B12 (Catofós®), ambos em dose única, e o grupo antibiótico (A), com três bezerros, foi tratado apenas com sulfametoxazol + trimetoprim em dose única. Observou-se que ambos os tratamentos empregados foram eficazes no combate da enfermidade, reduzindo a sintomatologia da doença, melhorando o pelame dos animais e negativando o exame coproparasitológico. Embora os parâmetros de leucograma, fibrinogênio e proteína plasmática não tenham alterado com os tratamentos, o grupo tratado com antibiótico mais catofós teve um aumento significativo no hematócrito, permitindo comprovar a eficiência de ambos os fármacos.

Introduction: Temporomandibular dysfunction (DTM) Most of the time is discovered during the adult phase, but its symptoms may be ginearly, even in childhood. Due to large muscular, skeletal and joint transformations present during craniofacial growth, children and adolescents may present signs and symptoms of DTM. Objective: To evaluate the frequency of signs and symptoms and the diagnosis of DTM, as well as the oral parafunctional habits in children and adolescents. Material and Method: Participated in this study 44 children and adolescents, regularly enrolled in the EU school B Luís Viana/germany and at the schoolour World/Bequimão located in the city of São Luís-MA, aged between 10:15 years, were excluded those individuals who have performed preortognáticas surgeries, have done or are conducting or thodontic treatments or for DTM´S, who had suffered trauma to the face and did not present the consent signed by the parents. The severity of the DTM was evaluated with the anamnesico content of Fonseca and the diagnosis of DTM with the diagnostic criterion in research RDC/TMD. This project was approved by the CEUMA University Research Ethics Committee, Opinion No. 1,307,233. All parents and guardians signed the term of consent free and clear. Results: The diagnosis of DTM in children and adolescents was demonstrated and the same wa selevated. The signs and symptoms of DTM and the oral parafunctional habits also presented high frequency and can be used as predictors of the worsening of DTM.

Objectives To detect by diffusion tensor imaging (DTI) the extent of microstructural integrity changes of the corpus callosum (CC) in patients with hippocampal sclerosis (HS) and to evaluate possible association with clinical characteristics. Methods Fourty-two patients with temporal lobe epilepsy (TLE) and HS and 30 control subjects were studied with DTI. We grouped patients according to lesion side (left or right) HS. Mean diffusivity (MD), fractional anisotropy (FA), radial (RD) and axial diffusivity (AD) were extracted from five segments in CC midsagittal section obtained by automatic segmentation. CC DTI findings were compared between groups. We also evaluated association of DTI changes and clinical characteristics. Results HS patients displayed decreased FA and increased MD and RD in the anterior, mid-posterior and posterior CC segments, compared to controls. No differences were observed in AD. Patients reporting febrile seizure as the initial precipitating event presented more intense diffusion changes. No differences were seen comparing left and right HS. Age at epilepsy onset, disease duration and seizure frequency were not associated with DTI findings. Conclusions This is one of the largest series of TLE-HS patients evaluating CC white matter fiber integrity by DTI, which allowed us to study how some clinical characteristics, such as seizure frequency, disease duration and lesion side, are related to CC integrity. Occurrence of febrile seizure was the only factor that had significant impact on tract integrity. Diffusion changes were not restricted to the posterior part of the CC; we observed the same changes for the anterior part of the CC. Diffusion changes were characterized by an increase in RD, while the AD remained intact for all regions of the CC.

BACKGROUND Rapidly progressive dementia (RPD) is usually associated with Creutzfeldt-Jakob disease, a fatal condition. Current advances in the understanding of immune-mediated diseases allow the diagnosis of previously unrecognized treatable RPDs. OBJECTIVE OF THE STUDY The objective of the study was to describe the prevalence and causes of RPD in a neurology service, identifying potentially reversible causes. METHODS We carried out a cross-sectional evaluation of all patients admitted to the neurology unit of a tertiary hospital in Brazil between March 2012 and February 2015. We included patients who had progressed to moderate or severe dementia within a few months or up to 2 years at the time of hospitalization, and used multivariable logistic regression analysis to identify factors associated with a favorable outcome. RESULTS We identified 61 RPD (3.7%) cases among 1648 inpatients. Mean RPD patients' age was 48 years, and median time to progression was 6.4 months. Immune-mediated diseases represented the most commonly observed disease group in this series (45.9% of cases). Creutzfeldt-Jakob disease (11.5%) and nonprion neurodegenerative diseases (8.2%) were less common in this series. Outcome was favorable in 36/61 (59.0%) RPD cases and in 28/31 (89.3%) of immune-mediated cases. Favorable outcome was associated with shorter time from symptom onset to diagnosis and abnormal cerebrospinal fluid findings. CONCLUSIONS Immune-mediated diseases were the most common cause of RPD in this series. Timely evaluation and diagnosis along with institution of appropriate therapy are required in RPD, especially in view of potentially reversible causes.

OBJECTIVE Memory impairment is a recognized complication of mesial temporal sclerosis (MTS). Epileptiform activity may negatively impact on cognition. We evaluated the impact of contralateral EEG involvement on memory in unilateral MTS (uMTS) patients. METHOD Retrospective review of 121 right-handed uMTS patients (69 left) evaluated with prolonged video-EEG and verbal and nonverbal memory tests (Rey Auditory Verbal Learning Test and Rey-Osterrieth Complex figure), with additional very delayed trials. Patients were classified according to ictal/interictal EEG findings and MTS side as left or right concordant or discordant. Thirty-nine normal individuals who underwent the same neuropsychological battery served as controls. RESULTS Demographic, disease, and treatment features did not differ among groups. On the 7-day verbal memory free recall, left discordant performed significantly worse than controls and right concordant, recognized fewer words, and had more recognition errors than all other groups, including left concordant. For nonverbal memory, right discordant performed significantly worse than controls on delayed recall, and attained lower scores than other groups on immediate and 7-day recall, but this difference did not reach statistical significance. Left discordant had higher scores of memory complaints than controls and disclosed a trend toward accentuated memory impairment compared with the other groups over time. CONCLUSIONS Our results suggest that contralateral electrographic involvement in uMTS was associated with more pronounced memory impairment for verbal material in left discordant patients, and to a lesser extent, for nonverbal material in right discordant patients. Left discordant group also had increased memory complaints. (PsycINFO Database Record

In clinical care settings, religiosity may serve as an important source of support for coping with the prenatal diagnosis of fetal abnormalities. This study evaluated the influence of religiosity on the situational coping of 28 pregnant women with fetal abnormalities. The study was approved by the institutional research ethics committee, and the informed consent document was obtained from all participants included in this study. Validated measures of religiosity and situational coping were used to evaluate data collected. Practical religiosity but not intrinsic religiosity correlated positively and significantly with coping scores. However, the severity of the fetal malformations did not correlate significantly with the scores of maternal coping. The results showed that religious practices were associated with improved coping in women diagnosed with fetal abnormalities and should be encouraged in care settings.

Scientific evidence indicates that depression and anxiety symptoms may be understood as risk factors associated with the incidence and progression of chronic diseases. Considering the lack of mental health assessment tools that meet strict methodological standards, the authors have chosen to validate the psychometric properties of Anxiety and Depression Item Banks - Emotional Distress domain of the Patient-Reported Outcomes Measurement Information System (PROMIS®) for the Brazilian population. In this study, 606 adults responded to the self-administered Anxiety and Depression Item Banks, which were calibrated using Factor Analyses (Exploratory and Confirmatory analysis) and adjustment of the Graded Response Model. Transcultural validity was assessed by Differential Item Functioning (DIF). The two-factor analysis confirmed the unidimensionality of Emotional Distress Items (CFI = 0.96, TLI = 0.96, RMSEA = 0.05). The residual correlation matrix did not identify item pairs with local dependence. Indicators marked with DIF presented a low impact for gender, age, and language variables. The instrument demonstrated greater reliability in the moderate-severe range, indicating that the error reduction is reflected in the − 1.0 to + 3.0 amplitude. The psychometric measurements of Anxiety and Depression Item Banks in the Brazilian version were equivalent to those in the original version. Additional research contemplating patients with different levels of emotional distress are necessary to better comprehend the results obtained in this study.

Background Recurrent use of oral corticosteroids (OCS) and over-use of short-acting beta-2-agonists (SABA) are factors associated with adverse side effects and asthma-related death. We aim to quantify high OCS exposure, SABA over-use and its association with prescription and adherence to maintenance treatment for respiratory disease, among patients with prescriptions for respiratory disease, from the Portuguese electronic prescription and dispensing database (BDNP). Methods This was a 1-year (2016) retrospective population-based analysis of a random sample of adult patients from the BDNP, the nationwide compulsory medication prescription system. We assessed high OCS exposure (dispensing ≥ 4 packages containing 20 doses of 20 mg each of prednisolone-equivalent, ≥ 1600 mg/year) on patients on persistent respiratory treatment (PRT-prescription for > 2 packages of any respiratory maintenance medications). Excessive use of SABA was defined as having a ratio of SABA-to-maintenance treatment > 1 or having SABA over-use (dispensing of > 1 × 200 dose canister/month, of 100 μg of salbutamol-equivalent). Factors associated with high OCS exposure were assessed by multinomial logistic regression. Results The estimated number of patients on PRT was 4786/100,000 patients. OCS was prescribed to more than 1/5 of the patients on PRT and 101/100,000 were exposed to a high-dose (≥ 1600 mg/year). SABA excessive use was found in 144/100,000 patients and SABA over-use in 24/100,000. About 1/6 of SABA over-users were not prescribed any controller medication and 7% of them had a ratio maintenance-to-total ≥ 70% (high prescription of maintenance treatment). Primary adherence (median%) to controller medication was 66.7% for PRT patients, 59.6% for patients exposed to high OCS dose and 75.0% for SABA over-users. High OCS exposure or SABA over-use were not associated with primary adherence. High OCS exposure was associated with a maintenance-to-total medication ratio 45 years old and male sex. Conclusions Exposure to high-dose of OCS (101 per 100,000 patients) and SABA over-use (24 per 100,000) were frequent, and were associated with a low maintenance-to-total prescription ratio but not with primary non-adherence. These results suggest there is a need for initiatives to reduce OCS and SABA inappropriate prescribing.

Background: Recently, a new HF entity, with LVEF between 40-49%, was presented to comprehend and seek better therapy for HF with preserved LVEF (HFpEF) and borderline, in the means that HF with reduced LVEF (HFrEF) already has well-defined therapy in the literature. Objective: To compare the clinical-therapeutic profile of patients with HF with mid-range LVEF (HFmrEF) with HFpEF and HFrEF and to verify predictors of hospital mortality. Method: Historical cohort of patients admitted with decompensated HF at a supplementary hospital in Recife/PE between April/2007 - August/2017, stratified by LVEF (< 40%/40 - 49/≥ 50%), based on the guideline of the European Society of Cardiology (ESC) 2016. The groups were compared and Logistic Regression was used to identify predictors of independent risk for in-hospital death. Results: A sample of 493 patients, most with HFrEF (43%), HFpEF (30%) and HFmrEF (26%). Average age of 73 (± 14) years, 59% men. Hospital mortality 14%, readmission within 30 days 19%. In therapeutics, it presented statistical significance among the 3 groups, spironolactone, in HFrEF patients. Hospital death and readmission within 30 days did not make difference. In the HFmrEF group, factors independently associated with death were: valve disease (OR: 4.17, CI: 1.01-9.13), altered urea at admission (OR: 6.18, CI: 1.78-11.45) and beta-blocker hospitalization (OR: 0.29, CI: 0.08-0.97). In HFrEF, predictors were: prior renal disease (OR: 2.84, CI: 1.19-6.79), beta-blocker at admission (OR: 0.29, CI: 0.12-0.72) and ACEI/ ARB (OR: 0.21, CI: 0.09-0.49). In HFpEF, only valve disease (OR: 4.61, CI: 1.33-15.96) and kidney disease (OR: 5.18, CI: 1.68-11.98) were relevant. Conclusion: In general, HFmrEF presented intermediate characteristics between HFrEF and HFpEF. Independent predictors of mortality may support risk stratification and management of this group.

SUMMARY: The supracondylar process is a hook shaped projection of the humerus. It is located superior to its medial epicondyle. This anatomic variation is often presented together with the Struther’s ligament, a fibrous arcade that connects the supracondylar process to the medial epicondyle. Both structures have been associated with neurovascular bundle compression on the distal third of the arm, as the median and ulnar nerves and the brachial and ulnar arteries may pass through the osteofibrous canal that these variants create. The SciElo, Pubmed, Scopus, TRIP, MEDLINE, COCHRANE and ScienceDirect databases were searched with the term “supracondylar process” or “supracondyloid process” with the purpose of performing a meta-analysis of this bony spur. Heterogeneity between studies was evaluated using I2 estimation and the Cochran Q statistic test. A random effect model was used for all analysis. A total of twenty articles (26.415 humeri) were included in this meta-analysis. The pooled prevalence of the supracondylar process was 0.68 % (95 % Confidence Interval: 0.47 % to 0.92 %). This variant was more commonly found in women than in men (statistically significant difference) and more commonly found on the left side than the right. The presence of the supracondylar process alone may induce neurovascular bundle compression. It can also be injured in traumatic or stress fractures. Knowledge of this variation and its prevalence may reduce misdiagnosis in radiographic images.

Objective We sought to correlate habitual physical activity with central sensitization, pain intensity, kinesiophobia, catastrophizing, and the severity of chronic myogenous temporomandibular disorder (TMD). Methods This was an observational study. Fifty-five individuals, male and female, aged 18 to 45 years, with pain for at least 3 months (chronic) related to myogenous TMD were included in the study. Myogenous TMD was evaluated by means of the Numerical Rating Scale, Catastrophic Thoughts on Pain Scale, Tampa Scale for Kinesiophobia, Fonseca Anamnestic Index, Central Sensitization Inventory, and habitual physical activity by means of the Baecke Questionnaire (BQ). The Spearman correlation coefficient (rs) was applied to verify the association of the BQ score with the pain variables. Results No significant correlations (P > .05) were observed in the total or mean BQ scores (both rs = −0.17 to −0.04), nor in the analyses performed on the occupational (rs = −0.03 to 0.14), sport (rs = −0.16 to 0.01), and leisure domains (rs = −0.16 to −0.02). Conclusion Habitual physical activity as measured by the BQ is not associated with pain intensity, catastrophizing, kinesiophobia, central sensitization, or the severity of chronic myogenous TMD.

Purpose To evaluate the effect of contralateral electrographic involvement on memory performance (measured by neuropsychological and Wada memory testing) in patients with epilepsy associated with unilateral mesial temporal sclerosis (MTS). Methods We studied 51 patients with medically-refractory epilepsy associated with unilateral MTS (27 women, 30/51, left MTS) submitted to prolonged non-invasive video-EEG monitoring and bilateral Wada testing. According to ictal electrographic involvement, patients were classified as: Contralateral ictal involvement, when one or more seizures evolved with rhythmic activity in the temporal region contralateral to the MTS or exclusive ipsilateral ictal involvement if all seizures showed ictal EEG activity exclusively on the MTS side. Wada testing involved a twelve-item memory paradigm. Wada memory asymmetry score was calculated for each patient subtracting the number of recalled items after injection on the lesion side from the number of recalled items after contralateral injection. Expected asymmetry (EA) was considered if Wada memory asymmetry > 0, and Symmetrical or Reversed memory asymmetry (S-RA) when ≤ 0. Neuropsychological testing was applied in the 51 patients and in 40 healthy controls. Verbal Memory was evaluated with the Rey Auditory Verbal Learning Test (RAVLT), considering the number of recalled items on immediate recall after the initial five consecutive encoding trials (RAVLT 6), a post-interference delayed (30 min) recall (RAVLT 7), and recall after 7 days. Nonverbal memory was tested with Wechsler Memory Scale-III (WMS-III) Faces subtests 1 e 2. Results Groups did not differ in demographic, clinical and video-EEG monitoring variables. S-RA was observed more frequently in the group with contralateral ictal involvement (57.2% vs. 27.0%; p: 0.03). Logistic regression analysis considering demographic, clinical, hippocampal volume and video-EEG monitoring variables showed contralateral ictal involvement as the only independent variable associated with S-RA (coefficient = 1.32, p = 0.029, odds ratio 3.77; 95% CI 1.1–12.47). Additionally, the patient group with contralateral ictal EEG involvement displayed worse verbal and nonverbal memory scores compared to healthy controls. Conclusion In this cohort of unilateral MTS patients, contralateral ictal involvement was associated with decreased memory performance on Wada and on neuropsychological testing.

Cherubism is a rare developmental condition of the gnathic bones that is usually inherited as an autosomal dominant trait with variable expressivity. An 11-year-old girl was referred because of an asymptomatic bilateral facial progressive swelling. Medical history was noncontributory. Locoregional physical examination revealed a bilateral firm swelling in the cheek and retromolar area covered by normal skin and normal oral mucosa, respectively. Panoramic radiograph and cone beam computed tomography scans showed bilateral extensive multilocular lesions in the mandibular posterior areas. Clinical diagnosis was cherubism, and histologic analysis of the specimen obtained by an incisional biopsy confirmed this hypothesis. The patient has been followed up and is under orthodontic treatment with satisfactory results.

This article discusses the features of multiparametric MR imaging as an accurate method to evaluate soft tissue tumors and pseudotumors. The discussion also considers conventional and advanced sequences providing both functional tissue and anatomic information to improve the diagnostic accuracy of this method and assess pretreatment staging, treatment response focused on the extent of necrosis, and recurrence.

Objective: The purpose of this investigation was to compare different rest period lengths between consecutive one maximum repetition bench press attempts on performance and ratings of perceived exertion. Method: Eighteen trained men (27.95 ± 4.25 years; 81.00 ± 9.21 kg; 174.62 ± 3.34 cm; bench press relative strength 1.33 ± 0.11 kg/kg of body mass) participated in three randomly ordered sessions that required two consecutive one maximum repetition bench press attempts with 20, 40, or 60-s rest between attempts. Results: The Cochran Q analysis showed no significant differences in the ability to successfully perform a second one maximum repetition attempt with 20, 40, or 60-s rest between attempts (p = 0.882). Specifically, no significant differences were found in the successful completion of the first and second attempts for the 20-s (p = 0.317), 40-s (p = 0.083), and 60-s (p = 0.157) trials, respectively. Briefly, for both 20 and 60-s rest conditions Δ% = 88.88% of subjects successfully performed the second attempt and, for the 40-s protocol, only Δ% = 83.33% completed. For the pre and post-set ratings of perceived exertion, the shorter rest period (20-s) promoted significantly higher values compared to the longer rest periods (pre-set ratings of perceived exertion, p = 0.04; post-set ratings of perceived exertion, p = 0.023). Conclusions: The results of this study can be applied to recreationally trained individuals with the intent of generating a time-efficient process for conducting a valid and reliable one maximum repetition bench press assessment.

Introduction: Reperfusion injury leads to systemic morphological and functional pathological alterations. Some techniques are already estabilished to attenuate the damage induced by reperfusion. Ischemic preconditioning is one of the standard procedures. In the last 20 years, several experimental trials demonstrated that the ischemic postconditioning presents similar effectiveness. Recently experimental trials demonstrated that statins could be used as pharmacological preconditioning. Methods: 41 Wistar rats (Rattus norvegicus albinus) were distributed in 5 groups: Ischemia and Reperfusion (A), Ischemic Postconditioning (B), Statin (C), Ischemic Postconditioning + Statins (D) and SHAM (E). After euthanasia, lungs, liver, kidneys and ileum were resected and submitted to histopathological analysis. Results: The average of lung parenchymal injury was A=3.6, B=1.6, C=1.2, D=1.2, E=1 (P=0.0029). The average of liver parenchymal injury was A=3, B=1.5, C=1.2, D=1.2, E = 0 (P