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Copyright of Brazilian Journal of Biology is the property of Instituto Internacional de Ecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Andaluza de Medicina del Deporte is the property of Centro Andaluza de Medicina del Deporte and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Osteological lesions can be important to positively identify human remains in forensic contexts, as well as contribute to past population studies. However, their analysis requires training and appropriate research conditions, which may be lacking in certain geographic areas as, for example, the northern region of Brazil. Emphasising existing resources, such as anatomical collections, may help to address this issue. This study explores the anatomical collection of Professor Dr. Manuel da Silva Braga of the Federal University of Pará (Brazil), introducing the traumatic lesions identified in seven crania (13.7%; 7/51) of male (four) and female (three) individuals. The sample profile and the cases identified are in accordance with the pattern of violent victims in the region. This study is the first of its kind in the Pará State, contributing with case studies and examples, to the disciplines of biological anthropology, paleopathology, and bioarchaeology and forensic discipline. It also highlights the significance that anatomical collections may have in the development of those disciplines, suggesting a need for reappraisal and reevaluation of existing resources, as these may be of use for training and research. Lastly, this study builds a bridge towards the social and cultural context of the collection, reinforcing the value of an interdisciplinary approach to human remains. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study assessed milk yield and composition of Angus and Angus-cross beef cows raised in southern Brazil. A total of 128 records were collected in 2 consecutive calving seasons from cows between 3 and 5 yr of age of 4 breed compositions: Angus (ANAN), Caracú x Angus (CRAN), Hereford x Angus (HHAN), and Nelore x Angus (NEAN). These cows were mated to Brangus (BN) or Braford (BO) bulls and managed under extensive grazing conditions in southern Brazil. Milk production of these cows was assessed by 2 procedures: indirectly by the calf weigh-suckle-weigh procedure (WD) and directly by machine milking (MM). Lactation curves were estimated using nonlinear regression and the following related traits were derived: peak yield (PY), peak week (PW), total yield at 210 d (TY210), and lactation persistence (PERS). Milk composition and calf weaning weight adjusted to 210 d (WW210) were also determined. The MM technique was considered more accurate because of lower standard errors of estimated means, greater statistical power, and greater correlation between TY210 and WW210 (0.50) compared to WD (0.36). Considering the more precise evaluation by MM, the CRAN and NEAN cows had greater TY210(1070 and 1116 kg, respectively) and PY (8.1 and 7.8 kg, respectively) compared to ANAN and HHAN cows, which had 858 and 842 kg for TY210 and 6.6 and 6.3 kg for PY, respectively. The NEAN cows had the latest PW at 10.8 wk. Late-calving cows had 21% lower TY210 compared to cows that calved earlier. Milk composition was influenced by cow genotype, with CRAN and NEAN cows producing milk with greater fat (3.8 and 3.9%, respectively) and protein (3.2 and 3.1%, respectively) content compared to ANAN and HHAN cows. Regardless of the genotype, fat, protein, and total solids increased in concentration from beginning to end of lactation, while lactose content decreased. Crossbreeding of Angus with adapted breeds of taurine or indicine origin can be effective in increasing milk yield and nutrient content and, consequently, producing heavier calves at weaning under extensive grazing in southern Brazil and other similar subtropical climate regions. [ABSTRACT FROM AUTHOR]

Copyright of Revista Saúde is the property of Revista Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objectives of this work were to assess alternative linear reaction norm (RN) models for genetic evaluation of Angus cattle in Brazil. That is, we investigated the interaction between genotypes and continuous descriptors of the environmental variation to examine evidence of genotype by environment interaction (GxE) in post-weaning BW gain (PWG) and to compare the environmental sensitivity of national and imported Angus sires. Data were collected by the Brazilian Angus Improvement Program from 1974 to 2005 and consisted of 63,098 records and a pedigree file with 95,896 animals. Six models were implemented using Bayesian inference and compared using the Deviance Information Criterion (DIC). The simplest model was M1, a traditional animal model, which showed the largest DIC and hence the poorest fit when compared with the 4 alternative RN specifications accounting for GxE. In M2, a 2-step procedure was implemented using the contemporary group posterior means of M1 as the environmental gradient, ranging from -92.6 to +265.5 kg. Moreover, the benefits of jointly estimating all parameters in a 1-step approach were demonstrated by M3. Additionally, we extended M3 to allow for residual heteroskedasticity using an exponential function (M4) and the best fitting (smallest DIC) environmental classification model (M5) specification. Finally, M6 added just heteroskedastic residual variance to M1. Heritabilities were less at harsh environments and increased with the improvement of production conditions for all RN models. Rank correlations among genetic merit predictions obtained by M1 and by the best fitting RN models M3 (homoskedastic) and M5 (heteroskedastic) at different environmental levels ranged from 0.79 and 0.81, suggesting biological importance of GxE in Brazilian Angus PWG. These results suggest that selection progress could be optimized by adopting environment-specific genetic merit predictions. The PWG environmental sensitivity of imported North American origin bulls (0.046 ± 0.009) was significantly larger (P < 0.05) than that of local sires (0.012 ± 0.013). Moreover, PWG of progeny of imported sires exceeded that of native sires in medium and superior production levels. On the other hand, Angus cattle locally selected in Brazil tended to be more robust to environmental changes and hence be more suitable when production environments for potential progeny is uncertain. [ABSTRACT FROM AUTHOR]

The objective of this study is to extend knowledge regarding sexual satisfaction, comparing the findings among pre- and post-lesion periods and a control group. From Brazil, the participants were 90 men, of whom 40 had a spinal cord injury (SCI) and 50 had no physical disability. The instrument used was a structured open and closed–ended questionnaire. Of the 40 men with SCI, 29 had paraplegia and 11 had tetraplegia. The participants were asked about their level of sexual satisfaction: 72% of the control group declared themselves to be very satisfied; 80% of the men with SCI in the pre-lesion period also reported being very satisfied, while in the postlesion period this number fell to 47.5%. In the pre-lesion period and in the control group sexual satisfaction exhibited positive correlations with: sexual frequency; sexual stimulation; sexual desire and intensity of orgasm. Meanwhile, in the post-lesion period there were correlations between variables that are modified by the SCI: erection sufficient for penetration; reaching orgasm; achieving penetration and finding sex possible without penetration. Noteworthy, the study found that there are changes in the sexual satisfaction of men with SCI. In many cases this change results from the difficulty in maintaining a sex life similar to that experienced pre-lesion. Furthermore, new correlations with sexual satisfaction appear in the post-lesion period. [ABSTRACT FROM AUTHOR]

Background and context: Control of metastatic breast cancer (mBC) is an area with high unmet need. Along the patient journey, policy development remains limited and varied across countries, particularly in detection, diagnosis and treatment. Multistakeholder engagements aim to address these policy gaps. Aim: 1. Understand breast cancer (BC)/mBC policy development in 16 countries and identify opportunities for improvement. 2. Illustrate promising practices spearheaded by civil society (NGOs and academia) that demonstrate success addressing identified gaps and exemplify models for replication. 3. Establish the importance of stakeholder collaboration to implement policies that support timely BC/mBC detection and treatment initiation. Strategy/Tactics: An analysis of National Cancer Control Plans (NCCPs), policies and programs was conducted across 16 countries representing different healthcare systems. Key BC diagnosis policy components were identified and evaluated, using standardized criteria on adoption and implementation of NCCP goals, and BC/mBC-specific policies and programs. Promising practices, spearheaded by civil society, that demonstrate success at filling policy gaps were identified. Their objective was to develop an information resource that other organizations can use as practice-based evidence. An example implemented in Brazil is presented. Program/Policy process: Although mBC screening is ineffective, national BC screening programs (NSPs) implementation promotes BC education and encourages prompt symptom reporting. Structured diagnosis guidelines and upskilled healthcare professionals (HCPs) also facilitate timely detection, as evidenced in Brazil, where diagnosis delays are prevalent. Outcomes: Despite policy efforts, gaps persist for timely BC/mBC detection and diagnosis. Implementation of official NSPs, diagnosis guidelines and HCP educational initiatives varied across countries. In Brazil, the Integrated Approach to Improving Oncology Care project brought together various stakeholders. The initiative aimed to use existing community resources as a pivot to address and improve BC diagnosis gaps, including HCP oncology education/training, capacity building in community health centers and increasing patient support. The initiative provided training to over 150 BC HCPs. Upskilled HCPs were supported to improve skills and system capacity to facilitate timely diagnosis. What was learned: Disparities in BC policy development exist across and within countries. Progress in BC policy is skewed toward the early part of the patient journey e.g., awareness, with key gaps remaining in diagnosis. Although national official action is indispensable, collaboration between different stakeholders is critical to address BC/mBC patient unmet needs. As exemplified in Brazil, we see that policy initiatives and promising practices demonstrate successful multistakeholder engagement to inform further advocacy and policy development. [ABSTRACT FROM AUTHOR]

The article discusses the diagnosis of the Brazilian patients with dystonia and abnormalities in the basal ganglia that features like the neurodegeneration with brain iron accumulation (NBIA) type 1. It presents the clinical study on the patients from the year 2005 to 2006 with the used of the magnetic resonance imaging (MRI) which it identifies a sign of the eye-of-the-tiger. The findings of the study shows that the mutation is not accumulated with the eye-of-the-tiger sign.

Kummer A, Scalzo P, Cardoso F, Teixeira AL. Evaluation of fatigue in Parkinson's disease using the Brazilian version of Parkinson's Fatigue Scale. Acta Neurol Scand: 2011: 123: 130-136. © 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Fatigue is common in Parkinson's disease (PD). However, factors associated with fatigue in PD are still controversial. This study aimed to translate the Parkinson's Fatigue Scale (PFS) into Brazilian-Portuguese, to test its psychometric properties, and to assess the severity of fatigue in PD as well as its relation to demographic and clinical features, depression, anxiety, excessive daytime sleepiness and cognitive performance. We translated and assessed the internal consistency of the Brazilian version of the PFS. After, we assessed 87 PD patients with several neurological and psychopathological instruments. The Brazilian version of PFS had good internal consistency (Cronbach's alpha = 0.939). Clinical significant fatigue was present in 36 patients (41.4%). A logistic regression analysis showed that fatigue was better explained by dysthymia ( P = 0.006), more severe symptoms of depression as assessed by the Hamilton Depression Rating Scale ( P = 0.027), daytime sleepiness ( P = 0.022) and female gender ( P = 0.031). Fatigue is a common non-motor symptom in PD and seems to be associated with female gender, dysthymia, severity of depression and daily somnolence. [ABSTRACT FROM AUTHOR]

Abstract: The object of this study was to evaluate the effectiveness of a phonoaudiology rehabilitation program directed towards the degenerative changes of the neurophysiological mechanisms responsible for the upper digestive system compromised by the age between 80 and 90 years, in a regime of internment in a long permanence institution in the city of Rio de Janeiro, which express, bodily, their difficulty in swallowing food of liquid or pasty consistency. To achieve such an object, the current study was developed in an experimental format or design, comprised of a sample group of 23 elderly subjects, of both genders, undergoing evaluation by the phonoaudiology protocol for evaluating the risk of dysphagia (abbreviated from the Portuguese name: Protocolo de Avaliação do Risco para Disfagia=PARD), pre- and post-intervention procedure. The developed program used the indirect therapy approach based on the adaptive myotherapeutic and myofunctional stimulation, contemplating two isometric and isokinetic orofacial active myotherapeutic exercises, two passive myotherapeutic manipulations for the supra-hyoidal musculature, as well as adaptive cephalic postural maneuvres, associated to the intra-oral olfactive and gustative sensory stimulation. The evolution of the individuals was analyzed before and after the therapy by estimating the capacity of swallowing food in the liquid fluid (LF) consistency, by the paired Student t-test, giving a p =0.01, making the difference of 2.31 between the 2 evaluations statistically significant. The changes produced by the PARD program in the capacity of individuals in swallowing food of a pasty consistency were also significant when analyzing the variance of the results on the 2 instances by using the F-test (pre- and post-intervention difference=4.47, p =0.039). [Copyright &y& Elsevier]

Purpose: To establish cutaneous silent period (CSP) normative values and investigate the variables that may influence them., Methods: We tested 41 healthy subjects. All subjects underwent nerve conduction studies, and we evaluated the CSP in both arms., Results: Four subjects did not have CSP and were excluded. The analyses were performed in the healthy group composed of 23 women and 14 men, with a mean age of 35 (range, 19-64) years. The CSP median duration was 23.2 milliseconds (ms), with 2 to 98th percentile at 11.3 and 48.7 ms. The median onset latency was 87.9 (range, 72.9-109) ms, and the median end latency was 112 (range, 93.8-138) ms. The CSP onset latency positively correlated with height, whereas CSP end latency and duration were weakly but significantly associated with age. Some measurements of ulnar nerve conduction study also correlated with CSP measures. The interrater coefficients for the primary measures of onset and end latency demonstrates the reproducibility of the method., Conclusions: The CSP with the fifth digit stimulation and recording from the abductor digiti minimi muscle is a valid diagnostic tool that can be used in clinical practice., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 by the American Clinical Neurophysiology Society.)

The aim of this study was to analyze oral health actions in four municipalities in Brazil during the COVID-19 pandemic according to a theoretical framework model on oral healthcare management. It was a qualitative study carried out in two stages. A theoretical-empirical model on the significance of oral healthcare management was developed, following the Grounded Theory method. Fourteen dentists and five healthcare managers participated, through open interview. Subsequently, collaborative research was performed, and the model was applied to analyze the documents produced to address the pandemic by each of four municipalities in Santa Catarina State. The model provided a framework for analyzing actions for coping with the pandemic regarding oral health services. Actions were identified in all dimensions of the model: reduction in supply of dental care due to restricted access to elective services; search for biosafety care standards; dissemination of standardized science-based guidelines; attempt to maintain comprehensive dental assistance through re-adaptation of specialized services and collective actions; and relocation of oral health professionals to assist in other sectors. The oral health care management framework can serve as a reference for redesigning oral health actions and services in other municipalities during the COVID-19 pandemic, in a broader perspective., Competing Interests: The authors declare no potential conflicts of interest regarding the research, authorship, and/or publication of this article., (Sociedad Argentina de Investigación Odontológica.)

Ivermectin is a safe and effective drug in humans and has been approved for use in numerous parasitic infections for over 50 years. In addition, many studies have already shown its antiviral activity. Ivermectin is generally well tolerated, with no indication of central nervous system-associated toxicity at doses up to 10 times the highest FDA-approved dose of 200 µg/kg. The in vitro results of ivermectin for reducing SARS-CoV-2 viral load are promising and show that Ivermectin kills SARS-CoV-2 within 48 hours. A hypothesized mechanism of action for this drug is a likely inhibition of IMPα/β1-mediated nuclear import of viral proteins as demonstrated for other RNA viruses. However, controlled and randomized studies are needed to prove its effectiveness in COVID-19 in humans. In a single in vivo study with published results, patients confirmed to be infected with SARS-CoV-2 received at least one dose of ivermectin at any time during hospitalization. The use of ivermectin was associated with lower mortality during treatment with COVID-19, especially in patients who required increased inspired oxygen or ventilatory support. Additionally, 81 studies with the clinical use of ivermectin in humans are being carried out worldwide according to ClinicalTrials.gov. However, none of these data has been published so far. However, private and public entities in Brazil have been adopting this drug in their protocols as prophylaxis and in the initial phase of the disease. In addition, ivermectin has been used in mass treatment to prevent onchocerciasis and lymphatic filariasis in sub-Saharan Africa for many years. Surprisingly, this region has the lowest proportional mortality rate among the continents, despite the increasing numbers of infected people released by the World Health Organization.

Professor Ângelo Barbosa Monteiro Machado (May 22, 1934 to April 6, 2020) was one of the most outstanding and respected professors in the Brazilian history. He worked broadly as a professor, neuroscientist, writer, dramaturgist, neurobiologist, and entomologist. The publication of the neuroanatomy book is pioneer, revolutionary, and iconic in the history of academic medical education in Brazil. In the literature field, he also wrote many books in which he adapted scientific knowledge to children. In this article, the authors approach the academic life of Professor Ângelo Machado and the steps that culminated in the most renowned Brazilian textbook of neuroanatomy: Neuroanatomia Funcional.

Genome-wide association studies were conducted to identify the more informative genomic regions and SNPs, as well as to identify candidate genes associated with infectious bovine keratoconjunctivitis (IBK) resistance/susceptibility in Hereford cattle. A Bayes B statistical approach was initially applied in genome-wide association studies by using deregressed estimated breeding values for IBK resistance/susceptibility. To estimate the combined effect of a genomic region that is potentially associated with QTL, 2504 non-overlapping 1-Mb windows that varied in SNP number were defined, with the most informative 24 windows including 427 SNPs and explaining more than 20% of the estimated genetic variance for IBK resistance/susceptibility. These regions were explored with respect to their biological functions through functional analysis to map potential candidate genes. The significant SNPs were mapped on chromosomes 1, 3, 5, 6, 7, 8, 10, 11, 12, 13, 14, 15, 18, 20, 23, and 28, and candidate genes were detected as related to the IBK. Most informative SNPs in term of genetic variance were located in proximity of genes related to phenotypic expression of lesions and biological processes associated to the IBK. Knowledge about phenotypic and genomic variation generated in the present study can be used to on design selection strategies to improve the resistance to IBK of Hereford cattle herds., (© 2021 Stichting International Foundation for Animal Genetics.)

Aim: The aim of this paper is to verify how cities' demographic rates and Human Development Index (HDI), as well as the birthdate of Brazilian elite soccer players influenced their identification and development. Methods: The sample was comprised of 5,359 players from the Brazilian Serie A Soccer Championship between 2003 and 2019. Players' birthdate and birthplace data were collected, as well as the HDI from their hometowns. Descriptive statistics, chi-square, Pearson correlation and linear regression tests were performed. Results: Results indicated that players born in the first semester of the year, in cities with a demographic rate of up to 100,000 inhabitants and HDI above 0.501, are more likely to play at the highest level (Serie A) of Brazilian soccer. Correlations were observed between birth quartile and HDI (r = -.059; se = 0.04; p < 0.001), birth quartile and demographic rates (r = -063, se = 0.03; p < 0.001), and between HDI and demographic rates (r = 0.458; se = 0.02; p < 0.001). The linear regression method yielded a valid model that included all three variables in this study (F (2)  = 9.512; p < 0.001). Conclusion: Based on these findings, it is possible to conclude that birthdate, demographic rate and HDI are important factors in the identification and development of soccer players in Brazil.

As there is a great scarcity of studies on the importance of good compounding practices in the preparation of cosmetics, this study aimed to evaluate the quality control of cosmetics with active ingredient caffeine for the treatment of cellulite prepared by magistrals pharmacies. Microbiological analyzes, pH determination, color measurement, quantification of the percentage of the active ingredient caffeine and viscosity in creams and gels with 5% of the active ingredient caffeine were performed. In the microbiological analysis, the presence of molds and yeasts was verified above the permitted level according to the Brazilian pharmacopoeia. The pH decreased over time, contributing to the formulations becoming more acidic. In the color parameters, it was found that pharmacy F4 showed a brownish color, both for the gel and for the cream. The percentage of caffeine was within specifications in all formulations and the viscosity remained unchanged during the shelf life of the samples. It is important that the compounding pharmacies demand more effectively the commitment of the team, as well as the analysis of the raw material according to the microbiological control regulations to translate into the quality of the products prepared by the pharmacies and favor the consumer in the effective objective that the product you want to achieve.

The evolution of beauty market and personal care is constant in Brazil as well in the rest of the world. Technological advances have brought up nanotechnology to the cosmetological field, employing active principles at atoms enveloped by vesicles, in order to take the active principle precisely to the target tissue to optimize the results achieved because of the considerable ease to cross skin barriers. Manufacturing of nanotechnology cosmetics is confronted with low absorption capacity. One of the many active principle found in cosmetic industry is caffeine, a pseudoalkaloid from the xanthine group used as a stimulant with the mechanism of the lipolytic action. This active is widely used in ​​a esthetics and cosmetics field in treatments involving dysfunctions such as localized fat and fibroedema geloid. To work out perfectly, the principle active need to interact and create a set of factors that includes lipolysis intensification. The caffeine encapsulation in gel-based nanocosmetics has the purpose of taking this active up to the adipocyte, the target cell, for mentioned dysfunctions treatment. Thus, we aim to present a review of how has been, the use of caffeine in the production of cosmetics.

The aim of the present study was to compare the visual search strategy (VSS) and anticipation between two groups of young players of different efficiencies in tactical behavior (TB). A total of 44 Brazilian male soccer players aged 14.00 (± 1.06) years from three regional clubs participated in the study. TB was assessed using FUT-SAT; anticipation score was obtained by a video-based assessment, while VSS was performed using the Mobile Eye-XG® system. The soccer players were divided into two groups based on their TB results into those more efficient and those less efficient. The results showed that soccer players with higher efficiency in TB were better at anticipating and performed a higher number of shorter visual fixations and a greater average amount of fixations per location. They were also able to adjust their VSS in performing a longer fixation time on the player in possession of the ball. Therefore, there is support for an integration of visual search strategy and anticipation within tactical behavior. Visual search strategy and anticipation seem to contribute to the efficiency of tactical behavior in young soccer players.

Objective: The establishment of modern medicine in Brazil was marked by the arrival of the Portuguese Court in 1808, when the Bahia and Rio de Janeiro Faculties of Medicine were founded., Methods: The French School of Medicine exerted a strong influence on Brazilian medicine and on the main pioneers of Brazilian neurology. The elite of "Parisian neurology" trained students and doctors from around the world, and were mentors to the pioneers of Brazilian neurology in the early 20th century., Conclusion: In this article, the authors review the origins of neurology faculties in Brazilian medicine and the main pioneers of Brazilian neurology., Results: Neurology is certainly a continuously changing field and has always adapted to new advances and discoveries, and it is an honor for the authors to pay homage to their pioneers.

Introduction: Parkinsonism is one of the most prevalent neurological syndromes in the elderly. There are only a few epidemiological studies focusing on parkinsonism in oldest-old individuals, particularly in Latin America. This study aims to investigate the prevalence and characteristics of parkinsonism in subjects aged 75 + years living in the community., Methods: The Pietà study is a population-based investigation on brain aging conducted in Caeté, southeast Brazil. A sample composed of 610 community-dwelling individuals aged 75 + years (48.7% of the total population within this age range) underwent clinical, neurological, cognitive and functional assessments., Results: The sample comprised mostly women (61.5%), with mean age of 83.3 years and mean schooling of 2.5 years. Parkinsonism was identified in 65 subjects (crude prevalence = 10.7%). Parkinson's disease, Parkinsonism + dementia syndrome, drug-induced parkinsonism, vascular parkinsonism and Lewy-body dementia were identified in, respectively, 19 (29.2%), 19 (29.2%), 8 (12.3%), 4 (6.1%) and 1 (1.5%) subjects. In 14 individuals (21.5%), the etiology of parkinsonism could not be determined. The most important vascular risk factor was hypertension (64.6%). Cognitive evaluation disclosed dementia in 37 (56.9%) subjects. Mean Pfeffer's functional activities questionnaire score was 12.2 points and 22 (33.8%) subjects were impaired in basic activities of daily living., Conclusion: Parkinsonism was common in this oldest-old population, being associated with dementia and vascular risk factors, particularly hypertension. Different confounders, such as concomitant dementia and exposure to anti-dopaminergic drugs, were present in this population, challenging the definition of causes of parkinsonism., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil., Methods: Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable "physiotherapy" with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified., Results: The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil., Conclusions: The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients' functional performance for a longer period.

In this study, we assessed the sensitivity, specificity, and diagnostic accuracy of a previously developed direct agglutination test (DAT) using a freeze-dried antigen derived from Leishmania infantum promastigotes and composed in a prototype kit for visceral leishmaniasis (VL) diagnosis, named DAT-LPC. To evaluate DAT-LPC reproducibility, the kit was used to analyse 207 serum samples from VL patients and 80 serum samples from patients with other parasitic infections or healthy subjects in four laboratories from different public health institutions in Brazil. DAT-LPC showed sensitivity between 96·2 and 99·5% (P = 0·14), specificity ranging from 96·2 to 97·5% (P = 0·95), and diagnostic accuracy ranging from 96·5 to 99% (P = 0·34). The inter-laboratory reproducibility of qualitative results was classified as excellent (κ index: 0·94-0·97). The reproducibility of the end-titre results in relation to the reference laboratory, ranged from 31 to 85%. These results demonstrate an excellent performance of the DAT-LPC, and validate it for the diagnosis of VL that could replace the immunofluorescent antibody test as the routine diagnostic test in the Brazilian public health system.

Information is a key feature that health professionals need to exercise their profession with efficiency and quality. This study aims to present the experience of the usage of an electronic system for clinical documentation in nursing in a university hospital. It is a methodological research of technology production. The system was developed in four phases: Conception, Elaboration, Construction, and Transition, and was named Electronic Documentation System of the University of São Paulo Nursing Process (PROCEnf-USP™). The knowledge base of PROCEnf-USP™ was organized in hierarchy of domains and classes, according to NNN linkages.

A bioeconomic model was developed to calculate economic values for biological traits in full-cycle production systems and propose selection indices based on selection criteria used in the Brazilian Aberdeen Angus genetic breeding programme (PROMEBO). To assess the impact of changes in the performance of the traits on the profit of the production system, the initial values ​​of the traits were increased by 1%. The economic values for number of calves weaned (NCW) and slaughter weight (SW) were, respectively, R$ 6.65 and R$ 1.43/cow/year. The selection index at weaning showed a 44.77% emphasis on body weight, 14.24% for conformation, 30.36% for early maturing and 10.63% for muscle development. The eighteen-month index showed emphasis of 77.61% for body weight, 4.99% for conformation, 11.09% for early maturing, 6.10% for muscle development and 0.22% for scrotal circumference. NCW showed highest economic impact, and SW had important positive effect on the economics of the production system. The selection index proposed can be used by breeders and should contribute to greater profitability., (© 2014 Blackwell Verlag GmbH.)

The objectives of this study were to characterize and define homogenous production environments of composite beef cattle in Brazil in terms of climatic and geographic variables by using multivariate exploratory techniques; to evaluate the presence of genotype by environment interaction (GxE) for post-weaning weight gain (PWG), yearling scrotal circumference (SC), and yearling muscling (MUS). Hierarchical and nonhierarchical cluster analysis was used to group farms located in regions with similar environmental variables into clusters. Six clusters of farms were formed. The effect of sire-cluster interaction was tested by single-trait analysis. Genetic parameters were estimated by multi-trait analysis considering the same trait to be different in each cluster. The effect of sire-cluster interaction was significant (P <0.01) for PWG and MUS. Estimates of genetic correlations among clusters ranged from 0.31 to 0.93 for PWG, 0.64 to 0.89 for SC, and 0.18 to 0.80 for MUS. These results indicate the need for a genetic analysis on a regional basis or inclusion of the GxE effect in the statistical model to permit appropriate evaluation of the animals.

Prevalence data on different types of tremor among the elderly population are very scarce. The objective of this study was to study the prevalence of tremor in a community-dwelling elderly population in the town of Bambuí, Brazil. The authors studied 1186 inhabitants aged≥64 years. This was a 2-phase study in which all participants who screened positive in a questionnaire for tremor and parkinsonism or who used drugs capable of causing/suppressing tremor were examined. In this population, the prevalence rate was 17.4% for tremor, 7.4% for essential tremor, 5.6% for parkinsonian tremor, 2.8% for enhanced physiological tremor, and 1.6% for other causes. There were no gender differences in prevalence rates for all types. Patients who had Parkinson's disease with tremor were older than those who had essential tremor, whereas patients who had enhanced physiological tremor were significantly younger. The age-specific prevalence of tremor increased with advancing age for both men and women. The prevalence of tremor in the studied population was high and increased with advancing age. Essential tremor, parkinsonian tremor, and enhanced physiological tremor were the most commonly identified causes. © 2013 Movement Disorder Society., (Copyright © 2013 Movement Disorder Society.)

The objective of the present study was to determine the presence of genotype by environment interaction (G × E) and to characterize the phenotypic plasticity of birth weight (BW), weaning weight (WW), postweaning weight gain (PWG) and yearling scrotal circumference (SC) in composite beef cattle using the reaction norms model with unknown covariate. The animals were born between 1995 and 2008 on 33 farms located throughout all Brazilian biomes between latitude -7° and -31°, longitude -40° and -63°. The contemporary group was chosen as the environmental descriptor, that is, the environmental covariate of the reaction norms. In general, higher estimates of direct heritability were observed in extreme favorable environments. The mean of direct heritability across the environmental gradient ranged from 0.05 to 0.51, 0.09 to 0.43, 0.01 to 0.43 and from 0.12 to 0.26 for BW, WW, PWG and SC, respectively. The variation in direct heritability observed indicates a different response to selection according to the environment in which the animals of the population are evaluated. The correlation between the level and slope of the reaction norm for BW and PWG was high, indicating that animals with higher average breeding values responded better to improvement in environmental conditions, a fact characterizing a scale of G × E. Low correlation between the intercept and slope was obtained for WW and SC, implying re-ranking of animals in different environments. Genetic variation exists in the sensitivity of animals to the environment, a fact that permits the selection of more plastic or robust genotypes in the population studied. Thus, the G × E is an important factor that should be considered in the genetic evaluation of the present population of composite beef cattle.

Objective: To investigate the frequency of bipolar disorder, dopamine dysregulation syndrome and punding in Parkinson's disease patients from a Brazilian movement disorders clinic., Method: One hundred patients underwent a comprehensive psychiatric examination composed of MINI-plus and specific questionnaires to investigate dopamine dysregulation syndrome and punding., Results: We identified, respectively, one and five Parkinson's disease patients with bipolar disorder type I and type II. All manic/hypomanic episodes occurred before Parkinson's disease onset. No patient was identified with dopamine dysregulation syndrome or punding., Conclusion: The frequency of manic/hypomanic episodes seems to decrease with Parkinson's disease onset, and local environmental factors (e.g. drug availability) may be responsible for the low frequency of dopamine dysregulation syndrome and punding in Brazilian Parkinson's disease patients.

Background: Changes in balance occur with the progression of Parkinson's disease (PD)., Objective: To validate the Brazilian version of the Berg Balance Scale (BBS) for PD patients, determining its reliability and internal consistency and correlating it with PD-specific instruments., Method: We evaluated 53 patients (M/F 37/16, mean age+/-SD, 62+/-7.9 years) with PD (mean+/-SD, 7.8+/-4.4 years). Unified Parkinson's Disease Rating Scale (UPDRS), Schwab and England Scale (SandE , Hoehn and Yahr Staging Scale (HY) and BBS were used to assess patients. Statistical analyses for inter-rater reliability, internal consistency and correlations among BBS, UPDRS, SandE and HY were performed., Results: The mean scores+/-SD on UPDRS and BBS were, respectively, 41.6+/-17.8 and 47.2+/-8.2. The median on SandE and HY scales were 80% and 2.5, respectively. The BBS presented a high intra-class correlation coefficient (ICC=0.84) and internal consistency (Cronbrach's alpha=0.92). There was a statistically significant correlation between BBS and disease duration (r(s)= -0.520, p<0.001), UPDRS subscales II and III (r(s)= -0.467, p=0.011; r(s)= -0.374, p=0.046, respectively), stage of disease (HY; r(s)= -0.507, p<0.001) and the activities of daily living (SandE; r(s)=0.492, p<0.001)., Conclusion: The BBS is a promising tool for the assessment of balance in PD, correlating with the stage of disease and the level of independence.

The aim of the study was to evaluate the frequency and to perform phenotypic and genotypic characterization of familial Parkinsonism and early onset Parkinson's disease (EOPD) in a Brazilian movement disorder unit. We performed a standardized clinical assessment of patients followed by sequencing of PRKN, PINK1 in EOPD cases and SNCA, LRRK2 in familial Parkinsonism individuals. During the period of study (January through December, 2006), we examined 575 consecutive patients of whom 226 (39.3%) met the diagnosis of Parkinsonism and idiopathic Parkinson's disease (IPD) was diagnosed in 202 of the latter. Of the IPD cases, 45 (22.3%) had EOPD. The age at onset in the EOPD cases (n = 45) was 34.8 +/- 5.4 years (mean +/- standard deviation). The age at onset in the familial late-onset PD patients (n = 8) was 52.3 +/- 12.2 years. In the early onset cases, we identified five known mutations in PRKN, two single heterozygous and three compound heterozygous (P153R, T240M, 255Adel, W54R, V3I); in addition, we identified one novel mutation in PINK1 (homozygous deletion of exon 7). In the familial cases (late onset), 1 patient had a novel LRRK2 variant, Q923H, but no SNCA mutations were identified. We have demonstrated that EOPD accounts for a high frequency of IPD cases in our tertiary referral center. PRKN was the most commonly mutated gene, but we also identified a novel mutation in PINK1 and a novel variant in LRRK2.

Dopa responsive Dystonia (DRD) was first described in 1971 and typically begins at childhood with gait dysfunction caused by foot dystonia progressing to affect other extremities. There is marked diurnal fluctuation and sustained improvement of symptoms with low dose levodopa therapy. Heterozygous mutation of the gene GCH1 has been shown to cause DRD. We studied GCH1 in nine patients with DRD from six families of Federal University of Minas Gerais Movement Disorders Clinic. We identified three mutations; two affected siblings carried a novel T209P mutation and two siblings from another family were compound heterozygous carriers of Met211Val and Lys224Arg mutations. To our knowledge this is the first report of GCH1 mutations underlying DRD in patients from Brazil., (2007 Movement Disorder Society)

Introduction: Patients with COPD have decreased exercise capacity and low oxygen consumption (Vo(2)) during formal cardiopulmonary exercise testing, and lower scores on health-related quality of life questionnaires. When isolated, these three variables show different correlations with COPD mortality. The multidimensional BODE (body mass index[BMI], airflow obstruction, dyspnea, and exercise capacity in COPD) index, which comprises four variables including the 6-min walk test (6MWT), predicts survival in COPD., Objectives: To evaluate the degree of association between the values of the BODE index using the 6MWT with the BODE index using maximal Vo(2) (Vo(2)max) obtained in a maximal incremental test., Materials and Methods: Fifty patients with mild-to-severe COPD (average age, 63.5 +/- 9.9 years; FEV(1), 65.3 +/- 23.6% of predicted) [+/- SD] had BMI, spirometric function (FVC and FEV(1)), and dyspnea status (Medical Research Council) evaluated. Two BODE index scores were then completed: one with the 6MWT, and one with the Vo(2)max obtained during maximal incremental testing on a treadmill., Results: Correlation between BODE index and Vo(2) in milliliters per minute per kilogram (r = - 0.41) was weak; the correlation was moderate (r = - 0.64) when Vo(2) percentage of predicted was used. The BODE index modified by replacing the 6MWT with Vo(2) showed excellent correlations with Vo(2) in milliliters per minute per kilogram (r = 0.92) and Vo(2) percentage of predicted (r = 0.95)., Conclusion: The excellent correlation between the conventional BODE index and the modified BODE index with Vo(2) replacing the 6MWT enables us to reach the conclusion that the original BODE index is very effective in the evaluation of COPD patients.

Regarded as one of the best Brazilian writers, Machado de Assis was diagnosed with epilepsy since childhood. In his vast work, some of the main pieces are rich in describing neuropsychiatric disorders, including epilepsy, depression, dementia (most likely related to neurosyphilis), acute confusional state (delirium), dysthymia and motor tics. An anti-psychiatric bias is clearly noticed in his approach to mental illness-related themes.

Surface proteins of schistosomes are exposed to host tissues and thus present as potential candidate molecules for the development of new intervention strategies. Herein, we have identified a new tegumental protein of Schistosoma mansoni, termed Sm29. In silico analysis revealed a signal peptide, three glycosylation sites and a transmembrane region on Sm29 amino acid sequence. Sm29 transcription in mammalian developmental stages cDNA libraries of S. mansoni was verified by PCR using specific primers for Sm29 nucleotide sequence and it revealed the presence of transcripts in schistosomula and adult worm stages of the parasite. Sm29 (40-169) fragment was produced in Escherichia coli and purified by affinity chromatography to be used in the immunological assays. Confocal microscopy confirmed bioinformatic studies, revealing that Sm29 is a membrane-bound protein localized on the tegument of S. mansoni adult worm. ELISA was performed using rSm29 protein to investigate the antibody isotype profile to Sm29 in sera of patients living in endemic areas for schistosomiasis. IgG1 and IgG3 subclass antibodies to rSm29 were predominant in sera of individuals naturally resistant to infection and resistant to re-infection whereas low levels of IgM, IgA or IgE were measured. Since, IgG1 and IgG3 are involved in parasite killing and in protective immunity the findings reported here suggest the use of Sm29 as a potential candidate vaccine against schistosomiasis.

Several community-based surveys on the prevalence of Parkinsonism and Parkinson's disease have been conducted worldwide, with variations on their methodology and results. The objective of this study is to assess the prevalence of Parkinsonism and its causes in a cohort of individuals age 64 years or older in Bambuí, a Brazilian town. In phase I, 1,186 people older than 64 years responded to a 9-question screening questionnaire for Parkinsonism. In phase II, all subjects who scored > or = 2 points on the test were examined independently by at least 2 movement disorder-trained physicians. A movement disorder senior specialist excluded or confirmed the diagnosis in all suspected cases. The response rate was high for both phases (96% for phase I and 94% for phase II). The prevalence rate per 100 population over 64 years of age in this group was 7.2% for Parkinsonism of all types (n = 86). The most frequent causes were idiopathic Parkinson's disease and drug-induced Parkinsonism, with prevalence rates of 3.3% (n = 39) and 2.7% (n = 32), respectively. The prevalence of vascular Parkinsonism was 1.1% (n = 13). We found 1 case of posttraumatic Parkinsonism and another with multiple system atrophy. In this first population-based study of Parkinsonism conducted in Brazil, the prevalence in a cohort of elderly subjects was higher than the observed in other populations worldwide, especially because of the high rates of drug-induced and vascular Parkinsonism. The prevalence of Parkinson's disease was similar to that observed in elderly people in door-to-door surveys in other American, European, and Eastern countries.

Objective: The objective of this study was to evaluate the applicability of a modified version of the Saint George's Respiratory Questionnaire. The version evaluated elicits "agree" and "do not agree", rather than "yes" and "no", responses. The intention is to facilitate the comprehension of double-negative questions and to promote better recollection of symptoms by patients by shortening their symptom histories from 12 months to 3 months., Methods: A total of 30 clinically stable patients with chronic obstructive pulmonary disease were evaluated. The Saint George's Respiratory Questionnaire and the modified version of the same were administered 15 days apart., Results: All of the patients presented health-related alterations in their quality of life. Comparing mean scores between the two questionnaires, the greatest difference was seen in the Symptoms domain. No significant differences were found in any of the remaining domains or in the total scores. In a subsequent analysis, significant correlations between the two questionnaires were found in all domains: Symptoms (r = 0.71; p < 0.001); Activity (r = 0.75; p < 0.001); Impact (r = 0.73; p < 0.001) and Total (r = 0.86; p < 0.001)., Conclusion: The modified version of the Saint George's Respiratory Questionnaire is as effective as the original in gauging quality of life. However, various symptoms recollection time frames should be investigated in order to determine which would be the best time frame to employ in the analysis.

Production of IFN-gamma guarantees helpful T cell-mediated immunity against Mycobacterium tuberculosis infection. We have evaluated the in vitro immune responses to M. tuberculosis antigens using IFN-gamma production among 43 Brazilian tuberculosis (TB) patients prior to and after specific treatment, and 18 community controls. Peripheral blood mononuclear cells (PBMC) were cultivated in the presence either of purified protein derivative, ferritin, 10 kDa, 38 kDa, MPT59, Ag85A or Ag85B. Also, the two M. tuberculosis and M. bovis heat-shock proteins (hsp) 65 and 70 kDa were compared, and 5 day supernatants were harvested for cytokine detection by ELISA. The results showed that the overall profile of primary PBMC in response to most M. tuberculosis antigens was well correlated, since high IFN-gamma levels were induced by Ag85A, Ag85B, 38 kDa, ferritin and 10 kDa, as well as M. tuberculosis hsp65 in TB patients. In addition, analysis was carried out of the in vitro expression of activation molecules on lymphocytes, as CD25 and CD69 expression assessed in 17 TB patients showed induction on CD4+ T cells by Ag85B. Overall, significantly low responses were found in untreated, in comparison with the treated TB patients. Furthermore, internal community but not healthy control individuals have higher immune responses than do TB patients.

Here, we describe the situation of canine visceral leishmaniasis in two villages of São José de Ribamar in Maranhão State/Brazil, where human cases have been registered. Blood samples of 36 household crossbred dogs from Sergio Tamer village and 43 dogs from Quinta village were collected and the serum used for serological diagnosis. An Indirect Fluorescent Antibody Test (IFAT) and enzyme-linked immunosorbent assay (ELISA) were used to detect antibodies against Leishmania. The clinical examination showed that 25% of the canine population of Quinta presented a poor body condition and in 39%, ectoparasites (ticks and fleas) were detected. In both tests, serology revealed that 21% (9 out of 43) of the dogs presented antibodies against Leishmania (55% were asymptomatic and 45% were symptomatic). In the Vila Sérgio Tamer, 25% (9 out of 36) of the dogs were seropositive for Leishmania (66.67% were asymptomatic and 33.33% were symptomatic), 33% presented poor body condition, and 22% have ectoparasites. The clinical signs more frequent were skin lesions. The statistical analysis showed that there was no statistical difference (p>0.05) between the seropositivity of the dogs from the two villages. The same was observed when the clinical signs were compared (p>0.05). Both villages have favorable conditions to maintain the cycle of leishmaniasis.

We compared the frequency of migraine among Sydenham's chorea (SC) patients, rheumatic fever (RF) patients without neurological symptoms and matched controls. Migraine was more frequent in SC patients (12/55, 21.8%) than in controls (9/110, 8.1%) and as common as in the RF group (10/55, 18.2%). Our data are in agreement with previous studies reporting higher frequency of migraine in other basal ganglia disorders, such as essential tremor and Tourette's syndrome.

Canine visceral leishmaniosis (CVL) may be an important factor preceding human outbreaks of the disease. We report that the prevalence of canine visceral leishmaniosis infection has been increasing in recent years in Anastácio town, located in the central western region of Brazil. Serological investigations showed that 75.3% of dogs presented antibody titres ranging from 1/40 to 1/160 in the indirect immunofluorescence antibody test (IFAT). Bone marrow and lymph node aspirates provided positive cultures and furnished parasites for enzymological and serological typing in 42.5% and 41.1% of the cases, respectively. All the strains were typed as Leishmania (L.) chagasi. This is primarily a canine disease that spills over into the human population as a zoonosis. The study showed the epidemiological features of the infection in a region in which the problem of visceral leishmaniosis has been underestimated.

Huntington disease (HD) is associated with expansions of a CAG trinucleotide repeat in the HD gene. Accurate measurement of a specific CAG repeat sequence in the HD gene in 92 Brazilian controls without HD, 44 Brazilian subjects with clinical findings suggestive of HD and 40 individuals from 6 putative HD families, showed a range from 7 to 33 repeats in normal subjects and 39 to 88 repeats in affected subjects. A trend between early age at onset of first symptoms and increasing number of repeats was seen. Major increase of repeat size through paternal inheritance than through maternal inheritance was observed. Data generated from this study may have significant implications for the etiology, knowledge of the incidence, diagnosis, prognosis, genetic counseling and treatment of HD Brazilian patients.

Objective: The aim of the present study is to investigate whether there are geographic differences in the etiology of parkinsonism (PA)., Background: 72% of patients with PA evaluated at movement disorders clinics in the Northern Hemisphere are diagnosed with Parkinson's disease (PD). Data regarding other regions are not available., Methods: We reviewed the charts of all patients with PA seen at the Federal University of Minas Gerais Movement Disorders Clinic from July 1993 through October 1995. PA was diagnosed by the presence of at least two of the following: rest tremor, bradykinesia, rigidity, and postural instability. The different etiologies were diagnosed based on standard clinical criteria., Results: During the period of the study, PA was recognized in 338 subjects. The following clinical diagnoses were made: PD (68.9%), drug-induced PA (DIP) (13.3%), vascular PA (4.7%), Progressive supranuclear palsy (PSP) (2%), multiple system atrophy (MSA) (1.8%), others (9.7%). Cinnarizine, haloperidol and flunarizine were the commonest drugs related to DIP., Conclusions: Similarly to other studies, PD accounts for about 70% of PA patients. However, there are differences between our results and previous series. DIP is much more common in the present series. This may be accounted for a more liberal use of antidopaminergic drugs in our environment, especially Calcium channel blockers. The lower frequency of MSA and PSP in our study may reflect a short follow-up, since many patients initially diagnosed with PD later are found to have Parkinson-plus syndromes.

Spinocerebellar ataxia type 1 (SCA1), spinocerebellar ataxia type 2 (SCA2) and Machado-Joseph disease or spinocerebellar ataxia type 3 (MJD/SCA3) are three distinctive forms of autosomal dominant spinocerebellar ataxia (SCA) caused by expansions of an unstable CAG repeat localized in the coding region of the causative genes. Another related disease, dentatorubropallidoluysian atrophy (DRPLA) is also caused by an unstable triplet repeat and can present as SCA in late onset patients. We investigated the frequency of the SCA1, SCA2, MJD/SCA3 and DRPLA mutations in 328 Brazilian patients with SCA, belonging to 90 unrelated families with various patterns of inheritance and originating in different geographic regions of Brazil. We found mutations in 35 families (39%), 32 of them with a clear autosomal dominant inheritance. The frequency of the SCA1 mutation was 3% of all patients; and 6% in the dominantly inherited SCAs. We identified the SCA2 mutation in 6% of all families and in 9% of the families with autosomal dominant inheritance. The MJD/SCA3 mutation was detected in 30% of all patients; and in the 44% of the dominantly inherited cases. We found no DRPLA mutation. In addition, we observed variability in the frequency of the different mutations according to geographic origin of the patients, which is probably related to the distinct colonization of different parts of Brazil. These results suggest that SCA may be occasionally caused by the SCA1 and SCA2 mutations in the Brazilian population, and that the MJD/SCA3 mutation is the most common cause of dominantly inherited SCA in Brazil.

Rheumatic fever (RF) remains a significant public health problem in developing countries. Although its incidence has been declining in developed areas, several outbreaks of RF have been identified in the United States since 1985. To study the prevalence and clinical features of Sydenham's chorea (SC), a well-recognized expression of RF, we examined 50 consecutive patients with RF seen at our Pediatric Cardiology Clinic. Chorea was rated on a scale of 0-4 (0 = no chorea; and 4 = severe chorea, patient unable to walk). Chorea, active or in remission, occurred in 13 patients (26%). The male-to-female ratio was 1.08 among the total population and 0.86 among the SC group. The mean age of the 50 patients at onset of RF was 8.4 years and the standard deviation (SD) 3.1 years. Carditis was diagnosed in 84% of patients with and without chorea, but arthritis was more common in the latter group (83.8%) than in the SC group (30.8%). The mean age at onset of SC was 9.2 years (SD 2.7). Involuntary movement, noticed by nine patients, was the most common initial symptom. Chorea went into remission in eight patients after 9.9 months (SD 13.4). Chorea was rated 3 in ten patients, 1 in two patients, and 4 in one patient. Among the five patients with active SC, three had hemichorea and two had generalized chorea. We recognized abnormal saccades in 80% of patients with active chorea, whereas just 13.5% of patients without chorea displayed this abnormality. SC remains an important cause of chorea in countries plagued by RF.

The clinical features of 32 patients (24 males) with Tourette's syndrome in Brazil were studied. The mean age at onset was 7.1 years, tics being the first symptom in 71% and hyperactivity in 29%. Blinking, grimacing, and shoulder elevation were the most common motor tics and sniffing, throat clearing, and grunting noises, the most frequent vocal tics. Coprolalia was present in 28%, echolalia in 16%, palilalia in 9%, and copropraxia in 25% of patients. Attention deficit and hyperactivity disorder was diagnosed in 63%, and obsessive compulsive behaviour in 44% of patients. In 84% of patients there was a family history of tics whereas attention deficit and hyperactivity disorder and obsessive compulsive behaviour were respectively present in relatives of 19% and 53% of the patients studied. These data suggest that Tourette's syndrome in Brazil is not clinically different from other countries, supporting the notion that genetic factors play the most important part in its aetiology.