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Ianna Lacerda Sampaio Braga,1–3 João Castelo-Filho,2 Rafael de Sousa Bezerra Pinheiro,3 Rodrigo Barbosa de Azevedo,3 Antônio Talys Ponte,4 Romulo Augusto da Silveira,4 Pedro Braga-Neto,5,6 Adriana Rolim Campos1,21Northeast Biotechnology Network, Universidade de Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil; 2Medical School Graduate Program, Health Sciences Center, Universidade de Fortaleza, Fortaleza, Ceará, Brazil; 3Internal Medicine Service, Hospital Geral Dr. César Carls, Fortaleza, Ceará, Brazil; 4Urology Service, Hospital Geral Dr. César Cals, Fortaleza, Ceará, Brazil; 5Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil; 6Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, BrazilCorrespondence: Ianna Lacerda Sampaio BragaMedical School Graduate Program, Health Sciences Center, Universidade de Fortaleza (UNIFOR), Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza, Ceará, BrazilEmail iannalacerda@unifor.brPedro Braga-NetoDepartment of Clinical Medicine, Universidade Federal do Ceará, Rua Prof. Costa Mendes, 1608 - 4 andar - Rodolfo Teófilo, Fortaleza, Ceará, BrazilTel +55 859 998 5616Email pbraganeto@ufc.brIntroduction: Postoperative delirium (POD) is a common disorder and its frequency varies from 15% to 25% after major elective surgery. There are few data on the incidence of POD in Brazil. Here, we sought to assess the incidence of POD following transurethral resection of the prostate (TURP) and to examine precipitating and predisposing factors associated.Method: We performed a prospective observational study of elderly male patients undergoing TURP (N=55) in Northeast Brazil. Information on demographic, medical, cognitive and functional characteristics were collected. The participants were followed until hospital discharge. POD was diagnosed by the Confusion Assessment Method.Results: A total of three participants (5.45%) were identified with POD. Episodes of delirium lasted 3±1 days. The study sample consisted of a healthy population. Patients with POD had longer hospital stay and more precipitating factors. The POD group showed statistically significant lower Barthel index score (p

Estimates of the spectrum and frequency of pathogenic variants in Parkinsons disease (PD) in different populations are currently limited and biased. Furthermore, although therapeutic modification of several genetic targets has reached the clinical trial stage, a major obstacle in conducting these trials is that PD patients are largely unaware of their genetic status and, therefore, cannot be recruited. Expanding the number of investigated PD-related genes and including genes related to disorders with overlapping clinical features in large, well-phenotyped PD patient groups is a prerequisite for capturing the full variant spectrum underlying PD and for stratifying and prioritizing patients for gene-targeted clinical trials. The Rostock Parkinsons disease (ROPAD) study is an observational clinical study aiming to determine the frequency and spectrum of genetic variants contributing to PD in a large international cohort. We investigated variants in 50 genes with either an established relevance for PD or possible phenotypic overlap in a group of 12 580 PD patients from 16 countries [62.3% male; 92.0% White; 27.0% positive family history (FH+), median age at onset (AAO) 59 years] using a next-generation sequencing panel. Altogether, in 1864 (14.8%) ROPAD participants (58.1% male; 91.0% White, 35.5% FH+, median AAO 55 years), a PD-relevant genetic test (PDGT) was positive based on GBA1 risk variants (10.4%) or pathogenic/likely pathogenic variants in LRRK2 (2.9%), PRKN (0.9%), SNCA (0.2%) or PINK1 (0.1%) or a combination of two genetic findings in two genes (∼0.2%). Of note, the adjusted positive PDGT fraction, i.e. the fraction of positive PDGTs per country weighted by the fraction of the population of the world that they represent, was 14.5%. Positive PDGTs were identified in 19.9% of patients with an AAO ≤ 50 years, in 19.5% of patients with FH+ and in 26.9% with an AAO ≤ 50 years and FH+. In comparison to the idiopathic PD group (6846 patients with benign variants), the positive PDGT group had a significantly lower AAO (4 years, P = 9 × 10-34). The probability of a positive PDGT decreased by 3% with every additional AAO year (P = 1 × 10-35). Female patients were 22% more likely to have a positive PDGT (P = 3 × 10-4), and for individuals with FH+ this likelihood was 55% higher (P = 1 × 10-14). About 0.8% of the ROPAD participants had positive genetic testing findings in parkinsonism-, dystonia/dyskinesia- or dementia-related genes. In the emerging era of gene-targeted PD clinical trials, our finding that ∼15% of patients harbour potentially actionable genetic variants offers an important prospect to affected individuals and their families and underlines the need for genetic testing in PD patients. Thus, the insights from the ROPAD study allow for data-driven, differential genetic counselling across the spectrum of different AAOs and family histories and promote a possible policy change in the application of genetic testing as a routine part of patient evaluation and care in PD.

Abstract Background To report a case of IgG4-related pachymeningitis presenting with cystic lesions mimicking neurocysticercosis. Case presentation A 40-year-old female patient with tetraparesis, dysphagia and dysphonia was evaluated with clinical examination, magnetic resonance imaging, and meningeal biopsy. Magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement involving the cranial, cervical, thoracic, and lumbar segments with spinal cord compression and cystic lesions. CSF immunology was initially positive for cysticercus cellulosae. After disease progression a meningeal biopsy was compatible with IgG4 related disease. The patient had partial response to rituximab and needed multiple surgical procedures for spinal cord decompression and CSF shunting. Conclusions This case highlights the possibility of IgG4-related disease in patients with diffuse pachymeningitis causing spinal cord compression, even with cystic lesions on MRI. Diagnosis of IgG4-related pachymeningitis is paramount due to the possibility of treatment response to immunotherapy, particularly to anti-CD20 agents.

Background Olfactory dysfunction (OD) represents a frequent manifestation of the coronavirus disease 2019 (COVID-19). Apolipoprotein E (APOE) is a protein that interacts with the angiotensin-converting enzyme receptor, essential for viral entry into the cell. Previous publications have suggested a possible role of APOE in COVID-19 severity. As far as we know, no publications found significant associations between this disease's severity, OD, and APOE polymorphisms (E2, E3, and E4).

Background Cerebellar ataxias comprise sporadic and genetic etiologies. Ataxia may also be a presenting feature in hereditary spastic paraplegias (HSPs).

ABSTRACT A 34-year-old man developed severe envenomation after being bitten by a Crotalus durissus (rattlesnake), which was treated with anticrotalic serum. Three weeks later, the patient reported paresthesia and neuropathic pain in the left hand, which had progressed to all four limbs. Electroneuromyography revealed asymmetric axonal sensorimotor multiple mononeuropathy. The patient was treated with prednisone, and six months later there was significant improvement in sensorimotor conduction. This is the first reported case of multiple mononeuropathy associated with C. durissus envenomation. Post-snake envenomation peripheral neuropathy is a rare complication requiring prompt recognition and treatment to optimize nerve function and enhance patient outcomes.

ABSTRACT Objective To determine the diagnostic accuracy of the Addenbrooke’s Cognitive Examination (ACE-R) for older adults with low education, without dementia, in two capitals in northeastern Brazil, compared to subjects with MCI. Methods 100 participants were collected from a previous neurological and psychiatric evaluation and were subsequently subjected to the ACE-R. Among them, 18 subjects with amnestic mild cognitive impairment (aMCI), 22 with non-amnestic mild cognitive impairment (naMCI), and 60 healthy controls. Results Optimal ACE-R accuracy yielded excellent values for the comparison between controls and naMCI [Area Under the Curve (AUC) = 0.919)] and controls and aMCI (AUC= 0.921); conversely, very fair accuracy was reported for the comparison between aMCI and naMCI (AUC= 0.578). Conclusions These findings support establishing reliable cutoff scores for cognitive assessment of elderlies with low schooling and cognitive decline, not dementia, taking into consideration ecological and regional variables.

Abstract Background Progressive Myoclonic Epilepsy (PME) is a group of rare diseases that are difficult to differentiate from one another based on phenotypical characteristics. Case report We report a case of PME type 7 due to a pathogenic variant in KCNC1 with myoclonus improvement after epileptic seizures. Discussion Myoclonus improvement after seizures may be a clue to the diagnosis of Progressive Myoclonic Epilepsy type 7.

Abstract Introduction Postural balance impairment can affect the quality of life of patients with Parkinson’s disease. Previous studies have described connections of the vestibular system with postural functions, suggesting a potential participation of the basal ganglia in receiving vestibular stimuli. This systematic review aims to summarize the evidence on the effectiveness of vestibular rehabilitation on postural balance in patients with Parkinson’s disease. Methods A systematic review was conducted using the electronic databases: PubMed, Embase, Scopus and PEDro. The study selection was independently conducted by two reviewers, and disagreements were evaluated by a third reviewer. The included studies had no restrictions on publication dates or languages and the last update occurred in July 2023. Results From the 485 studies found in the searches, only 3 studies were deemed eligible for the systematic review involving a total of 130 participants. The Berg Balance Scale was described as the tool for evaluation of postural balance in all studies. The meta-analysis showed statistically significant results in favor of vestibular rehabilitation (MD = 5.35; 95% CI = 2.39, 8.31; P

Inadequate turfgrass irrigation management poses a significant challenge, resulting in considerable water loss through runoff and the transport of contaminants, ultimately jeopardizing surface and groundwater quality. This study introduces a Machine Learning (ML)-based Decision Support System (DSS) designed to optimize turfgrass irrigation, concurrently minimizing runoff and preserving turfgrass quality. A robust ML classifier, specifically the Radial Basis Function - Support Vector Machine (RBF-SVM) was trained on synthetic data generated through the Monte-Carlo (MC) technique, which was then used to specify a set of irrigation rules implemented in the irrigation controller. The synthetic data were derived from observations collected from irrigation plots at the Texas A&M University Turfgrass Laboratory in Texas, United States, with Soil Wetting Efficiency Index (SWEI) serving as the target variable. When tested against a commercially available irrigation controller, the ML-based controller significantly reduced runoff by an average of 74 % while maintaining high Green Cover (GC) in turfgrass, achieving an accuracy of 87 %. These findings highlight the potential of ML-driven irrigation systems to improve water use efficiency, reduce environmental impact, and maintain turf quality. Such systems could be beneficial for urban landscapes, sports fields, and agriculture, helping users conserve water while achieving sustainable turf management.

Objectives: To describe clinical-sociodemographic characteristics of patients with multiple sclerosis (MS) vaccinated against COVID-19, evaluating clinical worsening after vaccination and factors associated with vaccine refusal. Methods: This is a cross-sectional observational study with application of a structured form in patients with MS from Hospital Universitário Walter Cantídio addressing clinical, sociodemographic and psychological factors related to vaccination against COVID-19. Data were tabulated and described using means with standard deviation and frequency/proportion. Statistical analysis was performed adopting statistical significance of 5%. Results: Fifty-one patients (76.4% women) were evaluated, mean age 43.3 years (18-72). Of these, 29 (57%) had mild side effects and 7 had COVID-19 after vaccination. There was no significant increase in the annualized rate of relapses or expanded disability status scale. Twelve patients reported fear regarding vaccination, with intentional delay in 5 patients. The main sources of fear mentioned were social networks, television and friends/family. Conclusions: In this study, vaccination for COVID-19 in patients with multiple sclerosis proved to be safe, not leading to relapses or functional worsening after vaccination. The fear of vaccinating led to delay in some patients, and social networks were the main source of fear.

The dynamics in mixtures of ionic liquid and monoatomic cations has been studied at different time scales ranging from the nanosecond up to the second. The mixtures were composed of cholinium bis(trifluoromethanesulfonyl)imide ([Chol][TFSI]) and LiTFSI, with LiTFSI mole fraction, Image 1, spanning from 0 to 0.5 (saturated solution), and [Chol][TFSI] and Image 2 from 0 to 0.12. The translational self-diffusion coefficients of Image 3, Image 4 and Image 5 have been measured, along with NMR their relaxation times at various magnetic fields, in order to decipher the intertwined dynamics between the ions, and to reveal how the local dynamics impact the long range translational diffusion. When the concentrations of lithium and lanthanum are increased in the liquid, the long range dynamics of all the ions drop. In the case of LiTFSI, the self-diffusion coefficient of lithium becomes higher than the one of TFSI at high concentration, revealing a change in lithium transport mechanisms. The NMR relaxation data confirm this change, showing a clearer transition at Image 6. It is interpreted as a change from a vehicular transport mechanism of the lithium below Image 6 to a hopping mechanism above. A similar crossover seems to occur in the lanthanum solutions. This phenomenon seems correlated to the departure of the hydroxyl group of the organic cation from the lithium solvation shell.

Sjogren's syndrome (SS) is a complex autoimmune disease characterized by lymphocytic infiltration of salivary and lacrimal glands, resulting in sicca symptoms. Additionally, SS presents with neurological manifestations that significantly impact the nervous system. This review aims to provide a comprehensive overview of the neurological aspects of SSj, covering both the peripheral and central nervous system involvement, while emphasizing diagnosis, treatment, and prognosis.

Abstract Background The prevalence and pathophysiological mechanisms of cognitive deficits (CD) Systemic Lupus Erythematosus (SLE) and Rheumatoid arthritis (RA) are very heterogeneous and poorly understood. We characterized CD in patients with SLE compared with RA patients and healthy controls. We compared the neuropsychological profile of SLE and RA with patients’ oxidative/inflammatory biomarkers for CD. Methods We performed a cross-sectional study, including 50 SLE patients, 29 RA patients, and 32 healthy controls. SLEDAI and DAS28 assessed disease activity. SF-36 questionnaire and a battery of cognitive tests were applied to all participants. Blood samples were collected to determine IL-6, S100ß, myeloperoxidase (MPO), malondialdehyde and reduced glutathione (GSH) alterations. Results In the SLE group, higher GSH was associated with the absence of CD (With CD = 69 ± 49, Without CD = 112 ± 81, p = 0.030), while higher IL-6 was associated with the presence of CD in the RA group (With CD = 603 ± 173, Without CD = 431 ± 162, p = 0.032). Regarding specific cognitive domains, in SLE higher MPO was associated with poor performance in reasoning and abstraction (p = 0.039), higher IL-6 was associated with poor performance in inhibitory control and attention (p = 0.031), and higher GSH was associated with better performance in memory(p = 0.021). Higher SLEDAI was associated with poor performance in semantic fluency(p = 0.031), inhibitory control, and attention in the SLE group(p = 0.037). In the RA group, higher DAS-28 was associated with poor performance in executive functions(p = 0.016) and phonemic fluency (p = 0.003). Conclusion SLE patients’ disease activity, inflammatory state, and oxidative stress were associated with CD. In RA patients, CD was associated with disease activity and inflammatory state. These results encourage further studies with larger samples aiming to confirm oxidative stress parameters as biomarkers of CD in SLE patients.

Abstract The objective of this work was to determine the acidity levels to obtain adequate soil chemical attributes for the maximum fruit yield of blackberry trees grown in acidic soils subjected to increasing limestone rates. The BRS Tupy, Brazos, Guarani, and BRS Xavante blackberry cultivars were evaluated on the Typic Hapludox (LVdf) and Rhodic Hapludox (LVd) soils, to which four rates of dolomitic limestone were applied (0, 1.5, 3.0, and 6.0 Mg ha-1). The effect of liming on soil chemical attributes, in a 2×4 factorial arrangement (soils and limestone rates), as well as leaf nutrient content and fruit yield, in a 2×4×4 factorial arrangement (soils, limestone rates, and cultivars), were evaluated. The maximum fruit yield was obtained with 3.3 Mg ha-1 dolomitic limestone. The blackberry cultivars showed a high demand for Ca, Mg, and base saturation and a low tolerance to aluminum in the soils. From 3.3 Mg ha-1 dolomitic limestone, the maximum fruit yield of blackberry trees grown in acidic soils is obtained with pH 5.6, maximum tolerated aluminum saturation of 6%, Ca and Mg concentration of 45.3 mmolc kg-1, and base saturation of 48.3%.

ABSTRACT Paroxysmal Hemicrania is a trigeminal autonomic cephalalgia described as a severe and strictly unilateral pain, which occurs in paroxysms at orbital, supraorbital and/ or temporal region. A 45-year-old woman presented to an orofacial pain specialist reporting severe, burning, throbbing, strictly right-sided headache associated to ipsilateral autonomic symptoms and orofacial pain. The pain was perceived on the maxillary region followed by pain spread to the head. Interdisciplinary evaluation, along with absolute responsiveness to indomethacin and normal Brain Magnetic Resonance imaging, led to the diagnosis of primary Episodic paroxysmal hemicrania with facial representation and myofascial pain of masticatory muscles. Dentists should be aware of paroxysmal hemicrania with facial representation and the possibility of temporomandibular disorder coexistence, in order to avoid misdiagnosis and inadequate management. Paroxysmal hemicrania may be first perceived on the face and may be associated with interparoxysmal pain. In these cases, efficient anamnesis and clinical evaluation followed by interdisciplinary approach is needed.

BackgroundParkinson’s disease (PD) is the second most common neurodegenerative illness and has the highest increase rate in recent years. There is growing evidence to suggest that PD is linked to higher osteoporosis rates and risk of fractures.ObjectiveThis study aims to estimate the prevalence and factors associated with osteoporosis as defined by the National Osteoporosis Foundation (NOF) and World Health Organization in patients with mild to moderate PD.MethodsWe performed a cross-sectional study at a tertiary public hospital in Fortaleza, Brazil, dating from May 2021 until April 2022. The study sample was comprised of patients with mild to moderate PD who were at least 40 years old and who had the ability to walk and stand unassisted. Bone Mineral Density (BMD) of both the hip (neck of the femur) and the lumbar spine were obtained via properly calibrated Dual Energy X-ray Absorptiometry (DXA) scanning. The FRAX (Fracture Risk Assessment Tool) score was used to determine a person’s 10-year risk of major osteoporotic fracture. The Revised European Working Group on Sarcopenia in Older People (EWGSOP 2) was used as a basis to confirm a sarcopenia diagnosis with the following parameters: low muscle strength gauged by handgrip strength and low muscle quantity by DXA. Physical performance was carefully evaluated by using the Short Physical Performance Battery test. Osteoporosis and osteopenia were diagnosed following the NOF guidelines and WHO recommendations.ResultsWe evaluated 107 patients in total, of whom 45 (42%) were women. The group’s mean age was 68 ± 9 years, and the mean disease time span was 9.9 ± 6.0 years and mean motor UPDRS was 43 ± 15. We found that 42.1% and 34.6% of the sample had osteopenia and osteoporosis following NOF criteria, respectively, and 43% and 33.6% following the WHO recommendations. Lower lean appendicular mass was associated to osteopenia and osteoporosis in multinomial logistic regression analysis in both diagnostic criteria.ConclusionOur findings provide additional evidence for the protective role of lean mass against osteoporosis in patients with PD.

Background Wyburn-Mason syndrome is a rare, non-hereditary congenital disease, belonging to the group of neurocutaneous syndromes with fewer than 100 cases reported since its first description in 1937.Case report A young adult man was initially evaluated at the age of 2 years for proptosis and progressive visual impairment of the right eye, followed by impairment in ocular abduction, adduction and elevation as well as amaurosis. MRI revealed an expansive formation centred in the right orbit compromising conal spaces with distortion of eye muscles and optic nerve. The lesion extended through the superior orbital fissure into the right cavernous sinus and to the contralateral orbit. Despite embolisation, proptosis and oedema of the periorbital tissue continued to worsen. The combination of facial, ocular and intracranial vascular malformations and the exclusion of alternative aetiologies led to a diagnosis of cerebrofacial arteriovenous metameric syndrome (CAMS) 1 (Wyburn-Mason syndrome).Discussion Important differential diagnoses are other CAMS, such as Sturge-Weber syndrome, as well as other conditions such as retinal cavernous haemangioma and vasoproliferative tumours. The optimal treatment regimen for severe cases of this syndrome is still unclear. Wyburn-Mason syndrome should be considered in patients presenting multiple arteriovenous malformations with orbital apex lesions.

Background Hereditary or familial spastic paraplegias (SPG) comprise a group of genetically and phenotypically heterogeneous diseases characterized by progressive degeneration of the corticospinal tracts. The complicated forms evolve with other various neurological signs and symptoms, including movement disorders and ataxia.

Objectives: To verify the association between the ABO blood type and the risk of SARS-CoV-2 infection and COVID-19 disease severity. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), using the 2020 PRISMA Checklist and flow diagram, and articles selected for review were analyzed using the Newcastle-Ottawa Quality Rating Scale. The research question was: “Would the ABO blood group influence the risk of infection and clinical course of patients infected with SARS-CoV-2?”, The following databases were used: Embase, PubMed, Virtual Health Library (VHL), Web of Science, ScienceDirect and Scopus. The protocol for this review was registered in the Prospective Register of Systematic Reviews (PROSPERO), number CRD42021245945. Results: We found 798 articles across PubMed, Embase, Scopus, Web of Science, Science Direct and Virtual Health Library and 54 articles were included in the final analysis. Among 30 studies evaluating the risk of COVID-19 infection, 21 found significant correlations with ABO blood groups, 14 of them revealing an increased risk in blood group A and 15 studies showing a decreased risk in blood group O. Most studies found no significant correlation with disease severity or mortality. Conclusion: The qualitative assessment of available information suggests that blood group A may be a risk factor for COVID-19 infection and that blood group O may have a protective effect. We were unable to determine a clear association between the ABO blood group and mortality. These conclusions are based on highly heterogenous evidence.

To effectively combat the re-infestation of boll weevils (Anthonomus grandis L.) in cotton fields, it is necessary to address the detection of volunteer cotton (VC) plants (Gossypium hirsutum L.) in rotation crops such as corn (Zea mays L.) and sorghum (Sorghum bicolor L.). The current practice involves manual field scouting at the field edges, which often leads to the oversight of VC plants growing in the middle of fields alongside corn and sorghum. As these VC plants reach the pinhead squaring stage (5–6 leaves), they can become hosts for boll weevil pests. Consequently, it becomes crucial to detect, locate, and accurately spot-spray these plants with appropriate chemicals. This paper focuses on the application of YOLOv5m to detect and locate VC plants during the tasseling (VT) growth stage of cornfields. Our results demonstrate that VC plants can be detected with a mean average precision (mAP) of 79% at an Intersection over Union (IoU) of 50% and a classification accuracy of 78% on images sized 1207 × 923 pixels. The average detection inference speed is 47 frames per second (FPS) on the NVIDIA Tesla P100 GPU-16 GB and 0.4 FPS on the NVIDIA Jetson TX2 GPU, which underscores the relevance and impact of detection speed on the feasibility of real-time applications. Additionally, we show the application of a customized unmanned aircraft system (UAS) for spot-spray applications through simulation based on the developed computer vision (CV) algorithm. This UAS-based approach enables the near-real-time detection and mitigation of VC plants in corn fields, with near-real-time defined as approximately 0.02 s per frame on the NVIDIA Tesla P100 GPU and 2.5 s per frame on the NVIDIA Jetson TX2 GPU, thereby offering an efficient management solution for controlling boll weevil pests.