Determinantes Sociales y Conocimiento de Higiene Oral en Inmigrantes

RESUMEN: Se desconoce la relación entre determinantes sociales y nivel de conocimiento asociado a los hábitos de higiene oral que tiene la población inmigrante en la V región, Chile en el año 2021. El objetivo de este trabajo consistió en determinar la relación entre determinantes sociales en salud y nivel de conocimientos asociado a hábitos de higiene oral en inmigrantes de la V región 2021, Chile. Estudio descriptivo, transversal, No probabilístico por conveniencia con encuesta previamente validada y una muestra de 101 sujetos de 18 a 35 años. Se mide la prevalencia de los determinantes sociales. Después de verificar la normalidad de los resultados, se efectúa análisis descriptivo e inferencial mediante estadístico de Pearson y T-student. El Margen de error de la muestra es de 10 % y un nivel de confianza de 95 %. Técnica de recogida de datos en vía pública, formulario online y búsqueda activa en centros de reunión de migrantes. De los sujetos encuestados, un 29 % tiene estudios de nivel primario incompleto, un 36 % tiene un ingreso mensual menor a US$300. Respecto a los hábitos de higiene, solamente un 27 % se cepilla después de cada comida, el porcentaje restante se cepilla dos o menos veces al día. Destaca que un 71 % tiene acceso a la salud pública y un 20 % no tiene protección de salud. Se relacionaron 86 pares de variables con estadística inferencial. Los resultados demuestran asociación en 12 de ellas, de las cuales: Nivel de educación, rango de ingresos y sistema previsional se relacionan con los hábitos de higiene y nivel de conocimiento (significancia asintótica bilateral menor a 0.05). De igual manera, se observa que aquellos que están adscritos a un sistema previsional, tienen mejores hábitos y nivel de conocimiento que la población sin cobertura. Las características multifactoriales relacionadas a las causas del movimiento migratorio en Latinoamérica, promueven determinantes sociales disminuidos. Si bien, existe evidencia científica que relaciona los determinantes sociales con el estado de salud de un individuo, la literatura asociada al nivel de conocimientos y hábitos de higiene es escasa. A partir de los resultados obtenidos, se concluye que las particularidades del inmigrante en Chile son propicias para una salud oral menguada en calidad, por lo que debiese ser discutida como política sanitaria a nivel país.

ABSTRACT: The objective of this study is to determine the relationship between social determinants of health and the level of knowledge associated with oral hygiene habits among migrants in the V Region 2021, Chile. Descriptive, cross-sectional, non-probabilistic study by convenience with a previously validated survey and a sample of 101 subjects aged 18 to 35 years. The prevalence of social determinants was measured. After verifying the normality of the results, descriptive and inferential analysis was performed using Pearson and T-student statistics. The margin of error of the sample is 10 % and a confidence level of 95 %. Data collection on public roads, online form and active search in migrant meeting centers. Of the subjects surveyed, 29 % have incomplete primary education, 36 % have a monthly income of less than US$300. With respect to hygiene habits, only 27 % brushed after every meal, the remaining percentage brushed two or fewer times a day. It should be noted that 71 % have access to public health care and 20 % have no health protection. Eighty-six pairs of variables were related with inferential statistics. The results show an association in 12 of them, of which: level of education, income range and social security system are related with the following variables and pension system are related to hygiene habits and level of knowledge (bilateral asymptotic significance less than 0.05). Likewise, it is observed that those who are affiliated to a pension system have better habits and level of knowledge than those who are not, have better habits and level of knowledge than the population without coverage. The multifactorial characteristics related to the causes of migratory movement in Latin America promote diminished social determinants. Although there is scientific evidence that relates social determinants to the health status of an individual, the literature associated with the level of knowledge and hygiene habits is limited. From the results obtained, it is concluded that the particularities of the migrants in Chile are conducive to a lower quality of oral health, which should be discussed as a health policy at a national level.

Anaerobic RSH-dependent tellurite reduction contributes to Escherichia coli tolerance against tellurite

BACKGROUND: Tellurium is a rare metalloid that exerts high toxicity on cells, especially on bacteria, partly due to reactive oxygen species (ROS) generation. Moreover, it has also been observed that tellurite can target free cell thiols groups (RSH) (i.e. reduced glutathione (GSH)), enhancing the cellular redox imbalance. Additionally, in vitro experiments have suggested that several enzymes can reduce tellurite (IV) to its elemental form (0); where RSH present on their active sites may be responsible for the process. Nevertheless, the mechanisms implemented by bacteria for tellurite reduction and its role in resistance have not been evaluated in vivo. RESULTS: This work shows that tellurite reduction to elemental tellurium is increased under anaerobic conditions in E. coli cells. The in vivo tellurite reduction is related to the intracellular concentration of total RSH, in the presence and absence of oxygen. This metabolization of tellurite directly contributes to the resistance of the bacteria to the oxyanion. CONCLUSIONS: We demonstrated that in vivo tellurite reduction is related to the intracellular thiol concentration, i.e. large availability of cellular RSH groups, results in a more significant reduction of tellurite. Furthermore, we observed that, when the bacterium exhibits less resistance to the oxyanion, a decreased tellurite reduction was seen, affecting the growth fitness. Together, these results let us propose that tellurite reduction and the intracellular RSH content are related to the oxyanion bacterial resistance, this tripartite mechanism in an oxygen independent anaerobic process.

Calidad de vida en demencia Alzheimer: un nuevo desafío / Quality of life in Alzheimer's dementia: a new challenge

Resumen El progresivo envejecimiento de la población mundial se encuentra directamente asociado al aumento de las patologías neurodegenerativas. Dentro de estas, la Enfermedad de Alzheimer es el tipo de demencia de mayor prevalencia a nivel mundial y se asocia a un mayor deterioro de la calidad de vida, no solo en los pacientes, sino que también en sus cuidadores y entorno familiar. Frente a este escenario, durante los últimos años ha adquirido especial importancia el evaluar la calidad de vida en pacientes con demencia Alzheimer, siendo un aspecto de creciente interés en el ámbito clínico y de la salud pública al ser considerado como un indicador en la medición de la efectividad de los distintos tipos de intervenciones, farmacológicas y no farmacológicas, sobre la enfermedad y su evolución. El conocer el concepto calidad de vida por parte de los equipos de salud y la evaluación clínica de esta en pacientes con demencia Alzheimer se ha vuelto un pilar fundamental tanto en el manejo, como en el uso de la información para la toma de decisiones en relación a políticas públicas relacionadas a pacientes con demencia. En este trabajo se abordará la temática desde tres ámbitos, la importancia de la enfermedad de Alzheimer, la calidad de vida a lo largo de los años, y como ésta puede ser utilizada en el manejo de patologías neurodegenerativas como la demencia.

The progressive aging of the world population is directly associated with the increase in neurodegenerative pathologies. Among these, Alzheimer's disease is the most prevalent type of dementia worldwide which is associated with a greater deterioration in the quality of life, not only in patients but also in their caregivers and family environment. In this context, during the last years has become important to evaluate the quality of life in patients with Alzheimer's dementia to be an area of growing interest in clinical and public health because it is considered as an indicator in effectiveness measurement of the different types of interventions, pharmacological and non-pharmacological, on the disease and its evolution. Heath teams know the concept of quality of life and its clinical evaluation in patients with Alzheimer's dementia and it has become fundamental support for both management and the use of information for decision-making in the field of public policies related to patients with dementia. In this viewpoint the theme will be addressed from three areas, the importance of Alzheimer's disease, quality of life throughout history, and how it can be used in the management of neurodegenerative diseases such as dementia.

Sexual transmission of American trypanosomiasis in humans: a new potential pandemic route for Chagas parasites

BACKGROUND The Trypanosoma cruzi infection endemic in Latin America has now spread to several countries across four continents; this endemic involves triatomine vector-free protists. We hypothesised that the sexual transmission of T. cruzi contributes to the ongoing spread of Chagas disease. OBJECTIVES A short-term longitudinal study was conducted to evaluate this hypothesis. METHODS The study population comprised 109 subjects from four families, among whom 21 had been diagnosed with acute Chagas disease by direct parasitological analysis. Blood mononuclear cells and serum samples were obtained from each study subject once per year for three consecutive years. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence serological examinations were used to detect specific T. cruzi antibodies. Polymerase chain reaction of T. cruzi DNA revealed 188-nucleotide bands, which hybridised to a specific radiolabelled probe and were confirmed by cloning and sequencing. RESULTS Three independent assessments at different time points revealed T. cruzi nuclear DNA footprints in 76% (83/109) of the study population with active infection. In contrast, the ELISA and indirect immunofluorescence assays detected the T. cruzi antibody in 28.4% (31/109) of the study samples. Moreover, the semen from 82.6% (19/23) of subjects people revealed harboured the 188- bp base pair T. cruzi footprint. Interestingly, the ejaculates of nuclear DNA-positive Chagas patient transmitted the T. cruzi upon peritoneal injection or infusion in the vagina of mice, and amastigotes were detected in the skeletal muscle, myocardium, vas deferens, and uterine tube. MAIN CONCLUSIONS T. cruzi infections can be transmitted from females or males to naïve mates through intercourse, and progeny showed discrepancies between the ratios of nuclear DNA footprints and specific antibody that can be explained by the tolerance attained during early embryo growth. Additional studies are needed to develop drugs to eradicate the infections. Additionally, the importance of a vigorous education, information, and communication program to prevent sexually transmitted Chagas disease in humans cannot be underemphasised.

Prácticas audiológicas en Chile: encuesta online para tecnólogos médicos mención otorrinolaringología / Audiological practices in Chile: an internet based survey for medical technologist with mayor in otorhinolaryngology

Introducción: A nivel internacional existen diversas instituciones que sugieren los estándares mínimos para la realización de los procedimientos audiológicos. Esto tiene como objetivo asegurar la calidad de las evaluaciones auditivas. Esto resulta de importancia en Chile debido a la implementación de programas de salud auditiva en el marco de las garantías explicitas de salud (GES). Objetivo: Documentar las prácticas comunes dentro de Tecnólogo Médico c/m Otorrinolaringología con la finalidad de obtener información para la creación y desarrollo de protocolos estandarizados para la evaluación audiológica. Material y método: Se aplicó un cuestionario de 38 preguntas distribuido a partir de una plataforma online a través de redes sociales y por correo electrónico a los socios de la Sociedad Chilena de Audiología y Otoneurología. Resultados: Se analizaron 121 encuestas finalizadas. Sobre el 70% de los encuestados que ejerce en la zona central. Procedimientos como audiometría de tonos puros, impedanciometría y logoaudiometría son frecuentemente realizados dentro de los encuestados. Estos procedimientos son realizados de acuerdo a lo sugerido dentro de estos profesionales. Conclusión: Existe una alta adherencia de las conductas sugeridas por instituciones internacionales para la realización de los procedimientos más comunes realizados en clínica por parte de los Tecnólogos Médicos c/m Otorrinolaringología.

Introduction: Internationally several institutions suggest minimum standards for the conduct of audiological procedures. This aims to ensure the quality of auditory assessments. This is of importance in Chile due to the implementation of hearing programs under the Explicit Health Guarantees (EHG). Aim: To document common audiological practices of Medical Technologist in order to development standardized protocols for audiological assessment. Material and method: An online-based questionnaire with 38 questions was provided through social networks and by email to members of the Chilean Society of Audiology and Otoneurology. Results: One hundred and twenty one completed surveys were analysed. About 70% of respondents work in the central region of Chile. Procedures such as pure audiometry, tympanometry and speech audiometry were frequently performed by respondents. Respondents followed international guidelines. Conclusion: There is a high adherence to international recommendations when conducting the most common procedures performed in audiology clinics in Chile by the Medical Technologists who responded to the survey.

Actinic cheilitis: Epidemiological study in a riverine population of northern Brazil

AIM: The aim of this survey was to assess the prevalence of AC in riverine population in countryside of Amazonas, northern Brazil. MATERIAL AND METHODS: Patients answered a questionnaire and were examined between January and December of 2008. Data were gathered on the following participant's characteristics: 1) age group; 2) gender; 3) ethnicity 4) outdoor activities (sunlight exposure); 5) smoking habits; 6) drinking habits; and 7) access to oral health services (the last dental visit). Clinical observation of the lips for determination of AC presence was used. Patients who presented clinical manifestation of moderate and severe AC were submitted to incisional biopsy to confirm the diagnosis. In case of a positive result after histopathological examination, patients were advised and appropriate treatment was offered. All patients received information about AC and its prevention. RESULTS: Among the 200 participants that were examined, the prevalence of AC was 2% (4 cases). Of all patients surveyed, women were the majority totalizing 124 patients (72.0%). According to age, 48 (24.0%) people were 20-34 year-old; 42 (21.0%) were 35-44-year-old; 50 (25.0%) were 45-60-year-old; and 60 (30.0%) were 61 or older. CONCLUSION: Even though AC was present in a low prevalence rate, an epidemiological variety is expected, once geographic and ethnic differences should be considered.

A importância de Leptospira interrogans sorovariedades Icterohaemorrhagiae e Canicola na zona litorânea e nos campos sulinos do Rio Grande do Sul / The importance of Leptospira interrogans serovars Icterohaemorrhagiae and Canicola in coastal zone and in southern fields of Rio Grande do Sul, Brazil

This study aimed to describe the occurrence of Leptospira interrogans serovars Icterohaemorrhagiae and Canicola, in coastal zone and in southern grasslands of Rio Grande do Sul, Brazil. In each one of the four analyzed farms blood samples were collected from free-living wild animals, domestic animals and humans to perform serological testing for leptospirosis. The presence of antibodies was verified by microscopic agglutination test (MAT). The criterion adopted to consider a serum as agglutination reactant was at least 50% of leptospira for a microscopic field of 100x. From 17 blood samples collected at Chuí, five (29.41%) were positive, three (60.00%) for serovar Icterohaemorrhagiae and two (40.00%) for Canicola. From 21 samples collected in the County of Santana da Boa Vista, six (28.57%) were positive, four (66.67%) for serovar Canicola and two (33.33%) for serovar Icterohaemorrhagiae. From 32 samples collected at Alegrete, 10 (31.25%) were positive, seven (70.00%) for serovar Icterohaemorrhagiae and three (30.00%) foro serovar Canicola. From 17 blood samples collected in Cruz Alta, three (17.64%) were positive, two (66.67%) for serovar Icterohaemorrhagiae and one (33.33%) for Canicola. It is necessary to improve sanitary practices on farms in the state of Rio Grande do Sul, in order to achieve success in leptospirosis control programs.

O presente estudo teve como objetivo descrever a ocorrência de Leptospira interrogans sorovariedades Icterohaemorrhagiae e Canicola, na zona litorânea e nos campos sulinos do Estado do Rio Grande do Sul. Em cada uma das quatro propriedades foram realizadas colheitas de sangue de animais selvagens de vida livre, de animais domésticos e de seres humanos para realização de sorologia para leptospirose. A presença de anticorpos foi verificada pela técnica de Soroaglutinação Microscópica (SAM). O critério adotado para considerar um soro como reagente foi aglutinação de pelo menos 50% das leptospiras no campo microscópico no aumento de 100x. Das 17 amostras de sangue colhidas na propriedade pertencente ao Município de Chuí, cinco (29,41%) foram positivas, três (60,00%) à sorovariedade Icterohaemorrhagiae e duas (40,00%) à Canicola. Das 21 amostras colhidas em Santana da Boa Vista, seis (28,57%) foram positivas, quatro (66,67%) à Canicola e duas (33,33%) à Icterohaemorrhagiae. Das 32 amostras colhidas em Alegrete, 10 (31,25%) foram positivas, sete (70,00%) à Icterohaemorrhagiae e três (30,00%) à Canicola. Das 17 amostras colhidas em Cruz Alta, três (17,64%) foram positivas, duas (66,67%) à Icterohaemorrhagiae e uma (33,33%) à Canicola. É necessário melhorias nas práticas sanitárias em propriedades rurais do Estado do Rio Grande do Sul, a fim de se obter sucesso em programas locais de controle da leptospirose.

Epileptologists probe vagus nerve stimulation in children with refractory epilepsy: a promise against sudden unexpected death in epilepsy / Epileptologistas indicam a estimulação do nervo vago em crianças com epilepsia refratária: uma promessa contra a morte súbita em epilepsia

It is clear that sudden unexpected death in epilepsy (SUDEP) is mainly a problem for people with refractory epilepsy, but our understanding of the best way to its prevention is still incomplete. Although the pharmacological treatments available for epilepsies have expanded, some antiepileptic drugs are still limited in clinical efficacy. In the present paper, we described an experience with vagus nerve stimulation (VNS) treatment by opening space and providing the opportunity to implement effective preventative maps to reduce the incidence of SUDEP in children and adolescents with refractory epilepsy.

Está claro que a morte súbita e inesperada em epilepsias (SUDEP) é principalmente um problema para as pessoas com epilepsia refratária, mas o entendimento para estabelecer medidas preventivas ainda está incompleto. Embora os tratamentos farmacológicos disponíveis para epilepsias tenham sido expandidos, algumas drogas antiepilépticas ainda são limitadas em termos de eficácia clínica. No presente trabalho, foi descrita uma experiência com a estimulação do nervo vago (VNS), abrindo espaço e fornecendo a oportunidade de implementar eficazes mapas preventivoss para reduzir a incidência da SUDEP em crianças e adolescentes com epilepsia refratária.

Paracoccidioidomicosis diseminada / Disseminated paracoccidioidomycosis

La paracoccidioidomicosis es causada por un hongo dimórfico llamado Paracoccidioides brasilensis, que afecta piel, mucosas, ganglio y órganos internos. Presentamos el siguiente caso: paciente varón de 31 años, obrero con antecedentes de alcoholismo crónico y tuberculosis pulmonar con recaída. Viajó a Madre de Dios en dos oportunidades. Hace un año empezó presentando baja de peso, lesiones ulcero-costrosas diseminadas y tos productiva, posteriormente dificultad respiratoria, adenopatías generalizadas, abdomen distendido con matidez desplazable y circulación colateral. La histopatología de las biopsias de ganglio y piel reveló un infiltrado inflamatorio granulomatoso y presencia de múltiples levaduras de Paracoccidioides brasiliensis con la tinción de Grocott. Durante su hospitalización el paciente inicia tratamiento con anfotericina B, tras lo cual entra en falla renal y fallece. La Paracoccidioidomicosis se caracteriza por presentar lesiones con marcado polimorfismo clínico y si diagnóstico requiere un alto índice de sospecha.

Paracoccidioimycosis is caused by the dumorphic fungus Paracoccidioides brasiliensis that affects skin, mucous membrane, lymph nodes and internal organs. We present the case of a 31 year-old man, with a history of chronic alcoholism and relapsed pulmonary tuberculosis. He traveled twice to Madre de Dios. In the last year he developed weight loss, multiple crusted ulcers, productive cough, respiratory distress, generalized lymphadenopathy, abdominal distention with shifting dullness and collateral circulation. Histopathology of lymph node and skin revealed granulomatous inflammatory infiltrate with multiple yeast of Paracoccidioides brasilensis on Grocott staining. Patient underwent treatment with amphotericin B, but developed renal failure and died. Paracoccidioidomycosis is characterized by extremely polymorphic lesions; diagnosis requires a high index of suspicion.

Mortality in children with severe epilepsy: 10 years of follow-up / Mortalidade em crianças com epilepsia severa: 10 anos de seguimento

Epilepsy is the main neurological condition in children and adolescents. Unfortunately patients with medical refractory epilepsy are more susceptible for clinical complications and death. We report a prospectively evaluated cohort of children followed for approximately 10 years. Fifty-three of 1012 patients died. Forty-two patients died due to epilepsy or its clinical complications and the main causes of death were pneumonia (in 16 cases), sepses (in 9 patients), status epilepticus (in 8 patients). In 11 patients cause of death was sudden unexpected death in epilepsy (SUDEP). Mental retardation was significantly more frequent in patients who did not die from SUDEP. SUDEP may be a significant condition associated with mortality in children and adolescents with epilepsy.

Epilepsia é uma das condições neurológicas mais comuns em crianças e adolescentes. Infelizmente, pacientes com epilepsias refratárias ao tratamento medicamentoso estão mais susceptíveis a complicações clínicas e óbito. Neste trabalho reportamos, em uma análise prospectiva, um cohort de crianças acompanhadas por aproximadamente dez anos. Cinquenta e três de 1012 pacientes foram a óbito. Quarenta e dois pacientes morreram em decorrência da epilepsia ou de suas complicações clínicas; as principais causas foram pneumonia (16 casos), sepse (9 casos) e estado de mal epiléptico (8 casos). Em 11 pacientes a causa da morte foi SUDEP. A presença de retardo mental foi significantemente associada a mortalidade em crianças e adolescentes com epilepsia.

Sudden death in a child with epilepsy: potential cerebellar mechanisms? / Morte súbita em uma criança com epilepsia: potenciais mecanismos cerebelares?

Epilepsy is the most common neurological disorder in humans. People with epilepsy are more likely to die prematurely than those without epilepsy, with the most common epilepsy-related category of death being sudden unexpected death in epilepsy (SUDEP). The central mechanisms underlying the fatal process remain unclear, but cardiac and respiratory mechanisms appear to be involved. Recently, cerebellar, thalamic, basal ganglia and limbic brain structures have been shown to be implicated in respiratory and cardiac rate regulation. We discuss here the potential mechanisms underlying the fatal process, with a description of cerebellar actions likely failing in that SUDEP process.

Epilepsia é uma das doenças neurológicas mais comuns em seres humanos. Pessoas com epilepsia têm maior chance de morrer prematuramente do que pessoas sem epilepsia, sendo a principal causa de óbito a morte súbita em epilepsia (SUDEP). Os mecanismos centrais envolvidos neste processo fatal não são claros, mas mecanismos cardíacos e respiratórios parecem estar envolvidos. Recentemente, regiões cerebrais como o cerebelo, núcleos talâmicos, gânglios basais e estruturas límbicas foram relacionadas com a variação das frequências cardíaca e respiratória. Aqui, discutiremos potenciais mecanismos envolvidos na SUDEP, com uma descrição do possível papel do cerebelo na sua ocorrência.

The utility of omega-3 fatty acids in epilepsy: more than just a farmed tilapia! / A utilidade do ácido graxo ômega-3 na epilepsia: mais do que uma criação de tilápias!

The epilepsies are one of the most common serious brain disorders and 20 to 30 percent of people developing epilepsy continue to have seizures and are refractory to treatment with the currently available therapies. Approximately one in a 1000 patients with chronic epilepsy will die suddenly, unexpectedly, and without explanation, even with post-mortem examination and this phenomenon is called sudden unexplained death in epilepsy (SUDEP). Understanding the mechanisms underlying SUDEP may lead to the identification of previously unrecognized risk factors that are more amenable to correction. We discuss here the possible implications of omega-3 fatty acids consumption on SUDEP prevention.

As epilepsias encontram-se entre as mais sérias doenças neurológicas; 20 a 30 por cento dos pacientes com epilepsia continuam apresentando crises e são refratários as terapias disponíveis atualmente. Aproximadamente um em cada 1000 pacientes com epilepsia crônica irá morrer de forma súbita, não esperada e sem explicação, mesmo com o exame pós-morte. Este fenômeno é denominado morte súbita e inesperada em epilepsia (SUDEP). Compreender os mecanismos envolvidos nos casos de SUDEP pode levar à identificação de fatores ainda não reconhecidos e passíveis de serem corrigidos. Discutiremos a seguir as possíveis implicações do consumo do ácido graxo ômega-3 na prevenção dos casos de SUDEP.

Serum magnesium: a clinical biomarker for sudden unexpected death in epilepsy? / Magnésio sérico: um biomarcador cerebral para morte súbita em epilepsia?

INTRODUCTION: Epilepsy is one of the most common chronic neurological disorder in the world and has a higher mortality rate than would be expected in a healthy population. One of the most related category of death is sudden unexpected death in epilepsy (SUDEP). Many risk factors have been related to SUDEP, but the mechanisms involved in its genesis is still unknown. OBJECTIVE: Here we describe one case of a patient with low serum magnesium levels that suffered of SUDEP. CONCLUSION: we discuss a possible cause-effect relation, suggesting that magnesium may be, in some cases, a biomarker of SUDEP.

INTRODUÇÃO: Epilepsia é uma das doenças neurológicas crônicas mais comuns, com uma elevada taxa de mortalidade quando comparada com a população saudável. Uma das principais causas de morte é a morte súbita em epilepsia (SUDEP). Muitos fatores de risco têm sido correlacionados com SUDEP, mas os mecanismos envolvidos na sua gênese são ainda desconhecidos. OBJETIVOS: será descrito um caso de um paciente com nível sérico de magnésio baixo que sofreu SUDEP. CONCLUSÕES: discutiremos uma possível relação de causa-efeito, sugerindo que o magnésio pode ser, em alguns casos, um biomarcador de SUDEP.

Funcionamento intelectual em pacientes pediátricos com epilepsia: comparação de crianças controladas com medicação, não controladas com medicação e controladas com cirurgia / Intellectual functioning in pediatric patients with epilepsy: a comparison of medically controlled, medically uncontrolled and surgically controlled children

OBJETIVO: Comparar o quociente intelectual (QI) em três grupos de crianças com epilepsia: 1) controlados com medicação, 2) não controlados com medicação e 3) controlados com cirurgia. MÉTODOS: Noventa e oito pacientes pediátricos, com idades entre 6 e 12 anos, foram selecionados de dezembro de 2007 a julho de 2008. A Escala de Inteligência Wechsler para Crianças - terceira edição (WISC-III) foi utilizada para a avaliação neuropsicológica dos pacientes. Os resultados foram relacionados com a síndrome epiléptica, a etiologia da epilepsia, o tratamento medicamentoso, a idade do paciente no início da epilepsia e a duração da epilepsia. RESULTADOS: Os escores da WISC foram significativamente melhores no grupo controlado com medicação quando comparados aos do grupo não controlado com medicação. O grupo controlado com medicação obteve um desempenho significativamente melhor na maioria dos subtestes da WISC quando comparado ao grupo não controlado com medicação: vocabulário, aritmética, compreensão, memória de dígitos, completar figuras, arranjo de figuras e cubos. Um número significativamente maior de pacientes com epilepsia idiopática e uso de monoterapia foi observado no grupo controlado com medicação quando comparado ao grupo não controlado. O grupo controlado com cirurgia não apresentou diferença significativa no desempenho do QI quando comparado ao grupo controlado com medicação. CONCLUSÕES: As crianças com um bom controle de crises tiveram um melhor desempenho no QI geral, verbal e de execução quando comparadas às crianças com epilepsia refratária. Esses resultados podem ser influenciados por fatores clínicos como o uso de monoterapia, o tipo de droga antiepiléptica utilizada, a síndrome epiléptica e a etiologia da epilepsia. A cirurgia de epilepsia pode causar um impacto positivo no desempenho cognitivo das crianças que ficaram livres de crises após o procedimento cirúrgico.

OBJECTIVE: To compare the intellectual coefficient (IQ) of three groups of children with epilepsy: 1) medically controlled, 2) medically uncontrolled and 3) surgically controlled. METHODS: From December 2007 until July 2008, 98 pediatric patients were selected, with an age range between 6 and 12 years. Neuropsychological assessment included the Wechsler Intelligence Scale for Children - third edition (WISC-III). Results are related to epileptic syndrome, etiology of epilepsy, drug therapy, age at epilepsy onset and epilepsy duration. RESULTS: WISC scores were significantly better in the medically controlled group when compared to the medically uncontrolled group. The medically controlled group performed significantly better in the majority of the WISC subtests when compared to the medically uncontrolled group: vocabulary, arithmetic, comprehension, digit span, picture completion, picture arrangement, and block design. A significantly higher number of idiopathic epilepsy and monotherapy cases was observed in the medically controlled group when compared to the medically uncontrolled group. Surgically controlled children had no significant differences in IQ performance when compared to medically controlled children. CONCLUSIONS: Children with good seizure control have higher general, verbal and performed intelligence when compared to children with refractory epilepsy. These results may be influenced by clinical factors such as use of monotherapy, drug type and epileptic syndrome and etiology. Epilepsy surgery can have a positive impact on cognitive performance of children who were free of seizures after surgery.

What are the similarities between stress, sudden cardiac death in Gallus gallus and sudden unexpected death in people with epilepsy / Similaridades entre stress, morte súbita cardíaca na espécie Gallus gallus e morte súbita em epilepsia

Individuals with epilepsy are at higher risk of sudden unexpected death in epilepsy (SUDEP), responsible for 7.5 percent to 17 percent of all deaths in epilepsy. Many factors are current associated with SUDEP and possible effect of stress and cardiac arrhythmia are still not clear. Sudden death syndrome (SDS) in chickens is a disease characterized by an acute death of well-nourished and seeming healthy Gallus gallus after abrupt and brief flapping of their wings, similar to an epileptic seizure, with an incidence estimated as 0.5 to 5 percent in broiler chickens. A variety of nutritional and environmental factors have been included: but the exactly etiology of SDS is unknown. Studies had suggested that the hearts of broiler chickens are considerably more susceptible to arrhythmias and stress may induce ventricular arrhythmia and thus, sudden cardiac death. In this way, SDS in Gallus gallus could be an interesting model to study SUDEP.

Indivíduos com epilepsia têm maior risco de sofrer morte súbita e inexplicada em epilepsia (SUDEP), responsável por 7,5 por cento a 17 por cento de todas as mortes em epilepsia. Diversos fatores têm sido associados com SUDEP e um possível efeito do stress e das arritmias cardíacas ainda não é claro. A síndrome da morte súbita (SDS) em galinhas é uma situação caracterizada por uma morte aguda em Gallus gallus bem nutridos e aparentemente saudáveis após um evento curto e abrupto de bater de asas, semelhante a uma crise epiléptica, com incidência de 0,5 a 5 por cento em granjas. Uma ampla variedade de fatores nutricionais e ambientais tem sido considerada, mas a causa exata da SDS é desconhecida. Estudos têm sugerido que o coração das galinhas criadas em granjas é mais sensível a arritmias cardíacas e que o stress poderia levar a arritmias cardíacas e, portanto, a morte súbita cardíaca. Assim, SDS em Gallus gallus pode ser considerado um interessante modelo de SUDEP.

Carbamazepine does not alter the intrinsic cardiac function in rats with epilepsy / Carbamazepina não altera o funcionamento cardíaco intrínseco em ratos com epilepsia

Among the causes for sudden unexpected death (SUDEP) in epilepsy, the effects of antiepileptic drugs on the heart have been poorly explored. Based on this, the aim of our study was to evaluate the heart rate (in vivo and isolated ex vivo) and ventricular pressure (isolated ex vivo) of rats with and without epilepsy treated with carbamazepine. Four groups of adult, male Wistar rats (200-250 g) were studied: [A] control rats (n=8), received neither pilocarpine nor carbamazepine [B] carbamazepine-treated rats (n=8), received a daily dose of 120 mg/Kg, i.p. of carbamazepine for two weeks; [C] rats with epilepsy that received just saline solution (n=8); [D] rats with epilepsy that received a daily dose of 120 mg/Kg, i.p. of carbamazepine for two weeks (n=8). Our results showed significant increase in heart rate in animals with epilepsy (with and without the use of carbamazepine) when compared to the control groups in vivo. In contrast, we did not find differences during isolated ex vivo experiments comparing animals with and without epilepsy and despite the use of carbamazepine. Our results suggest that, in isolation, carbamazepine may not be a potential risk factor for sudden unexpected death in epilepsy.

Entre as causas de morte súbita em epilepsia (SUDEPE), os efeitos das drogas antiepilépticas no coração têm sido pobremente explorados. Desta forma, o objetivo deste estudo foi avaliar a frequência cardíaca (in vivo e de forma isolada ex vivo) e a pressão ventricular (de forma isolada ex vivo) de ratos com e sem epilepsia tratados com carbamazepina. Quatro grupos de ratos Wistar machos adultos (peso 200 a 250 g) foram estudados: [A] ratos controle (n=8), não receberam pilocarpina ou carbamazepina; [B] ratos tratados com carbamazepina (n=8), receberam dose diária de carbamazepina de 120 mg/kg intraperitoneal, durante duas semanas (n=8); [C] ratos com epilepsia que receberam solução salina; [D] ratos com epilepsia que receberam dose diária de carbamazepina de 120 mg/kg intraperitoneal durante duas semanas. Nossos resultados evidenciaram uma diferença estatisticamente significativa na média da freqüência cardíaca in vivo entre os animais com epilepsia (com e sem o uso de carbamazepina) quando comparados aos grupos controles in vivo. Em contraste, não observamos diferenças estatísticas nos experimentos ex vivo quando comparados os animais com ou sem epilepsia, a despeito do uso da carbamazepina. Nossos resultados sugerem que, de forma isolada, a carbamazepina pode não ser um fator de risco potencial para a ocorrência de morte súbita em epilepsia.

Vaccination protocol and bacterial strain affect the serological response of beef calves against blackleg / Esquemas de vacinação e cepa bacteriana influenciam na resposta sorológica contra o carbúnculo sintomático em bezerros de corte

The serological response of beef calves was evaluated with different vaccination regimens against blackleg, using an official strain (MT) and a field-collected strain of Clostridium chauvoei as antigens. Sixty calves were randomly allocated to four different groups and were submitted to distinct vaccination protocols with a commercial polyvalent vaccine. Group G1 was first vaccinated at four months of age and a booster shot was given after weaning, at eight months. Group G2 was given the first dose at eight months and a booster shot 30 days later. Group G3 was vaccinated only once at eight months and the control group was not vaccinated. These alternative vaccination regimens were proposed in an effort to adequately protect cattle under open-field farming conditions. Serological evaluations were made by Elisa at 4, 8, 9 and 10 months of age. Both groups receiving booster shots had a significantly increased serological response 30 days later. However, the serum IgG levels against C. chauvoei were significantly higher in the calves that were first vaccinated at four months. At 10 months, the two booster shot groups (G1 and G2) had similar serological responses, while the calves that were treated with a single dose of vaccine at weaning (G3) had a response that was similar to that of the control group. The serological response of the calves was significantly inferior at several of the evaluation times when the field strain of the bacteria was used as a challenge antigen instead of the official MT strain. The serological response of calves that are vaccinated twice was found to be satisfactory, independent of the first injection being made at four or eight months of age. It was also concluded that it would be useful to include local bacterial strains in commercial vaccine production.

Foi avaliada a resposta sorológica de bezerros de corte submetidos a diferentes esquemas de vacinação contra o carbúnculo sintomático, empregando-se como antígenos duas cepas distintas de Clostridium chauvoei: uma oficial (MT) e a outra uma cepa de campo. Os animais (n=60) foram randomizados em quatro grupos (G1, G2, G3 e Controle) e submetidos a três protocolos distintos de vacinação com um produto comercial polivalente. O G1 foi primovacinado aos 4 meses de idade e recebeu o reforço após desmama (8 meses de idade). O G2 recebeu a primeira dose aos 8 meses de idade e reforço 30 dias após. O G3 foi vacinado somente aos 8 meses de idade e o Controle não foi vacinado. As avaliações sorológicas pelo ensaio imunoenzimático (Elisa) foram realizadas aos 4, 8, 9 e 10 meses de idade dos bezerros. Nos dois esquemas em que os animais receberam o booster (G1 e G2), houve um aumento significativo (p<0,05) da resposta sorológica quando foram avaliados 30 dias após. No entanto, os valores séricos de IgG contra C. chauvoei foram significativamente maiores nos animais primovacinados aos 4 meses de idade. Aos 10 meses, os dois grupos que receberam o reforço vacinal (G1 e G2) não diferiram entre si na resposta sorológica e os bezerros que receberam uma única dose de vacina na desmama (G3) não diferiu do Controle. A resposta sorológica dos bezerros foi significativamente inferior (p<0,05) em diversos momentos da avaliação, quando a cepa de campo foi empregada como antígeno e quando comparada à da cepa MT. Pode-se deduzir que a resposta sorológica dos bezerros vacinados aos 4 e 8 meses de idade foi satisfatória e que existiram diferenças significativas nos valores séricos de anticorpos contra C. chauvoei quando na avaliação foi empregada cepa de campo.