Etiquetado frontal de advertencia nutricional de alimentos y bebidas pre-envasados. Postura intersectorial de expertos en Centro América y República Dominicana / Front-of-package warning labelling system for pre-packaged foods and beverages: an intersectoral position of expertsin Central American and Dominican Republic

La región latinoamericana ha sido pionera en la implementación del etiquetado frontal de advertencia nutricional (EFAN), mismo que ha demostrado su eficacia y efectividad para identificar correctamente cuando un producto contiene cantidades excesivas de nutrientes asociados a Enfermedades no transmisibles (ENT). Sin embargo, ningún país del Sistema de la Integración Centroamericana (SICA); que incluye a Belice, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panamá y República Dominicana, lo ha adoptado. Por esta razón, el Instituto de Nutrición de Centro América y Panamá, convocó a un grupo de expertos de la academia y la sociedad civil con el objetivo de establecer una postura técnica, basada en la mejor evidencia científica, en relación al etiquetado frontal para los nutrientes críticos de alimentos y bebidas pre- envasados en la región centroamericana. Se presenta evidencia específica de la región del SICA que demuestran la superioridad del EFAN frente a otros etiquetados como las Guías Diarias de Alimentación (GDA), el semáforo y el Nutriscore para seleccionar opciones más saludables. Dentro del marco de los derechos de la niñez y de los consumidores, se brindan argumentos y se hace un llamado a los gobiernos para la pronta adopción del EFAN como una política costo-efectiva para la prevención de ENT. Además, se proveen recomendaciones para su monitoreo y evaluación, así como recomendaciones de otras políticas costo-efectivas como la regulación de la publicidad de alimentos no saludables dirigido a la niñez y adolescencia, entre otros, para la prevención de las ENT y la creación de ambientes y sistemas alimentarios más saludables y sostenibles(AU)

The Latin American region has been a pioneer in the implementation of a front- of-pack warning labeling system (FOPWL), which has demonstrated its efficacy and effectiveness in correctly identifying when a product contains excessive amounts of nutrients associated with Non-Communicable Diseases (NCDs). However, countries of the Central American Integration System (SICA); which includes Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the Dominican Republic, have no adopted it. For this reason, the Institute of Nutrition of Central America and Panama convened a group of experts from academia and civil society with the aim of establishing an evidence-based technical position, in relation to front-of-pack labelling for critical nutrients of pre-packaged foods and beverages in the Central American region. Specific evidence from the SICA region demonstrating the superiority of FOPWL over other labels such as the Guideline Daily Amount (GDA), the traffic light and Nutriscore to select healthier choices is presented. Within the framework of children's and consumer rights, arguments are provided, and a call is made to governments for the prompt adoption of FOPWL as a cost-effective policy for the prevention of NCDs. In addition, recommendations for its monitoring and evaluation are provided, as well as recommendations for other cost-effective policies such as the regulation of unhealthy food advertising aimed at children and adolescents, among others, for the prevention of NCDs and the creation ofhealthier and more sustainable environments and food systems(AU)

Aplicación del perfil de nutrientes de la OPS en productos ultraprocesados, inclusive en alimentos fortificados / Application of PAHO's nutrient profile in ultra-processed products, including fortified foods

Resumen Introducción: en la actualidad se recomienda limitar el consumo de productos ultraprocesados por su alto contenido en azúcar, grasas totales, grasas saturadas, grasas trans y sodio. El etiquetado frontal es una estrategia destinada a fortalecer en el consumidor su capacidad de elegir, pero la estrategia de adición de micronutrientes realizada por la industria alimentaria contribuye a que los consumidores sobrestimen su calidad nutricional. El objetivo de este estudio fue analizar según el modelo del Perfil de Nutrientes (PN) de la Organización Panamericana de la Salud (OPS), un grupo de productos ultraprocesados disponibles en el mercado argentino y aplicar el modelo de forma diferenciada en productos fortificados por la industria alimentaria. Materiales y método: estudio de campo, transversal, descriptivo. Se aplicó el perfil de nutrientes considerando: azúcares libres, grasas totales, grasas saturadas, grasas trans y sodio, en productos fortificados y sin fortificación. Cada una de las categorías generales de alimentos: galletitas dulces, alfajores, chocolates, golosinas, helados, cereales, bebidas, dulces untables, snacks salados y lácteos, fueron divididas en subcategorías, integradas por diferentes productos. Se realizó un análisis estadístico descriptivo por subcategorías. Resultados: la muestra se conformó por 682 productos y todos superaron el punto de corte de al menos un nutriente en cantidad excesiva. El 100% de los productos fortificados (n=146) presentó cantidad excesiva de algún nutriente, el 41,1% tuvo un nutriente en cantidad excesiva y el 50,7% dos nutrientes. 95,7-100% de los productos de los grupos cereales de desayuno, chocolatadas, yogures bebibles y en pote, se categorizaron como con cantidad excesiva de azúcares libres. Conclusiones: todos los productos analizados presentaron al menos un nutriente del PN de referencia, en cantidad excesiva. Los mismos productos tenían adición de vitaminas, minerales o fibra. Se visibiliza la necesidad de realizar estudios que investiguen si esta estrategia induce confusión en el consumidor al momento de elegir.

Abstract Introduction: it is currently recommended to limit the consumption of ultra-processed products because of their high content of sugar, total fats, saturated fats, trans fats and sodium. Front labelling is a strategy aimed at strengthening consumer choice, but the micronutrient addition strategy carried out by the food industry contributes to consumers overestimating their nutritional quality. The objective of this study was to analyze, following the model of the Nutrient Profile (PN) of the Pan American Health Organization (PAHO), a group of ultra-processed products available in the Argentine market and apply the model in a differentiated way in products fortified by the food industry. Materials and method: field study, cross-sectional, descriptive. The nutrient profile was applied considering: free sugars, total fats, saturated fats, trans fats and sodium, both in fortified and unfortified products. Each of the general food categories: sweet cookies, alfajores, chocolates, sweets, ice cream, cereals, beverages, spreadable sweets, salty snacks and dairy products, were divided into subcategories, made up of different products. A descriptive statistical analysis by subcategories was performed. Results: the sample consisted of 682 products and all exceeded the cut-off point of at least one nutrient in excessive quantity. 100% of the fortified products (n=146) had an excessive amount of some nutrient, 41.1% had an excess nutrient and 50.7% two nutrients. 95.7-100% of the products of the breakfast cereals, chocolate, drinking and potted yogurts groups were categorized as having excessive amounts of free sugars. Conclusions: all the products analyzed presented at least one nutrient from the reference NP, in excessive quantity. The same products had added vitamins, minerals or fiber. The need for studies to research whether this strategy induces confusion in the consumer when choosing is made visible.

Frontal osteomyelitis post-COVID-19 associated mucormycosis

Rhino-orbito-cerebral mucormycosis (ROCM) is the most commonly noted form of mucormycosis, which is the most common secondary fungal infection following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Osteomyelitis is one of the rare sequelae of ROCM, frontal osteomyelitis being the rarest. We present four patients of coronavirus disease 2019 (COVID-19)-associated mucormycosis, who presented with frontal bone osteomyelitis after being treated for ROCM surgically and medically. This is the first case series highlighting this complication in post–COVID-19 mucormycosis patients and needs utmost attention as it can be life-threatening and can cause extreme facial disfiguration. All four patients are alive with salvage of the affected globe and vision being preserved in one patient. If identified early, disfiguration of face and intracranial extension can be avoided.

Abordaje endoscópico extendido del seno frontal: Experiencia en Hospital Clínico Universidad de Chile / Extended endoscopic approach of the frontal sinus: Experience at Hospital Clínico Universidad de Chile

Introducción: El seno frontal es una estructura compleja y desafiante en términos quirúrgicos, siendo descritas numerosas técnicas para su abordaje. Dentro de ellas se destaca el abordaje endoscópico extendido de seno frontal: Draf IIB y Draf III, como una importante alternativa para resolución de patología refractaria de seno frontal. Objetivo: Describir las características de pacientes sometidos a abordaje endoscópico extendido de seno frontal en Hospital Clínico Universidad de Chile (HCUCH). Material y Método: Estudio retrospectivo, descriptivo. Se incluyeron a pacientes sometidos a abordaje endoscópico extendido de seno frontal entre los años 2013 y 2021. Se analizaron variables clínicas, intraoperatorias y de seguimiento. Resultados: Se registraron 118 pacientes, de los cuales 64 cumplieron criterios de inclusión al estudio, con una edad promedio de 48 años. La patología más frecuente fue la rinosinusitis crónica poliposa (42%) seguido del mucocele (20%). Del total de pacientes, el 68% fue sometido a cirugía Draf IIB y el resto a Draf III. Todos los pacientes fueron estudiados con endoscopía e imágenes, y seguidos con parámetros clínicos y endoscópicos. El porcentaje de estenosis postoperatoria se estimó en 10%. Conclusión: El abordaje endoscópico nasal extendido figura como una alternativa útil para manejo de patología de seno frontal refractario a tratamiento. En nuestra experiencia las indicaciones, tipos de cirugía y tasa de complicaciones son concordantes con la literatura internacional.

Introduction: The frontal sinus is a complex and challenging structure in surgical terms, numerous techniques have been described for its approach, among them the extended endoscopic approach: Draf IIB and Draf III, figures as an important alternative for the resolution of refractory pathology of frontal sinus. Aim: To describe the characteristics of patients who underwent an extended endoscopic approach to the frontal sinus at the Hospital Clínico Universidad de Chile (HCUCH). Material and Method: A retrospective, descriptive study included patients who underwent an extended endoscopic approach to the frontal sinus between 2013 and 2021. Clinical, intraoperative, and follow-up variables were analyzed. Results: 118 patients were registered, of which 64 met the inclusion criteria for the study, with an average age of 48 years. The most frequent pathology was chronic polypous rhinosinusitis (42%), followed by mucocele (20%). Of the patients, 68% underwent Draf IIB surgery, while the rest received a Draf III type procedure. All patients were studied with endoscopy and images and followed up with clinical and endoscopic parameters. The percentage of post operatory stenosis was 10%. Conclusion: The extended nasal endoscopic approach appears as a valuable alternative for managing frontal sinus pathology refractory to treatment. In our experience, the indications, types of surgery, and rate of complications are consistent with the international literature.

Effects of nutritional profile system and front labeling in food selection during purchases: a systematic review / Efecto de los sistemas de perfilado nutricional y etiquetado frontal en la selección de alimentos durante la compra: una revisión sistemática

Introduction. Nutritional profiling systems (NPS) are mainly used in front-end labeling policies in order to make the purchase and consumption choice conscious and healthy. Objetive. This study systematically reviewed evidence from interventions on the effect of NPS in the front-of- package on food purchases. Materials and methods. A bibliographic search was carried out in electronic sources from Medline, Elsevier, Scielo and Lilacs, of experimental studies and intervention between 2012 and 2022. A total of 14 articles were included in the review. They were analyzed according to the intervention modality used: 4 studies analyzed the effect of NPS in a real purchase situation and 10 evaluated purchase perception/intention. Results. According to the modality of intervention, the 6 studies that analyzed the NPS-warning system, all recorded healthier purchases compared to the control groups. While for the NPS-NutriScore, Health Star Rating and Multiple Traffic Lights were effective in the decision to purchase healthier foods, in 5 of 7 studies for the first NPS, in 4 of 7 for the second and in 4 of 8 for the third, compared with control groups. Conclusions. Findings of this study suggest that NPSs may be effective for healthy purchase choices, even so it is necessary to strengthen the system and policies with nutritional food education campaigns(AU)

Introducción. Los sistemas de perfilado nutricional (SPN) son utilizados principalmente en políticas de etiquetado frontal con la finalidad de que la elección de compra y consumo sea consciente y saludable. Objetivo. Este estudio revisó sistemáticamente la evidencia de las intervenciones sobre el efecto de SPN en el frente del paquete en las compras de alimentos. Materiales y métodos. Se realizó una búsqueda bibliográfica en fuentes electrónicas de Medline, Elsevier, Scielo y Lilacs, de estudios experimentales e intervenciones entre 2012 y 2022. Se incluyeron un total de 14 artículos en la revisión. Fueron analizados según la modalidad de intervención utilizada: 4 estudios analizaron el efecto de los SPN en una situación de compra real y 10 evaluaron percepción/intención de compra. Resultados. Según la modalidad de intervención, los 6 estudios que analizaron el SPN-sistema de advertencia, todos registraron compras más saludables en comparación con grupo controles. Mientras que para los SPN-NutriScore, Estrellas de Salud y Semáforo Tricolor Múltiple fueron efectivas en la decisión de compra de alimentos más saludables, en 5 de 7 estudios para el primer SPN, en 4 de 7 para el segundo y en 4 de 8 para el tercero, comparados con grupo controles. Conclusiones. Los hallazgos de este estudio sugieren que los SPN pueden ser efectivos para elecciones de compras saludables, aun así, es necesario reforzar el sistema y las políticas con campañas de educación alimentaria nutricional(AU)

Síndrome orbitofrontal en un interno con infracciones por secuestro agravado, violación sexual y muerte de una menor de edad

El síndrome orbitofrontal se caracteriza por la ausencia de inhibición, escaso control de impulsos, transgresión de normas sociales y, en determinados casos, con la materialización de conductas delictivas. Se presenta el caso de un interno varón de 18 años con infracciones por secuestro, violación sexual y homicidio de una menor de edad, a quien se evaluó a través de entrevistas y uso del test de Eysenck (Forma B), test de matrices progresivas de Raven, test de la figura compleja de Rey (Forma A), test de percepción de diferencias (Caras-R), test de Stroop (colores y palabras), test Mini-Mental y Cuestionario de cólera, irritabilidad y agresión (CIA). El evaluado muestra un lenguaje y vocabulario de acuerdo con su edad, no presenta problemas orgánicos, ni alteraciones en atención, lenguaje, escritura, lectura, praxias, cálculo, percepción y memoria. Los resultados destacan un coeficiente intelectual superior al término medio con óptimas capacidades cognitivas, temperamento melancólico con pensamientos depresivos, personalidad introvertida con baja sensibilidad a los cambios en el ambiente, escasa sociabilidad, ensimismamiento y evasión. Asimismo, evidencia tendencias perfeccionistas, con cambios emocionales bruscos y dificultad para reorientar patrones conductuales, alta tendencia a la impulsividad y escaso control inhibitorio; elementos característicos de un síndrome orbitofrontal. Finalmente, se destaca el uso de pruebas psicométricas y evaluaciones neuropsicológicas para el diagnóstico del síndrome orbitofrontal, necesarias a incorporar incorporar para el adecuado manejo de internos en los centros penitenciarios y/o de rehabilitación que no tienen acceso a estudios de neuroimagen y a partir de los cuales pueden diseñarse programas de intervención estratégicos.

Orbitofrontal syndrome is characterized by disinhibition, impulsiveness, transgression of social norms and sometimes the development of criminal behavior. This is the case of an 18-year-old male offender incarcerated for kidnapping, rape and homicide of a minor. He was evaluated through interviews and the use of the Eysenck personality questionnaire (Form B), Raven's progressive matrices (RPM), Rey-Osterrieth complex figure (Form A), Differences perception test (FACES-R), Stroop color and word test (SCWT), Mini-Mental state examination (MMSE) and Aggression questionnaire (AGQ). The research subject showed age-appropriate speech, language and vocabulary, and had neither physical problems nor attention, language, writing, reading, praxis, calculation, perception and memory disorders. The results highlight a higher-than-average intelligence quotient, optimal cognitive skills, melancholic temperament with depressive thoughts, introverted personality with low environmental sensitivity, poor social skills, self-absorption and avoidance. Additionally, perfectionist tendencies, sudden emotional changes, difficulty changing behavioral patterns, impulsiveness and disinhibition, all of which are characteristics of orbitofrontal syndrome. Finally, the research highlights the use of psychometric tests and neuropsychological evaluations for the diagnosis of orbitofrontal syndrome. Said tests and evaluations are necessary for the proper management of offenders incarcerated in prisons and/or detention centers who do not have access to neuroimaging; moreover, they may be used to design strategic intervention programs.

Suspensión frontal con aponeurosis temporal en paciente con ptosis palpebral traumática recidivante crónica / Frontal suspension with temporal aponeurosis in a patient with chronic recurrent traumatic eyelid ptosis

La ptosis palpebral es una de las patologías más frecuentes en la consulta de oftalmología, tanto en urgencias como en el ámbito ambulatorio. El trauma del párpado superior puede provocar ptosis o retracción o una combinación de ambos. En este tipo de ptosis palpebral, su resolución mediante tratamiento quirúrgico, existiendo múltiples alternativas de procedimientos que se decidirá de acuerdo con la causas que las originan, así como la severidad de la ptosis. En este trabajo es a propósito de un caso clínico en el cual nos encontramos una paciente con ptosis palpebral traumática recidivante, utilizándose suspensión frontal con aponeurosis de músculo temporal, realizándose una variación de la técnica de Crawford disminuyendo la probabilidad de nueva recidiva

Palpebral ptosis is one of the most frequent pathologies in the ophthalmology consultation, both in the emergency room and in the outpatient setting Trauma to the upper eyelid can cause ptosis or retraction or a combination of both. In this type of eyelid ptosis its resolution by surgical treatment, there are multiple alternatives of procedures that will be decided according to the causes that originate them, as well as the severity of the ptosis, in this work is about a clinical case in which we find a patient with Recurrent Traumatic Palpebral Ptosis, using frontal suspension with aponeurosis of temporal muscle, performing a variation of the Crawford Technique decreasing the probability of recurrence.

Funciones ejecutivas de niños con trastorno por déficit de atención e hiperactividad con o sin epilepsia rolándica benigna

Introducción: La relación entre el TDAH y la epilepsia, aunque muy frecuente, no es clara. Los estudios clínicos en neuropsicología y neurología (neuropsiquiatría) pueden ofrecer información valiosa para la evaluación, la intervención y el tratamiento. Método: Se realizó un estudio con diseño no experimental, enfoque cuantitativo, nivel descriptivo y corte transversal con el objetivo de comparar el funcionamiento ejecutivo de un grupo de niños con TDAH y un grupo de niños con TDHA y EBPCT. Se conformó una muestra por conveniencia de 40 niños emparejados (todos hombres) agrupados en dos grupos de 20 con edades entre los 7 y los 13 años. Para realizar la evaluación del funcionamiento ejecutivo se aplicaron algunas pruebas de la Batería Neuropsicológica de Funciones Ejecutivas y Lóbulos Frontales - BANFE. Resultados: De acuerdo con los valores de la significancia asintótica bilateral, se encontraron diferencias estadísticamente significativas en las variables Stroop A - Aciertos, Stroop B - Aciertos, Señalamiento autodirigido (Aciertos, Planeación y Tiempo), y Memoria de Trabajo Visoespacial (Nivel máximo, Perseveraciones y Errores de orden). Conclusiones: Los resultados del presente estudio coinciden con los fallos en el control inhibitorio y los problemas de atención sostenida reportados en la literatura. Los niños con EBPCT y TDAH tienen un perfil de funcionamiento ejecutivo diferente y más deteriorado que los niños con TDAH solo.

Introduction: The relationship between ADHD and epilepsy, although very frequent, is not clear. Clinical studies in neuropsychology and neurology (neuropsychiatry) can provide valuable information for assessment, intervention and treatment. Method: A non-experimental design, quantitative approach, descriptive level and cross-sectional study was carried out with the aim of comparing the executive functioning of a group of children with ADHD and a group of children with ADHD and CPSDD. A convenience sample of 40 matched children (all males) grouped in two groups of 20 children between 7 and 13 years of age was formed. In order to evaluate executive functioning, some tests of the Neuropsychological Battery of Executive Functions and Frontal Lobes - BANFE were applied. Results: According to the bilateral asymptotic significance values, statistically significant differences were found in the variables Stroop A - Hits, Stroop B - Hits, Self-directed Signaling (Hits, Planning and Time), and Visuospatial Working Memory (Maximum Level, Perseverations and Order Errors). Conclusions: The results of the present study coincide with the failures in inhibitory control and sustained attention problems reported in the literature. Children with EBPCT and ADHD have a different and more impaired executive functioning profile than children with ADHD alone.

Variability in the functional connectivity of the bilateral inferior frontal gyrus with the whole brain in persons with Broca′s aphasia / 中华物理医学与康复杂志

Objective:To observe the temporal variability of functional connectivity between the bilateral inferior frontal gyrus and rest of the brain in persons with Broca′s aphasia (BA) and to compare the connectivity between Uygur and Chinese aphasics.Methods:Thirty Chinese and Uygur BA patients (the patient group) and 30 healthy people speaking Uygur and Chinese (the healthy group) were included. rs-fMRI images were acquired, and the patient group was divided then into a Uygur language patient group (9 cases) and a Chinese language patient group (12 cases). The healthy group was divided into a Uygur language healthy group (13 cases) and a Chinese language healthy group (15 cases). Dynamic functional connectivity (dFC) calculations were performed, and a two-factor analysis of covariance was used to obtain the brain regions in which there was an interaction between language and aphasia and to analyze the correlation between the brain regions with abnormal dFCs and linguistic behavior.Results:Interaction between the bilateral inferior frontal gyrus and the left medial and paracentral cingulate gyrus and the right postcentral gyrus dFC was observed to vary. Temporal variability among the Uygur patients was significantly less than among the Uygur healthy and Chinese patient groups. The temporal variability of Broca′s mirror area and the right postcentral gyrus in the Chinese patient group was significantly greater than in the Chinese healthy group or the Uygur patient group. Variability of Broca′s area and the left medial and paracingulate cingulate gyrus in the Uygur patients group correlated positively with oral fluency, reading comprehension and writing.Conclusion:There are differences in the temporal variability of the dFC in the bilateral inferior frontal gyrus between Uygur and Chinese BA patients. The lower variability of Broca′s area with the left medial and paracingulate and cingulate gyrus may help to identify impaired language function in BA patients. The enhanced variability of the Broca′s mirror image area with the right postcentral gyrus may be the result of reorganization of the linguistic network in Chinese BA patients.

Investigating the role of Prefrontal Neurons in cognitive tasks through Fiber Photometry and Adapted Barnes Maze Protocols

The medial prefrontal cortex (mPFC) is essential in the execution of cognitive tasks, however very little is known on how these neurons are modulated during specific tasks and which subtype of neurons are responsible for so. Therego, with the intention of addressing this issue, we recorded mPFC gabaergic and glutamatergic activation patterns through fiber photometry (FIP) in mice, while simultaneously performing the Barnes Maze (BM) cognitive task (4 day behavioral trial). In addition, an altered structural and procedural protocol for BM was validated in this study due to necessary modifications allowing FIP and BM to happen simultaneously. A successful protocol validation was followed by our preliminary results, which showed that both glutamatergic and gabaergic neurons presented significant change in activation intensity and number of events in specific contexts throughout the task days. In addition, when stratified and crossed with BM performance parameters, such as latency to complete tasks and adopted strategy, glutamatergic and gabaergic neurons presented a significant decline in both activation patterns and number of activation events throughout the days. This data suggest not only an important role of glutamatergic and gabaergic mPFC neurons in learning, memory and decision making, but also that activation patterns of each of these groups may serve as markers for cognitive progression and/or dysfunction. KEY-WORDS: Memory, Learning, Decision Making, Medial Prefrontal Cortex (mPFC), Fiber Photometry (FIP), Barnes Maze (BM), Glutamatergic, Gabaergic, Neuronal Activity, Neuronal Activation Patterns, Neuronal Dynamics.

O córtex pré-frontal medial (mPFC) é essencial na execução de tarefas cognitivas, no entanto, pouco se sabe sobre como esses neurônios são modulados durante tarefas específicas e qual subtipo de neurônios é responsável por isso. Portanto, com a intenção de abordar essa questão, registramos os padrões de ativação de neurônios gabaérgicos e glutamatérgicos do mPFC por meio de fotometria de fibra (FIP) em camundongos, enquanto realizávamos simultaneamente a tarefa cognitiva do Labirinto de Barnes (BM) (ensaio comportamental de 4 dias). Além disso, um protocolo estrutural e procedimental alterado para o BM foi validado neste estudo devido a modificações necessárias que permitiram a realização simultânea de FIP e BM. Uma validação bem-sucedida do protocolo foi seguida pelos nossos resultados preliminares, que mostraram que tanto os neurônios glutamatérgicos quanto os gabaérgicos apresentaram mudanças significativas na intensidade de ativação e no número de eventos em contextos específicos ao longo dos dias da tarefa. Além disso, quando estratificados e cruzados com parâmetros de desempenho do BM, como latência para completar as tarefas e estratégia adotada, os neurônios glutamatérgicos e gabaérgicos apresentaram uma diminuição significativa nos padrões de ativação e no número de eventos de ativação ao longo dos dias. Esses dados sugerem não apenas um papel importante dos neurônios glutamatérgicos e gabaérgicos do mPFC na aprendizagem, memória e tomada de decisões, mas também que os padrões de ativação de cada um desses grupos podem servir como marcadores de progressão e/ou disfunção cognitiva. PALAVRAS-CHAVE: Memória, Aprendizagem, Tomada de Decisões, Córtex Pré-Frontal Medial (mPFC), Fotometria de Fibra (FIP), Labirinto de Barnes (BM), Glutamatérgico, Gabaérgico, Atividade Neuronal, Padrões de Ativação Neuronal, Dinâmica Neuronal.

Near-infrared spectroscopy-based study of the effects of gaming addiction disorders on brain cognitive control functions / 国际生物医学工程杂志

Objective:To explore the effects of game addiction disorders on brain cognitive control functions based on near-infrared spectroscopy.Methods:Thirteen subjects were screened according to the Online Game Addiction (OGA) Scale. The experimental paradigm was the stop-signal task. The relative concentration levels of oxyhemoglobin (HbO 2) and deoxyhemoglobin (Hb) in the prefrontal region of the brain during cognitive activity were collected using near-infrared spectroscopy to assess the cognitive control function of the subjects. Results:The game-addicted patients had lower keystroke accuracy in the stop-signal task than healthy subjects, and the difference was statistically significant ( P<0.05). Compared to healthy subjects, game-addicted patients had less activation in prefrontal areas and showed uncontrolled behavior and brain activity. Conclusions:Game addiction disorders impair brain cognitive control, which in turn triggers a weakening of cognitive control. The results of this study provide a reference for the prevention and treatment of game addiction.

Increasing Source-Object Distance: A Computed Radiographybased Strategy to Reducing Radiation Dose in Occipital-Frontal Skull X-Ray

@#Introduction: Exploring potential optimization strategies and developing evident practices is critical. Previous studies show that radiation dose can be reduced by increasing the source-image distance (SID). Although most studies use digital radiography, many hospitals in underdeveloped countries still use computed radiography (CR). Therefore, research will investigate the relationship between SID and Entrance surface dose (ESD) using the CR. Methods: This study involved the measurement of radiation dose and image quality of a radiological procedure performed at a reference SID; 100cm and the tested SIDs; 110cm, 120cm, and 130cm, using constant technical factors (70kVp, 25mAs, grid). A LiF; Mg Ti thermoluminescence dosimeter (TLD-100) chip was placed in the center of the radiation field of the OF10° skull radiography examination to measure ESD. Image quality was assessed using the European Commission guidelines and graded using relative visual assessment analysis (VGA). Results: Significant ESD reduction from 21% and 45% when SID was increased from 100cm to 130cm (p <0.001), where SID was negatively correlated with ESD (r= - 0.98). The VGA scores showed no statistical difference in the image quality of the OF10° skull radiography examination for the tested and reference images (p=0.21). VGA scores for 120cm images showed the highest image quality among the SIDs tested with a dose reduction of 37%. Conclusion: ESD was statically reduced when SID was increased from 100cm to 130cm, while image quality was diagnostically acceptable. The study suggests that 120cm is the optimal SID when both dose and image quality are considered.

Frontal ataxia: historical aspects and clinical definition / Ataxia frontal: aspectos históricos e definição clínica

Abstract Frontal ataxia, originally described by Bruns, is characterized by the presence of signs of frontal lobe dysfunction, such as perseveration, paratonia, frontal release signs, cognitive changes, and urinary difficulty, associated with imbalance, slow gait, broad-based, the presence of postural instability and falls, retropulsion, and bradykinesia in the lower limbs. The goal of the present study is to recall the historical aspects of this condition, to draw attention to the importance of this clinical finding for the differential diagnosis of ataxias and to review the main semiological differences between primary ataxias (frontal, cerebellar, and sensory ataxia).

Resumo A ataxia frontal, originalmente descrita por Bruns, caracteriza-se pela presença de sinais de disfunção do lobo frontal, como perseveração, paratonia, sinais de liberação frontal, alterações cognitivas e dificuldade urinária, associados a desequilíbrio, marcha lenta, base ampla, presença de instabilidade postural e quedas, retropulsão e bradicinesia em membros inferiores. O objetivo do presente trabalho é recordar os aspectos históricos desta condição, ressaltar a importância deste achado clínico para o diagnóstico diferencial das ataxias e revisar as principais diferenças semiológicas entre as ataxias primárias (ataxia frontal, cerebelar e sensitiva).

International Frontal Sinus Anatomy Classification (IFAC): evaluation of frontoethmoidal cells prevalence in a Brazilian population

Abstract Objectives: The aim of this study was to evaluate the prevalence of the frontal cell variants according to International Frontal Sinus Anatomy Classification (IFAC), in the population of a Brazilian tertiary hospital, and analyze the reliability of the classification between observers. Methods: A cross-sectional study in the Hospital de Clínicas of the State University of Campinas, Brazil. One hundred and three Computed Tomography's (CTs) were evaluated by radiologists and otorhinolaryngologist to estimate the prevalence of frontoethmoidal cells according to the IFAC. Intraclass Correlation Coefficient (ICC) among examinators was used to evaluate reliability of this findings. Results: 103 CT scans, totaling 206 sides, were evaluated independently. The agger nasi cell was the most prevalent, present in 95.63% of cases, 37.86% of the exams contained supra agger cells, frontal supra agger cell showed prevalence 37.37%; suprabularcell was present in 77.18% of the sides. As for the frontal suprabular cell, the prevalence was 30.09%, the supraorbital ethmoid cell was present in 32.03%, and frontal septal cell had a 33.49% prevalence. The ICC among the evaluators was classified as "good reliability" or "excellent reliability" for all cells. Conclusion: This study describes the frontal cell prevalence among a population in tertiary Brazilian hospital, using the IFAC. This classification had a high ICC. Level of evidence: Level 2: Individual cross-sectional study with consistently applied reference standard and blinding.

Use of transcranial magnetic stimulation in the treatment of nonfluent primary progressive aphasia: a case report / Uso da estimulação magnética transcraniana no tratamento da afasia progressiva primária não fluente: um relato de caso

ABSTRACT Primary progressive aphasia comprises a group of neurodegenerative diseases characterized by progressive speech and language dysfunction. Neuroimaging (structural and functional), biomarkers, and neuropsychological assessments allow for early diagnosis. However, there is no pharmacological treatment for the disease. Speech and language therapy is the main rehabilitation strategy. In this case report, we describe a female patient diagnosed with nonfluent primary progressive aphasia who underwent sessions of high-frequency transcranial magnetic stimulation in the left dorsolateral prefrontal cortex and showed improvement in depression scores, naming tasks in oral and written speech, and comprehension tasks in oral and written discourse.

RESUMO As afasias progressivas primárias (APP) representam um grupo de doenças neurodegenerativas caracterizadas por disfunção progressiva da fala e da linguagem. A neuroimagem (estrutural e funcional), os biomarcadores e as avaliações neuropsicológicas permitem o diagnóstico precoce. No entanto, não há tratamento farmacológico para a doença. A terapia fonoaudiológica é a principal estratégia de reabilitação. Neste relato de caso, descrevemos uma paciente com diagnóstico de APP não fluente que foi submetida a sessões de estimulação magnética transcraniana de alta frequência no córtex pré-frontal dorsolateral esquerdo e apresentou melhora nos escores de depressão, nas tarefas de nomeação da fala oral e escrita e nas tarefas de compreensão da fala oral e escrita.

MORPHOMETRIC STUDY OF THE FRONTAL HORN OF LATERAL VENTRICLES OF BRAIN BY IMAGING USING COMPUTERIZED TOMOGRAPHY

Introduction The cerebral ventricular system consists of a series of interconnecting spaces and channels which originate from the central lumen of the embryonic neural tube. The ventricular system ?lled with cerebrospinal ?uid, is an essential part of the brain. Understanding the normal anatomy and the variations of the ventricular system of brain is helpful for clinicians, neurosurgeons and radiologists in day-to-day clinical practice1. Aims And Objectives To determine the average dimensions and variations of the frontal horn of the normal lateral ventricles of brain by CT scan. Materials And Methods The study was conducted in individuals who attended the Department of Radiodiagnosis in Government Medical College, Thiruvananthapuram. Those patients whose brain CT scans were read as normal by the radiologist were taken up for the study. A total of 200 CT brain of individuals above 10 years of age were taken during the period from January 2017 to June 2018.100 males and 100 females were included in the study group. The length of the frontal Results horn of lateral ventricle of brain was found to be more on the left side and in male gender. It was also observed to be increasing with age. The present study outlines the normal values of the length of frontal horn of the lateral ventricles of brain Conclusion using Computerized tomography which would aid in the diagnosis and management of neurological disorders.

Incidence of Metopic Suture in Adult Human Crania in Uttar Pradesh

Introduction: Failure of ossification in the vertical direction between the two halves of the frontal bone is called a metopic suture; this suture is present in between the superciliary arch and tubers of the frontal bone so it is also called a median frontal suture. At birth, the frontal bone present is two half, in the 1st year they contact each other, and within the 7th to 8th year, they fused together. Sometimes, bones may not be fused completely and it becomes metopic fontanelle. MaterialsandMethods: The goal of the current study was to determine the prevalence of metopic suture in adult human skulls in Uttar Pradesh. One hundred and fifty macerated skulls of undetermined age and sex were used for this. The anatomical departments of Teerthankar Mahaveer Medical College and Research Center (Moradabad), King George Medical College (Lucknow), SRMS Institute of Medical Science (Bareilly), Govt. Medical College Kannauj, and Govt. Medical College Saharanpur provided these skulls. Results: This study has found the incidence of metopic sutures of about 12.90%. The two types of metopic sutures were found in this study, namely complete metopic suture 4.52% and incomplete metopic suture 8.38% in which found 0.64% “V” shape metopic suture. Conclusion: Themorphological study of metopic sutures on adult crania is useful for anatomists, experts in forensic medicine, and neurologists for performing surgical procedures in this area

Human Identification by Comparative Analysis of Frontal Sinuses: Study on Computed Tomography

ABSTRACT: Generally, primary methods of identification as the fingerprint analysis, dental analysis or DNA examination are indicated for the establishment of the identity of a corpse. In situations with poor body conservation, such as in advanced stage of putrefaction or skeletonization, imaging exams like medical and dental computed tomography can assist in the process of identification. The frontal sinuses present anatomical characteristics that allow the establishment of the identity of an in dividual. In this case report we used the technique of three-dimensional construction of the frontal sinuses through the generation of solid figures representative of the sinus morphology. After the comparative analysis of the antemortem and postmortem tomography of the alleged victim, we could establish similarities in both the variations in size, shape, symmetry and contour of borders, and the presence and number of septa, allowing us to infer that the two images described belong to the same individual, thus establishing the identity of the corpse found.

RESUMEN: Generalmente, los métodos primarios de identificación como el análisis dactiloscópico, el análisis dental o el examen de ADN están indicados para el establecimiento de la identidad de un cadáver. En situaciones de mala conservación del cuerpo, como en etapa avanzada de putrefacción o esqueletización, los exámenes de imagen como la tomografía computarizada médica y dental pueden ayudar en el proceso de identificación. Los senos frontales presentan características anatómicas que permiten establecer la identidad de un individuo. En este reporte de caso utilizamos la técnica de construcción tridimensional de los senos frontales a través de la generación de figuras sólidas representativas de la morfología sinusal. Tras el análisis comparativo de la tomografía antemortem y postmortem de la presunta víctima, pudimos establecer similitudes tanto en las variaciones de tamaño, forma, simetría y contorno de márgenes, como en la presencia y número de septos, lo que nos permite inferir que las dos imágenes descritas pertenecen al mismo individuo, estableciéndose así la identidad del cadáver encontrado.

Mucocele fronto-etmoidal gigante / Giant frontoethmoidal mucocele

Se presenta el caso de un paciente varón de 18 años, con un gran mucocele frontoetmoidal derecho, postoperado en dos oportunidades anteriores, que acudió a nuestro servicio por un empeoramiento de la diplopía. Al examen físico se visualizaba un desplazamiento del globo ocular hacia abajo y afuera. Se le realizó estudios de imágenes, una tomografía computarizada y una resonancia magnética nuclear que sugerían un mucocele frontoetmoidal derecho. Se le realizó una sinusotomía tipo Draf III para drenaje de la lesión, con mejoría de los síntomas.

We present the case of an 18-year-old male patient with a large right frontoethmoidal mucocele, postoperatively on two previous occasions, who came to our department due to worsening diplopia. Physical examination revealed a downward and outward displacement of the eyeball. Imaging studies, computed tomography, and magnetic resonance imaging were performed that suggested a right frontoethmoidal mucocele. A type Draf III sinusotomy was performed to drain the lesion, with improvement of the symptoms.

Endoscopic management of frontal sinus CSF leaks / Manejo endoscópic de fístulas liquóricas do seio frontal

Abstract Introduction: Endoscopic management of frontal sinus cerebrospinal fluid leaks has become the gold standard of treatment, with high success rates and low morbidity. The aim of this study is to review our experience in managing this challenging condition. Objective: To review our experience in treating frontal sinus cerebrospinal fluid leaks through an endonasal endoscopic approach. Methods: A retrospective evaluation of patients undergoing endoscopic surgery for frontal sinus cerebrospinal fluid leaks was performed. Demographics, defect location and etiology, surgical and reconstructive technique, complications, and postoperative followup were examined. Results: Twenty-two patients with a mean age of 40.4 years were treated surgically by the senior author between 2015 and 2019. Cerebrospinal fluid leak was either traumatic (17) or spontaneous (5). Successful first-attempt endoscopic repair was accomplished in all cases. A combined endoscopic-trephination approach was necessary in 5 patients (22.8%). No serious complications were reported, and frontal sinus drainage pathway was patent in all our cases. Revision surgery was necessary in only 2 patients for synechia formation. The mean patient followup was 22.7 months (range: 7 - 41 months). Conclusion: Progress in the field of endoscopic surgery has shifted the paradigm, establishing endoscopic repair of frontal sinus leaks as the standard of care. A few remaining limits of this approach could be addressed by combining endoscopy with frontal trephination.

Resumo Introdução: O manejo endoscópico das fístulas liquóricas do seio frontal tornou-se o padrão-ouro, com altas taxas de sucesso e baixa morbidade. Objetivo: Revisar nossa experiência no tratamento de fístulas liquóricas do seio frontal por meio de uma abordagem endoscópica endonasal. Método: Foi feita uma avaliação retrospectiva de pacientes submetidos à cirurgia endoscópica para fístulas liquóricas do seio frontal. Dados demográficos, localização e etiologia do defeito, técnica cirúrgica e reconstrutiva, complicações e seguimento pós-operatório foram analisados. Resultados: Foram tratados cirurgicamente pelo autor principal 22 pacientes com média de 40,4 anos entre 2015 e 2019. A fístula liquórica foi traumática (17) ou espontânea (5). O reparo endoscópico foi feito com sucesso na primeira tentativa em todos os casos. Uma abordagem combinada de trefinação e endoscopia foi necessária em 5 pacientes (22,8%). Nenhuma complicação grave foi relatada e a via de drenagem do seio frontal estava patente em todos os nossos casos. A cirurgia de revisão foi necessária em apenas 2 pacientes devido à formação de sinéquia. O seguimento médio dos pacientes foi de 22,7 meses (variação: 7 a 41). Conclusão: O progresso no campo da cirurgia endoscópica mudou o paradigma, estabeleceu o reparo endoscópico de fístulas liquóricas do seio frontal como o padrão de tratamento. Alguns poucos limites remanescentes dessa abordagem podem ser resolvidos pela combinação da endoscopia com a trefinação frontal.