Actitudes sexuales de acuerdo con el nivel de severidad del trauma craneoencefálico / Sexual attitudes according to the level of severity of the cranioencephalic trauma

El objetivo de esta investigación fue analizar la actitud hacia la sexualidad en pacientes con antecedentes de trauma craneoencefálico (TCE), de acuerdo al nivel de severidad presentado. Método: se llevó a cabo un estudio de tipo descriptivo en una muestra de 126 personas, con edades comprendidas entre los 18 y 49 años, con antecedente de trauma craneoencefálico leve, moderado y severo, a quienes se les aplicó la Escala de Actitudes hacia la Sexualidad Ampliada (ATSS) y una encuesta de actitudes hacia la sexualidad. Resultados: se encontró que la mayoría de los participantes manifestaron haber sufrido cambios en su sexualidad tras el TCE, caracterizados por la disminución de la frecuencia de las relaciones y el deseo sexual, sin embargo, evidencian una actitud positiva frente a la sexualidad. Conclusiones: si bien la sexualidad es considerada importante por los participantes del estudio, no se evidenció una conducta tendiente a la erotofilia. No se encontraron diferencias significativas respecto al nivel de severidad del trauma craneoencefálico

The objective of this research was to analyze the attitude towards sexuality in patients with a history of cranioencephalic trauma (TCE), according to the level of severity presented. Method: a descriptive study was carried out in a sample of 126 people, aged between 18 and 49 years, with a history of mild, moderate, and severe head trauma, to whom the Scale of Attitudes towards Extended Sexuality -ATSS and a Survey of Attitudes towards Sexuality were applied. Results: it was found that most of the participants reported having suffered changes in their sexuality after TCE, characterized by a decrease in the frequency of relationships and sexual desire, however, they show a positive attitude towards sexuality. Conclusions: although sexuality is considered important by the study participants, there was no evidence of behavior tending to erotophilia. No significant differences were found regarding the level of severity of cranioencephalic trauma

Traumatic brain injury (TBI): exploring degrees and causes of TBI in mental health impairment by comprising gender differences / Traumatismo cranioencefálico (TCE): explorando graus e causas do TCE e comprometimento da saúde mental por compreender gênero

ABSTRACT Objective: To exploring differences between degrees and causes of TBI in mental health impairment with comprising gender differences. Methods: The study was a cross-sectional observational study of TBI patients who bedded within 24 hours of presentation to the emergency department (ED), Khatam Hospital, located in Zahedan, Iran. Participants were randomized by a simple randomization technique. Information had been collected twice, first time screening patients by Glasgow Coma Scale score (GCS) and the second time was two months after discharging patients from the ED to estimate mental health impairment by using two separate clinical diagnostic tests. Results: The research considered 80 patients, with 66% being male and 34% female. The median age for both genders estimated 23.5 years. There was a statistically significant difference between degrees and causes of TBI on the total score of hospital anxiety and depression. In particular, degree and cause of TBI with depression in males (M = 14.54, SD = .22), and degrees of TBI on post-traumatic stress disorder in females (M = 87, SD = .7) were significant difference. Conclusion: The current investigation highlights the incidence of depression in male patients with severe levels of traumatic brain injury who injured by car accident multiple trauma; furthermore, this research found the remarkable rate of post-traumatic stress disorder in female patients with a mild degree of TBI. The researcher in traumatic brain injury should seriously deliberate and explore gender differences with the degree and cause of TBI in detail.

RESUMO Objetivo: Explorar diferenças entre graus e causas de traumatismo cranioencefálico (TCE) no comprometimento de saúde mental de acordo com o gênero. Métodos: Estudo observacional transversal de pacientes com TCE que se hospitalizaram dentro de 24 horas após a apresentação no pronto-socorro (PS) no Hospital Khatam, localizado em Zahedan, Irã. Os participantes foram randomizados e as informações foram coletadas duas vezes: na primeira vez, na triagem, os pacientes foram avaliados pela Escala de Coma de Glasgow (GCS); na segunda vez, dois meses depois da alta do PS, eles foram avaliados para estimar o comprometimento da saúde mental usando dois instrumentos de avaliação independentes. Resultados: A amostra foi constituída de 80 pacientes, 66% sendo do sexo masculino e 34% do sexo feminino. A idade mediana para ambos os sexos estimada foi de 23,5 anos. Houve uma diferença estatisticamente significativa entre graus e causas de TCE no escore total de ansiedade hospitalar e depressão. Em particular, o grau e a causa de TCE estiveram associados com depressão no sexo masculino (M = 14,54, DS = 0,22) e os graus de TCE, com transtorno de estresse pós-traumático em mulheres (M = 87, DS = 0,7). Conclusão: Este estudo destaca a incidência de depressão em pacientes do sexo masculino com níveis graves de lesão cerebral traumática e que se feriram por acidente de carro com trauma múltiplo; além disso, observamos uma notável taxa de transtorno de estresse pós-traumático em pacientes do sexo feminino com um grau leve de TCE. O pesquisador em lesão cerebral traumática deve explorar séria e detalhadamente as diferenças de gênero com o grau e a causa do TCE.

Impacts of cognitive impairment for different levels and causes of traumatic brain injury, and education status in TBI patients / Impactos do comprometimento cognitivo para diferentes níveis e causas de traumatismo cranioencefálico e grau de instrução em pacientes lesados

ABSTRACT Traumatic brain injury (TBI) is one of main causes of death and disability among many young and old populations in different countries. Objective: The aim of this study were to consider and predict the cognitive impairments according to different levels and causes of TBI, and education status. Methods: The study was performed using the Mini-Mental State Examination (MMSE) to estimate cognitive impairment in patients at a trauma center in Zahedan city. Individuals were considered eligible if 18 years of age or older. This investigation assessed a subset of patients from a 6-month pilot study. Results: The study participants comprised 66% males and 34% females. Patient mean age was 32.5 years and SD was 12.924 years. One-way analysis of variance between groups indicated cognitive impairment related to different levels and causes of TBI, and education status in patients. There was a significant difference in the dimensions of cognitive impairments for different levels and causes of TBI, and education status. A regression test showed that levels of traumatic brain injury (b=.615, p=.001) and education status (b=.426, p=.001) predicted cognitive impairment. Conclusion: Different levels of TBI and education status were useful for predicting cognitive impairment in patients. Severe TBI and no education were associated with worse cognitive performance and higher disability. These data are essential in terms of helping patients understand their needs. Therefore, the factors identified can help plan effective rehabilitation programs.

RESUMO A lesão cerebral traumática (TCE) é uma das principais causas de morte e incapacidade em muitos jovens e idosos em diferentes países. Objetivo: O objetivo deste estudo foi considerar e prever os prejuízos cognitivos para os diferentes níveis e causas do TCE e status de educação. Métodos: O estudo foi feito usando o Mini-Exame do Estado Mental (MMSE) para estimar o comprometimento cognitivo em pacientes dirigido a um centro de trauma na cidade de Zahedan. Os indivíduos foram considerados elegíveis se tivessem 18 anos de idade ou mais. Esta investigação avaliou um subconjunto de pacientes de um estudo piloto de 6 meses. Resultados: Os participantes do estudo foram 66% do sexo masculino e 34% do sexo feminino. A média de idade dos pacientes foi de 32,5 anos e DP foi de 12,924 anos. A análise de variância unidirecional entre grupos indicou comprometimento cognitivo relacionado a diferentes níveis e causas de TCE e status de educação em pacientes. Houve uma diferença significativa nas dimensões de deficiências cognitivas para os diferentes níveis e causas de TCE e status de educação. O teste de regressão mostrou que níveis de lesão cerebral traumática (b=0,615, p=0,001) e o status de educação (b=0,426, p=0,001) predizem o comprometimento cognitivo. Conclusão: Os diferentes níveis de TCE e estados de educação foram uteis para prever o comprometimento cognitivo em pacientes. TCE grave e sem educação foram relacionadas a piora do desempenho cognitivo e maior incapacidade. Esses dados são essenciais para ajudar os pacientes a entender o que realmente precisam, portanto, os fatores identificados podem contribuir no planejamento de programas de reabilitação efetivos.

Enteropathy-associated T-cell lymphoma:a clinicopathological analysis of nine cases / 临床与实验病理学杂志

Purpose To investigate the c1inicopatho1ogica1 and immunohistochemica1 characteristics of enteropathy-associated T-ce11 1ymphoma( EATL)and to eva1uate the criteria of diagnosis and differentia1 diagnosis. Methods There were enteropathy-associated T-ce11 1ymphoma patients co11ected with c1inica1 data(n=9). Histo1ogica1 features were observed under microscope by HE staining and by immunohistochemstry. EBV was tested by in situ hybridization. Results EATL type Ⅰ showed a variab1e histo1ogy consisting of medium-sized to 1arge 1ymphoid ce11s with round or po1ygona1 nuc1ei,containing remarkab1e nuc1eo1i. EATL typeⅡshowed that tumor ce11s were medium-sized,with round,hyperchromatic nuc1ei. Nuc1ear debris and necrosis cou1d be seen easi1y. A 1arge number of his-tiocytes and neutrophi1s formed the inf1ammatory background. Immunohistochemica1 findings showed that tumor ce11s of two types were diffuse1y positive for CD3,CD43 and TIA-1,whi1e negative for CD4,CD5,CD20,CD79a. Tumor ce11s of EATL type II expressed CD56 and CD8,but negative in EATL typeⅠ. A high pro1iferation index was demonstrated by Ki-67. EBER was negative detection. There were seven patients with fo11ow-up data from 0 to 18 months. Four patients died within 10 months and three patients died within 18 months. Conclusions EATL is a rare type of 1ymphoma with intestina1 invo1vement. Patients often present with chronic abdomina1 pain,diarrhea,persistent fever and abdomina1 mass for a 1ong time. Intestina1 perforation occurs in some cases. Diagnosis shou1d be corre1ated to c1inica1 symptoms whi1e the fina1 diagnosis is main1y based on the patho1ogica1 features and the immune phenotypes.

Sport-related concussions / Concussões relacionadas ao esporte

Traumatic brain injury (TBI) is a major cause of lifelong disability and death worldwide. Sport-related traumatic brain injury is an important public health concern. The purpose of this review was to highlight the importance of sportrelated concussions. Concussion refers to a transient alteration in consciousness induced by external biomechanical forces transmitted directly or indirectly to the brain. It is a common, although most likely underreported, condition. Contact sports such as American football, rugby, soccer, boxing, basketball and hockey are associated with a relatively high prevalence of concussion. Various factors may be associated with a greater risk of sport-related concussion, such as age, sex, sport played, level of sport played and equipment used. Physical complaints (headache, fatigue, dizziness), behavioral changes (depression, anxiety, irritability) and cognitive impairment are very common after a concussion. The risk of premature return to activities includes the prolongation of post-concussive symptoms and increased risk of concussion recurrence.

O traumatismo cranioencefálico (TCE) é uma das principais causas de deficiência ao longo da vida e de morte no mundo. As lesões cerebrais traumáticas relacionadas ao esporte são um problema de saúde pública de grande impacto. O intuito desta revisão foi expor a importância das concussões relacionadas ao esporte. A concussão é uma alteração transitória da consciência induzida por forças biomecânicas externas que podem ser direta ou indiretamente transmitidas ao cérebro. Sua ocorrência é comum, mas provavelmente é subnotificada. Esportes de contato, como futebol americano, rugby, futebol, boxe, basquetebol e hóquei, estão associados a uma prevalência relativamente alta de concussão. Diferentes fatores podem estar associados a um maior risco de concussão relacionada ao esporte, como idade, sexo, esporte jogado, categoria de esporte jogado e equipamentos utilizados. Queixas físicas (dores de cabeça, fadiga, tonturas), alterações comportamentais (depressão, ansiedade, irritabilidade) e comprometimento cognitivo são muito comuns após uma concussão. O risco de retorno prematuro às atividades inclui o prolongamento dos sintomas pós-concussionais e o aumento do risco de recorrência de concussão.

BPSD following traumatic brain injury / BPSD pós traumatismo cranioencefálico

Annually, 700,000 people are hospitalized with brain injury acquired after traumatic brain injury (TBI) in Brazil. OBJECTIVE: We aim to review the basic concepts related to TBI, and the most common Behavioral and Psychological Symptoms of Dementia (BPSD) findings in moderate and severe TBI survivors. We also discussed our strategies used to manage such patients in the post-acute period. METHODS: Fifteen TBI outpatients followed at the Center for Cognitive Rehabilitation Post-TBI of the Clinicas Hospital of the University of São Paulo were submitted to a neurological, neuropsychological, speech and occupational therapy evaluation, including the Mini-Mental State Examination. Rehabilitation strategies will then be developed, together with the interdisciplinary team, for each patient individually. Where necessary, the pharmacological approach will be adopted. RESULTS: Our study will discuss options of pharmacologic treatment choices for cognitive, behavioral, or affective disorders following TBI, providing relevant information related to a structured cognitive rehabilitation service and certainly will offer an alternative for patients and families afflicted by TBI. CONCLUSION: Traumatic brain injury can cause a variety of potentially disabling psychiatric symptoms and syndromes. Combined behavioral and pharmacological strategies, in the treatment of a set of highly challenging behavioral problems, appears to be essential for good patient recovery.

Anualmente, 700 mil pessoas são hospitalizadas com lesão encefálica adquirida após traumatismo cranioencefálico (TCE) no Brasil. OBJETIVO: Nossa meta é revisar os conceitos básicos relacionados ao TCE, e aos Sintomas Comportamentais e Psicológicos da Demência (BPSD) encontrados nos sobreviventes de TCE moderado e grave. Também discutimos as estratégias utilizadas para lidar com os pacientes pós-TCE.MÉTODOS: Quinze pacientes ambulatoriais acompanhados no Centro de Reabilitação Cognitiva pós-traumatismo cranioencefálico do Hospital das Clínicas de São Paulo foram submetidos a avaliações neurológica, neuropsicológica, fonoaudiológica e de terapia ocupacional, incluindo o mini exame do estado mental. Em seguida, estratégias de reabilitação serão desenvolvidas, com a equipe multidisciplinar, para cada paciente individualmente. E, se necessário, a abordagem farmacológica será adotada. RESULTADOS: Nosso estudo irá discutir as opções de escolha de tratamento farmacológico para desordens cognitivas, comportamentais e afetivas pós-TCE, fornecendo informações relevantes relacionadas a um serviço de reabilitação cognitiva estruturada e, certamente, irá oferecer uma alternativa para pacientes e famílias vítimas de TCE. CONCLUSÃO: O traumatismo cranioencefálico pode causar uma variedade de sintomas e síndromes psiquiátricos potencialmente incapacitantes. As estratégias farmacológica e comportamental combinadas para o tratamento de um conjunto de problemas comportamentais muito desafiador parece ser essencial para uma boa recuperação do paciente.

Experience of objective structured practical examination in traditional settings of human physiology curriculum.

Introduction: An integral part of a medical curriculum is an appropriate assessment of the students’ clinical competencies since assessment drives learning. A need of a more competence based assessment method led to introduction of Objective Structured Practical Examination (OSPE) which assesses the ‘shows how’ level of the Miller’s pyramid of clinical competence as Traditional Clinical Examination (TCE) focuses on the “knows” and “knows how” aspects .The present study focuses on the experience of OSPE in term of the reliability and validity in comparison with traditional assessment method. Methodology: After the institutional ethical committee approval, a pilot study for comparing TCE with OSPE was conducted with a batch of 50 first MBBS students at K.J.Somaiya medical college in the department of Physiology for 4 consecutive days. Three examiners with teaching experience of 35, 6 and 1 year respectively conducted TCE followed by OSPE which had 10 stations assessing cognitive, psychomotor and affective domain for the same batch of 25 students in each. Results: OSPE had a good face validity and content validly as compared to TCE. Predictive validity using Pearson’s correlation with the final year –end examination for TCE was 0.45 while for OSPE was 0.78 and reliability measured by internal consistency using Cronbach’s alpha for TCE was 0.66 and for OSPE was 0.73 . The inter-station reliability measured affective and psychomotor domain in OSPE was 0.279 and 0.4 respectively while that for cognitive domain was 0.963. Conclusion: OSPE is a reliable and valid assessment tool provided it is more comprehensive and standardized. However it needs to be incorporated with traditional assessment for an overall evaluation of student’s performance.

Cognitive rehabilitation following traumatic brain injury / Reabilitação cognitiva após traumatismo crânio encefálico

Abstract Annually, some 500,000 people are hospitalized with brain lesions acquired after traumatic brain injury (TBI) in Brazil. Between 75,000 and 100,000 individuals die within hours of the event and 70,000 to 90,000 evolve to irreversible loss of some neurological function. The principal causes of TBI include motor vehicle accidents (50%), falls (21%), assaults and robberies (12%) and accidents during leisure activities (10%). Within this context, cognitive rehabilitation, a clinical area encompassing interdisciplinary action aimed at recovery as well as compensation of cognitive functions altered as a result of cerebral injury, is extremely important for these individuals. Therefore, the aim of this study was to review the basic concepts related to TBI, including mechanisms of injury, severity levels of TBI, the most common findings in moderate and severe TBI survivors, and the most frequent cognitive impairments following TBI, and also to discuss the strategies used to handle patients post-TBI. The study results yielded relevant information on a structured cognitive rehabilitation service, representing an alternative for patients and families afflicted by TBI, enabling the generation of multiple research protocols.

Resumo Anualmente, 500 mil pessoas são hospitalizadas com lesão cerebral adquirida após traumatismo crânio-encefálico (TCE) no Brasil. Setenta e cinco a cem mil pessoas morrem poucas horas após o evento e 70 a 90 mil evoluem para perda irreversível de alguma função neurológica. Entre as principais causas de TCE estão os acidentes automobilísticos (50%), quedas (21%), assaltos e roubos (12%) e atividades de lazer (10%). Dentro deste contexto, a reabilitação cognitiva, uma área clínica de atuação interdisciplinar em busca de recuperação, tanto quanto a compensação de alterações das funções cognitivas resultantes de lesão cerebral, é extremamente importante para estes indivíduos. Portanto, neste estudo, foram revisados os conceitos básicos relacionados ao TCE, tais como os mecanismos de lesão, os níveis graves de TCE, os achados mais comuns em sobreviventes de TCE moderado e grave e as deficiências cognitivas mais comuns após TCE e discutidas as estratégias utilizadas para lidar com pacientes pós-TCE. Como resultado, nosso estudo irá fornecer informações relevantes relacionadas com um serviço de reabilitação cognitiva estruturada e, certamente, irá oferecer uma alternativa para pacientes e famílias vítimas de TCE e, portanto, gerar múltiplos protocolos de pesquisa.

Reabilitação cognitiva após traumatismo crânio encefálico: [revisão] / Cognitive rehabilitation followingtraumatic brain injury: [review]

Annually, some 500,000 people are hospitalized with brain lesions acquired after traumatic brain injury (TBI) in Brazil. Between 75,000 and 100,000 individuals die within hours of the event and 70,000 to 90,000 evolve to irreversible loss of some neurological function. The principal causes of TBI include motor vehicle accidents (50%), falls (21%), assaults and robberies (12%) and accidents during leisure activities (10%). Within this context, cognitive rehabilitation, a clinical area encompassing interdisciplinary action aimed at recovery as well as compensation of cognitive functions altered as a result of cerebral injury, is extremely important for these individuals. Therefore, the aim of this study was to review the basic concepts related to TBI, including mechanisms of injury, severity levels of TBI, the most common findings in moderate and severe TBI survivors, and the most frequent cognitive impairments following TBI, and also to discuss the strategies used to handle patients post-TBI. The study results yielded relevant information on a structured cognitive rehabilitation service, representing an alternative for patients and families afflicted by TBI, enabling the generation of multiple research protocols.

Anualmente, 500 mil pessoas são hospitalizadas com lesão cerebral adquirida após traumatismo crânio-encefálico (TCE) no Brasil. Setenta e cinco a cem mil pessoas morrem poucas horas após o evento e 70 a 90 mil evoluem para perda irreversível de alguma função neurológica. Entre as principais causas de TCE estão os acidentes automobilísticos (50%), quedas (21%), assaltos e roubos (12%) e atividades de lazer (10%). Dentro deste contexto, a reabilitação cognitiva, uma área clínica de atuação interdisciplinar em busca de recuperação, tanto quanto a compensação de alterações das funções cognitivas resultantes de lesão cerebral, é extremamente importante para estes indivíduos. Portanto, neste estudo, foram revisados os conceitos básicos relacionados ao TCE, tais como os mecanismos de lesão, os níveis graves de TCE, os achados mais comuns em sobreviventes de TCE moderado e grave e as deficiências cognitivas mais comuns após TCE e discutidas as estratégias utilizadas para lidar com pacientes pós-TCE. Como resultado, nosso estudo irá fornecer informações relevantes relacionadas com um serviço de reabilitação cognitiva estruturada e, certamente, irá oferecer uma alternativa para pacientes e famílias vítimas de TCE e, portanto, gerar múltiplos protocolos de pesquisa.

Traumatismo cranioencefálico de pacientes vítimas de acidentes de motocicletas / Cranioencephalic trauma of patients victims of motorcycle accidents

Nos últimos anos houve um aumento considerável no número de motocicletas nas cidades e rodovias do país. A conseqüência negativa desse fato está no aumento progressivo de vítimas de traumas mecânicos, dentre eles, o Trauma Crânioencefálico (TCE). O TCE é o principal determinante de óbito e seqüelas em politraumatizados, sendo por isso definido pela Organização Mundial de Saúde como um problema de saúde pública. O presente trabalho tem como objetivos levantar o número de TCE causados por acidentesmotociclisticos no período de dezembro de 2007 a fevereiro de 2008, atendidos no Pronto Atendimento de um hospital universitário; descrever o acidente segundo a etiologia, dia da semana, horário e período e caracterizara vítima segundo o sexo, a idade, a escala de Coma de Glasgow e seu encaminhamento. Foi realizado umestudo não-experimental, quantitativo e retrospectivo desenvolvido em um serviço de pronto-atendimentode um hospital escola de São José do Rio Preto. Os resultados revelaram que dentre as 68 vítimas de TCE poracidentes motociclisticos a maior incidência foi do sexo masculino com 80,9%, expondo que o tipo de acidentecom maior índice foi a colisão com 55,9%, na qual a cidade de São José do Rio Preto apresentou 63,1% doscasos de TCE, ocorridos aos sábados com 25% das vítimas, predominando uma faixa etária de 15 a 25 anoscom 44,1%, destacando o mês de dezembro com 44,1%, sendo que o período noturno destaca-se com 54,4%,ressaltando que 88,2% dos pacientes atendidos no PA foram encaminhados para a realização de exames e emrelação à Escala de Coma de Glasgow (ECGI), foram observados que 69,1 % das vitimas obtiveram 15 pontos.

In the last years there was a considerable increase in the number of motorcycles in the cities and highwaysof the country. The negative consequence of this is the progressive growing of victims of mechanicalinjuries such as cranioencephalic trauma (CET). CET is the main death cause and sequels in polytraumatized patients, being defined a problem of public health by the World Health Organization. The current work aimed at surveying the number of CET victims caused by motorcycle accidents in the period from December 2007 to February 2008 attended in the in Emergency care service of a school hospital; to describe the accident according to the etiology, day of the week, time and period and to characterize the victims according togender, age, Glasgow Coma scale and their refereeing . A quantitative non-experimental and retrospectivestudy was developed in an emergency care service of a school hospital of São José do Rio Preto, SP. The results showed that of the 68 CET patients of motorcycle accidents, the majority of the victims were men (80.9%), the predominant age range of victims was 15 to 25 years old ( 44.1%) and the most common type of accident was crashes (55.9%). Of the total, 63.1% of the accidents occurred in São José do Rio Preto, 25% happened on Saturdays. During this period more accidents occurred in December (44.1%) than the other months, and the majority of the accidents occurred at night (54.4%). Of the 68 patients treated in theemergence care service, 88.2% were referred for examinations, and 69.1% of the victims had 15 scores according to the Glasgow Coma Scale (GCS).

Síndromes disexecutivas do desenvolvimento e adquiridas na prática clínica: três relatos de caso / Developmental and acquired dysexecutive syndromes in clinical practice: three case-reports

Síndromes disexecutivas podem ser observadas em diversas condições neuropsiquiátricas, como transtorno do déficit de atenção e hiperatividade (TDAH), traumatismos cranioencefálicos (TCE) ou esquizofrenia, frequentemente se associando à ampla gama de comprometimento, incluindo ambientes familiar, acadêmico e profissional. O objetivo do presente estudo é apresentar três casos de disfunções executivas, nos quais, embora todos os pacientes tenham QI dentro dos limites da normalidade, existe significativo comprometimento social e ocupacional. O primeiro caso apresenta uma jovem que sofreu TCE, com queixas de dificuldades de memória para material novo, além de apatia e diminuição de iniciativa e persistência. O segundo caso versa sobre uma mulher que apresenta problemas desde a educação infantil, com histórico de tratamentos ineficazes e nenhum diagnóstico formal. Segundo relato de informante colateral, há déficits de planejamento, comportamentos antissociais, aversão a gratificações tardias e dificuldades de ativação. O último caso refere-se a indivíduo do sexo masculino, avaliado depois de grave TCE após acidente de carro. Há relato de mudança de comportamento com desinibição, diminuição da persistência e desatenção, relatadas como mais graves do que as apresentadas durante a infância, apesar de desempenho normal em testes de funções executivas. A avaliação de disfunções executivas (do desenvolvimento ou adquiridas) pode ser de extrema importância para servir como base de tratamento visando à diminuição de comprometimento nas atividades cotidianas.

Dysexecutive syndromes are often observed in several neuropsychiatric conditions, such as attention deficit hyperactivity disorder (ADHD), traumatic brain injuries (TBI) or schizophrenia, and usually associate with significant impairments, including familial, academic and professional areas. The present paper aims at presenting three cases of executive functions (EFs) deficits where despite having normal IQ, all subjects' exhibit significant functional and social impairment. The first case describes a young woman who suffered a TBI and her complaints relates to difficulties in memory for new material, apathy, less persistency and initiative. The second case is about a middle-age woman facing problems since kindergarten and with unsuccessful treatments and no formal diagnosis. In this case, collateral report suggests the presence of planning difficulties, some antisocial behavior, delay gratification aversion, poor activation and time estimation deficits. The last case refers to a middle-age man, evaluated after a severe TBI following a car accident. He presented some behavioral changes, such as disinhibition, lack of persistency and inattentive deficits that occur in a more severe level than presented during his childhood, despite having normal performance in tests of EFs. The evaluation of (developmental or acquired) EF deficits might be extremely important for providing adequate therapeutic approach in order to decrease related impairments in everyday activities.

Study of genetic polymorphism in solvent exposed population and its correlation to in vitro effect of trichloroethylene on lymphocytes.

Trichloroethylene (TCE) is major industrial pollutant that contaminate environment. Its exposure may lead to hepato-renal toxicity along with the cancer progression. Although extensive research is done on its toxicity, still not much is known about its genotoxic potential on humans in relation to genetic polymorphism. Cytochrome P450 (CYP P-450) and glutathione-S-transferases (GSTs) are important in cellular detoxification of TCE. Variations in gene sequences result in population specific regional genetic variations (polymorphism). Genotyping of CYP1A1, GSTM1, GSTT1 and GSTP1 polymorphism was performed in 220 normal and 97 solvent-exposed individuals from northern part of India using real time PCR, PCR and restriction digestion techniques. The parameters examined to study genotoxicity were chromosomal aberration (CA) and cytokinesis block micronucleus assay (CBMN) in lymphocyte culture in vitro. The observed average frequencies for GSTM1 (null) and GSTT1 (null) were 41, 22 and 12.7%, respectively in normal subjects whereas frequencies of CYP1A1/GSTP1 with (ile/ile) or (ile/val) or (val/val) were found to be 76.2/52, 21.4/42.1 and 2.4/5.9% respectively. It was further observed that the frequencies of above genes were found to be similar in solvent exposed groups. The distribution frequencies of GST genes, when compared with other reports from various regions of India show variations. In vitro TCE exposure (2, 4 and or 6 mM) did not show any significant genotoxic effect. TCE may be toxic due to its metabolite.