An appraisal to Hans Berger by the time of his 150th birthday: the human EEG and tales of blood flow, heat and brain waves / Um ensaio sobre o aniversário de 150 anos de Hans Berger: uma história de sangue, calor e ondas cerebrais

Abstract More than 100 years of research have passed by and still the human electroencephalogram (EEG) remains a puzzle to be solved. Starting from his studies on plethysmography until his theories on brain thermodynamics, Hans Berger was able to refine his method of recording cortical signs with the apparatus at his disposal in an ordinary neuropsychiatric yard towards an early account of human EEG. This review is an appraisal of his contribution to the field of modern neurophysiology.

Resumo Mais de 100 anos se passaram e o eletroencefalograma humano (EEG) continua sendo um enigma a ser desvendado. A partir de seus estudos sobre pletismografia até suas teorias sobre termodinâmica cerebral, Hans Berger conseguiu refinar seu método de registro da atividade elétrica cortical com os equipamentos a sua disposição em uma ala psiquiátrica comum produzindo uma descrição acurada do EEG humano. Esta revisão é um breve resumo de sua contribuição para o campo da neurofisiologia moderna.

Análisis comparativo de las características clínicas, evolución y mortalidad de pacientes hospitalizados por COVID-19 durante la primera y segunda ola de la pandemia (REGISTRO ECCOVID) / Comparative analysis of clinical characteristics, evolu tion and mortality of hospitalized patients with COVID-19 during the first and second wave of the pandemic (ECCOVID STUDY)

Resumen Introducción : Las características clínicas y evolutivas de los pacientes con diagnóstico de COVID-19 pueden diferir entre las distintas olas de la pandemia. El objetivo de este estudio fue comparar las características clínicas, evolución y mortalidad de pacientes hospitalizados por COVID-19 durante la primera y segunda ola en Argentina. Métodos : Registro multicéntrico y prospectivo de pacientes ≥ 18 años con diagnóstico confirmado de COVID-19 internados en 18 hospitales de Argentina durante la primera (marzo a octubre 2020) y la segunda ola (marzo a julio 2021) de la pandemia. Se compararon variables demográficas, características clínicas, y evolu ción a 30 días. Resultados : Se incluyeron un total de 1691 pacien tes (primera ola n = 809, segunda ola n = 882). Los pa cientes hospitalizados durante la segunda ola tenían mayor edad (mediana 53 años vs. 61 años, p < 0.001), comorbilidades (71% vs. 77%, p = 0.007) y requerimiento de oxígeno (21% vs. 62%, p < 0.001). Durante la hospi talización, los pacientes de la segunda ola requirieron más oxigenoterapia (49% vs. 85%, p < 0.001), asistencia mecánica respiratoria (12% vs. 22%, p <0,001) y presen taron mayor mortalidad (11% vs. 26%, p < 0.001). Compa rando únicamente a los que requirieron oxigenoterapia durante la hospitalización, la mortalidad a los 30 días fue de 20% y 30% p < 0.001 en la primera y segunda ola respectivamente. Conclusión : Comparados con los pacientes interna dos durante la primera ola, los internados durante la segunda ola de SARS-CoV-2 en Argentina presentaron mayor gravedad y mortalidad.

Abstract Introduction : Clinical features and outcomes of SARS-CoV-2 infections may change between different waves of the pandemic. The objective of this study was to compare clinical characteristics and outcomes between two cohorts of patients hospitalized for COVID-19 during the first and second waves in Argentina. Methods : Multicenter and prospective registry of patients ≥18 years old with a confirmed diagnosis of COVID-19 admitted to 18 hospitals in Argentina during the first wave (March to October 2020) and second wave (March to July 2021) of the pandemic. Demographics, clinical characteristics, and outcomes of these patients were compared. Results : A total of 1691 patients were included (first wave n = 809, second wave n = 882). Hospitalized pa tients during the second wave were older (median 53 years vs. 61 years, p < 0.001), had more comorbidities (71% vs. 77%, p=0.007) and required more supplemental oxygen at admission (21% vs 62%, p < 0.001). During hos pitalization, patients of the second wave required more supplemental oxygen (49% vs. 85%, p < 0.001), invasive ventilation (12% vs. 22%, p < 0.001) and had higher 30- day mortality (11% vs. 26%, p < 0.001). Comparing only patients who required supplemental oxygen during hos pitalization, 30-day mortality was 20% and 30% p < 0.001 for the first and second wave, respectively. Conclusion : Compared to patients admitted during the first wave, patients admitted with SARS-CoV2 dur ing the second wave in Argentina were more seriously ill and had a higher mortality.

Dengue como fenómeno epidemiológico emergente: dinámica de los brotes en la provincia de Buenos Aires en 2016 Y 2020 / Dengue as an emergent epidemiological phenomenon: dynamics of the outbreaks of 2016 and 2020 in Buenos Aires province

RESUMEN INTRODUCCIÓN: El dengue constituye un problema emergente en Argentina. En la provincia de Buenos Aires se inició un primer brote en 2016, y el de 2020 registró un 82% más de casos y afectó municipios sin antecedentes previos. El objetivo de este estudio fue caracterizar la dinámica de los brotes bonaerenses de 2016 y 2020 . MÉTODOS: Se realizó un estudio descriptivo, retrospectivo y transversal. Los casos fueron registrados en el Sistema Nacional de Vigilancia de la Salud. Fueron calculadas las distribuciones de frecuencia de los casos notificados, considerando también el origen: importados o autóctonos. Las tasas de incidencia y las razones de tasas se calcularon por Región Sanitaria. La difusión de la onda epidémica para ambos brotes fue obtenida mediante el cálculo de métricas adimensionales . RESULTADOS: Ambos brotes manifestaron ondas de similar comportamiento, pero con diferente expansión temporal y velocidades de difusión que se distanciaron en el inicio y luego hacia el final, presentando el último brote una mayor incidencia pero con una tasa de propagación de menor variación . DISCUSIÓN: La investigación realizada permitió caracterizar los brotes ocurridos en 2016 y 2020, y focalizar regionalmente la incidencia del fenómeno reemergente de la infección por arbovirus dengue (principalmente DEN-1 circulante) en la provincia de Buenos Aires, con cifras de incidencia que superaron lo conocido en la historia de la enfermedad en Argentina.

ABSTRACT INTRODUCTION: Dengue is an emerging problem in Argentina. In the province of Buenos Aires, the first outbreak was in 2016, and the one occurred during 2020 caused 82% more cases and affected districts with no previous cases. The objective of this study was to characterize the outbreak dynamics in the province of Buenos Aires in 2016 and 2020 . METHODS: A descriptive, retrospective and crosssectional study was conducted. The cases were registered in the National Health Surveillance System. The frequency distributions of the reported cases were calculated, considering also the origin: imported or autochthonous. Incidence rates and rate ratios were calculated for each Health Region. The diffusion of the epidemic wave for both outbreaks was obtained by calculating dimensionless metrics . RESULTS: Both outbreaks showed waves with similar behavior, but with different temporal expansion and diffusion speeds that distanced from each other at the beginning and then towards the end. The last outbreak had a higher incidence, but a propagation rate with less variation . DISCUSSION: This research allowed to characterize the two outbreaks occurred in 2016 and 2020, and to focus regionally on the incidence of the re-emerging phenomenon of dengue arbovirus infection (mainly circulating DEN-1) in the province of Buenos Aires, with incidence figures that exceeded those known in the history of the disease in Argentina.

Three years of COVID-19 pandemic: comparative analysis of incidence, lethality and mortality among the States of the south region of Brazil / Três anos de pandemia da COVID-19: análise comparativa da incidência, letalidade e mortalidade entre os Estados da região sul do Brasi

Introduction: the first COVID-19 case in Brazil was confirmed on February 26, 2020. As of March 17, 2023, the Ministry of Health reported 699,634 deaths from COVID-19, with a case fatality rate of 1.9%. The impact of the COVID-19 pandemic in Brazil extends to socioeconomic and healthcare systems, reflecting significant regional disparities. Objective: To analyze mortality, incidence, and case fatality rates for COVID-19 in the states of Paraná and Santa Catarina, in the southern region of Brazil. Methods: This is an ecological time-series study using official Brazilian secondary data for COVID-19 cases and deaths. Data were extracted from the dashboard of the State Health Department of Santa Catarina and Paraná. Temporal series were developed for trend analysis using the Prais-Winsten regression model. Statistical analyses were performed using STATA 14.0 software (College Station, TX, USA, 2013). Results: In the analysis of rates over the entire period, trends for mortality, case fatality, and incidence in the state of Santa Catarina are decreasing, decreasing, and stationary, respectively. In Paraná, rates over the entire period showed a stationary trend for mortality, decreasing for case fatality, and increasing for incidence. Conclusion: COVID-19 had a devastating effect on the states of Santa Catarina and Paraná. Both states experienced the progression of the COVID-19 pandemic, with higher case fatality and mortality rates observed in Paraná, while Santa Catarina had a higher incidence rate over the three years of the COVID-19 pandemic.

Modulation of brain waves in spinal cord injury patients with pain: cross-sectional analysis / Modulação de ondas cerebrais em pacientes com lesão medular e dor: uma análise transversal / Modulación de ondas cerebrales en pacientes con lesión de médula espinal y dolor: un análisis transversal

ABSTRACT: Objective: This study aimed to describe the encephalographic electrical rhythm pattern of the Alpha wave in patients with traumatic spinal cord injury in the thoracic spine. Methodology: This is a cross-sectional observational study conducted from January to March 2022. A total of 20 patients with traumatic spinal cord injury were included in the study and divided into two groups, with pain symptoms and without pain symptoms. Both groups were submitted for evaluation for population characterization, identification of the presence of pain and the possible presence of signs and symptoms of central sensitization and quantitative electroencephalographic examination. Results: Comparing them, it was possible to observe a reduction of 38.7% (2.69µV; 95%CI 1.28 to 4.09) in the Alpha 2 wave (10-12 Hz) in the group with pain symptoms. This alteration was identified in the parietal lobe, mainly in PZ. Conclusion: We observed a selective reduction of Alpha 2 waves, mainly in the parietal region (PZ), in spinal cord injury patients with pain compared to spinal cord injury patients without pain. Level of Evidence III; Diagnostic Studies.

RESUMO: Objetivo: O objetivo deste estudo foi descrever o padrão do ritmo eletroencefalográfico da onda Alfa em pacientes com lesão medular traumática na coluna torácica. Metodologia: Trata-se de um estudo observacional transversal, realizado no período de janeiro a março de 2022. No total 20 pacientes com lesão medular traumática foram incluídos no estudo e divididos em dois grupos, com sintomas de dor e sem sintomas de dor. Ambos os grupos foram submetidos a avaliação para caracterização populacional, identificação de presença de dor e possível presença de sinais e sintomas de sensibilização central e ao exame Eletroencefalográfico quantitativo. Resultados: Ao compará-los foi possível constatar uma redução de 38,7% (2.69µV; 95%IC 1,28 to 4.09) da onda Alfa 2 (10-12 Hz) do grupo com sintomas de dor. Essa alteração foi identificada no lobo parietal, principalmente em PZ. Conclusão: Observamos uma redução seletiva de ondas Alfa 2, principalmente na região parietal (PZ), em pacientes com lesão medular com dor em relação aos pacientes lesão medular sem dor. Nível de Evidência III; Estudo diagnóstico.

RESUMEN: Objetivo: El objetivo de este estudio fue describir el patrón del ritmo electroencefalográfico de la onda Alfa en pacientes con lesión medular traumática en la columna torácica. Metodología: Se trata de un estudio observacional transversal realizado entre enero y marzo de 2022. En total, se incluyeron 20 pacientes con lesión medular traumática en el estudio, divididos en dos grupos, uno con síntomas de dolor y otro sin síntomas de dolor. Ambos grupos fueron sometidos a evaluación para caracterización poblacional, identificación de presencia de dolor y posible presencia de signos y síntomas de sensibilización central, así como al examen electroencefalográfico cuantitativo. Resultados: Al compararlos, se pudo constatar una reducción del 38,7% (2,69 µV; IC del 95%: 1,28 a 4,09) en la onda Alfa 2 (10-12 Hz) del grupo con síntomas de dolor. Esta alteración se identificó en el lóbulo parietal, principalmente en PZ. Conclusión: Observamos una reducción selectiva de las ondas Alfa 2, principalmente en la región parietal (PZ), en pacientes con lesión medular y dolor en comparación con pacientes con lesión medular sin dolor. Nivel de Evidencia III; Estudios de diagnósticos.

Análisis no-lineal de la onda gamma del electroencefalograma en una prueba de atención e inhibición / Non-linear analysis of the electroencephalogram gamma wave in an attention and inhibition test

Introducción: Durante las últimas décadas se ha estudiado la señal del electroencefalograma desde una perspectiva de matemática no-lineal. Esto permite entender la actividad eléctrica cerebral como un sistema dinámico complejo. Objetivo: Evaluar los exponentes de Hurst y sus correlaciones en la onda gamma durante una tarea de atención alternante e inhibición de la interferencia en estudiantes universitarios. Métodos: La muestra se constituyó por 14 alumnos de educación física. Para evaluar la actividad eléctrica cerebral se utilizó el dispositivo cerebro-interfaz Emotiv Epoc®. La atención alternante se estimó con el test de símbolos y dígitos, mientras que para la inhibición de la interferencia se empleó la prueba de palabras y colores de Stroop. Resultados: En la prueba de atención alternante, cuatro individuos revelaron mayor propensión al caos en el hemisferio derecho, uno presentó más tendencia en el hemisferio izquierdo y dos no tuvieron una predisposición definida. Por otra parte, durante la prueba de inhibición de la interferencia, cinco presentaron variaciones de las medias de Hurst entre las tres láminas del efecto Stroop, sobre todo de la región temporal. Los exponentes Hurst en ambas pruebas fueron inferiores a 0,5. Conclusiones: Durante la prueba de atención se observó un mayor caos de la actividad eléctrica cerebral, sin existir correlaciones entre las regiones estudiadas. Durante la prueba de inhibición las modificaciones de los exponentes de Hurst no presentaron patrones definidos hacia el orden o caos(AU)

Introduction: During the last decades the electroencephalogram signal has been studied from a nonlinear mathematical perspective. This allows understanding brain electrical activity as a complex dynamical system. Objective: To evaluate Hurst exponents and their correlations in the gamma wave during an alternating attention and interference inhibition task in university students. Methods: The sample consisted of 14 physical education students. The Emotiv Epoc® brain-interface device was used to evaluate brain electrical activity. Alternating attention was estimated with the symbols and digits test, while the Stroop words and colors test was used for interference inhibition. Results: In the alternating attention test, four individuals revealed a greater propensity to chaos in the right hemisphere, one showed a greater tendency in the left hemisphere and two had no defined predisposition. On the other hand, during interference inhibition, variations of Hurst average values between the three Stroop effect slices were determined in five subjects, especially in the temporal region. Hurst exponents in both tests were found to be less than 0.5. Conclusions: During the attention test, a greater chaos of brain electrical activity is observed, with no correlations between the regions studied. During the inhibition test, the modifications of the Hurst exponents do not present defined patterns towards order or chaos(AU)

Effects of neurofeedback on major depressive disorder: a systematic review

ABSTRACT Background Major depressive disorder is a difficult-to-treat psychological disorder. Approximately 30% of patients with major depressive disorder do not respond to conventional therapies; thus, the efficacy of alternative therapies for treating major depressive disorder, such as neurofeedback, a non-invasive neuromodulation method used in the treatment of psychiatric diseases, must be investigated. Objective We aimed to evaluate the efficacy of neurofeedback in minimizing and treating major depressive disorder and its application as a substitute to or an adjuvant with conventional therapies. Methods We searched for experimental studies published between 1962-2021 in Scopus, PubMed, Web of Science, and Embase databases and identified 1,487 studies, among which 13 met the inclusion exclusion criteria. Results We noted that not all patients responded to neurofeedback. Based on depression scales, major depressive disorder significantly improved in response to neurofeedback only in a few individuals. Additionally, the number of training sessions did not influence the results. Conclusion Neurofeedback can reduce depression symptoms in patients; however, not all patients respond to the treatment. Therefore, further studies must be conducted to validate the effectiveness of neurofeedback in treating major depressive disorder.

Fetal electrocardiogram signal extraction and analysis method combining fast independent component analysis algorithm and convolutional neural network / 生物医学工程学杂志

Fetal electrocardiogram (ECG) signals provide important clinical information for early diagnosis and intervention of fetal abnormalities. In this paper, we propose a new method for fetal ECG signal extraction and analysis. Firstly, an improved fast independent component analysis method and singular value decomposition algorithm are combined to extract high-quality fetal ECG signals and solve the waveform missing problem. Secondly, a novel convolutional neural network model is applied to identify the QRS complex waves of fetal ECG signals and effectively solve the waveform overlap problem. Finally, high quality extraction of fetal ECG signals and intelligent recognition of fetal QRS complex waves are achieved. The method proposed in this paper was validated with the data from the PhysioNet computing in cardiology challenge 2013 database of the Complex Physiological Signals Research Resource Network. The results show that the average sensitivity and positive prediction values of the extraction algorithm are 98.21% and 99.52%, respectively, and the average sensitivity and positive prediction values of the QRS complex waves recognition algorithm are 94.14% and 95.80%, respectively, which are better than those of other research results. In conclusion, the algorithm and model proposed in this paper have some practical significance and may provide a theoretical basis for clinical medical decision making in the future.

Does low-intensity pulsed ultrasound accelerate phasic calcium phosphate ceramic-induced bone formation?

Purpose: Low-intensity pulsed ultrasound (LIPUS) has been used to stimulate the healing of the fresh fracture, delayed union, and non-union in both animal and clinical studies. Besides, biphasic calcium phosphate ceramic (BCP) is a promising biomaterial for bone repair as it shows favorable biocompatibility, osteoinduction, and osteoconduction. However, scarcity is known about the combined effect of LIPUS and BCP on bone formation. Methods: The combined effect of LIPUS and BCP was studied in a beagle model. Twelve dogs were used. BCP granules without any additions were implanted into bilateral erector spinae muscles. One side is the BCP group, while the counterlateral side is LIPUS + BCP group. Histological and histomorphometric analyses, and quantitative real-time polymerase chain reaction were evaluated. Results: Compared with BCP alone, the LIPUS + BCP showed no advantages in early bone formation. Furthermore, the Notch signaling pathway-related mRNA has no significant difference between the two groups. Conclusions: The preliminary results showed that the BCP, which has intrinsic osteoinduction nature, was an effective and promising material. However, LIPUS has no enhanced effect in BCP induced ectopic bone formation. Furthermore, LIPUS has no effect on the Notch signaling pathway. Whether costly LIPUS could be used in combination with BCP should be a rethink.

Clinical efficacy of acupuncture combined with extracorporeal shock wave therapy in the treatment of piriformis syndrome / 中国基层医药

Objective:To evaluate the clinical efficacy of acupuncture combined with extracorporeal shock wave therapy in the treatment of piriformis syndrome.Methods:Eighty patients with piriformis syndrome who received treatment in Huaihe Energy Occupational Disease Prevention Hospital Rehabilitation Medicine Center from February 2021 to December 2022 were included in this study. They were divided into a treatment group ( n = 40) and a control group ( n = 40) according to different treatment methods using a retrospective cohort study design. The treatment group was treated with acupuncture combined with extracorporeal shock wave therapy, once every 7 days for 3 consecutive weeks. The control group was treated with extracorporeal shock wave therapy alone once every 7 days for 3 consecutive weeks.Pre- and post-treatment visual analogue scale scores and clinical efficacy were compared between the two groups. Results:There was no significant difference in baseline data between the two groups (all P > 0.05). After treatment, the visual analogue scale score decreased in each group. After adjusting for covariates, there was no significant difference in visual analogue scale score between the two groups ( F = 112.38, P < 0.001). After adjusting the pre-treatment visual analogue scale score, the post-treatment visual analogue scale score in the treatment group was lower than that in the control group [1.417 (95% CI: 1.151-1.683)]. The total response rate in the treatment group was 97.5% (39/40), which was significantly higher than 82.5% (33/40) in the control group ( Z = -2.03, P = 0.042). Conclusion:Acupuncture combined with extracorporeal shock wave therapy is highly effective on piriformis syndrome.

Centenario de la radiodifusión en el Uruguay (1922 ­ 2022): médicos en su inicio / Centenary of radio broadcasting in Uruguay (1922 - 2022): doctors at the beginning / Centenário da radiodifusão no Uruguai (1922 - 2022): médicos em seu início

En 2022 se cumplen 100 años del comienzo formal de la radiodifusión en el Uruguay. Varios médicos estuvieron vinculados y desempeñaron un rol dominante en su inicio y en las actividades culturales desarrolladas a partir de la instalación de las radioemisoras.

The year 2022 marks the 100th anniversary of the formal beginning of radio broadcasting in Uruguay. Several physicians were linked to and played a dominant role in its beginning and in the cultural activities developed since the installation of radio stations.

2022 marca o 100º aniversário do início formal das transmissões de rádio no Uruguai. Vários médicos estiveram envolvidos e desempenharam um papel dominante em seu início e nas atividades culturais desenvolvidas desde a instalação das estações de rádio.

Mutagenicity in oral cells of individuals exposed to radiofrequency generated by different smartphones

Aim: This study aimed to investigate whether non-ionizing radiation emitted by smartphones is likely to cause genotoxic effects on oral epithelial cells. Methods: Thirty adults were distributed into two groups according to the mobile phone brand used, namely Samsung (Samsung, Seoul, South Korea) and Apple (Apple, California, USA). The material was collected with gentle swabbing of the right and left buccal mucosa using a cervical brush, then the micronucleus test was performed. Results: The Mann-Whitney test with a 5% significance level did not reveal statistically significant differences in micronuclei frequency between the exposed and non-exposed sides (p=0.251). The different brands do not seem to cause risks of inducing genetic damage because there were no statistically significant differences between them (p=0.47). Conclusion: Therefore, our results suggest no correlations of micronuclei frequency in the exposed buccal cells of mobile phone users at the exposure standard levels observed

Intensidad lumínica de las lámparas de fotocurado LED en los consultorios odontológicos de Piura, Perú / Output intensity of LED light curing units in dental offices of Piura, Peru

Introducción: La lámpara de fotocurado, que utiliza diodos emisores de luz (LED), se emplea en odontología para la conversión polimérica de los materiales de restauración dental. Se ha comunicado que una intensidad lumínica inadecuada de la lámpara no aseguraría la correcta polimerización del material de restauración. Objetivo: Determinar la intensidad lumínica de las lámparas de fotocurado LED en consultorios odontológicos de la ciudad de Piura, Perú, 2020. Métodos: Estudio observacional, descriptivo. Se midió la intensidad lumínica en 70 lámparas de fotocurado LED, usando un radiómetro con una longitud de onda de 400-500 nm, con capacidad de medida de la intensidad lumínica de hasta 3500 mw/cm2. Por debajo de los 400 mw/cm2 indica intensidad baja, de 400 a 800 mw/cm2 intensidad media, de 800 a 1200 mw/cm2 intensidad alta y por encima de los 1200 mw/cm2 indica intensidad muy alta. Resultados: El 48,5 por ciento de las lámparas analizadas presentaban intensidad media, el 22,86 por ciento intensidad alta, mientras que el 15,71 por ciento intensidad baja y finalmente el 12,86 por ciento de las lámparas presentaban intensidad muy alta. Se reportó menor frecuencia de lámparas con mayor uso clínico. Conclusiones: Las lámparas de fotocurado LED, utilizadas en los consultorios dentales de la provincia de Piura durante el 2020, emiten una intensidad lumínica promedio de 778,14 mW/cm2, equivalente a la intensidad media(AU)

Introduction: Light curing lamps that use light-emitting diodes (LED) are used in dentistry for the polymeric conversion of dental restorative materials. It has been reported that inadequate light intensity in the lamp would not ensure the appropriate polymerization of restorative materials. Objective: Determine the output intensity of LED light curing units used in dental offices of the city of Piura, Peru, in the year 2020. Methods: An observational descriptive study was conducted. Measurements were taken of the light output of 70 LED light curing lamps using a radiometer with a wavelength of 400-500 nm and a light intensity measurement capacity of up to 3 500 mw/cm2. Intensity below 400 mw/cm2 was recorded as low, from 400 to 800 mw/cm2 as medium, from 800 a 1 200 mw/cm2 as high and above 1 200 mw/cm2 as very high. Results: Intensity was medium in 48.5 percent of the lamps analyzed, high in 22.86 percent, low in 15.71 percent and very high in 12.86 percent. A lower frequency of lamps with greater clinical use was reported. Conclusions: The LED light curing lamps used in dental offices of the province of Piura during the year 2020 emit an average output intensity of 778.14 mW/cm2, which corresponds to medium intensity(AU)

Triphasic waves and brain atrophy in patients with acute encephalopathy / Ondas trifásicas y atrofia cerebral en pacientes con encefalopatía aguda

Abstract Introduction: Triphasic waves (TW) constitute an electroencephalographic pattern associated with certain kinds of encephalopathy. Brain atrophy may be a predisposing factor linked with TW. Objective: To compare the degree of brain atrophy and white matter disease between patients with acute encephalopathy with and without TW. Methods: A retrospective observational study including adult patients with encephalopathy, with and without TW, hospitalized between 2016 and 2017. The degree of brain atrophy and white matter lesion were defined using the Global Cortical Atrophy and Age Related White Matter Changes (ARWMC) scales, respectively. Scores were compared between groups. Mortality rates were registered. Results: Sixteen patients with TW were identified matched by age and sex with 30 patients without TW. The mean age was 80 years in the TW group. Women represented 87.5%. Multifactorial encephalopathy was the most frequent diagnosis followed by metabolic encephalopathy. Patients with TW had more brain atrophy (10.43 vs 6.9, p= 0.03). Mean ARWMC was 9.43±6.5 and 8.5 ±7.89 in patients with and without TW respectively (p= 0.5). Mortality rate was higher in the TW group (31.25 vs 6.66% p= 0.02). Conclusions: Patients with acute encephalopathy and TW had higher degree of cerebral atrophy. It is possible that this structural alteration predisposes to the appearance of TW. There was no significant difference in white matter lesion degree. The mortality of the TW group was high, so future studies are necessary to determine their prognostic value.

Resumen Introducción: Las ondas trifásicas (OT) constituyen un patrón electroencefalográfico asociado con diversas encefalopatías. La atrofia cerebral podría predisponer a su aparición. Objetivo: Comparar el grado de atrofia cerebral y de lesión de sustancia blanca en pacientes con encefalopatía aguda con y sin OT. Métodos: Estudio observacional retrospectivo, incluyó pacientes adultos con encefalopatía aguda con y sin OT internados entre 2016 y 2019. El grado de atrofia cerebral y de lesión de sustancia blanca se definieron según las escalas Global Cortical Atrophy y Age Related White Matter Changes (ARWMC), respectivamente. Se compararon los puntajes entre grupos. Se registró la mortalidad. Resultados: Se identificaron 16 pacientes con OT y 30 sin OT pareados según edad y sexo. La edad promedio del grupo con OT fue 80 años. El 87.5% fueron mujeres. La encefalopatía multifactorial fue el diagnóstico más frecuente seguido de la encefalopatía metabólica. El grado de atrofia fue mayor en pacientes con OT (10.43 vs 6.9, p= 0.03). El puntaje ARWMC fue 9.43 ±6.5 y 8.5 ±7.89 en pacientes con y sin OT respectivamente (p= 0.5). La mortalidad fue mayor en el grupo con OT (31.25 vs 6.66% p= 0.02). Conclusiones: Pacientes con encefalopatía aguda y OT tuvieron mayor grado de atrofia cerebral. Dicha alteración estructural podría relacionarse con la aparición de OT. No hubo diferencias significativas en el grado de lesión de sustancia blanca. La mortalidad del grupo con OT fue elevada. Son necesarios estudios para determinar su valor pronóstico.

Efectividad de la terapia por ondas de choque en lesiones de tendones y ligamentos del sistema osteomioarticular / Effectiveness of Shock Wave Therapy in Tendon and Ligament Injuries of the Osteomioarticular System

Introducción: Por más de 20 años la litotricia extracorpórea se ha aplicado con éxito en el mundo. Objetivo: Evaluar la efectividad de la terapia por ondas de choque en el tratamiento a pacientes que presentan lesiones en los tendones y ligamentos del sistema osteomioarticular. Métodos: Se realizó un estudio descriptivo, de corte transversal, con 107 pacientes diagnosticados con lesiones en los tendones y ligamentos del sistema osteomioarticular, los cuales fueron tratados con el equipo Well Wave (ondas de choque extracorpóreas) en el Complejo Científico Ortopédico Internacional Frank País, en el período comprendido entre marzo de 2019 y abril de 2020. Se realizó el análisis de las variables edad, sexo, dolor y discapacidad. Se obtuvieron frecuencias absolutas y relativas, y con ellas se confeccionaron las tablas que resumen la información estadística de la investigación. Resultados: Predominó el sexo femenino (71,9 por ciento), de 51 - 60 años (28 por ciento). El 40,2 por ciento de los pacientes fueron atendidos por presentar una tendinitis del supraespinoso. Todos los pacientes presentaban dolor antes de la aplicación de la terapia. Luego del tratamiento el 78,5 por ciento de los enfermos dejaron de sentirlo y el 71 por ciento presentó ausencia de discapacidad según escala de DASH. Según los criterios de evaluación de la respuesta al tratamiento los resultados fueron satisfactorios en el 56 por ciento de los pacientes. Conclusiones: La terapia con las ondas de choque posibilitó una rápida recuperación de los pacientes atendidos y su incorporación a las actividades diarias(AU)

ABSTRACT Introduction: Over more than 20 years, extracorporeal lithotripsy has been successfully used worldwide. Objective: To evaluate the effectiveness of shock wave therapy in the treatment of patients with injuries to the tendons and ligaments of the osteomioarticular system. Methods: A descriptive, cross-sectional study was carried out with 107 patients diagnosed with injuries to the tendons and ligaments of the osteomioarticular system. These subjects were treated with the Well Wave equipment (extracorporeal shock waves) at Frank País International Orthopedic Scientific Center, from March 2019 to April 2020. The variables age, sex, pain and disability were analyzed. Absolute and relative frequencies were obtained, and the results of statistical information of the investigation was shown in summarizing tables. Results: The female sex prevailed (71.9percent), 51 - 60 years old (28 percent). 40.2 percent of the patients were treated for supraspinatus tendinitis. All patients had pain before the use of therapy. After treatment, 78.5 percent of the patients stopped feeling pain and 71 percent showed no disability according to DASH scale. According to the treatment response evaluation criteria, the results were satisfactory in 56percent of the patients. Conclusions: This therapy enabled rapid recovery of the patients treated and their integration into daily activities(AU)

Influencia de la densidad de energía de ondas de choque focalizadas en el tratamiento de la fascitis plantar / Influence of energy density on the effectiveness of the treatment of plantar fasciitis with focused extracorporeal shock waves

Resumen La fascitis plantar (FP) es una patología frecuente e invalidante que puede tratarse con ondas de choque focalizadas. El objetivo principal del estudio fue valorar la eficacia del tratamiento con ondas de choque focalizadas en la FP según la densidad de energía utilizada. Se incluyeron 82 pacientes con diagnóstico clínico de FP que fueron asignados mediante muestreo aleatorio simple a dos grupos de tratamiento: densidad de energía media- alta (0,59mJ/mm2) y densidad de energía media-baja (0,27mJ/mm2). Se evaluaron el dolor y la funcionalidad, mediante las escalas EVA (Escala Visual Analógica) y AOFAS (American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale) respectivamente, al inicio del estudio (consulta base), y al primer, tercer y sexto mes tras el tratamiento. Por último, se evaluó el grado de satisfacción de los pacientes mediante la escala de Roles y Maudsley. Se compararon los resultados de las escalas en las revisiones posteriores al tratamiento, obteniéndose significación estadística para las variables principales del estudio (dolor y funcionalidad) en cada grupo de intervención. Aunque los niveles de dolor y la funcionalidad mejoraron en ambos grupos de estudio, se obtuvo una respuesta analgésica y funcional mayor y más precoz en el grupo tratado con densidad de energía media-alta.

Abstract Plantar fasciitis (FP) is a frequent and disabling condition that can be treated with focused extracorporeal shock waves. The main objective of this study was to assess the effectiveness of focused extracorporeal shockwave treatment in FP according to the energy density used. Eighty-two patients with a clinical diagnosis of FP were included and assigned, by simple random sampling, to two treatment groups: medium-high energy density (0.59mJ/mm2) and low-medium energy density (0.27mJ/mm2). Pain and functionality were assessed using the VAS (Visual Analogical Scale) and AOFAS (American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale) scales, respectively, at the start of the study (baseline consultation), and at the first, third and sixth month post-treatment. Finally, the degree of patient satisfaction was evaluated using the Roles and Maudsley score. The results of the scales in the post-treatment reviews were compared, and statistical significance was obtained for the main study variables (pain and functionality) in each intervention group. Although pain levels and functionality improved in both study groups after treatment, a greater and earlier analgesic and functional response was obtained for the medium-high energy density group.

Associação entre ondas de calor e mortalidade por doenças cardiovasculares nas capitais brasileiras / Association between heat waves and mortality from cardiovascular disease in brazilian capitals

As ondas de calor têm sido associadas a morbimortalidade por doenças do aparelho circulatório em diferentes locais, principalmente nos grupos considerados vulneráveis. Esta tese apresenta estudos sobre as características das ondas de calor e abordou seus efeitos nas doenças do aparelho circulatório nas capitais brasileiras no período de 2000 a 2016. O primeiro estudo teve como objetivo examinar a intensidade, a frequência e a duração dos eventos de ondas de calor nas capitais brasileiras, por meio das análises de séries temporais foi possível caracterizar a ocorrência das ondas de calor, os resultados mostraram que estão mais frequentes, duradouras e intensas e ocorrem durante todo o ano, inclusive no inverno em cidades das regiões Sudeste e Sul. O segundo estudo teve como objetivo identificar as capitais brasileiras que apresentaram desconforto térmico para população, por meio da caracterização do índice de calor. Os resultados mostraram que se utilizando as definições de temperatura aparente e conforto e desconforto térmico do diagrama do conforto humano, na maioria das capitais foram constatadas condições de desconforto para a saúde humana. Algumas capitais localizadas no Sudeste e no Sul apresentaram condições definidas por conforto térmico. O terceiro estudo teve como objetivo estimar os efeitos de ondas de calor na mortalidade do aparelho circulatório no município do Rio de Janeiro no ano de 2010. A análise de séries temporais foi utilizada para estimar o percentual do Risco Relativo (%RR) do efeito das ondas de calor na mortalidade de pessoas adultas a partir de ≥ 30 anos de idade. Os resultados deste estudo evidenciaram o aumento do %RR nas mortalidades por DAC associadas às ondas de calor no município do Rio de Janeiro. O quarto estudo teve como objetivo estimar os efeitos de ondas de calor na mortalidade por doenças do aparelho cardiovascular nas capitais brasileiras, a análise de séries temporais foi utilizada para estimar o percentual do Risco Relativo (%RR) do efeito das ondas de calor na mortalidade de pessoas adultas ≥ 30 anos de idade. Os resultados indicam uma associação entre ondas de calor e a mortalidade por doenças cerebrovasculares e doenças isquêmicas do coração na população adulta. Os achados deste conjunto de estudo permitem concluir que as ondas de calor estão mais frequentes, intensas e duradouras nas capitais brasileiras e, as doenças do aparelho circulatório estão associadas com este fenômeno.

Heat waves have been associated with circulatory disease morbidity and mortality in different locations, especially in groups considered vulnerable. This thesis present studies on the characteristics of heat waves and addressed its effects on circulatory diseases in Brazilian capitals from 2000 to 2016. The first study aimed to examine the intensity, frequency and duration of heat wave events in the Brazilian capitals, through temporal series analysis, it was possible to characterize the occurrence of heat waves, the results showed that they are more frequent, lasting and intense and occur throughout the year, including winter in cities in the Southeast and South regions. The second study aimed to identify the Brazilian capitals that presented thermal discomfort for the population, through the characterization of the heat index. The results showed that using the apparent temperature definitions and comfort and thermal discomfort of the human comfort diagram, most capitals were found conditions of discomfort for human health. Some capitals located in the Southeast and South had conditions defined by thermal comfort. The third study aimed to estimate the effects of heat waves on the mortality of the circulatory system in the municipality of Rio de Janeiro in 2010. Time series analysis was used to estimate the percentage of relative risk (%RR) of the effect of heat waves on adult mortality from ≥ 30 years of age. The results of this study showed the increase of %RR in DAC mortality associated with heat waves in the municipality of Rio de Janeiro. The fourth study aimed to estimate the effects of heat waves on mortality from cardiovascular disease in Brazilian capitals, timely series analysis was used to estimate the percentage of relative risk (%RR) of the effect of heat waves on mortality of adults ≥ 30 years of age. The results indicate an association between heat waves and mortality from cerebrovascular diseases and ischemic heart disease in the adult population. The findings of this study set allow you to conclude that heat waves are more frequent, intense and lasting in Brazilian capitals and circulatory diseases are associated with this phenomenon.

Abnormal average increase in sea surface temperature may promote the first documented mortality event of a marine sponge in the Southeastern Brazil / Aumento na temperatura média do mar pode ter causado o primeiro evento registrado de mortalidade de esponjas marinhas no Sudeste do Brasil

Abstract Frequent heat waves and mass mortality events on marine biota are positively correlated to ocean warming. Although literature has indicated some species of marine sponges, and some oceanic regions, like the Brazilian Exclusive Economic Zone, may be less affected or seem to be more resilient under future scenarios of climate changes, few studies have focused on the species responses on the climate change issue along Brazilian coast. This paradigm was undone throughout 2019 after an exceptional average increase of 2 °C in the sea surface temperature (SST) and on precipitation values since 2015 at Ilha Grande Bay (IGB, SE Brazil). The combination of SST and precipitation average increase possibly favored an environmental context for the unprecedented strong population decline and mass mortality rate of the marine sponge species Desmapsamma anchorata in the austral spring. The species used to be one of the most frequent benthic species at IGB however it was only recorded in 41.7% sites (n = 12). From 162 individuals recorded at Abraãozinho along 180 m rocky shore, 83 individuals (51.2%) were healthy, 74 (45.7%) were intensively covered by cyanobacteria and locally bleached, and five (3.1%) were completely bleached or died. Desmapsamma anchorata population deterioration in a biogeographic transition zone (Rio de Janeiro state) may reflect a shift in the marine community of IGB, opening space for opportunistic species establishment and coverage increase, since IGB has a high species turnover. The three-dimensionality, the shelter for several species, the high competitive ability and the potential to indicate polluted or not polluted areas make D. anchorata a key species for IGB monitoring in a climate change scenario.

Resumo Ondas de calor e eventos de mortalidade em massa da biota marinha são cada vez mais frequentes e estão positivamente correlacionados ao aquecimento do oceano. Embora a literatura tenha indicado que algumas espécies de esponjas marinhas e algumas regiões oceânicas, como a Zona Econômica Exclusiva do Brasil, podem ser menos afetadas ou serem mais resilientes em cenários futuros de mudanças climáticas, poucos estudos focaram na resposta das espécies à problemática das mudanças climáticas na costa brasileira. Esse paradigma foi desfeito em 2019 após um excepcional aumento médio de 2 °C na temperatura da superfície do mar e nos valores de precipitação, desde 2015 na Baía da Ilha Grande (BIG, SE Brasil). Essa combinação de fatores possivelmente favoreceu um contexto ambiental sem precedentes, levando ao forte declínio populacional e alta taxa de mortalidade da esponja marinha Desmapsamma anchorata na primavera austral. A espécie costuma ser uma das espécies bentônicas mais frequentes na BIG, mas só foi observada em 41,7% dos sítios (n = 12). De 162 indivíduos registrados em Abraãozinho ao longo de 180 m de costão rochoso, 83 indivíduos (51,2%) estavam saudáveis, 74 (45,7%) estavam cobertos por cianobactéria e localmente branqueados e cinco (3,1%) estavam completamente branqueados ou mortos. A deterioração da população de D. anchorata na zona de transição biogeográfica (estado do Rio de Janeiro) pode refletir em uma alteração na comunidade marinha da BIG, abrindo espaço para o estabelecimento de espécies oportunistas, uma vez que a BIG possui alto turnover. A tridimensionalidade, o abrigo a diversas espécies, a alta capacidade competitiva e o potencial de indicar áreas poluídas ou não tornam D. anchorata uma espécie chave no monitoramento da BIG em um cenário de mudanças climáticas.

Effects of qianlieshutong capsule combined with extracorporeal shock wave therapy on inflammatory factors and immune function in patients with chronic prostatitis / 中国医师进修杂志

Objective:To investigate the effects of qianlieshutong capsule combined with extracorporeal shock wave therapy on inflammatory factors and immune function in patients with chronic prostatitis (CP).Methods:The clinical data of 100 patients with CP in Yingcheng People′s Hospital from September 2019 to September 2020 were retrospectively analyzed. Among them, 50 cases were treated with extracorporeal shock wave therapy (control group), and 50 cases were treated with qianlieshutong capsule combined with extracorporeal shock wave therapy (observation group). The National Institutes of Healthy chronic prostatitis symptom index (NIH-CPSI), interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, T lymphocyte subsets, small particle of lecithin (SPL) and prostate specific antigen (PSA) before and after treatment were compared between 2 groups. The adverse reactions and efficacy were compared between 2 groups.Results:The total effective rate in observation group was significantly higher than that in control group: 88.0% (44/50) vs. 70.0% (35/50), and there was statistical difference ( χ2 = 4.88, P<0.05). There were no significant differences in NIH-CPSI respective scores and total score before treatment between 2 groups ( P>0.05); the NIH-CPSI respective scores of pain and discomfort, urination, symptoms, quality of life and total score after treatment in observation group were significantly lower than those in control group: (4.15±1.04) scores vs. (6.72±1.13) scores, (1.23±0.39) scores vs. (1.88±0.48) scores, (1.31±0.39) scores vs. (1.91±0.35) scores, (1.68±0.34) scores vs. (2.35±0.32) scores and (8.37±1.02) scores vs. (12.86±1.33) scores, and there were statistical differences ( P<0.01). There were no statistical differences in the prostatic fluid and serum IL-6, IL-8 and TNF-α before treatment between 2 groups ( P>0.05); the prostatic fluid and serum IL-6, IL-8 and TNF-α after treatment in observation group were significantly lower than those in control group, and there were statistical differences ( P<0.01). There were no statistical difference in CD 3+, CD 4+, CD 8+ and CD 4+/CD 8+ before treatment between 2 groups ( P>0.05); there were no statistical difference in CD 3+, CD 4+ and CD 8+ after treatment between 2 groups ( P>0.05), the CD 4+/CD 8+ after treatment in observation group was significantly higher than that in control group (1.48±0.33 vs. 1.35±0.28), and there was statistical difference ( P<0.05). There were no statistical differences in SPL and PSA before treatment between 2 groups ( P>0.05); the SPL after treatment in observation group was significantly higher than that in control group: (33.25±4.08) μg/L vs. (20.96±4.13) μg/L, the PSA was significantly lower than that in control group: (0.81±0.23) μg/L vs. (0.97±0.29) μg/L, and there were statistical differences ( P<0.01). There was no statistical difference in the incidence of adverse reactions between 2 groups ( P>0.05). Conclusions:Qianlieshutong capsule combined with extracorporeal shock wave therapy has a significant efficacy in patients with CP. It can effectively reduce the levels of inflammatory factors in prostate fluid and improve the immune function.

Low-intensity extracorporeal shock wave therapy for Peyronie's disease: a single-center experience / 亚洲男科学杂志(英文版)

The aim of this article is to assess the outcomes of a low-intensity extracorporeal shock wave therapy (LiESWT) protocol for the treatment of Peyronie's disease (PD). Patients treated for PD were prospectively recorded, and data were retrospectively reviewed. Age, characteristics of fibrous plaques, concomitant treatments, International Index of Erectile Function (IIEF-5), Lue score, and pain score on Likert scale were collected. Patients in acute phase of PD and an angulation of <40° were included. The protocol consisted of 6 weekly sessions of 4000 pulses each, applied from different directions, with a maximal power of 20 W and 8 Hz frequency. We included 39 patients (median age: 56.8 years, interquartile range [IQR]: 35.8-62.2 years). The median number of sessions received per patient was 7.2. After treatment, the median Lue score decreased from 6.8 initially to 3.3 (P = 0.003), the median Likert pain score dropped from 1.8 to 0.7 (P = 0.004), the median plaque size was reduced from 2 cm to 1.2 cm (P = 0.08), and the median penile curvature diminished from 31° to 17° (P = 0.07). On univariate and multivariate analysis, the only predictors of success were younger age (odds ratio [OR] = 0.95, P = 0.03 and OR = 0.91, P = 0.04, respectively) and concomitant use of phosphodiesterase-5 inhibitors (PDE5i; OR = 0.92, P = 0.02 and OR = 0.93, P = 0.01, respectively). LiESWT had a favorable impact on Lue score and notably penile pain, curvature, plaque size, and erectile function in patients treated for PD during the early inflammatory phase, with no side effects. Younger age and concomitant use of PDE5i were the only success predictors.