Neuropsychology of epilepsy surgery and theory-based practice: an opinion review / Neuropsicologia da cirurgia de epilepsia e prática teórica: uma revisão de opinião

Abstract The present review attempts to discuss how some of the central concepts from the Lurian corpus of theories are relevant to the modern neuropsychology of epilepsy and epilepsy surgery. Through the lenses of the main Lurian concepts (such as the qualitative syndrome analysis), we discuss the barriers to clinical reasoning imposed by quadrant-based views of the brain, or even atheoretical, statistically-based and data-driven approaches. We further advice towards a systemic view inspired by Luria's clinical work and theorizing, given their importance towards our clinical practice, by contrasting it to the modular views when appropriate. Luria provided theory-guided methods of assessment and rehabilitation of higher cortical functions. Although his work did not specifically address epilepsy, his theory and clinical approaches actually apply to the whole neuropathology spectrum and accounting for the whole panorama of neurocognition. This holistic and systemic approach to the brain is consistent with the network approach of the neuroimaging era. As to epilepsy, the logic of cognitive functions organized into complex functional systems, contrary to modular views of the brain, heralds current knowledge of epilepsy as a network disease, as well as the concept of the functional deficit zone.

Resumo A presente revisão tenta discutir como alguns dos conceitos centrais do corpus de teorias lurianas são relevantes para a moderna neuropsicologia da epilepsia e cirurgia da epilepsia. Através das lentes dos principais conceitos lurianos (como a análise qualitativa de síndromes), discutimos as barreiras ao raciocínio clínico impostas por visões do cérebro baseadas em quadrantes, ou mesmo abordagens ateóricas, baseadas em estatísticas e orientadas por dados. Aconselhamos ainda uma visão sistêmica inspirada na clínica e na teorização de Luria, dada sua importância para nossa prática clínica, contrastando-a com as visões modulares quando apropriado. Luria forneceu métodos teóricos de avaliação e reabilitação de funções corticais superiores. Embora seu trabalho não abordasse especificamente a epilepsia, sua teoria e abordagens clínicas na verdade se aplicam a todo o espectro da neuropatologia e respondem por todo o panorama da neurocognição. Essa abordagem holística e sistêmica do cérebro é consistente com a abordagem de rede da era da neuroimagem. Quanto à epilepsia, a lógica das funções cognitivas organizadas em sistemas funcionais complexos, ao contrário das visões modulares do cérebro, anuncia o conhecimento atual da epilepsia como uma doença em rede, bem como o conceito de zona de déficit funcional.

Estandarización de la batería neuropsicológica de funciones ejecutivas y lóbulos frontales BaNFE-2 en muestra paraguaya con esclerosis múltiple tipo recaída remisión

Introducción: la esclerosis múltiple (EM), enfermedad crónica del sistema nervioso (SNC), compromete significativamente la cognición. Su prevalencia en Paraguay es 9,2/100.000 habitantes, 72% con recaída remisión (EMRR) e incidencia de 2-3mujeres/hombre, afecta más a personas en edad productiva, con altos costos económicos y afectivos. Objetivos: caracterizar al paciente con EMRR, evaluar sus funciones ejecutivas (FEs) con BaNFE-2; establecer valores de corte ajustados al país. Metodología: con fundamento en teoría de la neurociencia cognitiva, diseño no experimental, cuantitativo, descriptivo, empírico, retrospectivo y transversal; técnica psicométrica y entrevista neuropsicológica en una muestra por conveniencia de 40 pacientes, 82,5% mujeres y edad 25-55 años (37,78±7,89). Resultados: se reportaron datos demográficos y clínicos, se caracterizaron las escalas de BaNFE-2 cuya consistencia interna resultó significativa. Se obtuvo 52,5% de alteración en la escala prefrontal y 42,5% en FEs; relaciones significativas con escolaridad, discapacidad física (DF), cantidad de brotes y deterioro cognitivo (DC); diferencias significativas por sexo, escolaridad, DF y DC. Se calcularon puntuaciones tipificadas por escolaridad, z<-1 establece el corte entre normalidad y alteración. Conclusión: las pruebas de BaNFE-2 perfilan la afectación del tiempo de ejecución, atención, memoria de trabajo y FEs. Este estudio aporta baremos ajustados al país y abre una novedosa línea de investigación aplicando BaNFE-2 en EM.

Introduction: Multiple sclerosis (MS) is a chronic, neurodegenerative, inflammatory disease of the central nervous system (CNS) that significantly compromises cognitive functions. In Paraguay, it occurs with a prevalence of 9.2/100,000 inhabitants, 72% in the clinical form of relapsing remission (RRMS) and an incidence of 2 to 3 women/men, affecting more people of productive age with high economic and emotional costs. Objectives: To characterize the Paraguayan patient with RRMS, to assess the state of their executive functions (EFs) with the BaNFE-2 battery, and to establish cut-off values adjusted to the country. Methods: Research based on the theory of cognitive neuroscience of non-experimental, quantitative and descriptive design for analytical purposes. It is empirical, retrospective and cross-sectional. The psychometric technique and neuropsychological interview were used in a convenience sample of 40 patients aged 25 to 55 (37.78 ± 7.89) and 82.5% women. Results: Demographic and clinical data of the participants were reported. The BaNFE-2 coded and normalized scales were statistically characterized, the internal consistency of which was significant. 52.5% of the alteration was obtained in the anterior prefrontal scale and 42.5% in FEs; there are significant relationships with schooling, physical disability (PD), number of outbreaks and cognitive impairment (CI); there were also significant differences by sex, education, PD and CI. Standardized scores adjusted for schooling were calculated such that z<-1 establishes the cutoff between normality and abnormality. Conclusion: BaNFE-2 battery tests profile the affectation of execution time, attention, working memory, and FEs. This study provides the adjusted scales for the country and opens a new line of research applying the BaNFE-2 battery in people with MS.

Impacted-button-battery-masquerading-as-recurrent-epistaxis-in-an-child

Epistaxis in children is one of the most common referral dealt by an ENT outpatient department . Here we report a case of a 2-year-old girl who presented with complaints of recurrent episodes of epistaxis and discharge from the right nasal cavity since 1 month duration. Endoscopic examination of the right side of nose revealed a button battery impacted between the inferior turbinate and the cartilaginous portion of nasal septum

Frailty as a predictor of outcome in heart failure in the elderly: An observational study at a tertiary care center

Introduction: Heart failure is the leading contributor to global morbidity and mortality. Frailty is an emerging prognostic factor in heart failure. There is little data on the prognostic role of frailty in patients admitted for acute heart failure as most studies have been done on stable heart failure patients. Methodology: The study included elderly (age ≥60 years) patients admitted with acute heart failure at a tertiary care center in India. Patients with dementia, cognitive impairment, and documented terminal illness were excluded. The sample size was 85 patients. Frailty assessment was done using short performance physical battery (SPPB) and Fried phenotype scales and follow‑up data was collected at 3 months postdischarge telephonically. The primary objective of the study was to determine the proportion of frailty in elderly in‑hospital heart failure patients. The secondary objectives were to see the agreement between the frailty assessment tools used (SPPB and Fried phenotype). Results: Eighty seven patients were included in the study. The majority were male (n = 45) and had heart failure with reduced ejection fraction (n = 56). Coronary artery disease (CAD) (n = 60) was the most common cause of heart failure. Eighty-two patients had at least one comorbidity. The proportion of frailty as per the SPPB was 43.67%, and as per the Fried phenotype was 68.9%. A total of 4 deaths and 15 re-admissions occurred during the follow-up period of 3 months. The majority belonged to the frail category as per both the frailty scales (P < 0.001 for SPPB, P = 0.087 for Fried phenotype). Fleiss’s kappa coefficient for agreement between the scales was 0.373 (SE = 0.106, P < 0.001), which signifies that there was a fair agreement between the two scales. The Spearman Rank correlation coefficient was −0.691 (P < 0.01) between the two scales. Hence, the SPPB score inversely correlated with the Fried phenotype. Conclusion: Frailty is largely prevalent in elderly heart failure patients. It can be used to predict poor outcomes in these patients. Clinicians should identify these high-risk patients at the time of discharge from their facility and consider interventions (tailored rehabilitation programs) to minimize the adverse outcomes.

The impact of childhood trauma on cognitive function in individuals with clinical high risk of psychosis / 中华行为医学与脑科学杂志

Objective:To explore the impact of cognitive function and childhood trauma in individuals with clinical high risk of psychosis (CHR).Methods:From June 2017 to September 2022, a total of 62 individuals with CHR(CHR group) were screened by structured interviews with psychiatric risk syndrome (SIPS) at Beijing Anding Hospital, and 61 healthy controls(healthy control group) matched in gender, age, and educational years were recruited. All participants were evaluated by the childhood trauma questionnaire (CTQ) and the Chinese version of the MATRICS consensus cognitive test battery (MCCB). Differences in cognitive function and childhood trauma between the two groups were compared by R4.1.1 software, and the correlation between cognitive function and childhood trauma in the CHR group was analyzed.Results:The scores of MCCB composite score (41.46±6.97), information processing speed (40.20±8.40), attention vigilance (40.92±11.00), working memory (41.09±9.97), verbal learning, and visual learning of CHR group were significantly lower than those of healthy controls(MCCB composite score(46.26±7.64), information processing speed(45.83±8.36), attention vigilance(46.30±9.57), working memory(46.18±8.49)), and with statistically significant differences ( t=-3.73--2.03, P<0.05). The total CTQ score, emotional abuse, physical abuse, and physical neglect factor scores of the CHR group (40.0 (36.0, 50.8), 7.5 (6.0, 10.0), 5.0 (5.0, 7.0), 9.0 (7.0, 11.0)) were significantly higher than those of the healthy control group (34.0 (31.0, 40.0), 6.0 (5.0, 8.0), 5.0 (5.0, 6.0), 9.0 (6.0, 10.0) ) ( Z=-4.07--2.06, P<0.05). In the CHR group, the total score of childhood trauma and the score of physical abuse factors were negatively correlated with working memory ( r=-0.29, -0.28, P<0.05), and the total score of cognitive function, attention vigilance, and word learning were negatively correlated with physical neglect ( r=-0.28, -0.26, -0.31, P<0.05). After partial correlation analysis using gender, age, years of education, and total SIPS score as covariates, the aforementioned correlation remained significant. Conclusion:CHR individuals have multiple cognitive deficits, and childhood trauma is more serious. Childhood trauma, especially physical trauma, may affect the cognitive function of CHR individuals.

Psychometric properties of the MATRICS Consensus Cognitive Battery in young patients with bipolar disorder / 四川精神卫生

ObjectiveTo investigate the psychometric features of MATRICS Consensus Cognitive Battery （MCCB） in adolescents with bipolar disorder， so as to evaluate its appropriateness for the measurement of cognitive deficits in adolescents with bipolar disorder. MethodsAdolescents with bipolar disorder （n=38）， adolescents with major depressive episode （n=40） and healthy controls （n=41） matched on age， sex and educational background were enrolled. Adolescents with bipolar disorder were assessed using Montreal Cognitive Assessment Scale （MoCA） and MCCB at baseline and 2 weeks later， while the rest were only assessed using MCCB at baseline. Thereafter， the psychometric features of MCCB such as internal consistency， test-retest reliability and criterion-related validity， discriminant validity and structural validity were evaluated using Cronbach's α coefficient， Pearson correlation analysis， analysis of covariance and confirmatory factor analysis. Results①The Cronbach's α coefficient of MCCB in adolescents with bipolar disorder was 0.784 at baseline and 0.773 at two weeks later， respectively. ②Among adolescents with bipolar disorder， the test-retest reliability over a two-week interval of each dimension in MCCB ranged from 0.630 to 0.812 （P<0.01）. ③ The criterion-related validity denoted that the score of short-term memory domain in MoCA was positively correlated with the speed of processing， verbal learning and working memory in MCCB （r=0.487， 0.522， P<0.05 or 0.01）. ④ Discriminant validity analysis implied that the scores of the processing speed， attention/vigilance， working memory， verbal learning and memory， visual learning and memory， reasoning and problem solving in MCCB yielded statistical differences among adolescents with bipolar disorder， adolescents with major depressive episode and healthy controls （F=3.790~7.243， P<0.01）. ⑤ Exploratory factor analysis showed that cumulative total variance contribution rate of MCCB amounted to 71.65% of four factors， and the confirmatory factor analysis indicated that the ideal 7-factor model had poor structural validity. ConclusionMCCB has good internal consistency， retest reliability and acceptable validity in adolescents with bipolar disorder.

The Figure Memory Test: diagnosis of memory impairment in populations with heterogeneous educational background / O Teste de Memória da Figura: diagnóstico de comprometimento da memória em populações com heterogeneidade educacional

ABSTRACT. Diagnosis of cognitive impairment is usually difficult in low-educated individuals. The Brief Cognitive Screening Battery (BCSB) was designed as a screening tool for the evaluation of cognitive impairment in low-educated individuals, but it may also be used for evaluating individuals with high educational level. Objectives: To perform a narrative review analyzing the origin of the BCSB, to report all studies that have used the Figure Memory Test (FMT) of the BCSB, and to demonstrate that it is a useful battery for regions where populations have heterogeneous educational background. Methods: We performed a search in PubMed, SciELO, and LILACS using the terms "Brief Cognitive Screening Battery" and "Brief Cognitive Battery". Results: We obtained 49 papers from PubMed, 32 from SciELO, and 28 from LILACS. After the exclusion of duplicate papers, 54 publications were obtained; five more studies were included from previous knowledge of the authors. Twenty-four papers were related to the impact of education on performance, diagnostic accuracy, cutoff scores and normative studies. The delayed recall of the FMT showed the best accuracy for the diagnosis of dementia with a cutoff score of ≤5 in different education levels. In 35 papers, the FMT of the BCSB was used in clinical studies with different settings, from outpatient memory clinics to epidemiological studies and evaluation of Amazon river basin dwelling individuals, and it was always considered to be easy to apply. Conclusions: The FMT of the BCSB is an easy and short tool for the diagnosis of dementia in populations with heterogeneous educational background.

RESUMO. O diagnóstico de comprometimento cognitivo costuma ser difícil em indivíduos de baixa escolaridade. A Bateria Breve de Rastreio Cognitivo (BBRC) foi elaborada como uma ferramenta de triagem para avaliação do comprometimento cognitivo em indivíduos de baixa escolaridade, mas também pode ser utilizada para avaliar indivíduos com alto nível educacional. Objetivos: Realizar uma revisão narrativa da origem da BBRC, relatar todos os estudos que utilizaram o Teste de Memória de Figuras (TMF) da BBRC e demonstrar que essa é uma bateria útil para regiões cuja população possui formação educacional heterogênea. Métodos: Foi realizada uma busca no PubMed, SciELO e LILACS utilizando os termos "Brief Cognitive Screening Battery" e "Brief Cognitive Battery". Resultados: Um total de 49 artigos no PubMed, 32 na SciELO e 28 na LILACS foram obtidos. Após a exclusão de artigos duplicados, totalizaram-se 54 publicações; mais cinco estudos foram incluídos com base no conhecimento prévio dos autores. Vinte e quatro artigos foram relacionados ao impacto da educação no desempenho, à precisão, pontuações de corte e estudos normativos. A recordação diferida do TMF mostrou a melhor precisão para o diagnóstico de demência com uma pontuação de corte de ≤5 em diferentes níveis educacionais. Em 37 artigos, o TMF da BBRC foi utilizado em estudos clínicos em diferentes ambientes, de ambulatórios de clínicas especializadas a estudos epidemiológicos e na avaliação de indivíduos residentes nas margens de rios da bacia amazônica, e sempre foi considerado de fácil aplicação. Conclusões: O TMF da BBRC é uma ferramenta simples e rápida para o diagnóstico de demência em população com heterogeneidade educacional.

Specific Learning Disability Assessment and Interpretation: NIMHANS SLD Battery and Beyond

To diagnose Specific Learning Disability (SLD) in India, only ‘NIMHANS Specific Learning Disability Battery (NSB)’ is accepted for assessment and certification of disability. Earlier editions of the NSB used ‘functioning at three standards below the current class of the child’ to arrive at a diagnosis of SLD, and was simple to administer and interpret. Given these, majority of psychologists used it in their routine assessments, and in most of the cases, it was relatively easy to diagnose SLD with this battery. A major limitation faced when using the NSB was that it had test items only till the 7th grade. In the updated NSB, there are test items till the 10th grade, which is definitely a big upgrade. However, as the battery is relatively concise and does not clearly describe the nuances of assessment and interpretation in marginal and complex scenarios, some young psychologists and research scholars might find it difficult to diagnose SLD. Some of these scenarios are, when the child shows problems in academics but does not exactly fulfil the NSB criteria; when the child is having problems with second language instead of the first language; when the child is from an international curriculum; when the child is studying in a class higher than grade 10; when comprehension appears to be impaired; and/or the issue of whether or not to have so many subtypes of SLD. This article highlights some of these issues, discusses and attempts to provide possible solutions with respect to assessment and interpretation.

Risk factors analysis of the complications caused by button battery ingestions in 58 children / 中国小儿急救医学

Objective:To analyze the clinical characteristics, endoscopic manifestations, complications and related risk factors of button battery ingestion in 58 children, thus providing the basis for clinical diagnosis and treatment.Methods:The medical data of 58 children with button battery ingestion were collected and researched at Children′s Hospital Affiliated to Zhengzhou University from September 2015 to September 2020.The demographic information, battery impaction location, duration, symptoms, mucosal injury level, battery size, treatment, complications and follow-up results were analyzed.Results:The average age of the patients with button battery ingestion was (25.7±15.4)months, including 40 boys(68.9%). The average retention time of the battery in digestive tract was 13.8(2, 96) h. Vomiting, salivation, dysphagia, cough and fever were the common chief complaints.There were 29(50.0%) cases of grade I mucosal injury, as well as 14(24.1%) cases, 10(17.2%) cases and 10(17.2%) cases for grade Ⅱ, grade Ⅲ and grade Ⅳ, respectively.Additionally, common complications included esophageal stenosis, esophageal perforation and esophageal-tracheal fistula.Logistic regression analysis showed that location(esophagus) and diameter(≥15 mm) of battery incarceration were important predictors of complications.Conclusion:The degree of mucosal damage is associated with the diameter and impaction location of battery.The button battery embedded in the esophagus is prone to complications, while the ones retained in the stomach were not vulnerable to serious complications.Endoscopy and other related examinations should be performed again in 1 to 3 weeks after the button removal to determine the outcome of complications and to intervene in time.

The intervention effect of transitional rehabilitation training on the clinical outcome of elderly patients with ADHF based on physical function evaluation / 中国实用护理杂志

Objective:To explore the effect of individual rehabilitation intervention on the clinical outcome of patients with acute decompensated heart failure.Methods:A total of 152 elderly patients with acute decompensated heart failure in a tertiary hospital from January 2017 to December 2018 were selected and randomly assigned to the test group and the control group. The test group developed individualized interim rehabilitation interventions based on the evaluation results of balance, mobility, muscle strength and endurance of patients. The control group only performed routine rehabilitation related health care and discharge follow up, the short physical performance battery and the rate of all-cause readmission 6 months after discharge were compared between the two groups.Results:Finally, 144 patients finished the reseach, 72 patients in each group. After 3 months of intervention, the total scores of balance test, 4-meter timed walking, time to complete 5 chair rise and SPPB in the test group were 3.05±1.01, 3.74±0.58, 2.75±0.76, 9.44±2.16, while those in the control group were 2.82±0.86, 3.30±1.02, 2.24±0.74, 8.33±2.46. There was significant difference between the two groups ( t value was from -5.287 to -2.001, P<0.01) . Six months after discharge, the all-cause readmission rate was 12.5% (9/72) in the test group and 23.6% (17/72) in the control group, the difference was statistically significant ( t value was -0.348, P<0.05). Conclusions:The individual rehabilitation exercise based on the results of physical function evaluation can effectively improve the patients' body function and quality of life. Besides this, it can reduce the rate of all-cause readmission 6 months after discharge, which can provide reference for the transitional rehabilitation training of the elderly patients with acute decompensated heart failure.

Investigation on lead exposure level of workers in lead-acid battery enterprises in Wuhan / 公共卫生与预防医学

Objective To investigate the lead pollution status in the workplaces of enterprises in the lead-acid battery industry in Wuhan, to analyze the correlation between lead level in the workplace and blood lead concentration in exposed workers, and to provide some advice on occupational health problems for companies. Methods Lead fume and lead dust in the workplaces were monitored from the workplaces of four lead-acid battery companies in Wuhan, and the blood lead levels of lead exposed workers were tested. Results The exceeding standard rate of lead concentration in the workplace was 34.95%, and the exceeding rate of blood lead was 1.74% among 1 435 workers. As the age of exposure increased, the average blood lead concentration of workers increased, and the difference in blood lead concentration among workers in each enterprise was statistically significant (P<0.05). Conclusion The lead concentration in the workplaces of the lead-acid battery industry in Wuhan seriously exceeded the standard. There were significant differences in blood lead concentrations among lead-exposed workers in different enterprises. Relevant departments and employees should take corresponding measures to reduce the harm.

A Total Cost of Operation (TCOp) Analysis of Electric Vehicles Introduction in Urban Transport in La Havana

Abstract The urban transport electrification is going upward in many countries. However, this electrification faces many hurdles, among them, the limited range and cost that present-day electric vehicles (EV) have. This paper analyzes which Battery Electric Vehicles (BEV) could meet the current car travel needs in different uses. The results from a survey about distance travelled in daily trips in La Havana, allow the assessment of maximum average daily distance travel (MADT) by the private owners, cars in public service, taxis and leasing. The Lognormal distribution adjusts to MADT´s histogram in each group, and yields estimates characterizing its behavior. The use of a database of BEV with more than 60 electric vehicles allows to select an appropriate model for each use. The BEV´s range is normally expressed using several driving cycles, being EPA (Environmental Protection Agency) the most adequate, but the range by EPA is not always available. A regression analysis was made to obtain the EPA range as a function of range by others driving cycles. Finally, a Total Cost of Operation (TCOp) is calculated considering the purchase cost, energy cost, maintenance, etc. The outcomes are that for the private use, only small BEV with a strong subsidy or battery leasing can compete with an Internal Combustion Engine Vehicle (ICEV). In the public, taxis and leasing sector, the BEV are competitive in several years. The daily mileage and electricity cost are decisive. The use of renewable energy to charge batteries can reduce this period to some extent.

Analytic Hierarchy Process Algorithm Applied to Battery Energy Storage System Selection for Grid Applications

Abstract The Brazilian Power Sector is preparing the introduction of battery energy storage in its distribution lines for energy quality control. The technical and financial viability of this new technology depends on several factors: battery technologies, geographical locations, environmental restrictions and the local regulation. One of the objectives of the present project was to create a methodology for helping technicians to choose the best battery technology for each particular application. The Analytic Hierarchy Process - AHP algorithm was selected to take into account all the above-mentioned factors. This methodology was applied to a case study considering four different commercially available battery energy storage systems (BESS) and the methodology was able to recommend the best choice by taking into account all the criteria and subcriteria considered. The second objective of the present project is to evaluate a real hybrid BESS operation composed of two different battery technologies. Up to the moment when this paper was submitted the BESS has not been installed yet. The installation place has already been selected, a feeder-line with 1,360 kW peak power, and monitored for energy quality. The BESS has been sized, a 250 kW/1 MWh flow battery together with a 250 kW/500 kWh lithium-ion battery and the purchase process has been initiated. Both battery technologies will work in separate and joint operations for power quality in on-grid and island cases.

Battery-induced Esophageal Foreign Body Injury, Complications and Treatment Outcome

ABSTRACT Objective: To assess the severity caused by button batteries in esophagus. Methods: A total of 32 patients admitted with ingesting button batteries were retrospectively evaluated. Chest X-ray was ordered for diagnosis. Hospital stays, interventions, complications and mortality of the patients were collected. The time between the patients ingested the buton battery and its removal was defined as its duration in esophagus. All the patients underwent rigid esophagoscopy under general anaesthesia. Buton batteries at the first narrowing were removed by magyl clamp. Results: Of 32 patients, 21 were females, with a mean age of 22 months. The mean duration of ingestion was 17 hours. The mean hospital stay was 10 days. Of the patients, 75% were admitted within 24 hours. Complication rate was 19% and mortality rate was 6%. There was a strong correlation among the number of the cases and the coming years (p < 0.001). The regression was between the number of cases per year (outcome variable) and the years of the study (explanatory variable), (p< 0.001, R = 0.644, Figure 3). There was a significant finding that more cases (90%) were admitted in the last 12 years compared with the number in first 12 years (p < 0.001). There were no complications in cases in which the button battery was impacted in esophagus for less than 24 hours; however, eight cases whose duration was more than 24 hours resulted in complications in six patients and fatality in two patients (p < 0.001). Conclusion: Batteries should be removed upon its diagnosis. Otherwise, the injury in the esophageal mucosa may be caused by delay and can cause an increase in morbidity and mortality.

Disc battery in the pediatric oesophagus

The wide usage of disc batteries in toys, in the late seventies presented a new problem. In the form of accidental lodgements in the pediatric aerodigestive tract. The physico-chemical nature of the disc battery necessitates an early removal, so as to avoid a fatal outcome if missed and retained for a long duration. Management of one such case is reported with radiographic documentation.

Cognition and epilepsy: Cognitive screening test / Cognição e epilepsia: teste de triagem cognitiva

ABSTRACT. Cognitive deficits often occur in people with epilepsy (PWE). However, in Brazil, PWE might not undergo neurocognitive evaluation due to the low number of validated tests available and lack of multidisciplinary teams in general epilepsy outpatient clinics. Objective: To correlate Brief Cognitive Battery-Edu (BCB-Edu) scores with epilepsy characteristics of 371 PWE. Methods: Clinical and cognitive assessment (MMSE, BCB-Edu) of 371 PWE aged >18 years was performed. The clinical aspects of epilepsy were correlated with BCB-Edu data. Cognitive data of PWE were compared against those of 95 healthy individuals (NC), with p-<0.05. Results: People with epilepsy had lower cognitive performance than individuals in the NC group. Cognitive aspects also differed according to epilepsy characteristics. Predictive factors for impairment in multiple cognitive domains were age and use of more than one antiepileptic drug (logistic regression; R2 Nagelkerke=0.135). Conclusion: Worse cognitive performance was found in PWE on different domains. There was a relationship between cognitive impairment and the aspects of epilepsy. BCB-Edu proved to be effective as a cognitive assessment screening test for epilepsy in adults.

RESUMO. É frequente a ocorrência de déficits cognitivos em pessoas com epilepsia (PWE). Entretanto, no Brasil, as PWE podem ficar sem avaliação neurocognitiva pelo reduzido número de testes disponíveis e validados para nossa cultura e pela ausência de equipes multidisciplinares em ambulatórios gerais de epilepsia. Objetivo: Relacionar os escores do Brief Cognitive Battery-Edu (BCB-Edu) aos aspectos da epilepsia de 371 PWE. Métodos: Foi feita avaliação clínica e cognitiva (MMSE, BCB-Edu) de 371 PWE com idade > 18 anos. Foram relacionados os aspectos da epilepsia com os dados do BCB-Edu. Os dados cognitivos foram comparados aos de 95 indivíduos normais (NC), com p<0.05. Resultados: PWE apresentam desempenho cognitivo inferior ao do grupo NC. Os aspectos cognitivos foram distintos, segundo aspectos da epilepsia. Na regressão logística, os fatores preditivos para comprometimento em múltiplos domínios cognitivos foram a idade e a utilização de mais de uma droga antiepiléptica (R2 Nagelkerke=0.135). Conclusão: Houve, nas PWE, pior desempenho cognitivo em diferentes domínios. Houve relação entre déficit cognitivo com aspectos da epilepsia. O BCB-Edu mostrou-se eficaz como teste de triagem cognitiva na epilepsia em adultos.

Dyspnea is associated with poor physical performance among community-dwelling older adults: a population-based cross-sectional study

ABSTRACT BACKGROUND: Dyspnea and poorer physical performance are conditions that may be related and be present among the elderly. However, few studies have evaluated associations between these variables. OBJECTIVE: To determine whether there is an association between dyspnea and physical performance among community-dwelling older adults of both sexes (age 60 years and over). DESIGN AND SETTING: Cross-sectional study conducted in the city of Macapá, state of Amapá, Brazil. METHODS: Socioeconomic and health data were collected using a structured form. Frailty syndrome was assessed based on the frailty phenotype proposed by Fried et al. Dyspnea was measured using the modified Medical Research Council (mMRC) scale and physical performance was measured using the Short Physical Performance Battery (SPPB). Data were analyzed using a linear regression model. RESULTS: A total of 411 subjects (70.15 ± 7.25 years) were evaluated, most of them females (66.4%). It was observed from the mMRC scale that 30.9% (n = 127) of the subjects had some dyspnea symptoms: grade 1 was most frequent. The physical performance score from the SPPB was 9.22 ± 2.01. Higher dyspnea scores were associated with poor physical performance, both in the crude analysis (β = -0.233; P = 0.028) and after adjustment for frailty condition (β = -0.148; P = 0.002) and for the socioeconomic and health variables (age, sex, number of diseases, smoking habit and frailty status) (β = -0.111; P = 0.025). CONCLUSION: Higher dyspnea score was independently associated with poor physical performance among community-dwelling older adults.

Cuerpos extraños radiopacos con doble contorno en la vía digestiva: ¿son siempre pilas de botón? / Are strange radiopaque bodies with double contours in the digestive tract always button cell batteries?

Resumen La ingesta accidental de cuerpos extraños constituye una emergencia en los servicios de atención pediátrica y el grupo más frecuentemente afectado se encuentra en los pacientes entre los 6 meses y los 3 años. Asimismo, la ingesta de pilas de botón es un factor de riesgo importante para el desarrollo de complicaciones tempranas severas como la perforación esofágica y mediastinitis, y a largo plazo, la aparición de estenosis. Por este motivo, su identificación temprana y la extracción constituyen las estrategias más importantes de manejo. Se ha descrito como característico el hallazgo del doble contorno en la radiografía frontal cérvico-toracoabdominal en estos pacientes. Sin embargo, se ha reportado el mismo signo radiológico en cuerpos extraños diferentes. En el presente artículo se presentan dos casos con estas características.

Abstract Accidental ingestion of foreign bodies constitutes an emergency for pediatric care services especially since the group most frequently affected consists of children between 6 months and 3 years of age. Ingestion of button cell batteries has high risks for severe early complications such as esophageal perforations and mediastinitis, as well as the long term risk of stenosis. Early identification and extraction are the most important management strategies. A double contour on a frontal cervical, thoracic, or abdominal x-ray is characteristic, but this same radiological sign has been reported for other foreign bodies. We present two cases with these characteristics.

Cross-cultural adaptation of the Childhood Executive Functions Battery (CEF-B) to brazilian portuguese / Adaptação Transcultural do Protocolo FEC - funções executivas em crianças para o português brasileiro / Adaptación Transcultural del Protocolo FEN - funciones ejecutivas en niños para el portugués brasileño

This study aimed to describe the processes of translation and cross-cultural adaptation to Brazilian Portuguese of the Childhood Executive Functions Battery (CEF-B), designed to evaluate executive functions in children and adolescents from 6 to 16 years of age. Six steps were carried out to ensure the quality of the processes: 1) instrument translation into the new language; 2) synthesis of the translated versions; 3) evaluation of the synthesized version by experts; 4) evaluation by the target population; 5) back-translation and 6) pilot study. We sought to ensure the translation and adaptation properties of the CEF-B in terms of semantic, idiomatic, experiential and cultural equivalence between the instructions in the original language and the target language. Results showed preliminary evidence of cultural adequacy and a satisfactory comprehension of the instrument instructions by the target population. (AU)

Este estudo objetiva descrever os procedimentos de tradução e adaptação transcultural para o português brasileiro do Protocolo Funções Executivas em Crianças (FEC), voltado para a avaliação das funções executivas de crianças e adolescentes de 6 a 16 anos. Para garantir a qualidade do processo, foram realizadas seis etapas: 1) tradução do instrumento do idioma de origem para o idioma-alvo; 2) síntese das versões traduzidas; 3) avaliação por experts; 4) avaliação pelo público-alvo; 5) tradução reversa e 6) estudo piloto. Buscou-se assegurar as propriedades da tradução e adaptação do protocolo FEC, em termos de equivalência semântica, idiomática, experiencial e cultural entre as instruções no idioma original e no idioma-alvo. Os resultados apontaram evidências iniciais de adequação cultural e boa compreensão das instruções do instrumento pelo público-alvo. (AU)

Este estudio objetiva describir los procedimientos de traducción y adaptación transcultural del protocolo Funciones Ejecutivas en Niños (FEN) para el portugués brasileño, dirigido a la evaluación de las funciones ejecutivas de los niños y adolescentes de 6 a 16 años. Para garantizar la calidad del proceso, se realizaron 6 etapas: 1) traducción del instrumento del idioma de origen al idioma de destino; 2) síntesis de las versiones traducidas; 3) evaluación por expertos; 4) evaluación por el público objetivo; 5) traducción inversa y 6) estudio piloto. Se buscó garantizar las propiedades de la traducción y adaptación del protocolo FEN, en términos de equivalencia semántica, idiomática, experiencial y cultural entre las instrucciones en el idioma original y en el idioma de destino. Los resultados apuntaron evidencias iniciales de adecuación cultural y buena comprensión de las instrucciones del instrumento por el público objetivo. (AU)

Outcomes Of Physical Fitness For Young Males With Type Ii Diabetes In Ksa

Background: Diabetes mellitus is one of the common public problems that its prevalence increase incredibly in the last three decades in KSA. The purpose of this work is to investigate the physical fitness of young male subjects with type 2 diabetes mellitus in KSA. Also, study the reliability of ALPHA-FIT test battery as easy, quick physical tools to test the physical fitness among Saudi society patients. Methods: Thirty males with type 2 diabetic were participated in the study and compared with thirty healthy volunteers represent the control group. The participants were investigated for their physical fitness by the ALPHA-FIT test battery. The seven categories of the test battery that forming the essential physical fitness for adults health and function. Results: The results of the study showed that there was a significant reduction in the physical fitness of the diabetic group compared with the control group. The cardiorespiratory fitness, the hand-grip is showing muscular strength, jump-to-reach indicating lower limbs power and strength, modified push-up owing to the trunk and upper limbs muscular endurance, standing on one-leg referring to balance state all results showing p-value < 0.05. In comparing both groups, there were no significant differences between diabetic and control groups regarding body mass index and waist circumference measures p-value > 0.05. Conclusion: Musculoskeletal and cardiorespiratory fitness were significantly lowered in patients with diabetes compared to age matching people. Health awareness and early physical intervention are recommended to prevent this reduction of fitness.