Oromandibular Dystonia is a Prominent Feature in Patients with Aromatic L-Amino Acid Decarboxylase (AADC) Deficiency

Abstract Aromatic L-Amino acid decarboxylase (AADC) deficiency is a rare neurometabolic disorder due to a homozygous or compound heterozygous pathogenic variant of the DDC gene, resulting in low synthesis of the biogenic amines dopamine, serotonin, epinephrine, and norepinephrine. Most patients had severe expression of the disease with global developmental delay, early hypotonia, movement disorders such as oculogyric crises, tremor, and dystonia. Oromandibular dystonia (OMD) is rarely recognized in patients with AADC deficiency. The aim of this study was to describe OMD in detail in 4 patients with AADC deficiency. OMD occurred in isolated form or in association with oculogyric crises, increasing the difficulty in care patients during the crises. The main form of OMD was tongue dystonia associated with mouth opening dystonia. AADC deficiency must be included in the list of genetic causes of OMD.

Uma juventude privada de escola: luto e sonhos em tempos de pandemia / Una juventud privada de escuela: duelo y sueños en tiempos de pandemia / A youth deprived of school: mourning and dreams in times of pandemic / Une jeunesse privée d'école: deuil et rêve en temps de pandémie

No contexto brasileiro de fechamento de escolas devido à pandemia da Covid-19, diante de múltiplas formas de crise social e de um projeto de destruição do país liderado pelas autoridades políticas, esta contribuição testemunha como os jovens que encontramos no momento da transição entre o ensino médio e a universidade no âmbito de um projeto de pesquisa viveram este período. As entrevistas realizadas trouxeram à tona a importante questão do relacionamento deles com a escola, enquanto instituição, nesse momento existencial de projeção. A pesquisa destaca o fato de que estes jovens foram capazes de atravessar estas crises se apoiando em uma forma de escola internalizada, um traço identificatório que tornou possível o trabalho psíquico do luto, permitindo-lhes não cair em um estado melancólico

En el contexto brasileño de cierre de escuelas debido a la pandemia del Covid-19, frente a múltiples formas de crisis socialy a un proyecto de destrucción del país liderado por las autoridades políticas, esta contribución da testimonio de cómo vivieron este período los jóvenes que conocimos en el momento de la transición entre la enseñanza media y la universidad en el marco de un proyecto de investigación. Las entrevistas realizadas sacaron a la luz la importante cuestión de su relación con la escuela, como institución,en este momento existencial de proyección. La investigación destaca el hecho de que estos jóvenes pudieron atravessar estas crisis apoyándose en una forma interiorizada de escuela, un rasgo de identificación que hizo posible el trabajo psíquico del duelo, permitiéndoles no caer en un estado melancólico

In the Brazilian context of school closures due to the Covid-19 pandemic, in the face of multiple forms of social crisis and a project of destruction of the country led by the political authorities, this contribution bears witness to how the young people we met at the moment of transition between high school and university within the framework of a research project experienced this period. The interviews conducted brought to light the important issue of their relationship with school, as an institution, at this existential moment of projection. The research highlights the fact that these young people were able to cross these crises by relying on an internalized form of school, an identificatory trait that made possible the psychic work of mourning, allowing them not to fall into a melancholic state

Dans le contexte brésilien de fermeture des écoles en raison de la pandemie de la Covid-19, face aux multiples formes de crises sociales et à un projet de destruction du pays mené par les autorités politiques, cette contribution témoigne de comment les jeunes rencontrés au moment du passage entre le lycée et l'université dans le cadre d'une recherche ont vécu cette période. Les entretiens menés ont fait émerger la question importante de leur rapport à l'école, en tant qu'institution,dans ce moment existentiel de projection. La recherche met en lumière le fait que ces jeunes ont pu traverser ces crisesen s'appuyant sur une forme d'école intériorisée, un trait identificatoire qui a renduossible le travail psychique du deuil,leur permettant de ne pas tomber dans un état mélancolique

A comparative study of intravenous labetalol VS intravenous nitroglycerin in the treatment of hypertensive crises

Hypertensive crises is still a major public health problem, causing end organ damage like myocardial infarction, stroke, and renal failure. Labetalol and nitroglycerine are among the two most commonly used medicine to control the blood pressure, but there is no head to head comparison between these two medicines. This was a prospective randomized non-blinded study which included 50 patients of hypertensive crises, out which 25 patients received intravenous labetalol and 25 patients received intravenous nitroglycerine. We found that labetalol controlled the blood pressure more rapidly in comparison to nitroglycerine, without causing any extra side effect

Impact of hydroxyurea on hospital stay & analgesic utilization in sickle cell anaemia with vaso-occlusive crises

Background & objectives: Hydroxyurea (HU) has been useful in preventing sickle cell vaso-occlusive crises (VOC). A few studies also suggest utility of HU, during acute VOC. Sickle cell anaemia (SCA) is of high prevalence in western districts of Odisha State, India, and VOC is a common presentation, despite being mostly of Arab-Indian haplotype. This study was undertaken to evaluate the impact of HU on hospital stay and analgesic utilization in acute painful VOC of SCA. Methods: Homozygous sickle cell disease (HbSS) patients were categorized as cases who were receiving low-dose HU (10 mg/kg/day) and patients who were not on HU were considered as control. Days of hospital stay, analgesic utilization and visual analogue scale (VAS) score in patients were compared with that of control. Analgesics used to control pain were tramadol hydrochloride, ketorolac and diclofenac. Results: A total of 359 homozygous sickle cell disease (SCD) patients with VOC were studied (187 patients and 172 controls). The patient group had lesser mean days of hospital stay (1.4 days less than controls, P<0.001) and required lesser days of analgesic utilization than controls (1.18 days less than controls, P<0.001). Significant differences were observed between patients and controls concerning VAS score and amount of tramadol hydrochloride, ketorolac and diclofenac utilization (P<0.05). Interpretation & conclusions: In this study, HU was found to have beneficial effects in acute VOC of homozygous SCD, which includes shortening the duration of hospital stay and reducing the net amount of analgesic utilization during hospitalization

La empresa moderna capitalista transnacional: entre el desarrollo y las crisis civilizatorias (dimension social) / The transnational modern-capitalistic company: between development and civilizatory crisis (social field) / A moderna empresa capitalista transnacional: entre o desenvolvimento e as crises civilizacionais (dimensão social)

RESUMEN La humanidad y el planeta enfrentan graves crisis socio-naturales que ponen en riesgo la sustentabilidad de la vida. En esto, mucho tienen que ver el entramado modernidad / capitalismo / desarrollo en general y las empresas transnacionales en particular Debido a la relevancia del tema, es precisamente en esta dirección que se plantea el interrogante que orienta el presente trabajo, a saber: ¿Es la organización empresarial transnacional un detonante del desarrollo, o, por el contrario, es responsable por diversas crisis civilizatorias en general y de la dimensión social en los diferentes contextos socio-naturales? Al respecto, la tesis defendida es la siguiente: las corporaciones transnacionales, al constituirse como instituciones que encuadran en y heredan los fundamentos de la modernidad-capitalista-desarrollista, contribuyen a promover las crisis civilizatorias en general y de la dimensión social en particular Finalmente, se resalta que el estudio privilegiò un paradigma constructivista - interpretativo, consecuentemente, una metodologia cualitativa. Se usaron los procesos para la construcción de textos argumentativos, los métodos de investigación-análisis documental y entrevistas a expertos. El análisis de los datos fue orientado por la teoria fundamentada. CLASIFICACION JEL M14, Q01

ABSTRACT Mankind and the earth cope several severe socio-natural crises which threaten life sustainability. Within this reality, both the framework modernity / capitalism / development as a whole and transnational companies are implied. Due to the relevance of the subject, it is precisely in that direction the guiding inquiry of this work is proposed, namely: is the transnational business organization a triggering of development, or; conversely it is responsible for civilizatory crisis in general and social crisis in different social-natural contexts? In this regard, the argued thesis is the following: insofar as transnational corporations get constitute as institutions framed in and inheritor of the fundamentals of the capitalistic-developmentalist modernity they contribute to promote civilizatory crisis in general and social crisis in particular Finally it is spotlighted that the study privileged a constructivist / interpretative paradigm, consequently, a qualitative methodology was implemented. The processes for argumentative texts construction, documentary research-analysis methods and interviews to experts were used. Data analysis was addressed by grounded theory. JEL CLASSIFICATION M14, Q01

RESUMO A humanidade e a terra enfrentam várias crises sócio-naturais graves que ameaçam a sustentabilidade da vida. Dentro desta realidade, tanto a estrutura de modernidade/capitalismo/desenvolvimento como um todo, quanto as empresas transnacionais estão implicadas. Devido à relevância do tema, é justamente nesta direção que se propõe a investigação orientadora deste documento, a saber: a organização empresarial transnacional é um gatilho para o desenvolvimento ou, pelo contrário, é responsável pela crise civilizacional em geral e pela crise social em diferentes contextos sócio-naturais? Neste sentido, a tese defendida é a seguinte: na medida em que as empresas transnacionais são constituídas como instituições enquadradas dentro e herdando as bases da modernidade capitalista-desenvolvimentista, elas contribuem para promover a crise civilizacional em geral e a crise social em particular. Finalmente, deve-se notar que o estudo privilegiou um paradigma construtivista/interpretativo, conseqüentemente, uma metodologia qualitativa foi implementada. Foram utilizados processos de construção de textos argumentativos, métodos de pesquisa-análise documental e entrevistas com especialistas. A análise dos dados foi abordada usando uma teoria fundamentada. CLASSIFICAÇÃO JEL M14, Q01

Lo dilemático de un (intento de) suicidio. El que encuentra, atesora / The Dilemma of a (Attempted) Suicide

El suicidio ­o las autolesiones como su antecesor mortífero­ no suelen ser más que una pantalla a un dolor imposible de ser procesado por el sujeto que padece. Las coordenadas que lo atraviesan se amplían, convergen y torsionan en una espiral sin fin cuando ya no quedan recursos para encontrar una salida vital. El proyecto de vida pareciera impensable, en especial, cuando las múltiples versiones de lo ominoso se hacen presentes. Si además el tiempo etario donde aparecen coincide con un tiempo crucial ­adolescencia, jóvenes, adultos mayores­ suele requerirse algún modo de apuntalamiento al Yo en crisis. En este episodio de New Amsterdam vemos como el desinvestimiento subjetivo que produce la invisibilidad del sujeto para los objetos externos diferenciados madre familia (Aulagnier,2004) hacen a una joven intentar construir su identidad bajo un tiempo extremo de angustia

Suicide ­or self-harm like its deadly predecessor­ are usually nothing more than a screen for a pain impossible to be processed by the subject who suffers. The coordinates that pass through it expand, converge and twist in an endless spiral when there are no more resources left to find a vital exit. The life project seems unthinkable, especially when the multiple versions of the ominous are present. If, in addition, the age period in which they appear coincides with a crucial time ­ adolescence, youth, older adults ­ some form of propping up the Self in crisis is usually required. In this episode of New Amsterdam we see how the subjective disinvestment that produces the invisibility of the subject for the differentiated external objects mother-family (Aulagnier, 2004) makes a young woman try to build her identity under an extreme time of anguish

Crisis hipertensivas en edades pediátricas

RESUMEN En el presente trabajo hacemos una revisión de los diferentes puntos de corte de hipertensión arterial severa capaz de provocar una crisis hipertensiva. Nos proponemos actualizar los criterios de diagnóstico y tratamiento de las crisis hipertensivas en edades pediátricas. Se describe la epidemiología, etiología, fisiopatología y manifestaciones clínicas de las crisis hipertensivas. Se aborda el manejo terapéutico teniendo en cuenta las características propias de cada paciente, los medicamentos más utilizados, las dosis y vía de administración, con la recomendación de evitar el descenso brusco de las cifras de presión arterial por el daño que puede causar. No existe un consenso en pediatría sobre el punto de corte que defina hipertensión severa capaz de desarrollar una crisis hipertensiva. La severidad de las cifras de presión arterial por sí solas no define la gravedad de la crisis, un cambio agudo en la presión arterial es más relevante que el grado absoluto de su elevación. La afectación sistémica o de órgano diana es la que marca la diferencia entre urgencia y emergencia hipertensiva y la celeridad en el tratamiento. Concluimos que las crisis hipertensivas en edades pediátricas se producen con mayor frecuencia en la hipertensión arterial secundaria, no obstante, pueden ocurrir en adolescentes con hipertensión arterial esencial. No existe un consenso en pediatría sobre el punto de corte que defina hipertensión severa capaz de desarrollar una crisis hipertensiva.

ABSTRACT In the present work we make a review of the different cut-off points of severe arterial hypertension that can cause a hypertensive crisis. We intend to update the criteria for the diagnosis and treatment of hypertensive crises in pediatric ages. The epidemiology, etiology, pathophysiology and clinical manifestations of hypertensive crises are described. Therapeutic management is addressed taking into account the characteristics of each patient, the most used drugs, doses and route of administration, with the recommendation to avoid the sharp drop in blood pressure figures due to the damage it can cause. There is no consensus in pediatrics on the cut-off point that defines severe hypertension can develop a hypertensive crisis. The severity of blood pressure figures alone does not define the severity of the crisis, an acute change in blood pressure is more relevant than the absolute degree of BP elevation. Systemic or target organ involvement is what makes the difference between urgency and hypertensive emergency and the speed of treatment. We conclude that hypertensive crises in pediatric ages occur more frequently in secondary arterial hypertension, however, they can occur in adolescents with essential arterial hypertension. There is no consensus in pediatrics on the cut-off point that defines severe hypertension can develop a hypertensive crisis.

História, crises e tendências da atenção hospitalar pública na Cidade do Rio de Janeiro / History, crises and trends in public hospital care in the City of Rio de Janeiro

O presente trabalho tem o objetivo de estudar a evolução da rede hospitalar na Cidade do Rio de Janeiro (CRJ), a forma como foi estruturada no decorrer dos anos e principalmente a adequação dos serviços após a criação do SUS. O estudo abrange o período colonial até o ano de 2020. Foram mensurados dados estatísticos e indicadores relativos ao número de unidades criadas antes e após a existência do SUS, população residente no município do Rio de Janeiro, oferta do número de leitos, internações de alta complexidade e oferta de serviços nas respectivas Áreas Programáticas. Foi realizado um levantamento histórico das unidades contemplando os anos de criação, vínculos e mudanças, assim como os serviços de atendimento nos âmbitos municipal, federal, estadual e unidades privadas. A criação do SUS trouxe novos desafios, novas discussões, a adoção do direito à saúde, além de necessidades relativas a uma nova forma de organização, agora na perspectiva de uma política pública de saúde. Neste sentido, o trabalho apresenta pontos de discussões e normatizações que fizeram parte da construção do sistema e formação da rede de saúde, principalmente na atenção hospitalar. O processo de municipalização das unidades federais, assim como a crise ocorrida em 2005 entre o município e o governo federal também foram elementos de discussão. Foi realizada uma pesquisa bibliográfica, optando-se pela utilização do método quantitativo. Através da pesquisa de dados, foi possível realizar um comparativo do número de unidades criadas e seu respectivo período histórico, assim como a extensão da rede após a criação do SUS. Também foram elencados itens relativos à distribuição dos hospitais nas diferentes áreas da CRJ, número de internações e leitos de alta complexidade, perfil socioeconômico e estimativo populacional. A pesquisa permitiu construção de um perfil com atuais características da rede hospitalar. Através da comparação de dados, foi possível observar que a expansão da rede não acompanhou devidamente a dinâmica populacional, se manteve fundamentalmente concentrada nas áreas do Leste da Cidade (AP 1.0, 2.1 e 2.2), mostrou principalmente as desigualdades na oferta de serviços hospitalares em relação à distribuição da população. As áreas mais populosas com perfil de menor poder aquisitivo, são as mais afetadas. Na pesquisa também foi possível observar a importância da CRJ para outros municípios e estados, considerando que 20% de internações não são de residentes no município. Também foi realizado um levantamento entre as regiões do ERJ, onde novamente a CRJ se destaca frente às demais regiões do Estado. A não adequação da rede hospitalar do SUS constitui a principal observação crítica do trabalho. O presente estudo tem o objetivo de contribuir para uma eventual correção futura, considerando que, a rede não contempla hoje as reais necessidades da população. Sua organização atual afeta principalmente as áreas menos favorecidas economicamente. O que temos hoje é uma insuficiência de planejamento da rede SUS na CRJ, sendo importante despertar uma reflexão sobre a estimativa de crescimento populacional, para que futuramente esta rede possa estar organizada e estruturada de forma a atender a população conforme as diretrizes do SUS. Devemos também considerar a situação dos municípios adjacentes, pois a ausência de estrutura é um dos motivos do deslocamento de usuários em busca de serviços na CRJ.

The present work aims to study the evolution of the hospital network in the City of Rio de Janeiro (CRJ), the way it was structured over the years and especially the adequacy of services after the creation of the SUS. The study covers the colonial period until the year 2020, measuring statistical data and indicators related to the number of units created before and after the existence of SUS, population residing in the city of Rio de Janeiro, supply of the number of beds, high hospital admissions complexity and supply of services in the respective Program Areas. A historical survey of the units was carried out, covering the years of creation, links and changes, as well as the care services at the municipal, federal, state and private units. The creation of the SUS brought new challenges, new discussions, the adoption of the right to health, in addition to needs related to a new form of organization, now in the perspective of a public health policy. In this sense, the work presents some points of discussion, norms that were part of the construction of the system and formation of the health network, especially in hospital care. The process of municipalization of federal units, as well as the crisis that occurred in 2005 between the municipality and the federal government were also elements of discussion. A bibliographic research was carried out and it was decided to use the quantitative method. Through data research, it was possible to compare the number of units created and their respective historical period, as well as the extension of the network after the creation of SUS. Items related to the distribution of hospitals in different areas of the city, number of hospitalizations and beds of high complexity, socioeconomic profile and population estimate were also listed, which allowed a greater understanding of the current characteristics of the hospital network in the City of Rio de Janeiro. Through the comparison of data, it was possible to observe that the expansion of the network did not properly follow the population dynamics, remaining fundamentally concentrated in the eastern areas of the City (AP 1.0, 2.1 and 2.2), mainly showing the inequalities in the offer of hospital services in in relation to population distribution. The most populous areas with a lower purchasing power profile are the most affected. In the research, it was also possible to observe the importance of CRJ for other municipalities and states, considering that 20% of hospitalizations are not residents of the municipality. A survey was also carried out among the regions of the ERJ, where again the CRJ stands out compared to the other regions of the state. The non-adequacy of the SUS hospital network constitutes the main critical observation of the work. The present study aims to contribute to a possible future correction, considering that the network does not currently address the real needs of the population. Its current organization mainly affects economically disadvantaged areas. What we have today is a lack of planning for the SUS network in the CRJ, and it is important to awaken a reflection on the estimate of population growth, so that in the future this network can be organized and structured in order to serve the population according to SUS guidelines. We must also consider the situation of adjacent municipalities, as the lack of structure is one of the reasons for users to travel in search of services in CRJ.

A pandemic triad: HIV, COVID-19 and debt in low- and middle-income countries

This article assesses the impact of the HIV and COVID-19 pandemics and debt dynamics on health, HIV and pandemic preparedness and response-related financing in developing countries. Using a novel dataset, we did a cross-national systematic analysis of all data sources available for government expenditures on health, HIV, COVID-19 and debt servicing in selected developing countries. We found an inadequate multilateral response with the ensuing gaps allowing both pandemics to thrive. The G20 Debt Service Suspension Initiative and the Common Framework only covered countries with a third of the global population of people living with HIV. Rising and unsustainable debt levels are limiting the capacity of governments to protect the health of their populations. Government spending is already falling in response to high debt payments. Specifically, debt servicing is crowding out lifesaving investments. In 2020, for every USD 5 available, USD 4 was spent on debt servicing. Only USD 1 was invested in health. This is a binding constraint on countries' efforts to control COVID-19. Even with a gargantuan effort to increase health expenditure, the outlook for health financing remains negative. Fiscal consolidation, with a heavy emphasis on expenditure cuts, is expected to take place across 139 countries in the coming years. These findings suggest that fiscal policymakers should be concerned about the crowding-out and constraining effects of public debt. To this end, pragmatic recommendations are made to treat and cancel debt as a critical policy lever to accelerate the end of the HIV and COVID-19 pandemics in developing countries as a key condition to addressing the growing inequalities and to ensure debt can be a benefit, not a burden.

Folate levels in children with sickle cell anemia on folic acid supplementation in steady state and crises at a tertiary hospital in Enugu, Nigeria a prospective, comparative study

Folic acid supplementation is an integral aspect of the management of children with sickle cell anaemia (SCA) especially in Africa. In spite of this, there have been concerns about lower folate levels, especially during crisis. AimTo determine red cell folate levels of children with sickle cell anaemia in steady state and during crisis and compare with those with haemoglobin AA genotype. Method This study was prospective, hospital based, and comparative. Fifty children with sickle cell anaemia were recruited during crises and followed up until they met the criteria for attaining steady state. The controls were fifty children matched with those with SCA for age and gender and had haemoglobin AA genotype. Red cell folate estimation was done with the Electrochemiluminescence Immunoassay (ECLIA) method using the automated Roche Cobas e411 equipment. Results The median (IQR) red cell folate level in children during sickle cell crisis was 265.95 (134.50) ng/ml, which was significantly lower than the median (IQR) of 376.30 (206.85) ng/ml obtained during steady state. Most children with SCA (41 out of 50) had significantly higher folate levels during steady state (T=1081, Z-score= -4.660, p < 0.001). Median level of red cell folate was lower during anaemic crisis compared to vaso-occlusive crisis, though not significantly so (N(50), U = 214.00, Z-score= -1.077, p = 0.305). The median red cell folate level of normal controls was 343.55 (92.90) ng/ml, which was significantly lower than the 376.30 (206.85) ng/ml obtained during steady state (N(50), U= 209.00, Z-score= -7.177, p <0.001). Conclusion Median red cell folate levels of the study participants were within normal limits, though most children with SCA had significantly higher levels during steady state compared to crisis. Normal controls had significantly lower red cell folate levels than the children with SCA during steady state

Covid-19 y gripe de 1918-1919: paralelos históricos, preguntas y respuestas / Covid-19 and the 1918-1919 influenza: historical parallels, questions and answers

Resumen El desarrollo de la pandemia de la covid-19 ha motivado un renovado interés por la gripe de 1918-1919 para buscar elementos que facilitaran la comprensión de la experiencia presente, pero también como oportunidad para reevaluar la grave crisis sanitaria del siglo XX a la luz de lo que estamos viviendo. En este contexto y con ese objetivo se inserta esta reflexión histórica sobre estos dos fenómenos pandémicos, que muestra los paralelismos existentes y la necesidad de una toma de conciencia de que nuestro modelo de sociedad está en crisis y se requiere una transformación profunda.

Abstract The rise of the covid-19 pandemic has led to renewed interest in the 1918-1919 influenza in search of aspects that might help us understand the current situation, but also as an opportunity to re-evaluate the serious twentieth-century health crisis in light of what we are experiencing now. In this context and with that goal, this historical reflection shows the parallels that exist and the need for a realization that our model of society is undergoing a crisis and requires profound transformation.

Efficacy and safety of levetiracetam as adjunctive therapy for refractory focal epilepsy / Eficácia e segurança do levetiracetam como terapia adjunta na epilepsia focal refratária

ABSTRACT Background: Epilepsy affects about 50 million people worldwide and around 30% of these patients have refractory epilepsy, with potential consequences regarding quality of life, morbidity and premature mortality. Objective: The aim of treatment with antiseizure medications (ASMs) is to allow patients to remain without seizures, with good tolerability. Levetiracetam is a broad-spectrum ASM with a unique mechanism of action that differs it from other ASMs. It has been shown to be effective and safe for treating adults and children with epilepsy. Methods: This was a phase III, multicenter, randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of levetiracetam in children and adults (4-65 years) as an adjuvant treatment for focal-onset seizures. It was conducted among 114 patients undergoing treatment with up to three ASMs. The primary efficacy analysis was based on the proportion of patients who achieved a reduction of ≥ 50% in the mean number of focal seizures per week, over a 16-week treatment period. The patients were randomized to receive placebo or levetiracetam, titrated every two weeks from 20 mg/kg/day or 1,000 mg/day up to 60 mg/kg/day or 3,000 mg/day. Results: Levetiracetam was significantly superior to placebo (p = 0.0031); 38.7% of the participants in the levetiracetam group and 14.3% in the control group shows reductions in focal seizures. Levetiracetam was seen to have a favorable safety profile and an adverse event rate similar to that of placebo. Conclusion: Corroborating the results in the literature, levetiracetam was shown to be effective and safe for children and adults with refractory focal-onset epilepsy.

RESUMO Introdução: A epilepsia afeta cerca de 50 milhões de pessoas em todo o mundo e aproximadamente 30% desses pacientes apresentam epilepsia refratária, com possíveis consequências na qualidade de vida, morbidade e mortalidade prematura. Objetivo: O objetivo do tratamento com fármacos antiepilépticos (FAEs) é permitir que os pacientes permaneçam sem crises epilépticas com boa tolerabilidade. O levetiracetam (LEV) é um FAE de amplo espectro, com mecanismo de ação único, diferente dos demais e que demonstra ser eficaz e seguro no tratamento de adultos e crianças. Métodos: Estudo de fase III, multicêntrico, randomizado, duplo-cego e controlado por placebo avalia a eficácia e a segurança do LEV em crianças e adultos (4-65 anos) como tratamento adjuvante para crises de início focal em 114 pacientes já tratados com até três FAEs. A análise de eficácia primária foi baseada na proporção de pacientes que apresentaram redução ≥50% no número médio de crises epilépticas focais semanais, durante 16 semanas. Os pacientes foram randomizados para receber placebo ou LEV, titulado a cada duas semanas de 20 mg/kg/dia ou 1.000 mg/dia até 60 mg/kg/dia ou 3.000 mg/dia. Resultados: LEV foi significativamente superior ao placebo (p=0,0031), com 38,7% dos participantes no grupo LEV e 14,3% no grupo controle que apresentaram redução das crises focais. LEV apresenta bom perfil de segurança com eventos adversos semelhantes ao placebo. Conclusão: Corroborando com os resultados da literatura, o levetiracetam mostra-se eficaz e seguro para crianças e adultos com epilepsia focal refratária.

Estonian response to COVID-19 pandemic: learning, cooperation, and the advantages of being a small country / Resposta da Estônia à pandemia da COVID-19: aprendizagem, cooperação e as vantagens de ser um país pequeno / Respuesta de Estonia a la pandemia de COVID-19: aprendizaje, cooperación y las ventajas de ser un país pequeño

Abstract Compared to many other countries in Europe, Estonia managed to curtail the spread of the new coronavirus rather effectively. This paper offers an overview of the measures undertaken to tackle the COVID-19 pandemic in March-May 2020 and explain why Estonia managed to successfully contain the epidemic. The paper argues that the management of the crisis was facilitated by political factors, quick policy learning, cooperation with the scientific community, and the existing ICT and e-government infrastructure.

Resumo Em comparação com outros países europeus, a Estônia conseguiu reduzir a disseminação do coronavírus de maneira bastante eficaz. Este artigo busca dar uma visão geral das medidas tomadas para enfrentar a crise da COVID-19 entre os meses de março e maio de 2020 e explicar por que a Estônia conseguiu conter a epidemia com sucesso. O artigo argumenta que a gestão da crise foi facilitada por fatores políticos, pela rapidez na aprendizagem de políticas públicas, pela cooperação com a comunidade científica e pela infraestrutura existente de TIC e governo eletrônico.

Resumen Comparada con otros países de Europa, Estonia ha logrado restringir la propagación del coronavirus relativamente bien. Este artículo se propone brindar una visión general de las medidas tomadas entre marzo y mayo del 2020 para enfrentar la crisis de la COVID-19 y explicar por qué Estonia logró contener la epidemia. El artículo argumenta que el manejo de la crisis fue facilitado por factores políticos, por el rápido aprendizaje sobre políticas públicas, por la cooperación con la comunidad científica, y por la infraestructura de tecnologías de comunicación e información y gobierno digital.

COVID-19 in Africa: a comparative analysis of early policy responses / COVID-19 na África: uma análise comparativa das primeiras políticas de resposta / COVID-19 en África: un análisis comparativo de las políticas de primera respuesta

Abstract The COVID-19 pandemic has caused turmoil around the world. In Africa, some similarities and differences could be observed in the nature of the outbreak and the policy responses across the continent. This article discusses the policy responses and reflects on their effectiveness as a containment strategy. We speculate on why these strategies seem to work or not, and the lessons therein. The analysis also examines the setting up of crisis teams and whether they indicate lack of trust in the existing public administration system. The article argues that though South African cases and testing diverged significantly from the rest of the continent, a wider similarity can be observed in pandemic management across the continent. The article identifies some factors including quick and early measures, recent experience managing epidemic/health crises, and a display of some form of community resilience acquired over years of living in a state of poor governance as some of the important factors in the management of the pandemic. We find there is a dearth of scholarship on crisis management in the context of public administration and suggest this should be an object of future study in the field. The use of ad-hoc crisis teams that assume emergency powers is a common practice, but there is insufficient rigorous analysis to show their effectiveness and impact on existing bureaucratic institutions.

Resumo A pandemia da COVID-19 causou grande turbulência em todo o mundo. Entre os países africanos pode-se perceber semelhanças e diferenças tanto em relação a natureza do surto como nas respostas políticas implementadas. Esse artigo discute essas respostas e reflete sobre sua eficácia como estratégia de contenção da pandemia. Especulamos as razões pelas quais essas estratégias parecem funcionar (ou não) e quais são as lições aprendidas, bem como examinamos a criação de 'equipes de crise' e se essas equipes demonstram confiança no sistema de administração pública existente. A análise nos permite argumentar que, embora a manifestação dos casos e os testes conduzidos na África do Sul tenham divergido significativamente do observado no resto do continente, há uma semelhança em geral em relação a gestão da pandemia em toda a África. Identificamos alguns elementos que refletem essa similaridade na gestão, entre eles a adoção de medidas rápidas e precoces, a experiência recente no gerenciamento de epidemias/crises de saúde e a existência de alguma forma de resiliência da comunidade, adquirida ao longo de anos de experiência em lidar com um estado de falta de governança. Ainda, observamos a escassez de estudos sobre gestão de crises no contexto da administração pública e sugerimos futuros trabalhos na área. Finalmente, percebemos que o uso de 'equipes de crise' constituídas especificamente e com poderes para lidar com a situação de emergência é uma prática comum. Entretanto, não há uma análise rigorosa suficiente para mostrar que essa estratégia é eficaz e tem impacto nas instituições burocráticas existentes.

Resumen La pandemia de COVID-19 causó una gran conmoción en todo el mundo. Entre los países africanos, se pueden observar similitudes y diferencias tanto en relación con la naturaleza del brote como en las respuestas políticas implementadas. Este artículo analiza esas respuestas y reflexiona sobre su eficacia como estrategia de contención de una pandemia. Especulamos sobre las razones por las que estas estrategias parecen funcionar (o no) y cuáles son las lecciones aprendidas, además de examinar la creación de "equipos de crisis" y si estos equipos muestran confianza en el sistema de administración pública existente. El análisis nos permite argumentar que, aunque la manifestación de casos y pruebas realizadas en Sudáfrica ha divergido significativamente de la observada en el resto del continente, existe una similitud en general en relación con el manejo de la pandemia en África. Identificamos algunos elementos que reflejan esta similitud en la gestión, incluida la adopción de medidas rápidas y tempranas, la experiencia reciente en el manejo de epidemias/crisis de salud y la existencia de alguna forma de resiliencia comunitaria, adquirida durante años de experiencia en lidiar con un estado de falta de gobernanza. Además, notamos la escasez de estudios sobre gestión de crisis en el contexto de la administración pública y sugerimos trabajos futuros en el área. Finalmente, percibimos que el uso de "equipos de crisis" específicamente constituidos y capacitados para hacer frente a la emergencia es una práctica común. Sin embargo, no existe un análisis suficientemente riguroso para demostrar que esta estrategia es efectiva y tiene un impacto en las instituciones burocráticas existentes.

As múltiplas pandemias englobadas na pandemia / The multiple pandemic included in the pandemic / Las múltiples pandemias englobadas en la pandemia / Les multiples pandémies contenues dans la pandémie

RESUMO O início da pandemia, além da angústia pela possibilidade de adoecer e até de morrer, se constitui em uma crise intensa pela mudança de paradigmas do cotidiano familiar. O lar passa a ser simultaneamente home office, escola, playground etc. Toda essa reformulação não é fácil de metabolizar. Nesse pandemônio, surgem outras pandemias associadas, como o aumento da ansiedade, o isolamento social, a falta de empatia dos governantes para com a dor dos cidadãos, o desencontro com a ciência e a criação de mitos e utopias. Com respeito a essas utopias de cunho maníaco, existe a noção de que o pós-pandemia significará o surgimento de um "novo normal", como se uma transformação quase mágica, pela experiência dolorosa, fosse mudar o homem para melhor. A história nos mostra que não é bem assim que as coisas funcionam.

ABSTRACT The beginning of the pandemic, besides bringing anxiety due to the possibility of getting sick and dying, happened in the middle of an intense crisis for the change on paradigms in the day-by-day of all families. Homes become work places, school areas, play areas, etc. All these changes are not easy to be accepted. During this pandemonium, other pandemics arise, such as more anxiety, social isolation and the lack of empathy by the government towards the people's suffering, science disagreements as well as the surge or myths and utopias. About these utopias connected to maniac nature, there is the idea that the post-pandemic phase will be the 'new normal'. As if a kind of magic change caused by painful experience, could change people for the better. History shows us that that's not exactly how things work.

RESUMEN El inicio de la pandemia, además de la angustia por la posibilidad de quedarse enfermo o incluso morir, se convierte en una crisis intensa por el cambio de paradigma del mundo familiar. El hogar pasa a ser simultáneamente home office, escuela, playground etc. Toda esa reformulación no se metaboliza fácilmente. Em ese pandemonio, surgen otras pandemias asociadas con el aumento de la ansiedad, el aislamiento social y la falta de empatía de los gobernantes hacia el dolor de los ciudadanos, el desencuentro con la ciencia y la creación de mitos y utopías. Con respecto a esas utopías de índole maligna, existe la noción de que la post pandemia significará un ''nuevo normal''. Como si un cambio casi mágico por la experiencia dolorosa, fuera a cambiar el hombre para mejor. La historia, por el contrario, nos muestra que las cosas no funcionan así.

RÉSUMÉ Le début de la pandémie, outre l'angoisse face à la possibilité de devenir malade et même de mourir, se constitue en une crise intense, en raison du changement de paradigme du quotidien familier. Le foyer devient en même temps home office, école, playground, etc. Toute cette reformulation n'est pas facile à métaboliser. Dans ce pandémonium, d'autres pandémies associées surgissent, telles que l'augmentation de l'anxiété, l'isolement social et le manque d'empathie de la part des gouvernants vis-à-vis la douleur des citoyens, le désaccord avec la science et la création de mites et d'utopies. On peut penser à la notion que la postpandémie signifiera l'apparition du « nouveau normal, ¼ dans ce qui concerne ces utopies d'origine maniaque. L'homme changerait et deviendrait meilleur comme dans un changement presque magique, en raison de l'expérience douloureuse. L'histoire nous montre que ce n'est pas tout à fait comme ça que les choses fonctionnent.

Economic crises, behavioral changes and hospitalization due to affective disorders in Brazil between 2003 and 2017: a nationwide cross-sectional study

ABSTRACT Our aim was to analyze hospitalization due to affective disorders in Brazil from 2003 to 2017 and the possible association with economic indicators during crises. We used data on hospitalizations due to affective disorders within the Brazilian National Health System, obtained from DATASUS; data on health-related behavior (television-viewing and physical activity) from the VIGITEL database; and economic data from the World Bank database. We found that the numbers of hospitalizations increased one year after the 2009 crisis and one year after the 2016 crisis. Negative changes in health-related behavior also followed changes in the numbers of hospitalizations due to affective disorders.

Diabetic Retinopathy Health Crises in Kurdistan Governorate-Iraq/Erbil

Introduction: The diabetic blindness can be prevented by upto 90%, in the early stages of the disease. At the time ofdiagnosing type two, 21% of them have retinopathy. After 20years of diabetes; the retinopathy affects 60% of type 2 andapproximately all of type 1 diabetic population.Subjects and Methods: This retrospective study comprisedof 1784 diabetic patients. Their vision assessed according tothe international classification of controlling blindness as legallyblind (visual acuity=< 20/200) or socially blind. For thispurpose, the Snellen Eye Chart used at a fixed distance of 20feet. Patients were checked regularly when checkup missed;excluded from the study.Result: About 46% of the diabetic population did not knowwhen their diabetes started with a p-value 0.000, which is avery highly significant correlation. Regarding patientsinformation how to control their diabetes; 82% of them did notknow how to handle the illness, and 76% did not know thedietary restrictions with a very highly significant p-value, thecorrelation between them and legal blindness. About 84.1%presented with legal blindness. After many interventions,37.9% remained legal blindness, but 62.1 improved. While 6%became socially blinded. Around 43.9% were unable to buy theanti-vascular endothelial growth factor drugs, with a p-value= 0.000. About 87.2 % of patients did not perform HbA1Ctwo times per year with very highly significant with the legallyblind.Conclusion: Lack of education program, patient's informationabout the disease, non-referrals, economic crisis and theunavailability of the anti-vascular endothelial growth factor; allcollectively created a blinded diabetic population.

Características clínicas de los pacientes con crisis hipertensivas que acuden a un Servicio de emergencias médicas

RESUMEN Introducción: los niveles de presión arterial por encima de las cifras normales aumentan el riesgo de padecer enfermedades cardiovasculares y cerebrales. Las complicaciones ocasionadas por las crisis hipertensivas son muy peligrosas y a menudo fatales. Es de suma importancia conocer bien sus características clínicas para tratar de contrarrestar su evolución. Objetivo: describir el comportamiento de las crisis hipertensivas en 500 pacientes del Servicio de Emergencias del Hospital de Clínicas, en el período de enero a junio de 2018. Metodología: estudio descriptivo y retrospectivo. Se utilizaron las hojas de recepción, acogida y clasificación de urgencias y las historias clínicas de pacientes ingresados con crisis hipertensivas. Se emplearon frecuencias absolutas y relativas (porcentaje) para resumir la información, y tablas para su presentación. Resultados: en el estudio predominó el sexo masculino, con 351 (70%) pacientes, y 149 (30%) de sexo femenino. El grupo etario en el que existió mayor predominio de pacientes (49%) fue el de 50-59 años de edad. Se observó un predominio de las urgencias hipertensivas con 399 (79,8%) pacientes, mientras que solo 101 (20,2%) pacientes desarrollaron emergencias hipertensivas. El órgano diana más frecuentemente dañado fue el cerebro en 43 (42,6%) pacientes con un accidente vascular cerebral, seguido por el síndrome coronario agudo en 34 (33,7%) pacientes. La alteración electrocardiográfica mas frecuente fue la hipertrofia del ventrículo izquierdo en 187 (37,4%) pacientes, y en segundo lugar se encontró el supradesnivel del ST, que se presentó en 111 (22,2%) pacientes. Conclusión: las complicaciones y los hallazgos más significativos en estos pacientes con crisis hipertensivas fueron los accidentes vasculares encefálicos y el síndrome coronario agudo, así como la hipertrofia del ventrículo izquierdo y la elevación del segmento ST dentro de las alteraciones electrocardiográficas.

ABSTRACT Introduction: Blood pressure levels above normal levels increase the risk of cardiovascular and cerebral diseases. Complications caused by hypertensive crises are very dangerous and often fatal. It is very important to know their clinical characteristics well to try to counteract their evolution. Objective: To describe the behavior of hypertensive crises in 500 patients of the Emergency Service of the Hospital de Clínicas, in the period from January to June 2018. Methodology: Descriptive and retrospective study. The reception and emergency classification sheets and the medical records of patients admitted with hypertensive crisis were used. Absolute and relative frequencies (percentage) were used to summarize the information, and tables for presentation. Results: In the study the male sex prevailed, with 351 (70%) patients, and 149 (30%) of female sex. The age group in which there was a greater prevalence of patients (49%) was 50-59 years old. A predominance of hypertensive urgencies was observed with 399 (79.8%) patients, while only 101 (20.2%) patients developed hypertensive emergencies. The most frequently damaged target organ was the brain in 43 (42.6%) patients with a stroke, followed by acute coronary syndrome in 34 (33.7%) patients. The most frequent electrocardiographic alteration was left ventricular hypertrophy in 187 (37.4%) patients, and in the second place was the ST elevation, which occurred in 111 (22.2%) patients. Conclusion: The most significant complications and findings in these patients with hypertensive crises were cerebrovascular accidents and acute coronary syndrome, as well as left ventricular hypertrophy and ST-segment elevation within electrocardiographic abnormalities.

Epidemiological and clinical study of sickle cell disease at tertiary care centre in Western India

Background: Sickle cell disorders are structural hemoglobinopathies, rendering red blood cells sickle shaped, less deformable and sticky leading to microvascular vaso-occlusion and premature red blood cells destruction which leads to varied clinical manifestations. It leads to lifelong morbidity thus affecting quality of life and contributes to early mortality thereby reducing the key national resources- the healthy workforce. This study was done to evaluate epidemiological and clinical profile of sickle cell disease attending the centre.Methods: This study was cross-sectional, observational study conducted at tertiary care hospital in Gujarat. After taking ethical clearance patients were enrolled as per inclusion and exclusion criteria and epidemiological and clinical profile of sickle cell disease patients was studied.Results: Mean age of sickle cell disease was 22.58 years. It was found in tribal communities of Gujarat like Rathwa, Baria, Tadvi etc. Commonest symptom was musculoskeletal pain (86.84%), followed by jaundice (71.05%), fever, dyspnoea, abdominal pain and chest pain. Most common systemic manifestation was pain crises (60.66%), followed by hemolytic anemia (31.15%), acute chest syndrome (30%), consolidation (11.67%), hepatopathy (10%) and avascular necrosis of hip. (6.56%).Conclusions: Sickle cell disease is seen in younger patients. In Gujarat mainly tribal communities are affected. Major systemic manifestations of sickle cell disease include pain crisis followed by hemolytic crisis, acute chest syndrome, hepatopathy and AVN of hip.

Diálogo aberto: pontos críticos da implementação no cuidado à crise psicótica / Open dialogue: critical points of implementation in psychotic crisis care

Resumo O objetivo desta pesquisa foi analisar os pontos críticos para a implementação da abordagem do diálogo aberto na atenção à crise psicótica. Trata-se de estudo qualitativo, utilizando os formulários preenchidos por profissionais de saúde mental que participaram de um seminário sobre a temática, realizado por Jaakko Seikkula em 2015, na Itália. Foram analisados 83 formulários com questões abertas autoaplicadas para detectar o perfil sociodemográfico dos participantes, convidando-os a indicar os pontos críticos da implementação do diálogo aberto. Os resultados foram organizados a partir dos sete princípios da abordagem e analisados segundo o conceito weberiano de tipo ideal de criticidade, sendo dispostos em dois tipos ideais: o organizacional e o cultural. Na percepção dos participantes a transferência dessa modalidade terapêutica para a Itália não parece livre de obstáculos. Os princípios de maior preocupação entre os profissionais enfermeiros e médicos foram: ajuda imediata, rede social, flexibilidade e mobilidade. Diante disso, reflete-se sobre os impasses perante a necessidade de mudar concepções, organizações, saberes e práticas de cuidado em saúde mental comunitária no contexto da desinstitucionalização.

Abstract This study sought to analyze the critical points to implement the Open Dialogue approach in psychotic crisis care. This qualitative study was based on the analysis of an open-ended questionnaire developed by mental health professionals who participated in a seminar on the subject conducted by Jaakko Seikkula in 2015, in Italy. Eighty-three self-administered questionnaires were analyzed to detect the participants' sociodemographic profile and their perception of the critical points of the implementation of Open Dialogue. The results were organized according to the seven principles of the approach and analyzed according to Weber's Ideal Type into two Ideal Types: organizational and cultural criticalities. In the participants' perception, the implementation in Italy of this therapeutic modality does not seem obstacle-free. The principles of greatest concern among nurses and physicians were immediate help, social networking, flexibility, and mobility. This paper thus reflected on the impasses regarding the need for a reframing in the conceptions, organizations, knowledge and practices of community mental health care in the context of deinstitutionalization.