Pharmacotherapeutic potential of Vitis vinifera(grape) in age-related neurological diseases / Potencial farmacoterapéutico de Vitis vinifera(uva) en enfermedades neurológicas asociadas a la edad

Age-related neurological disorders (ANDs), including neurodegenerative diseases, are complex illnesses with an increasing risk with advancing years. The central nervous system's neuropathological conditions, including oxidative stress, neuroinflammation, and protein misfolding, are what define ANDs. Due to the rise in age-dependent prevalence, efforts have been made to combat ANDs. Vitis viniferahas a long history of usageto treat a variety of illness symptoms. Because multiple ligand sites may be targeted, Vitis viniferacomponents can be employed to treat ANDs. This is demonstrated by the link between the structure and action of these compounds. This review demonstrates that Vitis viniferaand its constituents, including flavonoids, phenolic compounds, stilbenoidsandaromatic acids, are effective at reducing the neurological symptoms and pathological conditions of ANDs. This is done by acting as an antioxidant and anti-inflammatory. The active Vitis vinifera ingredients have therapeutic effects on ANDs, as this review explains.

Las enfermedades neurológicas asociadas a la edad (AND, por su sigla en inglés) incluyendo las enfermedades neurodegenerativas, son enfermedades complejas con un riesgo creciente con la edad. Las condiciones neuropatológicas del sistema nervioso central, que incluyen el estrés oxidativo, la neuro inflamación, y el plegado erróneo de proteínas, son lo que define las AND. Debido al aumento en la prevalencia dependiente de la edad, se han hecho esfuerzos para combatir las AND. Vitis vinifera tiene una larga historia de uso para el tratamiento de síntomas. Puesto que puede hacer objetivo a muchos sitios ligando, los componentes de Vitis viniferase pueden utilizar para tratar AND. Esto se demuestra por el vínculo entre la estructura y la acción de estos compuestos. Esta revisión demuestra que la Vitis viniferay sus constituyentes, incluídos los flavonoides, componentes fenólicos, estilbenoides, y ácidos aromáticos, son efectivos para reducir los síntomas neurológicos y las condiciones patológicas de AND. Esto se produce por su acción como antioxidante y antiinflamatorio. Los ingredientes activos de Vitis vinifera tienen efectos terapéuticos en AND, y esta revisión lo explica.

Vulnerability Scale for People with Motor Disabilities After an Acquired Neurological Lesion / Escala de vulnerabilidade das pessoas com deficiência motora após lesão neurológica adquirida / Escala de vulnerabilidad de las personas con discapacidad motora tras una lesión neurológica adquirida

Introduction: After an acquired neurological lesion, some people are in situations of greater vulnerability to complications and comorbidities, which can exert impacts on their life and health, compromise their quality of life, and lead to hospitalizations and premature death. Identifying the vulnerability situation can guide nurses in the development of actions to prevent complications, comorbidities, and other conditions after the neurological lesion. Objective: To validate a scale to identify the vulnerability situation of people with motor disabilities after an acquired neurological lesion (Escala de Vulnerabilidade de Pessoas com Deficiência, EVU-PcD). Materials and method: The article presents a methodological development and psychometric study with a quantitative approach. The construct validity stages were as follows: application of the Vulnerability Scale for people with motor disabilities after an acquired neurological lesion (EVU-PcD) and reliability and confirmatory factor analysis. EVU-PcD, initially with 38 items, was applied to 102 individuals with acquired motor disabilities. Reliability was assessed using Cronbach's alpha from 0.7 to 0.9. In the confirmatory factor analysis, the structural equations model for latent variables a path diagram was used. Results: The overall Cronbach's alpha coefficient was 0.86, which was considered excellent. The fit indices, chi-square ratio (1.63), root mean square of approximation errors (0.08) and parsimonious fit quality index (0.61) presented acceptable indicators of adequacy to the final model with three domains and 28 items. Conclusions: The final factor structure of the EVU-PcD scale with 28 items showed satisfactory reliability and validity results to identify the vulnerability of people with motor disabilities after an acquired neurological lesion.

Introdução: algumas pessoas, após lesão neurológica adquirida, estão em situações de maior vulnerabilidade a complicações, comorbidades e outras condições após a deficiência, as quais podem impactar na vida e na saúde, comprometer a qualidade de vida, levar a hospitalizações e à morte prematura. A identificação da situação de vulnerabilidade pode orientar o enfermeiro no desenvolvimento de ações para prevenir complicações, comorbidades e outras condições após lesão neurológica. Objetivo: validar uma escala para identificar a situação de vulnerabilidade de pessoas com deficiência motora após lesão neurológica adquirida (EVU-PcD). Materiais e método: estudo de desenvolvimento metodológico, psicométrico, com abordagem quantitativa. As etapas de validade de construto foram aplicação da "Escala de vulnerabilidade de pessoas com deficiência motora após lesão neurológica adquirida (EVU-PcD)", análise da confiabilidade e análise fatorial confirmatória. A EVU-PcD, composta inicialmente de 38 itens, foi aplicada a 102 pessoas com deficiência motora adquirida. A confiabilidade foi medida por meio do alfa de Cronbach de 0,7 a 0,9. Na análise fatorial confirmatória, utilizou-se o modelo de equações estruturais para variáveis latentes, por meio do diagrama de caminhos. Resultados: o alfa de Cronbach total foi 0,86, considerado excelente. Os índices de ajuste, razão de qui-quadrado (1,63), raiz média quadrática dos erros de aproximação (0,08) e índice de qualidade de ajuste parcimonioso (0,61) apresentaram aceitáveis indicadores de adequação ao modelo final com três domínios e 28 itens. Conclusões: a estrutura fatorial final da EVU-PcD com 28 itens mostrou resultados satisfatórios de confiabilidade e validade para identificar a vulnerabilidade de pessoas com deficiência motora após lesão neurológica adquirida.

Introducción: algunas personas, tras una lesión neurológica adquirida, se encuentran en situaciones de mayor vulnerabilidad a complicaciones y comorbilidades, que pueden repercutir en la vida y la salud, comprometer la calidad de vida, provocar hospitalizaciones y muerte prematura. La identificación de la situación de vulnerabilidad puede orientar al personal de enfermería en el desarrollo de acciones de prevención de complicaciones, comorbilidades y otras afecciones tras una lesión neurológica. Objetivo: validar una escala para identificar la situación de vulnerabilidad de las personas con discapacidad motora después de una lesión neurológica adquirida (EVU-PcD). Material y método: estudio metodológico, de desarrollo psicométrico con un enfoque cuantitativo. Las etapas de validez de constructo fueron la aplicación de la "Escala de vulnerabilidad de personas con discapacidad motora tras lesión neurológica adquirida (EVU-PcD)", el análisis de fiabilidad y el análisis factorial confirmatorio. La EVU-PcD, compuesta inicialmente por 38 ítems, se aplicó a 102 personas con discapacidad motora adquirida. La fiabilidad se midió utilizando el alfa de Cronbach de 0,7 a 0,9. El análisis factorial confirmatorio utilizó el modelo de ecuaciones estructurales para variables latentes, mediante el diagrama de trayectorias. Resultados: el alfa de Cronbach total fue de 0,86, considerado excelente. Los índices de ajuste, ratio chi-cuadrado (1,63), raíz cuadrada media de los errores de aproximación (0,08) e índice de calidad de ajuste parsimonioso (0,61) mostraron indicadores aceptables de adecuación al modelo final con tres dominios y 28 ítems. Conclusiones: la estructura factorial final de la EVU-PcD con 28 ítems mostró resultados satisfactorios de fiabilidad y validez para identificar la vulnerabilidad de las personas con discapacidad motora tras una lesión neurológica adquirida.

Hypophysitis an uncommon manifestation of IgG4-related disease: Case report

IgG4-related disease is a recently described disease that can involve various organs and systems. Single organ involvement is the exception to the rule, it is generally a multi-system entity. We present a 36-year-old woman, with no previous pathological history or autoimmune disease, with headache caused by cystic macroadenoma. A transsphenoidal resection was performed and pathology documented areas of fibrosis with a predominantly plasmolymphocytic infíltrate and positive IgG4 staining in more than 20 cells per high-power field, meeting diagnostic criteria for IgG4-related sclerosing disease. Involvement of other organs was ruled out, and the patient improved clinically after management.

La enfermedad relacionada con IgG4 es una entidad recientemente descrita, capaz de involucrar diversos órganos y sistemas. El compromiso de órganos aislados es la excepción a la regla, dado que generalmente se trata de una entidad multisistémica. Se presenta el caso de una mujer de 36 años, sin antecedentes patológicos previos, en quien como causa de cefalea se documenta un macroadenoma quístico llevado a resección transesfenoidal, cuyo resultado de patología documenta zonas de fibrosis con infiltrado de predominio plasmo-linfocitario y la tinción para IgG4 positiva en más de 20 células por campo de alto poder, lo que configura criterios diagnósticos para enfermedad esclerosante relacionada con IgG4; se descartó compromiso de otros órganos y hubo mejoría clínica posterior al manejo.

Principales patologías diagnosticadas por el servicio de Neurología en urgencias e internación en un hospital universitario en Colombia 2020 - 2021 / Main pathologies diagnosed by the Neurology service in emergencies and hospitalization in a university hospital in Colombia 2020 - 2021

RESUMEN INTRODUCCIÓN: Las enfermedades neurológicas constituyen gran parte de las urgencias médicas (10 %-15%). Por ende, se hace necesario el reconocimiento de la distribución de las principales condiciones tanto en urgencias como en hospitalización. Se decidió caracterizar la distribución real de la enfermedad neurológica atendida en un hospital universitario de tercer nivel en Boyacá. MATERIALES Y MÉTODOS: Estudio descriptivo de corte transversal. RESULTADOS: 1203 pacientes con edad promedio de 56,2 (± 21,2) años, la mayoría de sexo masculino, casi la mitad de ellos nivel de educación básica primaria. De un total de 81 diagnósticos, se caracterizaron clínica y sociodemográficamente los 12 primeros, encontrando que en el área de urgencias prevalece la enfermedad cerebrovascular, epilepsia, cefalea, polineuropatia y vértigo. CONCLUSIONES. Los principales motivos de interconsulta del servicio son la enfermedad cerebrovascular y el delirio en urgencias e internación respectivamente, siendo generadas principalmente por medicina general, medicina interna y unidad de cuidado intensivo.

ABSTRACT INTRODUCTION: Neurological diseases constitute a large proportion of medical emergencies (10%-15%). Knowledge of the distribution of the main neurological conditions both in the emergency room and in hospitalization is necessary. The real distribution of neurological disease treated in a tertiary university hospital in Boyacá can be characterized. METHODOLOGY: Descriptive cross-sectional study. Results: 1203 patients with a mean age of 56.2 (± 21.2) years, most of them male, almost half of them with basic primary education. From a total of 81 diagnoses, the first 12 were characterized clinically and socio demographically, we found that in the emergency department, cerebrovascular disease, epilepsy, headache, polyneuropathy and vertigo prevailed. CONCLUSIONS. The main reasons for consultation were cerebrovascular disease and delirium in the emergency department and hospitalization, respectively, being mainly generated by internal medicine and the intensive care unit.

Consequências da herpes tipo 1 no desenvolvimento neuropsicomotor / Consequences of herpes type 1 on neuropsymotor development / Consecuencias del herpes tipo 1 en el desarrollo neuropsicomotor

Objetivo: Descrever as consequências do herpes tipo 1 no desenvolvimento neuropsicomotor. Metodologia: Trata-se de uma revisão narrativa das consequências da Herpes do tipo 1 no Desenvolvimento Neuropsicomotor. Questão norteadora: "Quais os efeitos da infecção congênita da Herpes tipo 1 no Desenvolvimento Neuropsicomotor observadas entre os anos de 2010 a 2020?". O levantamento dos dados ocorreu: dezembro/2021 a janeiro/2022 nas bases de dados: Scientific Eletronic Library Online, Literatura Latino Americana e do Caribe em Ciências da Saúde e National Library of Medicine. Descritores: "Herpes"; "Desenvolvimento Neuropsicomotor"; "Herpes Congênita" e "Neuropsychomotor Development" com operadores booleanos AND e OR. Critérios de inclusão: artigos originais, texto completo. Exclusão: cartas ao editor, teses, dissertações e revisões de literatura. Resultados: Foram encontrados 21 artigos nas bases de dados pesquisadas, contudo, após a aplicação dos critérios de inclusão, 3 artigos foram considerados elegíveis. Após a análise, pode-se afirmar os impactos do Vírus Herpes pode gerar ao desenvolvimento neuropsicomotor, podendo ocasionar disfagia, disartria, alterações motoras, cognitivas e sociais, bem como outros sinais e sintomas que levarão ao atraso no desenvolvimento. Conclusão: O Herpes Vírus Simples pode ocasionar transtornos cerebrais em crianças, o que acarreta distúrbios para o amadurecimento normal, com consequente atrasos no desenvolvimento neuropsicomotor.

Objective: To describe the consequences of herpes type 1 on neuropsychomotor development. Methodology: This is a narrative review of the consequences of Herpes type 1 on Neuropsychomotor Development. Guiding question: "What are the effects of congenital Herpes type 1 infection on Neuropsychomotor Development observed between the years 2010 to 2020?". Data collection took place: December/2021 to January/2022 in the following databases: Scientific Electronic Library Online, Latin American and Caribbean Literature in Health Sciences and National Library of Medicine. Keywords: "Herpes"; "Neuropsychomotor Development"; "Herpes Congenita" and "Neuropsychomotor Development" with Boolean operators AND and OR. Inclusion criteria: original articles, full text. Exclusion: letters to the editor, theses, dissertations and literature reviews. Results: 21 articles were found in the searched databases, however, after applying the inclusion criteria, 3 articles were considered eligible. After the analysis, it can be said the impacts of the Herpes Virus can generate neuropsychomotor development, which can cause dysphagia, dysarthria, motor, cognitive and social changes, as well as other signs and symptoms that will lead to developmental delay. Conclusion: Herpes Simplex Virus can cause brain disorders in children, which causes disturbances to normal maturation, with consequent delays in neuropsychomotor development.

Objetivo: Describir las consecuencias del herpes tipo 1 en el desarrollo neuropsicomotor. Metodología: Se trata de una revisión narrativa de las consecuencias del Herpes Tipo 1 en el Desarrollo Neuropsicomotor. Pregunta norteadora: "¿Cuáles son los efectos de la infección congénita por Herpes tipo 1 en el desarrollo neuropsicomotor observados entre los años 2010 y 2020?". Los datos se recopilaron entre diciembre de 2021 y enero de 2022 en las siguientes bases de datos: Scientific Eletronic Library Online, Latin American and Caribbean Literature on Health Sciences y National Library of Medicine. Descriptores: "Herpes"; "Desarrollo neuropsicomotor"; "Herpes congénito" y "Desarrollo neuropsicomotor" con operadores booleanos AND y OR. Criterios de inclusión: artículos originales, texto completo. Criterios de exclusión: cartas al director, tesis, disertaciones y revisiones bibliográficas. Resultados: Se encontraron 21 artículos en las bases de datos consultadas, sin embargo, tras aplicar los criterios de inclusión, se consideraron elegibles 3 artículos. Después del análisis, se puede afirmar los impactos que el Herpes Virus puede tener en el desarrollo neuropsicomotor, que puede causar disfagia, disartria, alteraciones motoras, cognitivas y sociales, así como otros signos y síntomas que conducirán a un retraso en el desarrollo. Conclusión: El virus del herpes simple puede causar alteraciones cerebrales en los niños, lo que conduce a trastornos de la maduración normal, con los consiguientes retrasos en el desarrollo neuropsicomotor.

Uso de cannabidiol para el control de síntomas refractarios en síndromes convulsivos y enfermedades neurodegenerativas / Use of cannabidiol for the control of refractory symptoms in convulsive syndromes and neurodegenerative diseases

Como parte de las terapias alternativas para el control de síntomas refractarios en enfermedades avanzadas destaca el uso de cannabidiol. Este se ha estudiado en patologías como enfermedad de Alzheimer, Parkinson y trastornos convulsivos. Los síndromes convulsivos están presentes en todos los grupos etarios. Dentro de este, la epilepsia es refractaria hasta en un 40 % de los pacientes, quienes han demostrado disminución en la frecuencia de convulsiones con el uso concomitante de cannabidiol y antiepilépticos convencionales, con efectos secundarios leves, como diarrea y somnolencia. Con el objetivo de determinar el uso del cannabidiol para el control de síntomas neurológicos refractarios en pacientes con síndromes convulsivos y enfermedades neurodegenerativas, se realizó una búsqueda bibliográfica en Pubmed, Scopus y Embase. Se incluyeron metaanálisis, artículos originales, revisiones sistemáticas y bibliográficas, y documentos de la Organización Panamericana de la Salud, publicados entre 2017 y 2022. Los efectos del cannabidiol lo convierten en una alternativa, adicional a la terapéutica convencional, para el control de síntomas en trastornos neurológicos, disminuyendo de forma sostenida el número total de episodios con un perfil de seguridad aceptable. Existe limitada información respecto al uso de cannabidiol en enfermedades neurodegenerativas, por lo que no se ha evidenciado su efectividad

As part of the alternative therapies for the control of refractory symptoms in advanced diseases, the use of cannabidiol stands out. It has been studied in pathologies such as Alzheimer's disease, Parkinson's disease, and convulsive disorders. Convulsive syndromes are present in all age groups. Within this group, epilepsy is refractory in up to 40 % of patients, who have shown a decrease in the frequency of seizures with the concomitant use of cannabidiol and conventional antiepileptics, with mild side effects such as diarrhea and drowsiness. To determine the use of cannabidiol for the control of refractory neurological symptoms in patients with seizure syndromes and neurodegenerative diseases, a literature search was performed in PubMed, Scopus, and Embase. Meta-analyses, original articles, systematic and literature reviews, and documents from the Pan American Health Organization, published between 2017 and 2022, were included. The effects of cannabidiol make it an alternative, in addition to conventional therapeutics, for symptom control in neurological disorders, sustainably decreasing the total number of episodes with an acceptable safety profile. There is limited information regarding the use of cannabidiol in neurodegenerative diseases, the reason its effectiveness has not been demonstrated.

Updated Understanding of the Glial-Vascular Unit in Central Nervous System Disorders / 神经科学通报·英文版

The concept of the glial-vascular unit (GVU) was raised recently to emphasize the close associations between brain cells and cerebral vessels, and their coordinated reactions to diverse neurological insults from a "glio-centric" view. GVU is a multicellular structure composed of glial cells, perivascular cells, and perivascular space. Each component is closely linked, collectively forming the GVU. The central roles of glial and perivascular cells and their multi-level interconnections in the GVU under normal conditions and in central nervous system (CNS) disorders have not been elucidated in detail. Here, we comprehensively review the intensive interactions between glial cells and perivascular cells in the niche of perivascular space, which take part in the modulation of cerebral blood flow and angiogenesis, formation of the blood-brain barrier, and clearance of neurotoxic wastes. Next, we discuss dysfunctions of the GVU in various neurological diseases, including ischemic stroke, spinal cord injury, Alzheimer's disease, and major depression disorder. In addition, we highlight the possible therapies targeting the GVU, which may have potential clinical applications.

Correlation between four limbs perfusion index and lactic acid in patients with severe neurological diseases / 中华危重病急救医学

OBJECTIVE@#To observe the correlation between the four limbs perfusion index (PI) and blood lactic acid in patients with neurosis, and evaluate the predictive value of PI on microcirculation perfusion metabolic disorder in patients with neurosis.@*METHODS@#A prospective observational study was conducted. Adult patients admitted to the department of neurological intensive care unit (NICU) of the First Affiliated Hospital of Xinjiang Medical University from July 1 to August 20 in 2020 were enrolled. Under the condition of indoor temperature controlled at 25 centigrade, all patients were placed in the supine position, and the blood pressure, heart rate, PI of both fingers and thumb toes and arterial blood lactic acid were measured within 24 hours and 24-48 hours after NICU. The difference of four limbs PI at different time periods and its correlation with lactic acid were compared. Receiver operator characteristic curve (ROC curve) was used to evaluate the predictive value of four limbs PI on patients with microcirculatory perfusion metabolic disorder.@*RESULTS@#A total of 44 patients with neurosis were enrolled, including 28 males and 16 females; average age (61.2±16.5) years old. There were no significant differences in PI of the left index finger and the right index finger [2.57 (1.44, 4.79) vs. 2.70 (1.25, 5.33)], PI of the left toe and the right toe [2.09 (0.85, 4.76) vs. 1.88 (0.74, 4.32)] within 24 hours after entering the NICU, and the PI of the left index finger and the right index finger [3.17 (1.49, 5.07) vs. 3.14 (1.33, 5.36)], PI of the left toe and the right toe [2.07 (0.75, 5.20) vs. 2.07 (0.68, 4.67)] at 24-48 hours after NICU admission (all P > 0.05). However, compared to the PI of the upper and lower limbs on the same side, except for the 24-48 hours after ICU of the PI difference between the left index finger and the left toe (P > 0.05), the PI of the toe was lower than that of the index finger at the other time periods (all P < 0.05). The correlation analysis showed that the PI value of four limbs of patients in both time periods were significantly negatively correlated with arterial blood lactic acid (the r values of the left index finger, the right index finger, the left toe and the right toe were -0.549, -0.482, -0.392 and -0.343 respectively within 24 hours after entering the NICU; the r values of the left index finger, the right index finger, the left toe and the right toe were -0.331, -0.292, -0.402 and -0.442 respectively after entering the NICU 24-48 hours, all P < 0.05). Taking lactic acid ≥ 2 mmol/L as the diagnostic standard for metabolic disorder of microcirculation perfusion (total 27 times, accounting for 30.7%). The efficacy of four limbs PI in predicting microcirculation perfusion metabolic disorder were compared. ROC curve analysis showed that the area under the curve (AUC) and 95% confidence interval (95%CI) of left index finger, right index finger, left toe and right toe predicting microcirculation perfusion metabolic disorder were 0.729 (0.609-0.850), 0.767 (0.662-0.871), 0.722 (0.609-0.835), 0.718 (0.593-0.842), respectively. There was no significant difference in AUC compare with each other (all P > 0.05). The cut-off value of PI of right index finger for predicting microcirculation perfusion metabolic disorder was 2.46, the sensitivity was 70.4%, the specificity was 75.4%, the positive likelihood ratio was 2.86, and the negative likelihood ratio was 0.30.@*CONCLUSIONS@#There are no significant differences in PI of bilateral index fingers, bilateral toes in patients with neurosis. However, unilateral upper and lower limbs showed lower PI in the toe than in the index finger. There is a significantly negatively correlation between PI and arterial blood lactic acid in all four limbs. PI can predict the metabolic disorder of microcirculation perfusion, and its cut-off value is 2.46.

Atuação da psicologia em unidade neonatal no contexto da pandemia da covid-19 / The work of psychology in a neonatal unit in the covid-19 pandemic / Actuación de la psicología en una unidad neonatal en el contexto de la pandemia de la covid-19

A pandemia de covid-19 provocou intensas mudanças no contexto do cuidado neonatal, exigindo dos profissionais de saúde a reformulação de práticas e o desenvolvimento de novas estratégias para a manutenção da atenção integral e humanizada ao recém-nascido. O objetivo deste artigo é relatar a atuação da Psicologia nas Unidades Neonatais de um hospital público de Fortaleza (CE), Brasil, durante o período de distanciamento físico da pandemia de covid-19. Trata-se de estudo descritivo, do tipo relato de experiência, que ocorreu no período de março a agosto de 2020. No contexto pandêmico, o serviço de Psicologia desenvolveu novas condutas assistenciais para atender às demandas emergentes do momento, como: atendimento remoto; registro e envio on-line de imagens do recém-nascido a seus familiares; visitas virtuais; e reprodução de mensagens de áudio da família para o neonato. Apesar dos desafios encontrados, as ações contribuíram para a manutenção do cuidado centrado no recém-nascido e sua família, o que demonstra a potencialidade do fazer psicológico.(AU)

The COVID-19 pandemic brought intense changes to neonatal care and required health professionals to reformulate practices and develop new strategies to ensure comprehensive and humanized care for newborn. This study aims to report the experience of the Psychology Service in the Neonatal Units of a public hospital in Fortaleza, in the state of Ceará, Brazil, during the social distancing period of the COVID-19 pandemic. This descriptive experience report study was conducted from March to August 2020. During the pandemic, the Psychology Service developed new care practices to meet the emerging demands of that moment, such as remote care, recordings and online submission of newborns' pictures and video images for their family, virtual tours, and reproduction of family audio messages for the newborns. Despite the challenges, the actions contributed to the maintenance of a care that is centered on the newborns and their families, which shows the potential of psychological practices.(AU)

La pandemia de la COVID-19 ha traído cambios intensos en el contexto de la atención neonatal, que requieren de los profesionales de la salud una reformulación de sus prácticas y el desarrollo de nuevas estrategias para asegurar una atención integral y humanizada al recién nacido. El objetivo de este artículo es reportar la experiencia del Servicio de Psicología en las Unidades Neonatales de un hospital público de Fortaleza, en Ceará, Brasil, durante el periodo de distanciamiento físico en la pandemia de la COVID-19. Se trata de un estudio descriptivo, un reporte de experiencia, que se llevó a cabo de marzo a agosto de 2020. En el contexto pandémico, el servicio de Psicología desarrolló nuevas conductas asistenciales para atender a las demandas emergentes del momento, tales como: atención remota; grabación y envío em línea de imágenes del recién nacido; visitas virtuales; y reproducción de mensajes de audio de la familia para el recién nacido. A pesar de los desafíos encontrados, las acciones contribuyeron al mantenimiento de la atención centrada en el recién nacido y su familia, lo que demuestra el potencial de la práctica psicológica.(AU)

Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

Pattern and determinants of outcomes of neurological emergencies admitted into children emergency ward in a tertiary hospital in Port Harcourt, Nigeria

Background: Neurological emergencies are life-threatening central nervous system disorders, significantly contributing to childhood morbidity and mortality. The sequelae may be irreversible and may impact negatively on the quality of life of affected children and their families. This study identified the morbidity pattern and determinants of the outcomes of children with neurological emergencies in the Children Emergency Room (CHER) of the Rivers State University Teaching Hospital (RSUTH). Method: A 4-year retrospective study was carried out in the CHER. Data on demography, diagnosis and outcomes of children with neurological disorders were extracted from the records. Data analysed with SPSS 24 were expressed in percentages and frequency tables. Results: Of the 3040 children admitted in the CHER, 364(12%) aged 0-15 years had neurological emergencies, commoner among males (59.3%) and children aged less than five years (70.9%). Meningitis (40.2%) and febrile convulsion (28.2%) were the topmost diagnoses made. Raised intracranial pressure (17.4%) and head injuries (25.5%) were significantly more prevalent among children aged five years and above. The mortality rate was 61(16.8%) and more among adolescents (30.6%). All the mortalities took place within the first 48hours of admission especially among those with head injuries (46.5%) and perinatal asphyxia (95%), (p < 0.05). Conclusion: Meningitis and febrile convulsion were the commonest neurologic emergencies seen in this study. Mortality rate was high, especially in the first 48 hours of admission and mainly from perinatal asphyxia and head injuries. Education on the prevention and management of neurologic emergencies should be strengthened.

Gut microbiota: a new insight into neurological diseases / 中华医学杂志(英文版)

In the last decade, it has become increasingly recognized that a balanced gut microbiota plays an important role in maintaining the health of the host. Numerous clinical and preclinical studies have shown that changes in gut microbiota composition are associated with a variety of neurological diseases, e.g., Parkinson's disease, Alzheimer's disease, and myasthenia gravis. However, the underlying molecular mechanisms are complex and remain unclear. Behavioral phenotypes can be transmitted from humans to animals through gut microbiota transplantation, indicating that the gut microbiota may be an important regulator of neurological diseases. However, further research is required to determine whether animal-based findings can be extended to humans and to elucidate the relevant potential mechanisms by which the gut microbiota regulates neurological diseases. Such investigations may aid in the development of new microbiota-based strategies for diagnosis and treatment and improve the clinical management of neurological disorders. In this review, we describe the dysbiosis of gut microbiota and the corresponding mechanisms in common neurological diseases, and discuss the potential roles that the intestinal microbiome may play in the diagnosis and treatment of neurological disorders.

Síndrome de Guillain-Barré como manifestación neurológica autoinmune asociado a COVID-19: Una revisión de la literatura / no

La enfermedad por coronavirus (COVID-19) producida por el SARS-CoV-2 ha sido un reto para los servicios de salud en todo el mundo. La pandemia se ha extendido ampliamente con más de 80 millones de casos confirmados y más de un millón de muertes a nivel mundial, por lo que ha estado bajo constante investigación para entender todos los aspectos de la enfermedad. Recientemente se han reportado varios casos de pacientes con síndrome de Guillain-Barré asociado a COVID-19 como manifestación principal, convirtiéndola en la primera enfermedad neurológica autoinmune desencadenada por SARS-CoV-2; sin embargo, es necesario obtener más información para entender completamente los mecanismos inmunopatogénicos implicados en esta asociación.

The coronavirus disease (COVID-19) caused by SARS-CoV-2 has been a challenge for health services around the world. The pandemic has spread widely, with more than 80 million confirmed cases and more than one million deaths globally. There have been many studies to understand all aspects of the disease. Recently, several cases have been reported of patients with Guillain-Barré syndrome associated with COVID-19 as the main manifestation. As it may be one of the first autoimmune neurological diseases triggered by SARS-CoV-2, it is necessary to obtain more information to fully understand the immunopathogenic mechanisms involved in this association.

Guillain Barré syndrome in the paediatric population. Consequence of active infection or long Covid?

Background: Guillain-Barre syndrome is a polyradiculoneuropathy that has been associated with infectious diseases as triggers. There is currently little medical evidence exploring the relationship between the development of Guillain-Barre syndrome caused by SARS-CoV-2 infection and long Covid. Objective: To synthesize the medical evidence that describes the relationship between post Covid syndrome and Guillain-Barre syndrome in the paediatric population. Methodology: A scoping review was developed using Scopus and PubMed databases, including analytical and/or descriptive experimental and observational studies. Results: The main clinical manifestations presented by paediatric patients were distal and ascending weakness in the lower limbs and myalgia. The diagnostic approach was based on clinical findings, imaging findings on spinal magnetic resonance and electromyography. The therapeutic strategy is based on the use of intravenous human immunoglobulins. Conclusion: Guillain-Barre syndrome is a frequent disease in the paediatric population with active SARS-CoV-2 infection or in survivors, however, it is necessary to encourage further clinical studies that increase the medical literature that describes this association.

Introducción: El síndrome de Guillain-Barré es una polirradiculoneuropatía que se ha asociado con enfermedades infecciosas como desencadenantes. En la actualidad es escasa la evidencia médica que explore la relación entre el desarrollo del síndrome de Guillain-Barré causado por la infección por SARS-CoV-2 y la COVID prolongada. Objetivo: Sintetizar la evidencia médica que describe la relación entre el síndrome pos-COVID y el síndrome de Guillain-Barré en la población pediátrica. Metodología: Se realizó una revisión exploratoria utilizando las bases de datos de Scopus y PubMed, incluyendo estudios experimentales y observacionales analíticos o descriptivos. Resultados: Las principales manifestaciones clínicas presentadas por los pacientes fueron debilidad distal y ascendente en miembros inferiores y mialgias. El enfoque diagnóstico se apoyó en los hallazgos clínicos, hallazgos imagenológicos por resonancia magnética de columna y electromiografía. La estrategia terapéutica se basó en el uso de inmunoglobulinas humanas intravenosas. Conclusión: El síndrome de Guillain-Barré es una enfermedad frecuente en la población pediátrica con infección activa por SARS-CoV-2 o en sobrevivientes, sin embargo, es necesario incentivar el desarrollo de estudios clínicos que incrementen la literatura médica que describe esta asociación.

Interosseous atrophy beyond rheumatoid arthritis, a manifestation of amyotrophic lateral sclerosis

Interosseous atrophy of the hand is not an exclusive finding of rheumatoid arthritis, and in the case of amyotrophic lateral sclerosis it has a significant diagnostic and prognostic value. The physical examination and evidence of the "split hand" sign or sign of the double anatomical snuffbox is a finding that should alert the clinician to the need for complementary studies in order to rule out neurological pathology.

La atrofia de interóseos de la mano no es un hallazgo exclusivo de la artritis reumatoide, en el caso de la esclerosis lateral amiotrófica tiene un valor diagnóstico y pronóstico significativo, por lo que la exploración física y la evidencia del signo de la mano partida o signo de la doble tabaquera anatómica es un hallazgo que debe alertar al clínico de la necesidad de realizar estudios complementarios para descartar una enfermedad neurológica.

Afasia primaria progresiva y sus variantes: diagnóstico, evolución, características imagenológicas y manejo / Progressive primary aphasia and its variants: diagnosis, evolution, imaging characteristics and management

RESUMEN INTRODUCCIÓN: Las demencias son un conjunto de trastornos neurocognitivos, en personas con edad menor a 65 años sobresale la demencia frontotemporal, síndrome neurodegenerativo heterogéneo que tiene dos grandes variantes: conductual y afasia primaria progresiva. En esta última se describen tres variantes: no fluente, semántica y logopénica, que exigen en la práctica conocimientos actualizados para su diferenciación y comprensión. El objetivo de este escrito es hacer una revisión narrativa sobre las tres variantes clínicas de la afasia primaria progresiva, profundizando en diagnóstico, evolución, características imagenológicas y manejo. MATERIALES Y MÉTODOS: Artículo de revisión narrativa a partir del estado del arte en literatura biomédica sobre demencia frontotemporal, afasia primaria progresiva y sus variantes. RESULTADOS: El compromiso del lenguaje y de otras funciones cognitivas, así como los hallazgos imagenológicos, son heterogéneos en las tres variantes. Semiológicamente, la afasia primaria progresiva no fluente se caracteriza por apraxia del habla, la variante logopénica por fallas en la nominación y la variante semántica por fallas en el significado del mensaje. El compromiso imagenológico en la afasia primaria progresiva no fluente es más frontoinsular y corticosubcortical; en la variante semántica es habitualmente temporal del lado dominante; y en la variante logopénica priman alteraciones temporoparietales. No hay tratamiento específico, pero se puede vincular algunas opciones farmacológicas con procesos/técnicas de rehabilitación del lenguaje. CONCLUSIÓN: Si bien se trata de una forma heterogénea de demencia, tiene características clínicas (síntomas, signos y evolución) e imagenológicas importantes a la hora de su detección y diagnóstico en ambientes clínicos.

ABSTRACT INTRODUCTION: Dementias are a group of neurocognitive disorders, and in people under 65 years of age, frontotemporal dementia stands out, a heterogeneous neurodegenerative syndrome that has two major variants: behavioral and primary progressive aphasia. In the latter, three variants are described: non-fluent, semantic and logopenic, which require up-to-date knowledge in practice for their differentiation and understanding. The objective is to carry out a narrative review on the three clinical variants of primary progressive aphasia, delving into diagnosis, evolution, imaging characteristics and management. MATERIALS AND METHODS: Narrative review article based on the state of the art in biomedical literature on frontotemporal dementia, primary progressive aphasia and its variants. RESULTS: The compromise of language and other cognitive functions, as well as the imaging findings, are heterogeneous in the three variants. Semiologically, non-fluent progressive primary aphasia is characterized by apraxia of speech, the logopenic variant by failures in the nomination and the semantic variant by failures in the meaning of the message. Imaging involvement in non-fluent progressive primary aphasia is mainly frontoinsular and cortico-subcortical; in the semantic variant it is usually temporary on the dominant side; and in the logopenic variant, temporo-parietal alterations prevail. There is no specific treatment, but some pharmacological options can be linked with language rehabilitation processes / techniques. CONCLUSION: although Frontotemporal dementia is an heterogenous disorder, there are important clinical and imagenologic features that are useful to the diagnostic approach in the clinical field.

Relato da experiência da atuação fonoaudiológica em telessaúde em pacientes neurológicos com disfagia e disartria durante a pandemia de Covid-19 / Experience report of speech therapy in telehealth with neurological patients with dysphagia and dysarthria during the Covid-19 pandemic / Reporte de experiencia de desempeño logopédico en telesalud en pacientes neurológicos con disfagia y disartria durante la pandemia de Covid-19

Introdução: Devido à COVID-19, os pacientes com doenças neurológicas deixaram de frequentar presencialmente as consultas fonoaudiológicas em ambulatórios. Objetivo: Descrever o relato da experiência fonoaudiológica em pacientes com doença neurológica com disartria e/ou disfagia durante a pandemia da COVID-19 através da telessaúde. Método: Trata-se de um relato de experiência. Foram incluídos pacientes do ambulatório de fonoaudiologia de um hospital universitário, que ficaram privados do acompanhamento fonoaudiológico em período pandêmico e que tinham diagnóstico de disfagia e/ou disartria (prévios à pandemia). No total, 43 pacientes foram convidados a participar do estudo. Os indivíduos foram separados de acordo com seu diagnóstico fonoaudiológico: disfagia, disartria e disfagia/disartria. No início, todos foram reavaliados em videochamadas: disfagia (Northwestern dysphagia patient check sheet, Escala Funcional de Ingestão Via Oral e Instrumento de Autoavaliação da Alimentação); disartria (coleta de fala e questionário de autopercepção Radbould Oral Inventory Motor for Parkinson's disease). Após, os pacientes foram alocados aleatoriamente: teleatendimento fonoaudiológico por quatro semanas consecutivas, sendo o outro grupo controle, sem intervenções e/ou orientações. Todos foram reavaliados para a comparação pré e pós-acompanhamento fonoaudiológico. Resultados: Nove participantes concluíram todas as etapas do estudo, sendo 6 (66,66%) homens. A média de idade foi de 60,44 anos (±16,13). Os participantes possuíam diagnóstico médico de doença neurológica, sendo 2 neurogenética (22,22%), 5 neurodegenerativa (55,5%) e 2 neurológicas (22,22%). Não foram observadas diferenças descritivas entre os grupos nas avaliações pré e pós-intervenção. A perda na amostra aconteceu devido à falta de dispositivos tecnológicos e à sobrecarga dos cuidadores. Conclusões: A experiência em tele fonoaudiologia, apesar de ter sido positiva, revelou a dificuldade da sua implementação em pacientes neurológicos de baixa condições sócio financeiras e educacional.

Introduction: Due to COVID-19, patients with neurological disease no longer attend face-to-face speech therapy consultations in outpatient clinics. Objective: To describe the report of the speech therapy experience patients with neurological disease with dysarthria and/or dysphagia during the COVID-19 pandemic through telehealth. Method: This is an experience report. Patients from the speech therapy outpatient clinic of a university hospital who were deprived of speech therapy during a pandemic period and had a diagnosis of dysphagia and/or dysarthria (prior to the pandemic) were included. In total, 43 patients were invited to participate in the study. Individuals were separated according to their speech-language diagnosis: dysphagia, dysarthria, and dysphagia/dysarthria. In the beginning, all were reassessed in video calls: dysphagia (Northwestern dysphagia patient check sheet, Functional Oral Intake Scale, and Food Self-Assessment Instrument); dysarthria (speech collection and self-perception questionnaire Radbould Oral Motor Inventory for Parkinson's disease). Afterward, the patients were randomly allocated: speech therapy telecare for four consecutive weeks, with the other being a control group, without interventions and/or guidance. All were reassessed for comparison before and after speech therapy follow-up. Results:Nine participants completed all stages of the study, 6 (66.66%) men. The mean age was 60.44 years (±16.13). Participants had a medical diagnosis of neurological disease, 2 of which were neurogenetic (22.22%), five neurodegenerative (55.5%), and two neurologic (22.22%). No descriptive differences were observed between groups in pre- and post-intervention assessments. The loss in the sample happened due to the lack of technological devices and the overload of caregivers. Conclusions: The experience in telehealth was positive, revealing the difficulty of its implementation in neurological patients with low socio-financial and educational conditions.

Introducción: Debido al COVID-19, los pacientes con enfermedades neurologicas ya no asisten a consultas de logopedia presenciales en consultas externas. Objetivo: Describir el relato de la experiencia fonoaudiológica en pacientes con enfermedades neurologicas con disartria y/o disfagia durante la pandemia de COVID-19 a través de telesalud. Método: Este es un relato de experiencia. Se incluyeron pacientes de la consulta externa de logopedia de un hospital universitario, que fueron privados de logopedia durante un período de pandemia y que tenían diagnóstico de disfagia y/o disartria (previo a la pandemia). En total, 43 pacientes fueron invitados a participar en el estudio. Los individuos se separaron según su diagnóstico del habla y el lenguaje: disfagia, disartria y disfagia/disartria. Al principio, todos fueron reevaluados en videollamadas: disfagia (Northwestern dysphagia patient check sheet), Escala de ingesta oral funcional e Instrumento de autoevaluación de alimentos); disartria (cuestionario de recogida de voz y autopercepción Radbould Oral Motor Inventory for Parkinson's disease). Posteriormente, los pacientes fueron asignados aleatoriamente: teleasistencia logopédica durante cuatro semanas consecutivas, siendo el otro grupo control, sin intervenciones y/u orientaciones. Todos fueron reevaluados para compararlos antes y después del seguimiento con logopedia. Resultados: Nueve participantes completaron todas las etapas del estudio, 6 (66,66%) hombres. La edad media fue de 60,44 años (±16,13). Los participantes tenían diagnóstico médico de enfermedad neurológica, 2 de ellas neurogenéticas (22,22%), 5 neurodegenerativas (55,5%) y 2 neurológica (22,22%). No se observaron diferencias descriptivas entre los grupos en las evaluaciones previas y posteriores a la intervención. La pérdida en la muestra ocurrió por la falta de dispositivos tecnológicos y la sobrecarga de cuidadores. Conclusiones: La experiencia en telefonoaudiología, a pesar de ser positiva, reveló la dificultad de su implementación en pacientes neurológicos de baja condición socioeconómica y educativa.