Factors affecting executive function performance of Brazilian elderly in the Stroop test

Aging is related to a decrease in physiological abilities, especially cognitive functions. To unravel further evidence of age-related cognitive decline, we analyzed which physical and functional variables are predictors of cognitive performance in a sample of 498 Brazilian elderly (67.26% women). To do so, we used the Stroop test as a tool to evaluate executive functions and the General functional fitness index (GFFI) to evaluate the functional fitness of the participants. A linear regression analysis revealed that female sex (β=-0.097; t=-2.286; P=0.023), younger age (β=0.205; t=4.606; P<0.0001), more years of education (β=-0.280; t=-6.358; P<0.0001), and higher GFFI (β=-0.101; t=-2.347; P<0.02) were predictors of better cognitive performance. Body mass index (kg/m2) and nutritional status (underweight, eutrophic, overweight, or obese) were not predictors of cognitive performance. Interestingly, among the GFFI tasks, muscle strength influenced the test execution time, both in upper and lower limbs (elbow flexion: β=-0.201; t=-4.672; P<0.0001; sit-to-stand: β=-0.125; t=-2.580; P<0.01). Our findings showed that: 1) women performed the Stroop test faster than men; 2) the older the person, the lower was the cognitive performance; 3) the higher the education, the better the test execution time; and 4) higher scores in the GFFI were associated with a better performance in the Stroop test. Therefore, gender, age, education, and functional fitness and capacity were predictors of cognitive performance in the elderly.

Adrenergic receptor ß3 is involved in the memory consolidation process in mice

Attention and emotion have a positive impact on memory formation, which is related to the activation of the noradrenergic system in the brain. The hippocampus and amygdala are fundamental structures in memory acquisition, which is modulated by noradrenaline through the noradrenergic receptors. Pharmacological studies suggest that memory acquisition depends on the action of both the β3 (β3-AR) and β2 (β2-AR) receptor subtypes. However, the use of animal models with specific knockout for the β3-AR receptor only (β3-ARKO) allows researchers to more accurately assess its role in memory formation processes. In the present study, we evaluated short- and long-term memory acquisition capacity in β3-ARKO mice and wild-type mice at approximately 60 days of age. The animals were submitted to the open field test, the elevated plus maze, object recognition, and social preference. The results showed that the absence of the β3-AR receptor caused no impairment in locomotion and did not cause anxious behavior, but it caused significant impairment of short- and long-term memory compared to wild-type animals. We also evaluated the expression of genes involved in memory consolidation. The mRNA levels for GLUT3, a glucose transporter expressed in the central nervous system, were significantly reduced in the amygdala, but not in the hippocampus of the β3-ARKO animals. Our results showed that β3-AR was involved in the process of acquisition of declarative memory, and its action may be due to the facilitation of glucose absorption in the amygdala.

Mareo y/o vertigo como motivo de consulta en la policlínica neurológica: estudio descriptivo / Dizziness and/or vertigo as a reason for consultation in the neurology polyclinic: a descriptive case

Introducción: los mareos y vértigos son uno de los principales motivos de consulta en medicina. Los pacientes que los padecen realizan reiteradas consultas por la incapacidad que les produce, no logrando en muchos casos un diagnóstico etiológico claro. Produce un importante gasto tanto para los servicios de salud como para el propio paciente. Objetivos: 1. Conocer las características clínicas de una población de pacientes que consultaron por mareos y/o vértigos en policlínica de neurología del Hospital de Clínicas. 2. Evaluar tipo de vértigo y etiología. Material y método: se realizó un estudio prospectivo durante seis meses de una cohorte de pacientes mayores de 15 años que tuvieron como motivo de consulta mareos y/o vértigos. Resultados: en el período considerado se incluyeron 64 pacientes (84% mujeres, 16% hombres); la media de edad fue de 55,2 años. El 78% había consultado en otra oportunidad por estos síntomas. La especialidad más consultada fue el médico general en 28%. El 72% presentaba un vértigo verdadero con un tiempo de evolución de dichos síntomas mayor a un año en 52% de los casos. El examen físico evidenció que los signos clínicos más utilizados para valorar el sistema vestibular (Romberg, Barany y Unterberger) tienen una alta especificidad pero baja sensibilidad. El diagnóstico etiológico más frecuente fue el vértigo postural paroxístico benigno en 39% de los casos. Conclusiones: los mareos y/o vértigos son motivo de consultas frecuentes, usualmente reiteradas. Debemos extremar esfuerzos para lograr un correcto diagnóstico etiológico y un adecuado tratamiento.UAU)

Introduction: dizziness and vertigo are one of the main causes of consultation in medicine. Patients suffering from these symptoms repeatedly consult due to the impairments caused by them, and in many cases the etiological diagnosis is not clear. It is a costly condition both for health services and patients. Objectives: 1. To learn about the clinical features of the population that consulted for dizziness and/or vertigo in the neurology polyclinic of the University Hospital. 2. To evaluate the kinds of vertigo and their etiology Method: we conducted a prospective study during six months in a cohort of patients over 15 years old, who consulted for dizziness and /or vertigo. Results: 64 patients were included in the referred period of time (84% women, 16% men); average age was 55.2 years old. Seventy eight per cent of patients had already consulted previously, for these same symptoms. The specialists most frequently consulted were general practitioners (28%). Seventy two per cent of patients suffered from real vertigo and they had been experiencing the symptom for over a year in 52% of cases. Upon physical examination, the most widely used clinical signs to assess the vestibular system (Romberg, Barany y Unterberger) were found to have high specificity, although their sensitivity is low. The most frequent etiology diagnosis was benign paroxysmal positional vertigo (BPPV), in 39% of patients. Conclusions: dizziness and vertigo are frequent reasons for consultation, and usually patients consult repeatedly. We need to make our best to achieve the right etiologic diagnosis and appropriate treatment.

Introdução: as tonturas e vertigens são um dos principais motivos de consulta em medicina. Os pacientes consultam muitas vezes devido às limitações causadas por esses sintomas, porém em muitos casos não obtém um diagnóstico etiológico claro. As tonturas e vertigens causam gastos consideráveis tanto para os serviços de saúde como para o paciente. Objetivos: 1. Conhecer as características clínicas de uma população de pacientes que consultaram por tonturas e/ou vertigens no ambulatório de neurologia do Hospital de Clínicas. 2. Avaliar o tipo de vertigem e sua etiologia. Material e método: foi realizado um estudo prospectivo durante seis meses de uma coorte de pacientes maiores de 15 anos cujo motivo de consulta foi tonturas e/ou vertigens. Resultados: foram incluídos 64 pacientes (84% mulheres, 16% homens); a idade média foi 55,2 anos. 78% já haviam consultado pelos mesmos sintomas. A especialidade mais consultada foi medicina geral em 28%. 72% apresentava vertigem verdadeira com evolução dos sintomas por um período maior a um ano em 52% de los casos. O exame físico mostrou que os sinais clínicos mais utilizados para avaliar o sistema vestibular (Romberg, Barany e Unterberger) tem alta especificidade, mas baixa sensibilidade. O diagnóstico etiológico mais frequente foi vertigem posicional paroxística benigna em 39% dos casos. Conclusões: as tonturas e/ou vertigens são um motivo frequente de consulta e muitas vezes de varias consultas pelo mesmo paciente. Devemos buscar com afinco o diagnóstico etiológico correto e o tratamento adequado.

Mutation and genomic amplification of the PIK3CA proto-oncogene in pituitary adenomas

The tumorigenesis of pituitary adenomas is poorly understood. Mutations of the PIK3CA proto-oncogene, which encodes the p110-α catalytic subunit of PI3K, have been reported in various types of human cancers regarding the role of the gene in cell proliferation and survival through activation of the PI3K/Akt signaling pathway. Only one Chinese study described somatic mutations and amplification of the PIK3CA gene in a large series of pituitary adenomas. The aim of the present study was to determine genetic alterations of PIK3CA in a second series that consisted of 33 pituitary adenomas of different subtypes diagnosed by immunohistochemistry: 6 adrenocorticotropic hormone-secreting microadenomas, 5 growth hormone-secreting macroadenomas, 7 prolactin-secreting macroadenomas, and 15 nonfunctioning macroadenomas. Direct sequencing of exons 9 and 20 assessed by qPCR was employed to investigate the presence of mutations and genomic amplification defined as a copy number ≥4. Previously identified PIK3CA mutations (exon 20) were detected in four cases (12.1%). Interestingly, the Chinese study reported mutations only in invasive tumors, while we found a PIK3CA mutation in one noninvasive corticotroph microadenoma. PIK3CA amplification was observed in 21.2% (7/33) of the cases. This study demonstrates the presence of somatic mutations and amplifications of the PIK3CA gene in a second series of pituitary adenomas, corroborating the previously described involvement of the PI3K/Akt signaling pathway in the tumorigenic process of this gland.

Carcinoma da mama metastatico para leiomioma uterino. / Breast carcinoma metastatic to uterine leiomyoma

Os autores apresentam o caso de uma paciente portadora de carcinoma da mama estadio IV, com metastases no interior de um leiomioma uterino. Fazem uma revisao sobre a frequencia do acometimento uterino por metastases de orgaos extrapelvicos e discutem a importancia desse achado em pacientes portadores de carcinoma da mama

Embolectomia arterial tardia. / Delayed arterial embolization

Em raras ocasioes a isquemia determinada por fenomeno embolico arterial das extremidades e suficientemente compensado para nao levar a situacao definida de irreversibilidade com consequente perda do segmento comprometido, favorecendo a protelacao de procura de tratamento medico por parte do paciente. Quatorze pacientes foram atendidos nestas circunstancias, todos com tempo de isquemia igual ou superior a sete dias. Em todos os casos foi tentada a embolectomia convencional por meio de cateter, a qual foi conseguida em 13 casos ja que em um nao se conseguiu vencer o trombo localizado na bifurcacao da aorta.Em outro caso houve trombose subsequente a embolectomia. Dentre os demais pacientes ocorreu um obito e em um definiram-se lesoes irreversiveis do segmento isquemico.Desta forma, a emblolectomia foi efetiva em 72% dos casos, ocorrendo indice de mortalidade de 7%, e igual numero de amputacoes

Aneurisma toraco-abdominal.Consideracoes cirurgicas e anestesiologicas. / Thoraco-abdominal aneurysm: surgical and anestesiologic considerations

O aneurisma da aorta toraco-abdominal e apresentado como afeccao grave e de indicacao cirurgica. Os autores explicam sua experiencia inicial a aneurismectomia pela tecnica preconizada por Crawford, fazendo consideracoes a respeito do procedimento cirurgico e ressaltando as implicacoes anestesiologicas, bem como as dos preparo pre-operatorio