Allostatic load measures in older adults with subjective cognitive decline and mild cognitive impairment: A cross-sectional analysis from the Brazilian Memory and Aging Study.

INTRODUCTION: An increasing body of research suggests that stress and allostatic load are related to cognitive dysfunction and neurodegeneration. OBJECTIVES: to determine the relationship between allostatic load (AL) and cognitive status in older adults classified with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). METHODOLOGY: Using the Brazilian Memory and Aging Study (BRAMS) database, we analyzed data from 57 older adults with SCD and MCI. Blood neuroendocrine (cortisol, DHEA-s), inflammatory (C-reactive protein, fibrinogen), metabolic (HbA1c, HDL-cholesterol, total cholesterol, creatinine), and cardiovascular (blood pressure, waist/hip ratio) were transformed into an AL index. RESULTS: Despite a significant difference in the univariate analysis between waist/hip ratio (0.94 in the MCI group vs. 0, 88 in the SCD group, p = 0.03), total cholesterol levels (194 vs. 160, p = 0.02), and AL index (36.9 % in the MCI group vs. 27.2 % in the SCD group, p = 0.04), AL was not associated with SCD or MCI in the multivariate analysis. CONCLUSION: Our data suggest that different profiles of AL in MCI compared to individuals with SCD could be due to cofounding factors. These findings need to be confirmed in longitudinal studies investigating profiles of AL changes at preclinical and prodromal stages of Alzheimer's disease.

Características clínico epidemiológicas de pacientes con enfermedad por hígado graso no alcohólico: Serie de casos / Clinical-epidemiologic characteristics of patients with non-alcoholic fatty liver disease: Case series

Fundamento: El hígado graso no alcohólico es la enfermedad hepática por depósito de grasa en ausencia de un consumo significativo de alcohol. La mayoría de los pacientes tienen un nexo epidemiológico común asociado a factores de riesgo metabólico. Objetivo: Describir características clínico epidemiológicas de pacientes con enfermedad por hígado graso no alcohólico. Metodología: Se realizó un estudio descriptivo de una serie de casos en la consulta de Gastroenterología del Hospital General Provincial "Camilo Cienfuegos" de Sancti Spíritus, durante el período 6 de mayo de 2019 al 6 de mayo de 2020. Se consideró un total de 1167 pacientes pertenecientes a la provincia Sancti Spíritus; a 346 pacientes se le diagnosticó esteatosis hepática por ultrasonido; la muestra se conformó por 114 pacientes que cumplieron con los criterios de inclusión. Resultados: La mayoría de los pacientes con la enfermedad eran sintomáticos, hombres y tenían comorbilidad como la hipertensión arterial y obesidad, el índice de masa corporal y el índice de cintura abdominal/cadera estaban elevados en el sexo femenino, las alteraciones en la química sanguínea fueron colesterol y triacilglicéridos. Conclusiones: Predominó en el sexo masculino y la comorbilidad con la HTA y la obesidad, y la dislipidemia, además los hábitos alimenticios inadecuados y el sedentarismo; las medidas antropométricas resultaron elevadas en el sexo femenino.

Background: Nonalcoholic fatty liver disease is a resulting from fat accumulation in the absence of significant alcohol consumption. Most patients have a common epidemiologic link associated with metabolic risk factors. Objective: To describe the clinical and epidemiologic characteristics of patients with nonalcoholic fatty liver disease. Methodology: A descriptive study of a series of cases was carried out in the Gastroenterology consultation of the "Camilo Cienfuegos" Provincial General Hospital of Sancti Spíritus, during the period from May 6, 2019 through May 6, 2020. A total of 1167 patients belonging to the province of Sancti Spiritus were included in the study; 346 patients were diagnosed with hepatic steatosis by means of ultrasound; the sample consisted of 114 patients who fulfilled the inclusion criteria. Results: Most patients with the disease were symptomatic, men, and had comorbidities including hypertension and obesity, the body mass index and the waist-to-hip ratio of the abdomen were increased in women., the blood chemistry changes were cholesterol and triacylglycerides. Conclusions: It predominated in the male sex and comorbidity with HBP and obesity and dyslipidemia, in addition to inadequate dietary habits and sedentary lifestyle; in women, the anthropometric measurements were high.

Are we ready to use anti-amyloid therapy in Alzheimer's disease?

Alzheimer's disease (AD) is the most common neurodegenerative disease. Biomarkers have demonstrated that AD pathology exists over the disease continuum from a stage preceding symptoms over 15-25 years to the progressively more impaired symptomatic states, mild cognitive impairment (MCI), and dementia. Biomarkers include: amyloid (Aß), phosphorylated tau, and neurodegeneration. The plasma assays for Aß and tau show great promise for clinical and research use. This review has aimed not only to present the ATN diagnostic classification and the preclinical AD concepts in addressing some possibilities of cognitive assessment instruments, but also to briefly summarize the main anti-amyloid monoclonal antibodies studied in clinical trials. In addition, this paper presents a critical analysis by experts in cognitive neurology while addressing the question as to whether we are prepared for the anti-amyloid therapy era or not.

Are we ready to use anti-amyloid therapy in Alzheimer's disease? / Estamos prontos para o uso de terapia anti-amiloide na doença de Alzheimer?

ABSTRACT Alzheimer's disease (AD) is the most common neurodegenerative disease. Biomarkers have demonstrated that AD pathology exists over the disease continuum from a stage preceding symptoms over 15-25 years to the progressively more impaired symptomatic states, mild cognitive impairment (MCI), and dementia. Biomarkers include: amyloid (Aß), phosphorylated tau, and neurodegeneration. The plasma assays for Aß and tau show great promise for clinical and research use. This review has aimed not only to present the ATN diagnostic classification and the preclinical AD concepts in addressing some possibilities of cognitive assessment instruments, but also to briefly summarize the main anti-amyloid monoclonal antibodies studied in clinical trials. In addition, this paper presents a critical analysis by experts in cognitive neurology while addressing the question as to whether we are prepared for the anti-amyloid therapy era or not.

RESUMO A doença de Alzheimer (DA) é a doença neurodegenerativa mais comum. Os biomarcadores demonstraram que a patologia da DA existe ao longo do continuum da doença, desde um estágio anterior à sintomatologia, ao longo de 15 a 25 anos, até os estados sintomáticos progressivamente mais prejudicados, comprometimento cognitivo leve (CCL) e demência. Eles subdividem-se em três categorias: amiloide (Aß), tau fosforilada e neurodegeneração. A dosagem de Aß e tau plasmáticos mostra uma grande promessa para uso clínico e de pesquisa. Esta revisão teve como objetivo apresentar a classificação diagnóstica da ATN, os conceitos pré-clínicos da DA e abordar algumas possibilidades de instrumentos de avaliação cognitiva, mas principalmente resumir brevemente os principais anticorpos monoclonais anti-amiloide estudados em ensaios clínicos. Além disso, este artigo apresenta uma análise crítica de especialistas em neurologia cognitiva: estamos ou não preparados para a era da terapia anti-amiloide?

Subjective sleep parameters in prodromal Alzheimer's disease: a case-control study

Objective: People with Alzheimer's disease (AD) dementia have impaired sleep. However, the characteristics of sleep in the early stages of AD are not well known, and studies with the aid of biomarkers are lacking. We assessed the subjective sleep characteristics of non-demented older adults and compared their amyloid profiles. Methods: We enrolled 30 participants aged ≥ 60 years, with no dementia or major clinical and psychiatric diseases. They underwent [11C]PiB-PET-CT, neuropsychological evaluations, and completed two standardized sleep assessments (Pittsburgh Sleep Quality Inventory and Epworth Sleep Scale). Results: Comparative analysis of subjective sleep parameters across the two groups showed longer times in bed (p = 0.024) and reduced sleep efficiency (p = 0.05) in individuals with positive amyloid. No differences in other subjective sleep parameters were observed. We also found that people with multiple-domain mild cognitive impairment (MCI) had shorter self-reported total sleep times (p = 0.034) and worse overall sleep quality (p = 0.027) compared to those with single-domain MCI. Conclusions: Older adults testing positive for amyloid had a longer time in bed and lower sleep efficiency, regardless of cognitive status. In parallel, individuals with multiple-domain MCI reported shorter sleep duration and lower overall sleep quality.

Subjective sleep parameters in prodromal Alzheimer's disease: a case-control study.

OBJECTIVE: People with Alzheimer's disease (AD) dementia have impaired sleep. However, the characteristics of sleep in the early stages of AD are not well known, and studies with the aid of biomarkers are lacking. We assessed the subjective sleep characteristics of non-demented older adults and compared their amyloid profiles. METHODS: We enrolled 30 participants aged ≥ 60 years, with no dementia or major clinical and psychiatric diseases. They underwent [11C]PiB-PET-CT, neuropsychological evaluations, and completed two standardized sleep assessments (Pittsburgh Sleep Quality Inventory and Epworth Sleep Scale). RESULTS: Comparative analysis of subjective sleep parameters across the two groups showed longer times in bed (p = 0.024) and reduced sleep efficiency (p = 0.05) in individuals with positive amyloid. No differences in other subjective sleep parameters were observed. We also found that people with multiple-domain mild cognitive impairment (MCI) had shorter self-reported total sleep times (p = 0.034) and worse overall sleep quality (p = 0.027) compared to those with single-domain MCI. CONCLUSIONS: Older adults testing positive for amyloid had a longer time in bed and lower sleep efficiency, regardless of cognitive status. In parallel, individuals with multiple-domain MCI reported shorter sleep duration and lower overall sleep quality.

Aplicación de la Medicina Natural y Tradicional en quemaduras. Presentación de un caso / Application of Natural and Traditional Medicine in burns. Presentation of a case

Introducción: Se pueden clasificar a las lesiones por quemaduras las mayorías de las veces dentro de los traumas prevenibles, y constituyen una condición absolutamente no deseada por el paciente y su familia. constituyen estos pacientes un grupo vulnerable debido al alto riesgo de morbimortalidad, la presencia de lesiones invalidantes, funcionales y estéticas; es por tanto una causa de muerte accidental. El uso de la medicina natural y tradicional (fitoterapia) como tratamiento beneficioso que brindan a la salud humana, y la recuperación más armónica y natural, cumplen la función primordial de proteger el organismo humano. El frijol gandul con sus propiedades contra la acción de los Radicales Libres. Los antioxidantes, Vitaminas A, C y E, pueden desarrollar actividades antiviral y antimicrobiana y mejorar significativamente la función endotelial. Paciente adulta de treinta y tres años de edad, con antecedentes patológicos personales de salud. La cual durante labores del hogar se derrama contenido de agua hirviendo, se accidenta con quemaduras localizada en la región dorso medio plantar del pie izquierdo de magnitud.

Uso de la acupuntura en pacientes con Enfermedad Hepática Grasa No Alcohólica / Use of acupuncture in patients with Non-Alcoholic Fatty Liver Disease

Introducción: La acupuntura es una modalidad terapéutica de la Medicina Natural y Tradicional (MNT) que afirma que los flujos de energía dentro del cuerpo humano se pueden restablecer y mejorar el balance en el proceso salud ­ enfermedad. Objetivo: Describir los beneficios clínicos de la acupuntura como tratamiento en los pacientes con Enfermedad Hepática Grasa No Alcohólica. Metodología: Se revisaron artículos científicos en Bases de Datos Scielo, Medline, PubMed. Desarrollo: Numerosos estudios clínicos controlados y aleatorizados, y revisiones sistemáticas han intentado evaluar la eficacia clínica de la acupuntura. La evidencia derivada de estos trabajos avala la acupuntura como un tratamiento eficaz. Según la Medicina Tradicional China un hígado graso estaría relacionado con la acumulación de Flema de Tan y Humedad- Calor. A todo lo anterior se le conoce como síndrome de estancamiento del Qi (MNT), la cual requiere una cura o depuración para el hígado, por otro lado, la Enfermedad Hepática Grasa No Alcohólica (EHGNA) es la infiltración de grasa al hepatocito en ausencia del consumo de alcohol u otras enfermedades hepáticas crónicas secundarias. Comprende un espectro de afecciones hepáticas que va desde la simple esteatosis a la esteatohepatitis, fibrosis y hasta cirrosis. Conclusiones: El tratamiento con acupuntura constituye un soporte de fácil acceso. No produce efectos indeseados y su uso es aplicable en pacientes con comorbilidades. Siendo una nueva alternativa para tratar la enfrentar la Enfermedad Hepática Grasa No Alcohólica.

Alzheimer's disease and sleep disturbances: a review.

The association between Alzheimer's disease (AD) and sleep disturbances has received increasing scientific attention in the last decades. However, little is known about the impact of sleep and its disturbances on the development of preclinical AD stages, such as mild cognitive impairment. This review describes the evolution of knowledge about the potential bidirectional relationships between AD and sleep disturbances exploring recent large prospective studies and meta-analyses and studies of the possible mechanisms through which sleep and the neurodegenerative process could be associated. The review also makes a comprehensive exploration of the sleep characteristics of older people, ranging from cognitively normal individuals, through patients with mild cognitive impairment, up to the those with dementia with AD.

Alzheimer's disease and sleep disturbances: a review / Doença de Alzheimer e distúrbios do sono: uma revisão

ABSTRACT The association between Alzheimer's disease (AD) and sleep disturbances has received increasing scientific attention in the last decades. However, little is known about the impact of sleep and its disturbances on the development of preclinical AD stages, such as mild cognitive impairment. This review describes the evolution of knowledge about the potential bidirectional relationships between AD and sleep disturbances exploring recent large prospective studies and meta-analyses and studies of the possible mechanisms through which sleep and the neurodegenerative process could be associated. The review also makes a comprehensive exploration of the sleep characteristics of older people, ranging from cognitively normal individuals, through patients with mild cognitive impairment, up to the those with dementia with AD.

RESUMO A associação entre Doença de Alzheimer (DA) e distúrbios do sono vem recebendo atenção crescente nas últimas décadas. No entanto, pouco se sabe sobre o impacto do sono e suas alterações no desenvolvimento de estágios pré-clínicos da doença, como é o caso do Comprometimento Cognitivo Leve (CCL). Esta revisão descreve a evolução do conhecimento sobre as relações potencialmente bidirecionais entre DA e distúrbios do sono, explorando grandes estudos prospectivos e meta-análises, assim como estudos dos possíveis mecanismos da associação entre o sono e as doenças neurodegenerativas. Também revisamos amplamente as características do sono de pessoas idosas, incluindo indivíduos cognitivamente normais, com CCL e com demência por DA.

Validation of Mycobacterium tuberculosis real-time polymerase chain reaction for diagnosis of tuberculous meningitis using cerebrospinal fluid samples: a pilot study.

Background Timely diagnosis of tuberculous meningitis (TBM) remains challenging. Molecular diagnostic tools are necessary, particularly in low- and middle-income countries. There is no approved commercial polymerase chain reaction (PCR) assay that can be used to detect Mycobacterium tuberculosis in non-respiratory samples, such as the cerebrospinal fluid (CSF). We aimed to validate the threshold cycle (Ct) cut-off points; calculate the operational characteristics of real-time PCR for detection of M. tuberculosis (MTb qPCR) in the CSF; and the inhibitory affect of CSF red blood cells (RBC) and total proteins on MTb qPCR. Methods A total of 334 consecutive participants were enrolled. Based on clinical, laboratory and imaging data, cases of suspected TBM were categorized as definite, probable, possible or not TBM cases. Receiver operating characteristic curve analysis was used to select the best discriminating Ct value. Results For TBM cases categorized as definite or probable (n=21), the Ct validated for CSF (≤39.5) improved the diagnostic performance of MTb qPCR on CSF samples. The sensitivity was 29%, specificity was 95%, positive predictive value was 26%, negative predictive value was 95%, efficiency was 90% and positive likelihood was 5.3. The CSF RBC and total protein did not affect the positivity of the MTb qPCR. Conclusions These data support the validation of a highly specific but low sensitive MTb qPCR assay for the TBM diagnosis using CSF samples. MTb qPCR contributes significantly to the diagnosis, mainly when associated with conventional microbiology tests and clinical algorithms.

Oxford Cognitive Screen - Brazilian Portuguese version (OCS-Br) A pilot study.

Cognitive impairment is very common in stroke patients and underdiagnosed. Symptoms such as language, praxis, visuospatial, visuoconstructive and memory impairment are prominent. The screening cognitive tests available do not address some specific characteristics of stroke patients and have major limitations in relation to the most impaired cognitive domains. OBJECTIVE: To test the applicability of a Brazilian version of the Oxford Cognitive Screen in a convenience sample of individuals with normal cognition. METHODS: Thirty neurologically healthy participants underwent the OCS-Br in this pilot study. RESULTS: The mean score on each task was: naming: 3.4 (SD=0.72) (maximum value of 4); semantics: 3 (SD=0) (maximum 3); orientation: 4 (SD=0) (maximum 4); visual field: 4 (SD=0) (maximum 4); sentence reading: 14.53 (SD: 1) (maximum 15); number writing: 2.86 (0.6) (maximum 3); calculation: 3.8 (SD=0.48) (maximum 4); and accuracy on the broken hearts test: 47.3 (3.3) (maximum 50). The scores obtained were similar to those of the English original sample. CONCLUSION: We observed similar values on each separate OCS task in comparison to the original test, confirming that the Brazilian Portuguese version is comparable to other studies.

O comprometimento cognitivo é muito comum em pacientes com AVC e pouco diagnosticado. Déficits cognitivos envolvendo as funções de linguagem, praxia, habilidades visuoespaciais, visuoconstrutivas e memória são proeminentes. Os testes de avaliação cognitiva disponíveis não abordam algumas características específicas dos pacientes com AVC e apresentam limitação importante em relação aos domínios cognitivos mais comprometidos. OBJETIVO: Testar a aplicabilidade de uma versão brasileira do Oxford Cognitive Screen em uma amostra de conveniência com indivíduos sem prejuízo cognitivo. MÉTODOS: Trinta participantes neurologicamente saudáveis foram submetidos ao OCS-Br neste estudo piloto. RESULTADOS: O escore médio em cada tarefa foi: nomeação: 3,4 (DP=0,72) (valor máximo de 4); semântica: 3 (DP=0) (máximo de 3); orientação: 4 (DP=0) (máximo de 4); campo visual: 4 (DP=0) (máximo de 4); leitura de sentenças: 14,53 (DP: 1) (máximo de 15); número escrito: 2,86 (0,6) (máximo de 3); cálculo: 3,8 (DP=0,48) (máximo de 4); precisão no teste de corações partidos: 47,3 (3,3) (máximo de 50). Os escores foram semelhantes aos da amostra original. CONCLUSÃO: Observamos valores similares em cada tarefa separada do OCS em comparação ao teste original, o que torna a versão em português brasileiro comparável a outros estudos, e todos os itens foram bem compreendidos com potencial de usabilidade em nosso país.

Oxford Cognitive Screen - Brazilian Portuguese version (OCS-Br): a pilot study / Oxford Cognitive Scale - versão em português do Brasil (OCS-BR): um estudo piloto

ABSTRACT Cognitive impairment is very common in stroke patients and underdiagnosed. Symptoms such as language, praxis, visuospatial, visuoconstructive and memory impairment are prominent. The screening cognitive tests available do not address some specific characteristics of stroke patients and have major limitations in relation to the most impaired cognitive domains. Objective: To test the applicability of a Brazilian version of the Oxford Cognitive Screen in a convenience sample of individuals with normal cognition. Methods: Thirty neurologically healthy participants underwent the OCS-Br in this pilot study. Results: The mean score on each task was: naming: 3.4 (SD=0.72) (maximum value of 4); semantics: 3 (SD=0) (maximum 3); orientation: 4 (SD=0) (maximum 4); visual field: 4 (SD=0) (maximum 4); sentence reading: 14.53 (SD: 1) (maximum 15); number writing: 2.86 (0.6) (maximum 3); calculation: 3.8 (SD=0.48) (maximum 4); and accuracy on the broken hearts test: 47.3 (3.3) (maximum 50). The scores obtained were similar to those of the English original sample. Conclusion: We observed similar values on each separate OCS task in comparison to the original test, confirming that the Brazilian Portuguese version is comparable to other studies.

RESUMO O comprometimento cognitivo é muito comum em pacientes com AVC e pouco diagnosticado. Déficits cognitivos envolvendo as funções de linguagem, praxia, habilidades visuoespaciais, visuoconstrutivas e memória são proeminentes. Os testes de avaliação cognitiva disponíveis não abordam algumas características específicas dos pacientes com AVC e apresentam limitação importante em relação aos domínios cognitivos mais comprometidos. Objetivo: Testar a aplicabilidade de uma versão brasileira do Oxford Cognitive Screen em uma amostra de conveniência com indivíduos sem prejuízo cognitivo. Métodos: Trinta participantes neurologicamente saudáveis foram submetidos ao OCS-Br neste estudo piloto. Resultados: O escore médio em cada tarefa foi: nomeação: 3,4 (DP=0,72) (valor máximo de 4); semântica: 3 (DP=0) (máximo de 3); orientação: 4 (DP=0) (máximo de 4); campo visual: 4 (DP=0) (máximo de 4); leitura de sentenças: 14,53 (DP: 1) (máximo de 15); número escrito: 2,86 (0,6) (máximo de 3); cálculo: 3,8 (DP=0,48) (máximo de 4); precisão no teste de corações partidos: 47,3 (3,3) (máximo de 50). Os escores foram semelhantes aos da amostra original. Conclusão: Observamos valores similares em cada tarefa separada do OCS em comparação ao teste original, o que torna a versão em português brasileiro comparável a outros estudos, e todos os itens foram bem compreendidos com potencial de usabilidade em nosso país.

Neurosyphilis and ocular syphilis clinical and cerebrospinal fluid characteristics: a case series.

BACKGROUND: During the first decade of this century, a significant increase in the incidence of syphilis was documented. OBJECTIVE: To study clinical and laboratory characteristics of central nervous system and ocular syphilis. METHODS: A retrospective case series of 13 patients with a clinical and laboratory diagnosis of neurosyphilis and/or ocular syphilis who had been admitted to the Neurology and Neuro-ophthalmology Service of the Hospital de Clínicas, Federal University of Paraná. RESULTS: Nine patients had a diagnosis of neurosyphilis and two of them also had ocular syphilis. Four patients had a diagnosis of ocular syphilis alone. Among the patients with a diagnosis of neurosyphilis, six had symptomatic syphilitic meningitis, of whom one manifested as cranial nerve palsy alone, one as cranial nerve palsy plus ocular syphilis, two as transverse myelitis (syphilitic meningomyelitis), one as meningitis worsening the patient's myasthenia gravis symptoms and one as meningitis plus ocular syphilis. Additionally, we diagnosed three patients with meningovascular neurosyphilis. In the univariate analysis, patients without ocular syphilis showed greater levels of total protein and white blood cells in the cerebrospinal fluid than patients with ocular syphilis. CONCLUSION: This Brazilian case series of patients with neurosyphilis and ocular syphilis highlights the wide variability of this disease. A high degree of diagnostic suspicion is necessary when facing neurological and ocular symptoms for rapid diagnosis and appropriate management of patients.

Neurosyphilis and ocular syphilis clinical and cerebrospinal fluid characteristics: a case series / Características clínicas e liqúoricas de pacientes com neurossífilis e sífilis ocular: uma série de casos

ABSTRACT Background During the first decade of this century, a significant increase in the incidence of syphilis was documented. Objective To study clinical and laboratory characteristics of central nervous system and ocular syphilis. Methods A retrospective case series of 13 patients with a clinical and laboratory diagnosis of neurosyphilis and/or ocular syphilis who had been admitted to the Neurology and Neuro-ophthalmology Service of the Hospital de Clínicas, Federal University of Paraná. Results Nine patients had a diagnosis of neurosyphilis and two of them also had ocular syphilis. Four patients had a diagnosis of ocular syphilis alone. Among the patients with a diagnosis of neurosyphilis, six had symptomatic syphilitic meningitis, of whom one manifested as cranial nerve palsy alone, one as cranial nerve palsy plus ocular syphilis, two as transverse myelitis (syphilitic meningomyelitis), one as meningitis worsening the patient's myasthenia gravis symptoms and one as meningitis plus ocular syphilis. Additionally, we diagnosed three patients with meningovascular neurosyphilis. In the univariate analysis, patients without ocular syphilis showed greater levels of total protein and white blood cells in the cerebrospinal fluid than patients with ocular syphilis. Conclusion This Brazilian case series of patients with neurosyphilis and ocular syphilis highlights the wide variability of this disease. A high degree of diagnostic suspicion is necessary when facing neurological and ocular symptoms for rapid diagnosis and appropriate management of patients.

RESUMO Introdução Na primeira década deste século observou-se um aumento significativo da incidência de sífilis no mundo. Objetivo Estudar características clínicas e laboratoriais da sífilis no Sistema Nervoso Central e da sífilis ocular. Métodos Estudou-se, retrospectivamente, uma série de treze casos com diagnóstico clínico e laboratorial de neurossífilis e/ou sífilis ocular, admitidos aos Serviços de Neurologia ou Neuroftalmologia do Hospital de Clínicas da Universidade Federal do Paraná. Resultados Nove pacientes tiveram diagnóstico de neurosífilis e dois destes apresentaram concomitantemente sífilis ocular. Quatro pacientes tiveram somente o diagnóstico de sífilis ocular. Dos pacientes com diagnóstico de neurosífilis, seis apresentaram meningite sifilítica sintomática, dentre os quais um se apresentou com paralisia isolada de par craniano, um com paralisia de par craniano associada sífilis ocular, dois com mielite transversa (manifestação de meningomielite), um com meningite que agravou sintomas de Miastenia Gravis e um com meningite isolada associada a sífilis ocular. Houve 3 casos de neurosífilis meningovascular. Na análise univariada, pacientes sem manifestações oculares de sífilis apresentaram maiores níveis proteína total e leucócitos do que os pacientes com sífilis ocular. Conclusão Essa série brasileira de casos de pacientes com neurosífilis e sífilis ocular destaca a alta variabilidade clínica desta doença. Alto grau de suspeição diagnóstica é necessário quando em frente a sintomas neurológicos e oculares para rápido diagnóstico e adequado manejo dos pacientes.

Nonneurological Involvement in Late-Onset Friedreich Ataxia (LOFA): Exploring the Phenotypes.

Friedreich's ataxia (FDRA) is the most common inherited ataxia worldwide, caused by homozygous GAA expansions in the FXN gene. Patients usually have early onset ataxia, areflexia, Babinski sign, scoliosis and pes cavus, but at least 25 % of cases have atypical phenotypes. Disease begins after the age of 25 in occasional patients (late-onset Friedreich ataxia (LOFA)). Little is known about the frequency and clinical profile of LOFA patients. One hundred six patients with molecular confirmation of FDRA and followed in three Brazilian outpatient centers were enrolled. General demographics, GAA expansion size, age at onset, cardiac, endocrine, and skeletal manifestations were evaluated and compared between LOFA and classic FDRA (cFDRA) groups. We used Mann-Whitney and Fisher tests to compare means and proportions between groups; p values <0.05 were considered significant. LOFA accounted for 17 % (18/106) and cFDRA for 83 % (88/106) of the patients. There were 13 and 48 women in each group, respectively. LOFA patients were significantly older and had smaller GAA expansions. Clinically, LOFA group had a tendency toward lower frequency of diabetes/impaired glucose tolerance (5.8 vs. 17 %, p = 0.29) and cardiomyopathy (16.6 vs. 28.4 %, p = 0.38). Skeletal abnormalities were significantly less frequent in LOFA (scoliosis 22 vs. 61 %, p = 0.003, and pes cavus 22 vs.75 %, p < 0.001) as were spasticity and sustained reflexes, found in 22 % of LOFA patients but in none of the cFDRA patients (p = 0.001). LOFA accounts for 17 % of Brazilian FDRA patients evaluated herein. Clinically, orthopedic features and spasticity with retained reflexes are helpful tips to differentiate LOFA from cFDRA patients.

Apresentação atípica de neurossífilis em paciente atendido no serviço de neurologia do HC ­ UFPR / Atypical presentation of neurosyphilis in patient treated at the neurology service of HC - UFPR

A sífilis é uma infecção sistêmica crônica que cursa com variadas apresentações clínicas e que pode acometer o sistema nervoso central, caracterizando a neurossífilis. O objetivo é relatar um caso de neurossífilis com apresentação atípica. Relato do caso: homem, 44 anos que apresentou paralisia facial periférica bilateral persistente após tratamento com corticoide e fisioterapia. Após dois meses, ainda apresentava sintomas e foi internado para investigação, na qual apresentou VDRL reagente no soro sendo diagnosticado com neurossífilis. Tratado por 10 dias com penicilina cristalina, evoluindo com melhora.A paralisia facial periférica bilateral pode ser uma apresentação atípica de neurossífilis e o uso de critérios diagnósticos é necessário pois não há exame padrão ouro para essa patologia. A neurossífilis pode se apresentar como paralisia facial periférica bilateral, mesmo em indivíduos imunocompetentes, e essa apresentação deve ser incluída na pratica clínica, permitindo o correto manejo do paciente.

Syphilis is a chronic infection that leads to various clinical presentations that may involve the central nervous system, featuring the neurosyphilis. The main objective is to report a case of neurosyphilis with atypical presentation. Case report: man, 44 years old who presented persistent bilateral facial palsy after treatment with corticosteroids and physiotherapy. After two months, he still had symptoms and was admitted for investigation, which showed positive VDRL in serum being diagnosed with neurosyphilis. He was treat for 10 days with penicilina, evolving with complete elimination of the symptomatology. The bilateral facial palsy can be an atypical presentation of neurosyphilis and the use of diagnostic criteria is necessary since there is no gold standard test for this disease. Neurosyphilis may present as bilateral facial palsy, even in immunocompetent individuals and this presentation should be included in clinical practice allowing the correct management of patient.

ProCura - a arte da vida: um projeto pela humanização na saúde / ProCura - the art of living: a project for the humanization of health care

As modificações da medicina tornaram o conhecimento biomédico soberano, gerando a perda da relação médico-paciente, o que fomentou o movimento pela humanização. Na Universidade Federal do Paraná (UFPR), formou-se o projeto de extensão "ProCura - a arte da vida", a fim de implementar a humanização entre os alunos e em suas relações profissionais. Seus objetivos se baseiam nos pilares: relação estudante-paciente, relação estudante-estudante e formação teórico-reflexiva, e se subdividem nos grupos Cineclube, Clown e Contação de Histórias. De 2010 a 2012, 79 alunos participaram e atenderam 905 pacientes, 505 acompanhantes e 107 funcionários. Apesar de limitações de alcance no que concerne a atingir todos os alunos do Setor de Ciências da Saúde, o projeto pretende fomentar a discussão entre grupos e que seus ideais e atividades se espalhem e permeiem o meio acadêmico.

Changes in medicine have promoted biomedical knowledge to a position of sovereignty. Coupled with the decline of the physician-patient relationship, this has brought about the the humanization movement. At the Federal University of Paraná (UFPR), a community outreach project entitled "ProCura - the art of living" has been created to implement humanization among students and in their professional relationships. Its objectives are based on three pillars: student-patient relationship, student-student relationship and theoretical-reflexive training, subdivided into groups named Cineclube, Clown and Contação de Histórias. Between 2010 and 2012, 79 students participated in the project, attending to 905 to patients, 505 companions and 107 employees. Despite its limited scope as regards reaching all Department of Health Sciences students, the Project aims to promote discussion between groups and disseminate their ideals and activities throughout academic circles.