Enhancing affordability and profit in a non-cooperative, coordinated, hypothetical pediatric vaccine market via sequential optimization.

This study considers a hypothetical global pediatric vaccine market where multiple coordinating entities make optimal procurement decisions on behalf of countries with different purchasing power. Each entity aims to improve affordability for its countries while maintaining a profitable market for vaccine producers. This study analyzes the effect of several factors on affordability and profitability, including the number of non-cooperative coordinating entities making procuring decisions, the number of market segments in which countries are grouped for tiered pricing purposes, how producers recover fixed production costs, and the procuring order of the coordinating entities. The study relies on a framework where entities negotiate sequentially with vaccine producers using a three-stage optimization process that solves a MIP and two LP problems to determine the optimal procurement plans and prices per dose that maximize savings for the entities' countries and profit for the vaccine producers. The study's results challenge current vaccine market dynamics and contribute novel alternative strategies to orchestrate the interaction of buyers, producers, and coordinating entities for enhancing affordability in a non-cooperative market. Key results show that the order in which the coordinating entities negotiate with vaccine producers and how the latter recuperate their fixed cost investments can significantly affect profitability and affordability. Furthermore, low-income countries can meet their demands more affordably by procuring vaccines through tiered pricing via entities coordinating many market segments. In contrast, upper-middle and high-income countries increase their affordability by procuring through entities with fewer and more extensive market segments. A procurement order that prioritizes entities based on the descending income level of their countries offers higher opportunities to increase affordability and profit when producers offer volume discounts.

Deficiência de GDPD: um relato de caso / GDPD deficiency: a case report

INTRODUÇÃO: A deficiência da enzima G6PD afeta cerca de 400 milhões de pessoas no mundo. É uma doença autossômica ligada ao cromossomo X. A G6PD é uma enzima que desempenha um papel na prevenção de danos celulares causados por espécies reativas de oxigênio, evitando o estresse oxidativo. Após serem expostas a um agente exógeno portadores da deficiência de G6PD podem apresentar uma anemia hemolítica aguda, podendo até ser fatal. O caso relatado neste trabalho é de uma paciente que durante quatro anos buscou auxílio diagnóstico na rede básica de saúde por diversas ocasiões, recebendo o diagnóstico de deficiência de G6PD após investigação minuciosa durante o período de internação. OBJETIVO: O relato de caso de um diagnóstico desafiador na prática médica de uma condição que apesar de comum ainda é de difícil diagnóstico, principalmente quando apresentado sintomas na fase adulta. MÉTODOS: Esse foi um estudo do tipo relato de caso, em que se descreveu um caso de deficiência da enzima G6PD. Realizada pesquisa bibliográfica utilizando como complementação bibliográfica e embasamento teórico. RESULTADOS/DISCUSSÃO: Após intensa investigação e correlação com o quadro clínico, foi evidenciado níveis séricos reduzidos de G6PD, sendo estabelecido quadro de deficiência de G6PD. que também pode ter gerado um atraso no diagnóstico foi o fato da patologia psiquiátrica importante da paciente. É sabido que os paciente psiquiátricos são muitas vezes negligenciados pela equipe de saúde, sempre atribuindo todos os sintomas ao quadro psiquiátrico. CONCLUSÃO: A deficiência de G6PD é um diagnóstico desafiador na prática médica, e apesar de comum é subdiagnosticada, visto que é pouco aventada como etiologia de um quadro sistêmico, principalmente quando apresenta sintomas apenas na fase adulta, em especial, pacientes com transtornos psiquiátricos.

Preparation and Phytotoxicity Evaluation of Cellulose Acetate Nanoparticles.

The use of biocompatible and low-cost polymeric matrices to produce non-phytotoxic nanoparticles for delivery systems is a promising alternative for good practices in agriculture management and biotechnological applications. In this context, there is still a lack of studies devoted to producing low-cost polymeric nanoparticles that exhibit non-phytotoxic properties. Among the different polymeric matrices that can be used to produce low-cost nanoparticles, we can highlight the potential application of cellulose acetate, a natural biopolymer with biocompatible and biodegradable properties, which has already been used as fibers, membranes, and films in different agricultural and biotechnological applications. Here, we provided a simple and low-cost route to produce cellulose acetate nanoparticles (CA-NPs), by modified emulsification solvent evaporation technique, with a main diameter of around 200 nm and a spherical and smooth morphology for potential use as agrochemical nanocarriers. The non-phytotoxic properties of the produced cellulose acetate nanoparticles were proved by performing a plant toxic test by Allium cepa assay. The cytotoxicity and genotoxicity tests allowed us to evaluate the mitotic process, chromosomal abnormalities, inhibition/delay in root growth, and micronucleus induction. In summary, the results demonstrated that CA-NPs did not induce phytotoxic, cytotoxic, or genotoxic effects, and they did not promote changes in the root elongation, germination or in the mitotic, chromosomal aberration, and micronucleus indices. Consequently, the present findings indicated that CA-NPs can be potentially used as environmentally friendly nanoparticles.

Mercury spatiality and mobilization in roadside soils adjacent to a savannah ecological reserve.

Mercury (Hg) is a persistent environmental pollutant of global concern. Recognized anthropic contributions to environmental Hg pollution include fuel fossil emissions, soil erosion, and industrial and mining activities. Environmental Hg that enters water bodies can be methylated before entering the food chain and contaminating man and wildlife. We used a kriging approach for sampling and X-ray crystallography to study the pressure of road-traffic Hg emissions on soil Hg concentrations in an ecological reserve (ESECAE) in Central Brazil' savannah. We took samples of organic (n = 144) and mineral (n = 144) layers from the road-side and from the undisturbed soils at 0.1, 1, and 2 km from traffic, inside the ESECAE. Overall, total mercury (THg) concentrations determined by atomic absorption spectrophotometry were significantly higher in the organic layer than in the mineral layer. The mean soil THg in the organic and mineral layers was highest at the roadside (respectively 19.77 ± 12.01 and 16.18 ± 11.54 µg g-1), gradually decreasing with the distance from the road. At 2 km, the mean soil THg was 0.09 ± 0.30 and 0.029 ± 0.03 µg g-1, respectively, for the organic and mineral layers. X-ray crystallography showed mineralogical similarity of the sampled soils, indicating Hg externality, i.e, it did not originate from existing soil minerals. Co-kriging analysis (n = 288) confirmed Hg hotspots on the roadsides and a faster mobilization occurring up to a distance of 1 km for both layers. The soil reception and retention of traffic Hg emissions are mainly in the organic layer and can impact subsoil and adjacent areas. Thus, traffic soil-Hg pollution is limited to the road proximities; THg concentrations are high up to 100 m with an inflection point at 1 km.

Fatal pulmonary sporotrichosis caused by Sporothrix brasiliensis in Northeast Brazil.

BACKGROUND: A relevant case of pulmonary sporotrichosis due to Sporothrix brasiliensis is reported in a 50-year-old immunocompetent woman who had no history of skin trauma, but was in close contact with several stray cats at her nap time. The patient was hospitalized after 7 months of illness. The survey was conducted for pulmonary tuberculosis, an endemic disease in Brazil. She presented multiple central pulmonary nodules images, with central cavitation. METHODOLOGY/PRINCIPAL FINDINGS: The patient bronchoalveolar lavage was cultured and Sporothrix sp. growth was obtained. Then, the isolate (LMMM1097) was accurately identified to the species level by using species-specific polymerase chain reaction (PCR). Molecular diagnosis revealed that the emerging species Sporothrix brasiliensis was the agent of primary pulmonary sporotrichosis and the patient was treated with Amphotericin B lipid complex, but presented severe clinical symptoms and the fatal outcome was observed at day 25 after hospitalization. CONCLUSIONS/SIGNIFICANCE: Our report adds important contributions to the clinical-epidemiological features of sporotrichosis, showing the geographic expansion of the agent within different regions of Brazil and a rare clinical manifestation (primary pulmonary sporotrichosis) caused by the emerging agent S. brasiliensis in an immunocompetent female patient.

Angiosarcoma of small intestine: case report and literature review / Angiossarcoma de intestino delgado: relato de caso e revisão da literatura

ABSTRACT Introduction: Angiosarcomas are rare pathologies, and their appearance in the small intestine is extremely unusual. Case report: Female patient presenting vomiting, colic, abdominal distension and peritoneal irritation. An exploratory laparotomy and an enterectomy were performed. Histopathology revealed vascular neoplasm; immunohistochemistry, markers CD31, p53 and cell proliferation antigen Ki-67. The patient developed diffuse sarcomatosis and died two months after the onset of symptoms. Conclusion: This case demonstrates the difficulty in early diagnosing this pathology, due to its nonspecific clinical presentation. The disease aggressiveness, its unestablished predisposing factors and the controversy around the adequate treatment engender the poor prognosis.

RESUMO Introdução: Angiossarcomas são patologias raras, e o aparecimento deles no intestino delgado é extremamente incomum. Relato de caso: Paciente do sexo feminino apresentando vômitos, cólica, distensão abdominal e irritação peritoneal. Foram realizadas laparotomia exploratória e enterectomia, evidenciando-se neoplasia vascular ao anatomopatológico e marcadores CD31, p53 e antígeno de proliferação celular Ki-67 à imuno-histoquímica. A paciente evoluiu com sarcomatose difusa e faleceu dois meses após o início dos sintomas. Conclusão: Demonstra-se a dificuldade em diagnosticar precocemente essa patologia devido à sua clínica inespecífica. A agressividade da doença, seus fatores predisponentes indeterminados e a controvérsia referente ao tratamento adequado suscitam seu péssimo prognóstico.

Morphology and morphometry of feline bone marrow-derived mesenchymal stem cells in culture / Morfologia e morfometria das células-tronco mesenquimais isoladas de medula óssea de gato

Mesenchymal stem cells (MSC) are increasingly being proposed as a therapeutic option for treatment of a variety of different diseases in human and veterinary medicine. Stem cells have been isolated from feline bone marrow, however, very few data exist about the morphology of these cells and no data were found about the morphometry of feline bone marrow-derived MSCs (BM-MSCs). The objectives of this study were the isolation, growth evaluation, differentiation potential and characterization of feline BM-MSCs by their morphological and morphometric characteristics. in vitro differentiation assays were conducted to confirm the multipotency of feline MSC, as assessed by their ability to differentiate into three cell lineages (osteoblasts, chondrocytes, and adipocytes). To evaluate morphological and morphometric characteristics the cells are maintained in culture. Cells were observed with light microscope, with association of dyes, and they were measured at 24, 48, 72 and 120h of culture (P1 and P3). The non-parametric ANOVA test for independent samples was performed and the means were compared by Tukey's test. On average, the number of mononuclear cells obtained was 12.29 (±6.05x106) cells/mL of bone marrow. Morphologically, BM-MSCs were long and fusiforms, and squamous with abundant cytoplasm. In the morphometric study of the cells, it was observed a significant increase in average length of cells during the first passage. The cell lengths were 106.97±38.16µm and 177.91±71.61µm, respectively, at first and third passages (24 h). The cell widths were 30.79±16.75 µm and 40.18±20.46µm, respectively, at first and third passages (24 h).The nucleus length of the feline BM-MSCs at P1 increased from 16.28µm (24h) to 21.29µm (120h). However, at P3, the nucleus length was 26.35µm (24h) and 25.22µm (120h). This information could be important for future application and use of feline BM-MSCs.(AU)

As células tronco mesenquimais são utilizadas na terapia de várias doenças na medicina humana e veterinária. As células tronco foram isoladas da medula óssea de gato, entretanto, existem poucos dados referentes a morfologia e não existem informações sobre a morfometria das células tronco isoladas da medula óssea. Os objetivos do presente estudo foram o isolamento, avaliação do crescimento, potencial de diferenciação e caracterização morfológica e morfométrica das células mesenquimais de gato isoladas de medula óssea. A diferenciação in vitro foi realizada para confirmar a multipotencialidade das células mesenquimais de gato (diferenciação em osteoblastos, condrócitos, adipócitos). As células mesenquimais foram mantidas em cultivo para avaliações morfológica e morfométrica. As células foram coradas e observadas em microscopia ótica. As mensurações foram realizadas com 24, 48, 72 e 120h de cultura (primeira e terceira passagens). O teste não paramétrico ANOVA foi utilizado e as médias foram comparadas pelo teste de Tukey. O número médio de células mononucleares obtido foi de 12,29 (±6,05x106) células/mL de medula óssea. As células mesenquimais são longas e fusiformes, e escamosas com citoplasma abundante. No estudo morfométrico, observou-se aumento no comprimento médio das células durante a primeira passagem. As medidas de comprimento das células foram: 106,97±38,16µm e 177,91±71,61µm, respectivamente, na primeira e terceira passagens (24 horas). As medidas de largura das células foram: 30,79±16,75 µm e 40,18±20,46 µm, respectivamente, na primeira e terceira passagens (24 horas). O comprimento do núcleo na primeira passagem aumentou de 16,28µm (24h) para 21,29µm (120h) e na terceira passagem foi de 26,35µm (24h) para 25,22µm (120h). As informações são importantes para futuras aplicações e uso da célula mesenquimal de gato.(AU)

EEG in epilepsy: sensibility and specificity / EEG em epilepsia: sensibilidade e especificidade

Objective: the aim of this study was to determine the sensitivity (presence of epileptiform discharges in the EEGs of patientswith epilepsy) and specificity (absence of discharges in the EEGs in people without epilepsy) of EEG. Methodology: all EEGs performed at the Clinic Santa Vitória, in Campina Grande, PB, from April 2001 to April 2010 were reviewed. All recordings were performed in accordance with international standards for fixing the electrodes, minimum time of registration and methods activation (intermittent photic stimulation and hyperventilation). The reports were divided into 1) patients with epilepsy, previously diagnosed by neurologists, and 2) patients without epilepsy. For both groups, we evaluated the sensitivity and specificity of the EEG. We used SPSS for statistical tests. The study was approved by the Ethics Committee of UEPB. 10,408 EEGs were reviewed. Results: epileptiform discharges occurred in 1412 (13.56%). Among those with epilepsy, discharges occurred in 643 (45.57%) - true-positive. Among those who did not have epilepsy, in 54.43% - false positives. From a total of 8,996 (86.44%) EEGs without discharges, 1,276 (14.14%) were from the group of patients with epilepsy - false-negative and 7,720 (85.78%) were from the group of patients without epilepsy - true negative. The positive likelihood ratio test showed that the probability of finding EEG discharges is four times higher among patients with epilepsy compared to those who do not have epilepsy. The negative likelihood ratio test showed no differences between false negative and true negative. In general, a sensitivity of 33.5% and a specificity of 90.9%, with no differences in age and gender was observed. Therefore, EEG showed high specificity but low sensitivity as a diagnostic method in epilepsy...

Objetivo: o objetivo deste estudo foi verificar a sensibilidade (presença de descargas em EEGs de portadores de epilepsia) e a especificidade (ausência de descargas em EEGs de sem epilepsia) do EEG. Metodologia: foram revisados todos os EEGs realizados na Clínica Santa Vitória, em Campina Grande, PB, no período de abril de 2001 a abril de 2010. Todos os registros foram realizados de acordo com padrões internacionais para a fixação dos eletrodos, tempo mínimo de registro e métodos de ativação (fotoestimulação intermitente e hiperventilação). Os laudos foram divididos em 1) pacientes portadores de epilepsia, previamente diagnosticada por neurologistas, e 2) pacientes sem epilepsia. Para ambos os grupos, estudou-se a sensibilidade e a especificidade do EEG. Foram utilizados testes estatísticos através do programa SPSS. O estudo foi aprovado pelo Comitê de Ética da UEPB. Foram revisados 10.408 EEGs. Resultados: descargas epileptiformes ocorreram em 1412 (13,56%). Dentre os portadores de epilepsia, descargas ocorreram em 643 (45,57%) - verdadeiros-positivos. Dentre os que não apresentam epilepsia, em 54,43% - falsos-positivos. De um total de 8.996 (86,44%) de EEGs sem descargas, 1.276 (14,14%) eram do grupo de portadores de epilepsia - falsos-negativos e 7.720 (85,78%) eram do grupo de pacientes sem epilepsia - verdadeiros-negativos. O teste de verossimilhança positiva revelou que a probabilidade de ocorrerem descargas é quarto vezes maior dentre os portadores de epilepsia, comparados aos que não apresentam epilepsia. Já o teste de verossimilhança negativa não evidenciou diferenças significativas entre falsos-negativos e verdadeiros-negativos. De modo geral, foi observada uma sensibilidade de 33,5% e uma especificidade de 90,9%, sem diferenças quanto à idade e ao gênero. O EEG apresentou, portanto, alta especificidade, mas uma baixa sensibilidade, como método diagnóstico auxiliar nas epilepsias...

Pseudo-acute myocardial infarction due to transient apical ventricular dysfunction syndrome (Takotsubo syndrome).

Takotsubo syndrome is characterized by predominantly medial-apical transient left ventricular dysfunction, which is typically triggered by physical or emotional stress. The present article reports the case of a 61-year-old female patient presenting with dizziness, excessive sweating, and sudden state of ill feeling following an episode involving intense emotional stress. The physical examination and electrocardiogram were normal upon admission, but the troponin I and creatine kinase-MB concentrations were increased. Acute myocardial infarction without ST segment elevation was suspected, and coronary angiography was immediately performed, which showed severe diffuse left ventricular hypokinesia, medial-apical systolic ballooning, and a lack of significant coronary injury. The patient was referred to the intensive care unit and was successfully treated with supportive therapy. As this case shows, Takotsubo syndrome might simulate the clinical manifestations of acute myocardial infarction, and coronary angiography is necessary to distinguish between both myocardial infarction and myocardial infarction in the acute stage. The present patient progressed with spontaneous resolution of the ventricular dysfunction without any sequelae.

Pseudoinfarto agudo do miocárdio devido à síndrome da disfunção ventricular apical transitória (síndrome de Takotsubo) / Pseudo-acute myocardial infarction due to transient apical ventricular dysfunction syndrome (Takotsubo syndrome)

A síndrome de Takotsubo caracteriza-se por disfunção ventricular esquerda transitória, predominantemente medioapical, desencadeada caracteristicamente por estresse físico ou emocional. Relata-se aqui o caso de uma paciente de 61 anos de idade, admitida com tontura, sudorese profusa e mal-estar súbito, após intenso estresse emocional. Exame físico e eletrocardiograma inicial foram normais, porém havia elevação de troponina I e CKMB massa. Suspeitou-se de infarto agudo do miocárdio sem supradesnivelamento do segmento ST, indicando cineangiocoronariografia de urgência. Foram evidenciados ventrículo esquerdo com hipocinesia difusa grave, balonamento sistólico medioapical e coronárias sem lesões significativas. A paciente foi encaminhada aos cuidados intensivos, evoluindo satisfatoriamente com terapia de suporte. Conforme visto, a cardiomiopatia de Takotsubo pode simular infarto agudo do miocárdio, sendo a cineangiocoronariografia importante para distinção na fase aguda. Neste caso, a paciente evoluiu com resolução espontânea da disfunção ventricular, sem sequelas.

Takotsubo syndrome is characterized by predominantly medial-apical transient left ventricular dysfunction, which is typically triggered by physical or emotional stress. The present article reports the case of a 61-year-old female patient presenting with dizziness, excessive sweating, and sudden state of ill feeling following an episode involving intense emotional stress. The physical examination and electrocardiogram were normal upon admission, but the troponin I and creatine kinase-MB concentrations were increased. Acute myocardial infarction without ST segment elevation was suspected, and coronary angiography was immediately performed, which showed severe diffuse left ventricular hypokinesia, medial-apical systolic ballooning, and a lack of significant coronary injury. The patient was referred to the intensive care unit and was successfully treated with supportive therapy. As this case shows, Takotsubo syndrome might simulate the clinical manifestations of acute myocardial infarction, and coronary angiography is necessary to distinguish between both myocardial infarction and myocardial infarction in the acute stage. The present patient progressed with spontaneous resolution of the ventricular dysfunction without any sequelae.

The role of EEG in patients with syncope.

EEG is a popular, low-cost examination used in neurologic and nonneurologic evaluations. Nevertheless, the diagnostic usefulness of EEG has some limitations, and it may increase medical costs. The manifestations of syncope may lead to misdiagnoses, and frequently, it is mislabeled as epilepsy. An EEG is usually obtained, yet some studies have suggested that EEGs have little value in diagnosing this condition. We aimed to determine the diagnostic usefulness of EEG in patients with syncope. We retrospectively examined EEG recordings of 10,408 patients. EEG findings were evaluated for all patients with a diagnosis of syncope (syncope, convulsive syncope, loss of consciousness, or sudden unexplained falls), including requests from neurologists and nonneurologists. EEGs were classified into (1) normal, (2) epileptiform discharges (spike/sharp waves), and (3) slow waves. The EEGs were separated according to gender and age. From 1,003 patients with the diagnosis of syncope, 899 (89.53%) were normal, 62 (6.18%) showed bilateral slow waves, 19 (1.89%) right slow waves, 18 (1.79%) epileptiform discharges, and 6 (0.6%) left slow waves. Epileptiform discharges only occurred among females. Left focal sharp waves were disclosed in 18 (50%), generalized discharges in 8 (44.4%), and right focal discharges in 1 (5.6%). Bilateral slow waves were more prevalent among adults. We conclude that EEG is not useful for evaluating the diagnosis of syncope because of its very low diagnostic yield. Patients with syncope must have a correct history and physical examination plus cardiovascular tests.

Tratamento ortopédico funcional da deficiência mandibular: relato de caso / Functional orthopedic treatment of mandibular deficiency: case report

Apesar de ser amplamente utilizada, muitas vezes a terapia funcional não é totalmente compreendida. A questão principal que permanece é: existe crescimento extra, este tem relevância clínica? Como diferenciá-lo das alterações relacionadas com o crescimento? Qual a influência do potencial genético e fatores ambientais no sucesso do tratamento? Este trabalho tem como objetivo a apresentação de um caso clínico de Classe II dentária, 1º divisão e Classe II esquelética por deficiência mandibular tratado com aparelho ortopédico funcional removível dentossuportado tipo monobloco modificado. Neste caso clínico, verificou-se a manutenção da posição da maxila, aumento insignificante no posicionamento mandibular, aumento do comprimento total da mandíbula, uma redução da discrepância anteroposterior maxilomandibular, redução da projeção e inclinação dos incisivos superiores, aumento insignificante da inclinação dos incisivos inferiores e aumento vertical do padrão de crescimento facial. O resultado estético, dentário, esquelético e funcional do caso clínico foi favorável. Pôde-se concluir que as alterações que ocorreram são combinações de restrição do comprimento maxilar, compensações dentoalveolar, alteração de rotação do complexo nasomaxilar e mandibular e crescimento mandibular (menor grau).

Orthodontists rely on a large number of devices for the correction of dental malocclusion and improvement of facial aesthetics. Despite its widespread use, often functional therapy is not fully understood. This paper aims to present a case of dental Class II, division 1 and Class II malocclusions by mandibular deficiency treated with removable orthopedic functional device, a modified monobloc. It was observed maintenance of the maxilla position, insignificant increase in the mandible position, increasing in the total mandible length, reduction of the severe anteroposterior maxillomandibular discrepancy, reduction in the projection and tilt of the upper incisors, increase of the inclination of the lower incisors and increased vertical facial growth pattern. The changes are amendments or combinations of disorders and the restriction or redirection of growth, combined with dentoalveolar changes. The present case report concludes that the aesthetic result, dental, skeletal and functional case was favorable. The changes that have occurred are combinations of restriction the length maxillary dentoalveolar compensation, change the rotation of the nasomaxillary complex and mandibular growth mandibular (lesser extent).

Hemispheric assymetry of abnormal focal EEG findings / Assimetria hemisférica de anormalidades eletrencefalográficas focais

Left and right cerebral hemispheres are morphologically similar, although they are functionally different. Focal EEG abnormalities should appear with an equal frequency in both of them, but the literature has reported a left predominance. We presented the first Latin American study on lateralization of focal EEG abnormalities. METHOD: We retrospectively studied 10,408 EEGs from April 2001 to April 2010. They were separated by age and gender to estimate the frequency of left-sided versus right-sided focal abnormalities (discharges or slow waves). Associated clinical features were also accessed. RESULTS: Discharges were more prevalent in left cerebral hemisphere, in temporal lobe, and a stronger lateralization was found among adults. Right-sided discharges occurred more in frontal lobe. Slow waves were also more prevalent in the left cerebral hemisphere and among adults. Among left-sided slow waves group, women were more prevalent. Contrarily, men were more observed among right-sided slow waves EEGs. Left-sided slow waves were more prevalent in temporal and parietal lobes. Contrarily, right-sided slow waves occurred more in frontal and occipital lobes. Epilepsy was the most frequent disease among the patients with focal discharges in both cerebral hemispheres. Right-sided slow waves were more associated to epilepsy, and left-sided slow waves were more associated to headache. CONCLUSION: There were significant differences between cerebral hemispheres on focal EEG abnormalities, considering lateralization, gender, age and clinical features. These results suggest a neurofuncional asymmetry between cerebral hemispheres which may be explained by different specificities, as well as by cerebral neuroplasticity.

Embora sejam morfologicamente semelhantes, os hemisférios cerebrais apresentam diferenças funcionais geneticamente determinadas. Ainda assim, anormalidades eletrencefalográficas focais deveriam ocorrer simetricamente numa população geral, embora a literatura tenha referido um predomínio à esquerda. Nosso objetivo é relatar o primeiro estudo latino-americano sobre uma grande série de EEGs, no intuito de observar se há lateralização de anormalidades focais. MÉTODO: Foram estudados retrospectivamente 10.408 EEGs, realizados de abril de 2001 a abril de 2010, os quais foram classificados de acordo com a presença de anormalidades focais específicas (descargas) e inespecíficas (ondas lentas focais). Os EEGs foram divididos de acordo com o gênero e a idade, e foram analisados achados clínicos associados. RESULTADOS: As descargas foram mais prevalentes no hemisfério cerebral esquerdo, no lobo temporal, observando-se uma lateralização mais forte entre os adultos. À direita, elas prevaleceram no lobo frontal. Ondas lentas focais prevaleceram também à esquerda e no lobo temporal, especialmente entre os adultos. Entre os que apresentaram ondas lentas à esquerda, observou-se maior prevalência entre as mulheres. Os homens prevaleceram entre os que apresentaram ondas lentas à direita. À esquerda, ondas lentas prevaleceram nos lobos temporal e parietal. À direita, nos lobos frontal e occipital. Epilepsia foi o achado clínico mais associado à presença de descargas em ambos os hemisférios cerebrais. Ondas lentas à direita foram mais associadas a epilepsia, enquanto que, à esquerda, elas foram mais associadas a cefaleia. CONCLUSÃO: Houve diferenças entre os hemisférios cerebrais quanto à lateralização das anormalidades focais, assim como entre os gêneros, faixas etárias analisadas e quadro clínico associado.

Marcapassos vesicais: uso, histórico e estado atual / Bladder pacemaker: use history and current status

O presente trabalho faz uma revisão de literatura sobre os marcapassos vesicais, instrumentos utilizados no tratamento da incontinência urinária, mais especificamente nos casos de bexiga hiperativa. Aborda de maneira simples e elucidativa seu uso, histórico e estado atual, citando alguns trabalhos e consolidando conceitos de sua aplicação como opção concreta de tratamento dos casos selecionados (AU)

Marcapassos vesicais: uso, histórico e estado atual

O presente trabalho faz uma revisão de literatura sobre os marcapassos vesicais, instrumentos utilizados no tratamento da incontinência urinária, mais especificamente nos casos de bexiga hiperativa. Aborda de maneira simples e elucidativa seu uso, histórico e estado atual, citando alguns trabalhos e consolidando conceitos de sua aplicação como opção concreta de tratamento dos casos selecionados