Impact of the COVID-19 Pandemic on the Outcomes of Patients Undergoing Oncological Surgeries: CORONAL Study.

BACKGROUND: The impact of coronavirus disease 2019 (COVID-19) on postoperative recovery from oncology surgeries should be understood for the clinical decision-making. Therefore, this study was designed to evaluate the postoperative cumulative 28-day mortality and the morbidity of surgical oncology patients during the COVID-19 pandemic. METHODS: This retrospective cohort study included patients consecutively admitted to intensive care units (ICU) of three centres for postoperative care of oncologic surgeries between March to June 2019 (first phase) and March to June 2020 (second phase). The primary outcome was cumulative 28-day postoperative mortality. Secondary outcomes were postoperative organic dysfunction and the incidence of clinical complications. Because of the possibility of imbalance between groups, adjusted analyses were performed: Cox proportional hazards model (primary outcome) and multiple logistic regression model (secondary outcomes). RESULTS: After screening 328 patients, 291 were included. The proportional hazard of cumulative 28-day mortality was higher in the second phase than that in the first phase in the Cox model, with the adjusted hazard ratio of 4.35 (95% confidence interval [CI] 2.15-8.82). The adjusted incidences of respiratory complications (odds ratio [OR] 5.35; 95% CI 1.42-20.11) and pulmonary infections (OR 1.53; 95% CI 1.08-2.17) were higher in the second phase. However, the adjusted incidence of other infections was lower in the second phase (OR 0.78; 95% CI 0.67-0.91). CONCLUSIONS: Surgical oncology patients who underwent postoperative care in the intensive care unit during the COVID-19 pandemic had higher hazard of 28-day mortality. Furthermore, these patients had higher odds of respiratory complications and pulmonary infections. Trials registration The study is registered in the Brazilian Registry of Clinical Trials under the code RBR-8ygjpqm, UTN code U1111-1293-5414.

Treatment of Infected Pseudarthrosis of the Tibia Using the Ilizarov Method and the Orr Dressing.

Objective This study aims to analyze outcomes and clinical and epidemiological data of infected tibial pseudarthrosis using the Ilizarov method and the Orr dressing. Methods Data from n = 43 patients diagnosed with infected tibial pseudarthrosis were analyzed by descriptive and inferential statistical methods. In addition, Paley's assessment criteria evaluated bone and functional outcomes. Qualitative variables were presented as the distribution of absolute and relative frequencies. The presentation of quantitative variables followed the D'Agostino-Pearson test. Results Thirty-seven (86.04%) subjects were males, and six (13.95%) were females. The most frequent age group among patients was 50 to 59 years old (25.6%), with a p-value = 0.8610. The treatment time was longer for the trifocal treatment (23.8 months) when compared to the bifocal treatment (15.6 months), with a p-value = 0.0010* (highly significant). Excellent bone outcomes represented 72.09% of the sample; 23.25% of outcomes were good. Functional outcomes were excellent in 55.81%, good in 6.97%, and regular in 27.90% of subjects. The Orr dressing (using Vaseline gauze) proved effective, achieving wound healing with soft tissue coverage in all patients evaluated. Conclusions The Ilizarov method resulted in a substantial change in the treatment of bone infections, especially infected pseudarthrosis. The versatility of this method has turned it into an effective tool, allowing the healing of the infectious process and the correction of potential deformities and shortening.

Treatment of Infected Pseudarthrosis of the Tibia Using the Ilizarov Method and the Orr Dressing / Tratamento das pseudoartroses infectadas da tÍbia pelo mÉtodo de Ilizarov associado ao curativo de Orr

Abstract Objective This study aims to analyze outcomes and clinical and epidemiological data of infected tibial pseudarthrosis using the Ilizarov method and the Orr dressing. Methods Data from n = 43 patients diagnosed with infected tibial pseudarthrosis were analyzed by descriptive and inferential statistical methods. In addition, Paley's assessment criteria evaluated bone and functional outcomes. Qualitative variables were presented as the distribution of absolute and relative frequencies. The presentation of quantitative variables followed the D'Agostino-Pearson test. Results Thirty-seven (86.04%) subjects were males, and six (13.95%) were females. The most frequent age group among patients was 50 to 59 years old (25.6%), with a p-value = 0.8610. The treatment time was longer for the trifocal treatment (23.8 months) when compared to the bifocal treatment (15.6 months), with a p-value = 0.0010* (highly significant). Excellent bone outcomes represented 72.09% of the sample; 23.25% of outcomes were good. Functional outcomes were excellent in 55.81%, good in 6.97%, and regular in 27.90% of subjects. The Orr dressing (using Vaseline gauze) proved effective, achieving wound healing with soft tissue coverage in all patients evaluated. Conclusions The Ilizarov method resulted in a substantial change in the treatment of bone infections, especially infected pseudarthrosis. The versatility of this method has turned it into an effective tool, allowing the healing of the infectious process and the correction of potential deformities and shortening.

Resumo Objetivo Analisar os resultados e os dados clínicos e epidemiológicos do tratamento das pseudoartroses infectadas da tíbia pelo método de Ilizarov associado ao curativo de Orr. Métodos Para analisar os dados de n = 43 pacientes com diagnóstico de pseudoartrose infectada da tíbia foram aplicados métodos estatísticos descritivos e inferenciais e os resultados ósseos e funcionais foram avaliados de acordo com os critérios de avaliação de Paley. As variáveis qualitativas foram apresentadas por distribuição de frequências absolutas e relativas. As variáveis quantitativas foram apresentadas pelo teste de DAgostino-Pearson. Resultados Foi encontrado que 37 (86,04%) eram do sexo masculino, 6 (13,95%) femininos. A faixa etária mais frequente entre os pacientes foi de 50 a 59 anos (25.6%), p-valor = 0.8610. O tempo de tratamento é maior no tratamento trifocal (23.8 meses) quando comparado com o Bifocal (15.6 meses), p-valor =0.0010* (altamente significante). Os resultados ósseos excelentes representaram 72,09%, 23,25% foram de resultados considerados bons. Os resultados funcionais considerados excelentes foram 55,81%, os resultados bons foram 6,97%, resultados regulares foram 27,90. O curativo com gaze vaselinada (curativo de Orr) mostrou-se eficaz, alcançando assim a cicatrização das feridas com cobertura de partes moles em todos os pacientes avaliados. Conclusões O método de Ilizarov proporcionou uma mudança substancial no tratamentos das infecções ósseas, especialmente das pseudoartroses infectadas. A versatilidade deste método se transformou em uma ferramenta eficaz, permitindo a cura do processo infeccioso, bem como correção das possíveis deformidades e do encurtamento.

Everyday Evaluation of Herb/Dietary Supplement-Drug Interaction: A Pilot Study.

A lack of reliable information hinders the clinician evaluation of suspected herb-drug interactions. This pilot study was a survey-based study conceived as a descriptive analysis of real-life experiences with herb-drug interaction from the perspective of herbalists, licensed health-care providers, and lay persons. Reported dietary supplement-drug interactions were evaluated against the resources most commonly cited for the evaluation of potential supplement-drug interactions. Disproportionality analyses were performed using tools available to most clinicians using data from the U.S. Federal Adverse Event Reporting System (FAERS) and the US Center for Food Safety and Applied Nutrition (CFSAN) Adverse Event Reporting System (CAERS). Secondary aims of the study included exploration of the reasons for respondent use of dietary supplements and qualitative analysis of respondent's perceptions of dietary supplement-drug interaction. While agreement among reported supplement-drug interactions with commonly cited resources for supplement-drug interaction evaluation and via disproportionality analyses through FAERS was low, agreement using data from CAERS was high.

[Evaluation of the Knowledge of Women of Childbearing Age with Epilepsy about the Impact of Their Disease in Contraception, Pregnancy and Breastfeeding: A Multicenter Cross-Sectional Study]. / Avaliação do Conhecimento das Mulheres com Epilepsia em Idade Fértil sobre o Impacto da sua Doença na Contraceção, Gravidez e Amamentação: Um Estudo Transversal Multicêntrico.

INTRODUCTION: The interaction of antiseizure medication with contraceptives, its potential teratogenicity and implications in pregnancy and breastfeeding are aspects to consider in the neurological care of women with epilepsy of childbearing age. To ensure the commitment in therapeutic decisions and the appropriate planning of maternity, it is essential that women are informed about the implications of their disease in these domains. The main aim of this study was to assess the knowledge of women of childbearing age with epilepsy concerning the impact of epilepsy in contraception, pregnancy and breastfeeding. As secondary aims we defined (1) the demographic, clinical and therapeutic characterization of this group of patients, (2) the identification of variables that correlated with the level of knowledge of women with epilepsy, and (3) the identification of preferential methods to acquire new knowledge about epilepsy. MATERIAL AND METHODS: The study was observational, cross-sectional and multicentric, and was carried out in five hospitals of the Lisbon metropolitan area. After identifying all women of childbearing age with epilepsy followed in the epilepsy clinic of each center, we applied an electronic questionnaire based on a non-systematic review of the literature. RESULTS: One hundred and fourteen participants were validated, with a median age of 33 years. Half of the participants were on monotherapy, and the majority had no seizures in the last six months. We identified important gaps in the participants' knowledge. Sections about complications and administration of antiseizure medication during pregnancy were the ones with the worst results. None of the clinical and demographic variables correlated with the final questionnaire score. Having had a previous pregnancy and the desire to breastfeed in a future pregnancy were positively correlated with the performance in breastfeeding section. Face-to-face discussion during medical outpatient visits was selected as the preferential method to learn about epilepsy, and the internet and social media were the least preferred ones. CONCLUSION: The knowledge of women of childbearing age with epilepsy in the Lisbon metropolitan area concerning the impact of epilepsy in contraception, pregnancy and breastfeeding seems to have significant gaps. Medical teams should consider engaging in patient education particularly during outpatient clinics.

Introdução: A interação dos fármacos anticrise epilética com os métodos contracetivos, a sua potencial teratogenicidade e as implicações na gravidez e amamentação são aspetos a considerar no acompanhamento de mulheres com epilepsia em idade fértil. Para o seu desejado envolvimento nas decisões terapêuticas e o adequado planeamento da maternidade, é essencial que as mulheres estejam corretamente informadas acerca das implicações da sua doença. O objetivo principal do presente estudo foi avaliar o conhecimento das mulheres com epilepsia em idade fértil sobre o impacto da epilepsia na contraceção, gravidez e amamentação. Como objetivos secundários definiram-se (1) a caracterização demográfica, clínica e terapêutica deste grupo de doentes, (2) a identificação de variáveis correlacionadas com o nível de conhecimento das mulheres com epilepsia, e (3) a identificação de meios e suportes preferenciais para aquisição de novos conhecimentos sobre epilepsia. Material e Métodos: O estudo foi observacional, transversal e multicêntrico, tendo decorrido em cinco centros hospitalares da região metropolitana de Lisboa. Após identificação das mulheres com epilepsia em idade fértil seguidas na Consulta de Epilepsia de cada centro, aplicou-se um questionário eletrónico construído após revisão não sistemática da literatura. Resultados: Foram validadas 114 participantes, com uma idade mediana de 33 anos. Metade das participantes apresentavam-se sob monoterapia, tendo a maioria a epilepsia controlada há pelo menos seis meses. Identificaram-se importantes lacunas no conhecimento das participantes. Conceitos sobre complicações dos fármacos anticrise epilética e a sua administração durante a gravidez motivaram piores resultados. Não houve correlação entre variáveis clinico-demográficas e o resultado no questionário. A ocorrência de gravidez prévia e o desejo de amamentar numa gravidez futura correlacionaram-se com o desempenho na secção sobre amamentação. A discussão oral na consulta foi a forma preferencial para aquisição de novos conhecimentos sobre epilepsia, tendo a internet e as redes sociais sido os meios menos escolhidos. Conclusão: O conhecimento das mulheres com epilepsia em idade fértil na área metropolitana de Lisboa sobre o impacto da sua doença na contraceção, gravidez e amamentação parece apresentar lacunas importantes. A educação para a saúde deste grupo deverá constituir uma preocupação por parte das equipas médicas, devendo privilegiar-se a consulta como local de ensino.

Reflections on ideas and disputes in the context of the promotion of healthy eating. / Reflexões sobre ideias e disputas no contexto da promoção da alimentação saudável.

Actions in the promotion of healthy eating are strategic for reversing nutritional problems. This article analyzes the disputes over ideas in discursive repertoires on healthy eating in Brazil's national policies and international, government, civil society, and private commercial sector documents in the last 20 years. Based on the document analysis method in dialogue with the academic literature, the following perspectives on healthy eating were identified: traditional culturalist; medicalizing biological/nutritional; multidimensional; and systemic. The disputes are established between ideas in the following areas: the existence of "unhealthy foods"; the attributions, limits, and forms of State intervention; eating as an individual or public matter; and the meanings of sustainability, commensality, culture, and food. Policy positions on pesticides, food fortification, and supplementation are key elements in these disputes. In the policy sphere, the private commercial sector adopts strategies of fragmentation, downplaying, and distortion of meanings that reinforce polarization between individual actions (lifestyles, freedom of choice) and environmental interventions, thereby disseminating a narrow approach to food and nutrition education. Civil society pressures governments to establish concepts and principles in policies that directly affect the disputes' parameters. The latter act with greater or lesser permeability to pressures from internal or external stakeholders, depending on their composition and the institutional spaces for dialogue with society.

As ações de promoção da alimentação saudável são estratégicas para reversão dos problemas nutricionais. Este artigo analisa as disputas em torno das ideias presentes em repertórios discursivos sobre alimentação saudável em políticas nacionais, documentos internacionais, societários e do setor privado comercial, nos últimos vinte anos. Com base no método de análise documental em diálogo com a literatura acadêmica, foram identificadas as seguintes perspectivas de alimentação saudável: tradicional culturalista; nutricional biologicista medicalizante; multidimensional e sistêmica. As disputas instituem-se em torno das ideias sobre: a existência de "alimentos não saudáveis"; as atribuições, limites e formas de intervenção do Estado; a alimentação como uma questão da esfera individual ou de caráter público; os sentidos da sustentabilidade, da comensalidade, da cultura e da comida. Os posicionamentos adotados nas políticas em relação aos agrotóxicos, à fortificação de alimentos e à suplementação são elementos-chave dessas disputas. No âmbito da ação política, a fragmentação, a relativização e a distorção de significados são estratégias adotadas pelo setor privado comercial que reforçam a polarização entre ações individuais (estilos de vida, liberdade de escolha) e intervenções ambientais, e disseminam uma concepção restrita de educação alimentar e nutricional. A sociedade civil incide politicamente pressionando os governos a instituírem, em suas políticas, concepções e princípios que afetam diretamente os parâmetros das disputas. Estes, por sua vez, agem de forma mais ou menos permeável às pressões dos atores (internos ou externos) a depender de sua composição e dos espaços institucionais de interlocução com a sociedade.

Las acciones de promoción de la alimentación saludable son estratégicas para la reversión de los problemas nutricionales. Este artículo analiza las disputas en torno a las ideas presentes en repertorios discursivos sobre alimentación saludable en políticas nacionales, documentos internacionales, societarios y del sector privado comercial, en los últimos 20 años. En base al método de análisis documental, en diálogo con la literatura académica, se identificaron las siguientes perspectivas de alimentación saludable: tradicional-cultural; nutricional-biologicista-medicalizante; multidimensional y sistémica. Las disputas se instituyen en torno a las ideas sobre: la existencia de "alimentos no saludables"; las atribuciones, límites y formas de intervención del Estado; la alimentación como una cuestión de la esfera individual o de carácter público; los significados de la sostenibilidad, comensalidad, cultura y comida. Las posturas adoptadas en las políticas, relacionadas con los pesticidas, fortificación de alimentos y suplementación, son elementos-clave de esas disputas. En el ámbito de la acción política, la fragmentación, relativización y distorsión de significados son estrategias adoptadas por el sector privado comercial, que refuerzan la polarización entre acciones individuales (estilos de vida, libertad de elección) e intervenciones ambientales, y diseminan una concepción restringida de educación alimentaria y nutricional. La sociedad civil incide políticamente, presionando a los gobiernos a que instituyan en sus políticas concepciones y principios que afectan directamente los parámetros de las disputas. Estos, a su vez, actúan de forma más o menos permeable a las presiones de los actores (internos o externos) dependiendo de su composición y de los espacios institucionales de interlocución con la sociedad.

Do they really support "your freedom of choice"? FoPNL and the food industry in Brazil.

Introduction: In 2020, Brazil approved the introduction of a new front-of-package nutrition labeling (FoPNL) in the format of a magnifying glass (MG) after years of discussion. There is currently a lack of understanding of the role of the food industry in that process. This study aimed to describe the corporate political activity (CPA) of the food industry and conflicts of interest situations, as they happened during the development and approval of a new FoPNL system in Brazil. Materials and methods: We undertook bibliographical and documentary searches using material from food companies, trade associations and front groups involved in the regulatory process. We (1) collected information about the case study context, (2) collected data from documentary sources, and (3) prepared a synthesis of the results and a timeline of key events. Results/Discussion: During the FoPNL regulatory process in Brazil, the food industry opposed the introduction of warning labels, a model supported by health authorities and implemented with success in other countries in Latin America. The food industry rather promoted a traffic-light labeling system, known to be less effective at guiding individuals to make healthier food choices. Later in the process, when it was evident that its preferred model would not be used, and a MG would rather be introduced, the food industry argued for the use of a different version of this FoPNL model. We found that the food industry, all along the process, was directly involved in and influenced the development of the FoPNL, by providing technical support, advising and lobbying policymakers. The food industry also established relationships with a consumer non-governmental organization and nutrition professional societies. The food industry also produced and disseminated information supporting its position in order to influence public opinion and high-level decision makers, and used the legal system to delay the process. Conclusion: The FoPNL in Brazil is neither aligned with the recommendations of international health organizations nor with existing independent scientific evidence. The new FoPNL, as adopted in Brazil, reflects some of the preferences of the industry; it is likely that the influence of that sector during the legislative process was pivotal, even if its initial proposal was not adopted.

Paget-von Schroetter syndrome: Case report.

INTRODUCTION: Paget-von Schroetter Syndrome is a rare condition, which refers to primary venous thrombosis of the subclavian-axillary bed. It is related to vigorous activities involving the upper limbs, presenting pain, edema and muscle swelling. Its diagnosis involves, besides the clinical suspicion, Doppler ultrasonography and should be performed early to ensure immediate treatment. The therapy is initially made with anticoagulation, but thrombolysis, decompression surgery, venolysis and venoplasty should be considered, which can lead to a better prognosis and lower risk of complications. CASE REPORT: This article refers to a report of a male patient, with a history of physical activity, who developed thrombosis in the left upper limb and evolved, after anticoagulant treatment, to post-thrombotic syndrome. DISCUSSION: Paget-von Schroetter syndrome can be asymptomatic, but common features include hyperemia, edema, heaviness and pain in the affected arm, usually 24 h after the initial event and may be accompanied by low fever. In diagnostic investigation, imaging exam is essential. Early diagnosis of the syndrome allows the early start of treatment, leading to better results and prognosis. CONCLUSION: Therefore, this study has the goal of making the diagnosis more effective and improves the clinical-surgical management, from the increase in the level of medical professionals' suspicion regarding the disease.

Herb-Drug Interactions: Worlds Intersect with the Patient at the Center.

This review examines three bodies of literature related to herb-drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb-drug combinations. Interacting herb-drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen's kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb-drug information is needed, including open and respectful discussion with patients.

Reflexões sobre ideias e disputas no contexto da promoção da alimentação saudável / Reflexiones sobre ideas y disputas en el contexto de la promoción de la alimentación saludable / Reflections on ideas and disputes in the context of the promotion of healthy eating

As ações de promoção da alimentação saudável são estratégicas para reversão dos problemas nutricionais. Este artigo analisa as disputas em torno das ideias presentes em repertórios discursivos sobre alimentação saudável em políticas nacionais, documentos internacionais, societários e do setor privado comercial, nos últimos vinte anos. Com base no método de análise documental em diálogo com a literatura acadêmica, foram identificadas as seguintes perspectivas de alimentação saudável: tradicional culturalista; nutricional biologicista medicalizante; multidimensional e sistêmica. As disputas instituem-se em torno das ideias sobre: a existência de "alimentos não saudáveis"; as atribuições, limites e formas de intervenção do Estado; a alimentação como uma questão da esfera individual ou de caráter público; os sentidos da sustentabilidade, da comensalidade, da cultura e da comida. Os posicionamentos adotados nas políticas em relação aos agrotóxicos, à fortificação de alimentos e à suplementação são elementos-chave dessas disputas. No âmbito da ação política, a fragmentação, a relativização e a distorção de significados são estratégias adotadas pelo setor privado comercial que reforçam a polarização entre ações individuais (estilos de vida, liberdade de escolha) e intervenções ambientais, e disseminam uma concepção restrita de educação alimentar e nutricional. A sociedade civil incide politicamente pressionando os governos a instituírem, em suas políticas, concepções e princípios que afetam diretamente os parâmetros das disputas. Estes, por sua vez, agem de forma mais ou menos permeável às pressões dos atores (internos ou externos) a depender de sua composição e dos espaços institucionais de interlocução com a sociedade.

Las acciones de promoción de la alimentación saludable son estratégicas para la reversión de los problemas nutricionales. Este artículo analiza las disputas en torno a las ideas presentes en repertorios discursivos sobre alimentación saludable en políticas nacionales, documentos internacionales, societarios y del sector privado comercial, en los últimos 20 años. En base al método de análisis documental, en diálogo con la literatura académica, se identificaron las siguientes perspectivas de alimentación saludable: tradicional-cultural; nutricional-biologicista-medicalizante; multidimensional y sistémica. Las disputas se instituyen en torno a las ideas sobre: la existencia de "alimentos no saludables"; las atribuciones, límites y formas de intervención del Estado; la alimentación como una cuestión de la esfera individual o de carácter público; los significados de la sostenibilidad, comensalidad, cultura y comida. Las posturas adoptadas en las políticas, relacionadas con los pesticidas, fortificación de alimentos y suplementación, son elementos-clave de esas disputas. En el ámbito de la acción política, la fragmentación, relativización y distorsión de significados son estrategias adoptadas por el sector privado comercial, que refuerzan la polarización entre acciones individuales (estilos de vida, libertad de elección) e intervenciones ambientales, y diseminan una concepción restringida de educación alimentaria y nutricional. La sociedad civil incide políticamente, presionando a los gobiernos a que instituyan en sus políticas concepciones y principios que afectan directamente los parámetros de las disputas. Estos, a su vez, actúan de forma más o menos permeable a las presiones de los actores (internos o externos) dependiendo de su composición y de los espacios institucionales de interlocución con la sociedad.

Actions in the promotion of healthy eating are strategic for reversing nutritional problems. This article analyzes the disputes over ideas in discursive repertoires on healthy eating in Brazil's national policies and international, government, civil society, and private commercial sector documents in the last 20 years. Based on the document analysis method in dialogue with the academic literature, the following perspectives on healthy eating were identified: traditional culturalist; medicalizing biological/nutritional; multidimensional; and systemic. The disputes are established between ideas in the following areas: the existence of "unhealthy foods"; the attributions, limits, and forms of State intervention; eating as an individual or public matter; and the meanings of sustainability, commensality, culture, and food. Policy positions on pesticides, food fortification, and supplementation are key elements in these disputes. In the policy sphere, the private commercial sector adopts strategies of fragmentation, downplaying, and distortion of meanings that reinforce polarization between individual actions (lifestyles, freedom of choice) and environmental interventions, thereby disseminating a narrow approach to food and nutrition education. Civil society pressures governments to establish concepts and principles in policies that directly affect the disputes' parameters. The latter act with greater or lesser permeability to pressures from internal or external stakeholders, depending on their composition and the institutional spaces for dialogue with society.

Sleep-related hypermotor epilepsy and peri-ictal hypotension in a patient with syntaxin-1B mutation.

STX1B is a gene that encodes syntaxin-1B. STX1B mutations have recently been implicated in fever-associated epilepsy syndromes. However, these have not previously been reported in sleep-related hypermotor epilepsy. A 20-year-old man with a strong family history of epilepsy was investigated in our epilepsy monitoring unit due to uncontrolled epilepsy, compatible with sleep-related hypermotor epilepsy. Electroclinical and polygraphic physiological recordings revealed left frontal epileptiform discharges and prominent peri-ictal hypotension. Normal MRI using an epilepsy protocol prompted a search for a genetic epilepsy, which revealed a likely pathogenic mutation in the STX1B gene. The patient remained seizure-free after treatment optimization with carbamazepine. This case suggests that a sleep-related hypermotor epilepsy phenotype can be associated with syntaxin-1B gene mutation, and testing for this gene should be considered in such patients. Furthermore, it may also be concluded that autonomic dysfunction, characterized by peri-ictal hypotension, can also occur in this discorder. [Published with video sequences on www.epilepticdisorders.com].

Spiral waves and vertebrate embryonic handedness.

During early embryonic development, the vertebrate main body axis is segmented from head-to-tail into somites. Somites emerge sequentially from the presomitic mesoderm (PSM) as a consequence of oscillatory waves of genetic activity, called somitogenesis waves. Here, we discuss the implications of the dynamic patterns of early X-Delta-2 expression in the prospective somites (somitomeres) of Xenopus laevis. We report that right somitomeres normally emerge before left to form chiral structures (i.e. structures having clockwise or counter-clockwise handedness). From our observations, we infer that somitogenesis waves are normally counter-clockwise spirals, a novel dynamic mechanism for the control of handedness development in Xenopus. We propose that the same mechanism could control handedness development in all vertebrate embryos, providing a dynamical basis for the current asymmetric molecular transport model for generating left-right asymmetry.

DOK7 myasthenic syndrome with subacute adult onset during pregnancy and partial response to fluoxetine.

DOK7 congenital myasthenic syndrome (DOK7-CMS) generally presents early in life and is treated with salbutamol or ephedrine. This report describes an atypical case of a 39-year-old woman who presented with proximal upper limb weakness in the third trimester of pregnancy and was initially diagnosed with seronegative myasthenia gravis. Dramatic clinical worsening under pyridostigmine and further inefficacy of steroids, intravenous human immunoglobulin (IVIG) and plasma exchange (PLEX) led to the presumptive diagnosis of a CMS. Initially, a slow-channel CMS was regarded as more probable due to prominent finger extension weakness. Accordingly, fluoxetine was started and a lengthy improvement was seen. Clinical deterioration occurred after fluoxetine withdrawal, when a c.1124_1127dup homozygous mutation was detected in DOK7 gene. Afterwards, salbutamol was started and the patient became asymptomatic. This case highlights the importance of considering CMS before an adult-onset myasthenic syndrome and suggests a benefit from fluoxetine not previously reported in DOK7-CMS.

Relationship between risk classifications used to organize the demand for oral health in a small city of São Paulo, Brazil. / Relação entre classificações de risco utilizadas para organização da demanda em saúde bucal em município de pequeno porte de São Paulo, Brasil.

Oral health teams can work with both information of the people related to the family context as individual epidemiological through risk ratings, considering equity and service organization. The purpose of our study was to evaluate the association between tools that classify individual and family risk. The study group consisted of students from the age group of 5-6 years and 11-12 years who were classified regarding risk of caries and whether their parents had periodontal disease, in addition to the family risk. There was an association between the risk rating for decay in children (n = 128) and family risk classification with Coef C = 0.338 and p = 0.01, indicating that the higher the family's risk, the higher the risk of caries. Similarly, the association between the risk classification for periodontal disease in parents and family risk classification with Coef C = 0.5503 and p = 0.03 indicated that the higher the family risk, the higher the risk of periodontal disease. It can be concluded that the use of family risk rating tool is indicated as a possibility of ordering actions of the dental service, organizing their demand with greater equity, in this access door.

A Case Report of Nonvasculitic Autoimmune Inflammatory Meningoencephalitis with Sensory Ganglionopathy: A Rare Presentation of Sjögren Syndrome.

A 68-year-old Caucasian female was admitted to the emergency department with a progressive history of behavioural symptoms and anxiety followed by visual and auditory hallucinations, forgetfulness, and impaired gait in the previous 3 months. On examination she was psychotic and had a postural and rest tremor of the upper limbs, cogwheel rigidity of the four limbs, retropulsion on standing position, and inability to walk. During the following 2 weeks she developed xerostomia and unilateral parotiditis that improved with steroids. A simultaneous improvement of the cognitive abilities allowed for the detection of sensory ataxia of the lower limbs. Sensory ganglionopathy was then detected with electrophysiological studies. A diagnosis of Sjögren syndrome was suspected and confirmed by salivary gland scintigraphy, Schirmer's test, and submaxillary gland biopsy. We report a case of Sjögren syndrome associated with central and peripheral nervous system involvement, without sicca symptoms preceding the neurological clinical picture. The coexistence of ganglionopathy and a favourable response to immunosuppression are key features that can lead to the correct diagnosis in cases with atypical CNS symptoms, mimicking a rapidly progressive dementia.