Factors predicting long-term recovery from post-stroke aphasia.

Background: It remains widely accepted that spontaneous recovery from aphasia is largely limited to the first related factors. This has direct implications for acute and chronic interventions for aphasia. few months following stroke. A few recent studies challenge this view, revealing that some individuals' language abilities improve even during the chronic stage. Aims: To identify prognostic indicators of long-term aphasia recovery. Methods & Procedures: Eighteen people with aphasia initially evaluated in the chronic stage were retested at least one year later. The Western Aphasia Battery-Revised (WAB-R) Aphasia Quotient (AQ) was used to quantify changes in language impairment. Prognostic factors included those related to the patient (demographic, psychosocial), stroke (lesion volume and location), and treatment (medical, rehabilitative). Outcomes & Results: Twelve participants improved and 6 remained stable or declined. Linear regression analysis revealed that lesion volume predicted long-term language gains, with smaller lesions yielding greater improvements. Individuals who did not improve were more likely to have lesions encompassing critical frontal and temporoparietal cortical regions and interconnecting white matter pathways. Exploratory regression analysis of psychosocial and treatment-related factors revealed a positive relationship between improvement and satisfaction with life participation, and a negative relationship between improvement and perceived impairment severity. Critically, psychosocial and treatment-related factors significantly improved model fit over lesion volume, suggesting that these factors add predictive value to determining long-term aphasia prognosis. Conclusions: Long-term aphasia recovery is multidetermined by a combination of stroke-, psychosocial-, and treatment-related factors. This has direct implications for acute and chronic interventions for aphasia.

Morphological alterations in tongue epithelial cells infected by SARS-CoV-2: A case-control study.

OBJECTIVE: The aim of the present case-control study was to evaluate the morphological aspects of the epithelial cells from the dorsum of the tongue and the expression of the SARS-CoV-2 Spike protein in these cells, in patients with and without COVID-19 infection. METHODS: 24 individuals with at least one symptom of COVID-19 were recruited among inpatients from Hospital Universitário Pedro Ernesto (Rio de Janeiro, Brazil). 14 patients who tested positive for COVID-19 by RT-PCR were included in the case group, and 10 patients who tested negative were included in the control group. Cytological smears from the dorsum of the tongue were obtained from all patients and analyzed using immunohistochemistry directed against SARS-CoV-2-Spike protein. Morphological changes in epithelial cells were analyzed using light microscopy. RESULTS: Immunohistochemistry showed that 71% of the COVID-19 patients presented epithelial cells positive for the presence of the SARS-CoV-2 Spike protein, and all cells coming from patients in the control group were negative. Cytological analysis showed significant differences when comparing epithelial cells from COVID-19-positive and COVID-19-negative patients. CONCLUSION: COVID-19 may generate dimensional changes in tongue epithelial cells; however, further studies are necessary to understand how this happens.

Enhancing diversity in academic neurology: From agnosia to action.

Although recent years have seen a rapid increase in the diversity of patient populations and of society in general, individuals who belong to historically disadvantaged groups continue to struggle to achieve fuller representation and success in academic medicine. This is particularly true in academic neurology, where faculty from racial and ethnic minority groups are grossly under-represented. Raising awareness of this problem in the field is an important first step toward developing coordinated, strategic approaches to enhancing diversity in neurology. Therefore, the aims of this brief article are to underscore the increasing importance of diversity in neurology, point out some of the specific challenges that face diversity efforts in academic neurology, and suggest strategies that leaders in the field could consider in order to enhance the diversity of neurology departments. Ann Neurol 2016;79:705-708.

Discriminating Between Bipolar Disorder and Major Depressive Disorder.

Rates of misdiagnosis between major depressive disorder and bipolar disorder have been reported to be substantial, and the consequence of such misdiagnosis is likely to be a delay in achieving effective control of symptoms, in some cases spanning many years. Particularly in the midst of a depressive episode, or early in the illness course, it may be challenging to distinguish the 2 mood disorders purely on the basis of cross-sectional features. To date, no useful biological markers have been reliably shown to distinguish between bipolar disorder and major depressive disorder.

Presence of Helicobacter pylori in supragingival dental plaque of individuals with periodontal disease and upper gastric diseases.

BACKGROUND: Helicobacter pylori is a Gram-negative microorganism which is able to colonize the gastric mucosa and is associated with peptic ulcer, gastric carcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. Several studies have detected this bacterium in the oral cavity, suggesting it as a potential reservoir. The aim of this study was to investigate the presence of H. pylori in the oral cavity of individuals with periodontal disease and gastric diseases. METHODS: 115 individuals, with mean age 49.6 (±5.8) years, were divided in 4 groups: (A) with gastric diseases and periodontal disease; (B) with gastric diseases and no periodontal disease; (C) without gastric diseases and without periodontal disease, (D) without gastric diseases and with periodontal disease. Supra and subgingival plaque samples were collected from posterior teeth of the individuals with sterile paper points, and prepared for Polymerase Chain Reaction analysis. Fisher's exact test was used for detecting statistical differences between groups (p<0.05). RESULTS: H. pylori was detected in supragingival plaque of 9/36 (25%) of group A, 1/31 (0.3%) of group B, 0 (0%) of group C and 3/36 (8.3%) of group D. No subgingival samples were positive for H. pylori. There was a statistically higher prevalence of H. pylori in groups A and D when compared to B and C (p<0.05). CONCLUSION: H. pylori was detected in the supragingival plaque, but not in the subgingival plaque, of individuals with periodontal disease and upper gastric diseases. There was an association between the supragingival colonization of H. pylori and oral hygiene parameters such as the presence of plaque and gingival bleeding.

Detection of cytotoxin genotypes of Helicobacter pylori in stomach, saliva and dental plaque.

BACKGROUND: The aim of this study was to detect the presence of Helicobacter pylori and its virulent cagA genes in the oral cavity of individuals with upper gastric diseases. Sixty-two individuals (42+/-2.3 years) with dispepsy symptoms, referred for gastroscopy and who were H. pylori positive in the gastric biopsy, were recruited and separated in two groups: case group-individuals with gastric disease (n = 30); control group-individuals with no gastric disease (n = 32); saliva, dental plaque and biopsy samples were collected from all individuals. Oral and biopsy samples were analyzed by PCR using specific primers for H. pylori 16S ribosomal and cagA genes. PCR products were sequenced for DNA homology confirmation. H. pylori was detected neither in dental plaque nor in saliva in the control group. In the case group H. pylori DNA was detected in 16/30 (53.3%) saliva samples and in 11/30 (36.6%) dental plaque samples. The cagA gene was detected in 13/30 (43.3%) gastric biopsies, in 7/16 (43.8%) saliva samples, and in 3/11 (27.3%) dental plaque samples. Eighteen (60.0%) individuals in the case group were H. pylori positive both in oral and biopsy samples, and 8 (26.6%) of those were positive for cagA-H. pylori DNA. H. pylori and its virulent clone showed a higher prevalence in the oral cavity of individuals in the case group than in the control group (p < 0.05). Our results suggest that dental plaque and saliva may serve as temporary reservoir for H. pylori and its virulent cagA variant in individuals with gastric disease.

Higher levels of salivary MUC5B and MUC7 in individuals with gastric diseases who harbor Helicobacter pylori.

OBJECTIVE: The aim of the present study was to assess the salivary levels of MUC5B and MUC7 in individuals with dyspeptic disease and Helicobacter pylori (H. pylori) in the stomach, compared to individuals without dyspeptic disease. METHODS: 30 individuals with dyspeptic disease, who underwent endoscopy for upper gastrointestinal complaints at Hospital Pedro Ernesto-RJ, Brasil and tested positive for H. pylori, and 23 controls with no dyspeptic disease, with mean age 53.5+/-4.4 years, were included in the study. Saliva samples and 3 antral biopsy were taken for PCR analysis and histologic examination. In addition, saliva samples were tested by ELISA with F2 monoclonal antibody and EU7A antibody against MUC7, to determine MUC5B and MUC7 levels, prior to endoscopic examination. The expression pattern of the proteins was quantified by comparison to a pooled saliva sample of 19 healthy volunteers. RESULTS: MUC5B and MUC7 salivary levels were higher in the individuals with dyspeptic disease than in controls (p<0.0001). 33.3% (9/30) of the dyspeptic individuals and 0% of the controls had H. pylori in the oral cavity. CONCLUSIONS: Individuals with gastric diseases, with H. pylori in the stomach, showed higher levels of salivary H. pylori receptors-MUC5B and MUC7-than individuals without gastric diseases. These results suggest that higher levels of specific salivary mucins could be useful as risk indicators for infection by H. pylori.

A rapid diversification of rainforest trees (Guatteria; Annonaceae) following dispersal from Central into South America.

Several recent studies have suggested that a substantial portion of today's plant diversity in the Neotropics has resulted from the dispersal of taxa into that region rather than vicariance, but more data are needed to substantiate this claim. Guatteria (Annonaceae) is, with 265 species, the third largest genus of Neotropical trees after Inga (Fabaceae) and Ocotea (Lauraceae), and its widespread distribution and frequent occurrence makes the genus an excellent model taxon to study diversification patterns. This study reconstructed the phylogeny of Guatteria and inferred three major biogeographical events in the history of the genus: (1) a trans-oceanic Miocene migration from Central into South America before the closing of the Isthmus of Panama; (2) a major diversification of the lineage within South America; and (3) several migrations of South American lineages back into Central America via the closed Panamanian land bridge. Therefore, Guatteria is not an Amazonian centred-genus sensu Gentry but a major Miocene diversification that followed its dispersal into South America. This study provides further evidence that migration into the Neotropics was an important factor in the historical assembly of its biodiversity. Furthermore, it is shown that phylogenetic patterns are comparable to those found in Ocotea and Inga and that a closer comparison of these genera is desirable.

Fe cristiana y fecundación in vitro / Christian faith and in vitro fertilization

Las técnicas de reproducción humana asistida, y entre ellas la fecundación in vitro (FIV), suscitan interrogantes éticas. Su empleo promete beneficios para la humanidad y, específicamente para parejas infértiles la satisfacción de ser madres y padres. En este artículo se propone que la fe cristiana ha de afirmar la legitimidad ética de la FIV, ésta con base en los valores fundantes de la fe como la misericordia, la justicia, el bienenestar, el amor y el compromiso con los necesitados que practicó Jesucristo. Se argumenta que la FIV es una técnica que promueve la vida y la dignidad humanas. Además se propone que la ética se entiende mejor no en términos deontológicos, sino contextuales que responden a situaciones reales de la vida, específicamente una ética de la resposabilidad. Palabras claves: Fecundación in vitro, procreación como bendición, ética, fe cristiana, amor, vida y dignidad humanas, deontología, contextualismo, responsabilidad.

[Perinatal risk factors for mortality in the high-risk newborn]. / Factores de riesgo perinatal para mortalidad en el neonato de alto riesgo.

This study was to determine the risk factors for mortality in a cohort of neonates in a neonatal intensive care unit. Comparative study of the perinatal antecedents between lives and deaths, calculating risk factors for mortality by the chi square test, with Mantel and Haenzel corrected and bivariate analysis. We studied 425 neonates with, weight and age of gestation 1640 +/- 359 gr. and 32 +/- 2 weeks (X and SD), all required assisted mechanical ventilation during 10 +/- 12 days, and stayed in NICU 13 +/- 12 days. The risk factor for mortality were (p < 0.05); gesta IV, < 1 abortion previously, premature rupture of placenta, premature rupture of membranes with chorioamnionitis, pelvic delivery for vaginal via, age of gestation < 28 weeks, birth weight < 1,000 gr., septic shock, metabolic acidosis, acute renal failure, neonatal necrotizing enterocolitis and air leak. In this group of high risk neonates, for the prenatal, neonatal and postnatal antecedents, we find 12 risk factors for mortality; four attributed to the pregnancy, on to the delivery and seven for problems of the neonate.

[Evaluation of a newborn in a critical state, son of a mother with preeclampsia/eclampsia (pregnancy toxemia)]. / Evaluación del neonato en estado crítico, hijo de madre con preeclampsia/eclampsia (toxemia del embarazo).

The objective was to determine clinical characteristics and evolution of the neonate in critical status, son of mother with preeclampsia/eclampsia, in a neonatal intensive care unit (NICU). And looking for differences between the son of mother with preeclampsia and the mother with eclampsia. Revision of 425 charts of discharged neonates of a NICU. Infants of mother with preeclampsia/eclampsia were included. Was done the variables by means of descriptive statistics are analyzed, and t Student and chi square for the comparative study. 88 neonates were included, 46 of preeclampsia and 42 of eclampsia. Their characteristics were (X +/- SD): Maternal age 25 +/- 4 years, birth weight 1587 +/- 601 grams, gestational age 32 +/- 3 weeks. Apgar to the one minute 5 +/- 1. Apgar to the five minutes 6 +/- 1. All required mechanical ventilation during 8 +/- 9 days, NICU stay 12 +/- 10 days. Predominated masculine sex 63.2%, and with mortality 21.8% average. In the comparative study, preeclampsia vs eclampsia, of the same variables we found significant difference in; birth weight 1858 +/- 654 vs 1340 +/- 422 grams; gestational age 33 +/- 3 vs 31 +/- 2 weeks, and in nosocomial pneumonia 7 vs 33. Most of these neonates were preterm, with Apgar low, prevailed masculine sex, all required mechanic ventilation with stay of 12 days average in the NICU, mortality was low. And the son of mother with eclampsia presented more pneumonia nosocomial.

[Development of high risk infants following premature membrane rupture in a neonatal intensive care unit]. / Evolución del neonato de alto riesgo con antecedente de ruptura prematura de membranas en una unidad de cuidados intensivos neonatales.

The development of 77 neonates, with maternal premature membranes rupture in a neonatal intensive care unit was reviewed. Clinical characteristics, evolution, complications and mortality, as well as the risk factors for mortality were reviewed. The incidence was 25.8% in 298 neonates discharged, maternal age 25 + 6 years (X and standard deviation), number of gestations 2 + 1, maternal infection in 11 (14.2%), chorioamnioitis in 18 (23.3%), the ruptured membranes time was > 24 hours in 48%. Vaginal birth were 37.7%, and cesarean section 59.7%. Males predominated with 61%, gestational age 31 + 2 weeks, birth weight 1577 + 530. The three main morbidity causes were nosocomial pneumonia (44.1%), respiratory distress syndrome (39%), and intrauterine pneumonia (33.8%). By clinic and laboratory 3.8% neonates had septicemia, but only eight had some positive culture. Disease during pregnancy, vaginal birth, prematurity and neonatal sepsis were risk factors for mortality. Incidence of infants with PROM and neonatal sepsis is higher than majority of other reports. All premature neonates with PROM more; disease during pregnancy, vaginal birth, or neonatal sepsis, have high risk for mortality, then they need specially cares.

[Esophageal perforation in premature newborn infants. Presentation of 8 cases]. / Perforación de esófago en recién nacidos prematuros. Presentación de ocho casos.

We report eight newborn with esophageal perforation. They were preterm infants and received mechanical ventilation for respiratory problem. Six were associated with pneumothorax, three of they show aberrant way of an orogastric tube, and another three show milk fluid in the pleural tube installed for pneumothorax. The management was fasting during ten days, parenteral nutrition, wide spectrum antibiotics, and prevention of complications; surgery treatment is not the first of all recommended at present.

[Risk factors in neonatal necrotizing enterocolitis]. / Factores de riesgo en la enterocolitis necrosante neonatal.

In this case controls prospective study, risk factors for necrotizing enterocolitis from a neonatal intensive care unit, were investigated. In 34 cases and 69 controls, were found; the fetal distress, Apgar score < or = 5 at one minute, < or = 6 at five minutes, gestational age < or = 34 weeks and birth weight < or = 1500 g, like risk factors for necrotizing enterocolitis. The investigation of a new risk factor, abdominal distention with plentiful intestinal gas documented in X ray at initial hours of life, by energetic reanimation at birth, showed that it is not a risk factor.

[Neonatal conjunctivitis caused by Chlamydia trachomatis]. / Conjuntivitis neonatal por Chlamydia trachomatis.

32 newborns with neonatal Chlamydia trachomatis conjunctivitis were reported. Diagnosis was carried out through immunofluorescent monoclonal antibody of conjunctiva scraping staining; 37 conjunctiva samples were taken from same number of newborn patients not responds to topical antibiotic treatment. The sample came out from two different third level institutions with maternal facilities and attending more than five thousand deliveries per year each one of them. Were studied incidence and clinical picture from neonatal C. trachomatis conjunctivitis. Positive immunofluorescent and conjunctive culture of secretion to C. trachomatis in the sample were 86 per cent (32 out of 37). 19 of the newborns acquired Staphylococcus associated to C. trachomatis (59%): nine with S. aureus in six Staphylococcus negative coagulase was isolated and four with the latest two. Out of 32 patients who demonstrated positive cultures to C. trachomatis (86%), 22(69%) were males and ten (31%) were females. Significant proportion of newborns were identified as small for gestational age. 18 of them were born by natural way and 14 by cesarean section. In 16/32 (50%) had interstitial pneumonia by Chlamydia. The main clinical findings were stated as: conjunctiva exudate in different stages including purulent secretion and oedema or inflammation of the ophthalmic conjunctiva. Those newborns where topical therapy did not irradiate the organism and demonstrated clinical picture persistence or relapse and diagnosis of C. trachomatis infection, systemic treatment with erythromycin and topic tetracycline were installed, disappearing all symptoms. Maternal history related to neonatal disease were mainly: endocervical infection, miscarriages and or preterm delivery.

[Response to the treatment with indomethacin in persistent ductus arteriosus]. / Respuesta al tratamiento con indometacina en la persistencia del conducto arterioso.

The clinical charts of 46 newborn babies with persistent arterial duct, hospitalized in the Intensive Care Unit were reviewed. The diagnosis was made, on the average, after the fifth day of life, finding a precordial murmur in 75%, hyperdynamic precordium in 48%, and outstanding pulses in 22%. Radiologically, cardiomegaly was seen in 50% of the cases, an increase in the flow of the pulmonary artery in 41%, and no abnormalities 35%. Using echocardiography, the left atrium/aorta relation was found to be 1.4 on the average. Of the 25 patients who received indomethacin to close the conducts arteriosum, 21 (84%) responded favorably. The mortality rate was 43%. A comparative study was done between those children who were given the indomethacin and those who weren't, finding a significant difference in favor of those who did receive the medication when seeing the closure of the conduct and their survival rate.