Repetitive Transcranial Magnetic Stimulation in Stroke: A Literature Review of the Current Role and Controversies of Neurorehabilitation Through Electromagnetic Pulses.

Repetitive transcranial magnetic stimulation (rTMS) is an effective method used for the treatment of various neurological diseases, including stroke, epilepsy, and movement disorders. The pathophysiological mechanism for the effect of TMS is not clear. In this literature review, we conducted a detailed search regarding the effect of rTMS on neurotransmission and neuronal plasticity through the modulation of neuronal excitability. Evidence suggests that intramolecular subatomic mechanisms, including genetic changes related to neuronal prevention and death, play an important role. We also discuss the use of rTMS in the rehabilitation of patients with stroke and its main complications, as well as alternative mechanisms related to recovery, emphasizing the findings of available evidence and touching on possible controversies and limitations of the method.

Yogurt and whey beverages available in Brazilian market: Mineral and trace contents, daily intake and statistical differentiation.

Mineral and trace elements (Ca, Fe, K, Mg, Na, Pb, Cd, Cr, Cu, and Mn) in commercial strawberry-flavored yogurts and fermented whey beverages in Brazil were investigated. K, Ca, Na, Mg and Fe concentrations ranged from 1.6 to 1.4, 1.4 to 1.1, 0.74 to 0.68, 0.16 to 0.11, and 0.01 mg g-1 for yogurts and whey beverages, respectively. Similar concentrations of the minerals were observed for both products, except Mg (0.16 mg g-1 in yogurts and 0.11 mg g-1 in whey beverages). Cd, Cr, Cu, Mn, and Pb was found below the detection limit (21.4 to 94.1 µg g-1), demonstrating safety levels for consumption. Regarding the mineral daily intake, consumption of 100 g of the product has relevance for calcium in infants (>40%) and children between 4 and 8 years (>13%), and a greater contribution of yogurt over whey beverage was observed. PLSDA model suggested that Mg analytical determination should be performed to ensure the identity of the product.

Macrophage activation syndrome: A severe and frequent manifestation of acute pancreatitis in 362 childhood-onset compared to 1830 adult-onset systemic lupus erythematosus patients.

OBJECTIVE: We previously reported a case series of acute pancreatitis (AP) and macrophage activation syndrome (MAS) in childhood (cSLE) patients; however, there are no data regarding the comparison of AP and MAS in large populations of cSLE and adult SLE (aSLE). METHODS: A study included 362 cSLE and 1830 aSLE patients. MAS was diagnosed according to preliminary diagnostic guidelines and AP according to the presence of abdominal pain or vomiting associated to an increase of pancreatic enzymes and/or pancreatic radiological abnormalities. Demographic data, clinical features, SLEDAI-2K, SLICC/ACR-DI, and treatment were assessed. RESULTS: Age in MAS patients was significantly lower compared with those without this complication [15 (8.8-55) vs. 33.5 (10.2-45.7) years, p = 0.007]. The frequencies of fever (94% vs. 37%, p = 0.001), leucopenia (82% vs. 19%, p = 0.0001), thrombocytopenia (65% vs. 19%, p = 0.013), hypertriglyceridemia (87% vs. 42%, p = 0.037), and hyperferritinemia (93% vs. 37%, p = 0.011) were also more frequently observed in AP patients with MAS compared in AP patients without MAS. Fever and hyperferritinemia concomitantly were more frequent in the former group (86% vs. 12%, p = 0.0015). Higher and significant frequency of AP in cSLE compared to aSLE patients [12/362 (3.3%) vs. 20/1830 (1.1%), p = 0.003], with similar AP duration [22 (6-60) vs. 15 (4-90) days, p = 0.534]. MAS (85% vs. 30%, p = 0.003) and death by MAS complication (31% vs. 0%, p = 0.017) were significantly higher in children compared with aSLE. CONCLUSIONS: This study provides novel data demonstrating that MAS occur in the majority of cSLE with AP with a higher mortality compared to aSLE. In addition, we identified in AP patients, a cluster of MAS clinical and laboratorial parameters more associated with this complication.

Chronic arthritis in systemic lupus erythematosus: distinct features in 336 paediatric and 1830 adult patients.

The objectives of this study are to assess the frequency of chronic arthritis and compare the clinical and laboratory features in a large population of childhood-onset systemic lupus erythematosus (cSLE) and adult-onset (aSLE) patients. This historical study evaluated 336 cSLE and 1830 aSLE patients. Chronic arthritis was defined as synovitis of at least 6 weeks of duration. Rhupus was characterised as the association of SLE and chronic inflammatory arthritis with erosion and positive rheumatoid factor. Jaccoud's arthropathy is a non-erosive subluxation leading to severe deformity of the hands and feet. Data were compared using Student's t test or the Mann-Whitney test for continuous variables. For categorical variables, differences were assessed by Fisher's exact test and Pearson chi-square. Frequencies of chronic arthritis were similar in cSLE and aSLE (2.4 vs. 3.8%, p = 0.261). The median time from disease onset to appearance of chronic arthritis was shorter in cSLE (0 vs. 10 years, p < 0.001), and the median of age at chronic arthritis diagnosis was [10.8 (4.2-14.6) vs. 40 (21-67), p < 0.001]. The children presented with more chronic polyarthritis than the adults (75 vs. 32%, p = 0.024), a higher median number of joints with arthritis [8.5 (1-18) vs. 3 (1-9), p = 0.017] and a higher number of joints with limitation [1.5(0-24) vs. 0(0-4), p = 0.004]. The chronic arthritis diagnosis frequencies of hepatomegaly (25 vs. 0%, p = 0.009), splenomegaly (25 vs. 0%, p = 0.009), pericarditis (25 vs. 0%, p = 0.009), nephritis (37 vs. 3% , p = 0.006), haematuria (37 vs. 1.4%, p = 0.002), lupus anticoagulant (40 vs. 1.6%, p = 0.012), anticardiolipin IgM (40 vs. 1.5%, p = 0.012) and median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) [10.5(1-20) vs. 6(4-16), p = 0.029] were higher in cSLE. Frequency of rhupus, (12 vs. 17%, p = 1.0), Jaccoud's arthropathy (0 vs. 17%, p = 0.343) and treatments were similar in cSLE and aSLE. We determined that chronic arthritis in SLE has distinct features in children, with very early onset, polyarticular involvement and association with active disease. We further demonstrated in this series that a proportion of chronic arthritis involvement in SLE is manifested as rhupus and Jaccoud's arthropathy.

Higher Prevalence and Distinct Features of Herpes Zoster Infection in Children than Adults with Systemic Lupus Erythematosus.

Herpes zoster infection was significantly more often observed in children (10%, N = 362) than in adults (4%, N = 1830). At herpes zoster infection diagnosis, disease activity score (8 vs. 3, P = 0.002) was higher in children, and fever (43% vs. 12%, P < 0.0001), nephritis (45% vs. 25%, P = 0.038), anti-double-stranded DNA autoantibodies (76% vs. 15%, P < 0.0001) and low C4 (48% vs. 22%, P = 0.017) were more often observed in children versus adults. Post herpetic neuralgia was less common in children than adults (3% vs. 24%, P =0.005).

Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has been established as a reliable bariatric procedure, but questions have emerged regarding its long-term results. Our aim is to report the long-term outcomes of LSG as a primary bariatric procedure. METHODS: Retrospective analysis of patients submitted to LSG between 2005 and 2007 in our institution. Long-term outcomes at 5 years were analyzed in terms of body mass index (BMI), excess weight loss (EWL) and co-morbidities resolution. Surgical success was defined as %EWL>50%. Also, we compared long-term results according to preoperative BMI, using Mann-Whitney test. RESULTS: A total of 161 LSG were analyzed, and 114 patients (70.8%) were women. The median age was 36 years old (range 16-65), median preoperative BMI was 34.9 kg/m(2) (interquartile range [IQR], 33.3-37.5). A total of 112 patients (70%) completed 5 years of follow-up. At the fifth year, median BMI and %EWL was 28.5 kg/m(2) (IQR: 25.8-31.9) and 62.9% (IQR: 45.3-89.6), respectively, with a surgical success of 73.2% of followed patients. According to preoperative BMI, surgical success was achieved in 80% of patients with BMI<35 kg/m(2), 75% of BMI 35-40 kg/m(2), and 52.6% of BMI>40 kg/m(2), with significant lower %EWL in patients with BMI>40 kg/m(2) (P = .001 and .004). Dyslipidemia and insulin resistance resolution was 80.7% and 84.7%, respectively. A total of 26.7% of patients reported new-onset gastroesophageal reflux symptoms at 5 years. CONCLUSION: LSG as a primary procedure is a reliable surgery. We observed positive long-term outcomes of %EWL and co-morbidities resolution. In our series, best results are seen in patients with preoperative BMI<40 kg/m(2).

Metabolic surgery: roux-en-Y gastric bypass and variables associated with diabetes remission in patients with BMI <35.

Metabolic results of bariatric surgery have determined an expansion of its traditional indications, being increasingly performed in non-severely obese patients, especially in type 2 diabetes mellitus (T2DM). Our aim is to determine the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) in T2DM remission in patients with body mass index (BMI) below 35 kg/m(2) and the variables associated with T2DM remission after surgery. Retrospective analysis of diabetic patients with BMI <35 kg/m(2) who underwent LRYGB in our center between 2002 and 2010 was done. We analyzed patient's demographics, comorbidities, BMI, excess weight loss percentage (EWLp), complications, and metabolic results at 3 years. Univariate and multivariate analyses were performed to determine variables associated with T2DM remission. One hundred patients were included. Sixty patients (60 %) were women; median age was 48 years old (interquartile range (IQR) 42-54), and median preoperative BMI was 32.7 kg/m(2) (IQR 31.6-34.1). Median preoperative duration of T2DM was 4 years (IQR 2-7), with 49, 30, 2, and 18 % on treatment with one, two, and three hypoglycemic agents and insulin, respectively. Ninety-four percent achieved 36-month follow-up, and at this time, median EWLp was 93 % (IQR 67-121). A total of 53.2, 9.6, 25.5, and 11.7 % achieved a T2DM complete remission, partial remission, improvement, and no improvement, respectively. T2DM remission only was associated with non-insulin use in multivariate analysis, with an OR = 15.1 (2.8-81.2) and p = 0.002. LRYGB is a reliable and effective treatment in diabetic patients with a BMI <35 kg/m(2) at 3 years. T2DM remission's best results are observed in non-insulin diabetic patients.

Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy.

INTRODUCTION: Portal and mesenteric vein thrombosis are relatively uncommon surgical complications, with difficult diagnosis and potentially severe consequences due to higher risk of bowel infarction. The purpose of this study was to present a series of patients who developed postoperative portal vein thrombosis after laparoscopic sleeve gastrectomy. METHODS: This is a retrospective analysis of patients who underwent sleeve gastrectomy between June 2005 and June 2011 who developed portal vein thrombosis. Demographic data, personal risk factors, family history of thrombosis, and postoperative results of thrombophilia study were analyzed in this study. RESULTS: A total of 1,713 laparoscopic sleeve gastrectomies were performed. Seventeen patients (1 %) developed portal vein thrombosis after surgery. Of the 17 patients, 16 were women, 8 had a history of smoking, 7 used oral contraceptives, and 2 had a family history of deep vein thrombosis of the lower limbs. All patients were discharged on the third day of surgery with no immediate complications. Symptoms presented at a median of 15 (range, 8-43) days after surgery with abdominal pain in most cases. One case required emergency laparotomy and splenectomy because of an active bleeding hematoma with massive portomesenteric vein thrombosis. In 11 cases, a thrombosis of the main portal vein was identified, in 15 the right portal branch was compromised, and in 10 the left portal branch. Eleven patients presented thrombosis of the superior mesenteric vein, and ten patients presented a concomitant thrombosis of the splenic vein. A massive PMVT was presented in six cases. Seven patients had a positive thrombophilia study. CONCLUSIONS: Portal vein thrombosis and/or mesenteric thrombosis are relatively uncommon complications in patients undergoing bariatric surgery. In this series, the portomesenteric vein thrombosis was the most common complication after LSG in a high-volume center.

Prevalência e fatores associados à adiposidade central e periférica em estudantes do ensino fundamental brasileiro / Prevalence and factors associated with peripheral and central adiposity in primary school students in Brazil

The objective was to identify the prevalence of excess central adiposity and peripheral schoolchildren and its relationship with sedentary activities and physical activity level. Cross-sectional study was conducted with 524 elementary school student's city of Bauru (SP). Structured protocol was used, the PAQ-C and measured subscapular skinfolds thickness (PCS) and triciptal (TSF). There were descriptive analyses, bivariate and multivariate logistic regression. The PCT and PCS rates were respectively 13.6% and 16.5% in boys and 15.4% and 12.6%. In girls the frequency above three times a week on the computer and its use for more than three hours if associated with elevated PCT, low level of physical activity was associated with elevated PCS in boys, low level of physical activity and use of computer and / or video games for more than three hours/day were associated with higher PCS in boys. The frequency and number of hours in sedentary and low physical activity are important predictors of adiposity among children...

O objetivo foi identificar a prevalência de excesso de adiposidade central e periférica em escolares e sua relação com atividades sedentárias e nível de atividade física. Realizou-se estudo transversal com 524 alunos do ensino fundamental municipal de Bauru (SP). Utilizou-se protocolo estruturado, o PAQ-C e mensuradas as pregas cutâneas subescapular (PCS) e tricipital (PCT). Realizaram-se análise descritiva, bivariada e multivariada por regressão logística. As PCT e PCS elevadas foram, respectivamente, de 13,6% e 16,5% nos meninos e 15,4% e 12,6% nas meninas; nas meninas a freqüência acima de três vezes por semana no computador e o seu uso por mais de 3 horas se associaram com as PCT elevadas; baixo nível de atividade física associou-se com as PCS elevadas nos meninos; o uso de computador e/ou videogame por mais de três horas/dia se associaram com as PCS elevadas nos meninos. A frequência e número de horas em atividades sedentárias e baixo nível de atividade física são importantes preditores de adiposidade nos escolares...

Poliangeíte granulomatosa eosinofílica (Churg-Strauss) com acometimento renal, pulmonar e neurológico: relato de caso / Eosinophilic granulomatous polyangiitis (Churg-Strauss) with renal impairment, pulmonary and neurologic: case report

A poliangeíte granulomatosa eosinofílica (Síndrome de Churg-Strauss) é uma vasculite necrotizante de pequenos vasos, descrita em 1951. è uma patologia rara com incidência de 0,5 a 4 casos por 1.000.000 de habitantes no mundo...(AU)

Prevalência e fatores associados à adiposidade central e periférica em estudantes do ensino fundamental brasileiro / Prevalence and factors associated with peripheral and central adiposity in primary school students in Brazil

The objective was to identify the prevalence of excess central adiposity and peripheral schoolchildren and its relationship with sedentary activities and physical activity level. Cross-sectional study was conducted with 524 elementary school student's city of Bauru (SP). Structured protocol was used, the PAQ-C and measured subscapular skinfolds thickness (PCS) and triciptal (TSF). There were descriptive analyses, bivariate and multivariate logistic regression. The PCT and PCS rates were respectively 13.6% and 16.5% in boys and 15.4% and 12.6%. In girls the frequency above three times a week on the computer and its use for more than three hours if associated with elevated PCT, low level of physical activity was associated with elevated PCS in boys, low level of physical activity and use of computer and / or video games for more than three hours/day were associated with higher PCS in boys. The frequency and number of hours in sedentary and low physical activity are important predictors of adiposity among children...(AU)

O objetivo foi identificar a prevalência de excesso de adiposidade central e periférica em escolares e sua relação com atividades sedentárias e nível de atividade física. Realizou-se estudo transversal com 524 alunos do ensino fundamental municipal de Bauru (SP). Utilizou-se protocolo estruturado, o PAQ-C e mensuradas as pregas cutâneas subescapular (PCS) e tricipital (PCT). Realizaram-se análise descritiva, bivariada e multivariada por regressão logística. As PCT e PCS elevadas foram, respectivamente, de 13,6% e 16,5% nos meninos e 15,4% e 12,6% nas meninas; nas meninas a freqüência acima de três vezes por semana no computador e o seu uso por mais de 3 horas se associaram com as PCT elevadas; baixo nível de atividade física associou-se com as PCS elevadas nos meninos; o uso de computador e/ou videogame por mais de três horas/dia se associaram com as PCS elevadas nos meninos. A frequência e número de horas em atividades sedentárias e baixo nível de atividade física são importantes preditores de adiposidade nos escolares...(AU)