Intraspecific differentiation of sandflies specimens by optical spectroscopy and multivariate analysis.

Lutzomyia longipalpis and Lutzomyia cruzi are the main sandflies species involved in the transmission of Leishmania infantum protozoan in Brazil. The morphological characteristics can be used for species identification of males specimens, while females are indistinguishable. Although, sandflies identification is essential to understand vectorial capacity, and susceptibility to infectious agents or insecticides, there is a lack of new strategies for specimen identification. In this study, Fourier transform infrared photoacoustic spectroscopy combined with multivariate analysis identified intraspecific differences between Lutzomyia populations. Successfully group clustering was achieved by principal component analysis. The main differences observed can be related to the protein content of the specimens. A classification with 100% accuracy was obtained using machine learning approach, allowing the identification of sandflies specimens.

Variables de la sangre en hybrido tambacu cultivado en el estado de Amapá, norte de Brasil / Blood variables of hybrid tambacu farmed In Amapá State, Northern Brazil / Variáveis sanguíneas do híbrido tambacu cultivado no estado do Amapá, norte do Brasil

Este estudio comparó las características de la sangre de híbrido tambacu (Colossoma macropomum x Piaractus mesopotamicus) tres criaderos piscícolas en Macapá, Estado de Amapá (Brasil), con gestiones similares. No se observaron diferencias en los niveles de oxígeno y pH del agua de los estanques en los criaderos piscícolas, pero el factor de condición mostró buenas condiciones corporales en los peces. En la sangre de los tambacus fueron identificados trombocitos, linfocitos, monocitos, neutrofilos, leucocitos granulares PASpositivos (LG-PAS) y eosinofilos. Los niveles de glucosa y proteínas, hematocrito, recuento de leucocitos totales, el recuento total de trombocitos, monocitos, neutrófilos y eosinofilos fueron similares entre peces de los criaderos piscícolas. Sin embargo, la concentración de hemoglobina, recuento de eritrocitos, concentración de hemoglobina corpuscular media (CHCM), volumen corpuscular medio (VCM), el número de linfocitos y LG-PAS mostraron diferencias entre los peces de loscriaderos piscícolas. Aunque los resultados mostraron relativa similitud entre los parámetros de lo sangre de peces de los criaderos piscícolas, pero o manejo de las condiciones de la calidad del agua del estanque y la comida siempre debe mejorarse para aumentar la productividad en estas criaderos piscícolas.

This study compared the blood characteristics of hybrid tambacu (Colossoma macropomum x Piaractus mesopotamicus) from three fish farms in the Macapá, State of Amapa (Brazil), which has a similar management. There were differences in the levels of dissolved oxygen in the water and pH in the ponds of the fish farms, but condition factor showed good body condition of the fish. In blood of tambacu were identified thrombocytes, lymphocytes, monocytes, neutrophils, PAS-positive granular leukocytes (PAS-GL) and eosinophils. Plasma glucose and protein levels, hematocrit, total leucocyte count, total thrombocytes count, monocytes, neutrophils and eosinophils count were similar among the three fish farms. However, hemoglobin concentration, total erythrocytes count, mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), number of lymphocytes and PASGLshowed differences among fish of these fish farms. Although the results showed a relative similarity between the blood parameters in the fish of the different fish farms, but the management conditions regarding the water quality in the ponds and food should be improved to increase the productivity in these fish farms.

Este estudo comparou as características sanguíneas do híbrido tambacu(Colossoma macropomum x Piaractus mesopotamicus)de três pisciculturas de Macapá, Estado do Amapá (Brasil), com manejos semelhantes. Diferenças nos níveis de oxigênio dissolvido e do pH da água dos viveiros foram observadas, mas o fator de condição mostrou a boa condição dos peixes. No sangue dos tambacus foram identificados trombócitos, linfócitos, monócitos, neutrófilos, leucócitos granulares PAS-positivo (LG-PAS) e eosinófilos. Os níveis de glicose e proteína, hematócrito, contagem total de leucócitos, contagem total de trombócitos, contagem de monócitos, neutrófilos e eosinófilos foram similares entre as três pisciculturas. Entretanto, a concentração de hemoglobina, contagem de eritrócitos, da concentração de hemoglobina corpuscular média (CHCM), volume corpuscular médio (VCM), número de linfócitos e LG-PAS mostraram diferenças entre os peixes destas pisciculturas. Embora, os resultados mostraram relativa similaridade entre os parâmetros sanguíneos dos peixes das pisciculturas, mas condições de manejo, relativo à qualidade da água dos viveiros e à alimentação fornecida, devem ser melhoradas para aumentar a produtividade nestas pisciculturas.

Variables de la sangre en hybrido tambacu cultivado en el estado de Amapá, norte de Brasil / Blood variables of hybrid tambacu farmed In Amapá State, Northern Brazil / Variáveis sanguíneas do híbrido tambacu cultivado no estado do Amapá, norte do Brasil

Este estudio comparó las características de la sangre de híbrido tambacu (Colossoma macropomum x Piaractus mesopotamicus) tres criaderos piscícolas en Macapá, Estado de Amapá (Brasil), con gestiones similares. No se observaron diferencias en los niveles de oxígeno y pH del agua de los estanques en los criaderos piscícolas, pero el factor de condición mostró buenas condiciones corporales en los peces. En la sangre de los tambacus fueron identificados trombocitos, linfocitos, monocitos, neutrofilos, leucocitos granulares PASpositivos (LG-PAS) y eosinofilos. Los niveles de glucosa y proteínas, hematocrito, recuento de leucocitos totales, el recuento total de trombocitos, monocitos, neutrófilos y eosinofilos fueron similares entre peces de los criaderos piscícolas. Sin embargo, la concentración de hemoglobina, recuento de eritrocitos, concentración de hemoglobina corpuscular media (CHCM), volumen corpuscular medio (VCM), el número de linfocitos y LG-PAS mostraron diferencias entre los peces de loscriaderos piscícolas. Aunque los resultados mostraron relativa similitud entre los parámetros de lo sangre de peces de los criaderos piscícolas, pero o manejo de las condiciones de la calidad del agua del estanque y la comida siempre debe mejorarse para aumentar la productividad en estas criaderos piscícolas.(AU)

This study compared the blood characteristics of hybrid tambacu (Colossoma macropomum x Piaractus mesopotamicus) from three fish farms in the Macapá, State of Amapa (Brazil), which has a similar management. There were differences in the levels of dissolved oxygen in the water and pH in the ponds of the fish farms, but condition factor showed good body condition of the fish. In blood of tambacu were identified thrombocytes, lymphocytes, monocytes, neutrophils, PAS-positive granular leukocytes (PAS-GL) and eosinophils. Plasma glucose and protein levels, hematocrit, total leucocyte count, total thrombocytes count, monocytes, neutrophils and eosinophils count were similar among the three fish farms. However, hemoglobin concentration, total erythrocytes count, mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), number of lymphocytes and PASGLshowed differences among fish of these fish farms. Although the results showed a relative similarity between the blood parameters in the fish of the different fish farms, but the management conditions regarding the water quality in the ponds and food should be improved to increase the productivity in these fish farms.(AU)

Este estudo comparou as características sanguíneas do híbrido tambacu(Colossoma macropomum x Piaractus mesopotamicus)de três pisciculturas de Macapá, Estado do Amapá (Brasil), com manejos semelhantes. Diferenças nos níveis de oxigênio dissolvido e do pH da água dos viveiros foram observadas, mas o fator de condição mostrou a boa condição dos peixes. No sangue dos tambacus foram identificados trombócitos, linfócitos, monócitos, neutrófilos, leucócitos granulares PAS-positivo (LG-PAS) e eosinófilos. Os níveis de glicose e proteína, hematócrito, contagem total de leucócitos, contagem total de trombócitos, contagem de monócitos, neutrófilos e eosinófilos foram similares entre as três pisciculturas. Entretanto, a concentração de hemoglobina, contagem de eritrócitos, da concentração de hemoglobina corpuscular média (CHCM), volume corpuscular médio (VCM), número de linfócitos e LG-PAS mostraram diferenças entre os peixes destas pisciculturas. Embora, os resultados mostraram relativa similaridade entre os parâmetros sanguíneos dos peixes das pisciculturas, mas condições de manejo, relativo à qualidade da água dos viveiros e à alimentação fornecida, devem ser melhoradas para aumentar a produtividade nestas pisciculturas.(AU)

VARIABLES DE LA SANGRE EN HYBRIDO TAMBACU CULTIVADO EN EL ESTADO DE AMAPÁ, NORTE DE BRASIL / Blood variables of hybrid tambacu farmed in Amapá state, Northern Brazil / VARIÁVEIS SANGUÍNEAS DO HÍBRIDO TAMBACU CULTIVADO NO ESTADO DO AMAPÁ, NORTE DO BRASIL

Este estudio comparó las características de la sangre de híbrido tambacu (Colossomamacropomum x Piaractus mesopotamicus) tres criaderos piscícolas en Macapá, Estado deAmapá (Brasil), con gestiones similares. No se observaron diferencias en los niveles deoxígeno y pH del agua de los estanques en los criaderos piscícolas, pero el factor de condiciónmostró buenas condiciones corporales en los peces. En la sangre de los tambacus fueronidentificados trombocitos, linfocitos, monocitos, neutrofilos, leucocitos granulares PASpositivos (LG-PAS) y eosinofilos. Los niveles de glucosa y proteínas, hematocrito, recuentode leucocitos totales, el recuento total de trombocitos, monocitos, neutrófilos y eosinofilosfueron similares entre peces de los criaderos piscícolas. Sin embargo, la concentración dehemoglobina, recuento de eritrocitos, concentración de hemoglobina corpuscular media(CHCM), volumen corpuscular medio (VCM), el número de linfocitos y LG-PAS mostrarondiferencias entre los peces de loscriaderos piscícolas. Aunque los resultados mostraronrelativa similitud entre los parámetros de lo sangre de peces de los criaderos piscícolas, pero omanejo de las condiciones de la calidad del agua del estanque y la comida siempre debemejorarse para aumentar la productividad en estas criaderos piscícolas.

This study compared the blood characteristics of hybrid tambacu (Colossoma macropomum x Piaractus mesopotamicus) from three fish farms in the Macapá, State of Amapa (Brazil), which has a similar management. There were differences in the levels of dissolved oxygen in the water and pH in the ponds of the fish farms, but condition factor showed good body condition of the fish. In blood of tambacu were identified thrombocytes, lymphocytes, monocytes, neutrophils, PAS-positive granular leukocytes (PAS-GL) and eosinophils. Plasma glucose and protein levels, hematocrit, total leucocyte count, total thrombocytes count, monocytes, neutrophils and eosinophils count were similar among the three fish farms. However, hemoglobin concentration, total erythrocytes count, mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), number of lymphocytes and PAS-GL showed differences among fish of these fish farms. Although the results showed a relative similarity between the blood parameters in the fish of the different fish farms, but the management conditions regarding the water quality in the ponds and food should be improved to increase the productivity in these fish farms.

Este estudo comparou as características sanguíneas do híbrido tambacu(Colossomamacropomum x Piaractus mesopotamicus)de três pisciculturas de Macapá, Estado do Amapá(Brasil), com manejos semelhantes. Diferenças nos níveis de oxigênio dissolvido e do pH daágua dos viveiros foram observadas, mas o fator de condição mostrou a boa condição dospeixes. No sangue dos tambacus foram identificados trombócitos, linfócitos, monócitos,neutrófilos, leucócitos granulares PAS-positivo (LG-PAS) e eosinófilos. Os níveis de glicosee proteína, hematócrito, contagem total de leucócitos, contagem total de trombócitos,contagem de monócitos, neutrófilos e eosinófilos foram similares entre as três pisciculturas.Entretanto, a concentração de hemoglobina, contagem de eritrócitos, da concentração dehemoglobina corpuscular média (CHCM), volume corpuscular médio (VCM), número delinfócitos e LG-PAS mostraram diferenças entre os peixes destas pisciculturas. Embora, osresultados mostraram relativa similaridade entre os parâmetros sanguíneos dos peixes daspisciculturas, mas condições de manejo, relativo à qualidade da água dos viveiros e àalimentação fornecida, devem ser melhoradas para aumentar a produtividade nestaspisciculturas.

Giant intracranial aneurysms: morphology and clinical presentation.

The purpose of this study was to correlate the morphology of giant intracranial aneurysms (GIA) with their clinical presentation. Eighty patients with GIA, 14 males and 66 females, were studied. Univariate and multivariate analyses were made to test the associations between morphological and clinical features. The main locations of the unruptured GIA included the carotid cavernous segment, and for the ruptured GIA, the most frequent were the carotid supraclinoid and middle cerebral arteries. There was a significant association among communicating arteries (CA) of "bad" quality and presence of thrombus and calcification (TC). The risk of rupture is 8 times higher in patients with CA of "bad" quality and 11 times higher in patients without TC. GIA are more frequent in the cavernous segment. There is a high rupture risk in the middle cerebral artery. CA of "bad" quality are associated with TC. The rupture risk is significantly higher in patients without TC.

Oral and maxillofacial trauma in patients with epilepsy: prospective study based on an outpatient population.

OBJECTIVE: This study aimed to evaluate oral and maxillofacial trauma caused by falls during epileptic seizures. METHOD: A prospective case-control study was carried out among patients recruited from both the Epileptic Outpatient Clinic and the Emergency Room of Hospital de Base during 2006. The study group was composed of patients with epilepsy that had been diagnosed by a specialist. Oral and maxillofacial trauma was diagnosed using a questionnaire together with physical and radiographic examinations. A control group was formed from non-epileptic relatives or neighbors of the patients. The two groups were compared with regard to the number and type of oral and maxillofacial trauma events suffered. Odds ratios with a 95% confidence interval, dependency analysis and the Pearson χ(2) test were used for statistical analysis, and the significance level was set at p≤0.05. RESULTS: A total of 159 patients with epilepsy (91 males; 57.3%) and 68 control individuals (28 males; 41.1%) were enrolled in the study. The frequencies of oromaxillary trauma in the study and control groups were 23.9% and 4.4%, respectively. Generalized tonic-clonic, generalized and non-classified seizures were strongly associated with trauma. The commonest lesions were fractures of dental tooth crowns (32.9%), followed by tooth avulsion (7.6%), tooth luxation (5%) and fracturing of prostheses in edentulous patients (3.8%). CONCLUSION: This work shows that injuries to the face and teeth are statistically more common in patients with epilepsy than in the general population, and that individuals who suffer seizures without aura are the most affected.

Oral and maxillofacial trauma in patients with epilepsy: prospective study based on an outpatient population / Trauma oral e maxilofacial em pessoas com epilepsia: estudo prospectivo com base ambulatorial

OBJECTIVE: This study aimed to evaluate oral and maxillofacial trauma caused by falls during epileptic seizures. METHOD: A prospective case-control study was carried out among patients recruited from both the Epileptic Outpatient Clinic and the Emergency Room of Hospital de Base during 2006. The study group was composed of patients with epilepsy that had been diagnosed by a specialist. Oral and maxillofacial trauma was diagnosed using a questionnaire together with physical and radiographic examinations. A control group was formed from non-epileptic relatives or neighbors of the patients. The two groups were compared with regard to the number and type of oral and maxillofacial trauma events suffered. Odds ratios with a 95 percent confidence interval, dependency analysis and the Pearson c² test were used for statistical analysis, and the significance level was set at p≤0.05. RESULTS: A total of 159 patients with epilepsy (91 males; 57.3 percent) and 68 control individuals (28 males; 41.1 percent) were enrolled in the study. The frequencies of oromaxillary trauma in the study and control groups were 23.9 percent and 4.4 percent, respectively. Generalized tonic-clonic, generalized and non-classified seizures were strongly associated with trauma. The commonest lesions were fractures of dental tooth crowns (32.9 percent), followed by tooth avulsion (7.6 percent), tooth luxation (5 percent) and fracturing of prostheses in edentulous patients (3.8 percent). CONCLUSION: This work shows that injuries to the face and teeth are statistically more common in patients with epilepsy than in the general population, and that individuals who suffer seizures without aura are the most affected.

OBJETIVO: O objetivo desse estudo foi avaliar a relação da epilepsia sobre as ocorrências de trauma dento-alveolar e maxilofacial causados por quedas. MÉTODO: Estudo caso-controle prospectivo foi conduzido no ambulatório de epilepsia e do Pronto Atendimento do Hospital de Base de São José do Rio Preto-SP no ano de 2006. Pacientes do grupo caso foram diagnosticados pelo neurologista chefe (sênior) especialista em epilepsia e avaliados quanto ao trauma oral e maxilo-facial pelo pesquisador, por meio de questionário, exame clínico e radiográfico, por ordem de chegada. O grupo controle (GC) foi constituído incluindo indivíduos sem crises, que fossem familiares ou vizinhos próximos dos pacientes com diagnóstico de epilepsia. Intervalo de confiança 95 por cento, ODD, análise de dependência (ANADEP) e c² de Pearson foram utilizados para análise estatística e se adotou nível de significância de p≤0,05. RESULTADOS: Analisaram-se 159 pacientes com epilepsia, dos quais 91(57,3 por cento) masculinos e 68 do GC, dos quais 28 (41,1 por cento) masculinos. A frequência do trauma oro-maxilar em paciente com epilepsia foi 23,9 por cento e no GC foi de 4,4. As crises tônico-clônicas generalizadas, crises generalizadas e as não classificadas estão fortemente co-relacionadas ao trauma. Fraturas das coroas dentais (32,9 por cento), seguidas de avulsão dentária (7,6 por cento), luxação dentária (5 por cento) e fratura da prótese em pacientes edêntulos (3,8 por cento) foram as lesões mais encontradas. CONCLUSÃO: O trabalho mostra que os ferimentos na face e dentes são frequentes em pacientes com crises epilépticas quando comparados ao GC, sendo as pessoas com crises sem a aura as mais afetadas.

Emergency EEG: study of survival.

OBJECTIVE: To determine the survival rate according to the main findings of emergency electroencephalography (EEGs) of patients treated in a tertiary hospital. METHOD: In this prospective study, the findings of consecutive emergency EEGs performed on inpatients in Hospital de Base in São José do Rio Preto, Brazil were correlated with survival utilizing Kaplan-Meyer survival curves. RESULTS: A total of 681 patients with an average age of 42 years old (1 day to 96 years) were evaluated, of which 406 were male. The main reasons for EEGs were epileptic seizures (221 cases), hepatic encephalopathy [116 cases of which 85 (73.3%) were men, p-value=0.001], status epilepticus (104 cases) and impaired consciousness (78 cases). The underlying disease was confirmed in 578 (84.3%) cases with 119 (17.5%) having liver disease [91 (76.0%) were men, p-value=0.001], 105 (15.4%) suffering strokes, 67 (9.9%) having metabolic disorders, 51 (7.5%) central nervous system infections and 49 (7.2%) epilepsy. In the three months following EEG, a survival rate of 75% was found in patients with normal, discreet slow activity or intermittent rhythmic delta activity EEGs, of 50% for those with continuous delta activity and generalized epileptiform discharges, and of 25% for those with burst-suppression, diffuse depression, and in alpha/theta-pattern coma. Death was pronounced immediately in patients with isoelectric EEGs. CONCLUSION: The main findings of EEGs, differentiated different survival rates and are thus a good prognostic tool for patients examined in emergencies.

Emergency EEG: study of survival / EEG de urgência: taxa de sobrevivência

OBJECTIVE: To determine the survival rate according to the main findings of emergency electroencephalography (EEGs) of patients treated in a tertiary hospital. METHOD: In this prospective study, the findings of consecutive emergency EEGs performed on inpatients in Hospital de Base in São José do Rio Preto, Brazil were correlated with survival utilizing Kaplan-Meyer survival curves. RESULTS: A total of 681 patients with an average age of 42 years old (1 day to 96 years) were evaluated, of which 406 were male. The main reasons for EEGs were epileptic seizures (221 cases), hepatic encephalopathy [116 cases of which 85 (73.3 percent) were men, p-value=0.001], status epilepticus (104 cases) and impaired consciousness (78 cases). The underlying disease was confirmed in 578 (84.3 percent) cases with 119 (17.5 percent) having liver disease [91 (76.0 percent) were men, p-value=0.001], 105 (15.4 percent) suffering strokes, 67 (9.9 percent) having metabolic disorders, 51 (7.5 percent) central nervous system infections and 49 (7.2 percent) epilepsy. In the three months following EEG, a survival rate of 75 percent was found in patients with normal, discreet slow activity or intermittent rhythmic delta activity EEGs, of 50 percent for those with continuous delta activity and generalized epileptiform discharges, and of 25 percent for those with burst-suppression, diffuse depression, and in alpha/theta-pattern coma. Death was pronounced immediately in patients with isoelectric EEGs. CONCLUSION: The main findings of EEGs, differentiated different survival rates and are thus a good prognostic tool for patients examined in emergencies.

OBJETIVO: Determinar a taxa de sobrevivência (TS), segundo os principais achados de eletrencefalograma de urgência (E-EEG), dos pacientes atendidos nas emergências de hospital de alta complexidade. MÉTODO: Estudo prospectivo, por ordem de chegada, da correlação entre os achados de E-EEG, feitos nos pacientes à beira do leito, com TS, utilizando-se as curvas de sobrevidas de Kaplan Meyer no Hospital de Base de São José do Rio Preto, São Paulo/Brasil. RESULTADOS: Foram estudados 681 pacientes, dos quais 406 (59,6 por cento) masculinos, com idade média de 42 anos (1 dia a 96 anos). As principais motivações para o E-EEG foram crises epilépticas (221 casos), encefalopatia hepática [(116 casos, dos quais 85 masculinos (73,3 por cento), p= 0,001]; estado de mal epiléptico 104 e rebaixamento de consciência 78. O diagnóstico da doença de base foi confirmado em 578 (84,3 por cento), sendo 119 (17,5 por cento) hepatopatia, dos quais 91 (76, por cento) masculinos, p= 0,001; 105 (15,4 por cento) acidente vascular encefálico; 67 (9,9 por cento) distúrbio metabólico; 51 (7,5 por cento) infecção do sistema nervoso central e 49 (7,2 por cento) epilepsia. TS de 75 por cento nos três primeiros meses foi encontrada nos pacientes com E-EEG com alentecimento discreto ou com atividade delta rítmica intermitente. TS por volta de 50 por cento nos três meses foi encontrado nos pacientes com E-EEG com delta contínuo, crítico e com descargas periódicas. A TS foi menor que 25 por cento nos dois primeiros meses após E-EEG, nos pacientes com E-EEG com surto/supressão, com depressão difusa e com comas alfa/teta e 0 por cento nos E-EEG iselétricos. CONCLUSÃO: O E-EEG, com seus principais achados, foi capaz de diferenciar as diversas taxas de sobrevivências na amostra estudada, constituindo-se, portanto, bom instrumento de prognóstico para pacientes atendidos nas unidades de emergência hospitalar.

Fatores que influenciam a qualidade de vida de pessoas com epilepsia / Issues that affect people with epilepsy quality of life

A epilepsia é uma desordem crônica que prejudica a qualidade de vida (QV) e interfere em aspectos emocionais, pessoais, sociais e de relacionamento familiar. Este estudo avaliou a QV de 165 pessoas com diagnóstico de epilepsia, com idade entre 18 e 75 anos (M=41,28; DP= 13,26), por meio do QQV-65. Os escores do questionário foram comparados com características clínicas da doença e entre aqueles pacientes que possuíam refratariedade das crises e com pacientes com crises controladas parcialmente. Não houve diferença em relação às duas populações no fator QV. O fator Emocional foi o mais afetado em ambos os grupos, uma vez que o z-escore médio estimado foi de 51,0±14,4 para o Grupo I e 49,9±14,7 para o Grupo II. Quanto ao tipo de crise, a análise de variância (ANOVA) revelou que Saúde foi o único fator do QQV-65 que apresentou diferença estatisticamente significante entre os z-escores (P=0,024). Entretanto, para a freqüência das crises epiléticas, exceto Saúde (P=0,185), os demais fatores do QQV-65 mostraram-se relacionados de forma estatisticamente significante (P>0,05). O estudo demonstrou que a percepção de controle de crises é muito importante na avaliação da QV em todos os seus aspectos (saúde, físico, social, emocional, lócus de controle, auto-conceito e cognitivo)(AU)

Epilepsy is a chronic disorder that impairs life quality (LQ) and interferes in emotional, personal, social and family relationship aspects. This study evaluated 165 people with epilepsy diagnosis, ranging from 18 to 75 years old (M=41,28; SD= 13,26), by means of the QQV-65 (Life Quality Questionnaire with 65 questions) and investigated the association between the questionnaire scores and the disease features, comparing patients who showed refrectory seizures with patients with partially controled seizures. There was no difference in relation to the two groups regarding the LQ factor. The QQV-65 emotional factor was the most affected in both groups, since the estimated mean z-escore was 51,0±14,4 for Group I and 49,9±14,7 for Group II. Regarding the type of crisis, the analysis of variance (ANOVA) revealed that Health was the only factor in QQV-65 that showed a statistically significant difference between the z-scores (P = 0.024). However, for the frequency of epileptic seizures, except Health (P = 0.185), other factors QQV-65 proved to be related in a statistically significant way (P> 0.05). The research demonstrated that seizure control perception is quite important in the evaluation of life quality in all its aspects (health, body, society, emotion, locus of control, self-concept and cognition)(AU)

Radiculopathy due to iatrogenic fistula between subclavian artery and internal jugular vein.

Central venous cannulation is a routine procedure. We describe a rare complication of internal jugular vein catheterization leading to radiculopathy of the right upper arm. MRI of the neck showed compression of the spinal cord and C2-C7 roots by the engorged veins. Digital subtraction angiography demonstrated a fistula between subclavian artery and internal jugular vein. The fistula was successfully occluded by stent placement in the artery.

Demonstration Project on Epilepsy in Brazil: situation assessment.

PURPOSE: To provide a situation assessment of services for people with epilepsy in the context of primary health care, as part of the Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign 'Epilepsy out of the shadows'. METHODS: We performed a door-to-door epidemiological survey in three areas to assess the prevalence of epilepsy and its treatment gap. We surveyed a sample of 598 primary health care workers from different regions of Brazil to assess their perceptions of the management of people with epilepsy in the primary care setting. RESULTS: The lifetime prevalence of epilepsy was 9.2/1,000 people [95% CI 8.4-10.0] and the estimated prevalence of active epilepsy was 5.4/1,000 people. Thirty-eight percent of patients with active epilepsy were on inadequate treatment, including 19% who were taking no medication. The survey of health workers showed that they estimated that 60% of patients under their care were seizure-free. They estimated that 55% of patients were on monotherapy and that 59% had been referred to neurologists. The estimated mean percentage of patients who were working or studying was 56%. Most of the physicians (73%) did not feel confident in managing people with epilepsy. DISCUSSION: The epidemiological survey in the areas of the Demonstration Project showed that the prevalence of epilepsy is similar to that in other resource-poor countries, and that the treatment gap is high. One factor contributing to the treatment gap is inadequacy of health care delivery. The situation could readily be improved in Brazil, as the primary health care system has the key elements required for epilepsy management. To make this effective and efficient requires: i) an established referral network, ii) continuous provision of AEDs, iii) close monitoring of epilepsy management via the notification system (Sistema de Informação da Atenção Básica - SIAB) and iv) continuous education of health professionals. The educational program should be broad spectrum and include not only medical management, but also psycho-social aspects of epilepsy.

Demonstration project on epilepsy in Brazil: outcome assessment.

PURPOSE: To assess the outcome of patients with epilepsy treated at primary care health units under the framework of the demonstration project on epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy. METHOD: We assessed the outcome of patients treated at four primary health units. The staff of the health units underwent information training in epilepsy. The outcome assessment was based on: 1) reduction of seizure frequency, 2) subjective perception from the patients and the physicians point of view, 3) reduction of absenteeism, 4) social integration (school and work), and 5) sense of independence. RESULTS: A total of 181 patients (93 women - 51%) with a mean age of 38 (range from 2 to 86) years were studied. The mean follow-up was 26 months (range from 1 to 38 months, 11 patients had follow-up of less than 12 months). Seizure frequency was assessed based on a score system, ranging from 0 (no seizure in the previous 24 months) to 7 (>10 seizure/day). The baseline median seizure-frequency score was 3 (one to three seizures per month). At the end of the study the median seizure-frequency score was 1 (one to three seizures per year). The patients and relatives opinions were that in the majority (59%) the health status had improved a lot, some (19%) had improved a little, 20% experienced no change and in 2% the health status was worse. With regard to absenteeism, social integration and sense of independence, there were some modest improvements only. DISCUSSION: The development of a model of epilepsy treatment at primary health level based on the existing health system, with strategic measures centred on the health care providers and the community, has proved to be effective providing important reductions in seizure frequency, as well as in general well being. This model can be applied nationwide, as the key elements already exist provided that strategic measures are put forward in accordance with local health providers and managers.

Demonstration project on epilepsy in Brazil: situation assessment

PURPOSE: To provide a situation assessment of services for people with epilepsy in the context of primary health care, as part of the Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign 'Epilepsy out of the shadows'. METHODS: We performed a door-to-door epidemiological survey in three areas to assess the prevalence of epilepsy and its treatment gap. We surveyed a sample of 598 primary health care workers from different regions of Brazil to assess their perceptions of the management of people with epilepsy in the primary care setting. RESULTS: The lifetime prevalence of epilepsy was 9.2/1,000 people [95 percent CI 8.4-10.0] and the estimated prevalence of active epilepsy was 5.4/1,000 people. Thirty-eight percent of patients with active epilepsy were on inadequate treatment, including 19 percent who were taking no medication. The survey of health workers showed that they estimated that 60 percent of patients under their care were seizure-free. They estimated that 55 percent of patients were on monotherapy and that 59 percent had been referred to neurologists. The estimated mean percentage of patients who were working or studying was 56 percent. Most of the physicians (73 percent) did not feel confident in managing people with epilepsy. DISCUSSION: The epidemiological survey in the areas of the Demonstration Project showed that the prevalence of epilepsy is similar to that in other resource-poor countries, and that the treatment gap is high. One factor contributing to the treatment gap is inadequacy of health care delivery. The situation could readily be improved in Brazil, as the primary health care system has the key elements required for epilepsy management. To make this effective and efficient requires: i) an established referral network, ii) continuous provision of AEDs, iii) close monitoring of epilepsy management via the notification system (Sistema de Informação da Atenção Básica - SIAB) and iv)...

OBJETIVO: Avaliar a situação da assistência à epilepsia no contexto da atenção primária sob o Projeto Demonstrativo em epilepsia no Brasil, parte da Campanha Global Epilepsia Fora das Sombras da WHO/ILAE/IBE. MÉTODO: Fizemos um levantamento epidemiológico para definir a prevalência e lacuna de tratamento em epilepsia. Avaliamos a percepção de 598 profissionais de saúde da atenção básica de diferentes regiões do Brasil sobre epilepsia e seu manejo na rede básica de saúde. RESULTADOS: A prevalência acumulada de epilepsia foi de 9,2/1000 pessoas (95 por centoIC= 8,4-10) e a prevalência estimada de epilepsia ativa foi de 5,4/1000 pessoas. Trinta e oito porcento dos pacientes com epilepsia ativa estavam sendo tratados inadequadamente, incluindo 19 por cento que estavam sem medicação. A enquete com os profissionais de saúde mostrou que a média estimada de pacientes livre de crises sob os cuidados dos mesmos era de 60 por cento. A média estimada de porcentagem em monoterapia era de 55 por cento. A média estimada de porcentagem de referência para neurologistas era de 59 por cento. A média estimada de porcentagem de pacientes que estavam trabalhando ou estudando era de 56 por cento. A maioria dos médicos não se sente confiante em atender uma pessoa com epilepsia. DISCUSSÃO: A análise situacional da Fase I - estudo epidemiológico nas áreas de interesse do PD mostrou que a prevalência da epilepsia é similar a outros países em desenvolvimento e a lacuna de tratamento é grande. Um dos fatores importantes para a lacuna de tratamento é a falta de adequação à assistência na atenção básica. Essa situação pode ser revertida no Brasil, pois os elementos chaves existem na rede básica para o manejo de pessoas com epilepsia. Entretanto, para torna efetivo e eficiente é preciso i) estabelecimento de um sistema de referência e contra-referência, ii) fornecimento contínuo de medicação anti-epiléptica, iii) monitorização de manejo de pessoas com epilepsia através...

Demonstration project on epilepsy in Brazil: outcome assessment

PURPOSE: To assess the outcome of patients with epilepsy treated at primary care health units under the framework of the demonstration project on epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy. METHOD: We assessed the outcome of patients treated at four primary health units. The staff of the health units underwent information training in epilepsy. The outcome assessment was based on: 1) reduction of seizure frequency, 2) subjective perception from the patients and the physicians point of view, 3) reduction of absenteeism, 4) social integration (school and work), and 5) sense of independence. RESULTS: A total of 181 patients (93 women - 51 percent) with a mean age of 38 (range from 2 to 86) years were studied. The mean follow-up was 26 months (range from 1 to 38 months, 11 patients had follow-up of less than 12 months). Seizure frequency was assessed based on a score system, ranging from 0 (no seizure in the previous 24 months) to 7 (>10 seizure/day). The baseline median seizure-frequency score was 3 (one to three seizures per month). At the end of the study the median seizure-frequency score was 1 (one to three seizures per year). The patients and relatives opinions were that in the majority (59 percent) the health status had improved a lot, some (19 percent) had improved a little, 20 percent experienced no change and in 2 percent the health status was worse. With regard to absenteeism, social integration and sense of independence, there were some modest improvements only. DISCUSSION: The development of a model of epilepsy treatment at primary health level based on the existing health system, with strategic measures centred on the health care providers and the community, has proved to be effective providing important reductions in seizure frequency, as well as in general well being. This model can be applied nationwide, as the key elements already exist provided that strategic measures are put forward...

OBJETIVO: Avaliar o resultado do tratamento de pacientes com epilepsia na atenção básica sob o modelo proposto pelo Projeto Demonstrativo no Brasil, como parte da Campanha Global Contra a Epilepsia da WHO/ILAE/IBE. MÉTODO: Avaliamos o resultado do tratamento nos pacientes acompanhados em quatro unidades básicas de saúde. As equipes de saúde fizeram um treinamento padrão. O resultado do tratamento foi baseado em cinco aspectos: 1) redução da freqüência das crises, 2) percepção subjetiva dos pacientes e dos médicos, 3) redução de absenteísmo, 4) integração social (escola, trabalho), e 5) senso de independência. RESULTADOS: Um total de 181 pacientes (93 mulheres - 51 por cento), com uma média de 38 anos (variando de 2 a 86 anos) entraram nesta análise. O tempo médio de seguimento foi de 26 meses (variou de 1 a 38 meses, 11 pacientes tinham seguimento menos de 12 meses). A freqüência das crises foi categorizada variando de 0 (sem nenhuma crise nos últimos 24 meses) a 7 (>10 crises/dia). O escore mediano da freqüência de crises no começo era de 3 (uma a três crises por mês). O escore mediano da freqüência de crises no final era de 1 (uma a três crises por ano). A opinião dos pacientes e familiares é que a maioria (106 casos) houve uma melhora importante na saúde, 34 tiveram pouca melhora, 37 não tiveram mudanças e em quatro houve piora. Em relação ao absenteísmo, integração social e senso de independência houve pouca melhora. DISCUSSÃO: O modelo desenvolvido de tratamento de epilepsia na atenção primária com base na estrutura de saúde existente, com estratégias centradas nos profissionais de saúde e na comunidade, provou ser efetivo com redução importante na freqüência das crises bem como na melhora em geral da saúde. Esse modelo pode ser aplicado em âmbito nacional, pois os elementos chaves já existem, desde que essas estratégias sejam pactuadas com os organismos locais de saúde.

Prevalence and pattern of epilepsy treatment in different socioeconomic classes in Brazil.

PURPOSE: The worldwide prevalence of epilepsy is variable, estimated at 10//1,000 people, and access to treatment is also variable. Many people go untreated, particularly in resource-poor countries. OBJECTIVE: To estimate the prevalence of epilepsy and the proportion of people not receiving adequate treatment in different socioeconomic classes in Brazil, a resource-poor country. METHODS: A door-to-door survey was conducted to assess the prevalence and treatment gap of epilepsy in three areas of two towns in Southeast Brazil with a total population of 96,300 people. A validated screening questionnaire for epilepsy (sensitivity 95.8%, specificity 97.8%) was used. A neurologist further ascertained positive cases. A validated instrument for socioeconomic classification was used. RESULTS: Lifetime prevalence was 9.2/1,000 people [95% CI 8.4-10.0] and the prevalence of active epilepsy was 5.4/1,000 people. This was higher in the more deprived social classes (7.5/1,000 compared with 1.6/1,000 in the less deprived). Prevalence was also higher in elderly people (8.5/1,000). Thirty-eight percent of patients with active epilepsy had inadequate treatment (19% on no medication); the figures were similar in the different socioeconomic groups. CONCLUSION: The prevalence of epilepsy in Brazil is similar to other resource-poor countries, and the treatment gap is high. Epilepsy is more prevalent among less wealthy people and in elderly people. There is an urgent need for education in Brazil to inform people that epilepsy is a treatable, as well as preventable, condition.

Sleep parameters in patients using pacemakers with sleep rate function on.

INTRODUCTION: The cardiovascular system (CVS) is heavily influenced by the autonomic nervous system. Additionally, there is a functional alteration during the various stages of sleep. In nonrapid eye movement (NREM), a state of cardiovascular relaxation occurs during stages three and four. A large amount of rapid ocular movements is concentrated in rapid eye movement (REM) sleep. During this phase, fluctuations in arterial pressure (AP) and heart rate (HR) can be readily noted. Sleep disordered breathing (SDB) has been associated with cardiac rhythm disorders. Recently, cardiac rhythm disorder treatment with pacemaker (PM) highlighted a reduction in abnormal respiratory events during sleep. OBJECTIVE: Comparison of sleep parameters of patients using PM with a sleep rate (SR) algorithm based on its rate-modulated capability during physical activity (Integrity PM with SR function on and off). METHODS: Twenty-two patients (14 women, 8 men), implanted with an Integrity PM (St. Jude Medical Cardiac Rhythm Management Division, Sylmar, CA) with SR function for standard clinical indications, were evaluated utilizing a double-blind protocol. The indication for pacing included sinus node disease (SND), atrium ventricular blockage (AVB), and atrial fibrillation (AF). Following randomization, half of our patients had SR function switched to "on" mode while the other half were on "off" mode. During the first stage of the protocol, all patients underwent two consecutive nights of polysomnographic sleep recordings (PSG). During the first night patients slept in the sleep lab only for adaptation purpose. PSG full recording was carried out in the subsequent night. At a later stage, the programing of SR functions was shifted to "on" or "off" modes. One week later, a third assessment was undertaken. RESULTS: Twelve patients (54%) showed sleep efficiency improvement (total sleeping time/recording time) with PM SR on. This group had the least effective sleep efficiency with PM off, if compared with the others who highlighted no change in this sleep parameter (72 +/- 12 vs 81 +/- 7%, P = 0.01, respectively). This first group displayed a lower latency for REM sleep than the last one (89 +/- 55 vs 174 +/- 107 minutes, P = 0.01, respectively). In 11 (50%) patients, the number per sleep hour of microarousals was reduced when PM SR was switched on. When we compared such findings to the group whose parameters had not changed, we noted that the first set of patients were sleepier (ESE: 9 +/- 4 vs 5 +/- 5, P = 0.04, respectively), and showed more microarousals with PM SR off (20 +/- 14 vs 7 +/- 5 microarousal/hour, P = 0.007). CONCLUSION: In PM patients with sleep-related issues, the SR function activation improved sleep both from a qualitative and quantitative perspective.

Assessment of the epilepsy treatment gap in two cities of south-east of Brazil.

OBJECTIVE: To assess the epilepsy treatment gap in Campinas and São Josédo Rio Preto, two cities in the State of São Paulo, Brazil. METHOD: The treatment gap was estimated using the formula n1-n2/n1x100, where n1 was calculated using 1.86% prevalence and represented the number of individuals with epilepsy, while n2 represented the number of people who could be treated with an adult standard dose for a year utilizing the antiepileptic drugs supplied by the public health system. RESULTS: Our estimates revealed that in 2001, approximately 50% of the population with epilepsy was treated with the recommended antiepileptic medication. CONCLUSION: These results suggest that a relevant percentage of patients with epilepsy are not untreated. Further epidemiological studies are needed to investigate the reasons for this treatment gap so that interventions can reduce this gap and improve the quality of life of patients with epilepsy.

Assessment of the epilepsy treatment gap in two cities of south-east of Brazil

OBJETIVO: Estimar a lacuna de tratamento em epilepsia nas cidades de Campinas e São José do Rio Preto, interior do Estado de São Paulo. MÉTODO: Estimamos a lacuna de tratamento através da fórmula n1-n2/n1x100, onde se utiliza o número de pessoas com epilepsia, calculado pela prevalência (n1), e a quantidade de pessoas que podem ser tratadas com a dose padrão para adultos das DAEs, distribuídas no período de um ano na localidade (n2). Usamos a prevalência estimada de 1,86% e consumo de medicação antiepiléptica fornecida pela rede básica de saúde nestas duas cidades. RESULTADOS: Nossas estimativas mostram que somente em torno de metade da população com epilepsia foi tratada em 2001 usando doses preconizadas de medicação antiepiléptica. CONCLUSÃO: A nossa estimativa aponta que uma parcela importante dos pacientes com epilepsia não está sendo tratada no nosso meio. Estudos epidemiológicos futuros devem explorar os motivos desta lacuna de tratamento para que intervenções sejam realizadas para melhorar a qualidade de vida dos pacientes com epilepsia.

Urban prevalence of epilepsy: populational study in São José do Rio Preto, a medium-sized city in Brazil.

UNLABELLED: The aim of this study was to determine the prevalence of epilepsy in the urban population of São José do Rio Preto. This is a medium-sized city of 336000 inhabitants, located in the northwest of the state of São Paulo, Brazil. METHOD: A cross-sectional epidemiological investigation with a randomized sample was performed in two phases, a screening phase and a confirmation of the diagnosis phase. The gold standard was a clinical investigation and neurological examination. The chi-square test was used in analysis of the results and p-value value < 0.05 was considered significant. Prevalence was calculated with 95% confidence interval. RESULTS: The study sample size was 17293 individuals, with distributions of gender, age, and race similar to the general population. The prevalence per 1000 inhabitants of epilepsy was 18.6, of these 8.2 were active, defined as at least one seizure within the last two years. The prevalence per 1000 inhabitants for the age groups (years) was 4.9 (04), 11.7 (514), 20.3 (1564) and 32.8 (65 or over). CONCLUSION: Prevalence of both accumulated and active epilepsy was elevated, comparable to other developing nations, in particular those of Latin America. However, the prevalence of epilepsy in childhood was low, whilst in aged individuals it was high similar to industrialized nations.