Plasma Jet versus Electrocarbonization in the Treatment of Wrinkles of the Upper Palpebral Region.

Background: The plasma jet is a non-surgical and minimally invasive procedure that acts by heating the superficial region of the skin, providing rejuvenation of the region. Objective: We sought to compare the clinical and histological effects of direct plasma jet versus electrocarbonization without plasma in the treatment of wrinkles in the upper palpebral region. Methods: This is a clinical trial in which 20 volunteers participated and divided into two groups: electrocarbonization (EG) and plasma jet (JPG), which were clinically evaluated before and after treatment through evaluation protocols, photographs, and questionnaires. Three treatment sessions were performed in the upper eyelid region with an interval of 30 days. After the treatment, a surgical procedure of upper blepharoplasty was performed on two volunteers to remove a skin fragment and later histological analysis. Results: The JPG showed better clinical responses in rejuvenation. The EG promoted an increase in the number of fibroblasts, the number of blood vessels and the amount of inflammation. The JPG showed an increase in the number of fibroblasts and blood vessels. It was observed that the JPG generated activation of T lymphocytes (CD3), macrophages (CD68), and plasmocytes (CD138); in addition to reducing the number of positive cells for CD57 (NK cells). The satisfaction analysis shows that 100 percent in the JPG considered themselves satisfied with the treatment. Conclusion: We verified that in comparison with electrocarbonization, the use of a direct plasma jet promoted tissue improvement at the histological level, in addition to fewer adverse reactions.

THE EFFECTIVENESS OF FORAMINAL ROOT BLOCK IN RELIEVING SCIATIC PAIN DUE TO LUMBAR DISC HERNIATION.

Objective: To evaluate the clinical profile, pain improvement, and the need for surgical interventions in patients undergoing transforaminal block with the use of corticosteroids and anesthetics. Methods: This is a prospective, randomized, double-blind study with 45 patients with unilateral radicular pain in their lower limbs and a single-segment lumbar disc herniation diagnosis. In the intervention group, transforaminal blocks with bupivacaine, dexamethasone, and clonidine were applied and in the control group, distilled water and bupivacaine. The Oswestry questionnaire was applied. Results: We included 24 female (53.4%) and 21 male patients (46.6%). Of those with an occupation, 85.71% (n = 30) were relieved from their duties due to their illness and 14.29% (n = 5) continued to work with limitations. Those who underwent transforaminal block with an injection of corticosteroids, clonidine, and anesthetics showed immediate relief. However, such effect failed to alleviate patients' symptoms after three weeks. We observed that 52% of patients showed varying degrees of improvement. The control group experienced mild pain relief after one week, which also failed to last after three weeks. Moreover, 50% of patients improved in varying degrees. Conclusion: Further studies with larger samples, new epidemiological data, and longer follow-ups are necessary to validate our hypotheses. Level of Evidence II, Prospective Study.

Objetivo: Avaliar o perfil clínico, a melhora da dor e a necessidade de intervenções cirúrgicas em pacientes submetidos ao bloqueio transforaminal com uso de corticosteroides e anestésicos. Métodos: Estudo prospectivo, randomizado e duplo-cego realizado com 45 pacientes com dor radicular unilateral em membros inferiores e diagnóstico de hérnia discal lombar em um único segmento. No grupo intervenção, os bloqueios transforaminais foram feitos com bupivacaína, dexametasona e clonidina; no controle, água destilada e bupivacaína. Foi aplicado questionário de Oswestry. Resultados: A amostra foi composta de 24 mulheres (53,4%) e 21 homens (46,6%). Dos pacientes com ocupação, 85,71% (n = 30) estavam afastados de suas funções devido à doença e 14,29% (n = 5) continuavam a trabalhar com limitações. Os que foram submetidos ao bloqueio transforaminal com injeção de corticoide, clonidina e anestésico apresentaram alívio imediato. Após três semanas, contudo, o efeito não perdurou de forma tão satisfatória, e 52% dos pacientes apresentaram melhora em graus variados. No grupo controle, houve discreto alívio álgico após uma semana, que não perdurou de forma satisfatória após três semanas, com 50% dos pacientes evoluindo para melhora em graus variados. Conclusão: Mais estudos com espaço amostral maior, novos dados epidemiológicos e seguimento mais prolongado são necessários para validar as hipóteses aventadas. Nível de Evidência II, Estudo Prospectivo.

Situational analysis of syphilis cases taking place between 2015 and 2021 in the state of Rio Grande do Norte - Brazil / Análise situacional da sífilis entre os anos de 2015 e 2021 no estado do Rio Grande do Norte, Brasil

Introduction: Syphilis is a sexually transmitted infection that represents a severe public health problem worldwide and in Brazil it has not been different. The national compulsory notifications regarding syphilis cases are significantly increasing, and therefore, this fact alone justifies the study of such a relevant subject. Objective: This work presents a situational analysis of syphilis cases in the state of Rio Grande do Norte, Brazil, between 2015 and 2021, aiming primarily at assisting public healthcare authorities in decision-making processes to cope with the disease. Concomitantly, this research aims to build knowledge as well as to provide awareness to the population. Methods: This study analyzed data from compulsory notifications reports from 2015 to 2021, available in the database of the Brazilian Unified Health System's Informatics Department, in the Brazilian Information System of Notifiable Diseases and in the Brazilian Health Surveillance Secretariat. Results: In the state, 70% of patients with syphilis are aged 15 to 39 years. The rate of patients affected with acquired syphilis that have low education is 48%, and for pregnant women, this value rises to 77%. The declared mixed-race patients represent 48% of notifications for acquired syphilis, and for mixed-race pregnant women, this value increases to 60%. In congenital syphilis, 98% of compulsory notifications occurred for children aged up to 7 days of birth. Conclusion: Syphilis in Rio Grande do Norte is a public health problem that mainly affects the vulnerable population, predominantly the groups at risk with low education, mixed race, and young-adult people, being of paramount importance to combat the disease through population awareness, as well as through constant and adequate compulsory notification.

Introdução: A sífilis é uma infecção sexualmente transmissível que representa um grave problema de saúde pública para o mundo, bem como para o Brasil. As notificações compulsórias nacionais de casos de sífilis estão crescendo significativamente, portanto esse fato por si só justifica o estudo centrado nesta temática de primordial importância. Objetivo: Este trabalho apresenta uma análise situacional da sífilis entre os anos de 2015 e 2021 no estado do Rio Grande do Norte, visando principalmente auxiliar as autoridades públicas de saúde nos processos decisórios em resposta à sífilis, mas também construir conhecimento e embasar a conscientização da população. Métodos: Foram analisados dados das notificações de 2015 a 2021 disponíveis na base de dados do Sistema Único de Saúde, no Sistema de Informação de Agravos de Notificação e na Secretaria de Vigilância em Saúde. Resultados: No estado, mais de 70% dos pacientes afetados por sífilis têm entre 15 e 39 anos de idade. A taxa de pacientes com baixa escolaridade e que foram notificados com sífilis adquirida é de 48% e, para as gestantes, esse valor sobe para 77%. Pacientes declarados pardos representam 48% das notificações para sífilis adquirida e, para gestantes pardas, esse valor amplia-se para 60%. Na sífilis congênita, 98% das notificações ocorreram para crianças com idade de até sete dias de nascidos. Conclusão: A sífilis no Rio Grande do Norte é um problema de saúde pública que atinge principalmente a população vulnerável, com predominância dos grupos de baixa escolaridade, raça parda e jovens adultos, sendo de suma importância o combate à doença por meio da conscientização da população, como também a constante e adequada notificação compulsória.

Clinical manifestations of syphilis in the oral cavity: a review / Manifestações clínicas da sífilis na cavidade oral: uma revisão bibliográfica

Introduction: Syphilis is a sexually transmitted infection caused by Treponema pallidum bacterium, which impact on a significant increase in contagions reported worldwide, bringing up the need of urgent actions to ensure the control, treatment, and diagnosis of the disease. Objective: Given this context, this work presents a bibliographical review on syphilis, aiming to describe the most common oral manifestations that occur on the four stages of this infection. Methods: For the literature review, the searches were carried out in the PubMed, Science Direct, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature and databases of Virtual Health Library. Results: Regarding the primary syphilis, the main clinical manifestations in the oral cavity include chancres in the palate, buccal mucosa, tongue, and lips. In the secondary stage, the presence of diffuse and nonspecific oral lesions was identified. In tertiary syphilis, stomatitis and glossitis are present, being the hard palate and the tongue the main affected regions. In congenital syphilis, the patients are affected with dental and jaw malformations. Conclusion: The clinical manifestations of syphilis in the oral cavity can appear at any stage of the infection, being the oral cavity the second most affected region by this sexually transmitted infection. Therefore, the knowledge regarding this subject is extremely important for health professionals, as well as for the population, being essential to carry out the correct diagnosis and adequate treatment for the rapid cure of this infection (AU)

Introdução: A sífilis é uma infecção sexualmente transmissível oriunda da bactéria Treponema Pallidum, com transmissão através de relações sexuais sem o uso de preservativos ou por contato com lesões contaminadas. Nos últimos anos, diversos novos casos estão sendo reportados de forma alarmante, mostrando uma realidade dura sobre as dificuldades do diagnóstico da doença. Objetivo: Diante desse contexto, este trabalho apresenta uma revisão bibliográfica sobre a sífilis, com o objetivo de descrever as manifestações orais mais comuns nos quatros estágios possíveis da doença. Métodos: Para a revisão de literatura, realizou-se a busca dos artigos nas bases de pesquisas PubMed, Science Direct, Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde e Biblioteca Virtual em Saúde. Resultados: Observou-se que, na sífilis primária, as principais manifestações clínicas na cavidade oral ocorrem com a presença de cancros no palato, na mucosa jugal, na língua e nos lábios. No estágio secundário, identificou-se a presença de lesões orais difusas e inespecíficas. Na sífilis terciária, podem ocorrer estomatites e glossites, sendo o palato duro e a língua as principais regiões acometidas. Na sífilis congênita, os possíveis sinais clínicos na cavidade oral são malformações dentárias e nos maxilares. Conclusões: As manifestações clínicas da sífilis na cavidade oral podem surgir em qualquer estágio da infecção, sendo a cavidade oral a segunda região com maior acometimento da infecção. Portanto, é de extrema importância o conhecimento das manifestações orais da sífilis pelos profissionais da área da saúde, bem como pela população, sendo fundamental o correto diagnóstico e tratamento rápido para a cura precoce da doença. (AU)

The effectiveness of foraminal root block in relieving sciatic pain due to lumbar disc herniation / A eficácia do bloqueio radicular foraminal no alívio da dor ciática devido à hérnia discal lombar

ABSTRACT Objective: To evaluate the clinical profile, pain improvement, and the need for surgical interventions in patients undergoing transforaminal block with the use of corticosteroids and anesthetics. Methods: This is a prospective, randomized, double-blind study with 45 patients with unilateral radicular pain in their lower limbs and a single-segment lumbar disc herniation diagnosis. In the intervention group, transforaminal blocks with bupivacaine, dexamethasone, and clonidine were applied and in the control group, distilled water and bupivacaine. The Oswestry questionnaire was applied. Results: We included 24 female (53.4%) and 21 male patients (46.6%). Of those with an occupation, 85.71% (n = 30) were relieved from their duties due to their illness and 14.29% (n = 5) continued to work with limitations. Those who underwent transforaminal block with an injection of corticosteroids, clonidine, and anesthetics showed immediate relief. However, such effect failed to alleviate patients' symptoms after three weeks. We observed that 52% of patients showed varying degrees of improvement. The control group experienced mild pain relief after one week, which also failed to last after three weeks. Moreover, 50% of patients improved in varying degrees. Conclusion: Further studies with larger samples, new epidemiological data, and longer follow-ups are necessary to validate our hypotheses. Level of Evidence II, Prospective Study.

RESUMO Objetivo: Avaliar o perfil clínico, a melhora da dor e a necessidade de intervenções cirúrgicas em pacientes submetidos ao bloqueio transforaminal com uso de corticosteroides e anestésicos. Métodos: Estudo prospectivo, randomizado e duplo-cego realizado com 45 pacientes com dor radicular unilateral em membros inferiores e diagnóstico de hérnia discal lombar em um único segmento. No grupo intervenção, os bloqueios transforaminais foram feitos com bupivacaína, dexametasona e clonidina; no controle, água destilada e bupivacaína. Foi aplicado questionário de Oswestry. Resultados: A amostra foi composta de 24 mulheres (53,4%) e 21 homens (46,6%). Dos pacientes com ocupação, 85,71% (n = 30) estavam afastados de suas funções devido à doença e 14,29% (n = 5) continuavam a trabalhar com limitações. Os que foram submetidos ao bloqueio transforaminal com injeção de corticoide, clonidina e anestésico apresentaram alívio imediato. Após três semanas, contudo, o efeito não perdurou de forma tão satisfatória, e 52% dos pacientes apresentaram melhora em graus variados. No grupo controle, houve discreto alívio álgico após uma semana, que não perdurou de forma satisfatória após três semanas, com 50% dos pacientes evoluindo para melhora em graus variados. Conclusão: Mais estudos com espaço amostral maior, novos dados epidemiológicos e seguimento mais prolongado são necessários para validar as hipóteses aventadas. Nível de Evidência II, Estudo Prospectivo.

Low-grade tumour over the left temporal neocortex and ictal asystole: network and surgical implications.

We describe a patient with focal epilepsy characterized by ictal asystole episodes and low-grade tumour over the left temporal neocortex. Non-invasive pre-surgical evaluation showed an epileptogenic zone extended beyond the low-grade tumour. This extension was confirmed by intraoperative electrocorticography. One-stage surgery with anterior temporal lobe resection was performed. The patient was seizure-free after one year of follow-up. Detailed electroclinical and therapeutic reasoning with hypotheses defining epileptogenic and symptomatogenic networks are discussed.

Perampanel Increases Cortical EEG Fast Activity in Child and Adult Patients Affected by Epilepsy: A Quantitative EEG Study.

OBJECTIVE: Quantitative EEG (qEEG) is an established technique used as objective measure for evaluating the effect of antiseizure medications (ASMs) on EEG background activity and monitoring cognitive effects of ASMs. Perampanel (PER) has been associated with relatively more tolerable cognitive effects in patients with epilepsy. The primary aim of the present study was to verify the effect of PER as first add-on ASM on qEEG in child and adult patients affected by epilepsy. The secondary aim of this study was to verify the effectiveness of the drug as first add-on treatment in both child and adult patients with epilepsy. METHODS: We collected data from 17 adults and 10 children treated with PER as first add-on treatment, who underwent qEEG analysis before starting PER and at 3-month follow-up under stable treatment. RESULTS: PER resulted with significant effectiveness in reducing seizures in both children and adults. Considering qEEG analysis, we observed at follow-up the significant increase in beta1 and beta total bands both in children and adult patients. In particular, children showed the significant increase of beta band frequencies predominantly in the occipital regions, whereas adults showed a widespread increase of beta activity. Moreover, we documented in both child and adult patients the global reduction of delta bands activity. CONCLUSIONS: This qEEG study documented the relative increase of cortical EEG fast activity in both children and adult patients affected by epilepsy and treated by PER. This result may suggest a potential less negative impact of PER on cognition in patients affected by epilepsy, other than demonstrating effectiveness of the drug when used as first add-on treatment in both children and adult patients.

Mismatch Negativity Recording in Children With Duchenne Muscular Dystrophy: A Preliminary Study Integrating Neurophysiological and Neuropsychological Results.

Many studies on Duchenne muscular dystrophy children support the hypothesis of a specific neuropsychological phenotype affecting mostly phonological skills. This prospective study aimed to shed light on the role of phonological abilities. Fourteen Duchenne muscular dystrophy children and 7 healthy children underwent mismatch negativity. Moreover, verbal intelligence, visuospatial attention, immediate verbal memory, working memory, grammar, vocabulary, visuomotor skills, reading, text comprehension, writing, and arithmetic were tested in Duchenne muscular dystrophy children. No significant difference between control and Duchenne muscular dystrophy children was found neither for mismatch negativity amplitude (P = .191 and .116, respectively) nor for latency (P = .135). Eight (57.14%) patients showed an impairment of immediate verbal memory and of visuomotor skills, 7 (63.64%) patients had a deficit in writing and arithmetic skills, even with a mean normal intelligence quotient. Taken together, the results put in evidence a heterogeneous neuropsychological profile not explainable on the basis of a phonological deficit.

Comparing cortical auditory processing in children with typical and atypical benign epilepsy with centrotemporal spikes: Electrophysiologic evidence of the role of non-rapid eye movement sleep abnormalities.

OBJECTIVE: The mismatch negativity (MMN) is an objective measure of central auditory discrimination. MMN alterations have been shown in children with language and/or developmental disorders. In benign focal epilepsies, neuropsychological disorders are often reported and linked to interictal epileptic discharges (IEDs) during non-rapid eye movement (NREM) sleep. There are few studies reporting MMN in children with benign epilepsy with centrotemporal spikes (BECTS) and sleep IEDs. Moreover, no MMN recording has yet been reported in atypical BECTS children with continuous spike-and-wave during sleep (CSWS). We retrospectively compared MMN in typical and atypical BECTS children, particularly addressing the impact of NREM sleep IEDs on auditory discrimination. Moreover, we attempted a neuropsychological characterization of patients. METHODS: The MMN was recorded in 9 normal controls and 23 patients (14 typical BECTS and 9 atypical BECTS) in an oddball paradigm with syllable stimuli. MMN, sleep electroencephalography (EEG) and neuropsychological evaluation were realized in the same testing session. RESULTS: Measurable MMN responses to speech stimuli were identified in both the control and patient groups. A significant difference between control and atypical BECTS children was found with respect to amplitude (p = 0.0061). Atypical BECTS also showed a lower MMN amplitude with respect to typical BECTS, but this difference did not reach statistical significance (p = 0.0545). Statistical comparisons between groups revealed no differences in latency. Among the neuropsychological variables, academic difficulties were significantly more prominent in the patients with atypical BECTS (p = 0.04). SIGNIFICANCE: CSWS EEG pattern affects auditory discrimination and may have a long-lasting impact on academic skills acquisition, whereas in typical BECTS children with a lower degree of IED NREM sleep, plastic brain reorganization or the preservation of participating networks may prevent such difficulty. Early electrophysiologic identification of auditory discrimination deficits in epileptic children could be used in early rehabilitation, thereby reducing the risk of developing neuropsychological disorders.

Neuropsychological findings: myoclonic astatic epilepsy (MAE) and Lennox-Gastaut syndrome (LGS).

PURPOSE: To identify a specific neuropsychological profile associated with myoclonic astatic epilepsy (MAE) and Lennox-Gastaut syndrome (LGS). METHODS: Seven patients diagnosed with MAE and four patients diagnosed with LGS were selected from patients referred to our Child Neurology Unit. The patients were assessed both clinically (awake, sleep, Holter EEG, seizures frequency, and semiology) and neuropsychologically (IQ, language, attention, visuospatial and visuomotor abilities, and behavior). One representative case of each syndrome is presented here. RESULTS: The clinical picture of the MAE patient resembled that of an MAE condition associated with transitory epileptic encephalopathy. The neuropsychological findings suggest that electroclinical anomalies can temporarily affect cognitive and behavioral functioning. Early effective antiepileptic drug (AED) treatment was found to improve cognitive outcome. In contrast, LGS was associated with mental retardation, which persisted after seizure control. CONCLUSIONS: At present, it remains difficult to delineate a precise neuropsychological profile associated with MAE and LGS. The cognitive outcome of MAE is variable and depends on the clinical pattern. With regard to LGS, the hypothesis of a genetic predisposition underlying both the epilepsy and the mental retardation is still valid. Alternatively, exposure to subclinical electrophysiological anomalies during a critical period of cerebral development may be responsible for the mental retardation. At the time the clinical manifestations appear, drug treatment, even if effective, would have only limited impact on cognitive outcome. However, early multidisciplinary intervention may help to improve behavior and communicative abilities, enhancing the quality of life of these children and their families.