Recent patent applications for coffee and coffee by-products as active ingredients in cosmetics.

OBJECTIVE: Coffee is one of the most consumed beverages worldwide, and its production and consumption generate large amounts of by-products annually. Coffee by-products and coffee beans are rich in bioactive compounds of great commercial value, including potential applications as active ingredients in skin care products and cosmetic formulations. In addition, there has been growing interest in the use of natural ingredients for cosmetic purposes. Considering the importance of coffee in the world economy, its chemical constituents with potential for cosmetic and dermatological application, and the importance of patents for innovation and technological development, the present study aimed to review recent patents involving coffee and coffee by-product use in cosmetics. METHODS: This review was carried out using Espacenet. The following inclusion criteria were established: patents that included the terms "coffee" and "skin" in the title, abstract and claims and belonged to the classification A61Q, which is related to the "specific use of cosmetics or similar toilet preparations" considering the International Patent Classification (IPC) or Cooperative Patent Classification (CPC). RESULTS: Considering the 52 patents analysed, the bean was the main way to obtain extracts (39), followed by green beans (7), silverskin (3), peel and pulp (1), pulp (1) and beans and leaves (1). The formulations are mainly intended for use in nonspecific areas of skin (29), eye areas (12), scalp hair (9) and lip skin (2) with claims of anti-ageing, moisturizers, sun protection, hair growth, anti-dandruff, etc. CONCLUSION: Coffee and its residues have high amounts of phenolic compounds, caffeine, fatty acids and other substances known to have important biological properties for the skin. Coffee and its by-products are promising ingredients to be incorporated into topical formulations, ensuring skin health benefits and reducing the environmental impact.

OBJECTIF: Le café est l'une des boissons les plus consommées dans le monde, et sa production et sa consommation génèrent chaque année de grandes quantités de sous-produits. Les sous-produits du café et les grains de café sont riches en composés bioactifs d'une grande valeur commerciale, y compris des applications potentielles en tant qu'ingrédients actifs dans les produits de soins de la peau et les formulations cosmétiques. De plus, il y a eu un intérêt croissant pour l'utilisation d'ingrédients naturels à des fins cosmétiques. Compte tenu de l'importance du café dans l'économie mondiale, de ses constituants chimiques ayant un potentiel d'application cosmétique et dermatologique, et de l'importance des brevets pour l'innovation et le développement technologique, la présente étude visait à examiner les brevets récents concernant l'utilisation du café et des sous-produits du café dans les cosmétiques. MÉTHODES: Cette revue a été réalisée à l'aide d'Espacenet. Les critères d'inclusion suivants ont été établis: les brevets qui incluaient les termes "café" et "peau" dans le titre, l'abrégé et les revendications et appartenaient à la classification A61Q, qui est liée à "l'utilisation spécifique de cosmétiques ou de préparations de toilette similaires" compte tenu de la Classification internationale des brevets ou Classification coopérative des brevets. RÉSULTATS: Considérant les 52 brevets analysés, le grain était le principal moyen d'obtenir des extraits (39), suivi du grain vert (7), du silverskin (3), de la peau et de la pulpe (1), de la pulpe (1) et des grains et des feuilles (1). Les formulations sont principalement destinées à être utilisées dans des zones non spécifiques de la peau (29), des yeux (12), des cheveux du cuir chevelu (9) et de la peau des lèvres (2) avec des revendications anti-âge, hydratantes, protection solaire, croissance des cheveux, antipelliculaire, etc. CONCLUSION: Le café et ses résidus contiennent de grandes quantités de composés phénoliques, de caféine, d'acides gras et d'autres substances connues pour avoir des propriétés biologiques importantes pour la peau. Le café et ses sous-produits sont des ingrédients prometteurs à incorporer dans des formulations topiques, garantissant des bienfaits pour la santé de la peau et réduisant l'impact environnemental.

Chemical characterisation by UPLC-Q-ToF-MS/MS and antibacterial potential of Coffea arabica L. leaves: A coffee by-product.

INTRODUCTION: Coffea arabica L. leaves are considered a by-product of the coffee industry however they are sources of several bioactive compounds. OBJECTIVES: This study aimed to evaluate the chemical composition and the in vitro antibacterial activity of the lyophilised ethanol extract of arabica coffee leaves (EE-CaL). MATERIAL AND METHODS: The chemical characterisation of EE-CaL was performed using ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UPLC-Q-ToF-MS/MS). The in vitro antibacterial effect of EE-CaL was evaluated using the broth microdilution method and the adapted drop plate agar method to determine the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC), respectively. RESULTS: The chemical analysis of EE-CaL revealed the presence of compounds from the alkaloid class, such as trigonelline and caffeine, in addition to the phenolic compounds such as quinic acid, 5-caffeoylquinic acid, caffeic acid-O-hexoside, mangiferin, (epi)catechin, (epi)catechin monoglucoside and procyanidin trimer. Regarding the antibacterial potential, EE-CaL was active against Gram-positive and Gram-negative bacteria, being more effective against Escherichia coli (ATCC 25922) (MIC = 2500 µg/mL and bactericidal effect). CONCLUSION: The results of this research suggest that coffee leaves, a by-product, possess compounds with antibacterial properties. Thus, further studies with coffee leaf extracts must be carried out to relate the compounds present in the extract with the antibacterial activity and find the mechanisms of action of this extract against bacteria.

Entomopathogenic nematodes in pharmaceutical formulations for Rhipicephalus microplus (Acari: Ixodidae) control: In vitro evaluation of compatibility, thermotolerance, and efficiency.

This work aimed to investigate candidate biological control agents against the cattle tick Rhipicephalus microplus by studying three entomopathogenic nematodes (EPN) isolates from two species, Heterorhabditis bacteriophora (isolates LPP30 and HP88) and Heterorhabditis baujardi (isolate LPP7). The study comprised the pharmacotechnical development of four test formulations, and their biological evaluation, in three stages: 1) selection of the fittest EPN isolate at 16 ± 1 °C after 120 h of incorporation in the formulations; 2) determination of the effects of temperature and incubation time on the survival of the selected isolate in formulations; 3) evaluation of the in vitro efficacy (infectivity) of the selected EPN formulations and their components against R. microplus females after 72 h exposure. H. baujardi LPP7 presented the highest survival rates in 0.1% carboxymethyl cellulose sodium (CMC) formulations (100% at 25 °C, up to 10 days after incorporation). At the highest tested temperature (34.2 °C), 54% of LPP7 survived for up to 72 h in CMC formulations. The infectivity of LPP7-containing formulation against R. microplus was 99%, reducing oviposition, egg production index and larval hatching. Considering the pressing need for safer acaricide products, incorporation of EPNs in pharmaceutical formulations is presented as a promising approach for the biological control of cattle tick infestations, potentially reducing environmental impact and resistance development associated with chemical acaricides.

Evaluation of the acaricidal activity of thymol incorporated in two formulations for topical use against immature stages of Rhipicephalus sanguineus sensu lato (Latreille, 1806) (Acari: Ixodidae).

The objective of this study was to assess, for the first time, the in vitro acaricidal activity of two topical formulations containing thymol, on immature stages of Rhipicephalus sanguineus sensu lato. For this purpose, two base formulations were prepared: an oil-in-water (O/W) emulsion and a hydroalcoholic solution, containing different thymol concentrations (0.5 to 20 mg/mL). We used the larval packet test for non-engorged larvae and nymphs, and the immersion test for engorged larvae and nymphs. For emulsion, a mortality rate of 94.2% was achieved at 0.75 mg/mL in non-engorged larvae. For engorged larvae, there was 95.0% mortality at 5.0 mg/mL. Non-engorged nymphs showed 83.3% mortality at 2.5 mg/mL, and for engorged nymphs, 86.0% mortality was verified at 5.0 mg/mL. For the hydroalcoholic solution, the mortality found for non-engorged larvae was 88.1% at 2.5 mg/mL. For engorged larvae, the highest mortality was 25.0% at 20 mg/mL; non-engorged nymphs had 91.0% mortality at 1.0 mg/mL and for engorged nymphs; the maximum value verified was 18.3% mortality at 20 mg/mL. Preliminary stability tests were carried, and the hydroalcoholic solution remained stable under all the conditions analyzed. The O/W emulsion showed signs of early instability at the concentration of 5.0 mg/mL. The results obtained indicate that the acaricidal activity of thymol, when included in the proposed formulations, was enhanced against non-engorged larvae with topical treatment in comparison with data in the literature. Although there were variations in toxicity between the different stages, these formulations are promising for future therapeutic use.

A saúde da mulher e o tratamento da sífilis: narrativas de vida e contribuições para a prática profissional / Women's health and treatment of syphilis: life narratives and contributions for professional practice

Trata-se de estudo descritivo de abordagem qualitativa que utilizou o método narrativa de vida. Definiu como objeto: a experiência vivenciada da mulher em relação ao tratamento da sífilis. As questões norteadoras foram: qual a experiência vivenciada por mulheres que transmitiram sífilis para os seus filhos em relação ao tratamento? Quais as dúvidas mais co-muns das mulheres em relação à sífilis? Que fatores interferem na adesão da mulher ao trata-mento da sífilis? Objetivou: identificar a experiência vivenciada por mulheres que transmitiram sífilis para seus filhos em relação ao tratamento; descrever as dúvidas mais frequentes, apresentadas pelas mulheres relacionadas ao tratamento da sífilis; discutir os fatores que inter-ferem na adesão ao tratamento da sífilis; e propor uma estratégia educativa que favoreça o esclarecimento de dúvidas de mulheres que transmitiram sífilis para os seus filhos, para esti-mular a adesão ao tratamento. O cenário de estudo foi o setor de alojamento conjunto de um Hospital Maternidade Municipal no Rio de Janeiro. As participantes foram 18 mulheres que transmitiram sífilis a seus filhos e estavam internadas no cenário de pesquisa. O estudo teve aprovação do Comitê de Ética e Pesquisa da Secretaria Municipal de Saúde do Rio de Janeiro. A partir da análise temática das narrativas de vida segundo Daniel Bertaux emergiram três categorias que foram discutidas a luz da teoria de transição de Afaf Meleis e do senso comum segundo Rubem Alves. O estudo evidenciou que o pré-natal é eficaz no diagnóstico da sífilis, porém não tem a mesma eficácia na prevenção da sífilis congênita. A sífilis permanece no anonimato para muitas mulheres e o seu diagnóstico traz a revelação de comportamentos con-jugais, familiares e sociais muitas vezes não conhecidos ou indesejáveis. Permanecem nesta esfera muitas dúvidas sobre a sífilis e a sífilis congênita. A enfermagem tem amplo espaço de atuação nesta temática abordando a mulher no pré-natal, parto e puerpério. Segundo a teoria de transição de Afaf Meleis a enfermeira desenvolve planejamento holístico, individualizado e contínuo e tem a competência de ajudar a mulher na realização de uma transição saudável. A transição saudável consistirá na passagem da mulher pelo processo de mudança causado pela gravidez, pela doença dela e de seu filho com respostas positivas atingindo a estabilidade antes perdida ao início do evento crítico. É necessário ainda que sejam desenvolvidas estraté-gias que atendam a mulher na questão da educação sexual para além do período gravídico puerperal.

This is qualitative descriptive study that used the narrative method of life. Defined as an object: the lived experience of women in relation to the treatment of syphilis. The guiding questions were: what is the situation experienced by women who transmitted syphilis to their children in relation to the treatment? What are the most common questions women have about syphilis? What factors influence adherence of women to treatment of syphilis? The objective: to identify the experience lived by women who transmitted syphilis to their children in relation to treatment; describe the most frequently doubts submitted by women related to the treatment of syphilis; discuss the factors that influence adherence to treatment of syphilis; and propose an educational strategy that encourages clarify questions of women who transmitted syphilis to their children, to encourage adherence to treatment. The study setting was the rooming in at Municipal Maternity Hospital in Rio de Janeiro. The participants were 18 women who transmitted syphilis to their children that were hospitalized in the research setting. The study was approved by the Committee on Ethics and Research of the Secretary Municipal of Rio de Janeiro Health. From the thematic analysis of the life narratives according to Daniel Bertaux emerged three categories that were discussed in light of the transition theory Afaf Meleis and common sense said Rubem Alves. The study showed that prenatal care is effective in the diagnosis of syphilis, but does not have the same effectiveness in preventing congenital syphilis. Syphilis remains anonymous for many women and their diagnosis brings the revelation of marital, family and social behavior often not known or undesirable. Remain in this sphere many doubts about syphilis and congenital syphilis. Nursing has ample work space in this theme addressing women in prenatal, parturition and postpartum care. According to Afaf Meleis transition theory the nurse develops holistic, individualized and continuous planning and has the power to help women in achieving a healthy transition. Healthy transition will consist of moving the woman by the process of change caused by pregnancy and for her disease and disease her son with positive responses reaching stability before missing the start of the critical event. It is still necessary that strategies are developed that meet the woman on the issue of sex education beyond the puerperal gravid period.

A sífilis congênita no olhar da enfermagem / Congenital syphilis as seen by nursing / La sífilis congénita en la visión de la enfermería

Revisão integrativa que objetivou discutir publicações científicas relacionadas à sífilis congênita e à enfermagem. A questão norteadora foi: Que aspectos norteiam a assistência da enfermeira à gestante, em relação à prevenção e controle da Sífilis Congênita? Dados coletados de abril a maio de 2015, nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval Sistem On-Line e Scientific Eletronic Library Online, com os descritores sífilis congênita e enfermagem, nos idiomas português e inglês. Selecionaram-se oito publicações na íntegra, do período de 2005 a 2014. Emergiram três categorias: fatores de risco da sífilis congênita; inadequação da assistência prestada e dificuldades dos profissionais de saúde na prevenção e controle da sífilis. A prevenção e o controle da sífilis na gestação e sífilis congênita continuam um desafio para o Ministério da Saúde. Os resultados poderão ajudar na melhoria da qualidade da atuação do profissional.

This integrative review discussed scientific publications relating to congenital syphilis and to nursing. The guiding question was: What factors guide nursing care for pregnant women as regards preventing and controlling congenital syphilis? Data were collected from April to May 2015 from the following databases: Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online and Scientific Electronic Library Online, with the descriptors 'congenital syphilis' and 'nursing', in Portuguese and English. Eight full publications were selected, from the period 2005 to 2014. Three categories emerged: risk factors for congenital syphilis; inappropriateness of the care provided; and health staffs' difficulties in syphilis prevention and control. Prevention and control of syphilis in pregnancy and congenital syphilis remain a challenge for the Ministry of Health. The study results may help improve the quality of health personnel's work.

Revisión integradora cuyo objetivo fue discutir publicaciones científicas relacionadas con la sífilis congénita y la enfermería. La pregunta orientadora fue: ¿Qué aspectos guían la atención de la enfermería a las mujeres embarazadas, en cuanto a la prevención y el control de la sífilis congénita? Fueron obtenidos datos de abril a mayo de 2015, de las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Medical Literature Analysis and Retrieval Sistem Online y Scientific Electronic Library Online; las palabras clave fueron sífilis congénita y enfermería, en portugués e inglés. Se han seleccionado ocho publicaciones en su totalidad, del período de 2005 a 2014. Destacaron tres categorías: factores de riesgo de la sífilis congénita; inadecuación de la atención prestada y dificultades de los profesionales de salud en la prevención y control de la sífilis congénita. La prevención y el control de la sífilis durante el embarazo y la sífilis congénita siguen siendo un desafío para el Ministerio de Salud. Los resultados podrán ayudar a mejorar la calidad del desempeño profesional.

Análise do sistema de referência e contrarreferência da endodontia em um município da região metropolitana de Belo Horizonte, MG / System analysis and contrarreferência of Endodontics in a municipality of the metropolitan region of Belo Horizonte, MG

A avaliação nos serviços de saúde compreende a utilização de indicadores gerais de monitoramento dos serviços. A pesquisa avaliativa objetiva estudar o desempenho dos serviços e produzir recomendações que orientem soluções para os problemas identificados. As avaliações de serviços em atenção secundária em saúde bucal no Brasil estão em fase incipiente de construção de evidências, sobretudo após a implantação dos Centros de Especialidades Odontológicas. Este estudo teve como objetivo analisar o processo de referência e contrarreferência entre a Atenção Primária e a Atenção Secundária no serviço de Endodontia do CEO do município de Contagem, Minas Gerais e subsidiar o aperfeiçoamento do protocolo de encaminhamento para o serviço. Foram coletados dados secundários, dos sistemas de informação municipais, bem como de prontuários contidos nos arquivos do CEO em estudo, relativos ao universo dos 512 pacientes atendidos entre 2009 e 2014. Falhas nos registros impediram a verificação do tempo médio de espera pela primeira consulta. O tempo médio decorrido entre a primeira consulta e a conclusão do tratamento foi em média de 3,12 meses. Houve maior frequência relativa dos indivíduos oriundos das regiões administrativas municipais onde há maior população e maior número de unidades básicas de saúde. Houve números bastante semelhantes entre dentes uni radiculares e não uni radiculares tratados. Grande número de pacientes chegou ao serviço de endodontia do CEO apresentando dentes já sem possibilidade de tratamento. Foram gerados dados que pudessem subsidiar a renovação do protocolo de funcionamento vigente para o serviço estudado

The evaluation of health services may use both general service monitoring indicators and evaluation research, which aims at studying service performance and its enhancement through problem solving. The evaluation of secondary level oral health services in Brazil is incipient in evidence construction, hence after the creation of the CEO. This study aimed at analyzing the referral system between primary health care and the endodontics secondary level care from the CEO of the city of Contagem, Minas Gerais, searching for the enhancement of the existing referral protocol. Secondary data were collected from the city´s data systems as well as from service´s files, regarding all 512 patients who attended it between 2009 and 2014. Register flaws prevented the determination of mean waiting time before first appointment. Mean time between first appointment and treatment conclusion was 3.12 months. There was higher frequency of individuals from those city´s administrative regions with higher population and more availability of primary health care units. Similar proportions of single and non-single rooted teeth were treated. Great proportions of teeth reached CEO´s endodontics service without possible treatment. Data were generated to supply the renovation of the present service referral protocol

Acaricidal properties of the formulations based on essential oils from Cymbopogon winterianus and Syzygium aromaticum plants.

The cattle tick, Rhipicephalus (Boophilus) microplus, has caused serious harm to livestock raising in Brazil, considering the costs of controlling it, loss of revenue due to smaller production of milk and meat, and damage to leather, in addition to transmitting diseases. The use of medicinal plants is considered an alternative to the recurring resistance to chemicals. Due to the need for efficient alternatives with less environmental impact, this study aimed to develop contact formulations with essential oils from the Java citronella (Cymbopogon winterianus) and clove (Syzygium aromaticum) plants and to assess in vitro the effects in different stages of the tick cycle. In the present study, concentrations from 0.5-15.0% of the essential oils incorporated in the formulations were used. The ticks from different geographical areas were treated with those formulations, and their effects on the production levels of eggs, on the larvae hatching, and their efficiency on ticks were assessed. The obtained results were compared with other commercial acaricidal products. After the 20th day of treatment, the formulations with citronella essential oil had 2.09-55.51% efficiency, depending on the concentration of the oil incorporated. The efficiency of the treatment with formulations containing clove essential oil was higher, from 92.47-100%. The results showed the acaricidal effects of the formulations tested when compared to commercial chemical products. In vivo studies should be performed in order to assess the efficiency of those formulations in the fields, aiming to use these products as an alternative for controlling cattle ticks.

Speech preservation using a non-linear paradigm for determination of the extent of neocortical resection in patients with mesial temporal sclerosis submitted to cortico-amygdalo-hippocampectomy (CAH).

RATIONALE: The rationale for using a non-linear (proportional) paradigm for determining the extent of the neocortex to be removed in temporal lobe resection was based on anatomical and intra-operative cortical mapping findings. We present our results regarding speech preservation in patients submitted to CAH using the central artery as an anatomical landmark for determining the posterior border of neocortical resection. METHODS: Two hundred and fifty consecutive right-handed patients with left unilateral mesial sclerosis were studied. All patients were submitted to CAH under general anesthesia and without intraoperative electrocorticography. The posterior border of the lateral neocortical resection was defined by a line perpendicular to the temporal axis at the level of the central artery. RESULTS: Seven patients had transient (1-3 weeks; mean=9 days) receptive speech disturbance. There was no permanent speech deficit. Imaging documented edema or contusion at the posterior temporal cortical border in all patients who had transient speech deficits. The mean extent of cortical resection was 3.9 cm in adults and 3.1cm in kids. DISCUSSION: This is the first report in the literature discussing the use of a non-linear paradigm to determine the extent of lateral neocortical removal in this patient population. We found no permanent speech disturbances in this series. The non-linear approach used in this series proved to be safe and effective to avoid post-operative speech disorders. It was able to compensate for different brain and head sizes, and allowed smaller neocortical removal when compared to traditional linear approaches.

Intraoperative neurophysiological responses in epileptic patients submitted to hippocampal and thalamic deep brain stimulation.

PURPOSE: Deep brain stimulation (DBS) has been used in an increasing frequency for treatment of refractory epilepsy. Acute deep brain macrostimulation intraoperative findings were sparsely published in the literature. We report on our intraoperative macrostimulation findings during thalamic and hippocampal DBS implantation. METHODS: Eighteen patients were studied. All patients underwent routine pre-operative evaluation that included clinical history, neurological examination, interictal and ictal EEG, high resolution 1.5T MRI and neuropsychological testing. Six patients with temporal lobe epilepsy were submitted to hippocampal DBS (Hip-DBS); 6 patients with focal epilepsy were submitted to anterior thalamic nucleus DBS (AN-DBS) and 6 patients with generalized epilepsy were submitted to centro-median thalamic nucleus DBS (CM-DBS). Age ranged from 9 to 40 years (11 males). All patients were submitted to bilateral quadripolar DBS electrode implantation in a single procedure, under general anesthesia, and intraoperative scalp EEG monitoring. Final electrode's position was checked postoperatively using volumetric CT scanning. Bipolar stimulation using the more proximal and distal electrodes was performed. Final standard stimulation parameters were 6Hz, 4V, 300µs (low frequency range: LF) or 130Hz, 4V, 300µs (high frequency range: HF). KEY FINDINGS: Bilateral recruiting response (RR) was obtained after unilateral stimulation in all patients submitted to AN and CM-DBS using LF stimulation. RR was widespread but prevailed over the fronto-temporal region bilaterally, and over the stimulated hemisphere. HF stimulation led to background slowing and a DC shift. The mean voltage for the appearance of RR was 4V (CM) and 3V (AN). CM and AN-DBS did not alter inter-ictal spiking frequency or morphology. RR obtained after LF Hip-DBS was restricted to the stimulated temporal lobe and no contralateral activation was noted. HF stimulation yielded no visually recognizable EEG modification. Mean intensity for initial appearance of RR was 3V. In 5 of the 6 patients submitted to Hip-DBS, an increase in inter-ictal spiking was noted unilaterally immediately after electrode insertion. Intraoperative LF stimulation did not modify temporal lobe spiking; on the other hand, HF was effective in abolishing inter-ictal spiking in 4 of the 6 patients studied. There was no immediate morbidity or mortality in this series. SIGNIFICANCE: Macrostimulation might be used to confirm that the hardware was working properly. There was no typical RR derived from each studied thalamic nuclei after LF stimulation. On the other hand, absence of such RRs was highly suggestive of hardware malfunction or inadequate targeting. Thalamic-DBS (Th-DBS) RR was always bilateral after unilateral stimulation, although they somehow prevailed over the stimulated hemisphere. Contrary to Th-DBS, Hip-DBS gave rise to localized RR over the ipsolateral temporal neocortex, and absence of this response might very likely be related to inadequate targeting or hardware failure. Increased spiking was seen over temporal neocortex during hippocampal electrode insertion; this might point to the more epileptogenic hippocampal region in each individual patient. We did not notice any intraoperative response difference among patients with temporal lobe epilepsy with or without MTS. The relationship between these intraoperative findings and seizure outcome is not yet clear and should be further evaluated.

Outcome after cortico-amygdalo-hippocampectomy in patients with temporal lobe epilepsy and normal MRI.

RATIONALE: We describe seizure and neuropsychological outcome obtained after CAH in patients with TLE and normal MRI evaluated in the modern imaging era. METHODS: Forty-five adult consecutive patients with TLE and normal MRI were studied. All patients had neuropsychological testing, interictal and ictal EEG recordings and MRI. They were divided into two groups: Group 1 (n=18), included patients in whom non-invasive neurophysiological evaluation was lateralizing and Group 2 (n=27) included patients with non-lateralizing neurophysiological data who were submitted to invasive recordings. RESULTS: Seventy-seven percent of the Group 1 patients were rated as Engel I; 11% were rated as Engel II and 11% as Engel III. In Group 2, there were 57% of patients seizure-free, 26% in Engel II and 14% in Engel III. Pre-operatively, mean general IQ was 82 and 78 in Groups 1 and 2, respectively; post-operatively, mean general IQ was respectively 86 and 71. Some degree of verbal memory decline was noted in all patients submitted to dominant temporal lobe resection in both Groups 1 and 2. At last follow-up visit, 22% of Group 1 and 11% of Group 2 patients were receiving no antiepileptic drugs (AED). CONCLUSIONS: Our data showed that patients with TLE and normal MRI could get good surgical results after CAH although 60% of them would need invasive recordings and their results regarding seizure control and cognition were worse than those obtained in patients with MRI defined temporal lobe lesions. Caution should be taken in offering dominant temporal lobe resection to this subset of patients.

Vagus nerve stimulation might have a unique effect in reflex eating seizures.

We studied the effects of vagus nerve stimulation (VNS) on eating seizures, which theoretically would be triggered by neural activity and signaling from organs innervated by the vagus nerve. Three adult patients with daily nonreflex and reflex eating seizures were studied; one patient also had hot-water seizures. One patient had bilateral polymicrogyria and two had normal magnetic resonance imaging (MRI) findings. All patients were submitted to VNS implantation and had at least 2 years of postimplantation follow-up. Final stimulation parameters were 2.0-2.5 mA, 500 micros, and 30 Hz. Eating seizures decreased 70-95% and nonreflex seizures decreased 0-40% after VNS. There was no improvement in hot-water seizures. VNS seems to be an especially useful treatment modality in patients with reflex eating seizures not amenable to resective surgery.

Depression in women living with HIV: clinical and psychosocial correlates.

The number of Brazilian women living with HIV has increased significantly in past years, rendering studies of their particular care demands including psychiatric issues. This study measures the prevalence of major depression, using the Structured Clinical Interview for DSM-IV Axis I Disorders, in a sample of 120 women living with HIV in treatment at a reference centre in São Paulo. Socio-demographic variables, HIV-related clinical and laboratory data, including CD4+ cell counts and HIV plasma viral loads, as well as psychosocial features (intimate relationships, disclosure of HIV serostatus, partner's serostatus and patient's emotional and financial support) were investigated as factors potentially associated with depression. The prevalence of major depression at the time of evaluation was 25.8% (95% CI 18.2-33.4%). Clinical status (p = 0.002), lack of emotional support (p = 0.02), use of antidepressants (p = 0.028) and length of time since HIV diagnosis (p = 0.05) were associated with major depression in univariate analysis. In multivariate multiple-regression model, HIV clinical status, lack of emotional support and higher plasma viral loads were associated with depression. Sixty per cent of the women have a major depression diagnosis during lifetime. We conclude that major depression is highly prevalent among women living with HIV, but it is still underdiagnosed and undertreated.

Parkinsonism induced by VNS in a child with double-cortex syndrome.

We describe a child with epilepsy associated with double-cortex syndrome in whom vagus nerve stimulation (VNS) generated parkinsonian symptoms. A 13-year-old girl presented with refractory secondary generalized epilepsy from the age of 6 years and mental retardation. Her electroencephalography (EEG) showed diffuse polyspike and wave discharges. Magnetic resonance imaging (MRI) showed double-cortex syndrome. She was submitted to extended callosal section at the age of 10 years, which yielded 50% seizure frequency reduction. She was submitted to VNS by the age of 12 years. As stimulation intensity was increased, there was appearance of extrapyramidal symptoms: She developed bilateral tremor and rigidity, and gait and postural disturbance. All symptoms disappeared 7-10 days after VNS was turned off. Several attempts to reactivate VNS led to the same results. During the periods when VNS was on she presented with marked seizure frequency reduction. This is the first report of a clinically evident direct effect of VNS on the basal ganglia.

Centro-median stimulation yields additional seizure frequency and attention improvement in patients previously submitted to callosotomy.

RATIONALE: Deep brain stimulation (DBS) has been increasingly used in the treatment of refractory epilepsy over the last decade. We report on the outcome after thalamic centro-median (CM) DBS in patients with generalized epilepsy who had been previously treated with extended callosal section. METHODS: Four consecutive patients with generalized epilepsy who were previously submitted to callosal section and had at least 1 year of follow-up after deep brain implantation were studied. Age ranged from 19 to 44 years. All patients were submitted to bilateral CM thalamic DBS. Post-operative CT scans documented the electrode position in all patients. All patients had pre- and post-stimulation prolonged interictal scalp EEG recordings, including spike counts. Attention level was evaluated by means of the SNAP-IV questionnaire. The pre-implantation anti-epileptic drug regimen was maintained post-operatively in all patients. RESULTS: Post-operative CT documented that all electrodes were correctly located. There was no morbidity or mortality. Seizure frequency reduction ranging from 65 to 95% and increased attention level was seen in all patients. Interictal spiking frequency was reduced from 25 to 95%, but their morphology remained the same. There was re-synchronization of interictal discharges during slow-wave sleep in 2 patients. CONCLUSION: All patients benefit from the procedure. The CM seems to play a role in modulating the epileptic discharges and attention in these patients. On the other hand, it is not the generator of the epileptic abnormality and appeared not to be involved in non-REM sleep-related interictal spiking modulation.

Outcome after cortico-amygdalo-hippocampectomy in patients with severe bilateral mesial temporal sclerosis submitted to invasive recording.

INTRODUCTION: Although some degree of bilateral hippocampal involvement might be frequent in patients with temporal lobe epilepsy, severe bilateral mesial temporal sclerosis (MTS) is very rare. We present our experience while treating patients with severe bilateral MTS submitted to invasive recordings. METHODS: Nine adult patients were studied. All patients had simple and complex partial seizures. All patients had bilateral independent interictal temporal lobe spiking and non-lateralizing video-EEG findings. MRI showed severe bilateral MTS and no other brain lesion. All patients had severe verbal and non-verbal memory deficits. All patients were submitted to invasive recordings after bilateral subdural grids implantation. Cortico-amygdalo-hippocampectomy (CAH) was performed in all patients on the side suggested by invasive recording. Follow-up time ranged from 5 to 10 years. RESULTS: Invasive video-EEG showed exclusively unilateral seizure onset in seven patients; in two patients, seizures originating from both temporal lobes were found (80% of them originated from one side). Five patients were submitted to left and four to right CAH. Seven patients were rendered seizure-free after surgery (Engel I); the other two were rated as Engel II. There was no additional memory decline. There was no surgical morbidity or mortality. Pathological examination showed MTS in all patients. DISCUSSION: Good surgical outcome (77% seizure-free patients) could be obtained even in this apparently unsuitable group of patients. All patients benefit from the procedure. We did not see any cognitive decline in our patients with severe bilateral MTS. Patients with severe bilateral MTS would need invasive recordings despite any findings during surface video-EEG.

Outcome after hemispherectomy in hemiplegic adult patients with refractory epilepsy associated with early middle cerebral artery infarcts.

PURPOSE: To study the outcome after hemispherectomy (HP) in a homogeneous adult patient population with refractory hemispheric epilepsy. METHODS: Fourteen adult patients submitted to HP were studied. Patients had to be at least 18 years old, and have refractory epilepsy, clearly focal lateralized seizures and unilateral porencephalus consistent with early middle cerebral artery infarct on magnetic resonance imaging (MRI). All patients were submitted to functional hemispherectomy. We analyzed age of seizure onset, age by the time of surgery, gender, seizure type and frequency, interictal and ictal electroencephalography (EEG) findings, MRI and IQ scores preoperatively; seizure frequency, drug regimen, and IQ outcome were studied postoperatively. RESULTS: Mean follow-up was 64 months. All patients had frequent daily seizures preoperatively. All patients had unilateral simple partial motor seizures (SPS); 11 patients had secondarily generalized tonic-clonic (GTC) seizures and five patients had complex partial seizures (CPS), preoperatively. All patients had hemiplegia and hemianopsia. Twelve patients had unilateral EEG findings, and in two epileptic discharges were seen exclusively over the apparently normal hemisphere. Twelve patients were seizure-free after surgery and two patients had at least 90% improvement in seizure frequency. Pre- and postoperative mean general IQ was 84 and 88, respectively. Five of the twelve Engel I patients were receiving no drugs at last follow-up. There was no mortality or major morbidity. CONCLUSIONS: Our results suggest that well-selected adult patients might also get good results after HP. Although good results were obtained in our adult series, the same procedure yielded a much more striking result if performed earlier in life.

Outcome after corticoamygdalohippocampectomy in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis without preoperative ictal recording.

PURPOSE: We report on the surgical outcome obtained in patients with refractory temporal lobe epilepsy with mesial temporal sclerosis (MTS) who were evaluated preoperatively without ictal recording and were submitted to corticoamygdalohippocampectomy. METHODS: Two hundred twelve patients with refractory temporal lobe epilepsy were evaluated by means of clinical history, neurological examination, interictal electroencephalography (EEG), magnetic resonance imaging (MRI), and neuropsychological testing. MRI disclosed unilateral MTS in all patients. All patients were submitted to corticoamygdalohippocampectomy at the side determined by MRI. RESULTS: Interictal EEG showed unilateral temporal lobe spiking in 176 patients; in 36 patients, bilateral discharges were found. Mean follow-up time was 2.7 years. One hundred ninety-four patients (92%) were classified as Engel's class I. Eighteen patients (8%) were rated as Engel's class II. Thirty-two out of 36 patients, in whom bilateral discharges were found, were in Engel's class I. Sixty percent of the patients had an improvement in memory function related to the nonoperated temporal lobe. Fifty-nine percent of the patients had a 10-point increase in general IQ postoperatively. Verbal memory decline was noted in three patients. Pathological examination showed MTS in all patients. CONCLUSIONS: It is possible to adequately select good surgical candidates for temporal lobe resection using MRI and interictal EEG alone. In patients with MRI-defined MTS, we should expect a 90% postoperative remission rate. Cognitive decline was very rarely seen in this patient population. The finding of MTS on MRI is the single most important prognostic factor for good outcome after temporal lobe surgery.

Outcome after extended callosal section in patients with primary idiopathic generalized epilepsy.

PURPOSE: We report the outcome of patients with refractory idiopathic generalized epilepsy (IGE) who were submitted to extended one-stage callosal section. METHODS: Eleven patients with IGE who were submitted to extended one-stage callosal section were studied. Preoperative workup included history and neurologic examination, interictal, and ictal electroencephalography (EEG) recording, high resolution 1.5T magnetic resonance imaging (MRI) and intelligence quotient (IQ) testing. All patients were submitted to extended one-stage microsurgical callosal section, leaving only the splenium intact. RESULTS: Preoperative ictal patterns included repetitive spike and wave or polyspike and wave discharges or fast epileptic recruiting rhythm. MRI showed no focal lesions. Preoperatively, mean general IQ was 85. Postoperatively, at least a 75% reduction in the frequency of generalized tonic-clonic seizures was noted in all patients. In three patients absences disappeared completely, and the others had at least 90% reduction in seizure frequency. Only one patient had myoclonic seizures preoperatively, and these seizures disappeared after callosal section. After surgery, mean general IQ was 89. A very clear increase in attention level was noted in all patients. Postoperative interictal EEG recordings showed rupture of bilateral synchrony in all patients. DISCUSSION: This article reports on a large and homogeneous series of patients with refractory IGE submitted for callosal section. There was a marked decrease in generalized seizure frequency and increase in the attention level in this patient population. Our results suggest that corticocortical interaction might have a role in IGE pathogenesis. Callosotomy is a safe, effective, and underused palliative procedure in these well-selected patients with refractory IGE.

Surgical outcome in patients with refractory epilepsy associated to MRI-defined unilateral mesial temporal sclerosis.

INTRODUCTION: Several pre-operative work-up protocols have been used while selecting epileptic patients for surgery among different centers. The relative value of the different available pre-operative tests is still under discussion. OBJECTIVE: We report on the surgical outcome obtained in patients with refractory temporal lobe epilepsy associated to mesial temporal sclerosis (MTS) and who were evaluated pre-operatively by interictal EEG and MRI alone. METHOD: Forty one patients with refractory unilateral temporal lobe epilepsy were evaluated using interictal EEG and MRI. MRI disclosed unilateral MTS in all patients. All patients had at least 4 interictal EEG recordings. All patients were submitted to cortico-amygdalo-hippocampectomy at the side determined by MRI. RESULTS: Interictal EEG showed unilateral epileptiform discharges compatible with MRI findings in 37 patients; in four out of the 41 patients, bilateral discharges were found. Mean follow-up time was 4.3+/-1.1 years. Thirty-nine patients (95.1%) were classified as Engels Class I (70.6% Engel I-A). Two patients (4.9%) were rated as Engel's Class II. All patients in whom bilateral discharges were found were in Engels Class I. Pathological examination showed MTS in all patients. CONCLUSION: It is possible to adequately select good surgical candidates for temporal lobe resection using MRI and interictal EEG alone. In patients with MRI-defined MTS we should expect a postoperative remission rate higher then 90%. The finding of MTS on MRI is the most important good prognostic factor after temporal lobe resection.