RESUMO
Dengue fever has been associated with several neurological complications, cerebellar involvement being among the rarest of them. Here, we describe the case of a 70-year-old female who presented a cerebellar syndrome during the first day of an arboviral infection, posteriorly confirmed as dengue fever. Among the seven other cases in which the relationship between dengue virus and ataxia was reported, only in one cerebellar presentation occurred as early. Onset, course, and prognosis, as well as the adequate investigation and management of these patients, are discussed. While the disease pattern is not better characterized by future studies, differential diagnosis and close follow-up are essential tools for guaranteeing good outcomes.
Assuntos
Ataxia Cerebelar , Doenças Cerebelares , Dengue , Doença Aguda , Idoso , Ataxia Cerebelar/complicações , Ataxia Cerebelar/diagnóstico , Dengue/complicações , Dengue/diagnóstico , Feminino , HumanosRESUMO
Objective To compare initial brain computed tomography (CT) scans with follow-up CT scans at one year in children with congenital Zika syndrome, focusing on cerebral calcifications.Design Case series study.Setting Barão de Lucena Hospital, Pernambuco state, Brazil.Participants 37 children with probable or confirmed congenital Zika syndrome during the microcephaly outbreak in 2015 who underwent brain CT shortly after birth and at one year follow-up.Main outcome measure Differences in cerebral calcification patterns between initial and follow-up scans.Results 37 children were evaluated. All presented cerebral calcifications on the initial scan, predominantly at cortical-white matter junction. At follow-up the calcifications had diminished in number, size, or density, or a combination in 34 of the children (92%, 95% confidence interval 79% to 97%), were no longer visible in one child, and remained unchanged in two children. No child showed an increase in calcifications. The calcifications at the cortical-white matter junction which were no longer visible at follow-up occurred predominately in the parietal and occipital lobes. These imaging changes were not associated with any clear clinical improvements.Conclusion The detection of cerebral calcifications should not be considered a major criterion for late diagnosis of congenital Zika syndrome, nor should the absence of calcifications be used to exclude the diagnosis.
Assuntos
Encéfalo/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Infecção por Zika virus/diagnóstico , Zika virus/isolamento & purificação , Encéfalo/patologia , Encéfalo/virologia , Brasil , Calcinose/virologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Microcefalia/diagnóstico por imagem , Microcefalia/metabolismo , Microcefalia/virologia , Neuroimagem/métodos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico por imagem , Complicações Infecciosas na Gravidez/metabolismo , Complicações Infecciosas na Gravidez/virologia , Síndrome , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Substância Branca/virologia , Zika virus/imunologia , Infecção por Zika virus/congênito , Infecção por Zika virus/metabolismo , Infecção por Zika virus/virologiaRESUMO
PURPOSE: To investigate a method for development of surgical skills in medical students simulating venous dissection in surgical ex vivo pig model. METHODS: Prospective, analytical, experimental, controlled study with four stages: selection, theoretical teaching, training and assessment. Sample of 312 students was divided into two groups: Group A - 2nd semester students; Group B - students of 8th semester. The groups were divided into five groups of 12 students, trained two hours per week in the semester. They set up four models to three students in each skill station assisted by a monitor. Teaching protocol emergency procedures training were applied to venous dissection, test goal-discursive and OSATS scale. RESULTS: The pre-test confirmed that the methodology has not been previously applied to the students. The averages obtained in the theoretical evaluation reached satisfactory parameters in both groups. The results of applying OSATS scale showed the best performance in group A compared to group B, however, both groups had satisfactory medium. CONCLUSION: The method was enough to raise a satisfactory level of skill both groups in venous dissection running on surgical swine ex vivo models.
Assuntos
Dissecação/educação , Educação de Graduação em Medicina/métodos , Estudantes de Medicina , Venostomia/educação , Animais , Competência Clínica , Avaliação Educacional , Modelos Anatômicos , Modelos Educacionais , Estudos Prospectivos , Faculdades de Medicina , SuínosRESUMO
Purpose: To investigate a method for development of surgical skills in medical students simulating venous dissection in surgical ex vivo pig model. Methods: Prospective, analytical, experimental, controlled study with four stages: selection, theoretical teaching, training and assessment. Sample of 312 students was divided into two groups: Group A - 2nd semester students; Group B - students of 8th semester. The groups were divided into five groups of 12 students, trained two hours per week in the semester. They set up four models to three students in each skill station assisted by a monitor. Teaching protocol emergency procedures training were applied to venous dissection, test goal-discursive and OSATS scale. Results: The pre-test confirmed that the methodology has not been previously applied to the students. The averages obtained in the theoretical evaluation reached satisfactory parameters in both groups. The results of applying OSATS scale showed the best performance in group A compared to group B, however, both groups had satisfactory medium. Conclusion: The method was enough to raise a satisfactory level of skill both groups in venous dissection running on surgical swine ex vivo models.(AU)
Assuntos
Animais , Suínos , Educação Médica/métodos , Cirurgia Geral/educação , Cirurgia Geral/métodos , Estudantes de MedicinaRESUMO
Abstract Purpose: To investigate a method for development of surgical skills in medical students simulating venous dissection in surgical ex vivo pig model. Methods: Prospective, analytical, experimental, controlled study with four stages: selection, theoretical teaching, training and assessment. Sample of 312 students was divided into two groups: Group A - 2nd semester students; Group B - students of 8th semester. The groups were divided into five groups of 12 students, trained two hours per week in the semester. They set up four models to three students in each skill station assisted by a monitor. Teaching protocol emergency procedures training were applied to venous dissection, test goal-discursive and OSATS scale. Results: The pre-test confirmed that the methodology has not been previously applied to the students. The averages obtained in the theoretical evaluation reached satisfactory parameters in both groups. The results of applying OSATS scale showed the best performance in group A compared to group B, however, both groups had satisfactory medium. Conclusion: The method was enough to raise a satisfactory level of skill both groups in venous dissection running on surgical swine ex vivo models.
Assuntos
Animais , Estudantes de Medicina , Venostomia/educação , Dissecação/educação , Educação de Graduação em Medicina/métodos , Faculdades de Medicina , Suínos , Estudos Prospectivos , Competência Clínica , Modelos Educacionais , Avaliação Educacional , Modelos AnatômicosRESUMO
OBJECTIVE: To report radiological findings observed in computed tomography (CT) and magnetic resonance imaging (MRI) scans of the first cases of congenital infection and microcephaly presumably associated with the Zika virus in the current Brazilian epidemic. DESIGN: Retrospective study with a case series. SETTING: Association for Assistance of Disabled Children (AACD), Pernambuco state, Brazil. PARTICIPANTS: 23 children with a diagnosis of congenital infection presumably associated with the Zika virus during the Brazilian microcephaly epidemic. MAIN OUTCOME MEASURES: Types of abnormalities and the radiological pattern of lesions identified on CT and MRI brain scans. RESULTS: Six of the 23 children tested positive for IgM antibodies to Zika virus in cerebrospinal fluid. The other 17 children met the protocol criteria for congenital infection presumably associated with the Zika virus, even without being tested for IgM antibodies to the virus--the test was not yet available on a routine basis. Of the 23 children, 15 underwent CT, seven underwent both CT and MRI, and one underwent MRI. Of the 22 children who underwent CT, all had calcifications in the junction between cortical and subcortical white matter, 21 (95%) had malformations of cortical development, 20 (91%) had a decreased brain volume, 19 (86%) had ventriculomegaly, and 11 (50%) had hypoplasia of the cerebellum or brainstem. Of the eight children who underwent MRI, all had calcifications in the junction between cortical and subcortical white matter, malformations of cortical development occurring predominantly in the frontal lobes, and ventriculomegaly. Seven of the eight (88%) children had enlarged cisterna magna, seven (88%) delayed myelination, and six each (75%) a moderate to severe decrease in brain volume, simplified gyral pattern, and abnormalities of the corpus callosum (38% hypogenesis and 38% hypoplasia). Malformations were symmetrical in 75% of the cases. CONCLUSION: Severe cerebral damage was found on imaging in most of the children in this case series with congenital infection presumably associated with the Zika virus. The features most commonly found were brain calcifications in the junction between cortical and subcortical white matter associated with malformations of cortical development, often with a simplified gyral pattern and predominance of pachygyria or polymicrogyria in the frontal lobes. Additional findings were enlarged cisterna magna, abnormalities of corpus callosum (hypoplasia or hypogenesis), ventriculomegaly, delayed myelination, and hypoplasia of the cerebellum and the brainstem.