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INTRODUCTION: The International Classification of Functioning, Disability, and Health encompasses activities, participation, and contextual factors in health care, helping in the evaluation, planning, and management of patients. AIM: To develop an instrument to evaluate and classify speech-language needs, participation, and functioning in post-stroke based on the International Classification of Functioning, Disability, and Health. MATERIALS AND METHODS: This is a methodological research to develop an instrument. We adopted the following steps: a) selection of the International Classification of Functioning, Disability, and Health domains related to speech-language; b) development of guiding questions and qualification criteria; c) content validity; d) development of instructions; d) pilot test; e) inter-observer reliability. RESULTS: The Stroke Communication Scale is a clinical assessment in the Brazilian Portuguese language with 35 questions, integrating language, environmental, and personal aspects. This instrument showed good validity and reliability, demonstrating its applicability. Additionally, the possibility of using different sources of information (patient, caregiver, and health professional observations) and time of application of the protocol constitute positive factors for its use in different clinical settings. CONCLUSION: The Stroke Communication Scale allows a comprehensive clinical evaluation helping in the development of individualized treatment programs in post-stroke in a biopsychosocial approach centered on the patient.IMPLICATIONS FOR REHABILITATIONCommunication disorders post-stroke can be an important social barrier.An assessment based on the International Classification of Functioning, Disability, and Health offers an integral view of different perspectives of health.The Stroke Communication Scale is a holistic instrument to assess communication, participation, and functioning.The Stroke Communication Scale allows an evaluation of functional communication beyond the disorder.Interview-format encourages the participation of individuals with communication impairment, which is essential for their rehabilitation process and participation in social activities.
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Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Acidente Vascular Cerebral , Atividades Cotidianas , Brasil , Comunicação , Avaliação da Deficiência , Humanos , Reprodutibilidade dos TestesRESUMO
INTRODUCTION: The brain plays a key role in the perceptual regulation of exercise, yet neuroimaging techniques have only demonstrated superficial brain areas responses during exercise, and little is known about the modulation of the deeper brain areas at different intensities. OBJECTIVES/METHODS: Using a specially designed functional MRI (fMRI) cycling ergometer, we have determined the sequence in which the cortical and subcortical brain regions are modulated at low and high ratings perceived exertion (RPE) during an incremental exercise protocol. RESULTS: Additional to the activation of the classical motor control regions (motor, somatosensory, premotor and supplementary motor cortices and cerebellum), we found the activation of the regions associated with autonomic regulation (ie, insular cortex) (ie, positive blood-oxygen-level-dependent (BOLD) signal) during exercise. Also, we showed reduced activation (negative BOLD signal) of cognitive-related areas (prefrontal cortex), an effect that increased during exercise at a higher perceived intensity (RPE 13-17 on Borg Scale). The motor cortex remained active throughout the exercise protocol whereas the cerebellum was activated only at low intensity (RPE 6-12), not at high intensity (RPE 13-17). CONCLUSIONS: These findings describe the sequence in which different brain areas become activated or deactivated during exercise of increasing intensity, including subcortical areas measured with fMRI analysis.
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Exercício Físico/fisiologia , Córtex Motor/fisiologia , Adolescente , Adulto , Cerebelo/fisiologia , Córtex Cerebral/fisiologia , Ergometria/métodos , Humanos , Imageamento por Ressonância Magnética , Masculino , Percepção/fisiologia , Esforço Físico/fisiologia , Córtex Pré-Frontal/fisiologia , Adulto JovemRESUMO
OBJECTIVE: To identify and eliminate steps that do not add value for customers in the disinfection center. METHOD: We applied the Lean tool: Value Flow Map, using the concepts of gemba and kaizen in the work process of the disinfection unit for ventilatory care materials, aiming at improving such process. After performing a training with the team on the Lean concepts described above, applying the Value Flow Map in the gemba, analyzing the opportunities for improvement, and approving the changes, the Value Flow Map of the future state was devised and changes were implemented. RESULT: The time of the disinfection process was reduced in 2h37 and the financial resources required also decreased, in R$ 809.08/month. CONCLUSION: The application of Lean concepts presented positive results for the elimination of wastages in the disinfection center.
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Desinfecção/normas , Esterilização/normas , Gestão da Qualidade Total/métodos , Gestão da Qualidade Total/normas , Desinfecção/métodos , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/normas , Qualidade da Assistência à Saúde/normas , Esterilização/métodosRESUMO
ABSTRACT Objective: To identify and eliminate steps that do not add value for customers in the disinfection center. Method: We applied the Lean tool: Value Flow Map, using the concepts of gemba and kaizen in the work process of the disinfection unit for ventilatory care materials, aiming at improving such process. After performing a training with the team on the Lean concepts described above, applying the Value Flow Map in the gemba, analyzing the opportunities for improvement, and approving the changes, the Value Flow Map of the future state was devised and changes were implemented. Result: The time of the disinfection process was reduced in 2h37 and the financial resources required also decreased, in R$ 809.08/month. Conclusion: The application of Lean concepts presented positive results for the elimination of wastages in the disinfection center.
RESUMEN Objetivo: identificar y eliminar los pasos que no agregan valor para los clientes en el centro de desinfección. Método: aplicamos la herramienta Lean: mapa de la cadena de valor, conceptos de gemba y kaizen, en el proceso de trabajo de la unidad de desinfección para materiales de asistencia ventilatoria con el objetivo de mejorar el proceso. Después de realizar una capacitación con el equipo sobre los conceptos Lean descritos anteriormente, aplicamos el Mapa de la cadena de valor en el gemba, analizamos las oportunidades de mejora y aprobamos los cambios; se diseñó el Mapa de la cadena de valor del estado futuro y se implementaron los cambios. Resultado: el tiempo del proceso de desinfección se redujo en dos horas y treinta y siete minutos, y los recursos financieros requeridos también disminuyeron en R$ 809,08/mes. Conclusión: la aplicación de los conceptos Lean presentó resultados positivos para la eliminación de desperdicios en el centro de desinfección.
RESUMO Objetivo: identificar e eliminar as etapas que não agregam valor ao cliente na central de desinfecção. Método: foi aplicada a ferramenta Lean: Mapa de Fluxo de Valor, utilizando os conceitos Gemba e Kaizen no processo de trabalho da unidade de desinfecção de materiais para uso na assistência ventilatória com o intuito de melhorar o processo de trabalho. Foi realizada a capacitação da equipe em relação aos conceitos Lean descritos acima, foi aplicado o Mapa de Fluxo de Valor no Gemba, foram analisadas as oportunidades de melhoria e, após, aprovação das alterações, foi desenhado o Mapa de Fluxo de Valor do estado futuro e implementadas as mudanças. Resultado: obteve-se redução de tempo em 2h37 no processo de desinfecção e redução de recursos financeiros em R$ 809,08 reais/mês. Conclusão: a aplicação de conceitos Lean apresentou resultados positivos na eliminação de desperdícios na central de desinfecção.
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Humanos , Esterilização/normas , Desinfecção/normas , Gestão da Qualidade Total/métodos , Gestão da Qualidade Total/normas , Qualidade da Assistência à Saúde/normas , Esterilização/métodos , Desinfecção/métodos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/organização & administraçãoRESUMO
Purpose This paper aims to address problems in patient flow and identify the reasons behind extensive wait time at a public liver transplant outpatient clinic in an education and research hospital through the use of Lean health-care theories. Design/methodology/approach This paper opted for the application of Lean thinking and action research strategy. Data were collected through personal observations, interviews with users and team brainstorming. A value stream map was developed, improvement possibilities were identified and non-value-added activities were attempted to be eliminated. Findings Significant problems were identified and improvements were implemented and measured. The major remedial measures were: change the scheduling pattern, create a flow chart and a Kanban visual guide for medical students. In addition, an institutional change in the medical appointment scheduling software collaborated in the reduction of time and in the patient's displacement. The waiting time was reduced by 4.5 h, and the per cent complete and accurate increased by 50 per cent. Practical implications The flow was redesigned, and a culture of continuous improvement was introduced. Visiting the place where work was being done, leaders identified and created more value to the process without significant costs. The Gemba Walk was a powerful tool, interacting with people and processes in a Kaizen spirit. Originality/value Public health services in developing countries are one of the most deprived social needs of good practice. It will be useful for those who need examples about how to apply Lean tools in health care.
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Instituições de Assistência Ambulatorial/organização & administração , Eficiência Organizacional , Transplante de Fígado , Melhoria de Qualidade , Listas de Espera , Agendamento de Consultas , Brasil , Pesquisa sobre Serviços de Saúde , Humanos , Software , Fatores de TempoRESUMO
The aging process is associated with several changes in the elderly such as the decrease in cardiorespiratory fitness, strength and muscle mass, in addition to chronic low-grade inflammation. Concurrent training with blood flow restriction can be an interesting alternative to improve functional capacity with low mechanical stress in the elderly. The purpose of this study was to compare the inflammatory effects in older individuals submitted to two different protocols of concurrent training. Twenty-two healthy older adults (63.7±3.8 years; 69.8±8.9 kg; 1.6±0.1 m) performed 12 weeks of concurrent training (CT) or concurrent training with blood flow restriction (CTBFR) and the effects on inflammatory markers were analyzed. We found inflammatory behavior for the CTBFR group with a significant difference in serum concentration of C-reactive protein between pre- and post-moment (0.96±0.37 to 1.71±1.45, p=0.049), with no difference between groups, and a time effect in interleukin-6 (pre=0.86±0.43; post=1.02±0.46, p=0.016). We conclude that the CTBFR showed a pro-inflammatory profile after the period of intervention whereas the CT showed the opposite.
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Inflamação/sangue , Condicionamento Físico Humano/métodos , Músculo Quadríceps/irrigação sanguínea , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Feminino , Humanos , Interleucina-10/sangue , Interleucina-6/sangue , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Resistência Física/fisiologia , Músculo Quadríceps/anatomia & histologia , Fluxo Sanguíneo Regional/fisiologia , Treinamento Resistido , Fator de Necrose Tumoral alfa/sangueRESUMO
BACKGROUND: Brain mapping studies have demonstrated that functional poststroke brain reorganization is associated with recovery of motor function. Nonetheless, the specific mechanisms associated with functional reorganization leading to motor recovery are still partly unknown. In this study, we performed a cross-sectional evaluation of poststroke subjects with the following goals: (1) To assess intra- and interhemispheric functional brain activation patterns associated with motor function in poststroke patients with variable degrees of recovery; (2) to investigate the involvement of other nonmotor functional networks in relationship with recovery. METHODS: We studied 59 individuals: 13 patients with function Rankin > 1 and Barthel < 100; 19 patients with preserved function with Rankin 0-1 and Barthel = 100; and 27 healthy controls. All subjects underwent structural and functional magnetic resonance imaging (3T Philips Achieva, Holland) using the same protocol (TR = 2 seconds, TE = 30 ms, FOV = 240 × 240 × 117, slice = 39). Resting state functional connectivity was used by in-house software, based on SPM12. Among patients with and without preserved function, the functional connectivity between the primary motor region (M1) and the contralateral hemisphere was increased compared with controls. Nonetheless, only patients with decreased function exhibited decreased functional connectivity between executive control, sensorimotor and visuospatial networks. CONCLUSION: Functional recovery after stroke is associated with preserved functional connectivity of motor to nonmotor networks.
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Isquemia Encefálica/fisiopatologia , Transtornos Motores/fisiopatologia , Rede Nervosa/fisiopatologia , Plasticidade Neuronal/fisiologia , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Mapeamento Encefálico/métodos , Estudos Transversais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Córtex Motor , Transtornos Motores/etiologia , Movimento/fisiologia , Descanso , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Reabilitação do Acidente Vascular CerebralRESUMO
Introdução: Desde 2004, ano de fundação da Federação Brasileira de Epilepsia (Epibrasil), são realizadas reuniões anuais objetivando consolidar o apoio às associações de epilepsia, fortalecer o movimento e estabelecer metas de trabalho para o próximo ano. Neste ano, o Encontro Nacional foi realizado na Sede do Ministério Público de Rondônia, em Porto Velho, RO. Objetivo: Relatar os principais destaques do XIII Encontro e da XI Assembleia, ocorridos de 27 a 28 de março de 2015. Métodos: Registro descritivo dos eventos e análise qualitativa para compor o presente relato. Resultados: Estiveram presentes no evento representantes de 10 associações. As palestras abordaram temas em discussão na mídia, como o uso de canabidiol para o tratamento de epilepsia e a questão trabalhista, tendo sido ressaltada a dificuldade de inserção das pessoas com epilepsia no mercado de trabalho. Em consonância com as discussões do Encontro de 2014, manteve-se a ênfase na questão trabalhista, com o intuito de garantir às pessoas com epilepsia o acesso ao trabalho e a manutenção do emprego. Conclusão: A partir das discussões, delinearam-se as propostas com foco no próximo ano, especialmente no tema "Epilepsia e Trabalho", articulando diferentes setores da sociedade para promover a inclusão da pessoa com epilepsia...
Introduction: Since 2004, when the Brazilian Federation of Epilepsy (Epibrasil) was founded, annual meetings are held in order to consolidate support for epilepsy associations, aiming to strengthen the movement and establish working goals for the forthcoming year. This year, the National Meeting was held at the headquarters of the Public Ministry of Rondônia, in Porto Velho, RO. Objective: To report the main highlights of the XII National Meeting of Epibrasil, held on March 27th and 28th, 2014. Methods: Descriptive record of the events and qualitative analysis. Results and Discussion: In this meeting, there were representatives of 10 associations. Lectures covered topics discussed in the media, such as the use of cannabidiol for epilepsy treatment as well as labor issues with emphasis on difficulties faced by people with epilepsy to find and maintain jobs. Aligned with discussions during the last meeting, there was a special emphasis on labor issues, in order to ensure people with epilepsy access to work and job retention. Conclusion: Based in these discussions, proposals were drafted for the next year focusing especially on the topic "Epilepsy and Work", linking different sectors of society to promote the inclusion of people with epilepsy...
Introducción: Desde 2004, año de la fundación de la Federación Brasileña de Epilepsia (Epibrasil), son realizadas reuniones anuales con el objetivo de consolidar el apoyo a las asociaciones de epilepsia, fortalecer el movimiento y establecer metas de trabajo para el próximo año. Este año, el Encuentro Nacional se realizó en la Sede del Ministerio Público de Rondônia, en la ciudad de Porto Velho. Relatar los principales destaques del XIII Encuentro y de la XI Asamblea, ocurridos los días 27 y 28 de marzo de 2015. Métodos: Registro descriptivo de los eventos y análisis cualitativo para componer el presente relato. Resultados: Han estado presentes representantes de 10 asociaciones. Las conferencias abordaron temas en discusión en los medios, como el uso de cannabidiol para el tratamiento de epilepsia y la cuestión laboral, habiendo sido resaltada la dificultad de inserción de las personas con epilepsia en el mercado de trabajo. En consonancia con las discusiones en el Encuentro de 2014, se mantuvo el énfasis en la cuestión laboral, con el objetivo de asegurar a las personas con epilepsia el acceso al trabajo y el mantenimiento del empleo. Conclusión: A partir de las discusiones, fueron delineadas las propuestas en foco en el próximo año, en especial en el tema "Epilepsia y Trabajo", articulando diferentes sectores de la sociedad para promover la inclusión de la persona con epilepsia...
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Humanos , Epilepsia , Educação em SaúdeRESUMO
PURPOSE: Lateral pterygoid muscle (LPM) plays an important role in jaw movement and has been implicated in Temporomandibular disorders (TMDs). Migraine has been described as a common symptom in patients with TMDs and may be related to muscle hyperactivity. This study aimed to compare LPM volume in individuals with and without migraine, using segmentation of the LPM in magnetic resonance (MR) imaging of the TMJ. MATERIALS AND METHODS: Twenty patients with migraine and 20 volunteers without migraine underwent a clinical examination of the TMJ, according to the Research Diagnostic Criteria for TMDs. MR imaging was performed and the LPM was segmented using the ITK-SNAP 1.4.1 software, which calculates the volume of each segmented structure in voxels per cubic millimeter. The chi-squared test and the Fisher's exact test were used to relate the TMD variables obtained from the MR images and clinical examinations to the presence of migraine. Logistic binary regression was used to determine the importance of each factor for predicting the presence of a migraine headache. RESULTS: Patients with TMDs and migraine tended to have hypertrophy of the LPM (58.7%). In addition, abnormal mandibular movements (61.2%) and disc displacement (70.0%) were found to be the most common signs in patients with TMDs and migraine. CONCLUSION: In patients with TMDs and simultaneous migraine, the LPM tends to be hypertrophic. LPM segmentation on MR imaging may be an alternative method to study this muscle in such patients because the hypertrophic LPM is not always palpable.
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BACKGROUND/AIM: Currently, the equipment and techniques available to assess brain function during dynamic exercise are limited, which has restricted our knowledge of how the brain regulates exercise. This study assessed the brain areas activated during cycling by making use of a novel cycle ergometer, constructed to measure functional MRI (fMRI) brain images during dynamic exercise. Furthermore, we compared brain activation at different levels of ratings of perceived exertion (RPE) generated during the exercise. METHODS: Seven healthy adults performed cycling exercise in a novel MRI compatible cycle ergometer while undergoing brain fMRI. Participants completed a cycling block protocol comprising six trials of 2â min cycling with 16-s intervals between trials. Participants reported their RPE every minute through an audio link. The MRI cycling ergometer transferred the torque generated on the ergometer through a cardan system to a cycling ergometer positioned outside the MRI room. For data analysis, the effects of cycling as opposed to rest periods were examined after motion correction. RESULTS: The multiparticipant analysis revealed in particular the activation of the cerebellar vermis and precentral and postcentral gyrus when periods of cycling versus rest were compared. Single participant analysis in four participants revealed that activation of the posterior cingulate gyrus and precuneus occurred in cycling blocks perceived as 'hard' compared with exercise blocks that were less demanding. CONCLUSIONS: The present study offers a new approach to assess brain activation during dynamic cycling exercise, and suggests that specific brain areas could be involved in the sensations generating the rating of perceived exertion.
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Ciclismo/fisiologia , Encéfalo/fisiologia , Exercício Físico/fisiologia , Esforço Físico/fisiologia , Adulto , Ergometria , Voluntários Saudáveis , Humanos , Imageamento por Ressonância Magnética , Masculino , Percepção/fisiologia , Sensação/fisiologiaRESUMO
UNLABELLED: The two-arm Clinical Decisions/Diagnostic Workshop (CD/DW) approach to undergraduate medical education has been successfully used in Brazil. OBJECTIVE: Present the CD/DW approach to the teaching of stroke, with the results of its pre-experimental application and of a comparative study with the traditional lecture-case discussion approach. METHOD: Application of two questionnaires (opinion and Knowledge-Attitudes-Perceptions-KAP) to investigate the non-inferiority of the CD/DW approach. RESULTS: The method was well accepted by teachers and students alike, the main drawback being the necessarily long time for its completion by the students, a feature that may better cater for different educational needs. The comparative test showed the CD/DW approach to lead to slightly higher cognitive acquisition as opposed to the traditional method, clearly showing its non-inferiority status. CONCLUSION: The CD/DW approach seems to be another option for teaching neurology in undergraduate medical education, with the bonus of respecting each learner`s time.
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Educação de Graduação em Medicina/métodos , Neurologia/educação , Aprendizagem Baseada em Problemas/métodos , Brasil , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Inquéritos e QuestionáriosRESUMO
The two-arm Clinical Decisions/Diagnostic Workshop (CD/DW) approach to undergraduate medical education has been successfully used in Brazil. Objective Present the CD/DW approach to the teaching of stroke, with the results of its pre-experimental application and of a comparative study with the traditional lecture-case discussion approach. Method Application of two questionnaires (opinion and Knowledge-Attitudes-Perceptions-KAP) to investigate the non-inferiority of the CD/DW approach. Results The method was well accepted by teachers and students alike, the main drawback being the necessarily long time for its completion by the students, a feature that may better cater for different educational needs. The comparative test showed the CD/DW approach to lead to slightly higher cognitive acquisition as opposed to the traditional method, clearly showing its non-inferiority status. Conclusion The CD/DW approach seems to be another option for teaching neurology in undergraduate medical education, with the bonus of respecting each learner`s time. .
O método Decisões Clínicas/Oficinas Diagnósticas (DC/OD) é usado com sucesso na graduação médica no Brasil. Objetivo Apresentar o método DC/OD usando o exemplo do Acidente Vascular Encefálico, assim como os resultados de sua aplicação pré-experimental e de um estudo comparativo com o método tradicional (aula mais discussão de casos). Método Aplicação de questionários de opiniões e de questionários de conhecimentos, atitudes e percepções para investigar a não inferioridade do método DC/OD. Resultados DC/OD foi bem aceito por professores e estudantes. A principal crítica foi o tempo necessariamente longo para os estudantes completá-lo, característica que pode atender às diferentes necessidades educacionais. O estudo comparativo demonstrou que o método DC/OD levou a uma aquisição cognitiva maior que o tradicional, demonstrando sua não inferioridade. Conclusão O método DC/OD parece ser uma alternativa para o ensino da neurologia na graduação médica, com a vantagem de respeitar o diferente tempo de aprendizado dos estudantes. .
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Humanos , Educação de Graduação em Medicina/métodos , Neurologia/educação , Aprendizagem Baseada em Problemas/métodos , Brasil , Inquéritos e Questionários , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapiaRESUMO
OBJECTIVE: To compare the accuracy of SPM and visual analysis of brain SPECT in patients with mesial temporal lobe epilepsy (MTLE). METHOD: Interictal and ictal SPECTs of 22 patients with MTLE were performed. Visual analysis were performed in interictal (VISUAL(inter)) and ictal (VISUAL(ictal/inter)) studies. SPM analysis consisted of comparing interictal (SPM(inter)) and ictal SPECTs (SPM(ictal)) of each patient to control group and by comparing perfusion of temporal lobes in ictal and interictal studies among themselves (SPM(ictal/inter)). RESULTS: For detection of the epileptogenic focus, the sensitivities were as follows: VISUAL(inter)=68%; VISUAL(ictal/inter)=100%; SPM(inter)=45%; SPM(ictal)=64% and SPM(ictal/inter)=77%. SPM was able to detect more areas of hyperperfusion and hypoperfusion. CONCLUSION: SPM did not improve the sensitivity to detect epileptogenic focus. However, SPM detected different regions of hypoperfusion and hyperperfusion and is therefore a helpful tool for better understand pathophysiology of seizures in MTLE.
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Mapeamento Encefálico/métodos , Epilepsia do Lobo Temporal/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Encéfalo/irrigação sanguínea , Estudos de Casos e Controles , Doença Crônica , Eletroencefalografia , Epilepsia do Lobo Temporal/fisiopatologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To compare the accuracy of SPM and visual analysis of brain SPECT in patients with mesial temporal lobe epilepsy (MTLE). METHOD: Interictal and ictal SPECTs of 22 patients with MTLE were performed. Visual analysis were performed in interictal (VISUAL(inter)) and ictal (VISUAL(ictal/inter)) studies. SPM analysis consisted of comparing interictal (SPM(inter)) and ictal SPECTs (SPM(ictal)) of each patient to control group and by comparing perfusion of temporal lobes in ictal and interictal studies among themselves (SPM(ictal/inter)). RESULTS: For detection of the epileptogenic focus, the sensitivities were as follows: VISUAL(inter)=68 percent; VISUAL(ictal/inter)=100 percent; SPM(inter)=45 percent; SPM(ictal)=64 percent and SPM(ictal/inter)=77 percent. SPM was able to detect more areas of hyperperfusion and hypoperfusion. CONCLUSION: SPM did not improve the sensitivity to detect epileptogenic focus. However, SPM detected different regions of hypoperfusion and hyperperfusion and is therefore a helpful tool for better understand pathophysiology of seizures in MTLE.
OBJETIVO: Comparar a acurácia do SPM com a análise visual na detecção do foco epileptogênico e alterações perfusionais à distância no SPECT cerebral. MÉTODO: Foram realizados os SPECTs ictal e interictal de 22 pacientes com epilepsia de lobo temporal mesial (ELTM). A análise visual foi realizada nos estudos interictal (VISUAL(inter)) e ictal (VISUAL(ictal/inter)). Na análise com SPM foi comparado o estudo interictal (SPM(inter)) e ictal (SPM(ictal)) de cada paciente com o grupo controle e comparou-se a perfusão dos lobos temporais entre os estudos ictal e interictal (SPM(ictal/inter)). RESULTADOS: Para a detecção do foco epileptogênico, as sensibilidades foram as seguintes: VISUAL(inter)=68 por cento; VISUAL(ictal/inter)=100 por cento; SPM(inter)=45 por cento; SPM(ictal)=64 por cento and SPM(ictal/inter)=77 por cento. O SPM foi capaz de detectar mais áreas de hiperperfusão e hipoperfusão. CONCLUSÃO: O SPM não aumentou a sensibilidade na detecção do foco epileptogênico. Entretanto, o SPM detectou diferentes regiões de hipoperfusão e hiperperfusão e portanto, ele pode ser uma ferramenta de ajuda para se melhor entender a patofisiologia das crises na ELTM.
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mapeamento Encefálico/métodos , Epilepsia do Lobo Temporal , Tomografia Computadorizada de Emissão de Fóton Único , Encéfalo/irrigação sanguínea , Estudos de Casos e Controles , Doença Crônica , Eletroencefalografia , Epilepsia do Lobo Temporal/fisiopatologia , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância MagnéticaRESUMO
As seqüelas neurológicas da cinomose canina são consideradas irreversíveis e têm sido tratadas sintomaticamente, quando não há indicação de eutanásia, o que ocorre na maioria dos casos de seqüelas graves. Visando desenvolver uma nova abordagem terapêutica, testamos a injeção de células mononucleares de medula óssea alogeneicas extraídas de 5 cães doadores saudáveis, em 11 cães com seqüelas neurológicas com pré-diagnóstico de cinomose, sendo 7 com manifestações clínicas recentes e 4 com sinais clínicos crônicos. Dos 7 animais com seqüelas agudas ou recentes, 5 apresentaram remissão completa dos sinais clínicos e 2 melhora parcial e momentânea. Dos animais com sinais crônicos, 3 apresentaram melhora visível na primeira semana após o transplante, contudo, 2 deles, após curto período de estabilidade, apresentaram novamente os mesmos sinais clínicos vistos antes do transplante. Este protocolo mostrou-se bastante promissor para o tratamento de seqüelas neurológicas de cinomose canina(AU)
The neurologic sequels of canine distemper are currently considered irreversible, and are usually treated with palliative therapies when euthanasia is not recommended, what happens in the majority of severe cases. Aiming to develop a new therapeutic approach, we tested the systemic injection of allogeneic bone marrow mononuclear cells extracted from 5 healthy dogs, in 11 dogs with severe neurologic sequels with distemper previous diagnosis. 7 dogs had recent clinical manifestations and 4 had chronic signs. In the group of 7 animals with acute or recent sequels, 5 had complete remission of clinical signs and 2 had partial recovery. In the group with chronic sequels, 3 had visible recovery in the first week after transplantation, but 2 of them, after a short period of stability, presented again the same clinical signs seen before the transplantation. This protocol has demonstrated to be very promising for the treatment of neurologic sequels of canine distemper(AU)
Assuntos
Animais , Cães , Cinomose , Cães , Células da Medula Óssea , Transplante de Medula Óssea/veterináriaRESUMO
As seqüelas neurológicas da cinomose canina são consideradas irreversíveis e têm sido tratadas sintomaticamente, quando não há indicação de eutanásia, o que ocorre na maioria dos casos de seqüelas graves. Visando desenvolver uma nova abordagem terapêutica, testamos a injeção de células mononucleares de medula óssea alogeneicas extraídas de 5 cães doadores saudáveis, em 11 cães com seqüelas neurológicas com pré-diagnóstico de cinomose, sendo 7 com manifestações clínicas recentes e 4 com sinais clínicos crônicos. Dos 7 animais com seqüelas agudas ou recentes, 5 apresentaram remissão completa dos sinais clínicos e 2 melhora parcial e momentânea. Dos animais com sinais crônicos, 3 apresentaram melhora visível na primeira semana após o transplante, contudo, 2 deles, após curto período de estabilidade, apresentaram novamente os mesmos sinais clínicos vistos antes do transplante. Este protocolo mostrou-se bastante promissor para o tratamento de seqüelas neurológicas de cinomose canina
The neurologic sequels of canine distemper are currently considered irreversible, and are usually treated with palliative therapies when euthanasia is not recommended, what happens in the majority of severe cases. Aiming to develop a new therapeutic approach, we tested the systemic injection of allogeneic bone marrow mononuclear cells extracted from 5 healthy dogs, in 11 dogs with severe neurologic sequels with distemper previous diagnosis. 7 dogs had recent clinical manifestations and 4 had chronic signs. In the group of 7 animals with acute or recent sequels, 5 had complete remission of clinical signs and 2 had partial recovery. In the group with chronic sequels, 3 had visible recovery in the first week after transplantation, but 2 of them, after a short period of stability, presented again the same clinical signs seen before the transplantation. This protocol has demonstrated to be very promising for the treatment of neurologic sequels of canine distemper
Assuntos
Animais , Cães , Cinomose , Cães , Células da Medula Óssea , Transplante de Medula Óssea/veterináriaRESUMO
Epilepsy has been associated with increased risk of suicide; however, few studies have examined the relationship between epilepsy and suicidal behavior. The aims of this study were to evaluate the frequency of suicidal behavior in people with epilepsy and to identify characteristics that are associated with suicidal ideation in epilepsy. Of 171 people with epilepsy identified in a previous survey, 139 were included. A structured interview was conducted, and a second psychiatric evaluation was scheduled for those who agreed. The frequencies of suicidal thoughts, plans, and attempts during lifetime were 36.7, 18.2, and 12.1%, respectively. The following conditions were strongly associated with suicidal thoughts: anxiety (OR=3.3, 95% CI=1.4-7.5, P=0.001), depression (OR=4.8, 95% CI=1.9-12.5, P=0.001), and two or more standardized psychiatric diagnoses (OR=21.6, 95% CI=4.4-105.9, P<0.0001). Although specific characteristics of epilepsy were found to be related to suicidal thoughts, psychiatric diseases also play an essential role.
Assuntos
Epilepsia/epidemiologia , Epilepsia/psicologia , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Pesquisa Participativa Baseada na Comunidade , Estudos Transversais , Características Culturais , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Escalas de Graduação Psiquiátrica , Fatores de Risco , Suicídio/psicologia , Inquéritos e Questionários , Adulto JovemRESUMO
Cerebral atrophy has been described to occur in systemic lupus erythematosus (SLE) with variable frequency. The aim of this study was to determine white and gray matter abnormalities in brain magnetic resonance imaging (MRI) of patients with SLE and to determine if these abnormalities progress over a one-year period. Seventy-five patients with SLE and 44 healthy age and sex-matched controls were enrolled in this study. T1-weighted volumetric images were used for voxel based morphometry (VBM) analyses. SLE patients exhibited a significant reduction in white matter and gray matter volume compared to controls (p=0.001). Follow-up images, after an average interval of 19 months, revealed a progressive white matter and gray matter atrophy (p=0.001). Reduced white and gray matter volume was associated with disease duration and the presence of antiphospholipid antibodies. Patients with severe cognitive impairment had a more pronounced white and gray matter reduction than patients with moderate cognitive impairment. Total corticosteroid dose was associated with gray matter reduction and not with white matter loss in SLE patients. We concluded that brain tissue loss associated with SLE is significant and progresses over a relatively short period of time. Disease duration, the presence of antiphospholipid antibodies and cognitive impairment were associated with white and gray matter loss. Corticosteroid was associated only with gray matter atrophy.
Assuntos
Encéfalo/patologia , Vasculite Associada ao Lúpus do Sistema Nervoso Central/patologia , Adolescente , Corticosteroides/uso terapêutico , Adulto , Encéfalo/efeitos dos fármacos , Progressão da Doença , Feminino , Seguimentos , Humanos , Vasculite Associada ao Lúpus do Sistema Nervoso Central/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Chronic medial temporal lobe epilepsy (MTLE) is associated with memory loss due to damage in the hippocampal system. To investigate the relationship between volume of medial temporal lobe structures and performance on neuropsychological tests, we studied 39 consecutive patients with MTLE and unilateral hippocampal atrophy (HA) determined by volumetric magnetic resonance imaging (MRI). Structures of interest comprised hippocampus, amygdala, and entorhinal, perirhinal, parahippocampal, and temporopolar cortices. The findings indicated that (1) performance was significantly worse in the group with left HA as compared with the group with right HA on general memory, verbal memory, delayed recall, and verbal fluency tests and the Boston Naming Test (BNT), and (2) the volume of the left hippocampus and also the degree of asymmetry of perirhinal cortex volume were significant and independent predictors of performance on general memory, verbal memory, and verbal fluency tests and the BNT in patients with MTLE.
Assuntos
Epilepsia do Lobo Temporal/complicações , Hipocampo/patologia , Transtornos da Linguagem/etiologia , Transtornos da Memória/etiologia , Lobo Temporal/patologia , Adolescente , Adulto , Epilepsia do Lobo Temporal/patologia , Feminino , Humanos , Inteligência , Sistema Límbico/patologia , Masculino , Pessoa de Meia-Idade , Testes NeuropsicológicosRESUMO
The authors present a review article on memory aspects of temporal lobe epilepsy in childhood. We performed a search in the literature. Temporal lobe epilepsy (TLE)in childhood present with great clinical, electroencephalographical and etiological diversity. The neuropsychological features in children with TLE are not well-defined yet. The relationship between the lateralization of the lesion and performance on memory tests is not establihed. The studies performed in children with TLE show controversy. This finding may be use due to the etiological, clinical and electroencephalographic diversity seen in such group of children. Besides, most studies use different assessments. Therefore, it is clear that more studies are necessary to elucidate which neurophysiological deficits occur in children with TLE