Persistent psychosis associated with extreme delta brush in anti-NMDA receptor encephalitis: a case report.

BACKGROUND: Anti-NMDAR encephalitis is an emerging differential diagnosis of first episode and persistent psychosis in the psychiatric community, as clinical manifestations include psychiatric symptoms, cognitive dysfunction, seizures, decreased consciousness, and dyskinesias. This disease is associated with extreme delta brush (EDB), but the significance and temporal course of this EEG pattern still needs to be determined. Herein, we report a case of anti-NMDAR encephalitis with persistent psychosis associated with EDB occurrence on multiple occasions during a 5-year disease course. CASE PRESENTATION: A 15-year-old girl was diagnosed with anti-NMDAR encephalitis and treated with progressive improvement. Four years after initial manifestations, an EDB pattern was seen on electroencephalogram (EEG) without new neurological symptoms. She had residual symptoms of episodic auditory hallucinations and impulsivity. One year later, the patient had a recurrence of neurological symptoms (seizures, dyskinesias and impaired attention), persisting with EDB on EEG. Clinical symptoms and EDB resolved after second-line treatment with rituximab. CONCLUSION: We describe the first case of persistent psychosis in anti-NMDAR encephalitis associated with extreme delta brush on multiple EEGs on prolonged follow-up. Electroencephalographic patterns such as EDB may serve as markers of residual disease activity, including psychiatric symptoms. Further studies with prolonged EEG monitoring are needed to better understand these findings.

Controversies in immunotherapy for anti-NMDA receptor encephalitis: a scoping review with a proposal of operational definitions.

Anti-NMDA receptor encephalitis (NMDARE), an autoimmune encephalitis associated with autoantibodies against the N-methyl-D-aspartate (NMDA) receptor, affects predominantly young women and is associated with psychiatric symptoms, seizures, movement disorders, and autonomic instability. Traditional treatments of anti-NMDA receptor encephalitis involve corticosteroids, intravenous immunoglobulin, plasmapheresis, cyclophosphamide, and rituximab. However, many controversies remain in the treatment for NMDA receptor encephalitis, such as optimal timing and combination of different immunotherapies, the role of newer strategies (e.g., bortezomib or tocilizumab) for severe and refractory patients, and the need or not for long-term immunosuppression. Our goal was to perform a scoping review to discuss the controversial topics of immunotherapy for NMDA receptor encephalitis and propose operational definitions to guide clinical practice and future research in the field.

Myasthenia gravis exacerbation and myasthenic crisis associated with COVID-19: case series and literature review.

BACKGROUND: Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction that can be exacerbated by many viral infections, including COVID-19. The management of MG exacerbations is challenging in this scenario. We report 8 cases of MG exacerbation or myasthenic crisis associated with COVID-19 and discuss prognosis and treatment based on a literature review. RESULTS: Most patients were female (7/8), with an average age of 47.1 years. Treatment was immunoglobulin (IVIG) in 3 patients, plasma exchange (PLEX) in 2 patients, and adjustment of baseline drugs in 3. In-hospital mortality was 25% and 37.5% in 2-month follow-up. DISCUSSION: This is the largest case series of MG exacerbation or myasthenic crisis due to COVID-19 to this date. Mortality was considerably higher than in myasthenic crisis of other etiologies. Previous treatment for MG or acute exacerbation treatment did not seem to interfere with prognosis, although sample size was too small to draw definitive conclusions. Further studies are needed to understand the safety and effectiveness of interventions in this setting, particularly of PLEX, IVIG, rituximab, and tocilizumab.

Erratum: Aulestia Viera, M., et al. A Time-Frequency Acoustic Emission-Based Technique to Assess Workpiece Surface Quality in Ceramic Grinding with PZT Transducer. Sensors 2019, 19, 3913.

The authors wish to make the following erratum to this paper [...].

A Time-Frequency Acoustic Emission-Based Technique to Assess Workpiece Surface Quality in Ceramic Grinding with PZT Transducer.

Innovative monitoring systems based on sensor signals have emerged in recent years in view of their potential for diagnosing machining process conditions. In this context, preliminary applications of fast-response and low-cost piezoelectric diaphragms (PZT) have recently emerged in the grinding monitoring field. However, there is a lack of application regarding the grinding of ceramic materials. Thus, this work presents an analysis of the feasibility of using the acoustic emission signals obtained through the PZT diaphragm, together with digital signal processing in the time-frequency domain, in the monitoring of the surface quality of ceramic components during the surface grinding process. For comparative purpose, an acoustic emission (AE) sensor, commonly used in industry, was used as a baseline. The results obtained by the PZT diaphragm were similar to the results obtained using the AE sensor. The time-frequency analysis allowed to identify irregularities throughout the monitored process.

Peculiar aetiology for orbital apex syndrome: Wyburn-Mason syndrome as orbital apex lesion.

Background: Wyburn-Mason syndrome is a rare, non-hereditary congenital disease, belonging to the group of neurocutaneous syndromes with fewer than 100 cases reported since its first description in 1937. Case report: A young adult man was initially evaluated at the age of 2 years for proptosis and progressive visual impairment of the right eye, followed by impairment in ocular abduction, adduction and elevation as well as amaurosis. MRI revealed an expansive formation centred in the right orbit compromising conal spaces with distortion of eye muscles and optic nerve. The lesion extended through the superior orbital fissure into the right cavernous sinus and to the contralateral orbit. Despite embolisation, proptosis and oedema of the periorbital tissue continued to worsen. The combination of facial, ocular and intracranial vascular malformations and the exclusion of alternative aetiologies led to a diagnosis of cerebrofacial arteriovenous metameric syndrome (CAMS) 1 (Wyburn-Mason syndrome). Discussion: Important differential diagnoses are other CAMS, such as Sturge-Weber syndrome, as well as other conditions such as retinal cavernous haemangioma and vasoproliferative tumours. The optimal treatment regimen for severe cases of this syndrome is still unclear. Wyburn-Mason syndrome should be considered in patients presenting multiple arteriovenous malformations with orbital apex lesions.

Geographical variation in the chemical composition, anti-inflammatory activity of the essential oil, micromorphology and histochemistry of Schinus terebinthifolia Raddi.

ETHNOPHARMACOLOGICAL RELEVANCE: Schinus terebinthifolia Raddi (Anacardiaceae) is rich in essential oil, distinguished by a predominance of monoterpenes and sesquiterpenes, it being widely used in traditional medicine for the treatment of inflammations. AIM OF STUDY: This study's objective was to investigate the chemical composition of the essential oil of S. terebinthifolia (EOST) collected in six states of Brazil, evaluate its anti-inflammatory effects in mice, and analyze the histochemistry and micromorphology of leaves and stems. MATERIALS AND METHODS: Aerial parts of S. terebinthifolia were collected in six states of Brazil, and the essential oil was extracted by hydrodistillation and analyzed by gas chromatography-mass spectrometry (GC-MS). The histochemistry and micromorphology of leaves and stems were performed using standard reagents, light and field emission scanning electron microscopy, beyond energy-dispersive X-ray spectroscopy. The EOST were evaluated for anti-inflammatory activity and hyperalgesia using the carrageenan-induced paw edema methodology. RESULTS: The EOST showed variation across the six states in its yield (0.40%-0.86%) and chemical composition: hydrocarbon monoterpenes (28.76%-47.73%), sesquiterpenes, (31.43%-41.76%), oxygenated monoterpenes (14.31%-19.57%), and oxygenated sesquiterpenes (4.87%-14.38%). Both α-pinene and limonene were predominant constituents of essential in five regions, except for one state where α-phellandrene and limonene were the dominant components. A comprehensive description of the leaf and stem micromorphology and histochemistry was performed. In the in vivo testing, all EOST samples exerted antiedematogenic and anti-hyperalgesic effects, when tested in a carrageenan-induced paw inflammation (mechanical and thermal hyperalgesia) model with oral doses of 30 mg/kg. CONCLUSION: Our results indicate that the EOST samples collected in six Brazilian states differed in their chemical composition but not their anti-inflammatory and antihyperalgesic effects, which was correlated with the synergistic effect of its components, collaborating the etnhopharmacologycal use of this plant due to its an anti-inflammatory effect. Also, micromorphology and histochemistry of leaves and stems presented in this study provide anatomical and microchemical information, which aids species identification.

Synthesis, Characterization, Antiproliferative Activity of Galloyl Derivatives and Investigation of Cytotoxic Properties in HepG2/C3A Cells.

BACKGROUND: Appropriate substituents in the galloyl group could lead to significant biological properties. OBJECTIVES: Novel galloyl-substituted compounds bearing 2-substituted-1, 3, 4-oxadiazol-5-yl, 5- substituted-1,2,4-triazol-3-yl, and carboxamide groups were synthesized and evaluated for their antiproliferative activity. Additionally, galloyl hydrazide (2) was evaluated by performing cytotoxicity, membrane integrity, cell cycle, and apoptosis assays in HepG2/C3A cells. METHODS: General procedure was used for the synthesis of galloyl-substituted (3-9, 11) and characterized by their spectroscopic data (1H and 13C NMR). The antiproliferative activity of all novel galloyl derivatives was evaluated against nine human tumors and one nontumoral cell line. Three response parameters (GI50, TGI, and LC50) were calculated. The cytotoxicity test was performed for the resazurin assay. The membrane integrity, cell cycle, and apoptosis assays were performed by flow cytometry. RESULTS: The substitution of the methoxy group of the galloyl ring system for a carboxamide group (3, 4, 5, and 6) produced compounds with moderate antitumoral activity, particularly 6, against six human cancer cell lines, K-562, PC-3, NCI-ADR/RES, OVCAR, 786-0 and NCI-H460, with GI50 values ≤ 9.45 µg/mL. Triazole derivatives 7 and 8 exhibited higher antitumoral activity toward OVCAR, MCF-7 and leukemia K-562 cell lines, exhibiting GI50 values less than 10 µg/mL. Compound 11 displayed significant activity against PC-3 (GI50 = 4.31 µg/mL), OVCAR (GI50 = 8.84 µg/mL) and K-562 (GI50 = 8.80 µg/mL) cell lines. Galloyl hydrazide (2) had cytotoxic activity in HepG2/C3A cells (IC50 = 153.7 µg/mL). In membrane permeability, cell count, cell cycle, and apoptosis assays, as determined using the IC50 of compound (2) in HepG2/C3A cells, increased membrane permeability, decreased cell count, altered cell cycle, and initial apoptosis was observed compared to the control group. CONCLUSION: Thus, our results showed for the first time the synthesis, antiproliferative activity, and cytotoxicity of galloyl-substituted compounds. Galloyl-substitution does not have a very strong synergistic effect in the inhibition of cancer cell proliferation compared with galloyl hydrazide (2). Compound 2 demonstrated promising activity in HepG2/C3A hepatocarcinoma cells.

Variation in essential oil components and anti-inflammatory activity of Allophylus edulis leaves collected in central-western Brazil.

ETHNOPHARMACOLOGICAL RELEVANCE: An infusion obtained from the leaves of "chal-chal" (Allophylus edulis Radlk.) is used for popular treatment of intestinal disorders and as an anti-inflammatory throat treatment. Because of the anti-inflammatory medicinal folk use, a previous work reported scientific research confirming the anti-inflammatory activity of A. edulis essential oil collected in Dourados, MS, Brazil, in March 2015. AIM OF THE STUDY: The aim of this study was to evaluate the variation in the chemical profile of the essential oil of A. edulis plants collected in Dourados (EOAE-D) and Bonito (EOAE-B), two cities in Mato Grosso do Sul State, Brazil. Additionally, we evaluated the anti-inflammatory effects of the essential oil, as well as that of the major compounds (caryophyllene oxide and α-zingiberene), in experimental in vivo models of inflammation in mice. MATERIALS AND METHODS: Leaves were collected from plants at both sites in July 2018. The composition of the essential oil (EOAE-D and EOAE-B) was determined by GC/MS, and major compounds (caryophyllene oxide and α-zingiberene) were isolated and identified by chromatographic methods and NMR spectroscopy. Anti-inflammatory capacities were assessed using two classical models of inflammatory models, carrageenan- and CFA-induced paw inflammation (mechanical and thermal hyperalgesia). RESULTS: Both EOAE-D and EOAE-B showed sesquiterpenes as a major constituent, namely, caryophyllene oxide (29.5%) and α-zingiberene (45.0%), respectively. In tests, EOAE, caryophyllene oxide and α-zingiberene-induced antiedematogenic and antihyperalgesic effects were found in the different utilized models. CONCLUSIONS: The results indicate that samples from the two cities differed in chemical composition but not in their anti-inflammatory and antihyperalgesic effects. This finding corroborates the use of A. edulis as a medicinal plant and indicates its potential in the therapy of inflammatory conditions.

Anti-inflammatory Activity of Methanolic Extract and an Alkaloid from Palicourea crocea (Sw.) Roem and Schult.

Palicourea crocea (Sw.) Roem. and Schult., "douradinha," are used by treat inflammation (edema). Croceaine A (PC-1) was isolated from P. crocea (MEPC) leaves and studied for its antioxidant and anti-inflammatory activity, as well as concentrations of constituents and acute toxicity. The phenols and polyphenolics compounds and HPLC/DAD were determined. The antioxidant activity were evaluated for DPPH, ABTS, and MDA. MEPC (300, 100, and 300 mg/kg) and PC-1 (10 and 30 mg/kg) were tested for anti-inflammatory effects in paw edema, pleurisy, cold sensitivity, and mechanical hyperalgesia. Acute toxicity is also described. MEPC contained high concentrations of phenolic and flavonoid compounds (≤ 800.35 mg/g), as well as caffeic acid, ferulic acid, rutin, and quercetin, revealed by HPLC-DAD analysis. MEPC displayed antioxidant activity against ABTS radicals (IC50 = 68.5 µg/mL) and MDA (74%). MEPC and alkaloid PC-1 demonstrated an anti-edematogenic effect in Cg-induced paw edema in 2 and 4 h, and also significantly reduced mechanical hyperalgesia, cold response to acetone in mice, at 3 and 4 h after injection, as well as leukocyte migrationin the pleurisy model. No toxicity was detected by MEPC. For the first time, P. crocea was evaluated for its antioxidant, systemic anti-inflammatory, and anti-hyperalgesic activities.

Epidemiologia da mortalidade intraoperatória de um hospital público na Bahia no período de um ano / Epidemiology of intraoperative mortality of a public hospital in Bahia in a one-year period / Epidemiología de la mortalidad intraoperatoria en un hospital público de Bahía en un período de un año

A parada cardíaca com evolução para o óbito é o pior desfecho no cenário do paciente cirúrgico. A PCR intraoperatória é definida como aquela que ocorre do momento da admissão do paciente na sala cirúrgica até o fim da anestesia para o procedimento. Nesse contexto, a anestesia tem o potencial de induzir mudanças fisiológicas que interfiram na morbimortalidade do paciente cirúrgico. Avaliar a epidemiologia da mortalidade no intraoperatório do Hospital Geral Roberto Santos (HGRS) no período de um ano elucida o perfil de atendimento cirúrgico. Este estudo é do tipo transversal, retrospectivo de revisão de prontuários. Foram estudados pacientes submetidos à cirurgia eletiva ou de urgência com morte no intraoperatório, no período de junho de 2020 a junho de 2021. Dos óbitos avaliados, houve a predominância de pacientes do sexo masculino, entre 0 e 86 anos, de cirurgia de urgência e predisposição para ASA IV, tendo maior probabilidade de mortalidade. A causa mortis predominante foi choque, seguida por infarto agudo do miocárdio. As intercorrências foram bradicardia e parada cardiorrespiratória. O perfil epidemiológico do estudo em questão é muito semelhante ao de outros estudos, com restrições. Portanto, devido ao baixo número de mortes nesse período, faz-se necessária maior investigação do perfil epidemiológico, que visa analisar, juntamente, a mortalidade do intraoperatório e a mortalidade pós-operatória de trinta dias.

Cardiac arrest with evolution to death is the worst outcome in the surgical patient scenario. Intraoperative cardiac arrest is defined as that which occurs from the time of patient admission to the operating room until the end of anesthesia for the procedure. In this context, anesthesia may induce physiological changes that interfere in the surgical patient's morbidity and mortality. Assessing the epidemiology of intraoperative mortality at the Roberto Santos General Hospital (HGRS) in a one-year period contributes to elucidate the profile of surgical care. This cross-sectional, retrospective study reviewed medical records from patients who underwent elective or emergency surgery with intraoperative death from June 2020 to June 2021. Most deaths involved male patients aged between 0 and 86 years old, who underwent emergency surgery and showed predisposition for ASA IV, with a higher probability of mortality. Predominant cause of death was shock, followed by acute myocardial infarction. Complications were bradycardia and cardiorespiratory arrest. The epidemiological profile found is similar to that of other studies, with restrictions. Due to the low number of deaths in this one-year period, further investigation of the epidemiological profile is needed to jointly analyze intraoperative mortality and 30-day postoperative mortality.

El paro cardíaco con evolución a muerte es el peor desenlace en el escenario del paciente quirúrgico. El paro cardíaco intraoperatorio se define como el que ocurre desde que el paciente ingresa al quirófano hasta el final de la anestesia para el procedimiento. En ese contexto, la anestesia tiene el potencial de inducir cambios fisiológicos que interfieren en la morbimortalidad del paciente quirúrgico. La evaluación de la epidemiología de la mortalidad intraoperatoria en el Hospital General Roberto Santos (HGRS) durante un período de un año aclara el perfil de la atención quirúrgica. Se trata de un estudio transversal, retrospectivo de revisión de historias clínicas. Se estudiaron a pacientes sometidos a cirugía electiva o de emergencia con muerte intraoperatoria en el período de junio de 2020 a junio de 2021. De las muertes evaluadas hubo predominio de pacientes del sexo masculino, con edades entre 0 y 86 años, de cirugía de emergencia y predisposición para ASA IV, con mayor probabilidad de mortalidad. La causa predominante de muerte fue el shock, seguido del infarto agudo de miocardio. Las complicaciones fueron bradicardia y paro cardiorrespiratorio. El perfil epidemiológico del estudio en cuestión fue muy similar al de otros estudios, con restricciones. Por lo tanto, debido al bajo número de muertes en este período, es necesaria una mayor investigación del perfil epidemiológico, que tiene como objetivo analizar conjuntamente la mortalidad intraoperatoria y la mortalidad posoperatoria a los 30 días.

Câncer Gástrico em Minas Gerais: Estudo sobre o Perfil da Morbimortalidade Hospitalar / Gastric Cancer in Minas Gerais: Study on the Profile of Hospital Morbimortality / Cáncer Gástrico en Minas Gerais: Estudio sobre el Perfil de Morbilidad y Mortalidad Hospitalaria

Introdução: A neoplasia maligna do estômago é o quinto tipo mais incidente de neoplasia e a terceira principal causa de morte por câncer no mundo. É uma patologia grave, geralmente diagnosticada em estágios avançados no Brasil. Objetivo: Analisar, por meio dos registros no Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS), o perfil das internações por neoplasia maligna do estômago em hospitais conveniados aos setores público e privado no Estado de Minas Gerais de 2007 a 2017. Método: Estudo descritivo, quantitativo, observacional, com dados públicos retrospectivos do SIH-SUS, no período de 1 de janeiro de 2007 a 31 de dezembro de 2017. Os locais de estudo foram as unidades hospitalares que integram o SUS (públicas ou particulares conveniadas). Resultados: Houve semelhança quanto à realidade nacional na maioria dos aspectos analisados, como aumento na taxa de internações e redução das taxas de letalidade hospitalares no decorrer dos anos. A maioria dos atendimentos foi de urgência e em regime privado. O sexo masculino (67,3%) e a faixa etária de pessoas com 60 anos ou mais (60,7%) obtiveram maior incidência. O tempo médio de internação foi 1,4 vezes maior no regime público do que no privado; a letalidade hospitalar foi maior no serviço público (8,9%) em relação ao privado (4,9%) nos atendimentos eletivos. Conclusão: A distribuição dos resultados foi heterogênea entre as Macrorregiões de Saúde, demonstrando que a descentralização de recursos ainda é um grande desafio do sistema de saúde brasileiro

Introduction: Malignant stomach cancer is the fifth most incident type of neoplasm and the third leading cause of death by cancer worldwide. It is a severe pathology, usually diagnosed in advanced stages in Brazil. Objective: Analyze, through the records in the Hospital Information System of the Unified Health System (SIH-SUS), the profile of hospitalizations for malignant neoplasm of the stomach in hospitals affiliated to the public and private sector in the state of Minas Gerais from 2007 to 2017. Method: Descriptive, quantitative, observational, retrospective study with public data from the SIH-SUS, from January 1, 2007 to December 31, 2017. The study sites were the hospital units that are part of the SUS (public or private affiliated). Results: There was similarity regarding the national reality for most of the aspects analyzed, such as an increase in the rate of hospitalizations and reduction in hospital mortality rates over the years. Most of the consultations were urgent and in private hospitals. Higher incidence was found for males (67.3%) and individuals aged 60 years or older (60.7%). The mean time of hospitalization was 1.4 times longer in public compared with private hospitals; hospital lethality was higher in the public service (8.9%) compared with private (4.9%) in elective care. Conclusion: The distribution of results was heterogeneous among the health macro-regions, demonstrating that the decentralization of resources is still a major challenge for the Brazilian health system

Introducción: La neoplasia maligna del estómago es el quinto tipo de cáncer más común y la tercera causa principal de muerte por cáncer en todo el mundo. Es una patología grave, generalmente diagnosticada en etapas avanzadas en Brasil. Objetivo: Analizar, a través de los registros en el Sistema de Información Hospitalaria del Sistema Único de Salud (SIH-SUS), el perfil de hospitalizaciones por neoplasia maligna del estómago en hospitales afiliados al sector público y privado en el estado de Minas Gerais de 2007 a 2017. Método: Estudio descriptivo, cuantitativo, observacional, con datos públicos retrospectivos del SIH-SUS, del 1 de enero de 2007 al 31 de diciembre de 2017. Los sitios de estudio fueron las unidades hospitalarias que forman parte del SUS (acuerdos públicos o privados). Resultados: Hubo similitud con respecto a la realidad nacional en la mayoría de los aspectos analizados, como un aumento en la tasa de hospitalizaciones y una reducción en las tasas de mortalidad hospitalaria a lo largo de los años. La mayoría de las consultas fueron urgentes y privadas. El sexo masculino (67,3%) y el rango etario de las personas de 60 años o más (60,7%) tuvieron una mayor incidencia. La estadía promedio en el hospital fue 1,4 veces más larga en el régimen público que en el privado; mayor letalidad hospitalaria en el servicio público (8,9%) en comparación con el privado (4,9%) en atención electiva. Conclusión: La distribución de los resultados fue heterogénea entre las regiones de macrosalud, lo que demuestra que la descentralización de los recursos sigue siendo un desafío importante para el sistema de salud brasileño

Defining multivariate normative rules for healthy aging using neuroimaging and machine learning: an application to Alzheimer's disease.

BACKGROUND: Neuroimaging techniques combined with computational neuroanatomy have been playing a role in the investigation of healthy aging and Alzheimer's disease (AD). The definition of normative rules for brain features is a crucial step to establish typical and atypical aging trajectories. OBJECTIVE: To introduce an unsupervised pattern recognition method; to define multivariate normative rules of neuroanatomical measures; and to propose a brain abnormality index. METHODS: This study was based on a machine learning approach (one class classification or novelty detection) to neuroanatomical measures (brain regions, volume, and cortical thickness) extracted from the Alzheimer's Disease Neuroimaging Initiative (ADNI)'s database. We applied a ν-One-Class Support Vector Machine (ν-OC-SVM) trained with data from healthy subjects to build an abnormality index, which was compared with subjects diagnosed with mild cognitive impairment and AD. RESULTS: The method was able to classify AD subjects as outliers with an accuracy of 84.3% at a false alarm rate of 32.5%. The proposed brain abnormality index was found to be significantly associated with group diagnosis, clinical data, biomarkers, and future conversion to AD. CONCLUSION: These results suggest that one-class classification may be a promising approach to help in the detection of disease conditions. Our findings support a framework considering the continuum of brain abnormalities from healthy aging to AD, which is correlated with cognitive impairment and biomarkers measurements.

Telemedicina rural e COVID-19: ampliando o acesso onde a distância já era regra / Rural telemedicine and COVID-19: expanding access where distance was already the rule / Telemedicina rural y COVID-19: expandiendo el acceso donde la distancia ya era la regla

Rev Bras Med Fam Comunidade. Rio de Janeiro, 2020 Jan-Dez; 15(42):24841Telemedicina rural e COVID-19: ampliando o acesso onde a distância já era regraFábio Araujo Gomes de Castro1, Álisson Oliveira dos Santos2, Gustavo Valadares Labanca Reis1, Luara Brandão Viveiros1, Mariel Hespanhol Torres1, Pedro Paulo de Oliveira Junior1Rural telemedicine and COVID-19: expanding access where distance was already the ruleIntrodução: Diante da pandemia causada pelo novo coronavírus (SARS-CoV-2), evitar aglomerações e garantir o acesso aos serviços de saúde para aqueles que necessitam tem sido uma grande preocupação de profissionais e gestores. Na zona rural, as barreiras de acesso são ainda maiores. Métodos: Trata-se de relato de experiência da implantação de telemedicina via aplicativo de mensagens e chamadas por preceptor e residentes do Programa de Residência em Medicina de Família e Comunidade de Ouro Preto, em uma Unidade Básica de Saúde rural. Após três semanas da introdução da ferramenta, foi gerado manualmente um banco de dados por meio do programa Microsoft Excel® 2016, com posterior análise estatística descritiva. Resultados:No período analisado houve 329 interações por meio do WhatsApp, uma média de 25,3 pessoas por dia. Todas as demandas foram atendidas no prazo máximo de 24 horas. As teleconsultas foram realizadas nos formatos de mensagem escrita, áudios e videochamadas. A demanda para renovação de prescrições de medicamentos de uso continuado correspondeu a 20% dos atendimentos e a solicitação para análise de resultados de exames 9%. Dúvidas administrativas representaram 22% dos contatos realizados. Setenta e quatro por cento das teleconsultas foram resolvidas virtualmente e em 26% dos casos foi necessária avaliação presencial. Houve uma percepção positiva em relação à satisfação dos pacientes atendidos virtualmente, de acordo com os relatos dos Agentes Comunitários de Saúde e por meio de mensagens recebidas diretamente pela equipe médica pelo aplicativo. Conclusão: O uso de aplicativo de mensagens e chamadas, como ferramenta de telemedicina, mostrou ser uma estratégia viável durante a pandemia de SARS-CoV-2, especialmente importante no meio rural. Outros estudos serão necessários para investigar seus impactos no sistema de saúde e nos desfechos relevantes para a população

Introduction: Faced with the pandemic caused by the new coronavirus (SARS-CoV-2), avoiding crowds and guaranteeing access to health services for those in need has been a major concern for professionals and managers. In rural areas, access barriers are even greater. Methods: This is an experience report of the implementation of telemedicine via an app of messages and calls by a preceptor and residents of the Residency Program in Family Medicine and Community of Ouro Preto, in a rural Basic Health Unit. Three weeks after the introduction of the tool, a database was manually generated using the Microsoft Excel® 2016 program, with subsequent descriptive statistical analysis. Results: In the analyzed period, there were 329 interactions through WhatsApp, an average of 25.3 people per day. All demands were met within a maximum of 24 hours. Teleconsultations were conducted in the form of written messages, audios and video calls. The demand for renewing prescriptions for medications for continued use corresponded to 20% of the consultations and the request for appraisal of test results was 9%. Administrative questions represented 22% of the contacts made. Seventy-four percent of the teleconsultations were resolved virtually and in 26% of the cases, face-to-face evaluation was required. There was a positive perception in reaction to the satisfaction of patients seen virtually, according to the reports of the Community Health Workers and through messages received directly by the medical team through the app. Conclusions: The use of a messaging and calling app as a Telemedicine tool proved to be a viable strategy during the SARS-CoV-2 pandemic, especially important in rural areas. Further studies are needed to investigate its impacts on the health system and on the relevant outcomes for the population.

Introducción: Ante la pandemia causada por el nuevo coronavirus (SARS-CoV-2), evitar a las multitudes y garantizar el acceso a los servicios de salud para los necesitados ha sido una gran preocupación para los profesionales y gerentes. En las zonas rurales, las barreras de acceso son aún mayores. Método: Este es un informe de experiencia de la implementación de Telemedicina a través de la aplicación de mensajes y llamadas por parte de un preceptor y residentes del Programa de Residencia en Medicina Familiar y Comunidad de Ouro Preto, en una Unidad Básica de Salud rural. Tres semanas después de la introducción de la herramienta, se generó manualmente una base de datos utilizando el programa Microsoft Excel® 2016, con posterior análisis estadístico descriptivo. Resultados: En el período analizado, hubo 329 interacciones a través de WhatsApp, un promedio de 25.3 personas por día. Todas las demandas se cumplieron en un máximo de 24 horas. Las teleconsultas se realizaron en forma de mensajes escritos, audios y videollamadas. La demanda de renovar las recetas de medicamentos para uso continuo correspondió al 20% de las consultas y la solicitud de análisis de los resultados de las pruebas al 9%. Los asuntos administrativos representaron el 22% de los contactos realizados. El setenta y cuatro por ciento de las teleconsultas se resolvieron virtualmente y en el 26% de los casos, se requirió una evaluación cara a cara. Hubo una percepción positiva en reacción a la satisfacción de los pacientes vistos virtualmente, según los informes de los Agentes de Salud Comunitarios y a través de mensajes recibidos directamente por el equipo médico a través de la aplicación. Conclusión: El uso de una aplicación de mensajería y llamadas como herramienta de telemedicina demostró ser una estrategia viable durante la pandemia del SARS-CoV-2, especialmente importante en las zonas rurales. Se necesitan más estudios para investigar sus impactos en el sistema de salud y en los resultados relevantes para la población.

Relato de caso: carcinoma basaloide da próstata, um achado incomum / Case report: basaloid carcinoma of the prostate, an uncommon finding

Relata-se caso de paciente com 56 anos de idade, com disúria, estrangúria, um episódio de hematúria macroscópica e dosagem de antígeno prostático específico (PSA) total de 1,35 ng/mL. A propedêutica para doença oncológica da próstata diagnosticou carcinoma basaloide, um tumor com rara histologia e poucas vezes descrito na literatura.

Repod of a 56 years old patient with dysuria, stranguria, an episode of gross hematuria and serum prostate specific antigen (PSA) total of 1.35 ng / mL. Workup for prostate cancer disease diagnosed basaloid carcinoma, a tumor with rare histology and scarcely described in the literature.

Câncer de esôfago: perfil das manifestações clínicas, histologia, localização e comportamento metastático em pacientes submetidos a tratamento oncológico em um centro de referência em Minas Gerais / Esophageal cancer: profile of clinical manifestations, histology, location and metastatic behavior in patients undergoing cancer treatment at a cancer center in Minas Gerais

O câncer de esôfago (CE) é uma neoplasia com uma incidência crescente, com taxas de mortalidade próximas às taxas de incidência. Sua etiologia está associada ao tipo histológico da doença, sendo o carcinoma de células escamosas o mais comum e fortemente relacionado ao tabagismo e etilismo, e o adenocarcinoma associado ao esôfago deBarrett. Além desses fatores sabidamente conhecidos, o risco de desenvolver este tumor está aumentado em pessoasque ingerem alimentos e bebidas quentes (mate) e que possuem nutrição deficiente (hipovitaminose A, C e E); hátambém uma predisposição genética que ainda é pouco definida. Manifestações clínicas comuns durante a evoluçãodessa doença incluem: disfagia, odinofagia, desconforto retroesternal, hiporexia, náusea, vômitos, emagrecimento.Tais queixas merecem uma avaliação criteriosa, pois, quando essas se manifestam, a doença já se encontra, na maioria das vezes, em um estágio avançado, não sendo possível uma abordagem curativa destes pacientes. Os protocolos de tratamento do CE incluem cirurgia, quimioterapia e radioterapia, mas o melhor tratamento ainda é motivo de estudos. Este trabalho teve como objetivo descrever e analisar o perfil das manifestações clínicas, a relaçãoentre o tipo histológico e a localização, idade e comportamento metastático e terapêutica, de pacientes portadores deCE submetidos a tratamento oncológico no Centro de Oncologia e Radioisótopos (COR), Ipatinga-MG. Foi feita análise retrospectiva dos prontuários de 109 pacientes com diagnóstico de CE, de maio de 2004 a fevereiro de 2007. Para cálculos estatísticos, foi utilizado o programa Epi Info 6.04d.

Tipos de tumores incidentes em pacientes cadastrados no Centro de Oncologia e Radioisótopos do Vale do Aço / Types of tumors in patients enrolled at the Vale do Aço Oncology Center ("Centro de Oncologia e Radioisótopos do Vale do Aço") / Tipos de tumores incidentes en pacientes registrados en el Centro de Oncologia y Radioisótopos del Vale do Aço

No Brasil, observamos uma escassez de estatísticas sobre a incidência do câncer, dificultando uma visualização adequada de suas dimensões na população. Este estudo analisou a incidência dos tipos de tumores em clientes do Centro de Oncologia e Radioisótopos do Vale do Aço, estabelecendo comparações entre a idade média dos pacientes. Os resultados apontam o tumor de mama, próstata, colo de útero como os mais incidentes e uma variação ampla entre as idades dos pacientes. O tumor de próstata mostrou-se característico da terceira idade, ao contrário do de mama, que incidiu em mulheres de até 28 anos.

In Brazil, there is a lack of statistics on the prevalence of cancer, making it difficult to see its effects on the population. This study analyzed the kinds of tumors in patients in the oncology and radioisotope center of Vale do Aço, in Ipatinga, state of Minas Gerais, correlating with the mean age of the patients. The results show the greatest prevalence of breast, prostate and uterus tumors, and a wide variation in patients' ages. Prostate tumors are typical of elderly patients, contrasting with breast cancer, which affected women as young as 28 years old.

Observamos que en Brasil escasean estadísticas sobre la incidencia del cáncer, lo que nos impide tener una visión clara de sus dimensiones en la población. Este estudio analizó la incidencia de los tipos de tumores en pacientes del Centro de Oncología y Radioisótopos de Ipatinga y estableció comparaciones entre la edad promedio de los pacientes. Los resultados señalan que los tumores de mayor incidencia son los de mama, próstata y cuello del útero, con amplia variación entre la edad de los pacientes. El tumor de próstata aparece como característico de la tercera edad, al contrario del de mama, incidente en mujeres de hasta 28 años.

Medida da espessura cortical com imagens de ressonância magnética: técnica e aplicações na doença de Alzheimer e na polimicrogiria / Measurement of cortical thickness using magnetic resonance imaging: technique and applications in Alzheimer's disease and polymicrogyria

As técnicas de morfometria baseadas em imagens ressonância magnética desde o início do século XXI tem sido uma importante ferramenta para estudar doenças neurológicas. Um dos benefícios desta técnica é prover medidas de parâmetros que manualmente são difíceis de estimar e com um grande viés de operador. Este trabalho teve como objetivo descrever as alterações corticais em duas doenças, uma malformação do desenvolvimento cortical, e outra neurodegenerativa utilizando as técnicas de morfometria por estudo de superfície cortical. As imagens de ressonância magnética foram obtidas por sequências volumétricas ponderadas em T1 e analisadas através de um algoritmo específico, implementado no software FreeSurfer (Fischl et al., Harvard University - Estados Unidos). De um grupo de pacientes com malformação do desenvolvimento cortical foram analisados 3 pacientes com polimicrogiria (PMG), comparados com um grupo de 14 pessoas saudáveis e de idade similar. Foram também analisados 14 pacientes com alteração degenerativa (Doença de Alzheimer - DA) com manifestação recente, idade avançada e alto nível de escolaridade comparados com 20 idosos saudáveis. Este dado foi posteriormente utilizado para separar os dois grupos através de uma técnica de classificação multivariada, implementada pelo autor. A análise de cada um dos indivíduos com PMG comparados ao grupo controle apresentou aumento de espessura cortical nas áreas com polimicrogiria e redução também estatisticamente significante de espessura cortical em áreas sem polimicrogiria. No estudo do grupo de pacientes com DA observou-se redução de espessura cortical nas regiões do córtex para hipocampal, entorrinal, córtex límbico e córtex temporal superior. Além disso, a volumetria de estruturas subcorticais obtidas apresentou poder de classificação de 84,6% na comparação de pacientes com DA e controles saudáveis...

The techniques of brain morphometry based on magnetic resonance images since the beginning of the twenty-first century has been an important tool for studying neurological diseases. One of the benefits of this technique is to provide measures of parameters that are difficult to estimate manually and subject to operator bias. This study aimed to describe the changes in the cortex in two diseases, a malformation of cortical development and a neurodegenerative one, using surface based morphometry techniques. From a group of patients with malformation of cortical development were analyzed 3 with polymicrogyria (PMG), compared to a group of 14 healthy age matched subjects. The images from a T1 weighted volume were analyzed using a specific algorithm, implemented in the software FreeSurfer (Fischl et al., Harvard University - United States). We analyzed 14 patients with degenerative changes (Alzheimers disease - AD) with recent onset, advanced age and high level of education compared to 20 healthy age matched elderly. The images of this study were also obtained from a T1 weighted volume and were analyzed with the same software package. This analyzed data was used to separate the two groups through a multivariate classifier, implemented by the author. The analysis of each individual with PMG compared to the control group showed a statistically significant increase in cortical thickness in the areas with polymicrogyria and also a statistically significant reduction of cortical thickness in some areas without polymicrogyria. In the study group of AD patients the result was a cortical thinning statistically significant in hippocampal, entorhinal, limbic and superior temporal cortex. Moreover, the volume of subcortical structures has provided a classification power of 84.6% discriminating AD patients from healthy controls...