Timing Matters: Ultra-Early and Early versus Late Thromboprophyaxis Following Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis.

Spontaneous intracerebral hemorrhage (ICH) represents a critical and potentially devastating medical event resulting from the rupture of intracerebral vessels. Patients afflicted with ICH face an increased risk of venous thromboembolism (VTE) due to factors such as immobility. However, determining the ideal timing for initiating venous thromboembolism thromboprophylaxis (TP) remains uncertain, as it may carry the potential risk of exacerbating hematoma expansion. Thus, our objective was to ascertain the optimal timing for initiating TP following ICH through a comprehensive systematic review and meta-analysis.This systematic review and meta-analysis were performed following the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines, considering outcomes based on the time of intervention: Ultra early (UEPT) < 24 h, Early (EPT) < 48 h, Late (LPT) > 48 h to perform an analysis on hematoma expansion and mortality.Of 2.777 Hematoma expansion was not more frequent in the 440 patients receiving UEPT/EPT (n = 440) versus 565 receiving LPT (Odds ratio (OR) 0.94 (95% CI; 0.62 to 1.43; I2 = 0%)). Similarly, mortality was not lower in the 293 received UEPT or EPT versus 477 receiving LPT (OR 0.63 (95% CI; 0.39 to 1.0; I2 = 0%).This study, through a systematic review and meta-analysis, conclusively found no difference in intracranial hematoma expansion and/or increased mortality between the use of heparin in the early thromboprophylaxis (< 48 h) group compared to the late thromboprophylaxis (> 48 h) group. Implementing this approach in the management of spontaneous cerebral hemorrhage could facilitate progress towards more optimal care protocols.

Left Internal Capsule Cavernoma Using the Superior Frontal Sulcus as a Surgical Corridor: Why and How to Do It: 2-Dimensional Operative Video.

Cavernous angioma is a sinusoidal dilatation covered by a single layer of endothelium, separated by a collagen matrix with elastin and smooth muscle.1 The prevalence in the general population is estimated at 0.4% to 0.9%,2 representing around 5% to 10% of all vascular malformations.3 Studies indicate 9% to 35% of cavernomas are found in deep locations such as the brainstem, thalamus, and basal ganglia.4-6 Common symptoms of these deep lesions are cranial nerve deficit, hemiparesis, and paresthesia. These lesions have high rates of rebleeding after the first episode of bleeding but present excellent results of surgical resection and modified Rankin in the long term.7-13 Internal capsule cavernomas are particularly challenging due to the important projection fibers surround them. Although the gold standard of treatment is microsurgery, there needs to be a consensus on the best approach for lesions of this topography. We present a video case of a female in her 50s with right hemiparesis and dysphasia, exhibiting grade 3/5 strength on the right side. T1 MRI revealed a high intensity, heterogeneous, multinodular signal in the left basal ganglia, with tractography showing the lesion dividing the posterior limb of the internal capsule amid fibers of the right corticospinal tract. The patient consented to the procedure and to the publication of his/her image. This study was approved by the Ethics and Research Committee of our institution. We demonstrated that the superior frontal sulcus is a safe corridor to surgically cure cavernomas of the internal capsule, with the recovery of previous deficits.

Prevalência de transtornos mentais comuns em estudantes de medicina da Faculdade Evangélica do Paraná em 2011 / Prevalence of common mental disorders among medicine students at Faculdade Evangélica do Paraná in 2011

Transtornos mentais comuns (TMC)apresentam-se como sintomas de insônia, fadiga, esquecimento e dificuldade de concentração, podendo reduzir o desempenho de atividades diárias. Cerca de 25% dos estudantes de medicina encontram-se deprimidos, enquanto 50% apresentam exaustão. O objetivo do estudo foi avaliar a prevalência de TMC entre os estudantes do curso de Medicina da Faculdade Evangélica do Paraná (FEPAR). Foi aplicado o questionário SRQ-20 (Self Report Questionnaire ­ 20), versão validada para Português-Brasil. A população estudada constituiu-se de alunos entre o 1º e 8º semestres do curso de Medicina, matriculados em 2011. Considerou-se provável caso de TMC a pontuação ≥ 6 para homens e 8 para mulheres. O nível de significância foi de 0,05. O montante de 121 estudantes tiveram pontuação sugestiva de TMC (2/3 eram do sexo feminino) e 12,5% referiram pelo menos um dos sintomas. Conclui-se que a prevalência de TMC em estudantes da FEPAR, em 2011, foi de 31,51%

Common Mental Disorders (CMD) are presented symptoms as insomnia, fatigue, forgetfulness, concentration difficulties, what can decrease in daily performance. About 25% of the students are depressed while 50% present signs of exhaustion. The goal of the study was to evaluate the prevalence of CMD among the medicine students of Faculdade Evangélica do Paraná (FEPAR).The Self Report Questionnaire 20 was applied in Portuguese validated version. The studied population was constituted by students registered between the 1st and 8th semesters of graduation since 2011 at FEPAR. It was considered as likely cases when the score is ≥ 6 for men and 8 for women. The level of significance was 0,05%.The number of 121 students presented suggestive score of CMD (2/3 were women) and 12,5% presented at least one of the symptoms.It is concluded that the prevalence of CMD among medicine students of FEPAR was 31,51%