RESUMO
The recruitment of synaptic α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptors underlies the strengthening of neuronal connectivity during learning and memory. This process is triggered by N-methyl-D-aspartate (NMDA) receptor-dependent postsynaptic Ca2+ influx. Synaptotagmin (Syt)-1 and -7 have been proposed as Ca2+ sensors for AMPA receptor exocytosis but are functionally redundant. Here, we identify a cytosolic C2 domain-containing Ca2+-binding protein, Copine-6, that forms a complex with AMPA receptors. Loss of Copine-6 expression impairs activity-induced exocytosis of AMPA receptors in primary neurons, which is rescued by wild-type Copine-6 but not Ca2+-binding mutants. In contrast, Copine-6 loss of function does not affect steady-state expression or tetrodotoxin-induced synaptic upscaling of surface AMPA receptors. Loss of Syt-1/Syt-7 significantly reduces Copine-6 protein expression. Interestingly, overexpression of wild-type Copine-6, but not the Ca2+-binding mutants, restores activity-dependent exocytosis of AMPA receptors in Syt-1/Syt-7 double-knockdown neurons. We conclude that Copine-6 is a postsynaptic Ca2+ sensor that mediates AMPA receptor exocytosis during synaptic potentiation.
Assuntos
Exocitose , Receptores de AMPA , Receptores de AMPA/metabolismo , Exocitose/fisiologia , Neurônios/metabolismo , Receptores de N-Metil-D-Aspartato/metabolismo , Cálcio/metabolismoRESUMO
BACKGROUND/RATIONALE: There is an increase of spontaneous consultation and a need for effective management of it. For this reason we created the "High Resolution Nursing Consultation" (CIAR), giving nurses greater autonomy. OBJECTIVES: We aim to demonstrate the ability of nursing in the resolution of spontaneous consultation as well as to know demands more frequent and what is more resolving and to find out the correlation between the reason for visit registered at admissions and real. DESCRIPTION: Cross sectional study In CIAR, a primary care nurse serves adult patients who requested spontaneous consultation, without any preselection. We analyze results of eight months of consultation. The visits were performed according to protocols developed in the center. RESULTS: Nursing resolved 63% of them, 37% jointly Independent resolution increased to 75.7% in the last month. The most common reasons were: administrative, respiratory disease and otolaryngology. Nursing decided autonomously 98% of administrative visits, 80% of wounds/burns, 72% of the toothache and between 50% and 60% of GYN/emergency contraception, ophthalmology, internal medicine and digestive. With the implementation of the protocol of acute nasopharyngitis nursing resolution increased from 4.9% to 78.3%., the correlation between the reason for visit registered at admissions and real was 96%. CONCLUSIONS: Nursing is highly qualified for the management of spontaneous consultation with excellent results. Protocols are of great help in the resolution of nursing and it improves with the experience acquired.
Assuntos
Processo de Enfermagem , Encaminhamento e Consulta , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à SaúdeRESUMO
BACKGROUND: The prevalence of developmental alterations associated with in-utero Zika virus (ZIKV) exposure in children is not well understood. Furthermore, estimation of the Population Attributable Fraction (PAF) of developmental alterations attributed to ZIKV has not been performed due to lack of population-based cohorts with data on symptomatic and asymptomatic ZIKV exposures and an appropriate control group. The aim of this study was to characterize neurodevelopmental outcomes of children at 11 to 32 months of age with intrauterine ZIKV exposure and estimate the PAF of alterations secondary to ZIKV exposure. METHODOLOGY/PRINCIPAL FINDINGS: We performed a cohort of biannual community-based prospective serosurveys in a slum community in Salvador, Brazil. We recruited women participating in our cohort, with a documented pregnancy from January 2015 to December 2016 and children born to those mothers. Children were classified as ZIKV exposed in utero (born from women with ZIKV seroconversion during pregnancy) or unexposed (born from women without ZIKV seroconversion or that seroconverted before/after pregnancy) by using an IgG monoclonal antibody blockade-of-binding (BoB). We interviewed mothers and performed anthropometric, audiometric, ophthalmological, neurologic, and neurodevelopmental evaluations of their children at 11 to 32 months of age. Among the 655 women participating in the cohort, 66 (10%) were pregnant during the study period. 46 (70%) of them completed follow-up, of whom ZIKV seroconversion occurred before, during, and after pregnancy in 25 (54%), 13 (28%), and 1 (2%), respectively. The rest of women, 7 (21.2%), did not present ZIKV seroconversion. At 11 to 32 months of life, the 13 ZIKV-exposed children had increased risk of mild cognitive delay (RR 5.1; 95%CI 1.1-24.4) compared with the 33 children unexposed, with a PAF of 53.5%. Exposed children also had increased risk of altered auditory behavior (RR 6.0; 95%CI 1.3-26.9), with a PAF of 59.5%. CONCLUSIONS: A significant proportion of children exposed in utero to ZIKV developed mild cognitive delay and auditory behavioral abnormalities even in the absence of gross birth defects such as microcephaly and other neurodevelopmental domains. Furthermore, our findings suggest that over half of these abnormalities could be attributed to intrauterine ZIKV exposure.
Assuntos
Áreas de Pobreza , População Urbana , Infecção por Zika virus/epidemiologia , Adolescente , Adulto , Anticorpos Monoclonais , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Microcefalia/epidemiologia , Pessoa de Meia-Idade , Mães , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Prospectivos , Adulto Jovem , Zika virus , Infecção por Zika virus/diagnósticoRESUMO
OBJECTIVE: To describe the neurological and neurodevelopmental outcomes of children with Congenital Zika Syndrome (CZS) associated microcephaly beyond 2 years of age. METHOD: We followed children with CZS-associated microcephaly in an outpatient clinic in Salvador, Brazil. Neurological and neurodevelopmental assessments were performed using the Hammersmith Infant Neurological Examination (HINE) and Bayley Scales of Infant and Toddler Neurodevelopment (Bayley-III) respectively. RESULTS: Of the 42 children included, 19 were male (45.2%); median (interquartile range) age at neurological evaluation was 28 (25-32) months, and 36 (85.7%) had severe microcephaly. HINE and Bayley-III results were completed for 35/42 (83.3%) and 33/42 (78.5%) children respectively. Bayley-III identified a severe developmental delay in 32/33 (97.0%) children while 1/33 (3.0%) had only a mild delay. In the multivariable analysis, we found that Bayley-III and HINE scores were correlated. Better HINE scores were associated with higher Bayley-III cognitive raw scores (ß = 0.29; CI 95% = 0.02-0.57) and motor raw scores (ß = 0.43; CI 95% = 0.04-0.82) after adjusting for head circumference, prematurity, and age at neurodevelopmental evaluation. Furthermore, we found that greater head circumference at follow up was associated with higher cognitive (ß = 1.27; CI 95% = 0.01-2.53) and motor raw scores (ß = 2.03; CI 95% = 0.25-3.81). CONCLUSION: Children with CZS-associated microcephaly demonstrate severe neurodevelopmental delays and slower growth rates than their peers over time. Still, they have remarkably heterogeneous neurodevelopmental profiles according to neurological exam scores which correlate with their long-term outcomes. We found that HINE scores effectively captured the heterogeneity of neurological capabilities among these children and could be predictive of cognitive and motor development progress.
Assuntos
Deficiências do Desenvolvimento/diagnóstico , Microcefalia/diagnóstico , Microcefalia/epidemiologia , Infecção por Zika virus/diagnóstico , Brasil/epidemiologia , Cefalometria , Pré-Escolar , Deficiências do Desenvolvimento/fisiopatologia , Deficiências do Desenvolvimento/virologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Microcefalia/etiologia , Microcefalia/virologia , Exame Neurológico , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/virologia , Zika virus/patogenicidade , Infecção por Zika virus/complicações , Infecção por Zika virus/virologiaRESUMO
We report on the clinical observation of a girl patient with few signs of cri-du-chat syndrome. The chromosomal analysis in lymphocyte culture showed 46,XX,del(5)(p15.3) in 38% of cells. Psychological tests revealed motor, perceptive and visual-spatial problems, as well as immaturity and emotional dependence. The phoniatric evaluation showed poor vocabulary, difficulty with repeating words or numbers in sequence, and better receptive than expressive language. The spectrographic measurements showed disturbance of fundamental frequency (F0) in vocal pronunciation. The anatomic findings of the laryngoscopic evaluation were normal, indicating that the voice and speech problems were functional disorders. The present case revealed moderate clinical signs and vocal disturbance associated with a low percentage of 5p- cells and the breakpoint at 5p15.3. The short terminal deletion with a possible loss of the critical region for cat-like cry and the presence of a normal cell line, explain the cry not so typical at birth (weak but not high-pitched), the intermediate values of F0, and the moderate mental retardation. This case is compared with other mosaic 5p- patients reported in the literature.
Assuntos
Síndrome de Cri-du-Chat/genética , Criança , Deleção Cromossômica , Cromossomos Humanos Par 5 , Deficiências do Desenvolvimento/genética , Feminino , Humanos , Deficiência Intelectual/genética , Cariotipagem , FenótipoRESUMO
INTRODUCTION: Practical and portable the personal stereos if had become almost indispensable accessories in the day the day. Studies disclose that the portable players of music can cause auditory damages in the long run for who hear music in high volume for a drawn out time. OBJECTIVE: to verify the prevalence of auditory symptoms in users of amplified players and to know its habits of use METHOD: Observational prospective study of transversal cut carried through in three institutions of education of the city of Salvador BA, being two of public net and one of the private net. 400 students had answered to the questionnaire, of both the sex, between 14 and 30 years that had related the habit to use personal stereos. RESULTS: The symptoms most prevalent had been hyperacusis (43.5%), auricular fullness (30.5%) and humming (27.5), being that the humming is the symptom most present in the population youngest. How much to the daily habits: 62.3% frequent use, 57% in raised intensities, 34% in drawn out periods. An inverse relation between exposition time was verified and the band of age (p = 0,000) and direct with the prevalence of the humming. CONCLUSION: Although to admit to have knowledge on the damages that the exposition the sound of high intensity can cause the hearing, the daily habits of the young evidence the inadequate use of the portable stereos characterized by long periods of exposition, raised intensities, frequent use and preference for the insertion phones. The high prevalence of symptoms after the use suggests a bigger risk for the hearing of these young.
RESUMO
Introdução: em setembro de 2015, após um surto de zika vírus, observou-se um aumento anormal no número de bebês nascidos com microcefalia no Brasil em áreas afetadas por esse vírus. Com uma propagação rápida, a incidência de microcefalia aumentou em vinte vezes quando comparada a de anos anteriores. Objetivo: verificar o índice de falha na triagem auditiva de crianças expostas ao zika vírus durante a gestação procedentes da capital e interior do estado da Bahia. Metodologia: trata-se de um estudo transversal, descritivo, com abordagem quantitativa. A população-alvo foi constituída de crianças nascidas entre abril de 2015 a dezembro de 016, encaminhadas para o ambulatório de confirmação de microcefalia relacionada ao zika vírus, no Complexo Hospitalar Professor Edgard Santos da Universidade Federal da Bahia. Foram incluídas crianças com suspeita de síndrome congênita do zika vírus, com ou sem microcefalia, nascidas de mães com infecção por zika vírus confirmada por sorologia durante a gravidez ou com rash cutâneo autorreferido. Os testes de triagem realizados foram emissões otoacústicas por transientes (EOAt) e Potencial Evocado Auditivo de Tronco Encefálico (PEATE) nas intensidades de 80/30 dB. Considerou-se "passa" quando a criança obteve respostas adequadas nos dois testes. Resultados: foram revisados os dados de 76 crianças. A idade média de realização dos testes foi de 101±86 dias, e 65,8% delas eram do sexo feminino. A prevalência de falha nas emissões otoacústicas foi 6,6%, considerando teste e reteste. No PEATE, todas obtiveram condução nervosa com latências absolutas e intervalos interpicos adequados à idade e nível mínimo de resposta com amplitude clara em 30dBNA. Conclusão: a prevalência de falha na triagem auditiva foi de 6,6% considerando teste e reteste. Os resultados sugerem uma provável alteração condutiva entre os que falharam nas EOAt, visto que tinham presença de resposta eletrofisiológica a 30dBNA e latências absolutas dentro da normalidade na pesquisa da condução nervosa no PEATE. Os dados disponíveis não permitem confirmar a natureza da alteração nem estimar a acuidade auditiva com precisão.
Introduction: in September 2015, after an outbreak of zika virus, there was an abnormal increase in the number of babies born with microcephaly in areas affected by the virus in Brasil. With a rapid spread, the incidence of microcephaly increased by twenty times compared to previous years. Objective: to check the rate of failure in the hearing screening of children exposed to zika virus during pregnancy from the capital and interior of Bahia. Methodology: cross-sectional study, descriptive with quantitative approach. The target population was children, born between April 2015 and December 2016, referred to the outpatient clinic for microcephaly related to zika virus from the Hospital Edgar Santos Complex of the Federal University of Bahia. Children with suspected congenital zika virus syndrome, with or without microcephaly, born to mothers with a virus-confirmed zika virus infection during pregnancy or with selfreported skin rash were included. The screening tests performed were transient Otoacoustic Emissions (OEAt) and Brainstem Auditory Evoked Potentials (BAEP) at intensities of 80/30 dB. It was considered "pass" when the child obtained adequate answers in both tests. Results: data from 76 children were reviewed. The mean age of the tests was 101 ± 86 days, 65.8% were female. The prevalence of failure in otoacoustic emissions was 6.6%, considering test and retest. In the PEATE, all of them obtained nerve conduction with absolute latencies and age-appropriate interpeak intervals and minimal level with clear amplitude response at 30dBNA. Conclusion: the prevalence of hearing screening failure was 6.6% considering test and retest. The results suggest a probable conductive alteration among those who failed in the OEAt, since they had electrophysiological response at 30dBNA and absolute latencies within normality in the search for nerve conduction in the BAEP. The available data do not allow us to confirm the nature of the change or accurately estimate auditory acuity.
Assuntos
Zika virus , MicrocefaliaRESUMO
OBJETIVO: estabelecer qual indicador de risco para perda auditiva apresenta maior prevalência de resultados 'falha' da Triagem Auditiva Neonatal. MÉTODOS: a partir de análise retrospectiva de 702 prontuários de lactentes submetidos à triagem auditiva neonatal no Ambulatório de Audiologia da Universidade Federal da Bahia no período de 2007 a 2011, foi realizado o teste do qui-quadrado para a hipótese de ausência de associação entre os indicadores de risco e a 'falha' da Triagem Auditiva Neonatal. RESULTADOS: dos lactentes pesquisados, 352 (50,29%) foram do sexo masculino e 348 (49,71%) do sexo feminino, dois não tinham referências quanto ao gênero. A maioria dos bebês tinha idade entre um a três meses de vida e 45,40% dos bebês nasceram prematuros. Verificou-se que os bebês apresentaram os seguintes indicadores de risco: 28,83% tinham hiperbilirrubinemia; 22,54% tinham história de infecção congênita; 15,06% nasceram com peso inferior a 1.500g; 8,21% tiveram boletim Apgar de 0 a 4 no 1º minuto; 5,07% apresentaram boletim Apgar de 0 a 6 no 5º minuto; 9,09% receberam ventilação mecânica; 4,09% tinham síndromes associadas à perda auditiva e apenas 1 (0,84%) lactente teve meningite bacteriana. Entre esses lactentes, 92,45% não tinham histórico familiar de deficiência auditiva e 97,09% não apresentavam malformação craniofacial. CONCLUSÃO: houve associações entre cinco indicadores de risco e 'falha' na triagem auditiva neonatal. Os indicadores de risco apresentaram a seguinte ordem decrescente de prevalência: boletim de Apgar de 0 a 4 no 1º minuto; malformações craniofaciais; síndrome associadas a perdas auditivas; boletim de Apgar de 0 a 6 no 5º minuto; ventilação mecânica. .
PURPOSE: to establish which risk index for hearing loss shows the highest prevalence of 'failure' in newborn hearing screening. METHODS: using a retrospective analysis of medical records involving 702 infants undergoing neonatal hearing screening in the Audiology Clinic of the Federal University of Bahia in the period 2007-2011, the chi-square test was carried out for the hypothesis of no association between the risk indices and 'failure' of the newborn hearing screening. RESULTS: in relation to the infants studied, 352 (50.29%) were male and 348 patients (49.71%) were females, two had no references as to their gender. Most babies were between one to three months of age and 45.40% of babies were born prematurely. It was found that infants showed the following risk indices: 28.83% had hyperbilirubinemia; 22.54% had a history of congenital infection; 15.06% were born weighing less than 1,500 grams; 8.21% had Apgar scores of 0-4 in the 1st minute; 5.07% had Apgar scores 0-6 in the 5th minute; 9.09% received artificial respiration; 4.09% had syndromes associated with hearing loss and only 1 (0.84%) infant had bacterial meningitis. Among these infants, 92.45% had no family history of hearing impairment and 97.09% had no craniofacial malformation. CONCLUSION: there were associations between five risk indices and 'failure' in neonatal hearing screening. Risk indices showed the following decreasing order of prevalence: Apgar score 0-4 in the 1st minute; craniofacial malformations; syndromes associated with hearing loss; Apgar score 0-6 in the 5th minutes; artificial respiration. .
RESUMO
El insomnio es una patología frecuente, según estadísticas recientes hasta un 35% de la población general ha sido diagnosticada con insomnio en algún momento de la vida, un factor de riesgo para problemas cardiovasculares, accidentes y complicaciones psiquiátricas. Los datos sobre las consecuencias psiquiátricas del insomnio crónico, en nuestro medio son muy escasas, y muchas de las investigaciones realizadas hasta la fecha relacionan el insomnio como un síntoma dentro de los criterios para trastornos psiquiátricos, ejemplo de ello son los trastornos afectivos, sin embargo, las investigaciones recientes describen un problema de carácter bidireccional. La presente investigación tiene como objetivo Identificar riesgo de trastornos depresivos en pacientes con diagnóstico de insomnio crónico.
Assuntos
Transtorno Depressivo , Distúrbios do Início e da Manutenção do Sono , Saúde MentalRESUMO
Introdução: Práticos e portáteis os estéreos pessoais se tornaram acessórios quase indispensáveis no dia a dia. Estudos revelam que os tocadores de música portáteis podem causar danos auditivos a longo prazo para quem ouve música em alto volume por um tempo prolongado. Objetivo: verificar a prevalência de sintomas auditivos em usuários de tocadores amplificados e conhecer os seus hábitos de uso. Método: Estudo prospectivo observacional de corte transversal realizado em três instituições de ensino da cidade de Salvador- BA, sendo duas de rede pública e uma da rede privada. Responderam ao questionário 400 estudantes, de ambos os sexos, entre 14 e 30 anos que referiram o hábito de utilizar estéreos pessoais. Resultados: Os sintomas mais prevalentes foram hiperacusia (43,5%), plenitude auricular (30,5%) e zumbido (27,5), sendo que o zumbido é o sintoma mais presente na população mais jovem. Quanto aos hábitos diários: 62,3% usam frequentemente, 57% em intensidades elevadas, 34% em períodos prolongados. Verificou-se uma relação inversa entre tempo de exposição e a faixa de idade (p=0,000) e direta com a prevalência do zumbido. Conclusão: Apesar de admitirem ter conhecimento sobre os danos que a exposição a som de alta intensidade pode causar a audição, os hábitos diários dos jovens evidenciam o uso inadequado dos estéreos portáteis caracterizados por longos períodos de exposição, intensidades elevadas, uso frequente e preferência pelos fones de inserção. A alta prevalência de sintomas após o uso sugere um risco maior para a audição desses jovens...
Introduction: Practical and portable the personal stereos if had become almost indispensable accessories in the day the day. Studies disclose that the portable players of music can cause auditory damages in the long run for who hear music in high volume for a drawn out time. Objective: to verify the prevalence of auditory symptoms in users of amplified players and to know its habits of use. Method: Observational prospective study of transversal cut carried through in three institutions of education of the city of Salvador BA, being two of public net and one of the private net. 400 students had answered to the questionnaire, of both the sex, between 14 and 30 years that had related the habit to use personal stereos. Results: The symptoms most prevalent had been hyperacusis (43.5%), auricular fullness (30.5%) and humming (27.5), being that the humming is the symptom most present in the population youngest. How much to the daily habits: 62.3% frequent use, 57% in raised intensities, 34% in drawn out periods. An inverse relation between exposition time was verified and the band of age (p=0,000) and direct with the prevalence of the humming. Conclusion: Although to admit to have knowledge on the damages that the exposition the sound of high intensity can cause the hearing, the daily habits of the young evidence the inadequate use of the portable stereos characterized by long periods of exposition, raised intensities, frequent use and preference for the insertion phones. The high prevalence of symptoms after the use suggests a bigger risk for the hearing of these young...
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Hábitos , Estudantes , Transtornos da Audição/diagnósticoRESUMO
Este estudo apresenta o resultado da investigação do potencial cognitivo P300 em crianças com TDAH, em comparação com um grupo de crianças sem TDAH. Trata-se de um estudo descritivo, de caráter exploratório, que estimou a latência e a amplitude do P300 em crianças portadoras de TDAH, em comparação com crianças sem sintomas de TDAH. A casuística foi composta por 56 indivíduos na faixa etária de 7 a 16 anos, 25 dos quais pertenciam ao grupo com diagnóstico de TDAH e 31 sem sintomas de TDAH Todos os participantes, representados pelos pais ou responsáveis legais, responderam a um questionário para levantamento de dados sociodemográficos, dados de saúde geral, queixas específicas e desempenho escolar. As crianças foram submetidas a testes para avaliação da audição periférica e potencial evocado cognitivo (P300). Foi observado que os portadores de TDAH possuem latências maiores e amplitude menores, quando comparados com as crianças do grupo de controle, verificando-se significância estatística apenas para o grupo de maior faixa-etária (11 a 16 anos).
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Audiometria de Resposta Evocada , Potenciais Evocados Auditivos , Transtorno do Deficit de Atenção com HiperatividadeRESUMO
O avanço da tecnologia trouxe, para os nossos dias, níveis de ruído de diversas naturezas que são potencialmente lesivos ao ouvido humano. Os jovens, na sua maioria adolescentes, habitualmente estão expostos à música amplificada de alta intensidade, especialmente nas suas atividades de lazer. Este estudo verificou o grau de conhecimento de jovens adolescentes em relação às perdas auditivas induzidas pelo ruído, através de uma pesquisa de campo envolvendo 700 adolescentes entre 14 e 20 anos. Os resultados demonstram que, embora 88 por cento da população estudada afirme ter conhecimento de que ruídos de alta intensidade podem causar perdas auditivas, 90 por cento não sabem como proteger sua audição ou usam métodos ineficientes.