RESUMEN
BACKGROUND: Obesity and obstructive sleep apnea (OSA) are both associated with the prevalence of major cardiovascular illnesses and certain common factors they are considered responsible for, such as stress oxidative increase, sympathetic tonus and resistance to insulin. OBJECTIVE: The aim of the present study was to compare the effect of continuous positive airway pressure (CPAP) on oxidative stress and adiponectin levels in obese patients with and without OSA. METHODS: Twenty-nine obese patients were categorized into 3 groups: group 1: 10 individuals without OSA (apnea-hypopnea index, AHI
Asunto(s)
Adiponectina/sangre , Presión de las Vías Aéreas Positiva Contínua , Obesidad/fisiopatología , Estrés Oxidativo/fisiología , Apnea Obstructiva del Sueño/sangre , Apnea Obstructiva del Sueño/terapia , Estudios de Casos y Controles , Humanos , Resistencia a la Insulina/fisiología , Masculino , Persona de Mediana Edad , Nitratos/sangre , Nitritos/sangre , Obesidad/sangre , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/fisiopatología , Superóxidos/sangreRESUMEN
BACKGROUND: Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is a respiratory disorder with high morbidity and mortality. Continuous positive airway pressure (CPAP) is the most commonly prescribed conservative treatment for adults with OSAHS. CPAP therapy normalises or decreases OSAHS symptoms and can reduce and prevent OSAHS complications. AIMS: To evaluate adherence to nasal CPAP treatment and CPAP impact on daytime drowsiness. METHOD: A sample of 20 patients evaluated for daytime drowsiness using the Epworth sleepiness scale and interviewed for adherence to nasal CPAP use. RESULTS: There was a significant decrease in the level of daytime sleepiness of the patients users of nasal CPAP (p=0.017); patients not using nasal CPAP experienced a decrease without statistical significance (p=0.162). 100% of CPAP users reported benefits and 50% of these reported related discomforts. CONCLUSIONS: Patients with OSAHS that use CPAP have a greater reduced level of sleepiness than those who do not use it.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Apnea Obstructiva del Sueño/terapia , Fases del Sueño , Adulto , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Polymorphism of the gene for apolipoprotein E (APOE) is an important risk factor for the development of Alzheimer's disease. The epsilon4 allele of the APOE gene has been linked with a number of neuropsychiatric illnesses, and also with stress and depression among geriatric populations. OBJECTIVE: To identify APOE-epsilon4 polymorphism and correlate this with cognitive deficit among the elderly population of the island of Fernando de Noronha. METHOD: Neuropsychiatric tests (mini-mental state examination, verbal fluency test and clock drawing test) were applied to 52 elderly people without Alzheimer's disease. DNA was isolated from peripheral blood and genotyping of APOE was done by the PCR-RFLP method. RESULTS: 87% of the elderly population (mean age 69.6+/-7.0) had cognitive deficit. CONCLUSION: The observed frequency of the epsilon4 allele was 10%, but the correlation between the presence of epsilon4 and cognitive deficit in this population was not statistically significant.
Asunto(s)
Apolipoproteína E4/genética , Trastornos del Conocimiento/genética , Polimorfismo Genético , Factores de Edad , Anciano , Anciano de 80 o más Años , Alelos , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/genética , Análisis de Varianza , Brasil/epidemiología , Escalas de Valoración Psiquiátrica Breve , Distribución de Chi-Cuadrado , Cognición/fisiología , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/psicología , Escolaridad , Femenino , Genotipo , Evaluación Geriátrica , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Factores SexualesRESUMEN
Since the sixties immunosuppressive agents have been used in the treatment of multiple sclerosis as there was cumulating evidence of the inflammatory nature of the disease. Cyclophosphamide, azathioprine and methotrexate have been the most frequently employed drugs whereas other agents such as cyclosporine and cladribine have been recently tested for RRMS. Mithoxantrone, on the other hand, was approved by the FDA for treatment of aggressive forms of the disease. Other immunointerventions such as plasma exchange and autologous hematopoietic stem cell transplantation have recently been employed in some special circumstances. This paper analyses the most important published data on the use of the immunosuppressive agents, plasma exchange and autologous hematopoietic stem cell transplantation according to the classes of evidences and types of recommendations of these drugs and immunointerventions. It provides sufficient information to support the guidelines expressed in the BCTRIMS Expanded Consensus on Treatment of MS.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas/normas , Inmunosupresores/uso terapéutico , Esclerosis Múltiple/terapia , Intercambio Plasmático/normas , Medicina Basada en la Evidencia , Humanos , Trasplante AutólogoRESUMEN
There has been unprecedented advances in knowledge of multiple sclerosis (MS) in the last few years. A new set of criteria for its diagnosis and a bunch of recent clinical trials with disease-modifying agents (DMA) have been published. All of that has made it necessary to update and expand the previous consensus for MS treatment as formulated by the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS) two years ago. The BCTRIMS Expanded Consensus emphasizes the need to (1) consider MS treatment on an individual basis; (2) educate patients about the potential benefits and risks of treatment; (3) monitor drugs side effects; (4) have a signed Informed Consent Form; (5) consider the relative cost of the drug. The various clinical possibilities and the indications of the DMA and other immunointerventions are considered according to classes of evidences and types of recommendations. The BCTRIMS Expanded Consensus on Treatment of MS may turn out to be a model to other developing countries.
Asunto(s)
Medicina Basada en la Evidencia , Esclerosis Múltiple/tratamiento farmacológico , HumanosRESUMEN
PURPOSE: To describe headaches in patients with epilepsy and try to identify relations between epileptic seizures and headaches. METHODS: Cross-sectional study, with 304 patients from the epilepsy out-patient section of University Hospital of Federal University of Alagoas (Brazil) between February 2007 and February 2008. The presence of headaches and their relationships with the epileptic seizures were analyzed. RESULTS: Frequent seizures were associated with a greater tendency of occurrence of headaches (odds ratio=1.6 times, p=0.077). Headaches occurred in 66.1% of the cases. The highest occurrence was of migraine (32.9% of the patients), followed by tension-type headaches (9.2%). Two syndromes with a continuum epilepsy-migraine in the same seizure are worth mentioning: migralepsy in 6.6% and epilepgraine in 10.2% of the patients with epilepsy. CONCLUSIONS: A high prevalence of headaches in patients with epilepsy was observed, with emphasis on hybrid crises of epilepsy and migraine.
Asunto(s)
Epilepsia/epidemiología , Trastornos de Cefalalgia/epidemiología , Cefalea/epidemiología , Convulsiones/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
The aim of this study is to analyze executive function and motor symptoms in patients with idiopathic Parkinson's disease (PD). The sample consisted of 44 subjects with PD between the ages of 45 to 75, who were examined consecutively. The subjects were divided into two groups according to the duration of the disease. The control group was composed of spouses, family and accompanying members. Patients included were submitted to motor dysfunction evaluation using the UPDRS. The executive functions modalities analyzed included: operational memory, inhibitory control, planning, cognitive flexibility and inductive reasoning. Significant differences between the experimental and control groups were found in all the executive domains studied. Evidence of tremor, rigidity and bradykinesia correlation with executive dysfunction were not observed. Patients with PD, even in the initial phase of the disease, presented executive dysfunction. The cardinal motor signs of the disease were not correlated with the cognitive dysfunction found.
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Trastornos del Conocimiento/psicología , Discinesias/fisiopatología , Función Ejecutiva/fisiología , Enfermedad de Parkinson/psicología , Anciano , Atención/fisiología , Estudios de Casos y Controles , Trastornos del Conocimiento/fisiopatología , Femenino , Humanos , Inteligencia , Masculino , Memoria a Corto Plazo/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Enfermedad de Parkinson/fisiopatologíaRESUMEN
The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.
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Terapia Cognitivo-Conductual , Hipnóticos y Sedantes/uso terapéutico , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Enfermedad Aguda , Antidepresivos/uso terapéutico , Brasil , Enfermedad Crónica , Humanos , Sociedades MédicasRESUMEN
OBJECTIVE: The aim of this paper was to check the influence of obstructive sleep apnea (OSA) on obesity oxidative stress and CPAP (Continuous Positive Airway Pressure) effect on oxidative stress and in these patients. METHODS: Twenty nine male patients considered obese (BMI > 30 kg/m(2)) were divided into 3 groups: a) Group I: 10 OSA free patients (apnea-hipopnea index (AHI) < 5); b) Group 2: 10 with moderate to serious OSA (AHI > 20); c) Group 3: 9 with OSA from moderate to serious (AHI > 20) using CPAP, minimum 4 hours/night for 2 months. RESULTS: Significant differences before and after CPAP usage were observed in group 3 in the following variables: reduction of superoxide (SO) production [13.2 (10.3-19.6) vs. 10.5 (5.8-11.8) nmoles O2(-)/2 x 10(6) PMN] and increase in serum nitrite/nitrates levels [24.5 (16.7-33.5) vs. 49.5 (39.3-58.1) microM]. Positive correlation between Apnea-Hypopnea Index (AHI) and SO (r = 0,726) and negative correlation was observed between AHI and serum nitrite/nitrates levels (r = - 0.867). CONCLUSIONS: In conclusion, oxidative stress present in obesity is elevated by OSA and CPAP treatment can rise the levels of SO and can decrease serum nitrite/nitrates present in obese patients with OSA.
Asunto(s)
Obesidad/fisiopatología , Estrés Oxidativo/fisiología , Apnea Obstructiva del Sueño/fisiopatología , Índice de Masa Corporal , Presión de las Vías Aéreas Positiva Contínua , Humanos , Masculino , Persona de Mediana Edad , Nitratos/sangre , Nitritos/sangre , Obesidad/sangre , Polisomnografía , Apnea Obstructiva del Sueño/sangre , Apnea Obstructiva del Sueño/terapia , Superóxidos/sangreRESUMEN
É descrito um caso de hemicoreo-atetose aguda de etiologia vascular (hematomas da gânglia basal esquerda), seguido tardiamente por distonia de torçäo do tipo deformante e fixo durante o tratamento com butirofenoma, em uma paciente de 75 anos. A paciente era portadora de hipertensäo arterial e Diabetis mellitus, compensados clinicamente. O diagnóstico foi baseado na história clínica, exame neurológico e exames complementares (Radiografias do crânio, eletroencefalografia, líquido céfalo-raqueano e tomografia cerebral computadorizada)
Asunto(s)
Anciano , Humanos , Femenino , Atetosis/etiología , Corea/etiología , Hematoma/complicaciones , Atetosis/tratamiento farmacológico , Butirofenonas/uso terapéutico , Corea/tratamiento farmacológico , Haloperidol/uso terapéuticoRESUMEN
Foram estudados retrospectivamente 71 casos de polirradiculoneurites inflamatórias primitivas divididas em dois grupos: grupo I, 48 casos de polirradiculoneurite tipo Guillain-Barré e grupo II, 23 casos de polirradiculoneurite atípica, fora dos limites da conceituaçäo clássica de Guillain-Barré, sem dissociaçäo albumino-citológica (com hipercitose ou com líquido cefalorraquino normal) e/ou com sinais de comprometimento do sistema nervoso central. O material estudado corresponde ao decênio julho 74/junho 84. O estudo demonstrou que tanto as polirradiculoneurites tipo Guillain-Barré como as polirradiculoneurites atípicas tiveram um bom prognóstico em mais de 70% dos casos, näo havendo correlaçäo direta entre a intensidade das alteraçöes liquóricas e a evoluçäo clínica; o emprego da corticoidoterapia näo mostrou-se claramente efetivo na evoluçäo dos casos estudados nesta série