Influence of AIDS in collagen deposition and thickness of the bone marrow.

Bone marrow abnormalities are frequently observed in individuals with AIDS. Dysplasia, the most common abnormality, is found in more than 50% of patients infected with the HIV. The aim of this study was to assess trabecular thickness and collagen content as well as cellularity in the bone marrow of patients with AIDS. Sixty bone marrow samples were collected from the sternum of autopsied patients with or without AIDS (n = 30, each). Cellularity and trabecular thickness was assessed by performing hematoxylin-eosin staining; picrosirius staining was used to evaluate collagen content. Morphometric analyses were performed by using a Zeiss KS300 system (Kontron-Zeiss). Patients with AIDS showed a significant reduction in trabecular bone thickness and an increase in collagen deposition. No statistically significant differences were observed in cellularity between the 2 groups. Therefore, reduced thickness and increased collagen deposition were observed in the trabeculae of the bone marrow of patients with AIDS due to possible interaction between cytokines and bone marrow components.

Unruptured Myelomeningocele Closure Surgery: A Case Report.

Myelomeningocele (MMC) is an in-utero closure defect of the posterior portion of the neural tube, and it is the most common neural tube defect (NTD) compatible with life. It is usually associated with other congenital malformations, such as hydrocephalus and Chiari type 2 syndrome. Therefore, the long-term outcome depends on early repair, and the surgery is urgently scheduled. Newborns with MMC are a special population that requires meticulous preoperative preparation to maintain hemodynamic stability during the procedure and a favorable outcome. In this case report, we describe the challenges of unruptured myelomeningocele closure surgery in a newborn with 12 hours of life. This special case emphasizes the importance of a multidisciplinary approach between anesthesiologists, neurosurgeons, and plastic surgeons to provide the best care to this subset of patients.

Executive functions and functioning in women with fibromyalgia.

BACKGROUND: Fibromyalgia (FM) is a chronic condition characterized by widespread pain that is associated with sleep, emotional, and cognitive disturbances, including in executive functions (EFs). OBJECTIVE: To investigate the relationship between EFs and functionality in women with FM. METHODS: The study included 17 women with FM, aged between 30 and 59 years, with no history of neurological disease. The EFs were assessed using the Digit Span Subtest (DS), Five Digit Test, Trail Making Test (TMT), Corsi Block-Tapping Task, Hayling Test (HT), and Verbal Fluency Task. Functionality was evaluated through the Fibromyalgia Impact Questionnaire. The Beck Depression Inventory, Hamilton Anxiety Rating Scale, and Brief Pain Inventory were used to measure depression, anxiety, and pain, which were controlled in the statistical analyses. RESULTS: The FM patients showed longer response latency on the HT and TMT. They made fewer errors on part B of the HT, and they performed worse on the DS backward and on the Corsi Block-Tapping Task forward and backward. There were moderate correlations in the expected direction between performance on the Corsi Block-Tapping Task backward and interference at work, as well as between the time to complete part B of the Trail Making Test - B (TMT-B) and fatigue. An unexpected relationship was found between errors on part B of the HT and interference at work. CONCLUSION: The results suggest lower efficiency in processes such as inhibitory control and cognitive flexibility, difficulties in working memory and non-executive processes such as processing speed. Even with pain, anxiety, and depression controlled, some relationships between EFs and functionality were observed, indicating that these symptoms do not fully explain this relationship. We suggest that cognition, particularly EFs, and broader measures of functionality be considered in the evaluation of FM.

ANTECEDENTES: A fibromialgia (FM) é uma condição crônica caracterizada por dor generalizada, associada a distúrbios do sono, emocionais e cognitivos, entre os quais os das funções executivas (FEs). OBJETIVO: Investigar a relação entre FEs e funcionalidade em mulheres com FM. MéTODOS: O estudo incluiu 17 mulheres com FM, com idades entre 30 e 59 anos, sem histórico de doença neurológica. Para a avaliação das FEs, utilizou-se Subteste de Span de Dígitos (SD), o Teste dos Cinco dígitos, o Teste de Trilhas (TT), Tarefa dos Cubos de Corsi, O Teste de Hayling (TH), e a Tarefa de Fluência Verbal. A funcionalidade foi avaliada pelo Questionário de Impacto da Fibromialgia. O Inventário de Depressão de Beck, a Escala de Ansiedade Hamilton e o Inventário Breve de Dor foram usados para mensurar depressão, ansiedade e dor, que foram controladas nas análises estatísticas. RESULTADOS: Pacientes com FM apresentaram maior latência de resposta na TH e no TT. Elas cometeram menos erros na parte B da TH, e tiveram pior desempenho no SD em ordem inversa e na Tarefa dos Cubos de Corsi nas ordens direta e inversa. Houve relações moderadas, na direção esperada, entre a Tarefa dos Cubos de Corsi na ordem inversa e interferência no trabalho, assim como entre tempo até completar a parte B do Teste de Trilhas (TT) e fadiga. Encontrou-se uma relação inesperada entre erros na parte B da TH e interferência no trabalho. CONCLUSãO: Os resultados sugerem menor eficiência em processos como controle inibitório e flexibilidade cognitiva, dificuldades na memória de trabalho e em processos não executivos, como velocidade de processamento. Mesmo com controle da dor, da ansiedade e da depressão, houve algumas relações entre FEs e funcionalidade, o que indica que esses sintomas não explicam completamente essa relação. Sugere-se considerar a cognição, particularmente as FEs, e medidas mais abrangentes de funcionalidade na avaliação da FM.

Retinal abnormalities in a patient with cutis marmorata telangiectatica congenita.

Cutis marmorata telangiectatica congenita is a rare congenital vascular malformation characterised by cutaneous vascular abnormalities, typically diagnosed at birth or in the early postnatal period. Although typically benign, this disease is associated with other systemic abnormalities, including rare ocular alterations, such as congenital glaucoma, cataracts and retinopathy.This manuscript describes a female infant, who presented with generalised livedo reticularis, a band of alopecia and cutaneous atrophy in the temporal region above the coronal suture. The patient was diagnosed with cutis marmorata telangiectatica congenita by a paediatrician, and an ophthalmological evaluation was requested. A funduscopy examination in both eyes showed temporal and superior retina with avascular areas with new vessels, venous dilations and shunts, and no retinal detachments. Given these findings, we performed retinal photocoagulation laser treatment with excellent results.This case report highlights the importance of early ophthalmological evaluation of children with this disease to prevent secondary complications, such as vitreous haemorrhage and tractional retinal detachment.

Executive functions beyond the "Holy Trinity": A scoping review.

OBJECTIVE: Executive functions (EFs) are a multifaceted construct, important for several outcomes throughout life. The most commonly addressed executive components are inhibitory control, working memory, and cognitive flexibility. To map how other executive components are addressed conceptually and methodologically in the literature, a scoping review was carried out. METHOD: The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline was used. The database search (2017-2022) was carried out on the APA PsycInfo, Medline, Scopus, LILACS, and SciELO databases. A total of 3,473 articles were identified; 1,302 remained after screening. Given the large number of articles, a sample calculation was performed (95% CI and 5% error), with 297 articles randomly selected for full-text reading and 242 studies included for analysis. RESULTS: There was a predominance of health application studies in adults and older adults and in developed countries. There is relative conceptual consensus that EF are a multidimensional construct; however, there is no explicit identification of the theoretical model used in the studies. A diversity of EF was evidenced, which broadens the understanding of the construct, its assessment, and intervention targets. Furthermore, there was a variety of instruments used to assess these skills, with a predominance of performance tests, often with construct-instrument ambivalence between studies. CONCLUSIONS: The mapping showed a diversity of skills referred to as EF in addition to the core components and identified the instruments used in their assessment. Greater conceptual and structural clarity and greater methodological care are fundamental to support the assessment of EF and their intervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Safety and efficacy of repetitive stimulation of the left dorsolateral prefrontal cortex using transcranial focused ultrasound in treatment-resistant depressed patients: A non-inferiority randomized controlled trial protocol.

BACKGROUND: About 30% of patients diagnosed with major depressive disorder fail with the mainstream pharmacological treatment. Patients who do not achieve clinical remission of symptoms, even with two different antidepressants, are classified with treatment-resistant depression (TDR). This condition imposes an additional burden with increased Disability Adjusted Life Years. Therefore, complementary treatments, such as neuromodulation, are necessary. The transcranial focused ultrasound (tFUS) has emerged in the past few years as a reliable method for non-invasive neuromodulation in humans and may help treat TRD. This study aims to propose a research protocol for a non-inferiority randomized clinical trial of TDR with tFUS. METHODS: Patients with documented TRD will be screened upon entering the TRD outpatient clinic at UFMG (Brazil). One hundred patients without a clinical history of other psychiatric illness, anatomical abnormalities on magnetic resonance imaging (MRI), or treatment with electroconvulsive therapy will be invited to participate. Patients will be randomized (1:1) into two groups: 1) treatment with a previously established protocol of transcranial magnetic stimulation; and 2) treatment with a similar protocol using the stimulation. Besides regular consultations in the outpatient clinic, both groups will attend 7 protocolled spaced days of brain stimulation targeted at the left dorsolateral prefrontal cortex. They will also be submitted to 4 sessions of image studies (2 MRIs, 2 positron-emission tomography), 3 of neuropsychological assessments (at baseline, 1 week and 2 months after treatment), the Montgomery-Åsberg Depression Rating Scale to analyze the severity of depressive symptoms. DISCUSSION: This clinical trial intends to verify the safety and clinical efficacy of tFUS stimulation of the dorsolateral prefrontal cortex of patients with TRD, compared with a previously established neuromodulation method.

Articulation of cognitive-behavioral therapy and neuropsychology: A scoping review.

Cognitive-behavioral therapy (CBT) and neuropsychology are areas of psychology that have a common focus of interest on cognitive processing. The present study aimed to map and describe in a systematic way information about the association between CBT and neuropsychology by means of a scoping review. The systematic search for empirical articles published between 2010 and 2020, without language restriction, was carried out in the Medline, PsycInfo, LILACS, and SciELO databases. We found 3,723 articles, of which 198 were duplicates, which were excluded, and 3,525 articles went on to double-blind screening. For full text reading, we selected 323 articles, while 143 of them were selected for analysis. Results showed the characteristics, methodological aspects, and possible associations identified in the studies, which were as follows: neuropsychological assessment (NPA) and CBT assessment; NPA and CBT intervention; neuropsychological intervention and CBT intervention; and CBT strategy in neuropsychological intervention. The most used interventions were classic CBT, rehabilitation, and cognitive training, with the use of psychoeducation, cognitive restructuring, and problem solving, among others, applied, on the whole, to psychiatric and neurological conditions. We conclude that a greater understanding of the possible connections between the two areas can benefit patients from the psychiatric and neurological clinic.

Scaling-up of the adsorption process of ammonia nitrogen onto expanded vermiculite using fixed-bed columns.

Expanded vermiculite was used as an adsorbent to remove ammonia nitrogen from landfill leachate. Bench and pilot-scale adsorption experiments were performed with leachate collected from a closed sanitary landfill located in Curitiba, southern Brazil. At the bench-scale, two different heights of vermiculite and three different flow rates were tested using a fixed-bed column. These tests produced an average uptake capacity of 33.4 mg g-1 for the ammonia nitrogen concentration of 2,560 mg L-1. The Yan model was used to determine the breakthrough and the exhaustion times due to the best fit of the data to this model. At the pilot-scale, the flow rate was determined from the shortest length of the mass transfer zone obtained from bench-scale experiments. Tests were performed using one stainless-steel column filled with 26.2 kg of expanded vermiculite, which resulted in a bed height of 1.6 m. A leachate flow rate of approximately 350 L d-1 was applied to achieve the required contact time of 8.3 h. At this scale, an average uptake capacity of 18.1 mg g-1 was obtained for the ammonia nitrogen concentration of 1,193 mg L-1. It is worth mentioning that the flow rate and the concentration of the adsorbate in the feeding solution are fundamental to improve the operational time of the fixed-bed column. The main goal of this research was the determination of operating conditions to scale-up the adsorption process of ammonia nitrogen onto expanded vermiculite. The contact time was a key parameter to reach this goal.

Relations between theory of mind and family environment among Brazilian preschool children.

Given the importance of the environment for the development of the theory of mind (ToM) in childhood, as well as the scarcity of studies in low-income Latin American countries, we aimed to investigate the relation between family environment characteristics and performance in ToM tasks in a group of Brazilian children. A total of 49 children participated, whose ages ranged between 3 and 5 years (M = 4.43; SD = 0.71), all of whom attended a public kindergarten school located in the metropolitan region of São Paulo, Brazil, and took the Theory of mind test for children (TMTC). The observation of the characteristics of the family environment was conducted by using the Home Observation for Measurement of the Environment (HOME) instrument in the very home setting of each participating child. By controlling the effects of children's age, intelligence, vocabulary, and mother's and father's educational level, a consistent positive, significant, and low-magnitude correlation was found between HOME's Responsiveness subscale with the total score in TMTC. A robust regression analysis also showed that individual and contextual variables (above cited, plus sex) and Responsiveness accounted for 28.4% of ToM variance. This study corroborates previous findings on the relation between family aspects and ToM, specifically highlighting parents' responsiveness.

Is it possible to promote executive functions in university students? Evidence of effectiveness of the πFEx-Academics.

Executive functions (EF) impact the success of university students. These skills appear to have a predictive role in academic performance. The aim of this study was to investigate the effectiveness of an intervention program in EF aimed at university students, the πFex-Academics, seeking to verify whether there are gains in EF, a reduction in inattention and hyperactivity indicators and a transfer to reading comprehension. Participants were two professors and their respective classes, totaling 129 students. The classes were divided into: experimental group (EG) (n = 66) and control group (CG) (n = 63). All students underwent a pre- and post-intervention assessment. The program implementation process was mediated by the EG professor. Although no direct gains were identified in the indices of EF difficulties, greater gains in the EG were verified in the hyperactivity/impulsivity and reading comprehension indices, when compared to the CG. These findings are promising, demonstrating the first evidence of the effectiveness of the πFex-Academics. The incorporation of interventions into the university context can provide various benefits for students, with improved behavior and written language processing, necessary for the best possible academic success. Activities of EF mediation for higher education learning can be incorporated into extension courses or the curriculum of university courses.

Reporting characteristics of systematic reviews in Psychology: A scoping review.

This article describes the reporting characteristics of systematic reviews (SRs) in Psychology. The inclusion criteria were self-declared SRs in all branches of Psychology, published between 2019 and 2020. The search was performed in the PsycINFO and MEDLINE databases, from which 2487 records were identified, and 305 papers selected. There were many discrepancies in the reporting of Psychology SRs. Some PRISMA items, such as self-identification as an SR, description of the aim and the inclusion criteria, specification of the databases, and the description of the search and selection process using a flow diagram were reported in more than 90% of the SRs. Other items had lower coverage, such as the specification of the PICO framework, presentation of the complete search strategies, mention of the reporting guidelines, description of the exclusion criteria, performance of a risk of bias assessment, and analysis of the quality of the evidence, among others. The study highlights the need to improve the planning, performance and reporting of SR in Psychology.

Are adolescents more likely to have antenatal anxiety disorders than adult women? A comparison between two samples.

BACKGROUND: The literature reports that teenage pregnancy is considered a risk factor for anxiety disorders (ADs). However, research on this topic is limited. This study aimed to investigate if pregnant adolescents presented a greater likelihood of having ADs by comparing two samples of pregnant women in a southern city of Brazil. We also observed the prevalence rates of antenatal ADs among adolescents and adult women. METHODS: In this cross-sectional study, we evaluated 1852 women from two different studies: 995 pregnant adolescents attending prenatal care in the public health system (convenience sample) and 857 pregnant women from a population-based study. We used the Mini International Neuropsychiatric Interview (MINI Plus) to assess antenatal ADs, using the Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD) modules. The primary aim of this study was tested through multivariate analysis using Poisson regression. RESULTS: The prevalence of ADs was 11.0 % among pregnant adolescents and 13.8 % among adult pregnant women. Both samples presented similar rates of ADs (p = 0.065). In the adjusted analysis, maternal age did not predict antenatal ADs (PR = 0.97; p = 0.853). LIMITATIONS: Considering the particularities of each study where the samples came from, it was not possible to include other ADs such as panic disorder or phobias. CONCLUSIONS: Our findings suggest that pregnancy in adolescence does not increase the likelihood of antenatal ADs. However, we emphasize the importance of an adequate psychological screening and care in pregnancy in order to prevent possible psychiatric disorders.

Molecular and biological characterization of a new Brazilian begomovirus, euphorbia yellow mosaic virus (EuYMV), infecting Euphorbia heterophylla plants.

To date, no begomovirus has been fully characterized from Euphorbia heterophylla, a widely distributed weed, in Brazil. Here, we show the occurrence of a new begomovirus on E. heterophylla plants showing bright yellow mosaic. The bipartite viral genome was cloned from 10 samples, and all clones are almost identical to each other (95.6-98.8% nucleotide sequence identity). The DNA-A sequences shared a maximum nucleotide sequence identity of 87.3% with euphorbia mosaic Peru virus (EuMPV) and thus were classified as belonging to a novel begomovirus species, tentatively named Euphorbia yellow mosaic virus (EuYMV). The EuYMV DNA-B sequences share a maximum nucleotide sequence identity of 56.2% with a euphorbia mosaic virus (EuMV) isolate from Mexico. Phylogenetic analysis demonstrated that this new virus belongs to a different lineage than EuMV isolates from Central America.

The effect of different work-rest schedules on ergonomic risk in poultry slaughterhouse workers.

BACKGROUND: Rest breaks are an organizational measure to reduce the high risk of upper limb work-related musculoskeletal disorders (UL-WMSDs) to which slaughterhouse workers are subject. OBJECTIVE: To analyze the effect of different work-rest schedules on ergonomic risk in poultry slaughterhouse workers. METHODS: A total of 36 repetitive tasks was selected in a Brazilian slaughterhouse. Using the Occupational Repetitive Action (OCRA) Checklist, the level of exposure of workers to risk factors of UL-WMSDs in two work-rest schedules was evaluated. In the real condition, 6 rest breaks of 10 minutes were performed, and in the simulated condition, 3 rest breaks of 20 minutes. RESULTS: The right side of the body presented a higher score on the OCRA Checklist (72%of the tasks) than the left side (p = 0.037) in the real condition. Additionally, the OCRA score (18.3±2.5) was significantly lower (p < 0.001) than the simulated condition (21.9±3.0). It was verified that the risk level in simulated condition remained the same in 13 (36%) tasks, while in 23 (64%) tasks there was an increase in the risk level. CONCLUSIONS: Work-rest schedule of 6 breaks of 10 minutes was better than 3 breaks of 20 minutes to reduce the risk of UL-WMSDs in poultry slaughterhouse workers.

Millipore xMap® Luminex (HATMAG-68K): An Accurate and Cost-Effective Method for Evaluating Alzheimer's Biomarkers in Cerebrospinal Fluid.

Background: Alzheimer's disease (AD) biomarkers are of great relevance in clinical research, especially after the AT(N) framework. They enable early diagnosis, disease staging and research with new promising drugs, monitoring therapeutic response. However, the high cost and low availability of the most well-known methods limits their use in low and medium-income countries. In this context, Millipore xMap® Luminex may be a cost-effective alternative. In our study, using INNOTEST® as reference, we assess the diagnostic accuracy of Millipore xMap® and propose a cutoff point for AD. Methods: We performed lumbar puncture of seven older individuals with clinically defined AD, 17 with amnestic mild cognitive impairment (aMCI) and 11 without objective cognitive impairment-control group (CG). Cerebrospinal fluid (CSF) biomarkers concentrations for aB42, p-Tau, and t-Tau were measured by INNOTEST® and Millipore xMap®, and then the techniques were compared to assess the diagnostic accuracy of the new test and to define a cutoff. Results: INNOTEST® and Millipore xMap® measurements showed all correlations >0.8 for the same biomarker, except for t-Tau that was 0.66. Millipore xMap® measurements showed a robust accuracy for all biomarkers, with AUC higher than 0.808 (t-Tau), and the best for Aß42 (AUC = 0.952). The most accurate cutoffs were found at 1012.98 pg/ml (Aß42), 64.54 pg/ml (p-tau), 3251.81 pg/ml (t-tau), 3.370 (t-Tau/Aß42), and 0.059 (p-Tau/Aß42). Conclusion: Given its good accuracy and cost-effectiveness, Milliplex xMap® tests seems a reliable and promising tool, especially for low and middle-income countries.

Impact of neonatal anoxia and hypothermic treatment on development and memory of rats.

Therapeutic hypothermia (TH) is well established as a standard treatment for term and near-term infants. However, therapeutic effects of hypothermia following neonatal anoxia in very premature babies remains inconclusive. The present rodent model of preterm neonatal anoxia has been shown to alter developmental milestones and hippocampal neurogenesis, and to disrupt spatial learning and memory in adulthood. These effects seem to be reduced by post-insult hypothermia. Epigenetic-related mechanisms have been postulated as valuable tools for developing new therapies. Dentate gyrus neurogenesis is regulated by epigenetic factors. This study evaluated whether TH effects in a rodent model of preterm oxygen deprivation are based on epigenetic alterations. The effects of TH on both developmental features (somatic growth, maturation of physical characteristics and early neurological reflexes) and performance of behavioral tasks at adulthood (spatial reference and working memory, and fear conditioning) were investigated in association with the possible involvement of the epigenetic operator Enhancer of zeste homolog 2 (Ezh2), possibly related to long-lasting effects on hippocampal neurogenesis. Results showed that TH reduced both anoxia-induced hippocampal neurodegeneration and anoxia-induced impairments on risk assessment behavior, acquisition of spatial memory, and extinction of auditory and contextual fear conditioning. In contrast, TH did not prevent developmental alterations caused by neonatal anoxia and did not restore hippocampal neurogenesis or cause changes in EZH2 levels. In conclusion, despite the beneficial effects of TH in hippocampal neurodegeneration and in reversing disruption of performance of behavioral tasks following oxygen deprivation in prematurity, these effects seem not related to developmental alterations and hippocampal neurogenesis and, apparently, is not caused by Ezh2-mediated epigenetic alteration.

Depressive disorders in the elderly and dementia: An update.

The relationship between depressive disorders in the elderly and dementia, particularly Alzheimer's disease (AD), is highly complex. While the nature of this relationship is still a matter of debate, differential diagnosis and treatment remain a great clinical challenge. We review recent findings on the conundrum of depressive disorders in the elderly and AD. There is a biological continuum between depressive disorders in the elderly - or at least a subgroup of them - and AD. While elderly subjects with depression and patients with AD exhibit higher circulating levels of pro-inflammatory molecules and lower BDNF than matched controls, CSF levels of Aß42 can discriminate AD from depressive disorders in the elderly. The role of antidepressant treatment as a strategy to minimize the risk of AD remains to be established.

A relação entre transtornos depressivos em idosos e demência, particularmente a doença de Alzheimer (DA), é altamente complexa. Embora a natureza desse relacionamento ainda seja motivo de debate, o diagnóstico e o tratamento diferenciais continuam sendo um grande desafio clínico. Revisamos descobertas recentes sobre o dilema de transtornos depressivos em idosos e DA. Existe um contínuo biológico entre os transtornos depressivos em idosos ­ ou pelo menos um subgrupo deles ­ e a DA. Enquanto indivíduos idosos com depressão e pacientes com DA exibem níveis circulantes mais altos de moléculas pró-inflamatórias e menor BDNF do que os controles correspondentes, os níveis de Aß42 no LCR podem discriminar a DA de distúrbios depressivos em idosos. O papel do tratamento antidepressivo como estratégia para minimizar o risco de DA ainda precisa ser estabelecido.

Challenges in the diagnosis of dementia: insights from the United Kingdom-Brazil Dementia Workshop.

In July 2019, a group of multidisciplinary dementia researchers from Brazil and the United Kingdom (UK) met in the city of Belo Horizonte, Minas Gerais, Brazil, to discuss and propose solutions to current challenges faced in the diagnosis, public perception and care of dementia. Here we summarize the outcomes from the workshop addressing challenges in diagnosis. Brazil faces a major problem in dementia underdiagnosis, particularly involving the population in an adverse socioeconomic context. There is poor availability of resources and specialists, and the knowledge of general practitioners and other healthcare professionals is far from satisfactory. Low education level is a further obstacle in diagnosing dementia, as the most commonly used screening tests are not designed to evaluate this population. Patients and their families must overcome the stigma of a diagnosis of dementia, which is still prevalent in Brazil and increases the burden of this condition. Whilst the UK has greater resources, dedicated memory services and a National Dementia Strategy plan, the National Health Service (NHS) has limited funding. Therefore, some challenges regarding diagnosis are common across both countries. The authors suggest possible solutions to confront these, with the goal of improving assessment and recognition of dementia and reducing misdiagnosis.

Em julho de 2019, um grupo multidisciplinar de pesquisadores em demência do Brasil e do Reino Unido se reuniu em Belo Horizonte para discutir e propor soluções para os desafios no diagnóstico, percepção pública e tratamento dessa condição. Neste artigo, sintetizamos as conclusões do workshop sobre os desafios no diagnóstico de demência. O Brasil enfrenta um grande problema no subdiagnóstico de demência, principalmente entre a população em condições socioeconômicas adversas. Há pouca disponibilidade de recursos e de especialistas e o conhecimento de médicos generalistas e de outros profissionais de saúde é pouco abrangente. Baixa escolaridade é também um obstáculo no diagnóstico de demência, uma vez que os testes de rastreio mais utilizados na prática clínica não são estruturados para avaliar a população com esse perfil. Os pacientes com demência e suas famílias ainda têm que superar o estigma do diagnóstico, que é ainda muito prevalente no Brasil e colabora para a piora da qualidade de vida. O Reino Unido, por outro lado, dispõe de mais recursos financeiros e de pessoal, possui serviços dedicados à avaliação de problemas de memória e um plano estratégico nacional para demência. Contudo, o National Health Service (NHS) tem verbas limitadas, o que faz com que alguns dos desafios no diagnóstico de demência sejam comuns aos dois países. Os autores sugerem possíveis soluções para enfrentá-los, com o objetivo de melhorar a avaliação e o reconhecimento da demência e reduzir os erros de diagnóstico.

Cytokine, Genotype, and Viral Load Profile in the Acute and Chronic Hepatitis B.

Several hepatitis B virus (HBV) factors, including viral load, genotype, genome mutations, and cytokine production, have been reported to be associated with different risks of progression of liver disease. The aim of this study was to verify if there is an association among the levels of cytokines (interleukin [IL]-35, IL-6, IL-17A, interferon [IFN]-γ) in the plasma, viral load, and the different genotypes of HBV in patients with acute or chronic hepatitis B. Methods: 49 serum samples, 20 from acute and 29 from chronic cases, were submitted to a real-time and nested-polymerase chain reaction to quantify, detect, and genotype HBV DNA. The cytokines IL-35, IL-6, IL-17A, and IFN-γ were detected by an enzyme-linked immunosorbent assay (ELISA). The median viral load was 3.15 log10 IU DNA/mL and 2.90 log10 IU DNA/mL for acute and chronic patients, respectively. Genotype A, D, E, and F were identified in chronic carriers of HBV infection, while only genotype A and F were identified in individuals with acute infection. IFN-γ (p = 0.024) and IL-17A (p = 0.046) levels were significantly increased in chronic patients and IL-6 and IL-35 were higher in patients with acute infection, however, without statistical difference. IL-17A and IFN-γ can be modulating proinflammatory effects and inducing hepatocellular damage, in chronic patients, and IL-6 and IL-35 may be involved in viral elimination and protection against chronicity during the acute phase of infection. These results can contribute to understanding of the complex regulatory mechanisms of the host antiviral response related to cytokine production during acute and chronic HBV infection.