Carotid Intima-Media Thickness and Cardiometabolic Profile in Turner Syndrome: A Cross-Sectional Study.

INTRODUCTION: Turner syndrome (TS), one of the most common chromosomal abnormalities in females, often results in adult cardiovascular and metabolic complications. Information on pediatric age is scarce. This study aimed to compare the presence of cardiometabolic risk factors in children with TS and healthy controls. METHODS: This is a cross-sectional study comparing patients with TS to age-matched healthy controls, regarding cardiometabolic risk factors including lipid profile, fasting glucose, insulin resistance, body composition, body mass index, blood pressure, and carotid intima-media thickness (cIMT). RESULTS: We included nine TS patients and nine controls with a median age of 13 years (9-14 years). Three TS patients and three controls were prepubertal. All TS patients received growth hormone treatment (GHT), median treatment of six years (3-10 years); four patients underwent treatment with estradiol. No statistically significant differences were detected between TS patients and controls regarding body mass index (BMI), cholesterol levels, and insulin resistance. cIMT indexed to body surface area showed no significant differences between TS patients and controls (0.37 vs 0.35 mm/m2, respectively, p=0.605). TS patients had lower body fat levels (7.2% vs 34.9%, p=0.004). On the other hand, TS patients had higher levels of systolic (z-score 1.04 vs -0.08, p=0.001) and diastolic (z-score 1.08 vs 0.33, p=0.031) blood pressure (BP) and aspartate (AST) and alanine (ALT) aminotransferase levels (26 vs 20 U/L, p=0.008 and 19 vs 14 U/L, p=0.004, respectively). CONCLUSION: Patients with TS, all submitted to GHT, had lower body fat levels compared with controls, despite similar BMI. Although we found no differences in cIMT between the two groups, young girls with TS had higher BP and transaminase levels. Early anthropometric, cardiovascular, and analytical monitoring of patients with TS is essential to detect abnormalities and prevent further complications.

Telemonitoring of pediatric asthma in outpatient settings: A systematic review.

Telemonitoring technologies are rapidly evolving, offering a promising solution for remote monitoring and timely management of asthma acute episodes. We aimed to describe current pediatric asthma telemonitoring technologies. A systematic review was conducted until September 2023 on Medline, Scopus, and Web of Science. We included studies of children (0-18 years) with asthma or recurrent wheezing whose respiratory condition was telemonitored outside the healthcare setting. A narrative synthesis was performed. We identified 40 telemonitoring technologies described in 40 studies. The more frequently used technologies for telemonitoring were mobile applications (n = 21) and web-based systems (n = 14). Telemonitoring duration varied between 2 weeks and 32 months. Data collection included asthma symptoms (n = 30), patient-reported outcome measures (PROMs) (n = 11), spirometry/peak flow readings (n = 20), medication adherence (n = 17), inhaler technique (n = 3), air quality (n = 2), and respiratory sounds (n = 2). Both parents and children were the technology target users in most studies (n = 23). Technology training was reported in 23 studies of which 3 provided ongoing support. Automatic feedback was found in 30 studies, mostly related with asthma control. HCP were involved in data management in 27 studies. Technologies were tested in samples from 4 to 327 children, with most studies including school-aged children and/or adolescents (n = 38) and eight including preschool children. This review provides an overview of existing technologies for the outpatient telemonitoring of pediatric asthma. Specific technologies for preschool children represent a gap in the literature that needs to be specifically addressed in future research.

Quality of Life and Hormonal Impairment in Pediatric Patients With Craniopharyngiomas.

INTRODUCTION: Craniopharyngiomas (CP) are tumors in the sellar region that, despite a high survival rate, are associated with significant morbidity, including hypothalamic, hormonal, and visual dysfunction. This study aimed to assess the quality of life (QoL) in pediatric patients with CP and to evaluate its relationship with various factors, with a focus on the impact of endocrine dysfunction. METHODS: In this observational cross-sectional study, patients with CP aged between 0 and 18 years, currently followed up in a tertiary hospital by a multidisciplinary team, were included. QoL was assessed using the validated PEDS-QL4.0 questionnaire, which was administered to parents. This tool estimates Global QoL (QoL-G), further divided into Physical (QoL-P) and Psychosocial (QoL-PS) dimensions, including Emotional (QoL-Em), Social (QoL-S), and School (QoL-Sc) aspects. In Portugal, the estimated average QoL-G is 79.8, QoL-P is 83.5, and QoL-PS is 78.2. Variables studied included gender, current and diagnostic age, follow-up time, presence of hydrocephalus, hypothalamic involvement, type of resection (total or subtotal), radiotherapy, visual impairment, hormonal deficits, and therapy. RESULTS: The study included 11 patients with a median age of 15.2 years (interquartile ratio (IQR), 9.7-17.9 years) and a mean age at diagnosis of 9.3±4.1 years. Of these patients, 54.5% were male, and 36.4% were obese. Subtotal resection was performed in 72.7% of cases. Hydrocephalus was present in 54.5% of the patients, hypothalamic involvement in 63.7%, radiotherapy was received by 81.8%, and visual impairment was noted in 54.5%. All patients presented with at least one hormonal deficit. The average QoL-G was 69.9±22.5, with QoL-P at 66.9±30.0 and QoL-PS at 70.9±21.4. A worse QoL-S was associated with female gender (p=0.030) and subtotal resection (p=0.048). Worse QoL-G, QoL-P, QoL-Em, and QoL-PS were linked to hypothalamic involvement (p values 0.008, 0.025, 0.015, and 0.009, respectively). Irradiated patients had worse QoL-G (p=0.006). Treatment with sexual hormones enhanced QoL-Global (p=0.035) and QoL-Emotional (p=0.020), while treatment for adrenal insufficiency and diabetes insipidus improved QoL-Emotional (p=0.021 and p=0.013). No significant associations with visual deficit or obesity were found. CONCLUSIONS: Pediatric patients with CP appear to have poorer QoL-G, QoL-P, and QoL-PS compared to the healthy Portuguese population. However, the small sample size limits statistically significant associations with many of these variables. Predictors of worse QoL include female gender, hypothalamic involvement, subtotal resection, and radiotherapy. The results may be biased due to the small sample size, questionnaire administration to parents, and possible inadequacy of the questionnaire for the studied population. There is a need for a more suitable tool to enable a more precise assessment of QoL in these patients.

Cross-sectional assessment of mild cognitive impairment in pre-dialysis chronic kidney disease and its association with inflammation and changes seen on MRI: what the eyes cannot see / Avaliação transversal do comprometimento cognitivo leve em doença renal crônica pré-dialítica e associação com inflamação e alterações na ressonância magnética: o que os olhos não veem

Abstract Introduction: Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation. Objective: To evaluate the association of MCI in CKD stages 1-5 using inflammatory markers and changes by magnetic resonance imaging (MRI). Patients and Methods: Cross-sectional study in adult patients with pre-dialysis CKD. MCI was assessed by the Montreal Cognitive Assessment (MoCA) and the estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration equation. Sociodemographic and clinical data were collected from medical records. The cytokines IL-4, IL-6, IL-17, TNF-α and hs-CRP were determined. Brain MRI was performed in a 1.5 Tesla device, without paramagnetic contrast. A descriptive analysis followed by a comparison of abnormal versus normal MoCA scores among all studied variables. A linear regression analysis was performed using MoCA as a dependent variable, adjusted for confounding factors. Results: Of 111 invited patients, eighty completed the neuropsychological assessment and 56 underwent MRI, and were included in the study. Mean age was 56.3 ± 8.3 years and 51.8% (n = 29) had altered MoCA. When compared to the group with normal MoCA, the group with altered MoCA had higher levels of IL-6 and IL-17. There was no correlation between altered MoCA with eGFR or with MRI abnormalities. Conclusão: MCI assessed by MoCA was prevalent in patients with pre-dialysis CKD, it was associated with inflammation and showed no correlation with MRI changes.

Resumo Introdução: O comprometimento cognitivo leve (CCL) é prevalente e subdiagnosticado na doença renal crônica (DRC), condição com a qual compartilha fatores fisiopatológicos como a inflamação crônica. Objetivo: Avaliar a associação do CCL na DRC estágios 1 a 5, com marcadores inflamatórios e alterações de exames de imagem por ressonância magnética (RM). Pacientes e métodos: Estudo transversal em pacientes adultos, com DRC pré-dialítica. CCL foi avaliado pelo Montreal Cognitive Assessment (MoCA) e a taxa de filtração glomerular estimada (TFGe), pela equação do CKD-EPI. Dados sociodemográficos e clínicos foram coletados nos prontuários médicos. Dosadas citocinas IL-4, IL-6, IL-17, o TNF-α e PCR-us. A RM do encéfalo foi realizada em aparelho de 1,5 Tesla, sem contraste. Realizada análise descritiva seguida por comparação de pontuações do MoCA anormais versus normais entre todas as variáveis estudadas. A regressão linear foi realizada usando MoCA como uma variável dependente, ajustada para fatores de confusão. Resultados: De 111 pacientes convidados, oitenta completaram a avaliação neuropsicológica, 56 realizaram RM, tendo sido incluídos no estudo. A média de idade foi de 56,3 ± 8,3 anos e 51,8% (n = 29) apresentavam MoCA alterado. Quando comparado ao grupo MoCA normal, o grupo MoCA alterado apresentou níveis mais elevados de IL-6 e IL-17. Não houve correlação entre MoCA alterado com TFGe nem com anormalidades na RM. Nos modelos ajustados, a IL-6 foi preditor independente do MoCA alterado Conclusão: O CCL avaliado pelo MoCA foi prevalente em pacientes com DRC pré-dialítica, associou-se com inflamação e não apresentou correlação com alterações da RM.

Optical coherence tomography in neurodegenerative disorders.

BACKGROUND: Structural imaging of the brain is the most widely used diagnostic tool for investigating neurodegenerative diseases. More advanced structural imaging techniques have been applied to early or prodromic phases, but they are expensive and not widely available. Therefore, it is highly desirable to search for noninvasive, easily accessible, low-cost clinical biomarkers suitable for large-scale population screening, in order to focus on making diagnoses at the earliest stages of the disease. In this scenario, imaging studies focusing on the structures of the retina have increasingly been used for evaluating neurodegenerative diseases. The retina shares embryological, histological, biochemical, microvascular and neurotransmitter similarities with the cerebral cortex, thus making it a uniquely promising biomarker for neurodegenerative diseases. Optical coherence tomography is a modern noninvasive imaging technique that provides high-resolution two-dimensional cross-sectional images and quantitative reproducible three-dimensional volumetric measurements of the optic nerve head and retina. This technology is widely used in ophthalmology practice for diagnosing and following up several eye diseases, such as glaucoma, diabetic retinopathy and age-related macular degeneration. Its clinical impact on neurodegenerative diseases has raised enormous interest over recent years, as several clinical studies have demonstrated that these diseases give rise to reduced thickness of the inner retinal nerve fiber layer, mainly composed of retinal ganglion cells and their axons. In this review, we aimed to address the clinical utility of optical coherence tomography for diagnosing and evaluating different neurodegenerative diseases, to show the potential of this noninvasive and easily accessible method.

Cross-sectional assessment of mild cognitive impairment in pre-dialysis chronic kidney disease and its association with inflammation and changes seen on MRI: what the eyes cannot see.

INTRODUCTION: Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation. OBJECTIVE: To evaluate the association of MCI in CKD stages 1-5 using inflammatory markers and changes by magnetic resonance imaging (MRI). PATIENTS AND METHODS: Cross-sectional study in adult patients with pre-dialysis CKD. MCI was assessed by the Montreal Cognitive Assessment (MoCA) and the estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration equation. Sociodemographic and clinical data were collected from medical records. The cytokines IL-4, IL-6, IL-17, TNF-α and hs-CRP were determined. Brain MRI was performed in a 1.5 Tesla device, without paramagnetic contrast. A descriptive analysis followed by a comparison of abnormal versus normal MoCA scores among all studied variables. A linear regression analysis was performed using MoCA as a dependent variable, adjusted for confounding factors. RESULTS: Of 111 invited patients, eighty completed the neuropsychological assessment and 56 underwent MRI, and were included in the study. Mean age was 56.3 ± 8.3 years and 51.8% (n = 29) had altered MoCA. When compared to the group with normal MoCA, the group with altered MoCA had higher levels of IL-6 and IL-17. There was no correlation between altered MoCA with eGFR or with MRI abnormalities. CONCLUSÃO: MCI assessed by MoCA was prevalent in patients with pre-dialysis CKD, it was associated with inflammation and showed no correlation with MRI changes.

Optical coherence tomography in neurodegenerative disorders / Tomografia de coerência óptica em doenças neurodegenerativas

ABSTRACT Structural imaging of the brain is the most widely used diagnostic tool for investigating neurodegenerative diseases. More advanced structural imaging techniques have been applied to early or prodromic phases, but they are expensive and not widely available. Therefore, it is highly desirable to search for noninvasive, easily accessible, low-cost clinical biomarkers suitable for large-scale population screening, in order to focus on making diagnoses at the earliest stages of the disease. In this scenario, imaging studies focusing on the structures of the retina have increasingly been used for evaluating neurodegenerative diseases. The retina shares embryological, histological, biochemical, microvascular and neurotransmitter similarities with the cerebral cortex, thus making it a uniquely promising biomarker for neurodegenerative diseases. Optical coherence tomography is a modern noninvasive imaging technique that provides high-resolution two-dimensional cross-sectional images and quantitative reproducible three-dimensional volumetric measurements of the optic nerve head and retina. This technology is widely used in ophthalmology practice for diagnosing and following up several eye diseases, such as glaucoma, diabetic retinopathy and age-related macular degeneration. Its clinical impact on neurodegenerative diseases has raised enormous interest over recent years, as several clinical studies have demonstrated that these diseases give rise to reduced thickness of the inner retinal nerve fiber layer, mainly composed of retinal ganglion cells and their axons. In this review, we aimed to address the clinical utility of optical coherence tomography for diagnosing and evaluating different neurodegenerative diseases, to show the potential of this noninvasive and easily accessible method.

RESUMO A avaliação estrutural do cérebro, feita por meio dos exames de neuroimagem, é a forma mais utilizada de ferramenta diagnóstica e de acompanhamento das doenças neurodegenerativas. Técnicas de imagem mais sofisticadas podem ser necessárias especialmente nas fases mais precoces, antes mesmo do surgimento de quaisquer sintomas, porém costumam ser caras e pouco acessíveis. Sendo assim, é de fundamental importância a busca de biomarcadores não invasivos, de fácil acesso e baixo custo, que possam ser utilizados para rastreio populacional e diagnóstico mais precoce. Nesse cenário, o número de estudos com ênfase em técnicas de imagem para avaliação estrutural da retina em pacientes com doenças neurodegenerativas tem aumentado nos últimos anos. A retina apresenta similaridade embriológica, histológica, bioquímica, microvascular e neurotransmissora com o córtex cerebral, tornando-se assim um biomarcador único e promissor nas doenças neurodegenerativas. A tomografia de coerência óptica é uma moderna técnica de imagem não invasiva que gera imagens seccionais bidimensionais de alta resolução e medidas volumétricas tridimensionais reprodutivas do disco óptico e da mácula. Essa tecnologia é amplamente utilizada na prática oftalmológica para o diagnóstico e o seguimento de diversas doenças oculares, como glaucoma, retinopatia diabética e degeneração macular relacionada à idade. A redução da espessura da camada de fibras nervosas da retina e das camadas de células ganglionares em pacientes com doenças neurodegenerativas foi demonstrada em diversos estudos clínicos nos últimos anos. Nesta revisão, abordamos as principais aplicações clínicas da tomografia de coerência óptica nas doenças neurodegenerativas e discutimos o seu papel como potencial biomarcador nessas afecções.

Reativação da BCG após vacina contra COVID-19: relato de caso / BCG reactivation after COVID-19 vaccine: case report

A reativação da BCG pode ocorrer em diversos contextos: associada a quadros infecciosos, imunossupressão, autoimunidade e pós-vacinações. Além disso, especialmente em crianças abaixo de 5 anos de idade, deve ser valorizada como um achando presente em cerca de 50% dos casos de Doença de Kawasaki. Neste artigo, relatamos o primeiro caso publicado na literatura de uma paciente adulta jovem, a qual manifestou uma reativação de BCG após receber a primeira dose de vacina contra COVID-19 (AztraZeneca/Oxford/Biomanguinhos). Dentro das primeiras 24h após a administração da vacina, a paciente desenvolveu febre alta, sudorese, dor local, mialgia difusa e cefaleia. Após dois dias, iniciou eritema e enduração no local da cicatriz da vacina BCG. Ela tem como comorbidade a urticária crônica espontânea, porém estava assintomática sem crises há mais de 1 ano. Tem como antecedente familiar relevante o óbito materno por síndrome complexa de sobreposição de autoimunidade (lúpus eritematoso sistêmico, síndrome de Sjögren e síndrome do anticorpo antifosfolípide). Após ser medicada com anti-inflamatórios não esteroides (AINE) e corticoterapia tópica de moderada potência por 3 dias, houve resolução completa da reativação da BCG. A paciente, após 3 meses, recebeu a segunda dose da vacina e não manifestou nenhum sintoma. Acredita-se que a reativação da BCG ocorra devido a um mecanismo de reação cruzada entre HSP do indivíduo, elicitadas como mediadores da imunidade inata frente à inflamação vacinal, com alguns epítopos do M. bovis. Recomendase que seja investigada alguma condição imunossupressora ou autoimune nos pacientes que manifestem reativação da BCG, principalmente em adultos, na qual a doença de Kawasaki é bastante rara. As vacinas, incluindo as contra COVID-19, também podem desencadear o surgimento deste fenômeno imunológico ainda pouco compreendido.

BCG reactivation can occur in different contexts: associated with infectious conditions, immunosuppression, autoimmunity and post-vaccinations. Also, especially in children below of 5 years of age, should be valued as a finding present in about 50% of cases of Kawasaki disease. In this article, we report the first case published in the literature of a young adult patient, who manifested a reactivation of BCG after receiving the first dose of vaccine against COVID-19 (AztraZeneca/Oxford/Biomanguinhos). Within the first 24 hours after the administration of the vaccine, the patient developed high fever, sweating, local pain, diffuse myalgia and headache. After 2 days, erythema and induration at the site of the BCG vaccine scar began. she has how comorbidity to chronic spontaneous urticaria, but she was asymptomatic without crises for more than 1 year. The relevant family history is maternal death due to the complex syndrome of autoimmunity overlap (systemic lupus erythematosus, Sjögrens syndrome, and anti-phospholipid antibody). After being medicated with NSAID and moderate topical corticosteroid therapy potency for 3 days, there was complete resolution of BCG reactivation. The patient, after 3 months, received the 2nd dose of the vaccine and had no symptoms. It is believed that the reactivation of BCG occurs due to a cross-reaction mechanism between the individuals HSP, elicited as mediators of innate immunity against vaccine inflammation, with some epitopes of M. bovis. It is recommended that any immunosuppressive or autoimmune condition be investigated in patients that manifest BCG reactivation, especially in adults, in which Kawasaki disease is quite rare. Vaccines, including those against COVID-19, can also trigger of this immunological phenomenon still poorly understood.

Objective evaluation of immediate reading skin prick test applying image planimetric and reaction thermometry analyses.

The skin prick test is used to diagnose patients' sensitization to antigens through a mediated IgE response. It is a practical and quick exam, but its diagnosis depends on instruments for measuring the allergic response and observer's interpretation. The conventional method for inferring about the allergic reaction is performed from the dimensions of the wheals, which are measured using a ruler or a caliper. To make this diagnosis less dependent on human interpretation, the present study proposes two alternative methods to infer about the allergic reaction: computational determination of the wheal area and a study of the temperature variation of the patient's skin in the puncture region. For this purpose, prick test using histamine was performed on 20 patients randomly selected. The areas were determined by the conventional method using the dimensions of the wheals measured with a digital caliper 30 min after the puncture. The wheal areas were also determined by a Python algorithm using photographs of the puncture region obtained with a smartphone. A variable named circularity deviation was also determined for each analyzed wheal. The temperature variation was monitored using an infrared temperature sensor, which collected temperature data for 30 min. All results were statistically compared or correlated. The results showed that the computational method to infer the wheal areas did not differ significantly from the areas determined by the conventional method (p-value = 0.07585). Temperature monitoring revealed that there was a consistent temperature increase in the first minutes after the puncture, followed by stabilization, so that the data could be adjusted by a logistic equation (R2 = 0.96). This adjustment showed that the optimal time to measure the temperature is 800 s after the puncture, when the temperature stabilization occurs. The results have also shown that this temperature stabilization has a significant positive correlation with wheal area (p-value = 0.0015). Thus, we concluded that the proposed computational method is more accurate to infer the wheal area when compared to the traditional method, and that the temperature may be used as an alternative parameter to infer about the allergic reaction.

Relato de experiência: Dia Mundial do Acidente Vascular Cerebral / Experience report: World Stroke Day

Introdução: O Acidente Vascular Cerebral (AVC) é uma das maiores causas de morte e incapacidade adquirida em todo o mundo. Além da alta mortalidade, o AVC é um importante causador de déficits neurológicos irreversíveis que necessitam de reabilitação, sendo que aproximadamente 70% dos pacientes não retomarão ao seu trabalho e 30% necessitarão de auxílio para caminhar. Entender o perfil epidemiológico e a contribuição de cada fator de risco é essencial para estabelecer políticas locais específicas para diminuir a incidência da doença e prevalência de complicações que ocorrem devido ao AVC, tanto para o bem-estar a curto e a longo prazo da população. A prevenção pode ser feita em até 90% dos casos de AVC, visto que estes podem ser atribuídos a fatores de risco modificáveis. Objetivo: Conscientizar e orientar a população da cidade de Juiz de Fora, Minas Gerais acerca dos fatores de risco modificáveis do AVC e, consequentemente, sobre sua prevenção. Relato de experiência: No mês de outubro de 2018 foram realizadas palestras educativas e orientações a respeito do AVC e seus fatores de risco. Além disso, os pacientes do serviço de Neurologia, seus acompanhantes e transeuntes locais tiveram dois dos fatores de risco modificáveis associados ao AVC avaliados: a pressão arterial sistêmica e a circunferência abdominal. Aqueles com alterações foram orientados e encaminhados a procurar um serviço específico. Conclusão: A educação da população sobre as formas de prevenção de doenças cardiovasculares, em especial o acidente vascular cerebral, que é uma doença conhecida por apresentar tantos fatores causais modificáveis, é essencial para evitar o aumento da incidência dessas patologias tão prevalentes no país.

Introduction: Stroke is one of the most prevalent causes of death and acquired inability all over the world. Besides the high rates of mortality, stroke is an important cause of neurologic deficits that will need rehabilitee, since 70% of the patients will not come back for their work and 30% will need help to walk. Understand the epidemiology profile and the contribution of any risk factor is essential to establish specific local politics in order to lower the incidence and complication rates, not only in short term but also in long term. Prevention can be made at 90% cases of stroke, since these cases are attributed to modifiable risk factors. Objective: Guide and alert Juiz de Fora's population about changeable risk factors and prevention of stroke. Experience report: During the final week of October we made educative speeches and offer some guidance about stroke and his modifiable risk factors. Furthermore, the neurology patients, their companions and local people, had their blood pressure assessed, as so as their abdominal circumference. Those with some alteration were guided to look for specific medical support. Conclusion: Education about cardiovascular diseases prevention, in special stroke, which is known for having so many modifiable risk factors, is essential to avoid the incidence of these pathology to increase.

The role of optical coherence tomography in Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) is the most common cause of dementia and its incidence is increasing worldwide along with population aging. Previous clinical and histologic studies suggest that the neurodegenerative process, which affects the brain, may also affect the retina of AD patients. MAIN BODY: Optical coherence tomography (OCT) is a non-invasive technology that acquires cross-sectional images of retinal structures allowing neural fundus integrity assessment. Several previous studies demonstrated that both peripapillary retinal nerve fiber layer and macular thickness measurements assessed by OCT were able to detect neuronal loss in AD. Moreover, recent advances in OCT technology, have allowed substantial enhancement in ultrastructural evaluation of the macula, enabling the assessment not only of full-thickness retinal measurements but also of inner retinal layers, which seems to be a promising approach, mainly regarding the assessment of retinal ganglion cell layer impairment in AD patients. Furthermore, retinal neuronal loss seems to correlate with cognitive impairment in AD, reinforcing the promising role of OCT in the clinical evaluation of these patients. CONCLUSION: The purpose of this article is to review the main findings on OCT in AD patients, to discuss the role of this important diagnostic tool in these patients and how OCT technology may be useful in understanding morphological retinal changes in AD.

Montreal Cognitive Assessment (MoCA) screening mild cognitive impairment in patients with chronic kidney disease (CKD) pre-dialysis.

INTRODUCTION: Individuals with chronic kidney disease (CKD) are at higher risk of developing cognitive impairment (CI), initially mild (MCI), potentially identifiable, but still poorly diagnosed and treated. The Montreal Cognitive Assessment (MoCA) has been indicated for MCI screening in CKD. OBJECTIVE: To assess MCI in patients with CKD not yet on dialysis. METHODS: Study conducted in 72 non-elderly subjects with pre-dialysis CKD. The neuropsychological assessment included: The global cognitive assessment test MoCA; the clock drawing (CD); the digit span forward (DSF) and reverse (DSR); phonemic verbal (VF) fluency (FAS) and semantics (animals); the fist-edge-palm (FEP); and the memory 10 pictures. RESULTS: The average age of the participants was 56.74 ± 7.63 years, with predominance of male sex (55.6%), mainly with ≥ 4 years of education (84.3%), with CKD cathegories 1, 2 and 3a and 3b (67.6%), hypertension (93.1%) and diabetes mellitus (52.1%). MCI (MoCA ≤ 24) was observed in 73.6% of the patients. We did not find association among MCI with demographic and clinical variables, but a tendency to association with age (p = 0.07), educational level (p= 0.06) and diabetes (0.06). The executive function tests CD, DS-reverse and FEP, individually were able to identify CI with good sensibility and negative predictive value compared to MoCA and together, showed the same capability to identify MCI when compared to MoCA. CONCLUSION: The MCI is common in non-elderly patients with CKD not yet on dialysis. Together, the CD, DSR and FEP showed similar performance in identify MCI in this population when compared to MoCA, suggesting impairment of executive functions.

Macular Thickness Measurements with Frequency Domain-OCT for Quantification of Retinal Neural Loss and its Correlation with Cognitive Impairment in Alzheimer's Disease.

PURPOSE: To evaluate the ability of frequency domain optical coherence tomography (fd-OCT) to estimate retinal neural loss in eyes with Alzheimer's disease (AD). We also verified the existence of a correlation between AD-related cognitive impairment and macular and peripapillary retinal nerve fiber layer (RNFL) thickness measurements. METHODS: fd-OCT scans were obtained from 45 eyes of 24 patients with AD and 48 control eyes. Peripapillary RNFL, macular full-thickness and segmented inner macular thickness parameters were calculated. The inner macular parameters included macular retinal nerve fiber layer (mRNFL) thickness, ganglion cell layer (GCL) plus inner plexiform layer thickness (GCL+), and RNFL plus GCL+ thickness (GCL++). The Mini-Mental State Examination (MMSE) was used to assess cognition in all subjects. The two groups were compared and the relationship between MMSE scores and fd-OCT measurements was verified. RESULTS: Average, superior and inferior quadrant RNFL thickness parameters and all but one of the nine full-thickness macular measurements were significantly reduced in AD patients compared to controls. The segmented layers, GCL+ and GCL++ were significantly reduced in AD eyes. A significant correlation was found between most fd-OCT parameters (especially macular thickness measurements) and MMSE scores. CONCLUSIONS: Most fd-OCT peripapillary RNFL and macular full-thickness and segmented inner retinal layers parameters were reduced in AD eyes compared to controls. Moreover, neuronal loss, especially as reflected in macular parameters, correlated well with cognitive impairment in AD. Our results suggest that fd-OCT could be a potentially useful diagnostic tool in the evaluation and follow-up of AD patients.

Montreal Cognitive Assessment (MoCA) no rastreio de comprometimento cognitivo leve (CCL) em pacientes com doença renal crônica (DRC) pré-dialítica / Montreal Cognitive Assessment (MoCA) screening mild cognitive impairment in patients with chronic kidney disease (CKD) pre-dialysis

Resumo Introdução: Indivíduos com doença renal crônica (DRC) têm grande risco de desenvolver comprometimento cognitivo (CC), inicialmente leve (CCL), passível de identificação, mas ainda subdiagnosticado e subtratado. O Montreal Cognitive Assessment (MoCA) vem sendo indicado para rastreio de CCL na DRC. Objetivo: Avaliar o CCL em indivíduos com DRC pré-dialítica. Métodos: O estudo foi realizado em 72 indivíduos, não idosos, com DRC nos estágios pré-dialíticos. A avaliação neuropsicológica incluiu: o teste de cognição global MoCA; o teste do relógio (TDR); o Digit Span ordem direta (DOD) e inversa (DOI); o teste de fluência verbal (FV), fonêmica (FAS) e semântica (animais); o punho-borda-mão (PBM); e de memória 10 figuras. Resultados: A média de idade dos participantes foi de 56,74 ± 7,63 anos, com predominância de homens (55,6%), com escolaridade ≥ 4 anos (84,3%), a maioria com DRC 1, 2 e 3a e 3b (67,6%), hipertensa (93,1%) e diabética (52,1%). O CC (MoCA ≤ 24) foi observado em 73,6% dos usuários. Não encontramos associação das variáveis demográficas e clínicas com CC, mas tendência de associação com a idade (p = 0,07), com a escolaridade (p = 0,06) e com o DM (0,06). Os testes de função executiva, TDR, DOI e PBM, isoladamente, apresentaram boa sensibilidade e valor preditivo negativo comparados ao MoCA para a identificação de CC e, em conjunto, foram capazes de predizer o resultado do MoCA. Conclusão: O CCL é frequente em usuários não idosos com DRC pré-dialítica. O TDR, DOI e PBM associados são equivalentes ao MoCA na identificação do CC nessa população, sugerindo comprometimento de funções executivas.

Abstract Introduction: Individuals with chronic kidney disease (CKD) are at higher risk of developing cognitive impairment (CI), initially mild (MCI), potentially identifiable, but still poorly diagnosed and treated. The Montreal Cognitive Assessment (MoCA) has been indicated for MCI screening in CKD. Objective: To assess MCI in patients with CKD not yet on dialysis. Methods: Study conducted in 72 non-elderly subjects with pre-dialysis CKD. The neuropsychological assessment included: The global cognitive assessment test MoCA; the clock drawing (CD); the digit span forward (DSF) and reverse (DSR); phonemic verbal (VF) fluency (FAS) and semantics (animals); the fist-edge-palm (FEP); and the memory 10 pictures. Results: The average age of the participants was 56.74 ± 7.63 years, with predominance of male sex (55.6%), mainly with ≥ 4 years of education (84.3%), with CKD cathegories 1, 2 and 3a and 3b (67.6%), hypertension (93.1%) and diabetes mellitus (52.1%). MCI (MoCA ≤ 24) was observed in 73.6% of the patients. We did not find association among MCI with demographic and clinical variables, but a tendency to association with age (p = 0.07), educational level (p= 0.06) and diabetes (0.06). The executive function tests CD, DS-reverse and FEP, individually were able to identify CI with good sensibility and negative predictive value compared to MoCA and together, showed the same capability to identify MCI when compared to MoCA. Conclusion: The MCI is common in non-elderly patients with CKD not yet on dialysis. Together, the CD, DSR and FEP showed similar performance in identify MCI in this population when compared to MoCA, suggesting impairment of executive functions.

Anatomical deviation of male organs of land planarians from Rio de Janeiro, Brazil, with description of two new species of Cratera (Platyhelminthes, Tricladida).

Two new land planarian species, collected in the State of Rio de Janeiro, Brazil, are described. Their external aspect is similar to that of Imbira marcusi Carbayo et al., 2013 and Pseudogeoplana theresopolitana (Schirch, 1929), respectively. The analysis of the internal organs, however, revealed they belong to the genus Cratera. The male copulatory organs of one species is very different from any other geoplaninid, for the penis papilla holds a large, distal cavity receiving the ejaculatory duct and, furthermore, the papilla projects vertically downwards from the roof of the male atrium. Thus we consider it as a new species, Cratera cuarassu sp. nov. The second species differs from its congeners in that the dorsal insertion of the penis papilla is anterior to the ventral one, and in that the female atrium is narrowed in the anterior portion. The species was found in the type locality of Pseudogeoplana theresopolitana (Schirch, 1929) and compares well with it in the external features. However, since its internal organs are unknown and the type material of the species is seemingly lost, we describe it as Cratera anamariae Carbayo, sp. nov.

Carcinoma basoescamoso avançado de órbita: relato de caso / An advanced case of basosquamous carcinoma of the orbit: case report

Carcinoma basoescamoso é um tumor raro com características de tumor de células basais e escamosas interligados por uma área de transição. Tem sido descrito como um tumor agressivo com possibilidade de metástases à distância, o que difere substancialmente do carcinoma basocelular. Propomos neste relato a descrição de um caso de evolução crônica e das consequências do abandono do tratamento por causa do prognóstico reservado deste tipo de tumor de comportamento agressivo.

Basosquamous carcinoma is a rare tumor with features of both basal cell and squamous cell carcinoma, linked by a transition area. It is a rare epithelial neoplasm with a tendency for local recurrence. It also has a high incidence of distant metastasis, a condition that differentiates it from the basal cell carcinoma. In this case, the slow course of the infiltrative lesion associated to patient non-compliance to treatment led to a poor prognosis.

[An advanced case of basosquamous carcinoma of the orbit: case report]. / Carcinoma basoescamoso avançado de órbita: relato de caso.

Basosquamous carcinoma is a rare tumor with features of both basal cell and squamous cell carcinoma, linked by a transition area. It is a rare epithelial neoplasm with a tendency for local recurrence. It also has a high incidence of distant metastasis, a condition that differentiates it from the basal cell carcinoma. In this case, the slow course of the infiltrative lesion associated to patient non-compliance to treatment led to a poor prognosis.

Estudo comparativo entre a eficácia da escovaçäo orientada e supervisionada e a profilaxia profissional no controle da placa bacteriana dentária / Comparison of the efficacy of supervised toothbrushing and periodic professional prophylaxis on dental plaque control

A eficácia da escovaçäo supervisionada foi comparada com a profilaxia profissional no controle da placa bacteriana dentária. Com uma amostra de 45 escolares da faixa etária de 12 a 15 anos, três grupos foram formados. Usando soluçäo evidenciadora, a placa bacteriana foi mensurada, através da determinaçäo do Indice de O'Leary no início, no segundo mês e ao final do período experimental de quatro meses. Uma palestra sobre prevençäo da cárie com ênfase em higiene oral foi ministrada para o Grupo I no início do experimento. Os seguintes procedimentos foram realizados duas vezes por mês durante o período experimental de quatro meses: Grupo I) Escovaçäo e uso do fio dental sob supervisäo de um profissional; Grupo II) Profilaxia profissional; Grupo III) Escovaçäo usual näo-supervisionada. Os Indices de O'Leary médios observados para os três grupos nos três períodos de avaliaçäo foram, respectivamente, Grupo I: 52,93 por cento, 38,33 por cento e 32,62 por cento; Grupo II: 48,00 por cento, 46,38 por cento e 47,47 por cento; Grupo III: 46,57 por cento, 46,05 por cento e 45,93 por cento. Pela análise da variância foi observada uma diferença estatisticamente significante, a 5 por cento, nos resultados do Grupo I, os quais mostraram reduçäo a placa sob escovaçäo supervisionada. Conclui-se que a educaçäo e a escovaçäo supervisionada säo de extrema importância para estabelecimento de hábitos de higiene oral