The neurophysiological effect of mild hypothermia in gyrencephalic brains submitted to ischemic stroke and spreading depolarizations.

Objective: Characterize the neurophysiological effects of mild hypothermia on stroke and spreading depolarizations (SDs) in gyrencephalic brains. Methods: Left middle cerebral arteries (MCAs) of six hypothermic and six normothermic pigs were permanently occluded (MCAo). Hypothermia began 1 h after MCAo and continued throughout the experiment. ECoG signals from both frontoparietal cortices were recorded. Five-minute ECoG epochs were collected 5 min before, at 5 min, 4, 8, 12, and 16 h after MCAo, and before, during, and after SDs. Power spectra were decomposed into fast (alpha, beta, and gamma) and slow (delta and theta) frequency bands. Results: In the vascular insulted hemisphere under normothermia, electrodes near the ischemic core exhibited power decay across all frequency bands at 5 min and the 4th hour after MCAo. The same pattern was registered in the two furthest electrodes at the 12th and 16th hour. When mild hypothermia was applied in the vascular insulted hemispheres, the power decay was generalized and seen even in electrodes with uncompromised blood flow. During SD analysis, hypothermia maintained increased delta and beta power during the three phases of SDs in the furthest electrode from the ischemic core, followed by the second furthest and third electrode in the beta band during preSD and postSD segments. However, in hypothermic conditions, the third electrode showed lower delta, theta, and alpha power. Conclusion: Mild hypothermia attenuates all frequency bands in the vascularly compromised hemisphere, irrespective of the cortical location. During SD formation, it preserves power spectra more significantly in electrodes further from the ischemic core.

Depth-Specific Hypoxic Responses to Spreading Depolarizations in Gyrencephalic Swine Cortex Unveiled by Photoacoustic Imaging.

Spreading depolarizations (SDs) are a marker of brain injury and have a causative effect on ischemic lesion progression. The hemodynamic responses elicited by SDs are contingent upon the metabolic integrity of the affected tissue, with vasoconstrictive reactions leading to pronounced hypoxia often indicating poor outcomes. The stratification of hemodynamic responses within different cortical layers remains poorly characterized. This pilot study sought to elucidate the depth-specific hemodynamic changes in response to SDs within the gray matter of the gyrencephalic swine brain. Employing a potassium chloride-induced SD model, we utilized multispectral photoacoustic imaging (PAI) to estimate regional cerebral oxygen saturation (rcSO2%) changes consequent to potassium chloride-induced SDs. Regions of interest were demarcated at three cortical depths covering up to 4 mm. Electrocorticography (ECoG) strips were placed to validate the presence of SDs. Through PAI, we detected 12 distinct rcSO2% responses, which corresponded with SDs detected in ECoG. Notably, a higher frequency of hypoxic responses was observed in the deeper cortical layers compared to superficial layers, where hyperoxic and mixed responses predominated (p < 0.001). This data provides novel insights into the differential oxygenation patterns across cortical layers in response to SDs, underlining the complexity of cerebral hemodynamics post-injury.

Perfil epidemiologico de la poblacion que acude a una campaña de salud integral en tiempo de covid-19 en una ciudad peruana / Health profile of the population that attended to an integral health campaign in the time of covid-19 at a peruvian city

Objetivo: Determinar el Perfil Epidemiológico de la población que acude a una campaña de salud integral en tiempo de COVID-19. Materiales y métodos: Estudio transversal con componentes analíticos. La población se compone de un total de 289 pacientes que cumplieron con los criterios de selección. Resultados: Del total de pacientes (289) el 64,7% eran de sexo femenino y estas refirieron haber tenido COVID-19 (8,3%). Se reportó que los casos de COVID-19 fueron entre las edades de 15 a 59 años (37%). La comorbilidad más frecuente fue la obesidad (26,6%), seguida por la Hipertensión arterial (11,8%) y la Diabetes Mellitus (3,8%). Los signos y síntomas más frecuentes en los casos de COVID-19 fueron disnea (4,5%), mialgia (4,2%), tos (3,1%) y rinorrea (3,1%). Solo el 19,7% de pacientes refirieron haber recibido la vacuna contra COVID-19 al momento del estudio. Las patologías más frecuentemente reportadas fueron la patología respiratoria (26,3%), del Aparato locomotor (25,3%), endocrinológicas (12,1%) cardiovasculares (11,1%) e infecciosas (11,1%). Las variables asociadas fueron No comorbilidad (p = 0,014; IC 95 [0,208-0,853]; OR = 0,421), obesidad (p = 0,010; IC 95% [1,228-5,161] OR = 2,518) y disnea (p = 0,000; IC 95 [4,052-22,980]; OR = 9,649). Conclusiones: Se encontró predominancia de pacientes de sexo femenino. La obesidad fue la comorbilidad más frecuente. Las patologías más frecuentes fueron las respiratorias. La ausencia de comorbilidades muestra asociación protectora para COVID-19, mientras que la obesidad y la disnea aumentan dicha asociación.

Objective: The aim of the study was to determine the health profile of the population that attended an integrated health campaign in times of COVID-19.  Materials and Methods: It was a Cross-sectional, observational, descriptive, and retrospective study. The population is made up of a total of 289 patients who met the selection criteria.  Results: Of the total number of patients (289), 64.7% were female, from this group 8.3% reported having had COVID-19. COVID-19 cases were reported to be between the ages of 15 to 59 years (37%). The most frequent comorbidity was: obesity (26.6%), followed by arterial hypertension (11.8%) and diabetes mellitus (3.8%). The most frequent signs and symptoms of COVID-19 were: dyspnea (4.5%), myalgia (4.2%), cough (3.1%), and rhinorrhea (3.1%). Only 19.7% of patients reported having received the COVID-19 vaccine at the time of the study. The most frequently reported pathologies were: respiratory (26.3%), musculoskeletal (25.3%), endocrinological (12.1%), cardiovascular (11.1%), and infectious pathologies (11.1%). The associated variables were: no comorbidity (p = 0.014; CI 95 [0.208-0.853]; OR = 0.421), obesity (p = 0.010; CI 95% [1.228-5.161] OR = 2.518), and dyspnea (p = 0.000; CI 95 [4,052-22,980], OR = 9,649).  Conclusions: A predominance of female patients was found. Obesity was the most frequent comorbidity. The most frequent pathologies were those of the respiratory system. The absence of comorbidities shows a protective association for COVID-19, while obesity and dyspnea increase this association.

Ring enhancing intracranial lesion responding to antituberculous treatment in an HIV-infected patient / Lesão intracraniana que respondeu ao tratamento anti-tuberculoso em paciente infectado pelo HIV

Cerebral tuberculomas constitute a major differential diagnosis of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected patients in developing countries. We report the case of a 34-year old woman co-infected with HIV and possible disseminated tuberculosis (hepatitis, lymphadenopathy, and pleural effusion) who presented a large and solitary intracranial mass lesion. Despite extensive diagnostic efforts, including brain, ganglionar, and liver biopsies, no definitive diagnosis was reached. However, a trial with first-line antituberculous drugs led to a significant clinical and radiological improvement. Atypical presentations of cerebral tuberculomas should always be considered in the differential diagnosis of intracranial mass lesions in HIV-infected patients and a trial with antituberculous drugs is a valuable strategy to infer the diagnosis in a subset of patients.

Os tuberculomas cerebrais constituem diagnóstico diferencial importante da toxoplasmose cerebral em pacientes infectados pelo vírus da imunodeficiência humana (HIV) de países em desenvolvimento. Os autores relatam o caso de uma mulher HIV positiva de 34 anos de idade, que apresentou provável tuberculose disseminada (hepatite, adenomegalia, e derrame pleural) associada à lesão expansiva cerebral única e gigante. Apesar dos esforços diagnósticos realizados, incluindo biópsia cerebral, ganglionar e hepática, o diagnóstico etiológico não foi confirmado. Porém, a resposta clínico-radiológica ao tratamento tuberculostático permitiu definir o diagnóstico de tuberculoma cerebral e a paciente teve alta hospitalar. Apresentações atípicas de tuberculomas cerebrais devem ser sempre consideradas no diagnóstico diferencial das lesões expansivas cerebrais em pacientes infectados pelo HIV e o uso do tratamento tuberculostático constitui ferramenta útil na definição diagnóstica em um sub-grupo de pacientes.

Despolarización cortical extendida: un nuevo mecanismo fisiopatológico en las enfermedades neurológicas / Cortical spreading depolarization: A new pathophysiological mechanism in neurological diseases

La despolarización cortical extendida (cortical spreading depolarization en inglés) es una onda de despolarización casi completa de las células neuronales y de la glía acoplada a una respuesta de vasoconstricción y dilatación vascular que ocurre en la migraña con aura, la hemorragia subaracnoidea, la hemorragia intracerebral, el traumatismo craneoencefálico y el ictus isquémico. Estas ondas de despolarización se caracterizan por un cambio de potencial negativo con una amplitud de entre -10 a -30 mV, una duración de ∼1 min y cambios en la homeostasis iónica cerebral intracelular y extracelular. Bajo situaciones patológicas de hipoperfusión estas ondas despolarizantes pueden conducir a estrés oxidativo, agravamiento de estados hipóxicos y muerte neuronal debido a vasoconstricción arterial intensa causada por una repuesta hemodinámica inversa, fenómeno denominado isquemia extendida (spreading ischemia). En los últimos años se ha podido confirmar electrofisiológicamente la presencia de estas ondas despolarizantes propagándose en el cerebro humano y se ha visto una asociación entre su incidencia y el deterioro neurológico. Actualmente se está recogiendo evidencia clínica que apoya no solo su coexistencia con el daño neuronal, sino su causalidad. Existen medidas terapéuticas probadas en laboratorio que podrían reducir los efectos de este elemento fisiopatológico en el daño cerebral (AU)

Cortical spreading depolarization is a wave of almost complete depolarization of the neuronal and glial cells that occurs in different neurological diseases such as migraine with aura, subarachnoid hemorrhage, intracerebral hemorrhage, head trauma and stroke. These depolarization waves are characterized by a change in the negative potential with an amplitude between -10 and -30 mV, duration of ∼1 min and changes in the ion homeostasis between the intra- and extracellular space. This results in neuronal edema and dendritic distortion. Under pathologic states of hypoperfusion, cortical spreading depolarization can produce oxidative stress, worsen hypoxia and induce neuronal death. This is due to intense arterial vasoconstriction produced by an inverse response called spreading ischemia. Only in the last years there has been an electrophysiological confirmation of cortical spreading depolarization in human brains. Occurrence of cortical spreading depolarization has been associated with worse outcome in patients. Currently, increased knowledge regarding the pathophysiologic mechanisms supports the hypothetical correlation of cortical spreading depolarization with brain damage in humans. There are diverse therapeutic alternatives that promise inhibition of cortical spreading depolarization and subsequent better outcomes (AU)

Tricobezoar gastro-duodeno-jejunal: abordagem videolaparoscópica / Gastric-duodenum-jejune trichobezoar: videolaparoscopic management

Trichobezoars are gastric concretions of hair that sometimes extend throught the intestine. We report on a patient with trichobezoar managed by videolaparoscopic extraction, and discuss the advantages and disadvantages of this method, that can be the treatment of choice of this conditions.

Estimated prevalence of immunity to poliomyelitis in the city of Säo Paulo, Brazil: a population-based survey

OBJECTIVES: Estimate the prevalence of immunity to poliomyelitis (anti-polio antibodies) in the city of Säo Paulo/Brazil through a population-based survey. METHODS: A quantitative and inductive method was used to draw a representative sample of the population. Randomization and stratification (based on sex, age and residence region) was done, and 1,059 individuals were studied on a home-visit basis (structured questionnaires and blood samples). A microneutralization test was performed to detect anti-polio antibodies against serotypes 1, 2 and 3. RESULTS: The estimated prevalence of immunity to poliomyelitis was high, with 94.6 percent prevalence of anti-polio 1 antibodies, 98.8 percent anti-polio 2 and 91.9 percent anti-polio 3. Despite this high prevalence, there were significantly lower prevalence levels in some groups, specially among age and residence region groups. DISCUSSION: Routine child immunization and NIDs with OPV have provided excellent levels of serological immunity to poliomyelitis in the population of the city of Säo Paulo, Brazil. However, there may be specific groups with a lower prevalence of immunity. Estimations of the prevalence of immunity to poliomyelitis were made in a population-based survey, which could be used as an auxiliary tool for supporting the polio eradication program

Teste de inibiçäo da hemaglutinaçäo para anticorpos anti-rubéola em gestantes / Hemagglutination's inhibition test for anti-rubella antibodies in pregnant women

Foram testados 204 soros de pacientes do sexo feminino (18 a 40 anos) que compareceram para a realizaçäo de exames pré-natal, no Centro de Diagnóstico Clínico Pérola Byington de Guarulhos, estado de Säo Paulo. Através da reaçäo de inibiçäo de hemaglutinaçäo, visando a detecçäo de anticorpos para rubéola, 9,21% näo apresentaram anticorpos, enquanto as demais 185 os possuíam com títulos que variavam de 1:20 a 1:2560. Houve sensível predominância dos títulos de 1:160 a 1:320, considerados de médios a altos, no total de amostra examinada. O quadro sorológico encontrado em nada difere daquele verificado por outros autores em outras localidades. Os mesmos foram analisados e discutidos

Hepatite C e crioglobulinemia / Hepatitis C and cryoglobulinemia

A hepatite C e considerada atualmente a hepatite viral de maior importancia nos aspectos clinico e epidemiologico devido ao carater infeccioso lento e progressivo culminando com maior incidencia de cronicidade e consequentemente de maior suceptibilidade a cirrose e a um risco anual de aproximadamente 3 por cento para hepatocarcinoma...

Estimated prevalence of viral hepatitis in the general population of the municipality of Säo Paulo, measures by a serologic survey of a stratified, randomized and residence-based population

The present study was done to estimate the prevalence of Hepatitis A (HAV), B (HBV), C (HCV), and E (HEV) infection in the general population residing in the municipality of Säo Paulo, and to evaluate the level of knowledge related to the various modes of infection transmission by and protection against the different viruses. Blood samples and health questionnaires were collected from 1,059 individuals. The study design used an inductive metod of predictive statistical inferences through randomized sampling stratifield by sex, age and residence region. The estimated prevalence rated found were: Hepatitis A = 66.59 percent (63.75 percent - 69.44 per cent CI); Hepatitis B = 5.94 percent (4.50 percent-7.35 percent); Hepatitis C =1.42 percent (0,70 percent - 2.12 percent); Hepatitis E = 1.68 percent (0.91 percent - 2.46 percent). The frequency of hepatitis was similar in males and females. HAV showed an estimated prevalence of 56.16 percent in the population up to 17 years old, increasing to 65.30 percent in individuals between 18 and 29 years. The infection reached its peak of 90 percent in individuals 40 years of age or older. The study showed a greater tendency of dissemination of HBV among the population between 15 and 17 years. This specific age group showed an estimated prevalence of active infection of 1.04 percent (0.43 percent - 1.65 percent CI), and also demonstrated an ascending level of acquired immunity with an estimated prevalence of 4.90 percent (3.60 percent - 6.20 percent CI). HCV demonstrated an estimated prevalence of 1.42 percent (0.70 percent - 2.12 percent CI). This specific infection occurred more frequently among adults 30 years of age or older, with the prevalence reaching a peak of 3.80 percent among the group aged 50 to 59 years. HEV showed zero prevalence among the age group between 2 and 9 years. This was followed by a slighty ascending rate starting from age 10, with an estimated prevalence of 1.05 percent (0.94 percent - 3.04 percent CI) among those 10 to 14 years of age....

Estimativa da prevalência de anticorpos antidiftéricos na população do Município de São Paulo, em amostragem populacional estratificada, randomizada por sorteio aleatório e coleta domiciliar / Prevalence estimateof anti-diphtheria antibodie son general population of São Paulo city in stratified population sampling randomized by aleatory selection and home collection

Estimar a prevalência da soro positividade para difteria em estudo de base populacional representativa do município de São Paulo identificando e procurando diferenças na prevalência estimada de anticorpos séricos para difteria entre os estratos populacionais estudados. O desenho do estudo utilizou um método indutivo de inferências estatísticas preditivas a partir de amostragem casualizada por sorteio aleatório, estratificado segundo sexo, idade e região de moradia. Foram avaliados 1059 indivíduos (com coleta domiciliar e aplicação de questionário). O estudo foi planejado de modo a controlar o erro amostral da prevalência através de um intervalo com 95% de confiança. Realizou-se teste imunoenzimático para detectar imunidade antidifteria. Após a epidemia de difteria ocorrida na Comunidade dos Estados Independentes, na antiga União Soviética, vários países buscaram estimar a soroprevalência da população à esta doença reemergente. Com este propósito, dos 977 resultados válidos obtidos neste trabalho estimou-se na população do município de São Paulo uma soroprevalência de 95,9%. A faixa etária que compreende dos 18 aos 49 anos apresentou proporção menor de imunizados, com 94,1%, quando comparados na categoria de até 17 anos (97,6%)e na categoria de 50 anos ou mais com 98, 7%. Dados coincidentes foram obtidos por outros autores. O grupo de entrevistados vindos de estados da região Sudeste, apresentou 94,5% de casos imunes, proporção menor do que nas demais regiões. Nordeste, Sul e Norte/Centro Oeste que apresentaram 100% dos casos imunes. Não houve diferença significativa da prevalência estimada quanto ao sexo. Não foi encontrada associação estatística entre Zona de Residência e imunidade para a difteria. Ao contrário do passado, houve uma mudança do grau de escolaridade e a susceptibilidade à difteria. Dos grupos entrevistados, 98,2% dos analfabetos e primário incompleto apresentavam níveis séricos protetores. O grupo com 1° grau apresentou proporção de casos imunes significativamente maior do que a categoria 2° grau, 97,4% e 90,3%, respectivamente. O grupo com nível superior apresentou imunidade de 93,6%, sendo intermediária, não se diferenciando das demais categorias. Quando se estudou a soroprevalência à difteria aos dados sociais como ocupação, renda familiar e estado civil não houve associação estatística entre eles, pois qualquer camada social possui acesso à vacinação, por ser gratuita...