Posterior circulation collaterals as predictors of outcome in basilar artery occlusion: a sub-analysis of the BASICS randomized trial.

Introduction and purpose: Basilar artery occlusion (BAO) is still one of the most devastating neurological conditions associated with high morbidity and mortality. In the present study, we aimed to assess the role of posterior circulation collaterals as predictors of outcome in the BASICS trial and to compare two grading systems (BATMAN score and PC-CS) in terms of prognostic value. Methods: We performed a sub-analysis of the BASICS trial. Baseline clinical and imaging variables were analyzed. For the imaging analysis, baseline CT and CTA were analyzed by a central core lab. Only those patients with good or moderate quality of baseline CTA and with confirmed BAO were included. Multivariable binary logistic regression analysis was used to test the independent association of clinical and imaging characteristics with a favorable outcome at 3 months (defined as a modified Rankin Score of ≤3). ROC curve analysis was used to assess and compare accuracy between the two collateral grading systems. Results: The mean age was 67.0 (±12.5) years, 196 (65.3%) patients were males and the median NIHSS was 21.5 (IQR 11-35). Median NCCT pc-ASPECTS was 10 (IQR10-10) and median collateral scores for BATMAN and PC-CS were 8 (IQR 7-9) and 7 (IQR 6-8) respectively. Collateral scores were associated with favorable outcome at 3 months for both BATMAN and PC-CS but only with a modest accuracy on ROC curve analysis (AUC 0.62, 95% CI [0.55-0.69] and 0.67, 95% CI [0.60-0.74] respectively). Age (OR 0.97, 95% CI [0.95-1.00]), NIHSS (OR 0.91, 95% CI [0.89-0.94]) and collateral score (PC-CS - OR 1.2495% CI [1.02-1.51]) were independently associated with clinical outcome. Conclusion: The two collateral grading systems presented modest prognostic accuracy. Only the PC-CS was independently associated with a favorable outcome at 3 months.

RapidpulseTM cyclic aspiration system for acute ischemic stroke due to large vessel occlusions.

BACKGROUND: The best strategy to achieve optimal reperfusion outcomes during mechanical thrombectomy remains to be defined. The RapidPulseTM Cyclic Aspiration System is a novel technology, delivering high-frequency pulsed vacuum forces to increase the efficiency of aspiration thrombectomy. METHODS: Prospective, multicenter, open-label, core lab-adjudicated, two-arm study comparing safety and efficacy of a feasibility version of the RapidPulseTM system compared with contemporary controls. Primary endpoint was the rate of mTICI ≥ 2c after first-pass effect (FPE). Additional efficacy endpoints were the rates of mTICI ≥ 2b after first pass (modified FPE (mFPE)), last pass with study device defined as frontline technical success, and after all passes including rescue therapy. The primary safety endpoints included symptomatic ICH (sICH) within 24 h post-procedure. RESULTS: Between February 2022 to December 2022, 80 subjects were consented and enrolled in the study (n = 40 treatment arm, n = 40 control arm). In the intent to treat (ITT) population, mean age was 67.8 ± 11.5 years; 19 (47.5%) were male. Median NIHSS score was 16 (IQR: 13-22). Median ASPECTS score was 9 (IQR: 8-10). The rate of mTICI ≥ 2c after first pass was 53.9% in ITT population (60.0% in per-protocol population) versus 38.5% in the corresponding control population. Functional independence (mRS 0-2) at 90 days was achieved in 61.1% (22/36) in the RapidPulseTM arm and 52.8% (19/36) in the control arm. In the RapidPulseTM arm, no sICH within 24 h and no device-related morbidity or mortality occurred. CONCLUSION: Preliminary data suggests RapidPulseTM Aspiration System is highly effective and safe for recanalization of large vessel occlusions.

Effects of Larrea nitida nanodispersions on the growth inhibition of phytopathogens.

Larrea nitida Cav. (Zygophyllaceae) is a plant endemic to Argentina and Chile, and its extract has been studied over the last years due to the presence of antimicrobial agents that can be used to control the growth of some pathogens in agriculture. However, the extract is highly hydrophobic, which strongly affects its fungicidal activity in aqueous media. In this sense, the solid dispersion technique was used to produce L. nitida extract nanodispersions with polyethylene glycol (PLE) and with polyethylene glycol and zinc acetate (PZLE). In order to further evaluate the activity of the extract in PLE and PZLE, blank nanodispersions containing only polyethylene glycol (PEG) and zinc acetate (PZ) without the addition of the extract were also produced. The fungicidal activity of the water-soluble nanoparticles was evaluated at different concentrations (0.037-0.110 g.mL-1). In general, the nanoparticles were successfully produced on a nanometric size and presented a significant inhibitory activity on the growth of the pathogens Fusarium oxysporum and Fusarium verticillioides in aqueous media. Compared to PLE, PZLE presented increased fungistatic activity, possibly due to their increased solubility in water. Even though their application in agriculture should be further investigated, the nanodispersions present great potential to be applied as a green biotechnological tool.

Dog Population Rabies Immunity before a Mass Vaccination Campaign in Lima, Peru: Vulnerabilities for Virus Reestablishment.

Lima, Peru, has not had a case of canine rabies since 1999. However, Lima remains at risk of rabies reintroduction due to the free movement of dogs from nearby rabies-endemic areas. In Latin America, rabies vaccination campaigns must reach 80% of dogs to halt transmission, but estimates of vaccine coverage are often unavailable, unreliable, or inaccurate. Quantifying virus neutralizing antibodies (VNA) allows monitoring of the immunological status of the canine population, evaluation of the degree of humoral protection to the virus, and assessing, partially, the population response to vaccination. We evaluated the dog population's immunity level against the rabies virus before a mass vaccination campaign in Lima. We collected 141 canine blood samples in the district of Surquillo and quantified rabies virus neutralizing antibody titers using the fluorescent antibody virus neutralization test). We surveyed dogs owners to reconstruct canine vaccination histories. Among dogs previously vaccinated, 73.9% exceeded the seroconversion threshold of > 0.5 IU/mL. Among all dogs, only 58.2% reached the titer limit for seroconversion. Dogs ≤ 1 year old constituted 26.2% of the total canine population and had lower levels of VNA than dogs > 1 year old (χ2 = 9.071; P = 0.028). Importantly, dogs vaccinated with single-pathogen vaccines had higher levels of VNA than those who received combined-pathogen vaccines (χ2 = 7.721; P = 0.005). We provide an important and timely glimpse to the immunity status of the dog population in urban areas of Lima, a metropolis near a dog rabies-endemic region.

Baru oil (Dipteryx alata vog.) applied in the formation of O/W nanoemulsions: A study of physical-chemical, rheological and interfacial properties.

The oil extracted from baru (Dipteryx alata Vog.) seeds is in bioactive compounds and it presents potential to be used in food and cosmetic industries. Therefore, this study aims to provide insights into the stability of baru oil-in-water (O/W) nanoemulsions. For this purpose, the effects of the ionic strength (0, 100 and 200 mM), pH (6, 7 and 8), and storage time (28 days) on the kinetic stability of these colloidal dispersions were evaluated. The nanoemulsions were characterized in terms of interfacial properties, rheology, zeta potential (ζ), average droplet diameter, polydispersity index (PDI), microstructure, and creaming index. In general, for samples, the equilibrium interfacial tension ranged from 1.21 to 3.4 mN.m-1, and the interfacial layer presented an elastic behavior with low dilatational viscoelasticity. Results show that the nanoemulsions present a Newtonian flow behavior, with a viscosity ranging from 1.99 to 2.39 mPa.s. The nanoemulsions presented an average diameter of 237-315 nm with a low polydispersity index (<0.39), and a ζ-potential ranging from 39.4 to 50.3 mV after 28 days of storage at 25 °C. The results obtained for the ζ-potential suggest strong electrostatic repulsions between the droplets, which is an indicative of relative kinetic stability. In fact, macroscopically, all the nanoemulsions were relatively stable after 28 days of storage, except the nanoemulsions added with NaCl. Nanoemulsions produced with baru oil present a great potential to be used in the food, cosmetic, and pharmaceutical industries.

Ergonomic workplace analysis (EWA) as a model for creating an instrument to assess rest locations for truck drivers.

Introduction: The relationship between sleep quality and rest location is rarely explored in the literature. In this context, ergonomic analysis instruments can contribute with information for a satisfactory rest environment throughout the work schedule. Objectives: To analyze the performance of an instrument based on Ergonomic Workplace Analysis for assessing rest locations. Methods: This study adapted an ergonomic instrument to a new purpose. To analyze its performance, we assessed the rest locations of truck drivers working for a large transportation company located in the state of São Paulo. Results: The variables adapted from the original Ergonomic Workplace Analysis were rest location, sequence of tasks, lighting, noise, indoor comfort, and thermal comfort. Photos and flowcharts were used to better describe the data. Conclusion: The new instrument was shown to be adequate for assessing rest locations. The drivers evaluated the accommodations more positively than the analyst, and truck sleepers and company accommodations were considered different both by the drivers and the analyst.

Introdução: A relação entre a qualidade do sono e o local de descanso é pouco explorada pela literatura. Nesse contexto, os instrumentos de análise ergonômica podem contribuir com informações para um ambiente de descanso satisfatório ao longo das jornadas de trabalho. Objetivos: Analisar o desempenho de um instrumento de avaliação de locais de descanso, desenvolvido a partir da ferramenta ergonomic workplace analysis (análise ergonômica do posto de trabalho). Métodos: O presente estudo se caracteriza por adaptar um instrumento ergonômico para uma nova finalidade. Realizou-se avaliação dos locais de descanso de motoristas de caminhão de uma empresa transportadora de grande porte, localizada no estado de São Paulo. Resultados: As variáveis adaptadas da versão original do ergonomic workplace analysis foram o local de descanso, a sequência de tarefas, a iluminação, o ruído, o conforto interno e o conforto térmico. As fotos e os fluxogramas foram utilizados para melhor descrever os dados. Conclusões: O novo instrumento se mostrou adequado para avaliar locais de descanso. Os motoristas avaliaram mais positivamente os dormitórios do que o analista, sendo que o local de descanso do caminhão e os alojamentos foram considerados distintos tanto para os motoristas quanto para o analista.

"Two Cultures in Favor of a Dying Patient": Experiences of Health Care Professionals Providing Snakebite Care to Indigenous Peoples in the Brazilian Amazon.

In the Brazilian Amazon, deaths and disabilities from snakebite envenomations (SBEs) are a major and neglected problem for the indigenous population. However, minimal research has been conducted on how indigenous peoples access and utilize the health system for snakebite treatment. A qualitative study was conducted to understand the experiences of health care professionals (HCPs) who provide biomedical care to indigenous peoples with SBEs in the Brazilian Amazon. Focus group discussions (FGDs) were carried out in the context of a three-day training session for HCPs who work for the Indigenous Health Care Subsystem. A total of 56 HCPs participated, 27 in Boa Vista and 29 in Manaus. Thematic analysis resulted in three key findings: Indigenous peoples are amenable to receiving antivenom but not to leaving their villages for hospitals; HCPs require antivenom and additional resources to improve patient care; and HCPs strongly recommend a joint, bicultural approach to SBE treatment. Decentralizing antivenom to local health units addresses the central barriers identified in this study (e.g., resistance to hospitals, transportation). The vast diversity of ethnicities in the Brazilian Amazon will be a challenge, and additional studies should be conducted regarding preparing HCPs to work in intercultural contexts.

Complexation of anthocyanins, betalains and carotenoids with biopolymers: An approach to complexation techniques and evaluation of binding parameters.

Natural pigments are bioactive compounds that can present health-promoting bioactivities in the human body. Due to their strong coloring properties, these compounds have been widely used as color additives as an alternative to artificial colorants. However, since these pigments are unstable under certain conditions, such as the presence of light, oxygen, and heat, the use of complexation and encapsulation techniques with biopolymers is in demand. Moreover, some functional properties can be achieved by using natural pigments-biopolymers complexes in food matrices. The complexation and encapsulation of natural pigments with biopolymers consist of forming a complex with the aim to make these compounds less susceptible to oxidative and degrading agents, and can also be used to improve their solubility in different media. This review aims to discuss different techniques that have been used over the last years to create natural pigment-biopolymers complexes, as well as the recent advances, limitations, effects, and possible applications of these complexes in foods. Moreover, the understanding of thermodynamic parameters between natural pigments and biopolymers is very important regarding the complex formation and their use in food systems. In this sense, thermodynamic techniques that can be used to determine binding parameters between natural pigments and potential wall materials, as well as their applications, advantages, and limitations are presented in this work. Several studies have shown an improvement in many aspects regarding the use of these complexes, including increased thermal and storage stability. Nonetheless, data regarding the biological effects on the human body and the sensory acceptance of natural pigments-biopolymers complexes in food systems are scarce in the literature.

Habitat and Host Species Drive the Structure of Bacterial Communities of Two Neotropical Trap-Jaw Odontomachus Ants : Habitat and Host Species Drive the Structure of Bacterial Communities of Two Neotropical Trap-Jaw Odontomachus Ants.

Ants have long been known for their associations with other taxa, including macroscopic fungi and symbiotic bacteria. Recently, many ant species have had the composition and function of their bacterial communities investigated. Due to its behavioral and ecological diversity, the subfamily Ponerinae deserves more attention regarding its associated microbiota. Here, we used the V4 region of the 16S rRNA gene to characterize the bacterial communities of Odontomachus chelifer (ground-nesting) and Odontomachus hastatus (arboreal), two ponerine trap-jaw species commonly found in the Brazilian savanna ("Cerrado") and Atlantic rainforest. We investigated habitat effects (O. chelifer in the Cerrado and the Atlantic rainforest) and species-specific effects (both species in the Atlantic rainforest) on the bacterial communities' structure (composition and abundance) in two different body parts: cuticle and gaster. Bacterial communities differed in all populations studied. Cuticular communities were more diverse, while gaster communities presented variants common to other ants, including Wolbachia and Candidatus Tokpelaia hoelldoblerii. Odontomachus chelifer populations presented different communities in both body parts, highlighting the influence of habitat type. In the Atlantic rainforest, the outcome depended on the body part targeted. Cuticular communities were similar between species, reinforcing the habitat effect on bacterial communities, which are mainly composed of environmentally acquired taxa. Gaster communities, however, differed between the two Odontomachus species, suggesting species-specific effects and selective filters. Unclassified Firmicutes and uncultured Rhizobiales variants are the main components accounting for the observed differences. Our study indicates that both host species and habitat act synergistically, but to different degrees, to shape the bacterial communities in these Odontomachus species.

Perfil epidemiológico de pacientes com degeneração macular relacionada à idade / Epidemiological profile of patients with age-related macular degeneration

RESUMO Objetivo Demonstrar o perfil epidemiológico e fatores de riscos de pacientes com degeneração macular relacionada à idade. Métodos Estudo observacional e seccional. Foi incluído um olho de cada paciente com maior comprometimento visual por degeneração macular relacionada à idade atendido no Hospital Universitário Antônio Pedro. A variável principal a ser comparada foi a presença de degeneração macular relacionada à idade dividida nos estágios inexpressivo, inicial, intermediário e avançado, segundo classificação do estudo AREDS. As variáveis secundárias foram os dados demográficos (sexo, idade, raça, faixa etária), índice de massa corporal, cor da íris, história familiar de degeneração macular relacionada à idade, status do cristalino, longo tempo exposição à luz ultravioleta e tabagismo. Foram realizados testes estatísticos com análise de Kruskal-Wallis, do teste do qui-quadrado e teste t de Student. O nível de significância foi definido em 5%. Resultados Após os critérios de inclusão e exclusão, 126 pacientes foram incluídos neste estudo, sendo 20 pacientes com degeneração macular relacionada à idade inexpressiva, 30 pacientes com degeneração macular relacionada à idade inicial, 30 pacientes com degeneração macular relacionada à idade intermediária e 46 pacientes com degeneração macular relacionada à idade avançada. Dentre todos os fatores de risco pesquisados, apenas o tabagismo se mostrou estatisticamente significativo (p=0,03). Conclusão O tabagismo como fator de risco para degeneração macular relacionada à idade apresentou ter importância expressiva prevalente nesta pesquisa e até mesmo como fator preventivo dessa morbidade ocular.

ABSTRACT Purpose To demonstrate the epidemiological profile and risk factors of patients with age-related macular degeneration (ARMD). Methods Observational and sectional study. One eye of each patient with greater visual impairment due to AMD treated at the University Hospital Antônio Pedro was included. The main variable to be compared was the presence of AMD divided into inexpressive, initial, intermediate, and advanced stages, according to the classification of the AREDS study. The secondary variables were demographics (gender, age, race, age group), body mass index, iris color, family history of ARMD, lens status, long-term exposure to ultraviolet light and smoking. Statistical tests were performed with Kruskal-Wallis and Chi-square analyses and Student's t test. The significance level was set at 5%. Results After the inclusion and exclusion criteria, 126 patients were included in this study, 20 patients with non-expressive AMD, 30 patients with early AMD, 30 patients with intermediate AMD, and 46 patients with advanced AMD. Among all the risk factors surveyed, only smoking was statistically significant (p = 0.03). Conclusion Smoking as a risk factor for AMD had significant relevance prevalent in this research and even as a preventive factor for this ocular morbidity.

New insights into perceptions of technology claims in greek-style yogurt: A view in the COVID-19 pandemic.

The Covid-19 pandemic has strongly impacted people's lives and the food industry. In this sense, food products claiming nutritional and health-promoting benefits due to the presence of bioactive peptides and probiotics, such as Greek-style yogurt, have been in demand. The objective of this work was to investigate, through word association, the perception of the consumers regarding the seven concepts related to Greek-style yogurt (traditional, ultra-creamy, zero fat, high content proteins, zero lactose, light and with no added sugars), in the context of social isolation due to Covid-19. In this online survey, 346 participants completed a questionnaire. The participants were divided according to health concerns (increased, not changed, or decreased) and eating habits (improved, not changed, or worsened) during the Covid-19 pandemic. Chi-square and prototypical analysis were used as statistical tests. During the Covid-19 pandemic, based on self-report, around 66% of the participants had their eating habits and their concerns about health changed. The general associations were related to the categories pleasure, health, creamy, pleasant texture, food restriction, and loss of sensory quality. 'Health' and 'pleasure' were negatively associated with the conceptualization of Greek-style yogurt. For the zero-fat, light, and sugar-free Greek-style yogurts, the terms creamy and ultra-creamy are sensory appealing to the consumers. In general, the price and concerns about health are factors that strongly influence the purchase intention of Greek-style yogurts. The yogurts were associated with sensory and non-sensory characteristics, which can be useful for marketing strategies for of different product concepts.

Exposure to cellulose acetate films incorporated with garlic essential oil does not lead to homologous resistance in Listeria innocua ATCC 33090.

Essential oils (EOs) have been considered potential green additives for active food packaging. However, sub-lethal concentrations of EOs may lead to bacterial resistance, which is a concern. In this sense, the effects of 1% (GEO1) and 10% (GEO10) of garlic EO in cellulose acetate-based films regarding homologous resistance in Listeria innocua were investigated after incubation at 37 °C/24 h and 7 °C/10 d. The films were also characterized and tested on sliced mozzarella cheese as interfold packaging for 8-days storage at 7 °C. The EO did not alter the mechanical properties of the films nor their thermal degradation profile. However, GEO10 was less permeable to water vapor than GEO1. When tested against L. innocua, the incubation at 7 °C enhanced the films' antimicrobial effect: log reductions of 4.3 and 5.7 were obtained for GEO1 and GEO10, respectively. Moreover, 86.3% of L. innocua cells were injured at sub-lethal level when exposed to GEO10. Despite this, no occurrence of homologous resistance was found. When the active films were tested on cheese against the natural microbiota, they resulted in slices of mozzarella with fewer contaminants, however the reduction was not significant. Nevertheless, we considered this an important finding to the food industry since this work suggested that GEO is a safe active compound from the point of view of homologous resistance to be used against Listeria.

Diagnostic approach in a patient with Creutzfeldt-Jakob disease / Abordagem diagnóstica em uma paciente com doença de Creutzfeldt-Jakob

ABSTRACT Prion diseases are an important cause of rapidly progressive dementias. Among them, the most common is sporadic Creutzfeldt-Jakob disease (CJD). It is a rare and incurable disease, with rapid progression to death. Objective: To describe the diagnostic approach of a patient with Creutzfeldt-Jakob disease. Methods: The diagnosis is established through the clinical picture associated with characteristic changes in the brain magnetic resonance imaging, the electroencephalogram, and analysis of specific changes in the cerebrospinal fluid. Results: The present report describes the case of a 53-year-old patient in the city of Fortaleza-CE. The diagnosis was made based on the clinical condition and through diagnostic tests, including 14-3-3 protein and RT QUIC analysis. Differential diagnosis was performed with other rapidly progressive causes, such as infectious and immune-mediated diseases. Conclusions: The diagnosis of probable sporadic CJD was established.

RESUMO As doenças priônicas são uma importante causa de demências rapidamente progressivas. Entre elas, a mais comum é a doença de Creutzfeldt-Jakob (DCJ) esporádica. É uma enfermidade rara e incurável, com rápida progressão para óbito. Objetivo: Descrever a abordagem diagnóstica de uma paciente com doença de Creutzfeldt-Jakob. Métodos: O diagnóstico é estabelecido pelo quadro clínico associado a alterações características na ressonância magnética cerebral, no eletroencefalograma e pela análise de alterações específicas no líquido cefalorraquidiano. Resultados: O presente relato descreve o caso de um paciente de 53 anos na cidade de Fortaleza (CE). O diagnóstico foi feito com base na condição clínica e por meio de testes diagnósticos, incluindo proteína 14-3-3 e análise Real-Time Quaking-Induced Conversion (RT QUIC). O diagnóstico diferencial foi realizado com outras causas rapidamente progressivas, como doenças infecciosas e imunomediadas. Conclusões: Por fim, foi estabelecido o diagnóstico de provável DCJ esporádica.

Betalains nanodispersions: Effects on betalains stability and on rheological properties of Greek yogurt.

Red beetroot (Beta vulgaris L.) is a great source of betalains. The main betalains are the betacyanins, responsible for the purple color, and betaxanthins, which present a brownish color. These pigments can present antioxidant activity and are very unstable under certain conditions, such as temperature, extreme ranges of pH, and exposure to light. The aim of this work was to obtain beetroot extract (BE) via ultrasound and transform it into nanoparticles by using polyethylene glycol (PBE) and polyethylene glycol with low molecular weight chitosan (PCBE) as dispersants. The stability of the main betalains in the nanodispersions and the effects of the nanodispersions on the color and rheological properties of commercial Greek yogurt were evaluated. Compared to pristine BE, PCBE nanoparticles presented increased stability for the main betalains in acidic conditions (pH 3.0 and 5.0) of 56% and 22%, respectively. Both PBE and PCBE showed enhanced relative thermal stability compared to pristine BE. Furthermore, PCBE improved commercial Greek yogurt's rheological properties and color parameters. PCBE nanodispersions can be successfully applied as a color additive to commercial Greek yogurt.

Evaluation of truck driver rest locations and sleep quality.

Objectives: Truck drivers' work organization requires that rest and sleep be taken in various locations, where sleep quality might be affected by the discomfort of these environments. The purpose of this study was to evaluate truck drivers' rest locations and their association with sleep quality utilizing an ergonomic approach. Material and Methods: The sleep quality of 81 truck drivers was assessed using the Pittsburgh sleep quality index (PSQI). An adapted version of the ergonomics workplace analysis (EWA) instrument was used to evaluate 44 rest locations. Results: Half of the workers preferred sleeper berths (51.2%) as a rest place. Sleep was classified as poor by 71.6% of the drivers. Dorms were rated more positively (p<0.001) by truck drivers (2.0±1.1) than by the analyst (2.6±0.6). Sleeper berths and dorms were rated statistically different by truck drivers (p=0.002), as well as by the analyst (p=0.003). No correlation was found between EWA evaluations and total score for sleep quality. Separate analyses of dorms and truck berths showed very few correlations. The higher the noise of roommates in dorms, the worse the sleep quality. Conversely, noise in corridors or outside the room positively impacted sleep quality. Conclusion: Noise in the rest place may affect sleep in both directions, negatively or positively. Sleep was classified as poor regardless of resting place. The quality of resting places seemed to have little effect on sleep quality of truck drivers. Factors other than rest place, such as work scheduling, are probably more important for promoting good sleep quality.

Diagnostic approach in a patient with Creutzfeldt-Jakob disease.

Prion diseases are an important cause of rapidly progressive dementias. Among them, the most common is sporadic Creutzfeldt-Jakob disease (CJD). It is a rare and incurable disease, with rapid progression to death. Objective: To describe the diagnostic approach of a patient with Creutzfeldt-Jakob disease. Methods: The diagnosis is established through the clinical picture associated with characteristic changes in the brain magnetic resonance imaging, the electroencephalogram, and analysis of specific changes in the cerebrospinal fluid. Results: The present report describes the case of a 53-year-old patient in the city of Fortaleza-CE. The diagnosis was made based on the clinical condition and through diagnostic tests, including 14-3-3 protein and RT QUIC analysis. Differential diagnosis was performed with other rapidly progressive causes, such as infectious and immune-mediated diseases. Conclusions: The diagnosis of probable sporadic CJD was established.

As doenças priônicas são uma importante causa de demências rapidamente progressivas. Entre elas, a mais comum é a doença de Creutzfeldt-Jakob (DCJ) esporádica. É uma enfermidade rara e incurável, com rápida progressão para óbito. Objetivo: Descrever a abordagem diagnóstica de uma paciente com doença de Creutzfeldt-Jakob. Métodos: O diagnóstico é estabelecido pelo quadro clínico associado a alterações características na ressonância magnética cerebral, no eletroencefalograma e pela análise de alterações específicas no líquido cefalorraquidiano. Resultados: O presente relato descreve o caso de um paciente de 53 anos na cidade de Fortaleza (CE). O diagnóstico foi feito com base na condição clínica e por meio de testes diagnósticos, incluindo proteína 14-3-3 e análise Real-Time Quaking-Induced Conversion (RT QUIC). O diagnóstico diferencial foi realizado com outras causas rapidamente progressivas, como doenças infecciosas e imunomediadas. Conclusões: Por fim, foi estabelecido o diagnóstico de provável DCJ esporádica.

Retinopatia hipertensiva maligna secundária a lúpus eritematoso sistêmico em adolescente / Malignant hypertensive retinopathy secondary to systemic lupus erythematous in adolescent

RESUMO O lúpus eritematoso sistêmico é uma doença que pode apresentar comprometimento oftalmológico geralmente benigno, sendo as alterações mais encontradas a síndrome do olho seco e a catarata. Nos pacientes com a doença estável, o dano oftalmológico parece estar relacionado ao tratamento sistêmico a longo prazo, o que enfatiza a importância do exame oftalmológico completo de rotina. Porém, quando a doença está em franca atividade e, em especial, quando há o envolvimento renal, deve-se iniciar o tratamento precoce com corticoterapia sistêmica e com medidas de suporte, para se evitarem repercussões mais complexas, como as crises hipertensivas que podem levar ao óbito.

ABSTRACT Systemic lupus erythematosus may present ophthalmological involvement, usually benign, and the most common changes are dry eye syndrome and cataract. In patients with stable disease, ophthalmologic damage appears to be related to long-term systemic treatment, emphasizing the importance of routine complete ophthalmologic examination. However, in full-blown disease, especially when there is renal involvement, early treatment should start with systemic steroid therapy and supportive measures, to avoid major repercussions, such as hypertensive crises that may lead to death.

Evolution of Rabies in South America and Inter-Species Dynamics (2009-2018).

Rabies is listed as one of the World Health Organisation's (WHO) Neglected Tropical Diseases Worldwide, with a significant impact in South America. This paper explores the dynamics of rabies cases in humans, pets (dogs and cats), livestock and wildlife (bats in particular) in South America during the period 2009-2018. The data used in this study were derived from the two main databases for rabies in South America: the OIE-WAHIS from the World Organisation for Animal Health (OIE) and PANAFTOSA's Regional Information System for the Epidemiological Surveillance of Rabies (SIRVERA). Being a neglected disease with possible underreporting in some areas, the reported rabies cases may not always represent the real disease burden. The analysis focuses on the evolution of the number of cases in time and their spatial distribution, as well as on the main source of infections in humans, determined by laboratory assays of the antigenic variant or through epidemiological investigations. Additionally, Generalised Linear Mixed Models (GLMM) were used to evaluate the risk factors associated with the occurrence of human cases. Our results show that the highest impact of the disease in terms of number of cases was reported on livestock, while the overall number of cases (in animals and humans) progressively decreased along the study period. The spatial distribution of rabies in livestock showed two main clusters in the north-western (mainly Colombia) and in the south-eastern part of the affected area (Brazil), and a third smaller cluster in Peru. A cluster in dogs was observed in Bolivia. Out of the 192 human cases reported during the study period, 70% of them were transmitted by bats. The number of human cases reported during the study period were significantly associated with the number of rabies cases reported in livestock, pets and wildlife. Despite the overall decreasing case report rate, the disease still represents a major animal and public health concern in South America, and new strategies for compiling systematic information, networking and education are needed, as well as the education and training of veterinary staff.

Characterization of Headache in COVID-19: a Retrospective Multicenter Study.

Headache is the most common neurological symptom in COVID-19, reported in 6.5 to 34% of patients. Few studies have analyzed its characteristics, and some of them included cases without laboratory confirmation or reported only critical patients. We aimed to analyze the clinical characteristics of COVID-19 associated headache in laboratory-confirmed cases. We conducted a retrospective evaluation of patients with COVID-19 and neurological symptoms. Patients who reported headache answered an interview about its clinical characteristics. Twenty-four patients with COVID-19 associated headache completed the interview. Mean age of patients was 53.8 (standard deviation-17.44), and 14 out of 24 (58.3%) were male. The majority (75%) had no previous history of headache. Fever was documented in 19 out of the 24 patients (79.1%). Headache was predominantly bifrontal or holocranial, in pressure, during hours, worsening with cough or physical activity. COVID-19 headache tends to appear in the first days of symptoms, be either frontal or holocranial and last for days. The quality of pain in pressure and the worsening with cough or physical activity were reported in most cases. We have not found any characteristic that could differentiate COVID-19 associated headache from other causes of headache, possibly because of its multifactorial mechanism.

Hiperplasia linfoide reacional em boca: relato de caso / Reactional lymphoid hyperplasia in the mouth: case report

INTRODUÇÃO: A hiperplasia linfoide reacional compreende uma condição rara e benigna, onde há um aumento tecidual decorrente da proliferação de células linfoides para combater um agente agressor. Este caso clínico apresenta um paciente do sexo masculino, cinco anos de idade, portador de Síndrome do Coração Esquerdo Hipoplásico, em uso de carvediol, furosemida, losartana, marevan, montelucaste e clenil, que exibiu lesão hiperplásica nodular e eritematosa localizada em base de língua, séssil e indolor, com evolução rápida segundo observado por seu responsável (crescimento em cerca de 24 horas), acompanhada de febre, linfadenopatia bilateral e recusa na alimentação. MÉTODOS: As informações foram obtidas por meio de revisão do prontuário, entrevista com o responsável do paciente, registro fotográfico e revisão da literatura. Na avaliação clínica intraoral, o paciente apresentava lesões cariosas em todos os dentes decíduos, com extensa destruição coronária nos molares inferiores. As hipóteses diagnósticas estabelecidas compreendem rânula, cistos do ducto salivar e hiperplasia linfoide reacional, sendo descartadas as hipóteses relacionadas a efeitos colaterais dos medicamentos em uso. RESULTADOS: Optou-se pela realização dos procedimentos odontológicos em centro cirúrgico sob anestesia geral (remoção de cárie, exodontias e restaurações). Durante a cirurgia, o paciente foi medicado com corticoides por via intravenosa para melhorar a sintomatologia pós cirúrgica. Após a recuperação anestésica, foi observada remissão quase por completo da lesão, caracterizando um diagnóstico de lesão por hiperplasia linfoide reacional. Paciente recebeu alta após três dias, sendo medicado com amoxicilina e clavulanato de potássio por sete dias, retornando 14 dias depois para realização de ecocardiograma e exames laboratoriais, ambos atestando normalidade. CONSIDERAÇÕES FINAIS: O caso relatado demonstra o potencial lesivo de focos infecciosos em boca e a importância dos cuidados com a saúde bucal, especialmente em pacientes com alterações cardiovasculares. Através da evolução médica, verificou-se que o paciente encontra-se bem, sob proservação, sendo recomendado ao responsável acompanhamento odontológico a cada seis meses.