Cross-cultural adaptation and validation of the episodic autobiographic memory interview for Brazilian Portuguese / Validação e adaptação transcultural da entrevista para avaliação da memória episódica autobiográfica para o português brasileiro

Episodic memory enables the storage of personal events with specific temporal and spatial details, and their retrieval through a sensory experience, usually visual, which is called autonoetic consciousness. While, in Brazil, several scales for the evaluation of anterograde episodic memory have been validated, there is not yet an instrument to assess the episodic autobiographical memory. The aim of this study is thus to make a cross-cultural adaptation and validation of the Episodic Autobiographic Memory Interview (EAMI) for Brazilian Portuguese. Altogether, 11 patients with Alzheimer’s disease (AD) and 10 healthy controls (CTs) were evaluated. EAMI scores for AD patients were lower than those of CTs, and these scores also correlated positively with the Remember-Know coefficient. The intraclass correlation coefficient indicated a good inter-rater reliability. The Portuguese version of EAMI showed a good reliability and validity, which suggests that it is a useful tool for evaluation of autobiographical memory in Brazilian patients.

A memória episódica possibilita o arquivamento de eventos pessoais, com seus detalhes temporais e espaciais, e sua recuperação através de uma experiência sensorial, geralmente visual, chamada de consciência autonoética. No Brasil, foram validados vários instrumentos para avaliação da memória episódica anterógrada, porém não há ainda uma escala para avaliar a memória episódica autobiográfica. O objetivo deste estudo é realizar uma validação e adaptação transcultural da Entrevista para avaliação da Memória Episódica Autobiográfica (EMEA) para o português brasileiro. Onze pacientes com doença de Alzheimer (DA) e 10 controles normais foram avaliados. Os escores dos pacientes com DA na EMEA foram menores do que nos controles saudáveis. Estes escores se correlacionaram positivamente com o coeficiente Lembrar-Saber. O coeficiente de correlação intraclasse indicou uma confiabilidade inter-examinadores adequada. A EMEA demonstrou uma boa validade e confiabilidade, sugerindo que ela é um instrumento útil para a avaliação da memória autobiográfica em pacientes brasileiros.

Cross-cultural adaptation and validation of the episodic autobiographic memory interview for Brazilian Portuguese.

Episodic memory enables the storage of personal events with specific temporal and spatial details, and their retrieval through a sensory experience, usually visual, which is called autonoetic consciousness. While, in Brazil, several scales for the evaluation of anterograde episodic memory have been validated, there is not yet an instrument to assess the episodic autobiographical memory. The aim of this study is thus to make a cross-cultural adaptation and validation of the Episodic Autobiographic Memory Interview (EAMI) for Brazilian Portuguese. Altogether, 11 patients with Alzheimer's disease (AD) and 10 healthy controls (CTs) were evaluated. EAMI scores for AD patients were lower than those of CTs, and these scores also correlated positively with the Remember-Know coefficient. The intraclass correlation coefficient indicated a good inter-rater reliability. The Portuguese version of EAMI showed a good reliability and validity, which suggests that it is a useful tool for evaluation of autobiographical memory in Brazilian patients.

Characteristics of mesial temporal lobe epilepsy associated with hippocampal sclerosis plus neurocysticercosis.

Recent observations suggest that neurocysticercosis (NCC) might act as an initial precipitating injury (IPI) causing mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS). A total of 191 patients from Brazil, a country in which NCC is endemic, were surgically treated for MTLE-HS, and subsequent findings for patients with MTLE-HS were compared with those of patients with MTLE-HS plus NCC. Seventy-one patients (37,2%) presented chronic findings of NCC (cNCC). MTLE-HS plus cNCC was significantly more common in women (O.R.=2.45; 95%CI=1.30-4.60; p=0.005), in patients with no history of classical forms of IPI (O.R.=2.67; 95%CI=1.37-5.18; p=0.004), and in those with bi-temporal interictal spikes on video-EEG (O.R.=2.00; 95%CI=1.07-3.73; p=0.03). Single cNCC lesions were observed to occur significantly more often on the same side as hippocampal sclerosis, a finding suggesting an anatomical relationship between NCC and MTLE-HS. Taken together, our results suggest that NCC may be a marker, or contributes to or even causes MTLE-HS. Based on our findings, we propose two distinct, non-excluding, and potentially synergistic mechanisms involved in the development of MTLE-HS in NCC, one of them being inflammatory-mediated, while the other is electrogenic-mediated. Taken together, our observations may provide further evidence suggesting a role of NCC in the genesis or development of MTLE-HS.

Neurocysticercosis.

Cysticercosis is one of the most common parasitic diseases of the nervous system in humans, and constitutes a major public health problem for most of the developing world. The clinical manifestations of neurocysticercosis (NCC) largely depend on the the host immune response against the parasite. NCC diagnosis is based upon neuroimaging studies (computerized tomography, magnetic resonance imaging) and antibody/antigen detection in the serum and the cerebrospinal fluid. Anticysticercal therapy has been marked by an intense controversy. Randomized controlled trials evaluating the clinical benefit of treatment have yield conflicting data with some studies indicating a benefit and others failing to show a difference. Prevention strategies must rely on multiple approaches, tailoring each to the special features of the particular endemic area.

Neurocysticercosis / Neurocisticercose

Cysticercosis is one of the most common parasitic diseases of the nervous system in humans, and constitutes a major public health problem for most of the developing world. The clinical manifestations of neurocysticercosis (NCC) largely depend on the the host immune response against the parasite. NCC diagnosis is based upon neuroimaging studies (computerized tomography, magnetic resonance imaging) and antibody/antigen detection in the serum and the cerebrospinal fluid. Anticysticercal therapy has been marked by an intense controversy. Randomized controlled trials evaluating the clinical benefit of treatment have yield conflicting data with some studies indicating a benefit and others failing to show a difference. Prevention strategies must rely on multiple approaches, tailoring each to the special features of the particular endemic area.

A cisticercose é uma das doenças parasitárias mais frequentes do sistema nervoso humano e constitui grave problema de saúde pública na maioria dos países em desenvolvimento. As manifestações clínicas da neurocisticercose (NCC) estão na dependência do número, tipo, localização e estágio de desenvolvimento dos cisticercos, assim como da resposta imunológica do hospedeiro contra o parasita. O diagnóstico da NCC é baseado nos exames de neuroimagem (tomografia computadorizada, ressonância magnética) e na detecção de antígenos/anticorpos no soro e no líquido cefalorraquiano. O tratamento antiparasitário tem sido marcado por uma intensa controvérsia. Os ensaios controlados e randomizados avaliando os benefícios clínicos da terapêutica têm revelado dados conflitantes em que alguns estudos indicam um benefício e outros não. As estratégias de prevenção devem ser fundamentadas na adoção simultânea de múltiplas medidas, adaptadas às características específicas de uma determinada região endêmica.

Cognitive and surgical outcome in mesial temporal lobe epilepsy associated with hippocampal sclerosis plus neurocysticercosis: a cohort study.

BACKGROUND: Where neurocysticercosis (NCC) is endemic, chronic calcified neurocysticercosis (cNCC) can be observed in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS). Considering that both disorders cause recurrent seizures or cognitive impairment, we evaluated if temporal lobectomy is cognitively safe and effective for seizure control in MTLE-HS plus cNCC. METHODS: Retrospective cohort study of neuropsychological profile and surgical outcome of 324 MTLE-HS patients submitted to temporal lobectomy, comparing the results according to the presence or absence of cNCC. FINDINGS: cNCC occurred in 126 (38.9%) of our MTLE-HS patients, a frequency higher than expected, more frequently in women than in men (O.R. = 1.66; 95% C.I. = 1.05-2.61; p = 0.03). Left-side (but not right side) surgery caused impairment in selected neuropsychological tests, but this impairment was not accentuated by the presence of cNCC. Ninety-four (74.6%) patients with MTLE-HS plus cNCC and 153 patients (77.3%) with MTLE-HS alone were Engel class I after surgery (O.R. = 1.16; 95% C.I. = 0.69-1.95; p = 0.58). However, the chances of Engel class IA were significantly lower in MTLE-HS plus cNCC than in patients with MTLE-HS alone (31.7% versus 48.5%; O.R. = 2.02; 95% C.I. = 1.27-3.23; p = 0.003). Patients with MTLE-HS plus cNCC showed higher rates of Engel class ID (15.1% versus 6.6%; O.R. = 2.50; 95% C.I. = 1.20-5.32; p = 0.012). INTERPRETATION: cNCC can be highly prevalent among MTLE-HS patients living in areas where neurocysticercosis is endemic, suggesting a cause-effect relationship between the two diseases. cNCC does not add further risk for cognitive decline after surgery in MTLE-HS patients. The rates of Engel class I outcome were very similar for the two groups; however, MTLE-HS plus cNCC patients achieved Engel IA status less frequently, and Engel ID status more frequently. Temporal lobectomy can be safely performed in most patients with MTLE-HS plus cNCC without affecting cognitive outcome. Long-term surgical seizure control in MTLE-HS plus cNCC is still satisfactory, as long as selected patients remain under medication.

Modulation of angiogenic factor VEGF by DNA-hsp65 vaccination in a murine CNS tuberculosis model.

Tuberculosis (TB) is a serious public health problem. Development of experimental models and vaccines are essential to elucidate physiopathological mechanisms and to control the disease. Vascular endothelial growth factor (VEGF) is a potent activator of vascular permeability and angiogenesis. VEGF seems to participate in breakdown of the blood brain-barrier (BBB) in tuberculous meningitis (TBM), contributing to worsening of disease. Therefore, the objective here was to extent the characterization of our previously described murine model of central nervous system TB (CNS-TB) by describing the VEGF participation in the CNS disease, and suggesting a vaccination plan in mice. Plasmid encoding DNA protein antigen DNA-hsp65 has been described as a protector against TB infection and was used here to test its effectiveness in the prevention of VEGF production and TB disease. Vaccinated mice and its controls were injected with Mycobacterium bovis bacillus Calmette-Guerin (BCG) in cerebellum. Four weeks after BCG injection, mice were perfused and brains were paraffin-embedded for VEGF expression analysis. We observed VEGF immunohistochemical expression in TBM and granulomas in non-vaccinated mice. The DNA-hsp65 treatment blocked the expression of VEGF in mice TBM. Therefore, our murine model indicated the VEGF participation in the physiopathology of CNS-TB and the potential prevention of the DNA-hsp65 in the disease progression.

Altered expression of degranulation-related genes in CD8+ T cells in human T lymphotropic virus type I infection.

Human T lymphotropic virus type I (HTLV-1) is the etiological agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). CD8+ T cells may contribute to the protection or development of HAM/TSP. In this study we used SAGE methodology to screen for differentially expressed genes in CD8+ T cells isolated from HTLV-1 asymptomatic carriers (HAC) and from HAM/TSP patients to identify genes involved in HAM/TSP development. SAGE analysis was conducted by pooling samples according to clinical status. The comparison of gene expression profiles between HAC and HAM/TSP libraries identified 285 differentially expressed tags. We focus on cytotoxicity and cytokine-related genes due to their potential biological role in HTLV-1 infection. Our results showed that patients with HAM/TSP have high expression levels of degranulation-related genes, namely GZMH and PRF1, and of the cytoskeletal adaptor PXN. We found that GZMB and ZAP70 were overexpressed in HTLV-infected patients compared to the noninfected group. We also detected that CCL5 was higher in the HAM/TSP group compared to the HAC and CT groups. Our findings showed that CD8+ T cells of HAM/TSP patients have an inflammatory and active profile. PXN and ZAP70 overexpression in HTLV-1-infected patients was described for the first time here and reinforces this concept. However, although active and abundant, CD8+ T cells are not able to completely eliminate infected cells and prevent the development of HAM/TSP and, moreover, these cells might contribute to the pathogenesis of the disease by migrating to the central nervous system (CNS). These results should be further tested with biological functional assays to increase our understanding on the role of these molecules in the development of HTLV-1-related diseases.

The contribution of a murine CNS-TB model for the understanding of the host-pathogen interactions in the formation of granulomas.

Central nervous system (CNS) tuberculosis (TB) is the most severe form of TB, characterized morphologically by brain granulomas and tuberculous meningitis (TBM). Experimental strategies for the study of the host-pathogen interaction through the analysis of granulomas and its intrinsic molecular mechanisms could provide new insights into the neuropathology of TB. To verify whether cerebellar mycobacterial infection induces the main features of the disease in human CNS and better understand the physiological mechanisms underlying the disease, we injected bacillus Calmette-Guerin (BCG) into the mouse cerebellum. BCG-induced CNS-TB is characterized by the formation of granulomas and TBM, a build up of bacterial loads in these lesions, and microglial recruitment into the lesion sites. In addition, there is an enhanced expression of signaling molecules such as nuclear factor-κB (NF-κB) and there is a presence of inducible nitric oxide synthase (iNOS) in the lesions and surrounding areas. This murine model of cerebellar CNS-TB was characterized by cellular and biochemical immune responses typically found in the human disease. This model could expand our knowledge about granulomas in TB infection of the cerebellum, and help characterize the physiological mechanisms involved with the progression of this serious illness that is responsible for killing millions people every year.

The use of a neck brace does not influence visual vertical perception.

UNLABELLED: Subjective visual vertical (SVV) evaluates the individual's capacity to determine the vertical orientation. Using a neck brace (NB) allow volunteers' heads fixation to reduce cephalic tilt during the exam, preventing compensatory ocular torsion and erroneous influence on SVV result. OBJECTIVE: To analyze the influence of somatosensory inputs caused by a NB on the SVV. METHOD: Thirty healthy volunteers performed static and dynamic SVV: six measures with and six without the NB. RESULTS: The mean values for static SVV were -0.075º±1.15º without NB and -0.372º±1.21º with NB. For dynamic SVV in clockwise direction were 1.73º±2.31º without NB and 1.53º±1.80º with NB. For dynamic SVV in counterclockwise direction was -1.50º±2.44º without NB and -1.11º±2.46º with NB. Differences between measurements with and without the NB were not statistically significant. CONCLUSION: Although the neck has many sensory receptors, the use of a NB does not provide sufficient afferent input to change healthy subjects' perception of visual verticality.

The use of a neck brace does not influence visual vertical perception / O uso do colar cervical não influência na percepção de verticalidade visual

Subjective visual vertical (SVV) evaluates the individual's capacity to determine the vertical orientation. Using a neck brace (NB) allow volunteers' heads fixation to reduce cephalic tilt during the exam, preventing compensatory ocular torsion and erroneous influence on SVV result. OBJECTIVE: To analyze the influence of somatosensory inputs caused by a NB on the SVV. METHOD: Thirty healthy volunteers performed static and dynamic SVV: six measures with and six without the NB. RESULTS: The mean values for static SVV were -0.075º±1.15º without NB and -0.372º±1.21º with NB. For dynamic SVV in clockwise direction were 1.73º±2.31º without NB and 1.53º±1.80º with NB. For dynamic SVV in counterclockwise direction was -1.50º±2.44º without NB and -1.11º±2.46º with NB. Differences between measurements with and without the NB were not statistically significant. CONCLUSION: Although the neck has many sensory receptors, the use of a NB does not provide sufficient afferent input to change healthy subjects' perception of visual verticality.

A subjetiva vertical visual (SVV) avalia a capacidade do indivíduo determinar a posição vertical. O uso do colar cervical (CC) fixa a cabeça do voluntário, reduzindo a inclicação cefálica durante o exame e prevenindo a torção ocular compensatória que influencia na SVV. OBJETIVO: Analisar a influência de informações sometossensoriais causadas pelo uso de um CC na SVV. MÉTODO: Trinta voluntários saudáveis realizaram a SVV estática e dinâmica: seis medidas com e seis medidas sem o CC. RESULTADOS: O valor médio da SVV estática foi -0,075º±1,15º sem CC e -0,372º±1,21º com. Na SVV dinâmica no sentido horário foi 1,73º±2,31º sem CC e 1,53º±1,80º com. Na SVV dinâmica no sentido anti-horário foi -1,50º±2,44º sem CC e -1,11º±2,46º com. As diferenças entre as medidas com e sem CC não foram estatisticamente significativas. CONCLUSÃO: Apesar de o pescoço possuir inumeros receptores sensoriais, o uso do CC não fornece aferências suficientes para alterar a percepção de visual de verticalidade de voluntários saudáveis.

Pharmacokinetics of combined treatment with praziquantel and albendazole in neurocysticercosis.

AIMS: Neurocysticercosis is the most common cause of acquired epilepsy in the world. Antiparasitic treatment of viable brain cysts is of clinical benefit, but current antiparasitic regimes provide incomplete parasiticidal efficacy. Combined use of two antiparasitic drugs may improve clearance of brain parasites. Albendazole (ABZ) has been used together with praziquantel (PZQ) before for geohelminths, echinococcosis and cysticercosis, but their combined use is not yet formally recommended and only scarce, discrepant data exist on their pharmacokinetics when given together. We assessed the pharmacokinetics of their combined use for the treatment of neurocysticercosis. METHODS: A randomized, double-blind, placebo-controlled phase II evaluation of the pharmacokinetics of ABZ and PZQ in 32 patients with neurocysticercosis was carried out. Patients received their usual concomitant medications including an antiepileptic drug, dexamethasone, and ranitidine. Randomization was stratified by antiepileptic drug (phenytoin or carbamazepine). Subjects had sequential blood samples taken after the first dose of antiparasitic drugs and again after 9 days of treatment, and were followed for 3 months after dosing. RESULTS: Twenty-one men and 11 women, aged 16 to 55 (mean age 28) years were included. Albendazole sulfoxide concentrations were increased in the combination group compared with the ABZ alone group, both in patients taking phenytoin and patients taking carbamazepine. PZQ concentrations were also increased by the end of therapy. There were no significant side effects in this study group. CONCLUSIONS: Combined ABZ + PZQ is associated with increased albendazole sulfoxide plasma concentrations. These increased concentrations could independently contribute to increased cysticidal efficacy by themselves or in addition to a possible synergistic effect.

Unusual presentation of brain aspergillosis in chronic granulomatous disease.

Aspergillus is a frequently observed pathogen in patients with chronic granulomatous disease. We report on a patient with chronic granulomatous disease and severe brain aspergillosis with an unusual presentation and favorable course. We discuss the impact of this infection on morbidity and mortality, adequate therapeutic management, and the need to investigate a possible fungal infection, despite nonspecific signs.

The increasing female participation in authorship of articles published in neurology in Brazil.

During the past four decades the participation of women in medicine has increased dramatically. This study is focused on the women's participation in authorship of articles published in the Arquivos de Neuro-Psiquiatria, the official Journal of the Brazilian Academy of Neurology. The articles were analyzed according to the number of articles and sex of both first and the senior (last) authors. The data were collected from 1945 to 2005. A total of 950 articles were published in this period. The proportion of women serving as first authors increased from 2.8% to 36.6% and the proportion serving as senior authors increased from 2.8% to 23.8% (1945-2005).

The increasing female participation in authorship of articles published in neurology in Brazil / A crescente participação da mulher na autoria de trabalhos publicados em neurologia no Brasil

During the past four decades the participation of women in medicine has increased dramatically. This study is focused on the women's participation in authorship of articles published in the Arquivos de Neuro-Psiquiatria, the official Journal of the Brazilian Academy of Neurology. The articles were analyzed according to the number of articles and sex of both first and the senior (last) authors. The data were collected from 1945 to 2005. A total of 950 articles were published in this period. The proportion of women serving as first authors increased from 2.8 percent to 36.6 percent and the proportion serving as senior authors increased from 2.8 percent to 23.8 percent (1945-2005).

Nas últimas quatro décadas houve um aumento crescente na participação de mulheres na medicina. Este artigo apresenta a participação de mulheres como autoras de artigos publicados em Arquivos de Neuro-Psiquiatria, jornal oficial da Academia Brasileira de Neurologia. Foi analisada esta participação em quinquênios, a partir de 1945 até 2005. Foram publicados neste período 950 artigos. A participação de mulheres como primeiro autor apresentou aumento de 2,8 por cento (1945) para 36,6 por cento (2005) e como último autor (chefe de grupo) passou de 2,8 por cento (1945) para 23,8 por cento (2005).

[Evaluation of the contamination of lettuce crops after the establishment of the monitoring system in Ribeirão Preto, SP]. / Avaliação da contaminação de hortas produtoras de verduras após a implantação do sistema de fiscalização em Ribeirão Preto, SP.

This study evaluated the microbiological and parasitological contamination of 88 market gardens producing green vegetables, of which 47 had been investigated previously. The contamination rate was 38.3% in the market gardens previously evaluated and 43.9% in the new market gardens. Food safety requires a continuous and efficient sanitary surveillance system for market gardens.

Avaliação da contaminação de hortas produtoras de verduras após a implantação do sistema de fiscalização em Ribeirão Preto, SP / Evaluation of the contamination of lettuce crops after the establishment of the monitoring system in Ribeirao Preto, SP

O estudo avaliou a contaminação microbiológica e parasitológica de 88 hortas produtoras de verduras, das quais 47 haviam sido investigadas anteriormente. A taxa de contaminação foi de 38,3 por cento nas hortas previamente investigadas e de 43,9 por cento nas novas hortas. A segurança alimentar requer um contínuo e eficiente sistema de vigilância sanitária das hortas.

This study evaluated the microbiological and parasitological contamination of 88 market gardens producing green vegetables, of which 47 had been investigated previously. The contamination rate was 38.3 percent in the market gardens previously evaluated and 43.9 percent in the new market gardens. Food safety requires a continuous and efficient sanitary surveillance system for market gardens.

Proposal for diagnostic criteria of tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM).

After the first description of TSP/HAM in 1985 and the elaboration of WHO's diagnostic criteria in 1988, the experience of the professionals in this field has increased so that a critical reappraisal of these diagnostic guidelines was considered timely. Brazilian neurologists and observers from other countries met recently to discuss and propose a modified model for diagnosing TSP/HAM with levels of ascertainment as definite, probable, and possible, according to myelopathic symptoms, serological findings, and/or detection of HTLV-I DNA and exclusion of other disorders.

Taenia solium DNA is present in the cerebrospinal fluid of neurocysticercosis patients and can be used for diagnosis.

Neurocysticercosis is the most frequent parasitic infection of the CNS and the main cause of acquired epilepsy worldwide. Seizures are the most common symptoms of the disease, together with headache, involuntary movements, psychosis and a global mental deterioration. Absolute diagnostic criteria include the identification of cysticerci, with scolex, in the brain by MRI imaging. We demonstrate here, for the first time, that T. solium DNA is present in the cerebrospinal fluid of patients. The PCR amplification of the parasite DNA in the CSF enabled the correct identification of 29/30 cases (96.7 %). The PCR diagnosis of parasite DNA in the CSF may be a strong support for the diagnosis of neurocysticercosis.

[Analysis of the vegetable productive chain in Ribeirão Preto, SP]. / Análise da cadeia de produção de verduras em Ribeirão Preto, SP.

With the aim of assessing the cumulative risk of lettuce contamination, 45 production chains were investigated. The presence of thermotolerant coliforms, Salmonella and/or parasites was detected in 69% of these, in all steps of the production chain. Quality control in all steps of the lettuce production process should be intensified.