Signs and symptoms of human T-lymphotropic virus 1 and 2 infections in paediatric patients.

OBJECTIVE: To determine the prevalence of signs and symptoms of HTLV-1 and 2 infection in paediatric patients. METHODS: We included cohort, case-control and descriptive observational studies that reported the prevalence of signs and symptoms of HTLV-1 and 2 infections in paediatric patients. Searches were performed in MEDLINE® (Ovid), EMBASE and LILACS from inception to the present, and we saturated information with other sources of published and unpublished literature. We decided not to perform meta-analysis according to heterogeneity. RESULTS: A total of eight studies met the inclusion criteria for qualitative analysis. No studies of HTLV-2 were found. Females predominated and there was vertical transmission in nearly 100% of cases. Infective dermatitis was a common manifestation of HTLV in paediatric patients. In addition, persistent hyperreflexia, clonus and the Babinski sign were early neurological alterations observed in patients carrying the virus. CONCLUSION: HTLV screening is recommended in patients presenting infective dermatitis, persistent hyperreflexia, walking disturbances and in those who come from endemic zones.

Alto porcentaje de ausencia de reflejo bulbocavernoso en pacientes neurológicamente sanos con disfunción vesical / High Percentage of Absence of Bulbocavernosus Reflex in Neurologically-Healthy Patients with Bladder Dysfunction

Introducción y Objetivo El reflejo bulbocavernoso (RBCV) se ha observado ausente incluso en pacientes neurológicamente sanos. Los trastornos funcionales del piso pélvico deben incluir su evaluación. Nuestro objetivo primario fue evaluar la prevalencia de ausencia de RBCV en pacientes sanos. El objetivo secundario fue observar la afectación del RBCV en presencia de otras comorbilidades cómo enfermedad neurológica y diabetes mellitus tipo 2. Métodos Estudio descriptivo y retrospectivo, en el que se revisaron mil expedientes clínicos de pacientes sometidos a estudio urodinámico a quienes se les realizó exploración mecánica del RBCV como parte de una exploración rutinaria. Se realizó estadística descriptiva para las variables cuantitativas y cualitativas utilizando la prueba tde Student y la de chi cuadrado, respectivamente. Se consideraron estadísticamente significativos valores de p < 0,05. Resultados La muestra tenía una media de edad de 59,84 años (desviación estándar [DE]: ± 14,13 años), y contenía 36,19% de mujeres y 21,13% de hombres sin enfermedad neurológica y RBCV ausente. Se observó mayor ausencia de RBCV en pacientes con presencia de enfermedad neurológica en comparación con pacientes neurológicamente sanos: 21,6% versus 10,6%, respectivamente (p < 0,0001); además, se observó una ausencia importante de RBCV en presencia de diabetes mellitus en comparación con pacientes no diabéticos: 30.8% versus 18.8%, respectivamente (p < 0,0001). No se observaron diferencias al comparar grupos con respecto a disfunción vesical. Conclusión La ausencia de RBCV no es exclusiva de una enfermedad neurológica con repercusión de síntomas del tracto urinario inferior, y la proporción de pacientes neurológicamente sanos con ausencia de RBCV no es despreciable. No se encontró una diferencia significativa en los grupos con ausencia de RBCV con respecto a disfunción vesical.

Introduction and Objective Absence of the bulbocavernosus reflex (BCVR) has been observed even in neurologically-healthy subjects. Functional disorders of the pelvic floor should include its assessment. The primary objective of the present study was to evaluate the absence of BCVR in healthy subjects. The secondary objective was to evaluate the BCVR with regards to the presence of other comorbidities, such as neurogenic bladder and type-2 diabetes mellitus. Methods A descriptive and retrospective study in which we reviewed the clinical files of one thousand subjects who underwent a urodynamic study and were submitted to a mechanical exploration of the BCVR as part of a routine evaluation. Descriptive statistics were performed for the quantitative and qualitative variables using the Student t and the Chi-squared tests accordingly. Values of p < 0.05 was considered statistically significant. Results The sample had a mean age of 59.84 years (standard deviation [SD] ± 14.13 years), and it contained 36.19% of women and 21.13% of men without neurological disease and absent BCVR. A higher proportion of BCVR absence was observed in patients with neurological disease compared to their healthy counterparts: 21.6% and 10.6% respectively (p ≤ 0.0001); furthermore, an important absence of the BCVR was observed in patients with type-2 diabetes mellitus compared to non-diabetic patients: 30.8% and 18.8% respectively (p ≤ 0.0001). No statistically significant differences were observed in the group comparison regarding bladder dysfunction. Conclusion The absence of the RBCV is not exclusive to a neurological disease with repercussions in terms of lower urinary tract symptoms, and the proportion of neurologically healthy subjects with absence of the BCVR is not negligible. No significant difference was found in groups with absence of the BCVR with regards to bladder dysfunction

Linfoma intravascular canino - aspectos clínicos, patológicos e imunohistoquímicos / Intravascular lymphoma in canine - clinical, pathological and immunohistochemical aspects

Background: Intravascular lymphoma (IL) is a rare disease characterized by presence of neoplastic lymphocytes in thelumen of blood vessels. Any tissue can be affected; however, the most frequently compromised areas of the body are theskin and the central nervous system (CNS). The clinical signs and macroscopic alterations caused by IL are nonspecific andare usually secondary to a continuous proliferative disorder, which leads to occlusion of the blood vessels with consequentthrombosis, hemorrhage and infarction. The objective of this work is to report a case of IL in a dog.Case: An 8-year-old male Rottweiler dog was referred to the Veterinary Hospital of the Federal University of Paraná witha history of cerebellar ataxia that had not improved after treatment. At the neurological examination, cerebellar ataxia anddeficit of nasal reflex were detected. A complete blood count showed presence of slight anemia (4.8 million red bloodcells/mm3; normal ranges= 5.5-8.5 million/mm3) and thrombocytopenia (176.000/mm3; normal ranges= 250.000-500.000/mm3). Biochemical tests revealed a small increase in alanine aminotransferase (42 IU/L; normal ranges= 14-38 IU/L) and aslight decrease in alkaline phosphatase (49 IU/L; normal ranges= 90-170 IU/L). The cerebrospinal fluid (CSF) exhibited anincreased protein concentration (147.3 mg/dL; normal ranges= 18-44 mg/dL) and pleocytosis (8 cells/µL; normal ranges=up to 5 cells/µL). No alterations were observed at radiographic and ultrasonographic exams. A clinical treatment was prescribed; however, in view of the worsening of the clinical signs, euthanasia was performed, and the body was submittedto a Laboratory of Pathology. At necropsy, moderate multifocal ulcers were observed in the oral cavity and ventral side ofthe tongue; moderately infarcted areas were detected in the spleen. Additional alterations such as fatty liver degeneration...(AU)

Age-Related Changes in Presynaptic Inhibition During Gait Initiation.

Age-related changes in presynaptic inhibition (PSI) have not been observed during gait initiation, which requires anticipatory postural adjustment (APA). As APA is centrally modulated and is impaired in older compared to young adults, here we aimed to study the presynaptic control and co-contraction levels in the ankle muscles during gait initiation in older compared to young adults. Fifteen older (age range 65-80 years) and 15 young adults (age range 19-30 years) performed a gait initiation task on a force platform under 3 conditions: (i) without electrical stimulation; (ii) test Hoffman reflex (H-reflex); and (iii) conditioned H-reflex. H-reflexes were evoked on the soleus muscle when the APA amplitude exceeded 10%-20% of the average baseline mediolateral force. Participants also performed quiet stance as a control task. Results showed that both age groups presented similar PSI levels during quiet stance (p = .941), while in the gait initiation older adults presented higher PSI levels, longer duration, and lower amplitude of APA than young adults (p < .05). Older adults presented higher co-contraction ratio in both tasks than young adults (p < .05). Correlations between the PSI levels and the APA amplitude (r = -0.61, p = .008), and between the PSI levels and the co-contraction ratio during gait initiation (r = -0.64, p = .005) were found for older adults only. APA amplitude explained 49% of the variance of the PSI levels (p = .003). Our findings suggest that older compared to young adults have increased presynaptic control to compensate for the decreased supraspinal modulation on impaired APAs during gait initiation.

Linfoma intravascular canino - aspectos clínicos, patológicos e imunohistoquímicos / Intravascular lymphoma in canine - clinical, pathological and immunohistochemical aspects

Background: Intravascular lymphoma (IL) is a rare disease characterized by presence of neoplastic lymphocytes in thelumen of blood vessels. Any tissue can be affected; however, the most frequently compromised areas of the body are theskin and the central nervous system (CNS). The clinical signs and macroscopic alterations caused by IL are nonspecific andare usually secondary to a continuous proliferative disorder, which leads to occlusion of the blood vessels with consequentthrombosis, hemorrhage and infarction. The objective of this work is to report a case of IL in a dog.Case: An 8-year-old male Rottweiler dog was referred to the Veterinary Hospital of the Federal University of Paraná witha history of cerebellar ataxia that had not improved after treatment. At the neurological examination, cerebellar ataxia anddeficit of nasal reflex were detected. A complete blood count showed presence of slight anemia (4.8 million red bloodcells/mm3; normal ranges= 5.5-8.5 million/mm3) and thrombocytopenia (176.000/mm3; normal ranges= 250.000-500.000/mm3). Biochemical tests revealed a small increase in alanine aminotransferase (42 IU/L; normal ranges= 14-38 IU/L) and aslight decrease in alkaline phosphatase (49 IU/L; normal ranges= 90-170 IU/L). The cerebrospinal fluid (CSF) exhibited anincreased protein concentration (147.3 mg/dL; normal ranges= 18-44 mg/dL) and pleocytosis (8 cells/µL; normal ranges=up to 5 cells/µL). No alterations were observed at radiographic and ultrasonographic exams. A clinical treatment was prescribed; however, in view of the worsening of the clinical signs, euthanasia was performed, and the body was submittedto a Laboratory of Pathology. At necropsy, moderate multifocal ulcers were observed in the oral cavity and ventral side ofthe tongue; moderately infarcted areas were detected in the spleen. Additional alterations such as fatty liver degeneration...

Complex Movement Disorders in Ataxia with Oculomotor Apraxia Type 1: Beyond the Cerebellar Syndrome.

Background: Ataxia with oculomotor apraxia (AOA1) is characterized by early-onset progressive cerebellar ataxia with peripheral neuropathy, oculomotor apraxia and hypoalbuminemia and hypercholesterolemia. Case Report: A 23-year-old previously healthy woman presented with slowly-progressive gait impairment since the age of six years. Neurological examination revealed profound areflexia, chorea, generalized dystonia and oculomotor apraxia. Brain MRI revealed mild cerebellar atrophy and needle EMG showed axonal sensorimotor neuropathy. Whole exome sequencing revealed a mutation in the aprataxin gene. Discussion: AOA1 can present with choreoathetosis mixed with dystonic features, resembling ataxia-telangiectasia. This case is instructive since mixed and complex movement disorders is not very common in AOA1. Highlights: Ataxia with oculomotor apraxia type 1 (AOA1) is characterized by early-onset ataxia and oculomotor apraxia caused by variants in the APTX gene.Ataxia is usually not the sole movement abnormality in AOA1.Hyperkinetic movement disorders, especially chorea and dystonia, may occur.Mixed and complex movement disorders is not very common in AOA1.Patients with early-onset ataxia associated with mixed movement disorders should also be investigated for AOA1.

Neurological Development, Epilepsy, and the Pharmacotherapy Approach in Children with Congenital Zika Syndrome: Results from a Two-Year Follow-up Study.

Clinical outcomes related to congenital Zika syndrome (CZS) include microcephaly accompanied by specific brain injuries. Among several CZS outcomes that have been described, epilepsy and motor impairments are present in most cases. Pharmacological treatment for seizures resulting from epilepsy is performed with anticonvulsant drugs, which in the long term are related to impairments in the child's neuropsychomotor development. Here, we describe the results from a two-year follow-up of a cohort of children diagnosed with CZS related to the growth of the head circumference and some neurological and motor outcomes, including the pharmacological approach, and its results in the treatment of epileptic seizures. This paper is part of a prospective cohort study carried out in the state of Mato Grosso Sul, Brazil, based on a Zika virus (ZIKV)-exposed child population. Our data were focused on the assessment of head circumference growth and some neurological and motor findings, including the description of seizure conditions and pharmacological management in two periods. Among the 11 children evaluated, 8 had severe microcephaly associated with motor impairment and/or epilepsy. Seven children were diagnosed with epilepsy. Of these, 3 had West syndrome. In four children with other forms of epilepsy, there was no pharmacological control.

Neuroanatomical basis of Wallenberg syndrome.

Wallenberg syndrome, or lateral medullar syndrome, is the clinical presentation of the infarct in the territory of posterior inferior cerebellar artery. Its signs and symptoms include vertigo, nystagmus, diplopia, ipsilateral Horner syndrome, facial ruddiness and dry skin, dysphonia, dysphagia, dysarthria, ipsilateral loss of gag reflex, ipsilateral ataxia, ipsilateral impaired taste, ipsilateral facial pain and paresthesia, decreased ipsilateral blink reflex, contralateral hypoalgesia and thermoanaesthesia in the trunk and limbs; and ipsilateral facial hypoalgesia and thermoanaesthesia. Neuroanatomical knowledge is essential to its comprehension, study and diagnosis, because the classic neurological manifestations are easy to explain and understand if function and localization of affected anatomical structures are known as if the posterior cerebral circulation is.

El síndrome de Wallenberg, o síndrome bulbar lateral, es la manifestación clínica del infarto en el territorio de irrigación de la arteria cerebelosa posteroinferior. Su presentación incluye vértigo, nistagmo, diplopía, síndrome de Horner, rubicundez y anhidrosis facial homolateral, disfonía, disfagia, disartria, pérdida homolateral del reflejo nauseoso, ataxia homolateral, disgeusia homolateral, dolor y parestesia faciales homolaterales, pérdida o disminución homolateral del reflejo corneal, hipoalgesia y termoanestesia de tronco y extremidades contralaterales, hipoalgesia y termoanestesia facial homolateral. El conocimiento neuroanatómico es imprescindible para su comprensión, estudio y diagnóstico, ya que sus manifestaciones neurológicas clásicas son fácilmente explicables y entendibles si se conocen la función y la localización de las estructuras anatómicas afectadas, así como la irrigación cerebral posterior.

Características epidemiológicas, clínicas e imagenológicas en pacientes con microcefalia y sospecha de infección por el virus del zika. Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga / Epidemiological, clinical and imaging features of patients with microcephaly and suspected infection by zika virus. Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga

La infección por virus Zika es transmitida por la picadura del Aedes sp, aunque también se ha descrito la transmisión transplacentaria a los fetos. La microcefalia congénita es el primer hallazgo relacionado con la enfermedad y se asocia a defectos en la proliferación neuronal y muerte de las células progenitoras corticales que tiene como consecuencia una disminución de la producción neuronal y que resulta en una serie de trastornos cerebrales que comprometen la motricidad, visión, audición y funciones cognitivas. La presente investigación describió las características epidemiológicas, clínicas e imagenológicas en pacientes pediátricos con microcefalia secundario a la sospecha de infección por el virus Zika, que acudieron a la consulta de Neuropediatría del Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga de la ciudad de Barquisimeto, estado Lara durante el lapso diciembre 2016- septiembre 2017(AU)

Zika virus infection is transmitted by the bite of Aedes sp, although transplacental transmission to the fetuse has also been described. Congenital microcephaly is the first finding related to the disease and is associated with defects in neuronal proliferation and death of cortical progenitor cells, which result in a decrease in neuronal production and a group of brain disorders which compromise motor skills, vision, hearing and cognitive functions. The present study describes the epidemiological, clinical and imaging characteristics in pediatric patients with microcephaly secondary to suspected Zika virus infection who attended the Neuropediatric consultation of the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga during the December 2016-September 2017 period(AU)

An endothelial growth factor receptor compound mutation of T790M substitution with exon 19 deletion in a previously untreated patient: a case report.

BACKGROUND: Endothelial growth factor receptor (EGFR) mutations are an essential driver of personalized therapy for patients with lung cancer and are detected in approximately 15% of Caucasian and 50% of Asian patients. EGFR tyrosine kinase inhibitors have been developed and used for this set of patients. T790M mutation in exon 20 is usually associated with secondary resistance to EGFR tyrosine kinase inhibitors therapy but is also present in treatment-naïve patients. The frequency for baseline T790M mutation varies from 4 to 35% according to the detection method used. Newer techniques have yielded higher rates, but concerns about false-positive results have been raised. Compound mutations account for 4-14% of all EGFR-mutated tumors, with no studies yet to provide a frequency rate for T790M + 19 deletion association due to the small number of cases. However, there are reports that pretreatment T790M + L858R association is significantly more frequent compared to T790M + exon 19 deletion mutations. Diagnostic challenges, current knowledge on the subject, and therapeutic decisions are discussed. CASE PRESENTATION: We present the case of a 43-year-old Hispanic woman, a treatment-naïve patient, with metastasized lung cancer adenocarcinoma harboring a T790M deletion along with the classic 19 mutation. The initial symptoms were monoparesis of her left leg, associated with hyperreflexia, and hypoesthesia. In the absence of third-generation tyrosine kinase inhibitors, a platinum-based therapy was initiated with no response and she died 4 months after diagnosis. CONCLUSIONS: Osimertinib seems to be a suitable therapy for treatment-naïve patients with sensitizing and resistant compound EGFR mutations. More studies regarding the clinical characteristics of these patients and the appropriate management of this condition are needed to provide the highest standard of care.

Reflexos primitivos de neonatos nascidos em uma maternidade no sul do Brasil / Primitive reflexes of neonates born in a maternity in the Rio Grande do Sul State / Reflexiones de los recién nacidos primitivos nacidos en un maternidad en el Estado de Rio Grande do Sul

Objetivo: Quais as associações entre os reflexos primitivos de neonatos nascidos com sexo, cor, estatura, perímetro cefálico, perímetro torácico, índice de Apgar, idade gestacional, tipo de parto, intercorrências durante o trabalho de parto? Método: estudo quantitativo do tipo documental. Foram analisados os prontuários de gestantes e neonatos que nasceram nos meses de agosto a novembro de 2014 na maternidade de um hospital do norte do estado do Rio Grande do Sul. Resultados: Foram estudados 164 prontuários avaliando se nestes constava presença ou ausência de reflexos primitivos descritos na ficha de avaliação do nascimento. A presença de reflexos primitivos do neonatos apresentou significância no que se refere a estatura perímetro cefálico perímetro torácico intercorrências no trabalho de parto e idade gestacional. Conclusão: a presença de reflexos primitivos em neonatos tem uma relação direta com a gestação, parto e pós-parto, assim verifica-se a necessidade de desenvolver ações efetivas de assistência ao pré-natal e parto

Objective: Identifying what are the associations between the newborns' primitive reflexes with sex, color, height, cephalic perimeter, thoracic perimeter, Apgar index, gestational age, type of delivery, and intercurrences during labor. Methods: It is a documentary study with a quantitative approach. The medical records of both pregnant women and newborns were analyzed. The newborns considered in this study were born over the period from August to November 2014, in the maternity ward of a hospital in the Northern region of the Rio Grande do Sul State, Brazil. Results: 164 medical records were studied assessing whether there were presence or absence of primitive reflexes on the birth assessment sheet. The presence of primitive reflexes of the neonates presented significance in terms of height, head circumference, thoracic perimeter, and intercurrences in labor and gestational age. Conclusion: The presence of primitive reflexes in newborns has a direct relationship with gestation, delivery and postpartum, so the need to develop effective prenatal and delivery assistance actions is verified

Objetivo: ¿Cuáles son las asociaciones entre los reflejos primitivos de los recién nacidos que nacen con sexo, color, talla, circunferencia de la cabeza, circunferencia de pecho, las puntuaciones de Apgar, edad gestacional, tipo de parto, complicaciones durante el método de parto y el parto: estudio el tipo de documento. Las historias clínicas de las mujeres embarazadas y los recién nacidos que nacieron en los meses de agosto a noviembre de 2014 en la sala de maternidad de un estado al norte del hospital de Rio Grande do se analizaron Sul Resultados:. Se estudiaron 164 registros evaluar si estos presencia consistido o ausencia de reflejos primitivos descritos el nacimiento de la forma de evaluación. La presencia de reflejos primitivos de los recién nacidos mostró importancia en relación con la altura del cabezal complicaciones circunferencia circunferencia en el trabajo y la edad gestacional. Conclusión: La presencia de reflejos primitivos en los recién nacidos tiene una relación directa con el embarazo, parto y post-parto, por lo que existe la necesidad de desarrollar medidas eficaces de asistencia a la atención prenatal y el parto

A 30 s test for quantitative assessment of a relative afferent pupillary defect (RAPD): the infrared pupillary asymmetry (IPA).

BACKGROUND: Detection of a relative afferent pupillary defect (RAPD) by the swinging-light test can be challenging in clinical practice (dark eyes, anisocoria, dark environment). We developed a new method of RAPD quantification based on the recording of the infrared pupillary asymmetry (IPA) with a standard optical coherence tomography (OCT) device. METHODS: The diagnostic value of the IPA for detection of the RAPD was determined by receiver-operating characteristic (ROC) curves and area under the curve (AUC). RESULTS: Twenty-nine subjects were included in this study (17 controls and 12 unilateral optic neuropathies). The IPA was significantly greater in unilateral optic neuropathies (0.39) compared to controls (0.18, p = 0.001). The diagnostic value was good with a ROC-AUC of 0.843. Importantly, the IPA correlated significantly with the inter-eye percentage difference of the macular ganglion cell-inner plexiform layer (mGCIPL) thickness (R = 0.53, p = 0.01). Assessment of the IPA took less than 30 s. CONCLUSION: The present data show that the IPA is a practical and rapid test that can be applied in a clinical setting. The IPA may be a valuable functional outcome measure for clinical trials, complementing structural retinal OCT data in a biological meaningful way. The IPA should be further investigated for suitability for optic neuritis treatment trials.

Incomplete myelopathy and human T cell lymphotropic virus type-1 (HTLV-1).

This was a cross-sectional prospective study. We performed a multivariate statistical analysis of the neurological signs and symptoms of patients infected with human T cell lymphotropic virus type 1 (HTLV-1) in an attempt to separate them into distinct groups and identify clinical-neurological manifestations that could differentiate the various profiles. The study was performed in the city of Belém (state of Pará), located in the Amazon region of Brazil, from 2014 to 2016. We determined muscle strength and tone, reflexes, sensations, sphincter function, gait, and the Expanded Disability Status Scale score among individuals with HTLV-I. We then used exploratory statistical methods in an attempt to find different profiles and establish distinct groups. We analyzed 60 patients with HTLV-1. The filtering of the data, performed with mixed PCA, gave rise to a streamlined database with the most informative data and suggested the formation of three statistically distinct groups: asymptomatic carriers (AC), mono/oligosymptomatic (MOS), and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSPd), AC and MOS (p = 0.002), AC and HAM/TSPd (p < 0.001), and HAM/TSPd and MOS (p = 0.001). The subsequent cluster analysis confirmed the formation of three clusters. The classification and regression tree demonstrated that altered gait was the most important variable for the classification of an individual with HAM/TSPd and that, in the absence of this impairment, hyperreflexia characterized MOS. The present study was able to separate patients infected by HTLV-1 into three clinical groups (AC, HAM/TSPd, and MOS) and identify clinical manifestations that could differentiate the various patient groups.

Does trans-spinal direct current stimulation modulate the Hoffmann reflexes of healthy individuals? A systematic review and meta-analysisc.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: To summarize the available evidence regarding the effects of trans-spinal direct current stimulation (tsDCS) on spinal monosynaptic circuit excitability in healthy individuals. SETTING: Applied Neuroscience Laboratory, Brazil. METHODS: Abstract screening was performed independently by two authors for studies found in the following databases: PubMed, CINAHL, PsycINFO, Web of Science, and LILACS. If the authors were unable to agree, a third reviewer was consulted. Randomized clinical trials that reported monosynaptic reflex measures were included. Methodological quality was assessed using the Cochrane tool for assessing the risk of bias, and information extracted about the spinal neurophysiological and stimulation protocols and their results. RESULTS: The initial search identified 538 studies. After applying the inclusion criteria and excluding duplicates, seven crossover studies were included in the risk of bias assessment, and six studies in the meta-analyses. The meta-analysis results did not show any significant differences between anodal (pooled standardized mean difference (SMD) = -0.09, 95% CI = -0.72 to 0.55, p = 0.79, I2 = 67%) or cathodal tsDCS (pooled SMD = 0.28, 95% CI = -0.07 to 0.63, p = 0.11, I2 = 0%) and sham tsDCS for Hoffmann reflex modulation. CONCLUSION: tsDCS did not affect the Hoffmann reflex, as shown in six studies. However, these findings come from studies with selection, performance and detection bias, and further research is needed to examine the effect of this intervention.

Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report / Reflexo de Bezold-Jarisch em paciente submetida à simpatectomia endoscópica para tratamento de angina pectoris refratária: relato de caso

Abstract Background and objectives Ischemic cardiomyopathy is characterized by imbalance between supply and demand of myocardial oxygen. Endoscopic transthoracic sympathectomy is a therapeutic option indicated in refractory cases. However, the patient's position on the operating table may favor ischemic coronary events triggering the Bezold-Jarisch reflex. Case report A female patient, 47 years old, with refractory ischemic cardiomyopathy, admitted to the operating room for endoscopic transthoracic sympathectomy, developed the Bezold- Jarisch reflex with severe bradycardia and hypotension after placement in semi-sitting position to the procedure. Conclusion Bradyarrhythmia, hypotension, and asystole are complications potentially associated with patient placement in a semi-sitting position, particularly in cases with previous ischemic heart disease.

Resumo Justificativa e objetivos A cardiomiopatia isquêmica caracteriza-se pelo desbalanço entre a oferta e o consumo de oxigênio pelo miocárdio. A simpatectomia transtorácica endoscópica é uma opção terapêutica indicada nos casos refratários. Contudo, a posição do paciente na mesa cirúrgica pode favorecer eventos coronarianos isquêmicos e deflagrar o reflexo de Bezold-Jarisch. Relato de caso Paciente do sexo feminino, 47 anos, portadora de cardiomiopatia isquêmica refratária, admitida na sala de cirurgia para simpatectomia transtorácica endoscópica, deflagrou o reflexo de Bezold-Jarisch e desenvolveu bradicardia e hipotensão graves logo após colocação em posição semissentada para o procedimento. Conclusão Bradiarritmia, hipotensão e assistolia são complicações potencialmente associadas à colocação do paciente em posição semissentada, especialmente nos casos em que há prévio comprometimento isquêmico do coração.