ACTIVE-FIT program: Assessment of sleep quality and its relationship with physical activity in patients with relapsing-remitting multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) causes sleep disturbances in up to 70 % of individuals. These problems are linked to fatigue, mood and cognitive performance, thereby affecting the quality of life in people with MS (PwMS). The frequent and debilitating side effects of sleep medications prompt the exploration of alternative therapies. Physical activity has shown benefits in improving sleep, reducing fatigue, and enhancing quality of life. Combined with a controlled exercise program tailored for PwMS, the study aims to analyze the impact of moderate physical exercise on sleep quality, cognitive function, quality of life, mood, and fatigue. METHODS: A single-center prospective cohort study was designed to assess the impact of a 12-week physical exercise program on patients with relapsing-remitting multiple sclerosis. Changes in sleep and activity parameters are evaluated using an actigraph and cognitive, quality of life, fatigue and mood changes are assessed through specific questionnaires before, during, and after the exercise program application. RESULTS: 23 patients completed the study (women = 84.6 %) Mean age was 37.2 years (SD 7.5). The mean EDSS score was 1.9, and 80.8 % were diagnosed within the last six years. Significant improvements were noted in sleep efficiency between baseline and final measurements (χ2 = 27.5; p.adj = 0.004), sleep latency (χ2 = 275; p.adj = 0.000), sleep duration (χ2 = 251; p.adj = 0.001) and in the number of awakenings (χ2 = 269.5; p.adj = 0.000), with a decreased in total time in bed from 8.5 h to 7.35 h post-intervention. Regarding activity variables, an increase in caloric expenditure and an increase in the time participants engaged in light activity were observed. We found significant improvements in fatigue, quality of life and mood. Concerning neuropsychological exploration results, improvements were observed in all studied parameters, with statistically significant improvement in Verbal SRT (χ2 = 43; p = 0.022). CONCLUSION: Our study showed a positive impact of a 12-week physical exercise program on sleep performance, cognition and mood in PwMS. The observed improvements underscore the potential of tailored exercise interventions in promoting a more comprehensive and holistic care paradigm for PwMS.

Hopelessness in Patients with Early-Stage Relapsing-Remitting Multiple Sclerosis.

Background: Hopelessness is a risk factor for depression and suicide. There is little information on this phenomenon among patients with relapsing-remitting multiple sclerosis (RRMS), one of the most common causes of disability and loss of autonomy in young adults. The aim of this study was to assess state hopelessness and its associated factors in early-stage RRMS. Methods: A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The State-Trait Hopelessness Scale (STHS) was used to measure patients´ hopelessness. A battery of patient-reported and clinician-rated measurements was used to assess clinical status. A multivariate logistic regression analysis was conducted to determine the association between patients' characteristics and state hopelessness. Results: A total of 189 patients were included. Mean age (standard deviation-SD) was 36.1 (9.4) years and 71.4% were female. Median disease duration (interquartile range-IQR) was 1.4 (0.7, 2.1) years. Symptom severity and disability were low with a median EDSS (IQR) score of 1.0 (0, 2.0). A proportion of 65.6% (n=124) of patients reported moderate-to-severe hopelessness. Hopelessness was associated with older age (p=0.035), depressive symptoms (p=<0.001), a threatening illness perception (p=0.001), and psychological and cognitive barriers to workplace performance (p=0.029) in the multivariate analysis after adjustment for confounders. Conclusion: Hopelessness was a common phenomenon in early-stage RRMS, even in a population with low physical disability. Identifying factors associated with hopelessness may be critical for implementing preventive strategies helping patients to adapt to the new situation and cope with the disease in the long term.

Detecting disability using self-reported and clinical assessments in early-stage relapsing-remitting multiple sclerosis: Looking for a complementary approach.

Disability accrual is mainly driven by progression independent of relapse activity, which is present even in early stages of relapsing-remitting multiple sclerosis (RRMS) and sometimes overlooked. This multicenter, non-interventional study evaluated whether patient-reported outcomes measures (PROMs) could capture disability in 189 early-stage RRMS patients (mean age: 36.1 ± 9.4 years, 71.4% female, mean disease duration: 1.4 ± 0.8 years, median EDSS: 1.0). The 9-Hole Peg Test (9-HPT), NeuroQoL Upper Extremity (NeuroQoL-UE), Timed 25-Foot Walk (T25-FW), Multiple Sclerosis Walking Scale (MSWS-12), Symbol Digit Modalities Test (SDMT), and Perceived Deficits Questionnaire (PDQ-5) were used to assess hand function, gait, and cognition, respectively. These functions were at least mildly affected in this early-stage population, finding significant correlations between PROMs and clinical assessments. PROMs could enable early-stage RRMS patients to communicate their perceived disability in different domains, assisting clinicians in disease monitoring and decision making.

[Accounting basics for the self-employed physician]. / Notions de base de comptabilité à l'intention du médecin indépendant.

The work of a self-employed physician being a liberal activity, his practice does not only require the mastery of the medical art but also of the financial management of his practice. This article aims at reminding some basic accounting notions necessary for the adequate financial management of a medical practice.

Le travail du médecin indépendant étant une activité libérale, sa pratique n'impose pas seulement la maîtrise de l'art médical, mais également celle de la gestion financière de son cabinet. Cet article a pour but de rappeler quelques notions de base de comptabilité nécessaires à la gestion financière adéquate d'un cabinet médical.

Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis.

BACKGROUND: The evolving therapeutic landscape requires more participation of patients with relapsing remitting multiple sclerosis (RRMS) in treatment decisions. The aim of this study was to assess the association between patient's self-perception, cognitive impairment and behavioral factors in treatment choices in a cohort of patients at an early stage of RRMS. METHODS: We conducted a multicenter, non-interventional study including adult patients with a diagnosis of RRMS, a disease duration ≤18 months and receiving care at one of the 21 participating MS centers from across Spain. We used patient-reported measures to gather information on fatigue, mood, quality of life, and perception of severity of their MS. Functional metrics (Expanded Disability Status Scale [EDSS], cognitive function by the Symbol Digit Modalities Test [SDMT], 25-foot walk test) and clinical and radiological data were provided by the treating neurologist. The primary outcome of the study was status quo (SQ) bias, defined as participant's tendency to continue taking a previously selected but inferior treatment when intensification was warranted. SQ bias was assessed based on participants treatment preference in six simulated RRMS case scenarios with evidence of clinical relapses and radiological disease progression. RESULTS: Of 189 participants who met the inclusion criteria, 188 (99.5%) fully completed the study. The mean age was 36.6 ± 9.5 years, 70.7% female, mean disease duration: 1.2 ± 0.8 years, median EDSS score: 1.0 [IQR=0.0-2.0]). Overall, 43.1% patients (n = 81/188) had an abnormal SDMT (≤49 correct answers). SQ bias was observed in at least one case scenario in 72.3% (137/188). Participant's perception of their MS severity was associated with higher SQ bias (ß coeff 0.042; 95% CI 0.0074-0.076) among those with delayed cognitive processing. Higher baseline EDSS and number of T2 lesions were predictors of delayed processing speed (OR EDSS=1.57, 95% CI: 1.11-2.21, p = 0.011; OR T2 lesions=1.50, 95% CI: 1.11-2.03, p<0.01). Bayesian multilevel model accounting for clustering showed that delayed cognitive processing (exp coeff 1.06; 95% CI 1.04-1.09) and MS symptoms severity (exp coeff 1.28; 95% CI 1.22-1.33) were associated with SQ bias. CONCLUSION: Over 40% of patients in earlier stages of RRMS experience delays in cognitive processing that might affect their decision-making ability. Our findings suggest that patients' self-perception of disease severity combined with a delay in cognitive processing would affect treatment choices leading to status quo bias early in the course of their disease.

Long-term prognosis communication preferences in early-stage relapsing-remitting multiple sclerosis.

BACKGROUND: Multiple sclerosis is one of the most common causes of neurological disability in young adults with major consequences for their future lives. Improving communication strategies on prognosis may help patients deal with the disease and adjust their long-term life goals. However, there is limited information on patients' preferences of long-term prognosis (LTP) communication and associated factors. OBJECTIVE: The aim of this study was to describe patients' preferences and assess the factors associated with LTP communication preferences in early-stage relapsing-remitting multiple sclerosis (RRMS) patients. METHODS: A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration from first attack ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The Prognosis in MS questionnaire was used to assess how much patients want to know about their LTP. Different patient-reported measures were administered to gather information on symptom severity, pain, fatigue, mood/anxiety, quality of life, stigma, illness perception, feeling of hopelessness, self-efficacy, information avoidance and coping strategies. Cognition was assessed using the Symbol Digit Modalities Test (SDMT). A multivariate logistic regression analysis was performed to assess the association between LTP information preference and demographic and clinical characteristics, as well as patients' perspectives. RESULTS: A total of 189 patients were included (mean age: 36.1  ±  9.4 years, 71.4% female, mean disease duration: 1.2  ±  0.8 years). Median EDSS score was 1.0 (IQR = 0.0-2.0). A proportion of 68.5% (n  =  126) of patients had never discussed LTP with their neurologists, whereas 69.2% (n = 126) reported interest in knowing it (73.5% at diagnosis). Bivariate analyses suggested that patients were significantly more likely to have higher LTP information preferences if they were male and had a lower SDMT score. Male gender and a lower SDMT score were predictors of LTP information preferences. CONCLUSIONS: Patients with early-stage RRMS want to discuss their LTP shortly after diagnosis. Understanding the factors involved may be useful to design individualized communication strategies.

Understanding Retention in Pre-Exposure Prophylaxis Care in the South: Insights from an Academic HIV Prevention Clinic.

HIV pre-exposure prophylaxis (PrEP) is poorly utilized in the southern United States. We examined PrEP retention in care and sexually transmitted infections (STIs) through a retrospective review of the Duke University PrEP Clinic from January 1, 2015 to October 15, 2019. We evaluated short-term (3 months), long-term (additional 8-12 months), and longitudinal retention in care in our clinic. Adjusted odds ratios (aOR) were generated to explore demographics associated with retention. Kaplan-Meier curves were generated to view retention longitudinally. STIs were examined at baseline (1 year before initial PrEP visit) and while retained in care. Of a total of 255 patients; 88% were men, 37% were black, and 73% were men who have sex with men (MSM). Short- and long-term retention in care were met by 130/237 (55%) and 80/217 (37%) patients, respectively. MSM were more likely to be retained in the short term (aOR = 5.22, 95% confidence interval [CI] = 1.57-17.32). Self-referred patients were more likely to be retained in the long term (aOR = 2.18, 95% CI = 1.12-4.23). Uninsured patients were less likely to be retained in the long term (aOR = 0.32, 95% CI = 0.11-0.91). STI diagnoses include 42 infections at baseline and 69 infections during follow-up. STI diagnosed while in PrEP care was associated with longer retention in care over time. Patients discontinue PrEP care over time and STIs were frequently encountered. Additional studies are needed to determine the best way to retain patients in HIV preventative care.

Measuring productivity loss in early relapsing-remitting multiple sclerosis.

BACKGROUND: Multiple sclerosis is one of the most common causes of neurological disability in young adults with major consequences for their autonomy and capacity to maintain employment. OBJECTIVE: The aim of this study was to assess the impact on work productivity in early-stage relapsing-remitting multiple sclerosis (RRMS). METHODS: A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. Absenteeism, presenteeism, and unpaid work loss due to RRMS were measured using the Valuation of Lost Productivity (VOLP) questionnaire. The EDSS, SymptoMScreen, 5-item Modified Fatigue Impact Scale, Hospital Anxiety and Depression Scale, Symbol Digit Modalities Test, and Multiple Sclerosis Work Difficulties Questionnaire were used to gather information on disability, patients' perception of symptom severity, fatigue, mood/anxiety, cognition, and problems in the workplace, respectively. Associations between the VOLP and clinical and work outcomes were analyzed using Spearman's rank correlations. RESULTS: A total of 189 patients were included. Mean age (SD) was 36.1 ± 9.4 years and 71.4% were female. Mean disease duration was 1.2 ± 0.8 years. Median EDSS score was 1.0 (IQR 0, 2.0). One hundred thirty patients (68.8%) were working for pay or self-employed. Fifty-three patients (40.8%) reported absence from work in the past 3 months with an average of 14.3 absent workdays. Their health problems resulted in the loss of 3.4% of their actual work time in the past 7 days. Thirty patients got help (11.8 h) with their unpaid work activities in the past 7 days. Absenteeism was significantly correlated with anxiety and depression (rho=0.298 and 0.291, p<0.001), fatigue (rho=0.214, p = 0.014), and symptom severity (rho=0.213, p = 0.015). Presenteeism was significantly correlated with fatigue (rho=0.375, p<0.001), symptom severity (rho=0.373, p<0.001), depression (rho=0.263, p = 0.008), and disability (rho=0.215, p = 0.031). CONCLUSIONS: Productivity loss even in a RRMS population with short disease duration stresses the need for more efficient treatment control of disease activity from earlier stages.

Family literacy in preschoolers' linguistic and metalinguistic skill development / A literacia familiar no desenvolvimento de habilidades linguísticas e metalinguísticas de pré-escolares

ABSTRACT Purpose: to verify family literacy practices with preschoolers from a public school in a municipality of the Northeast Region of Brazil. Methods: 21 parents/guardians of pre-kindergarten and kindergarten students from a public school participated in this study. A questionnaire with 18 items on the parents'/guardians' participation in family literacy practices was develop for this research. The resulting data underwent descriptive and inferential analysis, with the significance level set at 5%. Results: the preschoolers' mean age was 69 months, and that of the parents/guardians who answered the questionnaire was 31 years. The educational level of most parents/guardians was either high school or unfinished middle school. A significant, positive relationship, between the parents'/guardians' educational level and the following questionnaire items was seen: paying attention to the children when they spoke, calling their attention to the sound of letters and words, and teaching/encouraging them to write their names. Conclusion: family literacy practices are not commonly developed in the culture of the Northeast Region of Brazil, and when so, most of them are similar to activities taught at school. There was also a weak correlation between the parents'/guardians' educational level and the family literacy practices.

RESUMO Objetivo: verificar a prática de literacia familiar com crianças pré-escolares de uma escola pública de um município da região nordeste do Brasil. Métodos: participaram 21 pais ou responsáveis de crianças pré-escolares do Infantil IV e V de uma escola pública. Um questionário com 18 perguntas sobre a participação dos pais ou responsáveis em práticas de literacia familiar foi elaborado para a pesquisa. Os dados obtidos foram analisados de forma descritiva e inferencial, adotando-se nível de significância de 5%. Resultados: a média da idade dos pré-escolares foi de 69 meses e dos pais ou responsáveis que responderam ao questionário foi de 31 anos. A escolaridade da maioria dos pais era Ensino Fundamental Incompleto ou Ensino Médio Completo. Sobre a relação positiva entre a escolaridade dos pais/responsáveis e os itens do questionário, houve significância entre as práticas de prestar atenção quando a criança fala, demonstrar os sons das letras e palavras e ensinar/incentivar a criança a escrever seu próprio nome. Conclusão: práticas de literacia familiar não são comumente desenvolvidas na cultura do nordeste brasileiro e quando são relacionam-se mais àquelas cujas atividades assemelham-se ao que é ensinado em ambiente escolar. Também foi encontrada correlação fraca entre escolaridade dos responsáveis e as práticas de literacia familiar.

Forms of nitrogen fertilizer application in Panicum maximum / Formas de aplicação de adubo nitrogenado em Panicum maximum

Nitrogen is one of the most important nutrients for increasing the yield and quality of forages. This study aimed to evaluate the effect of the different forms of application, spread on the total area using urea fertilizer and foliar using liquid urea, aiming at evaluating the yield and qualitative traits of Panicum maximum cv. Mombaça, at different times of the year. The experimental design was completely randomized blocks in subdivided plots, with three blocks, four treatments, and three collections. The treatments were applied in March 2015 and consisted of the following treatments: 1-control; 2-urea; 3-liquid urea; 4-urea + liquid urea; 5-urea + micronutrients; 6-urea + N liquid; 7-urea + N liquid + micronutrients; 8-control. Samples were collected in May, October, and December 2015. Crude protein (CP) dry matter (DM), mineral matter (MM), and acid detergent fiber (ADF) were evaluated. Results revealed that nitrogen was determinant in improving the yield and forage quality. Treatments with urea spread on total area resulted in increased dry matter production. For the crude protein, the source and the application form are not decisive. Collection time with higher rainfall positively affected the dry matter production, crude protein, and ADF, while urea spread on total area showed the best cost-benefit due to the good results of yield and quality.

O nitrogênio é um dos nutrientes mais importantes para o aumento da produtividade e qualidade das forrageiras. Este trabalho teve como objetivo avaliar o efeito das diferentes formas de aplicações, sendo elas à lanço (utilizando ureia fertilizante) e foliar (utilizando ureia líquida), a fim de avaliar as características produtivas e qualitativas da forrageira Panicum maximum cv. Mombaça, em diferentes épocas do ano. O delineamento experimental foi o de blocos inteiramente casualizados em parcelas subdivididas, com oito tratamentos e três coletas. Os tratamentos foram aplicados em março de 2015 e eram constituídos pelo tratamento 1: controle, tratamento 2: ureia, tratamento 3: ureia líquida, 4: ureia + ureia líquida; 5-ureia + micronutrientes; 6-ureia + N líquido; 7- ureia + N líquido + micronutrients; 8-controle. Foram realizadas coletas em maio/2015, outubro/2015 e dezembro/2015. Foram avaliadas proteína bruta (PB), massa de matéria seca (MMS), matéria mineral (MM) e fibra em detergente ácido (FDA). Os resultados revelaram que o nitrogênio foi determinante na melhora da produtividade e qualidade da forrageira. Os tratamentos com ureia aplicada a lanço resultaram na maior produção de massa de matéria seca. Para a proteína bruta, a fonte e o formato de aplicação não foram decisivos. A época de coleta com maior pluviosidade afetou positivamente a produção de massa de matéria seca, proteína bruta e o FDA da forrageira; e a ureia aplicada a lanço apresentou o melhor custo-benefício atrelado aos bons resultados de produtividade e qualidade.

Types of handwriting and signs of dysgraphia in children and adolescents with learning difficultie / Tipologia de letra e sinais sugestivos de disgrafia em crianças e adolescentes com dificuldade de aprendizagem

ABSTRACT Purpose: to characterize handwriting aspects of children and adolescents with complaints of learning difficulties, based on the type of handwriting they used. Methods: thirty-two children and adolescents participated in the study. They were first to eighth graders of both sexes, aged 7 to 15 years, with complaints of learning difficulties. The participants were divided according to the type of letter they used: SG1 (block letters), SG2 (cursive letters), and SG3 (mixed letters). A themed composition was analyzed with an adapted Dysgraphia Scale. Afterwards, the score obtained in the items of the Dysgraphia Scale was statistically analyzed, comparing the results between the three groups, between SG1 and SG2, SG1 and SG3, and SG2 and SG3. Appropriate statistical tests were applied, considering as significant the p-value < 0.05. Results: no difference was found regarding the groups' age and schooling level. As for the items in the Scale, there was a difference between the three groups regarding irregular spacing in between words, collisions and adhesions, and total score. Signs of dysgraphia were observed in the three groups, according to the Scale's criteria. Conclusion: changes in handwriting are common in children with learning difficulties, especially when they write using cursive and mixed letters.

RESUMO Objetivo: caracterizar aspectos da escrita de crianças e adolescentes com queixa de dificuldades de aprendizagem a partir do tipo de letra utilizada. Métodos: participaram 32 crianças e adolescentes, ambos os sexos, faixa etária entre sete e quinze anos, entre o primeiro e o oitavo ano do ensino fundamental com queixa de dificuldade de aprendizagem. Os participantes foram divididos conforme o tipo de letra: GE1 (letra bastão), GE2 (letra cursiva) e GE3 (letra mista). Analisou-se a escrita temática a partir da adaptação de uma Escala de Disgrafia. Posteriormente, foi realizada a análise estatística da pontuação obtida nos itens da Escala de Disgrafia, comparando os resultados entre os três grupos, GE1 e GE2, GE1 e GE3, GE2 e GE3. Foram aplicados testes estatísticos pertinentes, considerado significante valor de p<0,05. Resultados: não foi encontrada diferença quanto a idade e escolaridade dos grupos. Com relação aos itens da Escala, houve diferença entre os três grupos para o espaçamento irregular de palavras, colisões e aderências e na pontuação total. Observou-se presença de sinais de disgrafia nos três grupos, conforme critérios da escala. Conclusão: alterações de escrita são comuns em crianças com dificuldade de aprendizagem, principalmente quando utilizada a escrita de letras cursiva e mista.

Soil biomass and microbial activity in soybean crop area under different cover crops and different soil correction systems / Biomassa e atividade microbiana do solo em área de cultivo de soja sob diferentes plantas de cobertura e diferentes sistemas de correção de solo

This study aimed to evaluate soil biomass and microbial activity and soybean yield under different limestone and gypsum doses and different cover crops. The experiment was carried out in the experimental area of the Fundação de Apoio a Pesquisa Agropecuária de Chapadão, on a Dystrophic Red Latosol, using cultivar Desafio. The experiment consisted of a randomized blocks design, in a split-plot factorial scheme (3x4x3), with three replications. Plots consisted of three gypsum doses: control (without gypsum), recommended dose (2.3 Mg ha-1), and double dose (4.6 Mg ha-1). Subplots consisted of four limestone doses (2, 4, and 6 Mg ha-1) and the control (without limestone). Each block had three different cover crops: Brachiaria, Millet, and allow. The values obtained with the test revealed that brachiaria had better basal respiration in the absence of gypsum. Conversely, millet had better basal respiration in with the gypsum dose. Basal respiration, using brachiaria as cover crop, was higher at the dose of 2700 kg ha-1 of limestone. However, for the fallow and the millet, basal respiration was higher when using the highest limestone dose of 6000 kg ha-1. The variable microbial biomass showed differences between cover crops only in the absence of gypsum. Brachiaria and fallow presented the highest mean for microbial biomass. The use of millet as a cover crop together with gypsum doses increased the microbial biomass. The variables mass of 100 grains and grain yield had higher mean at the limestone dose of 6000 kg ha-1 .

O objetivo do trabalho foi avaliar a biomassa e atividade microbiana do solo, e produtividade da soja sob efeito das diferentes doses de calcário e gesso e diferentes coberturas de solo. O experimento foi conduzido na área experimental da Fundação de Apoio a Pesquisa Agropecuária de Chapadão, sob Latossolo Vermelho Distrófico, com a cultivar Desafio. O delineamento experimental utilizado foi em blocos casualizados, em esquema fatorial (3x4x3) de parcelas subdividas, com 3 repetições. As parcelas foram constituídas por 3 quantidades de gesso agrícola, sendo: controle (sem gesso), recomendado (2,3 Mg ha-1) e o dobro (4,6 Mg ha-1), as subparcelas por 4 doses de calcário (2, 4 e 6 Mg ha-1), além do controle (sem calcário), onde cada bloco apresentou 3 coberturas diferentes: Braquiaria, Milheto e Pousio. Os resultados foram submetidos ao teste de Tukey 5%. Com os valores obtidos pudemos observar que a respiração basal foi melhor para braquiária na ausência de gesso, e na presença o milheto se saiu melhor. A respiração basal, utilizando a braquiária como cobertura, foi maior na dose de 2700 kg ha-1 de calcário. Já utilizando o pousio e o milheto foi na maior dose 6000 kg ha-1. A variável biomassa microbiana apresentou diferença entre as coberturas apenas na ausência de gesso, onde a braquiária e o pousio apresentaram as maiores médias para esta variável. A utilização do milheto como cobertura em conjunto com as doses de gesso acarretou aumento da biomassa microbiana. A massa de 100 grãos e a produtividade de grãos apresentaram maior média na dose de 6000 kg ha-1 de calcário.

Altered individual behavioral and EEG parameters are related to the EDSS score in relapsing-remitting multiple sclerosis patients.

Functional neuroanatomy of cognitive impairment in multiple sclerosis is currently still a challenge. During the progression of the disease, several cognitive mechanisms deteriorate thus diminishing the patient's quality of life. A primary objective in the cognitive assessment of multiple sclerosis (MS) patients is to find reliable measures utilizing diverse neuroimaging techniques. Moreover, especially relevant in the clinical environment is finding technical approaches that could be applied to individual participants and not only for group analysis. A 64-channel electroencephalographic recording (EEG) was made with thirty participants divided into three groups of equivalent size (N = 10) (healthy control, low-EDSS (1-2.5) and moderate-EDSS (4-6)). Correlation analysis was applied to multiple measures: behavior, neuropsychological tests (Paced Auditory Serial Addition Test, 3 seconds (PASAT-3s) and the Symbol Digit Modality Test (SDMT)), Expanded Disability Status Scale (EDSS), even-related potential (P3) and event-related desynchronization (ERD) parameters and the correlation scores between individual participant's P3/ERD maps and the healthy grand average P3/ERDmaps. Statistical analysis showed that diverse parameters exhibited significant correlations. A remarkable correlation was the moderate score found between SDMT and EDSS (r = -0.679, p = 0.0009). However, the strongest correlation was between the value of integrated measures (reaction time, P3 and ERD latency) and EDSS (r = 0.699, p = 0.0006). In regard to correlations for grand average maps between groups, the P3 component exhibited a lower score according to a more deteriorated condition (higher EDSS). In contrast, ERD maps remained stable with an increase of EDSS. Lastly, a Z-transformation of individual values of all variables included in the study exhibited heterogeneity in cognitive alterations in the multiple sclerosis participants.

Impacto clínico e na qualidade de vida em pacientes submetidos ao implante transcateter da valva pulmonar Melody / Clinical impact and quality of life in patients undergoing to transcatheter pulmonary valve implant Melody

INTRODUÇÃO: O Implante transcateter da valva pulmonar (ITVP) é terapia consagrada para o reestabelecimento da via de saída do ventrículo direito (VD) em pacientes com disfunção pulmonar grave. Apesar de promover melhora do VD, pouco se sabe sobre o seu impacto na qualidade de vida (QV). MÉTODOS: Estudo prospectivo e multicêntrico com pacientes submetidos ao ITVP, com enfoque no impacto clínico e na qualidade de vida. Pacientes com disfunção pulmonar grave e submetidos ao ITVP foram incluídos. Dados clínicos, ecocardiográficos (ECO), de teste cardiopulmonar (TCP) e ressonância magnética (RNM) previamente e 1 ano após o ITVP foram comparados (média e desvio-padrão). Da mesma forma, foi avaliada a qualidade de vida através do questionário SF-36 para os maiores de 18 anos e SF-10 para os menores. RESULTADOS: De 17/12/2013 a 31/12/2017 foram incluídos 19 pacientes (11 masculinos). No procedimento tinham média de 21,0±7,1 anos e 56,2±15,7 Kg. O número de cirurgias prévias foi de 2 (1-4) e o tempo desde a última foi 10,6±5,6 anos. Dez pacientes apresentavam estenose pulmonar (53%), 4 insuficiências (21%) e 5 lesões mista (26%). Foi observado sucesso imediato, com queda do gradiente sistólico ao cate de 38,8±22,0 para 9,9±6,8 mmHg e relação das pressões do VD/Aorta de 0,70±0,21 para 0,37±0,07 mmHg (ambos p 0,001). Após 1 ano de seguimento, houve melhora dos índices: Classe funcional de 2 (1-3) para 1 (1-2) (p < 0,001), frequência cardíaca máxima ao TCP de 81,0±7,9 para 85,9±11,4 bpm (p 0,006), volumes diastólico e sistólico finais de VD (VDFVD e VSFVD) à RNM de 109,1±33,3 e 60,8±29,0 ml/m2 para 92,5±29,2 e 47,9±19,9 ml/m2 (p <0,0001 e p 0,004), respectivamente. Além disto, aumento dos VDFVE e VSFVE de 80,0±19,6 e 32,1±10,6 ml/m2 para 87,9±16,2 e 37,7±10,8 ml/m2 (p 0,049 e p 0,035). A análise da QV mostrou melhora somente nos pacientes maiores de 18 anos, com aumento da percepção de saúde física (PCS) de 45,7±8,0 para 52,1±6,3 (p 0,006) e saúde mental (MCS) de 46,1±11,2 para 55,1±8,4 (p 0,008). Neste período, não houve óbitos. Um dos pacientes apresentou endocardite bacteriana 9 meses após o implante e necessitou cirurgia cardíaca para troca valvar, com sucesso, sem complicações. CONCLUSÃO: O ITVP mostrou-se factível, seguro eficaz na primeira experiência brasileira. Após 1 ano de seguimento, houve inquestionável melhora clínica e na qualidade de vida - esta última, somente nos pacientes maiores de idade, provavelmente em virtude do baixo número de incluídos. (AU)

Tratamento percutâneo de pseudoaneurismas do ventrículo esquerdo e da aorta: série de três casos / Percutaneous treatment of left ventricle and aortic pseudoaneuryms: three case series

Pseudoaneurismas do ventrículo esquerdo são geralmente associados a infarto agudo do miocárdio, entretanto, podem surgir no pós-operatório tardio de cirurgias valvares, assim como os pseudoaneurismas aórticos. Acometem frequentemente pacientes com alto risco cirúrgico, e o tratamento percutâneo éhabitualmente realizado em centros de referência para o tratamento de cardiopatias congênitas devido às características anatômicas dos defeitos. Apresentamos dois casos de pseudoaneurismas do ventrículoesquerdo tratados por via transapical, sem necessidade de circulação extracorpórea, e um caso depseudoaneurisma aórtico tratado por via femoral, no qual foi utilizado laço por acesso contralateral para permitir suporte e direcionamento adequados da bainha longa para acessar o defeito...

Left ventricular pseudoaneurysms are usually associated with acute myocardial infarction; however, these conditions may emerge in the late postoperative period of valvar surgery, and this can also occur with aortic pseudoaneurysms. These pseudoaneurysms often affect patients with high surgical risk,and percutaneous treatment is usually performed in reference centers for treatment of congenital heartdiseases, due to anatomical characteristics of these defects. We present two cases of left ventricularpseudoaneurysms treated by transapical approach without need for cardiopulmonary bypass, and one caseof aortic pseudoaneurysm treated by femoral approach, in which a snare was introduced by contralateral access, to allow for adequate support and guidance of the long sheath for accessing the defect...

A comparison of radiation dose between standard and 3D angiography in congenital heart disease.

BACKGROUND: The use of three-dimensional rotational angiography (3D-RA) to assess patients with congenital heart diseases appears to be a promising technique despite the scarce literature available. OBJECTIVES: The objective of this study was to describe our initial experience with 3D-RA and to compare its radiation dose to that of standard two-dimensional angiography (2D-SA). METHODS: Between September 2011 and April 2012, 18 patients underwent simultaneous 3D-RA and 2D-SA during diagnostic cardiac catheterization. Radiation dose was assessed using the dose-area-product (DAP). RESULTS: The median patient age and weight were 12.5 years and 47.5 Kg, respectively. The median DAP of each 3D-RA acquisition was 1093µGy.m2 and 190µGy.m2 for each 2D-SA acquisition (p<0.01). In patients weighing more than 45Kg (n=7), this difference was attenuated but still significant (1525 µGy.m2 vs.413µGy.m2, p=0.01). No difference was found between one 3D-RA and three 2D-SA (1525µGy.m2 vs.1238 µGy.m2, p = 0.575) in this population. This difference was significantly higher in patients weighing less than 45Kg (n=9) (713µGy.m2 vs.81µGy.m2, P = 0.008), even when comparing one 3D-RA with three 2D-SA (242µGy.m2, respectively, p<0.008). 3D-RA was extremely useful for the assessment of conduits of univentricular hearts, tortuous branches of the pulmonary artery, and aorta relative to 2D-SA acquisitions. CONCLUSIONS: The radiation dose of 3D-RA used in our institution was higher than those previously reported in the literature and this difference was more evident in children. This type of assessment is of paramount importance when starting to perform 3D-RA.

A Comparison of Radiation Dose Between Standard and 3D Angiography in Congenital Heart Disease / Comparação das Doses de Radiação entre Angiografias Padrão e 3D em Cardiopatias Congênitas

Background: The use of three-dimensional rotational angiography (3D-RA) to assess patients with congenital heart diseases appears to be a promising technique despite the scarce literature available. Objectives: The objective of this study was to describe our initial experience with 3D-RA and to compare its radiation dose to that of standard two-dimensional angiography (2D-SA). Methods: Between September 2011 and April 2012, 18 patients underwent simultaneous 3D-RA and 2D-SA during diagnostic cardiac catheterization. Radiation dose was assessed using the dose-area-product (DAP). Results: The median patient age and weight were 12.5 years and 47.5 Kg, respectively. The median DAP of each 3D-RA acquisition was 1093µGy.m2 and 190µGy.m2 for each 2D-SA acquisition (p<0.01). In patients weighing more than 45Kg (n=7), this difference was attenuated but still significant (1525 µGy.m2 vs.413µGy.m2, p=0.01). No difference was found between one 3D-RA and three 2D-SA (1525µGy.m2 vs.1238 µGy.m2, p = 0.575) in this population. This difference was significantly higher in patients weighing less than 45Kg (n=9) (713µGy.m2 vs.81µGy.m2, P = 0.008), even when comparing one 3D-RA with three 2D-SA (242µGy.m2, respectively, p<0.008). 3D-RA was extremely useful for the assessment of conduits of univentricular hearts, tortuous branches of the pulmonary artery, and aorta relative to 2D-SA acquisitions. Conclusions: The radiation dose of 3D-RA used in our institution was higher than those previously reported in the literature and this difference was more evident in children. This type of assessment is of paramount importance when starting to perform 3D-RA. .

Fundamento: O uso da angiografia rotacional tridimensional (AR-3D) na avaliação de pacientes portadores de cardiopatia congênita parece ser promissor, apesar de haver pouca literatura disponível. Objetivos: O objetivo deste estudo foi descrever nossa experiência inicial com AR-3D, comparando sua dose de radiação com a da angiografia padrão bidimensional (AP-2D). Métodos: Entre setembro de 2011 e abril de 2012, 18 pacientes foram submetidos simultaneamente a AR-3D e AP-2D durante cateterização cardíaca diagnóstica. A dose de radiação foi avaliada através do produto dose-área (DAP). Resultados: A mediana de idade e de peso dos pacientes foi de, respectivamente, 12,5 anos e 47,5 kg. O DAP mediano de cada aquisição em AR-3D foi de 1093µGy.m2, e de 190µGy.m2 para cada aquisição em AP-2D (p < 0,01). Nos pacientes que pesavam mais de 45 kg (n=7), essa diferença foi menor, mas ainda significativa (1525µGy.m2 versus 413 µGy.m2, p = 0,01). Não houve diferença entre uma AR-3D e três AP-2D (1525µGy.m2 versus1238µGy.m2, p = 0,575) nesta população. Essa diferença foi significativamente maior em pacientes que pesavam menos de 45 kg (n = 9) (713 µGy.m2 versus 81 µGy.m2, p = 0,008), mesmo quando se comparou uma AR-3D com três AP 2D (242µGy.m2, respectivamente, p < 0,008). A AR-3D mostrou-se extremamente útil na avaliação de condutos de corações univentriculares, ramos pulmonares tortuosos e aorta em relação às aquisições em AP-2D. Conclusões: A dose de radiação da AR-3D em nossa instituição foi maior que a anteriormente relatada na literatura, sendo essa diferença mais evidente em crianças. Esse tipo de avaliação é de fundamental importância ...