Cerebral mansoni schistosomiasis: a systematic review of 33 cases published from 1989 to 2019.

BACKGROUND: We investigated the epidemiology, clinical presentation and outcomes of individuals affected by cerebral schistosomiasis. METHODS: This systematic review was planned in accordance with current guidelines for performing comprehensive systematic reviews and meta-analysis, including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. RESULTS: Most of patients presented with seizures (48.5%), which is a non-specific symptom despite its high prevalence. There was no specific clinical manifestation that could help the diagnosis, which was made in 69.7% by histopathological analysis of brain tissue. CONCLUSIONS: Seizures are a non-specific symptom to diagnose patients with cerebral schistosomiasis and accurate clinical indicators need to be derived through further studies.

Label-free nanostructured biosensor for Schistosoma mansoni detection in complex biological fluids.

Schistosomiasis is a neglected tropical disease with a worldwide prevalence. Neuroschistosomiasis is the most severe presentation of the disease and affects the central nervous system. In this work, Schistosoma mansoni detection was based on self-assembled layers of 3-mercaptopropyltrimethoxysilane (MPTS) and electrosynthesized gold nanoparticles (AuNPs). The DNA probe was chemisorbed onto AuNPs. The biosensor was characterized by electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV). The impedimetric response of the MPTS-AuNPs-DNAprobe system indicates an effective modification of the electrode surface. Topographical atomic force microscopy images were used to characterize the self-assembled layers on the gold electrode surface. The proposed biosystem was able to recognize the S. mansoni genome sequence at different concentrations in samples of urine, cerebrospinal fluid, and serum. Several concentration ranges were evaluated: urine (27-50 pg µL-1), cerebrospinal fluid (25-60 pg µL-1), and serum (27-42 pg µL-1). The limit detection (LOD) of the biosensor was 0.6 pg µL-1. The developed label-free genosensor was able to detect small concentrations of S. mansoni DNA in complex biological fluids.

Neuropsychiatric symptoms in vascular dementia: Epidemiologic and clinical aspects.

Dementia is a general term for a heterogeneous group of organic neurodegenerative diseases. Cerebrovascular causes account for 20% of cases. OBJECTIVE: To describe the clinical and epidemiological features of individuals aged >60 years diagnosed with vascular dementia (VD) or mixed dementia (MxD) in a referral hospital for dementia. METHODS: A descriptive, retrospective study was carried out from 2014 to 2017 involving elderly individuals (≥60 years) with VA or MxD. Patients presenting other forms of dementia or in use of medication that mimics cognitive disorders were excluded. The 12-item Neuropsychiatric Inventory was used to assess neuropsychiatric symptoms (NPS). RESULTS: 81.1% of the patients presented NPS and only 15% had two or more symptoms. Apathy was the most frequent NPS (56.6%). There was an association between CDR score 1 or 2 and NPS (OR = 6.16, 95% CI: 1.36-27.9, p = 0.02). CONCLUSION: Most patients had a single symptom, predominantly apathy. There was an association between mild-to-moderate dementia and NPS.

Demência é uma terminologia geral para um grupo heterogêneo de doenças orgânicas e neurodegenerativas. As causas cerebrovasculares são responsáveis por 20% dos casos. OBJETIVO: Descrever as características clínicas e epidemiológicas de indivíduos maiores de 60 anos diagnosticados com demência vascular ou mista em hospital de referência em demência. MÉTODOS: Estudo retrospectivo descritivo de 2014 a 2017 em idosos com demência. Outras formas de demência ou uso de medicamentos que mimetizem distúrbios cognitivos foram excluídos. O inventário neuropsiquiátrico de 12 itens foi usado para avaliar os sintomas neuropsiquiátricos (SNP). RESULTADOS: 81.1% dos pacientes apresentaram SNP, apenas 15% tiveram dois ou mais. Apatia foi o mais frequente (56,6%). Houve associação entre CDR 1 ou 2 e SNP (OR = 6.16, 95% CI: 1.36-27.9, p = 0.02). CONCLUSÃO: Geralmente há um sintoma isolado, sendo apatia o principal. Encontramos associação entre demência leve e moderada e SNP.

Neuropsychiatric symptoms in vascular dementia: Epidemiologic and clinical aspects / Sintomas neuropsiquiátricos na demência vascular: aspectos clínicos e epidemiológicos

ABSTRACT Dementia is a general term for a heterogeneous group of organic neurodegenerative diseases. Cerebrovascular causes account for 20% of cases. Objective: To describe the clinical and epidemiological features of individuals aged >60 years diagnosed with vascular dementia (VD) or mixed dementia (MxD) in a referral hospital for dementia. Methods: A descriptive, retrospective study was carried out from 2014 to 2017 involving elderly individuals (≥60 years) with VA or MxD. Patients presenting other forms of dementia or in use of medication that mimics cognitive disorders were excluded. The 12-item Neuropsychiatric Inventory was used to assess neuropsychiatric symptoms (NPS). Results: 81.1% of the patients presented NPS and only 15% had two or more symptoms. Apathy was the most frequent NPS (56.6%). There was an association between CDR score 1 or 2 and NPS (OR = 6.16, 95% CI: 1.36-27.9, p = 0.02). Conclusion: Most patients had a single symptom, predominantly apathy. There was an association between mild-to-moderate dementia and NPS.

RESUMO Demência é uma terminologia geral para um grupo heterogêneo de doenças orgânicas e neurodegenerativas. As causas cerebrovasculares são responsáveis por 20% dos casos. Objetivo: Descrever as características clínicas e epidemiológicas de indivíduos maiores de 60 anos diagnosticados com demência vascular ou mista em hospital de referência em demência. Métodos: Estudo retrospectivo descritivo de 2014 a 2017 em idosos com demência. Outras formas de demência ou uso de medicamentos que mimetizem distúrbios cognitivos foram excluídos. O inventário neuropsiquiátrico de 12 itens foi usado para avaliar os sintomas neuropsiquiátricos (SNP). Resultados: 81.1% dos pacientes apresentaram SNP, apenas 15% tiveram dois ou mais. Apatia foi o mais frequente (56,6%). Houve associação entre CDR 1 ou 2 e SNP (OR = 6.16, 95% CI: 1.36-27.9, p = 0.02). Conclusão: Geralmente há um sintoma isolado, sendo apatia o principal. Encontramos associação entre demência leve e moderada e SNP.

Impedimetric nanostructured genosensor for detection of schistosomiasis in cerebrospinal fluid and serum samples.

Schistosomiasis is a neglected disease closely related to the low levels of social development and a serious public health problem. In this work, we performed an electrochemical detection of Schistosoma mansoni DNA with a self-assembled monolayer of mercaptobenzoic acid (MBA) immobilizing nanostructures composed of gold nanoparticles (AuNPs) and magnetite nanoparticles (Fe3O4_NPs). Electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) were used to monitor the hybridization process. MBA-Fe3O4_NPs-AuNPs-DNAprobe system reveals an effective electrochemical response indicating the surface modification. The proposed biosystem was capable to recognize specific nucleotide sequence of S. mansoni present in cerebrospinal fluid (CFS) and serum samples at different genome DNA concentrations. The biorecognition resulted in an increase in the electron transfer resistance and a decrease of the current peaks at higher DNA concentrations during electrochemical measurements. The developed platform showed a DNA detection limit of 0.781 and 0.685pgµL-1 for serum and CFS, respectively. Therefore, the obtained biosensor can be considered as a useful tool for specific detection of S. mansoni at low concentrations in various biological fluids.

Nested polymerase chain reaction in cerebrospinal fluid for diagnosing spinal cord schistosomiasis: A promising method.

INTRODUCTION: Spinal cord schistosomiasis is a neglected, disabling neurological disease commonly identified in patients from northeast Brazil. The methods currently available for its diagnosis need improvement. PCR in feces and urine is a sensitive diagnostic tool for diagnosis of schistosomiasis, but its value in the cerebrospinal fluid (CSF) is still unknown. OBJECTIVE: The objective of this study was to detect Schistosoma mansoni DNA in CSF from patients with spinal cord schistosomiasis, using the nested PCR (NPCR) assay. METHODS: This was a cross-sectional study carried out from March 2013 to January 2014 at the Aggeu Magalhães Research Center/FIOCRUZ (Pernambuco state, Brazil). NPCR was used to detect Schistosoma mansoni DNA in CSF samples from 20 patients with spinal cord schistosomiasis and 30 controls. RESULTS: NPCR was positive in 16 patients with spinal cord schistosomiasis and none from the control group (sensitivity 80%; specificity 100%, positive predictive value 100%; negative predictive value 88.2%). CONCLUSION: The NPCR technique is highly sensitive and specific for diagnosis of spinal cord schistosomiasis and can be an important diagnostic tool, particularly in cases with negative CSF serology.

Caracterização da epilepsia com início após os 60 anos de idade / Characterization of epilepsy with onset after 60 years of age

Resumo Introdução: Apesar da elevada incidência, a epilepsia no idoso ainda exibe peculiaridades pouco estudadas. A apresentação clínica na maioria das vezes é atípica e os achados nos exames complementares pouco ajudam no diagnóstico. Existem poucas publicações caracterizando esse grupo de indivíduos. Objetivo: Descrever as características de pacientes com epilepsia iniciada após os 60 anos de idade. Método: Foi desenvolvido estudo descritivo de série de casos, onde foram avaliados, consecutivamente, 50 pacientes com diagnóstico de epilepsia iniciada após os 60 anos de idade, atendidos no ambulatório de epilepsia do Hospital da Restauração (Recife-PE). Resultados: Dos 50 pacientes incluídos no estudo, a idade média foi de 75,3 (±13) anos, sendo que 30 (60,0%) eram do sexo feminino e 20 (40,0%) do sexo masculino. A idade média da primeira crise foi de 72,5 (±11,5) anos. Predominaram as crises epilépticas focais (83,8%). A ocorrência de estado de mal epiléptico foi baixa nesse grupo (4,0%). A epilepsia sintomática foi a mais frequente, tendo como etiologia vascular a causa mais encontrada (43,0%). A medicação mais utilizada foi a carbamazepina, e as crises apresentaram uma boa resposta terapêutica com monoterapia em dose baixa. O eletroencefalograma apresentou resultado normal em número elevado de casos (50,0%) e a neuroimagem na maioria das vezes (83,0%) apresentou achados inespecíficos. Conclusão: A epilepsia no idoso é predominantemente focal e sintomática, apresenta baixa ocorrência de estado de mal epiléptico e boa resposta terapêutica. O eletroencefalograma e a neuroimagem, na maioria das vezes, são inespecíficos.

Abstract Introduction: Despite its high incidence, the characteristics of epilepsy in elderly patients have not yet been widely studied. The clinical presentation of the disease is mostly atypical and findings from complementary examinations provide little help with diagnosis. Few reports have characterized this group of individuals. Objective: To describe the characteristics of patients with epilepsy with onset after 60 years of age. Method: A descriptive study of a case series was designed. For this purpose, 50 patients diagnosed with epilepsy with onset after 60 years of age, treated at the outpatient epilepsy clinic of the Hospital da Restauração (Recife-PE), were consecutively assessed. Results: The 50 patients included in the study had an average age of 75.3 (±13) years, 30 (60.0%) were female and 20 (40.0%) were male. The average age at the first seizure episode was 72.5 (±11.5) years. Focal epilepsy seizures were the most predominant (83.8%). The occurrence of status epilepticus was low in this group (4.0%). Symptomatic epilepsy was the most frequent type, and most of the causes were of vascular etiology (43.0%). Carbamazepine was most commonly used for treatment, and the patients responded well to low-dose monotherapy. Electroencephalograms displayed normal results in many cases (50.0%), and neuroimaging showed nonspecific findings for most individuals (83.0%). Conclusion: Epilepsy in elderly patients is predominantly focal and symptomatic, with a low occurrence of status epilepticus and good therapeutic response. The encephalogram and neuroimaging results are frequently nonspecific.