Treatment of Hemichoreoathetosis with Arrhythmic Proximal Tremor after Stroke: The Role of Zona Incerta as a Target for Deep Brain Stimulation.

Deep brain stimulation (DBS) of the zona incerta has shown promising results in the reduction of medically refractory movement disorders. However, evidence supporting its efficacy in movement disorders secondary to hemorrhagic stroke or hemichoreoathetosis is limited. We describe a 48-year-old man who developed progressive hemichoreoathetosis with an arrhythmic, proximal tremor in his right arm following a thalamic hemorrhagic stroke. Pharmacological treatment was carried out with no change in the Abnormal Involuntary Movement Scale (AIMS) score after 4 weeks (14). After six sessions of botulinum toxin treatment, a subtle improvement in the AIMS score (13) was registered, but no clinical improvement was noted. The arrhythmic proximal movements were significantly improved after DBS of the zona incerta with a major decrease in the patient's AIMS score (8). The response to DBS occurring after the failure of pharmacological and botulinum toxin treatments suggests that zona incerta DBS may be an alternative for postthalamic hemorrhage movement disorders.

Surgical outcomes of rhegmatogenous retinal detachment associated with ocular toxoplasmosis / Resultados cirúrgicos do descolamento regmatogênico de retina associado à toxoplasmose ocular

ABSTRACT Purpose: To evaluate the anatomical and functional outcomes of surgical treatment of retinal detachment secondary to ocular toxoplasmosis. Methods: A retrospective analysis of data from patients who had undergone vitreoretinal surgery for retinal detachment secondary to ocular toxoplasmosis was conducted. The parameters that were analyzed include surgical procedures, anatomical outcomes, visual acuity, and postoperative complications. Results: This study included 22 patients, of which 13 were female (59.1%). The mean age was 28.5 years (SD ± 14.5, range 12-78 years) and the follow-up period varied from 1 to 163 months (mean 64 months). The mean baseline best-corrected visual acuity (BCVA) was 2.0 logMAR (SD ± 1.0). A total of 31 surgeries were performed, and the retina was reattached in 15 patients (68.2%) immediately after the first surgery and in 20 patients (90.9%) at a later point. The mean postoperative BCVA improved to 1.3 logMAR (SD ± 0.9) (p<0.05). Nineteen patients (86.4%) underwent cataract surgery with intraocular lens implant, and 12 patients (60.0%) underwent silicone oil removal. Five patients (22.7%) exhibited elevated intraocular pressure, and 1 patient (4.5%) developed hypotonia. Conclusion: Surgical treatment of retinal detachment secondary to ocular toxoplasmosis resulted in considerable anatomical and functional improvement. Although PPV with silicone oil injection demonstrated the best outcomes, it is not reasonable to conclude that this is the best surgical approach given the small number of patients included in this study.

RESUMO Objetivo: Avaliar os resultados anatômicos e funcionais após o tratamento do descolamento de retina secundário à toxoplasmose ocular. Métodos: Análise retrospectiva de dados de um banco de dados validado, que incluiu registros de pacientes submetidos à cirurgia vitreorretiniana para descolamento de retina secundário a toxoplasmose ocular. Foram analisados procedimentos cirúrgicos, sucesso anatômico, acuidade visual e complicações pós-operatórias. Resultados: Foram avaliados 22 olhos de 22 pacientes. Treze eram do sexo feminino (59,1%) e a idade média era de 28,5 anos (DP ± 14,5, intervalo de 12 a 78 anos). O período de acompanhamento variou de 1 a 163 meses (média de 64 meses). A melhor acuidade visual corrigida (BCVA) foi 2,0 logMAR (SD ± 1,0). Em geral, entre retinopexia (RSB) e vitrectomia pars plana (PPV) utilizando injeção de óleo de gás ou de silicone (SO), realizaram-se 31 cirurgias. A retina foi considerada colada em 15 olhos (68,2%) na primeira cirurgia e em 20 olhos (90,9%) ao final do estudo. A BCVA pós-operatória média melhorou para 1,3 logMAR (SD ± 0,9) (p<0,05). Dezenove olhos (86,4%) foram submetidos à cirurgia de catarata com implante de lente intraocular e 12 olhos (60,0%) tiveram remoção de óleo de silicone. Cinco olhos (22,7%) desenvolveram pressão intraocu­lar elevada e 1 (4,5%) desenvolveu hipotonia. Conclusão: A abordagem cirúrgica no descolamento de retina secundária a toxoplasmose ocular permitiu importante melhora anatômica e funcional. Embora a PPV com injeção de óleo de silicone tenha demonstrado melhores resultados, não é viável afirmar que é a melhor técnica cirúrgica, devido ao pequeno número e às particularidades dos olhos tratados.

Surgical outcomes of rhegmatogenous retinal detachment associated with ocular toxoplasmosis.

PURPOSE: To evaluate the anatomical and functional outcomes of surgical treatment of retinal detachment secondary to ocular toxoplasmosis. METHODS: A retrospective analysis of data from patients who had undergone vitreoretinal surgery for retinal detachment secondary to ocular toxoplasmosis was conducted. The parameters that were analyzed include surgical procedures, anatomical outcomes, visual acuity, and postoperative complications. RESULTS: This study included 22 patients, of which 13 were female (59.1%). The mean age was 28.5 years (SD ± 14.5, range 12-78 years) and the follow-up period varied from 1 to 163 months (mean 64 months). The mean baseline best-corrected visual acuity (BCVA) was 2.0 logMAR (SD ± 1.0). A total of 31 surgeries were performed, and the retina was reattached in 15 patients (68.2%) immediately after the first surgery and in 20 patients (90.9%) at a later point. The mean postoperative BCVA improved to 1.3 logMAR (SD ± 0.9) (p<0.05). Nineteen patients (86.4%) underwent cataract surgery with intraocular lens implant, and 12 patients (60.0%) underwent silicone oil removal. Five patients (22.7%) exhibited elevated intraocular pressure, and 1 patient (4.5%) developed hypotonia. CONCLUSION: Surgical treatment of retinal detachment secondary to ocular toxoplasmosis resulted in considerable anatomical and functional improvement. Although PPV with silicone oil injection demonstrated the best outcomes, it is not reasonable to conclude that this is the best surgical approach given the small number of patients included in this study.

Fatores associados à suplementação com ácido fólico em gestantes na cidade de Joinville, SC / Factors associated with acid supplementation in pregnant women in Joinville, SC

Objetivo: Avaliar a prevalência do uso de suplementação com ácido fólico em gestantes e identificar fatores associados a não realização dessa prática. Métodos: Estudo transversal com 316 puérperas, cujas informações foram obtidas através de entrevista e acesso aos prontuários. Para avaliar a influência de fatores sociodemográficos no uso de folato na gestação, construímos modelos de regressão logística multinomial. Resultados: A conclusão do ensino superior aumentou em 3,5 vezes a probabilidade de suplementação com folato (OR 3,5 (IC 95%, 1,1- 11,1)). O planejamento da gravidez e o início do pré-natal anterior à 11ª semana também aumentaram as chances de consumo de ácido fólico, (OR 2,0 (IC 95%, 1,2-3,5)) e (OR 2,2 (IC 95%, 1,2-4,3)) respectivamente. O conhecimento sobre ácido fólico foi o maior preditor de suplementação, aumentando-a em 10 vezes (OR 10,1 (IC 95%, 5,0-20,9)). Dentre as mulheres que usaram folato, somente 22 (19,6%) iniciaram antes da gravidez. Além disso, o tempo médio de uso (3,3 meses±2,7) esteve abaixo do recomendado. Conclusão: As chances de adesão à suplementação com folato foram maiores em gestantes que apresentaram maior escolaridade, planejamento da gravidez, início do pré-natal anterior à 11a semana e conhecimento sobre o papel do ácido fólico.

Objective: To evaluate the prevalence of folic acid intake in pregnant women and identify factors associated with failure of this practice. Methods: Cross-sectional study of 316 postpartum women. All information was obtained through interviews and access to medical records. We constructed logistic regression models in order to assess the influence of sociodemographic factors in the use of folate during pregnancy. Results: The college degree increased by 3.5 times the probability of folate supplementation (OR 3.5 (95% CI, 1.1 to 11.1)). Pregnancy planning and booking for antenatal care previous to 11 weeks also increased the odds of folic acid intake, (OR 2.0 (95% CI, 1.2 to 3.5)) and (OR 2.2 (95% CI , 1.2 to 4.3)), respectively. Knowledge about folic acid was the major predictor of supplementation, increasing it by a 10-fold probability (OR 10.1 (95% CI 5.0 to 20.9)). Among women who took folate, only 22 (19.6%) started before pregnancy. In addition, the mean duration of supplementation (3.3 months ± 2.7) was much lower than recommended. Conclusion: The chances of folate intake was significantly higher in pregnant who had higher education level, pregnancy planning, early booking for antenatal care and knowledge about the role of folic acid.

[Obesity during pregnancy: gestational complications and birth outcomes.] / Obesidade durante a gravidez: resultados adversos da gestação e do parto.

PURPOSE: To evaluate the influence of maternal obesity on pregnancy, childbirth, and neonatal outcomes. METHODS: A cross-sectional study with 298 postpartum women. Information was obtained through interviews and access to patients' medical records. The patients were divided into three groups according to their pre-gestational body mass index: normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). Data are reported as adjusted odds ratios with 95% confidence interval (95%CI) following multinomial logistic regression analysis to account for confounding variables. RESULTS: Compared to pregnant women with normal body mass index, overweight women had greater chances of having cesarean delivery, odds ratio (OR) of 2.2 and 95%CI 1.3-3.9, and obese women even more (OR=4.2; 95%CI 2.1-8.1). The chances of gestational diabetes increased in the Overweight (OR=2.5; 95%CI 1.1-5.6) and Obese groups (OR=11.1; 95%CI 5.0-24.6). The occurrence of hypertensive syndrome was also higher in overweight (OR=3.2; 95%CI 1.2-8.1) and obese pregnant women (OR=7.5; 95%CI 2.9-19.1). Major postpartum hemorrhage only showed greater values in the obese women group (OR=4.1; 95%CI 1.1-15.8). Regarding the newborns, the probability of a low Apgar score at first minute was higher in the Obese Group (OR=5.5; 95%CI 1.2-23.7) and chances of macrosomia were higher in the Overweight Group (OR=2.9; 95%CI 1.3-6.3). Data regarding neonatal hypoglycemia were not conclusive. CONCLUSION: Excessive weight (overweight and obesity) during pregnancy increases the chance of maternal complications (gestational diabetes, hypertensive syndrome, and major postpartum hemorrhage) and neonatal outcomes (cesarean delivery, macrosomia, and low Apgar score).

Obesidade durante a gravidez: resultados adversos da gestação e do parto / Obesity during pregnancy: gestational complications and birth outcomes

OBJETIVO: Avaliar a influência do excesso de peso materno na gestação, no parto e nos desfechos neonatais. MÉTODOS: Estudo transversal e retrospectivo que incluiu 298 puérperas. As informações foram obtidas por meio de entrevistas e acesso aos prontuários das pacientes. As puérperas foram divididas em três grupos, conforme o índice de massa corpórea pré-gestacional: normal (18,5–24,9 kg/m2); sobrepeso (25,0–29,9 kg/m2) e obesidade (≥30,0 kg/m2). Foram construídos modelos de regressão logística multinominal para ajustar o efeito das variáveis de confusão. Estabeleceram-se intervalos de confiança de 95% (IC95%). RESULTADOS: Comparadas às gestantes com peso normal, pacientes com sobrepeso apresentaram chances maiores de cesariana, sendo a odds ratio (OR) de 2,2 e IC95% 1,3–3,9, e as obesas tiveram ainda maiores (OR=4,2; IC95% 2,1–8,1). As chances de desenvolvimento de diabetes gestacional aumentaram nos grupos Sobrepeso (OR=2,5; IC95% 1,1–5,6) e Obesidade (OR=11,1; IC95% 5,0–24,6). A síndrome hipertensiva na gravidez também se mostrou mais provável nas gestantes com sobrepeso (OR=3,2; IC95% 1,2–8,1) e obesas (OR=7,5; IC95% 2,9–19,1). A hemorragia de grande porte no momento do parto somente apresentou maiores valores no grupo de obesas (OR=4,1; IC95% 1,1–15,8). Quanto aos recém-nascidos, a probabilidade de Apgar baixo no primeiro minuto foi superior entre as obesas (OR=5,5; IC95% 1,2–23,7), e a ocorrência de macrossomia aumentou nas mulheres com sobrepeso (OR=2,9; IC95% 1,3–6,3). Os resultados quanto à hipoglicemia neonatal não foram conclusivos. CONCLUSÃO: As chances de intercorrências maternas (diabetes gestacional, síndrome hipertensiva, hemorragia pós-parto) e neonatais (cesariana, macrossomia e escore Apgar ...

PURPOSE: To evaluate the influence of maternal obesity on pregnancy, childbirth, and neonatal outcomes. METHODS: A cross-sectional study with 298 postpartum women. Information was obtained through interviews and access to patients' medical records. The patients were divided into three groups according to their pre-gestational body mass index: normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2). Data are reported as adjusted odds ratios with 95% confidence interval (95%CI) following multinomial logistic regression analysis to account for confounding variables. RESULTS: Compared to pregnant women with normal body mass index, overweight women had greater chances of having cesarean delivery, odds ratio (OR) of 2.2 and 95%CI 1.3–3.9, and obese women even more (OR=4.2; 95%CI 2.1–8.1). The chances of gestational diabetes increased in the Overweight (OR=2.5; 95%CI 1.1–5.6) and Obese groups (OR=11.1; 95%CI 5.0–24.6). The occurrence of hypertensive syndrome was also higher in overweight (OR=3.2; 95%CI 1.2–8.1) and obese pregnant women (OR=7.5; 95%CI 2.9–19.1). Major postpartum hemorrhage only showed greater values in the obese women group (OR=4.1; 95%CI 1.1–15.8). Regarding the newborns, the probability of a low Apgar score at first minute was higher in the Obese Group (OR=5.5; 95%CI 1.2–23.7) and chances of macrosomia were higher in the Overweight Group (OR=2.9; 95%CI 1.3–6.3). Data regarding neonatal hypoglycemia were not conclusive. CONCLUSION: Excessive weight (overweight and obesity) during pregnancy increases the chance of maternal complications (gestational diabetes, hypertensive syndrome, and major postpartum hemorrhage) and neonatal outcomes (cesarean delivery, macrosomia, and low Apgar score). .

Obesidade materna e suas consequências na gestação e no parto: uma revisão sistemática / Maternal obesity and its consequences in pregnancy and birth outcomes: a systematic review

Introdução: O excesso de peso materno ocorre em 25 a 30% das gestações no Brasil. Entretanto, apenas recentemente tem-se avaliado o impacto da obesidade nos desfechos da gestação. Objetivo: Avaliar, com base nas publicações nacionais e internacionais, as consequências da obesidade materna na gestação, no parto e nos desfechos neonatais. Métodos: Revisão sistemática da literatura sobre obesidade na gravidez nas bases MEDLINE, LILACS, Embase e Cochrane. Os desfechos avaliados foram intercorrências maternas, intercorrências no parto e desfechos neonatais. Resultados e discussão: Dentre os 10.815 artigos inicialmente selecionados entre junho e dezembro de 2013, somente 23 estavam de acordo com os critérios estabelecidos. Desses, 1 apresentou grau de evidência A, 13 apresentaram B e 9 artigos, níveis de evidência C ou D. A maior parte das publicações selecionadas era referente às intercorrências maternas e no parto. Entretanto, o maior nível de evidência foi encontrado nos trabalhos que discorreram sobre desfechos neonatais. Conclusão: A obesidade materna está associada ao aparecimento de distúrbios endócrinos, cardiovasculares e ocorrência de parto instrumental. Os desfechos neonatais incluem malformações congênitas, escore Apgar baixo, macrossomia e morte neonatal.(AU)

Background: The maternal overweight occurs in 25-30% of pregnancies in Brazil. However, only recently have been evaluated the impact of obesity on pregnancy outcomes. Objective: To evaluate, based on national and international publications, the consequences of maternal obesity in pregnancy, childbirth and neonatal outcomes. Methods: A systematic review of the literature on obesity in pregnancy in MEDLINE, LILACS, Embase and Cochrane library. The outcomes assessed were maternal disorders, complications in childbirth and neonatal outcomes. Results and discussion: Among 10,815 articles initially selected between June and December 2013, only 23 were in accordance with the criteria set. Of these, 1 presented level of evidence A, 13, level of evidence B, and 9 articles, levels of evidence C or D. Most of the selected publications were referring to maternal complications and delivery. However, publications with the highest level of evidence assessed neonatal outcomes. Conclusion: Maternal obesity is associated with development of endocrine disorders, cardiovascular events and occurrence of instrumental delivery. Neonatal outcomes include congenital malformations, low Apgar scores, macrosomia and neonatal death.(AU)