Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS) With Extrapontine and Pulmonary Involvement: Case Report of a Rare Presentation and Review of Literature.

CLIPPERS is a rare subacute inflammatory disorder of the CNS, with a poorly understood pathogenesis and with heterogeneous clinical manifestations. Reports of extra-pontine involvement in this syndrome are rare, and as far as we know there are only two cases reported with simultaneous involvement of the CNS and pulmonary parenchyma. We report the case of a young patient with a subacute condition of cognitive dysfunction, as well as motor, sensory and balance changes. Imaging showed pontine and extrapontine brain involvement in association with multiple pulmonary nodules, characterizing a very unusual presentation of this syndrome. It is important for radiologists to be aware of that rare presentation in order to make a prompt diagnosis of this condition, enabling early treatment and avoiding permanent neurological sequelae.

Early childhood screen time and psychopathology in a Portuguese Sample / Tempo de tela na Primeira Infância e psicopatologia numa amostra portuguesa / Tiempo de pantalla en la primera infancia y psicopatologia en una muestra portuguesa

Objective: To characterize the habits of screen exposure time in a sample of infants and preschoolers and to assess if there is a relationship between the proportion of early childhood excessive screen exposure time and the presence of psychopathology and parental concerns. Methods: A cross-sectional cohort study was conducted with 38 infants and preschoolers in a Child and Adolescent Psychiatric outpatient unit and children followed exclusively in Primary Health Care in the same geographic area (Vila Nova de Gaia/ Espinho Hospital Center). Information was collected from a self-report questionnaire filled by the caregiver between October 1st, 2018, and June 30th, 2019. Results: Screen time was analyzed and organized in two groups: the H group (screen time higher than recommended) and R group (within the recommended), according to the American Academy of Pediatrics. The need for referral to a Child and Adolescent Psychiatry appointment and the presence of parental behavior concerns related to behavior changes during early childhood are significantly associated with screen time, with a greater proportion within the H group (71.8% (n=15) vs. 31.3% (n=6), p=0.006 for the appointment and 61.1% (n=13) vs. 25% (n=4), p=0.032 for behavior concerns). There is also a tendency towards a higher percentage of overweight/obesity, sleep and food-related concerns in the H group. Only 45% of the total sample fulfilled the recommendations regarding screen exposure (p value ≤0.05). Conclusion: The study found an association between screen exposure time above the recommended and presence of psychopathology and parental concern for behavioral changes. These findings were statistically significant

Objetivo: Pretende-se caracterizar os hábitos de exposição e tempo de tela numa amostra de crianças da primeira infância para avaliar a relação entre a exposição excessiva e a presença de psicopatologia e preocupações parentais. Métodos: Tratase de um estudo de coorte transversal realizado com 38 crianças da primeira infância da Consulta Externa de Psiquiatria da Infância e Adolescência e crianças acompanhadas exclusivamente em consulta de Cuidados de Saúde Primários da área de referência do Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal. Recolheu-se a informação através do preenchimento de um questionário pelo cuidador, entre 1 de Outubro de 2018 e 30 de Junho de 2019. Resultados: Analisou-se o tempo de tela, definindo-se dois grupos: H ­ tempo de tela superior ao recomendado; R ­ tempo de tela dentro do recomendado pela Academia Americana de Pediatria. A necessidade de acompanhamento em consulta de Pedopsiquiatria e as preocupações parentais relativas a alterações de comportamento estão significativamente associadas com o tempo de tela, com maior proporção no grupo H (71,8%(n=15) vs. 31.3%(n=6), p=0.006 para a consulta de Pedopsiquiatria e 61.1%(n=13) vs. 25%(n=4), p=0.032 para preocupações parentais). Existe ainda uma tendência a uma percentagem mais significativa de excesso de peso/obesidade, problemas de sono e alimentares no grupo H. Apenas 45% do total cumpriu as recomendações relativas ao tempo de tela (valor de p≤0,05). Conclusão: Este estudo demonstrou associação entre o tempo de tela superior ao recomendado e presença de psicopatologia, assim como preocupações parentais com alterações de comportamento. Estes resultados apresentam significância estatística.

Objetivo: Se pretende caracterizar los hábitos de exposición y tiempo de pantalla en una muestra de niños en la primera infancia para evaluar la relación entre la exposición excesiva y la presencia de psicopatología y preocupaciones parentales. Métodos: Se trata de un estudio de coorte transversal realizado con 38 niños en la primera infancia de la Consulta Externa de Psiquiatría de la Niñez y Adolescencia y niños acompañados exclusivamente en consulta de Cuidados de Salud Primarios del área de referencia del Centro Hospitalario de Vila Nova de Gaia/ Espinho, Portugal. Las informaciones fueron recogidas por medio de cuestionario, rellenado por el cuidador, entre 1 de Octubre de 2018 y 30 de Junio de 2019. Resultados: El tiempo de pantalla fue analizado definiéndose dos grupos: H ­ tiempo de pantalla superior al recomendado; R ­ tiempo de pantalla dentro del recomendado por la Academia Americana de Pediatría. La necesidad de acompañamiento en consulta de psiquiatría infantil y las preocupaciones parentales relativas a alteraciones de comportamiento están significativamente asociadas con tiempo de pantalla, con mayor proporción en el grupo H (71,8%(n=15) vs. 31.3%(n=6), p=0.006 para la consulta de psiquiatría infantil y 61.1%(n=13) vs. 25%(n=4), p=0.032 para preocupaciones parentales). Existe aún una tendencia a un porcentaje más significativo de exceso de peso/obesidad, problemas de sueño y alimentarios en el grupo H. Solo 45% del total cumplió las recomendaciones relativas al tiempo de pantalla (valor de p≤0.05). Conclusión: Este trabajo demostró asociación entre el tiempo de pantalla superior al recomendado y presencia de psicopatología, como también preocupaciones parentales con alteraciones de comportamiento. Estos resultados presentan significancia estadística.

A droga como dispositivo de controle social: uma análise das representações sociais do álcool, maconha e crack na imprensa brasileira / Las drogas como dispositivo de control social: un análisis de las representaciones sociales del alcohol, la marihuana y el crack en la prensa brasileña / Drugs as a social control device: an analysis of the social representations of alcohol, marijuana and crack in the brazilian press

RESUMO. As drogas se consolidam como um dos arquétipos culturais predominantes no cotidiano das sociedades urbanas, sendo sua presença ubíqua em praticamente todas as culturas. Os registros históricos apresentam ampla variabilidade de substâncias que em dado momento eram classificadas como o perigo social da época e que em outro se tornavam banalizadas ou tipificadas como inofensivas. Assim, esse estudo teve como objetivo analisar como dispositivo droga que se consolida em diferentes períodos históricos. Para isso, foram coletadas 4.227 matérias dos jornais Folha da Manhã, Folha da Noite e Folha de São Paulo, que abordassem questões relativas ao álcool (década de 1920), maconha (décadas de 1930 a 1960) e crack (década de 1980 a 2005) e realizada Análise Temática de Conteúdo. Os resultados permitem afirmar que a característica central que define todas as substâncias analisadas nos distintos momentos históricos é o risco social que ela apresenta. A droga se constitui como um risco aos usuários ao mesmo tempo que os institui enquanto uma figura de ameaça social. Ao se referenciar uma substância como uma droga, são ativados sentidos que remetem a um quadro de decadência e criminalidade.

RESUMEN. Las drogas se consolidan como uno de los arquetipos culturales predominantes en la vida cotidiana de las sociedades urbanas, y su presencia ubicua en prácticamente todas las culturas. Los registros históricos muestran una amplia variabilidad de sustancias que en un momento se clasificaron como el peligro social de la época y en otro momento se trivializaron o tipificaron como inofensivas. Así que este estudio tuvo como objetivo analizar cómo diferentes sustancias psicoactivas se encuentran en la prensa como un riesgo social en diferentes momentos. Para ello, se recogieron 4.227 artículos del periódico Folha da Manhã, Folha da Noite y Folha de São Paulo, que abordasen temas relacionados con el alcohol (1920), marihuana (1930 a 1960) y el crack (1980 a 2005) y se realizó un Análisis Temático de Contenido. Los resultados muestran que la característica definitoria de todas las drogas examinadas en los diferentes momentos históricos es el riesgo social que presenta. La droga se constituye como un riesgo para los usuarios mientras los establece como una figura de amenaza social. Al hacer referencia a una sustancia como droga, se activan sentidos que conducen a un marco de decadencia y criminalidad.

ABSTRACT Drugs are one of the predominant cultural archetypes in the daily life of urban societies, and their ubiquitous presence in almost all cultures. Historical records show a wide variability of substances that at one point were classified as the social danger of the time and at another time trivialized or typified as harmless. Thus, this study aimed to analyze how different psychoactive substances are constituted in the press as a social risk at different times. For this, we collected 4,227 articles of newspapers Folha da Manhã, Folha da Noite and Folha de São Paulo, that addressed issues related to alcohol (1920), marijuana (1930s to 1960) and crack (1980s to 2005) and performed a Thematic Content Analysis. The results indicate that the central defining characteristic of all drugs examined in the different historical moments is the social risk it has. The drug is constituted as a risk to users while establishing them as a figure of social threat. When referring a substance as a drug, senses are activated that denote to a situation of decadence and crime.

A wide spectrum of neurological manifestations in pediatrics patients with the COVID-19 infection: a case series.

Neurological symptoms in COVID-19 patients can also be found in the pediatric population, but they are usually described as mild symptoms. Herein, we described a case series of four pediatric patients with severe and highly heterogeneous central and peripheral nervous system manifestations. The objective was to report neurological manifestations of COVID-19 in children and adolescents. The design is case series. The participants are four children and adolescents with confirmed COVID-19. The main outcome and measures are as follows: Clinical data were gathered from electronic medical records, and data of all neurologic symptoms were checked by a trained neurologist. We reported four pediatric patients with COVID-19 and different neurologic symptoms. Case 1 was a 16-year-old girl with a sensory and motor polyradiculopathy with RT-qPCR for COVID-19 and dengue both detected in CSF that improved after appropriate treatment. Case 2 was a 15-year-old boy with Guillain-Barre syndrome and had good response after using human immunoglobulin. Case 3 was a 5-year-old girl with acute intracranial hypertension that improved after going through lumbar puncture and using acetazolamide. Case 4 was a 2-month-old male infant with focal epileptic seizures that recovered after antiepileptic treatment. We highlight the need to consider different neurologic manifestations as part of the COVID-19 clinical spectrum.

The addition of thoracic mobilization to aerobic exercise did not alter autonomic function and pain pressure threshold acutely in asymptomatic young people: A randomized controlled trial.

OBJECTIVE: To analyze the influence of acute aerobic exercise (AE) plus thoracic mobilization in pain perception and autonomic nervous system response in healthy adults. DESIGN: Randomized clinical trial. METHODS: Forty-eight asymptomatic adults were allocated into one of three groups: 1) Aerobic Exercise (AE), 2) Aerobic Exercise + Mobilization (AE + M), and 3) Placebo. Participants from groups AE and AE + M ran for 5 min on a treadmill with a 75-85% of age-predicted heart rate. Participants from AE + M group also received a rotatory thoracic passive accessory intervertebral mobilization at T4 after running. Participants from the Placebo group received placebo mobilization. We mesured the autonomic system modulation through Heart Rate Variability (HRV) (time-domain, frequency-domain, and non-linear variables). We measured Pressure Pain Threshold (PPT) with a handheld digital algometer. RESULTS: While aerobic exercise increased the sympathetic outflow and reduced the HRV, the addition of vertebral mobilization to exercise had no further effect on autonomic system modulation. There was no change in PPT in any group. Besides, there was no correlation between HRV and PPT. CONCLUSION: Thoracic mobilization did not increase the sympathetic response induced by aerobic exercise. Moreover, exercise alone or exercise plus thoracic mobilization did not change the PPT.

Ischaemic stroke as an initial presentation in patients with COVID-19: evaluation of a case series in an emergency in Brazil.

The disease caused by the new coronavirus, initially described in China in December 2019, became known as coronavirus disease 2019 and quickly spread to countries on all continents, becoming a pandemic with an important global impact. Despite being a virus that typically affects the respiratory tract, some studies have already described neurological manifestations associated with this infection, including acute ischaemic vascular insult. We report a case series including 30 patients, who presented with neurological symptoms during admission to our service, being diagnosed with ischaemic stroke and, concomitantly, coronavirus disease 2019. In the subgroup of patients analysed, a state of hypercoagulability and pro thrombosis was observed through laboratory tests, probably related to the cytokine storm syndrome associated with infection by this virus. With that, we discussed the possibility of this finding being an aggravating factor in the occurrence of stroke in these patients.

Multisystemic Infarctions in COVID-19: Focus on the Spleen.

The literature suggests that COVID-19 provokes arterial and venous thrombotic events, although the mechanism is still unknown. In this study, we describe patients with confirmed coronavirus infection associated with multisystemic infarction, focusing on splenic infarction. More data are required to elucidate how COVID-19 and thrombotic disease interact and so that preventive and early diagnosis strategies can be developed. LEARNING POINTS: Thrombotic disease as a complication of COVID-19 must be suspected by clinicians, and recognized and monitored by radiologists.Thrombosis is often the initial manifestation of SARS-CoV-2, hence the importance of early diagnosis to avoid complications and reduce morbidity and mortality.

Avaliação do Impacto do Nível Educacional na Doença de Alzheimer: Artigo Original / Evaluation of the Impact of Educational Level on Alzheimer's Disease: Original Article

A doença de Alzheimer (DA) consiste em uma doença neurodegenerativa progressiva, irreversível e de aparecimento insidioso. O grau de escolaridade formal, assim como a reserva cognitiva, vem sendo proposto como fator protetor da DA, interagindo com a predisposição genética na gênese e curso evolutivo da doença. Tal estudo tem como objetivo buscar associações da escolaridade formal e outras variáveis, que possam estabelecer relação com valores reduzidos do MEEM. Foram coletados dados como idade, sexo, estado civil, raça, escolaridade e pontuação no MEEM no período do diagnóstico da DA dos pacientes que se encontravam em fase inicial da doença. Os pacientes foram divididos em três grupos de acordo com a idade: 60-69 anos, 70-79 anos e = 80 anos. Após análise estatística, a comparação MEEM versus escolaridade se mostrou significativa (r=0,39; P=0,0001), enquanto MEEM versus idade não apresentou significância (r=-0,13; P=0,86), tal como para associação de MEEM e sexo (P=0,46). Na separação realizada por grupos etários, o nível de escolaridade foi significativamente maior nos indivíduos com idade entre 60-69 anos versus 70-79 versus = 80 anos, todavia, sem diferenças significativas entre os escores do MEEM (13 ± 6,2 versus 13± 6 versus 15 ± 5; mediana ± intervalo interquartil; P = 0,34). Assim sendo, esse estudo aponta relevante relação entre a escolaridade e pontuações obtidas no teste cognitivos, determinando associação entre o nível educacional mais elevado e maior habilidade cognitiva dos pacientes com DA. (AU)

Alzheimers disease (AD) consists of a progressive, irreversible and insidious neurodegenerative disease. The degree of formal schooling, as well as the cognitive reserve, has been proposed as a protective factor of AD, interacting with the genetic predisposition in the genesis and evolutionary course of the disease. This study aims to seek associations of formal schooling and other variables, which may establish a relationship with reduced MMSE values. Data such as age, sex, marital status, race, schooling and MMSE score were collected during the diagnosis of AD in patients who were in the initial phase of the disease. Patients were divided into three groups according to age: 60-69 years, 70-79 years and = 80 years. After statistical analysis, the MMSE versus schooling comparison was significant (r = 0.39, P = 0.0001), while MMSE versus age did not present significance (r = -0.13, P = 0.86), as for association of MEEM and sex (P = 0.46). In the separation by age groups, the educational level was significantly higher in individuals aged 60-69 years versus 70-79 versus = 80 years, however, without significant differences between the MMSE scores (13 ± 6.2 versus 13 ± 6 versus 15 ± 5, median ± interquartile range, P = 0.34). Therefore, this study points out a relevant relationship between schooling and scores obtained in the cognitive test, determining the association between the higher educational level and the greater cognitive ability of patients with AD. (AU)

Short-Term Effects of Different Rates of Thoracic Mobilization on Pressure Pain Thresholds in Asymptomatic Individuals: A Randomized Crossover Trial.

OBJECTIVE: The primary aim of this study was to determine the effects of different rates of thoracic spine passive accessory intervertebral mobilization (PAIVM) on pressure pain threshold (PPT) at T4. The secondary aim was to investigate the widespread effects of different rates of thoracic PAIVM. METHODS: Twenty asymptomatic participants were randomly assigned to 3 experimental conditions: posteroanterior rotatory thoracic PAIVM at 2 Hz, 0.5 Hz, and placebo. Each participant received all 3 experimental conditions in a random order with a washout period of at least 48 hours between each procedure. The PPT was measured in 3 different points: pre-treatment, immediately after, and 15 minutes after the treatment at C7 and T4 spinous process, first interossei dorsal on the right and left hands and tibial tuberosity bilaterally. A repeated-measures analysis of covariance adjusted by baseline values was used to assess between-group differences at each point. Pairwise comparisons were adjusted for multiple tests with a Bonferroni correction. A P value < .05 was considered significant. RESULTS: There was no between-group differences on PPT at T4 when comparing 0.5 Hz (mean difference -0.29; 95% CI -0.99 to 0.42; P = .999) or 2 Hz (mean difference -0.37; 95% CI -1.1 to 0.33; P = .528) to placebo. CONCLUSION: None of the mobilization techniques in this study (0.5 Hz, 2 Hz, and placebo) showed a significant change of PPT both locally and at distant sites at any point in asymptomatic participants.

Autonomic function and pressure pain threshold following thoracic mobilization in asymptomatic subjects: A randomized controlled trial.

OBJECTIVE: To compare the effects of two different mobilization techniques and a placebo intervention applied to the thoracic spine on heart rate variability (HRV) and pressure pain threshold (PPT) in asymptomatic individuals. METHODS: Sixty healthy asymptomatic subjects aged between 18 and 40 years old were randomized to a single session of one of the three interventions: posterior-to-anterior (PA) rotatory thoracic passive accessory intervertebral mobilization (PAIVM) (PA group), unilateral thoracic PA in slump position (SLUMP group) or placebo intervention (Placebo group). HRV and PPT at C7 and T4 spinous process, first dorsal interossei muscles bilaterally, and muscle belly of tibialis anterior bilaterally were measured before and immediately after the intervention. A univariate analysis of covariance (ANCOVA) adjusted for baseline values assessed the effect of "Group". Pairwise comparisons with Bonferroni adjustment for multiple comparisons were performed. RESULTS: There were no significant between-group differences for HRV. A significant between-group difference for PPT in the ipsilateral tibia was found favoring the SLUMP group in comparison with the PA group. There were no significant between-group differences for PPT in the other landmarks. CONCLUSION: A single treatment of thoracic PAIVM in prone lying and slump position did not alter PPT and HRV compared to placebo in asymptomatic subjects.

Assessment of the Centralization of Root Canal Preparation with Rotary Systems.

OBJECTIVE: Apical deviations are important factors in endodontic therapy, since they can cause the treatment failure. The aim of the present study was to determine the centering capacity of ProTaper Universal™, Twisted File™ and Revo-S® rotary systems using cone beam computed tomography analysis before and after the instrumentation of root canals. MATERIALS AND METHODS: Thirty mesiobuccal roots from human lower first molars were divided into three groups of ten: Group 1 - ProTaper Universal™ Rotary System; Group 2 - Twisted File™ Rotary System; and Group 3 - Revo-S® Rotary System. All teeth were scanned using computed tomography to determine the condition of the root canal before and after instrumentation (4mm, 3mm and 2mm from the root apex). Images were made using ICAT VISION software for both instrumented and non-instrumented canals. RESULTS: The results were analyzed statistically using the Kolmogorov-Smirnov normality test for quantitative variables. Comparisons were made with two groups (Mann-Whitney - abnormal) and with more than two groups (Kruskal Wallis - abnormal). The level of significance was set at p<0.05. A statistically significant difference was found for the measurement of 4 mm between the "ProTaper Universal" and "Twisted File" systems. For the Twisted File system, a statistically significant difference was recorded between the measurements of 4mm and 3 mm. CONCLUSION: None of the assessed instruments was completely effective in terms of the biomechanical preparation of root canals since all created deviation from the original anatomy of the canal.

Factors involved in the choice of dentistry as an occupation by pernambuco dental students in Brazil.

The aim of this study was to determine the factors that lead to the choice of dentistry as an occupation among dental students in Pernambuco, Brazil. A total of 1,024 students were surveyed. All participants were enrolled in dentistry courses in the state of Pernambuco in 2008. Pearson's chi-square test and Fisher's exact test were used for the statistical analysis of the data, with the level of significance set at 5.0 percent. The results demonstrated that the choice of occupation was made primarily for economic reasons (73.5 percent), followed by vocational reasons (68.3 percent), professional reasons (67.8 percent), and personal reasons (56.6 percent).