Avaliação da percepção do conhecimento sobre o sono e suas implicações entre médicos e internos / Assessment of the perception of knowledge about sleep and its implications between physicians and interns

Introdução: O sono é essencial para a qualidade de vida e possui funções fundamentais para o funcionamento do corpo. Sua privação traz consequências negativas na homeostase corporal e na cognição. Essa privação pode tornar-se fator de risco para diversas doenças. Há deficiências no currículo de graduação médica acerca do conhecimento sobre a saúde do sono, acarretando subdiagnósticos e subtratamentos, além de ter consequências no sono para os próprios doutorandos e médicos, afetando assim na sua saúde e no seu desempenho profissional. Objetivo: Avaliar se a percepção do conhecimento do médico sobre o sono adquirido na graduação interfere na promoção da saúde do sono nas esferas pessoal e profissional. Métodos: Estudo observacional de abordagem quantitativa e recorte transversal através de formulário digital. Médicos e internos fizeram parte do estudo. O questionário teve as seguintes etapas: epidemiologia; avaliação subjetiva do conhecimento sobre saúde do sono; aplicação de conhecimentos na vida profissional e pessoal; avaliação da qualidade de sono através do Índice de Qualidade de Sono de Pittsburgh (PSQI). Resultados: A amostra foi de 103 participantes. A maioria concordou em ter adquirido conhecimentos sobre a saúde do sono durante a graduação. Durante a anamnese o sono foi o tema menos perguntado. As medidas que favorecem a higiene do sono mais relatadas foram dormir em ambiente adequado e praticar exercícios físicos. Já as desfavoráveis foram uso de eletrônicos no quarto. Não houve diferença significativa entre ano e nível de formação em relação a qualidade de sono. Os índices significativamente mais alterados do índice foram disfunções diurnas e uso de medicamentos para dormir. Conclusão: A importância da saúde do sono é bem estabelecida, porém a qualidade de sono entre médicos e internos é ruim. Portanto se faz necessário futuras mudanças na área de ensino, atuação e pesquisa.

Introduction: Sleep is essential for the quality of life and has fundamental functions for the functioning of the body. Its deprivation has negative consequences on body homeostasis and cognition. Sleep deprivation can become a risk factor for several diseases. There are deficiencies in the undergraduate medical curriculum regarding knowledge about sleep health, leading to underdiagnosis and undertreatment for patients. In addition to having consequences on sleep for doctoral students and physicians, thus affecting their health and professional performance. Objective: To assess whether the physician's perception of knowledge about sleep acquired during graduation interferes with the promotion of sleep health in the personal and professional spheres. Methods: Observational study with a quantitative approach and a cross-sectional approach using a digital form. Physicians and interns were part of the study. The questionnaire had the following stages: epidemiology; subjective assessment of knowledge about sleep health; application of knowledge in professional and personal life; assessment of sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Results: The sample consisted of 103 participants. Most agreed to have acquired knowledge about sleep health during graduation. During the anamnesis, sleep was the least asked topic. The most reported measures that were positive to sleep hygiene were sleeping in a suitable environment and practicing physical exercises. The unfavorable ones were the use of electronics in the bedroom. There was no significant difference between year and level of training in relation to sleep quality. The most altered components of the index were daytime disorders and use of sleeping pills. Conclusion: The importance of sleep health is well established, but sleep quality among physicians and interns is poor. Therefore, future changes in teaching, performance and research are necessary

Abnormal Findings in Polysomnographic Recordings of Patients with Spinocerebellar Ataxia Type 2 (SCA2).

Spinocerebellar ataxia type 2 (SCA2) is characterized by a progressive cerebellar syndrome, and additionally saccadic slowing, cognitive dysfunction, and sleep disorders. The aim of this study was to assess the frequency of abnormal findings in sleep recordings of patients with SCA2. Seventeen patients with genetically confirmed SCA2 from the Movement Disorders Outpatient group of the Hospital de Clínicas da UFPR were evaluated with a structured medical interview and the Scale for the Assessment and Rating of Ataxia (SARA). Polysomnographic recordings were performed and sleep stages were scored according to standard criteria. There were 10 male subjects and 7 females, aged 24-66 years (mean 47.44). A sex- and age-matched control group of healthy subjects was used for comparison. There was a reduction of rapid eye movement (REM) sleep in 12 (70.58%), increased REM latency in 9 (52.94%), increased obstructive sleep apnea-index in 14 (82.35%), absent REM density (REM density was calculated as the total number of 3-s miniepochs of REM sleep with at least 1 REM per minute) in 13 (76.47%), and markedly reduced REM density in 4 (23.52%). There was an indirect correlation according to the SARA scale and the REM density decrease (r = - 0.6; P = < 0.001); and with a disease progression correlating with a reduction in the REM density (r = - 0.52, P = 0.03). In SCA2, changes occur mainly REM sleep. The absence/decrease of REM sleep density, even in oligosymptomatic patients, and the correlation of this finding with disease time and with the SARA scale were the main findings of the study.

Sleep disorders in spinocerebellar ataxia type 10.

As sleep disturbances have been reported in spinocerebellar ataxias (SCAs), including types SCA1, SCA2, SCA3, SCA6 and SCA13, identification and management of these disturbances can help minimise their impact on SCA patients' overall body functions and quality of life. To our knowledge, there are no studies that investigate sleep disturbances in SCA10. Therefore, the aim of this study was to assess sleep disturbances in patients with SCA10. Twenty-three SCA10 patients and 23 healthy controls were recruited. Patients were evaluated in terms of their demographic and clinical data, including disease severity (Scale for the Assessment and Rating of Ataxia, SARA) and excessive daytime sleepiness (Epworth Sleepiness Scale, ESS), and underwent polysomnography. SCA10 patients had longer rapid eye movement (REM) sleep (p = .04) and more REM arousals than controls (p< .0001). There was a correlation of REM sleep onset with the age of onset of symptoms (r = .459), and with disease duration (r = -.4305). There also was correlation between the respiratory disturbance index (RDI) and SARA (r = -.4013), and a strong indirect correlation between arousal index and age at onset of symptoms (r = -.5756). In conclusion, SCA10 patients had sleep abnormalities that included more REM arousals and higher RDI than controls. Our SCA10 patients had sleep disorders related to shorter disease duration and lower severity of ataxia, in a pattern similar to that of other neurodegenerative diseases.

Is there a relationship between narcolepsy, multiple sclerosis and HLA-DQB1*06:02?

We studied multiple sclerosis (MS) patients with the HLA-DQB1*06:02 allele and compared them with MS patients who did not carry the HLA-DQB1*06:02 allele. We analyzed clinical and neurophysiological criteria for narcolepsy in six MS patients with HLA-DQB1*06:02, compared with 12 MS patients who were HLA-DQB1*06:02 non-carriers. Only two patients with HLA-DQB1*06:02 allele scored higher than 10 on the Epworth Sleepiness Scale. Polysomnography recording parameters and the multiple sleep latency test showed an absence of narcolepsy in the study group. Our study suggested no significant correlation between narcolepsy, MS and HLA-DQB1*06:02. The HLA-DQB1*06:02 allele alone was not sufficient to cause MS patients to develop narcolepsy.

Is there a relationship between narcolepsy, multiple sclerosis and HLA-DQB1* 06: 02? / Existe relação entre narcolepsia, esclerose múltipla e HLA-DQB1* 06: 02?

ABSTRACT We studied multiple sclerosis (MS) patients with the HLA-DQB1*06:02 allele and compared them with MS patients who did not carry the HLA-DQB1*06:02 allele. We analyzed clinical and neurophysiological criteria for narcolepsy in six MS patients with HLA-DQB1*06:02, compared with 12 MS patients who were HLA-DQB1*06:02 non-carriers. Only two patients with HLA-DQB1*06:02 allele scored higher than 10 on the Epworth Sleepiness Scale. Polysomnography recording parameters and the multiple sleep latency test showed an absence of narcolepsy in the study group. Our study suggested no significant correlation between narcolepsy, MS and HLA-DQB1*06:02. The HLA-DQB1*06:02 allele alone was not sufficient to cause MS patients to develop narcolepsy.

RESUMO Pacientes com esclerose múltipla (EM) portadores do alelo HLA-DQB1*06:02 foram estudados e comparados com pacientes com EM mas que não são portadores do alelo HLA-DQB1*06:02. Os critérios clínicos e neurofisiológicos para narcolepsia foram analisados em pacientes com EM sendo 6 pacientes com o HLA-DQB1*06:02 comparados a 12 pacientes sem o HLA-DQB1*06:02. Somente 2 pacientes com EM e HLA-DQB1*06:02 tiveram escore maior que 10 na escala “Epworth Sleepiness Scale”. Os parâmetros da polissonografia e o teste de múltiplas latências do sono mostraram ausência de narcolepsia no grupo estudo. Nosso estudo não sugere correlações significantes entre narcolepsia, EM e HLA-DQB1*06:02. Somente o HLA-DQB1*06:02 não foi suficiente para desenvolver narcolepsia em pacientes com EM.

Holmes' tremor and neuroparacoccidioidomycosis: a case report.

We report on a case of neuroparacoccidioidomycosis that presented with a midbrain mass lesion associated with Holmes' tremor. The difficulties of pharmacological treatment of such tremor are emphasized.

Neuro-Behçet: report of three clinically distinct cases

We report three patients who collectively have very representative clinical forms of neuro-Behçet and different neurological findings. The first case, male, 49 years old, presents symptoms similar to multiple sclerosis. The second case, male 15 years old, presents with parenchymatous compromise and an association with antiphospholipid antibody. And the third case, female 25 years old, presents an acute meningitis. Neuro-Behçet must always be included as a differential diagnosis of neurological disorders that have any difficulties in establishing a definite diagnosis

Doenças de Dupuytren e de Ledderhose associadas ao uso crônico de anticonvulsivantes: relato de caso / Dupuytren's and Ledderhose's diseases associated with chronic use of anticonvulsants: case report

Relatamos o caso de um paciente que após uso crônico de anticonvulsivantes, sem epilepsia definida, desenvolveu contraturas das aponeuroses palmar (doença de Dupuytren) e plantar (doença de Ledderhose). Discutimos as principais dessas complicações, os fatores predisponentes e sua estreita relação com o uso de anticonvulsivantes, particularmente de fenobarbital.