Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: A systematic review.

Approximately one-third of patients with epilepsy remain with pharmacologically intractable seizures. An emerging therapeutic modality for seizure suppression is repetitive transcranial magnetic stimulation (rTMS). Despite being considered a safe technique, rTMS carries the risk of inducing seizures, among other milder adverse events, and thus, its safety in the population with epilepsy should be continuously assessed. We performed an updated systematic review on the safety and tolerability of rTMS in patients with epilepsy, similar to a previous report published in 2007 (Bae EH, Schrader LM, Machii K, Alonso-Alonso M, Riviello JJ, Pascual-Leone A, Rotenberg A. Safety and tolerability of repetitive transcranial magnetic stimulation in patients with epilepsy: a review of the literature. Epilepsy Behav. 2007; 10 (4): 521-8), and estimated the risk of seizures and other adverse events during or shortly after rTMS application. We searched the literature for reports of rTMS being applied on patients with epilepsy, with no time or language restrictions, and obtained studies published from January 1990 to August 2015. A total of 46 publications were identified, of which 16 were new studies published after the previous safety review of 2007. We noted the total number of subjects with epilepsy undergoing rTMS, medication usage, incidence of adverse events, and rTMS protocol parameters: frequency, intensity, total number of stimuli, train duration, intertrain intervals, coil type, and stimulation site. Our main data analysis included separate calculations for crude per subject risk of seizure and other adverse events, as well as risk per 1000 stimuli. We also performed an exploratory, secondary analysis on the risk of seizure and other adverse events according to the type of coil used (figure-of-8 or circular), stimulation frequency (≤ 1 Hz or > 1 Hz), pulse intensity in terms of motor threshold (<100% or ≥ 100%), and number of stimuli per session (< 500 or ≥ 500). Presence or absence of adverse events was reported in 40 studies (n = 426 subjects). A total of 78 (18.3%) subjects reported adverse events, of which 85% were mild. Headache or dizziness was the most common one, occurring in 8.9%. We found a crude per subject seizure risk of 2.9% (95% CI: 1.3-4.5), given that 12 subjects reported seizures out of 410 subjects included in the analysis after data of patients with epilepsia partialis continua or status epilepticus were excluded from the estimate. Only one of the reported seizures was considered atypical in terms of the clinical characteristics of the patients' baseline seizures. The atypical seizure happened during high-frequency rTMS with maximum stimulator output for speech arrest, clinically arising from the region of stimulation. Although we estimated a larger crude per subject seizure risk compared with the previous safety review, the corresponding confidence intervals contained both risks. Furthermore, the exclusive case of atypical seizure was the same as reported in the previous report. We conclude that the risk of seizure induction in patients with epilepsy undergoing rTMS is small and that the risk of other adverse events is similar to that of rTMS applied to other conditions and to healthy subjects. Our results should be interpreted with caution, given the need for adjusted analysis controlling for potential confounders, such as baseline seizure frequency. The similarity between the safety profiles of rTMS applied to the population with epilepsy and to individuals without epilepsy supports further investigation of rTMS as a therapy for seizure suppression.

How to Procrastinate Productively With ADHD: A Study of Smartphone Use, Depression, and Other Academic Variables Among University Students With ADHD Symptoms.

OBJECTIVE: The association between chemical dependency and Attention-Deficit Hyperactivity Disorder is widely recognized, but there is less data regarding modern behavioral addictions among young adults. METHOD: In this cross-sectional study, a sample of 408 Hungarian college students (67.2% female, mean age 23.37 years [SD = 3.87]) responded to an online survey including the Adult ADHD Self-Report Scale, the Center for Epidemiologic Studies-Depression Scale (CES-D), the Procrastination Scale, the Short College Boredom Scale, and the Smartphone Addiction Scale (SAS-SV). RESULTS: Regression analyses showed that passive procrastination (ß = .31, p < .001), depression (ß = .20, p < .001), academic boredom (ß = .18, p < .001), active procrastination (ß = -.12, p < .001), and smartphone addiction (ß = .13, p < .001) were significantly related to ADHD symptoms, accounting for 41% of the variance. CONCLUSION: Findings provide important additions to knowledge of mental health challenges among young adults with ADHD.

Attitudes of primary care physicians toward bariatric surgery: a free word association networks analysis.

BACKGROUND: Primary care physicians (PCPs) hold major responsibility in referring patients with obesity eligible for bariatric surgery (BS). OBJECTIVE: The aim was to explore PCPs' mental representation of BS in order to identify barriers and catalysts of BS referral practices. SETTING: Switzerland. METHODS: A total of 3526 PCPs were invited to participate in an online survey. PCPs were asked to write the first 5 words that came to their mind about the term "bariatric surgery." Additionally, they had to pick 2 emotions that best described each provided association. Demographic data and obesity-related referral patterns were collected. Mental representation network was constructed based on co-occurrence of associations, using validated data-driven methodology. RESULTS: In all, 216 PCPs completed the study (response rate: 6.13%). Respondents were aged 55 ± 9.8 years, had an equal sex distribution, and practiced mainly in urban settings. Three mental representations of BS emerged: indication-focused (most frequent associations: "obesity," "diabetes"), treatment-focused ("gastric bypass," "weight loss"), and outcome-focused ("complications," "challenging follow-up"). The emotional label "interested" was used significantly more frequently in the treatment-focused group. Comparison of PCPs among mental modules showed that those with a treatment-focused mindset referred patients for BS most frequently and were significantly more willing to follow up with postbariatric patients (χ2 = 17.8, P = .022). CONCLUSIONS: PCPs think about BS along 3 mental representations, and the treatment-focused attitude was coupled with the highest willingness to refer eligible patients for BS. Confidence in performing postbariatric follow-up was identified as catalyst of BS referral. Access to optimal care for patients with obesity may be improved accordingly.

Clinical characteristics and outcomes of hospital-manifested COVID-19 among Brazilians.

OBJECTIVES: To analyze the clinical characteristics and outcomes of admitted patients with the hospital- versus community-manifested COVID-19 and to evaluate the risk factors related to mortality in the first population. METHODS: This retrospective cohort included consecutive adult patients with COVID-19, hospitalized between March and September 2020. The demographic data, clinical characteristics, and outcomes were extracted from medical records. Patients with hospital-manifested COVID-19 (study group) and those with community-manifested COVID-19 (control group) were matched by the propensity score model. Logistic regression models were used to verify the risk factors for mortality in the study group. RESULTS: Among 7,710 hospitalized patients who had COVID-19, 7.2% developed symptoms while admitted for other reasons. Patients with hospital-manifested COVID-19 had a higher prevalence of cancer (19.2% vs 10.8%) and alcoholism (8.8% vs 2.8%) than patients with community-manifested COVID-19 and also had a higher rate of intensive care unit requirement (45.1% vs 35.2%), sepsis (23.8% vs 14.5%), and death (35.8% vs 22.5%) (P <0.05 for all). The factors independently associated with increased mortality in the study group were increasing age, male sex, number of comorbidities, and cancer. CONCLUSION: Hospital-manifested COVID-19 was associated with increased mortality. Increasing age, male sex, number of comorbidities, and cancer were independent predictors of mortality among those with hospital-manifested COVID-19 disease.

Effects of Ilex paraguariensis A. St. Hil. (yerba mate) on herpes simplex virus types 1 and 2 replication.

The antiherpes effects of the crude extract obtained from Ilex paraguariensis leaves (yerba mate) and their purified fractions were investigated. The most active fraction was selected and assayed to determine the viral multiplication steps upon which it acted. In order to detect the major components of this fraction, thin layer chromatography (TLC) analysis was performed. The antiviral activity was evaluated against HSV-1 and HSV-2 by a viral plaque number reduction assay (IC(50) ) and the cytotoxicity by a MTT assay (CC(50) ). According to the obtained results, all tested samples showed antiherpes activity at noncytotoxic concentrations, and the ethyl acetate fraction was the most active (SI = CC(50) /IC(50) = 188.7 and 264.7 for HSV-1 and HSV-2, respectively). The results also demonstrated that this fraction exerts antiviral activity by the reduction of viral infectivity, the inhibition of virus entry into cells and cell-to-cell virus spread, as well as by the impaired levels of ICP27, ICP4, gD and gE proteins of HSV-1. The TLC analysis showed that this fraction contains monodesmosidic triterpenoid saponins, matesaponin-1 (a bidesmosidic one), caffeic and chlorogenic acids and rutin, which suggests that they could act synergistically and be responsible for the detected antiherpes activity.

Concussion vs. resignation by submission: Technical-tactical behavior analysis considering injury in mixed martial arts.

This research study verified the technical-tactical actions during the mixed martial arts (MMA) fights to generate serious enough injury to stop the MMA round, determining technical-tactical potential risk factors for injury in official MMA combats, according to Concussion or Resignation per Submission. A total of 990 rounds with concussions and 627 resignations per submission were considered with severe injury (i.e., a fight ended by a doctor or referee). All injuries were diagnosed and managed by attending ringside physicians during the MMA fights and rounds and had a continuous technical-tactical behavior analysis, p ≤ 0.05. The leading cause of concussion was due to head trauma (~90%), with higher dependence on head strikes scored actions. Comparisons between Concussion and Resignation per Submission combats demonstrated differences between distance head strikes actions [13(6,25) vs. 9(4,18) frequencies], clinch head strikes actions [1(0;4) vs. 1(0;3) frequencies], ground head strikes actions [1(0;8) vs. 2(0;10) frequencies] and takedowns actions [0(0;1) vs. 1(0;2) frequencies]. This information may provide significant evidence regarding the doctor stoppage in concussion combats and when it could be called by officials supervising MMA.

The Effect of Neurofeedback on the Reaction Time and Cognitive Performance of Athletes: A Systematic Review and Meta-Analysis.

Our study evaluated the effect of training with neurofeedback (NFB) in improving athletes' reaction time and decision-making. A computerized search in PubMed, PsycINFO, Scielo, Web of Science, EMBASE, Scopus, BVS, and Cochrane databases was performed to identify studies published from 2011 to June 2021. The protocol was registered in PROSPERO. The quality of studies that was peer-reviewed and included was assessed using the Review Manager tool, Cochrane Risk of Bias, and design and reporting quality according to the CRED-nf checklist. Standard mean differences and 95% confidence intervals (CIs) were calculated and combined using a random-effects model. A total of 07 randomized controlled trials (RCTs) (173 athletes) met the inclusion criteria. Significant effects of NFB in the experimental group in relation to reaction time were found, indicating an improvement in sports performance [standardized mean difference (SMD) = -1.08; 95% CI = (-1.90, -0.25), p = 0.0009] and cognitive performance vs. decision-making with moderate effect [SMD = 1.12; 95% CI = (-0.40, 1.85), p = 0.0001]. However, the control group had a very small effect on cognitive performance [SMD = 0.19; 95% CI = (-0.20, 0.59), p = 0.086]. NFB could improve athletes' reaction time and decision-making, effectively increasing their performance in the sports field. Future studies should focus on standardized protocols for NFB training. Systematic Review Registration: http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021258387.

COVID-19 Pandemic Impacts on the Mental Health of Professional Soccer: Comparison of Anxiety Between Genders.

This study verifies associated factors with trait and state anxiety in professional soccer teams during the COVID-19 pandemic. The sample was composed of 315 athletes, coaches, and physical trainers of professional soccer teams during the COVID-19 pandemic. From this amount, 214 were classified with trait anxiety, and 315 were classified with state anxiety using the State-Trait Anxiety Inventory (STAI). This study is an epidemiological and cross-sectional study. We applied an observational method, and we performed a remote measurement. The measurement was made via online questionnaires in male and female individuals working on soccer teams (soccer professionals or athletes) who could be affected by anxiety during social isolation in the COVID-19 pandemic. Each questionnaire was composed of sociodemographic questions, self-perceived performance, and STAI. The main results indicated a significant difference between female vs. male soccer professionals in state anxiety (54.97 ± 9.43 vs. 57.65 ± 9.48 index) and trait anxiety (54.21 ± 5.74 vs. 55.76 ± 6.41 index) with higher results in men. Sociodemographic variables impacted significant differences between female and male athletes and professionals of soccer clubs, and anxiety during the pandemic COVID-19 period impacted self-perceived performance analysis. The present results highlight the importance of cognitive behavior therapy for professional soccer teams.

A simple one-step real-time RT-PCR for diagnosis of dengue virus infection.

Dengue is the most important arbovirus disease in tropical and sub-tropical countries, and can be caused by infection with any of the four-dengue virus (DENV) serotypes. Infection with DENV can lead to a broad clinical spectrum, ranging from sub-clinical infection or an influenza-like disease known as dengue fever (DF) to a severe, sometimes fatal, disease characterized by hemorrhage and plasma leakage that can lead to shock, known as dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). The diagnosis of dengue is routinely accomplished by serologic assays, such as IgM and IgG ELISAs, as well as HI tests, analyzing serum samples obtained from patients with at least 7 days of symptoms onset. These tests cannot be used for diagnosis during the early symptomatic phase. In addition, antibodies against dengue are broad reactive with other flaviviruses. Therefore, a specific diagnostic method for acute DENV infection is of great interest. In that sense, the real-time RT-PCR has become an important tool that can be used for early and specific detection of dengue virus genome in human serum samples. This study describes a simple, specific, and sensitive real-time RT-PCR for early diagnosis of dengue virus infection.

Mental toughness and physical fitness tests of boxing athletes associated with big five personality factors / Testes de resistência mental e aptidão física de atletas de boxe associados aos cinco grandes fatores de personalidade

ABSTRACT The present study related to boxing athletes' mental toughness and physical fitness performances with Big Five Factors. For this, the sample was composed of eleven recreational boxers who competed at the state level and were regularly training (technical and tactical) 4 times a week during the evaluation period. The 44-item Big Five Inventory (BFI) measures the Big Five dimensions of Conscientiousness, Agreeableness, Neuroticism, Openness, and Extraversion and the 14-item Sports Mental Toughness Questionnaire (SMTQ) were applied with Strength, Power, and Endurance Tests, Pearson and Spearman's correlations were used to verify the association between BFI, physical and mental tests, respectively, p≤.05. Our results demonstrated that significant and strong correlation between agreeableness factor and sit-ups test, with 40.85±12.36 freq./min (r=.72, p=.02) and, in SMTQ, a strong correlation between Neuroticism and Control [10(9;12) score, r=.76, p≤0.01], Constancy [10(9;12) score, r=.84, p≤0.01] and Total SMQT [37(34;37) score, r=.84, p≤0.01]. In conclusion, these results suggest that Neuroticism factors are associated with mental toughness, while the agreeableness factor is related to muscular endurance capability. Mental toughness and endurance results are associated with boxers' personalities whose drive motivates them relentlessly towards success and promotes thriving in boxing training environments or during championships.

RESUMO O presente estudo relacionou a resistência mental e o desempenho da aptidão física de atletas de boxe com os cinco grandes fatores. Para isso, compuseram o presente estudo onze boxeadores recreativos que competiram em nível estadual e estavam treinando regularmente (técnico e tático) 4 vezes por semana durante o período de avaliação. O Big Five Inventory (BFI) de 44 itens mede as dimensões de Conscienciosidade, Amabilidade, Neuroticismo, Abertura e Extroversão e o Questionário de Resistência Mental Esportiva (SMTQ) de 14 itens foram aplicados com Testes de Força, Potência e Resistência, Pearson e as correlações de Spearman foram utilizadas para verificar a associação entre IMC, testes físicos e mentais, respectivamente, p≤0.05. Nossos resultados demonstraram correlação significativa e forte entre o fator de amabilidade e o teste de abdominais, com 40,9±12,4 freq./min (r=0,72, p=0,02) e, no SMTQ, uma forte correlação entre Neuroticismo e Controle [10 (9;12) pontuação, r=0.76, p≤0,01], Constância [10(9;12) pontuação, r=0.84, p≤0,001] e total SMQT [37(34;37) pontuação, r= 0.84, p≤0,001]. Em conclusão, esses resultados sugerem que os fatores de neuroticismo estão associados à resistência mental, enquanto o fator de amabilidade está associado à capacidade de resistência muscular. Os resultados de resistência mental e resistência estão associados à personalidade dos boxeadores, cuja motivação os impulsiona implacavelmente para o sucesso e promove o sucesso em ambientes de treinamento de boxe ou durante campeonatos.

Ilheus and Saint Louis encephalitis viruses elicit cross-protection against a lethal Rocio virus challenge in mice.

Rocio virus (ROCV) was the causative agent of an unprecedented outbreak of encephalitis during the 1970s in the Vale do Ribeira, Sao Paulo State, in the Southeast region of Brazil. Surprisingly, no further cases of ROCV infection were identified after this outbreak; however, serological surveys have suggested the circulation of ROCV among humans and animals in different regions of Brazil. Cross-protective immunity among flaviviruses is well documented; consequently, immunity induced by infections with other flaviviruses endemic to Brazil could potentially be responsible for the lack of ROCV infections. Herein, we evaluated the cross-protection mediated by other flaviviruses against ROCV infection using an experimental C57BL/6 mouse model. Cross-protection against ROCV infection was observed when animals had prior exposure to Ilheus virus or Saint Louis encephalitis virus, suggesting that cross-reactive anti-flavivirus antibodies may limit ROCV disease outbreaks.

Phospholipase A2 isolated from the venom of Crotalus durissus terrificus inactivates dengue virus and other enveloped viruses by disrupting the viral envelope.

The Flaviviridae family includes several virus pathogens associated with human diseases worldwide. Within this family, Dengue virus is the most serious threat to public health, especially in tropical and sub-tropical regions of the world. Currently, there are no vaccines or specific antiviral drugs against Dengue virus or against most of the viruses of this family. Therefore, the development of vaccines and the discovery of therapeutic compounds against the medically most important flaviviruses remain a global public health priority. We previously showed that phospholipase A2 isolated from the venom of Crotalus durissus terrificus was able to inhibit Dengue virus and Yellow fever virus infection in Vero cells. Here, we present evidence that phospholipase A2 has a direct effect on Dengue virus particles, inducing a partial exposure of genomic RNA, which strongly suggests inhibition via the cleavage of glycerophospholipids at the virus lipid bilayer envelope. This cleavage might induce a disruption of the lipid bilayer that causes a destabilization of the E proteins on the virus surface, resulting in inactivation. We show by computational analysis that phospholipase A2 might gain access to the Dengue virus lipid bilayer through the pores found on each of the twenty 3-fold vertices of the E protein shell on the virus surface. In addition, phospholipase A2 is able to inactivate other enveloped viruses, highlighting its potential as a natural product lead for developing broad-spectrum antiviral drugs.

Galectin-1 exerts inhibitory effects during DENV-1 infection.

Dengue virus (DENV) is an enveloped RNA virus that is mosquito-transmitted and can infect a variety of immune and non-immune cells. Response to infection ranges from asymptomatic disease to a severe disorder known as dengue hemorrhagic fever. Despite efforts to control the disease, there are no effective treatments or vaccines. In our search for new antiviral compounds to combat infection by dengue virus type 1 (DENV-1), we investigated the role of galectin-1, a widely-expressed mammalian lectin with functions in cell-pathogen interactions and immunoregulatory properties. We found that DENV-1 infection of cells in vitro exhibited caused decreased expression of Gal-1 in several different human cell lines, suggesting that loss of Gal-1 is associated with virus production. In test of this hypothesis we found that exogenous addition of human recombinant Gal-1 (hrGal-1) inhibits the virus production in the three different cell types. This inhibitory effect was dependent on hrGal-1 dimerization and required its carbohydrate recognition domain. Importantly, the inhibition was specific for hrGal-1, since no effect was observed using recombinant human galectin-3. Interestingly, we found that hrGal-1 directly binds to dengue virus and acts, at least in part, during the early stages of DENV-1 infection, by inhibiting viral adsorption and its internalization to target cells. To test the in vivo role of Gal-1 in DENV infection, Gal-1-deficient-mice were used to demonstrate that the expression of endogenous Galectin-1 contributes to resistance of macrophages to in vitro-infection with DENV-1 and it is also important to physiological susceptibility of mice to in vivo infection with DENV-1. These results provide novel insights into the functions of Gal-1 in resistance to DENV infection and suggest that Gal-1 should be explored as a potential antiviral compound.

O absenteísmo nos serviços públicos odontológicos / Universidade de São Paulo. Faculdade de Saúde Pública

As ausências dos pacientes às consultas acarretam perda de recursos públicos e comprometem a continuidade e a integralidade da assistência. Apesar de haver constante procura pelo serviço de saúde bucal, uma considerável parcela dos pacientes agendados não comparece às consultas, muitas vezes sem justificar essas faltas posteriormente. Diante disso, o objetivo deste estudo foi analisar os motivos que levaram os usuários de uma USF a faltar às consultas odontológicas. Após esta análise, objetivou-se implementar estratégias em conjunto com a equipe de saúde bucal para o enfrentamento do absenteísmo. Para o desenvolvimento desta pesquisa foram utilizadas as metodologias quantitativa e qualitativa de análise, esta última abordada com o recurso entrevista semiestruturada. Os dados obtidos foram submetidos à análise temática. A taxa de absenteísmo no período estudado foi de aproximadamente 24%. Para justificar essas ausências temos que 30% dos entrevistados relataram que o horário da consulta coincidiu com o horário de trabalho, 17% relataram que o motivo foi o relacionamento estabelecido pela equipe, 13% disseram ter esquecido o agendamento. O fato de o presente estudo ter relacionado aspectos e percepções referentes ao tema absenteísmo por parte da equipe de saúde bucal em associação com as respostas dos pacientes foi de suma importância para despertar um cenário de escuta, garantindo um permanente despertar de novos pensamentos, estratégias e releituras de práticas para o enfrentamento do absenteísmo.

Crotoxin and phospholipases A2 from Crotalus durissus terrificus showed antiviral activity against dengue and yellow fever viruses.

Dengue is the most important arbovirus in the world with an estimated of 50 million dengue infections occurring annually and approximately 2.5 billion people living in dengue endemic countries. Yellow fever is a viral hemorrhagic fever with high mortality that is transmitted by mosquitoes. Effective vaccines against yellow fever have been available for almost 70 years and are responsible for a significant reduction of occurrences of the disease worldwide; however, approximately 200,000 cases of yellow fever still occur annually, principally in Africa. Therefore, it is a public health priority to develop antiviral agents for treatment of these virus infections. Crotalus durissus terrificus snake, a South American rattlesnake, presents venom with several biologically actives molecules. In this study, we evaluated the antiviral activity of crude venom and isolated toxins from Crotalus durissus terrificus and found that phospholipases A2 showed a high inhibition of Yellow fever and dengue viruses in VERO E6 cells.

O que é estimulação magnética transcraniana? / What is transcranial magnetic stimulation?

Estimulação magnética transcraniana (EMT) é uma técnica capaz de induzir correntes elétricas em regiões corticais de forma não invasiva que apresenta um grande potencial tanto como uma ferramenta diagnóstica quanto terapêutica nos transtornos neuropsiquiátricos, como na depressão, esquizofrenia e neurológicos como no AVC e epilepsia. Este artigo aborda sinteticamente a EMT: fundamentos, tipos, aplicações, efeitos adversos e medidas de segurança...

Transcranial magnetic stimulation (TMS) is a non-invasive technique that can induce electrical currents in cortical areas, having thus a significant potential both as an investigational and as a therapeutic tool in neuropsychiatric disorders, such as depression and schizophrenia, and neurological, such as stroke and epilepsy. This article synthetically summarizes the applications of transcranial magnetic stimulation: fundamentals, type of stimulation, applications, adverse effects e safety...

Antiviral and antiparasite properties of an L-amino acid oxidase from the snake Bothrops jararaca: cloning and identification of a complete cDNA sequence.

L-Amino acid oxidases (LAAOs, EC 1.4.3.2) are flavoenzymes that catalyze the stereospecific oxidative deamination of an L-amino acid substrate to the corresponding alpha-ketoacid with hydrogen peroxide and ammonia production. The present work describes the first report on the antiviral (Dengue virus) and antiprotozoal (trypanocidal and leishmanicide) activities of a Bothrops jararaca L-amino acid oxidase (BjarLAAO-I) and identify its cDNA sequence. Antiparasite effects were inhibited by catalase, suggesting that they are mediated by H2O2 production. Cells infected with DENV-3 virus previously treated with BjarLAAO-I, showed a decrease in viral titer (13-83-fold) when compared with cells infected with untreated viruses. Untreated and treated promastigotes (T. cruzi and L. amazonensis) were observed by transmission electron microscopy with different degrees of damage. Its complete cDNA sequence, with 1452 bp, encoded an open reading frame of 484 amino acid residues with a theoretical molecular weight and pI of 54,771.8 and 5.7, respectively. The cDNA-deduced amino acid sequence of BjarLAAO shows high identity to LAAOs from other snake venoms. Further investigations will be focused on the related molecular and functional correlation of these enzymes. Such a study should provide valuable information for the therapeutic development of new generations of microbicidal drugs.

Evaluation of antiviral activity of South American plant extracts against herpes simplex virus type 1 and rabies virus.

This paper describes the screening of different South American plant extracts and fractions. Aqueous and organic extracts were prepared and tested for antiherpetic (HSV-1, KOS and 29R strains) and antirabies (PV strain) activities. The evaluation of the potential antiviral activity of these extracts was performed by using an MTT assay for HSV-1, and by a viral cytopathic effect (CPE) inhibitory method for rabies virus (RV). The results were expressed as 50% cytotoxicity (CC(50)) for MTT assay and 50% effective (EC(50)) concentrations for CPE, and with them it was possible to calculate the selectivity indices (SI = CC(50)/EC(50)) of each tested material. From the 18 extracts/fractions tested, six extracts and four fractions showed antiviral action. Ilex paraguariensis, Lafoensia pacari, Passiflora edulis, Rubus imperialis and Slonea guianensis showed values of SI > 7 against HSV-1 KOS and 29-R strains and Alamanda schottii showed a SI of 5.6 against RV, PV strain.

Pacientes com epilepsia: satisfação com os serviços de atenção à saúde?: [revisão] / Patient with epilepsy: satisfaction with the health care system?: [review]

INTRODUÇÃO: A avaliação da qualidade dos serviços de saúde sob a ótica dos pacientes com epilepsia (PCE) pode ser uma ferramenta importante para organização e promoção do sistema de saúde. OBJETIVOS: Avaliar e apresentar alguns aspectos sobre a satisfação do PCE com os serviços de saúde: satisfação geral, grau de informação sobre epilepsia e sua comunicação oferecida pelos profissionais de saúde, preferências pelo atendimento no setor primário ou pelo hospitalar, acessibilidade às consultas, eficácia do tratamento (freqüência das crises epilépticas) e medidas de melhoria do serviço com enfoque no uso de enfermeiras especializadas em epilepsia. MÉTODOS: Foi realizada uma revisão sistemática baseada em artigos selecionados segundo os objetivos e captados nos bancos bibliográficos Pubmed e Science Direct. RESULTADOS: Na maioria dos estudos, foram encontradas avaliações no geral positivas ao atendimento. No entanto, em quase todos existem críticas específicas, como a falta de comunicação, atendimento não compartilhado pelo setor primário e especializado, acessibilidade deficiente às consultas e a falta de continuidade do tratamento. CONCLUSÃO: Na tentativa de prover uma melhoria do atendimento aos PCE é fundamental conhecer as suas perspectivas, percepções, preferência e necessidades.

INTRODUCTION: The evaluation of the quality of the health care under the patients with epilepsy (PWE) view can be an important tool for the organization and promotion of the health care system. OBJECTIVE: To evaluate and to present some aspects of the of the PWE satisfaction regarding the health care system services: general satisfaction, degree of information about epilepsy and its communication offered by the health care workers, preferences for the service in the primary health care or for the hospital care, accessibility to the consultations, effectiveness of the treatment (frequency of the epileptic seizures) and measures of improvement of the service with focus in the specialized nurses’ work in epilepsy. METHODS: A systematic review was carried out based on papers searched according to the objectives and obtained in the bibliographical banks Pubmed and Science Direct. RESULTS: In most of the studies, they were found evaluations in the general positive to the services. However, in almost all specific criticisms exist, as the communication lack, services not shared by the primary and specialized health care, insufficient accessibility to the consultations, and the lack of continuity of the treatment. CONCLUSION: In the attempt of providing an improvement of the service to PWE is fundamental to know their perspectives, perceptions, preference and needs.

Atenção primária à saúde e epilepsia: revisão de literatura / Primary health care and epilepsy: literature review

INTRODUÇÃO: A atenção primária à saúde (APS) possibilita a melhor cobertura populacional de cuidados à saúde e também o atendimento às pessoas com epilepsia (PCE). OBJETIVOS: Apresentar aspectos evolutivo-conceituais da APS, suas implicações na educação médica, e uso da telemedicina com repercussões no atendimento de PCE. METODOLOGIA: Revisão narrativa com os objetivos apresentados. RESULTADOS: Pessoas habitualmente cuidadas pelo médico de família são mais saudáveis, principalmente devido à abordagem holística; maior ênfase em prevenção e redução de custos por procurar a atenção dos especialistas apenas quando necessária. A educação médica e o mercado de trabalho estão se adaptando a esse perfil de atenção à saúde. Ao mesmo tempo em que médicos de família admitem estar despreparados para o atendimento de PCE, verificou-se não haver neurologistas suficientes para avaliação e condução dessa clientela. A telemedicina apresenta potencial para ensino, consultoria e qualificação da equipe de saúde à distância colaborando com a redução dos óbices mencionados. CONCLUSÃO: Proposições para o atendimento de PCE no Sistema de Saúde: treinamento formal dos profissionais da equipe da APS, criação de médicos especialistas intermediários e enfermeiras treinadas, com aumento dos recursos da telemedicina o que pode garantir a qualidade da APS e integração melhor do sistema de saúde.

INTRODUCTION: The primary health care (PHC) makes possible the best health care coverage and also the care to the people with epilepsy (PWE). OBJECTIVES: To present evolutionary-conceptual aspects of PHC, their medical education implications, and the use of the telemedicine with repercussions in the PWE care. METHODOLOGY: Narrative review with the presented objectives. RESULTS: People usually cared by family doctors are healthier, mainly due to the holistic approach; major health prevention emphasis and reduction of costs for seeking the specialists' attention just when necessary. Medical education and medicine labor market are gradually adapting to this health care profile. At the same time family doctors admit they are unprepared to care PWE it has been found out there are not enough neurologists to the appraisal and follow up of these clients. Telemedicine shows potential for distance health teaching, consulting and staff qualification helping to reduce the mentioned constraints. CONCLUSION: PWE care proposals in the Health Care System: formal training of the professionals' of PHC team, doctors' intermediate specialists and trained nurses creation, increasing of the resources of the telemedicine what can guarantee the quality of health care and provision of better integration of the system of health care.