Factors associated with non-treatment of hypertension and gender differences at baseline in the ELSA-Brasil cohort.

The treatment of arterial hypertension (AH) contributes to the reduction of morbidity and mortality. Gender differences are likely to play a role, as non-treatment is associated with clinical and sociodemographic aspects. The aim of this study was to investigate the factors associated with non-treatment of AH and gender differences in hypertensive individuals from the ELSA-Brasil cohort. The study was conducted with 5,743 baseline hypertensive cohort participants. AH was considered if there was a previous diagnosis or if systolic blood pressure (SBP) was ≥140 and/or diastolic BP (DBP) was ≥90 mmHg. Sociodemographic and anthropometric data, lifestyle, comorbidities, and use of antihypertensive medications were evaluated through interviews and in-person measurements. Treatment with renin-angiotensin-aldosterone system inhibitors (RAASi) or other antihypertensive medications and non-treatment were evaluated with multivariate logistic regression. Non-treatment was observed in 32.8% of hypertensive individuals. Of the 67.7% treated individuals, 41.1% received RAASi. Non-treatment was associated with alcohol consumption in women (OR=1.41; 95%CI: 1.15-1.73; P=0.001), lowest schooling level in men (OR=1.70; 95%CI: 1.32-2.19; P<0.001), and younger age groups in men and women (strongest association in males aged 35-44 years: OR=4.58, 95%CI: 3.17-6.6, P<0.001). Among those using RAASi, a higher proportion of white, older individuals, and with more comorbidities was observed. The high percentage of non-treatment, even in this civil servant population, indicated the need to improve the treatment cascade for AH. Public health policies should consider giving special attention to gender roles in groups at higher risk of non-treatment to reduce inequities related to AH in Brazil.

Unravelling the fungal darkness in a tropical cave: richness and the description of one new genus and six new species.

Caves are special environments that harbour an incredible diversity of life, including fungal species. Brazilian caves have been demonstrated to be biodiversity hotspots for known and unknown fungal species. We investigated the richness of culturable fungi in a tropical cave in Brazil by isolating these microorganisms from the sediment and air. The fungal abundance of colony-forming units (CFUs) was 3 178 in sediment and 526 in air. We used morphological features and phylogenetic analyses of actin (actA), calmodulin (cmdA), internal transcribed spacer regions and intervening 5.8S rRNA (ITS), large subunit (LSU) rDNA, RNA polymerase II second largest subunit (rpb2), translation elongation factor 1-alpha (tef1), and ß-tubulin (tub2) genes to identify these isolates. Forty-one species belonging to 17 genera of Ascomycota and two of Basidiomycota were identified, and the genus Aspergillus was most commonly observed in the cave (13 taxa). Twenty-four species were found in sediment (16 exclusives) and 25 species were found in air (17 exclusives). In this study, we introduced a new genus (Pseudolecanicillium gen. nov.) in the family Cordycipitaceae and six new species (14 % of the total taxa identified) of fungal isolates obtained from sediment and air: Aspergillus lebretii sp. nov., Malbranchea cavernosa sp. nov., Pseudohumicola cecavii sp. nov., Pseudolecanicillium caatingaense sp. nov., Talaromyces cavernicola sp. nov., and Tritirachium brasiliense sp. nov. In addition, we built a checklist of the fungal taxa reported from Brazilian caves. Our results highlight the contribution of Brazilian caves to the estimation of national and global fungal diversity. Citation: Alves VCS, Lira RA, Lima JMS, Barbosa RN, Bento DM, Barbier E, Bernard E, Souza-Motta CM, Bezerra JDP (2022). Unravelling the fungal darkness in a tropical cave: richness and the description of one new genus and six new species. Fungal Systematics and Evolution 10: 139-167. doi: 10.3114/fuse.2022.10.06.

Factors associated with non-treatment of hypertension and gender differences at baseline in the ELSA-Brasil cohort

The treatment of arterial hypertension (AH) contributes to the reduction of morbidity and mortality. Gender differences are likely to play a role, as non-treatment is associated with clinical and sociodemographic aspects. The aim of this study was to investigate the factors associated with non-treatment of AH and gender differences in hypertensive individuals from the ELSA-Brasil cohort. The study was conducted with 5,743 baseline hypertensive cohort participants. AH was considered if there was a previous diagnosis or if systolic blood pressure (SBP) was ≥140 and/or diastolic BP (DBP) was ≥90 mmHg. Sociodemographic and anthropometric data, lifestyle, comorbidities, and use of antihypertensive medications were evaluated through interviews and in-person measurements. Treatment with renin-angiotensin-aldosterone system inhibitors (RAASi) or other antihypertensive medications and non-treatment were evaluated with multivariate logistic regression. Non-treatment was observed in 32.8% of hypertensive individuals. Of the 67.7% treated individuals, 41.1% received RAASi. Non-treatment was associated with alcohol consumption in women (OR=1.41; 95%CI: 1.15-1.73; P=0.001), lowest schooling level in men (OR=1.70; 95%CI: 1.32-2.19; P<0.001), and younger age groups in men and women (strongest association in males aged 35-44 years: OR=4.58, 95%CI: 3.17-6.6, P<0.001). Among those using RAASi, a higher proportion of white, older individuals, and with more comorbidities was observed. The high percentage of non-treatment, even in this civil servant population, indicated the need to improve the treatment cascade for AH. Public health policies should consider giving special attention to gender roles in groups at higher risk of non-treatment to reduce inequities related to AH in Brazil.

Report of the Task Force on pre-graduate education in Europe of the education committee of the European Federation of Neurological Societies Composition of the task force of the education committee on pre-graduate education.

BACKGROUND AND PURPOSE: The demographical evolution and the technological revolution seen in the last decades, in developed countries, have dramatically changed the practice of Neurology. However, the academic curriculum in many medical schools has not been updated accordingly over many of the European Countries. The Education Committee of the European Federation of Neurological Societies (EFNS) implemented in 2000 a Task Force on pre-graduate education trying to give guidelines to adequate pre-graduate education to the present status. METHODS AND DISCUSSION: Based on the results of two questionnaires, the first sent to the delegates of the EFNS and to the delegates of the European Board of Neurology, and the second answered by the Task Force members themselves, this paper describes the Task Force recommendations aimed to improve Neurology Education in the Medical Schools. These recommendations are also discussed with the analyses of the current bibliography available.

Effects of feeding strategies including different proportion of pasture and concentrate, on carcass and meat quality traits in Uruguayan steers.

Eighty four steers were randomly assigned to three pasture treatments with increasing levels of grain (T1: 0%; T2: 0.6%; T3: 1.2% of live weight) and to an ad libitum concentrate treatment, T4, to study the effects on carcass and meat quality. Animals were slaughtered with 500 kg of average live weight per treatment. Average daily gain increased with increasing levels of energy, determining different slaughter dates. Intermediate treatments showed higher carcass weight than T1. T4 and T3 had a higher weight of valuable cuts than T1 and T4. Pistolas from T4 had a higher fat proportion and lower bone percentage. Increasing levels of energy in diet decreased fat yellowness. After 20 days of aging, T4 had the lowest muscle a(∗) values and shear force was higher for T4 than for T1. With pastures finishing strategy, no adverse effects on meat quality were detected and tenderness was enhanced.

Fatigue Resistance of Y-TZP/Porcelain Crowns is Not Influenced by the Conditioning of the Intaglio Surface.

OBJECTIVES: The objective of this study was to investigate the effects of treatments of the intaglio surface of Y-TZP frameworks and luting agents on the fatigue resistance of all-ceramic crowns. METHODS: A research design was chosen that attempted to reduce the likelihood of Hertzian cracking and to increase the probability of fracture initiation at the intaglio surface of the framework. Ninety identical preparations were machined in a dentin-like epoxy composite. Each preparation was restored with a Y-TZP framework made by a CAD/CAM system and veneered using feldspathic ceramic. Prior to cementation the intaglio surface of the ceramic was treated using one of four treatments: 1) cleaning with isopropyl alcohol; 2) application of an overglaze; 3) sandblasting with 125 µm aluminum oxide powder; and 4) sandblasting with 30 µm silica powder (CJ). One of three luting cements were used: 1) zinc phosphate; 2) glass ionomer; and 3) adhesive resin cement (PN). All three cements were tested against frameworks that were alcohol cleaned. Only the PN cements were tested against frameworks that had been sandblasted or glazed. Altogether, six groups of 15 specimens each were tested. Fatigue resistance was evaluated using stepwise loads at 1.4 Hz until failure: 5000 cycles at maximum load of 200 N, followed by 10,000 cycles at maximum loads of 800, 1000, 1200, and 1400 N. The cement thickness and failure modes were analyzed using a stereomicroscope and scanning electron microscopy. The results were analyzed using the Kaplan-Meier and Mantel-Cox log rank tests (5%), a one-way analysis of variance, Tukey multiple comparison test, and Weibull nonparametric test. RESULTS: The predominant failure mode was chipping of the veneer. The crowns cemented with the adhesive resin cement exhibited chipping failure at higher mean loads than did crowns cemented with cements that usually do not bond strongly with dentin. When the adhesive cement was used, glazing and sandblasting intaglio framework surface treatments exhibited lower mean loads at chipping than did crowns whose intaglio surface was only cleaned with alcohol. Weibull analysis indicated that all specimens had a high ratio of late-to-early failures. CONCLUSIONS: The fatigue experiment produced a pattern of failures that is very similar to that observed in clinical trials of Y-TZP crowns that are veneered with feldspathic porcelain. Crowns cemented with an adhesive resin cement exhibited chipping at a significantly higher mean load than those cemented with luting cements that do not usually form strong bonds with dentin. When cemented with adhesive resin cement, glazing or sandblasting the intaglio surface of the framework significantly reduced the mean fatigue loads at which chipping of veneers occurred, as compared to crowns whose intaglio surface had only been cleaned with alcohol. For this cement glazing or sandblasting the intaglio surface of the crown is not recommended.

The new drugs and the strategies to manage epilepsy.

After a short historical review of the development of the pharmaceutical treatment of the epilepsies the author reviews some of the possible strategies to manage patients with the different types of epilepsies and epileptic syndromes using the classical drugs. A strategy used by most of the physicians uses Sodium Valproate as the first line drug for almost all patients. This may be replaced by other drugs according to their efficacy against the different types of seizures to be treated whenever VPA has not enough efficacy or isn t well tolerated. On the other hand epileptologists use the different drugs according to the different epilepsies and epileptic syndromes depending on the relative efficacy of each drug available and the possible side effects. He then describes succinctly the better-known new drugs and makes some comments on the coming drugs now in development. Finally he proceeds to include them in the strategies above described. Lamotrigine and possibly Topiramate are good candidates to replace VPA in the one drug strategy. Lamotrigine, Oxcarbamazepine and possibly Gabapentin may be used in the future as 1st line drugs in selected patients. Vigabatrin is already used as one of the better alternatives for West syndrome and Oxcarbamazepine has replaced Carbamazepine in countries where it s available to the public. Some drawbacks have been apparent with these drugs like the hepatic and haematological toxic effect of Felbamate or the apparently irreversible fields constriction provoked by Vigabatrin, which did limit their use.

[Re-evaluation of barbexaclone in 20 epileptic patients]. / Reavaliação do barbexaclone em 20 pacientes epiléticos.

The clinically observed results in 20 patients treated with barbexaclone for a period of 2 1/2 years are reported. Therapeutic efficiency as well as side effects are discussed. The authors draw attention to the fact that there was a concomitant improvement in the behaviour of some patients and a diminution of maintainence dosage in relation to a previously published trial.

[Clinical trial with barbexaclone in epilepsies]. / Ensaio clinico com barbexaclone nas epilepsias

A open clinic assay with barbexaclone which is an association of phenobarvital with light stimulant of the central nervous system (tau-l-ciclohexil-2-methil-aminopropane) for the treatment of epileptic disorders is reported. The authors have studied 40 patients aged between 0-12 years of age, of both sexes, all of them having convulsive seizures of the Grand Mal type associated or not to other epileptic manifestations. After analysing the different aspects of the group they consider satisfactory the results obtained: very good or good in 82,5% of the cases.

[Reduction in glucose concentration in the brain of mice inoculated with cerebrospinal fluid from patients with amyotrophic lateral sclerosis]. / Redução na concentração de glicose no cérebro de camundongos inoculados com líquido cefalorraquiano de pacientes com esclerose lateral amiotrófica.

Using chromatographic analysis the authors studied glucose concentration in the brain of Swiss mice inoculated with CSF of four patients with amyotrophic lateral sclerosis. They found reduction in the levels of glucose, suggesting the existence of an exogenous factor transferred by CSF.

[Effect of barbexaclone in convulsive crisis difficult to control]. / Efeito do barbexaclone nas crises convulsivas de difícil controle.

A therapeutic trial using barbexaclone in uncontrolled seizures was undertaken showing favourable results. Special reference to the association of barbexaclone with acetazolamide with good results in many cases is made. Collateral effects are minimal in pacients using barbexaclone.

[Effects of barbexaclone in Lennox-Gastaut syndrome]. / Efeitos do barbexaclone na síndrome de Lennox-Gastaut.

The Lennox-Gastaut syndrome has been a source of interest for many workers both from a clinical and electroencephalographic view point. Treatment has always posed problems. Without suggesting an ideal medication for this syndrome, the authors have obtained good results with barbexaclone. Taking into consideration the convulsive manifestations, psychic changes and electroencephalographic details as parameters the therapeutic efficacy of this drug was studied in seven cases.

[Progressive hemifacial atrophy (Parry-Romberg disease): study of a case]. / Atrofia hemifacial progressiva (doença de Parry-Romberg): estudo de um caso.

A caracteristic case of hemifacial progressive atrophy at right is reported. The patient was a man with 45 year-old. There were epileptic crisis at left too. Alterations observed in clinical-neurological examination are referred. In computadorized tomographic axial examination there were parietotemporal atrophy at left and frontal contrast hipercaptation at right. In EEG there were lentification at right and depression at left who was in concordance with the pathological alterations of the patient: atrophy and cortical depression at left with facial atrophy at right and lentification and contrast hipercaptation at right with epileptic crisis at left. EMG showed facial velocity conduction slowed at right. The authors believe in atrophy hemifacial progressive has been a disease which injuries central and peripheral nervous system at one time.

[Neurochemical aspects of parkinsonism. Review of the literature]. / Aspectos neuroquimicos do parkinsonismo. Revisão da literatura.

The authors make a revision of literature on neurochemistry data, up to now found Parkinson's. They study the concentrations alteration of dopamine, acetylcholine, serotonin, noradrenalin, enzymes, neuroaminic acid, metals and amynoacids, concluding on the possible existence of a neurochemistry defect more generalized in the forementioned condition.

[Virologic studies in patients with amyotrophic lateral sclerosis]. / Estudos virológicos em pacientes com esclerose lateral amiotrófica.

The effects of intracerebral inoculation of cerebrospinal fluid in mice from 9 patients with amyotrophic lateral sclerosis are reported. There were 704 animals inoculated. The results were considered positive when the animals presented difficulties in walking and equilibrating. Cases 1, 2, 6, 7 and 9 were positives in the first passage. In case 1, the positivity was reached from first to fourth passage and in case 6, to third passage. At sight of this results, the possibility of that disease to be caused by slow-virus is discussed.

Amyotrophic lateral sclerosis in Brazil: 1998 national survey.

OBJECTIVES: To assess the epidemiologic characteristics of amyotrophic lateral sclerosis (ALS) in Brazil in 1998. METHOD: Structured Clinical Report Forms (CRFs) sent to 2,505 Brazilian neurologists from January to September 1998 to be filled with demographic and clinical data regarding any ALS patient seen at any time during that year. RESULTS: Five hundred and forty CRFs were returned by 168 neurologists. Data on 443 patients meeting the criteria of probable or definite ALS according to El Escorial definition were analysed: 63 probable (14.2%) and 380 definite (85. 8%). Two hundred and fifty-nine (58.5%) of the patients were male, mean age of onset was 52. Spinal onset occurred in 306 patients (69%); bulbar onset in 82 (18.5%), and both in 52 (11.7%). Twenty-six (5.9%) had a family history of ALS. Two hundred and fifty-nine (58.6%) were seen by private practitioners, and 178 (40. 2%) at a hospital clinic. Age-ajusted incidence shows a peak incidence at the 65-74 years old range. CONCLUSIONS: The disease's characteristics are similar to those described in international studies, except for age of onset (Brazilian patients are younger). This difference is not confirmed when figures are age-adjusted.

[Amyotrophic lateral sclerosis with deafness: report of a case and review of the literature]. / Esclerose lateral amiotrófica com surdez: relato de um caso e revisão da literatura.

A case of chronic bulb-pontine paralysis with deafness, with early onset, coursing along nine years is reported. There seem to be histopathologic and electromyographic evidences on which is concluded to be a variant form of juvenile amyotrophic lateral sclerosis (Van Laere form).

[Progressive extrinsic ophthalmoplegia. Report of 3 cases]. / Oftalmoplegia extrínseca progressiva. Registro de tres casos.

Three women with extrinsic oculo-muscular distrophy were studied. In two patients the symptoms were began at 25 and another one at 56 year-old. Non myogenic features were observed: in case one there was familial otosclerosis. This patient had impossibility to beget children. Her first menstruation was observed at 19 and the last at 40 year-old, like to case 2, which was the only to have electrocardiographic alterations. Romberg's signal and profound hyporeflexia was obtained in case 3, whose family had a lot of member with cataract. Biopsy of the non ocular muscles was made too, in spite of patient's symptoms had been concerning to ocular muscles only. All of non ocular muscles had myogenic features. In electromyogram examination of non ocular muscles the myogenic features were observed too. Therefore, we believe in diffuse myogenic process in spite of ocular manifestation had been the only patient's complaints.

[Mansonic neuroschistosomiasis: clinical, laboratory and therapeutic aspects]. / Neuroesquistossomose mansônica: aspectos clínicos, laboratoriais e terapêuticos.

The authors report 16 patients bearing the meningomyeloradicular form of Mansonic neuroschistosomiasis diagnosed according to clinical, laboratorial and image criteria. Patients have been observed at the Neurology Ambulatory of the Federal University of Bahia, within the period of April/91 to December/93. They have been treated with praziquantel, associated to corticosteroids. The aim has been to evaluate the drug's efficiency and safety in decreasing the neurological signs and symptoms.