Applying a new version of the Brazilian-Portuguese UPSIT smell test in Brazil

Standardized olfactory tests are now available to quantitatively assess disorders of olfaction. A Brazilian-Portuguese version of the University of Pennsylvania Smell Identification Test (UPSIT) is currently being developed specifically for the Brazilian population. The most recent Brazilian-Portuguese version of the UPSIT (UPSIT-Br2) was administered to 88 Brazilian subjects who had no history of neurological or otorhinolaryngological disease. UPSIT-Br2 scores decreased with age, were lower in men than in women, and were lower in subjects with lower income. The degree to which the poorer performance of subjects with lower socio-economic status reflects lack of familiarity with test items is not known. Although this version of the UPSIT provides a sensitive and useful test of smell function for the Brazilian population, a revision of some test items is needed to achieve comparable norms to those found using the North American UPSIT in the United States

Prenatal exposure to tobacco and alcohol are associated with chronic daily headaches at childhood: a population-based study

The influence of prenatal events on the development of headaches at childhood has not been investigated and is the scope of our study. Of 2,173 children identified as the target sample, consents and analyzable data were provided by 1,440 (77%). Parents responded to a standardized questionnaire with a validated headache module and specific questions about prenatal exposures. Odds of chronic daily headache (CDH) were significantly higher when maternal tabagism was reported. When active and passive smoking were reported, odds ratio (OR) of CDH were 2.29 [95% confidence intervals (CI)=1.6 vs. 3.6)]; for active tabagism, OR=4.2 (95% CI=2.1-8.5). Alcohol use more than doubled the chance of CDH (24% vs. 11%, OR=2.3, 95% CI=1.2-4.7). In multivariate analyses, adjustments did not substantially change the smoking/CDH association. Prenatal exposure to tobacco and alcohol are associated with increased rates of CDH onset in preadolescent children

Encefalitis chagásica pseudotumoral en pacientes con SIDA: presentación atípica en uno de ellos e historia de la enfermedad en una pequeña serie de casos

Chagas' disease is an intracellular parasitic infection owed to a protozoarium, the Trypanosoma cruzi1, affecting a large population in Latinamerica. Within the region 15 to 16 million people are infected2. The worldwide pandemia, due to the infection of the HIV 1 virus, also affects Latinamerican countries. The number of patients with this condition in Central and South Americas amounts to 1.6 million persons3,4. Therefore, both illnesses overlap in a broad geographical area and may coincide in the same patient. The HIV infection, which causes the AIDS syndrome, impairs the immunological system and predisposes to the appearance of opportunistic infections, which may have been hosted unnoticed by the patient until then. Therefore, Chagas' disease, which is a dormant infection in most patients5, may reactivate if the immunological surveillance wanes off as the consequence of the viral insult. Along the last years we6,7 and others8-10 found patients afflicted by AIDS, who developed brain lesions yielded by the Trypanosoma cruzi. The present communication describes three further patients with this condition; one of them is unique because his clinical, radiological and immunological findings differ from those previously reported in the literature.Fil: Sica, Roberto E. P.. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Gargiulo Monachelli, Gisella Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Papayanis, Cristina. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentin

Patients with multiple sclerosis do not necessarily consume more alcohol or tobacco than the general population

Peer reviewedPublisher PD

Perfil clínico e epidemiológico dos pacientes com esclerose múltipla na cidade de Uberaba (MG), Brasil

Multiple sclerosis (MS) is an immune-mediated disease that affects the central nervous system. Clinical presentation and prevalence vary widely around the world. OBJECTIVE: To describe the clinical and epidemiological aspects of patients with MS in Uberaba (MG). METHOD: We conducted a transversal descriptive study, with data analysis of 35 patients with MS. RESULTS: Prevalence of MS was 12.5 cases/100,000 inhabitants, with a predominance in females (71.4%) and Caucasoid (85.7%). The current average age was (43.8 ys). The most common initial symptom was sensory (40%), followed by optical neuritis (25.7%). Expanded Disability Status Scale average score was 2.4. The relapsing-remitting form was predominant (88.6%), most (74.3%) were on immunomodulatory treatment and (40%) had college education. CONCLUSION: Prevalence of MS in Uberaba (MG) is considered average in accordance to Kurtzke and Page and clinical features are consistent with most Brazilian studies.A esclerose múltipla (EM) é uma doença imunomediada que acomete o sistema nervoso central. Seus aspectos clínicos e prevalência variam consideravelmente em todo o mundo. OBJETIVO: Descrever a prevalência, os aspectos clínicos e epidemiológicos dos pacientes com EM na cidade de Uberaba (MG). MÉTODO: Realizado estudo descritivo transversal, com análise dos dados de 35 pacientes com EM. RESULTADOS: A prevalência de EM foi de 12,5 casos/100.000 habitantes, com predomínio no sexo feminino (71,4%) e etnia caucasóide (85,7%), idade média atual de 43,8 anos. Do total, 40 possuem curso superior. O sintoma inicial mais frequente foi o sensitivo (40%), seguido de neurite óptica (25,7%). A média dos escores da Escala de Status de Incapacidade Expandida foi de 2,4. A forma evolutiva recorrente-remitente foi predominante (88,6%), com (74,3%) dos pacientes em uso de imunomodulador. CONCLUSÃO: A prevalência de EM no município de Uberaba (MG) é considerada média, de acordo com Kurtzke e Page. Os aspectos clínico-epidemiológicos estão em consonância com a maioria dos estudos brasileiros

Post-Mortem diagnosis of dementia by informant interview.

The diagnosis of normal cognition or dementia in the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) has relied on postmortem interview with an informant. Objectives:To ascertain the sensitivity and specificity of postmortem diagnosis based on informant interview compared against the diagnosis established at a memory clinic. Methods:A prospective study was conducted at the BBBABSG and at the Reference Center for Cognitive Disorders (RCCD), a specialized memory clinic of the Hospital das Clínicas, University of São Paulo Medical School. Control subjects and cognitively impaired subjects were referred from the Hospital das Clínicas to the RCCD where subjects and their informants were assessed. The same informant was then interviewed at the BBBABSG. Specialists' panel consensus, in each group, determined the final diagnosis of the case, blind to other center's diagnosis. Data was compared for frequency of diagnostic equivalence. For this study, the diagnosis established at the RCCD was accepted as the gold standard. Sensitivity and specificity were computed. Results:Ninety individuals were included, 45 with dementia and 45 without dementia (26 cognitively normal and 19 cognitively impaired but non-demented). The informant interview at the BBBABSG had a sensitivity of 86.6% and specificity of 84.4% for the diagnosis of dementia, and a sensitivity of 65.3% and specificity of 93.7% for the diagnosis of normal cognition. Conclusions:The informant interview used at the BBBABSG has a high specificity and sensitivity for the diagnosis of dementia as well as a high specificity for the diagnosis of normal cognition

National epilepsy movement in Brazil

Purpose: To establish a social network of epilepsy lay organization in Brazil to provide advocacy for people with epilepsy and eventually forma powerful National Epilepsy movement. Method.-We actively searched for any associations, support groups or organizations related to epilepsy in the country by personal contacts, internet search and by telephone search. Contact was then established with any entity found. Results: The first meeting was held in Campinas in March 2003, and was attended by 270 people, including many people with epilepsy, members of all eleven epilepsy associations found, health professionals and representatives of the Brazilian chapters of IBE and ILAE and the Brazilian Ministry of Health. This first meeting resulted in a National Movement expressed every year through the National Week of Epilepsy and National Meeting of Lay Associations. Discussion: This strategy, developed by ASPE, was simple and effective, and in a very short time a national movement was active. These actions could be reproduced in any country developing a campaign against epilepsy. it is important to consider that this is a process of empowerment, thus people with epilepsy need to take actions into their own hands and to be active participants

Patients with ischemic stroke are taken care quickly in São Paulo Hospital

We observed inpatients with the diagnosis of ischemic stroke hospitalized at least 24 hours. We investigated the reasons for early or late arrival to the Emergency Room, the time span from arrival to computed tomography (CT) scanning, factors associated to hospitalization time, and patients outcome. We concluded that people who are cared for by São Paulo Hospital now get to the hospital sooner than they did 3 years ago (47% arrived in 3 hours or less) and that the patient flow inside the hospital became much faster, once any stroke patient is considered now a medical emergency by the hospital staff. Infections were the main complications presented by our patients, which is leading us to optimize protocols to improve emergency care by all the staff.Foram caracterizados os pacientes com diagnóstico de acidente vascular cerebral (AVC) isquêmico internados por período superior a 24 horas. Investigamos os fatores que influenciam a chegada precoce ou tardia do paciente ao pronto socorro, o intervalo de tempo entre a chegada e a realização de tomografia computadorizada (TC), os fatores que influenciam na permanência destes pacientes no hospital e o seu destino. Concluímos que a população atendida pelo Hospital São Paulo tem chegado ao hospital mais precocemente que há 3 anos (47% chegaram nas primeiras 3 horas de instalação) e que o fluxo interno do paciente ficou muito mais rápido, uma vez que o AVC é considerado emergência médica pela equipe de saúde. As principais complicações apresentadas pelos pacientes foram infecciosas e nos direcionam à proposta de implementação de protocolos para a melhoria aos cuidados que devem ser prestados pelos profissionais de saúde.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Hospital São PauloUniversidade Federal de São Paulo (UNIFESP) Departamento de EnfermagemUNIFESP, EPM, Hospital São PauloUNIFESP, Depto. de EnfermagemSciEL

Viés educacional na avaliação da demência grave: pontos de corte brasileiros para o Miniexame do Estado Mental grave

Cognitive assessment in advanced stages of Alzheimer’s disease (AD) is limited by the imprecision of most instruments.Objective:To determine objective cognitive responses in moderate and severe AD patients by way of the Severe Mini-Mental State Examination (SMMSE), and to correlate performances with Mini-Mental State Examination (MMSE) scores. Method:Consecutive outpatients in moderate and severe stages of AD (Clinical Dementia Rating 2.0 or 3.0) were evaluated and compared according to MMSE and SMMSE scores. Results:Overall 400 patients were included, 67.5% females, mean age 76.6±6.7 years-old. There was no significant impact of age or gender over MMSE or SMMSE scores. Mean schooling was 4.4±2.5 years, impacting SMMSE scores (p=0.008). Scores on MMSE and SMMSE were significantly correlated (F-ratio=690.6325, p<0.0001). Conclusion:The SMMSE is influenced by schooling, but not by age or gender, and is an accurate test for assessment of moderate and severe AD.A avaliação cognitiva na doença de Alzheimer (DA) avançada é insuficiente pela imprecisão dos instrumentos.Objetivo:Determinar respostas cognitivas objetivas em pacientes com DA moderada e grave por meio do Mini-Exame do Estado Mental Grave (MEEM-g) e correlacionar o seu desempenho com o Mini-Exame do Estado Mental (MEEM). Método:Pacientes consecutivos com DA moderada e grave (Clinical Dementia Rating – CDR: 2.0 e 3.0) foram avaliados e comparados conforme seus intervalos nos testes MEEM e MEEM-g. Resultados:Dentre 400 pacientes incluídos, 67,5% foram mulheres, com média de idade 76.6±6.7 anos. Não houve impacto significativo de gênero ou idade nas pontuações do MEEM ou MEEM-g. A escolaridade média foi de 4.4±2.5 anos, impactando nos escores do MEEM-g (p=0.008). Pontuações no MEEM e MEEM-g correlacionaram-se significativamente (F-ratio=690.6325, p<0.0001). Conclusão:O MEEM-g sofre influência da escolaridade, mas não de idade ou gênero, contribuindo para a precisão na avaliação da DA moderada ou grave.Universidade Federal de São Paulo (UNIFESP) Departamento de Neurologia e Neurocirurgia Departamento de Medicina ComportamentalUNIFESP, Depto. de Neurologia e Neurocirurgia Depto. de Medicina ComportamentalSciEL

Suplementacao de omega 3 em pessoas com epilepsia submetidas a um programa regular de hemidialise: veio para ficar

Among the many risk factors suggested for sudden unexpected death in epilepsy (SUDEP), higher frequency of seizures is a very consistent issue. Furthermore, it has been established that hemodialysis-associated seizure is a complication of the dialysis procedure. Thus, since a possible relation between cardiovascular abnormalities and SUDEP among patients with chronic renal insufficiency in regular hemodialysis program should not be neglected, we propose in this paper that omega-3 fatty acids offer opportunities for prevention of sudden cardiac death or improved treatment in people with epilepsy under the regular hemodialysis program.Dentre os fatores de risco sugeridos para a morte súbita inesperada em epilepsia (SUDEP), maior frequência de crises epilépticas é uma questão muito consistente. Além disso, tem sido estabelecido que as crises epilépticas associadas à hemodiálise são uma complicação do procedimento dialítico. Desse modo, como a existência de uma possível associação entre as alterações cardiovasculares e a SUDEP entre indivíduos com insuficiência renal crônica em tratamento dialítico não deve ser negligenciada, foi proposto neste artigo que o ômega 3 pode atuar na prevenção da morte súbita cardíaca ou melhorar o tratamento de pessoas com epilepsia inseridas em um programa regular de hemodiálise.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Disciplina de Neurologia ExperimentalUNIFESP-EPM Departamento de FisiologiaUniversidade Presbiteriana Mackenzie Programa de Pos-Graduacao em Disturbios do Desenvolvimento do Centro de Ciencias Biologicas e da SaudeUNIFESP, EPM, Disciplina de Neurologia ExperimentalUNIFESP, EPM Depto. de FisiologiaSciEL