Síndrome de Kleine-Levin: interface entre neurologia e psiquiatria

We report the first episode of Kleine-Levin (KLS) syndrome in a 17-year-old male. The illness onset, clinical features, neuropsychological evaluation and polysomnographic recording are described. Typical symptoms hypersomnia, hyperphagia and sexual disinhibition were observed besides behavioral disturbances, polysonographic and neuropsychological alterations. Behavioral disturbances similar to a manic episode including psychotic symptoms were relevant. The pharmacologic treatment included lithium, methylphenidate and risperidone. The introduction of risperidone aimed the control of psychotic symptoms and the persistent manifestations of hypersexuality after sleepness control and to the best of our knowledge there are no other report regarding risperidone use for KLS in the literature.Relatamos o primeiro episódio de síndrome de Kleine-Levin (SKL) num adolescente de 17 anos. São descritos o modo de aparecimento da doença, achados clínicos, avaliação neuropsicológica e polissonografia. Foram observados sintomas típicos como hipersonolência, hiperfagia e desinibição sexual, e outras alterações comportamentais, polissonográficas e neuropsicológicas. As alterações comportamentais assemelhadas a um episódio de mania, incluindo sintomas psicóticos, foram relevantes. O tratamento farmacológico incluiu lítio, metilfenidato e risperidona. A introdução de risperidona teve por objetivo o controle dos sintomas psicóticos e das persistentes manifestações da hipersexualidade, que permaneceram após diminuição da sonolência; não temos conhecimento de relatos anteriores, na literatura, de seu uso no tratamento da SKL.Federal University of São Paulo Department of PychobilogyUNIFESP, Department of PychobilogySciEL

Homeopathic Individualized Q-Potencies versus Fluoxetine for Moderate to Severe Depression: Double-Blind, Randomized Non-Inferiority Trial

Homeopathy is a complementary and integrative medicine used in depression, The aim of this study is to investigate the non-inferiority and tolerability of individualized homeopathic medicines [Quinquagintamillesmial (Q-potencies)] in acute depression, using fluoxetine as active control. Ninety-one outpatients with moderate to severe depression were assigned to receive an individualized homeopathic medicine or fluoxetine 20 mg day−1 (up to 40 mg day−1) in a prospective, randomized, double-blind double-dummy 8-week, single-center trial. Primary efficacy measure was the analysis of the mean change in the Montgomery & Åsberg Depression Rating Scale (MADRS) depression scores, using a non-inferiority test with margin of 1.45. Secondary efficacy outcomes were response and remission rates. Tolerability was assessed with the side effect rating scale of the Scandinavian Society of Psychopharmacology. Mean MADRS scores differences were not significant at the 4th (P = .654) and 8th weeks (P = .965) of treatment. Non-inferiority of homeopathy was indicated because the upper limit of the confidence interval (CI) for mean difference in MADRS change was less than the non-inferiority margin: mean differences (homeopathy-fluoxetine) were −3.04 (95% CI −6.95, 0.86) and −2.4 (95% CI −6.05, 0.77) at 4th and 8th week, respectively. There were no significant differences between the percentages of response or remission rates in both groups. Tolerability: there were no significant differences between the side effects rates, although a higher percentage of patients treated with fluoxetine reported troublesome side effects and there was a trend toward greater treatment interruption for adverse effects in the fluoxetine group. This study illustrates the feasibility of randomized controlled double-blind trials of homeopathy in depression and indicates the non-inferiority of individualized homeopathic Q-potencies as compared to fluoxetine in acute treatment of outpatients with moderate to severe depression

Immune Receptors and Co-receptors in Antiviral Innate Immunity in Plants

Plants respond to pathogens using an innate immune system that is broadly divided into PTI (pathogen-associated molecular pattern- or PAMP-triggered immunity) and ETI (effector-triggered immunity). PTI is activated upon perception of PAMPs, conserved motifs derived from pathogens, by surface membrane-anchored pattern recognition receptors (PRRs). To overcome this first line of defense, pathogens release into plant cells effectors that inhibit PTI and activate effector-triggered susceptibility (ETS). Counteracting this virulence strategy, plant cells synthesize intracellular resistance (R) proteins, which specifically recognize pathogen effectors or avirulence (Avr) factors and activate ETI. These coevolving pathogen virulence strategies and plant resistance mechanisms illustrate evolutionary arms race between pathogen and host, which is integrated into the zigzag model of plant innate immunity. Although antiviral immune concepts have been initially excluded from the zigzag model, recent studies have provided several lines of evidence substantiating the notion that plants deploy the innate immune system to fight viruses in a manner similar to that used for non-viral pathogens. First, most R proteins against viruses so far characterized share structural similarity with antibacterial and antifungal R gene products and elicit typical ETI-based immune responses. Second, virus-derived PAMPs may activate PTI-like responses through immune co-receptors of plant PTI. Finally, and even more compelling, a viral Avr factor that triggers ETI in resistant genotypes has recently been shown to act as a suppressor of PTI, integrating plant viruses into the co-evolutionary model of host-pathogen interactions, the zigzag model. In this review, we summarize these important progresses, focusing on the potential significance of antiviral immune receptors and co-receptors in plant antiviral innate immunity. In light of the innate immune system, we also discuss a newly uncovered layer of antiviral defense that is specific to plant DNA viruses and relies on transmembrane receptor-mediated translational suppression for defense

SEMI-ANALYTICAL SOLUTION OF THE HEAT CONDUCTION IN A PLATE WITH HEAT GENERATION

In the present work, a formulation for the solution of the two-dimensional steady state heat conduction with heat generation is presented. The classical integral transform technique (CITT) is used to solve the problem in a semi- analytical manner. CITT deals with expansions of the sought solution in terms of infinite orthogonal basis of eigenfunctions, keeping the solution process always within a continuous domain. For the particular problem, the resulting system is composed of a set of uncoupled differential equations which can be solved analytically. However, a truncation error is involved since the infinite series must be truncated to obtain numerical results. For comparison and validation purposes, the second order central finite difference method (FDM) is also implemented. The convergence analysis showed that CITT has a greater performance having no difficulties to obtain accurate results with very few terms in the solution summation. The FDM had convergence troubles specially for the positions near the center and for high concentration of heat generation in the center of the plate

Pain intensity of pain and adequacy of analgesia

Trata-se de um estudo inédito em nosso meio, no qual, avaliou-se a intensidade da dor e a adequação da analgesia no setor de emergência. Foram avaliadas 100 vítimas de acidentes de transporte atendidas em um hospital de referência para trauma. A dor foi presente em 90,0% dos casos; 56,0% referiram dor intensa na primeira avaliação e, após três horas de observação, 26,0% permaneceram com dor intensa e 38,0% com dor moderada. Uma significativa parte da população do estudo permaneceu sem analgesia durante o período de observação. Números expressivos de inadequação analgésica foram encontrados demonstrando a reduzida importância conferida a analgesia no trauma em nosso meio.Se trata de un estudio inédito en nuestro medio, en el cual se evaluó la intensidad del dolor y el adecuado procedimiento de analgesia en un sector de emergencia. Se evaluó a 100 víctimas de accidentes de tránsito atendidas en un hospital de referencia para trauma. El dolor fue constatado en el 90,0% de los casos. El 56,0% relató dolor intenso en la primera evaluación. Después de 3 horas de observación, el 26,0% permaneció con dolor intenso y el 38,0% con dolor moderado. Una significativa parte de la población estudiada permaneció sin analgesia durante el período de observación. Se encontró números expresivos de analgesia inadecuada, lo que demuestra la reducida importancia que se da a la analgesia en el trauma en nuestro medio.An unprecedented study in Brazil analyzed pain intensity and adequacy of analgesia at an emergency center. One hundred accident victims attended at a trauma reference hospital were evaluated. Pain was present in 90% of cases; 56.0% complained of severe pain on first evaluation and, three hours later, 26.0% remained in severe pain and 38.0% in moderate pain. A significant portion of the study population did not receive analgesia during the observation period. Considerable numbers of inadequate analgesia were found, confirming the reduced importance of analgesia in trauma in Brazil

The wineglass effect shapes particle export to the deep ocean in mesoscale eddies

Mesoscale eddies in the ocean strongly impact the distribution of planktonic particles, mediating carbon fluxes over ~1/3 of the world ocean. However, mechanisms controlling particle transport through eddies are complex and challenging to measure in situ. Here we show the subsurface distribution of eddy particles funneled into a wineglass shape down to 1000 m, leading to a sevenfold increase of vertical carbon flux in the eddy center versus the eddy flanks, the “wineglass effect”. We show that the slope of the wineglass (R) is the ratio of particle sinking velocity to the radially inward velocity, such that R represents a tool to predict radial particle movement (here 0.05 m s−1). A simple model of eddy spindown predicts such an ageostrophic flow concentrating particles in the eddy center. We explore how size-specific particle flux toward the eddy center impacts eddies' biogeochemistry and export fluxes

Interannual variability of primary production and dissolved organic nitrogen storage in the North Pacific Subtropical Gyre

Author Posting. © American Geophysical Union, 2012. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 117 (2012): G03019, doi:10.1029/2011JG001830.The upper ocean primary production measurements from the Hawaii Ocean Time series (HOT) at Station ALOHA in the North Pacific Subtropical Gyre showed substantial variability over the last two decades. The annual average primary production varied within a limited range over 1991–1998, significantly increased in 1999–2000 and then gradually decreased afterwards. This variability was investigated using a one-dimensional ecosystem model. The long-term HOT observations were used to constrain the model by prescribing physical forcings and lower boundary conditions and optimizing the model parameters against data using data assimilation. The model reproduced the general interannual pattern in the observed primary production, and mesoscale variability in vertical velocity was identified as a major contributing factor to the interannual variability in the simulation. Several strong upwelling events occurred in 1999, which brought up nitrate at rates several times higher than other years and elevated the model primary production. Our model results suggested a hypothesis for the observed interannual variability pattern of primary production at Station ALOHA: Part of the upwelled nitrate input in 1999 was converted to and accumulated as semilabile dissolved organic nitrogen (DON), and subsequent recycling of this semilabile DON supported enhanced primary productivity for the next several years as the semilabile DON perturbation was gradually removed via export.This work was supported in part by the Center for Microbial Oceanography, Research and Education (C-MORE) (NSF EF-0424599), Hawaii Ocean Time series program (NSF OCE09–26766), the Gordon and Betty Moore Foundation, and the Marine Biological Laboratory.2013-03-1