How does allocation of emotional stimuli impact working memory tasks? An overview

In this review, we investigated the influence of happy/pleasurable and sad/unpleasant emotional stimuli on working memory (WM) performance. Twenty-eight out of 356 articles were reviewed. We observed that emotional stimuli were used as mood inductors or as targets comprising the WM task. Results showed that WM modalities were influenced differently when updating, interference resolution, span, and complex tasks were applied. Specifically, we found distinct effects of emotional stimuli for updating tasks, in which (a) verbal modality seems to be impaired regardless of the emotional valence used compared to neutral stimuli, (b) visual updating processes appear to be improved by emotional stimuli as the targets of the task, and (c) emotional words improved interference resolution performance. As for storage, span, and complex WM tasks, sad/unpleasant emotional stimuli seem to decrease both verbal and visuospatial modalities when used as emotional inductors.- This work was supported by the Brazilian National Council for Scientific and Technological Development - CNPq under Grant 229520/2013-8. Furthermore, this study was partially conducted at the Psychology Research Centre (PSI/01662), School of Psychology, University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through the State Budget (UID/PSI/01662/2019)

Ice air caloric test in chronic peripheral vestibular dysfunction with spontaneous nystagmus

PURPOSE: to analyze the effect of air caloric stimulation at 10ºC on the post-caloric responses in patients with chronic peripheral dysfunction who presented spontaneous nystagmus with the eyes closed. METHODS: 61 patients with spontaneous nystagmus with closed eyes were submitted to air caloric stimulation under the following temperatures: 42, 18 and 10ºC. RESULTS: in 42 patients (69.8%), abnormal values of directional preponderance and / or unilateral hypoexcitability were observed following the 42ºC and 18ºC stimulations. For the 10ºC stimulations an asymmetry within normal limits was seen in 52.5% of the patients, while abnormal values were seen in 16.4% (p=0.012). Unilateral hypoexcitability was confirmed in 11.5% of the cases. In 8.2% of the patients there were abnormal findings not evidenced under 42ºC and 18ºC stimulations. CONCLUSION: in patients with chronic peripheral labyrinthine disorders who show spontaneous nystagmus with closed eyes, the 10ºC caloric test makes it possible to remove the influence of the spontaneous nystagmus on the post-caloric responses.OBJETIVO: analisar o efeito da estimulação gelada com ar a 10ºC sobre o nistagmo pós-calórico em pacientes com vestibulopatias periféricas crônicas que apresentam nistagmo espontâneo com olhos fechados. MÉTODOS: 61 pacientes foram submetidos às estimulações com ar a 42, 18 e 10ºC. RESULTADOS: em 42 casos (69,8%) foram encontrados valores anormais de preponderância direcional e/ou de predomínio labiríntico a 42 e 18ºC. A prova a 10ºC apresentou valores de assimetria dentro dos padrões de normalidade em 52,5% dos casos e valores anormais de assimetria em 16,4% (p=0,012), confirmou hiporreflexia unilateral em 11,5% e identificou anormalidades não evidenciadas a 42 e 18ºC em 8,2%. CONCLUSÃO: a estimulação gelada com ar a 10ºC possibilitou retirar a influência do nistagmo espontâneo de olhos fechados sobre o nistagmo pós-calórico em pacientes com vestibulopatias periféricas crônicas.Universidade Federal de São Paulo (UNIFESP) Programa de Pós-Graduação em Distúrbios da Comunicação HumanaUniversidade Federal de São Paulo (UNIFESP) Departamento de FonoaudiologiaUniversidade Federal de São Paulo (UNIFESP) Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço Departamento de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUniban Porograma de Pós-Graduação em Ciências da Reabilitação Neuro-MotoraUniversidade Federal de São Paulo (UNIFESP)UnibanUNIFESP, Programa de Pós-Graduação em Distúrbios da Comunicação HumanaUNIFESP, Depto. de FonoaudiologiaUNIFESP, Depto. de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço Depto. de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESPSciEL

Functional resonance magnetic imaging (fMRI) in adolescents with idiopathic musculoskeletal pain: a paradigm of experimental pain

Background: Studies on functional magnetic resonance imaging (fMRI) have shown that adults with musculoskeletal pain syndromes tolerate smaller amount of pressure (pain) as well as differences in brain activation patterns in areas related to pain. The objective of this study was to evaluate, through fMRI, the brain activation in adolescents with idiopathic musculoskeletal pain (IMP) while performing an experimental paradigm of pain. Methods: The study included 10 consecutive adolescents with idiopathic musculoskeletal pain (average age 16.3 +/- 1.0) and 10 healthy adolescents age-matched. fMRI exams were performed in a 3 T scanner (Magnetom Trio, Siemens) using an event-related design paradigm. Pressure stimuli were performed in the nondominant hand thumb, divided into two stages, fixed pain and variable pain. The two local Research Ethics Committees (Ethics Committee from Universidade Federal de Sao Paulo- Brazil, process number 0688/11, on July 1st, 2011 and Ethics Committee from Hospital Israelita Albert Einsten - Brazil, process number 1673, on October 19th, 2011) approved the study. Results: The idiopathic musculoskeletal pain (IMP) group showed a reduced threshold for pain (3.7 kg/cm(2) versus 4. 45 kg/cm2, p = 0.005). Control group presented increased bain activation when compared to IMP group in the following areas: thalamus (p = 0.00001), precentral gyrus (p = 0.0004) and middle frontal gyrus (p = 0.03). In intragroup analysis, IMP group showed greater brain activation during the unpredictable stimuli of the variable pain stage, especially in the lingual gyrus (p = 0.0001), frontal lobe (p = 0.0001), temporal gyrus (p = 0.0001) and precentral gyrus (p = 0.03), when compared to predictable stimulus of fixed pain. The same intragroup analysis with the control group showed greater activation during the unpredictable stimuli in regions of the precentral gyrus (p = 0.0001), subcallosal area (p = 0.0001), right and left occipital fusiform gyrus (p = 0.0001; (p = 0.0007), middle gyrus (p = 0.01) and precuneus p = (0.02). Conclusion: Adolescents with idiopathic musculoskeletal pain (IMP) tend to request higher brain function in cognitive-emotional areas when interpreting unpredictable sensory-perceptual situations. Therefore, it is assumed that this difference in pain processing in adolescents with IMP make the subjective experience of pain something more intense and unpleasant.Hospital Israelita Albert EinsteinCAPES (Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior)Univ Fed Sao Paulo, Escola Paulista Med, Dept Pediat, Researcher Rheumatol Sect, Sao Paulo, BrazilHosp Israelita Albert Einstein, Brain Inst, Sao Paulo, BrazilHosp Israelita Albert Einstein, Dept Diagnost Imaging, Sao Paulo, BrazilHosp Israelita Albert Einstein, Brain Inst, Sao Paulo, BrazilHosp Israelita Albert Einstein, Sao Paulo, BrazilUniv Minho, Braga, PortugalUniv Fed Sao Paulo, Escola Paulista Medicina, Dept Pediat, Pediat Rheumatol Unit, Rua Borges Lagoa 802,Vila Clementino, BR-04038002 Sao Paulo, SP, BrazilHosp Israelita Albert Einstein, Dept Pediat, Rua Borges Lagoa 802,Vila Clementino, BR-04038002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Pediat, Researcher Rheumatol Sect, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Medicina, Dept Pediat, Pediat Rheumatol Unit, Rua Borges Lagoa 802,Vila Clementino, BR-04038002 Sao Paulo, SP, BrazilWeb of Scienc

PULMONARY TUBERCUOLOSIS MORTALITY ANALYSIS IN THE SOUTHEASTERN REGION OF BRAZIL, 2015 TO 2020

Objetivo: Analisar dados sobre mortalidade por tuberculose pulmonar e analisar a incidência para os anos de 2015 a 2020 na região sudeste do Brasil. Métodos: Estudo descritivo ecológico que a coleta de dados consistiu em todas as mortes e internações por Tuberculose Pulmonar registradas no Sistema Único de Saúde, disponível no DATASUS. Resultados: Durante os anos estudados, na Região Sudeste os casos de internações por tuberculose pulmonar foram predominantemente maiores entre os homens e também nota-se que a faixa etária com maior número de internações é entre 40 e 59 anos. Houve maior aumento dessas taxas no estado do Rio de Janeiro (B= 4,57; p* =315; r²= 0,24), seguido por São Paulo ( β= 8,05; p*= 132; r²= 0,47) e Espírito Santo (β= 0,54; p*= 218; r²= 0,34).  Conclusão: Os resultados do presente estudo mostram que houve aumento das taxas de mortalidade por Tuberculose Pulmonar na Região Sudeste do Brasil.Objetivo: Analizar los datos sobre la mortalidad por tuberculosis pulmonar y analizar la incidencia para los años 2015 a 2020 en la región sudeste de Brasil. Métodos: Estudio descriptivo ecológico cuya recolección de datos consistió en todas las muertes y hospitalizaciones por Tuberculosis Pulmonar registradas en el Sistema Único de Salud, disponibles en el DATASUS. Resultados: Durante los años estudiados, en la Región Sureste los casos de hospitalizaciones por tuberculosis pulmonar fueron predominantemente mayores entre los hombres y también se observa que el grupo de edad con mayor número de hospitalizaciones se encuentra entre los 40 y los 59 años. Hubo un mayor aumento en estas tasas en el estado de Río de Janeiro (B= 4,57; p* = 315; r²= 0,24), seguido de São Paulo ( β = 8,05; p *= 132; r² = 0,47), y Espírito Santo (β = 0,54; p *= 218; r² = 0,34).  Conclusión: Los resultados del presente estudio muestran que hubo un aumento en las tasas de mortalidad por Tuberculosis Pulmonar en la Región Sudeste de Brasil.Objective: To analyze data on mortality from pulmonary tuberculosis and to analyze the incidence for the years 2015 to 2020 in the southeastern region of Brazil. Methods: Ecological descriptive study which data collection consisted of all deaths and hospitalizations for Pulmonary Tuberculosis registered in the Unified Health System, available on the DATASUS. Results: During the years studied, in the Southeastern Region cases of hospitalizations for pulmonary tuberculosis were predominantly higher among men and it is also noted that the age group with the highest number of hospitalizations is between 40 and 59 years old. There was a greater increase in these rates in the state of Rio de Janeiro (B= 4.57; p* =315; r²= 0.24), followed by São Paulo ( β= 8.05; p*= 132; r²= 0.47), and Espírito Santo (β= 0.54; p*= 218; r²= 0.34).  Conclusion: The results of the present study show that there was an increase in mortality rates from Pulmonary Tuberculosis in Southeastern Region Brazil

Differential Diagnosis of Entamoeba

Amoebiasis, a disease caused by Entamoeba histolytica, is usually diagnosed by microscopic examination, which does not differentiate the morphologically identical species of the E. histolytica/E. dispar complex. Furthermore, morphologically similar species such as Entamoeba hartmanni contribute to misidentification. Therefore, there is a need for more sensitive and specific methods. This study standardized a multiplex real-time PCR system for E. histolytica and E. dispar and a single real-time PCR for E. hartmanni. The multiplex protocol detected up to 0.0143 pg of E. histolytica DNA and 0.5156 pg of E. dispar DNA, and the average melting temperature (Tm) was 73°C and 70°C, respectively. For E. hartmanni, the Tm was 73°C and the amplification was successful down to 0.03 fg of plasmid DNA. Negative controls and other intestinal parasites presented no amplification. Among the 48 samples tested, E. dispar DNA was detected in 37; none exhibited E. histolytica DNA and 11 were negative in the multiplex protocol. In 4 of these 11 samples, however, E. hartmanni DNA was amplified. SYBR Green is demonstrated to be an interesting option and these combined PCR reactions can improve laboratory diagnosis of amoebiasis in developing countries

Differential Diagnosis of Entamoeba spp. in Clinical Stool Samples Using SYBR Green Real-Time Polymerase Chain Reaction

Amoebiasis, a disease caused by Entamoeba histolytica, is usually diagnosed by microscopic examination, which does not differentiate the morphologically identical species of the E. histolytica/E. dispar complex. Furthermore, morphologically similar species such as Entamoeba hartmanni contribute to misidentification. Therefore, there is a need for more sensitive and specific methods. This study standardized a multiplex real-time PCR system for E. histolytica and E. dispar and a single real-time PCR for E. hartmanni. The multiplex protocol detected up to 0.0143 pg of E. histolytica DNA and 0.5156 pg of E. dispar DNA, and the average melting temperature ( ) was 73 ∘ C and 70 ∘ C, respectively. For E. hartmanni, the was 73 ∘ C and the amplification was successful down to 0.03 fg of plasmid DNA. Negative controls and other intestinal parasites presented no amplification. Among the 48 samples tested, E. dispar DNA was detected in 37; none exhibited E. histolytica DNA and 11 were negative in the multiplex protocol. In 4 of these 11 samples, however, E. hartmanni DNA was amplified. SYBR Green is demonstrated to be an interesting option and these combined PCR reactions can improve laboratory diagnosis of amoebiasis in developing countries

Importância do uso profilático de Ferro e Vitamina D em lactentes

Introdução: O aleitamento materno é a fonte primordial de nutrição para os recém-nascidos. Todavia, o leite materno possui um teor reduzido de vitaminas e sais minerais, sendo necessário a realização de suplementação. Objetivo: Compreender a importância do uso preventivo de ferro e vitamina D em lactentes externalizando os benefícios dessa prática. Método: Revisão bibliográfica da literatura realizada em janeiro de 2023 nas bases de dados BVS, MEDLINE, LILACS e Google Scholar através dos seguintes DeCS: “Suplementos Nutricionais”, “Fatores de Risco” e “Lactentes” combinados entre si pelo operador booleano AND. Foram encontrados 98 estudos e após aplicar os critérios de inclusão e exclusão, foram selecionados 8 estudos para compor a revisão. Utilizou-se como pergunta norteadora:“Qual a importância do uso preventivo de Ferro e Vitamina D em lactentes?” Resultados: É notório os benefícios da suplementação de ferro e de vitamina D não apenas para os lactentes, mas em diversas fases da vida, essa intervenção pontual pode trazer diversos benefícios para a saúde em geral. Visto que a falta de ferro durante a gravidez estabelece uma ameaça para o desenvolvimento saudável do feto, principalmente em relação ao cérebro. Além disso, compreende-se que a hipovitaminose é considerada uma problemática de saúde pública mundial. Conclusão: As deficiências ocasionadas pela falta de ferro e vitamina D ocorrem com frequência, principalmente nos lactentes que apresentam fatores de risco dietéticos e não necessariamente nutricionais, os quais geralmente ocasionam desfechos clínicos adversos que afetam em sua maioria o desenvolvimento neurológico, impactando consideravelmente a qualidade de vida

Assessment of risk scores to predict mortality of COVID-19 patients admitted to the intensive care unit

ObjectivesTo assess the ABC2-SPH score in predicting COVID-19 in-hospital mortality, during intensive care unit (ICU) admission, and to compare its performance with other scores (SOFA, SAPS-3, NEWS2, 4C Mortality Score, SOARS, CURB-65, modified CHA2DS2-VASc, and a novel severity score).Materials and methodsConsecutive patients (≥ 18 years) with laboratory-confirmed COVID-19 admitted to ICUs of 25 hospitals, located in 17 Brazilian cities, from October 2020 to March 2022, were included. Overall performance of the scores was evaluated using the Brier score. ABC2-SPH was used as the reference score, and comparisons between ABC2-SPH and the other scores were performed by using the Bonferroni method of correction. The primary outcome was in-hospital mortality.ResultsABC2-SPH had an area under the curve of 0.716 (95% CI 0.693–0.738), significantly higher than CURB-65, SOFA, NEWS2, SOARS, and modified CHA2DS2-VASc scores. There was no statistically significant difference between ABC2-SPH and SAPS-3, 4C Mortality Score, and the novel severity score.ConclusionABC2-SPH was superior to other risk scores, but it still did not demonstrate an excellent predictive ability for mortality in critically ill COVID-19 patients. Our results indicate the need to develop a new score, for this subset of patients

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt