Transtorno disforico interictal: uma comorbidade psiquiatrica frequente entre pacientes com epilepsia acompanhados em dois servicos terciarios

Psychiatric disorders are frequent among patients with epilepsy. Data in the literature have shown a heterogeneous clinical presentation of psychiatric disorders in patients with epilepsy. Interictal dysphoric disorder could be a specific psychiatric comorbidity associated with epilepsy, primarily in patients treated in tertiary centers.Objective The present study aimed to determine the prevalence of interictal dysphoric disorder among patients with epilepsy who were followed in two tertiary epilepsy services in Brazil. Method Sixty-five patients with epilepsy completed the Portuguese version of the Interictal Dysphoric Disorder Inventory. Results Thirty-three (50.7%) patients fulfilled the diagnostic criteria for interictal dysphoric disorder, although all participants answered positively to having at least one key symptom. Conclusion The high rate of patients with epilepsy who fulfilled the diagnosis of interictal dysphoric disorder confirms an association between epilepsy and psychiatric disorders. However, there is clearly a need to improve diagnostic tools to allow better differentiation between interictal dysphoric disorder and other psychiatric disorders.Transtornos psiquiátricos são frequentes entre pacientes com epilepsia. Estudos evidenciam apresentações clínicas heterogêneas neste grupo. O transtorno disfórico interictal pode um transtorno específico destes pacientes, particularmente naqueles acompanhados em centros terciários.Objetivo Determinar a prevalência de transtorno disfórico interictal entre pacientes com epilepsia atendidos em dois serviços terciários de epilepsia do Brasil. Método Sessenta e cinco pacientes foram convidados a responder a versão brasileira do Interictal Dysphoric Disorder Inventory adaptado e validado para o Português. Resultados Trinta e três pacientes (50,7%) preencheram critérios para transtorno disfórico interictal, embora todos os entrevistados tenham afirmado que são acometidos por ao menos um dos sintomas-chave. Conclusão A alta prevalência de transtorno disfórico interictal em pacientes com epilepsia pode ser um indício da associação entre epilepsia e transtornos psiquiátricos. No entanto, é necessário melhorar a acurácia dos instrumentos de diagnóstico para poder diferenciar casos de transtorno disfórico interictal de outros transtornos psiquiátricos.Universidade Federal de São Paulo (UNIFESP) Department of Neurology and NeurosurgeryUniversidade Federal de Pernambuco Department of Neurology and NeurosurgeryUniversidade Federal de São Paulo (UNIFESP) Department of PsychiatryUNIFESP, Department of Neurology and NeurosurgeryUNIFESP, Department of PsychiatrySciEL

Efficacy and Tolerability of High- vs Low-Volume Split-Dose Bowel Cleansing Regimens for Colonoscopy: A Systematic Review and Meta-analysis

Background & Aims Efficacy of bowel preparation is an important determinant of outcomes of colonoscopy. It is not clear whether approved low-volume polyethylene glycol (PEG) and non-PEG regimens are as effective as high-volume PEG regimens when taken in a split dose. Methods In a systematic review of multiple electronic databases through January 31, 2019 with a registered protocol (PROSPERO: CRD42019128067), we identified randomized controlled trials that compared low- vs high-volume bowel cleansing regimens, administered in a split dose, for colonoscopy. The primary efficacy outcome was rate of adequate bowel cleansing, and the secondary efficacy outcome was adenoma detection rate. Primary tolerability outcomes were compliance, tolerability, and willingness to repeat. We calculated relative risk (RR) and 95% CI values and assessed heterogeneity among studies by using the I2 statistic. The overall quality of evidence was assessed using the GRADE framework. Results In an analysis of data from 17 randomized controlled trials, comprising 7528 patients, we found no significant differences in adequacy of bowel cleansing between the low- vs high-volume split-dose regimens (86.1% vs 87.4%; RR, 1.00; 95% CI, 0.98–1.02) and there was minimal heterogeneity (I2 = 17%). There was no significant difference in adenoma detection rate (RR, 0.96; 95% CI, 0.87–1.08) among 4 randomized controlled trials. Compared with high-volume, split-dose regimens, low-volume split-dose regimens had higher odds for compliance or completion (RR, 1.06; 95% CI, 1.02–1.10), tolerability (RR, 1.39; 95% CI, 1.12–1.74), and willingness to repeat bowel preparation (RR, 1.41; 95% CI, 1.20–1.66). The overall quality of evidence was moderate. Conclusions Based on a systematic review of 17 randomized controlled trials, low-volume, split-dose regimens appear to be as effective as high-volume, split-dose regimens in bowel cleansing and are better tolerated, with superior compliance

Study into the use of continuous positive airway pressure in obstructive sleep apnoea-hypopnoea syndrome patients with daytime drowsiness

Background: Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is a respiratory disorder with high morbidity and mortality. Continuous positive airway pressure (CPAP) is the most commonly prescribed conservative treatment for adults with OSAHS. CPAP therapy normalises or decreases OSAHS symptoms and can reduce and prevent OSAHS complications. Aims: To evaluate adherence to nasal CPAP treatment and CPAP impact on daytime drowsiness. Method: A sample of 20 patients evaluated for daytime drowsiness using the Epworth sleepiness scale and interviewed for adherence to nasal CPAP use. Results: There was a significant decrease in the level of daytime sleepiness of the patients users of nasal CPAP (p=0.017); patients not using nasal CPAP experienced a decrease without statistical significance (p=0.162). 100% of CPAP users reported benefits and 50% of these reported related discomforts. Conclusions: Patients with OSAHS that use CPAP have a greater reduced level of sleepiness than those who do not use it

A metodologia do projeto orquestra geração como fator primordial de motivação na permanência no projeto

Relatório de estágio - Mestrado em Ensino da MúsicaResumo I – Prática pedagógica - Esta seção está inserida no relatório de estágio do Mestrado em Ensino da Música, com especialização em violoncelo, pela Escola Superior de Música de Lisboa. A parte seguinte consiste na realização do Estágio do Ensino Especializado, e na elaboração do relatório sobre as práticas pedagógicas desenvolvidas nesse processo, relativo ao ano letivo de 2016/2017. A sua realização seguiu dois modelos, o de aulas observadas e aulas ministradas a 3 alunos de graus distintos. A observação de aulas decorreu na Escola Artística de Música do Conservatório Nacional, na classe do professor cooperante Luís Sá Pessoa, onde, durante um ano letivo, foram observadas aulas individuais de instrumento. As aulas ministradas tiveram lugar na EB1 Alto do Moinho onde decorrem as aulas do projeto Orquestra Geração do núcleo do Agrupamento Vertical de Almeida Garrett, ao qual o mestrando pertence como docente. No presente relatório encontramos uma contextualização da escola em questão; uma caracterização individual de cada aluno, com recurso à descrição de materiais, objetivos, estratégias e competências desenvolvidas com cada um. No final é feita uma reflexão da prática enquanto docente ao longo do estágio, onde se cruzam estratégias, pontos de vista e descobertas acerca do processo de ensino e aprendizagem do violoncelo. A descrição pormenorizada da prática profissional diária teve como resultado uma apurada reflexão pessoal sobre a mesma, com o objetivo de reforçar ou adaptar, mas sobretudo adotar modelos e estratégias de ensino que sejam mais eficazes para os tipos de aluno e os objetivos que se pretendem desenvolver.Resumo II - Este projeto de investigação tem como foco a metodologia de ensino utilizada na Orquestra Geração (OG) como fator motivacional principal na permanência dos alunos no projeto. A metodologia em questão é adaptada do reconhecido projeto venezuelano conhecido como El Sistema. A motivação é um dos temas centrais deste projeto e, como tal, mereceu um lugar de relevo na revisão da literatura, nomeadamente através da abordagem às teorias motivacionais para a aprendizagem musical que mais se relacionam com a temática proposta para este estudo. O interesse em aprofundar esta área de estudo prende-se com facto de o mestrando ser docente no projeto e sentir necessidade de saber mais sobre os alunos e o que os motiva em relação ao projeto e às suas especificidades. Os resultados observados acerca do impacto que o projeto tem na comunidade circundante ao núcleo onde está inserido - mais propriamente acerca dos motivos que levam os alunos a querer pertencer à OG e, das transformações por eles apontadas - foram cruzados com toda a informação constante na revisão da literatura. Desta forma, relacionou-se a natureza da sua motivação (interna ou externa), os fatores promotores dessa motivação, com as suas teorias e observou-se quais as estratégias e fatores motivacionais que conduzam a uma aprendizagem instrumental mais benéfica e eficaz, no contexto do projeto OG.Abstract I - This section is part of the internship report of the Master's degree in Music Teaching, with specialization in cello, by the Escola Superior de Música de Lisboa. The following part consists of the execution of the Internship of Specialized Teaching, and the preparation of the report about the pedagogical practices performed in that process, regarding the 2016/2017 academic year. This execution followed two models: observed classes and classes taught to three different level students. The observation of lessons happened in Escola Artística de Música do Conservatório Nacional, in the class of the cooperating teacher Luís Sá Pessoa, in which individual lessons were observed throughout an academic year. Taught classes were held in EB1 Alto do Moinho where the lessons of Orquestra Geração - Agrupamento Vertical de Almeida Garret - take place, and where the candidate works as a teacher. In this report, we will find a contextualization of the school in point; an individual characterization of every student with the aid of resource description, objectives, strategies and developed competences in each student. In the end of this report there will be a reflection regarding the practice as a teacher throughout this internship, where the strategies, the points of view and the discoveries about the process of cello teaching and learning will be interviewed. The detailed description of the daily professional practice produced a keen personal reflection over the same, with the goal of strengthening or adjusting, but - above all - adopting teaching strategies and models that are more effective to the kinds of students and the development objectives.Abstract II - This research Project focuses on the teaching methodology used in Orquestra Geração (OG) as the main motivational factor for the student’s continuity in the project. This methodology is adapted from the renowned Venezuelan project known as El Sistema. Motivation is one of the main subjects in this project and, as so, it deserved a significant focus while reviewing the literature, namely through the approach to the motivational theories regarding music learning that relate the most with the proposed subject for this study. The interest in deepening the knowledge in this field of study lies in the fact the master’s candidate is a teacher in the project, hence the need to know more about the students and what motivates them towards the project and its particularities. The observation results concerning the impact of the project in the surrounding community – more exactly, about the reasons for which the students want to belong to the OG, and the transformations they describe – were cross-referenced with all the information gathered in the literature review. This way, the nature of the motivation (internal or external), its motor and theories were related so that it would be possible to understand which strategies and motivational factors could lead to a healthier and more effective way of learning a musical instrument, within the context of OG project.N/

Efficacy and Tolerability of High- vs Low-Volume Split-Dose Bowel Cleansing Regimens for Colonoscopy: A Systematic Review and Meta-analysis

BACKGROUND & AIMS: Efficacy of bowel preparation is an important determinant of outcomes of colonoscopy. It is not clear whether approved low-volume polyethylene glycol (PEG) and non-PEG regimens are as effective as high-volume PEG regimens when taken in a split dose. METHODS: In a systematic review of multiple electronic databases through January 31, 2019 with a registered protocol (PROSPERO: CRD42019128067), we identified randomized controlled trials that compared low- vs high-volume bowel cleansing regimens, administered in a split dose, for colonoscopy. The primary efficacy outcome was rate of adequate bowel cleansing, and the secondary efficacy outcome was adenoma detection rate. Primary tolerability outcomes were compliance, tolerability, and willingness to repeat. We calculated relative risk (RR) and 95% CI values and assessed heterogeneity among studies by using the I2 statistic. The overall quality of evidence was assessed using the GRADE framework. RESULTS: In an analysis of data from 17 randomized controlled trials, comprising 7528 patients, we found no significant differences in adequacy of bowel cleansing between the low- vs high-volume split-dose regimens (86.1% vs 87.4%; RR, 1.00; 95% CI, 0.98-1.02) and there was minimal heterogeneity (I2 = 17%). There was no significant difference in adenoma detection rate (RR, 0.96; 95% CI, 0.87-1.08) among 4 randomized controlled trials. Compared with high-volume, split-dose regimens, low-volume split-dose regimens had higher odds for compliance or completion (RR, 1.06; 95% CI, 1.02-1.10), tolerability (RR, 1.39; 95% CI, 1.12-1.74), and willingness to repeat bowel preparation (RR, 1.41; 95% CI, 1.20-1.66). The overall quality of evidence was moderate. CONCLUSIONS: Based on a systematic review of 17 randomized controlled trials, low-volume, split-dose regimens appear to be as effective as high-volume, split-dose regimens in bowel cleansing and are better tolerated, with superior compliance.status: publishe

Multiple sclerosis in South America: month of birth in different latitudes does not seem to interfere with the prevalence or progression of the disease

Objective To assess whether the month of birth in different latitudes of South America might influence the presence or severity of multiple sclerosis (MS) later in life. Methods Neurologists in four South American countries working at MS units collected data on their patients' month of birth, gender, age, and disease progression. Results Analysis of data from 1207 MS patients and 1207 control subjects did not show any significant variation in the month of birth regarding the prevalence of MS in four latitude bands (0–10; 11–20; 21–30; and 31–40 degrees). There was no relationship between the month of birth and the severity of disease in each latitude band. Conclusion The results from this study show that MS patients born to mothers who were pregnant at different Southern latitudes do not follow the seasonal pattern observed at high Northern latitudes