Leukoencephalopathy resolution after atypical mycobacterial treatment: a case report

Abstract\ud \ud Background\ud Association of leukoencephalopathy and atypical mycobacteriosis has been rarely reported. We present a case that is relevant for its unusual presentation and because it may shed further light on the pathogenic mechanisms underlying reversible encephalopathies.\ud \ud \ud Case report\ud We report the case of a Hispanic 64-year-old woman with cognitive decline and extensive leukoencephalopathy. Magnetic resonance imaging revealed white-matter lesions with increased water diffusivity, without blood–brain-barrier disruption. Brain biopsy showed tissue rarefaction with vacuolation, mild inflammation, few reactive astrocytes and decreased aquaporin water-channel expression in the lesions. Six months later, she was diagnosed with atypical mycobacterial pulmonary infection. Brain lesions resolved after antimycobacterial treatment.\ud \ud \ud Conclusion\ud We hypothesize leukoencephalopathic changes and vasogenic edema were associated with decreased aquaporin expression. Further studies should clarify if reversible leukoencephalopathy has a causal relationship with decreased aquaporin expression and atypical mycobacterial infection, and mechanisms underlying leukoencephalopathy resolution after antimycobacterial treatment. This article may contribute to the understanding of pathogenic mechanisms underlying magnetic resonance imaging subcortical lesions and edema, which remain incompletely understood.Ministry of Education, Culture, Sports, Science and Technology (MEXT) of JapanHealth and Labor Sciences Research Grant on Intractable Diseases\ud (Neuroimmunological Diseases) from the Ministry of Health, Labor and\ud Welfare of Japa

Chronic obstructive pulmonary disease as a risk factor for suicide : a systematic review and meta-analysis

Patients living with chronic obstructive pulmonary disease (COPD) commonly present several limitations in their daily activities, high depression rates, and low quality of life, which makes this population a risk group for suicide. This study aims to systematically assess the literature on the association between CPOD and the likelihood of suicide. The protocol was registered in PROSPERO (CRD42018096618). The Latin-American and Caribbean Health Sciences Literature (LILACS), PubMed, SciELO, Scopus, LIVIVO, Web of Science, and PsychNET databases were used as primary study sources. OpenThesis and OpenGrey were used to partially capture the "grey literature". A manual search was also performed through a systematized analysis of the references of eligible articles. The risk of bias among the studies included was assessed with the Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews. A random effects meta-analysis was performed to estimate the variation in odds ratio (OR) and 95% confidence intervals (95% CI). The search provided 4762 results, from which only seven met the eligibility criteria and were ultimately included in the qualitative assessment of the review. The studies were published from 2002 to 2015. All studies presented low risk of bias. The total sample included 1390 suicide cases of COPD patients. The meta-analysis, which was based on five eligible case control studies, found that people with history of COPD are more likely to commit suicide (OR=1.90; 95% CI=1.27-2.48; p=0.002). COPD patients are 1.9 times more likely to commit suicide than people without COPD151111

SUBJETIVIDADE E ENFRENTAMENTO DA MORTE: CONSTRUINDO GESTÃO DE PESSOAS NA COTIDIANIDADE

O presente estudo objetivou compreender como, em local cujo trabalho exige enfrentamento com a morte, são pensadas e construídas,na cotidianidade, práticas de trabalho e de gestão de pessoas. Esse é um estudo qualitativo, no qual foi realizado o acompanhamento da rotina de 4 agentes funerários, 1 diretor de plantão, 1 gerente administrativo e 1 maquiadora necrotérica em seu contexto de trabalho, uma empresa funerária de pequeno porte em Porto Alegre. Para a coleta de dados, utilizaram-se técnicas etnográficas (CAVEDON, 2003), sendo a interpretação realizada por meio de análise de conteúdo (MINAYO, 2010). Os achados foram agrupados em quatro categorias que, entende-se, integram o processo de subjetivação do fazer/saber diante da morte: 1) redimensionando as certezas; 2) os saberes no/do trabalho frente à ressignificação da morte; 3) ser trabalhador atravessado pela representação da morte em sociedade;e 4) gestão se configurando no contexto da morte.Vimos que esses profissionais criam, reinventam suas maneiras de fazer, a partir de um processo de ressignificar e naturalizar a morte, sendo o ambiente organizacional, em consonância com Certeau (2008), um espaço onde trabalhadores fazem a gestão do seu cotidiano e de si mesmos com seus próprios significados.