Late-Onset Psychogenic Chronic Phonic-Tics

Background: Tics beginning in late adulthood often have an identifiable etiology. Psychogenic tics with onset around 60 years of age are rarely described in the literature. Case Report: A 67-year-old female had experienced phonic tics for 8 years. Episodes occurred without premonitory sensations and precipitant factors, and she could not suppress them. She had no history of childhood tic disorder, and secondary causes of tics were excluded. She was diagnosed with psychogenic tics and treated with quetiapine with mild improvement. Discussion: When physicians are faced with no identifiable cause of tics combined with certain clinical clues, a psychogenic disorder must be suspected

Acidente vascular cerebral isquêmico mimetizando a síndrome do sábado à noite

Universidade Federal de São Paulo (UNIFESP) Departamento de NeurologiaHospital Israelita Albert EinsteinUNIFESP, Depto. de NeurologiaSciEL

Pontine calcification in late stage cerebellar multiple system atrophy: a marker of synucleinopathy neurodegeneration?

Univ Fed Sao Paulo, Dept Neurol, Unidade Ataxia, Sao Paulo, SP, BrazilHosp Israelita Albert Einstein, Sao Paulo, SP, BrazilFac Ciencias Med Santa Casa Sao Paulo, Div Radiol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Neurol, Unidade Ataxia, Sao Paulo, SP, BrazilWeb of Scienc

The relevance of electroencephalogram as a follow-up test in Hashimoto encephalopathy course after corticosteroids therapy

Universidade Federal de São Paulo, Dept Neurol, BR-04023900 São Paulo, BrazilHIAE, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol, BR-04023900 São Paulo, BrazilWeb of Scienc

Acute coronary syndromes: how to make a correct diagnosis in the emergency room

The assessment of patients with chest pain or other symptomssuggestive of myocardial ischemia continues as one of the greatestchallenges for physicians who work in emergency units. Although thedoctor’s experience is relevant, the evaluation of chest pain patients isfrequently made in a subjective and inefficient manner when specificdiagnostic protocols are not applied. This leads to unnecessaryhospitalizations and high hospital expenditures. Our objective is tofurnish simple tools that can be easily applied in daily clinical practiceas guidelines for managing patients with chest pain in emergencycenters. We describe three steps for a correct diagnosis of patients withprecordial pain, based on medical history, physical examination, andancillary tests. These stages include the initial clinical analysis and theuse of a specific diagnostic protocol, if necessary. Finally, we presentthe protocol model implemented at our emergency care center

Síndrome da disfunção apical reversível (Takotsubo) Transient ventricular dysfunction (Takotsubo cardiomyopathy)

Homem portador de miastenia gravis, internado por descompensação da doença de base, em insuficiência respiratória aguda. Na evolução, apresentou quadro sugestivo de infarto agudo do miocárdio, com alterações eletrocardiográficas e enzimáticas compatíveis com o diagnóstico. Submetido a coronariografia de urgência, não evidenciou obstrução coronariana grave, entretanto o ventrículo esquerdo apresentava disfunção sistólica importante, com alteração característica pela ventriculografia da síndrome descrita como disfunção ventricular transitória ou síndrome de Takotsubo. Na evolução, houve completa recuperação das alterações eletrocardiográficas e da função ventricular sistólica avaliada pelo ecocardiograma, confirmando a síndrome.<br>The patient was a male with myasthenia gravis, hospitalized with acute respiratory failure due to decompensation of the underlying disease. He evolved with findings suggestive of acute myocardial infarction, with electrocardiographic and enzymatic alterations compatible with that diagnosis. The patient underwent emergency coronary angiography, which showed no severe coronary obstruction, although his left ventricle had significant systolic dysfunction with characteristic alterations, on ventriculography, of the syndrome described as transient ventricular dysfunction or Takotsubo syndrome. On evolution, complete recovery of the electrocardiographic alterations and systolic ventricular function assessed on echocardiography occurred, confirming the syndrome

Medical students’ personal choice for mode of delivery in Santa Catarina, Brazil: a cross-sectional, quantitative study

<p>Abstract</p> <p>Background</p> <p>The increase in overall rates of cesarean sections (CS) in Brazil causes concern and it appears that multiple factors are involved in this fact. In 2009, undergraduate students in the first and final years of medical school at the University of Santa Catarina answered questionnaires regarding their choice of mode of delivery. The aim of the study was to evaluate whether the education process affects decision-making regarding the waay of childbirth preferred by medical students.</p> <p>Methods</p> <p>A cross-sectional, quantitative study was conducted based on data obtained from questionnaires applied to medical students. The questions addressed four different scenarios in childbirth, as follows: under an uneventful pregnancy; the mode of delivery for a pregnant woman under their care; the best choice as a healthcare manager and lastly, choosing the birth of their own child. For each circumstance, there was an open question to explain their choice.</p> <p>Results</p> <p>A total of 189 students answered the questionnaires. For any uneventful pregnancy and for a pregnant woman under their care, 8.46% of the students would opt for CS. As a healthcare manager, only 2.64% of the students would recommend CS. For these three scenarios, the answers of the students in the first year did not differ from those given by students in the sixth year. In the case of the student’s own or a partner’s pregnancy, 41.4% of those in the sixth year and 16.8% of those in the first year would choose a CS. A positive association was found between being a sixth year student and a personal preference for CS according to logistic regression (OR = 2.91; 95%CI: 1.03–8.30). Pain associated with vaginal delivery was usually the reason for choosing a CS.</p> <p>Conclusions</p> <p>A higher number of sixth year students preferred a CS for their own pregnancy (or their partner’s) compared to first year students. Pain associated with vaginal delivery was the most common reason given for haven chosen a CS. The students’ preference for childbirth changed over time during their graduation in favor of cesarean sections. This finding deserves considerable attention when structuring medical education in Obstetrics.</p