Síndrome de Chiari e Hidrossiringomielia com comprometimento neurológico: um relato de caso

A Malformação de Chiari (MC) pertence a um amplo grupo de raras deformidades estruturais da junção craniocerebelomedular. O tipo I da doença caracteriza-se pela herniação tonsilar ou amigdaliana cerebelar devido à anomalia da base do crânio e da parte superior da coluna cervical, além de a porção medial do lobo inferior do cerebelo pelo canal cervical também se protuberar através do forame magno, impedindo que o líquor flua normalmente através do canal. A real prevalência da doença é desconhecida, pois muitos pacientes com herniação cerebelar são assintomáticos e o problema agrava-se na fase adulta, com queixas de cefaleia intensa e, por vezes, parestesia. O objetivo deste estudo é relatar um caso de síndrome de Chiari (SC) em uma paciente de 53 anos, ao abordar sua apresentação clínica, diagnóstico e tratamento. Paciente do sexo feminino, 53 anos, foi admitida em um hospital da rede pública de referência se queixando de cefaleia occipital intensa e cervicalgia com irradiação da dor para os membros superiores, acompanhada de parestesia nos quatro segmentos. Relatou já sentir dor há 2 anos, mas apresentou piora do quadro clínico há 8 meses. Foi, também, observada incontinência urinária devido à dissinergia detrusora-esfincteriana por provável bexiga neurogênica. Foi, então, realizado exame de imagem de ressonância magnética (RNM) do crânio e da coluna cervical, com obtenção de sequências ponderadas em T1, T2 e STIR, nos planos sagital e transverso com contraste, o qual evidenciou leve alargamento medular, além de sinais de hidrossiringomielia difusa, com hipossinal na sequência T2 intramedular na altura de D1-D2 (coluna dorsal). Foi notada discreta herniação das tonsilas cerebelares junta ao forame magno, típica da SC, sendo, por fim, confirmado o diagnóstico. A paciente, no entanto, não apresentava hidrocefalia, mesmo com a interrupção do fluxo do líquido cefalorraquidiano (LCR) para o canal vertebral. Ela encaixou- se nos parâmetros de indicação cirúrgica, sendo realizada craniotomia occipital, com acesso ao plexo coroide do quarto ventrículo do tronco encefálico com o intuito de elevar as tonsilas cerebelares baixas, herniadas no canal espinhal cervical e bloqueando o fluxo do LCR. Após a descompressão craniocervical, o curso do líquor foi restaurado e a paciente foi, por fim, encaminhada à sala de recuperação pós-operatória. A SC é uma rara doença que apresenta quadro clínico e alterações radiológicas complexas e extensas e, por vezes, o diagnóstico é retardado devido à inespecificidade dos sintomas confundidos com cervicalgias e cefaleias comuns. A hipótese diagnóstica deve ser embasada nas queixas do paciente, na anamnese minuciosa, exame clínico e nos exames de imagens, sendo a prevalência desta patologia de difícil definição e com faixas etárias distintas

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Immunosuppressants: Implications in Orthodontics

Submitted by Sandra Infurna ([email protected]) on 2018-11-29T15:44:02Z No. of bitstreams: 1 marcoa_martins_etal_IOC_2012.pdf: 287276 bytes, checksum: 4627be17f956ae8bc7f63038f44d57f6 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2018-11-29T15:55:50Z (GMT) No. of bitstreams: 1 marcoa_martins_etal_IOC_2012.pdf: 287276 bytes, checksum: 4627be17f956ae8bc7f63038f44d57f6 (MD5)Made available in DSpace on 2018-11-29T15:55:50Z (GMT). No. of bitstreams: 1 marcoa_martins_etal_IOC_2012.pdf: 287276 bytes, checksum: 4627be17f956ae8bc7f63038f44d57f6 (MD5) Previous issue date: 2012Universidade Federal de Campina Grande. Departamento Ortodontia. Campina Grande, PB, BrasilUniversidade do Estado de Minas Gerais. MG, Brasil.Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Departamento de Nefrologia. Unidade de Transplante Renal. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Inflamação. Rio de Janeiro, RJ. Brasil.Universidade Federal do Rio de Janeiro. Ortodontia. Rio de Janeiro, RJ, Brasil.There are medications capable of affecting bone metabolism and the rate of tooth movement. Among these medications are the immunosuppressants, which act by repressing the action of T lymphocytes, however they can cause bone loss and consequently lead to osteoporosis. Osteoporosis is a common complication following kidney, heart, liver or lung transplantation. The immunosuppressant treatment for preventing organ rejection after transplantation, in general, includes glucocorticoids, cyclosporine, tacrolimus, and sirolimus. All these drugs can have jeopardizing effects on bone mineral homeostasis and consequently influence tooth movement. In recent years, however, the increasing use of immunosuppressants has raised questions about their effects on bone metabolism in patients undergoing orthodontic treatment

Immunosuppressants: Implications in Orthodontics

Submitted by Sandra Infurna ([email protected]) on 2017-04-11T13:47:04Z No. of bitstreams: 1 marcos_martins_etal_IOC_2012.pdf: 287276 bytes, checksum: 4627be17f956ae8bc7f63038f44d57f6 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2017-04-11T13:56:55Z (GMT) No. of bitstreams: 1 marcos_martins_etal_IOC_2012.pdf: 287276 bytes, checksum: 4627be17f956ae8bc7f63038f44d57f6 (MD5)Made available in DSpace on 2017-04-11T13:56:55Z (GMT). No. of bitstreams: 1 marcos_martins_etal_IOC_2012.pdf: 287276 bytes, checksum: 4627be17f956ae8bc7f63038f44d57f6 (MD5) Previous issue date: 2012Universidade Federal de Campina Grande. Campina Grande, PB, Brasil.Universidade do Estado de Minas Gerais. MG, Brasil.Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Departamento de Nefrologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Inflamação. Rio de Janeiro, RJ. Brasil.Universidade Federal do Rio de Janeiro. Ortodontia. Rio de Janeiro, RJ, Brasil.Introduction: There are medications capable of affecting bone metabolism and the rate of tooth movement. Among these medications are the immunosuppressants, which act by repressing the action of T lymphocytes, however they can cause bone loss and consequently lead to osteoporosis. Osteoporosis is a common complication following kidney, heart, liver or lung transplantation. The immunosuppressant treatment for preventing organ rejection after transplantation, in general, includes glucocorticoids, cyclosporine, tacrolimus, and sirolimus. All these drugs can have jeopardizing effects on bone mineral homeostasis and consequently influence tooth movement. In recent years, however, the increasing use of immunosuppressants has raised questions about their effects on bone metabolism in patients undergoing orthodontic treatment. Objective: The objective of this review study was to inform orthodontists about the influence of immunosuppressants on bone metabolism and tooth movement

Profile of users of the VIVAVOZ telephone service on drugs of abuse

Introdução: O abuso de drogas é um problema importante de saúde pública, e intervenções telefônicas são utilizadas como uma modalidade de tratamento. Objetivou-se descrever o perfil sociodemográfico, o padrão de consumo e a dependência de substâncias psicoativas dos usuários que buscaram auxílio em um serviço de teleatendimento para drogas de abuso. Método: Foram utilizados os dados do 1º ano de funcionamento do serviço, coletados por consultores previamente capacitados, através de protocolo informatizado. Foram aplicados instrumentos para caracterização sociodemográfica, padrão de consumo e dependência dos usuários. Utilizou-se estatística descritiva para estimar a distribuição das variáveis, e os dados apresentam-se em freqüências. Resultados: No período, foram atendidas 28.257 ligações, sendo 7.956 incluídas no estudo. No total, foi encontrada maior prevalência de mulheres, estudantes, solteiros, maiores de 35 anos, com ensino fundamental incompleto e renda familiar menor que cinco salários mínimos procurando o teleatendimento. Dentre os usuários de drogas, predominaram homens, de 18 a 25 anos. As drogas mais utilizadas foram tabaco, maconha, álcool e cocaína. O uso de tabaco foi semelhante para ambos os sexos. Indivíduos do sexo masculino usaram mais drogas ilícitas. A maioria dos usuários era dependente, sendo que os homens apresentaram maiores índices de dependência para tabaco e solventes. Conclusões: Esses resultados traçam o perfil do usuário que procura auxílio telefônico para a questão de drogas, e revelam a importância desses serviços à população, auxiliando no direcionamento de ações preventivas.Introduction: Drug abuse is a major public health problem. Telephone interventions have been used as a treatment method. This study aimed at describing the sociodemographic profile, consumption pattern and dependence on psychoactive substances of individuals seeking help in a telephone service on drugs of abuse. Methods: Data were collected by previously trained consultants using an electronic protocol throughout the first year of the service. Instruments were applied to find the sociodemographic profile, consumption pattern and dependence of drug users. Descriptive statistics was used to estimate distribution of variables, and the data are presented as frequencies. Results: Throughout the study period there were 28,257 calls, of which 7,956 were included. In total there was higher prevalence of women, students, single individuals, older than 35 years, with incomplete primary education and family income lower than five minimum wages. Men aged 18-25 years were prevalent in the sample. The most frequently used drugs were tobacco, cannabis, alcohol and cocaine. Tobacco use was similar for both genders. Males used more illicit drugs. Most drug users were dependent, and men had higher rates of addiction to tobacco and solvents. Conclusions: These results outline the profile of individuals who seek care through a telephone service, showing the importance of these services for the population and guiding preventive actions

Anatomical differentiation and metabolomic profiling: a tool in the diagnostic characterization of some medicinal Plantago species

There is a large list of plants used by the population as medicine, but in some case the choice of the right plant becomes a real drawback in phytotherapy, since it is often difficult to differentiate morphologically between the active and inactive species. Plantago species are widely used throughout the world as analgesic, anti-inflammatory, expectorant, digestive and wound healing. Nonetheless, Plantago spp. share very strong morphological similarities, which hinders their correct botanical identification and, in addition, they are equivocally marketed by the same common name “Plantain”. Therefore, the establishment of a reliable approach to distinguish unambiguously closely related species arises as an important task in the development of herbal medicines. In this work, we report a method that combines anatomical leaf features and chemical composition of four Plantago species to generate a multivariate model, which allows the differentiation of these species. Descriptive leaf anatomy was converted into a binary matrix to create a qualitative/quantitative non-metric multidimensional scaling (nmMDS) based on Jaccard index. The main results show that P. lanceolata L. is the most distinct species, the only one that owns mesophyll isolateral, colateral vascular bundle and a glandular trichome with spindle cells. Plantago major L. also has a unique glandular trichome, with enlarged basal cell and collar cell. This statistical-based anatomical approach is suitable to solve similar drawbacks in plant medicines of any other plant-cases. In addition, it was generated a nmMDS to chemical markers by mass spectrometry (FIA–ESI–IT–MS), to define how similar the species are regarding their chemical composition. Plantago major showed all compounds evaluated and is the only species to have the compounds hellicoside (m/z 655) and lavandulifolioside (m/z 755). The conversion of anatomical features into statistical data with the chemical composition emerges as a useful approach toward the quantitative differentiation of morphologically close related specimens.Fil: Mesquita, Leonardo Mendes de Souza. Universidade de Sao Paulo; BrasilFil: Delevati Colpo, Karine. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Limnología "Dr. Raúl A. Ringuelet". Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Limnología; ArgentinaFil: da Rocha, Cláudia Quintino. University of Maranhão ; BrasilFil: Gatte Picchi, Douglas. Universidade de Sao Paulo; BrasilFil: Pereira Tangerina, Marcelo Marucci. Universidade de Sao Paulo; BrasilFil: Zachello Nunes, Beatriz. Universidade de Sao Paulo; BrasilFil: Gonçalves Martins, Maria Bernadete. Universidade de Sao Paulo; BrasilFil: Vilegas, Wagner. Universidade de Sao Paulo; Brasi

Chalcones Isolated from Arrabidaea brachypoda Flowers as Inhibitors of NorA and MepA Multidrug Efflux Pumps of Staphylococcus aureus

Bacterial resistance to antibiotics has become a public health issue around the world. The present study aimed to evaluate the antibacterial activity of chalcones isolated from flowers of Arrabidaea brachypoda, and their potential as efflux pump inhibitors of Staphylococcus aureus efflux pumps. Microdilution assays were performed with natural products from A. brachypoda. Chalcones 1, 3, 4, and 5 did not show intrinsic antimicrobial activity against all S. aureus strains tested, but they were able to potentiate the Norfloxacin action against the SA1199-B (norA) strain, with a better modulating action for the 4 trimethoxylated chalcone. All chalcones were also able to potentiate the action of EtBr against SA1199-B strain, suggesting a potential NorA inhibition. Moreover, chalcone 4 was able to interfere in the activity of MepA, and interfered weakly in the QacA/B activity. Molecular docking analyzes showed that tested chalcones are capable of binding in the hydrophobic cavity of NorA and MepA, in the same Norfloxacin binding site, indicating that chalcone 4 compete with the antibiotic for the same NorA and MepA binding sites. Association of chalcone 4 with Norfloxacin could be an alternative against multidrug resistant S. aureus over-productive of NorA or MepA