Repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive–compulsive disorder (OCD) and Tourette's syndrome (TS)

There is evidence that motor and premotor cortex are hyperexcitable in obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS). We tested whether low-frequency repetitive transcranial magnetic stimulation (rTMS) could normalize overactive motor cortical regions and thereby improve symptoms. Subjects with OCD or TS were treated with active rTMS to the supplementary motor area (SMA) for 10 daily sessions at 1 Hz, 100% of motor threshold, 1200 stimuli/day. Suggestions of clinical improvement were apparent as early as the first week of rTMS. At the second week of treatment, statistically significant reductions were seen in the YBOCS, YGTSS, CGI, HARS, HDRS, SAD, BDI, SCL-90, and SASS. Symptoms improvement was correlated with a significant increase of the right resting motor threshold and was stable at 3 months follow-up. Slow rTMS to SMA resulted in a significant clinical improvement and a normalization of the right hemisphere hyperexcitability, thereby restoring hemispheric symmetry in motor threshold

Role of Metalloproteases in the Release of the IL-1 type II Decoy Receptor

The IL-1 type II receptor (decoy RII) is a nonsignaling molecule the only established function of which is to capture IL-1 and prevent it from interacting with signaling receptor. The decoy RII is released in a regulated way from the cell surface. Here, we reported that hydroxamic acid inhibitors of matrix metalloproteases inhibit different pathways of decoy RII release, including the following: (a) the slow (18 h) gene expression-dependent release from monocytes and polymorphonuclear cells exposed to dexamethasone; (b) rapid release (minutes) from myelomonocytic cells exposed to tumor necrosis factor, chemoattractants, or phorbol myristate acetate; (c) phorbol myristate acetate-induced release from decoy RII-transfected fibroblasts and B cells. Inhibition of release was associated with increased surface expression of decoy RII. Inhibitors of other protease classes did not substantially affect release. However, serine protease inhibitors increased the molecular mass of the decoy RII released from polymorphonuclear cells from 45 to 60 kDa. Thus, irrespective of the pathway responsible for release and of the cellular context, matrix metalloproteases, rather than differential splicing, play a key role in production of soluble decoy RII

Spinocerebellar ataxia: perceptual and acoustic analysis of speech in three cases

BACKGROUND: dysarthrias are commonly found in patients with spinocerebellar ataxias (SCA). AIM: to characterize perceptual and acoustic features of speech in three patients with spinocerebellar ataxia and to verify the presence of similar features among these patients. METHOD: speech samples of two males with SCA3 and one male with SCA2 were obtained. Both perceptual and acoustic analyses were done. RESULTS: It was observed strain-strangled and breathiness phonation, vocal instability, increased noise-to-harmonics ratio and low alternate motion rate (AMR) and speech rate in all three patients. Deviated resonance and s/z ratio were also observed. CONCLUSION: phonatory disorders and altered temporal patterns of speech seem to be typical in dysarthric patients with spinocerebellar ataxia.TEMA: a disartria é freqüentemente descrita como característica marcante dentre as diversas manifestações clínicas das ataxias espinocerebelares (AEC). OBJETIVO: caracterizar as alterações perceptivo-auditivas e acústicas da fala de três pacientes com ataxia espinocerebelar e verificar a presença de manifestações comuns entre os casos. MÉTODO: amostras de fala de dois homens com AEC-3 e de um com AEC-2 foram coletadas e analisadas acústica e perceptivamente. RESULTADOS: foi identificada voz tensa e soprosa, instabilidade vocal, aumento da proporção ruído-harmônico, redução da diadococinesia oral de sílabas alternadas e redução da velocidade da fala nos três indivíduos, além de desvios ressonantais e da relação s/z. CONCLUSÃO: manifestações fonatórias e dos padrões temporais da fala parecem ser características de pacientes disártricos com ataxia espinocerebelar.Universidade Federal de São Paulo (UNIFESP) Prefeitura do Rio de JaneiroUNIFESP Atenção Básica à SaúdeRede Sarah Hospitais de ReabilitaçãoUNIFESP Departamento de FonoaudiologiaUNIFESP, Prefeitura do Rio de JaneiroUNIFESP, Atenção Básica à SaúdeUNIFESP, Depto. de FonoaudiologiaSciEL

Randomized sham-controlled trial of repetitive transcranial magnetic stimulation in treatment-resistant obsessive–compulsive disorder

In open trials, 1-Hz repetitive transcranial magnetic stimulation (rTMS) to the supplementary motor area (SMA) improved symptoms and normalized cortical hyper-excitability of patients with obsessive–compulsive disorder (OCD). Here we present the results of a randomized sham-controlled double-blind study. Medication-resistant OCD patients (n=21) were assigned 4 wk either active or sham rTMS to the SMA bilaterally. rTMS parameters consisted of 1200 pulses/d, at 1 Hz and 100% of motor threshold (MT). Eighteen patients completed the study. Response to treatment was defined as a ≽25% decrease on the Yale–Brown Obsessive Compulsive Scale (YBOCS). Non-responders to sham and responders to active or sham rTMS were offered four additional weeks of open active rTMS. After 4 wk, the response rate in the completer sample was 67% (6/9) with active and 22% (2/9) with sham rTMS. At 4 wk, patients receiving active rTMS showed on average a 25% reduction in the YBOCS compared to a 12% reduction in those receiving sham. In those who received 8-wk active rTMS, OCD symptoms improved from 28.2±5.8 to 14.5±3.6. In patients randomized to active rTMS, MT measures on the right hemisphere increased significantly over time. At the end of 4-wk rTMS the abnormal hemispheric laterality found in the group randomized to active rTMS normalized. The results of the first randomized sham-controlled trial of SMA stimulation in the treatment of resistant OCD support further investigation into the potential therapeutic applications of rTMS in this disabling condition

O PROCESSO DE ENFERMAGEM NO TRATAMENTO DAS ALTERAÇÕES DO PAPANICOLAOU À LUZ DE DUAS TEORIAS CONVERGENTES: UM EXERCÍCIO DIDÁTICO

This article is a report of an academic exercise performed during the subject Experiences in the Professional Practice of Nursing, in the masters degree course of the Federal University of Paraná (UFPR) along the second semester of 2004, in a teaching hospital in Curitiba. The objective of this experience was to develop the nursing process on assisting women who had received abnormal Papanicolaou (Pap)s test results and had to go under treatment. As theoretical background, two theories were used: the theory of the social representations, to ground the knowledge of the human being and the theory of Imogene King for the nursing process. Taking a theory from Social Psychology and a compatible nursing theory with this background, it was evidenced a possible convergence between them mainly on aspects that involve human interaction with their values and beliefs expressed by means of communication.Este trabajo es un relato de un ejercicio académico durante la disciplina de Experiencias Prácticas del Oficio de Enfermería, curso del Mestrado de la Universidade Federal do Paraná, durante el semestre de 2004, en un hospital de educación en Curitiba. El objetivo de esta experiencia fue convertir y aplicar el proceso de cuidar de las mujeres en que fue constatado el resultado del examen preventivo de cáncer de útero, con alteraciones, y si sujetaron al tratamiento. Como teórico referencial, se utilizó la teoría de las representaciones sociales, para basar el conocimiento del ser humano, y la teoría de Imogene King, para el proceso del oficio de enfermería. Incorporando en una alianza una teoría de la psicología social a una de oficio de enfermería compatible con ese referencial, fue constatada una convergencia posible entre ellas, principalmente en los aspectos que envuelven la interacción humana con valores y creencias manifiestos por medio de la comunicación.Relato de um exercício acadêmico realizado durante a disciplina, Vivências na Prática Profissional de Enfermagem, do curso de mestrado da Universidade Federal do Paraná, durante o segundo semestre de 2004, em um hospital de ensino em Curitiba. O objetivo desta experiência foi implementar o processo de enfermagem na assistência às mulheres que receberam o resultado do preventivo do câncer de colo de útero com alterações e se submeteram ao tratamento. Como referencial teórico, utilizei a teoria das representações sociais, para fundamentar o conhecimento do ser humano e a teoria de Imogene King para o processo de enfermagem. Aliando-se uma teoria proveniente da Psicologia Social a uma de enfermagem compatível com este referencial, constatou-se uma convergência possível entre ambas principalmente nos aspectos que envolvem a interação humana com seus valores, crenças e que são manifestos por meio da comunicação

Esterase screening using whole cells of Brazilian soil microorganisms

A miniaturized enzymatic assay using fluorescent probes to reveal esterase producing microorganisms was optimized and applied to screen 64 soil bacterial strains. The best results were validated using traditional non-fluorogenic assays with acetyl and propanoyl phenylethanol to confirm the miniaturized results. The most active microorganisms belong to the genus Bacillus showing esterase activity and good enantiomeric ratios for the resolution of phenylethanol derivatives (E > 30). Part of the microorganisms are kept in our laboratory in glycerol or freeze-dried and the best microorganisms will be deposited in the CBMAI/CPQBA/Unicamp culture collection.Um ensaio enzimático miniaturizado com sondas fluorescentes para triagem rápida de microrganismos produtores de esterases foi implementado e aplicado a 64 linhagens de bactérias de solo. Os melhores resultados foram validados por métodos convencionais e substratos não fluorogênicos (feniletanol acetilado e propanoilado) e confirmaram os resultados obtidos nas triagens rápidas. Os microrganismos que apresentaram atividades enzimáticas mais relevantes (razão enantiomérica E > 30) na hidrólise de ésteres e na obtenção de boas razões enantioméricas foram identificados como pertencentes ao gênero Bacillus. Parte dos microrganismos se encontra preservada em glicerol e/ou liofilizada no IQ/Unicamp e três linhagens serão depositadas na CBMAI do CPQBA/Unicamp como depósitos abertos.14841489Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Esterase screening using whole cells of Brazilian soil microorganisms

A miniaturized enzymatic assay using fluorescent probes to reveal esterase producing microorganisms was optimized and applied to screen 64 soil bacterial strains. The best results were validated using traditional non-fluorogenic assays with acetyl and propanoyl phenylethanol to confirm the miniaturized results. The most active microorganisms belong to the genus Bacillus showing esterase activity and good enantiomeric ratios for the resolution of phenylethanol derivatives (E > 30). Part of the microorganisms are kept in our laboratory in glycerol or freeze-dried and the best microorganisms will be deposited in the CBMAI/CPQBA/Unicamp culture collection

NURSING HANDOFFS: DEVELOPMENT AND VALIDATION OF INSTRUMENTS TO QUALIFY CARE CONTINUITY

Objetivo: desenvolver e validar o conteúdo de instrumentos para padronizar a passagem de plantão da enfermagem.Método: estudo de desenvolvimento e validação por consenso de especialistas, conduzido de janeiro a julho de 2019 em hospital do sul do Brasil. Participaram do estudo 24 profissionais de diferentes áreas, incluindo enfermeiros, técnicos e professores de enfermagem, com experiência na passagem de plantão hospitalar. Avaliou-se abrangência, clareza e pertinência dos itens dos instrumentos, sendo validados pelos especialistas sobre cada item dos instrumentos desenvolvidos,obtendo-se índice de concordância de 93%.Resultados: foram elaborados o “Formulário de Passagem de Plantão”, contemplando identificação dos pacientes, informações clínicas e intercorrências de cada turno, e o “Procedimento Operacional Padrão para Passagem de Plantão”, descrevendo atividades a serem realizadas para garantir a transmissão de informações precisas.Considerações finais: os instrumentos elaborados podem nortear a passagem de plantão da enfermagem na prática clínica, promovendo a continuidade e segurança do cuidado.Objetivo: desarrollar y validar el contenido de instrumentos para estandarizar el cambio de turno de Enfermería. Método: estudio para el desarrollo y la validación por consenso de especialistas realizado entre enero y julio de 2019 en un hospital del sur de Brasil. En el estudio participaron 24 profesionales de diferentes áreas, incluidos enfermeros, técnicos y profesores de Enfermería, con experiencia en el cambio de turno en hospitales. Se evaluó el alcance, la claridad y la pertinencia de los ítems de los instrumentos y los especialistas lo validaron en cada ítem de los instrumentos desarrollados, obteniéndose un índice de concordancia del 93%. Resultados: se elaboraron dos documentos, a saber: “Formulario de Cambio de Turno”, que contempla la identificación de los pacientes, información clínica y complicaciones de cada turno, y el “Procedimiento Operativo Estándar para Cambio de Turno”, que describe actividades que deben realizarse para garantizar la transmisión de información precisa. Consideraciones finales: los instrumentos elaborados pueden dirigir el cambio de turno de Enfermería en la práctica clínica, promoviendo así la continuidad y seguridad de la atención.Objective: to develop and validate the content of instruments to standardize Nursing handoffs.Method: a study for the development and validation through expert consensus conducted between January and July 2019 in a hospital of southern Brazil. The study participants were 24 professionals from different areas, including nurses, nursing technicians and professors, with experience in hospital handoffs. The experts evaluated and validated the scope, clarity and pertinence of the items of the instruments developed, obtaining an agreement index of 93%.Results: two documents were prepared, namely: the “Handoff Form”, considering the patients’ identification, clinical information, and complications during each shift, and the “Handoff Standard Operating Procedure”, describing activities to be performed to ensure the transmission of precise information.Final considerations: the instruments elaborated can guide Nursing handoffs in the clinical practice, promoting care continuity and safety

Characterization of the linguistic profile of a family with Perisylvian Syndrome

BACKGROUND: perisylvian syndrome refers to a variety of clinical manifestations associated to lesions in the perisylvian or opercular regions. Polymicrogyria is the most common structural malformation found. The syndrome may be inherited and the clinical spectrum includes subtle language disturbances on one end and more severe characteristics such as prominent pseudobulbar signs and refractory epilepsy on the other end. Other studies have already associated perisylvian polymicrogyria with developmental language disorders or specific language impairment. AIM: to describe the language deficits of four members of a family with Perisylvian Syndrome, and to correlate these deficits to neuroimaging data METHOD: the patients underwent neuroimaging investigation, psychological assessment using the Weschler Intelligence Scales, and specific speech-language evaluation. The following tests were used for the assessment of vocabulary, phonology, syntax, pragmatics, reading and writing: Thematical Pictures of Yavas, ABFW - Child Language Test, Peabody Picture Vocabulary Test (PPVT), and other specific protocols. RESULTS: magnetic resonance imaging revealed perisylvian polymicrogyria in all of the subjects, with varied locations and extensions. Speech-language assessment indicated significant oral and written language deficits in all of the subjects. CONCLUSION: the obtained data indicate that language impairment can co-exist with reading deficits in members of the same family. Neuroimaging findings reveal cortical alterations that are associated to specific language impairments within the spectrum of the Perisylvian Syndrome. Another important aspect evidenced by this study is the similarities in the language profiles of siblings and mother, suggesting that a variety of linguistic manifestations exist within the spectrum of the syndrome. Perisylvian polymicrogyria can be one of the neurobiological malformations involved in the manifestation of these deficits.TEMA: por Síndrome Perisylviana entende-se toda e qualquer manifestação clínica decorrente de lesão ou malformação que comprometa a região da fissura de Sylvius, sendo a polimicrogiria a alteração estrutural mais encontrada. A referida síndrome pode ser familiar, sendo que o espectro clínico pode variar desde manifestações leves de distúrbio de linguagem, até quadros extensos que cursam com proeminentes sinais pseudobulbares e epilepsia refratária. Estudos já correlacionaram a polimicrogiria perisylviana com a ocorrência do Distúrbio Específico de Linguagem. OBJETIVO: o objetivo desse trabalho foi descrever as alterações de linguagem em quatro membros de uma família com Síndrome Perisylviana, e relacioná-las a exames de neuroimagem. MÉTODO: os sujeitos foram submetidos a exames de ressonância magnética, à avaliação psicológica, por meio das Escalas Wechsler de Inteligência e à avaliação fonoaudiológica específica de linguagem. Para avaliação do vocabulário, fonologia, sintaxe, pragmática, leitura e escrita foram utilizados testes como: as Figuras temáticas do Yavas, o ABFW - Teste de Linguagem Infantil, o Peabody Picture Vocabulary Test (PPVT), além de outros protocolos específicos. RESULTADOS: os exames de ressonância magnética evidenciaram polimicrogiria perisylviana de localização e extensão variáveis em todos os sujeitos. A avaliação fonoaudiológica também demonstrou alterações de linguagem oral e escrita significativas em todos os sujeitos. CONCLUSÃO: os nossos dados mostraram que distúrbios de linguagem podem co-ocorrer com alterações de leitura em membros da mesma família. A constatação de alterações corticais evidencia a presença de distúrbios específicos da linguagem no espectro da síndrome perisylviana. Outro aspecto importante evidenciado nesse estudo é a semelhança do perfil de linguagem entre os irmãos e a mãe, sugerindo que seja possível a existência de uma variedade de manifestações lingüísticas dentro do espectro da referida síndrome, podendo ser a polimicrogiria perisylviana um dos substratos neurobiológicos destes distúrbios.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Unicamp Faculdade de Ciências MédicasUnicamp Departamento de NeurologiaUniversidade Federal de São Paulo (UNIFESP)Unicamp FCM Departamento de Genética MédicaUniversidade de São Paulo Faculdade de Odontologia Departamento de FonoaudiologiaUNIFESPSciEL