O acidentar-se no trabalho precoce

Orientador: Heleno Rodrigues Correa FilhoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Não informadoAbstract: Not informedMestradoSaude ColetivaMestre em Saude Coletiv

Cognitive performance of patients with temporal lobe epilepsy and juvenile myoclonic epilepsy: evaluation through the Wechsler Intelligence Scale WAIS-III

OBJECTIVES: To compare the results of a cognitive task of patients with epilepsy with two parameters: one provided by the Brazilian and the other by the US normative scores viewing the cultural differences. METHOD: Forty-five adult patients diagnosed with epilepsy were submitted to intellectual evaluation through the Wechsler Adult Intelligence Scale, WAIS-III, in the following items: Verbal Intelligence Quotient (V IQ), Performance Intelligence Quotient (P IQ) and Full Scale (FS IQ). The correction of the protocols followed the Brazilian and the US normative scores. RESULTS: Thirty out of the 45 patients were diagnosed with temporal lobe epilepsy (TLE) due to mesial temporal sclerosis (MTS), 15 in the left hemisphere and 15 in the right, and 15 with juvenile myoclonic epilepsy (JME). In all 45 WAIS protocols the results of the V IQ, P IQ and FS IQ were higher when the Brazilian parameters were employed. Therefore, 18 patients that achieved FS IQ in the Average and Low Average ranges, according to the Brazilian normative scores, got lower levels when corrected by the US normative scores, that is, the FS IQ of these 18 patients fell to the Borderline and Extremely Low ranges respectively. In the patients with TLE, the differences in the scores between the V IQ and P IQ did not correspond when evaluated by different normative scores and in five of them the verbal was higher than the performance when corrected by the US normative scores. In the patients with JME, the values of V IQ and P IQ were higher when the Brazilian normative scores were employed. CONCLUSION: The results of the cognitive evaluation through the WAIS of patients with epilepsy showed that interpretation of the intellectual level is very dissimilar when corrected by the Brazilian or US normative scores. There is also a difference in the qualitative analysis of the intellectual performance since the study of the inner discrepancy varied according the population normative scores employed.OBJETIVOS: Comparar os resultados em uma prova cognitiva de pacientes com epilepsia com dois parâmetros: um fornecido pelas normas brasileiras e outro pelas norte-americanas, tendo em vista as diferenças culturais. MÉTODO: Quarenta e cinco pacientes adultos com diagnóstico de epilepsia foram submetidos à avaliação de nível intelectual por meio da Escala Wechsler de Inteligência, WAIS-III nos seguintes itens: Quociente de Inteligência Verbal (QI V), Quociente de Inteligência de Execução (QI E) e Quociente de Inteligência Total (QI T). As correções dos protocolos seguiram as normas brasileiras e as norte-americanas. RESULTADOS: Dos 45 pacientes, 30 tinham o diagnóstico de epilepsia do lobo temporal (ELT) por esclerose mesial temporal (EMT), 15 no hemisfério esquerdo e 15 no direito, e 15 de epilepsia mioclônica juvenil (EMJ). Em todos os 45 protocolos do WAIS-III os resultados de QI V, QI E e QI T foram maiores quando empregados os parâmetros brasileiros. Assim, 18 pacientes que alcançaram QI T nas faixas Média e Média Inferior, segundo as normas brasileiras, obtiveram níveis inferiores quando corrigidos pelas normas norte-americanas, ou seja, o QI T destes mesmos pacientes caiu para as faixas Limítrofe e Muito Rebaixado respectivamente. Nos pacientes com ELT, as diferenças de pontos entre os QI V e QI E não foram concordantes quando cotejados por normas diferentes e em cinco deles o desempenho verbal foi maior do que o motor quando corrigidos pelas normas norte-americanas. Nos pacientes com EMJ, os valores do QI V e QI E foram maiores quando empregadas normas brasileiras. CONCLUSÃO: Os resultados da avaliação cognitiva pelo WAIS-III de pacientes com epilepsia mostram que a interpretação do nível intelectual é muito distinta quando corrigida segundo normas brasileiras ou norte-americanas. Há também diferença na análise qualitativa do desempenho intelectual, uma vez que o estudo das discrepâncias internas variou conforme a norma populacional utilizada.Universidade Federal de São Paulo (UNIFESP) Departamento de PsiquiatriaUniversidade Federal de São Paulo (UNIFESP)UNIFESP, Depto. de PsiquiatriaUNIFESPSciEL

A Safe-by-Design Approach to "Reef Safe" Sunscreens Based on ZnO and Organic UV Filters

In recent years, the issue of coral bleaching has led to restrictions in some tropical locations (i.e., Palau, Hawaii, etc.) on the use of some organic UV sunscreen filters, such as oxybenzone and ethyl hexyl methoxycinnamate. In contrast, ZnO is considered safe for marine environments and thus is often used without considering its photocatalytic and oxidative activities related to the generation of O-2(center dot-) and HO center dot. Moreover, ZnO needs to be used in combination with other filters to reach higher protection factors. Thus, the study of its interaction with formulations and with organic filters is important in sunscreen technology for the development of safer by-design products. In this work, the photocatalytic activity of zinc oxides with different surface areas (30, 25 and 9 m(2)/g) and their interaction with selected organic sunscreen filters were investigated. In particular, the ZnO photocatalytic kinetics were studied following the photodegradation of Acid Blue 9 (AB9) observing a first-order reaction with a chemical regime. Our evaluations of the selective inhibitions by h(vb)(+) and HO center dot demonstrated a substantial predominance of the hydroxide radicals in the expression of the photocatalysis, a trend that was also confirmed by the irradiation of ZnO in an ethanolic solution. Indeed, the formulations containing both ZnO and organic filters defined as "safe" for coral reefs (i.e., Diethylamino Hydroxybenzoyl Hexyl Benzoate, DHHB, and Ethylhexyl Triazone, EHT) showed a non-negligible photocatalytic oxidation and thus the combination was underlined as safe to use

Proton magnetic resonance spectroscopy study of juvenile myoclonic epilepsy patients suggests involvement of a specific neuronal network

OBJECTIVES: The neuroanatomical basis and the neurochemical abnormalities that underlay juvenile myoclonic epilepsy (JME) are not fully defined. While the thalamus plays a central role in synchronization of widespread regions of the cerebral cortex during a seizure, emerging evidence suggests that all cortical neurons may not be homogeneously involved. The purpose of this study was to investigate the cerebral metabolic differences between patients with JME and normal controls. METHODS: All patients had a JME diagnosis based on seizure history and semiology, EEG recording, normal magnetic resonance neuroimaging (MRI) and video-EEG. Forty JME patients (JME-P) were submitted to 1.5 T MRI proton spectroscopy (1H-MRS), multi-voxel with PRESS sequence (TR/TE = 1500/30 ms) over the following locations: prefrontal cortex (PC), frontal cortex (FC), thalamus, basal nuclei, posterior cingulate gyrus (PCG), insular, parietal and occipital cortices. We determined ratios for integral values of N-acetyl aspartate (NAA) and glutamine-glutamate (GLX) over creatine-phosphocreatine (Cr). The control group (CTL) consisted of 20 age and sex-matched healthy volunteers. RESULTS: Group analysis demonstrated a tendency for lower NAA/Cr ratio of JME-P compared to CTL predominantly on FC, PC, thalamus and occipital cortex. When compared to CTL, JME-P had a statistically significant difference in GLX/Cr on FC, PC, insula, basal nuclei, PCG and on thalamus. When evaluating the relationship among the various components of this epileptic network among JME-P, the strongest correlation occurred between thalamus and PC. Also, we found a significant negative correlation between NAA/Cr and duration of epilepsy. CONCLUSION: Reductions in NAA may represent loss or injury of neurons and/or axons, as well as metabolic dysfunction while glutamate is considered to be an excitatory neurotransmitter in the brain which is involved in the pathogenesis of epileptogenic seizures.UNIFESP-EPM Hospital São PauloUNIFESP, EPM, Hospital São PauloSciEL

Revisão sistemática do papel do Igra (interferon-γ release assay) no diagnóstico da tuberculose em crianças

A tuberculose (TB) é uma doença prevalente no Brasil e representa um grande desafio em saúde pública, tanto no tratamento da infecção como na detecção dos casos de infecção latente. Em pediatria, a criança geralmente adquire a doença de um adulto, pois geralmente é paucibacilífera, o que dificulta o diagnóstico. Este trabalho teve por objetivo realizar uma revisão sistemática da literatura, avaliando o papel do Interferon-Gamma Release Assay test (IGRA) no diagnóstico dos casos de TB doença e de infecção latente (ILTB) na população pediátrica. Foram selecionados 45 artigos, a maioria de países do Hemisfério Norte, que estudaram principalmente a população imigrante. Quando o IGRA foi comparado à prova tuberculínica (PT), a sensibilidade e a especificidade do teste mostraram grande variação, porém o exame mostrou-se ser útil nos casos em que a PT é duvidosa. Concluindo, trata-se de um teste factível em nosso meio, principalmente nos casos em que o diagnóstico mais acurado é necessário para definir a terapia correta.&nbsp

Cohort profile: the Jundiaí Zika cohort (JZC), a pregnancy and birth cohort in São Paulo state, Brazil.

PURPOSE: The Jundiaí Zika Cohort (JZC) is a prospective pregnancy and birth cohort setup in the State of São Paulo, Brazil, to investigate the epidemic of cases of microcephaly and other neurological disorders, presumed to be associated with Zika virus (ZIKV) infection. PARTICIPANTS: A total of 748 women with high-risk pregnancies were recruited in the period of March 2016 to August 2017. FINDINGS TO DATE: Baseline sociodemographic and medical data were collected at recruitment from 737 pregnant women. Biological samples (ie, blood, saliva and urine) were collected from 695 of the pregnant women (94.3%), of whom 53 (7.6%) were ZIKV-positive on subsequent testing by reverse transcription polymerase chain reaction (RT-PCR) in urine. Biological sample (ie, blood, saliva, urine and cerebrospinal fluid) were collected within 10 days of birth from 409 (57.4%) of the liveborn infants, of whom 19 (4.6%) were ZIKV-positive on subsequent testing by RT-PCR in urine. All remaining biological specimens, as well as colostrum, umbilical cord and placental samples, have been stored in a secure biorepository. Antenatal and postnatal imaging studies and neonatal anthropometry were carried out. FUTURE PLANS: The JZC provides a unique data set which will continue to be explored to study the effects of pregnancy comorbidities on Zika virus infection during pregnancy, the long-term outcomes of children with congenital Zika infection and how physiotherapy and group interventions can improve outcomes for congenitally-infected children. All women in the cohort have reached the end of their pregnancy and currently the oldest children are 2 years old. The study will continue until all the children reach their third birthday (April 2021)

Cognitive function of idiopathic childhood epilepsy

Most children with epilepsy are of normal intelligence. However, a significant subset will have temporary or permanent cognitive impairment. Factors that affect cognitive function are myriad and include the underlying neuropathology of the epilepsy, seizures, epileptiform discharges, psychosocial problems, age at seizure onset, duration of epilepsy, and side effects associated with antiepileptic drugs. This review article discusses cognitive function in children with idiopathic epilepsy and the effects of antiepileptic drugs on cognitive function in children

Motor system hyperconnectivity in juvenile myoclonic epilepsy: a cognitive functional magnetic resonance imaging study

Juvenile myoclonic epilepsy is the most frequent idiopathic generalized epilepsy syndrome. It is characterized by predominant myoclonic jerks of upper limbs, often provoked by cognitive activities, and typically responsive to treatment with sodium valproate. Neurophysiological, neuropsychological and imaging studies in juvenile myoclonic epilepsy have consistently pointed towards subtle abnormalities in the medial frontal lobes. Using functional magnetic resonance imaging with an executive frontal lobe paradigm, we investigated cortical activation patterns and interaction between cortical regions in 30 patients with juvenile myoclonic epilepsy and 26 healthy controls. With increasing cognitive demand, patients showed increasing coactivation of the primary motor cortex and supplementary motor area. This effect was stronger in patients still suffering from seizures, and was not seen in healthy controls. Patients with juvenile myoclonic epilepsy showed increased functional connectivity between the motor system and frontoparietal cognitive networks. Furthermore, we found impaired deactivation of the default mode network during cognitive tasks with persistent activation in medial frontal and central regions in patients. Coactivation in the motor cortex and supplementary motor area with increasing cognitive load and increased functional coupling between the motor system and cognitive networks provide an explanation how cognitive effort can cause myoclonic jerks in juvenile myoclonic epilepsy. The supplementary motor area represents the anatomical link between these two functional systems, and our findings may be the functional correlate of previously described structural abnormalities in the medial frontal lobe in juvenile myoclonic epilepsy