Discinesia paroxística não cinesiogênica: relato de caso

Modelo do estudo: Relato de caso. Importância do problema e comentários: A discinesia paroxística não cinesiogênica é um tipo de discinesia paroxística. É caracterizada por movimentos involuntários unilaterais ou bilaterais, do tipo coreico, distônico, balístico ou misto. É uma desordem rara e o diagnóstico precoce é crucial para seu tratamento e melhoria na qualidade de vida do indivíduo. O presente estudo relata um caso de Discinesia Paroxística Não Cinesiogênica e seus achados clínicos, além de apresentar breve revisão da literatura.Study type: Case report. Relevance and comments: Paroxysmal non-kinesigenic dyskinesia is a type of paroxysmal dyskinesia. It is characterized by involuntary unilateral or bilateral movements, of the choreic, dystonic, ballistic or mixed type. It is a rare disorder and the early diagnosis is crucial for the treatment and improvement of the individual's quality of life. The present report illustrates a case of paroxysmal non-kinesigenic dyskinesia and clinical findings, as well as a brief review of the literature

Influência da raça do touro (Bos indicus x Bos taurus) na tolerância ao estresse térmico calórico de embriões bovinos produzidos in vitro

Para melhor compreender as diferenças entre zebuínos e taurinos em relação à resistência ao ETC, objetivou-se verificar se a resistência ao ETC é resultado da contribuição genética do oócito, do espermatozoide ou de ambos. Oócitos de vacas das raças Nelore e mestiças com fenótipo predominante da raça Holandesa preto e branco (mHPB) foram coletados, maturados e fertilizados com espermatozoide de touros das raças Nelore (N), Angus (An), Brahman (Bra) e Gir (Gir). Noventa e seis horas pós-inseminação (hpi), embriões &gt; 16 células foram separados ao acaso em dois grupos: controle e ETC. Embriões do grupo controle foram cultivados a 39 ºC continuamente e do grupo ETC expostos a 41 ºC por 12 horas, retornando a seguir para 39 ºC. Não foi observado efeito do ETC nas raças estudadas, sem redução nas taxas de blastocisto e blastocisto eclodido. As taxas de clivagem e mórula dos embriões mHPB x Gir foram inferiores (p &lt; 0,05) às das demais raças. As raças mHPB x N apresentaram taxas de blastocisto superiores as raças mHPB x An e mHPB x Gir (p &lt; 0,05). Concluiu-se que a contribuição genética do oócito é mais importante do que a do espermatozoide, uma vez que a raça do touro não influenciou a resistência embrionária ao ETC.To better understand the differences related to HS resistance between Bos indicus and Bos taurus, we aim to verify if the HS tolerance is due mostly to the genetic contribution from the oocyte, spermatozoa or both. Oocytes from Nelore and crossbreed Holstein cows (cHST) were collected, matured and fertilized with semen from Nelore (N), Angus (An), Brahman (Bra) and Gir (Gir) bulls. Nine six hours post insemination (hpi), &gt; 16 cells embryos were separated in two groups: control and HS. In control group, embryos were cultured at 39 ºC, whereas in the HS group, embryos were subjected to 41 ºC for 12 h, and then returned to 39 ºC. There was no effect of HS on blastocyst and hatched blastocyst rates in all breeds analyzed. The percentage of oocytes that cleaved and reached morula stage was significantly lower (p < 0.05) in cHST x Gir as compared to the other breeds. Additionally, blastocyst rates was higher in cHST x N than in cHST x An and cHST x Gir (p < 0.05). It was concluded that the oocyte is more important than the spermatozoa for the development of thermotolerance, since the breed of the bull did not influence embryo development after HS

Determinação da taxa de ovulação e sua relação com diâmetro folicular e isoformas de mRNA para receptor de LH, em vacas da raça Nelore

Objetivou-se com o presente trabalho verificar a relação entre diâmetro folicular, taxa de ovulação e a expressão gênica das isoformas do receptor de LH em vacas da raça Nelore. O experimento 1 foi realizado para verificar a dose mínima de LH capaz de induzir ovulação em folículos com diâmetro entre 10 e 11 mm. Vacas Nelore (n=20) foram submetidas à sincronização da ovulação e o crescimento folicular passou a ser acompanhado diariamente por ultrassonografia (US). Quando os folículos atingiram diâmetro entre 10 e 11 mm, os animais foram divididos em quatro grupos para receber diferentes doses de LH (Lutropin-V®, Bioniche, Ontario, Canada; IM): 1,56; 3,12; 6,25 e 12,5 mg. Os dados foram analisados pelo Teste Exato de Fisher (PROC FREQ, do SAS). As taxas de ovulação foram 0 (0/5), 80 (4/5), 80 (4/5) e 80% (4/5), respectivamente, ocorrendo diferença significativa entre o grupo 1,56 mg e os demais (p<0,02). No experimento 2, foram utilizados 6,25 mg de LH para induzir ovulação em vacas Nelore (n=53) submetidas a sincronização da ovulação e divididas em cinco grupos de acordo com o diâmetro folicular (mm) no momento da administração de LH: Grupo 1 (7,0 a 7,5); Grupo 2 (7,6 a 8,0); Grupo 3 (8,1 a 8,5); Grupo 4 (8,6 a 9,0) e Grupo 5 (9,1 a 10,0). Os resultados foram analisados por Regressão Logística (PROC GENMOD, do SAS). As taxas de ovulação foram 0 (0/11), 20 (2/10), 36 (4/11), 36 (4/11) e 90% (9/10), respectivamente. Houve diferença significativa entre G5 e os demais grupos (p<0,01). Ao associar G1+G2 (7,0 a 8,0 mm), G3+G4 (8,1 a 9,0 mm) e G5 (9,1 a 10,0 mm) as taxas de ovulação foram 9 (2/21), 36 (8/22) e 90% (9/10), respectivamente. Houve diferença significativa entre G1+G2 vs G5 (p<0,01), G3+G4 vs G5 (p<0,02) e G1+G2 vs G3+G4 (p<0,03). Após a administração de LH, o diâmetro do menor folículo capaz de ovular foi 7,65 mm. No experimento...The aim of the present experiment was to verify the relationship between follicular diameter, ovulation rate and gene expression of LH receptor isoforms, in Nellore cows. Experiment 1 was performed to determine the lowest LH dose necessary to induce ovulation in follicles with 10 to 11 mm in diameter. Nellore cows (n=20) had their ovulation induced by hormonal treatment, and afterwards follicular growth was daily observed by ultrasonography (US). When the follicles reached 10 to 11 mm diameter, the cows were randomly allocated in four groups and treated with different doses of LH (Lutropin-V®, Bioniche, Ontario, Canada): Groups 1.56; 3.12; 6.25 and 12.5 mg. The data were analyzed by Fisher’s Exact Test (PROC FREQ, SAS). The ovulation rates were 0 (0/5), 80 (4/5), 80 (4/5) e 80% (4/5), respectively, and it was lower in group 1.56 when compared to the others (P<0.02). In experiment 2, the 6.25 mg LH dose was chosen to induce ovulation in Nellore cows (n=53), submitted to the same hormonal treatment used in experiment 1, and randomly allocated in five groups according to follicular diameter (mm) at the time of LH administration: Group 1 (7.0-7.5); Group 2 (7.6-8.0); Group 3 (8.1-8.5); Group 4 (8.6-9.0) and Group 5 (9.1-10.0). The results were analyzed by Logistic Regression (PROC GENMOD, SAS). The ovulation rates were 0 (0/11), 20 (2/10), 36 (4/11), 36 (4/11) and 90% (9/10), respectively, for G1, G2, G3, G4 and G5. There was significant difference between G5 and the others groups (P<0.01). When data from two groups (except Group 5) were combined G1+G2 (7.0-8.0 mm), G3+G4 (8.1-9.0 mm) and G5 (9.1-10.0) ovulation rates were, respectively, 9 (2/21), 36 (8/22) e 90% (9/10). There were significant differences when comparing G1+G2 v. G5 (P<0.01), G3+G4 v. G5 (P<0.02) and G1+G2 v. G3+G4 (P<0.03). After LH application, the smallest follicle that ovulated had a diameter of 7.65 mm. In ... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Luteinizing Hormone Receptor (LHR): basic concepts in cattle and other mammals. a review

Acquisition of the luteinizing hormone receptor (LHR) on granulosa cells of the dominant follicle is essential to physiological LH-mediated effects on the final stages of follicular growth, final maturation of the oocyte, ovulation and luteinization of the follicular wall. Therefore, LHR plays a key role in the final maturation of the dominant follicle from follicular dominance to ovulation. In this review, the basic molecular aspects of LHR (gene structure, alternative splicing and ligand mediated activation) and the physiological regulatory aspects (changes in LHR expression during antral follicle growth and a post-transcriptional model for downregulation of LHR transcripts) are addressed. Despite the accumulation of considerable amounts of information about LHR, a comprehensive and broad model for the role of LHR in bovine antral follicle growth is missing. Questions such as the function for alternative LHR transcripts, their transcriptional and translational regulation, and how the transcripts go to the cell surface and interact with ligands remain to be elucidated in bovine and other species.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Encephalopathy by glut-1 deficiency: case report

Importância do problema: A síndrome da deficiência do transportador de glicose tipo 1 (GLUT1DS), descrita pela primeira vez por De Vivo em 1991, é causada por um deficitário transporte de glicose na barreira hematoencefálica e astrócitos por mutações&nbsp;na maioria das vezes&nbsp;de novo&nbsp;heterozigóticas no gene SLC2A1, responsável pela codificação do transportador de glicose tipo 1 (GLUT-1). Esta mutação limita a disponibilidade de glicose cerebral levando a sua deficiência energética, sendo o mecanismo gerador de suas manifestações clínicas. Os&nbsp;sintomas sugestivos são convulsões,&nbsp;atraso no desenvolvimento,&nbsp;microcefalia, hipotonia, espasticidade e complexas alterações no movimento consistindo de ataxia e distonia. Em pacientes GLUT1DS, substratos energéticos alternativos são de fundamental importância. Inúmeros trabalhos recomendam a utilização da dieta cetogênica de maneira imperiosa como mecanismo padrão ouro de tratamento. Esta, nos primeiros anos de vida em pacientes com GLUT1DS, garante um melhor resultado cognitivo e melhora nos aspectos psicomotores. Comentários: A GLUT1DS por ser uma doença de recente descoberta, poucos casos descritos na literatura, características clínicas heterogêneas e falta substancial de casuística é muitas vezes subdiagnosticada. Neste sentido, critérios de suspeição e algoritmos diagnósticos se fazem necessários. Desta maneira, o objetivo deste artigo é chamar a atenção da comunidade médica brasileira a essa síndrome com vistas a incrementar seu diagnóstico e melhorar o prognóstico de epilepsias de difícil controle.Glut-1 deficiency syndrome (GLUT1DS), first described by De Vivo in 1991, is caused by a deficient glucose transport in the blood brain barrier and astrocytes by mutations mostly de novo heterozygous in the SLC2A1 gene encoding the glucose transporter type 1 (GLUT-1). This mutation limits the availability of cerebral glucose leading to energy deficiency, being the mechanism that generates its clinical manifestations. The suggestive symptoms are convulsions, developmental delay, microcephaly, hypotonia, spasticity, and complex changes in movement consisting of ataxia and dystonia. In GLUT1DS patients, alternative energy substrates are of fundamental importance. Numerous studies recommend the use of the ketogenic diet in an imperative manner as a gold standard treatment method. This, in the first years of life in patients with GLUT1DS, guarantees a better cognitive result and improvement in psychomotor aspects. Because GLUT1DS is a disease of recent discovery, few cases described in the literature, heterogeneous clinical features and substantial lack of casuistry is often underdiagnosed. Due to this, suspicion criteria and diagnostic algorithms become necessary. Thus, the purpose of this article is to draw the attention of the Brazilian medical community to this syndrome with a view to increasing its diagnosis and improving the prognosis of difficult-to-control epilepsy

Influência da raça do touro (Bos indicus x Bos taurus) na tolerância ao estresse térmico calórico de embriões bovinos produzidos in vitro

To better understand the differences related to HS resistance between Bos indicus and Bos taurus, we aim to verify if the HS tolerance is due mostly to the genetic contribution from the oocyte, spermatozoa or both. Oocytes from Nelore and crossbreed Holstein cows (cHST) were collected, matured and fertilized with semen from Nelore (N), Angus (An), Brahman (Bra) and Gir (Gir) bulls. Nine six hours post insemination (hpi), ≥ 16 cells embryos were separated in two groups: control and HS. In control group, embryos were cultured at 39°C, whereas in the HS group, embryos were subjected to 41°C for 12 h, and then returned to 39°C. There was no effect of HS on blastocyst and hatched blastocyst rates in all breeds analyzed. The percentage of oocytes that cleaved and reached morula stage was significantly lower (p < 0.05) in cHST x Gir as compared to the other breeds. Additionally, blastocyst rates was higher in cHST x N than in cHST x An and cHST x Gir (p < 0.05). It was concluded that the oocyte is more important than the spermatozoa for the development of thermotolerance, since the breed of the bull did not influence embryo development after HS

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)