Jaquilene Barreto da Costa

Motor‐axonal polyneuropathy associated with hepatitis C virus

The association between hepatitis C virus (HCV) infection, the presence of mixed cryoglobulinemia and peripheral neuropathy is well‐documented ( Apartis et al., 1996 ). HCV is the chief cause of essential mixed cryoglobulinemia (type II cryoglobulinemia) with cryoglobulins present in up to half of patients with HCV infection ( Akriviadis et al., 1997 ). More recently it has been stated that peripheral polyneuropathy may be associated with HCV chronic infection without mixed cryoglobulinemia ( Lidove et al., 2001 ).

Caracterização das internações psiquiátricas para desintoxicação de adolescentes dependentes químicos

The purpose of this research was to characterize the profile of adolescents hospitalized for detoxification in a public hospital in the West of Paraná and correlate the socio-demographic variables with the use of street drugs. It is a retrospective study from the consultations in 81 protocols of admission of addicted adolescents hospitalized from March 2007 to April 2008. The largest admission was of male adolescents (79%).The most frequently used drugs by were crack (87.6%), followed by marijuana (85.2%), from these, 79% of these adolescents use these two drugs concomitantly. Most adolescents (55.6%) reported using drugs for more than three years, and 56.8% had already received some type of treatment before admission. Factors that lead to abusive consumption of drugs, such as easy access, leaving school, the use of drugs in the family and lack of motivation for treatment were identified.El objetivo de esta investigacion fue caracterizar las internaciones de adolescentes hospitalizados para desintoxicacion en un hospital publico del Oeste de Parana y correlaceonar las variables sociodemograficas con el uso de drogas ilicitas. Se trata de un estudio retrospectivo apartir de consultas en 81 protocolos de admision de los adolescentes internados en el periodo de marzo de 2007 hasta abril de 2008. La mayoria de las internaciones fue de adolescentes del sexo masculino (79%). Las drogas consumidas con mas frecuencia fueron el crack (87,6%) y la marihuana (85,2%), siendo que, 79% de los adolescentes usan tales drogas de forma armonica. Se identificaron fatores que llevan al consumo abusivo de las drogas, como el acceso facil, abandono escolar, el uso de drogas en la familia y la falta de motivaciones para el tratamento.

Avaliação do sofrimento psíquico da mãe acompanhante em alojamento conjunto pediátrico

This study aimed to capture the feelings experienced by the mother who accompanies her child when admitted to hospital and also to identify the coping strategies used to deal with this situation. This is a qualitative study that used the Drawing-Story procedure as the data collection technique, applied to 17 mothers who roomed in with their children in a Pediatric Ward of a University Hospital. The psychological interpretation of the drawings was used in the analysis of the data, and also the analysis of the content of the language used in the story told by the mother, based on the drawings. For this purpose, the theoretical framework proposed by van Kolck was used to interpret the drawings. The data containing the words used by the individuals were analyzed along the lines of the content analysis proposed by Minayo. An expression of mental suffering was observed out of feelings of fear, concern, helplessness, sadness, leading to anxiety and anguish.

Vestibulo-ocular reflex dynamics with head-impulses discriminates spinocerebellar ataxias types 1, 2 and 3 and Friedreich ataxia

OBJECTIVE Although the diagnosis of inherited ataxias is ultimately genetic, this usually means an extensive and expensive process. This justifies the search for distinct clinical signs that may potentially help orient molecular diagnosis. METHODS We explored the vestibulo-ocular reflex (VOR) with the video Head Impulse Test in patients diagnosed with spinocerebellar ataxia (SCA) type 3 (n = 15), type 1 (n = 4) and type 2 (n = 4), Friedreichs ataxia (FA) (n = 9) and healthy controls (n = 40). We estimated the latency, regression (VORr) and instantaneous VOR gain at 40, 60 and 80 ms (VOR40, VOR60 and VOR80), and determined the latency, peak-velocity and occurrence rate of catch-up saccades triggered with head-impulses. RESULTS VOR latency was higher in FA (p < 0.001) and SCA3 (p = 0.02) as compared to controls, discriminating FA from other ataxic patients with an overall diagnostic accuracy of 88%. VORr, VOR40 and VOR60 were significantly lower in FA and SCA3 (p < 0.01). VOR80 was only significantly lower than controls in SCA3 (p < 0.01), discriminating these from other ataxic patients with an overall diagnostic accuracy of 78%. Covert saccades were only triggered in SCA3 but with low occurrence rate and peak velocity (11.1 ± 28.5% and 77.50 ± 15.30°/s) whereas overt saccades were present in all groups. VORr gain showed a negative correlation with disease severity evaluated with SARA (Spearman r = -0.46, p = 0.01). CONCLUSIONS vHIT provides phenotypic information that differentiates these autosomal ataxias and can serve as a strategy to orient genetic diagnosis. A correlation between VOR and SARA raises the possibility of using VOR gain as a neurophysiologic biomarker for disease severity.

Characterization of psychiatric admissions for detoxification of drug addicted adolescents

The purpose of this research was to characterize the profile of adolescents hospitalized for detoxification in a public hospital in the West of Paraná and correlate the socio-demographic variables with the use of street drugs. It is a retrospective study from the consultations in 81 protocols of admission of addicted adolescents hospitalized from March 2007 to April 2008. The largest admission was of male adolescents (79%).The most frequently used drugs by were crack (87.6%), followed by marijuana (85.2%), from these, 79% of these adolescents use these two drugs concomitantly. Most adolescents (55.6%) reported using drugs for more than three years, and 56.8% had already received some type of treatment before admission. Factors that lead to abusive consumption of drugs, such as easy access, leaving school, the use of drugs in the family and lack of motivation for treatment were identified.El objetivo de esta investigacion fue caracterizar las internaciones de adolescentes hospitalizados para desintoxicacion en un hospital publico del Oeste de Parana y correlaceonar las variables sociodemograficas con el uso de drogas ilicitas. Se trata de un estudio retrospectivo apartir de consultas en 81 protocolos de admision de los adolescentes internados en el periodo de marzo de 2007 hasta abril de 2008. La mayoria de las internaciones fue de adolescentes del sexo masculino (79%). Las drogas consumidas con mas frecuencia fueron el crack (87,6%) y la marihuana (85,2%), siendo que, 79% de los adolescentes usan tales drogas de forma armonica. Se identificaron fatores que llevan al consumo abusivo de las drogas, como el acceso facil, abandono escolar, el uso de drogas en la familia y la falta de motivaciones para el tratamento.

Transtorno de estresse pós-traumático e a presença de recordações referentes à unidade de terapia intensiva

OBJECTIVE: Identify the incidence of post-traumatic stress disorder (PTSD), in patients submitted to MV and analyze its relation with clinical and demographical variables, and with the presence of memories regarding intensive care unit (ICU). METHOD: It is a longitudinal prospective study, carried out in one year at an ICU of a university hospital. Evaluation occurred three months after ICU discharge during patients follow up at the ambulatory. Subjects were evaluated using the ICU memories (ICU-AMI) and the Impact of Event Scale-Revised (IES-R) instruments. RESULTS: From the total of subjects, 68.8% were male from 18 to 79 years of age, 43.5 years old average ± 17.1. From the evaluated patients, 14.5% presented symptoms of PTSD when a cut-off score > 20 was used. For a diagnostic accuracy a ≥ 33 cut-off score was also used, and in this case, only seven patients (5.1%) showed signs of PTSD. CONCLUSION: A few patients met the criteria for the PTSD diagnosis indicating that the great majority of patients admitted at ICU show only symptomatology related to PTSD.

Elaboração e avaliação de um instrumento para identificar memórias referentes à Unidade de Terapia Intensiva

OBJECTIVE: Describe the development of an instrument to identify records of their stay at the intensive care unit, and verify content validation and the applicability of the instrument. METHOD: It is a methodological study, based in Pasqualis (1998) psychological scale elaboration theory. To elaborate the instrument, three stages were followed: the built of items; appearance and content validation analysis performed by a panel of experts; together with implementation of a pilot study to validation instrument applicability in the targeted population. RESULTS: There was little unconformity among the experts when analyzing the questions according to the domain of the constructor. The items were positively evaluated having a punctuation value above 80%, which abides the instrument validation criteria. Thus, the items were considered consistent in relation to the domain and constructor allowing identification of recollection of memories lived by the patients during their stay at the ICU. CONCLUSIONS: The proposed items demonstrated to be comprehensive, clear, and having an adequate presentation structure. The instrument shows validation to the content certified by a panel of experts, thus demonstrating to have theoretical characteristics to identify short and long term recollections of ICU patients.

Anticompensatory quick eye movements after head impulses: A peripheral vestibular sign in spontaneous nystagmus.

BACKGROUND Differentiating central from peripheral origins of spontaneous nystagmus (SN) is challenging. Looking for a simple sign of peripheral disease with the video Head Impulsive Test we noticed anti-compensatory eye movements (AQEM) in patients with peripheral etiologies of spontaneous nystagmus (SN). Here we assess the diagnostic accuracy of AQEM in differentiating peripheral from central vestibular disorders. METHODS We recorded the eye movements in response to horizontal head impulses in a group of 43 consecutive patients with acute vestibular syndrome (12 with central, 31 with peripheral disorders), 5 patients after acute vestibular neurectomy (positive controls) and 39 healthy subjects (negative controls). AQEM were defined as quick eye movements (peak velocity above 50°/s) in the direction of the head movement. RESULTS All patients with peripheral disorders and positive controls had AQEM (latency 231 ± 53 ms, amplitude 3.4 ± 1.4°, velocity 166 ± 55°/s) when their head was moved to the opposite side of the lesion. Central patients did not have AQEM. AQEM occurrence rate was higher in peripheral patients with contralesional (74 ± 4%, mean ± SD) in comparison to ipsilesional (1 ± 4%) impulses (p< 0.001). Overall diagnostic accuracy for differentiating central from peripheral patients was 96% (95% CI for AUC ROC curve: 0.90 to 1.0) for VOR gain and 100% (95% CI: 1.0 to 1.0) for AQEM occurrence rate. CONCLUSIONS These results suggest that AQEM are a sign of vestibular imbalance in a peripheral deficit. In addition to VOR gain they should be added to the evaluation of the head impulse test.

Characteristics and Outcomes of Intensive Care Unit Survivors: Experience of a Multidisciplinary Outpatient Clinic in a Teaching Hospital

OBJECTIVES: To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. METHODS: Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. RESULTS: A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. CONCLUSIONS: A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

P534: Motor unit number index (MUNIX) in amyotrophic lateral sclerosis: a prospective cohort study

Methods: 1. Choose ALS patients whose pectoral reflex is active and the biceps, triceps reflex are decreased and agreed to do EMG examination. 2. Performed EMG examination in the clavicular part and sternal part of P. major, biceps, triceps and abductor digiti minim respectively, and compared their neurogenic damage; 3. Stimulate Erb dot antidromicly and record the amplitude of the pectoral reflex in the clavicular part and sternal part respectively, and standardize data. Results: 1. two parts of P. major are neurogenic damaged but mismatch with the muscles that innervated by the same cervical root. 2. The amplitude of pectoral reflex is increased significantly in the ALS patients. Conclusions: 1.The pectoral major appeared neurogenic damage lately. 2. The increased amplitude of pectoral reflex indicate the UMND damage in the ALS patients with significant upper limb atrophy.