Larissa Monteiro

Oxidative Stress in Neurodegenerative Diseases: Mechanisms and Therapeutic Perspectives

The incidence and prevalence of neurodegenerative diseases (ND) increase with life expectancy. This paper reviews the role of oxidative stress (OS) in ND and pharmacological attempts to fight against reactive oxygen species (ROS)-induced neurodegeneration. Several mechanisms involved in ROS generation in neurodegeneration have been proposed. Recent articles about molecular pathways involved in ROS generation were reviewed. The progress in the development of neuroprotective therapies has been hampered because it is difficult to define targets for treatment and determine what should be considered as neuroprotective. Therefore, the attention was focused on researches about pharmacological targets that could protect neurons against OS. Since it is necessary to look for genes as the ultimate controllers of all biological processes, this paper also tried to identify gerontogenes involved in OS and neurodegeneration. Since neurons depend on glial cells to survive, recent articles about the functioning of these cells in aging and ND were also reviewed. Finally, clinical trials testing potential neuroprotective agents were critically reviewed. Although several potential drugs have been screened in in vitro and in vivo models of ND, these results were not translated in benefit of patients, and disappointing results were obtained in the majority of clinical trials.

Associação entre meningite asséptica e uso da vacina tríplice viral (sarampo-caxumba-rubéola) durante campanha vacinal de 1997

Em 1997 foi realizada uma campanha de vacinação em massa com a vacina tríplice víral (sarampo, caxumba, rubéola), em quatro Estados brasileiros: Rio Grande do Sul, Bahia, Piauí e Ceará. Três semanas após o principal dia de campanha, os diversos estados notificaram um aumento da incidência de casos de meningite asséptica (MA), especialmente nas capitais. Logo após, foi iniciada uma investigação desenvolvida pelos técnicos locais das Secretarias Estaduais de Saúde e por pesquisadores do Instituto de Saúde Coletiva e Faculdade de Medicina da Universidade Federal da Bahia, com apoio do Programa Nacional de Imunizações PNI. Os resultados dessa investigação demonstram a existência de um surto de meningite asséptica que se iniciou de forma abrupta 2-3 semanas após a vacinação nas capitais estudadas, e persistiu por 4 semanas. Foi demonstrado que o maior risco após o uso da vacina correspondeu a 21-30 dias, quando comparado com o risco de MA antes da campanha. Apenas em Salvador o surto ocasionou um excessivo aumento da ocupação hospitalar. Esse texto discute os determinantes da ocorrência de um evento adverso na forma de um surto, as implicações sobre uma adequada assistência médica, e o impacto da informação sobre a adesão da população às vacinas empregadas pelo PNI.

Cisapride related movement disorders

OBJECTIVE: To describe a case of movement disorder associated with cisapride use. METHOD: Case report.RESULTS: This is the case of a male eight months old child who began to use cisapride, 0,2 mg/kg tid to treat gastroesophageal reflux disease. One month after beginning with the drug, he started to present repetitive movements of the hands characterized by opening and closing hands with flexion and extension of the wrists. According to the mother, these movements became more evident as the dose of the medication was increased, and, thereafter, started to happen also on the feet. When the child was six months old, time of the first neurological evaluation, he presented normal neurological development, except for the Parachute reflex, which was absent. After excluding metabolic, toxic and infectious diseases, the drug was withdrew. The child evolution was benign, with gradual disappearance of the movements, and he was completely normal 30 days after.CONCLUSIONS: The authors stress the need suspending the use of cisapride in any case of neurologic symptoms as seizures, somnolence, malaise or involuntary movements in previously normal patients.

Efficacy of physical therapy associated with botulinum toxin type A on functional performance in post-stroke spasticity: A randomized, double-blinded, placebo-controlled trial

The aim was to investigate if botulinum toxin type A (BTx-A) associated with physical therapy is superior to physical therapy alone in post stroke spasticity. A randomized, double-blinded controlled trial was performed in a rehabilitation unit on Northeastern, Brazil. Patients with post stroke spasticity were enrolled either to BTx-A injections and a pre-defined program of physical therapy or saline injections plus physical therapy. Primary endpoint was functional performance evaluated through time up and go test, six minutes walking test and Fugl-Meyer scale for upper limb. Secondary endpoint was spasticity improvement. Confidence interval was considered at 95%. Although there was a significant decrease in upper limbs flexor tonus (P<0.05) in the BTx-A group, there was no difference regarding functional performance after 9 months of treatment. When analyzing gait speed and performance, both groups showed a significant improvement in the third month of treatment, however it was not sustained over time. Although BTx-A shows superiority to improve muscle tone, physical therapy is the cornerstone to improve function in the upper limbs of post stroke patients.