Luciano Farage

White Matter Impairment in Rett Syndrome: Diffusion Tensor Imaging Study with Clinical Correlations

BACKGROUND AND PURPOSE: RTT, caused by mutations in the methyl CPG binding protein 2 (MeCP2) gene, is a disorder of neuronal maturation and connections. Our aim was to prospectively examine FA by DTI and correlate this with certain clinical features in patients with RTT. MATERIALS AND METHODS: Thirty-two patients with RTT underwent neurologic assessments and DTI. Thirty-seven age-matched healthy female control subjects were studied for comparison. With use of a 1.5T MR imaging unit, DTI data were acquired, and FA was evaluated to investigate multiple regional tract–specific abnormalities in patients with RTT. RESULTS: In RTT, significant reductions in FA were noted in the genu and splenium of the corpus callosum and external capsule, with regions of significant reductions in the cingulate, internal capsule, posterior thalamic radiation, and frontal white matter. In contrast, FA of visual pathways was similar to control subjects. FA in the superior longitudinal fasciculus, which is associated with speech, was equal to control subjects in patients with preserved speech (phrases and sentences) (P = .542), whereas FA was reduced in those patients who were nonverbal or speaking only single words (P < .001). No correlations between FA values for tracts and clinical features such as seizures, gross or fine motor skills, and head circumference were identified. CONCLUSIONS: DTI, a noninvasive technique to assess white matter tract pathologic features, may add specificity to the assessment of RTT clinical severity that is presently based on the classification of MeCP2 gene mutation and X-inactivation.

As medidas de segurança no trânsito e a morbimortalidade intra-hospitalar por traumatismo craniencefálico no Distrito Federal

Este estudo busca analisar a efetividade das medidas de seguranca no trânsito (cinto de seguranca, dispositivos de reducao de velocidade e faixa de pedestre), usando como parâmetro a diminuicao da frequencia de casos ou da gravidade do traumatismo crâniencefalico (TCE). METODOS: Estudo epidemiologico descritivo e analitico, baseado na avaliacao dos dados secundarios sobre trauma no Distrito Federal. Os dados foram analisados em dois periodos, um anterior (1992) e outro posterior (1997) a adocao das medidas de seguranca no trânsito. RESULTADOS: No estudo comparam-se os indices (por 100.000 habitantes) de vitimas entre os dois periodos. Em 1992 houve 125,5 casos (grupo 1), enquanto que em 1997 houve 155,8 (grupo 2). Deste total, no Grupo 1 tivemos 26,2 casos de TCE com 5,2 obitos pelo agravo, no Grupo 2 tivemos 62,1 casos com 4,1 obitos, ou seja, o TCE foi responsavel por 82,5% do obitos no primeiro periodo e por 79,4% no segundo. Quanto a gravidade no grupo 1, tivemos 9,6 casos e no Grupo 2 foram 8,1 casos de TCE moderado e grave. CONCLUSAO: Houve um aumento relativo e absoluto do numero de casos de TCE devido a acidentes automobilisticos no periodo, contudo foi reduzida a morbimortalidade hospitalar do traumatismo, sugerindo que as medidas de seguranca nao foram efetivas para diminuir o numero de casos, mas possam ter sido satisfatorias para reduzir a morbimortalidade decorrente deles.BACKGROUND The study analyzed the effectiveness of safety measures (seat belt, velocity control) in traffic. The parameters were the decrease in number and severity in head injury trauma (HIT). METHODS Epidemiological study, based on the evaluation of secondary data about head injury. The data were analyzed between two periods, before (1992) and after (1997) measures implementation. RESULTS We compared the indices (per 100.000 population) of victims in the two periods. In 1992 there were 125.5 victims, and in 1997 there were 155.8. From this total in group 1 we had 26.2 cases of HIT with 5.2 deaths, in 1997 we had 62.1 with 4.1 deaths. About severity: in the first period were 9.6 cases severe or moderate head injury, in group 2 there were 8.1 cases. CONCLUSIONS There was an increase in the number of victims of HIT caused by automobile accidents in this period, however the severity of the trauma showed a small decrease, possibly security measures were not efficiently in reducing the number of cases but may have been successful in reducing deaths related to this accidents.BACKGROUND: The study analyzed the effectiveness of safety measures (seat belt, velocity control) in traffic. The parameters were the decrease in number and severity in head injury trauma (HIT).METHODS: Epidemiological study, based on the evaluation of secondary data about head injury. The data were analyzed between two periods, before (1992) and after (1997) measures implementation.RESULTS: We compared the indices (per 100.000 population) of victims in the two periods. In 1992 there were 125.5 victims, and in 1997 there were 155.8. From this total in group 1 we had 26.2 cases of HIT with 5.2 deaths, in 1997 we had 62.1 with 4.1 deaths. About severity: in the first period were 9.6 cases severe or moderate head injury, in group 2 there were 8.1 cases.CONCLUSIONS: There was an increase in the number of victims of HIT caused by automobile accidents in this period, however the severity of the trauma showed a small decrease, possibly security measures were not efficiently in reducing the number of cases but may have been successful in reducing deaths related to this accidents.

Accuracy of contrast-enhanced spectral mammography for estimating residual tumor size after neoadjuvant chemotherapy in patients with breast cancer: a feasibility study

Objective To assess the feasibility of contrast-enhanced spectral mammography (CESM) of the breast for assessing the size of residual tumors after neoadjuvant chemotherapy (NAC). Materials and methods In breast cancer patients who underwent NAC between 2011 and 2013, we evaluated residual tumor measurements obtained with CESM and full-field digital mammography (FFDM). We determined the concordance between the methods, as well as their level of agreement with the pathology. Three radiologists analyzed eight CESM and FFDM measurements separately, considering the size of the residual tumor at its largest diameter and correlating it with that determined in the pathological analysis. Interobserver agreement was also evaluated. Results The sensitivity, specificity, positive predictive value, and negative predictive value were higher for CESM than for FFDM (83.33%, 100%, 100%, and 66% vs. 50%, 50%, 50%, and 25%, respectively). The CESM measurements showed a strong, consistent correlation with the pathological findings (correlation coefficient = 0.76-0.92; intraclass correlation coefficient = 0.692-0.886). The correlation between the FFDM measurements and the pathological findings was not statistically significant, with questionable consistency (intraclass correlation coefficient = 0.488-0.598). Agreement with the pathological findings was narrower for CESM measurements than for FFDM measurements. Interobserver agreement was higher for CESM than for FFDM (0.94 vs. 0.88). Conclusion CESM is a feasible means of evaluating residual tumor size after NAC, showing a good correlation and good agreement with pathological findings. For CESM measurements, the interobserver agreement was excellent.

Middle ear barotrauma after hyperbaric oxygen therapy - the role of insuflation maneuvers.

OBJECTIVE To analyze the association of insuflation maneuvers status before hyperbaric oxygen therapy with middle ear barotrauma. MATERIALS AND METHODS Fouty-one patients (82 ears) admitted to the Department of Hyperbaric Medicine from May 2011 to July 2012. Assessments occurred: before and after the first session, after sessions with symptoms. During the evaluations were performed: otoscopy with Valsalva and Toynbee maneuvers, video otoscopy and specific questionnaire. Middle ear barotrauma was graduated by the modified Edmonds scale. Tubal insuflation was classified in Good, Median and Bad according to combined results of Valsalva and Toynbee maneuvers. INCLUSION CRITERIA patients evaluated by an otolaryngologist before and after the first session, with no history of ear disease, who agreed to participate in the research (convenience sample). RESULTS Of the 82 ears included in the study, 32 (39%) had barotrauma after the first session. The rate of middle ear barotrauma according to tubal insuflation was: 17.9% (Good insuflation) 44.4% (Median insuflation) and 55.6% (Bad insuflation) (P = 0.013). CONCLUSION Positive Valsalva and Toynbee maneuvers before the first session, alone or associated were protective factors for middle ear barotrauma by ear after the first session.

Stroke: bowel dysfunction in patients admitted for rehabilitation.

Aim : to assess the prevalence of diminished frequency of bowel movements, lumpy or hard stools, intestinal constipation, straining, incomplete evacuation, incontinence (bowel dysfunctions) in patients with brain injury resulting from cerebrovascular accident, either self-reported or reported by their caregivers; to describe the type and frequency of such dysfunctions; and the prevalence of laxative use both before and after stroke. Method : cross-sectional study with 98 hospitalized patients admitted for rehabilitation between December 2009 and May 2010. Results : the prevalence of bowel dysfunctions before stroke was 23.96% whereas after the lesion it was 55.21% (p<0.0001). As reported by patients/caregivers, the chances of developing bowel dysfunctions increase sevenfold after stroke, 95% CI (2.44-24.26). The most frequent dysfunctions before stroke were intestinal constipation (73.91%) and diminished frequency of bowel movements (17.39%). After stroke, constipation remains to be the most frequent dysfunction reported (50%), followed by diminished frequency of bowel movements (26.79%), incomplete evacuation (12.50%), and lack of privacy (5.36%). The use of laxatives was 19,15% after the lesion, but not statisticaly significant (p=0.0736). Conclusion : Bowel dysfunctions increases significantly after stroke. Therefore, further studies are needed to better understand and characterize such dysfunctions, which are scarcely described in the literature.

Update on Middle Ear Barotrauma after Hyperbaric Oxygen Therapy—Insights on Pathophysiology

Introduction Middle ear barotrauma is the most common side effect of hyperbaric oxygen therapy. Knowledge and understanding of its pathophysiology are crucial for an accurate diagnosis and proper decision making about treatment and prevention. Objective Describe up-to-date information on pathophysiology of middle ear barotrauma after hyperbaric oxygen therapy considering the physiology of pressure variation of the middle ear. Data Synthesis Middle ear barotrauma occurs especially during the compression phase of hyperbaric oxygen therapy. The hyperoxic environment in hyperbaric oxygen therapy leads to ventilatory dysfunction of the eustachian tube, especially in monoplace chambers, where the patients are pressurized with 100% O2, favoring middle ear barotrauma. Conclusion The eustachian tube, the tympanic cavity, and mastoid work together in a neural controlled feedback system in which various mechanisms concur for middle ear pressure regulation.

Constipação intestinal em pacientes admitidos em programa de reabilitação neurológica

OBJECTIVES: To determine the prevalence of constipation in patients admitted for rehabilitation and to verify the results of two intervention models for bowel retraining during hospitalization. METHODS: A longitudinal, analytical study, with 98 patients admitted to rehabilitation ward between December 2009 and May 2010. RESULTS: The prevalence of constipation was 57.1%, there was no correlation with gender, education, age, transportation assistance, language disorder, physical activity, diet and presence of constipation; the improvement in functional capacity was a predictor of progress in intestinal frequency; interventions introduced demonstrated an important role in improving bowel habits. CONCLUSIONS: Conduct studies may provide treatment options for constipation, improving the quality of life for these individuals.

Correlation of clinical findings and brain volume data in multiple sclerosis

Brain volume measurements are becoming an important tool for assessing success in controlling multiple sclerosis (MS) activity. MSmetrix (icometrix) is an easy-to-use platform, specific for MS magnetic resonance imaging (MRI) of the brain. It provides data on total brain volume, grey matter volume and lesion load volume. The objective of the present study was to assess whether disability and the number of relapses during the previous year correlated with brain volume measurements from MSmetrix. Data on 185 icometrix reports from patients with MS were used to evaluate the potential correlation between brain volume measurements and clinical parameters. There was a significant correlation between higher disability and decreased brain volume (total and grey matter). Increased lesion load in the brain and higher number of relapses in the previous year were also independently correlated with decreased brain tissue volume and with increased disability. This is the first study with real-world data to show that icometrix is a relevant tool for the study of brain volume loss in MS.

Mastoid surface area-to-volume ratios in adult Brazilian individuals.

UNLABELLED Computed tomography-based measurements of mastoid surface area and volume have not been described for adult Brazilian individuals. These measurements add to the understanding of middle ear physiology, related diseases, and their impact on mastoid pneumatization. OBJECTIVE To check the ratio between mastoid surface area and volume. METHOD This contemporary cross-sectional cohort study included 28 patients submitted to CT imaging of the mastoid. Measurements of surface area and volume were made based on serial CT scans and produced with the aid of software package Image Pro Plus. RESULTS Mastoid volumes ranged from 5.5 to 72.4 cm³. Surface areas ranged from 43.9 to 525.2 cm². Surface areas varied linearly with volumes. CONCLUSION Mastoid surface areas and volumes of adult Brazilian subjects followed a linear correlation, as also described in studies carried out in other countries. Mean surface areas and volumes were higher than previously published, unlike surface area-to-volume ratios, which were lower. Further studies with larger populations will provide evidence as to whether Brazilian subjects have larger surface areas and volumes than other populations.

Constipación intestinal en pacientes admitidos en un programa de rehabilitación neurológica

OBJECTIVES: To determine the prevalence of constipation in patients admitted for rehabilitation and to verify the results of two intervention models for bowel retraining during hospitalization. METHODS: A longitudinal, analytical study, with 98 patients admitted to rehabilitation ward between December 2009 and May 2010. RESULTS: The prevalence of constipation was 57.1%, there was no correlation with gender, education, age, transportation assistance, language disorder, physical activity, diet and presence of constipation; the improvement in functional capacity was a predictor of progress in intestinal frequency; interventions introduced demonstrated an important role in improving bowel habits. CONCLUSIONS: Conduct studies may provide treatment options for constipation, improving the quality of life for these individuals.