Waldir Antonio Tognola

Urban prevalence of epilepsy: populational study in São José do Rio Preto, a medium-sized city in Brazil

ANTECEDENTES: O objetivo deste estudo foi determinar a prevalencia da epilepsia na populacao urbana de Sao Jose do Rio Preto, com 336000 habitantes, localizada no noroeste do Estado de Sao Paulo/ Brasil. METODO: O estudo populacional, tipo corte transversal, em amostra aleatoria, constituiuse de uma fase de rastreamento, mediante um questionario. O padrao ouro para confirmacao diagnostica foi a historia clinica e o exame neurologico. Os testes do c2 e intervalo de confianca de 95% (IC95%) foram usados para analise dos resultados, tendo sido considerados significantes os de valor p< 0,05. RESULTADOS: A amostra estudada foi de 17293 pessoas, cuja distribuicao quanto ao sexo, a faixa etaria e a raca foram semelhantes a da populacao em geral. A prevalencia de epilepsia por 1000 hab. foi 18,6, sendo 8,2 para ativa considerandose, pelo menos, uma crise no periodo dos ultimos 2 anos. A prevalencia na faixa etaria de 0 a 4 anos foi 4,9, de 5 a 14, 11,7; de 15 a 64, 20,3; e acima dos 65 anos foi 32,8. CONCLUSAO: As prevalencias de epilepsia acumulada e ativa foram elevadas, semelhantes as dos paises em desenvolvimento, em particular, aos da America Latina. A prevalencia de epilepsia na infância foi baixa, enquanto que nos idosos foi elevada, semelhantes as observadas em paises desenvolvidos. Estes resultados sao relevantes no planejamento de medidas sanitarias, adequacao ao tratamento da populacao, considerando a alta prevalencia encontrada, para minimizar o impacto da epilepsia na populacao.UNLABELLED The aim of this study was to determine the prevalence of epilepsy in the urban population of São José do Rio Preto. This is a medium-sized city of 336000 inhabitants, located in the northwest of the state of São Paulo, Brazil. METHOD A cross-sectional epidemiological investigation with a randomized sample was performed in two phases, a screening phase and a confirmation of the diagnosis phase. The gold standard was a clinical investigation and neurological examination. The chi-square test was used in analysis of the results and p-value value < 0.05 was considered significant. Prevalence was calculated with 95% confidence interval. RESULTS The study sample size was 17293 individuals, with distributions of gender, age, and race similar to the general population. The prevalence per 1000 inhabitants of epilepsy was 18.6, of these 8.2 were active, defined as at least one seizure within the last two years. The prevalence per 1000 inhabitants for the age groups (years) was 4.9 (04), 11.7 (514), 20.3 (1564) and 32.8 (65 or over). CONCLUSION Prevalence of both accumulated and active epilepsy was elevated, comparable to other developing nations, in particular those of Latin America. However, the prevalence of epilepsy in childhood was low, whilst in aged individuals it was high similar to industrialized nations.

Glutathione S-transferase variants increase susceptibility for late-onset Alzheimer's disease: association study and relationship with apolipoprotein E ɛ4 allele

Abstract Background: Several factors participate in the pathogenesis of Alzheimers disease (AD), including free radicals, which when out of balance with their antioxidant capacity contribute to the oxidative stress process and neuronal death. The glutathione S-transferase (GST) polymorphisms are associated with the organism detoxification capacity and can help with the identification of sub-groups that present susceptibility to the development of AD. The aim of this study was to analyze the association of GSTs, including GSTP1, GSTT1 and GSTM1 and apolipoprotein E (apoE) with AD and the distribution of these polymorphisms in the first-degree relatives of patients. Methods: For this, 41 patients with AD, 24 elderly without cognitive deficits (control group), 109 relatives of patients with AD and 41 relatives of controls were studied. A sample of peripheral blood was drawn for leukocyte DNA extraction. The genetic polymorphisms were analyzed by PCR-RFLP. Results: There was a significantly higher frequency of the ɛ4 allele in the patients (0.21) and in their relatives (0.25) when compared to controls (0.04; p=0.01) and their relatives (0.03; p<0.0001). The V allele of the GSTP1 polymorphism was higher in patients compared to controls (0.35 and 0.19, respectively; p=0.04). In contrast, the presence of the GSTT1 polymorphism prevailed in controls (79%) and their relatives. Conclusions: The V allele may be a risk factor for AD, mainly in the presence of the apoE ɛ4 allele, while the presence of GSTT1 may indicate protection against the disease. Clin Chem Lab Med 2008;46:439–45.

Association of apolipoprotein E polymorphism in late-onset Alzheimer's disease and vascular dementia in Brazilians

The genetic basis for dementias is complex. A common polymorphism in the apolipoprotein E (APOE) gene is considered to be the major risk factor in families with sporadic and late-onset Alzheimers disease as well as in the general population. The distribution of alleles and genotypes of the APOE gene in late-onset Alzheimers disease (N = 68), other late-life dementias (N = 39), and in cognitively normal controls (N = 58) was determined, as also was the risk for Alzheimers disease associated with the epsilon4 allele. Peripheral blood samples were obtained from a total of 165 individuals living in Brazil aged 65-82 years. Genomic DNA was amplified by the polymerase chain reaction and the products were digested with HhaI restriction enzyme. APOE epsilon2 frequency was considerably lower in the Alzheimers disease group (1%), and the epsilon3 allele and epsilon3/epsilon3 genotype frequencies were higher in the controls (84 and 72%, respectively) as were the epsilon4 allele and epsilon3/epsilon4 genotype frequencies in Alzheimers disease (25 and 41%, respectively). The higher frequency of the epsilon4 allele in Alzheimers disease confirmed its role as a risk factor, while epsilon2 provided a weak protection against development of the disease. However, in view of the unexpectedly low frequency of the epsilon4 allele, additional analyses in a more varied Brazilian sample are needed to clarify the real contribution of apolipoprotein E to the development of Alzheimers disease in this population.

Clinical application of magnetic resonance in acute traumatic brain injury

PURPOSE To evaluate the clinical applications of magnetic resonance imaging (MRI) in patients with acute traumatic brain injury (TBI): to identify the type, quantity, severity; and improvement clinical-radiological correlation. METHOD Assessment of 55 patients who were imaged using CT and MRI, 34 (61.8%) males and 21 (38.2%) females, with acute (0 to 5 days) and closed TBI. RESULTS Statistical significant differences (McNemar test): ocurred fractures were detected by CT in 29.1% and by MRI in 3.6% of the patients; subdural hematoma by CT in 10.9% and MRI in 36.4 %; diffuse axonal injury (DAI) by CT in 1.8% and MRI in 50.9%; cortical contusions by CT in 9.1% and MRI in 41.8%; subarachnoid hemorrhage by CT in 18.2% and MRI in 41.8%. CONCLUSION MRI was superior to the CT in the identification of DAI, subarachnoid hemorrhage, cortical contusions, and acute subdural hematoma; however it was inferior in diagnosing fractures. The detection of DAI was associated with the severity of acute TBI.

Clinical features of episodic migraine and transformed migraine: a comparative study

Transformed migraine (TM) is one of the most frequent types of chronic daily headache. Eighty patients: 40 with episodic migraine (EM) and 40 with TM with ages ranging from 18 to 60 years old were studied. Females were the majority. At first examination, the mean age was similar in both groups. The initial age of migraine attacks was significantly smaller in the TM group. Time history of episodic attacks was similar in both groups. In the EM group, the headache was predominantly located on only one side of the head; whereas in the TM group, on more than one side. There was variation in the character of pain and intensity in the TM group. Nocturnal awakening with headache, aura and family history did not show significant association with EM or TM. The TM was distinguished from the EM in relation to the frequency, location and pain intensity of the headache. Patients with early migraine headache onset may exhibit a further risk of developing TM.

Chronic daily headache: stress and impact on the quality of life

OBJECTIVE To evaluate the stress presence and its influence in the quality of life of patients with chronic daily headache (CDH). METHOD A hundred patients with at least 18 years old, with primary headache with duration greater than 4 hours a day, and frequency of 15 or more days monthly for at least three months were studied. Lipps Inventory of Stress Symptoms and the Medical Outcomes Study Short Form (SF-36) were used. RESULTS Stress was observed in 90% of the patients; nearly half of them was in the phase almost exhaustion. Patients with stress when compared with the ones with no stress presented significantly lower scores in all the domains of SF-36; except in physical functioning. The resistance phase presented scores significantly higher than almost exhaustion; except for bodily pain. CONCLUSION The majority of the patients presented stress with significant reduction in their quality of life. Consequently, the stress could be related with both the development and the maintenance of CDH.

Perfil epidemiológico de pacientes com traumatismo raquimedular atendidos em hospital terciário

OBJETIVO: Evaluar las caracteristicas epidemiologicas de los pacientes con lesion medular atendidos en hospital de tercer nivel. METODOS: Estudio descriptivo, transversal, prospectivo con 321 pacientes que sufrieron lesiones de la medula espinal, realizado desde enero del 2008 hasta junio del 2012. Se estudiaron las variables: sexo; edad; estado civil; profesion; escolarizacion; religion; origen; etiologia, la morfologia y la region del lesion; estado neurologico por la escala ASIA y lesiones asociadas. RESULTADOS: La muestra se compone de 72% de hombres y 28% de mujeres, con prevalencia del grupo de edad de 21-30 anos. el estado civil mas frequente fue casados (46.8%) y solteros (41.7%). El nivel de escolaridad fue educacion primaria incompleta (57%) y completa (17,8%). Las causas mas frecuentes fueron los accidentes de autos (38.9%) y las caidas (27,4%). La lesion mas comun fue la fractura por estallido (23,7%), la region mas afectada fue la subaxial cervical (41.7%) y la transicion lumbar toracica (30.5%). La lesion asociada mas frecuente fue la cerebral traumatica (LCT) (28.2%). El estado neurologico mas encontrado en la admision/alta fue ASIA-E. Hubo 25 muertes (7.8%), 76% de lesiones en la region cervical fueron estratificados como ASIA-A, y el 68% tuvo complicaciones respiratorias. CONCLUSION: La lesion de la medula espinal afecta mas jovenes varones casados y con bajo nivel de educacion. La causa mas comun fue el accidente de auto, el tipo de lesion fue fractura por estallido y la region cervical fue la mas afectada. El estado neurologico mas comun fue ASIA-E y las LCT asociadas fueron las mas frecuentes y mas graves en ASIA. La mayor gravedad por la clasificacion de ASIA en casos de afectacion cervical aumento el riesgo de complicaciones respiratorias y la morbi-mortalidad.OBJETIVO: Avaliar o perfil epidemiologico de pacientes com traumatismo raquimedular atendidos em hospital terciario. METODOS: Estudo descritivo, transversal, prospectivo, com 321 pacientes vitimas de traumatismo raquimedular, realizado de janeiro de 2008 a junho de 2012. Foram estudadas as variaveis: sexo; idade; estado civil; profissao; escolaridade; religiao; procedencia; etiologia, morfologia e regiao da lesao; condicao neurologica pela escala da ASIA e lesoes associadas. RESULTADOS: Amostra constituida por 72% pacientes do sexo masculino e 28% do feminino, prevalencia da faixa etaria de 21 a 30 anos. Os estados civis mais frequentes foram uniao estavel (46,8%) e solteiros (41,7%). O nivel de escolaridade foi ensino fundamental incompleto (57%) e completo (17,8%). As causas mais frequentes foram acidentes automobilisticos (38,9%) e queda (27,4%). A lesao mais presente foi fratura explosao (23,7%), as regioes mais afetadas foram cervical subaxial (41,7%) e transicao toracolombar (30,5%). A lesao associada mais frequente foi traumatismo cranioencefalico (TCE) (28,2%). O estado neurologico mais observado na internacao/alta foi ASIA-E. Ocorreram 25 obitos (7,8%), sendo que 76% com lesao na regiao cervical foram estratificados com ASIA-A, e 68% tiveram complicacoes respiratorias. CONCLUSAO: O trauma raquimedular acometeu mais adultos jovens do sexo masculino com uniao estavel e baixo nivel de escolaridade. A causa mais frequente foi acidente automobilistico, o tipo de lesao foi fratura explosao e a regiao cervical a mais acometida. A condicao neurologica mais presente foi ASIA-E, o TCE foi a lesao associada mais frequente e a maior gravidade pela classificacao da ASIA nos casos de envolvimento cervical aumentou o risco de complicacoes respiratorias e morbidade e mortalidade.OBJECTIVE: Evaluate the epidemiological profile of patients with spinal cord injury (SCI) treated in a tertiary hospital. METHODS: Descriptive, transversal and prospective study with 321 patients, conducted from January/2009 to June/2012. Variables studied: sex; age; marital status; profession; schooling; religion; origin; etiology, morphology and region of the lesion; neurological status by ASIA and the associated lesions. RESULTS: The sample consisted of 72% males and 28% females, the prevalent age group was 21-30 years. The most common marital status was married (46.8%) and singles (41.7%). The educational level was incomplete (57%) and complete (17.8%) elementary school. The most common causes were traffic accidents (38.9%) and falls (27.4%). The most common injury was burst fracture (23.7%), the most affected areas were subaxial cervical (41.7%) and thoracolumbar transition (30.5%). The most frequent associated injury was traumatic brain injury (TBI) (28.2%). The most frequent neurological condition at admission/discharge was ASIA-E. There were 25 deaths (7.8%) and 76% with lesion in the cervical region were classified with ASIA-A and 68% had respiratory complications. CONCLUSION: SCI affected more married young adult males with low level of education. The most common cause was motor vehicle accident, the type of injury was burst fracture and the cervical region was the most affected. The most common neurological status was ASIA-E and TBI was the most frequente associated injury and the greater severity by ASIA in cases with the cervical involvement increased the risk of respiratory complications and morbidity and mortality.

Proton magnetic resonance spectroscopy: clinical applications in patients with brain lesions

CONTEXT Proton spectroscopy has been recognized as a safe and noninvasive diagnostic method that, coupled with magnetic resonance imaging techniques, allows for the correlation of anatomical and physiological changes in the metabolic and biochemical processes occurring within previously-determined volumes in the brain. There are two methods of proton magnetic resonance spectroscopy: single voxel and chemical shift imaging. OBJECTIVE The present work focused on the clinical applications of proton magnetic resonance spectroscopy in patients with brain lesions. CONCLUSIONS In vivo proton spectroscopy allows the detection of certain metabolites in brain tissue, such as N-acetyl aspartate, creatine, choline, myoinositol, amino acids and lipids, among others. N-acetyl aspartate is a neuronal marker and, as such, its concentration will decrease in the presence of aggression to the brain. Choline increase is the main indicator of neoplastic diseases. Myoinositol is raised in patients with Alzheimers disease. Amino acids are encountered in brain abscesses. The presence of lipids is related to necrotic processes.

Low sensitivity of polymerase chain reaction for diagnosis of tuberculous meningitis in southeastern Brazil

Two polymerase chain reaction (PCR) protocols showed low sensitivity (36% and 53% for TB AMPLICOR and MPB64 nested PCR, respectively), when compared with classic microbiological methods (73% and 54% for Ziehl-Neelsen staining and culture, respectively), in the diagnosis of tuberculous meningitis in 91 patients in southeastern Brazil. Only three PCR-positive, microbiologically negative patients were found. Analysis of sequential cerebrospinal fluid samples by nested PCR detected Mycobacterium tuberculosis DNA up to 29 days after the introduction of antituberculosis chemotherapy.

Nullity of GSTT1/GSTM1 related to pesticides is associated with Parkinson's disease

Genetic and environmental factors affect the pathogenesis of Parkinsons disease (PD). Genetic variants of the enzyme glutathione S-transferases (GST) may be related to the disease. This study aimed to evaluate the influence of genetic variants of GST (GSTT1/GSTM1) and their association with the exposure to environmental toxins in PD patients. We studied 254 patients with PD and 169 controls. The GSTM1/GSTT1 variants were analyzed by polymerase chain reaction. We applied the Fishers exact test and the χ2 test for statistical analysis (p<0.05). The present and absence for GSTT1 and GSTM1 were similar in patients and controls. The null for GSTT1 and GSTM1 (0/0) and exposure to pesticides prevailed in patients (18%) compared to controls (13%, p=0.014). This study suggests the association between PD and previous exposure to pesticides, whose effect may be enhanced in combination with null for GSTT1/GSTM1.