Arquivos de neuro-psiquiatria最新文献

{"title":"The reality of epilepsy in primary care in Rio de Janeiro: the importance of educational projects for better patient care.","authors":"Vanessa Cristina Colares Lessa, Marília Bezerra Magalhães Martins, Alexandra Seide Cardoso Vidal, Leonardo Alves Araujo, Isabella D'Andrea Meira","doi":"10.1055/s-0044-1787796","DOIUrl":"https://doi.org/10.1055/s-0044-1787796","url":null,"abstract":"<p><strong>Background: </strong> The Basic Health Unit (Unidade Básica de Saúde - UBS, in Portuguese) is the first point of contact in the public healthcare system for people with epilepsy. Primary care professionals need to appropriately diagnose, treat, and refer, if necessary, to tertiary services.</p><p><strong>Objective: </strong> To evaluate the knowledge of UBS professionals on the management of patients with epilepsy in Rio de Janeiro.</p><p><strong>Methods: </strong> Online questionnaires were performed on the topic of epilepsy before and after exposure to classes taught by epileptologists.</p><p><strong>Results: </strong> A total of 66 doctors participated, 54.5% of whom were residents or trained in family medicine. The majority had from 1 to 3 years of practice. Insecurity prevailed in the management of pregnant women and the elderly. Around 59.1% of the participants referred patients with seizures without examinations. A total of 78% of the participants did not correctly classify seizure types, and 2/3 did not define drug-resistant epilepsy. Induction and broad-spectrum drugs were common. The therapeutic decision depended on availability in the basic health unit (UBS) (81.8%), dosage (60.6%), side effects (34.8%), and age (36.4%). Comorbidities and sex influenced 1/4 of the sample. For 23% of the participants, the type of crisis did not affect the choice. Regarding typical non-pharmacological options, 75% of the participants were aware of cannabidiol, 40.9% of surgery, 22.7% of ketogenic diet, and 22.8% of deep brain stimulation/vagus nerve stimulation (DBS/VNS). A total of 90.2% indicated the need for training.</p><p><strong>Conclusion: </strong> There are deficits in the knowledge of UBS professionals in the management of epilepsy. Specialized training is imperative to optimize the care offered within SUS.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"82 8","pages":"1-5"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rett syndrome due to mutation in the MECP2 gene and electroencephalographic findings.","authors":"Marta Rodrigues de Carvalho, Thiago Toscano Cavalcante, Pedro Sudbrack Oliveira, Pedro Vicente Ferreira Naves, Paulo Emidio Lobão Cunha","doi":"10.1055/s-0044-1787801","DOIUrl":"10.1055/s-0044-1787801","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"82 8","pages":"1-2"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke awareness in a Brazilian Northeastern capital city and the burden of the COVID-19 pandemic.","authors":"Letícia Januzi de Almeida Rocha, Monica Thalia de Brito Melo, Renata Girardi Piva, Samira Mercaldi Rafani, Octavio Marques Pontes-Neto, Eva Rocha, Jussara Almeida de Oliveira Baggio","doi":"10.1055/s-0044-1788583","DOIUrl":"https://doi.org/10.1055/s-0044-1788583","url":null,"abstract":"<p><strong>Background: </strong> The delay in recognizing stroke symptoms is a significant obstacle to receiving acute treatment. Therefore, it is essential to understand the gaps in the knowledge about stroke among the general population and promote campaigns based on these gaps.</p><p><strong>Objective: </strong> To investigate the general knowledge about stroke in a capital in Northeastern Brazil in a sample of individuals who attended a public hospital and the impacts of the coronavirus disease 2019 (COVID-19) pandemic on the use of emergency services.</p><p><strong>Methods: </strong> We included patients older than 18 years of age and their family members and/or companions. After obtaining consent, the researcher presented a typical case of stroke, and the participants filled out a questionnaire divided into 2 sections: sociodemographic data and 15 questions about stroke detection and seeking health services and treatment.</p><p><strong>Results: </strong> We included 154 individuals with a mean age of 44.45 ± 16.21 years. After presenting the case, 60.4% mentioned the acronym <i>AVC</i> (<i>acidente vascular cerebral</i>, or cerebrovascular accident [stroke], in Portuguese) as a possible explanation, and 54.5% reported that they would call the Mobile Emergency Care Service. However, 62.9% provided the incorrect telephone number for the Mobile Emergency Care Service or lacked knowledge of the accurate number. Regarding the risk factors for stroke, 27.9% did not know any of them, 65.5% were unaware of any treatment, and no reference was made to thrombolytic therapy. About their chosen conduct in the same case in the context of the COVID-19 pandemic, 98.1% of the participants would not change their behavior.</p><p><strong>Conclusion: </strong> These results can assist in the planning of public policies and campaigns emphasizing the issue of risk factors and how to access emergency medical services in the state of Alagoas, Brazil.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"82 8","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revolutionizing early Alzheimer's disease and mild cognitive impairment diagnosis: a deep learning MRI meta-analysis.","authors":"Li-Xue Wang, Yi-Zhe Wang, Chen-Guang Han, Lei Zhao, Li He, Jie Li","doi":"10.1055/s-0044-1788657","DOIUrl":"10.1055/s-0044-1788657","url":null,"abstract":"<p><strong>Background: </strong> The early diagnosis of Alzheimer's disease (AD) and mild cognitive impairment (MCI) remains a significant challenge in neurology, with conventional methods often limited by subjectivity and variability in interpretation. Integrating deep learning with artificial intelligence (AI) in magnetic resonance imaging (MRI) analysis emerges as a transformative approach, offering the potential for unbiased, highly accurate diagnostic insights.</p><p><strong>Objective: </strong> A meta-analysis was designed to analyze the diagnostic accuracy of deep learning of MRI images on AD and MCI models.</p><p><strong>Methods: </strong> A meta-analysis was performed across PubMed, Embase, and Cochrane library databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focusing on the diagnostic accuracy of deep learning. Subsequently, methodological quality was assessed using the QUADAS-2 checklist. Diagnostic measures, including sensitivity, specificity, likelihood ratios, diagnostic odds ratio, and area under the receiver operating characteristic curve (AUROC) were analyzed, alongside subgroup analyses for T1-weighted and non-T1-weighted MRI.</p><p><strong>Results: </strong> A total of 18 eligible studies were identified. The Spearman correlation coefficient was -0.6506. Meta-analysis showed that the combined sensitivity and specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.84, 0.86, 6.0, 0.19, and 32, respectively. The AUROC was 0.92. The quiescent point of hierarchical summary of receiver operating characteristic (HSROC) was 3.463. Notably, the images of 12 studies were acquired by T1-weighted MRI alone, and those of the other 6 were gathered by non-T1-weighted MRI alone.</p><p><strong>Conclusion: </strong> Overall, deep learning of MRI for the diagnosis of AD and MCI showed good sensitivity and specificity and contributed to improving diagnostic accuracy.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"82 8","pages":"1-10"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Lentiform fork sign\" in uremic striatopallidal syndrome: a rare cause of parkinsonism.","authors":"Trajano Aguiar Pires Gonçalves, Pedro José Tomaselli","doi":"10.1055/s-0044-1787763","DOIUrl":"10.1055/s-0044-1787763","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"82 8","pages":"1-2"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141557938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ataxias in Brazil.","authors":"Shoji Tsuji","doi":"10.1055/s-0044-1788782","DOIUrl":"10.1055/s-0044-1788782","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"82 8","pages":"1-2"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting the history of autism before Kanner and Asperger: a tribute to Grunya Sukhareva.","authors":"Cristina Maria Pozzi, Rudimar Dos Santos Riesgo, Francisco Baptista Assumpção Junior","doi":"10.1055/s-0044-1788269","DOIUrl":"https://doi.org/10.1055/s-0044-1788269","url":null,"abstract":"<p><p>Almost two decades before Kanner's and Asperger's works, the original paper by child psychiatrist Grunya Efimovna Sukhareva had already been written. It was published in 1926 by Sukhareva in a German scientific journal of psychiatry and neurology, with a detailed description of children who presented clinical conditions whose characteristics and evolution closely resemble autism, according to current criteria. In the present historical note, we intend to present Sukhareva's pioneering work and retrieve the meaning of her original contribution.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"82 8","pages":"1-3"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital health in stroke: a narrative review.","authors":"Gisele Sampaio Silva, João Brainer Clares de Andrade","doi":"10.1055/s-0044-1789201","DOIUrl":"10.1055/s-0044-1789201","url":null,"abstract":"<p><p>Digital health is significantly transforming stroke care, particularly in remote and economically diverse regions, by harnessing mobile and wireless technologies, big data, and artificial intelligence (AI). Despite the promising advancements, a notable gap exists in the formal clinical validation of many digital health applications, raising concerns about their efficacy and safety in real-world clinical settings. Our review systematically explores the landscape of digital health in stroke care, assessing the development, validation, and implementation of various digital tools. We adopted a comprehensive search strategy, scrutinizing peer-reviewed articles published between January 2015 and January 2024, to gather evidence on the effectiveness of digital health interventions. A rigorous quality assessment was conducted to ensure the reliability of the included studies, with findings synthesized to underscore key technological innovations and their clinical outcomes. Ethical considerations were meticulously observed to maintain data confidentiality and integrity. Our findings highlight the transformative potential of mobile health technologies, AI, and telemedicine in improving diagnostic accuracy, treatment efficacy, and patient outcomes in stroke care. Our paper delves into the evolution and impact of digital health in cerebrovascular prevention, diagnosis, rehabilitation and stroke treatment, emphasizing the digital health's role in enhancing access to expert care, mitigating treatment delays and improving outcomes. However, the review also underscores the critical need for rigorous clinical validation and ethical considerations in the development and deployment of digital health technologies to ensure their safe and effective integration into stroke care practices.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"82 8","pages":"1-10"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142071894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the Brazilian version of the Mini-Addenbrooke Cognitive Examination (M-ACE BR) to screen for cognitive impairment in older adults.","authors":"Maira Okada-Oliveira, Maria Teresa Carthery-Goulart, Karolina Gouveia César-Freitas, Ricardo Nitrini, Sonia Maria Dozzi Brucki","doi":"10.1055/s-0044-1788585","DOIUrl":"10.1055/s-0044-1788585","url":null,"abstract":"<p><strong>Background: </strong> Age is the most important risk factor for develop dementia, and the recommendation is that older adults are cognitively tested to detect impairment in the initial stage for adequate treatment. The demand for the care of these older adults is great, drawing attention to the need for rapid tests, with good accuracy and simple application to identify cognitive impairment.</p><p><strong>Objective: </strong> To develop and validate the Brazilian Mini-Addenbrooke Cognitive Examination (M-ACE BR) as a short screening test for cognitive impairment in older adults.</p><p><strong>Methods: </strong> The M-ACE BR was developed using the Mokken scaling analysis in 352 participants (cognitively unimpaired [CU] = 232, cognitive impairment no dementia [CIND] = 82; and dementia = 38) and validated in an independent sample of 117 participants (CU = 25; CIND = 88; and dementia = 4).</p><p><strong>Results: </strong> The Mokken scaling analysis derived 9 items (spatial orientation, anterograde memory, retrograde memory, delayed recall, recognition [name and address], letter verbal fluency, repetition of 4 words, naming of 10 items, and comprehension) with a maximum score of 51 points and an average duration time of 7 minutes. The cut-off score ≤ 43/51 for CIND had a sensitivity of 59.09% and a specificity of 80%. For a screening test in which sensitivity is prioritized for further investigation, we suggest using a cutoff of ≤ 47 (sensitivity 85.23% and specificity 24%), maintaining a good positive predictive value (79.8%).</p><p><strong>Conclusion: </strong> The M-ACE BR is a brief and adequate instrument to detect cognitive impairment in older Brazilian adults. However, screening for CIND and for different educational levels should be further explored.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"82 8","pages":"1-9"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High prevalence of intracranial arterial stenosis among acute ischemic stroke patients in a Brazilian center: a transcranial color-coded duplex sonography study.","authors":"Letícia Januzi de Almeida Rocha, Maria Clara Zanon Zotin, Renata da Silva Almeida Santos, Milena Carvalho Libardi, Millene Rodrigues Camilo, Clara Monteiro Antunes Barreira, Pedro Telles Cougo Pinto, Suleimy Cristina Mazim, Daniel Giansante Abud, Octavio Marques Pontes Neto","doi":"10.1055/s-0044-1788667","DOIUrl":"https://doi.org/10.1055/s-0044-1788667","url":null,"abstract":"<p><strong>Background: </strong> There is limited data available regarding the prevalence of intracranial arterial stenosis (ICAS) among acute ischemic stroke (AIS) patients in Brazil and Latin America.</p><p><strong>Objective: </strong> The present study sought to investigate the frequency and predictors of ICAS among patients with AIS or transient ischemic attack (TIA) in a Brazilian center, with transcranial color-coded duplex sonography (TCCS) technique.</p><p><strong>Methods: </strong> Consecutive AIS and TIA patients, admitted to an academic public comprehensive stroke center in Brazil from February to December 2014, evaluated by TCCS were prospectively selected. Vascular narrowings > 50% were considered as ICAS, based on ultrasound criteria previously defined in the literature.</p><p><strong>Results: </strong> We assessed 170 consecutive patients with AIS or TIA, of whom 27 (15.9%) were excluded due to an inadequate transtemporal acoustic bone window. We confirmed ICAS in 55 patients (38.5%). The most common location was the proximal segment of the middle cerebral artery (28.2%), followed by the vertebral (15.4%), posterior cerebral (13.6%), terminal internal carotid (9.1%) and basilar (8.2%) arteries. On multivariate models adjusting for potential confounders, systolic blood pressure (OR: 1.03, 95%CI: 1.01-1.04; <i>p</i> = 0.008) was independently associated with ICAS.</p><p><strong>Conclusion: </strong> We found significant ICAS in approximately ⅓ of patients admitted with symptoms of AIS or TIA in a public tertiary academic stroke center in Brazil. The TCCS is an accessible and noninvasive technique that can be used to investigate the presence of moderate and severe ICAS, especially in patients who cannot be exposed to more invasive exams, such as the use of intravenous contrast agents.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"82 8","pages":"1-8"},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}