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[SciELO Preprints] - Guidelines on the Diagnosis and Treatment of Hypertrophic Cardiomyopathy – 2024
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Fernandes, Fabio Simões, Marcus V. Correia, Edileide de Barros Marcondes-Braga, Fabiana G. Coelho-Filho, Otavio Rizzi Mesquita, Cláudio Tinoco Mathias-Junior, Wilson Rochitte, Carlos Eduardo Ramires, Felix José Alvarez Alves, Silvia Marinho Martins Montera, Marcelo Westerlund Lopes, Renato Delascio Oliveira-Junior, Mucio Tavares Scolari, Fernando L. Avila, Walkiria Samuel Canesin, Manoel Fernandes Bacal, Fernando Bocchi, Edimar Alcides Moura, Lídia Ana Zytynski Saad, Eduardo Benchimol Scanavacca, Mauricio I. Valdigem, Bruno Pereira Cano , Manuel Nicolas Abizaid , Alexandre Ribeiro, Henrique Barbosa Lemos-Neto, Pedro Alves Ribeiro, Gustavo Calado de Aguiar Jatene, Fabio Biscegli Dias, Ricardo Ribeiro Beck-da-Silva, Luis Rohde, Luis Eduardo P. Bittencourt, Marcelo Imbroinise Pereira, Alexandre Krieger, José Eduardo Villacorta, Humberto Martins, Wolney de Andrade Figueiredo-Neto, José Albuquerque de Cardoso , Juliano Novaes Pastore, Carlos Alberto Jatene, Ieda Biscegli Tanaka, Ana Cristina Sayuri Hotta, Viviane Tiemi Romano, Minna Moreira Dias Albuquerque, Denilson Campos de Mourilhe-Rocha, Ricardo Hajjar, Ludhmila Abrahão Brito, Fabio Sandoli de Caramelli , Bruno Calderaro, Daniela Farsky, Pedro Silvio Colafranceschi , Alexandre Siciliano Pinto, Ibraim Masciarelli Vieira , Marcelo Luiz Campos Danzmann, Luiz Claudio Barberato , Silvio Henrique Mady, Charles Martinelli-Filho, Martino Torbey , Ana Flavia Malheiros Schwartzmann, Pedro Vellosa Macedo, Ariane Vieira Scarlatelli Ferreira , Silvia Moreira Ayub Schmidt, Andre Melo , Marcelo Dantas Tavares de Lima-Filho, Moysés Oliveira Sposito, Andrei C. Brito, Flavio de Souza Biolo, Andreia Madrini-Junior, Vagner Rizk, Stéphanie Itala Mesquita, Evandro Tinoco

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Publication date: 2024-04-08

Abstract: Pt Es En

A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura > 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (> 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE.   Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI).

La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor > 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (> 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).

Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness > 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (> 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.

https://doi.org/10.1590/SciELOPreprints.8394

Otoneurological assessment and quality of life of individuals with complaints of dizziness and temporomandibular disorders: a case-control study
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Honorato, Mônica Claudino Medeiros

; Tavares, Luiz Felipe

; Bedaque, Henrique de Paula

; Mantello, Erika Barioni

; Almeida, Erika Oliveira de

; Ribeiro, Karyna Myrelly Oliveira Bezerra de Figueiredo

; Ferreira, Lidiane Maria de Brito Macedo

Brazilian Journal of Otorhinolaryngology

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dec 2022, Volume 88 Pages 185 - 191

Abstract: En | Text: En | PDF: En

Abstract Objectives: To evaluate the impact of temporomandibular disorders on the quality of life of patients with dizziness. Methods: An observational, case-control study evaluated 60 individuals with dizziness (20 cases and 40 controls), who were matched for gender and age. The individuals underwent to anamnesis, overall physical and otoneurological examination, tonal and vocal audiometry and impedanciometry, video head impulse test and the dizziness handicap inventory questionnaire. Results: The otoscopy was normal for all patients. There was an association between the presence of temporomandibular disorders and aural fullness (p<0.01) and otalgia (p<0.01). Audiometry was normal in 90% of the patients in the case group, with a significant association between temporomandibular disorders and normal audiometry (p<0.01). The video head impulse test findings were normal in 66% of the patients in the case group and 45% of the control group, and there was no association between having temporomandibular disorders and vestibular alterations at the video head impulse test (p = 0.12). There were significant differences in total dizziness handicap inventory and in the functional and emotional domains (p<0.01), with higher scores in the control group. Conclusion: Aural fullness and otalgia symptoms are associated with temporomandibular disorders in patients with dizziness, and there is an association between normal complementary audiological tests and temporomandibular disorders. Vestibular alterations are not associated with temporomandibular disorders. However, patients with dizziness and without temporomandibular disorders showed greater quality of life impairment. Level of evidence: 3. Original case-control study.

https://doi.org/10.1016/j.bjorl.2022.04.005

Diagnóstico e manejo da demência da doença de Parkinson e demência com corpos de Lewy: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia
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Parmera, Jacy Bezerra

; Tumas, Vitor

; Ferraz, Henrique Ballalai

; Spitz, Mariana

; Barbosa, Maira Tonidandel

; Smid, Jerusa

; Barbosa, Breno José Alencar Pires

; Schilling, Lucas Porcello

; Balthazar, Márcio Luiz Figueiredo

; Souza, Leonardo Cruz de

; Vale, Francisco Assis Carvalho

; Caramelli, Paulo

; Bertolucci, Paulo Henrique Ferreira

; Chaves, Márcia Lorena Fagundes

; Brucki, Sonia Maria Dozzi

; Nitrini, Ricardo

; Castilhos, Raphael Machado

; Frota, Norberto Anízio Ferreira

Dementia & Neuropsychologia

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sep 2022, Volume 16 N. 3 Pages 73 - 87

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A demência da doença de Parkinson (DDP) e a demência com corpos de Lewy (DCL) representam a segunda causa mais comum de demência neurodegenerativa em pessoas com mais de 65 anos, ocasionando progressivo declínio cognitivo e comprometimento da qualidade de vida. O presente estudo tem como objetivo prover um consenso de especialistas sobre a DDP e DCL, baseado em revisão sistemática da literatura brasileira e revisão não-sistemática de literatura internacional. Ademais, tal estudo visa promover informação e conceder recomendações sobre abordagem diagnóstica, com foco nos níveis de atenção primária e secundária em saúde. Com base nos dados disponíveis, recomendamos que os profissionais realizem pelo menos um breve instrumento cognitivo global, como o Mini-Exame do Estado Mental, contudo de preferência optem pela Avaliação Cognitiva de Montreal e o Exame Cognitivo de Addenbrooke-Revisado. Observa-se uma carência de instrumentos validados para a avaliação precisa das habilidades funcionais em pacientes brasileiros com DDP e DCL. Além disso, mais estudos focando em biomarcadores com coortes brasileiras também são necessários.

ABSTRACT Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) represent the second most common type of degenerative dementia in patients aged 65 years and older, leading to progressive cognitive dysfunction and impaired quality of life. This study aims to provide a consensus based on a systematic Brazilian literature review and a comprehensive international review concerning PDD and DLB. Moreover, we sought to report on and give recommendations about the best diagnostic approaches focusing on primary and secondary care. Based on the available data, we recommend clinicians to apply at least one brief global cognitive instrument to assess PDD, such as the Mini-Mental State Examination and preferably the Montreal Cognitive Assessment and the Addenbrooke’s Cognitive Examination-Revised. Validated instruments to accurately assess functional abilities in Brazilian PD patients are still incipient. Further studies should focus on biomarkers with Brazilian cohorts.

https://doi.org/10.1590/1980-5764-dn-2022-s105pt

Declínio cognitivo subjetivo, comprometimento cognitivo leve e demência - diagnóstico sindrômico: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia
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Smid, Jerusa

; Studart-Neto, Adalberto

; César-Freitas, Karolina Gouveia

; Dourado, Marcia Cristina Nascimento

; Kochhann, Renata

; Barbosa, Breno José Alencar Pires

; Schilling, Lucas Porcello

; Balthazar, Márcio Luiz Figueiredo

; Frota, Norberto Anízio Ferreira

; Souza, Leonardo Cruz de

; Caramelli, Paulo

; Bertolucci, Paulo Henrique Ferreira

; Chaves, Márcia Lorena Fagundes

; Brucki, Sonia Maria Dozzi

; Nitrini, Ricardo

; Resende, Elisa de Paula França

; Vale, Francisco Assis Carvalho

Dementia & Neuropsychologia

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sep 2022, Volume 16 N. 3 Pages 1 - 24

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Este consenso realizado pela Academia Brasileira de Neurologia (ABN) abordará de maneira prática como avaliar pacientes com queixas cognitivas e como realizar o diagnóstico clínico e etiológico das três síndromes clínicas associadas aos estágios de declínio cognitivo: declínio cognitivo subjetivo (DCS), comprometimento cognitivo leve (CCL) e demência. O diagnóstico de DCS é discutido pela primeira vez em consenso da ABN e as atualizações para o diagnóstico de CCL e demência são abordadas, bem como a recomendação para o uso de testes cognitivos apropriados, investigação etiológica pertinente e cuidados aos pacientes com declínio cognitivo nos diferentes níveis de atenção do Sistema Único de Saúde. Foi realizada pesquisa dos principais instrumentos de avaliação utilizados em nosso meio e na América Latina.

ABSTRACT This consensus, performed by the Brazilian Academy of Neurology (BAN) will approach practically how to evaluate patients with cognitive complaints and how to clinically and etiologically diagnose the three clinical syndromes associated with the different stages of cognitive decline: subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia. This BAN consensus discusses SCD diagnosis for the first time, updates MCI and dementia diagnoses, recommends the adequate cognitive tests and the relevant etiological work-up and care of patients with cognitive decline at different levels of care within the Brazilian Unified Health System. We also review the main assessment instruments used in Brazil and Latin America.

https://doi.org/10.1590/1980-5764-dn-2022-s101pt

Manejo das demências em fase avançada: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia
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Brucki, Sonia Maria Dozzi

; Aprahamian, Ivan

; Borelli, Wyllians Vendramini

; Silveira, Victor Calil da

; Ferretti, Ceres Eloah de Lucena

; Smid, Jerusa

; Barbosa, Breno José Alencar Pires

; Schilling, Lucas Porcello

; Balthazar, Márcio Luiz Figueiredo

; Frota, Norberto Anízio Ferreira

; Souza, Leonardo Cruz de

; Vale, Francisco Assis Carvalho

; Caramelli, Paulo

; Bertolucci, Paulo Henrique Ferreira

; Chaves, Márcia Lorena Fagundes

; Nitrini, Ricardo

; Schultz, Rodrigo Rizek

; Morillo, Lilian Schafirovits

Dementia & Neuropsychologia

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sep 2022, Volume 16 N. 3 Pages 101 - 120

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A doença de Alzheimer (DA) e outras demências neurodegenerativas têm um curso progressivo com comprometimento da cognição, capacidade funcional e comportamento. A maioria dos estudos enfocou a DA. A demência grave está associada ao aumento da idade, maior morbimortalidade e aumento dos custos de cuidados. É fundamental reconhecer que a demência grave é o período mais longo de progressão, com o paciente vivendo muitos anos nesta fase. É a fase mais heterogênea do processo, com diferentes habilidades e expectativa de vida. Esta diretriz de prática concentra-se na demência grave para melhorar o manejo e o cuidado nessa fase da demência. Como um longo período no continuum da demência, as abordagens não farmacológicas e farmacológicas devem ser consideradas. Intervenções multidisciplinares (fisioterapia, fonoaudiologia, nutrição, enfermagem, entre outras) são essenciais, além de educacionais e de apoio aos cuidadores.

ABSTRACT Alzheimer’s disease (AD) and other neurodegenerative dementias have a progressive course, impairing cognition, functional capacity, and behavior. Most studies have focused on AD. Severe dementia is associated with increased age, higher morbidity-mortality, and rising costs of care. It is fundamental to recognize that severe dementia is the longest period of progression, with patients living for many years in this stage. It is the most heterogeneous phase in the process, with different abilities and life expectancies. This practice guideline focuses on severe dementia to improve management and care in this stage of dementia. As it is a long period in the continuum of dementia, clinical practice should consider non-pharmacological and pharmacological approaches. Multidisciplinary interventions (physical therapy, speech therapy, nutrition, nursing, and others) are essential, besides educational and support to caregivers.

https://doi.org/10.1590/1980-5764-dn-2022-s107pt

Consensus of the Brazilian Headache Society (SBCe) for prophylactic treatment of episodic migraine: part II
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Santos, Paulo Sergio Faro

; Melhado, Eliana Meire

; Kaup, Alexandre Ottoni

; Costa, Aline Turbino Neves Martins da

; Roesler, Célia Aparecida de Paula

; Piovesan, Élcio Juliato

; Sarmento, Elder Machado

; Theotonio, Giselle Oliveira Martins

; Campos, Henrique Carneiro de

; Fortini, Ida

; Souza, Jano Alves de

; Maciel Júnior, Jayme Antunes

; Segundo, João Batista Alves

; Carvalho, João José Freitas de

; Speziali, José Geraldo

; Calia, Leandro Cortoni

; Barea, Liselotte Menke

; Queiroz, Luiz Paulo

; Souza, Marcio Nattan Portes

; Figueiredo, Marcos Ravi Cerqueira Ferreira

; Costa, Maria Eduarda Nobre de Magalhães

; Peres, Mário Fernando Prieto

; Jurno, Mauro Eduardo

; Peixoto, Patrícia Machado

; Kowacs, Pedro André

; Rocha Filho, Pedro Augusto Sampaio

; Moreira Filho, Pedro Ferreira

; Silva Neto, Raimundo Pereira

; Fragoso, Yara Dadalti

Arquivos de Neuro-Psiquiatria

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sep 2022, Volume 80 N. 9 Pages 953 - 969

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background Migraine affects 1 billion people worldwide and > 30 million Brazilians; besides, it is an underdiagnosed and undertreated disorder. Objective The need to disseminate knowledge about the prophylactic treatment of migraine is known, so the Brazilian Headache Society (SBCe, in the Portuguese acronym) appointed a committee of authors with the objective of establishing a consensus with recommendations on the prophylactic treatment of episodic migraine based on articles from the world literature as well as from personal experience. Methods Meetings were held entirely online, with the participation of 12 groups that reviewed and wrote about the pharmacological categories of drugs and, at the end, met to read and finish the document. The drug classes studied in part II of this Consensus were: antihypertensives, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, calcium channel blockers, other drugs, and rational polytherapy. Results From this list of drugs, only candesartan has been established as effective in controlling episodic migraine. Flunarizine, venlafaxine, duloxetine, and pizotifen were defined as likely to be effective, while lisinopril, enalapril, escitalopram, fluvoxamine, quetiapine, atorvastatin, simvastatin, cyproheptadine, and melatonin were possibly effective in prophylaxis of the disease. Conclusions Despite an effort by the scientific community to find really effective drugs in the treatment of migraine, given the large number of drugs tested for this purpose, we still have few therapeutic options.

Resumo Antecedentes Migrânea afeta um bilhão de pessoas em todo o mundo e mais de 30 milhões de brasileiros; além disso, é um distúrbio subdiagnosticado e subtratado. Objetivo Sabe-se sobre a necessidade de difundir o conhecimento sobre o tratamento profilático da migrânea; por isso, a Sociedade Brasileira de Cefaleias (SBCe) nomeou um comitê de autores com o objetivo de estabelecer um consenso com recomendações sobre o tratamento profilático da migrânea episódica com base em artigos da literatura mundial, assim como da experiência pessoal. Métodos As reuniões foram realizadas inteiramente online, com a participação de 12 grupos que revisaram e escreveram sobre as categorias farmacológicas dos medicamentos e, ao final, reuniram-se para a leitura e conclusão do documento. As classes de medicamentos estudadas na parte II deste Consenso foram: anti-hipertensivos, inibidores seletivos de recaptação de serotonina, inibidores de recaptação de serotonina e noradrenalina, bloqueadores dos canais de cálcio, outros medicamentos e politerapia racional. Resultados Desta lista de medicamentos, apenas o candesartan foi estabelecido como eficaz no controle da migrânea episódica. Flunarizina, venlafaxina, duloxetina e pizotifeno foram definidos como provavelmente eficazes, enquanto lisinopril, enalapril, escitalopram, fluvoxamina, quetiapina, atorvastatina, sinvastatina, ciproheptadina e melatonina foram possivelmente eficazes na profilaxia da doença. Conclusões Apesar do esforço da comunidade científica em encontrarmedicamentos realmente eficazes no tratamento da migrânea, dado o grande número de medicamentos testados para este fim, ainda dispomos de poucas opções terapêuticas.

https://doi.org/10.1055/s-0042-1755320

Consensus of the Brazilian Headache Society (SBCe) for the Prophylactic Treatment of Episodic Migraine: part I
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Melhado, Eliana Meire

; Santos, Paulo Sergio Faro

; Kaup, Alexandre Ottoni

; Costa, Aline Turbino Neves Martins da

; Roesler, Célia Aparecida de Paula

; Piovesan, Élcio Juliato

; Sarmento, Elder Machado

; Theotonio, Giselle Oliveira Martins

; Campos, Henrique Carneiro de

; Fortini, Ida

; Souza, Jano Alves de

; Maciel Júnior, Jayme Antunes

; Segundo, João Batista Alves

; Carvalho, João José Freitas de

; Speziali, José Geraldo

; Calia, Leandro Cortoni

; Barea, Liselotte Menke

; Queiroz, Luiz Paulo

; Souza, Marcio Nattan Portes

; Figueiredo, Marcos Ravi Cerqueira Ferreira

; Costa, Maria Eduarda Nobre de Magalhães

; Peres, Mário Fernando Prieto

; Jurno, Mauro Eduardo

; Peixoto, Patrícia Machado

; Kowacs, Pedro André

; Rocha-Filho, Pedro Augusto Sampaio

; Moreira Filho, Pedro Ferreira

; Silva-Neto, Raimundo Pereira

; Fragoso, Yara Dadalti

Arquivos de Neuro-Psiquiatria

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aug 2022, Volume 80 N. 8 Pages 845 - 861

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract The Brazilian Headache Society (Sociedade Brasileira de Cefaleia, SBCe, in Portuguese) nominated a Committee of Authors with the aim of establishing a consensus with recommendations regarding prophylactic treatment for episodic migraine based on articles published in the worldwide literature, as well as personal experience. Migraine affects 1 billion people around the world and more than 30 million Brazilians. In addition, it is an underdiagnosed and undertreated disorder. It is well known within the medical community of neurologists, and especially among headache specialists, that there is a need to disseminate knowledge about prophylactic treatment for migraine. For this purpose, together with the need for drug updates and to expand knowledge of the disease itself (frequency, intensity, duration, impact and perhaps the progression of migraine), this Consensus was developed, following a full online methodology, by 12 groups who reviewed and wrote about the pharmacological categories of the drugs used and, at the end of the process, met to read and establish conclusions for this document. The drug classes studied were: anticonvulsants, tricyclic antidepressants, monoclonal anti-calcitonin gene-related peptide (anti-CGRP) antibodies, beta-blockers, antihypertensives, calcium channel inhibitors, other antidepressants (selective serotonin reuptake inhibitors, SSRIs, and dual-action antidepressants), other drugs, and polytherapy. Hormonal treatment and anti-inflammatories and triptans in minimum prophylaxis schemes (miniprophylaxis) will be covered in a specific chapter. The drug classes studied for part I of the Consensus were: anticonvulsants, tricyclic antidepressants, monoclonal anti-CGRP antibodies, and beta-blockers.

Resumo A Sociedade Brasileira de Cefaleia (SBCe) nomeou um Comitê de Autores com o objetivo de estabelecer um consenso com recomendações sobre o tratamento profilático da enxaqueca episódica com base em artigos da literatura mundial e da experiência pessoal. A enxaqueca é um distúrbio subdiagnosticado e subtratado que acomete um bilhão de pessoas no mundo e mais de 30 milhões de brasileiros. É conhecido na comunidade médica de neurologistas e, sobretudo, dos especialistas em cefaleia, a necessidade de se divulgar o conhecimento sobre o tratamento profilático da enxaqueca. Com esta finalidade, aliada às necessidades de atualizações de drogas e de se aumentar o conhecimento sobre a doença em si (frequência, intensidade, duração, impacto e talvez a progressão da enxaqueca), foi elaborado este Consenso, com metodologia totalmente on-line, por 12 grupos que revisaram e escreveram sobre as categorias farmacológicas das drogas e, ao final, reuniram-se para a leitura e conclusão do documento. As classes de drogas estudadas para este Consenso foram: anticonvulsivantes, antidepressivos tricíclicos, anticorpos monoclonais do antipeptídeo relacionado ao gene da calcitonina (peptídeo relacionado ao gene da calcitonina — anti-CGRP), betabloqueadores, anti-hipertensivos, inibidores dos canais de cálcio, outros antidepressivos (inibidores seletivos de recaptação de serotonina, ISRSs, e antidepressivos de ação dual), outras drogas, e politerapia. O tratamento hormonal, bem como anti-inflamatórios e triptanas em esquema de profilaxia mínima (miniprofilaxia), será abordado em um capítulo próprio. As classes de drogas estudadas na parte I do Consenso foram: anticonvulsivantes, antidepressivos tricíclicos, anticorpos monoclonais anti-CGRP, e betabloqueadores.

https://doi.org/10.1055/s-0042-1756441

Double Product and Autonomic Function as Predictors of Quality of Life in Heart Transplant Recipients: A Cross-Sectional Study
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Rodrigues Junior, Luiz Fernando

; Moreira, Beatriz Robert

; Duque, Alice Pereira

; Oliveira, Juliana Rega de

; Figueiredo, Pedro Henrique Scheidt

; Oliveira, Cláudia Rosa de

; Colafranceschi, Alexandre Siciliano

; Mediano, Mauro Felippe Felix

; Guimarães, Tereza Cristina Felippe

Brazilian Journal of Cardiovascular Surgery

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aug 2022, Volume 37 N. 4 Pages 454 - 465

Abstract: En | Text: En | PDF: En

ABSTRACT Introduction: Heart rate control by the autonomic nervous system (ANS) is impaired in heart transplant (HT) recipients, leading to increased resting heart rate, metabolic demand, and fatigue, which can impair their quality of life (QoL). In this study, we hypothesized the association of hemodynamics and autonomic function as predictors of QoL in HT recipients. Methods: This is a cross-sectional study conducted with HT recipients aged ≥ 18 years at ambulatorial accompaniment. Blood pressure was used for hemodynamics assessment, and heart rate variability (HRV) was used for ANS assessment. QoL was assessed by the 36-item Short Form Health Survey. The significance level was set as P≤0.05. Results: Twenty-two volunteers were included in the study. Systolic blood pressure (SBP) and double product (DP) were significantly negatively associated with the physical functioning domain of QoL. DP, the number of consecutive normal RR interval differences > 50 ms (NN50), and the percentage of normal RR intervals that differed by > 50 ms from the adjacent interval (PNN50) exhibited negative association with the physical role domain. NN50 and PNN50 were significantly associated with bodily pain, social functioning, and emotional role domains. SBP was negatively associated with the vitality domain. Considering general and mental health domains, no variable demonstrated significant association. DP, NN50, and PNN50 were negatively associated with the total score of QoL. Conclusion: This study demonstrated DP and HRV as predictors of QoL in HT recipients. These innovative results can become a relevant therapeutic target for improving QoL in HT recipients prior to its deterioration.

https://doi.org/10.21470/1678-9741-2021-0083

Mother’s education and family relations protect children from dental caries experience: a salutogenic approach
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PAULA, Janice Simpson de

; RODRIGUES, Priscila Almeida

; MATTOS, Flávio Freitas

; ABREU, Mauro Henrique Nogueira Guimarães de

; CHALUB, Loliza Luiz Figueiredo Houri

; ZINA, Lívia Guimarães

Brazilian Oral Research

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2022, Volume 36 elocation e111

Abstract: En | Text: En | PDF: En

Abstract The objective of this study was to identify dental caries-protective factors among 5-year-old children using the salutogenic theory. A cross-sectional study was conducted in a small-sized municipality in the Southeast region of Brazil, with a representative sample of 247 children registered in preschool and their respective mothers. The data were collected through questionnaires administered to the mothers about the socioeconomic, behavioral, and biological aspects of the mother and children. Additionally, the collections included validated instruments concerning psychosocial aspects, such as a sense of coherence, resilience, family cohesion and religiosity, and intraoral examinations of the children through the decayed-missing-filled primary teeth (dmft) index. All examinations were performed by a trained and calibrated examiner. The non-adjusted and adjusted odds ratios (OR) and their respective confidence intervals (CI) were estimated using multiple logistic regression with a hierarchical model. Among the examined children, 41.7% were caries-free. In the final model, the chances of the absence of dental caries experience (dmft = 0) were greater in children with mothers who had higher education levels (> 8 years of study) (OR = 2.55 [95%CIi:1.42–4.59]) and those who lived in an environment of high family cohesion (OR = 3.66 [95%CI: 1.19–11.29]). The results indicated that mothers’ level of education and family relationships are protective factors against dental caries in 5-year-old children, which overlapped with behavioral and biological factors.

https://doi.org/10.1590/1807-3107bor-2022.vol36.0111

10.

Aprender e ensinar semiologia médica em situações de deficiência auditiva: nossa experiência
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Campos, Raquel Moret Henrique

; Pereira, Gabriela Cristina Coelho

; Figueiredo, Elisa Guimarães de

; Venturini, Evelyn Cristina Silva

; Maia, Luisa Cardoso

; Pimenta, Érika Lima

; Andrade, Gabriela Costa de

; Lazaroni, Thiago Luiz do Nascimento

Revista Brasileira de Educação Médica

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2022, Volume 46 N. 2 elocation e072

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo: Introdução: Da população brasileira, 5% vivem com algum nível de deficiência auditiva. Apesar desse número, poucas pessoas têm acesso à educação superior. A legislação nacional defende a integração e, principalmente, a inclusão dessas pessoas no ambiente acadêmico brasileiro. Poucos são os dados sobre o acesso dos deficientes auditivos ao curso de Medicina no Brasil. Relato de experiência: Este artigo apresenta relatos de experiências de uma estudante com deficiência auditiva que cursou a disciplina de Introdução à Semiologia Médica e de seus professores e da estudante-monitora que acompanhou a disciplina. Para discutir os temas, foram selecionados 12 artigos das bases de dados MEDLINE, SciELO e LILACS, publicados entre julho de 2019 e outubro de 2021. Também se utilizaram informações publicadas pelo IBGE e Portal MEC. Discussão: A estudante relata sua dificuldade em compreender termos semiológicos, bem como suas alternativas para adquirir habilidades referentes ao exame físico. O relato do professor aborda como a inclusão é possível porém desafiadora ao se ensinar semiologia médica a uma pessoa com deficiência auditiva. Conclusão: Estudantes deficientes auditivos se beneficiam de adequação acadêmica visando à integração e inclusão para obter êxito em adquirir e treinar suas habilidades semiotécnicas. Há urgente necessidade de novas pesquisas brasileiras nessa área, principalmente relacionadas à medicina e ao ensino médico.

Abstract: Introduction: Five percent of the Brazilian population lives with some level of hearing impairment. Despite this number, few of these people have access to higher education. National legislation defends the integration and, mainly, the inclusion of these people in the Brazilian academic environment. There are few data on the access of the hearing impaired to the Medicine course in Brazil. Experience report: This article brings reports of experiences of a medicine student with hearing impairment, her monitor and her professors, with the aim of discussing the challenges faced. A contextualization with the current literature was carried out. Discussion: The student reports her difficulty in understanding semiological terms, as well as her alternatives for acquiring skills related to the physical examination. The role of the monitor and the teacher is approached with personal accounts that show how inclusion is possible and challenging. Conclusion: Hearing impaired students benefit from academic adequacy aimed at integration and inclusion to successfully acquire and train their semiotechnical skills. There is an urgent need for new Brazilian research in this area, mainly related to medicine and medical education.

https://doi.org/10.1590/1981-5271v46.2-20210282

11.

Paleoenvironment of the Cerro Negro Formation (Aptian, Early Cretaceous) of Snow Island, Antarctic Peninsula
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SANTOS, ALESSANDRA

; PIOVESAN, ENELISE KATIA

; GUZMÁN, JULIANA

; USMA, CRISTIAN D.

; WEINSCHÜTZ, LUIZ CARLOS

; SANTOS, RADARANY JASMINE M. DOS

; OLIVEIRA, GUSTAVO R.

; FIGUEIREDO, RODRIGO G.

; RICETTI, JOÃO HENRIQUE Z.

; WILNER, EVERTON

; SAYÃO, JULIANA M.

; KELLNER, ALEXANDER W.A.

Anais da Academia Brasileira de Ciências

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2022, Volume 94 Suppl. 1 elocation e20201944

Abstract: En | Text: En | PDF: En

Abstract A study of macro and microfacies, palynoflora and palynofacies of the non-marine Cerro Negro Formation at President Head Peninsula, Snow Island, northwest of the Antarctic Peninsula, was developed. Two assemblages were recognized: Palynofacies assemblage 1 (P1) at the base of the section with a dominance of fern spores and conifer pollen grains, and facies association consisting of a clastic layer, with the predominance of mudstones; and Palynofacies assemblage 2 (P2) at the top of the section, with remarkable abundance of AOM/Pseudoamorphous particles, associated with facies that includes tuffs. The complete section shows in some levels the presence of freshwater algae and translucent phytoclasts. The integrated data characterizes a fluvial-lacustrine environment, what is reinforced by the occurrence of freshwater algae (Botryococcus) in some levels of P1 and P2. We could verify an increase in volcanic activity towards the top of the section that apparently has played an important role in the collapse of the palynoflora. The occurrence of the spore species Muricingulisporis annulatus, Sotasporites elegans, S. triangularis, Foraminisporis wonthaggiensis, and F. asymmetricus in the Cerro Negro Formation allows the correlation with sections in South America and Australia, suggesting an Aptian age for these deposits.

https://doi.org/10.1590/0001-3765202220201944

12.

Effect of phytase and protease combination on performance, metabolizable energy, and amino acid digestibility of broilers fed nutrient-restricted diets
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Bernardes, Romário Duarte

; Oliveira, Carlos Henrique de

; Calderano, Arele Arlindo

; Ferreira, Rafael de Sousa

; Dias, Kelly Morais Maia

; Almeida, Bruno Figueiredo de

; Aleixo, Pedro Eleutério

; Albino, Luiz Fernando Teixeira

Revista Brasileira de Zootecnia

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2022, Volume 51 elocation e20210211

Abstract: En | Text: En | PDF: En

ABSTRACT Three experiments were carried out to evaluate the effect of dietary combination of different enzymes (phytase + protease) on performance, metabolizable energy, and amino acid digestibility of broiler chickens fed diets with nutritional reduction. A total of 1,400, 336, and 384 male chickens were distributed in a completely randomized design, in the experiments of performance, metabolism, and digestibility, respectively. Treatments were divided as follows: positive control (PC), negative control - NC1 (PC minus 0.16% Ca, 0.15% available P (aP), and 0.5% crude protein (CP)), NC2 (PC minus 0.16% Ca, 0.15% aP, and 1% CP), NC1 added with phytase deriving from citrobacter and protease deriving from Bacillus licheniformis (CBE), NC1 added with phytase deriving from E. coli and protease deriving from microbial fermentation (SE), NC2 added with CBE, and NC2 added with SE. A protein-free diet was included in the digestibility experiment. The nutritional restriction did not affect feed intake of birds in the first experiment; however, the restriction inhibited body weight gain and feed conversion ratio in all phases. In experiment 2, the nutritional restriction decreased AME and AMEn values, although the addition of phytase and protease in diets improved both parameters, mainly in NC2. Treatment NC2 impaired the standardized digestibility of total essential amino acids of animals subjected to experiment 3, although the addition of enzymes helped to recover the digestibility to levels similar to PC. Supplementation of phytase in association with protease is effective to improve performance, energy metabolism, and standardized amino acid digestibility of broilers fed diets with nutrient restriction.

https://doi.org/10.37496/rbz5120210211

13.

Leaf extract of Coffea arabica L. reduces lipid peroxidation and has anti-platelet effect in a rat dyslipidemia model
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Simões, Mario Henrique Souza

; Salles, Bruno Cesar Correa

; Duarte, Stella Maris da Silveira

; Silva, Marcelo Aparecido da

; Viana, André Luiz Machado

; Moraes, Gabriel de Oliveira Isaac de

; Figueiredo, Sonia Aparecida

; Ferreira, Eric Batista

; Rodrigues, Maria Rita

; Paula, Fernanda Borges de Araújo

Brazilian Journal of Pharmaceutical Sciences

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2022, Volume 58 elocation e19562

Abstract: En | Text: En | PDF: En

Abstract This study aimed to evaluate the antioxidant potential of the Coffea arabica Lineu (L.) leaf extract and its effects on platelet aggregation of dyslipidemic rats. The extract was obtained by the percolation of C. arabica L. leaves in hydroethanolic solution 70% (v/v). The mass spectrometry FIA-ESI-MS² suggested the presence of chlorogenic acid, rutin acid, and quinic acid. The DPPH• radicals scavenging capacity was demonstrated (IC50 = 0.06 mg/mL). The extract was administered to rats by gavage (300 mg/kg/day) for 56 days. Dyslipidemia was induced by administering Triton WR-1339 (300 mg/kg body weight) on the 54th day. On day 56, blood was collected by puncturing the abdominal aorta artery and the aortic artery was removed. Lipid profile, markers of renal and hepatic injury, lipid peroxidation, and platelet aggregation tests were carried out. The ingestion of extract reduced the lipid peroxidation (aorta and plasma) and platelet aggregation in dyslipidemic rats. The extract did not affect markers of renal and hepatic function as analyzed in this study, suggesting neither impaired liver nor kidney function in these animals. Therefore, our results demonstrate that the extract of leaves of C. arabica L. show antioxidant potential in vitro and in vivo as well as anti-platelet aggregation in dyslipidemic animals.

https://doi.org/10.1590/s2175-97902022e19562

14.

Health-Related Quality of Life Reported by Patients With Chagas Disease: A Systematic Review of Qualitative Evidence With GRADE Recommendations
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Silva, Whesley Tanor

; Oliveira, Lucas Frois Fernandes

; Xavier, Diego Mendes

; Figueiredo, Pedro Henrique Scheidt

; Lacerda, Ana Cristina Rodrigues

; Mendonça, Vanessa Amaral

; Ávila, Matheus Ribeiro

; Ferreira Júnior, Cláudio Luiz

; Lima, Márcia Maria Oliveira

; Mediano, Mauro Felippe Felix

; Rocha, Manoel Otávio da Costa

; Costa, Henrique Silveira

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0377-2022

Abstract: En | Text: En | PDF: En

ABSTRACT Patients with Chagas disease have reduced health-related quality of life (HRQoL). Hence, we aimed to identify the factors that mostly affected their HRQoL. This was a systematic review of qualitative studies. The Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Web of Science, and SciVerse Scopus databases were searched for relevant studies without language or date restrictions. The search and data analysis were performed by independent reviewers; all qualitative studies that reported the factors that had an impact on the HRQoL of patients with Chagas disease were included. The risk of bias was assessed using the Critical Appraisal Skills Program Qualitative Study Checklist; confidence in the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative approach. Five studies were included in this review: four in Brazil and one in California, United States, with immigrants from Central and South America. The sample consisted of 207 patients with chronic Chagas disease. Stigma, physical limitations, work absenteeism, emotional or mental aspects, fear of treatment, and fear of the future had the strongest impact on the HRQoL. All items showed moderate confidence except for fear of treatment (low confidence). The physical, emotional, mental, and cultural aspects affected the HRQoL of patients with chronic Chagas disease. Identification of these factors is important in the development of strategies aimed at improving the HRQoL of this population.

https://doi.org/10.1590/0037-8682-0377-2022

15.

Seed germination of a myrmecochorous plant endemic to the Brazilian semiarid region: the wolf is not so bad
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Fagundes, Marcilio

; Silva, Ana Paula Mota Fernandes

; Mayrink, Bruno Henrique Silva

; Figueiredo, Luiz Henrique Arimura

; Jorge, Alessandre Custódio

; Gomes, Ingrid Lara Vieira

Acta Botanica Brasilica

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2022, Volume 36 elocation e20220093

Abstract: En | Text: En | PDF: En

ABSTRACT Studies about seed dispersal and germination are important to understand patterns of plant distribution and abundance, and help establish strategies for environmental conservation. We evaluated the role of two different dispersers, the ant Atta laevigata and the maned wolf Chrysocyon brachyurus, in the germination of Copaifera arenicola seeds, a characteristically myrmecochorous plant species. Germination was evaluated for seeds subjected to four treatments: (1) seeds manipulated by the ant, (2) seeds ingested by the maned wolf, (3) seeds that had the elaiosome removed manually, and (4) seeds with elaiosome (unmanipulated seeds). Seeds manipulated by the ant and seeds that had the elaiosome removed manually required less time to germinate and had higher germination percentages (98.6% and 95.8%, respectively) than the other treatments. However, seeds ingested by the maned wolf also had a high germination percentage (87.7%), above that of unmanipulated seeds (34.7%). Probably, elaiosomes of unmanipulated seeds and small remnants of this structure that resist digestion by maned wolf can decrease to some extent seed germination. We argue that dispersal of C. arenicola seeds by the ant and by the maned wolf result in different patterns of seed distribution in the environment and that they have complementary roles in structuring plant populations.

https://doi.org/10.1590/1677-941x-abb-2022-0093

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