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au:PAROLIN, ANDRE

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Prefrontal gray matter volume in adults bipolar I outpatients is associated with history of suicide attempts?
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Rocha, Marlos Vasconcelos

; Nery-Fernandes, Fabiana

; Baldaçara, Leonardo

; Jackowski, Andrea Parolin

; Quarantini, Lucas de Castro

; Ladeia-Rocha, Giovanna

; Araujo Neto, César de

; Oliveira, Irismar Reis de

; Caribé, André

; Miranda-Scippa, Ângela

Archives of Clinical Psychiatry (São Paulo)

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dec 2020, Volume 47 N. 6 Pages 187 - 191

Abstract: En | Text: En | PDF: En

ABSTRACT Background: Patients with Bipolar Disorder (BD) have the highest lifetime risk for suicidal behavior (SB) compared to other psychiatric disorders. Neuroimaging research provides evidence of some structural and functional abnormalities in the brain of BD suicide attempters (SA), but interpretation of these findings may represent a number of features. Objective: The purpose of this study was to evaluate the volume of the prefrontal cortex in euthymic BD type I outpatients, with and without history of SA. Methods: 36 euthymic BD I outpatients (18 with and 18 without suicide attempt history) were underwent structural MRI and total and regional gray matter volumes were assessed and compared with 22 healthy controls (HC). Results: We did not found any differences in all areas between suicidal and non-suicidal BD I patients and BD patients as a group compared to HC as well. Discussion: our findings suggest that can be a different subgroups of patients in relation to prefrontal cortex volumes according to some clinical and socio-demographic caractheristics, such as number of previous episodes and continuous use of medical psychotropic drugs that may induce neuroplasticity phenomena, which restore cerebral volume and possibly can lead to long-term euthymia state.

https://doi.org/10.15761/0101-60830000000260 114 downloads

Compatibility and horticultural performance of Pera sweet orange clones grafted to Swingle citrumelo rootstock
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Fadel, André Luiz

; Stuchi, Eduardo Sanches

; Silva, Simone Rodrigues da

; Parolin, Luiz Gustavo

; Oliveira, Carolina Rossi de

; Müller, Gerd Walter

; Donadio, Luiz Carlos

Bragantia

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dec 2019, Volume 78 N. 4 Pages 564 - 572

Abstract: En | Text: En | PDF: En

ABSTRACT Despite its interesting agricultural traits, Swingle citrumelo (Citrus paradisi Macfad. ‘Duncan’ × Poncirus trifoliata L. Raf.) rootstock exhibits severe incompatibility when grafted with Pera sweet orange [Citrus sinensis (L.) Osb.] scions, and this fact limits its use for propagation purposes. Nonetheless, the existence of certain Pera sweet orange clones that are compatible with Swingle citrumelo represents a substantial gain for the entire citrus industry. This study investigated the compatibility between seven Pera sweet orange clones and Swingle citrumelo rootstock, regarding the presence of a necrotic line at the graft union junction, the difference in diameter between rootstock and scion, the influence of clonal cleaning by micrografting, and the horticultural performance of the selected combinations. No trees died because of grafting incompatibility, even after twenty years (trial I), except for clone CV1, or after six years and nine months (trial II) from planting. The rootstock/scion trunk diameter ratio was not related to the presence of a necrotic line in the graft-union region. Additionally, these variables did not influence fruit yield and quality, and they were not affected by clonal cleaning or pre-immunisation of the old Pera sweet orange clones.

https://doi.org/10.1590/1678-4499.20190116 844 downloads

Migraine in 746 patients with multiple sclerosis
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Fragoso, Yara Dadalti

; Adoni, Tarso

; Alves-Leon, Soniza V.

; Apostolos-Pereira, Samira L.

; Carneiro, Marcos A. Diniz

; Chikota, Edila M.

; Diniz, Denise Sisterolli

; Eboni, Audred C. B.

; Gomes, Sidney

; Gonçalves, Marcus Vinicius M.

; Goncalves, Ricardo Pereira

; Inojosa, José Luiz

; Junqueira, Thiago F.

; Machado, Suzana Costa

; Malfetano, Fabiola Rachid

; Mansur, Letícia Fezer

; Mendes, Maria Fernanda

; Muniz, Andre

; Nobrega Junior, Adaucto W.

; Olival, Guilherme Sciascia do

; Parolin, Monica Fiuza

; Pimentel, Maria Lucia V.

; Rocha, Cristiane Franklin

; Ruocco, Heloisa Helena

; Santos, Gutemberg C.

; Siquineli, Fabio

; Soares, José Otavio D.

; Sousa, Nise Alessandra C.

; Tauil, Carlos Bernardo

; Winckler, Thereza Cristina A.

Arquivos de Neuro-Psiquiatria

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sep 2019, Volume 77 N. 9 Pages 617 - 621

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

RESUMO Enxaqueca piora o sofrimento do paciente que tem esclerose múltipla (EM). ID-migraine é uma ferramenta útil para seleção de pacientes com enxaqueca e Migraine Disability Assessment (MIDAS) é um questionário que avalia o impacto da doença. O objetivo do presente estudo foi avaliar a presença e impacto de enxaqueca em pacientes com EM. Métodos: Pacientes diagnosticados com EM e tratados em clínicas especializadas foram convidados a responder um questionário online se também apresentassem cefaleia. Resultados: O estudo incluiu 746 participantes com cefaleia e EM que preencheram completamente as respostas. Foram 625 mulheres e 121 homens, sendo 69% dos pacientes com idade entre 20 e 40 anos. Enxaqueca foi identificada em 404 pacientes (54,1%) e moderado a grave impacto da doença foi observado em 68,3% dos casos. Conclusão: Enxaqueca é uma cefaleia primária frequente e incapacitante relatada por pacientes com EM.

ABSTRACT Migraine adds to the burden of patients suffering from multiple sclerosis (MS). The ID-migraine is a useful tool for screening migraine, and the Migraine Disability Assessment questionnaire can evaluate disease burden. The aim of the present study was to assess the presence and burden of migraine in patients with MS. Methods: Patients diagnosed with MS attending specialized MS units were invited to answer an online survey if they also experienced headache. Results: The study included 746 complete responses from patients with MS and headache. There were 625 women and 121 men, and 69% of all the patients were aged between 20 and 40 years. Migraine was identified in 404 patients (54.1%) and a moderate-to-high burden of disease was observed in 68.3% of the patients. Conclusion: Migraine is a frequent and disabling type of primary headache reported by patients with MS.

https://doi.org/10.1590/0004-282x20190100 1666 downloads

Serological profile of John Cunningham virus (JCV) in patients with multiple sclerosis
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Branco, Luciana Prats

; Adoni, Tarso

; Apostolos-Pereira, Samira Luisa

; Brooks, Joseph Bruno Bidin

; Correa, Eber Castro

; Damasceno, Carlos Augusto

; Eboni, Audred Cristina Biondo

; Fezer, Leticia

; Gama, Paulo Diniz da

; Goncalves, Marcus Vinicius Magno

; Gomes, Sidney

; Grzesiuk, Anderson Kuntz

; Mendes, Maria Fernanda

; Morales, Rogerio Rizo

; Muniz, Andre

; Parolin, Monica Fiuza Koncke

; Pimentel, Maria Lucia Vellutini

; Ribeiro, Marlise de Castro

; Santos, Gutemberg Augusto Cruz dos

; Sato, Henry Koiti

; Scherpenhuijzen, Simone Batista

; Scorcine, Claudio

; Siquineli, Fabio

; Sousa, Nise Alexandra de Carvalho

; Varela, Daniel Lima

; Winckler, Tereza Cristina Avila

; Fragoso, Yara Dadalti

Arquivos de Neuro-Psiquiatria

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sep 2018, Volume 76 N. 9 Pages 588 - 591

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

RESUMO As opções terapêuticas para esclerose múltipla (EM) modificaram-se ao longo dos últimos anos, trazendo uma nova categoria de drogas com melhor perfil de eficácia. No entanto, estas drogas vieram com um novo perfil de potenciais eventos adversos que exigem que o neurologista os reconheça bem e rapidamente. Uma das complicações mais temidas destes tratamentos para a EM é a leucoencefalopatia multifocal progressiva (LEMP), causada pela reativação do vírus John Cunningham (JCV). Objetivo: Identificar o perfil sorológico de JCV em pacientes com EM. Métodos: Dados sorológicos de JCV foram obtidos através do ensaio por enzimas imuno-adsorvidas (ELISA) fornecido pelo programa STRATIFY-JCV. Resultados: Um total de 1.501 testes sanguíneos foram obtidos de 1.102 pacientes com EM. O grupo teve 633 pacientes (57,1%) soropositivos para anticorpos anti-JCV e 469 pacientes negativos (42,9%). Vinte e três pacientes se tornaram posivitos após resultados iniciais negativos para anticorpos anti-JCV. A taxa de soroconversão foi 18,5% em 22 meses. Conclusão: O perfil sorológico do JCV e a soroconversão nos pacientes brasileiros foi semelhante àquela descrita em outros países.

ABSTRACT Treatment options for multiple sclerosis (MS) have changed over the last few years, bringing about a new category of drugs with more efficient profiles. However, these drugs have come with a whole new profile of potential adverse events that neurologists have to learn well and quickly. One of the most feared complications of these MS treatments is progressive multifocal leukoencephalopathy caused by the reactivation of the John Cunningham virus (JCV). Objective: To identify the serologic profile of JCV in patients with MS. Methods: Data on serum antibodies for JCV were obtained using the enzyme-linked immunosorbent assay provided by the STRATIFY-JCV program. Results: A total of 1,501 blood tests were obtained from 1,102 patients with MS. There were 633 patients (57.1%) who were positive for antibodies for JCV and 469 patients who were negative (42.9%). Twenty-three patients became positive after initially having negative JCV antibody status. The rate of seroconversion was 18.5% over 22 months. Conclusion: The JCV serologic profile and seroconversion in Brazilian patients were similar to those described in other countries.

https://doi.org/10.1590/0004-282x20180083 3126 downloads

Brazilian Consensus for the Treatment of Multiple Sclerosis: Brazilian Academy of Neurology and Brazilian Committee on Treatment and Research in Multiple Sclerosis
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Marques, Vanessa Daccach

; Passos, Giordani Rodrigues dos

; Mendes, Maria Fernanda

; Callegaro, Dagoberto

; Lana-Peixoto, Marco Aurélio

; Comini-Frota, Elizabeth Regina

; Vasconcelos, Cláudia Cristina Ferreira

; Sato, Douglas Kazutoshi

; Ferreira, Maria Lúcia Brito

; Parolin, Mônica Koncke Fiuza

; Damasceno, Alfredo

; Grzesiuk, Anderson Kuntz

; Muniz, André

; Matta, André Palma da Cunha

; Oliveira, Bianca Etelvina Santos de

; Tauil, Carlos Bernardo

; Maciel, Damacio Ramón Kaimen

; Diniz, Denise Sisteroli

; Corrêa, Eber Castro

; Coronetti, Fernando

; Jorge, Frederico M. H.

; Sato, Henry Koiti

; Gonçalves, Marcus Vinícius Magno

; Sousa, Nise Alessandra de C.

; Nascimento, Osvaldo J. M.

; Gama, Paulo Diniz da

; Domingues, Renan

; Simm, Renata Faria

; Thomaz, Rodrigo Barbosa

; Morales, Rogério de Rizo

; Dias, Ronaldo Maciel

; Apóstolos-Pereira, Samira dos

; Machado, Suzana Costa Nunes

; Junqueira, Thiago de Faria

; Becker, Jefferson

Arquivos de Neuro-Psiquiatria

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aug 2018, Volume 76 N. 8 Pages 539 - 554

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

RESUMO O crescent arsenal terapêutico na esclerose múltipla (EM) tem permitido tratamentos mais efetivos e personalizados, mas a escolha e o manejo das terapias modificadoras da doença (TMDs) tem se tornado cada vez mais complexos. Neste contexto, especialistas do Comitê Brasileiro de Tratamento e Pesquisa em Esclerose Múltipla e do Departamento Científico de Neuroimunologia da Academia Brasileira de Neurologia reuniram-se para estabelecer este Consenso Brasileiro para o Tratamento da EM, baseados no entendimento de que neurologistas devem ter a possibilidade de prescrever TMDs para EM de acordo com o que é melhor para cada paciente, com base em evidências e práticas atualizadas. Por meio deste documento, propomos recomendações práticas para o tratamento da EM, com foco principal na escolha e no manejo das TMDs, e revisamos os argumentos que embasam as estratégias de tratamento na EM.

ABSTRACT The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS.

https://doi.org/10.1590/0004-282x20180078 8891 downloads

No correlation was observed between vitamin D levels and disability of patients with multiple sclerosis between latitudes 18° and 30° South
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Fragoso, Yara Dadalti

; Adoni, Tarso

; Alves-Leon, Soniza Vieira

; Apostolos-Pereira, Samira L.

; Arruda, Walter Oleschko

; Brooks, Joseph B. Bidin

; Cal, Henrique S. Rodrigues

; Damasceno, Carlos A. Albuquerque

; Gama, Paulo Diniz

; Goncalves, Marcus V. Magno

; Jesus, Carlos A. da Silva de

; Machado, Suzana C. Nunes

; Mansur, Letícia Fezer

; Matta, Andre P. da Cunha

; Mendes, Maria Fernanda

; Morales, Rogerio Rizo

; Nobrega-Jr, Adaucto Wanderley da

; Parolin, Monica K. Fiuza

; Peres, Mario Pietro

; Ribeiro, Marlise de Castro

; Ruocco, Heloisa Helena

; Scherpenhuijzen, Simone

; Siquinelli, Fabio

; Stoney, Patrick N.

; Varela, Daniel Lima

; Eboni, Audred Cristina Biondo

; Spessotto, Caroline Vieira

; Rocha, Elisa Teixeira da

; Lacerda, Pamela Emanuele

Arquivos de Neuro-Psiquiatria

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jan 2017, Volume 75 N. 1 Pages 3 - 8

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

RESUMO Objetivo: Vitamina D assumiu um papel central na pesquisa e tratamento da esclerose múltipla (EM). O objetivo deste estudo foi avaliar os níveis séricos de vitamina D de pacientes com EM e controles que residem em uma área tropical. Métodos: Foram analisados dados de 535 pacientes com EM e 350 indivíduos controle em 14 cidades próximas ao Trópico de Capricórnio. Resultados: O valor médio da determinação de 25-OH vitamina D foi 26,07 ± 10,27 ng/mL para controles e 28,03 ± 12,19 ng/mL para pacientes com EM. Não houve correlação entre os níveis de vitamina D e o grau de incapacidade ao longo da duração da doença. Conclusão: Pelo menos na região que cerca o Trópico de Capricórnio, os níveis séricos de vitamina D estão entre valores de 20 a 30 ng/mL tanto para controles quanto para pacientes com EM.

ABSTRACT Objective: Vitamin D has taken center stage in research and treatment of multiple sclerosis (MS). The objective of the present study was to assess the serum vitamin D levels of a large population of patients with MS and controls living in a restricted tropical area. Methods: Data from 535 patients with MS and 350 control subjects were obtained from 14 cities around the Tropic of Capricorn. Results: The mean serum 25-OH vitamin D level was 26.07 ± 10.27 ng/mL for the control subjects, and 28.03 ± 12.19 ng/mL for patients with MS. No correlation was observed between vitamin D levels and the disability of patients over the disease duration. Conclusion: At least for the region around the Tropic of Capricorn, serum levels of vitamin D typically are within the range of 20 to 30 ng/mL for controls and patients with MS.

https://doi.org/10.1590/0004-282x20160173 3011 downloads

Relationship between structural abnormalities in the cerebellum and dementia, posttraumatic stress disorder and bipolar disorder
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Baldaçara, Leonardo

; Borgio, João Guilherme Fiorani

; Araújo, Célia

; Nery-Fernandes, Fabiana

; Lacerda, Acioly Luiz Taveres

; Moraes, Walter André dos Santos

; Montaño, Maria Beatriz Marcondes Macedo

; Rocha, Marlos

; Quarantini, Lucas C.

; Schoedl, Aline

; Pupo, Mariana

; Mello, Marcelo F.

; Andreoli, Sergio B.

; Miranda-Scippa, Angela

; Ramos, Luiz Roberto

; Mari, Jair J.

; Bressan, Rodrigo Affonseca

; Jackowski, Andrea Parolin

Dementia & Neuropsychologia

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dec 2012, Volume 6 N. 4 Pages 203 - 211

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

RESUMO Novas evidências sugerem que o cerebelo apresenta alterações estruturais e funcionais nos transtornos psiquiátricos. Objetivo: Medir o volume do cerebelo e de suas sub-regiões em indivíduos portadores de transtornos psiquiátricos e relacionar tais achados aos sintomas. Métodos: Foi realizada a identificação de pacientes com diferentes graus de prejuízo cognitivo proveniente de um estudo populacional (Epidemiologia do Idoso - UNIFESP), pacientes com transtorno do estresse pós-traumático proveniente de outro estudo populacional e portadores de transtorno bipolar proveniente de um ambulatório especializado (Universidade Federal da Bahia). Todos os sujeitos foram submetidos à ressonância magnética estrutural de 1.5T. As medidas de volume, assim como os sintomas medidos por escalas psicométricas foram comparadas entre pacientes e controles. Resultados: Foi observado que o volume do cerebelo está reduzido nos portadores de prejuízo cognitivo sem demência e com demência, no transtorno do estresse pós-traumático e no transtorno bipolar quando comparados aos controles. Na demência e no transtorno do estresse pós-traumático o volume do hemisfério cerebelar esquerdo e do vérmis estão reduzidos. No transtorno bipolar os volumes de ambos os hemisférios e do vérmis estão reduzidos. Nos dois primeiros estudos estas reduções correlacionaram com os sintomas. Conclusão: A natureza exata do envolvimento do cerebelo nos processos mentais ainda não é compreendida. Entretanto, anormalidades na estrutura cerebelar e em suas funções têm sido relatadas em algumas dessas doenças. Pesquisas futuras, com amostras maiores, ainda são necessárias para esclarecer tais achados e investigar se são importantes para o tratamento e prognóstico.

ABSTRACT. New evidence suggests that the cerebellum has structural and functional abnormalities in psychiatric disorders. Objective: In this research, the goal was to measure the volume of the cerebellum and its subregions in individuals with psychiatric disorders and to relate these findings to their symptoms. Methods: Patients with different degrees of cognitive impairment (Epidemiology of the Elderly - UNIFESP) and patients with post-traumatic stress disorder (PTSD) from population studies were analyzed. Also, patients with bipolar disorder from an outpatient clinic (Center for the Study of Mood and Anxiety Disorders, Universidade Federal da Bahia) were recruited for this study. All subjects underwent a 1.5T structural magnetic resonance scan. Volumetric measures and symptom measurements, by psychometric scales, were performed and compared between patients and controls. Results: The cerebellum volume was reduced in patients with cognitive impairment without dementia and with dementia, in patients with PTSD, and in patients with bipolar disorder compared to controls. In dementia and PTSD, the left cerebellar hemisphere and vermis volume were reduced. In bipolar disorder, volumes of both hemispheres and the vermis were reduced. In the first two studies, these cerebellar volumetric reductions correlated with symptoms of the disease. Conclusion: The exact nature of cerebellar involvement in mental processes is still not fully understood. However, abnormalities in cerebellar structure and its functions have been reported in some of these diseases. Future studies with larger samples are needed to clarify these findings and investigate whether they are important for treatment and prognosis.

https://doi.org/10.1590/S1980-57642012DN06040003 1551 downloads

Cerebellar volume in patients with dementia
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Baldaçara, Leonardo

; Borgio, João Guilherme Fiorani

; Moraes, Walter André dos Santos

; Lacerda, Acioly Luiz Tavares

; Montaño, Maria Beatriz Marcondes Macedo

; Tufik, Sérgio

; Bressan, Rodrigo Affonseca

; Ramos, Luiz Roberto

; Jackowski, Andrea Parolin

Brazilian Journal of Psychiatry

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jun 2011, Volume 33 N. 2 Pages 122 - 129

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

OBJETIVO: O objetivo deste estudo foi examinar o volume cerebelar em indivíduos em diferentes fases da doença de Alzheimer e investigar se sua redução estaria relacionada com o declínio cognitivo. MÉTODO: Noventa e seis indivíduos de um estudo epidemiológico foram submetidos à ressonância magnética e avaliados por meio do Mini Exame do Estado Mental e do Questionário de Atividades Funcionais. Os sujeitos foram divididos em cinco grupos de acordo com a Escala de Gravidade da Demência. Vinte e seis indivíduos do grupo original que não tinham o diagnóstico de demência no início do estudo foram reavaliados após dois anos para detectar o desenvolvimento da doença. RESULTADOS: Os volumes dos hemisférios cerebelares, lobo cerebelar posterior, vermis e lobo temporal estavam diminuídos proporcionalmente à gravidade da doença. Houve correlações positivas e significativas entre o Questionário de Atividades Funcionais, Mini Exame do Estado Mental e seus respectivos subtestes para linguagem e atenção com os volumes do lobo temporal e cerebelar. A análise de regressão logística demonstrou que o volume reduzido do lobo temporal, lobo cerebelar posterior e vermis pode ser um fator de risco para o futuro desenvolvimento de demência. CONCLUSÃO: Este é o primeiro estudo que demonstrou que o volume do cerebelo pode estar reduzido na fase pré-demência e reforça o papel dessa estrutura na progressão da doença de Alzheimer. Considerando que o cerebelo pode não estar diretamente associado com a origem da doença de Alzheimer, este achado tem valor para o prognóstico.

OBJECTIVE: The aim of this study was to examine the cerebellar volume of subjects at different stages of Alzheimer's disease and to investigate whether volume reductions in this structure are related to cognitive decline. METHOD: Ninety-six subjects from an epidemiological study were submitted to a magnetic resonance imaging scan and evaluated using the Mini-Mental State Examination and the Functional Activities Questionnaire. Subjects were divided into five groups according to the Clinical Dementia Rating scale. Twenty-six subjects from the original group who had no dementia diagnosis at baseline were re-evaluated for the onset of dementia after two years. RESULTS: The volumes of the cerebellar hemispheres, posterior cerebellar lobe, vermis and temporal lobe were found to be reduced as a function of the severity of the disease. There were significant positive correlations between the volume of the temporal lobe and cerebellum and the language, attention, and total scores in the Mini-Mental State Examination and the Functional Activities Questionnaire. A logistic regression analysis demonstrated that reduced temporal lobe, posterior cerebellar lobe and vermal volume at baseline is a risk factor for the onset of dementia. CONCLUSION: This is the first study demonstrating that reduced cerebellar volume is already apparent at the predementia stage. The results of this study support the involvement of the cerebellum in the progression of dementia. Whereas the cerebellum might not be directly associated with the origin of Alzheimer's disease, it may provide useful information related to its prognosis.

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Hipertensão intracraniana com manifestações oculares associada ao uso de tetraciclina: relato de caso
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Santos, Frederico Xavier dos

; Parolin, André

; Lindoso, Elissandro Márcio Silva

; Santos, Fernando Henrique Xavier

; Sousa, Luciene Barbosa de

Arquivos Brasileiros de Oftalmologia

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oct 2005, Volume 68 N. 5 Pages 701 - 703

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

Os autores relatam o caso de uma paciente jovem, do sexo feminino, que desenvolveu quadro de hipertensão intracraniana benigna com manifestações oculares em concomitância ao uso de tetraciclina para o tratamento de otite. Esta é uma reação adversa rara deste medicamento, descrito em bula e com alguns relatos de caso em literatura internacional.

The authors describe a young female patient with intracranial hypertension associated with ocular manifestations, during treatment with tetracycline. This is a rare adverse effect described in the medication warnings, and in a few reported cases in the scientific literature.

9920 downloads

10.

Reasons not to select patients for corneal refractive surgery
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Ribeiro, André Luiz Parolin

; Schor, Paulo

; Allemann, Norma

; Chamon, Wallace

; Campos, Mauro Silveira de Queiroz

Arquivos Brasileiros de Oftalmologia

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aug 2002, Volume 65 N. 4 Pages 463 - 466

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

Objetivo: O objetivo deste estudo é mostrar como o setor de Cirurgia Refrativa da Escola Paulista de Medicina da Universidade Federal de São Paulo avalia seus candidatos e quais as razões para não selecioná-los para cirurgia refrativa. Métodos: Foram examinados 1626 pacientes. Anamnese, avaliação oftalmológica completa e topografia corneana foram realizadas em todos os pacientes. Os pacientes procuraram avaliação no setor de Cirurgia Refrativa espontaneamente sem triagem prévia. Resultados: Não foram selecionados 265 pacientes (16,29%) para cirurgia refrativa na córnea. A principal razão para contra-indicar a cirurgia refrativa corneana por excimer laser foi miopia de pacientes que se apresentaram e que não tinham paquimetria corneana suficiente para o tratamento (51 pacientes). Catarata (45 pacientes), ceratocone (31 pacientes), ambliopia (21 pacientes), hipermetropia > 5 dioptrias (19 pacientes), astigmatismo misto (19 pacientes), presbiopia (pacientes que não sabiam que teriam que usar óculos para leitura após a cirurgia; l6 pacientes), diâmetro pupilar > 5 mm em ambiente iluminado (9 pacientes), olho único (9 pacientes), miopia apresentando progressão (8 pacientes), ceratotomia radial prévia (7 pacientes) e, ametropia baixa (7 pacientes) foram as causas de contra-indicação. Conclusão: Candidatos para cirurgia refrativa corneana podem apresentar fatores de risco que devem ser conhecidos de modo a diminuir os riscos pós-operatórios.

Purpose: To present how the section of Refractive Surgery of the Federal University of São Paulo assesses the candidates and the reasons to indicate for corneal refractive surgery. Methods: We examined 1626 patients. Anamnesis, complete ophthalmologic examination and corneal topography were performed in all patients. The patients spontaneously seeked evaluation at the Refractive Surgery Section by telephone without a previous screening. Reasons to refuse patients for refractive surgery were previously established by the Refractive Surgery Section. Results: Based on current technology and clinical experience, 265 patients (16.29%) were refused for excimer laser corneal refractive surgery. Myopia of patients who had insufficient preoperative corneal pachymetry for the laser treatment was the main cause for refusal (51 patients). Cataract (45 patients), keratoconus (31 patients), amblyopia (21 patients), hyperopia > 5 diopters and mixed astigmatism (19 patients), presbyopia (unaware ness of the need for optical correction after the procedure; 16 patients), pupillary diameter > 5mm (9 patients), single eye (9 patients), progressive myopia (8 patients), postradial keratotomy (7 patients) and low ametropia (7 patients) were among the reasons for the refusal. Conclusion: Candidates for excimer laser corneal refractive surgery may present risk factors that should be known in order to avoid complications.

4556 downloads

11.

Colestase intra-hepática recurrente benigna: seguimento de um caso por 7 anos
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PAROLIN, Mônica Beatriz

; LANGOWISKI, André Ribeiro

; IOSHII, Sérgio Ossamu

; MAGGIO, Everton Marques

; COELHO, Júlio C. U.

Arquivos de Gastroenterologia

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oct 2000, Volume 37 N. 4 Pages 231 - 234

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

A colestase intra-hepática recurrente benigna é condição rara caracterizada por episódios autolimitados e recurrentes de colestase intra-hepática, intercalados por períodos nos quais a função e histologia hepática apresentam-se normais. Embora a colestase intra-hepática recurrente benigna não se associe a dano hepático permanente, os períodos de colestase podem acompanhar-se de considerável morbidade. Relato de um caso de colestase intra-hepática recurrente benigna em adulto do sexo masculino, acompanhado por 7 anos. Durante o período de observação deste caso, três episódios de prurido intenso e icterícia foram documentados, tendo sido excluídas outras etiologias. A duração dos episódios variou de 50 a 90 dias. Como costuma acontecer nesta entidade, as enzimas hepáticas permaneciam normais nos intervalos entre as crises. Apesar de rara, a colestase intra-hepática recurrente benigna deve ser considerada no diagnóstico diferencial das colestases. O esclarecimento do paciente quanto à natureza benigna desta condição é importante para se evitar a iatrogênese.

Benign recurrent intrahepatic cholestasis is a rare autosomal recessive disorder characterized by repeated episodes of intense pruritus and jaundice. Patients are completely asymptomatic for months to years between symptomatic periods. We report a case of a patient with a 7-year history of benign recurrent intrahepatic cholestasis. During the follow-up period the patient has suffered three attacks of cholestasis, confirmed by biochemical tests and histological exam. Liver enzimes were normal between the cholestasis episodes. Despite multiple attacks of cholestasis, no permanent liver damage has occurred. Although the diagnosis of benign recurrent intrahepatic cholestasis is rare, it should be included in the evaluation of a patient with cholestasis. The patients should be reassured of the benign course of this disorder.

20944 downloads

12.

Úlcera de córnea bilateral por Pseudomonas em usuário de lente de contato descartável
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Lipener, César

; Ribeiro, André Luiz Parolin

Arquivos Brasileiros de Oftalmologia

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dec 1999, Volume 62 N. 6 Pages 747 - 749

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

Introdução: Apesar da sua aparente simplicidade, o uso de lentes descartáveis deve ser feito respeitando-se os critérios de forma de uso, conservação e descarte. A úlcera de córnea bacteriana é a complicação mais temida em usuários de lente e pode ter relação com vários fatores tais como higiene, conservação e principalmente o uso prolongado. Objetivo: Descrever um caso de úlcera bilateral por Pseudomonas em um paciente usuário de lentes descartáveis, evidenciando e discutindo a importância do exame prévio, orientação e seguimento adequados, bem como ressaltando que por ser descartável a lente não é isenta de complicações graves. Relato do caso: Um estudante de 17 anos, usando lentes descartáveis há 6 meses, sem exame ou prescrição médica, nos procurou queixando-se de dor em OE no qual observou-se úlcera corneana infiltrada na meia periferia. Foi colhido material e iniciado tratamento com colírios fortificados. Após 8 horas, retornou referindo agora dor em OD, tendo sido observada ceratite difusa com secreção mucopurulenta. A conduta foi a mesma. Os exames revelaram Pseudomonas em ambos os olhos e o quadro regrediu sem seqüelas após uma semana de tratamento. Discussão: O autor discute os principais fatores envolvidos com o aparecimento de ceratite infecciosa em usuários de lentes de contato, lembrando que as lentes descartáveis, apesar da sua aparente simplicidade também estão relacionadas com este grave quadro. Ressalta ainda que o uso prolongado é considerado um dos seus principais fatores de risco. O relato de um caso de ceratite bilateral serve de alerta para o uso deste tipo de lente sem a devida orientação e acompanhamento.

Introduction: Although the use of contact lenses is appa-rently very simple, it is necessary to obey criteria for their correct use, conservation and disposal. Corneal bacterial ulcers are a much-feared complication for users of contact lenses and can be related to various factors such as hygiene, storage and most of all long-term use. Purpose: To describe a case of bilateral ulcer, caused by Pseudomonas in a patient who was a user of disposable lenses. This study highlights and discusses the importance of prior examination, instruction and adequate supervision. In addition it is emphasized that although the lenses are disposable, they are not free from the possibility of serious complications. Case Study: A seventeen-year-old student who had used contact lenses for six months without prior examination or medical prescription complained of pain in the left eye. When he was examined, we observed a corneal ulcer infiltrated in the median periphery. Samples were collected and a treatment with fortified eye-drops was started. After eight hours the patient returned now complaining of pain in the right eye which we examined and observed diffuse keratitis with a mucopurulent secretion. The treatment was the same. Laboratory tests revealed Pseudomonas in both eyes and the ailment was healed within a week's treatment without leaving sequelae. Discussion: The author discuss the factors involved in the occurrence of infectious keratitis in users of contact lenses illustrating that even though disposable lenses are appa-rently very simple they can cause serious problems. It also demonstrates that the long-term use of contact lenses is considered to be a main risk factor. The description of a case of bilateral keratitis is a warning about the use of this kind of lens without proper orientation and supervision.

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