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au:SILVA, GUILHERME DIOGO

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Understanding MOG antibody-associated disease in Brazil antibodyassociated antibody associated
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Callegaro, Dagoberto

; Silva, Guilherme Diogo

Arquivos de Neuro-Psiquiatria

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nov 2023, Volume 81 N. 11 Pages 941 - 942

Abstract: En | Text: En | PDF: En

https://doi.org/10.1055/s-0043-1777298

[SciELO Preprints] - Nutritional habits, physical activity, body composition, and stress among operational and administrative military police officers
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Jorge, Gabriel de Oliveira Aguiar, Diogo Gerbis Nascimento, Thiago Gomes Brito, Rebeca Lopes da Silva Alves, Paulo Henrique Ferreira Macedo, Francisco Guilherme Lima

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Publication date: 2023-06-07

Abstract: En Es Pt

Military police activity is a dangerous, stressful occupation that poses health risks. Nutritional habits, physical activity, body composition and perceived stress, in addition to being interrelated, influence components of professional performance, such as work motivation, general self-efficacy and absenteeism. The objective was to compare nutritional habits, physical activity, body mass index and perceived stress of military police officers working in operational and administrative services, of both sexes, and to investigate the correlation between these variables. The Mann-Whitney U test was used for the comparative analysis and, for the correlational study, the Pearson correlation coefficient. Perceived stress and physical activity were inversely correlated (r=-0.268; p<0.001). Nutritional habits correlated significantly: with physical activity (r=0.381; p<0.001), directly; and, conversely, body mass index (r=0.256; p<0.001) and perceived stress (r=-0.201; p<0.01). Military police officers from the operational service had significantly higher body mass index (U=3695; p<0.001) and physical activity (U=3776; p<0.001) than their counterparts from the administrative service. Men had significantly higher body mass index (U=1333; p<0.001) and physical activity (U=2205; p<0.01) than women, who had significantly higher stress levels than men (U=1927; p<0.001). The correlations and significant differences observed point to the need to implement personnel and health management policies aimed at improving the lifestyle, body composition and stress of military police officers. Study limitations and future directions are discussed.

La actividad de la policía militar es una ocupación peligrosa y estresante que presenta riesgos para la salud. Hábitos alimentarios, actividad física, composición corporal y estrés percibido, además de estar interrelacionados, influyen en componentes del desempeño profesional, como motivación para el trabajo, autoeficacia general y ausentismo. El objetivo fue comparar hábitos nutricionales, actividad física, índice de masa corporal y estrés percibido de policías militares que trabajan en servicios operativos y administrativos, de ambos sexos, e investigar la correlación entre estas variables. Para el análisis comparativo se utilizó la prueba U de Mann-Whitney y, para el estudio correlacional, el coeficiente de correlación de Pearson. Estrés percibido y actividad física se correlacionaron inversamente (r=-0,268; p<0,001). Hábitos nutricionales correlacionaron significativamente: con actividad física (r=0,381; p<0,001), directamente; y, por el contrario, con índice de masa corporal (r=0,256; p<0,001) y estrés percibido (r=-0,201; p<0,01). Los policías militares del servicio operativo presentaron índice de masa corporal (U=3695; p<0,001) y actividad física (U=3776; p<0,001) significativamente mayores que sus homólogos del servicio administrativo. Hombres tenían un índice de masa corporal significativamente mayor (U=1333; p<0,001) y actividad física (U=2205; p<0,01) que las mujeres, quienes tenían niveles de estrés significativamente más altos que los hombres (U=1927; p<0,001). Las correlaciones y diferencias significativas observadas apuntan a necesidad de implementar políticas de gestión de personal y salud dirigidas a mejorar el estilo de vida, composición corporal y estrés de los policías militares. Se discuten limitaciones del estudio y direcciones futuras.

A atividade policial militar é uma ocupação perigosa, estressante e que impõe riscos à saúde. Os hábitos nutricionais, atividade física, composição corporal e estresse percebido, além de relacionarem-se entre si, influenciam componentes do desempenho profissional, tais como motivação para o trabalho, autoeficácia geral e absenteísmo. O objetivo deste estudo foi comparar hábitos nutricionais, atividade física, índice de massa corporal e estresse percebido de policiais militares que atuam no serviço operacional e administrativo, de ambos os sexos, e investigar a correlação entre essas variáveis. Utilizou-se o teste U de Mann-Whitney para a análise comparativa e, para o estudo correlacional, o coeficiente de correlação de Pearson. O estresse percebido e a atividade física correlacionaram-se inversamente (r=-0,268; p<0,001). Os hábitos nutricionais correlacionaram-se significativamente: à atividade física (r=0,381; p<0,001), diretamente; e, inversamente, ao índice de massa corporal (r=0,256; p<0,001) e ao estresse percebido (r=-0,201; p<0,01). Policiais militares do serviço operacional apresentaram índice de massa corporal (U=3695; p<0,001) e atividade física (U=3776; p<0,001) significativamente superiores aos seus congêneres do serviço administrativo. Homens apresentaram índice de massa corporal (U=1333; p<0,001) e atividade física (U=2205; p<0,01) significativamente superiores aos das mulheres, as quais apresentaram níveis de estresse significativamente superiores aos dos homens (U=1927; p<0,001). As correlações e diferenças significativas observadas alertam para a necessidade de implementação de políticas de gestão de pessoal e de saúde voltadas à melhoria do estilo de vida, da composição corporal e do estresse de policiais militares. São discutidas limitações do estudo e direções futuras.

https://doi.org/10.1590/SciELOPreprints.5988

A brazilian nationwide multicenter study on deficiency of deaminase-2 (DADA2)
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Melo, Adriana

; Carvalho, Luciana Martins de

; Ferriani, Virginia Paes Leme

; Cavalcanti, André

; Appenzeller, Simone

; Oliveira, Valéria Rossato

; Chong Neto, Herberto

; Rosário, Nelson Augusto

; Poswar, Fabiano de Oliveira

; Guimaraes, Matheus Xavier

; Kokron, Cristina Maria

; Maia, Rayana Elias

; Silva, Guilherme Diogo

; Keller, Gabriel

; Ferreira, Mauricio Domingues

; Vasconcelos, Dewton Moraes

; Toledo-Barros, Myrthes Anna Maragna

; Barros, Samar Freschi

; Rosa Neto, Nilton Salles

; Krieger, Marta Helena

; Kalil, Jorge

; Mendonça, Leonardo Oliveira

Advances in Rheumatology

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2023, Volume 63 elocation 23

Abstract: En | Text: En | PDF: En

Abstract Introduction The deficiency of ADA2 (DADA2) is a rare autoinflammatory disease provoked by mutations in the ADA2 gene inherited in a recessive fashion. Up to this moment there is no consensus for the treatment of DADA2 and anti-TNF is the therapy of choice for chronic management whereas bone marrow transplantation is considered for refractory or severe phenotypes. Data from Brazil is scarce and this multicentric study reports 18 patients with DADA2 from Brazil. Patients and methods This is a multicentric study proposed by the Center for Rare and Immunological Disorders of the Hospital 9 de Julho - DASA, São Paulo - Brazil. Patients of any age with a confirmed diagnosis of DADA2 were eligible for this project and data on clinical, laboratory, genetics and treatment were collected. Results Eighteen patients from 10 different centers are reported here. All patients had disease onset at the pediatric age (median of 5 years) and most of them from the state of São Paulo. Vasculopathy with recurrent stroke was the most common phenotype but atypical phenotypes compatible with ALPS-like and Common Variable Immunodeficiency (CVID) was also found. All patients carried pathogenic mutations in the ADA2 gene. Acute management of vasculitis was not satisfactory with steroids in many patients and all those who used anti-TNF had favorable responses. Conclusion The low number of patients diagnosed with DADA2 in Brazil reinforces the need for disease awareness for this condition. Moreover, the absence of guidelines for diagnosis and management is also necessary (t).

https://doi.org/10.1186/s42358-023-00303-5

Diagnostic and therapeutic approach to chronic meningitis in Brazil: a narrative review
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Silva, Guilherme Diogo

; Guedes, Bruno Fukelmann

; Junqueira, Ióri Rodrigues

; Gomes, Hélio Rodrigues

; Vidal, José Ernesto

Arquivos de Neuro-Psiquiatria

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nov 2022, Volume 80 N. 11 Pages 1167 - 1177

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

Abstract Background Chronic meningitis (CM) is characterized by neurological symptoms associated with the evidence of cerebrospinal fluid pleocytosis lasting > 4 weeks. Studies on the management of CM in Brazil are scarce. Objective To critically review the literature on CM and propose a rational approach in the Brazilian scenario. Methods Narrative literature review discussing the epidemiology, clinical evaluation, basic and advanced diagnostic testing, and empirical and targeted therapy for the most relevant causes of CM. The present review was contextualized with the local experience of the authors. In addition, we propose an algorithm for the management of CM in Brazil. Results In Brazil, tuberculosis and cryptococcosis are endemic and should always be considered in CM patients. In addition to these diseases, neurosyphilis and other endemic conditions should be included in the differential diagnosis, including neurocysticercosis, Baggio-Yoshinari syndrome, and endemic mycosis. After infectious etiologies, meningeal carcinomatosis and autoimmune diseases should be considered. Unbiased and targeted methods should be used based on availability and clinical and epidemiological data. Conclusion We propose a rational approach to CM in Brazil, considering the epidemiological scenario, systematizing the etiological investigation, and evaluating the timely use of empirical therapies.

Resumo Antecedentes A meningite crônica (MC) é caracterizada por sintomas neurológicos associados à evidência de pleiocitose do líquido cefalorraquidiano por > 4 semanas. Os estudos sobre o manejo da MC no Brasil são escassos. Objetivo Rever criticamente a literatura sobre MC e propor uma abordagem racional no cenário brasileiro. Métodos Revisão da literatura narrativa discutindo a epidemiologia, avaliação clínica, testes diagnósticos básicos e avançados, além da terapia empírica e direcionada para as causas mais relevantes do MC. A presente revisão foi contextualizada com a experiência local dos autores. Além disso, propomos um algoritmo para o manejo da MC no Brasil. Resultados No Brasil, a tuberculose e a criptococose são endêmicas e devem ser sempre consideradas em pacientes com MC. Além destas doenças, a neurossífilis e outras condições endêmicas devem ser incluídas no diagnóstico diferencial, incluindo: neurocisticercose, síndrome de Baggio-Yoshinari e micoses endêmicas. Após etiologias infecciosas, devem ser consideradas a carcinomatose meningeal e doenças autoimunes sistêmicas. Métodos diagnósticos devem ser utilizados com base na disponibilidade, nos dados clínicos e nos dados epidemiológicos. Conclusão Propomos uma abordagem racional para a MC no Brasil, considerando o cenário epidemiológico, sistematizando a investigação etiológica e avaliando o uso oportuno de terapias empíricas.

https://doi.org/10.1055/s-0042-1758645

Reducing infection risk in multiple sclerosis and neuromyelitis optica spectrum disorders: a Brazilian reference center's approach
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Gomes, Ana Beatriz Ayroza Galvão Ribeiro

; Feo, Lucas Bueno

; Silva, Guilherme Diogo

; Disserol, Caio César Diniz

; Paolilo, Renata Barbosa

; Lara, Amanda Nazareth

; Tonácio, Adriana Coracini

; Mendes, Maria Fernanda

; Pereira, Samira Luísa Apóstolos

; Callegaro, Dagoberto

Arquivos de Neuro-Psiquiatria

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oct 2022, Volume 80 N. 10 Pages 1057 - 1066

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

Abstract Background Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are the most common autoimmune diseases of the central nervous system (CNS). They present chronic relapsing courses that demand treatment with disease-modifying drugs (DMDs) to prevent inflammatory activity. Disease-modifying drugs lead to immunomodulation or immunosuppression through diverse mechanisms (e.g., shifting lymphocyte and cytokine profile, suppressing specific lymphocyte subpopulations). Thus, patients are more prone to infectious complications and associated worsening of disease. Objective To present feasible strategies for mitigating the infection risk of MS and NMOSD treated patients. Methods Targeted literature review concerning the management of infection risk with an emphasis on vaccination, therapy-specific measures, and particularities of the Brazilian endemic infectious diseases' scenario. Conclusion We propose a vaccination schedule, infectious screening routine, and prophylactic measures based on the current scientific evidence. Awareness of emergent tropical diseases is necessary due to evidence of demyelinating events and possible parainfectious cases of MS and NMOSD.

Resumo Antecedentes A esclerose múltipla (EM) e a doença do espectro neuromielite optica (NMOSD) são as doenças autoimunes mais comuns do sistema nervoso central (SNC). Ambas apresentam curso crônico com recaídas (surtos) e exigem tratamento com drogas modificadoras de doenças (DMDs) para a prevenção de atividade inflamatória. As DMDs levam à imunomodulação ou imunossupressão através de diversos mecanismos (por exemplo deslocando e/ou suprimindo subpopulações linfocitárias ou alterando perfil de produção de citocinas). Desta forma, os pacientes com EM ou NMOSD são mais propensos a complicações infecciosas, as quais podem levar ao agravamento de suas doenças de base. Objetivo Apresentar estratégias viáveis para mitigar o risco de infecção de pacientes com EM ou NMOSD sob tratamento. Métodos Revisão bibliográfica focada em manejo de risco de infecção com ênfase em vacinação, medidas específicas de tratamento e particularidades de doenças infecciosas endêmicas do Brasil. Conclusão Propomos um calendário de vacinação, rotina de triagem infecciosa e medidas profiláticas baseadas em evidências científicas atuais. A conscientização das doenças tropicais emergentes é necessária devido a evidências de eventos desmielinizantes e possíveis casos parainfecciosos de EM e NMOSD.

https://doi.org/10.1055/s-0042-1754348

Challenges and insights in immunization in patients with demyelinating diseases: a bench-to-bedside and evidence-based review
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Silva, Guilherme Diogo

; Oliveira, Vítor Falcão de

; Mendonça, Leonardo Oliveira

Arquivos de Neuro-Psiquiatria

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may 2022, Volume 80 N. 5 Pages 173 - 181

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

RESUMO Antecedentes: Infecções estão entre as principais causas de morte de pacientes com doenças desmielinizantes do sistema nervoso central (DDSNC). Vacinas são métodos eficazes para reduzir internação e morte por doenças infecciosas, porém são desafiadoras em pacientes com DDSNC tanto pela autoimunidade quanto pela imunossupressão. Objetivos: Resumir o racional fisiopatológico e as principais evidências para as recomendações de vacinas em pacientes com DDSNC. Métodos: Especialistas com diferentes formações no tema: um neurologista especialista em doenças desmielinizantes, um infectologista e um imunologista, apresentam uma revisão crítica narrativa da Literatura de vacinação em pacientes com DDSNC, com destaque a quais vacinas devem ou não ser administradas e o melhor momento para isso. Resultados: Pacientes com DDSNC têm risco aumentado para infecções imunopreveníveis virais e bacterianas. Vacinas podem prevenir herpes zooster, reativação de hepatite B, verrugas e tumores associados ao HPV, pneumonias virais e bacterianas, além de meningites. Vacinas de vírus vivos atenuados não devem ser usadas quando o paciente está em uso de imunossupressão. Vacinas devem ser evitadas durante surtos. A maior eficácia vacinal é dada antes do tratamento ou ao final de doses de medicações. Conclusão: Os pacientes com DDSNC necessitam de imunização diferenciada em relação a vacinas adicionais, vacinas contraindicadas e melhor momento de vacinação.

ABSTRACT Background: Infections are among the main causes of death in patients with demyelinating diseases of the central nervous system (CNSDD). Vaccines are effective methods in reducing hospitalization and death from infectious diseases, but they are challenging in patients with CNSDD because of autoimmunity and immunosuppression. Objectives: To summarize the pathophysiological rationale and main evidence for vaccine recommendations in patients with CNSDD. Methods: Specialists with different backgrounds on the subject: a neurologist specialized in demyelinating diseases, an infectious diseases specialist and an immunologist, presented a critical narrative review of vaccination literature in patients with CNSDD, highlighting which vaccines should or should not be administered and the best time for it. Results: Patients with DDSNC are at increased risk of vaccine-preventable viral and bacterial infections. Vaccines can prevent herpes zoster, hepatitis B reactivation, HPV-associated warts and tumors, viral and bacterial pneumonia, and meningitis. Live attenuated virus vaccines should not be used when the patient is on immunosuppression. Vaccines should be avoided during relapses. The greatest vaccine efficacy is given before treatment or at the end of medication. Conclusion: Patients with DDSNC need differentiated immunization in relation to additional vaccines, contraindicated vaccines and timing of vaccination.

https://doi.org/10.1590/0004-282x-anp-2022-s121

A critical review and update on autoimmune encephalitis: understanding the alphabet soup
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Simabukuro, Mateus Mistieri

; Silva, Guilherme Diogo da

; Castro, Luiz Henrique Martins

; Lucato, Leandro Tavares

Arquivos de Neuro-Psiquiatria

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may 2022, Volume 80 N. 5 Pages 143 - 158

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

RESUMO As encefalites autoimunes compreendem um grupo de doenças mediadas por anticorpos contra antígenos de superfície neuronal ou sinapse, como canais iônicos ou receptores de neurotransmissores. Novas síndromes clínicas e os anticorpos a elas associados foram e ainda estão sendo caracterizados ao longo das últimas duas décadas. Dado que suas principais características clínicas são interdisciplinares, isto é, incluem -se sintomas neuropisquiátricos, disfunção cognitiva, crises epilépticas, distúrbio do movimento e do sono, há uma grande onda de interesse sobre esse campo de conhecimento. Algumas dessas doenças apresentam-se com uma síndrome bem definida, sendo possível reconhecê-las clinicamente. Diagnosticá-las corretamente é importante uma vez que se trata de doenças potencialmente tratáveis apesar da gravidade que lhes é característica. Por outro lado, o número crescente de anticorpos sendo descritos causam dúvida frequente sobre qual o melhor teste a solicitar e como interpretá-los. Nós aqui apresentamos uma revisão atualização resumida do conhecimento atual sobre as encefalites mediadas por anticorpos.

ABSTRACT Autoimmune encephalitis (AE) comprises a group of diseases mediated by antibodies against neuronal cell surface or synaptic antigens, such as ion channels or neurotransmitter receptors. New clinical syndromes and their associated antibodies were and are still being characterized over the last two decades. The fact that their main clinical features are interdisciplinary, - encompassing neuropsychiatric symptoms, cognitive dysfunction, epileptic seizures, movement and sleep disorders - has led to a surge of interest in this field. Some of these diseases present with a well-defined syndrome, being recognizable on clinical grounds. Correct diagnosis is important since AE are potentially treatable diseases, despite their severity. On the other hand, an increasing number of neuronal antibodies being described casts doubt upon the way we should utilize antibody testing and interpret results. In this article we review, summarize and update the current knowledge on antibody mediated encephalitis.

https://doi.org/10.1590/0004-282x-anp-2022-s122

Prevalence of COVID-19 in medical school and residency in Porto Alegre, RS
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Silva, Gabriela Salzano

; Avila, Georgia Oliveira

; Lubianca, Fernanda Nascimento

; Lubianca, João Pedro Neves

; Michelon, Victória Marques de Medeiros

; Kalil, Diogo Pereira

; Maestri, Lorenzo Feldman

; Lengler, Arthur Dementshuk

; Lima, Guilherme Pereira

; Lubianca Neto, José Faibes

Revista da Associação Médica Brasileira

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feb 2022, Volume 68 N. 2 Pages 206 - 211

Abstract: En | Text: En | PDF: En

SUMMARY OBJECTIVE: A multicentric, cross-sectional study was carried out to determine the prevalence and risk factors for Coronavirus disease 2019 in medical students and residents from four universities and affiliated hospitals in Brazil. METHODS: A survey about contamination risk and symptoms was sent to all participants through email and WhatsApp. Prevalence was measured by the self-report of positive polymerase chain reaction or serological test. Univariate and multivariate analyses were performed, and odds ratio and 95% confidence interval were calculated. RESULTS: Prevalence of infection by Sars-CoV-2 was 14.9% (151/1011). The disease was more prevalent in residents and interns than in undergraduate students. Contact with an infected relative outside the hospital or with colleagues without using personal protective equipment was associated with higher contamination. Contact with patients without wearing goggles and higher weekly frequency of contact were the two factors independently associated with the infection by Coronavirus disease 2019 in the multivariate analysis. CONCLUSIONS: Medical students, interns, and residents have a higher prevalence of Coronavirus disease 2019 than the general population, in which the last two groups are significantly at higher risk. Contacting patients at a higher weekly frequency increases the risk for infection. The use of goggles should be reinforced when contacting patients.

https://doi.org/10.1590/1806-9282.20211114

Recommendations by the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and the Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) on vaccination in general and specifically against SARS-CoV-2 for patients with demyelinating diseases of the central nervous system
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Becker, Jefferson

; Ferreira, Lis Campos

; Damasceno, Alfredo

; Bichuetti, Denis Bernardi

; Christo, Paulo Pereira

; Callegaro, Dagoberto

; Peixoto, Marco Aurélio Lana

; Sousa, Nise Alessandra De Carvalho

; Almeida, Sérgio Monteiro De

; Adoni, Tarso

; Santiago-Amaral, Juliana

; Junqueira, Thiago

; Pereira, Samira Luisa Apóstolos

; Gomes, Ana Beatriz Ayroza Galvão Ribeiro

; Pitombeira, Milena

; Paolilo, Renata Barbosa

; Grzesiuk, Anderson Kuntz

; Piccolo, Ana Claudia

; D´Almeida, José Arthur Costa

; Gomes Neto, Antonio Pereira

; Oliveira, Augusto Cesar Penalva De

; Oliveira, Bianca Santos De

; Tauil, Carlos Bernardo

; Vasconcelos, Claudia Ferreira

; Kaimen-Maciel, Damacio

; Varela, Daniel

; Diniz, Denise Sisterolli

; Oliveira, Enedina Maria Lobato De

; Malfetano, Fabiola Rachid

; Borges, Fernando Elias

; Figueira, Fernando Faria Andrade

; Gondim, Francisco De Assis Aquino

; Passos, Giordani Rodrigues Dos

; Silva, Guilherme Diogo

; Olival, Guilherme Sciascia Do

; Santos, Gutemberg Augusto Cruz Dos

; Ruocco, Heloisa Helena

; Sato, Henry Koiti

; Soares Neto, Herval Ribeiro

; Cortoni Calia, Leandro

; Gonçalves, Marcus Vinícius Magno

; Vecino, Maria Cecilia Aragón De

; Pimentel, Maria Lucia Vellutini

; Ribeiro, Marlise De Castro

; Boaventura, Mateus

; Parolin, Mônica Koncke Fiuza

; Melo, Renata Brant De Souza

; Lázaro, Robson

; Thomaz, Rodrigo Barbosa

; Kleinpaul, Rodrigo

; Dias, Ronaldo Maciel

; Gomes, Sidney

; Lucatto, Simone Abrante

; Alves-Leon, Soniza Vieira

; Fukuda, Thiago

; Ribeiro, Taysa Alexandrino Gonsalves Jubé

; Winckler, Thereza Cristina D’ávila

; Fragoso, Yara Dadalti

; Nascimento, Osvaldo José Moreira Do

; Ferreira, Maria Lucia Brito

; Mendes, Maria Fernanda

; Brum, Doralina Guimarães

; Glehn, Felipe Von

Arquivos de Neuro-Psiquiatria

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nov 2021, Volume 79 N. 11 Pages 1049 - 1061

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

RESUMO O DC de Neuroimunologia da ABN e o BCTRIMS trazem, nesse documento, as recomendações sobre vacinação da população com doenças desmielinizantes do sistema nervoso central (SNC) contra infecções em geral e contra o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), causador da COVID-19. Destaca-se a gravidade do atual momento frente ao avanço da COVID-19 em nosso País, o que torna mais evidente e importante a criação de guia de referência para orientação aos médicos, pacientes e autoridades de saúde pública quanto à vacinação, meio efetivo e seguro no controle de determinadas doenças infecciosa. O DCNI/ABN e o BCTRIMS recomendam que os pacientes com doenças desmielinizantes do SNC (ex., EM e NMOSD) sejam constantemente monitorados, quanto a atualização do seu calendário vacinal, especialmente, no início ou antes da mudança do tratamento com uma droga modificadora de doença (DMD). É importante também salientar que as vacinas são seguras e os médicos devem estimular o seu uso em todos os pacientes. Evidentemente, deve ser dada especial atenção às vacinas com vírus vivos atenuados. Por fim, é importante que os médicos verifiquem qual DMD o paciente está em uso e quando foi feita a sua última dose, pois cada fármaco pode interagir de forma diferente com a indução da resposta imune.

ABSTRACT The Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) provide recommendations in this document for vaccination of the population with demyelinating diseases of the central nervous system (CNS) against infections in general and against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. We emphasize the seriousness of the current situation in view of the spread of COVID-19 in our country. Therefore, reference guides on vaccination for clinicians, patients, and public health authorities are particularly important to prevent some infectious diseases. The DCNI/ABN and BCTRIMS recommend that patients with CNS demyelinating diseases (e.g., MS and NMOSD) be continually monitored for updates to their vaccination schedule, especially at the beginning or before a change in treatment with a disease modifying drug (DMD). It is also important to note that vaccines are safe, and physicians should encourage their use in all patients. Clearly, special care should be taken when live attenuated viruses are involved. Finally, it is important for physicians to verify which DMD the patient is receiving and when the last dose was taken, as each drug may affect the induction of immune response differently.

https://doi.org/10.1590/0004-282x-anp-2021-0162 1 downloads

10.

Acute chorea: case series from the emergency room of a Brazilian tertiary-level center
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SILVA, Guilherme Diogo

; PARMERA, Jacy Bezerra

; HADDAD, Monica Santoro

Arquivos de Neuro-Psiquiatria

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mar 2021, Volume 79 N. 3 Pages 233 - 237

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

RESUMO Introdução: Coreia é um distúrbio do movimento caracterizado por contrações musculares caóticas, migratórias, aleatórias e involuntárias. Usualmente, define-se como coreia aguda quando presente dentro de horas a dias. Neste cenário, três causas emergem como as mais comuns: vascular, tóxico-metabólica e inflamatória. Objetivos: O objetivo deste estudo foi identificar a prevalência das principais etiologias e os principais achados clínicos de coreia aguda na sala de emergência de um centro de referência terciário, a fim de sugerir uma abordagem para orientar a investigação diagnóstica e o manejo na emergência. Métodos: Revisamos retrospectivamente os dados clínicos e de neuroimagem, de 2015 a 2019, de 10 pacientes com coreia aguda na sala de emergência neurológica de um hospital terciário. Resultados: A etiologia mais comum foi o acidente vascular cerebral (AVC) (50% dos casos). Todos os AVCs foram isquêmicos e apenas um se apresentou como isquemia clássica do núcleo subtalâmico contralateral. Em relação às causas não vasculares, a hiperglicemia não cetótica demonstrou ser a principal, seguida pela coreia relacionada a medicamentos. Um paciente apresentou etiologia inflamatória, por provável reativação da coreia de Sydenham. Conclusão: A coreia aguda é um problema incomum e desafiador na sala de emergência, muitas vezes associado a causas potencialmente tratáveis. Nós sugerimos o acrônimo DANCE (Diagnosis of chorea, Acute stroke protocol, Normal glucose levels, Check neuroimaging, Exposure to drugs) para auxiliar na abordagem como primeiro passo na sala de emergência, a fim de enfatizar causas que requerem tratamento imediato e adequado (por exemplo, trombólise).

ABSTRACT Background: Chorea is a movement disorder characterized by random, brief and migratory involuntary muscle contractions. It is defined as acute when present within hours to days. Three main causes for this scenario have emerged as most likely: vascular, toxic-metabolic and inflammatory. Objectives: To identify the prevalence of the main etiologies and major clinical findings of acute chorea in the emergency room of a tertiary-level referral center; and to suggest an approach for guiding the diagnostic workup and clinical management. Methods: We retrospectively reviewed the clinical aspects and neuroimaging data of 10 patients presenting with acute chorea at the neurological emergency room of our hospital from 2015 to 2019. Results: Stroke was the most common etiology (50% of the cases). All of them were ischemic. It was noteworthy that only one case demonstrated the classical ischemic topographic lesion at the contralateral subthalamic nuclei. Regarding nonvascular etiologies, nonketotic hyperglycemia was the major cause, followed by drug-related chorea. One patient showed inflammatory etiology, which was probably Sydenham chorea reactivation. Conclusion: Acute chorea is an uncommon and challenging problem at the emergency room, often associated with potentially treatable causes. We suggest that use of the acronym DANCE (Diagnosis of chorea, Acute stroke protocol, Normal glucose levels, Check neuroimaging, Exposure to drugs) could form a potential initial approach in the evaluation, in order to emphasize causes that require prompt proper management (e.g. thrombolysis).

https://doi.org/10.1590/0004-282x-anp-2020-0124 342 downloads

11.

OXIDATIVE STABILITY AND COLD FILTER PLUGGING POINT OF BIODIESEL BLENDS DERIVED FROM FATS AND SOY OIL
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Braun, João V.

; Santos, Samuel J.

; Espíndola, Guilherme C.

; Mattos, Gabriel F. de

; Ongaratto, Diego P.

; Oliveira, Diogo M. de

; Silva, Marlon W. da

; Vendrusculo, Vinícius

; Santos, Vinícius O. B. dos

; Renner, Rodrigo E.

; Naciuk, Fabrício F.

; Marques, Marcelo V.

; Fontoura, Luiz A. M.

Química Nova

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sep 2020, Volume 43 N. 9 Pages 1246 - 1250

Abstract: En | Text: En | PDF: En

Biodiesel made from oils is rich in polyunsaturated fatty acids methyl esters, and, consequently, presents high tendency to oxidize. Biodiesel made from fats, on the other hand, is mainly comprised by saturated chains. Although it is highly stable, they easily crystalize at low temperatures. Blends from both can exhibit optimized properties. In this work, oxidative stability, expressed by induction period (IP), and cold filter plugging point (CFPP) of blends from palm, palm kernel, babassu, tallow or lard biodiesels with soy one were measured. Biodiesel samples were prepared by two steps transesterification methodology with KOH catalysis followed by H2SO4. IP increases, as the fat biodiesel content in the blend is higher, as expected. Blends comprised by 60% of fat biodiesel by volume had their IP increased from 1.5 (lard) to 2 times (palm kernel), compared to soy one. At this level, IP was found 8 h or higher, except for palm, which 80% was required. CFPP was observed at 8 °C or lower for the blends containing up to 60% of all the fat biodiesel, except for the palm one, which a 20% content must not be surpassed. Palm kernel 80% biodiesel blend reached the Brazilian specification, that is, IP higher than 12 h and CFPP lower than 5 °C.

https://doi.org/10.21577/0100-4042.20170619 374 downloads

12.

Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach
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APÓSTOLOS-PEREIRA, Samira Luisa

; SILVA, Guilherme Diogo

; DISSEROL, Caio César Diniz

; FEO, Lucas Bueno

; MATOS, Aline de Moura Brasil

; SCHOEPS, Vinicius Andreoli

; GOMES, Ana Beatriz Ayroza Galvão Ribeiro

; BOAVENTURA, Mateus

; MENDES, Maria Fernanda

; CALLEGARO, Dagoberto

Arquivos de Neuro-Psiquiatria

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jul 2020, Volume 78 N. 7 Pages 430 - 439

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

RESUMO Introdução: A mais recente pandemia causada pelo coronavírus SARS-CoV-2 (COVID-19, do inglês coronavirus disease 2019) representa uma ameaça potencial para pacientes com doenças autoimunes, incluindo esclerose múltipla (EM) e transtorno do espectro de neuromielite óptica (NMOSD, do inglês neuromyelitis optica spectrum disorders). Esses pacientes são geralmente tratados com medicamentos imunomoduladores ou imunossupressores que podem alterar a resposta normal do organismo a infecções. Até o momento, não há consenso sobre como o manejo dos pacientes com EM e NMOSD deve ser realizado durante a pandemia. Objetivo: Discutir estratégias para manejar esses pacientes. Métodos: Focamos em como 1) reduzir o risco de infecção por COVID-19, como distanciamento social, telemedicina e exames laboratoriais e de imagem em intervalos mais amplos; 2) manejo de surtos, incluindo evitar tratamento de surto leve e uso de corticoide oral; 3) gerenciar terapias modificadoras de doença, como a preferência por medicamentos associados a menor risco de infecção (interferons, glatirâmer, teriflunomida e natalizumabe) e infusão em intervalo estendido de natalizumabe, quando seguro; 4) individualizar a escolha da terapia de indução para EM (anticorpos monoclonais anti-CD20, alentuzumabe e cladribina); 5) manejar terapias preventivas de NMOSD, incluindo seleção inicial de terapia e manutenção do tratamento atual; 6) manejar pacientes com EM/NMOSD que foram infectados por COVID-19. Conclusão: No futuro, séries de casos de pacientes com MS/NMOSD infectados com COVID-19 nos ajudará a definir as melhores estratégias de manejo. Por enquanto, contamos com a experiência e orientação especializadas.

ABSTRACT Background: The novel coronavirus disease 2019 (COVID-19) pandemic poses a potential threat to patients with autoimmune disorders, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Such patients are usually treated with immunomodulatory or immunosuppressive agents, which may tamper with the organism’s normal response to infections. Currently, no consensus has been reached on how to manage MS and NMOSD patients during the pandemic. Objective: To discuss strategies to manage those patients. Methods: We focus on how to 1) reduce COVID-19 infection risk, such as social distancing, telemedicine, and wider interval between laboratory testing/imaging; 2) manage relapses, such as avoiding treatment of mild relapse and using oral steroids; 3) manage disease-modifying therapies, such as preference for drugs associated with lower infection risk (interferons, glatiramer, teriflunomide, and natalizumab) and extended-interval dosing of natalizumab, when safe; 4) individualize the chosen MS induction-therapy (anti-CD20 monoclonal antibodies, alemtuzumab, and cladribine); 5) manage NMOSD preventive therapies, including initial therapy selection and current treatment maintenance; 6) manage MS/NMOSD patients infected with COVID-19. Conclusions: In the future, real-world case series of MS/NMOSD patients infected with COVID-19 will help us define the best management strategies. For the time being, we rely on expert experience and guidance.

https://doi.org/10.1590/0004-282x20200056 2526 downloads

13.

[SciELO Preprints] - Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach
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Apóstolos, Samira Luisa Pereira Silva, Guilherme Diogo Disserol, Caio César Diniz Feo, Lucas Bueno Matos, Aline de Moura Brasil Schoeps, Vinicius Andreoli Gomes, Ana Beatriz Ayroza Galvão Ribeiro Boaventura, Mateus Mendes, Maria Fernanda Callegaro, Dagoberto

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Publication date: 2020-06-19

Abstract: En Pt

Background: The novel coronavirus disease 2019 (COVID-19) pandemic poses a potential threat to patients with autoimmune disorders, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Such patients are usually treated with immunomodulatory or immunosuppressive agents, which may tamper with the organism’s normal response to infections. Currently, no consensus has been reached on how to manage MS and NMOSD patients during the pandemic. Objective: To discuss strategies to manage those patients. Methods: We focus on how to 1) reduce COVID-19 infection risk, such as social distancing, telemedicine, and wider interval between laboratory testing/imaging; 2) manage relapses, such as avoiding treatment of mild relapse and using oral steroids; 3) manage disease-modifying therapies, such as preference for drugs associated with lower infection risk (interferons, glatiramer, teriflunomide, and natalizumab) and extended-interval dosing of natalizumab, when safe; 4) individualize the chosen MS induction-therapy (anti-CD20 monoclonal antibodies, alemtuzumab, and cladribine); 5) manage NMOSD preventive therapies, including initial therapy selection and current treatment maintenance; 6) manage MS/NMOSD patients infected with COVID-19. Conclusions: In the future, real-world case series of MS/NMOSD patients infected with COVID-19 will help us define the best management strategies. For the time being, we rely on expert experience and guidance.

Introdução: A mais recente pandemia causada pelo coronavírus SARS-CoV-2 (COVID-19, do inglês coronavirus disease 2019) representa uma ameaça potencial para pacientes com doenças autoimunes, incluindo esclerose múltipla (EM) e transtorno do espectro de neuromielite óptica (NMOSD, do inglês neuromyelitis optica spectrum disorders). Esses pacientes são geralmente tratados com medicamentos imunomoduladores ou imunossupressores que podem alterar a resposta normal do organismo a infecções. Até o momento, não há consenso sobre como o manejo dos pacientes com EM e NMOSD deve ser realizado durante a pandemia. Objetivo: Discutir estratégias para manejar esses pacientes. Métodos: Focamos em como 1) reduzir o risco de infecção por COVID-19, como distanciamento social, telemedicina e exames laboratoriais e de imagem em intervalos mais amplos; 2) manejo de surtos, incluindo evitar tratamento de surto leve e uso de corticoide oral; 3) gerenciar terapias modificadoras de doença, como a preferência por medicamentos associados a menor risco de infecção (interferons, glatirâmer, teriflunomida e natalizumabe) e infusão em intervalo estendido de natalizumabe, quando seguro; 4) individualizar a escolha da terapia de indução para EM (anticorpos monoclonais anti-CD20, alentuzumabe e cladribina); 5) manejar terapias preventivas de NMOSD, incluindo seleção inicial de terapia e manutenção do tratamento atual; 6) manejar pacientes com EM/NMOSD que foram infectados por COVID-19. Conclusão: No futuro, séries de casos de pacientes com MS/NMOSD infectados com COVID-19 nos ajudará a definir as melhores estratégias de manejo. Por enquanto, contamos com a experiência e orientação especializadas.

https://doi.org/10.1590/0004-282X20200056

14.

Metabolomics-Based Discovery of Biomarkers with Cytotoxic Potential in Extracts of Myracrodruon urundeuva
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Castro, Caio B.

; Luz, Licia R.

; Guedes, Jhonyson A. C.

; Porto, Diogo D.

; Silva, Maria Francilene S.

; Silva, Gisele S.

; Ribeiro, Paulo R. V.

; Canuto, Kirley M.

; Brito, Edy S.

; Zampieri, Dávila S.

; Pessoa, Claúdia Ó.

; Zocolo, Guilherme J.

Journal of the Brazilian Chemical Society

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apr 2020, Volume 31 N. 4 Pages 775 - 787

Abstract: En | Text: En | PDF: En

Myracrodruon urundeuva (“aroeira-do-sertão”) is a species threatened with extinction due to anthropogenic exploitation. Phytochemical analysis of bark, branch and leaf extracts revealed the presence of several compounds such as flavonoids, phenols, tannins, quercetin derivatives and anacardic acids. Dereplication methodology was performed to tentatively identify 50 compounds analyzed by ultra-performance liquid chromatography coupled with an electrospray ionization quadrupole time-of-flight mass spectrometry operating in MSE mode (UPLC-QTOF-MSE). The extracts exhibited anti-tumor effect in cancer cells HCT-116 (colorectal), SF-295 (glioblastoma), HL-60 (leukemia), and RAJI (leukemia). Also, these results correlate with the principal component analysis (PCA) data that identified three distinct groups indicating, efficiently, metabolic differences between organs of M. urundeuva. Through discriminatory analysis of the orthogonal partial least squares (OPLS-DA), the variable of importance in the projection (VIP) and S-Plot, we were able to determine 30 potential biomarkers. The fingerprint of hydroethanolic extracts was correlated with the cytotoxicity assay and demonstrated a significant difference in the composition of plant extract.

https://doi.org/10.21577/0103-5053.20190242 361 downloads

15.

Epidemiologia e desfecho dos pacientes de alto risco cirúrgico admitidos em unidades de terapia intensiva no Brasil
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Silva Júnior, João Manoel

; Chaves, Renato Carneiro de Freitas

; Corrêa, Thiago Domingos

; Assunção, Murillo Santucci Cesar de

; Katayama, Henrique Tadashi

; Bosso, Fabio Eduardo

; Amendola, Cristina Prata

; Serpa Neto, Ary

; Malbouisson, Luiz Marcelo Sá

; Oliveira, Neymar Elias de

; Veiga, Viviane Cordeiro

; Rojas, Salomón Soriano Ordinola

; Postalli, Natalia Fioravante

; Alvarisa, Thais Kawagoe

; Lucena, Bruno Melo Nobrega de

; Oliveira, Raphael Augusto Gomes de

; Sanches, Luciana Coelho

; Silva, Ulysses Vasconcellos de Andrade e

; Nassar Junior, Antonio Paulo

; Réa-Neto, Álvaro

; Amaral, Alexandre

; Teles, José Mário

; Freitas, Flávio Geraldo Rezende de

; Bafi, Antônio Tonete

; Pacheco, Eduardo Souza

; Ramos, Fernando José

; Vieira Júnior, José Mauro

; Pereira, Maria Augusta Santos Rahe

; Schwerz, Fábio Sartori

; Menezes, Giovanna Padoa de

; Magalhães, Danielle Dourado

; Castro, Cristine Pilati Pileggi

; Henrich, Sabrina Frighetto

; Toledo, Diogo Oliveira

; Parra, Bruna Fernanda Camargo Silva

; Dias, Fernando Suparregui

; Zerman, Luiza

; Formolo, Fernanda

; Nobrega, Marciano de Sousa

; Piras, Claudio

; Piras, Stéphanie de Barros

; Conti, Rodrigo

; Bittencourt, Paulo Lisboa

; D’Oliveira, Ricardo Azevedo Cruz

; Estrela, André Ricardo de Oliveira

; Oliveira, Mirella Cristine de

; Reese, Fernanda Baeumle

; Motta Júnior, Jarbas da Silva

; Câmara, Bruna Martins Dzivielevski da

; David-João, Paula Geraldes

; Tannous, Luana Alves

; Chaiben, Viviane Bernardes de Oliveira

; Miranda, Lorena Macedo Araújo

; Brasil, José Arthur dos Santos

; Deucher, Rafael Alexandre de Oliveira

; Ferreira, Marcos Henrique Borges

; Vilela, Denner Luiz

; Almeida, Guilherme Cincinato de

; Nedel, Wagner Luis

; Passos, Matheus Golenia dos

; Marin, Luiz Gustavo

; Oliveira Filho, Wilson de

; Coutinho, Raoni Machado

; Oliveira, Michele Cristina Lima de

; Friedman, Gilberto

; Meregalli, André

; Höher, Jorge Amilton

; Soares, Afonso José Celente

; Lobo, Suzana Margareth Ajeje

Revista Brasileira de Terapia Intensiva

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mar 2020, Volume 32 N. 1 Pages 17 - 27

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

RESUMO Objetivo: Definir o perfil epidemiológico e os principais determinantes de morbimortalidade dos pacientes cirúrgicos não cardíacos de alto risco no Brasil. Métodos: Estudo prospectivo, observacional e multicêntrico. Todos os pacientes cirúrgicos não cardíacos admitidos nas unidades de terapia intensiva, ou seja, considerados de alto risco, no período de 1 mês, foram avaliados e acompanhados diariamente por, no máximo, 7 dias na unidade de terapia intensiva, para determinação de complicações. As taxas de mortalidade em 28 dias de pós-operatório, na unidade de terapia intensiva e hospitalar foram avaliadas. Resultados: Participaram 29 unidades de terapia intensiva onde foram realizadas cirurgias em 25.500 pacientes, dos quais 904 (3,5%) de alto risco (intervalo de confiança de 95% - IC95% 3,3% - 3,8%), tendo sido incluídos no estudo. Dos pacientes envolvidos, 48,3% eram de unidades de terapia intensiva privadas e 51,7% de públicas. O tempo de internação na unidade de terapia intensiva foi de 2,0 (1,0 - 4,0) dias e hospitalar de 9,5 (5,4 - 18,6) dias. As taxas de complicações foram 29,9% (IC95% 26,4 - 33,7) e mortalidade em 28 dias pós-cirurgia 9,6% (IC95% 7,4 - 12,1). Os fatores independentes de risco para complicações foram Simplified Acute Physiology Score 3 (SAPS 3; razão de chance − RC = 1,02; IC95% 1,01 - 1,03) e Sequential Organ Failure Assessment Score (SOFA) da admissão na unidade de terapia intensiva (RC =1,17; IC95% 1,09 - 1,25), tempo de cirurgia (RC = 1,001; IC95% 1,000 - 1,002) e cirurgias de emergências (RC = 1,93; IC95% 1,10 - 3,38). Em adição, foram associados com mortalidade em 28 dias idade (RC = 1,032; IC95% 1,011 - 1,052) SAPS 3 (RC = 1,041; IC95% 1,107 - 1,279), SOFA (RC = 1,175; IC95% 1,069 - 1,292) e cirurgias emergenciais (RC = 2,509; IC95% 1,040 - 6,051). Conclusão: Pacientes com escores prognósticos mais elevados, idosos, tempo cirúrgico e cirurgias emergenciais estiveram fortemente associados a maior mortalidade em 28 dias e mais complicações durante permanência em unidade de terapia intensiva.

ABSTRACT Objective: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. Methods: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. Results: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). Conclusion: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.

https://doi.org/10.5935/0103-507x.20200005 1048 downloads

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issn	journal ISSN
in	SciELO colection code (e.g. scl - Brasil, col - Colômbia)
use_license	article usage license code

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