RESUMO Objetivo: Verificar a segurança, a efetividade e a reprodutibilidade da triagem de pacientes potencialmente neurocirúrgicos feita por smartphones. Métodos: Estudo retrospectivo e multicêntrico. Dados de prontuários dos pacientes submetidos à avaliação neurocirúrgica de urgência foram coletados e comparados com a avaliação realizada por neurocirurgiões por meio de smartphones, determinando a capacidade de identificar alterações na tomografia computadorizada de crânio, pacientes potencialmente graves e necessidade de transferência. Resultados: Foram analisados 232 casos. O principal diagnóstico foi traumatismo crânio encefálico, com 119 casos (51,3%). Destes, 105 (45,3%) tiveram alta após a avaliação. Os avaliadores por telemedicina apresentaram acurácia de 95,69% para identificação de alteração na tomografia computadorizada, com concordância de 0,858. Com relação à identificação de gravidade, a acurácia foi de 95,26%, com concordância de 0,858. Com relação à conduta, os avaliadores apresentaram concordância de 0,672, aumentando para 100% nos casos de tratamento cirúrgico. Conclusão: O uso da telemedicina em nosso estudo foi seguro, efetivo e reprodutível para triagem dos pacientes com afecções neurológicas agudas. A implementação do método tem potencial de impacto na melhora do resultado para o paciente devido à redução das transferências desnecessárias e do tempo até o atendimento.

ABSTRACT Objective: To ascertain the safety, effectiveness and reproducibility of screening potential neurosurgical patients by means of smartphones. Methods: This is a retrospective and multicentric study. Data were collected from the medical records of patients subjected to real emergency neurosurgical evaluations and compared with assessments by neurosurgeons using smartphones to determine the feasibility of identifying changes in cranial computed tomography scans, potentially serious conditions of patients, and the need for transfer to reference centers. Results: We analyzed 232 cases. The main diagnosis was traumatic brain injury, with 119 cases (51.3%). Of this, 105 (45.3%) patients were discharged immediately after the assessment. The telemedicine evaluators presented 95.69% accuracy in the identification of changes in computed tomography scans, with 0.858 concordance. Accuracy in the identification of severity was 95.26%, with 0.858 concordance. As for procedure, the concordance among evaluators was 0.672, increasing to 100% in cases that required surgical treatment. Conclusion: Our study indicated that the use of telemedicine for screening patients with acute neurological disorders was safe, effective and reproducible. Implementation of the method shows a promising potential to improve the patient's outcome by reducing unnecessary transfers and decreasing the time elapsed until a specialist can be consulted.

O objetivo desta pesquisa é validar um sistema de automação de níveis digitais, desenvolvido em uma tese de doutorado (Andolfato, 2010) e apresentado ao curso de pós-graduação em ciências Geodésicas da UFPR. O procedimento de validação consiste em utilizar o nível digital através do nivelamento geométrico pelo método das visadas extremas para determinar desníveis entre alvos distribuídos com diferentes distâncias em relação ao nível. A simulação do recalque foi realizada através de pinos fixados em várias colunas, em diferentes alturas. A primeira fase consistiu em determinar os desníveis e consequentemente os recalques com o sistema convencional, utilizando um técnico como observador. Posteriormente estes mesmos recalques foram determinados utilizando o SAND (Sistema de Automação de Nível Digital). Depois de concluídos os levantamentos, os resultados obtidos com o SAND foram comparados com os do levantamento convencional e constatou-se que as diferenças de valores entre os recalques detectados/calculados por ambos os métodos variaram no décimo do milímetro. As variâncias dos recalques calculados, em ambos os métodos, foram testadas utilizando o teste F de Snedecor ao nível de significância de 5% e constatou-se que a maioria dos resultados passou no teste de hipótese, ou seja, foram determinados com o mesmo grau de precisão.

The main goal of this research is to validate a digital level automation system developed in a PhD. Thesis by Andolfato (2010) and presented to the Geodetic Science postgraduate program from Federal University of Paraná. The validation procedure consists in applying the digital level to determine height differences between targets distributed at different distances in relation to the digital level. Settlements simulations were performed by fixing pins in several wall columns at different heights. In the first stage the height differences and consequently the settlements were determinated by the conventional leveling method where observations were acquired by a qualified technical. Afterwards, these same differences were determined using the method named SAND - Sistema de Automação de Nível Digital (Digital Level Automation System). After finished the surveyings, the results obtained by the SAND method were compared with results from conventional method and it was observed differences within the tenth of millimeter in the computed settlements. The variances of the height differences in both cases were tested using the F- Snedecor test, at a significance level of 5%, and most values were approved, what means that they were determined with the same degree of precision

OBJECTIVES: To study pre and postoperative WMA in MTLE patients. METHODS: We performed Voxel-Based Morphometry (VBM) with volume of interest (VOI) in 69 controls (mean age, 34.3±11.1 years) and 67 operated patients (mean age, 34.1±10.4 years) with unilateral MTLE. 34 became seizure-free (SzFree-Group), 23 improved (Engel IB-IIA [Partial recovery-group]) and 10 did not improve (Engel III-IV [Failure-Group]). All had pre and postoperative MRIs (one year minimum). We flipped MRIs of right MTLE patients in order to avoid right-to-left analysis cancelation. VBM was performed on SPM2/MATLAB7.0 with individual masks for surgical lacunae and 1% false-discovery-rate to control for multiple comparisons. We used MARSbar <www.marsbar.sourceforge.net> routine to select ROIs and t-test for statistical analyses. RESULTS: Mean postoperative follow-up was 60.2 (±SD 30.7) months. On baseline MRI, SzFree-Group showed White Matter Atrophy (WMA) involving temporal lobes [TL], ipsilateral occipital, parietal and frontal regions, with areas of significant recovery of WMA on postoperative MRI. Partial recovery-Group presented a more restricted pattern of WMA, involving ipsilateral temporal lobe, contralateral superior temporal gyrus and few areas in bilateral cingulated and orbitofrontal areas. In this group we also identified areas with relative increase of WM after surgery. By contrast, Failure-Group showed more widespread bi-hemispheric areas of WMA on baseline MRI without postoperative improvement. CONCLUSIONS: Although we have identified some differences in baseline WMA, we were unable to correlate a more widespread pattern with a worse prognosis, as SzFree-Group, also presented a bilateral distribution of WMA. The recovery of WMA in SzFree-Group and Partial recovery-group is in agreement with previous MRS and PET studies and suggests that a network of neuronal dysfunction in MTLE can be, at least in part, reversible after successful postoperative seizure control.