Objective: to measure reaction times (RT) to different frequencies of electrical sinusoidal curre... more Objective: to measure reaction times (RT) to different frequencies of electrical sinusoidal current stimulation. Methods: RTs were measured from 20 healthy volunteers (7 men). Electrical sinusoidal currents of 5, 250 and 2000 Hz at 1.1 sensory thresholds (ST) and also at 2ST for 5 Hz, were applied to the left index finger; responses were measure through the EMG responses of the right indicis proprius muscle. Results: The mean RT (range) obtained from fastest responses were significantly different, 0.57 (0.16 to 1.60) s, 0.34 (0.12 to 0.71) s and 0.22 (0.08 to 0.35) s, for responses to 5, 250 and 2000 Hz respectively and for 5 Hz at 2ST 0.22 (0.11 to 0.34) s. Conclusion: At. 1.1ST the RT elicited by sinusoidal electrical currents at different frequencies are mediated by different spectrum of fibers suggesting that 2000 Hz stimulates Aâ fibers, 250 Hz Aâ or Aä fibers, 5 Hz Aâ, Aä or C fibers and 5 Hz at 2ST stimulates Aâ fibers. Significance: Different frequencies of stimulation may a...
Mechanisms of heart failure deterioration / Heart failure care and quality of life 125 Conclusion... more Mechanisms of heart failure deterioration / Heart failure care and quality of life 125 Conclusion: Longitudinal strain is reduced in FRDA despite normal LVEF, indicative of subclinical cardiac dysfunction. Given late declines in LVEF in FRDA, longitudinal strain may provide an earlier index of myocardial dysfunction in FRDA.
Purpose: To examine accuracy of Emergency Department (ED) physicians and N-terminal (NT) proBNP l... more Purpose: To examine accuracy of Emergency Department (ED) physicians and N-terminal (NT) proBNP levels for diagnosing heart failure (HF) in a contemporary cohort of patients hospitalised with acute dyspnoea. Methods: We included 314 consecutive patients with dyspnoea and collected the probability of HF (0-100%) from the ED physicians prior to NT-proBNP measurements. HF was adjudicated according to guidelines by two independent senior physicians. Among non-HF related hospitalisations we also assessed whether there was coexisting myocardial dysfunction, e.g. patient with HF hospitalised due to pneumonia. Results: Mean age was 70±1 y and 143 patients (46%) were diagnosed with HF as the cause of the hospitalisation, of whom 52 patients (36%) had left ventricular ejection fraction≥50%. Several variables previously reported to be predictive of HF were independently associated with a diagnosis of HF in our patients, including NT-proBNP levels. The area under the curve (AUC) for ED physician to differentiate HF patients from the other patients was 0.864 (95% CI 0.821-0.900) compared to AUC=0.859 (0.816-0.896) for NT-proBNP levels, p=0.84. Excluding the patients with non-HF related hospitalisation but coexisting myocardial dysfunction (n=55) improved the AUC for both ED physicians and NT-proBNP levels: 0.898 (0.854-0.932) vs. 0.926 (0.887-0.955), respectively, p=0.17. Conclusion: The accuracy of ED physicians and NT-proBNP for diagnosing HF were sub-optimal in this cohort of elderly subjects hospitalised for acute dyspnoea compared to previous studies, which primarily was caused by a high proportion of coexisting myocardial dysfunction also in the group of patients with non-HF aetiology of the index hospitalisation. P669 | BEDSIDE Repeated echocardiography after first ever ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention, is it necessary
To determine whether 5 Hz and 2000 Hz sinusoidal electric currents evoke different sensations and... more To determine whether 5 Hz and 2000 Hz sinusoidal electric currents evoke different sensations and to indirectly evaluate which peripheral nerve fibers are stimulated by these different frequencies. One hundred and fifty subjects chose three among eight descriptors of sensations evoked by 5 Hz and 2000 Hz currents and the results were submitted to factor analysis. In 20 subjects, reaction times to 5, 250 and 2000 Hz currents were determined at 1.1 x ST and reaction times to 5 Hz currents were also determined at 2 x ST. Responses were grouped in four factors: Factor 1, which loaded mainly in descriptors related to tweezers stimulation, was higher than the other factors during 2000 Hz stimulation at 1.5 x ST. Factor 2, which loaded mainly in descriptors related to needle stimulation, was higher than the other factors during 5 Hz stimulation. Factor 1 increased and Factor 2 decreased with an increase in 5 Hz intensity from 1.5 to 4x ST. Reaction times measured from the fastest responses were significantly different: 0.57 s (0.16 to 1.60), 0.34 s (0.12 to 0.71) and 0.22s (0.08 to 0.35) for 5, 250 and 2000 Hz, respectively, and 0.22s (0.11 to 0.34) for 5 Hz at 2 x ST. Sinusoidal electrical stimulation of 5 Hz and 2000 Hz evoke different sensations. At juxta-threshold intensities, RT measurements suggest that 2000 Hz stimulates Abeta-fibers, 250 Hz Abeta- or A partial differential-fibers, 5 Hz Abeta-, A partial differential- or C-fibers. The fiber type, which was initially stimulated by the lower frequencies, depended on inter-individual differences.
Background Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an und... more Background Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an underdiagnosed disease. The clinical presentation can be highly variable. It typically presents with isolated classic orthostatic headache complaints, but patients can develop significant complications such as cerebral venous thrombosis (CVT). Objective To report 3 cases of SIH diagnosis admitted and treated in a tertiary-level neurology ward. Methods Review of the medical files of three patients and description of clinical and surgical outcomes. Results Three female patients with SIH with a mean age of 25.6 ± 10.0 years old. The patients had orthostatic headache, and one of them presented with somnolence and diplopia because of a CVT. Brain magnetic resonance imaging (MRI) ranges from normal findings to classic findings of SIH as pachymeningeal enhancement and downward displacement of the cerebellar tonsils. Spine MRI showed abnormal epidural fluid collections in all cases, and computed to...
As neuropatias, frequentemente, desafiam os neurologistas devido aos variados diagnósticos etioló... more As neuropatias, frequentemente, desafiam os neurologistas devido aos variados diagnósticos etiológicos. Na maioria dos casos exigem dispendiosos recursos financeiros e de tempo aplicados ao diagnóstico, bem como na escolha de uma abordagem terapêutica eficaz, podendo ocasionar grandes prejuízos à qualidade de vida dos pacientes. Neste artigo, fornecemos uma visão da abordagem diagnóstica aplicada no Setor de Investigação e Tratamento de Doenças Neuromusculares da Universidade Federal de São Paulo (UNIFESP), com o intuito de direcionarmos o raciocínio clínico, com base nos aspectos clínicos e anatômicos individuais de cada paciente.
and maintaining temperatures, and deficiencies in maintenance of equipment. PROJECT: The CMS surv... more and maintaining temperatures, and deficiencies in maintenance of equipment. PROJECT: The CMS survey Results stressed the importance of training staff to prevent foodborne illnesses. Infection Prevention rounded with management daily in order to help identify areas of improvement, and offer guidance to management in an effort to better protect our patients, visitors, and staff from behaviors that could result in foodborne illnesses. They became certified food managers, assisted in the development of an audit tool, ensured proper maintenance of equipment, and providing “just in time” training on the federal and state food code. RESULTS: Critical food code violations were identified during the daily rounds. These findings prompted immediate process changes and staff education with ongoing monitoring and feedback to ensure retention and implementation of knowledge. Other interventions included more effective labeling, maintaining proper time and temperature controls, developing a pest control plan, and enhanced cleaning and sanitizing in nutrition services. LESSON LEARNED: Regular infection prevention rounding of Nutrition Services Departmentwill continue to ensure that the food products provided to our patients, visitors, and staff is safe to consume. By increasing the rounding and providing immediate intervention, with routine checks, the systematic approach to food preparation, service, and storage has improved, which creates a safer facility for patients and employees alike.
Case rePOrT ERR, a male patient of 58 years old, initiated gradual bilateral facial paresis, dysp... more Case rePOrT ERR, a male patient of 58 years old, initiated gradual bilateral facial paresis, dysphonia and dysphagia at 47 years of age. Upon examination, the patient presented asymmetrical peripheral facial paresis (left > right) and reduced vibratory sensitivity in the lower limbs. The general clinical examination was normal, except for flaccid facial skin forming folds (cutis laxa). There was a similar positive familiar history which suggested autosomal dominant inheritance. The complementary exams were normal brain and trunk magnetic resonance imaging (MRI); electromyographic study (EMG) with axonal pattern of
We report a 30-year-old man with moving ear syndrome caused by focal myoclonic jerks of the right... more We report a 30-year-old man with moving ear syndrome caused by focal myoclonic jerks of the right temporal muscle. This focal myoclonus would disappear while the patient was sleeping, swallowing, or speaking. He was treated with botulinum toxin type A with a favorable outcome. Previous reports of this condition and possible therapeutic approaches are discussed.
Homocistinúria apresentando-se como trombose venosa cerebral é incomum. Relatamos o caso de um ad... more Homocistinúria apresentando-se como trombose venosa cerebral é incomum. Relatamos o caso de um adolescente com características fenotípicas de homocistinúria que foi admitido por cefaléia intensa, vômitos e sonolência. Investigação diagnóstica com tomografia computadorizada de crânio, ressonância magnética e angiorressonância foi compatível com trombose dos seios transversos e sigmóides. Altos níveis de homocisteína foram detectados no sangue e na urina. Apresentamos os aspectos clínicos e radiológicos deste caso discutindo a controversa fisiopatologia da tendência trombofílica associada a homocistinúria.
The aim of this study was to compare the outcomes of nerve autografts (GRF) and venous grafts con... more The aim of this study was to compare the outcomes of nerve autografts (GRF) and venous grafts containing mononuclear bone marrow cells (BMCs) in sciatic nerve-lesioned rats. Control animals underwent sham operations (SHAM), received empty venous grafts (EPV), or received venous grafts containing BMC vehicle (AGR). Outcome was evaluated through sciatic functional index (SFI), morphometric and morphologic analyses of the nerve distal to the lesion, and the number of spinal cord motor neurons positive for the retrograde tracer, Fluoro-Gold ® . All groups exhibited poor results in SFI when compared to SHAM animals throughout the postoperative period. All groups also had a significantly greater fiber density, decreased fiber diameter, and decreased motor neuron number than the SHAM group. No significant difference between the GRF and BMC groups was observed in any of these parameters. On the other hand, vessel density was significantly higher in BMC than all other groups. BMC-containing venous grafts are superior to nerve autografts in increasing vessel density during sciatic nerve regeneration.
Objective: to measure reaction times (RT) to different frequencies of electrical sinusoidal curre... more Objective: to measure reaction times (RT) to different frequencies of electrical sinusoidal current stimulation. Methods: RTs were measured from 20 healthy volunteers (7 men). Electrical sinusoidal currents of 5, 250 and 2000 Hz at 1.1 sensory thresholds (ST) and also at 2ST for 5 Hz, were applied to the left index finger; responses were measure through the EMG responses of the right indicis proprius muscle. Results: The mean RT (range) obtained from fastest responses were significantly different, 0.57 (0.16 to 1.60) s, 0.34 (0.12 to 0.71) s and 0.22 (0.08 to 0.35) s, for responses to 5, 250 and 2000 Hz respectively and for 5 Hz at 2ST 0.22 (0.11 to 0.34) s. Conclusion: At. 1.1ST the RT elicited by sinusoidal electrical currents at different frequencies are mediated by different spectrum of fibers suggesting that 2000 Hz stimulates Aâ fibers, 250 Hz Aâ or Aä fibers, 5 Hz Aâ, Aä or C fibers and 5 Hz at 2ST stimulates Aâ fibers. Significance: Different frequencies of stimulation may a...
Mechanisms of heart failure deterioration / Heart failure care and quality of life 125 Conclusion... more Mechanisms of heart failure deterioration / Heart failure care and quality of life 125 Conclusion: Longitudinal strain is reduced in FRDA despite normal LVEF, indicative of subclinical cardiac dysfunction. Given late declines in LVEF in FRDA, longitudinal strain may provide an earlier index of myocardial dysfunction in FRDA.
Purpose: To examine accuracy of Emergency Department (ED) physicians and N-terminal (NT) proBNP l... more Purpose: To examine accuracy of Emergency Department (ED) physicians and N-terminal (NT) proBNP levels for diagnosing heart failure (HF) in a contemporary cohort of patients hospitalised with acute dyspnoea. Methods: We included 314 consecutive patients with dyspnoea and collected the probability of HF (0-100%) from the ED physicians prior to NT-proBNP measurements. HF was adjudicated according to guidelines by two independent senior physicians. Among non-HF related hospitalisations we also assessed whether there was coexisting myocardial dysfunction, e.g. patient with HF hospitalised due to pneumonia. Results: Mean age was 70±1 y and 143 patients (46%) were diagnosed with HF as the cause of the hospitalisation, of whom 52 patients (36%) had left ventricular ejection fraction≥50%. Several variables previously reported to be predictive of HF were independently associated with a diagnosis of HF in our patients, including NT-proBNP levels. The area under the curve (AUC) for ED physician to differentiate HF patients from the other patients was 0.864 (95% CI 0.821-0.900) compared to AUC=0.859 (0.816-0.896) for NT-proBNP levels, p=0.84. Excluding the patients with non-HF related hospitalisation but coexisting myocardial dysfunction (n=55) improved the AUC for both ED physicians and NT-proBNP levels: 0.898 (0.854-0.932) vs. 0.926 (0.887-0.955), respectively, p=0.17. Conclusion: The accuracy of ED physicians and NT-proBNP for diagnosing HF were sub-optimal in this cohort of elderly subjects hospitalised for acute dyspnoea compared to previous studies, which primarily was caused by a high proportion of coexisting myocardial dysfunction also in the group of patients with non-HF aetiology of the index hospitalisation. P669 | BEDSIDE Repeated echocardiography after first ever ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention, is it necessary
To determine whether 5 Hz and 2000 Hz sinusoidal electric currents evoke different sensations and... more To determine whether 5 Hz and 2000 Hz sinusoidal electric currents evoke different sensations and to indirectly evaluate which peripheral nerve fibers are stimulated by these different frequencies. One hundred and fifty subjects chose three among eight descriptors of sensations evoked by 5 Hz and 2000 Hz currents and the results were submitted to factor analysis. In 20 subjects, reaction times to 5, 250 and 2000 Hz currents were determined at 1.1 x ST and reaction times to 5 Hz currents were also determined at 2 x ST. Responses were grouped in four factors: Factor 1, which loaded mainly in descriptors related to tweezers stimulation, was higher than the other factors during 2000 Hz stimulation at 1.5 x ST. Factor 2, which loaded mainly in descriptors related to needle stimulation, was higher than the other factors during 5 Hz stimulation. Factor 1 increased and Factor 2 decreased with an increase in 5 Hz intensity from 1.5 to 4x ST. Reaction times measured from the fastest responses were significantly different: 0.57 s (0.16 to 1.60), 0.34 s (0.12 to 0.71) and 0.22s (0.08 to 0.35) for 5, 250 and 2000 Hz, respectively, and 0.22s (0.11 to 0.34) for 5 Hz at 2 x ST. Sinusoidal electrical stimulation of 5 Hz and 2000 Hz evoke different sensations. At juxta-threshold intensities, RT measurements suggest that 2000 Hz stimulates Abeta-fibers, 250 Hz Abeta- or A partial differential-fibers, 5 Hz Abeta-, A partial differential- or C-fibers. The fiber type, which was initially stimulated by the lower frequencies, depended on inter-individual differences.
Background Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an und... more Background Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an underdiagnosed disease. The clinical presentation can be highly variable. It typically presents with isolated classic orthostatic headache complaints, but patients can develop significant complications such as cerebral venous thrombosis (CVT). Objective To report 3 cases of SIH diagnosis admitted and treated in a tertiary-level neurology ward. Methods Review of the medical files of three patients and description of clinical and surgical outcomes. Results Three female patients with SIH with a mean age of 25.6 ± 10.0 years old. The patients had orthostatic headache, and one of them presented with somnolence and diplopia because of a CVT. Brain magnetic resonance imaging (MRI) ranges from normal findings to classic findings of SIH as pachymeningeal enhancement and downward displacement of the cerebellar tonsils. Spine MRI showed abnormal epidural fluid collections in all cases, and computed to...
As neuropatias, frequentemente, desafiam os neurologistas devido aos variados diagnósticos etioló... more As neuropatias, frequentemente, desafiam os neurologistas devido aos variados diagnósticos etiológicos. Na maioria dos casos exigem dispendiosos recursos financeiros e de tempo aplicados ao diagnóstico, bem como na escolha de uma abordagem terapêutica eficaz, podendo ocasionar grandes prejuízos à qualidade de vida dos pacientes. Neste artigo, fornecemos uma visão da abordagem diagnóstica aplicada no Setor de Investigação e Tratamento de Doenças Neuromusculares da Universidade Federal de São Paulo (UNIFESP), com o intuito de direcionarmos o raciocínio clínico, com base nos aspectos clínicos e anatômicos individuais de cada paciente.
and maintaining temperatures, and deficiencies in maintenance of equipment. PROJECT: The CMS surv... more and maintaining temperatures, and deficiencies in maintenance of equipment. PROJECT: The CMS survey Results stressed the importance of training staff to prevent foodborne illnesses. Infection Prevention rounded with management daily in order to help identify areas of improvement, and offer guidance to management in an effort to better protect our patients, visitors, and staff from behaviors that could result in foodborne illnesses. They became certified food managers, assisted in the development of an audit tool, ensured proper maintenance of equipment, and providing “just in time” training on the federal and state food code. RESULTS: Critical food code violations were identified during the daily rounds. These findings prompted immediate process changes and staff education with ongoing monitoring and feedback to ensure retention and implementation of knowledge. Other interventions included more effective labeling, maintaining proper time and temperature controls, developing a pest control plan, and enhanced cleaning and sanitizing in nutrition services. LESSON LEARNED: Regular infection prevention rounding of Nutrition Services Departmentwill continue to ensure that the food products provided to our patients, visitors, and staff is safe to consume. By increasing the rounding and providing immediate intervention, with routine checks, the systematic approach to food preparation, service, and storage has improved, which creates a safer facility for patients and employees alike.
Case rePOrT ERR, a male patient of 58 years old, initiated gradual bilateral facial paresis, dysp... more Case rePOrT ERR, a male patient of 58 years old, initiated gradual bilateral facial paresis, dysphonia and dysphagia at 47 years of age. Upon examination, the patient presented asymmetrical peripheral facial paresis (left > right) and reduced vibratory sensitivity in the lower limbs. The general clinical examination was normal, except for flaccid facial skin forming folds (cutis laxa). There was a similar positive familiar history which suggested autosomal dominant inheritance. The complementary exams were normal brain and trunk magnetic resonance imaging (MRI); electromyographic study (EMG) with axonal pattern of
We report a 30-year-old man with moving ear syndrome caused by focal myoclonic jerks of the right... more We report a 30-year-old man with moving ear syndrome caused by focal myoclonic jerks of the right temporal muscle. This focal myoclonus would disappear while the patient was sleeping, swallowing, or speaking. He was treated with botulinum toxin type A with a favorable outcome. Previous reports of this condition and possible therapeutic approaches are discussed.
Homocistinúria apresentando-se como trombose venosa cerebral é incomum. Relatamos o caso de um ad... more Homocistinúria apresentando-se como trombose venosa cerebral é incomum. Relatamos o caso de um adolescente com características fenotípicas de homocistinúria que foi admitido por cefaléia intensa, vômitos e sonolência. Investigação diagnóstica com tomografia computadorizada de crânio, ressonância magnética e angiorressonância foi compatível com trombose dos seios transversos e sigmóides. Altos níveis de homocisteína foram detectados no sangue e na urina. Apresentamos os aspectos clínicos e radiológicos deste caso discutindo a controversa fisiopatologia da tendência trombofílica associada a homocistinúria.
The aim of this study was to compare the outcomes of nerve autografts (GRF) and venous grafts con... more The aim of this study was to compare the outcomes of nerve autografts (GRF) and venous grafts containing mononuclear bone marrow cells (BMCs) in sciatic nerve-lesioned rats. Control animals underwent sham operations (SHAM), received empty venous grafts (EPV), or received venous grafts containing BMC vehicle (AGR). Outcome was evaluated through sciatic functional index (SFI), morphometric and morphologic analyses of the nerve distal to the lesion, and the number of spinal cord motor neurons positive for the retrograde tracer, Fluoro-Gold ® . All groups exhibited poor results in SFI when compared to SHAM animals throughout the postoperative period. All groups also had a significantly greater fiber density, decreased fiber diameter, and decreased motor neuron number than the SHAM group. No significant difference between the GRF and BMC groups was observed in any of these parameters. On the other hand, vessel density was significantly higher in BMC than all other groups. BMC-containing venous grafts are superior to nerve autografts in increasing vessel density during sciatic nerve regeneration.
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