Although the scientific community has focused on the effects of concussions in contact sports, the role of subconcussive impacts, as it can occur during soccer heading, has recently gained attention, considering that it may represent an additional mechanism of cumulative brain injury. The aim of this study is to investigate the effects of soccer heading on cognitive functioning in active professional soccer players. Male soccer players (n = 44), from two soccer teams that play in the Brazilian A Series Championship, and non-athletes (n = 47), comparable in age and education, were submitted to cognitive assessment, consisting of computerized and conventional neuropsychological testing (Neupsilin battery). In the computerized cognitive assessment, soccer players performed better than controls on reaction time measures in general motor coordination, executive functioning and memory tests, and on accuracy measures in executive functioning tests. There were no significant differences between groups on the Neupsilin battery. A comparison between two sub-groups of soccer players, based on the self-reported number of headings, did not show significant differences on tests performance. No significant correlations were found between an estimate of exposure to heading during professional soccer career and cognitive performance. Our data demonstrate no evidence of cognitive impairment in soccer players, compared to non-athletes, and no association between heading exposure and performance on neuropsychological tests. Longitudinal investigations, including neuroimaging assessment, will help to clarify whether soccer heading may be associated with brain injury and cognitive dysfunction.
Objective: To identify the reasons for seeking the Pediatric Emergency Room (PER) of a city in the state of São Paulo and define the profile of users who seek the service. Metodology: Observational prospective study conducted from February to August 2021, through structured interviews with guardians of children taken to the PSP with a form developed for the research containing sociodemographic and clinical information, in addition to the emergency classification at the time of triage. Data were presented as mean ± standard deviation (SD) or absolute frequency and percentage. Results: A total of 252 caregivers were interviewed, with the majority being mothers (76.2%) or fathers (15.9%), with a mean age of 32 years (SD=±8.7). High or moderate level of concern about the childs health status was answered by 91.6% of caregivers, although most cases were classified at screening as minor or not urgent (77.3%). Conclusion: The level of concern of the caregiver and the belief that PER provides more effective care motivated the non-urgent search for this service. The data reflect the need for health education to raise awareness of the flow of care in the Unified Health System, identifying primary health care as the gateway to the system and the PER as a place intended for urgent and emergency care. Ultimately, it is intended to contribute to the provision of care in a qualified manner to the comprehensive health of the child.
Abstract Background Observational studies support a role for oral anticoagulation to reduce the risk of dementia in atrial fibrillation patients, but conclusive data are lacking. Since dabigatran offers a more stable anticoagulation, we hypothesized it would reduce cognitive decline when compared to warfarin in old patients with atrial fibrillation. Methods The GIRAF trial was a 24-month, randomized, parallel-group, controlled, open-label, hypothesis generating trial. The trial was done in six centers including a geriatric care unit, secondary and tertiary care cardiology hospitals in São Paulo, Brazil. We included patients aged ≥ 70 years and CHA2DS2-VASc score > 1. The primary endpoint was the absolute difference in cognitive performance at 2 years. Patients were assigned 1:1 to take dabigatran (110 or 150 mg twice daily) or warfarin, controlled by INR and followed for 24 months. Patients were evaluated at baseline and at 2 years with a comprehensive and thorough cognitive evaluation protocol of tests for different cognitive domains including the Montreal Cognitive Assessment (MoCA), Mini-Mental State Exam (MMSE), a composite neuropsychological test battery (NTB), and computer-generated tests (CGNT). Results Between 2014 and 2019, 5523 participants were screened and 200 were assigned to dabigatran ( N = 99) or warfarin ( N = 101) treatment. After adjustment for age, log of years of education, and raw baseline score, the difference between the mean change from baseline in the dabigatran group minus warfarin group was − 0.12 for MMSE (95% confidence interval [CI] − 0.88 to 0.63; P = 0.75), 0.05 (95% CI − 0.07 to 0.18; P = 0.40) for NTB, − 0.15 (95% CI − 0.30 to 0.01; P = 0.06) for CGNT, and − 0.96 (95% CI − 1.80 to 0.13; P = 0.02) for MoCA, with higher values suggesting less cognitive decline in the warfarin group. Conclusions For elderly patients with atrial fibrillation, and without cognitive compromise at baseline that did not have stroke and were adequately treated with warfarin (TTR of 70%) or dabigatran for 2 years, there was no statistical difference at 5% significance level in any of the cognitive outcomes after adjusting for multiple comparisons. Trial registration Cognitive Impairment Related to Atrial Fibrillation Prevention Trial (GIRAF), NCT01994265 .
<p class="abstract"><strong>Background:</strong> Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with cognitive impairment and dementia. Cognitive and functional impairments have been neglected in clinical trials with patients affected by AF. Dabigatran is a new drug, which can offer a more stable long-term anticoagulant therapy compared to warfarin. This advantage could be associated with a minor incidence of cognitive and functional decline. The objective of the study is to evaluate the effects of dabigatran compared with warfarin on cognitive and functional impairments, thrombin production, bleeding occurrence and cerebrovascular complications in elderly patients with AF.</p><p class="abstract"><strong>Methods:</strong> A randomized, prospective parallel, two-center, active-controlled trial will be performed in a sample of 200 patients with AF randomly designated to take dabigatran (150 mg twice daily) or warfarin (once daily, dose controlled by INR between 2 and 3). After one and two years, subjects will be assessed considering cognitive outcomes. Additionally, patients will be submitted to brain magnetic resonance imaging (MRI) at the beginning and ending of study to identify possible cerebrovascular events, as well as carotid ultrasonography to search for atherosclerotic disease.</p><strong>Conclusions:</strong> The GIRAF study expects to provide data about prevention of cognitive and functional impairments among patients on anticoagulant therapy for AF, and to explore new concepts on potential prevention of cognitive decline and benefits for AF patients and their relatives.
Abstract Background Soccer is the most popular sport worldwide and the only sport in which participants purposely hit the ball with their head. Although researchers have focused on the effects of concussions in contact sports, the role of sub‐concussive impacts (e.g. heading), has gained attention. The aim of this ongoing longitudinal study is to investigate the effects of soccer heading on cognitive functioning in active soccer players. Method Male professional soccer players (n=22), from two teams playing in the Brazilian championship, and non‐athletes (n=37), matched by age and education, were submitted to computerized (E‐Prime software) and conventional (NEUPSILIN battery) cognitive assessment. All subjects were tested on two occasions – T0 and T1 – separated by a one‐year interval. Result In T0, players performed better than controls on three variables of computerized testing – reaction time and accuracy in executive functioning tests – and on two variables of NEUPSILIN battery – scores in memory and arithmetic abilities tests. In T1, soccer players outperformed controls on three variables of the computerized testing – reaction time in general motor coordination test and accuracy in executive functioning tests – and on one variable of the NEUPSILIN battery – score in arithmetic abilities test. Intragroup analyses revealed that while controls improved their performance on three variables from T0 to T1 – reaction time in attention test, accuracy in executive functioning test and score in memory test – no improvement was observed among soccer players. However, a comparison involving variation in performance between T0 and T1 showed no significant differences between groups. Among soccer players, no significant correlations were found between self‐reported number of headings per game and cognitive performance in T0 and T1, controlling for concussion history. Conclusion There was no evidence of cognitive impairment in soccer players, compared to non‐athletes, in T0 and T1. Soccer players even outperformed controls on some tests. The change in cognitive performance from T0 to T1 was similar between groups. Moreover, estimate of exposure to heading did not correlate with performance of soccer players in tests. Further longitudinal investigations are needed to clarify the relationship between soccer heading and cognition.
The study investigated the effectiveness of the Bobath Method in improving postural control in children with Down syndrome, highlighting the importance of physical therapy interventions. The research involved a 4-year-old patient and used the Pediatric Balance Scale to assess balance, with promising results in motor functionality.
Background: Neuropathic pain (NP) is characterized by chronic pain with a generally strong intensity that leads to limitations regarding activities of daily living. Aims and Objectives: The aim of the study was to investigate the effect of B complex vitamins on NP intensity and life quality in patients undergoing hemodialysis. Materials and Methods: A randomized controlled double-blind clinical trial was conducted among hemodialysis patients with clinical diagnosis of NP randomly allocated to two groups: A (gabapentin) and B (B vitamins). DN4, visual analog scale, and Kidney Disease Quality of Life-Short Form questionnaire were used to identify NP, measure pain intensity, and assess quality of life, respectively. Results: A significant reduction in pain occurred after treatment with gabapentin (P=0.003). In the B group, the reduction of pain went from a mean of 7.27 to 5.09 after treatment (P=0.056). In the A group, a significantly poorer quality of life was reported after treatment in the social relations domain (P=0.010). A significant improvement in quality of life and environment domains (P=0.025 and 0.049, respectively) was reported after use of B vitamins. Conclusion: These findings demonstrate that B complex vitamins for the treatment of NP in hemodialysis patients should be investigated further, as this form of treatment contributed to a reduction in pain intensity and suffering with no side effects and at low cost.
Platelets play an important role in proinflammatory process in addition to haemostasis and share neuronal pathways that lead to synthesis of neurotransmitters and APP (amyloid precursor protein). Studies involving platelets have been of great interest, particularly with regard to platelet activation and its relation in the development of AD. P-selectin is an adhesion molecule that is expressed on the surface of platelet when it is activated. In the Brazilian population, few studies were conducted aiming to know more about platelet activity in patients with AD, Frontotemporal Dementia (FTD) and in elderly individuals without cognitive impairment. The aim of this study was to compare platelet activity in 23 AD patients diagnosed by cognitive tests and characterized by CSF biomarkers, including beta-amyloid protein (βA-42; <700 pg / mL), Tau-Total (> 400 pg / mL), phosphorylated Tau (P-Tau> 60 pg / mL) and IATI (<0.8), in 20 FTD patients and in 27 individuals without cognitive impairment according to clinical criteria (control group). P-selectin expression was evaluated by using CD62P and its quantification performed by flow cytometry. An increase in percentage of P-selectin expression was observed when comparing the AD and control groups (median = 3.42, Q1 = 1.50-Q3 = 7.56 versus 1.30, 0.34–2.82, p <0.0001), FTD and control groups (median = 2.27, Q1= 1.16-Q3= 6.74 versus1.30, 0.34–2.82; p= 0.025), but no difference was observed between DA and FTD (p= 0.318). P-selectin is involved in adhesion of platelets to endothelial cells and recruitment of leukocytes at sites of vascular lesions. P-selectin plays a fundamental role in inflammatory process and in development of micro thrombi, leading to worsening of local perfusion which may exacerbate neuroinflammation present in AD and cognitive decline. Regarding FTD, reports on platelet activity are scarce, however the increase in the expression of P-selectin compared to control group may be related to a neuroinflammatory process or dysfunction of microvasculature. In summary, platelets from AD and FTD patients presented an increased platelet activation reflecting a greater expression of P-selectin, compared to individuals without cognitive decline and of the same age group. Support: CNPq, CAPES and FAPEMIG.
Background: Pneumothorax is a clinical condition which can cause respiratory distress. It can have as its origin traumatic causes or even classified as spontaneous, mainly related to diseases of the lung parenchyma. Lipoid pneumonia is rarely described in dogs, and it is characterized by globules of lipid in the alveolar spaces. Endogenous lipoid pneumonia (EnLP) occurs when lesions on pulmonary cells release cholesterol and other lipids in the alveoli. There is no clinical approach established for EnLP in veterinary patients. The aim of this report is to describe a case of a young Maltese dog, with recurrent spontaneous pneumothorax in which EnLP was diagnosed Post mortem.Case: A 2-year-old sexually intact male Maltese dog was evaluated for restrictive dyspnea. Clinicopathologic findings included cyanotic, muffled chest auscultation with hypersonic thoracic percussion. Chest x-ray demonstrated an increase in pleuropulmonary radio transparency and a floating-looking heart, indicating pneumothorax. Complete blood counts andbiochemical panel results were normal. Dirofilaria immitis antigen test results were negative. Computed tomography demonstrated slightly hyper-expanded pulmonary fields, with slightly enlarged reticular marking with areas of mild multicentric panlobular emphysema and a fracture on the sixth left rib. The treatment was focused on improving the breathing pattern through sedation, supplementation with oxygen, and thoracentesis. Owing to the reserved prognosis of the case, the unknown etiology of the recurrent pneumothorax, and the clinical worsening of the patient, the owner opted for euthanasia. Necropsy displayed multiple, circular whitish areas in the lungs, distributed over the surface of all lobes. Histopathological examination revealed pulmonary tissue with the subpleural micronodular foci, multifocal to coalescent, with a moderate accumulation of foamy intra-alveolar macrophages, occasionally multinucleate, associated with cholesterol crystals compatible with endogenous lipid pneumonia. Discussion: The patient presented with clinical signs and physical examination characteristics of pneumothorax at the first visit. After the pneumothorax diagnosis, and clinical stabilization of the patient. No predisposing factor for the formation of the pneumothorax was identified as the radiography revealed only bronchitis and blood tests were normal, the patient was thus discharged after 24 h, with the recommendations for observing the breathing pattern. Initially, spontaneous pneumothorax was suspected. The antibiotics were administered since bacterial pneumonia, although not confirmed on chest x-ray, is the main cause of pneumothorax in dogs is lung parenchyma disease. With the worsening of the clinical condition of the patient, CT was performed and did not demonstrate any findings that would justify the presence of pneumothorax. Despite the placement of the chest tube for facilitating the management of thoracentesis, there was no stabilization of the condition, enhancing the frequency of centesis procedures, which led to the decision to euthanize. The microscopic examination of the pulmonary alterations was decisive for the diagnostic conclusion. The visualization of the accumulation of foamy intra-alveolar macrophages, occasionally multinucleate, associated with cholesterol crystals, was responsible for the diagnosis of EnLP. This condition is rarely described in dogs and as in the present report, it is a noninfectious inflammatory condition, characterized by intra- or extracellular globules of lipid in the alveolar spaces. In the present report, although it was not possible to determine the etiology of EnLP, we can conclude that although rare, it can affect dogs and can generate severe clinical repercussions.
Background: Neuropathic pain (NP) is characterized by chronic pain with a generally strong intensity that leads to limitations regarding activities of daily living. Aims and Objectives: The aim of the study was to investigate the effect of B complex vitamins on NP intensity and life quality in patients undergoing hemodialysis. Materials and Methods: A randomized controlled double-blind clinical trial was conducted among hemodialysis patients with clinical diagnosis of NP randomly allocated to two groups: A (gabapentin) and B (B vitamins). DN4, visual analog scale, and Kidney Disease Quality of Life-Short Form questionnaire were used to identify NP, measure pain intensity, and assess quality of life, respectively. Results: A significant reduction in pain occurred after treatment with gabapentin (P=0.003). In the B group, the reduction of pain went from a mean of 7.27 to 5.09 after treatment (P=0.056). In the A group, a significantly poorer quality of life was reported after treatment in the social relations domain (P=0.010). A significant improvement in quality of life and environment domains (P=0.025 and 0.049, respectively) was reported after use of B vitamins. Conclusion: These findings demonstrate that B complex vitamins for the treatment of NP in hemodialysis patients should be investigated further, as this form of treatment contributed to a reduction in pain intensity and suffering with no side effects and at low cost.
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