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Abstract Acute ischemic stroke is a sudden neurological event caused by brain ischemia. Patients with large vessel occlusion are at high risk of developing significant cerebral edema, which can lead to rapid neurological decline. The optimal timing for decompressive hemicraniectomy to prevent further brain damage is still uncertain. This study aimed to identify potential predictors of severe brain edema. The data indicate that specific cytokines may help identify patients with a higher risk of developing life-threatening brain swelling in the early phase post-stroke. The association between a positive biomarker and the outcome was calculated, and three biomarkers—S100B protein, MMP-9, and IL-10—were found to be significantly associated with malignant edema. A model was derived for early predicting malignant cerebral edema, including S100B protein and IL-1 beta. These findings suggest that molecular biomarkers related to the ischemic cascade may be a helpful way of predicting the development of malignant cerebral edema in ischemic stroke patients, potentially widening the time window for intervention and assisting in decision-making. In conclusion, this study provides insights into the molecular mechanisms of severe brain edema and highlights the potential use of biomarkers in predicting the course of ischemic stroke.

IntroductionMagnetic resonance–guided focused ultrasound (MRgFUS) thalamotomy of the ventralis intermediate (Vim) nucleus is an “incisionless” treatment for medically refractory essential tremor (ET). We present data on 49 consecutive cases of MRgFUS Vim thalamotomy followed-up for 3 years and review the literature on studies with longer follow-up data.MethodsA retrospective chart review of patients who underwent MRgFUS thalamotomy (January 2018–December 2020) at our institution was performed. Clinical Rating Scale for Tremor (CRST) and Quality of Life in Essential Tremor (QUEST) scores were obtained pre-operatively and at each follow-up with an assessment of side effects. Patients had post-operative magnetic resonance imaging within 24 h and at 1 month to figure out lesion location, size, and extent. The results of studies with follow-up ≥3 years were summarized through a literature review.ResultsThe CRST total (baseline: 58.6 ± 17.1, 3-year: 40.8 ± 18.0) and subscale scores (A + B, baseline: 23.5 ± 6.3, 3-year: 12.8 ± 7.9; C, baseline: 12.7 ± 4.3, 3-year: 5.8 ± 3.9) and the QUEST score (baseline: 38.0 ± 14.8, 3-year: 18.7 ± 13.3) showed significant improvement that was stable during the 3-year follow-up. Three patients reported tremor recurrence and two were satisfactorily retreated. Side effects were reported by 44% of patients (severe: 4%, mild and transient: 40%). The improvement in tremor and quality of life in our cohort was consistent with the literature.ConclusionWe confirmed the effectiveness and safety of MRgFUS Vim thalamotomy in medically refractory ET up to 3 years.

A Síndrome de Ekbom, também conhecida como delírio de parasitose, é uma doença psiquiátrica rara, caracterizada pela sólida crença do paciente de estar infectado por parasitas que saem pela pele, quase sempre, do couro cabeludo, região genital, olhos ou boca. Na tentativa de retirar os vermes, alguns pacientes removem fragmentos da própria pele, produzindo lesões e automutilações. É comum a procura inicial por dermatologistas, os quais, frequentemente, propõem tratamentos dermatológicos que não são resolutos. Quando diagnosticada por um psiquiatra, institui-se o tratamento por meio de antipsicóticos, sendo a Pimozida o fármaco mais relatado na literatura. Em razão da raridade desse transtorno, este estudo tem por objetivo relatar um caso de Síndrome de Ekbom em paciente idoso, do sexo feminino e com Transtorno Delirante do tipo persecutório, que apresentou remissão completa dos sintomas após uso associado de Olanzapina e Risperidona, retomando a qualidade de vida e sensação de bem-estar. Este trabalho se ampara em uma base de dados que abrange relatos de casos, revisões de literatura, artigos de periódicos, fontes de farmacologia e manuais de psiquiatria.

We discuss the joint calibration to SPX and VIX options of an affine Stochastic Volatility model with Jumps in price and Jumps in volatility (the SVJJ model). Conventionally, the SVJJ model assumes exponential jumps in the variance process, leaving the potential benefits of more flexible jump distributions unexplored. The purpose of our study is twofold. First, we show that choosing the gamma distributions for the jumps in variance significantly improves the performance of the joint calibration. However, this improvement comes at the cost of increased computational time. Second, we mitigate this loss of tractability by constructing novel approximations to option prices based on orthogonal polynomial expansions. Unlike the classical method of selecting an explicit reference density, our approach generalizes to all densities with explicit Laplace transform. We apply this methodology to the SVJJ model with gamma jumps and we find that the proposed price expansions achieve the same accuracy as exact transform inversion formulas while requiring only a fraction of the computational time. [ABSTRACT FROM AUTHOR]

Introdução: a migrânea é responsável pelo impacto na funcionalidade e no sofrimento psicológico de indivíduos acometidos por essa condição. A gravidade dos sintomas migranosos e o tempo de exposição estão associados e dizem respeito à idade de início da migrânea e ao tratamento precoce. Objetivo: o objetivo deste artigo é verificar se há associação entre o tempo de exposição à migrânea e a prevalência de sintomas depressivos e ansiosos, bem como identificar a relação, direta ou indireta, do tempo de tratamento sobre sintomas de transtornos psiquiátricos e a diminuição do impacto da doença na vida dos pacientes. Método: esta pesquisa configura-se como um estudo descritivo transversal, realizado em uma unidade especializada em atendimento de pacientes com migrânea com uma amostra dividida em grupo controle, migrânea episódica e migrânea crônica. Resultados e conclusões: concluiu-se que os pacientes com migrânea, seja ela crônica (MC) ou episódica (ME), pareados em relação à idade atual, relataram período de início das cefaleias aproximado, mas possuem tempo de tratamento diferente (MC=15 meses e ME=34 meses). Além disso, o grupo com migrânea crônica apresentou maior carga da doença.

Background: Drug-resistant epilepsy (DRE) secondary to hypothalamic hamartoma (HH) often requires surgical resection or stereotactic radiosurgery, which frequently fail to provide satisfactory outcomes and are associated with severe side effects. Magnetic resonance-guided focused ultrasound (MRgFUS) may represent a minimally invasive surgical approach to HH by offering precise thermal ablation of sub-millimetric brain targets while sparing surrounding structures. Methods: We present the case of a 19-year-old man with HH-associated DRE, who was successfully treated with MRgFUS. The procedure resulted in effective ablation of the hypothalamic interface of the HH, disconnecting the epileptogenic lesion from the surrounding brain tissue. We also reviewed the literature on MRgFUS for DRE. Results: The patient experienced a complete resolution of seizures and significant improvements in social and occupational functioning over an 18-month follow-up period. No neurological, cognitive, or endocrinological adverse effects were observed. Conclusion: Our case report and literature review suggest that MRgFUS may achieve adequate seizure control in DRE associated with HH without adverse effects. While MRgFUS shows promise for other forms of DRE, data remain preliminary, and some safety concerns persist. Further studies with long-term follow-up are warranted to better support the use of MRgFUS in DRE. [ABSTRACT FROM AUTHOR]

Novas tecnologias como a utilização da internet e do telefone celular alcançam cada vez mais a sala de aula. O objetivo desse artigo é compreender como ocorre a construção de uma epistemologia psicológica e comportamental em ambiente escolar. A metodologia utilizada se baseia na técnica de observação participante e pesquisa documental no firewall da rede de internet utilizada em uma escola, investigando o dia letivo em suas 24 horas, nos três, dos cinco dias de aulas semanais. Os resultados indicam que os horários de aula são justamente aqueles em que os estudantes mais acessam a rede, mesmo havendo proibição em contrário. Percebe-se que é tarefa educativa mediar a formação de hábitos mentais em relação ao tempo para o acesso às tecnologias sem se retirar o seu livre arbítrio que vem sendo exercido, através de burla à proibição imposta.

Olfactory areas in mammalian brains are linked to centers that modulate behavior. During aging, sensitivity to odors decreases and structural changes are described in olfactory areas. We explored, in two groups of male mice (young and elderly, 6 and 19 months old, respectively), the link between the changes in olfactory bulb structure, detected with magnetic resonance imaging, and behavioral changes in a battery of tests on motor, olfactory, cognitive performance, and emotional reactivity. The behavioral pattern of elderly mice appears less anxious, being less scared by new situations. Additionally, the olfactory bulb of young and elderly mice differed in two variables derived from magnetic resonance imaging (fractional anisotropy and T2 maps). A random forest approach allowed to select the variables most predictive of the differences between young and elderly mice, and correlations were found between three behavioral variables indicative of anxious behavior and the two magnetic resonance variables mentioned above. These data suggest that in the living mouse, it is possible to describe co-occurring age-related behavioral and structural changes in the olfactory bulb. These data serve as a basis for studies on normal and pathological aging in the mouse, but also open new opportunities for in vivo human aging studies.

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O cenário da pandemia de COVID-19 representa um desafio sem precedentes para a sociedade. Em que pese a importância das medidas imediatas visando à prevenção da propagação da doença, cuidados com os indivíduos acometidos e medidas para minimizar os impactos econômicos e sociais, a abordagem de temas relacionados à saúde mental da população em geral é também crucial. As contribuições interdisciplinares relacionadas à saúde mental envolvem a compreensão dos mecanismos cognitivos e comportamentais que sustentam hábitos, atitudes e crenças. Essa compreensão é fundamental para maximizar a eficácia das estratégias que implicam em mudanças significativas na forma de comportar, conceber e planejar atividades quotidianas. O presente artigo discute abordagens da psiquiatria, psicologia e ciências relacionadas no manejo de questões relacionadas à mudança de comportamento, hábitos de nutrição e atividade física, trabalho e grupos etários vulneráveis.

Introduction: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy of the ventralis intermediate (Vim) nucleus is an "incisionless" treatment for medically refractory essential tremor (ET). We present data on 49 consecutive cases of MRgFUS Vim thalamotomy followed-up for 3 years and review the literature on studies with longer follow-up data. Methods: A retrospective chart review of patients who underwent MRgFUS thalamotomy (January 2018-December 2020) at our institution was performed. Clinical Rating Scale for Tremor (CRST) and Quality of Life in Essential Tremor (QUEST) scores were obtained pre-operatively and at each follow-up with an assessment of side effects. Patients had post-operative magnetic resonance imaging within 24h and at 1 month to figure out lesion location, size, and extent. The results of studies with follow-up ≥3 years were summarized through a literature review. Results: The CRST total (baseline: 58.6 ± 17.1, 3-year: 40.8 ± 18.0) and subscale scores (A + B, baseline: 23.5 ± 6.3, 3-year: 12.8 ± 7.9; C, baseline: 12.7 ± 4.3, 3-year: 5.8 ± 3.9) and the QUEST score (baseline: 38.0 ± 14.8, 3-year: 18.7 ± 13.3) showed significant improvement that was stable during the 3-year follow-up. Three patients reported tremor recurrence and two were satisfactorily retreated. Side effects were reported by 44% of patients (severe: 4%, mild and transient: 40%). The improvement in tremor and quality of life in our cohort was consistent with the literature. Conclusion: We confirmed the effectiveness and safety of MRgFUS Vim thalamotomy in medically refractory ET up to 3 years. [ABSTRACT FROM AUTHOR]

Burnout is most commonly defined as a syndrome characterized by emotional exhaustion, cynicism, and ineffectiveness, which occurs in response to chronic stressors at work. It can adversely affect health workers' physical and mental health, and the quality of care provided. The COVID-19 pandemic increased stressors and could impact burnout prevalence in this group. There is a lack of information regarding the prevalence of burnout among hospital health workers in Brazil. A newer definition of burnout has been proposed that considers three different clinical profiles: the frenetic, underchallenged and worn-out subtypes. This differentiation could lead to interventions tailored for each subtype. The present study aimed to estimate the prevalence of burnout, its subtypes, and associated factors in workers of a public hospital network in Brazil, during the pandemic. A total of 143 randomly selected participants answered an online form that included sociodemographic and occupational items, and the Burnout Clinical Subtypes Questionnaire, a summarized version. This questionnaire evaluates three burnout dimensions (overload, lack of development, neglect) that can be used to discriminate the three burnout subtypes (frenetic, underchallenged, worn-out, respectively); higher scores indicate higher burnout levels. The prevalence of burnout was high (53.85%), similar to other studies during the pandemic. The most common subtypes were 'frenetic' (34.97%), characterized by increased efforts to meet work demands, to the point of neglecting personal needs, and 'lack of development' (23.78%), characterized by a sense that work is uninteresting and does not contribute to personal development, and a perfunctory behavior towards tasks. Age was associated with burnout: workers with less than 51 years presented higher levels of burnout. These findings indicate the need for effective interventions to prevent and/or treat burnout. The assessment of burnout subtypes can allow managers to better understand the processes affecting employees, and inform actions to improve workforce health. [ABSTRACT FROM AUTHOR]

Objetivou-se compreender autocuidado no processo de envelhecer de familiares que cuidam de idosos no domicílio. Pesquisa qualitativa do tipo exploratória. Participaram das entrevistas cinco familiares de idosos atendidos nas consultas de enfermagem de um ambulatório de Geriatria e Gerontologia. Utilizou-se análise de conteúdo que resultou em duas categorias: O envelhecimento do cuidador familiar de um idoso e a realização de seu autocuidado; O reflexo do cuidar de idosos por um familiar em processo de envelhecimento. Compreendeu-se que, além da tensão do papel de cuidador, o familiar convive com problemas secundários ao próprio envelhecimento, por vezes associados a agravos crônicos. A condição de ter que cuidar associada a esses agravos, influencia na dinâmica da vida do cuidador familiar. Os familiares compreendem quais são os requisitos universais de autocuidado, mas não conseguem exercê-los, pois priorizam o “ter que cuidar” do idoso sob sua responsabilidade. O estudo contribui para o processo de cuidar de famílias de idosos pelo enfermeiro, entretanto apresenta limitações quanto ao quantitativo da população, o que aponta para necessidade de novas investigações com aprofundamento nos custos sociais e financeiros que envolvam o processo de cuidar pela família de idosos no domicílio.

O Ensino de Ciências se insere em um contexto filosófico e científico embarcado em políticas públicas. Realizou-se revisão bibliográfica e análise crítica, análise documental, observação participante, com análise estatística (ANACOR) dos Projetos de graduação em regiões distintas do país. Os resultados evidenciam que ocorre uma hegemonia curricular que pode ter sido induzida por ideologias e políticas públicas dominantes. Conclui-se que perceber os interesses e políticas públicas que cercam a região amazônica pode ser um fator fundamental para um processo educativo efetivo e profícuo.