DMI - Departamento de Medicina Integrada

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23rd Congress of the european society for pediatric neurosurgery (ESPN), Amsterdam-the netherlands, 1–5 May 2012
(Springer, 2012) Silva Neto, Ângelo Raimundo da; https://orcid.org/0000-0002-3819-8951
..Apresenta um resumo das apresentações orais do congresso.
30-Day morbidity and mortality of bariatric metabolic surgeryin adolescence during the COVID-19 pandemic–the Geneva study
(Wiley, 2021-06-14) Quinino, Reynaldo Martins e; Singhal, Rishi; Wiggins, Tom; et al; https://orcid.org/0000-0002-4284-2543
Background Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients.
30-day morbidity and mortality of bariatric surgery during the COVID-19 pandemic: a multinational cohort study of 7704 patients from 42 countries
(Springer, 2021-07-30) Quinino, Reynaldo Martins e; Singhal, Rishi; Ludwig, Christian; et al; https://orcid.org/0000-0002-4284-2543
Background There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. Methods We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. Results Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. Conclusions BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.
30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data
(Springer, 2022-11-15) Quinino, Reynaldo Martins e; Singhal, Rishi; Cardoso, Victor Roth; Wiggins, Tom; https://orcid.org/0000-0002-4284-2543
BACKGROUND: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. MATERIALS AND METHODS: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. RESULTS: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). CONCLUSIONS: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.
Accessory nerve injury after deep brain stimulation surgery in a Parkinson’s disease patient
(Elsevier, 2021-10-13) Godeiro Junior, Clécio de Oliveira; Aquino, Barbara Cristina Vieira de; Pessoa Neto, Agabio Diogenes; Dourado Junior, M ário Emílio Teixeira; Dantas, Sérgio Adrian Fernandes; Silva, Rodrigo Alencar e; 0000-0002-4312-1633
DBS is an established form of surgical therapy for Parkinson’s disease and is also used for other pathologies, such as dystonia and essential tremor. There are few articles in the literature discussing exclusively about surgical complications. In fact, most papers describe surgical-related complications such seizures, device infection, hemorrhage and permanent deficit. However, less usual complications can also occur, as in the case described below, of an injury to the accessory nerve after the DBS procedure. We describe a case of a 56-year-old woman with PD who underwent to STN DBS, presented hypotrophy and weakness of the right trapezius after the surgery. Electroneuromyography (ENMG) suggested partial right spinal accessory injury. Patient recovery spontaneously 5 months after surgery. While DBS promises dramatic improvement in select PD symptoms, it can have disappointing or even serious adverse results. This paper ratifies the need of screening of accessory nerve injury for early rehabilitation.
Accessory nerve injury after deep brain stimulation surgery in a Parkinson’s disease patient
(2022-03) Aquino, Bárbara Cristina Vieira de; Pessoa Neto, Agábio Diógenes; Dourado Junior, Mário Emílio Teixeira; Dantas, Sérgio Adrian Fernandes; Silva, Rodrigo Alencar e; Godeiro Junior, Clécio de Oliveira
DBS is an established form of surgical therapy for Parkinson's disease and is also used for other pathologies, such as dystonia and essential tremor. There are few articles in the literature discussing exclusively about surgical complications. In fact, most papers describe surgical-related complications such seizures, device infection, hemorrhage and permanent deficit. However, less usual complications can also occur, as in the case described below, of an injury to the accessory nerve after the DBS procedure. We describe a case of a 56-year-old woman with PD who underwent to STN DBS, presented hypotrophy and weakness of the right trapezius after the surgery. Electroneuromyography (ENMG) suggested partial right spinal accessory injury. Patient recovery spontaneously 5 months after surgery. While DBS promises dramatic improvement in select PD symptoms, it can have disappointing or even serious adverse results. This paper ratifies the need of screening of accessory nerve injury for early rehabilitation.
Acesso trans-hepático para hemodiálise: avanço ou retrocesso?
(Revista Ciências em Saúde, 2018) Moreira, Ricardo Wagner Costa
Em 2014, segundo a Sociedade Brasileira de Nefrologia em seu Inquérito Brasileiro de Diálise Crônica, 112.004 pacientes necessitavam de diálise crônica no país, número que representa um aumento de 20.000 pacientes em relação aos quatro anos anteriores. Desse total de pacientes, 91,4% fazem tratamento por hemodiálise e 8,6% por diálise peritoneal. Outro dado importante é que 29,0% dos pacientes estão em fila de espera por um transplante renal. Para os pacientes que estão em hemodiálise, esta terapia necessita o acesso ao sistema vascular do paciente. O acesso vascular pode ser através do uso de cateteres venosos ou da criação de uma comunicação entre o sistema arterial e o venoso, nomeadamente a fístula arteriovenosa. No caso da fístula arteriovenosa, uma artéria e uma veia periférica de calibre adequado são escolhidas e uma comunicação entre as duas é criada cirurgicamente. No caso dos cateteres venosos, um cateter é inserido em uma veia de grosso calibre. Posteriormente, através de uma das vias, o sangue venoso é retirado pela máquina de hemodiálise e, após passar por filtração na máquina, é devolvido para a circulação venosa. As veias nas quais de rotina é possível inserir um cateter para hemodiálise são as veias jugulares internas, subclávias e femorais.
Acute foot drop syndrome mimicking peroneal nerve injury: an atypical presentation of ischemic stroke
(Elsevier, 2014) Figueiredo, Marcelo Marinho de; Ricarte, Irapuá Ferreira; Fukuda, Thiago Gonçalves; Pedroso, José Luiz; Silva, Gisele Sampaio
Foot drop syndrome is a frequent neurologic condition usually caused by peroneal nerve damage. On rare occasions, foot drop may present as the single neurologic manifestation of intracranial lesions. We presented a 43-year-old man admitted to our hospital with acute weakness in the dorsiflexion of his right foot that appeared 3 days before admission. Brain magnetic resonance imaging diffusion-weighted sequence revealed a small area of restricted diffusion in the left frontal cortex. Three months later, his motor deficit had completely improved (modified Rankin scale score 5 0). To our knowledge, this is the second report of sudden isolated foot drop caused by a cortical infarction.
Acute hemicerebellitis in a young adult: a potential pitfall
(SciELO, 2021-06-03) Godeiro Junior, Clecio de Oliveira; Moreira Neto, Manuel; Fraiman, Pedro Henrique Almeida; 0000-0002-4312-1633
A 20-year-old man presented with a new headache for 21 days. His neurological examination showed mild right-side ataxia while walking in tandem. Brain MRI revealed extensive hyperintensities in the right cerebellar hemisphere in FLAIR/T2WI and moderate choline peak and low NAA.
Acute parkinsonism and bilateral basal ganglia lesions
(SciELO, 2020-12) Godeiro Junior, Clécio de Oliveira; Silva, Rodrigo Alencar e; Sousa, Thadeu Alexandre Paulino de; 0000-0002-4312-1633
A 58-year-old man with arterial hypertension and poorly controlled type 2 diabetes using glyburide/metformin presented a history of sudden slurred speech and gait disturbance eight days before clinical evaluation.
Adhesion prevention in reabsorbable polyethylene glycol hydrogel (Coseal®) coated polypropylene mesh in rabbits
(Acta Cirurgica Brasileira, 2013-12) Quinino, Reynaldo Martins e; Araújo Filho, Irami; Lima, Francisco Piganataro; Barbosa, André Luís Costa; Maia, Tatiana de Carvalho; Goldenberg, Alberto; https://orcid.org/0000-0002-4284-2543
Purpose: To evaluate of postoperative adhesion prevention and inflammatory response to polypropylene mesh, coated with reabsorbable hydrogel of polyethylene glycol (Coseal®) in contact with small bowel in an experimental model in rabbits. Methods: Twenty female rabbits underwent laparotomy to implant two polypropylene meshes, 2x1cm, in the right and left flanks. The right mesh was protected with Coseal® spray (Group 1) and the left mesh received no treatment after implantation (Group 2). Thirty days after implantation, the rabbits underwent laparoscopy for adhesion analysis; the prosthesis were removed en bloc with the adjacent tissue for microscopic analysis of inflammation. Statistical analysis used the Mann-Whitney test. RESULTS: There was adhesion formation in five meshes (36%) from Group 1 and in 14 meshes (100%) from Group 2, with statistical significance (p<0.01). There were no differences in the inflammatory response, fibrosis, foreign body reaction, presence of collagen and type of inflammatory cells between the two groups. Conclusion: Polypropylene mesh coated with Coseal® showed a significantly lower rate of adhesion formation when compared with uncoated meshes, without interfering with inflammatory response.
Adynamic bone disease
(Jornal Brasileiro de Nefrologia, 2021-06-14) Oliveira, Rodrigo Azevedo de; Gueiros, Ana Paula Santana; Carvalho, Aluizio Barbosa; 0000-0003-1617-6759
Deve-se suspeitar de doença óssea adinâmica (DOA) em pacientes idosos, diabéticos, paratireoidectomizados, tratados intensivamente com calcimiméticos, calcitriol ou análogos, naqueles expostos ao alumínio ou à sobrecarga de cálcio, quer seja por via oral ou pelo dialisato com alta concentração de cálcio (3,5mEq/L) por tempo prolongado (Evidência). A doença óssea adinâmica (DOA) representa uma entidade clínica bem definida dentre os distúrbios do metabolismo mineral e ósseo da doença renal crônica (DMODRC).
Airflow limitation in brazilian caucasians: FEV1 /FEV6 vs. FEV1 /FVC
(Jornal Brasileiro de Pneumologia, 2008-06) Soares, André Luis Pinto; Rodrigues, Sílvia Carla Sousa; Pereira, Carlos Alberto de Castro
Objective: To evaluate the use of the forced expiratory volume in one second/forced expiratory volume in six seconds (FEV1 /FEV6 ) ratio as an alternative to the FEV1 /forced vital capacity (FVC) ratio in the detection of mild airway obstruction. Methods: Reference equations for the Brazilian population in 2006 were used in order to determine the lower limits of normality for the FEV1 /FEV6 and FEV1 /FVC ratios. The spirometry findings of 155 patients from 20 to 84 years of age were analyzed. All of the patients presented the following: a < 15% difference between predicted and observed FEV1 /FVC ratio; an FEV1 ≥ 60% of predicted; and an exhalation time of at least 6 s. The Brazilian Thoracic Society criteria for acceptability and reproducibility in spirometry were met. Results: Mean values (± SD) for FEV1 /FEV6 and FEV1 /FVC were 73 ± 4% and 75 ± 3%, respectively. Using the FEV1 /FVC ratio, we identified airflow obstruction in 61 patients, compared with only 46 patients when we used the FEV1 /FEV6 ratio, showing a sensitivity of 75% (p < 0.001). Conclusions: The FEV1 /FEV6 ratio has poor sensitivity and should not be used to replace the FEV1 /FVC ratio in the diagnosis of mild airway obstruction.
Amyotrophic Lateral Sclerosis and Palatal Myoclonus: An Uncommon Association
(Movement Disorders Clinical Practice, 2020-10-18) Godeiro Junior, Clécio de Oliveira; Fraiman, Pedro Henrique Almeida; Dourado, Mario Emilio; 0000-0002-4312-1633
We read the article by Rebello et al.1 with great interest. It is an interesting case because it aligns with the modern perspective that amyotrophic lateral sclerosis (ALS) neurodegeneration not only affects the motor neurons. However, we have few considerations related to major points for the uncommon association presented in the case.
Análise das informações veiculadas pela mídia em neurocirurgia pediátrica: judicialização e financiamento coletivo
(Revista de Administração em Saúde, 2022) Ballestero, Jaqueline Garcia de Almeida; Ballestero, Matheus Fernando Manzolli; Silva Neto, Angelo Raimundo da; Palha, Pedro Fredemir; Dias, Bruna Moreno; Oliveira, Ricardo Santos de; 0000-0002-3819-8951
Introdução: O Sistema Único de Saúde (SUS) foi concebido no final da década de 1980, como resultado de um longo e legítimo processo de redemocratização, do anseio pela participação social e da necessidade de redefinir o papel do Estado brasileiro e sua responsabilidade para com a saúde enquanto direito. Hoje, o SUS é a política pública de maior sucesso e de inclusão social da história do país, atendendo exclusivamente cerca de 75% da população. Os cuidados em neurocirurgia, são onerosos para o Sistema de Saúde, muitas vezes com repasses insuficientes para cobrir gastos. Assim, existe a possibilidade de recorrer a recursos extraoficiais como judicialização e, recentemente, uma nova estratégia de busca por recursos financeiros surgiu tem sido amplamente usada para atender às necessidades individuais de saúde - “crowdfunding” ou financiamento coletivo. Na atual sociedade, as redes sociais permitem a difusão de dados com agilidade e grande alcance, possibilitando, assim, que ações desenvolvidas com o intuito de solidariedade gerem fortes apelos, em especial quando se trata de adoecimentos do sistema nervoso que acometem crianças. Objetivos: Este estudo teve como objetivo analisar as solicitações de recursos extraoficiais para atenção à neurocirurgia pediátrica no Brasil veiculadas pela mídia, nos últimos 10 anos. Métodos: Estudo descritivo, exploratório, com uso de informações veiculadas em mídia leiga utilizando a ferramenta de busca do Google. A busca foi realizada em 20 julho de 2020, com uso dos termos de busca em português: “neurocirurgia”; “Meu filho precisa de uma cirurgia”; “ordem judicial”; “urgente”. Foram incluídas reportagens que apresentavam informações sobre a solicitação de procedimentos, equipamentos ou outras despesas relacionadas a condições de saúde que demandavam assistência neurocirúrgica para menores de 18 anos de cidadãos brasileiros. Foram excluídas publicações científicas. Resultados: A busca identificou 58 solicitações realizadas por demanda judicial ou campanha de financiamento coletivo. Dentre essas crianças 53,4% eram do sexo masculino, 46,6% do sexo feminino. A média de idade foi de 4,5 anos (variando de casos intrauterinos a 18 anos). As demandas por financiamento coletivo eram 86,2% e 13,8% de processos de judicialização. Quanto às doenças, 36,2% foram tumores cerebrais; 31,0% craniossinostose; 19,0% mielomeningocele; 10,3% espasticidade; 3,4% outras doenças. Em relação à distribuição geográfica, 27,6% crianças eram do Sul, 27,6% do Sudeste, 24,1% do Centro-Oeste, 20,7% do Nordeste e 3,4% do Norte. No que se refere ao sistema de saúde, 44,1% pais relataram ter procurado o SUS antes da solicitação. Para todas as demandas, o SUS oferece tratamento. Conclusões: Identificou-se que a crescente procura por recursos financeiros para cobertura de procedimentos de neurocirurgia pediátrica via judicialização e/ou por financiamento coletivo pode, a médio ou longo prazo, acirrar as disputas com a dotação orçamentária do SUS. Assim, há que se equacionar essas demandas por meio do processo de regulação e organização das Redes de Atenção à Saúde como formas de suprir os vazios assistenciais presentes hoje no SUS. Considera-se também que ajustar o acesso a procedimentos pelo fluxo regulatório, de forma rápida, ágil e transparente para profissionais e usuários, evitaria caminhos alternativos.
Analysis of the immunohistochemical expression of ghrelin in the gastric mucosa and correlation with weight loss after sleeve gastrectomy
(Springer, 2022-09-23) Quinino, Reynaldo Martins e; Barbosa, André Luis Costa; Xavier, Maíra de Araújo Barros; França, Romero de Lima; Freitas, Mirella Patrícia Cruz de; Goldenberg, Alberto; https://orcid.org/0000-0002-4284-2543
Introduction Sleeve gastrectomy is one of the main techniques used to treat severe obesity. The study of the immunohistochemical expression of ghrelin in the gastric mucosa has already been related to weight loss and can be a promising method to predict the surgical outcome. Purpose To analyze the immunohistochemical expression of ghrelin in the gastric mucosa and its correlation with weight loss, comorbidities, and infammatory changes after sleeve gastrectomy. Methods Thirty-fve patients submitted to sleeve gastrectomy were evaluated, 29 of whom were female (82.9%), with a mean age of 35.2 years and an average body mass index of 38.1 kg/m2 . Endoscopic samples of the mucosa were collected, whose ghrelin expression was evaluated in a semi-quantitative way through the stained antibody area. These data were correlated with weight loss at 3, 6, and 12 months and with the control of comorbidities, and infammatory alterations. Results The average total weight loss (TWL%) was 17.7, 26.4, and 32.1%, respectively, at 3, 6, and 12 months. A negative correlation was found between the immunohistochemical expression of ghrelin in the endoscopic biopsy of the fundus and weight loss at 3 (s= −0.536; p=0.001) and 6 months (s= −0.339; p=0.047). Conclusion The immunohistochemical expression of ghrelin in the mucosa of the gastric fundus was negatively correlated with early weight loss after sleeve gastrectomy
Um anjo para ELA: arquitetura baseada em visão computacional aplicada ao monitoramento on-line de parâmetros respiratórios de pacientes com Esclerose Lateral Amiotrófica (ELA) em ambiente hospitalar
(SBEB - Sociedade Brasileira de Engenharia Biomédica, 2013) Silva, Gustavo Henrique Souto da; Morais, Antônio Higor Freire de; Valentim, Ricardo Alexsandro de Medeiros; dantas, Rummenigge Rudson; Cavalcanti, Leila Raulino Câmara; Dourado Junior, Mario Emilio
Introdução: A Esclerose Lateral Amiotrófica (ELA) é uma doença neurodegenerativa, caracterizada por uma progressiva e fatal perda de neurônios motores do córtex cerebral, tronco encefálico e medula espinhal, mas que mantém preservada a atividade intelectual e cognitiva do paciente. Pacientes acometidos por essa doença irão invariavelmente necessitar do auxílio de ventiladores mecânicos. Métodos: Foi utilizado um conjunto de hardware e software para realizar o monitoramento dos parâmetros respiratórios dos pacientes em leitos hospitalares como forma de auxiliar à equipe de saúde. O monitoramento desses parâmetros deu-se por meio de uma webcam, que capturava os valores exibidos na tela do ventilador mecânico, e do emprego de técnicas de visão computacional e Optical Character Recognition (OCR). Neste sentido, o sistema foi testado sob três condições de luminosidade diferentes para verificar a eficácia do mesmo. Resultados: O sistema apresentou uma média geral de acertos de 94.90%. Além disso, quando a interferência luminosa foi mínima, o sistema obteve uma média geral de acertos de 97,76%. Conclusão: A adoção de um sistema computacional baseado em visão computacional para auxílio da equipe de saúde no monitoramento hospitalar de pacientes com ELA mostrou-se satisfatória. No entanto, a pesquisa mostrou que a adoção de um sistema com maior imunidade à interferências luminosas externas tende a apresentar melhores resultados
Antecedent infections in Guillain-Barré syndrome in endemic areas of arbovirus transmission: a multinational case-control study
(Wiley, 2021) Dourado Junior, Mário Emílio Teixeira; Leonhard, Sonja E.; Tan, heng Yin; Leonhard, Sonja E; Tan, Cheng Yin; Eijk, Annemiek A.; Reisin, Ricardo R.; Franken, Suzanne C.; Huizinga, Ruth; Arends, Samuel; Batstra, Manou R.; Jeronimo, Selma M. Bezerra; Drenthen, Judith; https://orcid.org/0000-0002-9462-2294
Half of the world's population is at risk of arthropod-borne virus (arbovirus) infec-tions. Several arbovirus infections have been associated with Guillain-Barré syn-drome (GBS). We investigated whether arboviruses are driving GBS beyond epidemicphases of transmission and studied the antibody response to glycolipids. The proto-col of the International Guillain-Barré syndrome Outcome Study (IGOS), an observa-tional prospective cohort study, was adapted to a case-control design. Serumsamples were tested for a recent infection with Zika virus (ZIKV), dengue virus(DENV), chikungunya (CHIKV) virus, hepatitis E virus, Epstein-Barr virus (EBV), cyto-megalovirus (CMV),Campylobacter jejuni, andMycoplasma pneumoniae, and for anti-bodies to glycolipids. Forty-nine patients were included from Brazil (63%), Argentina(14%), and Malaysia (22%). Evidence of a recent infection was found in 27/49 (55%)patients:C jejuni(n=15, 31%),M pneumoniae(n=5, 10%), CHIKV (n=2, 4%), EBV(n=1, 2%),C jejuniandM pneumoniae(n=2, 4%), CMV and DENV (n=1, 2%), andC jejuniand DENV (n=1, 2%). In 22 patients, 35 paired controls were collected.Odds ratio for recent infections did not significantly differ between cases and con-trols. No typical anti-ganglioside antibody binding was associated with recent arbovi-rus infection. We conclude that arbovirus infections occur in GBS patients outside ofepidemic viral transmission, although not significantly more than in controls. Broadinfection and anti-ganglioside antibody serology are important to establish the mostlikely pathogenic trigger in GBS patients. Larger studies are necessary to determinethe association between arboviruses and GBS.
ANTI-MA2 encephalitis mimicking diencephalic demyelinating syndrome
(Elsevier, 2020-11-03) Godeiro Junior, Clécio de Oliveira; Pessoa Neto, Agábio Diógenes; Aquino, Bárbara Cristina Vieira de; Brito, Paulo Santiago de Morais; Silva, Rodrigo de Alencar e; Moreira Neto, Manuel; Barsottini, Orlando Graziani Povoas; Dutra, Lívia Almeida; 0000-0002-4312-1633
Anti Ma 2 encephalitis is an autoimmune encephalitis, usually paraneoplastic, characterized by isolated or combined limbic, diencephalic, or brainstem dysfunction. Limbic encephalitis (LE) is the most common manifestation. Anti-Ma2 LE can also be manifested as a pure psychiatric disturbance associated or not with hypokinesia. Other patients exhibit excessive daytime sleepiness, vertical ophthalmoparesis, or both associated with LE, due to diencephalic and/or upper brainstem involvement. These cases are challenging and demand extensive work-up for differential diagnosis.
Antibrush border antibody disease: a case report and literature review
(Elsevier, 2021) Almeida, Jose Bruno de; Brito, Laíse Pereira Arcoverde Fechine; Guedes, Felipe Leite; Vale, Pedro Henrique Cavalcante; Santos, Rivaldo Pereira; Martins, Sílvia Queiroz Santos; Dantas, Gleiko Yuri de Figueredo; Wanderley, David; Araújo, Stanley de Almeida; Silva, Gyl Eanes Barros
Anti-brush border antibody (ABBA) disease, also called anti–low-density lipoprotein receptor-related protein 2 (anti-LRP2) nephropathy, occurs due to the formation of antibodies against brush border antigens of the renal proximal convoluted tubule. We report a case of ABBA disease in a male farmer in his 30s who presented with 2 years of polyuria, dysuria, nocturia, and urinary urgency. He described a history of long-term occupational exposure to pesticides and silica, evolving into possible pneumoconiosis, and prior pulmonary tuberculosis. At presentation, he had reduced kidney function (serum creatinine 3.6 mg/dL) with hyponatremia, hypokalemia, hypophosphatemia, a normal anion gap, metabolic acidosis, and respiratory acidosis, and 2.2 g/day of urine proteinuria. The kidney biopsy was consistent with ABBA, showing amorphous immune-deposits in the tubular basement membrane and strong positivity on indirect immunofluorescence in the brush border of the proximal tubules. The trigger for production of ABBA is still unknown, but it may be associated with chronic conditions such as pulmonary tuberculosis and occupational exposures such as silica and pesticides, as seen in the patient in this report. Most cases do not respond to immunosuppression, and the prognosis is poor.

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