Memoria para optar al título de Bioquímico / La enfermedad neurológica conocida como Paraparesia Espástica Tropical, mielopatía asociada al HTLV-I (TSP/HAM) se caracteriza por la degeneración axonal de los haces córtico-espinales. Aunque no se conoce mucho como el HTLV-I afecta selectivamente a los axones más largos del sistema nervioso central (SNC), es la proteína viral Tax secretada desde los linfocitos T-CD4+ el principal candidato por su actividad estimuladora de factores transcripcionales a través de varias vías de señalización. Esta proteína, se encuentra presente en forma crónica en el líquido cefalorraquídeo (LCR), pudiendo alterar el transporte axonal actuando extracelularmente, siendo afectados principalmente los axones más largos por su mayor vulnerabilidad. Estudios in vitro de la proteína Tax muestran que se une a varias proteínas celulares que regulan vías relacionadas con la transcripción y el citoesqueleto, incluyendo fosfatasas y quinasas, por lo que se sugiere que en esta patogenia podría haber un desbalance en el nivel de fosforilación/desfosforilación de las proteínas del citoesqueleto. Se han propuesto como biomarcadores de varias enfermedades neurodegenerativas los niveles de Tau total y/o fosfo-Tau en el LCR. Por lo tanto, los objetivos de esta investigación fueron comparar la fosforilación de Tau presente en el LCR de pacientes con TSP/HAM y sujetos controles, a fin de aclarar si estas proteínas están involucradas en la patogenia de esta enfermedad, y aislar la proteína Tau desde el LCR para posteriores estudios de proteómica de sus fosfoformas. Los niveles de Tau en el LCR y la evaluación del patrón molecular de fosforilación de residuos específicos como Tre181, Ser199, Tre205, Tre231, Ser262, Ser356, Ser396, Ser404 y Ser422 fue realizada por “immunowestern blot” utilizando anticuerpos policlonales monoespecíficos. Con todos los anticuerpos ensayados se observó la presencia de una banda principal de 52 kDa. Los niveles de Tau en el LCR de los TSP/HAM no fueron significativamente distintos de los de controles, y aunque no fue significativamente diferente (p = 0,06), se podría sugerir sólo una anormal hiperfosforilación de Tre181. Si se confirmara este mayor nivel fosforilación en Tre181 trabajando con un número mayor de pacientes o utilizando otros métodos más confiables, sugeriría un aumento en la actividad o una sobre-expresión de dos quinasas dirigidas a Ser/Tre-Pro, GSK3-α y β, Cdk5. Una caracterización completa de la fosforilación de los distintos residuos de Tau en el LCR de los controles y pacientes con TSP/HAM requirió la aplicación adicional de la técnica analítica de Espectrometría de Masas (MS). Por lo tanto, se trató de aislar Tau desde LCR utilizando una columna de afinidad por fosfopéptidos de Ga(III), y dos métodos de inmunoprecipitación, uno usando proteínas A/G acopladas a agarosa y una segunda con unión covalente de los anticuerpos (“Sepharose” activada con CNBr). Ni la columna de Ga(III) ni el primer método de inmunoprecipitación fueron adecuados para posterior análisis por MS. Después de demostrar por SDS/PAGE que el método que usaba los anticuerpos unidos covalentemente mostraba una banda principal de 52 kDa, se eluyó la proteína del gel, tripsinizó y analizó por MS MALDI-TOF. Se observó la posible presencia de proteínas asociadas al citoesqueleto que podrían haber coinmunoprecipitados con Tau. Estos resultados no fueron confirmatorios por el bajo “score” observado. En conclusión, dos de los resultados muestran diferencias entre TSP/HAM y varias enfermedades neurodegenerativas: el no aumento en los niveles de Tau total, y la posible hiperfosforilación de sólo Tre181. Fue importante lograr aislar Tau desde el LCR para futuros estudios de MS / The neurological disorder known as tropical spastic paraparesis / HTLV-I-associated myelopathy (TSP/HAM) is characterized by axonal degeneration of the cortico-spinal tracts. Although the selectivity of HTLV-I towards the longest axons of the central nervous system (CNS) is not fully understood, the main candidate is the secreted viral protein Tax from lymphocytes T-CD4+ that shows a stimulatory activity of transcriptional factors acting through several signaling pathways is the main candidate. This protein, chronically present in CSF, could extracellularly alter axonal transport. The longest axons are mainly affected because they are more vulnerable. In vitro studies on Tax protein have shown the binding of this protein to many cellular proteins that regulate transcription and cytoskeleton related pathways including phosphatases and kinases, therefore an imbalance in the level of cytoskeleton phosphorylated/unphosphorylated proteins could be involved in this pathogeny. Levels of total Tau and/or phospho-Tau in the CSF have been proposed as biomarkers of various neurodegenerative diseases. Hence, the aims of this investigation were to compare Tau phosphorylation present in CSF of TSP/HAM patients and control subjects, to elucidate if these proteins are involved in the pathogeny of this disease, and to isolate Tau protein from CSF for further proteomic studies of its phosphoforms. Levels of Tau in CSF and evaluation of the molecular pattern of phosphorylation of selected residues such as Thr181, Ser199, Thr205, Thr231, Ser262, Ser356, Ser396, Ser404 and Ser422 were performed by immunowestern blot, using monospecific polyclonal antibodies. With all the antibodies tested we observed a main band with 52 kDa. The CSF levels of Tau in TSP/HAM were not significantly different from those of controls. Only an abnormal hyperphosphorylation on Thr181, although it was not significantly different (p = 0.06), could be suggested in TSP/HAM patients. If a high phosphorylation level in Thr181 is confirmed by working with a larger number of patients or other more reliable methods, it would suggest an increase in activity or over-expression of two Ser/Thr-pro-directed kinases GSK3-α and β, and Cdk5. A complete characterization of Tau phosphorylation sites in CSF from control and TSP/HAM patients required the use of the additional analytical technique of Mass Spectrometry (MS). Therefore, we tried to isolate Tau from CSF samples using the phosphopeptide affinity column with Ga(III), and two immunoprecipitation methods, one using protein A/G-coupled agarose beads and a second one with covalently bound antibodies (Sepharose activated with CNBr). Neither the Ga(III) column nor the first immunoprecipitation method were adequated for MS analysis. After demonstrating by SDS/PAGE that the method that used covalently bound antibodies showed a main band of 52 kDa, the sample was eluted, trypsinized and analyzed in a Mass Spectrometer MALDITOF. This preliminary study suggested the presence of Tau and of some other cytoskeleton associated proteins that could have been coimmunoprecipited with Tau. The low “score” obtained did not allow reach confirmatory results. In conclusions, two of the results showed differences with various neurodegenerative diseases: lack of changes in Tau levels in CSF, and possible hyperphosphorylation of only threonine 181. It was important to have been able to isolate a Tau form from CSF for further studies of MS

Objetivo: verificar a aplicabilidade, reprodutibilidade e validade do SCIM III nos pacientes com paraparesia espástica. Método: estudo transversal incluindo 30 sujeitos (66% mulheres; 41,5±14,7 anos) com paraparesia espástica de etiologia genética, infecciosa ou a esclarecer que foram avaliados pela análise computadorizada da marcha, versão brasileira da SCIM III (0-100 pontos), MIF (18-126 pontos), por 2 examinadores (A e B) no mesmo dia e 1 semana depois (A). Resultados: o coeficiente de correlação intraclasse (CCI) para o uso da SCIM III indicou boa reprodutibilidade intra e inter-examinadores (CCI=0,9). A correlação de Spearman entre a SCIM III e a parte motora da MIF foi considerada adequada e estatisticamente significante (Spearman=0,6; p=0,001). A correlação entre as subescalas da SCIM III e os domínios da MIF foi considerada forte e significante para auto-cuidado (Spearman=0,8; p0,001) e moderada para transferências (Spearman=0,6; p=0,0005) e locomoção (Spearman=0,6; p=0,0006). A subescala mobilidade da SCIM III mostrou correlação positiva e significante para cadência (Spearman=0,8; p0,001), velocidade da marcha (Spearman=0,7; p0,001) e comprimento do passo (Spearman=0,6; p0,001). Conclusões: A SCIM III é um instrumento de avaliação funcional reprodutível intra e inter examinadores e capaz de avaliar o nível de independência dos indivíduos com paraparesia espástica. O SCIM III é mais sensível que a MIF, especialmente para pacientes com maior independência. Cadência, velocidade de marcha e comprimento do passo se correlacionaram com a subescala mobilidade / Purpose: to verify the applicability, reproducibility, and validity of the SCIM III patients with non-traumatic spastic paraplegia. Method: The cross-sectional study included 30 subjects (66% females; 41.5 ± 14.7 y) older with spastic paraparesis of any etiology were assessment by computerized gait analysis and with the Brazilian versions of SCIM III (0-100 points), FIM (18-126 points) by 2raters (A and B) at the same day and 1 week later (A). Results: The intraclass correlation coefficient (ICC) for the use of SCIM III indicated good intra and inter-evaluator reproducibility (ICC = 0.9). Correlation between the SCIM III and the motor FIM was appropriate (Spearman=0.6; p0.001). SCIM III subscales and the FIM domains correlated strongly for self-care (Spearman=0.8; p0.001), moderately for transfers (Spearman=0.6; p=0.0005) and locomotion (Spearman=0.6; p=0.0006). SCIM III mobility subscale positively correlated with the cadence (Spearman=0.8; p0.01), gait speed (Spearman=0.7; p0.01), and step length (Spearman=0.6;p0.01). Conclusions: SCIM III is a reproducible functional assessment instrument and capable of evaluating the level of independence of the individual with spastic paraplegia. The SCIM III is more sensitive than the FIM for non-traumatic spastic paraplegic patients with higher levels of independence. Linear gait parameters correlated with its mobility subscale.

Epidemics of a permanent, non-progressive spastic paraparesis with sudden onset hasbeen reported from several rural areas of sub-Saharan Africa. Studies in East Africasuggested an association with dietary cyanide intake from unprocessed cassava. InZaire the disease was attributed to an infectious cause as the cyanogenic glucosides inthe cassava consumed were known to be removed by traditional soaking. The aims ofthe thesis were to define the disease entity and elucidate its etiology. A communitybasedsurvey in rural Zaire identified 110 live and 24 dead cases among 6764inhabitants (16/1000). The clinical findings were identical to earlier studies and it wasdecided to name the disease konzo as in the first known report. Annual and monthlyincidence of konzo was associated with almost exclusive consumption of shortsoakedbitter cassava roots. The appearence of konzo coincided with the completionof a tarmac road from the capital, which turned cassava into the main cash crop, andinduced short-cuts in the processing. A processing experiment showed that flour fromshort-soaked roots was high in cyanogens. A higher cyanide intake in affectedcompared to un-affected populations was confirmed by much higher urinarythiocyanate levels, the main metabolite. A low urinary sulphate indicated lowavailability of sulphur, the substrate for detoxification. All three konzo patientsexamined at onset had blood cyanide levels above 4 Ilmolll, versus only 2 out of 23controls (p<O.Ol). This supports an etiological role for cyanide. An odds ratio of 11was found for short-soaking of cassava, in a multivariate logistic regression analysis ofa case referent study in Zaire, with a dose-response curve indicating higher risk ofkonzo with frequent consumption of short-soaked cassava. Serological investigationsof 33 cases in Zaire excluded retrovirus etiology for konzo. Konzo was also identifiedin low prevalence in the Central African Republic, again associated with consumptionof insufficiently processed cassava. Investigation in Sweden of two severely disabledTanzanian patients revealed normal magnetic resonance imaging but neurophysiologyshowed isolated upper motor neuron dysfunction. This is consistent with clinicalfindings and identifies konzo as a distinct disease entity. The evidence for anetiological role of high cyanide and low sulphur intake in konzo is now strongenough to urge for prevention by promotion of efficient processing of cassava roots.

Objetivo: verificar a aplicabilidade, reprodutibilidade e validade do SCIM III nos pacientes com paraparesia espástica. Método: estudo transversal incluindo 30 sujeitos (66% mulheres; 41,5±14,7 anos) com paraparesia espástica de etiologia genética, infecciosa ou a esclarecer que foram avaliados pela análise computadorizada da marcha, versão brasileira da SCIM III (0-100 pontos), MIF (18-126 pontos), por 2 examinadores (A e B) no mesmo dia e 1 semana depois (A). Resultados: o coeficiente de correlação intraclasse (CCI) para o uso da SCIM III indicou boa reprodutibilidade intra e inter-examinadores (CCI=0,9). A correlação de Spearman entre a SCIM III e a parte motora da MIF foi considerada adequada e estatisticamente significante (Spearman=0,6; p=0,001). A correlação entre as subescalas da SCIM III e os domínios da MIF foi considerada forte e significante para auto-cuidado (Spearman=0,8; p0,001) e moderada para transferências (Spearman=0,6; p=0,0005) e locomoção (Spearman=0,6; p=0,0006). A subescala mobilidade da SCIM III mostrou correlação positiva e significante para cadência (Spearman=0,8; p0,001), velocidade da marcha (Spearman=0,7; p0,001) e comprimento do passo (Spearman=0,6; p0,001). Conclusões: A SCIM III é um instrumento de avaliação funcional reprodutível intra e inter examinadores e capaz de avaliar o nível de independência dos indivíduos com paraparesia espástica. O SCIM III é mais sensível que a MIF, especialmente para pacientes com maior independência. Cadência, velocidade de marcha e comprimento do passo se correlacionaram com a subescala mobilidade / Purpose: to verify the applicability, reproducibility, and validity of the SCIM III patients with non-traumatic spastic paraplegia. Method: The cross-sectional study included 30 subjects (66% females; 41.5 ± 14.7 y) older with spastic paraparesis of any etiology were assessment by computerized gait analysis and with the Brazilian versions of SCIM III (0-100 points), FIM (18-126 points) by 2raters (A and B) at the same day and 1 week later (A). Results: The intraclass correlation coefficient (ICC) for the use of SCIM III indicated good intra and inter-evaluator reproducibility (ICC = 0.9). Correlation between the SCIM III and the motor FIM was appropriate (Spearman=0.6; p0.001). SCIM III subscales and the FIM domains correlated strongly for self-care (Spearman=0.8; p0.001), moderately for transfers (Spearman=0.6; p=0.0005) and locomotion (Spearman=0.6; p=0.0006). SCIM III mobility subscale positively correlated with the cadence (Spearman=0.8; p0.01), gait speed (Spearman=0.7; p0.01), and step length (Spearman=0.6;p0.01). Conclusions: SCIM III is a reproducible functional assessment instrument and capable of evaluating the level of independence of the individual with spastic paraplegia. The SCIM III is more sensitive than the FIM for non-traumatic spastic paraplegic patients with higher levels of independence. Linear gait parameters correlated with its mobility subscale.

No description available.

Submitted by Paula Lumi Goulart Nishimura (lumi.paula@gmail.com) on 2018-06-04T19:58:13Z No. of bitstreams: 1 Nishimura_Paula_diretrizes_design_cadeirasderodas.pdf: 8095797 bytes, checksum: 1357536835458a473e7ca38e94c32e9f (MD5) / Approved for entry into archive by Lucilene Cordeiro da Silva Messias null (lubiblio@bauru.unesp.br) on 2018-06-05T12:45:18Z (GMT) No. of bitstreams: 1 nishimura_plg_me_bauru.pdf: 7973597 bytes, checksum: d53a2fda1c6589b14cd407d952d45b81 (MD5) / Made available in DSpace on 2018-06-05T12:45:18Z (GMT). No. of bitstreams: 1 nishimura_plg_me_bauru.pdf: 7973597 bytes, checksum: d53a2fda1c6589b14cd407d952d45b81 (MD5) Previous issue date: 2018-03-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Muitas das cadeiras de rodas utilizadas por animais domésticos com problemas locomotores são feitas a partir de materiais improvisados, como canos, rodinhas de brinquedos e diversos materiais reciclados, devido, sobretudo, aos seus baixos custos. Porém, esses aparelhos improvisados podem ter desempenho comprometido e não atenderem às necessidades do animal, até mesmo causarem lesões por não serem devidamente adaptados. Uma das finalidades do Design é solucionar problemas de projeto, como também otimizar o produto e o seu processo de produção, podendo, dessa forma, auxiliar no desenvolvimento de equipamentos para cães com problemas locomotores, cuja área ainda carece de estudos. O objetivo da presente pesquisa foi propor as diretrizes necessárias para a construção de cadeiras de rodas eficientes para cães com problemas de locomoção nos membros pélvicos a partir de tecnologias de Prototipagem Rápida, as quais proporcionam a obtenção de peças com exatidão geométrica ou discrepância desprezível, assegurando maior conforto e melhor funcionalidade, com menores tempo de produção e custos. Esta pesquisa foi dividida em duas fases: (i) pesquisa teórica bibliográfica e (ii) pesquisa prática experimental. Na teórica, foram feitas revisões bibliográficas a respeito dos problemas locomotores em cães e sobre as tecnologias de Prototipagem Rápida, suas aplicações e estado da arte. Já na fase experimental, uma metodologia projetual adaptada de Munari (1981) foi utilizada para confecção e análise de aparelhos existentes, os quais contribuíram para a proposta de um modelo que suprisse as necessidades dos modelos analisados. A cadeira de rodas projetada, embora tenha atendido às principais expectativas, necessitou de alguns ajustes e alterações estruturais, podendo ser considerada um primeiro passo para o desenvolvimento de modelos futuros. Em vista disso, através das informações obtidas na produção desse aparelho, como também os dados coletados a partir dos outros testes e análises, foi possível elencar as diretrizes fundamentais para a produção de cadeiras de rodas eficientes, com peças impressas em 3D, para cães com problemas locomotores nos membros pélvicos. / Many wheelchairs used by domestic animals with locomotion problems are made from improvised materials such as pipes, toy wheels and many recycled materials, due to their low costs. However, these improvised devices can compromise performance and may not attend the needs of the animal, even causing injuries for not being properly adapted. One of Design's purposes is to solve problems within projects, as well as to optimize the product and its production process, and, in this way, to aid in the development of this kind of equipment for dogs with locomotive problems, whose area is still lacking in studies. The present research objective was to propose the necessary guidelines for the construction of efficient wheelchairs for dogs with locomotion problems in the pelvic area using Rapid Prototyping technologies, which provide pieces with geometric accuracy or negligible discrepancy, ensuring greater comfort and better functionality to the dog, with shorter production time and lower costs. This research was divided into two phases: (i) theoretical bibliographic research and (ii) experimental practical research. In the theoretical phase, bibliographical reviews were made regarding the locomotion problems in dogs and about Rapid Prototyping technologies, their applications, and state of the art. In the experimental phase, a design methodology adapted from Munari (1981) was used for the confection and analysis of existing devices, which contributed to the proposal of a model that would attend the needs of the models analyzed. The designed wheelchair, although had met the main expectations, required some adjustments and structural changes, and could be considered a first step for the development of future models. Consequently, through the information obtained in the production of this device, as well as the data collected from the other tests and analyzes, it was possible to list the fundamental guidelines for the production of efficient wheelchairs with 3D printed parts for dogs with locomotion problems in the pelvic area.

Orientadores: Leonilda Maria Barbosa dos Santos, Benito Pereira Damasceno / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T19:26:19Z (GMT). No. of bitstreams: 1 Silva_FelipevonGlehn_D.pdf: 6687964 bytes, checksum: 5e92607a118fbc6e4c8085aa93b540a0 (MD5) Previous issue date: 2013 / Resumo: A Neuromielite óptica (NMO) é uma doença inflamatória e desmielinizante do SNC, de natureza autoimune, caracterizada por surtos graves de neurite óptica e mielite transversa, de evolução mais freqüente na forma recidivante-remitente, com pouca remissão dos déficits entre as crises, altamente incapacitante. A presença do anticorpo anti-aquaporina 4 (anti-AQP4) foi descrito em 73% a 91% dos pacientes com diagnóstico de NMO. Doenças autoimunes podem frequentemente ser desencadeadas após infecções por micro-organismos, como agentes virais. A NMO e a infecção pelo HTLV-1 possuem prevalência coincidentemente elevada em certas áreas do globo, como o Brasil. Com o objetivo de avaliar a associação do HTLV-1 com a NMO, foi pesquisada a presença de anti-AQP4 e anti-HTLV-1 em 34 pacientes com DENMO, 43 pacientes infectados com HTLV-1, assintomáticos ou com a doença mielopatia associada ao HTLV-1 (HAM/TSP) e 23 controles sadios. Nenhum paciente com DENMO apresentou sorologia positiva para HTLV-1. Nenhum paciente infectado pelo HTLV-1 apresentou soropositividade para anti-AQP4. 60% dos casos de DENMO foram positivos para anti-AQP4. Esses resultados sugerem que a mielopatia associada à variante aguda da HAM/TSP e aquela associada ao anticorpo anti-AQP4 são entidades clínicas distintas, e provalvemente, não relacionadas de forma patogênica ao HTLV-1 em nosso meio. O cérebro humano expressa amplamente AQP4, mas estudos anatomopatológicos e de neuroimagem não detectaram lesões corticais desmielinizantes ou infiltrados inflamatórios no DENMO. A fim de avaliar melhor a presença de alterações estruturais nas substâncias cinzenta e branca encefálicas no DENMO, foram estudados 34 pacientes por RNM de 3T e tomografia de coerência óptica retiniana pareados com controles sadios, divididos nas apresentações NMO, mielite transversa longitudinal extensa (MTLE) e neurite óptica (NO), além de soropositivos versus soronegativo para anti-AQP4 e 5 anos ou menos de doença versus mais de 5 anos de doença. Houve maior grau de atrofia retiniana nos grupos NMO e NO, além dos grupos anti-AQP4+ e mais de 5 anos de doença. Foi constatado maior grau de atrofia cortical cerebral e estruturas da substância branca nos grupos NMO e MTLE, anti-AQP4+ e mais de 5 anos de doença. A atrofia retiniana se correlacionou positivamente com a atrofia do lobo occipital. Esses dados sugerem que o DENMO está associado à atrofia de estruturas das substâncias cinzenta e branca cerebrais; que a atrofia não se limita apenas às áreas das vias sensorial, motora e visual, mas é mais difusa; que quanto maior o tempo de doença e a presença do anticorpo anti-AQP4, maior é o grau de atrofia cortical, configurando estes fatores, tempo e anti-AQP4+, como de pior prognóstico; e a correlação positiva entre atrofia da camada de fibras nervosas retinianas e atrofia pericalcarina, além da escala de incapacidade funcional expandida (EDSS), sugere que a degeneração neuronal retrógrada e/ou anterógrada do tipo Walleriana é um importante causador da atrofia cortical no DENMO / Abstract: Neuromyelitis optica (NMO) is an inflammatory disease of the central nervous system (CNS) of putative autoimmune aetiology, which is characterized by severe attacks of myelitis and optic neuritis (ON). A relapsing course with rapid accumulation of neurological deficits with little or no remission is common. The NMO is autoimmune in nature and antibodies to Aquaporin 4 (AQP4) are associated with the development of the disease. AQP4 is the most common water channel protein of CNS; present in astrocytes processes, endothelium and piamater meninges. It predominates at some sites of the CNS, as optic nerve, brain stem and gray matter of medulla, the same sites of the usual inflammatory lesions. Autoimmune diseases may be triggered by microorganism infections and NMO and HTLV-1 infection have coincidentally high prevalence in certain areas of the world including Brazil. To study a possible relationship between these two diseases, we determined the seroprevalence of antibodies to AQP4 in 43 patients with HTLV-1 infection, asymptomatic or with HTLV-1 associated myelopathy (HAM/TSP) and that of HTLV-1 antibodies in patients with neuromyelitis optica spectrum disorders (NMOSD). AQP4ab positivity was found in 60% of NMOSD patients, but in none of the HAM/TSP patients and none of the asymptomatic HTLV-1 infected individuals. Conversely, all AQP4-Ab-positive NMOSD patients were negative for HTLV-1 antibodies. The results argue both against a role of antibodies to AQP4 in the pathogenesis of HAM/TSP and against an association between HTLV-1 infection and the development of AQP4-Ab. Moreover, the absence of HTLV-1 in all patients with NMOSD suggests that HTLV-1 is not a common trigger of acute attacks in patients with AQP4-Ab positive NMOSD in populations with high HTLV-1 seroprevalence. Although AQP4 is also expressed widely in the human brain cortex, beyond the common sites of lesions in NMO, recent studies have found no MRI or histopathological evidence for cortical demyelination. To investigate magnetic resonance imaging (MRI) patterns of gray matter (GM) and white matter (WM) abnormalities in patients with NMO and its incomplete forms, isolated longitudinally extensive transverse myelitis and optic neuritis, and to assess the prognostic impact of GM and WM abnormalities in these conditions, we performed both 3T high-resolution T1-weighted and diffusion tensor MRI in thirty-four patients with NMO spectrum disorders (NMOSD) and 34 matched healthy controls. Voxel-based morphometry (SPM8/MATLAB2012b), cortical analyses (Freesurfer), and diffusion tensor imaging analyses (TBSS-FSL) were used to investigate brain abnormalities. In addition, retinal nerve fiber layer was measured by means of optic coherence tomography (OCT). These analyses resulted in following findings: (1) NMOSD is associated with GM and WM atrophy, which encompasses more brain structures than the motor, sensory, and visual pathways; (2) this atrophy is more widespread in patients with NMO and LETM than in patients with ON; (3) the extent of GM atrophy correlates with disease duration, and (4) GM/WM atrophy in NMOSD is more pronounced in AQP4 antibody-seropositive than in -seronegative patients. Furthermore, it was demonstrated for the first time in NMOSD a correlation between RNFL atrophy and GM atrophy in the occipital lobes as assessed by OCT, indicating a role for retrograde degeneration in GM atrophy and suggesting that the extent of brain GM/WM atrophy may be of prognostic relevance in NMOSD / Doutorado / Neurologia / Doutor em Ciências Médicas

Estudamos a avaliação clínica de longo termo da resposta de pacientes com diagnóstico precoce de HAM/TSP ao tratamento com metil-prednisolona. Objetivamos pesquisar em relação ao tempo de evolução e apresentação da doença a eficácia deste tratamento. Realizamos o acompanhamento dos pacientes utilizando como parâmetros as escalas de critérios clínicos de Osame e Kurtzke e comparamos com um grupo controle que não recebeu este tipo de tratamento.Os pacientes do grupo experimental e do grupo controle que realizaram fisioterapia mantiveram-se estáveis ou obtiveram melhora de alguns sintomas da doença / We studied the long-term clinical response of patients with early diagnoses of HAM/TSP to treatment with methylprednisolone. The aim was to study this treatment in relation to the time of evolution and presentation of the disease and its effectiveness. The patients were followed using the scales of clinical criteria by Osame and Kurtzke, and compared with a control group of patients who did not receive this treatment type. We observed that patients in the experimental group and the control group, having been followed up with physiotherapy, either remained stable or presented improvement for some symptoms of the disease

Objetivo: Construir e testar a aplicabilidade de um instrumento baseado no Core Set resumido da CIF para lesão medular em indivíduos com etiologia não-traumática. Métodos: Foi realizada uma revisão sistemática para identificarmos as escalas de avaliação funcional que tenham sido aplicadas em indivíduos com paraparesia espástica. Para o desenvolvimento do instrumento utilizamos as descrição das categorias selecionadas para o Core Set resumido de lesão medular traumática crônica e elaboramos perguntas de fácil compreensão e alternativas de respostas descritos com detalhes que satisfizessem os seus qualificadores para guiar a aplicação do instrumento e garantir a reprodutibilidade dos achados. Após esta fase realizamos a aplicação desse instrumento em 40 indivíduos com lesão medular não-traumática (mulheres: 62,5%, média de idade: 44 ± 16 anos). A prevalência de incapacidade em cada uma das categorias da CIF foi definida pela proporção de indivíduos com os qualificadores de 1 a 4. Resultados: Na revisão sistemática identificamos 10 instrumentos de avaliação funcional a usados para paraparesia espástica, dos quais somente a Escala de Osame e a SCIM-III podem ser consideradas específicas para a nossa amostra. Dentre estes instrumentos de avaliação a MIF apresentou maior número de categorias da CIF, a Escala de Osame e o Rankin apresentaram menores números de categorias da CIF e o DEFU-QV foi a escala que continha mais categorias exclusivas. Desenvolvemos um instrumento baseado no Core Set resumido da CIF para lesão medular traumática crônica, contendo 43 perguntas com subitens. O instrumento foi considerado bom e de fácil uso pelos avaliadores, levando em média 45 minutos de aplicação. Os dados foram correlacionados com a Escala de Disfunção Motora Osame (0 - 13 pontos), que foi dicotomizada em dois grupos leve (0 a 4 pontos) e grave (>= 5) para análise. A pontuação média na Escala de Osame foi 5,4 ± 2,2, a SCIM-III apresentou a pontuação média de 83,0 ± 13,0. Indivíduos do grupo grave apresentaram maior frequência de deficiências quando avaliados pelo Core Set de lesão medular, principalmente: funções sexuais, neuromusculoesqueléticas, defecação e dor. A medula espinhal foi a Estrutura do Corpo citada com maior frequência. Nas categorias de Atividades e Participação: todos os indivíduos apresentaram deficiência na utilização de transporte, bem como dificuldade para o uso da mão e do braço, andar, dirigir, deslocar-se, realizar rotina diária, trabalho e lazer. As principais barreiras identificadas referiram-se a condições de ambientes internos e externos, enquanto os principais facilitadores foram os produtos para uso pessoal na vida diária, seguido daqueles usados para mobilidade e transporte pessoal em ambientes interno e externo, família imediata e profissionais de saúde. Conclusão: O instrumento desenvolvido propõe uma forma de aplicar o Core Set de lesão medular crônica. É de fácil compreensão e aplicação pelos profissionais que o utilizaram e foi capaz de diferenciar os indivíduos mais gravemente incapacitados. Tem vantagem de identificar e ponderar o impacto dos Fatores Ambientais / Objective: Building and test the applicability of an instrument based on the brief ICF Core Set for spinal cord injury in patients with non-traumatic etiology. Methods: A systematic review was performed to identify the functional assessment scales that have been applied in individuals with spastic paraparesis. For the development of this instrument, we used the description of the selected categories for the brief Core Set of chronic traumatic spinal cord injury and easy comprehension questions were elaborated along with choices for answers described with enough details in order to satisfy their qualifiers to guide the application of the instrument and ensure the reproducibility of the findings. After this phase we applied this instrument in 40 patients with non-traumatic spinal cord injury (women: 62.5%; mean age: 44 ± 16 years). The proportion of individuals defined the prevalence of disability in each ICF category with the qualifiers from 1 to 4. Results: The systematic review enabled us to identify 10 functional assessment instruments used for spastic paraparesis, of which only Osame Scale and SCIM-III may be considered specific to the sample used herein. Among these evaluation tools MIF presented a higher number of ICF categories, the Osame Scale and Rankin had lower numbers of ICF categories and DEFU-QOL was the scale which contained more exclusive categories. We have developed a tool based on the brief ICF Core Set for chronic traumatic spinal cord injury, containing 43 questions with sub-items. This instrument was considered good and easy to use by the evaluators, taking an average of 45 minutes of application. The data was correlated with Osame Motor Disability Scale (0 - 13 points), which was dichotomized into two groups: mild (0 to 4 points), and severe (>= 5) for analysis purposes. The average score in Osame Scale was 5.4 ± 2.2, and SCIM-III presented an average of 83.0 ± 13.0. Individuals from the severe group presented a greater frequency of disabilities when evaluated by the Core Set of spinal cord injury, mainly: sexual functions, neuromusculoskeletal, defecation and pain. The spinal cord was the Body Structure most frequently cited. In the categories of Activities and Participation, all of the individuals presented limitation to use transportation as well as the use of hand and arm, walking, driving, moving, carrying out daily routine tasks, work and leisure. The main barriers identified were related to the conditions of internal and external environments, while the main facilitators were the products for personal use in daily life, followed by those used for mobility and personal transport in internal and external environments, immediate family and health professionals. Conclusion: The developed instrument proposes a form to apply the Core Set of chronic spinal cord injury. It is easy to understand and be applied by professionals who used it. Furthermore, it was able to differentiate the individuals more severely disabled. It has the advantage to identify and ponder the impact of environmental factors as well

Estudamos a avaliação clínica de longo termo da resposta de pacientes com diagnóstico precoce de HAM/TSP ao tratamento com metil-prednisolona. Objetivamos pesquisar em relação ao tempo de evolução e apresentação da doença a eficácia deste tratamento. Realizamos o acompanhamento dos pacientes utilizando como parâmetros as escalas de critérios clínicos de Osame e Kurtzke e comparamos com um grupo controle que não recebeu este tipo de tratamento.Os pacientes do grupo experimental e do grupo controle que realizaram fisioterapia mantiveram-se estáveis ou obtiveram melhora de alguns sintomas da doença / We studied the long-term clinical response of patients with early diagnoses of HAM/TSP to treatment with methylprednisolone. The aim was to study this treatment in relation to the time of evolution and presentation of the disease and its effectiveness. The patients were followed using the scales of clinical criteria by Osame and Kurtzke, and compared with a control group of patients who did not receive this treatment type. We observed that patients in the experimental group and the control group, having been followed up with physiotherapy, either remained stable or presented improvement for some symptoms of the disease