ABSTRACT Introduction/framework/objectives Multiple Sclerosis has a reasonable prevalence and the diagnosis is generally made at working age, at a stage that is still demanding on a professional level, a time when there are also generally personal/family particularities that require some dedication. Furthermore, given the incidence, diversity and severity of the symptoms presented, limitations often arise that can seriously affect the ability to work or even lead to unemployment. It is then desirable that the members working in Occupational Health and Safety teams have some knowledge on the subject, in order to better guide their performance, safeguarding the interests of everyone involved. Methodology This is a Bibliographic Review, initiated through a search carried out in April 2023, in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP”. Content It is a demyelinating and autoimmune disease of the Central Nervous System; it is characterized by recurrent and intermittent episodes of inflammation, with generally progressive destruction of axonal myelin. In most cases there is a cycle of relapses and remissions and symptoms of varying intensity; the evolution is unpredictable. Causes autonomic, visual, motor and sensory symptoms; which makes independent daily living and the ability to work difficult; sometimes becoming debilitating. It is incurable and neurodegenerative. The severity varies depending on the neurological areas most affected. The function of myelin is to facilitate conduction at the level of axons; with changes in this, the electrical impulses that coordinate mental and physical functions become less effective. As myelin deteriorates, it is replaced by scars of abnormal tissue, with different consistency (stiffness, plaques), which further disrupts conduction. Injuries to the frontal and parietal lobes often result in cognitive and emotional changes; in the spinal cord, problems arise more easily in the lower limbs. Changes in the optic nerve and occipital lobe can cause visual problems. This is the neurological desease that causes most limitations in the young adult active population. Given the reasonably young age at which symptoms begin, there will be a decrease in quality of life, more significant than in other chronic diseases. Discussion and Conclusions Although the bibliography is not scarce, the emphasis in the vast majority of articles is not on Occupational Health or Safety. It would be relevant for some teams working in large companies with some prevalence, to evaluate the cases in detail, describing the main problems detected, proposed measures and their subsequent evaluation, in order to publish not only the path, but also the conclusions obtained, for greater dissemination of the subject.

RESUMO Introdução/enquadramento/objetivos A Esclerose Múltipla tem uma prevalência razoável e o diagnóstico faz-se geralmente em idade ativa, numa fase ainda exigente a nível profissional, altura essa onde geralmente também existem particularidades pessoais/familiares que necessitam de alguma dedicação. Para além disso, dada a incidência, diversidade e gravidade dos sintomas apresentados, com frequência surgem limitações que podem condicionar seriamente a capacidade de trabalho ou até levar ao desemprego. Será então desejável que os elementos a exercer em equipas de Saúde e Segurança Ocupacionais tenham alguns conhecimentos sobre o tema, de forma a melhor orientar o seu desempenho, salvaguardando os interesses de todos os envolvidos. Metodologia Trata-se de uma Revisão Bibliográfica, iniciada através de uma pesquisa realizada em abril de 2023, nas bases de dados “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina e RCAAP”. Conteúdo É uma doença desmielinizante e auto-imune do Sistema Nervoso Central; carateriza-se por episódios recorrentes e intermitentes de inflamação, com destruição de mielina axonal, geralmente progressiva. Na maioria dos casos existe um ciclo de relapsos e remissões e sintomas de intensidade oscilante; a evolução é imprevisível. Causa sintomas autonómicos, visuais, motores e sensoriais; o que dificulta a vida quotidiana independente e o trabalho, tornando-se por vezes debilitante. É incurável e neurodegenerativa. A gravidade varia com as áreas neurológicas mais atingidas. À medida que a mielina se detiora, ela é substituída por cicatrizes de tecido anormal, com diferente consistência (rigidez, placas), o que perturba ainda mais a condução. Lesões nos lóbulos frontal e parietal geralmente resultam em alterações cognitivas e emocionais; na espinal medula, mais facilmente surgem problemas nos membros inferiores. Alterações no nervo ótico e lobo occipital podem originar alterações visuais. Trata-se da doença neurológica que mais limitações causa na população ativa jovem adulta. Dada a idade razoavelmente jovem do início de sintomas, irá ocorrer diminuição da qualidade de vida, mais significativa que noutras doenças crónicas. Discussão e Conclusões Ainda que a bibliografia não seja escassa, a enfase da grande maioria dos artigos não é dada à Saúde ou Segurança Ocupacionais. Seria relevante que algumas equipas a exercer em empresas grandes e com alguma incidência, avaliassem com detalhe os casos, descrevendo os principais problemas detetados, medidas propostas e avaliação posterior das mesmas, de forma a publicar não só o caminho, mas também as conclusões obtidas, para maior divulgação do assunto.

Abstract Introduction Facial trauma can cause damage to the facial nerve, which can have negative effects on function, aesthetics, and quality of life if left untreated. Objective To evaluate the effectiveness of peripheral facial nerve direct end-to-end anastomosis and/or nerve grafting surgery for patients with facial nerve injury after facial trauma. Methods Fifty-nine patients with peripheral facial nerve paralysis after facial injuries underwent facial nerve rehabilitation surgery from November 2017 to December 2021 at Ho Chi Minh City National Hospital of Odontology. Results All 59 cases of facial trauma with damage to the peripheral facial nerve underwent facial nerve reconstruction surgery within 8 weeks of the injury. Of these cases, 25/59 (42.3%) had end-to-end anastomosis, 22/59 (37.3%) had nerve grafting, and 12/59 (20.4%) had a combination of nerve grafting and end-to-end anastomosis. After surgery, the rates of moderate and good recovery were 78.4% and 11.8%, respectively. All facial paralysis measurements showed statistically significant improvement after surgery, including the Facial Nerve Grading Scale 2.0 (FNGS 2.0) score, the Facial Clinimetric Evaluation (FaCE) scale, and electroneurography. The rate of synkinesis after surgery was 34%. Patient follow-up postoperatively ranged from 6 to > 36 months; 51 out of 59 patients (86.4%) were followed-up for at least 12 months or longer. Conclusion Nerve rehabilitation surgery including direct end-to-end anastomosis and nerve grafting is effective in cases of peripheral facial nerve injury following facial trauma. The surgery helps restore nerve conduction and improve facial paralysis. function aesthetics untreated endtoend end andor Fiftynine Fifty nine 201 202 Odontology 5 2559 25 25/5 42.3% 423 42 3 (42.3% 2259 22 22/5 37.3% 373 37 (37.3% 1259 12/5 20.4% 204 20 4 (20.4% 784 78 78.4 118 11 11.8% respectively 2 0 2. FNGS score FaCE (FaCE scale electroneurography 34 34% followup follow up 86.4% 864 86 (86.4% followedup followed 1 longer 255 25/ 42.3 (42.3 225 22/ 37.3 (37.3 125 12/ 20.4 (20.4 7 78. 11.8 86.4 (86.4 42. (42. 37. (37. 20. (20. 11. 86. (86. (42 (37 (20 (86 (4 (3 (2 (8 (

Abstract Background Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide and can be classified into electrophysiological subtypes and clinical variants. Objective This study aimed to compare the frequency of the sural-sparing pattern (SSP) in subtypes and variants of GBS. Methods This retrospective cohort study analyzed clinical and electrophysiological data of 171 patients with GBS hospitalized in public and private hospitals of Natal, Rio Grande do Norte, Brazil, between 1994 and 2018; all cases were followed up by the same neurologist in a reference neurology center. Patients were classified according to electrophysiological subtypes and clinical variants, and the SSP frequency was compared in both categories. The exact Fisher test and Bonferroni correction were used for statistical analysis. Results The SSP was present in 53% (57 of 107) of the patients with acute inflammatory demyelinating polyradiculoneuropathy (AIDP), 8% (4 of 48) of the patients with axonal subtypes, and 31% (5 of 16) of the equivocal cases. The SSP frequency in the AIDP was significantly higher than in the axonal subtypes (p < 0.0001); the value was kept high after serial electrophysiological examinations. Only the paraparetic subtype did not present SSP. Conclusion The SSP may be present in AIDP and axonal subtypes, including acute motor axonal neuropathy, but it is significantly more present in AIDP. Moreover, the clinical variants reflect a specific pathological process and are correlated to its typical electrophysiological subtype, affecting the SSP frequency. GuillainBarré Guillain Barré (GBS suralsparing sural sparing (SSP 17 Natal Norte Brazil 199 2018 center categories analysis 53 57 107 AIDP, , (AIDP) 8 4 ( 48 31 5 16 p 0.0001 00001 0 0001 0.0001) examinations neuropathy Moreover 1 19 201 10 (AIDP 3 0.000 0000 000 20 0.00 00 2 0.0 0.

Resumo Antecedentes A síndrome de Guillain-Barré (GBS) é a causa mais comum de paralisia flácida aguda em todo o mundo e pode ser classificada em subtipos eletrofisiológicos e variantes clínicas. Objetivo Este estudo teve como objetivo comparar a frequência do padrão de preservação do sural (SSP) em subtipos e variantes de GBS. Métodos É um estudo de coorte retrospectivo que analisou dados clínicos e eletrofisiológicos de 171 pacientes com GBS internados em hospitais públicos e privados de Natal, Rio Grande do Norte, Brasil, entre 1994 e 2018. Todos os casos foram acompanhados pelo mesmo neurologista em centro de referência em neurologia. Os pacientes foram classificados de acordo com os subtipos eletrofisiológicos e variantes clínicas e a frequência do SSP foi comparada em ambas as categorias. O teste exato de Fisher e a correção de Bonferroni foram utilizados para análise estatística. Resultados O SSP esteve presente em 53% (57 de 107) dos pacientes com polirradiculoneuropatia desmielinizante inflamatória aguda (PDIA), em 8% (4 de 48) dos pacientes com subtipos axonais e em 31% (5 de 16) dos casos não definidos. A frequência do SSP no AIDP foi significativamente maior do que nos subtipos axonais (p < 0,0001); o valor manteve-se elevado após exames eletrofisiológicos seriados. Apenas o subtipo paraparético não apresentou SSP. Conclusão O SSP pode estar presente na PDIA e nos subtipos axonais, incluindo a neuropatia axonal motora aguda, mas está significativamente mais presente na PDIA. Além disso, as variantes clínicas refletem um processo patológico específico e estão correlacionadas ao seu subtipo eletrofisiológico típico, afetando a frequência do SSP. GuillainBarré Guillain Barré (GBS (SSP 17 Natal Norte Brasil 199 2018 neurologia categorias estatística 53 57 107 PDIA, , (PDIA) 8 4 ( 48 31 5 16 definidos p 0,0001 00001 0 0001 0,0001) mantevese manteve se seriados disso típico 1 19 201 10 (PDIA 3 0,000 0000 000 20 0,00 00 2 0,0 0,

Abstract Objectives This study evaluated pain intensity in elderly subjects with hip fractures admitted to the emergency sector and undergoing preoperative pericapsular nerve group (PENG) block. Additionally, the degree of tolerable hip flexion was assessed. Methods A prospective, randomized, and controlled clinical trial with parallel groups. The control group consisted of elderly subjects with hip fractures undergoing standardized intravenous systemic analgesia. The intervention group consisted of elderly patients with hip fractures undergoing PENG block and standardized systemic analgesia. The groups were evaluated at rest and during movement using the Pain Assessment in Advanced Dementia (PAINAD) scale. We determined pain intensity and reduction, in addition to the degree of tolerable flexion of the fractured hip. All patient assessments occurred before the medication or block administration and at 45 minutes, 12, 24, and 36 hours postmedication or block. Results Preoperatively and 24 hours after PENG block, elderly subjects with hip fracture showed a significant reduction in pain at rest or movement compared to control patients (p< 0.05), with 60% of patients assessed at rest demonstrating desirable pain reduction (≥50%) and only 13.3% of the control group achieving the desired pain reduction. During movement, after undergoing PENG block, 40% of subjects demonstrated the desired pain reduction and no patient from the control group. The intervention group also showed a significant improvement in the tolerable hip flexion group (p< 0.05). Conclusion Preoperative PENG block in elderly subjects with hip fractures admitted to the emergency sector provided a significant reduction in pain compared with the control group. (PENG Additionally prospective randomized analgesia PAINAD (PAINAD scale 4 minutes 12 3 2 p< p (p 0.05, 005 0.05 , 0 05 0.05) 60 ≥50% 50 (≥50% 133 13 13.3 40 0.05. . 1 00 0.0 6 ≥50 5 (≥50 13. 0. ≥5 (≥5 ≥ (≥ (

Resumo Objetivos Este estudo avaliou a intensidade da dor em idosos acometidos por fratura do quadril internados no setor de emergência e submetidos ao Pericapsular Nerve Group (PENG) block no pré-operatório. Ademais, o grau de flexão tolerável do quadril foi avaliado. Métodos Ensaio clínico, prospectivo, aleatorizado e controlado em grupos paralelos. O grupo controle consiste em idosos com fratura do quadril, submetidos à analgesia sistêmica endovenosa padronizada. O grupo intervenção consiste em idosos com fratura do quadril submetidos ao PENG block e analgesia sistêmica padronizada. Os grupos foram avaliados em repouso e durante o movimento pela escala de dor Pain Assessment in Advance Dementia (PAINAD). Aferiram-se intensidade da dor e redução álgica, assim como o grau de flexão tolerável do quadril fraturado. Todos os pacientes foram avaliados previamente à administração de medicação ou bloqueio e aos 45 minutos, 12, 24 e 36 horas pós-medicação ou bloqueio. Resultados No pré-operatório e 24 horas após o PENG block, idosos com fratura do quadril apresentaram redução significativa da dor em repouso ou movimento em comparação com o controle (p< 0,05), com 60% dos pacientes avaliados em repouso, demonstrando a redução álgica desejável de ≥ 50% e apenas 13,3% do grupo controle com redução álgica desejável. Durante o movimento, após o PENG block, 40% demonstraram redução álgica desejada e nenhum paciente do grupo controle apresentou a redução desejada. Verificou-se, também, no grupo intervenção a melhora significativa da flexão tolerável do quadril (p < 0,05). Conclusão O PENG block no pré-operatório de idosos com fratura do quadril, internados no setor de emergência, proporcionou redução significativa da dor em comparação ao grupo controle. (PENG préoperatório. préoperatório pré operatório. operatório Ademais avaliado clínico prospectivo paralelos padronizada PAINAD. PAINAD . (PAINAD) Aferiramse Aferiram se fraturado 4 minutos 12 2 3 pósmedicação pós p< p 0,05, 005 0,05 , 0 05 0,05) 60 50 133 13 13,3 40 Verificouse, Verificouse Verificou se, Verificou-se também 0,05. (PAINAD 1 00 0,0 6 5 13, 0,

Abstract Amyloidosis results from deposition of insoluble fibrillar protein compounds in various organs, including the heart. Cardiac involvement occurs in both atria and ventricles, leading to restrictive cardiomyopathy, heart failure (HF), and arrhythmias. Five amyloid proteins affect cardiac tissue: light and heavy chain forms of immunoglobulin, transthyretin (TTR), apolipoprotein 1, and amyloid A. Approximately 95% of cardiac involvement stems from light chain of immunoglobulin and TTR deposition in heart. Chamber stiffness and rhythm disturbances occur in cardiac amyloidosis (CA), encompassing from HF to atrial and ventricular arrhythmias (VA), and both can compromise each other. It is known that conduction system disorders and VA increase sudden death risk, as amyloid infiltration, inflammation, and fibrosis alter myocardial electrophysiology. Beyond the heart, autonomous nerve systems suffer amyloid deposition, contributing to syncope manifestation and increasing the risk of death and poor prognosis. In this context, our review sheds light on the importance of recognizing syncope and rhythm disturbances as crucial markers in the early identification and management of CA, potentially offering avenues for prompt intervention and improved patient outcomes. organs ventricles cardiomyopathy HF, , (HF) tissue TTR, (TTR) 1 A 95 CA (CA) VA, (VA) other infiltration inflammation electrophysiology prognosis context outcomes (HF (TTR 9 (CA (VA

ABSTRACT A 34-year-old man developed severe envenomation after being bitten by a Crotalus durissus (rattlesnake), which was treated with anticrotalic serum. Three weeks later, the patient reported paresthesia and neuropathic pain in the left hand, which had progressed to all four limbs. Electroneuromyography revealed asymmetric axonal sensorimotor multiple mononeuropathy. The patient was treated with prednisone, and six months later there was significant improvement in sensorimotor conduction. This is the first reported case of multiple mononeuropathy associated with C. durissus envenomation. Post-snake envenomation peripheral neuropathy is a rare complication requiring prompt recognition and treatment to optimize nerve function and enhance patient outcomes. 34yearold yearold 34 year old rattlesnake, rattlesnake , (rattlesnake) serum hand limbs prednisone conduction C Postsnake Post snake outcomes 3 (rattlesnake

Resumen El Síndrome del Túnel Carpiano es una mononeuropatía asociada al atrapamiento del nervio mediano a nivel de la articulación carpiana, en el túnel que le da su nombre, y se trata de un padecimiento frecuente y subdiagnosticada. Actualmente se emplean un grupo de técnicas para su diagnóstico, que incluyen pruebas electrofisiológicas de velocidad de conducción nerviosa, sensitiva y motora. El presente estudio tuvo como objetivo identificar el método o combinación de métodos electrofisiológicos con mayor precisión en el diagnóstico del Síndrome del Túnel Carpiano. Se realizó un estudio observacional analítico de validez de pruebas diagnósticas, basado en la comparación de velocidades de conducción sensitiva y motora distal, en el segmento palma muñeca y la electromiografía de los pacientes. Se observó que la mejor fue la combinación de la latencia con la velocidad de conducción sensitiva y la velocidad de conducción motora en el segmento palma-muñeca con una sensibilidad del 98.62%, especificidad del 90%, el valor predictivo positivo fue de 99.08%, la razón de verosimilitud positiva fue de 9.8624 y la razón de verosimilitud negativa 0.0153. Por esta razón se considera que la secuencia ideal para el diagnóstico del padecimiento es el estudio de las latencias sensoriales y motoras en primer lugar, y si el resultado es negativo, entonces determinar la velocidad de conducción motora palma-muñeca.

Abstract Carpal Tunnel Syndrome is a mononeuropathy associated with the entrapment of the median nerve at the level of the carpal joint, in the tunnel that gives it its name, and it is a common and underdiagnosed condition. Currently, a group of techniques are used for its diagnosis, which include electrophysiological tests of nerve conduction velocity, sensory and motor. The objective of this study was to identify the method or combination of electrophysiological methods with the best accuracy in the diagnosis of Carpal Tunnel Syndrome. An analytical observational study of the validity of diagnostic tests was carried out, based on the comparison of distal sensory and motor conduction velocities, in the palm-wrist segment and the electromyography of the patients. It was observed that the best was the combination of latency with sensory conduction velocity and motor conduction velocity in the palm-wrist segment with a sensitivity of 98.62%, specificity of 90%, the positive predictive value was 99.08%. the positive likelihood ratio was 9.8624 and the negative likelihood ratio was 0.0153. For this reason, it is considered that the ideal sequence for diagnosing the condition is to first study the sensory and motor latencies, and if the result is negative, then determine the palm-wrist motor conduction speed.

Abstract Facial nerve schwannoma is a benign neoplasm originating from the Schwann cells of the facial nerve. It represents approximately 5% of facial paralysis cases and should be included in the differential diagnosis of peripheral facial paralysis. This neoplasm most frequently affects the tympanic and mastoid segments of the facial nerve. Therapeutic options include surgery, stereotactic radiosurgery or ’wait and scan’. We describe the case of a patient with an acute peripheral facial palsy, otalgia and left conduction hearing loss, that was interpreted as an acute otitis media complicated with facial paralysis based on the history, physical examination and imaging findings. Due to persistence the patient was submitted to an exploratory tympanomastoidectomy which confirmed the diagnosis of facial nerve schwannoma. During the procedure, a subtotal resection of the lesion was performed, which resulted in postoperative clinical and audiological improvement. After subtotal resection, we opted for regular observation and imaging evaluation of the tumor residue.

Resumo O schwannoma do nervo facial é uma neoplasia benigna com origem nas células de Schwann do nervo facial. Corresponde a cerca de 5% das paralisias faciais e deve ser incluído no diagnóstico diferencial de uma paralisia facial periférica. Esta neoplasia atinge mais frequentemente os segmentos timpânico e mastoideu do nervo facial. As opções terapêuticas incluem cirurgia, radiocirurgia estereotáxica ou vigilância clínico-imagiológica. Descrevemos o caso de um doente com um quadro agudo de paralisia facial periférica, otalgia e hipoacusia de condução esquerdas. O quadro clínico foi interpretado como uma otite média aguda complicada com paralisia facial com base na história, exame objetivo e achados imagiológicos de urgência. Por persistência das queixas, após uma semana, foi submetido a uma timpanomastoidectomia exploradora que confirmou o diagnóstico de schwannoma do nervo facial. Durante o procedimento foi efetuada uma ressecção subtotal da lesão, que se traduziu numa melhoria clínica e audiológica pós-operatória. Após resseção subtotal, optou-se por vigilância clínica e avaliação imagiológica regulares do resíduo tumoral.

Abstract Background The distinction between sensory neuronopathies (SN), which is by definition purely sensory, and sensory polyneuropathies (SP) and sensory multineuropathies (SM) is important for etiologic investigation and prognosis estimation. However, this task is often challenging in clinical practice. We hypothesize that F-wave assessment might be helpful, since it is able to detect subtle signs of motor involvement, which are found in SP and SM, but not in SN. Objective The aim of the present study was to determine whether F-waves are useful to distinguish SN from SP and SM. Methods We selected 21 patients with SP (12 diabetes mellitus, 4 transthyretin familial amyloid polyneuropathy, 4 others), 22 with SM (22 leprosy), and 26 with SN (13 immune-mediated, 10 idiopathic, 3 others) according to clinical-electrophysiological-etiological criteria. For every subject, we collected data on height and performed 20 supramaximal distal stimuli in median, ulnar, peroneal, and tibial nerves, bilaterally, to record F-waves. Latencies (minimum and mean) and persistences were compared across groups using the Kruskal-Wallis and Bonferroni tests. P-values < 0.05 were considered significant. Results All groups were age, gender, and height-matched. Overall, there were no significant between-group differences regarding F-wave latencies. In contrast, F-wave persistence was able to stratify the groups. Peroneal F-wave persistence was higher, bilaterally, in the SN group compared to SM and SP (p < 0.05). In addition, F-waves persistence of the ulnar and tibial nerves was also helpful to separate SN from SP (p < 0.05). Conclusion F-wave persistence of the peroneal nerves might be an additional and useful diagnostic tool to differentiate peripheral sensory syndromes. SN, , (SN) (SP (SM estimation However practice Fwave F wave involvement Fwaves waves 2 12 (1 mellitus polyneuropathy others, others (2 leprosy, leprosy leprosy) 13 immunemediated, immunemediated immune mediated, mediated immune-mediated 1 idiopathic clinicalelectrophysiologicaletiological electrophysiological etiological criteria subject median bilaterally Fwaves. waves. minimum mean KruskalWallis Kruskal Wallis tests Pvalues P values 005 0 05 0.0 age gender heightmatched. heightmatched matched. matched height-matched Overall betweengroup latencies contrast higher p 0.05. . 0.05) addition syndromes (SN ( 00 0.

Resumo Antecedentes A distinção entre neuronopatias sensitivas (SN) e polineuropatias sensitivas (SP) e multineuropatias sensitivas (SM) é importante para a investigação etiológica e para o prognóstico. Contudo, esta tarefa é desafiadora na prática clínica. Hipotetizou-se que a avaliação das ondas-F pode ser útil, por ser capaz de detectar envolvimento motor nas SP e SM, mas não nas SN. Objetivo Determinar se as ondas-F podem ajudar a distinguir entre SN, SP e SM. Métodos Selecionou-se 21 pacientes com SP (12 diabetes mellitus, 4 ATTR-FAP e 4 com outras neuropatias), 22 com SM (22 hanseníases) e 26 com SN (13 imunomediadas, 10 idiopáticas e 3 com outras neuronopatias), de acordo com critérios clínicos, etiológicos e eletrofisiológicos. Para cada indivíduo, foi aferida a altura e foram aplicados 20 estímulos distais supramáximos nos nervos mediano, ulnar, fibular e tibial, bilateralmente, para registrar as ondas-F. Uma comparação foi feita, por grupo, das latências (mínimas e médias) e persistências pelos testes Kruskal-Wallis e Bonferroni. Valores de p < 0.05 foram considerados estatisticamente significativos. Resultados Todos os grupos foram pareados por idade, sexo e altura. Não houve diferença estatística significativa entre os grupos quanto às latências das ondas-F. A persistência da onda-F foi capaz de estratificar os grupos, sendo as dos nervos fibulares bilateralmente maiores no grupo SN que nos grupos SM e SP (p < 0.05). Adicionalmente, a persistência das ondas-F dos nervos ulnares e tibiais também foi útil para distinguir SN de SP (p < 0.05). Conclusão A persistência das ondas-F dos nervos fibulares pode ser uma ferramenta adicional e útil para diferenciar síndromes sensitivas periféricas. (SN (SP (SM prognóstico Contudo clínica Hipotetizouse Hipotetizou ondasF ondas F Selecionouse Selecionou 2 12 (1 mellitus ATTRFAP ATTR FAP neuropatias, neuropatias , neuropatias) (2 hanseníases 13 imunomediadas 1 neuronopatias, neuronopatias) clínicos eletrofisiológicos indivíduo mediano ulnar tibial ondasF. F. feita mínimas médias KruskalWallis Kruskal Wallis Bonferroni 005 0 05 0.0 significativos idade ondaF onda 0.05. . 0.05) Adicionalmente periféricas ( 00 0.

Resumen Introducción: La hiponatremia se presenta en el 21,5-48% de los pacientes con síndrome de Guillaín-Barré (SGB), sin embargo, existe poca información sobre sus implicaciones clínicas en el SGB. Material y métodos: Se realizó un estudio observacional, transversal, de pacientes con diagnóstico de SGB. Recabamos información de variables clínicas, resultado del LCR y conducción nerviosa. Los pacientes con niveles de sodio < 135 meq/L en estudios de laboratorio al ingreso y antes del inicio de tratamiento fueron considerados con hiponatremia. Definimos buen pronóstico funcional a la presencia de marcha independiente (Hughes ≤ 2 puntos) a los 3 meses de seguimiento. Resultados: De 212 pacientes, 31 (14.6%) presentaron hiponatremia, sexo masculino 72%, edad promedio 45.9 ± 16 años, MRC score 30.1 ± 17 puntos, requerimiento de VMI 32%, presencia de disautonomía 32%. Recabamos ciento ochenta y dos estudios de conducción nerviosa y 165 resultados citoquímicos de punción lumbar. En el análisis comparativo entre los pacientes con hiponatremia vs sin hiponatremia, observamos diferencias significativas: edad (50.4 ± 14,9 vs. 43.8 ± 16.3, p = 0.03), días de hospitalización (mediana) (16 [IQR = 7-51] vs. 7 [IQR = 5-12] p = 0.03), disautonomía (54.8% vs. 28.2%, p = 0.006), niveles de proteínas (mgs/dL) en LCR (mediana) (105 [IQR = 59-165] vs. 39 [IQR = 28-57], p ≤ 0.001) y variante AIDP (70.4% vs. 42%, p = 0.011); En la recuperación de la marcha a los 3 meses, no hubo diferencia significativa (34,6% vs. 42,6%, p = 0.51). Conclusión: 14% de los pacientes con SGB presentan hiponatremia, con formas clínicas más severas, presencia de disautonomía, variante de AIDP más frecuente, niveles elevados de proteínas en LCR y mayor número de días de estancia hospitalaria, pero no afecta el pronóstico funcional.

Abstract Introduction: Hyponatremia occurs in 21-48% of patients with Guillain-Barre syndrome (GBS). However, little is known about the clinical implications in GBS. Materials and methods: In this observational, cross-sectional study, of patients diagnosed with GBS was conducted. Information used included: demographic clinical variables, cerebrospinal fluid (CSF) results, and nerve conduction studies. Patients with sodium levels < 135 meq/L in laboratory studies on admission and before treatment were considered to have hyponatremia. We defined good functional prognosis as the presence of independent gait (Hughes ≤ 2 points) at 3 months of follow-up. Results: Two hundred and twelve patients were initially screen and 31 (14.6%) presented hyponatremia; male gender was predominant with 72%, mean age was 45.9 ± 16 years, mean Modified Medical Research Council (MRC) score was 30.1 ± 17 points, invasive mechanical ventilation requirement was 32%, and the presence of dysautonomia 32%. One hundred and eighty-two nerve conduction studies, and 165 CSF cytochemical samples were collected. In the comparative analyses between the patients with hyponatremia versus without hyponatremia, we observed significant differences in mean age (50.4 ± 14.9 vs. 43.8 ± 16.3, p = 0.03), days of hospitalization (median) (16 [IQR = 7-51] vs. 7 [IQR = 5-12] p = 0.03), dysautonomia (54.8% vs. 28.2%, p = 0.006), protein levels (mgs/dL) in CSF (median) (105 [IQR = 59-165] vs. 39 [IQR = 28-57], p ≤ 0.001), and acute inflammatory demyelinating polyneuropathy (AIDP) variant (70.4% vs. 42%, p = 0.011). There was no significant finding in recovery of independent gait at 3 months (34.6% vs. 42.6%, p = 0.51). Conclusion: About 14% of patients with GBS presented with hyponatremia in our series and is associated with presence of dysautonomia, AIDP variant, elevated CSF protein levels and a greater number of days of hospital stay but did not impact functional prognosis.

SUMMARY: The preserved form of all components of the nerve fiber is a prerequisite for the proper conduction of the nerve impulse. various factors can change the shape of nerve fibers. In everyday practice, qualitative histological analysis is the gold standard for detecting changes in shape. Geometric morphometry is an innovative method that objectively enables the assessment of changes in nerve fibers' shape after local anesthetics action. A total of sixty sciatic nerves were used as material, which was intraneural injected with saline solution in the control group (n=30), and a solution of 1.33 % liposomal bupivacaine (n=30) in the test group. After the animals were sacrificed, nerve samples were taken and histological preparations were made. The preparations were first described and examined using a qualitative histological method, after which digital images were made. The images were entered into the MorphoJ program and processed using the method of geometric morphometry. Qualitative histological examination revealed no differences in nerve fibers after intraneurally applied physiological solution and liposomal bupivacaine. Using the method of geometric morphometry, a statistically significant change in the shape of axons was found after intraneurally applied saline solution and liposomal bupivacaine (p=0.0059). No significant differences in histological changes were found after the qualitative histological analysis of nerve fiber cross-section preparations. A statistically significant change in the shape of nerve fiber axons was observed after geometric morphometric analysis of digital images after intraneural application of saline and liposomal bupivacaine.

RESUMEN: La forma conservada de todos los componentes de la fibra nerviosa es un requisito previo para la conducción correcta del impulso nervioso. Varios factores pueden cambiar la forma de las fibras nerviosas. En la práctica diaria, el análisis histológico cualitativo es el estándar de oro para detectar cambios de forma. La morfometría geométrica es un método innovador que permite evaluar objetivamente los cambios en la forma de las fibras nerviosas después de la acción de los anestésicos locales. Se utilizó como material un total de sesenta nervios ciáticos, que se inyectaron intraneuralmente con solución salina en el grupo control (n=30), y una solución de bupivacaína liposomal al 1,33 % (n=30) en el grupo de prueba. Después de sacrificados los animales, se tomaron muestras de nervios y se realizaron preparaciones histológicas. Primero se describieron y examinaron las preparaciones utilizando un método histológico cualitativo, después de lo cual se tomaron imágenes digitales. Las imágenes fueron ingresadas al programa MorphoJ y procesadas mediante el método de morfometría geométrica. El examen histológico cualitativo no reveló diferencias en las fibras nerviosas después de la aplicación intraneural de solución fisiológica y bupivacaína liposomal. Usando el método de morfometría geométrica, se encontró un cambio estadísticamente significativo en la forma de los axones después de la aplicación intraneural de solución salina y bupivacaína liposomal (p = 0,0059). No se encontraron diferencias significativas en los cambios histológicos después del análisis histológico cualitativo de las preparaciones de secciones transversales de fibras nerviosas. Se observó un cambio estadísticamente significativo en la forma de los axones de las fibras nerviosas después del análisis de morfometría geométrica de imágenes digitales después de la aplicación intraneural de solución salina y bupivacaína liposomal.

Abstract Carpal tunnel syndrome (CTS) is the most frequent compressive mononeuropathy in clinical practice, with a higher prevalence in women. It is manifested by pain and paresthesia in the area of distribution of the median nerve, usually of nocturnal predominance. The diagnosis is based on anamnesis and physical examination, complemented by nerve conduction studies and electromyography. The Phalen and Tinnel tests are provocative maneuvers suggestive of CTS. As for treatment, in mild cases, a conservative approach can be chosen; in moderate to severe cases, or failure of conservative treatment, surgical treatment is indicated. The purpose of this article is to review the main guidelines regarding the approach and treatment of CTS. The family doctor is in a privileged position for the diagnosis and treatment of the clinical manifestations of CTS. All interventions must be carried out to improve patients' quality of life and obtain health gains. A multidisciplinary approach may be required, through active collaboration between Primary and Secondary Health Care.

Resumo A síndrome do canal cárpico (SCC) é a mononeuropatia compressiva mais frequente na prática clínica, com maior prevalência no sexo feminino. Manifesta-se por dor e parestesia na área de distribuição do nervo mediano, geralmente de predomínio noturno. O diagnóstico baseia-se na anamnese e exame objetivo, sendo complementado com os estudos de condução nervosa e eletromiografia. Os testes de Phalen e Tinnel são manobras provocatórias, sugestivas de SCC. Quanto ao tratamento, nos casos ligeiros pode-se optar por uma abordagem conservadora; nos casos moderados a graves, ou falência do tratamento conservador, está indicado o tratamento cirúrgico. O objetivo deste trabalho é rever as principais diretrizes no que diz respeito à abordagem e tratamento do SCC. O médico de família encontra-se numa posição privilegiada para o diagnóstico e tratamento das manifestações clínicas do SCC. Todas as intervenções devem ser feitas no sentido de melhorar a qualidade de vida dos doentes e obter ganhos em saúde. Poderá ser necessária uma abordagem multidisciplinar, através de uma colaboração ativa entre os Cuidados de Saúde Primários e Secundários.

SUMMARY OBJECTIVE: The aim of this study was to evaluate the efficacy of radial extracorporeal shock wave therapy on pain, functionality, and electrophysiological measurements in carpal tunnel syndrome. METHODS: Between June 2021 and January 2022, a total of 66 wrists in 45 participants with mild-to-moderate carpal tunnel syndrome were included in this double-blind, prospective, randomized, placebo-controlled study. Patients were randomized into two groups, namely, the radial extracorporeal shock wave therapy (group 1, n=33) and the sham radial extracorporeal shock wave therapy (group 2, n=33). Night splints and tendon nerve gliding exercises were given to all participants. The participants were evaluated at baseline and the first month after treatment. Participants were evaluated using a visual analog scale, the Boston Carpal Tunnel Questionnaire, Leeds Neuropathic Symptom and Symptom Assessment, and electrophysiological examinations. RESULTS: A total of 37 participants (a total of 55 wrists, radial extracorporeal shock wave therapy n=27, and sham radial extracorporeal shock wave therapy n=28) completed the study. After the intervention, there was a significant decrease in visual analog scale values (p<0.001) and a significant increase in Boston Carpal Tunnel Questionnaire scores (p<0.001) and Leeds Neuropathic Symptom and Symptom Assessment scores (p<0.001). In electrophysiological measurements, there was a significant decrease in median nerve sensory (p=0.002) and motor (p=0.003) distal latency, and a significant increase in median nerve sensory conduction velocity (p=0.026) was found in the radial extracorporeal shock wave therapy group. CONCLUSION: This study shows that radial extracorporeal shock wave therapy has positive effects on pain, functionality, and electrophysiological measurements for mild-to-moderate carpal tunnel syndrome 1 month after application. OBJECTIVE pain functionality METHODS 202 2022 6 4 mildtomoderate mild moderate doubleblind, doubleblind double blind, blind double-blind prospective placebocontrolled placebo controlled groups namely group n=33 n33 n 33 2 n=33. . treatment examinations RESULTS 3 5 n27 27 n=27 n=28 n28 28 intervention p<0.001 p0001 p 0 001 (p<0.001 p<0.001. p=0.002 p0002 002 (p=0.002 p=0.003 p0003 003 (p=0.003 latency p=0.026 p0026 026 (p=0.026 CONCLUSION application 20 n=3 n3 n2 n=2 p<0.00 p000 00 (p<0.00 p=0.00 (p=0.00 p=0.02 p002 02 (p=0.02 n= p<0.0 p00 (p<0.0 p=0.0 (p=0.0 p<0. p0 (p<0. p=0. (p=0. p<0 (p<0 p=0 (p=0 p< (p< p= (p= (p

SUMMARY OBJECTIVE: Teriflunomide is an oral medication approved for the treatment of patients with multiple sclerosis. The primary effect of teriflunomide is to reduce de novo pyrimidine synthesis by inhibiting mitochondrial dihydroorotate dehydrogenase, thereby causing cell-cycle arrest. We aimed to investigate the occurrence of peripheral neuropathy, a rare side effect of teriflunomide, in patients receiving teriflunomide. METHODS: Multiple sclerosis patients receiving teriflunomide (n=42) or other disease modifying therapies (n=18) and healthy controls (n=25) were enrolled in this cross-sectional study between January 2020 and 2021. The mean duration of teriflunomide treatment was 26 months (ranging from 6 to 54 months). All participants underwent neurological examination and nerve conduction studies of tibial, peroneal, sural, superficial peroneal, median, and ulnar nerves by using surface recording bar and bipolar stimulating electrodes. RESULTS: The mean superficial peroneal nerve distal latency and conduction velocity were significantly slower, and the mean superficial peroneal nerve action potential amplitude was lower in patients using teriflunomide (2.50 ms, p<0.001; 47.35 m/s, p=0.030; and 11.05 μV, p<0.001, respectively). The mean peroneal motor nerve distal latency was significantly longer and amplitude was lower in teriflunomide patients (3.68 ms, p<0.001, and 5.25 mV, p=0.009, respectively). During the study period, treatment switching to another disease-modifying therapy was planned in 10 patients, and all neuropathic complaints were reversed after switching. CONCLUSION: Teriflunomide has the potential to cause peripheral neuropathy. The awareness of peripheral neuropathy, questioning the symptoms, and if suspected, evaluation with electromyography and switching the therapy in patients under teriflunomide treatment are crucial. OBJECTIVE dehydrogenase cellcycle cell cycle arrest neuropathy METHODS n=42 n42 n 42 (n=42 n=18 n18 18 (n=18 n=25 n25 25 (n=25 crosssectional cross sectional 202 2021 2 ranging 5 months. . months) tibial sural median electrodes RESULTS slower 2.50 250 50 (2.5 ms p<0.001 p0001 p 0 001 4735 47 35 47.3 m s m/s p=0.030 p0030 030 1105 11 05 11.0 μV respectively. respectively respectively) 3.68 368 3 68 (3.6 525 5.2 mV p0009 009 p=0.009 period diseasemodifying 1 CONCLUSION symptoms suspected crucial n=4 n4 4 (n=4 n=1 n1 (n=1 n=2 n2 (n=2 20 2.5 (2. p<0.00 p000 00 473 47. p=0.03 p003 03 110 11. 3.6 36 (3. 52 5. p=0.00 n= (n= 2. (2 p<0.0 p00 p=0.0 3. (3 (n ( p<0. p0 p=0. p<0 p=0 p< p=

Abstract Background Dexmedetomidine (Dex) is widely used, and its most common side effect is bradycardia. The complete mechanism through which Dex induces bradycardia has not been elucidated. This research investigates the expression of gap junction proteins Connexin30.2 (Cx30.2) and Connexin40 (Cx40) within the sinoatrial node of rats with Dex-induced sinus bradycardia. Methods Eighty rats were randomly assigned to five groups. Saline was administered to rats in Group C. In the other four groups, the rats were administered Dex to induce bradycardia. In groups D1and D2, the rats were administered Dex at a loading dose of 30 μg.kg−1 and 100 μg.kg−1 for 10 min, then at 15 μg.kg−1.h−1 and 50 μg.kg−1.h−1 for 120 min separately. The rats in group D1A and D2A were administered Dex in the same way as in group D1and D2; however, immediately after the administration of the loading dose, 0.5 mg atropine was administered intravenously, and then at 0.5 mg.kg−1.h−1 for 120 min. The sinoatrial node was acquired after intravenous infusion was completed. Quantitative real-time polymerase chain reaction and western blot analyses were performed to measure mRNA and protein expression of Cx30.2 and Cx40, respectively. Results The expression of Cx30.2 increased, whereas the expression of Cx40 decreased within the sinoatrial node of rats with Dex-induced sinus bradycardia. Atropine reversed the effects of Dex on the expression of gap junction proteins. Conclusion Dex possibly altered the expression of gap junction proteins to slow down cardiac conduction velocity in the sinoatrial node.