Abstract INTRODUCTION: Human T-cell lymphotropic virus type 1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) causes, among other abnormalities, chronic pain that may impair quality of life (QOL). Home protocols can help those who have difficulty attending rehabilitation centers. This study aimed to evaluate the impact of a home-based exercise protocol on pain and QOL in people with HAM/TSP. METHODS: A randomized clinical trial of people with HAM/TSP (World Health Organization criteria) classified as probable or definite. The supervised group (SG) underwent training for 12 weeks and continued the protocol at home for another 12 weeks; the unsupervised group (UG) performed the same protocol at home without physical therapist supervision for 24 weeks; and the control group (CG) maintained the usual care. QOL was assessed by the Short Form-36 health survey and the pain condition by the Brief Pain Inventory (BPI). The Chi-square, analysis of variance, Kruskal-Wallis, and Friedman tests (5% alpha) were used for the analyses. The intention-to-treat method was adopted in case of follow-up losses. Record number RBR-849jyv/UTN: U1111-1176-2858. RESULTS: Of 56 participants, 49 completed the protocol. Mean pain was moderately reduced (>30%) in the UG and CG and mildly reduced (20%) in the SG. Loss in the vitality score of QOL in the CG was noted. CONCLUSIONS: The protocol generated mild and moderate pain relief and reduced losses in the functional QOL in the treatment groups.

Neurocysticercosis (NCC) is a common parasitic disease in our region, presenting diversity of neurological symptoms and signs. The present study has as primary objective an evaluation of the NCC's clinical and epidemiological profile within Bahia State, by means of a prospective study of 220 patients diagnosed from March 1988 to March 1999, with a follow-up of six months. Exams, such as Computed Cranial Tomography Scan (CT), Cerebral Spine Fluid (CSF) and Electroencephalogram (EEG), were accomplished in three distinct moments of these patients' evolution: at starting or diagnostic point (zero time), at after-intervention period (one month after treatment), and at control period (six months after treatment).

A Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS) em crianças conta com uma prevalência estimada de 1-3% e poderá estar associada a alterações neurocognitivas, comportamentais e cardiovasculares. Entretanto, alguns pediatras desconhecem o problema e este estudo poderá facilitar o reconhecimento de SAHOS pelos mesmos. OBJETIVO: Descrever as características clínicas e os índices respiratórios polissonográficos de crianças com SAHOS, em um laboratório de sono, entre janeiro de 2002 a julho de 2003. FORMA DE ESTUDO: Série de casos. MATERIAL E MÉTODO: Avaliaram-se 93 crianças, de 2 a 10 anos de idade, com diagnóstico polissonográfico de SAHOS. Analisaram-se idade, gênero, grupo racial e dados referentes à saúde e sono das crianças. Os dados polissonográficos estudados foram índice de apnéia-hipopnéia, dessaturação da oxihemoglobina e índice de microdespertar. RESULTADOS: O gênero masculino correspondeu a 61,3% dos casos. A média da idade foi de 5,2 ± 2,1 anos. As queixas que mais motivaram a realização do exame foram roncos, em 24,7% e sono inquieto em 24,7%. Condições médicas mais associadas foram rinite alérgica (98,9%) e hipertrofia de adenóides (50,6%). Apnéia leve ocorreu em 66% das crianças. A média e o desvio-padrão da saturação mínima de O2 foi de 89,1 ± 3,5 e a do número de microdespertares de 8,4 ± 3,5/hora de sono. CONCLUSÃO: Os resultados chamam atenção para a possibilidade de SAHOS em crianças com rinite alérgica e hipertrofia adenotonsilar, com queixas de ronco e sono inquieto.

Obstructive sleep apnea and hypopnea syndrome in children (osas) has an estimated prevalence of up to 3% and can be associated with neurocognitive and behavioural abnormalities, and also cardiovascular complications. This study may help pediatricians, who are unaware of the problem, to recognize osas. STUDY DESIGN: series of cases. AIM: to describe the clinical characteristics and polysomnographic respiratory findings in a population of children with obstructive sleep apnea and hypopnea syndrome referred to the sleep laboratory from january 2002 up to july 2003. METHODS: we studied 93 patients between 2 and 10 years of age with polysomnographic diagnosis of obstructive sleep apnea and hypopnea syndrome. Age, gender, racial group and questions about the children’s health and sleep related disorders were evaluated. Apnea-hypopnea index, oxyhemoglobin desaturation, and arousal index were evaluated too. RESULTS: males represented 61.3%, With a mean age of 5.2 ± 2.1 (Years-old). The complaints that most commonly lead to the exams were snoring in 24.7% And restless sleep in 24.7%. Associated medical conditions frequently reported were allergic rhinitis (98.9%) And adenoid hypertrophy (50.6%). Mild apnea was found in 66%. The mean and sd of spo2 nadir was 89.1 ± 3.5% And the mean and sd of the number of arousals was 8.4 ± 3.5/ Hour of sleep. CONCLUSION: the results suggest the possibility that obstructive sleep apnea and hypopnea syndrome should be suspected in children with allergic diseases and adenoid and tonsil hypertrophy with snoring and restless sleep complaints.

OBJETIVO: Descrever o perfil psiquiátrico, destacando os transtornos em co-morbidade entre os adolescentes em conflito com a lei da Casa de Acolhimento ao Menor (CAM), Salvador-BA, em 2003. MÉTODOS: Estudo de corte transversal, de caráter censitário, em população de 290 jovens cumprindo medidas de privação de liberdade. Utilizaram-se questionário para identificar dados demográficos, sinais e sintomas psicopatológicos e entrevista semi-estruturada para o exame dos adolescentes. RESULTADOS: Perfil sociodemográfico: 89,3% sexo masculino; 63,9% entre 15 e 18 anos incompletos; 95,1% com ensino fundamental incompleto ou analfabeto; 67,6% com renda familiar menor que um salário mínimo e 54% naturais da capital do estado da Bahia. Dos 290 indivíduos, 24,8% não apresentaram transtornos mentais e 75,2% preencheram critérios para um ou mais transtornos psiquiátricos de acordo com a décima revisão da Classificação Internacional de Doenças (CID-10). Entre os 218 jovens portadores de patologia, 47,7% apresentaram transtornos em co-morbidade.Aassociação de patologia mais prevalente foi entre transtornos de conduta e transtornos por uso nocivo de substância psicoativa (13,4%). Transtornos hipercinéticos só foram freqüentes quando associados a outras condições (10,7%). O uso nocivo de substância psicoativa foi identificado em combinação com os diversos quadros psiquiátricos. CONCLUSÃO: Observou-se alta taxa de co-morbidade psiquiátrica, sugerindo a necessidade de estratégias terapêuticas específicas entre jovens portadores de transtornos mentais envolvidos com a justiça.

OBJECTIVE: To describe the psychiatric profile, with emphasis on psychiatric comorbidities, of adolescents in conflict with the law interned on Casa de Acolhimento ao Menor (CAM), Salvador, Bahia, 2003. METHODS: This is a cross-sectional census study that enrolled a population of 290 adolescents kept on a deprivation of liberty regimen. Aquestionnaire was used to collect demographic and psychosocial data as well as psychopathologic signs and symptoms, and a semi-structured interview was carried out on the examination of the enrolled adolescents. RESULTS: Social-demographic profile: male (89.3%); between 15 and 18 years (63.9%), analphabets or had not completed the basic school years (95.1%); monthly family income below one minimum salary (67.6%). Among the 290 enrolled adolescents, 24.8% had no mental disturbance, while 75.2% fulfilled criteria to one or more psychiatric disorders according to ICD-10. Out of 218 adolescents who had at least one diagnosis, 47.7% had comorbidity disorders. The commonest association of conditions was between behavioral disorders and the noxious use of psychoactive drugs (13.4%). Hyperkinetic disorders are only frequent when associated with other conditions (10.7%). The noxious use of psychoactive drugs was also shown to be present, being noted in association with diverse psychiatric conditions. CONCLUSION: Ahigh rate of psychiatric comorbidity was found, suggesting the need for specific therapeutic approaches to aid adolescents with psychiatric conditions and in conflict with the law.

OBJETIVOS: descrever aspectos clínicos e liquóricos de pacientes com diagnóstico presuntivo de neuroesquistossomose (NE) e sugerir uma classificação para o diagnóstico liquórico presuntivo da NE. MÉTODO: as fichas de todos os pacientes cujo exame de líquor (LCR) foi realizado no Laboratório de Líquor, Fundação José Silveira, Salvador, Brazil, entre 1988 e 2002, foram revistas. Aqueles com suspeita clínica de NE e teste de imunofluorescência indireta (IFI) e ou inibição da hemaglutinação (IHA) positivos para S. mansoni foram identificados. RESULTADOS: dos 377 pacientes, 67,9% eram do sexo masculino, a mediana da idade foi 36 anos (média 37 + 16 anos, variação 3-82 anos). As queixas mais freqüentes foram paraparesia (59,9%), retenção urinária (36,2%), dor em membros inferiores (22,8%). A celularidade do LCR (células/mm³) foi > 4 em 66,0% (média 83 + 124, mediana 40, variação 4,3 - 1.100), a proteína (mg/dl) foi > 40 em 84,6% (média 185 + 519, mediana 81, variação 41-6.800) e eosinófilos estavam presentes em 46,9%. IFI e IHA foram positivas em 75,3%. Celularidade > 4 e presença de eosinófilos estiveram associadas com IFI e IHA positivas (67,3% versus 51,4%, p 0,014; 49,1% versus 23,0%, p 0,0001, respectivamente) e proteína > 40 não foi (85,4% versus 77,0%, p 0,09). Celularidade > 4, proteína > 40 e eosinófilos estiveram associados com IFI e IHA positivos (71,6% versus 38,2%, p 0,0003) mas a presença de eosinófilos e qualquer outra combinação de celularidade e proteína não estiveram. CONCLUSÃO: NE deve ser considerada uma possibilidade diagnóstica em pacientes que tiveram epidemiologia positiva para S. mansoni e desenvolveram uma mielopatia. A presença de IFI e IHA positivos para S. mansoni, celularidade > 4, proteína > 40 e presença de eosinófilos no líquor pode ser considerado critério de alta probabilidade para o diagnóstico presuntivo da NE.

OBJECTIVES: To describe the clinical and CSF findings among patients with presumptive neuroschistosomiasis (NS) and to suggest a classification for the CSF diagnosis of presumptive NS. METHOD: The charts of all patients whose CSF exam was performed at the CSF Lab, José Silveira Foundation, Salvador, Brazil, from 1988 to 2002 were reviewed. Those with clinically suspected NS whose indirect fluorescent antibody test (IFA) and or hemagglutination-inhibiting antibodies test (HAI) were positive to S. mansoni were identified. RESULTS: Of 377 patients, 67.9% were males; the median age was 36 years (mean 37 + 16 yrs, range 3-82 yrs). The most frequent complaints were paraparesis (59.9%), urinary retention (36.2%), lower limb pain (22.8%). WBC of CSF (count/mm³) was > 4 in 66.0% (mean 83 + 124, median 40, range 4.3-1,100), protein (mg/dl) was > 40 in 84.6% (mean 185 + 519, median 81, range 41-6,800) and eosinophils were present in 46.9%. IFA and HAI were positive in 75.3%. WBC > 4 and presence of eosinophils were associated with IFA and HAI positive (67.3% versus 51.4%, p 0.014; 49.1% versus 23.0%, p 0.0001, respectively) and protein > 40 was not (85.4% versus 77.0%, p 0.09). Presence of WBC > 4, protein > 40 and eosinophils was associated with IFA and HAI positive (71.6% versus 38.2%, p 0.0003) but presence of eosinophils and any other combination of WBC and protein were not. CONCLUSION: NS should be considered as a possible diagnosis in patients who had had contact with schistosome-infected water and present with spinal cord compromising. Presence of IFA and HAI positive to S. mansoni, WBC > 4, protein > 40 and presence of eosinophils in the CSF may be considered as a criterium of highly probable presumptive diagnosis.

O acometimento do sistema nervoso central pela tuberculose pode se manifestar de duas formas principais: tuberculose meníngea ou tuberculoma. Esta forma é uma condição que vinha decrescendo progressivamente, mas que encontrou nos dias atuais condições ideais para o seu desenvolvimento. O presente estudo discorre sobre três pacientes que desenvolveram expansão paradoxal de lesões de tuberculose cerebral durante o uso de tuberculostáticos, o que demonstra ser importante o acompanhamento tomográfico de pacientes que apresentem sinais neurológicos no curso do tratamento para a tuberculose. Os dois primeiros pacientes apresentaram o acometimento neurológico associado a tuberculose pulmonar, enquanto no terceiro havia história de tuberculose meníngea prévia. A tomografia computadorizada foi o exame utilizado para o acompanhamento desses pacientes. O tratamento constou do uso de tuberculostáticos e corticóide.

Central nervous system involvement by tuberculosis presents two main types: tuberculosus meningitis or tuberculoma. This second condition has nowadays ideal conditions for development. We report three patients who developed paradoxical brain tuberculosis expansive lesion during the use of tuberculostatic drugs. The cases point out the importance of tomography follow up of patients who present neurological signs in the course of treatment for tuberculosis. The first two patients presented onset of the a neurological symptoms, associated with lung tuberculosis. The third patient previously had tuberculous meninigitis. Computerized tomography was used to follow up these patients. Tuberculostatic and corticoid drugs were used for treatment.

Os autores relatam 16 casos de pacientes com forma meningomielorradicular da neuroesquistossomose mansônica, diagnosticados segundo critérios clínicos, laboratoriais e de imagem, acompanhados no Ambulatório de Neurologia-HUPES-UFBA no período de abril/91 a dezembro/93. Eles foram tratados com praziquantel associado a corticoterapia. O objetivo foi avaliar o grau de eficácia e de segurança da droga na regressão dos sinais e sintomas neurológicos.

The authors report 16 patients bearing the meningomyeloradicular form of Mansonic neuroschistosomiasis diagnosed according to clinical, laboratorial and image criteria. Patients have been observed at the Neurology Ambulatory of the Federal University of Bahia, within the period of April/91 to December/93. They have been treated with praziquantel, associated to corticosteroids. The aim has been to evaluate the drug's efficiency and safety in decreasing the neurological signs and symptoms.