No abstract
O hálux varo é um acometimento infrequente na rotina ortopédica e consiste no desvio medial do hálux em relação ao primeiro metatarso. No presente artigo, relatamos o caso de uma paciente, do sexo feminino, com 45 anos, que chegou ao serviço de saúde após sofrer um trauma na região do pé direito. A paciente evoluiu com uma deformidade, ao apresentar um hálux varo pós-traumático, que necessitará de posterior intervenção cirúrgica. Para tanto, foi aplicada a técnica Mini TightRope, a qual apresentou vantagens em relação a outras estratégias cirúrgicas, já que pode promover a reabilitação funcional e estética do paciente.
Context: We present a patient diagnosed with Tuberous Sclerosis (TS) who developed West Syndrome (WS) early on. Early diagnosis of TS is important for genetic counseling and WS requires early intervention to avoid neurodevelopmental deficits. Case report: Y.S.L.C., female, 45 days old, presented cardiac rhabdomyoma and 9 hypomelanotic lesions, being diagnosed with TS. At 2 months old, she presented epileptic seizures of flexion spasms, which progressed in 1 week to neuropsychomotor development (NP) regression and hypsarrhythmia. She was diagnosed with WS and treated with vigabatrin. There was suppression of hypsarrhythmic pattern at 8 months old. Currently 8 years old, she has hypochromic stains, hemangiomyolipomas in the right kidney, bilateral renal cysts, sebaceous adenomas, facial angiofibromas, cortical tubers, subependymal nodules, Intellectual Disability and Focal Epilepsy. Conclusions: ET is an autosomal dominant disease caused by mutations in TSC1 and TSC2 genes leading neurodevelopmental changes and cellular hyperplasias. TE diagnosis is clinical, based on major (such as facial angiofibromas, nail fibroma and hypopigmented macules) and minor criteria and molecular tests in doubtful cases. TE is associated with epilepsy in 80-90% of cases (30 to 50% of infantile spasms). WS is an encephalopathy of infantile spasms, NP arrest/regression and hypsarrhythmia. Early diagnosis and use of anti-epileptic drugs are necessary to avoid cognitive impairment.
Introduction: Neurology training involves practice in infirmaries and outpatient clinics in several subspecialties, as well as training in procedures and examinations. The analysis of Medical Residency Programs (MRPs) in Neurology in other countries is important to identify points of contrast and similarities as a way to keep the national training equivalent to other countries. Objectives: To analyze the duration and characteristics of the training of neurology physicians in Brazil and other countries. Methods: Cross-sectional study by active search on official web pages of governments and organizations/entities representing neurologists from 12 countries: Australia, Portugal, Italy, Greece, India, USA, Canada, Puerto Rico, Argentina, Chile, Uruguay, and Colombia. Information was obtained on the duration of medical school and residency, as well as the characteristics of this. Results: The duration of medical school was 4 to 7 years (median: 6; IIQ: 0.5). Duration in neurology was 3 to 6 years (median: 4; IIQ:1). Developed countries have a median duration of residency of 4.83 years ± 0.68 years, whereas in developing countries it was 3.66 ±0.47 years. Regarding access, 25% of the countries require a prerequisite. Regarding rotations, those present in most of the programs studied were: neurology outpatient clinic (100%), neuroradiology (83%), neuropediatrics (75%) clinical medicine (58%), psychiatry (58%). Conclusion: We identified differences in the standardization of PRM in Neurology among the countries studied. The duration of Brazilian residency is below the average of the other countries studied, but it includes the required rotations in developed countries.
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