The discussion about the palliative care approach in spinocerebellar ataxia (SCA) has become extremely relevant. Mainly after considering that most progressive ataxias are incurable, there are few published studies on their palliative and end-of-life care. Although many patients with degenerative neurological diseases have a normal life expectancy, some forms of SCA (e.g., type 1, 2, 3, and 17) can progress rapidly, with a shorter life span. This chapter will discuss current guidelines and recommendations that have been drawn from the broader field of progressive neurological conditions. In addition, we also review aspects of strategic end-of-life care management, the involvement of the multidisciplinary team and the contribution of allied health professionals are essential for excellent patient support care in a palliative approach. More studies on your supportive care and end-of-life care to manage this serious illness to improve quality of life and reduce suffering, addressing complex medical symptoms, psychosocial issues, general well-being, and planning strategies for better living and coping are needed.
Os prejuízos neurocognitivos após uma hemorragia subaracnóide (HSA) aneurismática, bem como as classificações de resultados neurocirúrgicos, vêm em processo de reavaliação. O tratamento endovascular dos aneurismas intracranianos, que inicialmente foi introduzido para a oclusão dos aneurismas mais difíceis, vem se tornando um método de escolha por ser menos invasivo, porem não se conhece o impacto neurocognitivo do tratamento da HSA aneurismática seja ele cirúrgico ou endovascular. Sabe-se que a HSA isoladamente também está associada com alterações cognitivas a longo prazo. Alguns fatores clínicos associados, como vasoespasmo, ressangramento, hidrocefalia, ruptura intra-operatória também podem agravar essas alterações cognitivas. Os estudos correlacionando essas variáveis foram iniciados há pouco tempo e não existe consenso a partir de estudo controlado na literatura. O objetivo deste relato visa demonstrar a aplicação clínica e neuropsicológica direcionada para analisar o estado cognitivo pré e pós-operatório em uma paciente que foi internada após duas hemorragias subaracnóideas (HSA) aneurismáticas, cujo aneurisma da artéria cerebral média esquerda foi clipado. São analisados o estado pré e pós-operatório tentado-se delimitar a disfunção dentro de padrão de comportamento individual, os distúrbios pré-operatórios e a seqüelas pós-operatórias quando ela foi averiguada mais tarde, analisando-se o impacto de ambas, hemorragia e cirurgia sobre o funcionamento cognitivo e funções afetivas.
It is of crucial importance to recognize the changes that occur in the brain ageing. Although neuroimaging studies are important tools used in the evaluation of changes in brain ageing mainly through the exclusion of comorbidities and neurodegenerative disorders, their role is still controversial. In this minireview, we discuss the main aspects of brain ageing, the differences between the young and old brain, the neuroimaging techniques and the use of neuroimaging to assess brain age. Differentiating the differences between normal structural and pathological ageing will provide a deeper understanding of the ageing process of the brain and will bring us new perspectives on biomarkers.
The recent appearance of Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in the context of ambulatory care and outpatient clinics in large metropolitan areas over all the world has attracted considerable interest from researchers in assessing the related epidemiological profiles. The present study aimed to identify potential predisposing risk factors of CA-MRSA infection using a case-control design. The epidemiological variables of patients diagnosed with CA-MRSA infection were compared to healthy controls. Data were collected from medical records and following univariate, logistic regression and forest plot calculation were performed. Smoking, HIV, trauma, congestive heart failure, recreational drugs, tattooing were potentially associated with an increased risk of community-associated MRSA predisposition. Dyslipidemia, diabetes mellitus and vascular catheter carriers were potentially associated with a risk of moderate predisposition while atopy, practice of sports, recent use of antibiotics was associated with no risk of CA-MRSA infection. Hypertension and COPD were possible protective factors. Although the study of predisposing risk factors for the CA-MRSA infection is promising, future clinical epidemiological studies including new strategies are recommended to better standardize predisposing risk factors and to control to spurious associations.
A specific metallopeptidase called angiotensin-converting enzyme 2 (ACE2) has been identified as the modulating receptor on the surface of the endothelium and other human cells infected by the new coronavirus causing Severe Acute Respiratory Syndrome (SARS-CoV-2) and Human Coronavirus Disease 2019 (COVID -19). This modulation of the expression of ACE2 in human cells may be responsible for the production of pro-inflammatory response with the development of the state of the systemic response of the inflammatory system, hypercoagulability/stasis also an increased risk of both ischemic and hemorrhagic strokes. Therefore, like ACE2, despite being present in almost all human organs, its expression is variable and probably dependent on epigenetic polymorphism, then this is still to be better understood. However, this highlights the importance to understand its pathogenesis and open the doors for the development of future treatment strategies aimed at various diseases related to ACE2, mainly cerebral vascular diseases, and perhaps COVID-19 itself.
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