Background: There is growing concern about individuals reported to suffer repeat COVID-19 disease episodes, these in a small number of cases characterised as de novo infections with distinct sequences, indicative of insufficient protective immunity even in the short term. Methods: Observational case series and case-control studies reporting 33 cases of recurrent, symptomatic, qRT-PCR positive COVID-19. Recurrent disease was defined as symptomatic recurrence after symptom-free clinical recovery, with release from isolation > 14 days from the beginning of symptoms confirmed by qRT-PCR. The case control study-design compared this group of patients with a control group of 62 patients randomly selected from the same COVID-19 database. Results: Of 33 recurrent COVID-19 patients, 26 were female and 30 were HCW. Mean time to recurrence was 50.5 days which was associated with being a HCW (OR 36.4 (p < 0.0 0 01)), and blood type A (OR 4.8 (p = 0.002)). SARS-CoV-2 antibodies were signifcantly lower in recurrent patients after initial COVID-19 (2.4 ± 0.610; p < 0.0 0 01) and after recurrence (6.4 ± 11.34; p = 0.007). Virus genome sequencing identified reinfection by a different isolate in one patient. Conclusions: This is the first detailed case series showing COVID-19 recurrence with qRT-PCR positivity. For one individual detection of phylogenetically distinct genomic sequences in the first and second episodes confirmed bona fide renfection, but in most cases the data do not formally distinguish between reinfection and re-emergence of a chronic infection reservoir. These episodes were significantly associated with reduced Ab response during initial disease and argue the need for ongoing vigilance without an assumption of protection after a first episode.

Objective The present paper aims to provide a review on the main complications involving traumatic brain injury (TBI) during pregnancy and on the vegetative state after TBI. Methods A systematic review was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria checklist. Results Seven studies were included, of which four were case reports, one was a follow-up, one was a comparative study, and one was a literature review. Discussion Presence of neurological deficits such as hemiparesis, neonatal seizures, cerebral palsy, hemorrhage or hydrocephalus was observed in children of mothers who suffered trauma during pregnancy. The prolongation of a pregnancy in these victims, even in brain death, is within the reach of current medicine. Ethical issues must be considered when deciding to prolong a pregnancy of a woman in brain death. Conclusion For the evaluation of pregnant women with TBI, there is a protocol that can be followed in the emergency care service. The cases reported in the literature suggest that there is no clear limit to restrict support to a pregnant patient in a vegetative state. Further studies should be done to elucidate this matter.

Introduction: Newborn represent a population at high risk for brain damage. Intracranial hemorrhages in newborn are uncommon, and epidural hematoma (EH) is rare. Material and methods: The authors present a literature review about EH in newborn. Results: EH in newborn occurs in only 2% and is frequently associated with the type of delivery. The clinical presentation is asymptomatic or heterogeneous. The diagnosis is made from anamnesis and imaging exams, and the treatment depends on the size of the EH. Conclusion: The knowledge of neurosurgeons, obstetricians and pediatricians about the occurrence of EH in newborn is extremely important. The rapid identification and management of the case is of paramount importance, to reduce neurological sequelae.

Introduction Basal ganglia traumatic hematoma (BGTH) is rare, occurring in 3% of closed traumatic brain injuries, and it is associated with a poor prognosis. In the present paper, the authors present a series of 16 BGTH cases, describing their causes, treatment, and results. Patients and Methods Thisis a retrospective study of 16 patients diagnosed with BGTH, associated with a literature review in the PubMed, ScienceDirect, and Google Scholar databases, using the terms craniocerebral trauma AND basal ganglia and basal ganglia AND hematoma AND trauma. Articles published in the period from 1986 to 2019 were selected, resulting in a total of 19 articles that met the inclusion criteria taking into account their citations and their respective impacts. Results Sixteen patients were studied. They were all male, with an average age of 21 years and 5 months. The main cause of BGTH was traffic accident (12). The mean score in the Glasgow coma scale at admission was 8. All patients underwent a computed tomography (CT) scan of the skull. The putamen was the most affected structure (5). Thirteen patients underwent conservative treatment, and three drained the associated intracranial hematoma. Nine patients died, and seven, and four had neurological sequel. Conclusions The neurosurgeon's knowledge of GBTH, including diagnosis and clinical surgical management, is extremely important, as this type of lesion is associated with a poor prognosis.

Introduction The middle meningeal artery (MMA) is an important artery in neurosurgery. As the largest branch of the maxillary artery, it provides nutrition to the meninges and to the frontal and parietal regions. Diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (TAVF), Moya-Moya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine, and meningioma, may be related to the MMA. The aim of the present study is to describe the anatomy of the MMA and to correlate it with brain diseases. Methods A literature review was performed using the PubMed, Scielo, Scientific Direct, Ebsco, LILACS, TripDataBase and Cochrane databases, with the following descriptors: neurosurgery, neuroanatomy, meninges and blood supply. Discussion The MMA is embedded in a cranial groove, and traumatic or iatrogenic factors can result in MMA-associated pseudoaneurysms or arteriovenous fistulas (AVFs). In hemodynamic stress, true aneurysms can develop. Arteriovenous fistulas, pseudoaneurysms, and true aneurysms can be effectively treated by endovascular or surgical removal. In MMD, the MMA plays a role in the development and in the improvement of collateral circulation. Finally, in cases of CSDH, when standard surgery and drainage fail, MMA embolization can constitute a great alternative. Conclusion The MMA is a relevant structure for the understanding of neurosurgical diseases. In conclusion, every neurosurgeon must know the anatomy of the MMA sufficiently to correlate it with the diagnosed pathology, thus obtaining treatment effectiveness and preventing brain lesion.

Introdução: O traumatismo cranioencefálico (TCE) por queda de Televisão (TV) tem sido pouco divulgado em nosso meio. Suas consequências são sequelas ou óbito. Metodologia: Foram analisados oito casos de crianças vítimas de TCE por queda de TV quanto ao sexo, idade, escore na escala de coma de Glasgow (ECG) na admissão, achados de tomografia computadorizada (TC) do crânio, tratamento e prognóstico. Discussão: Queda de TV pode causar significativo dano cerebral em crianças. As lesões mais comuns são de crânio, face, seguida de membros, tórax e abdome. Lesões associadas ao TCE pioram o prognóstico. Conclusão: É de suma importância que seja dada orientação aos familiares e cuidadores de crianças.

Introduction: Diabetic foot is responsible for 40% to 60% of all non-traumatic amputations. Early and intensive ulcer identification and treatment have been shown to reduce the number of amputations by 45 to 90%. Due to the deficit of low-cost computerized programs and aiming at an improvement in the prevention of diabetic foot complications, the Diabetic Foot System-SISPED was created. Therefore, the present work aims to validate the applicability of this SISPED system. Methods: 117 clinical foot examination records performed by a team of specialists in the detection of the risk foot were evaluated and lauded. Cases were categorized as having or not a risk foot, and the latter, when diagnosed, was classified as described in the literature. These data were then entered into SISPED. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the reports were calculated. Results: The mean age of the participants was 55.3 ± 15.5 years, female gender was predominant (71.8%), the meantime of Diabetes Mellitus (DM) diagnosis was 11.9 ± 9.6 years, and the mean glycated hemoglobin was 8.5±1.9%. Patients had type 1 risk foot in 85.5% of cases and only 12% had normal feet. Analysis of the SISPED results indicated a sensitivity of 92.8%, specificity of 99%, positive predictive value (PPV) of 92.8%, negative predictive value (NPV) of 99%, and accuracy of 98.3%. Conclusion: Comparison of the results of SISPED reports, which should be used by general practitioners, with those of a professional specialized in diabetic foot showed equivalence in diagnostic accuracy. The SISPED was valid to be implemented in the Brazil’s National Health System (SUS), in Sergipe, as a diagnostic support tool for health professionals in the assistance to people with diabetes mellitus.

A Síndrome do Piriforme é uma condição clínica de ciática não discogênica causada pela compressão do nervo ciático pelo músculo piriforme. Sua fisiopatologia ainda hoje é controversa, podendo ter causas primárias e secundárias. Seu diagnóstico, na maioria dos casos, tem sido clínico e por exclusão. Não existe um teste clínico patognômonico e o exame de ressonância magnética tem sido útil no seu diagnóstico e conduta. O tratamento de escolha a priori é conservador e apresenta bons resultados e, em caso de falha, pode ser indicada cirurgia. É preciso maior conhecimento acerca desta síndrome por parte dos neurocirurgiões, ortopedistas e fisioterapeutas para um diagnóstico precoce e tratamento adequado.