Dissertations / Theses: 'Clinical Neurology'

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Lindh, Jonas. "Cryptogenic Polyneuropathy : Clinical, Environmental, And Genetic Studies." Doctoral thesis, Linköpings universitet, Neurologi, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-71215.

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Objectives: The purpose of this medical thesis was to describe the clinical and neurophysiological features and to evaluate the health related quality of life (HR-QoL) in patients with cryptogenic polyneuropathy. We also wanted to investigate different occupational, and leisure time exposures as determinants for cryptogenic polyneuropathy, and to analyze whether polymorphisms for the null alleles of Glutathione S-Transferase Mu-1 (GSTM1), and Theta-1 (GSTT1), and a low activity genetic variation of epoxide hydrolase (EPHX) affect the risk of developing polyneuropathy. These genes were chosen because their enzymes are important in the metabolism of toxic compounds. Methods: The medical records of all patients aged 40–79 years with the diagnosis of cryptogenic polyneuropathy from 1993 to 2000 were analyzed, and data regarding clinical symptoms, laboratory findings, and neurophysiological findings at diagnosis were collected. 255 cases were found. When the medical records were reevaluated assessment to a protocol 168 patients remained as cryptogenic. Two validated instruments (SF-36 and EQ-5D) for measuring HR-QoL were sent to patients, and a reference group from the general population. Additional clinical information, and data on occupational, and leisure time exposure was obtained from postal questionnaires. Crude odds ratios (COR), and logistic regression odds ratios (LOR) were calculated for exposures with five or more exposed cases and referents taken together. We also tested for genetic polymorphisms of GSTM1 and GSTT1, and epoxide hydrolase exon three, EPHX*3. Results: 68% of the patients were men. The mean age at first symptom was 61 years and at diagnosis 64 years. Distal numbness was the most common symptom, but pain, pedal paresthesias, and impairment of balance were also common. The most common clinical findings were decreased or lost proprioception or sense of vibration (80%), and loss of ankle jerks (78%). Neurography showed mixed sensorimotor polyneuropathy of axonal or mixed axonal and demyelinating type. QOL was significantly affected concerning motor functions, with 42% of the patients reporting problems to walk, 3% having problems with daily activities, and 85% were suffering from pain. Mental health was preserved. Mobility was declining with increasing age, but was not affected by disease duration. Increased risks were found in men for occupational exposure to sulphur dioxide, xylene, methyl ethyl ketone, and herbicides and in women for occupational exposure to lead, nitrous oxide, and insecticides. Interaction between occupational and leisure time exposure were seen for several exposures. No significant correlation was found between GSTM1, GSTT1, and EPHX1 polymorphisms in patients with cryptogenic polyneuropathy compared with controls. A tendency, however, was seen for the GSTT1 null phenotype, which was enhanced among smokers compared to controls (OR 3.7). Conclusions: Cryptogenic polyneuropathy is a slowly progressive sensorimotor nerve lesion of mainly axonal type. Patients with cryptogenic polyneuropathy have a lower QOL compared to the general population, although mental health scores did not differ between the groups. Our results show that known determinants could be confirmed, but also some new appeared i.e. sulphur dioxide, hydrogen sulphide, fungicides, and vibrations in the feet. Moreover our results point to a synergistic effect of various exposures. Our hypothesis is that the GSTT1 null polymorphism may be related to an impaired metabolism of toxic substances and reactive oxygen that could lead to nerve damage in the peripheral nervous system. Our results are indicating that components in cigarette smoke might increase the risk of axonal neuropathy in genetically predisposed patients.

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Ferreira, Adriana Filipa da Silva. "Curricular training report: clinical trials coordination in neurology." Master's thesis, Universidade de Aveiro, 2015. http://hdl.handle.net/10773/21557.

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Mestrado em Biomedicina Farmacêutica
O presente relatório descreve as atividades desenvolvidas durante o estágio curricular como coordenadora de investigação clínica, que teve lugar na Unidade de Farmacologia Clínica do Instituto de Medicina Molecular e decorreu de Setembro de 2014 a Junho de 2015. A principal atividade desempenhada durante este estágio foi a coordenação de ensaios clínicos na área da neurologia, nomeadamente ensaios de fase II, III e IV. Foram desenvolvidas outras atividades, tais como gestão de dados clínicos, atividades de farmacovigilância e escrita científica e monitorização de estudos clínicos, com vista a complementar a formação curricular. Neste relatório é, também, apresentada uma breve contextualização do estado de arte do processo de Investigação & Desenvolvimento de novos medicamentos, tendências atuais e especificidades do desenvolvimento de medicamentos na área da neurologia. Para além disso são abordadas as dificuldades sentidas durante o estágio e as estratégias utilizadas para as ultrapassar, bem como a visão pessoal sobre o papel do coordenador de investigação clínica na condução de ensaios clínicos. Globalmente, a realização deste estágio curricular traduziu-se na oportunidade de aplicar e aprofundar os conhecimentos e competências adquiridos ao longo do percurso académico, em especial no Mestrado em Biomedicina Farmacêutica, e de desenvolver competências e aptidões, tanto a nível profissional como pessoal, fulcrais para um profissional de investigação clínica. Em conclusão, este estágio constituiu uma introdução à prática da investigação clínica.
This report describes the activities developed during the curricular training as coordinator of clinical research, which took place in the Unidade de Farmacologia Clínica of the Instituto de Medicina Molecular and was held from September 2014 to June 2015. The main activity performed during this training was the coordination of clinical trials in the field of neurology, mainly phase II, III and IV clinical trials. Other activities, such as data management, pharmacovigilance, medical writing and monitoring of clinical studies, were developed to complement the training. This report also presents a brief background of the state of the art of the Research & Development process of new drugs, current trends and specificities of the drug development in neurology. Furthermore, it addresses the difficulties experienced during the training and the strategies used to overcome them, as well as a personal insight on the role of the clinical research coordinator in conducting clinical trials. Overall, achieving this curricular training resulted in the opportunity to apply and deepen the knowledge and skills acquired throughout the academic career, especially in the Masters in Pharmaceutical Biomedicine, and to develop skills and abilities, at professional and personal level, central to a professional of clinical research. In conclusion, this training was an introduction to the practice of clinical research.

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Nygren, Ingela. "ALS - a clinical thesis /." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4804.

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Blanco, Núñez Igor D. "Diffuse optical monitoring of cerebral hemodynamics in experimental and clinical neurology." Doctoral thesis, Universitat Politècnica de Catalunya, 2015. http://hdl.handle.net/10803/285634.

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The study of the brain using diffuse optical methods has progressed rapidly in the recent years. The possibility of studying the cerebral microvasculature in addition to the portability and low cost of these devices, opens a new door in the study of the cerebral pathophysiologies. In this scenario, the study of the cerebral hemodynamics of ischemic patients might allow neurologists to improve the performance of the early medical treatments and therapies used up to date. In this thesis, I have conducted a pioneering study where cerebral autoregulation was studied in ischemic stroke patients during the early hours after the stroke. Similarly, some other diseases can provoke impaired cerebral autoregulation in the long term. One of them is the obstructive sleep apnoea (OSA) syndrome which can provoke a risk increase of developing cardiovascular diseases and ischemic stroke. In this regards, I have carried out the largest to date study conducted with Diffuse Correlation Spectroscopy in patients with OSA and I have compared their hemodynamical response to an orthostatic challenge test with a control group of healthy subjects. Finally, primary animal research is of great importance in the development of new therapies, medical strategies and in the validation of new drugs with the aim of reducing the high mortality and slow and costly recovery of ischemic patients. In consequence, many models of ischemia are reproduced in rodents where the cerebral hemodynamics are studied using expensive equipments such as MRI scanners or by techniques that involve invasive approaches like for instance removing the scalp or thinning the skull which in turn cause a worsening in the living conditions of the animal. In relation to this point, I have developed a fully non-invasive method to study the cerebral hemodynamics in rats that allows to proceed with longitudinal studies and which I hope will be useful in future biomedical research.
El estudio del cerebro mediante métodos de óptica difusa ha progresado rápidamente en los últimos años. La posibilidad de estudiar la microvasculatura cerebral junto con la portabilidad y bajo coste de estos equipos abre una ventana de posibilidades para el estudio de fisiopatologías cerebrales. En este escenario, el estudio de la hemodinámica cerebral en pacientes isquémicos podría permitir a los neurólogos mejorar el rendimiento de los tratamientos médicos tempranos y de las terapias utilizadas hasta la fecha. En esta tesis he realizado un estudio pionero al respecto, estudiando por primera vez la hemodinámica cerebral de pacientes isquémicos durante las primeras horas después del infarto cerebral. De igual manera, existen otro tipo de enfermedades que pueden desarrollar un empeoramiento a largo plazo de la autorregulación cerebral. Entre ellas destaca el síndrome de apnea obstructivo (SAO), debido al cual el empeoramiento de la hemodinámica cerebral provoca un aumento del riesgo directo de sufrir enfermedades cardiovasculares y un aumento del riesgo de infarto cerebral. Al respecto, he llevado a cabo el mayor estudio hasta la fecha con pacientes con SAO donde he estudiado su respuesta hemodinámica a un test ortostático comparado estos resultados con los obtenidos en grupo de control de pacientes sanos. Finalmente, la investigación primaria en animales es de vital importancia en el desarrollo de nuevas terapias y estrategias médicas así como en la validación de nuevos fármacos que reduzcan la alta mortalidad y la lenta y costosa recuperación de los pacientes isquémicos. En consecuencia, numerosos modelos de isquemia son reproducidos en roedores donde se estudia la hemodinámica cerebral mediante caros equipos como los resonadores magnéticos o mediante técnicas que implican someter al animal a cierta cirugía en la que se le sustrae el cuero cabelludo o se le lima el cráneo. En relación con esto último, he desarrollado un método completamente no invasivo para estudiar la hemodinámica cerebral en ratas y que permite llevar a cabo estudios longitudinales, el cual espero sea utilidad en futuras investigaciones biomédicas.

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Zuberi, Sameer Mustafa. "A clinical and genetic study of ion channel disorders in child neurology." Thesis, University of Edinburgh, 2010. http://hdl.handle.net/1842/29438.

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Ion channels are macromolecular proteins in cell membranes that control the passage of charged particles including sodium, potassium and calcium ions in and out of cells. Rapid electrical signalling in the nervous system is mediated through the passage of ions through these channels. It is therefore not surprising that genetic mutations in the genes coding for these channels can result in neurological disease. Ion channel disorders or channelopathies have emerged in the last ten to fifteen years as an important new way of understanding neurological disease. Many of these conditions are paroxysmal in nature and include generalised and focal epilepsies, movement disorders and neuromuscular disorders. Some of these conditions follow simple Mendelian inheritance and are rare forms of common disorders such as epilepsy but they provide a useful model for more common neurological diseases with complex inheritance. Some conditions such as Dravet syndrome, a severe infantile onset epilepsy and sodium channelopathy produce devastating consequences for the affected child. In this thesis I will describe the clinical work I have undertaken defining phenotypes of this emerging group of disorders. Detailed phenotyping is the first essential step in characterising new aspects of these genetic disorders. I have collaborated closely with molecular geneticists and cell physiologists in units around the world exchanging ideas in order to better understand the mechanisms of disease and hopefully translate this into better care for patients. The main themes covered in the thesis are episodic ataxias type 1 and 2 (EA1 & 2), benign familial neonatal convulsions, autosomal dominant nocturnal frontal lobe epilepsy, and Dravet syndrome and other SCN1A related epileptic encephalopathies. In the course of this work I have described novel relationships between EA1 and EA2 and epilepsy, described a novel gene and phenotypes associated with frontal lobe epilepsy, a novel presentation of a potassium channelopathy, a family with a new genetic mechanism for their neonatal convulsions and epilepsy, and children with a novel mechanism for Startle disease (hyperekplexia). I have demonstrated the clinical utility of this translational research by establishing a molecular genetic diagnostic service for sodium channel (SCN1A) related infantile epilepsies. A study of the results from this national UK service shows that genetic diagnosis allows early diagnosis of these epilepsies. This can result in earlier focused treatment, and the hope for better epilepsy control and developmental outcome. I discuss the implications of this work and ongoing and future research projects.

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Van, Coller Riaan. "A clinical, neurophysiological and genetic study of South African familial combined myoclonic syndromes." Thesis, University of Pretoria, 2021. http://hdl.handle.net/2263/78827.

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Myoclonus is a complex disorder of rapid repetitive muscle jerks that can occur in proximal or distal appendicular or axial muscles. It can be of cortical, sub-cortical or spinal cord origin; part of progressive and severely disabling epilepsy syndromes, basal ganglia conditions, and physiological or even functional (psychogenic)1. A systematic review of the literature shows the knowledge gap of the genetic causes of myoclonus in South Africa with 25 identified publications from Africa of which eleven were from South Africa. Publications varied from case studies to case series and included four publications with cortical myoclonic tremor (CMT) and two with North Sea Progressive Myoclonic Epilepsy, two with subcortical myoclonus and case studies with rare cases of individuals with myoclonic disorders. In this publication the study of myoclonus in three different settings is presented. In the first: cortical myoclonic tremor (CMT), a rapid distal form of myoclonus, resembling tremor, with neurophysiological evidence of cortical origin. The study researched a South African family with Familial Cortical Myoclonic Tremor with Epilepsy (FCMTE). The first part of this study showed the median onset of cortical tremor 16 was and that of epilepsy was 42 years; patients were stable with long term follow up after 30 years without evidence of progressive ataxia or cognitive impairment. The second part of the study presents the discovery of the genetic mutation causing this condition: a pentanucleotide repeat expansion in the intronic region of the STARD7 gene. This mutation was also found in families with FCMTE2 with a similar phenotype and followed on work showing pentanucleotide repeat expansion mutations in other forms of FCMTE in different genetic locations. The second setting proved a new mutation, a premature stop mutation p.L275X, in the epsilon-sarcoglycan gene causing subcortical origin, Myoclonus Dystonia Syndrome (MDS) in a three generation South African family with mild phenotype differences in the clinical presentation: myoclonus and dystonia in the same appendicular body part as well as truncal. Two of the affected individuals studied underwent Deep Brain Stimulation surgery of the Globus Pallidum with significant sustained improvement in the motor and non-motor features of MDS recorded and confirmed by a blinded rater. In the third setting, two patients with sporadic Paroxysmal Non-kinesigenic dyskinesia (PNKD) with the complex phenomenology of episodic dystonia, myoclonus and chorea of South African origin is presented. Both patients underwent successful DBS of the pallidum with long-term outcomes presented. Although these two individuals were not tested for the known myofibrillogenesis regulator-1 (MR-1) mutation they represent two cases of this rare disorder from South African setting and prove the successful use of DBS treatment.
Thesis (PhD)--University of Pretoria, 2021.
Neurology
PhD
Unrestricted

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Lindström, Per. "Diabetic neuropathy : clinical and experimental studies /." Stockholm, 1997. http://diss.kib.ki.se/1997/19971003lind.

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Albernaz, Raquel Mincarelli [UNESP]. "Aspectos clínicos e radiográficos da coluna cervical de bezerros submetidos a Prova do Laço." Universidade Estadual Paulista (UNESP), 2006. http://hdl.handle.net/11449/89034.

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Made available in DSpace on 2014-06-11T19:23:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-07-27Bitstream added on 2014-06-13T20:30:35Z : No. of bitstreams: 1 albernaz_rm_me_jabo.pdf: 606225 bytes, checksum: fc8139f6f3b1c020259e97b3cecff7e3 (MD5)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
A modalidade de rodeio denominada Prova do Laço de Bezerro tem sido questionada sobre a ocorrência de possíveis lesões nas vértebras cervicais ocasionadas pela tração da corda no pescoço dos bezerros. Neste trabalho avaliou-se 15 bezerros mestiços, machos ou fêmeas, entre cinco e seis meses de idade experimentalmente submetidos a prova do laço. Os animais foram laçados três vezes por semana, em dias alternados, durante cinco semanas, somando o total geral de 225 laçadas. A prova experimental foi realizada de forma semelhante à prova oficial, pelo mesmo cavaleiro profissional da modalidade. Os bezerros foram avaliados mediante exame clínico geral e neurológico ao início da primeira, durante a terceira e ao término da quinta semana experimental. Radiografias simples e contrastadas das vértebras cervicais foram efetuadas ao início da primeira e ao término da quinta semana de experimento. Os métodos de laçadas foram acompanhados e classificados qualitativamente em fortes ou fracos. Não foram encontradas alterações clínicas e radiográficas nos animais durante o experimento. O rigor da laçada foi considerado forte em 77% dos casos. O fato de não terem sido encontradas alterações clínicas e radiográficas indicam que a ocorrência de lesões cervicais em bezerros submetidos a prova de laço não é tão alta como o propalado, entretanto, trata-se de procedimento rude e agressivo. Número mais expressivo de experimentos semelhantes a este deverá ser conduzido tanto sob condições controladas como em provas reais para confirmar os dados da presente pesquisa.
The modality of roundup Calf Roping has been questioned on the occurrence of possible injuries in the cervical vertebrae caused by the rope tension in calfs neck. In this work 15 calves, male or female, ages varying from five and six months experimentally submitted to calf roping were evaluated. The procedure was carried through three times per week, in alternated days, during five weeks, adding the total of 225 lassoed. The experimental test was carried through of similar form to the official test, for the same professional knight of the modality. The calves had been evaluated by means of general and neurological clinical examination to the beginning of the first one, during third and to the ending of the fifth experimental week. Simple and contrasted x-rays of the cervical vertebrae had been made to the beginning of the first one and the ending of the fifth week of experiment. The lassoed methods had been observed and classified qualitatively in weak or strong. Clinical and radiographic alterations in the animais during the experiment had not been found. The severity of the lassoed was considered strong in 77% of the cases. The fact not to have been found clinical and radiographic abnormalities indicates that the occurrence of cervical injuries in calves submitted to calf roping is not as high as divulged, however, is about aggressive and rude procedure. Similar experiments must be made in such a way to be lead under controlled conditions as in real tests to confirm the data of the present research.

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Al, Talalwah Waseem. "The vascular variability of the iliac system and clinical diagnosis in radiology and neurology." Thesis, University of Dundee, 2013. https://discovery.dundee.ac.uk/en/studentTheses/1aa955a0-1289-4670-b226-0eea5425ae0b.

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The sciatic nerve is the largest nerve in the human body giving both motor and sensory innervations to the lower limb. It can be affected in chronic diseases, such as diabetes, or compressed anatomically by structures such as piriformis and aneurysms leading to sciatica or paralysis of the lower limb. The current study therefore focuses on the arterial supply of the sciatic nerve as well as its course. Embryologically, the sciatic nerve is supplied via the axial artery during the first trimester. As the axial artery regresses, the iliac system develops. A failure of sciatic artery regression leads to several variations of pelvic and femoral arteries, with a risk of iatrogenic injury/trauma for those patients undergoing pelvic, gluteal and thigh surgical procedures. An understanding of the variability of the pelvic arteries in relation to a coexistent sciatic artery will provide an appropriate background for clinicians. The present study proposes a new theory of sciatic artery development and persistence, as well as new theories for the superior and inferior gluteal, internal pudendal and obturator arteries. The thesis is in two parts: first an anatomical study on the dissection of 171 cadavers including the pelvic, gluteal and thigh regions to observe (i) the patterns of the arteries these regions, and (ii) the course of the sciatic nerve. With variable course of sciatic nerve, there is a variability of its blood supply. Moreover, it includes a new classification of sciatic nerve with respect to clinical implications. The thesis clarifies the origins of the sciatic artery and its course. The second part is a literature review of sciatic artery aneurysm cases in 171 patients, which clarifies the risk of aneurysm, together with its incidence with respect to pathologic finding and associated disorders. Radiologists have to be aware of the internal iliac artery classifications to be able to alert general surgeons, orthopaedic surgeons, obstetricians, gynecologists, and urologists so that they can improve patient management.

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Quintas, Inês de Avelar Teixeira Califórnia. "Canine intracranial pachymeningeal enhancement : a study of 2 clinical cases." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2019. http://hdl.handle.net/10400.5/18989.

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Dissertação de Mestrado integrado em Medicina Veterinária
Post-contrast pachymeningeal enhancement, synonymous of post-contrast dural or dura-arachnoid enhancement, is an imaging feature best appreciated on a contrast-enhanced magnetic resonance imaging (MRI). In humans, it may arise from various benign or malignant clinical processes, such as transient postoperative changes, intracranial hypotension or primary neoplasms, including meningiomas and secondary central nervous system lymphoma, and metastatic disease. The present study describes two clinical cases of canine diffuse intracranial pachymeningeal enhancement as the only intracranial imaging abnormality in a dog with toxoplasma suspected meningitis and in a dog with presumed idiopathic eosinophilic meningitis. Both dogs presented clinical signs compatible with intracranial and spinal disease. Both cases had cerebrospinal fluid analysis results compatible with central nervous system inflammatory disease. Clinical improvements were observed with corticosteroid therapy and worsening of the clinical signs appeared to be associated with corticosteroid tapering in both dogs. Despite the therapy instituted, both patients presented a negative evolution of their neurological condition, and the tutors opted for the euthanasia act at the end of a period of 2 and 7 months after the clinical diagnosis was established. Keywords:
RESUMO - INTENSIFICAÇÃO DO SINAL PAQUIMENÍNGICO CRANIANO CANINO: ESTUDO RETROSPECTIVO DE 2 CASOS CLÍNICOS - A intensificação do sinal paquimeníngico pós-contraste, sinónimo de intensificação do sinal dural ou dural-aracnóide pós-contraste, é um sinal imagiológico melhor apreciado na ressonância magnética (RM) com contraste. No Homem, pode surgir associado a vários processos clínicos benignos ou malignos, como é o caso de alterações pós-cirúrgicas transitórias, hipotensão intracraniana ou neoplasias primárias como meningioma e linfoma do sistema nervoso central e ainda de doença metastática. O presente estudo descreve dois casos clínicos de cães com diagnóstico diferencial primário de meningite por toxoplasma e meningite eosinofílica idiopática, que apresentaram intensificação do sinal paquimeníngico difuso na RM pós-contraste. Ambos os canídeos apresentaram sinais clínicos compatíveis com doença intracraniana e da medula espinhal e uma análise do líquido cefalorraquidiano compatível com doença inflamatória do sistema nervoso central. A instituição de corticoterapia permitiu em ambos os casos uma melhoria clínica, a qual foi agravando à medida que se diminuía a dose do medicamento a que o doente era sujeito. Apesar da terapia instituída, ambos os doentes apresentaram uma evolução negativa do seu quadro neurológico, tendo os cuidadores optado pela realização do acto de eutanásia ao final de um período de 2 e 7 meses após o diagnóstico clínico ter sido estabelecido.
N/A

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Danielsson, Olof. "The Clinical and Pathological Spectrum of Idiopathic Inflammatory Myopathies : Implications for pathogenesis, classification and diagnosis." Doctoral thesis, Linköpings universitet, Avdelningen för neuro- och inflammationsvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-132768.

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Background: Idiopathic inflammatory myopathies (IIM) constitute a heterogeneous group of diseases with severe consequences for the life of affected patients. Dermatomyositis, polymyositis and inclusion body myositis (IBM) are the classical representatives of this group. The treatments given today often have limited effects, and are taken at the cost of side effects. Major obstacles in the search for more effective treatments are; (1) an incomplete understanding of the disease mechanisms, (2) difficulties to delineate homogeneous disease groups for clinical studies and (3) the sometimes challenging task to diagnose these diseases. Aims: We addressed a number of “loose ends” in the areas of pathogenesis, classification and diagnosis; mechanisms of muscle fiber degeneration in IIM, with a focus of programmed cell death (apoptosis) and invasion of muscle fibers by inflammatory cells (partial invasion); protecting and mediating factors present in muscle; the association of other diseases with IIM, in particular celiac disease ; the evaluation of two classification systems and laboratory methods for increased diagnostic performance. The studies: We included 106 patients, diagnosed at the Neuromuscular unit in Linköping, Sweden, with pathological muscle findings consistent with IIM. The incidence in the county of Östergötland (during 5 years) was 7.3 per million/year (3 patients each year). Of 88 patients with confirmed IIM 4 (4.5 %) had celiac disease, 33 (38%) had an associated systemic inflammatory disease and 5 (5.7 %) had a malignancy. Ninety-nine patients were included for a comparison of two classification systems using criteria of the European Neuromuscle Centre (Amato/ENMC), and the widely used Bohan and Peter classification, both with the addition of IBM according to Griggs et al. Using the Amato/ENMC criteria the most prevalent diagnostic group after IBM (30%) was nonspecific myositis (23%), followed by polymyositis (20%) and dermatomyositis 17%). A substantial number of patients meeting Bohan and Peter (or Griggs) criteria were excluded by Amato/ENMC criteria, most (21/23) due to lack of detectable muscle weakness. Extended muscle sectioning increased the sensitivity of a muscle biopsy by 15 % and the specificity by 22%, and showed an overlap between disease groups. Muscle biopsies from patients with IIM and controls were used to investigate pathological findings considered specific for disease groups, and for the presence of programmed cell death (apoptosis) and disease protecting and mediating factors in muscle. The presence of apoptotic muscle fiber nuclei was detected in muscle with partial invasion (however not in the invaded fibers) in the presence of granzyme B and CD8+ cytotoxic T cells. The major apoptosis inhibiting protein Bcl-2 was shown to be constitutionally expressed in healthy muscle but weakened in IIM. Conclusion: We present apoptosis as a possible disease mechanism in parallel with partial invasion of fibers. Furthermore, partial invasion may not be a suitable distinguishing feature in the pathogenesis, or for classification and diagnosis of IIM. We also introduce the anti-apoptotic Bcl-2 as a possible relevant muscle fiber protecting factor. A more extensive pathological work-up improves classification and diagnosis of IIM. The proposed Amato/ENMC creates a substantial portion of patients with non-specific or unclassified myositis. Associated diseases are common in IIM, and also include celiac disease.

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Yue, Weiping Biotechnology &amp Biomolecular Sciences Faculty of Science UNSW. "Predicting the citation impact of clinical neurology journals using structural equation modeling with partial least squares." Awarded by:University of New South Wales. School of Biotechnology and Biomolecular Sciences, 2004. http://handle.unsw.edu.au/1959.4/20821.

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The ongoing debate on the evaluative role of citation analysis and the theory of citation recognizes that the citation process is complex and that citation counts are affected by certain extra-scientific or external factors. To date, little effort has been made to explore the effects of various external factors; this thesis addresses this lack. In the context of the various perspectives on citations and citation analysis, this study uses journals as the unit of analysis and investigates what, how, and to what extent extra-scientific factors influence the citation impact of journals. An integrated conceptual model of Journal Citation Impact that takes into account current theoretical positions and prior empirical research findings is developed. It addresses the interrelationships between Journal Citation Impact and a range of external factors (Journal Properties, Journal Visibility, Journal Accessibility, Journal Internationality, Journal Selectivity, Journal Promptness, Journal Editorial Prestige, and Perceived Journal Quality). The proposed conceptual model is novel in that it: (1) incorporates nearly all possible external factors that affect Journal Citation Impact; (2) addresses the complex interrelationships between a number of external factors and Journal Citation Impact in one model; (3) regards both Journal Citation Impact and its external factors as theoretical constructs; and (4) identifies the observed variables of the external factors and Journal Citation Impact. However, because of the difficulties in operationalizing all the theoretical constructs, this conceptual model is simplified to an operational model for empirical testing. The operational model includes the construct Journal Citation Impact and four of its external factors, Journal Properties, Journal Accessibility, Journal Internationality, and Perceived Journal Quality. Structural Equation Modeling (SEM) with Partial Least Squares (PLS) is used to test the operational model with empirical data from 41 research journals in clinical neurology. Data are collected from bibliographic database searching, web searching, printed journals, and from a web-based survey that was conducted to obtain information on perceptions of journal quality. Empirical results of the operational model show that Journal Accessibility, Journal Internationality, and Perceived Journal Quality have large, medium, and small effects respectively on Journal Citation Impact, thus indicating that certain extra-scientific factors can influence Journal Citation Impact significantly. The findings suggest that great care should be taken in interpreting and evaluating the results obtained from citation analysis. In terms of Journal Citation Impact, this research also suggests that various journal citation indicators should be ii used to reflect different aspects of citation impact. By exploring the phenomenological domain in the citing process, this exploratory study not only provides a better understanding of citation analysis, it also contributes to the development of the theory of citation. From the methodological perspective, introducing SEM with PLS to Informetrics and Scientometrics also contributes to the knowledge base of these fields. Pragmatically, the research findings will enhance the judgment of researchers and practitioners such as editors, publishers, librarians and other information specialists in assessing journal performance. Finally, the worldwide survey findings on peer assessment of journal outlets in clinical neurology will be useful for researchers, academics or clinicians in this field.

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Szewczyk-Krolikowski, Konrad. "Clinical and imaging characteristics of early Parkinson's disease." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:c118f620-19a9-4d0c-bcfc-018e3dd9ff3d.

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Background. Pathological processes in Parkinson’s disease (PD) start long before the first symptoms appear and by the time the disease is clinically established the results of neurodegeneration may be irreversible. Efforts to prevent or stem disease progression need to start in early disease and good characterization and new markers of early PD are urgently needed. Objectives. This thesis aims to characterize early disease stages in three projects. Firstly, clinical features of PD within 3 years of diagnosis will be explored in an incident cohort of patients and controls, using a range of tools to cover the whole breadth of clinical presentation of PD. Secondly, functional imaging studies in PD published so far will be examined through a meta-analysis to identify the most robust functional imaging markers. Thirdly, a functional MRI resting-state study in early PD will be performed to identify reproducible differences between patients and matched control subjects. Results. The cohort analysis found that age was a strong predictor of disease severity, independent of disease duration, while gender was seen to affect disease severity depending on the body region. A meta-analysis of all published functional imaging studies across all disease stages showed abnormal activations in the Basal Ganglia but also in a wide range of motor and non-motor brain areas. Dopamine supplementation normalized activations in the Basal Ganglia and some other areas, while other circuits remained resistant to medication suggesting non-dopaminergic abnormality. In the resting-state study, the Basal Ganglia Network showed greatly reduced connectivity in early PD compared to controls, which normalized on administration of dopaminergic medication. Reduced BGN connectivity was also validated on a separate group of PD subjects achieving very good separation of patients from controls. Conclusions. The effect of gender and age on early presentation of PD has potential significance for early diagnosis and choice of outcome measures for clinical trials. Within the realm of imaging, traditional task-based fMRI studies fail to show a clear and reproducible pattern of activations making this method unfeasible for early diagnostic testing. In contrast, resting-state fMRI connectivity in the Basal Ganglia Network appears to be a promising and reliable method even in the early stages of PD. Clinical profiling and resting imaging changes offer avenues for developing future biomarkers in early PD.

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Pedro, Adriana Caria. "Análise e interpretação de líquido cefalorraquidiano em cães na prática clínica : estudo retrospetivo de 130 casos." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2018. http://hdl.handle.net/10400.5/15252.

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Dissertação de Mestrado Integrado em Medicina Veterinária
A análise de Líquido Cefalorraquidiano (LCR) é um exame complementar de diagnóstico extremamente útil, pois permite o acesso a informações relativas à saúde neurológica dos pacientes. Esta é frequentemente realizada com o propósito de auxiliar no processo diagnóstico ou para o controlo da evolução clínica dos doentes. Com o presente estudo procurou-se conhecer a realidade clínica associada a este exame, desde os sinais clínicos dos cães a que é colhido LCR, passando pelos resultados desta análise, até ao desfecho clínico dos episódios em estudo. No presente estudo foram incluídos 130 cães, os seus LCR foram analisados, comparando-se os resultados obtidos nos exames citológicos e nos PCR realizados com o descrito na bibliografia. Foram ainda comparados os desfechos clínicos de 54 cães com diferentes resultados na avaliação citológica, procurando-se perceber se as conclusões extraídas da análise de LCR possuem valor como ferramenta de prognóstico. A contagem de células nucleadas totais apresentou-se aumentada em 62 (47,7%) amostras, 55 (42,3%) com pleocitoses de células mistas e 7 (5,38%) neutrofílicas, tendo sido identificada a presença de bactérias numa amostra deste último grupo. Não foram identificadas pleocitoses mononucleares. Em 32 amostras foram realizadas técnica de PCR para deteção de agentes infeciosos, tendo sido, em 4 delas identificados os seguintes agentes: uma com Toxoplasma gondii, uma com Neospora caninum e duas com o vírus da esgana canina. A amostra com Neospora caninum não evidenciou qualquer alteração à citologia, enquanto que as restantes 3 amostras apresentaram pleocitoses moderadas de células mistas. Os cães de raça Beagle demonstraram uma associação com as pleocitoses neutrofílicas. A análise citológica e PCR de LCR demonstrou não possuir valor prognóstico. Os dados obtidos reforçam a importância da análise do LCR em cães com doença neurológica, dada a frequência de pleocitoses e de agentes infeciosos no LCR neste estudo ter sido superior à descrita na bibliografia. Concluiu-se também que o recurso a técnicas moleculares é essencial, mesmo quando o LCR não apresenta as alterações analíticas esperadas, devendo os clínicos recorrer a estas técnicas sempre que suspeitem de qualquer agente infecioso como causa de meningite, não necessitando de o justificar na presença de uma pleocitose, mas sim nos sinais clínicos e diagnósticos diferenciais para cada caso.
ABSTRACT - CEREBROSPINAL FLUID ANALYSIS AND INTERPRETATION IN DOGS IN CLINICAL PRACTICE - RETROSPECTIVE STUDY OF 130 CASES - The analysis of cerebrospinal fluid (CSF) is an extremely useful complementary diagnostic exam, as it allows access to information regarding the patient’s neurological health. This test is often performed for the purpose of assisting the diagnosis process or for controlling the clinical evolution of patients. The present study aimed to understand the clinical reality of this exam, including the clinical signs of the dogs from which the CSF was collected, the results of this analysis and the clinical outcome of the episodes under study For this study, 130 dogs were included on which the CSF was analyzed, comparing the results obtained in the cytological tests and in the PCR with those described in the bibliography. The clinical outcomes of 54 dogs with different results in the cytological evaluation were also compared, in an attempt to understand whether the conclusions drawn from the CSF analysis were valuable as a prognostic tool. The total nucleated cell count was increased in 62 (47.7%) samples, 55 (42.3%) with mixed cell pleocytosis and 7 (5.38%) neutrophilic, with bacteria identified in a sample from last group. No mononuclear pleocytosis were identified. Infectious agents were identified in 4 of the 32 samples where the PCR technique was performed: one tested positive for Toxoplasma gondii, one for Neospora caninum and two for canine distemper virus. The sample with Neospora caninum showed no change in cytology, whilst the other 3 samples had moderate mixed cell pleocytosis. Beagle dogs showed an association with neutrophilic pleocytosis. CSF cytological and PCR analysis showed no prognostic value. The data obtained reinforced the importance of testing the CSF of dogs with neurological disease, given that the frequency of pleocytosis and infectious agents present in the CSF in this study was superior to that described in the literature. It can also be concluded that the use of molecular techniques is essential, even when the CSF does not present the expected analytical changes. The clinicians should resort to these techniques whenever they suspect an infectious agent as the cause of meningitis, without the need to justify it in the presence of pleocytosis, but in the clinical signs and the differencial diagnosis of each case.
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Albernaz, Raquel Mincarelli. "Aspectos clínicos e radiográficos da coluna cervical de bezerros submetidos a Prova do Laço /." Jaboticabal : [s.n.], 2006. http://hdl.handle.net/11449/89034.

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Orientador: José Corrêa de Lacerda Neto
Banca: Gelson Genaro
Banca: Claudia Acosta Duarte
Resumo: A modalidade de rodeio denominada Prova do Laço de Bezerro tem sido questionada sobre a ocorrência de possíveis lesões nas vértebras cervicais ocasionadas pela tração da corda no pescoço dos bezerros. Neste trabalho avaliou-se 15 bezerros mestiços, machos ou fêmeas, entre cinco e seis meses de idade experimentalmente submetidos a prova do laço. Os animais foram laçados três vezes por semana, em dias alternados, durante cinco semanas, somando o total geral de 225 laçadas. A prova experimental foi realizada de forma semelhante à prova oficial, pelo mesmo cavaleiro profissional da modalidade. Os bezerros foram avaliados mediante exame clínico geral e neurológico ao início da primeira, durante a terceira e ao término da quinta semana experimental. Radiografias simples e contrastadas das vértebras cervicais foram efetuadas ao início da primeira e ao término da quinta semana de experimento. Os métodos de laçadas foram acompanhados e classificados qualitativamente em fortes ou fracos. Não foram encontradas alterações clínicas e radiográficas nos animais durante o experimento. O rigor da laçada foi considerado forte em 77% dos casos. O fato de não terem sido encontradas alterações clínicas e radiográficas indicam que a ocorrência de lesões cervicais em bezerros submetidos a prova de laço não é tão alta como o propalado, entretanto, trata-se de procedimento rude e agressivo. Número mais expressivo de experimentos semelhantes a este deverá ser conduzido tanto sob condições controladas como em provas reais para confirmar os dados da presente pesquisa.
Abstract: The modality of roundup Calf Roping has been questioned on the occurrence of possible injuries in the cervical vertebrae caused by the rope tension in calfs neck. In this work 15 calves, male or female, ages varying from five and six months experimentally submitted to calf roping were evaluated. The procedure was carried through three times per week, in alternated days, during five weeks, adding the total of 225 lassoed. The experimental test was carried through of similar form to the official test, for the same professional knight of the modality. The calves had been evaluated by means of general and neurological clinical examination to the beginning of the first one, during third and to the ending of the fifth experimental week. Simple and contrasted x-rays of the cervical vertebrae had been made to the beginning of the first one and the ending of the fifth week of experiment. The lassoed methods had been observed and classified qualitatively in weak or strong. Clinical and radiographic alterations in the animais during the experiment had not been found. The severity of the lassoed was considered strong in 77% of the cases. The fact not to have been found clinical and radiographic abnormalities indicates that the occurrence of cervical injuries in calves submitted to calf roping is not as high as divulged, however, is about aggressive and rude procedure. Similar experiments must be made in such a way to be lead under controlled conditions as in real tests to confirm the data of the present research.
Mestre

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Niklewski, Paul J. "Surrogates, In-Vitro, and Clinical Investigations into the Safety and Effectiveness of Anesthesia." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1383644949.

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Lundin, Anna-Carin. "Tendinosis in Trigger Finger." Doctoral thesis, Linköpings universitet, Avdelningen för Kirurgi, Ortopedi och Onkologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-136784.

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Trigger finger is one of the most common hand conditions, with a prevalence of almost 3%. The aetiology remains unclear even though many causes have been suggested. The prevailing paradigm is that the pathogenesis of trigger finger is ascribed to primary changes in the first fibrous condensation of the tendon sheath (A1-pulley). Several studies have investigated pathology in the pulley, but few have investigated the tendon. The general aim of this thesis was to find out if there is pathology in the trigger finger tendon and to define it. We first looked at trigger finger tendon biopsies in a light microscope, and found that they were histologically different from healthy tendons. They showed signs of micro-ruptures, collagen degradation, increased amounts of ground substance, both hyper- and hypo-cellular areas, round active cell nuclei and absence of inflammatory cells, all similar to tendinosis. The histological picture was further assessed by using a scoring system for Achilles tendinosis. The trigger finger tendons scored high, suggesting a similar histopathology. Next, we performed a quantitative real-time polymerase chain reaction (qPCR) on trigger finger tendons. We assessed the mRNA expression of 10 genes, which have been described to be differently expressed in Achilles tendinosis (collagen 1 and 3, versican, decorin, biglycan, aggrecan, MMP-2, MMP-3, ADAMTS-5, and TIMP-3). The overall expression pattern agreed with previous studies on Achilles tendinosis, suggesting that the cellular function in trigger finger tendons is disturbed in a similar way as in Achilles tendinosis. Recent experimental and observational research has suggested potential side effects of statin treatment on tendons, but firm evidence was lacking. We performed an epidemiological study on two large population-based cohorts. Statin use was found to increase the risk of both trigger finger and tendinosis in the shoulder and Achilles tendons, especially among men. This suggests a similar pathology in trigger finger and tendinosis. We have also studied the time to treatment effect after a single injection of glucocorticoid in trigger finger. Our results suggest that 60-80% of patients can expect resolution of the triggering within 14 days, and half of them within seven days. This result allows correct information to be given to the patient and proper planning of follow-ups. In conclusion, the pathology in trigger finger tendons is similar to tendinosis in other tendons.

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Feng, Jenny J. "DEPRESSION IN MULTIPLE SCLEROSIS IS ASSOCIATED WITH WORSENING DISEASE-ANALYSIS OF A LARGE REAL WORLD COHORT OF RELAPSING-REMITTING MULTIPLE SCLEROSIS PATIENTS." Case Western Reserve University School of Graduate Studies / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=case1607518627442055.

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Lilja, Johan. "[18F]Flutemetamol PET image processing, visualization and quantification targeting clinical routine." Doctoral thesis, Uppsala universitet, Radiologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-317688.

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Alzheimer’s disease (AD) is the leading cause of dementia and is alone responsible for 60-70% of all cases of dementia. Though sharing clinical symptoms with other types of dementia, the hallmarks of AD are the abundance of extracellular depositions of β-amyloid (Aβ) plaques, intracellular neurofibrillary tangles of hyper phosphorylated tau proteins and synaptic depletion. The onset of the physiological hallmarks may precede clinical symptoms with a decade or more, and once clinical symptoms occur it may be difficult to separate AD from other types of dementia based on clinical symptoms alone. Since the introduction of radiolabeled Aβ tracer substances for positron emission tomography (PET) imaging it is possible to image the Aβ depositions in-vivo, strengthening the confidence in the diagnosis. Because the accumulation of Aβ may occur years before the first clinical symptoms are shown and even reach a plateau, Aβ PET imaging may not be feasible for disease progress monitoring. However, a negative scan may be used to rule out AD as the underlying cause to the clinical symptoms. It may also be used as a predictor to evaluate the risk of developing AD in patients with mild cognitive impairment (MCI) as well as monitoring potential effects of anti-amyloid drugs.Though currently validated for dichotomous visual assessment only, there is evidence to suggest that quantification of Aβ PET images may reduce inter-reader variability and aid in the monitoring of treatment effects from anti-amyloid drugs.The aim of this thesis was to refine existing methods and develop new ones for processing, quantification and visualization of Aβ PET images to aid in the diagnosis and monitoring of potential treatment of AD in clinical routine. Specifically, the focus for this thesis has been to find a way to fully automatically quantify and visualize a patient’s Aβ PET image in such way that it is presented in a uniform way and show how it relates to what is considered normal. To achieve the aim of the thesis registration algorithms, providing the means to register a patient’s Aβ PET image to a common stereotactic space avoiding the bias of different uptake patterns for Aβ- and Aβ+ images, a suitable region atlas and a 3-dimensional stereotactic surface projections (3D SSP) method, capable of projecting cortical activity onto the surface of a 3D model of the brain without sampling white matter, were developed and evaluated.The material for development and testing comprised 724 individual amyloid PET brain images from six distinct cohorts, ranging from healthy volunteers to definite AD. The new methods could be implemented in a fully automated workflow and were found to be highly accurate, when tested by comparisons to Standards of Truth, such as defining regional uptake from PET images co-registered to magnetic resonance images, post-mortem histopathology and the visual consensus diagnosis of imaging experts.

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Miralbell, Blanch Júlia. "Biomarkers of cognitive decline and dementia." Doctoral thesis, Universitat de Barcelona, 2012. http://hdl.handle.net/10803/91068.

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Cognitive impairment in the elderly encompasses many forms, ranging from subtle impairments in otherwise cognitively healthy individuals through mild cognitive impairment and dementia. Brain structural and functional changes underlie the observed cognitive impairment. Complementary to the clinical observation, biomarkers have been proposed as in vivo indicators of the underlying pathophysiology and neurobiological changes in a sufficiently reliable manner that they could be used to detect, track, and predict the disease course over time. In this thesis we used a combination of epidemiological and clinic-based approaches to investigate the mechanisms underlying vascular cognitive impairment (VCI) and Alzheimer’s disease (AD) and to identify possible biomarkers that could help early diagnosis of such conditions. To do so, a set of circulating and cerebrospinal fluid (CSF) biomarkers were studied in healthy and cognitively impaired subjects. Then, these measures were related to grey matter (GM) volumes, white matter (WM) integrity and cognition. The first two studies are part of the population-based Barcelona-ASIA neuropsychology study. Study I aimed to compare the cognitive patterns of risk markers for cerebrovascular disease (CVD) with the cognitive profile in relation to novel and traditional vascular risk factors (VRF) in a community-dwelling sample. Biomarkers of inflammation, endothelial dysfunction and vascular thrombosis were selected. Results showed that VRF and circulating markers of inflammation and endothelial dysfunction predicted performance in several cognitive domains. Cognitive patterns of inflammatory markers overlapped those related to VRF. Markers of endothelial dysfunction predicted lower performance in verbal memory. Study II was designed to further explore the structural changes mediating the relationships between risk markers of CVD and cognition. For that purpose the same set of markers of risk for CVD were related to GM atrophy and WM integrity and cognition. The main finding was an association of inflammation and vascular thrombosis with WM integrity loss in cortico-subcortical pathways and association fibres of frontal and temporal lobes. As expected, none of the biomarkers was related to GM volume changes. Vascular thrombosis also predicted lower performance in processing speed. The third study is a memory clinic-based investigation that was conducted aiming to test the potential use of CSF biomarkers cut-offs as components for the diagnostic work-up in AD. We assessed GM and cognitive patterns in cognitively impaired subjects using CSF Aβ1-42, t-tau and p-tau181 cut-offs as grouping criteria. Results indicated that patients with abnormal CSF levels of t-tau and p-tau (but not Aβ1-42) showed impairment and signs of regional GM atrophy in brain regions characteristic for AD, compared to those with normal levels. More specifically, GM volume differences were found in temporal, inferior parietal, lateral occipital and widespread prefrontal regions. Studies I and II show that risk markers of inflammation and vascular thrombosis are related to a VCI profile for both cognitive patterns and structural brain changes. A microvascular damage of WM projections in fronto-subcortical pathways, but not GM atrophy, could mediate the association between these pathogenic processes and cognitive performance. Markers of endothelial dysfunction are related to a different cognitive pattern which is characteristic of both vascular and neurodegenerative mechanisms. Study III provides evidence that patients with abnormal CSF levels of t-tau and p-tau (but not Aβ1-42) show cognitive an AD profile according to GM density patterns and cognitive impairment. Taken together, these results suggest that, complementary to the clinical observation, plasma and CSF markers and structural imaging are well placed to improve early diagnosis of both VCI and AD.
El terme deteriorament cognitiu (DC) es refereix al contínuum de canvis cognitius associats a l’envelliment sa i patològic. El diagnòstic precoç de les persones amb DC és clau, ja que els tractaments són més eficaços quan s’inicien als inicis de la malaltia. Els biomarcadors s’han proposat com a eines pel diagnòstic precoç del DC i la demència. Es consideren indicadors in vivo de la patologia i s’han plantejat com a possibles eines pel diagnòstic, pronòstic i seguiment del DC i la patologia subjacent. L’objectiu general de la present tesi era explorar els mecanismes patofisiològics subjacents al deteriorament cognitiu vascular (DCV) i la (MA). Per aquest motiu, vàrem mesurar diversos biomarcadors sanguinis i de LCR en persones sanes i en persones amb diagnòstic de deteriorament cognitiu i vàrem relacionar-los amb canvis de l’estructura cerebral i de la cognició. L’objectiu final era identificar possibles biomarcadors pel diagnòstic precoç d’aquestes malalties. Els estudis I i II s’emmarquen dins del projecte Barcelona-ASIA Neuropsicologia i tenien com a objectiu estudiar la relació entre biomarcadors en plasma de malaltia vascular cerebral (MVC) i canvis estructurals i cognitius. Els resultats obtinguts mostren que els biomarcadors d’inflamació i trombosi vascular es relacionen amb un perfil de deteriorament cognitiu vascular tant a nivell cognitiu com estructural. La lesió microvascular dels tractes de SB còrtico-subcorticals mediaria l’associació entre aquests mecanismes i la cognició. Els marcadors de disfunció endotelial es relacionen amb un perfil cognitiu diferent, que és característic tant de processos vasculars com neurodegeneratius. L’estudi III té com a objectiu valorar el possible ús dels biomarcadors de líquid cefaloraquidi pel diagnòstic de la MA. En concret, vàrem estudiar els perfils estructurals i cognitius en persones amb deteriorament cognitiu emprant punts de tall de líquid cefaloraquidi com a criteri d’agrupació. Els resultats mostren que pacients amb DC i amb nivells patològics de t-tau i p-tau al LCR (però no d’Aβ1-42) presenten un perfil cognitiu i estructural de MA. En conclusió, els resultats obtinguts en la present tesi suggereixen que, complementaris a l’observació clínica, els biomarcadors de LCR i plasma, així com els indicadors de morfologia cerebral podrien ser d’ús pel diagnòstic precoç del DCL i la demència.

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Hersh, Carrie M. "Comparative Efficacy and Adherence of Dimethyl Fumarate and Fingolimod in Clinical Practice." Case Western Reserve University School of Graduate Studies / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=case1445944219.

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Коленко, Оксана Іванівна, Оксана Ивановна Коленко, and Oksana Ivanivna Kolenko. "Роль внеаудиторной работы в формировании клинического мышления." Thesis, Сумский государственный университет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/48058.

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Несмотря на появление огромного количества высокотехнологичных методик, топическая диагностика остается фундаментом клинической неврологии, так как правильная локализация очага поражения является основой распознавания заболеваний нервной системы. Перемещение образовательного процесса от постели больного в компьютерные классы и Всемирную паутину не всегда в полной мере способствует формированию правильного подхода у будущих специалистов к процессу диагностики.

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Carvajal, González Alexander. "Glycine receptor antibodies : pathogenic mechanisms and clinical correlates." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:8d9e92c6-6c02-4d62-b3fc-086d8dd297a5.

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Glycine receptor antibodies have been identified in a few patients with progressive encephalomyelitis with rigidity and myoclonus (PERM), a highly disabling disorder characterised by rigidity, spasm and brainstem symptomatology. The clinical characteristics of patients with glycine receptor antibodies have not yet been fully described and it is not clear whether GlyR-Abs are pathogenic or just an epiphenomenon. This study examined the clinical features and immunotherapy responses of 45 patients; characterised the GlyR-Ab pathogenicity, subunit specificity and binding to different brain region in vitro, and examined mice injected with GlyR-Abs to model the disease in vivo. Most of the patients were classified as PERM but some patients had symptomatology beyond the classical motor manifestations and there were four patients with tumours (thymomas and lymphomas). GlyR-Ab titres were varied in serum and CSF, but there was intrathecal synthesis in the six patients with suitable samples. Most patients were very disabled but almost all showed excellent responses to immunotherapies. The antibodies were mainly IgG1 and IgG3 subclasses, activated complement on glycine receptor-transfected HEK cells at room temperature, and caused internalisation and lysosomal degradation of the glycine receptors at 37°C. GlyR-Abs bound to rodent spinal cord and brainstem co-localising with monoclonal antibodies to GlyRα1 on the surface of neurons. GlyR-IgG injected intra-peritoneally led to impairment in forced walking ability, sensorimotor function and coordination. Analysis of the brain showed that animals injected with patients' IgG, but not control IgG, had antibodies bound to the brainstem, spinal cord, cerebellum and caudate, co-localising with GlyRα1 monoclonal antibody. Intra-cerebroventricular injection of GlyR-IgG caused an anxiety-like behaviour in mice but no evident motor disturbances. These results provide the first evidence of in vitro and in vivo pathogenicity of the GlyR-Abs, supporting the use of long term immunosuppression in these patients to provide them with a good prognosis.

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Cruickshank, Travis Miles. "The clinical utility of multidisciplinary rehabilitation in individuals with Huntington’s Disease." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2015. https://ro.ecu.edu.au/theses/1586.

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Background Huntington’s disease (HD) is a chronic neurodegenerative disorder characterised by a progressive loss of cognitive function, motor control and psychiatric features. Individuals also display a variety of systemic features. Progressive neuronal dysfunction and neuronal cell death are thought to underlie the onset and progression of many clinical features of HD. Despite scientific progress, there is still no cure or disease modifying therapy for HD, and available pharmaceutical agents only provide partial relief of motor and psychiatric features. An emerging body of evidence indicates that lifestyle enrichment may delay the onset and progression of clinical features, and exert favourable effects on neuropathological aspects of HD. Few studies have evaluated the effects of lifestyle enrichment strategies like multidisciplinary rehabilitation on the clinical features of HD. Moreover, no study has evaluated the effects of multidisciplinary rehabilitation on neuropathological aspects of HD. Aims The initial aim of this thesis was to determine factors that contribute to features of the disease that negatively impact on activities of daily living such as mobility and balance (Chapter 2), and to identify, using a literature review, a rehabilitation strategy that could positively impact on these features of HD (Chapter 3). These studies informed our ultimate aim which was to investigate the clinical utility of multidisciplinary rehabilitation on clinical and neuropathological features of HD (Chapters 4, 5 and 6) Methods In study 1 (Chapter 2), 22 participants were assessed using a battery of balance, mobility, cognitive tests, assessments of muscle strength and body composition measures. Data was . then statistically examined using stepwise linear regression to identify factors that contribute to balance and mobility impairments in individuals with manifest HD. In study 2 (Chapter 3), a systematic search of journal databases was made from inception to July 2014 for studies reporting on resistance exercise in patients with neurodegenerative disorders. Selected studies were abstracted and critically appraised using a quality control checklist. For the intervention studies, (3 and 4 Chapters 4 and 5), 20 participants with manifest HD were randomly assigned to either a control or training group. Individuals randomised to the intervention group were provided with a nine month multidisciplinary intervention comprising once weekly supervised clinical exercise, thrice weekly home based exercise and fortnightly occupational therapy, while those randomised to the control group were asked to continue with their standard care and daily activities. Participants were assessed using motor, cognitive, psychological, body composition and quality of life measures at baseline and at the completion of the intervention. In study 5 (Chapter 6), 15 participants with manifest HD were assessed using magnetic resonance imaging and a battery of cognitive assessments after nine months of multidisciplinary rehabilitation to see whether such a therapy is capable of inducing favourable changes in brain structure and cognitive function. Results The main factors that contribute to mobility and balance impairments in patients with manifest HD were found to be lower limb muscle weakness and a loss of cognitive function (Study 1). Systematic evaluation of the effects of resistance exercise for neurodegenerative disorders showed that it is beneficial for multiple sclerosis and Parkinson’s disease. In particular, improvements in muscle strength, mobility, balance, clinical disease progression, fatigue, functional capacity, quality of life, disease biology, electromyography activity, mood, skeletal muscle volume and architecture were reported in individuals with multiple sclerosis or Parkinson’s disease (PD) after resistance exercise. The most robust effects of resistance exercise were found for muscle strength outcomes, and were more pronounced in individuals with PD (Study 2). The multidisciplinary rehabilitation intervention studies conducted as part of this thesis significantly improved isometric and isokinetic muscle strength, self-perceived balance, body mass, lean tissue mass and fat mass in patients with HD (Studies 3 and 4). Moreover, multidisciplinary rehabilitation also increased grey matter (GM) volume in the caudate nucleus and dorsolateral prefrontal cortex of patients. The significant increases in GM volume were accompanied by, and correlated to, a significant improvement in performance in verbal learning and memory. Conclusions The work presented here shows that lower extremity muscle weakness and a loss of cognitive function significantly contribute to impairments in mobility and balance. This work also shows that strength training has favourable effects on motor function, including strength, mobility and balance, as well as other clinical features in similar neurodegenerative disorders, and thus should be integrated into multidisciplinary rehabilitation interventions for HD. In addition, this study provides evidence that multidisciplinary rehabilitation can significantly improve aspects of motor control, cognitive function and body composition. Finally we show, for the first time, that multidisciplinary rehabilitation can increase GM volume in structures known to degenerate in HD, and that such increases are functionally related to changes in verbal learning and memory. Future work is urgently required to confirm and expand on these exciting findings, particularly with respect to the neurorestorative properties of multidisciplinary rehabilitation.

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Dorward, Benjamin J. "Specialists or Specialising Generalists A Grounded Theory of the Role of the Clinical Pharmacist in Neuroscience." Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/13940.

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Neuroscience is a relatively small and emerging clinical pharmacy specialism focusing on drug therapy for neurological disease. Against a professional momentum for specialist practice within pharmacy, there is paucity both of relevant research, and a clearly defined role for specialist pharmacy practice in neuroscience. A qualitative research study was undertaken, using constructivist grounded theory method, to explore how hospital based pharmacists practicing in neuroscience define and develop their role and specialism. Data were concurrently generated and analysed, through verbatim transcription of telephone interviews with fourteen pharmacists. Data analysis resulted in the identification of three processes: (1) Acquiring and utilising knowledge in practice; (2) Gatekeeping access to drug therapies; (3) Integrating into the neuroscience service. The key findings within each process are: (1) Pharmacists utilise different forms of knowledge and there can be barriers to gaining knowledge. Pharmacists identify strengths in their breadth of clinical knowledge and holistic consideration of patients’ drug therapy. (2) Pharmacists act as barriers to drug therapy but also act to expedite and secure access to drug therapy. (3) Pharmacists act as an organisational nexus between pharmacy and neuroscience services and identify the importance in practice of forming working relationships within neuroscience services, underpinned by trust. The study identified a basic social process: Maintaining an overview of drug therapy for patients with neurological disease. This process conceptualises the tensions experienced by the pharmacists between their role as near-patient facing clinical specialists, but also as pharmacist generalists. The study findings have implications for supporting pharmacy practice in neuroscience.

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Fridman, Leticia. "Histopathological Characterization of the Dystrophic Phenotype and Development of Therapeutic Candidates for a Gene Therapy Pre-Clinical Study in Dysferlin Deficient Mice." eScholarship@UMMS, 2009. http://escholarship.umassmed.edu/gsbs_diss/881.

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Dysferlin deficient muscular dystrophy is a devastating disease that leads to loss of mobility and quality of life in patients. Dysferlin is a 230 kD protein primarily expressed in skeletal muscle that functions in membrane resealing. Dysferlin loss of function leads to a decrease in the membrane resealing response after injury in skeletal muscle, which is thought to cause degeneration of the musculature over time. Dysferlin cDNA is 7.4 kb and exceeds AAV packaging capacity of ~ 5kb. This thesis focuses on the generation of mini dysferlin mutants that can be packaged in AAV for downstream testing of therapeutic efficacy. In addition, this thesis creates the groundwork for preclinical studies in mice that can potentially be translated to human patients. A mouse model for dysferlin deficiency was characterized and key disease phenotypes were identified. In addition, cell lines carrying a genetically encoded calcium indicator protein, gCaMP, were established to measure mini dysferlin resealing capacity and for downstream testing in vivo.

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27

Fridman, Leticia. "Histopathological Characterization of the Dystrophic Phenotype and Development of Therapeutic Candidates for a Gene Therapy Pre-Clinical Study in Dysferlin Deficient Mice." eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsbs_diss/881.

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Dysferlin deficient muscular dystrophy is a devastating disease that leads to loss of mobility and quality of life in patients. Dysferlin is a 230 kD protein primarily expressed in skeletal muscle that functions in membrane resealing. Dysferlin loss of function leads to a decrease in the membrane resealing response after injury in skeletal muscle, which is thought to cause degeneration of the musculature over time. Dysferlin cDNA is 7.4 kb and exceeds AAV packaging capacity of ~ 5kb. This thesis focuses on the generation of mini dysferlin mutants that can be packaged in AAV for downstream testing of therapeutic efficacy. In addition, this thesis creates the groundwork for preclinical studies in mice that can potentially be translated to human patients. A mouse model for dysferlin deficiency was characterized and key disease phenotypes were identified. In addition, cell lines carrying a genetically encoded calcium indicator protein, gCaMP, were established to measure mini dysferlin resealing capacity and for downstream testing in vivo.

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28

Alsadoon, Abdulaziz. "Clinical Prediction Rule for Treatment Change Based on Echocardiogram Findings in Transient Ischemic Attack and Non-Disabling Stroke." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32406.

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The goal of this study was to derive a clinical prediction rule for transient ischemic attack (TIA) and non-disabling stroke to predict a treatment change based on echocardiogram. Methods: We conducted a cohort sub-study for TIA and non-disabling stroke patients collected over five years from 8 Emergency Departments. We compiled a list of 27 potential predictors to look for treatment change based on echocardiogram findings. We used a univariate, logistic regression and recursive partitioning analysis to develop the final prediction model. Results: The frequency of treatment change was seen in 87 (3.1%) of 2804 cases. The final model contains six predictors: age less than 50 years old, coronary artery disease history, history of heart failure, any language deficit, posterior circulation infarct and middle cerebral artery infarct on neuroimaging. Conclusions: We have developed a highly sensitive clinic prediction rule to guide in the use of echocardiogram in TIA and non-disabling stroke.

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29

Fritz, Nora Elizabeth. "Contribution of Motor and Cognitive Factors to Gait Variability and Fall Risk:From Clinical Assessment to Neural Connectivity." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1373987431.

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30

Stangel, Martin, Ralf Gold, David Pittrow, Ulrich Baumann, Michael Borte, Maria Fasshauer, Manfred Hensel, Dörte Huscher, Marcel Reiser, and Claudia Sommer. "Treatment of patients with multifocal motor neuropathy with immunoglobulins in clinical practice: the SIGNS registry." Sage, 2016. https://tud.qucosa.de/id/qucosa%3A35539.

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Objectives: The management of patients with multifocal motor neuropathy (MMN) under everyday clinical conditions has been insufficiently studied. We therefore collected comprehensive observational data on patients with MMN who received intravenous (IV) or subcutaneous (SC) immunoglobulins (IGs) as maintenance therapy. Methods: This was a prospective, noninterventional study (registry) in neurological centres (hospitals and offices) throughout Germany. Results: As of 1 December 2015, 80 patients with MMN were included (mean age 55.4 ± 9.8 years, 67% males, mean disease duration 10.7 ± 10.2 years). The affected limb regions were predominantly distal muscle groups of the upper extremities. On the inflammatory neuropathy cause and treatment (INCAT) scale, 94% of the patients had some disability in the arms and 61% in the legs. At inclusion, 98.8% received IVIG and 1.3% SCIG. Substantial variation was observed between IVIG treatment intervals (every 0.7 to 17.3 weeks) and dosage (0.2–2.1 g/kg body weight received during a single administration; mean monthly dosage, 0.9 g/kg body weight). However, the mean monthly dosage was steady over time. At 1-year follow up, improvement was seen in muscle strength, INCAT and quality of life (QoL) scores (SF-36 questionnaire). Conclusions: The management of patients with MMN in everyday clinical practice demonstrates a wide range of absolute dosages and treatment intervals of IG, supporting the recommended practice of determining treatment dose on an individual patient basis. The improvements in muscle strength and reduction in disability, accompanied by increased QoL, strengthen the case for use of IG as a maintenance treatment for MMN.

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31

Nord, Maria. "Levodopa pharmacokinetics -from stomach to brain : A study on patients with Parkinson’s disease." Doctoral thesis, Linköpings universitet, Avdelning för neurobiologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-136560.

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Parkinson’s disease (PD) is one of the most common neurodegenerative disorders and it is caused by a loss of dopamine (DA) producing neurons in the basal ganglia in the brain. The PD patient suffers from motor symptoms such as tremor, bradykinesia and rigidity and treatment with levodopa (LD), the precursor of DA, has positive effects on these symptoms. Several factors affect the availability of orally given LD. Gastric emptying (GE) is one factor and it has been shown to be delayed in PD patients resulting in impaired levodopa uptake. Different enzymes metabolize LD on its way from the gut to the brain resulting in less LD available in the brain and more side effects from the metabolites. By adding dopa decarboxylase inhibitors (carbidopa or benserazide) or COMT-inhibitors (e.g. entacapone) the bioavailability of LD increases significantly and more LD can pass the blood-brain-barrier and be converted to DA in the brain. It has been considered of importance to avoid high levodopa peaks in the brain because this seems to induce changes in postsynaptic dopaminergic neurons causing disabling motor complications in PD patients. More continuously given LD, e.g. duodenal or intravenous (IV) infusions, has been shown to improve these motor complications. Deep brain stimulation of the subthalamic nucleus (STN DBS) has also been proven to improve motor complications and to make it possible to reduce the LD dosage in PD patients. In this doctoral thesis the main purpose is to study the pharmacokinetics of LD in patients with PD and motor complications; in blood and subcutaneous tissue and study the effect of GE and PD stage on LD uptake and the effect of continuously given LD (CDS) on LD uptake and GE; in blood and cerebrospinal fluid (CSF) when adding the peripheral enzyme inhibitors entacapone and carbidopa to LD infusion IV; in brain during STN DBSand during oral or IV LD treatment. To conclude, LD uptake is more favorable in PD patients with less severe disease and GE is delayed in PD patients. No obvious relation between LD uptake and GE or between GE and PD stage is seen and CDS decreases the LD levels. Entacapone increases the maximal concentration of LD in blood and CSF. This is more evident with additional carbidopa and important to consider in avoiding high LD peaks in brain during PD treatment. LD in brain increases during both oral and IV LD treatment and the DA levels follows LD well indicating that PD patients still have capacity to metabolize LD to DA despite probable pronounced nigral degeneration. STN DBS seems to increase putaminal DA levels and together with IV LD treatment also increases LD in brain possibly explaining why it is possible to decrease LD medication after STN DBS surgery.
Parkinsons sjukdom (PS) är en av de vanligaste s.k. neurodegenerativasjukdomarna och orsakas av förlust av dopamin(DA)producerande nervceller i hjärnan. Detta orsakar motoriska symptom såsom skakningar, stelhet och förlångsammade rörelser. Levodopa (LD) är ett ämne, som kan omvandlas till DA i hjärnan och ge symptomlindring och det är oftast förstahandsval vid behandling av patienter med PS. Flera faktorer påverkar tillgängligheten av LD, bl.a. den hastighet som magsäcken tömmer sig med och denna verkar förlångsammad hos personer med PS vilket ger sämre tillgänglighet av LD i blodet och därmed i hjärnan. LD bryts även ner i hög grad av olika enzym ute i kroppen vilket leder till mindre mängd LD som hamnar i hjärnan och till fler nedbrytningsprodukter som orsakar biverkningar. Tillägg av enzymhämmare leder till ökad mängd LD som kan nå hjärnan och omvandlas till DA. Det anses viktigt att undvika höga toppar av LD i hjärnan då dessa verkar bidra till utvecklandet av besvärliga motoriska komplikationer hos patienter med PS. Om LD ges mer kontinuerligt, exempelvis som en kontinuerlig infusion in i tarmen eller i blodet, så minskar dessa motoriska komplikationer. Inopererande av stimulatorer i vissa delar av hjärnan (DBS) har också visat sig minska dessa motoriska komplikationer och även resultera i att man kan minska LD-dosen. Huvudsyftet med den här avhandlingen är att studera LD hos patienter med PS; i blod och fettvävnad då LD ges i tablettform och se om det finns något samband med LD-upptag och hastigheten på magsäckstömningen (MT) och om kontinuerligt given LD påverkar LD-upptaget eller MT; i blod och i ryggmärgsvätska då enzymhämmarna entakapon och karbidopa tillsätts LD; i hjärna vid behandling med DBS och då LD ges både som tablett och som infusion i blodet. Sammanfattningsvis kan vi se att LD-upptaget är mer gynnsamt hos patienter med PS i tidigare skede av sjukdomens komplikationsfas. MT är förlångsammad hos patienter med PS och det är inget tydligt samband mellan LD-upptag och MT eller mellan MT och sjukdomsgrad. Kontinuerligt given LD minskar LDnivåerna. Enzymhämmaren entakapon ökar den maximala koncentrationen av LD i blod och ryggmärgsvätska och effekten är mer tydlig vid tillägg av karbidopa vilket är viktigt att ta i beaktande vid behandling av PS för att undvika höga toppar av LD i hjärnan. LD ökar i hjärnan då man behandlar med LD i tablettform och som infusion i blodet och DA-nivåerna i hjärnan följer LD väl vilket visar på att patienter med PS fortfarande kan omvandla LD till DA trots trolig uttalad brist av de DA-producerande nervcellerna i hjärnan. DBS verkar öka DA i vissa områden i hjärnan och tillsammans med LD-infusion i blodet verkar det även öka LD i hjärnan och det kan förklara varför man kan sänka LDdosen efter DBS-operation.

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32

Petrovic, Aleksandar. "Connectivity driven registration of magnetic resonance images of the human brain." Thesis, University of Oxford, 2010. http://ora.ox.ac.uk/objects/uuid:fd95c6d4-06d2-41b4-b6f2-5cbd73cb83a9.

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Image registration methods underpin many analysis techniques in neuroimaging. They are essential in group studies when images of different individuals or different modalities need to be brought into a common reference frame. This thesis explores the potential of brain connectivity- driven alignment and develops surface registration techniques for magnetic resonance imaging (MRI), which is a noninvasive neuroimaging tool for probing function and structure of the human brain. The first part of this work develops a novel surface registration framework, based on free mesh deformations, which aligns cortical and subcortical surfaces by matching structural connectivity patterns derived using probabilistic tractography (diffusion-weighted MRI). Structural, i.e. white matter, connectivity is a good predictor of functional specialisation and structural connectivity-driven registration can therefore be expected to enhance the alignment of functionally homologous areas across subjects. The second part validates developed methods for cortical surfaces. Resting State Networks are used in an innovative way to delineate several functionally distinct regions, which were then used to quantify connectivity-driven registration performance by measuring the inter- subject overlap before and after registration. Consequently, the proposed method is assessed using an independent imaging modality and the results are compared to results from state-of-the-art cortical geometry-driven surface registration methods. A connectivity-driven registration pipeline is also developed for, and applied to, the surfaces of subcortical structures such as the thalamus. It is carefully validated on a set of artificial test examples and compared to another novel surface registration paradigm based on spherical wavelets. The proposed registration pipeline is then used to explore the differences in the alignment of two groups of subjects, healthy controls and Alzheimer's disease patients, to a common template. Finally, we propose how functional connectivity can be used instead of structural connectivity for driving registrations, as well as how the surface-based framework can be extended to a volumetric one. Apart from providing the benefits such as the improved functional alignment, we hope that the research conducted in this thesis will also represent the basis for the development of templates of structural and functional brain connectivity.

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33

Caon, Giane. "Acompanhamento neuropsicomotor ambulatorial de crianças de alto risco neurológico." Universidade do Estado de Santa Catarina, 2005. http://tede.udesc.br/handle/handle/339.

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Made available in DSpace on 2016-12-06T17:07:08Z (GMT). No. of bitstreams: 1 02-Elementos Pre-textuais.pdf: 141371 bytes, checksum: 53522240ad7745d208315c98271c3a5a (MD5) Previous issue date: 2005-12-20
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Neuropsychomotor impairment prevention becomes essential when progresses in obstetrics and neonatology áreas promote larger survival of risk babies. Neonatology High Risk Clinics have been implemented to provide attendance for these children, that usually have prevalence of neurological risk factors. Promoting the attention for their Neuropsychomotor Development, this study aimed to present a proposal of High Neurological Risk Children Clinical Neuropsychomotor Follow up, what is in implantation in Clinic of Neonatolgy High Risk from Academical Hospital at Santa Catarina Federal University. In the evaluation protocol were used: File of Biopsychossocial Data Register (risk factors verification and notes of assessments accomplished in consultations), Neonatal Medical Índex (for preterm neurobehavioral risk categorization), and Brunet-Lèzine Test (in adaptation by SOUZA, 2003, for determination of neuropsychomotors data Developmental Ages and Quotients/ DA and DQ - in Postural, Eye-Hand Coordination, Language, Social and Global areas,). From setember/04 to setember/05, 87 evaluations were accomplished, distributed among 40 infants. Preterm birth was the more frequent risk factor (85%), with Moderate (44,1%) and Extreme (55,9%) degree; NMI III was the more commom manifestation (44,1%) and there was significant lineal relationship between neurobehavioral risk and DQ in Social area /DQS (P=0,026). In follow up analysis, DQs tended to decrease, with smaller scores in Eye-Hand Coordination area, and statistical significance in prematuridade degree (P=0,025) in this area. DQS performance presented significant difference among evaluations of first and second year of life (P=0,019). Females have better neuropsychomotor performance either in the first (Posture and Eye-Hand Coordination, P=0,025 and P=0,008) and second year of life (Posture, Language and Global, P=0,017, P=0,047 and P=0,036). High Neurological Risk Children Clinical Neuropsychomotor Follow up proposal seems to linked child attendance and neurpsychomotor research. Its continuity aim to reinforce the neuropsychomotor intervention program, in order to promote health and quality of life for chidren and their families, with an approach more global and efficient.
Enfatizar a prevenção de distúrbios neuropsicomotores torna-se fundamental à medida que os avanços em obstetrícia e neonatologia promovem maior sobrevivência de bebês de risco. Ambulatórios de Alto Risco em Neonatologia têm sido implementados para proporcionar o acompanhamento dessas crianças, em que geralmente há predomínio de fatores de risco neurológico. Promovendo a atenção ao Desenvolvimento Neuropsicomotor de tal população, este estudo busca apresentar uma proposta de Acompanhamento Neuropsicomotor Ambulatorial de Crianças de Alto Risco Neurológico, que está em implantação junto ao Ambulatório de Alto Risco em Neonatologia do Hospital Universitário, Universidade Federal de Santa Catarina. No protocolo de avaliação foram utilizados: Ficha de Registro de Dados Biopsicossocias (verificação de fatores de risco e registro de avaliações realizadas nas consultas), Neonatal Medical Index (Índice Médico Neonatal, para categorização do risco neurocomportamental em prematuros), e Escala de Brunet-Lèzine (na adaptação de SOUZA, 2003, para determinação de dados neuropsicomotores - Idades e Quocientes de Desenvolvimento/ID e QD - nas áreas Postural, Coordenação Óculo-Motriz, Linguagem, Social e Global). De setembro/04 a setembro/05 foram realizadas 87 avaliações, distribuídas entre 40 lactentes. Nascimento pré-termo foi o fator de risco mais freqüente (85%), com grau Moderado (44,1%) e Extremo (55,9%), sendo que a categoria III no NMI foi de maior manifestação (44,1%) e houve relação linear significativa entre risco neurocomportamental e QD na área Social/QDS (p=0,026). Em análise longitudinal, os QDs tenderam a decrescer, com menores escores na Coordenação Óculo-Motriz, e significância estatística em relação ao grau de prematuridade (p=0,025) nesta área. O desempenho do QDS apresentou diferença significativa entre avaliações de primeiro e segundo ano de vida (p=0,019). Foi observado melhor desempenho neuropsicomotor no sexo feminino, tanto no primeiro (Postura e Coordenação Óculo-Motriz, p=0,025 e p=0,008) como no segundo ano de vida (Postura, Linguagem e Global, p=0,017, p=0,047 e p=0,036). A proposta de Acompanhamento Neuropsicomotor Ambulatorial de crianças de risco parece ter conseguido promover a veiculação da assistência à saúde da criança com a pesquisa sobre o desenvolvimento infantil. Sua continuidade prossegue em termos do fortalecimento do programa de intervenção neuropsicomotora, a fim de promover de forma mais global e efetiva saúde e qualidade de vida das crianças e suas famílias.

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34

Osama, Mohammad. "Function of Vascular Endothelial Cells in Aging and Hypothermia: Clinical Implications." Ohio University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1534939514503588.

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35

Gilleron, Mylène. "Complexité des maladies mitochondriales : à partir de deux exemples." Thesis, Paris 6, 2014. http://www.theses.fr/2014PA066136/document.

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Les maladies mitochondriales représentent un ensemble très divers de pathologies. Au cours de ce travail, j’ai abordé leur complexité dans deux situations différentes : les déficits humains en complexe III de la chaîne respiratoire mitochondriale et l’analyse des relations génotype/phénotype dans une cohorte de patients suspects de mutations sur un même gène nucléaire (POLG). Le complexe III joue un rôle central au sein de la chaîne respiratoire mitochondriale. Contrairement à sa caractérisation biochimique très complète, son rôle physiologique a été relativement mal établi. D'une cohorte de 2000 patients dont les activités de la chaîne respiratoire mitochondriale avaient été mesurées sur tissu hépatique ou musculaire, nous avons sélectionné 15 patients avec un déficit en complexe III pour lesquels nous disposions de fibroblastes exprimant un déficit respiratoire. L’origine génétique était initialement connue pour quatre des déficits (UQCRB, BCS1L x2, MT-CYB) et, au cours de ce projet, nous avons pu en identifier trois autres (CYC1, MT-CYB, LYRM7). Nous avons cherché à évaluer l'existence d'un lien entre le phénotype et les caractéristiques du déficit : gène impliqué, distribution tissulaire et profil des réponses cellulaires au déficit. Notre population de fibroblastes, hétérogène sur le plan génétique, s’est également révélée très variée quant aux conséquences biochimiques et cellulaires du déficit. Il ne semble donc pas exister de « profil type » des déficits en complexe III. Les atteintes liées à une mutation du gène POLG sont souvent considérées comme les maladies mitochondriales les plus fréquentes chez l’adulte. Elles sont associées à des présentations cliniques très diverses. Nous avons étudié la spécificité et la sensibilité des différents signes cliniques et biologiques considérés comme évocateurs et conduisant donc au séquençage de POLG. A cette fin, nous avons analysé rétrospectivement le phénotype clinique et les investigations mitochondriales chez 154 patients dont le séquençage du gène POLG avait été effectué révélant des mutations touchant les deux allèles du gène chez 34 patients, une seule mutation chez 10 patients et une séquence normale chez 110 patients. L’étude clinique a inclus les signes/symptômes cliniques, les données électrophysiologiques et l'imagerie cérébrale. Les investigations mitochondriales englobaient l’histologie musculaire, le dosage du lactate sanguin, la mesure des activités de la chaîne respiratoire et la recherche de délétions multiples de l’ADN mitochondrial musculaire. Cette étude a montré que les mutations du gène POLG étaient responsables de signes cliniques et paracliniques récurrents présentant donc une sensibilité et une spécificité, notamment en association, permettant de proposer un arbre décisionnel pour l’indication du séquençage du gène POLG. Cette étude a également permis d’établir l’histoire naturelle des maladies de l’adulte dues à des mutations délétères de POLG. En conclusion, la classification des maladies mitochondriales par une anomalie biochimique commune, un déficit en complexe III dans le cas présent, conduit à regrouper des atteintes très différentes, aussi bien sur le plan clinique que biochimique et cellulaire. Au contraire, même dans des affections réputées comme extrêmement diverses comme celles dues aux mutations du gène POLG, la classification par le gène atteint permet d’identifier des présentations récurrentes dans la classe d’âge étudiée, patients adultes dans le cas présent…
Mitochondrial diseases represent a very diverse set of pathologies. With this work, I approached their complexity in two different situations: phenotypic analysis of fibroblasts derived from patients with defects of the respiratory complex III and phenotypic analysis of a cohort of patients, the POLG gene of whom had been sequenced. The complex III plays a central role in the mitochondrial respiratory chain. Contrary to its complete biochemical characterization, its physiological role has been relatively poorly established. We selected 15 patients with complex III defect in liver and/or muscle and with fibroblasts expressing a respiratory defect. The genetic origin was initially known for four of these defects (UQCRB, BCS1L x2, MT- CYB) and during this project, we were able to identify three additional cases (CYC1, MT- CYB, LYRM7). We sought to assess the existence of a link between the disease phenotype and the defect characteristics: gene involved, tissue expression and cellular responses. Our population of fibroblasts, genetically heterogeneous, turned also to be diverse with respect to the biochemical and cellular consequences of the defect. A "typical" profile of complex III defect therefore does not seem to exist. Pathologies related to POLG mutations are often considered the most common mitochondrial diseases in adults. Their clinical presentation is very diverse. We have investigated the specificity and sensitivity of different clinical and biological signs considered as suggestive for POLG mutations and therefore leading to POLG sequencing. To that purpose, we retrospectively analyzed the clinical phenotype and mitochondrial investigations in 154 patients for which POLG had been sequenced revealing mutations affecting two alleles of the gene in 34 patients, one allele for 10 patients and a normal sequence for 110 patients. This study has shown that POLG mutations were responsible of recurrent clinical and paraclinical signs, whose sensitivity and specificity when considered in association allowed to propose a diagnostic flowchart for POLG sequencing. This study has also permitted to establish the natural story of diseases associated with deleterious POLG mutations in adults. In conclusion, classification of mitochondrial diseases by a common biochemical abnormality, a complex III defect in the present case, leads to group very different diseases that differ from their clinical, biochemical and cellular patterns. On the contrary, even in diseases considered highly diverse as those due to POLG mutations, classification by the affected gene allows to identify recurrent presentations in a population of adult patients with neurological presentation

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36

Klee, Victoria H. "An Exploration of Genetic Counselors’ Practice Patterns Towards Alzheimer’s Disease in Non-Neurology Clinics." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1586969389732165.

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37

Welleford, Andrew. "Autologous Peripheral Nerve Grafts to the Brain for the Treatment of Parkinson's Disease." UKnowledge, 2019. https://uknowledge.uky.edu/neurobio_etds/23.

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Parkinson’s disease (PD) is a disorder of the nervous system that causes problems with movement (motor symptoms) as well as other problems such as mood disorders, cognitive changes, sleep disorders, constipation, pain, and other non-motor symptoms. The severity of PD symptoms worsens over time as the disease progresses, and while there are treatments for the motor and some non-motor symptoms there is no known cure for PD. Thus there is a high demand for therapies to slow the progressive neurodegeneration observed in PD. Two clinical trials at the University of Kentucky College of Medicine (NCT02369003, NCT01833364) are currently underway that aim to develop a disease-modifying therapy that slows the progression of PD. These clinical trials are evaluating the safety and feasibility of an autologous peripheral nerve graft to the substantia nigra in combination with Deep Brain Stimulation (DBS) for the treatment of PD. By grafting peripheral nerve tissue to the Substantia Nigra, the researchers aim to introduce peripheral nerve tissue, which is capable of functional regeneration after injury, to the degenerating Substantia Nigra of patients with PD. The central hypothesis of these clinical trials is that the grafted tissue will slow degeneration of the target brain region through neural repair actions of Schwann cells as well as other pro-regenerative features of the peripheral nerve tissue. This dissertation details analysis of the peripheral nerve tissue used in the above clinical trials with respect to tissue composition and gene expression, both of injury-naive human peripheral nerve as well as the post-conditioning injury nerve tissue used in the grafting procedure. RNA-seq analysis of sural nerve tissue pre and post-conditioning show significant changes in gene expression corresponding with transdifferentiation of Schwann cells from a myelinating to a repair phenotype, release of growth factors, activation of macrophages and other immune cells, and an increase in anti-apoptotic and neuroprotective gene transcripts. These results reveal in vivo gene expression changes involved in the human peripheral nerve injury repair process, which has relevance beyond this clinical trial to the fields of Schwann cell biology and peripheral nerve repair. To assess the neurobiology of the graft post-implantation we developed an animal model of the grafting procedure, termed Neuro-Avatars, which feature human graft tissue implanted into athymic nude rats. Survival and infiltration of human graft cells into the host brain were shown using immunohistochemistry of Human Nuclear Antigen. Surgical methods and outcomes from the ongoing development of this animal model are reported. To connect the results of these laboratory studies to the clinical trial we compared the severity of motor symptoms before surgery to one year post-surgery in patients who received the analyzed graft tissue. Motor symptom severity was assessed using the Unified Parkinson’s Disease Rating Scale Part III. Finally, the implications and future directions of this research is discussed. In summary, this dissertation advances the translational science cycle by using clinical trial findings and samples to answer basic science questions that will in turn guide future clinical trial design.

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38

Piano, Carla <1981&gt. "Sleep and Huntington Disease: Polysomnographic Findings and Clinical Correlates." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2016. http://amsdottorato.unibo.it/7298/.

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Huntington’s disease (HD) is a progressive, fatal, neurodegenerative disorder caused by an abnormal expansion of a CAG repeat sequence in the gene encoding the protein huntingtin (HTT) on chromosome 4. Clinical features of HD include progressive motor dysfunction, cognitive decline, and psychiatric disturbance. Sleep disturbances are frequent in HD patients. However, sleep alterations as well as their association with other symptoms and signs of the disease have not been systematically studied in large groups of HD patients.The aim of the study was to objectively evaluate sleep features in a large, single-center, population of HD patients by means of nocturnal, laboratory based video-polysomnography (V-PSG), and to correlate PSG findings with clinical parameters;evaluate subjective sleep-related symptoms by subjective sleep evaluation and compare the results with those obtained with the gold standard diagnostic tool, namely V-PSG;finally, evaluate the EEG modifications in HD patients during the sleep-wake cycle, by means of the exact LOw REsolution Tomography (eLORETA) software.The results suggest that sleep is severely disrupted in HD patients.Taken together,our data may suggest that the caudate degenerative process observed in HD account for the increased arousability, increased motor activity during wake and sleep (originating periodic limb movements), reduction of REM sleep and, overall, a general sleep disruption.As concerns the subjective sleep evaluation, our data suggest, overall, that the subjective evaluation of sleep in HD patients shows a poor correlation with PSG results. Our EEG data suggest a defined pattern of motor cortex dysfunction during wake and sleep, which correlates with the clinical and polysomnographic evidence of increased motor activity during wake and NREM, and nearly absent motor abnormalities in REM. It could be hypothesized that EEG modifications reflect motor cortex impairment or, conversely, an effort to counterbalance abnormal motor output.

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Peall, Kathryn J. "Clinical and genetic investigation of the epsilon-sarcoglycan complex in neurologic and psychiatric disease." Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/44844/.

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Myoclonus Dystonia Syndrome is a childhood onset hyperkinetic movement disorder characterised by alcohol responsive upper body myoclonus and dystonia. A proportion of cases are due to mutations in the maternally imprinted SGCE gene, which encodes the transmembrane epsilon-sarcoglycan protein. Previous studies suggest an increased rate of psychiatric disorders in those with SGCE mutations. This study aimed to establish a cohort of myoclonus dystonia syndrome patients, identify the rate and type of SGCE mutations, determine differences in motor characteristics between mutation positive and negative cases and whether psychiatric disorders form part of the disease phenotype. Eighty-nine probands with clinically suspected MDS were recruited. Information regarding onset and distribution of motor symptoms was collected via systematic questionnaires and video taped examination. SGCE was analysed using direct sequencing and for copy number variants. Psychiatric symptoms were assessed using systematic and standardised questionnaires and compared to a disability-matched, alcohol responsive tremor control group. Nineteen (21%) probands had an SGCE mutation. All had evidence of upper body predominant myoclonus and dystonia during their disease course. Five had contiguous gene deletions ranging from 0.7 to 2.3Mb in size with distinctive clinical features. Recruitment of family members increased the affected SGCE mutation positive group to 27 of whom 21 (77%) had psychiatric symptoms. Obsessive-Compulsive Disorder was eight times more likely (p<0.001) in mutation positive cases, compulsivity being the predominant feature (p<0.001). Generalized Anxiety Disorder (p=0.003) and alcohol dependence (p=0.02) were five times more likely in cases than tremor controls. Overall, SGCE mutations are associated with a narrow clinical and specific psychiatric phenotype. The presence of myoclonus, dystonia, age at onset ≤10 years and a positive family history of the disorder are the strongest predictors of an SGCE mutation. SGCE mutations are likely to have a pleiotropic effect in causing both motor and specific psychiatric symptoms.

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Carvour, Martha Lydia. "Patterns and predictors of survival following an HIV/AIDS-related neurologic diagnosis." Diss., University of Iowa, 2012. https://ir.uiowa.edu/etd/2454.

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Infection with human immunodeficiency virus (HIV) and progression to acquired immune deficiency syndrome (AIDS) often result in neurologic and neuropsychiatric changes, although the prognostic information available for patients affected by HIV/AIDS-related neurologic diagnoses has been limited. The objective of the present study was to characterize the patterns and predictors of survival, including the impacts of antiretroviral therapy (ART) use and potential factors in healthcare access and disparity, among patients with one or more of the following conditions: cryptococcosis, toxoplasmosis, primary central nervous system lymphoma, progressive multifocal leukoencephalopathy, and HIV-associated dementia. To accomplish this, a cohort was drawn from the Iowa HIV/AIDS reporting system, and a non-independent, university-based cohort was then used to validate the analyses conducted for the statewide sample. Patterns of ART use were identified in each cohort using logistic regression, and survival analyses were conducted using Kaplan-Meier analysis, Cox regression, and accelerated failure time modeling. Survival was poor in both cohorts, although the university-based setting (University of Iowa Hospitals and Clinics) was associated with better overall survival. Of 230 persons in the statewide cohort, 77.0% were deceased by the end of the study period (1982-2008), and the median survival was 1.13 years (95% CI: 0.90 to 1.86 years, n=225). By contrast, 56.4% of the university-based cohort was deceased by the end of the study period (1984-2009), and the median survival in this group was 3.04 years (95% CI: 1.79 to 11.62 years, n=172). Both cohorts were predominantly male, non-Hispanic white, and residents of a small metropolitan area at the time of the AIDS diagnosis. ART use had a strong protective effect on survival in both cohorts. Use of ART among patients diagnosed during the era of highly active antiretroviral therapies (HAART) was associated with an 80% reduction in the rate of death (HR=0.20, 95% CI: 0.08 to 0.46) compared to the non-users diagnosed during the pre-HAART era (that is, prior to 1996), after adjustment for age, race, birth sex, healthcare facility type, opportunistic infection count, HIV transmission risk category, neurologic condition, years since AIDS diagnosis, and timing of neuro-AIDS in a Cox regression model. In the UIHC cohort, the adjusted expected survival time among ART/HAART users was 37.71 (95% CI: 14.44 to 99.48) times that among non-users. Women had significantly poorer outcomes than men in the statewide cohort (adjusted HR=2.31, 95% CI: 1.22 to 4.35), and a similar, non-significant trend was observed among university-based cases. Secondary analyses suggested that this difference persisted over the course of the epidemic and was not attributable to differential ART response among men and women. Evidence for a role of disease severity, psychosocial support, and/or psychiatric comorbidity in the differential survival of men and women was identified. This study provides useful prognostic data for patients and providers and may guide future research efforts aimed toward improved survival for neuro-AIDS patients. The survival disadvantage of women compared to men should be confirmed and the mechanisms underlying this disparity elucidated. Meanwhile, clinical and public health efforts might be directed towards screening, treatment, and support for women affected by neuro-AIDS, including potential assessment of comorbid psychiatric disorders.

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Silva, David Willians. "Estudo das caracteristicas demograficas e clinicas da demencia no ambulatorio de neurologia do Hospital de Clinicas da UNICAMP." [s.n.], 2001. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308463.

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Orientador: Benito Pereira Damasceno
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-07-27T10:48:01Z (GMT). No. of bitstreams: 1 Silva_DavidWillians_M.pdf: 24861758 bytes, checksum: 4814eebfbdbf1dc6d42002636139858d (MD5) Previous issue date: 2001
Resumo: No Brasil, a população de idosos exibe grande crescimento proporcional. Demência assume crescente importância neste grupo etário (4 a 18% para aqueles com mais de 65 anos e até 25% para aqueles com mais de 85 anos). Seu diagnóstico apresenta desafios: não existem marcadores biológicos de fácil obtenção;. a caracterização clinica, principalmente dos casos leves, é dificil; a doença incide numa faixa etária de elevada comorbidade. No Brasil são poucos os estudos dedicados ao conhecimento das características demográficas e clinicas da demência; neste hospital, referência na região, não houve estudo similar. Este estudo objetiva descrever as características clinicodemográficas dos indivíduos com sÚldrome demencial, avaliados no Ambulatório de Neurologia do HC-UNICAMP, num período de dez anos (1989 a 1998) e comparar esses dados com os da literatura (especialmente com estudos brasileiros). Avaliaram-se 286 indivíduos com síndrome demencial, retrospectiva (89,7%) ou prospectivamente (10,3%). No diagnóstico de demência utilizaram-se os critérios do DSM-IV e CAMDEX. Para a gravidade utilizou-se o CAMDEX. Realizou-se avaliação neuropsicológica confonne o Luria Neuropsychological Investigation e o CAMDEX (formas original e reduzida, adaptadas à nossa cultura). No diagnóstico dos subtipos etiológicos utilizaram-se dados clinicos, laboratoriais, de neuroimagem e critérios específicos: CAMDEX (pseudodemência depressiva); NINCDS-ADRDA (Alzheimer's); NINCDS-AIREN/ADATC combinados (vascular); Lund-Manchester (frontotemporal) e tap-teste (hidrocefalia nonnotensa). Preencheram critérios para demência 261 pacientes (89,7%). Predominaram o sexo masculino (57,5%), a cor branca (88%), e o estado civil casado (79,6%). A idade média foi de 63,5 anos (variando de 20 a 87) e a escolaridade média foi de 3,7 anos (0 a 15 anos, com 25% de analfabetos). A maioria foi natural de outras regiões do Estado de São Paulo (39,1%), ou de outros Estados (33%); a maioria residia na cidade de Campinas (38,1%), ou na região de Campinas (39,1%). A demência foi mínima em 29 casos (11,1%); leve em 94 (36%), moderada 95 (36,4%) e severa 43 (16,5%). A etiologia: vascular, 65 casos (24,9%); A1zheimer's, 62 (23,7%); hidrocefálica, 31 (11,9%); pseudodemência depressiva, 29 (11,1%); degenerativa de subtipo não definido, 15 (5,7%); mista, 14 (5,4%; sendo 6 vascular-hidrocefálica, 5 vascular-Alzheimer's, 2 vascular-infecciosa e 1 vascularmetabólica); pós-traumática, 12 (4,6%); :frontotemporal, 9 (3,4%); alcoólica, 6 (2,3%); degenerativa especificada, 5 (1,9%; sendo 2 Parkinson, 2 paralisia supranuclear progressiva e 1 Huntington); deficiênciade BI2/folato, 4 (1,5%); diversas, 9 (3,4%; sendo 3 tumorais, 4 infecciosas, 1 hipotireoidismo e 1 Jakob-Creutzfeldt). O tempo médio de evolução dadoença até a avaliação no ambulatório foi de 37,8 meses. Predominou como primerio sintoma o "esquecimento" (42,5% casos); como antecedente hipertensão arterial (39,5%); no exame neurológico sinais de acometimento difuso do sistema nervoso (45,3%); na neuroirnagem, TC com atrofia córtico-subcortical (52,4%) e SPECT com hipoperfusão cortical difusa (31,7%). O CAMCOG adaptado mostrou correlação com o diagnóstico de demência e com a escolaridade (concordando com o MMSE). A proporção de demência vascular (24,9%) foi similar à de Alzheimer(24,5%), contrastando com a literatura (20-30% e 50% respectivamente). As provas cognitivas adaptadas do CAMDEX (formas original e reduzida) mostraram-se eficientes no diagnóstico da demência. Foi estabelecido um ponto-de-corte de 42 para o CAMCOG em sua forma reduzida
Abstract: In Brazil, with the growth of the old part of our population, we see an increasing prevalence of dementia syndrome, with it's social and economics consequences. There are many challenges as regards dementia diagnosis: there are no biological markers; the clinical diagnosis is difficult, specially in mild cases; and the disease occurs in an age with high comorbidity. In our country there are few studies devoted to knowing the clinical and demographic characteristics of dementia. This study aims to describe these aspects of dementia in patients who seek the neurological out patients service of UNICAMP's Hospital in a ten year period (1989-1998). We will compare our data with that of neurological literature, especially with findings of Brazilian studies. Two hundred and eighty six patients whit dementia syndrome were evaluated retrospectively (89.7%) and prospectively (10.3%). DSM-IV or CAMDEX criteria were used to diagnose dementia; and it's severity was estimated with CAMDEX scale. Neuropyschological evaluation was performed with Luria's battery or CAMDEX ( both large and short forms, adapted to our culture). The diagnosis of dementia etiology was made with clinical, laboratory and neuroimaging (computerized tomography or magnetic resonance) evaluations as well as with criteria of NINCDS-AIREN/ADDTC ( for vascular dementia); NINCDS-ADDTC (Alzheimer's disease); tap-test (normal pressure hydrocephalus); CAMDEX (depressive pseudodementia); and Lund-Manchester criteria (for frontotemporal dementia). Two hundred and sixty one patients (89.7%) fulfilled dementia criteria. There was predominance of male (57.5%), white (88%), and married people (79,6%). Average age was 63.5 years (ranging from 20 to 87 years). The mean educationallevel was 3.7 years (ranging from Oto 15 years; with 25% of illiterate ). Most patients were bom in distant provinces, but were living in Campinas or neighborhoods. The severity of dementia was evaluated as mild in 123 cases (47.1%), moderate in 95 (36.4%), and severe in 43 cases (16.5%). There were 65 cases of vascular dementia (24.9%); 62 cases of A1zheimer's disease (23.7%); 31 hydrocephalic (11.9%); 29 depressive pseudodementia (11.1%); 15 degenerative of non specific type (5.7%); 14 mixed (5.4%; of which 6 were vascular hydrocephalic, 5 were vascular-Alzheimer's, 2 vascular-infectious, and 1 vascularmetabolic); 12 post-traumatic (4.6%); 9 frontotemporal (3.4%); 6 alcoholics (2.3%); 5 degenerative specific (1.9%; of which 2 were Parkinson's disease, 2 supranuclear palsy, and 1 Huntington's disease); 4 B12/folate deficiency (1.6%); and 8 other dementia cases (3.2%; of which 3 were tumors, 3 infectious, 1 hypothyroidism, and 1 Creutzfeldt-Jakob's disease). The mean disease duration was 37.8 months. As mst symptom predominated amnesia (42.5% of cases). Hypertension was the main pathological antecedent (39.5%). Neurological examination showed mainly diffuse, non-lateralizing signs of CNS involvement (45.3%). Neuroimaging main findings was cortico-subcortical atrophy (52.4%), with SPECT showing diffuse hipoperfusion (31.7%). CAMCOG (CAMDEX cognitive battery) showed good correlation with dementia diagnosis and educational level (in concordance with MMSE). In our sample of patients, the prevalence of vascular dementia (24.9%) was similar to that of Alzheimer's disease (23.7%), which is in disagreement with the prevalence reported in the literature (20 to 30%, and 50%, respectively). CAMCOG (with cut-off point of 42 for the short form) was efficient in the diagnosis of dementia, with a sensitivity of 94,9% and a specificity of 87.5%
Mestrado
Neurologia
Mestre em Ciências Médicas

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42

Gillespie, Stephanie Marie 1958. "Reliability and validity of the Clinical Neurologic Assessment (CNA) Tool in children with head trauma." Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/278494.

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The Clinical Neurologic Assessment (CNA) Tool is a 21 item instrument designed to assess subtle neurologic changes that often accompany head trauma. This descriptive study was designed to test the reliability and validity of the CNA in children with head trauma. Interrater reliability of the CNA was assessed by determining Cohen's Kappa values for each item. Kappa values ranged from .74 to 1.00. Internal consistency of the CNA was assessed using Cronbach's alpha. The total CNA alpha was estimated to be .98 with subscale alphas ranging from .89 to .96. Concurrent and construct validity of the CNA were also assessed. Concurrent validity was estimated by determining Pearson's Product-Moment Correlation Coefficients for the CNA and the Glasgow Coma Scale (GCS) (r = .93; p = .001). Pearson's correlation coefficients were also estimated based on severity of head trauma (r = .57 to .74; p ≤ .017) and the age of the subject (r = .89 to .99; p ≤ .001). Construct validity was assessed using exploratory factor analysis which demonstrated a three factor solution. These factors reflected the following: a general overview of the level of consciousness, overall body and extremity position and movement, and muscle tone of the extremities.

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Menassa, David Antoine. "Magnetoencephalography and neuropathological studies of autism spectrum disorders and the comorbidity with epilepsy." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:e809ac19-1f3c-4ef9-83db-69950ab65994.

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Autism spectrum disorders (ASD) are neurodevelopmental disorders with multiple neurobiological aetiologies, which could be genetic, structural, metabolic or immune-mediated. ASDs are diagnosed with deficits in social communication and restricted and repetitive behaviours, and are associated with sensorial atypicalities. 30% of cases have co-existing epilepsy. A series of in vitro, in vivo and post-mortem investigations were undertaken to examine sensory atypicalities in ASD. In vitro characterisation of hippocampal neuronal cultures using immunofluorescence demonstrated the presence of multiple cell types including neurons, astrocytes and microglia. The distribution of ion channels of the Shaker family and tumour necrosis factor α receptors in astrocytes and neurons were identified but not explored further. Neuroanatomical and neuropathological investigations of primary olfactory cortex, using post-mortem stereology, demonstrated a specific increase in glial cell densities in layer II, which was negatively associated with age in ASD. Increases in glia were also associated with symptom severity and often co-localised with the presence of corpora amylacea in layer I. Qualitative analysis of the olfactory tubercle demonstrated that corpora amylacea did not extend to this neighbouring region of the primary olfactory cortex in ASD. These changes were independent of co-existing epilepsy and not observed in epilepsy without ASD. Preliminary pilot studies of the hippocampus provided a stereological sampling strategy to quantify cell densities in future investigations of this area in ASD. Neurophysiological investigations using collected magnetoencephalography data demonstrated diminished occipital gamma oscillatory synchrony in ASD in a visual time perception task. This did not always predict behavioural outcome but was specific to ASD and could not be explained simply in terms of changes in task performance. Moreover, changes in oscillatory synchrony were associated with symptom severity. These observations in primary sensory domains in post-mortem tissue and in patients suggest possible novel mechanisms in ASD and extend knowledge of the neurobiological bases of these disorders.

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Goi, Pedro Domingues. "Evidências clinicas para o modelo de neuroprogressão no transtorno bipolar." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/106844.

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O Transtorno Bipolar (TB) é uma patologia prevalente, grave, crônica, e que apresenta um curso longitudinal muito pior que se imaginava décadas atrás. Além da alternância entre períodos de depressão, mania e eutimia, a recorrência e a progressão do TB conferem gravidade e frequência crescentes aos episódios. A neuroprogressão foi um termo cunhado para definir a aceleração do processo de doença e seus fatores subjacentes, como alterações de biomarcadores periféricos, funções cognitivas, neuroimagem e funcionalidade, que emergem em graus variáveis dependendo da fase de evolução. Todas estas evidências justificaram a classificação do TB em estágios clínicos teóricos distintos, que ainda carecem de validação empírica. Um dos mais recentes deles propõe 1 estágio latente e 4 estágios clínicos distintos (Kapczinski et al, 2009) (1). O presente trabalho avaliou, portanto, as diferentes estratégias farmacológicas para a manutenção da eutimia em uma amostra de pacientes com TB em diferentes estágios (artigo 1), e a associação do atraso no tratamento do primeiro episódio com fatores de pior prognóstico e com os estágios do TB (artigo 2). Em conjunto, os resultados mostraram que a abordagem farmacológica instituída pelo psiquiatra clínico, necessária para manter o paciente em eutimia, é diferente conforme a classificação em estágios. O número de fármacos prescrito também está relacionado ao declínio da funcionalidade. Além disso, o atraso no início do tratamento do TB é diretamente proporcional ao estágio de evolução da doença, e está relacionado a fatores de pior prognóstico, como o número de episódios. Os achados fornecem evidência para modificar certas intervenções no TB: a primeira, que diretrizes de tratamento poderiam considerar os estágios, visando um tratamento mais personalizado para guiar a eficácia do tratamento; e por último, que o esforço em diagnosticar e tratar o TB com precisão e rapidez pode ser uma das medidas para frear a neuroprogressão.
Bipolar Disorder (TB) is a severe, prevalent, and chronic disease, that exhibits worse longitudinal course than previously thought. Beyond the switching phases of depression, mania and euthymia, recurrence and progression of TB increases severity and frequency of episodes. The neuroprogression was a term created to define the acceleration of the disease and its underlying factors, such as changes in peripheral biomarkers, in cognitive performance, in neuroimaging and functioning, that emerge in different degrees depending on the stage of evolution. All those evidences justify the classification of TB in different clinical stages, which still lack empirical validation. One of most recently proposed staging model describes 1 latent stage and 4 clinical stages (Kapczinski et al, 2009) (1). The present study therefore evaluated the different pharmacological strategies for the maintenance of euthymia in a sample of TB patients at different stages (Article 1), and the association of first-episode tretament delay with poor prognosis and BD stages (Article 2). Together, the results showed that maintenance pharmacological treatment in a naturallistic setting is different according to the staging classification. The number of drugs prescribed is also associated to functioning. Moreover, the treatment delay is positively correlated to the stage of the disease, and is related to poor outcomes (i.e. number of episodes). The findings provide evidence to modify certain interventions in TB: first, that treatment guidelines might consider staging to provide tailored approaches and to guide treatment efficacy; and secondly, that the effort to accurately diagnose and treat TB can be one of the measures to restrain neuroprogression.

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Pizza, Fabio <1977&gt. "Restless legs syndrome (RLS) secondary to end stage renal disease: clinical features, pathophysiology, and genetics." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2011. http://amsdottorato.unibo.it/4093/.

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Alton, Julie R. "The Current State of Music Therapy Clinical Practice with Adults with Neurologic Disorders: A Descriptive Questionnaire." Ohio University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1430747960.

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47

Albuquerque, Regina Celia Ajeje Pires de. "Prevalência de cefaléia em crianças e adolescentes da cidade de São José do Rio Preto SP." Faculdade de Medicina de São José do Rio Preto, 2009. http://bdtd.famerp.br/handle/tede/85.

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Several population-based studies have shown been headache as one of the most common symptoms in childhood. These have provided important consequences in headache diagnosis and treatment, since only about 11% of children with chronic headache seek medical treatment. Objectives: This study aimed at selecting a sample of school-aged children who complained headache in the last year, and to assess the headache prevalence in children and adolescents in São José do Rio Preto city (SJRP), SP. Casuistic and Methodology: A total of 5,232 children and adolescents (aged from 6 to 18 years) from SJRP randomly comprised this sample. They have been attended from the 1st to 8th grade in the year of 2004 in 13 schools: 10 public and 3 private. A questionnaire answered by parents and/or responsibles of children and adolescents was handed out in the schools to collect data. The used variables for descriptive demographic profile of the population were: age, gender, color, grade, and school for descriptive analysis of this population s demographic profile. Results: The majority was women (53.3%), white color (74.7%), and attending from the 1st to 4th grade (60%) and from the 5th to 8th grade (40%) of the elementary school. The returning of questionnaires was 61.7% in the public schools and 60% in the private. Out of the children and adolescents who have answered the questionnaire, 70% reported headache complain in the last year, only 7.2% of them did not. Out of the ones who have complained headache in the last year, 51.5% presented it occasionally during the year; 15.5%% once a month at least, 11.9% monthly and 5.2% daily. A significant difference observed in the study was regarding to the complain between the girls and the boys. More frequent headaches were reported by the girls; daily headache was twice higher than the percentile of the boys (6.6% and 3.6%, respectively). A higher headache frequency with the increase of age was observed in relation to headache and age. Our study has pointed out that headache prevalence was high in this studied population; predominantly the frequency being higher (monthly, weekly and daily) in girls and older age group.
Uma série de estudos populacionais tem mostrado que a cefaléia é um dos sintomas mais comuns na infância. Estes estudos têm importantes implicações no diagnóstico e tratamento das cefaléias, desde que somente 11% das crianças com cefaléia crônica procuram atendimento médico. Objetivos: O objetivo deste estudo foi selecionar uma amostra de escolares que declararam ter sentido dor de cabeça no último ano e estimar a prevalência de cefaléia em crianças e adolescentes da cidade de São José do Rio Preto (SJRP), SP. Casuística e Método: O grupo amostral foi constituído por 5.232 crianças e adolescentes (idades de 6 18 anos) de SJRP, que cursaram da 1ª a 8ª série no ano de 2004 em 13 escolas, sendo 10 públicas e 3 particulares, feita por seleção aleatória. A coleta de dados foi realizada por aplicação de um questionário distribuído nas escolas, respondido pelos pais e/ou responsáveis. As variáveis utilizadas foram: idade, gênero, cor, série e escola para a análise descritiva do perfil demográfico desta população. Resultados: O grupo amostral foi composto na maioria por mulheres (53,3%), cor branca (74,7%), cursando da 1ª a 4ª série (60%) e da 5ª a 8ª série (40%) do ensino fundamental. A taxa de devolução dos questionários foi de 61,7% nas escolas públicas e 60,1% nas particulares. Das crianças e adolescentes que participaram do estudo, 70% declararam ter sentido dor de cabeça no último ano, sendo que somente 7,2% nunca se queixaram de dor. Dos que responderam ter sentido cefaléia no último ano, 51,5% apresentaram cefaléia somente algumas vezes ao longo do ano, 15,5% pelo menos uma vez ao mês, 11,9% semanalmente e 5,2% diariamente. Uma diferença significativa observada em nosso estudo foi relacionada à queixa entre meninas e meninos. Cefaléias mais freqüentes foram relatadas pelas meninas, sendo que a queixa de cefaléia diária entre as meninas foi duas vezes maior que o percentual para os meninos (6,6% contra 3,6%). Observou-se uma relação da cefaléia com a idade, indicando que houve um aumento da freqüência da cefaléia com o aumento da idade. Nosso estudo indicou que a prevalência de cefaléia na população estudada foi alta, com maior predomínio de cefaléias mais freqüentes (mensalmente, semanalmente e diariamente) nas meninas e na faixa etária mais velha.

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Borges, Karina Kelly. "Qualidade de vida em pacientes com epilepsia." Faculdade de Medicina de São José do Rio Preto, 2007. http://bdtd.famerp.br/handle/tede/41.

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Epilepsy is a chronic disorder that affects the quality of life, especially in it?s critical periods, when the disease disadvantage life?s cultural, personal and social aspects as well as family relationships. This study analyzed the quality of life in epileptic patients (QV) related to different issues: social, physical and emotional, all of them correlated to the disease and individual variables: the perception of seizure control. Patients from the outpatient?s clinic of Hospital de Base and those identified in the community of S?o Jos? do Rio Preto were compared. 165 patients diagnosed with epilepsy were evaluated by Quality of Life 65 Questionnaire (QQV-65). 87 female and 78 male, from the ambulatory service of Hospital de Base (N=105) and patients from the community (N=-60) of S?o Jos? do Rio Preto city. Their ages ranged between 18 and 75 years old (mean = 41.28; standard deviation = 13.26). The study showed significant associations between age and final quality of life (p-value = 0.003) as well as education and final quality of life (p-value = 0.001). There was significant relation between perception and seizure control and all the aspects of QV: total range of QV (value p - p=0.000), health (value - p=0.000), physical aspects (value - p=0.000), social aspects (value - p=0.003), locus of control (value - p=0.000), self-concept (valor - p=0.025), emotional aspects (valor - p=0.000) and cognitive aspects (value - p=0.009). There was no correlation between patients' origin (ambulatory or outpatients? clinic) and the final quality of life and its aspects (health, physical, cognitive, emotional, self-concept and locus of control).
A epilepsia ? uma desordem cr?nica que prejudica a qualidade de vida, especialmente nos per?odos cr?ticos, influenciando os aspectos pessoais, relacionamento familiar, sociais e culturais. Objetivo: Este estudo analisou a qualidade de vida (QV) dos pacientes com epilepsia relacionando-a a diferentes fatores: social, f?sico e emocional as vari?veis da doen?a e ? vari?vel do sujeito: percep??o de controle de crises, comparando pacientes do ambulat?rio do Hospital de Base e pacientes da popula??o da cidade de S?o Jose do Rio Preto. Casu?stica e M?todo: Foram avaliados 165 sujeitos com diagn?stico de epilepsia, por meio do Question?rio de Qualidade de Vida 65 (QQV-65). Resultados: A amostra constou de 87 do sexo feminino e 78 do sexo masculino, pertencentes ao ambulat?rio do Hospital de Base (N=105) e pacientes populacionais (N=60) da cidade de S?o Jose do Rio Preto. A idade geral dos sujeitos variou entre 18 e 75 anos (M=41,28; DP= 13,26). O estudo mostrou associa??o significativa entre idade e QV final (valor - p= 0,003) e escolaridade e QV final (valor - p=0,001). Houve rela??o significativa entre a percep??o de controle de crises e todos os aspectos de QV: pontua??o total de QV (valor p - p=0,000), sa?de (valor - p=0,000), aspectos f?sicos (valor - p=0,000), aspectos sociais (valor - p=0,003), l?cus de controle (valor - p=0,000), auto-conceito (valor - p=0,025), aspectos emocionais (valor - p=0,000) e aspectos cognitivos (valor - p=0,009). Conclus?o: N?o houve correla??o entre a origem dos pacientes do ambulat?rio ou de postos de sa?de) e a QV final e seus aspectos (sa?de, f?sico, cognitivo, emocional, auto-controle e l?cus de controle).

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49

Aiello, Graciane. "Doença tálamo-cortical. Análise retrospectiva em cães e trauma experimental em coelhos." Universidade Federal de Santa Maria, 2016. http://repositorio.ufsm.br/handle/1/4123.

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The purposes of this study were to perform retrospective studies about epilepsy and idiopathic epilepsy in dogs presented at the Veterinary Neurology Service, University Veterinary Hospital, of Federal University of Santa Maria and use a flexible urethral catheter as an alternative method to measuring intracranial pressure in rabbits with head injury and compare the data with ventriculostomy catheter (conventional method) . In the first paper, 66 records of dogs with presumptive diagnosis of epilepsy were selected. 66.7% of them, were epilepsy idiopatic, 21.2% symptomatic and 12.1% probably symptomatic. The mongrel dogs were the most affected and age-group prevailed was one to 5-year-old. The tonic-clonic seizure was the most observed, the main pre-ictal symptom was to try to catch owner´s attention and compulsive walking in the post-ictal period. In the second paper, 21 dogs with idiopatic epilepsy were included; the median age at onset of seizures was 3.4 years, the median number of seizure before the start of treatment was 25.7 and duration of seizure before treatment was 71 days. The phenobarbital was used as monotherapy with dose from 1.4 to 12 mg kg-1 and the median of serum concentration was 26.41 μg kg-1. There was significant reduction in the frequency of the seizure after start the treatment. 19% of dogs were in remission of seizure. In blood analysis, there was increased serum activities of AP (23,81%) and ALT (14,20%), decreased total protein (42,29%), hypoalbuminemia (9,5%) and it was not increased AST activities. The main secondary lesions were liver disease and hypothyroidism. In the third paper, New Zealand rabbits were randomly distributed into two groups, G1: measuring the ICP with ventriculostomy catheter (n=6) and G2: measuring the ICP with urethral catheter (n=6). Two craniotomy were performed in the right and left parietal region for the implantation of the ventriculostomy catheter and/or flexible urethral catheter and epidural 4F Fogarty arterial embolectomy catheter, respectively. MAP, CPP, HR, RF and RT values were measured before and after craniotomy. The ICP value was mensured after craniotomy, ever five minutes during 40 minutes after the balloon was inflated with 0.3 ml of NaCl 0.9% and more 40 minutes after the balloon was inflated with 0.6 ml. The ICP value increased in both groups, however, the ICP values were lower in the rabbits measured with flexible urethral catheter. The flexible urethral catheter can be used as alternative method to measure ICP values im rabbits with head injury.
Os objetivos deste estudo foram: realizar um estudo retrospectivo sobre epilepsia em cães e outro com epilepsia idiopática atendidos no Serviço de Neurologia Veterinária, do Hospital Veterinário Universitário (HVU) da Universidade Federal de Santa Maria e utilizar a sonda uretral flexível como método alternativo para aferição da pressão intracraniana em coelhos com trauma cranioencefálico induzido pelo cateter de Fogarty 4 Fr (balão epidural) e comparar os dados obtidos com o método convencional de cateter de ventriculostomia. No primeiro artigo, foram selecionados os registros de 66 cães com diagnóstico presuntivo de epilepsia, sendo que 66,7% apresentaram epilepsia primária, 21,2% com sinais clínicos e em 12,1% com prováveis sinais clínicos. Os cães sem raça definida foram os mais acometidos e a faixa etária predominou entre um e cinco anos de idade. A crise epiléptica generalizada tônico-clônica foi a mais observada, a ocorrência maior das crises foram durante a noite; os sinais mais observados foram: a procura pelo tutor no período pré-ictal e o andar compulsivo no período pós-ictal. No segundo artigo, foram incluídos 21 cães com epilepsia idiopática, com média de idade para o início das crises epilépticas de 3,4 anos, apresentando em média 25,7 crises epilépticas antes do início do tratamento e o diagnóstico presuntivo foi determinado em média 71 dias após a primeira crise. Foi utilizada a monoterapia com fenobarbital na maioria dos cães e dose variou entre 1,4 a 12 mg kg-1 e a concentração sérica teve média de 26,41 μg ml-1. Após o início do tratamento houve uma redução significativa das crises epilépticas. 19% dos cães apresentaram remissão das crises epilépticas. Nos exames hematológicos, foi observado aumento da FA em 23,81% e da ALT em 14,29%, diminuição da proteína total em 42,86%, hipoalbuminemia em 9,5% dos cães e não foi observado aumento nos níveis da AST. As principais lesões secundárias observadas foram lesão hepática e hipotireiodismo. No terceiro estudo, coelhos da raça Nova Zelândia foram distribuídos aleatoriamente em dois grupos, denominados G1: mensuração da PIC com cateter de ventriculostomia (n=6) e G2: mensuração com sonda uretral (n=6). Foram realizadas duas craniotomias nas regiões parietal direita e esquerda para a implantação do cateter de ventriculostomia ou da sonda uretral flexível e o balão epidural, respectivamente. Foram mensuradas a PAM, PPC, FC, FR e a TR antes e após a craniotomia. A PIC foi avaliada após a craniotomia e a cada cinco minutos depois do preenchimento do balonete com 0,3 ml de NaCl 0,9% permanecendo por 40 minutos e, com 0,6 ml pelo mesmo período de tempo. A PIC aumentou em ambos os grupos, sendo menores os valores registrados com a sonda uretral flexível. Embora haja a necessidade de outros estudos, a sonda uretral flexível demonstrou ser um método alternativo de mensuração da PIC em coelhos com trauma cranioencefálico.

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Carreiro, Rita Margarida Tavares. "Training in clinical studies coordination in a research centre: Estágio em coordenação de estudos clínicos num centro de investigação." Master's thesis, Universidade de Aveiro, 2011. http://hdl.handle.net/10773/5653.

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É com prazer que agradeço a todos aqueles que tornaram o meu estágio possível. Primeiro, gostaria de agradecer profundamente aos meus orientadores, Professor Joaquim Ferreira e Professor José Carlos Lopes, pela sabedoria que me transmitiram, pela paciência e apoio, e por me terem guiado durante este meu percurso. Gostaria, também, de agradecer aos directores do Mestrado em Biomedicina Farmacêutica, Professor Luís Almeida e Professor Bruno Gago, pela educação, pelas oportunidades e pelo coaching nos últimos dois anos, que me fizeram crescer e tornar em quem sou hoje. Agradeço sinceramente à Ana Noronha e à Maria Finisterra por me terem recebido tão bem, fazendo do meu estágio uma fonte de aprendizagem contínua, por terem estado sempre ao meu lado e apoiado nas decisões mais difíceis. Agradeço ao João Terrível pela preciosa ajuda na formatação deste trabalho. Um obrigado especial aos meus colegas e amigos Catarina Silva, Cátia Magalhães, Igor Marques, Miguel Costa, Tiago Silva e Joana Rocha, pois sem vocês, não teria chegado até onde cheguei. Agradeço, ainda, a todos os meus colegas do Mestrado em Biomedicina Farmacêutica por terem partilhado comigo experiências únicas e sonhos comuns nos últimos dois anos.
Este relatório diz respeito a várias actividades e projectos desenvolvidos num Centro Clínico de Investigação Biomédica – O Grupo de Neurofarmacologia Clínica da Unidade Neurológica de Investigação Clínica do Instituto de Medicina Molecular – realizado no período de 13 de Setembro de 2010 a 13 de Junho de 2011, no âmbito do estágio como coordenadora de estudos clínicos. O estágio insere-se nas actividades curriculares do segundo ano do Mestrado em Biomedicina Farmacêutica da Universidade de Aveiro. Neste relatório, serão abordadas as actividades de coordenação de ensaios clínicos e estudos observacionais, bem como as actividades de investigação desenvolvidas paralelamente ao estágio. No decurso do estágio, pude pôr em prática os conhecimentos adquiridos ao longo do Mestrado e aprofundar o meu conhecimento e interesse na importância dos centros de investigação e do papel dos coordenadores de estudos na correcta realização de estudos clínicos, garantindo, sempre, os direitos, a segurança e o bem-estar dos participantes, assim como, a qualidade dos dados gerados. Este estágio permitiu, também, compreender as dificuldades logísticas que um centro de investigação se depara na condução de ensaios clínicos. Em conclusão, o estágio permitiu-me pôr em prática o conhecimento adquirido na Universidade, funcionando como uma ponte entre o mundo académico e o mundo laboral.

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