Rhinal and hippocampal event-related potentials as epileptogenic zone markers in the pre-surgical evaluation of temporal epilepsies: a systematic review

BACKGROUND

 Cognitive event-related potentials (ERPs) allow for lateralization of the epileptogenic zone (EZ) to estimate the reserve of memory in the contralateral non-epileptogenic hemisphere, and to investigate the prognosis of temporal lobe seizure control in unilateral temporal lobe epilepsy (TLE).

OBJECTIVE

 To define the accuracy of cognitive evoked anterior mesial temporal lobe (AMTL-N400) and P600 potentials in detecting the epileptogenic zone in temporal lobe epilepsy (TLE), and second, to evaluate the possibility of using them as markers of cognitive outcome.

METHODS

 The systematic review using Medline/PubMed, Embase, and Lilacs database was conducted in September 2021. Only articles published in English from 1985 to June 2021 were included. We searched for studies with: (1) depth intracranial electroencephalography (iEEG) recordings analysis of rhinal and hippocampal activity (2) correlations between ERP results obtained in the mesial temporal regions (AMTL-N400 and P600) and the epileptogenic zone.

RESULTS

 Six out of the seven studies included in this review defined the laterality of the epileptogenic zone (EZ) during presurgical investigation using ERPs. One study showed that the contralateral AMTL-N400 predicts seizure control. Another study found correlation between the amplitudes of the right AMTL-N400 and postoperative memory performance.

CONCLUSIONS

 There is evidence that the reduced amplitude of the AMTL-N400 has high accuracy in identifying the epileptogenic zone, as it does in estimating the extent of seizure control and memory impairment in postoperative patients.

MTL-P300 as a marker of the epileptogenic zone and hippocampal functionality in the presurgical evaluation of temporal lobe epilepsy: a systematic review

BACKGROUND

In the past twenty years, there has been an increasing interest among neuroscientists and physicians in mapping the cortical areas involved in the epileptogenic zone (EZ) through event-related potentials (ERPs) that enable the evaluation of the functional preservation of these areas. The present review is an update on publications on this topic.

OBJECTIVE

To investigate the accuracy of the cognitive evoked of the medial temporal lobe P300 (MTL-P300) potential in detecting the EZ in temporal lobe epilepsy (TLE).

METHODS

The systematic review of articles on the PubMed, Embase and Lilacs databases was conducted between February and December 2020. Articles published in English from 1985 to December 2020 were included. Additional studies were identified by searching the references of the selected studies and review articles. The studies were included for the following reasons: in-depth intracranial electroencephalography (iEEG) analysis of hippocampal activity; investigations of patients with TLE; and correlations between regarding the ERP results obtained in the temporal regions (MTL-P300) and the EZ.

RESULTS

In the three studies analyzed, the authors were able to define the laterality of the EZ during the preoperative investigation through the MTL-P300 results. The sensitivity of this method was of ∼ 70% to 80%, and the specificity between 70% and 94.7%. One of the limitations of the present review was the low number of studies.

CONCLUSION

There is evidence that the reduced amplitude of the MTL-P300 has high specificity in identifying the EZ, and this is a good marker for diagnosis in unilateral TLE. The low sensitivity and negative likelihood ratios negative that a normal MTL-P300 response does not exclude the epileptogenicity of the hippocampus.

Healthcare Workers' Knowledge about Chagas Disease: A Systematic Review

Transmission of Chagas disease (CD) has decreased in recent decades, but the disease remains an important problem in endemic areas. There was an increase in the proportion of nonvector transmission, mainly in non-endemic countries. The aim of this study was to gather evidence concerning healthcare professional's knowledge about CD. Searches were performed through Medline/PubMed, Lilacs, Web of Science databases, and Scielo archives, from which 13/97 articles were selected for a qualitative analysis after full-text reading. Most of the studies were from the United States, the oldest published in 2007 and the most recent in 2020, and most of them used surveys as the evaluation method. Each article used different methods, according to the epidemiological status of vector transmission. Two studies targeted specialty-related questions, and two used focus groups as methods for data gathering. Despite differences between the studies, all of them presented knowledge deficits among healthcare workers, regarding at least one of the evaluated aspects. In comparison with population surveys, healthcare professionals demonstrated higher results related to clinical aspects and awareness of the disease's importance. Most of the articles showed a low perception of CD's knowledge by the participants and a low probability of considering CD in the diagnosis of their patients. A previous contact with the subject was pointed by some studies as capable of improving knowledge of the participants. This study emphasizes the importance of continuing education to address deficits of healthcare professionals' knowledge.

Carriage prevalence of Neisseria meningitidis in the Americas in the 21st century: a systematic review

Neisseria meningitidis is a bacterium that colonizes the human nasopharynx and is transmitted by respiratory droplets from asymptomatic or symptomatic carriers. Occasionally, the pathogen invades the mucosa and enters the bloodstream, causing invasive meningococcal disease, a life-threatening infection. While meningococcal colonization is the first step in the development of invasive disease, the risk factors that predict progression from asymptomatic to symptomatic status are not well-known. The present report aimed to describe the prevalence of N. meningitidis carriers throughout the Americas, emphasizing the risk factors associated with carrier status, as well as the most prevalent serogroups in each studied population. We conducted a systematic review by searching for original studies in the MEDLINE/PubMed, Embase, LILACS and SciELO databases, published between 2001 and 2018. Exclusion criteria were articles published in a review format, case studies, case control studies, investigations involving animal models, and techniques or publications that did not address the prevalence of asymptomatic carriers in an American country. A total of 784 articles were identified, of which 23 were selected. The results indicate that the highest prevalence rates are concentrated in Cuba (31.9%), the United States (24%), and Brazil (21.5%), with increased prevalence found among adolescents and young adults, specifically university students and males. The present systematic review was designed to support epidemiological surveillance and prevention measures to aid in the formulation of strategies designed to control the transmission of meningococci in a variety of populations and countries throughout the Americas.

Surveillance for leptospirosis in the Americas, 1996-2005: a review of data from ministries of health

OBJECTIVE

To characterize current leptospirosis reporting practices in the Americas.

METHODS

Information was collected from the official websites of national ministries of health from the Americas region and two international organizations; personal communications; and three international morbidity databases. For all sources other than the morbidity databases, the review was limited to official reports citing clinically suspected and laboratory confirmed leptospirosis cases or deaths during the period 1996-2005.

RESULTS

A total of 73 out of 1 644 reports met the selection criteria and were included in the analysis. Published leptospirosis data were available from half of the countries/sovereign territories (24 out of 48), and 18 of them had mandatory notification policies for leptospirosis. The sum of the median number of leptospirosis cases notified annually by the 24 countries/territories was 4 713.5, but just three countries (Brazil, Costa Rica, and Cuba) accounted for 83.1% (3 9cas20 es) of the notifications. Eight (16.7%) countries reported deaths due to leptospirosis. The sum of the median number of deaths reported annually for the eight countries was 380, but 349 (91.8%) were reported by Brazil.

CONCLUSIONS

Notification practices in the Americas for leptospirosis are limited. Therefore, the numbers of cases and deaths reported are not representative for the region. The lack of leptospirosis data for many countries/territories may reflect weaknesses in certain aspects of national surveillance systems, including mandatory reporting policies, clinical laboratory infrastructure for performing case confirmation, and capacity to collect reported cases. Improved surveillance of leptospirosis cases and deaths in the Americas is needed to allow monitoring of regional epidemiological patterns and to estimate the burden of this important disease.

Intervenções educativas em asma na infância: uma revisão analítica da literatura

Foi realizada uma revisão analítica da literatura visando avaliar as internações educativas para asmáticos de 0 a 18 anos, no período de 1992 a 2002, e identificar características relacionadas com sua eficácia. Foram utilizados diversas bases de dados. Realizou-se também pesquisa manual, entre as referências bibliográficas dos trabalhos selecionados. Foram incluídos 39 trabalhos (27 controlados), tendo sido encontrados resultados variáveis, que, no entanto, permitiram vislumbrar a validade da educação no controle da asma pediátrica. Os parâmetros de avaliação usados pelos estudos foram: variáveis de morbidade, uso de serviços de saúde, qualidade de vida, função pulmonar, conhecimento sobre a doença e habilidades de automanejo. Em 32 estudos (82%), relatou-se benefício sobre uma ou mais variáveis. Entre os 27 estudos controlados, 85,7% produziram melhora nas habilidades de automanejo, 83,3% no conhecimento, 80% nos sintomas diurnos ou noturnos, 71,4% nas visitas médicas não programadas, 66,6% na capacidade para atividades físicas, 54,5% nas hospitalizações, 50% nas visitas à emergência, 50% na função pulmonar, 22,2% no absenteísmo escolar e 20% na qualidade de vida. O número de itens de conteúdo foi a única característica dos programas educativos revisados associada ao nível de eficácia. Técnicas educativas sofisticadas não contribuíram para melhores resultados. A educação de crianças e adolescentes asmáticos produz resultados benéficos, mas são necessários estudos com melhor controle de variáveis confundidoras, para uma avaliação mais precisa da sua eficácia.

Perfil radiológico do candidato ideal à cirurgia redutora de volume pulmonar no enfisema: uma revisão sistemática

INTRODUÇÃO: A cirurgia redutora de volume pulmonar é uma alternativa terapêutica para o enfisema pulmonar avançado. A avaliação radiológica do tipo e distribuição do enfisema parece ser o principal critério de indicação cirúrgica, além da função pulmonar. OBJETIVO: Determinar o nível de evidência científica referente ao padrão radiológico do candidato ideal à cirurgia redutora de volume pulmonar. MÉTODO: Revisão sistemática da literatura entre janeiro de 1994 e janeiro de 2004, utilizando as bases de dados: MEDLINE, EMbase, LILACS, The Cochrane Library e EBM Reviews. RESULTADOS: Foram identificados 208 artigos e 16 deles preenchiam os critérios do estudo. Destes, dois eram randomizados (um multicêntrico, denominado National Emphysema Treatment Trial, envolvendo 1.218 pacientes; e outro que, embora randomizado, com apenas 30 pacientes). Os 14 remanescentes eram estudos observacionais. O National Emphysema Treatment Trial identificou um subgrupo de pacientes de prognóstico favorável, quando submetidos à cirurgia redutora de volume pulmonar, formado por portadores de enfisema pulmonar avançado e heterogêneo, com predomínio nos lobos superiores, na presença de hiperdistensão pulmonar difusa e baixa capacidade para exercícios físicos. O padrão dos resultados dos demais estudos foi consistente na análise individual, apesar de sua heterogeneidade. Benefício cirúrgico, taxas de mortalidade e qualidade de vida também foram mensurados nos estudos observacionais. CONCLUSÃO: O perfil radiológico caracterizado pelo tipo de enfisema, sua heterogeneidade, distribuição e presença de hiperdistensão difusa, ao lado do nível de gravidade, representa o principal fator preditor de bom resultado cirúrgico. Esta recomendação tem o nível de evidência B, pela escassez de trabalhos na literatura.