Background: selective activation and the contempo- rary recording of A delta and C fibers from Yap laser on the scalp is a new neurophysiological assessment, allowing the selective activation of the nociceptive system...Background: selective activation and the contempo- rary recording of A delta and C fibers from Yap laser on the scalp is a new neurophysiological assessment, allowing the selective activation of the nociceptive system. Objectives: to evaluate if the damage of the nociceptive system was related to post herptic nevral-gia (PHN) development in a sample of 26 patients affected by Herpes zooster (HZ);secondly to assess if the impairment of thermal pathway and PHN development were related. Methods: Thirty-two patients were selected for the study, 26 of these were included in the study, whereas 6 were excluded because of cog- nitive impairment. All 26 study patients were sub- mitted to LEP analysis at baseline (T0) and after six months (T1), and the correlation between clinical thermal disease and the development of PHN was monitored. Results: pain duration was evidenced by the presence or absence of an instrumental signal in patients with acute HZ infection. There was total concordance between the absence of LEP signal and pain duration. The concordance between the clinical thermal disease and the pain duration was statisti- cally significant for 43% of the sample. Conclusions: our results suggested a possible role of LEP for PHN prognosis estimation;indeed, most patients affected by acute HZ, with absence of instrumental LEP signal had pain > 6 months. We also noted a significant (43% of cases) clinical concordance between the thermal pathway damage, the absence of instrumental signal and PHN development. Further studies are needed to address this issue.展开更多
Vitamin K antagonists, such as warfarin and phen-procoumon, are the first-line oral anticoagulants for primary and secondary prevention of cerebral embo-lism in patients with atrial fibrillation. Although vitamin K an...Vitamin K antagonists, such as warfarin and phen-procoumon, are the first-line oral anticoagulants for primary and secondary prevention of cerebral embo-lism in patients with atrial fibrillation. Although vitamin K antagonists can significantly decrease the risk of stroke, their use is limited by several important drawbacks, such as a narrow therapeutic window, the risk of intracranial and gastrointestinal bleeding, interactions with a number of drugs and nutrients, and the need for regular laboratory tests for therapy adjustment. Currently, new oral anticoagulants, such as direct thrombin inhibitors (e.g., dabigatran) and direct factor Xa inhibitors (e.g., apixaban, rivaroxaban), are being developed and tested in clinical trials. Dabigatran and rivaroxaban were recently approved for prevention of cerebral embolism in patients with atrial fibrillation. The ad-vantages of dabigatran in comparison to warfarin are a lower rate of major bleedings with dabigatran 110mg bid, a better efficacy with dabigatran 150mg bid, no clinically relevant interactions with other drugs and no need for routine coagulation monitoring. The disadvantages are the absence of antidote and the absence of routine laboratory tests for precise mea-surements of anticoagulant effect of direct thrombin/ factor Xa inhibitors. This review will focus on throm-bin and factor Xa inhibitors, which are new and promising oral anticoagulants for the prevention of cerebral embolism. We will discuss their pharmacol-ogical and clinical properties and provide the most recent updates on their clinical trials.展开更多
The spinal cord is a necessary pathway that transfers the body nociceptive inputs to the brain, and endo-genous opiate peptides (EOP) play an important role in pain modulation. Our previous work has proven that argini...The spinal cord is a necessary pathway that transfers the body nociceptive inputs to the brain, and endo-genous opiate peptides (EOP) play an important role in pain modulation. Our previous work has proven that arginine vasopressin (AVP) antinociception in the caudate nucleus (CdN) relates with the acetylcholine (Ach) system mainly. The communication was de-signed to investigate the interrelations between Ach system and EOP system at the spinal level during pain process. The results showed that: 1) pain stimulation increased L-enkephalin (L-Ek), β-endorphin (β-Ep), dynorphin A1-13(DynA1-13), Ach and choline (Ch, an Ach metabolic product) concentrations in the spinal cord;2) Ach increased L-Ek, β-Ep and DynA1-13 concentrations in the spinal cord;and 3) Atropine (M-receptor inhibitor) or hexahydric gallamine (N-receptor inhibitor) decreased L-Ek, β-Ep and DynA1-13 concentrations in the spinal cord. The data suggested that Ach antinociception was involved in the EOP system at the spinal level.展开更多
Immunocytochemical identification of the different cell types in the pituitary gland of Bagrus bayad was performed using antisera against mammalian (human and rat) and piscine hormones. The adenohypophysis was compose...Immunocytochemical identification of the different cell types in the pituitary gland of Bagrus bayad was performed using antisera against mammalian (human and rat) and piscine hormones. The adenohypophysis was composed of rostral pars distalis (RPD), proximal pars distalis (PPD) and pars intermedia (PI). Prolactin and adrenocorticotrophic cells were located in the rostral pars distalis of the pituitary. Gonadotrophic and growth hormone cells were distributed in the proximal pars distalis, but gonadotrophic cells appear also at the border of the pars intermedia. Somatolactin cells, as well as alpha-melanotrophic cells were located in the pars intermedia of B. bayad pitui-tary. The prolactin (PRL) cells were distributed in the RPD stained with orange G and showed strong immunoreactivity with antiserum to chum salmon. The adrenocorticotrophic (ACTH) cells were lead hema-toxylin-positive (PbH+) and showed strong im- mu-noreactivity with anti-human ACTH;these cells bor-dered the neurohypophysis and grouped in islets be-tween PRL cells in the RPD. Growth hormone (GH) cells were densely distributed with the gonadotrophic (GTH) cells in the PPD. They were orange G positive and reacted with antiserum to chum salmon. GTH cells were located in the central area of the PPD and in the external border of the PI. These cells were Alcyan Blue and PAS positive, and immunostained with anti-chum salmon GTH Iβ and anti-chum salmon GTH IIβ. In addition, antiserum to rat thyrotropin stimulating hormone β (TSHβ) reacted positively to the GTH cells. These results suggest that GTH I, GTH II and TSH are synthesized in the same cells in the pituitary of B. bayad. The PI was composed mainly of PbH+ cells and a PAS+ cell adjacent to the neurohypophysis. The PAS+ cells from the PI bound specifically to anti-chum somatolactin. Anti-alpha- melanin stimulating hormone (MSH) stained only the PbH+ (alpha-melanotrophic) cells of the PI.展开更多
Introduction: Human immunodeficiency virus infec- tion is associated with several different types of peripheral neuropathy: distal predominantly sensory axonal polyneuropathy, like Guillain Barre syndrome. Case presen...Introduction: Human immunodeficiency virus infec- tion is associated with several different types of peripheral neuropathy: distal predominantly sensory axonal polyneuropathy, like Guillain Barre syndrome. Case presentation: A 55-year-old Caucasian woman with Human immunodeficiency virus infection, diag- nosed with Guillain Barre syndrome was studied. Serum and CSF immunoglobulin G and Albumin levels were quantified by using an immunodiffusion technique. She had preceding viral symptoms. The clinical diagnosis of the illness in this patient was pa-resthesias or sensory loss, tendon reflexes. It was also observed cranial nerves abnormalities, acute mo- tor and sensory axonal neuropathy and ophthalmoplegia. The mean CD4 count was 367/mm3, CSF white blood cell 25 wbc/mm3. The serum sodium concentration was significantly low (133 mmol/L). She had a respiratory compromise as a result of their neuropa- thy and developed congestive heart failure and hy- potension and died of a cardiac arrest. The neuro-immunological response described by our patient was a blood/CSF barrier dysfunction without IgG intra-thecal synthesis. Conclusion: There is no doubt that this study is of great importance because will help clinicians increase their knowledge of the immune response in patients with this autoimmune disorder on the basis of this case report, in which, for first time, could be seen the neuroimmunological response through the reibergram in a patient with HIV- asso-ciated Guillain-Barre syndrome.展开更多
The objective was to measure the visual acuity (VA) of children with the diagnosis of hydrocephalus with or without peritoneal-ventricular shunt (PVS). A total of 55 children were included in the study (34 Female), wi...The objective was to measure the visual acuity (VA) of children with the diagnosis of hydrocephalus with or without peritoneal-ventricular shunt (PVS). A total of 55 children were included in the study (34 Female), with an age range of 0 to 291 weeks. The VA was measured by the sweep visual evoked potential technique. Of those with a PVS, in 31 the ventricular valve was inserted before 15 days after the diagnosis whereas in 14 the ventricular valve was inserted after 15 days. The sweep VEP was performed in all children, 95 exams (94%) were abnormal and only 6 were normal. There was a statistical difference in the VA between children with a PVS inserted before 15 days of the diagnosis and children with a PVS after 15 days (p = 0.038) or those without a shunt (p = 0.031). Children with no complications of the PVS had a better VA as compared to those with shunt complications (p < 0.001). In the group of children with complications, again those who had a shunt inserted be-fore 15 days had better VA results in com- parison to those in whom the shunt was inserted after 15 days (p = 0.029). No statistical difference in the VA was found between children without the PVS and with those in which the shunt was inserted after 15 days of the di-agnosis of hydrocephalus (p = 0.699). We conclude that the delayed insertion of the PVS may compromise the visual development of these children.展开更多
Attention Deficit Hyperactivity Disorder (ADHD) is a childhood onset autoregulation disorder characterized by attention deficit, hyperactivity and/or impul- siveness, which results in social and academic functional im...Attention Deficit Hyperactivity Disorder (ADHD) is a childhood onset autoregulation disorder characterized by attention deficit, hyperactivity and/or impul- siveness, which results in social and academic functional impairment. ADHD has a complex aetiology: along with genetic factors, anomalies in several cere-bral districts have been reported. We describe the case of a 9 year old boy with glucose-6-phosphate dehydrogenase deficiency in association with memory, behavioural and attentive disabilities. The patient’s clinical history is characterized by cerebral stroke at 3 years of age during a febrile episode, resulted in slight hemiparesis. Neuroimaging revealed a cystic lesion in the anterior portion of the right lenticular nucleus. Neuropsychological and psychiatric assess- ment evidenced alterations of executive functions. Diagnosis of ADHD secondary to lesion of the basal ganglia was made. We report the patient’s clinical profile in the light of current evidence pointing towards dysfunction of the basal ganglia as a crucial aetiological factor in memory and executive function impairment.展开更多
In this study the mechanical version of the three-disk Tower of London task with changes in the movements was conducted by fifteen elderly participants with concurrent articulatory suppression. Also, this executive ta...In this study the mechanical version of the three-disk Tower of London task with changes in the movements was conducted by fifteen elderly participants with concurrent articulatory suppression. Also, this executive task was conducted without verbal secondary task and the results of these two states were com- pared with each other. From this comparison, got evidences based on inner speech role in more complicated Tower of London tasks, although in general, the results suggest a more outstanding role of inner scribe in spatial planning in this executive task. Then inner speech and inner scribe roles have been described in Tower of London task applying “Baddeley and Logie” working memory model.展开更多
Purpose: To examine the impact of gender and social gender on the level and typology of interictal aggressiveness in patients with temporal lobe epilepsy. Material and Methods: 40 adult patients with Temporal Lobe Epi...Purpose: To examine the impact of gender and social gender on the level and typology of interictal aggressiveness in patients with temporal lobe epilepsy. Material and Methods: 40 adult patients with Temporal Lobe Epilepsy (TLE) and 86 healthy individuals were included. The qualitative and quantitative aggressiveness assess- ment was made with Buss-Durkee Hostility Inventory. The gender role behavior was measured with Bem Sex Role Inventory. Results: Patients with TLE didn’t differ from healthy subjects on the total scores of motor and attitudinal hostility components, but scored higher on subscales “resentment” and “guilt”. The comparative gender analysis showed there were no phenomenological differences in people with TLE. Assault dominated in healthy male subjects, resentment—in healthy female subjects. The prevalence of feminine social gender type was significantly higher in people with TLE in comparison to healthy people (55% vs. 26%, p 0.01). In patients with TLE, the number of masculine traits positively correlated with indirect hostility subscale and attitudinal hostility component scores. In healthy subjects, the masculine traits positively correlated with assault.展开更多
Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or th...Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves;to review outcomes including duration and degree of pain relief;to evaluate procedure’s complication rate and patient’s willingness to repeat the procedure;to compare effectiveness of the most recent RF ablation to patient’s first RF ablation. Methods: This is a single-center retrospective observational study of 23 patients with recurrent cervicogenic headaches and/or occipital neuralgia treated with repeated RF ablation of the C2 dorsal root ganglion and/or third occipital nerves. All patients receiving treatment from January 2010 to July 2014 are included in this single site retrospective study. This is an IRB approved medical chart review study. Results: 22 of 23 patients underwent follow-up. An average of 86.5% of participants reported pain relief on average of 25.4 weeks at time of follow-up. 41% reported side effects including suboccipital hyperesthesia and/or ear discomfort, 95% reported willingness to repeat the procedure again if severe symptoms recurred, 59% of patients reported the most recent RF ablation had the same results as the first, 32% reported the most recent RF was the most effective, and 9% reported that the first RF was the most effective. Conclusion: Repeated RF ablation is a feasible option for recurrent cervicogenic headaches and/or occipital neuralgia. Effectiveness of repeat intervention is the same or better than the first ablation. Though there was a higher likelihood of side effects including suboccipital neuralgia and/or ear discomfort on repeat treatment, the side effects were generally well tolerated.展开更多
Parkinson’s disease (PD) is the second most common severe neurodegenerative disorder. It is characterized by progressive degeneration of dopaminergic neurons in the substantia nigra pars compacta. Unfortunately, PD r...Parkinson’s disease (PD) is the second most common severe neurodegenerative disorder. It is characterized by progressive degeneration of dopaminergic neurons in the substantia nigra pars compacta. Unfortunately, PD remains incurable. Therapy based on regulatory peptides, particularly neuroprotective peptides, which can sustain or activate neuron plasticity to enable their survival and function in difficult environments and after violated homeostasis, is a promising approach to cure PD. Some studies show that the synthetic analogs of natural peptides may be used as an etiological or at least a complementary therapy in PD. Therefore, in the present pilot study, we investigated the effects of the synthetic peptides Semax and dopamine neuron stimulating peptide (DNSP-5), and a new synthetic Semax-DNSP-5 hybrid peptide (SD) on the functioning of brain neurons. An analysis of the levels of dopamine (DA), noradrenaline (NA), 5-hydroxytriptamine (5-HT), an expression analysis of Gdnf and Gdnf receptor genes Gfra1, Gfra2, Gfra3, Gfra4, and Gfral in various regions of the brain of rats with 6-OHDA-induced PD-like parkinsonism, and a study of the motor activity of the rats in an “open field” test showed that DNSP-5 and SD elevated the level of DA in the nonlesioned striatum. DNSP-5 also increased the expression of Gfra1 and Gfra2 in the nonlesioned striatum and lesioned substantia nigra (SN) which suggested that DNSP-5 had compensatory and neuroprotective properties. SD demonstrated similar, albeit less pronounced effects to DNSP-5 on DA metabolism and gene expression. Of the peptides studied, only SD tended to increase the horizontal and vertical activity of rats. In conclusion, these findings suggest that DNSP-5 and SD have potential neuroprotective properties and may stimulate the surviving DA neurons.展开更多
Background: Over the past decade, there has been recognition of the importance of the human microbiome. Beyond improved microbial cataloguing through high- throughput genetic sequencing, we have learned that human bei...Background: Over the past decade, there has been recognition of the importance of the human microbiome. Beyond improved microbial cataloguing through high- throughput genetic sequencing, we have learned that human beings are superorganisms integrating the identity, function and immunity of resident bacterial, while prepared throughout own innate and adaptive immune systems, to deal with invading organisms. Hypothesis: In keeping with the dynamic relation of infection, immunity and inflammation contained in I-Cubed, illness arises when protective immunity becomes the source of autoimmunity, conditioned by environmental and genetic factors. Results: This paradigm explains the etiopathogenesis of diverse medical (type 1 diabetes, spondyloarthropathy), neurologic (Lyme neuroborreliosis), and neuropsychiatric disorders (PANDAS, and autism spectrum disorders). Conclusion: Successful treatments employing immune-modulatory therapy may be employed. Public health officials will be called upon to guide the public’s understanding and mitigate the risk of disorders that result from the interplay of the human microbiome and I-Cubed.展开更多
Current research on the various forms of autoscopic phenomena addresses the clinical and neurological correlates of out-of-body experiences, autoscopic hallucinations, and heautoscopy. Yet most of this research is bas...Current research on the various forms of autoscopic phenomena addresses the clinical and neurological correlates of out-of-body experiences, autoscopic hallucinations, and heautoscopy. Yet most of this research is based on functional magnetic resonance imaging results and focuses predominantly on abnormal cortical activity. Previously we proposed that visual consciousness resulted from the dynamic retinogeniculo-cortical oscillations, such that the photoreceptors dynamically integrated with visual and other vision-associated cortices, and was theorized to be mapped out by photoreceptor discs and rich retinal networks which synchronized with the retinotopic mapping and the associated cortex. The feedback from neural input that is received from the thalamus and cortex via retinogeniculo-cortical oscillations and sent to the retina is multifold higher than feed-forward input to the cortex. This can effectively translate into out-of-body experiences projected onto the screen formed by the retina as it is perceived via feedback and feed-forward oscillations from the reticular thalamic nucleus, or “internal searchlight”. This article explores the role of the reticular thalamic nucleus and the retinogeniculo-cortical oscillations as pivotal internal components in vision and various autoscopic phenomena.展开更多
Introduction: Although anemia is not regarded as an usual vascular risk factor for stroke, it is one of the potential mechanism by which the brain does not receive adequate oxygenation. Moreover, the relationship betw...Introduction: Although anemia is not regarded as an usual vascular risk factor for stroke, it is one of the potential mechanism by which the brain does not receive adequate oxygenation. Moreover, the relationship between drop of hemoglobin and acute focal neurological deficits is not clear. We report two patients with cerebral infarction due to acute anemia. Case Reports: Case 1 was a 73-year-old man who complained an episode of loss of consciousness followed by right hemiparesis and dysarthria after few hours. The day after admission he presented melena caused by a duodenal ulcer bleeding. The hemoglobin dropped from 11.3 g/dl to5.6 g/dl in 24 hours. Areas of acute infarctions were evident at diffusion-weighted imaging (DWI) of the brain. Case 2 was a 77-year-old man with a transient episode of aphasia, right lower limb paresis and mental confusion twelve hours after an intervention of PTA and stenting of the left internal carotid artery. Hemoglobin was11.8 g/dl before intervention and9 g/dl 48 hours later. DWI showed bilateral and widespread acute infarcts. Conclusion: Anemia has to be considered as a potential factor in determining or worsening cerebral infarction, especially in patients with carotid or intracranial stenosis, high cerebrovascular lesions load or insufficient collateral supply. Acute or severe anemia may negatively impact the cerebral blood flow and decrease oxygen-carrying capacity, promote rapid deterioration of ischemic penumbra. Brain DWI and treatment of the underlying etiology of acute anemia are crucial in early identification and recovery of cerebral infarctions.展开更多
Cholinergic dysfunction is common to Alzheimer’s dementia and Schizophrenia. The objective of this study is to undertake a systematic review and meta-analysis of the literature on the cognitive and clinical effects o...Cholinergic dysfunction is common to Alzheimer’s dementia and Schizophrenia. The objective of this study is to undertake a systematic review and meta-analysis of the literature on the cognitive and clinical effects of cholinesterase inhibitors administered to patients with schizophrenia and co-morbid Alzheimer’s disease dementia. A literature search of the MEDLINE, CINAHL, PubMed, PsycINFO, EMBASE, AMED, BNI, HMIC and Health Business Elite databases has been performed (up to January 2013) to investigate the use of cholinesterase inhibitors in patients with schizophrenia and dementia. The terms “schizophrenia”, “dementia”, “rivastigmine”, “donepezil”, “galantamine” and “cognitive deficit” have been searched, with a restriction for English language. Five published studies including 1 RCT have been included for the qualitative review. Treatments include Donepezil 5 mg and 10 mg as well as Rivastigmine 9 mg. The numbers of participants vary from 2 incase report to20 inthe RCT. Only 1 study qualifies for meta-analysis. There is a very limited evidence on the efficacy and safety of using acetylcholinesterase inhibitors in the management of dementia co-morbid with schizophrenia. The only randomised controlled study shows lack of evidence in terms of efficacy in using cholinesterase inhibitors in the management of dementia with schizophrenia. Future research projects will have to look at an adequate sample size to explore treatment on various cognitive and noncognitive domains and the sample should be selected by using definitive and internationally acceptable diagnostic criteria.展开更多
Cats placed in the situation of a choosing between a high-value time-delayed and a low-value immediate food rewards elected to wait for the preferred reward or to obtain the worse reward quickly. On the basis of the s...Cats placed in the situation of a choosing between a high-value time-delayed and a low-value immediate food rewards elected to wait for the preferred reward or to obtain the worse reward quickly. On the basis of the selected behavior strategy the cats were classified into three groups - self-control ones, choosing predominantly a delayed high-value food reward, impulsive, choosing predominantly an immediate low-value food reward, and ambivalent - with mixed types of reactions. The correlated firing between simultaneously recorded neurons in prefrontal cortex (PFC), n. accumbens (NAcb) and dorsomedial striatum (DMStr) during choice behavior task was studied. It was revealed that a total number of NAcb functional neuron interactions at cats showing self-control reactions exceeded that of observed at ambivalent and impulsive cats. The number of PFC and DMStr functional correlated firing at impulsive and ambivalent cats was more significant than at cats capable to self-control. Observed correlated firing between PFC and NAcb neurons (fronto-accumbal interactions) progressively increased with the shift of behavior to impulsiveness and decreased with self-control behavior. Our results demonstrate that performance of impulsive and self-control behavior alters the correlation structure of neural firing in PFC, NAcb, DMStr and suggest the key role of local PFC, NAcb, DMStr networks in realization of choice behavior.展开更多
Introduction: Stroke is the second major cause of mortality worldwide and in several cases, and it may lead to disability. Factor V Leiden is a common genetic thrombophilia, which causes activated protein C (APC) resi...Introduction: Stroke is the second major cause of mortality worldwide and in several cases, and it may lead to disability. Factor V Leiden is a common genetic thrombophilia, which causes activated protein C (APC) resistance. Hyperhomocysteinemia and factor V Leiden deficiency, two independent coagulopathy factors, can lead to venous and arterial infarctions in multiple small and large arteries and veins anywhere in the body. Case Report: Here, we report a unique case in which both hyperhomocysteinemia and factor V Leiden deficiency are documented together with MTHFR (C677T) (Methylene Tetra Hydro Folate Reductase) gene polymorphism and activated protein C resistance respectively. Conclusion: More interestingly, the mode of presentation in this case highly resembled that of progressive multiple sclerosis;all signs and symptoms slowly progressed without any systemic signs at first few years. Further studies needed to assess current outcomes.展开更多
Neuropeptide receptors of the brain and spinal cord are parts of the pain circuits targeted by analgesic drugs. Some of these receptors have been found in the central nervous system as well as in intracranial vascular...Neuropeptide receptors of the brain and spinal cord are parts of the pain circuits targeted by analgesic drugs. Some of these receptors have been found in the central nervous system as well as in intracranial vascular structures and achieved revival of attention because of their role in acute and chronic pain syndromes. A number of them are of high clinical relevance for e.g. migraine. Others participate in symptoms of rare diseases like amyotrophic lateral sclerosis. Here we will focus on five of the neuropeptide receptors and their non-peptide ligands potentially or already successfully used as PET probes. Opioid receptors and neurotensin receptors are known to mediate analgesic actions. Bradykinin and calcitonin gene-related peptide (CGRP) receptors are known to be involved in the regulation of vascular tone and inflammatory responses, and neurokinin receptors play a role in the occurrence of pain perception in a rather indirect manner. Most experiences as PET tracers have been gathered with opioid receptor ligands and neurokinin receptor ligands. The most innovative fields revealed by the studies summarized in this report are the ligands of κ opioid receptors and CGRP receptors for which a first PET tracer was presented recently.展开更多
Objective: This study aimed to investigate the circadian typology of medical students at public universities from one of the northeastern states in Brazil, active in the morning and afternoon shifts, checking the comp...Objective: This study aimed to investigate the circadian typology of medical students at public universities from one of the northeastern states in Brazil, active in the morning and afternoon shifts, checking the compatibility between their study time, productivity, income and chronotype. Methods: To obtain the results, the assessment of the chronotype in 342 medical students of both sexes was considered. Each participant was submitted to the questionnaire developed by Horne and Ostberg, adapted by Cardinali, Colomberk and Rey. It’s composed of 9 questions, providing the general ranking of each individual. Based upon scored, the chronotypes were classified. Results: The sample was composed of 49.12% (168) male and 50.87% (174) female subjects, a similar gender distribution of enrolled students during data collection time. By applying the questionnaire, the prevalent rating among the medical students as moderately morning (29.82%) and intermediate (43.85%) has been relevant. The academic performance assessment in two morning-intermediate groups (8.16) had no significant distance from others considered afternoon active (8.20). Conclusion: The health sciences student, especially Medicine, faces constant adaptation of scheduling, in the attempt of fulfilling the requirements throughout the course, causing chronogram desynchronization effects and forced readaptation to each different school semester.展开更多
Objective: To determine the role of CD4+ and CD8+ T lymphocytes in the onset of stroke in people living with HIV. Methodology: This was a descriptive, cross-sectional study from January to July 2019, in the neurology ...Objective: To determine the role of CD4+ and CD8+ T lymphocytes in the onset of stroke in people living with HIV. Methodology: This was a descriptive, cross-sectional study from January to July 2019, in the neurology department of loandjili general hospital, including any patient hospitalized for a first episode of stroke confirmed by brain scan. The study variables were: age, sex, CRP value, serum T cell CD4+, CD8+. The statistical analysis was carried out using the EPI info 7 software. Results: Twenty stroke patients were included. The relative frequency of HIV was 20%. The risk factors were potentiated by immunosuppression of CD4+ T cells. Sixty percent (60%) of the patients had a CD4+ count < 200/mm<sup>3</sup> and the mean CD4+ count was ±191/mm<sup>3</sup>. Stroke was the predominant mechanism of injury with a frequency of 70%, the only injury mechanism of stroke in patients with CD8+ T cell count > 800/mm<sup>3</sup> (p = 0.04). Conclusion: Risk factors are potentiated by TCD4+ lymphocyte immunosupression, also CD8+ lymphocytes of immune system activation marker are a cardiovascular risk factor for living people with HIV.展开更多
文摘Background: selective activation and the contempo- rary recording of A delta and C fibers from Yap laser on the scalp is a new neurophysiological assessment, allowing the selective activation of the nociceptive system. Objectives: to evaluate if the damage of the nociceptive system was related to post herptic nevral-gia (PHN) development in a sample of 26 patients affected by Herpes zooster (HZ);secondly to assess if the impairment of thermal pathway and PHN development were related. Methods: Thirty-two patients were selected for the study, 26 of these were included in the study, whereas 6 were excluded because of cog- nitive impairment. All 26 study patients were sub- mitted to LEP analysis at baseline (T0) and after six months (T1), and the correlation between clinical thermal disease and the development of PHN was monitored. Results: pain duration was evidenced by the presence or absence of an instrumental signal in patients with acute HZ infection. There was total concordance between the absence of LEP signal and pain duration. The concordance between the clinical thermal disease and the pain duration was statisti- cally significant for 43% of the sample. Conclusions: our results suggested a possible role of LEP for PHN prognosis estimation;indeed, most patients affected by acute HZ, with absence of instrumental LEP signal had pain > 6 months. We also noted a significant (43% of cases) clinical concordance between the thermal pathway damage, the absence of instrumental signal and PHN development. Further studies are needed to address this issue.
文摘Vitamin K antagonists, such as warfarin and phen-procoumon, are the first-line oral anticoagulants for primary and secondary prevention of cerebral embo-lism in patients with atrial fibrillation. Although vitamin K antagonists can significantly decrease the risk of stroke, their use is limited by several important drawbacks, such as a narrow therapeutic window, the risk of intracranial and gastrointestinal bleeding, interactions with a number of drugs and nutrients, and the need for regular laboratory tests for therapy adjustment. Currently, new oral anticoagulants, such as direct thrombin inhibitors (e.g., dabigatran) and direct factor Xa inhibitors (e.g., apixaban, rivaroxaban), are being developed and tested in clinical trials. Dabigatran and rivaroxaban were recently approved for prevention of cerebral embolism in patients with atrial fibrillation. The ad-vantages of dabigatran in comparison to warfarin are a lower rate of major bleedings with dabigatran 110mg bid, a better efficacy with dabigatran 150mg bid, no clinically relevant interactions with other drugs and no need for routine coagulation monitoring. The disadvantages are the absence of antidote and the absence of routine laboratory tests for precise mea-surements of anticoagulant effect of direct thrombin/ factor Xa inhibitors. This review will focus on throm-bin and factor Xa inhibitors, which are new and promising oral anticoagulants for the prevention of cerebral embolism. We will discuss their pharmacol-ogical and clinical properties and provide the most recent updates on their clinical trials.
文摘The spinal cord is a necessary pathway that transfers the body nociceptive inputs to the brain, and endo-genous opiate peptides (EOP) play an important role in pain modulation. Our previous work has proven that arginine vasopressin (AVP) antinociception in the caudate nucleus (CdN) relates with the acetylcholine (Ach) system mainly. The communication was de-signed to investigate the interrelations between Ach system and EOP system at the spinal level during pain process. The results showed that: 1) pain stimulation increased L-enkephalin (L-Ek), β-endorphin (β-Ep), dynorphin A1-13(DynA1-13), Ach and choline (Ch, an Ach metabolic product) concentrations in the spinal cord;2) Ach increased L-Ek, β-Ep and DynA1-13 concentrations in the spinal cord;and 3) Atropine (M-receptor inhibitor) or hexahydric gallamine (N-receptor inhibitor) decreased L-Ek, β-Ep and DynA1-13 concentrations in the spinal cord. The data suggested that Ach antinociception was involved in the EOP system at the spinal level.
文摘Immunocytochemical identification of the different cell types in the pituitary gland of Bagrus bayad was performed using antisera against mammalian (human and rat) and piscine hormones. The adenohypophysis was composed of rostral pars distalis (RPD), proximal pars distalis (PPD) and pars intermedia (PI). Prolactin and adrenocorticotrophic cells were located in the rostral pars distalis of the pituitary. Gonadotrophic and growth hormone cells were distributed in the proximal pars distalis, but gonadotrophic cells appear also at the border of the pars intermedia. Somatolactin cells, as well as alpha-melanotrophic cells were located in the pars intermedia of B. bayad pitui-tary. The prolactin (PRL) cells were distributed in the RPD stained with orange G and showed strong immunoreactivity with antiserum to chum salmon. The adrenocorticotrophic (ACTH) cells were lead hema-toxylin-positive (PbH+) and showed strong im- mu-noreactivity with anti-human ACTH;these cells bor-dered the neurohypophysis and grouped in islets be-tween PRL cells in the RPD. Growth hormone (GH) cells were densely distributed with the gonadotrophic (GTH) cells in the PPD. They were orange G positive and reacted with antiserum to chum salmon. GTH cells were located in the central area of the PPD and in the external border of the PI. These cells were Alcyan Blue and PAS positive, and immunostained with anti-chum salmon GTH Iβ and anti-chum salmon GTH IIβ. In addition, antiserum to rat thyrotropin stimulating hormone β (TSHβ) reacted positively to the GTH cells. These results suggest that GTH I, GTH II and TSH are synthesized in the same cells in the pituitary of B. bayad. The PI was composed mainly of PbH+ cells and a PAS+ cell adjacent to the neurohypophysis. The PAS+ cells from the PI bound specifically to anti-chum somatolactin. Anti-alpha- melanin stimulating hormone (MSH) stained only the PbH+ (alpha-melanotrophic) cells of the PI.
文摘Introduction: Human immunodeficiency virus infec- tion is associated with several different types of peripheral neuropathy: distal predominantly sensory axonal polyneuropathy, like Guillain Barre syndrome. Case presentation: A 55-year-old Caucasian woman with Human immunodeficiency virus infection, diag- nosed with Guillain Barre syndrome was studied. Serum and CSF immunoglobulin G and Albumin levels were quantified by using an immunodiffusion technique. She had preceding viral symptoms. The clinical diagnosis of the illness in this patient was pa-resthesias or sensory loss, tendon reflexes. It was also observed cranial nerves abnormalities, acute mo- tor and sensory axonal neuropathy and ophthalmoplegia. The mean CD4 count was 367/mm3, CSF white blood cell 25 wbc/mm3. The serum sodium concentration was significantly low (133 mmol/L). She had a respiratory compromise as a result of their neuropa- thy and developed congestive heart failure and hy- potension and died of a cardiac arrest. The neuro-immunological response described by our patient was a blood/CSF barrier dysfunction without IgG intra-thecal synthesis. Conclusion: There is no doubt that this study is of great importance because will help clinicians increase their knowledge of the immune response in patients with this autoimmune disorder on the basis of this case report, in which, for first time, could be seen the neuroimmunological response through the reibergram in a patient with HIV- asso-ciated Guillain-Barre syndrome.
基金supported by grants to MFC from CNPq 401153/2009-6 Ciencias Humanas.MFC is CNPq research fellow.
文摘The objective was to measure the visual acuity (VA) of children with the diagnosis of hydrocephalus with or without peritoneal-ventricular shunt (PVS). A total of 55 children were included in the study (34 Female), with an age range of 0 to 291 weeks. The VA was measured by the sweep visual evoked potential technique. Of those with a PVS, in 31 the ventricular valve was inserted before 15 days after the diagnosis whereas in 14 the ventricular valve was inserted after 15 days. The sweep VEP was performed in all children, 95 exams (94%) were abnormal and only 6 were normal. There was a statistical difference in the VA between children with a PVS inserted before 15 days of the diagnosis and children with a PVS after 15 days (p = 0.038) or those without a shunt (p = 0.031). Children with no complications of the PVS had a better VA as compared to those with shunt complications (p < 0.001). In the group of children with complications, again those who had a shunt inserted be-fore 15 days had better VA results in com- parison to those in whom the shunt was inserted after 15 days (p = 0.029). No statistical difference in the VA was found between children without the PVS and with those in which the shunt was inserted after 15 days of the di-agnosis of hydrocephalus (p = 0.699). We conclude that the delayed insertion of the PVS may compromise the visual development of these children.
文摘Attention Deficit Hyperactivity Disorder (ADHD) is a childhood onset autoregulation disorder characterized by attention deficit, hyperactivity and/or impul- siveness, which results in social and academic functional impairment. ADHD has a complex aetiology: along with genetic factors, anomalies in several cere-bral districts have been reported. We describe the case of a 9 year old boy with glucose-6-phosphate dehydrogenase deficiency in association with memory, behavioural and attentive disabilities. The patient’s clinical history is characterized by cerebral stroke at 3 years of age during a febrile episode, resulted in slight hemiparesis. Neuroimaging revealed a cystic lesion in the anterior portion of the right lenticular nucleus. Neuropsychological and psychiatric assess- ment evidenced alterations of executive functions. Diagnosis of ADHD secondary to lesion of the basal ganglia was made. We report the patient’s clinical profile in the light of current evidence pointing towards dysfunction of the basal ganglia as a crucial aetiological factor in memory and executive function impairment.
文摘In this study the mechanical version of the three-disk Tower of London task with changes in the movements was conducted by fifteen elderly participants with concurrent articulatory suppression. Also, this executive task was conducted without verbal secondary task and the results of these two states were com- pared with each other. From this comparison, got evidences based on inner speech role in more complicated Tower of London tasks, although in general, the results suggest a more outstanding role of inner scribe in spatial planning in this executive task. Then inner speech and inner scribe roles have been described in Tower of London task applying “Baddeley and Logie” working memory model.
文摘Purpose: To examine the impact of gender and social gender on the level and typology of interictal aggressiveness in patients with temporal lobe epilepsy. Material and Methods: 40 adult patients with Temporal Lobe Epilepsy (TLE) and 86 healthy individuals were included. The qualitative and quantitative aggressiveness assess- ment was made with Buss-Durkee Hostility Inventory. The gender role behavior was measured with Bem Sex Role Inventory. Results: Patients with TLE didn’t differ from healthy subjects on the total scores of motor and attitudinal hostility components, but scored higher on subscales “resentment” and “guilt”. The comparative gender analysis showed there were no phenomenological differences in people with TLE. Assault dominated in healthy male subjects, resentment—in healthy female subjects. The prevalence of feminine social gender type was significantly higher in people with TLE in comparison to healthy people (55% vs. 26%, p 0.01). In patients with TLE, the number of masculine traits positively correlated with indirect hostility subscale and attitudinal hostility component scores. In healthy subjects, the masculine traits positively correlated with assault.
文摘Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves;to review outcomes including duration and degree of pain relief;to evaluate procedure’s complication rate and patient’s willingness to repeat the procedure;to compare effectiveness of the most recent RF ablation to patient’s first RF ablation. Methods: This is a single-center retrospective observational study of 23 patients with recurrent cervicogenic headaches and/or occipital neuralgia treated with repeated RF ablation of the C2 dorsal root ganglion and/or third occipital nerves. All patients receiving treatment from January 2010 to July 2014 are included in this single site retrospective study. This is an IRB approved medical chart review study. Results: 22 of 23 patients underwent follow-up. An average of 86.5% of participants reported pain relief on average of 25.4 weeks at time of follow-up. 41% reported side effects including suboccipital hyperesthesia and/or ear discomfort, 95% reported willingness to repeat the procedure again if severe symptoms recurred, 59% of patients reported the most recent RF ablation had the same results as the first, 32% reported the most recent RF was the most effective, and 9% reported that the first RF was the most effective. Conclusion: Repeated RF ablation is a feasible option for recurrent cervicogenic headaches and/or occipital neuralgia. Effectiveness of repeat intervention is the same or better than the first ablation. Though there was a higher likelihood of side effects including suboccipital neuralgia and/or ear discomfort on repeat treatment, the side effects were generally well tolerated.
文摘Parkinson’s disease (PD) is the second most common severe neurodegenerative disorder. It is characterized by progressive degeneration of dopaminergic neurons in the substantia nigra pars compacta. Unfortunately, PD remains incurable. Therapy based on regulatory peptides, particularly neuroprotective peptides, which can sustain or activate neuron plasticity to enable their survival and function in difficult environments and after violated homeostasis, is a promising approach to cure PD. Some studies show that the synthetic analogs of natural peptides may be used as an etiological or at least a complementary therapy in PD. Therefore, in the present pilot study, we investigated the effects of the synthetic peptides Semax and dopamine neuron stimulating peptide (DNSP-5), and a new synthetic Semax-DNSP-5 hybrid peptide (SD) on the functioning of brain neurons. An analysis of the levels of dopamine (DA), noradrenaline (NA), 5-hydroxytriptamine (5-HT), an expression analysis of Gdnf and Gdnf receptor genes Gfra1, Gfra2, Gfra3, Gfra4, and Gfral in various regions of the brain of rats with 6-OHDA-induced PD-like parkinsonism, and a study of the motor activity of the rats in an “open field” test showed that DNSP-5 and SD elevated the level of DA in the nonlesioned striatum. DNSP-5 also increased the expression of Gfra1 and Gfra2 in the nonlesioned striatum and lesioned substantia nigra (SN) which suggested that DNSP-5 had compensatory and neuroprotective properties. SD demonstrated similar, albeit less pronounced effects to DNSP-5 on DA metabolism and gene expression. Of the peptides studied, only SD tended to increase the horizontal and vertical activity of rats. In conclusion, these findings suggest that DNSP-5 and SD have potential neuroprotective properties and may stimulate the surviving DA neurons.
文摘Background: Over the past decade, there has been recognition of the importance of the human microbiome. Beyond improved microbial cataloguing through high- throughput genetic sequencing, we have learned that human beings are superorganisms integrating the identity, function and immunity of resident bacterial, while prepared throughout own innate and adaptive immune systems, to deal with invading organisms. Hypothesis: In keeping with the dynamic relation of infection, immunity and inflammation contained in I-Cubed, illness arises when protective immunity becomes the source of autoimmunity, conditioned by environmental and genetic factors. Results: This paradigm explains the etiopathogenesis of diverse medical (type 1 diabetes, spondyloarthropathy), neurologic (Lyme neuroborreliosis), and neuropsychiatric disorders (PANDAS, and autism spectrum disorders). Conclusion: Successful treatments employing immune-modulatory therapy may be employed. Public health officials will be called upon to guide the public’s understanding and mitigate the risk of disorders that result from the interplay of the human microbiome and I-Cubed.
文摘Current research on the various forms of autoscopic phenomena addresses the clinical and neurological correlates of out-of-body experiences, autoscopic hallucinations, and heautoscopy. Yet most of this research is based on functional magnetic resonance imaging results and focuses predominantly on abnormal cortical activity. Previously we proposed that visual consciousness resulted from the dynamic retinogeniculo-cortical oscillations, such that the photoreceptors dynamically integrated with visual and other vision-associated cortices, and was theorized to be mapped out by photoreceptor discs and rich retinal networks which synchronized with the retinotopic mapping and the associated cortex. The feedback from neural input that is received from the thalamus and cortex via retinogeniculo-cortical oscillations and sent to the retina is multifold higher than feed-forward input to the cortex. This can effectively translate into out-of-body experiences projected onto the screen formed by the retina as it is perceived via feedback and feed-forward oscillations from the reticular thalamic nucleus, or “internal searchlight”. This article explores the role of the reticular thalamic nucleus and the retinogeniculo-cortical oscillations as pivotal internal components in vision and various autoscopic phenomena.
文摘Introduction: Although anemia is not regarded as an usual vascular risk factor for stroke, it is one of the potential mechanism by which the brain does not receive adequate oxygenation. Moreover, the relationship between drop of hemoglobin and acute focal neurological deficits is not clear. We report two patients with cerebral infarction due to acute anemia. Case Reports: Case 1 was a 73-year-old man who complained an episode of loss of consciousness followed by right hemiparesis and dysarthria after few hours. The day after admission he presented melena caused by a duodenal ulcer bleeding. The hemoglobin dropped from 11.3 g/dl to5.6 g/dl in 24 hours. Areas of acute infarctions were evident at diffusion-weighted imaging (DWI) of the brain. Case 2 was a 77-year-old man with a transient episode of aphasia, right lower limb paresis and mental confusion twelve hours after an intervention of PTA and stenting of the left internal carotid artery. Hemoglobin was11.8 g/dl before intervention and9 g/dl 48 hours later. DWI showed bilateral and widespread acute infarcts. Conclusion: Anemia has to be considered as a potential factor in determining or worsening cerebral infarction, especially in patients with carotid or intracranial stenosis, high cerebrovascular lesions load or insufficient collateral supply. Acute or severe anemia may negatively impact the cerebral blood flow and decrease oxygen-carrying capacity, promote rapid deterioration of ischemic penumbra. Brain DWI and treatment of the underlying etiology of acute anemia are crucial in early identification and recovery of cerebral infarctions.
文摘Cholinergic dysfunction is common to Alzheimer’s dementia and Schizophrenia. The objective of this study is to undertake a systematic review and meta-analysis of the literature on the cognitive and clinical effects of cholinesterase inhibitors administered to patients with schizophrenia and co-morbid Alzheimer’s disease dementia. A literature search of the MEDLINE, CINAHL, PubMed, PsycINFO, EMBASE, AMED, BNI, HMIC and Health Business Elite databases has been performed (up to January 2013) to investigate the use of cholinesterase inhibitors in patients with schizophrenia and dementia. The terms “schizophrenia”, “dementia”, “rivastigmine”, “donepezil”, “galantamine” and “cognitive deficit” have been searched, with a restriction for English language. Five published studies including 1 RCT have been included for the qualitative review. Treatments include Donepezil 5 mg and 10 mg as well as Rivastigmine 9 mg. The numbers of participants vary from 2 incase report to20 inthe RCT. Only 1 study qualifies for meta-analysis. There is a very limited evidence on the efficacy and safety of using acetylcholinesterase inhibitors in the management of dementia co-morbid with schizophrenia. The only randomised controlled study shows lack of evidence in terms of efficacy in using cholinesterase inhibitors in the management of dementia with schizophrenia. Future research projects will have to look at an adequate sample size to explore treatment on various cognitive and noncognitive domains and the sample should be selected by using definitive and internationally acceptable diagnostic criteria.
文摘Cats placed in the situation of a choosing between a high-value time-delayed and a low-value immediate food rewards elected to wait for the preferred reward or to obtain the worse reward quickly. On the basis of the selected behavior strategy the cats were classified into three groups - self-control ones, choosing predominantly a delayed high-value food reward, impulsive, choosing predominantly an immediate low-value food reward, and ambivalent - with mixed types of reactions. The correlated firing between simultaneously recorded neurons in prefrontal cortex (PFC), n. accumbens (NAcb) and dorsomedial striatum (DMStr) during choice behavior task was studied. It was revealed that a total number of NAcb functional neuron interactions at cats showing self-control reactions exceeded that of observed at ambivalent and impulsive cats. The number of PFC and DMStr functional correlated firing at impulsive and ambivalent cats was more significant than at cats capable to self-control. Observed correlated firing between PFC and NAcb neurons (fronto-accumbal interactions) progressively increased with the shift of behavior to impulsiveness and decreased with self-control behavior. Our results demonstrate that performance of impulsive and self-control behavior alters the correlation structure of neural firing in PFC, NAcb, DMStr and suggest the key role of local PFC, NAcb, DMStr networks in realization of choice behavior.
文摘Introduction: Stroke is the second major cause of mortality worldwide and in several cases, and it may lead to disability. Factor V Leiden is a common genetic thrombophilia, which causes activated protein C (APC) resistance. Hyperhomocysteinemia and factor V Leiden deficiency, two independent coagulopathy factors, can lead to venous and arterial infarctions in multiple small and large arteries and veins anywhere in the body. Case Report: Here, we report a unique case in which both hyperhomocysteinemia and factor V Leiden deficiency are documented together with MTHFR (C677T) (Methylene Tetra Hydro Folate Reductase) gene polymorphism and activated protein C resistance respectively. Conclusion: More interestingly, the mode of presentation in this case highly resembled that of progressive multiple sclerosis;all signs and symptoms slowly progressed without any systemic signs at first few years. Further studies needed to assess current outcomes.
文摘Neuropeptide receptors of the brain and spinal cord are parts of the pain circuits targeted by analgesic drugs. Some of these receptors have been found in the central nervous system as well as in intracranial vascular structures and achieved revival of attention because of their role in acute and chronic pain syndromes. A number of them are of high clinical relevance for e.g. migraine. Others participate in symptoms of rare diseases like amyotrophic lateral sclerosis. Here we will focus on five of the neuropeptide receptors and their non-peptide ligands potentially or already successfully used as PET probes. Opioid receptors and neurotensin receptors are known to mediate analgesic actions. Bradykinin and calcitonin gene-related peptide (CGRP) receptors are known to be involved in the regulation of vascular tone and inflammatory responses, and neurokinin receptors play a role in the occurrence of pain perception in a rather indirect manner. Most experiences as PET tracers have been gathered with opioid receptor ligands and neurokinin receptor ligands. The most innovative fields revealed by the studies summarized in this report are the ligands of κ opioid receptors and CGRP receptors for which a first PET tracer was presented recently.
文摘Objective: This study aimed to investigate the circadian typology of medical students at public universities from one of the northeastern states in Brazil, active in the morning and afternoon shifts, checking the compatibility between their study time, productivity, income and chronotype. Methods: To obtain the results, the assessment of the chronotype in 342 medical students of both sexes was considered. Each participant was submitted to the questionnaire developed by Horne and Ostberg, adapted by Cardinali, Colomberk and Rey. It’s composed of 9 questions, providing the general ranking of each individual. Based upon scored, the chronotypes were classified. Results: The sample was composed of 49.12% (168) male and 50.87% (174) female subjects, a similar gender distribution of enrolled students during data collection time. By applying the questionnaire, the prevalent rating among the medical students as moderately morning (29.82%) and intermediate (43.85%) has been relevant. The academic performance assessment in two morning-intermediate groups (8.16) had no significant distance from others considered afternoon active (8.20). Conclusion: The health sciences student, especially Medicine, faces constant adaptation of scheduling, in the attempt of fulfilling the requirements throughout the course, causing chronogram desynchronization effects and forced readaptation to each different school semester.
文摘Objective: To determine the role of CD4+ and CD8+ T lymphocytes in the onset of stroke in people living with HIV. Methodology: This was a descriptive, cross-sectional study from January to July 2019, in the neurology department of loandjili general hospital, including any patient hospitalized for a first episode of stroke confirmed by brain scan. The study variables were: age, sex, CRP value, serum T cell CD4+, CD8+. The statistical analysis was carried out using the EPI info 7 software. Results: Twenty stroke patients were included. The relative frequency of HIV was 20%. The risk factors were potentiated by immunosuppression of CD4+ T cells. Sixty percent (60%) of the patients had a CD4+ count < 200/mm<sup>3</sup> and the mean CD4+ count was ±191/mm<sup>3</sup>. Stroke was the predominant mechanism of injury with a frequency of 70%, the only injury mechanism of stroke in patients with CD8+ T cell count > 800/mm<sup>3</sup> (p = 0.04). Conclusion: Risk factors are potentiated by TCD4+ lymphocyte immunosupression, also CD8+ lymphocytes of immune system activation marker are a cardiovascular risk factor for living people with HIV.
