Background: Delirium subsyndrome (SSD) and delirium (DL) are known complications in the intensive care unit (ICU) and are associated with worse clinical outcomes. The aim of this study was to screen for SSD and DL in individuals with COVID-19 admitted to the ICU and to study the associated factors and clinical outcomes. Method: An observational, longitudinal study was conducted in the reference ICU for COVID-19. All admitted individuals with COVID-19 were screened for SSD and DL during their ICU stay using the Intensive Care Delirium Screening Checklist (ICDSC). Individuals with SSD and/or DL were compared to those without SSD and/or DL. Results: Ninety-three patients were evaluated, of which 46.7% had SSD and/or DL. The incidence rate was 4.17 cases/100 person-days. Individuals with SSD and/or DL had higher severity of illness on admission to the ICU, as measured by the APACHE II score (median 16 versus 8 points, p < 0.001). SSD and/or DL were associated with longer ICU and hospital stays (median 19 versus 6 days, p < 0.001 and median 22 versus 7 days, p < 0.001, respectively). Conclusion: Individuals with SSD and/or DL had greater disease severity and longer ICU and hospital stays when compared to those without SSD and/or DL. This reinforces the importance of screening for consciousness disorders in the ICU.

Resumo Introdução A tuberculose, caracterizada pela Organização Mundial de Saúde (OMS) como emergência sanitária mundial, é uma doença de impacto global. Objetivo Realizar série histórica de casos de tuberculose em um período de 17 anos em Ouro Preto, Minas Gerais, considerando a histórica relação da doença com a mineração. Método Dados foram obtidos em sistema próprio de registros do município, por busca ativa em prontuários médicos e comparados à quantidade de casos notificados no Sistema de Informação de Agravos de Notificação (SINAN). Para análises de tendência, foram utilizados modelos de regressão polinomial para séries históricas. Resultados Idade média dos casos foi 40,3 ± 16,4 anos. Homens apresentaram 2,23 vezes mais casos e chance 2,07 vezes maior para desfechos negativos. A forma mais observada foi pulmonar (84%), e sorologia para HIV foi realizada em apenas 16,3% dos registros. Principal desfecho observado foi cura (70%), e desfechos negativos totalizaram 20,2% dos registros. Taxa de incidência média foi 29,76 e 16,23 casos/100 mil habitantes na área municipal e distrital, respectivamente. Conclusão Apesar da relação histórica entre mineração e tuberculose no município, observa-se que este ainda apresenta preocupantes vulnerabilidades em relação à vigilância da doença. Análise de série temporal sugeriu declínio na proporção de casos curados entre 2009 e 2015.

BackgroundHeadache is a common symptom that affects a significant portion of the general population. It constitutes a challenge for diagnosis in urgency and emergency care services, due to headache’s clinical variability and diverse possible etiologies, besides the limited time and resources of these facilities. Because of this insufficiency and the potential severity associated with the condition, headaches generate considerable expenditures to health systems, related to both diagnostic discrimination and treatment.ObjectiveEvaluating the diagnostic resources used on headache patients care, as well as its Public Health Relevanceand relation to cost in an Emergency and Urgency Care unit.MethodsCross-section study analyzing 450 medical records of patients with headache complaints in the time frame from January 1, 2019, and December 31, 2019. Patients were categorized according to the type of headache (primary and secondary), specialized evaluation, complementary exams used in the diagnosis, hospital observation time, and the final expenditure in each patient’s care.ResultsThe total estimated expenditures related to headache care equaled US$90,855.60 (average US$201.90 per patient). 38.9% of cases corresponded to primary headaches and 31.1% to secondary headaches. 30% of cases could not be classified. The resources utilized for secondary headaches diagnosis differed significantly from those used in primary headache diagnosis. However, the final expenditures were similar to both groups.ConclusionThe socio-economic impact caused by headaches is unquestionable. It is a highly frequent symptom and both its etiological distinction and adequate treatment require solid evaluation. Due to the resources spent in its evaluation and monitoring, headaches can be considered a public health problem. Therefore, this study suggests that resources should be allocated in the health education and professional training for the proper conduction of these patients, so that they may benefit from an optimized treatment of theircondition without overwhelming the health system.

Amyotrophic lateral sclerosis (ALS) is a rare degenerative disease of motor neurons, predominantly sporadic, with approximately 10% of the cases showing familial inheritance. To characterize the clinical and sociodemographic profile of patients with familial ALS type 8 (fALS8) and compare it with sporadic ALS (sALS). We reviewed the medical records (1997–2022) from a specialized Brazilian center. Patients with a confirmed diagnosis of ALSs were included, and sociodemographic and clinical data were collected. The sample was composed of 89 ALS patients, with a slight female predominance (53%) and a high frequency of fALS8 cases (45%). The fALS8 patients were diagnosed at a younger age, at approximately 50 years, compared to 53 years among the sALS patients (p = 0.043). Lower limb onset predominated in the fALS8 group (87%), while the sALS group showed more heterogeneous presentations, including bulbar onset (14%). The time until the diagnosis was significantly longer in the fALS8 group compared to the sALS group, both from symptom onset (approximately 51 versus 30 months respectively; p < 0.001) and after admission to a specialized center (7 versus 4 months respectively; p = 0.002). Dysphagia and gastrostomy were more frequent in the sALS group compared to the fALS8 group (p = 0.02 and p < 0.01 respectively), and older age at diagnosis was associated with worse functional scores. The fALS8 group presented with distinct clinical and demographic features compared to the sALS group, including younger age at diagnosis, more homogeneous symptom onset, and lower frequency of dysphagia and need for gastrostomy. The diagnosis was more delayed in the fALS8 group, and older age at diagnosis was associated with worse functional status. The current study contributes to the scarce data on fALS8 in South America.

Introduction Migraine, is one of the most prevalent types of headaches, affects around 15% of people worldwide, more common among women, and causes a great effect in the quality of life of the individual. The diagnosis criteria of this disease is due to its duration and other characteristics such as phonophobia, photophobia, unilateral, pulsatile and intense crisis, nausea and vomiting, which can be preceded by aura and premonitory symptoms. With the purpose to ease those symptoms, the patients have a drug overuse. The medication-overuse headache (MOH) is an emerging problem, due to the possibility of developing psychiatric disorders like obsessive compulsive disorder (OCD) and impulsivity. Impulsivity consists in actions where the individual does not reflect upon it and make decisions fast, without planning or analyzing the case in the long term. Compulsion is defined as repetitive actions with the intention to ease anxiety or an uncomfortable situation. Objective Determine a prevalence of OCD in migraine patients, evaluating different scopes of it, including the association or not with drug abuse. Methods A cross-sectional study with 117 patients of both sexes, older than 18 years old. The group was made with migraine patients diagnosed by a neurologist according to the International Classification of Headache Disorders (ICHD) separated in two groups, one that has analgesics abuse and other that do not have. Three questionnaires were used: Barratt Impulsiveness Scale (BIS-11); Obsessive Compulsive Inventory-Revised (OCI-R) and the Migraine Disability Assessment (MIDAS). The data collected was placed in an electronic worksheet and processed in Software SPSS Statistics 22.0. There was an assumption of a p value of 0,05 to all cases with the intention to reject the null hypothesis. (To see the complete abstract, please, check out the PDF).