Mestrado em Medicina
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- ItemVolumes cortical e subcortical como preditores do desempenho cognitivo em alcoolistas : um estudo de seguimento de 6 anos(Universidade Federal do Espírito Santo, 2017-11-24) Morgado, Adriano Daniel Peres; Nakamura-Palacios, Ester Miyuki; Rosa Júnior Marcos; Pacheco, Felipe TorresAlcohol use has been long proven to result in brain atrophy and cognitive deficiencies, but how changes of specific brain structures would be related to these cognitive changes remains unclear. This study explored changes of gray matter cortical and subcortical volumes of alcoholics after 6-years interval and their relation to changes of frontal executive and global cognitive mental status. Cortical and subcortical segmentation and corrections of magnetic resonance (1.5 T) images acquired in 2010 (T1) and 2016 (T2) from 16 alcoholics (14 males, mean age 49.8 years ± 8.5 SD in T1 and 55.7 years ± 8.4 SD in T2) with long-term use of alcohol (mean of 29.8 to 34.7 years) were performed using FreeSurfer. Results showed global reduction of gray matter volumes and more specifically in brain regions, mostly from prefrontal areas, subcortical structures and cerebellum cortex, highly related to the executive function and drug dependence condition. More importantly, reduction over the 6-year interval of gray matter volumes of right frontal pole (p < .01) and left cerebellar cortex (p < .05) were predictive of changes of frontal executive performance, and reduction of right putamen gray matter volume was predictive (p < .05) of changes of global cognitive mental status in alcoholics. We suggest that combination of volumetric analysis of gray matter from specific brain areas with brief examination of frontal executive and global cognitive mental status over the course of alcohol use may be clinically relevant to determine the degree of executive and cognitive commitment in alcoholism.
- ItemTratamento da toxoplasmose ocular adquirida : revisão sistemática(Universidade Federal do Espírito Santo, 2017-08-19) Lima, Guilherme Sturzeneker Cerqueira; Saraiva, Fábio Petersen; Carvalho, André Correa Maia de; Sarti, Thiago DiasOcular toxoplasmosis, a disease caused by the parasite Toxoplasma gondii, is the most common form of posterior infectious uveitis. Despite the fact that combined anti-parasitic therapy is still the usual practice regarding the treatment of ocular toxoplasmosis, there is no definitive evidence towards its routine necessity. The existence of multiple therapeutic schemes available nowadays has motivated the realization of this study, with the objective of trying to identify elements capable of guiding the physician to perform the best treatment in a case of ocular toxoplasmosis. It was concluded that there is no forceful scientific evidence that proves there is an ideal treatment and that there are no statistically significant differences between the functional outcomes obtained with the different therapeutic schemes employed in the present time.
- ItemRessonância magnética na avaliação das articulações do pé de pacientes com artrite reumatoide(Universidade Federal do Espírito Santo, 2016-06-24) Rondina, Ronaldo Garcia; Mello, Ricardo Andrade Fernandes de; Rosa Júnior, Marcos; Nacif, Marcelo Souto; Volpato, RichardPurpose: Study the joints of the clinically dominant foot of patients with rheumatoid arthritis by MRI using RAMRIS score and correlate with clinical data regarding disease activity and functional capacity, measured respectively by DAS28 and HAQ scores. Methods: Cross-sectional descriptive study of fifty-five patients diagnosed with RA followed by the rheumatology division of the Hospital Cassiano Antonio Moraes of the Federal University of Espírito Santo between February and December 2014. The patients' clinically dominant foot was assessed by MRI and clinical and laboratory data were collected to measure the DAS28. Results: Our study demonstrated a linear relationship between the degree of joint involvement, measured by the RAMRIS, with the loss of functional capacity, assessed by HAQ questionnaire. There was also a linear relationship between the score that measures disease activity (DAS28) and HAQ. There was no statistical relationship between the degree of joint involvement, measured by RAMRIS, and DAS28. Conclusion: We conclude that the assessment by MRI can document a state of persistently active disease despite clinical remission assessed by DAS28 score.
- ItemA rede padrão de repouso parece preservada intrinsecamente mas sua conectividade funcional extrínseca pode estar comprometida em usuários de crack-cocaína(Universidade Federal do Espírito Santo, 2016-06-17) Martins, Diego Lima Nava; Palácios, Ester Miyuki Nakamura; Pacheco, Felipe Torres; Rosa Júnior, Marcos; Volpato, Richard; Mello, Ricardo Andrade Fernandes deDefault Mode Network (DMN) seems to be affected in drug addiction. Decreased functional connectivity has been described in psychostimulants users (cocaine, nicotine, and caffeine) and also in addicted to depressant drugs (alcohol, heroin, prescribed opioids) but no study has investigated the DMN functional connectivity in crack-cocaine dependents so far. Here, inpatient crack-cocaine users in abstinence for at least 4 weeks and age-matched non-addicted controls underwent to functional Magnetic Resonance Imaging acquired when they rested with eyes closed (rs-fMRI) in 1.5 T or 3.0 T scanners. After data preprocessing, DMN were defined by spatial independent component analysis (ICA) and seed-based correlation analysis, by chosen regions of interest centered in the ventral Anterior Cingulate Cortex (vACC) and in the Posterior Cingulate Cortex (PCC). Global DMN functional connectivity was not different between crack-cocaine users and age-matched controls in rs-fMRI acquired in both scanners. The seed-based analysis showed greater negativity of the connectivity between vACC and superior parietal lobe when compared to agematched controls (p < 0.0322). No differences between groups were found in the functional connectivity between PCC and other brain regions. Thus, the total DMN functional connectivity searched by ICA was found preserved in crack-cocaine dependents in abstinence. When a seed-based correlation analysis was applied searching for a single metric functional connectivity between specific brain regions, a greater negativity was found between medial frontal region and the posterior brain region, suggesting that although a broad DMN was unaffected a selective functional connectivity may be compromised in crack-cocaine addiction.
- ItemO emprego da tomografia de coerência óptica na detecção da toxicidade ocular por etambutol(Universidade Federal do Espírito Santo, 2018-07-13) Taffner, Brunella Maria Pavan; Saraiva, Fábio Petersen; Jorge, Fabiano Cade; Magalhães Junior, Octaviano; Saraiva, Patricia Grativol CostaPurpose. To evaluate changes in retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT) secondary to use of ethambutol in the treatment of patients with tuberculosis or mycobacterium other than tuberculosis. In addition to studying the use of simpler tests, such as Amsler and Ishihara, in the screening of these cases. Methods. Thirty patients in use of etambutol were recruited from the reference service of tuberculosis at the Federal University of Espírito Santo from May 2015 to July 2016. After clinical history, the following parameters were analyzed; best corrected visual acuity, biomicroscopy, intraocular pressure, photomotor reflex testing, Ishihara test, Amsler's grid test, color digital retinography and optical coherence tomography with CIRRUS HD-OCT (Humphrey-Zeiss) every 2 months during treatment with ethambutol. They were divided into two groups according to the treatment: (1) standard group, two months of ethambutol; (2) extended group, nine to twelve months of ethambutol. Results. There was a reduction in optic disc OCT thickness between pre and post treatment in ten eyes of the extended group, mean reduction of 7,8 µm (variation between 3 and 19) and in seven eyes of the standard group, with an average of 5.57 µm (variation between 3 and 10). During the study, a significant reduction of RNFL thickness was observed in both groups at two months of treatment, and the delta percentage was higher in those patients who presented changes in the Ishihara test. Conclusion. There was a significant reduction in the thickness of the retinal nerve fiber layer by OCT in the patients studied, being more pronounced in those submitted to the extended treatment. This reduction was observed two months after the start of therapy, and was more significant in the cases that presented changes in the Ishihara test. The Amsler test did not present significant alteration in the evaluated groups. Most of the cases with reduction of CFNR by OCT does not showed reduction in visual acuity or change in the Ishihara test.