Dissertations / Theses on the topic 'Neurologic examination'

O presente trabalho teve como objetivo a descrição das atividades desenvolvidas no âmbito do estágio curricular do Mestrado Integrado em Medicina Veterinária pela Universidade de Évora. Numa primeira parte é apresentada a casuística acompanhada ao longo do estágio, com referência mais pormenorizada a alguns casos clínicos acompanhados nas diversas áreas de intervenção: clínica médica e cirúrgica de espécies pecuárias e equinos. A segunda parte deste relatório é composta por uma revisão bibliográfica sobre os temas “exame neurológico em equinos”, “ síndrome do poldro lavanda” e “vírus do Nilo ocidental”. Na última parte serão relatados de três casos clínicos acompanhados neste âmbito; Clinical medical and surgery in livestock species and horses Abstract: The current report describes the activities developed during the Curricular externship as parts of the Veterinary Medicine Integrated Masters from University of Evora. The first part includes the casuistry that took place along the externship, giving enphasis to some of the clinical cases assessed in different livestock species and equine clinic areas. The second part presents a literature review approaching “neurologic examination in horses”, “lavender foal syndrome” and “west Nile vírus” as its main themes. For the ending part there are described three clinical cases followed during the externship.

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Introduction: Toxoplasma gondii is the etiological agent of a parasitic parasitic disease of universal distribution, with infected individuals in all countries. The main forms of contagion are through the ingestion of different parasite evolutionary forms present in raw meats or undercooked, unfiltered water, unpasteurized milk, contaminated soil handling and contact with infected cats. Clinical disease is less frequent and the most severe forms can be found when congenital transmission occurs and in immunocompromised patients. When the fetus touches this infectious agent and survive, it can present several problems such as: restriction in the intrauterine growth, premature birth, microcephaly, hydrocephalus, brain calcifications, pneumonitis, hepatosplenomegaly, skin rash, intellectual disability, among others. The consequences to the fetus are higher in the first trimester of pregnancy and the transmissibility in the third trimester is the highest. The degree of commitment of the newborn will depend on the gestational period in the moment of the first transmission of the illness and the pregnant woman. Objective: The objectives of this study were to evaluate perceptible alterations in the neuropsychomotor examination and in anthropometric measures of newborns (RNs) of chronically infected mothers by Toxoplasma gondii. Methods: The study was performed in a population of 79 children of puerperal mothers, 41 of them were children of mother with infection of toxoplasmosis and 38 were children of not infected mother by the protozoan. It was made out a sociodemographic interview with these mothers through a questionnaire and an examination of primitive reflexes in their respective children. The study was conducted in one maternity of standard for risk pregnancy, in the city of Goiânia, Goiás, in the period from June 2015 to June 2016. The analysis were performed with the aid of the statistical package SPSS®, version 23. The serologic testing for confirmation of toxoplasmosis infection and absence of anti-T gondii in the mothers serum was made by Immunoassay of Microparticles by Chemiluminescense (CMIA). Results: Neuropsychomotor examination the absence of reflection escape the suffocation was found in two children of chronically infected mothers. In the comparison of the thoracic perimeter and the cephalic perimeter 31/79 children were classified as inadequate and two children of mothers chronically infected were too small for their gestational age. Conclusion: In relation to the neuropsychomotor examination and anthropometric measurements, in the group of newborn of puerperal mothers chronically infected by Toxoplasma gondii could not detect any perceptible alterations when in comparison to the control group of susceptible mothers.
Introdução: Toxoplasma gondii é o agente etiológico de uma parasitose de distribuição universal, com indivíduos infectados em todos os países. As principais formas de contágio são através da ingestão de diferentes formas evolutivas do parasito presentes em carnes cruas ou mal cozidas, água não filtrada, leite não pasteurizado, manipulação de terra contaminada e convívio com gatos infectados. A doença clínica é pouco freqüente e as formas mais graves podem ser encontradas quando ocorre a transmissão congênita e em pacientes imunocomprometidos. Quando o feto entra em contato com esse agente infeccioso e sobrevive pode apresentar inúmeros problemas como: restrição de crescimento intrauterino, nascimento prematuro, microcefalia, hidrocefalia, calcificações cerebrais, pneumonite, hepatoesplenomegalia, erupção cutânea, retardo mental, entre outros. As conseqüências para o feto são mais graves no primeiro trimestre de gestação, e a transmissibilidade no terceiro trimestre é mais elevada. O grau de comprometimento do recémnascido irá depender da fase em que a gestação se encontrava no momento do primeiro contágio da gestante com o parasito. Objetivos: Os objetivos deste estudo foram avaliar alterações perceptíveis no exame neuropsicomotor e nas medidas antropométricas de recém-nascidos (RNs) de mães cronicamente infectadas pelo Toxoplasma gondii. Métodos: A população do estudo foi composta por 79 filhos de puérperas, os quais 41 eram filhos de mães com toxoplasmose crônica e 38 filhos de mães não infectadas pelo protozoário. Foi realizada uma entrevista sociodemográfica com essas mães através de um questionário e um exame de reflexos primitivos em seus respectivos filhos. O estudo foi realizado em uma maternidade de referência para gestações de risco, na cidade de Goiânia, Goiás, no período de junho de 2015 a junho de 2016. As análises foram realizadas com o auxílio do pacote estatístico SPSS ®, versão 23. O teste sorológico para confirmação da toxoplasmose infecção e ausência de anticorpos anti-T gondii no soro das mães foi feito por Imunoensaio de Micropartículas por Quimioluminescência (CMIA). Resultados: No exame neuropsicomotor a ausência do reflexo de fuga ao sufocamento foi encontrada em duas crianças filhas de mães cronicamente infectadas. Na comparação entre perímetro torácico e perímetro cefálico 31/79 crianças foram classificadas como inadequadas e duas crianças de mães cronicamente infectadas estavam pequenas para a idade gestacional. Conclusão: Em relação ao exame neuropsicomotor e as medidas antropométricas no grupo de recém-nascidos filhos de puérperas cronicamente infectadas pelo Toxoplasma gondii não foi possível detectar alterações perceptíveis quando em comparação ao grupo controle de mães suscetíveis.

Background: According to the World Health Organization, between four to nine million newborns develop birth asphyxia. It is estimated that 1.2 million fatal outcomes and at least the same number develop disabling neurological sequelae and developmental delay. Early neurological evaluation promotes the improvement of the life expectancy of serious asphyxiated babies and It can be incorporated into the routine of neonatal intensive care units. Glasgow Coma Scale adapted for children can be an assessment tool used in high-risk newborns. Objective: To compare the clinical outcome of term infants with perinatal asphyxia (PA) moderate and severe that underwent a neurological neonatal serial evaluation protocol during hospital stay, with those not undergoing evaluation. Method: This is an epidemiologic, observational and analytical study, using a quantitative approach. The study considered two groups, intervention and control. For the control group, at first, it was made a survey data in charts and then the longitudinal, prospective, observational approach was adopted during the period of outpatient care. For the intervention group, a longitudinal approach, prospective, observational was used during the hospital stay and follow-up clinic. We sought to investigate the neurological clinical course of children, the length of stay in hospital and delay presence in the development of neuromotor skills. Results: The sample consisted of 112 newborns, 86 infants in the control group and 26 infants in the intervention group. The intervention group showed a median of less hospital stay (p<0.001) than the control group. Full-term newborns diagnosed with PA, which remained for a shortest time in hospital length and were subjected to a serial neurological evaluation protocol, incorporated into standard clinical procedures in the NICU for the management of PA, did not show disturbances in neuromotor development. Conclusion: The use of serial neurological evaluation protocol influenced significantly, the prevalence of delayed neuromotor development.
Introdução: Segundo a Organização Mundial da Saúde, cerca de quatro a nove milhões de recém-nascidos (RN) desenvolvem asfixia ao nascer. Estima-se que 1,2 milhão evoluem para óbito e, pelo menos, o mesmo número desenvolve sequelas neurológicas incapacitantes e atraso no desenvolvimento. A avaliação neurológica precoce promove melhora da perspectiva de vida dos anoxiados graves, podendo, esta, ser incorporada à rotina das unidades de terapia intensiva neonatal. A escala de coma de Glasgow adaptada para crianças poderá ser utilizada em RN de alto risco. Objetivo: Comparar a evolução clínica neurológica dos RN a termo com asfixia perinatal (AP) moderada e grave que foram submetidos a um protocolo de avaliação neurológica neonatal seriada durante período de internamento hospitalar, com aqueles não submetidos à avaliação. Métodos: Trata-se de um estudo epidemiológico, observacional, analítico, com abordagem quantitativa. O estudo considerou dois grupos, intervenção e controle. Para o grupo controle foi feito um levantamento de dados em prontuários e, em seguida, adotada a abordagem longitudinal, prospectiva, observacional, durante o período de atendimento ambulatorial. Para o grupo intervenção, foi utilizada uma abordagem longitudinal, prospectiva, observacional, durante o período intra-hospitalar e em ambulatório de seguimento. Buscou-se investigar a evolução clínica neurológica da criança, o tempo de permanência no serviço hospitalar e presença de atraso no desenvolvimento das habilidades neuromotoras. Resultados: A amostra foi constituída de 112 RN, sendo 86 RN do grupo controle e 26 RN do grupo intervenção. O grupo intervenção mostrou uma mediana de tempo de internamento hospitalar menor (p<0,001) que o grupo controle. RN a termo, diagnosticados com AP, que permaneceram por menor tempo em internamento hospitalar e foram submetidos a um protocolo de avaliação neurológica seriada, incorporado às condutas clínicas padronizadas na UTIN para a gestão da AP, não apresentaram distúrbios no desenvolvimento neuromotor. Conclusão: A utilização do protocolo de avaliação neurológica seriada influenciou a prevalência de atraso no desenvolvimento neuromotor.

Objetivos: Avaliar o desenvolvimento neuropsicomotor de crianças com Sequência de Robin isolada (SRI), submetidas ao tratamento de obstrução das vias aéreas conforme protocolo do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC/USP), com intubação nasofaríngea (INF) ou tratamento postural. Verificar se o desenvolvimento neuropsicomotor do grupo INF difere do grupo postural, e avaliar a eficácia da INF em evitar sequelas de hipóxia. Materiais e Métodos: Estudo prospectivo realizado no HRAC/USP, com crianças com SRI, de 2 a 6 anos, divididas em dois grupos de acordo com o tipo de tratamento realizado: INF (Grupo 1), e postural (Grupo 2). Dados do tempo de uso da INF e sonda nasogástrica (SNG), cirurgia de miringotomia, classificação socioeconômica, grau de escolaridade dos pais, entre outros, foram coletados. Os participantes foram avaliados por meio do Teste de Screnning de desenvolvimento de Denver II (Teste de Denver II) e Exame Neurológico Evolutivo Adaptado (ENEA). Resultados: Total de 62 crianças foram avaliadas, sendo 38 do Grupo 1 e 24 do Grupo 2. Os resultados do Teste de Denver II demonstraram que 73,7% das crianças do Grupo 1 e 79,2% do Grupo 2 apresentaram desenvolvimento normal. Os resultados do ENEA apresentaram-se normais para 89,5% das crianças do Grupo 1 e 87,5% do Grupo 2. Não houve diferença significativa entre os dois grupos no Teste de Denver (p=0,854) e no ENEA (p=0,789). Realizaram a miringotomia 47,3% das crianças do Grupo 1 e 58,3% do Grupo 2. Nos resultados dos dois testes, a área do desenvolvimento mais prejudicada foi a linguagem, o que pode ser reflexo das oscilações de audição e da disfunção velofaríngea. Houve concordância moderada (k=0,563) entre os resultados dos dois testes aplicados no Grupo 1, e concordância substancial (k=0,704) no Grupo 2. O tempo médio de uso da INF foi de 60 ± 28 dias. Na análise socioeconômica do Grupo 1, 42,1% se encaixavam na classificação baixa superior, e 28,9% na média inferior; no Grupo 2, 20,8% se encaixavam na baixa inferior, e 58,3% na baixa superior, sem diferença entre os grupos (p=0,211). Não houve associação significativa entre a classificação socioeconômica e os resultados dos testes de desenvolvimento aplicados. O nível de escolaridade mais encontrado entre os pais dos participantes foram: 3º grau completo (Grupo 1) e 2º grau completo (Grupo 2), sem diferença estatística entre os grupos. Conclusões: A maioria das crianças com SRI tratadas com INF apresentaram desenvolvimento neuropsicomotor normal, semelhante aos casos menos graves do grupo postural. As crianças tratadas com INF não apresentaram sinais clínicos evidentes de sequelas neurológicas da hipóxia.
Objectives: To assess the neurological and psychomotor development of children with Isolated Robin Sequence (IRS), submitted to the treatment of airway obstruction according to the protocol of the Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (HRAC/USP), with nasopharyngeal intubation (NPI) or postural treatment. Verify if the neurodevelopment of the NPI group differs from postural group, and evaluate the effectiveness of NPI to prevent sequels of hypoxia. Materials and Methods: Prospective study conducted at HRAC/USP, with children SRI, with 2 to 6 years old, divided into two groups according to the type of treatment performed: NPI (Group 1) and postural (Group 2). Time data of use NPI, nasogastric tube (NGT), myringotomy surgery, socioeconomic status, education level of parents, among others, were collected. Participants were assessed through the development of Screnning Denver II Test (Denver II) and Neurologic Evolutionary Examination Adapted (NEEA). Results: The total of 62 children was evaluated, being 38 in the Group 1 and 24 in the Group 2. The results of the Denver Developmental Screening Test II showed that 73.7% of Group 1 and 79.2% of Group 2 presented with normal development. The results of NEEA had presented normal for 89.5% of children in the Group 1 and 87.5% in the Group 2. There was no significantly difference between the two groups at Denver Test (p=0.854) and in the NEEA Test (p=0.789). The myringotomy was performed by 47.3% of children in the Group 1 and 58.3% of children in the Group 2. The results showed language as the most impaired area, which may reflect fluctuations of hearing and velopharyngeal dysfunction. There was moderate agreement (k=0.563) between the results of the two tests applied in the Group 1, and substantial agreement (k=0.704) in the Group 2. The average time of use of the NPI was 60 ± 28 days. In the socioeconomic analysis of Group 1, 42.1% fit the low ranking higher, and 28.9% in the average lower. In the analyses of Group 2, 20.8% were in the low ranking lower, and 58.3% were in the low ranking the top. There was no different statistic between groups (p=0.211). There was no significant association between socioeconomic status and results of development tests performed. The levels of education most found between the participants parents were: completed graduation (Group 1), and secondary school (Group 2) with no statistical difference between groups. Conclusions: Most of children with IRS treated with NPI showed normal neurological and psychomotor development, similar of minor cases of postural group. The children treated with NPI didn\'t show evident clinical signs of neurological sequels of hypoxia.

Dissertação de Mestrado Integrado em Medicina Veterinária
A Hérnia de Disco é a causa mais frequente de patologia da medula espinhal em cães. As hérnias de disco estão associadas a degenerescência dos discos intervertebrais, cujas causas não são totalmente conhecidas, resultando na extrusão ou protusão de material de disco para o interior canal medular causando a compressão da medula espinhal ou das raízes nervosas. Os sinais clínicos associados são variados e podem variar desde apenas dor espinhal até quadriplegia. O diagnóstico pode ser feito com base na idade, espécie, raça, história e sinais clínicos do doente colhidos no exame neurológico, exigindo a realização de exames complementares de radiologia simples e contrastada, para se estabelecer um diagnóstico definitivo de hérnia de disco. A terapêutica mais apropriada depende do quadro clínico que o doente apresenta. O prognóstico está na dependência do grau de défices neurológicos existentes, da duração do processo patológico e da terapêutica instituída. Com o ensaio realizado, foi possível concluir que 22,9% (8/35) dos doentes apresentaram discopatia de localização cervical e 77,1% (27/35) toracolombar, sendo a dor o principal sinal clínico e ocorrendo na maioria em animais condrodistróficos (62,9%; 22/35), sendo maior a incidência nos doentes da raça Caniche (48,6%; 17/35) e depois nos doentes de raça indeterminada (20,0%; 7/35). O quadro neurológico dos animais da amostra variou entre o grau de lesão 1 até ao 5, e a duração dos sinais clínicos entre 4 a 185 dias. O disco intervertebral mais afectado na coluna cervical foi C6-C7 (22,22%; 2/9) e na coluna toracolombar L1-L2 (9,7%; 3/31). O tempo médio de recuperação após início da terapêutica foi de 18,5 dias, e 94,3% (33/35) dos doentes recuperaram totalmente as funções neurológicas.
ABSTRACT - Intervertebral disc disease is the most frequent cause of spinal cord disease in dogs. It is associated with degeneration of the intervertebral discs, whose causes are not fully known, resulting in extrusion or protrusion of the disc material into the spinal canal causing spinal cord or nerve roots compression. Signs associated include paraspinal pain to paralysis. The diagnosis is based on age, species, race, history and clinical signs presented at neurological examination, but execution of survey radiography and myelography is required to establish a definitive diagnosis of intervertebral disc disease. The most appropriate therapy depends on the severity and duration of the clinical signs. The prognosis is dependent on the rate of onset, the degree and duration of clinical signs and on the therapy established. With the clinical test, it was possible to conclude that 22,9% (8/35) of intervertebral disc disease occurs in the cervical region and 77,1% (27/35) in the thoracolumbar region, with pain being the most significant sign. It is most commonly in chondrodytrophic dogs (62,9%; 22/35), with the biggest incidence on Poodles (48,6%; 17/35) and mixed-breed dogs (20,0%; 7/35). The presented neurological deficits ranged from 1 to 5 degrees of medullar injury, and duration of clinical signs from 4 to 185 days. The most affected intervertebral disc in the cervical spine was C6-C7 (22,2%; 2/9) and in the thoracolumbar spine was L1-L2 (9,7%; 3/31). The mean time for recovery after starting therapy was 18.5 days and 94.3% (33/35) of the patients recovered fully the neurological functions.

Introdução: O aperfeiçoamento da assistência pré-natal e dos cuidados intensivos neonatais contribuiu para a redução da mortalidade dos recémnascidos (RN) com riscos para alterações do desenvolvimento neuromotor. Apesar destes avanços, a difícil previsão e prevenção de danos neurológicos está associada ao aumento de crianças com problemas graves como a Paralisia Cerebral (PC). Das avaliações disponíveis atualmente, a que possui melhor valor preditivo de danos neurológicos em bebês até os cinco meses de idade é a \"Avaliação Qualitativa dos Movimentos Generalizados (MGs)\" de Prechtl. No entanto, apresenta pouca aderência na prática clínica devido à sua subjetividade e necessidade de treinamento prévio para aplicação. Objetivos: Desenvolver e analisar a confiabilidade de uma escala de avaliação baseada nos MGs caracterizados a partir da avaliação qualitativa de Prechtl em recémnascidos e lactentes com riscos para alterações no desenvolvimento neuromotor. Método: Estudo observacional transversal com a participação de 30 RNs e lactentes com idade compreendida entre 31 semanas pós-menstrual e 17 semanas pós-termo avaliados no Hospital Universitário da USP. Os MGs normais e anormais foram avaliados segundo a análise qualitativa dos MGs de Prechtl seguindo as três fases: pré-termo (n=7), writhing movements (n=13) e fidgety movements (n=10). A escala foi construída baseando-se nestas fases e foram elaboradas duas versões, sendo analisadas as confiabilidades inter e intra-examinador por meio do ICC e do índice de Kappa. A consistência interna da versão final foi analisada através do alfa de Cronbach. Resultados: Foram analisadas duas versões da escala com três diferentes sistemas de pontuação: respostas do tipo \"SIM ou NÃO\"; do tipo \"SEMPRE, ALGUMAS VEZES e NUNCA\"; e \"SEMPRE, QUASE SEMPRE, ALGUMAS VEZES, QUASE NUNCA E NUNCA\". Os resultados mais significativos foram obtidos com as respostas binárias (SIM ou NÃO), sendo que nas fases pré-termo e writhing movements a pontuação máxima é de 32 pontos e na fase dos fidgety movements é de 12 pontos. A análise da confiabilidade da versão final da escala evidenciou concordância excelente tanto para a confiabilidade intra-avaliador (ICCs: 0.914 a 0.999; Kappa: 0.6 a 1 e 0.606 a 1, considerando a escala binária), como para confiabilidade inter-avaliadores (ICCs: 0.871 a 0.966 para avaliação 1; Kappa: 0.682 a 0.775 para avaliação 1, considerando novamente a escala binária). Apenas o índice Kappa neste caso apresentou concordância boa. Os valores de alfa de Cronbach se mostraram de bons a excelentes (0.866 a 0.980). Verificou-se também que os bebês com MGs anormais apresentaram pontuação abaixo de valores entre 20 e 25 na fase pré-termo e dos writhing movements, e abaixo de valores entre 8 e 12 na fase dos fidgety movements. Conclusão: Foi possível desenvolver uma escala capaz de quantificar os MGs, com pontuação capaz de diferenciar MGs normais de anormais, com excelente confiabilidade inter e intra-avaliador e alta consistência interna. A escala apresenta grande relevância clínica e, aliada ao treinamento no método qualitativo, torna-se um instrumento promissor para a detecção precoce de riscos para atraso do desenvolvimento neuromotor e seleção dos RNs e lactentes para acompanhamento e intervenção precoce
Introduction: The technological improvement of neonatal care and intensive care contributed to reduction of preterm newborn (PTNB) mortality. Despite these improvements, is still difficult to predict and prevent neural damage and neurobehavioral impairments, which are associated to higher proportion of children with severe neurological problems, such as Cerebral Palsy (CP). Between all the available methods of babies\' assessment and examination, the Prechtl´s Method of Qualitative Assessment of General Movements (GMs) shows the higher predictive value to neurological damage. Nevertheless, this assessment is not widely used because of its subjectivity and the necessity of training of the examiners. Objective: To develop a quantitative scale based on GMs in the newborn and infant, and to verify its reliability. Method: Crosssectional observational study involving 30 newborns and infants aged between 31 weeks postmenstrual age and 17 weeks post term age assessed at university hospital of University of São Paulo. The normal and abnormal GMs were evaluated based on the Prechtl´s Method of Qualitative Assessment of GMs following the three phases: preterm GMs (n=7), writhing movements (n=13) and fidgety movements (n=10). The scale was developed based on these phases and Kappa and ICC statistics were applied in the reliability analysis (inter- and intra-observer agreement). Cronbach alpha was applied in the internal consistency analysis. Results: Two versions of the scale were analyzed with three different scoring systems: \"YES or NO\"; \"ALWAYS, SOMETIMES and NEVER; \"ALWAYS, OFTEN, SOMETIMES, ALMOST NEVER and NEVER\". The most significant results were obtained with \"YES or NO\" answers. The total score obtained in preterm and writhing movements phases was 32 points and in the fidgety movements phase was 12 points. Considering the assessment with the final version of the scale, high to very high inter- (ICCs 0.871-0.966; Kappa 0.682-0.775 for the first evaluation, considering \"YES or NO\" answers) and intra-observer reliability (ICCs: 0.914-0.999; Kappa: 0.6-1, considering \"YES or NO\" answers) was found. High to very high Cronbach alpha values was also found (0.866-0.980). The infants showed abnormal GMs score below values between 20 and 25 in preterm phase and writhing movements, and below values between 8 and 12 at fidgety movements age. Conclusion: It was possible to develop a scale able to quantify GMs, with scores that can differentiate normal from abnormal GMs, with excellent inter- and intra-observer reliability and internal consistency. The scale has great clinical relevance and, combined with training in qualitative method, it is a promising tool for early detection of risks for delayed neuromotor development and screening of newborns and infants for monitoring and early intervention

Introdução: Transplantes de órgãos ocorrem principalmente devido a doações provenientes de pacientes que apresentam morte encefálica (ME). Algumas situações limitam o diagnóstico de ME baseado apenas no exame neurológico, sendo necessário utilizar um exame de imagem ou gráfico para esta confirmação. No Brasil, o exame complementar é obrigatório por lei para todos os casos suspeitos. A maioria dos métodos complementares utilizados para confirmação de ME não está disponível em muitos locais do Brasil. Neste contexto, a angiografia por tomografia computadorizada (ATC) representaria uma alternativa, devido à presença de equipamentos de tomografia em diversos hospitais brasileiros. Porém, a capacidade de este exame reconhecer a interrupção da circulação intracraniana é desconhecida. Métodos: Realizou-se revisão sistemática para verificar evidência na literatura sobre o uso de ATC como teste avaliador de ME. Foram seguidas diretrizes de busca e extração de dados, sendo o QUADAS 2 utilizado para verificar risco de vieses e qualidade dos estudos. Os dados foram sumarizados para produzir metanálise. Resultados: Dez estudos com alto risco de vieses foram encontrados. Devido à falta de estudos controlados, não se obteve dados de especificidade. Trezentos e vinte e dois pacientes foram elegíveis para metanálise, a qual revelou 84,7% de sensibilidade. Houve variação de protocolos de avaliação das imagens de ATC entre os estudos, sobre a definição de resultados positivos ou negativos. Conclusão: ATC apresenta alta sensibilidade para detectar interrupção de circulação intracraniana entre pacientes com avaliação clínica compatível com ME. Este nível de evidência é similar ao de outros métodos utilizados no mundo. Há falta de estudos bem desenhados neste tema
Background: Organ transplantation depends more often of donation from brain dead (BD) individuals. Several complications make the diagnosis of BD medically challenging and a complimentary method is needed for confirmation. Additionally, in Brazil, the complimentary diagnosis is mandatory by law, despite there are still many areas where these methods are not available. In this context, computed tomography angiography (CTA) could represent a valuable alternative, because of its widespread presence. However, the reliability of CTA for confirming brain circulatory arrest remains unclear. Methods: A systematic review was performed to identify relevant studies regarding the use of CTA as ancillary test for BD confirmation. Guidelines for online search were followed, and the QUADAS 2 tool was used to verify study quality. Data from the studies retrieved were extracted aiming to perform the meta-analysis. Results: Ten low quality studies were found. Due to the absence of controls in all studies, specificity could not be calculated. Three hundred twenty-two patients were eligible for the meta-analysis, which exhibited 84,7% sensitivity. CTA image evaluation protocol exhibited variations between medical institutions regarding which intracranial vessels should be considered to determine positive or negative test results. Conclusions: For patients who were previously diagnosed with BD according to clinical criteria, CTA demonstrated high sensitivity to verify intracranial circulatory arrest. The current evidence that supports the use of CTA in BD diagnosis is comparable to other methods applied worldwide. Considering the importance of this subject, high quality studies are currently missing and needed

The argument that I present in this thesis is that while the idea of the Self is an illusion, a myth which our brains create, it is one that is necessary for our survival. However, by understanding its neurological origins we are able to take advantage of it without being victims of egocentricity. My first chapter, Neurology of the Self, lays down the neurological foundations for our concept of the Self and goes on to argue that, while biology and neurology must remain the basis of our understanding, we need to transcend our purely scientific concepts in order to integrate them with art and spirituality. Our transcendental view, I argue, seeks to establish values that make life worth living for and are essential to our survival. I consider some possible implications, both real and imagined, of neurological impairment. The second chapter, Consciousness and the Self, considers the neurological and chemical basis for consciousness and develops the ways in which the imagined Self can be used to create a balanced life that is not highjacked by ego. In the third chapter, Human Nature and the Self, I continue to argue for a liberated view of the Self bearing in mind its neurological origin which itself is the creator of our received reality. Compassion, which Schopenhauer's philosophy argued for as the basis of morality, is shown to be facilitated by the concept of a centred Self which I apply to the subject of morality in the fourth chapter, Morality and the Self. .with the fifth chapter, Illusion and the Imagined Self. I come to the very heart of the argument to which tny considered research findings and previous chapters have lead, namely, that the illusion of the Self is neurologically created by our brains and that we do not have an unchanging Self which is other than the experiences and ideas from which our whole Being derives meaning. Nonetheless, this Self and other values we create are essential for our well being and should be cherished in themselves as being crucial for our healthy individual and collective survival. Furthermore, since we are now aware of the origin of our idea of the Self we can gain our freedom from a manipulating ego and become centred Selves able to creatively transcend and transform the limits of our neurologically given reality by being actively involved in the ongoing process of change. This is the subject of my sixth chapter, Spirituality and the Creative Self, and is endorsed in my concluding chapter which, neglecting a view which carefully avoids accepting absolutes that just might be falsified tomorrow, argues that the best values that we create today should be used as absolutes from which to derive principles for living and continuing to live which could, at least, lessen the threat to our survival.

Philosophiae Doctor - PhD
Lumbo-sacral radiculopathy (LSR) is clinically defined as low back and referred leg symptoms accompanied by an objective sensory and/or motor deficit due to nerve root compromise. LSR is a common condition encountered by physiotherapists in clinical practice and the assessment and diagnosis remains a challenge owing to the complex anatomy of the lumbo-sacral spine segment and the various differentials. Moreover, LSR imposes a significant impact on patients’ health, functional ability, socio-economic status and quality of life. There are several diagnostic tools and procedures which are commonly utilised in practice, including diagnostic neuropathic pain screening questionnaires, clinical neurological tests, electro-diagnostics and imaging. However, the diagnostic utility and correlation of these tests have not been fully explored and remains debatable among clinicians and researchers in the fields of musculo-skeletal health and neurology. The aim of this study was to determine a correlation of the S-LANSS score, clinical neurological examination (CNE) findings and magnetic resonance imaging (MRI) reports in the diagnosis of LSR among patients who presented with low back and referred leg symptoms. The study was conducted in three phases. In phase one, two systematic literature reviews were conducted; firstly, to establish the evidence-based accuracy of CNE in diagnosing LSR, and secondly, to establish the evidence-based accuracy of MRI in diagnosing LSR. In both systematic literature reviews, the diagnostic tests accuracy (DTA) protocol was used in planning, design and execution of literature search, selection of relevant studies, quality assessment, data analysis and presentation of the results. In phase two, clinical validation of an adopted S-LANSS scale and lumbar MRI reporting protocol were established, and a standardised evidence based lumbar CNE protocol developed.The face and content validity of the original S-LANSS score was established among a sample of Kenyan physiotherapists and patients who presented with low back and referred leg symptoms, using both quantitative and qualitative research designs. This was followed by a test-re-test reliability study on the adapted version of the S- LNASS score. The face and content validity of the adopted lumbar MRI reporting protocol was established among a sample of Kenyan radiologists followed by an inter-rater reliability. An evidence-based lumbar CNE protocol was developed; standardised and inter-examiner reliability was also examined among a sample of Kenyan physiotherapists. Finally, in phase three, a cross-sectional blinded validity study was conducted in six different physiotherapy departments. Participants (patients, physiotherapists and radiologists) were recruited using strict in- and exclusion criteria and data was collected using a pain and demographic questionnaire, the S-LANSS scale, the CNE protocol, the Oswestry Disability Index (ODI) and the MRI lumbar spine reporting protocol. Data was captured, cleaned and analysed using SPSS version 21. Descriptive analysis was done using frequencies, means and percentages, while inferential analysis was conducted using Spearman’s rank correlation coefficient test r to establish the correlation between the diagnostic tests. Cross tabulations, receiver operating curves (ROC) and scatter plots were used to establish the sensitivity and/or specificity of S-LANSS scale and individual CNE tests as defined by MRI. In phase three, which formed the main study of the research project, a total of 102 participants were recruited in this study with a gender distribution of 57% females and 43% males. The majority (67%) had neuropathic pain according to the S-LANSS scale and their pain intensity ranged from moderate (4-6) to severe (7-9) as recorded on a Numeric Pain rating Scale (NPRS), and was more common among manual workers. Similarly, patients whose pain had a neuropathic component had moderate to severe disability. The S-LANSS scale and lower limb neuro-dynamic tests were the most sensitive tests 0.79 and 0.75 respectively, while deep tendon reflexes were the most specific tests (0.87). The S-LANSS and CNE correlated fairly but significantly with MRI (r=0.36, P=0.01).LSR is a common condition and its assessment and diagnosis remains a clinical challenge among physiotherapists. MRI is a high-cost diagnostic tool but is being used by many clinicians in making decisions regarding the management of patients. Rapid and low-cost neuropathic pain screening by the use of the S-LANSS scale, together with use of evidence-based CNE of neuro-conduction and neuro-dynamic tests may be used in confirming nerve-root related MRI findings. These may be used in making a decision on whether to manage a patient conservatively using pharmacological agents and manual physiotherapy and therapeutic exercise, or consider surgery in the initial management of patients with clinical suspicion of LSR. This is especially valuable in the resource-poor settings like Kenya and other sub-Saharan African countries where MRI is costly or unavailable.

Patients admitted with spinal injuries following trauma require careful serial examinations to detect any neurological deficit that may develop. Thorough documentation of the findings is of paramount importance. Enforced working practice within the NHS means that these patients are often assessed by different members of staff with varying levels of experience, thus inconsistent documentation can be a cause for concern. The project aim was to design a Human Computer Interface to standardise the performance and documentation of serial neurological examinations in patients with spinal injury, allowing the user to accurately detect any neurological deterioration. A prototype system was developed for ward based PC’s incorporating the essential requirements of the neurological examination. Usability testing was performed on the prototype by recruiting fifteen users who would be expected to routinely perform the neurological examination on spinal injury patients. Usability was defined by a number of well defined goals (impression, efficiency, learnability, memorability, safety and effectiveness) and methods used in the evaluation included direct observation during completion of tasks, a questionnaire and unstructured interview. Both quantitative and qualitative data was collected. This data was subsequently analysed using descriptive and inferential methods. The results of the analysis showed that the users responded favourably to the prototype in respects to the all usability goals except efficiency. This lack of efficiency was expected due to the rigid nature of computer based systems compared to paper based methods of recording data but this disadvantage was more than compensated for by the increased patient safety that the system would provide. It can be concluded from the usability testing that the prototype achieves the aims of the project but further work is required in developing the prototype into a final interface design before beta testing in a clinical environment can be considered.

Thesis (Ph. D.)--University of California, San Diego, 2006.
Title from first page of PDF file (viewed September 20, 2006). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references.

Dissertação de Mestrado Integrado em Medicina Veterinária
A integridade do sistema nervoso pode ser avaliada através de um exame neurológico completo, realizado com o intuito de averiguar se o sistema nervoso se encontra afectado num animal com um quadro sintomatológico suspeito. O contributo do exame neurológico completo na dedução fiável da localização de lesões neurológicas em doentes caninos é possível tendo como base o conhecimento da anatomia do sistema nervoso e da sua funcionalidade, bem como conjunto de sinais clínicos apresentados e a sua resposta aos testes realizados de modo sistemático. É sumarizada a informação necessária para a elaboração do exame neurológico e sua interpretação crítica, tornando possível a elaboração de um diagnóstico neuro-anatómico e tratamento adequados. O exame neurológico compreende os seguintes passos: avaliação do estado de consciência e comportamento, atitude e postura, tónus e massa musculares, reflexos espinhais, nervos cranianos, palpação, percussão e resposta do doente a estímulo doloroso. O Sistema Nervoso Central é constituído pelo cérebro e medula espinhal e o Sistema Nervoso Periférico pelos sistemas aferentes somático, visceral e proprioceptivo e eferentes somático e visceral. A apresentação e discussão dos casos clínicos da espécie canina acompanhados e o diagnóstico neuro-anatómico realizado são feitos com base no conhecimento adquirido, no exame neurológico e nos exames complementares de diagnóstico.
ABSTRACT - APPROACH TO THE NEUROLOGICAL PATIENT AND NEUROLOGIC LESION - The integrity of the nervous system can be evaluated through a systematic approach and complete neurological examination, thus confirming the presence of a lesion in a patient with concurrent clinical signs. A thorough neurological examination in the dog and its value in determining the presence of a lesion and its location is made based on the anatomy of the nervous system, the clinical picture of the patient and the examination results. The knowledge necessary to perform the neurological examination and to correctly interpret it is presented in this monography, aiding the reader to make a valuable diagnosis for a proper treatment. The neurological examination consists of the following steps: evaluation of behavior and level of consciousness, attitude and posture, tone and muscle mass, spinal reflexes, cranial nerves, palpation, percussion and the patient´s perception to pain. The Central Nervous System is composed of the brain and spinal cord and the Peripheral Nervous System is divided into functional systems: somatic afferent, visceral afferent and proprioceptive, somatic and visceral efferent. A presentation and discussion of neurologic cases and subsequent neurolocalization of lesions is made based on the knowledge previously acquired and on the neurological and ancillary examinations performed. LOCALIZATION IN THE DOG

Bakgrund: Smärtor i ben är vanligt förekommande och neuropati (nervskada) är en orsak som troligen är underdiagnostiserad. Bimanuell (tvåhändig/tvåsidig) nervpalpation och känseltest med sporre har visat sig vara ganska tillförlitliga och enkla test för att hitta nervskada men har inte testats på friska individer.

Syfte: Syftet var att undersöka om bimanuell nervpalpation i fossa poplitea framkallar smärta/obehag och om det finns skillnad mellan vänster och höger sida vid bimanuell undersökning med sporre på underben hos friska försökspersoner.

Metod: Ett bimanuellt palpationstest av nervi tibialis och peroneus i fossa poplitea och även ett bimanuellt känseltest med sporre över dermatomen L4, L5 och S1 på underben genomfördes. Urvalet var ändamålsenligt och totalt deltog 37 försökspersoner. Åldersspannet var 20 till 57 och medianålder 23.

Resultat: Vid palpationstestet hade intensiteten av smärta/obehag en median på 1 (variationsvidd 3) på den 11 gradiga skalan. En stor del skattade olika mellan sidorna i både palpationstestet (11 av 37) och känseltestet med sporre (25 av 37). Det var inte någon större skillnad mellan könen.

Slutsats: När man utför dessa nervtester måste man ta hänsyn till att även friska individer ofta anger en liten sidoskillnad och inte alltid skattar noll vad gäller smärta/obehag. Det behövs dock fler studier för att bekräfta dessa resultat.

Background: Leg pain is common and neuropathy (nerve disease) is one reason which probably is under diagnosed. Bimanual (bilateral) nerve palpation and sensory test with spurs has been shown to be quite reliable. Furthermore, the tests are straight forward detecting nerve disease but have not been tested on a healthy population.

Purpose: The purpose was to investigate whether peripheral nerve palpation in fossa poplitea induces pain/discomfort, and if side difference exists in a sensibility test with spurs on the lower leg in healthy subjects.

Method: A bimanual palpation test of the tibial and peroneal nerve in fossa poplitea and also a bimanual sensibility test with spurs of dermatome L4, L5 and S1 on the lower leg were carried out. In order to find healthy subjects a purposive sampling was made. A total of 37 subjects between 20 and 57 years with a median age of 23 participated in the study.

Results: At the palpation test the intensity of pain/discomfort had a median of 1 (range 3) in the 11 degrees of pain scale. A large part estimated differences between the sides in both the palpation test (11 of 37) and the sensibility test with spur (25 of 37). There was no significant difference between the sexes.

Conclusion: When performing these nerve tests it is important to keep in mind that even healthy individuals might perceive some pain/discomfort as well as side difference. However, we need more studies to confirm these results.

Introdução: O aperfeiçoamento da assistência pré-natal e neonatal contribuiu para maior sobrevida dos recém-nascidos com riscos para alterações do desenvolvimento. A detecção precoce e eficaz destes riscos é fundamental para a intervenção oportuna e minimização dos danos funcionais. A avaliação com melhor valor preditivo para anormalidades é pelos General Movements (GMs), porém a mais utilizada no Brasil é a Escala Motora Infantil de Alberta (EMIA). Objetivo: Verificar a validade dos GMs e da EMIA com um e três meses de idade para predizer o desfecho do desenvolvimento motor pela EMIA aos seis e 12 meses. Método: Estudo observacional longitudinal com 45 recém-nascidos e lactentes do Hospital Universitário da Universidade de São Paulo, avaliados do nascimento até os cinco meses de idade (corrigida, se prematuros) pelos GMs, e de um a 12 meses pela EMIA. Foi realizada análise descritiva e testes de kappa e curva roc para a comparação entre as avaliações. Resultados: Os participantes (masculino = 51,1%) apresentaram idade gestacional média de 34 semanas; 57,7% apresentaram alteração em pelo menos uma avaliação pelos GMs, com predomínio do repertório pobre (RP) e fidgety movements (FM) ausentes, enquanto 46,6% apresentaram alguma alteração na EMIA. A maioria (85,7%) apresentou avaliações normais aos 12 meses de idade pela EMIA; e os com avaliações anormais também tiveram GMs alterados em toda sua trajetória. Houve pobre confiabilidade entre os GMs e a EMIA no primeiro (kappa: 0,165) e no terceiro mês, ligeira confiabilidade (kappa: 0,259). Comparando os writhing movements (WM) com a EMIA com um mês, para prever desfecho aos seis meses de idade, foi encontrado uma sensibilidade dos WM de 78,6% e uma especificidade de 100%. Valores melhores de sensibilidade e especificidade também foram encontrados nos WM para desfecho com 12 meses de idade (sensibilidade de 75% e especificidade em 100%). Os lactentes que apresentavam alguma alteração nas avaliações eram encaminhados para fisioterapia. Conclusão: Foi possível observar um grande número de participantes com GMs alterados, porém com diminuição/normalização nas avaliações pela EMIA, podendo ser devido a intervenção fisioterapêutica nos casos mais graves. A avaliação com melhores valores para predição do desenvolvimento são os GMs na fase dos WMs. Não existe correlação entre a avaliação dos GMs com 1 mês e EMIA 1 com mês, nem entre estes dois métodos aos 3 meses
Introduction: Improvement of prenatal and neonatal care has contributed to a greater survival of newborns with risks for developmental disorders. Early and effective detection of these risks is essential for timely intervention and minimization of functional impairment. The most predictive value for abnormalities is the General Movements (GMs), but the most used in Brazil is the Alberta Infant Motor Scale (AIMS). Objective: To verify the validity of GMs and EMIA at one and three months of age to predict the outcome of motor development by EMIA at six and 12 months. Method: A longitudinal observational study with 45 newborns and infants of the University Hospital of the University of São Paulo, evaluated from birth to five months of age (corrected, if premature) by GMs, and from one to 12 months by EMIA. Descriptive analysis and kappa and roc curve tests were performed to compare the evaluations. Results: Participants (male = 51.1%) had a mean gestational age of 34 weeks; 57.7% presented alterations in at least one evaluation by GMs, with a predominance of poor repertoire (RP) and fidgety movements (FM) absent, while 46.6% had some alteration in EMIA. The majority (85.7%) presented normal evaluations at 12 months of age by EMIA; And those with abnormal ratings also had altered GMs throughout their trajectory. There was poor reliability between GMs and EMIA in the first (kappa: 0.165) and in the third month, slight reliability (kappa: 0.259). Comparing writhing movements (WM) with EMIA at one month, to predict outcome at six months of age, a WM sensitivity of 78.6% and a specificity of 100% was found. Better sensitivity and specificity values were also found in WM for 12-month-old outcome (75% sensitivity and 100% specificity). Infants who presented some alterations in the assessments were referred to physical therapy. Conclusion: It was possible to observe a large number of participants with altered GMs, but with a decrease / normalization in the evaluations by EMIA, and may be due to physiotherapeutic intervention in the most severe cases. The best predictive values for development prediction are GMs in the WM phase. There is no correlation between the evaluation of GMs at 1 month and EMIA 1 with month, nor between these two methods at 3 months

Увод: Процена минималних неуролошких дисфункција (МНД) пружа информације о неуролошком стању детета, помаже у идентификовању вулнерабилности детета ка развоју моторних слабости, тешкоћа у учењу или поремећаја понашања. Деформитети кичменог стуба код деце предшколског узраста су у сталном порасту. Циљ истраживања: Утврђивање преваленце МНД-а у узорку предшколске деце тестирањем по Touwen-у, евалуација постуралног статуса код деце предшколског узраста, као и утврђивање повезаности јављања минималних неуролошких дисфункција и постуралних поремећаја код деце предшколског узраста. Материјал и методе: Истраживање је урађено у предшколској установи „Радосно детињство“ из Новог Сада. Укупан узорак је обухватио 120-оро деце која су подељена у две групе у односу на узраст, 60-оро деце старости од 6 до 7 година (група А) и 60-оро деце старости од 5 до 6 година (група Б). Методом случајног избора су изабрана три вртића из различитих делова града, а деца су насумично одабрана са приближно једнаком заступљеношћу пола. Тестирање је урађено са Touwen-овим тестом модификованим од стране Hadders-Algre. Резултати су груписани у три групе: одсуство, присуство једноставних (присуство једне или две области дисфункције) и присуство комплексних МНД (присуство најмање три области дисфункције). Код све деце урађена је евалуација постуралног статуса, као и антропометријска мерења. Резултати: Постоји статистички значајна разлика у учесталости јављања МНД-а у односу на узраст, одступања су чешће присутна у млађем узрасту. МНД се чешће јављају код дечака у односу на девојчице, али није показана статистички значајна разлика. Код 68,3% деце уочени су елементи лошег држања тела. Најчешћа одступања од нормалног постуралног положаја била су у виду спуштених стопала (45,8%), асиметрије висине рамена (35%), искривљења ахилових тетива ван (30%), повећања слабинске кривине (29,2%) и асиметрије троуглова стаса (20%). Утврђена је статистички значајна позитивна повезаност између јављања минималних неуролошких дисфункција и лошег држања тела код деце предшколског узраста. Закључак: Деца старијих (узраст од 5 до 6 година) група предшколског узраста знатно чешће испољавају знаке минималне неуролошке дисфункције у односу на децу најстаријих (узраст од 6 до 7 година) група. Више од половине деце предшколског узраста показује одступање од нормалног постуралног статуса. Постоји статистички значајна позитивна повезаност између јављања минималних неуролошких дисфункција и лошег држања тела код деце предшколског узраста.
Uvod: Procena minimalnih neuroloških disfunkcija (MND) pruža informacije o neurološkom stanju deteta, pomaže u identifikovanju vulnerabilnosti deteta ka razvoju motornih slabosti, teškoća u učenju ili poremećaja ponašanja. Deformiteti kičmenog stuba kod dece predškolskog uzrasta su u stalnom porastu. Cilj istraživanja: Utvrđivanje prevalence MND-a u uzorku predškolske dece testiranjem po Touwen-u, evaluacija posturalnog statusa kod dece predškolskog uzrasta, kao i utvrđivanje povezanosti javljanja minimalnih neuroloških disfunkcija i posturalnih poremećaja kod dece predškolskog uzrasta. Materijal i metode: Istraživanje je urađeno u predškolskoj ustanovi „Radosno detinjstvo“ iz Novog Sada. Ukupan uzorak je obuhvatio 120-oro dece koja su podeljena u dve grupe u odnosu na uzrast, 60-oro dece starosti od 6 do 7 godina (grupa A) i 60-oro dece starosti od 5 do 6 godina (grupa B). Metodom slučajnog izbora su izabrana tri vrtića iz različitih delova grada, a deca su nasumično odabrana sa približno jednakom zastupljenošću pola. Testiranje je urađeno sa Touwen-ovim testom modifikovanim od strane Hadders-Algre. Rezultati su grupisani u tri grupe: odsustvo, prisustvo jednostavnih (prisustvo jedne ili dve oblasti disfunkcije) i prisustvo kompleksnih MND (prisustvo najmanje tri oblasti disfunkcije). Kod sve dece urađena je evaluacija posturalnog statusa, kao i antropometrijska merenja. Rezultati: Postoji statistički značajna razlika u učestalosti javljanja MND-a u odnosu na uzrast, odstupanja su češće prisutna u mlađem uzrastu. MND se češće javljaju kod dečaka u odnosu na devojčice, ali nije pokazana statistički značajna razlika. Kod 68,3% dece uočeni su elementi lošeg držanja tela. Najčešća odstupanja od normalnog posturalnog položaja bila su u vidu spuštenih stopala (45,8%), asimetrije visine ramena (35%), iskrivljenja ahilovih tetiva van (30%), povećanja slabinske krivine (29,2%) i asimetrije trouglova stasa (20%). Utvrđena je statistički značajna pozitivna povezanost između javljanja minimalnih neuroloških disfunkcija i lošeg držanja tela kod dece predškolskog uzrasta. Zaključak: Deca starijih (uzrast od 5 do 6 godina) grupa predškolskog uzrasta znatno češće ispoljavaju znake minimalne neurološke disfunkcije u odnosu na decu najstarijih (uzrast od 6 do 7 godina) grupa. Više od polovine dece predškolskog uzrasta pokazuje odstupanje od normalnog posturalnog statusa. Postoji statistički značajna pozitivna povezanost između javljanja minimalnih neuroloških disfunkcija i lošeg držanja tela kod dece predškolskog uzrasta.
Introduction: Assessment of minor neurological dysfunction (MND) provides information about a child's neurological condition, which helps to identify the vulnerability of the child to the development of motor impairment, difficulties in learning or behavioral disorders. Spinal deformities in preschool children are constantly increasing. Aim: Determining the prevalence of MND in a sample of preschool children using Touwen’s test, the evaluation of postural status in preschool children, as well as determining the relation between the occurrence of minor neurological dysfunction and postural disorders in preschool children. Material and methods: The examination was carried out in the preschool institution “Radosno detinjstvo” in the city of Novi Sad. The total sample included 120 children who were divided into two groups according to their age, 60 children aged 6 to 7 years (group A) and 60 children aged 5 to 6 years (group B). The children were recruited at three randomly selected kindergartens, and the children were randomly selected with approximately equal gender representation. The testing was done with Touwen's test modified by Hadders-Algra. The results were classified into three groups: the absence of MND, the presence of simple MND (presence of one or two domains of dysfunction) and the presence of complex MND (presence of at least three domains of dysfunction). Evaluation of postural status and anthropometric measurements were carried out for all the children. Results: There is a statistically significant difference in the prevalence of MND in relation to age, variations were more likely at a younger age. MND is more frequent in boys than in girls, but this difference is not statistically significant. In 68.3% of the children there are elements of bad posture. The most common deviations from the normal postural position are flat feet (45.8%), shoulder height asymmetry (35%), distortion of Achilles tendons to the outside (30%), excessive curvature of lower back (29.2%) and asymmetry of stature triangles (20%). There is a statistically significant positive correlation between the occurrence of minor neurological dysfunction and poor posture in children of preschool age. Conclusion: Children in older preschool groups (5 to 6 years old) more often show signs of minor neurological dysfunction in comparison to the children in the oldest groups (6 to 7 years old). More than half of the preschool children show deviation from normal postural status. There is a statistically significant correlation between the occurrence of minor neurological dysfunction and poor posture in children of preschool age.

Theory of mind is the ability to have mental states about mental states. Among theories concerning the structure and role of theory of mind is the view that theory of mind is the cognitive component of empathy. It is proposed that there is partial dissociation within theory of mind between emotional state representation and non-emotional state representation. In trying to test this hypothesis, an instrument was developed and implemented in a pilot study. Current theory of mind tests are reviewed and design features discussed in relation to the new hypothesis. The instrument aims to measure emotional and non-emotional state representation on separate subscales, as well as coding representations from emotional stories and non-emotional stories separately. The instrument was administered to 33 third level or higher students from the University of KwaZulu-Natal. Groups were chosen from science major (n = 9) and humanities major (n = 24) students. The findings fail to show the group performance patterns reported in literature, for example that humanities students tend to score higher in ToM tests than science students. A number of factors might contribute to the finding, but principally, low sample size and unequal general cognitive ability between groups are proposed as vital. Problems with the pilot study are identified and improvements suggested for subsequent testing.
Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2010.

碩士
中臺科技大學
醫療暨健康產業管理系碩士班
101
Objective: If you have had TBI(Traumatic Brain Injury), it can cause brain to retrogress factor, though right now do not have obvious symptoms but it is not meant your brain nerve function well. Due to this we can detect from patient deep tissue of brain to produce delta wave change by MEG (Magnetoencephalographic) further more for it location to early understand stroke, idiotic epilepsy evoke magnetic field changed. This study will to probe into the evaluation of brain neurological examination by MEG on high level health examination. Method: Random sampling by questionnaire to statistics and analysis from sampling characters and basic information. Result: Of 118 effective questionnaire to statistics and analysis, 25% of interviewee will accept MEG examination due to family illness history and 20% for privacy. Those interviewee have 86% willing to have MEG examination and 36% will care of MEG accuracy and safety. The others will be from friends and family who have suddenly brain disease and family illness history each of them are 34%. Conclusion: This study presented of patients to be certain of high level health examination and MEG examination but the MEG examination fee is expensive, we sincerely wish high level health examination institution can deliberate consider the charge of MEG examination, due to the charge will affect to accept MEG examination willing, meanwhile we strongly recommend our government for the populace point of view put MEG examination into reimbursement for routine clinic examination, if so it will benefit the public.

Présentement, le diagnostic d’otite moyenne-interne chez le veau est basé sur la présence de signes cliniques appropriés ainsi que les tests diagnostiques tels que la radiographie et la tomodensitométrie. L’objectif de cette étude prospective était d’évaluer les valeurs prédictives de l’examen neurologique, l’examen otoscopique et le test des potentiels auditifs évoqués (PAE) dans le diagnostic d’otite moyenne-interne chez le veau, en utilisant la tomodensitométrie comme test standard. Le deuxième objectif était de définir les valeurs de référence pour le PAE chez le veau normal et d’en décrire les anomalies chez des veaux atteints d’otite moyenne-interne. Dix-sept veaux de race Holstein entre 5-7 semaines d’âge ont été inclus. Tous les veaux ont eu un examen neurologique, un examen otoscopique et une évaluation des PAEs. Les veaux ont été tranquillisés avec de la xylazine intraveineuse (0,05-0,15mg/kg) pour la tomodensitométrie des bulles tympaniques afin d’évaluer pour la présence d’otite moyenne-interne. Selon les résultats de la tomodensitométrie, 11 des 17 veaux étaient atteints avec otite moyenne, 4 de façon unilatérale et 7 bilatéralement. Cinq ondes ont été identifiées de façon constante sur les tracés des PAEs des 6 veaux normaux. Les valeurs positives prédictives pour le PAE, l’examen neurologique et l’examen otoscopique étaient 94,7%, 91,7% et 66,7% respectivement. D’un point de vue clinique, le test le plus fiable dans le diagnostic d’otite moyenne-interne chez le veau est le PAE. Les anomalies ont été observées au PAE avant le développement des signes neurologiques chez certains veaux.
Currently, the antemortem diagnosis of otitis media-interna is based upon the presence of appropriate clinical signs and adjunctive diagnostic imaging including radiography and computed tomography. The purpose of this prospective study was to evaluate predictive values of neurological examination, otoscopic examination and BAER in calves for the diagnosis of otitis media-interna using computed tomography as the gold standard. The second objective was to define BAER reference values in normal calves and to describe BAER abnormalities in calves affected with otitis media-interna. Seventeen Holstein calves between 5 and 7 weeks of age were included. All calves had a neurological examination, otoscopic examination and BAER. Calves were sedated with intravenous xylazine (0.05-0.15 mg/kg [0.02-0.07 mg/lb]) for computed tomography of the tympanic bullae to evaluate for the presence of otitis media-interna. Based upon computed tomographic results, 11 of 17 calves were affected with otitis media, 4 unilaterally and 7 bilaterally. Five waveforms were consistently identified on BAER traces from 6 normal calves. The positive predictive value of BAER, neurological examination and otoscopic examination were 94.7%, 91.7% and 66.7% respectively. Clinically, the most reliable non-invasive diagnostic test to diagnose otitis media-interna in the calf is the BAER. Abnormalities were observed on BAER before the development of neurological deficits in approximately 40% of calves allowing earlier diagnosis.

碩士
嶺東科技大學
財經法律研究所
104
Owing to becoming aging society of my country and over expenditure of futile medical care, Central Institute of Health should change attitudeof people health care. We have to set up seamless medical network by combining different kind disease with related medical law. Therefore, it not only decrease social problem but also increase manpower and country competition. It is essential for our country to make the most of limit medical resource. It costs 309 hundred million Taiwan dollars for dying people（ one year before death ）each year. Among 80% of that, it is for patient in half a year before death. Much of money is for futile medical care. As if all of money were saved for preventing disease, taking care of disability and dementia patient, financial problem of “Patient Self-Determination Act”and “Long-Term Care Act” could be solved. Hospice and palliative care has already been recognized in the whole wide world. The idea for managing terminal illness patient has gradually been changed from cure to healing. It should emphasize patient’s quality of life from body and soul. The “Hospice Palliative Care Act”was enacted only for taking care of terminal illness patient. But the definition of terminal illness is not clear and easily makes people confused, medical doctor also have difficulty to abide by the law. The thesis suggests that National Institute of Health Stroke Scale （NIHSS）could be useful to evaluate neurological function affected by disease .The self-determination right is priority for patient in the terminal stage. On the contrary, right to life should be protected by government as patient is not compatible with the definition of terminal illness. The definition of terminal illness is too narrow and will influence benefit of the patient. The government could offense the law of protection of right to life if the definition of terminal illness becomes very relaxed. Both “Hospice Palliative Care Act”and “Patient Self-determination Act” are related to terminal illness patient so that it is very important to have clear definition of terminal illness. Hence, the thesis recommends that Central Institute of Health makes some proper modification of terminal illness definition to satisfy with most of the people.

碩士
國立臺灣大學
臨床動物醫學研究所
103
The neurological examination is crucial for clinicians to identify neurological problems, and obtain anatomical diagnosis. However, the reliability and accuracy of the neurological examination has not been fully established in many species. Cats and rabbits are especially difficult to handle, and results obtained from the neurological examination in these two species are often uncertain and inconsistent between examiners. Based on clinical experience, the author also notices that the agreement between neuro-localization based on examination and lesion location obtained from further diagnostic modalities is sometimes not ideal in feline patients. The purpose of the present study was to evaluate the feasibility and reliability in normal cats and rabbits, aiming to provide a revised neurological examination that produces more accurate results. In addition, the agreement between neuro-localization obtained from neurological examination and lesion location identified on MR images in feline patients were evaluated. Fifty-five cats and thirty-four rabbits were included in the first and second part of study. In both species, several tests were identified as poor either in feasibility or reliability. Specific methods producing higher reliability in certain tests were identified. The agreement between neuro-localization obtained from neurological examination and lesion location identified on magnetic resonance images was assessed in 73 cats with neurological diseases. The overall agreement was relatively low, especially in cases with a multifocal neuro-localization. Regarding individual neuro-localizations, agreement was high in the peripheral nervous system and forebrain. Based on the results, clinicians should bear in mind that the neurological examination may be misleading, and there may be a certain degree of mismatch between neuro-localization and lesion location. Identifying and performing reliable tests with suitable methods may increase the accuracy of the neurological examination in obtaining correct anatomic diagnosis.

Huntington’s disease (HD) is an autosomal dominant neurodegenerative disorder. The earliest and most severe neuropathological change in HD occurs within the striatum. Exogenous excitotoxic lesioning of the rodent and non-human primate (NHP) striatum is used to model HD. Apart from NHPs, no other excitotoxic large animal model of HD has been established. Sheep have the potential to be an important species for modelling neurodegenerative disease, primarily because of neuroanatomical similarities between the sheep and human brain. This thesis describes the development of an excitotoxic sheep model of HD using the excitotoxin, quinolinic acid (QA). QA is an N-methyl-D-aspartate (NMDA) glutamate receptor agonist that produces pathological changes within the striatum that resemble those seen in HD. Sixteen castrated-male, 18 month old, Merino-Border Leicester cross sheep underwent two surgical procedures, four weeks apart, to infuse 75 μl of 180 mM QA (experimental group) or 75 μl of saline (control group) into the left (first surgery) and then the right (second surgery) caudate nucleus of the striatum. Longitudinal magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) of the brains of the sheep was performed on a 3-Tesla scanner pre-surgically, one week after the first surgery, five weeks after the first surgery and sixteen weeks after the first surgery to investigate the neuropathological changes that occur in vivo after QA lesioning of the sheep striatum. The phenotypic consequences of lesioning the sheep striatum with QA were investigated using a veterinary neurological examination, dopamine agonist induced rotation and a two-choice discrimination task. The author / investigator was blind to the treatment group. MRI revealed QA-lesion hyperintensity and dilation of the lateral ventricles, consistent with atrophy of the caudate nucleus. MRS and DTI revealed a significant decrease in the neuronal marker N-acetylaspartate (NAA), and in fractional anisotropy (FA) in the acutely-lesioned (one week after surgery) striatae of the QA-lesioned sheep, followed by recovery in NAA and a significant increase in FA in the chronic (five to sixteen weeks) QA-lesioned striatae. NAA and FA changes are consistent with neuronal loss and structural disruption in the acute lesion, followed by recovery of reversibly impaired neurons, structural reorganisation and gliosis in the chronic lesion. Heterogeneous neuronal loss and damage and gliosis were visible on histological analysis of the QA-lesioned sheep striatae, supporting the in vivo MRS and DTI detected changes. Neurological examination of the sheep revealed evidence of laterality and mild hind limb motor paresis in seven out of eight of the QA-lesioned sheep, however the examination was not informative of lesion characteristics. A directional bias was evident in the QA-lesioned sheep during rotation studies. However, the direction and magnitude of bias in individual sheep at any one timepoint varied markedly, making identification of QA-lesioned individuals difficult. There was no difference between the QA-lesioned and saline-treated sheep in performance of the acquisition and reversal phases of the two-choice discrimination task. The behavioural studies described in this thesis were not suitable for comprehensive identification and characterisation of QA lesions in the striatum of sheep. This is the first description of the development of an acute excitotoxic sheep model of HD. The experiments demonstrate that longitudinal analysis of the neuropathological changes in the QA-lesioned sheep striatum is possible using advanced magnetic resonance modalities performed on a clinically relevant 3-Tesla scanner and that neuropathological changes are consistent with HD-like pathology in other species. Furthermore, phenotypic investigation of the QA-lesioned sheep is possible, however more refined methods than those described need to be utilised. The excitotoxic sheep model of HD is clinically relevant HD model with potential for use in disease mechanism and therapy investigations.
Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2020

Dissertação de Mestrado em Direito: Especialidade em Ciências Juridico-Forenses apresentada à Faculdade de Direito
A evolução científica tem trazido importantes contributos para o desenvolvimento de várias ciências, desde a medicina ao Direito. No Direito, a ciência muito tem contribuído para uma melhor investigação e, por essa via, para a descoberta da verdade material. A ciência pôs à disposição do processo penal poderosos instrumentos, desde os exames de ADN até aos aparelhos de gravação e de escuta telefónica, sem esquecer os meios de captação de imagens. Aproveitar a evolução científica para alcançar a descoberta da verdade no processo penal, compatibilizando-a com a defesa dos direitos fundamentais dos cidadãos, no respeito pela dignidade humana, é o caminho que deve ser seguido.É neste quadro que se insere o exame neurológico P300, o qual pode incluir-se na categoria das provas científicas, tal como o exame de ADN e o teste do álcool. O exame P300 foi utilizado no âmbito do processo penal noutros países (EUA, Espanha, Grécia e Índia), impondo-se abordar a sua natureza jurídica e analisar a sua viabilidade no processo penal português, curando de saber se e em que medida a sua utilização poderá pôr em causa direitos fundamentais, nomeadamente o direito à integridade pessoal, direito à reserva da intimidade da vida privada, direito à liberdade, direito ao desenvolvimento da personalidade, dando especial atenção ao princípio nemo tenetur se ipsum accusare, abordando a definição, fundamentos e delimitação subjetiva e material (fazendo referência aos diversos critérios de delimitação elaborados pela Doutrina e Jurisprudência).
The Scientific evolution has been bringing important contributions to the development of many sciences, from medicine to Law.In Law’s domain, science has been contributing to a much better investigation and thus to the discovery of real truth.Science has provided powerful tools to the criminal process, from DNA tests to recording and telephone listening devices, and also the means of capturing images.The way to follow is to take advantage of scientific evolution, to achieve the discovery of the truth in criminal proceedings, making it compatible with the defense of citizens' fundamental rights, while respecting human dignity.It is within this framework that the P300 neurological examination appears, which can be included in the scientific evidence category, such as the DNA and the alcohol tests. The P300 test was used in criminal proceedings in other countries (United States of America, Spain, Greece and India) and it is necessary to examine its legal nature and analyze its feasibility in Portuguese criminal proceedings, in order to determine whether, and to what extent, its use could jeopardize fundamental rights, in particular the right to personal integrity, the right to privacy, right to freedom, right to development of personality with particular emphasis to the principle nemo tenetur se ipsum accusare, addressing the definition, fundamentals and subjective contour and material (making reference to various criteria of delimitation drawn up by doctrine and jurisprudence).