Hospital of Sobrapar

The neurological examination has evolved from rudimentary clinical observations in ancient civilizations to a structured and indispensable tool in modern medical diagnostics. Early contributions from Hippocratic medicine emphasized the brain as the seat of cognition and introduced systematic observation of neurological signs. In the 19th century, figures such as Jean-Martin Charcot, Wilhelm Erb, William Gowers, and Joseph Babinski established the foundations of the modern neurological exam through anatomoclinical correlations, standardization of reflex assessment, and structured clinical reasoning. Throughout the 20th century, seminal textbooks-such as those by Mills, McKendree, DeJong, and Wartenberg-helped consolidate and disseminate neurological semiology globally. More recently, evidence-based approaches, exemplified by Steven McGee's work, have introduced statistical rigor to bedside examinations. Despite advances in neuroimaging and electrophysiology, examinations remain a cornerstone of clinical neurology, guiding diagnosis, promoting cost-effective care, and reinforcing the doctor-patient relationship.

Abstract Disclosure: D. Ribeiro: None. A. Pinheiro: None. J. Lapenda: None. A. de Souza: None. V. Sano: None. F.A. Kelly: None. Effects of Dapagliflozin on Blood Pressure and Glycemic Control in Patients with Type 2 Diabetes on Combination Antihypertensive Therapy: A Systematic Review and Meta-AnalysisBackground: Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, is commonly used for glycemic control in type 2 diabetes (T2D). In T2D patients receiving combination antihypertensive therapy, the effect of dapagliflozin on blood pressure and glycemic levels is of particular interest. This trial aims to evaluate the impact of dapagliflozin versus placebo on blood pressure and glycemic control in T2D patients on combination antihypertensive therapy. Methods: A search was conducted across PubMed, Embase, and Scopus to identify randomized controlled trials (RCTs) and cohort studies comparing the effects of dapagliflozin versus placebo on blood pressure and glycemic levels in T2D patients receiving combination antihypertensive therapy. Data were analyzed using a random-effects model, with Mean Difference (MD) and Risk Ratio (RR) calculated along with 95% confidence intervals (CI). P values >0.10 and I² >25% indicated heterogeneity. Statistical analysis was performed using R, version 4.4.2. Results: Nine studies, involving 27,486 participants, were included, with 13,791 (50.17%) receiving dapagliflozin. Significant reductions were observed in seated systolic blood pressure (SBP) (MD: −4.45; 95% CI −6.91; −2.00; p = 0.0003) and seated diastolic blood pressure (DBP) (MD: −1.40; 95% CI −2.53; −0.27; p = 0.014) in the dapagliflozin group. Total body weight also decreased significantly (MD: −1.66; 95% CI −2.54; −0.78; p = 0.0002). A significant improvement in Glycated Hemoglobin (HbA1c) was noted (MD: −0.48; 95% CI −0.54; −0.41; p < 0.000001). However, no significant difference was observed in fasting plasma glucose (MD: −14.69; 95% CI −29.75; 0.38; p = 0.056) or serum uric acid levels (MD: −10.91; 95% CI −33.70; 11.87; p = 0.34). The risk of hypoglycemia was higher in the dapagliflozin group (RR: 2.32; 95% CI 1.11; 4.82; p = 0.024). No significant difference was found in volume depletion events (hypotension, dehydration, or hypovolemia), with an RR of 1.38 (95% CI 0.26; 7.28; p = 0.70; I²: 0%).Conclusions: This meta-analysis highlights the significant benefits of dapagliflozin in patients with T2D, particularly in improving key metabolic markers. Significant reductions in systolic and diastolic blood pressure, HbA1c, and body weight were observed, demonstrating its efficacy in managing both glucose levels and cardiovascular risk. Although no substantial effects were seen on fasting plasma glucose or serum uric acid levels, the positive impact on key parameters remains notable. However, the increased risk of hypoglycemia requires careful monitoring, ensuring dapagliflozin’s benefits are maximized while minimizing potential risks in clinical practice. Presentation: Monday, July 14, 2025

Introduction: Craniosynostosis is a group of diseases whose main characteristic is the premature fusion of one or more cranial sutures. They can be subdivided into non-syndromic and syndromic. The posterior vault distraction osteogenesis (PVDO) has become the standard procedure for managing the intracranial hypertension of these patients. The objective of this paper is to report the experience of the Sobrapar Hospital (Campinas, Brazil) in treating and following up on syndromic craniosynostosis patients subjected to PVDO and highlight the lessons learned throughout this process. Methods: The medical records of the patients treated at the Sobrapar Hospital between 2013 and 2023 were reviewed. Results: The total of patients initially candidates to PVDO was 79, and 75 of them proceeded to the surgery. The mean age of surgery was 8,16 months old (ranging from 4 months to 12 years old). The length of stay ranged from 2 to 14 days, with a mean of 3,29 days. The distraction achieved ranged from 13 mm to 30 mm, with a mean distance of 23 mm. The postoperative complications were mostly cutaneous. CSF leak occurred in 3 patients. Conclusion: PVDO provides a progressive formation of a vascularized bone, its intracranial volume expansion is greater than the FOA, increasing the posterior fossa’s size (even when the craniotomy is supratorcular) and it improves Chiari’s symptoms, even when the radiologic abnormalities are not necessarily solved. A specialized and multidisciplinary team is essential to improving the success rates of the surgery.

Introduction: Neuropsychological assessment evaluates the cognitive profile by identifying deficits and enabling monitoring. At HRAC-USP, patients with craniosynostoses undergo this assessment due to impacts on neuropsychomotor development (DNPM). These conditions may cause cranial fusion, restricting brain growth and adversely affecting cognitive functions. Evaluation is crucial for guiding therapeutic and surgical approaches and ensuring better outcomes. Objective: To identify how surgical procedures impact the neuropsychological profile of patients with syndromic and isolated craniosynostoses through a scoping review. Methodology: This scoping review was conducted in March 2024 using PubMed, Embase, BVS/Lilacs, and Scopus databases; 1,215 articles were found and 18 original articles (E1-18) in English were selected that addressed the question: "What is the impact of surgery on neuropsychological aspects in patients with craniosynostoses?" Results: Studies on craniosynostosis highlighted the predominance of isolated cases (83.3%), with surgeries performed before one year of age associated with better cognitive outcomes. The cranial expansion technique (38.8%) was effective in non-syndromic cases, while cranial remodeling showed varied results. After surgery, there were overall improvements in DNPM, but also risks of language delay and motor deficits, especially in patients operated on at older ages. Conclusion: Surgery for craniosynostosis can improve neuropsychological outcomes, especially when performed early and with appropriate surgical techniques. More invasive procedures may lead to better outcomes, including increased Total Intelligence Quotient and better academic performance. It is crucial to consider such factors to optimize outcomes, reduce neurodevelopmental risks, and continuously monitor language and executive functions.

As questões ambientais e as alterações climáticas tornaram-se o foco das agendas de todos os países e organizações. Da mesma forma, a indústria 4.0 e as tecnologias emergentes mudaram por completo a forma de interagir e estar no mundo, o que levou as empresas a terem de se adaptar para conseguir sobreviver e prosperar. Além disso, no último ano tais mudanças ainda foram mais acentuadas, devido à pandemia do Covid-19 e, num curto espaço de tempo, as pessoas, empresas e organizações tiveram de moldar-se à nova realidade. Este artigo científico objetiva compreender as mudanças, como se interligaram e afetam a vida de todos os governos, empresas e pessoas; tal como as transformações verde e digital, impactos, tendências, práticas mais corretas e ainda como é que as empresas adotaram estas transformações para impulsionar a internacionalização. Adicionalmente, relata como a pandemia do covid-19 e a mudança no comportamento dos stakeholders as influenciaram. DOI: https://doi.org/10.54663/2183-3826.2022.v8.n15.99-121

Visual impairment secondary to orbital and periorbital dysmorphology is frequent in Pfeiffer syndrome patients. The etiopathogenesis of this aberrancy, however, remains unclear. Untreated Pfeiffer syndrome patients (n = 31) and normal control subjects (n = 43) were compared. Craniometric and volumetric analyses related to the orbital and periorbital anatomy were performed using Materialise (Leuven, Belgium) software. Overall, orbital cavity volume of Pfeiffer patients is reduced by 28 percent (p < 0.001), compared to normal, starting before 3 months of age (p = 0.004). Globe volume was diminished by 10 percent (p = 0.041) before 3 months of age, yet tended to catch up thereafter. However, the retrobulbar soft-tissue volume remained smaller beyond 1 year of age (17 percent, p = 0.003). Globe volume projection beyond the bony orbit increased in all observed ages (82 percent, p < 0.001). The volumes of sphenoid bone, maxilla, and mandible proportionately were restricted by 24 to 25 percent (p = 0.003 to 0.035) before 3 months of age. The volume of maxilla and mandible gradually approximate normal; however, the sphenoid bone volume in Pfeiffer patients remains less than normal (p = 0.002) into childhood. The anteroposterior length of both the zygoma and the maxilla was reduced by 14 percent (p < 0.001). Anterior positioning of the zygoma is less by 23 percent (p < 0.001) in Pfeiffer patients overall, with anterior positioning of maxilla reduced similarly by 23 percent (p < 0.001). Pfeiffer syndrome patients develop decreased retrobulbar soft-tissue and globe volume, along with a restricted orbital cavity volume in infancy. Significant hypoplasia of the sphenoid bone is associated with more severe central facial (maxilla) retrusion, compared to lateral facial structures (zygoma). Risk, II.

This retrospective study evaluated the prevalence of dental anomalies of number in different subphenotypes of isolated cleft palate. The sample comprised 26 individuals with submucous cleft palate (group S) and 68 individuals with complete cleft palate (group C) aged between 9 and 12 years from a single centre. Panoramic radiographs were evaluated regarding the presence of dental anomalies of number in permanent teeth. Intergroup comparison was performed using chi-square tests (P < 0.05). Tooth agenesis was found in 34.61 and 36.76 per cent of group S and group C, respectively. The most commonly missing teeth were the maxillary second premolar, maxillary lateral incisor, and mandibular second premolar. Supernumerary teeth were found in none and 1.47 per cent of the individuals with submucous and complete cleft palate, respectively. No statistically significant difference was found between groups for the frequency of tooth agenesis and supernumerary teeth. Only dental anomalies of number were evaluated. Individuals with submucous and complete cleft palate showed similar prevalence for tooth agenesis and supernumerary teeth. Dental anomalies frequency seems not to be a discriminator for subphenotypes of cleft palate.