Average annual cost of Parkinson's disease in a Brazilian multiethnic population

INTRODUCTION

With the current demographic transition, it is estimated that by 2050 Brazil will have a population of 90 million people aged 60 years or more, and in parallel Parkinson's disease (PD) will bring a considerable economic burden to our society. Brazil is considered multiracial due to its colonization, generating important social and regional inequalities. Knowing the costs of the PD may aid to improve local public policies. However, in Brazil, no estimates of these values have been made so far.

OBJECTIVES

To evaluate direct, indirect, and out-of-pocket costs in Brazilian people with PD (PwP).

METHODS

Categorical and numerical data were collected through a customized and standardized cost-related-questionnaire from 1055 PwP nationwide, from 10 tertiary movement disorders centers across all Brazilian regions.

RESULTS

The estimated average annual cost of PwP was US$ 4020.48. Direct and indirect costs accounted for 63% and 36% of the total, respectively, and out-of-pocket costs were 49%. There were no evidence of differences in the total cost of PD across the regions of the country; however, differences were reported between the stages of the Hoehn and Yahr scale (H&Y).

CONCLUSION

This data suggests a considerable burden of PD for Brazilian society in general, not only for the public health system, but mainly for those with PD.

Analysis of brain death declaration process and its impact on organ donation in a reference trauma center

Objective

To characterize the processes of brain death diagnosis and organ donation in a reference trauma center.

Methods

Observational and cross-sectional study with patients notified with brain death at a reference trauma center. Data were obtained through the collection of medical records and brain death declaration forms.

Results

One hundred fity-nine patients were notified with brain death, mostly male (82.6%), young adults (97.61%) and victims of brain traumatic injury (93.7%). Median of the total time interval for the diagnosis of brain death was 20.75 hours, with no difference between organ donors and non-donors. We had excessive time intervals on brain death declaration, but without statistical effect on organ donation numbers.

Conclusion

We had low efficacy in brain death declaration based on longer time intervals, with no impact on organ donation.

Harbinger of storm: influence of Oliver Sacks on levodopa therapy in early 1970s

Most known by his literary ability, the words of the neurologist Oliver Sacks (1933-2015) also had an impact on scientific community about the role of levodopa on parkinsonisms. Different from the most authors and based on his experience described on the book "Awakenings", he had a pessimistic opinion about levodopa, which was related on many articles written by himself and colleagues in early 1970s. We reviewed the scientific contribution of Oliver Sacks associated to levodopa therapy on parkinsonisms, and how he advised caution with its complications before the majority of physicians.

Cytoarchitecture of nitrergic neurons in the human striatum and subthalamic nucleus

BACKGROUND

Nitric oxide (NO) is a gaseous molecule that modulates several physiological processes, including signal transmission in the central nervous system. There is evidence supporting NO as a major neurotransmitter involved in motor and emotion/behavior control. We investigated the distribution and morphology of nitrergic neurons in the two main input structures of the basal ganglia of human brain: the striatum and subthalamic nucleus.

METHODS

We studied samples of striatum (caudate and putamen) and subthalamic nucleus of 20 human brains from subjects without neurological/psychiatric diseases. The tissues were stained by histochemistry for nicotinamide adenine dinucleotide phosphate diaphorase activity and by immunohistochemistry for neuronal NO synthase (nNOS). Subsequently, we analyzed the nitrergic neuronal profile and its morphometric parameters.

RESULTS

Our data corroborate that approximately 2% of neurons in striatum express nNOS and these exhibited morphology characteristic of interneurons. Posterior regions of the striatum have a higher nitrergic neuronal profile than anterior regions of this nucleus suggesting an anteroposterior gradient of nitrergic neurons. Posterior limbic-associated areas of the striatum have a higher nitrergic neuronal profile compared to other functional subdivisions. Also, approximately 90% of neurons in the subthalamic nucleus express nNOS.

CONCLUSIONS

A remarkable presence of nitrergic neurons in the human striatum and subthalamic nucleus suggests that NO may play a critical role in the physiology of these nuclei.