Neuropathic pain is a chronic syndrome that is difficult to treat and often affects patients with leprosy. Recommended treatment includes the the use of analgesic drugs, codeine, tricyclic antidepressants, neuroleptics, anticonvulsants and thalidomide, but without consensus on uniform dose and fully satisfactory results. Objective: To analyze botulinum toxin type A (BoNT-A) effectiveness in treatment of chronic neuropathic pain in refractory leprous patients, as well as evaluate and compare the quality of life of patients before and after using the medication. Methods: We used a specific protocol including clinical, demographic, DN4 protocol, analogue scale (VAS), sensory evaluation and evaluation of the WHOQOL-BREF. Therapeutic intervention was performed with BOTOX® BTX-A 100U administered subcutaneously. Fifteen patients were evaluated on days 0, 10 and 60. Results: Patients on VAS showed pain between 5 and 10, in one case there was complete pain relief in 60 days, while others showed improvement in the first week with the return of symptoms with less intensity after this period. WHOQOL-BREF's domains Quality of Life and Physical to have a significant increase in QOL. Conclusion: BoNT-A proved to be a good therapeutic option in relieving pain with improved quality of life for these patients.

COVID-19 is the disease caused by Novel Coronavirus (SARS-CoV-2) infection and world current main public health problem, due to its easy transmissibility and multiple clinical presentations. The main symptoms reported worldwide are dry cough, dyspnea, and fever, as well as anosmia and ageusia. COVID-19 diagnosis is made with RT-PCR, but many other complementary exams may be used to guide clinical practice, such as Chest Computerized Tomography (CT), showing ground glass opacities; increase in inflammatory markers, as C-Reactive Protein and Erythrocyte Sedimentation Rate; hemogram might show hypoalbuminemia, thrombocytopenia. Severe cases may evolve to thromboembolic and atheroembolic events, leading to stroke, myocardial infarction, pulmonary thromboembolism. Male, 28 years old, went for neurological appointment after presenting episode of intense headache, dysarthria, deviation of lip rhyme on appointment’s eve. Previously healthy, no comorbidities or risk factors. Underwent brain MRI and serum serological analysis. SARS-CoV-2 capacity of affecting brain homeostasis by breaking blood–brain barrier, makes it easier to develop ischemic or inflammatory damage, and invading central nervous system. Neurological symptoms and syndromes are the main consequences of COVID-19 pandemic and must be prevented through adequate clinical management.

Introduction: Neuropathic pain is a common and disabling late complication of leprosy. We investigated the clinical and electrophysiological characteristics of neuropathic pain in leprosy patients by evaluating nerve conduction, sympathetic skin response (SSR) and A-waves. Methods: Twenty one leprosy patients with neuropathic pain validated by the Douleur Neuropathique en 4 (DN4)Questionnaire were selected for study. Pain intensity was measured by the visual analog scale. Demographic and clinical data were collected for all patients. Clinical data included appraisal of the median, ulnar, radial, tibial and common peroneal nerves, assessment of the sympathetic skin response and conventional electrophysiological recordings. Results: Among all electroneuromyographic presentations, multifocal mononeuropathy was still the most prevalent. Sensory loss was observed more frequently than motor deficits. As most patients presented advanced clinical forms of leprosy and were under treatment, this high mean was found and the ulnar nerve was most frequently affected. The sympathetic skin response was absent in 16 patients. Higher DN4 Questionnaire scores were observed in women and in those receiving corticosteroid therapy. These inferences are possible to be made, but our study's limitations don't allow us to be certain about it. The statistical significance found only permits us to evidence what we related on the textual part of the study. Limitations: The small number of patients studied, the lack of sophisticated diagnostic methods for leprosy, as well as the difficulties in assessing nerve conduction were the main limitations of this study. Conclusion: The neurophysiological and clinical findings in leprous neuropathy were modest despite the conspicuous neuropathic pain. Although electrophysiological studies are a vital tool to verify nerve damage, variations in the clinical presentation of leprosy neuropathic pain render the diagnosis challenging. Further studies are needed to describe the neurophysiological evolution of this disease.

O e-book Manual de Semiologia Neurológica é uma iniciativa de professores/pesquisadores do curso de medicina da Universidade do Estado do Pará-UEPA, que tem o intuito de apresentar, de forma acessível e objetiva, os conhecimentos básicos sobre neurologia aos estudantes de medicina.

Background: This study assessed the efficacy of immersive virtual reality (VR) as an adjunct in the management of treatment-related anxiety and depression among breast cancer outpatients undergoing chemotherapy at the University of the Philippines -Philippine General Hospital Cancer Institute. Methods:In this open-label phase II randomized control trial, participants were randomly assigned into two groups during their first cycle of chemotherapy e the intervention group who were subjected to immersive VR experience using VR Box 3D goggle sets plus standard-of-care and the control group who received standard-ofcare only. Anxiety and depression scores of at-risk breast cancer patients were measured using the Hospital Anxiety and Depression Scale -Pilipino (HADS-P) questionnaire before and after chemotherapy. The influence of clinico-demographic factors on the mean difference of HADS-P scores was explored. Pre-and postchemotherapy blood pressures, heart rates, and respiratory rates were also determined. Results:The investigators were able to screen 114 patients and 65.8% (n¼75) had a HADS-P score of 11. The proportion of patients who were at-risk to develop treatment-related anxiety and depression was 73.5% (n¼50) and 22.1% (n¼15), respectively. A total of 68 patients were included in the randomization. Statistically significant mean differences of j-2.71j and j-4.74j (p<0.05) in the pre-and postchemotherapy HADS-P scores between the control group and intervention group were reported. Changes in mean arterial pressures, heart rates, and respiratory rates pre-and post-chemotherapy were not statistically significant.Conclusions: In this study, the investigators observed that immersive VR could potentially decrease the level of treatment-related anxiety and depression of at-risk breast cancer outpatients undergoing chemotherapy.