Detection of Plasmodium spp. in asymptomatic blood donors by the new Brazilian NAT PLUS HIV/HBV/HCV/Malaria Bio-Manguinhos kit.

BACKGROUND: Transfusion-transmitted malaria (TTM) is a public health problem in endemic and nonendemic areas. The Brazilian Ministry of Health (MH) requested the development of a nucleic acid amplification test (NAT) for the detection of Plasmodium spp. in public blood centers to increase blood safety. STUDY DESIGN AND METHODS: The new Brazilian NAT kit named NAT PLUS HIV/HBV/HCV/Malaria Bio-Manguinhos was first implemented in HEMORIO, a public blood center in the city of Rio de Janeiro. Since October 1, 2022, this blood center has been testing all its blood donations for malaria in a pool of six plasma samples to detect Plasmodium spp. by real-time polymerase chain reaction (PCR). RESULTS: Since the implementation of the NAT PLUS platform until February 2023, HEMORIO has successfully received and tested 200,277 donations. The platform detected two asymptomatic donors in the city of Rio de Janeiro, which is a nonendemic region for malaria. Our analyses suggested a malaria from the Amazon region caused by Plasmodium vivax, in the first case, while an autochthonous transmission case by Plasmodium malariae was identified in the rural area of Rio de Janeiro state. DISCUSSION: The NAT PLUS platform detects Plasmodium spp. in plasma samples with sensitivity capable of detecting subpatent infections. This is the first time worldwide that a group developed and implemented molecular diagnosis for Plasmodium spp. to be used by public blood centers to avoid TTM.

Association between fatigue and MDS-UPDRS in individuals with Parkinson's disease: cross-sectional study.

BACKGROUND: Fatigue is significant in the context of Parkinson's disease (PD), considering that one-third of patients classify it as the most restricting symptom in their daily life activities (DLAs). The objective was to verify the relationship (association) between fatigue and non-motor and motor symptoms of PD. METHODS: A cross-sectional study which included 100 individuals with PD. Initially, demographic and clinical data (modified Hoehn and Yahr scale-HY, anxiety, and depression) were collected. To assess the non-motor and motor symptoms of PD, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was applied. Fatigue was evaluated using the Parkinson Fatigue Scale. RESULTS: A higher HY score, greater severity of non-motor aspects of DLAs and motor aspects of DLAs, more motor complications, and higher levels of anxiety as well as depression were observed in the "fatigue" group. Fatigue was associated with a lower daily equivalent levodopa dose (LEDD), a higher body mass index (BMI), anxiety, depression, and the presence of non-motor symptoms. CONCLUSION: Non-motor symptoms are more determining factors for fatigue than the motor condition itself, with an association between fatigue and higher BMI scores, increased anxiety and depression, lower LEDD, and greater severity of non-motor aspects of DLAs. Individuals in the "fatigue" group had higher HY scores, anxiety, and depression, worse non-motor and motor symptoms related to experiences of daily life, as well as motor complications.

Sexual function in women of fertile age with epilepsy.

PURPOSE: To evaluate Sexual Function Scores in women of childbearing age with epilepsy. METHOD: Cross-sectional study and comparison of two groups, one with and the other without epilepsy. The instruments used were: semi-structured socioeconomic, demographic and clinical questionnaire; Beck Anxiety and Depression Inventories; Word Health Organization Quality of Life (WHOQOL-brief); Female Sexual Function Index (FSFI); and Female Genital Self Image Scale (FGSIS). Statistical analysis was performed using Fisher's Exact Test, Chi-Square, Mann-Whitney, and Spearman's Correlation, considering p < 0.05 as a measure of significance. RESULTS: 110 women were included (55 with epilepsy and 55 without epilepsy) with a mean age of 32 years. Both groups had sexual dysfunction (with epilepsy: 19.28 vs. without epilepsy: 21.05; p = 0.416). There was no significant difference between groups in the analysis of self-image of the genitalia, Quality of Life, or Anxiety. However, there was a statistical difference in Depression Symptoms (with epilepsy: 11.44 vs. without epilepsy:13.82, p = 0.038). When evaluating the influence of epilepsy on sexual function score, women who used enzyme-inducing drugs had worse scores in desire domain (5.21 vs. 6.65; p = 0.020) and lubrication domain (9.48 vs. 12.95; p = 0.047) when compared to women who used non-enzyme-inducing drugs, respectively. In the correlation of Sexual Function with Anxiety, Depression, Quality of Life, and Self-Image of the genitalia, it was observed that when Depression levels increase, desire is impaired [-0.273(p = 0.043)]. In Quality of Life, the psychological [0.311(p = 0.021)] and environmental [0.268(p = 0.048)] domains positively influenced desire. The social relationships domain improved desire [0.504(p = 0.000)], excitement [0.461(p = 0.000)], lubrication [0.342(p = 0.011)], orgasm [0.425(p = 0.001)], satisfaction [0.449(p = 0.001)], and decreased pain [0.402(p = 0.002)]. Consequently, these influence appeared to improve sexual function [0.521(p = 0.000)]. CONCLUSION: Women of childbearing age with epilepsy have sexual dysfunction. The presence of signs of depression and the use of enzyme-inducing drugs must be carefully analyzed, as they can worsen the sexual function score. Health professionals need to be aware that sexual dysfunction must be investigated because this issue influences the quality of life of these women.

Postpartum Treatment With Immunoglobulin Does Not Prevent Relapses of Multiple Sclerosis in the Mother.

Multiple sclerosis (MS) is a chronic, neurological, immune-mediated disease that can worsen in the postpartum period. There is no consensus on the use of immunoglobulin for prevention of disease relapses after delivery. We have shown that the controversial beneficial effect of immunoglobulin given immediately after birth could not be observed in patients with MS.

Morphological and hematological studies of Trypanosoma spp. infecting ornamental armored catfish from Guamá River-PA, Brazil.

A total of 281 specimens of freshwater armored ornamental fish species (Leporacanthicus galaxias,Lasiancistrus saetiger, Cochliodon sp., Hypostomus sp., Pseudacanthicus spinosus, Ancistrus sp. and Rineloricaria cf. lanceolata) were captured at the hydrological basin of Guamá River, Pará, Brazil. The infection by Trypanosoma spp. was inspected. The morphological and morphometric characterization of the parasites and the hematological parameters were determined. Leporacanthicus galaxias and Pseudacanthicus spinosus presented 100% infection prevalence, and the other species showed a variable prevalence of infection. The parasites showed clearly different morphotypes and dimensions, and probably belong to different species. The hematological response to the infection varied with the host. Cochliodon sp. showed no differences between infected and not infected fish. In other species several modifications on some hematological parameters were found, but apparently without causing disease. It is emphasized the possibility of introduction of the parasites in new environments due to the artificial movements of these ornamental fish.

Music-based therapy in rehabilitation of people with multiple sclerosis: a systematic review of clinical trials.

BACKGROUND: Multiple sclerosis (MS) is a major cause of chronic neurological disability in young adults. An increasing number of controlled studies have assessed the potential rehabilitative effects of new drug-free treatments, complementary to the standard care, including music-based therapy (MBT). OBJECTIVE: To analyze the evidence for the effectiveness of MBT within the therapeutic approaches to individuals diagnosed with MS. METHODS: A systematic review of clinical trials was performed with searches in the following databases: BIOSIS, CINAHL, Cochrane, EBSCO, ERIC, Google Scholar, IBECS, LILACS, LISA (ProQuest), Medline, PEDro, PsycINFO (APA), Psychological & Behavioral, PubMed, SciELO, Scopus, SPORTDiscus and Web of Science. Clinical trials comparing MBT versus conventional therapy/no intervention were included. RESULTS: From the 282 studies identified, 10 trials were selected. Among these, the total sample consisted of 429 individuals: 253 were allocated to the experimental group (MBT) and 176 to the control group (conventional therapies or no intervention). All the studies presented high methodological quality. Modalities of MBT were clustered into four groups: (1) Rhythmic auditory; (2) Playing musical instruments; (3) Dance strategy; and (4) Neurological music therapy. Overall, the studies consistently showed that MBT was better than conventional therapy or no intervention, with regard to gait parameters (double support time and walking speed), fatigue level, fatigability, coordination, dexterity, balance, walking endurance, lower extremity functional strength, emotional status and pain. Regarding mental fatigability and memory, the data were conflicting and the evidence was unclear. CONCLUSION: MBT is a safe and effective approach for clinical rehabilitation of MS patients that leads to positive results regarding both motor and non-motor functions.

A Large Cohort Study of SARS-CoV-2 Detection in Saliva: A Non-Invasive Alternative Diagnostic Test for Patients with Bleeding Disorders.

Diagnosis of SARS-CoV-2 infections is mostly based on the nasopharyngeal swabs (NPS). However, this collection is invasive and uncomfortable, especially for children and patients with coagulopathies, whose NPS collection often causes bleeding. Thus, the aim of this study was to evaluate the usefulness and accuracy of saliva for the diagnosis of COVID-19 in patients presenting bleeding disorders. Samples of NPS, oropharyngeal swabs (OPS), and saliva were collected simultaneously from 1159 hospitalized patients with hematological diseases and from 524 healthcare workers, both symptomatic and asymptomatic for SARS-CoV-2. All samples were evaluated for SARS-CoV-2 by qRT-PCR. SARS-CoV-2 was detected in NPS, OPS and saliva from 16.9%, 14.4% and 15.6% individuals, respectively. Tests in saliva showed sensitivity, specificity, and overall agreement of 73.3%, 96.9% and 92.7% (=0.74), respectively. Salivary tests had good accuracy (AUC = 0.7) for discriminating negative and positive qRT-PCR for SARS-CoV-2. Higher sensitivity was observed in symptomatic than in non-symptomatic patients, as well as in healthy subjects than in patients with hematological disease, in both OPS and saliva. The mean viral load in NPS was significantly higher than in OPS and in saliva samples (p < 0.001). Saliva is a good diagnostic tool to detect SARS-CoV-2, especially among patients symptomatic for COVID-19, and is a valuable specimen for mass screening of hospitalized patients with hematological diseases, especially for those that with bleeding disorders.

Effect of Convalescent Plasma in Critically Ill Patients With COVID-19: An Observational Study.

Background: Convalescent plasma is a potential therapeutic option for critically ill patients with coronavirus disease 19 (COVID-19), yet its efficacy remains to be determined. The aim was to investigate the effects of convalescent plasma (CP) in critically ill patients with COVID-19. Methods: This was a single-center prospective observational study conducted in Rio de Janeiro, Brazil, from March 17th to May 30th, with final follow-up on June 30th. We included 113 laboratory-confirmed COVID-19 patients with respiratory failure. Primary outcomes were time to clinical improvement and survival within 28 days. Secondary outcomes included behavior of biomarkers and viral loads. Kaplan-Meier analyses and Cox proportional-hazards regression using propensity score with inverse-probability weighing were performed. Results: 41 patients received CP and 72 received standard of care (SOC). Median age was 61 years (IQR 48-68), disease duration was 10 days (IQR 6-13), and 86% were mechanically ventilated. At least 29 out of 41CP-recipients had baseline IgG titers ≥ 1:1,080. Clinical improvement within 28 days occurred in 19 (46%) CP-treated patients, as compared to 23 (32%) in the SOC group [adjusted hazard ratio (aHR) 0.91 (0.49-1.69)]. There was no significant change in 28-day mortality (CP 49% vs. SOC 56%; aHR 0.90 [0.52-1.57]). Biomarker assessment revealed reduced inflammatory activity and increased lymphocyte count after CP. Conclusions: In this study, CP was not associated with clinical improvement or increase in 28-day survival. However, our study may have been underpowered and included patients with high IgG titers and life-threatening disease. Clinical Trial Registration: The study protocol was retrospectively registered at the Brazilian Registry of Clinical Trials (ReBEC) with the identification RBR-4vm3yy (http://www.ensaiosclinicos.gov.br).

Fatigue in Parkinson's disease: Brazilian validation of the modified fatigue impact scale.

BACKGROUND: The instruments that measure the impact of fatigue on physical, cognitive and psychosocial aspects has yet to be validated in Brazilian population with Parkinson's disease (PD). The aim of this study was to cross-culturally adapt and assess the psychometric properties of the Brazilian version of the Modified Fatigue Impact Scale (MFIS-PD/BR). METHODS: Ninety PD individuals were recruited. The adaptation of the MFIS-PD was performed by translation and back translation methodology. Psychometric analysis was applied in order to perform the administration of the socio-clinical questionnaire, Mini-Mental State Examination (MMSE), Unified Parkinson's Disease Rating Scale (UPDRS Part I-IV), Hoehn-Yahr disability scale (HY), hospital anxiety and depression scale (HADS), Geriatric Depression Scale (GDS), fatigue severity scale (FSS), Parkinson Fatigue Scale (PFS-16), and MFIS-PD/BR with retest of the MFIS-PD/BR after 7 days. RESULTS: The adaptation phase kept the same items of original MFIS-PD. The Cronbach's alpha for the MFIS-PD/BR was 0.878 when all responses items were scored. The test-retest intraclass correlation coefficients was above 0.80 (p<0.01) for the MFIS-PD/BR score, which was moderately correlated with the HADS, GDS, MDS-UPDRS score total and non-motor experiences of daily living, FSS and PFS-16. It was revealed the MFIS-PD/BR>29 points as cut-off point to indicate fatigued subjects with accuracy of 0.835 (p<0.001). CONCLUSIONS: The MFIS-PD/BR is valid and reproducible to use in assessing the fatigue symptom in Brazilian PD subjects.

Ecology of phlebotomine sand flies in a Brazilian area with recent leishmaniasis transmission (Itaúna, in Minas Gerais state).

INTRODUCTION: Leishmaniasis constitutes a serious but neglected tropical disease. Recently, socio-environmental, biological and physical changes have altered the range of leishmaniasis, causing it to spread into urban areas. In Minas Gerais, the disease is endemic, exhibiting regional differences and reaching urban centers. The purpose of this study was to evaluate entomological aspects related to the ecoepidemiology of leishmaniasis in Itaúna. METHODS: Monthly catches with HP traps were carried out from June 2017 to May 2018, in three ecological areas (urban, rural, and forest). The adaptability of the species to anthropic environments was assessed using the synanthropy index (SI). RESULTS: We collected 1306 specimens of phlebotomine sand flies. Of the species of medical importance, Lutzomyia longipalpis, the vector of Leishmania infantum, represented 90.4% of the specimens identified at species level (n=1260). Nyssomyia whitmani, the vector of Leishmania braziliensis, represented 1.6% of the total. Lu. longipalpis displayed an SI of +95.8, a value that denotes a marked preference for human environments. For Ny. whitmani, the SI was -25, expressing the tendency of this species to occupy uninhabited areas. The population of the three most numerous species captured increased with rain, high temperatures, and high relative humidity. Although captured at low numbers, Ny. whitmani showed a different profile concerning the climate variables analyzed. CONCLUSIONS: Understanding the epidemiology of the disease may assist the health services in formulating effective control measures for improving community health and contributing to the establishment of a dynamic relationship and a global awareness of the health/disease process.

Seroprevalence of anti-SARS-CoV-2 among blood donors in Rio de Janeiro, Brazil.

OBJECTIVE To estimate the seroprevalence of antibodies to SARS-CoV-2 among blood donors in the state of Rio de Janeiro, Brazil. METHODS Data were collected on 2,857 blood donors from April 14 to 27, 2020. This study reports crude prevalence of antibodies to SARS-CoV-2, population weighted prevalence for the state, and prevalence adjusted for test sensitivity and specificity. Logistic regression models were used to establish the correlates of SARS-CoV-2 prevalence. For the analysis, we considered collection period and site, sociodemographic characteristics, and place of residence. RESULTS The proportion of positive tests for SARS-Cov-2, without any adjustment, was 4.0% (95%CI 3.3-4.7%), and the weighted prevalence was 3.8% (95%CI 3.1-4.5%). We found lower estimates after adjusting for test sensitivity and specificity: 3.6% (95%CI 2.7-4.4%) for the non-weighted prevalence, and 3.3% (95%CI 2.6-4.1%) for the weighted prevalence. Collection period was the variable most significantly associated with crude prevalence: the later the period, the higher the prevalence. Regarding sociodemographic characteristics, the younger the blood donor, the higher the prevalence, and the lower the education level, the higher the odds of testing positive for SARS-Cov-2 antibody. We found similar results for weighted prevalence. CONCLUSIONS Our findings comply with some basic premises: the increasing trend over time, as the epidemic curve in the state is still on the rise; and the higher prevalence among both the youngest, for moving around more than older age groups, and the less educated, for encountering more difficulties in following social distancing recommendations. Despite the study limitations, we may infer that Rio de Janeiro is far from reaching the required levels of herd immunity against SARS-CoV-2.

Canine visceral leishmaniasis in area with recent Leishmania transmission: prevalence, diagnosis, and molecular identification of the infecting species.

INTRODUCTION: Canine visceral leishmaniasis (CVL) is an endemic disease in Brazil, and integrated control actions have been adopted by the Brazilian Ministry of Health to control its spread. However, the transmission profile is unknown in areas with recent CVL cases, including Itaúna, located in the Brazilian state of Minas Gerais, where the present study was carried out. METHODS: A total of 2,302 dogs from 12 neighborhoods were serologically tested for canine VL using the current diagnostic protocol adopted by the Brazilian Ministry of Health. Test positivity rate (TPR) and CVL prevalence were determined for each neighborhood. The presence of Leishmania was assessed in 60 seropositive dogs which had been recommended for euthanasia. Twenty-two of them (37%) were asymptomatic, and 38 (63%) were symptomatic for CVL. Parasitological (myeloculture and smear/imprint) and molecular (PCR) methods were employed for Leishmania detection in bone marrow, spleen, mesenteric lymph nodes, and ear skin. The infecting Leishmania species was identified by DNA sequencing. RESULTS: CVL prevalence (per 1,000 dogs) varied from 0.0-166.67, depending on the neighborhood, with a mean of 68.96 (SD 51.38). Leishmania DNA was detected in at least one tissue from all seropositive dogs, with comparable TPR among tissues. Leishmania parasites were identified in most (54/60) seropositive dogs, and the infecting parasite was identified as Leishmania infantum in all of these. CONCLUSIONS: Prevalence of CVL is a contributor to the spread of visceral leishmaniasis in Itaúna.

Entomological Studies in Itaúna, Brazil, an Area With Visceral Leishmaniasis Transmission: Fauna Survey, Natural Leishmania Infection, and Molecular Characterization of the Species Circulating in Phlebotomine Sand Flies (Diptera: Psychodidae).

Among neglected tropical diseases, visceral leishmaniasis (VL) shows great relevance in global terms and is a serious public health concern due to the possibility of severe and lethal forms in humans. In this study, we evaluate entomological factors such as diversity and abundance of phlebotomine sand flies (Diptera:Psychodidae) and the Leishmania species circulating in these species in possible association with VL transmission in the Brazilian town Itaúna. The entomological collections were performed during three consecutive nights, always in the third week of each month, within a period of 12 mo. A total of 1,786 sand fly specimens were collected, from which 20% were collected inside houses. The influence of three local climatic variables (temperature, rainfall, relative humidity) on the population sizes of these insects was evaluated. Temperature was the most influential factor, with a significant positive correlation with the local population size of phlebotomine sand flies collected per month. Lutzomyia longipalpis (Lutz & Neiva, 1912) was the predominant species in the study area. Leishmania DNA was detected in nine out of 133 pools of sand fly females, using nested/PCR, which resulted in a minimal natural infection rate of 2.91%. DNA from Leishmania infantum Nicolle, 1908 (Kinetoplastida: Trypanosomatida), was detected in Evandromyia cortelezzii (Bréthes, 1923), Ev. evandroi (Costa, Lima & Antunes, 1936), Ev. lenti (Mangabeira, 1938), and Ev. termitophila (Martins, Falcão & Silva, 1964), besides Lu. longipalpis. Our study indicates favorable conditions for VL spreading in Itaúna due to the presence of Lu. longipalpis and Le. infantum-infected phlebotomine sand flies.

Caracterização do sintoma fadiga em indivíduos após acidente vascular encefálico: revisão sistemática / Characterization of the fatigue symptom in individuals after stroke: systematic review

Introdução: O sintoma fadiga é uma das queixas mais comuns entre os indivíduos acometidos pelo acidente vascular encefálico (AVE). Objetivo: Apresentar as evidências a caracterização do sintoma fadiga após AVE. Metodologia: Foi realizada uma revisão sistemática de estudos observacionais com busca nas bases de dados Cinahl, Cochrane, Embase, Eric, Bireme (Lilacs, Medline, Ibecs, Scielo), Library and Information Science Abstracts ­ LISA (ProQuest), PEDro, PsychInfo, Pubmed, Web of Science. Foram utilizados os descritores de assunto 'acidente vascular encefálico', 'fadiga' e 'percepção'. Os procedimentos referentes à seleção dos estudos e extração dos dados foram desenvolvidos, de modo independente, por dois revisores. Os estudos selecionados foram analisados em texto completo contemplando delineamentos, caracterização da amostra, metodologia, resultados e conclusão. Resultados: Foram encontrados 12 estudos e selecionados quatro. A amostra total era composta por 76 indivíduos com diagnóstico de AVE. Não há um instrumento específico para avaliar fadiga associada ao AVE. Não há uma definição clara de fadiga pós-AVE nem consenso entre os indivíduos sobre sua descrição e diferença pré e pós AVE. Em relação às características, a fadiga é experimentada em aspectos físicos e mentais e descrito como cansaço muscular ou mental e causadora de grande impacto na qualidade de vida. Quanto aos fatores de alívio, o sono, repouso e exercícios aeróbicos foram os mais elencados. Conclusão: O sintoma fadiga é comum após o AVE com natureza multidimensional, sem uma definição clara com impacto biopsicossocial.

Introduction: The fatigue symptom is one of the most common post stroke. Objective: To present evidence about the characterization of the fatigue symptom resulting from stroke. Methodology: A systematic review of observational studies was carried out by searching the Cinahl, Cochrane, Embase, Eric, Bireme (Lilacs, Medline, Ibecs, Scielo), Library and Information Science Abstracts ­ LISA (ProQuest), PEDro, PsychInfo, Pubmed, Web of Science. The subject descriptors 'stroke', 'fatigue' and 'perception' were used. The procedures for the selection of studies and data extraction were independently developed by two reviewers. The selected studies were analyzed in full text, contemplating designs, sample characterization, methodology, results and conclusion. Results: Twelve studies were found and four were selected. The total sample consisted of 76 individuals diagnosed with stroke. There is no specific instrument to assess stroke-associated fatigue. There is no clear definition of post-stroke fatigue or consensus among individuals about its description and difference before and after stroke. Regarding the characteristics, fatigue is experienced in physical and mental aspects and described as muscular or mental tiredness, causing a great impact on quality of life. As for relief factors, sleep, rest, and aerobic exercises were the most listed. Conclusion: The fatigue symptom is common after stroke with a multidimensional nature, without a clear definition with biopsychosocial impact.

CCR5-Delta32 genetic polymorphism associated with benign clinical course and magnetic resonance imaging findings in Brazilian patients with multiple sclerosis.

The CCR5 chemokine receptor has been implicated in the pathogenesis of multiple sclerosis (MS). This research was carried out to investigate the association between the CCR5-Delta32 deletion in 124 patients with MS from Southern Brazil. Ninety-eight (79.0%) patients presented with relapsing-remitting MS (RR-MS), 17 (13.7%) secondary progressive MS (SP-MS), 8 (6.5%) primary progressive MS (PP-MS) and one (0.8%) clinically isolated syndrome (CIS). The control group consisted of 127 healthy blood donors from the same geographic region. The disease severity was assessed clinically using the Expanded Disability Status Scale (EDSS). Genomic DNA was extracted from peripheral blood cells and the genetic polymorphism was evaluated by polymerase chain reaction. Of the MS patients, 85 (68.5%) were females (p=0.0093). The CCR5-Delta32 frequency among the controls was 5.5%, and did not differ from that observed among the MS patients (4.8%) (p=0.7337). The mean (+/-SD) age at disease onset among the carriers and non-carriers of the CCR5-Delta32 allele was 31.7 (+/-11.1) and 36.6 (+/-12.0) years, respectively (p=0.1312). The duration (+/-SD) of the disease was 11.2 (+/-12.9) and 7.7 (+/- 5.6) years among the CCR5-Delta32 heterozygous, and CCR5 wild type, respectively (p=0.396). The mean (+/-SD) EDSS among the MS patients carriers and non-carriers of the CCR5-Delta32 allele was 2.4+/-1.2 and 2.67+/-2.2, respectively (p=0.9796). The MRI findings in MS patients with the CCR5-Delta32 genotype exhibited lower positive gadolinium enhancing-imaging (p=0.0013) and lower brain atrophy (p=0.1333) than MS patients with the CCR5 wild-type genotype. Despite that the differences were not significant, the results suggested that the disease onset and progression to disability may be prolonged in MS carriers of CCR5-Delta32, and CCR5-Delta32 could be considered a favorable prognostic biomarker of MS. Further studies comprising larger numbers of individuals carrying non-wild-type haplotypes are needed to determine CCR5-Delta32 involvement in the specific process of MS pathology and pathogenesis.

O ensino presencial no curso de fisioterapia: lições deixadas pela pandemia / Face-to-face teaching in the physiotherapy course: lessons left by the pandemic / Docencia presencial en el curso de fisioterapia: lecciones que deja la pandemia

Com a pandemia COVID-19, a ação docente necessitou ser repentinamente alterada para o formato de Ensino Remoto Emergencial (ERE) e após o retorno ao ensino houve alterações. Com o objetivo de apresentar a percepção docente sobre as contribuições do ERE para sua ação docente no modelo presencial. Trata-se de uma pesquisa qualitativa com entrevista a docentes que ministraram disciplinas no curso de Fisioterapia da Universidade Estadual do Centro-Oeste durante o ERE. Foram entrevistados 10 docentes. A aprendizagem foi caracterizada em seu processo de construção de conhecimento, os modelos envolvendo metodologias ativas foram mais utilizados, o contato humano ganhou relevância nos comentários. Todos os docentes transformaram sua ação didática. O modelo de ensino ERE promoveu alterações na forma de lecionar e os modelos de ensino baseados em metodologias ativas foram mais incorporados no modelo presencial.

With the COVID-19 pandemic, teaching needed to be suddenly changed to the emergency remote teaching format and after the return to face-to-face teaching there were changes. To present the professor's perception of the contributions of emergency remote teaching to their professional role in the face-to-face model. This is a qualitative research with interviews with professors who taught in the Physiotherapy course at the Midwest State University during the emergency remote teaching. Ten professors were interviewed. Learning was characterized in its knowledge construction process, models involving active methodologies were the most used, human contact gained relevance in the comments. All professors transformed their didactic action. The emergency remote teaching model promoted changes in the way of teaching and teaching models based on active methodologies were more incorporated into the face-to-face model.

Con la pandemia del COVID-19, la acción docente tuvo que cambiar de golpe a la forma de enseñanza a distancia de emergencia (ERE) y tras la vuelta a la docencia hubo cambios. Para presentar la percepción del docente sobre los aportes de la ERE a su acción docente en el modelo presencial. Se trata de una investigación cualitativa con entrevistas a profesores que impartieron asignaturas en el curso de Fisioterapia de la Universidad Estatal del Medio Oeste durante la ERE. 10 profesores fueron entrevistados. El aprendizaje se caracterizó en su proceso de construcción del conocimiento, se utilizaron más modelos que involucran metodologías activas, el contacto humano ganó relevancia en los comentarios. Todos los docentes transformaron su acción didáctica. El modelo de enseñanza ERE generó cambios en la forma de enseñar y los modelos de enseñanza basados en metodologías activas se incorporaron más al modelo presencial.

Cross-Cultural and Psychometric Properties Assessment of the Exercise Self-Efficacy Scale in Individuals with Spinal Cord Injury.

INTRODUCTION: The Exercise Self-Efficacy scale (ESES) is a reliable measure, in the English language, of exercise self-efficacy in individuals with spinal cord injury. The aim of this study was to culturally adjust and validate the Exercise Self-Efficacy scale in the Portuguese language. MATERIAL AND METHODS: The Exercise Self-Efficacy scale was applied to 76 subjects, with three-month intervals (three applications in total). The reliability was appraised using the intra-class correlation coefficient and Bland-Altman methods, and the internal consistency was evaluated using Cronbach´s alpha. The Exercise Self-Efficacy scale was correlated with the domains of the Quality of life Questionnaire SF-36 and Functional Independence Measure and tested using the Spearman rho coefficient. RESULTS: The Exercise Self-Efficacy scale-Brazil presented good internal consistency (alpha 1 = 0.856; alpha 2 = 0.855; alpha 3 = 0.822) and high reliability in the test-retest (intra-class correlation coefficient = 0.97). There was a strong correlation between the Exercise Self-Efficacy scale-Brazil and the SF-36 only in the functional capacity domain (rho = 0.708). There were no changes in Exercise Self-Efficacy scale-Brazil scores between the three applications (p = 0.796). DISCUSSION: The validation of the Exercise Self-Efficacy scale questionnaire permits the assessor to use it reliably in Portuguese speaking countries, since it is the first instrument measuring self-efficacy specifically during exercises in individuals with spinal cord injury. Furthermore, the questionnaire can be used as an instrument to verify the effectiveness of interventions that use exercise as an outcome. CONCLUSION: The results of the Brazilian version of the Exercise Self-Efficacy scale support its use as a reliable and valid measurement of exercise self-efficacy for this population.

Introdução: O instrumento Exercise Self-Efficacy scale (ESES) é fiável, na língua inglesa, para medir a autoeficácia em exercícios em indivíduos com lesão medular. O objetivo do estudo foi adaptar transculturalmente e validar a escala ESES para a língua Portuguesa. Material e Métodos: O Exercise Self-Efficacy scale foi aplicado três vezes em 76 indivíduos, a cada três meses. A fiabilidade foi avaliada pelo coeficiente de correlação intraclasse de Bland e Altman, e a consistência interna pelo alfa de Cronbach. O Exercise Self-Efficacy scale foi correlacionado com os domínios do Questionário de Qualidade de Vida SF-36 e da Medida de Independência Funcional e avaliado pelo rho de Spearman. Resultados: O Exercise Self-Efficacy scale-Brasil apresentou boa consistência interna (alpha 1 = 0,856; alpha 2 = 0,855 e alpha 3 = 0,822) e alta fiabilidade no teste-reteste (coeficiente de correlação intraclasse = 0,97). Houve correlação forte do Exercise Self-Efficacy scale-Brasil somente com o domínio Capacidade Funcional do SF-36 (rho = 0,708). Não houve mudança nas pontuações do Exercise Self-Efficacy scale-Brasil entre as três aplicações (p = 0,796). Discussão: A validação do Exercise Self-Efficacy scale permite que este seja utilizado nos países de língua portuguesa de forma fiável, pois representa o primeiro instrumento específico para o estudo da auto-eficácia em exercícios em indivíduos com lesão medular e, ainda, ser utilizado como instrumento para verificar a efetividade de intervenções que utilizem exercício como desfecho. Conclusão: A versão brasileira da Exercise Self-Efficacy scale é válida e fiável para avaliação da autoeficácia em exercícios para essa população.

Insulin resistance, atherogenicity, and iron metabolism in multiple sclerosis with and without depression: Associations with inflammatory and oxidative stress biomarkers and uric acid.

Depression is accompanied by metabolic disorders in iron metabolism, lipoproteins, and insulin resistance. We measured plasma levels of ferritin, iron, lipids, insulin, and glucose and computed the homeostasis model assessment (HOMA2IR) and atherogenic index of plasma (AIP) in MS patients with and without depression and healthy controls. Explanatory variables were serum uric acid, interleukin (IL)-6, lipid hydroperoxides (CL-LOOH), albumin, and C-reactive protein (CRP). Depression was assessed using the Hospital Anxiety and Depression Scale (HADS), neurological disability using the Expanded Disability Status Scale (EDSS), and disease progression using ∆EDSS over five years earlier. HOMA2IR and insulin were predicted by diagnosis (increased in MS), age and body mass index (BMI); AIP by diagnosis, sex, BMI, CRP, and uric acid; triglycerides by diagnosis (higher in MS without depression), age, BMI and uric acid; ferritin by diagnosis (higher in MS), sex, CRP, and albumin; and iron by albumin. The HADS score was significantly predicted by ∆EDSS, gastro-intestinal symptoms, iron (inverse), and age. MS is characterized by significantly increased insulin resistance, which is determined by increased insulin levels; and increased ferritin, a biomarker of inflammation. Depression in MS is not associated with increased insulin resistance and atherogenicity but with lowered iron.

Seroprevalence and molecular characterization of Leishmania in dogs from an endemic area of zoonotic visceral leishmaniasis in Brazil.

Visceral leishmaniasis (VL) can cause large-scale and tenacious epidemics with high fatality rates. Current seroprevalence and circulating Leishmania species were evaluated in dogs domiciled in the municipality of Sabará, a small historic and touristic city in the Brazilian state of Minas Gerais. A total of 3926 dogs domiciled in seven different districts of Sabará were serologically tested for canine visceral leishmaniasis (CVL) by indirect enzyme-linked immunosorbent (ELISA) and immunofluorescence (IFA) assays, in a two-years census survey (2011-2012). The average positivity rate of canine infection was 3.4%. Three additional diagnostic tests - imprint/smear direct parasitological, molecular (LnPCR) and myeloculture - were performed in a random sample of fifty seropositive dogs composed of symptomatic (39) and asymptomatic (eleven) animals. LnPCR showed 100% of positivity for Leishmania DNA in, at least, one among four tissue samples tested (mesenteric lymph node, skin, spleen and bone marrow), independently of the clinical canine group. Higher and statistically equivalent positivity rates (98% and 96%) for Leishmania DNA were found in canine lymph node and spleen. Asymptomatic dogs showed expressive positivity rates in all three additional diagnostic techniques. Leishmania infantum was confirmed as the etiological agent of CVL in Sabará.