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.

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.

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.

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.

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.

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.

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.

Music-based therapy in rehabilitation of people with multiple sclerosis: a systematic review of clinical trials / Terapia baseada na música na reabilitação de indivíduos com esclerose múltipla: revisão sistemática de ensaios clínicos

Abstract 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.

RESUMO Introdução: A esclerose múltipla (EM) é a maior causa de incapacidade neurológica crônica em adultos jovens. Um crescente número de estudos controlados avalia a reabilitação por meio de tratamentos não medicamentosos, cuidados complementares incluindo a terapia baseada na música (TBM). Objetivo: Analisar a evidência de efetividade da TBM na abordagem terapêutica de indivíduos diagnosticados com EM. Métodos: Foi realizada uma revisão sistemática de ensaios clínicos com busca nas bases de dados Biosis, Cinahl, Cochrane, Ebsco, Eric, Google Scholar, Ibecs, Lilacs, Lisa (ProQuest), Medline, PEDro, PsycINFO (APA), Psychological & Behavioral, PubMed, SciELO, Scopus, Sportdiscus e Web of Science. Foram incluídos ensaios clínicos comparando TBM versus terapia convencional/sem intervenção. Resultados: Dentre os 282 estudos identificados, 10 ensaios foram selecionados. Desses, a amostra total consistia em 429 indivíduos (253 alocados no grupo experimental (TBM) e 176 no grupo controle (terapias convencionais ou sem intervenção). Todos os estudos apresentaram elevada qualidade metodológica. Modalidades da TBM foram reunidas em quatro grupos: (1) Audição rítmica; (2) Tocar instrumentos musicais; (3) Dança como estratégia; e (4) Terapia neurofuncional baseada na música. A maioria dos estudos identificou que a TBM é melhor que a terapia convencional ou nenhuma intervenção nos parâmetros da marcha (duplo apoio e velocidade), níveis de fadiga, fatigabilidade, coordenação, destreza, equilíbrio, força de membros inferiores, estado emocional e dor. Os dados sobre fatigabilidade mental e memória foram conflitantes e as evidências são incertas. Conclusão: A TBM é uma abordagem segura na reabilitação clínica de indivíduos com EM e propicia resultados positivos nas funções motoras e não motoras.

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).

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.

Fatigue in Parkinsons disease: Brazilian validation of the modified fatigue impact scale / Fadiga na doença de Parkinson: validação brasileira da escala modificada de impacto da fadiga

ABSTRACT 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.

RESUMO Introdução: Os instrumentos que mensuram o impacto da fadiga nos aspectos físicos, cognitivos e psicossociais ainda não foram validados na população brasileira com doença de Parkinson (DP). O objetivo deste estudo foi adaptar culturalmente e avaliar as propriedades psicométricas da versão brasileira da escala modificada de impacto da fadiga (MFIS-PD/BR). Métodos: Setenta indivíduos com DP foram recrutados. A adaptação do MFIS-PD foi realizada pela metodologia de tradução e retrotradução. Na análise psicométrica foi realizada a administração de questionário socioclínico, Miniexame do estado mental (Mini-Mental State Examination - MMSE), Escala Unificada de Avaliação da DP (Unified Parkinson's Disease Rating Scale - UPDRS Parte I-IV), escala de incapacidade Hoehn-Yahr (HY), escala hospitalar de ansiedade e depressão (Hospital Anxiety and Depression Scale - HADS), escala de depressão geriátrica (Geriatric Depression Scale - GDS), escala de gravidade da fadiga (Fatigue Severity Scale - FSS), escala de fadiga de Parkinson (Parkinson Fatigue Scale - PFS-16) e a MFIS-PD/BR com reteste após 7 dias. Resultados: A fase de adaptação manteve os mesmos itens do MFIS-PD original. O coeficiente alfa de Cronbach para o MFIS-PD/BR foi de 0,878 quando todos os itens das respostas foram pontuados. Os coeficientes de correlação intraclasse teste-reteste foram superiores a 0,80 (p<0,01) para o escore MFIS-PD/BR, que foi moderadamente correlacionado com o escore HADS, GDS, MDS-UPDRS, total e aspectos não-motores da vida diária, FSS e PFS-16. Foi revelado o ponto de corte do MFIS-PD/BR>29 pontos para indicar indivíduos fatigados com acurácia de 0,835 (p<0,001). Conclusões: O MFIS-PD/BR é válido e reprodutível para a avaliação do sintoma de fadiga em indivíduos brasileiros com DP.

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.

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.

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 IgG and IgM anti-SARS-CoV-2 among voluntary blood donors in Rio de Janeiro, Brazil

Background: In Brazil, mathematical models for derivingestimates and projections of COVID-19 cases have been developed without data on asymptomatic SARS-CoV-2 infection. We estimated the seroprevalence of antibodies to SARS-CoV-2 among blood donors in the State of Rio de Janeiro. Methods: Data were collected on 2,857 blood donors from April 14 to 27, 2020. We report the crude prevalence of antibodies to SARS-CoV-2, the weighted prevalence by the total state population, and adjusted prevalence estimates for test sensitivity and specificity. To establish the correlates of SARS-CoV-2 prevalence, we used logistic regression models. The analysis included period and site of blood collection, sociodemographic characteristics, and place of residence. Results: The proportion of SARS-Cov-2 positive tests 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%). Further adjustment by test sensitivity and specificity produced lower estimates, 3.6% (95% CI 2.7-4.4%) and 3.3% (95% CI 2.6-4.1%), respectively. The variable most significantly associated with the crude prevalence was the period of blood collection: the later the period, the higher the prevalence. Regarding socio-demographic characteristics, the younger the blood donors, the higher the prevalence, and the lower the educational level, the higher the odds of a positive SARS-Cov-2 antibody. Similar results were found for the weighted prevalence. Discussion: Although our findings resulted from a convenience sample, they match some basic premises: the increasing trend over time, since the epidemic curve in the state is still on the rise; the higher prevalence among the youngest who are more likely to circulate; and the higher prevalence among the less educated as they have more difficulties in following the social distancing recommendations. Despite the study limitations, it is possible to infer that protective levels of natural herd immunity to SARS-CoV-2 are far from being reached in Rio de Janeiro. (AU)

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

Abstract 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.

Brazilian version of the Multidimensional Fatigue Inventory for Parkinsons disease / Versão brasileira do Inventário Multidimensional de Fadiga na doença de Parkinson

Abstract Introduction: The multidimensional fatigue inventory (MFI) has not been applied in Brazilian Parkinson`s disease (PD) population due to the lack of validation. Objective: The aim of this study was to cross-culturally adapt, to validate, and investigate the psychometric properties of Brazilian version of the MFI in PD. Method: Idiopathic PD individuals (N = 90) were recruited. The MFI was translated into Brazilian Portuguese using established forward-backward translation procedures, and the psychometric properties were evaluated. All individuals were assessed by socio-clinical questionnaire, Mini-Mental State Examination (MMSE), Unified Parkinson's Disease Rating Scale (MDS-UPDRS Part I-IV), Hoehn-Yahr disability scale (HY), hospital anxiety and depression scale (HADS), fatigue severity scale (FSS), Parkinson Fatigue Scale (PFS-16) and MFI-PD/ BR with retest of the MFI-PD/BR after seven days. Results: The adaptation phase kept the same items of original MFI-PD. No data missing, floor nor ceiling effects were found. The overall Cronbach's alpha coefficient for the 20 items was 0.81, ranging from 0.73 to 0.81 for each of the five subscales. Bland and Altman analysis showed no systematic differences between assessments. The intraclass correlation coefficient test-retest was higher or equal 0.70 (p < 0.01) for the MFI-PD/BR score, which was moderately correlated with the HADS, MDS-UPDRS score (motor examination, motor and non-motor experiences of daily living and motor complications), FSS and PFS-16. It was revealed the MFI-PD/ BR > 55 points as cut-off point to indicate fatigued subjects with accuracy of 0.84 (p < 0.001). Conclusion: The MFI-PD/BR can be considered a valid and reproducible instrument for assessing PD-related fatigue.

Resumo Introdução: O inventário multidimensional da fadiga (MFI) não tem sido administrado em indivíduos brasileiros com doença de Parkinson (DP) devido à falta de validação. Objetivo: Adaptar transculturalmente, validar e investigar as propriedades psicométricas da versão brasileira do MFI na DP. Método: Foram recrutados indivíduos com DP (N=90). O MFI foi traduzido para o português falado no Brasil usando procedimentos de tradução e retrotradução e as propriedades psicométricas foram avaliadas. Todos os indivíduos foram avaliados por meio de um questionário sócio-clínico, mini-exame do estado mental (MEEM), escala modificada de avaliação na DP (MDS-UPDRS Parte I-IV), escala de incapacidade de Hoehn-Yahr (HY), escala de ansiedade e depressão (HADS), escala de gravidade de fadiga (FSS), escala de fadiga da DP (PFS-16) e MFI-DP/ BR com reteste do MFI-PD/BR em sete dias. Resultados: A adaptação manteve os mesmos itens do instrumento original do MFI-PD. Nenhum dado perdido, efeito chão ou teto foram encontrados. O coeficiente alpha de Cronbach de todos os 20 itens foram 0.81, variando entre 0.73 a 0.81 entre as cinco subescalas. A análise de Bland-Altman não demonstrou nenhuma diferença sistemática entre as avaliações. O coeficiente de correlação intraclasse teste-reteste foi maior ou igual a 0.70 (p < 0.01) para os escores do MFI-DP/BR com correlações moderadas com HADS, MDS-UPDRS escore (exame físico, experiências motoras e não motoras de atividades de vida diária e complicações motoras), FSS e PFS-16. Foi revelado MFI-DP/ BR > 55 pontos como ponto de corte para indicar indivíduos com fadiga com acurácia de 0.84 (p < 0.001). Conclusão: O MFI-DP/BR pode ser considerado um instrumento válido e reprodutível para avaliar fadiga na DP.

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

ABSTRACT 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.

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

Abstract 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.

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.