Development of a Clinical Prediction Rule for Treatment Success with Transcranial Direct Current Stimulation for Knee Osteoarthritis Pain: A Secondary Analysis of a Double-Blind Randomized Controlled Trial.

The study's objective was to develop a clinical prediction rule that predicts a clinically significant analgesic effect on chronic knee osteoarthritis pain after transcranial direct current stimulation treatment. This is a secondary analysis from a double-blind randomized controlled trial. Data from 51 individuals with chronic knee osteoarthritis pain and an impaired descending pain inhibitory system were used. The intervention comprised a 15-session protocol of anodal primary motor cortex transcranial direct current stimulation. Treatment success was defined by the Western Ontario and McMaster Universities' Osteoarthritis Index pain subscale. Accuracy statistics were calculated for each potential predictor and for the final model. The final logistic regression model was statistically significant (p < 0.01) and comprised five physical and psychosocial predictor variables that together yielded a positive likelihood ratio of 14.40 (95% CI: 3.66−56.69) and an 85% (95%CI: 60−96%) post-test probability of success. This is the first clinical prediction rule proposed for transcranial direct current stimulation in patients with chronic pain. The model underscores the importance of both physical and psychosocial factors as predictors of the analgesic response to transcranial direct current stimulation treatment. Validation of the proposed clinical prediction rule should be performed in other datasets.

Biomarkers of cytokine storm as red flags for severe and fatal COVID-19 cases: A living systematic review and meta-analysis.

OBJECTIVE: To describe the laboratory parameters and biomarkers of the cytokine storm syndrome associated with severe and fatal COVID-19 cases. METHODS: A search with standardized descriptors and synonyms was performed on November 28th, 2020 of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, LILACS, and IBECS to identify studies of interest. Grey literature searches and snowballing techniques were additionally utilized to identify yet-unpublished works and related citations. Two review authors independently screened the retrieved titles and abstracts, selected eligible studies for inclusion, extracted data from the included studies, and then assessed the risk of bias using the Newcastle-Ottawa Scale. Eligible studies were those including laboratory parameters-including serum interleukin-6 levels-from mild, moderate, or severe COVID-19 cases. Laboratory parameters, such as interleukin-6, ferritin, hematology, C-Reactive Protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine, and D-dimer, were extracted from the studies. Meta-analyses were conducted using the laboratory data to estimate mean differences with associated 95% confidence intervals. DATA SYNTHESIS: The database search yielded 9,620 records; 40 studies (containing a total of 9,542 patients) were included in the final analysis. Twenty-one studies (n = 4,313) assessed laboratory data related to severe COVID-19 cases, eighteen studies (n = 4,681) assessed predictors for fatal COVID-19 cases and one study (n = 548) assessed laboratory biomarkers related to severe and fatal COVID-19 cases. Lymphopenia, thrombocytopenia, and elevated levels of interleukin-6, ferritin, D-dimer, aspartate aminotransferase, C-Reactive-Protein, procalcitonin, creatinine, neutrophils and leucocytes were associated with severe and fatal COVID-19 cases. CONCLUSIONS: This review points to interleukin-6, ferritin, leukocytes, neutrophils, lymphocytes, platelets, C-Reactive Protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine, and D-dimer as important biomarkers of cytokine storm syndrome. Elevated levels of interleukin-6 and hyperferritinemia should be considered as red flags of systemic inflammation and poor prognosis in COVID-19.

Bilingualism for delaying the onset of Alzheimer's disease: a systematic review and meta-analysis.

OBJECTIVE: To assess the effects of bilingualism compared to monolingualism on the clinical manifestation of Alzheimer's disease. METHODS: We searched the databases: MEDLINE, The Cochrane Central Register of Controlled Trials, Embase and LILACS, and searched by hand and in gray literature for studies published before September 2019. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Two reviewers independently searched for studies, extracted data, and performed the quality assessment. RESULTS: Eight studies were included in this review. Data from meta-analyses suggest that bilingual individuals with Alzheimer's disease exhibit symptoms (694 participants; mean difference (MD) (4.05 years; 95% CI: 1.87-6.22 and are diagnosed later (1012 participants; MD 2.0 years; 95% CI: 0.08-3.92) than monolingual participants. CONCLUSION: Bilingualism may delay the manifestation of symptoms and diagnosis of Alzheimer's disease. Further studies with more rigorous methodology are needed to improve the precision of the results.

Prevalence of high frequency hearing loss consistent with noise exposure among people working with sound systems and general population in Brazil: a cross-sectional study.

BACKGROUND: Music is ever present in our daily lives, establishing a link between humans and the arts through the senses and pleasure. Sound technicians are the link between musicians and audiences or consumers. Recently, general concern has arisen regarding occurrences of hearing loss induced by noise from excessively amplified sound-producing activities within leisure and professional environments. Sound technicians' activities expose them to the risk of hearing loss, and consequently put at risk their quality of life, the quality of the musical product and consumers' hearing. The aim of this study was to measure the prevalence of high frequency hearing loss consistent with noise exposure among sound technicians in Brazil and compare this with a control group without occupational noise exposure. METHODS: This was a cross-sectional study comparing 177 participants in two groups: 82 sound technicians and 95 controls (non-sound technicians). A questionnaire on music listening habits and associated complaints was applied, and data were gathered regarding the professionals' numbers of working hours per day and both groups' hearing complaint and presence of tinnitus. The participants' ear canals were visually inspected using an otoscope. Hearing assessments were performed (tonal and speech audiometry) using a portable digital AD 229 E audiometer funded by FAPESP. RESULTS: There was no statistically significant difference between the sound technicians and controls regarding age and gender. Thus, the study sample was homogenous and would be unlikely to lead to bias in the results. A statistically significant difference in hearing loss was observed between the groups: 50% among the sound technicians and 10.5% among the controls. The difference could be addressed to high sound levels. CONCLUSION: The sound technicians presented a higher prevalence of high frequency hearing loss consistent with noise exposure than did the general population, although the possibility of residual confounding due to unmeasured factors such as socioeconomic status cannot be ruled out.

Salivary gland ultrasonography as a predictor of clinical activity in Sjögren's syndrome.

PURPOSE: Primary Sjögren's syndrome is a multisystem autoimmune disease characterized by hypofunction of salivary and lacrimal glands and possible multi-organ system manifestations. Over the past 15 years, three sets of diagnostic criteria have been proposed, but none has included salivary gland ultrasonography. However, recent studies support its role in the diagnosis and prognostic evaluation of patients with Sjögren's syndrome. This study aimed to determine the value of salivary gland ultrasonography in the diagnosis and prognosis of Sjögren's syndrome by relating ultrasonography severity scores to clinical and laboratory data. METHODS: Seventy patients who fulfilled the 2002 American-European Consensus Group diagnostic criteria for primary Sjögren's syndrome were selected from 84 patients receiving care in specialized outpatient clinics at our institution from November 2013 to May 2016. Their serology, European League Against Rheumatism Sjögren's syndrome disease activity index (ESSDAI), salivary flow rate, immunoglobulin G, and salivary and serum beta-2 microglobulin levels were measured. Salivary gland ultrasonography was performed by an experienced radiologist, using scores of 1-4 to classify salivary gland impairment. RESULTS: Salivary gland ultrasonography scores of 1 or 2 were associated with an ESSDAI < 5. Ultrasonography scores of 3 or 4 were associated with an ESSDAI ≥5 (p = 0.064), a positive antinuclear antibody test (p = 0.006), positive anti-Ro/SSA antibodies (p = 0.003), positive anti-La/SSB antibodies (p = 0.077), positive rheumatoid factor (p = 0.034), and immunoglobulin G levels > 1600 mg/dL (p = 0.077). Salivary flow rate was lower in patients with scores 3 or 4 (p = 0.001). CONCLUSION: This study provides further evidence that salivary gland ultrasonography can be used not only for diagnosis but also for prognostic evaluation of primary Sjögren's syndrome. These findings confirm what has been reported in the literature. However, further analyses involving larger matched samples are required to support this finding and include salivary gland ultrasonography as part of the diagnostic criteria for Sjögren's syndrome.

Bilateral deep keratitis caused by systemic lupus erythematosus.

We report the optical and ultrasonic biomicroscopy and confocal microscopy findings in bilateral stromal keratitis (keratoendotheliitis), a rare ocular manifestation of systemic lupus erythematosus (SLE). Examination revealed deposits with polyrefringent crystals. Topical corticosteroid produced regression of the corneal edema, but there was an increase in corneal opacity. Ultrasound biomicroscopy images confirmed the deep location of the corneal opacities, and confocal microscopy showed a disruption of the corneal stroma and crystal-like bodies.

Effects of external cues on gait parameters of Parkinson's disease patients: a systematic review.

OBJECTIVES: A systematic review to evaluate the benefits of external cues on the gait of PD patients and their impact on the quality of life, freezing and psychomotor performance was performed. The types of cues that could lead to more significant gains were analyzed. METHODS: We searched for randomized clinical trials (RCTs) and quasi-randomized clinical trial (QRCTs) that assessed the influence of different external cues on gait, freezing, quality of life and psychomotor performance. RESULTS: Of 259 articles collected, seven (six RCTs and one QRCT) were included in the methodological quality criteria (two consider visual cues, two consider auditory cues, one considers verbal instructions, one considers combined cues and one considers sensory cues). All of the data regarding the methodology, interventions, population and bias were described. Cues generally led to a statistically significant improvement in the step and stride length, speed of gait, cadence and UPDRS. None of these studies assessed the quality of life, and one study analyzed freezing. CONCLUSION: Our review could show that external cues are effective for improving the gait parameters and psychomotor performance of PD patients. We need more studies to verify if the impact of this type of treatment could improve the quality of life of patients with PD.

Lidocaine for systemic sclerosis: a double-blind randomized clinical trial.

BACKGROUND: Systemic sclerosis (scleroderma; SSc) is an orphan disease with the highest case-specific mortality of any connective-tissue disease. Excessive collagen deposit in affected tissues is a key for the disease's pathogenesis and comprises most of the clinical manifestations. Lidocaine seems to be an alternative treatment for scleroderma considering that: a) the patient's having excessive collagen deposits in tissues affected by scleroderma; b) the patient's demonstrating increased activity of the enzyme prolyl hydroxylase, an essential enzyme for the biosynthesis of collagen; and c) lidocaine's reducing the activity of prolyl hydroxylase. The aim of this study was to evaluate the efficacy and safety of lidocaine in treating scleroderma. METHODS: A randomized double-blind clinical trial included 24 patients with scleroderma randomized to receive lidocaine or placebo intravenously in three cycles of ten days each, with a one-month interval between them. OUTCOMES: cutaneous (modified Rodnan skin score), oesophageal (manometry) and microvascular improvement (nailfold capillaroscopy); improvement in subjective self-assessment and in quality of life (HAQ). RESULTS: There was no statistically significant difference between the groups for any outcome after the treatment and after 6-months follow-up. Improvement in modified Rodnan skin score occurred in 66.7% and 50% of placebo and lidocaine group, respectively (p = 0.408). Both groups showed an improvement in subjective self-assessment, with no difference between them. CONCLUSIONS: Despite the findings of a previous cohort study favouring the use of lidocaine, this study demonstrated that lidocaine at this dosage and means of administration showed a lack of efficacy for treating scleroderma despite the absence of significant adverse effects. However, further similar clinical trials are needed to evaluate the efficacy of lidocaine when administered in different dosages and by other means.

Especificidades de auto-anticorpos na uveíte anterior aguda segundo a presença do alelo HLA-B27 / Autoantibody specificity in acute anterior uveitis according to the presence of the HLA-B27 allele

Introdução - As uveítes anteriores agudas (UAA) são a foram mais frequente de inflamação do trato uveal e grande proporção dessas está associada à presença do alelo B27 com ou sem espondiloartropatia. Acredita-se que a presença do HLA-27 esteja associada a particularidades clínicas e imunológicas. Objetivos - Estudar pacientes com uveíte anterior aguda HLA-B27 e HLA-B27 quanto à frequência e especificidade de auto-anticorpos órgão-epecíficos e não órgão-específicos. Métodos - Cinquenta e sete pacientes com uveíte anterior aguda foram avaliados por oftalmologista e pelo reumatologista, que realizaram os seguintes testes laboratoriais: immunoblot para anticorpos anti-células HeLa e antiextrato de íris bovina. A pesquisa do HLA-B27 foi realizada por microlinfotoxicidade. A análise estatística foi feita usando-se o teste de Mann-Whitney, teste do qui-quadrado, teste exato de Fisher e o teste de McNemar. Resultados - Dentre so 57 pacientes, 34 possuíam o alelo HLA-B27 (UAA-B27) e 23 não tinham esse alelo (UAA-B27-). Pela técnica de immunoblot com extrato total de células HeLa, no grupo UAA-B27, mas não no grupo UAA-B27, evidenciou-se alta frequência de anticorpos, contra proteínas de diferentes pesos moleculares; as reatividades mais frequentes foram contra proteínas de 46 e 56kDa. Por outro lado, o immunoblot com extrato total de íris evidenciou alta frequência de reatividade nos soros dos dois grupos de pacientes; as reatividades mais frequentes foram as de peso molecular estimado em 35,52 e 54kDa. Conclusão - A UAA, associada ao alelo HLA-B27, apresentou menor expressão de auto-anticorpos não específicos ao tecido uveal. Por outro lado, a expressão de anticorpos antiíris associou-se a UAA, independentemente da presença do alelo HLA-B27

Avaliação clínica de pacientes com uveíte anterior aguda segundo a presença do alelo HLA-B27 / Clinical evaluation of patients with acute anterior uveitis according to the presence of the HLA-B27 allele

Introdução: As uveítes anteriores agudas (UAA) são a forma mais frequente de inflamação do trato uveal e grande proporção dessas está associada à presença do alelo B-27 com ou sem espondiloartropatia. Objetivos: Estudar pacientes com uveíte anterior aguda HLA-B27 quanto a frequência de manifestações clínico-radiológicas e às características intrínsecas da doença ocular. Métodos: Cinquenta e sete pacientes com uveíte anterior aguda foram avaliados pelo oftalmologista e pelo reumatologista e realizaram testes laboratoriais (hemograma, velocidade de hemossedimentação, sorologia para sífilis, eletroforese de proteínas e urina tipo I) além de radiografias de tórax, coluna lombar e de articulações sacroilíacas. A pesquisa do HLA-B27 foi realizada pelo ensaio de microlinfotoxicidade. A análise estatística foi feita usando-se o teste de Mann-Whitney, teste do qui-quadrado e o teste exato de Fisher. Resultados: Dentre os 57 pacientes, 23 possuíam o alelo HLA-B27 (UAA-B27) e 34 não tinham esse alelo. Os dois grupos diferiram com relação à idade. No grupo o UAA-B27 houve predomínio do sexo masculino, alta frequência de comprometimento ocular unilateral recorrente, alta frequência de lombalgia do tipo inflamatório, de artrite periférica, de calcaneodínea e de alterações radiológicas compatíveis com sacroiliite e de sidnesmofitose nas radiografias da coluna. Conclusão: A UAA, associada ao alelo HLA B-27, apresentou características oftalmológicas, reumatológicas e radiológicas próprias, o que suporta sua classificação como entidade nosológica à parte