Chronic Chikungunya arthralgia reduces functionality, quality of life and occupational performance: descriptive cross-sectional study / Artralgia crônica por Chikungunya reduz funcionalidade, qualidade de vida e performance ocupacional: estudo descritivo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Chikungunya virus (CHIKV) chronic polyarthralgia deteriorates general functionality and work productivity. The objective of this study was to evaluate functionality, pain, quality of life, and sleep quality of individuals with chronic CHIKV arthralgia and correlate them with clinical symptoms, work productivity, and activity impairment. METHODS: This is a descriptive cross-sectional study with 61 chronic CHIKV arthralgia patients. Functionality was assessed using the Health Assessment Questionnaire (HAQ). Pain intensity and interference were measured by using the Visual Analog Scale (VAS) and the Brief Pain Inventory Short Form (BPI), respectively. Quality of life and sleep were evaluated using the Short Form 36 Health Survey (SF-36) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Work Productivity and Activity Impairment (WPAI) questionnaire was used to assess the effects of health in general symptoms on work. RESULTS: Low and moderate level of function was present in 39.4% and 55.7% of the sample, respectively. Moderate pain (5.57 ± 2.25), poor sleep quality (47.54%), and sleep disturbances (42.63%) were also observed. Pearson correlations showed significant correlation between absenteeism and presenteeism with HAQ scores (p = 0.03; r = 0.39 and p = 0.01; r = 0.43, respectively), BPI interference (p = 0.02; r = 0.41 and p = 0.001; r = 0.58, respectively) and SF-36 physical score (p = 0.007; r = -0.49 and p = 0.01; r = 0.58, respectively). Activity impairment showed a significant correlation with HAQ (p = 0.01; r = 0.44), BPI interference (p = 0.006; r = 0.5), SF-36 physical score (p = 0.01; r = -0.6) and SF-36 total score (p = 0.01; r = -0.44). Overall work productivity loss only correlated with BPI interference (p = 0.04; r = 0.37). CONCLUSION: These results suggest that CHIKV chronic arthralgia showed bilateral moderate pain in large joints that impacts activities of daily life, work productivity, and functional activity. HIGHLIGHTS Chronic chikungunya reduces functionality and causes moderate pain and poor sleep quality Clinical symptoms impact daily living activity, work productivity, and activity impairment. Functionality, pain, and sleep correlate with occupational performance.

RESUMO JUSTIFICATIVA E OBJETIVOS: A poliartralgia crônica do vírus Chikungunya (CHIKV) deteriora a funcionalidade e a produtividade do trabalho. O objetivo deste estudo foi avaliar funcionalidade, dor, qualidade de vida e sono de indivíduos com artralgia crônica por CHIKV correlacionada com sintomas clínicos, produtividade do trabalho e comprometimento das atividades. MÉTODOS: Trata-se de um estudo transversal descritivo com 61 pacientes crônicos de artralgia da CHIKV. A intensidade e a interferência da dor foram medidas usando a Escala Analógica Visual (EAV) e o Brief Pain Inventory Short Form (BPI), respectivamente. A qualidade de vida e o sono foram avaliados usando o Short Form 36 Health Survey (SF-36) e o Pittsburgh Sleep Quality Index (PSQI), respectivamente. O questionário Work Productivity and Activity Impairment (WPAI) foi usado para avaliar os efeitos dos sintomas gerais da saúde no trabalho. RESULTADOS: Foi observado um nível de funcionalidade baixo em 39,4% e moderado em 55,7% da amostra. Nível de dor moderada (5,57 ± 2,25), má qualidade do sono (47,54%) e distúrbios do sono (42,63%) também foram observados. O teste de Pearson apresentou correlação significativa entre absenteísmo e presenteísmo com as pontuações de Health Assessment Questionnaire (HAQ) (p = 0,03; r = 0,39 e p = 0,01; r = 0,43 respectivamente), interferência do BPI (p = 0,02; r = 0,41 e p = 0,001; r = 0,58 respectivamente) e score físico do SF-36 (p = 0,007; r = -0,49 e p = 0,01; r = 0,58, respectivamente). O comprometimento da atividade mostrou uma correlação significativa com o HAQ (p = 0,01; r = 0,44), interferência do BPI (p = 0,006; r = 0,5), pontuação física do SF-36 (p = 0,01; r = -0,6) e pontuação total do SF-36 (p = 0,01; r = -0,44). A perda geral de produtividade no trabalho correlacionou-se apenas com a interferência do BPI (p = 0,04; r = 0,37). CONCLUSÃO: Esses resultados sugerem que a artralgia crônica da CHIKV apresenta dor moderada bilateral em grandes articulações com impacto nas atividades de vida diária, produtividade no trabalho e atividade funcional. DESTAQUES A Chikungunya crônica reduz a funcionalidade e causa dor moderada e má qualidade do sono. Os sintomas clínicos afetam atividades de vida diária, a produtividade no trabalho e comprometimento de atividades. Funcionalidade, dor e sono estão correlacionados com o desempenho profissional.

Evaluation of bladder and bowel functions in children with microcephaly and congenital zika syndrome.

INTRODUCTION: Children with Congenital Zika Syndrome (CZS) present structural cortical changes that may compromise the integrity of their connections with urinary and digestive systems, causing bowel and bladder dysfunctions. OBJECTIVE: To evaluate bladder and bowel dysfunction (BBD) in children with CZS. STUDY DESIGN: This is an observational cross-sectional study of a series of CZS cases. Urinary tracts were investigated using a bladder function protocol consisting of clinical history, detailed physical examination, laboratory tests, ultrasound of the lower and upper urinary tracts, and urodynamic evaluation. The bowel function protocol expanded anamnesis with questions related to signs and symptoms of functional disorders, Bristol scale, and ultrasound of the rectal ampoule. RESULTS: Forty children with CZS, aged between one and five years were included. The majority (80%) had bladder and bowel dysfunction (BBD), 12.5% had bladder dysfunction only, and 7.5% only bowel dysfunction. A reduced bladder capacity was confirmed in 36 patients (90%), while 15 (40%) presented postvoid residual greater than 20% of their cystometric capacity. Thirty-five patients (87.5%) presented four signs/symptoms of functional bowel disorders and the rectal ampoule ultrasound was >2.9 cm in 21 (52.5%). Moreover, 19 (47.5%) presented urinary tract infection, while 5 (12.5%) developed pyelonephritis and required hospitalization. Renal ultrasound showed nephrolithiasis in three (7.5%), one (2.5%) presented horseshoe kidney, and a duplicated collecting system was found in three patients. Cryptorchidism was presented in eight (34%). DISCUSSION: Our study confirmed the presence of BBD in 80% of the children with CZS studied in this series. This is the first time that bowel dysfunction is confirmed in the settings of CZS. This recognition will facilitate early identification and appropriate therapies in an attempt to reduce complications. One limitation of the study is the absence of a control group. Due to the new aspects of CZS, it has been difficult to find a suitable group of patients with neurological disorders to compare and performing urodynamic studies in children without neurological or non-neurological voiding dysfunction is unethical. Appropriate control groups for future studies may be children with microcephaly due to other causes or older children with CZS who were not yet investigated or treated. Another limitation is the lack of a standard quantitative evaluation of bowel dysfunction in children with neurological disorders. CONCLUSION: Bladder and bowel dysfunction was confirmed in 80% of the children with CZS. This is a new Zika virus-associated neuromuscular disorder that needs to be further investigated.

Acute effect of high-definition and conventional tDCS on exercise performance and psychophysiological responses in endurance athletes: a randomized controlled trial.

Transcranial direct current stimulation (tDCS) has been used aiming to boost exercise performance and inconsistent findings have been reported. One possible explanation is related to the limitations of the so-called "conventional" tDCS, which uses large rectangular electrodes, resulting in a diffuse electric field. A new tDCS technique called high-definition tDCS (HD-tDCS) has been recently developed. HD-tDCS uses small ring electrodes and produces improved focality and greater magnitude of its aftereffects. This study tested whether HD-tDCS would improve exercise performance to a greater extent than conventional tDCS. Twelve endurance athletes (29.4 ± 7.3 years; 60.15 ± 5.09 ml kg-1 min-1) were enrolled in this single-center, randomized, crossover, and sham-controlled trial. To test reliability, participants performed two time to exhaustion (TTE) tests (control conditions) on a cycle simulator with 80% of peak power until volitional exhaustion. Next, they randomly received HD-tDCS (2.4 mA), conventional (2.0 mA), or active sham tDCS (2.0 mA) over the motor cortex for 20-min before performing the TTE test. TTE, heart rate (HR), associative thoughts, peripheral (lower limbs), and whole-body ratings of perceived exertion (RPE) were recorded every minute. Outcome measures were reliable. There was no difference in TTE between HD-tDCS (853.1 ± 288.6 s), simulated conventional (827.8 ± 278.7 s), sham (794.3 ± 271.2 s), or control conditions (TTE1 = 751.1 ± 261.6 s or TTE2 = 770.8 ± 250.6 s) [F(1.95; 21.4) = 1.537; P = 0.24; η2p = 0.123]. There was no effect on peripheral or whole-body RPE and associative thoughts (P > 0.05). No serious adverse effect was reported. A single session of neither HD-tDCS nor conventional tDCS changed exercise performance and psychophysiological responses in athletes, suggesting that a ceiling effect may exist.

Egg Model Training Protocol for Stereotaxic Neurosurgery and Microelectrode Implantation.

BACKGROUND: Neuroscience research uses neurosurgery in animal models for several experimental techniques. To our knowledge, there is no published method for small animal neurosurgery training. Based on the similar thickness of chicken eggshells and mouse, rat, and some small primate skulls, here we propose an egg model training protocol for stereotaxic surgery. MATERIALS AND METHODS: To perform training it was used a boiled egg and the same materials needed to perform stereotaxic neurosurgery in small animals. DISCUSSION: This protocol allows trainees in neuroscience research to become familiar with the microsurgery setting and learn neurosurgery techniques, such as craniotomy drilling, dura mater removal, and electrode implantation. CONCLUSION: Egg model suitably mimics animal neurosurgery for the replacement and sparing of animals intended for training in neurosurgical skills.

Genome-wide association study of metabolic traits reveals novel gene-metabolite-disease links.

Metabolic traits are molecular phenotypes that can drive clinical phenotypes and may predict disease progression. Here, we report results from a metabolome- and genome-wide association study on (1)H-NMR urine metabolic profiles. The study was conducted within an untargeted approach, employing a novel method for compound identification. From our discovery cohort of 835 Caucasian individuals who participated in the CoLaus study, we identified 139 suggestively significant (P<5×10(-8)) and independent associations between single nucleotide polymorphisms (SNP) and metabolome features. Fifty-six of these associations replicated in the TasteSensomics cohort, comprising 601 individuals from São Paulo of vastly diverse ethnic background. They correspond to eleven gene-metabolite associations, six of which had been previously identified in the urine metabolome and three in the serum metabolome. Our key novel findings are the associations of two SNPs with NMR spectral signatures pointing to fucose (rs492602, P = 6.9×10(-44)) and lysine (rs8101881, P = 1.2×10(-33)), respectively. Fine-mapping of the first locus pinpointed the FUT2 gene, which encodes a fucosyltransferase enzyme and has previously been associated with Crohn's disease. This implicates fucose as a potential prognostic disease marker, for which there is already published evidence from a mouse model. The second SNP lies within the SLC7A9 gene, rare mutations of which have been linked to severe kidney damage. The replication of previous associations and our new discoveries demonstrate the potential of untargeted metabolomics GWAS to robustly identify molecular disease markers.

Time-related effects of general functional training in spinal cord-injured rats

OBJECTIVES: This prospective, randomized, experimental study with rats aimed to investigate the influence of general treatment strategies on the motor recovery of Wistar rats with moderate contusive spinal cord injury. METHODS: A total of 51 Wistar rats were randomized into five groups: control, maze, ramp, runway, and sham (laminectomy only). The rats underwent spinal cord injury at the T9-T10 levels using the NYU-Impactor. Each group was trained for 12 minutes twice a week for two weeks before and five weeks after the spinal cord injury, except for the control group. Functional motor recovery was assessed with the Basso, Beattie, and Bresnahan Scale on the first postoperative day and then once a week for five weeks. The animals were euthanized, and the spinal cords were collected for histological analysis. RESULTS: Ramp and maze groups showed an earlier and greater functional improvement effect than the control and runway groups. However, over time, unexpectedly, all of the groups showed similar effects as the control group, with spontaneous recovery. There were no histological differences in the injured area between the trained and control groups. CONCLUSION: Short-term benefits can be associated with a specific training regime; however, the same training was ineffective at maintaining superior long-term recovery. These results might support new considerations before hospital discharge of patients with spinal cord injuries.

Spectral characteristics of the hippocampal LFP during contextual fear conditioning / Características espectrais da atividade elétrica hipocampal durante o medo condicionado ao contexto

Objective: The hippocampus has an important role in the acquisition and recall of aversive memories. The objective of this study was to investigate the relationship among hippocampal rhythms. Methods: Microeletrodes arrays were implanted in the hippocampus of Wistar rats. The animals were trained and tested in a contextual fear conditioning task. The training consisted in applying shocks in the legs. The memory test was performed 1 day (recent memory) or 18 days (remote memory) after training. We proposed a measure based on the FFT power spectrum, denominated "delta-theta ratio", to characterize the different behaviors (active exploration and freezing) and the memories types. Results: The delta-theta ratio was able to distinguish recent and remote memories. In this study, the ratio for the 18-day group was smaller than for the 1-day group. Moreover, this measure was useful to distinguish the different behavior states - active exploration and freezing. Conclusions: The results suggest delta-theta oscillations could reflect the demands on information processing during recent and remote memory recalls.

Objetivo: O hipocampo tem um importante papel na aquisição e evocação das memórias aversivas. Pretendeu-se, neste trabalho, investigar a dinâmica entre os ritmos hipocampais durante a evocação das memórias aversivas recente e remota. Métodos: Foram implantadas matrizes de microeletrodos em ratos Wistar. Os animais foram treinados e testados numa tarefa de condicionamento contextual de medo. O treino consistiu em aplicações de choques nas patas. O teste de memória foi realizado 1 dia (memória recente) ou 18 dias (memória remota) após o treino. Nesse trabalho, foi proposta uma medida baseada no espectro de potências, denominada "razão delta-theta", para caracterização dos diferentes comportamentos observados (vigília exploratória e congelamento) e tipos de memórias. Resultados: A razão delta-theta mostrou-se capaz de distinguir os grupos testados para as memórias recente e remota. Neste caso, observou-se, para o grupo testado 18 dias após, um valor menor do que para o grupo testado 1 dia após. Além disso, essa medida mostrou-se útil para distinguir os diferentes estados comportamentais. Conclusões: Os resultados sugerem que a dinâmica entre os ritmos delta e theta pode refletir o processamento da informação durante a evocação das memórias recente e remota.

Respostas posturais à perturbação externa inesperada em judocas de diferentes níveis de habilidade / Postural responses to unexpected external perturbance in judoists of different ability levels

O judô é uma modalidade esportiva na qual é requerido o controle eficiente do equilíbrio pelo atleta, por estar constantemente sujeito a movimentos inesperados impostos por seus adversários. Este estudo teve o objetivo de analisar as respostas posturais a uma perturbação externa inesperada de judocas (n = 20) em dois níveis de habilidade (faixas marrom e verde) e de um grupo de participantes não-atletas (n = 10). Uma perturbação externa posterior (PEP) foi aplicada através de uma tração horizontal ao dorso do participante, utilizando-se de um sistema de polia fixa. A PEP foi removida inesperada e rapidamente, provocando a resposta postural de interesse. Os deslocamentos do centro de pressão (CP) foram obtidos através de uma plataforma de força. As respostas posturais foram analisadas em oito intervalos de 1s (t1 a t8), iniciando-se no momento da liberação da PEP. As médias das velocidades e das posições do CP, na direção ântero-posterior, foram os principais parâmetros utilizados para analisar as respostas posturais na recuperação do equilíbrio. Análise de variância (ANOVA) com medidas repetidas para dois fatores (grupo x intervalo), seguida pelo pós-teste de Student Newman-Keuls (p < 0,05), foi aplicada para velocidade e posição de CP; ANOVA simples para o fator intervalo em cada grupo foi aplicada à posição do CP, para se verificar o padrão de reposicionamento do CP. O grupo de maior habilidade apresentou menor velocidade do CP em comparação com o grupo controle e um padrão de reposicionamento gradual e contínuo do CP durante a recuperação do equilíbrio. Nossos achados mostram que os atletas mais habilidosos apresentam melhor controle do equilíbrio e indicam que o treinamento esportivo proposto e o nível de habilidade do atleta podem influenciar o desempenho desse controle.

Judo is a sport in which the athlete must have an efficient balance control, as he or she is constantly vulnerable to unexpected movements imposed by the opponents. The aim of this study is to analyze judoist postural responses to an unexpected external perturbation (n = 20) in two levels of ability (brown and green belts) and in those of a non-athlete group (n = 10). An external posterior perturbation (EPP) was applied by means of a horizontal traction to the subject's dorsum, using a fixed pulley system. The EPP was unexpectedly and quickly removed, producing the desired postural response. Displacements of centre of pressure (COP) were obtained by means of a force platform. Postural responses were analyzed in eight intervals of 1 s (t1 to t8), beginning at the moment of EPP removal. The speed and position averages of COP, in anteroposterior plane, were the main parameters used to analyze the postural responses in the balance recovery. A two-factor (group x intervals) repeated measures analysis of variance (ANOVA) followed by Student Newman-Keuls post-hoc (p < 0.05) was applied for speed and COP. ANOVA for intervals factor in each group was applied to COP position, in order to verify COP displacement patterns. The group of greater ability presented lower COP speed compared with the control group, and a gradual and continuous COP displacement pattern during balance recovery. Our findings confirmed the hypothesis that the most skilled athletes present better balance control, and show that the proposed sport training and the athlete's level of ability may influence on this control performance.

El judo es una modalidad deportiva en la que se requiere el control eficiente del equilibrio por parte del atleta, por estar constantemente sujeto a movimientos inesperados impuestos por sus adversarios. Este estudio ha tenido el objetivo de analizar las respuestas de postura frente a la perturbación externa inesperada de los practicantes de judo (n = 20) en dos niveles de destreza (cinturón marrón y verde) y el de un grupo de participantes no atletas (n = 10). Una perturbación externa posterior (PEP) fue aplicada a través de una tracción horizontal al dorso del participante, usándose un sistema de polea fija. La PEP fue removida inesperada y rápidamente provocando la respuesta de postura de interés. Los desplazamientos del centro de presión (CP) fueron obtenidos mediante una plataforma de fuerza. Las respuestas posturales fueron analizadas en ocho intervalos de 1s (t1 a t8), iniciándose en el momento de la liberación de la PEP. Los promedios de velocidad y las posiciones de CP, en la dirección antero posterior, fueron los principales parámetros utilizados para analizar las respuestas de postura en la recuperación del equilibrio. El análisis de varianza (ANOVA) con medidas repetidas para los dos factores (grupo x intervalo), seguido por el pos test de Student Newman-Keuls (p < 0,05), fue aplicado a la velocidad y posición de CP; ANOVA simple para el factor intervalo en cada grupo fue aplicada a la posición de CP, para verificar el padrón de reposicionamiento de CP. El grupo de mayor destreza presentó menor velocidad de CP en comparación al grupo control y un padrón de reposicionamiento gradual y continuo de CP durante la recuperación de equilibrio. Nuestros hallazgos muestran que los atletas con más destreza presentan mejor control de equilibrio e indican que el entrenamiento deportivo propuesto y el nivel de destreza del atleta pueden influenciar el desempeño de este control.