Quality Assurance Model for Breast Cancer Prognostication Using the Modified Magee Equations.

CONTEXT.­: The Oncotype DX recurrence score (RS) is a widely used test that provides prognostic information on the likelihood of disease recurrence and predictive information on the benefit of chemotherapy in early-stage, hormone receptor-positive breast cancer. Despite its widespread use, quality assurance of the RS does not receive the same level of scrutiny as other tests, such as human epidermal growth factor receptor 2 (HER2) immunohistochemistry. OBJECTIVE.­: To use modified Magee equations to calculate Magee score (MS) as a quality check of RS. DESIGN.­: The MS is an easily accessible prognostic model that uses histopathologic and immunohistochemical criteria. We identified cases where the RS and MS differed by 10 points or more or were in different risk categories. These instances were considered significant discordances. MS was presented along with RS at multidisciplinary tumor boards and all discrepancies were discussed to determine clinical significance and appropriate next steps. RESULTS.­: Twenty-five of 155 cases (16.1%) had discrepancies between RS and MS. Of these 25 cases, 3 (12%) had problems with either the RS or the histopathologic interpretation. Among the cases with concordant RS and MS, no RS or interpretive problems were identified. CONCLUSIONS.­: Use of the MS as a quality control check for the RS can help ensure appropriate treatment decisions in breast cancer patients. Pathologists can play a key role in ensuring the quality of molecular-based prognostic scores by using histopathologic models to ensure accurate risk stratification and improve clinical outcomes.

Influence of intravenous fentanyl or dexmedetomidine infusions, combined with lidocaine and ketamine, on cardiovascular response, sevoflurane requirement and postoperative pain in dogs anesthetized for unilateral mastectomy.

OBJECTIVE: To compare the effects of constant rate infusions (CRI) of fentanyl or dexmedetomidine, combined with lidocaine and ketamine, on cardiovascular response during surgery, sevoflurane requirement and postoperative pain in dogs undergoing mastectomy. STUDY DESIGN: Prospective, randomized, blinded, clinical trial. ANIMALS: A total of 29 female dogs with mammary tumors. METHODS: Premedication consisted of intramuscular acepromazine and morphine. General anesthesia was induced with intravenous propofol and maintained with sevoflurane. Dogs were randomized to be administered intravenous DLK [dexmedetomidine 1 µg kg-1 loading dose (LD) and 1 µg kg-1 hour-1; lidocaine 2 mg kg-1 LD and 3 mg kg-1 hour-1; ketamine 1 mg kg-1 LD and 0.6 mg kg-1 hour-1; n = 14] or FLK (fentanyl 5 µg kg-1 LD and 9 µg kg-1 hour-1; same doses of lidocaine and ketamine; n = 15) during anesthesia. Cardiorespiratory variables and end-tidal sevoflurane (Fe'Sevo) were recorded during surgery. The number of dogs administered ephedrine to treat arterial hypotension [mean arterial pressure (MAP) < 60 mmHg] was recorded. Meloxicam was administered to both groups. Postoperative pain and rescue analgesia requirement were assessed for 24 hours using the short form of the Glasgow Composite Measure Pain Scale. Data were compared using a mixed effects model or a Mann-Whitney test. RESULTS: More dogs required ephedrine in FLK than in DLK (67% versus 7%). Heart rate was not significantly different between groups, whereas lower values of MAP (p ≤ 0.01) and Fe'Sevo (p = 0.018) were observed in FLK than in DLK. Rescue analgesia was administered to 2/15 dogs in FLK and 0/14 dogs in DLK. CONCLUSIONS AND CLINICAL RELEVANCE: Based on the cardiovascular response during surgery, intraoperative infusions of FLK and DLK provided adequate antinociception. Infusion of DLK provided greater stability of blood pressure. Both protocols resulted in minimal need for additional analgesia within 24 hours postoperatively.

Investigation of the prevalence and factors influencing tobacco and alcohol use among adolescents in Nigeria: A systematic literature review.

The increase in tobacco and alcohol prevalence among Nigerian teenagers necessitates the need to understand the factors influencing use. The aim of this systematic literature review was to synthesis evidence from studies on tobacco and alcohol use among Nigerian adolescents and young adults in order to determine factors influencing tobacco and alcohol use. Six databases MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ScienceDirect, and Google Scholar were used to search for peer-reviewed articles reporting the prevalence and predictors of tobacco and alcohol use among adolescents/youths published between 2010 and 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided this review. From our search, twelve articles from the 6 geopolitical zones within Nigeria were included. The high prevalence of tobacco and alcohol use among Nigerian adolescents necessitates the need to understand the factors influencing use. A high prevalence rate was recorded among the male gender. Gender, age, and curiosity appear to place adolescents at extra risk for tobacco and alcohol use. Lack of parental monitoring, peer influence, low socio-economic status, low education level, stressful life events, advertisements, availability, and accessibility are factors identified to influence adolescents' alcohol and tobacco use. Alcohol and tobacco use remains a major public health issue as it continues to contribute largely to the growing occurence of diseases globally. Our review showed that adolescents' alcohol and tobacco use behaviour is triggered by various factors on the personal, interpersonal, organisational, community, and policy levels, and these factors are understood to predict or protect against alcohol and tobacco use.

Agreement between hematocrit values determined by the Cobas b121 blood gas analyzer and the microhematocrit method in dogs, cats, and horses.

BACKGROUND: Packed cell volume (PCV) is important for assessing a patient's health status. Some blood gas analyzers measure hematocrit, and the agreement with PCV varies among different analyzers. OBJECTIVES: We aimed to determine the agreement between PCV measured by microcentrifugation and hematocrit measured by the Cobas b121 blood gas analyzer in dogs, cats, and horses. METHODS: Whole blood samples for PCV and blood gas analysis were collected in lithium-heparin syringes and analyzed within 10 min of collection. Agreement and association between the PCV and Cobas b121 generated hematocrit were assessed by the Bland-Altman method, Pearson's correlation, Deming regression analysis, and paired t tests. A total allowable error of 10% was used for the analysis. RESULTS: This study included 45 dogs, 45 cats, and 33 horses. The respective mean ± SD (minimum-maximum) of PCVs and hematocrits were: dogs, 34.9 ± 9.9% (9.0-55.0) and 32.5 ± 8.8% (10.4-50.6); cats, 29.0 ± 9.6% (11.0-51.0) and 26.9 ± 9.3% (10.2-50.9); horses, 34.2 ± 6.5% (24.0-47.0) and 34.1 ± 6.0% (22.5-46.1). There were no significant differences between the methods. The bias ± SD was: dogs, -2.4 ± 2.6%; cats, -2.2 ± 2.3%; horses, -0.1 ± 2.4%. Pearson's correlation coefficients were > 0.90 for all species (P < 0.0001). In 60%, 49%, and 85% of the samples for dogs, cats, and horses, respectively, the percentage differences between the methods were within 10%. CONCLUSIONS: The Cobas b121 blood gas analyzer provided accurate estimates of PCVs in horses. However, in dogs and cats, there was a large frequency of unacceptable differences between the methods.

Diagnostic yield and safety of transbronchial lung cryobiopsy for diffuse parenchymal lung diseases diagnosis: Comparison between 1.7-mm and 1.9-mm probes.

PURPOSE OF THE RESEARCH: transbronchial lung cryobiopsy has been recently accepted as a valid and less invasive alternative to surgical lung biopsy. The purpose of this randomized controlled study was to evaluate, for the first time, the quality and safety of biopsy specimens obtained by using the new disposable 1.7-mm cryoprobe compared with the standard re-usable 1.9 mm cryoprobe in the diagnosis of diffuse parenchymal lung diseases. METHODS: 60 consecutive patients were prospectively enrolled and randomly assigned to two different groups: 1.9 mm (group A) and 1.7 mm (group B); primary endpoints were pathological and multidisciplinary diagnostic yield, sample size and complication rate. PRINCIPAL RESULTS: the pathological diagnostic yield of cryobiopsy was 100% in group A and 93.3% in group B (p = 0.718); cryobiopsy median diameter was 6.8 mm in group A and 6.7 mm in group B (p = 0,5241). Pneumothorax occurred in 9 patients in group A and 10 in group B (p = 0.951); mild-to-moderate bleeding in 7 cases and 9 cases in group A and B respectively (p = 0.559). No death or severe adverse events were observed. CONCLUSIONS: there was no statistically significant difference between the two groups, regarding diagnostic yield, adverse events and sampling adequacy.

Zinc loading in urea-formaldehyde nanocomposites increases nitrogen and zinc micronutrient fertilization efficiencies in poor sand substrate.

Agricultural output needs significant increases to feed the growing population. Fertilizers are essential for plant production systems, with nitrogen (N) being the most limiting nutrient for plant growth. It is commonly supplied to crops as urea. Still, due to volatilization, up to 50 % of the total N application is lost. Slow or controlled release fertilizers are being developed to reduce these losses. The co-application of zinc (Zn) as a micronutrient can increase N absorption. Thus, we hypothesize that the controlled delivery of both nutrients (N and Zn) in an integrated system can improve uptake efficiency. Here we demonstrate an optimized fertilizer nanocomposite based on urea:urea-formaldehyde matrix loaded with ZnSO4 or ZnO. This nanocomposite effectively stimulates maize development, with consequent adequate N uptake, in an extreme condition - a very nutrient-poor sand substrate. Our results indicate that the Zn co-application is beneficial for plant development. However, there were advantages for ZnO due to its high Zn content. We discuss that the dispersion favors the Zn delivery as the nanoparticulated oxide in the matrix. Concerning maize development, we found that root morphology is altered in the presence of the fertilizer nanocomposite. Increased root length and surface area may improve soil nutrient uptake, potentially accompanied by increased root exudation of essential compounds for N release from the composite structure.

Different Zn loading in Urea-Formaldehyde influences the N controlled release by structure modification.

Nitrogen fertilization has been a critical factor for high crop productivity, where urea is currently the most used N source due to its high concentration and affordability. Nevertheless, urea fast solubilization leads to frequent losses and lower agronomic efficiency. The modification of urea structure by condensation with formaldehyde has been proposed to improve nutrient uptake by plants and to reduce environmental losses. Herein we show that the co-formulation with Zn strongly modifies the N release (in lab conditions) and, more important, the Zn source-ZnSO4 or ZnO-has a critical role. Urea-formaldehyde (UF) served as a matrix for the zinc sources, and chemical characterizations revealed that Zn particles influenced the length of the polymeric chain formation. Release tests in an aqueous medium showed that the UF matrix favors ZnO release and, on the other hand, delays ZnSO4 delivery. Soil incubation with the fertilizer composites proved the slow-release of N from UF, is ideal for optimizing nutritional efficiency. Our results indicated that the ZnO-UF system has beneficial effects for both nutrients, i.e., reduces N volatilization and increases Zn release.

Relationship between metalloproteinase-2 and -9 levels in plasma and vaginal secretion with preterm birth.

OBJECTIVE: To study the association of plasma and vaginal levels of matrix metalloproteinases 2 (MMP-2) and 9 (MMP-9), determined between 20+0 and 25+6 weeks of gestation, with preterm birth and its predictive value. STUDY DESIGN: All 129 cases of preterm birth (cases) and 258 randomly selected term patients (control group) were included in a cohort study with a nested case-control design. Inclusion criteria were living in Ribeirão Preto, Brazil, and gestational age 20+0 to 25+6 at enrollment. Exclusion criteria were multiple fetuses, congenital malformations or chromosome syndromes, and loss to follow-up. Maternal age, parity, smoking, and previous preterm birth were included as covariates. A blood sample and vaginal secretion were obtained for the determination of MMP-2 and MMP-9; the patients were screened for urinary tract infection and bacterial vaginosis, and cervical length was measured by ultrasound. The cut-off values for matrix metalloproteinases were calculated using receiver operating characteristic (ROC) curves for logistic regression analysis (crude and adjusted odds ratios). RESULTS: According to the WHO, in this study, preterm subtypes included 3.8 % extremely preterm, 6.9 % very preterm, and 89.2 % late preterm births. The plasma MMP-9 cut-off was 63.25 ng/mL and the area under the ROC curve was 0.725 (standard error 0.03; 95 % confidence interval, 0.677-0.769). The cut-off for plasma MMP-2 was 239.4 ng/mL and the area under the ROC curve was 0.585 (standard error 0.03, 95 % confidence interval, 0.521-0.649). Crude odds ratios showed an increased risk of preterm birth associated with plasma MMP-2 (odds ratio, 1.75; 95 % confidence interval, 1.14-2.68) and plasma MMP-9 (odds ratio, 3.26, 95 % confidence interval, 2.09-5.07); no association was detected for vaginal MMP-2 or 9. For plasma, adjusted odds ratios were 1.42 (95 % confidence interval, 0.80-2.53) for MMP-2 and 2.71 (95 % confidence interval, 1 .52-4.83) for MMP-9, along with an increased risk in other covariates. CONCLUSION: Elevated plasma MMP-9 levels and decreased MMP-2 levels were positively associated with preterm birth. Plasma MMP-9 level increased nearly three times the preterm risk.

Mucinous Rectal Adenocarcinoma in a Urutu Snake (Bothrops alternatus).

A 15-year-old captive female Urutu snake (Bothrops alternatus) was presented with anorexia, apathy, dehydration, pale mucous membranes and marked enlargement of the caudal third of the coelomic cavity. Radiographs and ultrasonography were suggestive of faecal impaction or neoplasia. Post-mortem findings consisted of solid faecal impaction of the intestines, secondary to obstruction caused by a rectal tumour. Cytological examination of impression smears of the tumour revealed polygonal to round neoplastic cells arranged in clusters in an abundant extracellular mucinous matrix. Histologically, there was transmural growth of neoplastic epithelial cells arranged in small nests or individually and immersed in abundant extracellular mucin lakes. The neoplastic cells were immunopositive for cytokeratin. Clinical and pathological aspects indicated a diagnosis of mucinous rectal adenocarcinoma.

Sedative effects of acepromazine in combination with nalbuphine or butorphanol, intramuscularly or intravenously, in healthy cats: a randomized, blinded clinical trial.

OBJECTIVES: The aim of this study was to compare the sedative effects in cats administered acepromazine-nalbuphine and acepromazine-butorphanol, intramuscularly (IM) and intravenously (IV), and the occurrence of adverse cardiorespiratory effects. METHODS: Forty-six cats were randomly divided into four groups and administered acepromazine (0.05 mg/kg) combined with nalbuphine (0.5 mg/kg) or butorphanol (0.4 mg/kg), IV (ACP-NALIV and ACP-BUTIV groups, respectively) or IM (ACP-NALIM and ACP-BUTIM groups, respectively). Sedation scores, ease of intravenous catheter placement (simple descriptive scale [SDS] scores), physiologic variables, venous blood gases and the propofol dose required for anesthetic induction were recorded. RESULTS: Mild sedation was observed in all groups approximately 30 mins after treatment administration (timepoint T1, prior to propofol administration). Sedation scores at T1 increased above baseline in all groups (P <0.05), but no significant difference was observed among groups. Dynamic interactive visual analogue scale sedation scores (range 0-100 mm) recorded at T1 were (median [interquartile range]): ACP-NALIM, 12 (10-12); ACP-NALIV, 11 (6-16); ACP-BUTIM, 11 (7-14); and ACP-BUTIV, 12 (7-19). Overall, SDS scores did not change from baseline at T1 and there was no significant difference among groups. The propofol dose did not differ among groups. Blood gases remained within the reference intervals for cats. Significant decreases from baseline were detected for all groups in systolic arterial pressure (SAP). Mean ± SD values at T1 were (mmHg): ACP-NALIM, 108 ± 13; ACP-NALIV, 102 ± 10; ACP-BUTIM, 97 ± 13; and ACP-BUTIV, 98 ± 21. Arterial hypotension (SAP <90 mmHg) was recorded at T1 in 0/11, 1/13, 4/11 and 5/11 cats in groups ACP-NALIM, ACP-NALIV, ACP-BUTIM and ACP-BUTIV, respectively, and was further exacerbated after the induction of anesthesia with propofol. CONCLUSIONS AND RELEVANCE: In healthy cats administered acepromazine-nalbuphine and acepromazine-butorphanol, IM and IV, the degree of sedation was mild regardless of the protocol and the route of administration. The main adverse effect observed was a reduction in arterial blood pressure.

Detection of enteric agents into a cats' shelter with cases of chronic diarrhea in Southern Brazil / Detecção de agentes enteropatogênicos associados à diarreia crônica em um gatil no Sul do Brasil

This study carried out a survey about enteropathogenic agents in domestic cats' shelter as a stage of investigation for the intermittent chronic diarrhea. Individual fecal samples from 39 cats with free access to the external environment were submitted to parasitological examination, parvovirus, and coronavirus by PCR, and Cryptosporidium spp., Giardia spp. and Tritrichomonas foetus by real-time PCR. From the cats evaluated, 30 (76.9%) were positive for one or more enteric agents, and coinfections were observed in 11 cats samples (28.2%). Helminth eggs were observed in 48.7% of cats (19/30), 16 (41%) were positive for parvovirus or coronavirus and 25.6% (10/30) were infected by protozoa. From the positives for protozoa, five cats were positive to T. foetus (12.82%). The first finding of this protozoan through PCR was in the southern Brazil, and the second was in the whole country. Chronic diarrhea in cats may be multifactorial in shelter animals where the population density is high and the control of parasitic, and viral infections are deficient. Moreover, it is due to poor hygiene conditions in these shelters. The factors associated with the proliferation of infectious diseases in shelters are correlated with new pathogens infections such as T. foetus.(AU)

Uma pesquisa de agentes enteropatogênicos em gatos domésticos de um abrigo foi realizado como etapa da investigação das causas de diarreias crônicas intermitentes. Amostras fecais individuais de 39 gatos, com livre acesso ao ambiente externo, foram obtidas para pesquisa de helmintos através do exame parasitológico, investigação de parvovírus e coronavírus e de Cryptosporidium spp., Giardia spp. e Tritrichomonas foetus através de PCR em tempo real. Dos gatos avaliados, 30 (76,9%) foram positivos para algum ou mais de um destes agentes entéricos. Desses, 11 (28,2%) apresentaram co-infecções parasitárias. Ovos de helmintos foram observados em 48,7% dos gatos (19/30), 16 felinos (41%) foram positivos para parvovírus ou coronavírus e 25,6% (10/30) estavam infectados por protozoários. Dos positivos para protozoários, cinco apresentaram Tritrichomonas foetus (12,82%), um organismo pouco relatado no Brasil, sendo este o primeiro relato de detecção deste protozoário através de PCR em fezes de gatos no Sul do Brasil e o segundo no país. A diarreia crônica em gatos pode ser multifatorial em animais de abrigo onde a densidade populacional é elevada e os meios de controle parasitário e viral são deficitários, além das condições de higiene precárias. Os fatores associados à proliferação de doenças infecciosas em abrigos promovem o surgimento de infecções por novos patógenos como o Tritrichomonas foetus, até então pouco relatado no Brasil.(AU)

Surgical results and survival of older patients with unsuspected N2 (stage IIIA) non-small cell lung cancer.

PURPOSES: The optimal treatment of N2 non-small cell lung cancer (NSCLC) in older patients is still debate and represent an important treatment and ethical problem. PATIENTS AND METHODS: Between January 2000 to December 2010, 273 older patients underwent lung resection for (NSCLC). RESULTS: The overall-operative mortality was 9.5%. Risk factors for in-hospital mortality were pneumonectomy and poli-vasculopathy. One, 3 and 5-year survival were 73%, 23% and 16% respectively. CONCLUSIONS: In potentially operable older patients with NSCLC we need to make every effort to exclude N2 involvement because very poor long-term survival. Pneumonectomy in older patients gains prohibitive in-hospital mortality.

Natural history of honeycombing: follow-up of patients with idiopathic pulmonary fibrosis treated with single-lung transplantation.

PURPOSE: Although honeycombing is one of the key features for the diagnosis of idiopathic pulmonary fibrosis (IPF), its origin and evolution are still poorly understood. The aim of our study was to analyse the natural history of honeycombing in patients treated with single-lung transplantation. MATERIALS AND METHODS: We considered seven patients who underwent single-lung transplantation; two of them (28.6%) were excluded from our analysis because they died in the posttransplantation period, whereas the remaining five (71.4%) were evaluated with computed tomography (CT) over 67.6±38.56 months. Each CT scan was assessed for disease extension and cyst size (visual score and size of target cysts); CT scans acquired after 2006 were also assessed for native lung volume. RESULTS: All patients showed disease progression (with a concurrent reduction in lung volume in two, 40%) and a progression of honeycombing, with increased number and size of cysts in four (80%). We observed dimensional changes in all target cysts (enlargement or reduction); three patients (60%) also had radiological evidence of complications, such as spontaneous rupture with pneumothorax and development of mycetomas within the cysts. CONCLUSIONS: Honeycombing is a dynamic process in which the overall trend is represented by a dimensional increase in cystic pattern; however, single cysts may have a different evolution (enlargement, reduction or complications). This behaviour could be explained by the variety of the pathogenetic processes underlying honeycombing, with cysts that may present abnormal communication with the airway, including the development of a check-valve mechanism.

New recurrent chromosome alterations in patients with multiple myeloma and plasma cell leukemia.

Chromosome abnormalities detected in metaphases from multiple myeloma (MM) cells have a clear impact on prognosis and response to therapy. Thirteen out of 50 (26%) patients with plasma cell disorders and abnormal karyotypes (11 with MM and 2 with plasma cell leukemia (PCL)) were selected for inclusion in the present report based on the presence of karyotypes with new and/or infrequent structural aberrations. Thirty-three new rearrangements, including a novel recurrent aberration: psu dic(5;1)(q35;q10), were detected. Chromosome 1 was the most frequently involved. Gains of genetic material (57%) were noted more frequently than losses (43%). Three rearrangements that were observed only once in the literature appear to be recurrent from our data: del(16)(q13), del(5)(p13) and i(3)(q10), the latter being a single structural aberration in the karyotype. Clinical parameters from our series were compared with 2 control groups: 20 MM cases with recurrent aberrations in MM/PCL with a similar distribution of abnormalities associated with poor prognosis (group 1), and 40 with normal karyotypes and fluorescence in situ hybridization analysis (group 2). Significantly increased serum calcium levels (p = 0.022) in patients with new and/or infrequent chromosome changes with respect to both control groups, and a higher percentage of bone marrow plasma cell infiltration (p = 0.005), ß(2) microglobulin, and lactate dehydrogenase levels (p < 0.0001) compared to group 2 were observed. Our results suggest that some of these novel rearrangements may be capable to deregulate genetic mechanisms related to the development and/or progression of the disease. The finding of new recurrent aberrations supports this hypothesis.

[Acute abdomen in renal transplant recipients. Epidemiology and treatment in not referral transplantation centers]. / L'addome acuto nel paziente trapiantato renale. Considerazioni epidemiologiche, diagnostiche e terapeutiche in DEA non dedicati.

The incidence of gastrointestinal complications in renal transplant recipients is relatively high while about 10% is related to acute abdomen. Data concerning gastrointestinal (GI) complications were reported in literature mainly from referral center studies. A multicenter retrospectively survey was performed in Lazio, Italy, in order to evaluate the incidence of acute abdomen in renal transplant recipients observed to the emergency departments of not referral transplantation centers. Clinical and demographic findings regarding 14 patients who experienced acute abdomen between February 2005 and Dicember 2008 have been collected. The following data was investigated: etiology, diagnostic workup, duration of symptoms, elapsed time between admission and emergency operation if performed, morbility and mortality. The severity of disease at presentation was assessed by mean of the Acute Physiology and Chronic Health Evaluation score (APACHE II). Acute abdomen was due to pancreatitis in three patients (23.1%); to cholecystitis in three (23.1%); to acute diverticolitis with colon perforation in two patients (15.4%); to acute appendicitis in two (15.4%) and to intestinal obstruction in 2 patients (15.4%). Small bowel perforation was observed in two patients (15.4%) which one case, upon pathological examination, showed malignant lymphoma. The mean APACHE II score was 14.0 ± 5.9. Ten patients (71.4%) were submitted to surgery. Overall mortality and morbidity were 35% and 42% respectively. Statistical analysis showed admission APACHE II score (p<0.01), duration of symptoms (p<0.05), and total time elapsed between the onset of symptoms and treatment (p<0.04) as factors significantly related to mortality.

The utility of a touch preparation in the diagnosis of fluctuant subcutaneous fat necrosis of the newborn.

Subcutaneous fat necrosis of the newborn (SFNN) is an uncommon self-limiting panniculitis. Lesions may be fluctuant and spontaneously drain. Here we report a technique to rapidly confirm the diagnosis of SFNN when fluctuance exists via a touch preparation that demonstrates the characteristic histologic features of this condition. The material can be collected by fine needle aspirate, from draining fluctuant lesions, or if biopsy if performed.

Preditores espaço-temporais do andar para testes de capacidade funcional em pacientes com doença de Parkinson / Gait spatial and temporal predictors for functional capacity tests in Parkinson's disease patients

OBJETIVOS: Determinar quais parâmetros espaço-temporais são preditores do andar de indivíduos com doença de Parkinson idiopática para os testes de resistência aeróbia e agilidade, propostos pela bateria de testes da American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD). MATERIAIS E MÉTODOS: Foram selecionados seis homens e seis mulheres com comprometimento e estágio da doença em níveis leve e moderado, que realizaram os testes de agilidade e resistência aeróbia, conforme o protocolo da AAHPERD, e andaram 8m sobre uma passarela. Uma câmera digital registrou uma passada central. Marcadores foram fixados no quinto metatarso e na face lateral do calcâneo do membro inferior direito e no primeiro metatarso e na face medial do calcâneo do membro inferior esquerdo. As variáveis dependentes selecionadas foram: tempo nos testes de agilidade e resistência e as variáveis cinemáticas (comprimento da passada - CP, cadência - CAD, duração da passada - DP, duração da fase de duplo suporte - DDS, duração do suporte simples - SS, duração da fase de balanço - DB e velocidade da passada - VP). RESULTADOS: Para agilidade, o teste de Pearson apontou correlação estatisticamente significativa entre as variáveis CP (r=-0,70; p<0,05), CAD (r=-0,72; p<0,01), VP (r=-0,83; p<0,01), DP (r=0,71; p<0,01) e DDS (r=0,90; p<0,01). Para resistência, houve correlação com as variáveis CP (r=-0,67; p<0,05), CAD (r=-0,72; p<0,01), VP (r=-0,82; p<0,01), DP (r=0,71; p<0,01) e DDS (r=0,90; p<0,01). A análise de regressão múltipla revelou que a DDS foi a única variável preditora dos testes de agilidade (R²=0,82; p<0,01) e resistência (R²=0,81; p<0,01). CONCLUSÕES: Observou-se o uso potencial da DDS como parâmetro espaço-temporal do andar preditor do desempenho dos testes de resistência aeróbia e agilidade em pacientes com doença de Parkinson idiopática.

OBJECTIVE: To determine which spatial and temporal parameters are predictors of the gait pattern of individuals with idiopathic Parkinson's disease, for the aerobic endurance and agility tests included in the battery of tests of the AAHPERD protocol. METHODS: Six men and six women with mild and moderate impairment and disease stage were selected. They performed agility and aerobic endurance test in accordance with the AAHPERD protocol, and walked 8 m on a walkway. A digital video camera recorded one central stride. Markers were attached to the fifth metatarsal and lateral face of the calcaneus of the right leg and to the first metatarsal and medial face of the calcaneus of the left leg. The dependent variables selected were the time taken in the agility and endurance tests and the kinematic variables: stride length (SL), cadence (CAD), stride time (ST), double support time (DS), single support time (SS), swing time (SW) and stride velocity (SV). RESULTS: For agility, Pearson's test showed statistically significant correlations with SL (r=-0.70; p<0.05), CAD (r=-0.72; p<0.01), SV (r=-0.83; p<0.01), ST (r=0.71; p<0.01) and DS (r=0.90; p<0.01). For endurance, there were correlations with SL (r=-0.67; p<0.05), CAD (r=-0.72; p<0.01), SV (r=-0.82; p<0.01), ST (r=0.71; p<0.01), and DS (r=0.90; p<0.01). Multiple regression analysis revealed that DS was the only variable that predicted performance in both the agility (R²=0.82; p<0.01) and the endurance (R²=0.81; p<0.01) tests. CONCLUSIONS: It was observed that DS measure has a potential use as a kinematic parameter of gait that predicts the performance in agility and aerobic endurance tests in patients with idiopathic Parkinson's disease.

Risco de quedas em idosos com doença de Parkinson e demência de Alzheimer: um estudo transversal / Risk of falls among elderly people with Parkinson's disease and Alzheimer's dementia: a cross-sectional study

OBJETIVO: Comparar o risco de quedas entre idosos com doença de Parkinson (DP), demência de Alzheimer (DA) e saudáveis (controle). Além disso, pretendeu-se analisar as relações do risco de quedas com declínio cognitivo e com nível de atividade física. MÉTODO: vinte idosos, sendo sete com DP (69,57 ± 2,40 anos), seis com DA (77,5 ± 2,32 anos) e sete saudáveis (74,71 ± 2,58 anos), foram avaliados por meio dos seguintes instrumentos: Escala de Equilíbrio Funcional de Berg (EEFB), Timed Up and Go test (TUG), Mini-Exame do Estado Mental (MEEM) e Questionário Baecke Modificado para Idosos (QBMI). RESULTADOS: O teste de Kruskal-Wallis apontou diferença significativa entre os grupos, tanto em relação à EEFB (KW=9,67, p<0,01), quanto em relação ao TUG (KW=9,14, p<0,01, para tempo despendido, e KW=10,04, p<0,01, para número de passos). A "análise aos pares" do teste post-hoc de Bonferroni apontou comprometimento maior do equilíbrio no grupo DA, no qual também foram observados menores valores no MEEM. O grupo DP foi caracterizado por apresentar um maior nível de atividade física. A análise de correlação de Spearman apontou correlação baixa entre MEEM e EEFB (r s=0,59); entre MEEM e TUG (r s=-0,62 e r s=-0,52); entre QBMI e EEFB (r s=0,54); e entre QBMI e TUG (r s=-0,39 e r s=-0,42). CONCLUSÕES: As baixas correlações observadas devem ser analisadas com cautela, pois tais variáveis sofrem influência de múltiplos fatores. No grupo DA, o declínio cognitivo pode estar relacionado ao maior risco de quedas e, no grupo DP, a atividade física pode ter auxiliado a manter um risco de quedas próximo ao grupo controle.

OBJECTIVE: To compare the risk of falls among elderly people with Parkinson's disease (PD) and Alzheimer's dementia (AD) and among healthy peers (controls). In addition, the aim was to analyze relationships between risk of falls and cognitive decay and between risk of falls and physical activity. METHOD: Twenty subjects were assessed: seven with PD (69.57 ± 2.40 years), six with AD (77.5 ± 2.32 years) and seven healthy peers (74.71 ± 2.58 years). The following instruments were used: Berg Balance Scale (BBS), Timed Up and Go test (TUG), Mini-Mental State Examination (MMSE) and Modified Baecke Questionnaire for Older Adults (MBQOA). RESULTS: The Kruskal-Wallis (KW) test indicated significant differences between the groups, relating to BBS (KW = 9.67, p<0.01) and TUG (KW = 9.14, p<0.01, for time expended, and KW = 10.04, p<0.01, for number of steps). Bonferroni post-hoc pairs analysis showed that balance was highly compromised in the AD group, such that lower MMSE values were observed. The PD group was characterized by presenting higher levels of physical activity. Spearman's test produced low correlations between MMSE and BBS (r s=0.59); MMSE and TUG (r s=-0.52 and r s=-0.62); MBQOA and BBS (r s=0.54); and MBQOA and TUG (r s=-0.39 and r s=-0.42). CONCLUSION: These low correlations must be analyzed carefully, because these variables are influenced by multiple factors. In the AD group, the cognitive decay can be positively associated with greater risk of falls. In the PD group, physical activity may have assisted in maintaining the risk of falls at similar levels to the control group.