Cactus species and tree forage hay in the diet of dairy goats.

The purpose of this study was to evaluate the influence of the association of Opuntia stricta (OS) or Nopalea cochenillifera (NC) with Moringa hay (MY) or Leucaena hay (LY) on nutrient intake, ingestive behavior, serum biochemistry, and milk production and composition of dairy goat. Eight multiparous Saanen goats were used, with an average of 68 ± 8 days in milk and 48.5 ± 6 kg of initial weight, fed with the following treatment diets: OS + MY; OS + LY; NC + MY, and NC + LY. The treatments were distributed in a double Latin square, in a 2 × 2 factorial scheme (two varieties of cactus and two of hay). Goats fed with NC had higher (P < 0.05) intakes of dry matter, crude protein, neutral detergent fiber (NDF), and non-fibrous carbohydrates. There was no influence (P > 0.05) on milk production, but goats fed with OS produced milk with higher (P < 0.05) fat content and presented higher (P < 0.05) feed efficiency. There was no effect (P > 0.05) of the hay type on the nutrient intake and milk production and composition of goats, but the animals fed with MY had higher (P < 0.05) serum cholesterol levels and greater efficiency of NDF rumination. Goats fed with OS showed greater feeding and rumination efficiency. Our results indicated that both cactus species could be successfully included in the diet of low yielding dairy goats fed 18.4% concentrate.

Congenital anomalies during the 2015-2018 Zika virus epidemic: a population-based cross-sectional study.

BACKGROUND: Congenital anomalies are associated with several clinical and epidemiological complications. Following the Zika epidemic onset in Latin America, the incidence of congenital anomalies increased in Brazil. This study aimed to determine the frequency of congenital anomalies in one Brazilian state and assess potential factors associated with them. METHODS: This cross-sectional descriptive study was based on data concerning congenital anomalies recorded in the Brazilian Live-Born Information System during the Zika epidemic in Mato Grosso do Sul state from 2015 to 2018. Congenital anomalies were stratified according to year of birth and classified using ICD-10 categories. RESULTS: In total, 1,473 (0.85%) anomalies were registered. Within the number of cases recorded, microcephaly showed the greatest frequency and variations, with a 420% increase observed in the number of cases from 2015 to 2016. We identified an increase in the incidence of central nervous system anomalies, with the highest peak observed in 2016 followed by a subsequent decrease. Musculoskeletal, nervous, and cardiovascular system anomalies, and eye, ear, face, and neck anomalies represented 73.9% of all recorded anomalies. There was an increased chance of congenital anomalies in uneducated (odds ratio [OR] 5.56, 95% confidence interval [CI] 2.61-11.84) and Indigenous (OR 1.32, 95% CI 1.03-1.69) women, as well as among premature births (OR 2.74, 95% CI 2.39-3.13). CONCLUSIONS: We estimated the incidence of congenital anomalies during the Zika epidemic. Our findings could help to support future research and intervention strategies in health facilities to better identify and assist children born with congenital anomalies.

Schools reopening and the COVID-19 pandemic: a case study from Macaé, Rio de Janeiro, Brazil.

Since the first reported case of COVID-19 in Brazil, the public and private educational system started to close. Up to November 2020, scientific discussions about the return of schooling activities have been rarely performed by the national scientific community and police-makers. The great delay of school returning in Brazil contrasts with successful international strategies of school reopening worldwide and seems counterintuitive with the reopening of non-essential activities. Here, important issues to be considered before and during school reopening are reviewed and discussed. COVID-19 testing is essential to avoid disease spreading, but high cost of individual RT-qPCRs impairs an extensive testing strategy for school returning. To reduce costs and increase the speed of diagnosis, we tested the efficiency of a pooled-sample PCR strategy in a cohort of the educational staff in the city of Macaé/RJ, finding five asymptomatic individuals (0,66%) among the 754 people tested. Thus, a polled-sample PCR testing strategy of the educational staff might prevent infection spreading in schools at a reasonable cost. We discuss how our test strategy could be coupled with internationally recognized safety rules to allow for a safe school return and how countries from different world regions are dealing with educational activities during COVID-19 pandemic.

SARS-CoV-2 Spatiotemporal Genomic and Molecular Analysis of the First Wave of the COVID-19 Pandemic in Macaé, the Brazilian Capital of Oil.

The SARS-CoV-2 virus infection led to millions of deaths during the COVID-19 pandemic. Hundreds of workers from several other Brazilian cities, as well as from other countries, arrive daily in Macaé to work in the oil supply chain, making this city a putative hotspot for the introduction of new viral lineages. In this study, we performed a genomic survey of SARS-CoV-2 samples from Macaé during the first outbreak of COVID-19, combined with clinical data and a molecular integrative analysis. First, phylogenomic analyses showed a high occurrence of viral introduction events and the establishment of local transmissions in Macaé, including the ingression and spread of the B.1.1.28 lineage in the municipality from June to August 2020. Second, SARS-CoV-2 mutations were identified in patients with distinct levels of COVID-19 severity. Third, molecular interactions of the mutated spike protein from three B.1.1.33 local samples and human ACE2 showed higher interactions than that of the wild-type spike protein from the ancestral virus. Altogether, these results elucidate the SARS-CoV-2 genomic profile in a strategic Brazilian city and further explore the functional aspects of SARS-CoV-2 with a characterization of emerging viral mutations associated with clinical data and the potential targets for drug development against SARS-CoV-2.

Occupational pesticide exposure and the risk of death in patients with Parkinson's disease: an observational study in southern Brazil.

BACKGROUND: Multiple studies have suggested that various pesticides are associated with a higher risk of developing Parkinson's disease (PD) and may influence the progression of the disease. However, the evidence regarding the impact of pesticide exposure on mortality among patients with PD is equivocal. This study examines whether pesticide exposure influences the risk of mortality among patients with PD in Southern Brazil. METHODS: A total of 150 patients with idiopathic PD were enrolled from 2008 to 2013 and followed until 2019. In addition to undergoing a detailed neurologic evaluation, patients completed surveys regarding socioeconomic status and environmental exposures. RESULTS: Twenty patients (13.3%) reported a history of occupational pesticide exposure with a median duration of exposure of 10 years (mean = 13.1, SD = 11.2). Patients with a history of occupational pesticide exposure had higher UPDRS-III scores, though there were no significant differences in regards to age, sex, disease duration, Charlson Comorbidity Index, and age at symptom onset. Patients with occupational pesticide exposure were more than twice as likely to die than their unexposed PD counterparts (HR = 2.32, 95% CI [1.15, 4.66], p = 0.018). Occupational pesticide exposure was also a significant predictor of death in a cox-proportional hazards model which included smoking and caffeine intake history (HR = 2.23, 95% CI [1.09, 4.59], p = 0.03)) and another which included several measures of socioeconomic status (HR = 3.91, 95% CI [1.32, 11.58], p = 0.01). CONCLUSION: In this prospective cohort study, we found an increased all-cause mortality risk in PD patients with occupational exposure to pesticides. More studies are needed to further analyze this topic with longer follow-up periods, more detailed exposure information, and more specific causes of mortality.

Associated factors, incidence, and management of gestational and congenital syphilis in a Brazilian state capital: a cross-sectional study.

Maternal and child health remains an enduring global challenge, having occupied a prominent position on international agendas since the dawn of the 21st century. During pregnancy, syphilis emerges as the second most prevalent cause of stillbirth on a global scale, potentially leading to a range of adverse outcomes. This study aimed to describe the clinical and epidemiological profile of cases of gestational and congenital syphilis and the hospital care provided for newborns in Campo Grande municipality, Mato Grosso do Sul State, Brazil, from 2013 to 2018. This is a cross-sectional study based on data from Brazilian Notifiable Diseases Surveillance System (SINAN) and hospital medical records. Chi-square or Fisher's exact test and logistic regression analysis were used to assess the associations and relationships between the child's clinical outcome at birth and the mother's clinical-obstetric and epidemiological characteristics. Cumulative detection rate of gestational syphilis was 174.3 cases per 1,000 live births and cumulative incidence of congenital syphilis was 47.7 cases per 1,000 live births. Alcoholism, prenatal care, number of prenatal visits, maternal treatment regimen, and timing of maternal diagnosis were associated with child's clinical outcome at birth and considered in the regression model. Prenatal visits showed a protective effect against the signs and symptoms of congenital syphilis (odds ratio = 0.37; 95% confidence interval = 0.17-0.77). Medical assistance was considered inadequate in 62.3% of cases. Prenatal consultations should be encouraged among pregnant women. There is a need for better education of health personnel on the treatment and diagnosis of syphilis.

HIV pre-exposure prophylaxis and incidence of sexually transmitted infections in Brazil, 2018 to 2022: An ecological study of PrEP administration, syphilis, and socioeconomic indicators.

BACKGROUND: Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is one of the pillars of a combination prevention strategy for reducing the risk of new infections caused by HIV. The daily use of antiretroviral drugs by individuals who are not infected with HIV is required to prevent infection. Although its efficacy has been well established in the literature, in recent years, the decreased supply of antiretroviral drugs has been associated with an increase in the incidence of sexually transmitted infections (STI) and changes in the social determinants of health. An ecological study was conducted covering a five-year period (2018-2022), starting from the year of initiation of PrEP administration in Brazilian state capitals. PRINCIPAL FINDINGS: Descriptive analysis was performed, and the spatial distribution of study data was taken into account. Correlation analysis was used to assess the association between PrEP administration, the incidence and detection rate of STI, and socioeconomic data. The southern region showed the highest incidence rates of STI, but the northern and northeastern regions demonstrated the worst socioeconomic indicators, especially those related to illiteracy and basic sanitation. PrEP administration was significantly correlated with illiteracy (ρ = -0.658), per capita income (ρ = 0.622), public garbage collection (ρ = 0.612), syphilis (ρ = 0.628) and viral hepatitis (ρ = 0.419) incidences. Further, all STI were significantly associated with illiteracy and per capita income. SIGNIFICANCE: Our findings highlight the need to continue exploring PrEP use and rising syphilis rates. In terms of policy, PrEP administration appears to be inversely associated with regions of greater social vulnerability. Further efforts should focus on the social determinants and health needs of this population to improve access to PrEP and reduce social disparities.

Adherence to antiretroviral therapy in people living with HIV with moderate or severe mental disorder.

Human immunodeficiency virus (HIV) infection remains a serious public health concern, with an estimated 38 million people living with HIV (PLHIV). PLHIV are often affected by mental disorders at higher rate than the general population. One challenge in the control and prevention of new HIV infections is adherence to antiretroviral therapy (ART), with PLHIV with mental disorders having seemingly lower adherence than PLHIV without mental disorders. This cross-sectional study assessed adherence to ART in PLHIV with mental disorders who attended the Psychosocial Care Network health facilities in Campo Grande, Mato Grosso do Sul, Brazil, from January 2014 to December 2018. Data from health and medical databases were used to describe clinical-epidemiological profiles and adherence to ART. To assess the associated factors (potential risk or predisposing factors) with ART adherence, we used logistic regression model. Adherence was extremely low (16.4%). Factors associated with poor adherence were lack of clinical follow-up, particularly in middle-aged PLHIV. Other apparently associated factors were living on the streets and having suicidal ideation. Our findings reinforce the need for improvements in the care for PLHIV with mental disorders, especially in the integration between specialized mental health and infectious disease health facilities.

A Case-Control Study of the Effects of Chimarrão (Ilex paraguariensis) and Coffee on Parkinson's Disease.

Introduction: Coffee has been inversely associated with Parkinson's disease (PD) in many studies, and caffeine is the leading candidate to mediate this effect. Mate (Ilex paraguariensis, IP), a caffeinated beverage rich in antioxidants consumed in South America, was also inversely associated with PD in one study from Argentina. Other varieties of IP infusion, such as chimarrão, were never studied in PD. Chimarrão is a common caffeinated beverage consumed in Brazil made with the leaves and stems of IP. Methods: A case-control study was conducted to evaluate the relationship between chimarrão ingestion and PD in southern Brazil. All subjects answered a questionnaire about the frequency of chimarrão and coffee intake. A multiple regression analysis adjusted for age and sex was performed to assess the association between PD and chimarrão consumption. Results: We included 200 PD patients and 200 healthy controls. High consumption of chimarrão was inversely associated with PD (OR = 0.44, 95% CI = 0.24-0.81, P = 0.008). High consumption of coffee was also inversely associated with PD, as expected. Chimarrão remained associated when adjusted for coffee consumption, smoking history, and age (OR 0.46, 95% CI = 0.25-0.86, P = 0.014). These two exposures showed an additive effect. Conclusion: Chimarrão consumption was inversely associated with PD, even after adjusting for coffee intake, suggesting a possible protective role. IP's effect can be mediated by caffeine and through its antioxidant components. Chimarrão has a lower concentration of caffeine compared with coffee and has numerous substances with antioxidative effects that may be important to PD protection. Further studies are needed to test this hypothesis.

SMART Syndrome Identification and Successful Treatment.

Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare late complication of brain irradiation. Patients commonly present recurrent attacks of headaches, seizures, and paroxysmal focal neurological deficits including aphasia, negligence, or hemianopsia. We report a 41-year-old male patient admitted to our emergency room with a reduced level of consciousness and global aphasia. One month prior to admission, he started with frequent headache attacks of moderate intensity and paroxysmal behavioral alterations, advancing to confusion, gait instability, language impairment, and somnolence. He had a history of medulloblastoma treated with surgical resection followed by craniospinal irradiation 21 years before symptom onset. After excluding more frequent causes for the patient's symptoms along with a suggestive image pattern, we started treatment for SMART syndrome with high-dose corticosteroid and calcium channel blocker verapamil. The patient gradually improved his level of consciousness and recovered from aphasia and gait instability without new seizures or neuropsychiatric symptoms. Follow-up brain magnetic resonance imaging showed resolution of the typical findings. This case displays a successful clinical evolution of a patient treated for SMART syndrome in which identification of previous radiation treatment, exclusion of other etiologies, and prompt treatment institution were key for effectively tackling this disease.

Molecular testing and analysis of disease spreading during the emergence of COVID-19 in Macaé, the Brazilian National Capital of Oil.

The Brazilian strategy to overcome the spread of COVID-19 has been particularly criticized due to the lack of a national coordinating effort and an appropriate testing program. Here, a successful approach to control the spread of COVID-19 transmission is described by the engagement of public (university and governance) and private sectors (hospitals and oil companies) in Macaé, state of Rio de Janeiro, Brazil, a city known as the National Oil Capital. In 2020 between the 17th and 38th epidemiological week, over two percent of the 206,728 citizens were subjected to symptom analysis and RT-qPCR testing by the Federal University of Rio de Janeiro, with positive individuals being notified up to 48 h after swab collection. Geocodification and spatial cluster analysis were used to limit COVID-19 spreading in Macaé. Within the first semester after the outbreak of COVID-19 in Brazil, Macaé recorded 1.8% of fatalities associated with COVID-19 up to the 38th epidemiological week, which was at least five times lower than the state capital (10.6%). Overall, considering the successful experience of this joint effort of private and public engagement in Macaé, our data suggest that the development of a similar strategy countrywise could have contributed to a better control of the COVID-19 spread in Brazil. Quarantine decree by the local administration, comprehensive molecular testing coupled to scientific analysis of COVID-19 spreading, prevented the catastrophic consequences of the pandemic as seen in other populous cities within the state of Rio de Janeiro and elsewhere in Brazil.

Validation of 19-items wearing-off (WOQ-19) questionnaire to Portuguese.

BACKGROUND: The treatment of Parkinson disease with dopaminergic therapy improves functionality and quality of life. However, as the disease progresses, the wearing-off phenomenon develops. To improve the recognition of this phenomenon, the 19-item wearing-off questionnaire (WOQ-19) was developed. OBJECTIVE: To translate and validate the WOQ-19 into Portuguese. METHODS: The questionnaire was translated into Portuguese and, subsequently, back-translated into English and analyzed. The final version was tested in Parkinson disease patients for reliability through the test-retest paradigm and internal consistency. Also, sensitivity and specificity were obtained in different cut-off positive items. RESULTS: The WOQ-19 showed good test stability, with an intraclass correlation coefficient of 0.877 (95%CI 0.690-0.951; p<0.001), and good internal consistency, with Cronbach alpha of 0.815. Two items of positive cut-off showed the best accuracy: 0.873 (95%CI 0.791-0.954). Sensitivity was 0.975 (95%CI 0.892-1) and specificity was 0.714 (95%CI 0.565-0.863). CONCLUSION: The Portuguese version of the WOQ-19 showed excellent diagnostic properties and can be used to diagnose wearing-off phenomena.

Spatio-temporal modeling of visceral leishmaniasis in Midwest Brazil: An ecological study of 18-years data (2001-2018).

Visceral leishmaniasis (VL) is a neglected vector-borne disease associated with socioeconomic and environmental issues. In Brazil, epidemics of VL have occurred in major cities since 1980. Applied models for medical and epidemiological research have been used to assess the distribution and characteristics of disease endpoints and identify and characterize potential risk factors. This study described the demographic features of VL and modeled the spatio-temporal distribution of human VL cases and their relationship with underlying predicitve factors using generalized additive models. We conducted an ecological study covering an 18-year period from the first report of an autochthonous case of VL in Campo Grande, state of Mato Grosso do Sul, in 2001 to 2018. The urban area of the city has 74 neighborhoods, and they were the units of analysis of our work. Socioeconomic and demographic data available from Brazilian public databases were considered as covariables. A total of 1,855 VL cases were reported during the study period, with an annual mean incidence rate of 13.23 cases per 100,000 population and a cumulative crude incidence of 235.77 per 100,000 population. The results showed the rapid transition from epidemic to endemic and the centrifugal dispersal pattern of the disease. Moreover, the model highlighted that the urban quality of life index, which is calculated based on income, education, housing conditions, and environmental sanitation data, plays a role in VL occurrence. Our findings highlighted the potential for improving spatio-temporal segmentation of control measures and the cost-effectiveness of integrated disease management programs as soon as VL is difficult to control and prevent and has rapid geographical dispersion and increased incidence rates.

Associated factors, incidence, and management of gestational and congenital syphilis in a Brazilian state capital: a cross-sectional study

ABSTRACT Maternal and child health remains an enduring global challenge, having occupied a prominent position on international agendas since the dawn of the 21st century. During pregnancy, syphilis emerges as the second most prevalent cause of stillbirth on a global scale, potentially leading to a range of adverse outcomes. This study aimed to describe the clinical and epidemiological profile of cases of gestational and congenital syphilis and the hospital care provided for newborns in Campo Grande municipality, Mato Grosso do Sul State, Brazil, from 2013 to 2018. This is a cross-sectional study based on data from Brazilian Notifiable Diseases Surveillance System (SINAN) and hospital medical records. Chi-square or Fisher's exact test and logistic regression analysis were used to assess the associations and relationships between the child's clinical outcome at birth and the mother's clinical-obstetric and epidemiological characteristics. Cumulative detection rate of gestational syphilis was 174.3 cases per 1,000 live births and cumulative incidence of congenital syphilis was 47.7 cases per 1,000 live births. Alcoholism, prenatal care, number of prenatal visits, maternal treatment regimen, and timing of maternal diagnosis were associated with child's clinical outcome at birth and considered in the regression model. Prenatal visits showed a protective effect against the signs and symptoms of congenital syphilis (odds ratio = 0.37; 95% confidence interval = 0.17−0.77). Medical assistance was considered inadequate in 62.3% of cases. Prenatal consultations should be encouraged among pregnant women. There is a need for better education of health personnel on the treatment and diagnosis of syphilis.

Correction: Congenital Zika Syndrome in a Brazil-Paraguay-Bolivia border region: Clinical features of cases diagnosed between 2015 and 2018.

[This corrects the article DOI: 10.1371/journal.pone.0223408.].

Congenital Zika Syndrome in a Brazil-Paraguay-Bolivia border region: Clinical features of cases diagnosed between 2015 and 2018.

Congenital Zika Syndrome (CZS) is a unique pattern of congenital abnormalities found in fetuses and neonates infected with the Zika virus (ZIKV). Here, we clinically identify and characterize infants with CZS between 2015 and 2018 in Mato Grosso do Sul, Brazil-a border area with Paraguay and Bolivia. This cross-sectional study, based on primary and secondary data, tracks the cases registered in the Brazilian Public Health Reporting System through the following stages: (1) preliminary data analysis, (2) identification of the congenital syndrome cases, (3) etiologic classification of the cases, (4) active search, and (5) clinical assessment. Of the 72 investigated cases, 16 were probable cases of CZS. Of these, it was only possible to clinically assess 11 infants. Considering the 16 probable cases of CZS, nine were classified as confirmed cases, and five as potential cases of the syndrome. Regarding clinical features, brain palsy was identified in all analyzed infants. Moreover, microcephaly and pseudobulbar syndrome were found in eight infants, and hydrocephalus was found in three individuals. In addition to these conditions, seven children were malnourished. Our study may provide significant insights for other researches that aim to elucidate CZS and its clinical and populational consequences.

Experimental infection and transmission of Leishmania by Lutzomyia cruzi (Diptera: Psychodidae): Aspects of the ecology of parasite-vector interactions.

Several parameters should be addressed before incriminating a vector for Leishmania transmission. Those may include its ability to become infected by the same Leishmania species found in humans, the degree of attractiveness for reservoirs and humans and capacity to sustain parasite infection under laboratory conditions. This study evaluated the vectorial capacity of Lutzomyia cruzi for Leishmania infantum and gathered information on its ability to harbor L. amazonensis. Laboratory-reared Lu. cruzi were infected experimentally by feeding them on dogs infected naturally with L. infantum and hamsters infected with L. amazonensis. Sand fly attractiveness to dogs and humans was determined using wild caught insects. The expected daily survival of infected Lu. cruzi, the duration of the gonotrophic cycle, and the extrinsic incubation period were also investigated for both parasites. Vector competence was investigated for both Leishmania species. The mean proportion of female sand flies that fed on hosts was 0.40. For L. infantum and L. amazonensis, Lu. cruzi had experimental infection rates of 10.55% and 41.56%, respectively. The extrinsic incubation period was 3 days for both Leishmania species, regardless of the host. Survival expectancy of females infected with L. infantum and L. amazonensis after completing the gonotrophic cycle was 1.32 and 0.43, respectively. There was no association between L. infantum infection and sand fly longevity, but L. amazonensis-infected flies had significantly greater survival probabilities. Furthermore, egg-laying was significantly detrimental to survival. Lu. cruzi was found to be highly attracted to both dogs and humans. After a bloodmeal on experimentally infected hosts, both parasites were able to survive and develop late-stage infections in Lu. cruzi. However, transmission was demonstrated only for L. amazonensis-infected sand flies. In conclusion, Lu. cruzi fulfilled several of the requirements of vectorial capacity for L. infantum transmission. Moreover, it was also permissive to L. amazonensis.

Monthly Distribution of Phlebotomine Sand Flies, and Biotic and Abiotic Factors Related to Their Abundance, in an Urban Area to Which Visceral Leishmaniasis Is Endemic in Corumbá, Brazil.

The monthly distribution and abundance of sand flies are influenced by both biotic and abiotic factors. The present study aimed to evaluate the seasonal distribution of sand flies and the relation between their abundance and environmental parameters, including vegetation and climate. This study was conducted over a 2-year period (April 2012 to March 2014). Monthly distribution was evaluated through the weekly deployment of CDC light traps in the peridomicile area of 5 residences in an urban area of the municipality of Corumbá in the State of Mato Grosso do Sul, Brazil. Meteorological data were obtained from the Mato Grosso do Sul Center for Weather, Climate, and Water Resources. The spectral indices were calculated based on spatial resolution images (GeoEye) and the percentage of vegetal coverage. Differences in the abundance of sand flies among the collection sites were assessed using the Kruskal-Wallis test, and the strength of correlations between environmental variables was determined by calculating Spearman's correlation coefficients. Lutzomyia cruzi, Lu. forattinii, and Evandromyia corumbaensis were the most frequently found species. Although no significant association was found among these sand fly species and the tested environmental variables (vegetation and climate), high population peaks were found during the rainy season, whereas low peaks were observed in the dry season. The monthly distribution of sand flies was primarily determined by Lu. cruzi, which accounted for 93.94% of the specimens collected each month throughout the experimental period. The fact that sand flies were detected year-round indicates a continuous risk of infection to humans, demonstrating the need for targeted management and education programs.

Iron and Oxidative Stress in Parkinson's Disease: An Observational Study of Injury Biomarkers.

Parkinson's disease (PD) is characterized by progressive motor impairment attributed to progressive loss of dopaminergic neurons in the substantia nigra (SN) pars compacta. In addition to an accumulation of iron, there is also an increased production of reactive oxygen/nitrogen species (ROS/RNS) and inflammatory markers. These observations suggest that iron dyshomeostasis may be playing a key role in neurodegeneration. However, the mechanisms underlying this metal-associated oxidative stress and neuronal damage have not been fully elucidated. To determine peripheral levels of iron, ferritin, and transferrin in PD patients and its possible relation with oxidative/nitrosative parameters, whilst attempting to identify a profile of peripheral biomarkers in this neurological condition. Forty PD patients and 46 controls were recruited to compare serum levels of iron, ferritin, transferrin, oxidative stress markers (superoxide dismutase (SOD), catalase (CAT), nitrosative stress marker (NOx), thiobarbituric acid reactive substances (TBARS), non-protein thiols (NPSH), advanced oxidation protein products (AOPP), ferric reducing ability of plasma (FRAP) and vitamin C) as well as inflammatory markers (NTPDases, ecto-5'-nucleotidase, adenosine deaminase (ADA), ischemic-modified albumin (IMA) and myeloperoxidase). Iron levels were lower in PD patients, whereas there was no difference in ferritin and transferrin. Oxidative stress (TBARS and AOPP) and inflammatory markers (NTPDases, IMA, and myeloperoxidase) were significantly higher in PD, while antioxidants FRAP, vitamin C, and non-protein thiols were significantly lower in PD. The enzymes SOD, CAT, and ecto-5'-nucleotidase were not different among the groups, although NOx and ADA levels were significantly higher in the controls. Our data corroborate the idea that ROS/RNS production and neuroinflammation may dysregulate iron homeostasis and collaborate to reduce the periphery levels of this ion, contributing to alterations observed in the pathophysiology of PD.

Validation of 19-items wearing-off (WOQ-19) questionnaire to Portuguese / Validação do questionário de 19 itens de wearing-off (WOQ-19) para a língua portuguesa

ABSTRACT Background: The treatment of Parkinson disease with dopaminergic therapy improves functionality and quality of life. However, as the disease progresses, the wearing-off phenomenon develops. To improve the recognition of this phenomenon, the 19-item wearing-off questionnaire (WOQ-19) was developed. Objective: To translate and validate the WOQ-19 into Portuguese. Methods: The questionnaire was translated into Portuguese and, subsequently, back-translated into English and analyzed. The final version was tested in Parkinson disease patients for reliability through the test-retest paradigm and internal consistency. Also, sensitivity and specificity were obtained in different cut-off positive items. Results: The WOQ-19 showed good test stability, with an intraclass correlation coefficient of 0.877 (95%CI 0.690-0.951; p<0.001), and good internal consistency, with Cronbach alpha of 0.815. Two items of positive cut-off showed the best accuracy: 0.873 (95%CI 0.791-0.954). Sensitivity was 0.975 (95%CI 0.892-1) and specificity was 0.714 (95%CI 0.565-0.863). Conclusion: The Portuguese version of the WOQ-19 showed excellent diagnostic properties and can be used to diagnose wearing-off phenomena.

RESUMO Introdução: O tratamento da doença de Parkinson com terapia dopaminérgica melhora a funcionalidade e a qualidade de vida. Entretanto, com a progressão da doença, os fenômenos de flutuação motora e não motora se desenvolvem. Para melhorar o reconhecimento dessa situação, foi desenvolvido o questionário de 19 itens de wearing-off (WOQ-19) Objetivo: Traduzir e validar o questionário WOQ-19 para a língua portuguesa. Métodos: O questionário foi traduzido do inglês para o português. Em seguida, foi retrotraduzido para o inglês e analisado. A versão final foi testada em pacientes parkinsonianos com paradigma teste-reteste e consistência interna. A sensibilidade e especificidade foram medidas em relação a vários pontos de cortes de itens positivos. Resultados: O questionário apresenta boa estabilidade de teste, com coeficiente de correlação intraclasse de 0,877 (IC95% 0,690-0,951; p<0,001), e boa consistência interna, com alfa de Cronbach de 0,815. O ponto de corte com dois itens positivos teve a melhor acurácia: 0,873 (IC95% 0,791-0,954). A sensibilidade foi de 0,975 (IC95% 0,892-1) e a especificidade foi 0,714 (0,565-0,863). Conclusão: A versão em português do WOQ-19 mostrou excelentes propriedades diagnósticas e pode ser utilizada para diagnosticar as condições de flutuações motoras e não motoras na doença de Parkinson.