Reliability and Validity of a Portable Traction Dynamometer in Knee-Strength Extension Tests: An Isometric Strength Assessment in Recreationally Active Men.

BACKGROUND: the study determined the validity and reliability of measurements obtained using the portable traction dynamometer (PTD) (E-Lastic, E-Sports Solutions, Brazil) and the reproducibility between evaluators (precision) in the evaluation of the isometric muscle strength of the knee extensors of healthy male adults, compared to measurements obtained with the "gold standard" computerized dynamometer (CD) (Biodex System 3, Nova York, NY, USA). METHODS: we evaluated sixteen recreationally active men (29.50 ± 7.26 years). The test-retest reliability of both equipment to determine quadriceps strength, agreement analysis, and the minimal important difference were verified. RESULTS: excellent test-retest interrater reliability was observed for absolute and relative measurements, with a low absolute error for both sets of equipment and excellent validity of the PTD against the CD, as verified by linear regression and Pearson's correlation coefficient. CONCLUSIONS: PTD is a valid and reliable instrument for assessing the isometric strength of knee extensors, with results similar to the isometric CD "gold standard".

Rounding and Quick Access Education to Reduce Catheter-Associated Urinary Tract Infections.

PURPOSE/OBJECTIVES: The acute care division of a tertiary medical center experienced a 167% increase in catheter-associated urinary tract infections, with 2 inpatient surgical units accounting for 67% of infections. A quality improvement project was implemented to address the infection rates on the 2 inpatient surgical units. The aim was to reduce catheter-associated urinary tract infection rates by 75% in the acute care inpatient surgical units. DESCRIPTION OF THE PROJECT/PROGRAM: A survey identified educational needs of staff, with response data informing the development of a quick response code containing resources for prevention of catheter-associated urinary tract infections. Champions rounded on patients and audited maintenance bundle adherence. Educational handouts were disseminated to increase compliance with bundle interventions. Outcome and process measures were tracked on a monthly basis. OUTCOME: Infection rates decreased from 1.29 to 0.64 per 1000 indwelling urinary catheter days, catheter utilization increased 14%, and maintenance bundle compliance was 67%. CONCLUSION: The project enhanced quality care through the standardization of preventive practices and education. The data reflect a positive effect on catheter-associated urinary tract infection rates from increased awareness of the nurse's role in the prevention process.

Field-Based Estimates of Muscle Quality Index Determine Timed-Up-and-Go Test Performance in Obese Older Women.

Objective: The muscle quality index (MQI) is associated with numerous health outcomes in adults; however, the effects of distinct MQI on functional capacity in obese older women have not yet been fully investigated. Thus, we investigated the contribution of different muscle quality indices on TUG performance prediction in obese older women. We secondarily evaluated the association between MQI, aerobic capacity performance (Treadmill performance and 6-minute walk test), and obesity indices (BMI, body fat percentage, and neck, waist, and hip circumference). Methods: Participants included 64 obese older women (mean age 67.05 ± 5.46 years, body fat ≥ 35%). General anthropometric, health history, body composition, treadmill exercise, and functional test (Time up and go) measures were collected. A hydraulic dynamometer was used to assess muscle strength, and Dual Energy X-ray Absorptiometry (DXA) to identify body fat percentage. The field MQI was defined as the highest reading divided by the subject's body mass index (BMI), while the laboratory MQI was obtained by the ratio of grip strength to the entire arm muscle in kilograms measured by DXA. A hierarchical multiple regression was performed to predict TUG-test performance. Results: An increase in field MQI of one unit is associated with a decrease of 2.59 seconds in the TUG test (ß = -0.540; p = 0.004). There was no association between laboratory MQI and TUG performance (ß = 0.067; p = 0.712). Furthermore, field MQI displays a positive correlation (p < 0.05) with aerobic capacity performance (6-minute walk test and peak O2 consumption) and a negative correlation (p < 0.05) with diverse obesity indices (neck and waist circumference, body fat, and BMI). Conclusion: MQI displayed an important prediction with TUG-test, a positive correlation with aerobic capacity, and a negative correlation with obesity indices.

In Silico Studies of Potential Selective Inhibitors of Thymidylate Kinase from Variola virus.

Continuing the work developed by our research group, in the present manuscript, we performed a theoretical study of 10 new structures derived from the antivirals cidofovir and ribavirin, as inhibitor prototypes for the enzyme thymidylate kinase from Variola virus (VarTMPK). The proposed structures were subjected to docking calculations, molecular dynamics simulations, and free energy calculations, using the molecular mechanics Poisson-Boltzmann surface area (MM-PBSA) method, inside the active sites of VarTMPK and human TMPK (HssTMPK). The docking and molecular dynamic studies pointed to structures 2, 3, 4, 6, and 9 as more selective towards VarTMPK. In addition, the free energy data calculated through the MM-PBSA method, corroborated these results. This suggests that these compounds are potential selective inhibitors of VarTMPK and, thus, can be considered as template molecules to be synthesized and experimentally evaluated against smallpox.

Intelligence and posterior fossa tumors in Brazilian youth.

Central nervous system tumors are the most frequent solid neoplasms in childhood and are frequently located in posterior fossa (PF). In Brazil, this diagnosis is associated to high mortality rates and this context is increasingly worrisome outside of large urban centers in which delayed diagnosis and defaulting from treatment compromise survivorship. Moreover, the lesion and therapeutic toxicity compromise cognitive domains. This study investigated the impact of PF tumors and their treatments on the intellectual capacity of 37 children and adolescents aged 6 to 16, divided into two groups: patients with low grade tumors, submitted only to neurosurgery (G1) and with tumors of higher malignancy submitted to neurosurgery, chemotherapy, and/or radiotherapy (G2). Using the Wechsler Intelligence Scales for Children, data reveal that G1 presented preserved mean performance, while G2 presented low average performance. Cluster-type analysis divided the participants into two groups regarding intelligence, clinical and sociodemographic variables. Inferential statistical analysis highlighted the influence of antineoplastic treatment on nonverbal domains. Mother's schooling demonstrated influence on verbal domains, revealing an important dissociation pattern. The results suggest the relevance of sociocultural factors on the expression of the damage, as well as the administration of radiotherapy at critical neurodevelopmental stages.

Molecular Modeling Study of Uncharged Oximes Compared to HI-6 and 2-PAM Inside Human AChE Sarin and VX Conjugates.

The deleterious effects of nerve agents over the enzymes acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) turned these compounds into the most dangerous chemical weapons known. Among the antidotes in use today against these agents, oximes in combination with other drugs are the only treatment with any action. HI-6 and 2-PAM are cationic oximes proved to be effective for the reactivation of AChE inhibited by the nerve agents VX and sarin (GB). However, when it comes to reactivation of AChE inside the central or peripheral nervous systems, charged molecules present low diffusion due to low penetration through the blood-brain barrier. Uncharged oximes appear as an interesting alternative to solve this problem, but the development and enhancement of more efficient uncharged oximes capable of reactivating human AChE is still necessary. Given the limitations for in vivo and in vitro experimental studies with nerve agents, modeling is an important tool that can contribute to a better understanding of factors that may affect the efficiency of uncharged oximes. In order to investigate the interaction and behavior of cationic and uncharged oximes, we performed here molecular docking, molecular dynamics simulations, and binding energies calculations of the known cationic oximes HI-6 and 2-PAM plus four uncharged oximes found in the literature, complexed with human AChE (HssACHE) conjugated with the nerve agents VX and GB. The uncharged oximes showed different behaviors, especially RS194B, which presented stability inside AChE-VX, but presented free binding energy lower than cationic oximes, suggesting that structural alterations could favor its interactions with these complexes. In contrast, HI-6 and 2-PAM showed higher affinities with more negative binding energy values and larger contribution of the amino acid Asp74, demonstrating the importance of the quaternary nitrogen to the affinity and interaction of oximes with AChE-GB and AChE-VX conjugates.

Neuropsicologia no Brasil: passado, presente e futuro / Neuropsychology in Brazil: past, present and future / Neuropsicología en Brasil: pasado, presente y futuro

Apresenta-se um panorama da Neuropsicologia brasileira, enfocando sua inserção no país, caracterizando o momento atual e desafios à sua consolidação. Aborda-se a trajetória da Neuropsicologia, traçando-se cinco períodos que a caracterizam, bem como sua trajetória nacional. A Neuropsicologia brasileira assiste à sofisticação da neuroimagem e ao avanço da pesquisa e interesse na área, à criação de entidades representativas, ao crescente número de publicações, grupos de pesquisa e de cursos de pós-graduação, ao desenvolvimento de instrumentos brasileiros e à ampliação da normatização e validação de instrumentos estrangeiros. Apesar desses avanços, ressalta-se a necessidade de constituir uma Neuropsicologia brasileira, sintonizada com os desafios de um país diverso, que contribua com políticas públicas, produza conhecimentos que atinjam diferentes populações e contribua para a diminuição das desigualdades sociais.(AU)

This paper aims to present an overview of Brazilian neuropsychology, focusing on the way the discipline was brought to Brazil, the present panorama of the discipline, and the challenges related to its consolidation. This article addresses the historical course of Neuropsychology, mapping the five distinct periods that characterized its history, as well as its national course. Brazilian neuropsychology is currently aided by the sophistication of neuroimaging techniques, the advancement in research and the interest in the area, as well as the creation of representative professional associations, the growing number of publications, research groups and graduate courses, the development of Brazilian instruments and the increase in standardization and validation of foreign instruments. Despite these advances, it is necessary to emphasize the need to make a Brazilian Neuropsychology, in tune with the challenges that come from a diverse country, one which contributes with public policies, produces knowledge that reaches different peoples and contributes towards reducing social inequalities.(AU)

Este artículo presenta un panorama de la Neuropsicología en Brasil, enfocándose en su inserción en el país, caracterizando el momento actual y los desafíos a su consolidación. Aborda la historia de la Neuropsicología, trazando los cinco períodos que la caracterizan y su trayectoria nacional. La Neuropsicología brasileña presencia la sofisticación de las técnicas de neuroimagen y el avance de la investigación y el interés de los estudiantes y profesionales, así como la creación de órganos representativos, el creciente número de grupos de investigación, cursos postgrado y publicaciones, el desarrollo de instrumentos brasileños de evaluación neuropsicológica y la estandarización de los procesos y validación de instrumentos extranjeros. A pesar de esos avances, se destaca la necesidad de establecer una Neuropsicología brasileña, en sintonía con desafíos y urgencias de un país diverso, que contribuya con políticas públicas, produzca y ponga en práctica conocimientos que alcancen diferentes poblaciones y contribuya con la reducción de las desigualdades sociales.(AU)

Anxiety and depression symptoms disrupt resting state connectivity in patients with genetic generalized epilepsies.

OBJECTIVE: To analyze the lifetime trajectories in genetic generalized epilepsies (GGEs) and investigate the impact of symptoms of anxiety and depression on resting state functional connectivity (FC). METHODS: Seventy-four GGE patients were classified according to the pharmacological response as seizure-free (12 patients), pharmacoresistant (PhR; 14 patients), and fluctuating (FL; 48 patients). Fifty-four subjects completed both the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and 38 also underwent 3-T resting state functional magnetic resonance imaging. These 38 patients were subdivided into a positive group (13 patients with concurrent symptoms of depression and anxiety) and a negative group (21 asymptomatic patients and four with mild anxiety or depression symptoms). For FC analysis of resting state networks, we matched 38 healthy asymptomatic volunteers and used the UF2C toolbox running on MATLAB2017/SPM12. RESULTS: The PhR group presented shorter duration of epilepsy (P = 0.016) and follow-up (P < 0.001) compared to the FL group. The PhR group showed higher levels (median = 20) on the BAI and BDI. Myoclonic seizures were the most difficult to control, as 50% of subjects persisted with them at last appointment, compared to generalized tonic-clonic seizures and absence seizures (<40%). Patients with concurrent anxiety and depression symptoms were 7.7 times more likely to exhibit pharmacoresistant seizures, although an increase of 1 year of epilepsy duration was associated with a decrease in the odds of presenting pharmacoresistance by a factor of 0.9. Overall, FC was altered between default mode network (DMN) and visuospatial/dorsal attention. However, only the positive group displayed abnormal FC between DMN and left executive control network, and between salience and visuospatial/dorsal attention. SIGNIFICANCE: Our findings may help clinicians to have a better understanding of GGE clinical course and increase attention to the potential relationship of psychopathologies and brain connectivity.

Measurement of anterior translation of the mandibular condyle using sonography.

[Purpose] To establish a standardized sonographic approach to quantify anterior translation of the mandibular condyle during mouth opening by examining the reliability of image acquisition and processing, and to understand how anterior condylar translation contributes to mouth opening. [Participants and Methods] Twenty-eight participants without temporomandibular disorder (TMD) participated. During day 1 of data collection, all participants performed maximal mouth opening while an examiner recorded anterior condylar translation using sonography. The mouth opening range of motion was also obtained. On day 2 of data collection, the same procedure was performed on 6 participants that participated in day 1 of data collection. To establish reliability of image processing, 3 examiners measured condylar translations on 2 separate days. To determine reliability of image acquisition, images obtained from 2 days of data collection were analyzed. [Results] Excellent intra-class correlation coefficients (ICCs) and small standard errors of measurement (SEMs) for image acquisition and processing were shown. A significant, linear model was found to describe the relationship between condylar anterior translations and mouth opening. [Conclusion] Anterior condylar translation during mouth opening can be reliably measured using sonography. The linear relation between condylar motion and mouth opening can be used to guide clinical practices.

Design of inhibitors of thymidylate kinase from Variola virus as new selective drugs against smallpox: part II.

Acknowledging the importance of studies toward the development of measures against terrorism and bioterrorism, this study aims to contribute to the design of new prototypes of potential drugs against smallpox. Based on a former study, nine synthetic feasible prototypes of selective inhibitors for thymidylate kinase from Variola virus (VarTMPK) were designed and submitted to molecular docking, molecular dynamics simulations and binding energy calculations. The compounds are simplifications of two more complex scaffolds, with a guanine connected to an amide or alcohol through a spacer containing ether and/or amide groups, formerly suggested as promising for the design of selective inhibitors of VarTMPK. Our study showed that, despite the structural simplifications, the compounds presented effective energy values in interactions with VarTMPK and HssTMPK and that the guanine could be replaced by a simpler imidazole ring linked to a -NH2 group, without compromising the affinity for VarTMPK. It was also observed that a positive charge in the imidazole ring is important for the selectivity toward VarTMPK and that an amide group in the spacer does not contribute to selectivity. Finally, prototype 3 was pointed as the most promising to be synthesized and experimentally evaluated. Communicated by Ramaswamy H. Sarma.

Behavior of uncharged oximes compared to HI6 and 2-PAM in the human AChE-tabun conjugate: a molecular modeling approach.

Tabun is one of the most dangerous nerve agents because it has deleterious effects like inhibition of the essential enzymes acetylcholinesterase (AChE) and butyrylcholinesterase. Some oximes such HI6 as 2-PAM are nucleophiles that are capable to reactivate inhibited human AChE under some conditions. Zwitterionic and cationic species have the best chance of productive action on inhibited AChE. However uncharged oximes can give important interaction information. In order to investigate the interaction and behavior of cationic and uncharged oximes, we performed molecular docking simulations and molecular dynamics and calculated binding energies of complexes of these compounds with human AChE. The uncharged oximes of larger structure were more susceptible to the influence of the substituents on the phosphorus atom and presented low binding energies. In contrast, HI 6 and 2-PAM showed high binding energy values with great contribution of the amino acid Asp74, demonstrating the importance of the quaternary nitrogen to the affinity and interaction of the oximes/AChE tabun-inhibited complexes.

Reinserção escolar e leucemia: tradução e adaptação do questionário comportamental Deasy-Spinetta / School Reintegration and Leukemia: Translation and Adaptation of Deasy-Spinetta's Behavioral Questionnaire / Reintegración Escolar y Leucemia: Traducción y Adaptación del Cuestionario de Comportamiento Deasy-Spinetta

O Questionário Comportamental Deasy-Spinetta (DSBQ) proporciona importante contribuição ao acompanhamento da reinserção escolar de crianças com câncer, notadamente àquelas diagnosticadas com Leucemia Linfoide Aguda (LLA), principal grupo de sobreviventes na oncologia pediátrica. O DSBQ investiga aspectos emocionais, de aprendizagem e socialização distribuídos em 38 questões. O presente estudo realizou a tradução e adaptação transcultural do DSBQ para o português brasileiro a partir de seis etapas: solicitação da autorização dos autores para a submissão do instrumento ao procedimento de tradução e adaptação transcultural; tradução e tradução reversa (back translation); comparação da tradução reversa com a versão inicial; julgamento de juízes quanto a necessidade de revisão dos itens e∕ou necessidade de adequações semânticas, e; administração da versão brasileira em 20 professores para avaliação da inteligibilidade dos itens. Os docentes avaliaram a versão final do instrumento traduzido e adaptado como adequado e compreensível, observado no acordo um valor bruto consensual de 81%. A concordância verificada com auxílio do Kappa de Fleiss foi de 0,6882 (±0.0247), indicando concordância substancial. O desenvolvimento, tradução e adaptação de instrumentos voltados à compreensão das alterações que repercutem no contexto escolar de crianças com LLA são essenciais dado a escassez de tais ferramentas, os frequentes relatos de dificuldades escolares e a necessidade de caracterização dos efeitos transitórios e tardios associados ao adoecimento e ao tratamento do câncer infantil que afetam o desenvolvimento escolar e a qualidade de vida desse subgrupo clínico.

The Deasy-Spinetta Behavior Questionnaire (DSBQ) offers an important contribution to the monitoring of school reintegration of children with cancer, especially those diagnosed with Acute Limphoblastic Leukemia (ALL), which account for the main survivors group in pediatric oncology. DSBQ investigates emotional, learning and socialization dimensions through 38 questions. The present study carried out the translation and cross-cultural adaptation of the DSBQ to Brazilian Portuguese on the basis of six steps: approval request of DSBQ authors for the translation and cross-cultural adaptation of the instrument; translation and reverse translation (or back translation); comparison of reverse translation with the original French version; assessment of a specialist committee regarding the need of items review and/or semantic adjustment; the submission of 20 teachers to Brazilian version in order to evaluate the intelligibility of items. Teachers considered the final version of the translated and adapted instrument as appropriate and intelligible, since a final consensus gross value of 81% was verified. The degree of agreement between raters was 0.6882 (±0.0247), which indicates a substantial agreement according to Fleiss' Kappa measure. The development, translation and adaptation of foreign instruments tailored to the comprehension of impairments that impact educational context of children with ALL is crucial, given the lack of such assessment tools, the frequent report of learning disabilities among these children and the need to characterize the transient and late effects associated to illness and to the treatment of childhood cancer, which affect scholar development and quality of life of this clinical subgroup.

El Cuestionario Conductual Deasy-Spinetta (DSBQ) presenta una importante contribución contribuye al acompañamiento de la reintegración escolar de niños con cáncer, especialmente aquellas diagnosticadas con Leucemia Linfoide Aguda (LLA), el principal grupo de supervivientes de la oncología pediátrica. El DSBQ investiga aspectos emocionales, de aprendizaje y socialización distribuidos en 38 cuestiones. El presente estudio realizó la adaptación transcultural del DSBQ para el portugués brasileño a partir de seis etapas: solicitación de autorización de los autores para la sumisión del instrumento a los procedimientos de adaptación transcultural; traducción de la versión francesa del instrumento para el portugués brasileño; traducción reversa (back translation) del portugués brasileño para la lengua francesa; comparación de la traducción reversa con la versión inicial; evaluación de jueces en cuanto la necesidad de revisión de los ítems y/o adecuaciones semánticas y; administración de la versión brasileña con 20 profesores para evaluar la inteligibilidad de los ítems. Los profesores evaluaron la versión final del instrumento adaptado como adecuado y comprensible, y fue observado en el acuerdo un valor bruto consensual de 81%. La concordancia verificada con auxilio del Kappa de Fleiss fue de 0,6882 (±0.0247), indicando concordancia substancial. El desarrollo y la adaptación de instrumentos diseñados para la comprensión de las alteraciones que repercuten en el contexto escolar de niños con LLA es esencial dada la escasez de tales herramientas, los relatos de dificultades escolares y la necesidad de caracterización de los efectos asociados a la enfermedad y al tratamiento del cáncer infantil que afectan la calidad de vida de este subgrupo clínico.