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There is growing evidence suggesting an association between neurodegeneration and inflammation playing a role in the pathogenesis of age-associated diseases, including Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). Objective: A systematic review and meta-analysis were performed to verify evidence on the diagnostic accuracy parameters of the inflammatory cytokines interleukin-6 (IL-6), interleukin-10 (IL-10) and tumor necrosis factor alpha (TNF-α). Methods: A search of Medical Literature Analysis and Retrieval System Online (Medline), Scientific Electronic Library Online (SciELO), Web of Science and Science Direct databases was performed and nine observational studies associated with peripheral inflammatory biomarkers in MCI were identified. Mean (±standard deviation - SD) concentrations of these biomarkers and values of true positives, true negatives, false positives and false negatives for MCI and healthy controls (HC) were extracted from these studies. Results: Significantly higher levels of IL-10 were observed in subjects in the MCI group and Mini-Mental State Examination (MMSE) scores were lower compared to HC. For the other investigations, no differences were found between the groups. Our meta-analysis for the TNF-α biomarker revealed high heterogeneity between studies in terms of sensitivity and specificity. Conclusion: These findings do not support the involvement of inflammatory biomarkers for detection of MCI, although significant heterogeneity was observed. More studies are needed to evaluate the role of these cytokines in MCI, as well as in other stages of cognitive decline and all-cause dementias.
Há evidências crescentes que sugerem uma associação entre a neurodegeneração e a inflamação, desempenhando um papel na patogênese de doenças associadas à idade, incluindo a doença de Alzheimer (DA) e o comprometimento cognitivo leve (CCL). Objetivo: Uma revisão sistemática e metanálise foram realizadas para verificar evidências relativas aos parâmetros de acurácia diagnóstica das citocinas inflamatórias interleucina-6 (IL-6), interleucina-10 (IL-10) e fator de necrose tumoral (TNF-α). Métodos: Foi realizada uma busca nas bases de dados Medical Literature Analysis and Retrieval System Online (Medline), Scientific Electronic Library Online (SciELO), Web of Science e Science Direct, e foram identificados nove estudos observacionais associados a biomarcadores inflamatórios periféricos no CCL. As concentrações médias (desvio padrão ±DP) desses biomarcadores e valores de verdadeiros positivos, verdadeiros negativos, falsos positivos e falsos negativos para CCL e controles saudáveis (CS) foram extraídos desses estudos. Resultados: Níveis significativamente mais elevados de IL-10 foram observados em indivíduos do grupo CCL e os escores do Miniexame do Estado Mental foram mais baixos em comparação com o CS. Para as demais investigações não foram encontradas diferenças entre os grupos. Nossa metanálise para o biomarcador TNF-α revelou alta heterogeneidade entre os estudos em termos de sensibilidade e especificidade. Conclusão: Esses achados não apoiam o envolvimento de biomarcadores inflamatórios na detecção do CCL, embora tenha sido observada heterogeneidade significativa. Mais estudos são necessários para avaliar o papel dessas citocinas no CCL, bem como em outros estágios de declínio cognitivo e demências de todas as causas.
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ABSTRACT Purpose: to describe the development, focusing on language, of children affected by congenital Zika syndrome and compare it with that of typically developing children. Methods: a quantitative, observational, cross-sectional, case-control study. Data from the group of children with congenital Zika virus syndrome (case) were matched for sex and age with data from the group of typically developing children without comorbidities (control). The research included 20 parents/guardians of the children in the case group and 20 parents/guardians of the children in the control group, using interview as an adapted instrument. The data underwent descriptive and inferential statistical analysis, through association tests and comparison of means, with the significance level set at 5%. Results: there was a statistical difference in motor, auditory, and language development between the groups, according to the parents' perception. Conclusion: Based on the caregivers' reports, most of the case group communicated non-verbally through babbling, shouting, and eye contact, whereas the minority communicated through dialogue, understood simple orders, and performed imitative behaviors, symbolic play, and shared attention. On the other hand, the control group communicated through complex sentences constructed into narratives.
RESUMO Objetivo: descrever o desenvolvimento infantil, com enfoque na linguagem, de crianças acometidas da síndrome congênita do Zika e compará-lo com o de crianças com desenvolvimento típico. Métodos: trata-se de um estudo observacional, transversal, do tipo caso-controle, e de natureza quantitativa. Os dados do grupo de crianças com Síndrome Congênita do Zika vírus (caso) foram pareados por sexo e idade com os dados do grupo de crianças sem comorbidades e desenvolvimento típico (controle). Participaram da pesquisa, 20 responsáveis pelas crianças do grupo caso e 20 pelas crianças do grupo controle e o instrumento utilizado foi uma entrevista adaptada. Os dados foram examinados por meio de uma análise estatística descritiva e inferencial por meio de testes de associação e de comparação de médias, com nível de significância de 5%. Resultados: foi observada diferença estatística entre os grupos estudados, referente ao desenvolvimento infantil, no âmbito motor, auditivo e de linguagem, com base na percepção dos pais. Conclusão: diante das informações dos cuidadores, a comunicação da maioria do grupo caso ocorre de forma não verbal por meio de gorjeios, gritos e contato visual; e a minoria comunica-se por diálogo, compreende ordens simples, realiza condutas imitativas, brincar simbólico e tem atenção compartilhada. Diferentemente, o grupo controle comunica-se por meio de frases complexas presentes em narrativas.
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BACKGROUND: Most of the Brazilian population relies on public healthcare and stroke is a major cause of disability in this country of continental dimensions. There is limited information about access to rehabilitation after stroke in Brazil. OBJECTIVE: To provide comprehensive information about Access to Rehabilitation After discharge from public hospitals in Brazil (AReA study), up to 6 months after stroke. METHODS: The present study intends to collect information from 17 public health centers in 16 Brazilian cities in the 5 macroregions of the country. Each center will include 36 participants (n = 612). The inclusion criteria are: age ≥ 18 years old; ischemic or hemorrhagic stroke, from 6 months to 1 year prior to the interview; admission to a public hospital in the acute phase after stroke; any neurological impairment poststroke; patient or caregiver able to provide informed consent and answer the survey. Patients can only be recruited in public neurology or internal medicine outpatient clinics. Outcomes will be assessed by a standard questionnaire about rehabilitation referrals, the rehabilitation program (current status, duration in months, number of sessions per week) and instructions received. In addition, patients will be asked about preferences for locations of rehabilitation (hospitals, clinics, or at home). TRIAL STATUS: The study is ongoing. Recruitment started on January 31st, 2020 and is planned to continue until June 2022. CONCLUSION: The AReA study will fill a gap in knowledge about access to stroke rehabilitation in the public health system in different Brazilian regions.
ANTECEDENTES: Grande parte da população brasileira depende de saúde pública e o acidente vascular cerebral (AVC) é uma das principais causas de incapacidade neste país de dimensões continentais. As informações sobre o acesso à reabilitação após AVC em instalações públicas no Brasil são limitadas. OBJETIVO: Fornecer informações abrangentes sobre o Acesso à Reabilitação pós-AVC (estudo AReA) nos primeiros 6 meses após a alta hospitalar da rede pública. MéTODOS: Serão coletadas informações de 17 centros de saúde públicos em 16 cidades brasileiras das cinco macrorregiões do país. Cada centro incluirá 36 participantes (n = 612). Os critérios de inclusão são: idade ≥ 18 anos; AVC isquêmico ou hemorrágico, com tempo de lesão entre 6 meses e 1 ano; admissão em hospital público na fase aguda; qualquer comprometimento neurológico pós-AVC; paciente ou cuidador capaz de fornecer consentimento informado e responder à pesquisa. Os pacientes só podem ser recrutados em ambulatórios públicos de neurologia ou medicina interna. Os resultados serão avaliados por um questionário padrão sobre encaminhamentos de reabilitação, o programa de reabilitação (estado atual, duração em meses, número de sessões por semana) e instruções recebidas. Além disso, os pacientes serão questionados sobre as preferências de locais de reabilitação (hospitais, clínicas ou casa). STATUS DO ESTUDO: O estudo está em andamento. O recrutamento começou em 31 de janeiro de 2020 e está previsto para continuar até junho de 2022. CONCLUSãO: O estudo AReA preencherá uma lacuna no conhecimento sobre o acesso à reabilitação para AVC no sistema público de saúde em diferentes regiões brasileiras.
Subject(s)
Stroke Rehabilitation , Stroke , Humans , Adolescent , Brazil , Hospitalization , Patient Discharge , Multicenter Studies as TopicABSTRACT
Abstract Background Most of the Brazilian population relies on public healthcare and stroke is a major cause of disability in this country of continental dimensions. There is limited information about access to rehabilitation after stroke in Brazil. Objective To provide comprehensive information about Access to Rehabilitation After discharge from public hospitals in Brazil (AReA study), up to 6 months after stroke. Methods The present study intends to collect information from 17 public health centers in 16 Brazilian cities in the 5 macroregions of the country. Each center will include 36 participants (n = 612). The inclusion criteria are: age ≥ 18 years old; ischemic or hemorrhagic stroke, from 6 months to 1 year prior to the interview; admission to a public hospital in the acute phase after stroke; any neurological impairment poststroke; patient or caregiver able to provide informed consent and answer the survey. Patients can only be recruited in public neurology or internal medicine outpatient clinics. Outcomes will be assessed by a standard questionnaire about rehabilitation referrals, the rehabilitation program (current status, duration in months, number of sessions per week) and instructions received. In addition, patients will be asked about preferences for locations of rehabilitation (hospitals, clinics, or at home). Trial Status The study is ongoing. Recruitment started on January 31st, 2020 and is planned to continue until June 2022. Conclusion The AReA study will fill a gap in knowledge about access to stroke rehabilitation in the public health system in different Brazilian regions.
Resumo Antecedentes Grande parte da população brasileira depende de saúde pública e o acidente vascular cerebral (AVC) é uma das principais causas de incapacidade neste país de dimensões continentais. As informações sobre o acesso à reabilitação após AVC em instalações públicas no Brasil são limitadas. Objetivo Fornecer informações abrangentes sobre o Acesso à Reabilitação pós-AVC (estudo AReA) nos primeiros 6 meses após a alta hospitalar da rede pública. Métodos Serão coletadas informações de 17 centros de saúde públicos em 16 cidades brasileiras das cinco macrorregiões do país. Cada centro incluirá 36 participantes (n = 612). Os critérios de inclusão são: idade ≥ 18 anos; AVC isquêmico ou hemorrágico, com tempo de lesão entre 6 meses e 1 ano; admissão em hospital público na fase aguda; qualquer comprometimento neurológico pós-AVC; paciente ou cuidador capaz de fornecer consentimento informado e responder à pesquisa. Os pacientes só podem ser recrutados em ambulatórios públicos de neurologia ou medicina interna. Os resultados serão avaliados por um questionário padrão sobre encaminhamentos de reabilitação, o programa de reabilitação (estado atual, duração em meses, número de sessões por semana) e instruções recebidas. Além disso, os pacientes serão questionados sobre as preferências de locais de reabilitação (hospitais, clínicas ou casa). Status do estudo O estudo está em andamento. O recrutamento começou em 31 de janeiro de 2020 e está previsto para continuar até junho de 2022. Conclusão O estudo AReA preencherá uma lacuna no conhecimento sobre o acesso à reabilitação para AVC no sistema público de saúde em diferentes regiões brasileiras.
ABSTRACT
Patients with Parkinson's disease (PD) have difficulties while performing dual-task activities, a condition present in everyday life. It is possible that strategies such as transcranial Direct Current Stimulation (tDCS) can be associated with motor training enriched with dual-task training to improve the performance of two concurrent tasks. Currently, it is unclear whether specific tasks and clinical conditions of PD patients have different results after the intervention. Therefore, the proposed randomized controlled trial will examine task-dependency in enhancing the effects of tDCS-linked rehabilitation training on PD and the relationships between baseline outcomes in responders and non-responders to therapy. Fifty-six patients with Parkinson's disease will be recruited to participate in this controlled, double-blind randomized multicentric clinical trial. Patients in modified Hoehn & Yahr stage 1.5-3, age between 40 and 70 years will be included. Subjects will be randomly assigned to an experimental group (EG) and a control group (CG). The EG will perform treadmill gait training associated with dual task exercises+tDCS, while the CG will only engage in treadmill gait training+tDCS. Blinded testers will assess patients before and after 12 intervention sessions and after a 4-week follow-up period. All patients will undergo a screening and an initial visit before being assessed for primary and secondary outcomes. The primary outcome measure is functional mobility measured by Timed Up and Go Test. Secondary outcomes include cognitive function, participation, motor function and body function and structure. This study will evaluate the effectiveness of an intervention protocol with tDCS, dual-task training and gait training in patients with PD. The study will also highlight the clinical factors and variability between individuals that could interfere in the training of a specific task and influence the therapeutic effect. Clinical Trial registration: www.ClinicalTrials.gov, identifier NCT04581590.
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BACKGROUND: Dementia is among the most common chronic noncommunicable neurodegenerative diseases. In the long term, it causes disability and loss of autonomy and independence. It is estimated that there are 35.6 million people with Alzheimer's disease worldwide. Several clinical aspects of this disease have been widely studied, but the main focus of study has been memory loss, which is one of the first symptoms. The present study proposes an innovative intervention that combines cognitive training and multisite transcranial direct current stimulation, which interferes with other clinical aspects of the subject. CASE PRESENTATION: In this study, we present two subjects diagnosed with mild Alzheimer's disease. Subject 1 is an 82-year-old Brazilian Latin American woman with a high school education who was diagnosed with Alzheimer's disease 8 years ago and uses an Exelon patch. Subject 2 is an 88-year-old Brazilian Latin American woman with an incomplete primary education who was diagnosed with Alzheimer's disease 1 year ago and received medical orientation to temporarily discontinue medications for Alzheimer's disease. Both participants were subjected to intermittent cognitive training sessions and concomitant transcranial stimulation in three weekly 30-minute sessions in which a brain area was stimulated every 10 minutes for a total of 24 sessions, with a 2-month follow-up. Transcranial stimulation was applied to six different regions of the cortex: the dorsolateral prefrontal cortex bilaterally, the somatosensory association cortex bilaterally and Broca's and Wernicke's areas. Comparing the results of tests performed before and after the treatment period, a 1-point improvement was observed for both subjects on the Word Recall task of the Alzheimer Disease Assessment Scale, which evaluates symptoms related to the decline of episodic memory. Improvement in the executive functions domain was also observed through the results of the Stroop test, Victoria version. CONCLUSIONS: The results from the two presented cases show that multisite transcranial stimulation associated with cognitive training is an effective adjuvant method for the treatment of patients diagnosed with mild Alzheimer's disease. Its effects can benefit patients' daily routines by reducing cognitive deficits by keeping intact areas active and/or compensating for lost functions. Trial registration NCT02772185. Registered 13 May 2016, http://www.clinicaltrials.gov/ct2/show/NCT02772185 . Retrospectively registered.
Subject(s)
Alzheimer Disease/therapy , Cognition/physiology , Memory, Episodic , Memory/physiology , Transcranial Direct Current Stimulation , Aged, 80 and over , Brazil , Executive Function , Female , Humans , Treatment OutcomeABSTRACT
ABSTRACT BACKGROUND AND OBJECTIVES: In temporomandibular disorder, the pain is a very present and striking symptom, with a tendency to chronicity, through mechanisms of maladaptive neuroplasticity. In the face of this, transcranial direct current stimulation appears as a possible strategy for the treatment of chronic pain in the temporomandibular disorder. This study aimed to evaluate the efficacy of anodal transcranial direct current stimulation in the pain symptoms and anxiety levels in individuals with chronic myofascial temporomandibular disorder. METHODS: The participants received three different types of intervention in a randomized order: anodic in the primary motor cortex, in the dorsolateral prefrontal cortex and sham stimulation. RESULTS: There were significant improvements in clinical pain in all stimulation protocols, with a relief of approximately 40% (p=0.001). There was no significant difference in the effect of the transcranial direct current stimulation between the different types of stimulation (p=0.14). There was a positive impact on anxiety symptoms, leading to a significant decrease in state anxiety levels (p=0.035) and trait (p=0.009). CONCLUSION: The use of the transcranial direct current stimulation improved the health status of patients with chronic myofascial temporomandibular disorder, promoting pain relief, decreased level of anxiety, and quality of life.
RESUMO JUSTIFICATIVA E OBJETIVOS: Na disfunção temporomandibular, a dor aparece de forma frequente e marcante, com tendência à cronicidade, através de mecanismos de neuroplasticidade mal adaptativo. Diante disso, a estimulação transcraniana por corrente contínua surge como uma possível estratégia de tratamento da dor crônica em disfunção temporomandibular. O presente estudo objetivou avaliar a eficácia da estimulação transcraniana por corrente contínua anódica nos sintomas dolorosos e, por conseguinte, nos níveis de ansiedade em indivíduos com disfunção temporomandibular muscular crônica. MÉTODOS: Os participantes receberam três tipos diferentes de intervenção cuja ordem foi randomizada: anódica no córtex motor primário, na região cortical dorsolateral pré-frontal e estimulação simulada. RESULTADOS: Houve melhorias significativas para a dor clínica em todos os protocolos de estimulação, com um alívio de aproximadamente 40% (p=0,001). Não houve diferença significativa no efeito da estimulação transcraniana por corrente contínua entre os diferentes tipos de estimulação (p=0,14). Ocorreu impacto positivo sobre os sintomas de ansiedade, com diminuição significativa nos níveis de ansiedade estado (p=0,035) e traço (p=0,009). CONCLUSÃO: O uso da estimulação transcraniana por corrente contínua melhorou a condição de saúde dos portadores de disfunção temporomandibular muscular crônica, promovendo um alívio do quadro álgico, diminuição do nível de ansiedade, além de gerar qualidade de vida.
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Objetivo: Identificar as características biopsicossociais de gestantes adolescentes, nas maternidades do Hospital Universitário Lauro Wanderley e do Instituto Cândida Vargas,no município de João Pessoa, Paraíba, Brasil. Material e Métodos: Trata-se de um estudo descritivo, observacional e com caráter transversal, cuja amostra foi constituída por104 adolescentes, na faixa etária entre 13 e 19 anos, que se encontravam no pós-parto imediato. Na coleta de dados,foram utilizadas informações constantes nos prontuários e nas entrevistas com as mães no pós-parto imediato. Resultados: A média de idade das participantes foi de 18,5 ±1,4 anos; 52,4% eram da cor parda; 61,5% encontravam-se fora da escola; 90% estudaram em escola pública. Referente à escolaridade, predominou o ensino fundamental (55,8%).A família e o parceiro apoiaram a adolescente na gestação,em 94,2% e 87,5% dos casos, respectivamente. Conclusão: Verificou-se que a faixa etária mais frequente das mães adolescentes era entre 16 e 19 anos de idade, embora também exista uma taxa significativa dos 17 aos 19 anos. Além disso,houve uma alta prevalência de mães que abandonaram os estudos devido à gestação, porém, de um modo geral, as adolescentes puderam contar com o apoio da família e do pai do bebê.
Objective: To identify the biopsychosocial characteristics of pregnant adolescents assisted in the maternities of Lauro Wanderley University Hospital and Candida Vargas Institute, in the city of João Pessoa, Paraíba, Brazil. Material and Methods: This was a descriptive, observational and cross sectional study, whose sample consisted of 104 adolescents, aged between 13 and 19 years, whom were approached in the immediate postpartum period. The data were collected from medical records and interviews with the mothers in the immediate postpartum period. Results: The mean age of participants was 18.5±1.4 years; 52.4 % had mixed ethnicity;61.5% had dropped out of school; 90% had studied in a public school. There was a predominance of the elementary education level (55.8%). The family and the partner supported the adolescent during pregnancy in 94.2% and 87.5% of cases, respectively. Conclusion: The most common age group of adolescent mothers was between 16 and 19 years, although there was a significant rate of mothers aged between 17 and 19 years. In addition, there was a high prevalence of mothers who dropped out of school due to pregnancy; however, in general, the adolescents were supported by their family and childs father.
