Psychometric Validation of a Hearing Screening Questionnaire for Preschoolers Based on Language Development Evaluation by Caregivers.

INTRODUCTION: This study aimed to validate three age-adjusted versions of a Hearing Screening Questionnaire for Preschoolers, in Brazilian Portuguese, based on parents' perception of their children's hearing and oral language. METHODS: Psychometric validation was conducted on three questionnaires, each comprising nine items with yes/no responses. Three items focused on hearing screening at birth, and six assessed hearing and oral language. The study included 152 parents and their children, who attended daycare centers in Belo Horizonte, Brazil. The children were categorized into three age bands: 12-18 months, 19-35 months, and 36-48 months. Audiological assessments, including tympanometry, transient-evoked otoacoustic emissions (TEOAE), and pure-tone audiometry (when applicable), were performed on the children. In case of abnormal findings in the previous exams, auditory brainstem response (ABR) testing was conducted. Descriptive data, false alarm, and false-negative analyses were carried out. RESULTS: Considering any type of hearing loss, whether unilateral or bilateral, the questionnaires showed a false-negative rate of 41.17% (7/17 children). However, when considering only bilateral hearing loss, the questionnaire showed a false alarm rate of 31.69% (45/142) and a false-negative rate of 30.0% (3/10). When focusing exclusively on sensorineural hearing loss, the questionnaire identified two children (1.31%), with a false-negative rate of 0% but a false-positive rate of 33.33%. CONCLUSION: Language-development-oriented questionnaires allowed quick screening of potential hearing loss in preschoolers. This study found a robust hit rate with these questionnaires. Their validation signifies a promising and cost-effective tool for conducting hearing screenings in preschool children, especially in nations lacking a comprehensive school screening policy. The validated questionnaire affords an easy-to-apply, low-cost, and effective instrument for preschool hearing screening.

Elderly people with human T-cell leukemia virus type 1-associated myelopathy present an early impairment in cognitive skills.

BACKGROUND: Cerebral changes occur in individuals with human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy (HAM) and seem to predominate in subcortical areas. Little is known about the cognitive decline in the elderly living with HTLV-1. OBJECTIVE: To evaluate the cognitive aging of individuals infected with HTLV-1 aged ≥ 50 years. METHODS: This is a cross-sectional study of former blood donors infected with HTLV-1 who have been followed in the cohort of the Interdisciplinary Research Group on HTLV-1 since 1997. The groups of study consisted of 79 HTLV-1 infected individuals aged ≥ 50 years, with 41 of them presenting symptomatic HAM and 38 being asymptomatic carriers, and 59 seronegative individuals (controls) aged ≥ 60 years. All were submitted to the P300 electrophysiological test and neuropsychological tests. RESULTS: Individuals with HAM presented delayed P300 latency in relation to the other groups, and this latency delay increased progressively with aging. The performance of this group in the neuropsychological tests was also the worst. The HTLV-1- asymptomatic group performance was similar to that of the control group. CONCLUSIONS: Individuals with HAM presented cognitive decline that progressed with aging and, although HTLV-1-asymptomatic carriers appear to present cognitive aging similar to that of healthy elderly people, concern about a subclinical cognitive impairment is warranted in this population.

ANTECEDENTES: Alterações cerebrais ocorrem em indivíduos com mielopatia associada ao vírus da leucemia de células T humanas tipo 1 (HTLV-1) (HAM) e parecem predominar em áreas subcorticais. Pouco se sabe sobre o declínio cognitivo em idosos vivendo com HTLV-1. OBJETIVO: Avaliar o envelhecimento cognitivo de indivíduos infectados pelo HTLV-1 com idade ≥ 50 anos. MéTODOS: Trata-se de um estudo transversal com ex-doadores de sangue infectados pelo HTLV-1 acompanhados na coorte do Grupo Interdisciplinar de Pesquisa em HTLV-1 há 20 anos. Os grupos de estudo foram compostos por 79 indivíduos infectados pelo HTLV-1 com idade ≥ 50 anos, sendo que 41 apresentavam HAM e 38 eram portadores assintomáticos, e 59 indivíduos soronegativos (controles) com idade ≥ 60 anos. Todos foram submetidos ao teste eletrofisiológico P300 e testes neuropsicológicos. RESULTADOS: Indivíduos com HAM apresentaram atraso na latência do P300 em relação aos demais grupos, e esse atraso de latência aumentou progressivamente com o envelhecimento. O desempenho desse grupo nos testes neuropsicológicos também foi o pior. O desempenho do grupo HTLV-1- assintomático foi semelhante ao do grupo controle. CONCLUSãO: Indivíduos com HAM apresentaram declínio cognitivo que progrediu com o envelhecimento e, embora os portadores assintomáticos do HTLV-1 pareçam apresentar envelhecimento cognitivo semelhante ao dos idosos saudáveis, justifica-se a preocupação com um comprometimento cognitivo subclínico nessa população.

Elderly people with human T-cell leukemia virus type 1-associated myelopathy present an early impairment in cognitive skills / Idosos com mielopatia associada ao vírus da leucemia de células T humanas tipo 1apresentam comprometimento precoce em habilidades cognitivas

Abstract Background Cerebral changes occur in individuals with human T-cell leukemia virus type 1 (HTLV-1 )-associated myelopathy (HAM) and seem to predominate in subcortical areas. Little is known about the cognitive decline in the elderly living with HTLV-1. Objective To evaluate the cognitive aging of individuals infected with HTLV-1 aged ≥ 50 years. Methods This is a cross-sectional study of former blood donors infected with HTLV-1 who have been followed in the cohort of the Interdisciplinary Research Group on HTLV-1 since 1997. The groups of study consisted of 79 HTLV-1 infected individuals aged ≥ 50 years, with 41 of them presenting symptomatic HAM and 38 being asymptomatic carriers, and 59 seronegative individuals (controls) aged ≥ 60 years. All were submitted to the P300 electrophysiological test and neuropsychological tests. Results Individuals with HAM presented delayed P300 latency in relation to the other groups, and this latency delay increased progressively with aging. The performance of this group in the neuropsychological tests was also the worst. The HTLV-1- asymptomatic group performance was similar to that of the control group. Conclusions Individuals with HAM presented cognitive decline that progressed with aging and, although HTLV-1-asymptomatic carriers appear to present cognitive aging similar to that of healthy elderly people, concern about a subclinical cognitive impairment is warranted in this population.

Resumo Antecedentes Alterações cerebrais ocorrem em indivíduos com mielopatia associada ao vírus da leucemia de células T humanas tipo 1 (HTLV-1) (HAM) e parecem predominar em áreas subcorticais. Pouco se sabe sobre o declínio cognitivo em idosos vivendo com HTLV-1. Objetivo Avaliar o envelhecimento cognitivo de indivíduos infectados pelo HTLV-1 com idade ≥ 50 anos. Métodos Trata-se de um estudo transversal com ex-doadores de sangue infectados pelo HTLV-1 acompanhados na coorte do Grupo Interdisciplinar de Pesquisa em HTLV-1 há 20 anos. Os grupos de estudo foram compostos por 79 indivíduos infectados pelo HTLV-1 com idade ≥ 50 anos, sendo que 41 apresentavam HAM e 38 eram portadores assintomáticos, e 59 indivíduos soronegativos (controles) com idade ≥ 60 anos. Todos foram submetidos ao teste eletrofisiológico P300 e testes neuropsicológicos. Resultados Indivíduos com HAM apresentaram atraso na latência do P300 em relação aos demais grupos, e esse atraso de latência aumentou progressivamente com o envelhecimento. O desempenho desse grupo nos testes neuropsicológicos também foi o pior. O desempenho do grupo HTLV-1- assintomático foi semelhante ao do grupo controle. Conclusão Indivíduos com HAM apresentaram declínio cognitivo que progrediu com o envelhecimento e, embora os portadores assintomáticos do HTLV-1 pareçam apresentar envelhecimento cognitivo semelhante ao dos idosos saudáveis, justificase a preocupação com um comprometimento cognitivo subclínico nessa população.

Galvanic vestibular stimulation to improve postural instability, voluntary attention, and quality of life in Parkinson's disease patients / Estimulação vestibular galvânica na melhora da atenção voluntária e da qualidade de vida em pacientes com doença de Parkinson e desequilíbrio corporal

ABSTRACT Galvanic vestibular stimulation (GVS) influences body balance and has proved to be useful to improve patients' mood, quality of life, and cognitive skills. This study aimed to present three cases of patients with Parkinson's disease and postural instability who had been submitted to GVS to improve their balance, by assessing the impact of this intervention on their cognition, mood, and quality of life. Patients were assessed before and after GVS sessions concerning P300 latency and scores on the 15-item Geriatric Depression Scale (GDS-15) and the 39-item quality-of-life Parkinson's Disease Questionnaire (PDQ-39). The three patients' P300 latency improved, possibly indicating improved attention. Their PDQ-39 score also improved, possibly indicating a positive impact on their quality of life. Their GDS-15 score did not change before and after the intervention. None of the patients had any intervention side effects. This three-case experimental pilot study has shown that GVS is a safe method, possibly useful to improve attention and, therefore, the quality of life of patients presented with Parkinson's disease.

RESUMO A Estimulação Vestibular Galvânica (EVG) atua no equilíbrio corporal e tem se mostrado útil na melhora do humor, da qualidade de vida e de habilidades cognitivas. O objetivo deste estudo foi apresentar três casos de pacientes com doença de Parkinson e instabilidade postural que foram submetidos à EVG para melhorar o equilíbrio e avaliar o impacto dessa intervenção na cognição, no humor e na qualidade de vida. Os pacientes foram avaliados antes e após as sessões de EVG quanto a latência do potencial evocado P300, pontuação na escala de depressão geriátrica de 15 itens (EDG-15) e pelo questionário de qualidade de vida na doença de Parkinson de 39 itens (PDQ-39). Os três pacientes apresentaram melhora na latência do P300, indicando possível melhora na atenção. Apresentaram melhora na pontuação do PDQ-39, indicando possível impacto positivo na qualidade de vida. A pontuação na EDG-15 não modificou antes e após a intervenção. Nenhum paciente apresentou efeitos colaterais decorrentes da intervenção. Com base neste estudo piloto experimental de três casos, a EVG mostrou-se um método seguro e possivelmente útil para melhorar a atenção e, consequentemente, a qualidade de vida de pacientes com doença de Parkinson.

Galvanic vestibular stimulation and its applications: a systematic review,

Abstract Objective: Galvanic vestibular stimulation has been evaluated in the context of vestibular rehabilitation. The objective was to identify evidence in the scientific literature about the clinical applications of galvanic vestibular stimulation. Methods: In this systematic review, the articles describing the applications of galvanic vestibular stimulation were extracted from PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The survey was limited to articles published in English, Portuguese and Spanish. All the articles about the clinical applications of galvanic vestibular stimulation were compiled. Repeated articles in the databases, literature review articles, case reports, letters and editorials were excluded. The descriptors included: galvanic vestibular stimulation, postural balance, central nervous system diseases, vestibular diseases, spinal cord diseases and cognition. Results: The search strategy resulted in the initial selection of 994 articles; the reading of titles and abstracts was accomplished in 470 articles and the complete reading in 23 articles. Clinical applications of galvanic vestibular stimulation included Ménière's disease, vestibular neuritis, bilateral vestibular disorders, vestibular schwannoma, Parkinson's disease, ischemic central lesions, motor myelopathies, anxiety disorders, cognition and memory. Conclusion: Galvanic vestibular stimulation has been considered a potentially useful strategy for balance rehabilitation, since it has the effect of stimulating the central connections related to the postural balance, favoring new neuronal synapses that allow the partial or total recovery of postural imbalance.

Galvanic vestibular stimulation and its applications: a systematic review.

OBJECTIVE: Galvanic vestibular stimulation has been evaluated in the context of vestibular rehabilitation. The objective was to identify evidence in the scientific literature about the clinical applications of galvanic vestibular stimulation. METHODS: In this systematic review, the articles describing the applications of galvanic vestibular stimulation were extracted from PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The survey was limited to articles published in English, Portuguese and Spanish. All the articles about the clinical applications of galvanic vestibular stimulation were compiled. Repeated articles in the databases, literature review articles, case reports, letters and editorials were excluded. The descriptors included: galvanic vestibular stimulation, postural balance, central nervous system diseases, vestibular diseases, spinal cord diseases and cognition. RESULTS: The search strategy resulted in the initial selection of 994 articles; the reading of titles and abstracts was accomplished in 470 articles and the complete reading in 23 articles. Clinical applications of galvanic vestibular stimulation included Ménière's disease, vestibular neuritis, bilateral vestibular disorders, vestibular schwannoma, Parkinson's disease, ischemic central lesions, motor myelopathies, anxiety disorders, cognition and memory. CONCLUSION: Galvanic vestibular stimulation has been considered a potentially useful strategy for balance rehabilitation, since it has the effect of stimulating the central connections related to the postural balance, favoring new neuronal synapses that allow the partial or total recovery of postural imbalance.

Development of an immunogen containing CD4+/CD8+ T-cell epitopes for the prophylaxis of tegumentary leishmaniasis.

Tegumentary leishmaniasis (TL) is a disease of high severity and incidence in Brazil, and Leishmania braziliensis is its main etiological agent. The inefficiency of control measures, such as high toxicity and costs of current treatments and the lack of effective immunoprophylactic strategies, makes the development of vaccines indispensable and imminent. In this light, the present work developed a gene encoding multiple T-cell (CD4+/CD8+) epitope, derived from conserved proteins found in Leishmania species and associated with TL, to generate a chimeric protein (rMEP/TL) and compose a vaccine formulation. For this, six T-cell epitopes were selected by immunoinformatics approaches from proteins present in the amastigote stage and associated with host-parasite interactions. The following formulations were then tested in an L. braziliensis murine infection model: rMEP/TL in saline or associated with MPLA-PHAD®. Our data revealed that, after immunization (three doses; 14-day intervals) and subsequent challenging, rMEP/TL and rMEP/TL + MPLA-vaccinated mice showed an increased production of key immunological biomarkers of protection, such as IgG2a, IgG2a/IgG1, NO, CD4+, and CD8+ T-cells with IFN-γ and TNF-α production, associated with a reduction in CD4+IL-10+ and CD8+IL-10+ T-cells. Vaccines also induced the development of central (CD44highCD62Lhigh) and effector (CD44highCD62Llow) memory of CD4+ and CD8+ T-cells. These findings, associated with the observation of lower rates of parasite burdens in the vaccinated groups, when compared to the control groups, suggest that immunization with rMEP/TL and, preferably, associated with an adjuvant, may be considered an effective tool to prevent TL. KEY POINTS: • Rational design approaches for vaccine development. • Central and effector memory of CD4+ and CD8+ T-cells. • Vaccine comprised of rMEP/TL plus MPLA as an effective tool to prevent TL.

Mapping linear B-cell epitopes of the Tryparedoxin Peroxidase and its implications in the serological diagnosis of tegumentary leishmaniasis.

Diagnosis of tegumentary leishmaniasis (TL) is essential to avoid permanent damage and severe functional sequelae and there is an urgent need to discover new antigens. The present study aimed to comprehensively evaluate the potential use of the Tryparedoxin Peroxidase (TryP) as an antigen for serological tests. The proposal integrates data from immunoproteomics with immunoinformatics, in addition to a precise analysis of protein levels in the evolutionary stages of the parasite by flow cytometry. To evaluate the performance in the diagnosis of TL, Enzyme-Linked Immunosorbent Assay (ELISA) assays were performed using the recombinant protein and the respective B-cell epitope, followed by an analysis of the contribution of this peptide in the recognition of the protein by patients, evaluated by serum depletion assays. We showed that the TryP has a linear B-cell epitope with high divergence compared to orthologs from Trypanosoma cruzi and Homo sapiens. The results also show high expression and positive cells for TryP (TryP+) in the infective metacyclic promastigotes (MET) and intracellular (24 and 48 hours) stages. From the depletion assays, it was possible to confirm the contribution of the peptide in the specific recognition of the TryP protein by patients with TL (13.7-15.9%). ELISA using the peptide showed high performance in the diagnosis compared to the recombinant TryP (rTryP), Soluble Leishmania braziliensis Antigen (sLba) and Immunofluorescence Assay (IFA) with accuracy of 94.29, 89.29, 65.00 and 37.14%, respectively). We can conclude that the MNEPAPP peptide is a potential antigen for the diagnosis of TL.

A feasibility analysis of digital interface to transfer information during doctors' handovers / Uma análise de viabilidade de interface digital para transferência de informações durante a passagem dos médicos / Análisis de viabilidad de la interfaz digital para apoyar los traspasos de turnos medicos

Objective: To report the pre-deployment analysis of a digital system to transfer patient information during physicians' obstetric shift sessions. Methods: A literature review explored evidence concerning electronic handover applications in hospitals. A survey met local approaches used to shift changing and the expectations of managers' stakeholders. To explore local practices, we analyzed a sample 251 obstetric handovers. Finally, requirements for the system were listed, and end-users evaluated mockups of the proposed design. Results: From the literature review, easy-to-use and integration with existing systems were the most critical requests to achieve user adherence. The main system requirement was using the hospital infrastructure to ensure full access to the current medical record. Mockup validation by end-users pinpointed items to improve a complete implementation and the positive acceptance of prefilled structured entries. Conclusions: There are blockages to overcome deficits in the quality of the information in clinical handovers to safely transfer patient care between doctors' shifts.

Objetivo: Relatar a análise pré-implantação de um sistema para transferência de dados clínicos durante as sessões de plantão obstétrico. Métodos: Uma revisão de literatura explorou evidências sobre sistemas hospitalares em uso. Um questionário levantou abordagens empregadas e as expectativas das partes interessadas. Para explorar as práticas, analisamos uma amostra de 251 transferências de plantão. Os requisitos para o sistema foram listados e os usuários finais avaliaram protótipos de interface. Resultados: A partir da revisão da literatura, a facilidade de uso e a integração com sistemas eletrônicos existentes foram os quesitos mais críticos para alcançar a adesão dos usuários. O principal requisito de sistema foi utilizar a infraestrutura do hospital para garantir o acesso ao prontuário eletrônio. Na validação das interfaces, identificaram-se itens de melhoria antes da implementação plena e uma aceitação de entradas estruturadas, pré-preenchidas. Conclusões: Há desafios para superar déficits na qualidade da informação clínica trocada em sessões de transferência de plantões médicos, para garantir a segurança do atendimento ao paciente.

Objetivo: Reportar el análisis previo al despliegue de un sistema digital para transferir información de pacientes durante las sesiones de turno de médicos obstétricos. Métodos: Uma revisión de literatura explorou evidencias sobre sistemas hospitalares em uso. Um questionário levantou abordagens empregadas e as expectativas das partes interessadas. Para explorar las prácticas, analizamos una muestra de 251 transferencias de planta. Los requisitos para el sistema de listados y los usuarios finales para evaluar los prototipos de la interfaz. Resultados: partir de la revisión de la literatura, la facilidad de uso y la integración de los sistemas electrónicos existentes para las preguntas más críticas para alcanzar el objetivo de los usuarios. O principal requisito de sistema para utilizar una infraestructura del hospital para garantizar o acesso ao prontuário eletrônio. Na validação das interfaces, identificaram-se itens de melhoria antes da implementação plena e uma aceitação de entradas estruturadas, pré-preenchidas. Conclusiones: Há desafios para superar los déficits en la calidad de la información clínica trocada en sesiones de transferencia de plantas médicas, para garantizar una atención segura al paciente.

Impact assessment of different DNA extraction methods for non-invasive molecular diagnosis of tegumentary leishmaniasis.

The aim of this study was to evaluate two methods of nucleic acid extraction (spin-column-based method - commercial kit and direct boil - DB) from swab sampling compared to biopsy sampling for the diagnosis of tegumentary leishmaniasis (TL), (cutaneous - CL and mucocutaneous - MCL forms). The impact of these nucleic acid extraction protocols on different types of PCR and LAMP techniques were compared regarding nucleic acid quality, molecular assays accuracy, indirect quantitation, and costs. The evaluated patients were 57 TL cases (36 CL and 21 MCL) and 34 non-cases. Swab samples extracted by the DB method showed a higher DNA degradation rate and worse DNA quality in comparison to the commercial kit. Molecular tests performed on biopsy samples showed identical or higher performance in all analysis, as compared to their own performance on swab samples for TL (CL and MCL). However, only the SSU rRNA TaqMan™ RT-PCR test showed a significant difference between the performance of biopsy and swab samples extracted by commercial kit. The kDNA-cPCR coupled with swab extracted by commercial kit showed the highest accuracy (95.6%) for TL diagnosis. The sensitivity of the LAMP-RT 18S method in swab samples extracted with a commercial kit (82.5%) was close to that found in biopsy samples (86%) for TL diagnosis. The DB extraction method presented the lowest cost. The use of swab as a minimally-invasive sampling method, associated with an efficient nucleic acid extraction protocol, may represent a low-cost alternative for the diagnosis of CL and MCL.

Use of hearing devices and fluency in Brazilian Sign Language and oral language in deaf students / Uso de dispositivos auxiliares da audição e fluência na Libras e na língua oral de estudantes surdos

ABSTRACT Purpose: to assess the relationship between deaf students' fluency in Brazilian Sign Language (BSL) and oral language and hearing aid use. Method: the sample comprised 112 professional BSL translators, interpreters, and instructors. They answered a questionnaire on hearing characteristics and BSL and oral language fluency of students accompanied by them, who attended municipal schools in a Brazilian city. Association analysis between oral language fluency, BSL fluency, the degree of hearing loss, and device use was made with the chi-square test or Fisher's Exact test. The significance level was set at p<0.05. Results: the professionals' responses referred to 88% (n = 126) of all deaf students enrolled in municipal schools. The students' mean age was 13 years; 72 (57%) were males, 98 (78%) had severe or profound hearing loss, 57 (45%) used electronic hearing devices, 83 (66%) were fluent only in BSL, 12 (10%) were fluent only in oral language, and 18 (14%) were fluent in both BSL and oral language. Hearing device use was statistically associated with oral fluency (p < 0.001). Of all students fluent in oral language (n = 30), 18 (60%) were also fluent in BSL (p < 0.001). Conclusion: BSL was the communication modality most used by students, including those who also used oral language and electronic hearing devices. This may indicate a change in the social perception of deaf people, their language, and their culture.

RESUMO Objetivo: avaliar a relação entre fluência na Libras, fluência na língua oral e o uso de dispositivos auxiliares para audição de estudantes surdos. Métodos: participaram 112 profissionais tradutores, intérpretes ou instrutores de Libras que informaram as características auditivas, fluência na Libras e língua oral dos estudantes acompanhados por eles, matriculados na rede municipal de uma cidade brasileira. A análise da associação entre fluência na Libras, fluência na língua oral, grau da perda auditiva e uso de dispositivo foi realizada por meio do teste qui-quadrado ou teste exato de Fisher, consideraram-se significantes valores de p<0,05. Resultados: as respostas dos profissionais referiram-se a 88% (n=126) do total de estudantes surdos matriculados na rede municipal. A média de idade dos estudantes foi de 13 anos, sendo 72 (57%) meninos, 98 (78%) com perda auditiva severa ou profunda, 57 (45%) usuários de dispositivos eletrônicos auxiliares para audição, 83 (66%) fluentes somente na Libras, 12 (10%) fluentes apenas na língua oral e 18 (14%) fluentes na Libras e língua oral. Estudantes que utilizavam dispositivo auxiliar para audição apresentaram melhor fluência oral (p<0,001). Dos estudantes que apresentavam fluência oral (n=30), 18 (60%) eram fluentes em Libras (p<0,001). Conclusão: a Libras foi a modalidade comunicativa utilizada majoritariamente pelos estudantes surdos, mesmo por aqueles que utilizavam também a língua oral e dispositivos eletrônicos, o que pode indicar mudança de percepção social em relação ao surdo, à sua língua e cultura.

Lian gong as a Therapeutic Treatment Option in Primary Care for Patients with Dizziness: A Randomized Controlled Trial.

Introduction Dizziness is one of the most common reasons for seeking primary health care. Vestibular rehabilitation (VR) is a conventional treatment method for peripheral balance disorders that effectively decreases symptoms. Lian gong [LG] is believed to benefit patients with dizziness and to reduce the impact of the condition on quality of life by stimulating visual fixation, attention, body balance, and neuroplasticity. Objective The present study aimed to evaluate the effects of LG on the impact of dizziness on quality of life and fear of falling in primary health care patients. Methods This was a two-arm, parallel randomized clinical trial that included 36 patients with dizziness not caused by central changes. After specific medical evaluations and indications for treatment, the participants were randomly assigned to 3 groups: the LG group ( n = 11), the VR group ( n = 11), and the control group ( n = 14). The interventions were conducted collectively over a period of 12 weeks. Results Lian gong reduced the influence of dizziness on quality of life in physical (1.8 points, 95% confidence interval [CI]: 0.2-3.4), functional (4.0 points, 95% CI: 2.1-5.9), and emotional domains of quality of life (4.4 points, 95% CI: 1.7-7.2), with no differences compared with VR. There were similar concerns among the groups about the risk of falling. Conclusion Lian gong was shown to be an effective balance rehabilitation strategy to reduce the impact of dizziness on quality of life, with similar results to those of VR.

Development of a chimeric protein based on a proteomic approach for the serological diagnosis of human tegumentary leishmaniasis.

Leishmania braziliensis is responsible for most cases of human tegumentary leishmaniasis (HTL) and has caused a wide range of clinical manifestations, including cutaneous (CL) and mucosal leishmaniasis (ML). The diagnosis is based on criteria that consider epidemiological data, clinical findings, and laboratory tests and is hard to establish. For laboratory tests, none of the assays available can be considered gold standards for disease detection. In addition, the Montenegro skin test, essential to supporting infectologists in the clinical management of the disease, is no longer available in Brazil. Thus, the aim of this study was to develop new targets to be used in diagnostic tests for HTL. In the first step, we carried out two-dimensional gel electrophoresis, followed by mass spectrometry, combined with heat map analysis and immunoproteomics approach, and disclosed eight proteins expressed in the amastigote stage specifically recognized by serum from CL and ML patients. A chimeric protein was designed based on the combination of thirteen linear B-cell epitopes, identified by immunoinformatics analysis, from L. braziliensis proteins. Our results showed that the strategy used in this work was successful in developing an antigen to be used in immunological assays (100.0% sensitivity and specificity) in the detection of HTL cases and in comparison with results obtained from an ELISA using soluble L. braziliensis antigen (SLb-Antigen) and immunofluorescence assay (Bio-Manguinhos/FIOCRUZ). The present technology opens the door for its use in field exams by means of an immunochromatographic test, which will be even more helpful in regions without laboratory structures.Key points• Rational strategy to develop antigens.• Integration between immunoproteomic and immunoinformatics analysis.• Chimeric protein shows high performance in HTL diagnosis.

Hearing and language screening in preschoolers / Triagem da audição e linguagem em pré-escolares

ABSTRACT Purpose: to describe the results of preschooler hearing and language screening and the association between them. Methods: a study with 75 children enrolled in preschool. The language was screened with the Behavior Observation Guide for 0-to-6-Year-Old Children. The hearing of children up to 1 year and 11 months old was screened with meatoscopy, acoustic immittance, behavioral hearing assessment, and otoacoustic emissions, while those in the age range 2 years or older were screened with meatoscopy, acoustic immittance, and play pure-tone audiometry. The children who failed the screening were referred for diagnosis. The results of the hearing and language assessments were compared with the McNemar test. Results: of the 75 children screened, 18 (24%) failed the hearing tests and 11 (15%) failed the language test. Hearing impairment was confirmed in 12 (66%) of those referred for diagnosis, and language impairment, in 10 (90%) of them. There was no association between hearing and language impairments (p = 0.230). Conclusion: hearing and language impairments were found in preschoolers. Although they were not associated, they can impact academic performance. This result emphasizes the need for developing strategies to implement preschooler screening programs that include hearing and language.

RESUMO Objetivo: descrever os resultados da triagem auditiva e de linguagem, bem como a associação entre ambos, em pré-escolares. Métodos: estudo realizado com 75 crianças matriculadas na pré-escola. A triagem de linguagem foi realizada por meio da aplicação do Roteiro de Observação do Comportamento de Crianças de 0 a 6 anos. A triagem auditiva das crianças com idade até 1 ano e 11 meses consistiu de meatoscopia, imitanciometria, avaliação auditiva comportamental e emissões otoacústicas. As crianças com idade igual ou superior a 2 anos realizaram meatoscopia, imitanciometria e audiometria tonal lúdica. As crianças que falharam na triagem foram encaminhadas para diagnóstico. A comparação entre resultado da avaliação audiológica e linguagem foi realizada por meio do teste McNemar. Resultados: das 75 crianças triadas, 18 (24%) falharam nos testes auditivos e 11 (15%) falharam no teste de linguagem. Das crianças encaminhadas para diagnóstico, 12 (66%) receberam confirmação de alteração auditiva e 10 (90%) receberam confirmação de alteração de linguagem. Não houve associação entre alteração de audição e linguagem (p=0,230). Conclusão: foram encontradas alterações de audição e linguagem em pré-escolares que, apesar de não associadas, podem impactar no desempenho acadêmico. Este resultado enfatiza a necessidade do desenvolvimento de estratégias para a implementação da triagem do pré-escolar abrangendo a audição e linguagem.

Aplicações dos potenciais evocados miogênicos vestibulares: revisão sistemática de literatura / Applications of vestibular-evoked myogenic potentials: a systematic literature review

RESUMO Objetivos Revisar a literatura científica sobre as principais técnicas usadas para gerar o potencial evocado miogênico vestibular (VEMP) e suas aplicações clínicas. Estratégia de pesquisa Os artigos que descrevem os métodos de registro e as aplicações do VEMP foram localizados nas bases de dados PubMed, Web of Science, MEDLINE, Scopus, LILACS e SciELO. O levantamento realizado limitou-se aos artigos publicados nos idiomas Inglês, Português e Espanhol, entre janeiro de 2012 e maio de 2018. Critérios de seleção Artigos sobre os aspectos técnicos para a realização do VEMP ocular, cervical ou do músculo sóleo, com estimulação auditiva ou galvânica e artigos sobre as aplicações clínicas do VEMP foram incluídos; artigos repetidos nas bases de dados, artigos de revisão de literatura, relato de casos, cartas e editoriais foram excluídos. Resultados A estratégia de busca resultou na seleção de 28 artigos. Os estudos evidenciaram três métodos de registro do VEMP: cervical, ocular e no músculo sóleo. As aplicações clínicas do VEMP incluíram doença de Ménière, neurite vestibular, síndrome da deiscência do canal semicircular superior, doença de Parkinson, lesões centrais isquêmicas e mielopatias motoras. Conclusão Independentemente da técnica de registro, o VEMP mostrou-se útil como ferramenta complementar para o diagnóstico de doenças vestibulares periféricas e centrais.

ABSTRACT Purpose To review the scientific literature on the main techniques used to generate vestibular-evoked myogenic potential (VEMP) and its clinical applications. Research strategy A search for articles describing VEMP recording methods and applications was conducted in the PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The search was limited to articles published in English, Portuguese, and Spanish between January 2012 and May 2018. Selection criteria Articles addressing the technical aspects for performing ocular, cervical or soleus VEMP with auditory or galvanic stimulation and articles on the clinical applications of VEMP were included in this review, whereas articles repeated in the databases, literature reviews, case reports, letters, and editorials were excluded. Results The search strategy resulted in the selection of 28 articles. The studies evidenced three methods of VEMP recording: responses from the cervical, ocular and soleus muscle. Clinical applications of VEMP included Meniere's disease, vestibular neuritis, superior semicircular canal dehiscence syndrome, Parkinson's disease, central ischemic lesions, and motor myelopathies. Conclusion Regardless of the recording technique, VEMP has proved to be useful as a complementary tool for the diagnosis of peripheral and central vestibular diseases.

Increased N200 and P300 latencies in cognitively impaired elderly carrying ApoE ε-4 allele.

OBJECTIVE: To compare the results of neuropsychological tests, evoked potentials N200 and P300 and polymorphisms of ApoE and BDNF rs6265 between patients with normal cognition and those with mild cognitive impairment (MCI) and Alzheimer's dementia (AD). METHODS: This is a cross-sectional study of elderly individuals with normal cognition and those with MCI and AD, who were submitted to evoked potential tests (N200 and P300) by means of hearing stimuli based on the auditory oddball paradigm. Genotyping was obtained by using the real-time PCR technique. RESULTS: Sixty-five patients were evaluated as follows: 14 controls, 34 with MCI and 17 with AD. N200 latency and P300 latency and amplitude were not associated with MCI and AD diagnosis. Patients with cognitive impairment (MCI or AD) showed increase in the latencies of P300 and N200. BNDF gene was not associated with cognitive impairment. CONCLUSION: Latencies of N200 and P300 increased in cognitively impaired patients with the presence of ApoE ε-4 allele.

Screening of hearing in elderly people: assessment of accuracy and reproducibility of the whispered voice test. / Triagem auditiva em idosos: avaliação da acurácia e reprodutibilidade do teste do sussurro.

Given the high prevalence of presbycusis and its detrimental effect on quality of life, screening tests can be useful tools for detecting hearing loss in primary care settings. This study therefore aimed to determine the accuracy and reproducibility of the whispered voice test as a screening method for detecting hearing impairment in older people. This cross-sectional study was carried out with 210 older adults aged between 60 and 97 years who underwent the whispered voice test employing ten different phrases and using audiometry as a reference test. Sensitivity, specificity and positive and negative predictive values were calculated and accuracy was measured by calculating the area under the ROC curve. The test was repeated on 20% of the ears by a second examiner to assess inter-examiner reproducibility (IER). The words and phrases that showed the highest area under the curve (AUC) and IER values were: "shoe" (AUC = 0.918; IER = 0.877), "window" (AUC = 0.917; IER = 0.869), "it looks like it's going to rain" (AUC = 0.911; IER = 0.810), and "the bus is late" (AUC = 0.900; IER = 0.810), demonstrating that the whispered voice test is a useful screening tool for detecting hearing loss among older people. It is proposed that these words and phrases should be incorporated into the whispered voice test protocol.

Devido à alta prevalência da presbiacusia e as suas consequências, métodos de triagem auditiva são necessários no âmbito da atenção primária. Diante disso, o objetivo do estudo foi verificar a reprodutibilidade e acurácia do teste do sussurro como metodologia de triagem auditiva em idosos. Trata-se de estudo transversal com medidas de acurácia que incluiu 210 idosos, entre 60 e 97 anos, submetidos ao teste do sussurro com dez expressões diferentes e ao exame de referência audiometria tonal limiar. Calculou-se a sensibilidade, a especificidade, o valor preditivo positivo, o valor preditivo negativo e a acurácia do teste, avaliada por meio da área sob a curva Receiver Operating Characteristic (ROC). O teste foi repetido em 20% das orelhas por um segundo examinador com a finalidade de avaliar a reprodutibilidade interexaminador (RIE). As expressões que apresentaram melhor área sob a curva ROC (AUC) e RIE foram: "sapato" (AUC = 0,918; RIE = 0,877), "janela" (AUC = 0,917; RIE = 0,869), "parece que vai chover" (AUC = 0,911; RIE = 0,810) e o "ônibus está atrasado" (AUC = 0,900; RIE = 0,810). Estas são, pois, as expressões propostas para fazerem parte do protocolo do teste do sussurro que mostrou-se como uma ferramenta útil para triagem auditiva em idosos.

Triagem auditiva em idosos: avaliação da acurácia e reprodutibilidade do teste do sussurro / Screening of hearing in elderly people: assessment of accuracy and reproducibility of the whispered voice test

Resumo Devido à alta prevalência da presbiacusia e as suas consequências, métodos de triagem auditiva são necessários no âmbito da atenção primária. Diante disso, o objetivo do estudo foi verificar a reprodutibilidade e acurácia do teste do sussurro como metodologia de triagem auditiva em idosos. Trata-se de estudo transversal com medidas de acurácia que incluiu 210 idosos, entre 60 e 97 anos, submetidos ao teste do sussurro com dez expressões diferentes e ao exame de referência audiometria tonal limiar. Calculou-se a sensibilidade, a especificidade, o valor preditivo positivo, o valor preditivo negativo e a acurácia do teste, avaliada por meio da área sob a curva Receiver Operating Characteristic (ROC). O teste foi repetido em 20% das orelhas por um segundo examinador com a finalidade de avaliar a reprodutibilidade interexaminador (RIE). As expressões que apresentaram melhor área sob a curva ROC (AUC) e RIE foram: "sapato" (AUC = 0,918; RIE = 0,877), "janela" (AUC = 0,917; RIE = 0,869), "parece que vai chover" (AUC = 0,911; RIE = 0,810) e o "ônibus está atrasado" (AUC = 0,900; RIE = 0,810). Estas são, pois, as expressões propostas para fazerem parte do protocolo do teste do sussurro que mostrou-se como uma ferramenta útil para triagem auditiva em idosos.

Abstract Given the high prevalence of presbycusis and its detrimental effect on quality of life, screening tests can be useful tools for detecting hearing loss in primary care settings. This study therefore aimed to determine the accuracy and reproducibility of the whispered voice test as a screening method for detecting hearing impairment in older people. This cross-sectional study was carried out with 210 older adults aged between 60 and 97 years who underwent the whispered voice test employing ten different phrases and using audiometry as a reference test. Sensitivity, specificity and positive and negative predictive values were calculated and accuracy was measured by calculating the area under the ROC curve. The test was repeated on 20% of the ears by a second examiner to assess inter-examiner reproducibility (IER). The words and phrases that showed the highest area under the curve (AUC) and IER values were: "shoe" (AUC = 0.918; IER = 0.877), "window" (AUC = 0.917; IER = 0.869), "it looks like it's going to rain" (AUC = 0.911; IER = 0.810), and "the bus is late" (AUC = 0.900; IER = 0.810), demonstrating that the whispered voice test is a useful screening tool for detecting hearing loss among older people. It is proposed that these words and phrases should be incorporated into the whispered voice test protocol.

Annexin A1 Is Involved in the Resolution of Inflammatory Responses during Leishmania braziliensis Infection.

Leishmaniases are diseases caused by several Leishmania species. Leishmania (Viannia) braziliensis can cause localized cutaneous leishmaniasis (LCL), which heals spontaneously, or mucosal leishmaniasis (ML), characterized by chronic and intense inflammation and scanty parasitism. Annexin A1 (AnxA1) is a protein involved in modulation and resolution of inflammation through multiple mechanisms. In the present study, the role of AnxA1 was investigated in L. braziliensis-infected BALB/c mice. AnxA1 levels increased at the peak of tissue lesion and parasitism in infected mice. AnxA1 increased also after L. braziliensis infection of BALB/c (wild-type [WT]) bone marrow derived macrophages. Despite a lower parasite intake, parasite burden in bone marrow-derived macrophages from AnxA1-/- mice was similar to WT and associated with an early increase of TNF-α and, later, of IL-10. AnxA1-/- mice controlled tissue parasitism similarly to WT animals, but they developed significantly larger lesions at later stages of infection, with a more pronounced inflammatory infiltrate and increased specific production of IFN-γ, IL-4, and IL-10. AnxA1-/- mice also presented higher phosphorylation levels of ERK-1/2 and p65/RelA (NF-κB) and inducible NO synthase expression, suggesting that AnxA1 may be involved in modulation of inflammation in this model of experimental leishmaniasis. Finally, assessment of AnxA1 levels in sera from patients with LCL or ML revealed that ML patients had higher levels of serum AnxA1 than did LCL patients or control subjects. Collectively, these data indicate that AnxA1 is actively expressed during L. braziliensis infection. In the absence of AnxA1, mice are fully able to control parasite replication, but they present more intense inflammatory responses and delayed ability to resolve their lesion size.

Flow cytometric-based protocols for assessing anti-MT-2 IgG1 reactivity: High-dimensional data handling to define predictors for clinical follow-up of Human T-cell Leukemia virus type-1 infection.

The present work provides an innovative methodological approach to assess the anti-HTLV-1 IgG1 reactivity with practical application in clinical laboratory. Serum from non-infected healthy controls (NI) and HTLV-1-infected patients, categorized as asymptomatic (AS), putatively progressing to HTLV-1 associated myelopathy/tropical spastic paraparesis - HAM/TSP (pHAM) or with clinical diagnosis of HAM/TSP (HT) were assayed in two-parallel flow cytometry platforms, referred as: Fix and Fix&Perm protocols. Operating-characteristics analysis indicated that a single pair of attributes ("serum dilution/cut-off") for Fix and Fix&Perm protocols presented excellent performance for the diagnosis of HTLV-1 infection. Conversely, Fix and Fix&Perm protocols displayed weak/moderate overall performances when applied with prognosis purposes of HTLV-1 infection. A panoramic snapshot provided by the reactivity boards revealed clearly the higher sensitivity of Fix&Perm protocol for detecting seropositivity for HT, suggesting that stepwise combinatory criteria would improve the global performance of using a single pair of attributes. Three data mining strategies were tested, including endpoint titer analysis, heatmap assemblage and decision tree analysis. Bi-dimensional heatmap analysis demonstrated that, while the clustering profile of NI vs HTLV-1+ revealed segregation in opposite poles, AS vs HT presented discrete segregation but still displaying an intertwined distribution pattern. The combination of methods for segregating AS from HT displayed a moderate but superior global accuracy (85.7%; LOOCV=71.4%). The comprehensive data analysis support that the combination of methods have improved the performance to the differential diagnosis of AS and HT, with direct association with laboratorial records, including serum cytokine levels and proviral load.