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BACKGROUND: Fatigue is significant in the context of Parkinson's disease (PD), considering that one-third of patients classify it as the most restricting symptom in their daily life activities (DLAs). The objective was to verify the relationship (association) between fatigue and non-motor and motor symptoms of PD. METHODS: A cross-sectional study which included 100 individuals with PD. Initially, demographic and clinical data (modified Hoehn and Yahr scale-HY, anxiety, and depression) were collected. To assess the non-motor and motor symptoms of PD, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was applied. Fatigue was evaluated using the Parkinson Fatigue Scale. RESULTS: A higher HY score, greater severity of non-motor aspects of DLAs and motor aspects of DLAs, more motor complications, and higher levels of anxiety as well as depression were observed in the "fatigue" group. Fatigue was associated with a lower daily equivalent levodopa dose (LEDD), a higher body mass index (BMI), anxiety, depression, and the presence of non-motor symptoms. CONCLUSION: Non-motor symptoms are more determining factors for fatigue than the motor condition itself, with an association between fatigue and higher BMI scores, increased anxiety and depression, lower LEDD, and greater severity of non-motor aspects of DLAs. Individuals in the "fatigue" group had higher HY scores, anxiety, and depression, worse non-motor and motor symptoms related to experiences of daily life, as well as motor complications.
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Fadiga , Doença de Parkinson , Índice de Gravidade de Doença , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Estudos Transversais , Fadiga/etiologia , Fadiga/diagnóstico , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Depressão/etiologia , Ansiedade/etiologia , Atividades Cotidianas , Levodopa/uso terapêuticoRESUMO
BACKGROUND: Transfusion-transmitted malaria (TTM) is a public health problem in endemic and nonendemic areas. The Brazilian Ministry of Health (MH) requested the development of a nucleic acid amplification test (NAT) for the detection of Plasmodium spp. in public blood centers to increase blood safety. STUDY DESIGN AND METHODS: The new Brazilian NAT kit named NAT PLUS HIV/HBV/HCV/Malaria Bio-Manguinhos was first implemented in HEMORIO, a public blood center in the city of Rio de Janeiro. Since October 1, 2022, this blood center has been testing all its blood donations for malaria in a pool of six plasma samples to detect Plasmodium spp. by real-time polymerase chain reaction (PCR). RESULTS: Since the implementation of the NAT PLUS platform until February 2023, HEMORIO has successfully received and tested 200,277 donations. The platform detected two asymptomatic donors in the city of Rio de Janeiro, which is a nonendemic region for malaria. Our analyses suggested a malaria from the Amazon region caused by Plasmodium vivax, in the first case, while an autochthonous transmission case by Plasmodium malariae was identified in the rural area of Rio de Janeiro state. DISCUSSION: The NAT PLUS platform detects Plasmodium spp. in plasma samples with sensitivity capable of detecting subpatent infections. This is the first time worldwide that a group developed and implemented molecular diagnosis for Plasmodium spp. to be used by public blood centers to avoid TTM.
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Infecções por HIV , Hepatite C , Malária , Humanos , Vírus da Hepatite B , Doadores de Sangue , Brasil/epidemiologia , Malária/diagnóstico , Malária/epidemiologia , Plasmodium malariae , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologiaRESUMO
Introdução: O sintoma fadiga é uma das queixas mais comuns entre os indivíduos acometidos pelo acidente vascular encefálico (AVE). Objetivo: Apresentar as evidências a caracterização do sintoma fadiga após AVE. Metodologia: Foi realizada uma revisão sistemática de estudos observacionais com busca nas bases de dados Cinahl, Cochrane, Embase, Eric, Bireme (Lilacs, Medline, Ibecs, Scielo), Library and Information Science Abstracts LISA (ProQuest), PEDro, PsychInfo, Pubmed, Web of Science. Foram utilizados os descritores de assunto 'acidente vascular encefálico', 'fadiga' e 'percepção'. Os procedimentos referentes à seleção dos estudos e extração dos dados foram desenvolvidos, de modo independente, por dois revisores. Os estudos selecionados foram analisados em texto completo contemplando delineamentos, caracterização da amostra, metodologia, resultados e conclusão. Resultados: Foram encontrados 12 estudos e selecionados quatro. A amostra total era composta por 76 indivíduos com diagnóstico de AVE. Não há um instrumento específico para avaliar fadiga associada ao AVE. Não há uma definição clara de fadiga pós-AVE nem consenso entre os indivíduos sobre sua descrição e diferença pré e pós AVE. Em relação às características, a fadiga é experimentada em aspectos físicos e mentais e descrito como cansaço muscular ou mental e causadora de grande impacto na qualidade de vida. Quanto aos fatores de alívio, o sono, repouso e exercícios aeróbicos foram os mais elencados. Conclusão: O sintoma fadiga é comum após o AVE com natureza multidimensional, sem uma definição clara com impacto biopsicossocial.
Introduction: The fatigue symptom is one of the most common post stroke. Objective: To present evidence about the characterization of the fatigue symptom resulting from stroke. Methodology: A systematic review of observational studies was carried out by searching the Cinahl, Cochrane, Embase, Eric, Bireme (Lilacs, Medline, Ibecs, Scielo), Library and Information Science Abstracts LISA (ProQuest), PEDro, PsychInfo, Pubmed, Web of Science. The subject descriptors 'stroke', 'fatigue' and 'perception' were used. The procedures for the selection of studies and data extraction were independently developed by two reviewers. The selected studies were analyzed in full text, contemplating designs, sample characterization, methodology, results and conclusion. Results: Twelve studies were found and four were selected. The total sample consisted of 76 individuals diagnosed with stroke. There is no specific instrument to assess stroke-associated fatigue. There is no clear definition of post-stroke fatigue or consensus among individuals about its description and difference before and after stroke. Regarding the characteristics, fatigue is experienced in physical and mental aspects and described as muscular or mental tiredness, causing a great impact on quality of life. As for relief factors, sleep, rest, and aerobic exercises were the most listed. Conclusion: The fatigue symptom is common after stroke with a multidimensional nature, without a clear definition with biopsychosocial impact.
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Com a pandemia COVID-19, a ação docente necessitou ser repentinamente alterada para o formato de Ensino Remoto Emergencial (ERE) e após o retorno ao ensino houve alterações. Com o objetivo de apresentar a percepção docente sobre as contribuições do ERE para sua ação docente no modelo presencial. Trata-se de uma pesquisa qualitativa com entrevista a docentes que ministraram disciplinas no curso de Fisioterapia da Universidade Estadual do Centro-Oeste durante o ERE. Foram entrevistados 10 docentes. A aprendizagem foi caracterizada em seu processo de construção de conhecimento, os modelos envolvendo metodologias ativas foram mais utilizados, o contato humano ganhou relevância nos comentários. Todos os docentes transformaram sua ação didática. O modelo de ensino ERE promoveu alterações na forma de lecionar e os modelos de ensino baseados em metodologias ativas foram mais incorporados no modelo presencial.
With the COVID-19 pandemic, teaching needed to be suddenly changed to the emergency remote teaching format and after the return to face-to-face teaching there were changes. To present the professor's perception of the contributions of emergency remote teaching to their professional role in the face-to-face model. This is a qualitative research with interviews with professors who taught in the Physiotherapy course at the Midwest State University during the emergency remote teaching. Ten professors were interviewed. Learning was characterized in its knowledge construction process, models involving active methodologies were the most used, human contact gained relevance in the comments. All professors transformed their didactic action. The emergency remote teaching model promoted changes in the way of teaching and teaching models based on active methodologies were more incorporated into the face-to-face model.
Con la pandemia del COVID-19, la acción docente tuvo que cambiar de golpe a la forma de enseñanza a distancia de emergencia (ERE) y tras la vuelta a la docencia hubo cambios. Para presentar la percepción del docente sobre los aportes de la ERE a su acción docente en el modelo presencial. Se trata de una investigación cualitativa con entrevistas a profesores que impartieron asignaturas en el curso de Fisioterapia de la Universidad Estatal del Medio Oeste durante la ERE. 10 profesores fueron entrevistados. El aprendizaje se caracterizó en su proceso de construcción del conocimiento, se utilizaron más modelos que involucran metodologías activas, el contacto humano ganó relevancia en los comentarios. Todos los docentes transformaron su acción didáctica. El modelo de enseñanza ERE generó cambios en la forma de enseñar y los modelos de enseñanza basados en metodologías activas se incorporaron más al modelo presencial.
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Ensino , Especialidade de Fisioterapia , AprendizagemRESUMO
Diagnosis of SARS-CoV-2 infections is mostly based on the nasopharyngeal swabs (NPS). However, this collection is invasive and uncomfortable, especially for children and patients with coagulopathies, whose NPS collection often causes bleeding. Thus, the aim of this study was to evaluate the usefulness and accuracy of saliva for the diagnosis of COVID-19 in patients presenting bleeding disorders. Samples of NPS, oropharyngeal swabs (OPS), and saliva were collected simultaneously from 1159 hospitalized patients with hematological diseases and from 524 healthcare workers, both symptomatic and asymptomatic for SARS-CoV-2. All samples were evaluated for SARS-CoV-2 by qRT-PCR. SARS-CoV-2 was detected in NPS, OPS and saliva from 16.9%, 14.4% and 15.6% individuals, respectively. Tests in saliva showed sensitivity, specificity, and overall agreement of 73.3%, 96.9% and 92.7% (=0.74), respectively. Salivary tests had good accuracy (AUC = 0.7) for discriminating negative and positive qRT-PCR for SARS-CoV-2. Higher sensitivity was observed in symptomatic than in non-symptomatic patients, as well as in healthy subjects than in patients with hematological disease, in both OPS and saliva. The mean viral load in NPS was significantly higher than in OPS and in saliva samples (p < 0.001). Saliva is a good diagnostic tool to detect SARS-CoV-2, especially among patients symptomatic for COVID-19, and is a valuable specimen for mass screening of hospitalized patients with hematological diseases, especially for those that with bleeding disorders.
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Transtornos da Coagulação Sanguínea/complicações , COVID-19/complicações , COVID-19/diagnóstico , Transtornos Hemorrágicos/complicações , SARS-CoV-2/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/virologia , Teste para COVID-19 , Criança , Pré-Escolar , Estudos de Coortes , Testes Diagnósticos de Rotina , Feminino , Pessoal de Saúde , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Saliva , Carga Viral , Adulto JovemRESUMO
PURPOSE: To evaluate Sexual Function Scores in women of childbearing age with epilepsy. METHOD: Cross-sectional study and comparison of two groups, one with and the other without epilepsy. The instruments used were: semi-structured socioeconomic, demographic and clinical questionnaire; Beck Anxiety and Depression Inventories; Word Health Organization Quality of Life (WHOQOL-brief); Female Sexual Function Index (FSFI); and Female Genital Self Image Scale (FGSIS). Statistical analysis was performed using Fisher's Exact Test, Chi-Square, Mann-Whitney, and Spearman's Correlation, considering pâ¯<â¯0.05 as a measure of significance. RESULTS: 110 women were included (55 with epilepsy and 55 without epilepsy) with a mean age of 32â¯years. Both groups had sexual dysfunction (with epilepsy: 19.28 vs. without epilepsy: 21.05; pâ¯=â¯0.416). There was no significant difference between groups in the analysis of self-image of the genitalia, Quality of Life, or Anxiety. However, there was a statistical difference in Depression Symptoms (with epilepsy: 11.44 vs. without epilepsy:13.82, pâ¯=â¯0.038). When evaluating the influence of epilepsy on sexual function score, women who used enzyme-inducing drugs had worse scores in desire domain (5.21 vs. 6.65; pâ¯=â¯0.020) and lubrication domain (9.48 vs. 12.95; pâ¯=â¯0.047) when compared to women who used non-enzyme-inducing drugs, respectively. In the correlation of Sexual Function with Anxiety, Depression, Quality of Life, and Self-Image of the genitalia, it was observed that when Depression levels increase, desire is impaired [-0.273(pâ¯=â¯0.043)]. In Quality of Life, the psychological [0.311(pâ¯=â¯0.021)] and environmental [0.268(pâ¯=â¯0.048)] domains positively influenced desire. The social relationships domain improved desire [0.504(pâ¯=â¯0.000)], excitement [0.461(pâ¯=â¯0.000)], lubrication [0.342(pâ¯=â¯0.011)], orgasm [0.425(pâ¯=â¯0.001)], satisfaction [0.449(pâ¯=â¯0.001)], and decreased pain [0.402(pâ¯=â¯0.002)]. Consequently, these influence appeared to improve sexual function [0.521(pâ¯=â¯0.000)]. CONCLUSION: Women of childbearing age with epilepsy have sexual dysfunction. The presence of signs of depression and the use of enzyme-inducing drugs must be carefully analyzed, as they can worsen the sexual function score. Health professionals need to be aware that sexual dysfunction must be investigated because this issue influences the quality of life of these women.
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Epilepsia , Disfunções Sexuais Fisiológicas , Adulto , Ansiedade/etiologia , Estudos Transversais , Epilepsia/complicações , Feminino , Humanos , Qualidade de Vida , Disfunções Sexuais Fisiológicas/etiologiaRESUMO
BACKGROUND: Multiple sclerosis (MS) is a major cause of chronic neurological disability in young adults. An increasing number of controlled studies have assessed the potential rehabilitative effects of new drug-free treatments, complementary to the standard care, including music-based therapy (MBT). OBJECTIVE: To analyze the evidence for the effectiveness of MBT within the therapeutic approaches to individuals diagnosed with MS. METHODS: A systematic review of clinical trials was performed with searches in the following databases: BIOSIS, CINAHL, Cochrane, EBSCO, ERIC, Google Scholar, IBECS, LILACS, LISA (ProQuest), Medline, PEDro, PsycINFO (APA), Psychological & Behavioral, PubMed, SciELO, Scopus, SPORTDiscus and Web of Science. Clinical trials comparing MBT versus conventional therapy/no intervention were included. RESULTS: From the 282 studies identified, 10 trials were selected. Among these, the total sample consisted of 429 individuals: 253 were allocated to the experimental group (MBT) and 176 to the control group (conventional therapies or no intervention). All the studies presented high methodological quality. Modalities of MBT were clustered into four groups: (1) Rhythmic auditory; (2) Playing musical instruments; (3) Dance strategy; and (4) Neurological music therapy. Overall, the studies consistently showed that MBT was better than conventional therapy or no intervention, with regard to gait parameters (double support time and walking speed), fatigue level, fatigability, coordination, dexterity, balance, walking endurance, lower extremity functional strength, emotional status and pain. Regarding mental fatigability and memory, the data were conflicting and the evidence was unclear. CONCLUSION: MBT is a safe and effective approach for clinical rehabilitation of MS patients that leads to positive results regarding both motor and non-motor functions.
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Esclerose Múltipla , Musicoterapia , Música , Ensaios Clínicos como Assunto , Emoções , Marcha , Humanos , Esclerose Múltipla/terapiaRESUMO
Abstract Background: Multiple sclerosis (MS) is a major cause of chronic neurological disability in young adults. An increasing number of controlled studies have assessed the potential rehabilitative effects of new drug-free treatments, complementary to the standard care, including music-based therapy (MBT). Objective: To analyze the evidence for the effectiveness of MBT within the therapeutic approaches to individuals diagnosed with MS. Methods: A systematic review of clinical trials was performed with searches in the following databases: BIOSIS, CINAHL, Cochrane, EBSCO, ERIC, Google Scholar, IBECS, LILACS, LISA (ProQuest), Medline, PEDro, PsycINFO (APA), Psychological & Behavioral, PubMed, SciELO, Scopus, SPORTDiscus and Web of Science. Clinical trials comparing MBT versus conventional therapy/no intervention were included. Results: From the 282 studies identified, 10 trials were selected. Among these, the total sample consisted of 429 individuals: 253 were allocated to the experimental group (MBT) and 176 to the control group (conventional therapies or no intervention). All the studies presented high methodological quality. Modalities of MBT were clustered into four groups: (1) Rhythmic auditory; (2) Playing musical instruments; (3) Dance strategy; and (4) Neurological music therapy. Overall, the studies consistently showed that MBT was better than conventional therapy or no intervention, with regard to gait parameters (double support time and walking speed), fatigue level, fatigability, coordination, dexterity, balance, walking endurance, lower extremity functional strength, emotional status and pain. Regarding mental fatigability and memory, the data were conflicting and the evidence was unclear. Conclusion: MBT is a safe and effective approach for clinical rehabilitation of MS patients that leads to positive results regarding both motor and non-motor functions.
RESUMO Introdução: A esclerose múltipla (EM) é a maior causa de incapacidade neurológica crônica em adultos jovens. Um crescente número de estudos controlados avalia a reabilitação por meio de tratamentos não medicamentosos, cuidados complementares incluindo a terapia baseada na música (TBM). Objetivo: Analisar a evidência de efetividade da TBM na abordagem terapêutica de indivíduos diagnosticados com EM. Métodos: Foi realizada uma revisão sistemática de ensaios clínicos com busca nas bases de dados Biosis, Cinahl, Cochrane, Ebsco, Eric, Google Scholar, Ibecs, Lilacs, Lisa (ProQuest), Medline, PEDro, PsycINFO (APA), Psychological & Behavioral, PubMed, SciELO, Scopus, Sportdiscus e Web of Science. Foram incluídos ensaios clínicos comparando TBM versus terapia convencional/sem intervenção. Resultados: Dentre os 282 estudos identificados, 10 ensaios foram selecionados. Desses, a amostra total consistia em 429 indivíduos (253 alocados no grupo experimental (TBM) e 176 no grupo controle (terapias convencionais ou sem intervenção). Todos os estudos apresentaram elevada qualidade metodológica. Modalidades da TBM foram reunidas em quatro grupos: (1) Audição rítmica; (2) Tocar instrumentos musicais; (3) Dança como estratégia; e (4) Terapia neurofuncional baseada na música. A maioria dos estudos identificou que a TBM é melhor que a terapia convencional ou nenhuma intervenção nos parâmetros da marcha (duplo apoio e velocidade), níveis de fadiga, fatigabilidade, coordenação, destreza, equilíbrio, força de membros inferiores, estado emocional e dor. Os dados sobre fatigabilidade mental e memória foram conflitantes e as evidências são incertas. Conclusão: A TBM é uma abordagem segura na reabilitação clínica de indivíduos com EM e propicia resultados positivos nas funções motoras e não motoras.
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Humanos , Esclerose Múltipla/terapia , Música , Musicoterapia , Ensaios Clínicos como Assunto , Emoções , MarchaRESUMO
Background: Convalescent plasma is a potential therapeutic option for critically ill patients with coronavirus disease 19 (COVID-19), yet its efficacy remains to be determined. The aim was to investigate the effects of convalescent plasma (CP) in critically ill patients with COVID-19. Methods: This was a single-center prospective observational study conducted in Rio de Janeiro, Brazil, from March 17th to May 30th, with final follow-up on June 30th. We included 113 laboratory-confirmed COVID-19 patients with respiratory failure. Primary outcomes were time to clinical improvement and survival within 28 days. Secondary outcomes included behavior of biomarkers and viral loads. Kaplan-Meier analyses and Cox proportional-hazards regression using propensity score with inverse-probability weighing were performed. Results: 41 patients received CP and 72 received standard of care (SOC). Median age was 61 years (IQR 48-68), disease duration was 10 days (IQR 6-13), and 86% were mechanically ventilated. At least 29 out of 41CP-recipients had baseline IgG titers ≥ 1:1,080. Clinical improvement within 28 days occurred in 19 (46%) CP-treated patients, as compared to 23 (32%) in the SOC group [adjusted hazard ratio (aHR) 0.91 (0.49-1.69)]. There was no significant change in 28-day mortality (CP 49% vs. SOC 56%; aHR 0.90 [0.52-1.57]). Biomarker assessment revealed reduced inflammatory activity and increased lymphocyte count after CP. Conclusions: In this study, CP was not associated with clinical improvement or increase in 28-day survival. However, our study may have been underpowered and included patients with high IgG titers and life-threatening disease. Clinical Trial Registration: The study protocol was retrospectively registered at the Brazilian Registry of Clinical Trials (ReBEC) with the identification RBR-4vm3yy (http://www.ensaiosclinicos.gov.br).
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INTRODUCTION: Canine visceral leishmaniasis (CVL) is an endemic disease in Brazil, and integrated control actions have been adopted by the Brazilian Ministry of Health to control its spread. However, the transmission profile is unknown in areas with recent CVL cases, including Itaúna, located in the Brazilian state of Minas Gerais, where the present study was carried out. METHODS: A total of 2,302 dogs from 12 neighborhoods were serologically tested for canine VL using the current diagnostic protocol adopted by the Brazilian Ministry of Health. Test positivity rate (TPR) and CVL prevalence were determined for each neighborhood. The presence of Leishmania was assessed in 60 seropositive dogs which had been recommended for euthanasia. Twenty-two of them (37%) were asymptomatic, and 38 (63%) were symptomatic for CVL. Parasitological (myeloculture and smear/imprint) and molecular (PCR) methods were employed for Leishmania detection in bone marrow, spleen, mesenteric lymph nodes, and ear skin. The infecting Leishmania species was identified by DNA sequencing. RESULTS: CVL prevalence (per 1,000 dogs) varied from 0.0-166.67, depending on the neighborhood, with a mean of 68.96 (SD 51.38). Leishmania DNA was detected in at least one tissue from all seropositive dogs, with comparable TPR among tissues. Leishmania parasites were identified in most (54/60) seropositive dogs, and the infecting parasite was identified as Leishmania infantum in all of these. CONCLUSIONS: Prevalence of CVL is a contributor to the spread of visceral leishmaniasis in Itaúna.