Sex differences exist in the likelihood of cognitive decline. The age at hypertension diagnosis is a unique contributor to brain structural changes associated with cerebral small vessel disease. ...However, whether this relationship differs between sexes remains unclear. Therefore, our objective was to evaluate sex differences in the association between the age at hypertension diagnosis and cerebral small vessel disease-related brain structural changes.
We used data from the UK Biobank to select participants with a known age at hypertension diagnosis and brain magnetic resonance imaging (n=9430) and stratified them by sex and age at hypertension diagnosis. Control participants with magnetic resonance imaging scans but no hypertension were chosen at random matched by using propensity score matching. For morphological brain structural changes, generalized linear models were used while adjusting for other vascular risk factors. For the assessment of white matter microstructure, principal component analysis led to a reduction in the number of fractional anisotropy variables, followed by regression analysis with major principal components as outcomes.
Males but not females with a younger age at hypertension diagnosis exhibited lower brain gray and white matter volume compared with normotensive controls. The volume of white matter hyperintensities was greater in both males and females with hypertension than normotensive controls, significantly higher in older females with hypertension. Compared with normotensive controls, white matter microstructural integrity was lower in individuals with hypertension, which became more prominent with increasing age.
Our study demonstrates that the effect of hypertension on cerebral small vessel disease-related brain structure differs by sex and by age at hypertension diagnosis.
Abstract
Congenital Zika syndrome (CZS) is a cluster of malformation, and the mechanisms that lead it are still unclear. Using hypothesis-driven candidate genes and their function in viral ...infections, single-nucleotide polymorphisms (SNPs) were genotyped by quantitative polymerase chain reaction in a sample population from Sergipe State, Brazil. This study shows that rs3775291 SNP at Toll-like receptor 3, which triggers type I interferon antiviral responses in mothers infected by Zika virus during pregnancy, is associated with CZS occurrence (odds ratio OR, 2.19; 95% confidence interval CI, 1.158–4.148). Moreover, rs1799964 SNP at tumor necrosis factor-α gene in CZS babies is associated with severe microcephaly (OR, 2.63; 95% CI, 1.13–6.21).
Purpose
This study aimed to identify opioid consumption trajectories among persons living with chronic pain (CP) and put them in relation to patient‐reported outcomes 6 months after initiating ...multidisciplinary pain treatment.
Methods
This study used data from the Quebec Pain Registry (2008–2014) linked to longitudinal Quebec health insurance databases. We included adults diagnosed with CP and covered by the Quebec public prescription drug insurance plan. The daily cumulative opioid doses in the first 6 months after initiating multidisciplinary pain treatment were transformed into morphine milligram equivalents. An individual‐centered approach involving principal factor and cluster analyses applied to longitudinal statistical indicators of opioid use was conducted to classify trajectories. Multivariate regression models were applied to evaluate the associations between trajectory group membership and outcomes at 6‐month follow‐up (pain intensity, pain interference, depression, and physical and mental health‐related quality of life).
Results
We identified three trajectories of opioid consumption: “no or very low and stable” opioid consumption (n = 2067, 96.3%), “increasing” opioid consumption (n = 40, 1.9%), and “decreasing” opioid consumption (n = 39, 1.8%). Patients in the “no or very low and stable” trajectory were less likely to be current smokers, experience polypharmacy, use opioids or benzodiazepine preceding their first visit, or experience pain interference at treatment initiation. Patients in the “increasing” opioid consumption group had significantly greater depression scores at 6‐month compared to patients in the “no or very low and stable” trajectory group.
Conclusion
Opioid consumption trajectories do not seem to be important determinants of most PROs 6 months after initiating multidisciplinary pain treatment.
The most widely used classification criteria for SLE are those derived and validated in adult patients by the ACR. Alternatives include the Boston weighted (BW) and SLICC criteria. The aim of this ...study was to compare the performance of BW and SLICC criteria with the 1997 ACR criteria in a JSLE cohort.
Cases were JSLE patients and controls were patients with other rheumatic diseases attending a tertiary centre in the past 10 years. Data were retrospectively collected to establish the ACR, BW and SLICC criteria fulfilled at the first visit and within the first year of follow-up. A consensus diagnosis of JSLE established by the same group of highly experienced paediatric rheumatologists was chosen as the standard of reference.
One hundred and seventy-three patients were included: 81 JSLE and 92 controls. There was a sharp increase in sensitivity and prevalence of all criteria within the first year of follow-up. The BW criteria had higher sensitivity than the ACR criteria (81.5% vs 58%, P < 0.001) at the first visit, but lower specificity in both periods. SLICC criteria had higher sensitivity (82.7% vs 58%, P < 0.001) at the first visit, but similar specificity in both periods.
In this JSLE population, the SLICC criteria performed best in terms of sensitivity and accuracy at the first visit and within the first year of follow-up.
Climate variability, land use and land cover changes (LULCC) have a considerable impact on runoff–erosion processes. This study analyzed the relationships between climate variability and ...spatiotemporal LULCC on runoff–erosion processes in different scenarios of land use and land cover (LULC) for the Almas River basin, located in the Cerrado biome in Brazil. Landsat images from 1991, 2006, and 2017 were used to analyze changes and the LULC scenarios. Two simulations based on the Soil and Water Assessment Tool (SWAT) were compared: (1) default application using the standard model database (SWATd), and (2) application using remote sensing multiple gridded datasets (albedo and leaf area index) downloaded using the Google Earth Engine (SWATrs). In addition, the SWAT model was applied to analyze the impacts of streamflow and erosion in two hypothetical scenarios of LULC. The first scenario was the optimistic scenario (OS), which represents the sustainable use and preservation of natural vegetation, emphasizing the recovery of permanent preservation areas close to watercourses, hilltops, and mountains, based on the Brazilian forest code. The second scenario was the pessimistic scenario (PS), which presents increased deforestation and expansion of farming activities. The results of the LULC changes show that between 1991 and 2017, the area occupied by agriculture and livestock increased by 75.38%. These results confirmed an increase in the sugarcane plantation and the number of cattle in the basin. The SWAT results showed that the difference between the simulated streamflow for the PS was 26.42%, compared with the OS. The sediment yield average estimation in the PS was 0.035 ton/ha/year, whereas in the OS, it was 0.025 ton/ha/year (i.e., a decrease of 21.88%). The results demonstrated that the basin has a greater predisposition for increased streamflow and sediment yield due to the LULC changes. In addition, measures to contain the increase in agriculture should be analyzed by regional managers to reduce soil erosion in this biome.
There is an urgent need to understand the complex relationship between cross-reactive anti-viral immunity, disease susceptibility, and severity in the face of differential exposure to related, ...circulating Flaviviruses. Co-exposure to Dengue virus and Zika virus in Brazil is a case in point. A devastating aspect of the 2015-2016 South American Zika outbreak was the dramatic increase in numbers of infants born with microcephaly to mothers exposed to Zika virus during pregnancy. It has been proposed that this is more likely to ensue from Zika infection in women lacking cross-protective Dengue immunity. In this case series we measure the prevalence of Dengue immunity in a cohort of mothers exposed to Zika virus during pregnancy in the 2015-2016 Zika outbreak that gave birth to an infant affected by microcephaly and explore their adaptive immunity to Zika virus.
Fifty women from Sergipe, Brazil who gave birth to infants with microcephaly following Zika virus exposure during the 2015-16 outbreak were tested for serological evidence of Dengue exposure and IFNγ ELISpot spot forming cell (SFC) response to Zika virus. The majority (46/50) demonstrated Dengue immunity. IFNγ ELISpot responses to Zika virus antigens showed the following hierarchy: Env>NS1>NS3>C protein. Twenty T cell epitopes from Zika virus Env were identified. Responses to Zika virus antigens Env and NS1 were polyfunctional with cells making IFNγ, TNFα, IL-4, IL-13, and IL-10. In contrast, responses to NS5 only produced the immune regulatory TGFβ1 cytokine. There were SFC responses against Zika virus Env (1-20) and variant peptide sequences from West Nile virus, Dengue virus 1-4 and Yellow Fever virus.
Almost all the women in our study showed serological evidence of Dengue immunity, suggesting that microcephaly can occur in DENV immune mothers. T cell immunity to Zika virus showed a multifunctional response to the antigens Env and NS1 and immune regulatory responses to NS5 and C protein. Our data support an argument that different viral products may skew the antiviral response to a more pro or anti-inflammatory outcome, with an associated impact on immunopathogenesis.
Abstract Background and purpose In the evolving landscape of healthcare, telerehabilitation is emerging as a pivotal modality, especially in delivering services to vulnerable populations. With the ...increasing reliance on digital health solutions, there is a pressing need for physiotherapists to be adequately trained in telerehabilitation. This training is essential for them to adapt to new technologies and methodologies, ensuring effective and efficient patient care. The aim of this study was to evaluate the effect of a telerehabilitation educational intervention on physiotherapists' knowledge and perceptions in Bucaramanga and its metropolitan area. Methods A group of 27 physiotherapists underwent an educational intervention focused on telerehabilitation. Before‐ and after‐intervention assessments were conducted to gauge their perceptions and knowledge. Results Participants generally held a positive perception of telerehabilitation both before and after the intervention Before Median (Md) and interquartile range (IQR): Md = 2.5 (IQR = 2.1–3); after: Md = 2.7 (IQR = 2.4–3.1), p = 0.256. A significant increase in their knowledge after‐intervention was observed Before: Md = 55.5 (IQR = 33.3–66.6); after: Md = 77.7 (IQR = 66.6–88.8), p = <0.001, emphasizing the potential benefits of targeted educational interventions. Conclusions The educational intervention significantly improved physiotherapists' knowledge of telerehabilitation, underscoring the importance of professional training in this domain. While perceptions remained consistently positive, the notable increase in knowledge suggests that such educational programs are crucial for enhancing the adoption and effective use of telerehabilitation in physiotherapy practice.
This systematic review aimed to verify the available scientific evidence on the clinical performance and diagnostic accuracy of nutritional screening tools in hospitalized pediatric patients.
A ...search was performed in the Medline (National Library of Medicine United States), LILACS (Latin American and Caribbean Health Sciences), PubMed (US National Library of Medicine National Institutes of Health), in the SCIELO (Scientific Electronic Library Online), through CAPES portal (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), bases Scopus e Web of Science. The descriptors used in accordance with the Descriptors in Health Sciences (DeCS)/Medical Subject Headings (MeSH) list were “malnutrition”, “screening”, and “pediatrics”, as well as the equivalent words in Portuguese.
The authors identified 270 articles published between 2004 and 2014. After applying the selection criteria, 35 were analyzed in full and eight articles were included in the systematic review. We evaluated the methodological quality of the studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Five nutritional screening tools in pediatrics were identified. Among these, the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) showed high sensitivity, almost perfect inter-rater agreement and between the screening and the reference standard; the Screening Tool Risk on Nutritional Status and Growth (STRONGkids) showed high sensitivity, lower percentage of specificity, substantial intra-rater agreement, and ease of use in clinical practice.
The studies included in this systematic review showed good performance of the nutritional screening tools in pediatrics, especially STRONGkids and STAMP. The authors emphasize the need to perform for more studies in this area. Only one tool was translated and adapted to the Brazilian pediatric population, and it is essential to carry out studies of tool adaptation and validation for this population.
Esta revisão sistemática tem por objetivo verificar as evidências científicas disponíveis sobre o desempenho clínico e acurácia diagnóstica dos instrumentos de triagem nutricional em pacientes pediátricos hospitalizados.
Realizou-se busca nas bases de dados Medline (National Library of Medicine United States), LILACS (Latin American and Caribbean Health Sciences), PubMed (US National Library of Medicine National Institutes of Health), na biblioteca eletrônica SCIELO (Scientific Electronic Library Online), através do portal de periódicos da CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), bases Scopus e Web of Science. Os descritores utilizados conforme lista do DeCS (Descritores em Ciências da Saúde)/MeSH (Medical Subject Headings) foram “desnutrição”, “triagem” e “pediatria”, bem como, “malnutrition”, “screening” e “pediatrics”, respectivamente.
Identificou-se 270 artigos, publicados entre 2004 e 2014. Após aplicação dos critérios de seleção, 35 foram analisados na íntegra, sendo incluídos 8 artigos na revisão sistemática. Avaliou-se a qualidade metodológica dos estudos utilizando-se o QUADAS (Quality Assessment of Diagnostic Accuracy Studies). Verificou-se 05 instrumentos de triagem nutricional em pediatria. Dentre estes, o STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics) apresentou sensibilidade elevada, concordância quase perfeita inter-avaliador e entre a triagem e padrão de referência; o STRONGkids (Screening Tool Risk on Nutritional Status and Growth) evidenciou sensibilidade elevada, menor percentual de especificidade, concordância intra-avaliador substancial e facilidade de uso na prática clínica.
Os estudos incluídos nesta revisão sistemática demonstraram um bom desempenho dos instrumentos de triagem nutricional em pediatria, principalmente STRONGkids e STAMP. Evidencia-se a necessidade de mais pesquisas nessa área. Apenas um instrumento foi traduzido e adaptado para a população pediátrica brasileira, sendo imprescindível a realização de estudos de adaptação e validação de instrumentos para essa população.
To date there are no specific classification criteria for childhood-onset systemic lupus erythematosus (cSLE). This study aims to compare the performance among the American College of Rheumatology ...(ACR) 1997, the Systemic Lupus International Collaborating Clinics criteria (SLICC) and the new European League Against Rheumatism (EULAR)/ACR criteria, in a cSLE cohort.
We conducted a medical chart review study of cSLE cases and controls with defined rheumatic diseases, both ANA positive, to establish each ACR1997, SLICC and EULAR/ACR criterion fulfilled, at first visit and 1-year-follow-up.
Study population included 122 cSLE cases and 89 controls. At first visit, SLICC criteria had higher sensitivity than ACR 1997 (89.3% versus 70.5%, p < 0.001), but similar specificity (80.9% versus 83.2%, p = 0.791), however performance was not statistically different at 1-year-follow-up. SLICC better scored in specificity compared to EULAR/ACR score ≥ 10 at first visit (80.9% versus 67.4%, p = 0.008) and at 1-year (76.4% versus 58.4%, p = 0.001), although sensitivities were similar. EULAR/ACR criteria score ≥ 10 exhibited higher sensitivity than ACR 1997 (87.7% versus 70.5%, p < 0.001) at first visit, but comparable at 1-year, whereas specificity was lower at first visit (67.4% versus 83.2%, p = 0.004) and 1-year (58.4% versus 76.4%, p = 0.002). A EULAR/ACR score ≥ 13 against a score ≥ 10, resulted in higher specificity, positive predictive value, and cut-off point accuracy. Compared to SLICC, a EULAR/ACR score ≥ 13 resulted in lower sensitivity at first visit (76.2% versus 89.3%, p < 0.001) and 1-year (91% versus 97.5%, p = 0.008), but similar specificities at both assessments. When compared to ACR 1997, a EULAR/ACR total score ≥ 13, resulted in no differences in sensitivity and specificity at both observation periods.
In this cSLE population, SLICC criteria better scored at first visit and 1-year-follow-up. The adoption of a EULAR/ACR total score ≥ 13 in this study, against the initially proposed ≥10 score, was most appropriate to classify cSLE. Further studies are necessary to address if SLICC criteria might allow fulfillment of cSLE classification earlier in disease course and may be more inclusive of cSLE subjects for clinical studies.
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