Correlation analysis in clinical and experimental studies

Hallux valgus and pes planus: Correlation analysis using deep learning-assisted radiographic angle measurements

BACKGROUND

The relationship between hallux valgus (HV) and pes planus remains unresolved. This study aims to determine the correlation between HV and pes planus using a deep learning (DL) model to measure radiographic angle parameters.

METHODS

In total, radiographs of 212 feet detectable by the DL model were analyzed. HV was evaluated using the hallux valgus and intermetatarsal angles, while pes planus was assessed using the lateral talo-first metatarsal (Meary's) and calcaneal pitch angles. Correlation analyses were performed for each DL model-measured angle parameter. We investigated whether pes planus worsened with increasing severity of HV and vice versa.

RESULTS

All parameters were significantly correlated with each other. Pes planus worsened with increasing severity of HV, and as the severity of pes planus increased, HV also worsened.

CONCLUSION

Utilizing the DL model-assisted radiographic angle measurements, this study established a significant correlation between HV and pes planus.

LEVEL OF EVIDENCE

III.

Prevalence and factors associated with olfactory impairment among patients with acne treated with oral isotretinoin: a cross-sectional study

OBJECTIVE

This study aimed to investigate the prevalence and factors associated with olfactory dysfunction in individuals exposed to Isotretinoin (ISO) for the treatment of acne, using the University of Pennsylvania Smell Identification Test (UPSIT®).

METHODS

This cross-sectional study enrolled age and sex-matched patients with acne who were current users of oral ISO and unexposed controls without olfactory complaints. UPSIT® and a validated questionnaire (Nasal Obstruction Symptom Evaluation) were administered to evaluate nasal obstruction in patients exposed to ISO.

RESULTS

A total of seventy patients were recruited, with 35 in the exposed group and 35 in the unexposed group, consisting of 18 males and 17 females in each group, aged from 17 to 47 years. The prevalence of olfactory dysfunction was higher in the exposed group compared to the non-exposed group (62.9% vs. 17.1%), yielding a Prevalence Ratio (PR) of 3.7 (95% CI 1.9-7.1). However, no participants were categorized as anosmia or severe hyposmia and the majority of dysfunction was mild hyposmia compared to moderate hyposmia (51.5% vs. 11.4%). Among the exposed individuals, gasoline, orange, coffee, and wood exhibited the highest rates of identification errors (≥54%). Olfactory function demonstrated a negative correlation with treatment duration (p = 0.01), cumulative dose (p = 0.02), and nasal obstruction (p = 0.02).

CONCLUSIONS

Olfactory dysfunction was more prevalent among ISO users, despite the patients being unaware of the disorder. Olfactory changes were correlated with treatment duration, cumulative dose, and nasal obstruction.

LEVEL OF EVIDENCE

Level 4.

Assessment of the Efficacy and Durability of IncobotulinumtoxinA in the Treatment of the Upper Face in Adult Women

INTRODUCTION

IncobotulinumtoxinA (Xeomin®) is used in the treatment of dynamic wrinkles and the aesthetic repositioning of facial structures. The duration of its muscular effect typically extends for around 4 months. However, the residual aesthetic benefit can be observed for a longer period. To date, the long-term aesthetic benefit of incobotulinumtoxinA in facial aesthetics has not been systematically evaluated. This study aimed to evaluate longitudinally the duration and aesthetic benefits of incobotulinumtoxinA in the treatment of the upper face in adult women.

METHODS

A quasi-experimental, evaluator-blind, clinical trial involving 28 adult women (30-60 years old) with facial movement lines, undergoing treatment of the upper face with incobotulinumtoxinA by two injectors, following an individualized protocol (ONE21 and glabellar contraction patterns) was performed. Participants were evaluated on the day of the intervention (day 0) and days 30, 120, 180, and 240, and subjected to standardized photographs. The following outcomes were evaluated blindly at each visit: Merz Aesthetics Facial Contraction Scale (MAS), GAIS (Global Aesthetic Improvement Scale), and patient satisfaction. Adverse effects were evaluated at each visit.

RESULTS

Participants ranged in age from 30 to 60 years, 93% were self-declared white, and most of their baseline MAS scores for dynamic lines were moderate and severe. All the parameters presented significative reduction from baseline until day 180. At day 240, the dynamic MAS scores were lower than baseline for forehead lines in 15.4% (95% confidence interval (CI) 0.8-30.0%) of the participants, for glabellar lines in 38.5% (95% CI 18.8-58.1%), and for crow's feet lines in 26.9% (95% CI 9.0-44.8%). Aesthetic improvement compared to baseline was identified in 35% (CI 95% 23‒50%) of the participants at day 240, and 62% (CI 95% 42‒81%) of the sample kept reporting some satisfaction with the procedure.

CONCLUSION

The aesthetic treatment of the upper face with incobotulinumtoxinA demonstrates enduring clinical benefits, and patient satisfaction lasting up to 180 days in most participants. The length of efficacy, which exceeded those reported in the literature, may be attributed to the use of techniques based on individualized assessment such as ONE21 and glabellar patterns of contraction.

The Correlation of Fluid Creep with Fluid and Electrolyte Imbalance In Pediatric Intensive Care Unit Dr. Cipto Mangunkusumo National Central Public Hospital

Fluid creep, used as a drug diluent can contribute to fluid and electrolyte balance. Fluid creep brings substantial volume and electrolyte load to patients, especially in critically ill children. This study is conducted to evaluate the correlation of fluid creep with fluid and electrolyte balance in critically ill children. This cross-sectional study was conducted in a single tertiary center. We include children aged 1 month- 18 years in the pediatric intensive care unit (PICU). Exclusion criteria were patients receiving renal replacement therapy and plasmapheresis. Fluids and electrolyte intake were recorded at admission and the first 24 hours in the PICU. A total of 64 patients were observed. The sources of fluid intake are 61% from parenteral, 25% from enteral nutrition, and 12% from fluid creep. There were significant correlations between the volume (r = 0.304, P = .015) and electrolyte intake (r = 0.742, P = .035) of fluid creep with daily fluid balance. There is no correlation between fluid creep and electrolyte changes in 24 hours. Fifty-two patients used WFI (81.2%) as a drug diluent. Our study showed that fluid creep constitutes 12% of daily fluid intake. There is a correlation between the volume and electrolyte intake from fluid creep to daily fluid balance, so it is important to include the volume of fluid creep in calculating the fluid balance. Thus, it is recommended to use hypotonic fluid like WFI compared to NaCl 0.9% for drug diluent.

Self-Reported Management of Incidentally Detected Heart Murmurs in Puppies: A Survey among Veterinarians

BACKGROUND

Heart murmurs in puppies can be innocent or pathologic; the latter is almost always related to a congenital heart disease. Differentiating between these murmurs can be challenging for practicing veterinarians, but this differentiation is essential to ensure the best prognosis for puppies having a congenital heart disease. Our study aimed to reveal how veterinarians manage puppies with a heart murmur.

METHODS

A web-based questionnaire was sent to Dutch and Belgian veterinary practices.

RESULTS

Data from 452 respondents were analyzed. Though 88% of the respondents find detecting a heart murmur easy, only 9% find differentiating innocent murmurs from pathologic murmurs in puppies easy. Of the respondents, only 80% recommend immediate additional examination when detecting a loud heart murmur during the first veterinary health check at 6 weeks of age. Most of the respondents are aware that normal growth and the absence of clinical signs do not exclude severe congenital heart disease. Of the respondents, 31% were uncertain whether early surgical intervention could lead to improved outcomes.

CONCLUSIONS

Veterinarians are aware of the importance of echocardiography for puppies with a loud heart murmur, and recognize their limitations when differentiating an innocent from a pathological heart murmur in a puppy.

Validity and reliability of the persian version of the modified telephone interview for cognitive status among community-dwelling older adults in Iran

Due to the increase in the population of the elderly, there is a growing trend in some diseases such as cognitive disorders (dementia) which are common in this era, and the diagnosis and treatment of this disease are still facing challenges. Therefore, early identification of cognitive disorders is of particular importance. In this regard, the use of any tool or cognitive tests may not be enough to diagnose dementia in the early stages and a special tool is needed.

Objective

The validity and reliability of the Persian version of the Modified Telephone Interview for Cognitive Status (P-TICS-M) in older adults living in the Iranian community for a comprehensive screening of mild cognitive impairment and dementia was investigated.

Methods

In the first phase, translation, re-translation, and word-taking were performed by using the face validity and content validity. In the second phase, a stratified convenient sampling with 150 participants aged ≥60 years was conducted based on cognitive status using the global deterioration scale in 2018. The external and internal reliability of the P-TICS-M using the interclass correlation coefficient and Cronbach's alpha coefficient of total items of this tool were estimated.

Results

The mean age of the participants was 68.6 (standard deviation±7.4) years. According to global deterioration scale, 87 (58.0%) had normal cognition, 40 (26.7%) had mild cognitive impairment, and 23 (15.3%) had dementia. The Spearman's correlation coefficient between P-TICS-M scores and Mini-Mental State Examination scale was 0.764. In exploratory factor analysis, seven domains were detected, which were compatible with those defined by the tool developer. The Cronbach's alpha of the P-TICS-M was 0.920. The absolute agreement between test-retest score was >0.90. The sensitivity of 92.2, 94.8, and 100%, and also the specificity of 79.4, 88.2, and 89.8% were calculated for detecting subjects with dementia, respectively. Furthermore, a mild cognitive impairment cutoff of >28 was determined.

Conclusion

The development and validation of a P-TICS-M tool can be useful in identifying older adult people with cognitive impairment. Demographic characteristics (level of education, age) can also affect the cutoff point of this tool.

Clinical characterization, physical frailty, and depression in elderly patients with psoriasis from a reference center in Brazil: a cross-sectional study

BACKGROUND

There are few studies dedicated to the characterization of the geriatric population with psoriasis, which has particularities in terms of clinical manifestations and therapeutic limitations. As psoriasis is a chronic disease, presenting a higher prevalence with age, the increase in life expectancy in Brazil demands knowledge about the behavior of the disease among the elderly.

OBJECTIVES

To characterize elderly people with psoriasis from a tertiary service, from the clinical-epidemiological point of view, presence of comorbidities, physical frailty, and affective impact, and to compare these aspects with adults with psoriasis and elderly people without the disease.

METHODS

Cross-sectional study of 64 elderly patients with psoriasis, 64 adults with psoriasis, and 64 elderly patients without the disease. Clinical-demographic aspects, the Beck depression scale, and Skindex-16 were evaluated. Indicators of physical frailty were evaluated in elderly patients: handgrip, sit-to-stand test, fatigue, and weight loss >5%.

RESULTS

In the elderly, the mean age (SD) of psoriasis onset was 44 (10) years, men represented 47% of the sample, the prevalence of arthritis was 22%, and ungual involvement occurred in 72%. Topical corticosteroids were used more often among elderly people with psoriasis (100%) than among adults with the disease (86%), with no difference among other systemic treatments. Diabetes mellitus occurred in 30% of the elderly. Hypertension (59%), dyslipidemia (52%), depression (34%), and fatigue (59%) were more prevalent among the elderly with psoriasis than among the healthy controls.

STUDY LIMITATIONS

The study was carried out in a public reference service for patients with psoriasis, all of which were undergoing treatment.

CONCLUSIONS

Elderly people with psoriasis from a tertiary service showed greater affective impairment, metabolic comorbidities, and physical frailty than elderly controls.

Human iPSC-derived microglia carrying the LRRK2-G2019S mutation show a Parkinson's disease related transcriptional profile and function

LRRK2-G2019S is one of the most common Parkinson's disease (PD)-associated mutations and has been shown to alter microglial functionality. However, the impact of LRRK2-G2019S on transcriptional profile of human induced pluripotent stem cell-derived microglia-like cells (iMGLs) and how it corresponds to microglia in idiopathic PD brain is not known. Here we demonstrate that LRRK2-G2019S carrying iMGL recapitulate aspects of the transcriptional signature of human idiopathic PD midbrain microglia. LRRK2-G2019S induced subtle and donor-dependent alterations in iMGL mitochondrial respiration, phagocytosis and cytokine secretion. Investigation of microglial transcriptional state in the midbrains of PD patients revealed a subset of microglia with a transcriptional overlap between the in vitro PD-iMGL and human midbrain PD microglia. We conclude that LRRK2-G2019S iMGL serve as a model to study PD-related effects in human microglia.

Effect of Selected Music Soundtracks on Cardiac Vagal Control and Complexity Assessed by Heart Rate Variability

Listening to music is experimentally associated with positive stress reduction effect on human organisms. However, the opinions of therapists about this complementary non-invasive therapy are still different.

PURPOSE

The aim of our study was to investigate the effect of selected passive music therapy frequencies without vocals on selected cardio-vagal and complexity indices of short-term heart rate variability (HRV) in healthy youth, in terms of calming the human.

MAIN METHODS

30 probands (15 male, averaged age: 19.7+/-1.4 years, BMI: 23.3+/-3.8 kg/m2) were examined during protocol (Silence baseline, Music 1 (20-1000 Hz), Silence 1, Music 2 (250-2000 Hz), Silence 2, Music 3 (1000-16000 Hz), and Silence 3). Evaluated HRV parameters in time, spectral, and geometrical domains represent indices of cardio-vagal and emotional regulation. Additionally, HRV complexity was calculated by approximate entropy and sample entropy (SampEn) and subjective characteristics of each phase by Likert scale.

RESULTS

the distance between subsequent R-waves in the electrocardiogram (RR intervals [ms]) and SampEn were significantly higher during Music 3 compared to Silence 3 (p=0.015, p=0.021, respectively). Geometrical cardio-vagal index was significantly higher during Music 2 than during Silence 2 (p=0.006). In the subjective perception of the healthy youths evaluated statistically through a Likert scale, the phases of music were perceived significantly more pleasant than the silent phases (p<0.001, p=0.008, p=0.003, respectively).

CONCLUSIONS

Our findings revealed a rise of cardio-vagal modulation and higher complexity assessed by short-term HRV indices suggesting positive relaxing effect music especially of higher frequency on human organism.

Expression of Endothelin-1, Endothelin Receptor-A, and Endothelin Receptor-B in facial melasma compared to adjacent skin

Background/Objectives

Although melasma is highly prevalent, its pathogenesis is not yet fully understood. In the skin, endothelin-1 (ET-1) is primarily produced by keratinocytes in response to UVB exposure, which is mediated by an increase in IL-1α or reactive oxygen species. ET-1 plays a role in melanogenesis by binding to specific receptor B (ERB) or receptor A (ERA). However, the expression of ET-1, ERA, and ERB in melasma has not been systematically investigated. The objective of this study was to evaluate the expression of ET-1, ERA, and ERB in facial melasma compared to the adjacent unaffected skin.

Methods

Cross-sectional study, with 40 skin samples (20: facial melasma; 20: adjacent unaffected skin) from women with facial melasma without treatment for 30 days except for sunscreen. A triple staining immunofluorescence technique was performed for anti-vimentin, DAPI, plus one of the following antibodies: (a) anti-ET1, (b) anti-ERA; (c) anti-ERB. Interfollicular areas on the slides of each topography (melasma; unaffected skin) were photographed in triplicate under confocal laser microscopy. The mean staining intensities of the image histograms (0-255 pixels intensity) were estimated for different types of cells (suprabasal keratinocytes, basal layer, and upper dermis) and were blindly compared between topographies.

Results

The mean (SD) age of the participants was 44.9 (9.2). The expression of ET-1 was increased in the whole epidermis with melasma when compared to the adjacent skin, being 32.8% (CI95% 14.7%-52.6%) higher in the spinous layer (p=0.013), 30.4% (CI95% 13.7%-47.9%) higher in the basal layer (p=0.014), and 29.7% (CI95% 11.4%-49.7%) higher in the melanocytes (p=0.006). There was no noticeable expression of ET-1 within the cells on the upper dermis. Neither ERA nor ERB resulted in differential epidermal expression between melasma and unaffected skin (p≥0.1).

Conclusion

ET-1 is expressed more intensely on the epidermis from the skin with facial melasma compared to the unaffected adjacent skin.

mHealth Impact on Gait and Dynamic Balance Outcomes in Neurorehabilitation: Systematic Review and Meta-analysis

Gait and dynamic balance are two main goals in neurorehabilitation that mHealth systems could address. To analyze the impact of using mHealth systems on gait and dynamic balance outcomes in subjects with neurological disorders. Randomized controlled trials (RCT) published in PubMed, Web of Science, Scopus, and PEDro databases were searched up to April 2023. Studies including adults with neurological disorders, analyzing the effectiveness of mHealth systems on gait and dynamic balance compared with conventional therapy and/or not intervention, were included. The PEDro scale and the Cochrane Collaboration's 2.0 tool were used for the methodological quality and risk of bias assessment. The Review Manager 5.4 software was used to obtain meta-analyses. 13 RCT were included in the systematic review and 11 in the meta-analyses, involving 528 subjects. A total of 21 mobile applications were identified for gait and balance training, and to enhance physical activity behaviors. There were significant differences in gait parameters, speed by 0.10 s/m (95% confidence interval (CI)=0.07,0.13;p<0.001), cadence by 8.01 steps/min (95%CI=3.30,12.72;p<0.001), affected step length by 8.89 cm (95%CI=4.88,12.90;p<0.001), non-affected step length by 8.08 cm (5%CI=2.64,13.51;p=0.004), and in dynamic balance, Timed Up and Go by -7.15 s (95%CI=-9.30,-4.99;p<0.001), and mobility subscale of Posture Assessment Scale for Stroke by 1.71 points (95%CI=1.38,2.04;p<0.001). Our findings suggested the use of mHealth systems for improving gait in subjects with neurological disorders, but controversial results on dynamics balance recovery were obtained. However, the quality of evidence is insufficient to strongly recommend them, so further research is needed.

Adverse Event Profiles of Antiseizure Medications and the Impact of Coadministration on Drug Tolerability in Adults with Epilepsy

BACKGROUND

Antiseizure medication (ASM) as monotherapy or in combination is the treatment of choice for most patients with epilepsy. Therefore, knowledge about the typical adverse events (AEs) for ASMs and other coadministered drugs (CDs) is essential for practitioners and patients. Due to frequent polypharmacy, it is often difficult to clinically assess the AE profiles of ASMs and differentiate the influence of CDs.

OBJECTIVE

This retrospective analysis aimed to determine typical AE profiles for ASMs and assess the impact of CDs on AEs in clinical practice.

METHODS

The Liverpool AE Profile (LAEP) and its domains were used to identify the AE profiles of ASMs based on data from a large German multicenter study (Epi2020). Following established classifications, drugs were grouped according to their mode of action (ASMs) or clinical indication (CDs). Bivariate correlation, multivariate ordinal regression (MORA), and artificial neural network (ANNA) analyses were performed. Bivariate correlation with Fisher's z-transformation was used to compare the correlation strength of LAEP with the Hospital Anxiety and Depression Scale (HADS) and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) to avoid LAEP bias in the context of antidepressant therapy.

RESULTS

Data from 486 patients were analyzed. The AE profiles of ASM categories and single ASMs matched those reported in the literature. Synaptic vesicle glycoprotein 2A (SV2A) and voltage-gated sodium channel (VGSC) modulators had favorable AE profiles, while brivaracetam was superior to levetiracetam regarding psychobehavioral AEs. MORA revealed that, in addition to seizure frequency, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) modulators and antidepressants were the only independent predictors of high LAEP values. After Fisher's z-transformation, correlations were significantly lower between LAEP and antidepressants than between LAEP and HADS or NDDI-E. Therefore, a bias in the results toward over interpreting the impact of antidepressants on LAEP was presumed. In the ANNA, perampanel, zonisamide, topiramate, and valproic acid were important nodes in the network, while VGSC and SV2A modulators had low relevance for predicting relevant AEs. Similarly, cardiovascular agents, analgesics, and antipsychotics were important CDs in the ANNA model.

CONCLUSION

ASMs have characteristic AE profiles that are highly reproducible and must be considered in therapeutic decision-making. Therapy using perampanel as an AMPA modulator should be considered cautiously due to its relatively high AE profile. Drugs acting via VGSCs and SV2A receptors are significantly better tolerated than other ASM categories or substances (e.g., topiramate, zonisamide, and valproate). Switching to brivaracetam is advisable in patients with psychobehavioral AEs who take levetiracetam. Because CDs frequently pharmacokinetically interact with ASMs, the cumulative AE profile must be considered.

TRIAL REGISTRATION

DRKS00022024, U1111-1252-5331.

Efficacy and Tolerability of Hyperdiluted Calcium Hydroxylapatite (Radiesse) for Neck Rejuvenation: Clinical and Ultrasonographic Assessment

Background

The subdermal injection of calcium hydroxylapatite (CaHA) can improve the mechanical properties of the skin, providing immediate correction and stimulating the endogenous production of collagen, elastin, angiogenesis, and dermal cell proliferation; however, few studies have examined the neck region.

Purpose

This study assessed the clinical and ultrasonographic improvement induced by two sessions of subdermal injection of hyperdiluted (1:4) CaHA for neck rejuvenation in 22 women.

Patients and Methods

A quasi-experimental longitudinal trial (before and after) was performed by enrolling 22 adult women with mild and moderate neck aging (grades 1 and 2) on Merz Neck Volume Scale at rest (laxity) and Neck Horizontal Lines. They were submitted to two sessions of subdermal hyperdiluted CaHA (D0 and D45) treatments and assessed clinically and ultrasonographically at D0, D45, and D120. The main outcomes were the blinded photographic assessment (Merz scales of neck laxity and horizontal lines), dermal thickness (at three points), and the GAIS (Global Aesthetic Improvement Scale) score.

Results

The mean (SD) age was 43.5 (5.6) years. At the inclusion, the Merz scores for neck laxity were mild for 27% and moderate for 73% of participants, and the Merz scores for necklines were mild for 32% and moderate for 68%. At D120, scores decreased in 86% (95% CI 68-99%) of the participants by at least one degree on the necklines scale and in 82% (95% CI 73-90%) for neck laxity. According to the GAIS, 91% (95% CI 77-99%) of the participants evidenced improvement at D120. The mean dermal thickness increased by 15% (95% CI 8-21%) at D120. No severe adverse effects were recorded, and high satisfaction was reported by 82% of the participants.

Conclusion

Two sessions of subdermal hyperdiluted CaHA were well-tolerated and improved necklines, neck laxity, and dermal thickness in adult women with mild and moderate cervical aging.

Psychometric Properties of the Brazilian Version of the Quality of Dying and Death for Adult Family Members of ICU Patients

Death is a complex, subjective phenomenon that requires an understanding of experiences to be qualified to provide care during the end-of-life process. This study aimed to analyze the psychometric properties of the Portuguese version (Brazil) of the Quality of Dying and Death (QODD) scale on family members of patients who died in adult intensive care units. A methodological study was conducted with 326 family members of patients that died in three ICUs of public hospitals in the state of São Paulo, Brazil. For this study, the QODD 3.2a (25 items and six domains) was administered during the period from December 2020 to March 2022. The analysis was performed using the classic theory of the tests and the goodness of fit of the model was tested using confirmatory factor analysis. We have used Spearman's correlation coefficients between the scores of the overall scale and domains. Cronbach's alpha coefficient and the intraclass correlation coefficient (ICC) were used for the evaluation of internal consistency and temporal stability, respectively. The Horn's parallel analysis indicated two factors that were not confirmed in the exploratory factor analysis. A single factor retained 18 of the initial 25 items and the analysis of the goodness of fit to the unidimensional model resulted in the following: CFI = 0.7545, TLI = 0.690, chi-squared = 767.33, df = 135, RMSEA = 0.121 with 90%CI, and p = 5.04409. The inter-item correlations indicated a predominance of weak correlations among the items of the instrument. The items with the largest number of moderate correlations were questions 13b, 9b, and 10b and a strong correlation was found between questions 15b and 16b. Cronbach's alpha coefficient was 0.8 and the ICC was 0.9. The Quality of Dying and Death-Version 3.2a (intensive therapy) in Brazilian Portuguese has a unidimensional structure and acceptable reliability. However, it did not obtain a good fit to the proposed factorial model.

Translation, adaptation and validation of the Chrononutrition Profile - Questionnaire (CP-Q) in Brazilian Portuguese

Chrononutrition is a science that studies the relationship between mealtimes and sleep/wake habits. However, these behaviors are not evaluated by a single questionnaire. Therefore, this study aimed to translate and culturally adapt the Chrononutrition Profile - Questionnaire (CP-Q) into Portuguese and validate the Brazilian version. The translation and cultural adaptation process consisted of: translation; synthesis of translations; backtranslation; expert committee and pre-test. The validation was performed with 635 participants (32.4 ± 11.2 years) who answered the CPQ-Brazil and Pittsburgh Sleep Quality Index (PSQI); Munich Chronotype Questionnaire (MCTQ); Night Eating questionnaire; Quality of life and health index (SF-36) and 24 h-recall. The participants were mostly female, single, from the northeastern region, a eutrophic profile, and average quality of life score of 55.8 ± 17.9. Moderate to strong correlations were observed in the sleep/wake schedules between CPQ-Brazil, PSQI and MCTQ, both for work/study days and free days. The correlations between largest meal, skipping breakfast, eating window, nocturnal latency, and last eating event with the same variables in the 24 h-recall showed moderate to strong positive correlations. The translation, adaptation, validation and reproducibility of the CP-Q generates a valid and reliable questionnaire to assess the sleep/wake and eating habits in the Brazilian population.

Adaptação transcultural e validação do “health sciences evidence based practice questionnaire” para o português do Brasil

Introdução: o instrumento “Health Sciences Evidence Based Practice Questionnaire” avalia as diferentes dimensões da construção da prática baseada em evidência como um processo para responder às situações decorrentes da prática clínica diária. Objetivos: adaptar culturalmente o instrumento Health Sciences Evidence Based Practice Questionnaire para a língua portuguesa do Brasil e avaliar suas qualidades psicométricas. Método: Estudo metodológico. A primeira etapa compreendeu o processo de tradução e adaptação transcultural. Na segunda etapa, o instrumento Questionário de Prática Baseada em Evidências e Efetividade Clínica foi aplicado para a validação convergente, utilizando-se o índice de correlação de Pearson, nível de significância 0,05 e realizada Análise Fatorial Confirmatória (AFC), de acordo com o modelo de equações estruturais. A confiabilidade foi avaliada pelo teste-reteste, utilizando o coeficiente de correlação r de Pearson. A consistência interna obtida por meio do coeficiente alpha de Cronbach. Resultados: validade de conteúdo obtida na terceira rodada, título final: Questionário HS-EBP- Prática Baseada em Evidência nas Ciências da Saúde, aplicado em 305 profissionais da saúde. A confiabilidade foi verificada por meio do coeficiente alfa de Cronbach (0,970), similar à versão original, e da estabilidade teste-reteste pelo índice de correlação r de Pearson (r = 0,766) que indicou uma correlação forte. Para a validação convergente foi aplicado o índice de correlação de Pearson (r = 0,683) positivo e com correlação moderada entre os instrumentos. Teste Qui-Quadrado foi significativo (<0,001) para todos os modelos obtidos, em todos os modelos testados. Conclusão: o instrumento mostrou-se válido e confiável para reprodutibilidade na versão brasileira.

Reference values for the cross-sectional area of the lumbar multifidus muscle in children

BACKGROUND

The multifidus muscle plays a major role in the growth and postural control of children. Therefore, the reference values of the cross-sectional area (CSA) of the lumbar multifidus muscle represent an important tool for assessing muscle development and the early monitoring of musculoskeletal disorders.

OBJECTIVE

The aim of this study was to provide percentile scores for the CSA of the lumbar multifidus muscle in eutrophic children aged 5 to 10 years.

METHODS

This was a cross-sectional, observational study, involving 736 children. An anthropometric assessment was conducted and ultrasound (US) imaging was used to assess the CSA of the lumbar (vertebral level L5) multifidus muscle. The CSA was expressed as percentile scores.

RESULTS

The CSA in the boys ranged from 1.8 cm2 to 5.3 cm2 and in girls from 1.9 cm2 to 5.9 cm. The CSA in the 50th percentile scores of both sexes was 3.4 cm2. There was an increase in the CSA between 5 and 7 years old in both sexes. The CSA presented a greater variance in girls than in boys. After 8 years of age, the multifidus CSA increased in girls and decreased in boys.

CONCLUSION

The present study has provided percentile scores for the CSA of the lumbar multifidus muscle for eutrophic children aged 5 to 10 years. An increase was observed of the CSA of the multifidus muscle between the ages of 5 and 7 years and there were no differences in the CSA percentiles in relation to sex. An increase in the CSA after 8 years of age was only observed in the girls.

IncobotulinumtoxinA for the Treatment of Glabella and Forehead Dynamic Lines: A Real-Life Longitudinal Case Series

Background

There is substantial interpersonal variation in the patterns of muscular contraction that substantiates the use of personalized points of application and dosages in clinical practice to achieve optimal results. Nevertheless, there has been no real-life therapeutic series with botulinum toxin for aesthetic treatment of the face in which the subjects were systematically followed to assess its long-term benefit.

Purpose

To assess the performance and length of the treatment of glabellar and forehead lines with IncobotulinumtoxinA in a real-life setting.

Patients and Methods

We enrolled 20 adults with indications for the treatment of upper facial dynamic lines (glabella and forehead) with botulinum toxin. The protocols of injection points were personalized by the injectors. The participants were photographed under maximum facial contraction before the application (D0) and after 15, 90, 120, and 180 days. The photos were randomly assessed by two blinded experienced raters to consensually grade the dynamic lines according to the Merz Aesthetics Scales (MAS). Efficacy was defined as the reduction in the MAS score.

Results

At D15, 18 (90%; 95% CI: 80%-100%) participants reached the zero score, or a 2-point reduction on the MAS score from the forehead and 16 (80%; 95% CI: 65-90%) reached that reduction for the glabella. These values from D90 were 14 (70%; 95% CI: 55-85%) for both sites. At D120, these values were 11 (55%; 95% CI: 35-75%) and 8 (40%; 95% CI: 25-55%) for the forehead and glabella. At D180, 10 (50%; 95% CI: 30-70%) participants presented a MAS score for forehead or glabella dynamic lines lower than the score assessed at D0.

Conclusion

As much as 70% of the patients sustained a reduction of scores after 120 days of the treatment for dynamic glabellar and forehead lines. Half of the patients evidenced prolonged benefit at 180 days.

Assessing the effectiveness of quarantine measures during the COVID-19 pandemic in Chile using Bayesian structural time series models

Background

With the emergence of the COVID-19 pandemic, all existing health protocols were tested under the worst health crisis humanity has experienced since the Black Death in the 14th century. Countries in Latin America have been the epicenter of the COVID-19 pandemic, with more than 1.5 million people killed. Worldwide health measures have included quarantines, border closures, social distancing, and mask use, among others. In particular, Chile implemented total or partial quarantine measures depending on the number of infections in each region of the country. Therefore, it is necessary to study the effectiveness of these quarantines in relation to the public health measures implemented by government entities at the national level.

Objective

The main objective of this study is to analyze the effectiveness of national- and region-level quarantines in Chile during the pandemic based on information published by the Chilean Ministry of Health, and answers to the following question are sought: Were quarantine measures in Chile effective during the COVID-19 pandemic?

Methods

The causal effect between the rates of COVID-19 infections and the population rates in Phase 1 and Phase 2 quarantines in the period from March 2020 to March 2021 in different regions of Chile were evaluated using intervention analyses obtained through Bayesian structural time series models. In addition, the Kendall correlation coefficient obtained through the copula approach was used to evaluate the comovement between these rates.

Results

In 75% of the Chilean regions under study (12 regions out of a total of 16), an effective Phase 1 quarantine, which was implemented to control and reduce the number of cases of COVID-19 infection, was observed. The main regions that experienced a decrease in cases were those located in the north and center of Chile. Regarding Phase 2, the COVID-19 pandemic was effectively managed in 31% (5 out of 16) of the regions. In the south-central and extreme southern regions of Chile, the effectiveness of these phases was null.

Conclusion

The findings indicate that in the northern and central regions of Chile, the Phase 1 quarantine application period was an effective strategy to prevent an increase in COVID-19 infections. The same observation was made with respect to Phase 2, which was effective in five regions of northern Chile; in the rest of the regions, the effectiveness of these phases was weak or null.

Influence of Population Size, the Human Development Index and the Gross Domestic Product on Mortality by COVID-19 in the Southeast Region of Brazil

We evaluated the influence of population size (POP), HDI (Human Development Index) and GDP (gross domestic product) on the COVID-19 pandemic in the Southeast region of Brazil, between February 2020 and May 2021.

METHODS

Cases, deaths, incidence coefficient, mortality rate and lethality rate were compared among states. The cities were divided into strata according to POP, GDP, and HDI. Data were compared by Welch's ANOVA, nonlinear polynomial regression, and Spearman's correlation test (rS).

RESULTS

The highest incidence coefficient (p < 0.0001) and mortality rate (p < 0.05) were observed in the states of Espírito Santo and Rio de Janeiro, respectively. Until the 45th week, the higher the POP, the higher the mortality rate (p < 0.01), with no differences in the remaining period (p > 0.05). There was a strong positive correlation between POP size and the number of cases (rS = 0.92, p < 0.0001) and deaths (rS = 0.88, p < 0.0001). The incidence coefficient and mortality rate were lower (p < 0.0001) for low GDP cities. Both coefficients were higher in high- and very high HDI cities (p < 0.0001). The lethality rate was higher in the state of Rio de Janeiro (p < 0.0001), in large cities (p < 0.0001), in cities with medium GDP (p < 0.0001), and in those with high HDI (p < 0.05).

CONCLUSIONS

Both incidence and mortality were affected by time, with minimal influence of POP, GDP and HDI.

Validation of a Novel Fluorescent Lateral Flow Assay for Rapid Qualitative and Quantitative Assessment of Total Anti-SARS-CoV-2 S-RBD Binding Antibody Units (BAU) from Plasma or Fingerstick Whole-Blood of COVID-19 Vaccinees

Background: Limited commercial LFA assays are available to provide a reliable quantitative measurement of the total binding antibody units (BAU/mL) against the receptor-binding domain of the SARS-CoV-2 spike protein (S-RBD). Aim: This study aimed to evaluate the performance of the fluorescence LFA FinecareTM 2019-nCoV S-RBD test along with its reader (Model No.: FS-113) against the following reference methods: (i) the FDA-approved GenScript surrogate virus-neutralizing assay (sVNT); and (ii) three highly performing automated immunoassays: BioMérieux VIDAS®3, Ortho VITROS®, and Mindray CL-900i®. Methods: Plasma from 488 vaccinees was tested by all aforementioned assays. Fingerstick whole-blood samples from 156 vaccinees were also tested by FinecareTM. Results and conclusions: FinecareTM showed 100% specificity, as none of the pre-pandemic samples tested positive. Equivalent FinecareTM results were observed among the samples taken from fingerstick or plasma (Pearson correlation r = 0.9, p < 0.0001), suggesting that fingerstick samples are sufficient to quantitate the S-RBD BAU/mL. A moderate correlation was observed between FinecareTM and sVNT (r = 0.5, p < 0.0001), indicating that FinecareTM can be used for rapid prediction of the neutralizing antibody (nAb) post-vaccination. FinecareTM BAU results showed strong correlation with VIDAS®3 (r = 0.6, p < 0.0001) and moderate correlation with VITROS® (r = 0.5, p < 0.0001) and CL-900i® (r = 0.4, p < 0.0001), suggesting that FinecareTM can be used as a surrogate for the advanced automated assays to measure S-RBD BAU/mL.

Thiohydantoins and hydantoins derived from amino acids as potent urease inhibitors: Inhibitory activity and ligand-target interactions

We report the investigation of hydantoins and thiohydantoins derived from L and d-amino acids as inhibitors against the Canavalia ensiformis urease (CEU). The biochemical in vitro assay against CEU revealed a promising inhibitory potential for most thiohydantoins with six of them showing %I higher than the reference inhibitor thiourea (56.5%). In addition, thiohydantoin derived from l-valine, 1b, as well as the hydantoin 2d, derived from l-methionine, were identified as the most potent inhibitors with %I = 90.5 and 85.9 respectively. Enzyme kinetic studies demonstrated a mixed and uncompetitive inhibition profile for these compounds with K_i values of 0.42 mM for 1b and 0.99 mM for 2d. These kinetic parameters, obtained from traditional colorimetric assay, were strictly related to the K_D values measured spectroscopically by the Saturation Transfer Difference (STD) technique for the urease complex. STD was also used to evince the moieties of the ligands responsible for the binding with the enzyme. Molecular docking studies showed that the thiohydantoin and hydantoin rings can act as a pharmacophoric group due to their binding affinity by hydrogen bonding interactions with critical amino acid residues in the enzyme active and/or allosteric site. These findings agreed with the experimental alpha values, demonstrating that 1b has affinity by free enzyme, and 2d derivative, an uncompetitive inhibitor, has great binding affinity at the allosteric site. The results for the thiohydantoin 1a, derived from d-valine, demonstrated a drastic stereochemical influence on inhibition, kinetics, and binding parameters in comparison to its enantiomer 1b.

Correlation of meiboscale symptom score and sign score for primary meibomian gland dysfunction in Indian eyes - A cross-sectional study

Purpose:

To evaluate the correlation of Meiboscale with symptom score (Ocular Surface Disease Index [OSDI]) and meibomian gland dysfunction (MGD) sign score.

Methods:

We performed a cross-sectional hospital-based study of 53 patients of primary MGD who filled the OSDI questionnaire form and underwent complete ocular examination. The MGD sign score was calculated in both eyes using the sum of six grading systems proposed by Arita et al. in 2016. The participants underwent imaging of the upper and lower eyelids of both eyes (212 eyelids) by specular microscope. The area of meibomian gland loss (MGL) was visually assessed and scored using the Meiboscale photographic card. Correlation between these three values – OSDI score, sign score, and MGL score based on Meiboscale - was calculated using Spearman’s correlation analysis and Jonckheere–Terpstra (J–T) test. Correlation coefficient r_s > 0.5 was considered clinically significant.

Results:

Associations between MGL score and OSDI score, as well as between OSDI and sign score were statistically significant, but not clinically significant (r_s = 0.3684, P < 0.001 and r_s = 0.41179, P < 0.001, respectively). The association between MGL score and MGD sign score was statistically as well as clinically significant (r_s = 0.8392, P < 0.001). J–T test revealed large effect size (P < 0.001, r-effect = 0.93).

Conclusion:

The Meiboscale card had not been tested for utility in the Indian outpatient setting yet. Meiboscale can be used for reliable assessment and grading of MGD, and has clinical utility similar to the sum of six MGD sign scores. Additionally, assessment of symptoms using OSDI or a similar questionnaire is also recommended.

Comparison of generic and specific instruments to assess the quality of life in patients with melasma

Objective

To compare the psychometric performance of a generic and specific instruments in assessing melasma-related quality of life.

Methods

A cross-sectional study was conducted with 150 patients with melasma attending an outpatient dermatology clinic of a public hospital in São Paulo state, Brazil. Data were collected using a questionnaire containing sociodemographic and clinical data as well as the generic WHOQOL-BREF, and the dermatological-specific Skindex-16 and HRQ-Melasma.

Results

The overall internal consistency of the domains of the three instruments was ≥ 0.7. A strong positive correlation was identified between the Skindex-16 and HRQ-Melasma domains (0.68-0.78). Item-response theory showed that most Skindex-16 and HRQ-Melasma domains were more informative than WHOQOL-BREF.

Conclusion

The three instruments for assessing QOL tested presented good psychometric performance, with satisfactory internal consistency values. Only the two dermatological instruments, however, demonstrated a strong correlation between the domains that assess social, emotional, and functional aspects of QOL, indicating that both were able to identify impairments in other QOL dimensions in addition to the physical domain.

Histological changes in facial melasma after treatment with triple combination cream with or without oral tranexamic acid and/or microneedling, a randomised clinical trial

BACKGROUND

Melasma is an acquired dyschromia with several histologic alterations in the epidermis, basement membrane and upper dermis. The treatment of melasma is challenging due to the irregular response and chronicity of the disease. To date, there are no curative strategies, largely due to the limited understanding of the intrinsic effects of each treatment.

OBJECTIVES

The objective of the study was to evaluate the histological changes promoted by triple combination cream, with or without complementary treatment with microneedling and oral tranexamic acid, in the treatment of melasma.

METHODS

A factorial, randomised, controlled and evaluator-blinded clinical trial was performed involving 64 women with facial melasma, divided in four groups, who underwent 60 days of treatment with triple combination cream alone (control group) or combined with two monthly microneedling sessions (microneedling group), TA 250 mg twice daily (tranexamic acid group), or both tranexamic acid group and microneedling group. The participants underwent biopsy of the area with melasma at inclusion (D1) and D60. The primary outcomes were the variation (D1 × D60) between the variables: Thickness of the epidermis and stratum corneum, stratum corneum compaction and solar elastosis; melanin density in the epidermis and upper dermis; proportion between the extension of the nonintact and intact basement membrane zone; mast cell count in the upper dermis; melanocyte count in the basal layer, pendulum melanocyte count and melanocyte area; immunostaining density of vascular endothelial growth factor; stem cell factor and keratinocyte growth factor.

RESULTS

One participant in the TG discontinued tranexamic acid due persistent headache; and herpes simplex occurred in three patients after microneedling. The groups showed a 24% (CI95%: 17-35%; P < 0.01) reduction in epidermal melanin density. There was no change in dermal melanin density or the area of melanocytes after treatment. There was an overall 25% (CI95%: 7-42%; P < 0.01) reduction in the number of pendulum melanocytes, especially in the microneedling and tranexamic acid group, that presented a 41% (CI95%: 7-73%; P < 0.01) reduction. The extension of the nonintact basal membrane relative to the intact basal membrane decreased after treatment, especially in microneedling group and microneedling and tranexamic acid group. There was an increase of 13% (CI95%: 5-21%; P = 0.02) in epidermal thickness and 6% (CI95%: 0-22%; P = 0.04) thinning of the stratum corneum in the groups. All groups showed stratum corneum compaction. Solar elastosis improved only in the microneedling group and microneedling and tranexamic acid group. Vascular endothelial growth factor immunostaining increased 14% (CI95%: 4-24%; P = 0.03) in the groups; and stem cell factor increased only in microneedling group. There was no change in the number of mast cells, CD34 and keratinocyte growth factor immunostaining.

LIMITATIONS

The site of biopsy may not represent all of the facial melasma and the immunohistochemical sensitivity of the cytokines does not have a stoichiometric relationship with proteins.

CONCLUSION

A greater thickness of the epidermis is associated with melasma bleaching. Dermal melanin seems to have no impact on melasma prognosis. Damage to the skin barrier and stimulus of angiogenesis should be avoided in the treatment of melasma. Microneedling complements the topical treatment of melasma by improving patterns of skin photoaging. Oral tranexamic acid complements the topical treatment of melasma by inhibiting the stem cell factor.

Prevalence and factors associated with gynoid lipodystrophy in Brazilian adolescent girls: a cross-sectional study

BACKGROUND

Gynoid lipodystrophy (GLD), or female cellulitis, is a chronic multifactorial disorder characterized by the irregular appearance of the skin surface on the thighs and gluteal regions, which affects 80-90% of women after puberty. No curative treatments are available, and there is a paucity of epidemiological studies related to its prevalence, quality of life impact, and risk factors. We aimed to identify the prevalence and factors associated with the development of GLD in Brazilian adolescent girls.

METHODS

A cross-sectional study examined adolescent girls from São Paulo, Brazil. The explored factors were grouped: familial history, gynecological and hormonal characteristics, exercise practice, nutrition and diet, anthropometric measures, body mass index, and body composition, according to GLD severity assessed through multivariate hierarchic statistics.

RESULTS

In total, 184 girls, aged from 12 to 18 years, were included in the study. The overall prevalence of GLD was 77.7% (CI 95% 71.7-82.1%); moderate and severe categories of GLD occurred in 56.5% (CI 95% 48.9-62.5%) of the sample. An impact on the quality of life was identified in 39.7% of the girls. GLD was independently associated with higher body mass index, early menarche, higher carbohydrate intake, lower water consumption, menstrual irregularity, familial report of GLD, and less exercise practice.

CONCLUSION

Gynoid lipodystrophy is a multifactorial disorder; its onset in adolescent girls is associated with familial occurrence, body composition, diet habits, exercise, and hormonal factors. These results support further interventions for GLD prevention and treatment.

Percepção de mulheres sobre o teleatendimento durante o período de pandemia do coronavírus (SARS-CoV-2)

Resumo Introdução Desde que foi declarada a pandemia do novo coronavírus (SARS-CoV-2), a área da saúde foi um dos campos que sofreu significativas modificações. O teleatendimento em saúde, que consiste na utilização de recursos tecnológicos e de comunicação para prestar assistência em saúde, foi uma alternativa encontrada para continuar, de maneira segura, o cuidado com os pacientes enquanto vigoravam as medidas de quarentena e isolamento social. Objetivo Analisar a percepção de mulheres assistidas em um hospital-escola do nordeste do Brasil referente ao teleatendimento implantado durante a pandemia de COVID-19. Métodos Estudo descritivo transversal realizado no Ambulatório de Fisioterapia da Mulher do Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), em Recife/PE. Foram incluídas mulheres maiores de 18 anos, em assistência remota via teleatendimento, excluindo aquelas que não deram continuidade ao atendimento por telessaúde. Para a coleta de dados, realizada de novembro de 2020 a julho de 2021, utilizou-se um questionário próprio, que foi enviado via WhatsApp para as participantes do estudo. Resultados Foram entrevistadas 26 pacientes com idade média de 52 ± 10,1 anos. A maioria (61,5%) foi atendida no ambulatório para tratar incontinência urinária e 38,5% estavam em tratamento fisioterapêutico há pelo ao menos seis meses. A maioria (92,3%) relatou se sentir segura com a assistência remota e 70,4% perceberam melhora dos sintomas. Conclusão A maior parte das participantes percebeu melhora dos sintomas, sentindo-se confortável e segura com o teleatendimento, e aceitaria continuar com o tratamento à distância mesmo após o retorno das atividades presenciais. Para uma resposta mais efetiva, contudo, as pacientes precisam ser bem orientadas e ter algum conhecimento prévio acerca do tratamento a ser proposto pela fisioterapia.

Perception of women about telehealth during the coronavirus pandemic (SARS-CoV-2)

Abstract Introduction Since the new coronavirus (SARS-CoV-2) was declared a pandemic, health care was one of the fields that underwent significant changes. Telemedicine, that uses technological and communication resources to provide health care, was deemed a safe alternative to continue patient care while quarantine and social isolation measures were in place. Objective To analyze the perception of women treated at an outpatient clinic in relation to remote health care implemented during the COVID-19 pandemic. Methods Descriptive research conducted at the Women’s Physiotherapy Outpatient Clinic of the Prof. Fernando Figueira Comprehensive Medicine Institute (IMIP) in Recife, Pernambuco state, Brazil. The study included women above the age of 18 years who were being remotely treated and excluded those who discontinued treatment. Data were collected from November 2020 to July 2021, using a questionnaire which was sent to the participants via WhatsApp. Results Twenty-six women with an average age of 52 ± 10.1 years were interviewed. Most (61.54%) were being treated for urinary incontinence at the outpatient clinic and 38.5% had been undergoing physiotherapy for at least six months. A total of 92.3% of the participants reported feeling safe with remote health care and 70.4% noticed an improvement in their symptoms. Conclusion Most patients noticed an improvement in their symptoms, felt comfortable and safe with teleservices and would agree to continue even after returning to in-person care. However, to ensure more effective results, patients need to be well informed and have some prior knowledge about the proposed treatment.

Development and Validation of a Dermoscopic Severity Score for Female Pattern Hair Loss

Introduction: Despite the high prevalence and impact on quality of life, there are no objective methods to estimate the severity of female pattern hair loss (FPHL). Here, we aimed to develop a dermoscopic severity score for FPHL. Methods: Cross-sectional study involving 76 women with FPHL and 12 controls. Standardized dermoscopic photos of the scalp were taken to evaluate the main findings of FPHL. The variable selection and their scores in the final model were defined by multivariate methods. Twenty participants were retested to assess the reliability, and 10 participants were tested before and after treatment for estimating its sensibility to change after 6 months. Results: Eight patients (11%) presented the Sinclair clinical scale grade I, 40 (53%) presented at grade II, 19 (25%) presented at grade III, and 9 (12%) presented at grades IV and V. In the multivariate exploration, the following variables were considered significant: total terminal hairs, total miniaturized hairs, brown peripilar sign, scalp honeycomb pigmentation, white peripilar sign, and yellow dots. The final model resulted in a high correlation (rho = 0.89) with the ranked clinical assessment. Conclusion: An objective and reliable severity score of FPHL was developed and validated, allowing its use as an additional outcome in therapeutic trials.

Dynamic Changes and Temporal Association with Ambient Temperatures: Nonlinear Analyses of Stroke Events from a National Health Insurance Database

BACKGROUND

The associations between ambient temperatures and stroke are still uncertain, although they have been widely studied. Furthermore, the impact of latitudes or climate zones on these associations is still controversial. The Tropic of Cancer passes through the middle of Taiwan and divides it into subtropical and tropical areas. Therefore, the Taiwan National Health Insurance Database can be used to study the influence of latitudes on the association between ambient temperature and stroke events.

METHODS

In this study, we retrieved daily stroke events from 2010 to 2015 in the New Taipei and Taipei Cities (the subtropical areas) and Kaohsiung City (the tropical area) from the National Health Insurance Research Database. Overall, 70,338 and 125,163 stroke events, including ischemic stroke and intracerebral hemorrhage, in Kaohsiung City and the Taipei Area were retrieved from the database, respectively. We also collected daily mean temperatures from the Taipei and Kaohsiung weather stations during the same period. The data were decomposed by ensemble empirical mode decomposition (EEMD) into several intrinsic mode functions (IMFs). There were consistent 6-period IMFs with intervals around 360 days in most decomposed data. Spearman's rank correlation test showed moderate-to-strong correlations between the relevant IMFs of daily temperatures and events of stroke in both areas, which were higher in the northern area compared with those in the southern area.

CONCLUSIONS

EEMD is a useful tool to demonstrate the regularity of stroke events and their associations with dynamic changes of the ambient temperature. Our results clearly demonstrate the temporal association between the ambient temperature and daily events of ischemic stroke and intracranial hemorrhage. It will contribute to planning a healthcare system for stroke seasonally. Further well-designed prospective studies are needed to elucidate the meaning of these associations.

Psychometric characteristics of DLQI-BRA and Skindex-16 to measure the impact of dermatological diseases on quality of life in Brazilian patients

OBJECTIVE

To compare the psychometric performance of the Dermatology Life Quality Index (DLQI-BRA) and Skindex-16 to assess quality of life (QoL) in Brazilian patients with dermatological diseases.

METHODS

This was a cross-sectional study carried out in a dermatology outpatient clinic of the São Paulo State University, with 188 patients with dermatological diseases. QoL was evaluated using the Dermatology Life Quality Index (DLQI-BRA) and Skindex-16. Cronbach's alpha and Intraclass Correlation for Perfect Concordance (ICC) were used to analyse the reliability and temporal stability, respectively.

RESULTS

A positive correlation was found between the total Skindex-16 score and DLQI-BRA (0.75). Both instruments showed a significant (p< 0.01) reduction in their scores at the second assessment, demonstrating that they were sensitive in detecting changes in responsiveness in cases where there was a clinical change. Cronbach alpha coefficients for the instruments showed satisfactory performance (>0,7), but Skindex-16 displayed the highest Cronbach alpha (0.94; CI = 0.93-0.95).

CONCLUSION

Both instruments tested showed a good psychometric performance assessing QoL in patients with skin dermatoses. The instruments displayed reliability and temporal stability as well as responsiveness.

Immunopathological Response, Histological Changes, Parasitic Burden, and Egg Output in Sheep Naturally Infected by Dicrocoelium dendriticum

Simple Summary

Dicrocoelium dendriticum, commonly known as the lancet liver fluke, is a liver parasite that affects ruminants and occasionally other species, including humans. The aim of this study was to investigate the histological modification and the phenotype of inflammatory cells in the livers of sheep naturally infected with D.dendriticum and the correlation of these variables with the parasitic burden, egg output, and gross appearance of the liver. We studied twenty-four sheep selected on the basis of positive D. dendriticum fecal egg counts. Gross and histological modifications of the liver and the number of adult D. dendriticum worms were examined. Macroscopically, the livers were swollen with thickened bile ducts, cholangitis, and fibrosis. Histologically, we observed leucocyte infiltration, bile duct hyperplasia, and fibrosis. Lesions were present in different degrees of severity and were scored. A significant positive association was observed between the number of adult worms recovered from the liver, egg per gram, macroscopic lesions, fibrosis, and bile duct hyperplasia. A significant negative association was observed among these variables and the degree of leukocyte infiltration. The immunohistochemical examination showed a CD3+ predominant cell population in all assessed animals. These findings allow us to better understand the complex mechanism of the host–parasite interaction, in relation to the egg output and parasitic burden in dicrocoeliosis.

Abstract

The aim of this study was to investigate the correlation between infection by Dicrocoelium dendriticum (class Trematoda) and the animal host response in terms of macroscopic lesions, the immunopathological response, and histological changes in the livers of naturally infected sheep. Twenty-four sheep were selected on the basis of positive D. dendriticum fecal egg counts (FECs). Gross and histological injuries were scored. A positive significant association was observed between the number of adult worms recovered from the liver, FEC, macroscopic lesions, fibrosis, and bile duct hyperplasia. A significant negative association was observed among these variables and the degree of leukocyte infiltration. In addition, immunophenotyping of the inflammatory cells was carried out using primary antibodies against T cell epitopes (CD3+, CD4+, and CD8+), B cell epitopes (CD79α), and the ionized calcium-binding adapter molecule 1 (IBA-1) antigen. Independently of the severity of the D. dendriticum infection, the predominant cell population was CD3-positive and associated with lesser numbers of CD79α- and Iba-I-positive cells. An increase in Iba-1-positive cells was observed in the livers of animals with a high worm burden. Our results provide a reference basis to better understand the local immune response in sheep naturally infected by D. dendriticum in relation to the FEC and parasitic burden.

Gait speed and functional performance in elderly women with knee osteoarthritis

Abstract Introduction: Knee osteoarthritis is a degenerative and inflammatory disease that causes skeletal muscle dysfunction and induces limitation of functional activities, such as gait. Objective: To assess the relationship between gait speed and functional performance in elderly women with knee osteoarthritis. Methods: 38 elderly women were divided into two groups: knee osteoarthritis group (KOAG) (n = 24, 68 ± 4.42) and control group (CG) (n = 14, 66.35 ± 3.54). Gait speed data was assessed through Qualisys system and functional performance through a checklist of the International Classification of Functioning, Disability and Health (ICF). Results: Comparing with CG (p < 0.05), KOAG patients had lower gait speed (p = 0.004) and worse functional performance in d4500 (walking short distances), d4501 (walking long distances), d4502 (walking on different surfaces), and d4503 (walking around obstacles) ICF categories. By associating gait speed and functional performance in KOAG, significant differences were found in the d4500 (p = 0.019) and d4501 (p = 0.035) categories, but none for either the d4502 (p = 0.511) or d4503 (p = 0.076) categories. Gait speed was negatively correlated with d4500 (rho = -0.585, p = 0.003), d4501 (rho= -0.552, p = 0.005), and d4502 (rho = -0,548, p = 0,006). Conclusion: Gait speed is related to functional performance in elderly women with knee osteoarthritis for the activities of walking short distances, walking long distances, and walking on different surfaces. However, it seems that gait speed is not related to walking around obstacles.

Validation of the Skindex-17 quality of life assessment instrument for a Brazilian population

BACKGROUND

Health-related quality of life assesses how diseases affect the daily life of people; there are several generic instruments for this assessment in dermatology. Skindex was created in 1996; it is a multidimensional instrument, aiming to encompass some psychological and social aspects not yet addressed by other questionnaires. Among its versions (Skindex-29, 16, and 17), Skindex-17 had not been validated in Brazil.

OBJECTIVES

To validate Skindex-17 for use in Brazilians with dermatological diseases.

METHODS

This was a methodological, cross-sectional, and prospective study of 217 patients attended at the Dermatology Service Outpatient Clinic, Faculdade de Medicina de Botucatu - Universidade Estadual Paulista (Botucatu, SP, Brazil), from December 2017 to September 2019. The following were evaluated: content validity, filling time, internal consistency, dimensional structure, concurrent validity (DLQI), temporal stability, and responsiveness.

RESULTS

The sample consisted of 71% women, mean age (SD) of 45 (16) years; phototypes II-IV accounted for 95% of the cases. Cronbach's alpha coefficients were 0.82 and 0.93 for the symptoms and psychosocial conditions, respectively. A high correlation was observed with the DLQI score: symptoms (rho = 0.69) and psychosocial conditions (rho = 0.75). The instrument's two-dimensional structure was confirmed through confirmatory factor analysis. Temporal stability (ICC > 0.9) and score responsiveness (p ≤ 0.02) were verified. The instrument was shown to be feasible in clinical practice due to the content validation performed by professionals and patients, as well as the low time spent completing it (< 5 min).

STUDY LIMITATIONS

Single-center study, with patients exclusively from the public healthcare system.

CONCLUSIONS

Skindex-17 was shown to be a valid and consistent instrument for assessing quality of life among patients with dermatological diseases, in Brazil. Its two-dimensional structure was confirmed.

Development of a clinical scale to assess the severity of striae distensae

BACKGROUND AND OBJECTIVE

There is no validated instrument to assess the clinical severity of striae distensae. Here, we aimed to develop a striae distensae severity scale.

MATERIAL AND METHODS

After a Delphi-based consensus, 15 items related to striae severity were assessed in 110 areas (breasts, abdomen, and buttocks) from 45 participants. The items were analyzed through a partial least squares model to select the most important variables. To assess the reliability of the scale, 43 areas were retested.

RESULTS

Of the 110 areas evaluated, 34 were breasts, 24 abdomens, and 52 buttocks. Striae were considered mild in 30% of the evaluations, moderate in 33%, severe in 21%, and extremely severe in 16%. The final model was composed by: width of the widest striae, width of the striae with the most frequent pattern, atrophy, number of affected quadrants, distribution (multiple or isolated), hypo or hyperchromia and topography. The scores of the scale demonstrated a high correlation with the clinical classification (rho = 0.77). There was a high agreement in the scores from the reassessed areas (intraclass correlation coefficient = 0.90).

CONCLUSION

An objective and reliable scale to assess the clinical severity of striae distensae on the breasts, abdomen, and buttocks was developed.

Prevalence and factors associated with depression and anxiety in patients with psoriasis

OBJECTIVE

To identify the prevalence and factors associated with depression and anxiety in patients with psoriasis.

BACKGROUND

Psoriasis is a chronic, non-contagious, autoimmune inflammatory skin disease associated with psychological comorbidities.

DESIGN

A cross-sectional study conducted between March 2017-December 2018 in a dermatology infirmary and outpatient clinic of a public hospital in the inner State of São Paulo (Brazil).

METHODS

We used questionnaires with sociodemographic data and clinical history, the HADS (Hospital Anxiety and Depression Scale), DLQI-BRA (Dermatology Life Quality Index) and PASI (Psoriasis Area Severity Index). The correlations between variables were explored using multivariate techniques. STROBE checklist was applied as the reporting guideline for this study (File S1).

RESULTS

A total of 281 participants were included, of which the majority were female 146 (52%), with a mean age of 52.1 years (SD: 13.8), elementary school 154 (55%), married/cohabiting 209 (74%) and with low income 201 (72%). The median (p25-p75) time with the disease was 14 years (7-23). Regarding the quality of life, 31% of respondents reported being little affected by the disease. The prevalence of depression was 19% and that of anxiety was 36%. The multivariate analysis showed that the variables that influenced the anxiety and depression scores were as follows: DLQI-BRA, income, female sex, illness length and age. For the multiple correspondence analysis, the highest levels of anxiety and depression referred to women, middle age, lower income and low PASI.

CONCLUSION

The prevalence of anxiety and depression symptoms was low. Female sex, income, age, illness length and quality of life were associated with anxiety and depression scores in patients with psoriasis.

RELEVANCE TO CLINICAL PRACTICE

Due to the scarcity of studies in the field of nursing with psoriasis patients, we believe these findings contribute to the reorganisation of the care provided, allowing nurses to timely identify mood disorders such as anxiety and depression and adopt the necessary measures to a service and/or specialised referral.

Integrative Approach to Assessing the Complex of Correlations between Indicators of Physiological Functions

We present the results of application of the combined correlation matrix method in some clinical studies. A practical algorithm is proposed for constructing a correlation matrix that compactly reflects a large number of interconnections for the situations when several diagnostic methods are used in an experimental clinical or preclinical trial. Several approaches to assessing and displaying the relationships are demonstrated for comparison.

The Role of Social Support in Participation Perspectives of Caregivers of Children with Intellectual Disabilities in India and South Africa

Caregivers are an intrinsic component of the environment of children with intellectual disabilities. However, caregivers' capacity to support children's participation may be linked to the social support that they, as caregivers, receive. Social support may increase participation, educational, psychological, medical and financial opportunities. However, there is a lack of information on social support in middle-income countries. The current study described and compared the social support of caregivers of children with intellectual disabilities by using the Family Support Survey (FSS) in India and South Africa. The different types of social support were subsequently considered in relation to participation, using the Children's Assessment of Participation and Enjoyment (CAPE). One hundred caregiver-child dyads from India and 123 from South Africa participated in this study. The data were analysed using non-parametric measures. Indian caregivers reported greater availability of more helpful support than did the South African caregivers. Social support was associated with children's participation diversity (India) and intensity (South Africa). The child-/caregiver-reported participation data showed different associations with participation. Results from this study suggest that perceived social support of caregivers differs between countries and is associated with their child's participation. These factors need to be considered when generalising results from different countries.

Dimensionality and psychometric analysis of DLQI in a Brazilian population

Background

The Dermatology Life Quality Index (DLQI) is the most commonly used instrument for clinical evaluation of the impact on health-related quality of life (HRQOL) in dermatological research protocols. The DLQI’s classical psychometric properties have been considered adequate in validation studies from several countries. However, the structure of the DLQI is a matter of discussion, especially concerning the dimensionality and informative properties of its questions according to the item response theory (IRT).

Methods

Pooled data from studies in Brazil that utilized the DLQI to assess HRQOL in 14 dermatoses were reanalyzed. Classical psychometrical analysis, dimensionality assessment through parallel analysis and IRT (Samejima’s ordinal model) analysis were performed.

Results

The sample consisted of 1286 patients with a mean age of 47 years (SD = 16), and the proportion of women was 59% (765). The DLQI scores ranged from 0 to 29, with a median (p₂₅–p₇₅) of 5 (2–11). All items indicated significant correlations with the total DLQI score (rho > 0.54). The Cronbach’s alpha result was 0.90 (CI 95% 0.89–0.91). Parallel analysis indicated a unidimensional factor structure. According to IRT analysis, items q6 (sports) and q7 (work/study) exhibited insufficient fit to the model (p < 0.01), while the items that indicated the best discrimination and information functions were q2 (embarrassment), q3 (shopping/gardening), q4 (clothing) and q5 (social/leisure). The ordination of the scores was confirmed for all items. Most items revealed non-uniform behavior according to sex, age and type of disease.

Conclusions

The DLQI exhibits adequate psychometric reliability and a unidimensional structure for assessing HRQOL in Brazilian dermatological patients. The DLQI’s performance varies in the assessment of HRQOL in heterogeneous samples.

Exploratory Study of Epidermis, Basement Membrane Zone, Upper Dermis Alterations and Wnt Pathway Activation in Melasma Compared to Adjacent and Retroauricular Skin

BACKGROUND

Melasma is a chronic acquired focal hypermelanosis which pathogenesis has not been fully elucidated. Classical pathophysiologic studies have analysed the affected and perilesional areas, but little is known about the status of sun-protected skin, which is subjected to the same endogenous and genetic factors.

OBJECTIVE

To assess the histological characteristics of melasma compared to adjacent and retroauricular skin.

METHODS

Skin samples were collected from 10 female from: melasma, perilesional area and retroauricular. The samples were stained (haematoxylin-eosin, periodic acid-Schiff, Fontana-Masson, picrosirius red, toluidine blue and Verhoeff), immunolabelled for CD34 and Wnt1. The data from the skin sites were analysed simultaneously by a multivariate model.

RESULTS

Melasma skin exhibited noteworthy stratum corneum compaction, greater collagen heterogeneity, solar elastosis, higher number of mast cells, basement membrane zone (BMZ) damage, Wnt1 expression, pendulum melanocytes, higher cellularity and vascular proliferation at the superficial dermis. Stratum corneum compaction, collagen heterogeneity and BMZ abnormalities were variables associated to melasma that not follow a continuum through retroauricular to adjacent skin. Mast cell count was the variable that disclosed correlation with the most other abnormalities as well as had the greater contribution in the multivariate model.

CONCLUSION

In addition to melanocyte hyperactivity, melasma skin exhibits alterations in the epidermal barrier, upper dermis and BMZ, which differ from the adjacent sun-exposed skin and retroauricular skin, indicating a distinct phenotype, rather than a mere extension of photoageing or intrinsic ageing. Mast cells appear to play a central role in the physiopathology of melasma.

Stigmatization and Quality of Life in Patients with Psoriasis

Introduction

Each dermatological condition associated with the presence of visible skin lesions can evoke the following psychological response of the patient: shame, anxiety, anger, or even depression. Psoriasis may additionally be a cause of social rejection, which significantly impairs a patient’s private life and social functioning, and may contribute to stigmatization, alienation, and deterioration of their quality of life. The aim of the study was to determine the level of stigmatization and the quality of life of persons with psoriasis in relation to sociodemographic characteristics.

Methods

The study, which included 166 patients with plaque psoriasis, was carried out with the 33-item Feelings of Stigmatization Questionnaire, Dermatology Life Quality Index (DLQI), and a dedicated sociodemographic survey.

Results

Compared with women, men had higher stigmatization scores in the “Feeling of being flawed” domain (p = 0.0362), and patients up to 30 years of age scored higher on the “Guilt and shame” domain (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\bar{x}$$\end{document}x¯ = 17.1 points) than those older than 30 years (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\bar{x}$$\end{document}x¯ = 14.6 points). Also, persons with visible skin lesions presented with higher stigmatization levels in the “Guilt and shame” domain than those without (p = 0.0028). Quality of life in persons with psoriasis did not depend on sociodemographic parameters but correlated significantly with two stigmatization domains, “Sensitivity to the opinions of others” (R = 0.31; p = 0.0030) and “Positive attitudes” (R = 0.27; p = 0.0115).

Conclusions

As stigmatization is a social problem, only greater social awareness of psoriasis may contribute to better understanding and broader acceptance of patients with this dermatosis. To help them to cope with the stigmatization and hence to improve their quality of life, persons with psoriasis should be provided with psychological counselling.

Contribution to characterization of skin field cancerization activity: morphometric, chromatin texture, proliferation, and apoptosis aspects

BACKGROUND

A skin field cancerization is a cutaneous area with subclinical changes resultant from chronic sun exposure, with a higher predisposition to development of pre-neoplastic and neoplastic lesions. So far, there are no well-defined objective parameters that can indicate their degree of activity.

OBJECTIVES

To describe and compare morphometric aspects and expression of factors related to apoptosis and cell proliferation in actinic keratosis (AK), in both photoexposed and photoprotected epidermis.

METHODS

A cross-sectional study of patients with actinic keratosis in the forearms, biopsied at two points: the actinic keratosis and the axillary region. The biopsies of the actinic keratosis, perilesional area, and axilla were evaluated through keratinocyte intraepithelial neoplasia (KIN), and immunohistochemistry of p53, survivin, and Ki67. Nuclear morphometry of basal layer cells was performed through digital image analysis: entropy, area, perimeter, Ra, fractal dimension, circularity, color intensity, and largest diameter.

RESULTS

There were 13 patients included and 38 actinic keratosis biopsied. In morphometry, 1039 nuclei were analyzed, of which 228 represented axillary skin, 396 demonstrated actinic keratosis, and 415 represented the perilesional area to the actinic keratosis. There was a significant difference (p<0.05) in all variables tested for the topographies evaluated. A significant correlation was identified between nucellar morphometric elements, KIN, proliferation markers, and apoptosis. Joint patterns of p53, Ki67, and KIN discriminated the topographies sampled.

STUDY LIMITATIONS

This was a cross-sectional study with a small number of patients.

CONCLUSIONS

There are patterns of proliferation, resistance to apoptosis, and different cellular morphometrics between photoprotected skin and photoexposed skin. The joint expression of p53, Ki67, and KIN can characterize skin field cancerization activity.

Application of correlation analysis in cytology: Opportunities to study specific activity of follicular thyrocytes

The task of biomedical diagnostics is to determine the dependence of the conclusion/diagnosis on the sets of parameters that characterize the state of the biosystem/patient. The performed analytical review of modern scientific literature permitted us to determine that Bayesian, regression and correlation analyzes and logical programming are most often used for biomedical diagnostics purposes. At the same time, their informativeness can only be realized for the solution of those diagnostic tasks in which quantitative parameters are analyzed. Qualitative and binary information provides an opportunity to find out more about features of the biosystem’s state. However, its use is limited, since the results obtained are presented in words (that is, in a linguistic form) that cannot be processed by means of traditional (digital) mathematical analysis. The objective of this work was determining the capabilities of the mathematical apparatus to deepen the study of hormonopoiesis in the thyroid gland. The object of the study was electron micrographs of ultrathin tissue sections, its subject was the features of correlations between ultrastructural cell elements which carry out the processes of synthesis and secretion in follicular thyrocytes. In the context of studying the features of synthetic and secretory activity of follicular thyrocytes of the thyroid glands in white male rats, it was shown that the objectification of non-numerical information about the state of cells allows us to use linguistic information about changes in their morphofunctional state. Implementation of correlation analysis for studying the relationships and interdependencies between organelles which implement synthesis and secretion of the hormonal product in the main structural unit of the thyroid gland – follicular thyrocyte – allows us to determine, study, analyze and generalize peculiarities of both changes in individual ultrastructures and their functional complexes (clusters) in response to the actions of various factors and to trace the interdependencies and mutual interactions existing between them, as well as to deepen the idea of the intimate mechanism features of the specific directions of follicular thyrocyte activity, which substantially expands the research platform in cytophysiology and cytomorphology.

Anomalous values and missing data in clinical and experimental studies

During analysis of scientific research data, it is customary to encounter anomalous values or missing data. Anomalous values can be the result of errors of recording, typing, measurement by instruments, or may be true outliers. This review discusses concepts, examples and methods for identifying and dealing with such contingencies. In the case of missing data, techniques for imputation of the values are discussed in, order to avoid exclusion of the research subject, if it is not possible to retrieve information from registration forms or to re-address the participant.