Validation studies of the clock drawing test in mild cognitive impairment

Introduction: Mild Cognitive Impairment (MCI) is a transitional entity between normal aging and Alzheimer’s disease. It is assumed that an early identification and intervention in MCI may delay or slow its progression to dementia and several neuropsychological brief-tests have been investigated in this context. The Clock Drawing Test (CDT) is a widely used instrument in this field; however, its application needs further validation in specific clinical populations, mainly in milder forms of cognitive decline and in the distinction between MCI subtypes. Objectives: To validate three scoring systems of the CDT for the detection of cognitive impairment in a cohort of MCI-patients previously classified in amnestic single-domain (aMCI) and amnestic multidomain (mdMCI) subtypes; to test inter-rater reliability and to compare different subtypes of MCI, attempting to define performance profiles according to qualitative analyses of errors. Methods: The study includes two clinical groups: aMCI and mdMCI, each with 90 subjects, recruited at the Neurology Department of the Centro Hospitalar e Universitário de Coimbra. Their performance was compared with a cohort of 90 community-dwelling controls matched according to gender, age and education. All participants were assessed with Mini Mental State Examination, Montreal Cognitive Assessment (MoCA) and CDT. Clock drawings of MCI patients were scored by a neuropsychologist and an inexperienced rater using three scoring systems - Rouleau, Cahn and Babins. Data were analysed with the Statistical Package for the Social Sciences. Results: There was high inter-rater reliability in CDT scoring systems (p<0,001). Significant correlations were found between the cognitive screening instruments and CDT scoring systems as well as a consistent relationship with performance in visuospatial and executive domains of the MoCA. We also observed qualitative differences between both forms of DCL, with higher error rate of “Conceptual deficit” and “Perseveration” in mdMCI, and “Nonspecific spatial error” regarding the aMCI group. There was only sufficient (60%) discriminatory capacity of total scores of the CDT, comparing control and MCI subjects. Conclusions: Our study showed that CDT scoring systems have high inter-rater reliability to screen for MCI and can be applied in large scale studies and primary health care. Although in this context CDT revealed only sufficient discriminatory capacity and should be used with other cognitive screening tests in order to increase the diagnostic accuracy

Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID‐19 infection: a systematic review

© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Background: Cardiovascular autonomic dysfunction may reportedly occur after a coronavirus-disease-2019 (COVID-19) infection, but the available evidence is scattered. Here we sought to understand the acute and mid-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiovascular autonomic function. Methods: We performed a systematic PubMed, Embase, Web of Science, medRxiv, and bioRxiv search for cases of cardiovascular autonomic dysfunction during an acute SARS-CoV-2 infection or post-COVID-19 condition. The clinical-demographic characteristics of individuals in the acute versus post-COVID-19 phase were compared. Results: We screened 6470 titles and abstracts. Fifty-four full-length articles were included in the data synthesis. One-hundred and thirty-four cases were identified: 81 during the acute SARS-CoV-2 infection (24 thereof diagnosed by history) and 53 in the post-COVID-19 phase. Post-COVID-19 cases were younger than those with cardiovascular autonomic disturbances in the acute SARS-CoV-2 phase (42 vs. 51 years old, p = 0.002) and were more frequently women (68% vs. 49%, p = 0.034). Reflex syncope was the most common cardiovascular autonomic disorder in the acute phase (p = 0.008) and postural orthostatic tachycardia syndrome (POTS) the most frequent diagnosis in individuals with post-COVID-19 orthostatic complaints (p < 0.001). Full recovery was more frequent in individuals with acute versus post-COVID-19 onset of cardiovascular autonomic disturbances (43% vs. 15%, p = 0.002). Conclusions: There is evidence from the scientific literature about different types of cardiovascular autonomic dysfunction developing during and after COVID-19. More data about the prevalence of autonomic disorders associated with a SARS-CoV-2 infection are needed to quantify its impact on human health.info:eu-repo/semantics/publishedVersio

Desenvolvimento de um bioprocesso para beneficiamento da torta de castanha do BRASIL (Bertholletia excelsa)

A castanha-do-pará, ou castanha-do-Brasil (Bertholletia excelsa H.B.K.) é cultivada em toda a Amazônia e se tornou um dos principais produtos comerciais da Região Norte do Brasil, apresentando uma amêndoa de alto valor energético, com cerca de 60 a 70% de óleo, 15 a 20% de proteínas, sendo estas, uma das mais ricas fontes de aminoácidos sulfurados (8% cisteína e 18% metionina) e selênio, que tem função antioxidante, aumentando assim o interesse do mercado consumidor e de pesquisadores. As amêndoas quebradas ou com algum defeito, geralmente 10% do total, têm seu valor comercial reduzido em 60%, e são utilizadas principalmente por pequenas indústrias para extração do óleo, gerando como subproduto uma torta, rica em proteínas, que geralmente era utilizada como ração animal. Atualmente a torta de castanha-do-pará tem tido aplicação no enriquecimento e preparo de alimentos, como biscoitos, doces, farinhas, pães e outros. Para valorização deste subproduto há alguns estudos que propõem o isolamento, modificação (acetilação) ou concentração da globulina, ou excelsina, uma das principais proteínas da castanha-do-pará, incorporando aos alimentos melhores características funcionais, como emulsificação, viscosidade e solubilidade. O objetivo deste trabalho é promover uma valorização da torta da castanha-do-pará através de um processo enzimático envolvendo enzimas celulolíticas, amilolíticas e proteolíticas, obtendo produtos protéicos, como concentrados, isolados e hidrolisados, ricos em aminoácidos e selênio, de grande interesse para indústria de cosméticos, para formulação de cremes hidratantes e condicionadores capilares, e na indústria alimentícia, como flavorizantes e emulsificantes. Em uma escala piloto, 70% da torta de castanha foram convertidos em produtos, sendo que destes 27% de produtos protéicos (com concentrações de 12% p/p de albumina e 27% p/p de globulina, 7,8% p/p de hidrolisado protéico), 10% de óleo recuperado e 33% de fase emulsionada, que geralmente apresentam uma concentração protéica de 50% p/p. As análises foram feitas, em sua maioria, baseados em métodos espectrofotométricos, como o Lowry, para a determinação de proteínas; Somogyi, para determinação de açúcares redutores, e outros, como o teor de sólidos totais e método micro-Kjeldahl, para determinação de proteínas em amostras sólidas

Inclusion of blood lactate O2 equivalent in the VO2-intensity regression at level and 10.5% grade running

This study aimed to analyze the influence of adding blood lactate ([La-]) energy equivalent (Eq) to the VO2 measurements during running exercise at different grades (0% and 10.5%) in order to estimate energy cost of running. Thirteen male highly-trained middle- and long-distance runners (age 28.1 ± 4.2 years; stature 1.75 ± 0.07 m; body mass 65.2 ± 4.9 kg; and maximal oxygen uptake 70.3 ± 4.9 ml∙kg-1 ∙min-1 ) volunteered after medical approval and performed two treadmill tests (0% and 10.5% grade) which included several bouts at a constant speed. Individual VO2-speed regressions were determined for each subject and alternative regressions were established by adding an energy equivalent of 3 ml O2 Eq∙kg-1 ∙mM [La-] to the mean VO2 values. No significant interaction between [La-] O2 equivalent inclusion and grade running was found. Results of within-subjects ANOVAs indicated a significant effect of [La-] inclusion in the regression slope and in the estimated energy cost of running at both level and grade running. However, the obtained effect sizes suggest that this effect is considerably higher at level compared with grade running. These findings indicate that the inclusion of [La-] measurements in VO2-intensity regression estimates at sub maximal running should be considered when testing highly trained runners on the treadmill.O estudo teve por objetivo analisar o efeito da adição do equivalente energético do lactato sanguíneo com a medida de VO2 durante a corrida em esteira horizontal (0%) e inclinada (10,5%), como forma de estimativa do custo energético da corrida. Treze corredores de meia e longa distância (idade 28,1 ± 4,2 anos; estatura 1,75 ± 0,07 m; massa corporal 65,2 ± 4,9 kg; VO2max 70,3 ± 4,9 ml·kg-1·min-1) cumpriram dois testes em esteira rolante (0% e 10,5%) que incluíram vários estágios em intensidade constante. Foram calculadas para cada atleta as regressões VO2-velocidade, bem como regressões alternativas com a adição de um equivalente energético de 3 ml O2 Eq·kg-1·mM [La-] às medições de VO2. Não se verificou interação significativa entre a adição do equivalente do lactato e a inclinação da esteira. A ANOVA indicou um efeito significativo da adição do equivalente do lactato na inclinação da reta de regressão e na estimativa do custo energético. Os tamanhos do efeito obtidos indicam que este efeito é mais forte na corrida horizontal. Estes resultados sugerem que em testes laboratoriais com corredores treinados se deverá considerar a adição dos valores de VO2 com os equivalentes energéticos do lactato

Spatial and temporal trends of visceral leishmaniasis by mesoregion in a southeastern state of Brazil, 2002-2013.

This article presents the spatial and temporal distribution of visceral leishmaniasis (VL) in Minas Gerais State and identifies the greater risk areas of transmission. This study is both timely and substantive because Minas Gerais is an important Brazilian state in the number of cases of visceral leishmaniasis. The results showed that during the 12-year time series the VL had a heterogeneous spatial and temporal distribution in the state of Minas Gerais. Among the 12 existing mesoregions, six (Central Mineira, Jequitinhonha, Metropolitan area of Belo Horizonte, Northwest of Minas, North of Minas, and Vale do Rio Doce) were responsible for the expansion and maintenance of VL in the state. Among them, the Vale do Rio Doce and Jequitinhonha mesoregions presented a considerable increase in the incidence rates of the disease in the last period. In the other six mesoregions only sporadic cases of the disease were reported during the study period. The results of in this study may contribute to a better understanding the dynamic of the disease in Minas Gerais. Also these findings can provide subsidies to assist the actions of the control program of VL

Spatiotemporal dynamics and risk estimates of COVID-19 epidemic in Minas Gerais State: analysis of an expanding process

COVID-19 is an infectious disease caused by the recently discovered coronavirus SARS-Cov-2. The disease became pandemic affecting many countries globally, including Brazil. Considering the expansion process and particularities during the initial stages of the epidemic, we aimed to analyze the spatial and spatiotemporal patterns of COVID-19 occurrence and to identify priority risk areas in Minas Gerais State, Southeast Brazil. An ecological study was performed considering all data from human cases of COVID-19 confirmed from the epidemiological week (EW) 11 (March 08, 2020) to EW 26 (June 27, 2020). Crude and smoothed incidence rates were used to analyze the distribution of disease patterns based on global and local indicators of spatial association and space-time risk assessment. Positive spatial autocorrelation and spatial dependence were found. Our results suggest that the metropolitan region of the State capital Belo Horizonte (MRBH) and Vale do Rio Doce mesoregions, as major epidemic foci in the beginning of the expansion process, have had important influence on the dispersion of SARS-CoV-2 in Minas Gerais State. Triangulo Mineiro/Alto Paranaiba region presented the highest risk of infection. In addition, six statistically significant spatiotemporal clusters were identified in the State, three at high risk and three at low risk. Our findings contribute to a greater understanding of the space-time disease dynamic and discuss strategies for identification of priority areas for COVID-19 surveillance and control

Clinical autonomic nervous system laboratories in Europe: a joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies

© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.Background and purpose: Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology-driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences. Methods: We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web-based survey. Results: We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head-up tilt tests/laboratory/year is 105 (49-251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100-360) outpatient visits/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4-110] inpatient stays/year). Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North/West Europe have at least one ANS laboratory versus 11 out of 21 from South/East/Greater Europe (p = 0.021). Conclusions: This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe.info:eu-repo/semantics/publishedVersio

EFAS/EAN survey on the influence of the COVID-19 pandemic on European clinical autonomic education and research

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Purpose: To understand the influence of the coronavirus disease 2019 (COVID-19) pandemic on clinical autonomic education and research in Europe. Methods: We invited 84 European autonomic centers to complete an online survey, recorded the pre-pandemic-to-pandemic percentage of junior participants in the annual congresses of the European Federation of Autonomic Societies (EFAS) and European Academy of Neurology (EAN) and the pre-pandemic-to-pandemic number of PubMed publications on neurological disorders. Results: Forty-six centers answered the survey (55%). Twenty-nine centers were involved in clinical autonomic education and experienced pandemic-related didactic interruptions for 9 (5; 9) months. Ninety percent (n = 26/29) of autonomic educational centers reported a negative impact of the COVID-19 pandemic on education quality, and 93% (n = 27/29) established e-learning models. Both the 2020 joint EAN-EFAS virtual congress and the 2021 (virtual) and 2022 (hybrid) EFAS and EAN congresses marked higher percentages of junior participants than in 2019. Forty-one respondents (89%) were autonomic researchers, and 29 of them reported pandemic-related trial interruptions for 5 (2; 9) months. Since the pandemic begin, almost half of the respondents had less time for scientific writing. Likewise, the number of PubMed publications on autonomic topics showed the smallest increase compared with other neurological fields in 2020-2021 and the highest drop in 2022. Autonomic research centers that amended their trial protocols for telemedicine (38%, n = 16/41) maintained higher clinical caseloads during the first pandemic year. Conclusions: The COVID-19 pandemic had a substantial negative impact on European clinical autonomic education and research. At the same time, it promoted digitalization, favoring more equitable access to autonomic education and improved trial design.info:eu-repo/semantics/publishedVersio

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt