A case-control study of the effects of Chimarrão ( Ilex paraguariensis) and coffee on Parkinson's disease

Introduction: Coffee has been inversely associated with Parkinson's disease (PD) in many studies, and caffeine is the leading candidate to mediate this effect. Mate (Ilex paraguariensis, IP), a caffeinated beverage rich in antioxidants consumed in South America, was also inversely associated with PD in one study from Argentina. Other varieties of IP infusion, such as chimarrão, were never studied in PD. Chimarrão is a common caffeinated beverage consumed in Brazil made with the leaves and stems of IP. Methods: A case–control study was conducted to evaluate the relationship between chimarrão ingestion and PD in southern Brazil. All subjects answered a questionnaire about the frequency of chimarrão and coffee intake. A multiple regression analysis adjusted for age and sex was performed to assess the association between PD and chimarrão consumption. Results: We included 200 PD patients and 200 healthy controls. High consumption of chimarrão was inversely associated with PD (OR = 0.44, 95% CI = 0.24–0.81, P = 0.008). High consumption of coffee was also inversely associated with PD, as expected. Chimarrão remained associated when adjusted for coffee consumption, smoking history, and age (OR 0.46, 95% CI = 0.25–0.86, P = 0.014). These two exposures showed an additive effect. Conclusion: Chimarrão consumption was inversely associated with PD, even after adjusting for coffee intake, suggesting a possible protective role. IP's effect can be mediated by caffeine and through its antioxidant components. Chimarrão has a lower concentration of caffeine compared with coffee and has numerous substances with antioxidative effects that may be important to PD protection. Further studies are needed to test this hypothesis

Validação do questionário de 19 itens de wearing-off (WOQ-19) para a língua portuguesa

Background: The treatment of Parkinson disease with dopaminergic therapy improves functionality and quality of life. However, as the disease progresses, the wearing-off phenomenon develops. To improve the recognition of this phenomenon, the 19-item wearing-off questionnaire (WOQ-19) was developed. Objective: To translate and validate the WOQ-19 into Portuguese. Methods: The questionnaire was translated into Portuguese and, subsequently, back-translated into English and analyzed. The final version was tested in Parkinson disease patients for reliability through the test-retest paradigm and internal consistency. Also, sensitivity and specificity were obtained in different cut-off positive items. Results: The WOQ-19 showed good test stability, with an intraclass correlation coefficient of 0.877 (95%CI 0.690-0.951; p<0.001), and good internal consistency, with Cronbach alpha of 0.815. Two items of positive cut-off showed the best accuracy: 0.873 (95%CI 0.791-0.954). Sensitivity was 0.975 (95%CI 0.892-1) and specificity was 0.714 (95%CI 0.565-0.863). Conclusion: The Portuguese version of the WOQ-19 showed excellent diagnostic properties and can be used to diagnose wearing-off phenomena.Introdução: O tratamento da doença de Parkinson com terapia dopaminérgica melhora a funcionalidade e a qualidade de vida. Entretanto, com a progressão da doença, os fenômenos de flutuação motora e não motora se desenvolvem. Para melhorar o reconhecimento dessa situação, foi desenvolvido o questionário de 19 itens de wearing-off (WOQ-19) Objetivo: Traduzir e validar o questionário WOQ-19 para a língua portuguesa. Métodos: O questionário foi traduzido do inglês para o português. Em seguida, foi retrotraduzido para o inglês e analisado. A versão final foi testada em pacientes parkinsonianos com paradigma teste-reteste e consistência interna. A sensibilidade e especificidade foram medidas em relação a vários pontos de cortes de itens positivos. Resultados: O questionário apresenta boa estabilidade de teste, com coeficiente de correlação intraclasse de 0,877 (IC95% 0,690-0,951; p<0,001), e boa consistência interna, com alfa de Cronbach de 0,815. O ponto de corte com dois itens positivos teve a melhor acurácia: 0,873 (IC95% 0,791-0,954). A sensibilidade foi de 0,975 (IC95% 0,892-1) e a especificidade foi 0,714 (0,565-0,863). Conclusão: A versão em português do WOQ-19 mostrou excelentes propriedades diagnósticas e pode ser utilizada para diagnosticar as condições de flutuações motoras e não motoras na doença de Parkinson

Occupational pesticide exposure and the risk of death in patients with Parkinson’s disease : an observational study in southern Brazil

Background: Multiple studies have suggested that various pesticides are associated with a higher risk of developing Parkinson’s disease (PD) and may influence the progression of the disease. However, the evidence regarding the impact of pesticide exposure on mortality among patients with PD is equivocal. This study examines whether pesticide exposure influences the risk of mortality among patients with PD in Southern Brazil. Methods: A total of 150 patients with idiopathic PD were enrolled from 2008 to 2013 and followed until 2019. In addition to undergoing a detailed neurologic evaluation, patients completed surveys regarding socioeconomic status and environmental exposures. Results: Twenty patients (13.3%) reported a history of occupational pesticide exposure with a median duration of exposure of 10 years (mean = 13.1, SD = 11.2). Patients with a history of occupational pesticide exposure had higher UPDRS-III scores, though there were no significant differences in regards to age, sex, disease duration, Charlson Comorbidity Index, and age at symptom onset. Patients with occupational pesticide exposure were more than twice as likely to die than their unexposed PD counterparts (HR = 2.32, 95% CI [1.15, 4.66], p = 0.018). Occupational pesticide exposure was also a significant predictor of death in a cox-proportional hazards model which included smoking and caffeine intake history (HR = 2.23, 95% CI [1.09, 4.59], p = 0.03)) and another which included several measures of socioeconomic status (HR = 3.91, 95% CI [1.32, 11.58], p = 0.01). Conclusion: In this prospective cohort study, we found an increased all-cause mortality risk in PD patients with occupational exposure to pesticides. More studies are needed to further analyze this topic with longer follow-up periods, more detailed exposure information, and more specific causes of mortality

Quality of life (QOL) in Parkinson´s disease : the PDQ-39 evaluates QV in disfagic individuals?

Objetivo: Avaliar o impacto da disfagia na qualidade de vida (QV) de indivíduos com Doença de Parkinson (DP) através do instrumento recomendado para essa população. Métodos: Participaram deste estudo pacientes com diagnóstico de DP. Todos os participantes foram submetidos à avaliação fonoaudiológica de deglutição com as consitências sólida (pão francês) e líquida (água), responderam ao PDQ-39 e tiveram o estadiamento da DP classificado pela escala de Hoehn &Yahr. Resultados: Foram avaliados 31 indivíduos com DP, sendo 21 (67,7%) do gênero masculino. A média de idade foi 59,6 anos (± 11,3), variando de 38 a 79 anos e o tempo doença desde o diagnóstico foi, em média, 9,8 (±4,8) anos. A disfagia esteve presente em 74,2% dos indivíduos avaliados e na correlação entre o PDQ-39 total e a presença de disfagia houve significância apenas no domínio estigma. Conclusão: Em indivíduos com DP avaliados através do PDQ-39 não fica evidente o impacto da disfagia na percepção de QV dessa população.Objective: To assess the impact of dysphagia on the overall quality of life (QOL) of patients with Parkinson’s disease (PD) through the tool recommended for this population. Methods: The study included 31 patients diagnosed with PD. All participants underwent clinical assessment of swallowing the solid consistency (French bread) and liquid (water), answered to the PDQ-39 and had the staging of PD classified by Hoehn & Yahr scale. Results: We evalueted 31 subjects with PD, 21 (67.7%) were male. The mean age was 59.6 years (± 11.3), ranging from 38 to 79 years and the disease time since diagnosis was on average 9.8 (± 4.8) years. Dysphagia was present in 74.2% of the individuals and the correlation between the PDQ-39 the presence of dysphagia was significant only in stigma domain. Conclusion: In patients with PD assessed by PDQ-39 is not evident the impact of dysphagia on the perception of overall QoL of this population

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Associação entre metabolismo do ferro e estresse oxidativo em pacientes com doeça de Parkinson

Introdução: A fisiopatologia da doença de Parkinson está associada a lesões por estresse oxidativo/nitrosativo. O ferro encontra-se acumulado na substância negra (SN) de pacientes com DP e está relacionado com esse dano através das espécies reagentes de oxigênio (EROs) e de nitrogênio (ERNs) na reação de Fenton. EROs e ERNs são produzidas normalmente em processos celulares e inflamatórios, e controladas por sistemas antioxidantes. Objetivo: Avaliar níveis periféricos de ferro em pacientes com DP para determinar se acúmulo na SN está relacionado com níveis elevados no sangue. Determinar biomarcadores periféricos confiáveis de estresse oxidativo/nitrosativo Métodos: Selecionados 40 pacientes com DP e 46 indivíduos controles para comparar níveis séricos de ferro, ferritina e transferrina, e de biomarcadores de estresse oxidativo/nitrosativo: superóxido dismutase (SOD), catalase, óxido nítrico (NOx), substâncias reativas ao ácido tiobarbitúrico (TBARS), tióis não-proteicos, “advanced oxidation protein products” (AOPP), “ferric reducing ability of plasma” (FRAP), NTPDases, ecto-5’-nucleotidase, adenosina deaminase (ADA), mieloperoxidase, albumina modificada pela isquemia (IMA) e vitamina C. Resultados: Níveis de ferro estavam diminuídos em pacientes com DP, enquanto ferritina e transferrina não mostraram diferença. Os biomarcadores de estresse oxidativo como TBARS, AOPP, NTPDases, IMA, mieloperoxidase, FRAP, vitamina C e tiois não-proteicos encontraram-se significativamente aumentados na DP. SOD, catalase, ecto-5’-nucleotidase não foram diferentes entre os grupos e os marcadores NOx e ADA foram significativamente aumentados nos controles. Nenhuma correlação foi encontrada entre os biomarcadores e dados sociodemográficos e de características da doença. Conclusão: Níveis plasmáticos de ferro encontram-se diminuídos em pacientes com DP comparados com controles saudáveis. Os biomarcadores TBARS, AOPP, NTPDases, IMA e mieloperoxidase mostraram-se confiáveis para lesão oxidativa, enquanto tióis não-proteicos, FRAP e vitamina C demonstram diminuição da capacidade antioxidante na DP.Background: Parkinson’s disease (PD) pathophysiology is associated with oxidative/nitrosative stress damage. Iron accumulates in the substantia nigra (SN) of PD patients and is related to this damage along with oxygen and nitrogen reactive species (ROS, RNS) through Fenton reaction. ROS and RNS are normally produced in cell and inflammatory processes, controlled by antioxidant systems. Objective: To determine peripheral levels of iron, ferritin and transferrin in PD patients to evaluate whether iron accumulation in the SN could be related to serum levels. To determine reliable peripheral biomarkers of oxidative/nitrative stress. Methods: Forty PD patients and 46 controls were selected to compared serum levels of iron, ferritin, transferrin and oxidative/nitrative stress biomarkers: superoxide dismutase (SOD), catalase, nitric oxide (NOx), thiobarbituric acid reactive substances (TBARS), non-protein thiols, advanced oxidation protein products (AOPP), ferric reducing ability of plasma (FRAP), NTPDases, ecto-5’-nucleotidase, adenosine deaminase (ADA), myeloperoxidase, ischemic-modified albumin (IMA) and vitamin C. Results: Iron levels were decreased in patients with PD, while ferritin and transferrin were not different. Oxidative stress biomarkers, TBARS, AOPP, NTPDases, IMA, myeloperoxidase, FRAP, vitamin C and non-proteic thiols were significantly higher in PD. SOD, catalase, ecto-5’-nucleotidase were not different between the groups and biomarkers NOx and ADA were significantly increased in the controls. No correlation was found between biomarkers and sociodemographic and disease data. Conclusion: Plasmatic levels of iron are decreased in patients with PD compared to healthy controls. Biomarkers TBARS, AOPP, NTPDases, IMA and myeloperoxidase presented as reliable to measure oxidative/nitrative damage, while non-proteic thiols, FRAP and vitamin C show a decrease in the antioxidant capacity in PD

Avaliação de fatores ambientais quanto a risco, proteção e mortalidade na doença de Parkinson : um estudo observacional sobre chimarrão e pesticidas

Introdução: A doença de Parkinson (DP) apresenta fisiopatologia complexa com prováveis interações gene-ambiente. Fatores ambientais, como a cafeína presente no chimarrão (Ilex paraguariensis) e os pesticidas usados na agricultura, são investigados na DP e podem mudar o risco de desenvolver a doença e a sua gravidade. Métodos: Um grupo de 177 pacientes com DP foi acompanhado no ambulatório de distúrbios do movimento do HCPA. Pacientes responderam questionário de exposições ambientais e informações sociodemográficas. Foram usados dados de exame neurológico (UPDRS completa), escalas de funcionalidade e avaliação cognitiva. Resultados: Primeiro artigo encontrou associação inversa entre consumo de chimarrão e DP. Indivíduos que ingerem altas doses de chimarrão diariamente (> 6 cuias/dia) tiveram associação significativa (OR = 0.40, 95% CI = 0.21-0.73, P = 0.003). O segundo artigo encontrou maior mortalidade nos pacientes com DP que apresentavam exposição ocupacional a pesticidas (HR = 2.32, 95% CI = 1.15, 4.66, P = 0.02). Esses dados foram controlados para outras exposições ambientais (cafeína e tabagismo) e para dados socioeconômicos que influenciam mortalidade. Conclusão: O consumo de chimarrão está inversamente associado com a DP em indivíduos com alto consumo diário, provavelmente pelo seu conteúdo de cafeína. A exposição ocupacional a pesticidas traz maior mortalidade em pacientes com DP independente de fatores de confusão.Introduction: Parkinson´s disease (PD) has a complex physiopathology with probable gene-environment interactions. Environmental factors, such as caffeine in chimarrão (Ilex paraguariensis) and pesticides used in agriculture, are investigated in PD and can change the risk of developing the disease and its severity. Methods: A group of 177 patients with PD was followed in the movement disorders clinic from HCPA. Patients answered an environmental exposure questionnaire and gave sociodemographic information. Data from a neurologic examination (complete UPDRS), a functionality scale and a cognitive evaluation were used. Results: In the first article, it was found an inverse association of chimarrão intake and PD. Individuals who consume daily high amounts of chimarrão (> 6 cuias/day) were significantly associated (OR = 0.40, 95% CI = 0.21-0.73, P = 0.003). In the second article, it was found higher mortality rates in PD patients who had occupational exposure to pesticides (HR = 2.32, 95% CI = 1.15, 4.66, P = 0.02). These data were controlled for different environmental exposures (caffeine and smoking) and for socioeconomic factors that influence mortality. Conclusion: Chimarrão intake is inversely associated with PD in individuals with high daily consumption, probably due to its caffeine content. Pesticide occupational exposure brings higher mortality rates in PD patients independent of confounding factors

Associação entre metabolismo do ferro e estresse oxidativo em pacientes com doeça de Parkinson

Introdução: A fisiopatologia da doença de Parkinson está associada a lesões por estresse oxidativo/nitrosativo. O ferro encontra-se acumulado na substância negra (SN) de pacientes com DP e está relacionado com esse dano através das espécies reagentes de oxigênio (EROs) e de nitrogênio (ERNs) na reação de Fenton. EROs e ERNs são produzidas normalmente em processos celulares e inflamatórios, e controladas por sistemas antioxidantes. Objetivo: Avaliar níveis periféricos de ferro em pacientes com DP para determinar se acúmulo na SN está relacionado com níveis elevados no sangue. Determinar biomarcadores periféricos confiáveis de estresse oxidativo/nitrosativo Métodos: Selecionados 40 pacientes com DP e 46 indivíduos controles para comparar níveis séricos de ferro, ferritina e transferrina, e de biomarcadores de estresse oxidativo/nitrosativo: superóxido dismutase (SOD), catalase, óxido nítrico (NOx), substâncias reativas ao ácido tiobarbitúrico (TBARS), tióis não-proteicos, “advanced oxidation protein products” (AOPP), “ferric reducing ability of plasma” (FRAP), NTPDases, ecto-5’-nucleotidase, adenosina deaminase (ADA), mieloperoxidase, albumina modificada pela isquemia (IMA) e vitamina C. Resultados: Níveis de ferro estavam diminuídos em pacientes com DP, enquanto ferritina e transferrina não mostraram diferença. Os biomarcadores de estresse oxidativo como TBARS, AOPP, NTPDases, IMA, mieloperoxidase, FRAP, vitamina C e tiois não-proteicos encontraram-se significativamente aumentados na DP. SOD, catalase, ecto-5’-nucleotidase não foram diferentes entre os grupos e os marcadores NOx e ADA foram significativamente aumentados nos controles. Nenhuma correlação foi encontrada entre os biomarcadores e dados sociodemográficos e de características da doença. Conclusão: Níveis plasmáticos de ferro encontram-se diminuídos em pacientes com DP comparados com controles saudáveis. Os biomarcadores TBARS, AOPP, NTPDases, IMA e mieloperoxidase mostraram-se confiáveis para lesão oxidativa, enquanto tióis não-proteicos, FRAP e vitamina C demonstram diminuição da capacidade antioxidante na DP.Background: Parkinson’s disease (PD) pathophysiology is associated with oxidative/nitrosative stress damage. Iron accumulates in the substantia nigra (SN) of PD patients and is related to this damage along with oxygen and nitrogen reactive species (ROS, RNS) through Fenton reaction. ROS and RNS are normally produced in cell and inflammatory processes, controlled by antioxidant systems. Objective: To determine peripheral levels of iron, ferritin and transferrin in PD patients to evaluate whether iron accumulation in the SN could be related to serum levels. To determine reliable peripheral biomarkers of oxidative/nitrative stress. Methods: Forty PD patients and 46 controls were selected to compared serum levels of iron, ferritin, transferrin and oxidative/nitrative stress biomarkers: superoxide dismutase (SOD), catalase, nitric oxide (NOx), thiobarbituric acid reactive substances (TBARS), non-protein thiols, advanced oxidation protein products (AOPP), ferric reducing ability of plasma (FRAP), NTPDases, ecto-5’-nucleotidase, adenosine deaminase (ADA), myeloperoxidase, ischemic-modified albumin (IMA) and vitamin C. Results: Iron levels were decreased in patients with PD, while ferritin and transferrin were not different. Oxidative stress biomarkers, TBARS, AOPP, NTPDases, IMA, myeloperoxidase, FRAP, vitamin C and non-proteic thiols were significantly higher in PD. SOD, catalase, ecto-5’-nucleotidase were not different between the groups and biomarkers NOx and ADA were significantly increased in the controls. No correlation was found between biomarkers and sociodemographic and disease data. Conclusion: Plasmatic levels of iron are decreased in patients with PD compared to healthy controls. Biomarkers TBARS, AOPP, NTPDases, IMA and myeloperoxidase presented as reliable to measure oxidative/nitrative damage, while non-proteic thiols, FRAP and vitamin C show a decrease in the antioxidant capacity in PD