Walking execution is not affected by divided attention in patients with multiple sclerosis with no disability, but there is a motor planning impairment

Purpose: We analysed the cognitive influence on walking in multiple sclerosis (MS) patients, in the absence of clinical disability. Method: A case-control study was conducted with 12 MS patients with no disability and 12 matched healthy controls. Subjects were referred for completion a timed walk test of 10 m and a 3D-kinematic analysis. Participants were instructed to walk at a comfortable speed in a dual-task (arithmetic task) condition, and motor planning was measured by mental chronometry. Results: Scores of walking speed and cadence showed no statistically significant differences between the groups in the three conditions. The dual-task condition showed an increase in the double support duration in both groups. Motor imagery analysis showed statistically significant differences between real and imagined walking in patients. Conclusion: MS patients with no disability did not show any influence of divided attention on walking execution. However, motor planning was overestimated as compared with real walking

Factors for Lower Walking Speed in Persons with Multiple Sclerosis

Objective. The purpose of this study was to analyze factors related to lower walking speed in persons with multiple sclerosis (PwMS). Methods. A cross-sectional survey was conducted. The study participants were 120 consecutive PwMS, who were able to walk, even with device assistance. Demographic and clinical data were collected. Walking speed was measured in 10 m walk test. Possible factors were assessed: disability, fatigue, visual functioning, balance confidence, physical activity level, walking impact, cognitive interference, and motor planning. A forward linear multiple regression analysis examined the correlation with lower speed. Results. Lower walking speed was observed in 85% of the patients. Fatigue (41%), recurrent falls (30%), and balance problems were also present, even with mild disability (average EDSS=2.68). A good level of physical activity was noted in most of the subjects. Dual-task procedure revealed 11.58% of walking speed reduction. Many participants (69.57%) imagined greater walking speed than motor execution (mean ≥ 28.42%). Physical activity level was the only characteristic that demonstrated no significant difference between the groups (lower versus normal walking speed). Many mobility measures were correlated with walking speed; however, disability, balance confidence, and motor planning were the most significant. Conclusions. Disability, balance confidence, and motor planning were correlated with lower walking speed

Prevalence and prognostic value of the programmed cell death-ligand 1 (PD-L1) expression among tumor samples from cervical cancer patients

Objectives: This study aimed to investigate the programmed cell death-ligand 1 (PD-L1) expression in a cohort of cervical cancer (CC) patients evaluating its prognostic significance. Methods: All patients diagnosed at Brazilian National Cancer Institute (INCA), in 2011, with invasive CC, squamous cell carcinoma (SCC) or adenocarcinoma (ADC) were retrospectively included. Clinical and treatment data were collected and PD-L1 expression was evaluated according to the percentage of viable tumor cells showing staining. The survival analysis was performed using the Kaplan Meier method. Results: In total, 152 patients (105 SSC and 47 ADC) were included and the mean age was 52.4 years (±14.4). According to the International Federation of Gynecology and Obstetrics (FIGO) 2009, 84.2% had locally advanced disease (IB2-IVA). PD-L1 expression was considered positive (=1%) in 53.3% of the cases. After adjustment, the multivariable analysis confirmed that SCC (p=0.026) and tumor size >4cm (p=0.023) were independently associated with PD-L1 expression. There were no significant differences in disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS) comparing the subgroups with distinct PD-L1 expression. Conclusion: In this cohort, PD-L1 expression was not associated with DFS, DSS and OS

The concurrent occurrence of Leishmania chagasi infection and childhood acute leukemia in Brazil

AbstractObjectiveThis study investigated the co-existence of Leishmania chagasi infection and childhood leukemia in patients naïve to treatment; this has serious clinical and epidemiological implications.MethodsThe seroprevalence of L. chagasi antibodies prior to any treatment was investigated in children with clinical features of acute leukemia. Serological tests were performed in 470 samples drawn from under 14-year-old children from different regions of Brazil with clinical suspicion of acute leukemia. Acute leukemia subtypes were characterized by immunophenotyping using flow cytometry. Morphological analyses of bone marrow aspirates were systematically performed to visualize blast cells and/or the formation of L. chagasi amastigotes. Data analysis used a standard univariate procedure and the Pearson's chi-square test.ResultsThe plasma of 437 children (93%) displayed antibodies against L. chagasi by indirect immunofluorescence assay and enzyme-linked immunosorbent assay tests. Of the 437 patients diagnosed from 2002 to 2006, 254 had acute lymphoblastic leukemia, 92 had acute myeloid leukemia, and 91 did not have acute leukemia. The seroprevalence of L. chagasi antibodies according to the indirect immunofluorescence assay test (22.5%) was similar in children with or without acute leukemia (p-value=0.76). The co-existence of visceral leishmanasis and acute leukemia was confirmed in 24 children. The overall survival of these children was poor with a high death rate during the first year of leukemia treatment.ConclusionIn the differential diagnosis of childhood leukemia, visceral leishmanasis should be considered as a potential concurrent disease in regions where L. chagasi is endemic