Artigos e Materiais de Revistas Científicas - FM/MLS
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- Distinct patterns of metabolic motor cortex activity for phantom and residual limb pain in people with amputations: A functional near-infrared spectroscopy study(2024) SIMIS, Marcel; MARQUES, Lucas Murrins; BARBOSA, Sara Pinto; SUGAWARA, Andre Tadeu; SATO, Joao Ricardo; PACHECO-BARRIOS, Kevin; BATTISTELLA, Linamara Rizzo; FREGNI, FelipeBackground: Phantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood. Objectives: The aim of this study was to understand, in patients with amputations, the association between PLP and residual limb pain (RLP), and the brain metabolic response in cortical motor circuits, using functional near-infrared spectroscopy (fNIRS). Methods: Sixty participants were recruited from the rehabilitation program in Sao Paulo, Brazil. Included patients were aged over 18 years, with traumatic unilateral lower-limb amputation, with PLP for at least 3 months after full recovery from amputation surgery. PLP and RLP levels were measured using visual analogue scales. fNIRS was performed during motor execution and motor mirror tasks for 20 s. In order to highlight possible variables related to variation in pain measures, univariate linear regression analyses were performed for both experimental conditions, resulting in four fNIRS variables (two hemispheres x two experimental conditions). Later, in order to test the topographic specificity of the models, eight multivariate regression analyses were performed (two pain scales x two experimental conditions x two hemispheres), including the primary motor cortex (PMC) related channel as an independent variable as well as five other channels related to the premotor area, supplementary area, and somatosensory cortex. All models were controlled for age, sex, ethnicity, and education. Results: We found that: i) there is an asymmetric metabolic activation during motor execution and mirror task between hemispheres (with a predominance that is ipsilateral to the amputated limb), ii) increased metabolic response in the PMC ipsilateral to the amputation is associated with increased PLP (during both experimental tasks), while increased metabolic response in the contralateral PMC is associated with increased RLP (during the mirror motor task only); ii) increased metabolic activity of the ipsilateral premotor region is associated with increased PLP during the motor mirror task; iii) RLP was only associated with higher metabolic activity in the contralateral PMC and lower metabolic activity in the ipsilateral inferior frontal region during motor mirror task, but PLP was associated with higher metabolic activity during both tasks. Conclusion: These results suggest there is both task and region specificity for the association between the brain metabolic response and the two different types of post-amputation pain. The metabolic predominance that is ipsilateral to the amputated limb during both tasks was associated with higher levels of PLP, suggesting a cortical motor network activity imbalance due to potential interhemispheric compensatory mechanisms. The present work contributes to the understanding of the underlying topographical patterns in the motor-related circuits associated with pain after amputations.
- Characterization of male sexual assault in the state of São Paulo, Brazil: an epidemiological study from 2014 to 2017(2024) SANTOS, Edmilson Ozorio dos; MOSCARDINI, Andrey Wellington; MIZIARA, Ivan DiebSexual violence is a pervasive global issue that affects individuals of all genders. However, the experiences of male survivors have often been marginalized and inadequately represented. Male rape, which encompasses several forms of sexual violence against men, remains a sensitive and under-discussed topic in academic literature and public discourse. This study presents a descriptive cross-sectional analysis based on data collected from the Legal Medicine Institute (IML-Sao Paulo, Brazil) between 2014 and 2017. The analysis includes 7386 reports of sexological examinations performed on male victims of alleged rape. The analysis reveals that a significant majority of rape reports involved victims under the age of 12 or 14, which is considered vulnerable rape by the Brazilian legislation. Regarding the examination of reported cases of abuse against men, it was observed that only the minority of these cases exhibited visible injuries consistent with rape or tested positive for the presence of spermatozoa in the perianal region. Since the absence of visible injuries or spermatozoa does not negate the possibility of rape, this work highlights the challenges in obtaining conclusive evidence, necessitating a comprehensive approach to investigate and prosecute these crimes, creating a more inclusive and supportive environment for all survivors of rape, irrespective of their gender.
- Lower Limb Exoskeleton During Gait and Posture: Objective and Subjective Assessment Procedures With Minimal Instrumentation(2023) PARIK-AMERICANO, Pedro; PINHO, Joao Pedro; SANTOS, Fabia Camile dos; UMEMURA, Guilherme Silva; BATTISTELLA, Linamara Rizzo; FORNER-CORDERO, ArturoIn this work, we propose and implement an enhanced methodology for assessing the impact of wearing a lower limb passive exoskeleton on the gait and posture of the wearer, integrating both objective and subjective assessment techniques. Using only an inertial measurement unit (IMU) and a heart rate monitor, we examined the gait of eighteen healthy volunteers during treadmill and overground walking, both with and without the exoskeleton. Postural control tests were conducted on a force platform and with an IMU during standing and crouching. Our findings indicate that exoskeleton use resulted in higher physical effort, perceived effort, and user frustration. Moreover, wearing the exoskeleton showed an augmented periodic stability, which is related to more constant strides, gait movements showed reduced smoothness, which is related to difficulties to adapt the strides in response to gait perturbations. Nevertheless, the exoskeleton exhibited better stability during stance, notably reducing medio-lateral displacement by over 30%. Finally, we found an increase in cognitive effort linked to exoskeleton use. These outcomes offer valuable insights into the comprehensive influence of exoskeletons on gait performance and user experience.
- The cerebellum is causally involved in episodic memory under aging(2023) ALMEIDA, Jorge; MARTINS, Ana R.; AMARAL, Lenia; VALERIO, Daniela; BUKHARI, Qasim; SCHU, Guilherme; NOGUEIRA, Joana; SPINOLA, Monica; SOLEIMANI, Ghazaleh; FERNANDES, Filipe; SILVA, Ana R.; FREGNI, Felipe; SIMIS, Marcel; SIMOES, Mario; PERES, AndreEpisodic memory decline is a major signature of both normal and pathological aging. Many neural regions have been implicated in the processes subserving both episodic memory and typical aging decline. Here, we demonstrate that the cerebellum is causally involved episodic memory under aging. We show that a 12-day neurostimulation program delivered to the right cerebellum led to improvements in episodic memory performance under healthy aging that long outlast the stimulation period - healthy elderly individuals show episodic memory improvement both immediately after the intervention program and in a 4-month follow-up. These results demonstrate the causal relevance of the cerebellum in processes associated with long-term episodic memory, potentially highlighting its role in regulating and maintaining cognitive processing. Moreover, they point to the importance of non-pharmacological interventions that prevent or diminish cognitive decline in healthy aging.
- Factors associated with pain pressure threshold in both local and remote sites in knee osteoarthritis(2024) IMAMURA, Marta; REBELLO-SANCHEZ, Ingrid; PARENTE, Joao; MARDUY, Anna; VASQUEZ-AVILA, Karen; PACHECO-BARRIOS, Kevin; CASTELO-BRANCO, Luis; SIMIS, Marcel; BATTISTELLA, Linamara; FREGNI, FelipeBackground: Knee osteoarthritis (KOA) is a prevalent condition, and its most frequent symptom is pain that often leads to disability. Pain sensitization is a core feature of KOA, and it can be measured through quantitative sensory testing protocols such as pain pressure threshold (PPT). However, there is a lack of understanding about the factors that may influence changes in PPTs in the KOA population.Objective: To explore the clinical and functional factors associated with PPTs in a sample of people with chronic KOA pain and to compare models of local (knees) and remote (thenar regions) sites.Design: Cross-sectional analysis of a prospective cohort.Setting: Primary care in public institution.Participants: 113 adults with KOA.Intervention: N/A.Main Outcome MeasuresMultivariable regression analyses evaluating demographic, clinical, and functional variables that could be associated with local and remote PPTs (main outcomes) were performed.Results: Both thenar region (adjusted-R-2: 0.29) and knee (adjusted-R-2: 0.45) models had the same significant negative association with being a female, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain levels (thenar: beta: -0.15, p = .002; knee: beta: -0.2, p < .001), and the 10-Meter Walking Test (thenar: beta: -0.05, p = .038; knee: beta: -0.08, p = .004). A small significant positive association with depressive symptoms was identified in both models, which acted as a confounder for WOMAC pain and was likely affected by unmeasured confounders.Conclusions: PPTs in KOA pain are associated with functional outcomes such as the 10-Meter Walking Test and activity-related pain intensity; thus more disability is associated with smaller pain thresholds. Similarity between models may suggest central sensitization.
- Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic(2024) RITTO, Ana Paula; ARAUJO, Adriana Ladeira de; CARVALHO, Carlos Roberto Ribeiro de; SOUZA, Heraldo Possolo De; FAVARETTO, Patricia Manga e Silva; SABOYA, Vivian Renata Boldrim; GARCIA, Michelle Louvaes; KULIKOWSKI, Leslie Domenici; KALLAS, Esper Georges; PEREIRA, Antonio Jose Rodrigues; COBELLO JUNIOR, Vilson; SILVA, Katia Regina; ABDALLA, Eidi Raquel Franco; SEGURADO, Aluisio Augusto Cotrim; SABINO, Ester Cerdeira; RIBEIRO JUNIOR, Ulysses; FRANCISCO, Rossana Pulcineli Vieira; MIETHKE-MORAIS, Anna; LEVIN, Anna Sara Shafferman; SAWAMURA, Marcio Valente Yamada; FERREIRA, Juliana Carvalho; SILVA, Clovis Artur; MAUAD, Thais; GOUVEIA, Nelson da Cruz; LETAIF, Leila Suemi Harima; BEGO, Marco Antonio; BATTISTELLA, Linamara Rizzo; DUARTE, Alberto Jose da Silva; SEELAENDER, Marilia Cerqueira Leite; MARCHINI, Julio; FORLENZA, Orestes Vicente; ROCHA, Vanderson Geraldo; MENDES-CORREA, Maria Cassia; COSTA, Silvia Figueiredo; CERRI, Giovanni Guido; BONFA, Eloisa Silva Dutra de Oliveira; CHAMMAS, Roger; BARROS FILHO, Tarcisio Eloy Pessoa de; BUSATTO FILHO, GeraldoIntroduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency.Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output.Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19.Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
- Vocational Rehabilitation and Length of Stay at Work after Work-Related Musculoskeletal Disorders: A Longitudinal Study in Brazil(2023) MIRANDA, C. B. de; SILVA-JUNIOR, J. S.; GARCIA, K. K. S.; SOUSA, F. N. E. F. de; FISCHER, F. M.Vocational rehabilitation is an intervention to enhance the return to work and improve quality of life. The aim of this study was to evaluate sociodemographic and occupational factors associated with the length of stay at work among workers with work-related musculoskeletal disorders (WRMDs) who had undergone rehabilitation through the Brazilian public social security system. This was a longitudinal study among 680 workers with histories of disability due to WRMDs who returned to the formal job market after vocational rehabilitation between 2014 and 2018. Survival analysis was performed to identify the factors influencing permanence in work. Job dismissal occurred for 29.26% of the workers. The average duration of employment after returning to the formal job position was 56 months. The following factors were associated with shorter length of employment: living in the southeastern region (HR: 2.78; 95% CI 1.12–6.91) or southern region (HR: 2.68; 95% CI 1.04–6.90) of Brazil; working in transportation, storage or postal services (HR: 2.57; 95% CI 1.07–6.17); or working in financial activities, insurance or related services (HR: 2.70; 95% CI 1.05–6.89). These findings may contribute to the discussion about prevention of disability and interventions to ensure health care for workers with WRMD disabilities who undergo rehabilitation.
article 0 Citação(ões) na Scopus The concordance study of the portable camera FLIR C5 for detecting asymmetry of skin temperature in patients with stroke sequelae(2023) ALFIERI, F. M.; SANTOS, A. C. A. dos; DIAS, C. da Silva; BATTISTELLA, L. R.BACKGROUND: Low-cost portable infrared cameras are increasingly used for health assessments, especially for investigating the skin temperature of the whole body. However, some of these devices have not yet been tested for agreement with high-resolution cameras. Therefore, the objective of this study was to test the agreement of FLIR C5, a portable infrared thermographic camera, compared to the FLIR T650sc, a high-quality and high-resolution thermographic device, for detecting thermal asymmetry between both sides of the body of patients with motor sequelae after stroke. MATERIALS AND METHODS: This is an observational and cross-sectional study conducted in a physical rehabilitation facility with 14 patients with stroke sequelae. Participants had their temperature simultaneously measured by FLIR T650sc and FLIR C5 infrared thermography cameras and analyzed with the software FLIR Tools®. The temperature difference of each ROI measured by both cameras was compared with Lin's Concordance Correlation Coefficient (rho or ρc) and Bland Altman the limits of agreement (LOA). RESULTS: the temperatures measured by FLIR C5 were lower than those measured by FLIR T650sc, regardless of the region of interest or side (-0.65, SD 1.44). We observed that the general concordance was classified as adequate to excellent (ρc=0.859; 95%CI 0.817-0.901; p<0.001) and that the forearm and leg in the posterior view presented the sites with the best associations between the temperature readings of FLIR C5 and FLIR T650sc. CONCLUSIONS: The temperature asymmetry usually found among patients with stroke sequelae may be assessed by the portable infrared thermographic camera FLIR C5, given its suitable concordance with FLIR T650sc.- Seroprevalence of Zika in Brazil stratified by age and geographic distribution(2023) BOTOSSO, Viviane Fongaro; PRECIOSO, Alexander Roberto; WILDER-SMITH, Annelies; OLIVEIRA, Danielle Bruna Leal de; OLIVEIRA, Fabyano Bruno Leal de; OLIVEIRA, Cairo Monteiro De; SOARES, Camila Pereira; OLIVEIRA, Lucyana Trindade Leal; SANTO, Ralyria Mello Vieira dos; UTESCHER, Carla Lilian de Agostini; COUTINHO, Francisco Antonio Bezerra; MASSAD, EduardoCongenital Zika is a devastating consequence of maternal Zika virus infections. Estimates of age-dependent seroprevalence profiles are central to our understanding of the force of Zika virus infections. We set out to calculate the age-dependent seroprevalence of Zika virus infections in Brazil. We analyzed serum samples stratified by age and geographic location, collected from 2016 to 2019, from about 16,000 volunteers enrolled in a Phase 3 dengue vaccine trial led by the Institute Butantan in Brazil. Our results show that Zika seroprevalence has a remarkable age-dependent and geographical distribution, with an average age of the first infection varying from region to region, ranging from 4.97 (3.03-5.41) to 7.24 (6.98-7.90) years. The calculated basic reproduction number, $ {R}_0 $, varied from region to region, ranging from 1.18 (1.04-1.41) to 2.33 (1.54-3.85). Such data are paramount to determine the optimal age to vaccinate against Zika, if and when such a vaccine becomes available.
- OPRM1 and BDNF polymorphisms associated with a compensatory neurophysiologic signature in knee osteoarthritis patients(2023) GONCALVES, Fernanda de Toledo; MARQUES, Lucas Murrins; PESSOTTO, Anne Victorio; BARBOSA, Sara Pinto; IMAMURA, Marta; SIMIS, Marcel; FREGNI, Felipe; BATTISTELLA, LinamaraObjective: The present study investigated the relationship between three genetic polymor-phisms of OPRM1 (rs1799971 -A118G and rs1799972 -C17T) and BDNF (rs6265 -C196T) and EEG-measured brain oscillations in Knee Osteoarthritis (KOA) patients.Materials and Methods: We performed a cross-sectional analysis of a cohort study (DEFINE cohort), KOA arm, with 66 patients, considering demographic (age, sex, and education), clinical (pain intensity and duration), OPRM1 (rs1799971 -A118G and rs1799972 -C17T) and BDNF (rs6265 -C196T) genotypes, and electrophysiological measures. Brain oscillations relative power from Delta, Theta, Alpha, Low Alpha, High Alpha, Beta, Low Beta and High Beta oscillations were measured during resting state EEG. Multivariate regression models were used to explore the main brain oscillation predictors of the three genetic polymorphisms.Results: Our findings demonstrate that Theta and Low Beta oscillations are associated with the variant allele of OPRM1-rs1799971 (A118G) on left frontal and left central regions, respectively, while Alpha brain oscillation is associated with variant genotypes (CT/TT) of BDNF-rs6265 on frontal (decrease of oscillation power) and left central (increase of oscillation power) regions. No significant model was found for OPRM1-rs1799972 (C17T) in addition to the inclusion of pain intensity as a significant predictor of this last model.Conclusion: One potential interpretation for these findings is that polymorphisms of OPRM1 that is involved with endogenous pain control lead to increased compensatory oscillatory mechanisms, characterized by increased theta oscillations. Along the same line, polymorphisms of the BDNF lead to decreased alpha oscillations in the frontal area, likely also reflecting the disruption of resting states to also compensate for the increased injury associated with knee OA. It is possible that these polymorphisms require additional brain adaption to the knee OA related injury.(c) 2023 Published by Elsevier Masson SAS.
- Robotic-Assisted Gait Training (RAGT) in Stroke Rehabilitation: A Pilot Study(2023) NEVES, Mariana Vita Milazzotto; FURLAN, Leonardo; FREGNI, Felipe; BATTISTELLA, Linamara Rizzo; SIMIS, MarcelObjective: To compare the effects of 2 types of robotic-assisted gait training (RAGT) devices that have been used in stroke rehabilitation. Design: Retrospective cohort.Setting: Rehabilitation hospital.Participants: 24 community dwelling people with stroke (N=24).Interventions: RAGT with either an exoskeleton (Lokomat) (mean age=53.8 years; 30% men; mean duration of stroke =17.8 months) or an end-effector (G-EO) (mean age=50.5 years; 77.8% men; mean duration of stroke =13.11) delivered 3 times per week (36 sessions total).Main Outcome Measures: The following tests/scales were employed before and after RAGT: Functional Ambulation Categories (FACs), timed Up and Go (TUG), 10-Meter Walk Test (10MWT), 6 -Minute Walk Test (6MWT), Trunk Impairment Scale, Dynamic Gait Index (DGI), Berg Balance Scale (BBS), and ability to climb stairs (time to climb 6 steps of 15 cm each; ability to climb stairs).Results: There were 5 dropouts, all from the G-EO group. At the end, 10 participants in the Lokomat and 9 in the G-EO group completed the intervention. From pre-to post-RAGT, G-EO patients improved on all functional tests/scales, whereas Lokomat patients improved only on the TUG, DGI, and BBS. Most patients showed improvements above the relative smallest real difference in the TUG, 10MWT, and 6MWT.Conclusions: Both end-effectors and exoskeletons may improve clinically relevant aspects of walking function. However, this study had a small sample, was retrospective, non-randomized, and had a significant number of drop-outs, therefore its findings should be interpreted carefully. Future studies are needed for investigating potential differences in clinical results, side effects, contraindications, and cost effectiveness between these 2 different types of RAGT.(c) 2023 The Authors.
- Multiple TP53 p.R337H haplotypes and implications for tumor susceptibility(2024) PINTO, Emilia M.; FRIDMAN, Cintia; FIGUEIREDO, Bonald C.; SALVADOR, Hector; TEIXEIRA, Manuel R.; PINTO, Carla; PINHEIRO, Manuela; KRATZ, Christian P.; LAVARINO, Cinzia; LEGAL, Edith A. M. F.; LE, Anh; KELLY, Gregory; KOEPPE, Erika; STOFFEL, Elena M.; BREEN, Kelsey; HAHNER, Stefanie; HEINZE, Britta; TECHAVICHIT, Piti; KRAUSE, Amanda; OGATA, Tsutomu; FUJISAWA, Yasuko; WALSH, Michael F.; RANA, Huma Q.; MAXWELL, Kara N.; GARBER, Judy E.; RODRIGUEZ-GALINDO, Carlos; RIBEIRO, Raul C.; ZAMBETTI, Gerard P.The germline TP53 p.R337H mutation is reported as the most common germline TP53 variant. It exists at a remarkably high frequency in the population of southeast Brazil as founder mutation in two distinct haplotypes with the most frequent co-segregating with the p.E134* variant of the XAF1 tumor suppressor and an increased cancer risk. Founder mutations demonstrate linkage disequilibrium with neighboring genetic polymorphic markers that can be used to identify the founder variant in different geographic regions and diverse populations. We report here a shared haplotype among Brazilian, Portuguese, and Spanish families and the existence of three additional distinct TP53 p.R337H alleles. Mitochondrial DNA sequencing and Y-STR profiling of Brazilian carriers of the founder TP53 p.R337H allele reveal an excess of Native American haplogroups in maternal lineages and exclusively European haplogroups in paternal lineages, consistent with communities established through male European settlers with extensive intermarriage with Indigenous women. The identification of founder and independent TP53 p.R337H alleles underlines the importance for considering the haplo-type as a functional unit and the additive effects of constitutive polymorphisms and associated variants in modifier genes that can in-fluence the cancer phenotype.
- A model for personalized diagnostics for non-specific low back pain: the role of the myofascial unit(2023) SIKDAR, Siddhartha; SRBELY, John; SHAH, Jay; ASSEFA, Yonathan; STECCO, Antonio; DESTEFANO, Secili; IMAMURA, Marta; GERBER, Lynn H.Low back pain (LBP) is the leading cause of disability worldwide. Most LBP is non-specific or idiopathic, which is defined as symptoms of unknown origin without a clear specific cause or pathology. Current guidelines for clinical evaluation are based on ruling out underlying serious medical conditions, but not on addressing underlying potential contributors to pain. Although efforts have been made to identify subgroups within this population based on response to treatment, a comprehensive framework to guide assessment is still lacking. In this paper, we propose a model for a personalized mechanism-based assessment based on the available evidence that seeks to identify the underlying pathologies that may initiate and perpetuate central sensitization associated with chronic non-specific low back pain (nsLBP). We propose that central sensitization can have downstream effects on the ""myofascial unit"", defined as an integrated anatomical and functional structure that includes muscle fibers, fascia (including endomysium, perimysium and epimysium) and its associated innervations (free nerve endings, muscle spindles), lymphatics, and blood vessels. The tissue-level abnormalities can be perpetuated through a vicious cycle of neurogenic inflammation, impaired fascial gliding, and interstitial inflammatory stasis that manifest as the clinical findings for nsLBP. We postulate that our proposed model offers biological plausibility for the complex spectrum of clinical findings, including tissue-level abnormalities, biomechanical dysfunction and postural asymmetry, ecological and psychosocial factors, associated with nsLBP. The model suggests a multi-domain evaluation that is personalized, feasible and helps rule out specific causes for back pain guiding clinically relevant management. It may also provide a roadmap for future research to elucidate mechanisms underlying this ubiquitous and complex problem.
- Digital Platform for Continuous Monitoring of Patients Using a Smartwatch: Longitudinal Prospective Cohort Study(2023) BIN, Kaio Jia; PRETTO, Lucas Ramos De; SANCHEZ, Fabio Beltrame; CASTRO, Fabio Pacheco Muniz De Souza e; RAMOS, Vinicius Delgado; BATTISTELLA, Linamara RizzoBackground: Since the COVID-19 pandemic, there has been a boost in the digital transformation of the human society, where wearable devices such as a smartwatch can already measure vital signs in a continuous and naturalistic way; however, the security and privacy of personal data is a challenge to expanding the use of these data by health professionals in clinical follow-up for decision-making. Similar to the European General Data Protection Regulation, in Brazil, the Lei Geral de Protecao de Dados established rules and guidelines for the processing of personal data, including those used for patient care, such as those captured by smartwatches. Thus, in any telemonitoring scenario, there is a need to comply with rules and regulations, making this issue a challenge to overcome.Objective: This study aimed to build a digital solution model for capturing data from wearable devices and making them available in a safe and agile manner for clinical and research use, following current laws.Methods: A functional model was built following the Brazilian Lei Geral de Protecao de Dados (2018), where data captured by smartwatches can be transmitted anonymously over the Internet of Things and be identified later within the hospital. A total of 80 volunteers were selected for a 24-week follow-up clinical trial divided into 2 groups, one group with a previous diagnosis of COVID-19 and a control group without a previous diagnosis of COVID-19, to measure the synchronization rate of the platform with the devices and the accuracy and precision of the smartwatch in out-of-hospital conditions to simulate remote monitoring at home.Results: In a 35-week clinical trial, >11.2 million records were collected with no system downtime; 66% of continuous beats per minute were synchronized within 24 hours (79% within 2 days and 91% within a week). In the limit of agreement analysis, the mean differences in oxygen saturation, diastolic blood pressure, systolic blood pressure, and heart rate were -1.280% (SD 5.679%), -1.399 (SD 19.112) mm Hg, -1.536 (SD 24.244) mm Hg, and 0.566 (SD 3.114) beats per minute, respectively. Furthermore, there was no difference in the 2 study groups in terms of data analysis (neither using the smartwatch nor the gold-standard devices), but it is worth mentioning that all volunteers in the COVID-19 group were already cured of the infection and were highly functional in their daily work life.Conclusions: On the basis of the results obtained, considering the validation conditions of accuracy and precision and simulating an extrahospital use environment, the functional model built in this study is capable of capturing data from the smartwatch and anonymously providing it to health care services, where they can be treated according to the legislation and be used to support clinical decisions during remote monitoring.
- Return to work after sick leave due to musculoskeletal disorder or injury: a longitudinal study conducted in Brazil(2023) SILVA, Joao Silvestre; MARTINEZ, Maria Carmen; SEKIYA, Felipe Seiti; MIRANDA, Cristiano Barreto de; FISCHER, Frida MarinaBackgroundMusculoskeletal disorders and injuries (MSDI) are conditions that affect the locomotor system characterized by pain and impairment of functionality. They are the leading cause of years lived with disability. The aim of this study was to analyze the factors that influence the return to work (RTW) among workers on sick leave due to MSDI. MethodsA longitudinal study was conducted in the city of Sao Paulo, Brazil, between 2020-2022. The participants were 216 workers who required social security compensation due to MSDI. They filled out online questionnaires about their sociodemographic characteristics, health risk behaviors, work characteristics and health conditions. They were followed for 365 days after their first day of sick leave. A Cox regression was performed to identify the factors that influenced their first RTW.ResultsMost participants were male (53.0%), mean age was 39.5 years (SD 10.6), 70.4% returned to work within the one-year follow-up period. The mean duration of sick leave was 192.6 days. Factors associated with a lower RTW were age 40 years and older (HR 0.54; 95%CI 0.39-0.76) and the interaction between perceptions of the need for improvement in the physical and psychological domains of quality of life (HR 0.67; 95%CI 0.48-0.94).ConclusionsOccupational healthcare professionals should pay greater attention to patients who are aging and those with perceived worse physical and psychological conditions, in order to facilitate the reintegration process and promote sustained RTW after sick leave due to musculoskeletal disorder or injury.
- Functional and Neural Correlates Associated with Conditioned Pain Modulation in Patients with Chronic Knee Osteoarthritis Pain: A Cross-Sectional Study(2023) SIMIS, Marcel; PACHECO-BARRIOS, Kevin; VASQUEZ-AVILA, Karen; REBELLO-SANCHEZ, Ingrid; PARENTE, Joao; CASTELO-BRANCO, Luis; MARDUY, Anna; MELO, Paulo S. de; IMAMURA, Marta; BATTISTELLA, Linamara; FREGNI, FelipeIn this study, we aimed to assess the factors that predict a dysfunctional conditioned pain modulation (CPM) in chronic knee OA. Methods: This is a cross-sectional analysis of patients with chronic knee OA from a prospective cohort study in Brazil (n = 85). We performed linear and logistic multivariate regression models using the purposeful selection approach to test the relationship between the CPM in both knees (average) as a dependent variable and demographics, clinical, and neurophysiological as independent variables. Results: A significant negative association between WOMAC pain scores and CPM (beta: 0.13) was found. This association was modified by the subjects' race, being stronger in the non-white subjects. In our logistic regression models, pain intensity indexed with the WOMAC pain scale remained a significant association with dichotomized CPM. Furthermore, a significant CPM association with balance, indexed with the Berg Balance score, was evidenced ( beta: 0.04). Neurophysiological variables showed a significant negative relationship with CPM, such as the relative power of delta oscillations in the frontal area ( beta: 3.11) and central area ( beta: 3.23). There was no significant relationship between CPM and the following domains: cognitive, emotion, sleep, opioid receptor polymorphisms, and intrinsic variables of OA disease. There was no association of CPM with TMS-indexed inhibitory markers. Conclusions: These results may indicate that less function of the pain descending inhibitory system in patients with OA is correlated with higher activity-related pain (WOMAC), less balance, and cortical plasticity especially with increased low-frequency (delta) brain oscillations. These associations seem modified by race.
- Analysis of genetic polymorphisms associated with the presence of freckles for phenotypic prediction(2022) FRIDMAN, Cintia; FERREIRA, Marcelo Alves; MARANO, Leonardo Arduino; FORLENZA, Bettina StingelinThe prediction of externally visible characteristics (EVCs) is a commonly used practice by the forensic sciences as an important resource in the investigation of criminal cases in which the identity of perpetrators or victims is unknown or even to recognize decomposed cadavers. With this purpose, genetic markers associated with pigmentation traits have been widely studied by forensic scientists and, nowadays, it is possible to predict phenotypic characteristics such as hair, eyes and skin colour, as well as the presence of skin freckles by analysing single nucleotide polymorphisms (SNPs). In this study, we analysed the association of six SNPs located in pigmentation genes to the presence of freckles in individuals from the Brazilian population for forensic DNA phenotyping. The study was based within the context of a larger project on a population sample of 534 adult Brazilians of both sexes and different skin colours. DNA was extracted from peripheral blood and genotyped using the TaqMan & REG; OpenArray & REG; Real-Time PCR System (ThermoFischer Scientific) technique. Statistical analyses were carried out with the R software (version 4.0.2). As for the results obtained, three SNPs were shown to be statistically associated to the freckling, rs12203592, rs1800404 and rs222847, with CT, AG and AA genotypes being the main contributors, respectively. Variables such as sex of the individuals and skin colour were found to also contribute to the manifestation of this pigmentation trait. Further statistical analyses will be carried out to evaluate the possibility of using the SNPs in this study for phenotyping prediction of the Brazilian population, improving existing DNA phenotyping models in forensic sciences.
- Neurophysiological biomarkers of motor improvement from Constraint-Induced Movement Therapy and Robot-Assisted Therapy in participants with stroke(2023) SIMIS, Marcel; THIBAUT, Aurore; IMAMURA, Marta; BATTISTELLA, Linamara Rizzo; FREGNI, FelipeBackgroundThe mechanism of stroke recovery is related to the reorganization of cerebral activity that can be enhanced by rehabilitation therapy. Two well established treatments are Robot-Assisted Therapy (RT) and Constraint-Induced Movement Therapy (CIMT), however, it is unknown whether there is a difference in the neuroplastic changes induced by these therapies, and if the modifications are related to motor improvement. Therefore, this study aims to identify neurophysiological biomarkers related to motor improvement of participants with chronic stroke that received RT or CIMT, and to test whether there is a difference in neuronal changes induced by these two therapies.MethodsThis study included participants with chronic stroke that took part in a pilot experiment to compare CIMT vs. RT. Neurophysiological evaluations were performed with electroencephalography (EEG) and transcranial magnetic stimulation (TMS), pre and post rehabilitation therapy. Motor function was measured by the Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment Upper Limb (FMA-UL).ResultsTwenty-seven participants with chronic stroke completed the present study [mean age of 58.8 years (SD +/- 13.6), mean time since stroke of 18.2 months (SD +/- 9.6)]. We found that changes in motor threshold (MT) and motor evoked potential (MEP) in the lesioned hemisphere have a positive and negative correlation with WMFT improvement, respectively. The absolute change in alpha peak in the unlesioned hemisphere and the absolute change of the alpha ratio (unlesioned/lesioned hemisphere) is negatively correlated with WMFT improvement. The decrease of EEG power ratio (increase in the lesioned hemisphere and decrease in the unlesioned hemisphere) for high alpha bandwidths is correlated with better improvement in WMFT. The variable ""type of treatment (RT or CIMT)"" was not significant in the models.ConclusionOur results suggest that distinct treatments (RT and CIMT) have similar neuroplastic mechanisms of recovery. Moreover, motor improvements in participants with chronic stroke are related to decreases of cortical excitability in the lesioned hemisphere measured with TMS. Furthermore, the balance of both EEG power and EEG alpha peak frequency in the lesioned hemisphere is related to motor improvement.
- Motor event-related synchronization as an inhibitory biomarker of pain severity, sensitivity, and chronicity in patients with knee osteoarthritis(2022) MARQUES, L. M.; BARBOSA, S. P.; PACHECO-BARRIOS, K.; GONCALVES, F. T.; IMAMURA, M.; BATTISTELLA, L. R.; SIMIS, M.; FREGNI, F.Objective: The study aimed to examine the clinical and neurophysiological predictors of motor event-related desynchronization (ERD) and synchronization (ERS) in patients with chronic pain due to knee osteoarthritis (KOA). Methods: We performed a cross-sectional analysis of our cohort study (DEFINE cohort), KOA arm, with 71 patients, including demographic, functionality, genetic and neurophysiological measures. ERD/ERS was evaluated during hand motor tasks (motor execution, active and passive observation, and imagery). Multivariate regression models were used to explore predictors of ERD/ERS. Results: Although we found an altered ERD/ERS pattern during motor execution and active observation, the ERS pattern could only be clearly differentiated after passive observation.‘. We found no predictors of ERD (excitatory biomarker). For ERS (inhibitory biomarker), our results showed that the main predictors differ across EEG frequency bands. Considering pain measures, we found that visual analogue scale (VAS, right knee) and chronicity of pain negatively predict low beta and high beta ERS, respectively. Pain threshold was positively correlated with alpha ERS, while 36-Item Short Form Survey (SF-36) emotional domain positively predicted beta ERS. Regarding transcranial magnetic stimulation (TMS) markers, intracortical inhibition (ICF) negatively predicted beta and low beta ERS, and left hemisphere cortical silent period (CSP) negatively predicted low beta ERS. Conclusion: Considering that higher power of ERS indicates a stronger cortical organization and inhibitory drive, our results show that limitation of activities due to emotional factors, lower pain threshold, higher VAS pain, and longer duration of pain are associated with lower ERS power (in alpha and beta frequencies), thus indicating a lower inhibitory drive. In the same direction, a lower inhibitory drive as indicated by higher ERS power is associated with higher ICF amplitude. Although there was a negative association between ERS and CSP, this may indicate that ICF values are adjusting CSP results. Our findings support the idea that a less organized cortical response as indicated by changes to the ERS is associated with higher pain correlates in subjects with KOA. © 2022
- Time-dependent vaccine efficacy estimation quantified by a mathematical model(2023) LORIA, Jennifer; ALBANI, Vinicius V. L.; COUTINHO, Francisco A. B.; COVAS, Dimas T.; STRUCHINER, Claudio J.; ZUBELLI, Jorge P.; MASSAD, EduardoIn this paper we calculate the variation of the estimated vaccine efficacy (VE) due to the time-dependent force of infection resulting from the difference between the moment the Clinical Trial (CT) begins and the peak in the outbreak intensity. Using a simple mathematical model we tested the hypothesis that the time difference between the moment the CT begins and the peak in the outbreak intensity determines substantially different values for VE. We exemplify the method with the case of the VE efficacy estimation for one of the vaccines against the new coronavirus SARS-CoV-2.