Sample Of Brazilian Patients Research Articles

Resistin serum levels and its association with clinical profile and carotid intima-media thickness in psoriasis: a cross-sectional study

BackgroundPsoriasis is a protean disease associated with several comorbidities that may have increased levels of adiponectin such as resistin. This may affect the patients atherosclerotic risk. ObjectiveTo study resistin levels in a sample of Brazilian patients with psoriasis and its association with clinical profile, comorbidities, and carotid Intima-Media Thickness (cIMT). MethodsThis is a cross-sectional study of 119 individuals: 34 healthy controls and 85 patients with psoriasis, 42 of which with skin involvement only and 43 with psoriatic arthritis. Clinical and epidemiological data, measurement of PASI (Psoriasis Area Severity Index) and DAPSA (Disease Activity in Psoriatic Arthritis), lipid profile, cIMT by ultrasound were collected from medical records. Resistin serum levels were measured by ELISA. ResultsPatients with psoriasis had higher resistin levels (p=0.009) and worse cIMT (p=0.0002) than controls. In the psoriasis sample, no associations of resistin levels with epidemiological, clinical findings, and activity indexes were found. Resistin serum levels were associated with the presence of diabetes (p=0.008) and metabolic syndrome (p=0.01) and correlated with total cholesterol (r=0.26) and triglycerides (r=0.33) but not with cIMT. Study limitationsThis work is limited by its transversal design and by the limited number of patients included. ConclusionResistin serum levels are elevated in psoriasis patients. In this sample, clinical, epidemiological, and activity indexes were not linked to resistin serum levels, but atherosclerotic risk factors were.

Cognitive evaluation in Parkinson's disease: applying the Movement Disorder Society recommendations in a population with a low level of formal education

The diagnosis of cognitive disorders in Parkinson disease (PD) can be very challenging. Aiming at establishing uniform and reliable diagnostic procedures, the International Parkinson's Disease and Movement Disorder Society (MDS) commissioned task forces to delineate diagnostic criteria for mild cognitive impairment (MCI) and dementia in PD. To investigate the applicability of the MDS recommendations for cognitive evaluation in a Brazilian sample of patients with PD with low levels of formal education. A total of 41 patients with PD were subjected to a comprehensive neuropsychological evaluation based on tests proposed by the MDS, which included the Mini-Mental State Examination, the Mattis Dementia Rating Scale (MDRS), the Trail Making Test (TMT) parts A and B, in addition to language and memory skills assessment. Neuropsychiatric and daily functioning features were also evaluated. Spearman correlation analyses were used to evaluate the association between the scores obtained in the cognitive scales and demographic/clinical variables. Although none of the participants had a formal diagnosis of dementia, 50% presented some degree of cognitive impairment when considering the results of the MDRS. Of note, a noticeable number of patients was not able to complete the full neuropsychological assessment. The TMT part B was the most difficult task, being completed by only 22 participants (54%). As expected, the greater the educational level, the better the performance on the cognitive tests. Better motor function was also associated with better scores in cognition. Adopting strict inclusion/exclusion criteria and a comprehensive clinical evaluation, we found remarkable limitations for the MDS recommendations when individuals with low educational levels are considered. A revision of the current guidelines is necessary considering differences among populations, especially related to formal education.

Prevalence of skin lesions in a sample of Brazilian patients with inflammatory bowel disease.

Inflammatory bowel diseases may have extra intestinal manifestations such as those affecting the skin. This study aimed to study skin manifestations in a cohort of Brazilian patients with inflammatory bowel diseases. Epidemiological and clinical data were obtained through a cross-sectional study of 70 inflammatory bowel diseases patients and a control group comprising 50 healthy individuals. All patients were subjected to dermatological examination and photography of skin lesions. Out of the 70 inflammatory bowel diseases patients, 50 had ulcerative colitis and 20 had Crohn's disease. Skin lesions occurred in 95.7% of the inflammatory bowel diseases patients and in 88% of individuals in the control group (p=0.001). Alopecia (p<0.0001), xerosis (p=0.03), striae (p=0.02), and acne (p=0.04) were more common in inflammatory bowel diseases patients than in the control group. Alopecia was more frequent in females (p=0.01) than in males. Two male patients, one with ulcerative colitis and the other with Crohn's disease, had pyoderma gangrenosum. Erythema nodosum was not observed in both groups. There was a high prevalence of skin lesions in the Brazilian inflammatory bowel diseases patients. Additionally, alopecia, xerosis, striae, and acne were more common in patients with inflammatory bowel diseases than in those in the control group.

Cross-cultural and clinical validation of the MDHAQ/RAPID3 questionnaire in electronic format for a Brazilian population of patients with rheumatoid arthritis

BackgroundPatients with rheumatologic diseases are monitored fundamentally through metric tools or index calculated from clinical data and patient exams, which allow us to assess the severity of the disease and guide the therapeutic decision. In rheumatoid arthritis (RA), for treatment to be optimized and considered effective, periodic assessment with composite disease activity index and a 'treat-to-target' approach is required. The Routine Assessment of Patient Index Data 3 (RAPID3) in the Multidimensional Health Assessment Questionnaire (MDHAQ) includes only three measures based on the central patient self-reported dataset and can be used in a 'treat-to-target' approach analogous to the Clinical Disease Activity Index (CDAI) and the Disease Activity Score 28-joints (DAS28). This tool, however, has not undergone cross-cultural or clinical validation in Brazil. In this research, we performed the MDHAQ cross-cultural and clinical validation for the Brazilian population of RA patients.MethodsThe Portuguese version of the MDHAQ was created identically in an electronic questionnaire and underwent a cross-cultural validation process with 38 participants. Test–retest was performed in 29 patients. Further, a clinical validation with 129 Rheumatoid Arthritis patients was performed. Electronic MDHAQ was answered through an online platform. We also collected socioeconomic data as well as other clinical (CDAI, SDAI, DAS28) and functional (HAQ) scores during the face-to-face assessment of patients.ResultsMDHAQ/RAPID3 maintained semantic, idiomatic, as well as conceptual and experience equivalence for the Brazilian population, with 92% acceptance of participants. It showed test–retest reliability, adequate internal consistency (Cronbach's α 0.85) and correlation of the scores obtained with adequate association with the DAS28 gold standard. RAPID3 also had high sensitivity (98%), adequate specificity (48%), high negative predictive value (92%) and negative post-test probability of 8%, attributes expected for a test tool for population screening.ConclusionThe use of MDHAQ/RAPID3 associated with traditional clinical measures can adequately allow for remote follow-up based on the 'treat-to-target' approach with performance comparable to the gold standard DAS28, being a viable tool in the sample of Brazilian patients with RA in the current context of telehealth.

National Brazilian survey on the outcomes of hepatitis c retreatment in patients non-responders to direct antiviral agents

Background and aimsTreatment of hepatitis C with direct antiviral agents (DAA) is associated with almost 95% of sustained virological response. However, some patients need retreatment. In Brazil, it should be done according to the Ministry of Health guidelines, frequently updated to include newly available drugs. This study aimed to conduct a national survey about the characteristics and outcomes of retreatment of hepatitis C in previously non-responders to DAAs. Patients and methodsInstitutions from all over the country were invited to participate in a national registry for retreatment, including information about clinical and epidemiological characteristics of the patients, type and outcomes of retreatment regimens. Only patients previously treated with interferon-free regimens were included. ResultsAs previous treatments the distribution was: SOF/DCV (56%), SOF/SIM (22%), 3D (11%), SOF/LED (6%) and SOF/RBV (5%). For retreatment the most frequently used drugs were SOF/GP (46%), SOF/DCV (23%) and SOF/VEL (11%). From 159 patients retreated, 132/159 (83%) had complete information in the registry and among them only seven patients were non-responders (SVR of 94.6%). All retreatments were well tolerated, without any serious adverse events or interruptions. ConclusionThe retreatment of patients previously non-responders to DAAs was associated with high rate of SVR in this sample of Brazilian patients. This finding allows us to conclude that the retreatment options available in the public health system in Brazil are effective and safe and are an important component of the strategy of elimination of hepatitis C in our country.

Polymorphic variants of the CASP3, CASP9, BCL-2 and NKX3-1 genes as candidate markers for prostate cancer susceptibility and poor prognosis.

There is an ongoing search for molecular markers that are specific, sensitive, and able to predict the stage of prostate cancer (PCa), which is the second most prevalent type of cancer in men worldwide. This study examined whether different single nucleotide polymorphisms (SNPs) were reliable markers of susceptibility to and prognosis of PCa in a sample of Brazilian patients. DNA samples were extracted from peripheral blood cells of 283 PCa patients and matched with samples from healthy controls. Single nucleotide polymorphisms (SNPs in four genes (BCL-2-rs2279115, CASP3-rs4647603, CASP9-rs1052571, and NKX3-1-rs11781886) were genotyped by real-time PCR using the TaqMan® probe. Odds Ratios with 95% confidence intervals were calculated for allelic and genotypic frequencies. The association between polymorphic variants, risk of developing PCa, and clinicopathological characteristics was analyzed by univariate and multivariate logistic regression analysis. SNPs in CASP3, CASP9, and NKX3-1 genes, either alone or in combination (BCL-2+NKX3-1 and CASP3+NKX3-1) were associated with the risk of developing PCa. Genotypes and tumor histopathological data indicated that the BCL-2, NKX3-1, and CASP3 allelic variants, either alone or combined in pairs, were associated with a poor prognosis of PCa. Genetic polymorphisms in CASP3, NKX3-1, and BCL-2 genes were associated with susceptibility to PCa. The SNPs in the three genes alone and the SNP in the BCL-2 gene combined with the other two genes were strongly associated with adverse outcomes in PCa patients and are promising candidates for molecular markers for PCa prognosis.

A Survey of Brazilian Patients with Oral Lichen Planus Showing No Evidence of Malignancy.

Objectives There is conflicting evidence as to whether oral lichen planus (OLP) can undergo malignant transformation into oral squamous cell carcinoma (OSCC). This study aimed to address this issue by analyzing a sample of Brazilian patients with either OLP or OSCC. Patients and Methods. This study was conducted in São Paulo, the world's fourth-largest city by population. Two groups of patients were analyzed. The OLP group consisted of 370 patients, while the OSCC group consisted of 154 patients. The OLP patients were followed up for up to 21 years to monitor clinical benefits from the management or changes in the lesion morphology; conversely, patients with OSCC were examined only twice for diagnostic purposes and referred to a specialized center. Data concerning systemic diseases, use of medications, type of oral lesions, and health-risk behaviors were recorded for patients in both groups. Results None of the patients with OLP developed OSCC at the lesion site. Only one female patient with erosive OLP developed OSCC in the normal, lesion-free oral mucosa. None of the OSCC patients had concomitant OLP lesions; however, a higher percentage of OSCC cases (17.5%) showed white plaques (most likely oral leukoplakia) as a precursor lesion. Conclusion The findings strongly suggest that malignant transformation of OLP is virtually nonexistent in the Brazilian population.

Real-world data from selective laser trabeculoplasty in Brazil

Evaluate real-world data of outcomes from selective laser trabeculoplasty (SLT) performed in different regions of Brazil and investigate potential predictors of success associated with treatment. Multicenter retrospective case series with patients who underwent a primary SLT procedure. A total of 835 eyes from 835 patients were included. The mean follow-up was 916.8 ± 563.0 days. The mean age was 64.5 ± 14.9 years and 56.6% were women. We observed an intraocular pressure reduction comparing baseline to post-SLT measurements (18.4 ± 3.8 mmHg versus 14.8 ± 3.5 mmHg; P < 0.001) and mean number of glaucoma medications (1.8 ± 1.3 versus 1.4 ± 1.4; P < 0.001). We observed visual acuity loss over time (0.1 ± 0.3 versus 0.2 ± 0.3 logMAR, baseline and post-SLT, respectively, P = 0.009) and decrease in visual field mean deviation values (− 5.4 ± 5.9 versus − 5.7 ± 6.0 dB; P = 0.054) The Kaplan–Meier survival analysis showed an estimated probability of treatment success of 88% at 12 months, declining to 70% at 24 months and 54% at 36 months post-SLT. In the multivariable model, we found that a denser angle pigmentation (HR 0.69; 95% CI 0.57–0.85, P = 0.001) and corticosteroid treatment following SLT (HR 0.59; 95% CI 0.39–0.91, P = 0.018) were significantly associated with a lower risk for failure. Primary SLT achieved relatively high success rates without sight-threating complications in this real-world study with a large sample of Brazilian patients. These findings corroborate previous studies regarding SLT outcomes and may help clinicians to identify the best candidates for laser treatment.

First Symptoms of Primary Progressive Aphasia and Alzheimer's Disease in Brazilian Individuals.

Background: Primary Progressive Aphasia (PPA) is characterized by progressive language impairment due to focal degeneration of brain areas related to linguistic processing. The detection and differential diagnosis of PPA can be difficult with clinical features that may overlap with features of other neurological conditions, such as Alzheimer's disease (AD). The scientific production on PPA in Latin American patients is still scarce. This study investigated the first symptoms in a Brazilian sample of patients with PPA in comparison with AD patients.Method: We compared the first symptoms reported by caregivers of people with PPA (n = 20; semantic variant n = 8, non-fluent variant n = 7, logopenic variant n = 3, and unclassified cases n = 2) and AD (n = 16). Data were collected through the application of a structured questionnaire that was presented in an interview format to the caregiver who knew the patient best.Results: Anomia, paraphasias and motor speech difficulties were the first symptoms capable of differentiating patients with PPA from those with AD, while memory was exclusive of AD. Among the PPA variants, anomia was the initial symptom associated with the semantic variant, while motor speech difficulties were associated with the non-fluent variant. The results are discussed considering the unique cultural and sociodemographic characteristics of this studied population.Conclusion: This study demonstrated that some of the initial symptoms of PPA patients may be unique to clinical variants of PPA and of AD, and their investigation may be useful for the early and differential diagnosis of this population.

Systemic lupus erythematosus in children and adults: A retrospective study in Brazilian patients.

Systemic lupus erythematosus (SLE) may have a different serological and clinical profile according to age of disease onset. To compare clinical presentation and serological data from patients with SLE onset in childhood (cSLE) with disease onset in adulthood (aSLE) in a sample of Brazilian patients. Retrospective study of 614 SLE patients from a single Rheumatology Unit from Brazil: 77 (12.5%) cSLE and 537 (87.4%) aSLE. Clinical and serological data were obtained from the charts. Comparisons of cSLE with aSLE in general and according to patient's gender were made. The comparison of whole sample showed that children had more malar rash (p = 0.04), seizures (p < 0.0001), psychosis (p = 0.02), glomerulonephritis (p = 0.001), anti-dsDNA (p = 0.008), anticardiolipin IgM (p = 0.04) but less discoid lesions (p = 0.01), anti-Ro (p < 0.0001) and anti-La antibodies (p = 0.007). When only the male sample was compared, no differences in glomerulonephritis and anti-dsDNA frequencies were found. Children had a higher frequency of severe manifestations (glomerulonephritis and central nervous system) than adults. The difference in glomerulonephritis occurrence disappeared when only males were compared.

Assessment of judgment ability in a Brazilian sample of patients with mild cognitive impairment and dementia.

ABSTRACT.Judgment is the ability to make sound decisions after consideration of relevant information, possible solutions, likely outcomes, and contextual factors. Loss of judgment is common in patients with mild cognitive impairment (MCI) and dementia. The Test of Practical Judgment (TOP-J) evaluates practical judgment in adults and the elderly, with 15- and 9-item versions that require individuals to listen to scenarios about everyday problems and report their solutions.Objective: Adaptation of TOP-J for a Brazilian sample, preparation of a reduced version and verification of the accuracy of both.Methods: Eighty-five older adults, including 26 with MCI, 20 with Alzheimer’s disease (AD), 15 with frontotemporal dementia behavioral variant (FTDbv) and 24 controls, underwent neuropsychological assessment including the Brazilian adaptation of the TOP-J (TOP-J-Br).Results: On both TOP-J-Br versions, controls outperformed MCI, AD and FTDbv patients (p<0.001) and MCI outperformed AD and FTDbv (p<0.001). For the TOP-J/15-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 91.7%, specificity of 59.0% and area under the curve of 0.8. For the TOP-J/9-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 79.9%, specificity of 72.1% and area under the curve of 0.82.Conclusion: The TOP-J/15-Br, and particularly the TOP-J/9-Br, showed robust psychometric properties and the potential for clinical utility in Brazilian older adults at various stages of neurodegenerative cognitive decline.

Clinical and autoantibody profile in male and female patients with systemic lupus erythematosus: A retrospective study in 603 Brazilian patients.

Sex and ethnic background may influence the clinical and autoantibody profile in systemic lupus erythematosus (SLE). This retrospective study aimed to compare the clinical and autoantibody profiles of male and female patients with SLE in a sample of Brazilian patients. This was a retrospective study of 603 patients (48 males and 555 females) from a single rheumatology center. Collected clinical data included clinical findings according to the definition of 2012 Systemic Lupus International Collaborating Clinics classification criteria, the presence of antiphospholipid antibody syndrome according to the Sydney classification criteria and autoantibody profile (anti-dsDNA, anti-Ro, anti-La, anti-Sm, anti-RNP, rheumatoid factor, anticardiolipin [aCl] IgG, aCl IgM, lupus anticoagulant, and direct antiglobulin test), and histological results of kidney biopsies. It was found that females had higher age at disease onset (p=0.02), more oral ulcers (p=0.001), and presented more often with alopecia (p<0.0001) than males. Males had a higher prevalence of glomerulonephritis (OR=6.5; 95%CI=3.0-13.7) and anti-dsDNA (OR=2.59; 95%CI=1.38-4.85) than females, but no differences were found in the pattern of renal biopsies (p=0.46). In this sample of Brazilian patients, the males had more renal involvement, fewer oral ulcers, and presented fewer times with alopecia than females.

Non-genetic factors and polymorphisms in genes CYP2C9 and VKORC1: predictive algorithms for TTR in Brazilian patients on warfarin.

This study was designed to evaluate the association of non-genetic factors and polymorphisms CYP2C9*2 (rs1799853), CYP2C9*3 (rs1075910), and VKORC1-G1639A (rs9923231) with time in therapeutic range (TTR), and to build a regression model to predict the quality of oral anticoagulation control in a sample of Brazilian patients. This is a retrospective cohort study developed at an anticoagulation clinic of a university hospital. Overall, 312 patients were included. The quality of oral anticoagulation control was evaluated by TTR. TTR was dichotomized for analysis, using two cutoff points for classification as inadequate (TTR ≤ 60.0%) and optimal (TTR ≥ 75.0%) control. The average age was 60.4 ± 13.5 years, with a predominance of women (187; 59.9%). The -G1639A polymorphism of the VKORC1 gene, when evaluated, based on the recessive inheritance pattern [AA × (GA + GG)], patients with AA genotype exhibited a higher TTR (68.2% versus 62.8%, p = 0.017). TTR ≤ 60.0% was associated with number of drugs in chronic use, assistance for warfarin administration, reports of not taking warfarin, absenteeism, sex (female), and target INR (International Normalized Ratio; 2.00-3.00). TTR ≥ 75.0% was associated with sex (male), target INR (2.00-3.00), assistance for warfarin administration, reports of not taking warfarin, and absenteeism. The two algorithms proposed showed adequate ability to predict TTR presenting good sensitivity and specificity. Our findings provided useful information for risk stratification depending on TTR level and for future investigations on the quality of oral anticoagulation control in Brazilian anticoagulation clinics.

An overview of the genetic basis of epidermolysis bullosa in Brazil: discovery of novel and recurrent disease-causing variants.

Epidermolysis bullosa (EB) is a genodermatosis that encompasses a group of clinically and genetically heterogeneous disorders classified in four major types: EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB) and Kindler syndrome. Our aim was to characterize recurrent and novel mutations associated to EB in a sample of Brazilian patients. Eighty-seven patients (25 EBS, 4 JEB and 58 DEB) were studied. We performed a next-generation sequencing-based multigene panel through ion torrent technology including 11 genes: KRT5, KRT14, PLEC, TGM5, LAMA3, LAMB3, LAMC2, COL17A1, ITGB4, COL7A1, and FERMT1. A total of 72 different pathogenic or likely pathogenic variants were identified, 32 of them are novel. The causal variant was detected in 82 patients (efficiency of 94.3%). Pathogenic variants in the residue 125 of KRT14 were identified in 32% of all EBS patients. In DEB patients, four COL7A1 variants were quite frequent, some of them clustered in specific Brazilian regions. Our study extends the spectrum of known mutations in EB and describes, for the first time, the genetic profile of EB patients from Brazil.

Lack of association between TCF7L2 gene variants and type 2 diabetes mellitus in a Brazilian sample of patients with the risk for cardiovascular disease.

Genetic variants in the transcription factor 7-like 2 (TCF7L2) gene have been described as the most noteworthy ones regarding the type 2 diabetes mellitus (T2DM) liability. This work is aimed to evaluate the association between rs12255372 and rs7903146 polymorphisms and T2DM in patients with cardiovascular disease (CAD) risk. A sample of six hundred and forty-seven patients that underwent the coronary angiography in a Cardiac Catheterization Lab was evaluated. The patients were investigated for the presence of T2DM and coronary stenosis. The TCF7L2 polymorphisms were genotyped by real-time PCR and the haplotype analysis was performed with the MLOCUS software. All genetic tests were carried out by considering the haplotype combinations in patients divided into three groups: 0 - carrying none disease risk allele, 1 - carrying one or two risk alleles and 2 - carrying three or four risk alleles. No significant associations between TCF7L2 risk haplotypes and the presence of T2DM or CAD were detected. Our results indicate that the TCF7L2 rs12255372 and rs7903146 polymorphisms do not influence T2DM in Brazilian patients with the high risk for CAD. Therefore, we assume that these variants may only be relevant for a specific subgroup of T2DM patients or some particular human population.

M95 - SCHIZOPHRENIA RELATED MIRNAS SELECTION IN A BRAZILIAN SAMPLE

Background Schizophrenia is a multifactorial complex disease that strikes approximately 1% of world population. A complex interaction between genetic and environmental factors seems to play a role in schizophrenia, and microRNAs might be involved. Single Nucleotide Polymorphism (SNP) in genes related to miRNAs biogenesis (such as DGCR8 located in the 22q11.2 region), in miRNA-encoding genomic loci (as in MIR137, classically associated to schizophrenia) or in seed match sequences of miRNAs target genes have been associated with a higher risk of developing psychiatric disorders. Although many studies on miRNAs have been conducted, few new miRNA targets are identified. In search of a better selection of target miRNAs, we propose to select miRNAs with a higher chance to be involved in schizophrenia taking as starting point SNPs associated to schizophrenia in a Brazilian sample of patients. Therefore, we aim to examine whether schizophrenia risk genes are more prone to be regulated by miRNA, identifying which miRNAs act in the regulation of the main risk genes involved in the disease. Methods The design of our study in a Brazilian mixed race sample was based on Engel Hauberg et al. study (2016). Differently, we are going to analyze an admixture casuistic, counting on 258 schizophrenia patients and 239 healthy control SNParray data. The samples were genotyped using SNParray HumanOmniExpress BeadChip (Illumina). The top 1% and 5% polymorphisms associated to schizophrenia and only those that codify proteins will be investigated regarding the regulation by miRNAs. Results The data are still under analysis. After applying quality control, 24365 variants and 6 individuals were excluded, remaining for analysis 668703 variants and 491 individuals (256 cases and 235 controls). In our preliminary results, the most significant analyzed SNPs were intergenic variants and in intronic regions and the most associated SNP presented a significance of 2.125×10-5. From the final association analysis results, we will select the SNPs at protein codifying genes and then proceed the remaining analysis. At the congress date we will present the main genes and related miRNAs probably involved in schizophrenia. Discussion This study will be the starting point to a deeper miRNA analysis. Although this is an in silico analysis, the results obtained from this study will be compared with miRNA-seq results as a study validation. As our next step, we intend to evaluate by miRNA-seq the miRNAs resulting from this analysis in serum exosome, once we already have this collected material of patients and health controls. Once the results have been confirmed, this may turn a useful method of selecting target miRNAs for new studies. It is worth remembering Engels-Hauberg et al. have recruited a Caucasian cohort and, replicating it in a mixed sample, such as the Brazilian one, will show the consistency of this method that, in a near future, may be used in studies of other diseases, whether psychiatric or not.

Low Sensitivity of the Mini-Mental State Examination for Cognitive Assessment of Brazilian Patients With Parkinson Disease.

Recent publications have highlighted the low sensitivity of the Mini-Mental State Examination (MMSE) for the cognitive assessment of patients with Parkinson disease (PD). The Montreal Cognitive Assessment (MoCA), otherwise, has shown greater sensitivity when compared to the MMSE. Based on this, we have searched for the cognitive impairment measurable by the MoCA and the functional performance on activities of daily living in a sample of Brazilian patients with PD and normal MMSE. We hypothesized that the low sensitivity of the MMSE, already shown by other authors, could be replicated in a low-income country. To describe the performance on the MoCA and the dependence on third parties for activities of daily living in a sample of Brazilian patients with PD and normal MMSE. We evaluated 43 volunteers with PD and normal MMSE considering the Brazilian cutoffs. Cognitive performance was assessed through the MoCA and functional performance through a modified version of the Disability Assessment for Dementia Scale. Despite normal score on the MMSE, considering the Brazilian cutoffs, 62.7% of the volunteers performed below the literature cutoff for the MoCA (26 points). Furthermore, 30.2% had dependence on third party for activities of daily living. By using a strict cutoff for the MMSE (26 points), 56.7% performed below the MoCA cutoff and 24.3% had dependence for activities of daily living. Our findings confirm the limitations of the MMSE for the cognitive screening of patients with PD in a low-income country.

The Use of the Clinical Dementia Rating Scale Sum of Boxes Scores in Detecting and Staging Cognitive Impairment/Dementia in Brazilian Patients With Low Educational Attainment.

The aim of this study was to evaluate the Clinical Dementia Rating Scale sum of the boxes (CDR-SB) diagnostic validity in detecting and staging cognitive impairment/dementia in a sample of Brazilian patients with amnestic mild cognitive impairment (aMCI), Alzheimer disease (AD), and vascular dementia (VD), of low educational attainment. Data were obtained from the Dementia Clinic of Hospital de Clínicas de Porto Alegre database and included 407 participants (115 healthy elderly, 41 aMCI, 165 AD, and 86 VD). Receiver operating characteristic curves were generated to detect best CDR-SB cutoffs. Average education was 4 years. A CDR-SB cutoff ≥0.5 was obtained to correctly identify MCI from normal controls (sensitivity of 100% and specificity of 98.3%). The cutoff ≥4.5 correctly identified aMCI from dementia altogether or separately (AD and VD) (sensitivity of 96.4% and specificity of 100%) in 96.9% of the individuals. Similar AUC was found for ≤4 and >4 years of education. The CDR-SB showed good clinical validity to detect and classify severity of cognitive impairment Brazilian patients with low educational attainment. Findings were similar to the original study carried out with higher educated individuals.

Prevalence of Porphyromonas gingivalis fimA II genotype in generalized aggressive periodontitis patients

Purpose: The objective of this study was to evaluate the prevalence of Porphyromonas gingivalis (Pg) and its filmA II genotype in a sample of Brazilian patients with generalized aggressive periodontitis (GAgP) and to correlate the presence of each pathogen/genotype eith clinical parameters. Methods: We used polymerase chain reaction (PCR) to evaluate the presence of Pg and filmA II genotype in subgingival plaque samples collected from the deepest site of 45 Brazilian patients aged 15-40 years with GAgP and correlated findings with age and clinical parameters (plaque index, gingival bleeding index, probing depth and clinical attachment loss). Results: Pg was identified in 64.4% patients. FilmA II genotype was present in 82.6% of Pg-positive patients. The presence of Pg and filmA II genotype was significantly associated with greater clinical attachment loss at the sampled periodontal site. Pg-positive patients were slightly older than Pg-negative patients. Conclusions: Pg and filmA II genotype were highly prevalente in Brazilian patients with GAgP. Pg was more commonly observed in slightly older individuals and in sites with more clinical attachment loss.

ID-Migraine™ questionnaire and accurate diagnosis of migraine.

To analyze the applicability of the Portuguese version of ID-MigraineTM in a sample of Brazilian patients. Patients with headache were recruited from the neurology outpatient clinic of a tertiary hospital and submitted to the ID-MigraineTM questionnaire. The diagnosis of headache was made according to the ICHD-2 criteria. Of the 232 patients, 86% had migraine. The questionnaire showed a sensitivity of 92% (95%CI, 88% to 95%), specificity of 60% (95%CI, 43% to 77%) and a positive predictive value of 93% (95%CI, 89% to 96%). Our results were similar to other international studies of the ID-MigraineTM application. The Portuguese version is considered easy to use, and an appropriate screening tool for migraine diagnosis in our sample. Considering the characteristics of our health system, we can infer that this questionnaire would be beneficial in a Brazilian primary care setting; however, more studies are necessary.