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Efeitos da estimulação transcraniana combinada com o treinamento cognitivo-linguístico de memória e atenção em crianças com transtorno fonológico: um estudo piloto cruzado, controlado, randomizado e triplo cego

2026-07-24T00:00:00Z

Título: Efeitos da estimulação transcraniana combinada com o treinamento cognitivo-linguístico de memória e atenção em crianças com transtorno fonológico: um estudo piloto cruzado, controlado, randomizado e triplo cego Autor(es): Alves, Maria Vanessa Martins Abstract: Introduction: Transcranial Direct Current Stimulation (tDCS), a non-invasive neuromodulation technique with the potential to induce neuroplastic effects, has shown promising results in modulating cognitive and language functions. However, the application of tDCS in children with specific language disorders remains underrepresented in the current literature, particularly in cases without the presence of other associated medical conditions. Objective: To investigate the effects of tDCS combined with a paired intervention on the cognitive abilities of memory and attention in children with Phonological Disorder (PD). Methods: This pilot, randomized, placebo-controlled, triple-blind, crossover clinical trial was conducted with 16 children aged 7 to 12 years diagnosed with PD. Participants underwent three consecutive weekly sessions of tDCS over four weeks, totaling 12 sessions. Anodal stimulation was applied over the left dorsolateral prefrontal cortex (F3), combined with a standardized cognitive-linguistic training program focused on memory and attention skills. Participants were assessed for cognitive and language functions using the Attention, Oral Language, Executive Functions, and Memory (working, verbal, visual, and semantic) subtests of the NEUPSILIN-Inf – Brief Neuropsychological Assessment Instrument for Children and were evaluated at three time points (T0, T1, and T2). Statistical analyses were performed using R software version 4.5.1, following the intention-to-treat principle. Missing data were handled using Multiple Imputation by Chained Equations (MICE). Considering the crossover design, two analytical approaches were conducted: (1) comparison of changes between T0 and T1 across groups and (2) within-subject analysis comparing the effects of active and sham stimulation. The domains of attention, memory, language, and executive functions were evaluated, in addition to exploratory analyses of individual subtests. Estimates were combined according to Rubin's Rules, and multiple comparisons were adjusted using the False Discovery Rate (FDR) method, adopting a significance level of 5%. Results: The study sample consisted of 16 children, including eight boys and eight girls, aged 7 to 12 years, with a mean age of 8.81 years (SD ± 1.8). Between-group comparison during the first intervention period (T0–T1) demonstrated significantly greater improvement in the attention domain among participants who received active tDCS compared with those who received sham stimulation (p = 0.0085). This finding was corroborated by the within-subject crossover analysis, which also demonstrated superior attentional performance following active stimulation (p = 0.039). Exploratory analyses revealed improvements in auditory attention (p = 0.032) and total attention score (p = 0.033) after active stimulation. Favorable trends were also observed for language and memory, although these findings did not reach statistical significance. Conclusion: The findings suggest that tDCS may primarily enhance attentional processes in children with PD, with potential positive effects on related cognitive functions, including memory and language. These results support the potential of non-invasive neuromodulation as an adjunctive strategy for cognitive rehabilitation, although studies with larger samples are needed to confirm these effects.

Impacto dos aspectos socioeconômicos e ambientais na incidência da leishmaniose visceral humana em Aracaju: um estudo ecológico uma revisão sistemática

2026-02-26T00:00:00Z

Título: Impacto dos aspectos socioeconômicos e ambientais na incidência da leishmaniose visceral humana em Aracaju: um estudo ecológico uma revisão sistemática Autor(es): Melo, Náira Alice Vieira Abstract: Visceral leishmaniasis (VL) is a disease caused by parasites of the genus Leishmania and transmitted by vectors called phlebotomine sand flies. Classified as a zoonosis, this disease is considered a serious public health problem in the country, given that Brazil is endemic, accounting for 90% of cases found in the Americas. In Sergipe, a Brazilian state in the Northeast region, this zoonosis has a high incidence and lethality rate. Therefore, due to the epidemiological situation, it was hypothesized that in Aracaju, the city where cases predominate, socioeconomic factors and environmental changes such as deforestation and disordered urbanization are important risk factors, since there is already scientific evidence that proves these correlations in other regions of the country. In this sense, the present project aims to investigate the impact of socioeconomic indicators and changes in vegetation cover on the incidence of human visceral leishmaniasis in Aracaju between 2019 and 2024. To this end, an ecological study was conducted using the Generalized Additive Model (GAM) and Principal Component Analysis (PCA). These methods complement each other, as GAM is predictive and inferential, aiming to determine the influence of variables individually, while PCA is exploratory and descriptive, aiming to explore multivariate patterns and determine the weight of variables in the occurrence of the disease. The databases used were: reports and official documents from the Brazilian Ministry of Health and the Sergipe State Health Secretariat, MapBiomas, DATASUS, and the Brazilian Institute of Geography and Statistics (IBGE). Evidence suggests that visceral leishmaniasis is concentrated in impoverished populations in Africa, Asia, and Latin America, particularly in Brazil, Ethiopia, India, Kenya, Sudan, and Yemen. This is similar to the findings of this research, as the GAM results indicated that the predictive variables for visceral leishmaniasis in Aracaju are: illiteracy, irregular water supply, irregular garbage collection, irregular sanitation, and population density. In the PCA, the variables with the greatest weight were: illiteracy, poverty, inaccessibility to electricity, irregular water supply, irregular garbage collection, and irregular sanitation. These findings revealed that socioeconomic and demographic determinants had the greatest influence on the incidence of the disease during the study period. Therefore, the need for the implementation of integrated public policies that consider social, economic, and environmental factors is evident in order to effectively control the incidence of the disease and enable health promotion for the municipality as a whole.

Adaptação transcultural do Skin Cancer Index para o português e avaliação da qualidade de vida em pacientes com câncer de pele não melanoma cervicofacial

2023-01-01T00:00:00Z

Título: Adaptação transcultural do Skin Cancer Index para o português e avaliação da qualidade de vida em pacientes com câncer de pele não melanoma cervicofacial Autor(es): Hora, Evânia Curvelo Abstract: Non-melanoma skin cancer (NMSC) is the most frequent malignant neoplasm in Brazil. NMSCs occur mostly in the cervicofacial region, are associated with high morbidity, and often require surgical management. This causes functional, aesthetic, and emotional sequelae impacting the patient's quality of life (QoL). The Skin Cancer Index (SCI) was created to measure the QoL of NMSC patients. This study aimed to perform a cross-cultural adaptation of the SCI to the Portuguese language and the culture of northeastern Brazil, and measure its psychometric properties of reliability, validity, and responsiveness in assessing the QoL of patients with cervicofacial NMSC. This way, a specific instrument was developed to measure the QoL of this population. This study was performed in two stages. The first stage consisted of methodological research on the cross-cultural adaptation of the SCI through five steps: initial translation, synthesis of translations, back-translation, expert committee approval, and testing of the pre-final version (n=40). The second stage was a cross-sectional study on the clinical validation and assessment of the QoL of these patients (n= 182). The first stage resulted in an adapted version of the SCI. This version reached a Content Validity Index level significantly higher than 80% (p<0.05), evaluated through the Exact Binomial test. Temporal stability of the SCI during the test and retest periods was observed. Moreover, the Pearson’s correlations, as well as the Intraclass Correlation Coefficient, showed coefficients higher than 0.9, indicating excellent reliability. In the second stage, the adapted version was administered together with the Brazilian version of the Dermatology Life Quality Index (DLQI), during the pre-and post- operative periods (4 months postoperatively). Reliability in the subscales, and the total instrument, guaranteed by McDonald's ω, were considered ideal (>0.8) in all sub- dimensions. Moreover, α was considered ideal in the “emotional” and “social” sub-dimensions.Construct validity was obtained in all sub-dimensions and on the scale using the criteria (χ2) p-value > 0.05, RMSEA < 0.08, CFI ≥ 0.9, and SRMR ≤ 0.08. QoL and responsiveness were assessed by the student’s t-test in a paired sample at T0 (preoperatively) and T1 (4 monthspostoperatively). Significant results were observed with an increase in the SCI scale scores in all its dimensions and the total instrument (p < 0.001), and a decrease in the DLQI scale (p = 0.001). This showed that the adapted scale demonstrated a better postoperative QoL. The variables that presented significant results in the total scale, which indicated better QoL, were “men” (p = 0.002), “without children” (p = 0.019), “income above 4 minimun wages (p < 0.001), “from the private sector” (p < 0.001), “did not report itching” (p = 0.021), and “no scalp lesions” (p=0.012). The QoL measurement indicated a change from the baseline and postoperative improvement in all subscales and in the total instrument. The final version of the SCI adapted to the Portuguese language was called “SCI-versão brasileira” and proved to be a valid, reliable, and responsive instrument that allows health professionals to identify changes in the QoL of patients with NMSC.

Perfil fenotípico e funcional de neutrófilos em paciente COVID-19 após vacinação

2024-01-01T00:00:00Z

Título: Perfil fenotípico e funcional de neutrófilos em paciente COVID-19 após vacinação Autor(es): Oliveira, Yrna Lorena Matos de Abstract: Introduction: A dysregulation in the innate immune response against the SARS-CoV-2 coronavirus may contribute to a worse prognosis in COVID-19. Serum biomarkers released by neutrophils such as the TREM-1 receptor and IL-6 are associated with the severity of inflammatory diseases. Different functional profiles of neutrophils have been described with an important role in antiviral defense and also in the inflammatory process triggered by the virus. With the advance of vaccination, it is important to understand how neutrophils are contributing to the pathogenesis of the disease. Aim: To evaluate the neutrophil profile in COVID1-9 after vaccination. Methods: This study was divided into two chapters, the first referring to a meta- analysis and the second to an experimental study. The meta-analysis was carried out in order to evaluate serum levels of the soluble form of TREM-1 (sTREM-1) in humans with viral pneumonia compared to healthy controls, according to the PRISMA guideline, and seven studies were included, four studies analyzed patients with COVID-19 and three studies evaluated other viruses. The cross-sectional study was carried out with severe COVID-19 patients, 17 unvaccinated and 12 vaccinated, admitted to intensive care units. The phenotypic and functional profile of neutrophils and the dosage of serum proteins and cytokines were evaluated. The neutrophil phenotype was determined by flow cytometry using the following surface markers: CD11b (cell adhesion), CD16 (phagocytic capacity), CD182 (chemotaxis), TREM-1 (activation), HLA-DR (antigen presentation) and CD274 (suppressive activity), together with the dosage of serum proteins, IL-6 and sTREM-1 assessed using specific immunoassays and, the dosage of cytokines : GM-CSF; IFN-γ; IL-1β; IL-2; IL-4; IL-5; IL-12 p70; IL-13; IL-18; and TNF-α by the LUMINEX method. Results: The meta-analysis found increased sTREM-1 levels in COVID-19 patients compared to healthy controls (SMD 1.53; 95% CI 0.53-2.52). In addition, higher sTREM-1 levels were found in vaccinated severe COVID-19 patients compared to healthy patients. There was no significant difference between severe and non-severe COVID-19 patients. The cross-sectional study found that serum IL-6 levels were significantly higher in unvaccinated severe COVID-19 patients compared to the vaccinated group. In vaccinated patients, neutrophils expressed more surface markers TREM- 1, CD182, HLA-DR, MFI of HLA-DR and PD-L1, as well as an increase in the CD16+CD182+TREM-1+ population (p=0.0009) and the HLA-DR+PDL-1+ population (p<0.0001). Correspondingly, vaccinated patients showed significant correlations mainly related to the number of PD-L1+ neutrophils and inflammatory cytokines, while in unvaccinated patients, inflammatory cytokines were negatively correlated with TREM-1 on the surface of neutrophils. Conclusion: From these data we can conclude that the TREM-1 molecule participates in the pathogenesis of COVID-19 and that vaccination has favored a more activated state or a more prepared immune system, in terms of regulation, antigen presentation, chemotaxis, inflammatory response and immune activation in the face of SARS-CoV-2 infection.