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INTRODUCTION: Neoadjuvant endocrine therapy (NET) is recommended for the treatment of invasive breast cancer (BC), particularly luminal subtypes, in locally advanced stages. Previous randomized studies have demonstrated the benefits of aromatase inhibitors in this context. However, NET is typically reserved for elderly or frail patients who may not tolerate neoadjuvant chemotherapy. Identifying non-responsive patients early and extending treatment for responsive ones would be ideal, yet optimal strategies are awaited. AIMS: This non-randomized phase 2 clinical trial aims to assess NET feasibility and efficacy in postmenopausal stage II and III luminal BC patients, identifying predictive therapeutic response biomarkers. Efficacy will be gauged by patients with Ki67 ≤ 10% after 4 weeks and Preoperative Endocrine Prognostic Index (PEPI) scores 0 post-surgery. Study feasibility will be determined by participation acceptance rate (recruitment rate ≥50%) and inclusion rate (>2 patients/month). METHODS: Postmenopausal women with luminal, HER2-tumors in stages II and III undergo neoadjuvant anastrozole treatment, evaluating continuing NET or receiving chemotherapy through early Ki67 analysis after 2 to 4 weeks. The study assesses NET extension for up to 10 months, using serial follow-ups with standardized breast ultrasound and clinical criteria-based NET suspension. Clinical and pathological responses will be measured overall and in the luminal tumor A subgroup. Toxicity, health-related quality of life, and circulating biomarkers predicting early NET response will also be evaluated.

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Multiple sclerosis (MS) is a chronic and demyelinating disease with an autoimmune origin, which leads to neurodegeneration and progressive disability. Approximately 30 to 50% of patients do not respond optimally to disease-modifying therapies (DMTs), and therapeutic response may be influenced by genetic factors such as genetic variants. Therefore, our study aimed to investigate the association of the HLA-DRB1*0403 genetic variant and therapeutic response to DMTs in MS. We included 105 patients with MS diagnosis. No evidence of disease activity based on the absence of clinical relapse, disability progression or radiological activity (NEDA-3) was used to classify the therapeutic response. Patients were classified as follows: (a) controls: patients who achieved NEDA-3; (b) cases: patients who did not achieve NEDA-3. DNA was extracted from peripheral blood leukocytes. HLA-DRB1*0403 genetic variant was analyzed by quantitative polymerase chain reaction (qPCR) using TaqMan probes. NEDA-3 was achieved in 86.7% of MS patients treated with DMTs. Genotype frequencies were GG 50.5%, GA 34.3%, and AA 15.2%. No differences were observed in the genetic variant AA between patients who achieved NEDA-3 versus patients who did not achieve NEDA-3 (48.7% vs. 43.1%, p = 0.6). We concluded that in Mexican patients with MS, HLA-DRB1*0403 was not associated with the therapeutic response to DMTs.

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BACKGROUND: The use of novel and accurate techniques to identify genetic variants (with or without a record in the National Center for Biotechnology Information (NCBI) database) improves diagnosis, prognosis, and therapeutics for patients with epilepsy, especially in populations for whom such techniques exist. The aim of this study was to find a genetic profile in Mexican pediatric epilepsy patients by focusing on ten genes associated with drug-resistant epilepsy (DRE). METHODS: This was a prospective, analytical, cross-sectional study of pediatric patients with epilepsy. Informed consent was granted by the patients' guardians or parents. Genomic DNA from the patients was sequenced using next-generation sequencing (NGS). For statistical analysis, Fisher's exact, Chi-square or Mann-Whitney U, and OR (95% CI) tests were performed, with significance values of p < 0.05. RESULTS: Fifty-five patients met the inclusion criteria (female 58.2%, ages 1-16 years); 32 patients had controlled epilepsy (CTR), and 23 had DRE. Four hundred twenty-two genetic variants were identified (71.3% with a known SNP registered in the NCBI database). A dominant genetic profile consisting of four haplotypes of the SCN1A, CYP2C9, and CYP2C19 genes was identified in most of the patients studied. When comparing the results between patients with DRE and CTR, the prevalence of polymorphisms in the SCN1A (rs10497275, rs10198801, and rs67636132), CYP2D6 (rs1065852), and CYP3A4 (rs2242480) genes showed statistical significance (p = 0.021). Finally, the number of missense genetic variants in patients in the nonstructural subgroup was significantly higher in DRE than in CTR (1 [0-2] vs. 3 [2-4]; p = 0.014). CONCLUSIONS: The Mexican pediatric epilepsy patients included in this cohort presented a characteristic genetic profile infrequent in the Mexican population. SNP rs1065852 (CYP2D6*10) is associated with DRE, especially with nonstructural damage. The presence of three genetic alterations affecting the CYP2B6, CYP2C9, and CYP2D6 cytochrome genes is associated with nonstructural DRE.

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Introducción: La proctitis actínica crónica hemorrágica (PACH) se presenta secundaria a la radioterapia pélvica. La coagulación con argón plasma (APC) es una terapéutica eficaz, segura, de fácil uso y relativo bajo costo. Objetivo: Describir la respuesta terapéutica a corto y largo plazo del APC en pacientes con PACH, así como evaluar la calidad de vida antes y después de la intervención. Material y Métodos: Estudio observacional, prospectivo de serie de casos en 46 pacientes con PACH, atendidos en el Centro Nacional de Cirugía de Mínimo Acceso entre 2017 y 2020. Se emplearon medidas de resumen y comparación de medias (t de Student pareada) para la hemoglobina inicial y final, así como para los puntajes de calidad de vida aplicados antes y después de la intervención. Para determinar el tiempo libre de resangrado se utilizó l Método de Kaplan-Meier. Se estimó una significación menor a 0.05 para un intervalo de confianza de 95 por . Resultados: Se necesitó una media de 3,6 ± 2,394 sesiones de APC. La media de hemoglobina se incrementó 1,9 g/L. La respuesta terapéutica a corto plazo se observó en 100 por ciento de los pacientes y a largo plazo en 91,3 . La media de puntaje para la calidad de vida descendió en 12,065 puntos (p˂ 0,00), La percepción global percibida se incrementó en una media de 7.326 puntos (p˂ 0,00). Conclusiones: El APC tiene buena respuesta terapéutica a corto y largo plazo con pocas sesiones y bajo número de complicaciones, con mejoría de la calidad de vida de los pacientes(AU)

Introduction: Chronic hemorrhagic radiation proctitis (CHRP) appears secondary to pelvic radiotherapy. Argon plasma coagulation (APC) is an effective, safe, easy-to-use, and relatively inexpensive therapy. Objective: To describe the short- and long-term therapeutic response of APC in patients with CHRP, as well as to evaluate the quality of life before and after the intervention. Material and Methods: Observational, prospective case series study of 46 patients with CHRP, treated at the National Center for Minimally Access Surgery between 2017 and 2020. Summary measures and comparison of means (paired Student's t-test) were used for baseline and final hemoglobin, as well as for the quality of life scores applied before and after the intervention. The Kaplan-Meier method was used to determine the recurrence free time. A level of significance less than 0.05 was estimated for a 95 por ciento confidence interval. Results: A mean of 3,6 ± 2,394 APC sessions was required. The mean hemoglobin increased 1,9 g / L. Short-term therapeutic response was observed in 100 % of patients, and long-term in 91,3 por ciento. The mean score for quality of life decreased by 12,065 points (p˂ 0,00). The perceived global perception increased by a mean of 7,326 points (p˂ 0,00). Conclusions: APC has a good therapeutic response in the short and long term with few sessions and a low number of complications, with an improvement in the quality of life of the patients(AU)

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Introduction: Immune reconstitution failure after HIV treatment is a multifactorial phenomenon that may also be associated with a single polymorphism of human leukocyte antigen (HLA); however, few reports include patients from the Brazilian Amazon. Our objective was to evaluate the association of the immunogenic profile of the "classical" HLA-I and HLA-II loci with treatment nonresponse in a regional cohort monitored over 24 months since HIV diagnosis. Materials and Methods: Treatment-free participants from reference centers in the state of Pará, Brazil, were enrolled. Infection screening was performed using enzyme immunoassays (Murex AG/AB Combination DiaSorin, UK) and confirmed by immunoblots (Bio-Manguinhos, FIOCRUZ). Plasma viral load was quantified by real-time PCR (ABBOTT, Chicago, Illinois, USA). CD4+/CD8+ T lymphocyte quantification was performed by immunophenotyping and flow cytometry (BD Biosciences, San Jose, CA, USA). Infection was monitored via test and logistics platforms (SISCEL and SICLOM). Therapeutic response failure was inferred based on CD4+ T lymphocyte quantification after 1 year of therapy. Loci A, B and DRB1 were genotyped using PCR-SSO (One Lambda Inc., Canoga Park, CA, USA). Statistical tests were applied using GENEPOP, GraphPad Prism 8.4.3 and BioEstat 5.3. Results: Of the 270 patients monitored, 134 responded to treatment (CD4+ ≥ 500 cells/µL), and 136 did not respond to treatment (CD4+ < 500 cells/µL). The allele frequencies of the loci were similar to heterogeneous populations. The allelic profile of locus B was statistically associated with treatment nonresponse, and the B*13, B*35 and B*39 alleles had the greatest probabilistic influence. The B*13 allele had the highest risk of treatment nonresponse, and carriers of the allele had a detectable viral load and a CD4+ T lymphocyte count less than 400 cells/µL with up to 2 years of therapy. The B*13 allele was associated with a switch in treatment regimens, preferably to efavirenz (EFZ)-based regimens, and among those who switched regimens, half had a history of coinfection with tuberculosis. Conclusions: The allelic variants of the B locus are more associated with non-response to therapy in people living with HIV (PLHIV) from a heterogeneous population in the Brazilian Amazon.

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This study aimed to evaluate the serum concentration of vitamin D (25-Hydroxyvitamin D) and acute phase proteins (APPs; alpha-1 acid glycoprotein, haptoglobin, transferrin, ceruloplasmin, albumin, IgA, IgG and alpha-1 - antitrypsin) as potential biomarkers for prognostic and therapy response in dogs with multicentric lymphoma submitted to the CHOP (Cyclophosphamide, Doxorubicin, Vincristine and Prednisone) chemotherapy protocol. Thirteen dogs with multicentric lymphoma classified as high grade by cytology were included in the treatment group (GL), while ten healthy dogs were included in the control group (GC). Serum was collected in the weeks T0, T5 and T10 of CHOP chemotherapy protocol, for the GL group, and in a single collection, for the GC group. All the collected samples were evaluated for the APPs and vitamin D concentrations through electrophoresis and chemiluminescence methods, respectively. Diagnostic and staging tests were performed for all the dogs in the GL group, and included cytopathology, histopathology and immunohistochemistry of the affected lymph node. Of these dogs, 9 achieved a complete response and 4 a partial response to the treatment. Data analysis was performed with the R software. The results demonstrated that serum concentrations of IgA, haptoglobin and α1-acid glycoprotein were significantly different between the groups and also between the different chemotherapy times analyzed (p<0.05), indicating that these proteins can be considered as sensitive biomarkers for lymphoma in dogs. Furthermore, the α1-acid glycoprotein showed prognostic value for the disease, with 63% specificity. However, vitamin D concentration was not correlated with prognosis of the dogs with lymphoma.

Objetivou-se caracterizar a concentração sérica da vitamina D e das PFAs (Proteínas de Fase Aguda) (alfa-1 glicoproteína ácida, haptoglobina, transferrina, ceruloplasmina, albumina, IgA, IgG e alfa-1 ­ antitripsina) em cães com linfoma multicêntrico, submetidos ao tratamento quimioterápico com protocolo CHOP (Ciclofosfamida, Doxorrubicina, Vincristina e Prednisona), determinando o valor prognóstico desses marcadores para a doença. Foram avaliadas as concentrações séricas das PFAs, através do método da eletroforese e as concentrações da vitamina D, através da quimioluminescência em dois grupos experimentais, um grupo de 13 cães com linfoma multicêntrico classificados como alto grau pela citologia (GL) durante as semanas T0, T5 e T10 do tratamento com protocolo quimioterápico antineoplásico e em um grupo de 10 animais saudáveis para compor o grupo controle (GC), em coleta única. Para isso, foi realizado o diagnóstico, estadiamento e avaliação de resposta terapêutica dos 13 pacientes com linfoma multicêntrico através de técnicas de citopatologia, histopatologia, imuno-histoquímica do linfonodo periférico acometido. Foi observado que 9 pacientes tiveram resposta completa e 4 pacientes tiveram resposta parcial ao tratamento. Os dados foram analisados através do software R. Os resultados indicam que as diferenças entre as variáveis IgA, haptoglobina e α1-glicoproteína ácida foram significativas entre os grupos, e entre os diferentes momentos da quimioterapia (p< 0,05), indicando que podem ser marcadores sensíveis ao linfoma em cães. A α1-glicoproteína ácida apresentou valor prognóstico para o linfoma, com 63% de especificidade. Porém a vitamina D não apresentou valor prognóstico para o linfoma multicêntrico em cães.

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Genes associated with wound healing have been shown to be risk factors for cutaneous leishmaniasis (CL) which is caused by Leishmania braziliensis. In this study, we examined whether the genes previously associated with CL influenced the clinical outcome. Patients were genotyped and retrospectively classified as responders, who were cured with a single course of pentavalent antimony (Sbv), or as refractories, who did not respond to Sbv. Patients characterised as responders showed a stronger response to the leishmanin skin test (LST) when compared to the refractory subjects (p = 0.0003). Furthermore, we observed an association between the FLI1 CC genotype and an increased size of ulcers (p = 0.0170). We suggest that the leishmanin skin test may be a predictive tool for therapeutic outcome and reinforce FLI1 as a potential influencer of susceptibility and lesion size in CL.

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BACKGROUND: Leishmaniasis is a parasitic disease caused by more than 20 species of the Leishmania genus. The disease is globally distributed and is endemic in 97 countries and three territories in the tropical and subtropical regions. The efficacy of the current treatments is becoming increasingly low either due to incomplete treatment or resistant parasites. Failure of treatment is frequent, and therefore, the search for early biomarkers of therapeutic response in cutaneous leishmaniasis (CL) is urgently needed. OBJECTIVE: The aim of this study was to compare the proteomic profiles in patients with CL before and after 7 days of treatment and identify early biomarkers of curative response. METHODS: Four patients with a parasitological diagnosis of leishmaniasis with confirmation of species by PCR-RFLP were recruited. All patients had a single lesion, and a protein from the middle of the ulcer was quantified by liquid chromatography and mass spectrometry. RESULTS: A total of 12 proteins showed differential expression in the comparative LC-electrospray ionization MS/MS (LC-ESI-MS/MS) triplicate analysis. Seven of them were up-regulated and five of them were down-regulated. Calcium binding proteins A2, A8, and A9 and hemoglobin subunits alpha-2 and delta showed high correlation with epidermis development and immune response. CONCLUSION: We identified changes in the profiles of proteins that had a positive therapeutic response to the treatment. The proteins identified with differential expression are related to the reduction of inflammation and increased tissue repair. These proteins can be useful as biomarkers for early monitoring of therapeutic response in CL.

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Visceral leishmaniasis (VL) is caused by Leishmania donovani and Leishmania infantum. The burden of VL is concentrated in tropical and subtropical areas; however, HIV infection has spread VL over a hyperendemic area. Several outcomes are observed as a result of VL-HIV coinfection. Impacts are observed in immunopathogenesis, clinical manifestation, diagnosis, and therapeutic response. Concerning clinical manifestation, typical and unusual manifestation has been observed during active VL in HIV-infected patient, as well as alteration in immunoresponse, inducing greater immunosuppression by low CD4 T-lymphocyte count or even by induction of immunoactivation, with cell senescence. Serological diagnosis of VL in the HIV-infected is poor, due to low humoral response, characterized by antibody production, so parasitological methods are more recommended. Another important and even more challenging point is the definition of the best therapeutic regimen for VL in HIV-coinfected patients, because in this population there is greater failure and consequently higher mortality. The challenge of better understanding immunopathogenesis in order to obtain more effective therapies is one of the crucial points to be developed. The combination of drugs and the use of secondary prophylaxis associated with highly active antiretroviral therapy may be the best tool for treatment of HIV coinfection. Some derivatives from natural sources have action against Leishmania; however, studies have been limited to in vitro evaluation, without clinical trials

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A leishmaniose visceral (LV) é causada por protozoários do gênero Leishmania, sendo as duas principais espécies: Leismania (Leishmania) donovani e Leishmania (Leishmania) infantum, as quais tem ocorrência geográfica diversa e estão relacionadas com diversidade de manifestações clinicas e de resposta terapêutica. Notadamente, a LV que ocorre, principalmente, na Índia Sudão, Sudão do Sul, Bangladesh e Etiópia é causada pela espécie L. donovani, enquanto nas Américas e em algumas regiões da África e Europa, a espécie causadora é a L. infantum. A LV causada pela L. (L.) donovani tem um espectro clínico variando de comprometimento visceral à lesão cutânea que ocorre após um episódio de LV, que é a leishmaniose dérmica póskalazar (PKDL), manifestações esta que não é muito frequente na LV causada pela L. infantum. Ademais, a resposta terapêutica é divergente entre essas espécies, visto que na LV causada por L. donovani há pobre resposta ao antimonial pentavalente, configurando um padrão de resistência elevado, enquanto que na LV causada pela L. infantum essa informação não é muito clara. Neste artigo abordamos a diversidade clínica e a resposta terapêutica da LV causada principalmente por L. infantum, que é de ocorrência nas Américas.

Visceral leishmaniasis (VL) is caused by protozoa of the genus Leishmania, of the species Leismania (Leishmania) donovani and Leishmania (Leishmania) infantum, which occur in different geographic regions and are related to the diversity of clinical manifestations and therapeutic response. Notably, VL occurring mainly in India, Sudan, South Sudan, Bangladesh and Ethiopia is caused by L. donovani, while in the Americas and in some regions of Africa and Europe is caused by L. infantum. Visceral leishmaniasis caused by L. donovani has a clinical spectrum ranging from visceral involvement to cutaneous lesion that occurs after a VL episode, which is post-kala-azar-dermal-leishmaniasis (PKDL), which is not very frequent in the VL caused by L. infantum. In addition, the therapeutic response is divergent among these species, since in VL caused by L. donovani there is poor response to pentavalent antimony, setting a high resistance pattern, whereas in VL caused by L. infantum this information is not very clear. In this article, we discuss the clinical diversity and therapeutic response of VL caused mainly by L. infantum, which is occurring in the Americas.

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A leishmaniose visceral (LV) é causada por protozoários do gênero Leishmania, sendo as duas principais espécies: Leismania (Leishmania) donovani e Leishmania (Leishmania) infantum, as quais tem ocorrência geográfica diversa e estão relacionadas com diversidade de manifestações clinicas e de resposta terapêutica. Notadamente, a LV que ocorre, principalmente, na Índia Sudão, Sudão do Sul, Bangladesh e Etiópia é causada pela espécie L. donovani, enquanto nas Américas e em algumas regiões da África e Europa, a espécie causadora é a L. infantum. A LV causada pela L. (L.) donovani tem um espectro clínico variando de comprometimento visceral à lesão cutânea que ocorre após um episódio de LV, que é a leishmaniose dérmica póskalazar (PKDL), manifestações esta que não é muito frequente na LV causada pela L. infantum. Ademais, a resposta terapêutica é divergente entre essas espécies, visto que na LV causada por L. donovani há pobre resposta ao antimonial pentavalente, configurando um padrão de resistência elevado, enquanto que na LV causada pela L. infantum essa informação não é muito clara. Neste artigo abordamos a diversidade clínica e a resposta terapêutica da LV causada principalmente por L. infantum, que é de ocorrência nas Américas.(AU)

Visceral leishmaniasis (VL) is caused by protozoa of the genus Leishmania, of the species Leismania (Leishmania) donovani and Leishmania (Leishmania) infantum, which occur in different geographic regions and are related to the diversity of clinical manifestations and therapeutic response. Notably, VL occurring mainly in India, Sudan, South Sudan, Bangladesh and Ethiopia is caused by L. donovani, while in the Americas and in some regions of Africa and Europe is caused by L. infantum. Visceral leishmaniasis caused by L. donovani has a clinical spectrum ranging from visceral involvement to cutaneous lesion that occurs after a VL episode, which is post-kala-azar-dermal-leishmaniasis (PKDL), which is not very frequent in the VL caused by L. infantum. In addition, the therapeutic response is divergent among these species, since in VL caused by L. donovani there is poor response to pentavalent antimony, setting a high resistance pattern, whereas in VL caused by L. infantum this information is not very clear. In this article, we discuss the clinical diversity and therapeutic response of VL caused mainly by L. infantum, which is occurring in the Americas.(AU)

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ABSTRACT INTRODUCTION: Cutaneous leishmaniasis (CL) is a tropical disease that affects millions of individuals worldwide. The current drugs for CL may be effective but have serious side effects; hence, alternatives are urgently needed. Although plant-derived materials are used for the treatment of various diseases in 80% of the global population, the validation of these products is essential. Gelatin capsules containing dried Artemisia annua leaf powder were recently developed as a new herbal formulation (totum) for the oral treatment of malaria and other parasitic diseases. Here, we aimed to determine the usefulness of A. annua gel capsules in CL. METHODS: The antileishmanial activity and cytotoxicity of A. annua L. capsules was determined via in vitro and in vivo studies. Moreover, a preliminary evaluation of its therapeutic potential as antileishmanial treatment in humans was conducted in 2 patients with uncomplicated CL. RESULTS: Artemisia annua capsules showed moderate in vitro activity in amastigotes of Leishmania (Viannia) panamensis; no cytotoxicity in U-937 macrophages or genotoxicity in human lymphocytes was observed. Five of 6 (83.3%) hamsters treated with A. annua capsules (500mg/kg/day) for 30 days were cured, and the 2 examined patients were cured 45 days after initiation of treatment with 30g of A. annua capsules, without any adverse reactions. Both patients remained disease-free 26 and 24 months after treatment completion. CONCLUSION: Capsules of A. annua L. represent an effective treatment for uncomplicated CL, although further randomized controlled trials are needed to validate its efficacy and safety.

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OBJECTIVE: To identify the prognostic factors for conventional physical therapy in patients with chronic low back pain (CLBP). METHODS: Prospective observational study. PARTICIPANTS: One hundred thirteen patients with CLBP selected at the Spinal Disease Outpatient Clinic. MAIN OUTCOME MEASURES: Pain intensity was scored using the Numeric Rating Scale (NRS), and function was measured using the Roland-Morris Disability Questionnaire (RMDQ). RESULTS: The Fear-Avoidance Beliefs Questionnaire work subscale results (FABQ-work; odds ratio [OR]=0.27, 95% confidence interval [CI] 0.13-0.56, p<0.001) and extraspinal pain (OR=0.35, 95% CI 0.17-0.74, p=0.006) were independently associated with a decreased response to conventional physical therapy for CLBP. CONCLUSION: We identified high FABQ-work and extraspinal pain scores as key determinants of a worse response to physical therapy among CLBP patients, supporting the need for a special rehabilitation program for this subgroup.

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ABSTRACT Objective: To identify the prognostic factors for conventional physical therapy in patients with chronic low back pain (CLBP). Methods: Prospective observational study. Participants: One hundred thirteen patients with CLBP selected at the Spinal Disease Outpatient Clinic. Main outcome measures: Pain intensity was scored using the Numeric Rating Scale (NRS), and function was measured using the Roland-Morris Disability Questionnaire (RMDQ). Results: The Fear-Avoidance Beliefs Questionnaire work subscale results (FABQ-work; odds ratio [OR] = 0.27, 95% confidence interval [CI] 0.13–0.56, p < 0.001) and extraspinal pain (OR = 0.35, 95% CI 0.17–0.74, p = 0.006) were independently associated with a decreased response to conventional physical therapy for CLBP. Conclusion: We identified high FABQ-work and extraspinal pain scores as key determinants of a worse response to physical therapy among CLBP patients, supporting the need for a special rehabilitation program for this subgroup.

RESUMO Objetivo: Identificar os fatores prognósticos para a fisioterapia convencional em pacientes com lombalgia mecânica comum crônica (LMC). Métodos: Estudo prospectivo observacional. Participantes: Foram selecionados pelo Ambulatório de Doenças da Coluna Vertebral 113 pacientes com lombalgia mecânica comum crônica. Medidas de desfecho principais: A intensidade da dor foi pontuada utilizando a Escala Numérica de Dor (END) e a função foi medida usando o Questionário Roland-Morris de Incapacidade (RMDQ). Resultados: Os resultados da subescala trabalho do Fear-Avoidance Beliefs Questionnaire (FABQ-trabalho; odds ratio [OR] = 0,27, intervalo de confiança de 95% [IC 95%] 0,13–0,56, p < 0,001) e da dor extraespinal (OR = 0,35, IC 0,17–0,74, p = 0,006) estiveram independentemente associados a uma diminuição na resposta à fisioterapia convencional para a lombalgia crônica. Conclusão: Foram identificados escores elevados na FABQ-trabalho e dor extraespinal como determinantes-chave para uma pior resposta à fisioterapia em pacientes com LMC o que apoia a necessidade de um programa de reabilitação especial para este subgrupo.

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OBJECTIVE: To identify the prognostic factors for conventional physical therapy in patients with chronic low back pain (CLBP). METHODS: Prospective observational study. PARTICIPANTS: One hundred thirteen patients with CLBP selected at the Spinal Disease Outpatient Clinic. MAIN OUTCOME MEASURES: Pain intensity was scored using the Numeric Rating Scale (NRS), and function was measured using the Roland-Morris Disability Questionnaire (RMDQ). RESULTS: The Fear-Avoidance Beliefs Questionnaire work subscale results (FABQ-work; odds ratio [OR]=0.27, 95% confidence interval [CI] 0.13 to 0.56, p<0.001) and extraspinal pain (OR=0.35, 95% CI 0.17 to 0.74, p=0.006) were independently associated with a decreased response to conventional physical therapy for CLBP. CONCLUSION: We identified high FABQ-work and extraspinal pain scores as key determinants of a worse response to physical therapy among CLBP patients, supporting the need for a special rehabilitation program for this subgroup.

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The definition of a biomarker provided by the World Health Organization is any substance, structure, or process that can be measured in the body, or its products and influence, or predict the incidence or outcome of disease. Currently, the lack of prognosis and progression markers for chronic Chagas disease has posed limitations for testing new drugs to treat this neglected disease. Several molecules and techniques to detect biomarkers in Trypanosoma cruzi-infected patients have been proposed to assess whether specific treatment with benznidazole or nifurtimox is effective. Isolated proteins or protein groups from different T. cruzi stages and parasite-derived glycoproteins and synthetic neoglycoconjugates have been demonstrated to be useful for this purpose, as have nucleic acid amplification techniques. The amplification of T. cruzi DNA using the real-time polymerase chain reaction method is the leading test for assessing responses to treatment in a short period of time. Biochemical biomarkers have been tested early after specific treatment. Cytokines and surface markers represent promising molecules for the characterisation of host cellular responses, but need to be further assessed.

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Proton magnetic resonance spectroscopy (H-MRS) may be helpful in suggesting tumor histology and tumor grade and may better define tumor extension and the ideal site for biopsy compared with conventional magnetic resonance (MR) imaging. A multifunctional approach with diffusion-weighted imaging, perfusion-weighted imaging, and permeability maps, along with H-MRS, may enhance the accuracy of the diagnosis and characterization of brain tumors and estimation of therapeutic response. Integration of advanced imaging techniques with conventional MR imaging and the clinical history help to improve the accuracy, sensitivity, and specificity in differentiating tumors and nonneoplastic lesions.

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