Protocolo intensivo de reabilitação para o desenvolvimento neuropsicomotor em uma criança com microcefalia: um estudo de caso / Intensive rehabilitation protocol for neuropsychomotor development in a child with microcephaly: a case report

A microcefalia é uma doença de origem multifatorial podendo ser desenvolvida de forma congênita ou por causas ambientais. Ela atinge os ossos da calota craniana, causando o fechamento prematuro das fontanelas, no qual restringe o espaço interno do crânio, que em consequência afeta o crescimento e desenvolvimento normal do encéfalo, levando a disfunções neuropsicomotoras leves, moderadas ou graves. Desta forma, este estudo tem como objetivo avaliar o desenvolvimento neuropsicomotor de uma criança com microcefalia, antes e após um protocolo fisioterapêutico intensivo. Trata-se de relato de caso no qual foram avaliados os marcos motores e os níveis de função apresentados pelo paciente, antes e após um protocolo fisioterapêutico intensivo, realizado por um período de 30 dias consecutivos. Foram obtidos importantes resultados no controle de cervical, alinhamento de cabeça em linha média, manuseio de objetos, elevação das mãos à boca e alinhamento postural. Desta forma, conclui-se que o protocolo fisioterapêutico intensivo é uma alternativa eficaz que auxilia e potencializa o desenvolvimento neuropsicomotor da criança

Microcephaly is a multifactorial disease that can be developed congenitally or due to environmental causes. It affects the skullcap bones, causing premature fontanelles closure, in which it restricts the internal skull space, which consequently affects the growth and normal development of the brain, leading to mild, moderate or severe neuropsychomotor disorders. Thus, this study aims to evaluate the neuropsychomotor development of a child with microcephaly, before and after an intensive physical therapy protocol. This is a case report in which the motor milestones and function levels were evaluated before and after an intensive physical therapy protocol performed for a consecutive 30 days period. Important results were obtained in cervical control, midline head alignment, object handling, lifting hands to mouth and postural alignment. Thus, it is concluded that the intensive physical therapy protocol is an effective alternative that helps and enhances the child's neuropsychomotor development

Second hand tobacco smoke adversely affects the bone of immature rats

OBJECTIVES: To evaluate the influence of secondhand cigarette smoke exposure on longitudinal growth of the tibia of growing rats and some parameters of bone quality. METHODS: Forty female rats were randomly divided into four groups: control: rats were sham exposed; 30 days: rats were exposed to tobacco smoke for 30 days; 45 days: rats were exposed to tobacco smoke for 45 days; and 60 days: rats were exposed to tobacco smoke for 60 days. Blood samples were collected to evaluate the levels of cotinine and alkaline phosphatase. Both tibias were dissected and weighed; the lengths were measured, and the bones were then stored in a freezer for analysis of bone mineral content and mechanical resistance (maximal load and stiffness). RESULTS: Exposure of rats to tobacco smoke significantly compromised bone health, suggesting that the harmful effects may be time dependent. Harmful effects on bone growth were detected and were more pronounced at 60-day follow-ups with a 41.8% reduction in alkaline phosphatase levels (p<0.01) and a decrease of 11.25% in tibia length (p<0.001). Furthermore, a 41.5% decrease in bone mineral density was observed (p<0.001), leading to a 42.8% reduction in maximum strength (p<0.001) and a 56.7% reduction in stiffness (p<0.001). CONCLUSION: Second hand cigarette smoke exposure in rats affected bones that were weaker, deforming them and making them osteopenic. Additionally, the long bone was shorter, suggesting interference with growth. Such events seem to be related to time of exposure.

Respostas anti-inflamatórias ao exercício terapêutico na osteoartrite de joelho: uma revisão sistemática / Anti-inflammatory responses to therapeutic exercise in knee osteoarthritis: a systematic review

Introdução: A osteoartrite (OA) de joelho atinge 10% da população mundial com idade de 60 anos ou mais. Citocinas, prostaglandinas e enzimas como IL-6, TNF-α, PCR, metaloproteínases, entre outras, são responsáveis por desencadear o processo inflamatório na articulação, degradação da cartilagem, formação de edema, incapacidades funcionais e dor. Embora o processo de degradação da cartilagem articular seja considerado de difícil reversão, sabe-se que pode ser estabilizado ou prevenido com o exercício físico. Objetivo: realizar uma revisão sistemática acerca dos efeitos de exercícios terapêuticos sobre o processo inflamatório em indivíduos com osteoartrite de joelho. Métodos: Foi realizada uma busca por artigos originais e em inglês e publicados em periódicos com fator de impacto indexados na base de dados Pubmed. Resultados: Foram encontrados 211 artigos originais, e 16 foram selecionados por se enquadrarem nos critérios de inclusão estabelecidos. Conclusão: O exercício terapêutico promoveu redução dos níveis séricos de citocinas pró-inflamatórias, em especial IL-6, TNF e PCR. Protocolos de exercícios de fortalecimento associados a exercícios aeróbios e dieta alimentar mostraram ser a combinação mais eficaz na redução da resposta inflamatória. O uso de medicamentos associados não interfere nos benefícios do exercício terapêutico na OA de joelho. (AU)

Introduction: Knee Osteoarthritis (OA) reaches 10% of the population aged 60 or older. Cytokines, prostaglandins and enzymes such as IL-6, TNF-α, PCR, metalloproteinases, and others are responsible for triggering the inflammatory process in joint, cartilage degradation, edema formation, functional disability and pain. Although the process of articular cartilage degradation is considered difficult to reverse, it is known that may be stabilized or prevented with physical exercise. Objective: to perform a systematic review about the effects of exercise therapy on the inflammatory process in individuals with knee osteoarthritis. Methods: A search was performed for original articles in English and published in journals with impact factor indexed in Pubmed database. Results: 211 original articles found, 16 were selected since they fit the established inclusion criteria. Conclusion: The exercise therapy promoted reduction of serum levels of pro-inflammatory cytokines, especially IL-6, TNF and PCR. Strengthening exercises protocols associated with aerobic and diet, showed to be the most effective combination in reducing the inflammatory response. The use of associated medications does not interfere with the therapeutic benefits of exercise on knee OA. (AU)

Anomalous bilateral contribution of extensor pollicis longus and muscle fusion of the first compartment of the wrist / Anômala contribuição bilateral do extensor longo do polegar e fusão dos músculos do primeiro compartimento dorsal do punho

Knowledge of the anatomical variations of the muscles of the first dorsal compartments of the wrist is clinically relevant to De Quervain's tenosynovitis and to reconstructive surgeries. In the literature, there are many reports of the presence of multiple insertion tendons in the first dorsal compartment of the wrist, but few reports describe occurrences of fusion and muscle contributions. This case report describes an anomalous bilateral contribution of the extensor pollicis longus. This anomalous contribution was found through a slender auxiliary tendon that crossed laterally under the extensor retinaculum, entered the first dorsal compartment of the wrist and merged with the tendon of the extensor pollicis brevis muscle. In the same cadaver in which this contribution was present, there was atypical muscle fusion of the abductor pollicis longus muscle and extensor pollicis brevis muscle. In conclusion, anomalous bilateral contribution of the extensor pollicis longus muscle and atypical muscle fusion, concomitant with a variant insertion pattern, are the highlight of this case report. Furthermore, it is concluded that additional tendons may be effectively used in reconstructive surgeries, but that there is a need for knowledge of the possible numerical and positional variations of these tendons, with a view to making more effective surgical plans.

O conhecimento das variações anatômicas dos músculos do primeiro compartimento dorsal do punho é clinicamente relevante na tenossinovite de De Quervain e nas cirurgias reconstrutivas. Na literatura encontram-se inúmeros relatos da presença de múltiplos tendões de inserção no primeiro compartimento dorsal do punho, mas são poucos os relatos que descrevem a ocorrência de fusão e de contribuições musculares. Este relato de caso descreve uma contribuição anômala bilateral do extensor longo do polegar. A anômala contribuição foi encontrada por um tendão auxiliar delgado que cruzou lateralmente sob o retináculo dos extensores, entrou no primeiro compartimento dorsal do punho e fundiu-se com o tendão do músculo extensor curto do polegar. No mesmo cadáver foi encontrada a presença dessa contribuição e uma fusão muscular atípica do músculo abdutor longo do polegar (APL) com o extensor curto do polegar (EPB). Em conclusão, a anômala contribuição bilateral do músculo extensor longo do polegar e a fusão muscular atípica, concomitante com um padrão de inserção variante, é o destaque deste relato de caso. Ainda, conclui que os tendões adicionais podem ser efetivamente usados nas cirurgias reconstrutivas e alerta sobre a necessidade de conhecimento das possíveis variações numéricas e posicionais desses tendões, com vistas a planejamentos cirúrgicos mais eficazes.

Allometric relationships among body mass, MUZZLE-tail length, and tibia length during the growth of Wistar rats1

PURPOSE : To investigate allometric relationships among body mass (BM), muzzle-tail length (MTL), and tibia length (TL) in Wistar rats and establish their growth rate change parameters. METHODS : Eighteen male and 18 female Wistar rats were studied from the 3rd to the 21st week of age. BM, MTL, and TL were measured daily, and relative growth was compared using allometry. RESULTS : A positive correlation between BM and MTL (p<0.05) and BM and TL (p<0.05) was observed. Males and females showed comparable curves; however, females had turning points at a younger age. The allometric relationship between BM and MTL presented a regular increase until reaching a mass of 351 g (males) and 405 g (females). BM and TL showed an initial increase until 185 g (males) and 182 g (females), and then reached a plateau that finished at 412 g (males) and 334 g (females), to display another increase. CONCLUSIONS : The allometric relationship of body mass with animal length and tibia length was comparable for male and female rats, with female rats maturing earlier. Animal longitudinal growth occurred in a single stage. In contrast, tibia length depicted two stages of accelerated growth with an intermediate period of deceleration.