Uma clínica catalisadora

Este artigo tem como objetivo revigorar a obra da psiquiatra Nise da Silveira (1905-1999), relacionando-a ao atual campo da clínica e da saúde mental. Nise da Silveira é reconhecida pelo combate aos métodos agressivos de tratamento do sofrimento mental, pelo trabalho com pacientes esquizofrênicos, por meio, sobretudo, de atividades expressivas, e extenso impacto na cultura brasileira. Os conceitos de Nise da Silveira, destacados no presente artigo, são inumeráveis estados do ser, mundo externo e mundo interno e afeto catalisador, discutidos a fim de se atualizar a proposição da sua clínica eminentemente humana, que não negligencia o manejo do inconsciente nem obscurece o seu papel de catalisadora das transformações sociais.

Efficacy of Sacrospinous Fixation or Uterosacral Ligament Suspension for Pelvic Organ Prolapse in Stages III and IV: Randomized Clinical Trial / Eficácia da fixação sacroespinhal ou da suspensão do ligamento útero-sacro no prolapso de órgãos pélvicos nos estágios III e IV: Ensaio clínico randomizado

Abstract Objective To evaluate the efficacy and outcomes of the surgical treatment for pelvic organ prolapse (POP) in stages III and IV by sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS) by comparing anatomical and subjective cure rates and quality-of-life parameters (through the version validated for the Portuguese language of the Prolapse Quality of Life [P-QoL] questionnaire) under two definitions: genital prolapse Ba, Bp, and C< −1 (stage I) and Ba, Bp, and C ≤ 0 (stage II). Materials and Methods After we obtained approval from the Ethics Committee (under CAAE 0833/06) and registered the study in ClinicalTrials.gov (NCT 01347021), 51 patients were randomized into two groups: the USLS group (N = 26) and the SSLF group (N = 25), with follow-up 6 and 12 months after the procedures. Results There was a significant improvement in the P-QoL score and anatomical measurements of all compartments in both groups after 12 months (p< 0.001). The anatomical cure rates in the USLS and SSLF groups, considering stage 1, were of 34.6% and 40% (anterior) respectively; of 100% both for groups (apical); and of 73.1% and 92% (posterior) respectively. The rates of adverse outcomes were of 42% (N = 11) and 36% (N = 11) for the USLS and SSLF groups respectively (p= 0.654), and those outcomes were excessive bleeding, bladder perforation (intraoperative) or gluteal pain, and urinary infection (postoperative), among others, without differences between the groups. Conclusion High cure rates in all compartments were observed according to the anatomical criterion (stage I), without differences in P-QoL scores and complications either with USLS or SSLF for the surgical treatment of accentuated POP.

Resumo Objetivo Avaliar a eficácia e os resultados do tratamento cirúrgico para prolapso de órgãos pélvicos (POP) nos estágios III e IV, por meio da técnica de fixação do ligamento sacroespinal (FLSE) ou suspensão do ligamento útero-sacro (SLUS), ao comparar os índices de cura anatômicos, subjetivos, e os parâmetros de qualidade de vida (por meio do questionário Prolapse Quality of Life [P-QoL] validado para a língua portuguesa) sob duas definições: prolapso genital Ba, Bp e C< −1 (estágio I) e Ba, Bp e C ≤ 0 (estágio II). Materiais e Métodos Após aprovação do Comitê de Ética (CAAE 0833/06) e registro no ClinicalTrials.gov (NCT 01347021), 51 pacientes foram randomizadas em dois grupos: grupo SLUS (N = 26) e (2) grupo FLSE (N = 25), com seguimento de 6 e 12 meses. Resultados Houve melhora significativa nas pontuações no P-QoL e nas medidas anatômicas de todos os compartimentos em ambos os grupos após 12 meses (p< 0,001). As taxas de cura anatômica nos grupos SLUS e FLSE , considerando o estágio 1, foram de 34,6% e 40% (anterior), respectivamente; de 100% em ambos os grupos (apical); e de 73,1% e 92% (posterior), respectivamente. As taxas de resultados adversos foram de 42% (N = 11) e 36% (N = 11), respectivamente, nos grupos SLUS e FLSE (p= 0,654), e elas foram sangramento excessivo, perfuração da bexiga (intraoperatória) ou dor glútea, e infecção urinária (pós-operatória), entre outras, sem diferenças entre os grupos. Conclusão Altas taxas de cura em todos os compartimentos foram observadas segundo critério anatômico (estágio I), sem diferença quanto às pontuações no P-QoL e às complicações tanto com SLUS quanto com FLSE para o tratamento cirúrgico de POP acentuado.

Curso Temporal de los Efectos Agudos de una Sesión de Estiramiento Muscular en Sujetos Jóvenes y Sanos / Time Course of the Acute Effects of a Muscle Stretching Session in Young and Healthy Subjects

Introducción. La duración de los efectos agudos del estiramiento muscular y su relación con el volumen total de estiramiento es un tema controversial. Método. Se distribuyeron aleatoriamente 29 varones jóvenes y deportistas en tres grupos: Control, "protocolo corto" (5 estiramientos x 30' segundos) y "protocolo largo" (10 estiramientos x 30 segundos). Para medir el efecto se usó el Active Knee Extension Test en forma previa y posterior a los 0, 3, 7, 12, 18 y 25 minutos. Cada medición se grabó en video, y se identificó el rango máximo de estiramiento con el software Kinovea. Se realizó comparación pre y postintervención entre grupos e inter grupo. Se incorporó análisis post hoc en medidas repetidas. Resultados. No hubo diferencias en la medición preintervención entre los grupos (P=0,266). Ambos protocolos tuvieron cambios significativos (P<0,007) respecto del grupo control (P=0,65). Todas las mediciones postintervención comparadas con la preintervención presentan diferencias en el protocolo corto (P≤0,018) y largo (P≤0,009). Hubo diferencia entre el grupo control con el de protocolo corto (P≤0,014) y control con protocolo largo (P≤0,004) para todas las mediciones, y una diferencia entre ambos protocolos en el post inmediato (P=0,033) pero no para las mediciones posteriores (P≤0,139). Conclusión. Un protocolo de 150 segundos de estiramiento estático en isquiotibiales en varones asintomáticos jóvenes, presenta efectos por al menos 25 minutos. Al duplicar a 300 segundos sólo presenta diferencia en la medición inmediatamente posterior. Por lo tanto, ambos protocolos son igualmente efectivos, pero el protocolo corto es más eficiente.

Background. The duration of the acute effects of muscle stretching and its relationship with the total volume of stretching is a controversial issue. Methods. 29 young male athletes were randomly distributed into three groups: control, "short protocol" (5 stretches x 30'') and "long protocol" (10 stretches x 30''). To measure the effect, the Active Knee Extension Test was used before and after 0, 3', 7', 12', 18' and 25'. Each measurement was videotaped, and the maximum range of stretch was identified using the Kinovea software. A pre-post intervention comparison was made between groups and inter groups. Post hoc analysis was incorporated into repeated measures. Results. There were no differences in the pre-intervention measurement between the groups (P=0.266). Both protocols had significant changes (P<0.007) compared to the control group (P=0.65). All post-intervention measurements compared to pre-intervention present differences in the short (P≤0.018) and long (P≤0.009) protocol. There was a difference between the control group with the short protocol (P≤0.014) and the control group with the long protocol (P≤0.004) for all measurements, and a difference between both protocols in the immediate post (P=0.033) but not for the measurements. subsequent measurements (P≤0.139). Conclusion. A protocol of 150'' of static stretching in hamstrings in asymptomatic young men, presents effects for at least 25'. When doubling at 300'', it only presents a difference in the immediately subsequent measurement. Therefore, both protocols are equally effective, but the short protocol is more efficient.

Resultados Precoces do Procedimento de Norwood em um Centro de Referência no Brasil / Early Outcomes of the Norwood Procedure in a Reference Center in Brazil

Resumo Fundamento Apenas dois artigos abordam os resultados precoces de pacientes com síndrome do coração esquerdo hipoplásico (SHCE) submetidos à operação de Norwood, no Brasil. Objetivos Avaliamos pacientes com SHCE submetidos ao primeiro estágio da operação de Norwood para identificar os fatores preditivos de mortalidade precoce (nos primeiros 30 dias após a cirurgia) e intermediária (desde a sobrevida precoce até o procedimento de Glenn). Métodos Foram incluídos pacientes com SHCE submetidos em nosso serviço ao primeiro estágio da operação de Norwood de janeiro de 2016 a abril de 2019. Dados demográficos, anatômicos e cirúrgicos foram analisados. Os desfechos foram mortalidade precoce (nos primeiros 30 dias após a cirurgia), mortalidade intermediária (desde a sobrevida precoce até o procedimento de Glenn) e a necessidade de suporte pós-operatório com ECMO. Foram realizadas análises univariadas e multivariadas e calculados odds ratios, com intervalos de confiança de 95%. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados Um total de 80 pacientes com SHCE foram submetidos ao primeiro estágio da operação de Norwood. A taxa de sobrevida em 30 dias foi de 91,3% e a taxa de sobrevida intermediária foi de 81,3%. Quatorze pacientes (17,5%) necessitaram de suporte com ECMO. Menor peso (p=0,033), estenose aórtica (vs atresia aórtica; p=0,036) e necessidade de suporte pós-operatório com ECMO (p=0,009) foram fatores preditivos independentes para mortalidade em 30 dias. A estenose da valva mitral ( vs atresia da valva mitral; p=0,041) foi um fator preditivo independente para mortalidade intermediária. Conclusão O presente estudo inclui a maior coorte brasileira de pacientes com SHCE submetidos ao primeiro estágio da operação de Norwood na era recente. Nossas taxas de sobrevida foram comparáveis às mais altas taxas de sobrevida relatadas globalmente. Baixo peso corporal, estenose valvar aórtica e necessidade de suporte pós-operatório com ECMO foram preditores independentes para mortalidade em 30 dias. A estenose da valva mitral foi o único fator preditivo independente para mortalidade intermediária.

Abstract Background Only two papers have addressed the early outcomes of patients with hypoplastic left heart syndrome (HLHS) undergoing the Norwood operation, in Brazil. Objectives We evaluated patients with HLHS undergoing the first-stage Norwood operation in order to identify the predictive factors for early (within the first 30 days after surgery) and intermediate (from early survival up to the Glenn procedure) mortality. Methods Patients with HLHS undergoing the stage I Norwood procedure from January 2016 through April 2019, in our service, were enrolled. Demographic, anatomical, and surgical data were analyzed. Endpoints were early mortality (within the first 30 days after surgery), intermediate mortality (from early survival up to the Glenn procedure) and the need for postoperative ECMO support. Univariate and multivariate analyses were performed, and odds ratios, with 95% confidence intervals, were calculated. A p-value <0.05 was considered statistically significant. Results A total of 80 patients with HLHS underwent the stage I Norwood procedure. The 30-day survival rate was 91.3% and the intermediate survival rate 81.3%. Fourteen patients (17.5%) required ECMO support. Lower weight (p=0.033), aortic stenosis (vs aortic atresia; p=0.036), and the need for postoperative ECMO support (p=0.009) were independent predictive factors for 30-day mortality. Mitral valve stenosis (vs mitral valve atresia; p=0.041) was an independent predictive factor for intermediate mortality. Conclusion The present study includes the largest Brazilian cohort of patients with HLHS undergoing the stage I Norwood procedure in the recent era. Our survival rates were comparable to the highest survival rates reported globally. Low body weight, aortic valve stenosis, and the need for postoperative ECMO support were independent predictors for 30-day mortality. Mitral valve stenosis was the only independent predictive factor for intermediate mortality.

Brazilian Academy of Neurology practice guidelines for stroke rehabilitation: part I / Diretrizes da Academia Brasileira de Neurologia para reabilitação do acidente vascular cerebral: parte I

ABSTRACT The Guidelines for Stroke Rehabilitation are the result of a joint effort by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology aiming to guide professionals involved in the rehabilitation process to reduce functional disability and increase individual autonomy. Members of the group participated in web discussion forums with predefined themes, followed by videoconference meetings in which issues were discussed, leading to a consensus. These guidelines, divided into two parts, focus on the implications of recent clinical trials, systematic reviews, and meta-analyses in stroke rehabilitation literature. The main objective was to guide physicians, physiotherapists, speech therapists, occupational therapists, nurses, nutritionists, and other professionals involved in post-stroke care. Recommendations and levels of evidence were adapted according to the currently available literature. Part I discusses topics on rehabilitation in the acute phase, as well as prevention and management of frequent conditions and comorbidities after stroke.

RESUMO As Diretrizes Brasileiras para Reabilitação do AVC são fruto de um esforço conjunto do Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia com o objetivo de orientar os profissionais envolvidos no processo de reabilitação para a redução da incapacidade funcional e aumento da autonomia dos indivíduos. Membros do grupo acima participaram de fóruns de discussão na web com pré-temas, seguidos de reuniões por videoconferência em que as controvérsias foram discutidas, levando a um consenso. Essas diretrizes, divididas em duas partes, focam as implicações de recentes ensaios clínicos, revisões sistemáticas e metanálises sobre reabilitação do AVC. O objetivo principal é servir de orientação a médicos, fisioterapeutas, fonoaudiólogos, terapeutas ocupacionais, enfermeiros, nutricionistas e demais profissionais envolvidos no cuidado pós-AVC. As recomendações e níveis de evidência foram adaptados de acordo com a literatura disponível atualmente. Aqui é apresentada a Parte I sobre tópicos de reabilitação na fase aguda, prevenção e tratamento de doenças e comorbidades frequentes após o AVC.

Os EPI's adotados para controle local de transmissibilidade da COVID-19 no retorno das atividades presenciais de atendimento à população nos cursos de odontologia em Minas Gerais / Personal protective equipment adopted for local control of transferability by COVID-19 in the return of face-to-face activities to serve the population in dentistry courses in Minas Gerais

Desde o início da pandemia, no final de 2019, até a retomada das atividades presencias de atendimento ao público nos cursos da área de saúde em Minas Gerais, especificamente nos cursos de odontologia; foram elaboradas notas técnicas, recomendações e manuais de biossegurança. Documentos esses que serviram como referencial para a padronização de protocolos de atendimento, incluindo o uso de EPI's mais eficientes no controle da transmissibilidade da Covid-19. A pesquisa de revisão foi realizada na base de dados PubMed/MEDLINE e Scielo, World Health Organization, Ministério da Saúde, Associação Brasileira de Ensino Odontológico, Conselho Federal de Odontologia, Conselhos Regionais de Odontologia dos Estados de São Paulo e Minas Gerais e instituições de ensino superior. Priorizando os conteúdos publicados entre os meses de janeiro a setembro de 2020. Período correspondente ao início da pandemia até o retorno das atividades de atendimento nos cursos de saúde em Minas Gerais. Buscando os documentos que nortearam esse retorno e que justificaram a adoção do uso desses EPI's pelos graduandos.

Since the beginning of the pandemic, at the end of 2019, until the resumption of face-to-face activities to serve the public in health care courses in Minas Gerais, specifically in dentistry courses; technical notes, recommendations and biosafety manuals were prepared. These documents served as a reference for the standardization of care protocols, including the use of more efficient personal protection equipment to control Covid-19's transmissibility. The review search was carried out in the PubMed/MEDLINE and Scielo databases, World Health Organization, Ministry of Health of Brazil, Brazilian Association of Dental Education, Federal Council of Dentistry, Regional Councils of Dentistry of the States of São Paulo and Minas Gerais and college. Prioritizing the contents published between January and September 2020. Period corresponding to the beginning of the pandemic until the return of care activities in health courses in Minas Gerais. Seeking the documents that guided this return and that justified the adoption of the use of this personal protective equipment by college students.

Papel dos atributos dos profissionais médicos na produção da abordagem centrada na pessoa em atenção primária à saúde / Role of physicians' attributes in the production of the person-centered approach in primary health care

Resumo Embora inúmeros fatores influenciem a abordagem médica, poucas pesquisas exploram a associação de características presentes no nível do médico com o tipo de prática por ele desempenhada. Este estudo tem como objetivo determinar os fatores que, no nível do médico, associam-se ao alto grau de orientação ao método clínico centrado na pessoa (MCCP), atribuído, pelas pessoas atendidas, à abordagem desse profissional em atenção primária à saúde (APS). O delineamento é transversal, realizado com pacientes hipertensos e/ou diabéticos e médicos em 12 unidades de um serviço de APS em Porto Alegre, RS. Para se medir o grau de orientação ao MCCP, utilizou-se o instrumento "Percepção do paciente sobre o centramento da consulta" (PPCC). As variáveis idade do médico, gênero, tempo de formado, de trabalho no serviço e na unidade e participação em educação continuada fora do serviço estudado foram correlacionadas com a mediana do escore geral do PPCC estimada para cada profissional. Verificou-se também diferença significativa na comparação entre as medianas do escore geral do PPCC de cada unidade de saúde. Discute-se a influência da experiência profissional, do gênero, da educação continuada e do contexto na abordagem desempenhada pelo médico.

Abstract Even though several factors influence the medical approach, there is few research examining the association of characteristics at the doctor's level with the kind of practice developed by this provider. This study aims at establishing the factors that, at the doctor's level, are associated with the high degree of patient-centered clinical method (PCCM) orientation assigned by the cared persons to the approach of this provider in primary health care (PHC). This cross-sectional study was conducted with hypertensive or diabetic patients and doctors in the 12 health care centers of a PHC service in Porto Alegre (RS), Brazil. The "Patient Perception of Patient-Centeredness" (PPPC) tool was used to measure the degree of PCCM orientation. The variables concerning the doctor's age, gender, time since graduation, service and unit seniority, and participation in continuing education outside the studied service were correlated with the median of the PPPC general score estimated for each professional. We also found a significant difference in the comparison between the medians of the PPPC general score in each health care center. We discuss the influence of professional experience, gender, continuing education, and the context on the approach developed by the doctor.

Knowledge about the disease and adherence to treatment in patients with diabetes

Introduction: Glycemic decompensation in diabetes is one of the major factors for the development of chronic disease complications. Factors involved in the adequate control of diabetes include adherence to pharmacological treatment and knowledge about the disease.Methods: Cross-sectional study on the factors associated with adherence to drug treatment and knowledge about diabetes in diabetic patients treated at Hospital Universitário de Santa Maria between 2018 and 2019, based on the validated Morisky-Green test and on the Diabetes Knowledge Questionnaire.Results: A total of 201 patients diagnosed with diabetes were included, the majority (85.6%) of which had type 2 diabetes and were white (75.6%), with a mean age of 59.4 years. An association between insufficient knowledge about diabetes and patients with type 2 diabetes was observed. An association was found between patients with type 2 diabetes using insulin and non-adherence to drug treatment compared with patients with type 2 diabetes who did use insulin. The research also showed that non-adherence to drug treatment was associated with higher occurrence of hypoglycemia compared with patients who adhered to drug treatment.Conclusion: The data obtained in our study allows us to conclude that non-adherence to pharmacological treatment makes diabetes therapy more complicated and worsens the prognosis.

The role of primary inguinal surgical debulking for locally advanced penile cancer followed by reconstruction with myocutaneous flap

ABSTRACT Purpose: To evaluate surgical complications and oncological outcomes of patients submitted to primary radical inguinal surgical debulking (PRISD) and myocutaneous pediculate flap reconstruction (MPFR) for locally advanced penile cancer (PC). Materials and Methods: Forty-two patients with ulcerated and/or fixed bulky inguinal masses underwent unilateral or bilateral PRISD with MPFR. Tensor fascia lata flap (TFL) was the standard of care for all patients. Additional use of the gracilis flap (GF) was carried out when necessary. Contra-lateral radical inguinal lymphadenectomy (RIL) was conduced when PRISD was performed unilaterally. Surgical complications were analyzed and stratified into minor and major according to the Bevan-Thomas classification. Adjunctive treatments were assessed and oncological outcomes analyzed. Results: Of the 42 patients evaluated, 10 (23.8%) underwent bilateral PRISD and 32 (76.2%) unilateral PRISD with contra-lateral RIL, totaling 84 lymphadenectomies. A total of 62 MPFRs were performed, 52 with TFL and 10 with GF. A total of 53 complications were identified, 49 related to PRISD with MPFR and 4 to RIL. Adjuvant chemotherapy was carried out in 16 patients. Median follow-up was 10.8 months with a median overall survival (OS) of 14.0 months against 6.0 months (p=0.006) for patients submitted to PRISD with adjuvant chemotherapy in relation to surgery alone. Conclusions: PRISD alone for advanced loco-regional PC is unlikely to promote long-term survival, although it can lead to temporary local control of the disease. Despite the feasibility of the procedure, it is related to high incidence of complications. Surgical treatment with adjuvant chemotherapy is associated with improved OS.

Secuelas físicas y emocionales en pacientes post hospitalización por COVID-19 / Physical and emotional sequelae after hospitalization for COVID-19

Background: Facing a severe life-threatening disease has physical and emotional consequences for patients. Aim: To evaluate the physical and emotional sequelae in patients who survived COVID-19 pneumonia. Material and Methods: This cross-sectional study collected data from post-COVID-19 pneumonia patients admitted to an outpatient follow-up program in a public hospital in Chile. One month after hospital discharge, the evaluation of physical capacity was carried out through the 1-minute sit-to-stand test (1STST). In addition, the Clinical Frailty Scale (CFS) and the Hospital Anxiety and Depression scale were applied. Results: We included 70 patients aged 63 ± 13 years (54% women). Eighty-five percent of the patients were able to execute the 1STST with an average of 20.6 ± 4.8 repetitions. Forty-eight percent of the patients had a performance below the 2.5th percentile according to the reference values and 28% of patients had exertional desaturation. The CFS classified as mildly vulnerable or with some degree of frailty to 33% of patients. Twenty-five percent of the patients presented symptoms of depression and 33% of anxiety. Conclusions: Patients who survived COVID-19 have a decrease in physical capacity and a significant proportion of depression and anxiety one month after hospital discharge.

Determinantes sociales de la salud asociados a la severidad y mortalidad en pacientes con COVID-19 / Social determinants of health associated with severity and mortality in patients with COVID-19

Resumen Introducción: Históricamente, las pandemias han tenido como resultado tasas de mortalidad más altas en las poblaciones más vulnerables. Los determinantes sociales de la salud (DSS) se han asociado a la morbimortalidad de las personas en diferentes niveles. Objetivo: Determinar la relación entre los DSS, la severidad de COVID-19 y la mortalidad por esta enfermedad. Métodos: Estudio retrospectivo en el que se recolectaron datos de pacientes con COVID-19 en un hospital público de Chile. Las variables sociodemográficas relacionadas con los DSS estructurales se clasificaron según las siguientes categorías: sexo, edad (< 65 años, ≥ 65 años), educación secundaria (completada o no), condición de trabajo (activo, inactivo) e ingreso económico (< USD 320, ≥ USD 320). Resultados: Fueron incluidos 1012 casos con COVID-19 confirmados por laboratorio. La edad promedio fue de 64.2 ± 17.5 años. La mortalidad de la muestra total fue de 14.5 %. La edad, nivel educativo, desempleo e ingresos tuvieron fuerte asociación con la mortalidad (p < 0.001). Conclusiones: Los hallazgos refuerzan la idea de que los DSS deben considerarse una prioridad de salud pública, por lo que los esfuerzos políticos deben centrarse en reducir las desigualdades en salud para las generaciones futuras.

Abstract Introduction: Historically, pandemics have resulted in higher mortality rates in the most vulnerable populations. Social determinants of health (SDH) have been associated with people morbidity and mortality at different levels. Objective: To determine the relationship between SDH and COVID-19 severity and mortality. Methods: Retrospective study, where data from patients with COVID-19 were collected at a public hospital in Chile. Sociodemographic variables related to structural SDH were classified according to the following categories: gender, age (< 65 years, ≥ 65 years), secondary education (completed or not), work status (active, inactive) and income (< USD 320, ≥ USD 320). Results: A total of 1,012 laboratory-confirmed COVID-19 cases were included. Average age was 64.2 ± 17.5 years. Mortality of the entire sample was 14.5 %. Age, level of education, unemployment and income had a strong association with mortality (p < 0.001). Conclusions: The findings reinforce the idea that SDH should be considered a public health priority, which is why political efforts should focus on reducing health inequalities for future generations.

Electro-removal of copper, chromium, and arsenic from chromated copper arsenate treated waste wood / Eletro-remoção de cobre, cromo e arsênico de resíduos de madeira tratada com arseniato de cobre cromado

ABSTRACT Wood is a renewable material considered eco-friendly and used for various purposes. While wood treated with chromated copper arsenate (CCA) does not deteriorate, its final disposal may entail risks due to the concentration and toxicity of the components. The removal of CCA from wood can be achieved in different ways. This study focuses on the reduction of the concentrations of Cu, Cr, and As chemical species by the electro-removal technique, aiming to obtain biomass with low deleterious potential that would allow multiple uses or safe disposal in landfills. The analytical results showed reductions of 79.5, 87.4, and 81.3% in the mean concentrations of Cu, Cr, and As, respectively. It is worth mentioning the occurrence of the fungus Xylaria sp. after treatment 6 (60 min, 5 g, and 25 V), further suggesting that the method was effective. Samples of these fungi were identified from isolates by culture in medium, DNA extraction, and sequencing of the Internal Transcribed Spacer (ITS) region.

RESUMO A madeira é um material renovável, considerado ecologicamente correto e utilizado para diversos fins. Embora a madeira tratada com arseniato de cobre cromado (CCA) não se deteriore facilmente, seu descarte final pode acarretar riscos devido à concentração e toxicidade dos componentes. A remoção do CCA da madeira pode ser realizada de diferentes maneiras. Este estudo teve como foco a redução das concentrações de espécies químicas Cu, Cr e As pela técnica de eletro-remoção, visando obter uma biomassa com baixo potencial deletério que permitiria múltiplos usos ou disposição final segura em aterros sanitários. Os resultados analíticos mostraram reduções de 79,5; 87,4 e 81,3% nas concentrações médias de Cu, Cr e As, respectivamente. Vale ressaltar a ocorrência do fungo Xylaria sp. após o tratamento 6 (60 min, 5 g e 25 V), sugerindo ainda que o método foi eficaz. Amostras desses fungos foram identificadas dos isolados por meio de cultura em meio, extração de DNA e sequenciamento da região do espaçador transcrito interno (ITS).

Capacidad funcional y desempeño de pacientes con neumonía por Covid-19 / Functional capacity and performance of patients with Covid-19 pneumonia

One year after the first case reported by a new coronavirus (COVID-19), the evidence has shown a series of persistent signs and symptoms once the acute process has been overcome.Under the WHO's framework for health and disability, these impairments at cardiorespiratory, cognitive, and musculoskeletal body functions and structures lead, at least in the short and mid-term, to activity limitations and participation restriction. In this review, we discussed the main alterations generating disability and the challenges of implementing effective evaluation strategies in this disease. Along with their role in the health emergency, rehabilitation teams are challenged to design and deliver timely intervention strategies to reduce post-COVID-19 disability. (AU)

Producción Científica e Investigación en Kinesiología en Chile. Una Revisión de los últimos 20 años / Scientific production and research in Kinesiology in Chile. A Review of the Last 20 Years

Introducción: La Kinesiología en Chile ha alcanzado un importante desarrollo, impulsado por el modelo biopsicosocial. La investigación ha mostrado un incipiente pero exponencial desarrollo vinculado a las universidades. El propósito de este estudio es describir y caracterizar el estado de la producción científica realizada por Kinesiólogas y Kinesiólogos de Chile en los últimos 20 años. Método: Se realizó una revisión exploratoria con búsqueda sistemática de la literatura producida entre los años 2000-2020, en diferentes bases de datos: MEDLINE, EMBASE, CINAHL, PEDro y SciELO. Los términos de búsqueda utilizados fueron: Kinesiología, Physiotherapy, Kinesiology, Physical Therapy y Chile. Resultados: Se identificaron 644 artículos con los criterios de inclusión. El idioma predominante fue el inglés (n=451). El 8,9% presentó participación exclusiva de mujeres y el 69,7% de hombres. Las áreas con mayor producción fueron musculoesquelético, cardiometabólico y fisiología del ejercicio, mientras que las más y las más emergentes ergonomía y el área de educación. Geográficamente, la Región Metropolitana concentró más de la mitad de las publicaciones, seguida por la región del Maule, que fue la segunda en cuatro de las seis áreas con mayor producción. Entre 2000- 2005 no se identificaron artículos publicados según los criterios definidos para esta investigación, mientras que entre 2017­2019 se concentró el 56,8%. Conclusiones: En los últimos tres años (2017, 2018 y 2019) ha existido un notorio crecimiento de publicaciones nacionales, concentrándose mayormente en la Región Metropolitana. Las áreas de mayor producción científica son las históricamente incluidas como parte de la formación en kinesiología. Existe una importante brecha de género en relación con la menor participación de mujeres como coautoras y autoras principales.

Introduction: Kinesiology in Chile has reached an important development, driven by the biopsychosocial model. Research has shown an incipient but exponential development with a strong relation with universities. The aim of this study is to describe and characterize scientific production carried out by Kinesiologist/Physical Therapist in Chile in the last twenty years. Methods: An exploratory review with systematic review of literature produced between 2000-2020 in different databases: MEDLINE, EMBASE, CINAHL, PEDro, SciELO.The search terms used were: Kinesiología, Physiotherapy, Kinesiology, Physical Therapy and Chile. Results: 644 articles with inclusion criteria were identified. Predominant language was english (n=451). 8,9% have exclusive participation of women and 69,7% of men. Areas with the highest production were musculoskeletal, cardiometabolic and exercise physiology, and the most emerging ergonomics and education. Geographically, Metropolitan Region concentrated more than half of publications, followed by Maule region, which was the second position in four of the six areas with highest production. Between 2000-2005 no published articles were identified according to the criteria defined for this research, while between 2017-2019, 56,8% were concentrated. Conclusions: In the last three years (2017, 2018 and 2019) there has been a noticeable growth of national publications, concentrating mainly in Metropolitan Region. Areas with greatest scientific production are those historically included as part of academic teaching/training in kinesiology. There is a significant gender gap in relation to the lower participation of women as co-authors and as main authors.

Evaluación Funcional y Respiratoria en Pacientes post COVID-19: ¿Cuáles son las mejores pruebas? / Functional and Respiratory Assessment in Post COVID-19 Patients: What are the best tests?

La evaluación de la capacidad respiratoria y funcional en pacientes con COVID-19 después de la fase aguda es esencial para estimar el impacto de los deterioros causados por la enfermedad en el nivel de funcionamiento relacionados con las actividades y tareas y su impacto en la participación. Esta información provee evidencia invaluable del impacto de la enfermedad para implementar las estrategias de rehabilitación más adecuadas. El objetivo de esta revisión es determinar cuáles son las mejores herramientas para evaluar la capacidad respiratoria y funcional en personas post-infección por COVID-19, para ello, se realizó una revisión narrativa de la literatura incluyendo estudios que aplicaron evaluaciones respiratorias y funcionales en pacientes post-infección por COVID-19. Se encontró que las herramientas más utilizadas para evaluar la función respiratoria fueron la capacidad de difusión y la espirometría. Para evaluar la capacidad funcional, las pruebas más utilizadas fueron el test de marcha de 6 minutos, el Sit-to-Stand test, Short Performance Physical Battery y el índice de Barthel. Finalmente, dada la heterogeneidad de la presentación clínica de la COVID-19, es fundamental contar con herramientas sencillas para evaluar y monitorizar las consecuencias de la enfermedad en la función respiratoria y el estado funcional de los pacientes.

The assessment of respiratory and functional capacity in patients with COVID-19 after the acute phase is essential to estimate the impact of the disease's impairments on functioning related to the activities and tasks and their impact on participation. This information provides invaluable evidence of the impact of the disease to implement the most appropriate rehabilitation strategies. This review aims to determine the best tests to assess people's respiratory and functional capacity after COVID-19 infection. A narrative review of the literature was carried out that includes studies that applied respiratory and functional assessment in post-COVID-19 infection patients. It was found that the most used tests to assess respiratory function were diffusion capacity and spirometry. The most widely used tests to assess functional capacity were the 6-minutes walk test, the Sit-to-Stand test, the Short Performance Physical Battery, and the Barthel index. Finally, due to the heterogeneity of the clinical presentation of COVID-19, it is essential to have simple tests to assess and monitor the consequences of the disease on patients' respiratory function and functional status.

Criobiopsia en enfermedades pulmonares intersticiales difusas. Experiencia en un centro de Argentina / Cryobiopsy in interstitial lung disease: a real-life experience from a single center in Argentina

Resumen La criobiopsia transbronquial pulmonar (CBTB) ha sido introducida recientemente para el diagnóstico histológico de las enfermedades pulmonares intersticiales difusas (EPID). Nuestro objetivo fue evaluar el rédito diagnóstico y la seguridad de la CBTB para EPID en un centro de tercer nivel, en Buenos Aires, Argentina. Se efectuó una revisión retrospectiva de sujetos a los que se les realizó una CBTB en este centro desde septiembre de 2016 a noviembre de 2019. Se registró la información referida al paciente, el procedimiento y sus complicaciones, el diagnóstico histológico y multidisciplinario. Se analizaron potenciales factores asociados a diagnóstico y complicaciones por regresión logística. Se incluyeron 52 pacientes. La media de muestras fue 5.7 (DE 1.7) con una mediana de diámetro de 6 mm (rango intercuartil 6-8). Trece (25%) enfermos desarrollaron neumotórax sin encontrarse casos de sangrado grave o muerte. El rédito diagnóstico fue de 73.1% y 84.5% para la histología y la evaluación multidisciplinaria respectivamente. El número de muestras se asoció al rédito diagnóstico en el análisis multivariado (OR 2.15 -IC95% 1.16-3.99). La CBTB parece ser segura y efectiva para la evaluación de las EPID en la práctica al aplicarse en un centro con acceso a evaluación multidisciplinaria.

Abstract Transbronchial lung cryobiopsy (TBLC) has been recently introduced for the histological assessment of interstitial lung diseases. The objectives were to assess the diagnostic yield and safety of TBLC for interstitial lung diseases in our setting. A retrospective review of subjects who underwent TBLC in a tertiary care center from September 2016 to November 2019 was performed. Data regarding subject and procedure characteristics, complications, histopathological and multidisciplinary diagnosis was recorded. Logistic regression was used to analyze potential factors associated to diagnosis and complications. A total of 52 subjects were included. Mean number of samples was 5.7 (SD 1.7) with a median sample diameter of 6 mm (interquartile range 6-8). Pneumothorax developed in 13 (25%) participants, and no cases of severe bleeding or death were registered. A 73.1% and 84.5% diagnostic yield was recorded through histology and added multidisciplinary evaluation respectively. The number of samples was associated to the diagnostic yield in a multivariate analysis (OR 2.15 -CI95% 1.163.99). TBLC appears to be safe and effective for the assessment of interstitial lung diseases in a real life setting when applied in a center with access to multidisciplinary evaluation.