Asociación entre niveles séricos de vitamina D y factores de riesgo cardiometabólicos en pacientes pediátricos del noroeste de México

RESUMEN Introducción: Actualmente se ha observado que la hipovitaminosis D y la obesidad pueden influir en el desarrollo de enfermedad cardiovascular en el futuro. Objetivo: Identificar la asociación entre deficiencia de vitamina D y factores de riesgo cardiometabólicos en los pacientes pediátricos del noroeste de México. Materiales y métodos : se incluyeron niños de 6 a 15 años, se les midieron variables somatométricas, niveles séricos de colesterol total, C-HDL, C-LDL, triglicéridos, glucosa, insulina, vitamina D e índice HOMA-IR. Se identificó la asociación de factores de riesgo cardiometabólicos y la deficiencia de vitamina D, mediante la prueba de Chi cuadrado. Resultados: De los 114 pacientes evaluados, se detectó eutrofia en 42.1%, sobrepeso en 12.3%, obesidad en 41.2% y desnutrición en 4.4%. La prevalencia de deficiencia en vitamina D, insuficiencia y suficiencia fueron 18.4%, 27.2% y 54.4% respectivamente. La deficiencia de vitamina D mostró mayor predominio en pacientes con obesidad (27 %). La hipertrigliceridemia se asoció estadísticamente con deficiencia de vitamina D (p 0.041). Se observaron correlaciones inversas entre niveles de vitamina D con HOMA (r=-0.191; p=0.41), score Z IMC (r=-0.210; p=0.025) e insulina (r=-0.227; p=0.015). Conclusiones: La deficiencia de vitamina D se asocia en niños con un IMC elevado y resistencia a la insulina, lo cual puede acelerar el desarrollo de síndrome metabólico, diabetes mellitus tipo 2 y enfermedad cardiovascular.

ABSTRACT Introduction: It has currently been observed that hypovitaminosis D and obesity can influence the future development of cardiovascular disease. Objective: To identify the association between vitamin D deficiency and cardiometabolic risk factors in pediatric patients from northwestern Mexico. Materials and methods: Children aged 6 to 15 years were included, somatometric variables, serum levels of total cholesterol, HDL-C, LDL-C, triglycerides, glucose, insulin, vitamin D and HOMA-IR index were measured. The association of cardiometabolic risk factors and vitamin D deficiency was identified using the Chi square test. Results: Of the 114 patients evaluated, normal body-mass index was detected in 42.1%, 12.3% were overweight, 41.2% were obese and 4.4% were malnourished. The prevalence of vitamin D deficiency, insufficiency and sufficiency were 18.4%, 27.2% and 54.4% respectively. Vitamin D deficiency was more prevalent in obese patients (27%). Hypertriglyceridemia was statistically associated with vitamin D deficiency (p = 0.041). Inverse correlations were observed between vitamin D levels with HOMA (r = -0.191; p = 0.41), BMI Z score (r = -0.210; p = 0.025) and insulin (r = -0.227; p = 0.015). Conclusions: Vitamin D deficiency is associated with a higher BMI and insulin resistance in children, which can accelerate the development of metabolic syndrome, type 2 diabetes mellitus and cardiovascular disease.

Puericultura na Atenção Primária: conhecimentos e atitudes em saúde bucal das mães / Childcare in Primary Health Care: knowledge and attitudes in oral health among mothers

A proposta deste trabalho foi avaliar os conhecimentos e atitudes em saúde bucal de mães acompanhadas em serviço de puericultura na atenção primária, particularmente direcionados aos seus bebês. Métodos: Estudo transversal, com a análise descritiva e analítica dos dados, desenvolvido com mães acompanhadas na puericultura de uma Unidade de Saúde da Família do Distrito Sanitário V da cidade do Recife, estado de Pernambuco. A amostra foi do tipo censitária, de acordo com os critérios de inclusão e exclusão adotados. Para a coleta de dados empregou-se a entrevista face a face com a aplicação de questionário, entre os meses de novembro e dezembro do ano de 2018. A margem de erro adotada para os testes estatísticos foi de 5% considerando-se os testes Exato de Fisher e Qui-quadrado de Pearson. O projeto deste estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Pernambuco, sob CAAE 95992518.8.0000.5208. Resultados: A amostra total foi composta por 77 mães, com sua maior frequência na faixa etária entre 21 e 30 anos, apresentando ensino fundamental incompleto e renda mensal familiar inferior a um salário mínimo. Dessas, a maioria não recebeu orientações sobre saúde bucal no serviço de puericultura. Aproximadamente metade dos bebês com até 24 meses de idade faziam o uso de mamadeira noturna, sem higiene após a mesma e com uma dieta rica em açúcar a partir dos seis meses de idade. Principais conclusões: As pesquisadas detinham um conhecimento insatisfatório, na grande maioria, quanto aos hábitos e cuidados de saúde bucal de seus filhos.

The purpose of this study was to evaluate the oral health knowledge and attitudes of mothers accompanied in primary care service, particularly in relation to their babies. Methods: Cross-sectional study, with descriptive and analytical analysis of the data, developed with mothers assisted in childcare at a Family Health Unit in the Health District V of the city of Recife, State of Pernambuco. The sample was of the census type, according to the adopted inclusion and exclusion criteria. Data was collected by conducting face-to-face interviews with the application of a questionnaire between November and December of the year 2018. The margin of error adopted for the statistical tests was 5% considering the Fisher's Exact and Person's Chi- square. The study project was approved by the Research Ethics Committee of the Federal University of Pernambuco under CAAE 95992518.8.0000.5208. Results: The sample consisted of 77 mothers, with the highest frequency in the age group of 21-30 years of age, presenting incomplete elementary education and monthly family income below a minimum wage. Of these, the majority did not receive oral health guidelines in the childcare service. Approximately half of the babies up to 24 months of age had bedtime bottle, with no hygiene after use and a high-sugar diet from six months of age. Main conclusions: The respondents had an unsatisfactory knowledge, in the great majority, on the oral health care and habits of their children.

Diabetes y enfermedad periodontal / Diabetes and periodontal disease

El objetivo de este trabajo fue establecer la relación entre el grado de enfermedad periodontal y el control metabólico de la glucemia en pacientes que padecen diabetes tipo 2. Es un estudio de tipo observacional, descriptivo, transversal. Se seleccionaron 42 pacientes con diagnóstico de diabetes mellitus tipo 2 de ambos sexos, entre 25 y 75. Se realizó odontograma y se evaluó el grado de enfermedad periodontal para determinar el grado de compensación metabólica de los pacientes se tomaron muestras de sangre venosa y se midieron los valores de hemoglobina glicosilada. Un 23,55% de los pacientes no presentaron enfermedad periodontal y el resto se dividió en leve, moderada y severa presentándose la enfermedad leve en primer orden. Los pacientes con mayor grado de enfermedad periodontal presentaron mayor número de piezas dentarias perdidas (p 0,0334). La enfermedad periodontal se distribuye de la misma manera en ambos grupos de control glucémico (p=0,1211). En el grupo estudiado, el grado de enfermedad periodontal es independiente del control glucémico de los pacientes (AU)

The objective of this work was to establish the relationship between the degree of periodontal disease and the metabolic control of glycemia in patients with type 2 diabetes. It is an observational, descriptive, cross-sectional study. 42 patients with a diagnosis of type 2 diabetes mellitus of both sexes, between 25 and 75, were selected. An odontogram was performed and the degree of periodontal disease was evaluated; venous blood samples were taken and glycosylated hemoglobin values were measured to determine the degree of metabolic compensation of the patients. 23.55% of the patients did not present periodontal disease and the rest were divided into mild, moderate, and severe, with mild disease presenting in the first order. The patients with a higher degree of periodontal disease had a higher number of missing teeth (p 0.0334). Periodontal disease is distributed in the same way in both glycemic control groups (p = 0.1211). In the group studied, the degree of periodontal disease is independent of the glycemic control of the patients (AU)

Análise biomecânica de membros inferiores em mulheres acometidas com dores articulares no joelho / Biomechanical analysis of inferior limbs in women affected with articular pains in the knee

Objetivo: analisar a biomecânica de membros inferiores em mulheres acometidas com dores articulares no joelho. Me-todologia: Estudo observacional analítico e descritivo do tipo transversal, com 40 mulheres entre 18 a 60 anos com dor no joelho. Utilizou-se ficha de avaliação contendo as variáveis antropométricas e postural, concomitante avaliação estática e dinâmica do joelho. Analisou-se os dados pelo software BioEstat 5.0 com nível α de significância de 5% (p≤0,05). Resultados: Foram coletadas 40 mulheres (idade: 45,2±14,7 anos, peso: 70,3±12,3 kg, altura: 1,60±0,05 cm, Índice de Massa Corpórea (IMC): 27,27±4,6, e tamanho do pé: 36,5±1,5cm), onde o joelho direito foi o mais acometido por lesão (70%). Observou-se que o comprimento do membro inferior direito (MID) foi 83,5±5,86 cm, membro inferior esquerdo (MIE) 83,4±5,89 cm, ângulo Q do MID 25,2±6,09 graus, ângulo Q do MIE 25,3±6,57 graus e inclinação pélvica de 1,20±0,89 cm, onde 25 mulheres (62,5%) apresentaram inclinação a esquerda. Para avaliação dinâmica houve positividade do teste Step Down de forma significativa apenas para o MID (77,5%; p=0,0009). Na associação das va-riáveis estudadas com teste de Step Down, houve significância estatística para peso (MID: p=0,05 e MIE: p=0,007), bem como tamanho do pé do MID (p=0,04), para o IMC apenas o MIE (p=0,01). E, na relação dos dados posturais houve significância estatística para o comprimento do MID (p=0,01). Conclusão: As variáveis peso, IMC, tamanho do pé e comprimento do membro inferior tiveram relação sobre o quadril e os MMII, sugerindo valgo dinâmico e/ou predisposição do agravamento de dores no joelho em mulheres.

Objective: to analyze the biomechanics of lower limbs in women with joint pain in the knee. Methodology: Observational descrip-tive and cross-sectional study with 40 women between 18 and 60 years with knee pain. An evaluation form containing the anthropometric and postural variables, concomitant static and dynamic evaluation of the knee was used. Data was analyzed by BioEstat 5.0 software with an α level of significance of 5% (p≤0.05). Results: A total of 40 women were gathered (age: 45.2 ± 14.7 years, weight: 70.3 ± 12.3 kg, height: 1.60 ± 0.05 cm, Body Mass Index (BMI): 27.27 ± 4.6, and foot size: 36.5 ± 1.5 cm), where the right knee was the most affected by injury (70%). It was observed that the length of the right lower limb (RLL) was 83.5 ± 5.86 cm, left lower limb (LLL) 83.4 ± 5.89 cm, Q angle of the RLL 25.2 ± 6.09 degrees , LLL Q angle of 25.3 ± 6.57 degrees and pelvic tilt of 1.20 ± 0.89 cm, where 25 women (62.5%) presented left slope. For dynamic evaluation, the Step Down test was positively significant only for the RLL (77.5%, p = 0.0009). In the association of the variables studied with the Step Down test, there was statistical significance for weight (RLL: p = 0.05 and LLL: p = 0.007), as well as foot size of the RLL (p = 0.04), for BMI only the LLL (p = 0.01). And, in the relation of the postural data there was statistical significance for the length of the RLL (p = 0.01).Conclusion: The variables weight, BMI, foot size and lower limb length had relation over the hip and LLL, suggesting dynamic valgus and / or predisposition for worsening of knee pain in women.

Dolor postoperatorio: frecuencia y caracterización del manejo / Postoperative pain: frequency and management characterization

Abstract Introduction: Acute postoperative pain is a usual symptom and a surgical challenge. Objective: To determine the frequency of pain in the postoperative period of patients undergoing elective surgery and to characterize pain management at a second-level public hospital. Material and methods: A cross-section study of 175 postop patients was conducted, analyzing variables such as level of pain 24 hours after surgery according to the visual analog scale, type of surgery, use of analgesics, and anesthetic technique. Results: The findings indicate that the frequency of moderate, severe, and excruciating pain is 66.3%. In all cases, the analgesia treatment was prescribed by the treating service, and 2 to 3 nonsteroidal anti-inflammatory drugs were used in 86.4% of the cases, with a minimal use of opioids in 13% of the patients. The anesthetic techniques used included balanced general anesthesia, neuro-axial block, and a mixed technique; the latter improved pain control. Conclusion: The frequency of postoperative pain is similar to the level reported in other trials (30%-70%), pointing to the need to review our current management, with more extensive participation and training of the staff involved in pain control.

Resumen Introducción: El dolor agudo postoperatorio es un síntoma frecuente, el cual representa un reto en el ámbito quirúrgico. Objetivo: determinar la frecuencia de dolor en el paciente postoperado de cirugía electiva y caracterizar el manejo del mismo en un hospital público de segundo nivel de atención. Material y métodos: se realizó un estudio transversal en 175 pacientes postoperados, analizando las variables de grado de dolor a las 24 horas del postoperatorio con la escala visual análoga, tipo de cirugía, uso de analgésicos, técnica anestésica. Resultados: Se encontró que la frecuencia de dolor moderado, severo o insoportable es del 66.3%. El tratamiento analgésico en todos los casos fue prescrito por el servicio tratante y en el 86.4% de los casos se emplearon AINE'S, en número de uno a tres. Con un uso mínimo de opioides en el 13% de los pacientes. Las técnicas anestésicas usadas fueron AGB, BNA y técnica mixta; con mejoría en el grado de dolor con la técnica mixta. Conclusión: Existe una frecuencia de dolor postoperatorio similar a lo reportado en otros estudios (30-70%), reflejando la necesidad de revisión del manejo actual, mayor participación y capacitación del personal involucrado en su manejo.

Forma activa de la vitamina D en pacientes pediátricos con sobrepeso y obesidad en el noroeste de México / Active form of vitamin D in overweight and obese pediatric patients in northwest Mexico

Resumen: Introducción: Los niveles bajos de vitamina D se han asociado con una gama de condiciones clínicas como obesidad, resistencia a la insulina y diabetes mellitus. Existen pocos estudios donde se hayan realizado mediciones de la forma activa de la vitamina D (1,25 (OH)2 vitamina D) en niños con obesidad. Sin embargo, los datos publicados no son concluyentes. El objetivo de este estudio fue determinar los niveles de la forma activa de la vitamina D en niños con obesidad y sobrepeso y determinar la asociación entre los niveles bajos de esta vitamina, la obesidad y las alteraciones del metabolismo de la glucosa. Métodos: Estudio transversal analítico en niños de 6 a 12 años de edad con exceso de adiposidad determinado por el índice cintura-estatura y el índice Z de masa corporal. Se midieron niveles de glucosa, insulina, perfil de lípidos completo, modelo homeostático para evaluar la resistencia a la insulina y la forma activa de la vitamina D. Se consideraron como niveles bajos de vitamina D aquellos menores a 30 pg/ml. Resultados: La prevalencia de niveles bajos de la forma activa de la vitamina D fue del 36%. La asociación entre niveles bajos de la forma activa de la vitamina D y niveles altos de insulina resultó estadísticamente significativa. No se encontró asociación significativa entre los niveles de la vitamina y las medidas de adiposidad. Conclusiones: Se encontraron niveles bajos de la forma activa de la vitamina D en el 36% de la población estudiada, y se demostró su asociación con la resistencia a insulina e hiperinsulinemia.

Abstract: Background: Low levels of vitamin D have been associated with a range of clinical conditions such as obesity, insulin resistance, and diabetes mellitus, among others. There are few studies that measure the active form of vitamin D (1,25 (OH)2 vitamin D) in obese children. However, published data are inconclusive. The aim of this study was to determine the active levels of vitamin D in obese and overweight children and to find an association between low levels of vitamin D, obesity and impaired glucose metabolism. Methods: A cross-sectional, analytical study was conducted in 6 to 12-year-old children with excess adiposity determined by waist-stature index and body mass index. Levels of glucose, insulin, complete lipid profile, homeostatic model assessment and the active form of vitamin D were measured in each patient. Levels < 30 pg/ml were considered as low levels of vitamin D. Results: The prevalence of low levels of active vitamin D was 36%. A significant association between low levels of active vitamin D and high levels of insulin was found. No significant association was found between vitamin levels and adiposity measures. Conclusions: Low levels of active vitamin D were found in 36% of the population studied. A significant association with insulin resistance and hyperinsulinemia was demonstrated.

Estructura familiar y estado de nutrición en adolescentes de Sonora, México / Family structure of obese/overweight and normal weight adolescents in México

Background: Feeding modes and appetence toward certain foods are usually conditioned by the family. Obesity during adolescence usually persists during adulthood. Aim: To determine differences in family structure of adolescents according to their nutritional status. Material and Methods: A cross-sectional study was conducted in 60 overweight-obese and 60 normal weight adolescents. Family type was determined based on their conformation (kinship and cohabitation), development (if the mother had a remunerated job), demography (geographical area), integration (functions of the couple); life cycle stage and functionality. Results: Fifty eight percent of normal weight adolescents had simple nuclear families and 47% of overweight-obese adolescents had an extended family. Thirty one and 21% of overweight/obese and normal weight adolescents lived with an overweight/obese individual, respectively. Conclusions: There are differences in the family structure of overweight/obese and normal weight adolescents.

Association between Sense of Coherence and Dental Caries Experience in Adolescents

To analyze the association between sense of coherence and dental caries experience in adolescents. Material and Methods:A cross-sectional study was conducted with 100 adolescents aged 11 to 15 years old who were attending the Debora Feijo State School in the city of Recife (Brazil). Information was collected on socio-demographic data ûage, gender, school failure and numberof residents per home. Sense of coherence (SOC) was evaluated using the SOC-13 questionnaire and the dental caries experience was determined using the DMFT index. For statistical analysis, the correlation test of Spearman and the association tests of Mann-Whitney and Kruskal-Wallis were used. The significance level was set at 5% (p<0.05). Results:A negative correlation was observed between the SOC and DMFT index (p < 0.001) which indicates that the higher the SOC, the lesser the DMFT. The mean SOC score was greater among adolescents with no dental caries experience. The SOC score was lower among those who failed school more often and those who lived with a greater number of people.Conclusion:The SOC-13 questionnaire can be considered a positive predictor of oral health status, representing an important tool in the establishment of health promotion actions focused on adolescents...

Realidad de la circulación de membrana extracorpórea neonatal en Colombia: descripción de los primeros casos / Current state of neonatal extracorporeal membrane oxygenation in Colombia: description of the first cases

La oxigenación de membrana extracorpórea se considera una terapia de rescate y soporte vital compleja, con beneficios en enfermedades cardiorrespiratorias durante el periodo neonatal, que cumple con las características de ser reversible en recién nacidos mayores de 34 semanas. El criterio de selección de los pacientes y el momento oportuno en que se indica son críticos para el resultado final, si bien las nuevas alternativas de manejo en falla respiratoria hipoxémica en recién nacidos a término y casi a término han generado una disminución de su uso, excepto en la hernia diafragmática, que continúa siendo una enfermedad compleja donde podría tener alguna aplicabilidad. Si bien nuestra experiencia está iniciándose, el entrenamiento constante hará de la oxigenación de membrana extracorpórea una opción para pacientes complejos en quienes la terapia máxima fracasa. Se hace un informe de los primeros casos neonatales por falla respiratoria hipoxémica manejados en la Fundación Cardiovascular de Colombia.

Extracorporeal membrane oxygenation is considered a rescue therapy and complex vital support with benefits in cardiorespiratory diseases during neonatal period that fulfil the characteristics of being reversible in neonates older than 34 weeks. The criteria for patient selection and its prompt use are critical for the final result. Even though new alternatives for management of hypoxemic respiratory failure in full term and almost full term neonates have decreased its use, congenital diaphragmatic hernia continues being a complex disease where it can have some applicability. Even though our experience is beginning, constant training will make of extracorporeal membrane oxygenation an option for complex patients in whom maximum therapy fails. This is a report of the first neonatal cases of hypoxemic respiratory failure managed at Fundación Cardiovascular de Colombia.

Efeitos da ventilação por pressão de suporte sobre a variabilidade cardiopulmonar em pacientes graves / Effects of support ventilation pressure on cardiopulmonary variability in critically ill patients

A variabilidade cardiopulmonar está presente em indivíduos saudáveis e tem impacto na sua fisiologia. A adição de variabilidade ao padrão respiratório pelo ventilador tem sido proposta como um método para melhorar a troca gasosa. A ventilação por pressão de suporte é um modo espontâneo frequentemente usado em desmame e mais recentemente usado em pacientes estáveis com lesão pulmonar aguda para prevenir atrofia muscular e com provável benefício na troca gasosa. No entanto, o impacto da pressão de suporte sobre a variabilidade cardiopulmonar não é bem estabelecido na literatura. Objetivo: Analisar a variabilidade do padrão cardiopulmonar em pacientes ventilados com diferentes níveis de pressão de suporte. Métodos: Catorze pacientes ventilados invasivamente em PS foram estudados de março a outubro de 2011. Após registro basal por 10 minutos, os pacientes eram ventilados em etapas decrescentes de PS partindo de 20 cmH2O em 4 degraus decrescentes com diferença de 5 cmH2O com duração de 10 minutos cada até atingir PS5 cmH2O . Foram adquiridos os sinais da pressão esofágica, de via aérea e fluxo contínua e concomitantemente com os sinais de pressão arterial e eletrocardiograma. A P 0.1 e a gasometria arterial foi coletada ao final de cada degrau. Foram calculados pressão transpulmonar, pico de fluxo inspiratório, tempo inspiratório, volumes minuto e corrente, frequência respiratória e produto pressão-tempo (PTP) ao longo do tempo. Para todas essas variáveis foram calculados os coeficientes de variação (CV). As comparações entre os níveis de PS foram realizadas com ANOVA e usado o teste Bonferroni para múltiplas comparações considerado p<0.05...

Reeducação Postural Global: uma revisão da literatura / Global Postural Re-education: a literature review

CONTEXTUALIZAÇÃO: O método de Reeducação Postural Global (RPG) tem sido utilizado na clínica com relatos de benefícios para a prevenção e recuperação de disfunções musculoesqueléticas. Após duas décadas de aplicação, estudos têm verificado sua eficácia no tratamento de diferentes condições clínicas e ele tem sido comparado com outros recursos fisioterapêuticos. Entretanto, são poucos os estudos voltados à comprovação dos princípios defendidos pelo autor do método, o que torna frágeis as argumentações em favor dele. OBJETIVO: Realizar, com base na literatura científica, uma análise crítica dos efeitos da intervenção fisioterapêutica utilizando o método RPG. MÉTODOS: Pesquisaram-se as bases de dados Medline, SciELO, LILACS e PeDRO, de 2000 a 2010, considerando os unitermos: RPG, alongamento global e alongamento ativo. RESULTADOS: Foram encontrados 25 estudos, sendo 13 relacionados ao método RPG e oito aos alongamentos global e ativo, além de três livros e uma tese. Após análise, 20 referências foram utilizadas. CONCLUSÕES: Parte dos estudos aponta que o método RPG é mais efetivo, enquanto outros mostram resultados similares a outros métodos de intervenção fisioterapêutica. Estudos indicam benefícios do método na melhora da força muscular respiratória, expansibilidade torácica, mobilidade toracoabdominal e da pressão respiratória máxima, além de reduzir a dor, a perda de urina em mulheres incontinentes, melhorar a flexibilidade, a atividade eletromiográfica nas disfunções temporomandibulares e a estabilidade postural em alterações ortopédicas de membros inferiores. Limitações metodológicas observadas sugerem a necessidade de maior rigor em futuras pesquisas.

BACKGROUND: The Global Postural Re-education (GPR) method has been widely used in clinical practice, with reported benefits for prevention and rehabilitation of musculoskeletal dysfunctions. In parallel with almost two decades of clinical implementation, research studies have tested and verified the effectiveness of GPR in treating different clinical conditions and have also compared this method with other physical therapy resources. However, few studies focused on the verification of the principles of mechanisms of action defended by the author of the method making the arguments in favor of the method weak. OBJECTIVE: To perform a critical systematic review of the effects of physical therapy intervention that use the GPR method. METHODS: We searched Medline, SciELO, LILACS and PeDRO, from 2000 to 2010, considering the key words: Global Postural Re-education, global and active stretching. RESULTS: We found 25 studies, 13 about GPR and 8 about global and active stretching in addition to three books and a thesis. After analysis, 20 references were included. CONCLUSIONS: Some of the studies indicated that the GPR method was more effective than other physical therapy interventions, while others demonstrated similar results of GPR when compared to other physical therapy interventions. Studies showed benefits of the GPR in improving the respiratory muscle strength, chest expansion, maximal respiratory pressure and in reducing pain, loss of urine in incontinent women, increasing flexibility, the electromyographic activity in temporomandibular disorders and postural stability in lower limb orthopedic alterations. Methodological limitations observed suggest the need for greater rigor in future research.

Efeitos da fisioterapia motora em pacientes críticos: revisão de literatura / Effects of motor physical therapy in critically ill patients: literature review

O desenvolvimento de fraqueza generalizada relacionada ao paciente crítico é uma complicação recorrente em pacientes admitidos em uma unidade de terapia intensiva. A redução da força muscular aumenta o tempo de desmame, internação, o risco de infecções e conseqüentemente morbimortalidade. A fisioterapia é usada nesses pacientes como recurso para prevenção da fraqueza muscular, hipotrofia e recuperação da capacidade funcional. O objetivo deste estudo foi rever a literatura relacionada ao uso da cinesioterapia em pacientes internados em unidades de terapia intensiva. A pesquisa da literatura foi realizada por meio das bases eletrônicas de dados MedLine, LILACS, CINAHL, Cochrane, High Wire Press e SciELO, de janeiro de 1998 a julho de 2009 e capítulos de livros utilizando palavras-chave incluindo: "critical illness", "cinesiotherapy", "physical therapy", "physiotherapy", "exercises", "training", "force", "active mobilization", "mobilization", "ICU", "rehabilitation", "mobility", "muscle strength" e "weakness". Apesar da escassez de estudos e da diversidade metodológica dos estudos encontrados demonstrando o uso da cinesioterapia como recurso terapêutico, o seu uso, inclusive precocemente parece uma alternativa à prevenção e reversão da fraqueza muscular adquirida na unidade de terapia intensiva.

The development of critical patient-related generalized weakness is a common complication in patients admitted to an intensive care unit. The reduced muscle strength increases the time for weaning, hospitalization, the risk of infections and consequent mortality. Physiotherapy is used in these patients as a resource for the prevention of muscle weakness, atrophy and functional capacity recovery. The aim of this study was to review the literature regarding the use of exercise alone in intensive care units staying patients. Literature searches were performed using the electronic databases Medline, LILACS, CINAHL, Cochrane, High Wire Press and SciELO, from January 1998 to July 2009 and book chapters, using keywords including "critical illness", "cinesiotherapy", "physical therapy", "physiotherapy", "exercises", "training", "force", "active mobilization", "mobilization", "ICU", "rehabilitation", "mobility", "muscle strength" and "weakness". Despite the lack of studies and methodological diversity of studies found, confirming the use of exercise alone as a therapeutic resource, its use, including early seems an alternative to prevent and reverse muscle weakness intensive care unit ICU-acquired.

Evaluation of the reproducibility of two techniques used to determine and record centric relation in angle's class I patients

The centric relation is a mandibular position that determines a balance relation among the temporomandibular joints, the chew muscles and the occlusion. This position makes possible to the dentist to plan and to execute oral rehabilitation respecting the physiological principles of the stomatognathic system. The aim of this study was to investigate the reproducibility of centric relation records obtained using two techniques: Dawson's Bilateral Manipulation and Gysi's Gothic Arch Tracing. Twenty volunteers (14 females and 6 males) with no dental loss, presenting occlusal contacts according to those described in Angle's I classification and without signs and symptoms of temporomandibular disorders were selected. All volunteers were submitted five times with a 1-week interval, always in the same schedule, to the Dawson's Bilateral Manipulation and to the Gysi's Gothic Arch Tracing with aid of an intraoral apparatus. The average standard error of each technique was calculated (Bilateral Manipulation 0.94 and Gothic Arch Tracing 0.27). Shapiro-Wilk test was applied and the results allowed application of Student's t-test (sampling error of 5 percent). The techniques showed different degrees of variability. The Gysi's Gothic Arch Tracing was found to be more accurate than the Bilateral Manipulation in reproducing the centric relation records.

Adolpho Lutz e a história da medicina tropical no Brasil / Adolpho Lutz and the history of tropical medicine in Brazil

Apresenta um balanço das atividades do projeto sobre Adolpho Lutz e a história da medicina tropical no Brasil: o andamento da preparaçäo dos textos e da correspondência do cientista para publicaçäo, a descriçäo e o tratamento dos componentes de seu arquivo, que se acha sob a guarda do Museu Nacional. Traz como anexos a relaçäo dos cargos, títulos, prêmios e condecoraçöes de Adolpho Lutz, sua bibliografia e uma seleçäo de cartas recebidas por ele.

Fight for survival: the life of a Hansen's disease sufferer through his correspondence with Adolpho Lutz

Apresenta a série completa da correspondência da família de um portador do mal de Hansen residente no Maranhäo, Nordeste do Brasil, com o médico e bacteriologista Adolpho Lutz. Fabrício Caldas de Oliveira e Numa Pires de Oliveira, pai e filho, mantiveram durante mais de vinte anos intensa troca de cartas com o cientista na busca da cura da doença que vitimava Numa desde criança. As 24 cartas aqui reunidas retratam, de maneira única, o drama médico-social enfrentado por esta família, os resultados do uso do chalmugra e outros medicamentos, a busca de tratamentos alternativos.

Control del tabaquismo en estudiantes universitarios: estudio cuasi experimental en dos cohortes / Tobacco control programs in university students: study in 2 cohorts

Con el antecedente de altas tasas de prevalencia de fumadores adolescentes que ingresan a estudiar a la Universidad de Concepción, se estimó necesario intervenir para reducir el tabaquismo en este grupo etáreo. Para ello se desarrolló un Programa de Control de Tabaquismo en un grupo experimental conformado por estudiantes de primer año de tres carreras del área de la salud y tres carreras del área de educación y se comparó los resultados obtenidos con un grupo control conformado por estudiantes de primer año de las mismas carreras. En el análisis estadístico se utilizaron pruebas chi cuadrado de independencia y homogeneidad. El estudio reveló que entre el grupo control y el grupo experimental hubo diferencia significativa entre ex fumadores y fumadores ocasionales. El resultado fue más efectivo en los estudiantes del área de la salud que en el área de educación, y hubo una repuesta más favorable en los estudiantes hombres que en las mujeres