Pediatric nephrologist-intensivist interaction in acute kidney injury / Interação nefro-intensivista pediátrica na lesão renal aguda

ABSTRACT Introduction: Acute Kidney Injury (AKI) in the Intensive Care Unit (ICU) have concepts of diagnosis and management have water balance as their main point of evaluation. In our ICU, from 2004 to 2012, the nephrologist's participation was on demand only; and as of 2013 their participation became continuous in meetings to case discussion. The aim of this study was to establish how an intense nephrologist/intensivist interaction influenced the frequency of dialysis indication, fluid balance and pRIFLE classification during these two observation periods. Methods: Retrospective study, longitudinal evaluation of all children with AKI undergoing dialysis (2004 to 2016). Parameters studied: frequency of indication, duration and volume of infusion in the 24 hours preceding dialysis; diuresis and water balance every 8 hours. Non-parametric statistics, p ≤ 0.05. Results: 53 patients (47 before and 6 after 2013). There were no significant differences in the number of hospitalizations or cardiac surgeries between the periods. After 2013, there was a significant decrease in the number of indications for dialysis/year (5.85 vs. 1.5; p = 0.000); infusion volume (p = 0.02), increase in the duration of dialysis (p = 0.002) and improvement in the discrimination of the pRIFLE diuresis component in the AKI development. Conclusion: Integration between the ICU and pediatric nephrology teams in the routine discussion of cases, critically approaching water balance, was decisive to improve the management of AKI in the ICU.

RESUMO Introdução: Os conceitos sobre diagnóstico e conduta da Lesão Renal Aguda (LRA) na Unidade de Terapia Intensiva (UTI) tem como ponto primordial a avaliação do balanço hídrico. Em nossa UTI, de 2004 a 2012, a participação do nefrologista era sob demanda. A partir de 2013, a participação passou a ser contínua em reunião de discussão de casos. O objetivo deste estudo foi determinar como a maior interação nefrologista/intensivista influenciou a frequência de indicação de diálise, no balanço hídrico e na classificação pRIFLE durante esses dois períodos de observação. Método: Estudo retrospectivo, avaliação longitudinal de todas as crianças com LRA em diálise (2004 a 2016). Parâmetros estudados: frequência de indicação, tempo de duração e volume de infusão nas 24 horas precedendo a diálise; diurese e balanço hídrico a cada 8 horas. Estatística não paramétrica, p ≤ 0,05. Resultado: 53 pacientes (47 antes e 6 após 2013). Sem diferença significativa no número de internações e nem de cirurgias cardíacas entre os períodos. Após 2013, houve diminuição significativa no número de indicação de diálise/ano (5,85 vs. 1,5; p = 0,000); no volume de infusão (p = 0,02), aumento do tempo de duração da diálise (p = 0,002) e melhora da discriminação do componente diurese do pRIFLE na indicação de LRA. Conclusão: Integração entre equipes de UTI e nefrologia pediátrica na discussão rotineira de casos, abordando criticamente o balanço hídrico, foi determinante para a melhora na conduta da LRA na UTI.

Equilíbrio postural e fatores associados ao risco de quedas em idosos com diabetes mellitus tipo 2 / Postural balance and associated factors with the fall risk assessed in older adults with type 2 diabetes mellitus

Resumo Objetivo Identificar os fatores clínico-funcionais associados ao risco de quedas, avaliado pelo Mini-BESTest, em idosos com diabetes mellitus tipo 2 (DM2). Método Trata-se de um estudo transversal. Um total de 145 idosos com idade =60 anos foram avaliados por meio das variáveis sociodemográficas (sexo, faixa etária, estado civil, nível de educação e percepção geral da saúde, audição e visão) Mini-BESTest, Mini-Mental State Examination (MMSE), Escala de Depressão Geriátrica (GDS-15) e o teste Timed Up and Go (TUG) (dupla tarefa). Foi utilizado um modelo de regressão logística múltipla. Resultados O domínio de orientação sensorial apresentou a pontuação média mais elevada, seguido pelos domínios estabilidade na marcha, ajustes posturais antecipatórios e respostas posturais. Os fatores associados ao risco de quedas em idosos foram: percepção visual ruim/muito ruim OR 3.40 (1,50-7,72); presença de doenças respiratórias OR 8.00 (1,32-48,46); sensação de tontura OR 2.53 (1,10-5,80); e tempo do teste Timed Up and Go (TUG) (dupla tarefa) igual ou superior a 13,5 segundos OR 3.31 (1,03-10,64). Conclusão Os idosos deste estudo apresentaram um equilíbrio postural comprometido, principalmente no domínio das respostas posturais. O conhecimento dos fatores associados ao risco de quedas em idosos com DM2 permite uma orientação mais eficaz na avaliação, prevenção e intervenção, visando minimizar a ocorrência de quedas e preservar ou otimizar o equilíbrio postural. Diversos fatores influenciaram esse resultado, tais como sobrepeso, baixa atividade física e nível educacional, várias comorbidades, polifarmácia, diagnóstico de DM2 por mais de dez anos, percepção negativa da saúde geral e da visão, e sintomas depressivos.

Abstract Objective Identify clinical-functional factors associated to the risk of falls, assessed by Mini-BESTest in older adults with type 2 diabetes mellitus (T2DM). Method This cross-sectional study. A total of 145 older adults aged ≥60 years were evaluated through sociodemographic variables (sex, age group, married, education level, general health status hearing and vision), Mini-BESTest, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and dual-task Timed Up and Go Test (TUG) Multiple logistic regression model was used. Results The sensory orientation domain presented the highest average score, followed by the gait stability, anticipatory postural adjustments and postural responses domains. Factors associated to the risk of falls in older adults are: poor/very poor visual perception OR 3.40 (1.50-7.72); have respiratory diseases OR 8.00 (1.32-48.46); feeling dizzy OR 2.53 (1.10-5.80); and TUGT (dual task) time equal to or greater than 13.5 seconds OR 3.31 (1.03-10.64). Conclusion Older adults in this study presented impaired postural balance, mainly in the postural responses domain. The knowledge of the factors associated with the risk of falls in older adults with T2DM allows for better guidance in prevention, assessment and intervention, in order to minimize the occurrence of falls and maintain or optimize postural balance. Several factors influenced this outcome, such as overweight, low physical activity and education, several comorbidities, polypharmacy, T2DM diagnosis for more than ten years, negative perception of general health and vision, and depressive symptoms.

Functional tests and isokinetic knee assessment in street runner athletes correlation / Correlación entre pruebas funcionales y evaluación isokinética de rodilla en practicantes de carrera de calle / Correlação entre testes funcionais e avaliação isocinética do joelho em atletas corredores de rua

ABSTRACT Introduction: The assessment of biomechanical changes related to the lower limbs is necessary in clinical practice to measure the potential risks of injury and the influences on existing dysfunction. Biomechanical changes related to previous ankle injuries are known to influence the performance of the entire lower limb. Objective: The aim of this study was to correlate muscle strength tests, performance tests and ankle stability with the Single Hop Test (SHT). Methods: 82 amateur runners were evaluated with isokinetic tests of quadriceps and hamstring muscle strength, as well as Y Balance Test (YBT), Weight-bearing Lung Test (WBLT), and the SHT. Results: The results showed there was a significant correlation between the SHT and the YBT in subjects with hamstring/quadriceps ratio (I/Q ratio) <0.55, and the length of the unilateral SHT with the peak torque of ipsilateral knee extensors. Conclusion: The study was successful in correlating the functional tests in question with the results obtained in isokinetic dynamometry. Level of Evidence V; Cross-Sectional Study.

RESUMEN Introducción: La evaluación de los cambios biomecánicos relacionados con las extremidades inferiores es necesaria en la práctica clínica para medir los riesgos potenciales de lesión y las influencias sobre la disfunción existente. Se sabe que los cambios biomecánicos relacionados con lesiones previas de tobillo influyen en el rendimiento de toda la extremidad inferior. Objetivo: Correlacionar las pruebas de fuerza muscular, las pruebas de rendimiento y la estabilidad del tobillo con la prueba de salto simple (Single Hop Test, SHT). Métodos: Se evaluó a 82 corredores aficionados con pruebas isocinéticas de fuerza muscular de cuádriceps e isquiotibiales, además de pruebas como Y Balance Test (YBT), Weight-bearing Lung Test (WBLT) y la prueba SHT. Resultados: Los resultados mostraron que existía una correlación significativa entre el SHT y el YBT en sujetos con ratio isquiotibiales/cuádriceps (ratio I/Q) <0,55, y la longitud del SHT unilateral con el par máximo de los extensores de la rodilla ipsilateral. Conclusión: El estudio logró correlacionar las pruebas funcionales en cuestión con los resultados obtenidos en la dinamometría isocinética. Nivel de Evidencia V; Estudio Transversal.

RESUMO Introdução: A avaliação de alterações biomecânicas relacionadas aos membros inferiores é necessária na prática clínica para mensurar os riscos potenciais de alguma lesão e as influencias sobre uma disfunção existente. As alterações biomecânicas relacionadas a lesões prévias de tornozelo são conhecidas pela influência na performance de todo o membro inferior. Objetivo: Correlacionar testes de força muscular, testes de performance e estabilidade do tornozelo com o teste de salto simples (Single Hop Test - SHT). Métodos: Foram avaliados 82 corredores amadores com testes isocinéticos de força muscular de quadríceps e isquiotibiais, além de testes Y Balance Test (YBT), Weight-bearing Lung Test (WBLT), e o SHT. Resultados: Os resultados demonstraram haver correlação significativa entre o SHT e o YBT nos indivíduos com relação Isquiotibiais/Quadríceps (relação I/Q) <0,55, e o comprimento do SHT unilateral com o pico de torque de extensores de joelho ipsilateral. Conclusão: O estudo foi bem sucedido em correlacionar os testes funcionais em questão com os resultados obtidos na dinamometria isocinética. Nível de Evidência V; Estudo Transversal.

Equilíbrio, quedas e risco de quedas na DPOC: revisão sistemática dos instrumentos de avaliação, propriedades de medida e utilidade clínica / Balance, falls, and risk of falls in COPD: systematic review of assessment instruments, measurement properties, and clinical utility

Resumo Objetivos Identificar os instrumentos de avaliação de equilíbrio, quedas e risco de quedas utilizados na DPOC, avaliar suas propriedades de medida, qualidade da evidência e utilidade clínica. Método A revisão foi produzida seguindo as orientações PRISMA e COSMIN, registrada no PROSPERO: CRD42021235118. As pesquisas foram realizadas de novembro de 2021 a setembro de 2022 nas bases de dados PubMed, LILACS, CINAHL, Embase, Web of Science e PEDro. Estudos observacionais transversais e coorte foram incluídos, sem restrição de idioma ou ano de publicação, desde que descreveram instrumentos clínicos de avaliação do equilíbrio, quedas e risco de quedas reportando no mínimo, uma das propriedades de medida: validade, confiabilidade e responsividade. Dois revisores independentemente aplicaram os critérios de elegibilidade, risco de viés pela COSMIN, qualidade da evidência pela abordagem GRADE e a avaliação da utilidade clínica pela Escala de Tyson e Connell. Resultados 9.102 estudos foram selecionados e 21 incluídos na revisão, nove estudos demonstraram propriedades de medida adequadas e suficientes e 12 instrumentos foram identificados, dos quais seis, foram avaliados quanto a qualidade de evidência. Conclusão Revisões sistemáticas de propriedades de medida requerem revisores especializados e habilidade em análise qualitativa. Com grau de recomendação "A", a Berg Balance Scale (BBS) e o teste Timed Up and Go (TUG) foram os instrumentos mais indicados na DPOC. Ao acrescentar a avaliação da utilidade clínica ao resultado, o TUG demonstra superioridade ao BBS, demostrando ser uma ótima ferramenta para triar indivíduos que necessitem de uma avaliação minuciosa do equilíbrio, quedas e risco de quedas.

Abstract Objectives to identify balance assessment instruments, issues and risks of issues used in COPD, evaluate their measurement properties, quality of evidence and clinical utility. Method A review was produced following the PRISMA and COSMIN guidelines, registered in PROSPERO: CRD42021235118. Searches were carried out from November 2021 to September 2022 in the PubMed, LILACS, CINAHL, Embase, Web of Science and PEDro databases. Cross-sectional and cohort observational studies were included, without restrictions on language or year of publication, as long as they described clinical instruments for assessing balance, falls and risk of falls reporting at least one of the measurement properties: validity, reliability and responsiveness. Two reviewers will independently apply the eligibility criteria, travel risk by COSMIN, quality of evidence by the GRADE approach and assessment of clinical utility by the Tyson and Connell Scale. Results 9,102 studies were selected and 21 included in the review, nine studies demonstrated adequate and sufficient measurement properties and 12 instruments were identified, of which six were evaluated for the quality of evidence. Conclusion Systematic reviews of measurement properties require specialized reviewers and skills in qualitative analysis. With a recommendation GRADE of "A", the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test were the most recommended instruments for COPD. By requiring the evaluation of the clinical utility of the result, the TUG demonstrates superiority to the BBS, proving to be a great tool for judging individuals who need a thorough assessment of balance, falls and risk of falls.

Regulation of Immune Balance by Traditional Chinese Medicine in Treatment of Cough Variant Asthma： A Review / 中国实验方剂学杂志

Cough variant asthma （CVA） is a chronic respiratory disease with cough as its main symptom. The occurrence of CVA is closely related to non-specific airway inflammation， and its pathogenesis involves environmental， genetic， immune， and other factors. In recent years， the advantages of traditional Chinese medicine （TCM） in the treatment of CVA have attracted the attention of experts and scholars in China and abroad， especially its prominent role in regulating immune balance， relieving cough symptoms in CVA patients， and reducing recurrence. T Helper cells 1 （Th1）， T helper cells 2 （Th2）， T helper cells 17 （Th17）， and regulatory T cells （Treg） are derived from CD4+ T cells. Immune imbalance of Th1/Th2 and Th17/Treg is a new hotspot in the pathogenesis of CVA and a potential key target in the treatment of CVA by TCM. Th cell subsets are in dynamic balance under physiological conditions， maintaining respiratory immune homeostasis in which pro-inflammatory cytokines and anti-inflammatory cytokines are balanced. Immature helper T cells （Th0） can be differentiated into Th1， Th2， Th17， Treg， and other cell subsets due to cytokine types in the microenvironment in the stage of CVA maturation. The proliferation of Th2 cells leads to eosinophilic airway inflammation. Excessive differentiation of Th17 cells induces neutrophil airway inflammation. Th1/Th2 and Th17/Treg cells are mutually restricted in number and function， and the immune imbalance of Th1/Th2 and Th17/Treg is easy to aggravate the generation of inflammatory response. Restoring immune balance is particularly important for the airway anti-inflammatory therapy of CVA. In this paper， the imbalance of Th1/Th2 and Th17/Treg and the pathogenesis of CVA were systematically expounded. Meanwhile， the latest research on the regulation of immune imbalance by TCM compound， single TCM， and its effective ingredients in the treatment of CVA was reviewed. It provides ideas and references for revealing the scientific connotation of TCM regulating immune balance therapy of CVA， as well as the development of clinical treatment and basic research of CVA.

Prevalencia de caídas y factores de riesgo intrínsecos en personas adultas mayores. Barranquilla (Atlántico), Colombia

Introducción: El riesgo de caídas es de carácter multifactorial, ya sea debido a factores extrínsecos o intrínsecos. Las caídas se consideran el principal mecanismo de lesión no intencional en los mayores. Objetivo: Determinar la prevalencia de caídas y factores de riesgo intrínsecos en personas adultas mayores de la ciudad de Barranquilla (Colombia). Materiales y métodos: Estudio descriptivo correlacional, realizado en 98 adultos mayores, tanto institucionalizados como en comunidad, residentes en Barranquilla (Atlántico), Colombia. Se aplicó una encuesta sobre factores de riesgo intrínsecos; el riesgo de caída se midió con la escala de Berg y se establecieron niveles de Vitamina D en sangre. Resultados: El promedio de edad fue de 75 años, con edades más avanzadas en población institucionalizada. La prevalencia general de caídas fue de 49 % en el último año. El 68,8 % de la población que presentó caídas fueron mujeres, con mayor proporción de caídas en los residentes en hogares geriátricos (52,1 %). Las mujeres provenientes de la comunidad se cayeron más que los hombres (91,3 %) lo cual muestra significancia estadística frente a las caídas (p = 0,002). El consumo de antihipertensivos fue el de mayor proporción (92 %), lo cual demuestra que es estadísticamente significativa para la población institucionalizada (p = 0,0224). El riesgo de caída alto y moderado fue mayor en la población institucionalizada (32 %). El 79,2 % de los individuos que presentaron caídas presentó niveles de vitamina D insuficientes. Conclusión: La población adulta mayor presenta una alta prevalencia de caídas, especialmente las mujeres y la población institucionalizada en centros geriátricos. Los hechos que presentaron significancia estadística fueron ser mujer y provenir de la comunidad, junto con el consumo de antihipertensivos en población institucionalizada.

Introduction: Fall risk can be related to multiple factors, whether they are of extrinsic or intrinsic nature. Falls are considered the main mechanism of accidental injury in the elderly. Objective: To determine the prevalence of falls and intrinsic risk factors in older adults in the city of Barranquilla (Colombia). Materials and methods: A descriptive correlation study was carried out on 98 institutionalized and community elderly adults from Barranquilla (Atlántico), Colombia. A survey on intrinsic risk factors was applied; the risk of falling was measured with the Berg scale and levels of Vitamin D in the blood were established. Results: The participant's average age was 75 years old, considering that the oldest ages were in the institutionalized population. The general prevalence of falls was 49% in the last year, 68.8% of the population that presented falls were women, and the highest proportion of falls occurred with residents of geriatric homes (52,1%). Women coming from the community fell more than men (91,3%) showing statistical significance compared to falls (p-value of 0,002). The consumption of antihypertensive drugs was the one with the highest proportion (92%), which showed statistical significance for the institutionalized population (p-value of 0,0224). The high and moderate risk of falls was higher in the institutionalized population (32%). Insufficient vitamin D levels (79,2% of those that fell) had a higher prevalence in women, without statistical significance. Conclusion: The elderly population has a high prevalence of falls, especially in women and in the population institutionalized in geriatric centers. The facts that presented statistical significance were being a woman and coming from the community, along with the consumption of antihypertensives in the institutionalized population.

Effect of seasonality on the leaf phenology and physiology of Byrsonima species (Malpighiaceae)

Introduction: Defined seasonality in savanna species can stimulate physiological responses that maximize photosynthetic metabolism and productivity. However, those physiological responses are also linked to the phenological status of the whole plant, including leaf phenophases. Objective: To study how physiological traits influence phenophase timing among congeneric and co-occurring savanna species. Methods: We evaluated the leaf phenology and physiological traits of populations of Byrsonima intermedia, B. coccolobifolia, and B. verbascifolia. Physiological measurements were performed at the onset of the dry and rainy seasons and again late in the season. Results: B. intermedia and B. coccolobifolia were classified as brevideciduous and B. verbascifolia as evergreen. The maximum quantum yield for B. intermedia and B. coccolobifolia were lowest during the dry season. At the onset of the dry period, the highest chloroplastidic pigment levels were observed, which decreased as the season advanced, total chlorophyll/carotenoid ratios were lowest, and carotenoid contents were highest. We detected low starch content values at the start of the rainy season, coinciding with the resumption of plant growth. Two months into this season, the leaves were at their peak structural and functional maturity, with high water-soluble polysaccharide values and photosynthetic rates, and were storing large amounts of starch. Conclusions: Physiological and leaf phenological strategies of the Byrsonima species were related to drought resistance and acclimatization to the seasonality of savanna water resources. The oscillations of the parameters quantified during the year indicated a strong relationship with water seasonality and with the phenological status of the leaves.

Introducción: La marcada estacionalidad en las especies de sabana puede estimular respuestas fisiológicas que maximicen el metabolismo fotosintético y la productividad. Sin embargo, esas respuestas fisiológicas están vinculadas al estado fenológico de toda la planta, incluidas las fenofases de las hojas. Objetivo: Estudiar cómo los rasgos fisiológicos influyen en el tiempo de la fenofase entre especies de sabana congenéricas y concurrentes. Métodos: Evaluamos la fenología y características fisiológicas de poblaciones de Byrsonima intermedia, B. coccolobifolia y B. verbascifolia. Las mediciones fisiológicas se realizaron al inicio de la estación seca y lluviosa, y de nuevo al final de la estación. Resultados: B. intermedia y B. coccolobifolia se clasificaron como brevicaducifolias y B. verbascifolia como perennifolias. El rendimiento cuántico máximo para B. intermedia y B. coccolobifolia fueron más bajos durante la época seca. Al inicio del período seco, se observaron niveles de pigmentos cloroplastídicos más altos, aunque los niveles de clorofila disminuyeron a medida que avanzaba la estación seca, las proporciones clorofila/carotenoides totales fueron más bajas y los contenidos de carotenoides más altos. Detectamos valores bajos de contenido de almidón al inicio de la época lluviosa, que coincide con la reanudación del crecimiento de la planta. A dos meses de esta época, las hojas estaban en su máxima madurez estructural y funcional, con altos valores de polisacáridos solubles en agua y tasas fotosintéticas, y almacenaban grandes cantidades de almidón. Conclusiones: Las estrategias fisiológicas y fenológicas de las hojas de las especies de Byrsonima estaban relacionadas con la resistencia a la sequía y la aclimatación a la estacionalidad de los recursos hídricos de la sabana. Las oscilaciones de los parámetros cuantificados durante el año indicaron una fuerte relación con la estacionalidad hídrica y con los estados fenológicos de las hojas.

Medidas abrangente e reduzida de comportamento de suporte do supervisor à família / Comprehensive and short-form measures of family supportive supervisor behaviors / Medidas integral y reducida de comportamiento de apoyo al supervisor familiar

O suporte do supervisor à família conceitua-se como comportamentos dos supervisores voltados a apoiar os papéis familiares dos funcionários. O presente estudo objetivou obter evidências de validade da Medida de Comportamento Suporte do Supervisor à Família, nas versões abrangente e reduzida, em amostras brasileiras. Participaram desta pesquisa 503 trabalhadores, de ambos os sexos. As análises fatoriais confirmatórias evidenciaram que a versão abrangente ficou composta por 14 itens, divididos em quatro fatores de primeira ordem (emocional, instrumental, modelo de papéis e gestão criativa) e um fator de segunda ordem. A versão reduzida unifatorial compôs-se por quatro itens. Ambas as versões apresentaram bons índices de consistência interna. Os instrumentos correlacionaram-se positivamente com o enriquecimento trabalho-família, suporte do supervisor e satisfação no trabalho, e negativamente com o conflito trabalho-família e intenção de rotatividade. Concluiu-se que os instrumentos apresentaram propriedades psicométricas que recomendam seu uso em investigações futuras.(AU)

The concept of a family-supportive supervisor refers to supervisors' behaviors aimed at supporting employees' family roles. This study aimed to obtain evidence of validity of the Measure of Family Supportive Supervisor Behaviors, both in its comprehensive and abbreviated versions, using Brazilian samples. A total of 503 workers of both sexes participated in this research. Confirmatory factor analyses showed that the comprehensive version consisted of 14 items, grouped into four first-order factors (emotional, instrumental, role model and creative management), all contributing to a second-order factor. The unifactorial reduced version consisted of four items. Both versions showed good internal consistency indices. The instruments exhibited positive correlations with work-family enrichment, supervisor support, and job satisfaction while demonstrating negative correlations with work-family conflict and turnover intention. It was concluded that the instruments presented psychometric properties that recommend their use in future research.(AU)

El apoyo del supervisor a la familia se define a las acciones de los supervisores dirigidos para respaldar los roles familiares de los empleados. El presente estudio tuvo como objetivo obtener evidencias de validez de la Medida del Comportamiento de Apoyo del Supervisor a la Familia, en las versiones extensa y breve, en muestras brasileñas. En esta investigación participaron 503 trabajadores de ambos sexos. Los análisis factoriales confirmatorios revelaron que la versión extensa quedó compuesta por 14 ítems, divididos en cuatro factores de primer orden (emocional, instrumental, modelo a seguir y gestión creativa) y un factor de segundo orden. La versión breve unifactorial constaba de cuatro ítems. Ambas versiones mostraron buenos índices de consistencia interna. Los instrumentos se correlacionaron positivamente con el enriquecimiento trabajo-familia, el apoyo del supervisor y la satisfacción laboral, y negativamente con el conflicto trabajo-familia y la intención de rotación. Se concluye que los instrumentos presentan propiedades psicométricas que respaldan su uso en futuras investigaciones.(AU)

Reabilitação vestibular: sua efetividade após a alta / Vestibular rehabilitation: Its effectiveness after discharge / Rehabilitación vestibular: su efectividad después del alta

ntrodução: A reabilitação vestibular é um tratamento para tontura crônica que utiliza exercícios personalizados visando restaurar o controle postural e reduzir a tontura. Pouco se discute na literatura sobre os benefícios em longo prazo desta intervenção. Objetivos: Descrever o perfil dos pacientes atendidos no Ambulatório de Reabilitação Vestibular e verificar a melhora do equilíbrio corporal após a alta fonoaudiológica. Métodos: Foram colhidas informações acerca dos dados sociodemográficos, diagnóstico, tratamento anterior e queixas existentes. As informações foram obtidas por contato telefônico e acesso aos prontuários. Os dados foram analisados estatisticamente utilizando nível de significância de 5%. Resultados: Participaram 26 indivíduos, sendo 21 (80,8%) do gênero feminino, com média de idade de 67 anos. A queixa principal foi tontura não rotatória. O resultado do teste vestibular mais comum foi hipofunção vestibular unilateral. Dentre os entrevistados, 25 (96,2%) relataram melhora dos sintomas com o tratamento, com redução da pontuação obtida no Dizziness Handicap Inventory. Sete participantes (26,9%) permaneceram assintomáticos desde o término da reabilitação. Aqueles que relataram ainda sentirem tontura, descreveram que esta possui menor intensidade que no período anterior à intervenção.Conclusão: Houve prevalência de indivíduos do gênero feminino, idosos, com ensino fundamental incompleto, sem diagnóstico otoneurológico estabelecido, com queixa de tontura não rotatória e resultado do teste vestibular de hipofunção vestibular unilateral.A reabilitação vestibular foi eficaz para redução dos sintomas apresentados. A exposição sucessiva aos exercícios após o tratamento auxilia na manutenção do equilíbrio. Contudo, a adesão à realização dos exercícios após a alta ainda é baixa. (AU)

Introduction: Vestibular rehabilitation is a treatment for chronic dizziness that uses personalized exercises aimed at restoring postural control and reducing dizziness. There is little discussion in the literature about the long-term benefits of this intervention. Objectives: To describe the profile of patients seen at the Vestibular Rehabilitation Outpatient Clinic and verify body balance improvement after speech-language-hearing therapy discharge. Methods: Sociodemographic data, diagnosis, previous treatment, and existing complaints were collected. The information was obtained via phone calls and medical records. The data were statistically analyzed using a significance level of 5%. Results: 26 individuals participated, of whom 21 (80.8%) were female, with a mean age of 67 years. The main complaint was non-rotational dizziness. The most common vestibular test result was unilateral vestibular hypofunction. Among the interviewees, 25 (96.2%) reported improved symptoms after the treatment, with reduced Dizziness Handicap Inventory scores. Seven participants (26.9%) remained asymptomatic since the end of rehabilitation. Those who still reported dizziness described it as less intense than before the intervention. Conclusion: There was a prevalence of females, older adults with incomplete middle school, no established otoneurological diagnosis, complaint of non-rotational dizziness, and vestibular test results of unilateral vestibular hypofunction. Vestibular rehabilitation effectively reduced the symptoms. Successive exposure to exercises after treatment helps maintain balance. However, adherence to exercise after discharge is still low. (AU)

Introducción: La rehabilitación vestibular es un tratamiento para la vértigo crónico que utiliza ejercicios personalizados con el objetivo de restaurar el control postural y reducir el vértigo. Hay poco debate en la literatura sobre los beneficios a largo plazo de esta intervención. Objetivos: Describir el perfil de los pacientes atendidos en el Ambulatorio de Rehabilitación Vestibular y verificar la mejora del equilibrio corporal después del alta fonoaudiológica. Métodos: Se recopilaron información sobre datos sociodemográficos, diagnóstico, tratamiento previo y quejas que aún persistían. La información se obtuvo por contacto telefónico y acceso a los registros médicos. Los datos se analizaron estadísticamente utilizando un nivel de significación del 5%. Resultados: Participaron 26 individuos, siendo 21 (80,8%) del género femenino, con una edad promedio de 67 años. La queja principal fue vértigo no rotatorio. El resultado del examen vestibular más común fue hipofunción vestibular unilateral. Entre los entrevistados, 25 (96,2%) informaron una mejora en los síntomas con el tratamiento, con una reducción en la puntuación obtenida en el Dizziness Handicap Inventory. Siete participantes (26,9%) permanecieron asintomáticos desde el final de la rehabilitación. Aquellos que informaron que todavía experimentaban vértigo describieron que este tenía una intensidad menor que en el período anterior a la intervención. Conclusión: Hubo una prevalencia de individuos del género femenino, ancianos, con educación primaria incompleta, sin un diagnóstico otoneurológico establecido, con queja de vértigo no rotatorio y un resultado del examen vestibular de hipofunción vestibular unilateral. La rehabilitación vestibular fue efectiva para reducir los síntomas presentados. La exposición sucesiva a los ejercicios después del tratamiento ayuda a mantener el equilibrio. Sin embargo, la adherencia a la realización de los ejercicios después del alta sigue siendo baja. (AU)

Balance decisional sobre el uso del condón asociado a la conducta sexual de riesgo en universitarios / Decisional balance of condom use associated with risky sexual behavior in university students

Resumen La adquisición de alguna Infección de Transmisión Sexual (ITS) y los embarazos no planificados son riesgos a los que se enfrentan los jóvenes ante la decisión de no usar condón al tener relaciones sexuales. La aproximación del balance decisional enfatiza qué costos y beneficios están asociados a la conducta sexual de riesgo. Las decisiones acerca del uso del condón son un precursor de la conducta y este proceso puede estar influido por los beneficios que se perciban sobre él. El objetivo de la presente investigación es identificar la relación de las ganancias y pérdidas del uso del condón con la conducta sexual de riesgo. Se evaluó la conducta sexual de riesgo y el uso del condón masculino en sus relaciones sexuales. Se midieron las ganancias y las pérdidas del condón con una escala de medición, en una muestra de 257 universitarios, con una edad entre 18 y 39 años (. = 22.34; DE = 3.6) de Querétaro, México. La evaluación del balance decisional indica que las ganancias son mayores que las pérdidas (costos) del uso consistente del condón en las relaciones sexuales. Se encontraron asociaciones entre las ganancias y las pérdidas con indicadores de la conducta sexual de riesgo. Se observa que los universitarios que no utilizan condón manifiestan mayores pérdidas por utilizarlo. En las ganancias, se aprecia un aumento en las puntuaciones cuando se usa condón. Lo encontrado provee apoyo para el desarrollo de intervenciones que promuevan las ganancias o beneficios para incrementar el uso consistente del condón.

Abstract The acquisition of a Sexually Transmitted Infection (STI) and unplanned pregnancies are risks that young people deal when deciding not to use a condom when having sexual intercourse. During the decision-making process, individuals value the benefits (gains) and losses (costs) associated with a behavior. Cost-benefit analysis has been investigated to examine the differential impact of gains and losses on risky behaviours. The decisional balance approach emphasizes that costs and benefits are associated with risky sexual behavior. Decisions about condom use are a precursor to behavior, and this process may be influenced by perceived benefits. In the present study, it is proposed that the balance between the benefit and the loss of condom use contributes to consistent condom use. These factors as determinants of behaviour must be considered under the cultural context in which they are carried out. The objective of this research is to identify the relationship of gains and losses from condom use with risky sexual behaviour. It was hypothesized that: 1) Young people will evaluate the benefits (gains) with higher scores compared to the losses (costs) in deciding to use a condom in sexual intercourse. 2) The gains will be greater in those college students who use a condom more frequently and the losses will not be the same among those who use a condom. To evaluate risky sexual behavior and the use of the male condom in their sexual relations were considered. Condom gains and losses were measured with a measurement scale in a sample of 257 university students, aged between 18 and 39 years (. = 22.34; SD = 3.6) from Querétaro, México. With reference to sexual behavior, it was found that 89.1 % have started their sexual activity. The average age of initiation of sexual life is 15.41 years. The frequency of sexual activity is once or twice each month. The mean of sexual partners is 4.2, with a median of 3. The 68.5 % reported using some contraceptive method and regarding the use of condoms, 27.8 % always use it and 5.7 % never use it. To evaluate the decisional balance, subtracting the gain and loss factors created a net difference score. The gain factor was subtracted from its counterpart of the loss factor to indicate the preference for having sex with a condom. The decisional balance assessment indicates that the gains are greater than the losses (costs) of consistent condom use in sexual intercourse. Associations were found between gains and losses with indicators of risky sexual behavior. It is observed that university students who do not use a condom show greater losses from using it. In gains, there is an increase in scores when using a condom. Additionally, it is observed that university students, who sometimes use a condom, show greater losses for using it, unlike those who always use it, which show low scores in the losses of using it. In gains factor, there is an increase in the scores when using a condom, that is, those who never or almost never use a condom have the lowest scores and as the scores increase, the frequency of using a condom in their sexual relations also increases. In conclusion, gains and losses from male condom use are associated with risky sexual behavior (age of sexual activity, number of partners and condom use) in the university context. The findings provide support for the development of interventions that promote gains or benefits to increase consistent condom use. It is important to consider in specific interventions those young people who decide to continue having sex without using a condom despite the costs and possible consequences of not using it.

A STUDY ON FINANCIAL MODELING USING 3 STATEMENT MODEL AND DCF VALUATION: AN INSIGHT FOR NEW ENTREPRENEURS

Financial statements reect the position of a company in respect of its wealth and protability in its short- term and long-term existence. The company's result in terms of protability is reected in the Prot and Loss statement for a nancial year. The Long term nancial health of the company in terms of its wealth creation will be reected in its Financial Position Statement, termed as a Balance sheet reecting its assets and liability position throughout its existence. Various nancial modelling techniques are used to predict the future of a company. The 3-statement model predicts the company's nancial strength for the future regarding the Balance sheet, prot and Loss Account and Cash ow statement. The study aims to predict the nancial statements for a future period of 5 years based on the company's past performance. The study was based on the nancial performance of Siemens AG for the past ve years, and it attempts to predict the future 5 years of the company under study.

Calidad de vida laboral y riesgo de disfunción sexual en enfermeras

Las experiencias y relaciones personales insatisfactorias en el ámbito laboral se asocian a resultados negativos en el aspecto sexual. La disfunción sexual femenina (DSF) es la alteración de cualquiera de las fases del orgasmo. La calidad de vida laboral (CVL) es la percepción del trabajador entre las exigencias del trabajo y las técnicas de afrontamiento. Objetivo: Determinar la asociación entre la calidad de vida laboral y el riesgo de disfunción sexual femenina en enfermeras de un hospital público del Callao, Perú. Método: Estudio observacional, transversal y analítico realizado en enfermeras del Hospital Nacional Daniel Alcides Carrión (HNDAC) de la provincia Constitucional del Callao, Perú. El riesgo de DSF fue medido con la prueba de Rosen. La CVL fue medida con el cuestionario de CVP-35. El análisis estadístico se realizó con el programa STATA versión 15. Se consideró significativo un valor de p<0,05 con un IC de 95%. Resultados: El estudio contó con la participación de 168 enfermeras que respondieron de forma completa. Las dimensiones de CVL asociadas a DSF fueron apoyo directo (p=0,01), motivación intrínseca (p=0,003), la pregunta sobre desconexión de trabajo (p=0,007), el ingreso mensual (p=0,003), el estado civil (p=0,001) y consumo de alcohol (p=0,014). No hubo asociación en el análisis multivariado. Conclusión: En el presente estudio no existió una asociación entre las dimensiones de la calidad de vida laboral y el riesgo de disfunción sexual femenina ajustado por confusores.

Unsatisfactory personal experiences and relationships in the work environment are associated with negative sexual outcomes. Female sexual dysfunction (FSD) is the disturbance of any of the phases of orgasm. Quality of work life (QWL) is the worker's perception between work demands and coping techniques. Objective: To determine the association between quality of work life and the risk of female sexual dysfunction in nurses of a public hospital in Callao, Peru. Methods: Observational, cross-sectional, analytical study conducted in nurses of the Hospital Nacional Daniel Alcides Carrión (HNDAC) of the Constitutional province of Callao, Peru. The risk of FSD was measured with the Rosen test. CVL was measured with the CVP35 questionnaire. Statistical analysis was performed with the STATA version 15 program. A value of p<0.05 with a 95% CI was considered significant. Results: The study involved 168 nurses who responded completely. The dimensions of CVL associated with DSF were direct support (p=0.01), intrinsic motivation (p=0.003), the question on work disconnection (p=0.007), monthly income (p=0.003), marital status (p=0.001) and alcohol consumption (p=0.014). There was no association in the multivariate analysis. Conclusion: In the present study there was no association between dimensions of quality of work life and confounder-adjusted risk of female sexual dysfunction.

Habilidades cognitivas em idosos com disfunção vestibular submetidos à reabilitação vestibular ­ estudo piloto / Cognitive skills in older people with vestibular dysfunction undergoing vestibular rehabilitation ­ A pilot study / Habilidades cognitivas en ancianos con disfunción vestibular en rehabilitación vestibular ­ estudio piloto

Introdução: estudos relatam melhora de habilidades cognitivas após a reabilitação vestibular, porém estes estudos utilizaram testes de rastreio cognitivo ou avaliaram habilidades cognitivas específicas, não contemplando uma avaliação cognitiva detalhada. Objetivo: avaliar as habilidades cognitivas, sintomas depressivos, funcionalidade e aspectos sociodemográficos de idosos com disfunção vestibular antes e após a reabilitação vestibular. Método: estudo longitudinal, quase experimental e analítico. A casuística foi composta por 11 idosos com idade entre 60 e 89 anos, ambos os sexos, todos com disfunção vestibular comprovada por meio dos exames VEMP e/ou v-HIT. Os participantes foram submetidos à avaliação cognitiva, da funcionalidade e dos sintomas depressivos antes e após oito sessões semanais de RV.Resultados: encontrou-se associação entre o MEEM com a escolaridade e com o DHI; o questionário de Pfeffer correlacionou-se com o DHI; a GDS-15 com a EVA e a EEB. Após a RV observou-se melhora do ganho do canal semicircular anterior direito, da EVA, do DHI e suas subescalas físico, funcional e emocional; GDS-15, Neupsilin total e suas subescalas percepção, memória e praxia. Conclusão: após a reabilitação vestibular houve aumento do ganho do reflexo vestíbulo-ocular, diminuição dos impactos causados pela tontura na qualidade de vida e do sofrimento psicológico, além da melhora da função cognitiva geral e das habilidades de percepção, memória e praxia.(AU)

Introduction: Studies have reported improved cognitive skills after vestibular rehabilitation (VR). However, they used cognitive screening tests or other ones that assess specific cognitive skills, not assessing cognition in detail. Objective: To assess cognitive skills, depressive symptoms, functioning, and sociodemographic aspects in older adults with vestibular dysfunction before and after vestibular rehabilitation. Method: Longitudinal, analytical, quasi-experimental study. The sample had 11 older adults aged 60 to 89 years, of both sexes, all of them with vestibular dysfunction verified with VEMP and/or vHIT examination. Participants were submitted to cognitive, functioning, and depressive symptoms assessment before and after eight weekly VR sessions. Results: MMSE was associated with educational attainment and DHI; the Pfeffer questionnaire was correlated with DHI; GDS-15 was correlated with VAS and BBS. After VR, there were improvements in gain in the right anterior semicircular canal, VAS, DHI and its physical, functional, and emotional subscales, GDS-15, and Neupsilin total score and its perception, memory, and praxis subscales. Conclusion: After VR, the vestibulo-ocular reflex gain increased, the impacts of dizziness on the quality of life and the psychological suffering decreased, and the overall cognitive function and perception, memory, and praxis skills improved. (AU)

Introducción: los estudios informan mejoría en las habilidades cognitivas después de la rehabilitación vestibular, pero estos estudios utilizaron pruebas de detección cognitiva o evaluaron habilidades cognitivas específicas, no contemplando una evaluación cognitiva detallada. Objetivo: evaluar habilidades cognitivas, síntomas depresivos, funcionalidad y aspectos sociodemográficos de ancianos con disfunción vestibular antes y después de la rehabilitación vestibular. Método: estudio longitudinal, cuasi-experimental y analítico. La casuística estuvo constituida por 11 ancianos con edades entre 60 y 89 años, de ambos sexos, todos con disfunción vestibular comprobada mediante exámenes VEMP y/o v-HIT. Los participantes se sometieron a una evaluación de síntomas cognitivos, funcionales y depresivos antes y después de ocho sesiones semanales de rehabilitación vestibular. Resultados: se encontró asociación entre el MMSE con la educación y con el DHI; el cuestionario de Pfeffer correlacionó con el DHI; el GDS-15 con el EVA y el EEB. Después de la RV, hubo una mejora en la ganancia del canal semicircular anterior derecho, la EVA, el DHI y sus subescalas física, funcional y emocional; GDS-15, Neupsilina total y sus subescalas percepción, memoria y praxis. Conclusión: después de la rehabilitación vestibular, hubo aumento en la ganancia del reflejo vestíbulo-ocular, disminución de los impactos causados por el mareo en la calidad de vida y el sufrimiento psicológico, mejoría en la función cognitiva general y en las habilidades de percepción, memoria y praxis. (AU)

Estrés relacionado con el trabajo y sintomatología mental en personas trabajadoras: Un análisis de género / Work-related stress and mental symptoms in working people: A gender analysis

El objetivo fue analizar el estrés laboral de mujeres y hombres con empleo y categorías laborales y demográficas similares, estudiando su asociación con la sintomatología mental. Estudio exploratoriodescriptivo y transversal con una muestra de conveniencia formada por 2643 personas con empleo y edades entre 18 y 64 años de las cuales el 54.3% son hombres y el 45.7% mujeres. Todas fueron evaluadas mediante cinco autoinformes y una hoja de recogida de datos sociodemográficos y de usos del tiempo. Resultados: El 67.5% de los hombres y el 66.5% de las mujeres tuvo algún tipo de estrés relacionado con el trabajo, no existiendo diferencias entre mujeres y hombres en ninguna de las medidas de estrés laboral, en insatisfacción con el rol laboral, ni en la asociación entre el estrés laboral y la sintomatología mental, asociación que era muy baja en mujeres y en hombres. Las mujeres tenían más estrés crónico no laboral y mayores contrariedades diarias que los hombres, además de mayor sintomatología mental de ansiedad, depresión grave, somática y de disfunción social. Asimismo, dedicaban más tiempo a las tareas domésticas y de cuidado y menos al ocio y a las actividades físico-deportivas que los hombres. Conclusiones: los resultados evidenciaron que el rol laboral no supone amenazas específicas para la salud mental de las mujeres con empleo, aunque sí parecen suponerlas su mayor dedicación a las tareas domésticas y de cuidado. Los resultados del presente trabajo son relevantes para el diseño de políticas y programas destinados a fomentar la salud de la ciudadanía y al logro de mayor igualdad de género(AU)

The objective was to analyze work stress in women and men with similar occupation and demographic categories, studying its association with mental symptomatology. Exploratory-descriptive and cross-sectional study with a convenience sample of 2643 employed persons aged 18 to 64 years, 54.3% of whom were men and 45.7% women. All were assessed by five self-reports and a sociodemographic and time-use data collection sheet. Results: 67.5% of the men and 66.5% of the women had some type of work-related stress. There were no differences between women and men in any of the measures of work stress, in dissatisfaction with the work role, or in the association between work stress and mental symptomatology, association that was very low in both women and men. Women had more chronic non-work stress and greater daily hassles than men, as well as greater symptomatology of anxiety, severe depression, somatic and social dysfunction. In addition, they spent more time on housework and caregiving and less time on leisure and physical-sports activities than men. Conclusions: the results show that the work role does not pose specific threats to the mental health of working women, although their greater dedication to domestic and caregiving tasks does seem to do so. The results of this study are relevant for the design of policies and programs aimed at promoting the health of citizens and achieving greater gender equality(AU)

Measurement properties of the Brazilian Portuguese version of the Lower-Extremity Motor Activity Log for chronic hemiparetic poststroke patients / Propriedades de medida da versão brasileira da Lower-Extremity Motor Activity Log para pacientes hemiparéticos crônicos pós-AVC

Abstract Background Stroke is among the three leading causes of disability around the world, and it results in immediate difficulty in mobility and gait. There is a lack of instruments to evaluate what daily life is like for these individuals using their lower limbs in real-life environments (outside of the clinical environment). Objective To perform the translation and cultural adaptation to Brazilian Portuguese of the Lower-Extremity Motor Activity Log (LE-MAL) and test its measurement properties in chronic poststroke individuals. Methods The LE-MAL was translated into Brazilian Portuguese and adapted to the Brazilian culture. The comprehension and relevance of the final version were analyzed by a committee of specialists. The reliability, validity, and responsiveness of the LE-MAL/Brazil to detect changes after lower extremity constraint-induced movement therapy (LE-CIMT) and an intensive conventional therapy were tested. Results The LE-MAL/Brazil showed excellent inter- and intrarater reliability, with an intraclass correlation coefficient and Cronbach alpha > 0.70, as well as standard error of measurement and smallest detectable change < 10% of the total instrument score when applied by the same evaluators. Conclusion The responsiveness of the LE-MAL/Brazil to detect changes showed better results after LE-CIMT than after the intensive conventional therapy, with most of the correlations > 0.50.

Resumo Antecedentes O acidente vascular cerebral (AVC) é a terceira causa de deficiência ao redor do mundo, e resulta em dificuldades imediatas relativas à marcha e à mobilidade. Nota-se a ausência de instrumentos que avaliem o dia a dia desses indivíduos quanto ao uso dos membros inferiores em ambientes reais (fora do ambiente clínico). Objetivo Traduzir e fazer a adaptação cultural para o português do Brasil da Lower-Extremity Motor Activity Log (LE-MAL), e testar suas propriedades psicométricas em indivíduos hemiparéticos crônicos pós-AVC. Métodos A LE-MAL foi traduzida para o português do Brasil e adaptada para a cultura brasileira. A compreensão e a confiabilidade da versão final foram testadas por um comitê de especialistas. A confiabilidade, a validade e a responsividade em detectar mudanças após a terapia de contensão induzida para membros inferiores (TCI-MMII) e uma terapia convencional também foram testadas. Resultados A LE-MAL/Brazil mostrou excelente confiabilidade intra e interavaliador, com coeficiente de correlação intraclasse e alfa de Cronbach > 0,70, bem como erro padrão da medida e mínima mudança detectável < 10% da pontuação total quando aplicada pelo mesmo avaliador. Conclusão A responsividade da LE-MAL/Brazil em detectar mudanças após a TCI-MMII apresentou resultados melhores do que após a terapia convencional, com a maioria das correlações > 0,50.

Children with malignancies and septic shock - an attempt to understand the risk factors

Abstract Objectives: To explain the high mortality of septic shock in children with cancer. Methods: A retrospective cohort from 2016 to 2020, of children aged 0 to 18 years, and septic shock. Results: The authors included 139 patients. Acute lymphocytic leukemia was the most frequent diagnosis (16.5%), and Gram-negative bacteria were the most frequent blood culture isolates (22.3%). There were 57 deaths in ICU (41%), 10 in the first 24 hours of shock (early death). A LASSO model with variables: neutropenia (coefficient 0.215), respiratory (0.81), hematological (1.41), and neurological (0.72) dysfunctions, age (-0.002) and solid tumor recurrence (0.34) generated AUC = 0.79 for the early death outcome. Survivors had significant differences in the PRISM-IV score (mean ± SD 10.9 ± 6.2 in the survivors, 14.1 ± 6.5 in the deceased, p = 0.004), and in the mean number of organ dysfunctions (3.2 ± 1.1 in the survivors, 3.8 ± 6.5 in the deceased, p < 0.001). A positive fluid balance in the first 24 hours of sepsis between 2% and 6% of body weight showed a reduction effect on the probability of death in ICU (hazard ratio 0.47, 95% CI 0.24-0.92, p = 0.027). The recurrence of any cancer was a predictor of in-hospital death, regardless of severity. Conclusions: Recurrence of any cancer is an important risk of sepsis-related death. A positive fluid balance between 20 and 60 mL/kg or 2% and 6% of body weight in the first 24 hours after the onset of sepsis is related to lower mortality.

miR-145-5p and miR-203a-5p overcome imatinib resistance in myelogenous leukemic cells through metabolic reprogramming-Supplemenntary data

Imatinib is the most effective therapy for chronic myeloid leukemia (CML), but many patients eventually develop resistance to it after an initial satisfactory response. This study investigated the potential of three miRNAs (miR-106b-5p, miR-145-5p, miR-203a-5p) in overcoming imatinib resistance in leukemic cells. The imatinib-resistant K562 (IR-K562) cells were developed and transfected with one of the three miRNAs to evaluate their potency in overcoming imatinib resistance. The changes in the metabolic profile were studied using flux balance analysis (FBA) and the data was validated using qRT-PCR.Among the three miRNAs, the ectopic expression of either miR-145-5p or miR-203a-5p was able to sensitize the IR-K562 cells to imatinib. The concentration of key oncometabolites; glucose, lactate, and glutamine, in the culture media of the miR-transfected IR-K562 cells, reverted to the same levels as seen in imatinib-sensitive K562 cells. In addition, the FBA analysis revealed that the metabolism of lipid, fatty acids, and electron transport chain were significantly altered in resistant cells. The FBA data was also validated at the molecular level. Interestingly, the imatinib treatment coupled with the transfection of miR-145-5p or miR-203a-5p cells could reverse the metabolic flux of IR-K562 to the levels seen in imatinib-sensitive K562 cells. This study highlights the key metabolic changes that occur during development of imatinib resistance. It also identifies the specific miRNAs which can be targeted to overcome imatinib resistance in CML.

miR-145-5p and miR-203a-5p overcome imatinib resistance in myelogenous leukemic cells through metabolic reprogramming

Imatinib is the most effective therapy for chronic myeloid leukemia (CML), but many patients eventually develop resistance to it after an initial satisfactory response. This study investigated the potential of three miRNAs (miR-106b-5p, miR-145-5p, miR-203a-5p) in overcoming imatinib resistance in leukemic cells. The imatinib-resistant K562 (IR-K562) cells were developed and transfected with one of the three miRNAs to evaluate their potency in overcoming imatinib resistance. The changes in the metabolic profile were studied using flux balance analysis (FBA) and the data was validated using qRT-PCR.Among the three miRNAs, the ectopic expression of either miR-145-5p or miR-203a-5p was able to sensitize the IR-K562 cells to imatinib. The concentration of key oncometabolites; glucose, lactate, and glutamine, in the culture media of the miR-transfected IR-K562 cells, reverted to the same levels as seen in imatinib-sensitive K562 cells. In addition, the FBA analysis revealed that the metabolism of lipid, fatty acids, and electron transport chain were significantly altered in resistant cells. The FBA data was also validated at the molecular level. Interestingly, the imatinib treatment coupled with the transfection of miR-145-5p or miR-203a-5p cells could reverse the metabolic flux of IR-K562 to the levels seen in imatinib-sensitive K562 cells. This study highlights the key metabolic changes that occur during development of imatinib resistance. It also identifies the specific miRNAs which can be targeted to overcome imatinib resistance in CML.

Capacidade funcional e déficits do controle postural em mulheres com síndrome da dor no grande trocânter / Functional capacity and deficits in postural control in women with greater trochanteric pain syndrome

Objetivo: Estabelecer a capacidade física e alterações do controle postural (COP) durante o apoio unipodal estático e dinâmico em mulheres com Síndrome de Dor no Grande Trocânter (SDGT). Métodos: Foram avaliadas 36 mulheres, sedentárias, maiores de 45 anos. Destas, 18 tinham diagnóstico de SDGT (Grupo Dor - GD) e 18 sem queixas álgicas (Grupo Controle - GC). Todas responderam ao questionário Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G) para análise da capacidade física relacionada a dor lateral do quadril, e foram submetidas à avaliação do controle postural na plataforma de força, em apoio unipodal estático e dinâmico (mini agachamentos). Os dados foram comparados e correlacionados, com significância estatística estabelecida 5%. Resultados: As participantes do GD apresentaram alto índice de dor (7), por 10 meses e baixa capacidade funcional (54,44 pontos no VISA-G). Na análise do controle postural estático, GD mostrou piores resultados para a área de oscilação do COP (p= 0,04) e maior amplitude de oscilação médio-lateral (p= 0,03). Na avaliação dinâmica, os resultados da amplitude médio-lateral (p= 0,02) e velocidade antero posterior (p= 0,04) foram maiores no GD, mas o COP foi pior no GC (p= 0,01). Conclusão: Mulheres com SDGT tem baixa capacidade funcional e pior controle postural estático e dinâmico. Estas variáveis devem ser avaliadas para estabelecer novas estratégias de prevenção e reabilitação em mulheres com SDGT

Objective: To establish physical capacity and changes in postural control (PCO) during static and dynamic single-legged support in women with Greater Trochanter Pain Syndrome (GTPS). Methods: A total of 36 sedentary women over 45 years of age were evaluated. Of these, 18 had a diagnosis of GTPS (Pain Group - DG), and 18 had no pain complaints (Control Group - CG). All participants answered the Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G) questionnaire to analyze their physical capacity regarding lateral hip pain. Therefore, were submitted to the evaluation of postural control on the force platform in static and dynamic single-legged support (mini squats). The data were compared and correlated, with statistical significance established at 5%. Results: The participants in the DG presented a high pain index (7) for 10 months and low functional capacity (54.44 points in the VISA-G). In the analysis of static postural control, DG showed worse results for the Center of Pressure (COP) oscillation area (p= 0.04) and greater amplitude of mediolateral oscillation (p= 0.03). In the dynamic evaluation, the results of the mediolateral amplitude (p= 0.02) and anteroposterior velocity (p= 0.04) were higher in the DG, but the COP was worse in the CG (p= 0.01). Conclusion: Women with GTPS have lower functional capacity and worse static and dynamic postural control. These variables should be evaluated to establish new prevention and rehabilitation strategies for women with GTPS