Avaliação da qualidade do sono em profissionais de saúde da emergência / Evaluación de la calidad del sueño en profesionales de la salud de emergencia / Sleep quality assessment in emergency health professionals

Resumo Objetivo Avaliar a qualidade do sono de profissionais dos serviços de emergência e sua associação com o nível de fadiga e qualidade de vida. Métodos Estudo descritivo, transversal e correlacional, realizado nas unidades do Serviço de Atendimento Móvel de Urgência (SAMU) e na Unidade de Pronto Atendimento (UPA), no ano de 2021, com 108 participantes. Para avaliação da qualidade do sono, foi utilizado o Índice de Qualidade do Sono de Pittsburgh versão Brasileira (PSQI-BR); para avaliação da Fadiga, foi utilizada a Escala de Fadiga de Chalder, em conjunto com a Escala de Necessidade de Descanso (ENEDE); e para avaliação da qualidade de vida, foi utilizado o World Health Organization Quality of Life Brief Version (WHOQOL-bref), sendo que os instrumentos utilizados foram adaptados para a língua portuguesa em estudos anteriores. Foram aplicados testes de associação para a análise estatística, tendo sido utilizados o Teste Qui-Quadrado de Pearson, o Teste U Mann-Whitney ou Kruskal Wallis e a correlação de Spearman. Valores de p <0,05 foram considerados como significativos. Resultados Foi identificado que 72,2% dos participantes apresentaram má qualidade do sono e 75,9% estavam fadigados. Foi observada associação significativa entre a qualidade do sono e a fadiga, a necessidade de descanso e a qualidade de vida. Conclusão Foi identificado que os profissionais de saúde que trabalham em serviço de urgência e emergência apresentam má qualidade do sono e de vida e níveis elevados de fadiga e necessidade de descanso, o que pode impactar diretamente suas atividades pessoais e profissionais.

Resumen Objetivo Evaluar la calidad del sueño de profesionales de los servicios de emergencia y su relación con el nivel de fatiga y calidad de vida. Métodos Estudio descriptivo, transversal y correlacional, realizado en las unidades del Servicio de Atención Móbil de Urgencia (SAMU) y en la Unidad de Pronta Atención (UPA), en el año 2021, con 108 participantes. Para evaluar la calidad del sueño, se utilizó el Índice de Calidad del Sueño de Pittsburgh, versión brasileña (PSQI-BR). Para evaluar la fatiga, se utilizó la Escala de Fatiga de Chalder, junto con la Escala de Necesidad de Descanso (ENEDE). Para evaluar la calidad de vida, se utilizó el World Health Organization Quality of Life Brief Version (WHOQOL-bref). Los instrumentos utilizados fueron adaptados al idioma portugués en estudios anteriores. Se aplicaron pruebas de asociación para el análisis estadístico, para lo cual se utilizó la Prueba χ2 de Pearson, la Prueba U de Mann-Whitney o la prueba de Kruskal-Wallis y la correlación de Spearman. Se consideraron valores de p<0,05 como significativos. Resultados Se identificó que el 72,2 % de los participantes presentó una mala calidad de sueño y el 75,9 % tenía fatiga. Se observó una asociación significativa entre la calidad del sueño y la fatiga, la necesidad de descanso y la calidad de vida. Conclusión Se identificó que los profesionales de la salud que trabajan en servicios de urgencia y emergencia presentaron mala calidad de sueño y de vida y niveles elevados de fatiga y necesidad de descanso, lo que puede impactar directamente en sus actividades personales y profesionales.

Abstract Objective To assess emergency service professionals' sleep quality and its association with the level of fatigue and quality of life. Methods A descriptive, cross-sectional and correlational study, carried out in the units of the Mobile Emergency Care Service (SAMU) and in the Emergency Care Unit (ECU), in 2021, with 108 participants. To assess sleep quality, the Pittsburgh Sleep Quality Index, Brazilian version (PSQI-BR), was used; to assess fatigue, the Chalder Fatigue Scale was used, together with the Need for Recovery Scale (NFR); and to assess quality of life, the World Health Organization Quality of Life Brief Version (WHOQOL-bref) was used, and the instruments used were adapted to Portuguese in previous studies. Association tests were applied for statistical analysis, using Pearson's chi-square test, Mann-Whitney U test or Kruskal Wallis and Spearman's correlation. P-values <0.05 were considered significant. Results It was identified that 72.2% of participants had poor sleep quality and 75.9% were fatigued. A significant association was observed between sleep quality and fatigue, the need for recovery and quality of life. Conclusion It was identified that health professionals working in emergency services have poor sleep quality and life, and high levels of fatigue and need for recovery, which can directly impact their personal and professional activities.

The effect of constraint-induced movement therapy assessed by accelerometry: the impact on daytime activity and sleep in children with cerebral palsy / O efeito da terapia por contensão induzida avaliada por meio de acelerômetros: o impacto na atividade diurna e no sono em crianças com paralisia cerebral

Abstract Introduction Spastic hemiparetic cerebral palsy (CP) is the most prevalent type of CP. Children with spastic hemiparesis experience difficulties when using their affected upper extremities, and one effective treatment is the Constraint-Induced Movement Therapy (CIMT). The study of rest-activity patterns provides information on children's daily activities with spastic hemiparetic CP during the day and sleep. Objective To investigate the effect of CIMT on the rest-activity patterns in children with spastic hemiparetic CP vs in a healthy group. Methods Nonrandomized controlled trial was conducted at the Neuropediatric Center of the Hospital de Clínicas Complex, in Curitiba, Brazil. Children with spastic hemi-paretic CP between 5 and 16 years old participated in the study group and receive the CIMT. The healthy group was composed of children between 5 and 15 years old. Both groups used accelerometer to record rest-activity patterns, that may be studied through nonparametric variables of accelerometer: M10 (an individual's most active 10h); L5 (an individual's least active 5h); and RA (relative amplitude of the circadian rest-activity patterns). Results Forty-five children were recruited, and 38 were included in the analyses (19 allocated to each group). In the study group, there was a significant increase in M10 and L5 (p < 0.001) after CIMT. The values of M10 and L5 were significantly higher (p < 0.001) in the healthy group compared to the study group after CIMT. Conclusion Our results showed that children with spastic hemiparetic CP became more active and participant in their daily life during the day as well as more efficient sleeping.

Resumo Introdução A paralisia cerebral (PC) hemiparética espástica é o tipo de PC mais prevalente. Crianças com hemiparesia es-pástica apresentam dificuldades ao usar as extremidades superiores afetadas e um tratamento eficaz é a Terapia por Contensão Induzida (TCI). O estudo dos padrões de atividade-repouso fornece informações sobre as atividades diárias de crianças com PC hemiparética espástica durante o dia e o sono. Objetivo Investigar o efeito da TCI nos padrões de repouso-atividade em crianças com PC hemiparética espástica versus um grupo saudável. Métodos Realizou-se um ensaio controlado não randomizado no Centro de Neuropediatria do Complexo do Hospital de Clínicas, Curitiba, Brasil. Crianças com PC hemi-parética espástica entre 5 e 16 anos participaram do grupo de estudo e receberam a TCI. O grupo saudável foi composto por crianças entre 5 e 15 anos. Ambos os grupos utilizaram um acelerômetro para registrar padrões de atividade-repouso, os quais podem ser estudados através de variáveis não paramé-tricas do acelerômetro: M10 (10h mais ativas de um indivíduo); L5 (5h menos ativas de um indivíduo); e AR (amplitude rela-tiva dos padrões de atividade-repouso). Resultados Foram recrutadas 45 crianças e 38 foram incluídas nas análises (19 alocadas em cada grupo). No grupo de estudo, houve aumento significativo de M10 e L5 (p < 0,001) após TCI. Os valores de M10 e L5 foram significativamente maiores (p < 0,001) no grupo saudável em comparação ao grupo de estudo após TCI. Conclusão Os resultados do presente estudo mostraram que crianças com PC hemiparética espástica tornaram-se mais ativas e participantes de sua vida diária durante o dia, bem como dormiram mais eficientemente.

Recovery between sets in strength training: systematic review and meta-analysis / Recuperación entre series en el entrenamiento de fuerza: revisión sistemática y meta-análisis / Recuperação entre séries no treino de força: revisão sistemática e meta-analise

ABSTRACT Introduction: The recovery interval (RI) between sets and exercises has received attention from strength training (ST) researchers, to understand the relationship of rest on performance maintenance, especially the total load in a training session. It is known that each individual responds in a specific way to the training stimulus. So, what would be the effect of the different recovery interval strategies on the strength performance? Objective: Compare the different recovery intervals in strength training volume, considering the number of repetitions in healthy adults. Methods: We conducted a systematic review and meta-analysis based on methodological criteria, comparing fixed and self-selected RI on training volume, identified by the number of repetitions performed in a weight training program. Three electronic databases (Pubmed, VHL Virtual Health Library, Ebsco Sportdiscus) were analyzed, combining the expressions "resistance training", "resistance exercise", "strength exercise", "recovery interval", "rest interval", "interval auto suggested", "auto range selected" with "AND" and "OR" combination. Results: Pooled data from five studies showed a large significant effect in favor of the experimental group (>2 minutes) (MD: 1.24; 95%-CI [0.78; 1.71]; z: 5.25, Q:1.08; p < 0.01), since in the studies, recovery interval allowed a greater training volume. Conclusion: Longer RI seems be better, for maintaining total training volume, although there is no consensus for different training objectives against the self-selected RI. Thus, we imagine that this strategy may be important in the organizing a bodybuilding exercise program. Level of Evidence I; Systematic Review and Meta Analysis.

RESUMEN Introducción: El intervalo de recuperación (IR) entre series y ejercicios ha recibido atención por parte de los investigadores del entrenamiento de fuerza (EF), contribuyendo a la comprensión de esta variable en relación con el mantenimiento del rendimiento, especialmente la carga durante el entrenamiento con pesas. Se sabe que cada individuo responde de manera específica al estímulo del entrenamiento, entonces, ¿cuál es el efecto de las diferentes estrategias de intervalos de recuperación sobre el rendimiento de fuerza? Objetivo: Comparar diferentes intervalos de recuperación en entrenamiento de fuerza en volumen de entrenamiento, identificados por el número de repeticiones en musculación en adultos sanos. Métodos: Realizamos una revisión sistemática y un metanálisis basado en criterios metodológicos, comparando IR fijo y autoseleccionado en función del volumen de entrenamiento, identificado por el número de repeticiones realizadas en un programa de entrenamiento con pesas. Se analizaron los registros de tres bases de datos electrónicas (Pubmed, Biblioteca Virtual en Salud de la BVS, Ebsco Sportdiscus), combinando las palabras "entrenamiento de resistencia", "ejercicio de resistencia", "ejercicio de fuerza", "intervalo de recuperación", "intervalo de descanso", "intervalo auto sugerido", "rango automático seleccionado" con la combinación "AND" y "OR". Resultados: Los datos agrupados de cinco estudios mostraron un gran efecto significativo a favor del grupo experimental (> 2 minutos) (DM: 1,24; IC del 95 % [0,78; 1,71]; z: 5,25, Q: 1,08; p < 0,01), ya que, en los estudios en cuestión, este intervalo de recuperación permitió un mayor volumen de entrenamiento. Conclusión: Los intervalos más largos parecen ser mejores, en el volumen total de entrenamiento, aunque no hay consenso para diferentes objetivos de entrenamiento frente al RI autoseleccionado. Por lo tanto, imaginamos que esta estrategia puede ser importante en la organización del programa de ejercicios de musculación. Nivel de Evidencia I; Revisión Sistemática y Meta Análisis.

RESUMO Introdução: O intervalo de recuperação (IR) entre séries e exercícios, tem recebido atenção dos pesquisadores de treinamento de força (TF), contribuindo no entendimento dessa variável em relação a manutenção do rendimento, em especial da carga durante o treinamento de musculação. Sabe-se que cada indivíduo responde de modo específico ao estimulo do treinamento, desta forma, qual o efeito das diferentes estratégias do intervalo recuperação no desempenho da força? Objetivo: Comparar diferentes intervalos de recuperação no treinamento de força no volume de treino, identificado pelo número de repetições na musculação em adultos saudáveis. Métodos: Realizamos, pelos critérios metodológicos, revisão sistemática e meta-análise, comparando o IR fixo e auto selecionado em função do volume de treino, identificado pelo número de repetições realizados em programa de musculação. Foram analisados os registros de três bases de dados eletrônicas (Pubmed, Biblioteca Virtual da Saúde BVS, Ebsco Sportdiscus), combinando as expressões "treinamento de resistência", "exercício resistido", "exercício de força", "intervalo de recuperação", "intervalo de descanso", "intervalo auto sugerido", "intervalo auto selecionado" com combinação "AND" e "OR". Resultados: Os dados reunidos de cinco estudos mostraram um grande efeito significante a favor do grupo experimental (>2 minutos) (MD: 1.24; 95%-IC [0.78; 1.71]; z: 5.25, Q:1.08; p < 0.01), uma vez que nos estudos em questão, esse intervalo de recuperação possibilitou maior volume de treino. Conclusão: Intervalos mais longos parecem ser melhores no volume total do treinamento, embora não haja consenso para diferentes objetivos do treinamento frente ao IR auto selecionado. Dessa forma, imaginamos que essa estratégia possa ser importante na organização do programa de exercício de musculação. Nível de Evidencia I; Revisão Sistemática e Meta Análise.

A Structured Pre- and Post-Operative Voice Therapy Program for Benign Vocal Fold Lesions

Benign vocal fold lesions (BVFLs) are acquired structural anomalies of the vocal folds, and these are primarily a result of vocal abuse or phonotrauma. Phonotraumatic lesions are not generally regarded as recurrent, provided that appropriate behavioral changes are made after resolution or surgical removal. Voice therapy plays a crucial role in this aspect. The aim of this article is to propose a structured pre- and post-operative voice therapy program for patients undergoing surgical intervention for BVFLs. Voice therapy post-surgery has been proven to reduce the rate of recurrence in BVFLs. Having a standard treatment protocol is a useful tool for the therapist, particularly one without extensive voice training.

Las lesiones benignas de los pliegues vocales (LBPV) son anomalías estructurales adquiridas de los pliegues vocales, y son principalmente el resultado de un abuso vocal o fonotrauma. Las lesiones fonotraumáticas generalmente no se consideran recurrentes, siempre que se realicen cambios apropiados en el comportamiento después de la resolución o la excisión quirúrgica. La terapia vocal juega un papel crucial en este aspecto. El objetivo de este artículo es proponer un programa estructurado de terapia de voz pre y postoperatorio para pacientes que son expuestos a una intervención quirúrgica para LBPV. Se ha demostrado que la terapia de voz después de la cirugía reduce la tasa de recurrencia en LBPV. Tener un protocolo de tratamiento estándar es una herramienta útil para el terapeuta, particularmente uno sin un entrenamiento extenso en patología de la voz.

Actividades de descanso y dificultades para su realización en estudiantes de medicina de la Universidad del Cauca, Colombia, durante la pandemia por SARS-COV-2

Introducción: un descanso adecuado determina el estado de ánimo y desempeño durante las actividades diarias, así como la salud mental y éxito académico de un estudiante de medicina, quien posee alta carga académica. Por esto, conocer qué actividades practican, así como las dificultades en las mismas orienta un abordaje que permita su adecuada ejecución. Objetivo: describir las actividades de descanso y las dificultades para su realización durante la jornada académica de los estudiantes de medicina de la universidad del Cauca en tiempos de pandemia por SARS-CoV-2. Materiales y métodos: estudio descriptivo, transversal realizado en 230 estudiantes de medicina de la Universidad del Cauca, seleccionados con un muestreo probabilístico bietápico a quienes se les aplicó una encuesta virtual de 108 preguntas que abordó aspectos sociodemográficos y cada uno de los componentes del descanso y estilos de vida. Resultados: el 99.1% de estudiantes practican actividades de ocio. El 29.5% de ellos realizan sesiones de relajación. La actividad física estuvo presente en un 63.3%. La mayor parte de las actividades aumentaron durante el confinamiento. Las principales dificultades para su ejecución fueron la falta de tiempo y espacios físicos adecuados. Conclusiones: las actividades de ocio fueron las más encontradas en esta población, este resultado contribuye a la búsqueda de planes de mejoramiento asociados al bienestar estudiantil. Hace falta evaluar el estrés y más aspectos sobre salud mental, nuevos estudios podrían enfocarse en este aspecto de suma importancia en estudiantes de medicina.

Summary Introduction: Adequate rest determines the mood and performance during daily activities, as well as the mental health and academic success of a medical student with a high academic load. Therefore, knowing what activities they engage in, as well as the difficulties to execute them, provides an approach that permits their accomplishment properly. Objective: To describe the rest activities and the difficul- ties in performing them during the academic day of medical students at the Universidad del Cauca in times of the SARS-CoV-2 pandemic. Materials and methods: A descriptive, cross-sectional study was conducted among 230 medical students of the Universidad del Cauca, selected with a two-stage probabilistic sampling, who were administered an online survey of 108 questions that addressed socio-demo- graphic aspects and each of the components of rest and lifestyles. Results: 99.1% of students undertake leisure activities. 29.5% of them do relaxation sessions. Physical exercise was present in 63.3%. Most of the activities increased during confinement. The main difficulties for their execution were the lack of time and adequate physical spaces. Conclusions: Leisure activities were the most frequently encountered in this population. Knowing the difficulties perceived by the students contributes to the exploration for improvement plans associated with student wellbeing. There is a need to assess stress and more aspects of mental health, new studies could focus on this aspect of utmost importance in medical students.

Calidad de sueño en Uruguay al inicio de la pandemia / Sleep quality in Uruguay at the beginning of the pandemic / Qualidade do sono no Uruguai no início da pandemia

El año 2020 será recordado por el comienzo de la pandemia de COVID-19, la que ha generado trágicas consecuencias para la salud personal y social. Además de los fallecimientos, contagios y el temor a estos, se redujo considerablemente la interacción social debido al confinamiento. Trabajos realizados en distintos países demostraron que la pandemia ha generado importantes trastornos del sueño. Con el objetivo de explorar si la pandemia afectó el sueño de los uruguayos, del 16 al 20 mayo del 2020 se realizó una encuesta anónima vía Web, a mayores de 18 años residentes en Uruguay (n =1137). Esta consistió en el Índice de Calidad de Sueño de Pittsburgh (ICSP), que es el cuestionario auto administrado más utilizado para este fin. El ICSP explora 7 dimensiones de sueño (calidad subjetiva, latencia, duración, eficiencia, perturbaciones, medicación y disfunción diurna), con un rango de puntaje de 0 a 21 (mayor puntuación, menor calidad de sueño), donde un ICSP mayor a 5 se considera una mala calidad de sueño. Los resultados mostraron que el ICSP promedio fue de 7,4 ± 4,0, presentando 63% de los encuestados un ICSP > 5. El ICSP fue mayor en mujeres (8,2 ± 4,0) que en hombres (6,4 ± 3,8; P < 0.001). El ICSP junto con otros parámetros relevados, sugieren que los residentes en Uruguay presentaron una mala calidad de sueño al comienzo de la pandemia.

The year 2020 will be remembered for the beginning of the COVID-19 pandemic, which has generated tragic consequences for personal and social health. In addition to deaths, infections and the fear of these, social interaction was considerably reduced due to confinement. Studies carried out in different countries showed that the pandemic has generated significant sleep disorders. With the aim of exploring whether the pandemic affected the sleep of Uruguayans, from May 16 to 20, 2020, an anonymous survey was carried out via the Web, to residents over 18 years of age in Uruguay (n = 1137). This consisted of the Pittsburgh Sleep Quality Index (PSQI), which is the most widely used self-administered questionnaire for this purpose. The PSQI explores 7 dimensions of sleep (subjective quality, latency, duration, efficiency, disturbances, medication, and daytime dysfunction), with a score range from 0 to 21 (higher score, lower sleep quality), where an ICSP greater than 5 it is considered a poor quality of sleep. The results showed that the average ICSP was 7.4 ± 4.0, with 63% of the respondents presenting an ICSP > 5. The ICSP was higher in women (8.2 ± 4.0) than in men (6.4 ± 3.8, P < 0.001). The ICSP, together with other parameters collected, suggest that residents of Uruguay had poor sleep quality at the beginning of the pandemic.

O ano de 2020 será lembrado pelo início da pandemia do COVID-19, que gerou consequências trágicas para a saúde pessoal e social. Além das mortes, das infecções e do medo destas, o convívio social foi consideravelmente reduzido devido ao confinamento. Trabalhos realizados em diferentes países mostraram que a pandemia gerou distúrbios significativos do sono. Com o objetivo de explorar se a pandemia afetou o sono dos uruguaios, de 16 a 20 de maio de 2020, foi realizada uma pesquisa anônima via Web, para maiores de 18 anos residentes no Uruguai (n = 1137). Este consistiu no Índice de Qualidade do Sono de Pittsburgh (ICSP), que é o questionário autoaplicável mais utilizado para esse fim. O ICSP explora 7 dimensões do sono (qualidade subjetiva, latência, duração, eficiência, distúrbios, medicação e disfunção diurna), com uma escala de pontuação de 0 a 21 (maior pontuação, menor qualidade do sono), onde um ICSP maior que 5 é considerado uma má qualidade de sono. Os resultados mostraram que o ICSP médio foi de 7,4 ± 4,0, com 63% dos entrevistados apresentando ICSP > 5. O ICSP foi maior nas mulheres (8,2 ± 4,0) do que nos homens (6,4 ± 3,8, P < 0,001). O ICSP, juntamente com outros parâmetros coletados, sugere que os residentes do Uruguai tinham má qualidade de sono no início da pandemia.

Comparison of three different measurement methods to determine resting energy expenditure in patients with decompensated hepatitis B cirrhosis / 中华肝脏病杂志

Objective: To compare the differences to determine resting energy expenditure (REE) measured with indirect calorimetry and REE predicted by formula method and body composition analyzer in patients with decompensated hepatitis B cirrhosis, so as to provide theoretical guidance for the implementation of precision nutrition intervention. Methods: Patients with decompensated hepatitis B cirrhosis who were admitted to Henan Provincial People's Hospital from April 2020 to December 2020 were collected. REE was determined by the body composition analyzer and the H-B formula method. Results: were analyzed and compared to REE measured by the metabolic cart. Results A total of 57 cases with liver cirrhosis were included in this study. Among them, 42 were male, aged (47.93 ± 8.62) years, and 15 were female aged (57.20 ± 11.34) years. REE measured value in males was (1 808.14 ± 201.47) kcal/d, compared with the results calculated by the H-B formula method and the measured result of body composition, and the difference was statistically significant (P = 0.002 and 0.003, respectively). REE measured value in females was (1 496.60 ± 131.28) kcal/d, compared with the results calculated by the H-B formula method and the measured result of body composition, and the difference was statistically significant (P = 0.016 and 0.004, respectively). REE measured with the metabolic cart had correlation with age and area of visceral fat in men (P = 0.021) and women (P = 0.037). Conclusion: Metabolic cart use will be more accurate to obtain resting energy expenditure in patients with decompensated hepatitis B cirrhosis. Body composition analyzer and formula method may underestimate REE predictions. Simultaneously, it is suggested that the effect of age on REE in H-B formula should be fully considered for male patients, while the area of visceral fat may have a certain impact on the interpretation of REE in female patients.

Effects of 21-hydroxylase deficiency on male fertility / 中华内分泌代谢杂志

Congenital adrenal hyperplasia(CAH) is a group of autosomal recessive disorders caused by deficiency of specific enzymes in the adrenocortical hormone synthesis pathway, resulting in impaired corticosteroid synthesis. 21-hydroxylase deficiency is the most common type of CAH, and the disorder can lead to impaired fertility in patients. Most current studies have focused on fertility problems in female CAH patients. The most common causes of impaired fertility in men with 21-OHD include testicular adrenal rest tumors(TART), low gonadotropin secretion, and inappropriate glucocorticoid therapy. This article reviews the causes of impaired fertility and its treatment in male patients with 21-OHD, with the aim of providing guidance for improving the fertility of male patients with 21-OHD.

Physical therapy protocols to attenuate skeletal muscle atrophy in critically ill patients: narrative review / Protocolos de terapia física para atenuar la atrofia del músculo esquelético en pacientes críticos: revisión narrativa

SUMMARY: To describe the physical therapy protocols used in critically ill patients to attenuate skeletal muscle atrophy. We conducted a search in PubMed and Embase from inception to November 2020. Observational or experimental studies published in English or Spanish that evaluated the effect of physical therapy protocols on the attenuation of skeletal muscle atrophy in critically ill patients through muscle strength or mass measurement were considered eligible. Studies were only included if they reported a detailed description of the dosing of the interventions. Seventeen studies met the eligibility criteria. We included randomised clinical trials (n = 16) and observational studies (n = 1). The total population of the included studies was 872 critically ill patients. The studies aimed to evaluate the reliability, safety or effectiveness of neuromuscular electrical stimulation (n = 10) protocols, early mobilisation (n = 3), ergometer training (n = 2), transfers in tilt table (n = 1), and blood flow restriction (n = 1). Physical therapy protocols are part of the critically ill patient's integral management. Strategies such as passive mobilisation, in-bed and out-of-bed transfers, gait training, ergometer training, and neuromuscular electrical stimulation substantially impact critically ill patients' prognoses and quality of life after hospital discharge.

RESUMEN: Describir los protocolos de terapia física usados en pacientes críticos para atenuar la atrofia muscular esquelética. Realizamos una búsqueda en PubMed y Embase desde el inicio hasta noviembre de 2020. Se consideraron los estudios observacionales o experimentales publicados en inglés o español que evaluaron el efecto de los protocolos de terapia física en la atenuación de la atrofia del músculo esquelético en pacientes críticos a través de la medición de la fuerza o la masa muscular. Los estudios solo se incluyeron si informaron una descripción detallada de la dosificación de las intervenciones. Diecisiete estudios cumplieron los criterios de elegibilidad. Se incluyeron ensayos clínicos aleatorizados (n = 16) y estudios observacionales (n = 1). La población total de los estudios incluidos fue de 872 pacientes en estado crítico. Los estudios tuvieron como objetivo evaluar la confiabilidad, seguridad o efectividad de los protocolos de estimulación eléctrica neuromuscular (n = 10), movilización temprana (n = 3), entrenamiento con ergómetro (n = 2), transferencias en mesa basculante (n = 1) y restricción del flujo sanguíneo (n = 1). Los protocolos de terapia física forman parte del manejo integral del paciente crítico. Es- trategias como la movilización pasiva, los traslados dentro y fuera de la cama, el entrenamiento de la marcha, el entrenamiento con ergómetro y la estimulación eléctrica neuromuscular tienen un impacto sustancial en el pronóstico y la calidad de vida de los pacientes críticos después del alta hospitalaria.

Dimensión vertical de la cara en adultos con diferentes relaciones oclusales / Vertical dimension of face in adults with different Angle class

RESUMEN: Se ha postulado que la posición postural mandibular (PPM) no presentaría la menor actividad electromiográfica (EMG) de los músculos masetero y temporal, y que esta menor actividad se encontraría en una apertura mayor. El objetivo de este estudio fue analizar la PPM en pacientes con diferentes relaciones oclusales y según tipo de método de posicionamiento, relacionándolo con la actividad EMG de los músculos Masetero y Temporal, además del registro de la actividad EMG en diferentes aperturas orales. Se analizó una muestra de 25 adultos de 18 a 28 años. Estos fueron clasificados según su sexo y clasificación de Angle. Se realizaron simultáneamente registros de EMG de superficie -masetero y porción anterior del temporal- y de EMA -posición de la mandíbula respecto al maxilar obteniendo distancia y ángulo- en diferentes posiciones mandibulares: PPM-considerando método sin comando y de deglución- y apertura gradual hasta alcanzar la máxima apertura. Se realizó un análisis estadístico descriptivo. La menor PPM obtenida fue de 1,0 ± 0,6 mm en mujeres Clase III y utilizando la técnica sin comando; el mayor fue de 2,5 ± 0,2 mm en mujeres Clase II y utilizando la técnica de deglución. La apertura angular presentó menor variabilidad que las distancias lineales. La actividad de los músculos Maseteros derecho e izquierdo presentaron valores similares entre sí, al igual que en los rangos de apertura hasta 30 mm en hombres y mujeres y en las diferentes relaciones oclusales. La actividad de los Temporales para hombres y mujeres y en las diferentes relaciones oclusales mostraron variaciones importantes entre derecha e izquierda y en los diferentes grados de apertura. La técnica presentada permitió el estudio de la dimensión vertical y aperturas orales a través de EMA y EMG.

SUMMARY: It has been postulated that the mandibular postural position (MPP) could not present the lower electromyographic activity (EMG) of the Masseter and Temporal muscles, and that the lower activity could be found in a larger opening. The objective of this study was to analyze the PPM in patients with different occlusal relationships and according to the positioning method, relating it to the EMG activity of the Masseter and Temporal muscles, in addition to recording the EMG activity in different oral openings. A sample of 25 adults aged 18 to 28 years was analyzed. Participants were classified according to their sex and Angle classification. Simultaneous recordings of surface EMG -Masseter and anterior portion of the Temporal- and EMA -position of the Mandible with respect to the Maxilla obtaining distance and angle- were performed in different mandibular positions: PPM-considering the method "without command" and "swallowing"- and gradual opening until the maximum opening is reached. A descriptive statistical analysis was performed. The lowest PPM obtained was 1.0 ± 0.6 mm in Class III women and using the "without command" method; the largest was 2.5 ± 0.2 mm in Class II women and using the "swallowing" method. The angular opening presented less variability than the linear distances. The activity of the right and left masseter muscles presented similar values, as well as in the opening ranges up to 30 mm in men and women and in the different occlusal relationships. The activity of the Temporals for men and women and in the different occlusal relationships showed important variations between right and left and in the different degrees of opening. The presented technique allowed the study of the vertical dimension and oral openings through EMA and EMG.

Características de los días de descanso otorgados a pacientes atendidos en una Red Asistencial de Salud de Perú / Characteristics of days of rest granted to patients treated at the health care network in Peru

Introducción: El descanso médico es una figura legal otorgada para reposar ante una lesión que incapacite, sin necesidad de que el trabajador se vea privado de sus haberes o remuneraciones laborales. Objetivo: Caracterizar los días de descanso médico según el tipo de diagnóstico en los pacientes atendidos en la seguridad social de Trujillo, Perú. Material y Métodos: Estudio transversal analítico de datos secundarios, a partir del uso de la base del otorgamiento por incapacidades temporales laborales se obtuvieron las características de los descansos médicos (medido en días), de 2009-2015 en un hospital de la seguridad social del norte del Perú. Se realizó la caracterización según el tipo de patología y la estadística analítica mediante la regresión lineal. Resultados: De los 145 077 descansos otorgados, el falso trabajo de parto fue la condición más frecuente. Los accidentes comunes, la fractura de maléolo externo, la fractura de radio y el trastorno de discos intervertebrales tuvieron más días de descanso, con un promedio superior en relación con otras incapacidades. La diarrea, la faringitis y la deshidratación generaron menos días de descanso con un promedio menor en comparación con otras patologías. En cuanto al sexo, en general, a los hombres se les otorgó más descansos laborales. Todo esto fue estadísticamente significativo. Conclusiones: Existen diferencias marcadas en la asignación de días de descanso según las características de a quién se le dio, esto debería ser evaluado con estudios que permitan encontrar valores estándar(AU)

Introduction: Medical rest is a legal figure granted to rest in the presence of an incapacitating injury, without depriving the worker of receiving the incomes from work. Objective: To characterize the days of medical rest according to the type of diagnosis in patients treated at the social security in Trujillo, Peru. Material and Methods: Analytical cross-sectional study involving secondary data, and using the basis of medical breaks (measured in days) due to temporary incapacity from 2009 to 2015 in a social security hospital in northern Peru. Characterization was obtained according to the type of pathology, and analytical statistics was performed using linear regression. Results: Of the 145077 rest days granted, false labor was the most frequent condition. However, common accidents such as external malleolus fracture, radius fracture, and intervertebral disc disorder had more days of rest, being above average for other disabilities. On the other hand, those that generated fewer days of rest were diarrhea, pharyngitis and dehydration, being below average for other pathologies. In terms of sex, in general, men were granted more medical rest. All this was statistically significant. Conclusions: There are marked differences in the allocation of days of rest according to the characteristics of the persons to whom they were given; this should be evaluated in further studies to find standard values(AU)

Avaliação do desperdício de alimentos em unidade escolar em Niterói-RJ / Evaluation of food waste in school unit in Niterói-RJ

O objetivo do estudo foi quantificar as perdas geradas após o almoço e determinar se as taxas de sobras e resto-ingestão estavam dentro do padrão adequado em uma unidade escolar localizada em Niterói-RJ. A avaliação do desperdício foi realizada por meio da pesagem dos alimentos produzidos em 04 (quatro) dias não consecutivos, em um refeitório que atende em média 250 crianças com idade entre 3 a 12 anos, além de uma média de 22 funcionários, totalizando em 272 comensais. Os resultados apresentados estão acima dos 10%, sendo classificados como inaceitáveis como valores de sobras e resto-ingestão, respectivamente, de 76,29 kg e 68,88 kg de alimentos. Concluindo, portanto, que houve uma média elevada de desperdício do buffet durante os dias de estudo, sendo recomendável traçar estratégias para amenizar tal problema

The aim of the study was to quantify the losses generated after lunch and determine whether the rates of leftovers and rest-intake were within the appropriate standard in a school unit located in Niterói-RJ. The waste assessment was performed by weighing the food produced on 04 (four) non-consecutive days, in a school cafeteria that serves on average 250 children aged 3 to 12 years, in addition to an average of 22 employees, totaling 272 diners. The results presented are above 10%, being classified as unacceptable as values of leftovers and rest-intake, respectively, of 76.29 kg and 68.88 kg of food. Concluding, therefore, that there was a high average of buffet waste during the study days, and it is recommended to outline strategies to soften this problem

Diagnosis and treatment of 21-hydroxylase deficiency with testicular adrenal rest tumors:a report of three cases and literature review / 中华内科杂志

Objective:To provide insight into the diagnosis for clinicians, the clinical characteristics, diagnosis and treatment history of 3 patients with 21-hydroxylase deficiency (21-OHD) and testicular adrenal rest tumors (TART) were analyzed.Methods:The clinical, laboratory and imaging data of 3 male patients with 21-OHD and TART, confirmed with CYP21 gene sequencing, from May 2010 to May 2021 in the First Medical Center of Chinese PLA General Hospital were analyzed retrospectively. The treatment strategy and clinical outcome were followed up.Results:All the 3 patients were first diagnosed with bilateral adrenal mass at the age of 27-42 years old. They were 145-162 cm tall. The levels of progesterone, 17-hydroxyprogesterone, and adrenocorticotropic hormone (ACTH) of the 3 patients were relatively high, and that of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) of the 3 patients were low. Testosterone level of 1 patient was significantly elevated, and that of the other 2 patients was below the lower limit of normal range. Testicular ultrasound showed heterogeneous hyperechoic masses in both testes. CT of the adrenal glands showed bilateral adrenal enlargement with mass. All 3 patients were treated with dexamethasone. After 4-96 months of follow-up, 17-hydroxyprogesterone level was kept above the median normal level. One of the patients got married and had a baby after treatment. The sizes of adrenal hyperplasia and testicular masses reduced to various degrees with the change of the testicular masses being proportional to that of adrenal hyperplasia.Conclusions:Patients with 21-OHD are prone to have TART, leading to the impaired testicular function. Early glucocorticold therapy is beneficial to the reduction of TART and restoration of testicular function.

Clinical effect of exercise intervention on improving frailty of bedridden patients / 中华老年医学杂志

Frailty is a common elderly syndrome with high prevalence, frailty after longtime bedridding will aggravate the physical frailty.Exercise intervention can ameliorate the physical function of frail patients, enhance their self-care ability and reduce the occurrence of poor prognosis.Due to the special environment of bedridden frail elderly patients, the exercise intervention is different from the traditional exercise program.Considering the physical ability and cognition of bedridden patients, active and passive physical exercise, auxiliary equipment exercise and neuromuscular electrical stimulation are helpful to improve frailty and ameliorate the life quality of the elderly.

Correlation between brain networks functional connectivity in resting state and executive function in patients with different degrees of cognitive impairment associated with white matter lesions / 中华行为医学与脑科学杂志

Objective:To investigate the cognitive-related networks of patients with different cognitive impairment related to white matter lesions (WMLs), and explore the correlation between the altered functional connectivity and the executive function.Methods:Patients with white matter lesions in Beijing Tiantan Hospital from January 2016 to December 2020 were selected , who were divided into WML-non-dementia vascular cognitive impairment (WML-VCIND) group( n=19)and WML-vascular dementia (VaD) group( n=19). At the same time, 24 normal control group (NC) with no cognitive impairment with age, gender and education level matched were enrolled. The Stroop B, Stroop C, trail making test(TMT-B) and verbal fluency test (VFT) were used to evaluate the executive function of all subjects. The ICA method was used to identity four cognitive-related RSNs: frontoparietal network (FPN), salience network (SN), default network (DMN), and dorsal attention network (DAN). Using SPSS 20.0 software, the functional connectivity (FC) of the regions of interest of the selected RSNs among the three groups were compared by analysis of covariance, and correlation between the altered FCs and executive function scores were explored by Spearman correlation analysis. Results:(1) The FC of the medial prefrontal cortex (MPFC)-left inferior parietal lobe (IPL.L) in the VaD group(0.267±0.320) was significantly lower than that in the NC group (0.520±0.253)( P=0.005). The FC of MPFC-posterior cingulate (PCC) was significantly lower in the VaD group(0.655±0.284) than that in the VCIND group(0.810±0.232) ( P=0.017). The FC of MPFC-left insula and MPFC-left dorsolateral prefrontal cortex (DLPFC.L)was significantly higher in the VaD group(0.411±0.277, 0.545±0.311)than that in the VCIND group(0.239±0.308, 0.353±0.270)( P=0.044, 0.028). The FC of the left superior parietal lobe (SPL.L)-right dorsolateral prefrontal cortex (DLPFC.R) in the VCIND group(0.488±0.157) was significantly higher than that in the NC group(0.301±0.257) ( P=0.010). The FC of MPFC-left insula and MPFC-DLPFC.L was higher in NC group than that in VaD group ( P=0.020, 0.037). (2) The FC of MPFC-PCC was negatively correlated with Stroop C score ( r=-0.279, P=0.036), and TMT-B score ( r=-0.313, P=0.018). The FC of MPFC-IPL.L was negatively correlated with Stroop B score ( r=-0.311, P=0.018), Stroop C score( r=-0.308, P=0.020) and TMT-B score ( r=-0.367, P=0.005), while positively correlated with VFT score ( r=0.357, P=0.006). The FC of SPL.L-DLPFC.R was positively correlated with the Stroop B score ( r=0.305, P=0.021). Conclusion:There are certain differences in the functional connectivity between brain areas within the cognitive related brain networks, and the differences in FC between different brain areas are correlated with executive function scores. The changes of the FC may indicate possibly decline in executive function, which can explain the mechanism of cognitive declines.

Qualitative study on psychosomatic experience of patients undergoing lumbar cistern drainage after transnasal endoscopic surgery / 中国实用护理杂志

Objective:To understand the psychosomatic experience and needs of patients with lumbar cistern drainage after transnasal endoscopic sinus surgery in neurosurgery while lying in bed.Methods:Using the purposeful sampling method, one-to-on, face-to-face semi-structured interviews were conducted among 12 patients with lumbar cistern catheter drainage who were treated in Beijing Tiantan Hospital Affiliated to Capital Medical University from July to August 2020. Colaizzi phenomenology study was used to analyze the interview data, and summarized the themes.Results:The experience and needs of patients with lumbar cistern catheterization during the catheter placement were summarized into 3 themes. Obvious physical and mental discomfort: pain, discomfort of body position restriction, expectation minimization constraint scheme. Knowledge and cognitive needs: understand the reasons for intubation, intubation time and precautions. Affectionate and professional care needs: eager for professional care and more attention from medical staff, eager to be accompanied by family member to achieve greater improvement of comfort.Conclusions:Clinical nursing should be based on the patient′s psychosomatic feelings and needs, actively explore personalized intervention measures suitable for patients with lumbar cistern drainage, and formulate corresponding predictive care content to improve patients′ compliance, comfort and satisfaction.

A densidade como uma "não tão nova" métrica da quantificação de cargas no treinamento de força / Work to rest ratio as a "not so new"metric to quantify strength training loads

O objetivo dessa carta resposta foi tecer algumas considerações sobre o ponto de vista do manuscrito "A densidade como uma nova métrica da quantificação de cargas no treinamento de força", publicado nessa tradicional revista brasileira. Erroneamente, os autores apontaram que o termo work to rest ratio utilizado no estudo Blood Pressure Response During Resistance Training of Different Work-to-Rest Ratio e publicado no Journal of Strength Conditioning Research estaria equivocado. Os autores também sugerem que a densidade seja calculada apenas pela fórmula: total de peso levantado/total de pausa. Isso limitaria o cálculo da densidade em métodos isométricos de treinamento de força, que podem ter a densidade calculada pela fórmula: tempo de tensão muscular/total de pausa. Essa breve comunicação amplia o contexto conceitual e de aplicação prática dessa métrica que é pouco conhecida no treinamento de força. (AU)

The aim of this reply letter was to present some considerations about the point of view of the manuscript "Density as new metric to quantify strength training loads", published in this traditional Brazilian journal. The authors erroneously pointed out that term "work to rest ratio" used in the study "Blood Pressure Response During Resistance Training of Different Work-to-Rest Ratio" and published in Journal of Strength Conditioning Research, would be wrong. The authors also suggest that density must be calculated only by the formula: total weight lifted / total rest interval. This would limit density calculation in isometric strength training methods, which can have density calculated by the formula: muscle tension time / total rest interval. This brief communication broadens the conceptual context and practical application of this metric that is little known in strength training. (AU)

El sujeto como resto: aproximación a la concepción del masoquismo de Lacan / The subject as remainder: an approach to Lacan's conception of masochism

En este trabajo se desarrollará el tema del masoquismo, con el objetivo de situar que, si bien nace como concepto a partir de su consideración como perversión sexual, desde Freud, también se imbrica con la pulsión de muerte, que toma allí un relieve particular. Sobre este último punto, se concibe con Lacan al masoquismo primordial del goce, que da cuenta de la captura de la sexualidad en la red significante, de la ausencia de correlación entre el sujeto y el objeto, la no-relación. Se distinguen, entonces, el masoquismo como síntoma y el masoquismo como correlato de la constitución subjetiva. La posición masoquista, que representa un intento fallido de recuperación del goce perdido, trasciende las estructuras clínicas, no es exclusiva de la perversión

n this work the theme of masochism will be developed, with the aim of locating that, although it was born as a concept from its consideration as sexual perversion, since Freud, it has also been overlaps with the death drive, which takes on a particular importance there. On this last point, Lacan conceives the primordial masochism of jouissance, which accounts for the capture of sexuality in the signifying network, the absence of correlation between subject and object, the non-relationship. Thus, masochism as a symptom and masochism as a correlate of the subjective constitution are distinguished. The masochistic position, which represents a failed attempt to recover the lost jouissance, transcends clinical structures, is not exclusive to perversion

Effects of conservative treatment of 2-week rigorous bed rest on muscle disuse atrophy in osteoporotic vertebral fracture patients / Journal of Rural Medicine

Objective: Osteoporotic vertebral fracture (OVF) is conventionally treated with conservative management such as bed rest, but a relatively prolonged bed rest has the potential risk of muscle disuse atrophy. This study aimed to examine whether the 2-week of rigorous bed rest affects muscle disuse atrophy in OVF patients.Patients and Methods: A total of 54 OVF patients (16 males; 38 females; mean age, 80.2 ± 9.2 years) were treated with an initial 2-week rigorous bed rest by hospitalization with persistent rehabilitation. Cognitive function, swallowing function, grip strength, and lower extremity circumference were evaluated at three-time points (admission, end of bed rest, and discharge).Results: Of the 51 patients who were able to walk independently before the injury, one patient (2.0%) had to use a wheelchair after the injury. During hospitalization, cognitive function decline was observed in 33.3% of patients, but not in patients with Revised Hasegawa’s Dementia Scale score ≥25 at admission. Swallowing function decline was observed in one patient, and none of the patients developed aspiration pneumonia during hospitalization. The grip strength significantly improved both at the end of bed rest (P=0.04) and discharge (P=0.02). Although the lower extremity circumference significantly decreased at the end of bed rest (P<0.01), it was recovered afterward. The lower extremity circumference did not significantly differ between the admission and discharge (P=0.17).Conclusion: Our results suggested that conservative treatment of OVF through an initial 2-week rigorous bed rest with persistent hospital rehabilitation poses a low risk of muscle disuse atrophy. If cognitive dysfunction is observed on admission, close monitoring for exacerbation should be performed during the hospital stay.

Panicum cf. hispidifolium Swallen: una gramínea con potencial forrajero para las Sabanas de Sucre / Panicum cf. hispidifolium Swallen: a grass with forage potential for the Savannas of Sucre

Introducción: En la región Caribe de Colombia hay presencia de especies nativas de gramíneas que aún no han sido evaluadas. Objetivo: Identificar taxonómicamente una gramínea de la región Sabanas de Sucre y estudiar la influencia de la edad sobre sus atributos morfológicos y de producción. Materiales y métodos: El estudio se ubicó en 9º12'38.59" N y 75º24'06.63", a 165 msnm. En 18 parcelas se evaluaron tres intervalos de corte (21, 28 y 35 días). Inicialmente, se identificó la gramínea. Fue evaluada la composición química, el número y longitud de las hojas, las relaciones entre material verde y seco y entre hojas y tallos, y su evolución, y la producción y tasa de acúmulo de MS. Resultados: La gramínea se identificó como Panicum cf. hispidifolium Swallen. El contenido de PB, NDT y cenizas disminuyeron (P<0,05) con el incremento en la edad, presentando valores medios de 12,3; 58,5 y 9,7%, respectivamente. Las fracciones MS, FDA y CNE aumentaron (P<0,05) con la edad, presentando valores medios de 21,6; 37,17 y 6,24%, respectivamente. La disponibilidad de MS y la tasa de acúmulo evolucionaron cuadráticamente (P<0,05), con mayor intensidad entre los días 21 y 28. El promedio de MS disponible fue de 8049,1 kg/ha y la tasa diaria de acúmulo fue de 281,2 kg/ha. Conclusión: Se concluye que P. hispidifolium es una gramínea con potencial forrajero para la región Sabanas de Sucre, y que se debe manejar con periodos de descanso de alrededor de 28 días, considerando la disponibilidad y calidad de la MS.

Introduction: In the Caribbean region of Colombia there are native species of grasses that have not yet been evaluated. Objective: To identify taxonomically a grass observed in the Savannas de Sucre region and study the influence of age on its morphological and production attributes. Materials and Methods: The study was located at 9º12'38.59"N and 75º24'06.63", at 165 meters above sea level. In 18 plots, three cut intervals were evaluated (21, 28 and 35 days). Initially, the grass was identified. The chemical composition, the number and length of the leaves, the relationships between green and dry material and between leaves and stems, and their evolution, and the production and accumulation rate of DM were tested. Results: The grass was identified as Panicum cf. hispidifolium Swallen. The content of PB, NDT and ash decreased (P <0.05) with increasing age, presenting mean values of 12.27; 58.5 and 9.7%, respectively. The MS, FDA and CNE fractions increased (P <0.05) with age, presenting mean values of 21.6; 37.17 and 6.24%, respectively. DM availability and accumulation rate evolved quadratically (P <0.05), with greater intensity between days 21 and 28. The average DM available was 8049.1 kg / ha and the daily accumulation rate was 281.2 kg / ha. Conclusion: It is concluded that P. hispidifolium is a grass with forage potential for the Savannas of Sucre region, and that it should be managed with rest periods of around 28 days, considering the availability and quality of the DM.