How COVID-19 elucidated challenges in the pedagogy of physiotherapy entry-level education in Brazil and directions for their remediation with special attention to digital teaching and learning.

INTRODUCTION: As experienced physiotherapy educators in Brazil, we observed that COVID-19 elucidated challenges in the pedagogy of entry-level education overall, and directions for their remediation. In this commentary, we describe our observations with particular attention to the opportunity for digital and distance teaching and learning in Brazil's exemplary middle-income country. BODY: First, the legislation in Brazil around health professional education, specifically entry-level physiotherapy education, is described concerning distanced learning. Then, we contrast such education before and during the COVID-19 pandemic, and in the aftermath of its peak. Our observations reinforce the need to preserve teaching and learning excellence in physiotherapy education with various approaches including distanced and digital learning; be aware of both advantages and disadvantages; and identify means of balancing these for optimal delivery and learner outcomes. Our collective experience and insights strongly support the need for change in the legislative document governing physiotherapy education in Brazil. CONCLUSION: We hope our experiences will enable other educators to evaluate their contexts, reflect on how best to deliver entry-level physiotherapy education in general and during a pandemic, and reinforce the essentiality of practical face-to-face classes in achieving physiotherapy competencies. Only in this way will global standards of practice be ensured, through quality professional education and the factors that inform and govern these.

[Illicit drug use by pregnant women infected with HIV]. / Uso de drogas ilícitas por gestantes infectadas pelo HIV.

PURPOSE: To determine if illicit drug use increases the vertical transmission of HIV, to identify the risk factors involved in mother and child health and the prevalence of illicit drug use among these pregnant women. METHODS: Sixty-four (7.6%) of 845 pregnant women from the metropolitan region of Belo Horizonte, Minas Gerais, Brazil, attended in the service between October 1997 and February 2012 reported the use of illicit drugs. Cases were HIV-positive drug users (n=64) and controls were women who did not use drugs (n=192). Three controls were selected for each case. Several conditions of exposure were considered in the control group such as tobacco use, alcohol use, alcohol and tobacco use, maternal age, educational level, ethnicity, and marital status. Problems during the prenatal period, delivery and postpartum, vertical HIV transmission and neonatal outcomes were also investigated. RESULTS: Univariate analysis showed as significant variables: maternal age, tobacco use, number of prenatal care visits, antiretroviral therapy, mode of infection, and viral load at delivery. Logistic regression revealed as significant variables: maternal age (less than 25 years); tobacco use, and number of prenatal care visits (less than 6). The vertical transmission of HIV was 4,8% (95%CI 1.7-13.3) among drug users and 2,1% (95%CI 0.8-5.2) in the control group, with no statistically significant difference between groups. Neonatal complications were more frequent among drug users, but also with no statistically significant difference between groups. CONCLUSION: The use of illicit drug is frequent during pregnancy among HIV-infected women. The approach to illicit drug use should be routine during prenatal care visits. These women are more discriminated against and tend to deny their habits or do not seek prenatal care. There was no difference in vertical virus transmission between groups, probably indicating adherence to antiretroviral use for antiretroviral therapies during pregnancy.

Uso de drogas ilícitas por gestantes infectadas pelo HIV / Illicit drug use by pregnant women infected with HIV

OBJETIVO: Determinar se o uso de drogas ilícitas aumenta a transmissão vertical do HIV, identificar os fatores de risco envolvidos na saúde materno-infantil e a prevalência do uso de drogas entre essas gestantes. MÉTODOS: Entre 845 gestantes da região metropolitana de Belo Horizonte, Minas Gerais, atendidas no serviço entre outubro de 1997 e fevereiro de 2012, 64 (7,6%) afirmaram usar drogas ilícitas. Os casos são as gestantes HIV positivas usuárias de drogas ilícitas (n=64) e os controles as não usuárias (n=192). Para cada caso foram selecionados três controles. Consideraram-se as diferentes exposições/condições no grupo controle como: tabagismo; etilismo; uso de tabaco e álcool; idade materna; escolaridade; etnia; e estado civil. Foram investigadas também intercorrências no pré-natal, parto e puerpério, taxa de transmissão vertical e resultados neonatais. RESULTADOS: As variáveis com significância estatística na análise univariada foram: idade materna; uso de tabaco; número de consultas de pré-natal; tipo de terapia antirretroviral; forma de contágio e carga viral na época do parto. A regressão logística mostrou como significantes: idade materna (menores de 25 anos), uso de tabaco e o número de consultas de pré-natal (menos de 6). A transmissão vertical entre usuárias foi de 4,8% (IC95% 1,7–13,3) e, no grupo controle, 2,1% (IC95% 0,8–5,2), sem diferença significante. As complicações neonatais foram mais frequentes entre os recém-nascidos das gestantes usuárias, também sem diferença significante. CONCLUSÃO: O uso de drogas ilícitas na gravidez entre mulheres infectadas pelo HIV é frequente. Assim, a abordagem sobre o uso dessas drogas deve fazer parte da rotina pré-natal. Essas ...

PURPOSE: To determine if illicit drug use increases the vertical transmission of HIV, to identify the risk factors involved in mother and child health and the prevalence of illicit drug use among these pregnant women. METHODS: Sixty-four (7.6%) of 845 pregnant women from the metropolitan region of Belo Horizonte, Minas Gerais, Brazil, attended in the service between October 1997 and February 2012 reported the use of illicit drugs. Cases were HIV-positive drug users (n=64) and controls were women who did not use drugs (n=192). Three controls were selected for each case. Several conditions of exposure were considered in the control group such as tobacco use, alcohol use, alcohol and tobacco use, maternal age, educational level, ethnicity, and marital status. Problems during the prenatal period, delivery and postpartum, vertical HIV transmission and neonatal outcomes were also investigated. RESULTS: Univariate analysis showed as significant variables: maternal age, tobacco use, number of prenatal care visits, antiretroviral therapy, mode of infection, and viral load at delivery. Logistic regression revealed as significant variables: maternal age (less than 25 years); tobacco use, and number of prenatal care visits (less than 6). The vertical transmission of HIV was 4,8% (95%CI 1.7–13.3) among drug users and 2,1% (95%CI 0.8–5.2) in the control group, with no statistically significant difference between groups. Neonatal complications were more frequent among drug users, but also with no statistically significant difference between groups. CONCLUSION: The use of illicit drug is frequent during pregnancy among HIV-infected women. The approach to illicit drug use should be routine during prenatal care visits. These women are more discriminated against and tend to deny their habits or do not seek prenatal care. There was no difference in vertical virus transmission between groups, probably indicating adherence to antiretroviral ...

Uso e dependência de cocaína/crack na gestação, parto e puerpério / Cocaine/crack use and dependence in pregnancy, delivery and puerperium

O uso de cocaína/crack entre gestantes está aumentando, o que traz riscos para a saúde da mulher e do recém-nascido. Uma estimativa exata da prevalência do uso destas drogas na gestação é difícil, dado o policonsumo e a superposição de fatores sociais. O crack é a forma de base livre da cocaína utilizado por via inalatória. Os principais efeitos da droga observados no corpo humano são: taquicardia,hipertensão, taquipneia, hipertermia, midríase, tensão muscular, contrações musculares, sudorese intensa,convulsões e até coma. Hemorragia intracraniana, acidentes vasculares encefálicos, isquemia mesentérica,insuficiência renal aguda e infartos renais são frequentes após uso abusivo da droga. A identificação do abuso de cocaína/crack por gestantes é um desafio, pois, além da negação, os sintomas podem ser confundidos com efeitos originados do abuso de outras substâncias ou a pré-eclâmpsia. As complicações maternas mais graves são descolamento prematuro da placenta, ruptura uterina, ruptura hepática, isquemia cerebral, infarto e morte.Em recém-nascidos expostos intraútero é observado baixo peso ao nascer, restrição no crescimento e risco de morte súbita. No atendimento ambulatorial às gestantes usuárias de drogas, o acompanhamento dos casos deve ser sistemático, periódico e multiprofissional, o que evidencia a necessidade de estruturação e fortalecimento da rede de atenção.(AU)

The use of cocaine/crack between pregnant women is rising and increases risks for mother and newborn child?s health. An exact number of these drugs users during pregnancy is hard to establish, because of many drugs used at the same time and the influence of social effects related. Crack represents the cocaine free base used by inhalation. The most common drug effects observed in the human body are: tachycardia, hypertension, tachypnea, hyperthermia, mydriasis, muscle tension, muscle contractions, intense sweating, seizures and even coma. Intracranial hemorrhage, stroke, mesenteric ischemia, acute renal failure and renal infarctions are common after drug abusing. Identifying the abuse of cocaine/crack during pregnancy is a challenge, because, beyond the denial, the symptoms can be confused with effects generated by the use of other drugs at the same time or preeclampsia. The most serious maternal complications are placenta previa, uterine rupture, ruptured liver, brain ischemia, infarction and death. Newborns exposed in utero present low birth weight, growth restriction and risk of sudden death. In women drug users attendance, case monitoring should be systematic, regular and multiprofessional, which highlights the need for structuring and strengthening health network.(AU)

The effects of acute restraint stress on nociceptive responses evoked by the injection of formalin into the temporomandibular joint of female rats.

The temporomandibular joint (TMJ) formalin test was used to evaluate the effects of acute restraint stress on the nociceptive behavioral responses of female rats during proestrus and estrus phases of the estrous cycle. Rats were subjected to one session of restraint stress (15, 30 min or 1 h). They were then either immediately killed to allow the collection of blood for hormonal radioimmunoassay determinations or subjected to TMJ formalin test to evaluate nociception. All stress protocols significantly raised the plasma concentrations of corticosterone. The performance of rats subjected to 15 and 30 min of restraint stress was similar to that of control rats, whereas rats that were stressed for 1 h showed a decrease in nociceptive responses, during both proestrus and estrus phases. The stress-induced analgesia (SIA) was greater in the proestrus phase. To evaluate the role of kappa-opioid receptors, the selective receptor kappa-opioid antagonist nor-binaltorphimine (nor-BNI; 200 microg or saline) was injected into the TMJ 24 h prior to the 1 h stress period and the TMJ formalin test. The local administration of nor-BNI partially reversed the SIA during the proestrus phase. These findings suggest that (1) acute stress for 1 h can produce analgesia both during proestrus and estrus phases; this effect is greater during the proestrus phase and (2) kappa-opioid receptor activation is involved in the SIA observed in the proestrus phase.

Influence of sex on temporomandibular disorder pain: a review of occurrence and development

Aim: The aim of this study was to develop a narrative literature review using international research to present the influence of sex on occurrence and development of temporomandibular disorder (TMD) pain. Methods: The data sources were computer-based searches in PubMed between 1987 and Feb 2008 using appropriate keywords. For inclusion in this review, articles had to meet the following criteria: be written in English; include human and nonhuman subjects; be published a full-text paper in a peer-reviewed medical journal. Results: The studies considered eligible for this narrative review presented results in agreement with the difference in sex and orofacial pain. Patients were almost always adults, with particular focus on patients’ sex. Clinical conditions were predominantly TDM pain. Since sexual dimorphism was detected in TMD pain, the results are focused on women. Conclusion: The findings of this review suggest that there is difference in the occurrence and development of pain according to the individual’s sex, women being more susceptible to TMD pain.

Processo de regeneração na lesão muscular: uma revisão / Regeneration process in the muscle injury: a review

Embora seja muito comum a lesão do sistema musculoesquelético nas clínicas de fisioterapia, o músculo responde a essas lesões, na maioria das vezes, com a regeneração completa. Assim, o objetivo desta revisão é detalhar a sequência dos eventos e os indicativos musculares que caracterizam a lesão, as fases da subsequênte regeneração e os recursos fisioterapêuticos utilizados durante a reabilitação muscular. Observam-se divergências na literatura em relação à eficácia dos recursos, devido, provavelmente, a diferentes métodos utilizados, o que dificulta a compreensão dos efeitos destes na regeneração muscular