SIMULTANEOUS RUPTURE OF THE PATELLAR AND CONTRALATERAL QUADRICEPS TENDONS IN A NEPHROPATHY PATIENT.

Simultaneous rupture of the patellar and contralateral quadriceps tendons in patients with chronic renal failure is an extremely rare condition, with few cases described in the medical literature. Several systemic pathological conditions that lead to a decline in kidney function can predispose individuals to spontaneous tendon rupture, such as rheumatological and endocrine diseases, and even gestational conditions, such as eclampsia. Objective: In this case report, we describe the case of a 39-year-old woman with chronic renal failure on dialysis due to a previous history of eclampsia that caused the simultaneous rupture of the patellar and contralateral quadriceps tendons. Methods: Data were collected by interviews, direct observation, and medical examinations, and include information about the case history, the patient's characteristics, the former interventions, and the results obtained. Results: The surgery to repair the patellar and contralateral quadriceps tendons was performed by transosseous tunnels and the Krackow technique with nonabsorbable sutures was used. The semitendinosus tendon was removed and used as reinforcement. Conclusion: Patient under follow-up with good functional results in both knees.Level of Evidence V, Expert Opinion.

A ruptura simultânea de tendão patelar e tendão quadricipital contralateral em paciente com insuficiência renal crônica é uma condição extremamente rara, havendo poucos casos descritos na literatura médica. Diversas condições patológicas sistêmicas que levam ao declínio das funções renais podem predispor à ruptura tendinosa espontânea, como doenças reumatológicas e endócrinas, até mesmo condições gestacionais, como a eclâmpsia. Objetivo: Neste relato de caso, descrevemos o caso de uma mulher de 39 anos com insuficiência renal crônica dialítica decorrente de quadro pregresso de eclâmpsia que culminou na ruptura simultânea de tendão patelar e tendão quadricipital contralateral. Métodos: Estudo realizado com dados coletados por meio de entrevista, observação direta e exames médicos. Os dados incluem informações sobre o histórico do caso, as características do paciente, as intervenções realizadas e os resultados obtidos. Resultados: A cirurgia para reparo da lesão de tendão patelar contralateral e tendão quadricipital foi realizada por túneis transosseos e a rafia foi feita com pontos Krakow utilizando fios não absorvíveis. Além disso, o tendão semitendinoso foi retirado e usado como reforço. Conclusão: A paciente apresentou bons resultados funcionais em ambos os joelhos operados. Nível de Evidência V, Opinião do Especialista.

Simultaneous rupture of the patellar and contralateral quadriceps tendons in a nephropathy patient / Ruptura simultânea de tendão patelar e quadricipital contralateral em paciente nefropata

ABSTRACT Simultaneous rupture of the patellar and contralateral quadriceps tendons in patients with chronic renal failure is an extremely rare condition, with few cases described in the medical literature. Several systemic pathological conditions that lead to a decline in kidney function can predispose individuals to spontaneous tendon rupture, such as rheumatological and endocrine diseases, and even gestational conditions, such as eclampsia. Objective: In this case report, we describe the case of a 39-year-old woman with chronic renal failure on dialysis due to a previous history of eclampsia that caused the simultaneous rupture of the patellar and contralateral quadriceps tendons. Methods: Data were collected by interviews, direct observation, and medical examinations, and include information about the case history, the patient's characteristics, the former interventions, and the results obtained. Results: The surgery to repair the patellar and contralateral quadriceps tendons was performed by transosseous tunnels and the Krackow technique with nonabsorbable sutures was used. The semitendinosus tendon was removed and used as reinforcement. Conclusion: Patient under follow-up with good functional results in both knees. Level of Evidence V, Expert Opinion.

RESUMO A ruptura simultânea de tendão patelar e tendão quadricipital contralateral em paciente com insuficiência renal crônica é uma condição extremamente rara, havendo poucos casos descritos na literatura médica. Diversas condições patológicas sistêmicas que levam ao declínio das funções renais podem predispor à ruptura tendinosa espontânea, como doenças reumatológicas e endócrinas, até mesmo condições gestacionais, como a eclâmpsia. Objetivo: Neste relato de caso, descrevemos o caso de uma mulher de 39 anos com insuficiência renal crônica dialítica decorrente de quadro pregresso de eclâmpsia que culminou na ruptura simultânea de tendão patelar e tendão quadricipital contralateral. Métodos: Estudo realizado com dados coletados por meio de entrevista, observação direta e exames médicos. Os dados incluem informações sobre o histórico do caso, as características do paciente, as intervenções realizadas e os resultados obtidos. Resultados: A cirurgia para reparo da lesão de tendão patelar contralateral e tendão quadricipital foi realizada por túneis transosseos e a rafia foi feita com pontos Krakow utilizando fios não absorvíveis. Além disso, o tendão semitendinoso foi retirado e usado como reforço. Conclusão: A paciente apresentou bons resultados funcionais em ambos os joelhos operados. Nível de Evidência V, Opinião do Especialista.

Protocolo de Controle de tronco em Ambiente Aquático para Crianças com Paralisia Cerebral: Ensaio Clínico Randomizado / Protocol of Control of Trunk in Aquatic Environment for Children with Cerebral Palsy: Randomized Clinical Trial

Objetivos: Avaliar os efeitos de um protocolo de controle de tronco em ambiente aquático e sua repercussão na funcionalidade de indivíduos com paralisia cerebral (PC) diparéticoespástico, classificados no nível IV do GMFCS (Gross Motor Function Classification System). Métodos: ensaio clínico controlado, randomizado, cego, descritivo-analítico, quantitativo. Foram triados 92 prontuários, 24 crianças foram incluídas e 22 finalizaram o estudo. Os pacientes foram alocados em grupo controle (GC), que realizou terapias convencionais e grupo intervenção (GI) que realizou o protocolo de exercícios aquáticos. Os grupos foram avaliados pré e pós-intervenção através da Trunk Control Measurement Scale (TCMS), Pediatric Reach Test (PRT), Eletromiografia de Superfície (EMG) dos músculos reto abdominal e latíssimo do dorso. Para análises estatísticas foram utilizados o teste de Kolmogorov-Smirnov no momento pré e pós intervenção, teste de Mann-Whitney para a análise intragrupo e teste de Wilcoxon para análise intergrupo. A Correlação de Spearman foi utilizada para observar o grau de associação entre duas variáveis. Foi considerado um intervalo de confiança (IC) de 95%, nível de significância de p<0,05. Resultados: na análise intragrupo constatou-se melhora no item reação de equilíbrio da TCMS, GI (p=0,019) e o GC (p=0,004). No PRT, GC apresentou maior deslocamento pós-intervenção (p=0,006) que o GI. No item 07 da TCMS houve melhora da ativação muscular do reto abdominal (RA) do GI (p=0,047). Conclusão: No presente estudo, observou-se que a fisioterapia aquática trouxe resultados positivos e ganhos motores relacionados ao controle de tronco e funcionalidade para crianças com paralisia cerebral diparética espásticas GMFCS nível IV. (AU)

Objectives: To evaluate the effects of a trunk control protocol in the aquatic environment and its impact on the functionality of individuals with spastic diparesis type of CP (Cerebral Palsy) classified as level IV on GMFCS. Methods: A quantitative, controlled clinical trial, randomized, blind, of descriptive and analytical character. 92 records were screened, 24 children were enrolled and 22 completed the study. Patients were allocated in control group (CG), which held conventional therapies and intervention group (IG) which performed the aquatic exercise protocol. Groups were evaluated pre and post intervention through Trunk Control Measurement Scale (TCMS), Pediatric Reach Test (PRT), Surface Electromyography (EMG) of rectus abdominis and latissimus dorsi muscles. For statistical analysis, it was used the Kolmogorov-Smirnov test for pre and post intervention analysis, Mann-Whitney and Wilcoxon test for intragroup and intergroup analysis, respectively. Spearman correlation was used to observe the rate of association between two variables. A confidence interval (CI) of 95% was considered, level of significance of p <0.05. Results: Intragroup analysis showed improvement in TCMS equilibrium reactions item in GI (p = 0.019) and CG (p = 0.004). In the PRT, GC presented greater post-intervention displacement (p = 0.006) than the GI. In item 07 of the TCMS there was improvement of rectus abdominis muscle activation in GI (p = 0.047). Conclusion: In the present study there were positive results and motor gains on trunk control and functionality for individuals with spastic diparesis type of CP classified as level IV on GMFCS after aquatic therapy intervention. (AU)

In vivo biodistribution of antihyperglycemic biopolymer-based nanoparticles for the treatment of type 1 and type 2 diabetes.

This study aimed to assess the biodistribution of antihyperglycemic insulin-loaded alginate/dextran sulfate-based nanoparticles dual coated with chitosan and technetium-99m-albumin (99mTc-BSA) after oral administration. The oral administration of 50IU/kg insulin-loaded nanoparticles to type 1 diabetic rats showed prolonged antihyperglycemic effects up to 12h and relative pharmacological availability of 5.04% comparing to the subcutaneous administration. The oral antihyperglycemic effect was further compared between type 1 and type 2 diabetic models by the intraperitoneal glucose tolerance test, revealing that the effect lasted longer in the type 1 diabetic model. 99mTc-BSA revealed to be a good nanoparticles' tracer since there was no systemic absorption and 99mTc-BSA-nanoparticles were capable of increasing their residence time in the intestinal epithelium of balb-c mice when compared with 99mTc-BSA biodistribution. Thus, this biopolymeric-based delivery nanoparticulate system is a promising tool for the therapy of type 1 and type 2 diabetic individuals and prevention of T1D.

Synergistic Effect of 1-Butyl-3-methylimidazolium Hexafluorophosphate and DMSO in the SARA ATRP at Room Temperature Affording Very Fast Reactions and Polymers with Very Low Dispersity.

An unusual synergistic effect between 1-butyl-3-methylimidazolium hexafluorophosphate (BMIM-PF6) and dimethyl sulfoxide (DMSO) mixtures is reported for the supplemental activator and reducing agent atom transfer radical polymerization (SARA ATRP) of methyl acrylate (MA) using a catalytic system composed by sodium dithionate (Na2S2O4) and CuBr2/Me6TREN (Me6TREN: tris[2-(dimethylamino)ethyl]amine) at room temperature. To the best of our knowledge, the use of ionic liquids (IL) has never been reported for the SARA ATRP. The kinetic data obtained for a broad range of target molecular weights revealed very fast polymerization rates, low dispersity values (D < 1.05) and well-defined chain-end functionalities.

PERSYVE - Design and validation of a questionnaire about adverse effects of antihypertensive drugs.

OBJECTIVE: The aim of this study was to design and validate a questionnaire to measure perceived symptoms associated with antihypertensive drugs (PERSYVE). METHODS: THE PERSYVE DEVELOPMENT AND VALIDATION INCLUDED FOUR STAGES: 1) item development (bibliographic review and questionnaire elaboration); 2) face and content validation; 3) field testing (pre-test); and 4) test-retest validation, assessment of internal consistency (Cronbach's alpha) and reproducibility over time (intraclass correlation coefficient and Cohen's kappa coefficient). RESULTS: PERSYVE IS DIVIDED INTO SIX SECTIONS ACCORDING TO RESULTS OBTAINED FROM THE LITERATURE REVIEW: (1) drug adherence, (2) perceived symptoms and how they affect quality of life (five-point Likert scale), (3) communication with health professionals, (4) perception of symptoms as adverse reactions, (5) influence on therapy compliance, and (6) adoption of non-pharmacological methods for blood pressure control. Content and face validation of the questionnaire led to some vocabulary changes and the introduction of section 2.1. Field-testing (n=26) revealed high comprehensibility of the questions. The Cronbach's alpha, calculated for section 2 (five-point Likert scale) was 0.850. PERSYVE was reproducible (n=167): kappa values presented fair to substantial reproducibility and, in section 2, ICC values resulted in good to excellent reproducibility. CONCLUSION: Results showed that PERSYVE is a well-structured, objective, patient-friendly, valid and reliable questionnaire. PERSYVE can be a very useful instrument in hypertensive patients' monitoring and in the screening of adverse effects.

PERSYVE - Design and validation of a questionnaire about adverse effects of antihypertensive drugs / PERSYVE - Diseño y validación de un cuestionario sobre efectos adversos de antihipertensivos

Objective: The aim of this study was to design and validate a questionnaire to measure perceived symptoms associated with antihypertensive drugs (PERSYVE). Methods: The PERSYVE development and validation included four stages: 1) item development (bibliographic review and questionnaire elaboration); 2) face and content validation; 3) field testing (pre-test); and 4) test-retest validation, assessment of internal consistency (Cronbach’s alpha) and reproducibility over time (intraclass correlation coefficient and Cohen’s kappa coefficient). Results: PERSYVE is divided into six sections according to results obtained from the literature review: (1) drug adherence, (2) perceived symptoms and how they affect quality of life (five-point Likert scale), (3) communication with health professionals, (4) perception of symptoms as adverse reactions, (5) influence on therapy compliance, and (6) adoption of non-pharmacological methods for blood pressure control. Content and face validation of the questionnaire led to some vocabulary changes and the introduction of section 2.1. Field-testing (n=26) revealedhigh comprehensibility of the questions. The Cronbach's alpha, calculated for section 2 (five-point Likert scale) was 0.850. PERSYVE was reproducible (n=167): kappa values presented fair to substantial reproducibility and, in section 2, ICC values resulted in good to excellent reproducibility. Conclusion: Results showed that PERSYVE is a wellstructured, objective, patient-friendly, valid and reliable questionnaire. PERSYVE can be a very useful instrument in hypertensive patients’ monitoring and in the screening of adverse effects (AU)

Objetivo: El objetivo de este estudio fue diseñar y validar un cuestionario para medir los síntomas percibidos asicados a medicamentos antihipertensivos (PERSYVE). Métodos: El desarrollo y validación de PERSYVE incluyó cuatro etapas: 1) desarrollo de ítems (revisión bibliográfica y elaboración del cuestionario); 2) validación de rostro y de contenido; 3) prueba de campo (pre-test); y 4) validación test-retest, evaluación de la consistencia interna (alfa de Chronbach) y reproductibilidad en el tiempo (coeficiente de correlación intra-clases y coeficiente kappa de Cohen). Resultados: De acuerdo con los resultados obtenidos de la revisión de la literatura, PERSYVE se divide en seis secciones: (1) adherencia a medicamentos, (2) síntomas percibidos y como afectan a la calidad de vida (escala Likert de cinco puntos), (3) comunicación con los profesionales de la salud, (4) percepción de síntomas como reacciones adversas, (5) influencia en el cumplimiento del tratamiento, y (6) adopción de métodos no farmacológicos para el control de la presión arterial. La validación de rostro y de contenido del cuestionario llevaron a algunos cambios de vocabulario y a la introducción de la sección 2.1. El ensayo de campo (n=26) reveló una alta comprensibilidad de las preguntas. El alfa de Cronbach calculado para la sección 2 (escala de Likert de 5 puntos) fue de 0,850. PERSYVE fue reproducible (n=167): valores de kappa presentaron una reproductibilidad sustancial y, en la sección 2, los valores de ICC resultaron de buenos a excelentes. Conclusión: Los resultados demostraron que PERSYVE es un cuestionario bien estructurado, objetivo, fácil de usar para el paciente, válido y confiable. PERSYVE puede ser un instrumento muy útil en la monitorización de pacientes hipertensos y en el rastreo de efectos adversos (AU)

Sulfolane: an Efficient and Universal Solvent for Copper-Mediated Atom Transfer Radical (co)Polymerization of Acrylates, Methacrylates, Styrene, and Vinyl Chloride.

A very fast and controlled atom transfer radical (co)polymerization (ATRP) of acrylates, methacrylates, styrene, and vinyl chloride is reported in a single dipolar aprotic solvent, sulfolane, with the use of ppm amount of the copper catalyst. The observed rates of polymerization (kpapp) of the monomers studied are similar to those reported using dimethyl sulfoxide (DMSO) and other polar solvents typically employed in single electron transfer (SET)-mediated atom transfer radical polymerization (ATRP) processes. As proof-of-concept, ABA type block copolymers of polystyrene-b-poly(vinyl chloride)-b-polystyrene and poly(methyl acrylate)-b-poly(vinyl chloride)-b-poly(methyl acrylate) were prepared for the first time using a reversible deactivation radical polymerization (RDRP) method in a single solvent. The quantitative preservation of halide chain-ends was confirmed by 1H NMR and MALDI-TOF analysis as well as by the complete shift of the GPC traces. The results presented establish an innovative and robust system to afford a vast portfolio of (co)polymers in a single widely used industrial solvent.

Variaçöes da artéria axilar e seus ramos / Variations of the axilary artery and its branches

Este estudo objetivou descrever e qualificar as as variações da artéria axilar e medir seu calibre e de seus principais ramos, buscando relacionar o calibre arterial e a presença de variaçäo anatômica.Ointenta e quatro regiões axilares foram avaliadas com a obtençäo dos calibres arteriais, e classificadas segundo a presença de variações anatômicas.O número total de artérias variáveis foi de 40 (47,6 por cento) sendo que a variaçäo mais frequentemente encontrada foi a artéria circunflexa posterior originando-se como da artéria subescapular (67,5 por cento das variações).Outras variações menos frequentes foram observadas.Quanto ao calibre arterial, näo foram encontradas diferenças significativas quando comparados lados direito e esquerdo, bem como artéria axilar se apresenta mais comumente com seis ramos principais, tal qual descrita na literatura, porém em 32 por cento dos casos ela se mostrou com apenas cinco ramos. A presença de variaçäo da artéria axilar näo alterou o calibre dos seus principais ramos.