Effects of adding scapular stabilization exercises to a periscapular strengthening exercise program in patients with subacromial pain syndrome: A randomized controlled trial.

BACKGROUND: Interventions focused on the scapula should be considered in treating subacromial pain syndrome (SAPS). However, the effect of adding scapular stabilization exercises to protocols of progressive strengthening of the shoulder complex muscles on a non-multimodal approach remains unclear. OBJECTIVE: To investigate the effect of adding scapular stabilization exercises, emphasizing retraction, and depression of the scapula, to a progressive periscapular strengthening protocol on disability, pain, muscle strength, and ROM in patients with SAPS. DESIGN: Randomized, controlled, superiority trial, prospectively registered, two-arms, parallel, blind assessor, blind patient, and allocation concealment. METHODS: Sixty patients with SAPS were randomly allocated into two groups: Periscapular Strengthening (PSG) or Scapular Stabilization (SSG) exercises. The interventions were performed three times a week for eight weeks. The primary outcome function and secondary outcomes (Pain, kinesiophobia, global perceived effect, satisfaction with treatment, the range of motion, scapula position and muscle strength) were measured in the baseline, four weeks, eight weeks (end of intervention) and 16 weeks after baseline. Shoulder pain and function were assessed by the Brazilian version of the Shoulder Pain and Disability Index (SPADI-Br). RESULTS: A total of 60 patients were included and randomized to PSG (n = 30) or SSG (n = 30) from March 2016 to June 2017. There were no between group differences in primary and secondary outcomes at any time point. CONCLUSION: The inclusion of the isolated scapular stabilization exercises, emphasizing retraction and depression of the scapula, to a progressive general periscapular strengthening protocol did not add benefits to self-reported shoulder pain and disability, muscle strength, and ROM in patients with SAPS. TRIAL REGISTRATION: ClinicalTrials.gov.

Lipoabdominoplasty: repercussions for diaphragmatic mobility and lung function in healthy women.

OBJECTIVE: To evaluate the impact of lipoabdominoplasty on diaphragmatic mobility (DM) and lung function in healthy women. METHODS: This was a prospective cohort study using high-resolution ultrasound and forced spirometry to assess DM and lung function, respectively, prior to lipoabdominoplasty, as well as on postoperative day (POD) 10 and POD 30. DM was measured under two conditions: during tidal volume breathing and during a VC maneuver. RESULTS: The sample consisted of 20 women, with a mean age of 39.85 ± 7.52 years and a mean body mass index of 26.21 ± 2.0 kg/m2. Comparing the preoperative and postoperative periods, we found that DM and lung function values were significantly lower after lipoabdominoplasty, the mean DM on POD 10 being 17% and 15% lower during tidal volume breathing and during the VC maneuver, respectively, in comparison with the preoperative mean (p = 0.009 and p < 0.001, respectively). In addition, FEV1, FVC, and PEF were significantly lower on POD 10 than in the preoperative period (p = 0.046, p = 0.002, and p < 0.001, respectively), returning to preoperative values by POD 30. CONCLUSIONS: Lipoabdominoplasty appears to have negative short-term repercussions for DM and lung function in healthy women. However, lung function and DM are both apparently restored to preoperative conditions by POD 30. (ClinicalTrials.gov identifier: NCT02762526 [http://www.clinicaltrials.gov/]).

Lipoabdominoplasty: repercussions for diaphragmatic mobility and lung function in healthy women / Lipoabdominoplastia: repercussão na mobilidade diafragmática e função pulmonar em mulheres saudáveis

ABSTRACT Objective: To evaluate the impact of lipoabdominoplasty on diaphragmatic mobility (DM) and lung function in healthy women. Methods: This was a prospective cohort study using high-resolution ultrasound and forced spirometry to assess DM and lung function, respectively, prior to lipoabdominoplasty, as well as on postoperative day (POD) 10 and POD 30. DM was measured under two conditions: during tidal volume breathing and during a VC maneuver. Results: The sample consisted of 20 women, with a mean age of 39.85 ± 7.52 years and a mean body mass index of 26.21 ± 2.0 kg/m2. Comparing the preoperative and postoperative periods, we found that DM and lung function values were significantly lower after lipoabdominoplasty, the mean DM on POD 10 being 17% and 15% lower during tidal volume breathing and during the VC maneuver, respectively, in comparison with the preoperative mean (p = 0.009 and p < 0.001, respectively). In addition, FEV1, FVC, and PEF were significantly lower on POD 10 than in the preoperative period (p = 0.046, p = 0.002, and p < 0.001, respectively), returning to preoperative values by POD 30. Conclusions: Lipoabdominoplasty appears to have negative short-term repercussions for DM and lung function in healthy women. However, lung function and DM are both apparently restored to preoperative conditions by POD 30. (ClinicalTrials.gov identifier: NCT02762526 [http://www.clinicaltrials.gov/])

RESUMO Objetivo: Avaliar o impacto da lipoabdominoplastia na mobilidade diafragmática (MD) e na função pulmonar de mulheres saudáveis. Métodos: Estudo prospectivo de coorte com ultrassonografia de alta resolução e espirometria forçada para a avaliação da MD e da função pulmonar, respectivamente, antes da lipoabdominoplastia, no 10º dia do pós-operatório e no 30º dia do pós-operatório. A MD foi medida durante a respiração em volume corrente e durante uma manobra de CV. Resultados: A amostra foi composta por 20 mulheres, com média de idade de 39,85 ± 7,52 anos e média de índice de massa corporal de 26,21 ± 2,0 kg/m2. Ao compararmos os períodos pré e pós-operatório, observamos que a MD e a função pulmonar foram significativamente menores após a lipoabdominoplastia; a média de MD no 10º dia do pós-operatório foi 17% menor durante a respiração em volume corrente e 15% menor durante a manobra de CV do que a média pré-operatória (p = 0,009 e p < 0,001, respectivamente). Além disso, o VEF1, a CVF e o PFE foram significativamente menores no 10º dia do pós-operatório que no pré-operatório (p = 0,046, p = 0,002 e p < 0,001, respectivamente), retornando aos valores pré-operatórios até o 30º dia do pós-operatório. Conclusões: A lipoabdominoplastia parece ter repercussões negativas em curto prazo na MD e função pulmonar de mulheres saudáveis. No entanto, tanto a função pulmonar como a MD aparentemente retornam ao estado pré-operatório até o 30º dia do pós-operatório. (ClinicalTrials.gov identifier: NCT02762526 [http://www.clinicaltrials.gov/])

Study of Complications of Varicella-Zoster Virus Infection in Hospitalized Children at a Reference Hospital for Infectious Disease Treatment.

OBJECTIVES: Varicella is a disease with potentially severe complications. We aimed to investigate characteristics of hospitalized children with varicella in Brazil in the prevaccine period and to identify predictors for requiring intensive care treatment. METHODS: A prospective cohort study was conducted from May 2011 to April 2014. Patients up to 13 years of age with varicella diagnosis were included. Information was collected through interview and review of medical records. Logistic regression analysis was performed. RESULTS: A total of 669 patients were admitted. The median age of subjects was 2.7 years (range 0-14 years) with a predominance of boys (56.6%). The main causes of hospitalization were bacterial complications (77.7%), viral complications (11.4%), and at-risk patients (10.9%). Main bacterial complications were skin infection and pneumonia. Main viral complications were herpes zoster, cerebellitis, and encephalitis. Most at-risk patients used corticosteroids or had a diagnosis of leukemia. At-risk patients were hospitalized earlier (P < .01) and remained hospitalized for longer periods (P = .03). A total of 44 patients (6.6%) were admitted to the ICU, and 5 (0.8%) died of septic shock. Thrombocytopenia was associated with more severe illness in patients with bacterial infections (P = .001). The long-time interval between onset of infection and admission was associated with the need for intensive care in all groups (P = .007). CONCLUSIONS: Secondary bacterial infection is the main cause of hospitalization, and thrombocytopenia in these patients leads to worse outcomes. Difficulties of access to the health system and delay in medical care are determining factors of greater severity in this population.

Avaliação nutricional em pacientes críticos: revisão de literatura / Nutritional assessment in critically ill patients: literature review

Introdução: O paciente internado em Unidade de Terapia Intensiva (UTI) necessita de cuidados clínicos imediatos e intensivos, tornando-se assim indispensável a elaboração e utilização de proto- colos de avaliação nutricional, visando à monitorização da alteração do estado nutricional no decorrer da internação. O diagnóstico nutricional bem definido favorece uma terapia nutricional pertinente ao quadro clínico atual do paciente, com metas calóricas e proteicas individualizadas, objetivando melhor desfecho clínico. Método: Realizamos uma revisão junto à literatura sobre os instrumentos de avaliação nutricional para pacientes críticos, incluindo métodos subjetivos e objetivos, dentre eles a antropometria, avaliação bioquímica e metabólica. A pesquisa da literatura foi realizada por meio das bases de dados eletrônicas SciELO, Lilacs, Capes, Bireme e PubMed, utilizando-se os descritores: "Nutritional assessment", "critical ill", "intensive care unit" e "visceral proteins". Foram utilizados artigos científicos publicados entre 1919 a 2016 e capítulos de livros. Resultados: Os estudos demonstram que existem muitas limitações para avaliação nutricional em pacientes críticos. Os tradicionais marcadores de proteína do soro, como albumina, pré-albumina, transferrina e proteína transportadora de retinol, apresentam um reflexo da resposta na fase aguda da doença, não sendo bem precisos nas alterações do estado nutricional do paciente crítico. Níveis individuais de PCR, interleucina-1, TNF e interleucina-6 são utilizados como marcadores inflamatórios. A antropometria é utilizada na avaliação do estado nutricional, porém no paciente crítico medidas simples, como peso e altura, nem sempre são possíveis de serem aferidas. Para avaliação metabólica, sugere- se a utilização da calorimetria indireta, preconizada como padrão ouro para estimar o gasto energético, não sendo possível, fórmulas preditivas podem ser utilizadas. Conclusões: É de suma importância a determinação e o acompanhamento do estado nutricional, porém a má nutrição no paciente crítico tem sido sempre difícil de definir, sendo fundamental a realização de mais estudos e protocolos para obtenção de um método específico para pacientes internados em UTI.(AU)

Introduction: The patient hospitalized in the Intensive Care Unit (ICU) requires immediate and intensive medical care, thus becoming essential to development and use of nutritional assessment protocols to the monitoring of changes in nutritional status during hospitalization. The well defined nutritional diagnosis favors an appropriate nutritional therapy to the current clinical status of the patient, individualized calorie and protein targets, aiming to better clinical outcome. Methods: We reviewed with the literature on the nutritional assessment tools for critical patients, including subjective and objective methods, including anthropometry, biochemical and metabolic evalu- ation. The literature search was conducted through electronic databases SciELO, Lilacs, Capes, Bireme and PubMed, using the key words: "Nutritional assessment", "critical ill", "intensive care unit" and "visceral proteins". We used scientific papers published between 1919-2016 and book chapters. Results: Studies show that there are many limitations for nutritional assessment in critically ill patients. Traditional serum protein markers, such as albumin, prealbumin, transferrin, retinol protein, carrier have a response reflecting the acute phase of the disease, not being very precise in the changes in the nutritional status of critically ill patients. Since the individual CRP, interleukin-1, TNF and interleukin-6 are used as inflammation markers. Anthropometry, used to assess nutritional status, but in critically ill patients simple measures such as weight and height are not always able to be measured. For metabolic assessment suggests the use of indirect calorimetry, advocated the gold standard to estimate energy expenditure, failing that, predictive formulas can be used. Conclusions: Determining and monitoring of nutritional status is very important, but malnutrition in the patient critic has always been difficult to define, it is essential to further studies and protocols to obtain a specific method for ICU patients.(AU)