Association and Risk Factors of Osteonecrosis of Femoral Head in Sickle Cell Disease: A Systematic Review.

OBJECTIVE: The objective was to evaluate the level of evidence about the associated factors and the risk factors of osteonecrosis of femoral head (ONFH) in sickle cell individuals. METHODS: The review was based on the search and selection of studies available in the electronic databases PubMed, SCIELO, LILACS, BVS. As descriptors, the terms of Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) corresponding to "Osteonecrosis", "Necrosis avascular" and "Aseptic necrosis" and "Femoral head" and "sickle cell disease" and "risk factor" and "predictor". RESULTS: Among clinical and laboratorial factors the most promising risk factors were the severity of sickle cell disease and acute chest syndrome. As a result, from studies of a moderate level of quality, blood pressure, body weight, previous trauma, haemoglobin to haematocrit ratio (Hb/HCT), and number of hospitalizations can be highlighted. Others, such as genetic markers and male gender, have also been positively associated in lower quality studies. CONCLUSION: For a better clarification of what the risk factors are for the ONFH, it is necessary to study with populations of different origins, different ages, different profiles of Hb, which present greater methodological rigor and perform a multivariate analysis to control confounding factors. Further study is also needed to understand the genetic determinants of ONFH.

Cardiorespiratory Adaptation to Pilates Training.

Several authors report health improvements with training based on the Pilates Method; however, no explicit analysis has been performed on cardiorespiratory effects after Method exclusive training. Purpose: The purpose of this study was to evaluate the effects of 15 weeks of Pilates training on cardiorespiratory fitness in young, sedentary women. Method: A total of 13 sedentary women 21-35 years volunteered and signed an informed consent for the observational study of a single group, performing control-test, pre- and post-exercise measurements. The Pilates program was conducted for 15 weeks, with two 50-min sessions per week. Cardiorespiratory responses were assessed using an open circuit ergospirometry system by gas analyzer (MGC, model CPX/D). Results: During the 15-week program, statistically significant advances were observed in maximum oxygen consumption F (1.25; 13.78) = 18.95; p =.001; ω2 =.858 with large effect size (r =.81; p <.001), first ventilatory threshold F (1.19; 13.15) = 20.43; p =.001; ω2 =.034 with large effect size (r =.77; p <.05) and second ventilatory threshold F (1.18; 13.00) = 24.56; p =.001 also presenting a large effect size (r =.85; p <.05). Conclusion: These results indicate that practicing Pilates for 30 × 50 min sessions had a positive influence on cardiorespiratory parameters in healthy sedentary women with low respiratory capacities.

Evaluation of the effectiveness of wearing compression stockings for prevention of occupational edema in hairdressers.

BACKGROUND: Occupational lower limb edema is an important factor in deterioration of quality of life. Prevention involves prescription of prophylactic measures, such as wearing compression stockings. OBJECTIVES: To evaluate the effectiveness of compression stocking for prevention of occupational edema and its repercussions for the quality of life of hairdressers. METHODS: A clinical trial involving measurements of the ankles (point B) and calves (Point C) of 38 hairdressers without venous disease at the beginning and end of workdays spent wearing or not wearing compression stockings. Participants also answered a questionnaire about symptoms and quality of life in venous disease. RESULTS: Point B measurements were: 21.1 ± 2.2 cm in the morning without stockings; 22.1 ± 2.3 cm at the end of the day without stockings (p = 0.0001 compared to baseline without stockings); and 21.2 ± 2.1 cm at the end of the day wearing compression stockings (p = 0.0001 compared to the end of day not wearing compression stockings). The comparison between point B values for the start of the day without compression stockings and the end of the day with stockings (p = 0.324) was not significant, showing that there was no lower limb edema at the end of the working day when compression stockings were worn. Improvements were observed in ratings for limitations of work activities (p = 0.0001), domestic activities (p = 0.008) and leisure or social activities performed standing up(p = 0.0001). CONCLUSIONS: Compression stockings are effective for preventing occupational lower limb edema and the attenuation of symptoms such as pain and fatigue directly contributes to better quality of life for hairdressers.

FUNCTIONAL OUTCOME OF OBERLIN PROCEDURE.

OBJECTIVE: To evaluate the functional outcome of patients with traumatic brachial plexus injury undergoing the Oberlin procedure. METHODS: Eighteen patients were assessed, comprising 17 men (94.4%) and 1 woman (5.6%), mean age 29.5 years (range 17-46 years), with upper traumatic brachial plexus injury (C5-C6 and C5-C7). We assessed active range of motion of the elbow, elbow flexion muscle strength and hand-grip strength, and applied the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. RESULTS: Four patients (22.2%) did not achieve effective elbow flexion strength (BMRC Grade 3). Mean active range of motion was 100.2° (±45.6°), and we observed a mean percentage of strength recovery relative to the contralateral limb of 35.5% (0-66.3%). Elbow flexion (p = 0.0001) and hand-grip (p = 0.0001) strength levels were lower on the affected side. CONCLUSION: The surgical technique described by Oberlin for brachial plexus injuries proved effective for restoring elbow flexion and produced no functional sequelae in the hand. Bicep strength outcomes were better when surgery was performed within 12 months of injury. Level of evidence II, retrospective study.

OBJETIVO: Avaliar o resultado funcional dos pacientes com lesão traumática do plexo braquial submetidos à cirurgia de Oberlin. MÉTODOS: Foram analisados 18 pacientes, sendo 17 homens (94,4%), com idade média de 29,5 anos (17 a 46 anos), com lesão traumática alta do plexo braquial (C5-C6 e C5-C7). Avaliamos a amplitude de movimento ativa do cotovelo, a força muscular de flexão do cotovelo e a força de preensão palmar, e aplicamos o questionário Disabilities of the Arm, Shoulder and Hand (DASH). RESULTADOS: Quatro pacientes (22,2%) não obtiveram força eficaz de flexão do cotovelo BRMC (Grau 3). A amplitude de movimentação ativa apresentou média de 100,2° (± 45,6°) e observamos média de 35,5% (0 a 66,3%) de percentual de recuperação da força em relação ao membro contralateral. Foi observada menor força de flexão de cotovelo (p = 0,0001) e de preensão manual (p = 0,0001) no lado acometido. CONCLUSÃO: A cirurgia descrita por Oberlin para lesões do plexo braquial mostrou-se eficiente para a restauração da flexão do cotovelo e não deixou sequelas funcionais para a mão. Os resultados para a força do bíceps são melhores nas cirurgias realizadas com menos de 12 meses de lesão. Nível de evidência II, estudo retrospectivo.

Therapeutic and preventive effects of exercise on cardiometabolic parameters in aging and obese rats.

BACKGROUND AND AIMS: Aging, obesity and sedentarism are among the most important predictors of cardiometabolic diseases. Aiming to reduce the impact of the combination of these three factors, we tested the therapeutic and preventive effects of exercise in aging and obese rats on the following cardiometabolic disease risk parameters: body fat, blood pressure, blood lipids, and glycemic homeostasis. METHODS: Eighteen male Wistar rats (initial age = 4 months, and final age = 14 months) were randomly distributed into three aging and obese groups: sedentary, therapeutic exercise and preventive exercise. Food and caloric intake, body adiposity, muscle mass, cardiovascular parameters, biochemical markers, glycemic homeostasis, and gene expression of insulin-dependent, insulin-independent and insulin resistance pathways in skeletal muscle were evaluated. RESULTS: Therapeutic and preventive exercises were associated with higher food and caloric intake, and expression of TBC1D1 in the soleus muscle, as well as lower total cholesterol/HDL and LDL/HDL ratios, glucose levels at the end (90 min) of the glucose tolerance test and IKBKB expression in the gastrocnemius and soleus muscles. Only the preventive exercise improved the cardiovascular and body composition parameters, glucose tolerance, insulin resistance and insulin sensitivity, besides reducing total cholesterol, triglycerides, triglycerides/HDL ratio, plasmatic insulin and MAPK8 expression in soleus. The preventive exercise group also presented greater expression of INRS, IRS1, IRS2, PIK3CA, AKT1, and SLC2A4 in gastrocnemius and soleus, TBC1D1 in gastrocnemius, and AKT2 and PRKAA1 in soleus. CONCLUSIONS: Therapeutic exercise promoted some improvements on cardiometabolic parameters in aging and obese rats, however, the best benefits were achieved through the preventive exercise.