Negligência no diagnóstico precoce de hanseníase na atenção primária: um relato de caso / Negligence in the early diagnosis of leprosy in primary care: a case report

A hanseníase é uma doença infecciosa, transmissível, de caráter crônico, com potencial grau de incapacidade, que ainda persiste como problema de saúde pública no Brasil. A demora e a falta de conhecimento técnico para realizar o diagnóstico resulta em inúmeros prejuízos aos pacientes acometidos pela doença, sendo que, a prevenção das incapacidades está relacionada diretamente com o diagnóstico precoce da doença. Com a finalidade de evitar a negligência diagnóstica e o desenvolvimento de incapacidades físicas, ressaltamos a importância do conhecimento técnico sobre o diagnóstico e o manejo da hanseníase por profissionais da saúde em qualquer nível de atenção à saúde ou especialidade.

Hansen is an infectious disease, transmissible, of a chronic nature, with serious potential for disability, which still persists as a public health problem in Brazil. The delay and the lack of technical knowledge to carry out the diagnosis with numerous prejudices to the patients affected by the disease, since the prevention of disabilities is directly related to the early diagnosis of the disease. In order to avoid diagnostic negligence and the development of physical disabilities, we highlight the importance of technical knowledge about the diagnosis and management of training by health professionals at any level of health care or special care.

Reliability of the Theory of Mind Task Battery (ToM TB) to assess social cognition in post-stroke patients.

Theory of mind is the ability to understand, and infer thoughts or mental states to others. This is a central domain of social cognition that can be impaired after brain injury, resulting in changes in social skills and implications for rehabilitation.The aim of this investigation was to analyze the reliability of the Theory of Mind Task Battery (ToM TB) in post-stroke patients.This is a cross-sectional prospective study with psychometric characteristics, involving 38 patients diagnosed with ischemic or hemorrhagic stroke assessed by three examiners using the ToM TB scale, translated and adapted to Brazilian Portuguese. Satisfactory levels of interexaminer agreement were found for almost all categories of the ToM TB: Kappa ranged from 0.036 to 1.00, total score (ICC) from 0.958 to 0.999 and a Cronbach's alpha of 0.658 was obtained with the complete instrument.The Brazilian version of the ToM TB in post-stroke patients is a reliable instrument that can be used to assess the theory of mind, prognosis and rehabilitation of post-stroke patients.

Effects of home-based inspiratory muscle training on sickle cell disease (SCD) patients

ABSTRACT Introduction: Inspiratory muscle training (IMT) has been shown to be an efficient method of improving exercise tolerance and inspiratory and expiratory muscle strength in several diseases. The effects of IMT on patients with sickle cell anemia (SCD) are relatively unknown. Our study aimed to evaluate the effects of IMT on adult SCD patients, regarding respiratory muscle strength (RMS) variables, lung function, exercise tolerance, blood lactation concentration, limitation imposed by dyspnea during daily activities and impact of fatigue on the quality of life. Methods: This was a randomized single-blind study, with an IMT design comprising true load (TG) and sham load (SG) groups. Initial assessment included spirometry, volumetric capnography (VCap) and measurement of RMS by maximal inspiratory and expiratory pressure (PImax and PEmax). The Medical Research Council dyspnea scale and modified fatigue impact scale were also applied and blood lactate concentration was measured before and after the 6-minute walk test. After this initial assessment, the patient used the IMT device at home daily, returning every 6 weeks for RMS reassessment. Both groups used the same device and were unaware of which group they were in. After a period totaling 18 weeks, patients underwent the final evaluation, as initially performed. Results: Twenty-five patients in total participated until the end of the study (median age 42 years). There were no significant differences between TG and SG based on age, sex, body mass index or severity of genotype. At the end of the training, both groups showed a significant increase in PEmax and PImax, improvement in Vcap and in exercise tolerance and dyspnea reduction while performing daily life activities. The same was observed in patients grouped according to disease severity (HbSS and HbSβ0 vs HbSC and HbSβ+), without differences between groups. Conclusion: Home-based inspiratory muscle training benefits outpatients with SCD, including the sham load group. Trial registration:http://www.ensaiosclinicos.gov.br; registration number: RBR-6g8n92.

Risco de Morte em Idosos com Sonolência Excessiva Diurna, Insônia e Depressão: Estudo de Coorte Prospectiva em População Urbana no Nordeste Brasileiro / Risk of Death in the Elderly with Excessive Daytime Sleepiness, Insomnia and Depression: Prospective Cohort Study in an Urban Population in Northeast Brazil

Resumo Fundamento A íntima relação entre a regulação do sono e os eventos cardiovasculares é um dos principais focos de investigação na medicina contemporânea. Hábitos e características do sono interferem na ritmicidade cardíaca e também na expectativa de vida, principalmente em idosos. Objetivo Estimar o risco de óbito e de eventos cardiovasculares em idosos comunitários que apresentam queixa de insônia e sonolência excessiva diurna ao longo de oito anos de seguimento. Método Foi desenhada uma coorte prospectiva com 160 idosos, a primeira onda em 2009 e a segunda em 2017. Os grupos de seguimento foram determinados pela exposição ou não às queixas de insônia primária e a sonolência excessiva diurna, com ou sem ronco. As covariáveis sexo, estado conjugal, depressão, hipertensão e diabetes foram controladas. O desfecho primário foi o óbito e o secundário, os eventos cardiocerebrovasculares (ECV). As probabilidades dos desfechos foram estimadas pelo risco relativo (RR), através da regressão de Poisson, adotando-se α ≤ 0,05. Resultados Registraram-se 40 mortes no período (25,97%:19,04-32,89) e 48 ECVs (30,76%:23,52-38,01). Os homens apresentaram maior risco (RR = 1,88;1,01-3,50) de óbito. A depressão (RR = 2,04;1,06-3,89), a gravidade da insônia (RR = 2,39;1,52-4,56) e a latência do sono entre 16-30 minutos (RR = 3,54;1,26-9,94) e 31-60 minutos (RR = 2,23;1,12-4,47) aumentaram independentemente o risco de óbito em idosos comunitários. Os ECVs foram preditos apenas por idosos hipertensos e/ou diabéticos (RR = 8,30; 1,98-34,82). Conclusão A mortalidade em idosos é influenciada pelo estado emocional e pela dificuldade de dormir, diferentemente dos ECVs, condicionados apenas pelas condições pressóricas arteriais e metabólicas.

Abstract Background The close relationship between sleep regulation and cardiovascular events is one of the main focuses of research in contemporary medicine. Sleep habits and characteristics interfere with the cardiac rhythm and also with life expectancy, especially in the elderly. Objective To estimate the risk of death and cardiovascular events in community-dwelling elderly individuals complaining of insomnia and excessive daytime sleepiness over eight years of follow-up. Method A prospective cohort was designed with 160 elderly, with the first wave occurring in 2009 and the second in 2017. Follow-up groups were determined by exposure or not to complaints of primary insomnia and excessive daytime sleepiness with or without snoring. The covariates gender, marital status, depression, hypertension and diabetes were controlled. The primary outcome was death and the secondary outcome was cardio-cerebrovascular events (CCV). Outcome risks were estimated by relative risk (RR) through Poisson regression, adopting α≤0.05. Results There were 40 (25.97%: 19.04-32.89) deaths over the period and 48 (30.76%: 23.52-38.01) CCV. Men had a higher risk (RR = 1.88; 1.01-3.50) of death. Depression (RR = 2.04; 1.06-3.89), insomnia severity (RR = 2.39; 1.52-4.56) and sleep latency between 16-30 minutes (RR = 3, 54; 1.26-9.94) and 31-60 minutes (RR = 2.23; 1.12-4.47) increased the risk of death independently in community-dwelling elderly. CCV were predicted only in the hypertensive and / or diabetic elderly (RR = 8.30; 1.98-34.82). Conclusion Mortality in the elderly is influenced by the emotional state and difficulty in falling asleep, unlike CCVs, which are conditioned only by arterial and metabolic blood pressure conditions.

Effectiveness of a home-based therapeutic exercise program on lower back pain and functionality in Sickle Cell Disease (SCD) patients

ABSTRACT Objective: To investigate the effectiveness of a home-based therapeutic exercise program on lower back pain and functionality of SCD patients. Setting: A Hematology and Transfusion Medicine Center, University of Campinas (HEMOCENTRO-UNICAMP). Methods: This was a prospective study, with a three-month follow-up of SCD patients with lower back pain. The lumbar spine functionality was evaluated by questionnaires, trunk flexion and extension analyses by fiber-optic-electrogoniometry and measurements of muscle strength of trunk flexor and extensors. The Intervention Group (IG) comprised 18 volunteers, median age 44y (28-58) and the control group (CG) comprised 15 volunteers, median age 42y (19-58), who did not perform exercises. The protocol consisted of daily home-based exercises with two evaluations: at the beginning and end of a three-month program. In order to compare the groups at baseline, the Fishers´ exact test and Mann-Whitney test were used for categorical and numeric variables, respectively. The Wilcoxon test was used for related samples comparing numeric measures of each group over time with a 5% (p < 0.05) significance level. Results: After the intervention, patients demonstrated a significant improvement, according to the Visual-Analog-Scale (VAS; p = 0.01), Rolland Morris Disability questionnaire (RMDQ; p < 0.01) and trunk flexion and extension muscle strength (p < 0.01). No significant differences were found for the Start-Back-Screening-Tool-Brazil (SBST) and in measures of trunk flexion and extension range-of-motion (RoM). Conclusion: Results suggest that daily home-based exercises for a three-month period ameliorate pain and improve disability related to lower back pain and muscle strength.

Risk of Death in the Elderly with Excessive Daytime Sleepiness, Insomnia and Depression: Prospective Cohort Study in an Urban Population in Northeast Brazil. / Risco de Morte em Idosos com Sonolência Excessiva Diurna, Insônia e Depressão: Estudo de Coorte Prospectiva em População Urbana no Nordeste Brasileiro.

BACKGROUND: The close relationship between sleep regulation and cardiovascular events is one of the main focuses of research in contemporary medicine. Sleep habits and characteristics interfere with the cardiac rhythm and also with life expectancy, especially in the elderly. OBJECTIVE: To estimate the risk of death and cardiovascular events in community-dwelling elderly individuals complaining of insomnia and excessive daytime sleepiness over eight years of follow-up. METHOD: A prospective cohort was designed with 160 elderly, with the first wave occurring in 2009 and the second in 2017. Follow-up groups were determined by exposure or not to complaints of primary insomnia and excessive daytime sleepiness with or without snoring. The covariates gender, marital status, depression, hypertension and diabetes were controlled. The primary outcome was death and the secondary outcome was cardio-cerebrovascular events (CCV). Outcome risks were estimated by relative risk (RR) through Poisson regression, adopting α≤0.05. RESULTS: There were 40 (25.97%: 19.04-32.89) deaths over the period and 48 (30.76%: 23.52-38.01) CCV. Men had a higher risk (RR = 1.88; 1.01-3.50) of death. Depression (RR = 2.04; 1.06-3.89), insomnia severity (RR = 2.39; 1.52-4.56) and sleep latency between 16-30 minutes (RR = 3, 54; 1.26-9.94) and 31-60 minutes (RR = 2.23; 1.12-4.47) increased the risk of death independently in community-dwelling elderly. CCV were predicted only in the hypertensive and / or diabetic elderly (RR = 8.30; 1.98-34.82). CONCLUSION: Mortality in the elderly is influenced by the emotional state and difficulty in falling asleep, unlike CCVs, which are conditioned only by arterial and metabolic blood pressure conditions.

FUNDAMENTO: A íntima relação entre a regulação do sono e os eventos cardiovasculares é um dos principais focos de investigação na medicina contemporânea. Hábitos e características do sono interferem na ritmicidade cardíaca e também na expectativa de vida, principalmente em idosos. OBJETIVO: Estimar o risco de óbito e de eventos cardiovasculares em idosos comunitários que apresentam queixa de insônia e sonolência excessiva diurna ao longo de oito anos de seguimento. MÉTODO: Foi desenhada uma coorte prospectiva com 160 idosos, a primeira onda em 2009 e a segunda em 2017. Os grupos de seguimento foram determinados pela exposição ou não às queixas de insônia primária e a sonolência excessiva diurna, com ou sem ronco. As covariáveis sexo, estado conjugal, depressão, hipertensão e diabetes foram controladas. O desfecho primário foi o óbito e o secundário, os eventos cardiocerebrovasculares (ECV). As probabilidades dos desfechos foram estimadas pelo risco relativo (RR), através da regressão de Poisson, adotando-se α ≤ 0,05. RESULTADOS: Registraram-se 40 mortes no período (25,97%:19,04-32,89) e 48 ECVs (30,76%:23,52-38,01). Os homens apresentaram maior risco (RR = 1,88;1,01-3,50) de óbito. A depressão (RR = 2,04;1,06-3,89), a gravidade da insônia (RR = 2,39;1,52-4,56) e a latência do sono entre 16-30 minutos (RR = 3,54;1,26-9,94) e 31-60 minutos (RR = 2,23;1,12-4,47) aumentaram independentemente o risco de óbito em idosos comunitários. Os ECVs foram preditos apenas por idosos hipertensos e/ou diabéticos (RR = 8,30; 1,98-34,82). CONCLUSÃO: A mortalidade em idosos é influenciada pelo estado emocional e pela dificuldade de dormir, diferentemente dos ECVs, condicionados apenas pelas condições pressóricas arteriais e metabólicas.

Effects of attentional focus on upper extremity motor performance in post stroke patients: A randomized pilot study.

INTRODUCTION: To facilitate the command to the learner, therapist can use verbal cues for guidance: internal focus (own body) and external focus (consequence of movement in the environment). OBJECTIVE: To examine the effects of different attentional focus on upper limb motor performance in post-stroke. METHODS: Randomized controlled trial with 2 groups. Study realized at Integrated Clinic of the Faculty of Health Science at Trairi (Santa Cruz, Rio Grande do Norte, Brazil). Twelve participants allocated into 2 groups. Two motor tasks were used: task 1, reach-point; task 2, reach-grasp-fit, with the paretic extremity, using verbal commands directed by a trained therapist. In the first phase, Group 1 received commands with internal focus, while Group 2 was instructed with commands with external focus. After 1 week, the command type was changed between groups. The variables collected was movement time, velocity and number of peaks velocity. RESULTS: Both attentional focus promoted significant differences in movement time and velocity, however, only Internal Focus provided significant results in both tasks of the same variables. DISCUSSION: The benefits of 1 attentional focus on the other are not fully confirmed. However, not receiving any kind of attention guidance compromises motor performance. The results support the hypothesis that the benefits of the External Focus are accentuated when preceded by the Internal Focus. CLINICAL TRIAL REGISTRATION: Research Ethics Committee of the Faculty of Helth Science at Trairi (Facisa - UFRN)- Number CAAE 2.625.609, approved on April 13, 2018; Brazilian Registry of Clinical Trials - RBR-4995cr approved on July 4, 2019 retrospectively registered (http://www.ensaiosclinicos.gov.br/rg/RBR-4995cr/).

Group-based constraint-induced movement therapy in the rehabilitation of chronic poststroke patients.

BACKGROUND: This study aimed to describe the effects of a 90-minute group-based constraint-induced movement therapy protocol (CIMT) on upper extremity (UE) rehabilitation in poststroke patients. METHOD: The study was a case series clinical study with 6 patients with chronic stroke admitted to the institutional integrated clinic. Ten 90-minute CIMT sessions were administered, based on the principles of the original therapy. On completion of the protocol, participants underwent group care once a week, for 1 hour a day. For comparison purposes, the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM) were applied on admission, shortly after completing the protocol, and 3 months after completion. In addition, the MAL and shaping tasks were applied daily. RESULTS: There was a statistically significant difference only in the MAL Amount of Use Scale applied daily between the 2nd (3.56) and 9th (3.31) and 2nd and 10th days (4.49) (P = .004), with a moderate effect size (d' = 0.46), and in the average value of shaping repetitions between the 1st (16.10) and 2nd (6.00) and 1st and 10th tasks (7.00) (P = .014), with a moderate effect size (d' = 0.35). CONCLUSION: The 90-minute CIMT protocol resulted in significant improvements in use of the more affected arm in activities of daily living during the 2-week protocol. Additional research with a larger sample and a control group is needed to confirm its effectiveness.

Effects of home-based inspiratory muscle training on sickle cell disease (SCD) patients.

INTRODUCTION: Inspiratory muscle training (IMT) has been shown to be an efficient method of improving exercise tolerance and inspiratory and expiratory muscle strength in several diseases. The effects of IMT on patients with sickle cell anemia (SCD) are relatively unknown. Our study aimed to evaluate the effects of IMT on adult SCD patients, regarding respiratory muscle strength (RMS) variables, lung function, exercise tolerance, blood lactation concentration, limitation imposed by dyspnea during daily activities and impact of fatigue on the quality of life. METHODS: This was a randomized single-blind study, with an IMT design comprising true load (TG) and sham load (SG) groups. Initial assessment included spirometry, volumetric capnography (VCap) and measurement of RMS by maximal inspiratory and expiratory pressure (PImax and PEmax). The Medical Research Council dyspnea scale and modified fatigue impact scale were also applied and blood lactate concentration was measured before and after the 6-minute walk test. After this initial assessment, the patient used the IMT device at home daily, returning every 6 weeks for RMS reassessment. Both groups used the same device and were unaware of which group they were in. After a period totaling 18 weeks, patients underwent the final evaluation, as initially performed. RESULTS: Twenty-five patients in total participated until the end of the study (median age 42 years). There were no significant differences between TG and SG based on age, sex, body mass index or severity of genotype. At the end of the training, both groups showed a significant increase in PEmax and PImax, improvement in Vcap and in exercise tolerance and dyspnea reduction while performing daily life activities. The same was observed in patients grouped according to disease severity (HbSS and HbSß0vs HbSC and HbSß+), without differences between groups. CONCLUSION: Home-based inspiratory muscle training benefits outpatients with SCD, including the sham load group. TRIAL REGISTRATION: http://www.ensaiosclinicos.gov.br; registration number: RBR-6g8n92.

Effectiveness of a home-based therapeutic exercise program on lower back pain and functionality in Sickle Cell Disease (SCD) patients.

OBJECTIVE: To investigate the effectiveness of a home-based therapeutic exercise program on lower back pain and functionality of SCD patients. SETTING: A Hematology and Transfusion Medicine Center, University of Campinas (HEMOCENTRO-UNICAMP). METHODS: This was a prospective study, with a three-month follow-up of SCD patients with lower back pain. The lumbar spine functionality was evaluated by questionnaires, trunk flexion and extension analyses by fiber-optic-electrogoniometry and measurements of muscle strength of trunk flexor and extensors. The Intervention Group (IG) comprised 18 volunteers, median age 44y (28-58) and the control group (CG) comprised 15 volunteers, median age 42y (19-58), who did not perform exercises. The protocol consisted of daily home-based exercises with two evaluations: at the beginning and end of a three-month program. In order to compare the groups at baseline, the Fisher´s exact test and Mann-Whitney test were used for categorical and numeric variables, respectively. The Wilcoxon test was used for related samples comparing numeric measures of each group over time with a 5% (p < 0.05) significance level. RESULTS: After the intervention, patients demonstrated a significant improvement, according to the Visual-Analog-Scale (VAS; p = 0.01), Rolland Morris Disability questionnaire (RMDQ; p < 0.01) and trunk flexion and extension muscle strength (p < 0.01). No significant differences were found for the Start-Back-Screening-Tool-Brazil (SBST) and in measures of trunk flexion and extension range-of-motion (RoM). CONCLUSION: Results suggest that daily home-based exercises for a three-month period ameliorate pain and improve disability related to lower back pain and muscle strength.

Kaurenoic acid and its sodium salt derivative: antibacterial activity against Porphyromonas gingivalis and their mechanism of action.

AIM: To evaluate the antibacterial activity of 12 kaurane-type diterpenes against a panel of bacteria that cause endodontic infection. METHODS & MATERIALS: We conducted tests against bacteria in the planktonic or in the sessile mode, cytotoxic assays for the most promising compounds against human normal lung fibroblast cells, and Porphyromonas gingivalis (ATCC 33277) proteomic analysis. RESULTS & CONCLUSION: Kaurenoic acid and its salt exhibited satisfactory antibacterial action against the evaluated bacteria. Proteomic analysis suggested that these compounds might interfere in bacterial metabolism and virulence factor expression. Kaurane-type diterpenes are an important class of natural products and should be considered in the search for new irrigating solutions to treat endodontic infections.

Translation, and interobserver and test-retest reliability of the Brazilian Portuguese version of Children's Hospital Oakland Hip Evaluation Scale for patients with sickle cell disease

ABSTRACT Background: The Children's Hospital Oakland Hip Evaluation Scale is a disease-specific tool for the clinical and functional assessment of the hip in sickle cell disease. Objectives: To translate the tool into Brazilian Portuguese and evaluate the interobserver and test-retest reliability. Methods: Eighteen patients diagnosed with sickle cell disease and a mean age of 49 ± 11.9 years participated in the study. The scale was applied by two evaluators who did not speak to each other regarding their understanding of the tool and who had no prior training. Interobserver and test-retest reliability of individual items and of the total score were evaluated using the intraclass correlation coefficient and the Bland-Altman method. Results: When the overall score for each hip was considered, the test-retest intraclass correlation coefficient score for the right hip was 0.95 (0.89-0.98) and for the left hip it was 0.96 (0.91-0.98). Considering all assignments (total score), the score was 0.96 (0.90-0.98). The test-retest intraclass correlation coefficient varied from 0.76 to 1 for 18 of the 27 items (excellent) and from 0.53 to 0.75 for nine items (moderate). When the overall score for each hip was considered, the interobserver intraclass correlation coefficient for both hips was 0.94 (0.86-0.98). Considering all assignments, the total score was 0.94 (0.86-0.98). The interobserver intraclass correlation coefficient varied from 0.48 to 0.75 for 18 out of 27 items (moderate) and varied from 0.77 to 1 for the remaining nine items (excellent). Conclusion: The results demonstrate that the Brazilian version of the Children's Hospital Oakland Hip Evaluation Scale presented adequate interobserver and test-retest reliability and that the version can be used to evaluate clinical function in sickle cell disease patients, producing consistent, standardized and reproducible results.

Translation, and interobserver and test-retest reliability of the Brazilian Portuguese version of Children's Hospital Oakland Hip Evaluation Scale for patients with sickle cell disease.

BACKGROUND: The Children's Hospital Oakland Hip Evaluation Scale is a disease-specific tool for the clinical and functional assessment of the hip in sickle cell disease. OBJECTIVES: To translate the tool into Brazilian Portuguese and evaluate the interobserver and test-retest reliability. METHODS: Eighteen patients diagnosed with sickle cell disease and a mean age of 49±11.9 years participated in the study. The scale was applied by two evaluators who did not speak to each other regarding their understanding of the tool and who had no prior training. Interobserver and test-retest reliability of individual items and of the total score were evaluated using the intraclass correlation coefficient and the Bland-Altman method. RESULTS: When the overall score for each hip was considered, the test-retest intraclass correlation coefficient score for the right hip was 0.95 (0.89-0.98) and for the left hip it was 0.96 (0.91-0.98). Considering all assignments (total score), the score was 0.96 (0.90-0.98). The test-retest intraclass correlation coefficient varied from 0.76 to 1 for 18 of the 27 items (excellent) and from 0.53 to 0.75 for nine items (moderate). When the overall score for each hip was considered, the interobserver intraclass correlation coefficient for both hips was 0.94 (0.86-0.98). Considering all assignments, the total score was 0.94 (0.86-0.98). The interobserver intraclass correlation coefficient varied from 0.48 to 0.75 for 18 out of 27 items (moderate) and varied from 0.77 to 1 for the remaining nine items (excellent). CONCLUSION: The results demonstrate that the Brazilian version of the Children's Hospital Oakland Hip Evaluation Scale presented adequate interobserver and test-retest reliability and that the version can be used to evaluate clinical function in sickle cell disease patients, producing consistent, standardized and reproducible results.

Effect of a probiotic beverage consumption (Enterococcus faecium CRL 183 and Bifidobacterium longum ATCC 15707) in rats with chemically induced colitis.

BACKGROUND: Some probiotic strains have the potential to assist in relieving the symptoms of inflammatory bowel disease. The impact of daily ingestion of a soy-based product fermented by Enterococcus faecium CRL 183 and Lactobacillus helveticus 416 with the addition of Bifidobacterium longum ATCC 15707 on chemically induced colitis has been investigated thereof within a period of 30 days. METHODS: Colitis was induced by dextran sulfate sodium. The animals were randomly assigned into five groups: Group C: negative control; Group CL: positive control; Group CLF: DSS with the fermented product; Group CLP: DSS with the non-fermented product (placebo); Group CLS: DSS with sulfasalazine. The following parameters were monitored: disease activity index, fecal microbial analyses, gastrointestinal survival of probiotic microorganisms and short-chain fatty acids concentration in the feces. At the end of the protocol the animals' colons were removed so as to conduct a macroscopical and histopathological analysis, cytokines and nitrite quantification. RESULTS: Animals belonging to the CLF group showed fewer symptoms of colitis during the induction period and a lower degree of inflammation and ulceration in their colon compared to the CL, CLS and CLP groups (p<0.05). The colon of the animals in groups CL and CLS presented severe crypt damage, which was absent in CLF and CLP groups. A significant increase in the population of Lactobacillus spp. and Bifidobacterium spp. at the end of the protocol was verified only in the CLF animals (p<0.05). This group also showed an increase in short-chain fatty acids (propionate and acetate). Furthermore, the intestinal survival of E. faecium CRL 183 and B. longum ATCC 15707 in the CLF group has been confirmed by biochemical and molecular analyzes. CONCLUSIONS: The obtained results suggest that a regular intake of the probiotic product, and placebo to a lesser extent, can reduce the severity of DSS-induced colitis on rats.

Evidence for a Negative Cooperativity between eIF5A and eEF2 on Binding to the Ribosome.

eIF5A is the only protein known to contain the essential and unique amino acid residue hypusine. eIF5A functions in both translation initiation due to its stimulation of methionyl-puromycin synthesis and translation elongation, being highly required for peptide-bound formation of specific ribosome stalling sequences such as poly-proline. The functional interaction between eIF5A, tRNA, and eEF2 on the surface of the ribosome is further clarified herein. Fluorescence anisotropy assays were performed to determine the affinity of eIF5A to different ribosomal complexes and reveal its interaction exclusively and directly with the 60S ribosomal subunit in a hypusine-dependent manner (Ki60S-eIF5A-Hyp = 16 nM, Ki60S-eIF5A-Lys = 385 nM). A 3-fold increase in eIF5A affinity to the 80S is observed upon charged-tRNAiMet binding, indicating positive cooperativity between P-site tRNA binding and eIF5A binding to the ribosome. Previously identified conditional mutants of yeast eIF5A, eIF5AQ22H/L93F and eIF5AK56A, display a significant decrease in ribosome binding affinity. Binding affinity between ribosome and eIF5A-wild type or mutants eIF5AK56A, but not eIF5AQ22H/L93F, is impaired in the presence of eEF2 by 4-fold, consistent with negative cooperativity between eEF2 and eIF5A binding to the ribosome. Interestingly, high-copy eEF2 is toxic only to eIF5AQ22H/L93F and causes translation elongation defects in this mutant. These results suggest that binding of eEF2 to the ribosome alters its conformation, resulting in a weakened affinity of eIF5A and impairment of this interplay compromises cell growth due to translation elongation defects.

Oscilação oral de alta frequência e fibrose cística: comparação entre instrumentais / High-frequency oral oscillation and cystic fibrosis: a comparison between instruments

Objetivos: Avaliar e comparar o efeito do Flutter VRP1® e do Shaker® referente à quantidade de secreção pulmonar expectorada e aos parâmetros cardiorrespiratórios de frequência cardíaca (fc) e de saturação periférica de oxigênio (SpO2). Método: Neste estudo randomizado do tipo intervencional, 16 pacientes, com idades entre 7 e 21 anos (12 anos ±4,11), realizaram sessões de fisioterapia em dois dias diferentes com ambos os dispositivos. Na primeira sessão, os participantes utilizaram um dos dispositivos, conforme o resultado da randomização. E, após sete dias sem intervenção, na segunda sessão, usaram o outro dispositivo. Verificaram-se os parâmetros cardiorrespiratórios de fc e SpO2 e registraram-se tais valores antes e ao final de cada coleta em cada dia de terapia. Colheu-se secreção pulmonar durante e após a terapia para determinação dos pesos seco e úmido. Resultados: Não houve diferença entre os dispositivos quanto a peso úmido (p=0,589) e seco (p=0,719) e parâmetros cardiorrespiratórios de fc e SpO2. Conclusão: Os dispositivos foram semelhantes em relação às variáveis analisadas

Objectives: To evaluate and compare the effect of Flutter VRP1® and Shaker® on the amount of expectorated pulmonary secretions and on heart rate (HR) and peripheral oxygen saturation (SO2) cardiorespiratory parameters. Method: In this randomized interventional study, 16 patients, aged between 7 and 21 years (12 years±4.11), performed physiotherapy sessions on two different days with both devices. In the first session, participants used one of the devices, according to the randomization. After seven days without intervention, they underwent a second session with the other device. The cardiorespiratory parameters of HR and SO2 were recorded immediately before and after each session on every day of therapy. The collection of pulmonary secretions was conducted during and after therapy to determine the dry and wet weights. Results: There was no difference between the devices as to the wet weight (p=0.589) and dry weight (p=0.719) nor HR and SO2 cardiorespiratory parameters. Conclusion: The devices were similar in relation to the analyzed variables.

Influência do estado nutricional na percepção da imagem corporal e autoestima de idosas / Influence of nutritional status in the perception of body image and self-steem in elderly woman

OBJETIVO: Verificar a relação entre o índice de massa corpórea, a autoestima e a autoimagem corporal de idosas participantes de grupos da terceira idade. MÉTODOS: Estudo transversal por amostragem casual e assistemática. Participaram do estudo 50 idosas residentes no município de João Pessoa-PB. As variáveis pesquisadas foram: sexo, idade, estado civil, renda, escolaridade e índice de massa corpórea. A análise da percepção da imagem corporal foi realizada utilizando-se a escala de nove silhuetas (Sorensen & Stunkard). Para avaliar a autoestima, utilizou-se a Escala de Autoestima de Rosenberg. RESULTADOS: Não se observou significância estatística entre as variáveis estudadas. A média de idade das idosas foi 72,12 (6,14). O índice de massa corpórea apresentou média de 26,91 Kg/m², sendo verificado excesso de peso em 51,02%; a maior parte das idosas (90,60%) apresentou autoestima satisfatória, embora mais da metade (79,31%) delas se encontrasse acima do peso ideal; 87,50% estavam insatisfeitas com seu próprio corpo devido ao excesso de peso. CONCLUSÃO: Embora os dados não tenham mostrado significância estatística entre as variáveis, os resultados sugerem que, apesar de a maioria das idosas estar com excesso de peso, a autoestima apresentou nível satisfatório, enquanto a percepção da autoimagem corporal foi insatisfatória.

OBJECTIVE: To investigate the relationship between body mass index, self-esteem and body self-image of elderly participants in groups of seniors. METHODS: Cross-sectional study by casual and unsystematic sampling. Participated in the study 50 elderly residents in the city of João Pessoa-PB. The variables investigated were: sex, age, marital status, income, education and body mass index. The analysis of body image perception was performed using the Nine-figure Outline Scale ( Sorensen & Stunkard). RESULTS: There was no statistical significance between variables. The mean age was 72.12 (6.14). The body mass index had an average of 26.91 kg/m², with overweight observed in 51.02% of this population; most women (90.60%) showed good self-esteem, although half (79.31%) of these were above ideal weight; 87.50% were dissatisfied with their own bodies due to excess weight. CONCLUSION: Although the data did not show statistical significance between the variables, the results suggest that, although most elderly women were overweight, self-esteem showed satisfactory level while the perception of body self-image was unsatisfactory.

Pilot randomized controlled trial to evaluate the effect of aquatic and land physical therapy on musculoskeletal dysfunction of sickle cell disease patients

Objective: To compare the effect of aquatic and land-based physiotherapy in reducing musculoskeletal hip and lower back pain and increasing overall physical capabilities of sickle cell disease patients. Methods: Informed written consent was obtained from all volunteers who were submitted to evaluations using different functional scales: Lequesne's Algofunctional Questionnaire and Oswestry Disability Index, trunk and hip range of motion, goniometry, trunk and hip muscle strength assessment using load cell, and surface electromyography of the iliocostalis, long dorsal (longissimus), gluteus maximus, gluteus medius and tensor fasciae latae muscles. Ten patients were randomized into two groups: aquatic physiotherapy with a mean age of 42 years (range: 25-67) and conventional physiotherapy with a mean age of 49 years (range: 43-59). Both groups were submitted to a twelve-week program of two sessions weekly. Results: After the intervention, significant improvements were observed regarding the Lequesne index (p-value = 0.0217), Oswestry Disability Index (p-value = 0.0112), range of motion of trunk extension (p-value = 0.0320), trunk flexion muscle strength (p-value = 0.0459), hip extension and abduction muscle strength (p-value = 0.0062 and p-value = 0.0257, respec- tively). Range of motion of trunk and hip flexion, extension, adduction and abduction, trunk extensor muscle strength and all surface electromyography variables showed no significant statistical difference. Conclusion: Physical therapy is efficient to treat musculoskeletal dysfunctions in sickle cell disease patients, irrespective of the technique; however, aquatic therapy showed a trend toward improvement in muscle strength. Further studies with a larger patient sample and longer periods of therapy are necessary to confirm these results.

Pilot randomized controlled trial to evaluate the effect of aquatic and land physical therapy on musculoskeletal dysfunction of sickle cell disease patients.

OBJECTIVE: To compare the effect of aquatic and land-based physiotherapy in reducing musculoskeletal hip and lower back pain and increasing overall physical capabilities of sickle cell disease patients. METHODS: Informed written consent was obtained from all volunteers who were submitted to evaluations using different functional scales: Lequesne's Algofunctional Questionnaire and Oswestry Disability Index, trunk and hip range of motion, goniometry, trunk and hip muscle strength assessment using load cell, and surface electromyography of the iliocostalis, long dorsal (longissimus), gluteus maximus, gluteus medius and tensor fasciae latae muscles. Ten patients were randomized into two groups: aquatic physiotherapy with a mean age of 42 years (range: 25-67) and conventional physiotherapy with a mean age of 49 years (range: 43-59). Both groups were submitted to a twelve-week program of two sessions weekly. RESULTS: After the intervention, significant improvements were observed regarding the Lequesne index (p-value=0.0217), Oswestry Disability Index (p-value=0.0112), range of motion of trunk extension (p-value=0.0320), trunk flexion muscle strength (p-value=0.0459), hip extension and abduction muscle strength (p-value=0.0062 and p-value=0.0257, respectively). Range of motion of trunk and hip flexion, extension, adduction and abduction, trunk extensor muscle strength and all surface electromyography variables showed no significant statistical difference. CONCLUSION: Physical therapy is efficient to treat musculoskeletal dysfunctions in sickle cell disease patients, irrespective of the technique; however, aquatic therapy showed a trend toward improvement in muscle strength. Further studies with a larger patient sample and longer periods of therapy are necessary to confirm these results.

Hypusine modification of the ribosome-binding protein eIF5A, a target for new anti-inflammatory drugs: understanding the action of the inhibitor GC7 on a murine macrophage cell line.

Inflammation is part of an important mechanism triggered by the innate immune response that rapidly responds to invading microorganisms and tissue injury. One important elicitor of the inflammatory response is the Gram-negative bacteria component lipopolysaccharide (LPS), which induces the activation of innate immune response cells, the release of proinflammatory cytokines, such as interleukin 1 and tumor necrosis factor α(TNF-α), and the cellular generation of nitric oxide (NO) by the inducible nitric oxide synthase (iNOS). Although essential to the immune response, uncontrolled inflammatory responses can lead to pathological conditions, such as sepsis and rheumatoid arthritis. Therefore, identifying cellular targets for new anti-inflammatory treatments is crucial to improving therapeutic control of inflammation-related diseases. More recently, the translation factor eIF5A has been demonstrated to have a proinflammatory role in the release of cytokines and the production of NO. As eIF5A requires and essential and unique modification of a specific residue of lysine, changing it to hypusine, eIF5A is an interesting cellular target for anti-inflammatory treatment. The present study reviews the literature concerning the anti-inflammatory effects of inhibiting eIF5A function. We also present new data showing that the inhibition of eIF5A function by the small molecule GC7 significantly decreases TNF-α release without affecting TNF-α mRNA levels. We discuss the mechanisms by which eIF5A may interfere with TNF-α mRNA translation by binding to and regulating the function of ribosomes during protein synthesis.