Risk factors for hospital mortality in intensive care unit survivors: a retrospective cohort study.

BACKGROUND: Deaths can occur after a patient has survived treatment for a serious illness in an intensive care unit (ICU). Mortality rates after leaving the ICU can be considered indicators of health care quality. This study aims to describe risk factors and mortality of surviving patients discharged from an ICU in a university hospital. METHODS: Retrospective cohort study carried out from January 2017 to December 2018. Data on age, sex, length of hospital stay, diagnosis on admission to the ICU, hospital discharge outcome, presence of infection, and Simplified Acute Physiology Score (SAPS) III prognostic score were collected. Infected patients were considered as those being treated for an infection on discharge from the ICU. Patients were divided into survivors and non-survivors on leaving the hospital. The association between the studied variables was performed using the logistic regression model. RESULTS: A total of 1,025 patients who survived hospitalization in the ICU were analyzed, of which 212 (20.7%) died after leaving the ICU. When separating the groups of survivors and non-survivors according to hospital outcome, the median age was higher among non-survivors. Longer hospital stays and higher SAPS III values were observed among non-survivors. In the logistic regression, the variables age, length of hospital stay, SAPS III, presence of infection, and readmission to the ICU were associated with hospital mortality. CONCLUSIONS: Infection on ICU discharge, ICU readmission, age, length of hospital stay, and SAPS III increased risk of death in ICU survivors.

Desenvolvimento e validação de um questionário de qualidade de vida em indivíduos com lesão da medula espinal / Development and validation of a quality of life questionnaire for individuals with spinal cord injury

Objetivo: Criar e testar as propriedades psicométricas de um instrumento específico para quantificação da qualidade de vida de indivíduos com lesão da medula espinal. Método: A partir dos métodos de consenso existentes, foi escolhida a técnica Delphi para criação do questionário e o SF-36 como método critério. Resultados: A consistência interna foi α=0,827. A confiabilidade intra e interavaliadores se mostram alta pelo coeficiente de correlação intraclasse e teste de bland e altman pela diferença da média. Pode-se observar correlações fortes entre o QVLM e SF-36 nos domínios capacidade funcional e aspectos físicos e correlação moderada nos domínios estado de saúde e aspectos emocionais. Houve diferença significante entre as quatro aplicações do QVLM demonstrando que o questionário é sensível à mudança. Conclusão: O QVLM foi criado com metodologia adequada e a avaliação das propriedades psicométricas traduzem em um instrumento válido, confiável, consistente e sensível a mudanças

Objective: Create and test the psychometric proprieties of the specific instrument for the quantification of the quality of life in subjects with spinal cord injuries. Methods: From the existing consensus methods was chosen the Delphi technique for the creation of the questionnaire and the SF-36 for criteria method. Results: The internal consistence was α=0,827. The intra and inter evaluators confidence shows itself high by the intra class correlation coefficient and the Brand and Altman test by the difference of average. Can be observed strong correlations between the QVLM and SF-36 in the functional capacity and physical aspects domains and moderate correlation in the health state and emotional aspects domains. There was a significant difference between the four applications of QVLM, demonstrating that the questionnaire is sensible to change. Conclusion: The QVLM was created with a suitable methodology and the evaluation of the psychometrics proprieties turn out to be on a valid, reliable, consisting and sensible to changes instrument

Quedas e fatores associados em idosos trabalhadores de uma instituição de ensino superior / Falls and associated factors among older workers in a university

Objetivo: Analisar fatores associados a quedas em idosos servidores de uma instituição de ensino superior pública. Métodos: Estudo transversal, com idosos trabalhadores de idade igual ou superior a 60 anos. Foi utilizado um questionário estruturado abordando aspectos sociodemográficos, ocupacionais e ocorrência de quedas nos últimos 12 meses. Instrumentos utilizados: Escala de Depressão Geriátrica, Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire, Timed Up and Go Test, Teste de "Sentar e Levantar" da cadeira 5 vezes, Velocidade da Marcha, Equilíbrio Estático e Força de Preensão Manual. Resultados: Participaram do estudo 254 idosos trabalhadores, 76% pertenciam à faixa etária entre 60 a 64 anos e 58,7% eram do sexo masculino. A amostra foi dividida em dois grupos, caidores e não caidores e a prevalência de quedas nos últimos doze meses foi de 21,3% ± 2,72 (IC 95% = 15,92-26,58). Verificou-se associação significativa entre queda e sexo (p = 0,043), hospitalização nos últimos 12 meses (p = 0,000) e velocidade da marcha (p = 0,007). No modelo de regressão Poisson permaneceram as três variáveis associadas à queda: sexo masculino (RPaj = 0,62 IC 95% 0,40-0,98); velocidade da marcha adequada (RPaj = 0,46 IC 95% 0,26-0,81) e hospitalização nos últimos 12 meses (RPaj = 2,79 IC 95% 1,80-4,32). Conclusão: Estudo identificou uma menor prevalência de quedas nesta população e verificou a relação positiva entre trabalho e envelhecimento, no qual os idosos que continuam trabalhando tendem a apresentar melhores condições de saúde que a população de idosos em geral

Objective: To analyze factors associated with falls among older workers in a public university. Methods: Cross-sectional study, with workers aged 60 or more. A structured questionnaire was used to cover socio-demographic and occupational characteristics and the occurrence of falls over the last 12 months. Instruments used: Geriatric Depression Scale, Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire, Timed Up and Go Test (TUG), Sitting-Rising Test (SRT), Gait Speed, Static Balance, and Grip strength. Results: The study included 254 older workers, 76% belonged to the age group between 60-64 years and 58.7% were male. The sample was divided into two groups, fallers and non-fallers, and the prevalence of falls over the last twelve months was 21.3% ± 2.72 (95% CI = 15.92-26.58). There was a significant association between falls and gender (p = 0.043), hospitalization over the last 12 months (p = 0.000), and gait speed (p = 0.007). In the Poisson regression model the three variables remained associated with falling: male gender (PRaj = 0.62, CI = 95% 0.40-0.98); suitable gait speed (PRaj = 0.46, CI = 95% 0.26-0.81), and hospitalization over the last 12 months (PRaj = 2.79, CI = 95% 1.80-4.32). Conclusion: The study identified a lower prevalence of falls in this group and found a positive relationship between work and the aging process, which proves that seniors who keep on working are healthier than the general population of the elderly

Validation of the Brazilian version of the neurological fatigue index for multiple sclerosis.

UNLABELLED: The Neurological Fatigue Index for Multiple Sclerosis (NFI-MS) is a new fatigue assessment instrument. The aim of this study was to cross-culturally adapt and assess the psychometric properties of the Brazilian version of the NFI-MS (NFI-MS/BR). METHOD: Two hundred and forty subjects with MS were recruited for this study. The adaptation of the NFI-MS was performed by translation and back translation methodology. In psychometric analysis was performed the administration of the questionnaires Epworth Sleep Scale, Fatigue Severity Scale, Modified Fatigue Impact Scale, Multiple Sclerosis Impact Scale-29, NFI-MS/BR and Pittsburgh Sleep Quality Index with retest of the NFI-MS/BR after 7 days. RESULTS: Reliability was assessed (intraclass correlation coefficients between 0.77 and 0.86), and validity by testing 41 hypotheses about expected correlations between subscales and confirmed 36. The majority of correlations were demonstrated. CONCLUSION: The NFI-MS/BR is a cross-culturally adapted, valid, and reliable instrument for assessing MS fatigue among Brazilian subjects.

Validation of the Brazilian version of the neurological fatigue index for multiple sclerosis / Validação da versão brasileira do índice neurológico de fadiga na esclerose múltipla

ABSTRACT The Neurological Fatigue Index for Multiple Sclerosis (NFI-MS) is a new fatigue assessment instrument. The aim of this study was to cross-culturally adapt and assess the psychometric properties of the Brazilian version of the NFI-MS (NFI-MS/BR). Method Two hundred and forty subjects with MS were recruited for this study. The adaptation of the NFI-MS was performed by translation and back translation methodology. In psychometric analysis was performed the administration of the questionnaires Epworth Sleep Scale, Fatigue Severity Scale, Modified Fatigue Impact Scale, Multiple Sclerosis Impact Scale-29, NFI-MS/BR and Pittsburgh Sleep Quality Index with retest of the NFI-MS/BR after 7 days. Results Reliability was assessed (intraclass correlation coefficients between 0.77 and 0.86), and validity by testing 41 hypotheses about expected correlations between subscales and confirmed 36. The majority of correlations were demonstrated. Conclusion The NFI-MS/BR is a cross-culturally adapted, valid, and reliable instrument for assessing MS fatigue among Brazilian subjects.

RESUMO O índice neurológico de fadiga na esclerose múltipla (EM) (NFI-MS) é um novo instrumento de avaliação da fadiga. O objetivo deste estudo foi adaptar transculturalmente e avaliar as propriedades psicométricas da versão Brasileira do NFI-MS (NFI-MS/BR). Método Duzentos e quarenta indivíduos com EM participaram deste estudo. A adaptação do NFI-MS/BR foi feita por meio de tradução e retrotradução. Na análise psicométrica foi realizada administração dos questionários Escala de Sono de Epworth, Escala de Severidade de Fadiga, Escala Modificada de Impacto de Fadiga, Escala de Impacto de EM, NFI-MS/BR e Índice de Qualidade de Sono de Pittsburgh com reteste do NFI-MS/BR em 7 dias. Resultados A confiabilidade foi avaliada (coeficiente de correlação intraclasse entre 0,77 e 0,86), e a validade foi avaliada testando 41 hipóteses sobre as correlações esperadas com confirmação de 36 hipóteses. A maioria das correlações da validade de constructo foi demonstrada. Conclusão O NFI-MS/BR é um instrumento adaptado transculturalmente, válido e confiável para avaliar fadiga em indivíduos brasileiros com EM.

Highly specific changes in antioxidant levels and lipid peroxidation in Parkinson's disease and its progression: Disease and staging biomarkers and new drug targets.

There is evidence that immune-inflammatory, stress of reactive oxygen and nitrogen species (IO&NS) processes play a role in the neurodegenerative processes observed in Parkinson's disease (PD). The aim of the present study was to investigate peripheral IO&NS biomarkers in PD. We included 56 healthy individuals and 56 PD patients divided in two groups: early PD stage and late PD stage. Plasma lipid hydroperoxides (LOOH), malondialdehyde (MDA), nitric oxide metabolites (NOx), sulfhydryl (SH) groups, catalase (CAT) activity, superoxide dismutase (SOD) activity, paraoxonase (PON)1 activity, total radical trapping antioxidant parameter (TRAP) and C-reactive protein (CRP) were measured. PD is characterized by increased LOOH, MDA and SOD activity and lowered CAT activity. A combination of five O&NS biomarkers highly significantly predicts PD with a sensitivity of 94.5% and a specificity of 86.8% (i.e., MDA, SOD activity, TRAP, SH-groups and CAT activity). The single best biomarker of PD is MDA, while LOOH and SOD activity are significantly associated with late PD stage, but not early PD stage. Antiparkinson drugs did not affect O&NS biomarkers, but levodopa+carbidopa significantly increased CRP. It is suggested that MDA may serve as a disease biomarker, while LOOH and SOD activity are associated with late PD stage characteristic. New treatments for PD should not only target dopamine but also lipid peroxidation.

Assessment of fatigue in multiple sclerosis: methodological quality of adapted original versions available in Brazil of self-report instruments / Evaluación de fatiga en la esclerosis múltiple: cualidad metodológica de las versiones originales ajustadas en Brasil de los instrumentos de autoinforme / Avaliação da fadiga na esclerose múltipla: qualidade metodológica das versões originais adaptadas no Brasil dos instrumentos de autorrelato

Assessment of fatigue in multiple sclerosis is a difficult task and its instruments have no uniformity regarding the methodological evaluation parameters to ensure validity and reliability of its inferences. The objective of this study was to analyze the methodological quality of development, cross-cultural adaptation to Portuguese language (Brazil), and psychometric properties of self-report instruments that assess fatigue in multiple sclerosis and are available in Brazil. A search was conducted in the electronic databases LILACS, MEDLINE, Embase, PsycINFO, CINAHL, SciELO and SPORTDiscus with analysis of the selected instruments by consensus-based standards for the selection of health measurement instruments. It was included 10 articles and presented the instruments Fatigue Severity Scale (FSS), Modified Fatigue Impact Scale (MFIS), Cognitive and Physical Fatigue in Multiple Sclerosis Scale (CPF-MS), Guy's Neurological Disability Scale (GNDS), Functional Assessment of Multiple Sclerosis (FAMS), and their adapted versions in Brazil. Most instruments present a multidimensional structure with documented cross-cultural adaptation in Brazil and emphasize the physical domain and adequate reliability. There is difficulty in identifying a self-report instrument to adequately assess fatigue in multiple sclerosis and that is an example of methodological and psychometric standards in their design and management.

La evaluación de fatiga en la esclerosis múltiple es una tarea difícil y sus instrumentos no disponen de uniformidad cuanto a los parámetros de evaluación metodológica para garantir la validad y confiabilidad de sus inferencias. El objetivo de eso estudio fue analizar la cualidad metodológica del desarrollo, de la adaptación transcultural para el idioma portugués (Brasil) y de las propiedades psicométricas de los instrumentos de autoinforme que evalúan la fatiga en la esclerosis múltiple y están disponibles en Brasil. Se realizó una búsqueda electrónica en las bases de datos LILACS, MEDLINE, Embase, PsycINFO, CINAHL, SciELO e SPORTDiscus, con un análisis de los instrumentos seleccionados por el consenso de parámetros para seleccionar instrumentos en el área de la salud. Fueron inclusos diez artículos y presentados la Fatigue Severity Scale (FSS), la Modified Fatigue Impact Scale (MFIS), la escala de fatiga cognitiva y física en la esclerosis múltiple (CPF-MS), la escala de incapacidad neurológica de Guy (GNDS), la Functional Assessment of Multiple Sclerosis (FAMS) y sus respectivas versiones ajustadas en Brasil. La mayoría de los instrumentos es multidimensional, específica, con documentada adaptación transcultural y predominio de la evaluación del dominio físico de la fatiga y evidencia de la confiabilidad adecuada. Hubo dificultad en identificarse un instrumento de autoinforme, que haga una evaluación adecuada de la fatiga en la esclerosis múltiple y sea ejemplo de los estándares metodológicos y psicométricos en su concepción y administración.

A avaliação da fadiga na esclerose múltipla é uma tarefa difícil e seus instrumentos não dispõem de uniformidade quanto aos parâmetros de avaliação metodológica para assegurar validade e confiabilidade de suas inferências. O objetivo deste estudo foi analisar a qualidade metodológica do desenvolvimento, da adaptação transcultural para a língua portuguesa (Brasil) e das propriedades psicométricas dos instrumentos de autorrelato que avaliam a fadiga na esclerose múltipla e estão disponíveis no Brasil. Foi realizada uma busca eletrônica nas bases de dados LILACS, MEDLINE, Embase, PsycINFO, CINAHL, SciELO e SPORTDiscus, com análise dos instrumentos selecionados pelo consenso de parâmetros para selecionar instrumentos na área da saúde. Foram incluídos dez artigos e apresentados os instrumentos Fatigue Severity Scale (FSS), Modified Fatigue Impact Scale (MFIS), escala de fadiga cognitiva e física na esclerose múltipla (CPF-MS), escala de incapacidade neurológica de Guy (GNDS), Functional Assessment of Multiple Sclerosis (FAMS) e suas respectivas versões adaptadas no Brasil. A maioria dos instrumentos é multidimensional, específica, com documentada adaptação transcultural e predomínio de avaliação do domínio físico da fadiga e evidência de confiabilidade adequada. Houve dificuldade em se identificar um instrumento de autorrelato, que avalie adequadamente a fadiga na esclerose múltipla e seja exemplo de padrões metodológicos e psicométricos em sua concepção e administração.

Análise do nível de concordância interobservadores na avaliação postural estática em idosos residentes no município de São Paulo / Analysis of the level of interobserver agreement in static postural assessment in elderly people living in São Paulo

Introdução: Diversos instrumentos de avaliação postural sãodescritos na literatura, porém não existe um consenso de qual seriao melhor método utilizado na prática clínica. Sabe-se que examesposturais precisos podem ser realizados com equipamentos simples,de baixo custo e fácil aplicabilidade. Como exemplo desses instrumentos,destacam-se o fio de prumo e o simetrógrafo. Entretanto,estes se caracterizam por serem métodos qualitativos e subjetivos.Objetivo: Nosso estudo teve como objetivo analisar o nível deconcordância interobservadores na avaliação postural em idososresidentes no município de São Paulo. Métodos: Durante a avaliaçãofoi utilizado o simetrógrafo e o fio de prumo, além de fotografiasnas vistas anterior, posterior, lateral direita e esquerda. Essa avaliaçãocontou com a participação de dois observadores, simultaneamentee sem comunicação. Para análise da concordância interobservadoresutilizou-se o teste de concordância de Kappa, com nível de significânciap < 0,001. Resultados: Cento e sessenta (160) idosos foramavaliados, sendo 104 mulheres e 56 homens, com idade 72,1 ± 7,1anos. Verificou-se um bom nível de concordância interobservadoresna avaliação postural dos idosos, destacando-se boa concordância em16 variáveis analisadas, com valor mínimo de 0,813 e valor máximode 0,949 e apenas duas categorias apresentaram baixa concordância,sendo valor mínimo de 0,737 e máximo de 0,750. Conclusão:A avaliação postural, realizada através do simetrógrafo e do fio deprumo, obteve bom nível de concordância entre os observadores.Por serem instrumentos de fácil aplicabilidade, baixo custo e grandepraticidade, recomenda-se seu uso nas avaliações posturais em idosos.

Introduction: Several postural assessment tools are described inthe literature, but there is no consensus as to the best method to beused in clinical practice. It is known that postural accurate tests canbe performed with simple equipment, low cost and easy applicability.As an example of these instruments, we highlight the plumb lineand squared. However, these methods are characterized as qualitativeand subjective. Aim: Our study aimed to analyze the level of interobserveragreement in evaluating postural elderly residents in thecity of São Paulo. Methods: During evaluation we used the squaredand plumb line, plus anterior, posterior, right and left side images.This evaluation included the participation of two observers simultaneouslyand without communication. For analysis of interobserveragreement we used the Kappa concordance test, with significancelevel of p < 0.001. Results: One hundred and sixty (160) seniorswere evaluated, including 104 women and 56 men, mean age 72,1± 7,1 years old. There was a good level of interobserver agreementin the assessment of postural elderly, especially good agreement on16 variables, with a minimum of 0.813 and maximum of 0.949and only two categories showed poor agreement, with minimumand maximum of 0.737 and 0.750 respectively. Conclusion: Posturalassessment, conducted by squared and plumb line, got good levelof agreement between observers. Because they are instruments ofeasy application, low cost and great practicality, we recommend itsuse in postural assessments in the elderly.

The effectiveness of aquatic physical therapy in the treatment of fibromyalgia: a systematic review with meta-analysis.

OBJECTIVE: To assess the effectiveness of aquatic physical therapy in the treatment of fibromyalgia. DATA SOURCES: The search strategy was undertaken using the following databases, from 1950 to December 2012: MEDLINE, EMBASE, CINAHL, LILACS, SCIELO, WEB OF SCIENCE, SCOPUS, SPORTDiscus, Cochrane Library Controlled Trials Register, Cochrane Disease Group Trials Register, PEDro and DARE. REVIEW METHODS: The studies were separated into groups: Group I - aquatic physical therapy × no treatment, Group II - aquatic physical therapy × land-based exercises and Group III - aquatic physical therapy × other treatments. RESULTS: Seventy-two abstracts were found, 27 of which met the inclusion criteria. For the functional ability (Fibromyalgia Impact Questionnaire), three studies were considered with a treatment time of more than 20 weeks and a mean difference (MD) of -1.35 [-2.04; -0.67], P = 0.0001 was found in favour of the aquatic physical therapy group versus no treatment. The same results were identified for stiffness and the 6-minute walk test where two studies were pooled with an MD of -1.58 [-2.58; -0.58], P = 0.002 and 43.5 (metres) [3.8; 83.2], P = 0.03, respectively. CONCLUSION: Three meta-analyses showed statistically significant results in favour of the aquatic physical therapy (Fibromyalgia Impact Questionnaire, stiffness and the 6-minute walk test) during a period of longer than 20 weeks. Due to the low methodological rigor, the results were insufficient to demonstrate statistical and clinical differences in most of the outcomes.

The effectiveness of postoperative physical therapy treatment in patients who have undergone arthroscopic partial meniscectomy: systematic review with meta-analysis.

STUDY DESIGN: Systematic review with meta-analysis. OBJECTIVES: To evaluate the effectiveness of postoperative physical therapy treatment for patients who have undergone arthroscopic partial meniscectomy. BACKGROUND: There is no consensus on which treatment is best for patients post meniscectomy. METHODS: A search for articles published from 1950 to March 2013 was conducted in the MEDLINE, Embase, CINAHL, LILACS, SciELO, IBECS, Scopus, Web of Science, PEDro, Academic Search Premier, and Cochrane Central Register of Controlled Trials databases. The key words were physiotherapy, physical therapy modalities, exercise therapy, rehabilitation, knee, placebo, groups, tibial meniscus, meniscus, arthroscopy, meniscectomy, partial meniscectomy, randomized controlled trial, controlled clinical trial, randomized, systematic review, and meta-analysis. RESULTS: Eighteen randomized controlled trials were included in the review, 6 of which were included in the meta-analysis. Outpatient physical therapy plus a home exercise program, compared to a home program alone, improved function compared to a home program alone (mean difference, 10.3; 95% confidence interval: 1.3, 19.3; P = .02) and knee flexion range of motion (mean difference, 9.1; 95% confidence interval: 3.7, 14.5; P = .0009). Inpatient physical therapy alone compared to inpatient plus outpatient physical therapy reduced the likelihood of effusion (odds ratio = 0.25; 95% confidence interval: 0.10, 0.61; P = .003). CONCLUSION: Physical therapy associated with home exercises seems to be effective in improving patient-reported knee function and range of motion in patients post-arthroscopic meniscectomy, although the included randomized controlled trials were classified from moderate to high risk of bias and should be interpreted with caution. LEVEL OF EVIDENCE: Therapy, level 1a-.

Quality of life of primary caregivers of spinal cord injury survivors.

The aim of this study was to analyze quality of life of caregivers who are relatives of patients with spine cord injury (SCI). Fourteen women (seven caregivers and seven controls) were evaluated by the Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) and the Caregiver Burden Scale (CBS) Questionnaires. The data from both questionnaires were compared using the Mann-Whitney U testing procedure for differences between caregivers and controls (p<0.05). The results from SF-36 were not statistically significant between groups, however, for the CBS data, there were significant differences between groups (p>0.05), characterized by the percentage difference of 62%, 66.7%, 55%, 50%, 57% and 63% for tension, isolation, disappointment, emotional involvement, environment and overall score, respectively. The CBS questionnaire was more adequate for verifying quality of life of caregivers of SCI patients, and caregiving may have a negative impact on their quality of life.

Quality of life of primary caregivers of spinal cord injury survivors / Qualidade de vida de cuidadores familiares de pessoas com lesão da medula espinal / Calidad de vida de cuidadores familiares de personas con lesión de medula espinal

The aim of this study was to analyze quality of life of caregivers who are relatives of patients with spine cord injury (SCI). Fourteen women (seven caregivers and seven controls) were evaluated by the Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) and the Caregiver Burden Scale (CBS) Questionnaires. The data from both questionnaires were compared using the Mann-Whitney U testing procedure for differences between caregivers and controls (p<0.05). The results from SF-36 were not statistically significant between groups, however, for the CBS data, there were significant differences between groups (p>0.05), characterized by the percentage difference of 62%, 66.7%, 55%, 50%, 57% and 63% for tension, isolation, disappointment, emotional involvement, environment and overall score, respectively. The CBS questionnaire was more adequate for verifying quality of life of caregivers of SCI patients, and caregiving may have a negative impact on their quality of life.

Este estudo objetivou avaliar a qualidade de vida de cuidadores familiares de pacientes com Lesão da medula espinal (LM). Quatorze mulheres (sete cuidadoras familiares e sete controles) foram submetidas à avaliação pelo questionário Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) e pelo questionário Caregiver Burden Scale (CBS). Utilizou-se o Teste de Mann-Whitney (p<0,05) para comparação entre os grupos acerca dos escores obtidos para os dois questionários. Para o primeiro questionário (SF-36) não houve diferença significativa entre os grupos, porém para o segundo questionário (CBS) os resultados apresentaram diferença estatisticamente significativa (p>0,05), caracterizada pela diferença percentual de 62%, 66,7%, 55%, 50%, 57% e 63%, para tensão geral, isolamento, decepção, envolvimento emocional, ambiente e escore global, respectivamente. O questionário CBS mostrou-se adequado para verificar a qualidade de vida dos cuidadores de pessoas com LM e o ato de cuidar produz um impacto negativo sobre a qualidade de vida destes.

Este estudio objetivó evaluar la calidad de vida de los cuidadores familiares de pacientes con Lesión de Médula Espinal (LM). Catorce mujeres (siete cuidadores familiares y 7 controles) se sometieron a la evaluación del cuestionario SF-36 y el cuestionario CBS. Para la comparación entre los grupos acerca de los cuestionarios se utilizó el test de Mann-whitney (p<0,05 ). Para el SF-36 no hubo diferencia significativa entre los grupos, pero para el CBS los resultados fueron estadisticamente significativos (p>0,05), por la diferencia de porcentaje del del 62 %, 66,7 %, 55 %, 50 %, 57 % y 63 %, para una tensión general, aislamiento, decepción, implicación emocional, el medio ambiente y puntuación global, respectivamente. El cuestionario CBS ha demostrado ser apropiado para comprobar la calidad de vida de los cuidadores de personas con LM y el ato de cuidar produce un impacto negativo sobre la calidad de vida de estos.

HLA-A, B and DRB1 allele and haplotype frequencies in volunteer bone marrow donors from the north of Parana State.

BACKGROUND: Knowledge of allele and haplotype frequencies of the human leukocyte antigen (HLA) system is important in the search for unrelated bone marrow donors. The Brazilian population is very heterogeneous and the HLA system is highly informative of populations because of the high level of polymorphisms. AIM: The aim of this study was to characterize the immunogenetic profile of ethnic groups (Caucasians, Afro-Brazilians and Asians) in the north of Parana State. METHODS: A study was carried out of 3978 voluntary bone marrow donors registered in the Brazilian National Bone Marrow Donor Registry and typed for the HLA-A, B and DRB1 (low resolution) loci. The alleles were characterized by the polymerase chain reaction sequence-specific oligonucleotides method using the LabType SSO kit (One Lambda, CA, USA). The ARLEQUIN v.3.11 computer program was used to calculate allele and haplotype frequencies RESULTS: The most common alleles found in Caucasians were HLA-A*02, 24, 01; HLA-B*35, 44, 51; DRB1*11, 13, 07; for Afro-Brazilians they were HLA-A*02, 03, 30; HLA-B*35, 15, 44; DRB1*13, 11, 03; and for Asians they were: HLA-A*24, 02, 26; HLA-B*40, 51, 52; DRB1*04, 15, 09. The most common haplotype combinations were: HLA-A*01, B*08, DRB1*03 and HLA-A*29, B*44, DRB1*07 for Caucasians; HLA-A*29, B*44, DRB1*07 and HLA-A*01, B*08 and DRB1*03 for Afro-Brazilians; and HLA-A*24, B*52, DRB1*15 and HLA-A*24, B*40 and DRB1*09 for Asians. CONCLUSION: There is a need to target and expand bone marrow donor campaigns in the north of Parana State. The data of this study may be used as a reference by the Instituto Nacional de Cancer/Brazilian National Bone Marrow Donor Registry to evaluate the immunogenetic profile of populations in specific regions and in the selection of bone marrow donors.

HLA-A, B and DRB1 allele and haplotype frequencies in volunteer bone marrow donors from the north of Parana state

BACKGROUND: Knowledge of allele and haplotype frequencies of the human leukocyte antigen (HLA) system is important in the search for unrelated bone marrow donors. The Brazilian population is very heterogeneous and the HLA system is highly informative of populations because of the high level of polymorphisms. AIM: The aim of this study was to characterize the immunogenetic profile of ethnic groups (Caucasians, Afro-Brazilians and Asians) in the north of Parana State. METHODS: A study was carried out of 3978 voluntary bone marrow donors registered in the Brazilian National Bone Marrow Donor Registry and typed for the HLA-A, B and DRB1 (low resolution) loci. The alleles were characterized by the polymerase chain reaction sequence-specific oligonucleotides method using the LabType SSO kit (One Lambda, CA, USA). The ARLEQUIN v.3.11 computer program was used to calculate allele and haplotype frequencies. Results: The most common alleles found in Caucasians were HLA-A*02, 24, 01; HLA-B*35, 44, 51; DRB1*11, 13, 07; for Afro-Brazilians they were HLA-A*02, 03, 30; HLA-B*35, 15, 44; DRB1*13, 11, 03; and for Asians they were: HLA-A*24, 02, 26; HLA-B*40, 51, 52; DRB1*04, 15, 09. The most common haplotype combinations were: HLA-A*01, B*08, DRB1*03 and HLA-A*29, B*44, DRB1*07 for Caucasians; HLA-A*29, B*44, DRB1*07 and HLA-A*01, B*08 and DRB1*03 for Afro-Brazilians; and HLA-A*24, B*52, DRB1*15 and HLA-A*24, B*40 and DRB1*09 for Asians. CONCLUSIONS: There is a need to target and expand bone marrow donor campaigns in the north of Parana State. The data of this study may be used as a reference by the Instituto Nacional de Cancer/Brazilian National Bone Marrow Donor Registry to evaluate the immunogenetic profile of populations in specific regions and in the selection of bone marrow donors.

Efeito da tração manual sobre o comprimento da coluna cervical em indivíduos assintomáticos: estudo randomizado controlado / The effect of manual traction on the length of cervical spine in asymptomatic individuals: a randomized controlled study

Os objetivos do estudo foram o de mensurar o comprimento da coluna cervical quando submetida à tração manual, e o de verificar as alterações da cervical após um período de 10 sessões consecutivas. Trata-se de estudo randomizado controlado, no qual 64 participantes foram submetidos a dois procedimentos radiológicos, antes e durante a tração. As distâncias das bordas anteriores e posteriores do corpo vertebral C2 até as do corpo vertebral de C7 foram mensuradas e comparadas. Na primeira etapa as medidas das bordas anteriores foi de 8,40 para 8,50 cm (P<0,001) e nas posteriores foi de 8,35 para 8,50 cm (P<0,001). Para a segunda etapa, os indivíduos foram aleatorizados em grupo controle (n=31) e intervenção (n=33), o qual recebeu dez sessões tração cervical. Após as sessões, as distâncias anterior e posterior do grupo intervenção aumentaram significativamente de 8,40 para 8,90 cm (P<0,001) e de 8,40 para 8,65 cm (P<0,001), respectivamente. Após as trações, todos os participantes repetiram os mesmos procedimentos radiológicos, as mensurações e as comparações das distâncias vertebrais. Quando os dois grupos foram comparados após as trações, houve diferença estatisticamente significante entre as distâncias anteriores e posteriores, de 8,20 e 8,90 cm (P=0,015) e de 8,30 e 8,65cm (P=0,030), respectivamente. Portanto, a tração aumentou o comprimento da coluna cervical. Após um período de aplicação das sessões, ocorreu aumento significativo das medidas entre as vértebras.

The objectives of the study were to measure the length of the cervical spine when submitted to manual traction and to verify changes in the cervical spine after 10 consecutive sessions. In this randomized controlled study 64 participants were submitted to two radiological procedures: one before and another during traction. The distances between the anterior and posterior vertebrae edges of C2 the C7 were measured and compared. In the first stage it was shown that measures of the anterior distance was 8.40 to 8.50 cm (P<0.001) and the posterior was 8.35 to 8.50 cm (P<0.001). For the second stage, subjects were randomized in control group (n=31) and intervention group (n=33) which received ten sessions of cervical traction. After the sessions the anterior and posterior distances of the intervention group increased significantly from 8.40 to 8.90 cm (P<0.001) and 8.40 to 8.65 cm (P<0.001) respectively. After the sessions all participants repeated the same radiological procedures, measurements and comparisons of the vertebral distance. When the groups were compared after the sessions there were statistically significant differences between the anterior and posterior distance of 8.20 and 8.90 cm (P=0.015) and 8.30 and 8.65 (P=0.030) respectively. Therefore the traction increased the length of the cervical spine and after a period of application of this intervention there was significant increase of the measures between the vertebral distances.

Electromyographic activity of selected trunk muscles in subjects with and without hemiparesis during therapeutic exercise.

The purpose of this study was to evaluate the trunk muscles activity of hemiparetic and control subjects during selected therapeutic exercises with surface electromyography (sEMG). The sEMG evaluation included 12 subjects presenting hemiparesis after having suffered a unilateral stroke and 12 apparently healthy subjects. A 16-channel sEMG system was used; data were band pass filtered from 20 to 450Hz. The signal was normalized through reference voluntary contraction (RVC) and presented in percentage. The exercises used in the evaluations were trunk flexion and trunk extension. Rectus abdominis presented greater activation on the paretic side of the experimental group than on the corresponding side of the control group (P=0.035) (Cohen's d¯=0.94). During leg elevation, the non-paretic obliquus externus abdominis showed greater activation than in other exercises (P=0.019) (Cohen's d¯=0.75). No inter-group differences were found for either erectus spinae activity or contraction onset. Experimental group subjects showed muscle activity alterations, principally in the rectus abdominis, indicating the occurrence of compensatory strategies.

Reduction in plasma levels of inflammatory and oxidative stress indicators after Roux-en-Y gastric bypass.

BACKGROUND: Obesity is considered to be associated with high levels of oxidative stress and inflammation. Anticipated weight loss secondary to bariatric surgery may offer an opportunity to evaluate this association. We studied a few markers of oxidative stress and inflammation in 20 obese patients submitted to Roux-en-Y gastric bypass (RYGBP). METHODS: Variations in plasma levels of indicators of oxidative stress (malondialdehyde (MDA), superoxide dismutase (SOD), catalase, glutathione (GSH), glutathione disulfide (GSSG), and total radical antioxidant parameter (TRAP)) and inflammation (alpha1-acid glycoprotein (AGP) and C-reactive protein (CRP)), as well as variations in plasma levels of leptin, glucose, glycated hemoglobin (HbA1c), and insulin were investigated in the preoperative period and 12 months postsurgery in 20 class III obese individuals submitted to bariatric surgery (obese group) and 20 non-obese individuals (control group). RESULTS: Twelve months postsurgery, there was a significant reduction (p < 0.01) in median values of BMI (46.75/30.17 kg/m(2)) and in plasma levels of MDA (16.70/9.11 nmol/g prot), SOD (10.70/9.24 U/mgHb), GSSG (210.80/148.20 mM/g of Hb), AGP (125.70/75.80 mg/dL), CRP (1.31/0.38 mg/dL), and leptin (15.04/3.58 ng/mL). A significant drop (p < 0.05) in plasma levels of HbA1c (5.81/4.98%) was also observed. On the other hand, a significant increase in plasma levels of GSH (2.002/2.823 mM/g of Hb) and TRAP (585.40/815.48 microM Trolox), p < 0.01, and in catalase plasma levels (12.06/13.22 Deltat/mgHb/min), p < 0.05, was seen. No statistically significant variations in glucose (96.3/84.8 mg/dL) or insulin plasma levels (9.91/7.88 U/mL) occurred. Calculated homeostasis model assessment index did not statistically change 12 months postsurgery (2.36/1.66). CONCLUSIONS: In the preoperative period, the obese group individuals showed higher oxidation and inflammation levels and lower indices of antioxidant defense than those of the control group. One year after RYGBP, an improvement in antioxidant protection, associated with a reduction in inflammatory and oxidative markers, was observed, indicating that these individuals presented a lower degree of oxidative stress.

Increased oxidative stress, decreased total antioxidant capacity, and iron overload in untreated patients with chronic hepatitis C.

The aim of this study was to determine oxidative stress in patients with untreated chronic hepatitis C (CHC), relating the obtained results with iron status and disease activity markers. Two groups (CHC patients and controls) were studied. CHC patients presented significantly higher values than the control group in some parameters: ALT, AST, GGT, iron, ferritin, and transferrin saturation, and also in tert-butyl hydroperoxide initiate chemiluminescence and thiobarbituric acid-reactive substances (TBARS) as well as lower values in total radical-trapping antioxidant parameter (TRAP). TBARS showed a significant correlation with serum AST and with transferrin saturation, whereas TRAP correlated inversely with serum albumin. Serum ferritin correlated with ALT and GGT, whereas serum iron did so with GGT. In conclusion, lower antioxidant capacity, higher levels of pro-oxidants activity, and iron overload occur in untreated patients with CHC. This greater oxidative activity could play an important role in pathogenesis and evolution of hepatitis C and thus further investigations.

Análise radiográfica da coluna cervical em indivíduos assintomáticos submetidos a tração manual / Radiographic analysis of the cervical spine in healthy individuals submitted to manual traction

OBJETIVO: Avaliar, radiograficamente, o efeito da tração manual sobre o comprimento da coluna cervical. MATERIAIS E MÉTODOS: Cinqüenta e cinco participantes de ambos os gêneros - 12 masculinos (22 por cento) e 43 femininos (78 por cento) - sem história de distúrbios cervicais contituíram a amostra deste estudo. Eles foram submetidos a dois procedimentos radiológicos, um antes e outro durante a tração manual sustentada por 120 segundos. As distâncias entre as bordas anteriores e posteriores da segunda à sétima vértebras cervicais foram mensuradas e comparadas antes e durante a tração manual. RESULTADOS: A mediana da distância anterior antes da tração foi de 8,40 cm e durante a tração aumentou para 8,50 cm (p=0,002). A mediana da distância posterior antes da tração foi de 8,35 cm e durante a tração aumentou para 8,50 cm (p<0,001). CONCLUSÃO: Os resultados demonstraram que a aplicação da tração manual promoveu aumento estatisticamente significante do comprimento da coluna cervical em indivíduos assintomáticos.

OBJECTIVE: To evaluate radiographically the effect of manual traction on the length of the cervical spine in healthy individuals. MATERIALS AND METHODS: The sample of the present study included 55 individuals - 12 men (22 percent) and 43 women (78 percent) - with no previous history of cervical disorders, submitted to two radiological procedures previously and during manual traction sustained for 120 seconds. Distances between the anterior and posterior edges from the second to the seventh cervical vertebrae were measured and compared before and during manual traction. RESULTS: The median of pre-traction anterior length was 8.40 cm, increasing to 8.50 cm during the traction (p=0.002); and the median of pre-traction posterior length was 8.35 cm, increasing to 8.50 cm during traction (p<0.001). CONCLUSION: Application of manual traction resulted in a statistically significant increase in the length the cervical spine in healthy individuals.

A criança com paralisia cerebral: características clínicas e fisioterapia / Children with cerebral palsy: characteristics and physical therapy

A paralisia cerebral abrange um grupo de alterações sensório-motoras, não progressivas, frequentemente mutáveis. Este estudo descritivo-retrospectivo refere-se ao levantamento de características clinicas de crianças com paralisia cerebral e associa-las com as condutas realizadas na fisioterapia. Os dados foram coletados em protocolos de 44 casos, com a colaboração do Serviço de Arquivo Médico e Estatístico do Hospital Universitário e Hospital de Clínicas da Universidade Estadual de Londrina. A análise de dados foi realizada por meio dos testes de Fischer e Qui-quadrado. Na distribuição topográfica e qualidade do tônus prevaleceram a quadriplegia (36,36%, a hemiplegia (36,36%) e a espasticidade (75%). Distúrbios associados ocorreram em 35 crianças (79,5%). Complicações no período peri e pós-natal ocorreram em 75%. As condutas utilizadas, com maior freqüência, em crianças hemiplégicas, diplégicas e quadriplégicas na fisioterapia foram: alongamentos, tomada de peso, ortostatismo, estimulação das reações automáticas e massagem miofascial. Houve associação entre hemiplegia e mobilização de cinturas pélvica e escapular (p = 0,018); diplegia com as passagens de posturas (p = 0,045) e a aplicação de toxina botulínica (p = 0,018); quadriplegia com as condutas respiratórias (p = 0,001) e massagem miofascial (p = 0,002). Na fisioterapia predominaram a cinesioterapia e a massoterapia, sendo que as terapias, nas crianças com hemiplegia e diplegia, eram voltadas a melhora funcional e, nas quadriplégicas, visavam a prevenção de complicações.

Cerebral palsy involves a group of non-progressive, frequently mutating sensorial-motor disorders. This retrospective descriptive study refers to identifying clinical characteristics of children with cerebral palsy and their association with physical therapy maneuvers. Data dates was collected from 44 protocols, with the collaboration of the Statistical and Medical Archives Service of the University Hospital and Polyclinic Hospital of the State University of Londrina. Data analysis was performed using Fischer and Qui-square tests. Considering the topographic distribution and tonus quality there were higher rates of quadriplegia (36.36%), hemiplegia (36.36%) and spasticity (75%). Associated disorders were observed in 35 children (79,5%). Complications during and after birth occurred in 75%. The main therapeutic maneuvers regarding hemiplegic and quadriplegic children were stretching, weight-bearing, orthostatism stimulation basic automatic reactions and myofascial massage. There were associations between hemiplegia and scapular and hip mobilization (p = 0,018); diplegia and changing posture (p = 0,045) and use the botox (p = 0,018); quadriplegia and respiratory maneuvers (p = 0,001) and myofascial massage (p = 0,002). Kinesiotherapy and massage therapy were the most frequent maneuvers in the management of children with cerebral palsy, which aimed at functional improvement, in cases of hemiplegia and diplegia, and at prevention of complications, in cases of quadriplegia.