Short-term functional changes after hospital discharge by COVID-19 through teleconsultation at a reference service in Northeast Brazil: A cross-sectional study.

Coronavirus infection disease 2019 (COVID-19) was associated with a physical-functional and emotional decline in patients with COVID-19 hospital internment. Objective: Evaluate the main functional changes after hospital discharge after COVID-19 by teleconsultation. A cross-sectional study was carried out between April and July 2020, the peak period of new cases, hospital admission, and deaths by COVID-19, in Recife-Brazil. We included patients (n = 89) over 18 years with positive COVID-19 RT-PCR tests and hospitalized for more than 7 days. Functional aspects such as muscle pain, shortness of breath, cough, weight loss >5 kg, weakness/fatigue, daily living activities, balance, walking, lying down, sensitivity, anxiety/sadness, altered memory, or understanding were assessed. Besides this, the impact of hospital admission on daily activities and the quality of information obtained by teleconsultation were quantified. The mean age was 63.5 years (±14), and in the hospital, the mean internment was 18 days (±16). The main findings of this study showed four predominant functional alterations: weight loss greater than 5 kg (60.7%), muscle fatigue/weakness (53.9%), muscle/joint pain (43.8%), and anxiety/sadness (46.1%). Of the functions analyzed, 59.6% of patients reported dysfunctions in at least three of the alterations evaluated. There were several short-term physical-functional and emotional changes in adults after hospital discharge.

A Mobile Early Stimulation Program to Support Children with Developmental Delays in Brazil.

Developmental delay is a deviation development from the normative milestones during the childhood and it may be caused by neurological disorders. Early stimulation is a standardized and simple technique to treat developmental delays in children (aged 0-3 years), allowing them to reach the best development possible and to mitigate neuropsychomotor sequelae. However, the outcomes of the treatment depending on the involvement of the family, to continue the activities at home on a daily basis. To empower and educate parents of children with neurodevelopmental delays to administer standardized early stimulation programs at home, we developed a mobile early stimulation program that provides timely and evidence-based clinical decision support to health professionals and a personalized guidance to parents about how to administer early stimulation to their child at home.

Physiotherapeutic approach on the late phase of chikungunya: a case report / Abordagem fisioterapêutica na fase tardia da chikungunya: um relato de caso

Abstract Introduction: in April of 2016, the epidemiological bulletin reported 39,017 suspected cases of chikungunya fever in Brazil. The main symptoms of the disease in the acute phase are: high fever, polyarthralgia, back pain, headache and fatigue; while in the late phase present polyarthralgia or musculoskeletal pain which often has prolonged duration. Description: in the late phase, the patient presented complaints mainly of: severe pain on the ankle joints wrists, elbows and shoulders. The medical handling consisted of continuous ultrasound sessions with the frequency of 1 MHz. The infrared laser with a dosage of 4J and 3s per point; TENS-burst with a pulse width of 250 us and the frequency of 2Hz, carried out for 10 days. The physiotherapeutic treatment proposal was an innovation, however there are no medical literatures for completementary medication for the treatment which could reduce the use of analgesics and could cause prolonged comfort to the patient ratified by EVA and the SF-36. Discussion: the use of ultrasound and low intensity laser are performed on the signs of chronic articular treatment in order to reduce inflammation, pain and joint stiffness. Therefore, a remarkable reduction of the algic state and the improvement of the patient's life along the r ten consecutive sessions of a proposed protocol in this study, thus there is a need for further researches on this issue so it is possible to perform a medical handling based on evidences on the theme.

Resumo Introdução: o boletim epidemiológico de abril de 2016 informou 39.017 casos prováveis de febre de chikungunya no país. Na fase aguda da doença os principais sintomas são: febre alta, poliartralgia, dores nas costas, dor de cabeça e fadiga; enquanto que na fase tardia estão presentes a poliartralgia ou dores músculo-esqueléticas, que frequentemente apresentam-se com duração prolongada. Descrição: o paciente apresentava na fase tardia como principais queixas: dores severas nas articulações dos tornozelos, punhos, cotovelos e ombros. O manejo clínico foi constituído de sessões com ultrassom contínuo com frequência de 1 MHz, Laser infravermelho com dosagem de 4J e 3s por ponto; TENS-burst com largura de pulso de 250 us e Frequência de 2Hz, realizado por 10 dias. O tratamento fisioterapêutico proposto foi inovador, pois não há na literatura tratamentos complementares que possam diminuir o uso de analgésicos e causar conforto prolongado ao paciente ratificado pelo EVA e o SF-36. Discussão: o uso do ultrassom e do laser de baixa intensidade são utilizados no tratamento de manifestações reumáticas crônicas com o objetivo de reduzir a inflamação, dor e rigidez articular. Por conseguinte, foi notável a redução do quadro álgico e melhora da qualidade de vida da paciente ao longo de dez sessões consecutivas com o protocolo proposto no presente estudo, sendo assim surge à necessidade de novas pesquisas acerca do assunto para que seja possível fazer um manejo clínico baseado em evidências sobre o tema.

Presumed congenital infection by Zika virus: findings on psychomotor development - a case report / Infecção congênita presumível por Zika vírus: achados do desenvolvimento neuropsicomotor - relato de casos

Abstract Introduction: the identification of Zika virus (ZikV) in the amniotic fluid, in the placenta and in newborns' brains suggests a neurotropism of this agent in the brain development, resulting in neuro-psycho-motor alterations. Thus, this present study reports the assessment of children diagnosed by a congenital infection, presumably by ZikV, followed-up at the Rehabilitation Center Prof. Ruy Neves Baptist at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). Description: as proposed by the Ministry of Health, the following instruments were used to evaluate the neuro-motor functions of four children with microcephaly aged between three and four months: The Test of Infant Motor Performance (TIMP); the functional vision assessment; the manual function scale development; and the clinical evaluation protocol on pediatric dysphagia (PAD-PED). Discussion: the children evaluated presented atypical motor performance, muscle tone and spontaneous motricity which encompass the symmetry and the motion range of the upper and lower limbs proven to be altered. The functional vision showed alterations which can cause limitations in the performance of functional activities and the learning process. Regarding to the speech articulator's functions observed that the maturation and coordination of sucking, swallowing and breathing did not yet encounter the appropriate age maturity level.

Resumo Introdução: a identificação do Zika vírus (ZikaV) no fluido amniótico, na placenta e no cérebro de recém nascidos, sugere um neurotropismo desse agente pelo cérebro em desenvolvimento, resultando em alterações neuropsicomotoras. Dessa forma, o presente estudo relata a avaliação de crianças com diagnóstico de infecção congênita, presumivelmente, pelo ZikaV, acompanhadas no Centro de Reabilitação Prof. Ruy Neves Baptista, no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). Descrição: foram utilizados os seguintes intrumentos, propostos pelo Ministério da Saúde, para avaliar as funções neuromotora de quatro crianças com microcefalia com idade entre três e quatro meses: o Test of Infant Motor Performance (TIMP); a avaliação da visão funcional; a escala de desenvolvimento da função manual; e o protocolo de avaliação clínica da disfagia pediátrica (PAD-PED). Discussão: as crianças avaliadas apresentaram desempenho motor atípico, o tônus muscular e a motricidade espontânea, que engloba a simetria e a amplitude de movimentos dos membros superiores e inferiores, revelaram-se alterados. A visão funcional mostrou-se alterada, o que pode provocar limitações no desempenho de atividades funcionais e no processo de aprendizagem. Em relação às funções fonoarticulatórias observou-se que a maturação e coordenação das funções de sucção, deglutição e respiração, ainda não se encontram em grau de maturidade adequadas para a idade.

[Influence of maternal and neonatal factors on bronchopulmonary dysplasia development]. / Influência de fatores maternos e neonatais no desenvolvimento da displasia broncopulmonar.

OBJECTIVE: To review epidemiological features of bronchopulmonary dysplasia (BPD) and its relationship with maternal and neonatal conditions in a neonatal unit. METHODS: Cross-sectional, descriptive and analytical study involving preterm newborns (NBs) with a birth weight lower than 1,500 g and gestational age under 37 weeks. Data was collected through a review of medical records of these newborns admitted to a neonatal unit. RESULTS: The study included 323 newborns with a mean birth weight of 1,161 g (± 231 g), gestational age between 24 and 36.5 weeks, with a BPD incidence of 17.6%. Among the NBs developing BPD, the mean of days using invasive mechanical ventilation (IMV), non-invasive ventilation (NIMV), and supplemental oxygen was 17.6, 16.2, and 46.1 days, respectively, with a time significantly longer for those NBs developing BPD (p < 0.001). BPD occurred significantly more often in NBs with a patent ductus arteriosus (PDA). CONCLUSION: BPD incidence in this study was similar to that found in the literature. No BPD association with maternal infection and antenatal corticosteroid use was found. NBs receiving exogenous surfactant had a higher BPD incidence because they had lower BW and GA. Concomitant occurrence of PDA and BPD is associated with staying longer on IMV, NIMV and supplemental oxygen.

Influência de fatores maternos e neonatais no desenvolvimento da displasia broncopulmonar / Influence of maternal and neonatal factors on bronchopulmonary dysplasia development

OBJETIVO: Analisar as características epidemiológicas da displasia broncopulmonar (DBP) e suas relações com condições maternas e neonatais em uma unidade neonatal. MÉTODOS: Estudo transversal, descritivo e analítico, sendo os dados coletados através da análise de prontuários envolvendo recém-nascidos (RNs) pré-termo com peso ao nascimento inferior a 1.500 g e idade gestacional abaixo de 37 semanas internados em uma unidade neonatal. RESULTADOS: Foram estudados 323 recém-nascidos com média do peso ao nascimento de 1.161 g (± 231 g), idade gestacional entre 24 e 36,5 semanas com incidência da DBP de 17,6 por cento. Entre os RNs que desenvolveram DBP, a média de dias de uso de assistência ventilatória mecânica invasiva (AVMI), ventilação não invasiva (VNI) e oxigênio foi, respectivamente, 17,6 dias, 16,2 dias e 46,1 dias, sendo significativamente maior naqueles RNs que desenvolveram a DBP (p < 0,001). A ocorrência da DBP foi significativamente maior nos RNs com diagnóstico de persistência do canal arterial (PCA). CONCLUSÃO: A incidência da DBP neste estudo foi semelhante à encontrada na literatura mundial. Não houve associação entre a presença de infecção materna e o uso de corticoide antenatal com a DBP. Os RNs que fizeram uso de surfactante tiveram maior incidência da DBP porque tinham menor PN e menor IG. A ocorrência da PCA e DBP simultaneamente está associada ao maior tempo de uso de AVMI, VNI e oxigênio.

OBJECTIVE: To review epidemiological features of bronchopulmonary dysplasia (BPD) and its relationship with maternal and neonatal conditions in a neonatal unit. METHODS: Cross-sectional, descriptive and analytical study involving preterm newborns (NBs) with a birth weight lower than 1,500 g and gestational age under 37 weeks. Data was collected through a review of medical records of these newborns admitted to a neonatal unit. RESULTS: The study included 323 newborns with a mean birth weight of 1,161 g (± 231 g), gestational age between 24 and 36.5 weeks, with a BPD incidence of 17.6 percent. Among the NBs developing BPD, the mean of days using invasive mechanical ventilation (IMV), non-invasive ventilation (NIMV), and supplemental oxygen was 17.6, 16.2, and 46.1 days, respectively, with a time significantly longer for those NBs developing BPD (p < 0.001). BPD occurred significantly more often in NBs with a patent ductus arteriosus (PDA). CONCLUSION: BPD incidence in this study was similar to that found in the literature. No BPD association with maternal infection and antenatal corticosteroid use was found. NBs receiving exogenous surfactant had a higher BPD incidence because they had lower BW and GA. Concomitant occurrence of PDA and BPD is associated with staying longer on IMV, NIMV and supplemental oxygen.

[A comparison of the continuous positive airway pressures produced by two systems]. / Comparação dos níveis de pressão positiva contínua nas vias aéreas através de dois sistemas.

OBJECTIVE: To compare the generation of continuous positive airway pressure using a hand-made device (underwater seal) or a ventilator (Inter 3). METHOD: Two positive airway pressure generation systems were compared through laboratory simulations. Measurements were not considered if the mechanical ventilator required calibration or in the presence of gas flow variation (flowmeter sphere oscillation). Recordings were assessed in terms of the capacity to produce the desired pressure (3, 5 and 6 cmH2O) when submitted to three different flow values (8, 10 and 12 l/min). For that end, Student's t test for paired samples and the nonparametric Man-Whitney test for independent samples were employed. RESULTS: We verified that the systems behave in different manners under the same conditions of flow and positive end expiratory pressure. For the mechanical ventilator, the mean pressure behavior under continuous positive airway pressure at 3 cmH2O with flows of 8, 10 and 12 l/min were 2.26+/-0.41, 2.22+/-0.37, 2.04+/-0.41, respectively; under positive end-expiratory pressure at 5 cmH2O we found 3.96+/-0.41, 3.87+/-0.43 and 3.75+/-0.52; and under positive end-expiratory pressure at 6 cmH2O the values recorded were 4.94+/-0.40, 4.85+/-0.41 and 4.72+/-0.37. For the underwater seal, the mean pressure behavior under continuous positive airway pressure at 3 cmH2O with flows of 8, 10 and 12 l/min were 4.24+/-0.24, 4.46+/-0.26, 4.72+/-0.37, respectively; at 5 cmH2O the values were 5.97+/-0.17, 6.28+/-0.18, 6.47+/-0.31; and at 6 cmH2O we recorded 6.85+/-0.20, 7.17+/-0.29 and 7.53+/-0.31. All the comparisons were statistically significant (p = 0.000). CONCLUSION: Through our recordings it was possible to observe that the Inter 3 continuous positive airway pressure system was more stable than the underwater seal.

Comparação dos níveis de pressão positiva contínua nas vias aéreas através de dois sistemas / A comparison of the continuous positive airway pressures produced by two systems

OBJETIVO: Comparar a geração de pressão positiva contínua nas vias aéreas através de um sistema artesanal (selo d'água) e um sistema integrado a um ventilador mecânico (Inter 3®). METODOLOGIA: Foi realizado um estudo de experiências controladas através de simulações em laboratório, no qual foram comparados dois sistemas de geração de pressão positiva nas vias aéreas, um deles produzido de forma artesanal (selo d'água), e outro oferecido por um ventilador mecânico neonatal Inter 3® (Intermed - São Paulo). Foram excluídos os registros onde se constatava descalibração do ventilador mecânico ou variação no fluxo de gases da rede (oscilação da esfera do fluxômetro). Os registros foram avaliados quanto à capacidade de produzir as pressões desejadas (3, 5 e 6 cmH2O) quando submetidos a três valores de fluxo (8, 10 e 12 l/min). Para isso, foram aplicados o teste t de Student para uma amostra pareada e o teste não-paramétrico de Mann-Whitney para amostras independentes. RESULTADOS: Verificamos que os sistemas se comportam de maneira diferente para as mesmas condições de fluxo e pressão positiva expiratória final. O comportamento da pressão média na pressão positiva contínua nas vias aéreas (ventilador mecânico) com 3 cmH2O e fluxos de 8, 10 e 12 l/min foi, respectivamente, 2,26±0,41, 2,22±0,37 e 2,04±0,41; com pressão positiva expiratória de 5 cmH2O, encontramos 3,96±0,41, 3,87±0,43 e 3,75±0,52; e com pressão positiva expiratória de 6 cmH2O, os valores registrados foram 4,94±0,40, 4,85±0,41 e 4,72±0,37. Já o comportamento da pressão média na pressão positiva contínua nas vias aéreas (selo d'água) com 3 cmH2O e fluxos de 8, 10 e 12 l/min foi, respectivamente, 4,24±0,24, 4,46±0,26 e 4,72±0,37; com 5 cmH2O, os valores foram 5,97±0,17, 6,28±0,18 e 6,47±0,31; e com 6 cmH2O, registramos 6,85±0,20, 7,17±0,29 e 7,53±0,31. Todos os registros realizados apresentaram significância estatística (p = 0,000). CONCLUSAO: Através dos nossos registros, foi possível observar que o sistema pressão positiva contínua nas vias aéreas no Inter 3® comportou-se de forma mais estável e linear do que a pressão positiva contínua nas vias aéreas no selo d'água, uma vez que esta apresentou grandes variações pressóricas.