A Combination of Gamma-Aminobutyric Acid, Glutamic Acid, Calcium, Thiamine, Pyridoxine, and Cyanocobalamin vs Ginger Extract in the Management of Chronic Motion Sickness: A Clinical Evaluation.

Background: Motion sickness (kinetosis) is a common and temporarily incapacitant ailment, manageable with behavioral as well as pharmacological measures. Objective: To assess the effectiveness and safety of a combination of gamma-aminobutyric acid, glutamic acid, calcium, thiamine, pyridoxine, and cyanocobalamin (Group A) (n = 170) and extract of Zingiber officinale (ginger) (Group B) (n = 165) in the management of chronic complaints consistent with motion sickness. Methods: Both groups were tested according to the following end points, under self-paired as well as comparative study designs: reduction of ≥20 score points in the total motion sickness assessment questionnaire (MSAQ) score, percentage of patients presenting a reduction of the total MSAQ score, absolute MSAQ score reduction, physician's assessment scores, final overall assessment of study medication, and willingness to continue treatment. Safety was also evaluated. Results: There was a statistically significant better performance under both study designs for Group A (P = 0.05 using different statistical tests) in all end points. Both regimens were safe, with different neurological and gastrointestinal tolerability outcomes. Conclusions: Group A and Group B regimens were effective and safe in the management of chronic complaints consistent with motion sickness and the Group A regimen was more effective than Group B.

Dados de mundo real: o impacto econômico da inclusão de antineoplásicos orais para as operadoras de saúde no Sistema de Saúde Suplementar do Brasil / Real world data: the economic impact of including oral antineoplastic agents for health care providers in the Brazilian Supplementary Health System

Objetivo: Avaliar o incremento mensal do custo por beneficiário da incorporação das terapias antineoplásicas orais se aprovado o PL nº 6.330/2019. Métodos: As características clínicas e dos medicamentos utilizados em pacientes em tratamento oncológico foram coletadas da base de dados de mundo real Auditron®, plataforma de avaliações de solicitações de pré-autorização de procedimentos médicos. Com base nas características dos pacientes, foram avaliadas as possibilidades de uso dos medicamentos antineoplásicos orais, conforme as diretrizes da NCCN e ESMO. O cálculo do custo incremental foi realizado utilizando o número total de pacientes diagnosticados com uma neoplasia específica e o número de pacientes aptos a receber antineoplásicos orais. Foi utilizada lista de preços CMED para cálculo dos custos de aquisição de medicamentos. Resultados: O custo incremental da incorporação de 34 drogas antineoplásicas orais em 2019 foi de R$ 5.362.642.580 (R$ 3.944.321.786- R$ 6.483.413.466), representando impacto mensal de R$ 9,50 por beneficiário. O custo incremental da incorporação de 21 drogas antineoplásicas orais em 2021 era de R$ 2.028.538.791 (R$ 1.485.919.710-R$ 3,016,407,794), representando impacto mensal de R$ 3,59 por beneficiário. Conclusão: A incorporação das drogas antineoplásicas orais acarretariam um baixo incremento mensal por beneficiário.

Objective: To evaluate the monthly increase in the cost per member of incorporating all oral neoplastic therapies if approved the bill 6,330/2019. Methods: The clinical characteristics and medications used by patients undergoing cancer treatment were collected from the real-world Auditron® database, a platform for evaluating requests for pre-authorization of medical procedures. Based on the characteristics of each patient, the possibility of using oral antineoplastic drugs according to the NCCN and ESMO guidelines was evaluated. The incremental cost calculation was performed using the total number of patients diagnosed with a specific neoplasm and the number of patients eligible to receive oral anticancer drugs. CMED price list was used to calculate drug acquisition costs. Results: The incremental cost of incorporating 34 neoplastic drugs in 2019 was R$ 5,362,642,580 (R$ 3,944,321,786- R$ 6,483,413,466), representing a monthly impact of R$ 9.50 per member. The incremental cost of incorporating 21 neoplastic drugs in 2021 was R$ 2,028,538,791 (R$ 1,485,919,710-R$ 3,016,407,794), representing a monthly impact of R$ 3.59 per beneficiary. Conclusion: The incorporation of oral anticancer drugs in the coverage of health plans following international and national treatment guidelines would result in a low monthly increase in the cost per beneficiary.

Even High-Quality CPGs Seldom Include Implementation Strategies.

Background: Implementation is a key step in ensuring that high-quality clinical practice guideline (CPG) recommendations are followed and have a positive impact. This step must be planned during CPG development. This study aims to inform professionals tasked with developing and implementing CPGs regarding implementation strategies and tools reported in high-quality CPGs for chronic non-communicable diseases (NCDs). Methods: NCD guidelines were selected based on Appraisal of Guideline Research and Evaluation (AGREE) II assessment. CPGs with a score of ≥60% in AGREE II domains 3 (rigor of development), 5 (applicability), and 6 (editorial independence), were considered high quality. The content related to implementation was extracted from CPG full texts and complementary materials. Implementation strategies and tools were assessed and classified using Mazza taxonomy. Results: Twenty high-quality CPGs were selected, most of which were developed by government institutions (16; 80%) with public funding (16; 80%); almost half (9; 45%) addressed the treatment of cardiovascular diseases. The countries with the most high-quality CPGs were the UK (6; 30%) and Colombia (5; 25%). These countries also had the highest average number of strategies, Colombia with 28 (SD = 1) distributed in all levels, and the UK with 15 (SD = 7), concentrating on professional and organizational levels. Although the content of the Colombian CPGs was similar regardless the disease, the CPGs from the UK were specific and contained data-based feedback reports and information on CPG compliance. Implementation strategies most frequently identified were at the professional level, such as distributing reference material (18; 80%) and educating groups of healthcare professionals (18; 80%). At the organizational level, the most frequent strategies involve changes in structure (15; 75%) and service delivery method (13; 65%). Conclusion: Countries with established CPG programs, such as the UK and Colombia, where identified as having the highest number of high-quality CPGs, although CPG implementation content had significant differences. Among high-quality CPGs, the most common implementation strategies were at the professional and organizational levels. There is still room for improvement regarding the implementation strategies report, even among high-quality CPGs, especially concerning monitoring of implementation outcomes and selection of strategies based on relevant implementation barriers.

Factors Associated With High-Quality Guidelines for the Pharmacologic Management of Chronic Diseases in Primary Care: A Systematic Review.

Importance: As the rate of publication of new and sometimes conflicting medical research increases, clinicians rely heavily on clinical practice guidelines (CPGs) to inform practice. However, CPGs are of widely variable quality, and there are no existing objective measures to rate the quality of CPGs. Objective: To systematically assess 421 CPGs for the management of common noncommunicable diseases in primary care using the validated Appraisal of Guidelines for Research and Evaluation Instrument, version II (AGREE-II) tool and elucidate the factors associated with quality of CPGs. Evidence Review: MEDLINE, Embase, the Cochrane Library, and 12 websites for CPGs were searched for CPGs for the management of common noncommunicable diseases in primary care published between January 1, 2011, and August 30, 2017. The assessment of the quality of CPGs was performed by 3 appraisers using the 6 domains of the AGREE-II instrument. A multiple logistic regression was performed to identify factors associated with quality of CPGs. Findings: Of the 421 CPGs reviewed, 23.5% (99) were classified as high quality. Among included guidelines, clarity of presentation (70%) and scope and purpose (61%) had the highest median AGREE-II scores. The domains with the lowest median scores were applicability (22%) and rigor of development (33%). Factors associated with high-quality CPGs included having more than 20 authors (odds ratio, 9.08; 95% CI, 3.35-24.62), development at governmental institutions (odds ratio, 10.38; 95% CI, 2.72-39.60), and reporting funding (odds ratio, 10.34; 95% CI, 4.77-22.39). Year of publication, region, guideline version, and scope were not associated with quality among included CPGs. Conclusions and Relevance: Primary care professionals and policymakers should be aware that CPGs in primary care are of widely variable quality, with less than 25% of included CPGs rated as high quality. High-quality CPGs were associated with a higher number of authors, governmental institutions, and the report of funding. Region of origin was not associated with quality of CPGs, which suggests that the improvement of the quality of CPGs should be an international concern.

Clinical practice guidelines for surgical antimicrobial prophylaxis: Qualitative appraisals and synthesis of recommendations.

RATIONALE, GOALS, AND OBJECTIVES: Clinical practice guidelines (CPGs) for preoperative care have been developed for surgical antimicrobial prophylaxis (SAP). The objective of this study was to synthetize recommendations for SAP based on best-evaluated CPGs. METHODS: A systematic literature search for documents related to SAP, published between January 2011 and December 2016, was conducted on MEDLINE (PubMed), EMBASE, and specific CPG websites. Three reviewers independently assessed the rigour of development and editorial independence of CPGs based on domains 3 and 6 of the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. CPGs with domain 3 scores of 50% and greater were selected for synthesis of recommendations. Two reviewers independently extracted CPG recommendations from among these documents. A third reviewer performed the synthesis of recommendations. RESULTS: The search retrieved 363 documents, of which 29 CPGs were appraised using AGREE II. Only eight (28%) scored 50% and greater in domain 3. Most CPGs addressed topics related to preoperative care, including SAP. No conflicting recommendations were found, and most recommendations were based on clinical practice. The only recommendation for which there was a difference among CPGs was with respect to the time to initiate the administration of antibiotics (1 hour before or close to the time of the surgical incision). Four CPGs provide recommendations that demonstrate concern about inadequate SAP prolongation. CONCLUSION: Several CPGs for SAP were developed without the desired methodological rigour or transparency. Synthesis of recommendations for best-evaluated CPGs provides a broad approach owing to the complementarity of the recommendations.

Polymorphism of IL10, IL4, CTLA4, and DAO Genes in Cross-Reactive Nonsteroidal Anti-inflammatory Drug Hypersensitivity.

Our aim was to evaluate genetic polymorphism of molecules involved in immunoregulatory/allergic processes in patients who presented with cutaneous hypersensitivity caused by chemically unrelated nonsteroidal anti-inflammatory drugs. Polymorphisms at IL10 (-1082 G>A), IL4 (-589 C>T), CTLA4 (+49A>G), and DAO (+8956 C>G) genes were studied in 55 cases and 97 controls by the polymerase chain reaction-restriction fragment length polymorphism technique. With regard to the polymorphism at IL10 -1082, higher frequencies of the AG genotype (57% vs 39%) and G allele carriers (70% vs 48%) were found among the patients, indicating a risk effect (odds ratio [OR] = 2.56 and P = .01 for AG genotype and OR = 2.52; P = .01 for AG/GG). For the CTLA4 +49 A/G single-nucleotide polymorphism (SNP), AG genotype (31.0%) (P = .02) and G carrier (54.0%) (P = .05) frequencies were found to be significantly lower in the patient group compared with the control group (51.0% and 69.0%, respectively). The SNP DAO +8956 C>G was associated with a strong protective effect, with OR values of 0.83 for CG and 0.11 for GG genotype (P = .04 for the codominant model), suggesting an allele dose effect. The combination of IL10 and DAO SNPs in a multivariate model did not alter the OR values, suggesting independent effects for both SNPs. The results are striking. In conclusion, these results suggest that polymorphisms in regulatory targets of the immune response and in DAO gene could modulate an individual's susceptibility to nonsteroidal anti-inflammatory drug hypersensitivity reactions. Further studies will be necessary to complement our results.

Assessment of acute motor deficit in the pediatric emergency room.

OBJECTIVES: This review article aimed to present a clinical approach, emphasizing the diagnostic investigation, to children and adolescents who present in the emergency room with acute-onset muscle weakness. SOURCES: A systematic search was performed in PubMed database during April and May 2017, using the following search terms in various combinations: "acute," "weakness," "motor deficit," "flaccid paralysis," "child," "pediatric," and "emergency". The articles chosen for this review were published over the past ten years, from 1997 through 2017. This study assessed the pediatric age range, from 0 to 18 years. SUMMARY OF THE DATA: Acute motor deficit is a fairly common presentation in the pediatric emergency room. Patients may be categorized as having localized or diffuse motor impairment, and a precise description of clinical features is essential in order to allow a complete differential diagnosis. The two most common causes of acute flaccid paralysis in the pediatric emergency room are Guillain-Barré syndrome and transverse myelitis; notwithstanding, other etiologies should be considered, such as acute disseminated encephalomyelitis, infectious myelitis, myasthenia gravis, stroke, alternating hemiplegia of childhood, periodic paralyses, brainstem encephalitis, and functional muscle weakness. Algorithms for acute localized or diffuse weakness investigation in the emergency setting are also presented. CONCLUSIONS: The clinical skills to obtain a complete history and to perform a detailed physical examination are emphasized. An organized, logical, and stepwise diagnostic and therapeutic management is essential to eventually restore patient's well-being and full health.

Association of IL10, IL4, IFNG, and CTLA4 Gene Polymorphisms with Efavirenz Hypersensitivity Reaction in Patients Infected with Human Immunodeficiency Virus.

We evaluated interleukin-10 (IL10) －592 C/A, IL4－589 C/T, interferon gamma (IFNG)＋874 A/T, cytotoxic T-lymphocyte-associated antigen 4 (CTLA4)＋49 A/G gene polymorphisms associated with efavirenz hypersensitivity reaction. A total of 63 human immunodeficiency virus-positive patients under treatment at a public hospital were included in the study, of whom 21 presented with efavirenz hypersensitivity. Patients who presented with efavirenz hypersensitivity reaction showed a higher frequency of the IL10 －592A allele than the controls (p＝0.028). The allele A was associated with increased risk of efavirenz hypersensitivity (odds ratio＝2.40). In case of IL4, a significant difference in the frequency of the IL4 －589 (C/T) polymorphism was not observed between patients and controls. A significant inverse correlation was observed when comparing the CTLA4＋49A/G and IL4 －589 C/T polymorphisms (r＝－0.650, p＝0.001); that is, the CTLA4 +49GG genotype, involved with the lowest capacity of inhibition, was inversely correlated IL4－589TT genotype, which induces high production of IL-4. With respect to the CTLA4＋49A/G and IFNG＋874T/A gene polymorphisms, significant differences in allele and genotype frequencies were not observed between the groups. Therefore, our data suggest that polymorphisms in regulatory regions of cytokine genes could modulate an individual's susceptibility to efavirenz hypersensitivity reaction.

Assessment of acute motor deficit in the pediatric emergency room / Avaliação do déficit motor agudo no ambiente de pronto socorro pediátrico

Abstract Objectives: This review article aimed to present a clinical approach, emphasizing the diagnostic investigation, to children and adolescents who present in the emergency room with acute-onset muscle weakness. Sources: A systematic search was performed in PubMed database during April and May 2017, using the following search terms in various combinations: "acute," "weakness," "motor deficit," "flaccid paralysis," "child," "pediatric," and "emergency". The articles chosen for this review were published over the past ten years, from 1997 through 2017. This study assessed the pediatric age range, from 0 to 18 years. Summary of the data: Acute motor deficit is a fairly common presentation in the pediatric emergency room. Patients may be categorized as having localized or diffuse motor impairment, and a precise description of clinical features is essential in order to allow a complete differential diagnosis. The two most common causes of acute flaccid paralysis in the pediatric emergency room are Guillain-Barré syndrome and transverse myelitis; notwithstanding, other etiologies should be considered, such as acute disseminated encephalomyelitis, infectious myelitis, myasthenia gravis, stroke, alternating hemiplegia of childhood, periodic paralyses, brainstem encephalitis, and functional muscle weakness. Algorithms for acute localized or diffuse weakness investigation in the emergency setting are also presented. Conclusions: The clinical skills to obtain a complete history and to perform a detailed physical examination are emphasized. An organized, logical, and stepwise diagnostic and therapeutic management is essential to eventually restore patient's well-being and full health.

Resumo Objetivos: Apresentar uma abordagem clínica, enfatizar a investigação diagnóstica, voltada para crianças e adolescentes no pronto-socorro com fraqueza muscular de surgimento agudo. Fontes: Foi feita uma pesquisa sistemática na base de dados PubMed entre abril e maio de 2017, com os seguintes termos de pesquisa em várias combinações: "agudo", "fraqueza", "déficit motor", "paralisia flácida", "criança", "pediátrico" e "emergência". Os trabalhos escolhidos para esta revisão foram publicados nos últimos dez anos, de 1997 a 2017. Este trabalho aborda a faixa etária pediátrica, até 18 anos. Resumo dos dados: O déficit motor agudo é uma causa razoavelmente comum para crianças e adolescentes procurarem o pronto-socorro. Os pacientes podem ser classificados como com deficiência motora localizada ou difusa e uma descrição precisa das características clínicas é essencial para possibilitar um diagnóstico diferenciado completo. As duas causas mais comuns de paralisia flácida aguda no pronto-socorro pediátrico são síndrome de Guillain-Barré e mielite transversa, independentemente de outras etiologias serem consideradas, como encefalomielite disseminada aguda, mielite infecciosa, miastenia grave, derrame, hemiplegia alternante da infância, paralisia periódica, encefalite do tronco encefálico e fraqueza muscular funcional. Os algoritmos da investigação de fraqueza aguda localizada ou difusa na configuração de emergência também são apresentados. Conclusões: São enfatizadas as habilidades clínicas para obter um histórico completo e fazer um exame físico detalhado. Um manejo diagnóstico e terapêutico organizado, lógico e por etapas é essencial para eventualmente restaurar o bem-estar e a saúde total do paciente.

Risk factors identified in users subject to cardiac catheterization / Fatores de risco identificados em usuários submetidos ao cateterismo cardíaco

The objective was to identify risk factors for cardiovascular disease present in patients undergoing cardiac catheterization. Documentary study, a retrospective, quantitative nature. Developed in the hemodynamic of a public hospital in Fortaleza, Ceará State, Brazil. We analyzed the records of 1269 patients undergoing cardiac catheterization. The data was collected by a program called teleficha existing in that hospital. Data were organized in tables and graphs. The study was approved by the Ethics Committee. The results were: 819 (65%) patients were male and the average age was 62 years old. It was identified as risk factors: hypertension (73%), dyslipidemia (44%), smoking (37%), heredity (25%) and diabetes mellitus (16%). It was concluded that existed a high prevalence of risk factors for cardiovascular disease in the population studied, showing the need for health education programs, aimed to clarify and control the risk factors of cardiovascular diseases.

O objetivo foi identificar os fatores de risco para a doença cardiovascular presentes nos usuários submetidos ao cateterismo cardíaco. Estudo documental, retrospectivo, de natureza quantitativa. Desenvolvido no serviço de hemodinâmica de um hospital público, Fortaleza, Estado do Ceará, Brasil. Foram analisados 1269 cadastros de usuários submetidos ao procedimento de cateterismo cardíaco. A coleta de dados ocorreu por um programa chamado teleficha existente no referido hospital. Os dados foram organizados em tabelas e gráficos. O estudo foi aprovado pelo comitê de ética. Os resultados obtidos foram: 819 (65%) usuários eram do sexo masculino; a média de idade foi de 62 anos. Identificaram-se como fatores de risco: hipertensão (73%), dislipidemia (44%), tabagismo (37%), fatores hereditários (25%) e diabetes mellitus (16%) . Concluiu-se que havia uma elevada prevalência de fatores de risco para a doença cardiovascular na população estudada, mostrando a necessidade de criar programas de educação em saúde, visando esclarecer e controlar os fatores de risco de doenças cardiovasculares.

[Self-perceived oral health among elderly individuals in a medium-sized city in Northeast Brazil]. / Autopercepção da saúde bucal de idosos de um município de médio porte do Nordeste brasileiro.

This study focused on self-perceived oral health of the elderly and associated variables. The sample consisted of 321 functionally independent individuals 60 years or older living in Parnaíba, Piauí State, Brazil. Oral examinations were performed and questionnaires were applied during home visits. The elderly presented poor oral health, with mean DMFT 29.41 (SD = 4.10). However, their self-perceived oral health was positive, with 52% showing high scores according to the Geriatric Oral Health Assessment Index (GOHAI). Multivariate analysis showed that predictors of self-perceived oral health included the need for upper prostheses, oral mucosal lesions, and self-rated oral health. The most important predictor was self-rated oral health, with a weight of 20% variation in self-perceived oral health. In conclusion, subjective measurement of oral health in the elderly is less associated with their actual clinical status and more with other subjective factors.

Autopercepção da saúde bucal de idosos de um município de médio porte do Nordeste brasileiro / Self-perceived oral health among elderly individuals in a medium-sized city in Northeast Brazil

This study focused on self-perceived oral health of the elderly and associated variables. The sample consisted of 321 functionally independent individuals 60 years or older living in Parnaíba, Piauí State, Brazil. Oral examinations were performed and questionnaires were applied during home visits. The elderly presented poor oral health, with mean DMFT 29.41 (SD = 4.10). However, their self-perceived oral health was positive, with 52% showing high scores according to the Geriatric Oral Health Assessment Index (GOHAI). Multivariate analysis showed that predictors of self-perceived oral health included the need for upper prostheses, oral mucosal lesions, and self-rated oral health. The most important predictor was self-rated oral health, with a weight of 20% variation in self-perceived oral health. In conclusion, subjective measurement of oral health in the elderly is less associated with their actual clinical status and more with other subjective factors.

Este estudo objetivou identificar a autopercepção da saúde bucal de idosos e investigar as variáveis associadas a essa autopercepção. Foram pesquisados 321 indivíduos, de 60 anos ou mais, funcionalmente independentes, residentes do Município de Parnaíba, Piauí, Brasil. Realizaram-se exames clínicos bucais e aplicaram-se formulários durante visitas domiciliares. Os idosos apresentaram precárias condições de saúde bucal, com média CPOD de 29,41, (DP = 4,10). A autopercepção da saúde bucal, medida pelo Geriatric Oral Health Assessment Index (GOHAI), no entanto, foi positiva, 52% dos idosos obtiveram escores altos no GOHAI. Resultados da análise multivariada demonstraram que os preditores da autopercepção foram necessidade de prótese superior, alterações em tecido mole e autoavaliação de saúde bucal. A preditora mais importante foi a autoavaliação de saúde bucal, com um peso de 20% na variação da autopercepção. Concluiu-se que a medida subjetiva relacionada à saúde bucal dos idosos está menos associada às situações clínicas que eles apresentam e mais ligada a outros fatores subjetivos.

Secondary leprosy infection in a patient with psoriasis during treatment with infliximab.

Tumor necrosis factor α antagonists are proven to be effective for the treatment of chronic inflammatory conditions, such as psoriasis. A major concern for patients is the risk of acquiring granulomatous infectious diseases caused by the immunosuppressive effects of the drugs. We report a 60-year-old man with psoriasis who underwent infliximab treatment for 2 years and developed secondary leprosy, presenting extensive erythematous and infiltrated plaques on the trunk and limbs with loss of sensitivity (thermal, pain and tactile). The skin lesion biopsy showed perivascular epithelioid granulomas, nodular dermal aggregates of foamy macrophages and bundles of acid-fast bacilli. The clinical picture associated with histopathologic evaluation suggested borderline lepromatous leprosy. Before infliximab treatment, the patient had a positive tuberculin skin test and underwent chemoprophylaxis treatment for latent tuberculosis. Although the tuberculin reactivity suggests a strong correlation with a latent Mycobacterium tuberculosis infection, the possibility of infections by other mycobacteria, such as Mycobacterium leprae, should not be discarded.

Principais queixas dolorosas em pacientes que procuram clínica de Fisioterapia / Major pain complaints of patients looking for the Physical Therapy clinic

JUSTIFICATIVA E OBJETIVOS: A dor é uma das queixas que mais levam pacientes procurar a fisioterapia.Quando não controlada influencia negativamente a qualidade de vida. O objetivo deste estudo foi mensurar a intensidade e qualidade da dor de pacientes da Clínica Escola de Fisioterapia da Pontifícia Universidade Católicade Minas Gerais Campus de Poços de Caldas.MÉTODO: Foram incluídos 102 pacientes de ambos os sexos, avaliados antes da primeira sessão de fisioterapia,avaliados pelo Mini Exame do Estado Mental, Escala Visual Numérica, Breve Inventário de Dor, Questionário de Dor de McGill, Inventário de Depressão de Beck e a Escala abreviada de qualidade de vida da Organização Mundia lde Saúde.RESULTADOS: Informaram presença de dor 65,5% dos pacientes, com intensidade média de 6,4 para a pior dor nas últimas 24h. Suas principais características foram: em pontada (58,8%), cansativa (57,4%) e aborrecida (42,6%).23% dos pacientes localizaram a dor nos membros inferiores, e para 25% a dor piorava com posturas mantidas.Não houve sinais de depressão nos pacientes, porém houve interferência da dor nas atividades de vida diária como o trabalho e a capacidade para aproveitar a vida.CONCLUSÃO: Houve prevalência de dor musculoesquelética localizada nos membros inferiores na maioria dos pacientes, que interferiu de maneira intensa na atividade laboral dos mesmos, uma vez que os movimentos e as posturas mantidas foram os principais fatores agravantes da dor. A intensidade de dor foi maior em indivíduos que desacreditam em Deus e em relação à qualidade devida a dor interferiu de modo importante nas atividades diárias, condições emocionais e sociais, e na capacidade de aproveitar a vida.

BACKGROUND AND OBJECTIVES: Pain is one ofthe major complaints leading people to look for physical therapy. When uncontrolled, pain negatively influences quality of life. This study aimed at measuring pain intensity and quality of patients of the Clinic School of Physical Therapy, Catholic University of Minas Gerais, Poços de Caldas Campus.METHOD: Participated in this study 102 patients of both genders, evaluated before the first physical therapy sessionby the Mini Exam of Mental Status, Numeric Visual Scale, Brief Pain Inventory, McGill Pain Questionnaire, Beck's Inventory of Depression and WHO's abbreviatedquality of life scale.RESULTS: Pain was referred by 65.5% of patients, with mean intensity of 6.4 for the worst pain in the last 24 hours. Major characteristics were: in sting (58.8%), tiresome (57.4%) and uncomfortable. Pain was located inlower limbs for 23% of patients, and for 25% pain would worsen with maintained postures. There were no signs of depression, however pain has interfered with daily life activities, such as work and ability to enjoy life.CONCLUSION: There has been prevalence of musculoskeletal pain in lower limbs for most patients, which has substantially interfered with their professional activities,since movements and maintained postures were major pain worsening factors. Pain intensity was higher in people not believing in God and, with regard to quality oflife, pain has significantly interfered with daily activities, emotional and social conditions, and with the ability toenjoy life.

Equoterapia na reabilitação da meningoencefalocele: estudo de caso / Hyppotherapy in meningoencephalocele rehabilitation: a case study

A equoterapia é uma das técnicas de reabilitação utilizada para pacientes com disfunções neurológicas. Os movimentos provocados pelo cavalo no corpo do paciente podem interferir positivamente em seu controle postural, melhorando a mobilidade geral e o desempenho motor funcional. O objetivo deste estudo foi verificar o efeito da equoterapia no equilíbrio, coordenação motora e funcionalidade de uma criança com meningoencefalocele. Uma menina de 3 anos e 6 meses foi submetida a 18 sessões de equoterapia (em três fases - alimentação, escovação e montaria) realizadas uma vez por semana. Para a avaliação foram utilizadas as escalas de equilíbrio de Berg e Tinneti e o Inventário de avaliação pediátrica de incapacidade (PEDI) para habilidades motoras gerais e funcionais, aplicados antes e após o período de terapia; e uma reavaliação foi feita oito semanas (sem intervenção) depois. A equoterapia melhorou de maneira significativa o equilíbrio e a coordenação motora da criança, o que se refletiu no controle de movimentos funcionais básicos para a realização de atividades de vida diária. O ganho funcional também foi percebido pela mãe da criança. Esse estudo oferece uma nova perspectiva sobre o uso da equoterapia como modalidade fisioterapêutica na reabilitação motora e funcional de criança com meningoencefalocele.

Hippotherapy is one among techniques used in rehabilitation of patients with neurological dysfunctions. The patient body's reactions to horse movements are known to have positive effects on patients' postural control, thus improving general mobility and motor functional performance. The purpose of this paper was to assess the effects of hippotherapy on balance, motor coordination, and functionality of a child with meningoencephalocele. A 3-and-a-half year-old girl with meningoencephalocele was submitted to 18 hippotherapy sessions (in a three- phase procedure - feeding, brushing, and riding) once a week. Outcome measures were obtained by means of the Berg and Tinetti balance scales and the Brazilian version of the Pediatric Evaluation of Disability Inventory (for general functional abilities), all applied before and after therapy, and at an 8-week follow-up assessment. Results showed the child's significantly improved balance and motor coordination, which reflected on functional movement control, basic for performing daily living activities. Functional gain was also perceived by the child's mother. This study provides a new insight into hippotherapy as a useful physical therapy modality for improving motor and functional ability of children with encephalocele.

Group Physical therapy program for patients with parkinson disease: alternative rehabilitation

Introduction: Parkinson's disease is a neurological disorder causing loss of functional abilities and progressive loss of independence despite medical treatment. Objective: The aim of this study was to evaluate the effects of group physical therapy on motor performance and activities of daily life in patients with Parkinson Disease (PD). Metodology: Five patients (both sex, average age: 69,2 years, mean time-period of PD:5.2 years, average Hoehn and Yahr score: 3 referred to the Clinic of Physical Therapy of Pontifical Catholic University of Minas Gerais in Poços de Caldas city, were evaluated (initial, intermediate and final stages) using the Berg Balance Scale (balance static and dynamic evaluation); Timed "Up &Go" tEST (gair evaluation); Bathel Index (activities of daily life evaluation). Thirty-five sessions were done, aiming to: improve general mobility, static and dynamic balance using hearing and visual cues. Results: The data shows a statistical difference in balance, gait and daily life performance fot the average scores comparing three stages of evaluation (p < 005; block variance analysis followed by multiple comparison test), where the intermediate and final evaluation provided a better score compared with the initial one. Conclusion: Our data provided promissing results for the use of group physical therapy for patients with PD, providing a cost-effective alternative in physical therapy.

A história do Congresso Médico Universitário da FMUSP: COMU / The history of Congresso Médico Universitário da FMUSP: COMU

Em 2008, o Congresso Médico Universitário da FMUSP - COMU, chega a sua vigésima sétima edição. O COMU é composto de cursos, palestras, mesas redondas, workshops, jantares e apresentação de trabalhos científicos de acadêmicos que visam contribuir para a formação profissional de estudantes de medicina...

In 2008, the Congresso Médico Universitário da FMUSP - COMU, comes to its 27th edition. The COMU consists of courses, seminars, workshops, dinners and presentation of academics scientific works which purpose is to contribute to the medical formation, stimulate of academics research e promote cultural integration...

Insuficiência Cardíaca congestiva em crianças do tratamento farmacológico ao transplante cardíaco / Heart failure in children: from the pharmacologic treatment to heart transplantation

A insuficiência cardíaca em crianças ocorre basicamente por: 1) defeitos cardíacos congênitos que levam à sobrecarga pressórica ou volumétrica na presença ou ausência de cianose; 2) cardiomiopatias congênitas ou adquiridas por erros inatos do metabolismo, distrofias musculares, infecções, drogas, toxinas e doença de Kawasaki; e 3) disfunção miocárdicaapós correção de defeitos cardíacos. Suas manifestações variam com a idade. Os sintomas mais comuns em lactentes são taquipnéia, taquicardia e dispnéia às mamadas; em crianças maiores fadiga e intolerância ao exercício; já em adolescentes são similares aos dos adultos. Seu tratamento pode ser a correção do defeito cardíaco congênito, com o uso ou não de drogas para otimizar o quadro clínico antes da cirurgia. Faz-se uso prolongado demedicação anti-congestiva em pacientes com defeitos cardíacos com tendência a fechamento espontâneo. As drogas utilizadas são digitálicos, diuréticos, inibidores da enzima conversorade angiotensina e os beta-bloqueadores. Estudos sobre eficácia das drogas mostram que a digoxina tem efeito benéfico modesto em crianças e os beta-bloqueadores melhoram a função ventricular. Há poucos estudos sobre a eficácia dos diuréticos e sobre os benefícios dos inibidores de angiotensina em crianças, principalmente se os inibidores possuem efeitos similares aos dos adultos e se apresentam efeitos no desenvolvimento da criança ao longo prazo. O transplante cardíaco tem sido indicado como tratamento principalmente para o estágioD de insuficiência cardíaca.

Heart failure in children occurs basically because of (1) congenital heart defectsthat lead to pressure or volume overload in the presence or absence of cyanosis; (2) congenital or acquired cardiomyopathies by innate errors in metabolism, muscular dystrophies, infections, drugs, toxins and Kawasaki disease; and (3) myocardial dysfunction after correction of cardiac defects. Its manifestation varies with age. The most common symptoms in infant aretachycardia, tachypnea and dyspnea while suckling; in older children, fatigue and intolerance to exercise; in the adolescents the symptoms are similar to those in the adults. Its treatmentcan be the correction of the cardiac defect with or without use of drugs to optimize the clinical condition before the surgery. Extended use of anticongestive medication is used in patients with cardiac defects that tend to amend spontaneously. The drugs utilized are digoxin, diuretics, angiotensin inhibitors and beta-blockers. Studies about drugs’ efficacy suggest that digoxin hasa modest beneficial effect in children and beta-blockers improve ventricular function. There are few studies about the efficacy of diuretics and about the benefits of angiotensin inhibitors inchildren, mainly if the ACI has similar effects of adults and if they may affect the child’s growth in long-term period. Heart transplantation has been indicated principally as a treatment forstage D heart failure.

Mapeamento da acessibilidade do portador de limitação física a serviços básicos de saúde / Demarcation of the accessibility of the handicapped to a basic health services

Reconhecendo os direitos dos portadores de limitação física no quesito acessibilidade, objetiva-se mapear as barreiras arquitetônicas de acesso aos serviços básicos de saúde. Estudo exploratório-descritivo, com amostra intencional de 12 unidades em município de médio porte. Coleta de dados por formulário tipo cheque-lista. Foi observado que a arquitetura externa dificulta ou impossibilita o acesso, pois as calçadas contêm obstáculos, ausência de rebaixamento de meio-fio, sinalização em pontos estratégicos e de estacionamento demarcado. Em contrapartida, a maioria das unidades possui rampas de acesso com corrimão e corredores com largura adequada. Balcões, mesas, assentos, telefones, bebedouros estão predominantemente a uma altura superior à preconizada, e os banheiros não oferecem espaço suficiente para transposição de cadeira de rodas; nestes não há barras horizontais, e a maioria das peças sanitárias está a uma altura inadequada. Tais barreiras são obstáculos para o usufruto, por parte dos portadores de limitação física, dos equipamentos de saúde disponibilizados à sociedade.

Efeitos analgésicos da Acupuntura associada à reeducação postural para pacientes portadores / Acupuncture analgesia associated with postural reeducation in intervertebral disk displacement patient: a complementary therapeutic approach

A hérnia de disco é uma patologia de incidência muito comum, atingindo indivíduos na faixa etária produtiva. O objetivo deste trabalho foi avaliar os resultados da acupuntura associada à reeducação postural (método Iso-stretching) no tratamento da hérnia de disco. Foram tratados 5 pacientes, sendo que todos realizaram posições de Iso-stretching (15 no total) em seguida a acupuntura num total de 15 sessões. Na avaliação inicial e final foram colhidos dados sobre o nível de dor, amplitude de movimento, medida dedo-chão, atividades de vida diária e padrão energético. O nível de dor também foi medido durante as sessões. Os resultados demonstraram uma melhora visível em todos os parâmetros colhidos, concluindo que o tratamento associado de Iso-stretching e acupuntura potencializa os resultados da melhora da sintomatologia do paciente com hérnia de disco lombar, dentro da sessão e ao longo do tratamento.

Intervertebral disk displacement is one of the pathologies with higher incidence level in productive ages. This work had the objective to analyze the association between acupuncture and postural reeducation (Iso-Stretching method) during intervertebral disk displacement treatment. We have used Iso-stretching postures (15 in total number) followed by acupuncture in all of the 5 patients during the whole treatment (15 sessions). During the initial and final evaluation, pain measurement, movement reach, “finger-floor” test, daily activities ability and energetic pattern were evaluated. The pain was still evaluated inside the sessions. The results have shown a visible improvement for all of the measurements. We can conclude that the association of iso-stretching and acupuncture increase the therapeutic results with a better attenuation of the patient’s symptoms.