Impact of vertical positioning on lung aeration among mechanically ventilated intensive care unit patients: a randomized crossover clinical trial / Impacto do posicionamento vertical na aeração pulmonar em pacientes de unidades de terapia intensiva ventilados mecanicamente: um estudo clínico transversal randomizado

ABSTRACT Objective: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. Methods: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). Results: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). Conclusion: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients. ClinicalTrials.gov registry: NCT04176445

RESUMO Objetivo: Avaliar o impacto de diferentes posicionamentos verticais na aeração pulmonar em pacientes em ventilação mecânica invasiva. Métodos: Trata-se de ensaio clínico aberto, randomizado e transversal, realizado entre janeiro e julho de 2020. Adultos em ventilação mecânica invasiva por mais de 24 horas e menos de 7 dias com estabilidade hemodinâmica, respiratória e neurológica foram distribuídos aleatoriamente em uma proporção de 1:1 à postura sentada seguida da condição de ortostatismo passivo ou o ortostatismo passivo seguido de postura sentada. O desfecho primário foi a aeração pulmonar avaliada pelo lung ultrasound score. O escore varia de zero (melhor) a 36 (pior). Resultados: Foram selecionados 186 indivíduos; destes, 19 foram incluídos (57,8% do sexo masculino; média idade de 73,2 anos). Todos os participantes foram selecionados para receber pelo menos um protocolo de verticalização. O ortostatismo passivo resultou em escores médios de aeração pulmonar por ultrassonografia que não diferiram significativamente da postura sentada (11,0 versus 13,7; diferença média, -2,7; IC95% -6,1 a 0,71; p = 0,11). Ocorreram eventos adversos em três indivíduos no grupo ortostatismo passivo e em um no grupo postura sentada (p = 0,99). Conclusão: Esta análise não encontrou diferenças significativas na aeração pulmonar entre os grupos ortostatismo passivo e postura sentada. É factível conduzir um estudo clínico transversal randomizado para avaliar o impacto do posicionamento vertical na aeração pulmonar em pacientes em ventilação mecânica invasiva. Infelizmente, o estudo foi interrompido devido à necessidade de tratar pacientes com COVID-19. Registro ClinicalTrials.gov: NCT04176445

Simultaneous Cesarean Section and Maternal Cardiac Surgery: Outcomes and Feasibility from a Tertiary Care Hospital in India.

INTRODUCTION: Cardiovascular disease is the leading cause of pregnancy-related mortality, and it has gradually increased over time; this rise has been attributed to numerous reasons including the growing number of women with congenital heart disease who are surviving to childbearing age. Valve surgery during pregnancy is a high risk, with a fetal and maternal mortality rate of 35% and 9%, respectively. Prior knowledge about the cardiovascular disease opens up a host of options for the mother even during pregnancy, but presentation in the 3rd trimester puts both the mother and the baby at risk. Simultaneous caesarean section and maternal cardiac surgery is a suitable option for this subset of patients, and with this study we aim to assess its outcomes and feasibility. METHODS: This is a retrospective study of five pregnant patients who presented with predominant symptoms of heart failure in the 3rd trimester between June 2019 and June 2021. Intraoperative and postoperative intensive care unit charts of all the patients were reviewed. RESULTS: All five patients underwent simultaneous cesarean section and maternal cardiac surgery successfully with no fetal or maternal mortality and are doing well in the follow-up period. CONCLUSION: Cesarean section followed by definitive maternal cardiac surgery in the same sitting is a safe and feasible approach in the management of such patients. A well-prepared team is pivotal for a safe delivery with a cardiopulmonary bypass machine on standby. Specialized multidisciplinary care in the antepartum, peripartum, and postpartum period is essential to improve outcomes.

Ergonomic interventions for work in a sitting position: an integrative review.

The sitting position is one of the most common positions in the workplace and one that can contribute to overloading the musculoskeletal system. Ergonomics can play a significant role in ensuring an appropriate relationship between people and their work and in achieving better conditions for workers' health. The objective of this study was to consult the available evidence on the results of different ergonomic interventions for the musculoskeletal systems of workers who perform their jobs in a sitting position. This was an integrative review, searching the LILACS, MEDLINE, PubMed, SciELO, and CINAHL electronic databases for articles published from 2010 to 2019. The following keywords were used: Trabalhadores OR Workers OR Trabajadores AND Dor OR Pain OR Dolor AND Postura Sentada OR Sitting Position OR Sedestación AND Ergonomia OR Ergonomics OR Ergonomía. A total of 183 articles were identified, 14 of which were selected for the review. For qualitative analysis, the articles were organized by author, year, sample/population, objective, analytical instrument, intervention and type of intervention: combinations of physical exercise programs and postural and ergonomic guidance; different types of guidance and facilitating instruments; or configuration of furniture and use of supporting devices. A quantitative analysis of study quality was conducted using the Physiotherapy Evidence Database, based on the Delphi list. The interventions contributed to improve physical conditions and the tasks being carried out, making them more appropriate for the workers.

A postura sentada é uma das mais adotadas nos ambientes de trabalho e pode contribuir na sobrecarga do sistema musculoesquelético. A ergonomia pode apresentar um papel significativo para manter a relação adequada do homem com o trabalho e para abordar melhores condições à saúde dos trabalhadores. O objetivo deste estudo foi verificar as evidências disponíveis sobre os resultados de diferentes intervenções ergonômicas no sistema musculoesquelético de trabalhadores que exercem atividades na postura sentada. Tratou-se de uma revisão integrativa, utilizando as bases de dados eletrônicas LILACS, MEDLINE, PubMed, SciELO e CINAHL, com busca de artigos publicados no período de 2010 a 2019. Utilizaram-se os seguintes descritores: Trabalhadores OR Workers OR Trabajadores AND Dor OR Pain OR Dolor AND Postura Sentada OR Sitting Position OR Sedestación AND Ergonomia OR Ergonomics OR Ergonomía. Foram encontrados 183 artigos, sendo 14 selecionados. A análise qualitativa organizou os artigos de acordo com autor, ano, amostra/população, objetivo, instrumento de análise, intervenção e tipo de intervenção: associação de programas de exercícios físicos e orientações posturais e ergonômicas; diferentes formas de orientação e instrumentos facilitadores; e configuração do mobiliário e utilização de dispositivos auxiliares. A análise quantitativa da qualidade dos estudos considerou a escala Physiotherapy Evidence Database, baseado na lista Delphi. As intervenções contribuíram para melhorar as condições físicas e as tarefas executadas, tornando-as mais apropriadas para os trabalhadores.

Evaluation of the ergonomic sitting position adopted by dental students while using dental simulators.

Background/purpose: Ergonomics in dentistry encourages the work to be in an organized manner, where a dentist achieves highest performance with maximum comfort and minimum physical and psychological effort. The purpose of this study was to evaluate the ergonomic sitting position of dental students from third, fourth and fifth year undergraduate programs while they prepared teeth 46 and 27 as Black Class I preparation for amalgam using dental simulators. Materials and methods: Ten students were randomly selected from each year for this study. Photos and videos were taken from them to record their sitting position as they performed a Black Class I amalgam preparation in Nissin simulators. Results: It was found that more students had a poor ergonomic sitting position while working in mandibular area (60%, torso and neck angle; 53% knee-angle; 50% elbow-angle). When comparing the average score between maxilla and mandible within students of the same year, fourth year students had a significant difference in their average, with a better performance in maxilla (P ≤ 0.01). They also showed better performance in maxillary area compared to fifth-year students (P ≤ 0.008). The main reasons that the students presented as justification for their bad posture were little work time, lack of knowledge, not knowing how to use indirect vision, and poor comfort. Conclusion: Every undergraduate year had a compromised sitting position, with the exception of fourth-year students when working in maxillary area. No correlation between undergraduate year and performance was found.

Anesthetic induction and endotracheal intubation in the sitting position due to the fixed forearm caught by a meat grinder

Abstract A male patient was scheduled for urgent amputation of his right forearm. His right forearm was stuck inside the insertion slot of a meat grinder, resulting in severe pain to his injured arm. His upper body could not move to sit in a semi-upright position. An endotracheal tube was successfully placed after rapid sequence intubation using a video laryngoscope from behind the patient on the first attempt. This case report is the first documentation of successful anesthetic induction with subsequent endotracheal intubation using a video laryngoscope from behind an injured patient whose upper body was upright with limited positioning.

Cerebral oxygenation assessed by near-infrared spectroscopy in the sitting and prone positions during posterior fossa surgery: a prospective, randomized clinical study.

OBJECTIVES: Sitting position (SP) or prone position (PP) are used for posterior fossa surgery. The SP induced reduction in cerebral blood flow and cerebral oxygen saturation (rSO2) has been shown in shoulder surgeries, but there is not enough data in intracranial tumor surgery. Studies showed that PP is safe in terms of cerebral oxygen saturation in patients undergoing spinal surgery. Our hypothesis is that the SP may improve cerebral oxygenation in the patients with intracranial pathologies due to reduction in intracranial pressure. Therefore, we compared the effects of the SP and PP on rSO2 in patients undergoing posterior fossa tumor surgery. METHODS: Data were collected patients undergoing posterior fossa surgery, 20 patients in SP compared to 21 patients in PP. The rSO2 was assessed using INVOS monitor. Heart rate (HR), mean arterial pressure (MAP), EtCO2, BIS, and bilateral rSO2 were recorded preoperatively, and at 5, 8, and 11.ßminutes after the intubation and every 3.ßminutes after patient positioning until the initial surgical incision. RESULTS: Cerebral oxygenation slowly reduced in both the sitting and prone position patients following the positioning (p.ß<.ß0.002), without any difference between the groups. The HR and MAP were lower in the sitting SP after positioning compared to the PP. CONCLUSION: Neurosurgery in the SP and PP is associated with slight reduction in cerebral oxygenation. We speculate that if we rise the lower limit of MAP, we might have showed the beneficial effect of the SP on rSO2.

Spinal cord ischemia as intraoperatory complication in shoulder surgery positioned in beach chair: case report.

Spinal cord infarction is an uncommon phenomenon, which can be caused by different etiologies, constituting a real diagnostic challenge which can lead to devastating consequences. General anesthesia in beach chair positioning with intraoperative hypotension in order to avoid surgical bleeding are associated with hypoperfusion and potential neurological ischemia-related complications. We present a case of spinal cord ischemia in the context of shoulder surgery in a beach chair position.

Anesthetic induction and endotracheal intubation in the sitting position due to the fixed forearm caught by a meat grinder.

A male patient was scheduled for urgent amputation of his right forearm. His right forearm was stuck inside the insertion slot of a meat grinder, resulting in severe pain to his injured arm. His upper body could not move to sit in a semi-upright position. An endotracheal tube was successfully placed after rapid sequence intubation using a video laryngoscope from behind the patient on the first attempt. This case report is the first documentation of successful anesthetic induction with subsequent endotracheal intubation using a video laryngoscope from behind an injured patient whose upper body was upright with limited positioning.

Simultaneous Cesarean Section and Maternal Cardiac Surgery: Outcomes and Feasibility from a Tertiary Care Hospital in India

ABSTRACT Introduction: Cardiovascular disease is the leading cause of pregnancy-related mortality, and it has gradually increased over time; this rise has been attributed to numerous reasons including the growing number of women with congenital heart disease who are surviving to childbearing age. Valve surgery during pregnancy is a high risk, with a fetal and maternal mortality rate of 35% and 9%, respectively. Prior knowledge about the cardiovascular disease opens up a host of options for the mother even during pregnancy, but presentation in the 3rd trimester puts both the mother and the baby at risk. Simultaneous caesarean section and maternal cardiac surgery is a suitable option for this subset of patients, and with this study we aim to assess its outcomes and feasibility. Methods: This is a retrospective study of five pregnant patients who presented with predominant symptoms of heart failure in the 3rd trimester between June 2019 and June 2021. Intraoperative and postoperative intensive care unit charts of all the patients were reviewed. Results: All five patients underwent simultaneous cesarean section and maternal cardiac surgery successfully with no fetal or maternal mortality and are doing well in the follow-up period. Conclusion: Cesarean section followed by definitive maternal cardiac surgery in the same sitting is a safe and feasible approach in the management of such patients. A well-prepared team is pivotal for a safe delivery with a cardiopulmonary bypass machine on standby. Specialized multidisciplinary care in the antepartum, peripartum, and postpartum period is essential to improve outcomes.

Association between isokinetic strength measures and functional performance in community-dwelling older adults / Asociación entre las medidas de fuerza isocinética y el rendimiento funcional en personas mayores en la comunidad / Associação entre medidas de força isocinética e desempenho funcional em pessoas idosas da comunidade

ABSTRACT Previous studies have shown an association between lower limb muscle strength and functional performance, but a dose-response relationship between the strength of each lower limb muscle group and performance in daily life activities in older adults has not been well established. Thus, this study aimed to investigate the association between isokinetic muscle strength of all eight major lower limb muscle groups and functional performance in community-dwelling older adults. The muscle strength of the plantar flexors and dorsiflexors of the ankle, flexors and extensors of the knee, and flexors, extensors, adductors, and abductors of the hip were evaluated using a Biodex System 4 Pro® isokinetic dynamometer. Functional performance was evaluated in 109 participants using the five-times sit-to-stand test (STS) and 4-meter usual walking speed (UWS). The multiple linear regression analyses showed that the hip abductors strength predicted 31.3% of the variability for UWS (p=0.011), and the knee extensors strength (p=0.015) predicted 31.6% of the variability for the STS. We conclude that hip abductors and knee extensors could be the key muscle groups involved in sit to stand and walking speed performance in older adults.

RESUMEN Estudios previos ya demostraron la asociación entre la fuerza muscular de los miembros inferiores y el rendimiento funcional, sin embargo, no está bien establecida la contribución de los principales músculos de los miembros inferiores sobre el rendimiento de las personas mayores en las actividades diarias. El objetivo de este estudio fue evaluar la asociación entre la fuerza muscular isocinética de los ocho principales grupos musculares de los miembros inferiores y el rendimiento funcional en personas mayores que viven en la comunidad. La fuerza muscular de los plantiflexores y dorsiflexores del tobillo, los flexores y extensores de la rodilla y los flexores, extensores, aductores y abductores de la cadera se evaluaron por medio del dinamómetro isocinético Biodex System 4 Pro®. El rendimiento funcional de 109 participantes se evaluó mediante el test de sentarse y pararse cinco veces (STS) y la velocidad de marcha habitual de 4 metros. Los análisis de regresión lineal múltiple mostraron que la fuerza de los abductores de la cadera predijo el 31,3% de la variabilidad para la velocidad de marcha habitual (p=0,011); y la fuerza de los extensores de la rodilla (p=0,015), el 31,6% de variabilidad para STS. Se concluyó que los abductores de la cadera y los extensores de la rodilla pueden ser los principales grupos musculares involucrados en el rendimiento de los adultos mayores para sentarse, pararse y caminar.

RESUMO Estudos anteriores já demonstraram a associação entre força muscular de membros inferiores e desempenho funcional, mas a contribuição dos principais músculos dos membros inferiores para o desempenho de pessoas idosas nas atividades cotidianas não foi bem estabelecida. O objetivo deste estudo foi investigar a associação entre a força muscular isocinética dos oito principais grupos musculares dos membros inferiores e o desempenho funcional em pessoas idosas da comunidade. A força muscular dos plantiflexores e dorsiflexores do tornozelo, flexores e extensores do joelho e flexores, extensores, adutores e abdutores do quadril foi avaliada utilizando um dinamômetro isocinético Biodex System 4 Pro®. O desempenho funcional de 109 participantes foi avaliado usando o teste de sentar e levantar cinco vezes (TSL) e de velocidade de marcha habitual de 4 metros (VMH). As análises de regressão linear múltipla mostraram que a força dos abdutores do quadril previu 31,3% da variabilidade para a VMH (p=0,011), e a força dos extensores do joelho (p=0,015) 31,6% da variabilidade para o TSL. Concluímos que os abdutores do quadril e os extensores do joelho podem ser os principais grupos musculares envolvidos no desempenho de pessoas idosas para sentar-levantar e caminhar.

Spinal cord ischemia as intraoperatory complication in shoulder surgery positioned in beach chair: case report

Abstract Spinal cord infarction is an uncommon phenomenon, which can be caused by different etiologies, constituting a real diagnostic challenge which can lead to devastating consequences. General anesthesia in beach chair positioning with intraoperative hypotension in order to avoid surgical bleeding are associated with hypoperfusion and potential neurological ischemia-related complications. We present a case of spinal cord ischemia in the context of shoulder surgery in a beach chair position.

Cerebral oxygenation assessed by near-infrared spectroscopy in the sitting and prone positions during posterior fossa surgery: a prospective, randomized clinical study

Abstract Objectives: Sitting position (SP) or prone position (PP) are used for posterior fossa surgery. The SP induced reduction in cerebral blood flow and cerebral oxygen saturation (rSO2) has been shown in shoulder surgeries, but there is not enough data in intracranial tumor surgery. Studies showed that PP is safe in terms of cerebral oxygen saturation in patients undergoing spinal surgery. Our hypothesis is that the SP may improve cerebral oxygenation in the patients with intracranial pathologies due to reduction in intracranial pressure. Therefore, we compared the effects of the SP and PP on rSO2 in patients undergoing posterior fossa tumor surgery. Methods: Data were collected patients undergoing posterior fossa surgery, 20 patients in SP compared to 21 patients in PP. The rSO2 was assessed using INVOS monitor. Heart rate (HR), mean arterial pressure (MAP), EtCO2, BIS, and bilateral rSO2 were recorded preoperatively, and at 5, 8, and 11 minutes after the intubation and every 3 minutes after patient positioning until the initial surgical incision. Results: Cerebral oxygenation slowly reduced in both the sitting and prone position patients following the positioning (p < 0.002), without any difference between the groups. The HR and MAP were lower in the sitting SP after positioning compared to the PP. Conclusion: Neurosurgery in the SP and PP is associated with slight reduction in cerebral oxygenation. We speculate that if we rise the lower limit of MAP, we might have showed the beneficial effect of the SP on rSO2.

Is physical inactivity and sedentary behavior associated with tumor stage in breast cancer patients? A cross-sectional study of Brazilian women

ABSTRACT Objective A comparative analysis of the association between sedentary behavior versus physical activity levels and tumor staging in women with breast cancer. Methods The present research adopted a cross-sectional study design to recruit a total of 55 adult and elderly women newly diagnosed with breast cancer for data collection and analysis. Inclusion criteria involved patients in procession of a formal approval for participation in the study by the treating physician and those not hitherto subjected to the first cycle of chemotherapy. Results Physical activity levels did not influence the pathological stage of breast cancer (p=0.26) or histological tumor grade (p=0.07) in the analyzed subjects. However, there was a significant association between physical activity levels and responsiveness to hormones (epidermal growth factor receptor (HER2), p<0.05) in the analyzed subjects. Significant difference was detected in the histological tumor grade in relation to the mean time spent sitting during the weekend (p<0.05). However, sedentary behavior had no influence on the tumor stage (p>0.05). Conclusion Physical activity levels did not influence the tumor stage and histological tumor grade. Sedentary behavior had a significant influence on the histological tumor grade.

Postural Hypervigilance and Perception of Correct Sitting Posture in Individuals With and Without Low Back Pain.

Objectives To verify if there is a difference in postural hypervigilance in sitting in individuals with and without low back pain. Additionally, to observe whether there is a difference in the perception of correct sitting posture between individuals with low back pain and without low back pain. Methods The present study has a cross-sectional observational design, as a sample size of 92 individuals, later divided equally into two groups (with low back pain and without low back pain). Two instruments were used: the hypervigilance scale to analyze the frequency that volunteers correct their sitting posture during the day, and posture scans to investigate the perception of volunteers about the correct sitting posture. The data were submitted to the Shapiro-Wilk Normality test. To compare the values of Hypervigilance Scale, the Mann-Whitney, Chi-Square, and Fisher Exact tests were used to assess correct sitting posture. Results There was no significant difference between postural hypervigilance in sitting between individuals with low back pain and without low back pain. There was no significant difference between the choice of correct sitting posture between the group of individuals with and without low back pain. Conclusion There is no difference between the choice of correct sitting posture and the amount of postural hypervigilance in individuals with or without low back pain.

Postural Hypervigilance and Perception of Correct Sitting Posture in Individuals With and Without Low Back Pain / Hipervigilância postural e percepção da postura correta sentada em indivíduos com e sem dor lombar

Abstract Objectives To verify if there is a difference in postural hypervigilance in sitting in individuals with and without low back pain. Additionally, to observe whether there is a difference in the perception of correct sitting posture between individuals with low back pain and without low back pain. Methods The present study has a cross-sectional observational design, as a sample size of 92 individuals, later divided equally into two groups (with low back pain and without low back pain). Two instruments were used: the hypervigilance scale to analyze the frequency that volunteers correct their sitting posture during the day, and posture scans to investigate the perception of volunteers about the correct sitting posture. The data were submitted to the Shapiro-Wilk Normality test. To compare the values of Hypervigilance Scale, the Mann-Whitney, Chi-Square, and Fisher Exact tests were used to assess correct sitting posture. Results There was no significant difference between postural hypervigilance in sitting between individuals with low back pain and without low back pain. There was no significant difference between the choice of correct sitting posture between the group of individuals with and without low back pain. Conclusion There is no difference between the choice of correct sitting posture and the amount of postural hypervigilance in individuals with or without low back pain.

Resumo Objetivos Verificar se há diferença na hipervigilância postural sentada em indivíduos com e sem dor lombar. Além disso, observar se há diferença na percepção da postura correta sentada entre indivíduos com dor lombar e sem dor lombar. Métodos O presente estudo possui delineamento observacional transversal, como tamanho amostral de 92 indivíduos, posteriormente divididos igualmente em dois grupos (com dor lombar e sem dor lombar). Foram utilizados dois instrumentos: a escala de hipervigilância para analisar a frequência que voluntários corrigem a postura sentada no dia; e o quadro de posturas para investigar a percepção dos voluntários sobre a postura correta sentada. Os dados foram submetidos ao teste de Normalidade de Shapiro-Wilk. Para comparar os valores da Escala de Hipervigilância foi utilizado o teste de Mann-Whitney e o teste Qui-quadrado e exato de Fisher para avaliação da postura correta sentada. Resultados Não houve diferença significativa entre a hipervigilância postural sentada entre indivíduos com dor lombar e sem dor lombar. Não houve diferença significativa entre a escolha da postura correta sentada entre o grupo de indivíduos com e sem dor lombar. Conclusão Não há diferença entre a escolha da postura correta sentada e quantidade de hipervigilância postural em indivíduos com ou sem dor lombar.

Reemplazo de silla por balón de estabilidad mejora fuerza muscular y calidad de vida en trabajadores de oficina: Estudio piloto / Chair Replacement by Stability Ball Improves Muscle Strength and Quality of Life in Office Workers: Pilot Study

RESUMEN Objetivo: Determinar si el reemplazo parcial de silla de oficina por un balón de estabilidad aumenta la fuerza-resistencia de musculatura extensora de tronco y equilibrio estático, así como mejora la calidad de vida relacionada con la salud en adultos que realizan trabajo de oficina. Materiales y métodos: Estudio de diseño preexperimental pre-post sin grupo control. La muestra fue intencionada, de 18 trabajadores de oficina entre 25 y 55 años. Durante 8 semanas se realizó un reemplazo parcial y progresivo de una silla de oficina por un balón de estabilidad durante las horas de trabajo. Pre y post al reemplazo se evaluó la fuerza-resistencia de la musculatura extensora de tronco mediante el test clínico Biering Sorensen, el equilibrio estático mediante oscilografía postural y la calidad de vida con el cuestionario de percepción de calidad de vida relacionado con la salud SF-36. Resultados: Se observó una mayor fuerza-resistencia muscular (p=0,003), y un mejor puntaje en las dimensiones rol físico (p=0,041), dolor corporal (p=0,017), salud general (p=0,027), función social (p=0,017), rol emocional (p=0,043) y salud mental (p=0,036). Conclusiones: El reemplazo parcial y progresivo de la silla de oficina por un balón de estabilidad durante 8 semanas aumentó la fuerza-resistencia de la musculatura extensora de tronco y mejoró la percepción de calidad de vida en trabajadores de oficina.

ABSTRACT Aim: To determine if the partial replacement of the office chair with a stability ball increases the strength-resistance of the trunk extensor muscles and static balance, as well as improves the health-related quality of life in office workers. Materials and methods: Pre-post experimental design study without control group. Intentional sample of 18 office workers between 25 and 55 years old. For 8 weeks, a partial and progressive replacement of an oice chair with a stability ball was performed during working hours. Before and after replacement, the strength-resistance of the trunk extensor muscles was evaluated using the Biering Sorensen clinical test, static balance was measured using postural oscillography and quality of life was evaluated with the quality of life perception questionnaire related to health SF-36. Results: Greater muscular strength-endurance (p = 0.003), and a better score in the dimensions of physical role (p = 0.041), body pain (p = 0.017), general health (p = 0.027), social function ( p = 0.017), emotional role (p = 0.043) and mental health (p = 0.036) were observed. Conclusions: The partial and progressive replacement of the office chair by a stability ball for 8 weeks increased the strength-resistance of the trunk extensor muscles and improved the perception of quality of life in office workers.

Comparison of three sitting positions for combined spinal - epidural anesthesia: a multicenter randomized controlled trial.

BACKGROUND AND OBJECTIVES: The aim of this prospective, multi-centered and multi-arm parallel randomized trial was to test the hypothesis that modified sitting positions including hamstring stretch position (HSP) and squatting position (SP) would reduce needle - bone contact events and increase the success rate of combined spinal - epidural anesthesia (CSEA) compared to traditional sitting position (TSP) in patients undergoing total knee or hip arthroplasty. PATIENTS AND METHODS: Three hundred and sixty American Society of Anesthesiologists (ASA) I-III patients, aged between 45-85 years were randomly allocated to one of three groups using computer-generated simple randomization: group TSP (n = 120), group HSP (n = 120), and group SP (n = 120). Primary outcome measures were the number of needle-bone contact and success rates. Secondary outcome measure was the ease of interspinous space identification. RESULTS: Seven patients in group SP and four of HSP could not tolerate their position and were excluded. Number of needle-bone contact, success rates, and grade of interspinous space identification were similar between groups (p = 1.000). Independent of positioning, the success rates were higher in patients whose interspinous space was graded as easy compared to difficult or impossible (p < 0.001). Success rates reduced, interspinous space identification became more challenging, and number of needle - bone contact increased as patient's body mass index (BMI) increased (p < 0.001). CONCLUSION: SP and HSP may be used as alternatives to the TSP. BMI and ease of interspinous space identification may be considered important determinants for CSEA success.

Posición semisentada en neurocirugía. Nota técnica y presentación de casos ilustrativos / Semi-sitting position in neurosurgery. Technical note and illustrative case presentation

Introducción: En las últimas décadas el uso de la posición sentada ha disminuido en frecuencia a causa de 2 complicaciones mayores: el embolismo aéreo venoso y la hipotensión intraoperatoria. Sin embargo es innegable que la posición sentada ofrece una serie de ventajas al neurocirujano, el anestesiólogo y al electrofisiólogo. Materiales y métodos: Estudio retrospectivo de pacientes operados en dos instituciones de Tucumán, entre enero de 2015 y diciembre de 2019. Resultados: Se operaron un total de 119 pacientes en posición sentada por vía posterior. Conclusión: Se presentó la técnica de posición semisentada paso a paso y consejos específicos. Se ilustró la utilidad de la misma mediante la presentación de casos representativos

Introduction: In the last decades, the use of the sitting position has been abandoned due to 2 major complications: venous air embolism and intraoperative hypotension. However, it is undeniable that the sitting position offers a series of advantages to the neurosurgeon, the anesthesiologist and the electrophysiologist. Materials and methods: Retrospective study of patients operated at two institutions in Tucumán, between January 2015 and December 2019. Results: A total of 119 patients were operated in a sitting position and posterior approach. Conclusion: The sitting position technique was presented step by step in detail, with the key steps and a series of tricks. The usefulness of the position was illustrated by presenting representative cases

Hippotherapy on postural balance in the sitting position of children with cerebral palsy - Longitudinal study.

Purpose: To verify the effects of 12, 24, 36 hippotherapy sessions over time on postural balance while sitting in children with cerebral palsy as well the effects of treatment after one interruption period of 45 days. Methods: Hippotherapy program with a twice-weekly treatment with a total of 13 children aged 5-10 years old. Measurements of postural balance during sitting were performed using the AMTI AccuSway Plus platform. Results: There was a statistically significant reduction in mediolateral and anteroposterior sway after the first 12 hippotherapy sessions, and further significant sway reduction occurred as the treatment progressed. Changes in the center of pressure displacement velocity variable began to occur after 24 sessions. Conclusion: Seated postural balance improved in children with cerebral palsy, as evidenced by lower COP displacement, particularly after a greater number of sessions. After the last evaluations, when completing 36 sessions of hippotherapy, it was verified that the improvements to the postural balance continued to occur. Therefore, further studies with a longer treatment period may help to clarify if, at some point, there is stabilization in the improvement of postural balance. Furthermore, it is important to analyze the impact of hippotherapy on functional activities over time.

Prevalência e fatores associados a sintomas osteomusculares em profissionais que trabalham predominantemente na postura sentada / Prevalence and factors associated with musculoskeletal symptoms in professionals working predominantly in sitting position

O objetivo dessa pesquisa foi estimar a prevalência de sintomas osteomusculares (SO) e identificar os fatores associados em profissionais de setores administrativos que trabalham predominantemente na postura sentada. Foi realizado um estudo analítico observacional transversal em uma instituição pública federal na região sul do país. Utilizou-se o questionário nórdico para estimar a prevalência de sintomas osteomusculares, sendo considerado variável dependente para a análise de associação o número de relatos. Após validação por juízes, selecionou-se para investigação 19 variáveis independentes, sendo três sociodemográficas, quatro comportamentais, seis ocupacionais e seis variáveis de saúde. Foi realizada a análise univariada e na sequência regressão múltipla de Poisson com variância robusta. As variáveis independentes foram inseridas por blocos em modelo hierárquico com critério backward stepwise, considerando p<0,20. As medidas de efeito foram expressas em Aumento Relativo (AR) na média, tendo os dados analisados para um nível de significância de 5% e intervalos com 95% de confiança. Participaram da pesquisa 451 trabalhadores, com média de idade de 44,4 anos, a maioria do sexo feminino (54,5%), com ensino superior ou pós-graduação (81,2%), não tabagista (84,2%) e praticante de atividade física (53,9%). O tempo médio sentado por dia no trabalho foi de 6,51 horas, em casa ou outros locais 3,12 horas e o tempo em ocupações na postura sentada de 20,29 anos. A prevalência de SO nos últimos 12 meses foi de 90% IC95% [87% ; 93%], sendo os locais mais afetados a coluna lombar com 61%, seguido de pescoço 49,7% e ombros 49,4%. As condições ergonômicas foram consideradas boas e 81,1% dos trabalhadores apresentaram índice de capacidade para o trabalho (ICT) bom ou ótimo. Quanto à saúde, 55,2% estavam com a circunferência da cintura acima do desejável, 54,1% fizeram uso de medicamentos nos últimos doze meses, 61,7% e 44,8% apresentaram baixa flexibilidade e resistência muscular, respectivamente. No modelo final da análise de regressão, as variáveis sexo feminino (AR=14,75%), ICT baixo (AR=100,02%) e moderado (AR=64,06%), uso de medicamentos (AR=48,06%) e circunferência da cintura em risco (AR=15,59%), tiveram associação significativa com o aumento da média de SO, já a escolaridade com ensino técnico, atuou como fator de proteção reduzindo a média em 36,46%. Ciente nesse contexto, podem-se propor medidas para melhoria, como por exemplo, realizar adaptações no ambiente laboral e mudanças da organização do trabalho objetivando mais atividade física e redução do tempo sentado por dia. Além de outros benefícios, essas ações contribuem diretamente na redução da pressão na coluna lombar e aumento do gasto energético, podendo contribuir na redução da obesidade abdominal e indiretamente melhorar a capacidade para o trabalho. Outra medida substancial é o tratamento à elevada presença de sintomas, pois toda dor, formigamento ou dormência necessitam de cuidados imediatos, evitando-se possíveis lesões incapacitantes no futuro. Portanto, a saúde desses trabalhadores requer cuidados específicos e maior atenção, com visão ampliada a fim de promover bem-estar e qualidade de vida sustentável no trabalho

The purpose of this survey was to estimate the prevalence of musculoskeletal symptoms (MS) and identify the related factors in professionals of administrative sectors who work predominantly seated. An analytical observational cross-sectional study was carried out in a federal public institution in the country's southern region. The Nordic questionnaire was used to estimate the prevalence of musculoskeletal symptoms, being considered dependent variable for the association analysis of the number of reports. After validation by judges, 19 independent variables were selected for study, being three sociodemographic, four behavioral, six occupational, and six health variables. A univariate analysis was performed and then multiple regression of Poisson with robust variance. The independent variables were inserted by blocks in hierarchical model with backward stepwise criterion, considering p<0.20. The effect measures were expressed in average Relative Increase (RI), having data analyzed for a significance level of 5% and confidence intervals in 95%. 451 workers took part of the survey, with mean age of 44.4 years, the most part females (54.5%), with higher education or graduate studies (81.2%), non-smokers (84.2%), and practicing physical activities (53.9%). The mean time seated per day at work was 6.5 hours, at home or other places 3.1 hours, and the time in sitting-posture occupations was 20.3 years. The prevalence of MS in the last 12 months was 90% CI95% [87% - 93%], being the most affected areas: lumbar spine with 61%, followed by neck with 49.7%, and shoulders 49.4%. The ergonomic conditions were considered to be good and 81.1% of the workers presented good or great work capability index (WCI). Regarding health, 55.2% were with waist circumference above recommended level, 54.1% used drug products in the last twelve months, and 61.7% and 44.8% presented low flexibility and muscular resistance, respectively. In the final model of regression analysis, the female variables (RI=14.75%), low WCI (RI=100.02%), and mild WCI (RI=64.06%), use of drug products (RI=48.06%), and waist circumference at risk (RI=15.59%), had significant association with the increase of MS average. The education with technical instruction acted as a protection factor by reducing the average by 36.46%. Aware of this context, improvement measures can be proposed, e.g., perform adaptations in the work environment and changes in the work organization, aiming more physical activities and reduction of time seated per day. In addition to other benefits, these actions contribute directly in reducing the lumbar spine pressure and increasing the consumption of energy, what may contribute in reducing abdominal obesity, and indirectly in improving the capability for work. Another substantial measure is the treatment to the high presence of symptoms, because every pain, tingling or numbness needs immediate care, avoiding potential disabling injuries in the future. Therefore, the health of these workers needs specific care and greater attention, with expanded view in order to promote welfare and sustainable quality of life at work