Aquatic therapy in congenital malformation during the use of external fixator for bone lengthening: It is possible?

OBJECTIVES: The objective of this study is to describe the rehabilitation of individuals with Congenital Malformations (CMF) during the use of an External Fixator (EF) in Aquatic Therapy (AT) and to analyze the association between diagnosis, EF type and location with rehabilitation process outcomes, surgical intervention, and adverse effects. METHODS: This retrospective study included 29 medical records from which the personal and rehabilitation data of the patient were collected. The AT used was described and the outcome variables were associated. The medical records were selected by screening the database of the CMF clinic at the AACD. The inclusion criteria were participants with CMF who used EF treated between 2011 and 2019 of both genders and without age restriction. The exclusion criteria were incomplete medical record data or not undergoing AT while using EF. The extracted data included diagnosis, gender, age, EF type and location, objective of the surgery, adverse events, surgical interventions, time of rehabilitation in AT, physiotherapeutic objectives, and rehabilitation process outcomes in AT. RESULTS: The mean age of the participants was 12.1 ± 3.99 years, with male predominance (55 %) and hemimelia cases (37 %). The most used EF was circular (51 %), located in the femur (37 %), and the main objective of surgery was bone lengthening (52 %). The most recurrent adverse effect was infection (62 %) and 76 % completed AT. There was no association between the variables analyzed. CONCLUSIONS: It was possible to describe CMF rehabilitation with EF in AT. There was no association between the variables analyzed.

Comparison of energy expenditure of individuals with Duchenne muscular dystrophy in the sitting posture on the ground and in water.

Duchenne Muscular Dystrophy (DMD) is one of the most frequent childhood dystrophies, affecting cardiopulmonary functions and walking ability. One of the main symptoms is fatigue, which is caused by altered muscle metabolism related to energy expenditure (EE). Aquatic physiotherapy is a therapeutic modality that facilitates the maintenance of this posture because of immersion on the body. This cross-sectional observational study aimed to compare the EE on the ground and water of individuals with DMD through oxygen consumption in the maintenance of sitting posture. The individuals were in a sitting position on the ground and in the water for 20 min for the assessments. The variables peripheral oxygen saturation, heart rate, maximum expiratory pressure, maximum inspiratory pressure, forced vital capacity, respiratory quotient (RQ), and oxygen consumption per kilogram of body weight (VO2 /kg) were compared, adopting a significance of 5 %. No difference was found between medians and quartiles of RQ when comparing the two environments. The same was observed for VO2 /Kg values on the ground and in water. The data from this study demonstrate that the EE of individuals with DMD did not change when maintaining a sitting posture on the ground and in water.

Profile of lactic acid bacteria (MALDI-TOF-MS) and physico-chemical and microbiological characteristics of the raw milk and fresh artisanal cheese from Serra Geral, Minas Gerais, Brazil.

Artisanal cheese from Serra Geral, Minas Gerais, Brazil, stands out for its cultural asset and socio-economic relevance. However, standards of identity and quality and the peculiar terroir associated with the edaphoclimatic conditions have not been established. Therefore, the production flow diagram and the physico-chemical and microbiological quality of the raw milk, pingo (natural starter culture), production benches, water and fresh cheese were investigated for the first time. In addition, lactic acid bacteria (LAB) from cheese and its production environment were identified by MALDI-TOF. For that, 12 cheese making facilities were selected. The raw milk and pingo showed adequate physico-chemical characteristics for cheesemaking; however, high microbial counts were found. In the water, total and thermotolerant coliforms were also identified. The fresh cheeses were classified as 'high moisture and fat' and 'soft mass'. Most physico-chemical parameters were satisfactory; however, there were high counts of total coliforms, Staphylococcus spp. and coagulase-positive staphylococci. There were high counts of LAB in the raw milk, pingo, bench surface and fresh cheese. A total of 84 microbial biotypes from MRS agar were isolated. Lactococcus lactis was the predominant LAB, followed by Lactococcus garvieae. Leuconostoc mesenteroides (benches), Leuconostoc pseudomesenteroides (fresh cheese), and Enterococcus faecium (pingo) were identified sporadically. These results indicate the risks to public health associated with the consumption of the fresh cheese, and measures to improve its safety are needed.

Nursing performance and occupational risks in family health strategy: an integrative review.

Primary health care is one of the different fields of nursing practice. The COVID-19 pandemic has caused a series of questions regarding exposure that nursing professionals face in terms of occupational risks in primary health care. The aim of this study was to discuss to discuss, based on scientific evidence, the occupational risks experienced by the nursing team in the Family Health Strategy. This integrative literature review was conducted in the Latin American and Caribbean Health Sciences Literature (LILACS) database and the Nursing Database (BDENF) between June and October 2020. The descriptors used in the search were: nursing, occupational risks, and primary health care. Inclusion criteria were original, open access articles published between 2005 and 2019 with the full text available. Of the 37 articles initially found, 6 were included in the analysis and after screening. Despite their presence during nursing work, occupational risks are not very perceptible except for biological risks, the understanding of which comes from professional practice rather than research and/or training. No article was addressed about the risk map or its use in the Family Health Strategy. Health managers must offer personal protective equipment and establish biosafety standards and training activities about occupational risks.

Entre os diversos campos de atuação da enfermagem, há a área de atenção primária à saúde. A pandemia causada pelo novo coronavírus ocasionou uma série de indagações referentes à exposição em que se encontram os profissionais de enfermagem perante os riscos ocupacionais na atenção primária à saúde, mais especificamente na estratégia saúde da família. Neste estudo, objetivou-se discutir, a partir de evidências científicas, os riscos ocupacionais vivenciados pela equipe de enfermagem na estratégia saúde da família. Tratou-se de uma revisão integrativa da literatura, realizada na base de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e na Base de Dados de Enfermagem no período de junho a outubro de 2020. Os descritores estabelecidos para busca foram enfermagem, riscos ocupacionais e atenção primária à saúde. Os critérios de inclusão foram pesquisas no formato de artigo original, disponíveis em formato completo e gratuito, publicadas entre 2005 e 2019. Inicialmente, foram encontrados 37 estudos; após o processo de triagem, permaneceram seis artigos. Apesar de presente durante a atuação do trabalho de enfermagem, os riscos ocupacionais ainda não são tão perceptíveis, com exceção do risco biológico, cujo entendimento é oriundo da prática profissional, e não de pesquisas e/ou capacitações. Nenhum artigo abordou o mapa de risco ou a sua utilização na estratégia saúde da família. Existe a necessidade de que os gestores em saúde tenham sensibilidade em ofertar equipamentos de proteção individual, estabeleçam normas de biossegurança e promovam atividades que visem à capacitação desses profissionais sobre riscos ocupacionais.

Atuação da fisioterapia aquática na esclerose lateral amiotrófica: revisão integrativa da literatura / Performance of aquatic physiotherapy in amyotrophic lateral sclerosis: integrative literature review

A Esclerose Lateral Amiotrófica (ELA) é uma doença neurodegenerativa do sistema nervoso central, caracterizada pela rápida progressão e incapacidade, resultando em atrofia muscular, fraqueza generalizada e fasciculações, marcada pelo acometimento bulbar, ocasionando disartria, disfagia e desconforto respiratório. Objetivo: Avaliar por meio de uma revisão integrativa da literatura a intervenção da fisioterapêutica aquática na esclerose lateral amiotrófica. Métodos: Consiste em uma revisão integrativa desenvolvida com base na estratégia PICO e registrada na plataforma PROSPERO ­ International prospective register of systematic reviews, 2020, seguindo as recomendações do checklist da PRISMA, abrangendo a leitura, análise e interpretação de artigos publicados na integra, em periódicos científicos disponibilizados em seu formato online, nos idiomas inglês e português, nas bases de dados Pubmed, Medline, Cochrane Library e Physiotherapy Evidence Database (PEDro), que abordaram a atuação da fisioterapia aquática apresentando seus resultados e condutas adotadas. Resultados: Dos 1.093 artigos encontrados, 5 foram selecionados para essa revisão, sendo respectivamente: 01 estudo randomizado com grupo de 22 pessoas; 02 estudos de caso com 1 pessoa, em cada estudo, do sexo masculino; 01 revisão sistemática da literatura, identificando 31 estudos que avaliaram o uso da fisioterapia aquática como tratamento em uma das quatro condições neurológicas, visão geral dos efeitos do treinamento físico em ratos e pacientes afetados pela ELA, através de uma revisão da literatura. Conclusão: Os estudos demostram que a fisioterapia aquática tem um futuro promissor, podendo ser considerado um importante recurso terapêutico para os pacientes com ELA, beneficiando tanto as questões motoras funcionais, como osaspectos psicológicos e sociais.

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease of the central nervous system, characterized by rapid progression and disability, resulting in muscle atrophy, generalized weakness and fasciculations, marked by bulbar involvement, causing dysarthria, dysphagia and respiratory distress. Objective: The objective of this study is to evaluate, through an integrative literature review, the intervention of aquatic physical therapy in amyotrophic lateral sclerosis. Methods: It consists of an integrative review developed based on the PICO strategy and registered on the PROSPERO platform - International prospective register of systematic reviews, 2020, following the recommendations of the PRISMA checklist, covering the reading, analysis and interpretation of articles published in full, in journals scientific articles made available in their online format in English and Portuguese in the Pubmed, Medline, Cochrane Library and Physiotherapy Evidence Database (PEDro) databases, which addressed the performance of aquatic physiotherapy, presenting their results and adopted behaviors. Results: Of the 1,093 articles found, 5 were selected for this review, respectively, a randomized study with a group of 22 people, 2 case studies with 1 person, in each study, male, a systematic review of the literature identified 31 studies that evaluated the use of aquatic physical therapy as a treatment in one of the four neurological conditions, overview of the effects of physical training in rats and patients affected by ALS, through a literature review. Conclusion: Studies show that aquatic physical therapy has a promising future, being considered an important therapeutic resource for patients with ALS, benefiting not only physical and functional issues, being important for psychological aspects and socialization.

Analysis of the concept of cardiovascular risk: contributions to nursing practice.

OBJECTIVES: to analyze the concept of cardiovascular risk to support nursing practice. METHODS: this is an analysis to define the concept of cardiovascular risk, through the use of eight steps of Walker's and Avant's framework, using a literature review in indexed scientific journals. RESULTS: cardiovascular risk is defined in a broad and original way as a context of health and nursing care that makes it possible to identify modifiable (cardiometabolic, behavioral, psychosocial, cultural and occupational) and non-modifiable (biological) risk factors for cardiovascular diseases that act as early and interrelated markers, of multiple and heterogeneous etiology, predisposing to cardiovascular vulnerability. CONCLUSIONS: with the analysis and definition of the concept of cardiovascular risk, we realized that it will be possible to base nursing practice, with implications in clinical practice for identifying and reducing risk factors for cardiovascular diseases, with nursing relevance in the care of these subjects.

Predictive Score for Carbapenem-Resistant Gram-Negative Bacilli Sepsis: Single-Center Prospective Cohort Study.

A clinical-epidemiological score to predict CR-GNB sepsis to guide empirical antimicrobial therapy (EAT), using local data, persists as an unmet need. On the basis of a case-case-control design in a prospective cohort study, the predictive factors for CR-GNB sepsis were previously determined as prior infection, use of mechanical ventilation and carbapenem, and length of hospital stay. In this study, each factor was scored according to the logistic regression coefficients, and the ROC curve analysis determined its accuracy in predicting CR-GNB sepsis in the entire cohort. Among the total of 629 admissions followed by 7797 patient-days, 329 single or recurrent episodes of SIRS/sepsis were enrolled, from August 2015 to March 2017. At least one species of CR-GNB was identified as the etiology in 108 (33%) episodes, and 221 were classified as the control group. The cutoff point of ≥3 (maximum of 4) had the best sensitivity/specificity, while ≤1 showed excellent sensitivity to exclude CR-GNB sepsis. The area under the curve was 0.80 (95% CI: 0.76-0.85) and the number needed to treat was 2.0. The score may improve CR-GNB coverage and spare polymyxins with 22% (95% CI: 17-28%) adequacy rate change. The score has a good ability to predict CR-GNB sepsis and to guide EAT in the future.

Analysis of the concept of cardiovascular risk: contributions to nursing practice / Análisis del concepto de riesgo cardiovascular: contribuciones a la práctica de enfermería / Análise do conceito de risco cardiovascular: contribuições para a prática de enfermagem

ABSTRACT Objectives: to analyze the concept of cardiovascular risk to support nursing practice. Methods: this is an analysis to define the concept of cardiovascular risk, through the use of eight steps of Walker's and Avant's framework, using a literature review in indexed scientific journals. Results: cardiovascular risk is defined in a broad and original way as a context of health and nursing care that makes it possible to identify modifiable (cardiometabolic, behavioral, psychosocial, cultural and occupational) and non-modifiable (biological) risk factors for cardiovascular diseases that act as early and interrelated markers, of multiple and heterogeneous etiology, predisposing to cardiovascular vulnerability. Conclusions: with the analysis and definition of the concept of cardiovascular risk, we realized that it will be possible to base nursing practice, with implications in clinical practice for identifying and reducing risk factors for cardiovascular diseases, with nursing relevance in the care of these subjects.

RESUMEN Objetivos: analizar el concepto de riesgo cardiovascular para apoyar la práctica de enfermería. Métodos: se trata de un análisis para definir el concepto de riesgo cardiovascular, mediante el uso de los ocho pasos del marco Walker y Avant, utilizando una revisión bibliográfica en revistas científicas indexadas. Resultados: el riesgo cardiovascular se define de manera amplia y original como un contexto de salud y cuidado de enfermería que permite identificar factores de riesgo modificables (cardiometabólicos, conductuales, psicosociales, culturales y laborales) y no modificables (biológicos) de enfermedades cardiovasculares, que actúan como marcadores tempranos e interrelacionados, de etiología múltiple y heterogénea, que predisponen a la vulnerabilidad cardiovascular. Conclusiones: con el análisis y definición del concepto de riesgo cardiovascular, percibimos que será posible fundamentar la práctica de enfermería, con implicaciones en la práctica clínica para la identificación y reducción de los factores de riesgo de enfermedades cardiovasculares, con protagonismo de enfermería en el cuidado de estas asignaturas.

RESUMO Objetivos: analisar o conceito de risco cardiovascular para fundamentar a prática de enfermagem. Métodos: trata-se de uma análise para definição do conceito de risco cardiovascular, por meio da utilização de oito etapas do referencial de Walker e Avant, utilizando uma revisão da literatura em periódicos científicos indexados. Resultados: define-se o risco cardiovascular de forma ampla e original como contexto de saúde e de cuidado de enfermagem que permite identificar fatores de risco para doenças cardiovasculares modificáveis (cardiometabólicos, comportamentais, psicossociais, culturais e laborais) e não modificáveis (biológicos), que atuam como marcadores precoces e inter-relacionados, de etiologia múltipla e heterogênea, predispondo à vulnerabilidade cardiovascular. Conclusões: com a análise e definição do conceito de risco cardiovascular, percebemos que será possível fundamentar a prática de enfermagem, com implicações na prática clínica para identificação e redução dos fatores de risco para doenças cardiovasculares, com protagonismo da enfermagem no cuidado desses sujeitos.

Assistência de enfermagem ao paciente com sepse: análise à luz do modelo conceitual de Myra Levine / Cuidados de enfermería a pacientes con sepsis: análisis a la luz del modelo conceptual de Myra Levine / Nursing care to patients with sepsis: analysis in the light of Myra Levine's conceptual model

RESUMO Objetivo estimular a reflexão acerca da assistência de enfermagem ao paciente com sepse a partir dos quatro princípios de conservação propostos pelo modelo conceitual de Myra Levine. Método estudo teórico-reflexivo sobre a relação existente entre os princípios de conservação de Levine e o paciente com sepse. Resultados vigilância aos princípios da conservação da energia observando oferta do oxigênio, idade dos pacientes e os parâmetros energéticos (sinais vitais); da integridade estrutural ao reconhecer precocemente às disfunções orgânicas no pacote hora-1; da integridade pessoal ao preservar a identidade do cliente com dificuldade de verbalizar ou outra condição e da integridade social ao relacionar-se com o paciente e família incluindo-os no processo de cuidado. Conclusão e implicações para a prática os princípios de conservação do modelo proposto apresentam relação com a assistência realizada pela equipe de enfermagem na manutenção do equilíbrio físico, pessoal e social do paciente com sepse. Espera-se que os enfermeiros articulem o conhecimento científico geral da assistência ao paciente com sepse ao seu conhecimento específico, por meio de um referencial teórico, para a promoção da adaptação, conservação e integridade do indivíduo.

RESUMEN Objetivo estimular la reflexión acerca de la atención de enfermería al paciente con sepsis a partir de los cuatro principios de conservación propuestos por el modelo conceptual de Myra Levine. Método estudio teórico-reflexivo sobre la relación entre los principios de conservación de Levine y el paciente con sepsis. Resultados vigilancia de los principios de conservación de la energía, observando el aporte de oxígeno, la edad de los pacientes y los parámetros energéticos (signos vitales); de la integridad estructural mediante el reconocimiento temprano de las disfunciones orgánicas en el paquete hora-1; de la integridad personal al preservar la identidad del cliente con dificultad para verbalizar u otra condición e de la integridad social al relacionarse con el paciente y su familia, incluyéndolos en el proceso de cuidado. Conclusión e implicaciones para la práctica los principios de conservación del modelo propuesto se relacionan con la atención brindada por el equipo de enfermería en el mantenimiento del equilibrio físico, personal y social del paciente con sepsis. Se espera que los enfermeros articulen el conocimiento científico general del cuidado del paciente con sepsis con sus conocimientos específicos, a través de un referencial teórico, para promover la adaptación, conservación e integridad del individuo.

ABSTRACT Objective encourage reflection on nursing care for patients with sepsis based on the four conservation principles proposed by Myra Levine's conceptual model. Method theoretical-reflective study on the relationship between Levine's conservation principles and the patient with sepsis. Results attentiveness to the principles of energy conservation, observing oxygen supply, patients' age and energy parameters (vital signs); of structural integrity by early recognition of organic dysfunctions in the hour-1 bundle; of personal integrity when preserving the identity of the client with difficulty to verbalize or another condition and social integrity when relating to the patient and family, including them in the care process. Conclusion and implications for practice the conservation principles of the proposed model are presented in relation to assistance provided by the nursing team in maintaining the physical, personal and social balance of the patients with sepsis. Nurses are expected to articulate the general scientific knowledge of sepsis patient care with their specific knowledge, through a theoretical framework, to promote the individual's adaptation, conservation and integrity.

Efeitos do treino aeróbico aquático sobre a cognição de um indivíduo após traumatismo crânio encefálico: estudo de caso / Effects of aquatic aerobic training on an individual's cognition after traumatic brain injury: a case study

Objetivo: Verificar a interferência do exercício aeróbico realizado no ambiente aquático na cognição de um indivíduo com Traumatismo Crânio Encefálico (TCE). Método: Trata-se de um estudo de caso experimental realizado no Setor de Fisioterapia Aquática da AACD, após a aprovação pelo CEP da instituição. Participou do estudo um indivíduo do sexo masculino, de 31 anos, que sofreu um TCE há quase de 12 meses da data da avaliação. Na anamnese, o indivíduo não relatou hidrofobia e, ao exame físico, o indivíduo não apresentou dor ou disfunções que comprometessem a realização dos exercícios do protocolo. Comprometeu-se a não realizar outra atividade física durante a realização do estudo. Foi submetido à avaliação neuropsicológica detalhada antes e após a intervenção de um protocolo de treino aeróbico aquático. O protocolo foi constituído de 12 sessões de 45 minutos, uma vez por semana, de treino aeróbico em uma bicicleta subaquática com acompanhamento de um fisioterapeuta. A temperatura da água foi de 33°C e imersão ao nível do processo xifóide. O monitoramento da intensidade do treino foi realizado através da frequência cardíaca (FC) e a FC alvo foi estipulada pela fórmula de Karvonenn. Resultados: O participante melhorou a pontuação nos testes de funções intelectuais, processos atencionais e velocidade de processamento de informações, habilidades viso espaciais, linguagem, raciocínio lógico, cálculo mental, raciocínio abstrato. Conclusão: O exercício aeróbico aquático interferiu positivamente nas funções cognitivas de um indivíduo com sequelas de um TCE.

Objective: To verify the interference of aerobic aquatic exercise performed in the cognition of an individual with Traumatic Brain Injury (TBI). Method: This is experimental case study occured in the Aquatic Physiotherapy Sector of the AACD. It was aprroved by the institution's Research Ethics Committee, protocol number 3,171,742. A 31-year-old male who underwent a TBI (almost 12 months from the evaluation date) participated in the study. The participant did not report hydrophobia and, on physical assessment, he did not present pain or dysfunctions that compromised his physical performance. He undertook not to perform another physical activity during the study. A neuropsychological evaluation was carried out before and after the intervention. The protocol consisted of 12 sessions of 45 minutes, once a week, aerobic training on an underwater bike with a physiotherapist monitoring. The water temperature was 33°C and immersion at the level of the xifoid process. The training intensity monitoring was performed through heart rate (HR) and target HR was stipulated by Karvonenn formula. Results: The participant improved the score in the tests of intellectual functions, intentional processes and speed of information processing, spatial vision skills, language, logical reasoning, mental calculus, abstract reasoning. Conclusion: Aquatic aerobic exercise positively interfered with the cognitive functions of an individual with sequelae of an TBI.

Rocuronium-Induced Dilated Nonreactive Pupils in a Patient With Coronavirus Disease 2019: A Case Report.

We report the clinical case of a patient with coronavirus disease 2019 (COVID-19) who had recently undergone neurosurgery and presented with dilated nonreactive pupils during continuous rocuronium infusion, which was reversible with the suspension of the drug. Both the neurosurgical procedure and possible disruption of the blood-brain barrier due to COVID-19 infection may have led to the action of rocuronium in the central nervous system (CNS). Thus, clinicians must remember that neuromuscular blocking agents (NMBAs) can cause dilated nonreactive pupils in patients with COVID-19.

Activity-Dependent Neuroplastic Changes in Autonomic Circuitry Modulating Cardiovascular Control: The Essential Role of Baroreceptors and Chemoreceptors Signaling.

Aerobic exercise training improves the autonomic control of the circulation. Emerging evidence has shown that exercise induces neuroplastic adaptive changes in preautonomic circuitry controlling sympathetic/parasympathetic outflow to heart and vessels. The mechanisms underlying neuronal plasticity are, however, incompletely understood. Knowing that sinoaortic denervation blocks training-induced cardiovascular benefits, we investigate whether baroreceptors' and chemoreceptors' signaling are able to drive neuronal plasticity within medullary and supramedullary pathways controlling autonomic outflow. Male Wistar rats submitted to sinoaortic denervation (SAD) or dopamine ß-hydroxylase-saporin lesion (DBHx) and respective controls (SHAM) were allocated to training (T) or sedentary (S) protocols for 8 weeks. After hemodynamic measurements at rest, rats were deeply anesthetized for brain harvesting. The density of DBH and oxytocin (OT) cell bodies and terminals were analyzed in brainstem and hypothalamic brain areas (double immunofluorescence reactions, optic and confocal microscopy). In SHAM rats training augmented the density of DBH+ neurons in the nucleus of solitary tract, increased the density of ascending NORergic projections and the number of DBH+ boutons contacting preautonomic OT+ neurons into paraventricular hypothalamic preautonomic nuclei, augmented the density of local OTergic neurons and enhanced the density of OT+ terminals targeting brainstem autonomic areas. These plastic changes occurred simultaneously with reduced sympathetic/increased parasympathetic activity, augmented baroreflex sensitivity and reduced resting heart rate. SAD reduced the density of both DBH+ fibers ascending from brainstem to paraventricular nucleus of hypothalamus and preautonomic OT+ neurons projecting to the brainstem, abrogated training-induced plastic changes and autonomic adaptive responses without changing the treadmill performance. Minor neuroplastic changes with preserved baroreflex sensitivity were observed in trained rats after partial selective disruption of ascending NORergic projections. Our data indicated that afferent inputs conveyed by arterial baroreceptors and chemoreceptors are the main stimuli to drive both inactivity-induced and activity-dependent neuroplasticity within the autonomic circuitry.

Análise eletromiográfica dos músculos tibial anterior e sóleo em pacientes hemiparéticos nos ambientes aquático e terrestre / Electromyographic analysis of the anterior tibialis and soleus muscle in hemiparetic patients in the aquatic and land environment

O objetivo deste trabalho foi verificar a ativação dos músculos tibial anterior e sóleo em pacientes hemiparéticos e indivíduos hígidos, em bipedestação no ambiente aquático em comparação ao solo e verificar se há correlação entre ativação muscular e medidas funcionais. Trata-se de um estudo transversal, no qual foram incluídos 6 indivíduos hígidos no grupo controle (GC) e 6 hemiparéticos no grupo estudo (GE). Os participantes foram caracterizados por meio dos instrumentos Mini-Exame do Estado Mental (MEEM), Escala de Equilíbrio de Berg (EEB), Medida da Independência Funcional (MIF) e eletromiografia (EMG) de superfície dos músculos tibial anterior e sóleo em diferentes posturas de bipedestação, nos ambientes terrestre e aquático em dois níveis de imersão, sendo eles processo xifoide (PX) e crista ilíaca ântero superior (CIAS). Como resultados, o GE obteve pontuação média de 24±6,7 no MEEM, sem perdas cognitivas, 80,8±2,7 na MIF, com dependência modificada e independência completa e 48,5±7,1 na EEB, sem riscos de quedas. A EMG evidenciou maior ativação do músculo sóleo no GE quando comparado ao GC, bem como maior ativação no lado hemiparético quando comparado ao lado não afetado. Constatou-se uma correlação inversamente proporcional entre a EMG e a EEB no GE. Com esse estudo foi possível compreender o comportamento dos músculos tibial anterior e sóleo de indivíduos hemiparéticos no ambiente aquático quando comparado ao solo, em posturas comumente utilizadas na reabilitação aquática. Esse melhor entendimento pode possibilitar uma intervenção mais adequada, com repercussões na prática clínica e de atividade física realizadas no ambiente aquático com indivíduos hemiparéticos....(AU)

The purpose of this present trial was to evaluate the activation of the tibialis anterior and soleus muscles in hemiparetics and health individuals, in a standing position performed in aquatic environment and compared to activation of this muscles on the land and verify if there is correlation between muscular activation and functional measures. In this cross-sectional study were included six health individuals in the control group (CG) and six hemiparetics individuals in the experimental group (EG). Participants were characterized by Mini Mental State Exam (MMSE), Berg Balance Scale (BBS), Functional Independence Measure (FIM) and surface electromyography (EMG) of the tibialis anterior and soleus muscles in different stand positions in aquatic environment and on the land in a two-step immersion to the xiphoid process and anterior superior iliac spine. As a result, the EG obtained a mean score of 24 ± 6.7 in the MMSE, without cognitive losses, 80.8 ± 2.7 in the FIM, with modified dependence and complete independence, and 48.5 ± 7.1 in BBE, without risks of falls. The surface EMG showed greater activation of the soleus muscle in the EG when compared to the CG, as well as greater activation on the hemiparetic side when compared to the unaffected side. An inverse proportional relationship between surface EMG and BBE in the EG was found. With this study it was possible to understand the behavior of the tibialis anterior and soleus muscles in hemiparetic individuals in the aquatic environment when compared to land, in postures commonly used in aquatic rehabilitation. This better understanding may allow a more adequate intervention, with repercussions in clinical practice and physical activity performed in the aquatic environment with hemiparetic individuals....(AU)

Caracterização de pacientes com lesão encefálica adquirida submetidos à cirurgia para correção de deformidades nos membros inferiores / Correction of orthopedic deformities deformities Orthopedic in adults with acquired encephalic injury in Adult Acdquired injury

RESUMO Objetivo: Identificar as características demográficas e clínicas dos pacientes com Lesão Encefálica Adquirida (LEA) submetidos a cirurgias ortopédicas para correção de deformidades em membros inferiores (MMII), e analisar quais procedimentos cirúrgicos foram mais realizados nesses pacientes.Métodos: estudo transversal com revisão de 103 prontuários de pacientes submetidos a cirurgia ortopédica para correção de deformidade em membros inferiores no período de 2012 a 2014. Resultados: Os pacientes com diagnóstico de Traumatismo Cranioencefálico (TCE) e sequela de dupla hemiparesia foram os frequentemente submetidos à cirurgia de correção de partes moles, sendo que o alongamento de tríceps sural a técnica mais realizada. Conclusão: Os pacientes vítimas de TCE foram submetidos a correções cirúrgicas de MMII, seguidos pelos pacientes vítimas de Acidente Vascular Cerebral (AVC), com faixa etária entre 39 e 51 anos, respectivamente, e predominância do sexo masculino, em todos os grupos. As técnicas mais realizadas envolveram a correção de deformidades no pé e tornozelo. Observamos que o tempo transcorrido entre a lesão e o procedimento cirúrgico fora igual ou superior a quatro anos, sendo comum que pacientes chegassem aos centros de reabilitação com deformidades, já instaladas, devido à espera para ingressar em algum serviço. (AU)

ABSTRACT Objective: to identify the demographic and clinical characteristics of patients with acquired brain injury (ABI) submitted to orthopedic surgeries to correct lower limb deformities (LLDF), and to analyze which surgical procedures were more commonly performed in these patients. Methods: Cross--sectional study with a review of 103 medical records of patients undergoing orthopedic surgery for correction of lower limb deformity in the period from 2012 to 2014. Results: Patients diagnosed with cranioencephalic trauma (CET) and sequelae of double hemiparesis were the ones frequently submitted to soft tissue correction surgery, and the triceps stretching sural was the most accomplished technique. Conclusion: Patients who were victims of CET underwent surgical correction of lower lim-bs, followed by patients with stroke, with age range between 39 and 51 years, respectively, and male predominance, in all groups. The most accomplished techniques involved the correction of foot and ankle deformities. We observed that the time elapsed between the lesion and the surgical procedure was equal to or greater than four years, and it was common for patients to arrive at rehabilitation centers with deformities, already installed, due to waiting to be admitted in some health service (AU)

Protocolo de Controle de tronco em Ambiente Aquático para Crianças com Paralisia Cerebral: Ensaio Clínico Randomizado / Protocol of Control of Trunk in Aquatic Environment for Children with Cerebral Palsy: Randomized Clinical Trial

Objetivos: Avaliar os efeitos de um protocolo de controle de tronco em ambiente aquático e sua repercussão na funcionalidade de indivíduos com paralisia cerebral (PC) diparéticoespástico, classificados no nível IV do GMFCS (Gross Motor Function Classification System). Métodos: ensaio clínico controlado, randomizado, cego, descritivo-analítico, quantitativo. Foram triados 92 prontuários, 24 crianças foram incluídas e 22 finalizaram o estudo. Os pacientes foram alocados em grupo controle (GC), que realizou terapias convencionais e grupo intervenção (GI) que realizou o protocolo de exercícios aquáticos. Os grupos foram avaliados pré e pós-intervenção através da Trunk Control Measurement Scale (TCMS), Pediatric Reach Test (PRT), Eletromiografia de Superfície (EMG) dos músculos reto abdominal e latíssimo do dorso. Para análises estatísticas foram utilizados o teste de Kolmogorov-Smirnov no momento pré e pós intervenção, teste de Mann-Whitney para a análise intragrupo e teste de Wilcoxon para análise intergrupo. A Correlação de Spearman foi utilizada para observar o grau de associação entre duas variáveis. Foi considerado um intervalo de confiança (IC) de 95%, nível de significância de p<0,05. Resultados: na análise intragrupo constatou-se melhora no item reação de equilíbrio da TCMS, GI (p=0,019) e o GC (p=0,004). No PRT, GC apresentou maior deslocamento pós-intervenção (p=0,006) que o GI. No item 07 da TCMS houve melhora da ativação muscular do reto abdominal (RA) do GI (p=0,047). Conclusão: No presente estudo, observou-se que a fisioterapia aquática trouxe resultados positivos e ganhos motores relacionados ao controle de tronco e funcionalidade para crianças com paralisia cerebral diparética espásticas GMFCS nível IV. (AU)

Objectives: To evaluate the effects of a trunk control protocol in the aquatic environment and its impact on the functionality of individuals with spastic diparesis type of CP (Cerebral Palsy) classified as level IV on GMFCS. Methods: A quantitative, controlled clinical trial, randomized, blind, of descriptive and analytical character. 92 records were screened, 24 children were enrolled and 22 completed the study. Patients were allocated in control group (CG), which held conventional therapies and intervention group (IG) which performed the aquatic exercise protocol. Groups were evaluated pre and post intervention through Trunk Control Measurement Scale (TCMS), Pediatric Reach Test (PRT), Surface Electromyography (EMG) of rectus abdominis and latissimus dorsi muscles. For statistical analysis, it was used the Kolmogorov-Smirnov test for pre and post intervention analysis, Mann-Whitney and Wilcoxon test for intragroup and intergroup analysis, respectively. Spearman correlation was used to observe the rate of association between two variables. A confidence interval (CI) of 95% was considered, level of significance of p <0.05. Results: Intragroup analysis showed improvement in TCMS equilibrium reactions item in GI (p = 0.019) and CG (p = 0.004). In the PRT, GC presented greater post-intervention displacement (p = 0.006) than the GI. In item 07 of the TCMS there was improvement of rectus abdominis muscle activation in GI (p = 0.047). Conclusion: In the present study there were positive results and motor gains on trunk control and functionality for individuals with spastic diparesis type of CP classified as level IV on GMFCS after aquatic therapy intervention. (AU)

Higiene, educação e assistência no fim do Império: o caso do Asilo de Meninos desvalidos (1875-1889) / Hygiene, Education, and Assistance at the End of the Empire: The Case of the Homeless Boys Asylum (1875-1889)

Analisa as condições de vida da criança no século XIX e como se dava a medicina, a educação e a assistência para desvalidos no Império brasileiro. Analisa o Asilo de Meninos Desvalidos

Efeitos da fisioterapia aquática na função motora de indiví­duos com paralisia cerebral: ensaio clí­nico randomizado / Effects of aquatic physical therapy in motor functional in subjects with cerebral palsy: randomized clinical trial

Objetivo: Avaliar os efeitos de um protocolo terapêutico para controle de tronco em ambiente aquático e sua repercussão na função motora de indiví­duos com Paralisia Cerebral (PC) diparética espástica, classificados no ní­vel II ou III do GMFCS. Métodos: Trata-se de um ensaio clí­nico randomizado, estratificado e cego. Os participantes foram selecionados por meio de triagem dos prontuários do banco de dados da Clí­nica de PC da instituição. Da triagem de 1.599 prontuários, 20 crianças foram incluí­das e 16 finalizaram o estudo. Os pacientes foram alocados por estratificação pelo ní­vel do GMFCS em grupo controle (GC) que realizou fisioterapia convencional e grupo intervenção (GI) que realizou o protocolo de exercí­cios aquáticos. Ambos os grupos foram submetidos í avaliação pré e pós-intervenção com os seguintes instrumentos: Gross Motor Function Measurement (GMFM), Trunk Control Measurement Scale (TCMS), Eletromiografia de superfí­cie (EMG) dos músculos reto abdominal e latí­ssimo do dorso, Teste de Caminhada de 6 minutos (TC6), Timed up and Go (TUG), Escala Visual Analógica (EVA) da marcha, Flexômetro de Wells e Child Health Questionnaire (CHQ) PF-50. Resultados: A amostra apresentou-se homogênea para as análises. Na análise intergrupo observa-se melhora no equilí­brio dinâmico sentado (p = 0,001) e reações de equilí­brio (p=0,015) para o GI, houve melhora da flexibilidade da musculatura posterior do tronco e membros inferiores no GC (p = 0,017), para os demais instrumentos não teve diferença significativa nas análises intergrupos. Na análise intragrupo para o GI, constatou melhora no equilí­brio estático e dinâmico do tronco nas três subescalas da TCMS, equilí­brio estático sentado (p= 0,033), equilí­brio dinâmico sentado (p = 0,012) e reações de equilí­brio (p = 0,027), assim como para a pontuação total da escala (p = 0,012); no GMFM, o aumento da pontuação das dimensões D (p = 0,012) e E (p = 0,020), bem como a média das três dimensões (p = 0,012); na EMG observa-se melhora da ativação muscular para o músculo LD; melhora da dor (p = 0,026); ambos os grupos melhoraram significativamente (p = 0,012) a distância percorrida no TC6 e o tempo no TUG, GC (p = 0,017) e GI (p = 0,036). Conclusão: O protocolo de exercí­cios aquáticos apresentou benefí­cios para o controle de tronco de indiví­duos com PC diparética espástica classificados no ní­vel II ou III do GMFCS sendo efetivo na melhora das reações de equilí­brio e no equilí­brio dinâmico. (AU)

Objective: To evaluate the aquatic trunk control effects and its impact on functionality in individuals with diparetic spastic type of CP, classified at level II or III on the GMFCS. Methods: This is a randomized, controlled, stratified and blind clinical trial. Participants were selected through the sorting of medical records of the institution's PC Clinic database. 1599 records were screened, 20 children were included and 16 completed the study. Patients were allocated by GMFCS in control group (CG) which underwent conventional therapy, and intervention group (IG) which performed an aquatic exercises protocol. Both groups underwent pre and post intervention evaluation with Gross Motor Function Measurement (GMFM), Trunk Control Measurement Scale (TCMS), rectus femuris and latissimus dorsi EMG, 6 Minute Walk Test (6MWT), Average Speed, Energy Expenditure Index, TUG, Gait EVA, Wells Flexometer and CHQ PF-50. Results: The sample was homogeneous for the analysis. In the intergroup analysis, there was an improvement in the sitting dynamic balance (p = 0.001) and balance reactions (p = 0.015) for the GI. We oberved an improvement in the flexibility of the posterior trunk and lower limbs muscles in the CG (p = 0.017). The other instruments did not have significant difference in the intergroup analyzes. In the intragroup analysis for the GI, we observed improvement in the static and dynamic trunk balance in the three subscales of the TCMS, sitting static balance (p = 0.033), sitting dynamic balance (p = 0.012) and equilibrium reactions (p = 0.027), as for the total score of the scale (p = 0.012); at GMFM score increased D (p = 0.012) and E (p = 0.020), as well as the mean of the three dimensions (p = 0.012); in the EMG we observed an improvement of the muscular activation for the DL muscle; improvement of pain (p = 0.026); both groups significantly improved the distance walked on the 6MWT and the time on the TUG, CG (p = 0.017) and IG (p = 0.036). Conclusion: There was an improvement of balance reactions and dynamic balance in individuals with CP. (AU)

Streptomyces luridus So3.2 from Antarctic soil as a novel producer of compounds with bioemulsification potential.

The present study aimed to identify novel microbial producers of bioemulsificant compounds from Antarctic soils. Fifty-nine microbial strains were isolated from five different locations at South Shetland Islands, Antarctica, and screened for biosurfactant production by ß-hemolytic activity. Strain So 3.2 was determined as bioemulsifier-producer and identified by phenotypic and molecular characterization as Streptomyces luridus. Emulsification activity, oil displacement method and drop-collapsing test were performed to evaluate the biosurfactant activity with different oils and hydrocarbons using two different culture media (Luria Bertani and Bushnell Haas in the presence of different carbon sources: glucose, glycerol, olive oil and n-Hexadecane). Cell free supernatant of Bushnell Haas culture supplemented with n-Hexadecane showed the best results for all tests. Emulsification of hydrocarbons exceeded 60%, reaching up to 90% on oil with high API grade, while displacement tests ranged from 8 cm to 4 cm in diameter according the culture media and tested oils. Our results revealed that Streptomyces luridus So3.2 is able to produce bioemulsifiers capable of emulsifying hydrocarbons and oils, which could be used in different biotechnological applications, particularly for bioremediation of environments contaminated by oil leaks.

Positive correlation between functional disability, excessive daytime sleepiness, and fatigue in relapsing-remitting multiple sclerosis.

METHOD: Retrospective review of medical records from patients with multiple sclerosis to collect data on severity of fatigue, disability, daytime sleepiness, and depression. From 912 medical records reviewed, 122 reported daytime sleepiness: 67% had relapsing remitting, 12% had primary progressive, and 21% had secondary progressive. RESULTS: In 95% of the patients with relapsing remitting who complained of daytime sleepiness and fatigue, association was found between these symptoms and neurological disability. Patients with relapsing remitting who complained of daytime sleepiness and fatigue also experienced depression (p = 0.001). No association between fatigue, excessive daytime sleepiness, depression, and disability was found in patients with progressive disease. CONCLUSION: In relapsing remitting, there is correlation between functional disability, excessive daytime sleepiness and fatigue, a finding not confirmed in primary progressive and secondary progressive form.

Fisioterapia aquática no tratamento de criança com distrofia muscular congênita merosina negativa: relato de caso / Aquatic physical therapy in the treatment of a child with merosin-deficient congenital muscular dystrophy: case report

Este relato de caso descreve um programa de fisioterapia aquática para uma criança com distrofia muscular congênita (DMC) merosina negativa. Objetivo: Verificar a interferência da fisioterapia aquática na velocidade e no índice de gasto energético durante o deslocamento sentado em superfície plana, e no alcance funcional com os membros superiores devido a fraqueza proximal que acomete estes pacientes visando maior independência. Métodos: Como instrumentos de avaliação foram utilizados a Medida da Função Motora (MFM); o Functional Reach Test (FRT); foi verificado o Índice de Gasto Energético (IGE) no deslocamento sentado; assim como o tempo gasto neste deslocamento e a ativação muscular com a eletromiografia (EMG). O programa durou 12 semanas e a intervenção incluiu atividades para melhorar a mobilidade e a agilidade no deslocamento sentado e o alcance na postura sentada. Resultados: Na MFM a variação no escore das duas dimensões (D2 e D3) focadas na terapia foi de 6,8%. O alcance funcional melhorou 16 centímetros (cm) e o tempo do deslocamento sentado diminuiu 19 segundos (s). O gasto energético diminuiu 252,31 batimentos por minuto (bpm). Conclusão: A fisioterapia aquática foi eficaz para melhora da agilidade no deslocamento sentado e na funcionalidade de membros superiores (MMSS) de uma criança com DMC merosina negativa

This case report describes an aquatic therapy program for a child with Merosin-Deficient Congenital Muscular Dystrophy. Objective: This study sought to investigate the effect of aquatic physical therapy on the speed and the rate of energy expenditure while moving around on a flat surface, in addition to the functional reach of the upper limbs suffering from the proximal weakness that affects these patients seeking greater independence. Methods: The Motor Function Measurement (MFM) and the Functional Reach Test (FRT) were used as assessment tools; the Energy Expenditure Index (EEI) was measured in seated locomotion, as well as the time spent, and muscle activation was measured via electromyography (EMG). The program lasted 12 weeks and included activities to improve mobility and agility as well as reaching from the seated position. Results: In the MFM the change in the score of the two dimensions (D2 and D3) that the treatment focused on was 6.8%. The functional reach improved by 16 centimeters (cm) and the amount of time moving while sitting decreased by 19 seconds (s). Energy expenditure decreased by 252.31 beats per minute (bpm). Conclusion: The aquatic physical therapy was effective for agility improvement in seated locomotion and upper limb functionality of a 6-year-old child with Merosin-Deficient Congenital Muscular Dystrophy