Características clínicas e funcionais de mulheres após AVC, caidoras e não caidoras: um estudo longitudinal / Clinical and functional characteristics of women after stroke, fallers and non-fallers: a longitudinal study

INTRODUÇÃO: A ocorrência de quedas está entre as complicações mais frequentes apresentadas por idosos e portadores de doenças neurológicas. Sabe-se que em idosos há maior frequência de quedas em mulheres. Em indivíduos após AVC, essa relação não é estabelecida. OBJETIVO: Diferenciar as características clínicas e funcionais de mulheres caidoras e não caidoras após AVC e verificar a associação entre mobilidade funcional e capacidade funcional nessas mulheres. DESENHO DE ESTUDO E LOCAL: Trata-se de um estudo prospectivo longitudinal realizado em Salvador (BA). MÉTODOS: Foram incluídas mulheres com marcha independente atendidas em ambulatório de referência. Foram coletados dados sociodemográficos e clínicos e aplicados a Escala do National Institutes of Health Stroke, o Índice de Barthel modificado, o Timed Up and Go (TUG) e a qualidade de vida europeia. O nível de significância adotado foi de 5%. RESULTADOS: Foram selecionadas 68 mulheres com média de idade de 56 (± 13,7) anos, 51% das mulheres caíram no seguimento, esta última tinha menos de 55 anos (± 13,4), com maior gravidade do AVC. O comprometimento do território vascular posterior foi mais evidente entre as mulheres que caíram (P = 0,009), mas todas, as que caíram e as que não caíram, apresentaram mobilidade funcional prejudicada (TUG = 15 segundos). No entanto, a amostra total foi classificada como totalmente independente ou com leve dependência das atividades de vida diária (AVDs) (MBI = 49). A correlação entre o tempo de TUG e MBI foi negativa e significativa (R = -0,702, P ≤ 0,001). CONCLUSÕES: O envolvimento da circulação posterior é um importante preditor de quedas, sendo um importante indicador no acompanhamento de mulheres após AVC. Também enfatiza que a menor mobilidade funcional impactou a capacidade funcional da mulher.

BACKGROUND: Occurrence of falls is among the most frequent complications presented by the elderly and individuals with neurological diseases. It is known that in the elderly, there is a greater frequency of falls in women. However, in individuals after stroke, this relationship is not established. The purpose of this study was to differentiate the clinical and functional characteristics of fallers and non-fallers women after stroke and to verify the association between functional mobility and functional capacity in these women. DESIGN AND SETTING: This is a longitudinal prospective study conducted in Salvador, Bahia, Brazil. METHODS: Women with independent gait assisted in a reference outpatient clinic were included. Sociodemographic and clinical data were collected, and the National Institutes of Health Stroke Scale, Modified Barthel Index, Timed Up and Go (TUG), and European quality of life were applied. The level of significance was set at 5%. RESULTS: A total of 68 women with a mean age of 56 (± 13.7) years were selected; 51% of the women fell in the follow-up, the latter was younger than 55 years (± 13.4), with greater severity of the stroke. Impairment in the posterior vascular territory was more evident among falling women (P = 0.009), but all falling and non-falling women presented impaired functional mobility (TUG = 15seconds). However, the total sample was classified as totally independent or with slight dependence on the activities of daily living (ADLs) (MBI = 49). The correlation between TUG time and MBI was negative and significant (R = -0.702, P ≤ 0.001). CONCLUSIONS: The involvement of posterior circulation is an important predictor of falls, an important indicator in the monitoring of women after stroke. It also emphasizes that the lower functional mobility impacted women's functional capacity.

Impacto das medidas de restrição social da pandemia da COVID-19 na participação social de pessoas com HTLV-1: estudo transversal / Impact of pandemic social restriction measures of COVID-19 on the social participation of people with HTLV-1: a transversal study

| INTRODUÇÃO: O vírus linfotrópico de células T humana tipo 1 (HTLV-1) é classificado como retrovírus e pode estar diretamente associado às doenças neurológicas. Por ser uma doença negligenciada pelas autoridades sanitárias e governamentais num panorama mundial, ainda existe uma carência de evidências científicas que investigam o impacto do HTLV-1 no âmbito da participação social dessa população. OBJETIVO: Analisar o impacto da pandemia da COVID-19 na participação social de indivíduos com HTLV-1. MATERIAL E MÉTODOS: Trata-se de um estudo observacional do tipo transversal realizado com indivíduos com HTLV-1 vinculados à Associação HTLVida. A coleta de dados foi realizada através de entrevistas via videoconferência; a primeira entrevista teve como objetivo explorar as características clínicas e sociodemográficas dos participantes, já a segunda investigou a participação social dos indivíduos comparando dois períodos (antes e durante a pandemia de COVID-19), através da aplicação do Questionário de Integração na Comunidade (QIC). RESULTADOS: Foram entrevistados 11 indivíduos, com predominância do sexo feminino (72,7%), com mediana de idade de 57 (52- 66) anos. No que tange os resultados referentes à participação social avaliada pelo QIC, observou-se a manutenção do escore do domínio de integração no ambiente doméstico, uma diferença de 3.00 pontos no domínio de integração no ambiente social, uma diferença de 2.00 pontos no domínio de integração no ambiente do trabalho e escola, além de uma diferença de 6.00 pontos no escore total do QIC. CONCLUSÃO: Identificou-se uma diminuição da participação social de indivíduos com HTLV-1 durante a pandemia da COVID-19, quando comparado ao período prévio de início da pandemia.

INTRODUCTION: Human T-cell Lymphotropic Virus type 1 (HTLV-1) is classified as a retrovirus and may be directly associated with neurological diseases. As it is a disease neglected by health and governmental authorities in a world panorama, there is still a lack of scientific evidence that investigates the impact of HTLV-1 in the scope of the social participation of this population. OBJECTIVE: To analyze the impact of the COVID-19 pandemic on the social participation of individuals with HTLV-1. MATERIAL AND METHODS: This is a transversal observational study carried out with individuals with HTLV-1, linked to the HTLVida Association. The data collection was carried out through interviews in a videoconference. The first interview aimed to explore the clinical and sociodemographic characteristics of the participants. In contrast, the second one investigated the social participation of individuals comparing two periods (before and during the COVID-19 pandemic) through the application of the Community Integration Questionnaire (CIQ). RESULTS: Eleven individuals were interviewed, predominantly female (72.7%), with a median age of 57 (52-66). About the results regarding social participation evaluated by the CIQ, was observed maintenance of the score in the domain of Integration in the home environment, a difference of 3.00 points in the domain of Integration in the social environment, a difference of 2.00 points in the domain of Integration in the work and school environment, and a difference of 6.00 points in the total CIQ score. CONCLUSION: A decrease in the social participation of individuals with HTLV-1 during the COVID-19 pandemic was compared to the period before the start of the pandemic.

Therapeutic effects of virtual reality video gaming on functional mobility, balance, and gait speed in individuals with tropical spastic paraparesis: A randomized crossover clinical trial.

INTRODUCTION: Individuals with human T-cell lymphotropic virus 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) experience sensorimotor alterations, which can affect functional performance. Virtual reality (VR) videogaming is a therapeutic option, though there is scarce evidence for its use in this population. We aimed to investigate the therapeutic effects of a VR video game on functional mobility, balance, and gait speed in individuals with HAM/TSP. METHODS: We conducted a blinded, crossover clinical trial comprising 29 individuals with HAM/TSP and randomized them into two groups: (1) early therapy: rehabilitative protocol started immediately after the initial evaluation and (2) late therapy: rehabilitative protocol started 10 weeks later. We assessed all participants for balance using the Berg Balance Scale (BBS) scores, functional mobility using the Timed Up and Go (TUG) test, and gait speed using video camera and CvMob software. Differences were considered significant if p<0.05. RESULTS: The early therapy group individuals presented with higher BBS scores (p=0.415), less TUG times (p=0.290), and greater gait speed (p=0.296) than the late therapy group individuals. CONCLUSIONS: VR videogaming is a useful option for rehabilitative therapy in individuals with HAM/TSP; it positively affects balance, functional mobility, and gait speed.

Therapeutic effects of virtual reality video gaming on functional mobility, balance, and gait speed in individuals with tropical spastic paraparesis: A randomized crossover clinical trial

Abstract INTRODUCTION: Individuals with human T-cell lymphotropic virus 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) experience sensorimotor alterations, which can affect functional performance. Virtual reality (VR) videogaming is a therapeutic option, though there is scarce evidence for its use in this population. We aimed to investigate the therapeutic effects of a VR video game on functional mobility, balance, and gait speed in individuals with HAM/TSP. METHODS: We conducted a blinded, crossover clinical trial comprising 29 individuals with HAM/TSP and randomized them into two groups: (1) early therapy: rehabilitative protocol started immediately after the initial evaluation and (2) late therapy: rehabilitative protocol started 10 weeks later. We assessed all participants for balance using the Berg Balance Scale (BBS) scores, functional mobility using the Timed Up and Go (TUG) test, and gait speed using video camera and CvMob software. Differences were considered significant if p<0.05. RESULTS: The early therapy group individuals presented with higher BBS scores (p=0.415), less TUG times (p=0.290), and greater gait speed (p=0.296) than the late therapy group individuals. CONCLUSIONS: VR videogaming is a useful option for rehabilitative therapy in individuals with HAM/TSP; it positively affects balance, functional mobility, and gait speed.

Efetividade do treino de marcha na água para pacientes com doença de parkinson: revisão sistemática / Effectiveness of gait training in water for patients with parkinson's disease: systematic review

INTRODUÇÃO: A hidroterapia é cada vez mais utilizada no tratamento de pacientes com doença neurodegenerativas visando melhora da funcionalidade e redução de quedas. Permite treino de marcha em condições seguras, promove relaxamento e reduz o medo de cair. Há a necessidade de analisar a qualidade metodológica dos estudos existentes neste contexto. OBJETIVO: Sistematizar o conhecimento acerca da efetividade do treino de marcha na água para pessoas com Doença de Parkinson. MÉTODOS: Trata-se de uma revisão sistemática. Foi feita busca na base de dados do Pubmed e Lilacs no período de março de 2017 a maio de 2018 sem filtros. Foram incluídos ensaios clínicos randomizados que verificaram efeitos de um protocolo de treino de marcha na água para pacientes com Doença de Parkinson. Foram excluídos estudos que realizaram treino na água, porém não especificamente de marcha. Foi utilizada ferramenta da Colaboração Cochrane para avaliar a qualidade metodológica dos estudos. RESULTADOS: Foram encontrados quinze estudos na busca, três destes foram incluídos. Houve uma diferença entre os artigos quanto aos desfechos, em relação ao aumento da velocidade da marcha. A análise da qualidade metodológica mostrou falhas de randomização e cegamento na metodologia dos estudos. CONCLUSÃO: Foi evidenciado que o treino de marcha na água tem efeitos positivos na velocidade da marcha e na mobilidade destes indivíduos. Para um resultado clínico positivo na marcha, devem ser associados exercícios para mobilidade e equilíbrio. São necessários futuros ensaios clínicos randomizados que sigam as diretrizes e apresentem uma qualidade metodológica satisfatória. [AU]

INTRODUCTION: Hydrotherapy is increasingly used in the treatment of patients with neurodegenerative disease, being aimed at improving functionality and reduce falls. Allows safe walking, promotes relaxation and reduces fear of falling. There is a requirement to analyze the methodological quality of existing studies in this context. OBJECTIVE: To systematize the knowledge about the effectiveness of water walking training for people with Parkinson's disease. METHODS: This is a systematic review. We searched the Pubmed and Lilacs database from March 2017 to May 2018 without filters. We included randomized clinical trials that verified the effects of a water gait training protocol for patients with Parkinson's disease. We excluded studies that performed water training, but not specifically gait. A Cochrane Collaboration tool was utilized to evaluate the methodological quality of the studies. RESULTS: Fifteen studies were found in the search, three of these were included. There was different from those between the articles regarding outcomes, in relation to the increase in walking speed. The methodological quality analysis showed randomization and blindness failure in the methodology of the studies. CONCLUSION: It was evidenced that gait training in water has a positive effect on gait velocity and the mobility of these individuals. For a positive clinical outcome in walking, exercises for mobility and balance should be associated. Further randomized clinical trials are necessary for follow the guidelines and have satisfactory methodological quality. [AU]

Alterações sensoriais em indivíduos com HTLV-1: revisão sistemática / Sensorial changes in individuals with HTLV-1: systematic review

Introdução: A função sensorial é reconhecida como precursora da recuperação do movimento, sendo assim, os sintomas apresentados por pessoas com HTLV-1 podem trazer prejuízo na realização de atividades funcionais Objetivo: Sistematizar o conhecimento sobre alterações sensoriais em pacientes com HTLV-1. Metodologia: Trata-se de uma revisão sistemática, com a busca primária dos artigos realizada nas bases de dados Medline, via biblioteca virtual Pubmed, sendo incluídos estudos observacionais que abordaram a alteração sensorial em indivíduos com HTLV-1. A estratégia de busca foi conduzida de forma independente por dois pesquisadores e as divergências resolvidas por consenso. Resultados: Foram encontrados 44 estudos na busca primária, e destes foram incluídos quatro estudos que abordaram a alteração sensorial em indivíduos com HTLV-1, com um total de 240 participantes. Todos os artigos foram classificados como baixo risco de viés no que diz respeito à descrição da questão do estudo, resultados e discussão. Conclusão: identificou-se uma alta prevalência de dor e alteração na sensibilidade vibratória em relação às outras disfunções sensoriais, no entanto, a escassez de trabalhos publicados acerca deste tema sugere que novas abordagens sejam feitas mostrando uma grande lacuna de conhecimento a ser explorada. [AU]

Background: Sensory function is recognized as a precursor of the movement recovery. Therefore, the symptoms presented by people with HTLV-1 can result in impairment in the performance of functional activities. Aim: To systematize knowledge about sensory alterations in patients with HTLV-1. Methods: This is a systematic review, with the primary search of the articles carried out in the Medline databases, via the Pubmed virtual library, including observational studies that addressed the sensory alteration in individuals with HTLV-1. The search strategy was conducted independently by two researchers and the divergences resolved by consensus. Results: A total of 44 studies were found in the primary search, including four studies addressing sensory impairment in individuals with HTLV-1, with a total of 240 participants. All articles were classified as low risk of bias regarding the description of the study question, results and discussion. Conclusion: We identified a high prevalence of pain and altered vibratory sensitivity in relation to other sensory disorders, however, shortage of published works on this topic suggests new approaches are made showing a large knowledge gap to be explored. [AU]

Síndrome metabólica e resistência insulínica pelo Homa-IR no climatério / Metabolic syndrome and insulin resistance by HOMA-IR in menopause

Fundamento: Síndrome metabólica é um importante fator de risco cardiovascular, e sua prevalência aumenta após a menopausa. Ainda é incerto, porém, se a menopausa é fator de risco independente para a síndrome metabólica. Uma das bases fisiopatológicas para síndrome metabólica é a resistência insulínica, que pode ser calculada pelo método Homeostatic Model Assessment-Insulin Resitance (HOMA-IR), sendo pouco conhecida a relação entre resistência insulínica e menopausa. Objetivos: Avaliar a relação entre síndrome metabólica e resistência insulínica em mulheres climatéricas. Métodos: Estudo descritivo, que avaliou 150 mulheres, com idades entre 40 e 65 anos, atendidas em um ambulatório de ginecologia em um hospital terciário público, entre maio e dezembro de 2013. A amostra foi dividida em dois grupos, sendo o Grupo I com pacientes na pré-menopausa e o II com pacientes na pós-menopausa. Foi avaliada a presença de síndrome metabólica, bem como de seus componentes, além da ocorrência de resistência insulínica nos dois grupos. A associação do estado menopausal e as variáveis estudadas foi realizada com os testes Mann-Whitney, qui quadrado e exato de Fisher. O nível de significância foi de 5%. A análise estatística foi feita por meio do STATA 12.0. Resultados: A síndrome metabólica foi mais prevalente nas mulheres pós-menopausa, bem como todos seus componentes tiveram maior frequência também nesse grupo. As mulheres pós-menopausa também apresentaram maior prevalência de resistência insulínica, mas não foi observada relação estatística entre os achados. Conclusão: O estado menopausal não se associou significativamente com síndrome metabólica e resistência insulínica. A resistência insulínica foi considerada fator de risco independente para o desenvolvimento de síndrome metabólica apenas no grupo pós-menopausa

Background: Metabolic syndrome is an important cardiovascular risk factor, and its prevalence increases after menopause. However, it is still uncertain whether menopause is an independent risk factor for metabolic syndrome. One of the pathophysiological basis for metabolic syndrome is insulin resistance, which can be calculated by the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) method, and the association between insulin resistance and menopause is little known. Objective: To evaluate the association between metabolic syndrome and insulin resistance in menopausal women. Method: Descriptive study, which evaluated 150 women, aged 40 to 65, treated at a Gynecology Outpatient Clinic of a tertiary public hospital, from May to December of 2013. The sample was divided into two groups: Group I, comprising women in the premenopausal period and Group II, comprising women in the post-menopausal period. The presence of metabolic syndrome and its components were evaluated, as well as occurrence of insulin resistance in both groups. The association of menopausal status and the assessed variables was assessed using the Mann-Whitney, Chi-square and Fisher's exact tests. The significance level was set at 5%. The statistical analysis was performed using STATA 12.0. Results: Metabolic syndrome and its components were more prevalent in postmenopausal women. Postmenopausal women also had a higher prevalence of insulin resistance, but no statistical association was observed between the findings. Conclusion: The menopausal status was not significantly associated with metabolic syndrome and insulin resistance. Insulin resistance was considered an independent risk factor for the development of metabolic syndrome only in the postmenopausal group

Balance, functional mobility, and fall occurrence in patients with human T-cell lymphotropic virus type-1-associated myelopathy/tropical spastic paraparesis: a cross-sectional study.

INTRODUCTION: Human T-cell lymphotropic virus type-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) may lead to reduced functional mobility and balance. It is important to establish specific parameters that identify these changes and predict the risk of falls in these patients. The aim was to compare balance, functional mobility, and occurrence of falls among patients with and without HAM/TSP and to suggest values to predict the risk of falls in these patients. METHODS: A cross-sectional study in patients with and without HAM/TSP involved balance assessments based on the berg balance scale (BBS) and functional mobility evaluation based on the timed up and go (TUG) test. From reports of falls, the sensitivity, specificity, and best cutoff points for the risk of falls assessed by these instruments were established using the receiver-operating characteristic (ROC) curve; 5% alpha was considered. RESULTS: We selected 42 participants: 29 with HAM/TSP and 13 without HAM/TSP. There was a statistically significant difference in the occurrence of falls, balance, and functional mobility between the groups (p<0.05). Good accuracy was determined for the BBS (77%) and TUG test (70%) and the cutoff points for the risk of falls were defined as 50 points for the BBS and 12.28 seconds for the TUG test. CONCLUSIONS: Patients with HAM/TSP present reduced functional mobility and balance in relation to those without HAM/TSP. The risk of falls increased for these patients can be evaluated by the values ​​of 50 points using the BBS and 12.28 seconds using the TUG test.

Balance, functional mobility, and fall occurrence in patients with human T-cell lymphotropic virus type-1-associated myelopathy/tropical spastic paraparesis: a cross-sectional study

Abstract INTRODUCTION: Human T-cell lymphotropic virus type-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) may lead to reduced functional mobility and balance. It is important to establish specific parameters that identify these changes and predict the risk of falls in these patients. The aim was to compare balance, functional mobility, and occurrence of falls among patients with and without HAM/TSP and to suggest values to predict the risk of falls in these patients. METHODS: A cross-sectional study in patients with and without HAM/TSP involved balance assessments based on the berg balance scale (BBS) and functional mobility evaluation based on the timed up and go (TUG) test. From reports of falls, the sensitivity, specificity, and best cutoff points for the risk of falls assessed by these instruments were established using the receiver-operating characteristic (ROC) curve; 5% alpha was considered. RESULTS: We selected 42 participants: 29 with HAM/TSP and 13 without HAM/TSP. There was a statistically significant difference in the occurrence of falls, balance, and functional mobility between the groups (p<0.05). Good accuracy was determined for the BBS (77%) and TUG test (70%) and the cutoff points for the risk of falls were defined as 50 points for the BBS and 12.28 seconds for the TUG test. CONCLUSIONS: Patients with HAM/TSP present reduced functional mobility and balance in relation to those without HAM/TSP. The risk of falls increased for these patients can be evaluated by the values ​​of 50 points using the BBS and 12.28 seconds using the TUG test.

Virtual Rehabilitation through Nintendo Wii in Poststroke Patients: Follow-Up.

OBJECTIVE: To evaluate in the follow-up the sensory-motor recovery and quality of life patients 2 months after completion of the Nintendo Wii console intervention and determine whether learning retention was obtained through the technique. METHODS: Five hemiplegics patients participated in the study, of whom 3 were male with an average age of 54.8 years (SD = 4.6). Everyone practiced Nintendo Wii therapy for 2 months (50 minutes/day, 2 times/week, during 16 sessions). Each session lasting 60 minutes, under a protocol in which only the games played were changed, plus 10 minutes of stretching. In the first session, tennis and hula hoop games were used; in the second session, football (soccer) and boxing were used. For the evaluation, the Fulg-Meyer and Short Form Health Survey 36 (SF-36) scales were utilized. The patients were immediately evaluated upon the conclusion of the intervention and 2 months after the second evaluation (follow-up). RESULTS: Values for the upper limb motor function sub-items and total score in the Fugl-Meyer scale evaluation and functional capacity in the SF-36 questionnaire were sustained, indicating a possible maintenance of the therapeutic effects. CONCLUSION: The results suggest that after Nintendo Wii therapy, patients had motor learning retention, achieving a sustained benefit through the technique.

Avaliação da Função Endotelial em Mulheres Climatéricas com Doença Arterial Coronariana / Evaluation of Endothelial Function in Pre-Menopausal Women With Coronary Arterial Disease

Fundamentos: O endotélio desempenha importante função reguladora vascular. Sua disfunção é um marcador precoce de risco cardiovascular. Entretanto, existem poucos estudos em nosso meio que avaliem a função endotelial em mulheres climatéricas. Objetivo: Avaliar a função endotelial em mulheres climatéricas na presença ou ausência de doença arterial coronariana utilizando-se um método biofísico (espessura médio-intimal das carótidas) e um método bioquímico (níveis séricos de PCR-US). Métodos: Estudo transversal que avaliou o espessamento médio-intimal da artéria carótida e níveis séricos de PCR-US de 31 mulheres climatéricas submetidas a cineangiocoronariografia, no Serviço de Hemodinâmica do Hospital Universitário da Universidade Federal do Maranhão, no período de março de 2012 a julho de 2013. Os dados foram submetidos à análise estatística. Considerou-se um nível de significância de 5%. Resultados:A amostra foi dividida em dois grupos, de acordo com presença de doença arterial coronariana (DAC): grupo com DAC (n = 13) e grupo sem DAC (n = 18). As médias de idades para os grupos foram 57,92 ± 5,17 e 51,72 ± 4,63 anos, respectivamente (p = 0,001). A EMI esteve alterada em 29,03% na população geral. A espessura médio- intimal foi de 1,55 ± 0,78 mm no grupo geral, 1,92 ± 0,94 mm no grupo com DAC e 1,18 ± 0,71 mm no grupo sem DAC (p = 0,001). As pacientes com DAC apresentaram predomínio de alteração da EMI quando comparadas aquelas sem DAC: 36,46% vs. 22,22%, respectivamente. Observou-se uma sensibilidade de 38%, especificidade de 77%, com um valor preditivo positivo de 0,55 e valor preditivo negativo de 0,63 com razão de verossimilhança para teste positivo (likelihood ratio) de 1,73. As pacientes com EMI alterado apresentaram níveis mais elevados de PCR-US, porém sem significância estatística. As pacientes com DAC apresentaram níveis mais elevados de PCR-US, porém sem significância estatística. Conclusão: Na população estudada, a avaliação da função endotelial pelo método da EMI apresentou maior sensibilidade e especificidade para o diagnóstico de DAC quando comparada a mensuração dos níveis de PCR-US em mulheres climatéricas

Background: The endothelium plays an important vascular regulatory function. Its dysfunction is an early marker of cardiovascular risk. However, there are few studies in our community that assess endothelial function in pre-menopausal women. Objective: To assess endothelial function in pre-menopausal women in the presence or absence of coronary artery disease, using a biophysical method (carotid intima media thickness) and a biochemical method (serum levels of hsCRP). Methods: Cross-sectional study that evaluated carotid intima-media thickness and serum levels of hsCRP of 31 pre-menopausal women undergoing coronary angiography at the Hemodynamics Service of Hospital Universitário da Universidade Federal do Maranhão from March 2012 to July 2013. The data were sent to statistical analysis and a statistical significance level of 5% was considered. Results: The sample was divided into two groups according to the presence of coronary artery disease (CAD): CAD group (n = 13) and group without CAD (n = 18). The average ages for the groups were 57.92 ± 5.17 and 51.72 ± 4.63 years, respectively (p = 0.001). CIMT was abnormal in 29.03% in the general population. Carotid intima-media thickness was 1.55 ± 0.78 mm in the general group, 1.92 ± 0.94 mm in the CAD group and 1.18 ± 0.71 mm in the group without CAD (p = 0.001). CAD patients had predominance of abnormal CMIT compared those without CAD: 36.46% vs. 22.22%, respectively. There was a sensitivity of 38%, specificity of 77% with a positive predictive value of 0.55 and a negative predictive value of 0.63 with likelihood ratio of 1.73. Patients with abnormal CIMT presented higher levels of hsCRP, but without statistical significance. CAD patients had higher levels of hsCRP, but without statistical significance. Conclusion: In the population studied, assessment of endothelial function using the CIMT method showed higher sensitivity and specificity for the diagnosis of CAD compared to the measurement of hsCRP levels in menopausal women

Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial.

OBJECTIVES: The study aimed to check the therapeutic effect of virtual reality associated with conventional physiotherapy on gait balance and the occurrence of falls after a stroke. METHODS: This was a randomized, blinded clinical trial conducted with post-stroke patients, randomized into two groups-treatment group and control group-and subjected to balance assessments by the Dynamic Gait Index and investigation of falls before and after 20 intervention sessions. Statistically significant difference was considered at P < .05. RESULTS: We selected 30 patients, but there were three segment losses, resulting in a total of 13 patients in the control group and 14 in the treatment group. There was an improvement in gait balance and reduced occurrence of falls in both groups. After intervention, the differences in gait balance in the control group (P = .047) and the reduction in the occurrence of falls in the treatment group (P = .049) were significant. However, in intergroup analysis, there was no difference in the two outcomes. CONCLUSIONS: Therapy with games was a useful tool for gait balance rehabilitation in post-stroke patients, with repercussions on the reduction of falls.

Culture, characterization and differentiation of neural precursors from the central nervous system of guinea pigs (Cavia porcellus Linnaeus, 1758) / Cultura, caracterização e diferenciação de precursores neurais do sistema nervoso central de porquinho-da-índia (Cavia porcellus Linnaeus, 1758)

Potentially neurogenic areas were initially identified by incorporation of bromodeoxyuridine (BrdU) in cells underlying the subventricular zone (SVZ) of the lateral ventricles wall, hippocampus and olfactory bulbs of newborn guinea pigs. Neural precursors from the SVZ were cultured in suspension, generating neurospheres (NSFs), which, upon dissociation were able to generate new NSFs. Upon culture in the absence of growth factors, cells dissociated from NSFs displayed evidence for neural differentiation, giving rise to cells from neural lineage. Flow cytometry analysis for of NSFs-derived cells after differentiation revealed approximately 13.3% nestin positive, 5.5% Beta-III-tubulin positive, 9% GFAP positive and 7.8% mGalC positive. Functional assays by measurement of calcium influx upon gamma butiric amino acid (GABA) and glutamate stimuli, revealed stimulation in differentiated cells, an indicator of neuronal differentiation. The ability of guinea pig SVZ cells to originate functional neurons in vitro is promising for research and towards a future use of neural stem cells in the therapy of neurological disorders.(AU)

Áreas potencialmente neurogênicas foram identificadas por incorporação de bromodeoxiuridina (BrdU) na zona subventricular (SVZ) dos ventrículos laterais, hipocampo e bulbos olfatórios de cobaias neonatos. Precursores neurais provenientes da SVZ foram cultivados em suspensão, resultando na geração de neuroesferas (NSFs), que quando dissociadas foram capazes de proliferar e gerar novas NSFs. Quando cultivadas na ausência de fatores de crescimento, as células provenientes de NSFs dissociadas apresentaram evidências de diferenciação neuronal, dando origem a células da linhagem neural. Citometria de fluxo em células das NSFs após a diferenciação revelou aproximadamente 13,3% positivas para nestina, 5,5% positivas para Beta-III-tubulina, 9% positivas para GFAP e 7,8% positivas para mGalC. Testes de funcionalidade pela mensuração de influxo de cálcio após estímulo com ácido gama amino butírico (GABA) e glutamato revelaram a estimulação de células diferenciadas, um indicador de função neuronal. A capacidade de células da SVZ de fetos de cobaias originarem células neurais funcionais in vitro é promissora para a pesquisa e eventual uso terapêutico de células tronco em disordens do sistema nervoso.(AU)

Morphometric analysis of fetal development of Cavia porcellus (Linnaeus, 1758) by ultrasonography--pilot study.

Measurements on the growth process and placental development of the embryo and fetuses of Cavia porcellus were carried out using ultrasonography. Embryo, fetus, and placenta were monitored from Day 15 after mating day to the end of gestation. Based on linear and quadratic regressions, the following morphometric analysis showed a good indicator of the gestational age: placental diameter, biparietal diameter, renal length, and crown rump. The embryonic cardiac beat was first detected at an average of 22.5 days. The placental diameter showed constant increase from beginning of gestation then remained to term and presented a quadratic correlation with gestational age (r(2) = 0.89). Mean placental diameter at the end of pregnancy was 3.5 ± 0.23 cm. By Day 30, it was possible to measure biparietal diameter, which followed a linear pattern of increase up to the end of gestation (r(2) = 0.95). Mean biparietal diameter in the end of pregnancy was 1.94 ± 0.03 cm. Kidneys were firstly observed on Day 35 as hyperechoic structures without the distinction of medullar and cortical layers, thus the regression model equation between kidney length and gestational age presents a quadratic relationship (r(2) = 0.7). The crown rump presented a simple linear growth, starting from 15 days of gestation, displaying a high correlation with the gestational age (r(2) = 0.9). The offspring were born after an average gestation of 61.3 days. In this study, we conclude that biparietal diameter, placental diameter, and crown rump are adequate predictive parameters of gestational age in guinea pigs because they present high correlation index.

Doença periodontal relacionada à obesidade / Periodontal disease related to obesity

Introdução: recentes estudos têm indicado que a doença periodontal pode produzir uma série de alterações na saúde geral dos indivíduos, contribuindo na morbidade e mortalidade de outras condições crônicas sistêmicas, como: doenças cardiovasculares, doenças respiratórias, doenças renais, além de complicações no diabetes mellitus, na gravidez e bebês de baixo peso. Objetivo: o objetivo do proposto trabalho foi avaliar o conhecimento dos profissionais de saúde sobre a medicina periodontal em hospitais da cidade de Bauru. Metodologia: foram distribuídos 100 questionários, em três diferentes hospitais de Bauru, com perguntas sobre medicina periodontal. A participação foi anônima e voluntária, e os hospitais participantes não foram identificados. Resultados: dos 100 questionários distribuídos, 74 foram respon¬didos adequadamente e devolvidos. A amostra foi composta por 17 médicos, 24 enfermeiros, dez técnicos de enfermagem, dez fisioterapeutas, 11 fonoaudiálogas e dois nutricionistas. Dois profissionais não tiveram conhecimento algum sobre medicina periodontal (2,73%), 54,79% tinham conhecimento limitado, 32,87% tinham conhecimento moderado, 9,58% tinham conhecimento bom e nenhum entrevistado obteve excelente conhecimento. Conclusão: o conhecimento sobre medicina periodontal dos profissionais de saúde dos hospitais pesquisados na cidade de Bauru/SP é considerado limitado.

Embryonic development of chicken (Gallus Gallus Domesticus) from 1st to 19th day-ectodermal structures.

Birds occupy a prominent place in the Brazilian economy not only in the poultry industry but also as an animal model in many areas of scientific research. Thus the aim of this study was to provide a description of macro and microscopic aspects of the ectoderm-derived structures in chicken embryos / fetuses poultry (Gallus gallus domesticus) from 1st to 19th day of incubation. 40 fertilized eggs, from a strain of domestic chickens, with an incubation period of 2-19 days were subjected to macroscopic description, biometrics, light, and scanning microscopy. All changes observed during the development were described. The nervous system, skin and appendages and organs related to vision and hearing began to be identified, both macro and microscopically, from the second day of incubation. The vesicles from the primitive central nervous system-forebrain, midbrain, and hindbrain-were identified on the third day of incubation. On the sixth day of incubation, there was a clear vascularization of the skin. The optic vesicle was first observed fourth day of development and on the fifth day there was the beginning of the lens formation. Although embryonic development is influenced by animal line as well as external factors such as incubation temperature, this paper provides a chronological description for chicken (Gallus gallus domesticus) during its embryonic development.

Embryonic development of endoderm in chicken (Gallus gallus domesticus).

The poultry industry is a sector of agribusiness which represents an important role in the country's agricultural exports. Therefore, the study about embryogenesis of the domestic chicken (Gallus gallus domesticus) has a great economic importance. The aim of this study was to evaluate embryonic development of the endoderm in chicken (Gallus gallus domesticus). Forty fertilized eggs of domestic chickens, starting from the 1st day of gestation and so on until the 19 days of the incubation were collected from the Granja São José (Amparo, SP, Brazil). Embryos and fetus were fixed in 10% formaldehyde solution, identified, weighed, measured, and subjected to light and scanning electron microscopy. The endoderm originates the internal lining epithelium of the digestive, immune, respiratory systems, and the organs can be visualized from the second day (48 h) when the liver is formed. The formation of the digestive system was complete in the 12th day. Respiratory system organs begin at the fourth day as a disorganized tissue and undifferentiated. Their complete differentiation was observed at the 10 days of incubation, however, until the 19 days the syrinx was not observed. The formation of immune system at 10th day was observed with observation of the spleen, thymus, and cloacal bursa. The study of the organogenesis of the chicken based on germ layers is very complex and underexplored, and the study of chicken embryology is very important due the economic importance and growth of the use of this animal model studies such as genetic studies.

Diaphragm morphology of guinea pig (Cavia porcellus).

The diaphragm is the main respiratory muscle. Along with other respiratory muscles, the diaphragm is responsible for the muscular contraction that generates the respiratory cycle and, as a consequence, the gaseous interchanges in the lungs. Guinea pigs (Cavia porcellus Linnaeus 1758) are largely used as experimental animals in many biology applications due to their easy management, low cost, and docile behavior. As the diaphragm exerts important effects on lung physiology and function, this study aimed at investigating the morphological characteristics of the muscle, through macroscopic, microscopic, and scanning electron microscopy to add reference data for future studies. We observed a "U"-shaped tendineous center and its morphology was similar to other mammals. These results cooperate with the descriptive and comparative anatomy of mammals, besides can be used as control data for areas of surgery and stem cells.

Características das papilas o dorso da língua de cabras (Capra hircus): estudo por de microscopia eletrônica de varredura e luz / Characteristics of dorsal lingual papillae of the goat (Capra hircus): light and scanning electron microscopy study

A morfologia das papilas linguais da cabra doméstica (Capra hircus) foi estudada por Microscopia Eletrônica de Varredura (MEV) e Microscopia de luz. Papilasfiiliformes, cônicas e lentiformes possuem função mecânica, enquanto que as papilas fungiformes e as valadas possuem função gustativa. As papilasfiiliformes estavam distribuídas por toda a extensão da língua, nas superfícies dorsal e lateral. Possuem um formato cônico com a extremidade pontiaguda direcionada caudalmente. Possuem vários processos secundários, de tamanhos diferentes, com a mesma orientação. A histologia revelou abundante tecido queratinizado. As papilas fungiformes foram observadas nas superfícies dorsal e lateral do ápice e do corpo da língua. Possuem formato semelhante a cogumelos, com epitélio corni[1]icado espesso e botões gustativos distribuídos na superfície. As papilas lentiformes se distribuíam na linha mediana da parte mais dorsal do toro, com projeções elevadas além da superfície da língua. Algumas apresentavam o formato de pirâmide e outras um formato mais achatado. As papilas valadas foram encontradas na superfície lateral da parte mais caudal do toro. Possuem formato arredondado, envolvido por um sulco pouco profundo. Possuem botões gustativos na parede lateral que se abrem no sulco. As papilas cônicas foram observadas no toro da língua e possuem formato alongado, com base larga e ponta romba. Embora as principais características morfológicas e estruturais do epitélio lingual sejam específicas da espécie, o tipo de alimentação e os hábitos alimentares podem influenciar na sua estrutura. Assim, o presente trabalho fornece uma descrição histológica e ultraestrutural da língua de cabras domésticas submetidas à alimentação baseada em gramíneas e ração.

The morphology of the lingual papillae of domestic goat (Capra hircus) was studied by scanning electron microscopy (SEM) and light microscopy (LM). Filiform, conical and lentiform papillae exert mechanical function whereas fungiform and valate papillae have gustative function. Filliform papillae were distributed all over the lateral and dorsal surfaces of the tongue. They present a conical shape with the thin ends pointed caudally; and possess several secondary processes, of different sizes, with the same orientation. Histological examination of these papillae revealed abundant queratinized tissue. Fungiform papillae were observed on the dorsal and lateral surface of the apical region and body of the tongue. Present a fungi-like shape, with a thick cornified epithelium and taste buds distributed on the surface. Lentiform papillae were distributed over the median line of the dorsal torus, presenting projections above the surface of the tongue. Some displayed pyramidal shapes; other were more flattened. Valate papillae were observed on the lateral surface of the posterior part of the torus and present a rounding shape delimited by a deep groove. These papillae possess taste buds on their lateral wall that open up on the groove. Conical papillae were observed on the lingual torus and present an extended shape, with a wide base and a blunt tip. Although the main morphological and structural characteristics of the lingual epithelium are species-specific, some features may be influenced by the type of food and alimentary habits. Therefore, the present study provides a histological and ultrastructural description of the tongue of the domestic goat fed with mixed food (grass and concentrate).

Characteristics of the equine embryo and fetus from days 15 to 107 of pregnancy.

In spite of numerous, substantial advances in equine reproduction, many stages of embryonic and fetal morphological development are poorly understood, with no apparent single source of comprehensive information. Hence, the objective of the present study was to provide a complete macroscopic and microscopic description of the equine embryo/fetus at various gestational ages. Thirty-four embryos/fetuses were aged based on their crown rump length (CRL), and submitted to macroscopic description, biometry, light and scanning microscopy, as well as the alizarin technique. All observed developmental changes were chronologically ordered and described. As examples of the main observed features, an accentuated cervical curvature was observed upon macroscopic examination in all specimens. In the nervous system, the encephalic fourth ventricle and the encephalic vesicles forebrain, midbrain, and hindbrain, were visualized from Day 19 (ovulation = Day 0). The thoracic and pelvic limbs were also visualized; their extremities gave rise to the hoof during development from Day 27. Development of other structures such as pigmented optical vesicle, liver, tail, cardiac area, lungs, and dermal vascularization started on Days 25, 25, 19, 19, 34, and 35, respectively. Light and scanning microscopy facilitated detailed examinations of several organs, e.g., heart, kidneys, lungs, and intestine, whereas the alizarin technique enabled visualization of ossification. Observations in this study contributed to the knowledge regarding equine embryogenesis, and included much detailed data from many specimens collected over a long developmental interval.