The Brazilian version of the High-Activity Arthroplasty Score: cross-cultural adaptation

ABSTRACT BACKGROUND: The High Activity Arthroplasty Score (HAAS) is a self-administered questionnaire, developed in British English, that reliably and validly measures the levels of sports activities in patients following hip and knee arthroplasty surgery. OBJECTIVE: To cross-culturally adapt the HAAS to Brazilian Portuguese language. DESIGN AND SETTING: A cross-sectional study was conducted at a public university hospital in Brazil. METHODS: The Brazilian version of the HAAS was created through a six-step process: translation, synthesis, committee review, pretesting, back-translation, and submission to developers. The translation step was conducted by two independent bilingual translators, both native speakers of Brazilian Portuguese. The back-translation was performed by an independent translator, a native speaker of British English. To ensure the questionnaire's comprehensibility, 46 volunteers (51% men; average age 34-63) participated in the pre-testing step. RESULTS: The cross-cultural adaptation process necessitated modifications to certain terms and expressions to achieve cultural equivalence with the original HAAS. CONCLUSION: The HAAS has been translated from English into Brazilian Portuguese and culturally adapted for Brazil. The validation process for HAAS-Brazil is currently underway.

The Brazilian version of the High-Activity Arthroplasty Score: cross-cultural adaptation.

BACKGROUND: The High Activity Arthroplasty Score (HAAS) is a self-administered questionnaire, developed in British English, that reliably and validly measures the levels of sports activities in patients following hip and knee arthroplasty surgery. OBJECTIVE: To cross-culturally adapt the HAAS to Brazilian Portuguese language. DESIGN AND SETTING: A cross-sectional study was conducted at a public university hospital in Brazil. METHODS: The Brazilian version of the HAAS was created through a six-step process: translation, synthesis, committee review, pretesting, back-translation, and submission to developers. The translation step was conducted by two independent bilingual translators, both native speakers of Brazilian Portuguese. The back-translation was performed by an independent translator, a native speaker of British English. To ensure the questionnaire's comprehensibility, 46 volunteers (51% men; average age 34-63) participated in the pre-testing step. RESULTS: The cross-cultural adaptation process necessitated modifications to certain terms and expressions to achieve cultural equivalence with the original HAAS. CONCLUSION: The HAAS has been translated from English into Brazilian Portuguese and culturally adapted for Brazil. The validation process for HAAS-Brazil is currently underway.

Validation of the Brazilian version of the Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement: a cross-sectional study

ABSTRACT BACKGROUND: The Hip Sports Activity Scale (HSAS) is a hip-specific instrument for assessing the present levels of physical activity among patients with femoroacetabular impingement (FAI) syndrome. When evaluating treatment outcomes in patients with FAI syndrome, it is necessary to use joint-specific instruments and ones that can evaluate the levels of physical activity in these patients, such as the HSAS-Brazil. OBJECTIVE: To validate the HSAS-Brazil among a group of physically active patients after arthroscopic treatment of FAI syndrome. DESIGN AND SETTING: Cross-sectional research of quantitative and qualitative types using data obtained from July 2018 to October 2019. METHODS: A total of 58 patients of both genders diagnosed with FAI syndrome and who had undergone hip arthroscopy participated in this research. To establish reliability and validity, patients first answered the Brazilian versions of the 12-Item Short-Form Health Survey (SF-12), Nonarthritic Hip Score (NAHS), and HSAS; after a 48-hour interval, they answered the HSAS-Brazil again. RESULTS: For test-retest reliability, the interclass correlation was 0.908 (P < 0.001). The HSAS-Brazil correlated to the NAHS-Brazil (r = 0.63, P < 0.001), as well as the SF-12 (Physical Health) (r = 0.42, P = 0.001). CONCLUSION: The HSAS-Brazil was validated and proved to be a reliable and valid scale to assess sports activity levels in physically active patients with FAI syndrome after arthroscopic treatment.

Influence of age and gender on knee and hip isometric strength of recreational physically active young and middle-aged subjects / Influencia de la edad y el sexo en la fuerza isométrica de la rodilla y la cadera de personas jóvenes y de mediana edad que practican actividades físicas recreativas / Influência da idade e do sexo na força isométrica do joelho e do quadril de indivíduos jovens e de meia idade praticantes recreacionais de atividades físicas

ABSTRACT Muscle strength is an essential part of the functional assessment of health professionals to select and analyze the effects of clinical interventions. This study aimed to determine the influence of gender and age on isometric strength of hip and knee muscle groups. A total of 127 subjects (50.4% men), aged from 20 to 49 years (stratified into three groups: 20-29 years; 30-39 years; and 40-49 years) participated in this study. A hand-held dynamometer was used to measure isometric normalized torque of the hip abductors, hip external rotators, knee extensors, and knee flexors muscles. Regressions and a two-way analysis of variance were used to identify the influence of age and gender on torque of each muscle group. Age and gender were included in the regression model for all groups. Generally, men aged 20-29 and 30-39 were stronger than age-paired women. For participants aged 40-49, torque was similar for men and women for all muscle groups. There was no difference among age groups for women. Generally, young men were stronger than older men. The association between age and gender in hip and knee strength was proved and liable of subgroup stratification after measurements with a hand-held isometric dynamometer.

RESUMEN La fuerza muscular es un componente básico de la evaluación funcional de los profesionales de la salud para seleccionar y analizar los efectos de las intervenciones clínicas. El objetivo de este estudio fue determinar la influencia del sexo y de la edad en las mediciones de fuerza isométrica de los grupos musculares de la cadera y la rodilla. En el estudio participaron 127 sujetos (50,4% hombres), de entre 20 y 49 años de edad (estratificados en grupos: 20 a 29 años; 30 a 39 años; y 40 a 49 años). El torque isométrico normalizado de los abductores y rotadores externos de la cadera y de los extensores y flexores de la rodilla se midió con un dinamómetro manual. Se utilizaron regresiones y el análisis de varianza (Anova) para identificar la influencia de la edad y el sexo en el torque. Tanto la edad como el sexo se incluyeron en el modelo para todos los grupos musculares. En general, los hombres de entre 20 y 29 años y los de 30 a 39 mostraron tener más fuerza que las mujeres del mismo grupo de edad. Para los participantes de 40 a 49 años, el torque fue similar entre hombres y mujeres para todos los grupos musculares. No hubo diferencias entre los grupos de edad en el grupo de mujeres. En general, los hombres más jóvenes demostraron ser más fuertes que los hombres de mediana edad. La relación entre la edad y el sexo en la fuerza muscular de la cadera y la rodilla se probó y demostró ser susceptible a la estratificación después de las mediciones realizadas con el dinamómetro manual.

RESUMO A força muscular é um componente essencial da avaliação funcional de profissionais da saúde para selecionar e analisar efeitos de intervenções clínicas. O objetivo do estudo foi determinar a influência do sexo e da idade sobre medidas de força isométrica de grupos musculares do quadril e do joelho. Participaram da pesquisa 127 sujeitos (50,4% homens), com idade de 20 a 49 anos (estratificados em grupos: 20 a 29 anos; 30 a 39 anos; e 40 a 49 anos). O torque isométrico normalizado de abdutores e rotadores externos de quadril e extensores e flexores de joelho foi medido com dinamômetro manual. Regressões e uma análise de variância (Anova) foram usados para identificar a influência da idade e do sexo sobre o torque. Tanto idade quanto sexo foram incluídos no modelo para todos os grupos musculares. Em geral, homens de 20 a 29 anos e de 30 a 39 anos demonstraram mais força do que mulheres da mesma faixa etária. Para participantes de 40 a 49 anos, o torque foi similar entre homens e mulheres para todos os grupos musculares. Não houve diferença entre as faixas etárias no grupo de mulheres. Em geral, homens mais jovens se mostraram mais fortes do que homens mais velhos. A relação entre idade e sexo na força muscular do quadril e do joelho foi provada e se mostrou passível de estratificação após as medições feitas com o dinamômetro manual.

Validation of the Brazilian version of the Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement: a cross-sectional study.

BACKGROUND: The Hip Sports Activity Scale (HSAS) is a hip-specific instrument for assessing the present levels of physical activity among patients with femoroacetabular impingement (FAI) syndrome. When evaluating treatment outcomes in patients with FAI syndrome, it is necessary to use joint-specific instruments and ones that can evaluate the levels of physical activity in these patients, such as the HSAS-Brazil. OBJECTIVE: To validate the HSAS-Brazil among a group of physically active patients after arthroscopic treatment of FAI syndrome. DESIGN AND SETTING: Cross-sectional research of quantitative and qualitative types using data obtained from July 2018 to October 2019. METHODS: A total of 58 patients of both genders diagnosed with FAI syndrome and who had undergone hip arthroscopy participated in this research. To establish reliability and validity, patients first answered the Brazilian versions of the 12-Item Short-Form Health Survey (SF-12), Nonarthritic Hip Score (NAHS), and HSAS; after a 48-hour interval, they answered the HSAS-Brazil again. RESULTS: For test-retest reliability, the interclass correlation was 0.908 (P < 0.001). The HSAS-Brazil correlated to the NAHS-Brazil (r = 0.63, P < 0.001), as well as the SF-12 (Physical Health) (r = 0.42, P = 0.001). CONCLUSION: The HSAS-Brazil was validated and proved to be a reliable and valid scale to assess sports activity levels in physically active patients with FAI syndrome after arthroscopic treatment.

The Brazilian version of the Hip Sports Activity Scale: translation and cross-cultural adaptation.

BACKGROUND: The Hip Sports Activity Scale (HSAS) is a reliable and valid tool for determining the levels of sports activities among patients with femoroacetabular impingement (FAI). OBJECTIVE: To translate and cross-culturally adapt the HSAS to the Brazilian Portuguese language. DESIGN AND SETTING: This was a cross-sectional study conducted at the State University of Rio de Janeiro. METHODS: The Brazilian version of the HSAS was developed following a process that comprised six steps: translation, synthesis, back-translation, review by committee, pretesting and submission of documentation to the developers. The translation phase involved three independent bilingual translators whose mother language was Brazilian Portuguese. The back-translation phase involved three independent translators whose mother language was English. In order to verify comprehension of the questionnaire, 30 undergraduate students in physical education (65% men), with mean age 23.2 years (standard deviation = 6.8), participated in the pre-testing phase. RESULTS: During the translation step, some terms and expressions were changed to obtain cultural equivalence to the original HSAS. In the pre-testing phase, each item of the scale showed a comprehension level of 100%. CONCLUSION: The HSAS was translated from English to the Brazilian Portuguese language and adapted to Brazilian culture. The HSAS validation is ongoing.

Secondary infections in a cohort of patients with COVID-19 admitted to an intensive care unit: impact of gram-negative bacterial resistance.

Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and in-hospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU- acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 - 3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality.

The Brazilian version of the Hip Sports Activity Scale: translation and cross-cultural adaptation

Abstract BACKGROUND: The Hip Sports Activity Scale (HSAS) is a reliable and valid tool for determining the levels of sports activities among patients with femoroacetabular impingement (FAI). OBJECTIVE: To translate and cross-culturally adapt the HSAS to the Brazilian Portuguese language. DESIGN AND SETTING: This was a cross-sectional study conducted at the State University of Rio de Janeiro. METHODS: The Brazilian version of the HSAS was developed following a process that comprised six steps: translation, synthesis, back-translation, review by committee, pretesting and submission of documentation to the developers. The translation phase involved three independent bilingual translators whose mother language was Brazilian Portuguese. The back-translation phase involved three independent translators whose mother language was English. In order to verify comprehension of the questionnaire, 30 undergraduate students in physical education (65% men), with mean age 23.2 years (standard deviation = 6.8), participated in the pre-testing phase. RESULTS: During the translation step, some terms and expressions were changed to obtain cultural equivalence to the original HSAS. In the pre-testing phase, each item of the scale showed a comprehension level of 100%. CONCLUSION: The HSAS was translated from English to the Brazilian Portuguese language and adapted to Brazilian culture. The HSAS validation is ongoing.

Secondary infections in a cohort of patients with COVID-19 admitted to an intensive care unit: impact of gram-negative bacterial resistance

ABSTRACT Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and in-hospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU- acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 - 3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality.

Thromboembolism in Arthroplasty: Compliance to Prophylaxis.

Objective The present paper aims to identify the profile of compliance to thromboembolism drug prophylaxis in patients undergoing knee or hip arthroplasty at a public hospital. Methods This is a prospective cohort study, carried out from August 2017 to September 2018, with adult patients who were followed-up from admission until the postoperative period. The Morisky Medication Adherence Scale, consisting of eight items, was applied. Compliance was quantified according to the sum of all correct answers as high (8 points), medium (6 to < 8 points), and low compliance (< 6 points). For the present study, subjects with high compliance were referred as highly compliant, whereas those with medium to low compliance were referred as partially compliant. Results The compliance analysis showed that 73.0% of the patients were highly compliant and 27.0% were partially compliant to thromboprophylaxis. The anticoagulant prescribed at hospital discharge was rivaroxaban, a direct factor Xa inhibitor. Compliance was greater in patients who did not require reinforcement in prophylaxis guidance during follow-up; these subjects reported good and excellent acceptance of prophylaxis, although they were on multiple medications at discharge. Conclusion The data analysis allowed us to conclude that the factors that most influenced compliance were the levels of understanding and acceptance of prophylaxis by the patients, the amount of medication used per day by the subject, the cost of the anticoagulant agent, and its potential to cause adverse reactions.

Acromial type in Brazilian young adults: a radiological study / Tipo acromial em adultos jovens brasileiros: um estudo radiológico

Introduction: curved and hooked acromia play a key role in shoulder impingement syndrome. Little is known about acromial type in the Brazilian population. Aim: To describe the acromial profile of Brazilian young adults; to evaluate its correlation with gender and handedness and the occurrence of symmetry between the genders. Methodology: forty acromia in 20 Brazilian adults of both genders, aged 21-25 years, were studied. The acromial type was classified through the Bigliani/Epstein method using radiographs in supraspinatus outlet view. Results: as there was no gender difference in occurrences of acromial type, we considered the male and female groups together. Thus, among the 20 right acromia, we found 5 type I (25%), 8 type II (40%) and 7 type III (35%). Among the 20 left acromia, we found 4 type I (20%), 11 type II (55%) and 5 type III (25%). The only left-handed volunteer (100%) presented acromial type III in both the right and the left shoulder. Among the 19 right-handed volunteers, 5 (26.3%) presented right acromion type I, 8 (42.1%) had type II and 6 (31.6%) had type III; for the left acromion, 4 (21.1%) presented type I, 11 (57.9%) had type II and 4 (21.1%) had type III. Acromial symmetry occurred in 60% of females and 70% of males. Conclusion: type II acromion was predominant, in both the right and the left shoulder in Brazilian young adults. There was no correlation between acromial type and gender. It was not possible to analyze the correlation between acromial type and handedness. Acromial type tended to be symmetrical in our sample.

Introdução: o acrômio curvo e gancho desempenham um papel fundamental na Síndrome do impacto do ombro. Pouco se sabe sobre o tipo acromial na população brasileira. Objetivo: descrever o perfil do tipo acromial em adultos jovens brasileiros e avaliar sua correlação com o gênero e a lateralidade e a ocorrência de simetria entre os sexos. Metodologia: foram estudados 40 acrômios de 20 adultos brasileiros, de ambos os sexos, com idade entre 21 e 25 anos. O tipo acromial foi classificado pelo método de Bigliani/ Epstein nas radiografias de perfil de escápula. Resultados: como não houve diferença na ocorrência do tipo acromial quanto ao gênero, consideramos os grupos masculino e feminino juntos. Assim, dos 20 acrômios direitos, foram encontrados 5 (25%) do tipo I, 8 (40%) do tipo II e 7 (35%) do tipo III, enquanto que dos 20 acrômios esquerdos, foram encontrados 4 (20%) tipo I, 11 (55%) tipo II e 5 (25%) tipo III. O único voluntário canhoto (100%) apresentou para o ombro direito e esquerdo o tipo acromial III. Dos 19 voluntários destros, 5 (26,3%) apresentavam acrômio direito tipo I, 8 (42,1%) tipo II e 6 (31,6%) tipo III; para o acrômio esquerdo, 4 (21,1%) apresentavam tipo I, 11 (57,9%) tipo II e 4 (21,1%) tipo III. A simetria acromial ocorreu nos grupos feminino (60%) e masculino (70%). Conclusão: o acrômio tipo II foi o mais predominante para os ombros direito e esquerdo em adultos jovens brasileiros. Não houve correlação entre o tipo de acromial e o gênero. Não foi possível analisar a correlação entre o tipo acromial e a lateralidade. O tipo acromial tende a ser simétrico em na amostra estudada.

Fast-track versus conventional surgery in relation to time of hospital discharge following total hip arthroplasty: a single-center prospective study.

BACKGROUND: Total hip arthroplasty (THA) has been used for over five decades for treating hip osteoarthritis. THA is a surgical procedure associated with prolonged hospital length of stay (LOS). The aim of this study was to analyze whether a protocol developed for fast-track THA could decrease the time taken to reach functional recovery after surgery and the hospital LOS. Blood transfusion and critical care requirements and the complication rate were evaluated as secondary endpoints. METHODS: Ninety-eight patients underwent THA at the University Hospital of the Federal University of Maranhão (São Luís, Brazil). The control group included 51 patients who underwent THA through the conventional method. The fast-track surgery (FTS) group included 47 patients who underwent THA through the FTS approach. The inclusion criteria were that the subjects needed to present hip osteoarthritis and at least one clinical indication for THA, and that their risk classification was in ASA category I or II. The following factors were evaluated: age, sex, diagnosis, laterality, type of arthroplasty, blood transfusion, critical care requirement, complications, LOS, and need for re-hospitalization for any reason. For spinal anesthesia, an opioid-free protocol was used. Comparison of categorical variables between the groups was performed using the chi-square test, Shapiro-Wilk test, Student t test, and Poisson regression approach. RESULTS: The FTS and control groups were similar in age and sex distribution (p > 0.05). The majority of the patients in the control group required both blood transfusion and use of the critical care unit, thus differing from the patients who underwent FTS (p < 0.001). The mean hospital LOS in the FTS group was 2.3 ± 0.8 days, compared with 6.4 ± 1.5 days in the control group (p < 0.001). CONCLUSION: Use of FTS was associated with decreased LOS, compared with conventional THA. TRIAL REGISTRATION: https://www.researchsquare.com/article/rs-369025/v1 .

Confiabilidade interavaliador do método de Bigliani para classificação do tipo acromial / Inter-rater reliability of the method of Bigliani for classifying acromial type

Introdução: em 1875, Hamilton identificou o formato do acrômio como uma etiologia de dor no ombro. Neer, em 1972, descreveu a síndrome do impacto no ombro como uma relação de causa e efeito entre a morfologia do acrômio e o impacto subacromial. Em 1986, Bigliani et al. apresentaram um esquema de classificação do acrômio de acordo com o formato de sua superfície inferior: plano (tipo I), curvo (tipo II) e gancho (tipo III). Em 1993, Epstein et al. proporam que o acrômio tipo II apresentaria um declive em seu terço médio e o tipo III no seu terço anterior. Objetivo: avaliar a reprodutibilidade/confiabilidade interavaliador do método de Bigliani et al. (1986) refinado por Espstein et al. (1993) para a classificação do tipo acromial. Metodologia: casuística composta por 20 voluntários brasileiros, de ambos os gêneros, entre 21-25 anos. A incidência radiográfica utilizada para visualizar o formato do acrômio foi perfil de escápula. O tipo acromial foi classificado por três avaliadores. A reprodutibilidade e confiabilidade foram avaliadas pelo teste McNemar e pelo índice Kappa. Resultados: teste de McNemar com p > 0,05; índice Kappa entre 0,61 e 0,8; e probabilidade de significância p de Kappa < 0,05 confirmam a muito boa reprodutibilidade e confiabilidade do método para classificação do tipo acromial entre os três avaliadores. Conclusão: o método de Bigliani et al. (1986) refinado por Epstein et al. (1993) para classificação do tipo acromial mostrou concordância entre todos os avaliadores confirmando a muito boa reprodutibilidade e confiabilidade entre os avaliadores do estudo.

Introduction: in 1875, Hamilton identified that acromion shape was an etiology for shoulder pain. In 1972, Neer described shoulder impact syndrome as a cause and effect relationship between acromion morphology and subacromial impact. In 1986, Bigliani et al. presented an acromion classification scheme according to the shape of its lower surface: flat (type I), curved (type II) and hook (type III). In 1993, Epstein et al. proposed that the type II acromion would have a slope in its middle third and type III in its anterior third. Objective: to evaluate the inter-rater reproducibility and reliability of the method of Bigliani et al. (1986) for classifying acromial type, as refined by Epstein et al. (1993). Methodology: this was a case series composed of 20 Brazilian volunteers of both genders, aged 21-25 years. The shape of the acromion was visualized radiographically using the supraspinatus outlet view. Acromial type was classified by three evaluators. Reproducibility and reliability were assessed using the McNemar test and kappa index. Results: the McNemar test showed probability p > 0.05 and the kappa index was between 0.61 and 0.8 significant result: p < 0.05. These confirmed that this method had very good reproducibility and reliability for classifying acromial type among the three evaluators. Conclusion: the method of Bigliani et al. (1986) for classifying acromial type, as refined by Epstein et al. (1993) showed agreement among all the evaluators. This confirmed that there was very good reproducibility and reliability among the evaluators of this study.

COVID-19 e Injúria Miocárdica em UTI Brasileira: Alta Incidência e Maior Risco de Mortalidade Intra-Hospitalar / COVID-19 and Myocardial Injury in a Brazilian ICU: High Incidence and Higher Risk of In-Hospital Mortality

Resumo Fundamentos A incidência de injúria miocárdica (IM) em pacientes com COVID-19 no Brasil é pouco conhecida e o impacto prognóstico da IM, mal elucidado. Objetivos Descrever a incidência de IM em pacientes com COVID-19 em unidade de terapia intensiva (UTI) e identificar variáveis associadas à sua ocorrência. O objetivo secundário foi avaliar a troponina I ultrassensível (US) como preditor de mortalidade intra-hospitalar. Métodos Estudo observacional, retrospectivo, entre março e abril de 2020, com casos confirmados de COVID-19 internados em UTI. Variáveis numéricas foram comparadas com teste t de Student ou U de Mann-Whitney, sendo o teste X2 empregado para as categóricas. Realizou-se análise multivariada com as variáveis associadas à IM e p<0,2 objetivando determinar preditores de IM. Curva ROC foi empregada para determinar o valor da troponina capaz de predizer maior mortalidade intra-hospitalar. Funções de sobrevida foram estimadas pelo método de Kaplan-Meier a partir do ponto de corte apontado pela curva ROC. Resultados Este estudo avaliou 61 pacientes (63,9% do sexo masculino, média de idade de 66,1±15,5 anos). A IM esteve presente em 36% dos casos. Hipertensão arterial sistêmica (HAS) [RC 1,198; IC95%: 2,246-37,665] e índice de massa corporal (IMC) [RC 1,143; IC95%: 1,013-1,289] foram preditores independentes de risco. Troponina I US >48,3 ng/ml, valor determinado pela curva ROC, prediz maior mortalidade intra-hospitalar [AUC 0,786; p<0,05]. A sobrevida no grupo com troponina I US >48,3 ng/ml foi inferior à do grupo com valores ≤48,3 ng/dl [20,3 x 43,5 dias, respectivamente; p<0,05]. Conclusão Observou-se alta incidência de IM na COVID-19 grave com impacto em maior mortalidade intra-hospitalar. HAS e IMC foram preditores independentes de risco de sua ocorrência. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background The incidence of myocardial injury (MI) in patients with COVID-19 in Brazil and the prognostic impact of MI have not been elucidated. Objectives To describe the incidence of MI in patients with COVID-19 in the intensive care unit (ICU) and to identify variables associated with its occurrence. The secondary objective was to assess high-sensitivity troponin I as a predictor of in-hospital mortality. Methods Retrospective, observational study conducted between March and April 2020 with cases of confirmed COVID-19 admitted to the ICU. Numerical variables were compared by using Student t test or Mann-Whitney U test. The chi-square test was used for categorical variables. Multivariate analysis was performed with variables associated with MI and p<0.2 to determine predictors of MI. The ROC curve was used to determine the troponin value capable of predicting higher in-hospital mortality. Survival functions were estimated by use of the Kaplan-Meier method from the cut-off point indicated in the ROC curve. Results This study assessed 61 patients (63.9% of the male sex, mean age of 66.1±15.5 years). Myocardial injury was present in 36% of the patients. Systemic arterial hypertension (HAS) [OR 1.198; 95%CI: 2.246-37.665] and body mass index (BMI) [OR 1.143; 95%CI: 1.013-1.289] were independent risk predictors. High-sensitivity troponin I >48.3 ng/mL, which was determined in the ROC curve, predicts higher in-hospital mortality [AUC 0.786; p<0.05]. Survival in the group with high-sensitivity troponin I >48.3 ng/mL was lower than that in the group with values ≤48.3 ng/dL [20.3 x 43.5 days, respectively; p<0.05]. Conclusion There was a high incidence of MI in severe COVID-19 with impact on higher in-hospital mortality. The independent risk predictors of MI were SAH and BMI. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

COVID-19 and Myocardial Injury in a Brazilian ICU: High Incidence and Higher Risk of In-Hospital Mortality. / COVID-19 e Injúria Miocárdica em UTI Brasileira: Alta Incidência e Maior Risco de Mortalidade Intra-Hospitalar.

BACKGROUND: The incidence of myocardial injury (MI) in patients with COVID-19 in Brazil and the prognostic impact of MI have not been elucidated. OBJECTIVES: To describe the incidence of MI in patients with COVID-19 in the intensive care unit (ICU) and to identify variables associated with its occurrence. The secondary objective was to assess high-sensitivity troponin I as a predictor of in-hospital mortality. METHODS: Retrospective, observational study conducted between March and April 2020 with cases of confirmed COVID-19 admitted to the ICU. Numerical variables were compared by using Student t test or Mann-Whitney U test. The chi-square test was used for categorical variables. Multivariate analysis was performed with variables associated with MI and p<0.2 to determine predictors of MI. The ROC curve was used to determine the troponin value capable of predicting higher in-hospital mortality. Survival functions were estimated by use of the Kaplan-Meier method from the cut-off point indicated in the ROC curve. RESULTS: This study assessed 61 patients (63.9% of the male sex, mean age of 66.1±15.5 years). Myocardial injury was present in 36% of the patients. Systemic arterial hypertension (HAS) [OR 1.198; 95%CI: 2.246-37.665] and body mass index (BMI) [OR 1.143; 95%CI: 1.013-1.289] were independent risk predictors. High-sensitivity troponin I >48.3 ng/mL, which was determined in the ROC curve, predicts higher in-hospital mortality [AUC 0.786; p<0.05]. Survival in the group with high-sensitivity troponin I >48.3 ng/mL was lower than that in the group with values ≤48.3 ng/dL [20.3 x 43.5 days, respectively; p<0.05]. CONCLUSION: There was a high incidence of MI in severe COVID-19 with impact on higher in-hospital mortality. The independent risk predictors of MI were SAH and BMI. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

FUNDAMENTOS: A incidência de injúria miocárdica (IM) em pacientes com COVID-19 no Brasil é pouco conhecida e o impacto prognóstico da IM, mal elucidado. OBJETIVOS: Descrever a incidência de IM em pacientes com COVID-19 em unidade de terapia intensiva (UTI) e identificar variáveis associadas à sua ocorrência. O objetivo secundário foi avaliar a troponina I ultrassensível (US) como preditor de mortalidade intra-hospitalar. MÉTODOS: Estudo observacional, retrospectivo, entre março e abril de 2020, com casos confirmados de COVID-19 internados em UTI. Variáveis numéricas foram comparadas com teste t de Student ou U de Mann-Whitney, sendo o teste X2 empregado para as categóricas. Realizou-se análise multivariada com as variáveis associadas à IM e p<0,2 objetivando determinar preditores de IM. Curva ROC foi empregada para determinar o valor da troponina capaz de predizer maior mortalidade intra-hospitalar. Funções de sobrevida foram estimadas pelo método de Kaplan-Meier a partir do ponto de corte apontado pela curva ROC. RESULTADOS: Este estudo avaliou 61 pacientes (63,9% do sexo masculino, média de idade de 66,1±15,5 anos). A IM esteve presente em 36% dos casos. Hipertensão arterial sistêmica (HAS) [RC 1,198; IC95%: 2,246-37,665] e índice de massa corporal (IMC) [RC 1,143; IC95%: 1,013-1,289] foram preditores independentes de risco. Troponina I US >48,3 ng/ml, valor determinado pela curva ROC, prediz maior mortalidade intra-hospitalar [AUC 0,786; p<0,05]. A sobrevida no grupo com troponina I US >48,3 ng/ml foi inferior à do grupo com valores ≤48,3 ng/dl [20,3 x 43,5 dias, respectivamente; p<0,05]. CONCLUSÃO: Observou-se alta incidência de IM na COVID-19 grave com impacto em maior mortalidade intra-hospitalar. HAS e IMC foram preditores independentes de risco de sua ocorrência. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

Correlation between muscle strength and the degrees of functionality and kinesiophobia reported by patients with chronic hip pain / Correlação entre força muscular e graus de funcionalidade e cinesiofobia relatada por pacientes com dor crônica no quadril

ABSTRACT BACKGROUND AND OBJECTIVES: This study aimed to identify the association between hip muscle strength and the scores from subjective functional and psychological evaluation questionnaires in patients with chronic hip pain. METHODS: Fifty-fivepatients with painful hip injuries (30 males) performed isometric peak strength tests of the abductors, extensors, and internal and external rotators of the hips with a hand-held dynamometer. The degree of functionality was measured by the Hip Outcome Score (HOS) and Lower Extremity Functional Score (LEFS), pain was estimated by the Visual Analog Scale (VAS) and kinesiophobia was calculated using the Tampa questionnaire. The Pearson correlation coefficient was used (alfa=5%) to test the associations between the muscle strength and the scores from the questionnaires. RESULTS: There were significant correlations between the strength of all four hip muscles and the HOS (r>0.29). Only the hip external rotators showed a significant correlation with pain (r=-0.30). No significant correlations were found for LEFS (r<0.24) and Tampa questionnaires (r¬0.15). CONCLUSION: The reduction in peak strength of the hip extensors, abductors and external rotators was associated with a reduction in the level of hip functionality but did not correlate with neither the level of overall functionality of the lower limbs nor the degree of kinesiophobia. Also, a reduction of hip external rotators strength was related to an increase in the intensity of pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: Este estudo teve como objetivo identificar a associação entre a força muscular do quadril e os escores de questionários subjetivos de avaliação funcional e psicológica em pacientes com dor crônica no quadril. MÉTODOS: Cinquenta e cinco pacientes com lesões dolorosas no quadril (30 homens) realizaram testes isométricos do pico de força de abdutores, extensores e rotadores internos e externos do quadril com um dinamômetro portátil. O grau de funcionalidade foi medido pelo Hip Outcome Score (HOS) e Lower Extremity Functional Score (LEFS), a dor foi avaliada pela escala analógica visual (EAV) e a cinesiofobia foi calculada pelo questionário de Tampa. O coeficiente de correlação de Pearson foi utilizado (alfa=5%) para testar as associações entre a força muscular e os escores dos questionários. RESULTADOS: Houve correlações significativas entre a força de todos os quatro músculos do quadril e o HOS (r>0,29). Apenas os rotadores externos do quadril apresentaram correlação significativa com a intensidade da dor (r=-0,30). Nenhuma correlação significativa foi encontrada para LEFS (r<0,24) e questionário de Tampa (r¬0,15). CONCLUSÃO: A redução no pico de força dos extensores, abdutores e rotadores externos do quadril foi associada à redução no nível de funcionalidade do quadril, mas não se correlacionou com o nível de funcionalidade geral dos membros inferiores ou com o grau de cinesiofobia. Além disso, uma redução da força dos rotadores externos do quadril foi relacionada a aumento na intensidade da dor.

Viscossuplementation for the treatment of osteoarthritis of the knee: A protocol for an umbrella review of systematic reviews with meta-analyses of randomized controlled trials.

BACKGROUND: Knee osteoarthritis (KOA) is a common chronic disease with worldwide prevalence of 10% to 79%, with costs ranging from $560 to $635 billion for year in United States of America. The main guidelines recommend interventions with undesirable adverse events (AE) or highly dependent on the patient's persistence. Thus, intra-articular (IA) therapies appear to be attractive in patients with KOA, as well as a valid therapy by maximizing effects locally in the joint and limiting systemic AE. Presently, the main available IA therapies are corticosteroids and hyaluronic acid.As several meta-analyses about the efficacy of intra-articular hyaluronic acid (IAHA) for treatment of KOA with discordant results were published, we decided to conduct an umbrella review to summarize this efficacy METHODS:: We will search MEDLINE/PubMed, EMBASE, Cochrane Library, and Virtual Health Library (BVS) from inception to February 2020 for systematic reviews with meta-analyses of randomized clinical trials that investigate IAHA for therapy of KOA. Grey literature will be searched in Opengray platform, Research Gate, and Google Scholar. The reference lists of eligible studies will be screened. The search will be performed without language restriction.We will include any type of IAHA as experimental intervention and different types of oral or intra-articular placebo or medications as controls. The primary outcome will be measures of efficacy as the Western Ontario and McMaster Universities Osteoarthritis Index.A synthesis of the evidence will be conducted and data will be presented in tables.Two reviewers will independently appraise the quality of included meta-analyses using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool and will classify the included systematic reviews into high, moderate, low, or critically low levels of confidence. RESULTS: The results of this study will be published in a peer-reviewed journal. ETHICS AND DISSEMINATION: No ethical approval is required since this study data is based on published literature. PROTOCOL REGISTRATION NUMBER: PROSPERO CRD42019120269 (https://www.crd.york.ac.uk/PROSPERO/#joinuppage).

Sinergismo entre o vasto lateral e vasto medial oblíquo durante a marcha após a reconstrução do ligamento cruzado anterior / Synergism between vastus lateralis and vastus medialis oblique during gait after anterior cruciate ligament reconstruction

Objetivo: O objetivo deste estudo foi comparar a co-contração muscular (CCM) e ativação dos músculos vasto lateral (VL) vasto medial oblíquo (VMB) durante a marcha e uma amostra saudável ­ grupo controle (GC) e pacientes submetidos a reconstrução do ligamento cruzado anterior (RLCA). Métodos: Vinte e três indivíduos participaram neste estudo, 14 GC e 9 RLCA. A atividade mioelétrica do VL e VMO foram captados para cálculo da CCM. A razão VL/VMO foi obtida dividindo o sinal normalizado desses dois músculos em cada ponto da curva. O valor da CCM e a relação de ativação na fase de apoio duplo, fase de apoio simples, fase de apoio terminal e fase de balanço foram obtidas pelo cálculo da média aritmética dos valores de intensidade da curva comum em cada intervalo. Resultado: CCM foi significativamente menor no grupo RLCA durante a fase de apoio dupla (p=0.001), efeito máximo (1.72). Não foram encontradas diferenças entre as outras comparações. Conclusão: O resultado desse estudo mostrou que a contração dos músculos VL e o VMO na fase inicial de apoio duplo da marcha foi diferente entre indivíduos saudáveis e submetidos a RLCA. Este achado pode estar relacionado a diminuição da estabilidade patelofemoral durante a resposta a carga, aumentando o potencial risco de desenvolver lesões nesta articulação.

Objective: The aim of this study was to compare vastus lateralis and vastus medialis oblique (VL/VMO) muscle co-contraction (MCC) and activation ratio during gait between healthy subjects- control group (CG), and those with anterior cruciate ligament reconstruction (ACLR). Methods: Twenty-three subjects participated in this study, 14 CG and 9 ACLR. The myoelectric activities of the VL and VMO were captured to calculate the MCC. The VL/VMO ratio was obtained by dividing the normalized signals of these two muscles at each point of the curve. The MCC values and the activation ratio in the initial double limb stance, single limb stance, terminal double limb stance and swing were obtained by calculating the arithmetic mean of the intensity values ​​of the common curve in each interval. Results: MCC was significantly lower in the ACLR group during the initial double limb stance phase (p=0.001), with a high effect size (1.72). No significant differences were found for the other comparisons. Conclusions: The results of this study showed that the VL and VMO muscles co-contraction in the initial double limb stance phase of gait was different between the healthy and ACLR individuals. This finding may be related to lower patellofemoral stability during the loading response, increasing the potential risk for the development of injuries in this joint.

Validation of the Brazilian version of the Hip Outcome Score (HOS) questionnaire.

BACKGROUND: The Hip Outcome Score (HOS) was developed to evaluate physically active patients with hip disease but without severe degenerative change. A translation and cultural adaptation into Brazilian Portuguese was previously conducted. The aim of this study was to validate the Brazilian version of the HOS (HOS-Brazil) among a group of physically active patients with a diagnosis of femoroacetabular impingement (FAI) or greater trochanteric pain syndrome (GTPS). METHODS: The following questionnaires were applied: the HOS-Brazil; the validated Brazilian versions of the Nonarthritic Hip Score (NAHS) and the 12-Item Short-Form Health Survey (SF-12). The psychometric properties analyzed with regard to the validation process were reliability and validity. Internal consistency and intra-rater test-retest reliabilities were analyzed using Cronbach's alpha and the intraclass correlation coefficient (ICC) statistical tests based on test-retest agreement. Construct and content validities were examined using Pearson's correlation coefficient. Content validity was also analyzed based on evidence of floor, ceiling, or both types of effects from the questionnaires. RESULTS: A total of 70 male and female patients were selected, aged between 19 and 70 years old. The internal consistency and intra-rater test-retest reliability values were high (Cronbach's α > 0.9; ICC > 0.9). The questionnaire showed acceptable convergent (r > 0.7) and divergent (r < 0.4) validities. No floor or ceiling effects were observed. CONCLUSION: The HOS-Brazil was validated. Additional studies are underway to evaluate its responsiveness.

Spatiotemporal expression of extracellular matrix components during the chondrogenic and osteogenic phases of bone healing.

In this study, we investigated the cascade of events involved in the early phases of bone healing in rats, especially the transition from chondrogenesis to osteogenesis, which involves cellular and extracellular matrix (ECM) components. We used a standardized closed tibial fracture model in Wistar rats, which was divided into nine groups of five animals each, and the fracture area was evaluated at 0, 12, 24, 48, 72, 96, 144, 192, and 240 hours post-injury. Histological, histochemical, immunohistochemical and morphometric techniques were used to evaluate the proliferating cell nuclear antigen (PCNA), transforming growth factor-beta (TGF-ß), vascular endothelial growth factor (VEGF), type I procollagen (procoll-I), type I collagen (coll-I), and type II collagen (coll-II) expression at every time point. TGF-ß expression peaked after 144 hours, in the initial chondrogenic phase. VEGF expression reached the first peak at 96-144 hours post-injury, in the initial chondrogenic phase and the second peak at 240 hours, in the osteogenic phase. Except at 48 hours, PCNA expression increased gradually from 12 hours and peaked at 96 hours in the prechondrogenic phase, and then decreased gradually until 240 hours in the osteogenic phase. Total collagen (T-coll) and coll-II reached an expression peak at 144 hours, in the chondrogenic phase. No differences were observed between their expression from 12 hours to 72 hours and at 240 hours post-injury. The results suggest that spatiotemporal expression of ECM components during the chondrogenic and osteogenic phases of bone healing depends on several combined and orchestrated factors. A better understanding of the coordinated participation of cells and ECM components in the early bone healing process may provide new insights into the etiology of abnormal or delayed fracture healing.