A brief and updated introduction to the neuroendocrine system of crustaceans.

The neuroendocrine system of crustaceans is complex and regulates many processes, such as development, growth, reproduction, osmoregulation, behavior, and metabolism. Once stimulated, crustaceans' neuroendocrine tissues modulate the release of monoamines, ecdysteroids, and neuropeptides that can act as hormones or neurotransmitters. Over a few decades, research has unraveled some mechanisms governing these processes, substantially contributing to understanding crustacean physiology. More aspects of crustacean neuroendocrinology are being comprehended with molecular biology, transcriptome, and genomics analyses. Hence, these studies will also significantly enhance the ability to cultivate decapods, such as crabs and shrimps, used as human food sources. In this review, current knowledge on crustacean endocrinology is updated with new findings about crustacean hormones, focusing mainly on the main neuroendocrine organs and their hormones and the effects of these molecules regulating metabolism, growth, reproduction, and color adaptation. New evidence about vertebrate-type hormones found in crustaceans is included and discussed. Finally, this review may assist in understanding how the emerging chemicals of environmental concern can potentially impair and disrupt crustacean's endocrine functions and their physiology.

Vomiting after intrathecal chemotherapy under anesthesia in pediatric patients with hematologic cancers: A cohort study.

INTRODUCTION: Despite preventive strategies, vomiting is an adverse event affecting patients with cancer. However, literature on the incidence and risk factors for vomiting in pediatric patients with cancer are scarce. AIM: To assess the incidence and risk factors for vomiting within 24 h and goodness of fit for the Eberhart score in pediatric patients with hematologic cancers after receiving intrathecal chemotherapy under deep sedation. METHODS: This prospective cohort study included patients under 20 years of age with hematologic cancers who were scheduled to undergo intrathecal chemotherapy under anesthesia. The primary outcome was the occurrence of vomiting within 24 h after the end of anesthesia. Sociodemographic and procedure data and underlying diseases were collected. Patients were monitored during the procedure, in the postanesthesia care unit, and the day after (by phone call). RESULTS: A total of 139 patients were included, and the incidence of vomiting was 30.9% within 24 h after intrathecal chemotherapy under anesthesia, with 90.7% of vomiting prior to 6 h. Prophylactic ondansetron was administered prior to the procedure to 45.3% of patients. Risk factors for vomiting were female gender (hazard ratio: 2.47, 95% confidence interval: 1.35-4.53, p: .003), consolidation phase of treatment (hazard ratio: 2.16, 95% confidence interval: 1.10-4.24, p: .025), and history of kinetosis (hazard ratio: 2.49, 95% confidence interval: 1.31-4.70, p: .005). Incidence of vomit was higher than estimated by the Eberhart score distribution (observed incidence in patients with a score of zero: 33.3%; with a score of one: 28.8%; with a score of two: 60%). CONCLUSION: A high incidence of vomiting was observed within 24 h after intrathecal chemotherapy under propofol deep sedation. Risk factors for this outcome were established (being female, consolidation phase of treatment, and previous kinetosis), and evidence suggested that the Eberhart score was not suitable for the studied population.

Phenolic chalcones as agents against Trichomonas vaginalis.

Trichomonas vaginalis, a flagellated and anaerobic protozoan, is a causative agent of trichomoniasis. This disease is among the world's most common non-viral sexually transmitted infection. A single class drug, nitroimidazoles, is currently available for the trichomoniasis treatment. However, resistant isolates have been identified from unsuccessfully treated patients. Thus, there is a great challenge for a discovery of innovative anti-T. vaginalis agents. As part of our ongoing search for antiprotozoal chalcones, we designed and synthesized a series of 21 phenolic chalcones, which were evaluated against T. vaginalis trophozoites. Structure-activity relationship indicated hydroxyl group plays a role key in antiprotozoal activity. 4'-Hydroxychalcone (4HC) was the most active compound (IC50 = 27.5 µM) and selected for detailed bioassays. In vitro and in vivo evaluations demonstrated 4HC was not toxic against human erythrocytes and Galleria mellonella larvae. Trophozoites of T. vaginalis were treated with 4HC and did not present significant reactive oxygen species (ROS) accumulation. However, compound 4HC was able to increase ROS accumulation in neutrophils coincubated with T. vaginalis. qRT-PCR Experiments indicated that 4HC did not affect the expression of pyruvate:ferredoxin oxidoreductase (PFOR) and ß-tubulin genes. In silico simulations, using purine nucleoside phosphorylase of T. vaginalis (TvPNP), corroborated 4HC as a promising ligand. Compound 4HC was able to establish interactions with residues D21, G20, M180, R28, R87 and T90 through hydrophobic interactions, π-donor hydrogen bond and hydrogen bonds. Altogether, these results open new avenues for phenolic chalcones to combat trichomoniasis, a parasitic neglected infection.

Metabolic changes in the subtropical frog Boana pulchella during experimental cooling and recovery conditions.

Frogs have developed biochemical and physiological adaptations to occupy diverse ecological niches on Earth successfully. Survival in frozen states is a fascinating strategy made possible by evolving adaptations to produce cryoprotectant solutes. The hylid frog Boana pulchella thrives in South American regions with cold climates, remaining active while enduring sporadic subzero temperatures during winter. The species' metabolic changes during subzero exposure remain unclear. Therefore, we exposed B. pulchella to cooling and recovery, assessing plasma and tissue metabolite changes. Cooling significantly reduced urea concentrations in plasma (P = 0.033), muscle (P = 0.001), heart (P = 0.009), and brain (P = 0.041) compared to acclimation. Liver glucose oxidation and glycogen synthesis were lower in cooling and recovery than in acclimation (P < 0.0001 and P = 0.0117, respectively). Muscle glycogen synthesis was lower in recovery than acclimation (P = 0.0249). These results demonstrate B. pulchella's physiological strategies during subzero exposure, likely reflecting species-specific evolutionary adaptations for brief subzero exposures that enable winter survival in its natural habitat.

The impact of chasing stress on the metabolism of the Atlantic Ghost Crab Ocypode quadrata (Fabricius, 1787).

Ocypode quadrata, a Ghost crab species found along the western Atlantic coast, is considered a bioindicator of anthropogenic impact on sandy beaches. Ghost Crabbing, a touristic activity in which ghost crabs are chased just for fun, is a potentially threatening activity for this crab. In crustaceans, metabolites such as glucose and lactate, and the gene expression of crustacean hyperglycemic hormone (CHH) and heat shock proteins (HSPs) increase when the animals are exposed to several types of stress, including alterations in temperature, salinity, or exposure to xenobiotics. This work was developed to identify if being chased by humans would affect these markers of stress in this species of crab. The effects of chasing stress on hemolymph and tissue metabolites and the gene expression levels of CHH and HSP70 were investigated. The levels of lactate in the hemolymph of stressed crabs were six times higher than those of control crabs immediately after chasing and decreased progressively during recovery, indicating an active anaerobic metabolism during the stress. On the contrary, glucose levels in the hemolymph of the stressed crabs increased progressively from 30 to 60 min after chasing, indicating an inverse correlation between glucose and lactate and the conversion of lactate to glucose by gluconeogenesis. In stressed crabs, the levels of triglycerides in the hemolymph decreased 30 min after chasing, while the opposite tended to occur in the hepatopancreas, indicating that during recovery, the crabs use triglycerides as energy source to sustain aerobic metabolism. Finally, this study demonstrates that ghost crabs are stressed by minimum human contact and that "ghost crabbing" must not be encouraged as a tourist activity.

Evaluation of the histamine H3 receptor antagonists from LINS01 series as cholinesterases inhibitors: Enzymatic and modeling studies.

Histamine is involved in several central nervous system processes including cognition. In the last years, H3 receptor (H3 R) antagonists have been widely explored for their potential on dementias and other cognitive dysfunctions, and the cooperative role between histamine and acetylcholine neurotransmissions on cognitive processes is widely known in literature. This motivated us to assess the potential of 1-[(2,3-dihydrobenzofuran-1-yl)methyl]piperazines (LINS01 compounds) as inhibitors of cholinesterases, and thus this work presents the inhibitory effect of such compounds against acetyl (AChE) and butyrylcholinesterase. A set of 16 selected compounds were evaluated, being compounds 2d and 2e the most potent inhibitors of both cholinesterases (IC50 13.2-33.9 µM) by competitive mechanism, as indicated by the kinetic assays. Molecular docking simulations suggested that the allylpiperazine and dihydrobenzofuran motifs present in these compounds are important to perform π-interactions with key tryptophan residues from the enzymes, increasing their affinity for both H3 R and cholinesterases. Metric analysis support that compound 2d (LINS01022) should be highlighted due to its balanced lipophilicity (ClogP 2.35) and efficiency (LE 0.32) as AChE inhibitor. The results add important information to future design of dual H3 R-cholinesterases ligands.

Effects of tributyltin (TBT) on the intermediate metabolism of the crab Callinectes sapidus.

This study investigated if the exposure to tributyltin (TBT), a chemical used worldwide in boat antifouling paints, could result in metabolic disturbances in the blue crab Callinectes sapidus. After the exposure to TBT 100 or 1000 ng.L-1 for 48 and 96 h, hemolymph and tissues were collected to determine the concentration of metabolites and lipid peroxidation. The levels of glucose, lactate, cholesterol, and triglycerides in the hemolymph were not affected by TBT exposure. Hemolymph protein and heart glycogen increased in the crabs exposed to TBT 1000 for 96 h. Anterior gills protein and lipoperoxidation decreased after 96 h in all groups. These results suggest that C. sapidus can maintain energy homeostasis when challenged by the TBT exposure for 48 h and that metabolic alterations initiate after 96 h.

Combination of Water Quality Parameters and Bioassays for the Assessment of Two Rivers, Southern Brazil.

In the present study, water physicochemical and microbiological parameters, as well as bioassays using Allium cepa L. seeds and the fish species Astyanax jacuhiensis were used to assess the water quality of two rivers - Ilha River and Paranhana River -, located in southern Brazil. Water samples were collected at the source and mouth of the rivers and then, laboratory experiments were performed. The results evidenced high levels of aluminum and iron in water samples collected at the four sampling sites. The micronucleus (MN) test in fish showed significant difference in the frequencies of nuclear abnormalities (NA) in the mouth of the Paranhana River in comparison to control group in one sampling period, whereas the A. cepa test evidenced significant spatial differences in cytotoxicity between the source and mouth of both rivers. Therefore, these data evidence the poor water quality of the rivers studied as well as the potential toxicity to the aquatic organisms.

Accuracy of EOS Imaging Technology in Comparison to Computed Tomography in the Assessment of Vertebral Rotational Orientation in Instrumented Spines in Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Retrospective radiographic reliability study. OBJECTIVE: The aim of this study was to assess the validity of EOS 3D imaging technology in the determination of vertebral rotations in the spine of patients with previous instrumentation. SUMMARY OF BACKGROUND DATA: There is a lack of evidence on the accuracy of vertebral rotational measurement using EOS 3D morphological analysis in the instrumented spine. METHODS: A retrospective review of 31 patients with adolescent idiopathic scoliosis (AIS) who underwent instrumented fusion and postoperative computed tomography (CT) scans of the spine was performed. Vertebral rotations of the apex vertebra, the uppermost (UIV) and lowermost (LIV) instrumented vertebra, the noninstrumented vertebra one level cranial to the UIV (UIV + 1) and one level caudal to LIV (LIV + 1) were determined using EOS 3D reconstruction. The vertebral rotation was also measured using reformatted CT axial images. Relative vertebral rotational difference (VRD) were calculated for UIV to apex, UIV + 1 to apex, LIV to apex, LIV + 1 to apex, UIV to LIV and UIV + 1 to LIV + 1. Paired t tests were used to compare the VRD measured using the two different imagining modalities. For values where P > 0.05, the Bland-Altman plot was used to assess the agreement between the measures. Interclass correlation (ICC) was used to determine interobserver and intraobserver reliabilities of EOS and CT measurements. RESULTS: EOS analysis of relative VRD was found to be significantly different from that of CT for UIV to apex (P = 0.006) and UIV + 1 to apex (P = 0.003). No significant differences were found for LIV to apex (P = 0.06), LIV + 1 to apex (P = 0.06), UIV to LIV (P = 0.59) and UIV + 1 to LIV + 1 (P = 0.64). However, Bland-Altman plots showed that agreement was poor, and variance was beyond acceptable. ICC showed good interobserver and good to very good intraobserver reliability for EOS. CONCLUSION: EOS 3D morphological analysis of VRD in the instrumented levels of the spine demonstrated significant difference and unacceptable variance in comparison to CT measurement.Level of Evidence: 4.

Back pain in adolescents with idiopathic scoliosis: the contribution of morphological and psychological factors.

PURPOSE: To define the relationship between 3D radiological features, psychological factors, and back pain prevalence and intensity in patients with adolescent idiopathic scoliosis (AIS). METHODS: Consecutive AIS patients answered self-reported questionnaires and underwent simultaneous posterior-anterior and lateral scans of the spine (EOS Imaging, Paris, France). 3D reconstructions of the spine and pelvis reported 18 parameters in the coronal, sagittal, and axial plane. RESULTS: Hundred and twenty-four patients with AIS were included in the study. Overall, 90% of AIS patients reported having some back pain over the last 6 months and 85.8% over the last 30 days. Pain intensity in the last month was reported to be mild in 37.5%, moderate in 31.8%, moderate to severe in 24.3%, and severe in 6.54% of cases. Location of back pain was associated with location of main curve (P = 0.036). Low back pain was associated with higher lumbar apical AVR and lower lumbar lordosis (P < 0.05). Independent risk factors for back pain in AIS were pain catastrophizing (B = 0.061, P = 0.035), poorer self-reported state of mental health (B = - 0.872, P = 0.023), decreased thoracic kyphosis (B = - 0.033, P = 0.044) and greater pelvic asymmetry (B = 0.146, P = 0.047). There was a significant association between self-reported pain intensity in the last 24 h and levels of catastrophizing. Pain catastrophizing level influenced the relationship between deformity severity and pain intensity. In low catastrophizers, there was a significant association between greater deformity severity and higher pain levels. CONCLUSIONS: Back pain in AIS is multifactorial and associated with psychological and morphological parameters. Pain catastrophizing is an important construct in AIS-related pain and should be taken into consideration when evaluating these patients.

Histopathological, genotoxic, and behavioral damages induced by manganese (II) in adult zebrafish.

Manganese is a metal often found as an environmental pollutant and very associated with neurological disorders when in high concentrations. However, little is known about the effects that this contaminant can cause when in environmentally relevant concentrations and occurrence, that is, much lower than those commonly studied. So, the aim of the study was to evaluate the effects that environmentally relevant concentrations of this metal would cause in different zebrafish organs (brain, liver, and blood). Acute 96-h and chronic 30-day exposures were performed using the manganese chloride salt as a pollutant. Behavioral alterations of anxiogenic type were observed in the animals after chronic exposures to 4.0 mg L-1 MnCl2, which traveled a greater distance at the bottom of the aquarium. This may be associated with neuronal damages in the telencephalic region responsible for motor and cognitive activity of the fish, observed in animals from the same exposure. In addition, hepatic histopathological damage as vacuolization of hepatocytes and genotoxic damage, identified by comet assay and micronucleus test, was also observed after acute and chronic exposure, especially at the highest pollutant concentrations (8.0 and 16.0 mg L-1 in acute exposure, and 4.0 mg L-1 in chronic exposure. The study reinforces the risk that environmental pollutants pose to the ecosystem, even in low concentrations.

Impact of Anthropogenic Activities on Water Quality of The Paranhana River, Southern Brazil

Abstract: The Paranhana River, located in Southern Brazil, is one of the major tributaries of the Sinos River basin and receives mainly industrial and domestic effluents. In the present study, water physicochemical and microbiological analyses, condition factor, micronucleus test, gill histopathology and metal bioaccumulation in the muscle of the native fish Bryconamericus iheringii collected at two sites (S1 and S2) of the Paranhana River under different degrees of anthropogenic pressures were assessed in four sampling campaigns. Data from water quality parameters, condition factor, mucous cells proliferation in fish gills and bioaccumulation of chromium and manganese in muscle evidenced higher impacts at S2, whereas a higher genotoxic potential was observed at S1. Gill histopathological alterations were found in fish captured at both sampling sites. Temporal variations in all biomarkers analyzed and bioaccumulation of manganese and nickel were observed at S1, whereas only variations in condition factor, gill alterations and bioaccumulation of manganese and aluminum were found at S2. Our study evidences that S1 is under minor anthropogenic impacts and that the high urbanization at S2 reflects in a poor water quality. Nonetheless, the human consumption of fish from the Paranhana River should be avoided given the high concentrations of cadmium, chromium and lead.

In situ monitoring of the Sinos River, southern Brazil: water quality parameters, biomarkers, and metal bioaccumulation in fish.

The Sinos River is an important water supply in Southern Brazil and receives industrial, agricultural, and domestic effluents which may affect aquatic biota. Water physicochemical and microbiological analyses, biomarker responses (scaled mass index (SMI), gill histopathology, and micronucleus and nuclear abnormality (MN and NA) frequencies), and metal bioaccumulation in muscle were assessed in the fish species Bryconamericus iheringii (Characidae) captured at three sampling sites (S1, S2, and S3) in four sampling periods. The mean values of five parameters (total phosphorus, thermotolerant coliforms, aluminum, iron, and lead) exceeded the limits established by the Brazilian legislation at the three sampling sites. Although physicochemical analysis indicated higher impacts at S3, in some samples, significantly higher MN frequencies and bioaccumulation of manganese in fish muscle were observed at S1, whereas low SMI and higher concentrations of aluminum and zinc in fish muscle were found at S2. Histopathological alterations in gills were observed in fish collected at the three sampling sites; however, no spatial differences were observed, indicating similar environmental conditions with respect to this biomarker. Moreover, temporal variation of biomarker responses and metal bioaccumulation were found at all sampling sites. Furthermore, the consumption of fish from the Sinos River should be avoided given the concentrations of chromium (all samples), cadmium, and lead in fish muscle above the threshold for safe human consumption.

Water quality parameters, biomarkers and metal bioaccumulation in native fish captured in the Ilha River, southern Brazil.

The Ilha River is one of the main tributaries of the Sinos River, southern Brazil, and it is located in an area characterized by low population density and presence of agricultural activities. Thus, this study aimed to assess the water quality of two sites of the Ilha River (source and mouth, S1 and S2 respectively) in five sampling periods using water physicochemical and microbiological analyses, biomarkers, such as condition factor, micronucleus test, gill histopathological analysis, and metal bioaccumulation in the native fish Bryconamericus iheringii. Mean values of BOD5, thermotolerant coliforms, aluminum, iron and lead exceeded the limits established by the Brazilian legislation for surface waters at both sampling sites. Significant higher micronucleus, nuclear abnormalities and mucous cells frequencies were found at S2 in, at least, one sampling period, whereas fish from S1 presented significant lower condition factor, higher frequencies of lamellar alterations and higher concentrations of chromium and nickel in muscle. Additionally, concentrations of cadmium, chromium and lead in fish muscle exceeded the limits considered safe for human consumption at both sites in at least one sampling period. Data from our study evidenced the mouth of the Ilha River suffers from point genotoxic effects, whereas the source is also contaminated by metals, despite being located in an area under minor anthropic activities.

Spontaneous spinal epidural hematoma management: a case series and literature review.

OBJECTIVE: Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord and leading to acute neurological deficits. Standard therapy is decompressive laminectomy, although spontaneous recoveries have been reported. Sub-optimal therapeutic principles contribute to SSEH's 5.7% mortality-which patient will benefit from surgery remains unclear. This study aims to investigate parameters that affect SSEH's progression, outlining a best-practice therapeutic approach. MATERIALS AND METHODS: Literature review yielded 65 cases from 12 studies. Furthermore, 6 cases were presented from our institution. All data were analyzed under American Spinal Injury Association (ASIA) score guidelines. RESULTS: Fifty percent of SSEH patients do not fully recover. In all, 30% of patients who presented with an ASIA score of A did not improve with surgery, although every SSEH patient who presented at C or D improved. Spontaneous recovery is rare-only 23% of patients were treated conservatively. Seventy-three percent of those made a full recovery, as opposed to the 48% improvement in patients managed surgically. Thirty-three percent of patients managed conservatively had an initial score of A or B, all improving to a score of D or E without surgery. Regardless, conservative management tends toward low-risk presentations. Patients managed conservatively were three times as likely to have an initial score of D than their surgically managed counterparts. DISCUSSION: The degree of pre-operative neural deficit is a major prognostic factor. Conservative management has proven effective, although feasible only if spontaneous recovery is manifested. Decompressive laminectomy should continue to remain readily available, given the inverse correlation between operative interval and recovery.

SEGURANÇA E REPRODUTIBILIDADE DO TESTE TIMED UP AND GO EM IDOSOS HOSPITALIZADOS / SAFETY AND REPRODUCIBILITY OF THE TIMED UP AND GO TEST IN HOSPITALIZED ELDERLY / SEGURIDAD Y REPRODUCIBILIDAD DE LA PRUEBA TIMED UP AND GO EN ANCIANOS HOSPITALIZADOS

RESUMO Introdução: Testes físicos seguros e confiáveis são importantes para rastrear risco de queda em idosos, entretanto, não existem estudos que tenham avaliado a segurança e a confiabilidade do teste Timed Up and Go (TUG) em idosos hospitalizados. Objetivos: Avaliar a segurança e reprodutibilidade do TUG em idosos hospitalizados. Métodos: Trata-se de um estudo transversal no qual foram coletadas três aferições do TUG para cada idoso, sendo considerado o melhor desempenho em segundos (s). Outras variáveis coletadas foram função cognitiva (MEEM), índice de comorbidades de Charlson, perfil admissional (clínico ou cirúrgico), relato de quedas no último ano e IMC. Para avaliar a confiabilidade relativa utilizou-se o coeficiente de correlação intraclasse (CCI) e para a confiabilidade absoluta, a análise de Bland-Altman. Resultados: Foram incluídos 68 idosos com média de idade de 70,4 ± 7,7 anos, índice de Charlson 5,4 ± 2,0 e predomínio do perfil clínico (64,7%). Nenhum dos 204 testes foi interrompido pelos critérios estabelecidos. Houve redução gradativa entre a primeira e a terceira aferição (1a = 11,6 ± 6,54; 2a = 10,7 ± 6,22 e 3a = 10,3 ± 5,54; p = 0,001) e elevado CCI (1a e 2a: CCI = 0,98; 1a e 3a: CCI = 0,98; 2a e 3a: CCI = 0,98; p = 0,001), sendo que a maior correlação com o melhor desempenho foi associada a 3a aferição (CCI = 0,99; p = 0,001). Identificou-se que os menores viés (0,29 s) e limites de concordância (-1,1 a 1,68 s) ocorreram também entre a terceira aferição e a de melhor desempenho. A medida de erro do método para avaliação da variabilidade foi 0,5 s e a alteração clinicamente significante 3,4 s. Conclusão: O TUG foi um instrumento seguro e com boa reprodutibilidade para mensuração do desempenho físico em idosos hospitalizados.

ABSTRACT Introduction: Safe and reliable physical tests are important to identify risk of falling in the elderly. However, there are no studies that have evaluated the safety and reliability of the test Timed Up and Go (TUG) in hospitalized elderly. Objectives: To evaluate the safety and reproducibility of the TUG in hospitalized elderly. Methods: This is a cross-sectional study where three measurements of the TUG were collected for each elderly, being considered the best performance in seconds (sec). Other variables collected were cognitive function (MMSE), Charlson comorbidity index, admission profile (clinical or surgical), history of falls in the last year and BMI. To assess the relative reliability we used the intraclass correlation coefficient (ICC), and for the absolute reliability we used the Bland-Altman analysis. Results: The study included 68 elderly with a mean age 70.4 ± 7.7 years, Charlson index 5.4 ± 2.0 and prevalence of clinical profile (64.7%). None of the 204 tests was interrupted by the established criteria. There was a gradual reduction between the first and third measurement (1st = 11.6 ± 6.54; 2nd = 10.7 ± 6.22 and 3rd = 10.3 ± 5.54; p = 0.001) and high ICC (1st and 2nd: ICC = 0.98; 1st and 3rd: ICC = 0.98; 2nd and 3rd: ICC = 0.98; p = 0.001), and the highest correlation with the best performance was associated with third measurement (ICC = 0.99; p = 0.001). We identified that the smallest bias (0.29 sec) and limits of concordance (-1.1 to 1.68 sec) also occurred between the third measurement and the best performance. The measure of the method error to evaluate the variability was 0.5 sec, and the clinically significant change was 3.4 sec. Conclusion: The TUG was a safe instrument with good reproducibility for measuring physical performance in hospitalized elderly.

RESUMEN Introducción: Pruebas físicas seguras y fiables son importantes para el rastreo del riesgo de caídas en los ancianos; sin embargo, no existen estudios que evaluaron la seguridad y la fiabilidad de la prueba Timed Up and Go (TUG) en ancianos hospitalizados. Objetivos: Evaluar la seguridad y fiabilidad del TUG en ancianos hospitalizados. Métodos: Se trata de un estudio transversal en el que se recogieron tres mediciones del TUG para cada anciano y se considera el mejor rendimiento en segundos (s). Otras variables recogidas fueron la función cognitiva (MMSE), el índice de comorbilidad de Charlson, perfil de ingreso hospitalario (clínico o quirúrgico), antecedentes de caídas en el último año y el IMC. Para evaluar la fiabilidad relativa se utilizó el coeficiente de correlación intraclase (CCI) y para la fiabilidad absoluta, el análisis de Bland-Altman. Resultados: Se incluyeron 68 ancianos con una edad media de 70,4 ± 7,7 años, índice de Charlson 5,4 ± 2,0 y prevalencia del perfil clínico (64,7%). Ninguna de las 204 pruebas fue interrumpida por los criterios establecidos. Hubo una reducción gradual entre la primera y tercera medición (1a = 11,6 ± 6,54, 2a = 10,7 ± 6,22 y 3a = 10,3 ± 5,54, p = 0,001) y CCI alto (1a y 2a: CCI = 0,98; 1a y 3a: CCI = 0,98; 2a y 3a: CCI = 0,98; p = 0,001), y la más alta correlación con el mejor rendimiento se asoció con la tercera medición (ICC = 0,99; p = 0,001). Se identificó que el sesgo más pequeño (0,29 s) y límites de concordancia (-1,1 a 1,68 s) también se produjo entre la tercera medición y el mejor rendimiento. La medición del error del método para la evaluación de la variabilidad fue de 0,5 s y el cambio clínicamente significativo fue 3,4 s. Conclusión: El TUG fue un instrumento seguro y reproducible para medir el rendimiento físico en ancianos hospitalizados.

[Relationship between functional capacity assessed by walking test and respiratory and lower limb muscle function in community-dwelling elders]. / Relação da função muscular respiratória e de membros inferiores de idosos comunitários com a capacidade funcional avaliada por teste de caminhada.

BACKGROUND: Sarcopenia is the most significant factor in the decline of peripheral and respiratory muscle strength. It can lead to progressive disability, loss of independence and impaired functional capacity. OBJECTIVES: To determine the strength of respiratory muscles (maximal inspiratory pressure - MIP and maximal expiratory pressure - MEP) and lower limb muscles, and to explore the possible relationships between these variables and the functional capacity of the elderly. METHODS: Sixty-five elderly patients (71.7+/-4.9 years old) took part in the study. Isokinetic dynamometry was used to assess the knee flexors and extensors, an analog vacuum manometer was used to assess the respiratory muscles, and the six-minute walking test was used as an outcome of functional capacity. The Mann-Whitney test and Student's t-test were used for gender comparison. The relationships were investigated using Pearson's correlation. The significance level was p<0.05. RESULTS: The lower limb and respiratory muscle strength variables and the walking distance variables were higher in men than women (p<0.05). Moderate and significant correlations were found between these variables (p<0.001). The higher values were between right knee extensor average peak torque (APT) and MIP (r=0.587), left knee flexor APT and MEP (r=0.638), as well as between walking distance and left knee extensor average power (AP; r=0.614), right knee flexor AP (r=0.539), MIP (r=0.508) and MEP (r=0.541) respectively. CONCLUSIONS: The relationship between walking distance and respiratory and lower limb muscle strength found in this study suggests that optimizing these functions may contribute to maintaining and improving functional capacity in the elderly.

Relação da função muscular respiratória e de membros inferiores de idosos comunitários com a capacidade funcional avaliada por teste de caminhada / Relationship between functional capacity assessed by walking test and respiratory and lower limb muscle function in community-dwelling elders

CONTEXTUALIZAÇÃO: A sarcopenia é considerada o fator mais significativo na redução da força muscular periférica e respiratória e pode ocasionar incapacidades progressivas, perda de independência e interferir na capacidade funcional dos idosos. OBJETIVOS: Caracterizar a força dos músculos respiratórios (pressão inspiratória máxima - PImax e pressão expiratória máxima - PEmax) e de membros inferiores (MMII), bem como as possíveis correlações existentes com a capacidade funcional dos idosos. MÉTODOS: Sessenta e cinco idosos, com 71,7±4,9 anos; foram avaliados por dinamometria isocinética para flexores e extensores dos joelhos, manovacuometria analógica para os músculos respiratórios pelo teste de caminhada de 6 minutos para capacidade funcional. Foram utilizados os testes Mann-Whitney e t de Student para comparação entre os gêneros. As correlações foram calculadas pelo coeficiente de correlação de Pearson. Para todos os testes foi considerado p<0,05. RESULTADOS: As variáveis isocinéticas, de força respiratória e distância caminhada apresentaram valores médios maiores para os homens em relação às mulheres (p<0,05). Foram encontradas correlações moderadas e significativas entre essas variáveis (p<0,001), sendo as de maior valor entre a média do pico de torque (MPT) extensor direito e PImax (r=0,587), MPT flexor esquerdo e PEmax (r=0,638), assim como da distância caminhada com a potência média extensora esquerda (r=0,614) e flexora direita (r=0,539) e com PImax (r=0,508) e PEmax (r=0,541). CONCLUSÕES: A associação entre força muscular respiratória e de MMII com a distância caminhada encontrada neste estudo sugere que a otimização dessas funções pode contribuir para manter e/ou melhorar a capacidade funcional da população idosa.

BACKGROUND: Sarcopenia is the most significant factor in the decline of peripheral and respiratory muscle strength. It can lead to progressive disability, loss of independence and impaired functional capacity. OBJECTIVES: To determine the strength of respiratory muscles (maximal inspiratory pressure - MIP and maximal expiratory pressure - MEP) and lower limb muscles, and to explore the possible relationships between these variables and the functional capacity of the elderly. METHODS: Sixty-five elderly patients (71.7±4.9 years old) took part in the study. Isokinetic dynamometry was used to assess the knee flexors and extensors, an analog vacuum manometer was used to assess the respiratory muscles, and the six-minute walking test was used as an outcome of functional capacity. The Mann-Whitney test and Student's t-test were used for gender comparison. The relationships were investigated using Pearson's correlation. The significance level was p<0.05. RESULTS: The lower limb and respiratory muscle strength variables and the walking distance variables were higher in men than women (p<0.05). Moderate and significant correlations were found between these variables (p<0.001). The higher values were between right knee extensor average peak torque (APT) and MIP (r=0.587), left knee flexor APT and MEP (r=0.638), as well as between walking distance and left knee extensor average power (AP; r=0.614), right knee flexor AP (r=0.539), MIP (r=0.508) and MEP (r=0.541) respectively. CONCLUSIONS: The relationship between walking distance and respiratory and lower limb muscle strength found in this study suggests that optimizing these functions may contribute to maintaining and improving functional capacity in the elderly.

Abordagem e condutas na fisioterapia pré e pós-cirúrgica da hérnia diafragmática congênita / Pre and postoperative physical therapy of congenital diaphragmatic hernia

A Hérnia Diafragmática Congênita (HDC) é resultante de um defeito na formação do músculo diafragma com pequena incidência, mas alto índice de mortalidade. Objetivo: Descrever as principais complicações, o prognóstico, o tratamento e os tipos de ventilação mecânica utilizadas nas crianças com Hérnia Diafragmática Congênita (HDC), a fim de direcionar a conduta da fisioterapia respiratória. Metodologia: Revisão crítica da literatura sobre HDC entre os anos de 1999 e 2008. Conclusão: Diversos estudos foram realizados no intuito de encontrar os procedimentos ideais para crianças com HDC, melhorar o seu prognóstico e a taxa de sobrevivência, mas ainda não foi possível definir qual(is) o(s) melhor(es) tratamento(s) e o momento correto para ser utilizado nestas crianças.

The Congenital Diaphragmatic Hernia (CDH) refers to a developmental defect of the formation of the diaphragm muscle, with small incidence, but high mortality rate. Objective: To describe the main complications, the prognostic, the treatment and the types of mechanical ventilation used in children with CDH, in order to direct the respiratory physical therapy. Methodology: Critical literature review between 1999 and 2008. Conclusion: Several studies have been produced with the purpose of finding the ideal procedures for children with CDH, to improve the prognostic and the survival rate, but it has not been possible to define which is the best treatment and the correct moment to be used in these children yet.

Disfunção dos músculos respiratórios de pacientes críticos sob ventilação mecânica por insuficiência respiratória aguda: revisão de literatura / Respiratory muscle dysfunction of critical patients receiving mechanical ventilation due to acute respiratory failure: a literature review

A disfunção dos músculos respiratórios é uma das consequências da ventilação mecânica em paciente crítico. Em alguns casos a fraqueza muscular é decorrente de sua doença de base. Nota-se a redução da força diafragmática após 12 h de ventilação mecânica...

Impairment of breathing muscles is one of many consequences of mechanical ventilation in critical patients. In some cases, muscle weakness is due to patients' disease itself. According to experimental studies conducted with animals, diaphragm force decreases after 12 hour of controlled mechanical ventilation...