Pediatric Rehabilitation: A Challenge

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Neonatal Brachial Plexus Palsy: Risk Factors and Its Prognostic Value

Introduction: Neonatal brachial plexus palsy affects 0.7 to 5.8 per 1,000 newborns and is characterised by upper limb paresis detected in the immediate neonatal period. Shoulder dystocia, instrumental delivery and foetal macrosomia are well-known risk factors. Most neonatal brachial plexus palsy evolve favourably, while 3%-27% of newborns have sequelae. Methods: A retrospective cross-sectional study was conducted to characterise neonatal brachial plexus palsy in the newborn population of a hospital with differentiated perinatal support and to assess the rela - tionship between the risk factors and lesion prognosis. The authors reviewed the newborn medical records referred to the physical medicine and rehabilitation clinic between January 2006 and December 2016. Results: During the study period, 137 cases of neo- natal brachial plexus palsy were identified in 36,833 births, which translate into an incidence of 3.7/1,000 live births. Foetal macrosomia was found in 41% and shoulder dystocia in 40%. According to the Narakas clas- sification, 58% were included in group I, 30% in group II, 9% in group III and 3% in group IV. The majority of patients were discharged without sequelae. Newborns with group II, III and IV lesions as well as macrosomic newborns were more likely to develop sequelae (p < 0.05). Shoulder dystocia and operative delivery did not present a statistically significant relationship with the prognosis of the lesion. Discussion: The incidence of neonatal brachial plexus palsy in this population was similar to is described in other series. The relationship between macrosomia and neonatal brachial plexus palsy with sequelae found may be of importance in the attempt to prevent this lesioninfo:eu-repo/semantics/publishedVersio

Identification and characterisation of xylanolytic yeasts isolated from decaying wood and sugarcane bagasse in Brazil

In this study, yeasts associated with lignocellulosic materials in Brazil, including decaying wood and sugarcane bagasse, were isolated, and their ability to produce xylanolytic enzymes was investigated. A total of 358 yeast isolates were obtained, with 198 strains isolated from decaying wood and 160 strains isolated from decaying sugarcane bagasse samples. Seventy-five isolates possessed xylanase activity in solid medium and were identified as belonging to nine species: Candida intermedia, C. tropicalis, Meyerozyma guilliermondii, Scheffersomyces shehatae, Sugiyamaella smithiae, Cryptococcus diffluens, Cr. heveanensis, Cr. laurentii and Trichosporon mycotoxinivorans. Twenty-one isolates were further screened for total xylanase activity in liquid medium with xylan, and five xylanolytic yeasts were selected for further characterization, which included quantitative analysis of growth in xylan and xylose and xylanase and ß-d-xylosidase activities. The yeasts showing the highest growth rate and cell density in xylan, Cr. laurentii UFMG-HB-48, Su. smithiae UFMG-HM-80.1 and Sc. shehatae UFMG-HM-9.1a, were, simultaneously, those exhibiting higher xylanase activity. Xylan induced the highest level of (extracellular) xylanase activity in Cr. laurentii UFMG-HB-48 and the highest level of (intracellular, extracellular and membrane-associated) ß-d-xylosidase activity in Su. smithiae UFMG-HM-80.1. Also, significant ß-d-xylosidase levels were detected in xylan-induced cultures of Cr. laurentii UFMG-HB-48 and Sc. shehatae UFMG-HM-9.1a, mainly in extracellular and intracellular spaces, respectively. Under xylose induction, Cr. laurentii UFMG-HB-48 showed the highest intracellular ß-d-xylosidase activity among all the yeast tested. C. tropicalis UFMG-HB 93a showed its higher (intracellular) ß-d-xylosidase activity under xylose induction and higher at 30 °C than at 50 °C. This study revealed different xylanolytic abilities and strategies in yeasts to metabolise xylan and/or its hydrolysis products (xylo-oligosaccharides and xylose). Xylanolytic yeasts are able to secrete xylanolytic enzymes mainly when induced by xylan and present different strategies (intra- and/or extracellular hydrolysis) for the metabolism of xylo-oligosaccharides. Some of the unique xylanolytic traits identified here should be further explored for their applicability in specific biotechnological processes

Features of structural-phase state of Pd-Ag nanoparticles supported on silica gel

International audienc

Hoxd13/Bmp2-mediated mechanism involved in zebrafish finfold design

The overexpression of hoxd13a during zebrafish fin development causes distal endochondral expansion and simultaneous reduction of the finfold, mimicking the major events thought to have happened during the fin-to-limb transition in Vertebrates. We investigated the effect of hoxd13a overexpression on putative downstream targets and found it to cause downregulation of proximal fin identity markers (meis1 and emx2) and upregulation of genes involved in skeletogenesis/patterning (fbn1, dacha) and AER/Finfold maintenance (bmps). We then show that bmp2b overexpression leads to finfold reduction, recapitulating the phenotype observed in hoxd13a-overexpressing fins. In addition, we show that during the development of the long finfold in leot1/lofdt1 mutants, hoxd13a and bmp2b are downregulated. Our results suggest that modulation of the transcription factor Hoxd13 during evolution may have been involved in finfold reduction through regulation of the Bmp signalling that then activated apoptotic mechanisms impairing finfold elongation.This work was financed by FEDER—Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020—Operacional Programme for Competitiveness and Internationalisation (POCI), Portugal 2020, and by Portuguese funds through FCT—Fundação para a Ciência e a Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior in the framework of the project POCI-01-0145-FEDER-030562 (PTDC/BTM-TEC/30562/2017). We are grateful to Andreia Pimpão, Madalena Marques, Carla Lopes and Raquel Ramos for their assistance in some of the experiments

Síndrome da dor regional complexa – relato de dois casos clínicos

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Post-Surgical Rehabilitation of Dupuytren's Disease: A Retrospective Study

Introdução: A doença de Dupuytren é uma patologia proliferativa benigna do tecido conjuntivo que envolve a fáscia palmar. A primeira manifestação clínica reportada pelo doente é o espessamento da pele junto à articulação MCF. O 5º dedo é o mais afetado, e a doença de Dupuytren atinge mais frequentemente homens com mais de 40 anos. A diabetes mellitus, a dependência do álcool e do tabaco e o VIH estão associados a um maior risco de desenvolvimento da doença. O tratamento gold standard nos estadios mais avançados é a indicação cirúrgica. A reabilitação pós-operatória deve começar entre 3 a 5 dias após a cirurgia com a colocação de uma ortótese palmar e o início de um programa de reabilitação funcional da mão. O objectivo do estudo foi caracterizar uma população com doença de Dupuytren submetida a intervenção cirúrgica e avaliar os ganhos dos doentes sujeitos a um programa de reabilitação pós-cirúrgico. Método: Estudo retrospetivo e longitudinal com consulta dos arquivos clínicos dos doentes com doença de Dupuytren tratados cirurgicamente, avaliados e seguidos no Serviço de Medicina Física e de Reabilitação de acordo com o programa de terapia ocupacional. Resultados: De um total de 50 doentes com doença de Dupuytren tratados cirurgicamente entre janeiro de 2014 e agosto de 2015, 92% são homens. A média de idades é de 64,22 anos de idade. Os fatores de risco associados foram predominantemente diabetes mellitus (22%), tabagismo (8%) e hábitos etanólicos moderados a acentuados (6%). Dos doentes, 54% foram operados à mão direita, e a maioria dos doentes foi operada ao 5º raio da mão (38%). Dos doentes, 42 (84%) frequentaram o programa de reabilitação duas vezes por semana. Treze doentes abandonaram o tratamento não tendo efetuado consulta de reavaliação. A média dos tratamentos foi de 70,14 dias (DP 42,5). Em comparação com o início e o fim do programa de reabilitação houve uma diferença significativa tanto na extensão como na flexão da MCF (p = 0,00, p = 0,03) e da IFP (p = 0,00, p = 0,01). Não se encontraram outras relações estatisticamente significativas. Conclusão: A cirurgia seguida de um programa de reabilitação estruturado na doença de Dupuytren permitiu nesta população uma melhoria das amplitudes articulares.info:eu-repo/semantics/publishedVersio

Factores preditivos da aderência dos pais a um programa de seguimento de crianças nascidas de muito baixo peso

Introduction: Newborn infants of very low birth weight (VLBW) are at high risk of neurodevelopment disorder, justifying the implementation of early intervention programs for these children. Objectives: Evaluate the effects of long-term "Care Programme for Development” (CPD) applied to VLBW infants, analyze parents' compliance to follow-up and identify perinatal variables with influence on neurodevelopment. Methods: Cross sectional and retrospective study on the implementation and adherence to CPD in a level III hospital between 2001 and 2005. Morbidity defined as neurological or sensorial sequels. Out of 323 VLBW newborns, 265 were enrolled for the study (49 died; 9 transferred). Results: CPD was made on 89%. Comparing groups with follow-up (156/59%) and without follow-up (109/41%), there were significant differences in maternal age (28.7 / 26.1, p=0.001) and pregnancy surveillance (89% / 78%, p=0.008). There was significant association of adherence with maternal age (odds ratio 1.059, 95% CI 1.009-1.112, p=0.019); pregnancy surveillance (odds ratio 0.336, 95% CI 0.141-0.802, p=0.014) and early consultation (Odds ratio 6.390, 95% CI 2.685 -15.208, p<0.001). Group with follow-up evaluated at an average age of 3.6 years. Seventy-nine per cent had normal neurodevelopment, 10% development delay or cognitive impairment, 6.4% cerebral palsy and 4% had attention deficit hyperactivity. Visual deficit in 7.8% and hearing impairment in 10% of 156 evaluated children. Regression analysis showed a positive association between the existence of sequels and male gender (odds ratio 0.384, 95% CI 0.169 to 0.869, p=0.022) and peri-intraventricular hemorrhage (odds ratio 2.965, 95% CI 1.104 to 7.963, p=0.031). After discharge, 31% required specific intervention. Discussion and conclusion: Adherence to CPD was higher in older mothers, surveillance of pregnancy, intervention started in NICU and early consultation after discharge. Low birth weight, male gender, IPVH, ventilation time and BPD seem to be variables associated with poor prognosis of neurodevelopment

Isolamento de bactérias associadas a plantas do bioma caatinga no semiárido nordestino.

A Caatinga é um bioma exclusivamente brasileiro e corresponde a 70% do território nordestino. Esse bioma caracteriza-se pela distribuição irregular das chuvas e pelas características sazonais de sua vegetação, que apresenta forte endemismo. Atrelada a essa rica vegetação e adaptada às condições peculiares desta região, está a microbiota, em especial as rizobactérias. Este trabalho teve por objetivo isolar bactérias e avaliar a densidade destes micro-organismos associados à raiz e rizosfera de plantas de cinco famílias botânicas da Caatinga. As amostras foram separadas em solo da rizosfera e raiz, sendo as amostras de tecido radicular submetidas a um processo de desinfecção superficial. As bactérias associadas à raiz e da rizosfera foram isoladas em meio TSA acrescido de 5% de NaCl. A densidade populacional bacteriana associada à raiz variou de 9,3 X 103 (Cobretum sp.) a 1,9 X 108 (Terminalia sp.) UCF/g TVF e da rizosfera a variação foi de 3,3 X 108 (Schinus sp.) e 8,3 X 104 (Cobretum sp.) UCF/g TVF. A variabilidade morfológica encontrada neste trabalho sugere uma ampla diversidade de genótipos bacterianos associados à rizosfera e raízes de plantas destes gêneros encontrados na Caatinga