Estudo de caso

História Clínica: Um paciente com história de diversas lesões nos membros inferiores foi intervencionado em ambos os pés, onde realizou uma tenossinovectomia dos peroneais com reparação de ruptura desses tendões (ao pé direito em 2006 sendo actualmente ao esquerdo). Avaliação Objectiva: Apresentava dor, edema, limitação articular de todos os movimentos da tibio-társica, fraqueza muscular, pés cavos e alterações do padrão de marcha e do equilíbrio. Objectivo: foi verificar se a mobilização com movimento (MWM) do astrágalo e da articulação tibio-peroneal inferior levava a uma diminuição da dor e aumentava a amplitude de dorsiflexão e inversão neste doente com pé cavo. Intervenção: foi realizada MWM do astrágalo e do perónio na articulação tibioperoneal inferior em descarga e em semi-carga, sendo mantida essa nova posição com uma ligadura de tape. Resultados: o paciente aumentou as amplitudes articulares em descarga e em carga, diminuiu o edema da perna e pé, aumentou a funcionalidade, mas em termos de força muscular não foram quantificadas alterações. Conclusão: mesmo o paciente tendo pé cavo e sequelas de uma tenossinovectomia dos peroneais, as manobras de mobilização com movimento do astrágalo e da articulação tíbio-peroneal inferior levaram a uma eliminação da dor e a um aumento da amplitude articular.Clinical History: A patient with a history of several injuries in the lower limbs was chirurgical intervened on both feet, where he made a peroneal tenosynovectomy with a rupture repair of these tendons (right foot in 2006 and in the present on left). Objective assessment: He had pain, swelling, ankle limitation of all movements, muscle weakness, pes cavus and walk and balance problems. Objective: To ascertain whether the ankle dorsiflexion and inversion mobilization with movement (MWM) result in pain decrease and increased range of motion of dorsiflexion and inversion in this patient with pes cavus. Intervention: MWM was performed in the talus and in the distal joint of the fibula in weight-hearing and in no weight-hearing, being held this new position with tape. Results: The patient increased range of motion in a weight-hearing and in a no weight-hearing position, decreased the swelling of the leg and foot, increased functionality, but in terms of muscle strength the changes were not quantified. Conclusion: Even the patients with pes cavus and with damage of a chirurgical intervention, the mobilization with movement technique of the talus and of the distal fibula joint results in a pain remove and in a increased range of motion

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

Recuperação da modulação autonômica cardíaca após sessão de exercícios com a haste oscilatória

This study aimed to analyze the effects of exercise with flexible pole in the recovery of cardiac autonomic modulation in healthy women. In this context, the first part of this report is to analyze the effects of an exercise protocol with flexible pole in the recovery of cardiac autonomic modulation by means of heart rate variability in healthy women, since it lacks in the literature evidence from studies with similar characteristics. To complement the dissertation, the second part of the study aimed to describe the response of cardiac autonomic recovery in isometric exercise, which is well known for generating great physiological stress on the cardiovascular system, however, the heart rate response in this exercise has been used to study the modulation of the autonomic nervous system on the heart. The observational study was conducted in 32 healthy women who performed an exercise protocol with the flexible pole and analyzed the pre-exercise heart rate variability: 10 minutes before exercise, 0-5 minutes, 5-10 minutes, 10- 15 minutes after exercise...Esta dissertação teve por objetivo analisar os efeitos do exercício com haste oscilatória na recuperação da modulação autonômica cardíaca em mulheres saudáveis. Dentro deste contexto, a primeira parte deste trabalho visa analisar a recuperação da modulação parassimpática após um estímulo mecânico causado por um protocolo de exercícios com haste oscilatória em mulheres saudáveis, uma vez que não foram encontradas na literatura evidências de estudos com características semelhantes. Um estudo observacional foi conduzido em 32 mulheres saudáveis que foram submetidas a um protocolo de exercício com a haste oscilatória e foi analisado a VFC pré-exercicio: 10 minutos, e pós-exercício: 0-5 minutos, 5-10 minutos, 10-15 minutos. Foram analisados os índices de VFC: SDNN (desvio padrão de todos os intervalos RR normais gravados em um intervalo de tempo), RMSSD (raiz quadrada da média do quadrado das diferenças entre intervalos RR normais adjacentes, em um intervalo de tempo), pNN50 (porcentagem dos intervalos RR adjacentes com diferença de duração maior que 50ms), LF (componente espectral de baixa frequência), HF (componente espectral de alta frequência) e a relação LF/HF..