Avaliação da função motora grossa pela GMFM pré e pós cirurgia ortopédica de membros inferiores em pacientes com paralisia cerebral

Em pacientes com paralisia cerebral (PC) deambuladores, a cirurgia ortopédica é bastante utilizada para melhora do padrão de marcha. Conforme aumenta o acometimento motor, os objetivos podem mudar, contudo, uma melhora na mobilidade é importante e pode ser conseguida através de procedimentos cirúrgicos. A Gross Motor Function Measure (GMFM) é uma escala quantitativa da função motora grossa, utilizada para diversos fins, como controle da evolução terapêutica, progressos na reabilitação e, em nosso serviço, avaliação de cirurgias ortopédicas. Objetivo: A avaliação padronizada e sistematizada dessas cirurgias, comparando a GMFM pré e pós procedimento. Método: Incluímos no estudo aqueles pacientes que apresentam uma maior limitação da mobilidade e com potencial para melhorar sua movimentação (níveis III e IV da Gross Motor Function Classification System), operados entre janeiro de 2010 e dezembro de 2012 obtendo 36 pacientes. Resultados: Notamos que não houve diferença estatisticamente significante entre os momentos da GMFM, a não ser, no domínio C (engatinhar e ajoelhar), no qual notamos uma queda da pontuação. A idade dos pacientes, o tempo de aferição entre as medidas, a natureza da cirurgia e, principalmente, o método de avaliação, que em nosso caso, foi a GMFM, foram citados na literatura como dificuldades em se quantificar objetivamente o resultado obtido pelas cirurgias ortopédicas de membros inferiores em pacientes com PC. Conclusão: Uma avaliação de um número maior de pacientes, talvez com um instrumento diferente do utilizado em nosso trabalho, se faz necessária para uma melhor percepção do real efeito da cirurgia ortopédica de membros inferiores em pacientes com PC.Orthopedic surgery is often used to improve the gait of ambulatory patients with cerebral palsy. The objectives may change, given the motor severity, however, an improve in the patient’s mobility can be achieved through surgical procedures of the lower extremity. The Gross Motor Function Measure (GMFM) is a measure of gross motor function, used to evaluate therapeutic choices, rehabilitation progress and in our institution, to evaluate, orthopedic surgeries. Objective: The main goal of this study was to evaluate orthopedic surgeries performed in children with cerebral palsy, through comparison of the GMFM’s score pre and post procedure. Method: We included in this study, patients with great limitation in mobility function but potential to improve (Levels III and IV of the Gross Motor Function Classification System), that underwent surgical procedures between January 2010 and December 2012, achieving a total of 36 subjects. Results: There was no statistically significant change between the measures, except for the C domain (crawling and kneeling), that presented a lower post-surgical procedure score. Age, time of follow up, the surgery’s characteristic, and, most of all, the instrument used, which in our case was the GMFM, were pointed as possible difficulties in measuring objectively the results of lower extremity surgery in children with cerebral palsy. Conclusion: A larger sample of subjects evaluated through a more appropriate instrument is still necessary to acknowledge the real effects of orthopedic surgery of lower extremity in patients with cerebral palsy

Ganglionopatia como manifestação inicial de neoplasia pulmonar: relato de caso

Ganglionopathy is a rare condition defined by an injury to the sensory neurons in the dorsal root ganglion. This disease belongs to a group of peripheral polyneuropathies with an exclusively sensory and axonal pattern and its diagnoses can be made by an electromyoneurographic study. The association between ganglionopathy and other underlying pathologies, such as some types of cancer, autoimmune diseases, and celiac disease is often mentioned in published studies. The purpose of this report was to describe the case of a patient suffering from ganglionopathy including a detailed discussion of the electromyoneurographic study that led the attending physician to a diagnosis of neoplastic lung disease. The conclusion therefore was that it is important for the neurophysiology specialist to keep in mind the possible causes of ganglionopathy and, through this diagnosis, to help the attending physician in making an early and full workup of the patient.A ganglionopatia é uma entidade rara que consiste na afecção dos neurônios sensitivos da raiz dorsal, fazendo parte do grupo das polineuropatias periféricas do tipo exclusivamente sensitivo com comprometimento axonal e tendo seu diagnóstico feito através de estudo eletroneuromiográfico. A associação entre a ganglionopatia e outras patologias como neoplasias, doenças autoimunes, doença celíaca, entre outras é amplamente citada na literatura. O objetivo deste trabalho é descrever o caso clínico de um paciente com diagnóstico de neoplasia pulmonar cuja manifestação inicial foi a ganglionopatia, incluindo a descrição detalhada do exame eletroneuromiográfico que auxiliou no processo diagnóstico do médico assistente. Concluímos ser importante que o médico neurofisiologista tenha em mente as possíveis causas da ganglionopatia e saiba apontar o médico assistente para que a investigação possa ser realizada de maneira completa e precoce

Impacto dos Esteroides Anabolizantes na Saúde Cardiovascular: Uma Revisão Abrangente da Literatura

This study conducted a comprehensive literature review on the impact of anabolic steroids on cardiovascular health. Through the analysis of epidemiological studies, systematic reviews, and meta-analyses, it was possible to identify a significant association between the use of anabolic steroids and an increased risk of adverse cardiovascular events, such as hypertension, atherosclerosis, myocardial infarction, and stroke. Underlying pathophysiological mechanisms, including alterations in lipid profile, vascular function, and promotion of thrombosis, were discussed to elucidate the cardiovascular effects of these substances. Considering the risks associated with the use of anabolic steroids, it is essential for healthcare professionals to be aware of these adverse effects and work together with patients to prevent cardiovascular complications.Este estudo realizou uma revisão abrangente da literatura sobre o impacto dos esteroides anabolizantes na saúde cardiovascular. Através da análise de estudos epidemiológicos, revisões sistemáticas e meta-análises, foi possível identificar uma associação significativa entre o uso de esteroides anabolizantes e o aumento do risco de eventos cardiovasculares adversos, como hipertensão, aterosclerose, infarto do miocárdio e acidente vascular cerebral. Mecanismos fisiopatológicos subjacentes, incluindo alterações no perfil lipídico, função vascular e promoção da trombose, foram discutidos para elucidar os efeitos cardiovasculares dessas substâncias. Considerando os riscos associados ao uso de anabolizantes, é essencial que profissionais de saúde estejam cientes desses efeitos adversos e trabalhem em conjunto com os pacientes para prevenir complicações cardiovasculares

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

Handgrip strength as a mobility predictor in lower limb amputees

The mobility of lower limb amputees is of great importance to the professionals working with these patients. Among the measures used to aid the prediction of mobility are age, number of comorbidities, global muscle strength and some scales like the Amputee Mobility Predictor (AMP). Simultaneously, the handgrip strength has been shown to be linked to the global muscular strength and the mobility of selected populations. Objective: Evaluate the relation between the handgrip strength and the mobility of lower limb amputees, measured using the AMP. As a secondary objective, the relation between comorbidities and mobility was measured for these patients. Methods: Handgrip strength, a representative measure of muscular strength was used and compared with a well-known scale of mobility of lower limb amputees (AMP), aiming the evaluation of its power of mobility prediction among these patients. The charts of the patients who had both measures, were revised and a total of 102 patients were included in this study. Results: A positive relation between AMP and handgrip strength was found, showing that the higher the handgrip strength, higher the AMP. A negative impact of the comorbidities on the mobility of these patients was found. Conclusion: The handgrip strength is a useful and efficient tool for the prediction of mobility in lower limb amputees. The number of comorbidities had a negative effect on the mobility of these patients.A mobilidade de pacientes que sofreram amputações de membros inferiores é de grande importância para os profissionais que trabalham com essa população específica. Entre as variáveis utilizadas no intuito de se predizer a mobilidade e o sucesso da protetização desses indivíduos, podemos citar a idade, as comorbidades, a força muscular global e, ainda, algumas escalas desenvolvidas para esse fim, como a AMP (Amputee Mobility Predictor). A força de preensão manual, por sua vez, possui relação com a força muscular global e com a mobilidade de populações específicas. Objetivo: Avaliar a relação entre a força de preensão manual e a mobilidade de pacientes com amputação de membros inferiores, aferida através da AMP. Como objetivo secundário, foi avaliada a relação entre a mobilidade e as comorbidades destes pacientes. Método: Foi utilizada uma medida representativa da força muscular, a força de preensão manual, e realizada a comparação a uma medida já consagrada, a AMP, na tentativa de avaliar seu poder de predição de mobilidade em pacientes com amputação de membros inferiores. Foram revisados os prontuários dos pacientes que possuíam as duas medidas avaliadas, obtendo-se um n de 102. Resultados: Foi encontrada uma relação positiva entre o valor da AMP e a força de preensão manual, mostrando que, quanto maior a força, maior será a mobilidade. Notou-se, ainda, um impacto negativo do número de comorbidades na mobilidade de pacientes com amputação de membros inferiores. Conclusão: A medida da força de preensão manual é uma medida útil e eficiente na predição da mobilidade de pacientes com amputação de membros inferiores. O número de comorbidades teve um impacto negativo na mobilidade dessa população.Dados abertos - Sucupira - Teses e dissertações (2018

Insuficiência venosa crônica - revisão de literatura

A insuficiência venosa crônica (IVC) é uma condição vascular que afeta milhões de pessoas globalmente, predominantemente nas veias das extremidades inferiores, causando uma série de sintomas desconfortáveis, incluindo dor, inchaço e úlceras venosas. Essa enfermidade é frequentemente desencadeada por válvulas venosas ineficazes, levando ao acúmulo de sangue nas veias e aumento da pressão venosa. Fatores como idade, sexo, estilo de vida sedentário e obesidade contribuem para o desenvolvimento da doença, que tende a progredir se não for tratada adequadamente. O diagnóstico precoce é crucial para mitigar os sintomas e prevenir complicações graves, como a formação de úlceras venosas. A ultrassonografia Duplex é o método padrão para diagnóstico, permitindo a avaliação do refluxo venoso e obstrução das veias. A Classificação CEAP é utilizada para estratificar a doença, considerando aspectos clínicos, etiológicos, anatômicos e fisiopatológicos. O tratamento da IVC envolve abordagens conservadoras, como o uso de meias de compressão, elevação das pernas e exercícios regulares, além de intervenções médicas específicas para casos mais avançados. Terapias intervencionistas, como escleroterapia e ablação endovenosa, são indicadas para pacientes com doença avançada, enquanto procedimentos cirúrgicos, como a ligadura e remoção da veia safena, são reservados para casos graves de disfunção venosa. Em resumo, o manejo eficaz da IVC requer uma abordagem individualizada e multidisciplinar, visando aliviar os sintomas, prevenir complicações e melhorar a qualidade de vida dos pacientes afetados. O entendimento dos aspectos-chave dessa doença complexa é fundamental para orientar intervenções mais eficazes e promover melhores resultados clínicos

Seminário de Dissertação (2024)

Página da disciplina de Seminário de Dissertação (MPPP, UFPE, 2022) Lista de participantes == https://docs.google.com/spreadsheets/d/1mrULe1y04yPxHUBaF50jhaM1OY8QYJ3zva4N4yvm198/edit#gid=