Estabilizaciones lumbares dinámicas

O funcionamento fisiológico normal da coluna depende da movimentação normal de cada unidade motora, que consiste em duas vértebras e o disco intervertebral interposto entre elas. Embora a artrodese da coluna vertebral venha sendo utilizada para o tratamento de diversas doenças da coluna, essa modalidade de tratamento acarreta a perda de movimentação dos níveis em que houve a fusão e como consequência pode sobrecarregar os níveis adjacentes podendo provocar a sua degeneração precoce. Proponentes das técnicas de estabilização dinâmicas acreditam que estas podem levar a correção dos problemas minimizando o risco de degeneração dos níveis adjacentes. Atualmente existem no mercado diversos métodos de estabilização dinâmica anteriores e posteriores. Já existem trabalhos biomecânicos que comprovam o benefício teórico de quase todos eles, porém ainda hoje, faltam ensaios clínicos que comprovem a sua utilidade e segurança por longos períodos de seguimento para o paciente. Portanto é fundamental que estes materiais sejam analisados de maneira acadêmica para que no futuro próximo possam ser utilizados em situações precisas e com segurança para os pacientes

Avaliação da satisfação dos usuários de fisioterapia em atendimento ambulatorial

Satisfaction is determined by the patient’s reaction to the service received, acting as a sensitive indicator of quality in medical care. The goal of this study was to compare the satisfaction of patients receiving outpatient physical therapy treatment in public clinics (PC), private healthcare clinics (PHC) and school clinics (SC). A total of 382 patients aged over 18 years old who had been to at least five appointments were divided into three groups. A questionnaire containing questions about sociodemographic data and overall satisfaction as well as satisfaction with the patienttherapist relationship, access to and support offered by the team, convenience and the environment was used. The majority of the patients was female (68.6%), their mean age being 52.0 years old. In the comparison of the services, the school clinic showed greater satisfaction rates than the public clinics in relation to the support team, convenience and physical environment; and greater satisfaction rates than the private healthcare clinics in relation the therapistpatient relationship and overall satisfaction. The private healthcare clinics were better evaluated than the public clinics in relation to convenience and physical environment. The correlation analysis between overall satisfaction and each variable showed good and moderate values for the therapist-patient relationship variable and the lowest values for the convenience variable. The questionnaire had good internal consistency and coherence for the three services (α≥0.94). These results represent an important indicator of the patients’ perception about the services investigated, allowing the proper implementation of public, private and academic policies aimed at the improvement of the quality of physical therapy care.Determinada por la reacción al servicio recibido, la satisfacción del paciente es un indicador sensible de la calidad de la atención. El objetivo de este estudio fue comparar la satisfacción de los usuarios que realizan tratamiento fisioterapéutico ambulatorio en clínicas públicas (CP), en clínicas privadas de convenio (CC) y en clínica-escuela (CE). Se evaluaron 382 pacientes, con edad mínima de 18 años, sometidos a por lo menos cinco atendimientos. Los pacientes fueron divididos en tres grupos y se utilizó un cuestionario con preguntas sobre datos sociodemográficos y satisfacción en los dominios interacción paciente-terapeuta, acceso y atención de la recepción, conveniencia, ambiente y satisfacción general. La mayoría de los pacientes eran mujeres (68,60%), con edad media de 51,96 años. En la comparación entre los servicios, la CE presentó mayor satisfacción que la CP en equipo de apoyo, conveniencia y ambiente físico, y la CC en la relación terapeuta-paciente y satisfacción general. La CC fue mejor evaluada que la CP en conveniencia y ambiente físico. El análisis de correlación entre la satisfacción general y cada uno de los dominios mostró valores de bueno a moderado para relación terapeuta-paciente, y los menores valores para el dominio conveniencia. El cuestionario mostró buena consistencia interna y coherencia en los tres servicios (α≥0,94). Estos resultados representan un importante indicador de la impresión de los usuarios en los servicios investigados, permitiendo un mejor direccionamiento en la implementación de políticas públicas, privadas y académicas, buscando la mejora de la calidad de las atenciones de fisioterapia.A satisfação é determinada pela reação do paciente ao serviço recebido, sendo, portanto, um indicador sensível da qualidade do atendimento. O objetivo deste estudo foi comparar a satisfação dos usuários que realizam tratamento fisioterapêutico ambulatorial em clínicas públicas (CP), em clínicas privadas de convênio (CC) e em clínica-escola (CE). Foram avaliados 382 pacientes, com idade mínima de 18 anos, que haviam sido submetidos a, no mínimo, cinco atendimentos. Os pacientes foram divididos em três grupos e utilizouse um questionário com perguntas sobre dados sociodemográficos e satisfação nos domínios interação paciente-terapeuta, acesso e atendimento da recepção, conveniência, ambiente e satisfação geral. A maior parte dos pacientes eram do sexo feminino (68,60%), com média de 51,96 anos de idade. Na comparação entre os serviços, a CE apresentou maior satisfação que a CP em equipe de apoio, conveniência e ambiente físico, e a CC em relação terapeuta-paciente e satisfação geral. A CC foi mais bem avaliada que a CP em conveniência e ambiente físico. A análise de correlação entre a satisfação geral e cada um dos domínios mostrou valores de bom a moderado para relação terapeuta-paciente, e os menores valores para o domínio conveniência. O questionário mostrou boa consistência interna e coerência nos três serviços (α≥0,94). Esses resultados representam um importante indicador da impressão dos usuários nos serviços investigados, permitindo melhor direcionamento na implementação de políticas públicas, privadas e acadêmicas, visando a melhora da qualidade dos atendimentos de fisioterapia

Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up

OBJECTIVES: To verify the incidence of facetary and low back pain after a controlled medial branch anesthetic block in a three-month follow-up and to verify the correlation between the positive results and the demographic variables. METHODS: Patients with chronic lumbar pain underwent a sham blockade (with a saline injection) and then a controlled medial branch block. Their symptoms were evaluated before and after the sham injection and after the real controlled medial branch block; the symptoms were reevaluated after one day and one week, as well as after one, two and three months using the visual analog scale. We searched for an association between the positive results and the demographic characteristics of the patients. RESULTS: A total of 104 controlled medial branch blocks were performed and 54 patients (52%) demonstrated >;50% improvements in pain after the blockade. After three months, lumbar pain returned in only 18 individuals, with visual analogue scale scores >;4. Therefore, these patients were diagnosed with chronic facet low back pain. The three-months of follow-up after the controlled medial branch block excluded 36 patients (67%) with false positive results. The results of the controlled medial branch block were not correlated to sex, age, pain duration or work disability but were correlated with patient age (

Effects of estrogen on functional and neurological recovery after spinal cord injury: An experimental study with rats

OBJECTIVES:To evaluate the functional and histological effects of estrogen as a neuroprotective agent after a standard experimentally induced spinal cord lesion.METHODS:In this experimental study, 20 male Wistar rats were divided into two groups: one group with rats undergoing spinal cord injury (SCI) at T10 and receiving estrogen therapy with 17-beta estradiol (4mg/kg) immediately following the injury and after the placement of skin sutures and a control group with rats only subjected to SCI. A moderate standard experimentally induced SCI was produced using a computerized device that dropped a weight on the rat's spine from a height of 12.5 mm. Functional recovery was verified with the Basso, Beattie and Bresnahan scale on the 2nd, 7th, 14th, 21st, 28th, 35th and 42nd days after injury and by quantifying the motor-evoked potential on the 42nd day after injury. Histopathological evaluation of the SCI area was performed after euthanasia on the 42nd day.RESULTS:The experimental group showed a significantly greater functional improvement from the 28th to the 42nd day of observation compared to the control group. The experimental group showed statistically significant improvements in the motor-evoked potential compared with the control group. The results of pathological histomorphometry evaluations showed a better neurological recovery in the experimental group, with respect to the proportion and diameter of the quantified nerve fibers.CONCLUSIONS:Estrogen administration provided benefits in neurological and functional motor recovery in rats with SCI beginning at the 28th day after injury

Effects of decompression time after spinal cord injury on neurologic recovery in Wistar rats

OBJETIVO: Lesões traumáticas da medula espinal são frequentemente observadas no ambiente hospitalar de politraumatismos e cursam com grande morbi-mortalidade além de grandes custos psico-sociais e de saúde publica. Até os dias de hoje o tratamento destas lesões permanece controverso, sendo que diversos estudos na literatura compararam resultados do tratamento conservador e do tratamento cirúrgico imediato, precoce e tardio. O objetivo deste estudo é comparar a intervenção cirúrgica com descompressão imediata em relação à descompressão realizada após 1 hora de compressão medular. MÉTODOS: Acreditando no melhor resultado do tratamento cirúrgico este estudo realiza comparação experimental do tipo caso-controle, com análise histo-patológica e funcional, dos resultados no tratamento cirúrgico por laminectomia posterior, imediata e após 1 hora de compressão, em 25 ratos da raça Wistar. RESULTADOS: Respostas quanto à função e grau de déficit neurológico foram melhores nos ratos tratados por descompressão cirúrgica imediata em relação aos tratados após 1 hora de lesão (p=0,036). CONCLUSÃO: Quanto mais precoce a descompressão espinal nas lesões medulares traumáticas agudas, melhores seriam os resultados finais em relação à função e presença de déficit neurológico.OBJECTIVE: Traumatic spinal Cord injuries are common in patients with high-energy trauma, and have significant morbidity and mortality rates, as well as high psychological and social costs, causing a major impact on public health. To date, the treatment of such lesions remains controversial, with various studies in the literature comparing the results of non-surgical treatment with immediate, early or late surgical decompression. The objective of the present study is to compare the results of immediate and early (within 1 hour) spinal Cord decompression. METHODS: In the belief that the surgical treatment obtains the best result, this experimental study has a case-control design, with histopathological and functional analysis of the results of surgical treatment of 25 Wistar mice submitted to posterior laminectomy immediately, or after one hour of spinal Cord compression. RESULTS: in terms of functional and neurological deficit, the responses were better in the mice treated with immediate surgical decompression than in those treated one hour after the lesion (p=0.036). CONCLUSION: The earlier the decompression of spinal Cord injuries is performed, the better the end results in terms of the function and presence of neurological deficit

[evaluation Of Data On Live Birth Certificates From The Information System On Live Births (sinasc) In Campinas, São Paulo, 2009].

To assess the completeness and reliability of the Information System on Live Births (Sinasc) data. A cross-sectional analysis of the reliability and completeness of Sinasc's data was performed using a sample of Live Birth Certificate (LBC) from 2009, related to births from Campinas, Southeast Brazil. For data analysis, hospitals were grouped according to category of service (Unified National Health System, private or both), 600 LBCs were randomly selected and the data were collected in LBC-copies through mothers and newborns' hospital records and by telephone interviews. The completeness of LBCs was evaluated, calculating the percentage of blank fields, and the LBCs agreement comparing the originals with the copies was evaluated by Kappa and intraclass correlation coefficients. The percentage of completeness of LBCs ranged from 99.8%-100%. For the most items, the agreement was excellent. However, the agreement was acceptable for marital status, maternal education and newborn infants' race/color, low for prenatal visits and presence of birth defects, and very low for the number of deceased children. The results showed that the municipality Sinasc is reliable for most of the studied variables. Investments in training of the professionals are suggested in an attempt to improve system capacity to support planning and implementation of health activities for the benefit of maternal and child population.32183-

A Comparative Study of Sagittal Balance in Patients with Neuromuscular Scoliosis

OBJECTIVES: Spinopelvic alignment has been associated with improved quality of life in patients with vertebral deformities, and it helps to compensate for imbalances in gait. Although surgical treatment of scoliosis in patients with neuromuscular spinal deformities promotes correction of coronal scoliotic deformities, it remains poorly established whether this results in large changes in sagittal balance parameters in this specific population. The objective of this study is to compare these parameters before and after the current procedure under the hypothesis is that there is no significant modification. METHODS: Sampling included all records of patients with neuromuscular scoliosis with adequate radiographic records treated at Institute of Orthopedics and Traumatology of Clinics Hospital of University of São Paulo (IOT-HCFMUSP) from January 2009 to December 2013. Parameters analyzed were incidence, sacral inclination, pelvic tilt, lumbar lordosis, thoracic kyphosis, spinosacral angle, spinal inclination and spinopelvic inclination obtained using the iSite-Philips digital display system with Surgimap and a validated method for digital measurements of scoliosis radiographs. Comparison between the pre- and post-operative conditions involved means and standard deviations and the t-test. RESULTS: Based on 101 medical records only, 16 patients met the inclusion criteria for this study, including 7 males and 9 females, with an age range of 9-20 and a mean age of 12.9±3.06; 14 were diagnosed with cerebral palsy. No significant differences were found between pre and postoperative parameters. CONCLUSIONS: Despite correction of coronal scoliotic deformity in patients with neuromuscular deformities, there were no changes in spinopelvic alignment parameters in the group studied

In silico approaches for drug repurposing in oncology: a scoping review

Introduction: Cancer refers to a group of diseases characterized by the uncontrolled growth and spread of abnormal cells in the body. Due to its complexity, it has been hard to find an ideal medicine to treat all cancer types, although there is an urgent need for it. However, the cost of developing a new drug is high and time-consuming. In this sense, drug repurposing (DR) can hasten drug discovery by giving existing drugs new disease indications. Many computational methods have been applied to achieve DR, but just a few have succeeded. Therefore, this review aims to show in silico DR approaches and the gap between these strategies and their ultimate application in oncology.Methods: The scoping review was conducted according to the Arksey and O’Malley framework and the Joanna Briggs Institute recommendations. Relevant studies were identified through electronic searching of PubMed/MEDLINE, Embase, Scopus, and Web of Science databases, as well as the grey literature. We included peer-reviewed research articles involving in silico strategies applied to drug repurposing in oncology, published between 1 January 2003, and 31 December 2021.Results: We identified 238 studies for inclusion in the review. Most studies revealed that the United States, India, China, South Korea, and Italy are top publishers. Regarding cancer types, breast cancer, lymphomas and leukemias, lung, colorectal, and prostate cancer are the top investigated. Additionally, most studies solely used computational methods, and just a few assessed more complex scientific models. Lastly, molecular modeling, which includes molecular docking and molecular dynamics simulations, was the most frequently used method, followed by signature-, Machine Learning-, and network-based strategies.Discussion: DR is a trending opportunity but still demands extensive testing to ensure its safety and efficacy for the new indications. Finally, implementing DR can be challenging due to various factors, including lack of quality data, patient populations, cost, intellectual property issues, market considerations, and regulatory requirements. Despite all the hurdles, DR remains an exciting strategy for identifying new treatments for numerous diseases, including cancer types, and giving patients faster access to new medications

Hierarchical Classification of Financial Transactions Through Context-Fusion of Transformer-based Embeddings and Taxonomy-aware Attention Layer

This work proposes the Two-headed DragoNet, a Transformer-based model for hierarchical multi-label classification of financial transactions. Our model is based on a stack of Transformers encoder layers that generate contextual embeddings from two short textual descriptors (merchant name and business activity), followed by a Context Fusion layer and two output heads that classify transactions according to a hierarchical two-level taxonomy (macro and micro categories). Finally, our proposed Taxonomy-aware Attention Layer corrects predictions that break categorical hierarchy rules defined in the given taxonomy. Our proposal outperforms classical machine learning methods in experiments of macro-category classification by achieving an F1-score of 93\% on a card dataset and 95% on a current account dataset