Escore funcional e de dor após cirurgia de hérnia de disco lombar e fisioterapia precoce = Funcional and pain score after lumbar disc surgery and early physiotherapy

Objetivos: Avaliar o efeito da intervenção fisioterapêutica no escore funcional e de dor dos pacientes submetidos à cirurgia de hérnia de disco lombar (HDL). Métodos: Estudo randomizado, controlado e cego, avaliando pacientes que internaram no Hospital São Lucas da PUCRS, no período de outubro de 2003 a maio de 2004, para realizar cirurgia de HDL. Amostra: 20 pacientes, 10 do grupo controle (cirurgia e repouso no pós-operatório) e 10 do grupo de intervenção (cirurgia e fisioterapia no pós-operatório). Intervenção fisioterapêutica: alongamento neural do ciático, alongamentos de Williams e uso da estimulação elétrica transcutânea três vezes ao dia, do primeiro dia pós-operatório até a alta hospitalar. Instrumentos para avaliar o escore de dor e de função, respectivamente: escala análogo-visual de dor e Roland Morris Questionnaire. Escores avaliados antes da cirurgia, no pós-operatório imediato e dois meses após os procedimentos. Resultados: Houve significância estatística na diferença do escore funcional (P = 0,009) e na redução da intensidade da dor (P = 0,028) dos pacientes no segundo mês pós-operatório, favorecendo o grupo com intervenção fisioterapêutica. Conclusões: A intervenção precoce de fisioterapia contribuiu para melhorar o estado funcional e reduzir a dor dos pacientes nos dois primeiros meses após o procedimento cirúrgico de HD

Evaluation of functional capacity for exercise in children and adolescents with sickle cell disease through the six minute walk test

OBJECTIVE: to evaluate lung functional capacity (FC) for physical exercise in children and adolescents with sickle cell disease (SCD) through the six-minute walk test (6MWT). METHOD: a cross-sectional prospective study was performed to evaluate the FC of 46 patients with SCD through the 6MWT. The following parameters were assessed: heart rate (HR), respiratory rate (RR), peripheral pulse oxygen saturation (SpO2), peak expiratory flow (PEF), blood pressure (systolic and diastolic), dyspnea, and leg fatigue (modified Borg scale) at rest, in the end of the test, and ten minutes after the 6MWT. The total distance walked was also recorded. For statistical analysis, the parametric variables were analyzed using the paired Student's t-test, analysis of variance (ANOVA), and Bonferroni multiple comparisons, with a significance level set at p < 0.05. RESULTS: the 46 patients were aged age 9.15 ± 3.06 years, presented baseline Hb of 9.49 ± 1.67 g/dL, and walked 480.89 ± 68.70 m. SCD diagnosis was as follows: group 1- HbSS (n = 20)/HbSβ0-thalassemia (n = 3) and group 2 - HbSC (n = 20)/HbSβ+-thalassemia (n = 3). Regarding total distance walked, patients in group 1 walked a shorter distance than patients in group 2 (459.39 ± 57.19 vs. 502.39 ± 73.60 m; p = 0.032). There was no statistical difference regarding PEF in the three moments of evaluation. The SpO2 in ambient air and SpO2 with O2 differed between groups 1 and 2 (p < 0.001 vs. p = 0.002), as well as the RR (p = 0.001). CONCLUSION: these patients showed a lower FC for exercise than that predicted for the age range in the literature. Patients diagnosed with HbSS/Sβ0-thalassemia had a lower performance in the test than those with HbSC/Sβ+-thalassemia regarding total distance walked, RR, and SpO2 after the 6MWT.OBJETIVO: avaliar a capacidade funcional pulmonar (CF) para o exercício físico de crianças e adolescentes com doença falciforme (DF) pelo teste da caminhada de seis minutos (TC6'). MÉTODOS: estudo transversal prospectivo avaliando a CF pelo TC6' de 46 pacientes com DF. Foram avaliados: frequência cardíaca (FC), frequência respiratória (FR), saturação de pulso de oxigênio (SpO2), pico de fluxo expiratório (PFE), pressão arterial (PA) sistólica e diastólica, dispneia e cansaço em membros inferiores (escala de Borg modificada) em repouso, ao término e 10 minutos após o TC6' e a distância percorrida. Análise estatística: test t-Student pareado, análise de variância e comparações múltiplas de Bonferroni, significância p < 0,05. RESULTADOS: dos 46 pacientes, a média ± dp da idade foi 9,15 ± 3,06 anos, hemoglobina basal 9,4 ± 1,67 g/dL e distância percorrida 480,89 ± 68,70 m. Diagnóstico da DF: Grupo 1- HbSS (n = 20)/HbSβ0-talassemia (n = 3); e Grupo 2 - HbSC (n = 20)/ HbSβ+-talassemia (n = 3). O Grupo 1 apresentou menor distância percorrida do que o Grupo 2 (459,39 ± 57,19 vs 502,39 ± 73,60m; p = 0,032). Não houve diferença estatística em relação ao PFE. A SpO2 em ar ambiente e a SpO2 com O2 (1 L/min) após o teste foi maior no Grupo 2 (p < 0,001 e p = 0,002, respectivamente). A FR foi maior no Grupo 1 ao final do TC6' (p < 0,001). CONCLUSÃO: esta amostra apresentou CF para o exercício abaixo do predito para a faixa etária na literatura. Os pacientes com HbSS/Sβ0-talassemia apresentaram desempenho inferior na distância percorrida, FR e SpO2 após o TC6', comparativamente aos pacientes com HbSC/Sβ+-talassemia.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade de São PauloUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Hospital São PauloUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP, EPM, Hospital São PauloUNIFESP, EPM, Depto. de PediatriaSciEL

Spectroscopic Definition of the CuZ° Intermediate in Turnover of Nitrous Oxide Reductase and Molecular Insight into the Catalytic Mechanism

Fundacao para a Ciencia e Tecnologia - PTDC/QUI-BIQ/116481/2010, PTDC/BBB-BQB/0129/2014, SFRH/BD/87898/2012 ; Unidade de Ciencias Biomoleculares Aplicadas-UCIBIO - FCT/MEC - UID/Multi/04378/2013 ; ERDF - POCI-01-0145-FEDER-007728Spectroscopic methods and density functional theory (DFT) calculations are used to determine the geometric and electronic structure of CuZ°, an intermediate form of the Cu4S active site of nitrous oxide reductase (N2OR) that is observed in single turnover of fully reduced N2OR with N2O. Electron paramagnetic resonance (EPR), absorption, and magnetic circular dichroism (MCD) spectroscopies show that CuZ° is a 1-hole (i.e., 3CuICuII) state with spin density delocalized evenly over CuI and CuIV. Resonance Raman spectroscopy shows two Cu-S vibrations at 425 and 413 cm-1, the latter with a -3 cm-1 O18 solvent isotope shift. DFT calculations correlated to these spectral features show that CuZ° has a terminal hydroxide ligand coordinated to CuIV, stabilized by a hydrogen bond to a nearby lysine residue. CuZ° can be reduced via electron transfer from CuA using a physiologically relevant reductant. We obtain a lower limit on the rate of this intramolecular electron transfer (IET) that is >104 faster than the unobserved IET in the resting state, showing that CuZ° is the catalytically relevant oxidized form of N2OR. Terminal hydroxide coordination to CuIV in the CuZ° intermediate yields insight into the nature of N2O binding and reduction, specifying a molecular mechanism in which N2O coordinates in a μ-1,3 fashion to the fully reduced state, with hydrogen bonding from Lys397, and two electrons are transferred from the fully reduced μ4S2- bridged tetranuclear copper cluster to N2O via a single Cu atom to accomplish N-O bond cleavage.authorsversionpublishe

COVID-19 Diagnostic and Management Protocol for Pediatric Patients

This review aims to verify the main epidemiologic, clinical, laboratory-related, and therapeutic aspects of coronavirus disease 2019 (COVID-19) in critically ill pediatric patients. An extensive review of the medical literature on COVID-19 was performed, mainly focusing on the critical care of pediatric patients, considering expert opinions and recent reports related to this new disease. Experts from a large Brazilian public university analyzed all recently published material to produce a report aiming to standardize the care of critically ill children and adolescents. The report emphasizes on the clinical presentations of the disease and ventilatory support in pediatric patients with COVID-19. It establishes a flowchart to guide health practitioners on triaging critical cases. COVID-19 is essentially an unknown clinical condition for the majority of pediatric intensive care professionals. Guidelines developed by experts can help all practitioners standardize their attitudes and improve the treatment of COVID-19

Post cardiac surgery In children: extubation failure predictor's

BACKGROUND AND OBJECTIVES: It is important to know the risk factors for extubation failure (EF) in children submitted to cardiac surgery in order to avoid inherent events due to reintubation (airways injury, usage of medications, cardiovascular changes) and because of prolonged ventilatory support (pneumonias, reduction of the ventilatory muscles strength). The objective of this study is to evaluate mechanical ventilation (MV) parameters, ventilatory mechanics [rapid shallow breathing index (RSBI), ventilatory muscles force [the maximum inspiratory pressure (MIP), the maximum expiratory pressure (MEP) and the load/force balance (LFB)] and blood gases before and after extubation in pediatric patients undergoing cardiac surgery. METHODS: Prospective (March 2004 to March 2006) observational cross sectional study, enrolling children submitted to cardiac surgery admitted to an university PICU hospital and considered able to be extubated. With the tracheal tube in situ and maintaining the children spontaneously breathing we evaluate: expiratory minute volume (V E), MIP and MEP. We calculated the RSBI [(RR/VT)/Weight)], LFB [15x [(3xMAP)/MIP] + 0.03 x RSBI-5], the mean airway pressure (MAP) [MAP={(PIP-PEEP)x[Ti/(Te+Ti)]}+PEEP] and the oxygenation index (OI) [OI=(FiO2 x MAP/PaO2)x100]. Arterial blood gas was collected one hour before extubation. If after 48 hours there was no need to reintubate the patient the extubation was considered successful (SE). RESULTS: 59 children were included. EF was observed in 19% (11/59). Median (QI25%-75%) for age, weight, MAP, OI, duration of MV after cardiac surgery (DMV) were respectively, 36 (12-82) months, 12 (8-20) kg, 8 (6-9), 2 (2-5), 1 (1-3) days. Median (QI25-75%) of EF in relation to SE for OI, LFB and DMV were respectively 5(3-8) versus 2(2-4), p = 0.005; [8(6-11) versus 5(4-6), p =0.002 and 3(2-5) versus 1(1-2) days, p = 0.026. Mean ± SD of EF in relation to SE for V E, PaO2 and MIP were respectively 1.7 ± 0.82 versus 3 ± 2.7 mL/kg/min, p = 0.003); 64 ± 34 versus 111 ± 50 mmHg, p = 0.002 and 53 ± 18 versus 78 ± 28 cmH2O; p=0.002. Concerning the risk factors for EF: OI > 2 (area under the ROC 0.74, p = 0.017) and LFB > 4 (area under the ROC 0.80, p = 0.002), achieved a sensibility of 100% and specificity of 80%; MIP 2, LFB > 4, DMV > 3 days; V E 2 (área 0,74, p = 0,017) e da RCF > 4 (área 0,80, p = 0,002); 80% de sensibilidade e 60% de especificidade da PiMáx 2, RCF > 4, tempo de VPM > 3 dias, V E < 1,7 mL/kg/min , PaO2 < 64 mmHg e PiMáx < - 53 cmH2O. A MAP, o diagnóstico de base, o IRS e os gases sangüíneos não estiveram relacionados com a falha da extubação.PUC-RSUNIFESP-EPMHospital São PauloPUC-RS Faculdade de MedicinaUFRGSHospital São Lucas Unidade de Terapia Intensiva PediátricaUNIFESP-EPM Faculdade de MedicinaHospital São Paulo Unidade de Cuidados Intensivos PediátricaPronto Socorro Infantil Sabará e Santa CatarinaHospital São Lucas UTIPHospital São Paulo UCIP e Semi-IntensivaHospital São Lucas UTIP Unidade de Terapia Intensiva NeonatalUNIFESP, EPMHospital São PauloUNIFESP, EPM Faculdade de MedicinaHospital São Paulo Unidade de Cuidados Intensivos PediátricaHospital São Paulo UCIP e Semi-IntensivaSciEL