Presença da fisioterapia preventiva no contexto escolar: educação e prevenção em saúde

Objetivo: este estudo tem por finalidade explicitar as ações da fisioterapia nas escolas, analisando alguns dos dados coletados durante uma das práticas da disciplina, em escola privada do município de Santa Cruz do Sul-RS. Método: estudo de caráter descritivo, foi composto por 206 estudantes, com idades entre 6 e 10 anos, de ambos os sexos, sendo alunos do 1° ao 4º ano do Ensino Fundamental, distribuídos em 11 turmas, de uma escola privada. A abordagem consistiu na “Educação Postural” no ambiente escolar e nas atividades de vida diárias, aplicação de um questionário de múltipla escolha que englobava a avaliação do aspecto biopsicossocial do aluno. Foi feita a avaliação postural estática, assim como da postura de cada escolar frente ao mobiliário em sala de aula, através de análise observacional individual, sendo realizada a pesagem dos alunos, das mochilas e o ajuste das mesmas também foi realizada. Resultados: a amostra foi composta por 206 estudantes do 1º ao 4º ano do Ensino Fundamental, com idade entre seis e 10 anos, de ambos os sexos. Os achados provenientes do questionário nos forneceram informações acerca da realidade de vida de cada aluno avaliado. Em relação às avaliações posturais realizadas, foram evidenciados quatro casos de escoliose em “C” na coluna lombar e um em "S”, já na coluna torácica foram encontrados sete casos de escoliose em “C”. O mobiliário se mostrou inadequado para a maioria dos estudantes e em relação ao peso das mochilas, 148 delas estavam acima dos 10% do peso corporal do aluno. Considerações finais: existe um vasto campo de atuação para a Fisioterapia Preventiva, dentre eles, a avaliação e intervenção na saúde na escola. As metodologias utilizadas na disciplina para esta prática possibilitaram o aprendizado e a [re] significação da prevenção na Fisioterapia, uma profissão fortemente enraizada na reabilitação

Community-acquired neonatal SARS-CoV-2 infection: case report

Background and Objectives: Data collection on the incidence of COVID-19 is conducted less frequently in newborns (NB) than in adults. In view of the small number of described neonatal SARS-CoV-2 infections, in this study, we report a clinical case of community-acquired COVID-19 infection in a newborn. Methods: Clinical characteristics were collected from the medical records from April 2021 until the final outcome of the newborn in May 2021. Results: This article discusses the case of a full-term male newborn aged 38 weeks. On the 17th day of life, this newborn was admitted to the pediatric unit with fever and zone 4 jaundice, mild lower chest retraction and tachypnea. The mother was diagnosed with COVID-19. Late neonatal sepsis with pulmonary focus was detected. The newborn was hospitalized and the antigen test for COVID-19 came back positive. The condition of the neonate rapidly deteriorated and he was referred to the neonatal intensive care unit (NICU), where he was intubated and placed on pressure-controlled mechanical ventilation. During his second week in the NICU, he developed severe pulmonary hypertension with decreased peripheral oxygen saturation and tachycardia. The newborn required blood transfusion and was put into prone position during part of the treatment. Reductions in mechanical ventilation parameters were not tolerated by the NB’s organism and he developed progressive hypoxemia. The newborn died 1 month and 3 days after hospitalization. Conclusion: Our study shows a case of community-acquired COVID-19 that progressed to the severe form of the disease

Efeitos da vibração de corpo inteiro sobre a composição corporal e perfil bioquímico de idosas

Introdução: a vibração de corpo inteiro (VCI) gerada através da plataforma vibratória (PV) se constitui em um recurso de treinamento para melhorar a saúde na população idosa. Objetivo: avaliar o efeito da VCI sobre a composição corporal, gasto metabólico, perfil bioquímico e estresse oxidativo de idosas. Método: ensaio clínico randomizado que avaliou 28 idosas alocadas no Grupo Controle (GC) e no Grupo Plataforma Vibratória (GPV). Antes e após treino de VCI (35 Hz) (8 semanas/2 mm/3 sessões semanais) foram avaliados o hemograma e a glicemia, perfil lipídico, níveis de ácido úrico, creatinina e ureia após coleta de amostra sanguínea. O estresse oxidativo foi avaliado por meio do teste das substâncias reativas ao ácido tiobarbitúrico através de análise da urina, sendo a composição corporal avaliada por meio de balança de bioimpedância. Resultados: amostra [GC (n= 16); GPV (n= 12)] com idade de 66,30±4,80 anos, apresentou aumento dos níveis de eosinófilos (p= 0,045), glicemia (p= 0,021), creatinina (p= 0,041) e massa gorda (p= 0,001) e redução dos níveis de monócitos (p= 0,010), massa magra (p= 0,001) e gasto metabólico (p= 0,001) após treinamento com VCI, sem que tenha alterado o estresse oxidativo das idosas avaliadas. Conclusões: a VCI não alterou clinicamente o perfil bioquímico, a composição corporal e o gasto metabólico basal e não alterou o estresse oxidativo das idosas avaliadas

Efeitos da Pressão Positiva Expiratória sobre a capacidade de exercício em sujeitos acometidos por Doença Pulmonar Obstrutiva Crônica

A Doença Pulmonar Obstrutiva Crônica (DPOC) leva a repercussões cardíacas e intolerância ao exercício. A pressão positiva expiratória nas vias aéreas (EPAP) aumenta a saturação de oxigênio (SpO2) e reduz o trabalho respiratório. O objetivo foi avaliar o EPAP na tolerância ao exercício em pacientes com DPOC. Estudo cruzado randomizado, avaliou-se 19 pacientes com DPOC através do teste de caminhada de seis minutos (TC6m): sem EPAP (G1) e com EPAP (G2). Variáveis analisadas no repouso, durante o TC6m e recuperação pós teste: SpO2, frequência respiratória (FR), frequência cardíaca (FC), BORG-esforço (BORG-e), BORG-dispneia (BORG-d), pressão arterial sistólica e diastólica e duplo produto (DP). Utilizou-se análise de variância para estimar a diferença dentro dos grupos e teste t de Student para a diferença entre os grupos. Dentro e em ambos os grupos: durante o TC6m verificou-se aumento da FC, do BORG-d, do DP e redução da SpO2 que se recuperou pós teste. Somente G2 recuperou a FC pós teste. Diferenças significativas foram observadas entre os grupos: no repouso para a SpO2 e FR; na recuperação pós TC6m para a FR. O EPAP de 5cmH2O, causa efeito positivo na SpO2 e FR de repouso e proporciona atenuada melhora na recuperação da FC e SpO2 pós TC6m

Infecção neonatal por SARS-CoV-2 adquirida na comunidade: relato de caso

Background and Objectives: Data collection on the incidence of COVID-19 is conducted less frequently in newborns (NB) than in adults. In view of the small number of described neonatal SARS-CoV-2 infections, in this study, we report a clinical case of community-acquired COVID-19 infection in a newborn. Methods: Clinical characteristics were collected from the medical records from April 2021 until the final outcome of the newborn in May 2021. Results: This article discusses the case of a full-term male newborn aged 38 weeks. On the 17th day of life, this newborn was admitted to the pediatric unit with fever and zone 4 jaundice, mild lower chest retraction and tachypnea. The mother was diagnosed with COVID-19. Late neonatal sepsis with pulmonary focus was detected. The newborn was hospitalized and the antigen test for COVID-19 came back positive. The condition of the neonate rapidly deteriorated and he was referred to the neonatal intensive care unit (NICU), where he was intubated and placed on pressure-controlled mechanical ventilation. During his second week in the NICU, he developed severe pulmonary hypertension with decreased peripheral oxygen saturation and tachycardia. The newborn required blood transfusion and was put into prone position during part of the treatment. Reductions in mechanical ventilation parameters were not tolerated by the NB’s organism and he developed progressive hypoxemia. The newborn died 1 month and 3 days after hospitalization. Conclusion: Our study shows a case of community-acquired COVID-19 that progressed to the severe form of the disease.Justificación y Objetivos: La recolección de datos sobre los contagios por covid-19 en recién nacidos (RN) no es tan frecuente como en adultos. En este contexto, y debido al bajo número de infecciones neonatales por SARS-CoV-2 descritas, en este estudio se describe un caso clínico de infección posnatal por covid-19 en un recién nacido en la comunidad. Métodos: Se recogieron características médicas de las historias clínicas desde abril de 2021 hasta el último resultado del RN en mayo de 2021. Resultados: Este artículo reporta el caso de un RN del sexo masculino, a término de 38 semanas. Al 17.º día de vida, el RN ingresó a la unidad de pediatría con fiebre e ictericia zona 4, leve retracción torácica inferior y taquipnea. La madre dio positivo para covid-19. En el RN se detectó sepsis neonatal tardía con foco pulmonar. Lo hospitalizaron, y la prueba de antígenos para covid-19 dio como resultado positivo. El estado del RN empeoró rápidamente, lo remitieron a la unidad de cuidados intensivos neonatales (UCIN), donde  requirió intubación y ventilación mecánica controlada por presión. En la segunda semana en la UCIN, desarrolló hipertensión pulmonar grave con disminución de la saturación periférica de oxígeno y taquicardia. El RN requirió transfusión sanguínea, y lo pusieron en posición prona por períodos. El paciente no soportó las reducciones en los parámetros del ventilador mecánico y presentó una hipoxemia progresiva. El RN falleció un mes y tres días después de la hospitalización. Conclusión: Los hallazgos muestran un caso del covid-19 adquirido en la comunidad que progresó a la forma grave de la enfermedad.Justificativa e Objetivos: A coleta de dados sobre a ocorrência de covid-19 em recém-nascidos (RN) não é tão frequente quanto em adultos. Portanto, devido ao baixo número de infecções neonatais por SARS-CoV-2 descritas, relatamos, neste estudo, um caso clínico de infecção por covid-19 em um recém-nascido na comunidade. Métodos: As características clínicas foram coletadas dos prontuários desde abril de 2021 até o último desfecho do RN, em maio de 2021. Resultados: Este artigo abordará um RN do sexo masculino, a termo, com 38 semanas. No 17º dia de vida, o RN deu entrada na unidade pediátrica com quadro de febre e icterícia zona 4, leve retração torácica inferior e taquipneia. A mãe foi diagnosticada com covid-19. Foi detectada sepse neonatal tardia com foco pulmonar. O RN foi internado e o teste de antígeno para covid-19 deu positivo. O quadro do RN regrediu rapidamente, sendo encaminhado à unidade de terapia intensiva neonatal (UTIN), onde foi entubado e adaptado à ventilação mecânica em modo pressão controlada. Na segunda semana de internação na UTIN, desenvolveu hipertensão pulmonar grave com diminuição da saturação periférica de oxigênio e taquicardia. O RN necessitou de transfusão sanguínea e a posição prona foi realizada por períodos. Reduções nos parâmetros do ventilador mecânico não foram toleradas e o RN apresentou hipoxemia progressiva. O RN faleceu um mês e três dias após a internação. Conclusão: Nossos achados apresentam um caso de covid-19 adquirida na comunidade que evoluiu para a forma grave da doença

USE OF PREFABRICATED MANDIBULAR ADVANCEMENT DEVICE FOR TREATMENT OF SLEEP APNEA SYNDROME IN INTERCITY TRANSPORT DRIVER: case report

ABSTRACT   Introduction: In obstructive sleep apnea syndrome (OSAS) there are obstructions in the upper airway that cause desaturations, sleep disorders and an increased risk of involvement in car accidents due to poor sleep quality. The Mandibular Advancement Device (MAD) is one of the therapeutic alternatives for this syndrome. Objective: To evaluate the effects of MAD in an intercity public transport driver with OSAS. Methods: This is a case report of an individual submitted to MAD for a period of eight weeks. The Epworth Sleepiness Scale, the Apnea-Hypopnea Index (AHI) were evaluated using the polysomnographic profile and the quality of life (QoL) using the SF-36 questionnaire. The severity of OSAS was defined by the (AHI in which ≥ 5 and ≤ 15 are classified as mild; moderate when ≥ 15 and < 29; and AHI ≥ 30, severe). Results: There was a reduction in the AHI from moderate to normal (16.0 → 1.8 ev/h), a reduction in the Epworth Sleepiness Scale (5 → 3), an increase in the domains of the QOL questionnaire in the domains of functional capacity (65 → 90), physical limitations (75 → 100), general condition (30 → 35), vitality (50 → 55), emotional aspects (33.33 → 100) and mental health (52 → 76). Conclusion: There was a reduction in the apnea and hypopnea index and sleepiness and increase in quality of life after using a mandibular advancement device in an intercity public transport driver. Keywords: Sleep Apnea, Obstructive; Quality of life; Sleepiness; Dental Research.Introduction: in obstructive sleep apnea syndrome there are obstructions in the upper airway that cause desaturation, sleep disorders and an increased risk of involvement in car accidents due to poor sleep quality. The mandibular advancement device is one of the therapeutic alternatives for this syndrome. Objective: to evaluate the effects of mandibular advancement device in an intercity public transport driver with obstructive sleep apnea syndrome. Methods: this is a case report of an individual submitted to mandibular advancement device for a period of eight weeks. The Epworth Sleepiness Scale, the Apnea-Hypopnea Index were evaluated using the polysomnographic profile, and the quality of life using the SF-36 questionnaire. The severity of obstructive sleep apnea syndrome was defined by the Apnea-Hypopnea Index (mild: ≥ 5 and ≤ 14; moderate: ≥ 15 and ≤ 29; severe: ≥ 30). Results: there was a reduction in the Apnea-Hypopnea Index from moderate to normal (16.0 → 1.8 ev/h), a reduction in the Epworth Sleepiness Scale (5 → 3), an increase in the domains of the quality of life questionnaire in the domains of functional capacity (65 → 90), physical limitations (75 → 100), general condition (30 → 35), vitality (50 → 55), emotional aspects (33 → 100) and mental health (52 → 76). Conclusion: there was a reduction in the severity of obstructive sleep apnea syndrome and sleepiness and an increase in quality of life after the use of the mandibular advancement device by intercity public transport drivers

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research