Physical activity practice during COVID-19 pandemic in patients with intermittent claudication

OBJECTIVE: To describe physical activity habits and barriers for physical activity practice in patients with peripheral artery disease and claudication symptoms during Coronavirus 2019 (COVID-19) pandemic. METHODS: In this cross-sectional survey study, 127 patients with peripheral artery disease (59.8% men; 68±9 years old; and 81.9% had the peripheral artery disease diagnosis ≥5 years old) were included. The physical activity habits and barriers for physical activity practice were assessed through telephone interview using a questionnaire with questions related to: (a) COVID-19 personal care; (b) overall health; (c) physical activity habits; (d) for those who were inactive, the barriers for physical activity practice. RESULTS: Only 26.8% of patients reported practicing physical activity during the COVID-19 pandemic. Exercise characteristics more common among these patients include walking, performed at least 5 days a week, during 31–60 min at light intensity. In contrast, among physically inactive patients, pain, injury or disability (55%), the COVID-19 pandemic (50%), the need to rest due to leg pain (29%), and lack of energy (27%) were the most frequent barriers to physical activity practice. CONCLUSION: The physical activity level of patients with peripheral artery disease is impacted by the COVID-19 pandemic

URINARY INCONTINENCE IN WOMEN: RISK FACTORS ACCORDING TO TYPE AND SEVERITY

Objetivo: verificar factores asociados con la incontinencia urinaria en mujeres, por tipo y porgravedad.Metodología: estudio transversal realizado entre noviembre de 2018 y abril de 2019 con30 mujeres en un hospital escuela de Pernambuco. Se utilizó el instrumento Gaudenz-Fragebogen para identificar los tipos de incontinencia y el Incontinence Severity Index paraclasificar la gravedad de la pérdida de orina. Se utilizó la prueba exacta de Fisher para analizarlas variables cualitativas, y el t-Student para las variables racionales.Resultados: la incontinencia urinaria por esfuerzo fue el tipo más frecuente (66,7%), en su formamoderada (43,3%) y estuvo asociada a un bajo nivel de escolaridad (p<0,001), a un Índicede Masa Corporal de 28,6 (p=0,043), a una circunferencia abdominal de 103,4 (p<0,001),diabetes (p<0,001), cantidad de partos superior a 4 (p=0,046), cirugía ginecológica (p=0,023)y a la falta de actividad física (p=0,001).Consideraciones finales: identificar el tipo, la gravedad y los principales factores de riesgomodificables podrá ayudar a diseñar intervenciones preventivas y curativas más eficientes yefectivas.Objetivo: verificar fatores associados a incontinência urinária em mulheres por tipo e gravidade.Metodologia: estudo transversal, realizado de novembro de 2018 a abril de 2019, com 30 mulheres em um hospital escola de Pernambuco. Foi utilizado o instrumento Gaudenz-Fragebogen para identificar os tipos de incontinência e o Incontinence Severity Index para classificar a gravidade da perda urinária. Utilizou-se o teste Exato de Fisher para analisar variáveis qualitativas e t-Student para variáveis racionais.Resultados: incontinência urinária de esforço foi o tipo mais frequente (66,7%), na forma moderada (43,3%) e esteve associada a baixa escolaridade (p<0,001), índice de massa corporal de 28,6 (p=0,043), circunferência abdominal de 103,4 (p<0,001), diabetes (p<0,001), número de partos superior a 4 (p=0,046), cirurgia ginecológica (p=0,023) e falta de atividade física (p=0,001).Considerações Finais: a identificação do tipo, da gravidade e dos principais fatores de risco modificáveis poderá subsidiar intervenções preventivas e curativas mais eficientes e efetivas.Objective: To verify factors associated with urinary incontinence in women by type and severity.Methodology: A cross-sectional study conducted from November 2018 to April 2019 with30 women in a teaching hospital of Pernambuco. The Gaudenz-Fragebogen instrument wasused to identify incontinence types, and the Incontinence Severity Index to classify urinaryloss severity. Fisher’s exact test was used to analyze qualitative variables, and the t-Studenttest for rational variables.Results: Stress-induced urinary incontinence was the most frequent type (66.7%), in itsmoderate form (43.3%), and was associated with low schooling (p<0.001), Body Mass Indexof 28.6 (p=0.043), abdominal circumference of 103.4 (p<0.001), diabetes (p<0.001), numberof deliveries above 4 (p=0.046), gynecological surgery (p=0.023), and lack of physical activity(p=0.001).Final Considerations: Identifying the type, severity, and main modifiable risk factors maysupport more effective and efficient preventive and curative interventions

Health and lifestyle parameters in peripheral artery disease at two periods of the COVID-19 pandemic: comparison between men and women

ABSTRACT Objective: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. Results: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. Conclusion: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease

Covid-19 em pacientes oncológicos: perfil nutricional e desfecho clinico / Covid-19 in cancer patients: nutritional profile and clinical outcome

INTRODUÇÃO: A Coronavírus disease (COVID-19) é uma doença causada pelo Coronavírus, cuja a transmissão ocorre principalmente por meio de gotículas respiratórias. Dados clínicos e epidemiológicos expõem que comorbidades específicas aumentam o risco de infecção, lesão pulmonar e morte. Pacientes oncológicos correspondem a um grupo populacional vulnerável em apresentar a forma grave da doença. OBJETIVOS: Descrever estado nutricional e o desfecho clínico de pacientes oncológicos com COVID-19. METODOLOGIA: Estudo transversal retrospectivo e prospectivo, realizado com ficha de acompanhamento nutricional de pacientes oncológicos, diagnosticados com COVID-19. Foram coletadas variáveis demográficas e estilo de vida, variáveis clinicas, variáveis antropométricas, e dados referentes as principais sintomatologias associadas ao COVID-19.  RESULTADOS:  A amostra foi composta por 23 pacientes de ambos os sexos. O tipo de câncer mais prevalente foi o do trato gastrointestinal e mais da metade da de amostra estava em tratamento quimioterápico. Apresentaram faltar de ar e tosse como principal sintoma apresentado (30,4%), e a maioria necessitou de suporte intensivo. Quando avaliado o estado nutricional, observamos a prevalência de 47,8% de excesso de peso, em contrapartida, 65% dos pacientes referiram perda de peso em 3 meses, caracterizando uma perda de peso grave. CONCLUSÃO: O estudo demonstrou que pacientes com maiores médias de IMC apresentaram necessidade de cuidados intensivos no tratamento da infecção por COVID-19, que pode ser justificado pelo processo inflamatório no paciente obeso

ANÁLISE COMPARATIVA DO USO DE LISDEXANFETAMINA E DE METILFENIDATO NO TRATAMENTO DO TDAH

&nbsp; Considering the increasing prevalence of Attention Deficit Hyperactivity Disorder (ADHD) and the need for effective and safe therapeutic interventions, this research aimed to conduct a comparative analysis between lisdexamfetamine and methylphenidate in the treatment of ADHD. To this end, a comprehensive qualitative literature review was conducted, using sources such as Scielo, Google Scholar, scientific journals, institutional repositories, and virtual libraries, without specific time period limitations. Thus, it was observed that both medications demonstrated efficacy in reducing ADHD symptoms. Lisdexamfetamine showed a more prolonged and consistent effect on dopaminergic neurotransmission and a potentially more favorable side effect profile, with fewer reports of severe adverse effects compared to methylphenidate. Methylphenidate, in turn, showed significant efficacy, especially in the short term. It is concluded that both lisdexamfetamine and methylphenidate are valid therapeutic options for the treatment of ADHD, with specific advantages in different clinical contexts. The choice between these medications should consider the individual characteristics of patients and the available evidence of efficacy and safety, contributing to the optimization of treatment and the improvement of the quality of life of patients with ADHD.Considerando a crescente prevalência do Transtorno de Déficit de Atenção e Hiperatividade (TDAH) e a necessidade de intervenções terapêuticas eficazes e seguras, esta pesquisa objetivou realizar uma análise comparativa entre lisdexanfetamina e metilfenidato no tratamento do TDAH. Para tanto, procedeu-se a uma revisão bibliográfica qualitativa abrangente, utilizando fontes como Scielo, Google Acadêmico, revistas científicas, repositórios institucionais e bibliotecas virtuais, sem limitação de período específico. Desse modo, observou-se que ambos os medicamentos demonstraram eficácia na redução dos sintomas do TDAH. A lisdexanfetamina apresentou um efeito mais prolongado e consistente na neurotransmissão dopaminérgica e um perfil de efeitos colaterais potencialmente mais favorável, com menos relatos de efeitos adversos graves em comparação ao metilfenidato. O metilfenidato, por sua vez, mostrou eficácia significativa, especialmente em curto prazo. Conclui-se que tanto a lisdexanfetamina quanto o metilfenidato são opções terapêuticas válidas para o tratamento do TDAH, com vantagens específicas em diferentes contextos clínicos. A escolha entre esses medicamentos deve considerar as características individuais dos pacientes e as evidências de eficácia e segurança disponíveis, contribuindo para a otimização do tratamento e a melhoria da qualidade de vida dos pacientes com TDAH

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 &lt;= 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

Diretrizes para o tratamento e acompanhamento periodontal durante o tratamento ortodôntico

The aim of this paper was to search though a revision of the literature the cares before, during and after the orthodontic treatment in patients with a periodontal disease. The literature shows that the orthodontical treatment in healthy patients brings no risk to the periodontium, although the presence of an active periodontal disease counter indicates the dental movement. Thus, it is extremely important to execute a correct diagnosis of any periodontal alteration and treat them before the beginning of the orthodontical treatment. Besides, during the whole orthodontical treatment is also important to have a periodontal control with periodic reevaluations and at the end of the orthodontical treatment, a new oral hygiene orientation may be needed to finally establish the follow-up of the patient according to the risk of periodontal disease.Objetivo deste trabalho foi, através de uma revisão da literatura, ressaltar os cuidados antes, durante e depois do tratamento ortodôntico em pacientes com doença periodontal. Diante da literatura exposta, foi possível verificar que o tratamento ortodôntico em pacientes saudáveis não traz nenhum risco ao periodonto, mas a presença de doença periodontal ativa contraindica a movimentação dentária. Por isso, é extremamente importante antes de iniciar a terapia ortodôntica, executar um diagnóstico correto das alterações periodontais e tratá-las; e durante toda a terapia ortodôntica, ter um controle periodontal com reavalia- ções periódicas. Além disso, ao final do tratamento ortodôntico, aconselha-se fazer uma nova orientação de higiene oral e estabelecer a manutenção de acordo com a exposição aos fatores de riscos do paciente a doença periodontal

Avaliação comparativa in vivo da eficácia do óleo de melaleuca, clorexidina e listerine sobre streptococcus mutans e microrganismos totais na saliva

Objective: To compare the efficacy of the mouthwashes 0.12% chlorhexidine, Listerine, and 0.5% and 2% Melaleuca Alternifolia oil against the salivary levels of Streptococcus mutans and total microorganisms. Methods: This study was double-blind controlled and paired clinical assay. Twenty-six volunteers aged 21 to 35 years old were enrolled. At baseline, 1 mL of unstimulated saliva was collected from each subject, 1 and 15 min after mouthrinsing with the following solutions: sterile distilled water, 0.12% chlorhexidine digluconate, Listerine (©Johnson & Johnson do Brasil), 0.5% and 2% concentrations of Melaleuca Alternifolia (Sigma-Aldrich). The volunteers used all the evaluated mouthrinses with a 15-day interval between the solutions. Immediately after rinsing, saliva was collected and serial dilutions were performed, followed by plating in blood agar culture medium for growth of total microorganisms and SB-20 (Sucrose-Bacitracin agar) for growth of S. mutans, and incubation at 37 °C for 48 h in microaerophilia. After incubation, the number of colonies was counted and expressed as colony forming units (UFC/mL). Results: Chlorhexidine showed antimicrobial action by reducing total microorganisms and S. mutans, while the action of 0.5% Melaleuca Alternifolia was similar to that of distilled water. Listerine and 2% Melaleuca Alternifolia oil reduced total microbial counts by 11% and 9% respectively, and S. mutans by 20% and 11%. Conclusion: A single rinse with 0.12% chlorhexidine is effective in reducing the levels of total microorganisms and S. mutans present in saliva. Under the same testing conditions, Listerine and 0.5% and 2% Melaleuca Alternifolia oil presented lower efficacy than chlorhexidine.Objetivo: Comparar a eficácia dos enxaguatórios bucais: clorexidina 0,12%, Listerine e óleo de Melaleuca Alternifolia 0,5% e 2% sobre os níveis salivares de Streptococcus mutans e microrganismos totais. Métodos: O estudo foi um ensaio clínico, controlado, duplo cego e emparelhado. Para tanto foram selecionados 26 voluntários com idade entre 21 - 35 anos. Foi coletada de cada participante, no baseline, a quantidade de 1 mL de saliva não estimulada, 1 e 15 min após os bochechos com as seguintes soluções: água destilada estéril, digluconato de clorexidina 0,12%, Listerine (©Johnson & Johnson do Brasil), Melaleuca Alternifolia (Sigma-Aldrich St Louis, MO, USA) nas concentrações de 0,5% e 2%. Os participantes fizeram uso de todos os enxaguatórios bucais pesquisados, com intervalo de 15 dias entre cada solução. Imediatamente após o bochecho, foi coletada a saliva e realizadas as diluições seriadas, seguidas de plaqueamento em meio de cultura Agar sangue para o crescimento de microrganismos totais e SB- 20 (Agar Sacarose Bacitracina) para S. mutans, mantidos por 48h a 37°C em microaerofilia. Após o período de incubação, as colônias foram contadas e transformadas em unidades formadoras de colônias (UFC/mL). Resultados: A clorexidina mostrou ação antimicrobiana na redução dos microrganismos totais e S. mutans, enquanto a ação do óleo Melaleuca Alternifolia 0.5% foi semelhante à água destilada. O listerine e o óleo Melaleuca Alternifolia 2% apresentaram redução microbiana, respectivamente, de 11% e 9% para microrganismos totais, entretanto para S. mutans o listerine reduziu os níveis em 20% e o óleo Melaleuca Alternifolia 2% em 11%. Conclusão: O bochecho único com clorexidina 0,12% é eficaz na redução de níveis de microrganismos totais e S. mutans presentes na saliva. Ao comparar a clorexidina com o listerine e óleo Melaleuca Alternifolia 0,5% e 2% nas mesmas condições a eficácia da ação destas soluções é diminuída

Impact of the COVID-19 pandemic on health lifestyle in patients with peripheral artery disease: A cross-sectional study

Background: Social isolation has been one of the main strategies to prevent the spread of Coronavirus 2019 (COVID-19). However, the impact of social isolation on the lifestyle of patients with peripheral artery disease (PAD) and claudication symptoms remains unclear. Objectives: To analyze the perceptions of patients with PAD of the impact of social isolation provoked by COVID-19 pandemic on health lifestyle. Design: Cross-sectional. Setting: The database of studies developed by our group involving patients with PAD from public hospitals in São Paulo. Methods: In this cross-sectional survey study, 136 patients with PAD (61% men, 68 ± 9 years old, 0.55 ± 0.17 ankle-brachial index, 82.4% with a PAD diagnosis ≥5 years old) were included. Health lifestyle factors were assessed through a telephone interview using a questionnaire containing questions related to: (a) COVID-19 personal care; (b) mental health; (c) health risk habits; (d) eating behavior; (e) lifestyle; (f) physical activity; (g) overall health; and (h) peripheral artery disease health care. Results: The majority of patients self-reported spending more time watching TV and sitting during the COVID-19 pandemic and only 28.7% were practicing physical exercise. Anxiety and unhappiness were the most prevalent feelings self-reported among patients and 43.4% reported a decline in walking capacity. Conclusion: Most patients with PAD self-reported increased sedentary behavior, lower physical activity level, and worse physical and mental health during the COVID-19 pandemic. Thus, it is necessary to adopt strategies to improve the quality of life of these patients during this period