Avaliação funcional de idoso vítima de fraturas na hospitalização e no domicílio Evaluación funcional del anciano víctima de fracturas en la hospitalización y en el domicilio Functional evaluation of aged with fractures at hospitalization and at home

O trauma frequentemente está associado à incapacidade funcional, tornando-se uma importante questão social, econômica e de saúde. O estudo busca avaliar a independência funcional de idosos com fratura, na admissão, alta, e após um mês em domicílio, e também verificar suas relações com as variáveis demográficas e de saúde. Trinta e quatro idosos hospitalizados no Instituto de Ortopedia e Traumatologia do HCFMUSP foram entrevistados e submetidos à aplicação da Medida de Independência Funcional (MIF). Das fraturas, 67,6% eram de fêmur. Os valores da MIF motora e total aumentaram na alta; já os valores da MIF total diminuíram após um mês em domicílio. A incapacidade funcional aumentou com a idade e para um maior número de dias de internação. O hipotireoidismo foi associado à incapacidade cognitiva, ao passo que a demência e a depressão foram associadas à incapacidade motora.<br>El trauma es frecuentemente asociado con la incapacidad funcional, convirtiéndose en un importante tema social, económico y de salud. El estudio busca evaluar la independencia funcional de ancianos con fracturas en la admisión, al momento del alta y después de un mes en domicilio, incluso así como verificar sus relaciones con las variables demográficas y de salud. Treinta y cuatro ancianos hospitalizados en el Instituto de Ortopedia y Traumatología del HCFMUSP fueron entrevistados y sometidos a la aplicación de la Medida de Independencia Funcional (MIF). Las fracturas fueron del fémur en un 67,6%. Los valores de la MIF motora y total aumentaron para el momento del alta; ya los valores de la MIF total disminuyeron después de un mes en domicilio. La incapacidad funcional aumentó con la edad, haciendo necesario un mayor número de días de hospitalización. El hipotiroidismo se asoció a la incapacidad cognitiva, mientras que la demencia y la depresión se asociaron a la incapacidad motriz.<br>Trauma is often related to functional impairment, representing an important social, economic and health issue. This study intended to evaluate the functional independence of aged individuals with fractures, at admission, discharge and after one month from their regressing home. Furthermore, this study also intended to verify the relationship between functional independence and demographic and health variables. Thirty-four aged individuals hospitalized at the Orthopedics and Traumatology Institute of the University of São Paulo Faculty of Medicine were interviewed and submitted to the application of the Functional Independence Measure (FIM). Among all fractures, 67.6% were femur fractures. The motor and total FIM scores increased at discharge; on the other hand, the total FIM score decreased one month after their returning home. Functional impairment increased with age and also with longer length of stay. Hypothyroidism was related to cognitive impairment, while dementia and depression were related to motor impairment

Prevalence of mutations related to HIV-1 antiretroviral resistance in Brazilian patients failing HAART

Background: Current guidelines for antiretroviral (ARV) therapy recommend at least triple-drug combination, the so-called highly active antiretroviral therapy (HAART). Not all patients respond to HAART and the development of drug resistance remains one of the most serious obstacles to sustained suppression of HIV. Objective: in an attempt to correlate the HIV therapeutic failure with reverse transcriptase (RT) and protease resistance mutations, we describe the ARV resistance profile in patients failing HAART in Brazil. We studied 267 Brazilian HIV-1 infected patients failing HAART looking for mutations in RT and protease genes. the mutation profile of the viruses infecting these individuals were deduced and correlated to laboratorial parameters. Study Design: Two different HIV-1 genomic regions were targeted for PCR amplification, the protease (pro) and pal RT (palm finger region) genes. the mutations related to drug resistance in RT gene was analyzed using a line probe assay (LIPA(R)) and pro amino acids positions 82 and 90 were screened through RFLP using HincII restriction digestion. Results: There was strong correlation between the mutation in the pro and RT genes and therapeutic failure. the main mutation found in RT gene was the M184V (48%) followed by T69D/N (47%), T215Y/F (46%), M41L (39%), and L74V (7%). in the pro gene the main mutation found was L90M (26%) followed by dual substitution in L90M and V82A (6%). All mutations profiles matched very well with the patients drug regimen. Conclusions: This study has shown that 84.7% of HIV infected subjects failing HAART for more than 3 months presented viral genomic mutations associated with drug resistance. (C) 2002 Elsevier Science B.V. All rights reserved.Univ Fed Rio de Janeiro, CCS, Inst Biol, Dept Genet,Lab Virol Mol, BR-21944970 Rio de Janeiro, BrazilBrazilian Minist Hlth, Programa Brasileiro AIDS STD, Brasilia, DF, BrazilFiocruz MS, Inst Oswaldo Cruz, Lab Imunol, BR-21045900 Rio de Janeiro, BrazilUniv Fed Rio de Janeiro, Hosp Univ Clementino Fraga Filho, Lab Petrobras, BR-21944970 Rio de Janeiro, BrazilUniv Fed Espirito Santos, Vitoria, ES, BrazilUniv Brasilia, Virol Lab, Brasilia, DF, BrazilLab Cent Saude Publ, Recife, PE, BrazilUniv Fed Estado São Paulo, Lab Retrovirol, São Paulo, BrazilUniv São Paulo, Dept Epidemiol, São Paulo, BrazilLab Cent Saude Publ, Florianopolis, SC, BrazilUniv Fed Santa Catarina, Florianopolis, SC, BrazilUniv Fed Estado São Paulo, Lab Retrovirol, São Paulo, BrazilWeb of Scienc