Neurophthalmological conditions mimicking glaucomatous optic neuropathy: analysis of the most common causes of misdiagnosis

Background: To analyze the most common neurophthalmological conditions that may mimic glaucomatous optic neuropathy and to determine which most often lead to misdiagnosis when evaluated by a glaucoma specialist. Methods: We reviewed the charts of consecutive patients with optic neuropathies caused by neurophthalmological conditions screened in a single Eye Clinic within a period of 24 months. Within these enrolled patients, we selected the eyes whose fundoscopic appearance could resemble glaucoma based in pre-defined criteria (vertical cup-to-disc ratio >= 0.6, asymmetry of the cup-to-disc ratio >= 0.2 between eyes, presence of localized retinal nerve fiber layer and/or neuroretinal rim defects, and disc haemorrhages). Then, color fundus photographs and Humphrey Visual Field tests (HVF) of these eyes were mixed with tests from 21 consecutive glaucomatous patients (42 eyes with normal tension glaucoma). These images were mixed randomly and a masked glaucoma specialist was asked to distinguish if each set of exams was from a patient with glaucoma or with a neurophthalmologic condition. Results: Among the 101 eyes (68 patients) enrolled with neurophthalmological diseases, 16 (15.8%) were classified as conditions that could mimic glaucoma. The most common diagnoses were ischemic optic neuropathy (25%), compressive optic neuropathy (18.7%) and hereditary optic neuropathy (18.7%). Based on the analysis of fundus photographs and HVF tests, 25% of these were misdiagnosed as glaucoma (two ischemic optic neuropathies and two congenital optic disc anomalies). Conversely, 11.9% of the glaucomatous neuropathies were misdiagnosed as neurophthalmological disorders. Overall, the glaucoma specialist correctly diagnosed 84.5% of the eyes. Conclusions: Some neurophthalmological disorders can mimic glaucoma. In our study, isquemic and compressive optic neuropathies were the ones that most often did so. Almost one quarter of the eyes were misdiagnosed when evaluated by a glaucoma specialist, which can lead to inadequate management and influence the prognosis of these patients.Univ Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, BrazilHosp Med Olhos, Glaucoma Unit, Sao Paulo, BrazilUniv Sao Paulo, Dept Ophthalmol, Sao Paulo, BrazilMayo Clin, Dept Ophthalmol, 4500 San Pablo Rd, Jacksonville, FL 32224 USAUniv Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, BrazilWeb of Scienc

Ergoespirometria computadorizada ou calometria indireta: um método não invasivo de crescente valorização na avaliação cardiorrespiratória ao exercício

O desenvolvimento tecnológico de sistemas computadorizados utilizados em ergoespirometria ou calorimetria indireta tem sido de grande valor na avaliação de indivíduos com graus variados de capacidade funcional

Efeitos do treinamento físico específico nas respostas cardiorrespiratórias e metabólicas em repouso e no exercício máximo em jogadores de futebol profissional

The purpose of this investigation was to study the effect of the specific training on the cardiorespiratory and metabolic responses in sixteen male professional soccer players, aged 24.2 ± 3.6 years. They were evaluated before and after fifteen weeks of specific training. All subjects were submitted to an exercise test on treadmill, using the Ellestad’s protocol. The heart rate was recorded by means of ECG, and the arterial blood pressure by auscultatory measurement. Oxygen uptake, carbon dioxide production and pulmonary ventilation were measured by a Measurement Metabolic Cart (Beckman). The maximum anaerobic capacity was evaluated by blood lactate concentration, using an automated analyser. The specific training did not modify the maximum heart rate (192 ± 8 versus 186 ± 6 beats.min-1) and the maximum systolic blood pressure (196 ± 10 versus 198 ± 8 mmHg). The maximum respiratory ventilation was significantly increased by specific training (129 ± 19 versus 140 ± 16 L.min-1), whereas the maximum aerobic capacity was not significantly increased (50 ± 6 versus 53 ± 5 ml.kg.-1min-1 ofO2). On the other hand, the maximum anaerobic capacity improved significantly (8.3± 0 .2 vs 9.8 ± 2.4 mmol.L-1). In conclusion : 1) the specific training used in the present study did not modify the heart rate and arterial blood pressure responses at rest and during maximum exercise; 2) the improvement of maximum pulmonary ventilation and the higher lactic acid concentration during maximum exercise demonstrated that the exercise training used in this study was caracterized by predominantly intense exercise and 3) the specific training was not an adequate stimuli to improve the maximum aerobic capacity of the soccer players.O objetivo deste estudo foi analisar as alterações provocadas pelo treinamento físico específico (TFE) nas respostas cardiorrespiratórias e metabólicas de 16 jogadores de futebol profissional, com média de idade de 24,2 ± 3,6 anos. Todos os atletas foram avaliados antes e depois de quinze semanas de um programa de TFE, durante período competitivo. Os futebolistas foram submetidos a teste máximo em esteira rolante, utilizando-se o protocolo de Ellestad. A resposta de freqüência cardíaca (FC) foi registrada por meio de um eletrocardiógrafo de 3 derivações simultâneas e a pressão arterial (PA), por meio de método auscultatório. A ventilação pulmonar (VE), o consumo de oxigênio (VO2), a produção de dióxido de carbono (VCO2) e a razão de troca respiratória (RER) foram calculados a partir de valores medidos por um sistema espirométrico computadorizado (BECKMAN) e a capacidade anaeróbia máxima, por meio da concentração sanguínea de ácido lático, utilizando-se analisador automático. O TFE não modificou significativamente a FC máxima (192 ± 8 versus 186 ± 6 bpm) e a PA sistólica máxima (196 ± 10 versus 198 ± 8 mmHg). A resposta ventilatória máxima foi significativamente aumentada (129 ± 19 versus 140 ± 16 L .min-1 [p< 0.05]), enquanto a capacidade aeróbia máxima não foi significativamente modificada (50,0 ± 6,0 vs 53,0 ± 5,0 ml.kg.-1min-1) por esse treinamento. Ao contrário, a capacidade anaeróbia máxima aumentou significativamente (8,3 ± 0,2 versus 9,8 ± 2,4 mmol. L-1 [p< 0,05]). Concluiu-se: 1) O TFE não modificou as respostas de FC e PA no repouso e no exercício máximo; 2) A maior VE no exercício máximo associada a elevada concentração sanguínea de ácido lático demonstraram que o TFE utilizado nesse estudo foi caracterizado por exercícios predominantemente intensos e 3) O TFE não representou estímulo adequado para aumentar a capacidade aeróbia máxima dos futebolistas

Perfil de aptidão cardiorrespiratória e metabólica em bailarinos profissionais

The main goal on this investigation was to analyze cardiorespiratory features and metabolic alterations caused by specific dance training in a group of sixteen professional classical ballet dancers, divided into 8 women and 8 men, average aged 18.2 ± 3.8 and 26.2 ± 4.5, respectively. All subjects were submitted to a maximum exercise test on tradmill, using Bruce’s protocol. The cardiorespiratory and metabolic responses were analyzed by a computerized system Metabolic Measurement Cart - MMC Beckman. The following results were found between the male ballet dancers group vs male control group:VO2max. (46 ± 4 vs 43 ± 6 mL.kg-1.min-1 of O2). HRmax.(194 ± 12 vs 202 ± 11 beats.min-1); VEmax. (112 ± 16 vs 123 ± 181.min-1); VO2 at AT (35 ± 4 vs 26 ± 4 ml.kg-1.min-1 of O2 [p < 0,01]); HR at AT (169 ± 18 vs 163 ± 15 beats.min-1). Female ballet dancers group vs female control group: VO2max. (39 ± 6 vs 35 ± 6 ml.kg-1. min-1 of O2); HRmax. (197 ± 10 vs 201 ± 6 beats.min-1); VE max. (72 ± 9 vs 81 ± 6 1.min-1); VO2 at AT (26 ± 4 vs 27 ± 4 m1.kg-1.min-1 of O2); HR at AT (164 ± 10 vs 176 ± 17 beats.min-1). Conclusion: 1) The specific ballet dance training routine does not seem to generate an adequate stimuli to improve the cardiorespiratory and metabolic ballet dancers aptitude and 2) We suggest an additional physical training program to improve ballet dancers physical conditioning.O principal objetivo deste estudo foi analisar aspectos cardiorrespiratórios e metabólicos e as alterações provocadas pelo treinamento específico de dança em umgrupo de 16 bailarinos de balé profissional, modalidade clássico, sendo 8 mulheres e 8 homens, com média de idade de 18,2 ± 3,8 anos e 26,2 ± 4,5 anos, respectivamente. Todos foram submetidos a teste máximo em esteira rolante, utilizando-se o protocolo de Bruce. Foi utilizado, na análise das respostas respiratórias e metabólicas, um sistema computadorizado Metabolic Measurement Cart da Beckman. Os seguintes resultados foram obtidos entre o grupo de balé vs o grupo-controle (masculino): VO2 max. (46 ± 4 vs 43 ± 6 mLO2. kg-1. min-1). FC máx.(194 ± 12 vs 202 ± 11 bpm); VE máx. (112 ± 16 vs 123 ± 181.min-1); VO2-LA (35 ± 4 vs 26 ± 4 mLO2.kg-1.min-1 [p < 0,01]); FC-LA (169 ± 18 vs 163 ± 15 bpm). Grupo de balé vs grupo-controle (feminino): VO2 máx. (39 ± 6 vs 35 ± 6 mLO2. kg-1-.min-1); FC máx. (197 ± 10 vs 201 ± 6 bpm); VE máx. (72 ± 9 vs 81 ± 61.min-1); VO2 -LA (26 ± 4 vs 27 ± 4 mLO2.kg-1.min-1); FC-LA (164 ± 10 vs 176 ± 17 bpm). Conclusões: 1) a rotina específica de dança parece não gerar estímulo suficiente para aprimorar a aptidão cardiorrespiratória e metabólica dos bailarinos, e 2) sugere-se condicionamento físico adicional ao treinamento de balé

Chronic lumbar pain: rehabilitation

This study revised articles from the MEDLINE (PubMed) databases and other research sources, with no time limit. To do so, the search strategy adopted was based on (P.I.C.O.) structured questions (from the initials "Patient"; "Intervention"; "Control" and "Outcome".  With the above keywords crossings were performed according to the proposed theme in each topic of the (P.I.C.O.) questions. After analyzing this material, therapy narrow articles regarding the questions were selected and, by studying those, the evidences that fundamented the directives of this document were established.Este estudo revisou artigos nas bases de dados do MEDLINE (PubMed) e demais fontes de pesquisa sem limite de tempo. Para tanto, adotou-se a estratégia de busca baseada em perguntas estruturadas na forma (P.I.C.O.) das seguintes iniciais: "Paciente"; "Intervençao"; "Controle"; "Outcome". Com esses descritores efetivaram-se cruzamentos de acordo com o tema proposto em cada tópico das perguntas (P.I.C.O.). Analisado esse material, foram selecionado os artigos relativos às perguntas e, por meio do estudo dos mesmos, estabeleceram-se as evidências que fundamentaram às diretrizes do presente documento

Síndrome do manguito rotador: reabilitação

Iniciamos a elaboraçao desta diretriz com a capacitaçao dos autores por meio da metodologia empregada pelo Oxford Centre for Evidence Based Medicine, para elaboraçao de diretrizes clínicas pelo Programa Diretrizes da Associaçao Médica Brasileira (AMB). Foram revisados artigos nas bases de dados do MedLine (PubMed) e outras fontes de pesquisa, sem limite de tempo. A estratégia de busca utilizada baseou-se em perguntas estruturadas na forma P.I.C.O. (das iniciais "Paciente", "Intervençao", "Controle", "Outcome").We began the preparation of this guideline with the training of the authors using the methodology employed by the Oxford Centre for Evidence-Based Medicine, for the development of clinical guidelines for the Programa Diretrizes da Associaçao Médica Brasileira-AMB (Brazilian Medical Association's Guideline Program-BMA). Articles were reviewed from the MEDLINE (PubMed) database and other research sources, on an open-ended basis. The search strategy used was based on structured questions in the P.I.C.O. form (from the initials of "Patient", "Intervention", "Control", and "Outcome")

Como as mães colocam seus bebês no berço para dormir? : um estudo sobre conhecimentos e hábitos quanto ao posicionamento de lactentes no berço e uma estratégia educativa associada (projeto piloto)

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Physical Model Tests on Spar Buoy for Offshore Floating Wind Energy Conversion

ABSTRACT: The present paper describes the experiences gained from the design methodology and operation of a 3D physical modelexperiment aimed to investigate the dynamic behaviour of a spar buoy floating offshore wind turbine. The physical model consists in a Froude-scaled NREL 5MW reference wind turbine (RWT) supported on the OC3-Hywind floating platform. Experimental tests have been performed at Danish Hydraulic Institute (DHI) offshore wave basin within the European Union-Hydralab+ Initiative, in April 2019. The floating wind turbine model has been subjected to a combination of regular and irregular wave attacks and different wind loads. Measurements of displacements, rotations, accelerations, forces response of the floating model and at the mooring lines have been carried out. First, free decay tests have been analysed to obtain the natural frequency and the modal damping ratios of each degree of freedom governing the offshore. Then, the results concerning regular waves, with orthogonal incidence to the structure, are presented. The results show that most of longitudinal dynamic response occurs at the wave frequency and most of lateral dynamic response occurs at rigid-body frequencies.This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 654110, HYDRALAB+