Tradução e adaptação cultural do Duke activity status index para a língua portuguesa

INTRODUCTION: The limited number of valid and reliable questionnaires for the evaluation of exercise tolerance has stimulated the development of simple international assessment tools for this purpose, one of the most widely used of which is the Duke Activity Status Index (DASI). However, this index has not yet been translated and adapted to the Portuguese language. OBJECTIVE: To develop a Brazilian version of the DASI and cross-culturally adapt it for the evaluation of cardiorespiratory fitness among patients with cardiovascular disease in Brazil. MATERIALS AND METHODS: The translation process involved four stages: initial translation, back-translation, multidisciplinary committee review and pre-test with 16 subjects (8 cardiac patients and 8 healthy individuals). Patients were screened from outpatient Cardiac Surgery, São Paulo Hospital. The Mann-Whitney and chi-square tests were employed to determine differences between controls and individuals with heart disease. RESULTS: The sample was characterized by individuals aged ≥ 50 years who were mainly from the southeastern region of Brazil (62.5%) and were non-smokers (56.2%). Less than half of the cohort was considered physically active (43.75%). The level of non-understanding was less than 10% of the sample. Doubts were prevalent among individuals with heart disease (75%) regarding the level of fatigue caused when performing a task. CONCLUSION: The present findings demonstrate that the DASI was successfully translated and adapted to Brazilian Portuguese.INTRODUÇÃO: A limitação quanto ao uso rotineiro e em escala populacional dos métodos de maior acurácia para avaliação da capacidade incentivou o desenvolvimento de questionários de estimativa. O questionário Duke Activity Status Index (DASI) é um dos mais utilizados, no entanto ainda não traduzido e adaptado para língua portuguesa. OBJETIVO: Desenvolver uma versão brasileira do DASI e adaptá-lo culturalmente para avaliação da capacidade cardiorrespiratória de cardiopatas no Brasil. MATERIAIS E MÉTODOS: Foram realizadas quatro etapas metodologicamente recomendadas para esta finalidade: tradução inicial, tradução reversa, revisão por comitê multidisciplinar e pré-teste de verificação com 16 indivíduos (oito cardiopatas e oito saudáveis). Os pacientes foram triados no ambulatório da Cirurgia Cardíaca do Hospital São Paulo. Para verificar as possíveis diferenças entre os indivíduos saudáveis e cardiopatas foram utilizados os testes α Mann-Whitney ou qui-quadrado. RESULTADOS: A amostra foi caracterizada por indivíduos procedentes da região Sudeste (62,5%), não tabagistas (56,2%), ativos (43,75%) e com idade ≥ 50 anos. O nível de não compreensão aceitável foi de até 10% dos entrevistados. As dúvidas foram predominantes nos cardiopatas (75%) em relação ao grupo saudável (12,5%), sendo concentradas na consideração ou não do nível de cansaço para realizar a tarefa. CONCLUSÃO: Os resultados demonstram que o DASI foi satisfatoriamente traduzido e adaptado para a lingua portuguesa.Brasília UniversityFederal University of São Paulo Sector of Cardiovascular SurgeryNove de Julho UniversityUniversity of Illinois Chicago College of Applied Health Sciences University of Illinois ChicagoBrasília University Physical Therapy CourseUNIFESP, Sector of Cardiovascular SurgerySciEL

Relevância clínica em não fi brose cística bronquiectasia seguida em uma prática real

INTRODUCTION: Bronchiectasis is a chronic disorder characterized by permanent dilation of the bronchi and bronchioles accompanied by inflammatory changes in the walls of these structures and adjacent lung parenchyma. OBJECTIVE: The aim of the present study was to perform a clinical and functional characterization of adult patients with non-cystic fibrosis bronchiectasis. METHODS: A clinical, descriptive, retrospective, case-series study was carried out involving 232 patients with non-cystic fibrosis bronchiectasis treated at a lung ambulatory between 2004 and 2012. RESULTS: The sample consisted of 232 patients (134 females; mean age: 52.9 years ± 17.7; body mass index: 23.5 kg/m² ± 4.4). The predominant symptoms were cough (91.4%), expectoration (85.8%) and dyspnea (76.3%). The majority of cases were of a non-tuberculosis etiology (64.7%). Regarding lung function, the obstructive breathing pattern was predominant (43.5%). The most common comorbidities were of a cardiovascular origin (51.0%). CONCLUSIONS: Adult patients with non-cystic fibrosis bronchiectasis (mainly post-infection or post-tuberculosis in origin) are characterized by a low educational level, excessive cough, sputum, dyspnea, muscle fatigue, an obstructive breathing pattern with frequent hypoxemia and multiple comorbidities, mainly of a cardiovascular origin. However, our patients have a low index of exacerbations and hospitalizations that can be assigned to a clinical protocol for monitoring.INTRODUÇÃO: Bronquiectasia é uma doença crônica caracterizada pela dilatação permanente dos brônquios e bronquíolos acompanhada por alterações inflamatórias nas paredes dessas estruturas e parênquima pulmonar adjacente. OBJETIVO: O objetivo do presente estudo é realizar uma caracterização clínica e funcional de pacientes adultos com bronquiectasias e fibrose não cística. Métodos: Um estudo clínico descritivo e retrospectivo foi realizado com pacientes com bronquiectasias e fibrose não cística atendidos em um ambulatório de pulmão entre 2004 e 2012. RESULTADOS: A amostra foi composta por 232 pacientes (134 mulheres, idade média: 52,9 anos ± 17,7, índice de massa corporal: 23,5 ± 4,4 kg/m2). Os sintomas predominantes foram tosse (91,4%), expectoração (85,8%) e dispneia (76,3%). A maioria dos casos foi de etiologia não tuberculosa (64,7%). Em relação à função pulmonar, o padrão de respiração obstrutiva foi predominante (43,5%). As comorbidades mais comuns foram de origem cardiovascular (51,0%). CONCLUSÕES: pacientes adultos com bronquiectasias de fibrose não cística (principalmente pós-infecção ou pós-tuberculose de origem) são caracterizados por um baixo nível de escolaridade, tosse excessiva, expectoração, dispneia, fadiga muscular, um padrão de respiração obstrutiva com hipoxemia frequente e múltiplas comorbidades, essencialmente de origem cardiovascular. No entanto, nossos pacientes têm um baixo índice de exacerbações e hospitalizações que podem ser atribuídos a um protocolo clínico para o acompanhamento.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Nove de JulhoUniversidade Federal de São Paulo (UNIFESP) Center for Pulmonary Rehabilitation, Pulmonology DepartmentUniversity of Fortaleza Medicine SchoolUniversidade Federal de São Paulo (UNIFESP) Pulmonology DepartmentUNIFESP, Center for Pulmonary Rehabilitation, Pulmonology DepartmentUNIFESP, Pulmonology DepartmentSciEL

Effect of low-level laser therapy on pain, quality of life and sleep in patients with fibromyalgia: study protocol for a double-blinded randomized controlled trial

BACKGROUND: Low-level laser therapy (LLLT) has been widely used as adjuvant strategy for treatment of musculoskeletal disorders. The light-tissue interaction (photobiostimulation) promotes analgesic and anti-inflammatory effects and improves tissue healing, which could justify the recommendation of this therapy for patients with fibromyalgia, leading to an improvement in pain and possibly minimizing social impact related to this disease. The present study proposes to evaluate the effect of LLLT on tender points in patients with fibromyalgia, correlating this outcome with quality of life and sleep. METHODS/DESIGN: One hundred and twenty patients with fibromyalgia will be treated at the Integrated Health Center and the Sleep Laboratory of the Post Graduate Program in Rehabilitation Sciences of the Nove de Julho University located in the city of Sao Paulo, Brazil. After fulfilling the eligibility criteria, a clinical evaluation and assessments of pain and sleep quality will be carried out and self-administered quality of life questionnaires will be applied. The 120 volunteers will be randomly allocated to an intervention group (LLLT, n = 60) or control group (CLLLT, n = 60). Patients from both groups will be treated three times per week for four weeks, totaling twelve sessions. However, only the LLLT group will receive an energy dose of 6 J per tender point. A standardized 50-minute exercise program will be performed after the laser application. The patients will be evaluated regarding the primary outcome (pain) using the following instruments: visual analog scale, McGill Pain Questionnaire and pressure algometry. The secondary outcome (quality of life and sleep) will be assessed with the following instruments: Medical Outcomes Study 36-item Short-Form Health Survey, Fibromyalgia Impact Questionnaire, Berlin Questionnaire, Epworth Sleepiness Scale and polysomnography. ANOVA test with repeated measurements for the time factor will be performed to test between-groups differences (followed by the Tukey-Kramer post hoc test), and a paired t test will be performed to test within-group differences. The level of significance for the statistical analysis will be set at 5% (P ≤0.05). TRIAL REGISTRATION: The protocol for this study is registered with the Brazilian Registry of Clinical Trials – ReBEC (RBR-42gkzt

General Characteristics and Risk Factors of Cardiovascular Disease among Interstate Bus Drivers

Workers in the transportation industry are at greater risk of an incorrect diet and sedentary behavior. The aim of our study was to characterize a population of professional bus drivers with regard to clinical and demographic variables, lipid profile, and the presence of cardiovascular risk factors. Data from 659 interstate bus drivers collected retrospectively, including anthropometric characteristics, systolic and diastolic blood pressure, lipid profile, fasting blood glucose, meatoscopy, and audiometry. All participants were male, with a mean age of 41.7 ± 6.9 years, weight of 81.4 ± 3.3 kg, and BMI 27.2 ± 3.3 Kg/m2; the mean abdominal and neck circumferences were 94.4 ± 8.6 cm and 38.9 ± 2.2  cm; 38.2% of the sample was considered hypertensive; mean HDL cholesterol was 47.9 ± 9.5 mg/dL, mean triglyceride level was 146.3 ± 87.9 mg/dL, and fasting glucose was above 100 mg/dL in 249 subjects (39.1%). Drivers exhibited reduced audiometric hearing at 4–8 kHz, being all sensorineural hearing loss. The clinical characterization of a young male population of interstate bus drivers revealed a high frequency of cardiovascular risk factors, as obesity, hypertension, hyperlipidemia, and hyperglycemia, as well as contributing functional characteristics, such as a low-intensity activity, sedentary behavior, long duration in a sitting position, and high-calorie diet, which lead to excessive weight gain and associated comorbidities

Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial

Background: The project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning. Methods/design A prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test. Discussion This paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population. Trial registration ReBEC RBR-9B5DH

Low-Level Laser Therapy Reduces Lung Inflammation in an Experimental Model of Chronic Obstructive Pulmonary Disease Involving P2X7 Receptor

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by irreversible airflow limitation, airway inflammation and remodeling, and enlargement of alveolar spaces. COPD is in the top five leading causes of deaths worldwide and presents a high economic cost. However, there are some preventive measures to lower the risk of developing COPD. Low-level laser therapy (LLLT) is a new effective therapy, with very low cost and no side effects. So, our objective was to investigate if LLLT reduces pulmonary alterations in an experimental model of COPD. C57BL/6 mice were submitted to cigarette smoke for 75 days (2x/day). After 60 days to smoke exposure, the treated group was submitted to LLLT (diode laser, 660 nm, 30 mW, and 3 J/cm(2)) for 15 days and euthanized for morphologic and functional analysis of the lungs. Our results showed that LLLT significantly reduced the number of inflammatory cells and the proinflammatory cytokine secretion such as IL-1 beta, IL-6, and TNF-alpha in bronchoalveolar lavage fluid (BALF). We also observed that LLLT decreased collagen deposition as well as the expression of purinergic P2X7 receptor. On the other hand, LLLT increased the IL-10 release. Thus, LLLT can be pointed as a promising therapeutic approach for lung inflammatory diseases as COPD.Sao Paulo Research Foundation (FAPESP) [2012/16498-5, 2012/15165-2]FAPESP [2015/23152-6, 2014/14604-8, 2015/13486-4]Univ Nove Julho UNINOVE, Post Grad Program Biophoton Appl Hlth Sci, Sao Paulo, SP, BrazilBrazilian Inst Teaching & Res Pulm & Exercise Imm, Sao Jose Dos Campos, SP, BrazilUniv Nove Julho UNINOVE, Masters Degree & PhD Program Rehabil Sci, Expt Cardioresp Physiol Lab, Sao Paulo, SP, BrazilUniv Calif San Diego UCSD Hlth Sci, Div Trauma Surg Crit Care Burns & Acute Care Surg, Dept Surg, San Diego, CA USAFed Univ Sao Paulo UNIFESP, Inst Sci & Technol, Sao Jose Dos Campos, SP, BrazilUniv Brasil, Postgrad Program Bioengn, Sao Paulo, SP, BrazilFed Univ Sao Paulo UNIFESP, Postgrad Program Sci Human Movement & Rehabil, Santos, SP, BrazilFed Univ Sao Paulo UNIFESP, Inst Sci & Technol, Sao Jose Dos Campos, SP, BrazilFed Univ Sao Paulo UNIFESP, Postgrad Program Sci Human Movement & Rehabil, Santos, SP, BrazilFAPESP [2012/16498-5, 2012/15165-2]FAPESP [2015/23152-6, 2014/14604-8, 2015/13486-4]Web of Scienc

Assessment of the Body Composition and the Loss of Fat-Free Mass through Bioelectric Impedance Analysis in Patients Who Underwent Open Gastric Bypass

Background. Bariatric surgery is considered an effective option for the management of morbid obesity. The incidence of obesity has been gradually increasing all over the world reaching epidemic proportions in some regions of the world. Obesity can cause a reduction of up to 22% in the life expectancy of morbidly obese patients. Objective. The objective of this paper is to assess the weight loss associated with the first 6 months after bariatric surgery using bioelectric impedance analysis (BIA) for the evaluation of fat mass and fat-free mass. Method. A total of 36 morbidly obese patients were subjected to open gastric bypass surgery. The patients weight was monitored before and after the procedure using the bioelectric impedance analysis. Results. Bariatric surgery resulted in an average percentage of weight loss of 28.6% (40 kg) as determined 6 months after the procedure was performed. Analysis of the different components of body weight indicated an undesirable loss of fat-free mass along with the reduction of total body weight. Conclusion. Open gastric bypass induced a significant loss of total weight and loss of fat-free mass in patients six months after the surgery. The use of bioelectric impedance analysis resulted in an appropriate estimation of the total weight components in individuals subjected to bariatric surgery allowing a more real analysis of the variation of weight after the surgery

Effects of two different decellularization routes on the mechanical properties of decellularized lungs

Considering the limited number of available lung donors, lung bioengineering using whole lung scaffolds has been proposed as an alternative approach to obtain lungs suitable for transplantation. However, some decellularization protocols can cause alterations on the structure, composition, or mechanical properties of the lung extracellular matrix. Therefore, the aim of this study was to compare the acellular lung mechanical properties when using two different routes through the trachea and pulmonary artery for the decellularization process. This study was performed by using the lungs excised from 30 healthy male C57BL/6 mice, which were divided into 3 groups: tracheal decellularization (TDG), perfusion decellularization (PDG), and control groups (CG). Both decellularized groups were subjected to decellularization protocol with a solution of 1% sodium dodecyl sulfate. The behaviour of mechanical properties of the acellular lungs was measured after decellularization process. Static (Est) and dynamic (Edyn) elastances were obtained by the end-inspiratory occlusion method. TDG and PDG showed reduced Est and Edyn elastances after lung decellularization. Scanning electron microscopy showed no structural changes after lung decellularization of the TDG and PDG. In conclusion, was demonstrated that there is no significant difference in the behaviour of mechanical properties and extracellular matrix of the decellularized lungs by using two different routes through the trachea and pulmonary artery

TÉCNICA DE DESCELULARIZAÇÃO DE PULMÕES PARA A BIOENGENHARIA DE ÓRGÃOS

As principais doenças do sistema respiratório, tais como a obstrução pulmonar crônica, o enfisema pulmonar, a fibrose pulmonar idiopática e a hipertensão arterial pulmonar primária, tem como resultado um dano estrutural no parênquima pulmonar irreversível, sendo o transplante pulmonar a única indicação terapêutica. Infelizmente, o sucesso do transplante pulmonar é limitado, principalmente devido à escassez do número de doadores de órgãos e incidência de bronquiolite obliterante o que resulta em uma resposta aloimune provocada pelas disparidades entre o doador e os antígenos do receptor. Neste contexto, a bioengenharia de pulmões é considerada uma alternativa terapêutica em potencial. Este estudo visa demonstrar em um modelo experimental animal o processo de descelularização de pulmões visando a preparação de scaffolds para a recriação artificial de órgãos. A matriz de órgãos descelularizados, potencialmente, mantém a arquitetura tridimensional e a composição bioquímica, bem como a microvasculatura do tecido original. Esta capacidade torna o pulmão descelularizado promissor para a geração bioartificial de pulmões funcionais

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio