XXXVII COMU Scientific Awards

[...] This year we accepted 41 scientific projects to apply for the traditional and renowned Oswaldo Cruz Awards, Panel Awards and Monograph Awards. All the projects were evaluated focusing to improve the medical formation, excellence in teaching, commitment to the research and to prepare qualifiedprofessional. [...

Synthesis of Ent-16-hydroxycleroda-4(18),13-dien-15,16-olide and Ent-cleroda-4(18),13-dien-15,16-olide from (+)-hardwickiic acid

The absolute configurations of two natural diterpene butenolides were confirmed through the synthesis of ent-16-hydroxycleroda-4(18),13-dien-15,16-olide (2) and ent-cleroda-4(18),13-dien-15,16-olide (3), enantiomers of the natural products, starting from (+)-hardwickiic acid (1).As configurações absolutas de dois diterpenos butenolidos naturais foram confirmadas através da síntese do ent-16-hidroxicleroda-4(18),13-dien-15,16-olida (2) e ent-cleroda-4(18),13-dien-15,16-olida (3), enantiômeros de produtos naturais, a partir do ácido (+)-hardwickiico (1).417420Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Lombalgia

A lombalgia é uma das queixas mais comuns no ser humano. Várias são as razões de sua ocorrência. Dentre elas destacam-se as de origem músculo-esquelética, incluindo especialmente, as síndromes dolorosas miofasciais. Os dados de história e de exame físico são a base do diagnóstico das etiologias e nosologias das lombalgias. A investigação diagnóstica com exames laboratoriais, eletrofisiológicos e de imagens deve ter seus achados validados com base no exame clínico e na história. O tratamento é fundamentado no controle dos sintomas e de suas repercussões físicas e psicossociais e na restauração da funcionalidade das estruturas regionais.Lumbalgia is one the of most common reasons of chronic pain, specially in adults. Many are the causes of lumbalgia; the most frequent aetiology are the muscleskeletal conditions, mainly the myofascial pain syndromes. The data of the history and clinical examination are more important for the diagnosis those that the complementary exams; the laboratorial, electrophysiological and image exams should be vailidated with clinical basis. The treatment of lumbalgia is based on the aleviation of symptoms, removal of the aetiological factors and on the restoration of the physiology of the elements of the lumbar region

Spectrum of topics for world congresses and other activities of the International Society for Physical and Rehabilitation Medicine (ISPRM) : a first proposal

Background: One of the objectives of the International Society for Physical and Rehabilitation Medicine is to improve the continuity of World Congresses. This requires the development of an abstract topic list for use in congress announcements and abstract submissions. Methods: An abstract topic list was developed on the basis of the definitions of human functioning and rehabilitation research, which define 5 main areas of research (biosciences in rehabilitation, biomedical rehabilitation sciences and engineering, clinical Physical and Rehabilitation Medicine (PRM) sciences, integrative rehabilitation sciences, and human functioning sciences). For the abstract topic list, these research areas were grouped according to the proposals of congress streams. In a second step, the first version of the list was systematically compared with the topics of the 2003 ISPRM World Congress. Results: The resulting comprehensive abstract topic list contains 5 chapters according to the definition of human functioning and rehabilitation research. Due to the high significance of clinical research, clinical PRM sciences were placed at the top of the list, comprising all relevant health conditions treated in PRM services. For congress announcements a short topic list was derived. Discussion: The ISPRM topic list is sustainable and covers a full range of topics. It may be useful for congresses and elsewhere in structuring research in PRM

Tratamento e follow-up da tendinite patelar (jumper's knee) com eletroacupuntura Ryodoraku

Patellar tendinitis is a common lesion in athletes who are involved in some type of repeti tive activity of the extensor mechanism of the knee such as jumping, running, bicycling or kicking. This study evaluated the therapeutic effects of electroacupuncture Ryodoraku on stage three patella tendinitis in 58 cases (66 knees). Complete rilief of pain and return to previous activity levei was observed in 43 patients (74,1 %). It was concluded that electrocupuncture Ryodoraku in an efficient method in treating patella tendinitis, easy execution, and low cost, requiring only a few sections to obtain pain relief.A tendinite da patela é uma lesão comum em atletas que utilizam repetidamente o mecanismo desacelerador do músculo extensor do joelho, como nos saltos, corridas, ciclismos e chute. Os autores apresentam os resultados do tratamento conservador de 58 doentes (66 joelhos) portadores de tendinite patelar grau 3 através da Eletroampuntura Ryodoraku. Alívio completo da dor e retorno da dor à atividade esportiva prévia foi observado em 43 casos (74,1%). Os autores concluem que a Eletroacupuntura Ryodoraku é um método eficaz, de fácil execução e baixo custo operacional; necessitando um pequeno número de aplicações para a obtenção do alívio da dor

Intra-hospital complications in acute traumatic spinal cord injury

Há poucos dados sobre complicações hospitalares em pacientes com LMT aguda. Objetivo: Reportar as características de complicações em pacientes com LMT em um grande centro de trauma. Método: Estudo transversal com 434 pacientes com LMT aguda de 2004 a 2014. Os desfechos foram a frequência e característica das complicações, o tempo de internação (TDI), e fatores associados com seu aumento. Resultados: Incidência de complicações foi 82,2%, sendo as mais frequentes: infecção do trato urinário (ITU)=64,4%, úlcera de pressão (UP)= 50,6% e pneumonia= 23,7%. Pneumonia, intubação, e ser submetido a qualquer cirurgia para UP foram independentemente associados com aumento do TDI. Conclusão: ITUs e UP foram as complicações mais prevalentes, e devem ser melhor estudadas para melhor atenção a LMT. As investigações sobre as complicações na lesão medular traumática devem ser mandatórias nos centros e unidades dedicadas ao tratamento da Lesão Medular.There is scarce data about intra-hospital complications in acute traumatic spinal cord injury (TSCI). Objective: To report characteristics of complications in patients with TSCI in a major trauma center. Method: This is a cross-sectional study with 434 patients with acute TSCI from 2004 to 2014. Outcomes were frequency and description of complications, length of hospital stay (LOS), and causes of increased LOS. Results: Patients presented at least 1 complication in 82.2% of the cases: urinary tract infection (UTI) = 64.4%, pressure ulcers (PU) = 50.6%, and pneumonia = 23.7%. Pneumonia, intubation and cases of surgical corrections for PU were independently associated with increased LOS. Conclusion: UTIs and PUs were the most frequent complications. Investigating its causes and consequences is paramount in the care of patients with SCI. Possible reasons for such complications could comprise time, and frequency of repositioning in bed. Investigating intra-hospital complications is paramount in SCI centers

Randomized controlled clinical trials in orthopedics: difficulties and limitations

Os ensaios clínicos controlados e randomizados (ECCR) são considerados o padrão ouro da medicina baseada em evidências na atualidade, sendo importantes para direcionar a conduta médica através de observações científicas consistentes. Passos como seleção dos pacientes, randomização e cegamento são fundamentais na realização de um ECCR e apresentam algumas dificuldades extras nos ensaios que envolvem procedimentos cirúrgicos, como é comum na Ortopedia. O objetivo deste artigo é destacar e discutir algumas dificuldades e eventuais limitações dos ECCR na área cirúrgica.Randomized controlled clinical trials (RCTs) are considered to be the gold standard for evidence-based medicine nowadays, and are important for directing medical practice through consistent scientific observations. Steps such as patient selection, randomization and blinding are fundamental for conducting an RCT, but some additional difficulties are presented in trials that involve surgical procedures, as in common in orthopedics. The aim of this article was to highlight and discuss some difficulties and possible limitations on RCTs within the field of surgery

Dor miofascial em pacientes com osteoartrose do quadril

A osteoartrose (OA) do quadril é uma doença de alta prevalência, especialmente nas faixas etárias mais avançadas. Seu tratamento por meio da artroplastia tem resultados muito satisfatórios não apenas no que concerne a dor mas também em termos de melhora funcional. Contudo, diante da presença também elevada de outras afecções que complicam o procedimento anestésico e o acompanhamento pós-operatório, o uso de alternativas terapêuticas menos invasivas é recomendável, sendo, por vezes, a única forma restante de tratamento, mesmo que apenas paliativo. A investigação de outras causas de dor e incapacidade nestes pacientes é uma obrigação do médico preocupado com o bemestar destes pacientes. Neste artigo faremos uma breve revisão de aspectos clínicos da osteoartrose do quadril e proporemos uma nova abordagem, tendo em vista a pesquisa de pontos dolorosos relacionados à síndrome dolorosa miofascial

Neurophysiological biomarkers of motor improvement from Constraint-Induced Movement Therapy and Robot-Assisted Therapy in participants with stroke

BackgroundThe mechanism of stroke recovery is related to the reorganization of cerebral activity that can be enhanced by rehabilitation therapy. Two well established treatments are Robot-Assisted Therapy (RT) and Constraint-Induced Movement Therapy (CIMT), however, it is unknown whether there is a difference in the neuroplastic changes induced by these therapies, and if the modifications are related to motor improvement. Therefore, this study aims to identify neurophysiological biomarkers related to motor improvement of participants with chronic stroke that received RT or CIMT, and to test whether there is a difference in neuronal changes induced by these two therapies.MethodsThis study included participants with chronic stroke that took part in a pilot experiment to compare CIMT vs. RT. Neurophysiological evaluations were performed with electroencephalography (EEG) and transcranial magnetic stimulation (TMS), pre and post rehabilitation therapy. Motor function was measured by the Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment Upper Limb (FMA-UL).ResultsTwenty-seven participants with chronic stroke completed the present study [mean age of 58.8 years (SD ± 13.6), mean time since stroke of 18.2 months (SD ± 9.6)]. We found that changes in motor threshold (MT) and motor evoked potential (MEP) in the lesioned hemisphere have a positive and negative correlation with WMFT improvement, respectively. The absolute change in alpha peak in the unlesioned hemisphere and the absolute change of the alpha ratio (unlesioned/lesioned hemisphere) is negatively correlated with WMFT improvement. The decrease of EEG power ratio (increase in the lesioned hemisphere and decrease in the unlesioned hemisphere) for high alpha bandwidths is correlated with better improvement in WMFT. The variable “type of treatment (RT or CIMT)” was not significant in the models.ConclusionOur results suggest that distinct treatments (RT and CIMT) have similar neuroplastic mechanisms of recovery. Moreover, motor improvements in participants with chronic stroke are related to decreases of cortical excitability in the lesioned hemisphere measured with TMS. Furthermore, the balance of both EEG power and EEG alpha peak frequency in the lesioned hemisphere is related to motor improvement