RESUMO
BACKGROUND: Immersive virtual reality (VR) is an innovative strategy for inpatient rehabilitation programs. Using immersive VR in early mobilization protocols has not yet been investigated in the setting of hospitalized patients with acute decompensated heart failure (ADHF), especially to improve perceived dyspnea, a common symptom of heart failure (HF). METHODS: This is a single-center parallel superiority randomized clinical trial. The study will be conducted at a public teaching hospital in Brazil from January 2023 to January 2024. The sample will include adult patients with ADHF hospitalized for at least 24 h, randomly assigned in a 1:1 ratio to the control (standard early mobilization protocol conducted in the intensive care unit (ICU)) or intervention group (the same standard early mobilization protocol but associated with immersive VR). The primary outcome will be assessing perceived dyspnea, and the secondary outcome will be assessing patient experience. DISCUSSION: Using immersive VR in early mobilization protocols in the ICU is expected to improve perceived dyspnea in patients with ADHF as well as patient experience regarding care. This study has the potential to increase patient adherence to early mobilization protocols in the setting of ADHF as well as to promote a positive patient experience. Filling this gap could promote the rational incorporation of technologies in health care. TRIAL REGISTRATION: This study protocol is in its first version. CLINICALTRIALS: gov NCT05596292. Registered on 1 December 2022.
Assuntos
Deambulação Precoce , Realidade Virtual , Adulto , Humanos , Unidades de Terapia Intensiva , Brasil , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Epigenetic changes have been shown to be associated with both aging process and aging-related diseases. There is evidence regarding the benefits of physical activity on the functionality, cognition, and quality of life of institutionalized older adults, however, the molecular mechanisms involved are not elucidated. The purpose of this pilot study was to investigate the effects of a multimodal exercise intervention on functional outcomes, cognitive performance, quality of life (QOL), epigenetic markers and brain-derived neurotrophic factor (BDNF) levels among institutionalized older adult individuals. Participants (n = 8) without dementia who were aged 73.38 ± 11.28 years and predominantly female (87.5%) were included in this quasi-experimental pilot study. A multimodal exercise protocol (cardiovascular capacity, strength, balance/agility and flexibility, perception and cognition) consisted of twice weekly sessions (60 minutes each) over 8 weeks. Balance (Berg Scale), mobility (Timed Up and Go test), functional capacity (Six-Minute Walk test), cognitive function (Mini-Mental State Examination) and QOL (the World Health Organization Quality of Life-BREF Scale questionnaire) were evaluated before and after the intervention. Blood sample (15 mL) was also collected before and after intervention for analysis of biomarkers global histone H3 acetylation and brain-derived neurotrophic factor levels. Significant improvements were observed in cognitive function, balance, mobility, functional capacity and QOL after the intervention. In addition, a tendency toward an increase in global histone H3 acetylation levels was observed, while brain-derived neurotrophic factor level remained unchanged. This study provided evidence that an 8-week multimodal exercise protocol has a significant effect on ameliorating functional outcomes and QOL in institutionalized older adult individuals. In addition, it was also able to promote cognitive improvement, which seems to be partially related to histone hyperacetylation status. The Ethics Research Committee of Centro Universitário Metodista-IPA, Brazil approved the current study on June 6, 2019 (approval No. 3.376.078).
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The imbalance of epigenetic, oxidative stress and inflammatory markers is associated with the aging physiopathology. Then, the influence of bioactive nutritional compounds and physical training on these biomarkers has been studied, although the combination of both strategies has been not investigated. Therefore, our aim was to verify the effect of the association of physical training with red grape juice (Vitis labrusca) consumption on global histone acetylation H3 and H4 levels, oxidative stress markers and interleukin 6 (IL-6) levels in peripheral blood of healthy elderly women. This double-blind randomized clinical study consisted of 29 volunteers, aged 59 years and over, divided into three groups: grape juice group (GJG, n = 9); placebo and exercise group (PLEG, n = 10) and grape juice and exercise group (GJEG, n = 10). During 1 month, GJG consumed 400 ml of grape juice per day (integral and conventional), while the PLEG and GJEG groups, besides consuming juice or placebo were submitted to a concurrent physical training protocol (two times per week, 60 min / session). The volunteers were submitted to blood collections before and after the intervention for the biomarkers analysis, e.g. IL-6, histone acetylation H3 and H4, lipid oxidative damage (TBARS), proteins (Carbonyl), non-enzymatic antioxidant defense (Sulfhydryl groups) and activity of antioxidant enzymes (superoxide dismutase and catalase). There were no statistically significant differences in the global levels of histone acetylation H3 and H4 post intervention compared to the basal period as well and between groups were found. However, PLEG and GJEG showed a remarkable reduction on IL-6 levels after intervention. We also observed an increase in Carbonyl levels, SOD activities and Sulfhydryl levels comparing before and after intervention. Considering the interaction of time and groups, a significant increase in Sulfhydryl levels only in GJG was found. The physical training protocol associated or not with grape juice consumption showed anti-inflammatory effects and an influence in the antioxidant defenses (non enzymatic and enzymatic) in elderly women. However in grape juice group, without exercise, we observed an increase in non enzymatic antioxidant defense, what could be attributed to the polyphenols content. These responses seem not to be involved with histone acetylation status.
Assuntos
Vitis , Idoso , Antioxidantes , Bebidas/análise , Método Duplo-Cego , Epigênese Genética , Feminino , Histonas , Humanos , Estresse OxidativoRESUMO
Objetivo: Avaliar a influência da cicatrização e amplitude de movimento na qualidade de vida de pacientes queimados em acompanhamento ambulatorial. Método: Estudo transversal realizado no Hospital de Pronto Socorro-Porto Alegre. Instrumentos avaliativos: escala de cicatrização de Vancouver, goniometria ativa e questionário Burn Specific Health Scale Revised. Resultados: Amostra composta por 15 participantes, sendo 53,3% homens, e a média de idade foi 46,47±14,02 anos. Em relação à cicatriz, houve prevalência de cicatrizes hiperpigmentadas (n=11), maleáveis (n=6), deformadas (n=5) e firmes (n=5), com prevalência de hiperpigmentação nos fototipos cutâneos II (n=4) e III (n=4). Na variável amplitude de movimento articular, 93,3% apresentou limitação. A articulação mais acometida foi o punho (33,30%) e 86,70% das queimaduras eram bilaterais, com prevalência de limitação para movimentos de flexão e extensão (66,70%) das articulações testadas. No questionário, o subgrupo "afeto e imagem corporal" apresentou pior escore. "Afeto e imagem corporal" teve associação significativa com os subgrupos "tratamento" e "relações interpessoais" (p<0,05), e "sensibilidade da pele" teve associação significativa com o subgrupo "trabalho" (p<0,01). Conclusões: Alterações cicatriciais/estéticas e prejuízo funcional p equeno foram encontrados, podendo ser associados à redução da qualidade de vida, prejudicada principalmente nos aspectos de autoimagem e sensibilidade da pele, advindos da cicatrização. A associação destes fatores traz dificuldade no retorno ao trabalho e atividades de vida diária, gerando custos e isolamento social.
Objective: To assess the influence of healing and range of motion on the quality of life of burned patients in outpatient care. Methods: Cross-sectional study carried out at Hospital de Pronto Socorro-Porto Alegre. evaluation instruments: Vancouver Scar Scale, active goniometer and questionnaire Burn Specific Health Scale Revised. Results: Sample composed of 15 participants, 53.3% men and the mean age 46.47±14.02 years. Regarding the scar, there was a prevalence of hyperpigmented scars (n=11), flexible (n=6) deformed (n=5) and firm (n=5), with a prevalence of hyperpigmentation in skin phototypes II (n=4) and III (n=4). In the variable range of motion, 93.3% had limitation. The most affected joint was the handle (33.30%) and 86.70% of the burns were bilateral, with a prevalence for limiting flexion and extension movements (66.70%) of the tested joints. Considering the questionnaire, subgroup "affection and body image" had a worse score. "Affect and body image" was significantly associated with subgroups "treatment" and "Interpersonal Relations" (p<0.05), and "sensitive skin" was significantly associated with the subgroup "work" (p<0.01). Conclusions: Scar/aesthetic changes and small functional impairment have been found, and may be associated to a reduction in the quality of life, which is mainly impaired in the autoimaging and sensitivity aspects of the skin, resulting from scarring. The association of these factors brings difficulty in returning to work and activities of daily living, generating costs and social isolation.
Objetivo: Evaluar la influencia de la cicatrización y amplitud de movimiento en la calidad de vida de pacientes quemados en seguimiento ambulatorial. Método: Estudio transverso cumplido en el Hospital de Pronto Socorro-Porto Alegre. Instrumentos de evaluación: Escala de Cicatrización de Vancouver, goniómetro activa y el cuestionario Burn Specific Health Scale Revised. Resultados: Muestra compuesta de 15 participantes, 53,3% eran hombres y la edad media de 46.47±14.02 años. En cuanto a la cicatriz era prevalencia de cicatrices hiperpigmentadas (n=11), flexible (n=6) deformada (n=5) y firme (n=5), Con una prevalencia de hiperpigmentación en la piel fototipos II (n=4) y III (n=4). En el rango variable de movimiento, 93,3% tenían limitación. La articulación más afectado fue el mango (33,30%) y 86,70% de las quemaduras fueron bilaterales, con una prevalencia para limitar de flexión y extensión movimientos (66,70%) de las articulaciones ensayadas. En el cuestionario, subgrupo "afecto y la imagen corporal" tuvo una puntuación peor. "Afecto y la imagen corporal" se asoció significativamente con subgrupos "tratamiento" y "Relaciones interpersonales" (p<0,05), y "piel sensible" se asoció significativamente con el subgrupo "trabajo" (p<0,01). Conclusiones: Se han encontrado alteraciones cicatrices/estéticas y pérdida funcional pequeña, pudiéndose asociar a la reducción de la calidad de vida, perjudicada principalmente en los aspectos de autoimagen y sensibilidad de la piel, provenientes de la cicatrización. La asociación de estos factores trae dificultad en el retorno al trabajo y actividades de vida diaria, generando costos y aislamiento social.
