Löfgren Syndrome: A Case Report and Treatment Challenge.

Sarcoidosis is an inflammatory and immune-mediated multisystemic disorder of unknown etiology, characterized by the presence of non-caseating granulomas, impacting various organs. This indolent condition manifests with numerous nonspecific symptoms and lacks a definitive diagnostic test, typically requiring histopathologic confirmation. However, a distinct and more readily diagnosable form of sarcoidosis does exist. The Löfgren syndrome (LöS) is characterized by the triad of erythema nodosum (EN), bilateral hilar lymphadenopathy, and symmetrical inflammatory arthralgias or arthritis. The simultaneous presence of these elements obviates the necessity for a biopsy. Predominantly affecting women in their second and third decades of life, this syndrome generally carries a favorable prognosis with spontaneous resolution or the requirement for a nonsteroidal anti-inflammatory drug (NSAID) alone. Despite its rarity, in particular cases, the treatment can be more challenging. This article presents a case study of LöS in a young woman, whose more aggressive disease course led to the need for steroidal therapy.

Novel Approach to Intradialytic Progressive Resistance Exercise Training.

Physical activity levels are typically undesirably low in chronic kidney disease patients, especially in those undergoing haemodialysis, and particularly on dialysis days. Intradialytic exercise programmes could be a solution to this issue and have been reported to be safe and relatively easily implemented in dialysis clinics. Nevertheless, such implementation has been failing in part due to barriers such as the lack of funding, qualified personnel, equipment, and patient motivation. Intradialytic aerobic exercise has been the most used type of intervention in dialysis clinics. However, resistance exercise may be superior in eliciting potential benefits on indicators of muscle strength and mass. Yet, few intradialytic exercise programmes have focused on this type of intervention, and the ones which have report inconsistent benefits, diverging on prescribed exercise intensity, absent or subjective load progression, equipment availability, or exercise supervision. Commonly, intradialytic resistance exercise interventions use free weights, ankle cuffs, or elastic bands which hinder load progression and exercise intensity monitoring. Here, we introduce a recently developed intradialytic resistance exercise device and propose an accompanying innovative resistance exercise training protocol which aims to improve the quality of resistance exercise interventions within dialysis treatment sessions.

Intradialytic resistance training for short daily hemodialysis patients as part of the clinical routine: a quasi-experimental study.

Background and purpose: Hemodialysis patients have chronic systemic inflammation, musculoskeletal impairments, and body composition changes from several factors and exercise may attenuate. We evaluated the effects of an intradialytic resistance training program on body composition, physical function, and inflammatory markers in patients under short daily hemodialysis treatment. Materials and methods: A quasi-experimental study in clinical routine was conducted over eight months. Measures of physical function (handgrip strength, five-time sit-to-stand, timed-up and go, and gait speed), body composition (by bioelectrical impedance), and inflammatory markers (interleukin [IL]-1 beta, IL-6, IL-8, IL-10, IL-12p70, and tumor necrosis factor-α) were assessed at baseline as well as at four and eight months past continued intervention. Patients underwent two intradialytic resistance training sessions per week supervised by exercise professionals. Results: A total of 18 patients (62 ± 14 years; 55.6% ≥ 60 years; 44% female) were included. Significant increases in body mass index and basal metabolic rate were found at four and eight months compared to baseline. For physical function, timed-up and go performance improved at four and eight months compared to baseline. The other body composition and physical function measures, as well as all inflammatory markers, did not significantly change over time. Conclusion: A supervised intradialytic resistance training program for patients on short daily hemodialysis treatment, as part of the clinical routine, may induce modest changes in body mass index, basal metabolic rate, and timed-up and go performance.

Heat Preparation and Knowledge at the World Athletics Race Walking Team Championships Muscat 2022.

PURPOSE: To assess elite racewalkers' preparation strategies, knowledge, and general practices for competition in the heat and their health status during the World Athletics Race Walking Teams Championships (WRW) Muscat 2022. METHODS: Sixty-six elite racewalkers (male: n = 42; mean age = 25.8 y) completed an online survey prior to WRW Muscat 2022. Athletes were grouped by sex (males vs females) and climate (self-reported) they live/trained in (hot vs temperate/cold), with differences/relationships between groups assessed. Relationships between ranking (medalist/top 10 vs nonmedalist/nontop 10) and precompetition use of heat acclimation/acclimatization (HA) were assessed. RESULTS: All surveyed medalists (n = 4) implemented, and top 10 finishers were more likely to report using (P = .049; OR = 0.25; 95% CI, 0.06%-1%), HA before the championships. Forty-three percent of athletes did not complete specific HA training. Females (8% [males 31%]) were less likely to have measured core temperature (P = .049; OR = 0.2; 95% CI, 0.041-0.99) and more likely to not know expected conditions in Muscat (42% vs 14%; P = .016; OR = 4.3; 95% CI, 1%-14%) or what wet bulb globe temperature is (83% vs 55%; P = .024; OR = 4.1; 95% CI, 1%-14%). CONCLUSIONS: Athletes who implemented HA before the championships tended to place better than those who did not. Forty-three percent of athletes did not prepare for the expected hot conditions at the WRW Muscat 2022, primarily attributed to challenges in accessing and/or cost of equipment/facilities for HA strategies. Further efforts to bridge the gap between research and practice in this elite sport are needed, particularly in female athletes.

The Potential Modulatory Effects of Exercise on Skeletal Muscle Redox Status in Chronic Kidney Disease.

Chronic Kidney Disease (CKD) is a global health burden with high mortality and health costs. CKD patients exhibit lower cardiorespiratory and muscular fitness, strongly associated with morbidity/mortality, which is exacerbated when they reach the need for renal replacement therapies (RRT). Muscle wasting in CKD has been associated with an inflammatory/oxidative status affecting the resident cells' microenvironment, decreasing repair capacity and leading to atrophy. Exercise may help counteracting such effects; however, the molecular mechanisms remain uncertain. Thus, trying to pinpoint and understand these mechanisms is of particular interest. This review will start with a general background about myogenesis, followed by an overview of the impact of redox imbalance as a mechanism of muscle wasting in CKD, with focus on the modulatory effect of exercise on the skeletal muscle microenvironment.

Inferior Vena Cava Atresia: A Rare Vascular Malformation.

Inferior vena cava (IVC) atresia is a rare congenital vascular malformation. We describe the case of a 20-year-old woman with IVC atresia who presented with a 3-month history of fatigue, oedema of the lower limbs and episodes of lipothymia. Transthoracic echocardiography and cardiac catheterization were performed, revealing interruption of the IVC with circulation through the azygos and hemiazygos system. An abdominal and pelvic computerized tomography (CT) scan confirmed the findings, demonstrating the absence of the IVC below the renal veins. Blood tests did not reveal any relevant results. These findings are consistent with the diagnosis of IVC atresia, a rare condition with no standard treatment. As a surgical approach was not possible, pharmacological measures were implemented for primary prevention of possible thrombotic events. LEARNING POINTS: Inferior vena cava atresia is a rare vascular malformation.The clinical presentation is non-specific: most diagnoses are made after a thrombotic event or as an incidental finding on imaging.Consensus on definitive treatment is lacking, but the increased thrombotic risk warrants primary prevention of thrombosis.

Glittre activities of daily living test is reliable and valid in hemodialysis patients.

PURPOSE: To examine the validity, and the relative and absolute within-day reliability of the TGlittre in chronic kidney disease patients undergoing hemodialysis (HD). MATERIALS AND METHODS: Thirty HD patients (52 ± 12 years) undertook the TGlittre twice on a single day, in a cross-sectional design. For validation purposes, participants TGlittre performance and accelerometry-based physical activity were correlated. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were determined to assess within-day reliability. RESULTS: There was a moderate correlation between TGlittre performance and moderate to vigorous physical activity (r= -0.587; p= 0.001). The relative reliability of the test showed an ICC of 0.96. For the absolute reliability, the SEM was 13.05 s (0.22 min), and the MDC was 36.17 s (0.60 min). CONCLUSIONS: TGlittre performance is associated with moderate to vigorous physical activity in HD patients, highlighting that those with higher levels of physical activity are likely to perform better on the TGlittre. Additionally, TGlittre shows a good to excellent intra-rater reliability and a low SEM. An MDC value was established.Implications for rehabilitationPatients on hemodialysis have a low physical capacity and often struggle to simply complete their physical activities of daily living.The TGlittre is a tool for assessing functional capacity through completion of multiple physical activities of daily living and can be easily applied in a clinical setting.TGlittre is a valid test that elicit reliable physiological, hemodynamic, and physical performance responses in HD patients.

How is exercise being prescribed for patients on hemodialysis? A scoping review.

BACKGROUND: Exercise is important for patients on hemodialysis, but details and descriptions on how it is prescribed are lacking. We reviewed the existing literature and described how exercise is being prescribed for patients on hemodialysis. METHODS: A scoping review according to the JBI and PRISMA-ScR guidelines was conducted. MEDLINE, EMBASE and other databases were searched from inception until December 2021. Websites, books, and guidelines were also searched. We included evidence from patients on hemodialysis, describing exercise protocols, in all settings and designs. RESULTS: Two hundred and eighty-five studies were included, yielding 327 exercise protocols. Aerobic (38.8%) and strength (21.4%) were the most prescribed exercise types. Exercise was mainly prescribed during dialysis (71.0%) and delivered within the first half of the session (94.6%). Although 33.3% of the exercise protocols did not report whether there was supervision or not, those that did were mostly delivered by physiotherapists (20.5%) and exercise physiologists (17.4%). The most followed exercise training principles were type (99.0%) and frequency (93.2%), whereas progression was adopted in 40.7% protocols. The most prescribed frequency and duration were three times/week (79.9%) and 30-60-min (69.2%) sessions, respectively. Exercise intensity was predominantly prescribed in moderate cut-offs (72.3%), mostly assessed by subjective methods (47.5%). CONCLUSIONS: Aerobic and strength were the most prescribed exercise types, mainly during dialysis. Interventions were mostly supervised by physiotherapists and exercise physiologists. Future exercise protocols for patients on hemodialysis should adopt recommended exercise principles, especially with systematic progression.

Heat Adaptation and Nutrition Practices: Athlete and Practitioner Knowledge and Use.

PURPOSE: To survey elite athletes and practitioners to identify (1) knowledge and application of heat acclimation/acclimatization (HA) interventions, (2) barriers to HA application, and (3) nutritional practices supporting HA. METHODS: Elite athletes (n = 55) and practitioners (n = 99) completed an online survey. Mann-Whitney U tests (effect size [ES; r]) assessed differences between ROLE (athletes vs practitioners) and CLIMATE (hot vs temperate). Logistic regression and Pearson chi-square (ES Phi [ϕ]) assessed relationships. RESULTS: Practitioners were more likely to report measuring athletes' core temperature (training: practitioners 40% [athletes 15%]; P = .001, odds ratio = 4.0, 95% CI, 2%-9%; competition: practitioners 25% [athletes 9%]; P = .020, odds ratio = 3.4, 95% CI, 1%-10%). Practitioners (55% [15% athletes]) were more likely to perceive rectal as the gold standard core temperature measurement site (P = .013, ϕ = .49, medium ES). Temperate (57% [22% hot]) CLIMATE dwellers ranked active HA effectiveness higher (P < .001, r = .30, medium ES). Practitioners commonly identified athletes' preference (48%), accessibility, and cost (both 47%) as barriers to HA. Increasing carbohydrate intake when training in the heat was more likely recommended by practitioners (49%) than adopted by athletes (26%; P = .006, 95% CI, 0.1%-1%). Practitioners (56% [28% athletes]) were more likely to plan athletes' daily fluid strategies, adopting a preplanned approach (P = .001; 95% CI, 0.1%-1%). CONCLUSIONS: Practitioners, and to a greater extent athletes, lacked self-reported key HA knowledge (eg, core temperature assessment/monitoring methods) yet demonstrated comparatively more appropriate nutritional practices (eg, hydration).

Gestão em foco / Management in focus

Este e-book tem como objetivo trazer um compêndio de relatos de experiência relacionados à gestão de saúde do Estado de Goiás. Cada capítulo traz a descrição dos projetos desenvolvidos no âmbito da Secretaria de Estado da Saúde de Goiás, que são vinculados aos objetivos estratégicos do órgão. Estes projetos têm como objetivo fortalecer as ações estratégicas para otimizar o planejamento do Sistema Único de Saúde

This e-book aims to bring a compendium of experience reports related to health management in the State of Goiás. Each chapter brings a description of the projects developed within the scope of the State Department of Health of Goiás, which are linked to the strategic objectives of the agency. These projects aim to strengthen strategic actions to optimize the planning of the Unified Health System

Polymorphonuclear leucocyte phagocytic function, γδ T-lymphocytes and testosterone as separate stress-responsive markers of prolonged, high-intensity training programs.

Excessive exercise with limited recovery may lead to detrimental states of overreaching or the overtraining syndrome. Chronic maladaptation in endocrine and immune mechanisms occur with the incidence of these states. Exercise-induced cortisol and testosterone responses have been proposed as biomarkers of overreaching, with blunted responses following intensified-training periods. Yet, limited information on the effects of overreaching in immunity is available. Healthy individuals completed a 30-min running protocol (the RPETP) before and after a 12-day intensified-training period. Blood and saliva were collected before, after and 30min after RPETP at pre-training and post-training. Plasma and salivary cortisol and testosterone, leucocyte proliferation and polymorphonuclear leucocyte phagocytic activity were examined. Plasma and salivary cortisol were acutely unaffected pre-training (-14% and 0%, p â€‹> â€‹0.05) and post-training (-14% and +46%, p â€‹> â€‹0.05). Comparing pre-training with post-training, blunted responses were observed in plasma testosterone (43%-19%, p â€‹< â€‹0.05) and salivary testosterone (55%-24%, p â€‹> â€‹0.05). No acute or resting changes in total leucocyte counts or most leucocyte subsets occurred pre-training or post-training. Yet, a 194% acute elevation in γδ T-lymphocyte number occurred pre-training (p â€‹< â€‹0.05), and average resting concentrations were 174% higher post-training. Baseline phagocytic activity was 47% lower post-training (p â€‹< â€‹0.05). Intensified training was detrimental, significantly reducing phagocytic activity. Testosterone blunted post-training, indicating an excessive training-related hypothalamic-pituitary gonadal dysfunction. The γδ T-lymphocytes sensitivity to exercise was noted, rendering it as a potential stress-responsive cellular marker. The usefulness of the RPETP to track the onset of overreaching is proposed.

Association between physical activity and mortality in end-stage kidney disease: a systematic review of observational studies.

BACKGROUND: End-stage Kidney Disease patients have a high mortality and hospitalization risk. The association of these outcomes with physical activity is described in the general population and in other chronic diseases. However, few studies examining this association have been completed in end-stage Kidney Disease patients, raising the need to systematically review the evidence on the association of physical activity with mortality and hospitalization in this population. METHODS: Electronic databases (EBSCO, Scopus and Web of Science) and hand search were performed until March 2020 for observational studies reporting the association of physical activity with mortality or hospitalization in adult end-stage Kidney Disease patients on renal replacement therapy (hemodialysis, peritoneal dialysis and kidney transplant). Methodological quality of the included studies was assessed using the Quality in Prognosis Studies tool. The review protocol was registered in PROSPERO (CRD42020155591). RESULTS: Eleven studies were included: six in hemodialysis, three in kidney transplant, and two in hemodialysis and peritoneal dialysis patients. Physical activity was self-reported, except in one study that used accelerometers. All-cause mortality was addressed in all studies and cardiovascular mortality in three studies. Nine studies reported a significant reduction in all-cause mortality with increased levels of physical activity. Evidence of a dose-response relationship was found. For cardiovascular mortality, a significant reduction was observed in two of the three studies. Only one study investigated the association of physical activity with hospitalization. CONCLUSIONS: Higher physical activity was associated with reduced mortality in end-stage Kidney Disease patients. Future studies using objective physical activity measures could strengthen these findings. The association of physical activity with hospitalization should be explored in future investigations.

Reliability of salivary cortisol and testosterone to a high-intensity cycling protocol to highlight overtraining.

Athletes physically overload to improve performance. Unbalanced stress/recovery may induce overtraining, which is difficult to diagnosis as no diagnostic marker exists. Hormonal responses to a 55/80 cycle (30-min of alternating blocks of 1-min at 55% and 4-min at 80% maximum work rate) may highlight early-stage overtraining (overreaching), as blunted cortisol and testosterone responses to 55/80 follows intensified training. However, the reliability of hormonal responses to 55/80 when not overreached is unknown. Therefore, reported blunted hormonal responses could be due to inconsistent cortisol and testosterone responses to 55/80. Participants (n = 23) completed three 55/80 bouts, >7 days apart, with no exercise 24 h pre-trials. Pre-exercise urine osmolality and stress questionnaire responses were measured. Pre, post, and 30-min post-exercise saliva samples were collected for cortisol and testosterone assessment. Salivary cortisol and testosterone responses, osmolality and well-being were not different between trials. Salivary cortisol and testosterone elevated from pre- to post-exercise [by 4.2 nmol.L-1 (cortisol) and 307 pmol.L-1 (testosterone)], and 30 min post-exercise [by 160 pmol.L-1 (testosterone) only]. Intraclass correlation coefficients for pre to peak post-exercise cortisol (0.89; good) and testosterone (0.53; moderate) were calculated. This demonstrates that 55/80 induces reliable elevations of salivary cortisol and testosterone when in a healthy state.

Muscle-Bone Crosstalk in Chronic Kidney Disease: The Potential Modulatory Effects of Exercise.

Chronic kidney disease (CKD) is a prevalent worldwide public burden that increasingly compromises overall health as the disease progresses. Two of the most negatively affected tissues are bone and skeletal muscle, with CKD negatively impacting their structure, function and activity, impairing the quality of life of these patients and contributing to morbidity and mortality. Whereas skeletal health in this population has conventionally been associated with bone and mineral disorders, sarcopenia has been observed to impact skeletal muscle health in CKD. Indeed, bone and muscle tissues are linked anatomically and physiologically, and together regulate functional and metabolic mechanisms. With the initial crosstalk between the skeleton and muscle proposed to explain bone formation through muscle contraction, it is now understood that this communication occurs through the interaction of myokines and osteokines, with the skeletal muscle secretome playing a pivotal role in the regulation of bone activity. Regular exercise has been reported to be beneficial to overall health. Also, the positive regulatory effect that exercise has been proposed to have on bone and muscle anatomical, functional, and metabolic activity has led to the proposal of regular physical exercise as a therapeutic strategy for muscle and bone-related disorders. The detection of bone- and muscle-derived cytokine secretion following physical exercise has strengthened the idea of a cross communication between these organs. Hence, this review presents an overview of the impact of CKD in bone and skeletal muscle, and narrates how these tissues intrinsically communicate with each other, with focus on the potential effect of exercise in the modulation of this intercommunication.

Exercise-Induced Salivary Hormone Responses to High-Intensity, Self-Paced Running.

PURPOSE: Physical overexertion can lead to detrimental overreaching states without sufficient recovery, which may be identifiable by blunted exercise-induced cortisol and testosterone responses. A running test (RPETP) elicits reproducible plasma cortisol and testosterone elevations (in a healthy state) and may detect blunted hormonal responses in overreached athletes. This current study determined the salivary cortisol and testosterone responses reproducibility to the RPETP, to provide greater practical validity using saliva compared with the previously utilized blood sampling. Second, the relationship between the salivary and plasma responses was assessed. METHODS: A total of 23 active, healthy males completed the RPETP on 3 occasions. Saliva (N = 23) and plasma (N = 13) were collected preexercise, postexercise, and 30 minutes postexercise. RESULTS: Salivary cortisol did not elevate in any RPETP trial, and reduced concentrations occurred 30 minutes postexercise (P = .029, η2 = .287); trial differences were observed (P < .001, η2 = .463). The RPETP elevated (P < .001, η2 = .593) salivary testosterone with no effect of trial (P = .789, η2 = .022). Intraindividual variability was 25% in cortisol and 17% in testosterone. "Fair" intraclass coefficients of .46 (cortisol) and .40 (testosterone) were found. Salivary and plasma cortisol positively correlated (R = .581, P = .037) yet did not for testosterone (R = .345, P = .248). CONCLUSIONS: The reproducibility of salivary testosterone response to the RPETP is evident and supports its use as a potential tool, subject to further confirmatory work, to detect hormonal dysfunction during overreaching. Salivary cortisol responds inconsistently in a somewhat individualized manner to the RPETP.

Wound healing cream formulated with Kalanchoe pinnata major flavonoid is as effective as the aqueous leaf extract cream in a rat model of excisional wound.

Leaves of Kalanchoe pinnata are used worldwide for healing skin wounds. This study aimed to develop and compare two creams containing a leaf aqueous extract of K. pinnata (KP; 6%) and its major flavonoid [quercetin 3-O-α-L-arabinopyranosyl-(1→2)-α-L-rhamnopyranoside] (0.15%). Both creams were topically evaluated in a rat excision model for 15 days. On the 12th day, groups treated with KP leaf-extract and KP major flavonoid creams exhibited 95.3 ± 1.2% and 97.5 ± 0.8% of healing, respectively (positive control = 96.7 ± 0.8%; negative control = 76.1 ± 3.8%). Both resulted in better re-epithelialization and denser collagen fibres. Flavonol glycosides are the main phenolics in KP leaf-extract according to HPLC-ESI-MS/MS analysis. KP major flavonoid plays a fundamental role in the wound healing. The similar results found for both creams indicate that the use of KP crude extract should be more profitable than the isolated compound.

Impact of physical activity and exercise on bone health in patients with chronic kidney disease: a systematic review of observational and experimental studies.

BACKGROUND: Chronic Kidney Disease (CKD) patients frequently develop life-impairing bone mineral disorders. Despite the reported impact of exercise on bone health, systematic reviews of the evidence are lacking. This review examines the association of both physical activity (PA) and the effects of different exercise interventions with bone outcomes in CKD. METHODS: English-language publications in EBSCO, Web of Science and Scopus were searched up to May 2019, from which observational and experimental studies examining the relation between PA and the effect of regular exercise on bone-imaging or -outcomes in CKD stage 3-5 adults were included. All data were extracted and recorded using a spreadsheet by two review authors. The evidence quality was rated using the Cochrane risk of bias tool and a modified Newcastle-Ottawa scale. RESULTS: Six observational (4 cross-sectional, 2 longitudinal) and seven experimental (2 aerobic-, 5 resistance-exercise trials) studies were included, with an overall sample size of 367 and 215 patients, respectively. Judged risk of bias was low and unclear in most observational and experimental studies, respectively. PA was positively associated with bone mineral density at lumbar spine, femoral neck and total body, but not with bone biomarkers. Resistance exercise seems to improve bone mass at femoral neck and proximal femur, with improved bone formation and inhibited bone resorption observed, despite the inconsistency of results amongst different studies. CONCLUSIONS: There is partial evidence supporting (i) a positive relation of PA and bone outcomes, and (ii) positive effects of resistance exercise on bone health in CKD. Prospective population studies and long-term RCT trials exploring different exercise modalities measuring bone-related parameters as endpoint are currently lacking.

Reproducibility of Acute Steroid Hormone Responses in Men to Short-Duration Running.

PURPOSE: Progressively overloading the body to improve physical performance may lead to detrimental states of overreaching/overtraining syndrome. Blunted cycling-induced cortisol and testosterone concentrations have been suggested to indicate overreaching after intensified training periods. However, a running-based protocol is yet to be developed or demonstrated as reproducible. This study developed two 30-min running protocols, (1) 50/70 (based on individualized physical capacity) and (2) RPETP (self-paced), and measured the reproducibility of plasma cortisol and testosterone responses. METHODS: Thirteen recreationally active, healthy men completed each protocol (50/70 and RPETP) on 3 occasions. Venous blood was drawn preexercise, postexercise, and 30 min postexercise. RESULTS: Cortisol was unaffected (both P > .05; 50/70, ηp2 = .090; RPETP, ηp2 = .252), while testosterone was elevated (both P < .05; 50/70, 35%, ηp2 = .714; RPETP, 42%, ηp2 = .892) with low intraindividual coefficients of variation (CVi) as mean (SD) (50/70, 7% [5%]; RPETP, 12% [9%]). Heart rate (50/70, effect size [ES] = 0.39; RPETP, ES = -0.03), speed (RPETP, ES = -0.09), and rating of perceived exertion (50/70 ES = -0.06) were unchanged across trials (all CVi < 5%, P < .05). RPETP showed greater physiological strain (P < .01). CONCLUSIONS: Both tests elicited reproducible physiological and testosterone responses, but RPETP induced greater testosterone changes (likely due to increased physiological strain) and could therefore be considered a more sensitive tool to potentially detect overtraining syndrome. Advantageously for the practitioner, RPETP does not require a priori exercise-intensity determination, unlike the 50/70, enhancing its integration into practice.

Fatores relacionados à utilização de insulina em diabéticos acompanhados pela estratégia saúde da família / Factors associated with the use of insulin in diabetic patients monitored by the family health strategy

Objetivou-se analisar o manejo empregado na utilização de insulina por pessoas com DM2, acompanhadas pela Estratégia Saúde da Família (ESF). Estudo quantitativo realizado com 87 usuários diabéticos do tipo 2, de três Centros de Saúde da Família, em Fortaleza, Ceará. Os dados foram coletados, por meio de formulário aplicado de março a maio de 2012, organizados em tabelas, e analisados pela estatística descritiva. A maioria dos entrevistados, 71,3%, era do sexo feminino, com idade superior a 51 anos, 39,1% faziam uso da insulina entre 1 a 5 anos, 47,1% associavam a insulina NPH com a Regular. 57,5% praticavam a autoaplicação e 96,6% higienizavam as mãos, antes do procedimento. A reutilização das seringas foi realizada por 94,3% dos entrevistados, e 47,1% não armazenavam corretamente a insulina. Com relação ao descarte das seringas, a maioria o realizava incorretamente. Concluiu-se que os cuidados com a insulinização não são realizados de forma integral.

The objective was to analyze the care employed in managing insulin use for people with type 2 diabetes mellitus, monitored by the Family Health Strategy. This was a quantitative study conducted with 87 users with type 2 diabetes, at three Family Health Centers in Fortaleza, Ceará. Data were collected via a questionnaire, between March and May 2012, organized in tables, and analyzed using descriptive statistics. The majority of respondents, 71.3%, were female, over 51 years of age, 39.1% had been using insulin between 1 and 5 years, 47.1% combined NPH with Regular insulin. 57.5% practiced self-administration, and 96.6% washed their hands before proceeding. The reuse of syringes was practiced by 94.3% of respondents, and 47.1% were not properly storing the insulin. Regarding disposal of syringes, most performed this incorrectly. It was concluded that the care employed in insulin treatment is not being handled in a comprehensive manner.

Evaluation of the fixation of the trabecular metal wedge in patients undergoing revision of total hip arthroplasty

Objective: this study aimed to evaluate the fixation of the trabecular metal wedge in patients undergoing revision of total hip arthroplasty. Methods: twenty-three cases with minimum grading of Paprosky II-B that were operated between July 2008 and February 2013 were evaluated. These cases were evaluated based on radiographs before the operation, immediately after the operation and later on after the operation. Loss of fixation was defined as a change in the abduction angle of the component greater than 10° or any mobilization greater than 6 mm. Results: it was found that there was 100% fixation of the acetabula after a mean of 29.5 months. One case underwent removal of the implanted components due to infection. Conclusions: there is still no consensus regarding the best option for reconstructing hips with bone loss. However, revision using a trabecular metal wedge has presented excellent short-and medium-term results. This qualifies it as an important tool for achieving a fixed and stable acetabular component...

Objetivo: avaliar a fixação das cunhas de metral trabeculado (CMT) em pacientes submetidos à revisão de artroplastia total de quadril. Métodos: foram avaliados 23 casos graduados no mínimo como II-B de Paprosky, operados entre julho de 2008 e fevereiro de 2013. Os casos foram avaliados com base nas radiografias pré e pós-operatórias imediatas e tardias. A perda da fixação foi definida como uma variação do ângulo de abdução do componente maior do que 10° ou qualquer mobilização maior do que 6 mm. Resultados: verificou-se 100% de fixação dos acetábulos após 29,5 meses em média. Um caso foi submetido à retirada dos componentes implantados por infecção. Conclusões: ainda não há consenso no que diz respeito à melhor opção de reconstrução do quadril com perda óssea, porém a revisão com CMT vem apresentando excelentes resultados em curto e médio prazo. Tal fato a qualifica como uma importante ferramenta na obtenção de um componente acetabular fixo e estável...