Height benefit of GnRH agonists after age 8 in a Portuguese cohort of central precocious puberty.

OBJECTIVE: Idiopathic central precocious puberty (iCPP) is common in paediatric endocrinology. Gonadotropin-releasing hormone agonists (GnRHa) are safe, but the effect on final height and the ideal timing for treatment remains controversial. This study aims to assess the effectiveness of GnRHa on growth outcomes in girls with iCPP treated before and after the age of 8 years old. DESIGN AND PATIENTS: This retrospective longitudinal study evaluated data from Portuguese girls with iCPP who completed treatment between 2010 and 2021. MEASUREMENTS: Auxological and clinical characteristics were compared according to age at treatment onset. RESULTS: A cohort of 134 girls with iCPP, was divided into early treatment (ET) (<8 years, n = 48) and later treatment (LT) groups (≥8 years, n = 86). In both groups, most children presented with Tanner II and III. Tanner IV was more frequent in LT group (p = .003). At the end of treatment, predicted adult height increased in both groups (ET p = .032; LT p = .04) and bone age significantly slowed down in all participants (p = .008, p = .034). The height gain was greater in the ET group, but without significant differences (p = .065). CONCLUSIONS: Treatment with GnRHa improved final height in all girls with iCPP, even when initiated after 8 years. To achieve better outcomes, treatment should be provided promptly after diagnosis.

Incidence of Medical Adhesive-Related Skin Injuries and Associated Factors After Pediatric Congenital Heart Surgery: A Prospective Cohort Study.

PURPOSE: The aim of this study was to identify the incidence, characteristics, and factors associated with medical adhesive-related skin injuries (MARSI). DESIGN: Prospective cohort study. SUBJECTS AND SETTINGS: The sample comprised 136 children in the postoperative period after congenital heart surgery. The study setting was in a 31-bed pediatric surgical intensive care unit (ICU) of a university hospital in Sao Paulo, Brazil. METHODS: Patients were followed from admission, with daily skin assessments, until the onset of MARSI or ICU discharge. Outcomes were compared by Fisher's exact test, Pearson's χ2 test, Mann-Whitney test, Brunner-Munzel test, and Welch 2-sample t test. RESULTS: The incidence of MARSI was 60.3%, with 85 injuries in 82 patients. The highest occurrence was on postoperative day 2 (27 wounds; 31.8%). The most frequent medical adhesive associated with MARSI was transparent film dressing (n = 74; 86.6%). Factors associated with MARSI were age (P = .000), number of devices inserted (P = .000), Braden Q Scale score (P = .005), duration of surgery (P = .021), cardiopulmonary bypass duration (P = .000), duration of mechanical ventilation (P = .000), and length of ICU stay (P = .000). Children who developed MARSI received more blood components (P = .039), vasopressors (P = .000), and corticosteroids (P = 0.000); required longer sedation (P = .000); and had more edema (P = .001). CONCLUSION: This high incidence indicates the need for greater awareness and prompt action in response to MARSI. Polyurethane transparent film without concurrent use of a skin barrier product should be avoided.

Image quality of compressive single-pixel imaging using different Hadamard orderings.

Single-pixel imaging is an imaging technique that has recently attracted a lot of attention from several areas. This paper presents a study on the influence of the Hadamard basis ordering on the image reconstruction quality, using simulation and experimental methods. During this work, five different orderings, Natural, Walsh, Cake-cutting, High Frequency and Random orders, along with two different reconstruction algorithms, TVAL3 and NESTA, were tested. Also, three different noise levels and compression ratios from 0.1 to 1 were evaluated. A single-pixel camera was developed using a digital micromirror device for the experimental phase. For a compression ratio of 0.1, the Cake-cutting order achieved the best reconstruction quality, while the best contrast was achieved by Walsh order. For compression ratios of 0.5, the Walsh and Cake-cutting orders achieved similar results. Both Walsh and Cake-cutting orders reconstructed the images with good quality using compression ratios from 0.3. Finally, the TVAL3 algorithm showed better image reconstruction quality, in comparison with NESTA, when considering compression ratios from 0.1 to 0.5.

Do GnRH Agonists Really Increase Body Weight Gain? Evaluation of a Multicentric Portuguese Cohort of Patients With Central Precocious Puberty.

Introduction: There are several concerns associated with gonadotropin-releasing hormone agonist (GnRHa) treatment for central precocious puberty (CPP), such as obesity and changes in body mass index (BMI). We aimed to investigate whether any anthropometric differences exist and if they persist over time. Methods: We conducted an observational study of Portuguese children (both sexes) diagnosed with CPP between January 2000 and December 2017, using a digital platform, in order to analyze the influence of GnRHa treatment on BMI-SD score (BMI-SDS). Results: Of the 241 patients diagnosed with CPP, we assessed 92 patients (8% boys) in this study. At baseline, 39% of the patients were overweight. BMI-SDS increased with treatment for girls but then diminished 1 year after stopping GnRHa therapy (p = 0.018). BMI-SDS variation at the end of treatment was negatively correlated with BMI-SDS at baseline (p < 0.001). Boys grew taller and faster during treatment than did girls (p < 0.001), and therefore, their BMI-SDS trajectory might be different. Conclusions: This study showed an increase of body weight gain during GnRHa treatment only in girls, which reversed just 1 year after stopping treatment. The overall gain in BMI-SDS with treatment is associated with baseline BMI-SDS.

Novel mutations of the BSCL2 and AGPAT2 genes in 10 families with Berardinelli-Seip congenital generalized lipodystrophy syndrome.

CONTEXT: Congenital generalized lipodystrophy, or Berardinelli-Seip syndrome, is a rare autosomal recessive disease caused by mutations in either the BSCL2 or AGPAT2 genes. This syndrome is characterized by an almost complete loss of adipose tissue usually diagnosed at birth or early infancy resulting in apparent muscle hypertrophy. Common clinical features are acanthosis nigricans, hepatomegaly with or without splenomegaly and high stature. Acromegaloid features, cardiomyopathy and mental retardation can also be present. DESIGN: We investigated 11 kindreds from different geographical areas of Brazil (northeast and southeast). All coding regions as well as flanking intronic regions of both genes were examined. Polymerase chain reaction (PCR) amplifications were performed using primers described previously and PCR products were sequenced directly. RESULTS: Four AGPAT2 and two BSCL2 families harboured the same set of mutations. BSCL2 gene mutations were found in the homozygous form in four kindreds (c.412C>T c.464T>C, c.518-519insA, IVS5-2A>G), and in two kindreds compound mutations were found (c.1363C>T, c.424A>G). In the other four families, one mutation of the AGPAT2 gene was found (IVS3-1G>C and c.299G>A). CONCLUSIONS: We have demonstrated four novel mutations of the BSCL2 and AGPAT2 genes responsible for Berardinelli-Seip syndrome and Brunzell syndrome (AGPAT2-related syndrome).

Congenital muscular torticollis: where are we today? A retrospective analysis at a tertiary hospital.

BACKGROUND: The congenital muscular torticollis is characterized by a persistent lateral flexion of the head to the affected side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. The majority of the cases resolve with conservative management, with parents/caregivers education and physical therapy.The aim of this study was to assess demographic and clinical characteristics, treatment options, and outcome, amongst infants referred to pediatric rehabilitation consultation due to congenital muscular torticollis. METHODS: Retrospective cohort study of infants diagnosed with congenital muscular torticollis between January 2012 and December 2014. Obstetric and perinatal data, clinical presentation, comorbidities, treatment, and outcome were abstracted from clinical records. RESULTS: One hundred six infants were included. There was no sex predominance and mean age at first pediatric rehabilitation consultation was 11.6 (10.4) weeks. Most women were primiparous (76.4%), dystocic labor predominated (73.6%), and pelvic fetal presentation occurred in 20.8%. At examination, 49.1% of the infants had abnormalities, beyond the tilt cervical, mainly range of motion restrictions and palpable nodule in sternocleidomastoid muscle. Among the 87 children who performed the cervical ultrasound, 29 (27.4%) had anomalies. Associated clinical conditions such as hip dysplasia were identified. The majority (71.7%) were submitted to conservative treatment, 30.2% in the Pediatric Rehabilitation Department. Most infants (97.2%) showed a complete resolution of the torticollis. CONCLUSIONS: Congenital muscular torticollis is the most common cause of torticollis in the infants. Early diagnosis, parent/caregivers education, and conservative treatment are crucial to achieving good results.

Urinary tract infection in patients with spinal cord injury after urodynamics under fosfomycin prophylaxis: a retrospective analysis.

BACKGROUND: Urinary tract infection (UTI) is a common complication of spinal cord injury (SCI). Urodynamic testing is widely used for characterization of vesico-sphincteric dysfunction and for therapeutic orientation. As an invasive procedure, the risk of UTI is increased so, in some medical centers, antibiotic prophylaxis is instituted. Fosfomycin is one of the antibiotics used. OBJECTIVE: The aim of this study was to evaluate the incidence of UTI after urodynamics in patients with SCI, under fosfomycin prophylaxis. METHODS: Retrospective analysis was performed on patients with SCI, admitted to a rehabilitation center between January 2016 and June 2017, who underwent urodynamics studies under fosfomycin prophylaxis. Demographic data, risk factors for UTI-bacteriuria before urodynamics, high residual volume (>100 mL), bladder emptying method, vesico-sphincteric dyssynergia, and detrusor hyperactivity were analyzed. The incidence of UTI after urodynamics was evaluated. RESULTS: The study included 84 patients, predominantly men 55 (65.5%). The mean age of the patients was 55.6 (18.9). Eleven (22.5%) had vesico-sphincteric dyssynergia, 32 (65.3%) detrusor hyperactivity and 22 (44.9%) had a high residual volume. Thirty-seven (44.1%) had asymptomatic bacteriuria before the urodynamics. Urinary complaints suggestive of UTI after urodynamics were observed in 2(2.4%) of patients, without significant bacteriuria and identification of bacterial agent. CONCLUSIONS: The incidence of UTI after invasive procedures is reported between 3% and 20% in the literature, so antibiotic prophylaxis has been instituted, although controversial. In the study, in none of the patients the diagnosis of UTI was confirmed. Fosfomycin prophylaxis may have been important in reducing the incidence of UTI.

Nonpharmacological interventions to improve quality of life in heart failure: an integrative review. / Intervenções não farmacológicas para melhor qualidade de vida na insuficiência cardíaca: revisão integrativa.

OBJECTIVE:: to identify articles that assessed the effectiveness or efficacy of nonpharmacological interventions to improve quality of life of people with heart failure in the literature. METHOD:: an integrative literature review was performed in Lilacs, MedLine and SciELO databases, including randomized or nonrandomized clinical trials and quasi-experimental studies published between 2003 and 2014, in Portuguese, English or Spanish. RESULTS:: twenty-three studies were included. The categories of nonpharmacological interventions that improved quality of life of people with heart failure were: Remote health monitoring, Instructions on health practices, Physical activity follow-up and Traditional Chinese Medicine practices. CONCLUSION:: these results can guide the selection of interventions to be implemented by health professionals that treat people with heart failure. Future systematic reviews with meta-analyses are needed in order to identify the most effective interventions for improving these individuals' quality of life.

HIV/aids no Brasil: feminização da epidemia em análise / HIV/aids in Brazil: the feminization of the epidemic under analysis / VIH/sida en Brasil: la feminización de la epidemia en análisis

Resumo Este trabalho analisa a feminização da epidemia de HIV/aids no Brasil e a importância de considerar esse processo no planejamento de ações em saúde pública. A pesquisa foi desenvolvida por meio de revisão de literatura e estudo de dados oficiais do Ministério da Saúde. Os resultados mostram que ações eficazes no combate à infecção por HIV/aids entre as mulheres devem contemplar diferenças de gênero e condições socioculturais de cada região. O artigo ainda propõe que é imprescindível um processo amplo de educação em saúde, que abranja simultaneamente homens e mulheres e tenha foco no empoderamento e no cuidado de si e do outro.

Abstract This article analyzes the feminization of the HIV/aids epidemic in Brazil and the importance of considering this process when planning public health actions. This study is a literature review and also includes the analysis of official data from the Ministry of Health. The results show that effective actions to combat HIV/aids infection among women must take gender differences and the sociocultural conditions of each region into consideration. The need for a broad health education process for both men and women focusing on empowerment, self-care and caring for others can also be highlighted.

Resumen Este artículo analiza el proceso de feminización de la epidemia de HIV/sida en Brasil y su importancia en las acciones de planificación en la salud pública. La investigación parte de una revisión de la literatura y de datos oficiales del Ministerio de Salud de Brasil. Las acciones efectivas para combatir la infección por VIH/sida entre las mujeres deben abordar las diferencias de género y las condiciones socioculturales en cada región. Es esencial un amplio proceso de educación sanitaria, que abarque a las poblaciones masculinas y femeninas, centrándose en el empoderamiento, el autocuidado y el cuidado de los demás dentro de las relaciones establecidas.

Intervenções da Terapia Ocupacional com pacientes pós-Febre Chikungunya: Um Relato de Experiência / Intervenciones de Terapia Ocupacional con pacientes después del Fiebre Chikungunya: un informe de experiencia / Occupational Therapy interventions with post Chikungunya Fever patients: an experience report

Introdução: Indivíduos acometidos pela Febre Chikungunya, a depender do grau de gravidade do quadro clínico, por muitas vezes, deixam de realizar algumas de suas atividades cotidianas devido a intensidade de dores. Deste modo, as perdas funcionais resultam em mudança nos papéis ocupacionais exercidos. Objetivos: Relatar a experiência da assistência terapêutica ocupacional com pacientes pós-Febre Chikungunya, e descrever as intervenções e estratégias utilizadas. Método: Estudo descritivo, do tipo relato de experiência a partir de vivências em projeto de extensão com 10 pacientes pós-Febre Chikungunya, realizado na clínica escola de Fisioterapia com colaboração do Departamento de Terapia Ocupacional da Universidade Federal de Pernambuco, durante o período de abril a dezembro de 2018. Resultados: Participaram do estudo 8 pacientes do sexo feminino e 2 do sexo masculino, com idade entre 48 e 74 anos. A Terapia Ocupacional colaborou com o projeto a partir de ações, como: avaliação terapêutica ocupacional, discussão em equipe, realização de grupo de autocuidado e de um grupo dialógico de discentes da Fisioterapia e Terapia Ocupacional, e um atendimento individualizado. Conclusão: As ações mostraram-se importantes para a construção do conhecimento sobre a doença e melhor enfrentamento da mesma a partir do foco da Terapia Ocupacional. Considerou-se que as intervenções terapêuticas ocupacionais podem ser individuais e/ou em grupo, utilizando-se como base os princípios de reumatologia sobre proteção articular e conservação de energia como importantes referenciais para o subsídio de ações terapêuticas.

Introducción: las personas afectadas por la fiebre chikungunya, según el grado de gravedad del cuadro clínico, a menudo no pueden realizar algunas de sus actividades diarias debido a la intensidad del dolor. De esta manera, las pérdidas funcionales resultan en cambios en los roles ocupacionales ejercidos. Objetivos: Informar la experiencia de asistencia de terapia ocupacional con pacientes después de la fiebre Chikungunya, y describir las intervenciones y estrategias utilizadas. Método: Estudio descriptivo, un informe de experiencia basado en experiencias en un proyecto de extensión con 10 pacientes después de la Fiebre Chikungunya, realizado en la clínica de la escuela de fisioterapia con la colaboración del Departamento de Terapia Ocupacional de la Universidad Federal de Pernambuco, durante el período de abril hasta diciembre de 2018. Resultados: el estudio incluyó a 8 pacientes de sexo femenino y 2 pacientes de sexo masculino, con edades comprendidas entre 48 y 74 años. La terapia ocupacional colaboró con el proyecto en base a acciones tales como: evaluación terapéutica ocupacional, discusión en equipo, grupo de autocuidado y grupo dialógico de estudiantes de fisioterapia y terapia ocupacional, y atención individualizada. Conclusión: Las acciones demostraron ser importantes para la construcción de conocimiento sobre la enfermedad y para enfrentarla mejor desde el enfoque de la Terapia Ocupacional. Se consideró que las intervenciones terapéuticas ocupacionales pueden ser individuales y/o grupales, basadas en los principios de la reumatología en la protección de las articulaciones y la conservación de la energía como referencias importantes para subsidiar acciones terapéuticas.

Introduction: Individuals affected by Chikungunya Fever, depending on the severity of the clinical picture, often fail to perform some of their daily activities due to pain intensity. Thus, functional losses result in changes in occupational roles. Objectives: To report the experience of occupational therapeutic care with patients after Chikungunya Fever, and describe the interventions and strategies used. Methods: This is a descriptive, experience-based study from experiences in an extension project with 10 patients after Chikungunya Fever, conducted at the Physical Therapy School Clinic in collaboration with the Occupational Therapy Department of the Federal University of Pernambuco, from April to December from 2018. Results: Eight female and two male patients aged 48 to 74 years participated in the study. Occupational Therapy collaborated with the project through actions such as: occupational therapeutic evaluation, team discussion, self-care group and a dialogical group of students of Physical Therapy and Occupational Therapy, as well as individualized monitoring by one of the project participants. Conclusion: The actions proved to be important for the construction of knowledge about the disease and better coping with it from the focus of Occupational Therapy. It was considered that occupational therapeutic interventions can be individual and/or group, based on the principles of rheumatology on joint protection and energy conservation as important references for subsidizing therapeutic actions.

Órteses e próteses de membro superior impressas em 3D: uma revisão integrativa / Upper limbs orthesis and prostheses printed in 3D: an integrative review

Resumo Introdução A impressão tridimensional (3D) é capaz de confeccionar produtos físicos avançados e especializados por meio de tecnologia computadorizada e softwares específicos. Alguns desses produtos são as órteses e próteses, que podem favorecer a funcionalidade do sujeito em seu cotidiano. Objetivo Identificar o tipo, o uso e a aplicabilidade da impressão 3D na confecção de órteses e próteses para membro superior. Método Revisão integrativa realizada nas bases de dados PubMed, LILACS, Web of Science, Scopus e Science Direct, sem delimitação de tempo, na língua portuguesa, inglesa ou espanhola, seguindo os critérios de elegibilidade: estudos do tipo experimental, observacional e relatos de casos, cujo objeto de estudo foram as órteses e próteses impressas em 3D, com pacientes de qualquer idade e qualquer diagnóstico de comprometimento do membro superior. Resultados Foram incluídos nove artigos, sete referentes ao uso da impressão 3D na confecção de prótese e dois referentes à confecção de órteses. Muitos dos estudos foram direcionados ao público infantil e os materiais mais utilizados para confecção foram o PLA e o ABS. A equipe multidisciplinar foi apresentada como fundamental no processo de avaliação, criação e testagem dos dispositivos. Conclusão Apesar dos estudos analisados tangenciarem fases iniciais de desenvolvimento e investigação da aplicabilidade da impressão 3D na criação de órteses e próteses, observou-se que já existem melhorias do custo-benefício gerado pelo uso desta tecnologia, bem como a possibilidade de gerar produtos mais versáteis. Apontando-se como um campo promissor para ampliar a aplicação da impressão 3D como recurso facilitador do processo de reabilitação.

Abstract Introduction Three-dimensional (3D) printing is capable of making advanced and specialized physical products using computerized technologies and specific software. Some of these products are orthosis and prostheses which can support patients' functionality in their daily lives. Objective To identify the type, the usage, and the applicability of 3D printing on the development of upper limbs' orthosis and prostheses. Method Integrative review carried out on the following databases: Pubmed, LILACS, Web of Science, Scopus e Science Direct, with no specific publication period, written in English, Spanish or Portuguese. It also had to fit the following criteria: experimental and observational studies and case reports which had 3D printed orthosis and prosthesis as the object of study with patients of any age or diagnosis of upper limb damage. Results Nine studies were included. Seven referred to the use of 3D printing to make prosthesis and 2 to make orthosis. Many studies were directed to children and the most used materials were PLA and ABS. The multidisciplinary team was fundamental in the process of evaluation, creation, and testing of the devices. Conclusion Despite the analyzed studies mention initial phases of development and investigation of the applicability of 3D printing in the creation of orthosis and prostheses, it was observed that cost-benefit improvements generated by the use of this technology already exist, as well as the possibility of generating more versatile products. It's a promising field to amplify the applicability of 3D printing as a resource facilitating the rehabilitation process.

Insulin resistance in adolescents with Down syndrome: a cross-sectional study.

BACKGROUND: The prevalence of diabetes mellitus is higher in individuals with Down syndrome (DS) than in the general population; it may be due to the high prevalence of obesity presented by many of them. The aim of this study was to evaluate the insulin resistance (IR) using the HOMA (Homeostasis Model Assessment) method, in DS adolescents, describing it according to the sex, body mass index (BMI) and pubertal development. METHODS: 15 adolescents with DS (8 males and 7 females) were studied, aged 10 to 18 years, without history of disease or use of medication that could change the suggested laboratory evaluation. On physical examination, the pubertal signs, acanthosis nigricans (AN), weight and height were evaluated. Fasting plasma glucose and insulin were analysed by the colorimetric method and RIA-kit LINCO, respectively. IR was calculated using the HOMA method. The patients were grouped into obese, overweight and normal, according to their BMI percentiles. The EPIINFO 2004 software was used to calculate the BMI, its percentile and Z score. RESULTS: Five patients were adults (Tanner V or presence of menarche), 9 pubertal (Tanner II-IV) and 1 prepubertal (Tanner I). No one had AN. Two were obese, 4 overweight and 9 normal. Considering the total number of patients, HOMA was 1.7 +/- 1.0, insulin 9.3 +/- 4.8 microU/ml and glucose 74.4 +/- 14.8 mg/dl. The HOMA values were 2.0 +/- 1.0 in females and 1.5 +/- 1.0 in males. Considering the nutritional classification, the values of HOMA and insulin were: HOMA: 3.3 +/- 0.6, 2.0 +/- 1.1 and 1.3 +/- 0.6, and insulin: 18.15 +/- 1.6 microU/ml, 10.3 +/- 3.5 microU/ml and 6.8 +/- 2.8 microU/ml, in the obese, overweight and normal groups respectively. Considering puberty, the values of HOMA and insulin were: HOMA: 2.5 +/- 1.3, 1.4 +/- 0.6 and 0.8 +/- 0.0, and insulin: 13.0 +/- 5.8 microU/ml, 7.8 +/- 2.9 microU/ml and 4.0 +/- 0.0 microU/ml, in the adult, pubertal and prepubertal groups respectively. CONCLUSION: The obese and overweight, female and adult patients showed the highest values of HOMA and insulin.

Educação moral e cívica: a retomada da obrigatoriedade pela agenda conservadora / Moral and civic education: the resumption of obligation by the conservative agenda / Educación moral y cívica: la reanudación de la obligación por parte de la agenda conservadora / La reprise de l'obligation de l'enseignement moral et civique par l'agenda politique conservateur

Resumo O artigo tem como objetivo problematizar a proposta de reintrodução da educação moral e cívica como disciplina obrigatória na escola em um contexto favorável a grupos defensores do que seria o arquétipo de moral e bons costumes, cuja articulação está em consonância com o Programa Nacional das Escolas Cívico-Militares. Foi utilizada a ferramenta analítica do ciclo de políticas e considerado o processo de hibernação como mecanismo para influenciar a entrada e saída dessa disciplina. Pesquisamos a oferta da disciplina em peças legislativas a partir de 1996, atribuindo ênfase aos ordenamentos da agenda conservadora pós-eleição presidencial de 2018. Conclui-se que tal disputa relaciona-se a um projeto de gestão como tecnologia moral, que se contrapõe à gestão democrática da escola pública.

Abstract This paper seeks to confront the proposal of reintroducing the moral and civic education as a compulsory subject at school by the group who defends an archetype of morality and good customs, whose this favorable context have been articulated with de National Program of the Civic-Military Schools. We use the analytical tool of the policy cycle and consider the concept of hibernation as a mechanism to maintain this subject in activity. The empirical analysis is based on legislatives documents which are intent to offer the moral and civic education as a subject since 1996, putting emphasis on documents of the conservative agenda after the presidential election, in 2018. We conclude that this dispute is related to a management project as moral technology that opposes the democratic management of public schools.

Resumen El artículo problematiza la propuesta de restablecer la disciplina de educación moral y cívica como obligatoria en la escuela, en un contexto favorable a grupos defensores de lo que sería el arquetipo de la moral y de los buenos costumbres, cuya articulación está en consonancia con el Programa Nacional de las Escuelas Cívico-Militares. Utilizamos la herramienta analítica del ciclo de políticas y consideramos el proceso de hibernación como mecanismo para influir en la entrada y la salida de los contenidos de esa disciplina. De este modo, pesquisamos en el escenario brasileño el ofrecimiento de la disciplina en las leyes, desde 1996, con destaque a los ordenamientos de la agenda conservadora pos elección presidencial de 2018. Concluimos que tal disputa se relaciona a un projecto de gestión como tecnología moral, lo que se contrapone a la gestión democrática de la escuela pública.

Résumé L'article a comme but de problématiser la proposition de la réintroduction de l'obligation de l'enseignement moral et civique à l'école, dans un contexte favorable à des groupes qui défendent l'archétype de la morale et de bonnes mœurs et dont l'articulation est en accord avec le Programa Nacional das Escolas Cívico-Militares.. On a utilisé comme outil l'analyse du cycle de politiques et considéré le processus d'hibernation comme un mécanisme pour influencer l'apparition et disparition de ce sujet. On a recherché son offre dans des documents légistatifs à partir de 1996, en mettant l'accent sur les commandes de l'agenda politique conservateur après les éléctions de 2018. La conclusion indique que tel litige a un rapport avec un projet de gestion comme technologie morale, contraire à la gestion démocratique de l'école publique.

Aplicabilidade da captura de movimentos na pesquisa interdisciplinar de tecnologia assistiva: um relato de experiência / Applicability of motion capture in interdisciplinary research of assistive technology: a report of experience

Resumo Introdução A Tecnologia Assistiva (TA) é apontada como uma das soluções para proporcionar uma melhor funcionalidade e qualidade de vida às pessoas com doenças reumatológicas. Projetos interdisciplinares com foco em avaliar, indicar e desenvolver TA são importantes para os avanços na pesquisa e assistência clínica. A captura de movimento, por meio da instrumentação tecnológica, apresenta-se como um tema inovador por fornecer dados objetivos sobre o usuário. Mais estudos nessa área são necessários para conhecer as possibilidades de aplicação da instrumentação tecnológica em pesquisas de TA. Objetivo Descrever a aplicabilidade da captura de movimento, por meio de um equipamento de alta tecnologia, numa pesquisa interdisciplinar de TA para pacientes reumatológicos. Método Trata-se de Relato de Experiência, com uma abordagem qualitativa, no qual foi descrito as ações utilizando um equipamento tecnológico específico para captura de movimentos. Resultados Foi utilizada a captura de movimento com três finalidades: apoio educacional; avaliação de usabilidade de recursos de TA desenvolvidos; e suporte a grupos de estudo de terapeutas ocupacionais para análises de atividades. Conclusão Nas diferentes ações, a captura de movimento funcionou como um recurso complementar para as análises de atividades realizadas pelos terapeutas ocupacionais, o que contribuiu para a indicação, desenvolvimento e avaliação dos dispositivos de TA e para facilitar as orientações dadas no manual e nos grupos de orientação sobre Proteção Articular. O trabalho interdisciplinar foi o diferencial para o uso adequado do equipamento.

Abstract Introduction Assistive Technology (AT) is pointed as one of the possible solutions to offer better functionality and quality of life for people with rheumatological diseases. Interdisciplinary projects focused on assessing, indicating, and developing AT are important for advances in research and clinical care. Motion capture, through technological instrumentation, is an innovative theme for providing objective data about the user. Further studies in this area are needed to know the possibilities of applying technological instrumentation in AT research. Objective To describe the applicability of motion capture, using high-tech equipment, in an interdisciplinary AT research for rheumatological patients. Method It is an Experience Report, with a qualitative approach, in which the actions were described using specific technological equipment to motion capture. Results: Motion capture was used for three purposes: educational support; usability evaluation of AT resources developed; and support for study groups of occupational therapists to activity analysis. Conclusion In the different actions, the motion capture was used as a complementary resource for activities' analysis performed by occupational therapists, which contributed to the indication, development, and evaluation of AT devices and to facilitate the instructions provided in manual and in the guidance groups about Joint Protection. Interdisciplinary work was differentiated for the proper use of equipment.

Repercussões do treinamento com realidade virtual não imersiva nas habilidades motoras manuais de pessoas com doença de Parkinson / Repercussions of training with non immersive virtual reality in manual skills of pepople with Parkinson's disease

Dentre os problemas motores e não motores que acometem as pessoas com Doença de Parkinson, existem as dificuldades na escrita manual, denominada micrografia. No treino com realidade virtual não imersiva para escrita, o terapeuta ocupacional tem competência para planejar o tratamento por meio da análise da atividade, a fim de amenizar e prevenir os impactos da Doença de Parkinson nas ocupações. Objetivo: Analisar as repercussões do treinamento com realidade virtual não imersiva nas habilidades motoras manuais de pessoas com Doença de Parkinson. Métodos: Trata-se de um estudo de intervenção, do tipo ensaio clínico não controlado, de natureza quantitativa. O treinamento com realidade virtual não imersiva contemplou o uso do tablet e dos aplicativos Dexteria®, Smash Hit e Dots. O estudo foi vinculado ao Programa de Extensão Pró-Parkinson e ao Projeto Pró-Parkinson: Terapia Ocupacional. Resultados: A amostra foi composta por dez participantes de ambos os sexos. Em relação à dominância do membro superior, apenas um participante era canhoto. A análise da atividade foi fundamental para estimular as habilidades requeridas pelos aplicativos. Discussão: De acordo com o analisado, os resultados encontrados são favoráveis aos participantes da pesquisa por corresponder a uma doença neurodegenerativa. A realidade virtual não imersiva é um recurso favorável para fornecer estímulos visuais com propósito de melhorar a velocidade de movimento, refletindo na mobilidade funcional. Conclusão: O treino com os aplicativos selecionados pela técnica de análise da atividade, em realidade virtual não imersiva melhorou e/ou manteve as habilidades motoras dos participantes, mesmo nos estágios mais avançados da doença.

Among the motor and non-motor problems that affect people with Parkinson's disease, there are difficulties in manual writing, called micrography. In training with non-immersive virtual reality for writing, the occupational therapist has the competence to plan treatment through activity analysis, in order to mitigate and prevent the impacts of Parkinson's Disease on occupations. Objective: To analyze the repercussions of training with non-immersive virtual reality in the motor skills of people with Parkinson's disease. Methods: This is an intervention study of the non-controlled clinical trial type of a quantitative nature. Training with non-immersive virtual reality included the use of tablet and applications Dexteria®, Smash Hit and Dots. The study was linked to the Pro-Parkinson Extension Program and the Pró-Parkinson Project: Occupational Therapy. Results: The sample consisted of ten participants of both sexes. Regarding the dominance of the upper limb, only one participant was left-handed. Activity analysis was instrumental in stimulating the skills required by the applications. Discussion: According to the analyzed, the results are favorable to the participants of the research for corresponding to a neurodegenerative disease. Non-immersive virtual reality is a favorable resource to provide visual stimuli for the purpose of improving speed of movement, reflecting functional mobility. Conclusion: Training with applications selected by activity analysis technique, in non-immersive virtual reality improved and/or maintained the motor skills of participants, even in the most advanced stages of the disease.

Berardinelli-Seip syndrome: highlight of treatment challenge.

Berardinelli-Seip congenital lipodystrophy (BSCL) syndrome is a rare autosomal-recessive disease characterised by lipoatrophy and associated with deregulations of glycidic and lipid metabolism. We report three BSCL cases with its typical clinical picture and complications. Clinically, they all show marked atrophy of adipose tissue, acromegaly, acanthosis nigricans and tall stature. Two cases present attention deficit hyperactivity and developmental learning disorders; another patient has hypertrophic myocardiopathy and polycystic ovary syndrome. In all the cases AGPAT2 was the identified mutation. All the cases present hypertriglyceridemia. One case has developed hyperinsulinism controlled with metformin and another case already has type 2 diabetes with a difficult clinical control. There is no curative treatment and the current treatment options are based only on symptomatic control of the complications. Recently, published studies showed that leptin-replacement therapy appears a promising tool in the metabolic correction of BSCL complications, highlighting the importance of further investigations in BSCL treatment.

Septo-optic dysplasia: fitting the pieces together.

A 7-year-old boy was admitted for a general tonic-clonic seizure with severe hypoglycaemia (1.39 mmol/l). His medical history was remarkable for a congenital left eye strabismus, unilateral cryptorchidism and three previous episodes of hypoglycaemic seizures with inconclusive metabolical and neurological investigations. Physical examination revealed a hoarse tone voice, dry skin, cold extremities and height in the third percentile (target height between 50th and 85th percentile). Left wrist radiography revealed a bone age of 4.5 years ±6 months Laboratory studies confirmed growth hormone deficiency and central hypothyroidism. The brain MRI showed an ectopic neurohypophysis. Neuroophthalmology investigation revealed left optic nerve hypoplasia and septo-optic dysplasia was then diagnosed. Thyroid and recombinant growth hormone replacement were started showing clinical improvement. A detailed clinical history and a careful physical examination in children presenting with multiple clinical signs of hypopituitarism may lead to a timely diagnosis, avoiding clinical morbidity associated to untreated hormonal abnormalities.

Intervenções não farmacológicas para melhor qualidade de vida na insuficiência cardíaca: revisão integrativa / Intervenciones no farmacológicas para una mejor calidad de vida en la insuficiencia cardíaca: revisión integrativa / Nonpharmacological interventions to improve quality of life in heart failure: an integrative review

RESUMO Objetivo: identificar, na literatura, artigos que avaliaram a efetividade ou eficácia de intervenções não farmacológicas para melhorar a qualidade de vida de pessoas com insuficiência cardíaca. Método: revisão integrativa de literatura realizada nas bases de dados Lilacs, MedLine e SciELO, incluindo ensaios clínicos randomizados ou não randomizados e estudos quase-experimentais publicados entre 2003 e 2014, em português, inglês e espanhol. Resultados: foram incluídos 23 estudos. As categorias de intervenções não farmacológicas que melhoraram a qualidade de vida de pessoas com insuficiência cardíaca foram: Monitoramento remoto da saúde, Orientação sobre práticas de saúde, Acompanhamento de atividade física e Práticas de Medicina Tradicional Chinesa. Conclusão: estes resultados podem direcionar a seleção de intervenções a serem implementadas por profissionais de saúde que cuidam de pessoas com insuficiência cardíaca. Futuras revisões sistemáticas com metanálise são necessárias para identificar as intervenções mais eficazes para melhorar a qualidade de vida desses indivíduos.

RESUMEN Objetivo: identificar, en la literatura, artículos que evaluaron la efectividad o eficacia de intervenciones no farmacológicas para mejorar la calidad de vida de personas con insuficiencia cardíaca. Método: revisión integrativa de literatura realizada en las bases de datos Lilacs, MedLine y SciELO, incluyendo ensayos clínicos aleatorios o no aleatorios y estudios casi experimentales publicados entre 2003 y 2014, en portugués, inglés y español. Resultados: fueron incluidos 23 estudios. Las categorías de intervenciones no farmacológicas que mejoraron la calidad de vida de personas con insuficiencia cardiaca fueron: Monitoreo remoto de la salud, Orientación sobre prácticas de la salud, Acompañamiento de actividad física y Prácticas de Medicina China Tradicional. Conclusión: estos resultados pueden direccionar la selección de intervenciones a ser implantadas por profesionales de la salud que tratan de personas con insuficiencia cardiaca. Futuras revisiones sistemáticas con meta-análisis son necesarias para identificar las intervenciones más eficaces para mejorar la calidad de vida de estos individuos.

ABSTRACT Objective: to identify articles that assessed the effectiveness or efficacy of nonpharmacological interventions to improve quality of life of people with heart failure in the literature. Method: an integrative literature review was performed in Lilacs, MedLine and SciELO databases, including randomized or nonrandomized clinical trials and quasi-experimental studies published between 2003 and 2014, in Portuguese, English or Spanish. Results: twenty-three studies were included. The categories of nonpharmacological interventions that improved quality of life of people with heart failure were: Remote health monitoring, Instructions on health practices, Physical activity follow-up and Traditional Chinese Medicine practices. Conclusion: these results can guide the selection of interventions to be implemented by health professionals that treat people with heart failure. Future systematic reviews with meta-analyses are needed in order to identify the most effective interventions for improving these individuals’ quality of life.

Análise da rotulagem nutricional de pães de forma com informação nutricional complementar comercializados no município de Belo Horizonte - MG / Analysis of nutritional label of breads with complementary nutritional information sold in Belo Horizonte ­ MG

A busca da população por alimentos práticos, rápidos e saudáveis tem aumentado a preocupação com a rotulagem nutricional visto que este é o principal veículo de informação ao consumidor sobre as características nutricionais dos alimentos embalados. Este estudo objetivou verificar o índice de conformidades e inconformidades da rotulagem de pães embalados diante das regulamentações vigentes. Para tanto, foi avaliada a rotulagem de 23 pães de forma com informação nutricional complementar disponíveis na região metropolitana de Belo Horizonte-MG. As análises foram realizadas através de uma lista de verificação produzida a partir dos requisitos estabelecidos pela legislação sendo classificados como "adequado" ou "inadequado". Os resultados demonstraram que 95% dos rótulos analisados foram classificados como inadequado em algum dos parâmetros avaliados, sendo que 26% dos rótulos foram inadequados no parâmetro "Denominação de venda" e 35% no parâmetro "Tabela de Informação nutricional". O quesito "Informação Nutricional Complementar" obteve o maior número de inadequações concentrando 82,6% da totalidade avaliada. Com base nos resultados obtidos concluiu-se que a falta de entendimento por parte dos fabricantes das leis detentoras da rotulagem nutricional no país entre outros fatores associados, podem explicar as frequentes falhas na rotulagem de alimentos embalados, o que pode ocasionar privação à informação e direito de escolha dos consumidores brasileiros.

The search of the population for fast, healthy and practical foods has increased concern with nutritional labeling, since this is the main vehicle for informing the consum labeling of packaged breads considering the current regulations. The present work evaluated the labeling of 23 breads with complementary nutritional information. The analyzes were carried out through a checklist in which the requirements established by current legislation were used and classified as "satisfactory" or "unsatisfactory". The results showed that 95% of the analyzed labels were classified as unsatisfactory in any of the evaluated parameters, 26% of the labels evaluated were unsatisfactory in the parameter "Sales denomination", 35% in the parameter "Nutrition Information Table" and the " Nutritional Complementary "obtained the greatest number of inadequacies, concentrating 82.6% of the totality evaluated. Based on the results obtained, it is concluded that the lack of understanding by the manufacturers of the laws that have the nutritional labeling in the country, among other associated factors can explain the frequent failures in the labeling of packaged foods, which can cause deprivation to the information and wrong choice of Brazilian consumers.

Validade da estimativa da massa corporal por meio da circunferência abdominal medida em diferentes posições / Validity of body mass estimation by mean of abdominal circumference measured at different positions

A necessidade do uso de fórmulas de estimativas de massa corporal se torna constante por diversos fatores que impossibilitam os pacientes a se colocarem de pé. Rabito e outros, em 2006, propuseram uma fórmula para estimativa de massa corporal com intuito de atender à população brasileira. Baseado nesta nova fórmula, o objetivo do presente estudo foi verificar a validade da fórmula de Rabito e outros (2006), realizando as medidas da circunferência abdominal em três posições diferentes. A amostra constitui-se de 60 pacientes deambulantes, e para o cálculo da fórmula de estimativa de massa corporal foram realizadas as medidas da circunferência do braço, circunferência da panturrilha e a circunferência abdominal, realizada com o paciente em três posições: em pé, em decúbito dorsal e sentado. Os pacientes foram divididos por estado nutricional, através do índice de massa corporal, as massas corporais estimadas foram analisadas estatisticamente com a massa corporal real do paciente quantificada pela balança. Os resultados demonstraram valores estatisticamente semelhantes entre a massa corporal estimada e a massa corporal real em pacientes desnutridos em qualquer posição avaliada. Para pacientes eutróficos e com sobrepeso/obeso, a fórmula se mostrou eficiente para predição da massa corporal real apenas quando sentados. Estes achados podem levar a acreditar que o aumento da massa corporal pode influenciar negativamente na aplicabilidade do método nesta posição. Sugere-se a utilização da fórmula de estimativa de massa corporal proposta por Rabito e outros exclusivamente com o paciente sentado, por demonstrar valores semelhantes, independentemente do diagnóstico de estado nutricional.