Influence of Gestational Age on Pelvic Floor Muscle Activity, Plantar Contact, and Functional Mobility in High-Risk Pregnant Women: A Cross-Sectional Study.

During pregnancy, biomechanical changes are observed due to hormonal and physical modifications, which can lead to alterations in the curvature of the spine, balance, gait patterns, and functionality of the pelvic floor muscles. This study aimed to investigate the progressive impact of biomechanical changes that occur during gestational weeks on the myoelectric activity of the pelvic floor muscles, plantar contact area, and functional mobility of high-risk pregnant women. METHODS: This was a cross-sectional observational study carried out from November 2022 to March 2023. A total of 62 pregnant women of different gestational ages with high-risk pregnancies were analyzed using surface electromyography to assess the functionality of the pelvic floor muscles, plantigraphy (Staheli index and plantar contact area), and an accelerometer and gyroscope using the timed up and go test via an inertial sensor on a smartphone. Descriptive statistics and multivariate linear regression analyses were carried out to test the predictive value of the signature. RESULTS: Increasing weeks of gestation resulted in a decrease in the RMS value (ß = -0.306; t = -2.284; p = 0.026) according to the surface electromyography analyses. However, there was no association with plantar contact (F (4.50) = 0.697; p = 0.598; R2 = 0.53). With regard to functional mobility, increasing weeks of gestation resulted in a decrease in time to standing (ß = -0.613; t = -2.495; p = 0.016), time to go (ß = -0.513; t = -2.264; p = 0.028), and first gyrus peak (ß = -0.290; t = -2.168; p = 0.035). However, there was an increase in the time to come back (ß = 0.453; t = 2.321; p = 0.025) as the number of gestational weeks increased. CONCLUSIONS: Increased gestational age is associated with a reduction in pelvic floor myoelectric activity. The plantar contact area did not change over the weeks. Advancing gestation was accompanied by a decrease in time to standing, time to go, and first gyrus peak, as well as an increase in time to come back.

Gait patterns in ischemic and hemorrhagic post-stroke patients with delayed access to physiotherapy.

OBJECTIVES: (1) To assess the effects of a conventional, delayed physiotherapy protocol used by Ischemic Stroke (IS) and Hemorrhagic Stroke (HS) post-stroke patients, in their electromyographic activation patterns during hemiparetic gait; and (2) to study whether this protocol may improve the functional abilities in this population. METHODS: This is an observational, descriptive, and analytical quasi-experimental trial. Forty patients with unilateral IS ( n = 25 ) and HS ( n = 15 ) stroke were recruited; the stroke involved the motor cortex or sub-cortical areas, and the patients were able to walk independently. Interventions with standard protocols of physiotherapy were carried out. Evaluations (clinical and gait assessment) were performed at the time of admission and at the end of the protocol. Outcome measures include Stroke Impact Scale, Timed Up and Go Test, and gait electromyographic evaluation. RESULTS: Only IS patients (with an average of 124 . 4 ± 45 . 4 months delayed access to physiotherapy rehabilitation) had improvements in Timed Up and Go Test (change in speed =- 8 . 0 seg p < 0 . 05 ) and presented an anticipation of the onset in Upper leg muscles after the intervention. BF ( p = 0 . 05 ), ST ( p = 0 . 001 ), and RF ( p = 0 . 024 ), started their recruitment (onset) earlier at the swing phase of the gait cycle, which is more similar to the normal pattern (grey shadow). IS and HS ( 120 . 4 ± 28 . 4 months since last stroke) patients presented higher electromyographic activation, after physiotherapy, of the posterior leg muscles (gastrocnemius, semitendinosus and biceps femoris) during stance phase ( p < 0 . 05 ). CONCLUSION: IS patients had improvements after delayed conventional physiotherapy. For HS limited response to intervention was observed.

Using sellar region tumor's size as a predictor of psychophysical and electrophysiological perimetric visual losses: a logistic regression approach.

BACKGROUND: Sellar region tumor growth represents an important cause of visual loss due to mechanical compression of the optic nerve apparatus. Many investigations have used non-invasive tools to evaluate the visual field consequences of this damage, and good associations have been reported between psychophysical and electrophysiological perimetries. Few reports have considered the tumor size as a predictor of visual field loss. AIMS: In the present study, we evaluated the association between the visual perimetry measured by Humphrey visual field analyzer and multifocal visual evoked cortical potential (mfVECP) and the tumor size. METHODS: Our sample was composed of 14 patients diagnosed with sellar tumors by magnetic resonance imaging. We accounted the number of sectors with negative visual responses for both methods. A simple logistic regression analysis was used to evaluate the association between the tumor dimensions and the visual field features RESULTS: Three patients had preserved visual fields, three patients showed hemianopic defects, and eight patients had generalized visual field losses at both evaluations. We observed that the three maximum diameters of the tumor and total tumor volume had different predictive abilities regarding the extent of visual field loss when using psychophysical and mfVECP data. The maximum craniocaudal diameter of the tumor was the better predictor of the psychophysical measurements, whereas for the mfVECP results, all tumor dimensions and volumes had similar values that predict visual field losses. CONCLUSION: Tumor size as a predictor of visual loss has potential to assist in the clinical intervention and to prevent the irreversible visual impairment caused by tumors of the sellar region.

Case Report: Second-order Contrast Sensitivity in Tourette Syndrome. / Olgu Sunumu: Tourette Sendromunda Ikinci Düzey Kontrast Duyarliligi.

disease, characterized by motor and vocal tics with no changes in the ocular structures in the ophthalmological evaluations. The visual field evaluations suggest a reduction in central visual field sensitivity. The studies on visual function in this population is scarce. In this case report we present a patient with GTS who has significant alterations in the measure of contrast sensitivity for second order vision without any vision complaints. This reduction occurred in the measure of contrast sensitivity with a white noise carrier for practically all tested space frequencies. The mean contrast sensitivity for first and second-order stimuli with a pink-noise carrier was normal. The second order contrast sensitivity with a white noise carrier is dependent on local and lateral inhibition since it includes many local luminance components. The existence of this sensitivity suggests that specific visual processing mechanisms are affected. Keywords: Tourette Syndrome, Contrast Sensitivity, Contrast Psychophysical Channels, Second-Order Perception.

Postural Adjustments in HTLV-1 Infected Patients during a Self-Initiated Perturbation.

BACKGROUND: Human T-cell lymphotropic virus type 1 (HTLV-1) infection can be associated with tropical spastic paraparesis (TSP/HAM), which causes neurological myelopathy and sensory and muscle tone alterations, leading to gait and balance impairments. Once trunk perturbation is predicted, the motor control system uses anticipatory and compensatory mechanisms to maintain balance by recruiting postural muscles and displacement of the body's center of mass. METHODS: Twenty-six participants (control or infected) had lower limb muscle onset and center of pressure (COP) displacements assessed prior to perturbation and throughout the entire movement. RESULTS: Semitendinosus (ST) showed delayed onset in the infected group compared to the control group. The percentage of trials with detectable anticipatory postural adjustment was also lower in infected groups in the tibialis anterior and ST. In addition, COP displacement in the infected group was delayed, had a smaller amplitude, and took longer to reach the maximum displacement. CONCLUSIONS: HTLV-1 infected patients have less efficient anticipatory adjustments and greater difficulty recovering their postural control during the compensatory phase. Clinical assessment of this population should consider postural stability during rehabilitation programs.

Validity and reliability of a smartphone-based assessment for anticipatory and compensatory postural adjustments during predictable perturbations.

BACKGROUND: Postural adjustments involve displacements of the center of mass (COM), controlled by the central nervous system (CNS), to maintain equilibrium whilst standing. Postural adjustments can be anticipatory (APAs) or compensatory (CPAs), and are triggered to counteract predictable perturbations. RESEARCH QUESTION: Is the new smartphone application, Momentum, a valid and reliable tool for the assessment of body balance, by measuring APAs and CPAs using accelerometer readings? METHODS: 20 young adults were exposed to external predictable perturbations induced at the shoulder level, whilst standing. COM linear acceleration was recorded by Momentum (extracting data from a smartphone's accelerometer) and a 3D motion capture system. RESULTS: The key results demonstrated a very high, significant correlation (r ≥ 0.7, p < 0.05) between the two device settings in the APA parameters, which obtained r = 0.65, denoting a high correlation. Considering the reliability, variables that are compensatory in nature are presented on a scale of good to excellent in measurement methods, kinematics, and Momentum. However, the anticipatory variables presented excellent reliability only for the kinematics. SIGNIFICANCE: These experiments show that Momentum is a valid method for measuring COM acceleration under predictable perturbations and is reliable for compensatory events.

Postural Adjustments and Kinematic Index Finger Features in Frail Older Adults under Different Equilibrium Constraints.

Background: Anticipatory postural adjustments (APAs) are significantly affected by age and may represent restrictions on functional independence. Previous studies in young adults have already highlighted that changing postural stability (i.e., seated vs. upright posture) affects the motor planning and APAs. In frail older adults (FOAs), the effect of these different conditions of postural stability have not yet been established, and the present study aimed to disentangle this issue. Methods: Participants executed an arm-pointing task to reach a diode immediately after it turned on, under different conditions of stability (seated with and without foot support and in an upright posture). A kinematic profile of the index finger and postural electromyographic data were registered in their dominant-side leg muscles: tibialis anterior, soleus, rectus femoris, and semitendinosus. Results: The main finding of this study was that the adopted posture and body stabilization in FOAs did not reflect differences in APAs or kinematic features. In addition, they did not present an optimal APA, since postural muscles are recruited simultaneously with the deltoid. Conclusion: Thus, FOAs seem to use a single non-optimal motor plan to assist with task performance and counterbalance perturbation forces in which they present similar APAs and do not modify their kinematics features under different equilibrium constraints.

Ganglion cells and displaced amacrine cells density in the retina of the collared peccary (Pecari tajacu).

In the present study, we investigated the topographical distribution of ganglion cells and displaced amacrine cells in the retina of the collared peccary (Pecari tajacu), a diurnal neotropical mammal of the suborder Suina (Order Artiodactyla) widely distributed across central and mainly South America. Retinas were prepared and processed following the Nissl staining method. The number and distribution of retinal ganglion cells and displaced amacrine cells were determined in six flat-mounted retinas from three animals. The average density of ganglion cells was 351.822 ± 31.434 GC/mm2. The peccary shows a well-developed visual streak. The average peak density was 6,767 GC/mm2 and located within the visual range and displaced temporally as an area temporalis. Displaced amacrine cells have an average density of 300 DAC/mm2, but the density was not homogeneous along the retina, closer to the center of the retina the number of cells decreases and when approaching the periphery the density increases, in addition, amacrine cells do not form retinal specialization like ganglion cells. Outside the area temporalis, amacrine cells reach up to 80% in the ganglion cell layer. However, in the region of the area temporalis, the proportion of amacrine cells drops to 32%. Thus, three retinal specializations were found in peccary's retina by ganglion cells: visual streak, area temporalis and dorsotemporal extension. The topography of the ganglion cells layer in the retina of the peccary resembles other species of Order Artiodactyla already described and is directly related to its evolutionary history and ecology of the species.

Hand Resting Tremor Assessment of Healthy and Patients With Parkinson's Disease: An Exploratory Machine Learning Study.

The aim of this study is comparing the accuracies of machine learning algorithms to classify data concerning healthy subjects and patients with Parkinson's Disease (PD), toward different time window lengths and a number of features. Thirty-two healthy subjects and eighteen patients with PD took part on this study. The study obtained inertial recordings by using an accelerometer and a gyroscope assessing both hands of the subjects during hand resting state. We extracted time and temporal frequency domain features to feed seven machine learning algorithms: k-nearest-neighbors (kNN); logistic regression; support vector classifier (SVC); linear discriminant analysis; random forest; decision tree; and gaussian Naïve Bayes. The accuracy of the classifiers was compared using different numbers of extracted features (i.e., 272, 190, 136, 82, and 27) from different time window lengths (i.e., 1, 5, 10, and 15 s). The inertial recordings were characterized by oscillatory waveforms that, especially in patients with PD, peaked in a frequency range between 3 and 8 Hz. Outcomes showed that the most important features were the mean frequency, linear prediction coefficients, power ratio, power density skew, and kurtosis. We observed that accuracies calculated in the testing phase were higher than in the training phase. Comparing the testing accuracies, we found significant interactions among time window length and the type of classifier (p < 0.05). The study found significant effects on estimated accuracies, according to their type of algorithm, time window length, and their interaction. kNN presented the highest accuracy, while SVC showed the worst results. kNN feeding by features extracted from 1 and 5 s were the combination with more frequently highest accuracies. Classification using few features led to similar decision of the algorithms. Moreover, performance increased significantly according to the number of features used, reaching a plateau around 136. Finally, the results of this study suggested that kNN was the best algorithm to classify hand resting tremor in patients with PD.

Dengue maculopathy: visual electrophysiology and optical coherence tomography.

The objective of this study was to evaluate the visual loss due to dengue fever using retinal and cortical electrophysiology and retinal imaging. The participants were three female patients with low visual acuity after dengue fever. They were evaluated by routine ophthalmological investigations, transient pattern electroretinogram (tPERG), transient pattern visual evoked cortical potential (tPVECP), and retinal optical coherence tomography (retinal OCT). tPERG and tPVECP amplitude (microV) and implicit time (ms) were the parameters evaluated using OCT retinal thickness (microm) and reflectivity. All patients presented low visual acuity and scotomata with or without changes in the oculus fundus. tPERG from two patients showed decreased amplitude or absence of the main components; it was not possible to record a reliable response in the third patient due to excessive blinking. tPVECP at 0.5 cpd was normal in all three patients, while at 2 cpd the main components were absent in one patient and normal in the other two patients. OCT image was abnormal in two patients, one of them with high reflectance areas and another with decreased retinal thickness (the third patient was not studied with this technique).The dengue fever can lead to visual impairment detectable by ophthalmological exams such as angiography, retinography, and OCT imaging, as well as retinal and cortical electrophysiology. Dengue maculopathy which could be caused by vascular alterations and/or aberrant immune response after infection may result in temporary or permanent visual losses.

Comparison of Visual Functions of Two Amazonian Populations: Possible Consequences of Different Mercury Exposure.

The present study investigated the visual perimetry and color vision of two Amazonian populations differently exposed to mercury. Ten riverines environmentally exposed to mercury by fish eating and 34 gold-miners occupationally exposed to mercury vapor. The visual perimetry was estimated using the Förster perimeter and the color vision was evaluated using a computerized version of Farnsworth-Munsell test. Riverine and gold-miners' hair mercury concentrations were quantified. Mercury hair concentration of the riverines was significantly higher than that from gold-miners. Riverines had lower perimetric area than the gold-miners. The errors in the hue ordering test of both Amazonian populations were larger than the controls (non-exposed subjects), but there was no difference between themselves. Riverines had significant multiple association between the visual function and hair mercury concentration, while the gold-miners has no significant association with the exposure. We concluded that the different ways of mercury exposure led to similar visual outcomes, with greater impairment in riverines (organic mercury exposed subjects).

Psychophysical Evaluation of Visual Functions of Ex-Alcoholic Subjects After Prolonged Abstinence.

Chronic alcohol abuse can lead to a brain damages, and the health status of alcoholics even after a long-term alcohol abstinence is a public health concern. The present study investigated the color vision and spatial luminance contrast sensitivity of a group of 17 ex-alcoholics (46.3 ± 6.7 years old) in long-term alcohol abstinence after having been previously under alcohol dependence for many years. We also investigated the association of impaired psychophysical performance in different tests we applied. The mean time of alcohol consumption was 16.9 ± 5.1 years and the mean abstinence period was 12.4 ± 8.5 years. Achromatic vision of all subjects was evaluated using spatial luminance contrast sensitivity function (CSF) test and color vision was evaluated using Mollon-Reffin color discrimination test (MR) and the Farnsworth-Munsell 100 hue arrangement test (FM100). Relative to controls, the spatial luminance contrast sensitivity was lower in 10/17 of the ex-alcoholic subjects. In the color vision tests, 11/16 ex-alcoholic subjects had impaired results compared to controls in the FM100 test and 13/14 subjects had color vision deficits measured in the MR test. Fourteen subjects performed all visual tests, three subjects had impaired results for all tests, seven subjects had impaired results in two tests, three subjects had visual deficit in one test, and one had normal results for all tests. The results showed the existence of functional deficits in achromatic and chromatic vision of subjects with history of chronic alcoholism after long abstinence. Most subjects had altered result in more than one test, especially in the color vision tests. The present investigation suggests that the damage in visual functions produced by abusive alcohol consumption is not reversed after long term alcohol abstinence.

A proposed correction in the weighted method to score the Ishihara test.

OBJECTIVE: Ishihara test is a color vision test, whose results consider that all plates of the test have the same weighting. Rodriguez-Carmona et al. (Aviat Space Environ Med 83:19-29, 2012) proposed an equation to quantify the Ishihara test results (severity index), which took an account the rate of hits from the different plates of the test considering the performance of trichromat or colorblind population. We proposed a correction in Rodiguez-Carmona's equation for the severity index. We evaluated 60 normal trichromats and 107 subjects with congenital color deficiency. We calculated three indexes to quantify the results of each subject: a non-weighted index, a weighted index similar to the Rodriguez-Carmona et al., and a weighted index modified which combined the hit frequency for each plate in a trichromat population and of the error reading frequency for each plate in color-blind populations. RESULTS: Compared to the non-weighted evaluation, the weighted index was reduced by 22.95%, 32.92%, and 35.38% from trichromats, protan and deutan groups, respectively. Receiver Operating Characteristics (ROC) analysis showed perfect performance of the classifier for all metrics to measure the Ishihara test results. The proposal correction changed significantly the value of the index, but the overall benefits were small.

Influence of proprioceptive neuromuscular facilitation on the muscle tonus and amplitude of movement in HTLV-1-infected patients with HAM/TSP.

An HTLV-1-infected patient can develop paraparesis that limits their movements. Rehabilitation techniques could improve the motor abilities of these patients. The present study investigates five cases of physical therapy intervention in HTLV-1 patients to evaluate the influence of functional rehabilitation on the tonus and range of motion (ROM) of HTLV-1 patients with spasticity. The patients had a gain of ROM, especially in the lower limb, and reduction in hypertonia/spasticity after functional treatment. The reduction in hypertonia increased the ROM. Thus, functional methods may be valuable for the rehabilitation of HTLV-1 patients with neurological damage.

Application to help physiotherapists in the evaluation of pelvic dysfunctions after cervical cancer / Aplicativo para auxiliar fisioterapeutas na avaliação de disfunções pélvicas após câncer de colo do útero

Abstract Introduction Cervical cancer is caused by a persistent infection with some types of human papillomavirus (HPV), and its treatment entails chemotherapy, radiotherapy and surgery. This may cause different kinds of dysfunction in the pelvic floor. Hence, physiotherapy plays an important role in the evaluation and treatment of urogynecological dysfunctions occasioned by the oncological treatment. Objective To develop a digital technology in application format to help physiotherapists in the assessment of pelvic dysfunctions after cervical cancer. Methods A digital technology in application format was developed after approval from the Ethics in Research Committee of the Tropical Medical Center. The instrument was developed by a physiotherapist with expertise and experience in the area. The researchers held meetings to finalize the creation of the checklist, and the application was programmed using the Android Studio Environment. In the end, the application was evaluated by two physiotherapist experts in the field. Results The application created displays five sections addressing the symptoms of urinary dysfunction, sexual function, anal function, pain and alterations such as: lymphedema, vaginal stenosis and vaginal fibrosis. Conclusion The use of the application may help physiotherapists in the assessment of pelvic dysfunctions after cervical cancer.

Resumo Introdução O câncer de colo do útero é causado pela infecção persistente por alguns tipos de papilomavírus humano e o seu tratamento envolve quimioterapia, radioterapia e cirurgia, podendo ocasio-nar diferentes disfunções no assoalho pélvico. Desta forma, a fisioterapia tem papel importante na avaliação e tratamento das disfunções pélvicas decorrentes do tratamento oncológico. Objetivo Desenvolver uma tecnologia digital em formato de aplicativo para auxiliar fisioterapeutas na avaliação de disfunções pélvicas após câncer de colo do útero. Métodos Trata-se do desenvolvimento de uma tecnologia digital em formato de aplicativo, que foi realizado após aprovação do Comitê de Ética em Pesquisa do Núcleo de Medicina Tropical. O instrumento foi elaborado por fisioterapeutas com expertise e experiência na área. Os pesquisadores realizaram reuniões para finalizar o processo de criação do checklist, e o aplicativo foi programado em ambiente Androide Studio. Ao final, o aplicativo foi avaliado por duas fisioterapeutas especialistas na área. Resultados O aplicativo criado apresenta cinco capítulos abordando sintomas de disfunção urinária, função sexual, função anal, dor e alterações como linfedema, estenose vaginal e fibrose vaginal. Conclusão A utilização do aplicativo poderá auxiliar os profissionais fisioterapeutas na avaliação de disfunções pélvicas após câncer de colo do útero.

Anticipatory Postural Adjustments and kinematic arm features when postural stability is manipulated.

Beyond the classical paradigm that presents the Anticipatory Postural Adjustments (APAs) as a manner to create forces that counteract disturbances arising from the moving segment during a pointing task, there is a controversial discussion about the role APAs to facilitate the movement and perform a task accurately. In addition, arm kinematics features are classically used to infer the content of motor planning for the execution and the control of arm movements. The present study aimed to disentangle the conflicting role of APAs during an arm-pointing task in which the subjects reach a central diode that suddenly turns on, while their postural stability was manipulated. Three postures were applied: Standing (Up), Sit without feet support (SitUnsup) and Sit with feet support (SitSup). We found that challenging postural stability induced an increase of the reaction time and movement duration (observed for the SitUnsup compared to SitSUp and Up) as well as modified the upper-limb velocity profile. Indeed, a greater max velocity and a shorter deceleration time were observed under the highest stability (SitSup). Thus, these Kinematics features reflect less challenging task and simple motor plan when the body is stabilized. Concerning the APAs, we observed the presence of them independently of the postural stability. Such a result strongly suggests that APAs act to facilitate the limb movement and to counteract perturbation forces. In conclusion, the degree of stability seems particularly tuned to the motor planning of the upper-limb during a pointing task whereas the postural chain (sitting vs. standing) was also determinant for APAs.

Color vision impairment with low-level methylmercury exposure of an Amazonian population - Brazil.

Land exploitation that follows deforestation and mining can result in soil erosion and the release of mercury to the waters of rivers in the Amazon Basin. Inorganic mercury is methylated by bacteria that are present in the environment and it serves as a source of human contamination through fish consumption in the form of methylmercury. Long-term exposure to low-level methylmercury in the riverside populations can lead to nervous system alterations, some of which are visual impairments such as loss of luminance contrast sensitivity, restricted visual fields and color vision defects. The present study sought to examine color vision in a group of adults living in the central Brazilian Amazon who were exposed to low-levels of methylmercury. Total Hg concentrations were measured from hair collected at the time of the testing. The D15d and FM100 color vision arrangement tests were applied in a population of 36 (22 males) and 42 (25 males), respectively. Controls were healthy volunteers from the cities of São Paulo for the D15d and Belém for the FM100. There was a statistically significant difference in performance between those who were exposed and controls for both tests (p < 0.01 and p < 0.0001, respectively, Mann-Whitney U test), meaning that adults living in this region of the Amazon made more mistakes on both tests when compared to controls. A linear regression was performed using Hg concentrations and test scores. Hg concentrations accounted for 7% and 2% of color D15d and FM100 arrangement test errors, respectively. Although other studies have previously found color vision impairment in the Amazon, they tested inhabitants on the east side of the Amazon, while this study was conducted in the central Amazon region and it is the first study in a population with no direct contact with the Hg source of contamination. These results suggest that long-term exposure to low-level methylmercury in riverside populations is more widely spread in the Amazon Basin than previously reported. This information is needed to implement public health policies that will ensure a safer environment for the Amazonian population.

[Levels of mercury found in hair and fish consumption of riverine communities in the Tapajós region of the Brazilian Amazon]. / Teores de mercúrio em cabelo e consumo de pescado de comunidades ribeirinhas na Amazônia brasileira, região do Tapajós.

Riverine communities are exposed to mercury due to the high ingestion of fish in their diet. In order to evaluate the levels of exposure in the Tapajós region, also assessing the fish ingestion frequency, a study was conducted in adults living in riverine communities in the municipality of Itaituba in the State of Pará. Hair samples were collected for the determination of total mercury and the weekly frequency data of fish ingestion was recorded. The mean concentration of total mercury varied from 7.25µg/g (in 2013) to 10.80µg/g (in 2014), with no significant difference being observed (p = 0.1436). As for fish ingestion frequency, the majority of the individuals evaluated revealed high consumption both in 2013 and in 2014. High levels of total mercury were observed only in those with high consumption of fish in both years. The importance of ongoing monitoring of exposure levels in humans should be stressed, basing itself on indices of tolerance of 6µg/g recommended by the World Health Organization, and investigation about the consumption of fish such that strategies for control and prevention are improved.

Comunidades ribeirinhas estão expostas ao mercúrio devido à dieta composta por elevada ingestão de peixes. Com o objetivo de avaliar os níveis de exposição na região do Tapajós, identificando também a frequência de ingestão de pescado, realizou-se um estudo em adultos residentes nas comunidades ribeirinhas do município de Itaituba/PA. Foram coletadas amostras de cabelo para a determinação de mercúrio total e dados de frequência semanal de ingestão de peixes. A concentração média de mercúrio total variou de 7,25µg/g (em 2013) para 10,80µg/g (em 2014), não sendo observada diferença significativa (p = 0,1436). Quanto à frequência de ingestão de pescado, a maioria dos indivíduos avaliados apresentou um alto consumo, tanto em 2013 quanto em 2014. Índices elevados de mercúrio total foram observados somente naqueles com alto consumo de pescado em ambos anos. Ressalta-se a importância da continuação do monitoramento dos níveis de exposição em humanos, fundamentando-se nos índices de tolerância de 6µg/g preconizado pela Organização Mundial de Saúde, e na investigação quanto ao consumo de peixes para que as estratégias de controle e prevenção sejam melhoradas.

Deaths by COVID-19 in a hospital from a city from Legal Amazon region: what lessons could be learned? / Mortes por COVID-19 em um hospital de uma cidade da região da Amazônia Legal: que lições podem ser aprendidas?

Objective: Describe the epidemiology of COVID-19 deaths within a hospital in the Amazon region in a period of 64 days, which corresponds to the growth curve of the COVID-19 first-wave pandemic in 2020. Methods: The data were obtained from medical records of 152 deaths registered for adults and elderly hospitalized. The data were also compared with the number of deaths in previous years during the same period studied to assess the impact of the pandemic on this hospital. The study also assesses the impact of intra-hospital transfers, accounting for the number of times patients who died performed transfers between sectors of the hospital. Results: During the period analyzed, there was an increase in deaths compared to the previous years. The majority of dead patients were male, aged between 34 and 96 years. The deaths were associated comorbidities such as arterial hypertension, diabetes mellitus, and kidney disease. The SARS-CoV-2 infection was confirmed in 91 cases. Among them, 15 individuals were admitted without conditions related to SARS-CoV-2 infection; they had a three-fold higher number of hospital transfers than those admitted with SARS-CoV-2 infection symptoms. Sixteen patients with SARS-CoV-2 infection developed respiratory symptoms just after hospitalization. The diagnostic exam for SARS-CoV-2 infection was performed on average 4 (± 6) days after the onset of symptoms and 6 (± 6) days after admission, and the average time from the onset of respiratory symptoms to death was 4 (± 6) days. Conclusions: These data suggest the high presence of hospital infection by SARS-CoV-2 in the Brazilian Amazon region, which may be related to the number of sectorial transfers, delay in confirming the diagnosis, and lack of management. We report a serious public health problem, as it demonstrates the fragility of healthcare institutions in the hospital environmen (AU).

Objetivo: Descrever a epidemiologia de mortes por COVID-19 em um hospital na região da Amazônia em um período de 64 dias, que corresponde à curva de crescimento da primeira onda da pandemia de COVID-19 em 2020. Métodos: Os dados foram obtidos de 152 óbitos registrados em prontuários de adultos e idosos hospitalizados. Os dados foram também comparados com o número de óbitos em anos anteriores, no mesmo período estudado, de forma a avaliar o impacto da pandemia neste hospital. O estudo também avalia o impacto das transferências intra-hospitalares, contabilizando o número de vezes que os pacientes que faleceram realizaram transferências entre setores do hospital. Resultados: No período analisado, houve aumento de óbitos em relação aos anos anteriores. A maioria dos pacientes mortos era do sexo masculino, com idade entre 34 e 96 anos. Os óbitos foram associados a comorbidades como hipertensão arterial, diabetes mellitus e doença renal. A infecção por SARS-CoV-2 foi confirmada em 91 casos. Entre eles, 15 indivíduos foram internados sem condições relacionadas à infecção por SARS-CoV-2; eles tiveram um número três vezes maior de transferências hospitalares do que aqueles admitidos com sintomas de infecção por SARS-CoV-2. Dezesseis pacientes com infecção por SARS-CoV-2 desenvolveram sintomas respiratórios logo após a hospitalização. O exame diagnóstico para infecção por SARS-CoV-2 foi realizado em média 4 (± 6) dias após o início dos sintomas e 6 (± 6) dias após a admissão, e o tempo médio do início dos sintomas respiratórios até o óbito foi de 4 ( ± 6) dias. Conclusões: Esses dados sugerem alta presença de infecção hospitalar por SARS-CoV-2 na região amazônica brasileira, o que pode estar relacionado ao número de transferências setoriais, demora na confirmação do diagnóstico e falta de manejo. Relatamos um grave problema de saúde pública, pois demonstra a fragilidade das instituições de saúde no ambiente hospitalar (AU).

Heart rate variability in multibacillar leprosy: Linear and nonlinear analysis.

OBJECTIVE: To evaluate the heart rate variability (HRV) in patients with multibacillary leprosy using dynamic linear and nonlinear analysis. MATERIAL AND METHODS: Twenty-one leprosy patients (mean age: 39.14 ±10.58 years) and 21 healthy subjects (mean age: 36.24 ± 12.64 years) completed the sample. Heart rate variability recording was performed by a Polar RS800 CX heart monitor during a period of 15 min in the supine position and 15 min in a sitting position. Analysis of HRV was performed by frequency domain from high frequency (HF) and low frequency (LF) spectral indexes in absolute and normalized units. The nonlinear analysis of HRV was calculated using symbolic analysis (0V%, 1V%, 2LV% and 2UV% indexes), Shannon entropy (SE) and normalized complexity index (NCI). RESULTS: Linear analysis: both groups showed higher HF values (p < 0.05) and smaller LF values (p < 0.05) in supine than in sitting position. The leprosy patients showed higher LF values (p < 0.05) and smaller HF values (p < 0.05) compared to the controls on supine position. Symbolic analysis: leprosy patients had higher 0V% values (p < 0.05), smaller 2LV% values (p < 0.05) and 2UV % values compared to healthy subjects on both positions. The 1V % had higher values (p < 0.05) for leprosy patients than for controls in the sitting position. The control subjects had smaller 0V % values (p < 0.05), and higher 2UV % values (p < 0.05) in the supine position compared to the sitting position. Leprosy patients had higher 2UV index values (p < 0.05) in the supine position compared to the sitting position. In the complexity analysis, leprosy patients had smaller SE and NCI values (p < 0.05) than the control in the supine position. There was no difference between the SE and NCI values of leprosy and the control subjects in the sitting position. The control subjects had higher SE and NCI values (p < 0.05) in the supine position than in the sitting position. CONCLUSION: Leprosy patients had higher sympathetic modulation and smaller vagal modulation than controls, indicating less HRV and cardiac modulation with lower complexity. The control group displayed significant HRV differences in response to position changes while leprosy patients had fewer HRV differences after the same postural change. An analysis of HRV with linear and non-linear dynamics proved to be a reliable method and promising for the investigation of autonomic dysfunction in patients with multibacillary leprosy.