Rehabilitation interventions targeting the activity and participation of patient with neuromuscular diseases: what do we know? A systematic review.

BACKGROUND: To be objective and achievable, the rehabilitation goals must be focused on the functional expectations of patients with neuromuscular disease (NMD). OBJECTIVE: Investigate rehabilitation programs that are able to modify the activity/participation of patients with NMD. Data search: Embase, BVS/Lilacs, Physiotherapy Evidence Database (PEDro), CINAHL/EBSCO, and Medline were searched in June 2021. It was last updated in March 2023. METHODS: Randomized controlled trials investigating any rehabilitation therapy for patients with NMD with an outcome encompassing the activity/participation components of the International Classification of Functioning, Disability and Health (ICF) were included. Pharmacological therapy studies were excluded. The results were synthesized according to the ICF core sets for NMD. The methodological quality and level of evidence were assessed using PEDro criteria and Grading of Recommendations Assessment, Development, and Evaluation (GRADE). This systematic review followed the PRISMA 2020 guideline and was registered at PROSPERO (CRD42020209359). RESULTS: Of a total of 1943 identified studies, 12 were included in this review with a methodological quality between regular and good. Light to moderate-intensity aerobic exercise was the most studied intervention. The mobility was assessed in all included studies. CONCLUSION: The variability of the types of NMD and the small sample size of the included studies demonstrates that there is very limited evidence of interventions focused on the activity/participation of individuals with NMD. Light to moderate-intensity aerobic exercise seems to improve the mobility, self-care, and social participation of patients with NMD, especially those with slow progression.

ANTECEDENTES: As metas de reabilitação devem ser focadas nas expectativas funcionais de pessoas com doenças neuromusculares (DNM) para que sejam objetivas e alcançáveis. OBJETIVO: Investigar programas de reabilitação capazes de modificar a atividade/participação de pessoas com DNM. Foi realizada busca nas bases de dados: Embase, BVS/Lilacs, Physiotherapy Evidence Database (PEDro), CINAHL/EBSCO e Medline em junho/2021. A última atualização foi realizada em março de 2023. MéTODOS: Foram incluídos estudos clínicos randomizados investigando qualquer terapia de reabilitação para pessoas com DNM com desfecho voltado para atividade/participação da Classificação Internacional de Funcionalidade e Saúde (CIF). Terapias farmacológicas foram excluídas. Os resultados foram sintetizados de acordo com os Core Sets da CIF para DNM. A qualidade metodológica e o nível de evidência foram avaliados usando os critérios PEDro e Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Esta revisão sistemática foi registrada na PROSPERO (CRD42020209359). RESULTADOS: De 1943 estudos identificados, 12 foram incluídos com uma qualidade metodológica entre regular e boa. O exercício aeróbio de intensidade leve a moderada foi a intervenção mais estudada. A mobilidade foi avaliada em todos os estudos incluídos. CONCLUSãO: A variabilidade dos tipos de DNM e o baixo número amostral dos estudos incluídos contribuem para uma evidência muito limitada de intervenções focadas na atividade/participação de pessoas com DNM. O exercício aeróbio de baixa a moderada intensidade parece melhorar a mobilidade, autocuidado e participação de pessoas com DNM, especialmente para as DNM de progressão lenta.

Rehabilitation interventions targeting the activity and participation of patient with neuromuscular diseases: what do we know? A systematic review / Reabilitação com foco na atividade e participação para pessoas com doenças neuromusculares: o que sabemos? Uma revisão sistemática

Abstract Background To be objective and achievable, the rehabilitation goals must be focused on the functional expectations of patients with neuromuscular disease (NMD). Objective Investigate rehabilitation programs that are able to modify the activity/participation of patients with NMD. Data search: Embase, BVS/Lilacs, Physiotherapy Evidence Database (PEDro), CINAHL/EBSCO, and Medline were searched in June 2021. It was last updated in March 2023. Methods Randomized controlled trials investigating any rehabilitation therapy for patients with NMD with an outcome encompassing the activity/participation components of the International Classification of Functioning, Disability and Health (ICF) were included. Pharmacological therapy studies were excluded. The results were synthesized according to the ICF core sets for NMD. The methodological quality and level of evidence were assessed using PEDro criteria and Grading of Recommendations Assessment, Development, and Evaluation (GRADE). This systematic review followed the PRISMA 2020 guideline and was registered at PROSPERO (CRD42020209359). Results Of a total of 1943 identified studies, 12 were included in this review with a methodological quality between regular and good. Light to moderate-intensity aerobic exercise was the most studied intervention. The mobility was assessed in all included studies. Conclusion The variability of the types of NMD and the small sample size of the included studies demonstrates that there is very limited evidence of interventions focused on the activity/participation of individuals with NMD. Light to moderate-intensity aerobic exercise seems to improve the mobility, self-care, and social participation of patients with NMD, especially those with slow progression.

Resumo Antecedentes As metas de reabilitação devem ser focadas nas expectativas funcionais de pessoas com doenças neuromusculares (DNM) para que sejam objetivas e alcançáveis. Objetivo Investigar programas de reabilitação capazes de modificar a atividade/participação de pessoas com DNM. Foi realizada busca nas bases de dados: Embase, BVS/Lilacs, Physiotherapy Evidence Database (PEDro), CINAHL/EBSCO e Medline em junho/2021. A última atualização foi realizada em março de 2023. Métodos Foram incluídos estudos clínicos randomizados investigando qualquer terapia de reabilitação para pessoas com DNM com desfecho voltado para atividade/participação da Classificação Internacional de Funcionalidade e Saúde (CIF). Terapias farmacológicas foram excluídas. Os resultados foram sintetizados de acordo com os Core Sets da CIF para DNM. A qualidade metodológica e o nível de evidência foram avaliados usando os critérios PEDro e Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Esta revisão sistemática foi registrada na PROSPERO (CRD42020209359). Resultados De 1943 estudos identificados, 12 foram incluídos com uma qualidade metodológica entre regular e boa. O exercício aeróbio de intensidade leve a moderada foi a intervenção mais estudada. A mobilidade foi avaliada em todos os estudos incluídos. Conclusão A variabilidade dos tipos de DNM e o baixo número amostral dos estudos incluídos contribuem para uma evidência muito limitada de intervenções focadas na atividade/participação de pessoas com DNM. O exercício aeróbio de baixa a moderada intensidade parece melhorar a mobilidade, autocuidado e participação de pessoas com DNM, especialmente para as DNM de progressão lenta.

Towards Fast Plume Source Estimation with a Mobile Robot.

The estimation of the parameters of an odour source is of high relevance for multiple applications, but it can be a slow and error prone process. This work proposes a fast particle filter-based method for source term estimation with a mobile robot. Two strategies are implemented in order to reduce the computational cost of the filter and increase its accuracy: firstly, the sampling process is adapted by the mobile robot in order to optimise the quality of the data provided to the estimation process; secondly, the filter is initialised only after collecting preliminary data that allow limiting the solution space and use a shorter number of particles than it would be normally necessary. The method assumes a Gaussian plume model for odour dispersion. This models average odour concentrations, but the particle filter was proved adequate to fit instantaneous concentration measurements to that model, while the environment was being sampled. The method was validated in an obstacle free controlled wind tunnel and the validation results show its ability to quickly converge to accurate estimates of the plume's parameters after a reduced number of plume crossings.

Foreign body granuloma treatment with 22-MHz ultrasound-guided corticoid infiltration.

Intralesional corticoid infiltration guided by 22-MHz ultrasound is a new, noninvasive, and safe dermatological method for the treatment of foreign body granuloma. The great advantage of the procedure is that the medication is delivered straight to the desired target, preventing adverse treatment effects in noninjured areas.

Influence of HOTAIR rs920778 and rs12826786 genetic variants on prostate cancer risk and progression-free survival.

AIM: Evaluate the impact of the single nucleotide polymorphisms rs920778 and rs12826786 in the long noncoding RNA HOTAIR in the susceptibility and prognosis of prostate cancer (PCa) patients. PATIENTS & METHODS: HOTAIR single nucleotide polymorphisms were genotyped by restriction fragment length polymorphism in 151 PCa cases and 180 cancer-free controls. Odds ratio, 95% CIs and prognostic significance were calculated. RESULTS: Our data showed no statistically significant associations between HOTAIR polymorphic variants in rs920778 and rs12826786 and PCa susceptibility. However, the CC genotype in rs12826786 was significantly associated with shorter biochemical recurrence-free survival in pT3-stage PCa patients. CONCLUSION: Our results indicate that HOTAIR rs12826786 CC genotype may be an independent prognostic biomarker in a particular subset of PCa tumors.

Educação em saúde para a prevenção do câncer cérvico-uterino / Health education for cervical cancer prevention

Este estudo se trata do relato de uma experiência vivenciada por graduandos de Medicina e Enfermagem participantes do PET-Saúde da Universidade de Brasília, cujo objetivo foi realizar atividades de educação em saúde dentro do tema prevenção de câncer cérvico-uterino nos municípios de Ceres e Santa Isabel, Goiás. Para tanto, foram feitas diferentes ações comunicativas, tais como: confecção e distribuição de cartazes/panfletos; produção de um programa de rádio; e promoção de rodas de conversa na sala de espera das unidades básicas de saúde. Essa atividade se mostrou como uma oportunidade de compartilhar experiências e sentimentos, bem como discutir ideias e conceitos visando a construir um novo conhecimento, com contribuições do saber teórico dos acadêmicos e do saber prático das usuárias. As dúvidas e questionamentos das usuárias estavam de acordo com os apontados trazidos pela literatura, e as atividades mostraram-se uma boa forma de esclarecer as dúvidas das usuárias e aproximar sistema de saúde e população, bem como de promover a educação em saúde, especialmente no âmbito da autovalorização, da prevenção e da promoção da saúde.

This case report describes the experience of undergraduate medical and nursing students participating in the Educational Program for Health Work (PET-Saúde) at the University of Brasília, the objective of which was to conduct health education activities in cervical cancer prevention in Ceres and Santa Isabel, Goiás State. The following communications activities were used: preparation and distribution of posters and leaflets; production of a radio program; and conversation groups held in the waiting rooms of primary healthcare units. This activity provided an opportunity to share experiences and feelings, as well as discussing ideas and concepts aimed at building new knowledge, with contributions from the students' academic training and the users' practical knowhow. The users' doubts and questions were consistent with those found in the literature, and the activities proved to be a good way for clearing up users' doubts and drawing the health system and the population closer, as well as promoting health education, especially in the areas of self-esteem, prevention, and health promotion.

Capacitação do agente comunitário de saúde na prevenção do câncer de colo uterino / Training community health agents in cervical cancer prevention

Atualmente, intensificam-se as discussões a respeito da educação em saúde, principalmente em relação aos agentes comunitários de saúde (ACS), para os quais a capacitação deve ser constante. Este estudo tem como objetivo relatar a experiência de capacitação de ACSs a respeito do tema câncer cérvico-uterino. A escolha do tema abordado baseou-se em sua relevância e na necessidade concreta dos ACSs observados, que não se sentiam empoderados com relação ao assunto. Diante disso, nove acadêmicos de Medicina e Enfermagem, monitores do PET-Saúde da Universidade de Brasília (UnB), realizaram encontros com ACSs dos municípios de Ceres e Santa Isabel (GO), com o intuito de fornecer a esses profissionais mais informações e técnicas para que a abordagem das usuárias em relação ao exame colpocitologico fosse bem-sucedida. A metodologia utilizada foi a integração entre educação bancária e educação dialógica, a fim de que elas se complementassem para alcançar melhores resultados. Foi evidenciado êxito, uma vez que os ACSs demonstraram ter assimilado o conteúdo e ter organizado os conceitos e puderam aplicá-los de forma criativa, envolvendo-se com o aprendizado e acrescentando a ele as suas vivências próprias em relação ao conhecimento aprendido.

Recent years have witnessed increasing discussion on health education, especially for community health workers (CHWs), who should receive continuing training. The aim of this study was to report on an experience with CHWs trained in cervical cancer prevention. The choice of the theme was based on its relevance and the observed need among CHWs, who did not feel empowered to deal with it. Thus, nine undergraduate medical and nursing students, who were monitors in the PET-Saúde project at the University of Brasília (UnB), held meetings with CHWs in the municipalities (counties) of Ceres and Santa Isabel, Goiás State, Brazil, to provide them with information and techniques in order to improve the success of Pap smears for patients. The methodology used a combination of traditional and critical dialogical learning in order to achieve the best results. The training proved successful, since the CHWs assimilated the concepts and were able to apply them creatively, interacting with the learning process and enriching it with their own personal experiences.

Detecção da colonização por Streptococcus agalactiae e avaliação da suscetibilidade aos antimicrobianos em gestantes atendidas no Hospital Universitário de Brasília / Detection of Streptococcus agalactiae colonization and evaluation of antimicrobial susceptibility in pregnant women seen at the University Hospital of Brasilia

Objetivos. Estimar a taxa de colonização pelo estreptococo do grupo B e a suscetibilidade aos antimicrobianos em um grupo de gestantes atendidas no Hospital Universitário de Brasília. Método. Estudo observacional transversal retrospectivo com coleta de dados secundários em prontuário, que elencou 116 mulheres submetidas à obtenção de swab vaginal e ou retal para pesquisa de colonização pelo estreptococo do grupo B de 1.º de janeiro de 2010 a 31 de janeiro de 2011. Critérios de inclusão: mulher gestante à época da coleta, submetida à cultura de pelo menos um dos sítios referidos. Foram excluídas mulheres que fizeram uso de agente antimicrobiano por pelo menos quatorze dias antes da coleta das amostras. A identificação do patógeno e determinação da sensibilidade aos antimicrobianos seguiram as normas internacionais do Clinical and Laboratory Standards Institute. Resultados. Atenderam aos critérios de inclusão 85 pacientes, das quais 74 submeteram-se à coleta de amostras vaginal e retal e 11 à coleta vaginal isoladamente por meio de swabs. A prevalência de colonização foi 5,9% (cinco casos). Nenhuma amostra retal foi positiva. Observou-se falta de padronização quanto ao sítio anatômico retal mais apropriado para a coleta e em relação às idades gestacionais mínima e máxima para o rastreio. Todas as culturas mostraram suscetibilidade à vancomicina e à ampicilina. Quatro culturas foram suscetíveis ao ciprofloxacino, uma ao cloranfenicol e uma à eritromicina. Conclusão. Apesar da utilização de método e meio de cultura não específicos, a frequência encontrada na amostra e o espectro de sensibilidade antimicrobiano são condizentes com os dados apresentados pelos estudos de prevalência da literatura. No entanto, a implementação de protocolo sistematizado poderá aumentar a acurácia do rastreio do estreptococo do grupo B.

Objectives: To estimate group B Streptococcus colonization and antimicrobial susceptibility in a group of pregnant women seen at the Department of gynecology of the University Hospital of Brasilia. Method: We carried out a retrospective, observational, cross-sectional study with secondary data collection based on medical records. The study involved 116 women, who underwent vaginal and/or rectal swab testing to screen for group B streptococcus colonization from January 1, 2010 to January 31, 2011. The following inclusion criteria were considered: women who were pregnant at the time of sample collection and who had specimens collected of at least one of the sampling locations mentioned above. Women who had undergone antimicrobial treatment for at least fourteen days before sample collection were excluded from the study. Pathogen identification and antimicrobial-sensitivity determination followed the international guidelines of the Clinical and Laboratory Standards Institute. Results: Eighty-five patients met the inclusion criteria, of which 74 underwent collection of vaginal and rectal swabs and 11 underwent vaginal swab collection only. The prevalence of colonization was 5.9% (five cases). No rectal sample was positive. There was no standardization in relation to the most appropriate rectal location for sample collection or in relation to minimum and maximum gestational age. All cultures showed susceptibility to vancomycin and ampicillin. Four cultures were susceptible to ciprofloxacin, one was susceptible to chloramphenicol, and one to erythromycin. Conclusion: Although different methods and culture media were used, the frequency found in the sample and the spectrum of antimicrobial sensitivity are in accordance with data presented in prevalence studies in the literature. Nevertheless, implementation of a systematized protocol can improve accuracy in screening for group B Streptococcus.

Observer design in switching control of neuromuscular blockade: clinical cases.

This paper concerns the application of multiple model switched methods to the control of neuromuscular blockade of patients undergoing anaesthesia. Since the model representing the neuromuscular blockade process is subject to a high level of uncertainty due both to inter-patient variability and time variations, switched methods provide the adaptation capability needed to achieve the desired performance. The paper contributions are twofold: first, it is shown that, for the type of process control problem considered, the design of the associated observer must be carefully performed. Guidelines are provided for adequate selection of the characteristic polynomial defining the observer error dynamics. Second, clinical results using atracurium as blocking agent are reported in order to illustrate the use of the proposed control structure in actual clinical practice.

Control of neuromuscular blockade in the presence of sensor faults.

The problem of embedding sensor fault tolerance in feedback control of neuromuscular blockade is considered. For tackling interruptions of feedback measurements, a structure based upon Bayesian inference as well as a predictive filter is proposed. This algorithm is general and can be applied to different situations. Here, it is incorporated in an adaptive automatic system for feedback control of neuromuscular blockade using continuous infusion of muscle relaxants. A significant contribution consists in the experimental clinical testing of the algorithm in patients undergoing surgery.

Hipocrates: a robust system for the control of neuromuscular blockade.

OBJECTIVE: Development of an automatic system (software package Hipocrates) for the control of neuromuscular blockade by continuous infusion of the non-depolarising types of muscle relaxant drugs presently used in anaesthesia, namely atracurium, cisatracurium, vecuronium and rocuronium. METHODS: Hipocrates incorporates control strategies based upon classical, adaptive and robust control, as well as a wide range of noise reduction techniques and on-line adaptation to patient-specific characteristics. Therefore, the system provides strong robustness to inter- and intra-individual variability of the patients responses or unexpected circumstances and adaptation to the individual requirements. RESULTS: The control system is easy to set up and to use in a clinical environment. It consists of a portable PC computer, a Datex AS/3 NMT sensor and a B/Braun compact perfusion pump. In the simulation mode the software package incorporates sophisticated generation of pharmacokinetic/pharmacodynamic models driven by simulated drug administration regimes (bolus, continuous infusion and a combination of both). CONCLUSIONS: Hipocrates is an advanced standalone application for the control of neuromuscular blockade with a friendly graphic interface. It has been extensively validated, and it can be used on patients undergoing surgery as well as for simulation studies. Therefore Hipocrates also provides an excellent environment for education and training purposes.