High sodium, rather than high blood pressure, induces immune cell activation and renal infiltration in ovariectomized adult Wistar rats.

We used an animal model of salt-sensitive hypertension (SSH) in which ovariectomized (oVx) rats developed hypertension with high salt (HS) intake. Hypertension is accompanied by changes in the percentage of CD4+ T lymphocytes, immune CD45+ cell infiltration into renal tissue, and changes in Na+, K+- ATPase (NKA) expression in both renal tissue and peripheral blood mononuclear cells (PBMCs). To determine whether the observed changes resulted from HS intake, high blood pressure, or both, hydralazine (HDZ) was used to lower blood pressure. The oVx HS rats received two HDZ schedules either to prevent or to treat hypertension. NKA was overexpressed in the kidneys of all oVx groups and in PBMCs of oVx HS rats. This pattern was not altered with HDZ treatment. Changes in CD4+ T lymphocytes and renal infiltration of CD45+ cells were not reversed either. High salt, but not high blood pressure, induces immune cell activation and renal infiltration. Overexpressed NKA is the primary event, and HS is the perturbation to the system in this model of SSH, which resembles the postmenopausal state.

[Pituitary cryptococcoma: a strange case of secondary granulomatous hypophysitis]. / Cryptococcoma hipofisiario: un extraño caso de hipofisitis granulomatosa secundaria.

Hypophysitis is a pathology with low incidence and prevalence. Likewise, deep fungal infections in immunocompetent patients also represent a rare phenomenon. Even rarer is the case described below, where these two mentioned elements are combined, namely: pituitary cryptococcoma or granulomatous hypophysitis caused by said pathogen in a host without altered immune response. After research in PubMed, there are limited cases in the medical literature of granulomatous hypophysitis caused by Cryptococcus spp., which simulated a pituitary macroadenoma by clinical and imaging manifestations. We did not find reports in which there is no evidence of involvement of the meningeal tissue. The fungal etiology is scarcely described in the reference guidelines for hypophysitis and we believe that Cryptococcus spp. it should be taken into account in the differential diagnosis of secondary granulomatous hypophysitis since it is a ubiquitous pathogen and the treatment is substantially different from other entities. It becomes more relevant given the current trend towards the use of high-dose systemic glucocorticoids for the treatment of hypophysitis, which could have generated greater damage if the correct diagnosis had not been made.

La hipofisitis es una afección con baja incidencia y prevalencia. Asimismo, las infecciones profundas por hongos en pacientes inmunocompetentes también representan un fenómeno infrecuente. Más raro aún es el caso que se describe a continuación, en donde se conjugan estos dos elementos mencionados, a saber: cryptococcoma hipofisario o hipofisitis granulomatosa causado por dicho patógeno en un huésped sin alteración de la respuesta inmune. Luego de una búsqueda realizada en PubMed, existen limitados casos en la literatura médica de hipofisitis granulomatosa por Cryptococcus spp., que simuló por manifestaciones clínicas e imagenológicas un macroadenoma hipofisario. No encontramos informes en los que no haya evidencia de afectación del tejido meníngeo. La etiología micótica está escasamente descrita en las guías de referencia para hipofisitis y creemos que Cryptococcus spp. debe ser tenido en cuenta en el diagnóstico diferencial de las hipofisitis granulomatosas secundarias dado que es un patógeno ubicuo y el tratamiento es sustancialmente diferente a otras entidades. Cobra mayor relevancia ante la tendencia actual al uso de glucocorticoides sistémicos a altas dosis para el tratamiento de la hipofisitis, que podría haber generado mayor daño de no haberse hecho el diagnóstico correcto.

Cryptococcoma hipofisiario: un extraño caso de hipofisitis granulomatosa secundaria / Pituitary cryptococcoma: a strange case of secondary granulomatous hypophysitis

Resumen La hipofisitis es una afección con baja incidencia y prevalencia. Asimismo, las infecciones profundas por hongos en pacientes inmunocompetentes también re presentan un fenómeno infrecuente. Más raro aún es el caso que se describe a continuación, en donde se conjugan estos dos elementos mencionados, a saber: cryptococcoma hipofisario o hipofisitis granulomatosa causado por dicho patógeno en un huésped sin altera ción de la respuesta inmune. Luego de una búsqueda realizada en PubMed, existen limitados casos en la literatura médica de hipofisitis granulomatosa por Cryptococcus spp., que simuló por manifestaciones clínicas e imagenológicas un macro adenoma hipofisario. No encontramos informes en los que no haya evidencia de afectación del tejido meníngeo. La etiología micótica está escasamente descrita en las guías de referencia para hipofisitis y creemos que Cryp tococcus spp. debe ser tenido en cuenta en el diagnóstico diferencial de las hipofisitis granulomatosas secundarias dado que es un patógeno ubicuo y el tratamiento es sustancialmente diferente a otras entidades. Cobra mayor relevancia ante la tendencia actual al uso de glucocorticoides sistémicos a altas dosis para el tratamiento de la hipofisitis, que podría haber gene rado mayor daño de no haberse hecho el diagnóstico correcto.

Abstract Hypophysitis is a pathology with low incidence and prevalence. Likewise, deep fungal infections in immuno competent patients also represent a rare phenomenon. Even rarer is the case described below, where these two mentioned elements are combined, namely: pituitary cryptococcoma or granulomatous hypophysitis caused by said pathogen in a host without altered immune response. After research in PubMed, there are limited cases in the medical literature of granulomatous hypophysitis caused by Cryptococcus spp., which simulated a pituitary macroadenoma by clinical and imaging manifestations. We did not find reports in which there is no evidence of involvement of the meningeal tissue. The fungal etiology is scarcely described in the reference guidelines for hypophysitis and we believe that Cryptococcus spp. it should be taken into account in the differential diagnosis of secondary granuloma tous hypophysitis since it is a ubiquitous pathogen and the treatment is substantially different from other entities. It becomes more relevant given the current trend towards the use of high-dose systemic glucocorticoids for the treatment of hypophysitis, which could have generated greater damage if the correct diagnosis had not been made.

NCoA3 upregulation in breast cancer­associated adipocytes elicits an inflammatory profile.

Nuclear receptor coactivator 3 (NCoA3) is a transcriptional coactivator of NF­κB and other factors, which is expressed at relatively low levels in normal cells and is amplified or overexpressed in several types of cancer, including breast tumors. NCoA3 levels have been shown to be decreased during adipogenesis; however, its role in tumor­surrounding adipose tissue (AT) remains unknown. Therefore, the present study assessed the modulation of NCoA3 in breast cancer­associated adipocytes and evaluated its association with the expression of inflammatory markers. 3T3­L1 adipocytes were stimulated with conditioned medium from human breast cancer cell lines and the expression levels of NCoA3 were evaluated by reverse transcription­quantitative (q)PCR. NF­κB activation was measured by immunofluorescence, and tumor necrosis factor and monocyte chemoattractant protein 1 levels were analyzed by qPCR and dot blot assays. The results obtained from the in vitro model were supported using mammary AT (MAT) from female mice, MAT adjacent to tumors from patients with breast cancer and bioinformatics analysis. The results revealed that adipocytes expressing high levels of NCoA3 were mainly associated with a pro­inflammatory profile. In 3T3­L1 adipocytes, NCoA3 downregulation or NF­κB inhibition reversed the expression of inflammatory molecules. In addition, MAT from patients with a worse prognosis exhibited high levels of this coactivator. Notably, adipocyte NCoA3 levels could be modulated by inflammatory signals from tumors. The modulation of NCoA3 levels in synergy with NF­κB activity in MAT in a tumor context could be factors required to establish breast cancer­associated inflammation. As adipocytes are involved in the development and progression of breast cancer, this signaling network deserves to be further investigated to improve future tumor treatments.

Effectiveness of hippotherapy and therapeutic horseback riding on balance in hemiparetic patients after stroke / Efetividade da hipoterapia e da equoterapia terapêutica no equilíbrio de pacientes hemiparéticos pós-acidente vascular cerebral

Abstract Introduction: Stroke is one of the leading causes of disability and death worldwide. Individuals who suffered stroke present numerous functional limitations. Hippo-therapy (HPOT) is proposed as capable of promoting the recovery of postural balance in patients with neurological impairment. Objective: To analyze published articles, seeking the effects of HPOT on changes in postural balance, through the Berg Balance Scale (BBS), in individuals with stroke. Methods: We conducted a systematic review and meta-analysis of studies published on the electronic databases PubMed, VHL, SCIELO, Cochrane, SCOPUS, WoS, and Cinahl. Keywords: "hippotherapy", "horseback riding" and "stroke" linked by the OR and AND boolean operators. The research was restricted to clinical trials in an adult population with a history of stroke. Results: Four articles were included in this meta-analysis, which used HPOT as an intervention to improve postural balance. Three studies used a mechanical device (horseback riding), and the horse. The age ranged from 61 to 71 years, being more predominant the male sex. Sessions ranged from 6 to 12 weeks of 20 to 30 minutes per session. Quality analysis using the PEDro scale demonstrated scores ranging from 6 to 8 points in the selected studies. Overall, treatment with mechanical and conventional therapy resulted in an improvement in the total BBS score. As compared with conventional therapy just studies with horseback riding was superior to conventional therapy to improve postural balance in hemiparetic stroke patients. Conclusion: There are few studies of high quality; then, it is not possible to evaluate the effectiveness of HPOT using a horse or a mechanic simulator in patients with stroke when compared with conventional therapy. Future studies could clarify if HPOT has potential benefits as a complementary therapeutic strategy to conventional physiotherapy to promote the improvement of postural balance after stroke.

Resumo Introdução: O acidente vascular encefálico (AVE) é uma das principais causas de incapacidade e morte em todo o mundo. Existem diferentes prospostas terapêuticas para melhorar o equilíbrio postural de hemiparéticos após AVE, mas a efetividade de técnicas como a hipoterapia ainda está por ser esclarecida. Objetivo: Avaliar através da Escala de Equilíbrio de Berg (EEB) a efetividade da hipoterapia para melhorar o equilíbrio postural em pacientes hemiparéticos após acidente vascular encefálico em comparação à terapia convencional Métodos: Uma revisão sistemática foi conduzida com buscas nas bases de dados eletrônicas PubMed, BVS, SCIELO, Cochrane, SCOPUS, WoS e Cinahl. Palavras-chave: "hippotherapy", "horseback riding" e "stroke" ligadas pelos operadores booleanos OR e AND. A pesquisa foi restrita a ensaios clínicos numa população adulta com histórico de AVE. Resultados: Após a análise dos estudos, foram incluídos nessa metanálise quatro artigos que utilizaram a hipoterapia como intervenção para melhora do controle postural e equilíbrio postural. Três artigos utilizaram hipoterapia com simulador mecânico e um estudo realizou com cavalos. O grupo de comparação foi a fisioterapia convencional. A idade variou de 61 a 71 anos, sendo mais predominante o sexo masculino. As sessões, com duração de 20 a 30 minutos, variaram entre 6 e 12 semanas. A análise de viés dos estudos com a escala PEDro revelou pontuações de 6 a 8 pontos. O resultado de três dos quatro ensaios clínicos sugere que o simulador mecânico e convencional resultou em melhora estatisticamente significativa do escore total da EEB. Conclusão: Uma vez que há poucos estudos de alta qualidade, não é possível estabelecer a efetividade da hipoterapia utilizando cavalos ou simulador mecânico para promover a melhoria no equilíbrio postural em pacientes sobreviventes após AVE quando comparada ao tratamento convencional. Estudos futuros podem esclarecer se a hipoterapia pode ser considerada um tratamento complementar para melhoria do equilíbrio postural após AVE.

Extract from Aloysia polystachya Induces the Cell Death of Colorectal Cancer Stem Cells.

Cancer stem cells (CSCs) are an important player in the resistance of cancers to therapy. In this work, we determined the flavonoids composition and biological action of Aloysia polystachya (AP) extracts in colorectal cancer. The chemical characterization of extracts was performed by HPLC. Assays of cytotoxicity, apoptosis, migration and invasion, metalloproteases activity, clonogenic growth, tumorspheres formation, Hoechts efflux, pluripotency marker expression and sensitization to chemotherapeutic drugs were performed in vitro in human HCT116 and murine CT26 colorectal cancer cells. The AP toxicity and effect in tumor growth administered alone or in combination with 5- Fluorouracile was analyzed in vivo, including histopathological studies. We found that AP extracts induced in vitro the apoptosis of colorectal cancer cell lines decreasing the CSC proportion. Moreover, they were capable to kill 5-Fluorouracile resistant side population cells. At not toxic doses in vivo, AP extracts inhibited tumor growth. Regarding the ability to reduce the CSC population, AP extracts deserves to be investigated as a useful therapy for colorectal cancer treatment.

Uso de medicamentos em crianças de zero a cinco anos de idade residentes no município de tubarão, santa catarina / Use of drugs in children aged zero to five years old in tubarão, santa catarina, brazil

RESUMO Objetivo: Analisar o perfil de utilização de medicamentos em crianças de zero a cinco anos de idade. Métodos: Estudo transversal baseado em entrevistas realizadas em domicílio com cuidadores (pais, tios ou avós) das crianças cadastradas em dez unidades de Estratégia Saúde da Família (ESF), distribuídas em diferentes pontos geográficos do município de Tubarão, Santa Catarina. Resultados: Foram entrevistados 350 cuidadores, cujas crianças sorteadas possuíam, em média, 2,6 anos de idade. Destas, 56,9% utilizaram, pelo menos, um medicamento nos 15 dias anteriores à entrevista, sendo que 31,1% foram expostas à automedicação e 35,7% utilizaram, pelo menos, um medicamento obtido por prescrição atual. O uso de medicamentos foi associado à faixa etária de até 24 meses, consulta periódica com pediatra e diagnóstico de doenças agudas e doenças crônicas. Entre as crianças medicadas, 19,1% foram expostas a pelo menos um medicamento de forma inadequada (considerando dose, intervalo entre doses ou período de tratamento). Quanto ao armazenamento, 55,2% dos medicamentos estavam guardados em lugar inseguro, ou seja, ao acesso das crianças, e 32,0% em locais inadequados, por estarem expostos a luz, calor ou umidade. Ainda, 45,2% estavam sem bula, 38,9% sem embalagem secundária e 1,6% fora do prazo de validade. Conclusões: As crianças estudadas apresentam uma frequência elevada de uso de medicamentos, devendo ser incentivadas ações que visem ao uso seguro e racional de fármacos nessa população.

ABSTRACT Objective: To analyze the context of drug use in children aged zero to five years old. Methods: Cross-sectional study based on interviews conducted at home with caregivers (parents, uncles or grandparents) of the children enrolled in ten Family Health Strategy units across different geographical points of the city of Tubarão, Santa Catarina, Brazil. Results: A total of 350 caregivers were interviewed, whose children's mean age was 2.6 years. Of these, 56.9% had used at least one drug in the 15 days prior to the interview, 31.1% had been exposed to self-medication and 35.7% had used at least one medication obtained by current prescription. The use of medication was associated with the age range up to 24 months, periodic consultation with pediatricians and diagnosis of chronic and acute diseases. Among medicated children, 19.1% inappropriately had been exposed to at least one medication (considering dose, dose interval or period of treatment). Regarding medication storage, 55.2% of interviewees stored them in unsafe places that could be accessed by children and 32.0% in inappropriate places, with exposure to light, heat or humidity. Moreover, 45.2% of the interviewees stored drugs out of their packages, 38.9% without secondary packaging, and 1.6% of drugs had expired date. Conclusions: Drug use is high among children in this age range, and actions aimed at the safe and rational use of these substances in this population should be encouraged.

Absenteísmo-doença entre servidores públicos do setor saúde do Distrito Federal / Sickness absence among public workers in the healthcare sector of the Federal District, Brazil

Introdução: Descrever o perfil e os indicadores de absenteísmo-doença entre servidores de 18 unidades de saúde pública de uma Regional de Saúde do Distrito Federal (Brasília), Brasil. Métodos: Estudo transversal de todas as licenças médicas homologadas em 2014 superiores a três dias. Os indicadores de absenteísmo-doença foram calculados de acordo com sexo, estado civil, faixa etária, nível de escolaridade, categoria profissional, tempo de serviço, carga horária e lotação. Resultados: A população de 2.501 servidores apresentou 2.205 licenças médicas que resultaram em 40.755 dias de trabalho perdidos. Os indicadores demonstraram prevalência de absenteísmo-doença de 39%, índice de frequência de licenças de 88%, índice de gravidade de 16 dias, duração média do absenteísmo-doença de 42 dias e duração média das licenças de 18 dias. Mais de 85% dos dias perdidos foram atribuídos aos servidores com recorrência de licenças médicas. Transtornos mentais e comportamentais, além das doenças osteomusculares, representaram maiores causas de afastamento. Conclusão: O planejamento das ações em saúde do servidor exige o conhecimento das características dessa população, bem como do perfil de morbidade. Os resultados apresentados expressam a magnitude do absenteísmo- doença no setor saúde do serviço público e apontam para a necessidade de mudanças profundas na organização do processo de trabalho, com intervenções inovadoras nos espaços profissionais

Background: To describe the profile and indicators of sickness absence for civil servants allocated to the 18 public health units of a Federal District (Brasilia) Health Region, Brazil. Methods: Cross-sectional study of all sick leaves longer than 3 days granted in 2014. Sickness absence indicators were calculated and analyzed per sex, marital status, age, educational level, professional category, length in the job, working hours and workplace. Results: The analyzed population (n=2,501) was granted 2,205 sick leaves in total, corresponding to 40,755 missed work days. The prevalence of sickness absence was 39%, the leave frequency index 88%, the severity index 16 days, the average sickness absence length 42 days, and the average length of leaves 18 days. More than 85% of the missed work days corresponded to workers with recurrence of sickness absence. Mental and behavioral disorders and musculoskeletal diseases were the main causes of sick leave. Conclusion: Planning health actions demands accurate knowledge of the characteristics and morbidity profile of this population of workers. The results of the present study express the magnitude of sickness absence in the public health sector, and point to the need for thorough change in the organization of the work process and innovative interventions in the workplace

Qualidade de Vida de cuidadores de praticantes de equoterapia no Distrito Federal / Quality of Life of caregivers of equine therapy practitioners in the Federal District

RESUMO O cuidador oferece atendimento individualizado, e a qualidade de sua atuação influencia na Qualidade de Vida (QV) da pessoa com deficiência. A sobrecarga de trabalho ou a falta de orientação quanto à melhor forma de sua atuação pode influenciar negativamente em sua saúde. Este artigo teve como objetivo avaliar a QV dos cuidadores dos praticantes de centros de equoterapia do Distrito Federal. Foi realizado um estudo de corte transversal em oito centros de equoterapia do Distrito Federal vinculados a Ande-Brasil, utilizando como instrumento de avaliação o questionário WHOQOL-bref para avaliar a QV dos cuidadores dos praticantes de equoterapia. Foram estudados 389 cuidadores, dos quais 71,72% correspondem ao gênero feminino e 28, 27% correspondem ao gênero masculino. Na análise dos resultados dos questionários, o domínio Relações Sociais obteve maior satisfação com escore de 66,13; o domínio Psicológico obteve escore de 64,52; o domínio Ambiente obteve escore de 60,8; e o domínio Físico apresentou o menor escore, obtendo 56,46. A média dos escores obtidos foi de 61,89. Os resultados demonstraram que a tarefa de cuidador pode provocar alterações físicas e mentais de forma negativa, e isso pode influenciar na qualidade de atendimento e no bem-estar do praticante.

ABSTRACT The caregiver offers individualized care, and the quality of his/her performance influences the Quality of Life (QoL) of disabled individuals. Overworking or lack of guidance can affect the caregiver's health either positively or negatively. This article aimed at evaluating the QoL of caregivers of equine therapy practitioners in the Federal District. A cross-sectional study was carried out in eight equine therapy centers of the Federal District, linked to Ande-Brasil, using the WHOQOL-bref questionnaire, to evaluate the QoL of caregivers of equine therapy practitioners. A total of 389 caregivers were studied, 71.72% of which were females and 28.27% were males. The analysis of answers to the questionnaires showed that the Social Relations domain obtained the highest satisfaction score (66.13); the Psychological domain scored 64.52; the Environment domain scored 60.8; and the Physical domain presented the lowest score, 56.46. Scores average was 61.89. The results showed that the work the caregiver performs may cause negative physical and mental changes, and these changes can influence the quality of care and her/his own well-being.

Fatores associados a quedas em idosos com catarata / Factors associated with falls in older adults with cataracts

Resumo O objetivo deste artigo é avaliar os fatores associados a quedas em idosos comunitários com diagnóstico de catarata. Trata-se de pesquisa transversal e analítica. A amostra se constituiu de idosos comunitários residentes no Distrito Federal, Brasil. Foram aplicados os seguintes instrumentos: questionário sociodemográfico; Timed Up and Go; Short Battery Performance Test; a Plataforma de Equilíbrio Biodex Balance System; o Índice de Katz, escala de Lawton; Mini-Exame do Estado Mental; e os critérios de fragilidade de John Hopkins Medical Institutions. Para análise empregou-se regressão logística binária. Participaram 142 idosos (85 destes com catarata), com média de idade de 69,39 anos (± 5,67). Observou-se associação das quedas com sexo feminino (OR:4,45) e pontuação submáxima no SPPB (OR:3,53) entre os pacientes com catarata, ao passo que a presença de multimorbidades (OR:5,10) foi o fator de risco para os idosos sem catarata. Os dados sugerem fatores de risco diferentes para idosos com diagnóstico de catarata.

Abstract The aim of the present study was to evaluate factors associated with falls in community-dwelling older adults diagnosed with cataracts. An analytical, cross-sectional study was conducted with a sample of community-dwelling older adults residing in the Federal District of Brazil. Interviews and assessment tools were administered, such as the Timed Up and Go test, Short Physical Performance Battery (SPPB), Biodex Balance System, Katz Index, Lawton Scale, Minnesota Leisure Time Physical Activity Questionnaire and Mini Mental State Examination. Statistical analysis involved binary logistic regression. One hundred forty-two older adults (85 with cataracts) participated in the study (mean age: 69.39 ± 5.67 years). Falls were associated with the female sex (OR: 4.45) and sub-maximum score on the SPPB (OR: 3.53) among patients with cataracts, whereas multimorbidity (OR: 5.10) was the risk factor risk for older adults without cataracts. The data suggest different risk factors for falls among older adults diagnosed with cataracts.

High RAC3 expression levels are required for induction and maintaining of cancer cell stemness.

RAC3 is a transcription coactivator, usually overexpressed in several tumors and required to maintain the pluripotency in normal stem cells. In this work we studied the association between RAC3 overexpression on cancer cell stemness and the capacity of this protein to induce cancer stem properties in non tumoral cells. We performed in vitro and in vivo experiments using two strategies: by overexpressing RAC3 in the non tumoral cell line HEK293 and by silencing RAC3 in the human colorectal epithelial cell line HCT116 by transfection. Furthermore, we analysed public repository microarrays data from human colorectal tumors in different developmental stages. We found that RAC3 overexpression was mainly associated to CD133+ side-population of colon cancer cells and also to early and advanced stages of colon cancer, involving increased expression of mesenchymal and stem markers. In turn, RAC3 silencing induced diminished tumoral properties and cancer stem cells as determined by Hoechst efflux, tumorspheres and clonogenic growth, which correlated with decreased Nanog and OCT4 expression. In non tumoral cells, RAC3 overexpression induced tumoral transformation; mesenchymal phenotype and stem markers expression. Moreover, these transformed cells generated tumors in vivo. Our results demonstrate that RAC3 is required for maintaining and induction of cancer cell stemness.

Avaliação da força muscular, da atividade muscular e das alterações metabólicas de amputados transtibiais / Assessment of muscle strength, muscle activity and metabolic changes of patients with transtibial amputation

Objetivo: Reunir os achados na literatura sobre eletromiografia, força muscular e alterações metabólicas em amputados transtibiais. Métodos: Revisão da literatura, realizada no período de janeiro a março de 2014, com pesquisa nas bases de dados eletrônicas: Pubmed, Scielo, Lilacs, BVS, Dedalus e BCE; utilizando-se as palavras-chave: amputado transtibial, EMG, abaixo do joelho, amputados, força muscular, gasto energético e frequência cardíaca, além de seus correspondentes na língua inglesa. Resultados: Foram identificados 144 artigos. Após análise e avaliação, 33 artigos foram selecionados. A demanda metabólica apresenta-se maior durante a marcha de indivíduos amputados em comparação a não amputados. Para o estudo eletromiográfico nessa população são utilizados, principalmente, os músculos bíceps femoral e reto femoral. O torque foi a variável mais descrita por sua relação direta com a força muscular. Conclusão: Os sinais EMG estão fortemente relacionados ao modo como o amputado. (AU)

Objective: To assemble findings in the literature regarding electromyography, muscle strength and metabolic alterations in patients with transtibial amputations. Methods: Literature review from January to March 2014 in Pubmed, Scielo, Lilacs, BVS, Dedalus and BCE databases; the following key words were used: transtibial amputee, sEMG, below the knee, amputees, muscle strength, energy expenditure and its Portuguese equivalents. Results: 144 articles were identified. After subsequent analysis and evaluation, 33 were selected. Metabolic demand appears to be increased during amputees gait in comparison to non-amputees subjects. Concerning EMG studies, the main muscles used in this population are both biceps femoris and rectus femoris. Torque was the most described variable for its directly relation with muscle strength. Conclusion: EMG signals are strongly related to the transtibial amputee locomotion. The proper prosthesis selection may reduce metabolic demand. (AU)

Fear of falling and associated factors in community elderly with cataracts / Medo de quedas e fatores associados em idosos comunitários com catarata

ABSTRACT Objective: To investigate prevalence of the fear of falling of elderly with cataracts living in the community and the associated factors with high concern with falling occurrences. Methods: A cross-sectional, analytical and observational study. It was composed by 86 elderly diagnosed with bilateral cataracts. To quantify the fear of falling among elderly, the scale Falls Efficacy Scale-International-Brasil (FES-I-BRASIL) was used. Other variables were obtained through application of a structured questionnaire. Results: Between participants, 41.9% reported low concern of falling, while 58.1% reported high concern. From those last ones, 52% fell at least once on the past 12 months and, 30% of them are recurrent fallers. The activities "to walk in slippery surfaces", "to walk in irregular surfaces" and, "to walk up and down the stairs" represented higher concern for elderly. Conclusion: Cataracts or any other visual issue predispose falls due to difficulty in overcoming obstacles present in the environment. Fear of falling is especially associated with factors acquired after the first fall episode.

RESUMO Objetivo: Investigar a prevalência do medo de quedas em idosos com catarata residentes na comunidade e os fatores associados à alta preocupação com a ocorrência de quedas. Métodos: Pesquisa de corte transversal, analítico e observacional. Foi composta por 86 idosos com diagnóstico de catarata bilateral. Para quantificar o medo de quedas entre idosos foi utilizada a escala Falls Efficacy ScaleInternational-Brasil (FES-I-BRASIL). As demais variáveis foram obtidas por meio de aplicação de questionário estruturado. Resultados: Entre os participantes, 41,9% relataram baixa preocupação em cair, enquanto 58,1% relataram alta preocupação. Destes últimos, 52% sofreram ao menos uma queda nos últimos 12 meses e 30% deles são caidores recorrentes. As atividades "andar em superfícies escorregadias", "andar em superfícies irregulares" e "subir e descer escadas" foram as que representaram maior preocupação para os idosos. Conclusão: A catarata ou qualquer outro problema visual é um predisponente à queda pela dificuldade em enfrentar os obstáculos encontrados no ambiente. O medo de quedas está associado, principalmente, a fatores adquiridos após o primeiro episódio de queda.

Hemangioblastoma located in the posterior incisural space mimicking a tentorial meningioma: a case report.

BACKGROUND: The most common type of vascularized tumor located in the posterior incisural space in older patients is the falcotentorial meningioma. Solid hemangioblastomas are rarely found in this particular area of the brain. To the best of our knowledge, the case of only one patient harboring a hemangioblastoma not associated with Von Hippel-Lindau disease has been previously reported in the literature in this anatomic region. Regarding age presentation, it is rare for sporadic hemangioblastoma in any part of the brain to occur in older patients; only two cases have previously been reported, and neither were in this anatomical space. A solid hemangioblastoma represents a surgical challenge because of its high vascularization, very similar to an arteriovenous malformation, and it should be removed en bloc to prevent significant intraoperative bleeding. CASE PRESENTATION: We report here the case of a 63-year-old white male patient with a sporadic hemangioblastoma located in the posterior incisural space mimicking a tentorial meningioma. It was completely removed en bloc via an infratentorial supracerebellar approach with an excellent outcome. CONCLUSIONS: A hemangioblastoma should be considered among the differential diagnosis of hypervascularized masses in the posterior incisural space, even in cases of solid tumors, in older patients, or in the absence of Von Hippel-Lindau disease. These tumors located in the posterior incisural space represent a challenge, and the infratentorial supracerebellar approach provides panoramic exposure to allow safe resection.

Extent of resection and postoperative functional declination of Klekamp's type A intramedullary tumors in adult patients.

BACKGROUND: The most commonly primary intramedullary spinal cord tumors (ISCT) in adults are the noninfiltrative lesions, corresponding to Klekamp's type A classification. There are few reports exclusively considering this type of lesions, their resectability and postoperative functional declination risk, and to our knowledge, none from Latin America. This led us to evaluate our results to provide information that might contribute to the decision making process in our region. METHODS: A retrospective observational study was conducted comprising a cohort of 21 adults having primary Klekamp's type A ISCT. Diagnosis was made by magnetic resonance imaging (MRI), along with diffusion tensor/tractography in the last 7 cases. Preoperative functional status was assessed using the McCormick's modified scale (mMs), which was also used for the postoperative assessment within postoperative 90 days period. MRI was used to confirm the extent of resection. RESULTS: Radical resection was obtained in 20/21 cases. The postoperative functional status was stable in 42.8% of the cases, and in 57.4% was even better than in the preoperative period. Temporary declination was observed in 2 cases in the early postoperative period. There were 2 cases with complications; one patient had cerebrospinal fluid fistula with meningitis, which was conservatively resolved, and another patient died from pulmonary embolism. CONCLUSION: Although the number of patients in this series does not allow to conclude from a statistical point of view, the outcomes showed that the modern surgery of Klekamp's type A ISCT permits a complete resection with low functional declination risk.

Controle autonômico cardíaco de idosas hipertensas / Cardiac autonomic control of hypertensive elderly

Fundamentos: O envelhecimento é uma condição natural e pertinente à idade, produzindo declínio fisiológico de diversos sistemas funcionais. O sistema autônomo cardíaco é um dos que sofrem alterações com a idade; a condução dos impulsos elétricos do coração é comprometida, promovendo alterações nos intervalos entre as ondas RR do eletrocardiograma. Objetivo: Verificar a existência de alterações significativas sobre o sistema nervoso autonômico cardíaco por meio da variabilidade da frequência cardíaca de idosas ativas hipertensas e normotensas. Materiais e métodos: Doze idosas entre 60 e 79 anos (media de 70 anos), sendo 7 hipertensas e 5 normotensas, foram submetidas a uma avaliação funcional e cognitiva, eletrocardiograma e nível de atividade física; e a um protocolo de captação da variabilidade da frequência cardíaca, utilizando um cardiofrequencímetro (Polar RS800CX), na condição de repouso e de exercício físico. As variáveis para análise foram os intervalos RR e o índice de variabilidade da frequência cardíaca (RMSSD). Resultados: Os valores dos intervalos RR entre os grupos não apresentaram diferenças estatisticamente significantes, o mesmo ocorreu com o RMSSD (p>0,05). Na análise intragrupo houve uma redução significativa, dos intervalos RR e do RMSSD da condição de repouso para exercício físico (p<0,05). Conclusão: As voluntárias hipertensas, quando controladas com medicamentos e exercício físico, demonstram um ajuste autonômico cardíaco semelhante às normotensas, nas diferentes condições estudadas

Background: Aging is a natural condition and appropriate to the age, producing physiological decline of various functional systems. Cardiac autonomous system is one of those that change with age; the conduction of electrical impulses of the heart is compromised, promoting changes in RR intervals between the waves of the electrocardiogram. Objective: To verify the existence of significant changes on cardiac autonomic nervous system through the heart rate variability in hypertensive and normotensive active women. Materials and methods: Twelve elderly between 60 and 79 years (mean 70 years), 7 hypertensive and 5 normotensive, underwent a functional and cognitive assessment, electrocardiogram and level of physical activity assessment; and to a protocol of heart rate variability using a heart rate monitor (Polar RS800CX), at rest and exercise. The variables for analysis were the RR intervals and the variability index of heart rate (RMSSD). Results: The values of RR intervals between groups showed no statistically significant differences, so has the RMSSD (p>0.05). In the intragroup analysis there was a significant reduction of RR intervals and RMSSD from the rest condition to exercise (p<0.05). Conclusion: The hypertensive volunteers, when controlled with medication and exercise, demonstrate a heart autonomic adjustment similar to normotensive, under different conditions