A Case of Multifocal Primary Pyomyositis Complicated With Toxic Shock Syndrome in a Non-tropical Region.

Primary pyomyositis, also known as tropical pyomyositis, is a primary bacterial infection of skeletal muscle following hematogenous infections. It is primarily caused by Staphylococcus aureus or Group A Streptococcus and predominantly affects children and young adults. Although rarely observed in temperate climates, its prevalence appears to be increasing. Here, we present the case of a 36-year-old male patient who manifested with persistent fever and inflammatory signs in multiple skeletal muscle locations following acute pharyngitis, further complicated by toxic shock syndrome within 48 h of admission. The blood cultures were positive for Streptococcus pyogenes and ultrasound evaluation demonstrated muscle tissue heterogeneity, associated with areas of liquid collection and subcutaneous edema, in the right pectoral muscles and bilaterally in the fibularis longus and extensor digitorum longus muscles, confirming the diagnosis of primary pyomyositis. After treatment with a prolonged course of antibiotics, the patient showed substantial clinical improvement and was completely asymptomatic at 6-month follow-up. This case illustrates the possible risks associated with primary pyomyositis and the importance of its early recognition and treatment, regardless of geographic location.

Assessing Participation in Stroke Survivors: Psychometric Properties of the Participation Measurement Scale (PM-Scale) Brazil.

Initial evidence supports the reliability of the Participation Measurement Scale (PM-Scale) in Brazil, but further exploration of its psychometric properties is needed for Brazilian stroke survivors. The aim of the study is to analyze the reliability, convergent validity, internal consistency, and accuracy of the PM-Scale Brazil. A methodological study involved three assessments over intervals of 7-14 days. Reliability was evaluated through the Intraclass Correlation Coefficient. Convergent validity was assessed using Spearman's correlation coefficient to evaluate the alignment of the PM-Scale Brazil with the SATIS-Stroke. Internal consistency was assessed through Cronbach's α. Accuracy was estimated by calculating the area under the receiver operating characteristic curve. The study involved 110 stroke survivors, revealing adequate intra-rater and inter-rater reliability. A significant weak correlation was observed between the PM-Scale and SATIS-Stroke. Internal consistency and accuracy were adequate. The PM-Scale Brazil demonstrates good reliability, internal consistency, and sensitivity. However, its weak correlation with SATIS-Stroke suggests limited convergent validity.

Assessing Participation in Stroke Survivors: Reliability and Validity of the PM-Scale BrazilIn our study, we looked at how well the PM-Scale Brazil works for measuring participation after stroke. We found that it gives consistent and reliable results, meaning it can be trusted. Although it is sensitive to identifying participation issues, it did not strongly agree with another measure called SATIS-Stroke. This might be because the two tools measure different things: SATIS-Stroke looks at activities and participation broadly, while the PM-Scale focuses specifically on participation.

The Impact of Stimulation Parameters on Cardiovascular Outcomes in Chronic Stroke Patients Following Transcranial Direct Current Stimulation-A Pilot Controlled, Randomized, Double-Blind Crossover Trial.

BACKGROUND: Stroke survivors often experience autonomic nervous system (ANS) dysfunction. While Transcranial Direct Current Stimulation (tDCS) has been shown to modulate the ANS when applied to the left hemisphere, its effects on the right hemisphere remain unexplored. OBJECTIVE: We aimed to compare the effects of tDCS applied to both the injured and the contralateral hemispheres on heart rate variability (HRV) and functional capacity in individuals post-stroke. METHODS: Twenty individuals with cerebral hemisphere lesions (ten with right-hemisphere lesions and ten with left-hemisphere lesions) were randomized into four groups: anodal and sham tDCS on the left temporal cortex (T3) and anodal and sham tDCS on the right temporal cortex (T4). HRV was assessed before the intervention, after the six-minute walk test (6MWT), and following tDCS. HRV data were categorized into frequency ranges: low frequency (LF), high frequency (HF), and sympathovagal balance. The 6MWT (meters) was conducted both pre- and post-tDCS. RESULTS: In individuals with right-hemisphere lesions, a higher global LF value was observed (right side: 71.4 ± 16.8 nu vs. left side: 65.7 ± 17.3 nu; p = 0.008), as well as lower values of the HF component (right side: 29.5 ± 18.9 nu vs. left side: 34.0 ± 17.4 nu; p = 0.047), consequently exhibiting higher global values of the low/high-frequency ratio (right side: 3.9 ± 2.8 vs. left side: 2.9 ± 2.4). Regarding the stimulation site, tDCS over T3 led to a lower overall value of the low/high-frequency ratio (left hemisphere: 3.0 ± 2.2 vs. right hemisphere: 3.7 ± 2.9; p = 0.040) regardless of the lesion location. A significant increase in the distance covered in the 6MWT was observed for individuals with lesions in both hemispheres after tDCS at T3. CONCLUSIONS: Participants with right-hemisphere lesions exhibited superior global sympathetic autonomic nervous system activity. When the tDCS was applied on the left hemisphere, it maintained lower sympathovagal balance values and improved functional capacity regardless of the hemisphere affected by the stroke.

Does Transcranial Direct Current Stimulation reduce central and peripheral muscle fatigue in recreational runners? A triple-blind, sham-controlled, randomized, crossover clinical study.

BACKGROUND: Runners seek health benefits and performance improvement. However, fatigue might be considered a limiting factor. Transcranial Direct Current Stimulation (tDCS) has been investigated to improve performance and reduce fatigue in athletes. While some studies showing that tDCS may improve a variety of physical measures, other studies failed to show any benefit. OBJECTIVE: To evaluate the acute effects of tDCS on central and peripheral fatigue compared to a sham intervention in recreational runners. METHODS: This is a triple-blind, controlled, crossover study of 30 recreational runners who were randomized to receive one of the two interventions, anodal or sham tDCS, after the fatigue protocol. The interventions were applied to the quadriceps muscle hotspot for 20 min. Peak torque, motor-evoked potential, and perceived exertion rate were assessed before and after the interventions, and blood lactate level was assessed before, during, and after the interventions. A generalized estimated equation was used to analyze the peak torque, motor-evoked potential, and blood lactate data, and the Wilcoxon test was used for perceived exertion rate data. RESULTS: Our findings showed no difference between anodal tDCS and sham tDCS on peak torque, motor-evoked potential, blood lactate, and perceived exertion rate. CONCLUSION: The tDCS protocol was not effective in improving performance and reducing fatigue compared to a sham control intervention. BRAZILIAN CLINICAL TRIALS REGISTRY: RBR-8zpnxz.

Effect of transcranial direct current stimulation combined with pelvic muscle training in women: Randomized, controlled, double-blind, and clinical trial.

BACKGROUND: Pelvic floor muscle training (PFMT) is widely used for pelvic floor muscle (PFM) weakness in women; however, it has no prolonged effects. OBJECTIVE: To evaluate the effect of Transcranial Direct Current Stimulation (tDCS) associated with PFMT on PFM contraction, sexual function and quality of life (QoL) in healthy women. STUDY DESIGN: 32 nulliparous women, aged 22.7 ± 0.42 years, were randomized into two groups: G1 (active tDCS combined with PFMT) and G2 (sham tDCS combined with PFMT). The treatment was performed three times a week for 4 weeks, totaling 12 sessions. PFM function was assessed using the PERFECT scheme (P = power, E = endurance, R = repetitions, F = rapid contractions, ECT = each timed contraction) and the perineometer (cmH2O). Sexual function was assessed by The Female Sexual Function Index, and QoL by the SF-36 questionnaire. These assessments were performed before and after the 12nd treatment session and after 30-day follow-up. RESULTS: There was a significant increase (p = 0.037) in the power of G2 compared to G1; repetitions and fast contraction increased in the G1 group, and the resistance increased in both groups, however, without statistical difference between the groups. ECT increased in the G1 group (p = 0.0). CONCLUSION: Active tDCS combined with PFMT did not potentiate the effect of the PFMT to increase the PFM function, QoL, and sexual function in healthy women. However, adjunctive tDCS to PFMT improved the time of contractions, maintaining it during follow-up.

Biodiesel production potential of Eichhornia crassipes (Mart.) Solms: comparison of collection sites and different alcohol transesterifications.

Renewable resources have stood out as raw materials in producing biofuels. This study aimed to evaluate the parameters of alcohol transesterification (ethanol and methanol) and localization of collection of aquatic macrophyte Eichhornia crassipes (Mart.) Solms in the production of biodiesel by in situ transesterification. E. crassipes was collected in Dourados and Corumbá (Brazil) municipalities. The fatty acid ester composition of the biodiesel was characterized and quantified by gas chromatography. The biodiesel properties were estimated using the BiodieselAnalyzer© program prediction. The ethyl transesterification resulted in higher yields, but the localization of collection was the most relevant parameter in biodiesel production according to the Permutation Multivariate Analysis of Variance. The simulation and comparison of the physical-chemical properties of E. crassipes biodiesel and BD 100 (commercial biodiesel) were promising for commercial application.

The effect of transcranial direct current stimulation associated with video game training on the postural balance of older women in the community: A blind, randomized, clinical trial.

BACKGROUND: Falls are frequent in older adults and can cause trauma, injury, and death. Fall prevention with virtual reality presents good results in improving postural control. Transcranial Direct Current Stimulation (tDCS) has been used with the same aim; however, the combination of the two techniques has still been little studied. PURPOSE: To assess whether tDCS can enhance the effect of video game training (VGT) on improving the postural balance of healthy older women. METHOD: A blinded, randomized, controlled clinical trial was conducted with 57 older women who were randomized to three balance training groups: Control Group (VGT), Anodal Group (VGT combined with anodic tDCS-atDCS), and Sham Group (VGT combined with sham tDCS-stDCS). Balance training was performed twice a week for four weeks, totalizing eight 20-min sessions using VGT associated with tDCS. Postural balance was assessed pre-and post-training and 30 days after the end of the eight sessions using the Mini-Balance Evaluation Systems Test. RESULTS: Compared to pre-intervention the Mini BEST test increased similarly in the three groups in post-intervention (control: pre 23.7 ± 2.8 to post 27.0 ± 2.2; anodal: pre 24.4 ± 1 to post 27.7 ± 0.8 and sham: pre 24.2 ± 1.9 to post 26.5 ± 1.6; p < 0.001) and follow-up (control: pre 23.7 ± 2.8 to follow-up 26.8 ± 2.3; anodal: pre 24.4 ± 1 to follow-up 27.3 ± 1.4 and sham: pre 24.2 ± 1.9 to follow-up 26.8 ± 1.5; p < 0.001). CONCLUSION: There was an improvement in the postural balance of the three training groups that were independent of tDCS. DISCUSSION: Some studies have shown the positive tDCS effects associated with other tasks to improve balance. However, these results convey the effects of only anodic-tDCS compared to sham-tDCS. Possibly, the effect of VGT surpassed the tDCS effects, promoting a ceiling effect from the combination of these two therapies. However, studies with other therapies combined with tDCS for older adults deserve to be investigated, as well as in frail older people.

Predictors of the Social Participation of Adults with Down Syndrome: An Analysis Based on the Biopsychosocial Model of the International Classification of Functioning, Disability, and Health.

OBJECTIVE: The aim of the study is to identify the predictors of social participation in Down syndrome adults from the biopsychosocial model of the International Classification of Functioning, Disability, and Health. METHODS: An exploratory, analytical, cross-sectional study was conducted with Down syndrome adults. The social participation was assessed using the Life Habits Assessment. The independent variables were determined using the International Classification of Functioning, Disability, and Health biopsychosocial model: body functions were assessed by body mass index, cognition function (Mini-Mental State Examination), and lower limbs muscle strength (Sit-to-Stand Test). Activities were assessed by the 8-Foot Up and Go Test. Environmental factors were assessed by the measure of the quality of the environment, and personal factors were assessed by age, sex, and education level. RESULTS: The total Life Habits Assessment score indicates that individuals show moderate restriction in social participation, with major restriction in the education, employment, and responsibilities domains. The 8-Foot Up and Go Test was the best social participation predictor variable, followed by Mini-Mental State Examination, and the Sit-to-Stand Test. Contextual factors were not predictors of participation. CONCLUSIONS: It was concluded that individuals with Down syndrome present the most restrictions to social participation in activities that involve social roles. The predictors influencing social participation are functional mobility, cognition, and lower limb muscle strength.

Effects of Transcranial Direct Current Stimulation and Pelvic Floor Muscle Training in Women: protocol for a controlled, randomized, double-blind clinical trial / Efectos de la estimulación transcraneal por corriente directa y del entrenamiento muscular del suelo pélvico en mujeres: protocolo de un ensayo clínico controlado, aleatorizado y doble ciego / Efeitos da estimulação transcraniana por corrente contínua e treinamento muscular do assoalho pélvico em mulheres: protocolo para um ensaio clínico controlado, randomizado e duplo-cego

ABSTRACT Pelvic floor muscle weakness can lead to urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Although it can be minimized by pelvic floor muscle training (PFMT), its effects are not lasting. Therefore, using combination therapy seems promising. This study aims to evaluate the effect of transcranial direct current stimulation (tDCS) combined with PFMT on intravaginal pressure, pelvic floor muscle strength (PFMS), sexual function (SF), and quality of life (QoL) in healthy women. A total of 32 women, aged from 18 to 45 years, will undergo PFMT (with perineal contractions and relaxation) with the aid of pressure biofeedback associated with active tDCS or sham tDCS. Sessions will last 20 minutes, three times per week, for four weeks, totaling 12 sessions. During the protocol, participants will be instructed to also perform the home-based PFMT daily. The tDCS anodal electrode will be positioned over the supplementary motor area of the dominant cortical hemisphere, whereas the cathodal will be over the contralateral supraorbital region, with a 2mA intensity for 20 minutes. Intravaginal pressure (pressure gauge), PFM strength (measured by digital palpation and the PERFECT scheme), FSFI (Female Sexual Function Index), and QoL (SF-36 questionnaire) will be evaluated before and after the 12 sessions and after a 30-day follow-up.

RESUMEN La debilidad de la musculatura del suelo pélvico puede provocar incontinencia urinaria, prolapso de órganos pélvicos y disfunción sexual, y puede minimizarse mediante el entrenamiento de la musculatura del suelo pélvico (EMSP). Sin embargo, este efecto no es duradero. En este contexto, una terapia combinada puede ser prometedora para mejorar la situación. Este estudio tiene por objetivo evaluar el efecto de la estimulación transcraneal por corriente directa (ETCC) combinada con EMSP sobre la presión intravaginal, la fuerza muscular del suelo pélvico (FMSP), la función sexual (FS) y la calidad de vida (CV) en mujeres sanas. Participarán 32 mujeres, de entre 18 y 45 años, que se someterán a EMSP (contracciones y relajación del perineo) y a Biofeedback asociado a ETCC activa o ETCC sham durante 20 minutos, tres veces por semana, durante 4 semanas, con un total de 12 sesiones. Durante el protocolo, las participantes también se someterán diariamente a EMSP en casa. El electrodo anodal de la ETCC se colocará sobre el área motora suplementaria del hemisferio cortical dominante, y el electrodo catodal sobre la región supraorbital contralateral, a una intensidad de 2 mA, durante 20 minutos. Se evaluarán la presión intravaginal (manómetro), la FMSP (palpación digital, esquema Perfect), la FS (Índice de Función Sexual Femenina) y la CV (cuestionario SF-36) antes y después de las 12 sesiones, así como tras un seguimiento de 30 días.

RESUMO A fraqueza muscular do assoalho pélvico pode gerar incontinência urinária, prolapso de órgãos pélvicos e disfunção sexual, e pode ser minimizada pelo treinamento muscular do assoalho pélvico (TMAP). No entanto, este efeito não é duradouro. Assim, terapia combinada parece ser promissora para a melhora deste quadro. Dessa forma, objetiva-se avaliar o efeito da estimulação transcraniana por corrente contínua (ETCC), combinada ao TMAP, sobre a pressão intravaginal, força muscular do assoalho pélvico (FMAP), função sexual (FS) e qualidade de vida (QV) em mulheres saudáveis. Serão 32 mulheres, entre 18 e 45 anos, que realizaram TMAP (contrações e relaxamento do períneo) e Biofeedback associados a ETCC ativa ou ETCC sham por 20 minutos, três vezes por semana, por 4 semanas, totalizando 12 sessões. Durante o protocolo, as participantes também realizarão diariamente, em domicílio, o TMAP. O eletrodo anodal da ETCC será posicionado sobre a área motora suplementar do hemisfério cortical dominante, e o catodal sobre a região supraorbital contralateral, com intensidade de 2mA, por 20 minutos. A pressão intravaginal (manômetro de pressão), FMAP (palpação digital, esquema Perfect), FS (Índice de Função Sexual Feminina) e QV (questionário SF-36) foram avaliadas antes e depois das 12 sessões, bem como após acompanhamento de 30 dias.

Gibberellin and miRNA156-targeted SlSBP genes synergistically regulate tomato floral meristem determinacy and ovary patterning.

Many developmental processes associated with fruit development occur at the floral meristem (FM). Age-regulated microRNA156 (miR156) and gibberellins (GAs) interact to control flowering time, but their interplay in subsequent stages of reproductive development is poorly understood. Here, in tomato (Solanum lycopersicum), we show that GA and miR156-targeted SQUAMOSA PROMOTER-BINDING PROTEIN-LIKE (SPL or SBP) genes interact in the tomato FM and ovary patterning. High GA responses or overexpression of miR156 (156OE), which leads to low expression levels of miR156-silenced SBP genes, resulted in enlarged FMs, ovary indeterminacy and fruits with increased locule number. Conversely, low GA responses reduced indeterminacy and locule number, and overexpression of a S. lycopersicum (Sl)SBP15 allele that is miR156 resistant (rSBP15) reduced FM size and locule number. GA responses were partially required for the defects observed in 156OE and rSBP15 fruits. Transcriptome analysis and genetic interactions revealed shared and divergent functions of miR156-targeted SlSBP genes, PROCERA/DELLA and the classical WUSCHEL/CLAVATA pathway, which has been previously associated with meristem size and determinacy. Our findings reveal that the miR156/SlSBP/GA regulatory module is deployed differently depending on developmental stage and create novel opportunities to fine-tune aspects of fruit development that have been important for tomato domestication.

Describing Trends in Maternal Mortality in the State of São Paulo, Brazil, from 2009 to 2019.

BACKGROUND: Maternal mortality is a significant public health concern, with varying impacts across different regions in Brazil, particularly affecting women from lower-income social classes with limited access to social resources. The aim of this study is to describe the trends in maternal mortality in São Paulo, Brazil, from 2009 to 2019. MATERIALS AND METHODS: This study employed an ecological approach utilizing a time-series design to examine maternal deaths. Secondary data from the Mortality Information System (SIM) and the Live Births Information System (SINASC) from 2009 to 2019 were utilized. The analysis included all maternal deaths among women aged 10 to 49 years residing in the state of São Paulo. Time-series data for maternal mortality ratios were constructed for the seven regions within São Paulo State. Joinpoint regression analysis was applied to characterize the maternal mortality ratio. The study estimated the annual percentage variation, the average annual percentage variation, and their respective 95% confidence intervals. RESULTS: In São Paulo, a total of 3075 maternal deaths were reported, resulting in a mortality ratio of 45.9 deaths per 100,000 live births. The leading causes of maternal death were eclampsia (7.13%), gestational hypertension (6.09%), and postpartum hemorrhage (5.89%). The analysis of the annual percentage change in the maternal mortality ratio for São Paulo State and its six clusters showed stationarity. CONCLUSIONS: The assessment of the maternal mortality ratio in the state of São Paulo, Greater São Paulo, and Baixada Santista revealed an increase in the maternal death ratio over the studied period.

Clinical-epidemiological characterization of patients submitted to hemodialysis according to the national kidney foundation, the kidney disease outcomes quality initiative ­ KDOQI in a hemodialysis reference center in the metropolitan region of São Paulo, Brazil

Introduction: hemodialysis is a treatment that helps in the survival of patients with renal failure, through an established cardiopulmonary bypass to carry out blood filtration, as a result, there is a need for a feasible, lasting and effective vascular access. There are two types of vascular access, arteriovenous fistulas, using autogenous veins or prostheses, and venous catheters. The indications for choosing the type of vascular access are related to the characteristics and restriction of use of each patient.Objective: to analyze the epidemiological, demographic and clinical profile of patients undergoing hemodialysis in two reference services in the metropolitan region of São Paulo, Brazil, and compare the clinical-surgical processes with those defined by the Kidney Guidelines disease Outcomes Quality Initiative (KDOQI).Methods: data were collected in two public hospitals, with patients undergoing hemodialysis, through registration forms and medical records, from August to December 2016. The volunteers were informed about the procedures and objectives of the study and, after agreeing, they signed a consent form. The variables age, gender, weight, height, body mass index, hemodialysis time, types of accesses already used , complications related to the accesses and underlying disease were analyzed. Patients with chronic renal failure undergoing hemodialysis of both genders, with no age restriction, were included. Patients not able to perform one of the techniques, arteriovenous fistula or catheter, were excluded . The collected data were compared with the Kidney guidelines disease Outcomes Quality Initiative (KDOQI).Results: a total of 252 individuals were included, of which 182 are patients undergoing reference hospital treatment in the city of São Bernardo do Campo, SP and 70 patients at the State University Hospital Mário Covas, a State reference in the clinical management of patients undergoing hemodialysis care.Conclusion: chronic kidney disease is highly prevalent with progression to end-stage chronic kidney failure (dialysis). The definition of the epidemiological profile of the population undergoing treatment, as well as the journey of venous accesses for hemodialysis (catheters and fistulas), are fundamental for the multidisciplinary team's learning curve about complications throughout the course of the disease/treatment. Furthermore, the clinical-surgical management of this population is in line with the guidelines of the National Kidney Foundation. The treatment performed in these hemodialysis centers is efficient and in line with what the KDOQI recommends.

Early diagnosis of diabetic neuropathy and prophylaxis of diabetic foot / Diagnóstico precoce da neuropatia diabética e profilaxia do pé diabético

Introduction: the diabetic foot is one of the most serious complications of diabetes mellitus. About 50% of non-traumatic amputations occur in these patients. In addition, it is an important public health problem and constitutes a chronic and complex metabolic disorder that is characterized by impaired metabolism of glucose and other complications in essential organs for the maintenance of life. Objective: to evaluate the sensitivity and specificity of diabetic neuropathy using the Michigan self-assessment and physical examination in type 1 and type 2 diabetics. Methods: this is a cross-sectional study. The "Michigan Neuropathy Screening Instruments" classification was used to assess the degree of peripheral neuropathy, in which participants answered the questionnaire and were evaluated for the presence of foot lesions. All participants were stratified by the risk of developing foot ulcers according to the IWGDF protocol. Results: the sample had 200 participants. Regarding the IWGDF classification, 23 patients were classified as moderate risk (11.50%) and 61 as high risk for developing foot ulcers (30.50%). Using a cutoff of 2.5 on the physical examination score to diagnose neuropathy, a sensitivity of 97.62% and a specificity of 47.41% were obtained. Using a score greater than or equal to 6 in the self-assessment for the diagnosis of neuropathy, a sensitivity of 50.00% and a specificity of 94.83% were found. Conclusion: the association of the Michigan physical examination (high sensitivity) with self-assessment (high specificity) increases the accuracy for the diagnosis of diabetic neuropathy

Introdução: o pé diabético é uma das complicações mais sérias do diabetes mellitus. Cerca de 50% das amputações não traumáticas ocorrem nesses pacientes. Além disso, é um importante problema de saúde pública por ser um distúrbio metabólico crônico e complexo que se caracteriza pelo comprometimento do metabolismo da glicose associada a outras complicações em órgãos essenciais para manutenção vital. Objetivo: avaliar a sensibilidade e especificidade para neuropatia diabética da autoavaliação e do exame físico de Michigan nos diabéticos tipo 1 e tipo 2. Método: trata-se de um estudo transversal. Foi utilizada a classificação "Michigan Neuropathy Screening Instruments" para avaliação do grau de neuropatia periférica, em que os participantes responderam ao questionário e foram avaliados quanto a presença de lesões nos pés. Todos os participantes foram estratificados quanto ao risco de desenvolver úlcera nos pés de acordo com o protocolo do IWGDF. Resultados: a amostra contou com 200 participantes. Quanto à classificação do IWGDF, 23 pacientes foram classificados como risco moderado (11,50%) e 61 como alto risco para o desenvolvimento de úlceras nos pés (30,50%). Utilizando-se um corte de 2,5 na pontuação do exame físico para diagnosticar a neuropatia, foi obtida uma sensibilidade de 97,62% e uma especificidade de 47,41%. Utilizando-se uma pontuação maior ou igual a 6 na autoavaliação para o diagnóstico de neuropatia, foi obtida uma sensibilidade de 50,00% e uma especificidade de 94,83%. Conclusão: a associação do exame físico de Michigan (alta sensibilidade) com a autoavaliação (alta especificidade) tem melhor acurácia para o diagnóstico de neuropatia diabética.

Effect of osteopathic visceral manipulation for individuals with functional constipation and chronic nonspecific low back pain: Randomized controlled trial.

OBJECTIVE: To investigate the effect of osteopathic visceral manipulation (OVM) on disability and pain intensity in individuals with functional constipation and chronic nonspecific low back pain. METHODS: This study is a randomized controlled trial with a blinded assessor. Seventy-six volunteers with functional constipation and chronic nonspecific low back pain were randomized to two groups: OVM and sham OVM. The primary clinical outcome was pain intensity measured using a numeric rating scale (NRS) and disability measured using the Oswestry Disability Index (ODI). The secondary outcomes were electromyographic signals measured during the flexion-extension cycle, the finger-to-floor distance during complete flexion of the trunk and the Fear-Avoidance Beliefs Questionnaire (FABQ). All outcomes were determined after six weeks of treatment as well as three months after randomization. RESULTS: The OVM group reported a reduction in pain intensity after six weeks of treatment and at the three-month evaluation (p < .0002) and the sham group reported a reduction in pain intensity after three-month evaluation (p < .007). For the ODI was also found in the OVM group six weeks after the end of treatment (treatment effect = -6.59, 95% CI: -12.01 to -1.17, p = .01) and at the three-month evaluation (treatment effect = -6.02, 95% CI: -11.55 to -0.49, p = .03). Significant differences were also found for paravertebral muscle activity during the dynamic phases (flexion and extension) six-week evaluations. CONCLUSIONS: The OVM group demonstrated a reduction in pain intensity and improvement in disability after six-weeks and three-month follow-up while the sham group reduction in pain three-month follow-up.

Tomato miR156-targeted SlSBP15 represses shoot branching by modulating hormone dynamics and interacting with GOBLET and BRANCHED1b.

The miRNA156 (miR156)/SQUAMOSA PROMOTER-BINDING PROTEIN-LIKE (SPL/SBP) regulatory hub is highly conserved among phylogenetically distinct species, but how it interconnects multiple pathways to converge to common integrators controlling shoot architecture is still unclear. Here, we demonstrated that the miR156/SlSBP15 node modulates tomato shoot branching by connecting multiple phytohormones with classical genetic pathways regulating both axillary bud development and outgrowth. miR156-overexpressing plants (156-OE) displayed high shoot branching, whereas plants overexpressing a miR156-resistant SlSBP15 allele (rSBP15) showed arrested shoot branching. Importantly, the rSBP15 allele was able to partially restore the wild-type shoot branching phenotype in the 156-OE background. rSBP15 plants have tiny axillary buds, and their activation is dependent on shoot apex-derived auxin transport inhibition. Hormonal measurements revealed that indole-3-acetic acid (IAA) and abscisic acid (ABA) concentrations were lower in 156-OE and higher in rSBP15 axillary buds, respectively. Genetic and molecular data indicated that SlSBP15 regulates axillary bud development and outgrowth by inhibiting auxin transport and GOBLET (GOB) activity, and by interacting with tomato BRANCHED1b (SlBRC1b) to control ABA levels within axillary buds. Collectively, our data provide a new mechanism by which the miR156/SPL/SBP hub regulates shoot branching, and suggest that modulating SlSBP15 activity might have potential applications in shaping tomato shoot architecture.

Adverse effects after vaccination against SARS-CoV-2 (COVID-19) in Down syndrome adults / Efeito adverso pós-vacinação contra a Covid-19 em adultos com síndrome de down

Introduction: Comorbidities in adults with Down syndrome are common making them a risk group for COVID-19. Thus, vaccinating against COVID-19 becomes necessary, but requires care against possible side effects. Objective: To investigate possible adverse effects after vaccination against COVID-19 in adults with Down Syndrome (DS). Methodology: Descriptive study in which ninety-seven adults diagnosed with DS were interviewed using a questionnaire containing seventeen questions related to personal and historical data, and seven questions related to vaccination. Results: The most applied vaccine was AstraZeneca (94%), Pfizer (4%), and CoronaVac (2%); 74% of the subjects had adverse effects, the most frequent after the first dose being pain at the injection site (65.3%), fever (37.9%), muscle pain (37.8%), malaise (29.5%); in the second dose there was a decrease in these adverse effects; 95% of symptoms disappeared after the first 24 hours following application. Conclusion: More than half of the individuals interviewed had adverse effects after the application of the first dose of the vaccine, decreasing with the second dose; the most frequent was pain at the site of application.

Introdução: Comorbidades em adultos com síndrome de Down são comuns tornando-os um grupo de risco para COVID-19. Dessa forma, vacinar contra a COVID-19 torna-se necessária, mas requer cuidados contra possíveis efeitos colaterais. Objetivo: Pesquisar possíveis efeitos adversos após vacinação contra COVID-19 em adultos com Síndrome de Down (SD). Metodologia: Estudo descritivo no qual 97 adultos diagnosticados com SD foram entrevistados por meio de um questionário contendo dezessete questões relacionadas a dados pessoais e histórico, e sete questões relacionadas à vacinação. Resultados: A vacina mais aplicada foi a AstraZeneca (94%), Pfizer (4%) e CoronaVac (2%); 74% dos sujeitos apresentaram efeitos adversos, sendo os mais frequentes após a primeira dose: dor no local da injeção (65,3%), febre (37,9%), dores musculares (37,8%), mal-estar (29,5%); na segunda dose houve diminuição desses efeitos adversos; 95% dos sintomas desapareceram após as primeiras 24 horas após a aplicação. Conclusão: Mais da metade dos indivíduos entrevistados apresentou efeitos adversos após a aplicação da primeira dose da vacina, diminuindo com a segunda dose; a mais frequente foi a dor no local de aplicação.

Influência da inatividade física na capacidade funcional de idosos saudáveis durante a pandemia da Covid-19 / Influence of physical inactivity on the functional capacity of healthy older people during the Covid-19 pandemic

Resumo Introdução: A pandemia da COVID-19 contribuiu para a diminuição das atividades habituais dos idosos, o que pode interferir na capacidade funcional (CF) dos mesmos. Objetivo: Verificar o impacto da inatividade física durante a pandemia da COVID-19 na CF de idosos e associar o nível de atividade física com a CF dos mesmos. Métodos: Participaram do estudo 20 idosos que frequentavam um programa de atividade física antes da pandemia da COVID-19. Foi avaliada a capacidade funcional pelo teste AVD-Glittre, teste de caminhada de 6 minutos (TC6) e Time Up and Go (TUG); os resultados foram comparados com os resultados dos testes obtidos em 2019 (antes da pandemia da COVID-19). Para verificar o nível de atividade física, foi aplicado o Questionário Internacional de Nível de Atividade Física (IPAQ). Os dados foram analisados pelo teste t pareado de Wilcoxon e teste de correlação de Pearson. Resultados: Houve um aumento do tempo da execução do teste de AVD-Glittre de 171.90 ± 35.56 para 272.00 ± 344.77 segundos, no TUG teste de 6.27 ± 119 para 6.92 ± 1.53 segundos, e no TC6 houve uma diminuição de 564.97 ± 85.22 para 464.65 ± 105.95 metros, com p<0.001 em todas as análises. A correlação entre IPAQ e o teste de AVD-Glittre foi fraca (r=0.11, p<0.63), fraca com TC6 (r= -0.10, p>0.001) e moderada com TUG (r=0.59, p>0.001). Conclusão: Houve diminuição da CF dos idosos durante a pandemia da COVID-19, o nível de atividade física influenciou no TUG.

Introduction: The COVID-19 pandemic contributed to a decrease in the usual activities of older adults, which may interfere with their functional capacity (FC). Objective: To verify the impact of physical inactivity during the COVID-19 pandemic on the older adults' FC and associate the level of older adults' physical activity with the FC. Methods: The study included 20 older people who attended a physical activity program before the COVID-19 pandemic. Functional capacity was evaluated by the ADL-Glittre test, 6-minute walk test (6MWT) and Time Up and Go (TUG) test. The tests' results were compared to the tests obtained in 2019 (before the COVID-19 pandemic). The International Physical Activity Level Questionnaire (IPAQ) was applied to verify the physical activity level. Data were analyzed using Wilcoxon's paired t-test and Pearson's correlation test. Results: There was an increase in the execution time of the ADL-Glittre test from 171.90 ± 35.56 to 272.00 ± 344.77 seconds, in the TUG test from 6.27 ± 119 to 6.92 ± 1.53 seconds, and in the 6MWT there was a decrease from 564.97 ± 85.22 to 464.65 ± 105.95 meters, with p<0.001 in all analyses. The correlation between IPAQ and the ADL-Glittre test was weak (r=0.11, p<0.63), weak with 6MWT (r= -0.10, p>0.001) and moderate with TUG (r=0.59, p>0.001). Conclusion: There was a decrease in the FC of older adults during the COVID-19 pandemic; the level of physical activity influenced the TUG.

Associação entre diabetes mellitus e evolução para intubação ou morte para os indivíduos hospitalizados com Covid-19 / Association between diabetes mellitus and evolution to intubation or death for individuals hospitalized with Covid-19

Introdução: Pacientes infectados com COVID-19 parecem manifestar evolução mais grave quando apresentam comorbidades, como a Diabetes Mellitus (DM). No entanto, dados da população brasileira ainda são pouco disponíveis. Objetivo: Analisar a associação entre DM e evolução para intubação e óbito em indivíduos internados com COVID-19. Metodologia: Estudo transversal, observacional, quantitativo com dados dos prontuários de 74 participantes adultos internados no Hospital Professora Lydia Storópoli, com diagnóstico de COVID-19. O Comitê de Ética em Pesquisa Humana aprovou este estudo e os participantes assinaram o termo de consentimento do estudo. Resultados: Dos 74 pacientes, 18 apresentavam DM, dos quais seis evoluíram para intubação e cinco evoluíram para óbito. Não houve associação significativa (p>0,05) entre DM e intubação e óbito. Conclusão: Na presente amostra a DM não foi associada com a evolução clínica para intubação e óbito.

Introduction: Patients infected with COVID-19 seem to manifest a more severe evolution when they have comorbidities, such as Diabetes Mellitus (DM). However, data on the Brazilian population are still scarcely available. Objective: To analyze the association between DM and evolution to intubation and death in individuals hospitalized with COVID-19. Methodology: Cross-sectional, observational, quantitative study with data from the medical records of 74 adult participants admitted to Professora Lydia Storópoli Hospital, diagnosed with COVID-19. The Human Research Ethics Committee approved this study, and participants signed the study consent form. Results: 74 patients with Covid-19, 18 had DM, of which six evolved to intubation, and five evolved to death. There was no significant association (p>0.05) between DM and intubation and death. Conclusion: In the present study, DM was not associated with clinical evolution to intubation and death.

Progressive Platelet Rich Fibrin tissue regeneration matrix: Description of a novel, low cost and effective method for the treatment of chronic diabetic ulcers-Pilot study.

INTRODUCTION: Chronic lower limb ulcers (CLLU) are those injuries that persist for more than six weeks despite adequate care. They are relatively common; it is estimated that 10/1,000 people will develop CLLU in their lifetime. Diabetic ulcer, because of its unique pathophysiology (association between neuropathy, microangiopathy, and immune deficiency), is considered one of the most complex and difficult etiologies of CLLU for treatment. This treatment is complex, costly, and sometimes frustrating, as it is often ineffective, which worsens the quality of life of patients and makes its treatment a challenge. OBJECTIVE: To describe a new method for treating diabetic CLLU and the initial results of using a new autologous tissue regeneration matrix. METHOD: This is a pilot, prospective, an interventional study that used a novel protocol of autologous tissue regeneration matrix for the treatment of diabetic CLLU. RESULTS: Three male cases with a mean age of 54 years were included. A total of six Giant Pro PRF Membrane (GMPro) were used varying their application between one to three sessions during treatment. A total of 11 liquid phase infiltrations were performed varying their application between three and four sessions. The patients were evaluated weekly and a reduction in the wound area and scar retraction was observed during the period studied. CONCLUSION: The new tissue regeneration matrix described is an effective and low-cost method for the treatment of chronic diabetic ulcers.

Translation and cross-cultural adaptation of the Brazilian version of the PM-Scale: A specific measure of participation after stroke.

BACKGROUND: The PM-Scale was developed specifically to assess participation in individuals after stroke based on the concepts contained in the International Classification of Functioning, Disability and Health. However, this measure is only available in English and French. OBJECTIVE: To translate and cross-culturally adapt the PM-Scale to Brazilian Portuguese, followed by the validation and testing of reliability of the translated version. METHODS: The translation process followed standard guidelines. Preliminary test-retest reliability was determined using the intraclass correlation coefficient (ICC2,1). The Rasch model was employed to analyse the validity, unidimensionality, invariance, and internal consistency of the Brazilian version of the PM-Scale. RESULTS: The final translated version of the PM-Scale presented appropriate semantic, idiomatic, cultural, and conceptual equivalence. The preliminary analysis revealed excellent intra-observer and inter-observer reliability (ICC2,1 = 0.91; 95%CI: 0.83, 0.95 and ICC2,1 = 0.81; 95%CI: 0.64, 0.89, respectively). The analysis of the Rasch model revealed only one erratic item. An excellent overall fit was found for items (mean ± SD = 0.01 ± 1.02) and adequate fit was found for persons (mean ± SD = 1.16 ± 0.88). Internal consistency was considered adequate (person separation index = 1.77, reliability = 0.76). No significant invariance was found with regards to the personal characteristics of the sample (p > 0.05). CONCLUSION: The Brazilian version of the PM-Scale is a valid, unidimensional, linear, reliable scale for measuring participation in stroke survivors and can be administered in less than five minutes.