Distribution of cases of congenital heart disease in a hospital in Oeste Paulista / Distribuição dos casos de cardiopatias congênitas em um hospital do Oeste Paulista

The aim of this research was to conduct a comprehensive spatial-temporal analysis of the population affected by congenital heart anomalies assisted at the Pediatric Cardiology Outpatient Department at the distinguished Western Paulista reference hospital. We conducted a retrospective study involving the analysis of electronic database records and patient medical charts for individuals diagnosed with congenital heart disease during the period from July 2013 to July 2018. A total of 298 medical records were selected for the analysis of variables encompassing the ICD-10 codes, gender, spatial distribution, and temporal trends. It was possible to observe that septal defects were the most prevalent congenital heart abnormalities, and there was no gender-based difference. An increase in diagnoses was noted from 2014, coinciding with the implementation of the "heart test," and 51% of the cases were from Presidente Prudente, with a higher concentration of cases in the industrial park area. There is an association between cardiac congenital malformations and an adverse environmental context. The findings can inform public health policies aimed at reducing the exposure of the most vulnerable population in pursuit of improving health indicators (AU).

O objetivo deste trabalho foi analisar a distribuição espaço-temporal dos pacientes com cardiopatias congênitas aten-didos no Ambulatório de Cardiologia Pediátrica do Hospital de referência do Oeste Paulista. Realizamos um estudo retrospectivo com análise de dados de base eletrônica e prontuários dos pacientes diagnosticados com cardiopatia congênita entre os períodos de julho de 2013 a julho de 2018. Foram selecionados 298 prontuários para análise das variáveis de CID-10, gênero, distribuição espacial e série temporal. Foi possível observar que os defeitos septais foram as cardiopatias mais prevalentes, não houve diferença entre os gêneros. Notou-se aumento do diagnóstico a partir de 2014, com implementação do teste do coraçãozinho e 51% dos casos eram da cidade de Presidente Prudente, com maior concentração de casos na região do parque industrial. Há uma relação na incidência das malformações cardíacas com o meio ambiente desfavorável. Os resultados encontrados podem guiar políticas de saúde pública, visando reduzir a exposição da população mais vulnerável, na busca da melhora nos índices de saúde (AU).

Chronic consumption of contaminated feed with 2 4 dichlorophenoxyacetic acid (2 4 D) herbicide in rodents: effects on male reproductive health / Consumo crônico de ração contaminada com herbicida ácido 2 4 di clorofenoxiacético (2 4 D) em roedores: efeitos na saúde reprodutiva masculina

Introduction: The herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) is one of the most widely used pesticides in the world. There is evidence that this herbicide can induce deleterious effects in non-target organisms, including impairment of reproduction function. Objective: The aim of this study was to evaluate the reproductive effects of the chronic consumption of contaminated feed with 2,4-D in rats using food environmental spraying simulation. Methods: Animals orally exposed received nebulized chow with 2,4-D solution in different concentrations for 180 days: 0 (control - CG), 20.69 (LCG), 34.63 (MCG), or 51.66 ppm day−1 (HCG). Results: Sperm quality was impaired to 2,4-D. The percentage of sperm with progressive movement, number of sperm in the testis and daily sperm production were decreased in all exposed groups to the herbicide compared to CG. Sperm counts in the caput/corpus and cauda epididymis were reduced in MCG and HCG, and sperm transit time was delayed in the epididymis of LCG. There was a negative impact on sperm morphology and plasma membrane integrity in MCG and HCG, respectively. Germ cell exfoliation within the lumen of the seminiferous tubules and epithelial vacuolization in epididymis were found in the HCG. Conclusion: This is the first study to describe the negative impact on male reproductive morphophysiology after chronic exposure to 2,4-D using food nebulization in environmentally relevant concentrations, based on agronomic use of the herbicide. The reproductive injuries identified raise concerns about the impacts of wide population exposure to 2,4-D (AU).

Introdução: O herbicida 2,4- ácido diclorofenoxiacético (2,4-D) é um dos agrotóxicos mais utilizados no mundo. Há evidências de que este herbicida pode induzir efeitos deletérios em organismos não-alvo, incluindo prejuízo na função reprodutiva. Objetivo: O objetivo deste estudo foi avaliar os efeitos reprodutivos do consumo crônico de ração contaminada com 2,4-D em ratos, utilizando simulação de pulverização ambiental de alimentos. Métodos: Animais expostos oralmente receberam ração nebulizada com solução de 2,4-D em diferentes concentrações por 180 dias: 0 (controle - GC), 20,69 (LCG), 34,63 (MCG) ou 51,66 ppm dia−1 (HCG). Resultados: A qualidade espermática foi prejudicada pelo 2,4-D. A porcentagem de espermatozoides com movimento progressivo, número de espermatozoides no testículo e produção diária de espermatozoides foram menores em todos os grupos expostos ao herbicida, quando comparados ao GC. A contagem de espermatozoides na cabeça/corpo e cauda do epidídimo foi reduzida em MCG e HCG, e o tempo de trânsito espermático atrasou no epidídimo em LCG. Houve impacto negativo na morfologia espermática e na integridade da membrana plasmática em MCG e HCG, respectivamente. Esfoliação de células germinativas no lúmen dos túbulos seminíferos e vacuolização epitelial no epidídimo foram encontradas em HCG. Conclusão: Este é o primeiro estudo a descrever o impacto negativo na morfofisiologia reprodutiva masculina após exposição crônica ao 2,4-D, utilizando nebulização de alimentos em concentrações ambientalmente relevantes, com base no uso agronômico do herbicida. As lesões reprodutivas identificadas levantam preocupações sobre os impactos da ampla exposição da população ao 2,4-D (AU).

Allergic sensitization and exposure to ambient air pollution beginning early in life lead to a COPD-like phenotype in young adult mice.

The perinatal period and early infancy are considered critical periods for lung development. During this period, adversities such as environmental exposures, allergic sensitization, and asthma are believed to impact lung health in adulthood. Therefore, we hypothesized that concomitant exposure to allergic sensitization and urban-derived fine particulate matter (PM2.5) in the early postnatal period of mice would cause more profound alterations in lung alveolarization and growth and differently modulate lung inflammation and gene expression than either insult alone in adult life. BALB/c mice were sensitized with ovalbumin (OVA) and exposed to PM2.5 from the fifth day of life. Then, we assessed lung responsiveness, inflammation in BALF, lung tissue, and alveolarization by stereology. In addition, we performed a transcriptomic analysis of lung tissue on the 40th day of life. Our results showed that young adult mice submitted to allergic sensitization and exposure to ambient PM2.5 since early life presented decreased lung growth with impaired alveolarization, a mixed neutrophilic-eosinophilic pattern of lung inflammation, increased airway responsiveness, and increased expression of genes linked to neutrophil recruitment when compared to animals that were OVA-sensitized or PM2.5 exposed only. Both, early life allergic sensitization and PM2.5 exposure, induced inflammation and impaired lung growth, but concomitant exposure was associated with worsened inflammation parameters and caused alveolar enlargement. Our experimental data provide pathological support for the hypothesis that allergic or environmental insults in early life have permanent adverse consequences for lung growth. In addition, combined insults were associated with the development of a COPD-like phenotype in young adult mice. Together with our data, current evidence points to the urgent need for healthier environments with fewer childhood disadvantage factors during the critical windows of lung development and growth.

Digital image processing: a useful tool in the analysis of lung injuries caused by chronic inhalation of agricultural herbicides.

The herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) is widely used in agriculture to control various weeds. The objective of this study was to use the digital image processing method to identify alveolar lesions in the lungs of rats submitted to chronic 2,4-dichlorophenoxyacetic acid (2,4-D) inhalation exposure. We used forty adult male Wistar rats. The rats were divided into four groups: control group (CG), low concentration group (LCG), medium concentration group (MCG), and high concentration group (HCG). In a 6-month exposure period, we used two boxes connected to ultrasonic nebulizers for herbicide spraying. After this period, the rats were euthanized for the collection and study of lung tissue. For each image, counts of injuries and blisters were performed automatically using a methodology based on digital image processing techniques. For analysis of the results, an electronic database (Excel®) was created. We used the Pearson method for correlation analysis; values of p <0.05 were considered significant. In the evaluation of healthy alveoli, we recorded positive and significant correlations between analysis from a pathologist and computational analysis. In the evaluation of injured alveoli, we recorded a positive but non-significant correlation between analysis from a pathologist and computational analysis. These results show the effectiveness of digital image processing when evaluating alveolar integrity.

Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature.

Acute viral respiratory infections are the main infectious disease in the world. In 2020, a new disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), coronavirus disease 2019 (COVID-19), became a global pandemic. The immune response to the virus depends on factors such as genetics, age and physical state, and its main input receptor is the angiotensin-converting enzyme 2. The practice of physical exercises acts as a modulator of the immune system. During and after physical exercise, pro- and anti-inflammatory cytokines are released, lymphocyte circulation increases, as well as cell recruitment. Such practice has an effect on the lower incidence, intensity of symptoms and mortality in viral infections observed in people who practice physical activity regularly, and its correct execution must be considered to avoid damage. The initial response is given mainly by type I interferons (IFN-I), which drive the action macrophages and lymphocytes, followed by lymphocyte action. A suppression of the IFN-I response has been noted in COVID-19. Severe conditions have been associated with storms of pro-inflammatory cytokines and lymphopenia, as well as circulatory changes and virus dispersion to other organs. The practice of physical activities strengthens the immune system, suggesting a benefit in the response to viral communicable diseases. Thus, regular practice of adequate intensity is suggested as an auxiliary tool in strengthening and preparing the immune system for COVID-19. Further studies are needed to associate physical exercise with SARS-CoV-2 infection.

Evaluation of genotoxicity after acute and chronic exposure to 2,4-dichlorophenoxyacetic acid herbicide (2,4-D) in rodents using machine learning algorithms.

2,4-Dichlorophenoxyacetic acid (2,4-D) is one of the most widely used herbicides in the world, but its mutagenic and carcinogenic potential is still controversial. We simulated environmental exposure to 2,4-D, with the objective of evaluating the genotoxic effect of acute and chronic exposure to 2,4-D in rodents. We also evaluated the performance of machine learning algorithms in detecting differences in exposure groups through recognition performed from genotoxic characteristics. In the acute phase, 88 Swiss mice were used, distributed in five groups and exposed to nebulizations at different time intervals (24, 48, 72 and 192 hr). In the chronic phase, 88 Wistar rats were used, distributed in two groups (inhaled and oral) and exposed for six months. Femoral bone marrow cells were collected for a micronucleus test and comet assay. Data were evaluated by pattern recognition algorithms. In acute exposure, medium and high concentrations induced DNA damage in the comet assay, but these concentrations did not increase micronucleated cells. In the chronic exposure, there was an increase in micronuclei and DNA damage in the comet assay in all exposed groups regardless of the exposure route. The data showed a robust pattern of distinction between exposed and nonexposed groups to 2,4-D. Our data showed that both acute inhalation exposure and chronic oral and inhalation exposure to 2,4-D can cause genotoxic effects regardless of concentration. Machine learning showed a clear distinction between the control groups and those exposed to 2,4-D, and the effects of exposure are not concentration-dependent.

O uso da tecnologia no ensino da anatomia humana: revisão sistemática da literatura de 2017 a 2020 / The use of technology in human anatomy teaching: a systematic review of the literature from 2017 to 2020

RESUMO: A tecnologia destaca-se como agente de avanço, principalmente na área da saúde. O estudo da anatomia humana nos cursos de medicina permanece tradicionalista com palestras teóricas e dissecção de cadáveres, por isso, metodologias tecnológicas parecem auxiliar o ensino, tornando-o interativo. Assim, o objetivo do estudo é analisar as perspectivas do uso de tecnologias no ensino da anatomia humana para inseri-las na graduação em medicina. Realizou-se uma revisão sistemática da literatura abrangendo artigos publicados entre janeiro de 2017 a março de 2020 nas bases de dados eletrônicas PubMed e Science Direct. Elencaram-se três critérios de inclusão: estudos com estudantes de medicina ou direcionado aos estudantes de medicina, estudos com residentes de medicina e estudos que avaliam o uso do desenvolvimento tecnológico no ensino da anatomia humana; e três de exclusão: estudos com animais, estudos com estudantes de outros cursos da área da saúde e estudos envolvendo área ou técnica cirúrgica específica. Onze artigos foram lidos na íntegra. Como resultado smartphones, código de resposta rápida (QR), realidade virtual (VR), modalidades impressas tridimensionais (3DP), próteses em 3D e outras tecnologias beneficiaram os alunos no aprendizado anatômico, os quais relataram instrumento atraente, de fácil manejo e acessível mesmo distante do laboratório. Além disso, demonstrou-se maior interesse dos acadêmicos em associar métodos tradicio-nais com as novas tecnologias. As tecnologias se mostraram eficazes no ensino da anatomia humana, visto que a maior parte dos estudos comprovou seu potencial enriquecedor nas avaliações que atingiram resultados iguais e melhores do que o ensino com as práticas tradicionais. (AU)

ABSTRACT: Technology stands out as an advancing agent, especially in the area of health. The study of human anatomy in medical courses remains traditionalist with theoretical lectures and dissection of cadavers, so technological methodologies seem to assist the teaching, making it interactive. Thus, the objective of the study is to analyze the per-spectives of the use of technologies in the teaching of the human anatomy to insert them in undergraduate medical courses. A systematic review of the literature was carried out covering papers published between January 2017 and March 2020 in the electronic databases PubMed and Science Direct. Three inclusion criteria were listed: studies with medical students or targeted to medical students, studies with medical residents, and studies that evaluate the use of technological development in the teaching of human anatomy; and three exclusion criteria: studies with animals, studies with students from other health courses, and studies involving specific surgical area or technique. Eleven papers were read in full. As a result, smartphones, rapid response code (QR), virtual reality (VR), three-dimensional printed modalities (3DP), 3D prostheses, and other technologies benefited the students in anatomical learning, who reported an attractive instrument, easy to handle, and accessible even far from the laboratory. Technologies have proven to be effective in teaching human anatomy, given that most studies have proven their enriching potential in assessments that have achieved similar and better results than teaching with traditional practices. (AU)

Correction to: Structural alterations and markers of endothelial activation in pulmonary and bronchial arteries in fatal asthma.

[This corrects the article DOI: 10.1186/s13223-019-0363-0.].

Evaluation of buccal damage associated with acute inhalation exposure to 2,4-dichlorophenoxyacetic acid (2,4-D) in mice.

BACKGROUND: The herbicide dichlorophenoxyacetic acid (2,4-D) is one of the most widely used crop spraying products in the world. Some pesticides induce the degranulation of mast cells and increase allergic responses. This is the first study to evaluate the damage to the oral mucosa after an experimental simulation of environmental inhalation exposure to the 2,4-D herbicide. The aim of this study was evaluate the possible oral damage caused by acute inhalation exposure to the herbicide 2,4-D. RESULTS: There was a difference between the exposure concentrations in relation to tissue congestion intensity (p = 0.002) and mast cell counts (p = 0.002), a difference in the evaluation of the interaction between the exposure concentrations and nebulization time in the dorsum epithelium thickness (p = 0.013), and a significant correlation between the epithelial thickness and the number of nucleoli organizing regions on the dorsum of the tongue (p = 0.048). CONCLUSIONS: Even after acute exposure, the herbicide 2,4-D had the potential to damage the oral epithelium, especially at higher doses.

Structural alterations and markers of endothelial activation in pulmonary and bronchial arteries in fatal asthma.

BACKGROUND: There is interest in better understanding vessel pathology in asthma, given the findings of loss of peripheral vasculature associated with disease severity by imaging and altered markers of endothelial activation. To date, vascular changes in asthma have been described mainly at the submucosal capillary level of the bronchial microcirculation, with sparse information available on the pathology of bronchial and pulmonary arteries. The aim of this study was to describe structural and endothelial activation markers in bronchial arteries (BAs) and pulmonary arteries (PAs) of asthma patients who died during a fatal asthma attack. METHODS: Autopsy lung tissue was obtained from 21 smoking and non-smoking patients who died of an asthma attack and nine non-smoking control patients. Verhoeff-Masson trichrome staining was used to analyse the structure of arteries. Using immuno-histochemistry and image analyses, we quantified extracellular matrix (ECM) components (collagen I, collagen III, versican, tenascin, fibronectin, elastic fibres), adhesion molecules [vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1)] and markers of vascular tone/dysfunction [endothelin-1 (ET-1) and angiotensin II type 2 receptor (AT2)] in PAs and BAs. RESULTS: There were no significant differences in ECM components, ICAM-1, ET-1 or AT2 between asthma patients and controls. Smoking asthma patients presented with decreased content of collagen III in both BA (p = 0.046) and PA (p = 0.010) walls compared to non-smoking asthma patients. Asthma patients had increased VCAM-1 content in the BA wall (p = 0.026) but not in the PA wall. CONCLUSION: Our data suggest that the mechanisms linking asthma and arterial functional abnormalities might involve systemic rather than local mediators. Loss of collagen III in the PA was observed in smoking asthma patients, and this was compatible with the degradative environment induced by cigarette smoking. Our data also reinforce the idea that the mechanisms of leukocyte efflux via adhesion molecules differ between bronchial and pulmonary circulation, which might be relevant to understanding and treating the distal lung in asthma.

Environmental photochemical fate and UVC degradation of sodium levothyroxine in aqueous medium.

The synthetic hormone sodium levothyroxine (LTX) is one of the most prescribed drugs in the world and the most effective in hypothyroidism treatment. The presence of LTX in the environment has become a matter of major concern due to the widespread use of this hormone and by the fact that it is only partially removed in conventional water and sewage treatment plants. However, information regarding the photochemical fate of this hormone in environmental or engineered systems is scarce in the literature. In this work, the sunlight-driven direct and indirect LTX degradation was investigated by determining the photolysis quantum yield, ΦLTX = 3.80 (± 0.02) × 10-5, as well as the second-order kinetic constants of the reactions with hydroxyl radicals, kLTX,•OH = 1.50 (± 0.01) × 1010 L mol-1 s-1 and singlet oxygen, kLTX,1O2 = 1.47 (± 0.66) × 108 L mol-1 s-1. Mathematical simulations indicate that LTX photodegradation is favored in shallow, nitrite-rich, and dissolved organic matter (DOM)-poor environments, with LTX half-life times varying from less than 10 days to about 80 days. LTX removals of 85 and 95% were achieved by UVC photolysis and UVC/H2O2 after 120 min, respectively. Three transformation products, triiodothyronine, diiodothyronine, and diiodotyrosine, were identified during LTX degradation by the UVC-based processes studied. The results herein regarding photo-induced kinetics coupled with environmental fate simulations may help evaluate LTX persistence and also the design of water and wastewater treatment processes.

Entomological surveillance of Zika virus in Sardinia, Italy, 2016.

Zika Virus (ZIKV) is a RNA virus belonging to the genus Flavivirus, family Flaviviridae. This virus is transmitted through bite of Aedes mosquitoes, in particular Ae. aegypti. On February 1st 2016, the World Health Organization (WHO) has declared ZIKV a Public Health Emergency of International Concern. Successively, considering the establishment of Ae. albopictus, WHO has classified Italy as having a moderate likelihood of local transmission of ZIKV, preceded in Europe only by France. For this reason an entomological surveillance plan was been activated in Sardinia in 2016. BG Sentinel Mosquito Traps have been positioned in 29 sites, comprising urban areas and points of entry, as ports and airports. Mosquitoes were collected fortnightly from April to December. A total of 3,089 mosquitoes were collected belonging to 10 species. The most numerous species have been Cx. pipiens s.l. and Ae. albopictus. All mosquitoes sampled have been assayed by real time reverse transcriptase PCR for detection of ZIKV RNA. A total of 584 pool have been analyzed and have been reported no evidence of ZIKV. A permanent entomological surveillance should be implemented principally in the urban areas and points of entry, as ports and airports, because Ae. albopictus, susceptible to ZIKV, is established in Sardinia and also know the recent introduction of invasive mosquitoes species Ae. koericus and Ae. japonicus in Italy.

Impact of obesity on autonomic modulation, heart rate and blood pressure in obese young people.

INTRODUCTION: Obesity can be understood as a comorbidity of increasing systemic impact, including a deficit in the autonomic nervous system. OBJECTIVE: To analyze cardiac autonomic behavior and hemodynamic parameters in obese young people. METHODS: 92 individuals (20.58±1.48 years) were evaluated, divided into two groups: obese and eutrophic. Heart rate (HR) was captured for 30 min in the supine position whilst breathing spontaneously. Blood pressure (BP) values were obtained prior to performance of the protocol. For the autonomic analysis, 1000 beats were used for the calculation of heart rate variability indices in the time (Mean RR, SDNN and RMSSD) and frequency (LF, HF and LF/HF) domains, in addition to the Poincaré plot (SD1, SD2, SD1/SD2 and qualitative visual analysis). RESULTS: The obese group presented higher baseline BP and HR values compared to the eutrophic. Regarding autonomic modulation a significant decrease was observed in the RMSSD; SD1, HFms and HFnu indices in the obese group, indicating a decrease in vagal activity and reduced SDNN and SD2 rates, with statistical significance for the former, suggesting a reduction in overall variability. The high value of the LFnu index and decrease in Mean RR in the obese group pointed to relative sympathetic predominance in these individuals. The visual analysis of the Poincaré plot showed less dispersion of the points in the obese group. CONCLUSION: The obese group presented higher BP and HR values at rest and autonomic impairment, characterized by a reduction in parasympathetic activity and relative predominance of sympathetic activity.

Effect of pursed-lip breathing in patients with COPD: Linear and nonlinear analysis of cardiac autonomic modulation.

OBJECTIVE: The aim of the present study was to evaluate the effect of pursed-lip breathing (PLB) on cardiac autonomic modulation in individuals with chronic obstructive pulmonary disease (COPD) while at rest. METHODS: Thirty-two individuals were allocated to one of two groups: COPD (n = 17; 67.29 ± 6.87 years of age) and control (n = 15; 63.2 ± 7.96 years of age). The groups were submitted to a two-stage experimental protocol. The first stage consisted of the characterization of the sample and spirometry. The second stage comprised the analysis of cardiac autonomic modulation through the recording of R-R intervals. This analysis was performed using both nonlinear and linear heart rate variability (HRV). In the statistical analysis, the level of significance was set to 5% (p ≤ 0.05). RESULTS: PLB promoted significant increases in the SD1, SD2, RMSSD and LF (ms(2)) indices as well as an increase in α1 and a reduction in α2 in the COPD group. A greater dispersion of points on the Poincaré plots was also observed. The magnitude of the changes produced by PLB differed between groups. CONCLUSION: PLB led to a loss of fractal correlation properties of heart rate in the direction of linearity in patients with COPD as well as an increase in vagal activity and impact on the spectral analysis. The difference in the magnitude of the changes produced by PLB between groups may be related to the presence of the disease and alterations in the respiration rate.

Sports injuries and their risk factors in adolescents who practice swimming

INTRODUCTION: swimming is a popular sport among adolescents; however, your practice can lead to injuries. OBJECTIVES: to characterize the sport injuries and associate them with risk factors in teenage swimmers from different levels of competitiveness. METHODS: 251 swimmers were interviewed, it an average age of 12.43±2.10, both sexes, recruited randomly and they were classified into three competitive levels: initiation, development, and training category. It was used the morbidity survey adapted to the characteristics of swimming as collection instrument containing personal and training of volunteers data, as age, anthropometric variables and training variables and information relating to injuries sustained during a period of 12 months. All findings were described at the 5% significance level. RESULTS: It was verified that there is an association between the presence and absence of injury with the variable height and variable time. The causal mechanism most common was the non-contact mechanism for the categories of initiation and training. The most affected anatomical site was the lower limb and upper limb for all competitive levels. The mild severity, the training time and the absence of recurrence predominated. The asymptomatic return was more frequent for initiation, whereas the symptomatic return prevailed in the training category. CONCLUSION: the injury rate in teenage swimmers was low. The variables height and training time were associated with the occurrence of injuries. The characteristics of the injuries depended on the competitive level of the swimmers...(AU)

INTRODUÇÃO: a natação é uma modalidade popular entre os adolescentes, no entanto, sua prática pode conduzir às lesões. OBJETIVOS: caracterizar as lesões desportivas e associá-las com fatores de risco em adolescentes praticantes de natação de diferentes níveis de competitividade. MÉTODO: foram entrevistados 251 nadadores, com média de idade de 12,43±2,10 anos, ambos os sexos, recrutados ao acaso, classificadas em três níveis competitivos: categoria de iniciação, aperfeiçoamento e treinamento. Foi utilizado o inquérito de morbidade referida adaptado com as características da natação como instrumento de coleta que continha informações pessoais e de treinamento dos voluntários, como: idade, variáveis antropométricas e variáveis de treinamento e informações referentes às lesões ocorridas durante 12 meses. Todas as conclusões foram descritas no nível de 5% de significância. RESULTADOS: Foram observadas 0,11 lesões por atleta e 1,03 lesões por atleta lesionado. Foi constatada associação entre presença e ausência de lesão com a variável estatura e tempo de treinamento. O mecanismo causal mais frequente foi o sem contato para as categorias de iniciação e treinamento. Os locais anatômicos mais acometidos foram os MMII e MMSS para todos os níveis de competitividade, assim como a gravidade leve, o treinamento e a ausência de recidiva predominaram. O retorno assintomático foi mais frequente para a iniciação, enquanto que o retorno sintomático prevaleceu na categoria de treinamento. CONCLUSÃO: a taxa de lesão nos adolescentes nadadores foi baixa. As variáveis estatura e tempo de treinamento foram associadas à ocorrência dos agravos. As características das lesões dependeram do nível de competitividade dos nadadores...(AU)

Sports injuries and their risk factors in adolescents who practice swimming

INTRODUCTION: swimming is a popular sport among adolescents; however, your practice can lead to injuries. OBJECTIVES: to characterize the sport injuries and associate them with risk factors in teenage swimmers from different levels of competitiveness. METHODS: 251 swimmers were interviewed, it an average age of 12.43±2.10, both sexes, recruited randomly and they were classified into three competitive levels: initiation, development, and training category. It was used the morbidity survey adapted to the characteristics of swimming as collection instrument containing personal and training of volunteers data, as age, anthropometric variables and training variables and information relating to injuries sustained during a period of 12 months. All findings were described at the 5% significance level. RESULTS: It was verified that there is an association between the presence and absence of injury with the variable height and variable time. The causal mechanism most common was the non-contact mechanism for the categories of initiation and training. The most affected anatomical site was the lower limb and upper limb for all competitive levels. The mild severity, the training time and the absence of recurrence predominated. The asymptomatic return was more frequent for initiation, whereas the symptomatic return prevailed in the training category. CONCLUSION: the injury rate in teenage swimmers was low. The variables height and training time were associated with the occurrence of injuries. The characteristics of the injuries depended on the competitive level of the swimmers...

INTRODUÇÃO: a natação é uma modalidade popular entre os adolescentes, no entanto, sua prática pode conduzir às lesões. OBJETIVOS: caracterizar as lesões desportivas e associá-las com fatores de risco em adolescentes praticantes de natação de diferentes níveis de competitividade. MÉTODO: foram entrevistados 251 nadadores, com média de idade de 12,43±2,10 anos, ambos os sexos, recrutados ao acaso, classificadas em três níveis competitivos: categoria de iniciação, aperfeiçoamento e treinamento. Foi utilizado o inquérito de morbidade referida adaptado com as características da natação como instrumento de coleta que continha informações pessoais e de treinamento dos voluntários, como: idade, variáveis antropométricas e variáveis de treinamento e informações referentes às lesões ocorridas durante 12 meses. Todas as conclusões foram descritas no nível de 5% de significância. RESULTADOS: Foram observadas 0,11 lesões por atleta e 1,03 lesões por atleta lesionado. Foi constatada associação entre presença e ausência de lesão com a variável estatura e tempo de treinamento. O mecanismo causal mais frequente foi o sem contato para as categorias de iniciação e treinamento. Os locais anatômicos mais acometidos foram os MMII e MMSS para todos os níveis de competitividade, assim como a gravidade leve, o treinamento e a ausência de recidiva predominaram. O retorno assintomático foi mais frequente para a iniciação, enquanto que o retorno sintomático prevaleceu na categoria de treinamento. CONCLUSÃO: a taxa de lesão nos adolescentes nadadores foi baixa. As variáveis estatura e tempo de treinamento foram associadas à ocorrência dos agravos. As características das lesões dependeram do nível de competitividade dos nadadores...

Associação entre atividade física e fatores de risco cardiovasculares em indivíduos de um programa de reabilitação cardíaca / Association between physical activity and cardiovascular risk factors in individuals undergoing cardiac rehabilitation program

INTRODUÇÃO: A prática de atividade física (AF) apresenta relação inversa com fatores de risco (FR) de doenças cardiovasculares, com efeitos positivos na qualidade de vida e em outras variáveis físicas e psicológicas. Contudo, não estão estabelecidos os benefícios das atividades cotidianas. OBJETIVO: Investigar a prevalência e a associação entre dos fatores de risco cardiovasculares e diversas categorias de atividade física de pacientes de um programa de reabilitação cardíaca. MÉTODOS: Avaliou-se 69 participantes e foram verificados peso, altura e pressão arterial. Logo após, os pacientes responderam aos questionários autorreferidos para avaliar o nível de atividade física, nível de estresse e verificar a presença dos FR. Utilizou-se regressão logística para estimar a razão de chance. RESULTADOS: Encontrou-se alta prevalência de FR nos indivíduos, sendo idade e hipertensão arterial mais prevalentes, enquanto tabagismo e estresse apresentaram menor prevalência. A maioria foi classificada como sedentária, exceto para AF de locomoção (AFL). CONCLUSÃO: Há alta prevalência de FR em pacientes que frequentam programas de reabilitação cardíaca e os sedentários possuem maior chance de apresentarem os FR hipertensão arterial, obesidade, tabagismo, álcool e estresse que os ativos, dependendo da categoria de AF.

INTRODUCTION: Physical activity (PA) practice presents an inverse relation with risk factors (RF) of cardiovascular disease, with positive effects in quality of life and other physical and psychological variables. However, the benefits of daily activities have not been established. OBJECTIVE: To investigate the prevalence and association of cardiovascular risk factors and physical activity in different categories of patients under a cardiac rehabilitation program. METHODS: 69 participants of a cardiac rehabilitation program were evaluted and weigth, heigth and blood pressure were checked. Afterwards, the patients answered questionnaires to assess self-reported physical activity level, stress level and verify the presence of RF. Logistic regression ws used to estimate odds ratio. RESULTS: High prevalence of RF was found in the subjects, age and hypertension were more prevalent while smoking and stress had lower prevalence. Most individuals were classified as sedentary, except for locomotion PA (LPA). CONCLUSION: That there is high prevalence of RF in patients attending cardiac rehabilitation programs, while sedentary ones are more likely to have the RF hypertension, obesity, smoking, alcohol and stress than the active ones, depending on the PA category.

Caracterização das categorias de atividade física e associação com variáveis antropométricas de funcionários universitários / Characterization of physical activity categories and association with anthropometric variables of university employees

Os efeitos da atividade física (AF) representam uma proteção para o sistema cardiovascular e podem estar associadas às medidas antropométricas. Assim, o objetivo do estudo foi caracterizar as categorias de AF de funcionários de uma Universidade e comparar e associar com as variáveis antropométricas. Avaliou-se 311 funcionários divididos em três grupos: docente (n = 136), técnico-administrativo (tec/adm) (n = 110) e operacional (n = 65). Os mesmos foram visitados no próprio local de trabalho e coletou-se o peso, a altura e a circunferência abdominal. As categorias de AF foram avaliadas pelo inventário de Baecke aplicado em forma de entrevista. A comparação das categorias de AF e das variáveis antropométricas entre os grupos de funcionários foi realizada por meio de análise de variância (ANOVA ONE-WAY) seguida da aplicação do teste de Tukey para dados com distribuição normal ou teste de Kruskal-Wallys seguido da aplicação do teste de Dunn para dados com distribuição não normal. Para análise da chance dos grupos ativo e sedentário apresentarem obesidade e risco cardiovascular foi utilizado o teste de Odds Ratio com intervalo de confiança de 95%. Os resultados mostram que o grupo docente apresentou menores escores para AF ocupacional (2,20 ± 0,44; p = 0,0042) e de locomoção (2,10 ± 0,54; p = 0,0761), enquanto o grupo tec/adm para AF total (6,35 ± 1,58; p = 0,0012) e operacional para AF de tempo livre (2,03 ± 0,95; p = 0,0111). Encontraram-se maiores valores antropométricos para o grupo operacional (índice massa corporal: p = 0,0045; circunferência abdominal: p = 0,0111) e não houve associação entre os níveis de AF e as variáveis antropométricas (p > 0,05). Assim, conclui-se que existe diferença entre categorias de AF e variáveis antropométricas dos grupos estudados. Não houve associação significante entre as variáveis, porém os sedentários apresentaram mais chance de serem obesos e terem risco cardiovascular aumentado.

The effects of physical activity (PA) represent a protection for the cardiovascular system and may be associated with anthropometric measurements. The aim of this study was to characterize the categories of PA of employees from a university and compare and associate these categories with anthropometric variables. We evaluated 311 employees and divided them into three groups: teachers (n =136), technical / administrative (tce / adm) (n = 110) and operational group (n = 65). They were visited in the workplace and collected the weight, height and waist circumference. The categories of PA were assessed by inventory Baecke applied as an interview. The comparison of categories of PA with anthropometric variables between employee’s groups was performed by variance’s analysis (ANOVA ONE-WAY) followed by the Tukey test for normally distributed data or Kruskal-Wallys followed the Dunn test for non-normally distributed data. To analyze the chance of active and sedentary groups to present obesity and cardiovascular risk the test odds ratio was used with a confidence interval of 95%. The results showed that the teachers group had lower scores for occupational PA (2.20 ± 0.44, p = 0.0042) and transport (2.10 ± 0.54, p = 0.0761), while the tec / adm group had total physical activity (6.35 ± 1.58, p = 0.0012) and operational PA free time (2.03 ± 0.95, p = 0.0111). It were observed higher values of anthropometric variables for operational group (body mass index: p = 0.0045; abdominal circumference: p = 0.0111) and there was no association between PA levels and anthropometric variables (p> 0.05). Therefore, in conclusion there are differences between categories of PA and anthropometric variables for the studied groups. There was no significant association between the anthropometric variables, but sedentary people had more chance to being obese and having increased cardiovascular risk.

A respiração frenolabial na doença pulmonar obstrutiva crônica: revisão da literatura / Pursed-lip breathing in chronic obstructive pulmonary disease: a literature review

Esta revisão teve por objetivo destacar os principais achados publicados nos últimos dez anos sobre os efeitos da respiração frenolabial (RFL) em pacientes com doença pulmonar obstrutiva crônica (DPOC). A busca dos artigos foi realizada nas bases de dados Lilacs, IBECS, MEDLINE e SciELO, por meio dos seguintes descritores da área da saúde (DeCS): doença pulmonar obstrutiva crônica, reabilitação, respiração, hiperinsuflação e dispneia, e suas respectivas versões na língua inglesa (MeSH), além do termo pursed-lip breathing. Após a eliminação dos títulos repetidos, foram selecionados somente os estudos que abordavam a RFL como tema principal, resultando em 12 artigos científicos, 10 ensaios clínicos e 2 revisões bibliográficas. Segundo os achados, a RFL proporciona: alterações sobre a gasometria arterial, caracterizada pelo aumento da saturação e pressão parcial de oxigênio; padrão ventilatório, com diminuição da frequência respiratória e aumento de tempo expiratório e do volume corrente; mecânica ventilatória, por meio do recrutamento de musculatura abdominal expiratória e dos músculos da caixa torácica e acessórios da inspiração; diminuição no consumo de oxigênio; alterações na modulação autonômica cardíaca induzida pelo aumento da atividade parassimpática e, por fim, melhora na qualidade de vida destes pacientes. A RFL é considerada uma manobra de grande importância, por repercutir de forma positiva em diversos sistemas e sobre a qualidade de vida de pacientes portadores da DPOC.

This review aimed at standing out the main findings published in the last ten years on the effects of pursed-lip breathing (PLB) in patients with chronic obstructive pulmonary disease (COPD). The search for articles was performed in Lilacs, IBECS, MEDLINE, and SciELO database by using the descriptors of health (DeCS): doença pulmonar obstrutiva crônica, reabilitação, respiração, hiperinsuflação e dispneia, and their respective versions in the English language (MeSH), the term pursed-lip breathing was also in such list. After removing the repeated titles, only studies addressing PLB as the main theme were selected, resulting in 12 papers, 10 clinical trials, and 2 systematic reviews. According to the findings, the PLB provides: changes on arterial gases, which are characterized by increased oxygen saturation and partial pressure of oxygen; ventilatory pattern with decreased respiratory rate and increased expiratory time and tidal volume; respiratory mechanics, by recruiting the expiratory abdominal muscles and muscles of the rib cage and accessories inspired; decrease in oxygen consumption; alterations in cardiac autonomic modulation induced by increase in parasympathetic activity and, ultimately, improved quality of life of these patients. The PLB is considered a maneuver of great importance to have a positive effect on various systems and on the quality of life of patients with COPD.

Hydatidiform mole resulting from sexual violence.

BACKGROUND: Hydatidiform mole (HM) is characterized by abnormal proliferation of human trophoblast with producers functioning tissues of human chorionic gonadotropin. It can evolve with ovarian cysts tecaluteínicos, hypertension of pregnancy or hyperthyroidism. The incidence of HM is variable and its etiology poorly known, associated with nutritional factors, environmental, age, parity, history of HM, oral contraceptives, smoking, consanguinity or defects in germ cells. There is no reference in literature on HM resulting from sexual violence, objective of this report. METHOD: Description of two cases of HM among 1146 patients with pregnancy resulting from sexual violence treated at Hospital Pérola Byington, São Paulo, from July 1994 to August 2011. RESULTS: The cases affected young, white, unmarried, low educated and low parity women. Sexual violence was perpetrated by known offenders unrelated to the victims, under death threat. Ultrasound and CT of the pelvis showed bulky uterus compatible with HM without myometrial invasion. One case was associated with theca lutein cysts. The two cases were diagnosed in the second trimester of pregnancy and evolved with hyperthyroidism. There was no hypertension, disease recurrence, metastasis or sexually transmitted infection. CONCLUSION: The incidence of HM was 1:573 pregnancies resulting from rape, within the range estimated for Latin American countries. Trophoblastic material can be preserved to identify the violence perpetrator, considering only the paternal HM chromosomes. History of sexual violence should be investigated in cases of HM in the first half of adolescence and women in a vulnerable condition.