Effect of Senior Dance (DanSE) on Fall Risk Factors in Older Adults: A Randomized Controlled Trial.

BACKGROUND: Older people's participation in structured exercise programs to improve balance and mobility is low. Senior Dance is an alternative option, as it may provide a safe and fun way of targeting balance. OBJECTIVE: The aim was to investigate the effect of Senior Dance on balance, mobility, and cognitive function compared with a control intervention. DESIGN: The study was a randomized controlled trial. SETTING/PATIENTS: Eighty-two community-dwelling older people aged 60 years or over and cognitively intact were recruited in Brazil. INTERVENTION: Participants were randomly allocated to 2 groups: Dance plus education (intervention group) and education alone (control group). The Senior Dance program consisted of 12 weeks of twice-weekly group-based dance classes. Participants in both groups attended a single 1-hour educational session on prevention of falls. MEASUREMENTS: The primary outcome was single-leg stance with eyes closed. Secondary outcomes were timed sit-to-stand test, standing balance test, timed 4-m walk, and cognitive function tests, for example, Trail Making Test and Montreal Cognitive Assessment. RESULTS: Of the 82 participants randomized, 71 (87%) completed the 12-week follow-up. Single-leg stance with eyes closed (primary outcome) improved in the Senior Dance group (mean difference [MD] = 2.3 seconds, 95% confidence interval [CI] = 1.1 to 3.6) compared with the control group at follow-up. Senior Dance group performed better in the standing balance tests (MD = 3.7 seconds, 95% CI = 0.6 to 6.8) and were faster in the sit-to-stand test (MD = - 3.1 seconds, 95% CI = -4.8 to -1.4) and 4-m walk test (MD = -0.6 seconds, 95% CI = -1.0 to -0.1). There were no significant between-group differences for cognitive function tests. LIMITATIONS: Participants and therapists were not blinded. CONCLUSION: Senior Dance was effective in improving balance and mobility but not cognitive function in community-dwelling older people.

Idiopathic scoliosis: Static analysis of the influence of shim use on postural angles / Escoliose Idiopática: Análise estática da influência do uso de calço nos ângulos posturais

Abstract Introduction: Scoliosis is characterized as a three-dimensional deformity. In this scenario, the use of shims can promote correction of postural imbalances. Objective: To verify the static changes associated with unilateral manipulation of shims in idiopathic scoliosis. Methods: Two experimental groups composed of participants with scoliosis with double and single curves, and a control group of participants without scoliosis. 10 reflective markers were used, filmed for 15 seconds in the static position in three conditions (no shim; low shim of 1 cm, and high shim of 3 cm) on the right and left foot. The following postural angles were calculated: alpha 1, alpha 2, alpha 3, and alpha 4. Results: There were differences in the shim condition between the control group (CG) and experimental scoliosis with "S" (GES) for alpha 2 and 4 and Scoliosis "C" (GEC) for alpha 2. For shims under the right foot, there were differences between the control group and GES for alpha 4 and the GEC for alpha 1, 2 and 4, and between shims for the GES for alpha 3 and 4. Shims under the left foot were responsible for significant differences between the control group and the GES and GEC groups. Conclusion: These static postural changes indicate that scoliosis curves show adaptability and postural reorganization in response to manipulation with shims, and the greatest influence is seen in the lower segments, both in simple and double curves. According to the results it is concluded that residual scoliotic curvatures have flexibility that allows postural adjustment with shims.

Resumo Introdução: A escoliose é caracterizada como uma deformidade tridimensional. Neste cenário, o uso de calços pode promover correções de assimetrias posturais. Objetivo: Verificar as alterações estáticas associadas com manipulações unilaterais de calços na escoliose idiopática. Métodos: Dois grupos experimentais compostos de participantes com escoliose de curvas duplas e simples, e um grupo controle de participantes sem escoliose. Foram utilizados 10 marcadores reflexivos, filmados durante 15 segundos na posição estática em três condições (sem calço; com calço baixo de 1 cm; e alto de 3 cm) sob o pé direito e esquerdo. Foram calculados ângulos posturais: alfa 1, alfa 2, alfa 3 e alfa 4. Resultados: Houve diferenças na condição sem calço, entre grupos controle (GC) e experimental com escoliose em "S" (GES) para alfa 2 e 4 e com escoliose em "C" (GEC) para alfa 2. Calços sob o pé direito, houve diferenças entre os grupos controle e GES para alfa 4 e GEC para alfa 1, 2 e 4, e entre calços para GES para alfa 3 e 4. Calços sob o pé esquerdo foram responsáveis por diferenças significantes entre grupos controle e GES e GEC. Conclusão: Estas alterações posturais estáticas indicam que curvas escolióticas apresentam capacidade de adaptação e reorganização postural em resposta à manipulação dos calços, sendo que a maior influência é observada nos segmentos inferiores, tanto em curvas simples como duplas. De acordo com os resultados observados, conclui-se que as curvaturas escolióticas apresentam flexibilidade residual que permite ajustes posturais na presença de calços.

Vasculopathy associated with peripheral neuropathy in gait parameters of diabetic people

Abstract Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus when glycemic levels are poorly controlled. Sometimes DPN is accompanied by vasculopathy (DPV), which can worsen the clinical prognosis. The aim of this study was to analyze the gait parameters of nondiabetic individuals and diabetic individuals with DPN with or without DPV. METHOD The study included 68 individuals (50 to 65 years old) divided into three groups: people without diabetes mellitus (n = 33), diabetic patients with DPN (n = 18), and diabetic patients with both DPN and DVP (n = 17). The participants underwent a gait evaluation using electronic baropodometry to obtain the single and double support, velocity, and pressure-time integral. RESULTS The pressure-time integral, velocity, and single support variables were lower, and the double support and double support/single support ratio were higher in the diabetic neuropathy and vasculopathy group. The velocity was lower the greater the degree of impairment of the diabetic foot. Some correlations were identified with velocity. CONCLUSION In diabetic individuals, there was a significant worsening of the gait parameters analyzed according to increasing degree of clinical impairment.

Effectiveness of Senior Dance on risk factors for falls in older adults (DanSE): a study protocol for a randomised controlled trial.

INTRODUCTION: Strong evidence shows that exercise is effective to improve fall risk factors among older people. However, older people's participation and adherence to exercise programmes is suboptimal. Type of exercise and apathy are reported to be barriers to exercise participation, suggesting that new effective interventions are needed. The primary aim of this randomised controlled trial is to investigate the effect of Senior Dance plus brief education for falls prevention on balance among people aged 60 years or over, compared with a control group receiving only brief education. METHODS AND ANALYSIS: This single-blind randomised controlled trial will involve 82 community-dwelling older people aged 60 years or over who are cognitively intact. Participants allocated to the intervention group will attend a single educational class on strategies to prevent falls, and will participate in a 12-week, twice-weekly group-based programme of Senior Dance. The Senior Dance consists of different choreographies, which include rhythmic and simple movements with rhythmic folk songs. Participants allocated to the control group will attend the same educational class that intervention group participants will receive, and will be instructed not to take part in any regular exercise programme. The primary outcome will be single-leg stance with eyes closed. Secondary outcomes include: Short Physical Performance Battery, Falls Efficacy Scale, Trail Making Test and the Montreal Cognitive Assessment. Continuous outcomes will be reported using mean (SD) or median (IQR), depending on the distribution of the data. The linear regression approach to analysis of covariance will be used to compare the mean effect between groups. All patients will be included in the analyses following an intention-to-treat approach. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Human Ethics Committee of the São Paulo State University (CAAE 48665215.9.0000.5402). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at conferences. TRIAL REGISTRATION NUMBER: NCT02603523, Pre-results.

Composição corporal e expansibilidade toracoabdominal em idosas praticantes de programa exercício físico supervisionado / Body composition and thoracoabdominal expansion in elderly women submitted to a supervised physical exercise program

Objetivos: Avaliar os efeitos do exercício físico supervisionado sobre a composição corporal e a expansibilidade toracoabdominal de mulheres idosas inseridas em um programa de exercício físico regular e supervisionado. Métodos: Foram incluídas mulheres com idade igual ou superior a 60 anos, integrantes de um programa de exercício físico supervisionado, com frequência superior a 75%. As participantes foram dividas em dois grupos: programa duas vezes por semana (P2) e programa três vezes por semana (P3), sendo avaliadas antes do início do programa e após seis meses. Para as medidas de circunferência durante os movimentos respiratórios, foi realizada a cirtometria nas regiões axilar, xifoide, 12as costelas e região umbilical; e para a avaliação da composição corporal, a bioimpedância. Resultados: A amostra constou de 60 idosas, 29 pertencentes ao P2, com média de idade de 73,93±6,76 anos, e 31 pertencentes ao P3, com média de idade de 67,41±5,61 anos. A cirtometria demonstrou que em P2 houve aumento do coeficiente respiratório das 12as costelas entre o início (média 1,94±1,67 cm) e o fim do programa (média 3,07±1,67 cm), p=0,018; e em P3 houve aumento do coeficiente respiratório na região axilar entre a avaliação inicial (média 2,17±0,97 cm) e a final (média 2,84±1,81 cm), p=0,030. Nas outras variáveis em estudo não houve modificações. Na comparação entre os grupos, não houve diferenças significativas entre as medidas correspondentes a cada período da avaliação. Com relação à composição corporal, o grupo P2 apresentou aumento em massa magra e diminuição de gordura corporal entre o início e o fim do programa, enquanto as participantes do P3 mantiveram os mesmos valores. Conclusões: Após seis meses de participação em um programa de exercício físico supervisionado com sessões duas ou três vezes por semana, mulheres idosas demonstraram alguma melhora na expansibilidade toracoabdominal, aumento da massa magra e diminuição e/ou manutenção da gordura corporal.

Aims: To evaluate the effects of supervised exercise on body composition and thoracoabdominal expansion of women submitted to a regular and supervised exercise program. Methods: Women aged 60 years or older participating in a supervised exercise program, with attendance greater than 75%, were included in the study. The subjects were divided into two groups: exercises twice a week (P2) and three times a week (P3), evaluated before the program and after six months. The circumference measurements during respiratory motion were obtained in the axillary, xiphoid, and umbilical regions, and in the 12th pair of ribs, whereas body composition was assessed by bioimpedance. Results: The sample consisted of 60 elderly women, 29 of whom belonged to P2, with a mean age of 73.93±6.76 years, and 31 to P3, with a mean age of 67.41±5.61 years. Cirtometry demonstrated a higher respiratory coefficient for the 12th pair of ribs in P2 between the beginning (mean 1.94±1.67 cm) and end of the program (mean of 3.07±1.67 cm), p=0.018, and a higher respiratory coefficient in the axillary region in P3 at baseline (mean of 2.17±0.97 cm) and at the end of the program (mean of 2.84±1.81 cm), p=0.030. The other variables remained unchanged. No significant differences were observed when the groups were compared. Regarding body composition, the P2 group had an increase in lean body mass and a decrease in body fat between the beginning and end of the program, while the P3 group maintained the same indices. Conclusions: The elderly women revealed some improvement in thoracoabdominal expansion, increase in lean body mass, and a decrease or maintenance of body fat after six months in the supervised exercise program, with sessions twice or three times a week.

Efficiency of occlusal splints on police officers with TMD

Aim: To evaluate of the effect of two different occlusal splints on police officers with TMD. Methods: Thirty police officers were selected based on Research Diagnostic Criteria for TMD and on clinical exams. Volunteers (ten per group) were distributed according to occlusal splints: group A - Control, group B - Michigan Occlusal Splint (MOS), and group C - Planas Appliance (PA). Experimental groups were analyzed using a visual analog pain scale (VAPS), subject to a clinical evaluation of temporomandibular joint. Bilateral surface electromyographic activities of anterior and posterior temporal, masseter and suprahyoid muscles were analyzed at rest and during clenching, before and after four weeks using the occlusal splints. Results: The left and right temporal and masseter muscles sensitivity decreased after using both splints. Pain symptoms increased for group A (Control) and decreased for group C. Conclusions: Planas Appliance was more efficient on pain reduction than the Michigan Occlusal Splint.

Força muscular isométrica nas neuropatias diabética e hansênica / Isometric muscle strength on diabetic and leprosy neuropathies

Este estudo tem por objetivo avaliar a força muscular do tornozelo de portadores de hanseníase ou diabetes mellitus acometidos por neuropatia periférica (NP), comparando-os com sujeitos sadios e, assim, verificar se NPs com fisiopatologias distintas culminam em déficit muscular semelhante. Cinquenta indivíduos (60,72 ± 8,36 anos de idade), sendo 21 do grupo diabético (GD), nove do grupo hansênico (GH) e 20 do grupo controle (GC), participaram do estudo. Inicialmente coletou-se os dados gerais, seguido do teste de sensibilidade somatossensitiva com os monofilamentos Semmes-Weinstein da Sorri-Bauru® e, por fim, realizou-se o teste de força muscular do tornozelo, por meio de dinamômeto isométrico digital. No GD e no GH houve insensibilidade ao monofilamento de 10g, confirmando a presença de NP. A dinamometria muscular, em ambos os tornozelos acusou déficits da força muscular de dorsiflexores e plantiflexores no GD e mais acentuadamente no GH em comparação ao GC. A plantiflexão apontou alterações mais significantes porque, além de referir alteração da variável em relação ao GC, também indicou diminuição da força muscular do GH em relação ao GD. Ao final, verificou-se diminuição da força muscular do tornozelo de neuropatas, no entanto, esse déficit divergiu entre os grupos analisados sugerindo-se, assim, que o motivo da alteração pode estar relacionado à sua respectiva etiopatologia, uma vez que os dados indicaram maior agressividade da NP hansênica no comprometimento neuromuscular em relação à NP diabética. Torna-se evidente, portanto, considerar esse fator no planejamento de intervenções.

This study aims to evaluate ankle muscle strength in patients with leprosy or diabetes mellitus with peripheral neuropathy (PN), when compared to healthy subjects, and thus verify if PNs with different patho-physiologies culminate in similar muscular deficit. Fifty subjects (60.72 ± 8.36 years old), 21 of them from the diabetic group (DG), nine from the leprosy group (LG) and 20 from the control group (CG), have participated in the study. Initially, general data were collected, followed by the somatosensory test with Semmes-Weinstein monofilament (SORRI-BAURU®) and, finally, the ankle muscle strength was tested using an isometric digital dynamometer. In DG and LG groups, no sensitivity was found for the 10-g monofilament, confirming the PN diagnosis. The muscle dynamometry, in both ankles, presented strength deficits of the dorsal and plantar flexors in DG and more markedly in LG, when compared to CG. The deficit in plantar flexion was more significant because, in addition to demonstrating deficit in relation to the CG, it has also showed decreased muscle strength from LG in relation to DG. In the end, a decreased ankle muscle strength of subjects with neuropathy was noticed; however, this deficit differed among the groups suggesting, therefore, that the reason for such change may be related to their respective aetiopathology, since the data indicated more neuromuscular aggression in leprosy PN in relation to diabetic PN. Thus, this fact can be clearly considered when planning interventions.

Conferências locais, distritais e municipais de saúde: mudança de escala e formação de um sistema participativo, representativo e deliberativo de políticas públicas / Texto para Discussão (TD) 1727: Conferências locais, distritais e municipais de saúde: mudança de escala e formação de um sistema participativo, representativo e deliberativo de políticas públicas

Analisa em que medida a mudança de escala impacta as dinâmicas participativa, representativa e deliberativa das conferências de saúde realizadas em Belo Horizonte nos níveis local, distrital e municipal.

TSH neurosecretory dysfunction (TSH-nd) in Down syndrome (DS): low risk of progression to Hashimoto's thyroiditis / Disfunção neurossecretora de TSH na síndrome de Down: baixo risco de progressão para a tireoidite de Hashimoto

INTRODUCTION: Patients with Down syndrome (DS) often have elevated TSH (hypothalamic origin), which is called TSH neurosecretory dysfunction (TSH-nd). In these cases, there is slight elevation in TSH (5-15 µUI/mL), with normal free T4 and negative thyroid antibodies (AB). OBJECTIVE: To recognize the risk of progression to Hashimoto's thyroiditis (HT). SUBJECTS AND METHODS: We retrospectively analyzed 40 DS patients (mean age = 4.5 years), followed up for 6.8 years. RESULTS: HT was diagnosed in 9/40 patients, three early in monitoring, and six during evolution. In 31/40 patients, TSH-nd diagnosis remained unchanged over the years, with maximum TSH values ranging from 5 to 15 µUI/mL. In this group, free T4 also remained normal and AB were negative. There was a significant TSH reduction (p = 0.017), and normal TSH concentrations (< 5.0 µUI/mL) were observed in 29/31 patients, in at least one moment. No patient had TSH > 15 µUI/mL. CONCLUSION: DS patients with TSH-nd present low risk of progression to HT (10 percent for females and 6 percent for males).

INTRODUÇÃO: Pacientes com síndrome de Down (SD) geralmente apresentam TSH elevado (de origem hipotalâmica), uma desordem chamada de disfunção neurossecretora de TSH (TSH-nd). Nesses casos, há uma leve elevação do TSH (5-15 µUI/mL), com T4 livre normal e anticorpos antitireoide (AB) negativos. OBJETIVO: Reconhecer o risco de progressão para a tireoidite de Hashimoto (HT). SUJEITOS E MÉTODOS: Analisamos retrospectivamente 40 pacientes com SD (idade média = 4,5 anos), acompanhados por 6,8 anos. RESULTADOS: A HT foi diagnosticada em 9/40 pacientes, três logo no início da avaliação e seis durante a evolução. Em 31/40 dos pacientes, o diagnóstico de TSH-nd permaneceu estável durante os anos, com valores máximos de TSH variando de 5 a 15 µUI/mL. Neste grupo, o T4 livre também permaneceu normal e os AB foram negativos. Houve uma redução significativa do TSH (p = 0,017), e concentrações normais de TSH (< 5,0 µUI/mL) foram observadas em 29/31 pacientes, em pelo menos um momento. Nenhum paciente apresentou TSH > 15 µUI/mL. CONCLUSÃO: Pacientes com SD e TSH-nd apresentam baixo risco de progressão para a HT (10 por cento para o sexo feminino e 6 por cento para o sexo masculino).

[Growth hormone therapy and hypersensitivity type III reaction: a contraindication for desensitization]. / Hormônio de crescimento e hipersensibilidade por imunocomplexo (Tipo III): uma contraindicação para a dessensibilização.

Allergic reactions against GH are rare, and usually represented by the hypersensitivity type I (IgE-mediated). This type of reaction can be treated by desensitization. In this case report, we present a patient showing an allergic reaction soon after starting GH therapy mediated by immune complex (hypersensitivity type III reaction). In this condition, the attempt to perform the desensitization procedure can perpetuate immune complex deposition determining a life threatening renal and respiratory insufficiency.

Estudo de alguns aspectos microbiológicos e microscópicos em ovos de páscoa produzidos artesanalmente / Study of some aspects of microbiological and microscopic in easter eggs

Ovos de Páscoa de chocolate são obtidos a partir de uma massa de chocolate recheada ou não. O conjunto de características que distinguem estes ingredientes determina o grau, o tipo de contaminação e as condições higiênicas durante a preparação e comercialização, temperatura e tempo de aquecimento, podendo conduzir a transferência de micro-organismos patogênicos e incentivar o crescimento de bolores e leveduras. Este é um estudo dos resultados analíticos obtidos através de análises microbiológicas para determinação de coliformes totais a 35°C, termotolerantes a 45°C e Salmonella, de acordo com APHA (1992).(...) Todas as amostras apresentaram fibras sintéticas, duas das quais continham presença de inseto e fragmentos, e uma amostra apresentou material carbonizado. Isso sugere que a investigação de materiais estranhos nesses produtos seja contínua, porque esses resultados indicam alimentos que podem apresentar riscos à saúde humana, sendo necessário um programa de monitoramento mais adequado nos locais de produção de chocolate e seus produtos, incluindo a formação dos manipuladores e cumprimento das Boas Práticas de Fabricação (BPF), bem como a Análise dos Pontos Críticos de Controle (APPCC).

Estudo de alguns aspectos microbiológicos e microscópicos em ovos de páscoa produzidos artesanalmente / Study of some aspects of microbiological and microscopic in easter eggs

Ovos de Páscoa de chocolate são obtidos a partir de uma massa de chocolate recheada ou não. O conjunto de características que distinguem estes ingredientes determina o grau, o tipo de contaminação e as condições higiênicas durante a preparação e comercialização, temperatura e tempo de aquecimento, podendo conduzir a transferência de micro-organismos patogênicos e incentivar o crescimento de bolores e leveduras. Este é um estudo dos resultados analíticos obtidos através de análises microbiológicas para determinação de coliformes totais a 35°C, termotolerantes a 45°C e Salmonella, de acordo com APHA (1992). Através da verificação do percentual de amostras aprovadas e rejeitadas, de acordo com as normas da legislação brasileira (ANVISA, 2001) e análise microscópica, utilizou-se o método da Association of Official Analytical Chemists International: Tecn. 965.38 (AOAC, 2000), com modificações. Observou-se que apenas uma amostra apresentou contaminação por coliformes ambiental e termotolerantes de acordo com as normas nacionais e, em 100% das amostras, ausência de Salmonella sp., indicando condições higiênicas e sanitárias inadequadas durante a produção, manipulação, armazenamento e comercialização. Todas as amostras apresentaram fibras sintéticas, duas das quais continham presença de inseto e fragmentos, e uma amostra apresentou material carbonizado. Isso sugere que a investigação de materiais estranhos nesses produtos seja contínua, porque esses resultados indicam alimentos que podem apresentar riscos à saúde humana, sendo necessário um programa de monitoramento mais adequado nos locais de produção de chocolate e seus produtos, incluindo a formação dos manipuladores e cumprimento das Boas Práticas de Fabricação (BPF), bem como a Análise dos Pontos Críticos de Controle (APPCC).(AU)

Easter eggs chocolate are obtained from a mass of chocolate, stuffed or not. The set of characteristicsthat distinguish these ingredients determines the degree, type of contamination and hygienic conditionsduring processing and marketing, temperature and heating time, which may lead to transfer of pathogenic microorganisms and encourage the growth of yeasts and molds. This is a study of the analytical results obtained by microbiological analysis for determination of total coliforms at 35 o C and thermotolerant at 45 o C, and salmonella, according to APHA (1992). Through monitoring the percentage of samples approved and rejected, according to the rules of the Brazilian legislation (ANVISA, 2001)and microscopic analysis, we used the method of the Association of Official Analytical Chemists International: Tech. 965.38 (AOAC, 2000), with modifications. It was observed that only one sample showed contamination by fecal coliforms and environmental according to national standards, and 100% of the samples, Salmonella sp., Indicating hygienic conditions and inadequate hygiene during production, handling, storage and marketing. Ali samples showed fibers, two of which contained the presence of insect fragments, and one sample carbonized material. This suggests that the investigation of foreignmaterials such products is continuing, because these results indicate that food can pose risks to human health, requiring a monitoring program best suited to local production of chocolate and its products, including the training of handlers and compliance with Good Manufacturing Practices (GMP) and the Analysis of Critical Control Points (HACCP). (AU)

Hormônio de crescimento e hipersensibilidade por imunocomplexo (Tipo III): uma contraindicação para a dessensibilização / Growth hormone therapy and hypersensitivity type III reaction: a contraindication for desensitization

As reações alérgicas ao GH são raras e usualmente representadas por reações de hipersensibilidade tipo I (IgE mediadas), passíveis de tratamento por dessensibilização. Neste relato de caso, descrevemos a presença de reação alérgica ao GH mediada por imunocomplexo (hipersensibilidade tipo III). Nesta situação, a tentativa de dessensibilização pode perpetuar a formação de imunocomplexo, cujo depósito pode determinar insuficiência renal e respiratória.

Allergic reactions against GH are rare, and usually represented by the hypersensitivity type I (IgE-mediated). This type of reaction can be treated by desensitization. In this case report, we present a patient showing an allergic reaction soon after starting GH therapy mediated by immune complex (hypersensitivity type III reaction). In this condition, the attempt to perform the desensitization procedure can perpetuate immune complex deposition determining a life threatening renal and respiratory insufficiency.

TSH neurosecretory dysfunction (TSH-nd) in Down syndrome (DS): low risk of progression to Hashimoto's thyroiditis.

INTRODUCTION: Patients with Down syndrome (DS) often have elevated TSH (hypothalamic origin), which is called TSH neurosecretory dysfunction (TSH-nd). In these cases, there is slight elevation in TSH (5-15 µUI/mL), with normal free T4 and negative thyroid antibodies (AB). OBJECTIVE: To recognize the risk of progression to Hashimoto's thyroiditis (HT). SUBJECTS AND METHODS: We retrospectively analyzed 40 DS patients (mean age = 4.5 years), followed up for 6.8 years. RESULTS: HT was diagnosed in 9/40 patients, three early in monitoring, and six during evolution. In 31/40 patients, TSH-nd diagnosis remained unchanged over the years, with maximum TSH values ranging from 5 to 15 µUI/mL. In this group, free T4 also remained normal and AB were negative. There was a significant TSH reduction (p = 0.017), and normal TSH concentrations (< 5.0 µUI/mL) were observed in 29/31 patients, in at least one moment. No patient had TSH > 15 µUI/mL. CONCLUSION: DS patients with TSH-nd present low risk of progression to HT (10% for females and 6% for males).

Avaliação da coluna vertebral: relação entre gibosidade e curvas sagitais por método não-invasivo / Spine evaluation: Determination of the relationship between thoracic spinal deformity and sagittal curves by a noninvasive method

Os objetivos do estudo foram avaliar o alinhamento, no plano sagital, da coluna de indivíduos com alterações na medida da gibosidade, comparando com um grupo sem alterações; testar a confiabilidade do instrumento utilizado e verificar se existem correlações entre as medidas da gibosidade e os valores das curvaturas vertebrais. Foram avaliados 40jovens, divididos em grupo controle ? ausência ou presença de gibosidades inferiores a 0,5 cm na curvatura torácica e 0,7 cm na lombar (n=20) e, grupo experimental ? gibosidades superiores às descritas (n=20). A gibosidade e as curvaturas no plano sagital foram mensuradascom um instrumento adaptado a um nível d?água e o teste de Adams. As coletas foram realizadas em duas datas distintas, nos dois grupos. Após aplicação do teste Mann- Whitney não foi encontrada diferença entre as ocasiões de coletas e, emparelhando-se os grupos, foi encontrada diferença apenas na medida cervical. Na verificação de existênciade relação entre as medidas coletadas, foi encontrada correlação linear (Spearmann) no grupo controle ? curvatura torácica e gibosidade torácica; em ambos os grupos ? curvaturas torácica e lombar; e no grupo experimental ? gibosidade torácica e as curvaturas lombar esacral e, curvatura sacral e curvaturas torácica e lombar. Pôde-se concluir que a medida da gibosidade tem relações com as curvaturas no plano sagital. Por ser um método confiável, simples e acessível, pode ser reproduzido sem altos custos financeiros e sem causar prejuízoà saúde do paciente.

The objectives of this study were to compare sagittal plane alignment between subjects with spinal deformities and a group presenting no changes; to test the reliability of the tool used, and to determine the existence of correlations between spinal deformity and sagittal curvaturemeasures. Forty young subjects were divided into two groups: a control group (n=20) presenting no changes or spinal deformity less than 0.5 cm in the dorsal curvature and 0.7 cm in the lumbar curvature, and an experimental group (n=20) with spinal deformities greater than those described for the control group. Spinal deformity and sagittal plane curvatures were measured using a water level-based tool and by the Adams test. Data were collected from the two groups on two distinctoccasions. The Mann-Whitney test showed no difference between sampling times. A significant difference between the two groups was only observed in terms of cervical curvature. Spearman?s test revealed a linear correlation between dorsal curvature and dorsal spinal deformity in thecontrol group, between dorsal and lumbar curves in the two groups, and between dorsal spinal deformity and lumbar and sacral curves and between sacral curvature and dorsal and lumbar curves in the experimental group. In conclusion, spinal deformity measurement is associated with sagittal plane curvatures. The method proposed here is reliable, simple and accessible and can be reproduced without high costs and damage to the patient?s health.

Prolonged physical training decreases mRNA levels of glucocorticoid receptor and inflammatory genes.

BACKGROUND/AIMS: Prolonged physical exercise induces adaptive alterations in the hypothalamic-pituitary axis, increasing cortisol metabolism, and reducing cortisol synthesis and glucocorticoid sensitivity. The mechanisms responsible for this relative glucocorticoid resistance remain unknown but may involve expression of genes encoding glucocorticoid receptor (GR) and/or inflammatory molecules of nuclear factor kappa B1 (NFkB1) signaling pathway and cytokines. This study aimed to determine the impact of prolonged physical training on the expression of genes involved in glucocorticoid action and inflammatory response. METHODS: Normal sedentary male cadets of the Brazilian Air Force Academy were submitted to 6 weeks of standardized physical training. Eighteen of 29 initially selected cadets were able to fully complete the training program. Fasting glucose, insulin and cortisol levels, cytokine concentration and the expression of genes encoding GR, NFkB1, inhibitor of NFkB1 and IkB kinase A were determined before and after the training period. RESULTS: Prolonged physical exercise reduced the basal cortisol levels and the percent cortisol reduction after dexamethasone. These findings were associated with a significant reduction in the mRNA levels of GR (6.3%), NFkB1 (63%), inhibitor of NFkB1 (25%) and IkB kinase A (46%) with concomitant reduction in cytokine concentrations (ELISA). CONCLUSIONS: Prolonged physical training decreases the glucocorticoid sensitivity and the mRNA levels of the GR gene combined with decreased mRNA of genes related to the NFkB pathway.

Impact of prolonged low-grade physical training on the in vivo glucocorticoid sensitivity and on glucocorticoid receptor-alpha mRNA levels of obese adolescents.

BACKGROUND/AIM: Healthy individuals present variable responses of the hypothalamic-pituitary-adrenal (HPA) axis induced by different patterns of physical training. The aim of this study was to evaluate whether prolonged low-grade physical training influences the HPA axis and also glucocorticoid receptor-alpha (GRalpha) mRNA levels in mononuclear cells of obese adolescents. METHODS: We studied 19 patients with BMI above the 95th percentile (male:female ratio 7:12) aged from 9.5 to 15.5 years. Patients underwent a 12-week physical exercise program. Before and after exercise, in vivo glucocorticoid sensitivity was determined by employing a very-low-dose intravenous dexamethasone suppression test, and in vitro GRalpha mRNA levels were evaluated by quantitative real-time PCR. RESULTS: After exercise there was a trend to reduce the in vivo glucocorticoid sensitivity (p = 0.071) and a significant increase in GRalpha mRNA levels (p = 0.025). CONCLUSION: For this subset of obese adolescents, prolonged low-grade physical training tended to reduce glucocorticoid sensitivity. The discrepancy of cortisol response to dexamethasone and the GRalpha mRNA measurement suggest a post-receptor phenomenon or should be related to target tissue-specific differences in glucocorticoid sensitivity. Future studies should address the adaptive GRalpha mRNA during different exercise protocols, and also the correlation of pituitary sensitivity with glucocorticoid target tissue sensitivity.

Avaliação da força muscular isométrica do tornozelo. dinamometria: descrição de uma nova técnica / Measurement of ankle isometric muscular strength. dynamometer: a new method description

A quantidade de força exercida por um músculo traduz seu grau de eficiência, que pode ser analisado pela dinamometria. Existem dois grandes grupos de dinamômetros no mercado: o isocinético e o portátil. São encontrados numerosos estudos que validam o uso do dinamômetro portátil de diversas maneiras e com vários segmentos do corpo. Boa parte desses estudos realiza o teste de força muscular da articulação do tornozelo, partindo-se de total extensão e em decúbito dorsal, mesmo esse não sendo o posicionamento mais adotado durante as atividades cotidianas. O estudo descreve uma forma de avaliação da força de tornozelos, utilizando um dinamômetro digital portátil, adaptado a uma pequena mesa de dois andares, com a articulação posicionada em 90º. No andar mais baixo é fixada a célula de carga do dinamômetro, na qual é acoplada uma das extremidades de um cabo de aço. A outra extremidade é presa a uma catraca. No andar superior da mesa, encontram-se dois orifícios para passagem do cabo, sob o qual será posicionado ora o pé, ora a coxa do voluntário. O indivíduo realizará, ora dorsiflexão, ora plantiflexão de maneira isométrica, sendo assim quantificada a força de tornozelo a partir do posicionamento de 90º. Dando devida atenção aos procedimentos e considerações do texto, a adaptação torna-se uma ferramenta útil para avaliação da força muscular dessa articulação.

The amount of force exerted by a muscle reflects their degree of efficiency that can be examined by dynamometry. There are two major groups of dynamometers on the market: the isokinetic and the portable. They are found numerous studies that validate the use of portable dynamometer in different ways and in different body segments. Much of these studies shall test the muscular strength of the ankle joint, starting from the total ankle extension and supine position, even this is not the position adopted during most daily activities. This study describes a way of assessing the ankle strength, using a handheld digital dynamometer, adapted to a small table with two floors, with the joint positioned in 90º. On the lower floor is fixed to a load cell dynamometer, which is coupled one end of a steel cable. The other end is attached to a ratchet. Upstairs from the table, there are two openings for cable passage, which will be positioned, sometimes, on the foot, sometimes on the subject thigh. The individual will execute isometric dorsiflexion or plantarflexion, therefore, ankle (in 90º position) strength will be quantified. Giving due attention to procedures and considerations of the text, the adaptation becomes a useful tool for evaluating muscle strength of this joint.