High and low-fidelity simulation for respiratory diseases pediatric training: a prospective and randomized study.

OBJECTIVE: To compare high and low-fidelity simulations for the recognition of respiratory distress and failure in urgency and emergency pediatric scenarios. METHODS: 70 fourth-year medical students were randomly distributed in high and low-fidelity groups and simulated different types of respiratory problems. Theory tests, performance checklists, and satisfaction and self-confidence questionnaires were used in the assessment. Face-to-face simulation and memory retention was applied. The statistics were evaluated by averages and quartiles, Kappa, and generalized estimating equations. The p-value was considered 0.05. RESULTS: In the theory test there was an increase in scores in both methodologies (p < 0.001); in memory retention (p = 0.043) and at the end of the process the high-fidelity group had better results. The performance in the practical checklists was better after the second simulation (p > 0,05). The high-fidelity group felt more challenged in both phases (p = 0.042; p = 0.018) and showed greater self-confidence to recognize changes in clinical conditions and in memory retention (p = 0.050). The same group, in relation to the hypothetical real patient to be treated in the future, felt better confident to recognize respiratory distress and failure (p = 0.008; p = 0.004), and better prepared to make a systematic clinical evaluation of the patient in memory retention (p = 0.016). CONCLUSION: The two levels of simulations enhance diagnostic skills. High fidelity improves knowledge, leads the student to feel more challenged and more self-confident in recognizing the severity of the clinical case, including memory retention, and showed benefits regarding self-confidence in recognizing respiratory distress and failure in pediatric cases.

ERAS programme in a Portuguese tertiary hospital: An audit of the first six months of implementation in elective colorectal surgery.

INTRODUCTION AND OBJECTIVES: Enhanced Recovery After Surgery (ERAS) is a multimodal strategy designed to optimize postoperative recovery and reduce morbidity, length of hospital stay, and care costs. The aim of this study was to evaluate compliance and clinical outcomes 6 months of implementation of the program in scheduled colorectal surgery in a tertiary hospital. MATERIAL AND METHODS: Data from 209 patients who underwent elective colorectal surgery were analysed. The first 102 patients (pre-ERAS group) who underwent surgery between January and May 2018, before the implementation of the program, were compared with the 107 patients treated between May and October 2019, after ERAS implementation. The main outcomes were patient education and counselling, use of intravenous fluids, early mobilization, incidence of postoperative nausea and vomiting, return of bowel function, length of stay, complications, mortality, and overall compliance. RESULTS: The ERAS program was associated with a significant increase in patient education and counselling (p<0.001) and with a significant reduction in intra- and postoperative IV fluid administration (p=0.007 and p<0.001, respectively) and postoperative nausea or vomiting (17.6% vs 5.0%, p=0.007). Time to recovery of activities of daily living (5.29 vs 2.85 days; p<0.001), time to solid oral intake (6.21 vs 4.35 days; p<0.001), time to first flatus (2.41 vs 1.51 days; p<0.001) and defecation (3.35 vs 1.66 days; p<0.001) decreased with ERAS. There were no statistically significant differences in length of stay, complications, and mortality. CONCLUSION: This study showed that the ERAS program improved perioperative outcomes and postoperative recovery in patients undergoing colorectal surgery in our hospital.

High and low-fidelity simulation for respiratory diseases pediatric training: a prospective and randomized study

Abstract Objective: To compare high and low-fidelity simulations for the recognition of respiratory distress and failure in urgency and emergency pediatric scenarios. Methods: 70 fourth-year medical students were randomly distributed in high and low-fidelity groups and simulated different types of respiratory problems. Theory tests, performance checklists, and satisfaction and self-confidence questionnaires were used in the assessment. Face-to-face simulation and memory retention was applied. The statistics were evaluated by averages and quartiles, Kappa, and generalized estimating equations. The p-value was considered 0.05. Results: In the theory test there was an increase in scores in both methodologies (p < 0.001 ); in memory retention (p = 0.043) and at the end of the process the high-fidelity group had better results. The performance in the practical checklists was better after the second simulation (p > 0,05). The high-fidelity group felt more challenged in both phases (p = 0.042; p = 0.018) and showed greater self-confidence to recognize changes in clinical conditions and in memory retention (p = 0.050). The same group, in relation to the hypothetical real patient to be treated in the future, felt better confident to recognize respiratory distress and failure (p = 0.008; p = 0.004), and better prepared to make a systematic clinical evaluation of the patient in memory retention (p = 0.016). Conclusion: The two levels of simulations enhance diagnostic skills. High fidelity improves knowledge, leads the student to feel more challenged and more self-confident in recognizing the severity of the clinical case, including memory retention, and showed benefits regarding self-confidence in recognizing respiratory distress and failure in pediatric cases.

Association of Discrimination, Violence, and Resilience with Depressive Symptoms Among Transgender Women in Rio de Janeiro, Brazil: A Cross-Sectional Analysis.

Transgender women experience violence and discrimination that lead to stress responses and contribute to poor mental health. In this analysis of baseline data from Transcendendo, a trans-specific open cohort in Rio de Janeiro, Brazil, we hypothesized that the experience of discrimination and violence would be associated with depressive symptoms and that resilience could mitigate this association. Results showed that prior experiences with discrimination and sexual and physical violence were associated with depressive symptoms, while resilience was inversely associated with depressive symptoms. Resilience did not moderate nor mediate the strong effects of discrimination and violence on depressive symptoms in adjusted models.

Consequências do parto cesárea sem indicação clínica / Consequences of cesarean delivery without clinical indication / Consecuencias de la cesárea sin indicación clínica

Objetivo: analisar o conhecimento sobre as consequências do parto cesárea sem indicação clínica por mulheres da rede privada. Método: A metodologia utilizada foi de abordagem qualitativa e método descritivo seguindo os pressupostos de Minayo. Resultados: A coleta de dados ocorreu em uma página virtual da rede social Facebook designada Espaço Gestante. Teve como critérios de inclusão para participar mulheres que tiveram parto cesárea sem indicação clínica e que tiverem idade igual ou superior a 18 anos, que aceitaram o convite e concordaram com o Termo de Consentimento Livre e Esclarecido. A entrevista ocorreu por meio da ferramenta de formulário Google Forms, onde as participantes responderam a um questionário de 7 perguntas norteadoras. A análise de dados ocorreu concomitantemente a coleta de dados, seguidamente foram transcritos e agrupados conforme a semelhança. Nos resultados foram entrevistadas 5 mulheres com idade entre 23 e 42 anos, que tiveram ao menos uma cesárea. Conclusão: Na discussão foram apresentadas 6 categorias, dentre elas a de maior relevância a orientação sobre riscos e consequência da cesárea sem indicação clinica onde se revela divergência quanto as orientações recebidas de riscos do procedimento. É preciso ser analisado o nível de importância dado ao acesso as informações pelas mulheres sobre indicação, riscos maternos e fetais e o seu direito a participar efetivamente no processo de decisão da escolha da via de parto.

Objective: to analyze the knowledge about the consequences of cesarean delivery without clinical indication by women in the private network. Method: The methodology used was a qualitative approach and descriptive method following the assumptions of Minayo. Results: Data collection took place on a virtual page of the social network Facebook called Espaço Gestante. The inclusion criteria for participating were women who had cesarean delivery without clinical indication and who were 18 years of age or older, who accepted the invitation and agreed to the Free and Informed Consent Form. The interview took place through the Google Forms form tool, where the participants answered a questionnaire with 7 guiding questions. Data analysis occurred concomitantly with data collection, then they were transcribed and grouped according to similarity. In the results, 5 women aged between 23 and 42 were interviewed, who had at least one cesarean section. Conclusion: In the discussion, 6 categories were presented, among them the most relevant guidance on risks and consequences of cesarean section without clinical indication, where divergence regarding the guidelines received on the risks of the procedure is revealed. It is necessary to analyze the level of importance given to access to information by women about indication, maternal and fetal risks and their right to effectively participate in the decision-making process of choosing the route of delivery

Objetivo: analizar el conocimiento sobre las consecuencias del parto por cesárea sin indicación clínica por parte de las mujeres en la red privada. Método: La metodología utilizada fue de enfoque cualitativo y método descriptivo siguiendo los supuestos de Minayo. Resultados: La recolección de datos ocurrió en una página virtual de la red social Facebook llamada Espaço Gestante. Los criterios de inclusión para participar fueron mujeres que tuvieron parto por cesárea sin indicación clínica y que tenían 18 años o más, que aceptaron la invitación y accedieron al Término de Consentimiento Libre e Informado. La entrevista se realizó a través de la herramienta de formularios Google Forms, donde los participantes respondieron un cuestionario con 7 preguntas orientadoras. El análisis de los datos ocurrió concomitantemente con la recolección de los datos, luego fueron transcritos y agrupados de acuerdo con la similitud. En los resultados se entrevistaron 5 mujeres con edades entre 23 y 42 años, que tuvieron al menos una cesárea. Conclusión: En la discusión se presentaron 6 categorías, entre ellas las orientaciones más relevantes sobre riesgos y consecuencias de la cesárea sin indicación clínica, donde se revela divergencia en cuanto a las orientaciones recibidas sobre los riesgos del procedimiento. Es necesario analizar el nivel de importancia otorgado al acceso a la información por parte de las mujeres sobre la indicación, los riesgos maternos y fetales y su derecho a participar efectivamente en el proceso de toma de decisiones de elección de la vía del parto

A Saúde dos Trabalhadores nas Estradas- Dados da Extensão em Goiás / Workers Health on the Roads- Extension Data in Goiás / La salud de los trabajadores de la carretera- Datos de extensión en Goiás

Objetivo: discorrer sobre a execução do projeto, bem como apresentar parte dos dados obtidos por meio da ação comunitária desenvolvida no Estado de Goiás em 2021, denominada: Projeto Saúde na Estrada. Método: trata-se de um estudo descritivo, tipo relato de experiência originado em um projeto de extensão, cujos dados coletados foram de aproximadamente 2277 participantes. Resultados: Os resultados deste estudo trouxeram a necessidade profunda de mudanças organizacionais, de logística e até na gestão dos serviços de saúde. Apresentaram um número significativo de pessoas que dirigem na estrada, em condições pouco saudáveis. Conclusão: É necessário que sejam fomentados projetos e pesquisas da parte do poder público para esses trabalhadores, que possuem pouco ou nenhum tempo para procurar uma unidade básica de saúde ou um hospital público por onde passam. As políticas de saúde hoje desenvolvidas no âmbito da promoção da saúde e da prevenção de doenças, ainda estão muito limitadas a um local, de comodidade para os que nele trabalham. A mentalidade do trabalho dentro da instituição faz parte de um processo cultural difícil de ser quebrado.

Objective: describe the execution of the project, as well as present part of the data obtained through the community action developed in the State of Goiás in 2021, called: Projeto Saúde na Estrada. Method: this is a descriptive study, experience report type originated in an extension project, whose collected data were from approximately 2277 participants. Results: The results of this study brought about a deep need for organizational, logistical and even management changes in health services. They showed a significant number of people driving on the road, in unhealthy conditions. Conclusion: It is necessary to promote projects and research by the government for these workers, who have little or no time to look for a basic health unit or a public hospital where they visit. Health policies developed today within the scope of health promotion and disease prevention are still very limited to a place of convenience for those who work there. The work mentality within the institution is part of a cultural process that is difficult to break.

Objetivo: es hablar sobre la ejecución del proyecto, así como presentar parte de los datos obtenidos a través de la acción comunitaria desarrollada en el Estado de Goiás en 2021, denominada: Projeto Saúde na Estrada. Método: se trata de un estudio descriptivo, tipo relato de experiencia originado en un proyecto de extensión, cuyos datos recolectados fueron de aproximadamente 2277 participantes. Resultados: Los resultados de este estudio provocaron una profunda necesidad de cambios organizativos, logísticos e incluso de gestión en los servicios de salud. Mostraron un número significativo de personas conduciendo por la carretera, en condiciones insalubres. Conclusión: Es necesario impulsar proyectos e investigaciones del gobierno para estos trabajadores, que tienen poco o ningún tiempo para buscar una unidad básica de salud o un hospital público donde visitan. Las políticas de salud desarrolladas hoy en el ámbito de la promoción de la salud y la prevención de enfermedades aún están muy limitadas a un lugar de conveniencia para quienes allí laboran. La mentalidad laboral dentro de la institución es parte de un proceso cultural difícil de romper

Meningite na infância: uma análise das internações hospitalares no Brasil / Meningitis in childhood: an analysis of hospital hospitalizations in Brazil

Objetivo: Analisar o perfil epidemiológico da meningite em crianças no Brasil. Método: Trata-se de estudo descritivo, cujos dados foram obtidos através de análise documental do Departamento de Informática do Sistema Único de Saúde (DATASUS) por meio de dados disponibilizados pela notificação no Sistema de Informação e Agravos de Notificação (Sinan). Foram utilizados dados da notificação de meningite no período de 2008 a 2019, em crianças até os 14 anos de idade no país. Resultados: Na faixa etária pediátrica, foram notificados 127.508 casos, o equivalente a 55,83% de todos os diagnósticos realizados neste período em todas as faixas etárias. Na amostra, houve maior prevalência da faixa etária entre 1 ano a 4 anos. Em relação ao sexo, o masculino foi o mais prevalente. Quanto à evolução dos casos notificados, a maioria dos pacientes tiveram alta hospitalar. Destes, a faixa etária entre 1 a 4 anos obteve maior prevalência. Quanto aos óbitos por meningite, houve maior prevalência da faixa etária de menores de 1 ano. O método quimiocitológico foi o método diagnóstico mais utilizado, evidenciando principalmente a meningite de etiologia viral. Conclusão: Verifica-se que os casos de meningite são prevalentes na faixa etária pediátrica, havendo predomínio da faixa etária entre 1 a 4 anos e do sexo masculino neste estudo. Ressalta-se a importância de ações preventivas, como a imunização vacinal, sobretudo quando se percebe a maior letalidade da meningite bacteriana

Food allergy-From food avoidance to active treatment.

The prevalence of food allergy (FA) has increased too rapidly, possibly due to environmental factors. The guidelines recommend strict allergen avoidance, but FA is still the main cause of anaphylaxis in all age groups. Immunotherapy is the only treatment able to change the course of allergic disease, and oral immunotherapy (OIT) is the more effective route in FA. However, it carries the risk of adverse reactions, including anaphylaxis. To improve OIT safety, adjuvant therapy with the immunoglobulin E (IgE) monoclonal antibody omalizumab has been extensively used. Results suggest particular benefit in patients with high risk of fatal anaphylaxis. An alternative approach is to use omalizumab instead of OIT to prevent severe allergic reactions upon accidental exposure. This paper reviews current evidence regarding IgE-mediated FA, focusing on natural tolerance and food sensitization acquisition, and on avoidance measures and their limitations.

Antibacterial activity of propolis extracts from the south of Portugal.

To examine the antibacterial activity of diverse extracts of propolis harvested at winter and spring from several locations of Algarve, Portugal, against Gram-negative and Gram-positive bacteria was the main goal of the present work. For such, the antibacterial activity was determined by agar diffusion. The results showed that all tested bacterial strains showed susceptibility to diluted propolis extracts and in a dose-dependent manner. Two propolis samples collected at springtime showed higher antibacterial activity, in comparison with samples harvested at wintertime. Ethanolic and methanolic extracts have a very similar activity (P<0.05). Helicobacter pylori strains J99 and 26695 were the most susceptible strains to the tested extracts (33.67±2.52 mm and 35.67±0.58mm, respectively). This study constitutes the first approach of the biological activities of Portuguese propolis from the Algarve region and evidences its potential use to combat bacterial infections, in particular against the gastric pathogen H. pylori.

Lower limb strength and flexibility in athletes with and without patellar tendinopathy.

OBJECTIVES: To compare the hip, knee and ankle torques, as well as knee and ankle flexibility between athletes with patellar tendinopathy and asymptomatic controls. DESIGN: Cross-sectional study. SETTING: Laboratory setting. PARTICIPANTS: Fourteen male volleyball, basketball or handball athletes, divided into 2 groups, patellar tendinopathy group (TG; n = 7) and asymptomatic control group (CG; n = 7). MAIN OUTCOME MEASURES: Hip, knee and ankle isometric torques were measured with a handheld dynamometer. Weight-bearing ankle dorsiflexion, hamstring and quadriceps flexibility were measured with a gravity inclinometer. RESULTS: The TG had 27% lower hip extensor torque when compared to the CG (P = 0.031), with no group differences in knee and ankle torques (P > 0.05). Also, the TG had smaller weight-bearing ankle dorsiflexion (P = 0.038) and hamstring flexibility (P = 0.006) when compared to the CG. Regarding quadriceps flexibility, no group differences were found (P = 0.828). CONCLUSIONS: Strength and flexibility deficits might contribute to a greater overload on the knee extensor mechanism, possibly contributing to the origin/perpetuation of patellar tendinopathy. Interventions aiming at increasing hip extensors strength as well as ankle and knee flexibility might be important for the rehabilitation of athletes with patellar tendinopathy.

Reflections on the Production of the Formation of Physiotherapy in the Con-text of SUS / A produção de reflexões sobre a formação dos Fisioterapeutas no contexto do SUS

Abstract Background: This study was motivated by the need of understanding how the relationship of the training with the national health system is treated, both in the sphere of health services and the aca-demic area. This work aims to contribute to the debate on the inclusion of the physiotherapist in SUS (Brazil's NHS) by pointing out issues that need to be deepened in future studies. Purpose: To analyze the national literature production on the relationship between the training of therapists and their work in SUS, from 1996 to 2010. Methods: Descriptive research with literature on the bases: LILACS, SCI-ELO Bank and CAPES thesis. Results: We found 13 publications, sorted by: year, publication type, region where it was published in the categories "national curriculum guidelines," "professional respon-sibility", "integrality in health" and "conceptions of teachers in training in Physiotherapy ". There no publishing from 1996 to 2005, gradually increasing from this year. It was identified a higher number of articles compared to other types of publications; there is also an important difference between the Brazilian regions, with higher prevalence of studies in the South (53.8%) and a greater number of pub-lications in the category "national curriculum guidelines". Conclusion: It was possible to raise ques-tions that involve the applicability of the National Curriculum Guidelines on the pedagogical courses; suitability of teachers to the reality of SUS; investigation of the models covered in health care envi-ronments trainers, and the lack of contribution by higher education institutions on teaching-research and teaching and public service, contributing to form an important agenda of study. {#}.

Resumo Contextualização: Este estudo foi motivado pela necessidade de compreender como a relação da formação dos profissionais com o sistema nacional de saúde é tratada, tanto na esfera dos serviços de saúde quanto no espaço acadêmico. Almeja contribuir para o debate sobre a inserção do fisioterapeuta no SUS ao apontar questões que precisam ser aprofundadas em estudos futuros. Objetivo: Analisar a produção bibliográfica nacional sobre a relação entre a formação de fisioterapeutas e sua atuação no SUS, no período de 1996 a 2010. Métodos: Pesquisa descritiva, com levantamento bibliográfico nas bases: LILACS, SCIELO e Banco de teses CAPES. Resultados: Foram encontradas 13 publicações, classificadas por: ano, tipo de publicação, região em que foi publicada e pelas categorias "diretrizes curriculares nacionais", "responsabilidade do profissional", "integralidade em saúde" e "concepções dos docentes na formação em Fisioterapia". Não houve publicação desde 1996 até 2005, ocorrendo aumento progressivo a partir deste ano. Identificou-se maior quantidade de artigos em relação aos outros tipos de publicações; importante diferença entre as regiões brasileiras, com maior prevalência de estudos no Sul (53,8%); e um maior número de publicações referentes à categoria "diretrizes curriculares nacionais". Conclusão: Foi possível levantar questões que giram em torno da aplicabilidade das Diretrizes Curriculares Nacionais nos projetos pedagógicos dos cursos; adequação dos docentes à realidade do SUS; investigação dos modelos de atenção à saúde abordados nos ambientes formadores; e a carência de contribuição das Instituições de Ensino Superior de cunho particular na articulação ensino-pesquisa e ensino-serviço público, contribuindo para formar uma importante agenda de estudo.

Rehabilitation of Patellar Tendinopathy Using Hip Extensor Strengthening and Landing-Strategy Modification: Case Report With 6-Month Follow-up.

Study Design Case report. Background Although eccentric exercises have been a cornerstone of the rehabilitation of athletes with patellar tendinopathy, the effectiveness of this intervention is sometimes less than ideal. Athletes with patellar tendinopathy have been shown to have different jump-landing patterns and lower hip extensor strength compared to asymptomatic athletes. To our knowledge, the effectiveness of an intervention addressing these impairments has not yet been investigated. Case Description The patient was a 21-year-old male volleyball athlete with a 9-month history of patellar tendon pain. Pain was measured with a visual analog scale. Disability was measured with the Victorian Institute of Sport Assessment-patella questionnaire. These assessments were conducted before and after an 8-week intervention, as well as at 6 months after the intervention. Hip and knee kinematics and kinetics during drop vertical jump and isometric strength were also measured before and after the 8-week intervention. The intervention consisted of hip extensor muscle strengthening and jump landing strategy modification training. The patient did not interrupt volleyball practice/competition during rehabilitation. Outcomes After the 8-week intervention and at 6 months postintervention, the athlete was completely asymptomatic during sports participation. This favorable clinical outcome was accompanied by a 50% increase in hip extensor moment, a 21% decrease in knee extensor moment, and a 26% decrease in patellar tendon force during jump landing measured at 8 weeks. Discussion This case report provides an example of how an 8-week intervention of hip muscle strengthening and jump-landing modification decreased pain and disability and improved jump-landing biomechanics in an athlete with patellar tendinopathy. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2015;45(11):899-909. Epub 21 Sep 2015. doi:10.2519/jospt.2015.6242.

Forefoot varus predicts subtalar hyperpronation in young people.

BACKGROUND: Subtalar joint hyperpronation is a foot misalignment that has been associated with several musculoskeletal injuries. Forefoot varus is thought to result in subtalar hyperpronation during weightbearing circumstances. However, few studies have aimed to verify whether there is a significant relationship between forefoot alignment and subtalar hyperpronation. Moreover, no study has attempted to verify whether forefoot varus can predict subtalar hyperpronation in young individuals. Therefore, the purpose of this study was to verify whether forefoot varus can predict subtalar hyperpronation, measured using the rearfoot eversion angle test, the navicular drop test, and the Foot Posture Index (FPI), in young people. METHODS: Fifty-four healthy adolescents volunteered for this study (28 boys and 26 girls). A single examiner evaluated the forefoot angle, rearfoot angle, navicular drop, and FPI of each participant. Statistical analysis included the Pearson correlation test and a linear regression analysis to establish the relationship between the variables. RESULTS: These results showed a high positive correlation between forefoot varus and rearfoot angle (r = 0.86; P < .001), navicular drop (r = 0.76; P < .001), and FPI (r = 0.82; P < .001). Moreover, the forefoot varus variable was able to predict 74% of the variability in the rearfoot angle, 58% in the navicular drop, and 67% in the FPI (P < .001). CONCLUSIONS: These findings support previous assumptions that individuals with forefoot varus present subtalar hyperpronation. Clinicians should not overlook forefoot alignment when prescribing foot orthoses for treating patients with foot misalignments.

The influence of forefoot varus on eccentric hip torque in adolescents.

Hip strength impairments have been established as risk factors for lower limb injuries. Hip muscles strength might be influenced by foot misalignments, however this has not yet been verified. Forefoot varus (FV) has been shown to cause subtalar joint hyperpronation. Subtalar hyperpronation has been associated with excessive lower limb internal rotation in weight-bearing activities. Also, subtalar hyperpronation might result in greater ground reaction force dissipation at the foot. Consequently, there would be less demand for force dissipation at the hip joint, which could reduce the capacity for hip eccentric torque in these subjects. Therefore, the purpose of this study was to determine if FV influences the eccentric hip torque generation of young subjects. Forty-four sedentary, healthy adolescents were divided into 2 groups: subjects with FV (VG, n = 22) and subjects with neutral forefoot alignment (CG, n = 22). An isokinetic dynamometer was used to assess the eccentric torque generated in hip extension and external rotation in these subjects. Group differences were assessed using a one-way multivariate analysis of variance. The VG presented smaller eccentric torque for hip extension (P = 0.014) when compared to the CG, with no difference between groups in external rotation torque (P = 0.433). These results indicate that FV influences hip eccentric torque generation of young subjects. Considering that the muscles involved in hip extension are related to the stabilization of the lumbar spine, hip and knee, these findings bring further enlightenment to the role of foot misalignments as risk factors for injuries in the lower limbs and lumbo-pelvic complex in young subjects.

Relação entre hiperpronação subtalar e lesões do ligamento cruzado anterior do joelho: revisão de literatura / Relationship between subtalar hyperpronation and injuries on the anterior cruciate ligament of the knee: literature review

INTRODUÇÃO: A ruptura do ligamento cruzado anterior (LCA) é uma lesão severa, que resulta em instabilidade funcional e distúrbios articulares degenerativos. Fatores de risco proximais à articulação do joelho têm sido bastante enfatizados na última década, mas pouca atenção tem sido dada para os fatores de risco distais ao joelho. A hiperpronação subtalar (HS) foi sugerida por alguns autores como possível fator de risco às lesões do LCA, mas as evidências da literatura a respeito são escassas e pouco conclusivas. OBJETIVO: O propósito deste estudo foi realizar uma revisão dos estudos da literatura que avaliaram as alterações de alinhamento da articulação subtalar associadas à lesão do LCA ou associadas a outros fatores de risco conhecidos para essa lesão. MATERIAIS E MÉTODOS: Foi realizada uma busca em bases eletrônicas (PubMed, MEDLINE, COCHRANE, Web of Science, PEDro, SciELO, LILACS e EMBASE), compreendendo publicações de 1966 até 2011. RESULTADOS E DISCUSSÃO: Foram encontrados nove estudos clínicos considerados pertinentes ao tema. Desses trabalhos, quatro identificaram HS em indivíduos com lesão do LCA e um apontou correlação entre HS e outros fatores de risco para lesões do LCA. A não identificação de correlação entre essas variáveis nos demais estudos se deve, provavelmente, a diferenças metodológicas nas avaliações. Deve-se ressaltar que a natureza retrospectiva dos estudos encontrados não permite o estabelecimento de causa e consequência nesse contexto. São necessários estudos prospectivos, com mais uniformidade metodológica, para o definitivo estabelecimento da HS como efetivo fator de risco para as lesões do LCA.

INTRODUCTION: Anterior cruciate ligament (ACL) rupture is a severe knee injury, leading to functional instability and degenerative joint disease. Risk factors proximal to the knee joint have been highly emphasized in the last decade, but less attention has been focused on risk factors located distal to the knee. Subtalar hyperpronation (SH) has been suggested by some authors as a possible risk factor for ACL injuries, but the evidences regarding this matter are still scarce and inconclusive. OBJECTIVE: The purpose of this study was to carry out a review of literature studies that have performed assessments of the subtalar joint alignment associated to ACL injuries or associated to other known risk factors for this injury. MATERIALS AND METHODS: A search in electronic databases (PubMed, MEDLINE, COCHRANE, Web of Science, PEDro, SciELO, LILACS and EMBASE) was performed from 1966 to 2011. RESULTS AND DISCUSSION: Nine clinical studies were found to be pertinent to this matter. Among these, four studies have identified SH in subjects with ACL injury and one study has found a correlation between SH and other risk factors for ACL injury. The inexistence of correlation between these variables in the other studies is probably due to methodological differences in the assessments. It should be noted that the retrospective nature of the studies found does not allow the establishment of cause and consequence in this context. Prospective studies, with more methodological uniformity, are necessary for the definitive establishment of SH as an effective risk factor for ACL injuries.