Electrical stimulation of the posterior tibialis nerve improves symptoms of poststroke neurogenic overactive bladder in men: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of electrical stimulation of the posterior tibialis nerve in men with neurogenic overactive bladder secondary to ischemic stroke at 45 days and 12 months after treatment. MATERIALS AND METHODS: We studied 24 patients older than 18 years, with ischemic stroke that occurred between 6 months and 3 years previously and with no prior urinary symptoms. These patients were randomly allocated to receive electrical stimulation of the posterior tibialis nerve twice weekly for 6 weeks (treatment group, n = 12) or general advice and stretching sessions 1 to 3 times monthly for 6 weeks (control group, n = 12). Each session lasted 30 minutes in both groups. The primary outcomes were reduction in urinary frequency, reduction in urinary urgency, and overall improvement in voiding diary variables. RESULTS: Patients in the electrical stimulation group, in relation to baseline and to control group, experienced improvement in urinary symptoms, reducing urinary urgency and frequency, and reported subjective improvement after treatment. This effect persisted after 12 months of follow-up. The patients with lesion in right hemisphere, advanced age, and with higher body mass index presented more chance to develop urinary symptoms. CONCLUSION: Electrical stimulation of the posterior tibialis nerve is a safe and effective option for the treatment of poststroke neurogenic overactive bladder in men, reducing urinary frequency and urgency.

Beta-binomial/Poisson regression models for repeated bivariate counts.

We analyze data obtained from a study designed to evaluate training effects on the performance of certain motor activities of Parkinson's disease patients. Maximum likelihood methods were used to fit beta-binomial/Poisson regression models tailored to evaluate the effects of training on the numbers of attempted and successful specified manual movements in 1 min periods, controlling for disease stage and use of the preferred hand. We extend models previously considered by other authors in univariate settings to account for the repeated measures nature of the data. The results suggest that the expected number of attempts and successes increase with training, except for patients with advanced stages of the disease using the non-preferred hand.

Transporte intra-hospitalar de pacientes internados em UTI Neonatal: fatores de risco para intercorrências / Intra-hospital transport of neonatal intensive care patients: risk factors for complications

OBJETIVO: Estudar os fatores associados à hipotermia e ao aumento da necessidade de oxigênio e/ou suporte ventilatório durante o transporte intra-hospitalar de pacientes internados em Unidade de Terapia Intensiva neonatal. MÉTODOS: Estudo prospectivo de todos os pacientes internados na unidade neonatal que necessitaram de transporte intra-hospitalar de janeiro de 1997 a dezembro de 2000, entre segundas-feiras e sextas-feiras, das 8h às 17h. Fatores associados à hipotermia e ao aumento da necessidade de oxigênio e/ou de suporte ventilatório durante e até duas horas após o transporte foram estudados por meio de regressão logística. RESULTADOS: Foram realizados 502 transportes no período. Os pacientes tinham em média 2.000g, 35 semanas de idade gestacional ao nascer e 22 dias de vida. As principais indicações do transporte foram: cirurgia e realização de exames de imagem. A hipotermia ocorreu em 17 por cento dos transportes e o aumento da necessidade de oxigênio e/ou de suporte ventilatório em 7 por cento. Fatores associados à hipotermia foram: duração do transporte >3h (OR=2,1; IC95 por cento=1,2-3,6), presença de malformações neurológicas (OR=1,7; IC95 por cento=1,1-2,5), transporte realizado em 1997 (OR=1,7; IC95 por cento=1,1-2,6) e peso no transporte >3.500g (OR=0,3; IC95 por cento=0,16-0,68). Fatores de risco para o aumento da necessidade de oxigênio e/ou de suporte ventilatório foram: idade gestacional ao nascimento em semanas (OR=0,9; IC95 por cento=0,8-0,9), idade em dias no transporte (OR=1,0; IC95 por cento=1,0-1,1) e presença de malformações gastrintestinais e geniturinárias (OR=3,1; IC95 por cento=1,6-6,2). CONCLUSÕES: As intercorrências relativas ao transporte intra-hospitalar são freqüentes nos neonatos em UTI e estão associadas às condições dos pacientes e dos transportes.

OBJECTIVE: Evaluate factors associated with hypothermia and increased need of oxygen and/or ventilatory support during intra-hospital transport of neonatal intensive care patients. METHODS: Prospective study of infants admitted to a single neonatal unit in need of at least one intra-hospital transport during weekdays, from 8:00AM to 05:00PM, from January 1997 to December 2000. Factors associated with hypothermia and increased need of oxygen and/or need of ventilatory support during and up to two hours after transport were studied by regression analyses. RESULTS: During the study period, 502 transports were analyzed. At the time of transport, the neonates had a mean weight and gestational age of, respectively, 2,000g and 35 weeks, and they were 22 days old. The main reasons for transport were: surgery and image exams. Hypothermia occurred in 17 percent of the transported infants and increased need of oxygen and/or ventilatory support in 7 percent. Factors associated with hypothermia were: duration of transportation >3h (OR=2.1; 95 percentCI=1.2-3.6), neurologic malformation (OR=1.7; 95 percentCI=1.1-2.5), transport performed in 1997 (OR=1.7; 95 percentCI=1.1-2.6) and weight at time of transport >3,500g (OR=0.3; 95 percentCI=0.16-0.68). Factors associated with increased need of oxygen and/or ventilation support were: gestational age at birth in weeks (OR=0.9; 95 percentCI=0.8-0.9), age in days at transportation (OR=1.0; 95 percentCI=1.0-1.1) and presence of gastrointestinal and genitourinary malformation (OR=3.1; 95 percentCI=1.6-6.2). CONCLUSIONS: Complications related to neonatal intra-hospital transports are frequent and associated with the patients' characteristics and transport conditions.

Strict guideline reduces the need for RBC transfusions in premature infants.

The aim of this study was to verify if the adoption of a strict guideline would reduce the need for red blood cell transfusions in the first 28 days of life in very low birth weight preterm infants. Retrospective study of two cohorts of very low birth weight infants transfused according to neonatologist decision (Period 1) or according to a strict guideline for erythrocytes transfusion (Period 2). Clinical and hematological data of 80 premature infants transfused in both periods of the study were obtained by chart review. During the first 28 days of life, 45 (62.5%) of 72 premature infants born in the Period 1, and 44 (55.7%) of 79 newborns born in Period 2 received at least one erythrocyte transfusion; p = 0.40. Among patients transfused, the median number of transfusions was four per infant transfused (range: 1-13; mean: 4.6 +/- 3.2) in Period 1 and 3 (range: 1-18; mean: 4.0 +/- 3.5) in Period 2; p = 0.26. The median volume of erythrocytes administered per infant transfused in Period 1 was 40 ml kg(-1) (range: 10-170; mean: 48.8 +/- 38.3) and in Period 2 was 30 ml kg(-1) (range: 10-225; mean: 43.4 +/- 40.4), p = 0.41. Multiple linear regression analysis, after adjusting for birth weight, clinical risk index for babies, blood loss and days of ventilation, showed that the adoption of the strict guideline reduced the volume of erythrocytes transfused in 15.91 ml kg(-1) per infant transfused (95% CI: -24.69-7.14) p < 0.001. The adoption of a strict guideline reduced the need for red blood cells transfusions in very low birth weight infants.

Salivary cortisol as an indicator of adrenocortical function in healthy infants, using massage therapy.

CONTEXT AND OBJECTIVE: The evaluation of adrenocortical function with the use of therapeutic massage has been little studied in Brazil. The purpose of this study was to evaluate the salivary cortisol levels before and after Shantala massage therapy on healthy infants. DESIGN AND SETTING: Prospective case series, in a public nursery, in São Paulo. METHODS: Saliva was obtained from 11 infants at the times of 8:00-9:00 a.m. and 4:00-5:00 p.m. in a nursery and 9:00-10:00 p.m. at home. They received a 15-minute therapeutic massage on two consecutive days, and saliva was collected before and after the massage. The procedure was repeated after a one-week interval. Cortisol values (intra-assay < 5%; inter-assay < 10%) at different times of the day were compared by ANOVA. RESULTS: The mean cortisol values (nmol/l +/- SD) on the first day were: morning (M) = 14.1 +/- 5.7, afternoon (A) = 8.3 +/- 2.7, night (N) = 3.3 +/- 1.1; after two consecutive days of therapeutic massage: M = 22.3 +/- 13.5, A = 13.4 +/- 6.0, N = 5.8 +/- 3.5; after a one-week interval: M = 15.8 +/- 7.7, A = 14.3 +/- 7.7, N = 3.4 +/- 2.0. CONCLUSION: There was a modification in the salivary cortisol values following massage, thus reflecting possible adaptation of the hypothalamic-pituitary-adrenal axis.

Salivary cortisol as an indicator of adrenocortical function in healthy infants, using massage therapy

CONTEXTO E OBJETIVO: A avaliação da função adrenocortical com uso da massagem terapêutica no Brasil tem sido pouco estudada. O objetivo foi avaliar os níveis de cortisol salivar antes e após a massagem terapêutica Shantala em lactentes sadios. TIPO DO ESTUDO E LOCAL: Prospectivo/série de casos, numa creche pública em São Paulo. MÉTODOS: Amostras de saliva foram obtidas de 11 lactentes durante um dia entre 08h00 e 09h00, 16h00 e 17h00 na creche, e entre 21h00 e 22h00 na residência. Durante dois dias consecutivos os lactentes receberam 15 minutos de massagem terapêutica, coletando-se a saliva antes e após a massagem. O procedimento foi repetido após intervalo de uma semana. Os valores de cortisol (duplicatas; coeficiente de variação intra e interensaio < 5% e < 10%) nos diferentes períodos do dia foram comparados por análise de variância com medidas repetidas (ANOVA) e análise descritiva. RESULTADOS: Os valores médios no primeiro dia (± desvio padrão) de cortisol (nmol/l) foram: manhã (M) = 14,1 ± 5,7; tarde (T) = 8,3 ± 2,7; noite (N) = 3,3 ± 1,1; e, após dois dias consecutivos com massagem terapêutica, foram: M = 22,3 ± 13,5; T = 13,4 ± 6,0; N = 5,8 ± 3,5, respectivamente. Após intervalo de uma semana, foram: M = 15,8 ± 7,7; T = 14,3 ± 7,7 e N = 3,4 ± 2,0 nmol/l. CONCLUSÃO: Houve modificação nos valores de cortisol salivar pós-massagem, refletindo possível adaptação do eixo hipotalâmico-hipofisário-adrenal nos lactentes.

Cognitive dysfunction in children with sleep-disordered breathing.

Two daily school periods are mandatory in Brazil owing to a shortage of academic facilities, which can decrease cognitive performance, especially in children with sleep-disordered breathing. This study aimed to verify the influence of starting time to school on cognition, comparing children with sleep disorders and normal children. Cognition was assessed in 79 children with sleep-disordered breathing, 468 children with nonrespiratory sleep disorders, and 633 normal control children. We analyzed total sleep time, starting time to school (morning or afternoon), and grades. First grade morning students with sleep-disordered breathing had 8.04 higher odds for cognitive dysfunction than normal children. For children with sleep-disordered breathing, second and third grade morning students had higher odds for cognitive dysfunction than those who studied in the afternoon (3.69 and 4.07). Fourth grade morning students had 8.27 higher odds for cognitive dysfunction than first grade children. In conclusion, sleep-disordered breathing, grades, and starting time to school interact to affect cognition in Brazilian children.