Physical performance testing in post-COVID-19 patients: protocol for a systematic review of psychometric measurement properties.

INTRODUCTION: COVID-19 is an infectious disease that causes severe acute respiratory syndrome. A large variety of exercise capacity tests are used for the evaluation of post-COVID-19 patients, but the psychometric properties of these exercise tests remain undetermined in this population. This study aims to critically appraise, compare and summarise the psychometric properties (validity, reliability and responsiveness) of all physical performance tests that are used to assess exercise capacity in post-COVID-19 patients. METHODS AND ANALYSIS: This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. We will include studies with hospitalised adult post-COVID-19 patients (aged 18 years or older and with a confirmed diagnosis of COVID-19). The research will cover randomised controlled trials (RCTs), quasi-RCTs and observational studies published in English and performed in the following settings: hospital, rehabilitation centre, outpatient clinic. We will search the following databases with no date restrictions: PubMed/MEDLINE, EMBASE, SciELO, Cochrane Library, CINAHL and Web of Science. Two authors will independently assess the risk of bias (using the Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of bias checklist) and the certainty of evidence (using the Grading of Recommendations, Assessment, Development and Evaluations). According to the results obtained, data will be meta-analysed or reported narratively. ETHICS AND DISSEMINATION: No ethical approval is required for this publication since it will be based on published data. Results of this review will be disseminated via peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42021242334.

Psychometric properties of the sit-to-stand test for patients with pulmonary hypertension: A systematic review protocol.

BACKGROUND: Pulmonary hypertension (PH) is a complex syndrome characterized by increased pulmonary arterial pressure and classified into five groups, according to dyspnea on exertion and systemic muscle dysfunction. These symptoms can be identified using the sit-to-stand test (STS), which indirectly evaluates exercise tolerance and lower limb muscle strength. Previous studies used the STS in PH; however, psychometric properties to understand and validate this test were not described for patients with PH. OBJECTIVE: To evaluate the psychometric properties (validity, reliability, and responsiveness) of different STS protocols in patients with PH. METHODS AND ANALYSES: This is a systematic review protocol that will include studies using STS in patients with PH. Searches will be conducted on PubMed/MEDLINE, EMBASE, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases following PICOT mnemonic strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Rayyan software will be used for study selection. The Risk of bias will be assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) tool, while the quality of evidence will be assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Two researchers will independently conduct the study, and a third researcher will be consulted in case of disagreement. The psychometric properties will be evaluated according to the COSMIN. This protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, no. CRD42021244271). CONCLUSION: This systematic review will attempt to identify and show the available evidence on STS for different groups of PH and report validity, reliability, and responsiveness of different protocols.

Association of miltefosine with granulocyte and macrophage colony-stimulating factor (GM-CSF) in the treatment of cutaneous leishmaniasis in the Amazon region: A randomized and controlled trial.

OBJECTIVES: To compare topical granulocyte and macrophage colony-stimulating factor (GM-CSF) and miltefosine (G + M) versus placebo and miltefosine (P + M) or parenteral meglumine antimoniate (MA) in the treatment of 150 patients with cutaneous leishmaniasis (CL) caused by Leishmania guyanensis in the Amazon. DESIGN: A randomized and double-blinded clinical trial. RESULTS: At 90 days after the initiation of therapy, the cure rates were 66%, 58%, and 52% for the groups P + M, G + M, and MA, respectively (p > 0.05). Cure rates at 180 days did not differ. Healing time was similar in the 3 groups, but faster in the MA group as compared to the G + M group (p = 0.04). Mild and transitory systemic adverse events were frequent in all groups (above 85%). Nausea (85%) and vomiting (39%) predominated in the miltefosine groups and arthralgia (51%) and myalgia (48%) in the MA group. One patient (group MA) stopped treatment after presenting with fever, exanthema, and severe arthralgia. CONCLUSIONS: Miltefosine did not present a higher cure rate than MA, and the association of GM-CSF did not improve the therapeutic response. Nevertheless, because of its less toxicity, easier administration, and a similar cure rate when compared with MA, miltefosine should remain as one of the main drugs for treating CL due to L. guyanensis. (Clinicaltrials.gov Identifier NCT03023111).

Motor neuroprosthesis for promoting recovery of function after stroke.

BACKGROUND: Motor neuroprosthesis (MN) involves electrical stimulation of neural structures by miniaturized devices to allow the performance of tasks in the natural environment in which people live (home and community context), as an orthosis. In this way, daily use of these devices could act as an environmental facilitator for increasing the activities and participation of people with stroke. OBJECTIVES: To assess the effects of MN for improving independence in activities of daily living (ADL), activities involving limbs, participation scales of health-related quality of life (HRQoL), exercise capacity, balance, and adverse events in people after stroke. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (searched 19 August 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (August 2019), MEDLINE (1946 to 16 August 2019), Embase (1980 to 19 August 2019), and five additional databases. We also searched trial registries, databases, and websites to identify additional relevant published, unpublished, and ongoing trials. SELECTION CRITERIA: Randomized controlled trials (RCTs) and randomized controlled cross-over trials comparing MN for improving activities and participation versus other assistive technology device or MN without electrical stimulus (stimulator is turned off), or no treatment, for people after stroke. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, extracted data, and assessed risk of bias of the included studies. Any disagreements were resolved through discussion with a third review author. We contacted trialists for additional information when necessary and performed all analyses using Review Manager 5. We used GRADE to assess the certainty of the evidence. MAIN RESULTS: We included four RCTs involving a total of 831 participants who were more than three months poststroke. All RCTs were of MN that applied electrical stimuli to the peroneal nerve. All studies included conditioning protocols to adapt participants to MN use, after which participants used MN from up to eight hours per day to all-day use for ambulation in daily activities performed in the home or community context. All studies compared the use of MN versus another assistive device (ankle-foot orthosis [AFO]). There was a high risk of bias for at least one assessed domain in three of the four included studies. No studies reported outcomes related to independence in ADL. There was low-certainty evidence that AFO was more beneficial than MN on activities involving limbs such as walking speed until six months of device use (mean difference (MD) -0.05 m/s, 95% confidence interval (CI) -0.10 to -0.00; P = 0.03; 605 participants; 2 studies; I2 = 0%; low-certainty evidence); however, this difference was no longer present in our sensitivity analysis (MD -0.07 m/s, 95% CI -0.16 to 0.02; P = 0.13; 110 participants; 1 study; I2 = 0%). There was low to moderate certainty that MN was no more beneficial than AFO on activities involving limbs such as walking speed between 6 and 12 months of device use (MD 0.00 m/s, 95% CI -0.05 to 0.05; P = 0.93; 713 participants; 3 studies; I2 = 17%; low-certainty evidence), Timed Up and Go (MD 0.51 s, 95% CI -4.41 to 5.43; P = 0.84; 692 participants; 2 studies; I2 = 0%; moderate-certainty evidence), and modified Emory Functional Ambulation Profile (MD 14.77 s, 95% CI -12.52 to 42.06; P = 0.29; 605 participants; 2 studies; I2 = 0%; low-certainty evidence). There was no significant difference in walking speed when MN was delivered with surface or implantable electrodes (test for subgroup differences P = 0.09; I2 = 65.1%). For our secondary outcomes, there was very low to moderate certainty that MN was no more beneficial than another assistive device for participation scales of HRQoL (standardized mean difference 0.26, 95% CI -0.22 to 0.74; P = 0.28; 632 participants; 3 studies; I2 = 77%; very low-certainty evidence), exercise capacity (MD -9.03 m, 95% CI -26.87 to 8.81; P = 0.32; 692 participants; 2 studies; I2 = 0%; low-certainty evidence), and balance (MD -0.34, 95% CI -1.96 to 1.28; P = 0.68; 692 participants; 2 studies; I2 = 0%; moderate-certainty evidence). Although there was low- to moderate-certainty evidence that the use of MN did not increase the number of serious adverse events related to intervention (risk ratio (RR) 0.35, 95% CI 0.04 to 3.33; P = 0.36; 692 participants; 2 studies; I2 = 0%; low-certainty evidence) or number of falls (RR 1.20, 95% CI 0.92 to 1.55; P = 0.08; 802 participants; 3 studies; I2 = 33%; moderate-certainty evidence), there was low-certainty evidence that the use of MN in people after stroke may increase the risk of participants dropping out during the intervention (RR 1.48, 95% CI 1.11 to 1.97; P = 0.007; 829 participants; 4 studies; I2 = 0%). AUTHORS' CONCLUSIONS: Current evidence indicates that MN is no more beneficial than another assistive technology device for improving activities involving limbs measured by Timed Up and Go, balance (moderate-certainty evidence), activities involving limbs measured by walking speed and modified Emory Functional Ambulation Profile, exercise capacity (low-certainty evidence), and participation scale of HRQoL (very low-certainty evidence). Evidence was insufficient to estimate the effect of MN on independence in ADL. In comparison to other assistive devices, MN does not appear to increase the number of falls (moderate-certainty evidence) or serious adverse events (low-certainty evidence), but may result in a higher number of dropouts during intervention period (low-certainty evidence).

Analysis of oral health conditions and risk factors for dental caries in patients with sickle cell disease / Condições de saúde bucal e análise de fatores de risco de cárie dentária de pacientes portadores de doença falciforme

ABSTRACT Objective: To analyze the oral health conditions and risk factors for caries in patients with sickle cell disease. Methods: An observational, cross-sectional study was conducted in the clinic of the Association of Persons with Hemoglobinopathies of Alagoas, in the city of Maceió-AL, Brazil. The sample composed of 43 patients were included by census sampling. The ICDAS/DMFT/dmf-t caries indices were used, and simplified oral hygiene, salivary flow and buffer capacity tests were performed. Patients were interviewed to check their level of knowledge about oral hygiene and diet. Spearman correlation and ANOVA statistical tests were applied (p<0.05). Results: The mean DMFT was 15.49±4.43; oral hygiene regular (IHOS=2.22±0.18); mean salivary flow 0.92±0.26, and mean buffer capacity 4.60±0.32. Correlation was found between salivary flow and buffer capacity (p = 0.009). Patients with the highest caries prevalence, in the age-ranges 6 to 12, and 20 to 26 years, had the lowest buffer capacity values (p = 0.04). Interviews showed that 58% did not use dental floss, 88% consumed cariogenic snacks, 100% reported never having received guidance from dentists about the cariogenic potential of foods and 60% reported the use of anticholinergic medications to reduce drooling (Tramal® and morphine) during pain crises. Conclusion: These patients presented extremely high caries prevalence, with predominance of carious teeth. The salivary parameters analyzed and level of knowledge about oral hygiene and cariogenic diet presented, showed that patients with sickle cell disease belonged to a group with risk for development of dental caries.

RESUMO Objetivo: Analisar as condições de saúde bucal e fatores de risco de cárie de pacientes com doença falciforme. Métodos: A pesquisa observacional e transversal foi realizada na Associação de Pessoas com Hemoglobinopatias de Alagoas situada na cidade de Maceió-AL. Amostra composta por 43 pacientes incluídos por amostragem censitária. Foram utilizados os índices de cárie ICDAS/CPOD/ceod e de higiene oral simplificado, testes de fluxo salivar e capacidade tampão. Os pacientes foram entrevistados para a verificação do nível de conhecimento sobre higiene bucal e dieta. Foram aplicados os testes de correlação de Spearman e ANOVA (p<0,05). Resultados: O CPOD médio foi de 15,49±4,43, higiene oral regular (IHOS=2,22±0,18), fluxo salivar médio de 0,92±0,26 e capacidade tampão média de 4,60±0,32. Existiu correlação entre o fluxo salivar e capacidade tampão (p= 0,009). Os pacientes com maiores prevalências de cárie, nas faixas etárias de 6 a 12 anos e 20 a 26 anos, possuíam os mais baixos valores de capacidade tampão (p= 0,04). A entrevista mostrou que 58% não utilizavam fio dental, 88% lanchavam alimentos cariogênicos, 100% relataram nunca ter recebido orientações do cirurgião dentista sobre o potencial cariogênico dos alimentos e 60% relataram que utilizavam medicamentos redutores de salivação (Tramal® e morfina) durante as crises álgicas. Conclusão: Os pacientes apresentaram uma prevalência de cárie muito alta, com a predominância de dentes cariados. Os parâmetros salivares analisados e o nível de conhecimento, sobre higiene bucal e dieta cariogênica apresentados, mostraram que pacientes com doença falciforme pertencem a um grupo de risco de desenvolvimento de cárie dentária.

[The mental health promotion of children and teenagers in vulnerability and social violence: the challenges for an intersectoral network]. / La promotion de la santé mentale des enfants et adolescents en situation de vulnérabilité et violence sociale : les défis pour un réseau intersectoriel.

This paper presents and discusses the results of an intervention research conducted in Ouro Preto, Brazil from August 2014 to March 2016. The main objective was to contribute to the development of an intersectoral and interdisciplinary network to face psychosocial vulnerabilities of children and teenagers, especially related to sexual violence and drug use. To achieve this, we identified the difficulties faced by the Sistema de Garantia de Direitos Humanos da Criança e do Adolescente (SGDHCA) implemented by the municipality which take care of this population. We also identified protective and promotion factors accomplished to empower them. The methodology used combines Deleuze and Guattari Cartography, Institutional Analysis and the Cross Training. This latter methodology was developed by a group of researchers of Douglas Institute, in Montreal, which we met through scientific co-operation with our laboratory. On account of the practical-theoric and co-participative activities with the professional network of Ouro Preto, we produced a detailed diagnosis of the SGDHCA and a document proposing short, medium and long-term strategies. As final result, we intend to help the local collective-the Forum Intersetorial da Infância e Juventude-to develop a work plan from the proposed actions. In this paper we will concentrate the potential of the methodology used by presenting outcome from two important moments of the research: the discussions of successful and unsuccessful cases that elucidate the network operation and the potential and difficulties arising from the Rotation Positional, important technical of the Cross Training.

Correlation between balance, speed, and walking ability in individuals with chronic hemiparesis / Correlação entre equilíbrio, velocidade e capacidade de deambular em indivíduos com hemiparesia

Abstract Alterations in balance and gait are frequently present in patients with hemiparesis. This study aimed at determining whether there is a correlation between static and functional balance, gait speed and walking capacity. To that end, 17 individuals with chronic hemiparesis of both sexes (58.8% men and 42.25 women), mean age of 56.3 ± 9.73 years, took part in the study. Static balance was assessed by computerized baropodometry, under two different sensory conditions: eyes open (EO) and eyes closed (EC). Functional balance was evaluated by Berg Balance Scale and walking ability by the Functional Ambulation Classification. Gait speed was assessed by kinemetry. The Kolmogorov-Smirnov test was used to verify data distribution normality. Parametric variables were correlated by Pearson's test and their non-parametric parameters by Spearman's test. Functional balance showed a positive correlation with gait speed (p=0.005; r=0.64) and walking ability (p = 0.019; r = 0.56). Anteroposterior (AP) and mediolateral (ML) alterations with EO and EC exhibited negative correlations with gait speed (EO: AP amplitude (p = 0.0049 and r = -0.48); mean ML deviation (p = 0.019 and r =-0.56)/ EC: mean AP deviation (p = 0.018 and r = -0.56) and mean ML deviation (p = 0.032 and r = -0.52); AP amplitude (p = 0.014 and r = -0.57) and ML amplitude (p = 0.032 and r = -0.52); postural instability (p = 0.019 and r = -0.55)) and walking ability (EO: mean AP deviation (p = 0.05 and r = -0.47) and AP amplitude (p = 0.024 and r = -0.54)). The results suggest correlations between static and functional balance and gait speed and walking ability, and that balance training can be an important component of gait recovery protocols.

Resumo Alterações no equilíbrio e marcha são sequelas frequentes em sujeitos com hemiparesia. Este trabalho objetivou verificar se há correlação entre equilíbrio estático e funcional, velocidade e capacidade de deambular. Participaram do estudo 17 sujeitos com hemiparesia crônica, de ambos os sexos (58,8% de homens) com média de idade de 56,3±9,73 anos. A avaliação do equilíbrio estático foi realizada por baropodometria computadorizada em duas condições sensoriais: olhos abertos (AO) e fechados (OF). O equilíbrio funcional foi avaliado pela Escala Equilíbrio de Berg e a capacidade de deambulação, pela Categoria de Deambulação Funcional. A velocidade da marcha foi avaliada por meio da Cinemetria. A normalidade dos dados foi verificada pelo teste de Kolmogorov-Smirnov e as variáveis foram correlacionadas pelos testes de Pearson ou Spearman. O equilíbrio funcional apresentou correlação positiva com a velocidade (p = 0,005; r = 0,64) e com a capacidade de deambulação (p = 0,019; r = 0,56). As oscilações antero-posteriores (AP) e médio-laterais (ML) com OA e OF apresentaram correlações negativas com velocidade da marcha (OA: amplitude AP (p = 0,0049 e r = -0,48); desvio médio ML (p = 0,019 e r = -0,56) / OF: desvio médio AP (p = 0,018 e r = -0,56) e ML (p = 0,032 e r = -0,52); amplitude AP (p = 0,014 e r = -0,57) e ML (p = 0,032 e r = -0,52); instabilidade postural (p = 0,019 e r = -0,55) e com capacidade de deambulação (OA: desvio médio AP (p = 0,05 e r = -0,47) e amplitude AP (p = 0,024 e r = -0,54). Os resultados sugerem a existência de correlações entre o equilíbrio estático e funcional com a velocidade de marcha e capacidade de deambular, bem como que o treino do equilíbrio pode ser um importante componente para protocolos de recuperação da marcha.

Acesso de sujeitos pós-acidente vascular cerebral aos serviços de fisioterapia / Individuals' access after cerebrovascular accident to the physical therapy services / Acceso de sujetos post-accidente vascular cerebral a los servicios de fisioterapia

Objetivo: caracterizar o acesso aos serviços de fisioterapia de sujeitos após o AVC. Método: recorte de estudo longitudinal com indivíduos pós-AVC admitidos em um hospital público de uma capital do Nordeste. Os dados foram coletados por meio de entrevistas estruturadas, entre 15 e 21 dias após a alta hospitalar e 90 e 105 após a primeira entrevista. Posteriormente, esses dados foram processados no software estatístico R. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, CAAE nº 06573712.9.0000.5188. Resultados: 66,7% dos pacientes apresentavam deficiência classificada de moderada a grave; 30,8% tiveram acesso aos serviços de fisioterapia; 41,7% utilizaram o serviço público para a marcação; 66,7% realizaram a fisioterapia em domicílio; 58,3% pagaram pelo serviço e realizaram duas a três sessões semanais e 50% entre 11 e 20 sessões. No momento da entrevista, apenas 50% estavam em tratamento. Conclusão: destaca-se a necessidade de ampliar o acesso aos serviços de fisioterapia. O estudo pode subsidiar um melhor planejamento e reorganização da rede de saúde em seus diversos níveis de atenção.(AU)

Objective: to characterize the access to physical therapy services to individuals after a stroke. Method: this is a longitudinal study clipping with post-stroke individuals admitted to a public hospital in a capital of the Northeast. Data were collected through structured interviews after 15 and 21 days hospital discharge and after 90-105 days of the first one. Then, the data were processed using the statistical software R. The Research Ethics Committee, CAAE 06573712.9.0000.5188, approved the research project. Results: 66.7% of patients had moderate to severe disabilities classified; 30.8% had access to physiotherapy services; 41.7% used the public service for appointments; 66.7% had physical therapy at home; 58.3% have paid for the service and had treatment from two to three times a week e 50% between 11 and 20 sessions. At the time of the interview, only 50% were being treated. Conclusion: it is highlighted the need to expand access to physiotherapy services. The study can support better planning and reorganization of the health system in its different levels of care.(AU)

Objetivo: caracterizar el acceso a los servicios de fisioterapia de sujetos después de un AVC. Método: recorte de estudio longitudinal con individuos post-AVC admitidos en un hospital público en una capital del Nordeste. Los datos fueron recogidos por medio de entrevistas estructuradas, entre 15 e 21 días después de alta hospitalaria y 90-105 después de la primera. Posteriormente, los datos fueron procesados en el software estadístico R. El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, CAAE nº 06573712.9.0000.5188. Resultados: 66,7% de los pacientes presentaban deficiencia clasificada de moderada a grave; 30,8% tuvieron acceso a los servicios de fisioterapia; 41,7% utilizaron el servicio público para la marcación; 66,7% realizaron la fisioterapia en su domicilio; 58,3% pagaron por el servicio y realizaron dos a tres sesiones semanales y 50% entre 11 y 20 sesiones. En el momento de la entrevista apenas 50% estaban en tratamiento. Conclusión: se destaca la necesidad de ampliar el acceso a los servicios de fisioterapia. El estudio puede subsidiar un mejor planeamiento y reorganización de la red de salud en sus diversos niveles de atención.(AU)

Desempenho psicomotor de crianças pré- escolares / Psychomotor Performance of preschool children

Avaliar o desempenho psicomotor em crianças pré-escolares com 5 anos de idademediante a utilização de uma escala validada. Métodos: Estudo prospectivo e observacional,de abordagem dedutiva com procedimento descritivo e estatístico, o qual realizou avaliaçãopsicomotora em 30 crianças matriculadas em um Centro de Referência em Educação Infantil(CREI) de João Pessoa-PB, em 2011, utilizando-se uma escala de desenvolvimento validadae adaptada. Os dados foram analisados utilizando-se o software SPSS 16.0. Resultados:Notou-se nas áreas de aquisição que os avaliados atingiram 21 (89,4%) dos 24 pontos damotricidade, 10 (84,7%) dos 12 pontos da maturação socioemocional, 16 (75,3%) dos21 pontos da visomotricidade, e 11 (71,3%) dos 15 pontos da audição-linguagem falada,caracterizando a área mais comprometida da psicomotricidade. Conclusão: Os achadosdo estudo demonstraram déficits em todas as perspectivas psicomotoras avaliadas,indicando desempenho psicomotor não satisfatório com a idade cronológica, com ênfasenas dificuldades de aquisição da audição-linguagem falada, nos exercícios de lateralizaçãodefinida e na realização de atividades de socialização...

Análise do prognóstico de hipertensos cadastrados no HiperDia / Hypertension prognostic analysis of registered patients in HiperDia

A Hipertensão Arterial Sistêmica (HAS) apresenta alta prevalência no mundo, Isso acarreta um grande impacto na saúde pública, uma vez que provoca sérias complicações cardiovasculares, elevado índice de morbimortalidade e custos referentes ao tratamento. Acredita-se que há uma limitação no direcionamento das ações de prevenção da HAS, quando tratamos da Atenção Primária à Saúde, para grupos específicos e com maiores demandas em saúde. Assim, este estudo tem como objetivo descrever e analisar o perfil de hipertensos cadastrados no programa HiperDia no estado da Paraíba, a partir do Risco Estratificado e Quantificação de Prognóstico presente no sistema de informação DATASUS. Para análise dos resultados, optou-se por uma análise descritiva das variáveis relacionadas com a HAS. Para um maior entendimento da relação entre a Classificação de Risco e a faixa etária, será utilizada a Análise de Correspondência para melhor relacionar as categorias destas variáveis. Constata-se a associação entre a classificação do prognóstico e a faixa etária, na qual o risco elevado se aproxima da faixa etária entre 40 e 59anos. Ressalta-se a crescente relação da Estratificação de Risco com as condições de vida e comorbidades. Diante dos achados, destaca-se a importância de identificar a relação entre a quantificação do prognóstico e as Faixas Etárias mais prevalentes, com o intuito de fornecer subsídios para minimizar o impacto socioeconômico provocado pela HAS e colaborar para a melhoria na qualidade de vida da população

Hypertension is highly prevalent in the world causing a major impact on public health due to cause serious cardiovascular complications, high rates of morbidity and costs related to treatment. It is believed that there is a limitation in the direction of prevention of hypertension at the level of primary health care for specific groups and greater demands on health. Therefore, this study aims to describe and analyze the profile of hypertensive patients enrolled in the program HiperDia in the state of Paraíba, from Stratified Risk Quantification and Prognosis with the information provided by the DATASUS system. For data analysis, we chose a descriptive analysis of the variables related to hypertension. For a greater understanding of the relationship between the risk rating and age group, it will be used correspondence analysis to better relate the categories of these variables. Finds an association between the classification of the prognosis and age, in which the high risk approaches theage group between 40 and 59 years. We highlightthe growing relationship of Risk Stratification in the living conditions and comorbidities. Given the findings, it is highlightedthe importance of identifying the relationship between theprediction and quantification of the most prevalent age groups, with the aim of providing subsidies to minimize the socioeconomic impact caused by hypertension and to help improve the quality of life.

Long-term lithium treatment reduces glucose metabolism in the cerebellum and hippocampus of nondemented older adults: an [¹8F]FDG-PET study.

Lithium modulates several intracellular pathways related to neuroplasticity and resilience against neuronal injury. These properties have been consistently reported in experimental models, and involve the up-regulation of neurotrophic response and autophagy, and down-regulation of apoptosis, oxidative stress, and inflammation. Clinical and epidemiological studies in bipolar disorder show that acute treatment with lithium increases plasma concentrations of brain-derived neurotrophic factor, and long-term treatment lowers the risk of dementia. Neuroimaging studies indicate that lithium use is further associated with increased cortical thickness and larger hippocampal volumes. The objective of the present study was to evaluate whether these neurobiological properties of lithium reflect in increased regional brain glucose metabolism, as shown by [(18)F]FDG-PET. Participants (n = 19) were nondemented older adults recruited at the end point of a controlled trial addressing clinical and biological effects of lithium in a sample of patients with amnestic mild cognitive impairment. Twelve patients who had received low-dose lithium carbonate for 4 years were compared to seven matched controls. Chronic lithium treatment was not associated with any significant increase in brain glucose metabolism in the studied areas. Conversely, we found a significant reduction in glucose uptake in several clusters of the cerebellum and in both hippocampi. These findings were not associated with any clinical evidence of toxicity. The clinical implications of the present findings need to be clarified by future controlled studies, particularly in the light of the potential use of lithium as a disease-modifying treatment approach for certain neurodegenerative disorders, namely, Alzheimer's disease and amyotrophic lateral sclerosis.

Percepção Fisioterapêutica de Indivíduos Parkinsonianos Correlacionando Escalas de Avaliação / Physiotherapeutic Perception Of Parkinsonian Individuals correlating Assessment Scales

A doença de Parkinson é caracterizada portremor, bradicinesia, rigidez e instabilidade postural. Podeacarretar alterações neurológicas, cognitivas e respiratórias,provocando limitações funcionais que variam conforme onível de gravidade sintomatológico e ocasionando diminuiçãodas atividades de vida diária e laborais, além de umaprogressiva postura de afastamento do convívio social.Objetivo: Correlacionar escalas de avaliação do estadocinético-funcional, do comprometimento cognitivo e daqualidade de vida em três indivíduos com doença deParkinson. Material e Métodos: Participaram três pacientes,duas do sexo feminino e um do sexo masculino, com faixaetária variando de 51 a 61 anos e nível de escolaridadedesde o ensino fundamental menor completo até pósgraduaçãona área da educação. Para caracterizar os sujeitosdo estudo em relação ao estadiamento da doença deParkinson, utilizou-se antes de iniciar o tratamentofisioterapêutico os seguintes questionários: Mini-MentalState Examination (MEEM), Medida de IndependênciaFuncional (MIF), Parkinson’s Disease Questionnaire (PDQ-39) e Escala de Mobilidade e Equilíbrio de Tinetti / Teste doAndar. Resultados: Quanto à análise do equilíbrio e da marcha,os três pacientes apresentaram déficit em ambos, sendoque com movimentos distintos para deambular, como: marchalenta, passos curtos e passos assimétricos. Todos ospacientes também demonstraram moderado risco de quedas.Conclusão: Observou-se a existência de correlação quantoà aplicação das escalas de avaliação do estado cinéticofuncional,visto que os três pacientes possuem equilíbrio emarcha deficitários atestados na Escala de Mobilidade e Equilíbrio de Tinetti e no Teste do Andar...

Introduction: Parkinson’s disease is characterized by tremor,bradykinesia, rigid muscles, and postural instability. It maylead to neurological, cognitive, and respiratory alterations,causing functional limitations that vary according to the levelof symptomatic severity. As a result, daily life and labouractivities may be decreased, in addition to gradual self-removalfrom social life. Objective: To correlate assessment scalesfrom the kinetic functional state, cognitive impairment, andquality of life in three individuals living with Parkinson’sdisease. Material and Methods: Three patients were involvedin the study, two female and one male, age group varyingbetween 51 and 61 years and educational level varying sincecompleted elementary school up to graduate degree in theeducational area. In order to characterize the study subjectsas to Parkinson’s disease staging, before starting thephysiotherapeutic treatment, the following questionnaireswere used: Mini-Mental State Examination (MEEM), FunctionalIndependence Measure (FIM), Parkinson’s DiseaseQuestionnaire (PDQ-39), and Tinetti Mobility and BalanceScale / Gait Scale. Results: The three patients presenteddeficit in both balance and gait analyses, with distinct walkingmovements, such as idling, short steps and asymmetricalsteps. All patients also showed moderate risk of falls.Conclusion: There was a correlation as to the application ofthe assessment scales of the kinetic-functional state, giventhat the three patients showed balance and gait deficitsdetected in the Tinetti’s Mobility and Balance Scale and in theGait test...

Lymphangiectatic Kaposi's sarcoma in a patient with AIDS.

Kaposi's sarcoma is a malignant disease that originates in the lymphatic endothelium. It has a broad spectrum of clinical manifestations. Its four distinct clinical forms are: classic, endemic, iatrogenic and epidemic Kaposi's sarcoma. In non-HIV-associated Kaposi's sarcoma, the disease is typically limited to the lower extremities, but in immunodeficient patients, it is a multifocal systemic disease. The clinical course of the disease differs among patients, ranging from a single or a few indolent lesions to an aggressive diffuse disease. Advanced Kaposi's sarcoma lesions, typically those on the lower extremities, are often associated with lymphedema. In this paper, we report a case of a patient with a rare form of AIDS-associated Kaposi sarcoma called lymphangiectatic Kaposis's sarcoma.

Lobomycosis and squamous cell carcinoma.

The occurence of squamous cell carcinoma on long-lasting ulcers is classic. Malignant transformation may occur on burn scars and chronic ulcers of varying etiology, including infectious agents. Transformation of old lobomycosis lesion scars into squamous cell carcinoma has been rarely reported. Careful and long-term follow-up of such patients is important to avoid carcinomatous transformation.

Lymphangiectatic Kaposi's sarcoma in a patient with AIDS / Sarcoma de Kaposi linfangiectásico em paciente com Aids

Kaposi's sarcoma is a malignant disease that originates in the lymphatic endothelium. It has a broad spectrum of clinical manifestations. Its four distinct clinical forms are: classic, endemic, iatrogenic and epidemic Kaposi's sarcoma. In non-HIV-associated Kaposi's sarcoma, the disease is typically limited to the lower extremities, but in immunodeficient patients, it is a multifocal systemic disease. The clinical course of the disease differs among patients, ranging from a single or a few indolent lesions to an aggressive diffuse disease. Advanced Kaposi's sarcoma lesions, typically those on the lower extremities, are often associated with lymphedema. In this paper, we report a case of a patient with a rare form of AIDS-associated Kaposi sarcoma called lymphangiectatic Kaposis's sarcoma. .

O sarcoma de Kaposi é uma neoplasia originária do endotélio linfatico, que apresenta um amplo espectro de manifestações, com quatro formas clínicas: sarcoma de Kaposi clássico, endêmico, iatrogêncio e epidêmico ou associado ao HIV. Em pacientes imunocompetentes, a doença é tipicamente limitada às extremidades. Porém em pacientes imunideprimidos, o sarcoma de Kaposi é uma doença sistêmica multifocal. Apresenta cursos clínicos diferentes, desde simples lesões cutâneas isoladas até lesões agressivas e difusas, com ou sem envolvimento sistêmico. Lesões avançadas de sarcoma de Kaposi, principalmente as localizadas nas extremidades, podem apresentar linfedema. Neste trabalho, reportamos caso de paciente com forma rara de Sarcoma de Kaposi associado a Aids, chamada de sarcoma de Kaposi linfangiectásico. .

Lobomycosis and squamous cell carcinoma / Lobomicose e carcinoma espinocelular

The occurence of squamous cell carcinoma on long-lasting ulcers is classic. Malignant transformation may occur on burn scars and chronic ulcers of varying etiology, including infectious agents. Transformation of old lobomycosis lesion scars into squamous cell carcinoma has been rarely reported. Careful and long-term follow-up of such patients is important to avoid carcinomatous transformation.

A ocorrência de carcinoma espinocelular sobre lesões cutâneas de longa evolução é clássica em cicatrizes de queimadura e úlceras crônicas de etiologia variada, inclusive infecciosa. Na literatura, são raros os casos de pacientes com lobomicose de longa evolução que desenvolveram CEC. O seguimento cuidadoso desses pacientes é importante, pois, nas áreas de traumas, ulcerações e cicatrizes crônicas pode ocorrer degeneração carcinomatosa. .