Pediatric Spinal Cord Injury: A Review.

A spinal cord injury (SCI) can be a devastating condition in children, with profound implications for their overall health and quality of life. In this review, we aim to provide a concise overview of the key aspects associated with SCIs in the pediatric population. Firstly, we discuss the etiology and epidemiology of SCIs in children, highlighting the diverse range of causes. We explore the unique anatomical and physiological characteristics of the developing spinal cord that contribute to the specific challenges faced by pediatric patients. Next, we delve into the clinical presentation and diagnostic methods, emphasizing the importance of prompt and accurate diagnosis to facilitate appropriate interventions. Furthermore, we approach the multidisciplinary management of pediatric SCIs, encompassing acute medical care, surgical interventions, and ongoing supportive therapies. Finally, we explore emerging research as well as innovative therapies in the field, and we emphasize the need for continued advancements in understanding and treating SCIs in children to improve their functional independence and overall quality of life.

Follow-up of participants with subjective cognitive decline from Tremembé epidemiologic study, Brazil.

Subjective cognitive decline is defined as a self-perceived cognitive decline but with normal performance in neuropsychological assessments. Objective: To verify the evolution of patients diagnosed with subjective cognitive decline compared to the cognitively normal group without any concern. Methods: This is a follow-up study based on data analysis from the Tremembé epidemiologic study, in Brazil. The 211 individuals classified as cognitively normal and 174 diagnosed as having subjective cognitive decline at baseline were invited to participate. Results: After a median follow-up time of five years, 108 subjective cognitive decline participants (62.0%) were reassessed. Of these, 58 (53.7%) kept this diagnosis, whereas 14 individuals (12.9%) progressed to mild cognitive impairment and 5 (4.6%) to dementia. In the cognitively normal group, 107 (50.7%) were reassessed, of which 51 (47.7%) were still classified likewise, 6 (5.6%) evolved to mild cognitive impairment and 9 (8.4%) to dementia. The presence of cognitive decline had a significant association with increasing age and depression symptoms. Considering the total number of baseline participants in each group: the subjective cognitive decline group showed higher percentage of mild cognitive impairment (p=0.022) and no difference was found in progression to dementia (p=0.468) between the groups after follow-up assessment. Conclusion: Most subjective cognitive decline participants at baseline kept their cognitive complaint at follow-up and this group progressed more to mild cognitive impairment than the other group. No difference in the progression to dementia was found, despite the higher incidence of dementia in the cognitively normal group.

O declínio cognitivo subjetivo (DCS) é definido como autopercepção de declínio cognitivo, mas com desempenho normal nas avaliações neuropsicológicas. Objetivo: O objetivo foi verificar a evolução dos pacientes diagnosticados com DCS em relação ao grupo cognitiva mente normal (CN), sem qualquer queixa. Métodos: Trata-se de um estudo de seguimento baseado na análise de dados do estudo epidemiológico de Tremembé, Brasil. Os 211 indivíduos classificados como CN e os 174 diagnosticados como DCS na fase inicial do estudo foram convidados a participar. Resultados: Após o tempo médio de seguimento de cinco anos, 108 participantes da DCS (62,0%) foram reavaliados. Deles, 58 (53,7%) mantiveram o diagnóstico de DCS, enquanto 14 (12,9%) evoluíram para comprometimento cognitivo leve (CCL) e cinco (4,6%) para demência. No grupo CN, 107 (50,7%) foram reavaliados, dos quais 51 (47,7%) ainda foram classificados como CN, seis (5,6%) evoluíram para CCL e nove (8,4%) para demência. A presença de declínio cognitivo teve associação significativa com o aumento da idade e com sintomas de depressão. Considerando-se o número total de participantes da fase inicial do estudo de cada grupo: o grupo DCS apresentou maior percentual de CCL (p=0,022) e não houve diferença na progressão para demência (p=0,468) entre ambos os grupos após a avaliação de seguimento. Conclusão: A maioria dos participantes DCS da fase inicial do estudo manteve sua queixa cognitiva no seguimento, e esse grupo progrediu mais para CCL. Não foi encontrada diferença na progressão para demência, apesar da maior incidência de demência no grupo CN.

Exposure of patients with chronic kidney disease on dialysis to pesticides / Exposição de pacientes com doença renal crônica em tratamento dialítico aos agrotóxicos

ABSTRACT Introduction: Pesticides can trigger kidney disease. Objective: To describe the exposure to pesticides of patients with chronic kidney disease on dialysis. Methods: Quantitative and descriptive field research, with 90 patients with chronic kidney disease on dialysis in two hemodialysis units in the state of Santa Catarina, through the application of a structured questionnaire. Participants were divided into two groups: with and without exposure to pesticides. The questionnaire was applied in hemodialysis clinics during treatment. Laboratory test values were collected from clinical records. Data were analyzed using descriptive statistics and association using the chi-square test. For laboratory test data, a comparison of means was performed using the unpaired Student's t-test between the groups. Results: The mean age of exposed participants was 58 years (±13.7; minimum = 23; maximum = 75) and that of non-exposed participants was 64 years old (±13.9; minimum = 35; maximum = 96). Of the 90 patients, 30% were exposed to pesticides. The mean exposure time was 6.7 ± 3.8 hours/day. There was a statistically significant association between the preparation of the mixture with pesticides and diabetes (p ≤ 0.048). There was no statistically significant difference between the results of laboratory tests in the exposed and non-exposed groups. Conclusion: This study shows that pesticides can be triggering factors for chronic kidney disease (CKD); however, we must expand research in this field to prove the relationship between exposure to pesticides and CKD.

Resumo Introdução: O uso de agrotóxicos pode desencadear doença renal. Objetivo: Descrever a exposição a agrotóxicos de pacientes com doença renal crônica em tratamento dialítico. Métodos: Pesquisa de campo, quantitativa e descritiva, com 90 portadores de doença renal crônica em tratamento dialítico em duas unidades de hemodiálise no estado de Santa Catarina, por meio da aplicação de um questionário estruturado. Os participantes foram divididos em dois grupos: sem e com exposição a agrotóxicos. O questionário foi aplicado nas clínicas de hemodiálise durante o tratamento. Foram coletados valores de exames laboratoriais dos prontuários clínicos. Os dados foram analisados pela estatística descritiva e associação pelo teste qui-quadrado. Para os dados dos exames laboratoriais, foi realizada comparação de médias pelo teste t de Student não pareado entre os grupos. Resultados: A idade média dos participantes expostos foi de 58 anos (±13,7; mínimo = 23; máximo = 75) e a dos não expostos, de 64 anos (±13,9; mínimo = 35; máximo = 96). Dos 90 pacientes, 30% foram expostos a agrotóxicos. O tempo médio de exposição foi de 6,7 ± 3,8 horas/dia. Houve associação estatística significativa entre o preparo da calda com agrotóxicos e a presença de diabetes (p ≤ 0,048). Não houve diferença estatística significativa entre os resultados dos exames laboratoriais do grupo exposto e do não exposto. Conclusão Esta pesquisa evidencia que os agrotóxicos podem ser fatores desencadeadores da doença renal crônica (DRC), entretanto sugere-se ampliar pesquisas na área que possam comprovar a relação entre exposição a agrotóxicos e DRC.

Evaluation of the Cutaneous Silent Period in a Healthy Brazilian Population.

PURPOSE: To establish cutaneous silent period (CSP) normative values and investigate the variables that may influence them. METHODS: We tested 41 healthy subjects. All subjects underwent nerve conduction studies, and we evaluated the CSP in both arms. RESULTS: Four subjects did not have CSP and were excluded. The analyses were performed in the healthy group composed of 23 women and 14 men, with a mean age of 35 (range, 19-64) years. The CSP median duration was 23.2 milliseconds (ms), with 2 to 98th percentile at 11.3 and 48.7 ms. The median onset latency was 87.9 (range, 72.9-109) ms, and the median end latency was 112 (range, 93.8-138) ms. The CSP onset latency positively correlated with height, whereas CSP end latency and duration were weakly but significantly associated with age. Some measurements of ulnar nerve conduction study also correlated with CSP measures. The interrater coefficients for the primary measures of onset and end latency demonstrates the reproducibility of the method. CONCLUSIONS: The CSP with the fifth digit stimulation and recording from the abductor digiti minimi muscle is a valid diagnostic tool that can be used in clinical practice.

Exposure of patients with chronic kidney disease on dialysis to pesticides.

INTRODUCTION: Pesticides can trigger kidney disease. OBJECTIVE: To describe the exposure to pesticides of patients with chronic kidney disease on dialysis. METHODS: Quantitative and descriptive field research, with 90 patients with chronic kidney disease on dialysis in two hemodialysis units in the state of Santa Catarina, through the application of a structured questionnaire. Participants were divided into two groups: with and without exposure to pesticides. The questionnaire was applied in hemodialysis clinics during treatment. Laboratory test values were collected from clinical records. Data were analyzed using descriptive statistics and association using the chi-square test. For laboratory test data, a comparison of means was performed using the unpaired Student's t-test between the groups. RESULTS: The mean age of exposed participants was 58 years (±13.7; minimum = 23; maximum = 75) and that of non-exposed participants was 64 years old (±13.9; minimum = 35; maximum = 96). Of the 90 patients, 30% were exposed to pesticides. The mean exposure time was 6.7 ± 3.8 hours/day. There was a statistically significant association between the preparation of the mixture with pesticides and diabetes (p ≤ 0.048). There was no statistically significant difference between the results of laboratory tests in the exposed and non-exposed groups. CONCLUSION: This study shows that pesticides can be triggering factors for chronic kidney disease (CKD); however, we must expand research in this field to prove the relationship between exposure to pesticides and CKD.

Follow-up of participants with subjective cognitive decline from Tremembé epidemiologic study, Brazil / Seguimento dos participantes com declínio cognitivo subjetivo do estudo epidemiológico de Tremembé, Brasil

ABSTRACT. Subjective cognitive decline is defined as a self-perceived cognitive decline but with normal performance in neuropsychological assessments. Objective: To verify the evolution of patients diagnosed with subjective cognitive decline compared to the cognitively normal group without any concern. Methods: This is a follow-up study based on data analysis from the Tremembé epidemiologic study, in Brazil. The 211 individuals classified as cognitively normal and 174 diagnosed as having subjective cognitive decline at baseline were invited to participate. Results: After a median follow-up time of five years, 108 subjective cognitive decline participants (62.0%) were reassessed. Of these, 58 (53.7%) kept this diagnosis, whereas 14 individuals (12.9%) progressed to mild cognitive impairment and 5 (4.6%) to dementia. In the cognitively normal group, 107 (50.7%) were reassessed, of which 51 (47.7%) were still classified likewise, 6 (5.6%) evolved to mild cognitive impairment and 9 (8.4%) to dementia. The presence of cognitive decline had a significant association with increasing age and depression symptoms. Considering the total number of baseline participants in each group: the subjective cognitive decline group showed higher percentage of mild cognitive impairment (p=0.022) and no difference was found in progression to dementia (p=0.468) between the groups after follow-up assessment. Conclusion: Most subjective cognitive decline participants at baseline kept their cognitive complaint at follow-up and this group progressed more to mild cognitive impairment than the other group. No difference in the progression to dementia was found, despite the higher incidence of dementia in the cognitively normal group.

RESUMO. O declínio cognitivo subjetivo (DCS) é definido como autopercepção de declínio cognitivo, mas com desempenho normal nas avaliações neuropsicológicas. Objetivo: O objetivo foi verificar a evolução dos pacientes diagnosticados com DCS em relação ao grupo cognitiva mente normal (CN), sem qualquer queixa. Métodos: Trata-se de um estudo de seguimento baseado na análise de dados do estudo epidemiológico de Tremembé, Brasil. Os 211 indivíduos classificados como CN e os 174 diagnosticados como DCS na fase inicial do estudo foram convidados a participar. Resultados: Após o tempo médio de seguimento de cinco anos, 108 participantes da DCS (62,0%) foram reavaliados. Deles, 58 (53,7%) mantiveram o diagnóstico de DCS, enquanto 14 (12,9%) evoluíram para comprometimento cognitivo leve (CCL) e cinco (4,6%) para demência. No grupo CN, 107 (50,7%) foram reavaliados, dos quais 51 (47,7%) ainda foram classificados como CN, seis (5,6%) evoluíram para CCL e nove (8,4%) para demência. A presença de declínio cognitivo teve associação significativa com o aumento da idade e com sintomas de depressão. Considerando-se o número total de participantes da fase inicial do estudo de cada grupo: o grupo DCS apresentou maior percentual de CCL (p=0,022) e não houve diferença na progressão para demência (p=0,468) entre ambos os grupos após a avaliação de seguimento. Conclusão: A maioria dos participantes DCS da fase inicial do estudo manteve sua queixa cognitiva no seguimento, e esse grupo progrediu mais para CCL. Não foi encontrada diferença na progressão para demência, apesar da maior incidência de demência no grupo CN.

Fasting and 24-h urine pH in patients with urolithiasis using potassium citrate.

PURPOSE: To evaluate the correlation between the pH readings in 24-h urine and the random fasting specimen in patients with urolithiasis using 2 methods. METHODS: A total of 114 patients with urinary lithiasis using potassium citrate were prospectively analyzed. All patients collected 24-h urine and an additional sample, after nocturnal fasting, collected on the day they brought the 24-h sample at the lab. Two different methods (test strip and digital meter) were used to determine pH values. RESULTS: The pH analysis using strips in the 24-h urine presented a mean value similar to the one obtained in the fasting sample (6.07 ± 0.74 vs. 6.02 ± 0.82, respectively; P > 0.05). The same behavior was seen considering the readings with a digital pH meter (5.8 ± 0.78 vs. 5.75 ± 0.83; P > 0.05). However, readings conducted in the same specimen with pH meter and test strip were dissonant (P < 0.05), suggesting that the colorimetric method is not reliable in the assessment of urinary pH in this population. CONCLUSION: pH assessment in a random urinary specimen proved as efficient as the 24-h urine standard method to monitor patients with kidney stones in the use of potassium citrate. Classical test strip analysis is not sensitive enough to evaluate the urine pH in this population and digital pH meter reading is preferred.

Antioxidant therapy reverses sympathetic dysfunction, oxidative stress, and hypertension in male hyperadipose rats.

AIMS: The rostral ventrolateral medulla (RVLM) is the main sympathetic output of the central nervous system to control blood pressure. Reportedly, reactive oxygen species (ROS) can increase arterial pressure, leading to hypertension. As ROS increase the sympathetic tone in RVLM and obese animals present grater oxidative stress, it would be important to note this relationship. MAIN METHODS: Therefore, we evaluated the systemic and central effects (in the RVLM) of vitamin C (vit C, an antioxidant) on the redox balance and cardiovascular and autonomic profiles in hyperadipose male rats. We also evaluated the neurotransmission by L-glutamate (L-glu) and vit C in the RVLM of awake hyperadipose rats. KEY FINDINGS: Our study confirmed that hyperadipose rats were hypertensive and tachycardic, presented increased sympathetic and decreased parasympathetic modulation of the heart, and had increased plasma lipoperoxidation compared with the control rats (CTR). Oral vitamin C treatment reverted cardiovascular, autonomic, and plasma redox dysfunction. Hyperadipose rats presented a higher blood pressure increase after L-glu microinjection and a lower response to vit C in the RVLM compared with the CTR group. Biochemical analysis of redox balance in RVLM punches showed that hyperadipose rats have increased NBT and T-BARS, and after treatment with vit C, the oxidative profile decreased. The antioxidative activity of vit C reduced the amount of ROS in the RVLM area that might have resulted in lowered blood pressure and sympathetic modulation. SIGNIFICANCE: Our data suggest central and peripheral benefits of vit C treatment on cardiovascular, autonomic, and oxidative dysfunctions in hyperadipose animals.

Effects of myofascial reorganization associated with kinesiotherapy on chronic pain and functionality of breast cancer survivors: development of a study protocol / Efeitos da reorganização miofascial associada à cinesioterapia na dor crônica e funcionalidade de sobreviventes de câncer de mama: desenvolvimento de um protocolo de estudo

Abstract Introduction: Breast cancer is the most common type of cancer among women. Treatments can lead to complications modifying upper limbs movement patterns and generating pain and functionality loss. Kinesiotherapy and myofascial reorganization (MR) have shown positive effects reducing chronic pain and improving upper limbs function. We hypothesize that these techniques can maximize results and reduce treatment time in clinical practice. Objective: To develop a study protocol to verify whether MR associated with kinesiotherapy is more effective than isolated kinesiotherapy to treat chronic pain and upper limb dysfunction in breast cancer survivors. Methods: Participants will be divided into two groups: intervention group (myofascial reorganization + kinesiotherapy) and sham group (traditional massage + kinesiotherapy). Six treatment sessions (once a week) and three-time assessment will occur. Instruments for assessing pain and functionality will be Visual Analogue Scale, Body Pain Diagram, Disabilities of the Arm, Shoulder and Hand Questionnaire, and goniometry. Statistical analysis will be conducted based on intention-to-treat analysis. To analyze the difference of means between groups, we will use T-Student or U Mann-Whitney test. Repeated measures ANOVA will be used to check treatments effects. Significance level for all tests will be 5%. Conclusion: We believe that the developed study protocol will show that MR associated with kinesiotherapy improve chronic pain and upper limbs functionality of breast cancer survivors.

Resumo Introdução: O câncer de mama é o tipo de câncer mais comum entre as mulheres. Os tratamentos podem levar a complicações, modificando os padrões de movimento dos membros superiores e gerando dor e perda de funcionalidade. A cinesioterapia e a reorganização miofascial (RM) têm demonstrado efeitos positivos na redução da dor crônica e na melhora da função dos membros superiores. A hipótese do presente estudo é que essas técnicas podem maximizar os resultados e reduzir o tempo de tratamento na prática clínica. Objetivo: Desenvolver um protocolo para verificar se a RM associada à cinesioterapia é mais eficaz do que a cinesioterapia isolada no tratamento da dor crônica e disfunção do membro superior em sobreviventes de câncer de mama. Métodos: As participantes serão divididas em dois grupos: grupo intervenção (reorganização miofascial + cinesioterapia) e grupo sham (massagem tradicional + cinesioterapia). Serão realizadas seis sessões de tratamento (uma vez por semana) e três avaliações. Os instrumentos de avaliação da dor e da funcionalidade serão a Escala Visual Analógica, o Diagrama de Dor Corporal, o Questionário de Deficiências do Braço, Ombro e Mão e a goniometria. A análise estatística será realizada com base na análise de intenção de tratar. Para analisar a diferença de médias entre os grupos, serão utilizados o teste T-Student ou U Mann-Whitney. ANOVA de medidas repetidas será utilizada para verificar os efeitos dos tratamentos. O nível de significância para todos os testes será de 5%. Conclusão: Espera-se que a RM associada à cinesioterapia melhore a dor crônica e a funcionalidade dos membros superiores de sobreviventes de câncer de mama.

Emotion Regulation, Subjective Happiness and Meaning of Life of University Students in the Pandemic / Regulação Emocional, Felicidade Subjetiva e Sentido da Vida de Universitários na Pandemia / Regulación Emocional, Felicidad Subjetiva y Sentido de la Vida de los universitarios en la Pandemia

Abstract Emotion regulation in adverse situations may be essential to aspects related to subjective happiness and the meaning of life. The aim was to investigate associations between emotion regulation strategies and levels of subjective happiness and meaning of life university students in the context of the COVID-19 pandemic. 348 university students participated in the study, being applied a sociodemographic questionnaire, Emotion Regulation Questionnaire (ERQ), Subjective Happiness Scale (SHS) and Meaning of Life Questionnaire (MLQ) through an online platform. Descriptive and inferential analyses were performed using the JASP software. The results indicated positive associations between the cognitive reassessment strategy and the presence of subjective happiness and meaning of life, while the strategy of emotional suppression negatively interfered. Cognitive change was an emotion regulation strategy that proved effective, both in the reassessment of the situation and in the ability to manage the demands arising from the pandemic.

Resumo A regulação emocional em situações adversas pode ser essencial aos aspectos relacionados à felicidade subjetiva e ao sentido da vida. O objetivo deste estudo foi investigar associações entre as estratégias de regulação emocional e os níveis de felicidade subjetiva e de sentido da vida de universitários no contexto da pandemia da COVID-19. Participaram 348 universitários, sendo aplicados questionário sociodemográfico, Questionário de Regulação Emocional (QRE), Escala de Felicidade Subjetiva (SHS) e Questionário de Sentido da Vida (QSV) por meio de plataforma online. Foram realizadas análises descritivas e inferenciais através do software JASP. Os resultados indicaram associações positivas entre a estratégia de reavaliação cognitiva e a presença de felicidade subjetiva e de sentido da vida, enquanto a estratégia de supressão emocional interferiu negativamente. A mudança cognitiva foi uma estratégia de regulação emocional que se mostrou efetiva, tanto na reavaliação da situação, quanto na capacidade de gerenciar as demandas provenientes da pandemia.

Resumen La regulación emocional en situaciones adversas puede ser esencial para aspectos relacionados con la felicidad subjetiva y el sentido de la vida. El objetivo fue investigar las asociaciones entre las estrategias de regulación emocional y los niveles de felicidad subjetiva y significado de la vida entre universitarios en la pandemia COVID-19. 348 universitarios participaron del estudio, aplicándose un cuestionario sociodemográfico, Cuestionario de Regulación Emocional (QRE), Escala de Felicidad Subjetiva (SHS) y Cuestionario de Sentido de Vida (QSV) a través de una plataforma online. Los resultados indicaron asociaciones positivas entre la estrategia de reevaluación cognitiva y la presencia de felicidad subjetiva y el significado de la vida, mientras que la estrategia de supresión emocional interferido negativamente. El cambio cognitivo fue una estrategia de regulación emocional que resultó efectiva, tanto en la reevaluación de la situación como en la capacidad de gestionar las demandas derivadas de la pandemia.

Lesão renal aguda em pacientes críticos em ventilação mecânica com pressão positiva / Lesión renal aguda en pacientes críticos en ventilación mecánica con presión positiva / Acute kidney injury in critically ill patients on positive pressure mechanical ventilation

Resumo Objetivo Avaliar o efeito do uso de ventilação mecânica com pressão positiva expiratória final (PEEP) na função renal dos pacientes internados em Unidade de Terapia Intensiva (UTI). Métodos Estudo de coorte retrospectivo, quantitativo, desenvolvido na UTI de um hospital público de Brasília, Distrito Federal. A amostra foi constituída de 52 prontuários de pacientes internados na UTI de novembro de 2016 a dezembro de 2018. A coleta dos dados foi realizada por meio de um questionário com dados demográficos, clínicos e laboratoriais. Os pacientes foram alocados em grupos: (1) PEEP ≤ 5 cmH2O, (2) PEEP > 5 cmH2O e < 10 cmH2O e (3) PEEP ≥ 10 cmH2O. Resultados A média de idade dos pacientes foi de 59 anos e 50% deles tinha mais de 63 anos. Constatou-se que 63,16% dos pacientes que estavam em ventilação mecânica com pressão positiva ao final da expiração ≥ 10 cmH2O evoluíram no estágio 1 (menor gravidade de lesão renal aguda (LRA)) e 21,5% no estágio 2 (moderada gravidade). Ainda assim, um pequeno percentual (5,8%) de pacientes evoluiu a óbito. Pacientes sem sucesso no desmame da ventilação mecânica apresentaram 10,24 vezes a chance de evoluir com LRA. Conclusão o emprego da ventilação mecânica pode determinar danos à função renal dos pacientes internados em unidade de terapia intensiva e que aqueles com maior necessidade de oferta de PEEP evoluíram com diferentes gravidades e persistência da LRA.

Resumen Objetivo Evaluar el efecto del uso de la ventilación mecánica con presión positiva espiratoria final (PEEP) en la función renal de los pacientes internados en Unidad de Cuidados Intensivos (UTI). Métodos Estudio de corte retrospectivo, cuantitativo, desarrollado en la UCI de un hospital público de Brasília, Distrito Federal. La amuestra estuvo constituida por 52 prontuarios de pacientes internados en la UCI de noviembre de 2016 a diciembre de 2018. La recolección de los datos se realizó por medio de un cuestionario con datos demográficos, clínicos y laboratoriales. Los pacientes fueron distribuidos en grupos: (1) PEEP ≤ 5 cmH2O, (2) PEEP > 5 cmH2O y < 10 cmH2O y (3) PEEP ≥ 10 cmH2O. Resultados El promedio de edad de los pacientes era de 59 años y el 50 % de ellos tenía más de 63 años. Se constató que el 63,16 % de los pacientes que estaban en ventilación mecánica con presión positiva al final de la expiración ≥ 10 cmH2O evolucionaron en la etapa 1 (menor gravedad de lesión renal aguda (LRA)) y 21,5 % en la etapa 2 (moderada gravedad). Aun así, un pequeño porcentaje (5,8 %) de pacientes falleció. Pacientes sin éxito en la descontinuación de la ventilación mecánica presentaron 10,24 veces la posibilidad de evolucionar con LRA. Conclusión el uso de la ventilación mecánica puede determinar daños a la función renal de los pacientes internados en una unidad de cuidados intensivos y que los que tengan una mayor necesidad de oferta de PEEP evolucionaron con distintas gravedades y persistencia de la LRA.

Abstract Objective To assess the effect of using mechanical ventilation with positive end-expiratory pressure (PEEP) on the renal function of patients admitted to the Intensive Care Unit (ICU). Methods This is a quantitative retrospective cohort study developed in the ICU of a public hospital in Brasília, Distrito Federal. The sample consisted of 52 medical records of patients admitted to the ICU from November 2016 to December 2018. Data collection was performed through a questionnaire with demographic, clinical and laboratory data. Patients were allocated in two groups: (1) PEEP ≤ 5 cmH2O, (2) PEEP > 5 cmH2O and < 10 cmH2O, and (3) PEEP ≥ 10 cmH2O. Results The mean age of patients was 59 years and 50% of them were over 63 years. It was found that 63.16% of patients who were on mechanical ventilation with positive end-expiratory pressure ≥ 10 cmH2O evolved in stage 1 (less severe acute kidney injury (AKI)) and 21.5% in stage 2 (moderate gravity). Even so, a small percentage (5.8%) of patients died. Patients who were unsuccessful in weaning from mechanical ventilation had a 10.24-fold chance of developing AKI. Conclusion mechanical ventilation use can cause damage to the renal function of patients hospitalized in the intensive care unit and that those with greater need to offer PEEP evolved with different severities and persistence of AKI.

Tiempo de ventilación mecánica invasiva y lesión renal aguda en pacientes críticos / Invasive Mechanical Ventilation Time and Acute Kidney Injury in Critically Ill Patients

Introducción: La evidencia científica vincula el uso de la ventilación mecánica invasiva con una mayor probabilidad de desarrollar lesión renal aguda, pero la falta de consenso sobre esta asociación no es infrecuente. Objetivo: Identificar la relación entre tiempos de ventilación mecánica y la aparición y gravedad de la lesión renal aguda. Métodos: Cohorte histórica realizada en una Unidad de Cuidados Intensivos del Distrito Federal, Brasil, entre 2016 y 2018. La población fue compuesta por 387 pacientes, pero la muestra consistió en 52 pacientes que necesitaron ventilación mecánica invasiva durante una semana y dos. El registro de los datos se realizó en un cuestionario estructurado compuesto por variables de identificación, datos clínicos, variables hemodinámicas y parámetros de laboratorio. Para los análisis de asociación se utilizaron las pruebas de Chi-cuadrado, Exacta de Fisher y Mann-Whitney. Los resultados con p < 0,05 se consideraron significativos. Resultados: La lesión renal aguda de diferentes severidades predominó en más de la mitad de los pacientes (55,80 por ciento), siendo el estadio 2 más prevalente (aproximadamente 30 por ciento ). Los pacientes que permanecieron en ventilación mecánica durante una semana o dos mostraron una disminución del riesgo de lesión renal aguda (OR 0,85; IC del 95 por ciento: 0,72 a 0,99, p = 0,038) y OR 0,77; IC 95 por ciento 0.63-0.94, p = 0,010, respectivamente). Conclusión: La lesión renal aguda de diferentes severidades estuvo presente en pacientes con ventilación mecánica invasiva. Sin embargo, el tiempo de ventilación mecánica solo no fue determinante de lesión renal aguda(AU)

Introduction: Scientific evidence associates the use of invasive mechanical ventilation with a higher probability of developing acute kidney injury, but the lack of consensus on this association is not uncommon. Objective: To identify the relationship between mechanical ventilation times and the onset and severity of acute kidney injury. Methods: Historical cohort carried out, between 2016 and 2018, in an intensive care unit of the Federal District, Brazil. The population consisted of 387 patients, but the sample consisted of 52 patients who required invasive mechanical ventilation for one week and two. The data were recorded with a structured questionnaire composed of identification variables, clinical data, hemodynamic variables and laboratory parameters. Chi-square, Fisher's exact and Mann-Whitney tests were used for the association analysis. Results with P < 0.05 were considered significant. Results: Acute kidney injury of different severity degrees predominated in more than half of the patients (55.80 percent), stage 2 being the most prevalent (approximately 30 percent). Patients who remained on mechanical ventilation for a week or two showed a decreased risk for acute kidney injury (OR: 0.85, 95 percent CI: 0.72-0.99, P = 0.038 and OR: 0.77, 95 percent CI: 0.63-0.94, P = 0.010, respectively). Conclusion: Acute kidney injury of different severity degrees was present in patients with invasive mechanical ventilation. However, the time of mechanical ventilation alone was not a determinant of acute kidney injury(AU)

Computed Tomography Colonography as a Sensible Option for Colorectal Cancer Screening: Evidence Based on Metanalysis / Colonografia por tomografia computadorizada como uma opção sensível para o rastreamento do câncer colorretal: Evidências baseadas em metanálise

Abstract Objective This metanalysis aimed to evaluate the sensitivity and specificity of computed tomography colonography in colorectal polyp detection. Methods A literature search was performed in the PubMed and Web of Science databases. Results A total of 1,872 patients (males 57.2%, females 42.8%) aged 49 to 82 years old (mean age 59.7 ± 5.3 years) were included in this metanalysis. The estimated sensitivity of computed tomography colonography was 88.4% (46.3-95.7%, coefficient of variation [CV]=28.5%) and the estimated specificity was 73.6% (47.4-100.0%, CV=37.5%). For lesions up to 9mm, the sensitivity was 82.5% (62.0-99.9%, CV =25.1%) and the specificity was 79.2% (32.0-98.0%, CV=22.9%). For lesions>9mm, the sensitivity was 90.2% (64.0-100.0%, CV=7.4%) and the specificity was 94.7% (80.0-100.0%, CV=6.2%). No statistically significant differences in sensitivity according to the size of the lesion were found (p=0.0958); however, the specificity was higher for lesions>9mm (p<0.0001). Conclusions Most of the studies analyzed in the present work were conducted before 2010, which is about a decade after computed tomography colonography started being indicated as a screening method by European and American guidelines. Therefore, more studies aimed at analyzing the technique after further technological advancements are necessary, which could lead to the development of more modern devices.

Resumo Objetivo Esta meta-análise teve como objetivo avaliar a sensibilidade e especificidade da colonografia por tomografia computadorizada na detecção de pólipos colorretais. Métodos Foi realizada uma pesquisa bibliográfica nas bases de dados da PubMed e da Web of Science. Resultados Um total de 1.872 pacientes, 57,2% homens e 42,8% mulheres, com idades entre 49 a 82 anos de idade (média de 59,7 ± 5,3 anos) foram incluídos nesta meta análise. A sensibilidade da colonografia por tomografia computadorizada foi estimada em 88,4% (46,3-95,7%; coeficiente de variância [CV]=28,5%) e a especificidade em 73,6% (47,4%-100,0%; CV=37,5%). Para lesões de até 9mm, a sensibilidade foi de 82,5% (62,0-99,9%; CV=25,1%) e a especificidade de 79,2% (32,0-98,0%; CV=22,9%). Para lesõesmaiores que 9mm, a sensibilidade foi de 90,2% (64,0-100,0%; CV=7,4%) e a especificidade de 94,7% (80,0-100,0%; CV=6,2%). Não houve diferença estatisticamente significante entre as sensibilidades por tamanho da lesão (p=0,0958), porém a especificidade foi maior em lesões acima de 9mm (p<0,0001). Conclusão A maioria dos estudos analisados no presente trabalho foi realizada antes de 2010, cerca de uma década depois que a colonografia por tomografia computadorizada passou a ser indicada como método de triagem pelas diretrizes europeias e americanas. Portanto, são necessários mais estudos com o objetivo de analisar a técnica apósmaiores avanços tecnológicos, o que poderia levar ao desenvolvimento de dispositivos mais modernos.

Pain mapping and characteristics in breast cancer survivors during task-oriented training: analysis at 3, 6, and 9 months.

PURPOSE: To evaluate the frequency and characteristics of trunk and upper limb pain in women diagnosed with breast cancer, in different movement planes, during task-oriented training (TOT) 3, 6, and 9 months after surgery. METHODS: A prospective cohort study with 20 women. The body pain diagram (BPD), VAS, and McGill questionnaire were used. The TOT consisted of 20 exercises based on the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) questionnaire. BPD overlay was performed in GIMP® image editor. The chi-square test was applied to the relationship between population characteristics and pain. Freedman's ANOVA and the Cochran's Q test were used in the comparison of pain site frequencies and intensity over time. RESULTS: In total, 297 BPDs were generated, which identified the affected upper limb as the body area with the highest frequency of pain at the three moments. However, at 9 months, the unaffected upper limb presented the same frequency as the affected limb. Radiotherapy presented a statistically significant relationship (p < 0.05) with pain at 9 months. The pain was characterized as moderate at the three moments, affective at 3 and 6 months, and sensory at 9 months. CONCLUSION: The most frequent area of pain at 3 and 6 months was the affected upper limb however, at 9 months, the unaffected upper limb presented the same frequency of pain as the affected upper limb. Pain was characterized as moderate at the three evaluation moments.

Comparison between Two Methods to Evaluate Function in Postoperative Breast Cancer Survivors.

INTRODUCTION: Treatment for breast cancer can cause adverse effects such as pain and reduced upper limb function which can affect activities of daily living. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most used tool for evaluating function in breast cancer survivors. However, some specific aspects have raised discussions about its restricted coverage, which can generate several biases. OBJECTIVE: To determine if DASH scores differed when assessed before and after task-oriented training (TOT) at 3 and 6 months after breast cancer surgery. DESIGN: Prospective cohort study. SETTING: Institutional study of 22 women assessed at 3 and 6 months after breast cancer surgery. MAIN OUTCOME MEASURES: The DASH questionnaire and TOT assessment. Two correlation tests were performed: Spearman's correlation between the total score of the two DASH scores (pre- and post-TOT) and the Kendall's tau correlation between each of the items. RESULTS: There was a moderate and excellent correlation between final DASH scores, pre- and post-TOT, at both 3 and 6 months postoperatively. However, when assessed individually, most of the DASH items were poorly correlated. There was also no agreement between the total DASH scores pre- and post-TOT as assessed by Bland-Altman plots. CONCLUSION: Both the DASH and TOT are considered useful in clinical practice to assess upper limb function, although the use of TOT in some of the DASH items may reduce memory bias and improve skills estimation.

How can neurophysiological studies help with movement disorders characterization in clinical practice? A review.

BACKGROUND: Neurophysiological studies are ancillary tools to better understand the features and nature of movement disorders. Electromyography (EMG), together with electroencephalography (EEG) and accelerometer, can be used to evaluate a hypo and hyperkinetic spectrum of movements. Specific techniques can be applied to better characterize the phenomenology, help distinguish functional from organic origin and assess the most probable site of the movement generator in the nervous system. OBJECTIVE: We intend to provide an update for clinicians on helpful neurophysiological tools to assess movement disorders in clinical practice. METHODS: Non-systematic review of the literature published up to June 2019. RESULTS: A diversity of protocols was found and described. These include EMG analyses to define dystonia, myoclonus, myokymia, myorhythmia, and painful legs moving toes pattern; EMG in combination with accelerometer to study tremor; and EEG-EMG to study myoclonus. Also, indirect measures of cortical and brainstem excitability help to describe and diagnose abnormal physiology in Parkinson's disease, atypical parkinsonism, dystonia, and myoclonus. CONCLUSION: These studies can be helpful for the diagnosis and are usually underutilized in neurological practice.

How can neurophysiological studies help with movement disorders characterization in clinical practice? A review / Como os exames neurofisiológicos podem ajudar na caracterização dos transtornos do movimento na prática clínica? Uma revisão

ABSTRACT Background: Neurophysiological studies are ancillary tools to better understand the features and nature of movement disorders. Electromyography (EMG), together with electroencephalography (EEG) and accelerometer, can be used to evaluate a hypo and hyperkinetic spectrum of movements. Specific techniques can be applied to better characterize the phenomenology, help distinguish functional from organic origin and assess the most probable site of the movement generator in the nervous system. Objective: We intend to provide an update for clinicians on helpful neurophysiological tools to assess movement disorders in clinical practice. Methods: Non-systematic review of the literature published up to June 2019. Results: A diversity of protocols was found and described. These include EMG analyses to define dystonia, myoclonus, myokymia, myorhythmia, and painful legs moving toes pattern; EMG in combination with accelerometer to study tremor; and EEG-EMG to study myoclonus. Also, indirect measures of cortical and brainstem excitability help to describe and diagnose abnormal physiology in Parkinson's disease, atypical parkinsonism, dystonia, and myoclonus. Conclusion: These studies can be helpful for the diagnosis and are usually underutilized in neurological practice.

RESUMO Introdução: Os estudos neurofisiológicos são métodos auxiliares para compreender melhor as características e a natureza dos distúrbios do movimento. A eletromiografia (EMG), em associação com o eletroencefalograma (EEG) e o acelerômetro, podem ser utilizados para avaliar um espectro de movimentos hipo e hipercinéticos. Técnicas específicas podem ser aplicadas para melhor caracterizar a fenomenologia, ajudar a distinguir a origem psicogênica da orgânica e avaliar o local mais provável de geração do movimento no sistema nervoso. Objetivo: Pretendemos fornecer ao clínico uma atualização sobre ferramentas neurofisiológicas úteis para avaliar distúrbios do movimento na prática clínica. Métodos: Revisão não sistemática da literatura publicada até junho de 2019. Resultados: Uma diversidade de protocolos foi encontrada e descrita. Dentre eles, inclui-se o uso de EMG para a definição do padrão de distonia, mioclonia, mioquimia, miorritmia e painfull legs moving toes, além do uso de EMG em associação ao acelerômetro para avaliar tremor e, em associação ao EEG para avaliar mioclonia. Ademais, técnicas para medida indireta de excitabilidade cortical e do tronco encefálico ajudam a descrever e diagnosticar a fisiologia anormal da doença de Parkinson, parkinsonismo atípico, distonia e mioclonia. Conclusão: Esses estudos podem ser úteis para o diagnóstico e geralmente são subutilizados na prática neurológica.

Physical symptoms and components of labor tasks associated with upper limb disability among working breast cancer survivors.

BACKGROUND: Each year, the number of breast cancer (BC) cases increases in Brazil and worldwide. In addition, BC affects women of working age who need to resume their jobs after treatments. This is an observational, cross-sectional study that investigated the association of physical symptoms and work tasks with upper limb disability and return to work in BC survivors. METHODS: Sociodemographic, labor, clinical and surgical aspects, and physical incapacity of the upper limbs of 62 women diagnosed with BC were evaluated through a questionnaire of our own and the disability of the arm, shoulder, and hand (DASH) questionnaire. The data were analyzed by the IBM Statistical Package for Social Sciences SPSS version 20.0 and a significance of p < 0.05 was adopted. Logistic regression and odds ratio were used to verify the level of association between work tasks and pain with return to work, and multiple linear regression verified the association of physical symptoms with upper limb functionality. RESULTS: The work tasks associated with non-return to work were raising objects above the head (OR 3.64, 95% CI 1.26-10.51), lifting objects of more than 5 kg (OR 2.88, 95% CI 1.02-8.13), and loading objects of more than 5 kg (OR 3.93; 95% CI 1.14-10.07). The pain in the upper quadrant homologous to the surgery explained 64% of the variance in physical incapacity of the upper limbs. CONCLUSIONS: There is an association of labor tasks that require upper limb strength and range of motion with non-return to work, and also pain in the upper quadrant homologous to the BC with reduction in the functionality of the upper limbs.

Letter-name knowledge: Predicting reading and writing diffi culties / Conhecimento do nome das letras: predizendo difi culdades de leitura e de escrita

This study evaluated the precision of a Letter-Name Knowledge task in predicting children at risk/non-risk of reading and writing difficulties in Brazil. A second goal was to compare the precision of classification of two versions of this task: a 26 letter-task and a 15 letter-task. A total of 213 Brazilian children performed the 26 letter-task when they were in kindergarten. Of those children, 176 performed a writing task and 174 performed a reading task in 1st grade Elementary School. The choice of letters for the 15 letter-task was based on the Item Response Theory and on neural network simulation. The results based on the Receiver Operating Characteristic curve analysis, showed that both tasks could be used for screening children with reading and writing difficulties (areas under the curve of 0.83 and 0.80).

Este estudo avaliou a precisão de classificação do risco de dificuldade de leitura e escrita, a partir do conhecimento do nome das letras. Foram aplicadas duas versões da tarefa de reconhecimento das letras, a primeira com todas as 26 letras do alfabeto, e a outra com apenas 15. A tarefa foi aplicada a 213 crianças brasileiras, matriculadas no último ano da Educação Infantil, sendo que, no primeiro ano do Ensino Fundamental, 176 delas realizaram a tarefa de escrita, e 174 a de leitura. Utilizaram-se a Teoria da Resposta ao Item e a simulação de rede neural para a escolha das 15 letras da versão reduzida da tarefa, e a análise da curva de Características Operacionais do Recebedor para avaliar a precisão de classificação das duas versões da tarefa. Os resultados indicaram que ambas as versões podem ser utilizadas para rastrear crianças com dificuldades de leitura e de escrita, áreas sob curvas de 0,83 e 0,80.

Embarazo triple monocorial espontáneo. A propósito de un caso / Spontaneous monochorionic trigemellar pregnancy. A case report / Gravidez monocoriônica espontânea tripla. Relato de caso

Resumen: El embarazo triple monocorial espontáneo tiene una incidencia muy baja, no identificándose factores causales que lo expliquen. La corionicidad determina el resultado perinatal de estas gestaciones, siendo la frecuencia de malos resultados mayor a medida que aumenta el número de fetos con una única placenta. Se presenta un caso de embarazo triple monocorial espontáneo cuyo seguimiento fue realizado en el Centro Hospitalario Pereira Rossell con excelente resultado perinatal.

Summary: Spontaneous monochorionic trigemellar pregnancies have a very low incidence, and there is no cause that may explain them. The chorionicity will determine the perinatal result of this gestations, but the frequency of poor results is higher as the number of fetuses sharing the same placenta increases. We present a case of a spontaneous monochorionic trigemellar gestation whose follow-up was carried out in the Pereira Rossell Pediatric Center with an excellent perinatal result.

Resumo: A tríplice gestação monocorial espontânea tem incidência muito baixa, não sendo identificados os fatores causais que a explicam. A corionicidade determina o resultado perinatal dessas gestações, e a frequência de resultados ruins é maior à medida que aumenta o número de fetos com uma única placenta. Apresentamos um caso de gravidez tríplice monocoriônica espontânea cujo seguimento foi realizado no Centro Hospitalar Pereira Rossell com excelentes resultados perinatais.