Analysis of strength and electromyographic activity of lower limbs of individuals with down syndrome assisted in physiotherapy and hippotherapy.

INTRODUCTION: one of the characteristics of Down Syndrome (DS) is muscle hypotonia. Different therapeutic approaches have a positive influence, between them Physiotherapy applications with different therapeutic approaches such as Hippotherapy have a positive effect on the physical health and quality of live of individuals with DS. OBJECTIVE: to evaluate the effects of both treatments on the strength and electromyographic activity of the lower limbs of children and adolescents with DS. METHODS: fourteen individuals, aged between 10 and 18 years, participated in two groups: Physiotherapy group (n = 5) and Hippotherapy group (n = 9). Thirty interventions were performed for each type of therapy, once a week, lasting 30 min. Pre and post-interventions, the 30-Second Chair Stand Test (30s-CST) was used to assess the strength of the lower limbs and the surface electromyography equipment (EMG 800RF) to assess the lower limb myoelectric activity. RESULTS: there was a reduction in the post-intervention electromyographic values for both treatments (p˂0.001), with significantly less myoelectric activity in Hippotherapy compared to Physiotherapy for all evaluated muscles (p˂0.001) and a significant increase in muscle strength for the Hippotherapy, post-intervention group (p = 0.0007). CONCLUSION: Physiotherapy and Hippotherapy are interventions that promote positive changes in the myoelectric activities of individuals with DS. However, only hippotherapy promoted an increase in strength of the lower limbs.

Macroscopic Evaluation of Atherosclerosis in the Arteries: An Autopsy Assessment Tool. / Avaliação Macroscópica da Aterosclerose nas Artérias: Uma Ferramenta de Avaliação na Autópsia.

BACKGROUND: Atherosclerosis, in some cases, is an asymptomatic condition, and it is important to know the degree of arterial impairment caused by plaques and its association with risk factors. Autopsy examination provides understanding of basic disease processes and assessment to data about macroscopic characteristic of atherosclerotic involvement. OBJECTIVE: To macroscopically assess and standardize atherosclerotic involvement of aorta, carotid and iliac arteries and compare with age, gender and causes of death. METHODS: We collected 53 aortic arteries, 53 right carotid arteries, 53 left carotid arteries, 53 right iliac arteries and 53 left iliac arteries. For this assessment, the extension of fatty streaks, atheromatous plaques, fibrosis and calcification were considered, being the reference to score the degree of atherosclerotic involvement. Many degrees of atherosclerosis and accurate values were observed for mild, moderate and severe classification. For statistical analysis, data were analyzed using the software GraphPad Prism® 7.0. Differences were considered statistically significant if p-value was less than 5% (p <0.05). RESULTS: Carotid arteries had greater atherosclerotic involvement compared to the other arteries (K = 15.73, p = 0.0004). Atherosclerosis was progressive and significant with increasing age (carotid arteries: t = 6.321; p <0.0001; aorta: U = 83.5; p <0.0001; iliac: U = 306; p <0.0001) and as cause of cardiovascular death (carotids: t = 5.047; p <0.0001; aorta: U = 98.5; p = 0.0068; iliac: U = 467.5; p = 0.0012). CONCLUSION: Macroscopic assessment of atherosclerosis is an innovative and low-cost way of direct visualization of atherosclerotic plaques, enabling an association with risk factors such as increasing age and cardiovascular diseases, providing important data for clinical practice.

FUNDAMENTO: A aterosclerose, em alguns casos, é uma condição assintomática, sendo necessário conhecer o grau de comprometimento arterial provocado pelas placas e sua associação com os fatores de risco. O exame de autópsia permite a compreensão dos processos básicos de doenças, assim como a avaliação e fornecimento de dados sobre a característica macroscópica do acometimento aterosclerótico. OBJETIVO: Avaliar macroscopicamente e padronizar o acometimento aterosclerótico das artérias aorta, carótidas e ilíacas e comparar com a idade, o sexo e a causa de morte. MÉTODOS: Foram coletados 53 artérias aorta, 53 artérias carótida direita, 53 artérias carótida esquerda, 53 artérias ilíaca direita e 53 artérias ilíaca esquerda. Para essa avaliação, foi considerada a extensão de estrias lipídicas, de placas ateromatosas, de fibrose e de calcificação, as quais serviram de referência para pontuar a intensidade do acometimento aterosclerótico. Foram observados vários graus da aterosclerose e valores acurados para a classificação discreta, moderada e acentuada. Para a análise estatística, os dados foram analisados utilizando-se o software GraphPad Prism ® 7.0. As diferenças foram consideradas estatisticamente significativas quando "p" foi menor que 5% (p<0,05). RESULTADOS: As artérias carótidas apresentaram maior acometimento aterosclerótico em comparação às outras artérias avaliadas (K=15,73, p=0,0004). A ocorrência da aterosclerose se mostrou progressiva e significativa com o decorrer da idade (carótidas: t=6,321; p<0,0001; aortas: U=83,5; p<0,0001; ilíacas: U=306; p<0,0001) e na causa de morte cardiovascular (carótidas: t=5,047; p<0,0001; aortas: U=98,5; p=0,0068; ilíacas: U=467,5; p=0,0012). CONCLUSÃO: A avaliação macroscópica da aterosclerose trata-se de uma forma inovadora e de baixo custo de avaliação através da visualização direta das placas ateroscleróticas, possibilitando uma associação com fatores de risco como idade avançada e doenças cardiovasculares, fornecendo dados importantes para a prática clínica.

Avaliação Macroscópica da Aterosclerose nas Artérias: Uma Ferramenta de Avaliação na Autópsia / Macroscopic Evaluation of Atherosclerosis in the Arteries: An Autopsy Assessment Tool

Resumo Fundamento A aterosclerose, em alguns casos, é uma condição assintomática, sendo necessário conhecer o grau de comprometimento arterial provocado pelas placas e sua associação com os fatores de risco. O exame de autópsia permite a compreensão dos processos básicos de doenças, assim como a avaliação e fornecimento de dados sobre a característica macroscópica do acometimento aterosclerótico. Objetivo Avaliar macroscopicamente e padronizar o acometimento aterosclerótico das artérias aorta, carótidas e ilíacas e comparar com a idade, o sexo e a causa de morte. Métodos Foram coletados 53 artérias aorta, 53 artérias carótida direita, 53 artérias carótida esquerda, 53 artérias ilíaca direita e 53 artérias ilíaca esquerda. Para essa avaliação, foi considerada a extensão de estrias lipídicas, de placas ateromatosas, de fibrose e de calcificação, as quais serviram de referência para pontuar a intensidade do acometimento aterosclerótico. Foram observados vários graus da aterosclerose e valores acurados para a classificação discreta, moderada e acentuada. Para a análise estatística, os dados foram analisados utilizando-se o software GraphPad Prism ® 7.0. As diferenças foram consideradas estatisticamente significativas quando "p" foi menor que 5% (p<0,05). Resultados As artérias carótidas apresentaram maior acometimento aterosclerótico em comparação às outras artérias avaliadas (K=15,73, p=0,0004). A ocorrência da aterosclerose se mostrou progressiva e significativa com o decorrer da idade (carótidas: t=6,321; p<0,0001; aortas: U=83,5; p<0,0001; ilíacas: U=306; p<0,0001) e na causa de morte cardiovascular (carótidas: t=5,047; p<0,0001; aortas: U=98,5; p=0,0068; ilíacas: U=467,5; p=0,0012). Conclusão A avaliação macroscópica da aterosclerose trata-se de uma forma inovadora e de baixo custo de avaliação através da visualização direta das placas ateroscleróticas, possibilitando uma associação com fatores de risco como idade avançada e doenças cardiovasculares, fornecendo dados importantes para a prática clínica.

Abstract Background Atherosclerosis, in some cases, is an asymptomatic condition, and it is important to know the degree of arterial impairment caused by plaques and its association with risk factors. Autopsy examination provides understanding of basic disease processes and assessment to data about macroscopic characteristic of atherosclerotic involvement. Objective To macroscopically assess and standardize atherosclerotic involvement of aorta, carotid and iliac arteries and compare with age, gender and causes of death. Methods We collected 53 aortic arteries, 53 right carotid arteries, 53 left carotid arteries, 53 right iliac arteries and 53 left iliac arteries. For this assessment, the extension of fatty streaks, atheromatous plaques, fibrosis and calcification were considered, being the reference to score the degree of atherosclerotic involvement. Many degrees of atherosclerosis and accurate values were observed for mild, moderate and severe classification. For statistical analysis, data were analyzed using the software GraphPad Prism® 7.0. Differences were considered statistically significant if p-value was less than 5% (p <0.05). Results Carotid arteries had greater atherosclerotic involvement compared to the other arteries (K = 15.73, p = 0.0004). Atherosclerosis was progressive and significant with increasing age (carotid arteries: t = 6.321; p <0.0001; aorta: U = 83.5; p <0.0001; iliac: U = 306; p <0.0001) and as cause of cardiovascular death (carotids: t = 5.047; p <0.0001; aorta: U = 98.5; p = 0.0068; iliac: U = 467.5; p = 0.0012). Conclusion Macroscopic assessment of atherosclerosis is an innovative and low-cost way of direct visualization of atherosclerotic plaques, enabling an association with risk factors such as increasing age and cardiovascular diseases, providing important data for clinical practice.

Impact of equine assisted therapy on the cardiovascular parameters of the elderly / Impacto da terapia assistida por equinos nos parâmetros cardiovasculares de idosos

INTRODUCTION: Physical activity programs in the elderly aim to prevent and/or reduce the functional decline resulting from the senescence process. Several studies provide evidence that Equine Assisted Therapy (EAT) is an effective means of improving health. However, studies addressing the effects of EATon the cardiovascular system are scarce. OBJECTIVE: To evaluate the effect of Equine Assisted Therapyon the cardiovascular responses of participants divided into two groups: normotensive and hypertensive. METHODS: Twenty individuals participated, aged between 60 and 79 years, divided into three groups: Normotensive Group (n=14), Hypertensive Group (n=6) and all participants, Total Group (n=20). The Omron® HEM 742 blood pressure monitor was used to measure blood pressure and the Gerathem® portable finger oximeter to measure heart rate and blood oxygen saturation. Ten visits were made once a week, lasting 30 minutes. RESULTS: Between the first and tenth interventions, there was a reduction in blood pressure and heart rate, with statistical significance of systolic blood pressure for the Hypertensive Group (p=0.0478), the Total Group (p=0.0201) and diastolic pressure for the Total Group (p=0.0421). There was also a statistically significant difference in systolic blood pressure and heart rate during some visits. Blood oxygen saturation increased after the intervention, but without statistical significance. CONCLUSION: Equine Assisted Therapy can promote a reduction in blood pressure in the elderly, especially hypertensive individuals.

INTRODUÇÃO: Programas de atividade física em idosos visam prevenir e/ou reduzir o declínio funcional decorrente do processo de senescência. Vários estudos fornecem evidências de que a Terapia Assistida por Equinos (TAE) é um meio eficaz de melhorar a saúde. No entanto, estudos que abordam os efeitos da TAE no sistema cardiovascular são escassos. OBJETIVO: Avaliar o efeito da Terapia Assistida por Eqüinos nas respostas cardiovasculares dos participantes dividos em dois grupos: normotensos e hipertensos. MÉTODOS: Participaram 20 indivíduos, com idade entre 60 a 79 anos, distribuídos em três Grupos: Grupo Normotenso (n=14), Grupo Hipertenso (n=6) e todos os participantes, Grupo Total (n=20). Foi utilizado o monitor de pressão arterial Omron® HEM 742 para aferir a pressão arterial e o oxímetro de dedo portátil Gerathem® para medir a freqüência cardíaca e a saturação de oxigênio no sangue. Foram realizados dez atendimentos uma vez por semana, com duração de 30 minutos. RESULTADOS: Entre a primeira e décima intervenção, houve redução da pressão arterial e da frequência cardíaca, com significância estatística da pressão arterial sistólica para o Grupo Hipertenso (p=0,0478), o Grupo Total (p=0,0201) e da pressão diastólica para o Grupo Total (p=0,0421). Também houve diferença estatisticamente significante da pressão arterial sistólica e da frequência cardíaca durante alguns atendimentos. A saturação de oxigênio no sangue aumentou após a intervenção, porém sem significância estatística. CONCLUSÃO: A Terapia Assistida por Eqüinos pode promover redução da pressão arterial em idosos, principlamente de hipertensos.

Electromyographic analysis of stomatognathic muscles in elderly after hippotherapy.

The aging process affects the entire human body, including the stomatognathic system, and can trigger not only occlusal but also postural imbalances involving other muscular chains. Hippotherapy has been used to promote cervical, postural, and balance control in individuals with diverse impairments. The present study used electromyography to evaluate the masseter and temporal muscles in an elderly population pre- and post-hippotherapy. Participants included 17 individuals, mean age 66,5±7 years. Electromyographic recording of the bilateral masseter and temporal muscles was performed during the postural resting condition and activities that involved the active participation of these muscles in different conditions. The practitioner performed no other type of activity or exercise during the intervention because the objective is to evaluate the effect of the three-dimensional movement provided by the horse. Raw electromyographic data were tabulated using commercially available software (IBM® SPSS® Statistics 234.0) and subjected to statistical analysis, in which p ≤ 0.05 was considered to be statistically significant. Post-hippotherapy, there was lower electromyographic activity for the masseter and temporalis muscles in all the static mandibular tasks, with significant effect for time for the right temporal muscle (p = 0.038), the left temporal muscle (p = 0.028) and in the all dynamic mandibular tasks for the left temporal muscle (p = 0.025) and the left masseter muscle (p = 0.027). Hippotherapy promotes a reduction in the myoelectric activity of the masticatory muscles of elderly individuals.

Impact of hippotherapy for balance improvement and flexibility in elderly people.

INTRODUCTION: The decrease in functional ability, strength, balance, flexibility, agility, and coordination owing to neurological and muscular changes is one of the characteristic features of the human aging process. Hippotherapy has been highlighted as a therapeutic approach with physical and psychological benefits for this section of the population. However, the effects of hippotherapy in elderly people need to be further studied by assessing their balance and flexibility. METHODS: Thirty elderly people were recruited and divided into two groups; 15 in the Hippotherapy Group (HG), and 15 in the control group (CG) (aged 66.07 ±â€¯5.80 and 68.47 ±â€¯5.85 years, respectively). The HG received ten 30-min sessions of hippotherapy once a week. Assessment included the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), the Functional Reach Test (FRT)and the Sit-and-Reach Test with the Well's box before the first and after the tenth session of hippotherapy; and the Sit-and-Reach Test before and after each session. RESULTS: The HG demonstrated a significant difference in the TUG test execution time and the FRT scores before and after the hippotherapy sessions (p = 0.036, p = 0.030, respectively), indicating an improvement in functional range. The examination of flexibility with the Wells's box also revealed a significant difference in the rates (cm) before and after 10 sessions of the hippotherapy for the HG (p = 0.033). CONCLUSIONS: The present findings showthat hippotherapy improved elderly people's functional mobility, dynamic balance, and flexibility. These results will guide professionals who treat this population.

Analysis of mast cells and myocardial fibrosis in autopsied patients with hypertensive heart disease.

OBJECTIVE: To analyze the percentage of collagen fibers and mast cell density in the left ventricular myocardium of autopsied patients with and without hypertensive heart disease. METHODS: Thirty fragments of left ventricular myocardium were obtained from individuals autopsied at the Clinical Hospital of the Federal University of Triângulo Mineiro (UFTM) in the period from 1987 to 2017. Individuals were divided into two groups: those with hypertensive heart disease (HD) and those with no heart disease (ND). Subjects were also assessed according to age, gender and race (white and non-white). Collagen fibers were quantified by computed morphometry and mast cell density was assessed by immunohistochemical methods. RESULTS: There were significantly more collagen fibers in the left ventricle in the HD group than in the ND group (p<0.001). Mast cell density was significantly higher in the left ventricle of individuals with HD immunolabeled with anti-chymase and anti-tryptase antibodies (p=0.02) and also of those immunolabeled only with anti-tryptase antibodies (p=0.03). Analyzing the HD group, there was a significant positive correlation between the percentage of collagen fibers in the left ventricle and mast cell density immunolabeled by anti-chymase and anti-tryptase antibodies (p=0.04) and also mast cell density immunolabeled only with anti-tryptase antibodies (p=0.02). CONCLUSIONS: Mast cells are involved in the development of hypertensive heart disease, contributing to the remodeling of collagen fibers in this disease.

Alterações na Epiderme de Pacientes com Aids Autopsiados em Uso da Terapia Antirretroviral / Changes in the Epidermis of Autopsied AIDS Patients Using Antiretroviral Therapy

Objetivo: Avaliar a influência da terapia na morfologia da epiderme de pacientes com Síndrome da Imunodeficiência Adquirida - AIDS. Metodologia: Estudo transversal desenvolvido na Universidade Federal do Triângulo Mineiro, Brasil. Foram selecionados pacientes com AIDS de ambos os sexos, que foram agrupados de acordo com o tratamento com Terapia antir-retroviral de alta eficiência: pacientes em uso de HAART (n = 14) e pacientes sem uso de HAART (n = 14). Outras informações foram coletadas do prontuário clínico. Resultados: A idade média dos pacientes em tratamento foi de 49,07 ± 7,89 anos e dos pacientes sem TARV foi de 55,11 ± 10,17 anos. A maioria dos pacientes na terapia utilizada pertencia ao sexo feminino, 9 (64,28%). Estes apresentaram espessamento epidérmico (150,04 x 86,09µm), número de camadas celulares (8,0 x 5,5 camadas) e densidade de células de Langerhans superiores àquelas que não utilizaram a terapia, com diferença significativa. Conclusão: Nossos achados sugerem que o HAART propor-ciona a recuperação dos constituintes da epiderme alterados pela doença, melhorando sua função como barreira chave na proteção do corpo contra microorganismos ambientais. (AU)

Objective: To evaluate the influence of therapy in the morphology of the epidermis of patients with Acquired Immunodeficiency Syndrome. Methodology: Cross-sectional study developed at the Triangulo Mineiro Federal University, Brazil. This study has been approved by Triângulo Mineiro Federal University Research Ethics Committee on protocol number 1780/2010. Patients with AIDS, of both genders were selected and arranged according to treatment with Highly Active Antiretroviral Therapy: patients in use of HAART (n = 14), and patients without use of HAART (n = 14). Other information was collected from the clinical record. Results: The mean age of the patients undergoing therapy was 49.07±7.89 years, and of the patients without HAART was 55.11±10.17 years. The majority of the patients using the therapy, belonged to the female gender, 9 (64.28%). These showed epidermal thickness (150.04 x 86.09µm), number of cell layers (8.0 x 5.5 layers) and density of Langerhans cells higher than those who did not use the therapy, with a significant difference. Conclusion: Our findings suggest that the HAART provides recovery of epidermis constituents altered by the disease, improving its function as a key barrier in protecting the body against environmental microorganisms. (AU)

Effect of horse riding equipment in activity of trunk and lower limb muscles in equine-assisted therapy

Equine-assisted therapy uses the horse in rehabilitation and/or education of people, such as Down syndrome(SD), cerebral palsy(PC)and intellectual disability(DI). In context, the rehabilitation program and horse riding equipment should be usedaccording to the specific characteristics of each individual, becoming an ally in the quest for excellence in equine-assisted therapy programs. The aim was to evaluate the effect of riding equipment used in equine-assisted therapy on the muscular activityof trunk and lower limb of individuals with SD, PC and DI. The study included 15 individuals equally assigned to each group: SD, PC and DIwith a mean age of 16.2 (±1.10), 16 (±1.22)e 16 (±0) years,respectively. The analysis of muscle activity was performed through surface electromyography, using four variations of horse riding equipment: saddle with and without feet supported on the stirrups and blanket with and without feet supported on the stirrups. Sigma Stat 3.5®software was used for statistical analysis.The Shapiro Wilk's test was used for normality of the data, the Bartlett test for homogeneity of the variances and the Kruskal-Wallis test for repeated measures with no normal distribution.Statistically significant differences were observed forp<0.05.The SDgroup presented a greater muscular activity of trunk and lower limbs with blanket equipment without the feet supported in the stirrups (H = 15.078, p = 0.002), as in the DI group (H=8.302, p = 0.040), while inPCgroup was the saddle with feet supported in the stirrups (H=11.137,p = 0.011). The choice of riding equipment used in equine-assisted therapy interferes differently in the pattern of muscular activation of the trunk and the lower limbs, according to the pathological processes of the practitioners. It should be an important aspect to consider when planninga treatment.

Analysis of the electromiographic activity of lower limb and motor function in hippotherapy practitioners with cerebral palsy.

OBJECTIVE: Investigation of the effects of hippotherapy treatment on lower limb muscle activity and gross motor function in subjects with cerebral palsy (CP), comparing them to a group of subjects with adequate motor development. METHODS: Evaluation was made of seven individuals with spastic diparetic CP, average age 9.3 (±3.3) years (CP group), Gross Motor Function Classification System (GMFCS) levels I and II, and eight individuals with adequate motor development, average age 10.9 (±3.2) years (control group). The groups were submitted to 25 sessions of hippotherapy, each lasting 30 min, on a weekly basis, and the muscle activity of the lower limbs was evaluated using surface electromyography during the 1st, 10th, 20th, and 25th sessions. For the CP group, Gross Motor Function Measurement (GMFM-88) was performed before and after hippotherapy treatment. RESULTS: There was higher muscle activity in the 10th session, compared to the other sessions, with greater activity of the tibialis anterior muscles, for both groups studied. After treatment, the CP group showed significant improvement in the GMFM total score, and in the scores for dimensions D and E. CONCLUSION: Hippotherapy sessions improved the muscle responses in both groups, and improved the gross motor function of the subjects with CP.

Width of sulcus and thickness of gyrus in patients with cerebral atherosclerosis: a new tool for the prevention of vascular cognitive impairment

SUMMARY BACKGROUND AND PURPOSE Cerebral atherosclerosis is the main cause of lesions that contribute to vascular cognitive impairment and vascular dementia, followed by arteriosclerosis of small vessels and cerebral amyloid angiopathy. The purpose of this study was to compare the post-mortem radiological alterations of autopsied adults with the macroscopic alterations in the posterior region of these brains in order to establish a relationship between the two forms of analysis and to discuss the relevance of the prevention of vascular cognitive impairment in patients with encephalic atherosclerosis. MATERIALS AND METHODS Thirteen brains were analysed macroscopically to assess the degree of atherosclerosis of the basilar and the posterior cerebral arteries. The patients were autopsied in the Subject of General Pathology at General Hospital of Triângulo Mineiro Federal University in Uberaba, state of Minas Gerais, Brazil. The qualitative analysis of atherosclerosis was performed with classification into mild, moderate or severe. In the posterior region of the brains, width of sulcus and thickness of gyrus were measured by macroscopic analysis and by tomographic analysis. RESULTS AND CONCLUSIONS There was a decrease in calcarine sulcus width and an increase in medial temporal occipital gyrus thickness in patients with a higher degree of atherosclerosis, macroscopically and in tomography, respectively. Low oxygenation caused by atherosclerosis probably leads to an encephalic parenchyma inflammation that causes microglial cells hypertrophy provoking increase in the gyrus thickness and decrease in the sulcus width, as observed in the present study.

RESUMO INTRODUÇÃO E OBJETIVO A aterosclerose cerebral é a principal causa de lesões que contribuem para o comprometimento cognitivo vascular (CCV) e demência vascular, seguida da arteriosclerose de pequenos vasos e da angiopatia amiloide cerebral. Sendo assim, este estudo comparou as alterações radiológicas post mortem de adultos autopsiados com as alterações macroscópicas na região posterior desses encéfalos a fim de estabelecer uma relação entre as duas formas de análise e discutir sobre a relevância da prevenção do CCV em pacientes com aterosclerose encefálica. MATERIAL E MÉTODOS Treze encéfalos foram analisados macroscopicamente para avaliar o grau de aterosclerose das artérias basilar e cerebral posterior. Os pacientes foram autopsiados na disciplina de Patologia Geral no HC-UFTM em Uberaba, Minas Gerais, Brasil. A análise qualitativa da aterosclerose foi realizada com as classificações discreta, moderada ou acentuada. A espessura dos giros e a largura dos sulcos na região posterior dos encéfalos foram analisadas macroscopicamente e por tomografia computadorizada. RESULTADOS E CONCLUSÃO Houve diminuição na largura do sulco calcarino e aumento na espessura do giro occipital temporal medial de acordo com o aumento do grau de aterosclerose macroscopicamente e por tomografia, respectivamente. A baixa oxigenação causada pela aterosclerose provoca a inflamação do parênquima encefálico, provavelmente levando à hipertrofia das células da micróglia e ao consequente aumento dos giros e estreitamento dos sulcos, como observado no presente estudo.

Avaliação da flexibilidade de crianças com paralisia cerebral espástica após intervenção fisioterapêutica / Assessment of the flexibility of children with spastic cerebral palsy after physiotherapeutic intervention

Introdução: A fisioterapia favorece a flexibilidade e diminue a espasticidade de crianças com paralisia cerebral (PC). Objetivos: avaliar os benefícios da fisioterapia convencional para a flexibilidade a curto e longo prazo de crianças com PC espástica. Métodos: participaram seis pacientes com PC espástica, idade de seis a 14 anos, ambos os gêneros. Foram realizadas 16 sessões de fisioterapia convencional com alongamentos passivos. Para avaliação da flexibilidade, aplicou-se o Teste de Sentar e Alcançar utilizando o Banco de Wells antes e após cada sessão. Para a análise estatística foi utilizado o Software Sigma-Stat® versão 3.5 com significância estatística (p<0,05). Resultados: houve aumento significativo da flexibilidade da cadeia muscular posterior comparando pré e pós individualmente (p<0,05) e da média pré e pós sessões (p<0,0001). Conclusão: fisioterapia convencial por meio de exercícios de alongamentos passivos melhora a flexibilidade da cadeia muscular posterior de crianças com PC espástica a curto ou a longo prazo.

Introduction: Physiotherapy favors flexibility and reduce the spasticity of children with spastic cerebral palsy. Objectives: To evaluate the benefits of conventional physiotherapy to improve the flexibility of the posterior muscle chain in the short and long term of children with spastic cerebral palsy. Methods: participated six patients with a diagnosis of Cerebral Palsy, age of six to 14 years, both genders. There were 16 sessions of conventional physiotherapy with passive stretching. For the assessment of flexibility, the sit and reach test was applied using the Wells's box before and after each session. For statistical analysis, Sigma-Stat® Software version 3.5 was used with statistical significance (p <0.05). Results: There was a significant increase in the flexibility of the posterior muscular chain of the children when comparing pre and post individually (p <0.05) and the mean before and after the sessions (P <0.0001). Conclusion: Conventional physiotherapy through passive stretching exercises improves the flexibility of the posterior muscular chain of children with spastic Cerebral Palsy in the short or long term.

Analysis of the collagen fibers on autopsied patients' uterus with the Acquired Immunodeficiency Syndrome / Análise das fibras colágenas do útero de pacientes autopsiadas com a Síndrome da Imunodeficiência Adquirida

Abstract Objectives: to compare the percentage of collagen fibers in the autopsied women's uterine body and cervix with and without the Acquired Immunodeficiency Syndrome (Aids). Methods: 30 autopsied women's medical files were selected from 1988 to 2013. 30 fragments of the uterine body and 30 cervix were collected and then divided into two groups, 15 with Aids and 15 without, The quantification of the collagen fibers of the uterine body and cervix was performed on slides stained with picrosirius, using the KS-300® system. Results: the percentage of collagen fibers was lower for cervix (U=336544; p=0.001) and higher for the uterine body (U=308726,5; p=0.004) in the retroviral group when compared to the group without the disease. The percentage was higher for cervix than the uterine body in the group with Aids (t=0,4793; p=0.0031). the same result was found in the group without Aids (t=2,397; p=0.0637). Conclusions: the increase in the percentage of collagen fibers in the uterine body of women with Aids' indicates an immune response for viral infection and reveals a failure in keeping the infection restricted to the cervix. The interpretation of the histochemical and morphometric parameters can be useful in the diagnosis associated to HIV infection, contributing for clinical improvement and life expectancy.

Resumo Objetivos: comparar a porcentagem de fibras colágenas no corpo e colo uterino de mulheres autopsiadas com e sem a Síndrome da Imunodeficiência Adquirida (Aids). Métodos: foram selecionados 30 prontuários de mulheres autopsiadas no período de 1988 a 2013. Foram coletados 30 fragmentos do corpo uterino e 30 do colo uterino, dividido em dois grupos, 15 com Aids e 15 sem. A quantificação das fibras colágenas do corpo e colo uterino foi feita nas lâminas coradas por picrosirius, utilizando-se o sistema KS-300®. Resultados: a porcentagem de fibras colágenas foi menor no colo (U=336544; p=0,001) e maior no corpo uterino (U=308 726,5; p=0,004) no grupo com a retrovirose quando comparado ao grupo sem a doença. A porcentagem no grupo com Aids foi maior no colo uterino do que no corpo (t=0,4793; p=0,0031). Sendo o mesmo resultado encontrado para o grupo sem Aids (t=2.397; p=0,0637). Conclusões: um aumento da porcentagem de fibras colágenas no corpo uterino das mulheres com Aids indica uma resposta imune frente a infecção viral e revela uma falha em manter a infecção restrita ao colo. A interpretação dos parâmetros histoquímicos e morfométricos podem ser úteis no diagnóstico das condições associadas à infecção pelo HIV, contribuindo para a melhora clínica e expectativa de vida.

Activation of lower limb muscles with different types of mount in hippotherapy.

OBJECTIVES: To analyze muscle activation of lower limbs (LL) of subjects in hippotherapy sessions. METHODS: The study included 10 healthy subjects, five male and five female, with an average age of 24.03 (±4.06) years. Subjects underwent four hippotherapy sessions of 30 min with interval of one week, and each session was performed with a different type of mount material in the following order: 1st performed with saddle and feet in the stirrups (S1), 2nd with saddle and feet off the stirrups (S2), 3rd with blanket and feet off the stirrup (S3) and 4th with blanket and feet in the stirrups (S4). Surface electromyographies were performed at 1, 10, 20 and 30 min of session, and the electrodes were placed on muscle bellies bilaterally on the muscles rectus femoris, vastus medialis, vastus lateralis and tibialis anterior. RESULTS: The analysis of muscle activity during these four sessions showed a significant difference in muscle recruitment in LL, and sessions with blanket and feet in the stirrups provided greater muscle activation of quadriceps and tibialis anterior with the horse at step gait (p = 0.0002). CONCLUSION: The results suggest that feet positioned in the stirrups is a relevant factor for greater muscle recruitment in LL to maintain postural balance while riding, especially using a blanket as mount material for ride a horse.

Width of sulcus and thickness of gyrus in patients with cerebral atherosclerosis: a new tool for the prevention of vascular cognitive impairment.

BACKGROUND AND PURPOSE: Cerebral atherosclerosis is the main cause of lesions that contribute to vascular cognitive impairment and vascular dementia, followed by arteriosclerosis of small vessels and cerebral amyloid angiopathy. The purpose of this study was to compare the post-mortem radiological alterations of autopsied adults with the macroscopic alterations in the posterior region of these brains in order to establish a relationship between the two forms of analysis and to discuss the relevance of the prevention of vascular cognitive impairment in patients with encephalic atherosclerosis. MATERIALS AND METHODS: Thirteen brains were analysed macroscopically to assess the degree of atherosclerosis of the basilar and the posterior cerebral arteries. The patients were autopsied in the Subject of General Pathology at General Hospital of Triângulo Mineiro Federal University in Uberaba, state of Minas Gerais, Brazil. The qualitative analysis of atherosclerosis was performed with classification into mild, moderate or severe. In the posterior region of the brains, width of sulcus and thickness of gyrus were measured by macroscopic analysis and by tomographic analysis. RESULTS AND CONCLUSIONS: There was a decrease in calcarine sulcus width and an increase in medial temporal occipital gyrus thickness in patients with a higher degree of atherosclerosis, macroscopically and in tomography, respectively. Low oxygenation caused by atherosclerosis probably leads to an encephalic parenchyma inflammation that causes microglial cells hypertrophy provoking increase in the gyrus thickness and decrease in the sulcus width, as observed in the present study.

Rupture of the myocardium in autopsied MI hearts / Ruptura do miocárdio em corações com IM autopsiados

Summary Although myocardial rupture occurs in only 2% to 4% of cases of acute myocardial infarction (AMI), there is a high mortality rate due to acute cardiogenic shock. We present the anatomopathological findings of three cases of myocardial rupture in autopsied hearts in the last 30 years, with a diagnosis of cardiac rupture in acute myocardial infarction. In these 30 years the percentage of AMI with myocardial rupture was 0.2%. Risk factors for post-AMI myocardial rupture include older age, atherosclerosis, diabetes mellitus and systemic arterial hypertension.

Resumo Embora a ruptura do miocárdio ocorra em apenas 2 a 4% dos casos de infarto agudo do miocárdio (IAM), está associada a alta mortalidade, principalmente em decorrência do estado de choque cardiogênico agudo. São apresentados os achados anatomopatológicos de três casos de ruptura do miocárdio de pacientes autopsiados nos últimos 30 anos, com diagnóstico de ruptura cardíaca em decorrência de IAM. Nesse período, a porcentagem de IAM com ruptura do miocárdio foi de 0,2%. Os fatores de risco para ruptura do miocárdio pós-IAM incluem idade avançada, arteriosclerose, diabetes mellitus e hipertensão arterial sistêmica.

Rupture of the myocardium in autopsied MI hearts.

Although myocardial rupture occurs in only 2% to 4% of cases of acute myocardial infarction (AMI), there is a high mortality rate due to acute cardiogenic shock. We present the anatomopathological findings of three cases of myocardial rupture in autopsied hearts in the last 30 years, with a diagnosis of cardiac rupture in acute myocardial infarction. In these 30 years the percentage of AMI with myocardial rupture was 0.2%. Risk factors for post-AMI myocardial rupture include older age, atherosclerosis, diabetes mellitus and systemic arterial hypertension.

Correlação entre cardiopatias hipertensivas e aterosclerose na artéria aorta / Correlation between hypertension cardiopathies and atherosclerosis in the aortic artery

A hipertensão arterial sistêmica é uma doença multifatorial, comportando-se como fator desencadeador das doenças cardiovasculares e da aterosclerose. O objetivo foi descrever a associação de idade, gênero, cor da pele e o grau de aterosclerose na artéria aorta na cardiopatia hipertensiva em indivíduos autopsiados. Foram avaliados 34 seguimentos de artérias aortas abdominais de indivíduos autopsiados com cardiopatia hipertensiva (20) e sem cardiopatia hipertensiva (14). A idade, gênero, cor da pele e causa de morte foram coletadas do laudo de autopsia, a quantificação da intensidade de aterosclerose e o grau de aterosclerose através de escala padronizada. Neste estudo, a causa de morte e a intensidade da aterosclerose apresentaram associação significativa com a cardiopatia hipertensiva; houve prevalência de placas de ateroma de maior extensão entre os indivíduos com esta entidade. Desse modo, a aterosclerose deve ser investigada em indivíduos com cardiopatia hipertensiva visando prevenir graves repercussões, que podem culminar com o óbito.

Systemic arterial hypertension is a multifactorial disease, behaving as a triggering factor for cardiovascular diseases and atherosclerosis. The objective was to describe the association of age, gender, skin color and, the atherosclerosis level in the aortic artery in hypertensive cardiopathy of autopsied individuals. We assessed 34 parts of abdominal aortic arteries of autopsied individuals with hypertensive cardiopathy (20) and without hypertensive cardiopathy (14). We collected age, gender, skin color and cause of death from the autopsy report; the quantification of the atherosclerosis intensity and the atherosclerosis level were determined using a standardized scale. In this study, the cause of death and atherosclerosis intensity had a significant association with hypertensive cardiopathy; there was a prevalence of large atheroma plaques among individuals with this entity. Thus, atherosclerosis should be investigated in individuals with hypertensive cardiopathy to prevent severe repercussions which could lead to death.

Implications of alcoholic cirrhosis in atherosclerosis of autopsied patients.

INTRODUCTION:: Alcoholism is a major public health problem, which has a high social cost and affects many aspects of human activity. Liver disease is one of the first consequences of alcohol abuse, and steatosis, liver cirrhosis and hepatitis may occur. Other organs are also affected with pathological changes, such as pancreatitis, cardiomyopathies, dyslipidemias and atherosclerosis. OBJECTIVE:: To identify the occurrence and degree of atherosclerosis in alcohol-dependent individuals with liver cirrhosis, observing macroscopic and microscopic changes in lipid and collagen deposits and in the liver. We also aimed to verify the association of lipid and collagen fiber deposits with gender, age and body mass index, and to relate alcoholism, liver cirrhosis and atherosclerosis. METHOD:: We performed a study based on autopsy reports of patients with alcoholic liver cirrhosis, with analysis of aorta and liver fragments to verify the occurrence and degree of atherosclerosis, as well as collagen contents. RESULTS:: Microscopic atherosclerosis was higher in young subjects (early injury) and in patients with alcoholic liver cirrhosis. The macroscopic analysis of atherosclerosis in aortas showed that patients in more advanced age groups presented more severe classifications. Atherosclerosis, both micro and macroscopically, and the percentage of fibrosis in the liver and aorta were more expressive in females. CONCLUSION:: Cirrhotic patients presented a higher percentage of fibrosis and lipidosis, and may represent a group susceptible to the accelerated progression of cardiovascular diseases. Investigative studies contribute to targeting health-promoting interventions, reducing the mortality and costs of treating cardiovascular disease.

Implications of alcoholic cirrhosis in atherosclerosis of autopsied patients / Implicações da doença hepática alcoólica na aterosclerose de pacientes autopsiados

Summary Introduction: Alcoholism is a major public health problem, which has a high social cost and affects many aspects of human activity. Liver disease is one of the first consequences of alcohol abuse, and steatosis, liver cirrhosis and hepatitis may occur. Other organs are also affected with pathological changes, such as pancreatitis, cardiomyopathies, dyslipidemias and atherosclerosis. Objective: To identify the occurrence and degree of atherosclerosis in alcohol-dependent individuals with liver cirrhosis, observing macroscopic and microscopic changes in lipid and collagen deposits and in the liver. We also aimed to verify the association of lipid and collagen fiber deposits with gender, age and body mass index, and to relate alcoholism, liver cirrhosis and atherosclerosis. Method: We performed a study based on autopsy reports of patients with alcoholic liver cirrhosis, with analysis of aorta and liver fragments to verify the occurrence and degree of atherosclerosis, as well as collagen contents. Results: Microscopic atherosclerosis was higher in young subjects (early injury) and in patients with alcoholic liver cirrhosis. The macroscopic analysis of atherosclerosis in aortas showed that patients in more advanced age groups presented more severe classifications. Atherosclerosis, both micro and macroscopically, and the percentage of fibrosis in the liver and aorta were more expressive in females. Conclusion: Cirrhotic patients presented a higher percentage of fibrosis and lipidosis, and may represent a group susceptible to the accelerated progression of cardiovascular diseases. Investigative studies contribute to targeting health-promoting interventions, reducing the mortality and costs of treating cardiovascular disease.

Resumo Introdução: O alcoolismo é um grande problema de saúde pública, de elevado custo social e que afeta vários aspectos da atividade humana. Hepatopatia é uma das primeiras consequências do abuso de álcool, podendo ocorrer esteatose, cirrose hepática e hepatite. Outros órgãos, porém, também são afetados, ocorrendo alterações patológicas, como pancreatite, cardiomiopatias, dislipidemias e aterosclerose. Objetivo: Identificar a ocorrência e a intensidade de aterosclerose em alcoolistas com cirrose hepática, observando alterações macro e microscópicas do depósito lipídico e de fibras colágenas e fígado. Verificar a associação de depósito lipídico e de fibras colágenas com gênero, idade e índice de massa corporal (IMC). Relacionar alcoolismo, cirrose hepática e aterosclerose. Método: Foi realizado estudo com base em laudos de autópsias de pacientes com cirrose hepática alcoólica, sendo estudados aortas e fígados para verificar a ocorrência e a intensidade de aterosclerose, bem como a quantidade de colágeno encontrada. Resultados: A aterosclerose microscópica foi maior em jovens (lesão inicial) e em pacientes com cirrose hepática alcoólica. A análise macroscópica da aterosclerose nas aortas mostrou que pacientes com faixas etárias mais avançadas apresentaram classificações mais intensas. A aterosclerose, tanto micro quanto macroscopicamente, e a porcentagem de fibrose no fígado e na aorta foram mais expressivas no gênero feminino. Conclusão: Os pacientes cirróticos apresentaram maior porcentagem de fibrose e lipidose, e podem representar um grupo susceptível à acelerada progressão de doenças cardiovasculares. Estudos investigativos contribuem para o direcionamento das intervenções promotoras da saúde, reduzindo a mortalidade e os custos no tratamento das doenças cardiovasculares.