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1.
Arch Bronconeumol ; 2019 Nov 26.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31784347

RESUMO

INTRODUCTION: It is unclear whether low-risk patients with acute symptomatic pulmonary embolism (PE) should undergo echocardiogram. METHODS: We performed a meta-analysis of studies that enrolled patients with acute low-risk PE to assess the prognostic value of echocardiographic diagnosis of right ventricular (RV) dysfunction for the primary outcome of short-term all-cause mortality, and the secondary outcome of short-term PE-related mortality. We used a random-effects model to pool study results, a Begg rank correlation method to evaluate for publication bias, and I2 testing to assess heterogeneity. RESULTS: The meta-analysis included a total of 11 studies 1,868 patients with low-risk PE. Ten of the 447 (2.2%; 1.1%-4.1%) low-risk patients with echocardiographic RV dysfunction died soon after the diagnosis of PE compared with 10 of 1,421 (0.7%; 0.3-1.3%) patients without RV dysfunction. RV dysfunction was not significantly associated with short-term all-cause mortality (odds ratio 2.0; 95% confidence interval, 0.8-5.1, p=.14; I2=8%). RV dysfunction was significantly associated with short-term PE-related mortality (odds ratio 5.2; 95% confidence interval, 1.7-16, p <.01; I2=0%). CONCLUSIONS: In patients with low-risk PE, echocardiographic RV dysfunction is not associated with all-cause mortality, but identifies patients with an increased risk for short-term PE-related mortality.

2.
Aging Clin Exp Res ; 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31290021

RESUMO

BACKGROUND: Although patient environment is a factor to consider when planning a vestibular rehabilitation program, there are no studies correlating this factor to outcomes of balance assessment. AIM: To evaluate whether there are differences in objective evaluation of balance in elderly patients at risk of falls according to the environment in which they live (urban or rural) and their lifestyle (considering cardiovascular risk factors). METHODS: Cross-sectional study of a sample of 139 elderly patients with high risk of falls assessed with objective outcome measures: Computer Dynamic Posturography (CDP), and the modified Timed Up-and-Go (TUG) test; and subjective outcome measures: Dizziness Handicap Inventory (DHI) and short Falls Efficacy Scale-International (short FES-I). Rural or urban environment was defined according to administrative and legal criteria. RESULTS: Elderly patients at risk of fall living in rural environment show better composite results in SOT with better scores in Condition 6 and fewer falls during the CDP. They also require fewer steps to perform the TUG test. DISCUSSION: The present study provides evidence that patient environment has an influence in balance. CONCLUSION: Patient environment should be considered when analyze tests evaluating static and dynamic balance.

3.
Aging Clin Exp Res ; 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30977081

RESUMO

BACKGROUND: Our previous study has shown that vestibular rehabilitation (VR) is an effective technique to reduce falls in elderly patients. It would be interesting to establish patients' clinical characteristics in which vestibular rehabilitation is expected to be more effective. AIMS: Evaluate factors that could modify rehabilitation outcomes in elderly patients with previous falls. METHODS: Fifty-seven patients randomized to one of the intervention group (computerized dynamic posturography-CDP-training, optokinetic stimulus or exercise at home) and with previous falls were analyzed. Patients were assessed with objective outcome measures (sensorial organization test and limits of stability-LOS-of CDP, modified timed up and go test-TUG-and number of falls) and with subjective outcome measures (dizziness handicap inventory and Short falls efficacy scale-international-Short FES-I) during a 12-month follow-up period. RESULTS: In the logistic regression model, a worse score in the maximum excursion (MXM), and a shorter time in the TUG significantly associated with a reduction > 50% of falls. Also, association with a higher score in the Short FES-I was close to a statistical significance. There was no statistical significance association with other covariables. DISCUSSION: In patients with reduced limits of stability, VR seems to be more effective and they should be encouraged to perform it. But on the other hand, patients with longer time in the TUG show worse outcomes and may benefit more with gait training. CONCLUSIONS: VR in elderly people with previous falls is effective regardless of their age and gender.

4.
J Steroid Biochem Mol Biol ; 190: 115-125, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30940596

RESUMO

Serum concentrations of lathosterol, the plant sterols campesterol and sitosterol and the cholesterol metabolite 5α-cholestanol are widely used as surrogate markers of cholesterol synthesis and absorption, respectively. Increasing numbers of laboratories utilize a broad spectrum of well-established and recently developed methods for the determination of cholesterol and non-cholesterol sterols (NCS). In order to evaluate the quality of these measurements and to identify possible sources of analytical errors our group initiated the first international survey for cholesterol and NCS. The cholesterol and NCS survey was structured as a two-part survey which took place in the years 2013 and 2014. The first survey part was designed as descriptive, providing information about the variation of reported results from different laboratories. A set of two lyophilized pooled sera (A and B) was sent to twenty laboratories specialized in chromatographic lipid analysis. The different sterols were quantified either by gas chromatography-flame ionization detection, gas chromatography- or liquid chromatography-mass selective detection. The participants were requested to determine cholesterol and NCS concentrations in the provided samples as part of their normal laboratory routine. The second part was designed as interventional survey. Twenty-two laboratories agreed to participate and received again two different lyophilized pooled sera (C and D). In contrast to the first international survey, each participant received standard stock solutions with defined concentrations of cholesterol and NCS. The participants were requested to use diluted calibration solutions from the provided standard stock solutions for quantification of cholesterol and NCS. In both surveys, each laboratory used its own internal standard (5α-cholestane, epicoprostanol or deuterium labelled sterols). Main outcome of the survey was, that unacceptably high interlaboratory variations for cholesterol and NCS concentrations are reported, even when the individual laboratories used the same calibration material. We discuss different sources of errors and recommend all laboratories analysing cholesterol and NCS to participate in regular quality control programs.


Assuntos
Colesterol/sangue , Fitosteróis/sangue , Colestanol/sangue , Colesterol/análogos & derivados , Cromatografia Gasosa/métodos , Cromatografia Líquida/métodos , Humanos , Sitosteroides/sangue , Inquéritos e Questionários
5.
BMC Geriatr ; 19(1): 1, 2019 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-30606112

RESUMO

BACKGROUND: Accidental falls, especially for the elderly, are a major health issue. Balance disorders are one of their main causes. Vestibular rehabilitation (VR) has proven to be useful in improving balance of elderly patients with instability. Its major handicap is probably its cost, which has prevented its generalisation. So, we have designed a clinical trial with posturographic VR, to assess the optimum number of sessions necessary for a substantial improvement and to compare computerised dynamic posturography (CDP) (visual feedback) and mobile posturography (vibrotactile feedback). METHODS: Design: randomized controlled trial. It is an experimental study, single-center, open, randomized (balanced blocks of patients) in four branches in parallel, in 220 elderly patients with high risk of falls; follow-up period: twelve months. SETTING: Department of Otorhinolaryngology of a tertiary referral hospital. PARTICIPANTS: people over 65 years, fulfilling two or more of the following requirements: a) at least one fall in the last twelve months. b) take at least 16 s or require some support in perform the "timed up and go" test. c) a percentage of average balance in the sensory organization test (SOT) of the CDP < 68%. d) at least one fall in any of the conditions in SOT-CDP. e) a score in Vertiguard's gSBDT > 60%. INTERVENTION: Four differents protocols of vestibular rehabilitation (randomization of the patients). MAIN OUTCOME MEASURE: The percentage of average balance in the SOT-CDP. Secondary measures: time and supports in the "timed up and go" test, scores of the CDP and Vertiguard, and rate of falls. DISCUSSION: Posturographic VR has been proven to be useful for improving balance and reducing the number of falls among the aged. However, its elevated cost has limited its use. It is possible to implement two strategies that improve the cost-benefit of posturography. The first involves optimising the number of rehabilitation sessions; the second is based on the use of cheaper posturography systems. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03034655. Registered on 25 January 2017.


Assuntos
Acidentes por Quedas/economia , Redução de Custos/economia , Exercício/fisiologia , Equilíbrio Postural/fisiologia , Tato/fisiologia , Vibração/uso terapêutico , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Dispositivos Eletrônicos Vestíveis/economia
6.
Med Sci Sports Exerc ; 50(11): 2242-2252, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30334920

RESUMO

PURPOSE: Cross-sectional studies suggest that training can increase muscle carnosine (MCarn), although longitudinal studies have failed to confirm this. A lack of control for dietary ß-alanine intake or muscle fiber type shifting may have hampered their conclusions. The purpose of the present study was to investigate the effects of high-intensity interval training (HIIT) on MCarn. METHODS: Twenty vegetarian men were randomly assigned to a control (CON) (n = 10) or HIIT (n = 10) group. High-intensity interval training was performed on a cycle ergometer for 12 wk, with progressive volume (6-12 series) and intensity (140%-170% lactate threshold [LT]). Muscle carnosine was quantified in whole-muscle and individual fibers; expression of selected genes (CARNS, CNDP2, ABAT, TauT, and PAT1) and muscle buffering capacity in vitro (ßmin vitro) were also determined. Exercise tests were performed to evaluate total work done, V˙O2max, ventilatory thresholds (VT) and LT. RESULTS: Total work done, VT, LT, V˙O2max, and ßmin vitro were improved in the HIIT group (all P < 0.05), but not in CON (P > 0.05). MCarn (in mmol·kg dry muscle) increased in the HIIT (15.8 ± 5.7 to 20.6 ± 5.3; P = 0.012) but not the CON group (14.3 ± 5.3 to 15.0 ± 4.9; P = 0.99). In type I fibers, MCarn increased in the HIIT (from 14.4 ± 5.9 to 16.8 ± 7.6; P = 0.047) but not the CON group (from 14.0 ± 5.5 to 14.9 ± 5.4; P = 0.99). In type IIa fibers, MCarn increased in the HIIT group (from 18.8 ± 6.1 to 20.5 ± 6.4; P = 0.067) but not the CON group (from 19.7 ± 4.5 to 18.8 ± 4.4; P = 0.37). No changes in gene expression were shown. CONCLUSIONS: In the absence of any dietary intake of ß-alanine, HIIT increased MCarn content. The contribution of increased MCarn to the total increase in ßmin vitro appears to be small.


Assuntos
Carnosina/metabolismo , Treinamento Intervalado de Alta Intensidade , Músculo Esquelético/metabolismo , Adaptação Fisiológica , Limiar Anaeróbio , Distribuição da Gordura Corporal , Peso Corporal , Dieta Vegetariana , Teste de Esforço , Expressão Gênica , Humanos , Ácido Láctico/sangue , Masculino , Fibras Musculares de Contração Rápida/metabolismo , Fibras Musculares de Contração Lenta/metabolismo , Consumo de Oxigênio , beta-Alanina
7.
Sci. med. (Porto Alegre, Online) ; 28(4): ID32169, out-dez 2018.
Artigo em Português | LILACS | ID: biblio-981130

RESUMO

OBJETIVOS: Analisar os dados de gestações com risco de toxoplasmose congênita e investigar a evolução dos recém-nascidos, em um hospital de nível II em Portugal. MÉTODOS: Um estudo transversal retrospetivo incluiu recém-nascidos com risco de toxoplasmose congênita e suas mães, cujo parto ocorreu entre janeiro de 2000 e dezembro de 2015. Os critérios de inclusão foram mãe com soroconversão para toxoplasmose durante a gestação ou primeira amostra sérica com IgM e IgG específicas positivas. O diagnóstico de toxoplasmose congênita foi definido por IgM específica positiva ao nascimento e/ou reação em cadeia da polimerase positiva no líquido amniótico e/ou persistência de IgG específica até os 12 meses de vida. A toxoplasmose congênita foi definida como sintomática quando os achados clínicos foram atribuídos à doença. Os testes Qui-quadrado ou Exato de Fisher foram usados para testar associações entre variáveis, assumindo-se significado estatístico quando p<0,05. RESULTADOS: Ocorreram 39.585 nascimentos vivos no período em estudo e foram identificados 98 casos com risco de toxoplasmose congênita, dos quais 89 completaram o seguimento. A prevalência de IgG para T. gondii nas gestantes foi de 26% (intervalo de confiança [IC] 95% 24-27%). Foram confirmados 22 casos de toxoplasmose congênita (5,6 por 10.000 nascidos vivos, IC95% 3,5-8,5 por 10.000). Dos 22 recém-nascidos, 18 (82%, IC95% 61-93%) eram sintomáticos. Os achados clínicos mais frequentes foram calcificação intracraniana (64%), hepatomegalia e/ou elevação das transaminases (32%) e retinocoroidite (14%). As lesões cerebrais foram mais frequentes quando a infeção materna foi documentada no primeiro e segundo trimestres em comparação com o terceiro (p=0,018). Em 31 casos (35%), as gestantes foram tratadas desde o momento do diagnóstico até o parto com espiramicina, não se tendo encontrado diferenças relativamente à taxa de transmissão vertical ou ao aparecimento de manifestações clínicas entre os recém-nascidos de mães tratadas e não tratadas. CONCLUSÕES: A prevalência de toxoplasmose congênita foi superior à reportada em outros países da Europa. A prevalência de calcificações intracranianas foi maior do que a descrita na literatura, enquanto que a de retinocoroidite e estrabismo foi menor. As alterações cerebrais nos recém-nascidos foram mais frequentes nas infecções de primeiro e segundo trimestre. Não houve diferença na taxa de transmissão vertical e na ocorrência de manifestações clínicas entre os recém-nascidos cujas mães receberam espiramicina na gestação ou não receberam tratamento.


AIMS: To analyze the data on pregnancies with risk of congenital toxoplasmosis and to investigate the newborns' outcome, in a level II hospital in Portugal. METHODS: A cross-sectional retrospective study included newborns at risk for congenital toxoplasmosis and their mothers, whose delivery occurred between January 2000 and December 2015. The inclusion criteria were mother with seroconversion to toxoplasmosis during pregnancy or first serum sample with positive specific IgM and IgG. The diagnosis of congenital toxoplasmosis was defined by positive specific IgM at birth and/or polymerase chain reaction positive in amniotic fluid and/or persistence of specific IgG up to 12 months of life. Congenital toxoplasmosis was defined as symptomatic when clinical findings were attributed to the disease. Chi-square or Fisher's exact tests were used to test associations between variables, assuming statistical significance when p<0.05. RESULTS: There were 39,585 live births in the study period and 98 cases with risk of congenital toxoplasmosis were identified, of which 89 completed the follow-up. The prevalence of anti-T. gondii IgG in the pregnant women was 26% (95% confidence interval [CI] 24-27%). Twenty-two cases of congenital toxoplasmosis (5.6 per 10,000 live births, 95%CI 3.5-8.5 per 10,000) were confirmed. Of the 22 newborns, 18 (82%, 95%CI 61-93%) were symptomatic. The most frequent clinical findings were intracranial calcification (64%), hepatomegaly and / or elevation of transaminases (32%) and retinochoroiditis (14%). Cerebral lesions were more frequent when maternal infection was documented in the first and second trimester compared to the third trimester (p=0.018). In 31 cases (35%), the pregnant women were treated from the time of diagnosis until delivery with spiramycin, and no differences were found regarding the rate of vertical transmission or the appearance of clinical manifestations among the newborns of treated and non-treated mothers treated. CONCLUSIONS: The prevalence of congenital toxoplasmosis was higher than that reported in other European countries. The prevalence of intracranial calcifications was higher than that described in the literature, whereas retinochoroiditis and strabismus occurrence was lower. Brain lesions in newborns were more frequent in first- and second-trimester infections. There was no difference in the rate of vertical transmission and in the occurrence of clinical manifestations among newborns whose mothers received spiramycin during gestation and those whose mothers did not receive treatment.


Assuntos
Toxoplasmose Congênita , Pediatria , Recém-Nascido , Medicina
8.
Aging Clin Exp Res ; 30(11): 1353-1361, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30008159

RESUMO

BACKGROUND: Our previous study had shown the effectiveness of vestibular rehabilitation (VR) in improving balance in elderly patients, assessed immediately afterwards. AIMS: The main goal of the present study is to consider whether this improvement in balance assessment turns out in a reduction of the number of falls. METHODS: 139 elderly patients with high risk of falls were included and randomized to one of the following study arms: computerized dynamic posturography (CDP) training, optokinetic stimulus, exercises at home or control group. Patients were assessed with objective outcome measures (sensorial organization test and limits of stability of CDP, number of falls and number of hospital admissions due to falls) and subjective outcome measures (dizziness handicap inventory and short falls efficacy scale-international) during a 12-month follow-up period. RESULTS: Average number of falls significantly declined from 10.96 (before VR) to 3.03 (12-month follow-up) in the intervention group (p < 0.001); meanwhile, in the control group, the average number of falls changed from 3.36 to 2.61 during a 12-month follow-up period (p = 0.166). DISCUSSION: The present study provides evidence that VR can decisively improve balance in elderly patients with instability, which can lead in turn to a significant reduction of falls. CONCLUSION: We recommend performing VR in any older person with high risk of falls.


Assuntos
Acidentes por Quedas/prevenção & controle , Terapia por Exercício/métodos , Equilíbrio Postural , Doenças Vestibulares/reabilitação , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Testes de Função Vestibular
9.
Med Sci Sports Exerc ; 2018 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-29933348

RESUMO

PURPOSE: Cross-sectional studies suggest that training can increase muscle carnosine (MCarn), although longitudinal studies have failed to confirm this. A lack of control for dietary ß-alanine intake or muscle fibre type shifting may have hampered their conclusions. The purpose of the present study was to investigate the effects of high-intensity interval training (HIIT) on MCarn. METHODS: Twenty vegetarian men were randomly assigned to a control (CON; n=10) or HIIT (n=10) group. HIIT was carried out on a cycle ergometer for 12 weeks, with progressive volume (6-12 series) and intensity (140-170% lactate threshold [LT]). MCarn was quantified in whole-muscle and individual fibres; expression of selected genes (CARNS, CNDP2, ABAT, TauT and PAT1) and muscle buffering capacity in vitro (ßmin vitro) were also determined. Exercise tests were performed to evaluate total work done (TWD), VO2max, ventilatory thresholds (VT) and LT. RESULTS: TWD, VT, LT, VO2max and ßmin vitro were improved in the HIIT group (all P<0.05), but not in CON (p>0.05). MCarn (in mmol·kg dry muscle) increased in the HIIT (15.8±5.7 to 20.6±5.3; p=0.012) but not the CON group (14.3±5.3 to 15.0±4.9; p=0.99). In type I fibres, MCarn increased in the HIIT (from 14.4±5.9 to 16.8±7.6; p=0.047) but not the CON group (from 14.0±5.5 to 14.9±5.4; p=0.99). In type IIa fibres, MCarn increased in the HIIT group (from 18.8±6.1 to 20.5±6.4; p=0.067) but not the CON group (from 19.7±4.5 to 18.8±4.4; p=0.37). No changes in gene expression were shown. CONCLUSION: In the absence of any dietary intake of ß-alanine, HIIT increased MCarn content. The contribution of increased MCarn to the total increase in ßmin vitro appears to be small.

10.
RFO UPF ; 22(3): 281-287, 10/06/2018.
Artigo em Português | LILACS-Express | ID: biblio-904968

RESUMO

Objetivo: foi avaliar a contaminação de resinas compostasutilizadas nas clínicas do curso de Odontologia daUniversidade Regional de Blumenau (FURB). Materiais emétodo: foram avaliados os tubetes das resinas: Z 350®,Z 250®, opallis®, charisma® e vit-l-escense®, divididosem grupo I, composto por resinas que, após o uso na clínica,foram armazenadas em geladeira, e grupo II, compostopor resinas analisadas logo após o uso. Ainda foramidentificados os grupos controle negativo, contendoresinas novas, controle zero, contendo o meio de culturaBrain Heart Infusion (BHI) HIMEDIA®, e controle positivo,contendo material coletado da mucosa bucal. Forampreparados 160 tubos de ensaio com BHI. As amostrasdos grupos I e II foram fracionadas, retirando-se 2 mm deresina e introduzindo em tubos de ensaios, assim sistematicamente,até o total de 8 mm, totalizando 144 tubosde ensaios. A turvação foi identificada em uma amostrado grupo I e em duas do grupo II e no grupo controlepositivo. As amostras dos grupos I e II com turvamentoforam submetidas à coloração de Gram e à detecção decatalase, identificando cocos gram-positivos com contaminaçãopor Staphylococcus sp. Os resultados foramsubmetidos ao teste Qui-Quadrado de Pearson, não mostrandoresultados estatisticamente significativos para acontaminação bacteriana das RC (p=0,560). Conclusão:as resinas compostas utilizadas não estavam contaminadas,indicando a eficácia nas técnicas de manutenção dacadeia asséptica empregada; entretanto, casos isoladosde contaminação sugerem a importância de coibir açõesque levem à contaminação.

11.
Eur Arch Otorhinolaryngol ; 274(6): 2395-2403, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28251319

RESUMO

Balance becomes more precarious with age, and even without pathological disorders, the physiological decline in balance that occurs with age is a factor that also favors falls. So the aim of the present study is to assess the short-term effectiveness of three different methods of vestibular rehabilitation, compared to a control group, in improving balance in elderly patients with postural instability. 139 elderly patients with high risk of falls were included and randomized to one of the following study arms: computer dynamic posturography (CDP) training, optokinetic stimulus, exercises at home, or control group. Patients were assessed with objective and subjective outcome measures. The individuals that trained using CDP improved significantly more than the control group on the average balance score (p < 0.001) and reducing the number of falls in the sensorial organization test (p < 0.001). In addition, the analysis showed a statistically significant effect in the limits of stability only with the CDP training in comparison with the control group (p < 0.001). In our present study, supervised and customized exercises with CDP were more effective than the control group in the posturographic short-term assessment. An increased age did not affect the potential for improvement after training. So we conclude that elderly patients with high risk of falling should begin vestibular rehabilitation as soon as possible in order to avoid the potential harm of falls, mainly injuries and psychological consequences due to fear of falling again.


Assuntos
Acidentes por Quedas/prevenção & controle , Terapia por Exercício/métodos , Doenças Vestibulares/reabilitação , Idoso , Feminino , Avaliação Geriátrica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Equilíbrio Postural/fisiologia , Medição de Risco , Testes de Função Vestibular/métodos
12.
Patient Educ Couns ; 100(1): 154-159, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27516436

RESUMO

OBJECTIVE: The Health Literacy INDEX tool has been developed for creating accessible and readable health information materials for people of all literacy levels. To increase knowledge of falls risk factors and actively engage older adults, we developed an improved manual for prevention of falls for low-health literacy older people entitled "Preventing falls-I can do it",with the aid of INDEX. METHODS: First time application of the INDEX tool for assessing the health literacy demands of available manuals for prevention of falls for older adults and subsequent development of an improved manual using the INDEX tool as a checklist, supported by a pretest phase involving sixteen adults ≥65, living in the community, with literacy ≤4th grade and limited functional health literacy. RESULTS: The engagement of older adults from the target audience and their feedback obtained during the validation process contributed to the development of an improved health literacy- and age-friendly manual for prevention of falls. CONCLUSION: By offering effective health information materials, older adults can play a more active role in their health care. PRACTICE IMPLICATIONS: The manual developed to be health literacy- and age-friendly is available to be included in any multifactorial program for the prevention of falls in older adults.


Assuntos
Acidentes por Quedas/prevenção & controle , Alfabetização em Saúde , Educação de Pacientes como Assunto/métodos , Materiais de Ensino/normas , Idoso , Feminino , Humanos , Masculino , Fatores de Risco
13.
Med Image Anal ; 35: 327-344, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27567734

RESUMO

The evaluation of changes in Intervertebral Discs (IVDs) with 3D Magnetic Resonance (MR) Imaging (MRI) can be of interest for many clinical applications. This paper presents the evaluation of both IVD localization and IVD segmentation methods submitted to the Automatic 3D MRI IVD Localization and Segmentation challenge, held at the 2015 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI2015) with an on-site competition. With the construction of a manually annotated reference data set composed of 25 3D T2-weighted MR images acquired from two different studies and the establishment of a standard validation framework, quantitative evaluation was performed to compare the results of methods submitted to the challenge. Experimental results show that overall the best localization method achieves a mean localization distance of 0.8 mm and the best segmentation method achieves a mean Dice of 91.8%, a mean average absolute distance of 1.1 mm and a mean Hausdorff distance of 4.3 mm, respectively. The strengths and drawbacks of each method are discussed, which provides insights into the performance of different IVD localization and segmentation methods.


Assuntos
Imagem Tridimensional/métodos , Disco Intervertebral/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Algoritmos , Humanos
14.
BMJ Case Rep ; 20162016 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-28003229

RESUMO

We describe a case of coeliac disease that was diagnosed in the psychiatry inpatient unit of a general hospital. The patient was admitted due to suicidal behaviours and developed an agitated catatonic state while in the inpatient psychiatry unit. An extensive diagnostic study allowed for the diagnosis of coeliac disease and while her state was unresponsive to antidepressants, anxiolytics, antipsychotics and electroconvulsive therapy, the patient improved significantly when a gluten-free diet was started. While it is well known that, occasionally, gluten sensitivity and coeliac disease can present as brain gluten sensitivity, such cases are typically characterised by motor and/or cognitive symptoms and by white matter abnormalities. Psychiatric presentations of these conditions have only rarely been reported.


Assuntos
Doença Celíaca/psicologia , Dieta Livre de Glúten , Transtornos Mentais/etiologia , Assistência ao Convalescente , Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Doença Celíaca/diagnóstico , Doença Celíaca/dietoterapia , Feminino , Humanos , Imagem por Ressonância Magnética , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Fisioter. mov ; 29(3): 581-588, July-Sept. 2016. tab
Artigo em Inglês | LILACS-Express | ID: lil-796222

RESUMO

Abstract Introduction: Motor development is a continuous process of motor behavior changes throughout life, allowing for movement control. Premature birth can affect this process, with a greater risk of delays in acquiring these skills. Objective: Compare motor development during the fundamental movement phase of preterm infants submitted to early stimulation and full-term babies. Methods: An analytical cross-sectional study with convenience sampling, performed with twenty 3-year-old children of both sexes, distributed into two groups: the preterm group (n = 10), which received physical therapy in the first months of life, and the term group (n = 10). Motor development stages were assessed between January and April 2013, using the Motor Development Scale (Escala de Desenvolvimento Motor - EDM) developed by Francisco Rosa Neto, with an average execution time of thirty minutes. Statistical analysis was performed using BioEstat 5.0 software, and the Shapiro-Wilk test was applied to verify data normality. A significance level of p ≤ 0.05 was adopted, analyzed using the Mann-Whitney test. Results: The term group exhibited significant differences in relation to the preterm group for the variables Fine and Gross Motor Skills, and Spatial and Temporal Awareness, with no differences in Balance and Body Scheme. Conclusion: Only the premature infants submitted to early intervention achieved normal levels of Balance and Body Scheme on the EDM Scale.


Resumo Introdução: Desenvolvimento motor é um processo contínuo de alterações do comportamento motor ao longo da vida, permitindo controle de movimentos. O nascimento prematuro pode ser um evento que acarrete implicações ao processo, com maior risco para atrasos na aquisição das habilidades. Objetivo: Comparar o desenvolvimento motor de crianças nascidas prematuras estimuladas precocemente e crianças nascidas a termo, na fase motora fundamental. Métodos: Estudo transversal analítico, de conveniência, realizado com 20 crianças na faixa etária de 03 anos, de ambos os sexos, distribuídas em dois grupos, grupo pré-termo (n = 10) o qual, durante os primeiros meses receberam intervenção fisioterapêutica e grupo a termo (n = 10). As fases do desenvolvimento motor foram avaliadas através da Escala de Desenvolvimento Motor (EDM), desenvolvida por Francisco Rosa Neto, com execução média de trinta minutos, entre janeiro e abril de 2013. A análise estatística dos resultados foi realizada através do pacote BioEstat 5.0 e para verificar a normalidade entre os dados utilizou-se o Teste de Shapiro-Wilk. Em relação ao padrão de significância adotou-se o valor de p ≤ 0,05, analisado por meio do teste de Mann-Whitnney. Resultados: O grupo a termo demonstrou diferenças significativas quando comparado com o grupo pré-termo nas variáveis Motricidade Fina e Global, na Organização Espacial e Temporal, não apresentando discrepância de valores nas variáveis Equilíbrio e Esquema Corporal. Conclusão: Somente os prematuros que receberam a intervenção precoce conseguiram alcançar níveis estabelecidos como normais nas variáveis Equilíbrio e Esquema Corporal da Escala EDM.

16.
Acta Otolaryngol ; 136(11): 1125-1129, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27376710

RESUMO

CONCLUSIONS: There was a difference in average score of the sensory organization test (SOT) of the case group (elderly instability) compared to the control group (healthy subjects). Cases had worse scores on the limits of stability (LOS) than controls, but were only able to confirm statistically significant differences in the movement velocity. OBJECTIVE: To study the LOS of elderly patients with instability vs healthy subjects of the same age to try to explain the increased risk of falls in elderly patients with instability. METHODS: Fifty individuals ≥65 years, 30 cases (at least one of the next inclusion criteria: ≥1 fall in the last 12 months, >15 s or some support in the timed up and go test, composite <68 in SOT, ≥1 fall during production of the SOT) compared to 20 controls. Postural study: SOT and LOS, Smart Equitest Neurocom® platform. STATISTICAL ANALYSIS: t-Student test (p < 0.05). RESULT: Mean value of overall balance: patients with instability =56% vs controls =77.1% (p < 0.001). Movement velocity: cases =2243°/s vs controls =2860°/s (p = 0.029). The reaction time (cases =1217 s vs controls =1.077 s), excursion (56.95% vs 59.35%) and directional control (56.95% vs 59.35%) differences were not statistically significant.


Assuntos
Acidentes por Quedas , Equilíbrio Postural , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino
17.
Ann Otol Rhinol Laryngol ; 125(7): 550-8, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26848036

RESUMO

OBJECTIVES: To analyze the equilibriometric differences between 2 populations of elderly patients (young elderly and very elderly) with instability induced solely by age. METHODS: Cross-sectional study, with 2 study groups classified according to patient age (cut-points in twenty-fifth and seventy-fifth percentiles of the age of the sample). POPULATION: 64 patients aged 65 years or more. Two groups of 32 subjects were established: group A (people 65 years of age or older but less than 72.6, twenty-fifth percentile) and group B (patients 82.5 years, seventh-fifth percentile, or older). Main analyzed variables: timed up-and-go test, sensory organization test of the computerized dynamic posturography, Dizziness Handicap Inventory (DHI), and Short Falls Efficacy Scale-International (FES-I) questionnaires. Student's t test or the Mann-Whitney test were used. RESULTS: The older patients obtain poorer scores in the equilibriometric tests but not in all of them. In the sensory organization test, the older patients make poorer use of visual and vestibular information; they also require more time and steps for the timed up-and-go. With regards to the questionnaires, fear of falling is greater (higher Short FES-I scores) but not subjective perception of disability (DHI scores without differences). CONCLUSIONS: There is a need to establish aged subgroups of elderly patients with instability, adapting therapeutic strategies.


Assuntos
Acidentes por Quedas , Envelhecimento , Tontura/fisiopatologia , Equilíbrio Postural , Transtornos das Sensações/fisiopatologia , Doenças Vestibulares/fisiopatologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários
18.
Aging Clin Exp Res ; 28(3): 423-8, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26187012

RESUMO

OBJECTIVE: The aim of the study is to assess whether obesity affects balance in elderly patients with postural instability. STUDY DESIGN: It is a case-control study, with cases defined by BMI ≥30 kg/m(2), and developed in a third level university hospital. METHODS: We included 135 patients aged 65 years old or more who presented postural instability. Balance assessment was through the sensory organisation test (SOT), limits of stability (LOS) and rhythmic weight shift (RWS) of computerised dynamic posturography (CDP) and the modified timed up-and-go (TUG) test. The patients also completed the Dizziness Handicap Inventory and short Falls Efficacy Scale-International questionnaire. RESULTS: Patients with obesity took longer to perform the modified TUG and required more steps. Also these patients had poorer scores in the subjective tests. In the CDP there were no significant differences in the SOT nor the LOS, and only there was a statistical significant difference in the anterior-posterior directional control of the RWS. Obese patients have a higher risk of fallings compared to non-obese patients. CONCLUSION: In essence, our results indicate that obesity interferes in the balance of elderly patients with postural instability, putting them at a greater risk of fallings, performing worse dynamic tasks and feeling more disabled. Although continued education on training balance may be useful in older population, since the obese group shows more rate of fallers, rehabilitation programmes focus on dynamic tasks in these patients could be useful to reduce their fall risk and improve their quality of life.


Assuntos
Acidentes por Quedas , Obesidade , Equilíbrio Postural , Qualidade de Vida , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Avaliação Geriátrica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/fisiopatologia , Obesidade/psicologia , Educação de Pacientes como Assunto , Modalidades de Fisioterapia , Desempenho Psicomotor/fisiologia , Medição de Risco/métodos , Espanha/epidemiologia , Inquéritos e Questionários
19.
Eur J Intern Med ; 28: 85-90, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26577223

RESUMO

OBJECTIVE: The dynamics of cholesterol homeostasis and the development of cardiovascular disease (CVD) are complex and multifactorial, to which adds individual variability in the proportion of cholesterol from exogenous versus endogenous sources. The aim of this study was to undertake the first characterization of cholesterol absorption and synthesis profiles in Portuguese hypercholesterolemic adults through the quantification of surrogate markers, and the analysis of the predictive value of age and sex on the cholesterol homeostasis biomarkers. METHODS: Serum samples for the measurement of lipid profiles and cholesterol homeostasis markers were obtained for 100 men and 112 women, aged 30-65, with TC ≥ 5.2 mmol/L (~200mg/dL) and/or LDL-C ≥ 2.6 mmol/L (~100mg/dL), none of whom were on any lipid-lowering therapy. RESULTS: Overall, sex-specific significant differences were observed in the cholesterol homeostasis markers and lipid profiles; women had lower cholesterol synthesis marker concentrations (P<0.01 for lathosterol) and lipid parameters (except for HDL-C concentrations). Age-related significant differences were also found, including higher concentrations of cholesterol absorption markers in association with increasing age. CONCLUSION: In our study, the predictors of higher levels of cholesterol absorption markers were higher age and female gender.


Assuntos
HDL-Colesterol/sangue , LDL-Colesterol/sangue , Dieta , Hipercolesterolemia/sangue , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Colestanol/sangue , Colesterol/análogos & derivados , Colesterol/sangue , Colesterol/metabolismo , Estudos Transversais , Desmosterol/sangue , Feminino , Homeostase , Humanos , Masculino , Pessoa de Meia-Idade , Fitosteróis/sangue , Portugal , Fatores Sexuais , Sitosteroides/sangue , Triglicerídeos/sangue
20.
Arch Gerontol Geriatr ; 62: 90-6, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26412554

RESUMO

Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to evaluate whether there is a correlation between FOF, estimated via the short FES-I test, and objective evaluation of balance in a group of elderly patients with age-related instability. The balance of 139 subjects of more than 65 years of age is evaluated by the timed up and go test and the computerised dynamic posturography (CDP). Different groups of elderly patients were established according to the number of falls in the previous 12 months, and the correlation with short FES-I test scores was evaluated. Based on the results, ROC curves were calculated. The short FES-I test presents a good capacity to distinguish between subjects with ≤ 3 falls/year and subjects with ≥ 4 falls/year (AUC 0.719, 95%CI 0.627-0.810). A test score of 14.5 is the best cut-off point (74% sensitivity, 51% specificity). Using this cut-off point, the study sample comprises two groups: subjects with test scores of 7-14 vs 15-28, with the first group obtaining best results with statistical significance (Student's t-test and the Mann-Whitney test) in most of the balance tests. The short FES-I is an excellent instrument that measures FOF in the elderly, and it is correlated with their number of falls both in real life and on the CDP. It is simple and fast, and so can be considered an extraordinary screening test relative to real risk of falls in the elderly.


Assuntos
Acidentes por Quedas/prevenção & controle , Envelhecimento/fisiologia , Medo/psicologia , Avaliação Geriátrica/métodos , Equilíbrio Postural , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Psicometria/métodos , Psicometria/normas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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