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1.
Rev. bras. neurol ; 56(2): 10-19, abr.-jun. 2020. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1102905

RESUMO

The infection caused by the new coronavirus had its first case described in December 2019, in Wuhan, China, and reached a pandemic status in March 2020. Since then, knowledge about the different aspects of this infection has evolved, as well as increased reports concerning related neurological manifestations. Thus, the neurologist assumes a fundamental role in the care of these patients, who may have a clinical phenotype that goes beyond respiratory aspects. In the present study, we highlight the data available in the literature so far regarding the main neurological implications related to COVID-19 infection, in addition to calling attention for some aspects related to patients with previous neurological diseases who contract this infection.


A infecção causada pelo novo Coronavírus teve seu primeiro caso descrito em dezembro de 2019, em Wuhan, China e alcançou o status de pandemia em março de 2020. Desde então, o conhecimento sobre os diferentes aspectos da referida infecção evolui assim como aumentam relatos de manifestações neurológicas relacionadas. Assim, o neurologista assume papel fundamental na assistência desses pacientes, que podem ter um fenótipo clínico que ultrapassa os aspectos respiratórios. No presente estudo, destacamos os dados disponíveis na literatura até o presente momento no tocante às principais implicações neurológicas relacionadas à infecção pelo COVID-19, além de destacar alguns aspectos relativos aos pacientes com doenças neurológicas prévias que contraem a referida infecção.

3.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 107-111, Jan.-Mar. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1090552

RESUMO

Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively (p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, produc- ing favorable results with good applicability in otolaryngology clinical practice.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Faringe/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Apneia Obstrutiva do Sono/cirurgia , Músculos Faríngeos/cirurgia , Registros Médicos , Estudos Retrospectivos , Estudos Longitudinais , Resultado do Tratamento
5.
Int J Stroke ; : 1747493019890700, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31793395

RESUMO

BACKGROUND: RESILIENT is a prospective, multicenter, randomized phase III trial to test the safety, efficacy, and cost-effectiveness of mechanical thrombectomy as compared to medical treatment alone in patients treated under the less than ideal conditions typically found in the public healthcare system of a developing country. METHODS: Subjects must fulfill the following main inclusion criteria: symptom onset ≤8 h, age ≥18 years, baseline NIHSS ≥8, evidence of intracranial ICA or proximal MCA (M1 segment) occlusion, ASPECTS ≥6 on CT or >5 on DWI-MRI and be either ineligible for or unresponsive to intravenous alteplase. The primary end-point is the distribution of disability levels (on the modified Rankin Scale, mRS) at 90 days under the intention-to-treat principle. RANDOMIZATION: Randomization is performed under a minimization process using age, baseline NIHSS, intravenous alteplase use, occlusion site and center. DESIGN: The trial is designed with an expectation of a 10% difference in the proportion of favorable outcome (mRS 0-2 at 90 days) common odds ratio of 1.615. PRIMARY OUTCOME: Projected sample size is 690 subjects with pre-planned interim analyses at 174, 346, and 518 subjects. SECONDARY OUTCOMES: Secondary end-points include: 90-day functional independence (mRS ≤2), mRS shift stratified for treatment with IV rt-PA at 90 days, infarct volume on 24 h CT or MRI, early dramatic response (NIHSS 0-2 or improvement ≥8 points) at 24 h, vessel recanalization evaluated by CTA or MRA at 24 h, and the post-procedure rate of successful reperfusion (defined as a modified Treatment in Cerebral Infarction 2b or greater). Safety variables are mortality at 90 days, symptomatic intracranial hemorrhage at 24 h and procedure-related complications.

6.
Cerebrovasc Dis ; 48(3-6): 99-108, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31694010

RESUMO

BACKGROUND: The role of patent foramen ovale is a field of debate and current publications have increasing controversies about the patients' management in young undetermined stroke. Work up with echocardiography and transcranial Doppler (TCD) can aid the decision with better anatomical and functional characterization of right-to-left shunt (RLS). Medical and interventional strategy may benefit from this information. SUMMARY: a group of experts from the Latin American participants of the Neurosonology Research Group (NSRG) of World Federation of Neurology created a task force to review literature and describe the better methodology of contrast TCD (c-TCD). All signatories of the present consensus statement have published at least one study on TCD as an author or co-author in an indexed journal. Two meetings were held while the consensus statement was being drafted, during which controversial issues were discussed and voted on by the statement signatories. The statement paper was reviewed and approved by the Executive Committee of the NSRG of the World Federation of Neurology. The main objective of this consensus statement is to establish a standardization of the c-TCD technique and its interpretation, in order to improve the informative quality of the method, resulting in expanding the application of TCD in the clinical setting. These recommendations optimize the comparison of different diagnostic methods and encourage the use of c-TCD for RLS screening and complementary diagnosis in multicenter studies.


Assuntos
Circulação Cerebrovascular , Meios de Contraste/administração & dosagem , Forame Oval Patente/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/normas , Consenso , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/fisiopatologia , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia
7.
Neurol Sci ; 40(12): 2595-2601, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31363936

RESUMO

BACKGROUND AND PURPOSE: Chagas disease and ischemic stroke (IS) have a close but poorly understood correlation. In endemic settings, continued transmission over time has resulted in increasing prevalence of both asymptomatic infection and cardiomyopathy with increasing age. Latin America has made substantial progress towards Chagas disease control. Although several epidemiological studies have been conducted, information regarding epidemiology and distribution of IS in Chagas disease is still lacking. METHODS: We retrospectively studied the electronic medical record data of all patients with both IS and Chagas disease admitted at SARAH Hospitals across Brazil from 2009 to 2013 to make epidemiological quantifications and statistical inferences. RESULTS: A total of 279 patients with Chagas disease and IS were analyzed from 7729 IS-related admissions, indicating a median prevalence of 3.6% of Chagas disease in IS patients in our cohort. Mean age was 60 years, with female predominance (65%). Most of the cases were from Bahia (61%), followed by Minas Gerais (19%) and Goiás (9.7%). Low-income cities, with decreased access to healthcare, showed the highest number of cases. Distribution of vascular risk factors and outcome after stroke differed among the units. According to current guidelines, secondary prevention was inadequate in 60% of patients. CONCLUSIONS: Chagas disease was common in IS patients; prevalence of concurrent Chagas disease and IS was high in some regions of the country. However, the infection frequency seems to be reduced in the last few years. Public health issues for improving the treatment of Chagas disease and IS are urgently needed.


Assuntos
Isquemia Encefálica/epidemiologia , Doença de Chagas/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Brasil/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
8.
Life Sci ; 232: 116627, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31276690

RESUMO

AIM: Evidence suggests that task-specific gait training improves locomotor impairments in people with incomplete spinal cord injury (SCI); however, plastic changes in brain areas remain poorly understood. The aim of this study was to examine the possible effects of a task-specific overground gait training on locomotor recovery and neuroplasticity markers in the cortex, cerebellum, and lumbar spinal cord in an experimental model of incomplete-SCI. MAIN METHODS: Using a blind, basic experimental design, 24 adult Wistar rats underwent a surgical procedure and were allocated into sham, non-trained SCI (SCI), and trained SCI (Tr-SCI) groups. On postoperative day 14, trained animals started a 4-week overground gait training program. All groups were subjected to weekly assessment of locomotor recovery of the hind limbs. On postoperative day 40, brain and lumbar spinal cord structures were dissected and processed for biochemical analysis of the synaptophysin, microtubule-associated protein 2 (MAP-2), and brain-derived neurotrophic factor (BDNF). KEY FINDINGS: Tr-SCI group showed greater locomotor function recovery compared with non-trained SCI from the postoperative day 21 (p < 0.05). The training was able to improve the neuroplasticity markers synaptophysin, MAP-2, and BDNF expressions in motor cortex (p < 0.05), but not in the cerebellum and in the spinal cord for trained SCI group compared to non-trained. SIGNIFICANCE: Task-specific overground gait training improves locomotor recovery in a rat model of incomplete thoracic-SCI. Furthermore, training promotes motor cortex plasticity, evidenced for increasing expression of the neuroplasticity markers that may support the functional recovery.


Assuntos
Terapia por Exercício/métodos , Locomoção/fisiologia , Animais , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Modelos Animais de Doenças , Feminino , Marcha/fisiologia , Masculino , Proteínas Associadas aos Microtúbulos/metabolismo , Atividade Motora , Plasticidade Neuronal/fisiologia , Ratos , Ratos Wistar , Recuperação de Função Fisiológica , Medula Espinal/metabolismo , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/terapia
9.
Front Neurol ; 10: 686, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31297085

RESUMO

Neuromuscular adaptations are well-reported in stroke survivors. The death of motor neurons and the reinnervation of residual muscle fibers by surviving motor neurons, for example, seem to explain the increased density of muscle units after stroke. It is, however, unknown whether reinnervation takes place locally or extensively within the muscle. Here we combine intramuscular and surface electromyograms (EMGs) to address this issue for medial gastrocnemius (MG); a key postural muscle. While seven stroke survivors stood upright, two intramuscular and 15 surface EMGs were recorded from the paretic and non-paretic gastrocnemius. Surface EMGs were triggered with the firing instants of motor units identified through the decomposition of both intramuscular and surface EMGs. The standard deviation of Gaussian curves fitting the root mean square amplitude distribution of surface potentials was considered to assess differences in the spatial distribution of motor unit action potentials and, thus, in the distribution of muscle units between limbs. The median number of motor units identified per subject in the paretic and non-paretic sides was, respectively, 2 (range: 1-3) and 3 (1-4). Action potentials in the paretic gastrocnemius were represented at a 33% wider skin region when compared to the non-paretic muscle (Mann-Whitney; P = 0.014). Side differences in the representation of motor unit were not associated with differences in subcutaneous thickness (skipped-Spearman r = -0.53; confidence interval for r: -1.00 to 0.63). Current results suggest stroke may lead to the enlargement of the gastrocnemius muscle units recruited during standing. The enlargement of muscle units, as assessed from the skin surface, may constitute a new marker of neuromuscular plasticity following stroke.

10.
JAMA Neurol ; 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31058947

RESUMO

Importance: Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging, especially in low- and middle-income countries. Objective: To assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for care of patients with AIS and TIA. Design, Setting and Participants: This 2-arm cluster-randomized clinical trial assessed 45 hospitals and 2336 patients with AIS and TIA for eligibility before randomization. Eligible hospitals were able to provide care for patients with AIS and TIA in Brazil, Argentina, and Peru. Recruitment started September 12, 2016, and ended February 26, 2018; follow-up ended June 29, 2018. Data were analyzed using the intention-to-treat principle. Interventions: The multifaceted quality improvement intervention included case management, reminders, a roadmap and checklist for the therapeutic plan, educational materials, and periodic audit and feedback reports to each intervention cluster. Main Outcomes and Measures: The primary outcome was a composite adherence score for AIS and TIA performance measures. Secondary outcomes included an all-or-none composite end point of performance measures, the individual process measure components of the composite end points, and clinical outcomes at 90 days after admission (stroke recurrence, death, and disability measured by the modified Rankin scale). Results: A total of 36 hospitals and 1624 patients underwent randomization. Nineteen hospitals were randomized to the quality improvement intervention and 17 to routine care. The overall mean (SD) age of patients enrolled in the study was 69.4 (13.5) years, and 913 (56.2%) were men. Overall mean (SD) composite adherence score for the 10 performance measures in the intervention group hospitals compared with control group hospitals was 85.3% (20.1%) vs 77.8% (18.4%) (mean difference, 4.2%; 95% CI, -3.8% to 12.2%). As a secondary end point, 402 of 817 patients (49.2%) at intervention hospitals received all the therapies that they were eligible for vs 203 of 807 (25.2%) in the control hospitals (odds ratio, 2.59; 95% CI, 1.22-5.53; P = .01). Conclusions and Relevance: A multifaceted quality improvement intervention did not result in a significant increase in composite adherence score for evidence-based therapies in patients with AIS or TIA. However, when using an all-or-none approach, the intervention resulted in improved adherence to evidence-based therapies. Trial Registration: ClinicalTrials.gov Identifier: NCT02223273.

11.
12.
Aerosp Med Hum Perform ; 90(5): 462-465, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31023406

RESUMO

BACKGROUND: Middle-ear barotrauma is a common problem reported by aircrew members and passengers. Studies have shown that 20-50% of passengers report ear complaints during the flight or after landing. The aim of this study is to determine the prevalence of otitis media with effusion in aircrew members and describe the time to resolution of the condition.METHODS: All aircrew members presenting at Civil Aviation Center at Congonhas Airport at São Paulo for annual flight medical examinations from September 2014 to May 2015 were reviewed retrospectively for the presence of otologic disorders. Eligible participants were all pilots, copilots, and flight attendants with a diagnosis of otitis media with effusion confirmed by immittance testing.RESULTS: Of 1607 aircrew members, 155 (9.65%) were diagnosed as having otitis media with effusion. Most participants were men (51.6%). Regarding aircrew position, 81.9% were flight attendants, 11.6% were copilots, and 6.5% were pilots. The mean time to resolution of the otitis media was 8.23 (± 3.02) days.DISCUSSION: Otolaryngologists must be aware of the effects of gas expansion in the middle ear at higher altitudes for the appropriate treatment of diseases related to pressure changes. The recommendation for an aircrew member to return to flying duties should occur only after the individual has been treated and complete resolution, confirmed by immittance testing, has been documented.Pinto JA, dos Santos Sobreira Nunes H, dos Santos RS, Cavallini A, Freitas G, Knoll D, Duarte C. Otitis media with effusion in aircrew members. Aerosp Med Hum Perform. 2019; 90(5):462-465.


Assuntos
Medicina Aeroespacial/estatística & dados numéricos , Aviação/estatística & dados numéricos , Comércio/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Otite Média com Derrame/epidemiologia , Barotrauma/complicações , Brasil/epidemiologia , Feminino , Humanos , Masculino , Doenças Profissionais/etiologia , Otite Média com Derrame/etiologia , Prevalência , Estudos Retrospectivos , Licença Médica/estatística & dados numéricos , Fatores de Tempo
13.
J Neurol Sci ; 400: 10-14, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30878634

RESUMO

BACKGROUND: Chagas disease (CD) and ischemic stroke (IS) have a significant but poorly understood correlation. There is paucity of evidence regarding secondary prophylaxis of IS and etiological causes. OBJECTIVES: To compare arterial stroke topography and the respective morbidities and mortality in patients with CD of undetermined and cardioembolic etiologies and with cardioembolic IS (atrial fibrillation [AF]). METHODS: We compared vascular topography and outcomes using data obtained from the electronic medical records of all patients with IS with either CD (with cardioembolic or undetermined etiology) or AF, admitted to SARAH Hospital Brasilia between 2009 and 2013. RESULTS: A total of 115 patients were investigated: 49 involving AF, 23 involving CD of unclear etiology, and 43 involving CD of cardioembolic etiology. Middle cerebral artery stroke was predominant in all groups, although more frequent in patients with CD of undetermined etiology. No significant difference was found in the arterial territories. Hemodynamic stroke was predominant among CD patients who experienced cardioembolic events. AF patients had worse modified Rankin scale scores upon admission and a higher mortality rate than CD patients in both categories. CONCLUSIONS: Stroke topography is not useful in determining the etiological diagnosis. Patients with AF and IS are more likely to have worse outcomes than are those with CD and IS. The autonomic nervous system could be affected in patients with CD.

14.
Arq. neuropsiquiatr ; 77(3): 208-214, Mar. 2019. graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1001340

RESUMO

ABSTRACT The present article provides the historical background of the Sociedade Brasileira de Doenças Cerebrovasculares (Brazilian Society for Cerebrovascular Diseases), including details on its function, structure, challenges and main achievements.


RESUMO O presente texto apresenta um relato histórico da Sociedade Brasileira de Doenças Cerebrovasculares, incluindo detalhes da sua fundação, estruturação, dificuldades e principais realizações.

15.
Am Heart J ; 207: 49-57, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30415083

RESUMO

BACKGROUND: Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging especially in low- and middle-income countries. OBJECTIVES: The aim of this study is to assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for AIS and TIA patients care. DESIGN: We designed a pragmatic, 2-arm cluster-randomized trial involving 36 clusters and 1624 patients from Brazil, Argentina, and Peru. Hospitals are randomized to receive a multifaceted quality improvement intervention (intervention group) or to routine care (control group). The BRIDGE Stroke multifaceted quality improvement intervention includes case management, reminders, health care providers' educational materials (including treatment algorithms), interactive workshops, and audit and feedback reports. Primary outcome is a composite adherence score to AIS and TIA performance measures. Secondary outcomes include an "all or none" composite end point to performance measures, the individual components of the composite end points, and clinical outcomes at 90 days following admission (stroke recurrence, death, and disability measured by the modified Rankin scale). SUMMARY: The BRIDGE Stroke Trial is an international pragmatic evaluation of a multifaceted quality improvement intervention. If effective, this intervention could be potentially extended widely to improve the quality of care and outcomes of patients with AIS or TIA.


Assuntos
Ataque Isquêmico Transitório/terapia , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde , Acidente Vascular Cerebral/terapia , Doença Aguda , Comitês Consultivos/organização & administração , Algoritmos , Argentina , Brasil , Administração de Caso/organização & administração , Auditoria Clínica , Medicina Baseada em Evidências , Retroalimentação , Pessoal de Saúde/educação , Hospitais , Humanos , Ataque Isquêmico Transitório/prevenção & controle , Adesão à Medicação , Peru , Guias de Prática Clínica como Assunto , Sistemas de Alerta , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo
16.
Rev. bras. med. esporte ; 24(6): 460-464, Nov.-Dec. 2018. tab, graf, ilus
Artigo em Inglês | LILACS | ID: biblio-977857

RESUMO

INTRODUCTION: Basketball is a sport that requires good motor coordination as well as intense and multidirectional movements. Chronic ankle instability affects about 40% of patients who have sustained a sprain injury. In order to minimize the effects of this dysfunction, functional elastic tape has been widely used due to its mechanical properties, having some positive effects on athletes' functional performance. OBJECTIVE: To evaluate the effect of elastic tapes on the ankles of basketball players with and without chronic instability. METHOD: Thirteen athletes from a varsity basketball team of both sexes, aged between 18 and 30 years (23.2 ± 3.2 years), who had been playing the sport for at least one year and trained at least twice a week. The subjects were assessed using the anterior drawer test for the presence or absence of chronic ankle instability and in three different situations: placebo, elastic tape and control, and the order of use of the implements was randomly determined, using the Star Excursion Balance Test (SEBT) to assess the ankle stability of these athletes. RESULTS: Among the eight directions proposed in the SEBT, there was statistical significance in the difference in three directions for the placebo method in comparison to elastic taping and control. There was no statistical significance in the difference in four directions between the assessments, and there was no statistical significance in the difference in all directions between the control and elastic tapes. CONCLUSION: It can be inferred from the study that elastic taping does not have positive effects on joint stability in athletes with and without chronic instability, taking into account their functionality. Levef of Evidence I; High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals. (AU)


INTRODUÇÃO: O basquete é um esporte que requer boa coordenação motora e movimentos intensos e multidirecionais. A instabilidade crônica de tornozelo acomete cerca de 40% dos pacientes que sofreram lesão por entorse. Visando minimizar os efeitos dessa disfunção, a fita atlética elástica vem sendo bastante usada por suas propriedades mecânicas, apresentando alguns efeitos positivos sobre o desempenho funcional dos atletas. OBJETIVO: Avaliar o efeito da fita atlética elástica no tornozelo de jogadores de basquete com e sem instabilidade crônica. MÉTODO: Foram avaliados 13 atletas de times de basquete universitário, de ambos os sexos, com idade entre 18 e 30 anos (23,2 ± 3,2 anos), que praticavam a modalidade há pelo menos um ano, com frequência de treino de, no mínimo, duas vezes por semana. Os sujeitos foram avaliados pelo teste de gaveta anterior quanto à presença ou não de instabilidade crônica de tornozelo em três situações distintas: com placebo, com fita atlética elástica e controle, e a ordem de uso dos implementos foi randomicamente determinada, sendo aplicado o Star Excursion Balance Test (SEBT) para avaliar a estabilidade do tornozelo desses atletas. RESULTADOS: Entre as oito direções propostas no SEBT, houve significância estatística na diferença em três direções para o placebo, com relação à fita atlética elástica e o controle. Não houve significância estatística na diferença em quatro direções entre as avaliações e não houve significância estatística na diferença em todas as direções entre as avaliações controle e fita atlética elástica. CONCLUSÃO: A partir deste estudo, foi possível observar que a fita atlética elástica não tem efeitos positivos sobre a estabilização articular em atletas com e sem instabilidade crônica em termos da avaliação da funcionalidade. Nível de Evidência I; Estudo clínico randomizado de alta qualidade com ou sem diferença estatisticamente significante, mas com intervalos de confiança estreitos. (AU)


INTRODUCCIÓN: El baloncesto es un deporte que requiere una buena coordinación motora y movimientos intensos y multidireccionales. La inestabilidad crónica del tobillo afecta a aproximadamente el 40% de los pacientes que han sufrido una lesión de esguince. Con el fin de minimizar los efectos de este trastorno, la cinta atlética elástica viene siendo bastante usada por sus propiedades mecánicas, presentando algunos efectos positivos en el rendimiento funcional de los atletas. OBJETIVO: Evaluar el efecto de la cinta atlética elástica en el tobillo de jugadores de baloncesto con y sin inestabilidad crónica. MÉTODO: Fueron evaluados 13 atletas del equipo de baloncesto universitario, de ambos sexos, con edad entre 18 y 30 años (23,2 ± 3,2 años), que practicaban la modalidad desde hace por lo menos un año, con frecuencia de entrenamiento de, como mínimo, dos veces por semana. Los sujetos fueron evaluados por el test de cajón anterior cuanto a la presencia o no de inestabilidad crónica del tobillo en tres situaciones diferentes: con placebo, con cinta atlética elástica y control, y el orden de uso de los implementos aleatoriamente determinado, siendo aplicado el Star Excursion Balance Test (SEBT) para evaluar la estabilidad del tobillo de estos atletas. RESULTADOS: Entre las ocho direcciones propuestas en el SEBT, hubo significancia estadística en tres direcciones para el placebo, con relación a la cinta atlética elástica y el control. No hubo significancia estadística en la diferencia en cuatro direcciones entre las evaluaciones y no hubo significancia estadística en la diferencia en todas las direcciones entre las evaluaciones control y cinta atlética elástica. CONCLUSIÓN: A partir de este estudio, fue posible observar que la cinta atlética elástica no tiene efectos positivos sobre la estabilización articular en atletas con y sin inestabilidad crónica, en términos de evaluación de la funcionalidad. Nivel de Evidencia I; Estudio clínico aleatorio de alta calidad, con o sin diferencia estadísticamente significativa, pero con estrechos intervalos de confianza. (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Entorses e Distensões/reabilitação , Basquetebol/lesões , Fita Atlética , Instabilidade Articular/reabilitação , Articulação do Tornozelo , Esportes , Entorses e Distensões/terapia , Atletas
17.
Rev. bras. med. esporte ; 24(6): 477-482, Nov.-Dec. 2018. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-977848

RESUMO

INTRODUCTION: Ankle sprains are recurrent injuries in basketball, hence more and more athletes are taping their ankles to promote joint stability, aiming at improving dynamic balance and, consequently, functional performance. OBJECTIVE: To verify the effects of elastic and rigid athletic taping on the functional performance and level of comfort of basketball players with chronic ankle instability. METHODS: Twenty-one athletes aged between 18 and 30 years (mean age 23.7 ± 3.2) with chronic ankle instability (CAI), verified using the Cumberland Ankle Instability Tool, were selected to take part in this study. The Star Excursion Balance Test (SEBT) and the Figure-of-8 hop test (F8) were applied unilaterally to assess functional performance, considering the ankle of greater instability in three situations: without athletic taping, with rigid athletic taping and with elastic athletic taping. A draw was held to determine the order in which the tests (held over a number of days) would be applied. A questionnaire was conducted to assess comfort on the same day the athletic tapes were applied. RESULTS: There was no significant difference between the tests in any direction of the SEBT, but there was a significant difference in F8 between the rigid athletic taping x control and elastic athletic taping x control situations. In addition, the elastic athletic tape was considered significantly more comfortable than the rigid athletic tape. CONCLUSION: Athletic taping appears to effectively improve the dynamic balance and functional performance of athletes with CAI only in activities that cause considerable joint stress, as is the case in F8. Elastic athletic tape appears to be just as effective as rigid athletic tape in these situations, in addition to being a significantly more comfortable alternative. Levef of Evidence I; High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals.


INTRODUÇÃO: No basquete, as entorses de tornozelo são lesões recorrentes e, por isso, cada vez mais atletas vêm utilizando fitas atléticas para de promover a estabilização articular, visando a melhora do equilíbrio dinâmico e, consequentemente, da performance funcional. OBJETIVO: Verificar os efeitos da fita atlética elástica e rígida sobre a performance funcional e o nível de conforto dos jogadores de basquete que têm instabilidade crônica de tornozelo. MÉTODOS: Foram selecionados para este estudo 21 atletas com idade entre 18 e 30 anos (média 23,7 ± 3,2) com instabilidade crónica de tornozelo (ICT), verificada com a Cumberland Ankle Instability Tool. O Star Excursion Balance Test (SEBT) e o Figure-of-8 hop test (F8) foram realizados unilateralmente para avaliar a performance funcional, considerando o tornozelo de maior instabilidade em três situações: sem fita atlética, com fita rígida e com fita elástica. Um sorteio foi realizado para determinar a ordem na qual os testes (mantidos por vários dias) seriam aplicados. Um questionário foi conduzido para avaliar o conforto no mesmo dia em que as fitas atléticas foram aplicadas. RESULTADOS: Não houve diferença significativa entre os testes em nenhuma direção do SEBT, mas houve diferença significativa no F8 entre as tiras atléticas rígida vs. controle e elástica vs. controle. Além disso, a fita atlética elástica foi considerada significativamente mais confortável do que a rígida. CONCLUSÃO: As fitas atléticas parecem melhorar efetivamente o equilíbrio dinâmico e a performance funcional de atletas com ICT apenas em atividades que ocasionam grande estresse articular, como o F8. A fita atlética elástica parece ser uma alternativa tão eficaz quanto a rígida nessas situações, além de ser uma alternativa significativamente mais confortável. Nível de Evidência I; Estudo clínico randomizado de alta qualidade com ou sem diferença estatisticamente significante, mas com intervalos de confiança estreitos.


INTRODUCCIÓN: En el baloncesto, los esguinces de tobillo son lesiones recurrentes y debido a esto, cada vez más atletas han utilizado cintas atléticas con el fin de promover estabilidad articular, con el objetivo de mejorar el equilibrio dinámico y en consecuencia el rendimiento funcional. OBJETIVO: Verificar los efectos de la cinta atlética elástica y rígida sobre el rendimiento funcional y nivel de comodidad de los jugadores de baloncesto que tienen inestabilidad crónica de tobillo. MÉTODOS: Fueron seleccionados para este estudio 21 atletas con edad entre 18 y 30 años (promedio 23,7 ± 3,2) con inestabilidad crónica de tobillo (ICT), verificada con la Cumberland Ankle Instability Tool. Para evaluar el desempeño funcional se realizó el Star Excursion Balance Test (SEBT) y el Figure-of-8 hop (F8) de forma unilateral, teniendo en cuenta el tobillo de mayor inestabilidad en tres situaciones: sin cinta atlética, con cinta rígida y con cinta elástica. Los tests se llevaron a cabo en el orden definido por sorteo, y se realizaron en días diferentes. El mismo día que se utilizaron las cintas atléticas se aplicó un cuestionario para evaluar la comodidad de las cintas atléticas. RESULTADOS: No hubo diferencia significativa entre los tests en ninguna dirección del SEBT, pero hubo diferencia significativa en el F8 entre las cintas atléticas rígidas vs. control y elásticas vs. control. Además, la cinta atlética elástica fue significativamente más cómoda que la rígida. CONCLUSIÓN: Las cintas atléticas parecen mejorar efectivamente el equilibrio dinámico y el desempeño funcional de atletas con ICT sólo en actividades que causan gran estrés articular, como el F8. La cinta atlética elástica parece ser una alternativa tan eficaz como la rígida en estas situaciones, además de ser significativamente más cómoda. Nivel de Evidencia I; Estudio clínico aleatorio de alta calidad, con o sin diferencia estadísticamente significativa, pero con estrechos intervalos de confianza.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Basquetebol , Desempenho Atlético/fisiologia , Fita Atlética , Atletas , Instabilidade Articular/prevenção & controle , Articulação do Tornozelo , Entorses e Distensões/prevenção & controle , Equilíbrio Postural/fisiologia , Teste de Esforço/métodos
18.
Adv Exp Med Biol ; 1088: 139-151, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30390251

RESUMO

In muscle tissue there is a balance between the processes muscle synthesis and degradation. The mammalian target of rapamycin (mTOR) signaling pathway plays a critical role in regulating protein synthesis in order to maintain muscular protein turnover and trophism. Studies have shown that both down- and upregulation mechanisms are involved in this process in a manner dependent on stimulus and cellular conditions. Additionally, mTOR signaling has recently been implicated in several physiological conditions related to cell survival, such as self-digestion (autophagy), energy production, and the preservation of cellular metabolic balance over the lifespan. Here we briefly describe the mTOR structure and its regulatory protein synthesis pathway. Furthermore, the role of mTOR protein in autophagy, aging, and mitochondrial function in muscle tissue is presented.


Assuntos
Envelhecimento , Autofagia , Músculos/fisiologia , Biossíntese de Proteínas , Transdução de Sinais , Serina-Treonina Quinases TOR/metabolismo , Humanos
19.
Front Neurol Neurosci ; 43: 177-184, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30419563

RESUMO

Machado de Assis (1839-1908) suffered from temporal lobe epilepsy, probably with origin in the non-dominant hemisphere. The evidence for this is provided by the detailed reports of the characteristics of his seizures by his contemporaries and by his correspondence with other writers. He was treated with bromides and homeopathy. It is unclear whether his neurological disorder influenced his artistic performance. What is evident is that he was deeply ashamed of the disease - he avoided the word "epilepsy" and just wrote about it in his personal correspondence with friends in the last years of his life. Though controversial, he had no clear traces of personality disorders linked to his temporal lobe epilepsy. Despite all his adversities, including being "mulatto," having a stutter, being of humble origins, and epileptic in a period when there was no efficacious therapy and a profound stigma associated with the disease, Machado de Assis became one of the most important Brazilian writers of all times.


Assuntos
Epilepsia do Lobo Temporal/psicologia , Epilepsia/história , Epilepsia/psicologia , Pessoas Famosas , Medicina na Literatura/história , Brasil , História do Século XIX , História do Século XX , Humanos , Masculino , Redação
20.
Value Health Reg Issues ; 17: 150-157, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30195236

RESUMO

OBJECTIVES: To estimate the proportion of patients with drug-related morbidities (DRMs), DRM preventability, and the cost of illness of the DRMs in Brazil. METHODS: We used the decision-analytic model initially developed by Johnson and Bootman (Drug-related morbidity and mortality. A cost-of-illness model. J Manag Care Pharm 1996;2:39-47), which was adapted to the reality of the present study. A hypothetical cohort of patients in ambulatory care setting was simulated considering the perspective of the Brazilian public health system. Direct costs related to health care were obtained from the national databases, and the probability of occurrence of DRMs was established by a panel of clinical experts. Sensitivity analyses were conducted. RESULTS: An estimated 59% ± 14% of all patients assisted by the health system suffer some DRMs. Given these cases, 53% ± 18% were considered preventable. The average cost of managing a patient with any DRM was US $155. The cost of illness of the DRMs in Brazil would account for nearly US $18 billion (US $9-$27 billion) (best and worst case scenarium) annually. This amount is 5 times higher than what the Ministry of Health spends to guarantee free medicines in Brazil. Hospitalizations and long-term stays in hospital correspond to 75% of this cost. The sensitivity analysis showed that the model is sensitive to variations in these two outcomes. CONCLUSIONS: According to the model, a large proportion of patients experience DRM and the economic impact to solve these problems is substantial for the health system. Considering that more than half of these cases are preventable, it could be possible to achieve an enormous saving of resources through actions that improve the process of medication use.


Assuntos
Efeitos Psicossociais da Doença , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/economia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Morbidade , Brasil/epidemiologia , Técnicas de Apoio para a Decisão , Custos de Cuidados de Saúde , Hospitalização/economia , Humanos , Modelos Econômicos
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