Reliability of nasal auscultation and their relation to middle ear condition – a clinical interest to pediatrics respiratory physiotherapy

Background: Acute respiratory infections are usual in children under three years old occurring in upper respiratory tract, having an impact on child and caregiver’s quality of life predisposing to otitis media or bronchiolitis. There are few valid and reliable measures to determine the child’s respiratory condition and to guide the physiotherapy intervention. Aim: To assess the intra and inter rater reliability of nasal auscultation, to analyze the relation between sounds’ classification and middle ear’s pressure and compliance as well as with the Clinical Severity Score. Methods: A cross-sectional observational study was composed by 125 nursery children aged up to three years old. Tympanometry, pulmonary and nasal auscultation and application of Clinical Severity Score were performed to each child. Nasal auscultation sounds’ were recorded and sent to 3 blinded experts, that classified, as “obstructed” and “unobstructed”, with a 48 hours interval, in order to analyze inter and intra rater reliability. Results: Nasal auscultation revealed a substantial inter and intra rater reliability (=0,749 and evaluator A - K= 0,691; evaluator B - K= 0,605 and evaluator C - K= 0,724, respectively). Both ears’ pressure was significantly lower in children with an "unobstructed" nasal sound when compared with an “obstructed” nasal sound (t=-3,599, p<0,001 in left ear; t=-2,258, p=0,026 in right ear). Compliance in both ears was significantly lower in children with an "obstructed" nasal sound when compared with “unobstructed” nasal sound (t=-2,728, p=0,007 in left ear; t=-3,830, p<0,001 in right ear). There was a statistically significant association between sounds’ classification and tympanograms types in both ear’s (=11,437, p=0,003 in left ear; =13,535, p=0,001 in right ear). There was a trend to children with an "unobstructed" nasal sound that had a lower clinical severity score when compared with “obstructed” children. Conclusion: It was observed a good intra and substantial inter reliability for nasal auscultation. Nasal auscultation sounds’ classification was related to middle ears’ pressure and compliance.

A eficácia entre duas intervenções na Síndrome do Canal Cárpico

A Síndrome do Canal Cárpico (SCC) é a neuropatia compressiva mais comum do membro superior, causada pela compressão direta sobre o nervo mediano no interior do canal cárpico.Os resultados deste estudo mostram em cada um dos grupos, após a intervenção, uma melhoria estatisticamente significativa da sintomatologia no G-AFN (p=0,02) e no GTRN/ EAA (p=0,004) e uma melhoria estatisticamente significativa do estado funcional no G-AFN (p=0,022). Verificamos também em cada um dos grupos, após a intervenção, uma melhoria estatisticamente significativa na “Força de preensão” (p=0,005), na “Pinça polegar/dedo indicador” (p=0,021), na “Pinça polegar/dedo médio” (p=0,026) e “Pinça polegar/dedo anular” (p=0,026) no G-AFN, e uma melhoria estatisticamente significativa na “Pinça polegar/indicador” (p=0,016), na “Pinça polegar/dedo médio” (p=0,035), na “Pinça polegar/dedo anular” (p=0,010), na “Pinça trípode” (p=0,005) e na “Pinça lateral” (p=0,051) no G-TRN/EAA. Após a intervenção, não verificamos diferenças estatisticamente significativas nos valores das escalas de gravidade de sintomas (p=0,853) e de estado funcional (p=0,148) entre os grupos, mas diferenças estatisticamente significativas nos valores dos testes neurofisiológicos (p=0,047) e força de preensão da mão (p=0,005). Do estudo, concluímos que a utilização da intervenção articular/fascial/neural (AFN) e a intervenção com tala de repouso noturna e exercícios de auto alongamento (TRN/EAA), beneficia os indivíduos com SCC não severa, como nos casos incipientes, ligeiros ou moderados. Os indivíduos com esta condição clínica apresentam sintomatologia caraterística de dor, parestesia, especialmente noturna e disfunção muscular da mão. Tais manifestações originam perda funcional com implicações nas áreas de desempenho ocupacional, nomeadamente, nas atividades da vida diária, produtivas e de lazer. O tratamento conservador na SCC não severa, como nos casos incipientes, ligeiros e moderados, apesar de controverso, é recomendado. O tema suscita o nosso interesse, razão pela qual nos propomos realizar um estudo experimental em indivíduos com o diagnóstico clínico de SCC não severa e aplicar num grupo a intervenção articular, fascial e neural (AFN) e noutro grupo a intervenção com tala de repouso noturna e exercícios de auto alongamento (TRN/EAA). O estudo tem como principais objetivos, por um lado, verificar o impacto das intervenções em cada um dos grupos e, por outro lado, comparar o seu impacto entre os grupos, no que respeita à gravidade de sintomas, ao estado funcional, à força de preensão da mão e força de pinças finas. Fomos também comparar os resultados dos testes neurofisiológicos (Velocidade de Condução Motora) antes e depois da intervenção AFN e da intervenção com TRN/EAA, e averiguar o seu impacto nos valores da latência motora distal e da velocidade de condução sensitiva, entre os grupos. Identificamos também quais as variáveis sócio demográficas e as que caraterizam a patologia que estão relacionadas com o problema em estudo e com os valores obtidos com as escalas do Boston Carpal Tunnel Questionnaire (BCTQ), no grupo articular, fascial e neural (G-AFN) e no grupo com tala de repouso noturna e exercícios de auto alongamento (G-TRN/EAA). Para a concretização do estudo, recorremos a uma amostra de 23 indivíduos de ambos os sexos do Hospital Curry Cabral, Empresa Pública Empresarial -Centro Hospitalar de Lisboa Central (HCC, EPE -CHLC).

Clay body wrap with microcurrent: effects in central adiposity

Introduction Increased fat mass is becoming more prevalent in women and its accumulation in the abdominal region can lead to numerous health risks such as diabetes mellitus. The clay body wrap using compounds such as green clay, green tea and magnesium sulfate, in addition to microcurrent, may reduce abdominal fat mass and minimize or prevent numerous health problems. Objective This study aims at measuring the influence of the clay body wrap with microcurrent and aerobic exercise on abdominal fat. Methods Nineteen female patients, randomized into intervention (n = 10) and control (n = 9) groups, were evaluated using ultrasound for visceral and subcutaneous abdominal fat, calipers and abdominal region perimeter for subcutaneous fat and bioimpedance for weight, fat mass percentage and muscular mass. During 10 sessions (5 weeks, twice a week) both groups performed aerobic exercise in a cycloergometer and a clay body wrap with microcurrent was applied to the intervention group. Results When comparing both groups after 5 weeks of protocol, there was a significant decrease in the subcutaneous fat around left anterior superior iliac spine in the intervention group (ρ = 0.026 for a confidence interval 95%). When comparing initial and final abdominal fat in the intervention group, measured by ultrasound (subcutaneous and visceral fat) and by skinfold (subcutaneous fat), we detected a significant abdominal fat reduction. Conclusion This study demonstrated that the clay body wrap used with microcurrent and aerobic exercise can have a positive effect on central fat reduction.

Persistent organic pollutant levels in human visceral and subcutaneous adipose tissue in obese individuals - Depot differences and dysmetabolism implications

Background: The role of persistent organic pollutants (POPs) with endocrine disrupting activity in the aetiology of obesity and other metabolic dysfunctions has been recently highlighted. Adipose tissue (AT) is a common site of POPs accumulation where they can induce adverse effects on human health. Objectives: To evaluate the presence of POPs in human visceral (vAT) and subcutaneous (scAT) adipose tissue in a sample of Portuguese obese patients that underwent bariatric surgery, and assess their putative association with metabolic disruption preoperatively, as well as with subsequent body mass index (BMI) reduction. Methods: AT samples (n=189) from obese patients (BMI ≥35) were collected and the levels of 13 POPs were determined by gas chromatography with electron-capture detection (GC-ECD). Anthropometric and biochemical data were collected at the time of surgery. BMI variation was evaluated after 12 months and adipocyte size was measured in AT samples. Results: Our data confirm that POPs are pervasive in this obese population (96.3% of detection on both tissues), their abundance increasing with age (RS=0.310, p<0.01) and duration of obesity (RS=0.170, p<0.05). We observed a difference in AT depot POPs storage capability, with higher levels of ΣPOPs in vAT (213.9±204.2 compared to 155.1±147.4 ng/g of fat, p<0.001), extremely relevant when evaluating their metabolic impact. Furthermore, there was a positive correlation between POP levels and the presence of metabolic syndrome components, namely dysglycaemia and hypertension, and more importantly with cardiovascular risk (RS=0.277, p<0.01), with relevance for vAT (RS=0.315, p<0.01). Finally, we observed an interesting relation of higher POP levels with lower weight loss in older patients. Conclusion: Our sample of obese subjects allowed us to highlight the importance of POPs stored in AT on the development of metabolic dysfunction in a context of obesity, shifting the focus to their metabolic effects and not only for their recognition as environmental obesogens.

Artificial antibodies for troponin T by its imprinting on the surface of multiwalled carbon nanotubes: Its use as sensory surfaces

A novel artificial antibody for troponin T (TnT) was synthesized by molecular imprint (MI) on the surface of multiwalled carbon nanotubes (MWCNT). This was done by attaching TnT to the MWCNT surface, and filling the vacant spaces by polymerizing under mild conditions acrylamide (monomer) in N,N′-methylenebisacrylamide (cross-linker) and ammonium persulphate (initiator). After removing the template, the obtained biomaterial was able to rebind TnT and discriminate it among other interfering species. Stereochemical recognition of TnT was confirmed by the non-rebinding ability displayed by non-imprinted (NI) materials, obtained by imprinting without a template. SEM and FTIR analysis confirmed the surface modification of the MWCNT. The ability of this biomaterial to rebind TnT was confirmed by including it as electroactive compound in a PVC/plasticizer mixture coating a wire of silver, gold or titanium. Anionic slopes of 50 mV decade−1 were obtained for the gold wire coated with MI-based membranes dipped in HEPES buffer of pH 7. The limit of detection was 0.16 μg mL−1. Neither the NI-MWCNT nor the MWCNT showed the ability to recognize the template. Good selectivity was observed against creatinine, sucrose, fructose, myoglobin, sodium glutamate, thiamine and urea. The sensor was tested successfully on serum samples. It is expected that this work opens new horizons on the design of new artificial antibodies for complex protein structures.

Detection of Arah1 (a major peanut allergen) in food using an electrochemical gold nanoparticle-coated screen-printed immunosensor

A gold nanoparticle-coated screen-printed carbon electrode was used as the transducer in the development of an electrochemical immunosensor for Ara h 1 (a major peanut allergen) detection in food samples. Gold nanoparticles (average diameter=32 nm) were electrochemically generated on the surface of screen-printed carbon electrodes. Two monoclonal antibodies were used in a sandwich-type immunoassay and the antibody–antigen interaction was electrochemically detected through stripping analysis of enzymatically (using alkaline phosphatase) deposited silver. The total time of the optimized immunoassay was 3 h 50 min. The developed immunosensor allowed the quantification of Ara h 1 between 12.6 and 2000 ng/ml, with a limit of detection of 3.8 ng/ml, and provided precise (RSD <8.7%) and accurate (recovery >96.6%) results. The immunosensor was successfully applied to the analysis of complex food matrices (cookies and chocolate), being able to detect Ara h 1 in samples containing 0.1% of peanut.