Iniciação da marcha em indivíduos com AVE. Sequência de ativação muscular do tibial anterior e solear

Introdução: A iniciação da marcha, enquanto tarefa motora complexa que consiste na transição de uma postura mantida pelo apoio simultâneo dos dois membros inferiores para um equilíbrio dinâmico, permitindo a progressão anterior do corpo, constitui um exemplo que implica uma correta sequência de ativação muscular. Objetivos: Verificar a modificação da fase de iniciação da marcha face à aplicação de um programa de recuperação funcional, analisando a sequência de ativação dos músculos tibial anterior e solear. Registar as repercussões funcionais na participação nas diferentes atividades da vida diária, em contexto padronizado e social. Metodologia: Nos dois participantes em estudo foi realizada uma avaliação antes e após um programa de intervenção, segundo a abordagem do Conceito de Bobath, através da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, da Fugl Meyer Assessment of Sensorymotor Recovery After Stroke, electromiografia e plataforma de forças. Resultados: Após a aplicação do programa de recuperação funcional, verificaram-se alterações na sequência de ativação do tibial anterior e solear. O músculo tibial anterior passou a ser o primeiro a ser recrutado nesta sequência. Conclusão: Foi possível verificar modificações durante a fase de iniciação da marcha, face a um programa de recuperação funcional, em que a sequência de ativação do tibial anterior e solear, tendencialmente, se assemelharam ao comportamento em indivíduos saudáveis, repercutindo-se numa melhoria funcional na participação nas atividades da vida diária.

Activation timing of soleus and tibialis anterior muscles during sit-to-stand and stand to sit in post-stroke vs healthy subjects

O documento em anexo encontra-se na versão post-print (versão corrigida pelo editor).

Efeito agudo do exercício físico na rigidez arterial

Este estudo pretendeu reproduzir uma tarefa da vida diária (marcha com transporte de peso nos membros superiores) realizada de forma rotineira e até aconselhada no contexto da prevenção e reabilitação de patologia cardiovascular, desta forma, teve como objectivo avaliar o efeito agudo de uma sessão de exercício aeróbio associado a exercício isométrico na rigidez arterial em indivíduos jovens. Foram recrutados 14 indivíduos do sexo masculino com média de idade de 30,3±3,6 anos. Foram realizadas duas sessões de exercício com uma semana de intervalo. Em ambas as sessões de exercício, os sujeitos caminharam num tapete rolante a uma velocidade de 5,0 km/h por um período de dez minutos, sendo que, numa das sessões, determinada aleatoriamente, carregaram o equivalente a 10% do seu peso corporal distribuído igualmente pelos dois membros superiores em dois garrafões de água. Avaliou-se em repouso e imediatamente após o exercício, a pressão arterial periférica, a frequência cardíaca e a rigidez arterial. A análise da rigidez arterial foi efectuada na artéria radial do membro superior direito com um sistema transdutor automático de pressão. Os parâmetros reportados neste estudo são a frequência cardíaca, a pressão arterial sistólica e diastólica, a pressão arterial média, a pressão central (aórtica) sistólica, a pressão de pulso central, a pressão de aumentação e o índice de aumentação a 75 bmp (Aix@75). Em repouso, não se verificaram diferenças significativas entre as duas sessões de exercício nos parâmetros avaliados. O principal resultado do presente estudo indica que a rigidez arterial aumenta de forma aguda com a realização de caminhada (exercício aeróbio) apenas quando esta é acompanhada do transporte nos membros superiores de uma carga externa (exercício isométrico) [Aix@75: -5.5(8.4) para -1.36(8.17)%, p<0.05]. Relativamente ao protocolo exclusivamente aeróbio não se verificaram diferenças significativas na rigidez arterial [Aix@75: -4.2(9.1) para -4.69(7.93)%, p>0.05]. Em conclusão, os resultados do presente estudo indicam que a rigidez arterial, em indivíduos jovens e aparentemente saudáveis, aumenta de forma significativa apenas quando o exercício aeróbio é acompanhado de exercício isométrico de membros superiores com transporte de carga adicional.

Diversity and characterisation of coagulasenegative staphylococci isolated from healthy individuals in Portugal

In the past few years the interest in coagulase-negative staphylococci (CoNS) has significantly increased in human medicine. CoNS are common commensal colonisers of the human skin, although now also recognised as major nosocomial pathogens. Over the last decades, several studies have been carried out in order to understand the pathogenicity mechanisms of CoNS. The well known determinants in the pathogenesis of CoNS infections are their ability to form biofilms and an exceptional resistance to several antibiotics. Nevertheless, there is a lack of studies regarding the commensal lifestyle of these microorganisms. Additionally, it is now hypothesised that commensal bacteria might be a reservoir of pathogenic determinants. Therefore, the work described throughout this thesis was aimed to perform a phenotypic and genotypic characterisation of different CoNS species isolated from healthy Portuguese individuals. A total of 61 CoNS isolates, comprising 7 different species, were obtained and characterised at the level of biofilm formation and antibiotic susceptibility profiles. According to the results, biofilm formation ability and presence of biofilm-associated genes were commonly found features, highlighting their pivotal role in the colonising lifestyle of CoNS. This study also addressed the correlation between phenotypic and genotypic characteristics of biofilm formation, corroborating and raising questions about the importance of some genes in this process. Moreover, it was observed a great proportion of isolates with decreased susceptibility and multiple resistances to some important antibiotics. A significant association between antibiotic resistance and biofilm formation was also demonstrated, and some hypotheses about the nature of such association were provided. Lastly, the expression patterns of two biofilm-associated genes at two distinct biofilm developmental stages were determined, confirming their importance in the accumulative stage of biofilm formation. Overall, the results presented in this thesis indicate that staphylococcal skin flora might be an important reservoir of potentially pathogenic bacteria and, simultaneously, bring to light new perceptions about the molecular basis of staphylococcal biofilm formation, and the nature of the association between antibiotic resistance and biofilm formation.

Cardiorespiratory fitness is negatively associated with metabolic risk factors independently of the adherence to a healthy dietary pattern

Background and aim: Cardiorespiratory fitness (CRF) and diet have been involved as significant factors towards the prevention of cardio-metabolic diseases. This study aimed to assess the impact of the combined associations of CRF and adherence to the Southern European Atlantic Diet (SEADiet) on the clustering of metabolic risk factors in adolescents. Methods and Results: A cross-sectional school-based study was conducted on 468 adolescents aged 15-18, from the Azorean Islands, Portugal. We measured fasting glucose, insulin, total cholesterol (TC), HDL-cholesterol, triglycerides, systolic blood pressure, waits circumference and height. HOMA, TC/HDL-C ratio and waist-to-height ratio were calculated. For each of these variables, a Z-score was computed by age and sex. A metabolic risk score (MRS) was constructed by summing the Z scores of all individual risk factors. High risk was considered when the individual had 1SD of this score. CRF was measured with the 20 m-Shuttle-Run- Test. Adherence to SEADiet was assessed with a semi-quantitative food frequency questionnaire. Logistic regression showed that, after adjusting for potential confounders, unfit adolescents with low adherence to SEADiet had the highest odds of having MRS (OR Z 9.4; 95%CI:2.6e33.3) followed by the unfit ones with high adherence to the SEADiet (OR Z 6.6; 95% CI: 1.9e22.5) when compared to those who were fit and had higher adherence to SEADiet.

Iron Metabolism: From Health to Disease

Background Iron is vital for almost all living organisms by participating in a wide range of metabolic processes. However, iron concentration in body tissues must be tightly regulated since excessive iron may lead to microbial infections or cause tissue damage. Disorders of iron metabolism are among the most common human diseases and cover several conditions with varied clinical manifestations. Methods An extensive literature review on the basic aspects of iron metabolism was performed, and the most recent findings on this field were highlighted as well. Results New insights on iron metabolism have shed light into its real complexity, and its role in both healthy and pathological states has been recognized. Important discoveries about the iron regulatory machine and imbalances in its regulation have been made, which may lead in a near future to the development of new therapeutic strategies against iron disorders. Besides, the toxicity of free iron and its association with several pathologies has been addressed, although it requires further investigations. Conclusion This review will provide students in the fields of biochemistry and health sciences a brief and clear overview of iron physiology and toxicity, as well as imbalances in the iron homeostasis and associated pathological conditions.

Ankle anticipatory postural adjustments during gait initiation in healthy and post-stroke subjects

Background: Anticipatory postural adjustments during gait initiation have an important role in postural stability but also in gait performance. However, these first phase mechanisms of gait initiation have received little attention, particularly in subcortical post-stroke subjects, where bilateral postural control pathways can be impaired. This study aims to evaluate ankle anticipatory postural adjustments during gait initiation in chronic post-stroke subjects with lesion in the territory of middle cerebral artery. Methods: Eleven subjects with post-stroke hemiparesis with the ability to walk independently and twelve healthy controls participated in this study. Bilateral electromyographic activity of tibialis anterior, soleus and medial gastrocnemius was collected during gait initiation to assess the muscle onset timing, period of activation/deactivation and magnitude of muscle activity during postural phase of gait initiation. This phase was identified through centre of pressure signal. Findings: Post-stroke group presented only half of the tibialis anterior relative magnitude observed in healthy subjects in contralesional limb (t=2.38, p=0.027) and decreased soleus deactivation period (contralesional limb, t=2.25, p=0.04; ipsilesional limb, t=3.67, p=0.003) as well its onset timing (contralesional limb, t=3.2. p=0.005; ipsilesional limb, t=2.88, p=0.033) in both limbs. A decreased centre of pressure displacement backward (t=3.45, p=0.002) and toward the first swing limb (t=3.29, p=0.004) was observed in post-stroke subjects. Interpretation: These findings indicate that chronic post-stroke subjects with lesion at middle cerebral artery territory present dysfunction in ankle anticipatory postural adjustments in both limbs during gait initiation.

Reliability of Two Methods for Identifying the Postural Phase of Gait Initiation in Healthy and Post-stroke Subjects

This study aims to compare two methods of assessing the postural phase of gait initiation as to intrasession reliability, in healthy and post-stroke subjects. As a secondary aim, this study aims to analyse anticipatory postural adjustments during gait initiation based on the centre of pressure (CoP) displacements in post-stroke participants. The CoP signal was acquired during gait initiation in fifteen post-stroke subjects and twenty-three healthy controls. Postural phase was identified through a baseline-based method and a maximal displacement based method. In both healthy and post-stroke participants higher intra-class correlation coefficient and lower coefficient of variation values were obtained with the baseline-based method when compared to the maximal displacement based method. Post-stroke participants presented decreased CoP displacement backward and toward the first swing limb compared to controls when the baseline-based method was used. With the maximal displacement based method, there were differences between groups only regarding backward CoP displacement. Postural phase duration in medial-lateral direction was also increased in post-stroke participants when using the maximal displacement based method. The findings obtained indicate that the baseline-based method is more reliable detecting the onset of gait initiation in both groups, while the maximal displacement based method presents greater sensitivity for post-stroke participants.

Ankle antagonist coactivation in the double-support phase of walking: Stroke vs. healthy subjects

Introduction: Lesions at ipsilateral systems related to postural control at ipsilesional side, may justify the lower performance of stroke subjects during walking. Purpose: To analyse bilateral ankle antagonist coactivation during double-support in stroke subjects. Methods: Sixteen (8 females; 8 males) subjects with a first isquemic stroke, and twenty two controls (12 females; 10 males) participated in this study. The double support phase was assessed through ground reaction forces and electromyography of ankle muscles was assessed in both limbs. Results: Ipsilesional limb presented statistical significant differences from control when assuming specific roles during double support, being the tibialis anterior and soleus pair the one in which this atypical behavior was more pronounced. Conclusion: The ipsilesional limb presents a dysfunctional behavior when a higher postural control activity was demanded.

Writing and living on the stage of history

This article studies the intercultural trajectory of a Portuguese female aristocrat of the eighteenth to nineteenth centuries. Her trajectory of intercultural transition from a Portuguese provincial lady into an independent owner of a sugar mill in tropical Bahia is documented through family letters, which provide a polyphonic representation of a movement of personal, family, and social transculturation over almost two decades. Maria Bárbara began her journey between cultures as a simple spectator-reader, progressively becoming a commentator-actor-protagonist-author in society, in politics, and in history. These letters function as a translation that is sometimes consecutive, other times simultaneous, of the events lived and witnessed. This concept of intercultural translation is based on the theories of Boaventura de Sousa Santos (2006, 2008), who argues that cultural differences imply that any comparison has to be made using procedures of proportion and correspondence which, taken as a whole, constitute the work of translation itself. These procedures construct approximations of the known to the unknown, of the strange to the familiar, of the ‘other’ to the ‘self’, categories which are always unstable. Likewise, this essay explores the unstable contexts of its object of study, with the purpose of understanding different rationalities and worldviews.