Efeitos da inclinação da esteira na marcha de indivíduos hemiparéticos crônicos

Objective: To examine the effects of treadmill inclinations on the walking of hemiparetic chronic subjects. Design: Observational descriptive study. Location: Laboratory of human movement analysis. Participants: Eighteen subjects, 10 men and 8 women were evaluated, with a mean age of 55.3 ± 9.3 years and the time since the injury of about 36 ± 22.8 months. Intervention: Not applicable. Main Outcome Measures: All subjects were evaluated for functional independence (Functional Independence Measure - FIM) and balance (Berg Balance Scale). Angular variations of the hips, knees and ankles in the sagittal plane were observed, as well as the speed of the movement (m/s), cadence (steps/min), stride length (m), cycle time (s), step time on the paretic leg and on the non-paretic leg (s), support phase time and balance phase time on the paretic leg (s) and the ratio of symmetry inter-limb as subjects walked on a treadmill at three conditions of inclination (0%, 5% and 10% ). Results: There were angular increases in the initial contact of the hip, knee and ankle, amplitude increase in the hip between 0% and 10% (37.83 ± 5.23 versus 41.12 ± 5.63, p < 0,001) and 5% and 10% (38.80 ± 5.96 versus 41.12 ± 5.63, p = 0,002), amplitude increases in the knee between 0% and 10% (47.51 ± 15.07 versus 50, 30 ± 12.82, p = 0,040), extension decreases in the hip, dorsiflexion increases in the balance phase and in the time of support phase from 0% to 5% (0.83 ± 0.21 versus 0.87 ± 0, 20, p = 0,011) and 0% and 10% (0.83 ± 0.21 versus 0.88 ± 0.23, p = 0,021). Conclusion: The treadmill inclination promoted angle changes as such as the increase of the angle of the hip, knee and ankle during the initial contact and the balance phase and the increase of the range of motion of the hip and knee; furthermore, it also promoted the increase of the support time of the paretic lower limb

Saberes sobre a literatura: um estudo com professores de 1º ao 5º ano do Ensino Fundamental

El estudio investiga los saberes literários del profesores del Enseño Fundamental de las series iniciales sobre la literatura. Cuando se piensa en la influencia del profesor como aquel que tiene papel decisivo en la enseñanza de la lectura y reconocimiento de la función y formación del mediador profesional, buscamos compreender que conocimiento tiene sobre la literatura. Optamos por los profesores que trabajan en los años iniciales del Enseño Fundamental basadas en el entendimiento de la educación básica, es de suma importância en la formación del lector literário. El estudio se caracteriza por ser un enfoque cualitativo. Adoptamos como procedimientos metodológicos, la entrevista semiestructurada, elaborada com preguntas abiertas que se centran en eventos de lectura de las practicas em família, en la escuela, en la educación superiory en el ejercicio de enseãnza grabadas en audio, además de elevar um diário de campo. La investigación lleva a cabo en cuatro escuelas de la ciudad de Natal – Rn, con dicinueve profesores que trabajan con alumnos de 1º a 5º año del Enseñanza Fundamental. El corpus de la entrevista constituye el análisis de los profesores y es analizado tomando como referencia los princípios de análisis de contenido, especificado por Laurence Bardin (1997). Se tomó como referencial sobre la lectura, la literatura y práctica pedagógica los estudios teóricos de Amarilha (1991, 1992, 1994, 1997, 2003, 2006, 2007, 2009, 2010, 2013); Cosson (2011); Lajolo (2006); Larrossa (1996, 2003); Morin (2010); Yunes (2003, 2010). Sobre la teoría literaria, Candido (2002, 2012); Zilberman (1993); Culler (1999). Acerca de la estética recepción, Eco (1994); Iser (1996); Jauss (2002). Sobre los saberes docentes, Nóvoa (1992, 1997, 2002); Perrenoud (1999, 2002), Tardif (1991, 2000, 2002, 2005). Sobre los saberes literários, Paulino (2004, 2007), dentre outros. El análisis señala que los profesores dominan vários conocimientos sobre la literatura que son transportados a la formación a través del diálogo con otras lecturas, con otros espacios interactivos, en convivência con otros lectores. Cabe destacar el saber que la literatura es humanizar el fator, por lo tanto, la necesidad de escolarizá que a través de las prácticas literárias que involucran estudiantes, professores y comunidad escola. El studio también revela que en la escuela recital literário es necesario para la enseñanza de valores, para enseñar a leer, para inculcar el amor por la lectura. En este contexto, destacamos la importancia de la mediación del profesor como formador de lectores que domina los conocimientos necesarios para satisfacer las necesidades de los estudiantes, desarrollando los letctores conocimientos para fomentar el gusto por el texto literário

Síndrome de Guillain-Barré: epidemiologia, prognóstico e fatores de risco

Introduction. Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy and the principal cause of acute neuromuscular paralysis. The most prominent GBS subtypes are: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN) and Fisher syndrome (FS). Differences in geographical distribution of variants have been reported. In Brazil, there are few studies describing the characteristics of GBS, but none on the frequency of GBS variants and their clinical manifestations. Infection-induced aberrant immune response resulting from molecular mimicry and formation of cross-reacting antibodies, contribute to complement activation. Functional biallelic polymorphism in immunoglobulin receptors that influence the affinity of IgG subclasses and the type of immune response have been described, suggesting genetic susceptibility to developing disease. It remains unclear whether individuals carrying different FCGR alleles have differential risk for GBS and⁄or disease severity. The goals of this study were: (1) To characterize GBS and describe the clinical findings in a cohort of patients with GBS from the state of Rio Grande do Norte, Brazil; (2) to determine whether polymorphism in FCGR were associated with development of GBS, and (3) to tease out whether the global gene expression studies could be a tool to identify pathways and transcriptional networks which could be regulated and decrease the time of disease. Methods. Clinical and laboratory data for 149 cases of GBS diagnosed from 1994 to 2013 were analyzed. Genomic DNA and total RNA were extracted from whole blood. Antigangliosides antibodies were determined in the sera. In addition, we also assessed whether FCGR polymorphism are present in GBS (n=141) and blood donors (n=364), and global gene expressions were determined for 12 participants with GBS. Blood samples were collected at the diagnosis and post-recovery. Results. AIDP was the most frequent variant (81.8%) of GBS, followed by AMAN (14.7%) and AMSAN (3.3%). The incidence of GBS was 0.3 ⁄ 100,000 people for the state of Rio Grande do Norte and cases occurred at a younger age. GBS was preceded by infections, with the axonal variant associated with episodes of diarrhea (P = 0.025). Proximal weakness was more frequent in AIDP, and distal weakness predominant in the axonal variant. Compared to 42.4% of cases with AIDP (P<0.0001), 84.6% of cases with the axonal variant had nadir in <10 days. Individuals with the axonal variant took longer to recover deambulation (P<0.0001). The mortality of GBS was 5.3%. A worse outcome was related to an axonal variant (OR17.063; P=0.03) and time required to improve one point in the Hughes functional scale (OR 1.028; P=0.03). The FCGR genotypes and allele frequencies did not differ significantly between the patients with GBS and the controls (FCGR2A p=0.367 and FCGR3A p=0.2430). Global gene expression using RNAseq showed variation in transcript coding for protein isoforms during acute phase of disease. Conclusions. The annual incidence of GBS was 0.3 per 100,00 and there was no seasonal pattern. A predominance of the AIDP variant was seen, and the incidence of the disease decreased with age. The distribution of weakness is a function of the clinical variants, and individuals with the axonal variant had a poorer prognosis. Early diagnosis and variant identification leads to proper intervention decreasing in long-term morbidity. FCGR polymorphisms do not seem to influence susceptibility to GBS in this population. This study found deregulated genes and signs of transcriptional network alterations during the acute and recovery phases in GBS. Identification of pathways altered during disease might be target for immune regulation and with potential to ameliorate symptoms.