Poliuretana de mamona (Ricinus communis) para desvio da crista tibial no cão

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efficacy, safety and tolerability of terbinafine for Tinea capitis in children: Brazilian multicentric study with daily oral tablets for 1, 2 and 4 weeks

Background: Tinea capitis is a common skin disease seen predominantly in children. The standard therapies for this disease are griseofulvin and ketoconazole. Nevertheless, these drugs have drawbacks in that they are only fungistatic and require treatment for at least 6 weeks. Previous studies with oral terbinafine for the treatment of Tinea capitis have shown that this agent is effective when given for 4 weeks, comparable to an 8-week regimen with griseofulvin. To date there is no data on the use of oral terbinafine in Brazilian children. Objectives: To assess the efficacy, safety and tolerability of oral terbinafine in short-term treatments (1-, 2- and 4-week treatment) of Tinea capitis in children. Patients and methods: One hundred and thirty-two children aged 1-14 years were enrolled in this study, but only 107 were considered for the final efficacy analysis. Diagnosis included clinical assessment and examination by Wood's light. Confirmation was obtained by direct microscopy and culture for fungus. Terbinafine dosage (125 or 250 mg/day) was adjusted according to patient weight. Efficacy was evaluated both by clinical and mycological assessment. Safety and tolerability variables included data on adverse reaction and clinical laboratory evaluations. Results: Mycological evaluation in the follow-up visit at week 12 showed negative direct microscopy and culture results in 48.6, 60.5 and 69.7% patients in groups 1-, 2- and 4-week, respectively (n.s.). At week 12, 84.8% patients in group 4-week achieved clinical cure with a significant difference compared to groups 1- and 2-week, 54.3 and 60.5%, respectively (P < 0.01). Adverse reactions were present in 4.8, 6.8 and 10.9% of patients in groups 1-, 2- and 4-week, respectively. Terbinafine was not associated with clinically relevant increases in liver function tests. Conclusions: Terbinafine is an effective, well tolerated and safe antifungal agent for the treatment of Tinea capitis m children. The shorter duration of treatment resulted in lower cure rates. However, it is important to note that depending on the severity of the disease, a 1-week-only treatment can also be effective in this indication.

Síntomas depresivos y trastorno motor en pacientes con enfermedad de Parkinson

Introduction. Complex relations between brain and psychopathology have attracted the interest of researchers, aiming to clarify the neurobiological mechanisms of depression in Parkinson's disease, obviously in addiction to mental features. Aims. The association of motor impairment and decline of personal autonomy with severity of depressive symptoms was the hypothesis of the present study. Aiming to check this hypothesis, the objective of this study consisted in investigating relationships between the severity of depressive symptoms and motor characteristics of Parkinson's disease. Patients and methods. Thirty patients (53 to 80 year-old) with medical diagnosis of idiopathic Parkinson's disease in initial clinic stages were studied. The Unified Parkinson's Disease Rating Scale, Hoehn-Yahr Scale, and Schwab & England Scale were used to assess the clinic signs and symptoms. The depressive symptoms were identified by complete anamnesis, examination of mental condition, and the Hamilton Rating Scale for Depression and the Anxiety and Depression Scale. Statistical analysis was performed by Pearson's correlation and multiple regression analysis. Results. A significant correlation of severity of depression symptoms with disease stage (p < 0.02), with motor signs (p < 0.008), and with functional performance (p < 0.007) was found. Conclusion. There was significant association between motor impairment and severity of depressive symptoms, and between depression and early disease onset or prolonged duration of Parkinson's disease. © 2007, Revista de Neurología.

Métodos de avaliação da eficácia dos tratamentos para a dor.

Pain is a subjective condition and, thus, difficult to measure. The best tools to assess pain are the pain evaluation questionnaires, which provide either diagnostic, pain evolution or pain intensity information. To provide information which could help differentiate between nociceptive pain and neuropathic pain is one of the most important functions of these questionnaires. The questionnaires can measure pain intensity, quality of life, or sleep quality. Quality of life and sleep are two really important characteristics to assess the pain impact on patients' life. Pain intensity assessing questionnaires combine physical evaluations with questions, providing information either from the patient sensations or clinical assessment of pain manifestations as well as the underlying biological mechanisms (such as hyperalgesia or allodynia). For example, the Pain Detect questionnaire has two parts: the patient form (intuitive, with pictures and easy understandable) and the physician form. Thus, in this questionnaire, subjective information is provided by the patient and the objective one is provided by the physician. Other pain intensity questionnaires are NPSI, DN4, LANSS or StEP. Quality of life questionnaires are versatile (can be used in different pathologies). These questionnaires include functional self-evaluation questions, and other ones associated to physical and mental health. Two of such quality of life questionnaires are SF-36 and NHP. Sleep evaluation questionnaires include quantitative features such as the number of sleep interruptions, sleep latency or sleep duration as well as qualitative characteristics such as rest sensation, mood and dreams. One of the most used sleep evaluation questionnaires is PSQI, which includes patient questions and bed-partner questions, providing information from two points of view. Copyright 2009 Prous Science, S.A.U. or its licensors. All rights reserved.

A randomized and controlled trial about the use of oral isotretinoin for photoaging

Topical retinoids are used to treat photoaging; oral isotretinoin is gold standard for acne; off label indications, including photoaging, have been reported with insufficient evidence of efficacy. This is a randomized controlled phase II trial with clinical and histological assessment to evaluate efficacy and safety of oral isotretinoin for photoaging. Study population was comprised of 32 menopausal or sterilized women, aged 40-55, divided in 2 groups: A (21) received 20mg isotretinoin, 3 times per week, nightly moisturizer, and daily sunscreen, for three months; B (11) just moisturizer/sunscreen. Main outcome measures were: overall clinical assessment; profilometry, corneometer and elasticity tests in periocular regions and left forearm; before/after biopsies from left forearm in patients of B and in 10 randomly selected of A. Microscopic blinded evaluation of epidermal thickness, dermal elastosis, new collagen, p53 epidermal expression was performed by quantitative digital image analysis. All data were submitted to statistical analysis. Clinical evaluation showed slight improvement; profilometry, corneometer and skin elasticity tests presented significant difference in pre/post values (P = 0.001 to 0.028), but no differences between A/B. Histological findings and p53 expression were comparable between groups before treatment (P > 0.1); microscopic analysis showed no differences between groups for most variables, after treatment. Slight but significant difference between A/B for p53 with major reduction post isotretinoin [0.66±0.31 vs. 0.94±0.34 respectively (P = 0.04) was observed. There were minor side effects and no significant laboratory test alterations. We concluded that no significant clinical, microscopic changes but p53 epidermal expression reduction were observed. The role of ultra-violet induced p53 mutation in skin carcinogenesis reinforces retinoids chemoprevention. Oral isotretinoin seemed safe but not effective to treat photoaging. Caution should be considered for women prone to pregnancy. Further controlled studies are necessary. © 2010 The International Society of Dermatology.

Vasectomia no sistema público de saúde: Características dos candidatos e variáveis associadas

Objective: This study aimed to characterize candidates undergo vasectomy in the public health system, Araçatuba- SP and to study related variables. Methods: We surveyed 300 medical patients and vasectomized contacted by telephone to assess several characteristics. The variables analyzed for the study were age, marital status, education, religion, monthly family income and per capita, number of living children, reason for seeking treatment method, contraceptive use, marital relationship quality, decision time (date of intent to perform the procedure) and not because of the procedure. Data were pooled for the analysis of results. Results: The age of the candidates ranged from 23 to 65 years (mean 36.86 years) and average 2.56 living sons. The average monthly family income was R$ 1.079,15, with average per capita income of R$ 249,07. The couple's contraception before the procedure was on account of the woman who used oral anti-conception (84%). The complication rate with the method was around 6.04%, the biggest complication was dehiscence (77.7% of cases of complications), these being mainly during the first 100 cases. Conclusion: Vasectomy is a very effective contraceptive method, with low complication rate and low cost, should be encouraged by the public health system as a means of family planning policy.

Treinamento esfncteriano anal: Estudo transversal em crianças de 3 a 6 anos de idade

Objective: To assess the practice of children's toilet training through interviews with parents and caretakers. Methods: A cross-sectional study of healthy children using a questionnaire applied to parents or caretakers of 100 consecutive children aged 3 to 6 years old. Results: 97% of the children were home-trained by their mothers and 92% of them used their intuition, previous experience with an older child and grandmothers' experience. Bowel and bladder toilet training started simultaneously in 84% of the cases, whereas 41% of the children mastered stool control earlier. Mothers with lower educational level and of social classes C, D and E initiated the training earlier and one of the related reasons was the cost of disposable diapers. Age in initiation or duration of toilet training was similar for boys and girls. Children presented most of the readiness symptoms for toilet training and only a small number of them used a seat reducer or a foot support. There was no increase in constipation prevalence after toilet training and there was no encopresis. Conclusions: Mothers were responsible for bowel toilet training and initiated it with no specialized help. In C-D-E social classes, the cost of diapers was determinant to initiate bowel toilet training.

Efeitos da prática da natação adaptada sobre o perfil bioquímico e o estado de condicionamento físico de indivíduos com lesão medular

Introduction: The lack of physical exercises generated by immobilization of the lower limbs leads to changes in body composition that are generally associated with the imbalance of metabolic rate coupled with a sedentary status, which can result in obesity, diabetes mellitus and cardiovascular disease. Therefore, the improvement of physical fitness can contribute to promoting health and quality of life for these patients. As there is a very small number of research in this direction, our purpose was to investigate the effects of an adapted swimming program in protocol interval, for people with spinal cord injury, aiming to verify the improvement of your fitness and, consequently, some biochemical variables important for health. Methodology: The study included 17 subjects with spinal cord injury, sedentary, divided into two groups: 11 participants in the training group (TG) and 6 in control group (CG). TG was applied by a protocol of interval training in swimming for eight consecutive weeks, three times a week. The protocol employed a stroke of breaststroke in work periods of moderate to severe, and stroke in the backstroke, in periods of active recovery. The CG has not participated in any physical activity. Both groups were collecting blood for biochemical analysis, before (evaluation) and after (revaluation) the swimming program. Results and Discussion: The concentrations of triglycerides, total cholesterol and LDL-cholesterol showed no significant changes in assessment for reassessment in both groups. However the TG, the level of HDL-cholesterol were significant differences (p=0,0110), showing an improvement in posttraining, which did not occur in the CG. With respect to the state of fitness, the results revealed a significant difference in relation to time and distance covered in water when compared with the pre-training (p<0,001), showing a great improvement in the ability to shift with the stroke of breaststroke and a significant improvement in cardiorespiratory function. Conclusion: The swimming program interval used, with moderate to severe intensity, can even in a short period of time, promote positive changes in HDLcholesterol in individuals with spinal cord injury studied, and substantially improve your fitness.

Associação entre doenças crônicas em adultos e redução dos níveis de atividade física

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efficacy and safety of travoprost 0.004%/timolol 0.5% fixed combination as transition therapy in patients previously on prostaglandin analog monotherapy

Purpose: To assess the safety and efficacy of transitioning patients whose intraocular pressure (IOP) had been insufficiently controlled on prostaglandin analog (PGA) monotherapy to treatment with travoprost 0.004%/timolol 0.5% fixed combination with benzalkonium chloride (TTFC). Methods: This prospective, multicenter, open-label, historical controlled, single-arm study transitioned patients who had primary open-angle glaucoma, pigment dispersion glaucoma, or ocular hypertension and who required further IOP reduction from PGA monotherapy to oncedaily treatment with TTFC for 12 weeks. IOP and safety (adverse events, corrected distance visual acuity, and slit-lamp biomicroscopy) were assessed at baseline, week 4, and week 12. A solicited ocular symptom survey was administered at baseline and at week 12. Patients and investigators reported their medication preference at week 12. Results: Of 65 patients enrolled, 43 had received prior travoprost therapy and 22 had received prior nontravoprost therapy (n = 18, bimatoprost; n = 4, latanoprost). In the total population, mean IOP was significantly reduced from baseline (P = 0.000009), showing a 16.8% reduction after 12 weeks of TTFC therapy. In the study subgroups, mean IOP was significantly reduced from baseline to week 12 (P = 0.0001) in the prior travoprost cohort (19.0% reduction) and in the prior nontravoprost cohort (13.1% reduction). Seven mild, ocular, treatment-related adverse events were reported. Of the ten ocular symptom questions, eight had numerically lower percentages with TTFC compared with prior PGA monotherapy and two had numerically higher percentages with TTFC (dry eye symptoms and ocular stinging/burning). At week 12, TTFC was preferred over prior therapy for 84.2% of patients (48 of 57) by the patients themselves, and for 94.7% of patients (54 of 57) by their physicians. Conclusion: When TTFC replaced PGA monotherapy in patients whose IOP had been uncontrolled, the outcome was a significant reduction in IOP and an acceptable safety and tolerability profile. Most patients and investigators preferred TTFC to prior PGA monotherapy. © 2012 Costa et al, publisher and licensee Dove Medical Press Ltd.

Associations between bioelectrical impedance parameters and cardiovascular events in chronic dialysis patients

Purpose: Malnutrition and fluid overload contribute to the poor cardiovascular prognosis of dialysis patients. Since bioelectrical impedance analysis is an option for the evaluation of body composition and for the monitoring of hydration state, it may assist in the identification of subjects at high cardiovascular risk. The objective of this study was to evaluate the association between bioelectrical impedance parameters and cardiovascular events. Methods: The association between bioelectrical impedance parameters and fatal and non-fatal cardiovascular outcome was evaluated in 145 dialysis patients. Results: The mean age of the population studied was 54.9 ± 15.4 years, 49.7 % were males, and 35.9 % had diabetes. Forty (27.6 %) patients developed cardiovascular events during the 16 months (8; 32) of follow-up. Comparison of patients with and without cardiovascular events revealed higher extracellular mass/body cell mass (ECM/BCM) and extracellular water/total body water ratios and higher C-reactive protein levels in the former. Survival analysis showed that an ECM/BCM ratio >1.2 and a phase angle <6° were associated with poor cardiovascular prognosis. Among nondiabetic patients, these parameters and capacitance were independently associated with cardiovascular events, suggesting that poor nutritional status and fluid overload are associated with the occurrence of these events. Conclusions: Phase angle, capacitance and ECM/BCM ratio are valuable parameters for the evaluation of cardiovascular prognosis, supporting the use of bioelectrical impedance for the clinical assessment of dialysis patients. © 2012 Springer Science+Business Media Dordrecht.

Intra-abdominal hypertension in horses

Intra-abdominal hypertension (IAH) may lead to a multiple organ dysfunction syndrome associated with significant dysfunction of the cardiovascular, respiratory, renal, gastrointestinal and central nervous systems of human patients. A recent prospective multicentre epidemiological investigation in man concluded that IAH was associated with an increased risk of mortality in critically ill patients. In this review, we present current information pertaining to the potential clinical importance of IAH in the context of equine clinical practice. In conclusion, consideration of intra-abdominal pressure should be a part of the clinical assessment of patient well-being in critically ill equine patients. © 2011 EVJ Ltd.

Lower limb strength is associated with gait biomechanical abnormalities in older female fallers and non-fallers

BACKGROUND: Age-related loss in lower limb strength is related with impaired mobility. However, the association between decreased lower limb strength and gait biomechanical abnormalities is unclear. %In line with this, With respect to these statements, our study aimed to compare the maximum isokinetic voluntary strength (MIVS) of hip, knee and ankle of older women with and without history of falls. Also, we correlate the strength of each group with gait biomechanics. METHODS: The MIVS were assessed during concentric/concentric movements performed for hip, knee and ankle joints. Gait biomechanics (kinematic and electromyography) were assessed during 1-minute recorded during the volunteers walking on the treadmill at self-selected speed. Electromyographic signal was analyzed by the linear envelop after heel strike and before toe-off. The kinematic data were analyzed using the variables: step time, length and step width and ankle angle at heel strike, and hip angle at toe-off. RESULTS: In faller group, we found that a decreased hip abduction and adduction MIVS is associated with a higher tibialis anterior activation at initial stance (p =0.04 and r =-0.53 and p=0.04 and r=-0.52). CONCLUSION: Therefore, an impaired strength of hip could causes compensation in ankle stabilizer muscles activation at initial stance in older female fallers. © 2013 - IOS Press and the authors. All rights reserved.

Efeito imediato e contínuo da informação somatossensorial adicional na sensibilidade plantar e nos parâmetros do andar de indivíduos com doença de Parkinson

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeito de dica auditiva na marcha livre e adaptativa em pacientes com doença de Parkinson

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)