Análise das prevalências de doenças detectadas pelo programa nacional de triagem neonatal no município de Araraquara no ano de 2009

The National Neonatal Screening Program (NNSP) set up in all Brazil, aims, through planned phases of local implementation, to detect diseases such as phenylketonuria, congenital hypothyroidism, hemoglobinopathies and cystic fibrosis. The aim of this study was to assess, through a cross-sectional observational study, the prevalence of the diseases detected by the NNSP in the city of Araraquara, in records issued by the São Paulo APAE laboratory in the period between April and December 2009.The results show that Araraquara had a prevalence of phenylketonuria and congenital hypothyroidism 0.06% above the national averages of 0.01% and 0.03% respectively. With respect to hemoglobinopathies, the prevalence of sickle cell trait was 2.15% below the national average of 2.6%. The prevalence of Hb C in the city was 0.57%, similar to national values reported in the literature. Confirmed Hb Bart's had a prevalence of 0.13% in Araraquara, below the average of 0.38% for the surrounding region. The neonatal screening by heel-prick test and counseling for caregivers are important factors in reducing morbidity related to the evolution of these diseases.

Neurectomia digital em eqüinos: comparação das técnicas guilhotina e stripping

Compararam-se as dificuldades transcirúrgicas e as complicações pós-operatórias das técnicas guilhotina (TG) e stripping (TS) para a neurectomia digital em eqüinos. Sob anestesia com halotano, quatro éguas tiveram os nervos digitais de um dos membros torácicos e um dos pélvicos submetidos à TG, enquanto os nervos digitais dos membros colaterais foram submetidos à TS. Os tempos cirúrgicos médios de TG e TS foram semelhantes. O comprimento médio do fragmento do nervo removido foi três vezes maior em TS (P<0,001). Independente da técnica utilizada, houve perda total da sensibilidade nos talões de todos os membros dentro dos quatro primeiros meses da cirurgia. Após 14 meses, houve retorno da sensibilidade em 37% dos membros em TG e 18,8% em TS (P=0,06). Ao exame de palpação para identificação de neuromas dolorosos, houve episódios de sensibilidade discreta em um maior número de cotos nervosos proximais operados com TS, 53,6% contra 6,4% dos operados com TG (P=0,003). Ambas as técnicas foram satisfatórias por não apresentarem maiores complicações durante ou após a cirurgia. Considerou-se que TG apresentou menor potencial para produzir reinervação e neuromas dolorosos.

Corrective shoeing in horses: analysis of the adaptation period to the new condition imposed

O ferrageamento corretivo é um método comumente ma Dvideow. O nível de significância adotado foi de 5%. No utilizado para alterar o padrão do andamento dos animais, presente estudo, não houve diferença significativa entre os assim como na terapêutica de diversas afecções do siste-dias avaliados, a elevação em seis graus da pinça ou talões ma locomotor dos equinos. No entanto, não existem, até não gerou desconforto durante a passada, portanto, os ani o momento, estudos científicos que revelem o período de mais podem retornar às atividades regulares de exercício e adaptação do andamento dos animais a este tipo de in-treinamento imediatamente após o ferrageamento. tervenção.O objetivo deste estudo foi avaliar o período de adaptação à ferraduras com elevação em seis graus da pinça ou talões em equinos caminhando em esteira rolante. O período de adaptação à ferradura foi avaliado nos tempos 0, 48 e 96 horas após cada tipo de ferrageamento proposto. Os animais foram gravados caminhando em esteira rolante. O comprimento da passada e a análise qualitativa do andamento foram realizados com o auxílio do programa Dvideow. O nível de significância adotado foi de 5%. No presente estudo, não houve diferença significativa entre os dias avaliados, a elevação em seis graus da pinça ou talões não gerou desconforto durante a passada, portanto, os animais podem retornar às atividades regulares de exercício e treinamento imediatamente após o ferrageamento.

Crescimento radicular de soja em razão da sucessão de cultivos e da compactação do solo

O objetivo do experimento foi avaliar o crescimento radicular e produção de matéria seca da parte aérea da soja (Glycine max (L.) Merrill) cultivada após diversas espécies vegetais, em solo com diferentes níveis de compactação. O trabalho foi realizado em vasos contendo amostras de um Latossolo Vermelho, textura franco arenosa, com camada de 3,5 cm (profundidade de 15 a 18,5 cm) compactada até as densidades 1,12, 1,36 e 1,60 Mg m-3, onde cultivaram-se anteriormente aveia-preta, guandu, milheto, mucuna-preta, soja, sorgo granífero e tremoço-azul, e um tratamento sem planta (pousio). Essas espécies se desenvolveram por 37 a 39 dias, foram cortadas ao nível do solo, picadas em partes de aproximadamente 3 cm e deixadas sobre a superfície do vaso por 40 dias. Após esse período, cultivou-se a soja até 28 dias após a emergência, quando, então, as plantas foram colhidas. Foram avaliados produção de matéria seca da parte aérea e de raízes, e comprimento e diâmetro radicular da soja. O cultivo anterior com aveia-preta, guandu e milheto favoreceu o crescimento radicular da soja abaixo de camadas compactadas do solo. Independentemente do nível de compactação, o cultivo anterior com qualquer das espécies estudadas beneficiou a produção de matéria seca da parte aérea da soja.

Hipotireoidismo congênito: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

O hipotireoidismo congênito (HC) é o distúrbio endócrino congênito mais frequente, com incidência variando de 1:2.000 a 1:4.000 crianças nascidas vivas e uma das principais causas de retardo mental que pode ser prevenida. Os Programas de Triagem Neonatal para a doença permitem a identificação precoce dos afetados e seu tratamento de modo a evitar as complicações da falta do hormônio. A maioria dos casos de hipotireoidismo congênito é decorrente de disgenesias tireoidianas (85%), entre elas a ectopia, hipoplasia ou agenesia tireoidianas, e os demais resultam de defeitos de síntese hormonal. As crianças afetadas (> 95%) geralmente não apresentam sintomas sugestivos da doença ao nascimento. Os sintomas e sinais mais comuns são: icterícia neonatal prolongada, choro rouco, letargia, movimentos lentos, constipação, macroglossia, hérnia umbilical, fontanelas amplas, hipotonia e pele seca. Várias estratégias são utilizadas para a triagem do HC. No Brasil, esta é obrigatória por lei e geralmente é feita com a dosagem de TSH em sangue seco coletado do calcanhar. A idade recomendada para sua realização é após as 48 horas de vida até o quarto dia. A confirmação diagnóstica é obrigatória com as dosagens de TSH e T4 livre ou T4 total.

Effects of postural threat on walking features of Parkinson's disease patients

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

Diagnóstico de hemoglobinopatias em recém-nascidos do Hospital de Base de São José do Rio Preto-SP

The neonatal period is considered the most effective for the screening of hemoglobinopathies. This allows prophylaxis and prevention, improving the patient's survival and guidance of parents and heterozygote carriers. The present work aims at the early detection of abnormal hemoglobins, the establishment of standard analysis and to examine the viability of the prevention program. Blood samples were collected by heel stick and from blood cord of children born in the Hospital de Base São José do Rio Preto, from April 1998 to November 1999. Electrophoresis and cytological, biochemical, cromatographic analyses were made for abnormal hemoglobin characterization. A total of 1,478 neonatal blood samples were analyzed in which 14.62% presented with hemoglobins alterations: 3.32% had Hb S; 0.61% had Hb C; 7.44% were suggestive of alpha thalassemia; 1.55% were suggestive of beta thalassemia, and 1.70% had alpha/beta thalassemia interactions. The samples collected from the blood cord showed better results in all analyses while the blood samples collected by heel stick on filter paper, were applicable to only specific methodologies. The routine laboratory methods allowed identification of the thalassemic and variant forms, and isoelectric focusing presented sensitivity only for variant identification in this age range. The suspected cases were reassessed after six months, which permitted genetic counseling of their family members and clinic attendance. A multidisciplinary approach in programs of this kind is fundamental for its success.

Allergenic extracts from Metarhizium anisopliae: Obtainment and characterization

Metarhizium anisopliae is used as a biopesticide for insects that damage agricultural plantations like sugar cane and forage plants. In a previous study the sensitization to this fungus of asthmatic patients coming from sugar cane areas was showed. The aims of this work were: to compare crude extracts obtained with Tris-HCl and Coca liquid from several growth phases of M. anisopliae concerning the total content of proteins and their electrophoretic analysis profile; to evaluate in vivo allergic sensitization in Balb/c mice and allergic patients from a sugar cane area, and to characterize the allergenic fractions in the sera of patients positive for the prick test by means of Western-blotting. The extract obtained with Coca liquid on the 16(th) day was the one that presented the greatest number of proteic fractions, including all those present in the other extracts. Twelve fractions were verified in this extract with approximate molecular weights from 94 to 14 kDa. The allergenicity of the extract obtained on the 16(th) day was proven by the production of IgE antibodies in Balb/c mice, with titres of 200. Prick tests carried out with the extract of the 16(th) day in 79 atopic individuals (from sugar cane area), 35 atopic individuals (from urban area) and 11 non- atopic individuals showed respective positivity of 29%, 9% and 0%. The allergenic characterization in vitro was performed by means of Western blotting, and the fractions that reacted with the positive individuals' sera were those of approximate molecular weights of 67 kDa (95%); 20 kDa (55%); 94 kDa (36%); 34 and 36 kDa (23%); 43 and 48 kDa (14%): 16 kDa (9%) and 54kDa (5%). It was concluded that the crude allergenic extract, obtained with Coca liquid from the 16(th) day growth of Metarhizium anisopliae, contains allergenic fractions and can be used in diagnostic screening tests.

Calcaneal apophysitis: a quantitative radiographic evaluation of the secondary ossification center

Background: Calcaneal apophysitis in children is a self-limited condition that may interfere with walking and physical performance in sports, thus causing concern to the patient and parents. There is still controversy about the significance of the radiographic changes in children with heel pain, since the report of Sever in 1912. One of the reasons is that normal children may display a considerable variation in the radiographic aspects of the secondary ossification center of the calcaneus at different ages. Methods: In this investigation, the developmental aspects of primary and secondary ossification centers of the calcaneus were studied in radiographs obtained from healthy boys and from boys with calcaneal apophysitis. The normal population comprised 392 children and adolescents ranging in age from 6 to 15 years. There were 69 individuals with calcaneal apophysitis ranging in age from 8 to 14 years. Lateral standard radiographs were obtained of both heels, and a copper step wedge was used as a calibration to determine bone density. The following parameters were analyzed on the plain films: time of appearance, fusion and number of fragments of the secondary nucleus, area and bone densitometry of the primary and secondary ossification centers of the calcaneus. Results: In the normal population, the ossification of the secondary nucleus began at 7 years of age, and at 15 years of age, the nucleus was fused in all individuals. In the apophysitis group, the secondary ossification center was present and not fused in all individuals. Both secondary nuclei increased in size with age with no difference between the two groups. Regarding bone density, both the primary and secondary nuclei were less dense in the apophysitis group than their counterparts in the normal population. The most significant difference between the two populations referred to the degree of fragmentation, which was greater in the apophysitis group. Conclusion: Our data showed that the sclerotic aspect of the secondary nucleus of the calcaneus is a normal feature and, therefore, should not be used to establish the diagnosis of Sever's disease. The most consistent difference between the normal and apophysitis group was related to the more fragmented aspect of the secondary nucleus in the latter individuals, which may suggest a mechanical etiology for that condition.

Ensaio randomizado, duplo-cego e controlado de anestesia tópica induzida por iontoforese de lidocaína

Introduction: Needle infi ltration of local anesthetic is a painful procedure, thus, a topical anesthetic is a comfortable alternative; however, it is diffi cult to deliver transcutaneous polar drugs. Iontophoresis is a noninvasive technique that uses electrical current for releasing electrically charged drugs through biological membranes. Objective: To evaluate the anesthesia induced by iontophoresis of lidocaine for a standardized painful stimulus. Material and methods: Randomized, controlled, double-blind study, involving 10 volunteers under the anesthetic effects of topical application of lidocaine gel 2% and noradrenaline 1:50,000, with or without iontophoresis of 1.85 milliamps for 13 minutes. Pain sensitivity was evaluated by the prick of a 21G needle in the arms posterior region, using a visual numerical scale. Results: Patients mean age was 50.8 ± 11.4 years. Nine of them were women. All had previously received infi ltrative anesthesia. Iontophoresis was well tolerated by volunteers. The median pain scores were 0 and 3 for the arm that received the iontophoresis and for the one that did not receive, respectively (p < 0.01). Conclusion: The anesthetic effect in the region subjected to iontophoresis suggests an effi cient and comfortable method for promoting local anesthesia in the surgical approach of pediatric, hyperalgic, or needlephobic patients.

Effects of fatigue induced by prolonged gait when walking on the elderly

Purpose. Fatigue has been pointed as a fall risk in the elderly; however, the effects of prolonged gait on neuromuscular recruitment and on its pattern remain unknown. The aim of this study was to evaluate the effects of prolonged gait on neuromuscular recruitment levels and spatial-temporal gait variables. Methods. Eight healthy older women (age: 72.63 ± 6.55 years) walked at their preferred walking speed for twenty minutes on a treadmill. The Root Mean Square (RMS) from the vastus-lateralis, femoral biceps, tibialis anterior and lateral gastrocnemius muscles were determined at the first and last minute of the test during the moments of Heel Strike (HS), Terminal Stance and Terminal Swing (TS). In addition, coactivation in the knee and ankle as well as the stride cadence and length were measured in the test. The two RMS data (taken at the first and last minute) were compared by means of a Student's t-test. Results. Twenty minutes of walking induced fatigue in the subjects, as observed through an increase in RMS, notably during the HS and TS. Coactivation was also influenced by the prolonged gait test. The only gait phase where a risk of falling was enhanced was the HS. Nonetheless, subjects developed strategies to maintain a safe motor pattern, which was evidenced by an increase in stride length and a decrease in stride cadence. Conclusion. Tests lasting just twenty minutes on a treadmill were enough to induce fatigue in older adults. However, the level of fatigue was not enough to present a danger or fall risk to elderly individuals.

Association between energy cost of walking, muscle activation, and biomechanical parameters in older female fallers and non-fallers

Objective: To determine the nervous activation, muscle strength, and biomechanical parameters that influence the cost of walking in older fallers and non-fallers. Methods: Maximal voluntary isokinetic torque was measured for the hip, knee and ankle of older women. Oxygen consumption was measured at rest and during 8 min of walking at self-selected speed. An additional minute of walking was performed to collect kinematic variables and the electromyographic signal of trunk, hip, knee, and ankle muscles, which was analyzed by the linear envelope. Cost of walking was calculated by subtracting resting body mass-normalized oxygen consumption from walking body mass-normalized oxygen consumption. Stride time and length, and ankle and hip range of motion were calculated from kinematic data. Findings: Older adult fallers had 28% lower knee extensor strength (p = 0.02), 47% lower internal oblique activation at heel contact (p = 0.03), and higher coactivation between tibialis anterior and gastrocnemius lateralis in each of the gait phases (p < 0.05). For fallers, a higher activation of gluteus maximus was associated with a higher cost of walking (r = 0.55, p < 0.05 and r = 0.71, p < 0.01, before and after heel contact, respectively). For non-fallers, an association between cost of walking and age (r = 0.60, p = 0.01) and cost of walking and thigh muscle coactivation (r = 0.53, p = 0.01) existed. Interpretation: This study demonstrated that there may be links between lower-extremity muscle weakness, muscle activation patterns, altered gait, and increased cost of walking in older fallers. © 2013 Elsevier Ltd. All rights reserved.

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.

Adaptação voluntária do andar em idosos com doença de Parkinson sob dica visual dinâmica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeito de um treinamento de FNP sobre variáveis biomecânicas em idosos caidores

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)