Piperacillin/tazobactam-induced neurotoxicity in a hemodialysis patient: a case report

Antibiotics are potentially a cause of neurotoxicity in dialysis patients, the most common are thebeta-lactams as ceftazidime and cefepime, and few cases have been reported after piperacillin/tazobactam use. This report presents a case of a hypertensive and diabetic 67-year-old woman inregular hemodialysis, which previously had a stroke. She was hospitalized presenting pneumonia,which was initially treated with cefepime. Two days after treatment, she presented dysarthria, lefthemiparesis, ataxia, and IX and X cranial nerves paresis. Computed tomography showed no acutelesions and cefepime neurotoxicity was hypothesized, and the antibiotic was replaced bypiperacillin/tazobactam. The neurologic signs disappeared; however, 4 days after with piperacillin/tazobactam treatment, the neurological manifestations returned. A new computed tomographyshowed no new lesions, and the second antibiotic regimen withdrawn. After two hemodialysissessions, the patient completely recovered from neurological manifestations. The patient presentedsequentially neurotoxicity caused by two beta-lactams antibiotics. This report meant to alertclinicians that these antibiotics have dangerous neurological effects in chronic kidney diseasepatients.

Prevalence and clinical characteristics of urinary incontinence in elderly individuals of a low income

To estimate the prevalence of urinary incontinence (UI) in elderly individuals of low income assisted by the primary health care system in Sao Paulo, Brazil. In this community-based, observational, cross-sectional study, participants assisted by the health family program in Sao Paulo, Brazil, were sampled and interviewed face to face by questionnaire. Participants (n = 388) were selected from the collaborative program developed by the 10/66 Dementia Research Group, an International Network of investigators. Demographics, health history and a detailed assessment of UI and urinary symptoms were obtained. Prevalence of UI was calculated. Other variables included age, body mass index (BMI), duration of incontinence and characteristics of the symptoms. The association between UI and the variables was estimated using the Kruskal-Wallis test, Chi-squared test and Fisher test (depending on normality of the distribution and expected frequencies). Prevalence of UI was 38.4%. UI was more common in women than in men (50% vs. 18.3%, p < 0.001). Diabetes, obesity and hypertension were associated with UI. Almost 36.2% of the cases were of mixed incontinence, 26.8% of urge incontinence and 24.2% of stress incontinence. Men were more likely to have urge-incontinence, while women were more likely to have mixed incontinence (p = 0.001). UI is prevalent in the elderly of low income living in Sao Paulo and rates are higher than most previous studies. Chronic conditions such as hypertension, diabetes and obesity were associated with UI. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Postural control in elderly women with osteoporosis: comparison of balance, strengthening and stretching exercises. A randomized controlled trial

Objective: To compare the efficacy of balance training associated with muscle strengthening or stretching, relative to no intervention, in the postural control of elderly women with osteoporosis. Design: A randomized, controlled trial. Subjects and interventions: Sample consisted of 50 women aged 65 years or older, with osteoporosis, randomized into one of three groups: strengthening group (n = 17) performed balance training with muscle strengthening; stretching group (n = 17) performed balance training with stretching; and control group (n = 16), no activities. Interventions lasted eight weeks, twice a week, 60 minutes a day. Main measures: Postural control was evaluated by the modified Clinical Test of Sensory Interaction for Balance (CTSIBm) and Limits of Stability Test. Strength was assessed by dynamometry and the shortening of the hamstrings by goniometry. Results: Relative to controls, participants in the strengthening group displayed significantly increased dorsiflexion strength and knee flexion strength, as well as centre of pressure velocity, directional control, and oscillation velocity (CTSIBm test). The stretching group had significantly improvements in hamstring length, knee flexion strength, centre of pressure velocity, and amplitude of movements. Relative to the stretching group, the strengthening group yielded better knee extension strength and directional control. Conclusion: The results suggest that both interventions are effective in improving postural control when compared to the control group, and the strengthening group was superior to the stretching group in knee extension strength and in directional control.

Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study

Objectives: To estimate the effects of low level laser therapy in combination with a programme of exercises on pain, functionality, range of motion, muscular strength and quality of life in patients with osteoarthritis of the knee. Design: A randomized double-blind placebo-controlled trial with sequential allocation of patients to different treatment groups. Setting: Special Rehabilitation Services. Subjects: Forty participants with knee osteoarthritis, 2-4 osteoarthritis degree, aged between 50 and 75 years and both genders. Intervention: Participants were randomized into one of two groups: the laser group (low level laser therapy dose of 3 J and exercises) or placebo group (placebo laser and exercises). Main measures: Pain was assessed using a visual analogue scale (VAS), functionality using the Lequesne questionnaire, range of motion with a universal goniometer, muscular strength using a dynamometer, and activity using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire at three time points: (T1) baseline, (T2) after the end of laser therapy (three weeks) and (T3) the end of the exercises (11 weeks). Results: When comparing groups, significant differences in the activity were also found (P = 0.03). No other significant differences (P > 0.05) were observed in other variables. In intragroup analysis, participants in the laser group had significant improvement, relative to baseline, on pain (P = 0.001), range of motion (P = 0.01), functionality (P = 0.001) and activity (P < 0.001). No significant improvement was seen in the placebo group. Conclusion: Our findings suggest that low level laser therapy when associated with exercises is effective in yielding pain relief, function and activity on patients with osteoarthritis of the knees.

EFFECTS OF MUSCULAR STRETCHING AND SEGMENTAL STABILIZATION ON FUNCTIONAL DISABILITY AND PAIN IN PATIENTS WITH CHRONIC LOW BACK PAIN: A RANDOMIZED, CONTROLLED TRIAL

Objective: The purpose of this study was to compare the effects of 2 exercise programs, segmental stabilization exercises (SSEs) and stretching of trunk and hamstrings muscles, on functional disability, pain, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain. Methods: A total of 30 participants were enrolled in this study and randomly assigned to 1 of 2 groups as a function of intervention. In the segmental stabilization group (SS), exercises focused on the TrA and lumbar multifidus muscles, whereas in the stretching group (ST), exercises focused on stretching the erector spinae, hamstrings, and triceps surae. Severity of pain (visual analog scale and McGill pain questionnaire) and functional disability (Oswestry disability questionnaire) and TrA muscle activation capacity (Pressure Biofeedback Unit, or PBU) were compared as a function of intervention. Interventions lasted 6 weeks, and sessions happened twice a week (30 minutes each). Analysis of variance was used for intergroup and intragroup comparisons. Results: As compared with baseline, both treatments were effective in relieving pain and improving disability (P < .001). Those in the SS group had significantly higher gains for all variables. The stretching group did not effectively activate the TrA (P = .94). Conclusion: Both techniques improved pain and reduced disability. In this study, SS was superior to muscular stretching for the measured variables associated with chronic low back pain. (J Manipulative Physiol Ther 2012;35:279-285)

Efficacy of graded activity versus supervised exercises in patients with chronic non-specific low back pain: protocol of a randomised controlled trial

Abstract Background Low back pain is a relevant public health problem, being an important cause of work absenteeism worldwide, as well as affecting the quality of life of sufferers and their individual functional performances. Supervised active physical routines and of cognitive-behavioral therapies are recommended for the treatment of chronic Low back pain, although evidence to support the effectiveness of different techniques is missing. Accordingly, the aim of this study is to contrast the effectiveness of two types of exercises, graded activity or supervised, in decreasing symptoms of chronic low back pain. Methods/design Sample will consist of 66 patients, blindly allocated into one of two groups: 1) Graded activity which, based on an operant approach, will use time-contingent methods aiming to increase participants’ activity levels; 2) Supervised exercise, where participants will be trained for strengthening, stretching, and motor control targeting different muscle groups. Interventions will last one hour, and will happen twice a week for 6 weeks. Outcomes (pain, disability, quality of life, global perceived effect, return to work, physical activity, physical capacity, and kinesiophobia) will be assessed at baseline, at treatment end, and three and six months after treatment end. Data collection will be conducted by an investigator blinded to treatment allocation. Discussion This project describes the randomisation method that will be used to compare the effectiveness of two different treatments for chronic low back pain: graded activity and supervised exercises. Since optimal approach for patients with chronic back pain have yet not been defined based on evidence, good quality studies on the subject are necessary. Trial registration NCT01719276

Equilíbrio, controle postural e força muscular em idosas osteoporóticas com e sem quedas

Um dos maiores problemas de saúde pública na população idosa são as quedas, agravando-se quando relacionadas à presença de osteoporose. Dentre os vários fatores de risco, destacam-se a diminuição do equilíbrio, controle postural e força muscular. O objetivo deste trabalho foi comparar o equilíbrio, o controle postural e a força muscular em idosas osteoporóticas com e sem quedas referidas no último ano. Foram avaliadas 45 mulheres entre 65 e 85 anos, divididas em dois grupos com base no relato de quedas nos 12 meses anteriores à avaliação: grupo com quedas (GCQ; n=21) e grupo sem quedas (GSQ; n=24). O equilíbrio foi avaliado por meio da escala de equilíbrio de Berg; o controle postural pelo teste clínico modificado de interação sensorial no equilíbrio (mCTSIB), realizado no equipamento Balance Master®; e a força muscular dos flexores e extensores de joelho e dorsiflexores de tornozelo, com dinamômetro EMG System do Brasil®. Foi considerado nível de significância α=0,05. Houve diferença significativa no equilíbrio (p<0,01) e na velocidade de oscilação do Centro de Pressão (CP) durante o teste mCTSIB nas condições olhos fechados superfície estável (p=0,05) e olhos abertos superfície instável (p<0,01), com valores maiores para o GCQ. Os grupos foram semelhantes entre si em relação à força muscular (p>0,05). Nossos resultados indicam que idosas osteoporóticas com histórico de quedas nos últimos 12 meses possuem pior equilíbrio e controle postural em relação às osteoporóticas sem quedas referidas.

Spektromikroskopische Analyse von Nukleationsdomänen in epitaktischen Diamantschichten auf Ir,SrTiO 3 und von präsolaren SiC-Meteoritenkörnern

Im Rahmen dieser Arbeit wurden zwei verschiedene Systeme untersucht, deren verbindende Gemeinsamkeit in den verwendeten ortsauflösenden, spektroskopischen Messmethoden der Oberflächenanalytik, wie z.B. abbildendes XPS, Röntgennahkanten-Photoemissionsmikroskopie (XANES-PEEM) und Augerspektroskopie (AES) liegt. Im ersten Teil der Arbeit wurden Diamant-Nukleationsdomänen auf Ir/SrTiO3 untersucht und mit vorherrschenden Modellen aus der Literatur verglichen. Die Nukleationsdomänen, wie sie im Mikrowellen-induzierten CVD Prozess unter Verwendung der BEN Prozedur (bias-enhanced nucleation) entstehen, bilden die „Startschicht“ für ein heteroepitaktisches Wachstum einer hoch orientierten Diamantschicht. Sie entwickeln sich aber unter Bedingungen, unter denen 3D-Diamant abgetragen und weggeätzt wird. Mittels XANES-PEEM Messungen konnte erstmals die lokale Bindungsumgebung des Kohlenstoffs in den Nukleationsdomänen ortsaufgelöst aufgezeigt werden und aus AES Messungen ließ sich die Schichtdicke der Nukleationsdomänen abschätzen. Es zeigte sich, dass die Nukleationsdomänen Bereiche mit etwa 1 nm Dicke darstellen, in denen der Übergang von eine sp2-koordinierte amorphen Kohlenstoff- zu einer Diamantschicht mit hohem sp3 Anteil abläuft. Zur Erklärung des Nukleationsprozesses wurde auf das „Clustermodell“ von Lifshitz et al. zurückgegriffen, welches um einen wesentlichen Aspekt erweitert wurde. Die Stabilität der Nukleationsdomänen gegen die Ätzwirkung des Nukleationsprozesses auf Volumendiamant wird durch eine starke Wechselwirkung zwischen dem Diamant und dem Iridiumsubstrat erklärt, wobei die Dicke von etwa 1 nm als Maß für die Ausdehnung dieses Wechselwirkungsbereichs angesehen wird. Der zweite Teil der Arbeit beschäftigt sich mit der Charakterisierung präsolarer SiC-Körner und darin eingeschlossener Spurenelemente. Neben den Hauptelementen Si und C wurden auch Spinelle wie Chromit (FeCr2O4), Korund (Al2O3) und auch verschiedene Spurenelemente (z. B. Al, Ba und Y) nachgewiesen. Ferner wurden XPS-Linien bei Energien nachgewiesen, welche sich den Seltenen Erden Erbium, Thulium und Dysprosium zuordnen lassen. Aufgrund von Abweichungen zur Literatur bzgl. der ausgeprägten Intensität der XPS-Linien, wurde als alternative Erklärungsmöglichkeit für verschiedene Signale der Nachweis von stark schwefelhaltigen Körnern (z.B. so genannte „Fremdlinge“) mit Aufladungen von mehreren Volt diskutiert. Es zeigt sich, dass abbildendes XPS und XANES-PEEM Methoden zur leistungsfähigen chemischen Charakterisierung von SiC-Körnern und anderer solarer und präsolarer Materie im Größenbereich bis herab zu 100 – 200 nm Durchmesser (z.B. als Grundlage für eine spätere massenspektrometrische Isotopenanalyse)darstellen.

Accountability em educação : Políticas educativas e regulação da qualidade

O trabalho tem por objetivo discutir questoes atinentes à accountability em educaçao, considerando a emergência de políticas de responsabilizaçao e prestaçao de contas como mecanismo de regulaçao da qualidade no setor. Com base na revisao de literatura e por meio do recurso da análise de conteúdo, aborda aspectos conceituais do tema, realçando o caráter ambíguo e plural do termo no momento em que novas agendas políticas nacionais adotam a accountability como recurso de gestao pública. Segue discutindo sua recente entrada no campo da educaçao, nomeadamente na América Latina, onde ganha força o debate da responsabilizaçao. Por fim, destaca confluências e especificidades da accountability na educaçao básica brasileira, para o que revisita publicaçoes nacionais que enfocam o tema na sua especificidade, e questiona opçoes políticas de sistemas formais de accountability que se esgotam na recolha e publicitaçao de resultados educacionais, baseados em testes estandardizados. De forma conclusiva, alude que a visao de regulaçao da qualidade, predominante em vários países, confina a accountability a formatos que atribuem preponderantemente à escola a responsabilizaçao pelos resultados oficiais que produz

Accountability em educação : Políticas educativas e regulação da qualidade

O trabalho tem por objetivo discutir questoes atinentes à accountability em educaçao, considerando a emergência de políticas de responsabilizaçao e prestaçao de contas como mecanismo de regulaçao da qualidade no setor. Com base na revisao de literatura e por meio do recurso da análise de conteúdo, aborda aspectos conceituais do tema, realçando o caráter ambíguo e plural do termo no momento em que novas agendas políticas nacionais adotam a accountability como recurso de gestao pública. Segue discutindo sua recente entrada no campo da educaçao, nomeadamente na América Latina, onde ganha força o debate da responsabilizaçao. Por fim, destaca confluências e especificidades da accountability na educaçao básica brasileira, para o que revisita publicaçoes nacionais que enfocam o tema na sua especificidade, e questiona opçoes políticas de sistemas formais de accountability que se esgotam na recolha e publicitaçao de resultados educacionais, baseados em testes estandardizados. De forma conclusiva, alude que a visao de regulaçao da qualidade, predominante em vários países, confina a accountability a formatos que atribuem preponderantemente à escola a responsabilizaçao pelos resultados oficiais que produz

Accountability em educação : Políticas educativas e regulação da qualidade

O trabalho tem por objetivo discutir questoes atinentes à accountability em educaçao, considerando a emergência de políticas de responsabilizaçao e prestaçao de contas como mecanismo de regulaçao da qualidade no setor. Com base na revisao de literatura e por meio do recurso da análise de conteúdo, aborda aspectos conceituais do tema, realçando o caráter ambíguo e plural do termo no momento em que novas agendas políticas nacionais adotam a accountability como recurso de gestao pública. Segue discutindo sua recente entrada no campo da educaçao, nomeadamente na América Latina, onde ganha força o debate da responsabilizaçao. Por fim, destaca confluências e especificidades da accountability na educaçao básica brasileira, para o que revisita publicaçoes nacionais que enfocam o tema na sua especificidade, e questiona opçoes políticas de sistemas formais de accountability que se esgotam na recolha e publicitaçao de resultados educacionais, baseados em testes estandardizados. De forma conclusiva, alude que a visao de regulaçao da qualidade, predominante em vários países, confina a accountability a formatos que atribuem preponderantemente à escola a responsabilizaçao pelos resultados oficiais que produz

Los fills de la morta-viva : apunts bio-bibliográfichs per la historia del Renaiximent lliterari llemosí en Valencia

Obra premiada ab un Brot de Llorer de Argent, en los Joschs Florals celebrats en dita ciutat la nit del 24 de juliol de l'any MDCCCLXXIX

Solenes fiestas que celebro Valencia a la Immaculada Concepcion de la Virgen Maria : por el supremo decreto de N.S.S. Pontifice Alejandro VII ...

Contiene: sermones predicados en la fiesta por el canonigo Melchor Fuster, por fray Cirilo Pasqual y por fray Miguel de Fuentes (p. 1-112)

Noticias del hallazgo del cuerpo de S. Pedro Pascual ... con el sermon que en el dia 27. de octubre 1743. predicò ... Josef Climent ...

Sign. : *4, 2*1, A-G4, H2