Effects of an exercise training program in physical condition after liver transplantation in familial amyloidotic polyneuropathy: a case report

Introduction: Familial amyloidotic polyneuropathy (FAP) is a neurodegenerative disease that leads to sensory and motor polyneuropathies as well as functional limitations. So far, liver transplantation is the only treatment for FAP because the mutated protein causing the disease is mainly produced in the liver. With the increasing survival of transplant recipients, functional and cardiovascular problems as consequences of immunosuppressant side effects are increasing associated with sedentary lifestyles and/or retransplantation status. We sought to analyze the impact of exercise training programs on 1 FAP patient’s course long-term after liver transplantation. Methodology. A FAP patient (female; 49 years of age; body mass index 18.8 kg/m2) underwent a liver transplantation 133 months before assessment. She was assessed for body composition, isometric quadriceps muscle strength, functional capacity, fatigue, and levels of physical activity before and after a 6-month period of combined exercise training. Results: After the exercise training program, almost all variables were improved, namely, total body skeletal muscle mass, proximal femoral bone mineral density, quadriceps strength, maximal oxygen consumption on 6 minutes walk test (6mwt) or VO2peak, total ventilation on 6mwt, and fatigue. The improvement in distance on 6mwt (69.2 m) was clinically significant. Preintervention the levels of physical activity were below international recommendations for health; after the program they achieved the recommendations. Conclusion: The results showed an improvement in functional capacity with a decrease in future disability risk associated with a better lifestyle with respect to physical activity levels in 1 patient.

Rash after measles vaccination: laboratory analysis of cases reported in São Paulo, Brazil

OBJECTIVE: The clinical differential diagnosis of rash due to viral infections is often difficult, and misdiagnosis is not rare, especially after the introduction of measles and rubella vaccination. A study to determine the etiological diagnosis of exanthema was carried out in a group of children after measles vaccination. METHODS: Sera collected from children with rash who received measles vaccine were reported in 1999. They were analyzed for IgM antibodies against measles virus, rubella virus, human parvovirus B19 (HPV B19) using ELISA commercial techniques, and human herpes virus 6 (HHV 6) using immunofluorescence commercial technique. Viremia for each of those viruses was tested using a polimerase chain reaction (PCR). RESULTS: A total of 17 cases of children with exanthema after measles immunization were reported in 1999. The children, aged 9 to 12 months (median 10 months), had a blood sample taken for laboratory analysis. The time between vaccination and the first rash signs varied from 1 to 60 days. The serological results of those 17 children suspected of measles or rubella infection showed the following etiological diagnosis: 17.6% (3 in 17) HPV B19 infection; 76.5% (13 in 17) HHV 6 infection; 5.9% (1 in 17) rash due to measles vaccine. CONCLUSIONS: The study data indicate that infection due to HPV B19 or HHV 6 can be misdiagnosed as exanthema due to measles vaccination. Therefore, it is important to better characterize the etiology of rash in order to avoid attributing it incorrectly to measles vaccine.

Relatório de estágio. Terapia manual ortopédica

Objectivo: Descrever a intervenção em fisioterapia aplicada num paciente com o diagnóstico de entorse da Tíbio-társica de grau III. Participantes e Métodos: Paciente que em 1 de Dezembro de 2009 na sequência de uma disputa de bola, sofreu uma entorse da tíbio-társica. Iniciou fisioterapia a 4 de Janeiro de 2010, tendo sido utilizadas para o tratamento técnicas de Mulligan, nomeadamente MWM, mobilização articular, reforço muscular e treino proprioceptivo. O tratamento foi realizado diariamente durante 6 semanas. Resultados: Após a aplicação das técnicas de Mulligan MWM na 1ªsemana, o perónio encontra-se devidamente reposicionado, no entanto o calcâneo ainda se encontra posteriorizado. No fim da 2ªsemana, a amplitude articular aumentou significativamente, aproximando-se dos valores do membro contralateral, verificouse um ganho de força muscular progressivo. Na 3ª e 4ª semana progrediu-se o tratamento em termos de fortalecimento muscular e treino proprioceptivo. Na 5ª semana apresentava amplitudes de movimento de 17º de dorsiflexão, 43º de flexãoplantar, 15º de eversão e 18º de inversão. Relativamente à força, o músculo tibial anterior apresentava um grau 5 de força, longo e curto peronial e flexores plantares grau 4+. No fim de 6 semanas, terminada a sua recuperação encontrava-se sem qualquer limitação funcional, igual força muscular bilateral e proprioceptividade normal. Conclusão: Foi salientado o processo de raciocínio clínico desenvolvido pelo fisioterapeuta ao longo das 6 semanas de intervenção: a recolha e interpretação dos dados da história, levantamento das primeiras hipóteses, testes dessas hipóteses no exame objectivo, estabelecimento de um diagnóstico funcional e construção e implementação de um plano de intervenção com a colaboração do utente que permitiram uma recuperação funcional que foi de encontro aos objectivos traçados.

Evaluation of the improvements on pharmacy technicians' work practices after implementation of operational procedures

Several antineoplasic drugs have been demonstrated to be carcinogenic or to have mutagenic and teratogenic effects. The greatest protection is achieved with the implementation of administrative and engineering controls and safety procedures. Objective: to evaluate the improvements on pharmacy technicians' work practices, after the implementation of operational procedures related to individual protection, biologic safety cabinet disinfection and cytotoxic drug preparation. Method: case-study in a hospital pharmacy undergoing a certification process. Six pharmacy technicians were observed during their daily activities. Characterization of the work practices was made using a checklist based on ISOPP and PIC guidelines. The variables studied concerning cleaning/disinfection procedures, personal protective equipment and procedures for preparing cytotoxic drugs. The same work practices were evaluated after four months of operational procedures implementation. Concordance between work practices and guidelines was considered to be a quality indicator (guidelines concordance practices number/total number of practices x 100). Results: improvements were observed after operational procedures implementation. An improvement of 6,25% in personal protective equipment practice was achieved by changing second pair of gloves every thirty minutes. The major progress, 10%, was obtained in disinfection procedure, where 80% of tasks are now realized according to guidelines.By now, we hot an improvement of only 1% at drug preparation procedure by placing one cytotoxic drug at a time inside the biological safety cabinet. Then, 85% of practices are according to guidelines. Conclusion: before operational procedures implementation 80,3% of practices were according to the guidelines, while now is 84,4%. This indicates that is necessary to review the procedures frequently in the benefit to reduce the risks associated with handling cytotoxic drugs and maintenance of drug specifications.

Comparative analysis of the ground reaction forces, during the support phase, in a group of pregnant women on their 3rd trimester of pregnancy and in a group of not pregnant women

PURPOSE: To analyze and compare the Ground Reaction Forces (GRF), during the stance phase of walking in pregnant women in the 3rd trimester of pregnancy, and non pregnant women. METHODS: 20 women, 10 pregnant and 10 non pregnant, voluntarily took part in this study. GRF were measured (1000 Hz) using a force platform (BERTEC 4060-15), an amplifier (BERTEC AM 6300) and an analogical-digital converter of 16 Bits (Biopac). RESULTS: The study showed that there were significant differences among the two groups concerning absolute values of time of the stance phase. In what concerns to the normalized values the most significant differences were verified in the maximums values of vertical force (Fz3, Fz1) and in the impulse of the antero-posterior force (Fy2), taxes of growth of the vertical force, and in the period of time for the antero-posterior force (Fy) be null. CONCLUSIONS: It is easier for the pregnant to continue forward movement (push-off phase). O smaller growth rates in what concerns to the maximum of the vertical force (Fz1) for the pregnant, can be associated with a slower speed of gait, as an adaptation strategy to maintain the balance, to compensate the alterations in the position of her center of gravity due to the load increase. The data related to the antero-posterior component of the force (Fy), shows that there is a significant difference between the pregnant woman’s left foot and right foot, which accuses a different functional behavior in each one of the feet, during the propulsion phase (TS).

Chitosan-alginate microparticulate delivery system for an alternative route of administration of BCG vaccine

Immunisation against M. tuberculosis with current available BCG vaccine lacks efficacy in preventing adult pulmonary tuberculosis. Targeting nasal mucosa is an attractive option for a more effective immunization. The delivery of BCG via the intranasal route involves overcoming barriers such as crossing the physical barrier imposed by the mucus layer and ciliar remotion, cellular uptake and intracellular trafficking by antigen presenting cells. Due to its biodegradable, immunogenic and mucoadhesive properties, chitosan particulate delivery systems can act both as vaccine carrier and adjuvant, improving the elicited immune response. In this study, different combinations of Chitosan/Alginate/TPP microparticles with BCG were produced as vaccine systems. The developed microparticle system successfully modulates BCG surface physicochemical properties and promotes effective intracellular uptake by human macrophage cell lines Preliminary immune responses were evaluated after s.c. and intranasal immunisation of BALB/c mice. BCG vaccination successfully stimulated the segregation of IgG2a and IgG1, where intranasal immunisation with chitosan/alginate particulate system efficiently elicited a more equilibrated cellular/humoral immune response.

Factors associated with infant feeding practices after hospital discharge

OBJECTIVE: To assess factors associated with infant feeding practices on the first day at home after hospital discharge. METHODS: A total of 209 women, who had a child aged four months or less and were living in Itapira, Brazil, were interviewed during the National Immunization Campaign Day in 1999. Statistical analysis was performed using the Chi-square test and a logistic regression model was used for verifying an association between dependent and independent variables. RESULTS: Women aged 25.5 years on average and 18.2% were teenagers. Fifty-three percent of the women delivered vaginally and most vaginal deliveries (78.5%) took place in the public hospital. The prevalence of exclusive breastfeeding on the first day at home was 78.1% and 11.6% of the infants were receiving formula at this time. The only factor associated with EBF on the first day at home was being a teenaged-primiparous mother (OR=9.40; 95% CI: 1.24-71.27). This association remained statistically significant even after controlling for type of delivery and hospital where the birth took place. Feeding formula on the first day at home was only significantly associated with the hospital (i.e., birth at the city hospital was a protective factor (OR=0.33; 95% CI: 0.13-0.86), even after controlling for vaginal delivery. CONCLUSIONS: On the first day at home after hospital discharge, teenaged-primiparous mothers were more likely to exclusive breastfeeding as well as those infants born in the municipal public hospital. Further studies are needed from a multidisciplinary approach.

Determinants of vaccination after the Colombian health system reform

OBJECTIVE: To assess the effects of individual, household and healthcare system factors on poor children's use of vaccination after the reform of the Colombian health system. METHODS: A household survey was carried out in a random sample of insured poor population in Bogota, in 1999. The conceptual and analytical framework was based on the Andersen's Behavioral Model of Health Services Utilization. It considers two units of analysis for studying vaccination use and its determinants: the insured poor population, including the children and their families characteristics; and the health care system. Statistical analysis were carried out by chi-square test with 95% confidence intervals, multivariate regression models and Cronbach's alpha coefficient. RESULTS: The logistic regression analysis showed that vaccination use was related not only to population characteristics such as family size (OR=4.3), living area (OR=1.7), child's age (OR=0.7) and head-of-household's years of schooling (OR=0.5), but also strongly related to health care system features, such as having a regular health provider (OR=6.0) and information on providers' schedules and requirements for obtaining care services (OR=2.1). CONCLUSIONS: The low vaccination use and the relevant relationships to health care delivery systems characteristics show that there are barriers in the healthcare system, which should be assessed and eliminated. Non-availability of regular healthcare and deficient information to the population are factors that can limit service utilization.

Tendências dos processos de profissionalização no campo da saúde

Neste artigo, resultante de uma comunicação proferida nas III Jornadas de Ciências Sociais e Humanas em Saúde, abordam-se as dinâmicas presentes nas relações profissionais e as tendências dos processos de profissionalização que ocorrem no campo da saúde. O trabalho de investigação empírica, realizado no quadro de um estudo de caso sobre os técnicos de cardiopneumologia e o desenvolvimento da reflexão sobre o tema, constituem o ponto de partida da análise sobre o tema que toma como referência o conjunto dos grupos socioprofissionais deste setor. Após enquadrar os contextos de transformação social que têm ocorrido desde as últimas décadas do século XX e a forma como incidiram no campo da saúde, bem como na recomposição dos respetivos grupos socioprofissionais, salientam-se cinco tendências relativas aos processos de profissionalização observadas neste setor, relacionadas com as relações de poder e dominação profissional; os efeitos da delegação de tarefas e competências ao nível da transferência de legitimidade entre os grupos socioprofissionais; o grau de autonomia; a variabilidade das situações quotidianas ocorridas em diferentes contextos de trabalho que se traduz numa disparidade de tendências muitas vezes contraditórias e paradoxais entre si; o efeito das alterações recentes nos cenários de inserção profissional, num contexto de crescente precariedade e desregulação do mercado de trabalho.

Comparação do cálculo de dose com os algoritmos Analytical Anisotropic Algorithm e Pencil Beam Convolution na patologia de pulmão

Mestrado em Radioterapia.

Eficácia de um programa de exercícios específicos no domicílio em idosos

Introdução: As quedas são um dos mais sérios problemas de saúde pública associado à idade. Objectivo: Analisar a influência de um programa de exercícios específicos, realizado no domicílio, em idosos, na força muscular dos membros inferiores, no equilíbrio, no medo de cair e na autonomia. Métodos: Foi realizado um estudo quase-experimental, com a duração de 3 meses, em dois grupos de mulheres idosas, o grupo experimental (n=6), que foi submetido ao programa de exercícios e o grupo controlo (n=6), que apenas recebia visitas mensais para ser submetido às avaliações. Para avaliar os factores de risco de queda foram utilizados o Five-Times-Sit-to-Stand-Test para avaliar a força muscular dos membros inferiores, o Functional Reach Test para avaliar o equilíbrio, a Falls Efficacy Scale para avaliar o medo de cair e a Medida de Independência Funcional para avaliar a autonomia das participantes. Resultados: Verificou-se uma melhor prestação do grupo experimental na realização do FTSST, conseguindo melhorar cerca de 9 segundos em média ao longo do estudo. Os resultados obtidos através do FRT demonstraram uma melhoria da média e mediana entre o 1º e 2º momento de avaliação, nos dois grupos, piorando progressivamente após esse momento. Inicialmente, o número de participantes com medo de cair era superior no grupo experimental (66,7%), sendo apenas 33% no final do estudo, verificando-se um aumento na média das pontuações no grupo experimental até ao 3º momento de avaliação,. Através dos resultados da MIF verificou-se que os dois grupos se encontravam na classificação de independência completa, não se tendo observado influência do programa de exercícios na independência das idosas. Conclusão: O exercício físico específico melhorou a força muscular dos membros inferiores e o medo de cair.

Os programas de matemática do ensino básico de 1990 e de 2007 e o processo de implementação do programa de 2007, no 1º ciclo do Ensino Básico

Mestrado em Educação Matemática na Educação Pré – Escolar e nos 1.º e 2.º Ciclos do Ensino Básico

Cryptotermes brevis (Isoptera: Kalotermitidae) in the Azores : Lessons After 2 yr of Monitoring in the Archipelago

The dispersal flights of West Indian drywood termite, Cryptotermes brevis (Walker) (Isoptera: Kalotermitidae) were surveyed in the major cities of Azores. The sampling device used to estimate termite density consisted of a yellow adhesive trap (size 45 by 24 cm), placed with an artificial or natural light source in a dark attic environment. In addition, data from two other projects were used to improve the knowledge about the geographical distribution of the species. The level of infestation in the two main Azorean towns differed, with high levels in the houses of Angra do Heroísmo, whereas in Ponta Delgada, there are fewer houses with high levels of infestation. The infestation in Ponta Delgada shows a pattern of spreading from the center outward to the city's periphery, whereas in Angra do Heroísmo, there was a pattern of spreading outward from several foci. The heavy infestation observed in Angra do Heroísmo and the clear increase of infestation levels observed from 2010 to 2011 is a reason for concern and calls for an urgent application of an Integrated Pest Management (IPM) control strategy.

The evidence of conventional physiotherapeutic interventions after exercise-induced muscle damage: systematic review and meta-analysis

Abstract Introduction: Exhaustive and/or unaccustomed exercise, mainly those involving eccentric muscle actions, induces temporary muscle damage, evidenced by Delayed Onset Muscle Soreness. Different strategies to recover the signs and symptoms of this myogenic condition have been studied by researchers, as a result a significant number of articles on this issue have been published. Purpose: A systematic review was conducted to assess the evidence of the physiotherapeutic interventions of exercise-induced muscle damage. Methods: The electronic data bases were searched, including MEDLINE (1996-2011), CINHAL (1982- 2011), EMBASE (1988-2011), PEDro (1950-2011), and SPORTDiscus (1985-2011). Systematic review was limited to randomized control trials (RCTs) studies, written in English or Portuguese, which included physiotherapeutic interventions, namely massage, cryotherapy, stretching and low-intensity exercise, on adult human subjects (18-60 years old) of either gender. Studies were excluded when the intervention could not be assessed independently. The methodological quality of RCTs was independently assessed with the PEDro Scale by three reviewers. Results: Thirty-three studies were included in the systematic review; eight analyzed the effects of the massage, ten analyzed the effects of the cryotherapy, eight the effect of stretching and seventeen focused low-intensity exercise intervention. The results suggest that massage is the most effective intervention and that there is inconclusive evidence to support the use of cryotherapy; whereas the other conventional, namely stretching and low-intensity exercise, there is no evidence to prove their efficacy. Conclusion: The results allow the conclusion that massage is the physiotherapeutic intervention that demonstrated to be the most effective in the relief of symptoms and signs of exercise-induced muscle damage, as a result, massage should still be used in the muscular recovery after sports activities.