BACKGROUND AND OBJECTIVES: Surgery and radiotherapy (RT) may induce upper limb (UP) pain, functional disorder and daily life activities impairment. This study aimed at evaluating and comparing superficial sensitivity (SS) on the dermatome corresponding to the intercostobrachial sensory nerve (ICBN), pain and disability of UL ipsilateral to surgery before and after adjuvant RT. METHOD: Twenty females submitted to surgery including axillary lymphadenectomy (AL) were evaluated before and immediately after adjuvant RT (25-30 sessions). The following tools were used to evaluate SS, pain and disability: esthesiometry, McGill Pain Questionnaire (MPQ), Pain Rating Index and shoulder disability (SPADI). Two measures were obtained from MPQ: number of words chosen (NWC) and pain rating index (PRI). Wilcoxon Signed Rank Test for paired samples was used for intragroup comparison, considering significant p < 0.05. RESULTS: There has been significant SS decrease after RT by increased esthesiometer pressure from 1.9 ± 0.2 to 2.8 ± 0.2 (p = 0.004) indicating hypoesthesia. There has been no difference in contralateral UL. NWC and PRI scores have significantly increased (p = 0.005 and p = 0.006) after RT. There has been significant total SPADI score increase after RT (p = 0.0001), with increased disability from 24.6 ± 5.7 to 39.2 ± 5.7 (p = 0.001) and pain from 26.3 ± 6.4 to 48.4 ± 7.1 (p = 0.001). CONCLUSION: Hypoesthesia was identified in the ICBN pathway, in addition to UL pain and disability after adjuvant RT.
O presente estudo comparou a função pulmonar e a fadiga de mulheres antes e após a radioterapia (RT) adjuvante para tratamento do câncer de mama, e correlacionou a função pulmonar com a dose de radiação e fadiga. Foi conduzido um estudo observacional longitudinal envolvendo 20 mulheres. A função pulmonar foi avaliada pela espirometria (ClementClarke®) e manovacuometria (GlobalMed®, modelo MVD 300), e a fadiga pelo Functional Assessment of Cancer Therapy Fatigue (FACT-F). Todas as avaliações foram realizadas antes da primeira sessão e uma semana após o término da RT adjuvante. Para a análise estatística foram utilizados os testes Wilcoxon Signed Rank Test e correlação de Spearman, adotando-se nível de significância p<0,05. Na espirometria, encontrou-se redução significativa da capacidade vital forçada (23,52%), do volume expiratório forçado no primeiro segundo (26,23%) e do pico de fluxo expiratório (10,12%) (p=0,001). As pressões expiratórias e inspiratórias máximas também diminuíram significativamente (25,45 e 32,92%, respectivamente). Observou-se diminuição significativa do bem-estar físico e do bem-estar funcional, e um aumento significativo da fadiga no FACT-F (p=0,001). Não foram observadas correlações entre as variáveis da função pulmonar com a dose de radiação e fadiga. Em curto prazo, a RT promoveu redução na função pulmonar, mas a mesma permaneceu próxima à normalidade para a amostra estudada. Observou-se aumento significativo da fadiga e diminuição dos escores dos domínios bem-estar físico e funcional.
Chronic nonspecific low back pain is common and one of the most disabling conditions in the world. There is moderate evidence that chronic low back pain patients present altered functional connectivity in areas related to pain processing. Quantitative sensory testing is a way of clinical measure of these alterations. Although there is not enough evidence, there are some reports that electroacupuncture is supposedly more effective in relieving pain than acupuncture because the addition of electric current could optimize the effects of traditional technique. Thus, the objective of this randomized clinical trial was to verify if electroacupuncture treatment reduces pain and changes quantitative sensory testing responses in patients with chronic nonspecific low back pain. Patients were evaluated before and after 10 sessions regarding pain (11-point numerical rating pain scale) and quantitative sensory testing (pressure pain threshold, temporal summation, and conditioned pain modulation). There were 1 treatment group (electroacupuncture (EA)) and three different control groups (CTR 1, CTR 2, and CTR 3). A total of 69 patients participated in the study. No significant differences were found in pain intensity or quantitative sensory testing responses when comparing electroacupuncture group to the three control groups. There was a significant reduction in both resting and movement pain intensity in groups EA, CTR 1, and CTR3. Although ten sessions of electroacupuncture have diminished pain intensity in both resting and movement, it could not change significantly quantitative sensory testing and diminish central sensitization in patients with chronic nonspecific low back pain. The implications of this study involve the fact that, maybe, in chronic nonspecific low back pain, electroacupuncture should be associated with other treatments that target central sensitization.
Objetivo: Analisar as ações de promoção, proteção e apoio à prática da amamentação realizada pelos profissionais de saúde, no olhar das puérperas. Métodos: Estudo descritivo e observacional, realizado em uma maternidade de alto risco no município de Aracaju, SE. Resultados: 96% das puérperas realizaram o pré-natal completo e 56,78% não receberam nenhum tipo de orientação. Dentre as orientações recebidas, a mais citada refere-se ao tempo recomendado para a amamentação (12,29%), seguida da importância da amamentação (9,75%). Conclusão: Mesmo com a adesão da maioria das puérperas à realização do pré-natal completo, há ainda uma necessidade de maiores informações, orientações e apoio dos profissionais quanto ao aleitamento materno.Descritores: Orientação profissional; Aleitamento materno; Puerpério.PROFESSIONAL ORIENTATION ON BREASTFEEDING: THE LOOKING OF PUERPERAS IN A MATERNITY OF HIGH RISK IN THE STATE OF SERGIPEObjective: To analyze the actions of promotion, protection and support to the practice of breastfeeding performed by health professionals, in the eyes of puerperal women. Methods: Descriptive and observational study, carried out in a high risk maternity hospital in the city of Aracaju, State of. Results: 96% of the women who completed the full prenatal care and 56.78% received no guidance. Among the received guidelines, the most cited refers to the recommended time for breastfeeding (12.29%), followed by the importance of breastfeeding (9.75%). Conclusion: Even though the majority of postpartum women are adherent to complete prenatal care, there is still a need for more information, guidance and support from professionals regarding breastfeeding.Descriptors: Professional orientation; Breastfeeding; Puerperium.ORIENTACIÓN PROFESIONAL EN EL ALCANCE MATERNO: LA MIRADA DE LAS PUÉRPERAS EN UNA MATERNIDAD DE ALTO RIESGO EN EL ESTADO DE SERGIPEObjetivo: Para analizar las acciones de promoción, protección y apoyo a la práctica de los amamantamiento realizados por la salud, en los ojos de las mujeres puerperales. Métodos: Descriptive and observational study, llevado a cabo en un alto riesgo de maternidad hospital en la ciudad de Aracaju, State of. Resultados: 96% de las mujeres que completó el completo prenatal care y el 56.78% recibido en la guía. En las primeras pautas, el más citado se refería al recomendado para el amamantamiento (12.29%), seguido por la estima del amamantamiento (9.75%). Conclusión: Sin embargo, la mayoría de las mujeres postpartum de las mujeres son adherentes a completar el prenatal care, todavía no es necesario obtener más información, orientación y apoyo de los profesionales que se comprometen a amamantar.Descriptores: Orientación professional; Lactancia materna; Puerperio.
Verificar o efeito da fisioterapia na amplitude de movimento (ADM) e no desempenho funcional do membro superior homolateral no pós-operatório para tratamento do câncer de mama e correlacionar estas variáveis. Materiais e Métodos: Série de casos envolvendo mulheres submetidas à cirurgia unilateral para tratamento do câncer de mama, associado à linfadenectomia axilar. A ADM foi mensurada nos dois membros superiores através da goniometria, sendo o membro contralateral à cirurgia considerado o controle. O desempenho funcional foi avaliado pelo questionário "deficiência do ombro, braço e mão" (DASH). O protocolo de fisioterapia foi de 10 sessões de alongamentos e exercícios ativo-livres dos MMSS. A goniometria e os escores do DASH foram comparados pelo Wilcoxon signed rank test e para correlacionar estas variáveis foi utilizado o teste de correlação de Spearman, adotando significância de 5%. Resultados: Foram incluídas 10 mulheres com mediana de idade de 52,5 (41,7-59,5) anos, sendo sete submetidas à mastectomia radical e três à quadrandectomia. Encontrou-se aumento significativo da ADM de todos os movimentos avaliados, principalmente da flexão, abdução e rotação externa (p=0,005). Ao final do estudo, a ADM dos membros superiores não apresentou diferença significativa. O escore do DASH reduziu significativamente 38,9 (36-46,4) para 21,2 (9,5-23,8), (p=0,005). Não foi observada nenhuma associação entre a ADM e o escore do DASH. Conclusão: Verificou-se após 10 sessões de fisioterapia houve melhora significativa da amplitude de movimento e do desempenho funcional do membro superior homolateral à cirurgia, mas nenhuma correlação foi encontrada entre as variáveis estudadas. Palavras-chave: neoplasias da mama; mastectomia; ombro; amplitude de movimento articular; fisioterapia; reabilitação.
BackgroundSeveral studies have used placebo acupuncture methods in recent years as a way for blinding therapeutic effect of acupuncture, however placebo method selection has not followed enough methodological criteria to the point of stabilishing a consensus of what should be the best method to be used. This study aimed to evaluate the effectiveness of three different placebo acupuncture methods for blinding applied in healthy subjects.MethodsThis study was approved by the Ethics Committee of the Federal University of Sergipe with the number 47193015.5.0000.5546 and all individuals participating in the study signed a free and informed consent. For this study, 321 healthy volunteers were randomly divided into seven groups using the abdominal point stomach (ST) 25 and seven groups using the lumbar point bladder (Bl) 52 for stimulation. For real acupuncture procedure, three different methods of placebo acupuncture plus a mix between real acupuncture and placebo applied in the same individual, totaling fourteen groups in this study. Outcome assessments were performed before and immediately after applying the technique. Investigator who assessed variables had no knowledgement about the method was applied. Identification, weight and height were measured before puncture by using. At the end, subjects were asked if they believed they were receiving real or placebo acupuncture.ResultsThere was no significant difference between groups for the perception about the type o stimulation (wheter real or placebo puncture). Percentage of subjects who reported to have received real acupuncture in the abdominal point was 69.56% in real group, 86.95% in group Park Sham, 82.60% in needle + foam, 91.30% in insertion and removal, 78.26% in real + Park Sham, 86.36% in real + needle and foam, 86.95% in real + insertion and removal, and for the lumbar point was 86.36% in real group, 86.95% in group Park Sham, 69.56% in needle + foam, 72% in insertion and removal, 86.95% in real + Park Sham, 81.81% in real + needle and foam and 78.26% in real + insertion and removal.ConclusionAll placebo acupuncture methods proposed in this study were equally effective for bliding the study participants using either abdominal or lumbar acupoints, and none of the placebo methods presented benefit compared to the other to be used in future clinical trials.Ethics CommitteeFederal University of Sergipe (UFS), number of approval: 47193015.5.0000.5546Trial registrationensaiosclinicos.gov.br RBR-3w2p32 Registered in 28th January 2016.
Introduction: Surgery for breast cancer can impair range of motion (ROM) and functionality of upper limb (UL). Objective: To compare ROM and functional performance of homolateral UL after physiotherapeutic approach and to correlate these variables. Methods: A non-randomized clinical trial study enrolled 33 women who were submitted to mastectomy or quadrantectomy associated with axillary lymphadenectomy. ROM was assessed by homolateral UL and contralateral limb (control) goniometry. Functional performance was assessed by "Disability of arm, shoulder and hand" (DASH) questionnaire. The protocol consisted in 10 sessions (3 sessions per week during 60 minutes), involving passive mobilization of glenohumeral and scapulothoracic joint, soft tissue mobilization, neck muscles and upper limb muscles stretching, exercises in all planes of motion, applied alone or in combination. Weight bearing exercise with elastic bands and dumbbells from 0.5 to 1.0 kilograms were also applied. Results: There was a meaningful increase in ROM of all movements after physiotherapy; however, flexion, abduction and lateral rotation remained lower than
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