Context:After years of focusing on the management of anterior cruciate ligament (ACL) injuries, the most common soccer-related injuries, the orthopedic community has concluded that soccer players have a wide range of variation in joint biomechanics and has thus started to focus research efforts on the morphological factors that might contribute to ACL trauma. One such factor is decreased hip-rotation range of motion (ROM), which may be due to compensatory musculoskeletal changes occurring in response to longstanding soccer practice since childhood.Objective:This study sought to assess decreased hip rotation and the influence of stretching exercises on the behavior of the hip joint in players of the youth soccer categories of a Brazilian soccer team.Design:Randomized clinical trial.Setting:University hospital.Patients:262 male soccer players.Interventions:Subjects were randomly allocated into 2 groups—control or a stretching program.Main Outcome Measures:Subjects were reassessed after 12 wk.Results:The findings suggest that hip-rotation ROM decreases over the years in soccer players. In the study sample, adherence to a stretching program improved only external hip-rotation ROM in the nondominant limb.Conclusion:Playing soccer can restrict rotation ROM of the hip, and adherence to stretching exercises may decrease the harmful effects on the hip joints.
Background: Exercise intolerance is a common finding in heart failure that generates a vicious cycle in which the individual starts to limit his activities even more due to progressive fatigue. Regular physical exercise can increase the cardiopulmonary exercise capacity of these individuals. A new approach to physical exercise, known as functional training, could improve the oxygen consumption and quality of life of patients with heart failure; however, there is no information about the effect of this modality of exercise in this patient population. This randomized trial will compare the effects of 36 sessions of functional training versus strength training in heart failure patients. Methods: This randomized parallel-design examiner-blinded clinical trial includes individuals of both sexes aged ≥40 years receiving regular follow-up at a single academic hospital. Subjects will be randomly allocated to an intervention group (for 12-week functional training) or an active comparator group (for 12-week strength training). The primary outcomes will be the difference from baseline to the 3-month time point in peak oxygen consumption on cardiopulmonary exercise testing and quality of life assessed by the Minnesota Living with Heart Failure Questionnaire. Secondary outcome measures will include functionality assessed by the Duke Activity Status Index and gait speed test; peripheral and inspiratory muscular strength, assessed by hand grip and manovacuometry testing, respectively; endothelial function by brachial artery flow-mediated dilation; lean body mass by arm muscle circumference; and participant adherence to the exercise programs classified as a percentage of the prescribed exercise dose.
BACKGROUND: Prone positioning is used for patients with ARDS undergoing invasive mechanical ventilation; its effectiveness in nonventilated awake patients is unclear. We aimed to evaluate the effectiveness of the prone maneuver in decreasing the risk of intubation and increasing the odds of favorable events. METHODS: We prospectively evaluated 66 subjects with COVID-19-related moderate ARDS who were admitted to the ICU; treated with high-flow nasal cannula, noninvasive ventilation, a reservoir mask, or a nasal cannula; and subjected to awake prone maneuvers from March 1, 2020-August 30, 2020. The following factors were recorded at ICU admission: age, sex, prior illness, simplified acute physiology score 3, body mass index, and changes in gas exchange after and before prone positioning. Subjects were divided into a group of responders and nonresponders according to a 20% increase in the P aO 2 /F IO 2 ratio before and after the maneuver. The need for intubation within 48 h of the start of the maneuver was also evaluated. We also analyzed the differences in mortality, ICU length of stay, hospital length of stay, and duration of mechanical ventilation. A generalized estimating equation model was applied to preprone and postprone means. To control for confounding factors, multivariate Poisson regression was applied. RESULTS: Forty-one subjects age 54.1 y 6 12.9 were enrolled. Responders showed increased S pO 2 (P < .001), P aO 2 (P < .001), and P aO 2 /F IO 2 ratios (P < .001) with the maneuver and reduced breathing frequency. Responders had shorter lengths of stay in the ICU (P < .001) and hospital (P < .003), lower intubation rates at 48 h (P < .012), fewer days of ventilation (P < .02), and lower mortality (P < .001). Subjects who responded to the maneuver had a 54% reduction in the risk of ventilation and prolonged stay in the ICU. CONCLUSIONS: Among the responders to prone positioning, there were fewer deaths, shorter duration of mechanical ventilation, shorter ICU length of stay, and shorter hospital length of stay.
No início de 2020 a Organização Mundial de Saúde (OMS) definiu a Covid-19 como uma doença pandêmica e, desde então foram criados diversos protocolos preventivos de propagação do vírus incluindo o isolamento social, algo que, somado a todas as incertezas que cercavam o novo cenário mundial resultou em um aumento do sofrimento psicológico e consequentemente o uso de substâncias psicoativas. No Brasil, a comercialização dos psicofármacos aumentou 17% em 2020 e 13% só nos primeiros cinco meses de 2021, em específico o zolpidem, que teve o maior crescimento (113%) no período de 2019 a 2021. O presente estudo se propôs a analisar o aumento do uso do zolpidem durante a pandemia da Covid 19 através de uma revisão narrativa baseada em artigos científicos e compêndios oficiais. Desse modo, foi constatado que a crescente procura do zolpidem ainda traz uma problemática maior, o uso indiscriminado do medicamento e diversos problemas associados, fazendo-se necessária a implementação de estratégias para assegurar o uso racional da substância, como a terapia cognitiva comportamental (TCCs), cursos de educação em saúde e a necessidade de reavaliar a notificação do receituário, visto que, atualmente, o zolpidem é adquirido por meio de receitas do tipo B1 e de controle especial, podendo implicar em um tempo de tratamento maior que o indicado.
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