Objetivo: avaliar o grau de amplitude de movimento da articulação do tornozelo em crianças com paralisia cerebral, do tipo diparesia e tetraparesia espástica, após a aplicação de toxina botulínica tipo A em músculos gastrocnêmios, seguida por fisioterapia. Método: estudo observacional e transversal, avaliando 10 crianças, de ambos os sexos, faixa etária de 2 a 7 anos, sendo 5 diparéticas e 5 tetraparéticas do tipo espástica, com presença de equinismo bilateral. Realizadas 3 avaliações em intervalos pré e pós bloqueio, sendo que o grau de mobilidade do tornozelo, obtido através da goniometria articular. Resultados: constatou-se que a injeção intramuscular de toxina otulínica do tipo A aumentou o grau de movimento da articulação do tornozelo e, ainda, aumentou a pontuação na escala de atividades dinâmicas. Conclusão: a toxina botulínica tipo A combinada ao tratamento fisioterapêutico é um método eficaz no processo de reabilitação de pacientes que apresentam espasticidade por seqüela de PC. DESCRITORES: paralisia cerebral; espasticidade; toxina botulínica tipo A; fisioterapia.
Summary Covid‐19, a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, may present with polymorphic symptomatology and subclinical, neurological, gastrointestinal, dermatological, renal and severe acute respiratory manifestations. The diffuse alveolar damage caused by the disease presents with fibrin deposition, oedema, lymphocytic inflammatory infiltrate, destruction of epithelial cells, hyaline membrane formation and occasional angiogenesis formation of microthrombi. A common radiological finding is bilateral ground glass opacity, present even in mild cases. Severe cases occur mainly among the elderly and individuals with underlying comorbidities. Here, we provide an overview of the pathophysiology of the disease associated with SARS‐CoV‐2 infection, interaction of the virus with the immune system, and subsequent dysfunctional immune response, essential for progression of Covid‐19. We also discuss the role of the nervous system as a possible aggravating agent of the respiratory condition and propose a protocol for airway management based on the pathophysiological and immunological characteristics of the disease. Finally, we highlight the implications of such approaches for future therapeutic intervention.
Introdução: O câncer de colo do útero se apresenta como a segunda neoplasia maligna mais comum entre as mulheres. Seu tratamento consiste principalmente em cirurgias, quimioterapia e radioterapia, o que pode trazer como consequência disfunções no assoalho pélvico. Objetivo: Objetivou-se neste estudo avaliar as disfunções do assoalho pélvico consequente ao tratamento de câncer do colo do útero. Material e métodos: Durante a coleta de dados foram avaliadas 12 mulheres, investigando presença de dispareunia, grau de força da musculatura pélvica, presença de disfunção miccional e existência de estenose vaginal. Resultados: Ao verificar dispareunia, observou-se que 75% das pacientes relataram dor durante a relação sexual. No que diz respeito à força dos músculos do assoalho foi verificado que 41,7% das mulheres apresentavam AFA 2. Quanto à presença de disfunção miccional, nenhuma das pacientes relatou alguma disfunção. Ao verificar presença de estenose vaginal, observou-se uma media de 6,63. Quando comparado o número de sessões de radioterapia com a estenose vaginal, não houve significância estatística devido ao número restrito da amostra. Conclusão: Com o trabalho pode-se concluir que entre as participantes deste estudo, todas apresentaram alguma disfunção do assoalho pélvico após o tratamento de câncer do colo do útero.Palavras-chave: neoplasias do colo do útero, colo do útero, saúde sexual, incontinência urinária.
Introduction: The early years of a child’s life are marked by a significant development, as well as high sensitivity to environmental influences such as poverty, housing, quality and family structure. Thus, the identification of environmental risk factors and delayed neurodevelopment, coupled with early intervention, are essential for an healthy development. Objective: To analyze the effect of environmental factors on the neuropsychomotor development of children in the Amazon community. Methods: This is a quantitative and qualitative study of analytical and cross-sectional approach with 50 children between 24 and 36 months of age, of both sexes, living in an Amazonian community. Two types of the socio-economic-environmental questionnaire were used; a) Infant/Toddler (IT) HOME Inventory to analyze the quality of the family environment; b) the Denver Screening Test II for screening neurodevelopment. Also, a descriptive analysis was performed using a calculation of means and standard deviations. Results: The study found that a significant majority of the children had normal neuropsychomotor development; however, children classified as delayed, the more significant impact variable in the development was the quality of the family environment, which in turn was influenced by the lower economic class, lack of water treatment, lack of electricity and external toilet. Conclusion: Environmental factors were not significant on the neuropsychomotor development of the local children of the Amazon community.
Balance disorders have been poorly investigated and somewhat neglected in people infected with the human immunodeficiency virus, especially in children, whose have intrinsic and extrinsic risk factors that may compromise the balance. To evaluate the foot plantar pressures and the balance in children with acquired immunodeficiency. We recruited 53 children aged between 6 and 15 years: 33 healthy children, and 20 children with positive serology for the human immunodeficiency virus. A physical examination included anthropometric, reflexes, tactile sensitivity of the foot and orthopedic evaluation. We also collected data of them using Pediatric Equilibrium Scale, baropodometry, and stabilometry. We considered significance level of 0.05 for statistics. Both groups were aged-, sex-matched and similar body mass index and scores of the Pediatric Equilibrium Scale. Three infected children had altered tactile sensitivity, and none had orthopedic or reflex alteration. Infected children had higher mean plantar pressure in the hindfoot than of the control group (p = 0.02). There was higher maximum plantar pressure in the hindfoot of the infected children than of the controls (p = 0.04). Controls had lower maximum plantar pressure in the forefoot than the infected children (p = 0.04). Infected children had larger displacement of the center of pressure (p = 0.006), larger mean velocity of displacement (p = 0.006), and longer duration between successive peaks of displacement than the controls (p = 0.02). Children living with the human immunodeficiency virus discharges great plantar pressures in the hindfoot and to present balance disturbances in the absence of neurological symptomatology.
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