The aim of this study is to make a literature review about the different techniques of respiratory physiotherapy used after cardiac surgery and their effectiveness in reverting pulmonary dysfunction. It has been used as reference publications in English and Portuguese using as keywords thoracic surgery, respiratory exercises, physiotherapy modalities, postoperative complications and coronary artery bypass grafting, contained in the following databases -BIREME, SciELO Brazil, LILACS, PUBMED, from 1997 to 2007. A secondary study through list of references of identified articles also was performed. It has been selected eleven randomized trials (997 patients). Among the articles included in this study, incentive spirometry was used in three; deep breathing exercises in six; deep breathing exercises associated with positive expiratory pressure in four and positive expiratory pressure associated with inspiratory resistance in two. Three studies used intermittent positive pressure breathing. Continuous positive airway pressure and bi-level positive airway pressure has been used in three and two studies respectively. The protocols used in the studies were varied and the co-interventions were present in most of them. The different analyzed variables and the time of postoperatory follow-up make a comparative analysis difficult. Pulmonary dysfunction is evident in the postoperatory period of cardiac surgery. The use of non-invasive ventilation has been associated with good results in the first postoperatory days. Despite the known importance of postoperatory respiratory physiotherapy, until now, there is no consensus in the literature about the superiority of one technique over the others. 563RENAULT, JA ET AL -Respiratory physiotherapy in the pulmonary dysfunction after cardiac surgery Bras Cir Cardiovasc 2008; 23(4): 562-569 Rev METHODS Search StrategyUsing a primary and secondary search strategy, we performed a literature review of the different techniques of respiratory physiotherapy used in the PO of heart surgery and their effectiveness in the reversion of pulmonary dysfunction, using as publications in English and Portuguese as references. The descriptors used were thoracic surgery, respiratory exercises, physiotherapy modalities, postoperative complications and CABG, and were searched for in the following data sources: BIREME, SciELO Brazil, LILACS and PUBMED from 1997 until 2007. We avoided an excess of similar studies. A secondary search through the considered articles' list of references was also performed. Criteria for the selection of studiesRandomized clinical studies were selected for analysis if they had more than 20 patients and adults who had undergone HS, and if they compared different techniques of respiratory physiotherapy, or if they compared these techniques to procedures without respiratory physiotherapy in the PO. We also selected articles about HS and its pulmonary repercussions in order to introduce the subject and provide a stronger theoretical base. Variables analyzedThe analyzed v...

ResumoObjetivos: Determinar as concentrações de proteína C reativa ultra-sensível (PCR-US) em crianças/adolescentes com e sem obesidade e sua correlação com o índice de massa corporal (IMC) e variáveis clínico-laboratoriais.Métodos: Estudo transversal comparativo de grupos paralelos, sendo um grupo de crianças/adolescentes com sobrepeso ou obesidade (grupo obesidade, n = 131) e grupo controle de crianças/adolescentes não obesos (grupo controle, n = 114). Os valores de PCR-US foram determinados através de nefelometria de alta sensibilidade.Resultados: O grupo obesidade apresentou maiores concentrações de PCR-US que o grupo controle (p < 0,0005). Os valores de PCR-US relacionaram-se com IMC (p < 0,0001) e com dosagens de triglicerídeos (p = 0,05). Após ajuste pelo IMC, a relação entre PCR-US e triglicerídeos foi atenuada, deixando de ter significância estatística (p = 0,10). Conclusões:Os valores da PCR-US elevaram-se à medida que o IMC se elevou. A maioria dos indivíduos sem excesso de peso apresentou concentrações de PCR-US abaixo de 2 mg/L. J Pediatr (Rio J). 2007;83(5):477-480:Obesidade, sobrepeso, inflamação, proteína C reativa. AbstractObjectives: To determine the levels of high sensitivity C-reactive protein (hsCRP) in children/adolescents with and without obesity and their correlation with body mass index (BMI) and clinical and laboratory variables. Methods:A cross-sectional study comparing two parallel groups, one a group of overweight or obese children/adolescents (obesity group, n = 131) and the other a control group of children/ adolescents without obesity (control group, n = 114). High sensitivity nephelometry was used to determine hsCRP concentrations. Results:The obesity group exhibited greater hsCRP concentrations than the control group (p < 0.0005). There were relationships between hsCRP and BMI (p < 0.0001) and hsCRP and triglycerides (p = 0.05). The relationship between hsCRP and triglycerides was attenuated by adjustment for BMI, losing its statistical significance (p = 0.10). Conclusions:The hsCRP concentrations increased as BMI increased. The majority of individuals who were not overweight exhibited hsCRP concentrations of less than 2 mg/L. J Pediatr (Rio J). 2007;83(5):477-480:Obesity, overweight, inflammation, C-reactive protein. IntroduçãoAssociação entre obesidade, doença cardiovascular e diabete foi demonstrada em vários estudos, porém sem definição de causalidade. Recentes pesquisas têm apontado a reação inflamatória como fator comum entre essas doenças 1,2 . O tecido adiposo secreta substâncias (fator de necrose tumoral-α, interleucina-6, adiponectina, resistina) que têm ação no endotélio vascular e no metabolismo da glicose e dos lipídeos 3,4 . A proteína C reativa (PCR) é produzida no fígado, em resposta ao estímulo das citocinas inflamatórias. Sua dosagem vem sendo utilizada, desde a década de 1970, para diagnós-tico de estados inflamatórios e infecções 5 . Recentemente,

Objectives: To determine the levels of high sensitivity C-reactive protein (hsCRP) in children/adolescents with and without obesity and their correlation with body mass index (BMI) and clinical and laboratory variables. Methods:A cross-sectional study comparing two parallel groups, one a group of overweight or obese children/adolescents (obesity group, n = 131) and the other a control group of children/adolescents without obesity (control group, n = 114). High sensitivity nephelometry was used to determine hsCRP concentrations. Results:The obesity group exhibited greater hsCRP concentrations than the control group (p < 0.0005). There were relationships between hsCRP and BMI (p < 0.0001) and hsCRP and triglycerides (p = 0.05). The relationship between hsCRP and triglycerides was attenuated by adjustment for BMI, losing its statistical significance (p = 0.10). Conclusions:The hsCRP concentrations increased as BMI increased. The majority of individuals who were not overweight exhibited hsCRP concentrations of less than 2 mg/L. J Pediatr (Rio J). 2007;83(5):477-480:Obesity, overweight, inflammation, C-reactive protein.

A pandemia da obesidade juvenil e do sedentarismo está relacionada com o maior risco de doenças cardiovasculares no futuro. Ambas com fisiopatologia inflamatória, essas condições têm atraído significativa atenção científica. O início dos eventos que agridem o endotélio vascular pode ocorrer na infância, porém, sinais clínicos da aterosclerose geralmente só aparecem na fase adulta. O tecido adiposo é hoje reconhecido por seu papel ativo, induzindo a produção de citocinas pró e anti-inflamatórias, como o fator de necrose tumoral-alfa, as interleucinas 1, 6 e 10, a proteína C-reativa e outras. Há várias evidências de que os níveis sanguíneos dessas citocinas se encontram mais altos em indivíduos com excesso de peso, inclusive crianças e adolescentes. A prevenção precoce, desde a infância, apresenta-se como a melhor maneira de evitar os danos da obesidade na fase adulta, enquanto o potencial da prática regular de exercícios físicos tem se mostrado surpreendente. Sua ação anti-inflamatória se manifesta através de menores concentrações séricas de interleucina 6, de proteína C-reativa e leptina, além de aumentos na adiponectina. Observa-se escassez de estudos randomizados e controlados avaliando as relações entre obesidade, inflamação e exercícios para a população jovem. Com resultados às vezes controversos, a maioria das conclusões é procedentede estudos com adultos. O objetivo desta revisão é avaliar o papel anti-inflamatório, e assim cardioprotetor, da atividade física regular na obesidade infantojuvenil.Palavras-chave: obesidade/metabolismo, estilo de vida, doenças cardiovasculares/prevenção & controle, inflamação. aBStRaCtNowadays, juvenile obesity and physical inactivity are pandemic conditions which relate to a greater future risk of cardiovascular diseases. From an inflammatory point of view, they have attracted massive scientific attention. The beginning of the events related to atherosclerosis may occur in childhood, generating endothelial and metabolic dysfunction; however, the symptoms usually only appear later on, in adulthood. The fat tissue is recognized as being metabolically active, stimulating the production of inflammatory cytokines, such as the tumoral necrosis factor, interleukines 1, 6 and 10, C-reactive protein, among others. There is plenty of evidence that the serum levels of these citokines are higher in overweight individuals, including children and adolescents. Early prevention as young as possible is the best way to avoid future consequences of obesity. In this context, the potential benefits of regular physical exercise have been surprising. Researchers have shown evidence of antiinflammatory responses, including lower levels of interleukine 6, C-reactive protein, leptin, besides higher levels of adiponectins after engagement in regular physical activity. However, we still have few controlled randomized studies addressing the relations between obesity, inflammation and exercise for the pediatric population. There are controversial findings in this field, and many of them come from adult st...

Introdução: A terapia manual e TENS são recursos fisioterapêuticos utilizados para analgesia em disfunções articulares. Objetivo: Comparar a efetividade da terapia manual e TENS na hipoalgesia e funcionalidade na osteoartrite de joelhos. Métodos: Trata-se de um ensaio clínico aleatório randomizado, duplo-cego, com 24 voluntários divididos em grupo experimental (Terapia Manual) e controle (TENS), submetidos a 12 intervenções durante quatro semanas. Os dados foram analisados através do teste “t” de Student bicaudal pareado (p