INTRODUÇÃO: O crescente número de vitimas de lesão medular nos tempos atuais, suas incapacidades e consequências físico-funcionais motivaram-nos a abordar no presente estudo a intervenção fisioterapêutica respiratória ambulatorial nesta população. OBJETIVO: Escolhemos pesquisar sujeitos com lesão adquirida traumática oriundos de uma associação na cidade de Curitiba, PR. Considerando-se que o prognóstico relaciona-se ao nível sensitivo e motor, selecionamos sujeitos com lesões cervicais, por se tratarem de quadros que estão acompanhados de disfunções respiratórias, estas decorrentes do acometimento dos músculos acessórios da respiração. Portanto, essa população é merecedora de uma abordagem preventiva, uma vez que as referidas disfunções podem produzir complicações e piora de prognóstico geral. Tivemos a preocupação de demonstrar as possíveis alterações da capacidade de força respiratória, em função da intervenção fisioterapêutica. METODOLOGIA: Utilizamos, para tanto, o instrumento de medida, comparação e controle da força muscular inspiratória denominado manovacuometria. No tratamento, utilizamos o Threshold IMT, que é um incentivador respiratório. Para os critérios metodológicos, optamos por amostra conveniente, de corte longitudinal, em que foi realizada uma avaliação de força inspiratória inicial, objetivando-se alcançar os valores de pressão inspiratória máxima (PImáx), para comparar com a posterior reavaliação, pós intervenção. Os sujeitos foram submetidos a 30 atendimentos de 15 minutos cada, três vezes por semana. Após este período foram reavaliados sob os mesmos critérios técnicos, para as devidas comparações. RESULTADOS: Os resultados permitiram constatar significativa melhora no condicionamento muscular respiratório, o qual atingiu o nível relevante do desvio padrão (p < 0,05). CONCLUSÃO: Concluímos, portanto, que a proposta de tratamento é eficaz.
Introduction: Sirolimus-eluting stents (SES) significantly reduce restenosis and major adverse cardiac events (MACE) compared to bare metal stents (BMS). The novel sirolimus analog, Biolimus A9T (BA9), presented similar safety and efficacy in the randomized, controlled STEALTH I trial. This study compared the efficacy of a BA9-eluting stent versus sirolimus-eluting and bare metal control stents. Methods: Forty-five patients with de novo coronary lesions were randomly assigned in a 2:1 basis to receive either BA9-eluting (n = 30) or bare metal (n=15) S-stents. Quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS), at 6 months, were then compared to a matched series of patients who received either sirolimuseluting (n = 30) or bare metal (n = 15) Bx Velocity stents. Baseline clinical and angiographic characteristics were similar among all groups, except for a significantly higher percentage of females and Class C lesions in the BA9-eluting stent group. Results: At 6 month follow-up, there was no significant difference in clinical outcomes between any of the groups. QCA revealed significantly lower late loss in both drug-eluting stents (DES) groups compared to bare metal controls, but no significant difference between BA9 and SES groups was observed (0.24 ± 0.39mm vs. 0.15 ± 0.38mm, p = NS). Obstruction volume measured by 3D IVUS was significantly reduced in both DES groups compared to bare metal controls, but did not differ between the BA9 and SES groups (2.23% vs. 3.30%, BA9 vs. SES, p=NS). Conclusions: BA9-eluting stents reduce neointimal hyperplasia, safely and effectively, compared to BMS, and the magnitude of this inhibition is similar to that of SES.
Introduction: The impact of chronic kidney disease (CKD) on the quality of life of patients receiving hemodialysis is widely studied. Despite the vast amount of literature on the topic, it is still important to investigate the educational approaches related to this population's quality of life, evolution, and treatment. Objective: To systematically review the literature on educational approaches focusing on people with CKD receiving hemodialysis. Methods: An integrative systematic review of studies published between 2010 and 2015 was conducted using the PubMed, LILACS, PROQUEST, SCIENCEDIRECT, and SciELO databases using the keywords "quality of life and hemodialysis and adults", with their translation equivalents in Portuguese and Spanish. Results: The studies included in this review investigated biological conditions, treatment adherence, psychosocial conditions, and even spiritual influence. These studies unanimously recognized the validity of educational approaches, be it for treatment adherence, actor´s empowerment, or self-knowledge, as well as the importance of addressing a wider patient view and participatory therapy planning. Conclusion: The quality of life of people with CKD is a widely and differently studied topic, but the number of educational approaches focusing on this group of patients is modest and poorly represented in the existing literature. The few studies that address this topic are in complete agreement about the importance and relevance of educational approaches for people
Despite the undeniable contribution of intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA) to assess drug-eluting stent (DES) effectiveness, the way these image modalities correlate to each other and to target-lesion revascularization (TLR) after PCI, is yet to be established. Thus we sought to evaluate whether there is an acceptable correlation between QCA and IVUS after DES implantation. We analyzed 204 pts treated with DES: Zotarolimus-(126), Sirolimus-(57), and Biolimus (31) with baseline and follow-up QCA and IVUS. The correlation between QCA lumen loss (LL) and intimal hyperplasia (IH) volume obstruction by IVUS was assessed by multiple regression analysis. Two QCA parameters (in-segment diameter stenosis and insegment LL) and one IVUS variable (in-stent volume of IH) were evaluated as quantitative surrogates of 6 month TLR. The receiver operating characteristic method with c-statistics was used to assess the ability of each surrogate endpoint to predict TLR. QCA LL correlated positively with IVUS IH volume of obstruction (r = 0.69; CI95% 0.61-0.75: P \ 0.0001), independent of DES type. The 2 QCA parameters were superior to the IVUS parameter as surrogates for TLR. Of note, QCA LL (c = 0.99) correlated best with TLR, even better than percent DS. In the DES era there is a good correlation between QCA measured LL and IVUS IH volume and therefore can be used as a surrogate of DES efficacy.
EditorialAo assumir pela segunda vez a coordenação do curso de Fisioterapia da PUCPR, reitero o compromisso com o crescimento e o desenvolvimento da Fisioterapia enquanto pro issão, ciência, e por que não dizer, "vocação". Cumprindo o propósito de oportunizar a divulgação cientí ica da Fisioterapia, não abrimos mão de contribuir com o editorial deste renomado periódico -a revista Fisioterapia em Movimento -, que, na essência de concepção do seu próprio nome "movimento", reporta-nos a transmitir o que se espera de uma pro issão atualizada, em constante evolução, crescimento e compromisso com a saúde da população.Nesta edição, somos brindados por oportuna re lexão sobre o comportamento epidemiológico das "doenças deste século". São 20 artigos originais e 3 de revisão abordando disfunções temporomandibulares, cinesioterapia no idoso frágil, e o emergente método Pilates. Nos artigos originais temos, como sempre, o fortalecimento de áreas que re letem as necessidades sociais e demandas de saúde, caso da gerontologia com os temas fragilidade, mal de Parkinson, equilíbrio postural e estimulação sensório-motora. A área neurofuncional traz o per il do desempenho respiratório em crianças com doenças neuromusculares, órteses em paralisia cerebral, funcionalidade de hemiparéticos, e in luência do peso no desenvolvimento de lactentes compondo o retrato de diferentes realidades do agir pro issional. Não por acaso, podemos identi icar, nestes trabalhos cientí icos, que a Fisioterapia vem oferecendo propostas concretas para a diminuição dos agravos à saúde, as denominadas "doenças crônicas degenerativas", destacadas aqui pelas pesquisas em treinamento aeróbico e controle glicêmico, exercícios na ibromialgia, dor musculoesquelética e sedentarismo, e lombalgia crônica. A reabilitação pulmonar traz pesquisas sobre exercícios e DPOC, sua relação com a osteoporose e a respiração bucal como preditor da alteração postural. Temos neste número, também, um importante artigo metodológico que analisa a con iabilidade do teste clínico da queda do navicular, e outras duas excelentes abordagens da reabilitação do manguito rotador e diástase abdominal.Chamamos a atenção, ainda, para os artigos sobre Fisioterapia na Estratégia Saúde da Família (NASF) e funcionalidade de hemiparéticos com base na Classi icação Internacional de Funcionalidade (CIF). Esses ressaltam a importância atual de nossas intervenções na promoção, prevenção, tratamento e cura dos agravos à saúde, bem como na compreensão dos nossos compromissos em alavancar um "novo modelo de saúde", que tenha a prevenção como base e a CIF como orientação do caminho a ser seguido.Desejo a todos uma boa leitura. Prof. Msc. Pedro Cezar BeraldoCoordenador do curso de Fisioterapia da PUCPR
Aim: N-terminal proBNP peptide (NTproBNP) is a valuable tool in the diagnosis of heart failure and has a prognostic value in CAD patients (pts). Parameters derived from gated SPECT and kidney function have however also a strong prognostic value in these pts. Our study aim was to assess whether gated SPECT data and kidney function are independent determinants of NTproBNP in CAD pts above 65 years. Methods: We studied 131 consecutive pts with stable CAD referred for myocardial perfusion imaging. Left ventricular (LV) volumes were derived from myocardial gated SPECT data. Summed stress, rest and difference scores were calculated using semi-quantitative 4DM SPECT software (Michigan U.). Glomerular filtration rate (GFR) was calculated with a validated equation based on serum creatinine level.Univariate clinical and SPECT determinants of NTproBNP were investigated using ANOVA. A linear regression model was used to determine independent predictors of log NTproBNP. Results: The study population consisted of 131 pts (79 males, mean age 71Ϯ6 y). Univariate predictors of a higher NTproBNP were a lower GFR (pϽ.001), a longer QRS duration (pϭ .008), higher resting & post-stress end-diastolic and end-systolic (ESV) volumes (all pϽ.001)and a a higher summed stress and rest score (both pϽ .001). GFR (F changeϭ 44.4; pϽ .001) and post stress LV ESV (F changeϭ 31.5; pϽ.001) were the only independent determinants of log NTproBNP in the regression analysis. In the figure mean log NTproBNP values in these pts are shown according to a low versus high GFR (divided on the median) and post stress LVESV (divided in tertiles).Background: early detection of coronary atherosclerotic disease (CAD) is important to prevent death and disability. Myocardial perfusion scintigraphy (MPS) has the appropriate diagnostic and prognostic applications for patients who have an intermediate or high likelihood of disease, but it may not be cost-effective and should be performed only when reasonable doubt is left from other less sophisticated approaches. Based on clinical-epidemiological (CE) probability algorithms of CAD, patients classified as low likelihood of disease might either have no testing or simply undergo exercise testing (EXT). If the EXT results negative the patient is simply followed up; if the EXT is positive, the nuclear test is appropriate. Although this information is useful, it has some problems when in clinical practice. The challenges are how to adequately define patients in terms of likelihood of disease and how to integrate the pre-test probability with EXT results. Objective: to create and evaluate a logistic regression equation to classify patients to be referred to MPS based on the analysis of CE and EXT data. Methods: CE and EXT data on 2099 patients who had MPS performed in a nuclear medicine laboratory from 06/2000 to 06/2003 were collected for analysis. None of these patients had previous history of CAD. Each one was classified by utilizing a modified CE score based on the Framingham study database and EXT information derived f...
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