No abstract

RESUMOObjetivo: Verificar os efeitos da intervenção clown no padrão de depressão em idosos institucionalizados. Material e método: Estudo quantitativo experimental, realizado numa instituição de longa permanência de Divinópolis, Minas Gerais, Brasil. Utilizou-se a Escala de Depressão Geriátrica, Yesavage (GDS-15), aplicada em dois momentos, em dois grupos: intervenção (n=14) e controle (n=10). As intervenções foram visitas onde acadêmicos vestidos de palhaço realizaram atividades lúdicas. A comparação estatística da efetividade das intervenções foi realizada através do método JT. Resultados: Os resultados no primeiro momento demonstraram que no grupo controle 40% apresentavam depressão e após as atividades 50% apresentavam tal quadro. Já no grupo experimental não foram observadas mudanças quanto ao número de indivíduos com transtorno depressivo antes e após as intervenções. Pode-se inferir que a terapia do humor foi benéfica do ponto de vista da não progressão da depressão entre os idosos institucionalizados. Conclusão: Tornam-se necessários novos estudos a cerca da efetividade da animação clown para melhora dos traços de depressão em idosos.Palavras chave: Terapia do Riso, depressão, idosos, instituição de longa permanência para idosos.

Objective: To assess the quality of life and functional status of patients subjected to debridement of ulcers in the posterior ankle who required complete Achilles tendon resection without any type of reconstruction or tendon transfer. Method: This is a case series of 5 (mostly diabetic) patients who underwent complete Achilles tendon resection due to an ulcer in the posterior ankle region. Preservation of the Achilles tendon was prevented due to tendon exposure, extensive degeneration and the need for infection control. Patients answered the Brazilian Portuguese version of the Achilles Tendon Total Rupture Score (ATRS-BR) questionnaire and the 36-item Short-Form Health Survey (SF-36) during the postoperative period, and follow-up varied between 6 and 24 months. The ATRS-BR ranges from 0 to 100, and higher scores indicate fewer symptoms and limitations. The SF-36 consists of 36 questions comprising 8 domains, which are independently assessed and given a score of up to 100 points, with higher scores indicating better health status. Results: The mean age of patients was 70 years. The mean score on the SF-36 physical functioning domain was 70 (50-95) points. The mean value of the ATRS-BR was 54.6 (31-88) points; however, the patients had few complaints about their functional status. Conclusion: Non-reconstruction of the Achilles tendon in predominantly diabetic elderly patients with posterior ankle ulcers presents encouraging functional outcomes. This study suggests that complete Achilles tendon resection is a viable option for ulcer treatment in this population. Level of Evidence IV; Therapeutic Studies; Cases Series.

Objective: The objective of this study is to perform a functional and quality of life assessment of patients subjected to debridement of ulcers in the posterior region of the ankle, which progressed to complete Achilles tendon resection without any type of tendon reconstruction or transfer. Methods: This is a case series of 4 patients, mostly diabetic, who underwent complete resection of an exposed and degenerated Achilles tendon due to ulcer in the posterior region of the ankle that precluded preservation given the need to control the infectious process considering the diagnosis of calcaneal osteomyelitis. This diagnosis was compatible with changes observed in the magnetic resonance imaging evaluation and was confirmed in cultures of bone tissue removed during debridement. The patients filled out the Brazilian Portuguese version of the Achilles Tendon Total Rupture Score (ATRS-BR) and 36-Item Short Form Survey (SF-36) during the postoperative period, and follow-up ranged from 6 to 24 months. The ATRS score ranges from 0 to 100, and the higher the scores are, the fewer symptoms and limitations the patients have. The SF-36 consists of 36 questions covering 8 domains: physical role functioning, physical functioning, bodily pain, general health perceptions, social role functioning, vitality, mental health and emotional role functioning. The items are independently assessed, and the total possible score is 100 points, which is indicative of the best health status. Results: All 4 Achilles tendons were approached. The mean age of the patients was 69.8 years. The mean score on the physical functioning section of the SF-36 was 63.8 points. When comparing the outcome with literature data, we observed that when patients with ulcers were compared with individuals of a similar age group, our study showed better results than previous studies. The mean score of the ATRS-BR was 46.3 points, which suggests a poor outcome. However, the patients had few complaints about their physical functioning, as shown in the SF-36 analysis. The decision not to perform Achilles tendon reconstruction was made jointly by the medical team and the patients and their families. Conclusion: Not reconstructing the Achilles tendon in patients, mostly elderly diabetic patients with posterior ankle ulcers, led to encouraging functional scores. The present study suggests that this type of ulcer treatment is a viable option for such populations.