Porto Alegre, Brazil
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Franco C.R.C.,HCPA | Leao P.,Physiotherapy | Townsend R.,Federal University of Rio Grande do Sul | Rieder C.R.M.,Movement Disorders Clinic
Arquivos de Neuro-Psiquiatria | Year: 2011

Axial rigidity is an important motor manifestation in Parkinson's disease (PD). Trunk mobility impairment can cause gait, balance and postural problems. However, only few instruments analyze the trunk mobility in PD patients. The aim of this study is to present a new Trunk Mobility Scale (TMS) and its validation in PD. The TMS constituted of dynamic tests involving trunk movements in sagittal, transversal and coronal planes. Ninety eight PD patients and 31 normal controls were analyzed. A strong correlation was found between the TMS scores and the Hoehn & Yahr staging scale (r: 0.72; p<0.01), motor Unified Parkinson's Disease Rating Scale (r: 0.84; p<0.01) and Schwab and England Activities of Daily Living (r: -0.72; p<0.01). The scale showed a satisfactory reliability rate (α Cronbach: 0.85, ICC: 099). TMS is a simple and reliable instrument to evaluate trunk mobility impairment in patients with PD.

Netto B.,Federal University of Rio Grande do Sul | Piltcher O.B.,Federal University of Rio Grande do Sul | Meotti C.D.,Hospital Of Clinicas Of Porto Alegre Hcpa | Lemieszek J.,HCPA | Isolan G.R.,HCPA
Rhinology | Year: 2015

Background: The superior attachment of the uncinate process (SAUP) is an important landmark in the nasofrontal recess, but its anatomical distribution is still unclear. The objective of this study was to assess the location and number of superior attachments of the uncinate process on computed tomography (CT) images. Methodology: A cross-sectional, retrospective study conducted at the Department of Radiology, Hospital de Clínicas de Porto Alegre, Brazil. Sinus CT scans of adult patients with no history of sinonasal surgery, craniofacial fractures, malignant neoplasms, or malformations were examined for identification of the site of SAUP. Results: 152 CT scans (304 sides) were assessed. The SAUP was appropriately identified in 292 sides (96%). Six distinct SAUP patterns were identified: to the lamina papyracea or anterior ethmoidal cells (193, 63.48%); to the middle turbinate (19, 6.25%); to the skull base (19, 6.25%); to the lamina papyracea and middle turbinate (29, 9.53%); to the lamina papyracea and skull base (29, 9.53%); and to the skull base and middle turbinate (3, 0.98%). Conclusion: The site of superior attachment of the uncinate process is highly variable, but is in contact with the lateral nasal wall in 82.5% of the cases. © 2015, AMC. All Rights Reserved

Muller L.,Hospital Pequeno Principe | Caputo G.,Federal University of Rio Grande do Sul | Zago M.K.,HCPA | Gomes J.L.E.,Federal University of Rio Grande do Sul
Journal of Musculoskeletal Research | Year: 2015

Objective: To evaluate whether 60° and 90° V-shaped osteotomies in sheep femurs have statistically significant differences when submitted to compressive strength tests. Material and Methods: A total of 30 left femurs of recently slaughtered sheep were removed, the proximal segment was discarded, and the bones were randomly divided into two groups of 15 specimens each. The bones underwent distal osteotomy at the supracondylar region at a 90° angle between cuts, in group 1, and at a 60° angle in group 2. The osteotomy was V-shaped and the distal apex started in the lateral face of the femur; medial cortical bone remained intact. Compressive tests were conducted, and four points of the deformation curve were collected for the calculation of the deformation rate using an interpolation scheme. Deformation patterns were evaluated according to two groups: intercondylar fracture and medial cortical fracture. Results: Group 1 had a mean resistance to failure to compressive load of 232kgf (SD 59.551; 150-400), whereas in group 2, mean resistance to failure to compressive load was 157.13kgf (SD 67.4; 70-346); this difference was statistically significant (p=0.000619, Kruskal-Wallis). Conclusions: Osteotomy at a 90° angle had a greater resistance to compression and resulted in less weakening of the distal area of the femur after osteotomy. There were no differences in the pattern of fracture generated by compression according to osteotomy angle. © 2015 World Scientific Publishing Company.

Schestatsky P.,Emg Unit From Hospital Of Clinicas Of Porto Alegre Hcpa | Schestatsky P.,Federal University of Rio Grande do Sul | Dall-Agnol L.,Federal University of Rio Grande do Sul | Gheller L.,Federal University of Rio Grande do Sul | And 5 more authors.
European Journal of Neurology | Year: 2013

Background and purpose: Poor sleep is commonly associated with alterations in pain perception. However, there is a lack of studies that address work-associated sleep restriction (SR) and changes in non-nociceptive perception and autonomic responses after work-induced SR. Methods: This study was performed with 19 medical students after a normal-sleep night (NS phase) and after a night shift at the local emergency room (SR phase). We performed clinical assessment, quantitative sensory testing for electrical and temperature sensation, RR interval analysis, and recorded sudomotor skin responses (SSRs). Results: The total mean duration of sleep was 436 ± 18 min in the NS group and 120 ± 28 min in the SR group (P < 0.001). The anxiety scores were higher following the SR phase compared with those after the NS phase (P < 0.01). After SR, there was a decrease in heat-pain threshold, but neither warm nor electrical thresholds were affected. Following SR, subjects showed higher SSR amplitudes and an increased number of double responses at an interstimulus interval of 2 s. We also observed a moderate inverse correlation between heat-pain thresholds and SSR amplitude (r = -0.46; P < 0.01). However, there was no correlation between anxiety scores and SSR parameters. Conclusions: The effects of SR in the context of work stress on pain are specific and appear unrelated to general changes in sensory perception. Hyperalgesia was associated with abnormal autonomic responses, but not with increased anxiety, which suggests an association between the nociceptive and autonomic nervous systems that is independent of the emotional state. © 2012 The Author(s). European Journal of Neurology © 2012 EFNS.

Nery R.M.,HCPA | Martini M.R.,HCPA | Vidor C.R.,UNISINOS | Mahmud M.I.,HCPA | And 3 more authors.
Brazilian Journal of Cardiovascular Surgery | Year: 2010

Objective: To check changes in the functional capacity of patients undergoing coronary artery bypass grafting (CABG) through the six-minute walk test (6MWT) in a 2- year follow-up. Methods: In this prospective cohort study in 215 patients who underwent CABG, 13 did not meet the criteria for inclusion. Of these, 202 patients were evaluated preoperatively, 13 died during hospitalization and 6 in the 2-year follow-up. Four patients were considered lost-tofollow- up. This study followed 179 patients for two years classified into active and sedentary, according to physical activity in leisure time and to the 6MWT preoperatively and 2 years later. Results: One hundred and twenty patients were evaluated in the day before CABGS, being 67% male with an average age of 63 (±9.75) years. Before surgery and 2 years later, 52 were active and the 6MWT distances performed had been 359m (±164.47) and 439m (±171.34), respectively; P= 0.016. Forty five patients were classified as sedentary before and 2 years after surgery. The 6MWT distances walked before and after surgery had been 255m (±172.15) and 376m (±210.92), respectively; P< 0.001. Eighty two patients transited between these two groups, 71 passed from sedentary to active and had walked before and after surgery 289m (±157.15) and 380m (±125.44), respectively; P= 0.001. The 11 patients who were active and passed to the sedentary group walked 221m (±191.91) and 384m (±63.73), respectively; P= 0.007. Conclusion: The functional capacity of the patients who underwent CABGS had a significant improvement in a medium-term follow-up.

Perin C.,Federal University of Rio Grande do Sul | Perin C.,Hospital Of Clinicas Of Porto Alegre | Fagondes S.C.,Federal University of Rio Grande do Sul | Casarotto F.C.,Federal University of Rio Grande do Sul | And 3 more authors.
Sleep and Breathing | Year: 2012

Purpose: Questions remain about the polysomnographic findings and the predictors for sleep desaturation in cystic fibrosis (CF) patients. Our study aimed to evaluate sleep parameters in a sample of adult CF patients comparing them with healthy controls and to determine the best predictors of sleep desaturation in CF patients with awake resting peripheral oxygen saturation (SpO2) ≥90%. Methods: In a cross-sectional study, with data collected prospectively, 51 clinically stable adult CF patients (mean age 25.1 ± 6.7 years) and 25 age-matched controls underwent an overnight polysomnography and answered sleep questionnaires. CF patients had their pulmonary function, 6-min walk test, and echocardiography assessed. Results: CF patients and control subjects had similar sleep architecture. However, CF patients had impaired subjective sleep quality and a higher arousal index than controls. The apnea-hypopnea index was similar in both groups, and only two CF patients (3.9%) fulfilled the criteria for obstructive sleep apnea syndrome. Sleep desaturation was more common in CF patients (29.4% vs 0%; p < 0.001). In a logistic regression model, we observed that awake resting SpO2 was the single best variable associated with sleep desaturation in CF population (p < 0.001). The awake SpO2 <94% had a sensitivity, specificity, positive and negative predictive value for sleep desaturation of, respectively, 93.3%, 100%, 100%, and 97.3%. Conclusions: CF patients had a worse subjective sleep quality and small changes in sleep architecture. In nonhypoxic, adult CF patients, sleep desaturation is common, is not associated with obstructive sleep events, and can be accurately predicted by awake resting SpO2 <94%. © 2011 Springer-Verlag.

PubMed | Instituto Nacional Of Ciencia E Tecnologia Medicina Translacional, Hospital Of Clinicas Of Porto Alegre, Centro Universitario Metodista, HCPA and Federal University of Rio Grande do Sul
Type: Comparative Study | Journal: Trends in psychiatry and psychotherapy | Year: 2016

Prenatal cocaine exposure (PCE) is associated with neurobehavioral problems during childhood and adolescence. Early activation of the inflammatory response may contribute to such changes. Our aim was to compare inflammatory markers (IL-6 and IL-10) both in umbilical cord blood and in maternal peripheral blood at delivery between newborns with history of crack/cocaine exposure in utero and non-exposed newborns.In this cross-sectional study, 57 newborns with a history of crack/cocaine exposure in utero (EN) and 99 non-exposed newborns (NEN) were compared for IL-6 and IL-10 levels. Sociodemographic and perinatal data, maternal psychopathology, consumption of nicotine and other substances were systematically collected in cases and controls.After adjusting for potential confounders, mean IL-6 was significantly higher in EN than in NEN (10,208.54, 95% confidence interval [95%CI] 1,328.54-19,088.55 vs. 2,323.03, 95%CI 1,484.64-3,161.21; p = 0.007; generalized linear model [GLM]). Mean IL-10 was also significantly higher in EN than in NEN (432.22, 95%CI 51.44-812.88 vs. 75.52, 95%CI 5.64-145.39, p = 0.014; GLM). Adjusted postpartum measures of IL-6 were significantly higher in mothers with a history of crack/cocaine use (25,160.05, 95%CI 10,958.15-39,361.99 vs. 8,902.14, 95%CI 5,774.97-12,029.32; p = 0.007; GLM), with no significant differences for IL-10. There was no correlation between maternal and neonatal cytokine levels (Spearman test, p 0.28 for all measures).IL-6 and IL-10 might be early biomarkers of PCE in newborns. These findings could help to elucidate neurobiological pathways underlying neurodevelopmental changes and broaden the range of possibilities for early intervention.

PubMed | Hospital Of Clinicas Of Porto Alegre Hcpa, Federal University of Rio de Janeiro, Pediatric Pulmonology Unit, HCPA and Federal University of Rio Grande do Sul
Type: Journal Article | Journal: Pediatric pulmonology | Year: 2016

To investigate the accuracy of clinical evaluation of swallowing in a sample of children with laryngomalacia or glossoptosis and describe the prevalence of dysphagia in each of these diseases, as well as characterize the swallow response to speech and language therapy interventions.Children aged 1 month to 11 years receiving care at the Department of Otolaryngology, Hospital de Clnicas de Porto Alegre, Brazil, were evaluated in a cross-sectional design. Evaluation of swallowing was performed at two time points by two blinded speech-language pathologists, one responsible for clinical evaluation and the other for videofluoroscopic study. The protocols employed were based on the instruments proposed by DeMatteo et al. (DeMatteo C, Matovich D, Hjartarson A. Comparison of clinical and videofluoroscopic evaluation of children with feeding and swallowing difficulties. Dev Med Child Neurol 2005;47:149-157.).The study sample consisted of 29 patients: 10 patients with laryngomalacia and 19 patients with glossoptosis. The sensitivity of clinical evaluation did not exceed 50% in any of the evaluations, but specificity reached 100% in some cases, using thickened liquids. The prevalence of dysphagia was 100%, and the use of thickened liquids significantly reduced tracheal aspiration.Dysphagia was highly prevalent in this sample. The sensitivity of clinical evaluation to detect laryngeal penetration and tracheal aspiration was low, as the majority of aspiration events were silent. The videofluoroscopic study is important in order to determine a safest method to feed the patient. Pediatr Pulmonol. 2017;52:41-47. 2016 Wiley Periodicals, Inc.

PubMed | Hospital Of Clinicas Of Porto Alegre, HCPA and Federal University of Rio Grande do Sul
Type: Journal Article | Journal: Archives of endocrinology and metabolism | Year: 2016

Body weight is regulated by the ability of hypothalamic neurons to orchestrate behavioral, endocrine and autonomic responses via afferent and efferent pathways to the brainstem and the periphery. Weight maintenance requires a balance between energy intake and energy expenditure. Although several components that participate in energy homeostasis have been identified, there is a need to know in more detail their actions as well as their interactions with environmental and psychosocial factors in the development of human obesity. In this review, we examine the role of systemic mediators such as leptin, ghrelin and insulin, which act in the central nervous system by activating or inhibiting neuropeptide Y, Agouti-related peptide protein, melanocortin, transcript related to cocaine and amphetamine, and others. As a result, modifications in energy homeostasis occur through regulation of appetite and energy expenditure. We also examine compensatory changes in the circulating levels of several peripheral hormones after diet-induced weight loss.

PubMed | Federal University of Health Sciences, Porto Alegre, Hospital Of Clinicas Of Porto Alegre, HCPA and Federal University of Rio Grande do Sul
Type: Journal Article | Journal: Trends in psychiatry and psychotherapy | Year: 2015

Anxiety disorders (AD) share features of both anxiety and fear linked to stress response. The hypothalamic-pituitary-adrenal (HPA) axis is considered the core biological pathway of the stress system and it is known that an inappropriate response to environmental stimuli may be related to individual genetic vulnerability in HPA-linked genes. Despite the biological plausibility of a relationship between the HPA axis and AD, few studies have investigated associations between genetic polymorphisms linked to the HPA axis and this complex disorder.To investigate whether AD are associated with genetic polymorphisms in HPA-linked genes in adolescents.Our study consisted of a cross-sectional evaluation of a community sample comprising a total of 228 adolescents (131 cases of AD). We extracted DNA from saliva and genotyped polymorphisms in HPA-linked genes (FKBP5: rs3800373, rs9296158, rs1360780, rs9470080 and rs4713916; NR3C1: rs6198; CRHR1: rs878886; and SERPINA6: rs746530) with real time polymerase chain reaction (PCR). The instruments used to diagnose and assess the severity of AD were the Schedule for Affective Disorder and Schizophrenia for School-Age Children - Present and Lifetime (K-SADS-PL) and the Screen for Child and Anxiety related Emotional Disorders (SCARED).We failed to detect any associations between AD and genetic polymorphisms in HPA-linked genes (p > 0.05).To our knowledge, this is the first study evaluating these specific polymorphisms in relation to AD in adolescents, which encourages us to design further research on the subject.

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