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As doenças valvares cardíacas vêm aumentando sua prevalência ao redor do mundo nos últimos anos em decorrência do aumento da expectativa de vida e aprimoramento dos métodos diagnósticos. A evolução da doença valvar pode afetar a função cardíaca de maneira a deteriorar a capacidade funcional e influenciar negativamente a qualidade de vida. Os parâmetros obtidos durante a avaliação de aptidão física do indivíduo podem auxiliar o processo de tomada de decisão no tratamento das doenças valvares e possibilitar intervenção cirúrgica antes do agravamento da doença. A manutenção adequada do nível de atividade física pode impactar diretamente o desfecho clínico desses pacientes. O presente estudo aborda atualizações no tratamento das doenças valvares e a influência do condicionamento cardiorrespiratório sobre os desfechos clínicos nas doenças valvares cardíaca

A hipertensão arterial sistêmica (HAS) é uma doença prevalente na população adulta e associada a alta morbidade e mortalidade cardiovascular. Uma das medidas que auxiliam no controle da doença é a prática de exercício físico. O exercício intervalado de alta intensidade high-intensity interval training, HIIT) é uma modalidade de atividade física que ganha destaque na atualidade, pois a prática exige menos tempo e oferece bons resultados. Apesar disso, há uma ampla variedade de protocolos na literatura, o que dificulta a análise da evidência de cada um deles. Objetivamos assim, apresentar resultados de estudos clínicos e revisões sistemáticas com metanálise disponíveis nos últimos cinco anos sobre o treino HIIT na HAS. Foi realizada uma busca sistematizada da literatura na base PubMed, com estratégia de busca previamente padronizada. Após a triagem, os artigos selecionados foram lidos na íntegra e tabulados para análise. Foram localizados 62 artigos com a inclusão de 15 (13 trabalhos clínicos e duas revisões com metanálise). Os resultados dos artigos selecionados que aplicaram o HIIT como protocolo de treinamento para hipertensos, mostra que a modalidade foi uma ferramenta efetiva para controle da pressão arterial em diferentes protocolos e populações. Os artigos fomentam esses achados com análise de sua ação em musculatura endotelial, angiogênese, hiperreatividade do sistema simpático e viscosidade sanguínea. O efeito sobre a fração de ejeção ventricular e o controle glicêmico atribui a este protocolo destaque na reabilitação da população hipertensa com comorbidade associada.

Introduction/Purpose Obesity increases significantly every year worldwide. Since 1980, the prevalence of individuals with obesity has practically doubled. Obesity plays an important role in the pathophysiology of diseases that arise from a complex interaction of nutritional, genetic, and metabolic factors, characterizing a chronic inflammatory state. This study aimed to verify the systemic inflammatory response through the analysis of IGF-1, IL-23, and resistin levels and the lipid profile in severely obese women undergoing surgery for obesity and weight-related diseases. Materials and Methods This randomized controlled clinical trial includes female patients clinically diagnosed with severe obesity with an indication for bariatric surgery. Results In the initial evaluation, no significant difference was observed between the control (CG) and bariatric surgery (BSG) groups. The weight, BMI, systolic and diastolic blood pressures, total cholesterol, LDL, HDL, total non-HDL cholesterol, and glucose in BSG patients showed a significant change after surgery. Pre- and post-surgery levels of resistin, IGF-1, and IL-23 showed a significant difference in the BSG group, but only IL-23 was changed after 6 months in the CG. Conclusion The results of this study confirmed that weight loss induced by surgery for obesity and weight-related diseases improved the lipid profile and reduced the chronic inflammatory status in women with severe obesity.

Introdução: Hipercolesterolemia familiar é uma doença hereditária autossômica dominante que acarreta alteração do metabolismo das lipoproteínas. Nela, os níveis de colesterol da lipoproteína de baixa densidade (LDL-c) são superiores a 190 mg/dL e a doença é confirmada por teste genético. Os pacientes que apresentam a rara condição encontram dificuldades em seu processo terapêutico, pela pouca descrição sobre a prescrição de exercícios. Objetivo: Descrever a reabilitação cardiovascular e em indivíduos com hipercolesterolemia familiar homozigótica. Resultados: Após a busca em base de dados, foram localizados oito artigos com menção a programas de atividade física onde se discute o alto risco cardiovascular precoce. Identificou-se que o exercício pode contribuir para o controle da hipercolesterolemia, mas deve ser prescrito após avaliação clínica e laboratorial rigorosa, o que inclui teste de esforço. O número de sessões semanais de exercício proposto nos estudos localizados foi de cinco a sete sessões quando há proposta de treino aeróbio e até três sessões quando a atividade era anaeróbia. Durante o treino foi preconizado uso de frequencímetro e oxímetro de pulso, com acompanhamento de sinais clínicos e monitoração do paciente com eletrocardiograma. Conclusão: Ainda há poucos estudos clínicos na hipercolesterolemia familiar homozigótica e as terapias carecem de evidência; porém, na maioria dos estudos, foi salientada a necessidade de uso precoce de estatina e bons hábitos de vida, como atividade física diária

Objective. Translate and adapt the Functional Gait Assessment (FGA) to Brazilian Portuguese as a measure of balance during gait in stroke patients and determine its validity and reliability based on evidence of its measurement properties. Method. A convenience sample of 45 stroke survivors (average of seven months since diagnosis) was included (mean age: 55 years; 51% women). The instrument under consideration was translated and back-translated. The performance of the FGA was assessed by two raters to determine intrarater and interrater reliability. Concurrent and discriminant validity were investigated using the Berg Balance Scale (BBS) as well as normal and fast walking speed. Results. No difficulties with the translation were found during the application of the tests. Therefore, no structural or conceptual changes to the translated version were needed to achieve cultural equivalence. Intrarater (intraclass correlation coefficient=0.93) and interrater reliability (intraclass correlation coefficient=0.90) were almost perfect for the total scores. The reliability of single items was also strong, ranging from 0.74 to 0.95. Concurrent validity with other measures of gait and balance was moderate to substantial. The FGA was correlated (p

O artigo objetiva analisar o conhecimento de uma equipe de enfermagem sobre o processo de humanização em um hospital público e buscar suas interpretações. O estudo é transversal com 29 voluntários da equipe de enfermagem de um hospital vinculado ao SUS no Estado de Minas Gerais. Todos os participantes estiveram em uma entrevista e responderam a um questionário semiestruturado com as perguntas construídas a partir das diretrizes preconizadas pelo Manual da Humanização. A maioria dos entrevistados conhece alguns conceitos sobre humanização, porém não se apropriam de todas as interpretações do programa de humanização e seguem a realizar o atendimento de forma intuitiva. O conhecimento sobre humanização na perspectiva da equipe de enfermagem foi classificado como empírico e não compreendeu a visão do programa nacional de humanização como ferramenta capaz de garantir ambiência hospitalar.

Objective. The present study is aimed at assessing heart rate variability (HRV) and its correlation with visual acuity (VA) assessment of preterm newborns (PTNB) in neonatal intensive care units. Method. Cross-sectional study analyzing HRV during assessment of VA with the aid of a Polar RS800CX heart rate monitor (Polar Electro Oy, Finland). HRV was analyzed according to time and frequency domains and the chaos domain used the autocorrelation coefficient and entropy. The sample consisted of hospitalized PTNB, and static analysis included simple regression diagnosis. Results. A total of 14 PTNB were included in the sample. VA varied between 0.23 and 1.60 cpd, and only five PTNB obtained below-expected values for age. Statistical analysis demonstrated a negative correlation between VA and time domain (SDDN and SD2) and a positive correlation between frequency domain (heart rate and hertz), but in simple linear regression analysis, these variables did not influence VA. Conclusion. The results of the study demonstrate that visual acuity was inversely correlated with SDNN and SD2 and during stimulation, showing that the higher the visual performance, the lower the autonomic modulation response.

A doença causada pelo novo coronavírus (Covid-19) é uma doença, cujas manifestações moderadas e graves exigem internação com oxigenoterapia e ventilação mecânica prolon-gada com grave perda muscular periférica e consequentemente da capacidade funcional. Objetivo: Avaliar e identificar o impacto da reabilitação cardiopulmonar na fase ambulatorial em pacientes após contaminação pelo SARS-CoV-2 (Severe acute respiratory syndrome co-ronavirus 2). Método: O presente estudo é uma revisão narrativa da literatura. Para seleção dos artigos, foram englobadas publicações nacionais e internacionais em ciências da saúde de maneira ampla e selecionados de acordo com o objetivo da pesquisa. Resultado: Dentre 1180 artigos, após exclusão de revisões, diretrizes e consensos, foram incluídos neste estudo apenas oito, voltados à reabilitação cardiopulmonar ambulatorial. A quantidade limitada de estudos possibilitou identificar os princípios e impacto da reabilitação cardiopulmonar no tratamento das complicações da Covid-19. Conclusão: A reabilitação cardiopulmonar baseada em exercício pós internação por Covid-19 pode melhorar a capacidade funcional, pulmonar e a qualidade de vida, e deve ser individualizada e adequada às características dos pacientes, apesar da literatura escassa até o momento

Introduction: The Syndrome Z (SyndZ) has been drawing scientific community’s attention on the past years. It is characterized by the interaction between obstructive sleep apnea (OSA) and Metabolic Syndrome (MetS). On its turn, MetS is knew for the association with various metabolic disturbances occurring simultaneously in the same patient, those of which include central obesity, systemic hypertension (SH), glucose intolerance or insulin resitance, low serum high-density lipoprotein cholesterol (HDL), and elevated serum triglycerides. OSA is a prevalent condition all over the world, and presents potential adverse health outcomes, with a particular impact in cardiovascular diseases. Therefore, OSA and MetS present important cardiovascular risk factors, that when superimposed can mean a higher cardiovascular morbi-mortality. This associated pathogenesis has not been completely elucidated. Objectives: A pilot study to determine the prevalence and severity of SyndZ in severely obese female patients on the waiting list for bariatric surgery. Methods/Design: This cross-sectional study will be conducted with severely obese female patients, on waiting list for bariatric surgery, from the Santa Casa de Misericordia de São Paulo Hospital, in the city of Sao Paulo (Brazil). Demographic, anthropometric and clinical data will be collected, as well as blood’s biochemical analysis. The patients will also undergo standard overnight polysomnography at the Sleep Laboratory of Nove de Julho University.

Background: Although the progressive nature of pulmonary hypertension (PH), including the impairment of respiratory muscle function, studies have demonstrated beneficial effects of physical exercise on the functional limitations caused by the disease in this population, being an important ally to the conventional drug therapy. There is no training protocol focused exclusively on respiratory musculature that is performed without supervision, since these patients have low adherence to the rehabilitation programs performed in an outpatient setting. Respiratory muscle training (RMT) improves functional capacity and quality of life (QoL) in patients with chronic diseases such as heart failure and COPD. However, the effects of an unsupervised RMT protocol on PH are not yet known. Objective: To developed an unsupervised, home-based RMT protocol for patients with PH. Methods: A double-blind, controlled, randomized clinical trial to evaluate the effectiveness of this protocol on respiratory muscle strength and endurance, functional capacity, by the six-minute walk test and QoL with the questionnaire The Medical Outcomes Study 36- item Short Form Health Survey (Sf-36) before and after an unsupervised training protocol and performed in a home environment with POWERbreathe. Two groups (IMT and SHAM) will be followed for 12 weeks with training performed 30 minutes daily. Results: We hope the intervention idealized by the protocol may will increase the respiratory muscle strength and endurance, the walk distance in six-minute walk test and QoL. Conclusions: Patients with PH who perform the intervention with inspiratory muscle training protocol may will be increase the respiratory muscle strength, functional capacity and QoL.

Introduction: Vaginismus is characterized by involuntary recurrent or persistent contraction of the perineum muscles adjacent to the lower third of the vagina when vaginal penetration with penis, finger, tampon or speculum is attempted. However, there may be low adherence to the therapy due to the need of the touch of the perineal region by the therapist. The interferential current can be an alternative, once it can be used externally and superficially. Objective: To evaluate a clinical protocol with the use of interferential current to treat vaginismus and to observe the decrease of pain and the behavior of the electrical activity on the perineal musculature. Methods: The protocol was registered in the Clinical Trials (NCT03176069) and it was approved by the Research Ethics Committee (CAAE: 51995515.4.0000.5479). This will be a controlled clinical trial with a group of patients with Vaginismus (n = 30) and another without (n = 30). All women will be submitted to evaluation and reassessment with algometry, electromyographic biofeedback and visual analogue pain scale. The vaginismus group will perform 10 sessions, twice a week, with the interferential current (frequency = 2000 Hz, modulated amplitude = 80 Hz, pulse width = 200 μs and intensity according to sensory level) for 30 minutes. The evolution of vaginismus group before and after the intervention and the correlations between groups will be statistically analysed with the t Student’s or the Mann-Whitney test with a significance level of 5% (p ≤ 0.05). Hypothesis: This protocol will present a possible alternative for the treatment of vaginismus and it will investigate the electrical activity of the pelvic floor musculature in vaginismus compared to women who do not suffer from this disorder. It is expected to decrease the pain, to measure the muscular electrical activity before and after the intervention in the vaginismus group and to investigate the muscular electrical activity in the group without sexual dysfunction.

To evaluate the effect of high-intensity interval training (HIT) on the cardiorespiratory performance and substrate oxidation pattern in insulin-resistant and insulin-sensitive obese adolescents. Methods: We recruited 25 obese adolescents in three schools, and trained them in six HIT sessions, comprising of six series at 100% and recovery at 50% peak velocity (Vpeak). For the evaluation, the participants were divided into two groups: insulin-resistant (IR, n = 12; HOMA index ≥3.16) and insulin-sensitive (IS, n = 13). All participants underwent cardiopulmonary and indirect calorimetry testing. We compared the effects of HIT before and after the intervention among the two groups. The data were analyzed using Student’s t and Mann–Whitney (intergroup comparisons) and Student’s t and Wilcoxon (pre- and post-training comparisons) tests; and Cohen’s d (influence of HIT). Results: There was a significant post-training increase in Vpeak, oxygen consumption (VO2), velocity (V), and heart rate (HR) at the exertion intensity at the first ventilatory anaerobic threshold (VAT1) in both groups (p < 0.05; d < 0.02). The exercise promoted changes in substrate oxidation rates of the groups, with an increase in carbohydrate oxidation (CHOox) for both IR (p = 0.064) and IS (p = 0.034). Conclusion: Six HIT sessions improved cardiorespiratory performance in both groups and increased CHOox in insulin-sensitive obese adolescents, suggesting its utility for increasing physical fitness and controlling glycemia in these population groups.

Introdução: Uma das técnicas cirúrgicas utilizadas como uma alternativa í amputação no tratamento de sarcomas ósseos é a substituição do segmento acometido por endopróteses não convencionais. Embora a endoprótese melhore a qualidade de vida dos indiví­duos existe uma necessidade de reabilitação intensiva para se obter melhores resultados funcionais. Objetivo: Realizar uma revisão de literatura sobre as intervenções fisioterapêuticas no pós-operatório de endoprótese não convencional de tí­bia proximal, para o tratamento de sarcomas ósseos. Métodos: Revisão de literatura, direcionada a protocolos fisioterapêuticos na reabilitação de pacientes submetidos í cirurgia de preservação de membros de tí­bia proximal. Resultados: Dentre os artigos estudados, três foram selecionados para comparação de protocolos fisioterapêuticos de tratamento no pós-operatório de cirurgia de preservação de membros de tí­bia proximal. Conclusão: Concluiu-se que é necessário um maior incentivo no desenvolvimento de pesquisas relacionadas a protocolos de reabilitação fisioterapêutica no pós-operatório de LSS em tí­bia proximal, para que sejam obtidas mais alternativas de tratamento que visam melhorar a qualidade de vida e sobrevida destes pacientes.Palavras-chave: osteossarcoma, próteses e implantes, tí­bia, salvamento de membro, joelho.

Investigar por meio de uma revisão sistemática o impacto do uso de cicloergômetro na função respiratória, cardiovascular, capacidade aeróbica, funcional e qualidade de vida em pacientes com doença renal crônica durante a hemodiálise. Métodos: A pesquisa buscou referências de janeiro de 2010 a dezembro de 2018. Foram incluí­das as bases Pubmed, Scielo, PEDro, Lilacs e Cochrane Library e foram usadas palavras-chave pré-selecionadas. Os artigos encontrados foram avaliados pela escala PEDro. A busca e análise foram realizadas por dois autores de forma independente. Resultados: Um total de 81 artigos foi identificado, no entanto apenas quatro atendiam aos critérios de inclusão e exclusão. Devido ao pequeno número de artigos incluí­dos e í sua heterogeneidade, seus resultados não puderam ser submetidos í metanálise e foram apresentados de forma descritiva. Conclusão: O exercí­cio aeróbico com uso de cicloergômetro realizado durante as sessões de hemodiálise promove melhora da capacidade aeróbia e condicionamento fí­sico e por consequência na qualidade de vida.Palavras-chave: doença renal crônica, diálise renal, terapia por exercí­cio, técnicas de exercí­cio e de movimento.

Bladder cancer is a worldwide health problem, due to both its high prevalence and the cost related to the treatment. It is usually identified on the basis of visible blood in the urine or blood found on urine testing, but emergency admission is a common way for bladder cancer to present and is often associated with a poor prognosis. The contracted bladder is a rare and serious complication which is disabling. In these cases, there is a need for a neobladder, which may lead to voiding dysfunction. Physiotherapeutic avenues have demonstrated effectiveness in the treatment of voiding dysfunction; they rehabilitate the individual and improve their quality of life. This study reports the case of a male patient who underwent transurethral resection of a bladder tumour (high-grade T1 carcinoma), which developed complications during treatment with Bacillus Calmette-Guérin. He also underwent cystoprostatectomy with ileal orthotopic neobladder.

MEPS, the acronym of microextraction by packed sorbent, is a simple, fast and user- and environmentally-friendly miniaturization of the popular solid-phase extraction technique (SPE). In fact, it has been widely shown that MEPS can easily replace SPE for most, if not all, previous applications. It can attain this with obvious gains in sample and solvent usage, which is greatly reduced without compromising the extraction efficiency. Furthermore, MEPS can be operated with semiautomatic electronic syringes, making it very reliable and versatile, particularly to handle very low and very high sample volumes. This review will focus on the strengths and weaknesses of this technique and the different MEPS architectures commercially available in the context of the MEPS applications reported in the last five years. Additionally, innovative improvements will be highlighted, particularly those related with new applications and recent MEPS configurations and sorbents, such as the controlled directional flow or the innovative μSPEed variant.

Background: Children with Down Syndrome have poorer functional and sensory skills compared to children with typical development. Virtual reality training could help improve these skills. Moreover, transcranial direct current stimulation has achieved promising results in terms of enhancing the effects of physical and sensory therapy by modulating cortical excitability. Methods/design The sample will be defined after conducting a pilot study with the same methodology as that to be used in the main study. The study will involve individuals with Down Syndrome with a cognitive age of six to 12 years according to the Wechsler Abbreviated Intelligence Scale. Will be randomly allocated into two groups: Group 1 AtDCS combined with a virtual reality game and a manual motor task. Group 2 sham AtDCS with a virtual reality game and a manual motor task. The training protocol will involve 10 sessions of AtDCS during memory and motor task games. Three 20-minute sessions will be held per week for a total of 10 sessions. Evaluations will be performed on three different occasions: pre-intervention, post-intervention (after session 10) and follow-up (one month after the proposed training). The evaluations will consist of an analysis of electroencephalographic signals, electromyographic signals of the biceps and triceps brachii and the three-dimensional reconstruction of the reaching movement. The results will be analyzed statistically, with the significance level set at 5% (p ≤ 0.05). Discussion: The optimization of the results obtained is believed to be related to interactive training with a wide range of activities and scenarios involving multiple sensory channels and the creation of exercises, the intensity of which can be adjusted to the needs of individuals. Therefore, the proposed study aims to complement the literature with further information and different variables to provide the scientific community with clinical data on this combination of interventions. Trial Registration: REBEC protocol number RBR-43pk59 registered on 2019/03/27 and Human Ethics Committee number 3.608.521 approved on 2019/09/30.

Endometriosis is characterised by the presence of endometrial tissue outside the uterine cavity that responds to oestrogen and stimulates local inflammatory processes, adhesions, pelvic pain, and infertility. The treatment of endometriosis includes the use of medications and videolaparoscopy for excision of adhesions or lesions. Some complications are associated with the videolaparoscopy, such as vascular, intestinal, urinary, neurological, and more rarely, vulvar oedema, which makes the rehabilitation difficult in the immediate postoperative period. In relation to the urinary dysfunction and to the vulvar oedema, physiotherapy has resources with demonstrated efficacy in the treatment of such complications after videolaparoscopy; they can rehabilitate the patient and improve their quality of life in a short time. In this study, the authors report the case of a patient treated by the Physical Therapy Service of the Santa Casa de Misericórdia Hospital of São Paulo, São Paulo, Brazil, with urinary retention and vulvar oedema after videolaparoscopy for endometriosis, which showed improvement in vulvar oedema with the application of physiotherapy.

O Unidos pela Vida – Instituto Brasileiro de Atenção à Fibrose Cística é uma organização da sociedade civil, que tem como missão fortalecer e desenvolver o ecossistema da fibrose cística por meio de ações que impactem na melhora da qualidade de vida dos pacientes, familiares e demais envolvidos. Desenvolve nacionalmente projetos ligados à comunicação, suporte, incentivo à atividade física, desenvolvimento organizacional, políticas públicas, advocacy, educação e pesquisa. Dentro deste último eixo de atuação, apresenta orgulhosamente esta Edição Especial, graças à parceria com a Universidade Federal do Paraná e com a Revista Visão Acadêmica. O Instituto tem sede em Curitiba e atuação nacional. Para saber mais: www.unidospelavida.org.br - contato@unidospelavida.org.br

The autonomic nervous system (ANS) plays an important role in modulating bronchial smooth muscle contractility, which is altered in cystic fibrosis (CF). A convenient approach to probe ANS regulation is the quantitative analysis of heart rate variability (HRV). The purpose of this study was to evaluate ANS regulation in children with CF and to investigate the influence of colonization by Pseudonomas aeruginosa via assessment of HRV in colonized CF (CCF) children and noncolonized CF (NCCF) children. Sixteen children with CF (7 CCF and 9 NCCF) and seven healthy age-matched control children were enrolled in the study. Heart rate was recorded for 10 min at rest in the supine and standing positions and HRV analysis was carried out using autoregressive spectral analysis. The CCF group was characterized by lower forced expiratory volume than NCCF, indicating an impairment of respiratory function. The HRV parameters further confirmed the possible sympathetic overactivity in CCF. Children with CF exhibited hyperactivity of the sympathetic nervous system. In particular, the CCF group presented a greater impairment of ANS modulation. Both CCF and NCCF children showed lower supine vagal activation in the HRV indices related to sympathetic activation and reduction of indices indicating vagal activity with the postural change from supine to standing when compared to the NCCF group.

O objetivo deste estudo foi avaliar a correlação entre depressão e qualidade de vida em indivíduos com lombalgia. Participaram do estudo 51 indivíduos de ambos os sexos, com média de idade de 33,35 ± 12,34, sendo 90,2% do gênero feminino, submetidos à aplicação de ficha de avaliação e questionário (Inventário de Depressão de Beck, Whoqol-bref e Índice Funcional de Oswestry). Como resultado houve efeito significativo da Oswestry sobre as classificações de Beck (p=0,003) e um efeito significativo da classificação da depressão sobre os domínios da qualidade de vida (p=0,001). A média de Oswestry dos indivíduos com depressão foi moderada e significantemente maior que nos indivíduos sem depressão (p=0,002). Conclui-se com este trabalho que existe uma correlação positiva da depressão e o índice de qualidade de vida em indivíduos com lombalgia.

As doencas degenerativas da coluna vertebral sao condicoes que envolvem a perda de estrutura e a funcao normal da coluna e podem levar a piora da capacidade funcional, a diminuicao da tolerância ao exercicio e a reducao da qualidade de vida por claudicacao neurogenica e dor lombar cronica. A escolha da artrodese ocorre devido a presenca de lesao neurologica evolutiva ou dor intratavel. Objetivo: Analisar e comparar valores espirometricos e forca muscular respiratoria em pacientes com estenose lombar. Metodo: Estudo transversal com 38 pacientes de ambos os sexos, dividido em um grupo de 19 pacientes operados e outro grupo de 19 pacientes que aguardavam cirurgia, com idade entre 50 e 80 anos, que foram avaliados por espirometria e manovacuometria. Resultados: Em nosso estudo, observou-se que a funcao pulmonar estavam dentro dos valores de referencias, considerando que o grupo de pacientes operados apresentou melhor desempenho em espirometria e manovacuometria. Conclusao: pacientes operados apresentaram melhora na funcao pulmonar em comparacao com pacientes nao operados.

Objective: To analyze the impact of a physiotherapy protocol in maximum inspiratory and expiratory pressure in patients with adolescent idiopathic scoliosis (AIS) by manovacuometry. AIS may change the respiratory dynamics and the performance of inspiratory and expiratory muscles, affecting ventilatory capacity. Methods: Patients with AIS aged 10 to 20 years old were randomly assigned to receive an aerobic exercise-training program or no treatment. They were evaluated for respiratory muscle strength before and after the treatment period by means of manovacuometry, thorax and spine radiographs. Physical therapy exercising protocol comprised three weekly sessions including stretching and aerobic exercises during four months. Results: Forty five patients received physical therapy and 45 patients received no treatment (control group). The mean maximum inspiratory pressure (Pimax) was -52.13 cm H20 and the maximum expiratory pressure (Pemax) was 62.38 cm H20. There was a significant increase of Pimax and Pemax (p=0,000) in the group receiving physical therapy. There were no drop-outs and no adverse events in this study. Respiratory muscle strength, scoliosis and kyphosis degrees were not statistically correlated. Conclusion: Exercising is beneficial to patients with AIS, who have shown significant increases in respiratory muscle strength after physical therapy. There was no correlation between respiratory pressure and spine deformity. Level of Evidence I, High quality randomized trial.

Introducao : A pandemia da COVID-19 gerou a necessidade do estudo de medidas que possam alterar a evolucao da doenca, principalmente na internacao hospitalar com o paciente que apresenta sinais de insuficiencia respiratoria e alteracao da oxigenacao que classifica a gravidade dos pacientes e a posicao PRONA pode tornar-se um recurso indicado. Objetivo: Apresentar uma experiencia de utilizacao da posicao PRONA intermitente em paciente sem o suporte ventilatorio invasivo com diagnostico de COVID-19 sob internacao hospitalar. Relato de Caso : Homem de 49 anos, com COVID-19, antecedente de asma controlada, com tres dias de sintomas, que foi internado devido a piora clinica com evolucao grave nos primeiros seis dias de internacao. Foi indicada a utilizacao da PRONA a partir do terceiro dia. O paciente adotou o recurso espontaneamente com aumento progressivo e referia se posicionar devido a percepcao de melhora do desconforto respiratorio. As imagens radiograficas de torax, uso de oxigenoterapia em alta concentracao e o calculo da PaO2 /FiO2 demonstraram que o paciente era de extrema gravidade. Apos 17 dias de uso da PRONA o paciente recebeu alta, sem dependencia de oxigenio, independente e sem complicacoes relacionadas ao posicionamento. Conclusao : A posicao PRONA mostrou-se como alternativa possivel, promissora, de baixo custo e risco, com sucesso para este paciente que recebeu alta hospitalar sem o uso de oxigenoterapia. Palavras-chave: Infeccoes por coronavirus, Decubito ventral, Respiracao, Fisioterapia, Pneumonia ABSTRACT Introduction: The pandemic of COVID-19 developed the need to study measures that can change the evolution of the disease, especially in hospitalization with the patient who shows signs of respiratory failure. This happened because the alteration of oxygenation classifies the severity of patients made the prone position an indicated resource. Objective: To present an experience of using the intermittent prone position in a patient without invasive ventilatory support diagnosed with COVID-19 during hospitalization. Case Report : A 49-year-old man with COVID-19, with history of controlled asthma, with three days of symptoms, who was hospitalized due to clinical worsening with severe evolution in six days initially of hospitalization. The use of the prone was indicated in the third day. Afterwards, the patient spontaneously adopted the resource with progressive increase and referred to position himself due to the perception of improvement in respiratory distress. Radiographic images of the chest, use of oxygen in high concentration and the calculation of PaO2 / FiO2 demonstrated that the patient was extremely serious. After 17 days, the patient was discharged, without oxygen dependence, independently and without complications related to positioning. Conclusion : The prone position proved to be a possible, promising, low cost and risky alternative, successfully for this patient who was discharged from the hospital without the use of oxygen therapy. Keyworks: Coronavirus infections, Prone position, Respiration, Physical therapy specialty, Pneumonia

OBJETIVO: Avaliar o impacto da cinesioterapia laboral na qualidade de vida dos auxiliares de enfermagem de um centro cirúrgico geral de um hospital universitário de um hospital terciário da cidade de São Paulo.MÉTODOS: Ensaio clínico prospectivo, duplo-cego, randomizado em grupo de intervenção e de controle, realizado com auxiliares de enfermagem atuantes em centro cirúrgico. O protocolo do estudo foi dividido em três etapas, onde foi avaliada a qualidade de vida pelo questionário Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), ministrada aula educativa e os participantes foram submetidos à cinesioterapia laboral por um período de 15 minutos, três vezes por semana durante dois meses no local de trabalho. A análise descritiva foi realizada entre as variáveis de interesse.RESULTADOS: Foram elegíveis para o estudo 90 participantes e excluídos 44 por não atenderem aos critérios de inclusão. Foram randomizados 46 pacientes e alocados 23 em cada grupo (controle e intervenção). Os participantes do grupo intervenção demonstraram aumento significativo após o protocolo proposto de cinesioterapia laboral, nos escores de capacidade funcional (p=0,001), aspectos físicos (p=0,001) e dor (p=0,001) avaliados pelo questionário SF-36.CONCLUSÕES: A cinesioterapia laboral foi eficaz na melhora da qualidade de vida, com valores estatisticamente significante nos escores de dor, da capacidade funcional e dos aspectos físicos, avaliados por meio do questionário de qualidade de vida SF-36.

Question: In adolescents with idiopathic scoliosis, does combined aerobic and resistance training improve respiratory function, perceived exertion and functional exercise capacity more than aerobic training only? Design: Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. Participants: Forty adolescents with idiopathic scoliosis and formal indication for surgical correction (spinal curvature ≥ 45 deg). Intervention: Both groups undertook three 60-minute training sessions per week for 12 weeks. The experimental group performed combined aerobic and resistance training and the control group performed only aerobic training. Outcome measures: At baseline and upon completion of treatment, participants completed: a 6-minute walk test with Borg scale (0 to 10) rating of exertion, spirometry, maximal respiratory pressures and peak expiratory flow measurement. Results: After 12 weeks of training, the experimental group improved more than the control group on the 6-minute walk test (MD 22 m, 95% CI 4 to 40), with lower perceived exertion at the end of the test (MD –1.2, 95% CI –1.9 to –0.4). The experimental group also improved more than the control group on several respiratory measures, including: FEV1 (MD 270 ml, 95% CI 30 to 510), maximal inspiratory pressure (MD 4 cmH2O, 95% CI 1 to 8) and peak expiratory flow (MD 33 l/minute, 95% CI 7 to 58). Conclusion: In adolescents with idiopathic scoliosis, combined aerobic and resistance training improves functional exercise capacity and several respiratory outcomes more than a similar training regimen with aerobic training only. It is unclear whether the magnitude of the benefits is large enough to be worthwhile. Trial registration: NCT02413788. Key words: Exercise, Exercise test, Resistance training, Physical therapy, Scoliosis

Background Obesity is a worldwide disease related to genetic, environmental, and behavioral factors, and it is associated with high rates of morbidity and mortality. Recently, obesity has been characterized by a low-grade inflammatory state known as inflammome indicated by chronic increases in circulating concentrations of inflammatory markers. The purpose of this study was to evaluate the effect of weight loss induced by surgery for obesity and weight-related diseases on pro-inflammatory cytokine (TNF-α) and anti-inflammatory adipokine (adiponectin) levels, and on an adipose-derived hormone (leptin) in severely obese subjects. Methods This randomized, controlled trial involved 55 severe obese patients (50 women, age 18–63 years, and body mass index of 35.7–63 kg/m2) who underwent bariatric surgery (BS). Patients with a BMI > 65 kg/m2 and clinical and mental instability, or significant and unrealistic expectations of surgery were excluded. Blood samples were collected during the fasting period to analyze tumor necrosis factor alpha (TNF-α), adiponectin, and leptin levels by enzyme-linked immunosorbent assay. Results At baseline, no significant difference was observed in the anthropometric, demographic, clinical characteristics and biochemistry and inflammatory markers between the control group (CG) and bariatric surgery group (BSG). The same finding was also observed when we compared the baseline variables to those at the 6-month follow-up in the CG. However, the same variables in the BSG group were significantly different between baseline and the 6-month follow-up after BS. Conclusions Weight loss induced by surgery for obesity and weight-related diseases reduced the inflammome state in severely obese patients.

Antecedentes: A hipertensao arterial sistemica (HAS) e uma doenca cardiovascular comum que reflete uma importante incidencia e prevalencia para a saude publica, sendo a apneia obstrutiva do sono (AOS) considerada a segunda causa de HAS. O exercicio aerobico e uma das acoes para controlar as alteracoes da pressao arterial. Objetivos: Verificar o perfil antropometrico, a aptidao fisica, a funcao pulmonar, a presenca de disturbios respiratorios do sono e o comportamento da atividade autonomica em hipertensos submetidos ao treinamento aerobico. Metodos / Projeto: Este e um estudo randomizado, controlado e cego. O desenho, conducao e relatorio deste estudo seguiram as diretrizes do CONSORT (declaracao CONsolidated Standards of Reporting Trials). O estudo sera realizado entre julho de 2015 e dezembro de 2017, e incluira pacientes hipertensos controlados de ambos os sexos, com idade entre 30 e 70 anos, com diagnostico clinico de hipertensao primaria (estagio 1, pressao arterial sistolica e diastolica com variacoes de 140/79 a 90/109 mmHg), controlados por medicamentos especificos, que nao contem betabloqueadores. Os pacientes que nao apresentarem liberacao clinica para participar do programa de treinamento, com presenca de outra doenca cardiovascular ou doenca nos orgaos-alvo e que apresentarem os fatores de risco de fumaca e alcool, estarao nos criterios de exclusao. A amostra sera de conveniencia, encaminhada pela Secretaria de Saude do Bairro Aeroporto Velho e pela Unidade de Referencia Especializada - URE de Santarem (PA). Inicialmente, sera uma avaliacao clinica realizada por um cardiologista e os sujeitos serao submetidos a varios exames de rotina, como ecocardiograma, radiografia de torax e exames laboratoriais (hemograma completo, glicose, glicemia de jejum, colesterol e fracoes totais, triglicerideos, proteina C reativa , potassio, etc). Apos a avaliacao medica inicial, serao aplicados alguns questionarios e outros testes especificos, como o Questionario de Qualidade de Vida (SF-36), Questionario de prontidao para atividade fisica, Questionario de Berlim, Escala de sonolencia Epworth, Escala de sonolencia de Stanford, Escala de sonolencia de Stanford, Monitoramento cardiorrespiratorio do sono, Questionario de aptidao fisica , monitoramento da variabilidade da frequencia cardiaca, testes de funcao pulmonar e teste de caminhada de seis minutos. Todos os pacientes realizarao os testes antes e apos o protocolo de exercicios de reabilitacao de 12 semanas. O protocolo de treinamento aerobico sera de 30 a 60 minutos, com intensidade variando entre 70% e 85% da FC maxima alcancada no teste de esforco de avaliacao funcional e sera realizado por tres meses, tres vezes por semana. INSCRICAO DO TESTE: Este estudo de protocolo foi aprovado pelo Comite de Etica em Pesquisa da Universidade Nove de Julho (UNINOVE), Brasil, processo no 370474/2010, e sera registrado no ensaiosclinicos.gov.br

OBJECTIVE: To analyze the clinical and radiographic changes in patients with postural rounded upper back. METHODS: 30 patients diagnosed with postural rounded upper back were studied, being 22 male and eight female, aged between 10 and 20 years, referred by the outpatient clinic of the Grupo de Cirurgia da Coluna of the Irmandade da Santa Casa de Misericórdia de São Paulo, SP, Brazil. Patients underwent assessment of posture, special tests to check for muscle retractions and radiographic examination to measure the curvatures of spine using the Cobb method. RESULTS/CONCLUSION: It is concluded that in the postural roundback there is a moderate increase of the thoracic kyphosis; the lumbar and cervical curvatures do not increase as a compensatory mechanism; the head appears anteriorized and the shoulder is also anteriorized and medially rotated; muscle retractions are present in the hamstrings, hip flexors, pectoralis minor and adductors of the shoulder muscles; the mobility of the lumbar spine is preserved and there is no relationship between the magnitude of thoracic curvature and the retraction of the hamstring muscles. OBJETIVO: Analisar as alterações clínicas e radiográficas do paciente com dorso curvo postural. MÉTODOS: Foram estudados 30 pacientes com diagnóstico de dorso curvo postural, sendo 22 do sexo masculino e oito do feminino, com idades entre 10 e 20 anos, encaminhados pelo ambulatório do Grupo de Cirurgia da Coluna da Irmandade da Santa Casa de Misericórdia de São Paulo, SP, Brasil. Os pacientes foram submetidos à avaliação da postura, a testes especiais para verificar as retrações musculares e a exame radiográfico para mensurar as curvaturas da coluna vertebral pelo método de Cobb. RESULTADOS/CONCLUSÃO: Concluímos que no dorso curvo postural existe um aumento moderado da cifose torácica; as curvaturas lombar e cervical não aumentam como mecanismo compensatório; a cabeça apresenta-se anteriorizada e os ombros anteriorizados e rodados medialmente; as retrações musculares estão presentes nos músculos isquiotibiais, flexores do quadril, peitoral menor e adutores do ombro; a mobilidade da coluna lombar está preservada e não existe relação entre a magnitude da curvatura torácica e a retração dos músculos isquiotibiais. OBJETIVO: Analizar las características clínicas y radiológicas del paciente con dorso curvo postural. MÉTODOS: Se estudiaron 30 pacientes con diagnóstico de dorso curvado postural, siendo 22 hombres y ocho mujeres, con edades entre 10 y 20 años, encaminados por el ambulatorio del Grupo de Cirurgia da Coluna da Irmandade da Santa Casa de Misericórdia de São Paulo, SP, Brasil. Los pacientes se sometieron a la evaluación de la postura, pruebas especiales para detectar las retracciones musculares y examen radiográfico para medir las curvaturas de la columna vertebral por el método de Cobb. RESULTADOS/CONCLUSIONES: Se concluye que en el dorso curvado postural hay un aumento moderado de la cifosis torácica; las curvaturas lumbar y cervical no aumentan como mecanismo compensatorio; la cabeza se presenta anteriorizada y el hombro también es anteriorizado y con rotación medial; las retracciones musculares están presentes en los músculos isquiotibiales, flexores de la cadera, pectoral menor y aductores del hombro; la movilidad de la columna lumbar se conserva preservada y no hay relación entre la magnitud de la curvatura torácica y la retracción de los músculos isquiotibiales.

The purpose of this study was to assess the effectiveness of global postural reeducation (GPR) relative to segmental exercises (SE) in the treatment of scapular dyskinesis (SD) associated with neck pain.Participants with SD and neck pain (n = 30) aged 18 to 65 years were randomly assigned to one of two groups: GPR and SE (stretching exercises). The upper extremity was assessed using the Disabilities of the Arm, Shoulder, and Hand questionnaire; function of the neck was estimated using the Neck Disability Index; pain severity was measured using a visual analogical scale; and health-related quality of life was assessed using the Short Form-12. Assessments were conducted at baseline and after 10 weekly sessions (60 minutes each). The significance level adopted was α.05.For pre-post treatment comparisons, GPR was significantly associated with improvements in function of neck and upper extremities, pain, and physical and mental domains of quality of life (P.05). Segmental exercises improved function of upper extremities and of the neck and severity of pain (P.05). When contrasting groups, GPR was significantly superior to SE in improving pain and physical domains of the quality of life.This study showed that GPR and SE had similar effects on function of the neck and upper extremity in patients with SD associated with neck pain. When comparing groups, GPR was superior to SE in improving pain and quality of life.

Objective: To evaluate heart rate variability during an inspiratory muscle endurance protocol at three different load levels [30%, 60% and 80% of maximal inspiratory pressure], in patients who had previously undergone coronary artery bypass grafting. Methods: Nineteen late postoperative myocardial revascularization patients participating in a cardiovascular rehabilitation program were studied. Maximal inspiratory pressure maneuvers were performed. An inspiratory muscle endurance protocol at 30%, 60% and 80% of maximal inspiratory pressure was applied for four minutes each, in random order. Heart rate and RR intervals were recorded and heart rate variability was analyzed by time (RMSSD-the mean of the standard deviations for all R-R intervals, and RMSM-root-mean square differences of successive R-R intervals) and frequency domains indices (high and low frequency) in normalized units. ANOVA for repeated measurements was used to compare heart rate variability indices and Student t-test was used to compare the maximal inspiratory pressure and maximal expiratory pressure values. Results: Heart rate increased during performance of maximal respiratory pressures maneuvers, and the maximal inspiratory pressure and maximal expiratory pressure mean values were significantly lower than predicted values (P

Study design Clinical prospective, random study. Objective Analyze the results of the six-minute walk test (6MWT) in patients with adolescent idiopathic scoliosis. Summary of background data Although it is widely believed that Adolescent Idiopathic Scoliosis (AIS) causes cardiorespiratory dysfunctions, there is no report in literature of objective measurements of this restriction in the ventilatory performance during physical exertion. Methods One hundred twenty-six adolescents matched by gender and age were prospectively studied at a tertiary teaching institution: 40 patients without spine deformities (group I-controls), and 86 patients with AIS with a spine curve ranging from 45 degrees to 138 degrees (group II). All patients underwent radiographic evaluations and the 6MWT. Results Normal controls presented significantly lower mean heart rate and Borg scores, as well as higher oxygen saturation and walked longer distances on the 6MWT. Conclusion The 6MWT effectively demonstrated the cardiorespiratory restrictions presented by patients with AIS.

JUSTIFICATIVAS E OBJETIVOS: A manobra de recrutamento alveolar (MRA) é indicada no tratamento de atelectasias intraoperatórias. O objetivo do presente estudo foi comparar duas técnicas de MRA por meio da resposta da relação PaO2/FiO2 e da soma [PaO2+PaCO2], em pacientes obesos grau III. MÉTODO: Estudo prospectivo aberto em pacientes adultos, obesos grau III, submetidos a procedimento cirúrgico bariátrico em ventilação controlada a volume, pressão positiva no final da expiração (PEEP) de 5 cmH2O e divididos em três grupos: G CONT: PEEP de 5 cmH2O; G MRA10/15/20 após sutura da aponeurose: aumento progressivo da PEEP para 10,15 e 20 cmH2O, pausa de 40 segundos e manutenção de cada valor da PEEP por 2 minutos; G MRA30: após sutura da aponeurose: aumento súbito da PEEP para 30 cmH2O, 40 segundos de pausa e manutenção da PEEP em 30 cmH2O por dois minutos. Foram analisadas as variáveis frequência cardíaca, pressão arterial média, sistólica, diastólica, pressão média das vias aéreas (P MVA) e de platô (P PLAT), pressão arterial de oxigênio (PaO2), pressão arterial de CO2 (PaCO2), relação PaO2/FiO2 (fração inspiratória de oxigênio) e soma [PaO2+PaCO2]. RESULTADOS: As variáveis que apresentaram diferença estatística significativa entre os três grupos foram: P PLAT, P MVA, PaO2, relação PaO2/FiO2 e soma [PaO2+PaCO2] (p < 0,0001). Na comparação dos grupos dois a dois, verificou-se diferença estatística significativa para as variáveis P PLAT e P MVA: G CONT X G MRA10/15/20 e G CONT X G MRA30 e para as variáveis relação PaO2/FiO2 e soma [PaO2+PaCO2]: G CONT X G MRA30. CONCLUSÕES: A técnica de MRA com aumento súbito da PEEP para 30 cm H2O mostrou a melhor resposta da relação PaO2/FiO2. BACKGROUND AND METHDS: Alveolar recruitment maneuver (ARM) is indicated in the treatment of intraoperative atelectasis. The objective of the present study was to compare two techniques of ARM using the response of the PaO2/FiO2 ratio and [PaO2 + PaCO2] in patients with grade III obesity. METHODS: This was an open prospective study with adult patients with grade III obesity who underwent bariatric surgery under volume-controlled mechanical ventilation with positive end-expiratory pressure (PEEP) of 5 cmH2O, divided in three groups: G CONT: PEEP of 5 cmH2O; G ARM10/15/20 after suture of the aponeurosis: progressive increase in PEEP to 10, 15, and 20 cmH2O with a 40-second pause and maintaining each level of PEEP for 2 minutes; and G ARM30 after suture of the aponeurosis: sudden increase in PEEP to 30 cmH2O with a 40-second pause and maintaining a PEEP of 30 for 2 minutes. Heart rate, mean arterial pressure, systolic and diastolic blood pressure, mean (P AW) and plateau (P PLAT) airways pressure, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), PaO2/FiO2 ratio (inspired fraction of oxygen), and [PaO2 + PaCO2] were analyzed. RESULTS: The following parameters showed statistically significant differences among the study groups: P PLAT, P AW, PaO2, PaO2/FiO2 ratio, and [PaO2 + PaCO2] (p < 0.0001). Comparing the groups two by two, the following parameters showed statistically significant differences: for P PLAT and P AW: G CONT x G2ARM10/15/20 and G CONT x G ARM30; and for PaO2/FiO2 ratio and [PaO2 + PaCO2]: G CONT x G ARM30. CONCLUSIONS: Alveolar recruitment maneuver with sudden increase of PEEP to 30 cmH2O showed a better response of the PaO2/FiO2 ratio. JUSTIFICATIVAS Y OBJETIVOS: La maniobra de reclutamiento alveolar (MRA) se indica en el tratamiento de atelectasias intraoperatorias. El objetivo del presente estudio fue comparar dos técnicas de MRA por medio de la respuesta de la relación PaO2/FiO2 y de la suma [PaO2+PaCO2], en pacientes obesos con grado III. MÉTODO: Estudio prospectivo abierto en pacientes adultos, obesos grado III, sometidos a procedimiento quirúrgico bariátrico en ventilación controlada a volumen, presión positiva al final de la expiración (PEEP) de 5 cmH2O y divididos en tres grupos: G CONTROL: PEEP de 5 cmH2O; G MRA10/15/20 después de la sutura de la aponeurosis: aumento progresivo de la PEEP para 10,15 y 20 cmH2O, pausa de 40 segundos y mantenimiento de cada valor de la PEEP por 2 minutos; G MRA30: después de la sutura de la aponeurosis: aumento súbito de la PEEP para 30 cmH2O, 40 segundos de pausa y mantenimiento de la PEEP en 30 cmH2O por dos minutos. Se analizaron las variables frecuencia cardíaca, presión arterial promedio, sistólica, diastólica, presión promedio de las vías aéreas (P MVA) y de meseta (P PLAT), presión arterial de oxígeno (PaO2), presión arterial de CO2 (PaCO2), relación PaO2/FiO2 (fracción inspiratoria de oxígeno) y suma [PaO2+PaCO2]. RESULTADOS: Las variables que presentaron una diferencia estadística significativa entre los tres grupos fueron: P PLAT, P MVA, PaO2, relación PaO2/FiO2 y suma [PaO2+PaCO2] (p < 0,0001). En la comparación de los grupos dos a dos, se verificó una diferencia estadística significativa para las variables P PLAT y P MVA: G CONTROL X G MRA10/15/20 y G CONTROL X G MRA30 y para las variables relación PaO2/FiO2 y suma [PaO2+PaCO2]: G CONTROL X G MRA30. CONCLUSIONES: La técnica de MRA con aumento súbito de la PEEP para 30 cm H2O mostró la mejor respuesta de la relación PaO2/FiO2.

Introduction Bronchiectasis is a chronic disorder characterised by permanent and irreversible abnormal dilation of the bronchi and bronchioles, primarily caused by repeated cycles of pulmonary infections and inflammation, which lead to reduced mucociliary clearance and to the excessive production of sputum. Patients with non-cystic fibrosis bronchiectasis may be predisposed to hypoxemia during sleep, or to symptoms that may lead to arousals and thereby reduce the quality of life, because of the irreversible dilation of the bronchi and the presence of secretions and airflow obstruction. Methods and analysis For this cross-sectional observational study, patients with a clinical diagnosis of non-cystic fibrosis bronchiectasis will be recruited from the Bronchiectasis Clinic of the Pneumology Department of the Santa Casa de Misericordia Hospital and the Federal University of São Paulo (São Paulo, Brazil). Patients of either sex will be included if high-resolution CT of the thorax and classic sweat test confirms they have non-cystic fibrosis bronchiectasis, are between 18 and 80 years old, use long-acting bronchodilators, are clinically stable for a least 1 month, agree to participate in the study and they sign a statement of informed consent. The first part of the study will involve a clinical evaluation, maximal respiratory pressures, spirometry and the Saint George's Respiratory Questionnaire. The Sleep Laboratory of the Master's and Doctoral Postgraduate Program in Rehabilitation Sciences of the Nove de Julho University (São Paulo, Brazil) will perform the polysomnographic studies, Berlin Questionnaire, Epworth Sleepiness Scale, waist and neck circumferences, modified Mallampati classification and tonsil index. Ethics and dissemination This protocol has been approved by the Human Research Ethics Committees of Santa Casa de Misericordia Hospital (process number 178/2012) and Human Research Ethics Committee of Nove de Julho University (process number 370474/2010). All participants will sign a statement of informed consent. The study findings will be published in peer-reviewed journals and presented at conferences.

O envelhecimento traz aspectos sociais e físicos que devem ser considerados pelos profissionais da saúde para adequar o dia a dia dos pacientes à rotina medicamentosa. A prevalência da hipertensão arterial sistêmica e a necessidade do consumo regular das medicações de controle interferem diretamente na morbimortalidade dos idosos hipertensos e em sua qualidade de vida. Assim, objetivamos avaliar a qualidade de vida e a aderência ao tratamento da hipertensão em idosos, analisando o impacto de um manual de orientações para a rotina medicamentosa em idosos hipertensos institucionalizados e de uma comunidade de um município paulista. Foram incluídos 28 idosos alocados em dois grupos: intervenção (receberam as orientações de um manual para o consumo das medicações) e controle (não receberam orientações adicionais na rotina medicamentosa). Todos foram avaliados e reavaliados após dois meses com o teste de Morisky-Green e os questionários WHOQOL-OLD e BREF, sendo observado o aumento da pontuação da primeira pergunta do primeiro teste e da pontução de alguns domínios do questionário OLD após a reavaliação no grupo intervenção. Por fim, foi possível perceber que houve melhora na qualidade de vida dos idosos após terem recebido as orientações do manual proposto.

To create a clinical database of respiratory function in patients with adolescent idiopathic scoliosis; computerize and store this clinical data through the use of a software; incorporate this electronic protocol to the SINPE© (Integrated Electronic Protocols System) and analyze a pilot project with interpretation of results.From the literature review a computerized data bank of clinical data of postural deviations was set up (master protocol). Upon completion of the master protocol a specific protocol of respiratory function in patients with adolescent idiopathic scoliosis was designed and a pilot project was conducted to collect and analyze data from ten patients.It was possible to create the master protocol of postural deviations and the specific protocol of respiratory function in patients with adolescent idiopathic scoliosis. The data collected in the pilot project was processed by the SINPE ANALYZER©, generating charts and statistics.The establishment of the clinical database of adolescent idiopathic scoliosis was possible. Computerization and storage of clinical data using the software were viable. The electronic protocol of adolescent idiopathic scoliosis could be incorporated into the SINPE© and its use in the pilot project was successful.

Introduction Bronchiectasis is a chronic disorder characterised by permanent and irreversible abnormal dilation of the bronchi and bronchioles, primarily caused by repeated cycles of pulmonary infections and inflammation, which lead to reduced mucociliary clearance and to the excessive production of sputum. Patients with non-cystic fibrosis bronchiectasis may be predisposed to hypoxemia during sleep, or to symptoms that may lead to arousals and thereby reduce the quality of life, because of the irreversible dilation of the bronchi and the presence of secretions and airflow obstruction. Methods and analysis For this cross-sectional observational study, patients with a clinical diagnosis of non-cystic fibrosis bronchiectasis will be recruited from the Bronchiectasis Clinic of the Pneumology Department of the Santa Casa de Misericordia Hospital and the Federal University of Sao Paulo (Sao Paulo, Brazil). Patients of either sex will be included if high-resolution CT of the thorax and classic sweat test confirms they have non-cystic fibrosis bronchiectasis, are between 18 and 80 years old, use long-acting bronchodilators, are clinically stable for a least 1 month, agree to participate in the study and they sign a statement of informed consent. The first part of the study will involve a clinical evaluation, maximal respiratory pressures, spirometry and the Saint George9s Respiratory Questionnaire. The Sleep Laboratory of the Master9s and Doctoral Postgraduate Program in Rehabilitation Sciences of the Nove de Julho University (Sao Paulo, Brazil) will perform the polysomnographic studies, Berlin Questionnaire, Epworth Sleepiness Scale, waist and neck circumferences, modified Mallampati classification and tonsil index. Ethics and dissemination This protocol has been approved by the Human Research Ethics Committees of Santa Casa de Misericordia Hospital (process number 178/2012) and Human Research Ethics Committee of Nove de Julho University (process number 370474/2010). All participants will sign a statement of informed consent. The study findings will be published in peer-reviewed journals and presented at conferences.

Fernanda Dultra Dias,1 Luciana Maria Malosá Sampaio,1 Graziela Alves da Silva,1 Évelim LF Dantas Gomes,1 Eloisa Sanches Pereira do Nascimento,1 Vera Lucia Santos Alves,2 Roberto Stirbulov,2 Dirceu Costa11Post Graduate Program in Rehabilitation Sciences, Nove de Julho University – UNINOVE, São Paulo, Brazil; 2Pneumology Clinic at Santa Casa de Misericórdia de São Paulo (AME), São Paulo, BrazilIntroduction: Pulmonary rehabilitation (PR) is a multidisciplinary program of care for patients with chronic obstructive pulmonary disease (COPD) with the goal of improving the functional capacity and quality of life, as well as maintaining the clinical stability of COPD sufferers. However, not all patients are available for such a program despite discomfort with their condition. The aim of this study was to evaluate the effects of a home-based PR (HBPR) program on functional ability, quality of life, and respiratory muscle strength and endurance.Patients and methods: Patients with COPD according to the Global Initiative of Chronic Obstructive Lung Disease were randomized (double-blind) into two groups. One group performed a protocol at home with aerobic and muscle strength exercises and was called the intervention group; the other group received only instructions to perform breathing and stretching exercises, characterizing it as the control group (CG). We assessed the following variables at baseline and 2 months: exercise tolerance (incremental shuttle walk test and upper limb test), respiratory muscle (strength and endurance test), and health-related quality of life (Airways Questionnaire 20).Results: There were no significant changes after the intervention in either of the two groups in exercise tolerance and quality of life. However, the intervention group had improved respiratory endurance compared with the CG, while the CG presented a decrease in the load sustained by the respiratory muscles after the HBPR.Conclusion: A program of HBPR with biweekly supervision (although not enough to provide significant improvements in physical capacity or quality of life) played an important role in maintaining the stability of the clinical features of patients with COPD; the patients had no worsening of symptoms during the intervention period according to the daily log.Keywords: home-based pulmonary rehabilitation, COPD, shuttle walk test

Background Idiopathic adolescent scoliosis (AIS) causes not only spinal deformities but rib cage abnormalities that lead to abnormal volumes and pulmonary capacity on pulmonary function testing (PFT). The objective of this study was to analyze the impact of a physical rehabilitation program on respiratory function in surgical patients with AIS. Methods From October 2003 to October 2004, a total of 34 patients (age range, 10 to 18 years) presenting with AIS and a thoracic curvature between 45° and 88° were studied prospectively at a tertiary academic hospital. The patients underwent clinical and radiographic evaluations of the vertebral deformity, chest radiographs, PFT, evaluation of peak expiratory flow, and 6-min walk tests (6MWTs) before and after joining a physical rehabilitation program for 4 months. Results An improvement in FVC, inspiratory capacity, FEV 1 , expiratory reserve volume, and performance assessed by 6MWT were observed after rehabilitation. Conclusions Global conditioning improved after the rehabilitation program. This was expressed by both PFT and 6MWT results.