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Enquadramento: As ambulâncias de suporte imediato de vida (SIV) possibilitam ao enfermeiro capacidade de intervenção em contexto pré-hospitalar, suportada pelo seu conhecimento técnico-científico, protocolos complexos de atuação e regulação médica por telemedicina. Objetivo: Analisar os contributos da intervenção dos enfermeiros SIV, na evolução do estado clínico da pessoa em situação crítica (PSC). Metodologia: Estudo quantitativo, descritivo-correlacional, retrospetivo, realizado em meios SIV, na região norte de Portugal. Analisados 574 registos clínicos eletrónicos, entre 01 de novembro e 31 de dezembro de 2019, que correspondem ao mesmo número de pessoas avaliadas. Utilizada a escala National Early Warning Score (NEWS) para avaliar a evolução clínica da PSC. Resultados: Observou-se uma evolução positiva do score NEWS da PSC, após a intervenção do enfermeiro SIV (M = 4,43 ± 3,901 vs 3,34 ± 3,329; sig < 0,001). Em sentido inverso, o risco clínico diminuiu significativamente após a intervenção do enfermeiro. Conclusão: Demonstrou-se a relevância da intervenção do enfermeiro SIV no contexto pré hospitalar, enquanto garantia de segurança, qualidade e melhoria contínua dos cuidados à PSC.

Introdução: Tem sido crescente a evidência da reabilitação da pessoa após COVID-19 devido ao seu impacto no desempenho das AVD. A reabilitação destas pessoas centra-se no alívio da sintomatologia, melhoria funcional motora e respiratória e ensino de estratégias de conservação de energia. Metodologia: Foi feita uma revisão narrativa da literatura através de todas as bases de dados da EBSCOhost Web e de pesquisa livre no GOOGLE SCHOOLAR, com inclusão das monografias de relevo evidenciadas nos artigos consultados. Resultados e Discussão: O treino de exercício deve contemplar atividades como exercícios respiratórios, treino de AVD, treino de flexibilidade, treino de equilíbrio e/ou a caminhada ligeira. Posteriormente, promove-se a atividade física (AF) de baixa intensidade, progredindo para AF moderada e treino de resistência muscular. Por fim, integra-se o treino funcional e de coordenação. Conclusão: A gestão da fadiga e da intolerância à atividade podem ser alcançadas através de treino de exercício gradual, estruturado, individualizado e doseado.

Background: To compare the effects of short-term 8 week heavy-resistance or plyometric training protocols (HRT or PLY) incorporated into regular soccer practice on measures of neuromuscular functional performance in professional soccer players, a single-blind randomized controlled trial was conducted. Methods: Forty-seven participants aged 22.3 ± 3.52 years were assigned to three groups: HRT (n = 15), PLY (n = 15), and control (CON; n = 17). The HRT group performed 3 sets and 10 repetitions twice a week using 80% of their baseline 1-RM (weeks 1–3), followed by 8 repetitions at 85% 1-RM (weeks 4–6), and 6 repetitions at 90% 1-RM (weeks 7–8) of 6 lower-body strength exercises with a 1 min rest period between sets. The PLY protocol involved a preparatory phase (weeks 1–2), followed by two 3-week progressive periods (weeks 3–5 and weeks 6–8). The plyometric sessions consisted of four jump exercises/drills with progressively increasing number of sets and total number of foot contacts. The rest intervals between repetitions and sets were 15 and 90 s, respectively. Outcome measures included tests assessing 10 and 30 m speed (t10m and t30m), one-repetition maximum half-back squat (1-RM squat), isokinetic peak torques for the quadriceps and hamstring muscles (Qcon and Hcon), countermovement jump (CMJ), and squat jump (SJ). Results: Two-way ANOVA detected main effects of time and group×time interactions for all examined variables, except t30m, 1-RM, and relative 1-RM. Post hoc analyses revealed significant increases in the HRT group (t10m: 6.3%, t30m: 7.1%; absolute 1-RM: 29.6%; relative 1-RM: 30.3%, Qcon: 24.5%; Hcon: 14.4%; CMJ: 5.9%; SJ: 7.2%, all p < 0.001) and the PLY group (t10m: 3.1%; t30m: 4.1%; absolute 1-RM:19.1%; relative 1-RM: 20.3%; Qcon: 12.6%; Hcon: 8.7%; CMJ: 3.3%; SJ: 3.5%, all p < 0.001). HRT was superior compared to PLY in relative 1-RM, Qcon and Hcon (all p < 0.001). In addition, we found knee muscular strength imbalance in 70.5% of participants from the total sample (H/Q ratio < 60%). The HRT and PLY protocols resulted in improved neuromuscular functional performance compared to the regular soccer regime. Conclusions: This study showed that during the pre-competitive season, additional HRT and PLY drills/exercises as a substitute for standard soccer training as part of a regular 90 min practice twice a week for 8 weeks, can produce acute physical performance-enhancing effects in professional soccer players.

Background: For survival, it is crucial to continuously evaluate the presence or absence of risk in the environment. Previously, a safety cue for the observation of aversive pictures attenuated their aversiveness in healthy participants. Here, we investigated whether patients with Posttraumatic Stress Disorder (PTSD) would fail to engage in safety cues using brain reactivity to aversive pictures as a proxy. Methods: Patients with PTSD (n = 20) and control participants (n = 23) were exposed to neutral and mutilation pictures. Before the presentation of pictures, a text informed that those were fictitious (“safe context”) or real-life scenes (“real context”); appropriate images were also shown to increase the credibility of the text. A voxel-wise approach identified valence-responsive regions for further testing of an interaction pattern. Results: A GROUPxCONTEXTxVALENCE interaction was found in the right supramarginal gyrus spreading anteriorly to the postcentral gyrus - a region involved in the processing of peripersonal space and defensive reactions. Control participants showed, in the real context, increased BOLD response in the right supramarginal gyrus for mutilation pictures compared to neutral ones and, in the safe context, no significant difference between those pictures, indicating an attenuation of brain reactivity. Patients with PTSD presented high brain reactivity in both real and safe contexts. Limitations: Patients with PTSD were under pharmacological treatment, and the time posttrauma and comorbidities were not assessed. Conclusions: Differently from controls, patients with PTSD did not show attenuation of brain reactivity, reflected by supramarginal response in the safe context. This suggests an inappropriate engagement in safety cues.

Introduction: Living at high altitude increases oxidative stress. Likewise, growth and maturation during adolescence can increase levels of reactive oxygen species (ROS). Changes in redox profiles have been evaluated in adults living at high altitudes; however, there are no studies on these changes in peripubertal populations living at moderate altitudes, we determine how living at moderate altitude affects the oxidative and inflammatory status of healthy preadolescents and adolescents. Materials and Methods: A cross-sectional study was conducted in healthy male Colombian preadolescents and adolescents (9–18 years old, Tanner scale classification) who lived at low altitude (n = 26) or moderate altitude (n = 26). Plasma oxidative and inflammatory status was assessed via spectrophotometry. Oxidative markers included malondialdehyde, 4-hydroxy-trans-2-nonenal, and carbonyl groups. Antioxidant markers included total antioxidant status, glutathione, catalase, superoxide dismutase, uric acid, and thiols. Inflammatory markers included interleukins-1, -6, and -10 and tumor necrosis factor. Results: Only uric acid levels were higher in adolescents (5.34 and 5.66 mg/dl) compared to preadolescents (3.85 and 4.07 mg/dl) in both moderate and low altitude groups, respectively. Participants who lived at moderate altitude presented significantly higher levels of malondialdehyde (4.82 and 3.73 nM/mg protein) and lower level of glutathione and thiols (1.21 and 1.26 μmol/mg protein) than in those at low altitude. Their inflammatory profiles did not differ. Conclusion: Oxidant profiles increased in peripubertal populations residing at moderate altitude; this could be owing to antioxidant consumption by ROS and active metabolism during puberty.

Chronic spinal cord injury affects several respiratory-function-related parameters, such as a decrease in respiratory volumes associated with weakness and a tendency to fibrosis of the perithoracic muscles, a predominance of vagal over sympathetic action inducing airway obstructions, and a difficulty in mobilizing secretions. Altogether, these changes result in both restrictive and obstructive patterns. Moreover, low pulmonary ventilation and reduced cardiovascular system functionality (low venous return and right stroke volume) will hinder adequate alveolar recruitment and low O2 diffusion, leading to a drop in peak physical performance. In addition to the functional effects described above, systemic and localized effects on this organ chronically increase oxidative damage and tissue inflammation. This narrative review describes both the deleterious effects of chronic spinal cord injury on the functional effects of the respiratory system as well as the role of oxidative damage/inflammation in this clinical context. In addition, the evidence for the effect of general and respiratory muscular training on the skeletal muscle as a possible preventive and treatment strategy for both functional effects and underlying tissue mechanisms is summarized.

Abstract Background Dementia is a leading cause of death and disability that was declared as one of the greatest health and social care challenges of the twenty-first century. Regular physical activity and exercise have been proposed as a non-pharmacological strategy in disease prevention and management. Multicomponent Training (MT) combines aerobic, strength, balance and postural exercises and might be an effective training to improve both functional capacity and cognitive function in individuals with dementia (IwD). Nevertheless, data on the effects of MT in IwD are still limited and the extent to which IwD can retain improvements after an exercise intervention still needs to be elucidated. The aim of “Body & Brain” study is to investigate the effects of a 6-month MT intervention and 3-month detraining on the physical and cognitive function of IwD. Additionally, we aim to explore the impact of this intervention on psychosocial factors and physiologic markers related to dementia. Methods This study is a quasi-experimental controlled trial using a parallel-group design. The study sample consists of community-dwelling individuals aged ≥60 years who are clinically diagnosed with dementia or major neurocognitive disorder. Participants will be either allocated into the intervention group or the control group. The intervention group will participate in MT biweekly exercise sessions, whereas the control group will receive monthly sessions regarding physical activity and health-related topics for 6 months. The main outcomes will be physical function as measured by the Short Physical Performance Battery (SPPB) and cognitive function evaluated using the Alzheimer Disease Assessment Scale – Cognitive (ADAS-Cog) at baseline, after 6-months and 3-months after the end of intervention. Secondary outcomes will be body composition, physical fitness, daily functionality, quality of life, neuropsychiatric symptoms and caregiver’s burden. Cardiovascular, inflammatory and neurotrophic blood-based biomarkers, and arterial stiffness will also be evaluated in subsamples. Discussion If our hypothesis is correct, this project will provide evidence regarding the efficacy of MT training in improving physical and cognitive function and give insights about its impact on novel molecular biomarkers related to dementia. This project may also contribute to provide guidelines on exercise prescription for IwD. Trial registration ClinicalTrials.gov – identifier number NCT04095962 ; retrospectively registered on 19 September 2019.

Apresentação - Número Especial

Background: Modern lifestyles, especially high-caloric intake and physical inactivity, contribute to the increased prevalence of non-alcoholic fatty liver disease (NAFLD), which becomes a significant health problem worldwide. Lifestyle changes, however, affect not only parental generation, but also their offspring, reinforcing the need for efficient preventive approaches to deal with this disease. This transgenerational influence of phenotypes dependent on parents (particularly maternal) behaviours may open additional research avenues. Despite persistent attempts to design an effective pharmacological therapy against NAFLD, physical activity, as a non-pharmacological approach, emerges as an exciting strategy. Scope of Review: Here we briefly review the effect of physical exercise on liver mitochondria adaptations in NAFLD, highlighting the importance of mitochondrial metabolism and transgenerational and epigenetic mechanisms in liver diseases. Major Conclusions: A deeper look into cellular mechanisms sheds a light on possible effects of physical activity in the prevention and treatment of NAFLD through modulation of function and structure of particular organelles, namely mitochondria. Additionally, despite of increasing evidence regarding the contribution of epigenetic mechanisms in the pathogenesis of different diseases, the role of microRNAs, DNA methylation, and histone modification in NAFLD pathogenesis still needs to be elucidated. Keywords: NAFLD, Physical exercise, Mitochondrial dysfunction, Epigenetics

A crucial subject in sports is identifying the inter-individual variation in response to training, which would allow creating individualized pre-training schedules, improving runner’s performance. We aimed to analyze heterogeneity in individual responses to two half-marathon training programs differing in running volume and intensity in middle-aged recreational women. 20 women (40 ± 7 years, 61 ± 7 kg, 167 ± 6 cm, and VO2max = 48 ± 6 mL⋅kg–1⋅min–1) underwent either moderate-intensity continuous (MICT) or high-intensity interval (HIIT) 12-week training. They were evaluated before and after training with maximal incremental tests in the laboratory (VO2max) and in the field (time to exhaustion, TTE; short interval series and long run). All the women participated in the same half-marathon and their finishing times were compared with their previous times. Although the improvements in the mean finishing times were not significant, MICT elicited a greater reduction (3 min 50 s, P = 0.298), with more women (70%) improving on their previous times, than HIIT (reduction of 2 min 34 s, P = 0.197, 50% responders). Laboratory tests showed more differences in the HIIT group (P = 0.008), while both groups presented homogeneous significant (P < 0.05) increases in TTE. Both in the short interval series and in the long run, HIIT induced better individual improvements, with a greater percentage of responders compared to MICT (100% vs 50% in the short series and 78% vs 38% in the long run). In conclusion, variability in inter-individual responses was observed after both MICT and HIIT, with some participants showing improvements (responders) while others did not (non-responders) in different performance parameters, reinforcing the idea that individualized training prescription is needed to optimize performance.

Free-running wheel (FRW) is an animal exercise model that relies on high-intensity interval moments interspersed with low-intensity or pauses apparently similar to those performed in high-intensity interval training (HIIT). Therefore, this study, conducted over a 12-weeks period, aimed to compare functional, thermographic, biochemical and morphological skeletal and cardiac muscle adaptations induced by FRW and HIIT. Twenty-four male Wistar rats were assigned into three groups: sedentary rats (SED), rats that voluntarily exercise in free wheels (FRW) and rats submitted to a daily HIIT. Functional tests revealed that compared to SED both FRW and HIIT increased the ability to perform maximal workload tests (MWT-cm/s) (45 ± 1 vs. 55 ± 2 and vs. 65 ± 2). Regarding thermographic assays, FRW and HIIT increased the ability to lose heat through the tail during MWT. Histochemical analyzes performed in tibialis anterior (TA) and soleus (SOL) muscles showed a general adaptation toward a more oxidative phenotype in both FRW and HIIT. Exercise increased the percentage of fast oxidative glycolytic (FOG) in medial fields of TA (29.7 ± 2.3 vs. 44.9 ± 4.4 and vs. 45.2 ± 5.3) and slow oxidative (SO) in SOL (73.4 ± 5.7 vs. 99.5 ± 0.5 and vs. 96.4 ± 1.2). HITT decreased fiber cross-sectional area (FCSA-μm2) of SO (4350 ± 286.9 vs. 4893 ± 325 and vs. 3621 ± 237.3) in SOL. Fast glycolytic fibers were bigger across all the TA muscle in FRW and HIIT groups. The FCSA decrease in FOG fibers was accompanied by a circularity decrease of SO from SOL fibers (0.840 ± 0.005 vs. 0.783 ± 0.016 and vs. 0.788 ± 0.010), and a fiber and global field capillarization increase in both FRW and HIIT protocols. Moreover, FRW and HIIT animals exhibited increased cardiac mitochondrial respiratory control ratio with complex I-driven substrates (3.89 ± 0.14 vs. 5.20 ± 0.25 and vs. 5.42 ± 0.37). Data suggest that FRW induces significant functional, physiological, and biochemical adaptations similar to those obtained under an intermittent forced exercise regimen, such as HIIT.

Objetivos: Analisar a função cognitiva, a ocorrência de sintomas depressivos e os parâmetros bioquímicos como possíveis preditores de mortalidade em idosos com insuficiência renal crônica (IRC) submetidos à diálise. Métodos: Foram realizados o Mini-Exame do Estado Mental (MEEM), o Teste do Desenho do Relógio (TDR), o Teste de Fluência Verbal, a Escala de Depressão Geriátrica (EDG) e exames laboratoriais em 62 idosos com IRC e em diálise em um centro nefrológico de Ribeirão Preto, SP. Resultados: O grupo de idosos vivos (GV) após 12 meses mostrou-se mais jovem (68,18 ± 5,7 anos) que os do grupo com óbito (GO) (74,06 ± 7,36) com p = 0,001. O sexo masculino foi predominante (60,7%). Nos grupos GV e GO, os resultados dos exames laboratoriais foram, respectivamente: paratormônio 369,87 ± 318,90 e 368,50 ± 501,47 (p > 0,05); creatinina sérica 6,89 ± 2,05 e 5,23 ± 1,15 (p = 0,002); albumina 3,66 ± 0,35 e 3,74 ± 0,644 (p > 0,05); colesterol total 165,55 ± 45,16 e 169,35 ± 38,68 (p > 0,05); triglicérides 144,57 ± 80,95 e 126,94 ± 77,71 (p > 0,05); HDL 38,27 ± 14,26 e 44,22 ± 10,78 (p > 0,05); cálcio 9,40 ± 0,77 e 9,14 ± 0,68 (p > 0,05); e KT/V 1,64 ± 0,32 e 1,63 ± 0,27 (p > 0,05). O MEEM foi significativamente diferente entre os grupos (p = 0,03) e a creatinina mostrou possível relação direta ao risco de morte. A EDG mostrou resultados semelhantes entre os grupos (p = 0,06). Conclusões: Disfunção cognitiva foi associada à maior mortalidade em idosos em hemodiálise. A relação entre baixo nível de creatinina e mortalidade provavelmente reflete pior status nutricional entre estes pacientes.

Apresentação número temático.

The main purpose of this paper is to describe and map the existing assimilation phenomena in Brazilian Portuguese, showing data that support this mapping in order to certify that in this language, assimilation processes occur both from right to left (regressive assimilation) and from left to right (progressive assimilation). We aim to show also that progressive assimilation involving voicing/devoicing often requires that the target is a consonant [+voiced]. Finally, we also treat cases of assimilation involving vowels, which seem to occur bidirectionally.

Objective: To investigate whether a sensorimotor deficit of the upper limb following a brachial plexus injury (BPI) affects the upright balance. Design: Eleven patients with a unilateral BPI and 11 healthy subjects were recruited. The balance assessment includes the Berg Balance Scale (BBS), the number of feet touches on the ground while performing a 60s single-leg stance and posturographic assessment (eyes open and feet placed hip-width apart during a single 60s trial). The body weight distribution (BWD) between the legs was estimated from the center of pressure (COP) lateral position. The COP variability was quantified in the anterior-posterior and lateral directions.Results: BPI patients presented lower BBS scores (p=0.048) and a higher frequency of feet touches during the single-leg stance (p=0.042) compared with those of the healthy subjects. An asymmetric BWD toward the side opposite the affected arm was showed by 73% of BPI patients. Finally, higher COP variability was observed in BPI patients compared with healthy subjects for anterior-posterior (p=0.020), but not for lateral direction (p=0.818).Conclusions: This study demonstrates that upper limb sensorimotor deficits following BPI affect body balance, serving as a warning for the clinical community about the need to prevent and treat the secondary outcomes of this condition.

The Metabolic Syndrome increases the risk for atherosclerotic cardiovascular disease and type 2 Diabetes Mellitus. Increased fructose consumption and/or mineral deficiency have been associated with Metabolic Syndrome development. This study aimed to investigate the effects of 8 weeks consumption of a hypersaline sodium-rich naturally sparkling mineral water on 10% fructose-fed Sprague-Dawley rats (Metabolic Syndrome animal model). The ingestion of the mineral water (rich in sodium bicarbonate and with higher potassium, calcium, and magnesium content than the tap water used as control) reduced/prevented not only the fructose-induced increase of heart rate, plasma triacylglycerols, insulin and leptin levels, hepatic catalase activity, and organ weight to body weight ratios (for liver and both kidneys) but also the decrease of hepatic glutathione peroxidase activity and oxidized glutathione content. This mineral-rich water seems to have potential to prevent Metabolic Syndrome induction by fructose. We hypothesize that its regular intake in the context of modern diets, which have a general acidic character interfering with mineral homeostasis and are poor in micronutrients, namely potassium, calcium, and magnesium, could add surplus value and attenuate imbalances, thus contributing to metabolic and redox health and, consequently, decreasing the risk for atherosclerotic cardiovascular disease.

A construção e manipulação espacial de imagens corporais têm origem basicamente visual e somato-motora. No entanto, a contribuição relativa de cada modalidade sensorial nos processos de simulação mental pode variar. Sirigu e Duhamel (2001) propuseram que a estratégia utilizada durante a simulação mental de movimentos produziria a ativação de circuitos neurais distintos. Neste estudo, investigamos o efeito da estratégia adotada na simulação mental de uma tarefa motora que envolve ajustes posturais utilizando as técnicas de cronometria mental e de estabilometria. Os voluntários, posicionados sobre uma plataforma de força vertical com os pés unidos e os olhos fechados, foram solicitados a realizar as seguintes tarefas: a) manter a postura ereta normal durante 20 segundos; b) contar mentalmente de um a 15; c) imaginar-se realizando o movimento de flexão plantar bilateral 15 vezes e d) executar o mesmo movimento por 15 vezes. Ao final do teste, relataram qual a estratégia utilizada para a realização da simulação mental. Com base no relato verbal foram então distinguidos em dois grupos: visuais e somato-motores. A análise da cronometria mental mostrou que o tempo utilizado para simular mentalmente os movimentos de flexão plantar não foi diferente daquele gasto durante a sua execução. Diferiu, porém, da condição contar para ambos os grupos. Para a análise estabilométrica, calculou-se um índice de simulação mental (ISM). Dos valores obtidos durante o imaginar, foram subtraídos os valores da condição contar, dividindo-se então a resultante pela soma dos dois. O grupo somato-motor apresentou índices positivos e significativamente diferentes do grupo visual para a área elíptica de deslocamento e amplitude de deslocamento no eixo ântero-posterior (y). Esses dados indicam um menor bloqueio da saída motora durante o imaginar de um movimento que envolve ajustes posturais no primeiro grupo. Essa diferença sugere que circuitos corticais e sub-corticais distintos serão ativados em função da estratégia adotada para simular mentalmente o movimento.

Although doxorubicin (DOX) is a very effective antineoplastic agent, its clinical use is limited by a dose-dependent, persistent and cumulative cardiotoxicity, whose mechanism remains to be elucidated. Previous works in animal models have failed to use a multi-organ approach to demonstrate that DOX-associated toxicity is selective to the cardiac tissue. In this context, the present work aims to investigate in vivo DOX cardiac, hepatic and renal toxicity in the same animal model, with special relevance on alterations of mitochondrial bioenergetics. To this end, male Wistar rats were sub-chronically (7 wks, 2 mg/Kg) or acutely (20 mg/Kg) treated with DOX and sacrificed one week or 24 hours after the last injection, respectively. Alterations of mitochondrial bioenergetics showed treatment-dependent differences between tissues. No alterations were observed for cardiac mitochondria in the acute model but decreased ADP-stimulated respiration was detected in the sub-chronic treatment. In the acute treatment model, ADP-stimulated respiration was increased in liver and decreased in kidney mitochondria. Aconitase activity, a marker of oxidative stress, was decreased in renal mitochondria in the acute and in heart in the sub-chronic model. Interestingly, alterations of cardiac mitochondrial bioenergetics co-existed with an absence of echocardiograph, histopathological or ultra-structural alterations. Besides, no plasma markers of cardiac injury were found in any of the time points studied. The results confirm that alterations of mitochondrial function, which are more evident in the heart, are an early marker of DOX-induced toxicity, existing even in the absence of cardiac functional alterations.