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Questions: Do aerobic, resistance and combined exercise training improve aerobic capacity, arterial blood pressure and haemodialysis efficiency in people requiring haemodialysis for end-stage renal disease? Is one exercise training modality better than the others for improving these outcomes?, Design: Systematic review with network meta-analysis of randomised trials., Participants: Adults requiring haemodialysis for end-stage renal disease., Intervention: Aerobic training, resistance training, combined training and control (no exercise or placebo)., Outcome Measures: Aerobic capacity, arterial blood pressure at rest, and haemodialysis efficiency., Results: Thirty-three trials involving 1254 participants were included. Direct meta-analyses were conducted first. Aerobic capacity improved significantly more with aerobic training (3.35 ml/kg/min, 95% CI 1.79 to 4.91) and combined training (5.00 ml/kg/min, 95% CI 3.50 to 6.50) than with control. Only combined training significantly reduced systolic (-9 mmHg, 95% CI -13 to -4) and diastolic (-5 mmHg, 95% CI -6 to -3) blood pressure compared to control. Only aerobic training was superior to control for haemodialysis efficiency (Kt/V 0.11, 95% CI 0.02 to 0.20). However, when network meta-analysis was conducted, there were some important different findings. Both aerobic training and combined training again elicited greater improvements in aerobic capacity than control. For systolic blood pressure, combined training was superior to control. For diastolic blood pressure, combined training was superior to aerobic training and control. No modality was superior to control for haemodialysis efficiency. Combined training was ranked as the most effective treatment for aerobic capacity and arterial blood pressure., Conclusion: Combined training was the most effective modality to increase aerobic capacity and blood pressure control in people who require haemodialysis. This finding helps to fill the gap created by the lack of head-to-head comparisons of different modalities of exercise in people with end-stage renal disease., Registration: PROSPERO CRD42015020531., (Copyright © 2018 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

In this work the cost of hospital treatment for diabetic foot wounds was estimated and the literature regarding prophylaxis for these lesions was examined. For this purpose, the records of all patients with diabetic foot symptoms submitted to surgical treatment over a period of 16 months in a public hospital were reviewed. There were 44 admissions with an average hospitalization period of 11.93 days, (± 6.34), 61 surgical procedures, with amputations in 65% of the cases. An average cost of R$ 4,367.05 (± 9249.01) and a total cost of R$ 192,150.40 was calculated for the hospital treatment involved. Treatment of diabetic foot symptoms had a high cost and required amputation in the majority of cases. A review of the literature revealed many possible models to be adopted for action in the prophylaxis of wounds associated with the diabetic foot, which can avoid amputations and save funds.

Background: despite the increasingly careful attempts to reduce perioperative risks, pulmonary complications following surgery are still very common, leading to longer length of hospital stays or death., Objective: to describe the incidence of pulmonary complications and identify their association with duration of extracorporeal circulation (ECC), surgery and ischemia, number of bypass grafts performed, location of drains and length of drainage following myocardial revascularization (MRV)., Methods: this contemporaneous cohort consisted of 202 patients undergoing elective myocardial revascularization (MRV) with saphenous vein graft and internal mammary artery graft and ECC, at a referral university cardiology hospital in Southern Brazil, from April 2006 to November 2007. The following outcomes were analyzed: duration of mechanical ventilation; pneumonia onset; atelectasis; pleural effusion; location of drains and time of removal; and length of hospital stay., Results: of the 202 patients, 90 developed some sort of pulmonary complication. The incidence of pleural effusion was 84%, whereas atelectasis was 65%. The following variables were associated with pulmonary complications: duration of ECC (p = 0.003), surgery (p = 0.040) and ischemia (p = 0.001); length of drainage (p = 0.050) and location of pleural drains (p = 0.033); age (p = 0.001); ejection fraction (p = 0.010); diagnosis of asthma (p = 0.047) and preoperative abnormal chest X-ray findings (p = 0.029)., Conclusion: variables related to the complexity of the surgery and preexisting comorbidities are associated with a high incidence of postoperative pulmonary complications. These data reinforce the importance of having patients undergo perioperative clinical assessment to detect early respiratory complications after MRV.

Introduction: The coronary artery bypass graft surgery is an option of treatment for cardiovascular diseases, and the patients who underwent such procedure can suffer from preoperative anxiety., Objective: The aim of this study is to verify the effects of physiotherapeutic instructions at the anxiety level on patients undergone coronary artery bypass graft surgery., Methods: Randomized clinical trial, with the sample composed by 51 individuals, 27 on the control group and 24 on the intervention; on which it was assessed the anxiety (Beck Scale for Anxiety) and pain (Visual Analog Scale) levels on the pre- and postoperative period and only the second group received instructions about the surgery procedures and ventilatory exercises. For statistical analysis the Wilcoxon, Mann-Whitney and Spearman tests were used., Results: The lower anxiety levels were observed in patients that received the intervention on the period before surgery (9.6 +/- 7.2 versus 13.4 +/- 5.9, P=0.02). On the control group, the difference among the anxiety levels before and after the surgery was statistically significant (P= 0.003). The female individuals presented more anxious before the surgery compared to the male ones (P=0.058). It was also verified a relationship between length of stay at hospital and postoperative anxiety (P=0.05), where the more anxious individuals remained more time at the hospital., Conclusion: Patients oriented and instructed about physiotherapeutic ventilatory exercises and hospital routine, presented their levels of anxiety reduced on the preoperative compared to the control group. However, at the postoperative, both groups presented their anxiety levels reduced without significant difference between them.

Objective: To assess the ventilatory, radiological and clinical profile of patients undergoing elective CABG in a cardiology reference hospital in South Brazil., Methods: This study included 108 patients undergoing elective CABG surgery, in the period between April 2006 and February 2007 at the Cardiology Institute of Rio Grande do Sul (IC-FUC). The surgical procedure involved median sternotomy, and the saphenous vein and/or internal mammary artery were used for grafting. Lung volume and capacity, as well as the possible existence of ventilatory changes, were assessed by spirometry, and the ventilatory muscle strength was assessed using a vaccum manometer. All evaluations were performed on the preoperative period and on the sixth postoperative day., Results: Preoperative levels of FEV1 and FVC were significantly reduced on the 6th postoperative day (P<0.001) when compared to the preoperative levels. A significant decrease of ventilatory muscle strength, expressed as maximum inspiratory and expiratory pressures (MIP and MEP), was also observed from the pre- to the sixth postoperative day (P<0.001). Pulmonary events were more frequent on the 6th postoperative day (78%) than on the 1st postoperative day (40%)., Conclusion: Patients undergone CABG surgery present important reduction in pulmonary volume and capacity, as well as on the ventilatory muscle strength during the postoperative period.