João Páscoa Pinheiro

Regular Physical Exercise as a Strategy to Improve Antioxidant and Anti-Inflammatory Status: Benefits in Type 2 Diabetes Mellitus

Over the last 30 years the combination of both a sedentary lifestyle and excessive food availability has led to a significant increase in the prevalence of obesity and aggravation of rates of metabolic syndrome and type 2 diabetes mellitus (T2DM). Several lines of scientific evidence have been demonstrating that a low level of physical activity and decreased daily energy expenditure leads to the accumulation of visceral fat and, consequently, the activation of the oxidative stress/inflammation cascade, which underlies the development of insulin resistant T2DM and evolution of micro, and macrovascular complications. This paper focuses on the pathophysiological pathways associated with the involvement of oxidative stress and inflammation in the development of T2DM and the impact of regular physical exercise (training) as a natural antioxidant and anti-inflammatory strategy to prevent evolution of T2DM and its serious complications.

Cross-cultural adaptation and validation of the Portuguese version of the Knee injury and Osteoarthritis Outcome Score (KOOS).

OBJECTIVE The objective of this study was to translate and culturally adapt the Knee injury and Osteoarthritis Outcome Score (KOOS) to the Portuguese language and to test its reliability, validity, floor/ceiling effects and responsiveness. METHODS This new version was obtained with forward/backward translations, consensus panels and a pre-test. The Portuguese KOOS and Medical Outcomes Study - 36 item Short Form (SF-36) questionnaires, visual analogue scales (VAS) of pain, disability and discomfort, and a form for the characteristics of the patients were applied to 223 subjects with knee osteoarthritis (OA). RESULTS Reliability was acceptable with Cronbachs alpha coefficients between 0.77 and 0.95, and intraclass correlation coefficients (ICC) ranging from 0.82 to 0.94 for the KOOS subscales. Construct validity was supported by the confirmation of six of the seven predefined hypotheses involving expected correlations between KOOS subscales, SF-36 subscales and VAS. An additional predefined hypothesis was also confirmed with the subjects that need walking aids obtaining lower scores in all five KOOS subscales (P< or =0.001). Floor/ceiling effects were considered to be not present, except for the subscale function in sport and recreation (33.6% of the subjects reported worst possible score). Responsiveness to 4 weeks of physical therapy was demonstrated with standardized effect size between 0.78 and 1.08, and standardized response mean ranging from 0.83 to 1.37 for the KOOS subscales. CONCLUSION The Portuguese KOOS evidenced acceptable psychometric characteristics.

Reliability, validity and responsiveness of the Portuguese version of the Knee injury and Osteoarthritis Outcome Score – Physical Function Short-form (KOOS-PS)

OBJECTIVE To test the reliability, validity and responsiveness of the Portuguese version of the Knee injury and Osteoarthritis Outcome Score--Physical Function Short-form (KOOS-PS). METHODS The Portuguese full KOOS and Medical Outcomes Study e 36 item Short-Form (SF-36) questionnaires, and a form of individual characteristics of the patients were applied to 85 subjects with knee osteoarthritis (OA). RESULTS Cronbachs alpha coefficient was 0.89 and intraclass correlation coefficient (ICC) was 0.85, certifying that KOOS-PS reliability was acceptable. Construct validity was supported by the confirmation of the five predefined hypotheses involving expected correlations between KOOS-PS scale, KOOS subscales and SF-36 subscales. An additional predefined hypothesis was also confirmed with the subjects that need walking aids obtaining higher KOOS-PS scale scores (P = 0.011). Responsiveness to 4 weeks of conventional physical therapy treatments and to a 6-week health education and exercise program was demonstrated with a standardized effect size of 0.88 and 0.50, and a standardized response mean of 1.21 and 0.73, respectively. CONCLUSION The Portuguese KOOS-PS evidenced acceptable psychometric characteristics.

Cross-cultural adaptation and validation of the Portuguese version of the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS)

The objective of this study was to cross-culturally adapt and validate the Portuguese version of the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS). This version was obtained with forward/backward translations, consensus panels and pre-testing. The Portuguese KOS-ADLS and Medical Outcomes Study, 36-item Short Form (SF-36) questionnaires, visual analogue scales (VAS) of pain, disability and discomfort, and a form for patient’s characteristics were administered to 168 subjects with knee osteoarthritis (OA). Reliability was acceptable (Cronbach’s alpha = 0.91; ICC = 0.97). There were significant correlations with SF-36 physical component subscales, all VAS, and duration of knee OA. The subjects with bilateral knee OA and that need walking aids obtained lower scores (p < 0.001). No floor/ceiling effects were detected. Responsiveness to physical therapy was showed (standardized effect size = 0.62; standardized response mean = 1.02). The Portuguese KOS-ADLS evidenced acceptable reliability, validity, floor/ceiling effects, and responsiveness.

Cross-cultural adaptation and validation of the Portuguese version of the intermittent and constant osteoarthritis pain (ICOAP) measure for the knee

The Intermittent and Constant OsteoArthritis Pain (ICOAP)1 questionnaire for the knee is a patient-centered measure for pain which was designed to assess patients with knee osteoarthritis (OA). It has the peculiarity of being able to evaluate both constant and intermittent pain1, two distinct types of pain that were identified as important by OA patients in a focus group study2. There was no Portuguese version available before the current study and, in order to apply this questionnaire in Portugal, a process of crosscultural adaptation and validationwas needed. The objective of this paper is to present the process followed by the authors to translate and culturally adapt the ICOAP to the Portuguese language and to test its reliability and validity in patients with knee OA. This new version was obtained with forward/backward translations, consensus panels and a pre-test. The validation study showed that the Portuguese ICOAP evidenced acceptable psychometric characteristics, in terms of internal consistency, reproducibility and construct validity.

Low-level laser therapy on skeletal muscle inflammation: evaluation of irradiation parameters

Abstract. We evaluated the effect of different irradiation parameters in low-level laser therapy (LLLT) for treating inflammation induced in the gastrocnemius muscle of rats through cytokines concentration in systemic blood and analysis of muscle tissue. We used continuous (830 and 980 nm) and pulsed illuminations (830 nm). Animals were divided into five groups per wavelength (10, 20, 30, 40, and 50 mW), and a control group. LLLT was applied during 5 days with a constant irradiation time and area. TNF-α, IL-1β, IL-2, and IL-6 cytokines were quantified by ELISA. Inflammatory cells were counted using microscopy. Identical methodology was used with pulsed illumination. Average power (40 mW) and duty cycle were kept constant (80%) at five frequencies (5, 25, 50, 100, and 200 Hz). For continuous irradiation, treatment effects occurred for all doses, with a reduction of TNF-α, IL-1β, and IL-6 cytokines and inflammatory cells. Continuous irradiation at 830 nm was more effective, a result explained by the action spectrum of cytochrome c oxidase (CCO). Best results were obtained for 40 mW, with data suggesting a biphasic dose response. Pulsed wave irradiation was only effective for higher frequencies, a result that might be related to the rate constants of the CCO internal electron transfer process.

Evaluation of low level laser therapy irradiation parameters on rat muscle inflammation through systemic blood cytokines

Low level laser therapy (LLLT) has been used for inflammation treatment. Here, we evaluate the effect of different doses, using continuous (830 and 980 nm) and pulsed illumination (830 nm), in the treatment of inflammation induced in the gastrocnemius muscle of Wistar rats, through cytokines concentration in systemic blood and histological analysis of muscle tissue. Animals were randomly divided into five groups per wavelength (5 animals per group: 10, 20, 30, 40 and 50 mW) plus a control group. LLLT was applied during five days, with constant exposure time and irradiated area (3 minutes; 0.5026 cm2). Blood was collected on days 0, 3 and 6. TNF-α, IL-1β, IL-2 and IL-6 cytokines were quantified by ELISA. Rats were killed on day 6. Muscle inflammatory cells were counted using optical microscopy. Treatment effects occurred for all applied doses (largest effect at 40 mW: 7.2 J, 14 J/cm2 per irradiation), with reduction of proinflammatory TNF-α, IL-1β and IL-6 cytokines and lower number of inflammatory cells. Results were better for 830 nm. Identical methodology was used with pulsed illumination. Average power (40 mW) and duty cycle were kept constant (80%) at five frequencies (5, 25, 50, 100 and 200 Hz). Treatment effects were observed at higher frequencies, with no significant differences between them. However, the treatment effect was lower than for continuous illumination. LLLT effect on inflammation treatment can be monitored by measuring systemic blood cytokines. A larger treatment effect was observed with continuous illumination, where results seem to be compatible with a biphasic dose response.

New trends in food science: the use of nutraceuticals as an antiinflammatory therapeutic tool in exercise

Prolonged high-intensity training seems to result in increased systemic inflammation, which might explain muscle injury, delayed onset muscle soreness, and overtraining syndrome in athletes. Furthermore, an impaired immune function caused by strenuous exercise leads to the development of upper respiratory tract infections in athletes. Nutraceuticals might help counteract these performance-lowering effects. The use of nanotechnology is an interesting alternative to supply athletes with nutraceuticals, as many of these substances are insoluble in water and are poorly absorbed in the digestive tract.

Myositis ossificans of the quadriceps femoris in a soccer player

A young soccer player was diagnosed with myositis ossificans 6 weeks after a muscle strain in the right thigh. Radiographic and sonographic investigations initially helped to confirm diagnosis and later supported clinical improvement. We present our approach to the case and discuss pathophysiology, prevention and treatment of this rare condition.

Neuroimaging, serum biomarkers, and patient characteristics as predictors of upper limb functioning 12 weeks after acute stroke: an observational, prospective study

ABSTRACT Objective: To evaluate the potential of neuroimaging, serum biomarkers, stroke etiology, and clinical characteristics as predictors of upper limb functioning 12 weeks after stroke. Methods: This was a prospective, observational study of patients (18–85 years-old) hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery. Patients were hospitalized at a stroke rehabilitation center, where they underwent a standardized rehabilitation program. Clinical, imagiology, laboratory (biomarkers: C-reactive protein, D-dimer, and fibrinogen, and S100 calcium binding protein β [S100β]), and functionality assessments were conducted four different times: within 24 hours, and at 48 hours, 3 weeks, and 12 weeks after acute stroke. Results: Upper limb functioning at 12 weeks was significantly associated with Alberta Stroke Program Early CT Score (ASPECTS) score (OR:2.012 [CI:1.349–3.000]; P = 0.001) and S100β protein levels (OR:0.997 [CI:0.994–0.999]; P = 0.007). Advanced age was associated with poor upper limb functioning. S100β protein levels < 140.5 ng/L at 48 hours and ASPECTS scores ≥ 7.5 within 24 hours of admission predicted good hand functioning at 12 weeks. Upper limb functioning and general functioning were significantly correlated (P < 0.001), with strong negative correlations (all correlation coefficients ≤–0.586) for all comparisons. Conclusion: ASPECTS score ≥ 8 within 24 hours and S100β protein < 140.5 ng/L at 48 hours predict better upper limb functioning, while advanced age predicts worse upper limb functioning 12 weeks after stroke.