Maria do Amparo Andrade

Análise da carga de trabalho de analistas de sistemas e dos distúrbios osteomusculares

OBJECTIVE: The purpose of this research was to conduct assessment of ergonomic conditions of systems analysts in order to understand the factors causing physical and cognitive overload, its implications for workers and propose improvements to reduce these physical and cognitive overload. METHODOLOGY: The SHTM (human-machine-task) method was used for ergonomic evaluation, the Corlett diagram for evaluation of bodily discomfort, questionnaire evaluation of the furniture and the NASA-TLX to assess mental workload. RESULTS: It was found a prevalence of pain in the lumbar spine of 71% and 64% of respondents in the cervical spine. After evaluation of mental workload, it was observed that the mental demand was most required among systems analysts and the average loading rate was of 13.23. CONCLUSION: It can be concluded that the high prevalence of musculoskeletal pain may be caused by the presence of inappropriate furniture, adoption of incorrect postures and high mental demand of the developed activities performed by systems analysts.

Influence of maternal and neonatal factors on bronchopulmonary dysplasia development

OBJECTIVE To review epidemiological features of bronchopulmonary dysplasia (BPD) and its relationship with maternal and neonatal conditions in a neonatal unit. METHODS Cross-sectional, descriptive and analytical study involving preterm newborns (NBs) with a birth weight lower than 1,500 g and gestational age under 37 weeks. Data was collected through a review of medical records of these newborns admitted to a neonatal unit. RESULTS The study included 323 newborns with a mean birth weight of 1,161 g (± 231 g), gestational age between 24 and 36.5 weeks, with a BPD incidence of 17.6%. Among the NBs developing BPD, the mean of days using invasive mechanical ventilation (IMV), non-invasive ventilation (NIMV), and supplemental oxygen was 17.6, 16.2, and 46.1 days, respectively, with a time significantly longer for those NBs developing BPD (p < 0.001). BPD occurred significantly more often in NBs with a patent ductus arteriosus (PDA). CONCLUSION BPD incidence in this study was similar to that found in the literature. No BPD association with maternal infection and antenatal corticosteroid use was found. NBs receiving exogenous surfactant had a higher BPD incidence because they had lower BW and GA. Concomitant occurrence of PDA and BPD is associated with staying longer on IMV, NIMV and supplemental oxygen.

Effects of electrical muscle stimulation early in the quadriceps and tibialis anterior muscle of critically ill patients

Abstract Background: Electrical muscle stimulation (EMS) is applied to critically ill patients in order to improve their muscle strength, thereby preventing hypotrophy and promoting functional recovery. Objective: To assess the effects of early EMS on the range of movement of the ankle joint, and on thigh and leg circumference in critically ill patients. Methods: This is a prospective randomized clinical trial comprising 11 patients undergoing mechanical ventilation. Before and after EMS the thigh and leg circumference in both lower limbs and the goniometry of the tibiotarsal joint were measured. The angle of 90° on the goniometer was taken as the standard neutral position (NP), with the arm fixed on the lateral malleolus of the ankle joint. Other measurements, namely dorsiflexion and plantar flexion, referred to as mobile arm, were taken from the NP. These recordings were obtained following an active contraction of the patients’ muscles. Results: Compared with the electrostimulated limb, a difference in dorsiflexion of the control limb was observed (96.2 ± 24.9 versus 119.9 ± 14.1°; p = 0.01). A girth of 10 cm of the leg was found in limb reduction when compared to the electrostimulated one (24.7 ± 3.1 versus 26.4 ± 4.0 cm; p = 0.03). Conclusions: EMS used at low current intensity and for a short duration failed to prevent muscle atrophy in critically ill patients. However, we did find a significant improvement in active dorsiflexion of the ankle joint suggesting that it could help to prevent against stance plantar flexion in these patients.

Influência de fatores maternos e neonatais no desenvolvimento da displasia broncopulmonar

OBJECTIVE: To review epidemiological features of bronchopulmonary dysplasia (BPD) and its relationship with maternal and neonatal conditions in a neonatal unit. METHODS: Cross-sectional, descriptive and analytical study involving preterm newborns (NBs) with a birth weight lower than 1,500 g and gestational age under 37 weeks. Data was collected through a review of medical records of these newborns admitted to a neonatal unit. RESULTS: The study included 323 newborns with a mean birth weight of 1,161 g (± 231 g), gestational age between 24 and 36.5 weeks, with a BPD incidence of 17.6%. Among the NBs developing BPD, the mean of days using invasive mechanical ventilation (IMV), non-invasive ventilation (NIMV), and supplemental oxygen was 17.6, 16.2, and 46.1 days, respectively, with a time significantly longer for those NBs developing BPD (p < 0.001). BPD occurred significantly more often in NBs with a patent ductus arteriosus (PDA). CONCLUSION: BPD incidence in this study was similar to that found in the literature. No BPD association with maternal infection and antenatal corticosteroid use was found. NBs receiving exogenous surfactant had a higher BPD incidence because they had lower BW and GA. Concomitant occurrence of PDA and BPD is associated with staying longer on IMV, NIMV and supplemental oxygen

Atividade mioelétrica dos músculos respiratórios em crianças asmáticas durante manobra inspiratória máxima

OBJECTIVES: to evaluate the activity of the scalene and sternocleidomastoid muscles at the baseline and during the maximum inspiratory pressure maneuver (PImax) in children with asthma. METHODS: fifteen children were divided into an asthma (n=8) and a control group (n=7). Lung functioning was investigated and the PImax using spirometry and manovacometry respectively. The myoelectrical activity of the scalene and sternocleidomastoid muscles was measured using surface electromyography at the baseline and during the PImax maneuver. RESULTS: the baseline surface electromyography for the scalene muscle was greater in the asthma group than in the control. However, the base surface electromyography for the sternocleidomastoid muscles showed no statistically significant difference between the two groups. The percentage of electromyographs of the scalene muscles and the sternocleidomastoid muscles was higher in the asthma group than in the controls. CONCLUSIONS: the baseline electromyographs for scalene muscles is heightened in children with asthma. The electromyographic activity of the sternocleidomastoid muscles for the baseline was similar in both groups. The electromyographs for the sternocleidomastoid and scalene muscles on the generation of intrathoracic pressure, during the PImax maneuver give higher values among children with asthma.

Influência do treino fisico moderado sobre a estrutura da parede arterial de ratos submetidos à desnutrição proteica gestacional e neonatal

We evaluated the effects of moderate physical training (MPT) associated with nutritional recovery on the left common carotid artery and horizontal carotid walls in 24 male, Wistar adult male rats submitted to protein malnutrition on the gestational and neonatal phases. The animals were divided in Nourished (N, n=12, casein 17%) and Malnourished (D, n=12, casein 8%). After weaning, all animals received standard diet (Labina®) and at the 60th day of life, both groups were subdivided in 4 groups with 6 animals each: Not-Trained Nourished (NTN), Trained Nourished (TN), Not-Trained Recovery (NTR) and Trained Recovery (TR). The MST was performed on treadmill during eight weeks, five days per week, 60 minutes a day. Histophotometry of both arteries was done with the Scion Image software for Windows (Beta 4.0.2). Arteries walls thickness was obtained by the mean value of 4 different points (0°, 90°, 180°, 270°), and the diameter of the lumen of the vessels from 2 values, starting from 4 opposite points. For the comparison between groups, Students t test was used and data were shown in mean±standard deviation. Mean thickness of the left common carotid artery (µm) and horizontal aorta (mm) was lower on the NTR group (32.51 ± 5.54; 0.11 ± 0.02, respectively) in comparison with the NTN group (40.91± 3.56; 0.15 ± 0.01). The diameter of the common left carotid artery was higher in the TR animals (724 ± 44.64) when compared with the NTR (630.73 ± 79.67). Therefore, the MPT associated with nutritional recovery was not capable of recovering the structural alterations due to malnutrition on the common left carotid and horizontal aorta arteries wall.

Regular physical exercise improves cardiac autonomic and muscle vasodilatory responses to isometric exercise in healthy elderly

The objective of this study was to evaluate cardiac autonomic control and muscle vasodilation response during isometric exercise in sedentary and physically active older adults. Twenty healthy participants, 10 sedentary and 10 physically active older adults, were evaluated and paired by gender, age, and body mass index. Sympathetic and parasympathetic cardiac activity (spectral and symbolic heart rate analysis) and muscle blood flow (venous occlusion plethysmography) were measured for 10 minutes at rest (baseline) and during 3 minutes of isometric handgrip exercise at 30% of the maximum voluntary contraction (sympathetic excitatory maneuver). Variables were analyzed at baseline and during 3 minutes of isometric exercise. Cardiac autonomic parameters were analyzed by Wilcoxon and Mann–Whitney tests. Muscle vasodilatory response was analyzed by repeated-measures analysis of variance followed by Tukey’s post hoc test. Sedentary older adults had higher cardiac sympathetic activity compared to physically active older adult subjects at baseline (63.13±3.31 vs 50.45±3.55 nu, P=0.02). The variance (heart rate variability index) was increased in active older adults (1,438.64±448.90 vs 1,402.92±385.14 ms, P=0.02), and cardiac sympathetic activity (symbolic analysis) was increased in sedentary older adults (5,660.91±1,626.72 vs 4,381.35±1,852.87, P=0.03) during isometric handgrip exercise. Sedentary older adults showed higher cardiac sympathetic activity (spectral analysis) (71.29±4.40 vs 58.30±3.50 nu, P=0.03) and lower parasympathetic modulation (28.79±4.37 vs 41.77±3.47 nu, P=0.03) compared to physically active older adult subjects during isometric handgrip exercise. Regarding muscle vasodilation response, there was an increase in the skeletal muscle blood flow in the second (4.1±0.5 vs 3.7±0.4 mL/min per 100 mL, P=0.01) and third minute (4.4±0.4 vs 3.9±0.3 mL/min per 100 mL, P=0.03) of handgrip exercise in active older adults. The results indicate that regular physical activity improves neurovascular control of muscle blood flow and cardiac autonomic response during isometric handgrip exercise in healthy older adult subjects.

Acute Effect of Neuromuscular Electrical Stimulation on Oxidative Stress and Hematological Parameters in Critical Patients

Aims: To analyze oxidative cellular stress and monitor the evolution of hematological parameters before and after of neuromuscular electrical stimulation (NMES) in critically ill patients. Methods: A controlled and randomized clinical trial, composed of a sample of 19 patients, admitted to the Agamenon Magalhaes Hospital intensive care unit. The patients were divided into two groups: NMES group (n=9), patients that underwent only one NMES in the quadriceps muscle for 20 min, and the other, control group (n=10) that did undergo any therapeutic intervention. Results: In relation to the demographic and clinical variables, the groups were homogeneous at the beginning of the study. For the nitric oxide (NO) analysis, we perceived a reduction, when comparing the before and after analyses, in NO in the stimulated cell (p=0.0188) and non-stimulated cell (p=0.0258) in the NMES group. Also in relation to NO, when comparing the two groups, we observed a significant reduction in the NMES group compared to the control one. For the hematological parameters we did not observe any difference when comparing before and after in the two groups studied. Conclusion: We can conclude that the use of NMES causes a reduction in cellular NO levels, showing the beneficial effects in reducing oxidative stress. With relation to complete blood count, we observed that its application was not able to causes any alterations.

Oxidative stress and immune system analysis after cycle ergometer use in critical patients

OBJECTIVE: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

Terapia complexa descongestiva com uso de material alternativo na redução e controle do linfedema em pacientes de área endêmica de filariose: um ensaio clínico

268 Complex decongestant therapy with use of alternative material to reduce and control lymphedema in patients with endemic area of filariasis: a clinical trial Terapia complexa descongestiva com uso de material alternativo na redução e controle do linfedema em pacientes de área endêmica de filariose: um ensaio clínico Terapia compleja descongestiva con el empleo de material alternativo reduce y controla el linfedema en pacientes de zonas endémicas de filariasis: estudio clínico Helen Pereira dos Santos Soares1, Abraham Rocha2, Ana Maria Aguiar-Santos2, Benícia Santos Silva1, Cristiane Moutinho Lagos de Melo1, Maria do Amparo Andrade3La filariasis linfatica presenta riesgo para muchas personas en el mundo. Pero poco se sabe acerca del impacto de la morbilidad cronica de esta enfermedad, como es el linfedema. Y surge la terapia compleja descongestiva como la forma de tratarlo, pero todavia no hay protocolos que le posibilite su implementacion en paises en desarrollo. Este estudio clinico tiene el proposito de valorar la eficacia de esta tecnica, con el empleo de material alternativo, y de comparar sus efectos en la calidad de vida, funcionalidad y peso corporal. Se evaluaron a los grupos intervencion y control a traves de medicion y calculo del volumen de los miembros, de cuestionario de calidad de vida Whoqol-Bref, de la prueba de funcionalidad y movilidad de los miembros inferiores Timed Up and Go y la evaluacion del peso corporal. El grupo intervencion hizo la terapia compleja descongestiva dos veces a la semana, durante diez semanas, y utilizo un material alternativo, el linon, para el vendaje, lo que mostro ser de bajo costo en comparacion a otras vendas importadas. El grupo control vio una charla que exponia informaciones sobre la enfermedad y sobre los cuidados e higienizacion de los miembros. Treinta pacientes con promedio de edad de 50,8±10 anos formaron la muestra, con un 52,9% de participantes mujeres. En el analisis estadistico se emplearon las pruebas t de Student, Multivariate analysis of variance, la prueba de Wilcoxon y Kolmogorov-Smirnov. El nivel de significacion ha sido de 5% (p<0,05). Se observo una significativa reduccion en el volumen y en la medicion del linfedema en el grupo intervencion, pero habia aumentado en el grupo control. La funcionalidad no ha presentado mejora en la evaluacion por la prueba Timed Up and Go. La calidad de vida ha presentado mejora en los dominios fisico y medioambiente en el grupo intervencion. El efecto del tratamiento en el peso corporal tambien ha sido significativo por presentar reduccion en el grupo control e intergrupal. La terapia compleja descongestiva puede ser eficaz en la reduccion y en el control del linfedema, ademas de aumentar positivamente los valores en los dominios fisico y medioambiente de la calidad de vida del grupo intervencion.