Patricia Driusso

Comparação da qualidade de vida nos diferentes tipos de incontinência urinária feminina

OBJETIVOS: Comparar o impacto do tipo de incontinencia urinaria sobre a qualidade de vida em mulheres. METODOS: Foram avaliados retrospectivamente 77 prontuarios de mulheres incontinentes que realizaram tratamento fisioterapeutico entre fevereiro de 2005 a outubro de 2006. De acordo com os dados do exame urodinâmico, as mulheres foram classificadas em tres grupos: incontinencia urinaria de esforco (IUE), hiperatividade vesical (HV) e incontinencia urinaria mista (IUM). As voluntarias responderam a uma anamnese com dados demograficos e ao Kings Health Questionnaire, questionario especifico para avaliacao da qualidade de vida em individuos com incontinencia urinaria. RESULTADOS: A maioria das pacientes (44%) apresentou IUM. A idade das pacientes acometidas por HV foi significativamente maior se comparada a idade das pacientes dos demais grupos. As mulheres acometidas por IUM apresentaram um impacto negativo significativamente maior sobre a qualidade de vida (dominio percepcao geral da saude) e sobre a percepcao de que a incontinencia afeta de modo negativo a propria vida em comparacao com as pacientes dos demais grupos. CONCLUSAO: Este estudo indicou que pacientes com IUM apresentaram um maior impacto negativo sobre a qualidade de vida.

Individual and group pelvic floor muscle training versus no treatment in female stress urinary incontinence: a randomized controlled pilot study §

OBJECTIVE To compare the effects of pelvic floor muscle training (PFMT) performed during group treatment sessions (GT) and individual treatment sessions (IT) to a control group (CG) of women with stress urinary incontinence (SUI). HYPOTHESIS The group treatment sessions would have better effects compared to individual treatment sessions. STUDY DESIGN This randomized controlled pilot study included women aged over 18 years, who complained of urinary leakage on stress and who had not undergone physical therapy for SUI before. Forty-nine women were randomly allocated to the PFMT in group treatment session (GT) (n=17), PFMT in individual treatment session (IT) (n=17) and control group (CG) (n=15). The study was carried out in an outpatient physical therapy department in São Carlos, Brazil. Subjects on intervention groups were treated with the same PFMT protocol for 6 weeks, with two 1-h weekly sessions. The GT group carried out the PFMT in group treatment session and IT group in individual treatment session. The CG did not receive any treatment during the corresponding time. They were evaluated before and after treatment for primary outcome, urinary loss, and secondary outcomes, Kings Health Questionnaire, pressure perineometry, pelvic floor muscle strength by digital palpation and subjective satisfaction. Participants, evaluator and the physical therapist were not blinded. Forty-five women completed the study and were included in the analysis. The statistical analysis was performed using Wilcoxon test for intragroup analysis and Kruskal-Wallis and Mann-Whitney test for intergroup analysis (p<0.05). RESULTS In intragroup analysis, there was a significant reduction in urinary loss measured by pad test only in the IT group. For primary outcome, there was a significant difference only after treatment between GT and CG (p<0.0001; effect size -0.91; 95% confidence interval from 0.56 to 5.80) as well as between IT and CG (p<0.0001; effect size -0.90; 95% confidence interval from 0.54 to 5.84). There were differences after treatment in GT and IT groups for secondary outcomes: perineometry, muscle strength and in the domains of the quality of life questionnaire. For the CG group, there were not significant differences in any variables. In intergroup analysis for all variables, there were no differences between GT and IT groups. The two treated groups had similar subjective satisfaction (86%). There were no complaints of adverse effects due to treatment from either group. CONCLUSION The results indicated similar improvement in clinical variables and in satisfaction with the treatment between IT and GT.

In vivo biological performance of a novel highly bioactive glass-ceramic (Biosilicate®): A biomechanical and histomorphometric study in rat tibial defects

This study aimed to investigate bone responses to a novel bioactive fully crystallized glass-ceramic of the quaternary system P(2)O(5)-Na(2)O-CaO-SiO(2) (Biosilicate®). Although a previous study demonstrated positive effects of Biosilicate® on in vitro bone-like matrix formation, its in vivo effect was not studied yet. Male Wistar rats (n = 40) with tibial defects were used. Four experimental groups were designed to compare this novel biomaterial with a gold standard bioactive material (Bioglass® 45S5), unfilled defects and intact controls. A three-point bending test was performed 20 days after the surgical procedure, as well as the histomorphometric analysis in two regions of interest: cortical bone and medullary canal where the particulate biomaterial was implanted. The biomechanical test revealed a significant increase in the maximum load at failure and stiffness in the Biosilicate® group (vs. control defects), whose values were similar to uninjured bones. There were no differences in the cortical bone parameters in groups with bone defects, but a great deal of woven bone was present surrounding Biosilicate® and Bioglass® 45S5 particulate. Although both bioactive materials supported significant higher bone formation; Biosilicate® was superior to Bioglass® 45S5 in some histomorphometric parameters (bone volume and number of osteoblasts). Regarding bone resorption, Biosilicate® group showed significant higher number of osteoclasts per unit of tissue area than defect and intact controls, despite of the non-significant difference in the osteoclastic surface as percentage of bone surface. This study reveals that the fully crystallized Biosilicate® has good bone-forming and bone-bonding properties.

Effects of low-level laser therapy on the expression of osteogenic genes related in the initial stages of bone defects in rats

Abstract. We evaluate the effects of low-level laser therapy (LLLT) on the histological modifications and temporal osteogenic genes expression during the initial phase of bone healing in a model of bone defect in rats. Sixty-four Wistar rats were divided into control and treated groups. Noncritical size bone defects were surgically created at the upper third of the tibia. Laser irradiation (Ga-Al-As laser 830 nm, 30 mW, 0.028  cm2, 1.071  W/cm2, 1 min and 34 s, 2.8 Joules, 100  J/cm2) was performed for 1, 2, 3, and 5 sessions. Histopathology revealed that treated animals presented higher inflammatory cells recruitment, especially 12 and 36 h postsurgery. Also, a better tissue organization at the site of the injury, with the presence of granulation tissue and new bone formation was observed on days three and five postsurgery in the treated animals. The quantitative real time polymerase chain reaction showed that LLLT produced a significantly increase in mRNA expression of Runx-2, 12 h and three days post-surgery, a significant upregulation of alkaline phosphatase mRNA expression after 36 h and three days post-surgery and a significant increase of osteocalcin mRNA expression after three and five days. We concluded that LLLT modulated the inflammatory process and accelerated bone repair, and this advanced repair pattern in the laser-treated groups may be related to the higher mRNA expression of genes presented by these animals.

Effect of pelvic floor muscle training on labour and newborn outcomes: a randomized controlled trial

BACKGROUND The use of the pelvic floor muscle training for urinary incontinence treatment is well established but little is known about its effects in labor and newborn outcomes. OBJECTIVES To evaluate the effects of antenatal pelvic floor muscle training and strength in labor and newborn outcomes in low-income pregnant women. METHODS This is a randomized controlled trial that recruited forty-two nulliparous healthy pregnant women aged between 18-36 years old and able to contract the pelvic floor muscles. The participants were included in the study with 20 weeks of gestational age and had their pelvic floor muscles measured by vaginal squeeze pressure. They were randomly allocated into two groups: training group and a non-intervention control group. Then, all participants had their labor and newborn outcomes evaluated through consultation of medical records by a blinded researcher. RESULTS There were no statistically significant differences between the groups regarding gestational age at birth, type of labor, duration of the second stage of labor, total time of labor, prevalence of laceration, weight and size of the baby, and Apgar score. No correlation was observed between pelvic floor muscle strength and the second stage or the total length of labor. CONCLUSIONS This randomized controlled trial did not find any effect of pelvic floor muscle training or pelvic floor muscle strength on labor and newborn outcomes.

Comparison of thoracic kyphosis degree, trunk muscle strength and joint position sense among healthy and osteoporotic elderly women: A cross-sectional preliminary study

Increased thoracic kyphosis is one of the most disfiguring consequences of osteoporotic spine fractures in the elderly. However, mechanisms involved in the increasing of the kyphosis degree among osteoporotic women are not completely understood. Then, the aims of this cross-sectional preliminary study were comparing thoracic kyphosis degree, trunk muscle peak torque and joint position sense among healthy and osteoporotic elderly women and investigating possible factors affecting the kyphosis degree. Twenty women were selected for 2 groups: healthy (n=10) and osteoporotic (n=10) elderly women. Bone mineral density (BMD), thoracic kyphosis degree, trunk muscles peak torque and joint position sense were measured. Differences among groups were analyzed by Students Test T for unpaired data. Correlations between variables were performed by Pearsons coefficient correlation. The level of significance used for all comparisons was 5% (p≤0.05). We observed that the osteoporotic women demonstrated a significantly higher degree of kyphosis and lower trunk extensor muscle peak torque. Moreover, it was found that the BMD had a negative correlation with the thoracic kyphosis degree. Kyphosis degree showed a negative correlation between extensor muscle strength and joint position sense index. This study suggests that lower BMD may be associated to higher degree of kyphosis degree, lower trunk extensors muscle strength and an impaired joint position sense. It is also suggested that lower extensor muscle strength may be a factor that contributes to the increasing in kyphosis thoracic degree.

Low-level laser therapy (904nm) can increase collagen and reduce oxidative and nitrosative stress in diabetic wounded mouse skin.

BACKGROUND AND OBJECTIVE Over the last decade we have seen an increased interest in the use of Low-Level Laser Therapy (LLLT) in diseases that involve increased oxidative stress. It is well established that hyperglycemia in diabetes elicits a rise in reactive oxygen species (ROS) production but the effect of LLLT remains unclear. This study aimed to investigate whether LLLT was able to improve oxidative/nitrosative stress parameters in the wound healing process in diabetic mice. STUDY DESIGN/MATERIALS AND METHODS Twenty male mice were divided into four groups: non-irradiated control (NIC), irradiated control (IC), non-irradiated and diabetic (NID), irradiated and diabetic (ID). Diabetes was induced by administration of streptozotocin. Wounds were created 120days after the induction of diabetes in groups IC and ID and these groups were irradiated daily for 5days (superpulsed 904nm laser, average power 40mW, 60s). All animals were sacrificed 1day after the last irradiation and histology, collagen amount, catalase activity, nitrite and thiobarbituric acid reactive substances (TBARS) were measured. RESULTS Histology showed that collagen fibers were more organized in IC and ID when compared to NID group, and significant differences in collagen content were found in group ID versus NID. Catalase activity was higher in IC group compared to other groups (p<0.001). TBARS levels were higher in IC versus NIC, but were lower in ID versus NID (p<0.001). Nitrite was lower in both irradiated groups versus the respective non-irradiated groups (p<0.001). CONCLUSIONS Delayed wound healing in diabetes is still a challenge in clinical practice with high social costs. The increased production of collagen and decreased oxidative and nitrosative stress suggests that LLLT may be a viable therapeutic alternative in diabetic wound healing.

Influência da universidade aberta da terceira idade (UATI) e do programa de revitalização (REVT) sobre a qualidade de vida de adultos de meia-idade e idosos

Influence of the Open University for the Third Age (UATI) and the revitalization program (REVT) on quality of life in middle-aged and elderly adults

Influence of a physical training program on muscle strength, balance and gait velocity among women with osteoporosis

Objectives: The trend towards increased life expectancy will certainly lead to increases in morbidity and mortality relating to osteoporosis. Because of the lack of well defined protocols on the intensity and frequency of easily performed physical exercises for Brazilian women, this study proposed to analyze the effects of a training program for ankle muscle strength, balance performance and gait velocity among women with a densitometric diagnosis of osteoporosis. Methods: Twelve female volunteers (age 68.7 ± 2.7 years) underwent physical evaluation and subsequent reevaluation after twelve weeks. The physical activity program was guided by a physical therapist, who conducted 60-minute sessions, three times a week for twelve weeks. Each training session included some stretching exercises, strengthening exercises for the ankle dorsiflexor and plantar-flexor muscles, with 50% of 10-repetition maximum (10-RM), and balance training. Results: The variables analyzed regarding balance index, gait velocity and muscle strength presented significant improvement (p ≤ 0.05), as shown by the Wilcoxon non-parametric test. Conclusion: After the 12-week exercise program, the participants presented benefits in terms of their fitness. The results demonstrate that the training had a role in improving the condition of this group of patients, thus suggesting that this program was effective, easy to implement and safe for Brazilian women with osteoporosis. Therefore, it can be seen that physical activity programs are efficient in improving balance performance, gait velocity and ankle muscle strength among elderly women with osteoporosis.

Long-Term Effects of Pelvic Floor Muscle Training With Vaginal Cone in Post-Menopausal Women With Urinary Incontinence: A Randomized Controlled Trial

The findings are limited about the long‐term effects of treatment with vaginal cones in women with stress urinary incontinence (SUI). The aim of this study was to investigate the long‐term effects of vaginal cones and pelvic floor muscle training in post‐menopausal women with SUI.