Paulo Magalhães

Prevalence and determinants of diabetic polyneuropathy and diabetic foot complications in a specialized clinic

Background Diabetic peripheral neuropathy is one of the common chronic complications of diabetes and a cause of limb amputations. Foot complications are considered to be a serious consequence of diabetes mellitus. At the time of diagnosis, more than 10% of people with type 2 diabetes mellitus have one or two risk factors for foot ulceration and a lifetime risk of 15%. Identifying the extent of this problem and its risk factors will enable health providers to set up better prevention programs.

Dispositivos ventilatórios não invasivos em criança portadora de amiotrofia espinhal do tipo 1: relato de caso

Introducao: amiotrofia espinhal do tipo 1 (AME 1) e uma doenca genetica autossomica recessiva que promove morte celular de neuronios motores localizados no corno anterior da medula e nucleos motores do tronco cerebral. A precoce morbimortalidade esta associada a disfuncao bulbar e insuficiencia respiratoria, necessitando de internamento hospitalar e de suporte ventilatorio artificial. O objetivo do estudo foi divulgar a relevância da manutencao de paciente com AME 1 sem protese ventilatoria invasiva e com protocolo de fisioterapia individualizado, proporcionando melhor qualidade de vida e integracao com seus familiares. Descricao: relato de caso de menor diagnosticado com AME 1 que aos 11 meses foi submetido a ventilacao mecânica invasiva (VMI) por 76 dias, obtendo sucesso no desmame apos aplicacao de um protocolo de fisioterapia respiratoria, incluindo a utilizacao de tosse mecanicamente assistida e ventilacao nao invasiva (VNI). Discussao: apesar das dificuldades e intercorrencias observadas, a assistencia proposta alcancou o objetivo de retirada da VMI e transferencia para internacao domiciliar com dispositivos ventilatorios nao invasivos. A VMI por traqueostomia e considerada tratamento de eleicao no Brasil, no entanto, as familias precisam ser esclarecidas da irreversibilidade da doenca e das possibilidades estrategicas das terapeuticas atuais (VMI, VNI e paliacao) para o manuseio de crianca grave com AME 1.

CONTRIBUIÇÕES DE UM GRUPO DA TERCEIRA IDADE PARA A SAÚDE DAS IDOSAS PARTICIPANTES

Objective: Aging leads to significant losses in the elderly, whether physical, psychological or social. In this context, social support programs and welcoming environments are highlighted by being prosecutor elements of security and well-being, stimulating and enhancing the autonomy of the elderly. Given this, we aimed to identify the social benefits of a support group for older participants under their own perspective. Material and Methods: A cross-sectional study was conducted consisting of 20 women with a mean age of 69.1 ± 6.29 years, participants of Group Renascer (“Reborn”), inland of Paraiba state. Results: It was verified a good ability to perform functional activities that require flexibility, in contrast with a deficit for activities requiring strength. Regarding contributions to the self-image, 65% reported having greater satisfaction in living upon participation of the group, and 35% felt more socially valued. In the social relationships, 57% reported “ease of living”; 24% greater emotional expressiveness; while 19% said nothing had changed. Conclusion: the Group “Reborn” provided improvements in the personal dimension concerning individual skills, making the elderly more confident, with more self-esteem, better functional capacity and quality of life. In the social dimension, there was an improvement in the relationships among the elderlies themselves and in their social relationships, in addition to an encouragement for collective constructions. DESCRIPTORS Public Health. Social Assistance. Elderly.

Level of independence, functional capacity and respiratory muscle strength of patients with mucopolysaccharidosis type VI in the Northeast of Brazil

Objectives: to assess the functional independence, functional capacity and respiratory muscle strength (RMS) in individuals with mucopolysaccharidosis (MPS) type VI. Methods: in this cross-sectional study, the Pediatric Evaluation of Disability Inventory (PEDI) and the Functional Independence Measure (FIM) scales were used to assess the functional independence. The functional capacity and the RMS were assessed by a 6-minute walk test (6MWT) and Manovacuometry, respectively. The associations between RMS and 6MWD were analyzed by using the adjusted simple linear regression models. And besides, the T-test was used to compare the differences among the groups. Results: twenty-four patients with MPS VI were included, the median age was 8 (ranged from 2-38 years old). The PEDI presented a functional performance below the expectations at the self-care and mobility domains of 33.3% when compared to groups of Brazilian children at the same age assessed with typical development. The decreased social function was found in only one single case. According to the FIM, of the 12 patients evaluated (age>7.5 years), 58.3% were classified as modified dependence and 41.7% as modified independence. The mean distance in the 6MWT was significantly lower than predicted, 263m in G1 (children, n=7) and 336m in G2 (adolescents and adults, n=6), p<0.001. The RMS was also lower than predicted in both groups, except for the RMS in G1. Conclusions: the functional capacity and the RMS were significantly reduced in individuals with MPS VI, with a decreased functional independence in one-third of the patients. However, a multidisciplinary follow-up in this population is essential to prevent, diagnose and treat early complications.Objetivos: avaliar a independência funcional, capacidade funcional e força muscular respiratória (FMR) em indivíduos com mucopolissacaridose (MPS) tipo VI. Métodos: neste estudo transversal, as escalas Inventário de Avaliação Pediátrica de Incapacidade (PEDI) e Medida de Independência Funcional (MIF) foram utilizadas para avaliar a independência funcional. A capacidade funcional e a FMR foram avaliadas por teste de caminhada de 6 minutos (6MWT) e Manovacuometria, respectivamente. As associações entre FMR e 6MWD foram analisadas usando modelos de regressão linear simples. Além disso, t-test foi usado para comparar diferenças entre grupos. Resultados: vinte e quatro pacientes com MPS VI foram incluídos no estudo, a média da idade foi 8 anos (2-38 anos). A PEDI apresentou desempenho funcional abaixo das expectativas nos domínios de autocuidado e mobilidade em 33,3% quando comparada com grupos de crianças brasileiras com desenvolvimento típico da mesma idade avaliada. A diminuição da função social foi encontrada em apenas um único caso. De acordo com a MIF, dos 12 pacientes avaliados (idade> 7,5 anos), 58,3% foram classificados como dependência modificada e 41,7% como independência modificada. A distância média no 6MWT foi significativamente menor do que o previsto, 263 m em G1 (crianças, n = 7) e 336 m em G2 (adolescentes e adultos, n = 6), p<0,001. A FMR também foi menor do que o previsto em ambos os grupos, com exceção em G1. Conclusões: a capacidade funcional e a FMR foram significativamente reduzidas em indivíduos com MPS VI, com diminuição da independência funcional em um terço dos pacientes. Portanto, o seguimento multidisciplinar no acompanhamento dessa população é essencial para prevenir, diagnosticar e tratar complicações precocemente. Palavras-chave Fisioterapia, Mucopolissacaridose VI, Tolerância ao exercício, Músculos respiratórios

VENTILAÇÃO NÃO INVASIVA NA INSUFICIÊNCIA CARDÍACA ASSOCIADA À APNEIA DO SONO

Objective: This study aimed to review the literature on the use of Noninvasive Ventilation (NIV) as a non-pharmacological treatment in respiratory care to patients with sleep apnea syndrome in cases associated with severe heart failure (HF). Material and Methods: This is an integrative literature review comprising a sample 19 articles from journals in the field of health, available from the databases Scientific Electronic Library Online (SciELO), PubMED and Science Direct, published between 1999 and 2012. A combination of the following descriptors was used: heart failure, noninvasive ventilation and sleep apnea syndromes. Results: Data were analyzed through the technique of content analysis. Studies have shown that NIV reduces premature ventricular beats; improves the ejection fraction of the left ventricle (LV), saturation of oxygen in arterial blood (SO2), as well as central and obstructive sleep apnea. Moreover, it contributes to improved quality of life and reduced mortality in these patients. Conclusion: Various studies indicate that the effects of NIV in patients with HF seem to be promising in the treatment of stable cardiac disease, especially in cases with concomitant sleep disturbance. DESCRIPTORS Noninvasive Ventilation. Heart Failure. Sleep Apnea.

Mucopolysaccharidosis type VI: Assessment of functionality, functional capacity and respiratory muscle strength

Introduction: Maroteaux-Lamy Syndrome (MPS VI) is a rare type of mucopolysaccharidosis in the world, however in Brazil it is one of the most commonly diagnosed. Objectives: to measure the functionality, functional capacity and strength of the respiratory muscles of MPS type VI carriers in a Brazilian Center of inborn errors of metabolism. Method: cross sectional study. Pediatric Evaluation of Disability Inventory (PEDI) or Functional Independence Measure (FIM) was applied according with the age. Relation between muscles strength and total distance walked on the test (6MWD) were analyzed based on simple linear regression models. Students t test and ANOVA test were performed to measure the average difference between groups. Relations between Maximal Inspiratory Pressure (MIP), Maximal Expiratory Pressure (MEP) and the total distance walked on 6MWT were analysed based on simple linear regression models, significant p<0.05. Results: from the 24 MPS VI carriers, the average distance walked on the 6MWT was 300 meters (about 984ft) and it´s average predicted value was 585 meters (p<0.001) (about 1919ft). The average values found in the respiratory muscles strength tests was MIP -56 ± 36.0 cmH2O, and the predicted average MIP= -62±12,7cmH2O ( p =0,002). In the PEDI evaluation, 33.3% showed lower performance than expected in the self-care and mobility areas. In the FIM evaluation, 53.3% showed modified dependence and 41.7% showed modified independence. Conclusion: we observed reduction on the functional capacity and significant reduction strength of the respiratory muscles in MPS VI patients, besides the functional dependence in most of the patients.