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- ItemSomente MetadadadosAnálise de parâmetros metabólicos e ventilatórios durante a realização de atividades da vida diária (AVD) em portadores de doença pulmonar obstrutiva cronica (DPOC) e indivíduos normais(Universidade Federal de São Paulo (UNIFESP), 1998) Velloso, Marcelo [UNIFESP]; Jardim, José Roberto de Brito [UNIFESP]Os membros superiores (MMSS) estao amplamente envolvidos em atividades, sejam elas de higiene pessoal, servico domestico, no trabalho ou no lazer. Individuos normais realizam estas atividades sem notar o gasto energetico exigido pelas mesmas. Porem, pacientes com doenca pulmonar obstrutiva cronica (DPOC) referem intenso cansaco ao realiza-las. O objetivo deste trabalho foi avaliar a demanda metabolica e ventilatoria em pacientes com DPOC em quatro atividades que utilizam os MMSS em posicoes distintas, e comparar com o consumo maximo de oxigenio estimado, para determinar o grau de demanda fisica. Foram avaliados dez individuos normais e nove pacientes com DPOC, do sexo masculino, sedentarios, submetidos a avaliacao clinica e espirometrica. Em seguida foram encaminhados ao Laboratorio de Fisiologia Respiratoria e Exerclcio em Humanos, e submetidos a dois testes em dias diferentes, tendo-se determinado o consumo de oxigenio (VO2), producao de dioxido de carbono (VCO2), ventilacao minuto (VE) e frequencia cardiaca (FC) durante a realizacao de quatro atividades da vida diaria (AVD): varrer, apagar lousa, elevar potes e trocar lampadas. Nao houve diferenca entre os resultados dos dois testes. Houve um aumento do V02, VCO2 e VE durante a realizacao das AVD com os MMSS, tanto para pacientes com DPOC como para individuos normais. Foram testados dez individuos normais, com uma faixa etaria mais baixa que os pacientes com DPOC (27,9 n 7,3 anos), para averiguar a reprodutibilidade dos testes propostos. Nao houve diferenca entre os dois testes e, em media, para as quatro atividades, a relacao V02/ VCO2max. foi 17,75 por cento , a relacao VE/VVM foi 9,8 por cento , e a relacao FC/FCmax. foi 52,4 por cento . A relacao do consumo de oxigenio medido com o consumo maximo de oxigenio estimado (VO2 medido/ VO2max. em cicloergometro) em porcentagem da media mostrou que pacientes com DPOC consomem 55 por cento do VO2max. para varrer, 48 por cento do VO2max. para apagar lousa, 58 por cento do VO2max. para elevar potes e 45 por cento do VO2max. para trocar lampadas. A relacao do volume minuto medido com a ventilacao voluntaria maxima (VE/VVM) em porcentagem da media mostrou que pacientes com DPOC utilizam 57,2 por cento da VVM para varrer, 54,7 por cento da VVM para apagar lousa, 62,8 por cento da VVM para elevar potes e 54,7 por cento da VVM para trocar lampadas. A relacao da frequencia cardiaca medida com a frequencia cardiaca maxana (FC medida/FCnax)...(au)
- ItemAcesso aberto (Open Access)Conservative interventions for treating middle third clavicle fractures in adolescents and adults(Inst Israelita Ensino & Pesquisa Albert Einstein, 2016) Lenza, Mario; Faloppa, Flavio [UNIFESP]Background Clavicle (collarbone) fractures account for around 4% of all fractures. Most (76%) clavicle fractures involve the middle-third section of the clavicle. Treatment of these fractures is usually non-surgical (conservative). Commonly used treatments are arm slings, strapping and figure-of-eight bandages. This is an update of a Cochrane review first published in 2009 and updated in 2014. Objectives To evaluate the effects (benefits and harms) of different methods for conservative (non-operative) treatment for acute (treated soon after injury) middle third clavicle fractures in adolescents and adults. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE (from 1966), Embase (from 1980), LILACS (from 1982), trial registers, orthopaedic proceedings and reference lists of articles. We applied no language or publication restrictions. The date of the last search was 5 January 2016. Selection criteria Randomised and quasi-randomised controlled trials testing conservative interventions for treating adolescents and adults with acute middle third clavicle fractures. The primary outcomes were shoulder function or disability, pain and treatment failure. Data collection and analysis For this update, two review authors selected eligible trials, independently assessed risk of bias and cross-checked data extraction. We calculated risk ratios and 95% confidence intervals for dichotomous variables, and mean differences and 95% confidence intervals for continuous variables. There was very limited pooling of data. Main results We included four trials in this review with 416 participants, who were aged 14 years or above. One new trial was included in this update. Very low quality evidence was available from three trials (296 participants) that compared the figure-of-eight bandage with an arm sling for treating acute middle third clavicle fractures. The three trials were underpowered and compromised by poor methodology. Shoulder function was assessed in different ways in the three trials (data for 51, 61 and 152 participants)
- ItemAcesso aberto (Open Access)Minimal important difference after hand surgery: a prospective assessment for dash, mhq, and sf-12(Ivyspring Int Publ, 2016) Maia, Mauricio Vieira de Padua [UNIFESP]; Moraes, Vinícius Ynoe de [UNIFESP]; Santos, João Baptista Gomes dos [UNIFESP]; Faloppa, Flávio; Belloti, Joao Carlos [UNIFESP]Introduction: Minimal important difference (MID) score is an important measure for surgical clinical research and impacts on treatment decisions. Our approach considered patient satisfaction as the relevant anchor criteria. The aims of this study were: determine after surgery MID for three relevant questionnaires: Disabilities of the Arm, Shoulder and Hand (DASH), Michigan Hand Questionnaire (MHQ), and Short Form 12 (SF-12)
- ItemAcesso aberto (Open Access)Minimal invasive ostheosintesis for treatment of diaphiseal transverse humeral shaft fractures(Sociedade Brasileira de Ortopedia e Traumatologia, 2014-01-01) Zogaib, Rodrigo Kallás; Morgan, Steven; Belangero, Paulo Santoro; Fernandes, Hélio Jorge Alvachian; Belangero, William Dias; Livani, Bruno; Universidade Estadual de Campinas (UNICAMP); Swedish Medical Center; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE:To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique.METHODS:Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures.RESULTS:In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury.CONCLUSION:It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft.Level of Evidence III, Therapeutic Study.
- ItemAcesso aberto (Open Access)Predição de peso ao nascimento pela ultra-sonografia tridimensional usando o volume do braço fetal: resultados preliminares(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2008-04-01) Vieira, Márcio Fragoso [UNIFESP]; Nardozza, Luciano Marcondes Machado [UNIFESP]; Araujo Júnior, Edward [UNIFESP]; Guimarães Filho, Hélio Antonio [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: to evaluate the accuracy of fetal upper arm volume, using three-dimensional ultrasound (3DUS), in the prediction of birth weight. METHODS: this prospective cross-sectional study involved 25 pregnancies without structural or chromosomal anomalies. Bidimensional parameters (biparietal diameter, abdominal circumference and femur length) and the 3DUS fetal upper arm volume were obtained in the last 48 hours before delivery. The multiplanar method, using multiple sequential planes with 5.0-mm intervals, was used to calculate fetal upper arm volume. Polynomial regressions were used to determine the best equation in the prediction of fetal weight. The accuracy of this new formula was compared with Shepard's and Hadlock's formulas. RESULTS: fetal upper arm volume was strongly correlated to birth weight (r=0.83; p<0.005). Linear regression was the best equation [birth weight=681.59 + 43.23 x fetal upper arm volume]. The fetal upper arm volume mean error (0 g), mean absolute error (196.6 g) and mean percent absolute error (6.5%) were lower than using Shepard's formula; however, the difference did not reach significance (p>0.05). Birth weight predicted by fetal upper arm volume had a mean error lower than Hadlock's formula, but this difference was not statistically significant (p>0.05). CONCLUSIONS: the accuracy of fetal upper arm volume obtained through 3DUS is similar to the accuracy of bidimensional ultrasound in the prediction of birth weight. These findings need to be confirmed by larger studies.
- ItemAcesso aberto (Open Access)Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire(Associação Brasileira de Divulgação Científica, 2005-02-01) Orfale, Adriana Garcia [UNIFESP]; Araujo, Pola Maria Poli de [UNIFESP]; Ferraz, Marcos Bosi [UNIFESP]; Natour, Jamil [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The objective of the present study was to translate, adapt and validate a Brazilian Portuguese version of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. The study was carried out in two steps. The first was to translate the DASH into Portuguese and to perform cultural adaptation and the second involved the determination of the reliability and validity of the DASH for the Brazilian population. For this purpose, 65 rheumatoid arthritis patients of either sex (according to the classification criteria of the American College of Rheumatology), ranging in age from 18 to 60 years and presenting no other diseases involving the upper limbs, were interviewed. The patients were selected consecutively at the rheumatology outpatient clinic of UNIFESP. The following results were obtained: in the first step (translation and cultural adaptation), all patients answered the questions. In the second step, Spearman's correlation coefficients for interobserver evaluation ranged from 0.762 to 0.995, values considered to be highly reliable. In addition, intraclass correlation coefficients ranged from 0.97 to 0.99, also highly reliable values. Spearman's correlation coefficients and the intraclass correlation coefficients obtained during intra-observer evaluation ranged from 0.731 to 0.937 and from 0.90 to 0.96, respectively, being highly reliable values. The Ritchie Index showed a weak correlation with Brazilian DASH scores, while the visual analog scale of pain showed a good correlation with DASH score. We conclude that the Portuguese version of the DASH is a reliable instrument.