RESUMO
Introduction: To assess the effectiveness of seating devices during the sitting position on postural stability and upper limb functionality in users with dyskinetic type cerebral palsy. Method: A systematic review that included randomized, quasi-randomized, cohort, and pre-post intervention clinical trials with evaluation before and after the intervention. This review included studies of chil-dren with a diagnosis of cerebral palsy, mainly of the dyskinetic type, with ages between 2 and 10 years old. The databases of CINAHL Plus, Cochrane (Central), EMBASE (Via Ovid), Virtual Health Library, OT Seeker, Medline (Via PubMed) and OpenGrey were used. Results: Two studies met the inclusion criteria; however, the analysis was carried out qualitatively due to the methodological quality for these, with presence of a high risk of bias. The study by Cimolin described greater trunk stability and smooth upper extremity movements with the use of a dynamically configured seat. Nwaobi described better upper extre-mity functionality in a seat inclined at 0º and 30º, not referring to trunk stability. Conclusion: From the review of the results it is concluded that there is not enough scientific evidence to determine that the use of seating devices favors the postural control and the functionality of upper extremities in children with cerebral dyskinesia type cerebral palsy.
Introducción: Evaluar la eficacia del posicionamiento sedente en la estabilidad postural y funcionalidad de extremidades superiores, en ni-ños con parálisis cerebral discinética, comparando el uso y el no uso de seating de posicionamiento. Método: Revisión siste-mática incluyendo ensayos clínicos de tipo aleatorio, cuasialeatorizado, de cohorte y casos con evaluación antes y después de la intervención. Se incluyó niños con parálisis cerebral discinético, entre 2 y 10 años de edad. Se utilizó bases de datos de CI-NAHL Plus, Cochrane (Central), EMBASE (Vía Ovid), Biblioteca Virtual de la Salud, OT Seeker, Medline (Via PubMed) y Open Grey. Resultados: Dos estudios cumplieron criterios de inclusión, aunque el análisis se realizó de forma cualitativa por la calidad metodológica de estos. Cimolin detectó mayor estabilidad de tronco y suavidad en los movimientos de extremidades superiores con el uso de un asiento de configuración dinámica. Nwaobi describió mejor funcionalidad de extremidad superior en un asiento inclinado a 0º y 30º, no haciendo referencia a la estabilidad de tronco. Conclusión: De la revisión de los resulta-dos, se concluye que no existe evidencia científica suficiente que determine que el uso de seating favorezca o no el control postural y la funcionalidad de extremidades superiores en niños y jóvenes con parálisis cerebral de tipo discinética.
Assuntos
Humanos , Pré-Escolar , Criança , Paralisia Cerebral/reabilitação , Extremidade Superior/fisiologia , Postura Sentada , Paralisia Cerebral/fisiopatologia , Discinesias/fisiopatologia , Discinesias/reabilitação , Equilíbrio PosturalRESUMO
OBJECTIVE: To measure lung function by impulse oscillometry (IOS) and spirometry in recurrent wheezer pre-schoolers according to their asthma predictive index (API) condition. METHODS: We performed a case-control study enrolling all pre-schoolers with recurrent wheezing episodes (>3 episodes confirmed by physician) who presented at a paediatric pulmonology clinic. The population was divided according to stringent API criteria into positive or negative. RESULTS: In the nine-month period, 109 pre-schoolers were enrolled. After excluding one patient (due to lung function technique problems) 108 pre-schoolers (56 males, age range from 24 to 72 months) completed the study; 50 belong to positive API and 58 to negative API group. There were no differences in demographics between groups. More use of ICS was found in those with positive API than with negative API (62% vs. 12%, respectively, p=0.001). No differences in basal lung function and post-bronchodilator response to salbutamol (by IOS or spirometry) were found between positive and negative API pre-schoolers. However, those positive API pre-schoolers with ICS had significantly higher central basal airway resistance (RA at 20Hz) and higher post-BD response (% change in FEF25-75 and in FEV0.5) than those positive API without ICS. CONCLUSION: Recurrent wheezer pre-schoolers with positive API and ICS used may have airway dysfunction. More studies are needed to confirm this finding.
Assuntos
Asma/diagnóstico , Sons Respiratórios/diagnóstico , Sistema Respiratório/metabolismo , Estudos de Casos e Controles , Pré-Escolar , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Recidiva , Testes de Função Respiratória/métodosRESUMO
An extensive survey was performed from 2002 to 2006 to detect and identify phytoplasmas associated with Chilean grapevines. Nested polymerase chain reaction assays using phytoplasma universal primer pairs P1/P7 and R16F2n/R2 detected phytoplasmas in 34 out of the 94 samples tested (36%). Restriction fragment length polymorphism (RFLP) analyses, cloning, and sequencing allowed identification of phytoplasmas belonging to ribosomal subgroups 16SrI-B, 16SrI-C, 16SrVII-A, and 16SrXII-A. The 16SrVII-A phytoplasma represents a new finding in grapevine; moreover, variability of the RFLP profile was observed in some of the 16SrXII-A phytoplasmas, indicating possible new ribosomal subgroups. Mixed phytoplasma infections and infections of phytoplasmas together with one or more viruses also occurred.
RESUMO
We have performed a prospective, randomized, double-blind clinical study to assess the efficacy of ondansetron, droperidol, or both, in preventing postoperative emesis. We studied 242 patients undergoing biliary or gynaecological surgery under general anaesthesia. Shortly before induction of anaesthesia, patients received: saline i.v. (group I, n = 62); droperidol 2.5 mg i.v. (group 2, n = 60); ondansetron 4 mg i.v. (group 3, n = 57); or droperidol 2.5 mg with ondansetron 4 mg i.v. (group 4, n = 63). Nausea occurred in 45%, 37%, 32% and 29% (P = 0.234) and vomiting in 23%, 17%, 9% and 5% (P = 0.016) of patients in groups 1, 2, 3 and 4, respectively, during the first 24 h. Groups 2 and 4 had greater sedation scores than group 1 during the first 3 h (P < 0.01). We conclude that both droperidol and ondansetron showed a significant antiemetic effect, ondansetron was not significantly better than droperidol, and the combination of droperidol and ondansetron was better than droperidol but no better than ondansetron alone.
Assuntos
Antieméticos/uso terapêutico , Droperidol/uso terapêutico , Ondansetron/uso terapêutico , Náusea e Vômito Pós-Operatórios/prevenção & controle , Adolescente , Adulto , Anestesia Geral , Procedimentos Cirúrgicos do Sistema Biliar , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: Postoperative nocturnal hypoxemia (PONH) is a main factor in the genesis of respiratory, cardiac and neurologic complications after surgery. AIM: To describe the phenomenon of PONH after elective laparoscopy and laparotomy, and to evaluate the usefulness of oxygen therapy in its prevention. PATIENTS AND METHODS: Fifteen elective patients (6 M, 9 F, 51 +/- 8 years old) scheduled for laparotomy (n = 8) or laparoscopy (n = 7) were studied. Ventilatory parameters and pulse oximetry were measured pre and postoperatively. Patients were randomly assigned to receive oxygen by nasal cannula either during the first or the second postoperative night. RESULTS: PONH (SatO2 < 85) developed in seven patients (47%), of which four had undergone laparoscopic surgery. PONH was more frequent in mildly obese patients and those presenting preoperative hypoxemia (p = 0.03). Peak Flow was lower in patients presenting PONH (p = 0.04). In five patients, PONH was associated with significant tachycardia. Oxygen administration was associated with a higher SatO2 and prevented PONH in 6/7 patients. CONCLUSIONS: PONH is a common event in patients older than 40 years scheduled for open or laparoscopic abdominal surgery, and develops more frequently in those with preoperative nocturnal hypoxemia and greater ventilatory impairment. PONH can be prevented, most of the time, with oxygen administration.
Assuntos
Abdome/cirurgia , Hipóxia/etiologia , Hipóxia/prevenção & controle , Oxigenoterapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Adulto , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Gastric mucosal pH may be a good indicator of splanchnic tissue oxygenation. AIM: To study the effects of abdominal surgical procedures on gastric mucosal pH. PATIENTS AND METHODS: Eighteen patients subjected to abdominal surgery were studied. All patients received general anesthesia and hemodynamic parameters were maintained within 20% of basal values. A tonometer was placed in the stomach after induction of anesthesia. Arterial blood gases and samples from the tonometer were obtained 30 minutes after induction and at 2 hours of surgery. Intramucosal pH was calculated using Henderson-Haselbach equations. RESULTS: Basal gastric mucosal pH was 7.4 +/- 0.1 and did not change during surgery. Two patients had a pH persistently below 7.35 without hemodynamic alterations or systemic acidosis. CONCLUSIONS: Gastric mucosal pH is not modified by abdominal surgery and some patients have low values despite the absence of hemodynamic derangement.