Introdução: Dermatite atópica (DA) é uma doença cutânea crônica, predominante na infância, cujo sintoma principal é o prurido de intensidade variável, e os sinais são classicamente as lesões de padrão eczematoso. Há anormalidades na formação e função da barreira cutânea, que estão presentes não somente nas lesões cutâneas como na pele clinicamente não afetada. Objetivo: Analisar a correlação entre as medidas biofísicas da função de barreira cutânea e os critérios clínicos e intensidade da dermatite, de acordo com os critérios de Rajka e Langeland. Métodos: 231 doentes do Departamento de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com diagnóstico clínico de dermatite atópica segundo os critérios diagnósticos de Rajka e Langeland foram avaliados por exame físico, anamese, medidas biofísicas de grau de hidratação de camada córnea pelo método de capacitância (corneometria) e pelo método de perda de água transepidérmica (TEWL); a medida sérica de IgE também foi solicitada no ato do exame. Resultados: Houve uma relação significativa entre as medidas de corneometria, TEWL e gravidade clínica da dermatite atópica. Os dados demonstraram uma correlação inversamente proporcional entre a corneometria e o TEWL, e houve uma diferença estatisticamente significativa (p<0,001) entre as médias de corneometria e TEWL e grau de DA (leve, moderada ou intensa). Com relação aos níveis séricos de IgE, as medidas de corneometria apresentaram uma correlação negativa significativa; para TEWL, a correlação positiva foi estatisticamente significativa (p<0,001). Conclusão: As medidas biofísicas de barreira cutânea na DA, mesmo em pele aparentemente não lesada, podem funcionar como fator de avaliação do grau clínico da DA e da intensidade do prurido. / Background: Atopic dermatitis (AD) is a chronic dermatosis, predominant in childhood, characterized by pruritus and eczematous type lesions with xerosis as the proeminent clinical sign. Objectives: To analyze the correlation between biophysical measurements of skin barrier function and other assessment criteria of clinical severity according to Rajka and Langelands criteria. Methods: Biophysical measurements (Transepidermal water loss and corneometry) were obtained from 231 patients from the department of dermatology, Hospital das Clinicas FMUSP with the diagnsosis of atopical dermatitis. Serum levels of IgE were also evaluated. Results: A significant correlation between corneometry, TEWL and clinical severity of atopic dermatitis were found. Data showed an inverse correlation between corneometry, TEWL, and AD severity, and a significant difference (p<0,001) between means of corneometry and TEWL and AD severity (mild, moderate and severe). As for IgE levels, corneometry had significant negative correlation, in contrast with TEWL, wich showed a significant positive correlation (p<0,001). Conclusion: Biophysical measurements of skin barrier in non lesional skin of atopic dermatitis may work as an evaluation factor for AD severity and pruritus.

Dengue fever (DF) and dengue hemorrhagic fever (DHF) are emerging infectious diseases which are endemic in many regions of the globe, many of which are resource-poor areas. DHF and DF impose a severe economic health burden in tropical and subtropical areas. Dengue virus causes an acute febrile illness that can be a self-limited febrile illness, as seen in most cases of DF, or a life-threatening illness with plasma leakage and shock, as seen in cases of DHF. A systematic review of the literature revealed gaps in the knowledge base of clinical laboratory findings of dengue illness with regards to longitudinal dynamics and classification and predictive modeling of disease severity. The objective of this thesis was to investigate the utility of clinical laboratory variables for classification and prediction of disease outcomes. The data used in this investigation was derived from a prospective study of Thai children presenting to either of two study hospitals within 72 hours of onset of an acute febrile illness. Systematic data collection, including clinical laboratory parameters, and routine clinical management continued each day until 24 hours after the fever had subsided. A final diagnosis of DHF, DF, or other febrile illness (OFI) was assigned by an expert physician after chart review. The first research objective of this study was to describe the temporal dynamics of clinical laboratory parameters among subjects with DHF, DF, or OFI. Data were analyzed using lowess curves and population-average models. Quadratic functions of clinical variables over time were established and demonstrated significantly divergent patterns between the various diagnostic groups. The second research objective was to establish and validate tools for classification of illness severity using easily obtained clinical laboratory measures. Bivariate logistic regression models were established using data from one hospital in an urban area of Thailand as a training data set and validated with a second data set from a hospital in a rural area of Thailand. The validated models maintained a high sensitivity and specificity in distinguishing severe dengue illnesses without using the hallmark indicators of plasma leakage. The third research objective used classification and regression tree (CART) analysis to established diagnostic decisions trees using data obtained on the day of study enrollment, within the first 3 days of acute illness. Decision trees with high sensitivity were established for severe dengue defined either as: 1) DHF with evidence of shock (dengue shock syndrome, DSS); or 2) DSS or dengue with significant pleural effusion. This study expands existing knowledge of the potential utility of clinical laboratory variables during different phases of dengue illness. The application of the results of these studies should lead to promising opportunities in the fields of epidemiological research and disease surveillance to reduce the health burden, and improve the clinical management, of dengue illness. Future directions involve application of these algorithms to different study populations and age groups. Additionally, other analytical techniques, such as those involving CART analysis, can be explored with these data.

No / A significant number of people in the UK experience chronic pain, resulting in high levels of suffering and reduced quality of life. Management of chronic pain is complex, time consuming and not always successful. Good communication between patients and healthcare professionals is essential to ensure realistic treatment plans and outcomes can be negotiated. Accurate assessment is also key, and nurses play a fundamental role in ensuring patients with chronic pain receive the most appropriate care.

<p>Ciljevi: Cilj ove studije je da ispita bezbednost rane karotidne endarterektomije (CEA) u odnosu na odložene CEA nakon akutnog ishemijskog neurolo&scaron;kog deficita (TIA/CVI). Drugi cilj je da istražimo da li postoji razlika u brzini neurolo&scaron;kog oporavka između navedenih grupa. Metode: Ukupno 157 ispitanika u prospektivnoj studiji je praćeno 30 dana postoperativno. Grupa I ili rana CEA, je imala 50 ispitanika operisanih od 3. do 14. dana po TIA/CVI događaju. Grupa II ili odložena CEA, je imala 107 ispitanika operisanih od 15. do 180. dana nakon TIA/CVI. Praćen je proceduralni op&scaron;ti i specifični morbiditet i mortalitet u 30-dnevnom postoperativnom periodu. Rankin skor (mRS) smo koristili za procenu neurolo&scaron;kog invaliditeta. U odnosu na vrednost mRS skora smo formirali dve podgrupe mRS&lt;3 i mRS3. U statističkoj analizi koristili smo Pirsonov hi test, Studentov test, ANOVU analizu varijanse, Boniferonijev test i multiplu analizu varijanse za ponovljena merenja (GLM- general line model), kao i parametarsku i neparametarsku korelaciju i regresiju. Nivo značajnosti je bio 0,05. Rezultati: Prosečna starost ispitanika je bila 66,72 godine uz 66,2% osoba mu&scaron;kog pola. U grupi I je prosečno vreme do intervencije bilo 9,5 dana, a u grupi II 72,22 dana. Grupe su homogene u odnosu na faktore rizika i komorbiditet. Grupa I je imala 54% nestabilnih aterosklerotskih plakova u poređenju sa grupom II gde ih je bilo 31,8% (&chi;2 = 7.084; p &lt; 0.01). U grupi I TIA je imalo 50% ispitanika, a u grupi II CVI nalaza je bilo 68,2% (&chi;2 =4.825; p &lt;0.05). CVI do 1 cm veličine je statistički značajno vi&scaron;e zastupljen u grupi I , a CVI do 2 cm u grupi II (&chi;2 = 6.913; p &lt;0.05). Stopa CVI je u grupi I bila 2.0% a u grupi II je 2.8% (F = 0.083; p &gt; 0.05). Stopa postoperativnog infarkta miokarda (IM) je u grupi I je 2.0% a u grupi II je 1.9%. Stopa specifičnog hirur&scaron;kog morbiditeta je u grupi I 4.0% a u grupi II 3.7%. U grupi I ukupni morbiditet bio 6.0% a u grupi II 7.5%, razlika nije bila statistički značajna (F =0.921; p &gt; 0.05). Mortaliteta u obe grupe nije bilo. CVI/IM/smrt stopa je u grupi I bio 4.0% a u grupi II je bio 4.7% (F = 0.122; p &gt;0.05). Hiperlipidemija je signifikantan faktor rizika za CVI/IM/smrt (&chi;2 = 4.083; p &lt; 0.05). Pobolj&scaron;anje mRS je u grupi I imalo 52%, a u grupi II 31,8% pacijenata (&chi;2 = 5.903; p &lt;0.01). Relativni rizik je 2,4 odnosno toliko puta je veća &scaron;ansa da kod bolesnika dođe do promene mRS ako je bolesnik u grupi I. Pad mRS koji nastupa između trećeg i desetog dana nakon CEA je statistički visoko značajno izraženiji u grupi ranih CEA ( F 3,701 df 1 p=0,029). Kod bolesnika sa TIA u preko 60% slučajeva do&scaron;lo je do pada mRS, a kod onih koji su imali CVI u oko 25.5% (&chi;2 = 18.050; p &lt; 0.01). Kod Rankin skora podgrupe mRS&lt;3 i mRS3 je pad bio značajan i po vremenu (F 18,774; df 6; p=0,000) i po podgrupi ali je daleko brži pad zapažen u podgrupi mRS&lt;3(F 6,010; df 1; p=0,003). Zaključak: Rana CEA je jednako bezbedna kao i odložena CEA u pogledu incidence perioperativnog morbiditeta i mortaliteta. Ranom CEA se postiže znatno brži neurolo&scaron;ki oporavak pacijenata, naročito onih sa TIA i mRS&lt;3 skorom.</p> / <p>Objectives: The aim of this study was to investigate the safety of early carotid endarterectomy (CEA) in relation to the delayed CEA after acute ischemic neurological events (TIA / CVI). The second objective was to investigate whether there is a difference in speed of neurological recovery between these groups. Methods: A total of 157 patients in the prospective study followed 30 days postoperatively. Group I or early CEA, had 50 patients operated from 3 to 14 days after TIA / CVI event. Group II or delayed CEA, had 107 patients operated from 15 to 180 days after the TIA / CVI. Accompanied by the general and specific procedural morbidity and mortality in 30-day postoperative folow up. Rankin score (mRS) were used for evaluation of neurologic disability. In relation to the value of mRS score we formed two subgroups mRS &lt;3 i mRS3. In the statistical analysis we used the Pearson chi test, Student&#39;s test, ANOVA analysis of variance, Boniferony test and multiple analysis of variance for repeated measures (GLM- general line model), as well parametric and nonparametric correlation and regression. The significance level was 0.05. Results: The mean age was 66.72 years with 66.2% of males. In Group I is the average time to intervention was 9.5 days, and in group II 72.22 days. The groups were homogeneous in relation to risk factors and comorbidities. Group I had 54% of unstable atherosclerotic plaques compared with group II, where it was 31.8% (&chi;2 = 7.084; p &lt;0.01). In the group I TIA had 50% of respondents, while in group II CVI was 68.2% (&chi;2 = 4.825; p &lt;0.05). CVI to 1 cm in size were significantly more frequent in the group I, a CVI to 2 cm in group II (&chi;2 = 6.913; p &lt;0.05). CVI rate in the group I was 2.0%, and in group II was 2.8% (F = 0.083, p&gt; 0.05). Postoperative myocardial infarction (MI) in the group I is 2.0%, and in group II was 1.9%. Specific surgical morbidity rate in the group I and 4.0% in the group II 3.7%. In group I total morbidity was 6.0% in group II 7.5%, the difference was not statistically significant (F = 0.921; p&gt; 0.05). Mortality in both groups was not. CVI/IM/death rate in group I was 4.0% in group II was 4.7% (F = 0.122; p&gt; 0.05). Hyperlipidemia is a significant risk factor for CVI/IM/death (&chi;2 = 4.083; p&lt;0.05). Improving mRS in the group I had 52% and in group II 31.8% of patients (&chi;2 = 5.903; p &lt;0.01). The relative risk was 2.4 times as much and is more likely to occur in patients mRS changes if the patient in group I. Improving mRS that occurs between the third and tenth days after CEA was highly statistically significantly greater in the group of early CEA (F 3,701 df 1 p = 0.029). In patients with TIA in 60% of cases there was a decline mRS, and those had CVI in about 25.5% (&chi;2 = 18.050; p &lt;0.01). In Rankin score subgroups mRS &lt;3 i mRS 3 the decline was significant and time (F 18,774; df 6; p =0.000) and in the subgroup but it is far more rapid decline observed in the subgroup mRS &lt;3 (F 6.010; df 1; p = 0.003). Conclusions: Early CEA is as safe as the delayed CEA in respect incidence of perioperative morbidity and mortality. Early CEA is achieved significantly faster recovery of neurological patients, especially those with TIA and mRS &lt;3 compared with delayed CEA.</p>

Para verificar a expressão das proteínas Fas e Bcl-2 em linfócitos e suas correlações com a atividade da doença foram avaliados 38 pacientes com lúpus eritematoso sistêmico de início na infância e 25 controles sem doença autoimune. Observou-se que as porcentagens de linfócitos T CD3+ e CD8+ e linfócitos B que expressavam a proteína Fas e a intensidade média de fluorescência da proteína Bcl-2 nos linfócitos T CD3+, CD4+ e CD8+ dos pacientes com lúpus foram significativamente maiores quando comparadas aos controles. Os pacientes com doença ativa apresentavam porcentagens de linfócitos B que expressavam a proteína Fas significativamente maiores que os pacientes com doença inativa e os controles e houve correlação direta entre estas porcentagens e o SLEDAI (p=0.02, r=0.38) / In order to verify the expression of Fas and Bcl-2 proteins on lymphocytes and their relationship with disease activity 38 patients with juvenile-onset systemic lupus erythematosus and 25 healthy controls were studied. The measurements showed that percentages of lymphocytes T CD3+ and CD8+ and B lymphocytes positively stained for Fas antigen and mean fluorescence intensity of Bcl-2 on CD3+, CD4+ and CD8+ T cells from lupus patients were significantly increased compared to healthy controls. Lupus patients with active disease presented percentages of lymphocytes B positive for Fas antigen significantly higher compared to patients with inactive disease and healthy controls and there was a statistically significant direct correlation between these percentages and SLEDAI score (p=0.02, r=0.38).

Para verificar a expressão das proteínas Fas e Bcl-2 em linfócitos e suas correlações com a atividade da doença foram avaliados 38 pacientes com lúpus eritematoso sistêmico de início na infância e 25 controles sem doença autoimune. Observou-se que as porcentagens de linfócitos T CD3+ e CD8+ e linfócitos B que expressavam a proteína Fas e a intensidade média de fluorescência da proteína Bcl-2 nos linfócitos T CD3+, CD4+ e CD8+ dos pacientes com lúpus foram significativamente maiores quando comparadas aos controles. Os pacientes com doença ativa apresentavam porcentagens de linfócitos B que expressavam a proteína Fas significativamente maiores que os pacientes com doença inativa e os controles e houve correlação direta entre estas porcentagens e o SLEDAI (p=0.02, r=0.38) / In order to verify the expression of Fas and Bcl-2 proteins on lymphocytes and their relationship with disease activity 38 patients with juvenile-onset systemic lupus erythematosus and 25 healthy controls were studied. The measurements showed that percentages of lymphocytes T CD3+ and CD8+ and B lymphocytes positively stained for Fas antigen and mean fluorescence intensity of Bcl-2 on CD3+, CD4+ and CD8+ T cells from lupus patients were significantly increased compared to healthy controls. Lupus patients with active disease presented percentages of lymphocytes B positive for Fas antigen significantly higher compared to patients with inactive disease and healthy controls and there was a statistically significant direct correlation between these percentages and SLEDAI score (p=0.02, r=0.38).

O presente estudo validou para a Língua Portuguesa a escala de graduação do paciente com hidrocefalia de pressão normal (HPN) desenvolvida na Língua Inglesa como \"Grading scale for idiopathic normal pressure hydrocephalus\". Duas traduções independentes da escala de HPN foram feitas por médicos brasileiros, fluentes na Língua Inglesa. Após harmonização dessas, a tradução resultante foi retrotraduzida independentemente por dois outros médicos, que desconheciam a escala original. Seguiu-se a última tradução e revisão para a Língua Portuguesa por uma profissional tradutora da área da saúde. A comparação da versão final traduzida com a escala original foi realizada pelo comitê multiprofissional que não estava envolvido no processo de tradução, pontuando-se para item distúrbio de marcha: 0 ausente; 1 marcha instável, mas independente; 2 anda com um apoio; 3 anda com 2 apoios ou andador e 4 não é possível andar. No item demência: 0 ausente; 1 sem demência aparente, mas apático; 2 socialmente dependente, mas independente na residência; 3 parcialmente dependente na residência e 4 totalmente dependente. Incontinência Urinária: 0 ausente; 1 ausente, mas com polaciúria ou urgência miccional; 2 às vezes, apenas à noite e 4 frequente. Para obtenção da pontuação final, devem-se somar os itens, sendo que, quanto maior o escore final, maior comprometimento do paciente. O resultado foi pré-testado em um estudo-piloto. A versão final da escala de HPN para o Português, bem como as escalas de equilíbrio de Berg, índice de marcha dinâmica e \"timed up and go\" foram aplicadas simultaneamente em cento e vinte e um pacientes consecutivos com diagnóstico médico de hidrocefalia de pressão normal (setenta e três homens e quarenta e oito mulheres) que procuraram o Ambulatório de Hidrodinâmica Cerebral, da Divisão de Neurocirurgia Funcional do Instituto de Psiquiatria do Hospital das Clínicas de São Paulo da FMUSP, no período de julho de 2010 a março de 2012. Foram testadas as propriedades psicométricas do questionário, como confiabilidade e validade. A idade mediana foi de 71,09 anos (intervalo de 35 a 92 anos). O período médio de reteste para a escala de HPN foi de sete dias. Nenhuma alteração do formato original da escala foi observada no final do processo de tradução e adaptação cultural. O grau de concordância e reprodutividade foi alta, como demonstrado pela medida de concordância Kappa, com excelente correlação intraobservador para itens da escala de HPN individualmente avaliados: marcha (0,8), demência (0,90) e incontinência (0,87). Na análise interobservador, o resultado foi excelente, com item marcha (0,91), demência (0,86) e incontinência (0,87). A correlação entre a escala de HPN com as demais escalas foi considerada de moderada a satisfatória para a maioria dos itens, variando de -,069 a 0,55 na correlação de Pearson. A avaliação individual entre escalas sobre os itens incontinência urinária, demência e marcha foram também satisfatórias e estatisticamente significantes. A versão para o Português da escala de graduação do paciente com HPN foi traduzida e validada com sucesso para aplicação em pacientes brasileiros de ambos os sexos, apresentando satisfatória confiabilidade e validade / The current study validated to Portuguese language the graduation scale for patients with normal pressure hydrocephalus (NPH) developed on English language as \"Grading scale for idiopathic normal pressure hydrocephalus\". Two translations independent of NPH scale were done by Brazilian doctors, fluent on English language. After harmonization of both, the resulting translation was back-translated independently by two other doctors, that unaware to the original scale. Followed the last translation and revision to Portuguese language by a professional translator of health area. The comparison of last translated version with original scale was performed by one multiprofessional committee not involved on translation process. Was established specific punctuation to components of NPH classical triad, the punctuation to gait: 0 absent; 1 unstable gait, but independent; 2 walk with a support; 3 walk with 2 supports or walker an 4 is not possible to walk. On dementia item: 0 absent; 1 without apparent dementia, but apathetic; 2 socially dependent, but independent on resistance; 3 partial dependent on resistance and totally dependent. Urinary incontinence: 0 absent, 1 absent but with pollakisuria or urinary urgency, 2 sometimes, just at night; 3 sometimes even during the day and 4 frequently. The obtained final punctuation was given by summation of three items, and the higher the final punctuation, greater involvement of the patient. The result was pre-tested in a pilot study. The last version of NPH to Portuguese, as well the Berg balance scales, Dynamic Gait Index and \"timed up and go\" were applied simultaneously in 121 consecutive patients with medical diagnostic of normal pressure hydrocephalus (73 men and 48 women) who sought the Ambulatory of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas in Sao Paulo from FMUSP, on period July / 2010 to march / 2012. The psychometric properties, reliability and validity of questionnaire were tested. The mean age was 71,09 years, ranging from 35 to 92 years. The period of mean retest was 7 days. None change to the original format of the scale was observed at the end of the translation process and cultural adaptation. The rate of agreement and reproducibility was high, as confirmed by measure of agreement of Kappa, with excellent intra-observer correlation for NPH scale items individually evaluated: gait (0,80), dementia (0,90) and incontinence (0,87). The correlation between the NPH scale with the other scales was considered moderate to satisfactory for most items, ranging from - 069 to 0.55 in Pearson correlation. The individual evaluation between scales on the items on urinary incontinence, dementia and gait were also satisfactory and stistically significant. The Portuguese version of the graduation scale for patients with NPH was successfully translated and validated for use in Brazilian patients of both genders, with satisfactory reliability and validity

Made available in DSpace on 2016-06-02T20:18:17Z (GMT). No. of bitstreams: 1 Retido.pdf: 19733 bytes, checksum: 6aad255badc436a06364517de2344ab6 (MD5) Previous issue date: 2012-02-29 / Financiadora de Estudos e Projetos / The thesis consisted of three studies described below. The study I, entitled: Oxygen uptake and heart rate on-kinetics in patients with Chronic obstructive pulmonary disease (COPD): comparison between cycle ergometry and elliptical equipment aimed to evaluate and compare the kinetics of both oxygen consumption (VO2) and heart rate (HR) in constant work-rate tests on a cycle ergometer (CCT) and on an elliptical machine (ECT) in COPD patients and healthy individuals. Eighteen male COPD patients between 55 and 78 years old with moderate to very severe obstruction (COPD group) and 18 apparently healthy males (control group: CG) were evaluated; the subjects were paired by age and submitted to the following tests on alternate days: 1) symptom-limited incremental cycle ergometer test (IT); 2) CCT and 3) ECT, both at 70% of the maximum intensity obtained in the IT. Expired gases were collected in all tests, and the kinetics of VO2 and HR were analyzed. The COPD group presented significantly higher tau (&#964;) and mean response time (MRT) for VO2 on the CCT than the CG (p<0.05); however, there was no significant difference on the ECT. Regarding the different tests, the COPD group had a significantly higher &#964; and MRT on the CCT than the ECT; on the other hand, no differences between the tests were observed in the CG. We conclude that VO2 kinetics are slowed in COPD; however, this depends on the ergometer used for testing. The faster kinetics found on the ECT for the COPD group may be related to the effects of the body position or to higher recruitment of muscle fibers, as well as to the greater ventilatory and chronotropic stress observed in this test. Following, the study II, entitled: BODE index, body composition, peripheral muscle strength and oxygen uptake and heart rate kinetics on a cycle ergometer and on elliptical equipment in COPD patients: there is relationship between them? aimed to determine if there is a relationship between oxygen consumption (VO2) and heart rate (HR) on-kinetics in constant work-rate exercise test on cycle ergometer (CCT) and on elliptical equipment (ECT) with the BODE index and their isolated variables, muscle mass (MM), lean body mass index (LBMI) and with peripheral muscle strength (PMS) represented by one-repetition maximum strength test (1RM) in patients with COPD. Fourteen men patients with moderate to very severe COPD (COPD group), between 55 and 78 years, were submitted to the following tests on alternate days: 1) six-minute walking test (6MWT); 2) IT; 3) CCT and 4) ECT at 70% of the maximum intensity obtained in CPT; 5) 1RM test and 6) body composition evaluation. Expired gases were collected in CPT, CCT and ECT, and response of the VO2 and HR on-kinetics were analyzed. The BODE index was calculated. The BODE index was calculated. The Pearson correlation coefficient (p<0.05) presented a moderate positive relationship between BODE index and &#964; and MRT of VO2 and HR (r=0.55 and r=0.63; r=0.66 and r = 0.74, respectively); and negative correlation between &#964;VO2 and MRT-VO2 with FEV1 (r=-0.69; r=-0.68), DW- 6MWT (r=-0,.62; r=-0.65) and DW-6MWT %predict (r=-0.64; r=-0.70). Still, significant negative correlations were observed between the &#964;-HR and MRT-HR with DW-6MWT (r=- 0,.81; r=-0.82) and DW-6MWT %predict (r=-0.83; r=-0.65). Significant correlations between the TRM and &#964; of VO2 and of HR with MM, LBMI and PMS; and correlations with oxygen consumption (VO2) and heart rate (HR) on-kinetics in ECT were not observed. In general, our data show that patients with moderate to very severe COPD have slowed VO2 kinetics in the CCT compared the ECT. Furthermore, the VO2 and HR on-kinetics in CCT has a moderate correlation with the classification of COPD severity assessed by the BODE index, FEV1 and DW-6MWT, showing that COPD severity, airflow limitation and exercise capacity are reflected by the slowing of the on-kinetics in COPD patients, but it depends on the ergometer. Finally, the study III, entitled: Effect of aerobic/resisted and interval physical training on oxygen uptake and heart rate on-kinetics in patients with COPD: randomized, controlled trial evaluated and compared the effect of aerobic/resisted physical training (TFAR) and interval physical training program on elliptical equipment (TFI) of high intensity on VO2 and HR onkinetics during CCT and ECT in patients with COPD. Eighteen men patients with moderate to very severe COPD, between 55 and 80 years, randomly divided into two groups: nine of the patients had been engaged in TFAR group, and nine in TFI group, were submitted to the following tests on alternate days: 1) IT; 2) CCT, and 3) ECT both at 70% of the maximum intensity obtained in IT, and one repetition maximum test (1RM), being reevaluated after six weeks physical training. program. The TFAR group consisted of aerobic training by thirty minutes, and three sets of fifteen repetitions of resisted training in lower limbs on leg press. The TFI group realized training program on an elliptical equipment, by thirty minutes at 100% of the maximum intensity obtained in IT, separated by 1-min rest periods. The two training groups completed 6 week (3x/week) of exercise training, until completing a total of eighteen sessions. Expired gases were collected in in all tests, and response of the VO2 and HR on-kinetics were analyzed. No significant difference post-training in the TFAR group both tests (CCT and ECT) were observed; but, the TFI group displayed slower VO2 onkinetics (> &#964; and > MRT) in the CCT and ECT after training. In relation HR on-kinetics, no significant difference in both groups and both constant workload exercise tests post-training were observed. We conclude that the interval physical training program on elliptical equipament lead to slower VO2 kinetics the onset at high-intensity exercise (CCT and ECT) in patients with COPD. Furthermore, the TFAR program is no sufficient to provoke improvements in VO2 and HR on-kinetics in the CCT and ECT. / A tese constou de três estudos descritos a seguir. O estudo I, intitulado: Cinética-on do consumo de oxigênio (VO2) e da frequência cardíaca (FC) de pacientes com doença pulmonar obstrutiva crônica (DPOC): comparação entre cicloergômetro e equipamento elíptico teve como objetivo avaliar e comparar a cinética do VO2 e da FC em testes de carga constante em cicloergômetro (TCC) e em equipamento elíptico (TCE), em pacientes com DPOC e indivíduos saudáveis. Foram avaliados 18 homens com DPOC de obstrução moderada a muito grave (grupo DPOC) entre 55 e 78 anos e 18 homens aparentemente saudáveis (grupo controle: GC) pareados por idade, submetidos em dias alternados aos seguintes testes: 1) teste incremental em cicloergômetro (TI) limitado por sintomas; 2) TCC e 3) TCE ambos a 70% da intensidade máxima obtida no TI. Foram coletados os gases expirados em todos os testes, e a cinética do VO2 e da FC foram analisadas. O grupo DPOC apresentou a tau (&#964;) e o tempo de resposta média (TRM) do VO2 significativamente maiores no TCC em comparação ao GC (p<0,05), porém sem diferenças significativas para o TCE. Em relação aos diferentes testes, no grupo DPOC a &#964; e o TRM foram significativamente maiores no TCC em comparação ao TCE (p<0,05), em contraste, no GC, não foram observadas diferenças significativas entre os testes. Concluímos que a cinética do VO2 é lentificada na DPOC, entretanto, a mesma depende do ergômetro testado. A cinética mais rápida encontrada no TCE no grupo DPOC pode estar relacionada aos efeitos da posição corporal adotada ou ao maior recrutamento de fibras musculares, bem como ao maior estresse ventilatório e cronotrópico observado neste teste. Na sequência, o estudo II, intitulado: Índice BODE, composição corporal, força muscular periférica e cinética-on do consumo de oxigênio e da frequência cardíaca em cicloergômetro e em equipamento elíptico em pacientes com DPOC: há correlação entre eles? objetivou verificar se há correlação entre a cinética-on do VO2 e da FC no TCC e no TCE com o índice BODE e suas variáveis isoladas, massa muscular (MM), índice de massa magra corporal (IMMC) e com a força muscular periférica (FMP) representada pelo teste de uma repetição máxima (1RM) em pacientes com DPOC. Foram avaliados 14 homens com DPOC de obstrução moderada a muito grave entre 55 e 78 anos, submetidos em dias alternados aos seguintes testes: 1) teste de caminhada de seis minutos (TC6); 2) TI; 3) TCC e 4) TCE ambos a 70% da intensidade máxima obtida no TI; 5) teste de uma repetição máxima (1RM) e 6) avaliação da composição corporal. Foram coletados os gases expirados no TI e TCC, e a cinética do VO2 e da FC foram analisadas. O índice BODE foi calculado. Observou-se correlação moderada entre a &#964; e o TRM do VO2 e da FC com o índice BODE no TCC (r=0,55 e r=0,63; r=0,66 e r = 0,74, respectivamente); e correlações negativas significativas entre a &#964; e o TRM do VO2 com o VEF1 (r=-0,69; r=-0,68), a distância percorrida no TC6 (DP-TC6) (r=-0,62; r=-0,65) e a DP-TC6 %prevista (r=-0,64; r=-0,70). Ainda a &#964; e o TRM da FC correlacionou-se com a DP-TC6 (r=-0,81; r=-0,82) e a DP-TC6 %prevista (r=-0,83; r=-0,65). Esse mesmo comportamento não foi observado para a cinética do VO2 e da FC no TCE. Não foram observadas correlações estatisticamente significativas entre a &#964; e o TRM do VO2 e da FC com a MM, IMMC e FMP. Concluímos que a cinética-on do VO2 e da FC no TCC correlacionou-se com o índice BODE, VEF1 e DPTC6, mostrando que a gravidade da doença, limitação ao fluxo aéreo e a capacidade ao exercício são refletidas pela lentificação da cinética, entretanto a mesma depende do ergômetro utilizado. Finalmente, o estudo III, intitulado: Efeitos do treinamento físico aeróbio/resistido e intervalado na cinética-on do VO2 e da FC em pacientes com DPOC: estudo controlado, randomizado avaliou e comparou os efeitos do treinamento físico aeróbio/resitido (TFAR) e treinamento físico intervalado de alta intensidade em equipamento elíptico (TFI) na cinética-on do VO2 e da FC no TCC e no TCE em pacientes com DPOC. Dezoito homens com DPOC, foram randomizados para: grupo de TFAR (n=9) e grupo TFI (n=9), e submetidos ao: 1) TI; 2)TCC e 3)TCE ambos a 70% da intensidade máxima obtida no TI; e 4)teste de uma repetição máxima (1RM); reavaliados após seis semanas de treinamento físico. O grupo TFAR realizou 30 minutos de cicloergômetro, com intensidade entre 60-70% da carga máxima atingida no TI, sendo aumentados 10% após três semanas de treinamento; e três séries de 15 repetições em leg-press com intensidade de 40-60% da carga máxima tolerada no teste de 1RM, sendo aumentado 10% a cada duas semanas de treinamento, e adotou-se intervalo de dois minutos entre as séries. Já, o grupo TFI realizou 30 minutos de treinamento em equipamento elíptico com carga máxima atingida no TI e intervalos de um minuto. Ambos os programas foram realizados 3x/semana por seis semanas, completando 18 sessões. Foram coletados os gases expirados no TI, TCC e TCE, e a cinética do VO2 e da FC foram analisadas. Não foram observadas diferenças significativas na cinética do VO2 após o treinamento físico no grupo TFAR, em ambos os testes. Entretanto, no grupo TFI, verificou-se lentificação da mesma no TCC e no TCE após o treinamento. Quanto à cinética-on da FC, não foram constatadas diferenças significativas nos dois grupos e testes, após os dois programas. Concluímos que a cinética-on do VO2 é lentificada nos pacientes com DPOC, quando realizam TCC e TCE após o programa de TFI de alta intensidade. Entretanto, o programa de TFAR não proporcionou benefícios na cinética-on do VO2 e da FC na DPOC, nos TCC e TCE.

O presente estudo validou para a Língua Portuguesa a escala de graduação do paciente com hidrocefalia de pressão normal (HPN) desenvolvida na Língua Inglesa como \"Grading scale for idiopathic normal pressure hydrocephalus\". Duas traduções independentes da escala de HPN foram feitas por médicos brasileiros, fluentes na Língua Inglesa. Após harmonização dessas, a tradução resultante foi retrotraduzida independentemente por dois outros médicos, que desconheciam a escala original. Seguiu-se a última tradução e revisão para a Língua Portuguesa por uma profissional tradutora da área da saúde. A comparação da versão final traduzida com a escala original foi realizada pelo comitê multiprofissional que não estava envolvido no processo de tradução, pontuando-se para item distúrbio de marcha: 0 ausente; 1 marcha instável, mas independente; 2 anda com um apoio; 3 anda com 2 apoios ou andador e 4 não é possível andar. No item demência: 0 ausente; 1 sem demência aparente, mas apático; 2 socialmente dependente, mas independente na residência; 3 parcialmente dependente na residência e 4 totalmente dependente. Incontinência Urinária: 0 ausente; 1 ausente, mas com polaciúria ou urgência miccional; 2 às vezes, apenas à noite e 4 frequente. Para obtenção da pontuação final, devem-se somar os itens, sendo que, quanto maior o escore final, maior comprometimento do paciente. O resultado foi pré-testado em um estudo-piloto. A versão final da escala de HPN para o Português, bem como as escalas de equilíbrio de Berg, índice de marcha dinâmica e \"timed up and go\" foram aplicadas simultaneamente em cento e vinte e um pacientes consecutivos com diagnóstico médico de hidrocefalia de pressão normal (setenta e três homens e quarenta e oito mulheres) que procuraram o Ambulatório de Hidrodinâmica Cerebral, da Divisão de Neurocirurgia Funcional do Instituto de Psiquiatria do Hospital das Clínicas de São Paulo da FMUSP, no período de julho de 2010 a março de 2012. Foram testadas as propriedades psicométricas do questionário, como confiabilidade e validade. A idade mediana foi de 71,09 anos (intervalo de 35 a 92 anos). O período médio de reteste para a escala de HPN foi de sete dias. Nenhuma alteração do formato original da escala foi observada no final do processo de tradução e adaptação cultural. O grau de concordância e reprodutividade foi alta, como demonstrado pela medida de concordância Kappa, com excelente correlação intraobservador para itens da escala de HPN individualmente avaliados: marcha (0,8), demência (0,90) e incontinência (0,87). Na análise interobservador, o resultado foi excelente, com item marcha (0,91), demência (0,86) e incontinência (0,87). A correlação entre a escala de HPN com as demais escalas foi considerada de moderada a satisfatória para a maioria dos itens, variando de -,069 a 0,55 na correlação de Pearson. A avaliação individual entre escalas sobre os itens incontinência urinária, demência e marcha foram também satisfatórias e estatisticamente significantes. A versão para o Português da escala de graduação do paciente com HPN foi traduzida e validada com sucesso para aplicação em pacientes brasileiros de ambos os sexos, apresentando satisfatória confiabilidade e validade / The current study validated to Portuguese language the graduation scale for patients with normal pressure hydrocephalus (NPH) developed on English language as \"Grading scale for idiopathic normal pressure hydrocephalus\". Two translations independent of NPH scale were done by Brazilian doctors, fluent on English language. After harmonization of both, the resulting translation was back-translated independently by two other doctors, that unaware to the original scale. Followed the last translation and revision to Portuguese language by a professional translator of health area. The comparison of last translated version with original scale was performed by one multiprofessional committee not involved on translation process. Was established specific punctuation to components of NPH classical triad, the punctuation to gait: 0 absent; 1 unstable gait, but independent; 2 walk with a support; 3 walk with 2 supports or walker an 4 is not possible to walk. On dementia item: 0 absent; 1 without apparent dementia, but apathetic; 2 socially dependent, but independent on resistance; 3 partial dependent on resistance and totally dependent. Urinary incontinence: 0 absent, 1 absent but with pollakisuria or urinary urgency, 2 sometimes, just at night; 3 sometimes even during the day and 4 frequently. The obtained final punctuation was given by summation of three items, and the higher the final punctuation, greater involvement of the patient. The result was pre-tested in a pilot study. The last version of NPH to Portuguese, as well the Berg balance scales, Dynamic Gait Index and \"timed up and go\" were applied simultaneously in 121 consecutive patients with medical diagnostic of normal pressure hydrocephalus (73 men and 48 women) who sought the Ambulatory of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas in Sao Paulo from FMUSP, on period July / 2010 to march / 2012. The psychometric properties, reliability and validity of questionnaire were tested. The mean age was 71,09 years, ranging from 35 to 92 years. The period of mean retest was 7 days. None change to the original format of the scale was observed at the end of the translation process and cultural adaptation. The rate of agreement and reproducibility was high, as confirmed by measure of agreement of Kappa, with excellent intra-observer correlation for NPH scale items individually evaluated: gait (0,80), dementia (0,90) and incontinence (0,87). The correlation between the NPH scale with the other scales was considered moderate to satisfactory for most items, ranging from - 069 to 0.55 in Pearson correlation. The individual evaluation between scales on the items on urinary incontinence, dementia and gait were also satisfactory and stistically significant. The Portuguese version of the graduation scale for patients with NPH was successfully translated and validated for use in Brazilian patients of both genders, with satisfactory reliability and validity

To enable improved interpretation of the total score and faster scoring of the Rivermead Mobility Index (RMI) by studying item ordering or hierarchy and formulating start-and-stop rules in patients after stroke. DESIGN: Cohort study. SETTING: Rehabilitation center in the Netherlands; stroke rehabilitation units and the community in the United Kingdom. PARTICIPANTS: Item hierarchy of the RMI was studied in an initial group of patients (n=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 304 [49%] left hemisphere lesion, and 269 [43%] right hemisphere lesion), and the adequacy of the item hierarchy-based start-and-stop rules was checked in a second group of patients (n=237; mean age +/- SD, 60.0+/-11.3y; 139 [59%] men; 103 [44%] left hemisphere lesion, and 93 [39%] right hemisphere lesion) undergoing rehabilitation after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate the fit of the double monotonicity model, indicating hierarchical item ordering. The percentages of patients with a difference between the RMI total score and the scores based on the start-and-stop rules were calculated to check the adequacy of these rules. RESULTS: The RMI had good fit of the double monotonicity model (coefficient H(T)=.87). The interpretation of the total score improved. Item hierarchy-based start-and-stop rules were formulated. The percentages of patients with a difference between the RMI total score and the score based on the recommended start-and-stop rules were 3% and 5%, respectively. Ten of the original 15 items had to be scored after applying the start-and-stop rules. CONCLUSIONS: Item hierarchy was established, enabling improved interpretation and faster scoring of the RMI.