Resumo Antecedentes As metas de reabilitação devem ser focadas nas expectativas funcionais de pessoas com doenças neuromusculares (DNM) para que sejam objetivas e alcançáveis. Objetivo Investigar programas de reabilitação capazes de modificar a atividade/participação de pessoas com DNM. Foi realizada busca nas bases de dados: Embase, BVS/Lilacs, Physiotherapy Evidence Database (PEDro), CINAHL/EBSCO e Medline em junho/2021. A última atualização foi realizada em março de 2023. Métodos Foram incluídos estudos clínicos randomizados investigando qualquer terapia de reabilitação para pessoas com DNM com desfecho voltado para atividade/participação da Classificação Internacional de Funcionalidade e Saúde (CIF). Terapias farmacológicas foram excluídas. Os resultados foram sintetizados de acordo com os Core Sets da CIF para DNM. A qualidade metodológica e o nível de evidência foram avaliados usando os critérios PEDro e Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Esta revisão sistemática foi registrada na PROSPERO (CRD42020209359). Resultados De 1943 estudos identificados, 12 foram incluídos com uma qualidade metodológica entre regular e boa. O exercício aeróbio de intensidade leve a moderada foi a intervenção mais estudada. A mobilidade foi avaliada em todos os estudos incluídos. Conclusão A variabilidade dos tipos de DNM e o baixo número amostral dos estudos incluídos contribuem para uma evidência muito limitada de intervenções focadas na atividade/participação de pessoas com DNM. O exercício aeróbio de baixa a moderada intensidade parece melhorar a mobilidade, autocuidado e participação de pessoas com DNM, especialmente para as DNM de progressão lenta. (DNM alcançáveis atividadeparticipação atividade dados Embase BVSLilacs BVS Lilacs BVS/Lilacs PEDro, , (PEDro) CINAHLEBSCO CINAHL EBSCO junho2021 junho 2021 junho/2021 2023 CIF. . (CIF) excluídas Assessment Development GRADE. GRADE (GRADE) CRD42020209359. CRD42020209359 CRD (CRD42020209359) 194 identificados 1 boa estudada lenta (PEDro junho202 202 junho/202 (CIF (GRADE CRD4202020935 (CRD42020209359 19 junho20 20 junho/20 CRD420202093 (CRD4202020935 junho2 2 junho/2 CRD42020209 (CRD420202093 junho/ CRD4202020 (CRD42020209 CRD420202 (CRD4202020 CRD42020 (CRD420202 CRD4202 (CRD42020 CRD420 (CRD4202 CRD42 (CRD420 CRD4 (CRD42 (CRD4 (CRD

Abstract Background To be objective and achievable, the rehabilitation goals must be focused on the functional expectations of patients with neuromuscular disease (NMD). Objective Investigate rehabilitation programs that are able to modify the activity/participation of patients with NMD. Data search: Embase, BVS/Lilacs, Physiotherapy Evidence Database (PEDro), CINAHL/EBSCO, and Medline were searched in June 2021. It was last updated in March 2023. Methods Randomized controlled trials investigating any rehabilitation therapy for patients with NMD with an outcome encompassing the activity/participation components of the International Classification of Functioning, Disability and Health (ICF) were included. Pharmacological therapy studies were excluded. The results were synthesized according to the ICF core sets for NMD. The methodological quality and level of evidence were assessed using PEDro criteria and Grading of Recommendations Assessment, Development, and Evaluation (GRADE). This systematic review followed the PRISMA 2020 guideline and was registered at PROSPERO (CRD42020209359). Results Of a total of 1943 identified studies, 12 were included in this review with a methodological quality between regular and good. Light to moderate-intensity aerobic exercise was the most studied intervention. The mobility was assessed in all included studies. Conclusion The variability of the types of NMD and the small sample size of the included studies demonstrates that there is very limited evidence of interventions focused on the activity/participation of individuals with NMD. Light to moderate-intensity aerobic exercise seems to improve the mobility, self-care, and social participation of patients with NMD, especially those with slow progression. achievable . (NMD) activityparticipation activity search Embase BVSLilacs BVS Lilacs BVS/Lilacs PEDro, , (PEDro) CINAHLEBSCO CINAHL EBSCO CINAHL/EBSCO 2021 2023 Functioning (ICF excluded Assessment Development GRADE. GRADE (GRADE) 202 CRD42020209359. CRD42020209359 CRD (CRD42020209359) 194 1 good moderateintensity moderate intensity intervention selfcare, selfcare self care, care self-care progression (NMD (PEDro (GRADE 20 CRD4202020935 (CRD42020209359 19 2 CRD420202093 (CRD4202020935 CRD42020209 (CRD420202093 CRD4202020 (CRD42020209 CRD420202 (CRD4202020 CRD42020 (CRD420202 CRD4202 (CRD42020 CRD420 (CRD4202 CRD42 (CRD420 CRD4 (CRD42 (CRD4 (CRD

Abstract Objective: To describe study protocol and initial results of research project COVID-Inconfidentes. Method: This paper described the methodological procedures adopted and the prevalence of the SARS-CoV-2 infection in the population. A household survey was conducted between October and December 2020, in two historic cities of Brazil's mining region. Anti-SARS-CoV-2 antibody was detected using the Wondfo® rapid test. The face-to face interview consisted of administration of a questionnaire containing registration data, sociodemographic and economic variables, living habits, general health condition, mental health, sleep habits, and eating and nutrition. Results: We evaluated 1,762 residents, of which 764 (43.4 %) were in Mariana and 998 (56.6 %) in Ouro Preto. For both cities, 51.9 % of the interviewees were female, with a predominance of the age range 35 to 59 years old (47.2 %). The prevalence of the SARS-CoV-2 infection was 5.5 % in both cities, 6.2 % in Ouro Preto, and 4.7 % in Mariana (p-value > 0.05). Conclusion: The study was effective to estimate the seroprevalence of infection by the virus and its findings will enable further analyses of the health conditions of the population related to social isolation and the risk of infection with SARS-CoV-2.

Resumen Describir el protocolo de estudio y los resultados iniciales del proyecto de investigación COVID Inconfidentes. Método: Este artículo describe los procedimientos metodológicos adoptados y la prevalencia de la infección por SARS-CoV-2 en la población. Se realizó una encuesta domiciliaria entre octubre y diciembre de 2020, en dos ciudades históricas de la región minera de Brasil. El anticuerpo anti-SARS-CoV-2 se detectó mediante la prueba rápida Wondfo®. La entrevista cara a cara consistió en la administración de un cuestionario que contenía datos de registro, variables sociodemográficas y económicas, hábitos de vida, estado general de salud, salud mental, hábitos de sueño, alimentación y nutrición. Resultados: Se evaluaron 1.762 habitantes, de los cuales 764 (43,4 %) estaban en Mariana y 998 (56,6 %) en Ouro Preto. Para ambas ciudades, el 51,9 % de los entrevistados eran del sexo femenino, con predominio del rango de edad de 35 a 59 años (47,2 %). La prevalencia de la infección por SARS-CoV-2 fue del 5,5 % en ambos municipios, del 6,2 % en Ouro Preto y del 4,7 % en Mariana (p > 0,05). Conclusión: El estudio fue efectivo para estimar la seroprevalencia de infección por el virus y sus hallazgos permitirán analizar más las condiciones de salud de la población relacionadas con el aislamiento social y el riesgo de infección por SARS-CoV-2.

Resumo O objetivo deste trabalho foi avaliar os efeitos das inclusões de polpa cítrica peletizada e de inoculante microbiano sobre características fermentativas, fracionamento de carboidratos e proteínas, e teores de nutrientes digestíveis totais de silagem de capim 'Massai' (Megathyrsus maximus × Megathyrsus infestus). O delineamento experimental foi inteiramente casualizado, em arranjo fatorial 2×4 (aplicação ou não de inoculante × 0, 10, 20 e 30% de polpa cítrica), com cinco repetições. Houve aumento da recuperação de matéria seca em função dos níveis de polpa cítrica. Os valores obtidos para pH e nitrogênio amoniacal indicaram adequado processo fermentativo. Sob níveis crescentes de polpa cítrica, houve redução dos teores de fibra insolúvel em detergente neutro e aumento do teor de carboidratos não fibrosos e proteína ligada à fibra. O teor de nutrientes digestíveis totais atinge ponto máximo de 513,1 g kg1 com a inclusão de 12,50% de polpa cítrica. O inoculante microbiano, quando isolado, não influencia os perfis de carboidratos e proteínas. Inclusões entre 10 e 20% de polpa cítrica são capazes de manter parâmetros fermentativos adequados e melhorar o perfil de nutrientes digestíveis, com adequada recuperação de matéria seca.

Abstract The objective of this work was to evaluate the effects of the inclusion of pelleted citrus pulp and microbial inoculant on the fermentation characteristics, carbohydrate and protein fractionation, and total digestible nutrient contents of 'Massai' grass (Megathyrsus maximus × Megathyrsus infestus) silage. The experimental design was completely randomized, in a 2×4 factorial arrangement (application or not of inoculant × 0, 10, 20, and 30% citrus pulp) with five replicates. There was an increase in dry matter recovery as affected by citrus pulp levels. The values obtained for pH and ammonia nitrogen indicated an adequate fermentation process. Under increasing citrus pulp levels, there was a reduction in neutral detergent fiber and an increase in nonfibrous carbohydrate contents and in protein linked to fiber. Total digestible nutrient content reaches a peak of 513.1 g kg1 with the inclusion of 12.50% citrus pulp. The microbial inoculant, when isolated, does not influence carbohydrate and protein profiles. Inclusions between 10 and 20% citrus pulp are able to maintain adequate fermentative parameters and improve the digestible nutrient profile, with an adequate dry matter recovery.

Background: A population study is an important tool that can be used to understand the actual epidemiological scenario of the Covid-19 in different territories, identify its magnitude, understand its transmission dynamics, and its demographic, geographical, and social distribution. Objective: The aim of this study was to determine the prevalence and dynamics of SARS-CoV-2 infection in the population of two Brazilian cities during the pandemic first wave and subsequent socioeconomic and health effects. Materials & methods: This paper described the methodological procedures adopted and the prevalence of the SARS-CoV-2 infection in the population. A household survey was conducted between October and December 2020, in two historic cities of Brazil's mining region. Anti-SARS-CoV-2 antibody was detected using the Wondfo® rapid test. The face-to-face interview consisted of administration of a questionnaire containing registration data, sociodemographic and economic variables, living habits, general health condition, mental health, sleep habits, and eating and nutrition. Results: We evaluated 1,762 residents, of which 764 (43.4%) were in Mariana and 998 (56.6%) in Ouro Preto. For both cities, 51.9% of the interviewees were female, with a predominance of the age range 35 to 59 years old (47.2%). The prevalence of the SARS-CoV-2 infection was 5.5% in all cities, 6.2% in Ouro Preto, and 4.7% in Mariana. The prevalence was similar between cities (P>0.05). Conclusion: The study was effective in verifying the seroprevalence of infection by the virus and its findings will enable further analyses of the health conditions of the population related to social isolation and the risk of infection with SARS-CoV-2.

Abstract This work aimed to evaluate the performance of different drying methods in the development of phenolic compounds, methylxanthines, and antioxidant activity in cocoa bean and to evaluate the presence of ochratoxin A (OTA). Antioxidant activity was determined using DPPH, FRAP, ORAC and β-carotene-linoleic acid assays. Phenolic compounds and methylxanthines were determined using high-performance liquid chromatography with an ultraviolet detector (HPLC-UV). OTA was determined by ultra-performance liquid chromatography with fluorescence detection (UPLC-FLR). It was found that during cocoa drying, there was a reduction in antioxidant activity with reduced phenolic compound content (0.04 mg.g-1 of catechin before drying to 0.02 mg.g-1 after drying) and reduced methylxanthines (19.44 mg.g -1 of theobromine before drying to 11.71 mg.g-1 after drying). Only one sample showed contamination by OTA (7.1 μg.kg-1). The traditional drying method showed the highest conservation of antioxidant activity and methylxanthine and phenolic compound content.

INTRODUÇÃO: O baixo peso de recém-nascidos (RN) é considerado um problema de saúde pública e, geralmente, é associado à prematuridade. A etiologia do parto prematuro é bastante complexa e, frequentemente, está relacionada a vários fatores. Diversas teorias têm correlacionado a saúde periodontal de gestantes com o nascimento de bebês prematuros (idade gestacional) e/ou com baixo peso ao nascer. OBJETIVO: O objetivo do presente estudo foi avaliar a possível correlação de saúde periodontal com idade gestacional e/ou com nascimento de bebês com baixo peso. MATERIAL E MÉTODO: Estudo observacional longitudinal prospectivo com gestantes que foram atendidas em um projeto de extensão da Universidade Federal do Piauí - Programa Preventivo para Gestantes e Bebês - PPGB. A coleta dos dados foi estruturada em dois momentos: 1º- Preenchimento de ficha contendo dados relativos à saúde geral e exame periodontal completo, e 2º- Coleta de dados referentes a tipo de parto, duração da gestação, peso e condição de saúde do bebê. RESULTADO: De 62 gestantes atendidas, 43 participaram do segundo momento do estudo. Ocorreu uma predominância de gestantes com idade entre 25 e 35 anos (55,81%). O índice de sangramento gengival variou de 1,19% a 92,50%. A média do peso dos bebês foi 3.365,33 g e do tempo gestacional foi 39,33 semanas. CONCLUSÃO: Os resultados deste estudo não deram suporte à hipótese de que a doença periodontal está associada à idade gestacional.

INTRODUCTION: The birth of newborn (NB) underweight is considered a public health problem and is often associated with prematurity. The etiology of preterm birth is complex and often is related to several factors. Several theories have correlated the periodontal health of pregnant women with preterm birth (gestational age) and / or with low birth weight. OBJECTIVE: The objective of this study is to evaluate the possible correlation between periodontal health with gestacional time and/or with low birth weight. MATERIAL AND METHOD: A Prospective longitudinal observational study with pregnant women that were attending a extension project of UFPI - Preventive Program for Pregnant Women and Babies - PPPWB. Data collection was structured in two moments: 1st fill sheet containing questions related to health of the pregnant woman, complete clinical and periodontal examination of the oral cavity and 2nd data collection on the type of delivery, gestation length, baby's weight and health condition. RESULT: A total of 62 pregnant women were attended and only 43 patients participated in the second moment of the study. There was a predominance of women aged between 25 to 35 years (55.81%). The bleeding index ranged from 1.19% to 92.50%. The average weight of infants was 3365.33 g and gestational time was 39.33 weeks. CONCLUSION: The results of this study did not support the hypothesis that periodontal disease is associated with gestacional time and/or low birth weight.

Publicações sobre a síndrome de Guillain-Barré (SGB) no idoso são escassas e várias questões sobre o tema estão abertas. OBJETIVO: Descrever aspectos clínico-eletrofisiológicos, terapêuticos e prognóstico no idoso. MÉTODO:Revisamos os prontuários de pacientes acima de 60 anos com SGB. A escala de Hughes foi usada para quantificar os déficits iniciais e finais. RESULTADOS: No total de 18 pacientes (média de idade 64,8 anos), 50% tiveram pródromo e 80% tiveram déficit sensitivo-motor no início. SGB desmielinizante foi encontrada em 8 pacientes, axonal em 6 e uma síndrome de Miller-Fisher. Três casos não puderam ser classificados. Plasmaférese (PFX) foi empregada isoladamente em 12 pacientes e imunoglobulina endovenosa (IVIg) em 2. A disfunção inicial nos dois grupos tratados era semelhante, assim como a evolução a curto e longo prazo. CONCLUSÃO: A forma axonal da SGB parece ser mais freqüente no idoso e isto pode ter implicações prognósticas. PFX e IVIg foram eficazes, mas complicações ocorreram apenas no grupo tratado com PFX. Estudos prospectivos são necessários para um melhor entendimento e manejo da SGB no idoso.

There are few papers devoted to geriatric Guillain-Barré (GBS) and many related issues remain unanswered. OBJECTIVE: To describe clinical, electrophysiological and therapeutic features in this age. METHOD: Clinico-epidemiological data and therapy of GBS patients older than 60 years were reviewed. Hughes scores were used to quantify neurological deficit and define outcome. RESULTS: Among 18 patients (mean age 64.8 years), 9 had evident prodrome and 80% noticed initially sensory-motor deficit. Demyelinating GBS was found in 8 and axonal in 6 subjects. There was one Miller-Fisher and 3 unclassified cases. Plasmapheresis (PFX) was single therapy in 12 patients and intravenous immunoglobulin (IVIg) in 2. Disability scores just before therapy were similar in both groups, so as short and long term outcome. CONCLUSION: Axonal GBS seems to be more frequent in the elderly and this may have prognostic implications. PFX and IVIg were suitable options, but complications were noticed with PFX. Prospective studies are needed to better understand and manage GBS in the elderly.

Analisamos a experiência do Hospital das Clínicas da Unicamp com plasmaferese: (PF) na miastania grave (MG). 17,8 % do total dos casos de MG submeteu-se a PF, 26 casos, 19 mulheres e sete homens. A idade média de início da MG foi 28 anos (extremos 11 e 69). O menor déficit clínico foi IIb (O & G) e IIIa (MGFA). A PF foi indicada no pré-operatório de timectomia em um caso e em sete devido a crise miastênica. Em 18 casos, com MG generalizada e sintomas bulbares ou com exacerbação de déficit prévio, a PF foi indicada como intervenção aguda. Em dois pacientes desse grupo ela foi indicada também em regime crônico de ciclos mensais. Os 26 pacientes submeteram-se a 44 ciclos e a 171 sessões de PF. O número médio de sessões em cada ciclo foi 3,9 (DP ± 1,4); mediana de 5, extremos 2 e 6. O tempo médio de cada sessão foi 106,5 minutos (DP ± 35,2); mediana de 100,5 (extremos 55 e 215).O volume médio de plasma trocado em cada sessão foi 2396 ml (DP ± 561); mediana 2225 (extremos 1512 e 4500). Efeitos colaterais foram reversíveis: hipotensão (sete casos), tremor ou parestesias leves (sete casos). Taxas de infecção e mortalidade devido a PF foram zero. A totalidade dos pacientes teve benefícios imediatos a cada ciclo de PF e usualmente receberam prednisona ou outro imunossupressor. Houve boa aceitação ao procedimento em 80,7% dos pacientes.

We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD ± 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD ± 35.2); median 100.5 (extremes of 55 and 215). The mean volume of plasma exchanged in each session was 2396 ml (SD ± 561); median 2225 (extremes 1512 and 4500). Side effects occurred: reversible hypotension (seven cases), mild tremor or paresthesias (seven cases). Infection and mortality rates due to PE were zero. All patients had immediate benefit of each PE cycle and usually they also received prednisone or other immunosuppressors. Good acceptance of the procedure was observed in 80.7% of patients.

A doença de Whipple (DW) é distúrbio multissistêmico raro causado pelo bacilo Tropheryma whipplei. O envolvimento do sistema nervoso central é um aspecto clássico da doença, sendo observado em 20 a 40% dos pacientes. Relatamos o caso de homem de 62 anos com DW que desenvolveu manifestações neurológicas durante sua evolução, com o objetivo de discutir os sinais e sintomas mais comuns e destacar os critérios diagnósticos e propostas terapêuticas mais recentes.

Whipple's disease (WD) is an uncommon multisystem condition caused by the bacillus Tropheryma whipplei. Central nervous system involvement is a classical feature of the disease observed in 20 to 40% of the patients. We report the case of a 62 yeards old man with WD that developed neurological manifestations during its course, and discuss the most usual signs and symptoms focusing on recent diagnostic criteria and novel treatment regimens.

Meningorradiculite refere-se ao envolvimento simultâneo das meninges e das raízes dos nervos. O local mais freqüentemente acometido é a região lombossacra. Patologias inflamatórias, infecciosas e neoplásicas são as causas mais freqüentes. Meningorradiculite é manifestação rara de infecção por Cryptococcus neoformans. Descrevemos um caso de paresia flácida dos membros inferiores, com diagnóstico de meningorradiculite lombossacra baseado nos achados clínicos, de ressonância magnética da coluna lombar e em alterações inflamatórias do líquido cefalorraqueano (LCR). Avaliação microbiológica do LCR revelou a presença de Cryptococcus neoformans e extensa investigação clínica e laboratorial excluiu imunodeficiências primárias e adquiridas.

Meningoradiculitis refers to combined involvement of meninges and nerve roots. The most frequent location is the lumbosacral region. Etiology is diverse, including inflammatory, infectious and neoplastic disorders. Meningoradiculitis is a rare form of involvement in cryptococcal infection. We describe a case of subacute lower limbs flaccid paresis diagnosed as lumbosacral meningoradiculitis in view of cerebrospinal fluid (CSF) inflammatory changes and typical enhancement on MRI of lumbar spine. Cryptococcus neoformans was isolated from CSF. Extensive screening yielded no immunodeficiencies.

Paquimeningite hipertrófica é uma causa incomum de sintomas neurológicos, sendo frequentemente secundária a infecções, carcinomatose ou doenças inflamatórias. Pode também ser idiopática. Relatamos um caso de paquimeningite que se manifestou inicialmente por psicose e diminuição da acuidade visual com atrofia óptica e destruição do septo nasal. A paciente, de 45 anos de idade, foi submetida a extensa investigação, não sendo evidenciada nenhuma doença de base. Foi realizada biopsia de meninge, a qual evidenciou um processo inflamatório com intensa fibrose e raros granulomas em estágio inicial. Esses achados sugerem neurossarcoidose ou paquimeningite hipertrófica idiopática.

Hypertrophic pachymeningits is an unusual cause of neurological symptoms and is often secondary to infections, carcinomatosis or inflammatory diseases. It may also be idiopathic. We report a case of pachymeningitis which was manifested primarily by psychosis and visual loss with optic atrophy and destruction of nasal septum. The patient, a 45 year old woman was submitted to extensive investigation without evidence of any underlying disease. A meningeal biopsy was performed and showed a mostly unspecific inflammatory process with extensive fibrosis of the dura and few early stage granulomas. These findings suggest either neurosarcoidosis or idiopathic hypertrophic pachymeningitis.