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BACKGROUND AND PURPOSE: The present study aimed to assess the concurrent validity of the International Classification of Functioning, Disability and Health (ICF) core set to classify physical health of older adults in relation to self-rated health. METHODS: This is a methodological study conducted in Santa Cruz, Rio Grande do Norte (RN) state, in Northeastern Brazil, with 101 community-dwelling older adults. The participants rated their health status, which was classified into 3 groups: very good, fair, and poor/very poor. An interview was then conducted using self-reported and objective measurements to classify physical health according to the ICF core set. It consists of 30 categories, 14 of which belong to the body function (b) component, 4 to body structures (s), 9 to activities and participation (d), and 3 related to environmental factors (e). To analyze the compromised and problematic categories in the ICF, an impairment index was created for each component. The relationship between self-rated health and the impairment indexes was assessed using the multinomial logistic regression test adjusted for age, sex, schooling, and perception of income sufficiency. RESULTS: A greater likelihood of poor or very poor self-rated health was found in older individuals with the highest impairment index in (b) (odds ratio [OR] = 1.18; P < .001); (s) (OR = 1.11; P ≤ .001); (d) capacity (OR = 1.09; P = .02); and (d) performance (OR = 1.08; p = 0.01). CONCLUSION: The results suggest that the ICF core set is a valid instrument to assess the physical health of older adults, since it is associated with self-rated health and shows potential for use in clinical practice and scientific research, with universal language regarding functionality and physical health in older adults.

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With the objective of characterizing the composition and spatial distribution of plastic fragments in a subtropical lagoon system, five sample areas affected by various anthropogenic impacts were chosen in the southern part of the Estuarine Lagoon System in Laguna, Santa Catarina, Brazil. The total density of the floating meso- and microplastics encountered was 7.32/m3, with the greatest density in the access channel and external area of the lagoon. Plastic filament was the most abundant and mainly comprised polyester (PET), polypropylene (PP) and polyethylene (PE) from 0.05 to 0.71 mm2. Fishing and urbanization were the main sources of the meso- and microplastics in the environment. This is the first study to evaluate contamination by meso- and microplastics in the southern part of the Estuarine Lagoon System and provides information about the nature and extent of contamination by plastics in this estuarine ecosystem.

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BACKGROUND: Physical health is an important factor for what is considered successful aging. Using valid and reproducible tools to classify PH of older adults may help to develop appropriate rehabilitation protocols for this population. OBJECTIVE: To evaluate the convergent validity and reproducibility of the International Classification of Functioning, Disability and Health (ICF) core set to classify the physical health of older adults. METHODS: A total of 101 older adults were evaluated for handgrip strength, physical performance (Short Physical Performance Battery), and physical activity level (International Physical Activity Questionnaire). Physical health was classified with the ICF core set (14 categories of body functions, 4 of body structures, 9 of activity and participation, and 3 environmental factors) and an impairment index was calculated for each component. RESULTS: Higher levels of physical activity were associated to lower impairment index in the body function and activity and participation components, but was not associated to environmental factors. Better physical performance and handgrip strength were also related to lower impairment index in all components. The Intraclass Correlation Coefficient analysis indicated good reproducibility for body function, body structure, the capacity component of the activity and participation, and for two environmental factors (use of medications and assistive devices), but moderate reproducibility for the performance component of activity and participation, and poor reproducibility for the environmental factor related to access to health services. CONCLUSION: The ICF core set for the physical health of older adults is a valid and reproducible tool and can be used in clinical practice and research.

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RESUMO O envelhecimento populacional vem ocorrendo rapidamente em todo o mundo, levando à necessidade de capacitação dos profissionais de saúde envolvidos no cuidado ao idoso, dentre eles o fisioterapeuta. O objetivo deste estudo foi descrever o perfil dos cursos de fisioterapia de instituições do ensino superior (IES) do Brasil quanto ao ensino direcionado à saúde do idoso. Trata-se de um estudo observacional e transversal. Foi realizado um levantamento de informações sobre os cursos de fisioterapia do Brasil através de análise da grade curricular, projetos pedagógicos e formulário específico. Foram analisadas 525 IES, das quais 91,3% oferecem uma disciplina que aborda a saúde do idoso, sendo 98,4% de caráter obrigatório e 91,3% do tipo teórico-prático. Nas práticas, 25,6% são em campo de estágio, sendo 81,9% realizadas com idosos voluntários e 54,9% direcionadas a todos os níveis de atenção. Ao analisar a distribuição da disciplina por região, observou-se que esta está mais presente na região Sudeste (40,2%) (p=0,03). As IES do Brasil abordam, em sua maioria, a saúde do idoso na grade curricular do curso de fisioterapia. No entanto, a distribuição dessa disciplina no país é desigual, podendo trazer divergências na conduta terapêutica e representar prejuízos na qualidade da assistência ao idoso.

RESUMEN El envejecimiento de la población ha estado ocurriendo rápidamente en el mundo, lo que resulta necesaria la capacitación de los profesionales de la salud involucrados en el cuidado del anciano, incluido el fisioterapeuta. El presente estudio tuvo el objetivo de describir el perfil de los cursos de fisioterapia en las instituciones de educación superior (IES) en Brasil con respecto a la enseñanza sobre la salud del anciano. Es un estudio observacional y transversal. Se realizó una recopilación de informaciones sobre los cursos de fisioterapia en Brasil mediante el análisis del plan de estudios, los proyectos pedagógicos y un formulario específico. Se analizaron 525 IES, de las cuales el 91,3% ofertan una materia que aborda la salud del anciano, de esta, el 98,4% son obligatorias y el 91,3% del tipo teórico-prácticas. En las del tipo prácticas, el 25,6% están en el ámbito de pasantías, siendo que el 81,9% se realizan con ancianos voluntarios y el 54,9% están dirigidas a todos los niveles de atención. En el análisis de la distribución de la materia por región, se observó una mayor presencia en la región Sudeste (40,2%) (p=0,03). La mayoría de las IES en Brasil abordan la salud de los ancianos en el plan de estudios del curso de fisioterapia. No obstante, la distribución de la materia es desigual en el país, lo que puede resultar en divergencias en la conducta terapéutica e influir negativamente en la calidad de la asistencia a los ancianos.

ABSTRACT Population aging has been occurring rapidly around the world, leading to the need for training for health professionals involved in caring for older adults, including the physical therapist. The aim of this study was to describe the profile of physical therapy courses in higher education institutions (HEIs) in Brazil regarding teaching directed to the health of older adults. This is an observational, cross-sectional study. A survey of information on physical therapy courses in Brazil was carried out through analysis of the curriculum, pedagogical projects and specific form. We analyzed 525 HEIs, of which 91.3% offer a discipline that addresses the health of older people, 98.4% of which is mandatory and 91.3% is the theoretical-practical type. In practice, 25.6% are in the internship field, with 81.9% carried out with older volunteers and 54.9% directed to all levels of care. When analyzing the distribution of the discipline by region, it was observed that it is more present in the Southeast (40.2%) (p=0.03). Most HEIs in Brazil address the health of older adults in the curriculum of the physical therapy course. However, the distribution of this discipline in the country is uneven, which can lead to divergences in therapeutic practice and represent losses in the quality of care for older people.

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SUMMARY Cardiac amyloidosis is an infiltrative cardiomyopathy, resulting from amyloid deposition within the myocardium. In primary systemic (AL-type) amyloidosis, the amyloid protein is composed of light chains resulting from plasma-cell dyscrasia, and cardiac involvement occurs in up to 50% of the patients We present a case of a 43-year-old man, with complaints of periodical swollen tongue and xerostomia, bleeding gums and haematuria for two months. His blood results showed normocytic anaemia, thrombocytopenia and a high spontaneous INR, therefore he was referred to the Internal Medicine clinic. In the first visit, he showed signs and symptoms of overt congestive heart failure and was referred to the emergency department. The electrocardiogram showed sinus tachycardia and low voltage criteria. Echocardiography showed biventricular hypertrophy with preserved ejection fraction, restrictive physiology with elevated filling pressures, thickened interatrial septum and atrioventricular valves, small pericardial effusion and relative "apical sparing" on 2D longitudinal strain. Cardiac MRI showed diffuse subendocardial late enhancement. Serum protein electrophoresis was inconclusive, however urine analysis revealed nephrotic range proteinuria, positive Bence Jones protein and an immunofixation test with a monoclonal lambda protein band. Abdominal fat biopsy was negative for Congo red stain, nevertheless a bone marrow biopsy was performed, revealing lambda protein monoclonal plasmocytosis, confirming the diagnosis of primary systemic amyloidosis. This case represents a rare cause of heart failure in a young adult. Low-voltage QRS complexes and typical echocardiography features should raise the suspicion for cardiac amyloidosis. Prognosis is dictated by the level of cardiac involvement; therefore, early diagnosis and treatment are crucial.

RESUMO A amiloidose cardíaca corresponde a uma miocardiopatia infiltrativa, resultante do depósito da proteína amiloide no miocárdio. Na amiloidose sistêmica primária (tipo AL), a proteína amiloide é composta por cadeias leves que resultam de discrasia dos plasmócitos, havendo envolvimento cardíaco em até 50% dos doentes. Apresentamos o caso de um homem de 43 anos, com queixas de edema periódico da língua e xerostomia, hemorragia gengival e hematúria há dois meses. Analiticamente havia a destacar anemia normocítica, trombocitopenia e um INR alto espontâneo, pelo que foi referenciado à consulta de Medicina Interna. Na primeira consulta, apresentou-se com sinais de insuficiência cardíaca congestiva franca, pelo que foi referenciado ao Serviço de Urgência. O eletrocardiograma demonstrou taquicardia sinusal e critérios de baixa voltagem. O ecocardiograma revelou hipertrofia biventricular com fração de ejeção preservada, fisiologia restritiva com elevação das pressões de enchimento, espessamento do septo interauricular e das válvulas auriculoventriculares, derrame pericárdico ligeiro e padrão de apical sparing no strain longitudinal 2D. Realizou ainda ressonância magnética cardíaca, que mostrou realce tardio subendocárdico difuso. A eletroforese das proteínas foi inconclusiva, contudo a análise da urina revelou proteinúria no espectro nefrótico, presença de proteína de Bence Jones e um teste de imunofixação com uma banda monoclonal de cadeias lambda. A biópsia da gordura abdominal foi negativa. Não obstante, foi realizada uma biópsia da medula óssea, verificando-se plasmocitose monoclonal lambda, o que confirmou o diagnóstico de amiloidose primária sistêmica. Este caso representa uma causa rara de insuficiência cardíaca no jovem adulto. A baixa voltagem no eletrocardiograma e os achados ecocardiográficos típicos devem fazer suspeitar de amiloidose cardíaca. O prognóstico é ditado pelo nível de envolvimento cardíaco, motivo pelo qual o diagnóstico e o tratamento precoces são essenciais.

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Cardiac amyloidosis is an infiltrative cardiomyopathy, resulting from amyloid deposition within the myocardium. In primary systemic (AL-type) amyloidosis, the amyloid protein is composed of light chains resulting from plasma-cell dyscrasia, and cardiac involvement occurs in up to 50% of the patients We present a case of a 43-year-old man, with complaints of periodical swollen tongue and xerostomia, bleeding gums and haematuria for two months. His blood results showed normocytic anaemia, thrombocytopenia and a high spontaneous INR, therefore he was referred to the Internal Medicine clinic. In the first visit, he showed signs and symptoms of overt congestive heart failure and was referred to the emergency department. The electrocardiogram showed sinus tachycardia and low voltage criteria. Echocardiography showed biventricular hypertrophy with preserved ejection fraction, restrictive physiology with elevated filling pressures, thickened interatrial septum and atrioventricular valves, small pericardial effusion and relative "apical sparing" on 2D longitudinal strain. Cardiac MRI showed diffuse subendocardial late enhancement. Serum protein electrophoresis was inconclusive, however urine analysis revealed nephrotic range proteinuria, positive Bence Jones protein and an immunofixation test with a monoclonal lambda protein band. Abdominal fat biopsy was negative for Congo red stain, nevertheless a bone marrow biopsy was performed, revealing lambda protein monoclonal plasmocytosis, confirming the diagnosis of primary systemic amyloidosis. This case represents a rare cause of heart failure in a young adult. Low-voltage QRS complexes and typical echocardiography features should raise the suspicion for cardiac amyloidosis. Prognosis is dictated by the level of cardiac involvement; therefore, early diagnosis and treatment are crucial.

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Pneumococcal endocarditis is a rare entity, corresponding to 1 to 3% of native valve endocarditis cases. It has a typically adverse prognosis, with high mortality. There is a reported predilection for the aortic valve; thus, a common presentation is acute left heart failure. We present a case of a 60-year-old woman with a history of sinusitis, who was admitted with the diagnosis of pneumonia. She rapidly deteriorated with signs of septic shock and was transferred to the critical care unit. The transesophageal echocardiogram revealed severe aortic regurgitation due to valve vegetations. Blood cultures were positive for Streptococcus pneumoniae. She underwent cardiac surgery and had multiple postoperative complications. Nonetheless, the patient made a slow and complete recovery. Infectious endocarditis should be ruled out if any suspicion arises, and echocardiography should be performed in an early stage in patients with poor response to vasopressors and inotropes. Patients with pneumococcal endocarditis benefit from an aggressive approach, with performance of early surgery.

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RESUMO A endocardite pneumocócica é uma entidade rara, cuja incidência se situa entre 1% e 3% dos casos de endocardite de válvula nativa. Esta patologia tem um prognóstico naturalmente adverso, com elevada mortalidade. Relata-se predileção pela válvula aórtica, de forma que é frequente que se apresente com insuficiência cardíaca. Apresentamos o caso de uma paciente do sexo feminino com 60 anos de idade e história pregressa de sinusite, admitida com diagnóstico de pneumonia. Após rápida deterioração, com sinais de choque séptico, ela foi transferida para a unidade de terapia intensiva. O ecocardiograma transesofágico revelou grave refluxo aórtico, devido à presença de vegetações valvares. As hemoculturas foram positivas para Streptococcus pneumoniae. A paciente foi submetida à cirurgia cardíaca e apresentou múltiplas complicações pós-operatórias. Apesar disso, apresentou lenta, porém completa recuperação. A endocardite infecciosa deve ser afastada em caso do surgimento de qualquer suspeita, e a ecocardiografia deve ser realizada precocemente nos pacientes com resposta insuficiente aos vasopressores e inotrópicos. Pacientes com endocardite pneumocócica se beneficiam de uma abordagem agressiva, com realização precoce da intervenção cirúrgica.

ABSTRACT Pneumococcal endocarditis is a rare entity, corresponding to 1 to 3% of native valve endocarditis cases. It has a typically adverse prognosis, with high mortality. There is a reported predilection for the aortic valve; thus, a common presentation is acute left heart failure. We present a case of a 60-year-old woman with a history of sinusitis, who was admitted with the diagnosis of pneumonia. She rapidly deteriorated with signs of septic shock and was transferred to the critical care unit. The transesophageal echocardiogram revealed severe aortic regurgitation due to valve vegetations. Blood cultures were positive for Streptococcus pneumoniae. She underwent cardiac surgery and had multiple postoperative complications. Nonetheless, the patient made a slow and complete recovery. Infectious endocarditis should be ruled out if any suspicion arises, and echocardiography should be performed in an early stage in patients with poor response to vasopressors and inotropes. Patients with pneumococcal endocarditis benefit from an aggressive approach, with performance of early surgery.

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Evidences of a possible association between endomyocardial fibrosis and schistosomiasis have been recently investigated. We describe the finding of cardiac schistosomal granulomas in a 14 year-old-girl presenting symptoms and signals of right side endomyocardial fibrosis. Refractory ascistis and progressive atrioventricular block were observed during follow-up. Endomyocardial biopsy and post mortem specimens showed inflammatory infiltrates, schistosomal granuloma and fibrosis.

Evidências da possível correlação entre fibrose endomiocárdica e esquistossomose mansônica têm sido recentemente suspeitadas. Relatamos a presença de um granuloma esquistossomótico, em jovem de 14 anos, com quadro clínico de endomiocardiofibrose do coração direito, evoluindo com ascite refratária e bloqueio atrioventricular do 1º grau que progrediu para bloqueio atrioventricular total. As amostras de tecido cardíaco, obtidas durante biopsia transoperatória e análise histopatológica do coração postmortem, revelaram presença de infiltrado inflamatório, granuloma esquistossomótico e fibrose

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