Trunk performance has considerable influence over activities of daily living.  Specific training improves trunk performance in inpatients after recent stroke and is superior to conventional therapy.  Inpatient training significantly increases scores in Brunel's and Berg's balance scales.

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Background Over-the-counter use of ivermectin amongst other drugs as SARS-CoV-2 treatment has been increasingly common, despite the lack of evidence on its clinical efficacy. Objective To evaluate the effect of ivermectin use on production of antibodies against SARS-CoV-2 in health care workers (HCW) diagnosed with COVID-19 and of Th1/Th2 cytokines by stimulated peripheral blood mononuclear cells of the same cohort (PBMCs). Methods This cross-sectional study evaluated seroconversion and neutralizing antibodies production in HCW at Complexo Hospitalar Universitário Professor Edgard Santos (Salvador, Brazil), diagnosed with COVID-19 from May to July, 2020, as well as in vitro production of antibody against SARS-CoV-2 and Th1/Th2 cytokines. Analyses were performed between December 2020 and February 2021. Participants were stratified according to the use of ivermectin (≤ 1 dose vs. multiple doses) for treatment of COVID-19. Results 45 HCW were included (62% women). Mean age was 39 years, and disease severity was similar across groups. Neutralizing antibodies were detected less frequently in multiple doses (70%) vs. ≤ 1 dose (97%) groups, p = 0.02). PBMCs of patients in multiple doses group also were less likely to produce antibodies against SARS-CoV-2 following in vitro stimulation with purified spike protein in comparison with patients in ≤ 1 dose group ( p < 0.001). PBMC´s production of Th1/Th2 cytokines levels was similar across groups. Abdominal pain (15% vs 46%, p = 0.04), diarrhea (21% vs. 55%, p = 0.05) and taste perversion (0% vs. 18%, p = 0.05) were more frequently reported by participants that used multiple doses of ivermectin. Conclusions Although there was no evidence for differential disease severity upon ivermectin use for treatment of COVID-19 it was associated with more gastro-intestinal side-effects and impairment of anti-SARS-CoV2 antibodies production, in a dose dependent manner. This potentially impacts the effectiveness of immune response and the risk of reinfection and warrants additional studies for clarifying the mechanisms and consequences of such immunomodulatory effects.

Objetivo: Reunir na literatura evidências sobre a efetividade da terapia física complexa no tratamento do linfedema em pacientes submetidas ao tratamento cirúrgico de câncer de mama. Método: Foram incluídos estudos de ensaios clínicos randomizados, publicados nas bases de dados indexadas no PubMed/Medline, SciELO , utilizando as principais palavras-chave: mastectomia, linfedema, cirurgia de câncer de mama, terapia física complexa, fisioterapia, terapia descongestiva completa e seus correlatos na língua inglesa. A qualidade metodológica dos artigos foi analisada de acordo com componentes individuais de avaliação segundo a cochrane collaboration. Resultados: Foram encontrados três estudos randomizados que comparam a terapia física complexa a outras formas de intervenção em pacientes com linfedema que foram submetidas à cirurgia da mama como forma de tratamento onde, dois artigos evidenciaram a efetividade da terapia física complexa na redução do linfedema. Conclusão: A terapia física complexa isolada parece ser a técnica mais efetiva para o tratamento do linfedema. Mais estudos randomizados e controlados são necessários para permitir a análise e comparação dos resultados.