Brazil was the country that received the largest number of Africans during the time of colonization, and Bahia was the Brazilian state that received the largest number of slaves from Africa. The purpose of this study was to evaluate the coverage of the newborn screening program for sickle cell disease in the Recôncavo Baiano region of the state of Bahia, and to show the frequency of the subjects with hemoglobin variants in the 2006-2009 period. Blood samples from neonates in twelve cities in the Recôncavo Baiano region were analyzed by High Performance Liquid Chromatography. A total of 16,402 children were born in this period, 14,773 of which underwent newborn screening. In this period 1416 children were born carrying hemoglobin variants HbS and HbC. Forty-seven patients-20 HbSS genotype and 27 HbSC genotype-were diagnosed in eleven of the twelve cities surveyed. The proportion of children born with sickle cell disease in the Recôncavo Baiano region was 1/314, which was higher than the 1/650 rate for the state of Bahia. The data presented in this study confirm the high frequency of sickle cell disease in Recôncavo Baiano, demonstrating the need to create a referral center for the care of patients with sickle cell diseases in the region.

There are several instruments of evaluation of the craniocervical equilibrium; the most reliable are the radiographies. This study used the cephalometric analysis of Rocabado to measure the sensibility and specificity of the Cervical Range of Motion (CROM), a goniometer designed to assess cervical movements in degrees, and measure the forward head position in centimeters. This instrument frequently used, has been tested as a reliable instrument to evaluate the cervical movements but not the forward head. The sample consisted of 30 volunteers, 18 females, 12 males, mean age of 24.63 years. All participants were evaluated with CROM and radiographies in the resting head position and in erect head position. The values considered by the cephalometry consisted in the angle made between the McGregor plane and the vertical line formed by the base of the odontoid process to its apex; the posterior space between C0-C1 and C1-C2 and the hyoid triangle. Results: 30% of the subjects had forward head posture, according to de cephalometry of Rocabado (decreased space between C0-C1, C1-C2) and 43,3% according to CROM. 16,6% had decreased posterior-inferior angle, and 13% had the hyoid triangle facing up. ROC curve of identifying forward head posture yielded area under the curve of 0,778 (95% confidence interval 0,596-0,960). The sensibility of CROM was: 77%. The specificity 71%. Conclusion: This study suggests that CROM has a moderate sensibility and specificity, useful for clinic use, but not for research.

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The objective present study was to investigate the presence of low back pain in caregivers of a nursing home, related with the labored activities executed by these workers. 16 subjects were investigated, 15 female and one male, with 40,8 age average all being caregivers as their profession. It consisted of three phases, where the first concerns the analysis of the collective work, assessed in a perspective of caregivers, Second, a postural assessment to verify the retractions in such workers and the third stage was used Diagram of Corllet to identify the presence of signs and symptoms in caregivers. The study demonstrated that organizational and biomechanical factors are responsible for the high level of physical fatigue and presence of pain in 93,75% of the caregivers in some region of the body. 50% referred pain in the lumbar region. The results of the postural evaluation confirmed that the caregivers had alterations in the postural alignment, presenting retractions of the anterior and posterior chain. The suggestions are to minimize the risk factors of this productive process and the symptoms and signals presented from these workers by adoption ergonomic measures and the realization of a physical program with stretching and muscular strengthening of the muscles of thee anterior and posterior body chain based on the method of Reorganization Postural Sensoperceptive .

Chronic pain in Sickle Cell Disease (SCD) is probably related to maladaptive plasticity of brain areas involved in nociceptive processing. Transcranial Direct Current Stimulation (tDCS) and Peripheral Electrical Stimulation (PES) can modulate cortical excitability and help to control chronic pain. Studies have shown that combined use of tDCS and PES has additive effects. However, to date, no study investigated additive effects of these neuromodulatory techniques on chronic pain in patients with SCD. This protocol describes a study aiming to assess whether combined use of tDCS and PES more effectively alleviate pain in patients with SCD compared to single use of each technique. The study consists of a one-session double blind, block-randomized clinical trial (NCT02813629) in which 128 participants with SCD and femoral osteonecrosis will be enrolled. Stepwise procedures will occur on two independent days. On day 1, participants will be screened for eligibility criteria. On day 2, data collection will occur in four stages: sample characterization, baseline assessment, intervention, and post-intervention assessment. These procedures will last ~5 h. Participants will be divided into two groups according to homozygous for S allele (HbSS) (n = 64) and heterozygous for S and C alleles (HbSC) (n = 64) genotypes. Participants in each group will be randomly assigned, equally, to one of the following interventions: (1) active tDCS + active PES; (2) active tDCS + sham PES; (3) sham tDCS + active PES; and (4) sham tDCS + sham PES. Active tDCS intervention will consist of 20 min 2 mA anodic stimulation over the primary motor cortex contralateral to the most painful hip. Active PES intervention will consist of 30 min sensory electrical stimulation at 100 Hz over the most painful hip. The main study outcome will be pain intensity, measured by a Visual Analogue Scale. In addition, electroencephalographic power density, cortical maps of the gluteus maximus muscle elicited by Transcranial Magnetic Stimulation (TMS), serum levels of Brain-derived Neurotrophic Factor (BDNF), and Tumor Necrosis Factor (TNF) will be assessed as secondary outcomes. Data will be analyzed using ANOVA of repeated measures, controlling for confounding variables.