Cuestionarios de valoración funcional en traumatología / Trauma functional assessment questionnaires

RESUMEN Introducción: Las enfermedades musculoesqueléticas son dolencias de alta prevalencia, impacto y repercusión. La historia clínica y las pruebas complementarias son las primeras pautas para diagnosticarlas. Se recomienda el uso de cuestionarios para la valoración de las limitaciones e impacto en la calidad de vida de los pacientes. Objetivo: Valorar el uso y eficacia de los cuestionarios en traumatología. Métodos: Se revisaron las bases de datos Medline, Pubmed. Se obtuvieron 32 publicaciones, fundamentalmente, en inglés, aunque también en español y otros idiomas, realizadas entre 2001-2018, que recogen la experiencia de los investigadores con el uso de los cuestionarios. Los términos de búsqueda empleados fueron: Musculoskeletal Disorders, Musculoskeletal pain; and Foot and Ankle, hip and knee, Upper Extremity, low back pain; and disability, quality of life questionnaires and assessment tool. Resultados: Se han revisado 46 cuestionarios: 4 de calidad de vida, 16 de miembro superior (1 general y 15 por localización de la lesión), 19 de miembro inferior (4 generales y 15 por localización de la lesión) y 7 para raquis. Conclusiones: No hay acuerdo en los autores sobre cuál es el mejor cuestionario para la valoración de impacto y repercusión, y se combinan varios de ellos. La elección del cuestionario y el que sea genérico (de calidad de vida) o específico (de miembro superior, inferior o raquis), está en consonancia con el objetivo buscado en la investigación, la experiencia del investigador, su uso clínico y tiempo necesario para cumplimentarlo(AU)

ABSTRACT Introduction: Musculoskeletal diseases are ailments of high prevalence, impact and impact. The medical record and the complementary tests are the first guidelines to diagnose them. The use of questionnaires is recommended to assess the limitations and impact on the quality of life of patients. Objective: To assess the use and effectiveness of traumatology questionnaires. Methods: Medline, Pubmed databases were reviewed. We recovered 32 publications mainly in English, but also in Spanish and other languages, made from 2001 to 2018. These publications collect the experience of researchers with the use of questionnaires. The search terms used were Musculoskeletal Disorders, Musculoskeletal pain; and Foot and Ankle, hip and knee, Upper Extremity, low back pain; and disability, quality of life questionnaires and assessment tool. Results: Forty six questionnaires were reviewed. Four on quality of life, 16 on the upper limbs (one general and 15 by location of the lesion), 19 on the lower limbs (four general and 15 by location of the lesion) and 7 on spine. Conclusions: There is no consensus among the authors on which is the best questionnaire for assessing of the impact and repercussion. Several of them are combined. The choice of the questionnaire and the one that is generic (on quality of life) or specific (on upper, lower limbs or spinal) is in line with the objective sought in this research, the researcher´s experience, clinical use and the time needed to fill it out(AU)

RÉSUMÉ Introduction: Les troubles musculo-squelettiques sont des affections dont la prévalence, l'impact et le retentissement sont élevés. Le dossier médical et les examens complémentaires sont les premières orientations pour les diagnostiquer. L'emploi des questionnaires pour évaluer les limitations et l'impact sur la qualité de vie des patients est recommandé. Objectif: Évaluer l'emploi et l'efficacité des questionnaires en traumatologie. Méthodes: On a consulté les bases de données Medline et PubMed. On a obtenu 32 publications notamment en anglais, mais aussi en espagnol et d'autres langues, parues entre 2001-2018, recueillant toute l'expérience des chercheurs dans l'usage des questionnaires. Les termes de recherche utilisés ont été: Musculoskeletal Disorders, Musculoskeletal pain ; and Foot and Ankle, hip and knee, Upper Extremity, low back pain ; and disability, quality of life questionnaires and assessment tool. Résultats: Sur 46 questionnaires, on a révisé 4 concernant la qualité de vie, 16 concernant les membres supérieurs (1 de sujet général et 15 de localisation de la lésion), 19 concernant les membres inférieurs (4 de sujet général et 15 de localisation de la lésion), et 7 concernant le rachis. Conclusions: Les auteurs ne sont pas arrivés à un consensus sur le meilleur questionnaire pour évaluer l'impact et le retentissement; on a fait une combinaison de plusieurs d'entre eux. La sélection d'un questionnaire et le fait qu'il soit générique (qualité de vie) ou spécifique (membre supérieur, inférieur ou rachis) ont été en concordance avec l'objectif de la recherche, l'expérience du chercheur, l'usage clinique et le temps nécessaire pour le compléter(AU)

Localización de lesiones osteomusculares por actividades relacionadas con el ejercicio profesional en el personal de salud: revisión de la literatura / Localization of osteomuscular injuries by activities related to professional exercise in health personnel: review of literature

Introducción: Las lesiones osteomusculares se han convertido en uno de los principales problemas de salud pública y de las aseguradoras de riesgos profesionales, ya que estas afectan la calidad de vida, del trabajador, el ausentismo, la disminución productiva, las incapacidades temporales o permanentes, reubicación del personal aumento de los costos económicos, de los cuidados a la salud, los cambios en las perspectivas y actitudes psicosociales individuales, familiares y sociales. Objetivo: Determinar la prevalencia de lesiones osteomusculares en el personal de salud. Metodología: se realizó una revisión documental de los estudios recientes enfocados en la percepción de alteraciones osteomusculares, tras obtener los artículos en las bases de datos Hinari, Elsevier, Scopus, Pubmed, Ebsco, se seleccionaron los estudios que cumplieron con los criterios de inclusión. Resultados: Se evidencio que el principal síntoma de origen osteomuscular es el dolor, presentado inicialmente en cuello y espalda, el género femenino resultó más vulnerable y en especial el grupo etáreo correspondiente a 41 a 50 años, la principal causa son los movimientos repetitivos. Conclusiones: el personal de salud, en especial enfermería esta frecuentemente expuesto a factores de riesgo para desarrollar patologías osteomusculares, por lo que es indispensable la implementación de estrategias para mantener una adecuada salud ocupacional para la prevención y tratamiento oportuno.

Introduction: Musculoskeletal injuries have become one of the main public health problems and professional risk insurers, since they affect the quality of life, of the worker, absenteeism, productive decline, temporary or permanent disabilities, relocation of staff increased economic costs, health care, changes in perspectives and individual psychosocial attitudes, family and social. Objective: To determine the prevalence of osteomuscular injuries in health personnel Methodology: a documentary review of the recent studies focused on the perception of musculoskeletal alterations was made, after obtaining the articles in the databases Hinari, Elsevier, Scopus, Pubmed, Ebsco, the studies that met the inclusion criteria were selected. Results: It was evidenced that the main symptom of musculoskeletal origin is pain, presented initially in the neck and back, the female gender was more vulnerable and especially the age group corresponding to 41 to 50 years, the main cause are repetitive movements. Conclusions: health personnel, especially nurses, are frequently exposed to risk factors to develop musculoskeletal conditions, so it is essential to implement strategies to maintain adequate occupational health for prevention and timely treatment.

Late-onset Pompe disease: what is the prevalence of limb-girdle muscular weakness presentation? / Doença de Pompe de início tardio: qual é a prevalência na apresentação de fraqueza muscular de cinturas?

ABSTRACT Pompe disease is an inherited disease caused by acid alpha-glucosidase (GAA) deficiency. A single center observational study aimed at assessing the prevalence of late-onset Pompe disease in a high-risk Brazilian population, using the dried blood spot test to detect GAA deficiency as a main screening tool. Dried blood spots were collected for GAA activity assay from 24 patients with "unexplained" limb-girdle muscular weakness without vacuolar myopathy in their muscle biopsy. Samples with reduced enzyme activity were also investigated for GAA gene mutations. Of the 24 patients with dried blood spots, one patient (4.2%) showed low GAA enzyme activity (NaG/AaGIA: 40.42; %INH: 87.22%). In this patient, genetic analysis confirmed two heterozygous mutations in the GAA gene (c.-32-13T>G/p.Arg854Ter). Our data confirm that clinicians should look for late-onset Pompe disease in patients whose clinical manifestation is an "unexplained" limb-girdle weakness even without vacuolar myopathy in muscle biopsy.

RESUMO A doença de Pompe é uma doença hereditária causada pela deficiência da enzima alfa-glicosidase ácida (GAA). Estudo observacional foi realizado, em um único centro, para determinar a prevalência da doença de Pompe de início tardio (LOPD) em uma população brasileira de alto risco, usando teste em gota seca (DBS) como ferramenta principal de triagem para detectar a deficiência da GAA. DBS foi coletado para avaliar a atividade da GAA em 24 pacientes com fraqueza muscular de cinturas "não explicada" sem miopatia vacuolar na biópsia muscular. As amostras com atividade enzimática reduzida foram também submetidas a análise de mutações no gene GAA. Dos 24 pacientes com DBS, baixa atividade da enzima GAA (NaG/AaGIA: 40.42; %INH: 87.22%) foi encontrada em um paciente (4.2%). Nessa paciente, a análise genética confirmou duas mutações em heterozigose composta no gene GAA (c.-32-13T > G/p.Arg854Ter). Nossos resultados confirmam que LOPD deve ser investigada quando a manifestação clínica é uma fraqueza muscular de cinturas "não explicada", mesmo na ausência de miopatia vacuolar na biópsia muscular.

Correlation of frailty severity with muscle mass and physical function in Chinese older adults:preliminary findings / 中华老年医学杂志

Objective To explore the relationship between the severity of frailty and muscle mass/function in older people,and to determine whether and/or how the results would be influenced by the assessment method for frailty.Methods A total of 106 older adults aged 63-95 years were recruited from individuals undergoing regular health examinations at the Outpatient Department of Beijing Hospital.The characteristics of participants were collected through a questionnaire and subsequently evaluated.Frailty was assessed by both the Fried phenotype and an index of accumulated deficits (FI).Sarcopenia was identified based on the criteria of the Asian Working Group for Sarcopenia (AWGS).Average skeletal muscle mass,appendicular skeletal muscle mass and the appendicular skeletal muscle index (ASMI) were measured by bioelectrical impedance analysis (BIA).Furthermore,grip strength,the 4 m walking test,the timed up and go test (TUGT),the five times sit to stand test (FTSST),and the balance test were performed to investigate the physical performance.Results There were 15 (14.2％) frail and 65 (61.3％) pre-frail cases in this group.Poor grip strength 59 (55.7％) and slow gait speed 33 (31.1％) were more prevalent in frail older people.Meanwhile,when the phenotypic definition of frailty was used,muscle mass and ASMI decreased as the severity of frailty increased (F=6.579,3.969,4.507,respectively;all P＜0.05).Frail older people had significantly slower gait speed and poorer grip strength than those who were not frail (F=23.897,4.583,respectively;both P＜0.05).Moreover,frail older people were more likely to be sarcopenia (53.5％) than those who were pre frail (30.8％) or not frail (3.8％).Participants with frailty performed worse on FTSST,TUGT and the balance test (all P＜0.05) and had markedly lower levels of FI (0.15±0.04,0.18±0.06,and 0.28±0.09,respectively;F=21.764,P＜0.05) than those in the pre-frail and non-frail groups.Appendicular skeletal muscle mass,skeletal muscle mass,grip strength and walking speed were negatively correlated with FI (r =-0.256,-0.321,-0.343,-0.374,respectively;all P＜0.05) while ASMI showed no statistical correlation with FI (P＞0.05).Conclusions Poor grip strength and slow gait speed are very common in frail older people.There is a close correlation between muscle mass/function and frailty.The degree of association of frailty severity with physical performance remains largely unchanged regardless of what assessment method is used.

Aspectos distintos de ressonância magnética de músculos entre dermatomiosite e polimiosite / Different aspects of magnetic resonance imaging of muscles between dermatomyositis and polymyositis

Introdução: Embora a dermatomiosite (DM) e a polimiosite (PM) compartilhem diversos aspectos clínicos em comum, cada uma delas apresenta características fisiopatológicas e histológicas próprias. É possível que estas diferenças também se reflitam macroscopicamente, como, por exemplo, em imagens musculares vistas em ressonância magnética (RM). Objetivos: Comparar simultaneamente a RM de diversos compartimentos musculares das coxas de pacientes com DM e PM adultos. Materiais: Estudo transversal, em que foram avaliadas, entre o período de 2010 a 2013, as imagens de RM das coxas realizadas em aparelho de 1,5 Tesla (T) com sequências ponderadas em T1 e T2 com supressão de gordura, para rastreamento, de 11 DM e 11 PM (Bohan e Peter, 1975) recém-diagnosticados, em atividade clínica e laboratorial. Resultados: A média de idade na ocasião da RM, o tempo entre o início de sintomas e a realização das RM, a distribuição de sexos e a terapia medicamentosa foram comparáveis entre os dois grupos (p>0,050). Em termos de RM, edema muscular foi encontrado significantemente em DM, e principalmente na região proximal dos músculos. A área de lipossubstituição dos músculos foi encontrada predominantemente em PM. Essa lipossubstituição, quando de uma forma parcial, ocorreu principalmente nos terços médio e distal, enquanto que a forma total transcorreu apenas no terço distal dos músculos. Não houve nenhuma área de fibrose muscular. Conclusões: A DM e a PM apresentam características distintas entre si em RM de músculos, a exemplo de distinções fisiopatológicas e histológicas. .

Introduction: Although dermatomyositis (DM) and polymyositis (PM) share many clinical features in common, they have distinct pathophysiological and histological features. It is possible that these distinctions reflect also macroscopically, for example, in muscle alterations seen in magnetic resonance images (MRI). Objectives: To compare simultaneously the MRI of various muscle compartments of the thighs of adult DM and PM. Materials: The present study is a cross-sectional that included, between 2010 and 2013, 11 newly diagnosed DM and 11 PM patients (Bohan and Peter's criteria, 1975), with clinical and laboratory activity.They were valued at RM thighs,T1 and T2 with fat suppression, 1.5 T MRI scanner sequences. Results: The mean age at the time of MRI, the time between onset of symptoms and the realization of the MRI distribution of sex and drug therapy were comparable between the two groups (p>0.050). Concerning the MRI, muscle edema was significantly found in DM, and mainly in the proximal region of the muscles. The area of fat replacement was found predominantly in PM. The partial fat replacement area occurred mainly in the medial and distal region, whereas the total fat replacement area occurred mainly in the distal muscles. There was no area of muscle fibrosis. Conclusions: DM and PM have different characteristics on MRI muscles, alike pathophysiological and histological distinctions. .

Lúpus Eritematoso Sistêmico com fraqueza muscular por Miastenia Gravis / Systemic Lupus Erythematosus with muscle weakness due to Myasthenia Gravis

O Lúpus Eritematoso Sistêmico (LES) e a Miastenia Gravis (MG) são doenças autoimunes cuja associação em um mesmo paciente é raramente descrita. Essas patologias compartilham algumas características como acometimento de mulheres jovens, positividade para anticorpos antinucleares, evolução em períodos de exacerbações e remissões. O presente relato de caso analisa as possíveis hipóteses diagnósticas para um quadro clínico de ptose palpebral e fraqueza muscular proximal em uma paciente portadora de lúpus recente que evoluiu com MG associada.

Systemic lupus erythematosus (SLE) and myasthenia gravis (MG) are autoimmune diseases, whose association in the same patient is rarely reported. Both pathologies share the following characteristics: affect mainly young women; alternate exacerbation and remission periods; and have positive antinuclear antibody (ANA) test. This case report assesses possible diagnostic hypotheses for the clinical findings of eyelid ptosis and proximal muscle weakness in a female patient recently diagnosed with SLE, who evolved with associated MG.

Myopathology, a 14-year Siriraj experience: What have we learned.

Neuromuscular laboratory, Department of Pathology Siriraj Hospital was established in 1989. Within fourteen years, 315 specimens from 304 patients were received. The patients’ age ranged from 22-week gestation to 76 years old. The ratio of males to female was 1.11:1. Muscular dystrophies comprised 26.63%, non-specific changes 25.66%, primary myopathies, including unclassified myopathy 13.82%, neurogenic muscle diseases 12.82% dysimmune and infectious myopathies 8.89%, mitochondrial myopathy 4.94% and others 7.24%. Summaries of our patients were described.

Synthetic rehabilitation treatment of congenital muscular torticollis / 中国康复理论与实践

@#ObjectiveTo investigate the relationship between the prognosis and both of treatment way and curative age of congenital muscular torticollis.Methods138 children accepted conservative and/or operative treatment according to different ages.A prospective study had been made. ResultsConservative treatment was given to 82 children,71 of them were <1-year-old. 49 of them were follwed up and had satisfactory outcome.7 patients who was >1-year-old had operations later because of asymmetry of head.63 children received operations.56 of them were followed up over one year,47 cases had good-looking,the outcome of other 9 was not satisfied.Conclusions Operative intervention was necessary for >1-year-old patients. Manipulation was suitable way to cure <1-year-old patients.It was the best operating time at the age of 1-5 years old.