Go Zika Go: feasibility study with modified motorized ride-on cars for the mobility of children with Congenital Zika Syndrome (CZS).

PURPOSE: To explore the feasibility of an intervention using modified ride-on cars in terms of acceptability and potential changes in goal attainment, mobility, social function, and participation of children with Congenital Zika Syndrome (CZS). MATERIALS AND METHODS: A pre- and post-intervention feasibility study was conducted with children with CZS, levels IV and V of the Gross Motor Function Classification System (GMFCS). The intervention consisted of 12 weeks of training (3 times a week for 40 min per session) and 4 weeks of follow-up. The primary outcomes included adherence, satisfaction, and learning in mobility. Secondary outcomes encompassed goal attainment, mobility, social/cognitive function, and participation. Descriptive statistics were performed. To explore potential individual changes with the intervention, Wilcoxon test was used to analyze Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) data and Young Children's Participation and Environment Measure (YC-PEM)/Participation and Environment Measure for Children and Youth (PEM-CY), along with standard error measurements of the PEDI-CAT domains. RESULTS: Four children participated (median age 4.75 years; two females: three at level V on the GMFCS). Adherence was 75% of the total intervention time, and family members reported being satisfied or very satisfied. Children showed gains in learning the use of the modified ride-on cars and an increase in goal attainment after the intervention. Individual changes were observed in the PEDI-CAT domains (mobility and social/cognitive), but there were no significant changes in participation outcomes. CONCLUSIONS: Children with CZS at GMFCS levels IV and V can learn to use motorized ride-on cars, attainment goals, and experience satisfaction.

Motorized mobility for children with Congenital Zika Syndrome and severe physical and cognitive disabilities is feasible and can encourage future interventions focused on activities and participation.This research contributes to the understanding of the potential changes that motorized mobility can have on goal attainment, satisfaction, and learning.Motorized mobility can be a means to enable children with Congenital Zika Syndrome to have opportunities for participation and guarantee their rights.

Association between asthma, rhinitis and atopic dermatitis with leprosy: A case-control study.

Background Considering the cross-regulation of Th1 and Th2 responses, we hypothesised that atopic diseases (Th2) inhibit the protective Th1 immune response to Mycobacterium leprae and exacerbates leprosy. Objective In this study, we aimed to evaluate the association between leprosy and atopic diseases. Methods To evaluate the association of atopic diseases with leprosy, we conducted a case-control study that included leprosy patients (n = 333) and their household contacts (n = 93). The questionnaire from the International Study of Asthma and Allergies in Childhood, which is validated in several countries for epidemiological diagnosis of atopic diseases, was applied to determine the occurrence of atopic diseases, allergic rhinitis, asthma, and atopic dermatitis among leprosy patients and the household contacts. Results Considering clinical and epidemiological data, among the leprosy group 51.6% (n = 172) were determined to have at least one atopic disease, while atopy was observed less frequently at 40.86% among household contacts (n = 38). When two or more atopic diseases were assessed, the frequency was significantly higher among the leprosy patients than in the household contacts (21.9% vs. 11.8%; P-value = 0.03). Likewise, the frequency of asthma was significantly higher among leprosy patients (21%) than in the household contacts (10.8%; P-value = 0.02). Thus, our analyses revealed an association of atopic diseases with leprosy, with a significant linear increase in the occurrence of leprosy with an increase in the number of atopic diseases (P-value = 0.01). Limitation Due to the difficulties in recruiting household contacts that have prolonged contact with patients, but are not genetically related to the patient, the household contacts group is smaller than the leprosy patient group. Conclusion The data reveal an association between atopic diseases and leprosy outcomes. This knowledge could improve the treatment of leprosy patients with co-incident atopic diseases.

Avaliação da qualidade de vida de pacientes com urticária crônica em Aracaju - Sergipe / Analysis of the quality of life of patients with chronic urticaria in Aracaju - Sergipe

Introdução: A urticária crônica é uma doença com prevalência em pelo menos 0,1% da população, definida pela presença de pápulas pruriginosas, angioedema ou ambos por período superior a seis semanas. Os pacientes com urticária crônica têm um severo prejuízo na qualidade de vida. Objetivo: Avaliar o impacto da urticária crônica na qualidade de vida dos portadores da doença dentro de um serviço especializado no estado de Sergipe. Métodos: Trata-se de um estudo descritivo observacional a partir de dados coletados de 40 pacientes atendidos, em 2021, no Serviço de Alergia e Imunologia do Ambulatório de Alergia e Imunologia do Decós Day Hospital, através de dois questionários específicos para a avaliação da qualidade de vida na urticária crônica: o Chronic Urticaria Quality of Life Questionnaire e o Urticaria Control Test. Resultados: Foi possível identificar uma correlação positiva, através do questionário Urticaria Control Test, entre a intensidade dos sintomas e a piora da qualidade de vida (r = 0,774; p < 0,001). Também foi possível identificar uma correlação positiva entre a intensidade dos sintomas e a piora da qualidade de vida, desta vez mensurada pela escala Chronic Urticaria Quality of Life Questionnaire (r = 0,768; p < 0,001). Noventa por cento dos pacientes afirmaram se sentir cansados durante o dia porque não dormiram bem, 87,5% sentem dificuldade para se concentrar, 90% sentem-se nervosos, 80% afirmaram sentirem-se para baixo, 75% disseram ter vergonha das lesões da urticária que aparecem no corpo, e 60% tem vergonha de frequentar lugares públicos. Conclusões: A urticária crônica compromete a qualidade de vida, medida pelos questionários Urticaria Control Test e Chronic Urticaria Quality of Life Questionnaire. O comprometimento da qualidade de vida dos doentes com urticária crônica ocorre principalmente nos aspectos psicológicos, nos relacionamentos sociais e na qualidade do sono.

Introduction: Chronic urticaria is a disease with a prevalence in at least 0.1% of the population, defined by the presence of pruritic papules, angioedema or both for a period longer than six weeks. Patients with chronic urticaria have a severe loss in quality of life. Objective: To assess the impact of chronic urticaria on the quality of life of patients with the disease within a specialized service in the state of Sergipe. Methods: This is a descriptive observational study based on data collected from 40 patients treated, in 2021, at the Allergy and Immunology Service of the Allergy and Immunology Outpatient Clinic of Decós Day Hospital, using two specific questionnaires for quality assessment of life in chronic urticaria: the Chronic Urticaria Quality of Life Questionnaire and the Urticaria Control Test. Results: It was possible to identify a positive correlation, through the Urticaria Control Test questionnaire, between the intensity of symptoms and the worsening of quality of life (r = 0.774, p < 0.001). It was also possible to identify a positive correlation between the intensity of symptoms and worsening quality of life, this time measured by the Chronic Urticaria Quality of Life Questionnaire scale (r = 0.768, p < 0.001). 90% said they felt tired during the day because they didnt sleep well, 87.5% found it difficult to concentrate, 90% felt nervous, 80% said they felt down, 75% said they were ashamed of the urticaria lesions that appear on the body and 60% are ashamed to go to public places. Conclusions: Chronic urticaria compromises quality of life, as measured by the Urticaria Control Test and the Chronic Urticaria Quality of Life Questionnaire. The impairment of the quality of life of patients with chronic urticaria occurs mainly in the psychological aspects, in social relationships and in the quality of sleep.

Increased visceral adiposity and cortisol to cortisone ratio in adults with congenital lifetime isolated GH deficiency.

CONTEXT: Adult-onset GH deficiency (GHD) increases visceral adiposity and the activity of the enzyme 11ß-hydroxysteroid dehydrogenase, which converts cortisone (E) to cortisol (F), both linked to insulin resistance and increased cardiovascular risk. Conversely, we reported that adults with congenital isolated GHD (IGHD) have increased insulin sensitivity. OBJECTIVE: To assess the type of fat distribution and the amount of visceral and sc fat and to correlate them to the F/E ratio in adults with untreated IGHD due to a mutation in the GHRH receptor gene. METHODS: Body composition was assessed by dual-energy x-ray absorptiometry, thickness of sc and visceral fat was measured by sonography, and serum F and E were measured in 23 IGHD subjects and 21 age-matched controls. RESULTS: Waist/hip ratio (WHR), trunk fat, and trunk/extremity fat (TR/EXT) ratio were higher in IGHD subjects. Visceral fat index (VFI) (but not sc fat index [SFI]) was higher in IGHD. F and F/E ratio were also higher in IGHD. In all 44 individuals, WHR correlated with TR/EXT ratio, thickness of visceral fat, VFI/SFI ratio, F, and F/E ratio. TR/EXT ratio correlated with visceral fat thickness, VFI/SFI ratio, and F. Age had a significant effect on VFI and on F/E ratio. Body mass index SD score and WHR have a similar significant effect on TR/EXT ratio and on F/E ratio. CONCLUSIONS: Lifetime congenital untreated IGHD causes increased visceral adiposity with a high F/E ratio. However, the increased insulin sensitivity suggests that visceral adiposity needs a minimal GH secretion to translate into increased insulin resistance.

Hiponatremia na fase precoce do traumatismo raquimedular / Hyponatremia in the early stage of spinal cord injury

Analisar pacientes com traumatismo raquimedular (TRM) e os níveis séricos de sódio nos 14 primeiros dias pós-trauma, tratamento e prognóstico. Método: Trata-se de um estudo prospectivo, longitudinal e descritivo realizado no Serviço de Neurocirurgia do Hospital de Urgência de Sergipe (HUSE). Resultados: Foi prevalente o sexo masculino (80%). A idade média foi de 38,4. Quanto mais alto o nível da lesão, maior relação com o surgimento de hiponatremia. Conclusão: Por causa da incidência precoce dessa patologia em pacientes pós-TRM, é importante conscientizar a comunidade médica para a importância do rastreamento dessa patologia, evitando o aumento da morbimortalidade...

Aimed to analyze patients with SCI and serum sodium in 14/1 days post-trauma, treatment and prognosis. Method: This study is a prospective, longitudinal, descriptive realized in Emergency Hospital of Sergipe (HUSE), Department of Neurosurgery. Results: It was prevalent among males (80%). There is higher incidence in the age group below 40 years, with an average age of 38.4. The level of injury has relationship with the onset of hyponatremia. It was not necessary to impose any treatment. There were no deaths in the first two weeks. Conclusion: Due to the incidence of this disease in patients early after SCI is important to find ways to alert the medical community to the importance of screening for this disease, preventing increased morbidity and mortality...

Fractura compuesta de cráneo: reporte de casos y revisión de la literatura / Compound fracture of skull: case report and literature review

Introducción: Las fracturas son generalmente clasificados como simples (cerrada) o compuesta (abierta). En el caso de las fracturas de cráneo, pueden ser fracturas lineales, elevados, o triturado con la depresión. Fractura de cráneo compuesta rara vez se ha reportado en la literatura médica y cursa con una alta morbilidad y mortalidad. Los autores presentan seis casos de fracturas múltiples del cráneo, hablan sobre el tratamiento y pronóstico. Pacientes y métodos: Se analizaron seis casos de fractura compuesta del cráneo. Analizado por sexo, causa, localización, diagnóstico, tratamiento y pronóstico. Resultados: El sexo 5M / 1F. La edad media fue de 22 a. Las causas fueron: tres por agresión física, dos por accidente de coche y uno por explosión de neumático. Todos los pacientes fueron sometidos a TC. GCS medio al ingreso fue de 8. El tratamiento quirúrgico fue instituido en todos los casos. Tres pacientes desarrollaron infecciones (meningitis 2, empiema 1). Las secuelas fueron tres convulsiones, trastornos de la conducta 2. Hubo una muerte. Conclusión: La fractura compuesta del cráneo es rara y depende de la superficie del objeto y energía cinética. Las fracturas compuestas del cráneo con fragmentos de la depresión, son más frecuentes debido a la fuerza que se aplica hacia el cráneo. Su tratamiento inicial es quirúrgico y frecuentemente evoluciona con un mal pronóstico.

Introduction: Fractures are usually classified as simple (closed) or compound (open). In the case of skull fractures, they may be linear, high, or comminuted fracture with subsidence. The compound skull fracture has been rarely reported in medical literature and courses with high morbidity and mortality. The authors present six cases of compound fractures of the skull, discuss the treatment and prognosis. Patients and methods: We reviewed six cases of compound fracture of the skull. Analyzed according to gender, causes, location, diagnostic, treatment and prognosis. Results: The gender 5M / 1F. The mean age was 22 a. The two causes were physical aggression 3, car accident 2 and explosion of a tire 1. All patients underwent CT. Average score on ECG in admission 8. Surgical treatment was instituted all cases. Sequels were seizures 3 and behavioral disorders 2. There is one death. Conclusion: The compound fracture of the skull is rare and depends on the surface of blunt object and kinetic energy. The compound skull fractures with fragments of depression are more common, due to the force that is applied toward the skull. The initial treatment is surgical, and usually evolves with poor prognosis.

Hiper-hidrose em paciente com traumatismo raquimedular / Hyperhidrosis in patient with spinal trauma

A hiper-hidrose é uma condição caracterizada por excessiva sudorese, sobretudo das palmas das mãos e axilas. Pode ser primária ou secundária. A primária tem sido associada com a hiperatividade do sistema nervoso simpático. A hiper-hidrose pode ser tratada clinicamente ou por meio da simpatectomia. Paciente do sexo masculino, 28 anos, ajudante de obras. Vítima de agressão física por arma de fogo. Exame neurológico: desperto. Pupilas isocóricas e ECG 15. Paraplegia crural com nível sensitivo-motor T10. TC da coluna dorsal: fratura do corpo e lâminas de T8, com fragmentos metálicos no canal medular. Quatro meses após o trauma, procurou o ambulatório de Neurocirurgia para acompanhamento do quadro neurológico e referia que após dois meses do trauma apresentou hiper-hidrose axilar e palmar bilateral. Submetido a tratamento conservador, fisioterapia motora e respiratória. Encaminhado ao serviço de Psiquiatria, que referiu a hiper-hidrose como consequência de ansiedade, sendo prescrito antidepressivo tricíclico, mas sem melhora do quadro da hiper-hidrose. Foi encaminhado para tratamento com a dermatologia e a possibilidade de ser submetido à intervenção cirúrgica endoscópica. Até a presente data não retornou ao ambulatório de neurocirurgia. Dentre as complicações clínicas do TRM, a hiper-hidrose tem sido relatada em alguns casos. A produção de suor é afetada após o trauma por causa de uma alteração do sistema nervoso simpático. O tratamento com antidepressivos proporciona apenas alívio parcial e pode apresentar efeitos colaterais. A intervenção cirúrgica, embora passível de efeitos secundários, é um método minimamente invasivo e eficiente no tratamento da hiper-hidrose primária ou secundária.

Hyperhidrosis is a condition characterized by excessive sweating, especially of the hands palms and armpits. It may be primary or secondary. The primary has been associated with hyperactivity of the sympathetic nervous system. Hyperhidrosis can be treated medically or by sympathectomy. Patients, male patient, 28 years old, assistant works. Victim of physical assault by a firearm. Neurological exam: awake. Pupils isochoric and ECG 15. Crural paraplegia with sensory-motor level T10. CT of the spine: fracture of the blades and vertebral body T8, with metal fragments in the spinal canal. Four months after the trauma, came to the neurosurgery clinic for follow-up of the neurological status and stated that two months after the trauma had bilateral palmar and axillary hyperhidrosis. The patient underwent conservative treatment, physical and respiratory therapy. Referred to the Department of Psychiatry, where he was informed that the hyperhidrosis was a consequence of anxiety, and it was prescribed tricyclic antidepressant, but without hyperhidrosis cure. He was referred to dermatology for treatment and the possibility of undergoing surgery as the evolution of endoscopic. To date not returned to the clinic of neurosurgery. Among the clinical complications of SCI, hyperhidrosis has been reported in some cases. The production of sweat is affected after trauma due to a change in the sympathetic nervous system. Treatment with antidepressants provides only partial relief and can have side effects. Surgical intervention, although susceptible to side effects, is a minimally invasive and effective treatment of primary or secondary hyperhidrosis.