The role of botulinum toxin in the management of nonneurogenic overactive bladder in children: Highlights for clinical practice. A systematic review.

Overactive bladder (OAB) is the most common voiding dysfunction in children; however, nonneurogenic or idiopathic OAB remains poorly studied. First-line treatment includes conservative measures; however, as many patients are refractory, have adverse effects, or are contraindicated for anticholinergics, new options must be explored. This review covers the use of intravesical botulinum toxin (BoNT) for idiopathic OAB treatment in children, emphasizing its efficacy, safety, differences between toxins, doses, and injection techniques. Clinical results were promising, with all 8 studies reporting good results. All authors used BoNT type A (BoNT-A), either onabotulinum or abobotulinum toxin A. Response rates were variable, with full-response percentages of 32%-60%. As proven by the full-response rates of 50%, repeated injections are as safe and effective as first injections. Only a few cases of urinary tract infection, transient urinary retention, and hematuria have been reported, with no major local or systemic adverse effects. Despite these limitations, evidence encourages and supports BoNT-A use as a safe and effective treatment modality for refractory idiopathic OAB in pediatric settings, regardless of dosage and target toxin. To the best of our knowledge, this is the first systematic review of the use of intravesical BoNT-A for idiopathic OAB treatment in children.

Post-stroke dysphagia: Clinical characteristics and evolution in a single-primary stroke center.

BACKGROUND: Dysphagia is a common manifestation after stroke and seems to play a major role in clinical and functional outcomes. OBJECTIVES: To identify clinical predictors of higher degrees of dysphagia, as well as assess its burden in our hospital, in order to understand how to improve the approach to this symptom. METHODS: We included 311 patients admitted in an acute stroke unit in a year-long period. The relationship of dysphagia with different outcomes, both in acute phase and within the first year after stroke, were investigated. RESULTS: Using the Pearson Correlation Coefficient, NIHSS score at admission was positively correlated with the degree of dysphagia (r = 0,783; p < 0,001) and total anterior circulation infarcts and age (> 70 years) were also associated with higher risk of dysphagia (p < 0.001). During hospitalization both respiratory infections and mortality occurred at significantly higher rates for dysphagic patients (p < 0.001) and we observed an increasing trend towards a higher mortality rate, the higher the degree of dysphagia. These patients stayed longer in the stroke unit, with less chance to be discharged home and more frequently transferred to inpatient rehabilitation care. One year after admission, dysphagic patients were more frequently readmitted due to pneumonia and we observed a higher mortality rate compared to patients without dysphagia (p < 0.001). CONCLUSION: The presence of the above-mentioned dysphagia predictive factors should alert us to the need for an early approach, starting in the stroke unit, but also after discharge, taking into account its impact on clinical outcomes, mortality and healthcare costs.

Falls in unilateral lower limb amputees living in the community. A Portuguese study.

INTRODUCTION: Lower limb amputees present a high risk of falling. This study aims to characterise fall history in unilateral lower limb amputees that are autonomous in the community, identifying differences between transfemoral and transtibial amputees and assessing fear of falling between fallers and non-fallers. MATERIAL AND METHODS: Descriptive, cross-sectional study of consecutive community-dwelling unilateral lower limb adult amputees of any aetiology, attending outpatient consultation in a Portuguese Physical and Rehabilitation Medicine central and university hospital department. INCLUSION CRITERIA: a prior 12 week individualised rehabilitation program for prosthesis training; regular prosthesis use for more than one year with autonomous gait; and a Functional Independence Measure® score equal to or greater than 100. Injury severity was classified according to the National Database of Nursing Quality Indicators® injury falls measure. In order to assess walking performance over short distances and fear of falling we used the 10-meter walk test and the Falls Efficacy Scale, respectively. RESULTS: In a sample of 52 lower limb amputees, mainly men (80.8%) and of traumatic aetiology (63.5%), with a mean age of 57.21 ± 11.55 years, 36.5% reported at least one fall in the previous 12 months, all classified as minor injuries. Transfemoral amputees (n = 23) presented a higher number of falls (2.22 ± 3.23, p = 0.025) and lower gait velocity (0.77 ± 0.26 m per second, p < 0.001). Regarding fear of falling, we found no significant differences between fallers and non-fallers. DISCUSSION: The prevalence of falls was low and of minor severity. Transfemoral amputees fell more often and were slower. There were no reported differences in fear of falling between groups. CONCLUSION: This paper contributes information about Portuguese lower limb amputees, whose studies are scarce and are rarely dedicated to falling.

Introdução: Amputados do membro inferior apresentam um elevado risco de queda. Neste estudo pretende-se caracterizar a história de queda em amputados unilaterais de membros inferiores, autónomos da comunidade, identificar diferenças entre transfemorais e transtibiais e avaliar diferenças no medo de cair entre os que caíram e os que não caíram. Material e Métodos: Estudo descritivo, transversal, de amputados unilaterais de membros inferiores, adultos, residentes na comunidade, de qualquer etiologia, consecutivamente recrutados da consulta do serviço de Medicina Física e de Reabilitação de um hospital central e universitário de Portugal. Critérios de inclusão: reabilitação de 12 semanas para treino protético; uso regular de prótese superior a um ano, marcha autónoma e Medida de Independência Funcional® igual ou superior a 100. A gravidade de queda foi classificada recorrendo à National Database of Nursing Quality Indicators® injury falls measure e a capacidade de andar e medo de cair com, respetivamente, o 10-meter walk test e a Falls Efficacy Scale. Resultados: Foi analisado um total de 52 amputados, maioritariamente homens (80,8%) e de etiologia traumática (63,5%) e com idade média 57,21 ± 11,55 anos, dos quais 36,5% relataram pelo menos uma queda, todas de baixa gravidade. Os transfemorais (n = 23) apresentaram mais quedas (2,22 ± 3,23, p = 0,025) e menor velocidade de marcha (0,77 ± 0,26 m por segundo, p < 0,001). Relativamente ao medo de cair, não encontrámos diferenças significativas entre doentes amputados com e sem história de quedas. Discussão: A prevalência e gravidade de queda foi baixa. Amputados transfemorais apresentaram mais quedas e menor velocidade de marcha. Não existiram diferenças no medo de cair em função da história de queda. Conclusão: Este trabalho acrescenta informação acerca dos amputados do membro inferior portugueses, cujos estudos são escassos e raramente dedicados a queda.