Neurological Phenotypes of IRF2BPL Gene Variants: A Report of Four Novel Variants.

IRF2BPL gene variants have recently been associated to developmental disability and epilepsy in children and movement disorders in adults. So far, only few cases have been reported; here we present four novel cases identified by exome sequencing, while investigating developmental delay, adult-onset cerebellar ataxia or regression.

Assessing small fiber neuropathy and subtle cardiac involvement in Fabry disease

Abstract Fabry disease (FD) is an X-linked lysosomal storage disorder characterized by reduced or absent activity of the enzyme α-galactosidase A. Due to systemic accumulation of glycolipids, FD phenotype is diverse, and diagnosis may be challenging. Clinical manifestations include small fiber neuropathy, renal dysfunction, cardiac involvement, cerebrovascular disease, among others. In the present study, we describe biopsy proven small fiber neuropathy and subclinical cardiac involvement in two cousins diagnosed with FD secondary to a recently described pathogenic variant, highlighting the importance of diagnostic tools to document organ damage and allow early treatment.

[Treatment networks and associations of patients with rare diseases]. / Redes de tratamento e as associações de pacientes com doenças raras.

Patients' associations are an example of biosocial groups, since their formation is motivated by common biological characteristics, such as rare diseases, and they are sometimes included in social movements in health. Even though the National Policy on Comprehensive Care for Persons with Rare Diseases was enacted in 2014, patients still struggle to ensure access to and treatment by the Unified Health System. The way in which associations of patients with rare diseases gain access to treatment via social networks, is investigated. This research is part of a study about the use of social media by associations of patients with rare diseases, which employs netnography - ethnography applied to the web - as the data-gathering method. Data sources were pages of the associations on Facebook in Brazil. It was seen that the activities of the associations are multi-faceted, ranging from patient and family guidance about treatment and quality of life, to active participation in the elaboration and implementation of public policies. The discourses suggest that the focus of patients' associations is, in the majority of cases, the access to drugs rather than the effective enactment of the national policy geared towards rare diseases.

As associações de pacientes são um exemplo de grupos biossociais, já que sua constituição é motivada por questões biológicas comuns, tais como as doenças raras, e estão, por vezes, inscritas no movimento social em saúde. Apesar da Política Nacional de Atenção Integral às Pessoas com Doenças Raras ter sido promulgada em 2014, os pacientes ainda têm dificuldade em garantir acesso a tratamento pelo Sistema Único de Saúde. Investigamos como as associações de pacientes com doenças raras tecem, através das redes sociais virtuais, o acesso a tratamento. Esta pesquisa é parte de um estudo sobre o uso das mídias sociais pelas associações de pacientes com doenças raras, e emprega como método a netnografia. As fontes da pesquisa foram páginas de associações de pacientes com doenças raras no Brasil presentes no Facebook. Observamos que a atuação das associações de pacientes é plural, indo desde a orientação de pacientes e familiares sobre questões relacionadas a tratamento e qualidade de vida, até a participação ativa na elaboração e implementação de políticas públicas. Os discursos sugerem que o foco destas associações é, na maior parte dos casos, o acesso a medicamentos, em detrimento da implantação efetiva da Política Nacional de Atenção Integral às Pessoas com Doenças Raras.

Redes de tratamento e as associações de pacientes com doenças raras / Treatment networks and associations of patients with rare diseases

Resumo As associações de pacientes são um exemplo de grupos biossociais, já que sua constituição é motivada por questões biológicas comuns, tais como as doenças raras, e estão, por vezes, inscritas no movimento social em saúde. Apesar da Política Nacional de Atenção Integral às Pessoas com Doenças Raras ter sido promulgada em 2014, os pacientes ainda têm dificuldade em garantir acesso a tratamento pelo Sistema Único de Saúde. Investigamos como as associações de pacientes com doenças raras tecem, através das redes sociais virtuais, o acesso a tratamento. Esta pesquisa é parte de um estudo sobre o uso das mídias sociais pelas associações de pacientes com doenças raras, e emprega como método a netnografia. As fontes da pesquisa foram páginas de associações de pacientes com doenças raras no Brasil presentes no Facebook. Observamos que a atuação das associações de pacientes é plural, indo desde a orientação de pacientes e familiares sobre questões relacionadas a tratamento e qualidade de vida, até a participação ativa na elaboração e implementação de políticas públicas. Os discursos sugerem que o foco destas associações é, na maior parte dos casos, o acesso a medicamentos, em detrimento da implantação efetiva da Política Nacional de Atenção Integral às Pessoas com Doenças Raras.

Abstract Patients' associations are an example of biosocial groups, since their formation is motivated by common biological characteristics, such as rare diseases, and they are sometimes included in social movements in health. Even though the National Policy on Comprehensive Care for Persons with Rare Diseases was enacted in 2014, patients still struggle to ensure access to and treatment by the Unified Health System. The way in which associations of patients with rare diseases gain access to treatment via social networks, is investigated. This research is part of a study about the use of social media by associations of patients with rare diseases, which employs netnography - ethnography applied to the web - as the data-gathering method. Data sources were pages of the associations on Facebook in Brazil. It was seen that the activities of the associations are multi-faceted, ranging from patient and family guidance about treatment and quality of life, to active participation in the elaboration and implementation of public policies. The discourses suggest that the focus of patients' associations is, in the majority of cases, the access to drugs rather than the effective enactment of the national policy geared towards rare diseases.

Physiotherapy and patients with osteogenesis imperfecta: an experience report / Fisioterapia e pacientes com osteogênese imperfeita: história de uma experiência

Introduction Individuals with osteogenesis imperfecta (OI) have bone fragility and osteopenia which cause fractures, mobility restriction and pain. Objective This article examines a physiotherapy experience with people diagnosed with OI in an OI reference center of Rio de Janeiro. Materials and methods This was an exploratory qualitative study, based on field notes related to physiotherapy care to 92 patients of both genders with clinical diagnoses of OI, aged between 30 days and 37 years old, during the period 2004–2008. The analysis comprised a reading of the field notes as a corpus, considering them as a means of understanding the subjects’ perspectives. Two different forms of codification were applied — open and focused — followed by semiotic analysis techniques. Results Early encouragement to perform active movements within a safe environment, or even after fractures, reduced articular contractures and enhanced muscular tonus; physiotherapy manipulation facilitated the integration of body perception in relation to movements and responses to tactile-kinesthetic-vestibular stimuli; promoting family involvement, by adopting practical solutions adapted to each patient’s reality, contributed to reduce fear of fractures and allowed the construction of a new functional image. Conclusion Physiotherapy assessment and treatment should be based not only on clinical and neurofunctional elements and technical strategies, but also on a dialogue that includes the multiple dimensions of the patients and their family members, in order to engage them in a learning process to stimulate potentials, abilities and competences. .

Introdução Os indivíduos com osteogênese imperfeita (OI) sofrem de grande fragilidade óssea e osteopenia, que ocasionam inúmeras fraturas, restrição da mobilidade e dor. Objetivo Expor pacientes com diagnóstico de OI à experiência do tratamento fisioterapêutico levado a cabo em centro de referência em Osteogênese Imperfeita do Rio de Janeiro. Materiais e métodos Estudo qualitativo, exploratório, baseado em notas de campo relativas à assistência fisioterapêutica a 92 pacientes com diagnóstico clínico de OI, com idade variando entre 30 dias e 37 anos, de ambos os sexos, atendidos entre 2004 e 2008. A análise compreendeu a leitura das anotações enquanto um corpus, considerando todo o registro da experiência de campo tal como ela se desenvolveu, empreendendo-se uma codificação aberta e uma enfocada, seguidas da aplicação de técnicas semióticas. Resultados O incentivo precoce aos movimentos ativos em ambiente seguro ou mesmo após as fraturas reduziu contraturas articulares e melhorou o tônus muscular; os manuseios fisioterapêuticos empregados facilitaram a integração da percepção do corpo quanto à ação dos movimentos e às respostas aos estímulos táteis, cinestésicos e vestibulares; a promoção do envolvimento familiar, via adoção de soluções práticas adaptadas à realidade de cada paciente, ajudou no afastamento do medo às fraturas e permitiu a construção de uma nova imagem corporal. Conclusão Para além da técnica, dos componentes clínicos e neurofuncionais, a ação fisioterapêutica deve se assentar num diálogo que permita abranger as múltiplas dimensões dos pacientes e seus familiares, no sentido de engajá-los em um processo de aprendizagem agenciador de potencialidades, competências e habilidades. .

Analysis of pre-test interviews in a cohort of Brazilian patients with movement disorders.

Spinocerebellar ataxias and Huntington disease are heritable, adult onset, neurodegenerative disorders of movement. Both are autosomal dominant and caused by expansions in trinucleotide sequences in several genes. Because these expansions are associated with an almost complete penetrance, genetic tests are available at the diagnostic and predictive level. In this study, we describe the expectations and issues raised during pre-test interviews for genetic counselling for these diseases. Data from pre-test interviews with 97 patients and at-risk relatives for spinocerebellar ataxia (SCA) or Huntington disease was comprised of close-ended questions (demographics, personal and current disease history) and open-ended questions, where individuals were asked to describe their hopes and expectations on the genetic counselling evaluation and also their degree of knowledge about genetics and medical genetics. Amongst the main expectations identified in patients and at-risk relatives, issues related to the aetiological diagnosis and/or disclosure of the at-risk status were those most frequently mentioned (57 %). Improvement in quality of life was another identified issue (17 %). Interestingly, the issue of inheritance/transmission was identified as the main expectation by a minority of individuals (3 %). Pre-test interviews are valuable tools to identify issues raised by consultands and promote a better communication between the patient, family and the genetic counselling team.

Segmental uniparental isodisomy of chromosome 6 causing transient diabetes mellitus and merosin-deficient congenital muscular dystrophy.

Segmental uniparental isodisomy (iUPD) is a rare genetic event that may cause aberrant expression of imprinted genes, and reduction to homozygosity of a recessive mutation. Transient neonatal diabetes mellitus (TNDM) is typically caused by imprinting aberrations in chromosome 6q24 TNDM differentially-methylated region (DMR). Approximately, 15.12 Mb upstream in 6q22-q23 is located LAMA2, the gene responsible of merosin-deficient congenital muscular dystrophy type 1A (MDC1A). We investigated a patient diagnosed both with TNDM and MDC1A, born from a twin dichorionic discordant pregnancy. Parents are first-degree cousins. Methylation sensitive-PCR of the imprinted 6q24 TNDM CpG island showed only the non-methylated (paternal) allele. Microsatellite markers and SNP array profiling disclosed normal biparental inheritance at 6p and a segmental paternal iUPD, between 6q22.33 and 6q27. Sequencing of LAMA2 exons showed a homozygous frameshift mutation, c.7490_7493dupAAGA, which predicts p.Asp2498GlufsX4, in exon 54. Her father, but not her mother, was a carrier of the mutation. While segmental paternal iUPD6 causing TNDM was reported twice, there are no previous reports of MDC1A caused by this event. This is a child with two genetic disorders, yet neither is caused by the parental consanguinity, which reinforces the importance of considering different etiological mechanisms in the genetic clinic.

[Contradictions of public health policies geared to rare disorders: the example of the Osteogenesis Imperfecta Treatment Program in the Brazilian Unified Health System (SUS)]. / Contradições das políticas públicas voltadas para doenças raras: o exemplo do Programa de Tratamento da Osteogênese Imperfeita no SUS.

The scope of this paper is to examine the process of consolidation of a public health policy in Brazil geared to a rare disorder, namely osteogenesis imperfecta, the treatment for which has fallen under the responsibility of the Brazilian Unified Health System (SUS) after the publication of Ministerial Ruling GM/MS2305/2001. The implementation of this law has been accompanied by many contradictions, especially with respect to therapeutic decisions and the strengthening of the specialized network for addressing this condition. These attitudes are clearly shown both by the drafting process and the final text of the new law (Ministerial Ruling 714/2010).

Contradicoes das politicas publicas voltadas para doencas raras: o exemplo do Programa de Tratamento da Osteogenese Imperfeita no SUS / Contradictions of public health policies geared to rare disorders: the example of the Osteogenesis Imperfecta Treatment Program in the Brazilian Unified Health System (SUS)

O artigo visa discutir o processo de consolidação de uma política pública, no Brasil, voltada a uma doença rara - a osteogênese imperfeita, cujo tratamento passou a responsabilidade do SUS em 2001 através da Portaria GM/MS2305/2001. O processo de implementação desta terapia vem sendo acompanhado de contradições, sobretudo no que diz respeito às decisões terapêuticas e ao fortalecimento da rede especializada na abordagem desta condição, atitudes claramente percebidas tanto no processo de elaboração quanto no texto da nova Portaria 714/2010.

The scope of this paper is to examine the process of consolidation of a public health policy in Brazil geared to a rare disorder, namely osteogenesis imperfecta, the treatment for which has fallen under the responsibility of the Brazilian Unified Health System (SUS) after the publication of Ministerial Ruling GM/MS2305/2001. The implementation of this law has been accompanied by many contradictions, especially with respect to therapeutic decisions and the strengthening of the specialized network for addressing this condition. These attitudes are clearly shown both by the drafting process and the final text of the new law (Ministerial Ruling 714/2010).

Spinocerebellar ataxias in Brazil--frequencies and modulating effects of related genes.

This study describes the frequency of spinocerebellar ataxias and of CAG repeats range in different geographical regions of Brazil, and explores the hypothetical role of normal CAG repeats at ATXN1, ATXN2, ATXN3, CACNA1A, and ATXN7 genes on age at onset and on neurological findings. Patients with symptoms and family history compatible with a SCA were recruited in 11 cities of the country; clinical data and DNA samples were collected. Capillary electrophoresis was performed to detect CAG lengths at SCA1, SCA2, SCA3/MJD, SCA6, SCA7, SCA12, SCA17, and DRPLA associated genes, and a repeat primed PCR was used to detect ATTCT expansions at SCA10 gene. Five hundred forty-four patients (359 families) were included. There were 214 SCA3/MJD families (59.6 %), 28 SCA2 (7.8 %), 20 SCA7 (5.6 %), 15 SCA1 (4.2 %), 12 SCA10 (3.3 %), 5 SCA6 (1.4 %), and 65 families without a molecular diagnosis (18.1 %). Divergent rates of SCA3/MJD, SCA2, and SCA7 were seen in regions with different ethnic backgrounds. 64.7 % of our SCA10 patients presented seizures. Among SCA2 patients, longer ATXN3 CAG alleles were associated with earlier ages at onset (p < 0.036, linear regression). A portrait of SCAs in Brazil was obtained, where variation in frequencies seemed to parallel ethnic differences. New potential interactions between some SCA-related genes were presented.

Constitutional and somatic methylation status of DMRH19 and KvDMR in Wilms tumor patients.

The most frequent epigenetic alterations in Wilms tumor (WT) occur at WT2, assigned to 11p15. WT2 consists of two domains: telomeric domain 1 (DMRH19) that contains the IGF2 gene and an imprinted maternally expressed transcript (H19) and centromeric domain 2 (KvDMR) that contains the genes KCNQ1, KCNQ1OT1 and CDKN1C. In this work, we used pyrosequencing and MS-MLPA to compare the methylation patterns of DMRH19/KvDMR in blood and tumor samples from 40 WT patients. Normal constitutional KvDMR methylation indicated that most of the epigenetic alterations in WT occur at DMRH19. Constitutional DMRH19 hypermethylation (HM DMRH19) was observed in two patients with Beckwith-Wiedemann syndrome. Pyrosequencing and MS-MLPA showed HM DMRH19 in 28/34 tumor samples: 16/34 with isolated HM DMRH19 and 12/34 with concomitant HM DMRH19 and KvDMR hypomethylation, indicating paternal uniparental disomy. With the exception of one blood sample, the MS-MLPA and pyrosequencing findings were concordant. Diffuse or focal anaplasia was present in five tumor samples and was associated with isolated somatic HM DMRH19 in four of them. Constitutional 11p15 methylation abnormalities were present in 5% of the samples and somatic abnormalities in the majority of tumors. Combined analysis of DMRH19/KvDMR by pyrosequencing and MS-MLPA is beneficial for characterizing epigenetic anomalies in WT, and MS-MLPA is useful and reliable for estimation of DNA methylation in a clinical setting.

A prevalência de instabilidade articular e hipotoniamuscular na osteogênese imperfeita / Prevalence of joint instability and muscle hypotonia

A Osteogênese Imperfeita (OI) é uma doença raracaracterizada por grande fragilidade óssea e osteopenia, que levaa ocorrência de fraturas ao longo da vida. O tratamento incluicirurgias ortopédicas, reabilitação fisioterapêutica e o uso de bifosfonatos.Objetivos: Avaliar a prevalência de instabilidade articular ede hipotonia muscular em pacientes com OI. Material e métodos:Trata-se de estudo transversal, retrospectivo com indivíduos comdiagnóstico de OI, atendidos no INSMCA/IFF/FIOCRUZ. Osdesfechos foram instabilidade articular e hipotonia muscular. Osdados clínicos foram coletados dos prontuários e do instrumentode avaliação da fisioterapia. Para análise estatística utilizou-se ostestes de qui-quadrado e Mann-Whitney. Resultados: Dentre 92pacientes avaliados, quatro foram excluídos por comorbidades eum por dados insuficientes, totalizando 87 pacientes. A médiade idade foi de 7,8 anos. A maioria era constituída por meninas(58,6%). Os indivíduos foram distribuídos de acordo com Sillenceem OI tipo I (37,9%), OI tipo III (39,1%) e OI tipo IV (23%).A instabilidade articular e a hipotonia muscular foram observadasem 63,9% e 74,7% respectivamente, a primeira associada à idadee a segunda ao tipo de OI. Conclusão: Diante da prevalência deinstabilidade articular em 63,9% dos casos de OI e da hipotoniamuscular em 74,7% comprovam-se ambas como aspectos fulcraispara o exercício da clínica fisioterapêutica aplicada aos indivíduoscom OI, sobretudo no seu papel de coadjuvante ao tratamentocom bifosfonatos. Recomenda-se que o trabalho fisioterapêuticodeve voltar-se para: a) minimização do estresse articular; b) ganhode força muscular para aumentar a resistência óssea; c) estimulaçãosensório-motora e d) aquisição de um alinhamento biomecânicomais neutro para evitar fraturas...

Osteogenesis Imperfecta (OI) is a rare disease,characterized by bone fragility and recurrent fractures. Treatmentincludes orthopedic surgery, physical therapy rehabilitation andbiphosphonates. Purpose: To evaluate the prevalence of joint instabilityand muscle hypotonia in OI patients. Methods: This wasa retrospective, transversal study, with OI patients, followed-up atINSMAC/IFF/FIOCRUZ. Main outcomes were joint instabilityand muscle hypotonia. Clinical data were collected from medicalrecords and from physical therapy evaluation charts. For statisticalanalysis chi-square and Mann-Whitney tests were used. Results: 92patients were evaluated, and 87 selected (four were excluded dueto associated diseases and one due to insufficient data). Patient’smean age was 7.8 years-old. The majority was female (58.6%). Allpatients were classified according to Sillence in OI type I (37.9%),OI type III (39.1%) and OI type IV (23%). Joint instability andmuscle hypotonia were observed in 63.9% and 74.7%. Joint instabilitywas associated with age and muscle hypotonia with OI type.Conclusion: In face of the prevalence of joint instability in 63.9% ofthe cases and muscle hypotonia in 74.7% of them it is proved thatboth are of major interest to physical therapy practice applied toindividuals with OI, most of all when functioning as a coadjutantto biphosphonates treatment. We recommend that physical therapyrehabilitation should focus on: a) joint stress reduction; b) gain ofmuscular strength to increase bone resistance; c) sensorial-motorstimulation; and d) acquisition of neutral biochemical alignmentfor fractures prevention...

Sirenomelia associada a defeitos congênitos raros: relato de três casos / Sirenomelia associated with rare congenital defects: report of three cases

Sirenomelia é um defeito congênito muito raro do campo primário do desenvolvimento, definido pela substituição dos membros inferiores, normalmente pareados por um único membro mediano. Geralmente, associa-se a graus variados de anomalias gênito-urinárias. Relatamos três casos necropsiados dessa entidade, incluindo estudo radiológico do membro inferior único, associados a agenesia renal bilateral, de ureteres e da bexiga, atresia retal, ânus imperfurado, testículos abdominais e ausência de genitália externa, além de outros defeitos congênitos infrequentemente observados, que somente puderam ter seus diagnósticos firmados por meio da necropsia.

Sirenomelia, an extremely rare congenital defect, is defined as a limb abnormality in which the normally paired lower limbs are replaced by a single midline limb. It is commonly associated with varied genitourinary anomalies. We report three cases of sirenomelia including x-ray documentation of the lower limb. Other associated aspects, whose diagnoses were established exclusively through autopsy, included bilateral renal, ureteral and bladder agenesis, rectal atresia, imperforate anus, intra-abdominal testis, absence of external genitalia and other rare congenital abnormalities.

Portuguese c.156_157insAlu BRCA2 founder mutation: gastrointestinal and tongue neoplasias may be part of the phenotype.

We have screened BRCA2 c.156_157insAlu founder mutation in a cohort of 168 women with diagnosis of breast cancer referred for genetic counseling because of risk of being carriers of hereditary breast and ovarian cancer syndrome. Portuguese founder mutation BRCA2 c.156_157insAlu was identified in three unrelated breast cancer probands. Genotyping identified a common haplotype between markers D13S260 and D13S171, and allele sizes were compatible to those described in the Portuguese families. Allele sizes of marker D13S1246, however, were concordant in two families, suggesting that the haplotype may be larger in a subset of families. Tumor phenotypes in Brazilian families seem to reinforce the high prevalence of breast cancer among affected males. However, an apparent excess of gastrointestinal and tongue neoplasias were also observed in these families. Although these tumors are not part of the phenotypic spectrum of hereditary breast and ovarian cancer syndrome, they might be accounted for by other risk alleles contained in the founder haplotype region.

Stimulation of acidic reduction of nitrite to nitric oxide by soybean phenolics: possible relevance to gastrointestinal host defense.

This study aimed to evaluate the potential of soybean-promoted acidic nitrite reduction and to correlate this activity with the content of phenolics and with the bactericidal activity against Escherichia coli O157:H7. Extracts of embrionary axes and cotyledons enriched in phenolics increased •NO formation at acidic pH at values that were 7.1 and 4.5 times higher, respectively, when compared to the reduction of the nonenriched extracts. Among the various phenolics accumulated in the soybean extracts, five stimulated nitrite reduction in the following decreasing order of potency: epicatechin gallate, chlorogenic acid, caffeic acid, galic acid and p-coumaric acid. Extracts of embrionary axes presented higher contents of epicatechin gallate and caffeic acid, compared to that of cotyledons, indicating a positive correlation between activity of the extracts and content of phenolics with regard to nitrite reducing activity. Soybean extracts enriched in phenolics interacted synergistically with acidified nitrite to prevent E. coli O157:H7 growth. The results suggest that soybean phenolics may interfere with the metabolism of •NO in an acidic environment by accelerating the reduction of nitrite, with a potential antimicrobial effect in the stomach.

Determinantes da marcha independente na osteogênese imperfeita / Independent walk in osteogenesis imperfect

OBJETIVOS: Investigar o processo de locomoção em pacientes com osteogênese imperfeita (OI) e os fatores que o influenciam, sublinhando pontos clínicos relevantes à reabilitação motora. MÉTODOS: Estudo transversal, retrospectivo, realizado no ambulatório de fisioterapia motora do Instituto Fernandes Figueira. Foram incluídos todos os pacientes com diagnóstico clínico de OI. Foram excluídos os que apresentavam comorbidades e idade inferior a dois anos. Utilizou-se o Epi-Info versão 3.4 para construção do banco de dados e o SPSS versão 15 para análise estatística. Foi calculado risco relativo para mensurar associação de características clínicas com a marcha independente, adotando-se nível de significância de 5 por cento para as análises. RESULTADOS: Foram incluídos 69 pacientes. Dentre eles, 43,5 por cento tinham OI tipo I; 37,7 por cento tipo III e 18,8 por cento tipo IV. 76,8 por cento apresentavam deformidades em ossos longos. Observou-se associação negativa entre hipotonia, número de fraturas e marcha independente e positiva entre marcha independente e OI tipo I. CONCLUSÕES: A clínica fisioterápica, como complementar à ortopédica e à administração de fármacos da família dos bifosfonatos, é de fundamental importância para a reabilitação da capacidade motora dos indivíduos com OI. Nivel de Evidência, estudos transversais.

OBJECTIVES: Investigation of the locomotion process in patients with osteogenesis imperfecta (OI), and the factors that influence it, with special attention to clinical aspects relating to motor rehabilitation. METHODS: a retrospective, cross-sectional study was carried out at the physical therapy outpatient clinic of the Instituto Fernandes Figueira. All patients with a clinical diagnosis of OI were included. Patients with other diseases, and those aged under two years, old were excluded. Epi-Info version 3.4 was used to construct the database, and SPSS version 15 for the statistical analysis. RESULTS: The odds-ratio was used to measure the association between independent walking and clinical characteristics, adopting a level of significance of 5 percent for the analysis. Results: 69 patients were included. Of these, 43.5 percent were classified as OI type I; 37.7 percent as type III and 18.8 percent as type IV. 76.8 percent presented long bone deformities. A negative association was observed between hypotonia, number of fractures, and independent walking. A positive association was observed between independent walking and OI type I. CONCLUSIONS: physical therapy, as a complementary approach to orthopedics, and the administration of medications of the biophosphonates class, are of fundamental importance for the rehabilitation of motor capacity of individuals with OI. Level of Evidence, cross sectional.

Troca de seringas na cidade de São Paulo: uma estratégia de redução de danos para usuários de drogas injetáveis / Needle exchange in São Paulo city: a harm reduction strategy for injection drug users

Objetivo: Realizar uma revisão da literatura sobre a troca de seringas como estratégia de redução de danos (RD) e relatar a implantação de um programa desse tipo no município de São Paulo. Método: a) Busca: bases de dados como a Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scielo e Medline; livros; sites de Ministério da Saúde, Prefeitura Municipal de São Paulo, Google e Reduc; Jornal DST/AIDS - Cidade de São Paulo; Boletim Epidemiológico de AIDS do Município de São Paulo e informações de especialistas da área; b) entrevistas com três membros envolvidos no Projeto de Redução de Danos da Cidade de São Paulo, unidade Butantã (PRD Sampa). Resultados: A revisão da literatura sugere que os programas de troca de seringas realizados em outros países estão contribuindo para a diminuição da incidência de contaminação por HIV entre os usuários de drogas injetáveis. Embora os dados não tenham sido colhidos a partir de estudos sistematizados, os indicadores epidemiológicos da prefeitura de São Paulo sugerem redução do número de novos casos de HIV positivo após a implantação do programa. Conclusões: Faz-se necessária uma sistematização do processo de avaliação para comprovar a efetividade desse tipo de programa.