Meralgia Paresthetica: A Report of a Rare Case.

Meralgia paresthetica (MP) is a painful condition caused by damage or constriction of the lateral femoral cutaneous nerve (LFCN). This entrapment condition typically arises due to various factors, including trauma, pelvic tumors, external compression from belts or snug attire, and weight gain. The prognosis is generally favorable since most cases are self-limiting or respond to conservative treatment. We present the case of a 53-year-old overweight man, with no relevant medical history, who was a victim of a traffic accident in October 2023 which resulted in polytrauma, according to the Case Reports (CARE) checklist. The main complaint of the patient was tingling of the left thigh, with dysesthesia to gentle rubbing along the anterolateral surface. After a diagnostic study, a diagnosis of post-trauma MP was thus established, probably due to seat-belt compression of the LFCN, and physiatric treatment was initiated. With the assistance of ultrasound, a large hematoma was seen, above the inguinal ligament with drainage of 140ccc of serosanguineous fluid with resolution of the symptoms. This case emphasizes the importance of a physiatry consultation for a correct diagnosis and focuses on the main complaint of a polytrauma patient.

Intratendinous Ganglion Cyst of the Extensor Indicis: A Case Report.

An intratendinous ganglion cyst is a very rare benign lesion with an unknown etiology. The clinical diagnosis can be difficult as patients may have mild symptoms or impaired hand functionality. Ultrasound and magnetic resonance imaging can differentiate a ganglion cyst from other soft-tissue tumors and tumor-like lesions and provide excellent information on the location of an intratendinous lesion to schedule surgical treatment. We present a case report of a 50-year-old female diagnosed with an intratendinous ganglion cyst of the extensor indicis. She complained of right-hand swelling for three months, which was associated with pain. The US revealed an oval hypoechoic mass with cystic formation at the extensor indicis, measuring 9 x 4 mm, compatible with an intratendinous ganglion cyst. The cyst was excised by enucleation. After surgery, the patient was referred to the Department of Physical and Rehabilitation Medicine for evaluation. She started a rehabilitation programme. The patient presented a favourable clinical evolution with a return to her previous professional activity. However, six months after surgery, the cyst recurred, but with a smaller size and no associated pain.

Risk factors for Healthcare-associated Infection on a Rehabilitation Unit / Factores de riesgo de Infección Nosocomial en una Unidad de Rehabilitación

Objective: Ascertain healthcare-associated infection (HAI) prevalenceand identify risk factors associated with a higher incidence of infectionin a Rehabilitation Ward.Materials and Methods: Two-year retrospective cohort study conducted in a post-acute Rehabilitation Ward of a tertiary-care, public,university-affiliated hospital. Demographic and clinical data were collected from electronic medical record. The assessment of risk factorswas done by comparison of patients with or without HAI. Univariateand multivariate logistic regression analysis was used to identify riskfactors.Results: There were 262 admissions to the Rehabilitation Ward during the study period. One-hundred thirty-one HAIs were detected in95 (36.3%) of the 262 patients. The most common infections wereurinary tract infections (87.8% of all infections). An age-sex adjustedmultivariate logistic regression model showed that urinary catheter,surgery in the last 30 days and length of stay ≥ 30 days were independent risk factors for HAI. Length of stay was associated with anincreased odd of developing HAI (median length of 28 days for thosewithout HAI, 35 days for those with only one HAI and 55 days for patients having ≥ 2 HAI). Only one patient died of infection.Conclusions: HAI is a frequent complication in a post-acute Rehabilitation Ward. The logistic regression model identified patients withurinary catheter, surgery in the last 30 days and length of stay ≥ 30days as having an higher risk for HAI, thereby being the main targetsof surveillance and adoption of preventive measures. (AU)

Objetivo: Determinar la prevalencia y los factores de riesgo de infección nosocomial en pacientes ingresados en una Unidad de Rehabilitación.Material y Métodos: Estudio de cohorte retrospectivo de dos añosrealizado en una Unidad de Rehabilitación posaguda de un hospitalpúblico. La evaluación de los factores de riesgo se realizó mediante lacomparación de pacientes con o sin infección nosocomial. Se utilizóun análisis de regresión logística univariado y multivariado para identificar los factores de riesgo.Resultados: Hubo 262 ingresos a la Unidad de Rehabilitación duranteel período de estudio. Se detectaron 131 infecciones nosocomialesen 95 (36,3%) de los 262 pacientes. Las infecciones más frecuentes fueron las del tracto urinario (87,8%). Un modelo de regresiónlogística multivariado ajustado por edad y sexo mostró que el catéterurinario, la cirugía en los últimos 30 días y la duración de la estancia≥ 30 días fueron factores de riesgo independientes para infecciónnosocomial. La duración de la estancia se asoció con una mayor probabilidad de desarrollar una infección nosocomial (duración media de28 días para aquellos sin infecciones, 35 días para aquellos con solouna infección y 55 días para pacientes con ≥ 2 infecciones). Solo unpaciente murió de infección.Conclusiones: La infección nosocomial es una complicación frecuente en una Unidad de Rehabilitación. El modelo de regresión logísticaidentificó a los pacientes con catéter urinario, cirugía en los últimos30 días y estadía ≥ 30 días con mayor riesgo de infección, por lo queson los principales objetivos de la vigilancia y adopción de medidaspreventivas. (AU)

Cardiac rehabilitation and improvement of chronotropic incompetence: Is it the exercise or just the beta blockers?

INTRODUCTION: Clinical use of chronotropic response has been limited due to lack of consensus on the appropriate formula for chronotropic index (Ci) calculation and the definition of chronotropic incompetence. OBJECTIVES: To assess the effects of cardiac rehabilitation programs (CRP) on Ci, irrespective of betablockers (BB) use and dosage. Assess the relative contribution of change in Ci on improvement in functional capacity. METHODS: Retrospective analysis of a sample of patients admitted to a CRP after acute coronary syndrome, with at least 12 months of follow-up. Ci was calculated using the conventional (CCi) and the Brawner formula (BCi) for age-predicted maximum heart rate. Ci and functional capacity were estimated at three time points: T1 and T2, before and at the end of the CRP, and T3, at 12 months. The sample was categorized according to BB dosage modification between T1 and T3: G1 - reduced; G2 - no change; G3 - increased. RESULTS: In G1, CCi increased from 63.5% in T1 to 77.9% in T3; in G2, from 67.3% to 77.9%; in G3, from 71.2% to 75.4%. In G1, BCi increased from 110.4% to 140.0%; in G2, from 122.8% to 140.1%; in G3, from 133.3% to 139.2%. An average increase in 1.0% in CCi was associated with an average increase in functional capacity of 0.37 METS. CONCLUSIONS: Chronotropic index significantly improves with CRP, irrespective of BB dose changes. CCi is more closely related with improvement in functional capacity than BCi. Improvement of Ci is an important predictor of functional capacity and prognosis in cardiovascular disease patients.

Facemasks during aerobic exercise: Implications for cardiac rehabilitation programs during the Covid-19 pandemic.

INTRODUCTION AND OBJECTIVES: During the COVID-19 pandemic, among the safety measures adopted, use of facemasks during exercise training sessions in cardiac rehabilitation programs raised concerns regarding possible detrimental effects on exercise capacity. Our study examined the cardiorespiratory impact of wearing two types of the most common facemasks during treadmill aerobic training. METHODS: Twelve healthy health professionals completed three trials of a symptom-limited Bruce treadmill protocol: Without a mask, with a surgical mask and with a respirator. Perceived exertion and dyspnea were evaluated with the Borg Scale of Perceived Exertion and the Borg Dyspnea Scale, respectively. Blood pressure, heart rate and arterial oxygen saturation (SpO2) were measured at each 3-minute stage. RESULTS: Using a surgical mask or a respirator resulted in a shorter duration of exercise testing. At peak capacity, using a respirator resulted in higher levels of dyspnea and perceived exertion compared to not wearing a facemask. A significant drop in SpO2 was present at the end of exercise testing only when using a respirator. There were no differences in either chronotropic or blood pressure responses between testing conditions. CONCLUSIONS: Professionals involved in cardiac rehabilitation should be aware of the cardiorespiratory impact of facemasks. Future studies should assess whether exposure to these conditions may impact on the overall results of contemporary cardiac rehabilitation programs.

Facemasks during aerobic exercise: Implications for cardiac rehabilitation programs during the Covid-19 pandemic.

INTRODUCTION AND OBJECTIVES: During the COVID-19 pandemic, among the safety measures adopted, use of facemasks during exercise training sessions in cardiac rehabilitation programs raised concerns regarding possible detrimental effects on exercise capacity. Our study examined the cardiorespiratory impact of wearing two types of the most common facemasks during treadmill aerobic training. METHODS: Twelve healthy health professionals completed three trials of a symptom-limited Bruce treadmill protocol: Without a mask, with a surgical mask and with a respirator. Perceived exertion and dyspnea were evaluated with the Borg Scale of Perceived Exertion and the Borg Dyspnea Scale, respectively. Blood pressure, heart rate and arterial oxygen saturation (SpO2) were measured at each 3-minute stage. RESULTS: Using a surgical mask or a respirator resulted in a shorter duration of exercise testing. At peak capacity, using a respirator resulted in higher levels of dyspnea and perceived exertion compared to not wearing a facemask. A significant drop in SpO2 was present at the end of exercise testing only when using a respirator. There were no differences in either chronotropic or blood pressure responses between testing conditions. CONCLUSIONS: Professionals involved in cardiac rehabilitation should be aware of the cardiorespiratory impact of facemasks. Future studies should assess whether exposure to these conditions may impact on the overall results of contemporary cardiac rehabilitation programs.

INTRODUÇÃO E OBJETIVOS: Durante a pandemia Covid-19 a utilização de máscaras faciais, incluindo durante o exercício terapêutico, faz parte das medidas de segurança adotadas. Este facto originou preocupação a nível das unidades de reabilitação cardíaca, uma vez que as máscaras faciais podem promover efeitos deletérios na capacidade de exercício. Este estudo avaliou o impacto da utilização das máscaras faciais durante o treino aeróbio em passadeira. MÉTODOS: Doze profissionais de saúde saudáveis completaram três provas em passadeira de acordo com o protocolo de Bruce: sem máscara, com máscara cirúrgica e com um respirador. A perceção de esforço e dispneia foi avaliada com a Escala de Perceção de Esforço de Borg e com a Escala de Dispneia de Borg, respetivamente. A pressão arterial, frequência cardíaca e saturação arterial de oxigénio (SpO2) foram registadas em cada estadio do protocolo. RESULTADOS: A utilização de máscara facial resultou numa menor duração da prova e, em determinados momentos, níveis de perceção de dispneia e de esforço mais elevados. Verificou-se uma descida significativa da SpO2 no final da prova com respirador. Não se verificaram diferenças na resposta cronotrópica ou da pressão arterial entre as diferentes condições de prova. CONCLUSÕES: Os profissionais envolvidos na reabilitação cardíaca devem reconhecer os impactos cardiorrespiratórios provocados pela utilização da máscara facial. São necessários mais estudos para determinar se a exposição a estas condições de treino pode ter impacto nos resultados dos programas de reabilitação cardíaca.

Avascular femoral necrosis as part of Cushing syndrome presentation: a case report.

BACKGROUND: The clinical characteristics and complications of Cushing syndrome (CS) are well known and described in the literature. Nevertheless, rare, atypical presentations may go unnoticed. Osteonecrosis is a well-documented complication of glucocorticoid therapy. However, endogenous hypercortisolism is a rare, but relevant, cause of bone avascular necrosis. We describe the case of a woman with CS undiagnosed for 2 years after presenting with femoral avascular necrosis. CASE PRESENTATION: A 38-year-old Caucasian woman was referred for evaluation of secondary amenorrhea, associated with oral contraception withdrawal in the context of deep venous thrombosis (DVT). She had a previous right hip arthroplasty for treatment of avascular necrosis of the femoral head, diagnosed after 3 years of progressive right hip pain and limited mobility. She also had high blood pressure (HBP) of 5 years' duration, and reported weight gain (4 kg in 2 years). There was no history of infertility (gravida 2, para 2). Physical examination revealed buffalo hump, truncal obesity, facial plethora, muscular atrophy and proximal myopathy, and easy bruising (under anticoagulant treatment for DVT). Workup showed abnormal overnight dexamethasone suppression test (DST) (serum cortisol 21.5 µg/dL; normal < 1.8 µg/dL), elevated 24-hour urinary free cortisol (UFC) (728.9 µg/day; reference range 36.0-137.0 µg/day), and suppressed plasma adrenocorticotropic hormone (ACTH) (< 1.0 pg/mL), findings consistent with ACTH-independent CS. Urinary metanephrines and catecholamines were normal, and the remaining analytical study showed no major changes, apart from glycated hemoglobin (HbA1c) of 6.8%. Adrenal computed tomography (CT) scan showed a 25 mm lesion in the left adrenal gland, with density non-suggestive of adenoma. The patient underwent unilateral adrenalectomy and started steroid replacement. Histology revealed an adrenal cortex adenoma. Three months after surgery the patient presented with resolution of HBP and hypercortisolism (UFC 37.4 µg/day; reference range 36.0-137.0 µg/day). CONCLUSION: In some cases, CS signs may go unnoticed and the diagnosis postponed. Avascular necrosis is a rare presenting feature of endogenous hypercortisolism, and, if left untreated, complete collapse of the femoral head may ensue, rendering the need for hip replacement in up to 70% of patients. Suspicion and recognition of atypical features is therefore important in avoiding complications and delay in treatment of CS.

Bone Marrow Edema: A Case of Regional Migratory Osteoporosis.

Bone marrow edema represents a typical pattern on magnetic resonance imaging consisting of an area of abnormal bone signal with low to intermediate intensity on T1-weighted images and a high intensity on fat-suppressed T2-weighted images. Bone marrow edema syndromes are a group of entities characterized by idiopathic bone marrow edema and osteoporosis. Regional migratory osteoporosis is a bone marrow edema syndrome characterized by a self-limited migrating arthralgia of the lower limbs not related to trauma or other events. Its clinical presentation is variable and may include a less frequent form of migration of the bone marrow edema within the same joint, illustrated here by means of a case report. Conservative treatment is the preferred approach to this condition, and usually, it resolves completely and with no sequelae. Physicians should be made aware of this condition to avoid unnecessary and costly diagnostic and therapeutic measures.

Hereditary Pheochromocytoma.

INTRODUCTION: Pheochromocytomas (PHEO) and paragangliomas (PGL) are rare neuroendocrine tumors with an estimated occurrence of 2 to 5 patients per million per year and an incidence of about 1 per 100 000 in the general population. These tumors may arise sporadically or be associated to various syndromes, namely multiple endocrine neoplasia type 2, neurofibromatosis type 1, Von Hippel-Lindau syndrome, and hereditary paraganglioma-pheochromocytoma syndromes. OBJECTIVES: This article aims to review the current epidemiology, pathogenesis, clinical presentation, and genetic aspects of syndromes associated with hereditary PHEO/PGL. METHODS: The literature research, conducted at PubMed database, included review articles, published from February 2009 to February 2014, written in English or Portuguese, using as query: "Hereditary AND Pheochromocytoma." CONCLUSION: These tumors can be part of a myriad hereditary conditions that are not yet fully understood. Nevertheless, important systemic symptoms and even fatal outcomes can occur. Knowledge of these hereditary conditions can ensure a more efficient detection, treatment, and even prevention of these neuroectodermal tumors, thus new tests and studies should be conducted.

A Constituição de um subcampo do esporte: o caso do taekwondo / La constitución de un sub campo del deporte: el caso de taekwondo / The taekwondo case: the constitution of a subfield of the sports

Este trabalho discute a relação do Taekwondo com o esporte moderno. Identificaram-se fatores históricos, sociais e políticos envolvidos em seu possível processo de esportivização. Optou-se pelo referencial teórico de Pierre Bourdieu e Norbert Elias. Utilizou-se a técnica de entrevista semiestruturada com os “mestres”. Considerou-se: a) que evidências advindas de um processo evolutivo social não planejado formam a configuração na qual o Taekwondo assentou seu arcabouço corporal, cultural e social; b) sua divulgação como subcampo esportivo dá o valor diplomático e simbólico necessário para a divulgação de uma moral nacional garantindo sua passagem pelo mundo; c) sua exposição alavancou um processo de imposição da nacionalidade coreana como forma de violência simbólica.

The present work discusses the relation of Taekwondo with modern sports. Historical, social and political elements involved in an eventual process of “sportivization” were identified. The option was to work with the theoretic referential of Pierre Bourdieu and Norbert Elias and also a semi- structured technique interview with the masters was used. Considerations: a) its evidences occurred to a social evolutionary process not planned, created the configuration in which Taekwondo placed its corporal, cultural and social framework. b) its diffusion as a sports sub field offers the diplomatic and symbolical necessary values towards a diffusion of a national moral that confirms its entry to the world. c) its exposition led off to an imposing process of the corean nationality as a symbolic violence aspect.

El trabajo presente discute la relación de Taekwondo con lo deporte moderno. Históricos, sociales y políticos elementos implicados en un proceso eventual de esportivización se identificaron. La opción fue trabajar con el referencial teórico de Pierre Bourdieu y Norbert Elias y también un medido estructurado de técnica se utilizó. Las consideraciones: a) sus evidencias ocurrieron a un proceso evolutivo social no planeado, creó la configuración en la que Taekwondo colocó a su cabo, armazón cultural y social. b) su difusión como un sub-campo de deporte ofrece los valores diplomáticos y simbólicos necesarios hacia una difusión de una moral nacional que confirma su entrada al mundo. c) su exposición empezó a un proceso imponente de la nacionalidad coreana como un aspecto simbólico de violencia.