Medial Hoffa Fracture: A Case Report and Literature Review of Approach and Management.

BACKGROUND Hoffa fractures are an uncommon form of coronal fracture that impact the femoral condyle. As a result, they are not very prevalent. It is necessary to perform anatomical reduction and rigorous fixation on these fractures; however, there is no consensus among medical professionals on the surgical procedure and implant that would be the most successful in treating these fractures. CASE REPORT A 50-year-old woman who had poliomyelitis in her right lower limb presented with a displaced medial Hoffa fracture of her left knee. She had fallen and was suffering from poliomyelitis. The trauma that caused this fracture had a modest energy level. Open reduction and internal fixation with 2 retrograde cannulated screws were included in her surgical procedure. An approach known as the medial parapatellar route was used for this treatment. As part of her postoperative rehabilitation, she participated in physiotherapy, exercises that did not require weight bearing, exercises that used passive and active assistance, activities that involved partial and full weight bearing, and exercises that involved complete weight bearing. At the 2-year follow-up, the patient's left knee continued to be painless and stable, and it had unrestricted range of motion across the whole extremity. It was determined via radiographs that the fracture had healed without any problems or arthritic changes developing. She was able to walk without help and carry out her daily tasks since she was able to walk with the use of a cane. CONCLUSIONS Retrograde cannulated screws can be a reliable and successful choice for treatment of medial Hoffa fractures, with positive results according to both clinical and radiographic characteristics. Further research is needed to analyze the outcomes over a longer period of time and make comparisons between this technique and others.

Post-polio syndrome is not a dysimmune condition.

BACKGROUND: Poliomyelitis is a global disabling disease affecting 12-20 million of people. Post poliomyelitis syndrome (PPS) may affect up to 80% of polio survivors: increased muscle weakness, pain, fatigue, functional decline. It relies on aging of an impaired neuro-muscular system with ongoing denervation processes. A late involvement of humoral or cellular pro-inflammatory phenomena is also suspected. AIM: To assess the dysimmune hypothesis of PPS by comparing lymphocyte subpopulations and humoral immune factors between PPS patients and controls. DESIGN: Cross-sectional study. SETTING: Montpellier University Hospital. POPULATION: Forty-seven PPS and 27 healthy controls. METHODS: PPS patients and controls were compared on their lymphocyte subpopulations and humoral immune factors (IL-1ß, IL-6, IL-8, IL-17, IL-21, IL-22, IL-23, IFN-γ, TNF-α, GM-CSF, RANTES, MCP1, MIP-3a, IL-10, TGF-ß, IL4, IL13). Patients were further compared according to their dominant clinical symptoms. Sample size guaranteed a power >90% for all comparisons. RESULTS: PPS patients and controls were comparable in gender, age and corpulence. Most patients had lower limb motor sequelae (N.=45, 95.7%), a minority had upper limb motor impairment (N.=16, 34.0%). Forty-five were able to walk (94%), 35/45 with technical aids. The median of the two-minute walking test was 110 meters (interquartile range 55; 132). Eighteen (38%) required help in their daily life. Their quality of life was low (SF36). All described an increased muscular weakness, 40 (85%) a general fatigue, and 39 (83%) muscular or joint pain. Blood count, serum electrolytes, T and B lymphocyte subpopulations and cytokines were comparable between patients and controls, except for creatine phospho kinase that was significantly higher in PPS patients. None of these variables differed between the 20/47 patients whose late main symptoms were pain or fatigue, and other patients. CONCLUSIONS: Our results suggest that PPS is not a dysimmune disease. CLINICAL REHABILITATION IMPACT: Our results do not sustain immunotherapy for PPS. Our work suggest that PPS may be mostly linked to physiological age-related phenomena in a disabled neuromuscular condition. Thus, our results emphasize the role of prevention and elimination of aggravating factors to avoid late functional worsening, and the importance of rehabilitation programs that should be adapted to patients' specific conditions.

Gait stability and the relationship with energy cost of walking in polio survivors with unilateral plantarflexor weakness.

BACKGROUND: Polio survivors often exhibit plantarflexor weakness, which impairs gait stability, and increases energy cost of walking. Quantifying gait stability could provide insights in the control mechanisms polio survivors use to maintain gait stability and in whether impaired gait stability is related to the increased energy cost of walking. RESEARCH QUESTION: Is gait stability impaired in polio survivors with plantarflexor weakness compared to able-bodied individuals, and does gait stability relate to energy cost of walking? METHODS: We retrospectively analyzed barefoot biomechanical gait data of 31 polio survivors with unilateral plantarflexor weakness and of 24 able-bodied individuals. We estimated gait stability by calculating variability (SD) of step width, step length, double support time, and stance time, and by the mean and variability (SD) of the mediolateral and anteroposterior margin of stability (MoSML and MoSAP). In addition, energy cost of walking (polio survivors only) at comfortable speed was analyzed. RESULTS: Comfortable speed was 31% lower in polio survivors compared to able-bodied individuals (p < 0.001). Corrected for speed differences, step width variability was significantly larger in polio survivors (+41%), double support time variability was significantly smaller (-27%), MoSML (affected leg) was significantly larger (+80%), and MoSAP was significantly smaller (affected leg:-17% and non-affected leg:-15%). Step width and step length variability (affected leg) were positively correlated with energy cost of walking (r = 0.502 and r = 0.552). MoSAP (non-affected leg) was negatively correlated with energy cost of walking (r = -0.530). SIGNIFICANCE: Polio survivors with unilateral plantarflexor weakness demonstrated an impaired gait stability. Increased step width and step length variability and lower MoSAP could be factors related to the elevated energy cost of walking in polio survivors. These findings increase our understanding of stability problems due to plantarflexor weakness, which could be used for the improvement of (orthotic) interventions to enhance gait stability and reduce energy cost in polio survivors.

Declaración SLIPE: Aumento de la cobertura antipoliomielítica con vacunas más seguras: una urgencia inaplazable en Latinoamérica / SLIPE Declaration: Increasing anti-polio coverage with safer vaccines: an urgent need that cannot be postponed in Latin America

Ante el riesgo real de ocurrencia de brotes de parálisis fláccida aguda en la región debidos a poliovirus derivado de la vacuna Sabin o a la importación de poliovirus salvaje, la Sociedad Latinoamericana de Infectología Pediátrica comisionó a un grupo ad hoc de expertos integrantes del Comité de Vacunas y Biológicos de la institución, para redactar un documento oficial de posición sobre la necesidad imperiosa de incrementar los niveles de inmunización contra la enfermedad en la región e incorporar definitivamente en forma exclusiva la vacuna de polio inactivada en todos los esquemas nacionales de vacunación. La presente publicación discute las principales conclusiones y recomendaciones generadas como resultado de esta actividad.

Given the actual risk of poliomyelitis outbreaks in the region due to poliovirus derived from the Sabin vaccine or the importation of wild poliovirus, the Latin American Society of Pediatric Infectious Diseases commissioned an ad hoc group of experts from the institution's Vaccines and Biologicals Committee, to draft an official position paper on the urgent need to increase immunization levels against the disease in the region and incorporate inactivated polio vaccine exclusive schedules in all national immunization programs. This publication discusses the main conclusions and recommendations generated as a result of such activity.

Increasing polio coverage with safer vaccines: a pressing need in Latin America

Given the actual risk of poliomyelitis outbreaks in the region due to poliovirus derived from the Sabin vaccine or the importation of wild poliovirus, the Latin American Society of Pediatric Infectious Diseases commissioned an ad hoc group of experts from the institution's Vaccines and Biologicals Committee, to draft an official position paper on the urgent need to increase immunization levels against the disease in the region and incorporate inactivated polio vaccine exclusive schedules in all national immunization programs. This publication discusses the main conclusions and recommendations generated as a result of such activity.

Ante el riesgo real de ocurrencia de brotes de parálisis fláccida aguda en la región debidos a poliovirus derivado de la vacuna Sabin o a la importación de poliovirus salvaje, la Sociedad Latinoamericana de Infectología Pediátrica comisionó a un grupo ad hoc de expertos integrantes del Comité de Vacunas y Biológicos de la institución, para redactar un documento oficial de posición sobre la necesidad imperiosa de incrementar los niveles de inmunización contra la enfermedad en la región e incorporar definitivamente en forma exclusiva la vacuna de polio inactivada en todos los esquemas nacionales de vacunación. La presente publicación discute las principales conclusiones y recomendaciones generadas como resultado de esta actividad.

Pólio: baixa cobertura vacinal e o risco iminente de novas infecções / Polio: low vaccination coverage and the imminent risk of new infections

A poliomielite, comumente chamada de pólio ou paralisia infantil, é uma doença viral altamente infecciosa que afeta principalmente crianças menores de 5 anos de idade. O vírus é transmitido de pessoa para pessoa, disseminado principalmente pela via fecal-oral ou, menos frequentemente, por fômites (água ou alimentos contaminados); sendo que o agente etiológico pode se espalhar rapidamente em áreas cujos sistemas de higiene e saneamento são precários. Também pode haver transmissão por meio de gotículas de secreções da garganta durante a fala, tosse ou espirro ( WHO, 20 22 a ; SBIm, 2022)

Polio, commonly called polio or infantile paralysis, is a highly infectious viral disease that primarily affects children under 5 years of age. The virus is transmitted from person to person, spread mainly by the fecal-oral route or, less frequently, by fomites (contaminated water or food); being that the agent etiologic disease can spread rapidly in areas where hygiene and sanitation systems are precarious. There may also be transmission through droplets of secretions from the throat during speech, coughing or sneezing (WHO, 20 22 a ; SBIm, 2022)

Describiendo el síndrome pospolio / Describing post-polio syndrome

Introducción: Las personas con secuelas de poliomielitis pueden presentar nuevos síntomas que constituirían el síndrome pospolio (SPP). Objetivo Identificar el perfil clínico y funcional, y las características epidemiológicas de personas que padecen SPP. Pacientes y métodos: Estudio retrospectivo de 400 pacientes afectados de poliomielitis visitados en consulta externa del Institut Guttmann, de los cuales a 310 se les diagnosticó SPP. Se describieron variables epidemiológicas, clínicas y electromiográficas. Se analizó la relación entre edad de adquisición de la polio y gravedad de la misma, así como entre el sexo y la edad de aparición del SPP y la frecuencia de síntomas. Resultados: Se observó mayor frecuencia de SPP en mujeres (57,7%). La edad media de inicio de la clínica fue 52,4 años, más precoz en mujeres. Edad de primoinfección mayor de 2 años no se relacionó con mayor gravedad de la polio. La frecuencia de síntomas fue: dolor 85%, pérdida de fuerza 40%, fatiga 65,5%, cansancio 57,8%, intolerancia al frío 20,2%, disfagia 11,7%, quejas cognitivas 9%, síntomas depresivos 31,5%. La fatiga, el cansancio, la depresión y las quejas cognitivas fueron significativamente más frecuentes en mujeres. El 59% de los pacientes presentaban hallazgos electromiográficos sugestivos de SPP. Conclusiones: El tipo de sintomatología que presentaba nuestra muestra es similar a la publicada, no así en la frecuencia de la misma. Creemos que el perfil clínico de los pacientes podría ser muy diverso, y dar mayor peso a parámetros objetivos como el empeoramiento o la aparición de debilidad y el estudio de biomarcadores podría acercarnos más a un diagnóstico preciso. (AU)

Introduction: Patients presenting sequelae of poliomyelitis may present new symptoms, known as post-polio syndrome (PPS). Objective: To identify the clinical and functional profile and epidemiological characteristics of patients presenting PPS. Patients and methods: We performed a retrospective study of 400 patients with poliomyelitis attended at the Institut Guttmann outpatient clinic, of whom 310 were diagnosed with PPS. We describe patients’ epidemiological, clinical, and electromyographic variables and analyse the relationships between age of poliomyelitis onset and severity of the disease, and between sex, age of PPS onset, and the frequency of symptoms. Results: PPS was more frequent in women (57.7%). The mean age at symptom onset was 52.4 years, and was earlier in women. Age at primary infection > 2 years was not related to greater poliomyelitis severity. The frequency of symptoms was: pain in 85% of patients, loss of strength in 40%, fatigue in 65.5%, tiredness in 57.8%, cold intolerance in 20.2%, dysphagia in 11.7%, cognitive complaints in 9%, and depressive symptoms in 31.5%. Fatigue, tiredness, depression, and cognitive complaints were significantly more frequent in women. Fifty-nine percent of patients presented electromyographic findings suggestive of PPS. Conclusions: While the symptoms observed in our sample are similar to those reported in the literature, the frequencies observed are not. We believe that patients’ clinical profile may be very diverse, giving more weight to such objective parameters as worsening of symptoms or appearance of weakness; analysis of biomarkers may bring us closer to an accurate diagnosis. (AU)

Colovesical fistula secondary to hernia mesh migration: an unusual incident / Fístula colovesical secundária à migração da malha para reparo de hérnia: um incidente incomum

ABSTRACT We evaluated a 27-year old male with pneumaturia and fecaluria with a past history of right inguinal hernia repair. Though, cystoscopy and contrast enhanced computed tomography did not furnish any evidence to arrive at a diagnosis, interestingly, colonoscopy revealed a mesh in the sigmoid colon making apparent the diagnosis of colovesical fistula secondary to mesh migration. Later, surgical removal of the mesh from the sigmoid colon with rent closure of the fistulous opening was done successfully. Our case thus, highlights the vital role of common diagnostic tool like colonoscopy in making an uncommon diagnosis.

RESUMO Avaliamos um homem de 27 anos com pneumaturia e fecalúria com antecedentes de reparo da hérnia inguinal direita. Embora a cistoscopia e a tomografia computadorizada com contraste (TCC) não tenham fornecido nenhuma evidência para obter-se um diagnóstico, curiosamente, a colonoscopia revelou uma malha no cólon sigmoide, estabelecendo o diagnóstico de fístula colovesical (FCV) secundária à migração da malha. Mais tarde, foi feita a remoção cirúrgica da malha do cólon sigmoide com fechamento da abertura fistulosa com sucesso. Nosso caso, portanto, destaca o papel vital de uma ferramenta diagnóstica comum, como a colonoscopia, para obter-se um diagnóstico incomum.

Síndrome de fatiga crónica en adolescentes / Chronic fatigue syndrome in adolescents

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Síndrome post-polio, quejas cognitivas y exploración neuropsicológica / Postpolio syndrome, subjective cognitive complaints and neuropsychological assessment

Objetivo: Estudiar el rendimiento psicométrico de una muestra de pacientes afectados por el síndrome post-polio que manifiestan quejas cognitivas. Pacientes y método: La muestra estaba formada por 37 pacientes (17 hombres) con síndrome post-polio atendidos en consulta externa de Neuropsicología. La edad media en el momento de la exploración neuropsicológica era de 55 años (DE: 4,58 años). El 59,5% recibía tratamiento farmacológico por la presencia de sintomatología ansioso-depresiva. Los resultados obtenidos por los pacientes en la exploración neuropsicológica fueron comparados con los baremos normativos a fin de identificar el porcentaje de pacientes con puntuaciones patológicas para cada uno de los test aplicados. Resultados: Los pacientes presentaban puntuaciones patológicas en todos los test neuropsicológicos; siendo especialmente relevante el porcentaje de puntuaciones indicativas de alteración cognitiva en los test que valoraban velocidad de procesamiento cognitivo, aprendizaje verbal, fluencia verbal fonémica y flexibilidad cognitiva. No se observaron diferencias estadísticamente significativas en el rendimiento de los pacientes en función de la presencia o ausencia de sintomatología ansioso-depresiva. Conclusiones: Los pacientes afectados de síndrome post-polio que manifiestan quejas cognitivas presentan un rendimiento psicométrico inferior al de la población general (AU)

Objective: To examine psychometric performance in a sample of patients with postpolio syndrome (PPS) with subjective cognitive complaints. Patients and methods: The sample consisted of 37 PPS patients (17 men) referred to our outpatient neuropsychological service. The mean age at the neuropsychological assessment was 55 years (SD: 4.58 years). A total of 59.5% was receiving pharmacological treatment for anxiety-depression. The results obtained by patients in the neuropsychological assessment were compared with normative data to identify the percentage of patients with pathological scores on the tests applied. Results: Patients with PPS had pathological scores on all the neuropsychological tests. A particularly significant finding was the percentage of patients with scores indicative of cognitive impairment in tests that assessed cognitive processing speed, verbal learning, phonemic verbal fluency and cognitive flexibility. No statistically significant differences were observed in patients’ performance depending on the presence or absence of anxiety or depression. Conclusions: Patients with PPS and subjective cognitive complaints performed less well on neuropsychological assessment than the general population (AU)

Fase actual de control de la vigilancia epidemiológica de la poliomielitis en España / Current phase of control of epidemiological surveillance of poliomyelitis in Spain

En España, el último caso de poliomielitis por virus salvaje autóctono ocurrió en 1988. Desde entonces los casos detectado por el sistema de vigilancia epidemiológica corresponden o bien a casos importados, casos asociados a la vacuna o derivados de la vacuna oral (VDPV). El Plan de Actuaciones necesarias para la Consecución del Certificado de Erradicación de la Poliomielitis se inició en 1997. Las actividades incluidas fueron consensuadas con las comunidades autónomas y aprobadas en el Consejo Interterritorial del Sistema Nacional de Salud. El plan integra actividades de vigilancia epidemiológica y actividades de Laboratorio: - Implantar un sistema de vigilancia eficaz de parálisis flácida agudas (PFA) en menores de 15 años. - Alcanzar y mantener altas cobertura de inmunización (del 95% en la serie primaria, en menores de 2 años). - Vigilancia medioambiental mediante la vigilancia de enterovirus. En la aplicación del Plan en España se han mantenido altas coberturas de vacunación y especial preocupación por evitar bolsas de susceptibles en grupos de población vulnerables. El Sistema de Vigilancia de Parálisis Flácida Aguda en menores de 15 años ha sido constantemente evaluado mediante los indicadores de calidad referidos a la sensibilidad, oportunidad (en la notificación y toma de muestras) y los indicadores referentes a la investigación epidemiológica y de laboratorio. Los retos de la vigilancia de la poliomielitis son la introducción de casos: importados de polio producido por poliovirus salvaje, poliovirus derivados de la vacuna (VDPV) o poliovirus vacunales. Por ello, todas las actividades deben continuar hasta conseguir un mundo libre de polio (AU)

In Spain, the last case of indigenous wild virus poliomyelitis occurred in 1988. Since then cases detected by the surveillance system are either imported cases, cases associated with vaccine or OPV derivatives (VDPV). The Plan of Action required for Certificate of Achievement of polio eradication began in 1997. The activities were agreed with the regions and approved by the Inter-territorial Council of Health. The plan integrates epidemiological surveillance and laboratory activities: - Implement an effective surveillance system acute flaccid paralysis (AFP) in children under 15 years - Achieve and maintain high immunization coverage (95% in the primary series in children under 2 years old). - Environmental monitoring through surveillance of enteroviruses. In the implementation of the Plan in Spain have remained high vaccination coverage and concern to avoid susceptible bags in vulnerable populations. Surveillance System Acute Flaccid Paralysis in children under 15 years has been consistently evaluated by the quality indicators related to the sensitivity, timeliness (in reporting and sampling) and the indicators for epidemiological research and laboratory. The challenges of polio surveillance are introducing cases: imported polio caused by wild poliovirus, vaccine-derived poliovirus (VDPV) or poliovirus vaccine. Therefore, all activities should continue until a polio-free world (AU)

Poliomielitis paralítica. Nuevos problemas: el síndrome postpolio / Polio paralytic. New Problems: postpolio syndrome

En 1875 M Raymond describió la aparición de una atrofia y debilidad muscular progresiva en 3 individuos supervivientes de una poliomielitis aguda en la infancia. Jean-Martin Charcot, sugirió que la lesión inicial debía dejar a las neuronas de estos individuos más sensibles para desarrollar enfermedades medulares posteriores y que la nueva debilidad era consecuencia del sobreuso de los músculos afectos. En 1979, tras la publicación de la descripción realizada por un paciente de 57 años de las dificultades motoras que desarrolló tras el padecimiento de una poliomielitis en la infancia, se produjo un incremento muy importante de comentarios de otros individuos con síntomas similares, llegando a acuñarse en los años 80 el término de síndrome post-polio (SPP). El término se reserva para describir el desarrollo de nuevos síntomas neurológicos, en especial para el desarrollo de una debilidad muscular, atrofia muscular y fatiga muscular nueva que no son explicables por otra causa médica, y que aparecen después de más de 15 años de la infección aguda. Se estima que afecta del 20 al 85% de individuos con antecedentes de poliomielitis en la infancia. En el año 2000 se describieron los primeros criterios diagnósticos. El SPP condiciona una alteración de la capacidad funcional del individuo. Su etiopatogenia es desconocida, pudiendo estar relacionada con el envejecimiento. También podría deberse a un cuadro inflamatorio persistente o estar influenciado por factores genéticos. No existe tratamiento farmacológico eficaz, por lo que sólo se puede recomendar tratamiento sintomático y de entrenamiento muscular moderado (AU)

In 1875 M Raymond described a progressive muscle wasting and weakness in 3 individuals survivors of childhood acute poliomyelitis. Jean-Martin Charcot suggested that the initial injury should let these guys neurons more sensitive to develop posterior spinal diseases and new weakness was the result of overuse of the affected muscles. In 1979, after the publication of the description given by a 57 year old patien on motor difficulties that developed after suffering of polio in childhood, there was a very significant increase of comments of other individuals with similar symptoms, reaching wedged in the 80s the term of post-polio syndrome. The term is reserved for describing the development of new neurological symptoms, especially for the development of muscle weakness, muscle atrophy and new muscle fatigue not explained by other medical causes, and appear after more than 15 years of infection acute. Is estimated to affect 20 to 85% of individuals with a history of polio in childhood. In 2000 first described the diagnostic criteria. This syndrome determines a change in the functional abilities. Its pathogenesis is unknown, may be associated with aging. It could also be due to an inflammatory persistent or be influenced by genetic factors. There is no effective drug treatment, so I can only recommend symptomatic and moderate muscle training (AU)

Comparative assessment of Oral Hygiene and Periodontal status among children who have Poliomyelitis at Udaipur city, Rajasthan, India

Objective: To assess and compare the oral hygiene and periodontal status among children with Poliomyelitis having upper limb disability, lower limb disability and both upper and lower disability at Udaipur city, Rajasthan, India. Study design: Total sample comprised of 344 Poliomyelitis children (upper limb disability: 33.4%; lower limb disability: 33.7%; both upper and lower limb disability: 32.9%) in the age group of 12-15 years. Clinical examination included recording Simplified Oral Hygiene Index and Community Periodontal Index. Analysis of variance (ANOVA), multiple logistic and stepwise linear regression were used for statistical analysis. Results: The mean OHI-S (2.52±1.05) score was found to be highest among children who had both upper and lower limb disability (p<0.05). The highest and lowest mean number of healthy sextants were found among those with only lower limb disability (4.53±2.05) and among those with both upper and lower limb disability (0.77±1.39), respectively (p<0.05). Stepwise multiple linear and multiple logistic regression analysis showed that the best predictor for oral hygiene and periodontal status was limb involved in the disability. Conclusion: The results of the study depicted an overall poor oral hygiene and periodontal status of the group. It was recognized that limbs involved in the disability had an impact on the oral hygiene and periodontal condition. The situation in this specialized population draws immediate attention for an integrated approach in improving the oral health and focus towards extensive research (AU)

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Fiabilidad test-retest de dinamometría manual en personas con secuelas de poliomielitis paralítica / Test-retest reliability of hand grip in people with paralytic poliomyelitis sequelae

Introducción. Las personas con secuelas de poliomielitis paralítica necesitan en la mayoría de los casos de bastones ingleses y ortesis para realizar las actividades diarias como mantener la postura corporal, caminar, etc. a fin de no sufrir un detrimento en su calidad de vida. Por ello, es necesario determinar los índices de fiabilidad (absolutos y relativos) en un test de dinamometría manual que indique la fuerza de los músculos flexores de ambas manos para así comprobar la efectividad de un programa de actividad física en esta población. Material y método. Se aplicó un protocolo de medición de la fuerza de prensión de ambas manos con un dinamómetro manual en 2 ocasiones con un intervalo de 12 semanas a una muestra de 18 personas con secuelas de poliomielitis paralítica. El análisis estadístico consistió en el calculo de los índices de fiabilidad relativa (coeficiente de correlación intraclase) y absoluta (error estándar de medida y mínima diferencia real) y la representación de las diferencias individuales mediante gráficos de Bland-Altman. Resultados y discusión. los resultados obtenidos muestran un coeficiente de correlación intraclase alto así como índices de error absoluto bajos. La medición de la fuerza de los músculos flexores de ambas manos en personas con SPP mediante dinamometría manual presenta una consistencia temporal alta y un escaso error de medida por lo que puede ser considerado como método para medir la eficacia de programas de terapia física con una duración inferior a 12 semanas (AU)

Introduction. Persons having Polio Paralytic Sequelae must use walking canes and orthosis in most cases to perform daily activities such as maintaining posture, walking, etc. in order to maintain their quality of life. Therefore, reliability indexes (absolute and relative) should be determined in a hand held dynamometry test indicating the strength of the flexor muscles of both hands in order to verify the effectiveness of a physical activity program for this population. Material and Method. A protocol for measuring grip strength in both hands using a manual dynamometer two times separated by a 12-week interval was applied in a sample of 18 persons with Polio Paralytic Sequelae. Statistical analysis was made by calculating rates of relative (intraclass correlation coefficient) and absolute reliability indexes (standard error of measurement and smallest real difference) and representation of individual differences by Bland-Altman plots. Results and Discussion. The results obtained show a high intraclass correlation coefficient and low absolute error rates. Measuring the strength of the flexor muscles of both hands in SPP patients by hand grip dynamometer show a high temporal consistency and a low measurement error so this can be considered as a method to measure the effectiveness of physiotherapy programs of 12 weeks or less (AU)

Análisis de la fatiga asociada al movimiento periódico de las extremidades durante el sueño en pacientes con antecedente de poliomielitis / Analysis of fatigue associated to periodic limb movement during sleep in former poliomyelitis patient

Introducción. Tras padecer poliomielitis, es posible que los pacientes sufran trastornos del sueño a raíz de movimientos de las extremidades, hecho que producirá fatiga y una función muscular más dificultosa al día siguiente. Objetivo. Establecer la presencia o ausencia de fatiga muscular en estos pacientes mediante electromiografía y relacionar los datos con los hallazgos polisomnográficos. Pacientes y métodos. Se realizó un estudio analítico transversal con 19 pacientes con secuelas motoras en las extremidades inferiores causadas por la poliomielitis. Se les practicaron tests cuantitativos para valorar aspectos neurofisiológicos (reflejo rotuliano, reflejo aquíleo y fuerza muscular periférica del recto femoral) y un estudio del sueño (estándar, polisomnografía de nivel I). Resultados. Se observó una diferencia estadísticamente significativa (p < 0,01) en la fuerza muscular, lo que demuestra la existencia de una fatiga muscular asociada al trastorno del sueño. Conclusión. Los individuos con secuelas de la poliomielitis presentan trastornos del sueño que pueden acarrear fatiga muscular. Los movimientos periódicos de las extremidades pueden contribuir a que se dé este fenómeno (AU)

Introduction. Following poliomyelitis, patients may experience sleep disorders stemming from periodic limb movement, leading to fatigue and compromised muscle function the following day. Aim. To establish the presence or absence of muscle fatigue in these patients using electromyography and relating the data to polysomnographic findings. Patients and methods. An analytical cross-sectional study was carried out involving 19 individuals with motor sequelae in the lower limbs stemming from poliomyelitis. Quantitative tests for the assessment of neurophysiological aspects (knee-jerk/ Achilles reflexes and peripheral muscle strength of rectus femoris) and a sleep study (standard, level I polysomnography) were administered. Results. A statistically significant difference was detected (p < 0.01) in muscle strength, demonstrating muscle fatigue associated to sleep disorder. Conclusion. Individuals with sequelae from poliomyelitis exhibit sleep disorders that may lead to muscle fatigue. Periodic limb movement may contribute to this phenomenon (AU)

Disfagia orofaríngea secundaria a síndrome pospolio / No disponible

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Bloqueo femoral continuo para analgesia postoperatoria en un paciente con poliomielitis / No disponible

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Síndrome pós-poliomielite / Post-poliomyelitis syndrome

A poliomielite é uma doença erradicada no Brasil, desde os anos 80, mas atualmente estão aparecendo novos sintomas relacionados a essa patologia, a síndrome pós-polio, que é caracterizada por uma nova desordem neurológica. Esses sintomas aparecem 30 a 40 anos após a infecção aguda da poliomielite e, como é uma patologia recente, há poucos estudos e casos diagnosticados. O objetivo deste estudo é descrever o aparecimento do caso dessa síndrome, através do relato de caso de uma paciente que realiza tratamento fisioterapêutico na clínica de Fisioterapia do Hospital Regional de Araranguá, localizado na cidade de Araranguá/SC, em agosto de 2006. Conforme a literatura, os sinais e sintomas que foram relatados pelo estudo são considerados como uma conseqüência tardia da infecção aguda da poliomielite, devido à degeneração dos brotamentos dos axônios atingidos pela poliomielite há 40 anos.

The poliomyelitis disease was eradicated in Brazil in the eighties, but now new symptoms related to this pathology are rising, like the post-polio syndrome, which is characterized by a new neurological disorder. These symptoms rise 30 to 40 years after the acute poliomyelitis infection and, as it is a recent pathology, studies and diagnosed cases are scarce. The objective of this study was to describe the onset of this syndrome, through the case of a patient attended in a Physical Therapy Clinic of a Regional Hospital of Araranguá, located in the city of Araranguá/SC, Brazil, in August 2006. According to literature, signs and symptoms reported in the study are considered as the consequence of acute poliomyelitis infection, due to degeneration of budding axons damaged by the poliomyelitis 40 years ago.

Repercussões respiratórias da ventilação por cinta abdominal pneumática em ratos normais / Respiratory repercussions of the ventilation with abdominal pneumatic belt in normal rats

A Cinta Abdominal Pneumática (CAP) é um aparelho utilizado no mercado internacional com o objetivo de melhorar a função pulmonar de pacientes com seqüelas de poliomielite, doenças neuromusculares e lesão raquiomedular. O objetivo desta pesquisa foi avaliar os parâmetros respiratórios durante o uso da CAP através de um experimento com sete ratos normais. A variação da pressão intrapleural (Ppl), o tempo inspiratório (Ti), o tempo expiratório (Te), o tempo total do ciclo (Ttot), a freqüência respiratória (FR), a relação Ti/Ttot e o produto pressão tempo (PTP) foram mensurados com um transdutor de pressão no espaço pleural dos ratos, sem e com a CAP; a fim de se verificar seus reais efeitos fisiológicos. Os resultados mostraram que a CAP determina variação significativa na pressão pleural (p = 0,0489) o que melhora os volumes pulmonares e conseqüentemente a ventilação. A FR, Ti, Te, Ttot não sofreram alterações significativas. A variação da relação Ti/Ttot e do PTP não foi significativamente diferente, o que é vantajoso, uma vez que refletem aumento do gasto energético da respiração. Observou-se também assincronia durante seu uso, funcionando como estímulo inspiratório e não como auxílio expiratório.

The Abdominal Pneumatic Belt (APB) is a device used in the international market with the objective to improve the pulmonary function of patients with polio sequels, neuromuscular disorders and injury of spinal cord. This research considered an evaluation of the respiratory parameters during the use of the APB through an experiment with seven normal rats. The variation of the pleural pressure (Ppl), the inspiratory time (Ti), the expiratory time (Te), the total time of the cycle (Ttot), the respiratory frequency (FR), the Ti/Ttot relation and the pressure-time product (PTP) had been measure, through a transducer of pressure in the pleural space, without and with such equipment; in order to analyze its real physiological effect. The results had shown that the APB determines significant variation in the pleural pressure (p = 0,0489) what probably determines better pulmonary volumes and consequently better ventilation. The FR, Ti, Te and Ttot had not suffered significant alterations. The variation of the Ti/Ttot relation and the PTP is not significant too, what it would be advantageous, because it reflects increase of energy expense of the breath. It was observed an antagonism during the use, functioning as inspiratory stimulation and not as expiratory aid.