A hiatus in the rivalry between Pierre Marie and Jules Dejerine: a collaborative study on sensory disorders by Andre Pierre Marie and Gustave Roussy.

Personal and professional rivalries involving prominent neurologists mark the history of nineteenth-century French neurology. One of the great examples is the feud between Pierre Marie and Jules Dejerine. The dispute between the two, nevertheless, did not prevent Pierre Marie's son, André Marie, and Gustave Roussy - one of Dejerine's favorite pupils, from collaborating on significant research that led to the doctoral dissertation by Andre Marie regarding sensory disturbances associated with painful hemiagnosia found in thalamic lesions.

As rivalidades pessoais e profissionais entre neurologistas proeminentes marcaram a história da neurologia francesa do século XIX. Um dos grandes exemplos é a rivalidade entre Pierre Marie e Jules Dejerine. A disputa entre os dois, no entanto, não impediu que o filho de Pierre Marie, André Marie, e Gustave Roussy, um dos pupilos preferidos de Dejerine, colaborassem numa investigação significativa que resultou na tese de doutorado de André Marie sobre os distúrbios sensoriais associados à hemiagnosia dolorosa encontrada nas lesões talâmicas.

Postural performance assessment in aging people with diabetes and diabetic peripheral neuropathy using a Wii balance board.

PURPOSE: To determine the effect of sensory perturbations on static postural control in older people with type 2 diabetes mellitus by comparing postural outcomes of people with and without diabetic neuropathy using a Wii Balance Board (WBB). MATERIALS AND METHODS: Static postural balance assessments were performed in 31 participants: nine with type 2 diabetes mellitus; 12 with diabetic neuropathy; and 10 non-diabetic controls. Participants stood on the WBB under sensory perturbations (visual and proprioceptive). Body balance was analysed using centre of pressure ellipse area, mean velocity, and sample entropy. The effects of within-participant factors, sensory perturbations and the between-participants factor 'group' on outcomes were analysed using a multivariate analysis of variance model. RESULTS: Type 2 diabetes mellitus participants with and without neuropathy showed altered postural performance under sensory perturbations compared to non-diabetic participants. Moreover, participants with diabetic neuropathy showed impaired postural performance when one perceptual system was disturbed. Finally, participants with type 2 diabetes mellitus without neuropathy decreased their postural performance when both sensory disturbances were present. CONCLUSIONS: The Wii Balance Board can be a useful alternative for balance impairment screening related to diabetic neuropathy and contribute as an affordable source of insight in early interventions in integral diabetes care.Implications to rehabilitationOlder people with diabetic peripheral neuropathy depend on visual and somatosensory cues to keep their static postural balance.Static balance assessment using the Wii Balance Board allows the identification of alterations in postural performance in participants with diabetes.This low-cost method used can be considered as a complement to integral diabetes care.

Repercussions of the Degrees of Hearing Loss and Vestibular Dysfunction on the Static Balance of Children With Sensorineural Hearing Loss.

OBJECTIVE: The purpose of this study was to assess the static balance of children with sensorineural hearing loss (SNHL) according to the degrees of SNHL and the function of the vestibular system. METHODS: This cross-sectional study was conducted in public schools located in Caruaru, Pernambuco state, Brazil, with 130 children (65 with normal hearing and 65 with SNHL as documented by air and bone conduction audiometry) of both sexes between 7 and 11 years old. Static balance was assessed by a stabilometric analysis using a force platform consisting of the circular area of center-of-pressure displacement of the children evaluated in 3 positions: bipedal support with feet together and parallel (PF), tandem feet (TF), and 1 foot (OF), carried out under 2 sensory conditions each, with eyes open and eyes closed. After balance assessments, the children with SNHL received examinations of auditory and vestibular functions-through audiometry and computerized vectoelectronystagmography, respectively-to compose the groups according to degrees of SNHL and vestibular function. RESULTS: The children with severe and profound SNHL demonstrated more static balance instabilities than the children with normal hearing in 5 positions assessed with eyes open (PF, TF, and OF) and eyes closed (PF and TF). The same phenomenon occurred in children with SNHL and associated vestibular dysfunction in all of the positions assessed with eyes open and eyes closed (PF, TF, and OF). CONCLUSION: The larger the degree of SNHL, the greater the balance instability of the children. The children with SNHL and associated vestibular dysfunction showed the highest balance instabilities in this study. IMPACT: Children with larger degrees of SNHL and associated vestibular dysfunction might require prolonged periods to rehabilitate their balance.

Effect of sentinel lymph node biopsy on upper limb function in women with early breast cancer: A systematic review of clinical trials.

PURPOSE: Axillary surgery is still essential in the management of early breast cancer. Conservative procedures like sentinel lymph node biopsy (SLNB) are less invasive than the traditional axillary node dissection (ALND). However, some extent of ipsilateral upper limb dysfunction might still occur. This systematic review aimed to describe the incidence of lymphedema, pain, sensory, and motor disorders after SLNB in women with early breast cancer. METHODS: We conducted a systematic review of randomized controlled trials. The search was performed on Pubmed, EMBASE, CINAHAL, and Web of Science. The search was based on the following concepts: breast cancer, sentinel lymph node biopsy, axillary dissection, upper limb complications. The risk of bias was evaluated using the Cochrane Rob 2.0 toll. RESULTS: We obtained 979 unique registries from the primary search and 381 additional records from the included articles' reference lists. Fifty-one articles were assessed as full text. Nine studies were included in the review. A total of 5161 patients undergone SLNB, and 4110 patients were assessed for ipsilateral arm complications. Six months after the surgery, 0-11% of patients presented lymphedema, 11-16% pain, 2-22% sensory disorders, and 0-9% motor disorders. CONCLUSIONS: SLNB was associated with persistent postoperative complications. The burden of complications, although lower when compared to ALND, should not be ignored. PROTOCOL REGISTRATION: PROSPERO registration number CRD42018090540, registered July 09, 2018.

Audiological implications of COVID-19: an integrative literature review / Implicações audiológicas da COVID-19: revisão integrativa da literatura

ABSTRACT Purpose: to survey the national and international literature on the impacts of the coronavirus infection on the auditory system. Methods: an integrative review with search in the BIREME, PubMed, Scopus, and Web of Sciences databases. Inclusion criteria: articles in Portuguese and English whose subject was the coronavirus infection and its effects on the auditory system. Exclusion criteria: information from books and/or chapters, letters to editors, review articles, experience reports. The search strategy was based on the following combined descriptors, respectively in Portuguese and English: "Infecções por coronavírus", "Audição", "Perda auditiva", "Coronavirus infections", "Hearing", "Hearing Loss". Results: out of 43 articles found, two approached the issue. The first study assessed 20 patients that tested positive for COVID-19, though asymptomatic, who underwent pure-tone threshold audiometry and otoacoustic emissions. A significant increase in the auditory thresholds at high frequencies and a smaller response amplitude in the transient evoked otoacoustic emissions of those who tested positive for COVID-19 were observed when compared to that of controls. The second study reported the case of an asymptomatic 35-year-old COVID-19 female patient, who complained of otalgia and tinnitus, after being contaminated. The pure-tone threshold audiometry and tympanometry indicated mild unilateral (right ear) conductive hearing loss, with a type B tympanometric curve on that side. Conclusion: the studies included in this review showed different consequences of COVID-19 on hearing, with possible impairments on the sensory and mechanical structures of the auditory system. The knowledge of COVID-19 is limited, and further studies on its real impact on the auditory system are necessary.

RESUMO Objetivo: realizar um levantamento da literatura nacional e internacional sobre os impactos da infecção por coronavírus no sistema auditivo. Métodos: revisão integrativa com pesquisa nas bases de dados Bireme, PubMed, Scopus e Web of Sciences. Critérios de inclusão: artigos em português e em inglês que tinham como tema a infecção por coronavírus e seus efeitos no sistema auditivo. Critérios de exclusão: informações de livros e/ou capítulos, cartas ao editor, artigos de revisões e de relatos de experiência. Para a estratégia de busca, utilizou-se a combinação dos descritores em português e em inglês, respectivamente: "Infecções por coronavírus", "Audição", "Perda auditiva", "Coronavirus infections", "Hearing", "Hearing Loss". Resultados: dos 43 artigos encontrados, dois abordaram o tema proposto. O primeiro estudo avaliou 20 pacientes que testaram positivo para COVID-19, porém assintomáticos, esses realizaram audiometria tonal liminar e emissões otoacústicas. Observou-se como resultado um aumento significativo dos limiares auditivos nas altas frequências e menor amplitude de resposta no exame de emissões otoacústicas evocadas por estímulo transiente, quando comparados ao grupo controle. O segundo estudo relatou o caso de uma paciente de 35 anos de idade com COVID-19 assintomática, que apresentou queixa de otalgia e zumbido após a contaminação. A audiometria tonal liminar e timpanometria indicaram perda auditiva do tipo condutiva de grau leve unilateral à direita com curva timpanométrica do tipo B deste lado. Conclusão: os estudos incluídos mostraram diferentes repercussões da COVID-19 na audição, com possíveis acometimentos nas estruturas sensoriais e mecânicas do sistema auditivo. O conhecimento sobre a COVID-19 é limitado e mais estudos primários sobre seu real impacto no sistema auditivo são necessários.

Effects of the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) on the nervous system. What can we expect from SARS -CoV-2? / [Efectos de los coronavirus del síndrome respiratorio agudo grave (SARS-CoV) y del síndrome respiratorio del Medio Oriente (MERS-CoV) en el sistema nervioso. ¿Qué esperar del SARS-CoV-2?]

Coronaviruses cause respiratory and gastrointestinal disorders in animals and humans. The current SARS-CoV-2, the COVID-19 infectious agent, belongs to a subgroup called betacoronavirus including the SARS-CoV and MERS-CoV responsible for epidemics in 2002 and 2012, respectively. These viruses can also infect the nervous system due to their affinity for the human angiotensin-converting enzyme 2 (ACE2) expressed in neurons and glial cells. Infections with SARS-CoV, MERS-CoV, and now SARS-CoV-2 also produce neurological signs such as acute cerebrovascular disease, impaired consciousness, and muscle injury, as well as dizziness, hypogeusia, hyposmia, hypoxia, neuralgia, and hypoxic encephalopathy. For this reason, close attention should be paid to the neurological manifestations of COVID-19 patients.

Los coronavirus son una familia de virus que se caracterizan por producir afectaciones respiratorias y gastrointestinales en animales y en seres humanos. El actual SARS-CoV-2, agente infeccioso de la COVID-19, pertenece a un subgrupo denominado betacoronavirus del que hacen parte el SARS-CoV y MERS-CoV, virus responsables de epidemias en el 2002 y el 2012, respectivamente. Estos virus también pueden infectar el sistema nervioso debido a su afinidad con la enzima convertidora de angiotensina humana 2 (ACE2), la cual se expresa en neuronas y células gliales. Se ha demostrado que las infecciones con SARS-CoV y MERS-CoV, y ahora también con el SARS-CoV-2, ocasionan condiciones neurológicas como la enfermedad cerebrovascular aguda, la conciencia alterada y las lesiones musculares, así como mareos, hipogeusia, hiposmia, hipoxia, neuralgia y encefalopatía hipóxica. Por ello debe prestarse mucha atención a las manifestaciones neurológicas de los pacientes de COVID-19.

Neuroanatomical basis of Wallenberg syndrome.

Wallenberg syndrome, or lateral medullar syndrome, is the clinical presentation of the infarct in the territory of posterior inferior cerebellar artery. Its signs and symptoms include vertigo, nystagmus, diplopia, ipsilateral Horner syndrome, facial ruddiness and dry skin, dysphonia, dysphagia, dysarthria, ipsilateral loss of gag reflex, ipsilateral ataxia, ipsilateral impaired taste, ipsilateral facial pain and paresthesia, decreased ipsilateral blink reflex, contralateral hypoalgesia and thermoanaesthesia in the trunk and limbs; and ipsilateral facial hypoalgesia and thermoanaesthesia. Neuroanatomical knowledge is essential to its comprehension, study and diagnosis, because the classic neurological manifestations are easy to explain and understand if function and localization of affected anatomical structures are known as if the posterior cerebral circulation is.

El síndrome de Wallenberg, o síndrome bulbar lateral, es la manifestación clínica del infarto en el territorio de irrigación de la arteria cerebelosa posteroinferior. Su presentación incluye vértigo, nistagmo, diplopía, síndrome de Horner, rubicundez y anhidrosis facial homolateral, disfonía, disfagia, disartria, pérdida homolateral del reflejo nauseoso, ataxia homolateral, disgeusia homolateral, dolor y parestesia faciales homolaterales, pérdida o disminución homolateral del reflejo corneal, hipoalgesia y termoanestesia de tronco y extremidades contralaterales, hipoalgesia y termoanestesia facial homolateral. El conocimiento neuroanatómico es imprescindible para su comprensión, estudio y diagnóstico, ya que sus manifestaciones neurológicas clásicas son fácilmente explicables y entendibles si se conocen la función y la localización de las estructuras anatómicas afectadas, así como la irrigación cerebral posterior.

Severe Dizziness Related to Postural Instability, Changes in Gait and Cognitive Skills in Patients with Chronic Peripheral Vestibulopathy

Abstract Introduction Peripheral vestibular disorders can lead to cognitive deficits and are more common in elderly patients. Objective To evaluate and correlate cognitive, balance and gait aspects in elderly women with chronic peripheral vestibular dizziness, and to compare them with elderly women without vestibular disorders. Methods Twenty-two women presenting peripheral vestibular dizziness episodes for at least six months participated in the study. The individuals were categorized by dizziness severity level: moderate (n = 11) or severe (n = 11). The control group (n = 11) included women showing no vestibulopathy, light-headedness or dizziness. Cognitive assessments and semi-static and dynamic balance assessments were performed with the Balance Master (Neurocom International, Inc., Clackamas, OR), while the Dizziness Handicap Inventory provided a score for the severity of the symptoms. The groups were submitted to statistics of inference and correlation between cognitive, balance and stability variables. Results The group with severe dizziness showed higher sway speed of the center of pressure in the anteroposterior direction, smaller step length, and slower gait than the control group. Regarding the cognitive variables, the group with severe dizziness symptoms presented significant correlations with stability and gait variables. Conclusion The relationship between cognitive aspects, balance and gait was stronger in women with severe dizziness than in those with no vestibulopathy.

Multidisciplinary protocol for the management of fibromyalgia associated with imbalance. Our experience and literature review.

OBJECTIVE: We reported our multidisciplinary protocol for the management of fibromyalgia associated with imbalance. Our aim was to verify the effectiveness of a proprioceptive training program as a complementary therapy for a traditional protocol of education, mindfulness, and exercise training for the management of fibromyalgia associated with imbalance. METHODS: Retrospective cohort study on 84 women, with primary fibromyalgia associated to imbalance. A group of patients performed traditional exercise training; in a second group the training was supplemented with proprioception exercises. Each session lasted from 40 to 60 minutes and was performed three times a week for 12 weeks. RESULTS: After three months of training and eight months after the end of the training, the balance evaluation revealed significant differences in the comparison of the Timed Up and Go test, Berg Balance Scale, and Tinetti scale with the baseline, there was a better improvement in the proprioceptive training group (p<0.05). A reduction in pain and improvement in functional and muscular performance and quality of life were observed in both groups (p<0.05), but with no significant differences between them in the Numeric Pain Rating Scale, Fibromyalgia Impact Questionnaire, and Short Form Health Survey (p>0.05). Fifteen months after the end of the program, the effects of training were not maintained. CONCLUSION: The present study revealed that training supplemented with proprioception exercises has beneficial effects on clinical findings and improves balance in patients with fibromyalgia, even if the positive results did not persist after the interruption of the rehabilitative program in the long term.

Multidisciplinary protocol for the management of fibromyalgia associated with imbalance. Our experience and literature review

SUMMARY OBJECTIVE We reported our multidisciplinary protocol for the management of fibromyalgia associated with imbalance. Our aim was to verify the effectiveness of a proprioceptive training program as a complementary therapy for a traditional protocol of education, mindfulness, and exercise training for the management of fibromyalgia associated with imbalance. METHODS Retrospective cohort study on 84 women, with primary fibromyalgia associated to imbalance. A group of patients performed traditional exercise training; in a second group the training was supplemented with proprioception exercises. Each session lasted from 40 to 60 minutes and was performed three times a week for 12 weeks. RESULTS After three months of training and eight months after the end of the training, the balance evaluation revealed significant differences in the comparison of the Timed Up and Go test, Berg Balance Scale, and Tinetti scale with the baseline, there was a better improvement in the proprioceptive training group (p<0.05). A reduction in pain and improvement in functional and muscular performance and quality of life were observed in both groups (p<0.05), but with no significant differences between them in the Numeric Pain Rating Scale, Fibromyalgia Impact Questionnaire, and Short Form Health Survey (p>0.05). Fifteen months after the end of the program, the effects of training were not maintained. CONCLUSION The present study revealed that training supplemented with proprioception exercises has beneficial effects on clinical findings and improves balance in patients with fibromyalgia, even if the positive results did not persist after the interruption of the rehabilitative program in the long term.

RESUMO OBJETIVO Relatamos nosso protocolo multidisciplinar para o manejo da fibromialgia associada ao desequilíbrio. Nosso objetivo foi verificar a eficácia do programa de treinamento proprioceptivo como terapia complementar de um protocolo tradicional (exercícios aeróbicos, de resistência e flexibilidade). MÉTODOS Estudo retrospectivo em 84 mulheres com fibromialgia primária associada a desequilíbrio. Um grupo de pacientes realizou o treinamento tradicional; em um segundo grupo o treinamento foi complementado com exercícios de propriocepção. Cada sessão durou de 40 a 60 minutos e foi realizada três vezes por semana durante 12 semanas. RESULTADOS Após três meses de treinamento e oito meses após o término do treinamento, a avaliação do equilíbrio revelou diferenças significativas nos testes Timed Up and Go, Escala de Equilíbrio de Berg e Escala de Tinetti em comparação com a linha de base, com uma melhora maior no grupo de treinamento proprioceptivo (p<0,05). Redução da dor e melhora do desempenho funcional e muscular e da qualidade de vida foram observadas em ambos os grupos (p<0,05), mas sem diferenças significativas entre eles na Escala Numérica de Dor, Fibromyalgia Impact Questionnaire e Short Form Health Survey (p>0,05). Quinze meses após o final do programa, os efeitos do treinamento não foram mantidos. CONCLUSÃO O presente estudo revelou que o treinamento suplementado com exercícios de propriocepção tem efeitos benéficos sobre os achados clínicos e melhora o equilíbrio em pacientes com fibromialgia, mesmo que os resultados positivos não tenham persistido após a interrupção do programa de reabilitação no longo prazo.

The prevalence of peripheral neuropathy severe enough to cause a loss of protective sensation in a population-based sample of people with known and newly detected diabetes in Barbados: a cross-sectional study.

AIMS: To determine the prevalence and potential risk factors for diabetic peripheral neuropathy with a loss of protective sensation in Barbados. METHODS: A representative population sample aged > 25 years with previously diagnosed diabetes or a fasting blood glucose ≥ 7 mmol/l or HbA1c ≥ 48 mmol/mol (6.5%) was tested by 10 g monofilament at four plantar sites per foot and a 28 Hz tuning fork and neurothesiometer at the hallux. Data were adjusted to the age structure of people with diabetes in Barbados. Multivariable logistic regression assessed associations with peripheral neuropathy with a loss of protective sensation. RESULTS: Of 236 participants [74% response rate, 33% men, 91% black, median age 58.6 years, mean BMI 30.1 kg/m2 , mean HbA1c 54 mmol/mol (7.1%)], 51% had previously diagnosed diabetes. Foot examination demonstrated that 25.8% (95% CI 20.2 to 31.5) had at least one insensate site with monofilament testing, 14.8% (95% CI 10.2 to 19.4) had an abnormal tuning fork test and 10.9% (95% CI 6.9 to 14.9) had a vibration perception threshold > 25 V. Peripheral neuropathy with a loss of protective sensation prevalence was 28.5% (95% CI 22.7 to 34.4) as indicated by monofilament with ≥ 1 insensate site and/or vibration perception threshold > 25 V. With previously diagnosed diabetes the prevalence was 36.4% (95% CI 27.7 to 45.2) with 98.4% of cases identified by monofilament testing. Increasing age, previously diagnosed diabetes, male sex and abdominal obesity were independently associated with peripheral neuropathy with a loss of protective sensation. CONCLUSIONS: Over a third of people with previously diagnosed diabetes had evidence of peripheral neuropathy with a loss of protective sensation. Monofilament testing alone may be adequate to rule out peripheral neuropathy with a loss of protective sensation. Monofilament and neurothesiometer stimuli are reproducible but dependent on participant response.

Factors associated with balance disorders of elderly living in the city of São Paulo in 2006: evidence of the Health, Well-being and Aging (SABE) Study. / Fatores associados às alterações de equilíbrio em idosos residentes no município de São Paulo em 2006: evidências do Estudo Saúde, Bem-Estar e Envelhecimento (SABE).

OBJECTIVE: To analyze the influence of demographic, health condition, and lifestyle factors on body balance disorders among elderly subjects living in the city of São Paulo, Brazil, in 2006. METHODS: Thestudy was developed based on information provided by the Health, Well-being, and Aging (SABE) Study. Itincluded 60-year-old subjects, both men and women, or those over this age. The sample comprised 1,226 subjects that represented 930,639 elderly subjects. The dependent variable was the elderly's body balance disorder, which was measured using part of the Short Physical Performance Battery (SPPB). The independent variables were divided into three groups: demographic, health conditions, and lifestyle. The multiple binary logistic regression analysis was applied to estimate the association between balance disorders and demographic, health, and lifestyle variables in the elderly. RESULTS: Age, difficulties in at least one mobility, and performance of regular physical activities showed a significant influence on the elderly's body balance (p < 0.05). Age was the strongest related determiner. Being aged 75-79 years and 80 years or more increased 3.77 and 5.31 times, respectively, the chances of the elderly subjects present balance disorders in comparison with the 60- to 64-years-old. CONCLUSION: Preventive measures that aim at reversing a body instability condition should be preconized and incorporated in the elderly's health-care schedule.

OBJETIVO: O objetivo deste estudo foi investigar a influência dos fatores demográficos, de condições de saúde e de estilo de vida nas alterações do equilíbrio corporal dos idosos residentes no município de São Paulo em 2006. MÉTODOS: O estudo foi desenvolvido com base em dados provenientes do Estudo Saúde,Bem-Estar e Envelhecimento (SABE). Foram selecionados todos os indivíduos com 60 anos e mais de idade, de ambos os sexos. A amostra considerada era de 1.226 indivíduos, representando 930.639 idosos. A variável dependente foi a alteração de equilíbrio corporal do idoso. Para mensurá-la utilizou-se parte do Short Physical Performance Battery (SPPB). As variáveis independentes foram classificadas em três grupos: demográficas, de condições de saúde e de estilo de vida. Para estimar a associação entre as alterações de equilíbrio com as variáveis demográficas, de saúde e de estilo de vida em idosos foi realizada uma análise de regressão logística binária múltipla. RESULTADOS: Idade, dificuldades em pelo menos uma mobilidade e realização de atividade física regular exercem uma significativa influência no equilíbrio corporal dos idosos (p < 0,05). A idade foi o determinante mais fortemente relacionado. Ter idade entre 75 a 79 anos e 80 anos e mais aumenta em 3,77 e 5,31vezes a chance, respectivamente, de os idosos apresentarem alterações de equilíbrio em comparação às idades de 60 a 64 anos. CONCLUSÃO: Medidas preventivas e que visam reverter um quadro de instabilidade corporal devem ser preconizadas e incorporadas na agenda de atenção à saúde dos idosos.

Alterações sensoriais em respiradores orais: revisão sistemática baseada no método prisma / Sensory changes in mouth breathers: systematic review based on the prisma method

RESUMO Objetivo: Revisar, na literatura, estudos que abordem alterações nos sistemas sensoriais apresentadas por respiradores orais. Fonte de dados: A busca foi realizada nas bases de dados PubMed, BIREME, LILACS, Web of Science e Scopus. A busca foi realizada independentemente por dois pesquisadores, seguindo os critérios de seleção. Foram selecionados artigos originais que abordaram a respiração oral e as alterações nos sistemas sensoriais publicados nos idiomas português, inglês e espanhol. Os artigos de revisão da literatura, as dissertações, os capítulos de livros, os estudos de caso e os editoriais foram excluídos. Síntese dos dados: Foram encontrados 719 artigos, dos quais 663 foram excluídos pelo título e 22 pelo resumo. Trinta e quatro manuscritos foram analisados, dos quais 23 estavam repetidos e 8 foram excluídos pelo texto lido na íntegra. Assim, três artigos foram selecionados para esta revisão. Conclusões: A maioria dos estudos apresenta a ocorrência de alterações dos sistemas sensoriais em crianças respiradoras orais. Contudo, observa-se maior preocupação na avaliação da recepção sensorial. Além disso, a avaliação dos sistemas sensoriais foi realizada de forma não padronizada, o que pode ter acarretado resultados menos precisos na população estudada.

ABSTRACT Objective: To review, in the literature, information regarding changes in the sensory systems of mouth breathers. Data sources: The search was conducted in the following databases PubMed, BIREME, LILACS, Web of Science and Scopus. The search was independently carried out by two researchers, following the selection criteria. Original articles that approached mouth breathing and changes in sensory systems published in Portuguese, English and Spanish were published. Literature review of articles, dissertations, book chapters, case studies and editorials were excluded. Data synthesis: We found 719 articles. Among them, 663 were excluded by the title and 22 by the summary. Among the 34 analyzed manuscripts, 23 were repeated and 8 were excluded by reading the full text. Thus, 3 articles were selected for this review. Conclusions: Most studies presents the occurrence of changes in sensory systems in mouth breathing children. However, sensory reception is a matter of more concern. Besides, the evaluation of sensory systems was not standardized, which may have led to less precise results in the studied population.

Presence of vestibular symptoms and related disability in migraine with and without aura and chronic migraine.

OBJECTIVE: To assess the presence and handicap due to vestibular symptoms in three subgroups of patients with migraine and controls. METHODS: Women between 18-55 years old were diagnosed by headache specialists and stratified as migraine with aura (n = 60), migraine without aura (n = 60), chronic migraine (n = 60) and controls (n = 60). Information regarding demographics, headache and vestibular symptoms were collected in this cross-sectional study. The self-perceived handicap related to vestibular symptoms was assessed through the Dizziness Handicap Inventory questionnaire. RESULTS: A total of 85% of women with migraine with aura and chronic migraine had vestibular symptoms contrasted to 70% of the migraine without aura group ( p < 0.05), and 12% of the control group reported symptoms ( p < 0.0001). Patients with migraine exhibited greater Dizziness Handicap Inventory scores than controls ( p < 0.001); and migraine with aura and chronic migraine groups reached greater scores than migraine without aura ( p < 0.01). Presence of migraine is associated with a greater risk of vestibular symptoms (migraine without aura: 5.20, migraine with aura: 6.60, chronic migraine:6.20, p < 0.0003) and with a greater risk of moderate-to-severe handicap (migraine without aura: 20.0, migraine with aura: 40.0, chronic migraine: 40.0, p < 0.0003). The presence of aura and greater migraine frequency adds to the risk of any handicap (migraine with aura: 1.9, chronic migraine: 1.7, p < 0.04) and to the risk of moderate-to-severe handicap (migraine with aura: 2.0, chronic migraine: 2.0, p < 0.0003). Migraine aura, intensity and frequency predict 36% of the dizziness handicap. CONCLUSION: The prevalence of vestibular symptoms is increased in migraine during and between headache attacks, particularly in migraine with aura and chronic migraine along with an increased handicap due to those symptoms. Vestibular symptoms among subgroups of migraine should be considered when evaluating the functional impact of migraine.

SENSORY CHANGES IN MOUTH BREATHERS: SYSTEMATIC REVIEW BASED ON THE PRISMA METHOD. / ALTERAÇÕES SENSORIAIS EM RESPIRADORES ORAIS: REVISÃO SISTEMÁTICA BASEADA NO MÉTODO PRISMA.

OBJECTIVE: To review, in the literature, information regarding changes in the sensory systems of mouth breathers. DATA SOURCES: The search was conducted in the following databases PubMed, BIREME, LILACS, Web of Science and Scopus. The search was independently carried out by two researchers, following the selection criteria. Original articles that approached mouth breathing and changes in sensory systems published in Portuguese, English and Spanish were published. Literature review of articles, dissertations, book chapters, case studies and editorials were excluded. DATA SYNTHESIS: We found 719 articles. Among them, 663 were excluded by the title and 22 by the summary. Among the 34 analyzed manuscripts, 23 were repeated and 8 were excluded by reading the full text. Thus, 3 articles were selected for this review. CONCLUSIONS: Most studies presents the occurrence of changes in sensory systems in mouth breathing children. However, sensory reception is a matter of more concern. Besides, the evaluation of sensory systems was not standardized, which may have led to less precise results in the studied population.

OBJETIVO: Revisar, na literatura, estudos que abordem alterações nos sistemas sensoriais apresentadas por respiradores orais. FONTE DE DADOS: A busca foi realizada nas bases de dados PubMed, BIREME, LILACS, Web of Science e Scopus. A busca foi realizada independentemente por dois pesquisadores, seguindo os critérios de seleção. Foram selecionados artigos originais que abordaram a respiração oral e as alterações nos sistemas sensoriais publicados nos idiomas português, inglês e espanhol. Os artigos de revisão da literatura, as dissertações, os capítulos de livros, os estudos de caso e os editoriais foram excluídos. SÍNTESE DOS DADOS: Foram encontrados 719 artigos, dos quais 663 foram excluídos pelo título e 22 pelo resumo. Trinta e quatro manuscritos foram analisados, dos quais 23 estavam repetidos e 8 foram excluídos pelo texto lido na íntegra. Assim, três artigos foram selecionados para esta revisão. CONCLUSÕES: A maioria dos estudos apresenta a ocorrência de alterações dos sistemas sensoriais em crianças respiradoras orais. Contudo, observa-se maior preocupação na avaliação da recepção sensorial. Além disso, a avaliação dos sistemas sensoriais foi realizada de forma não padronizada, o que pode ter acarretado resultados menos precisos na população estudada.

Sensory abnormalities in children with autism spectrum disorder / Alterações sensoriais em crianças com transtorno do espectro do autismo

Abstract Objective: The clinical picture of children with autism spectrum disorder is characterized by deficits of social interaction and communication, as well as by repetitive interests and activities. Sensory abnormalities are a very frequent feature that often go unnoticed due to the communication difficulties of these patients. This narrative review summarizes the main features of sensory abnormalities and the respective implications for the interpretation of several signs and symptoms of autism spectrum disorder, and therefore for its management. Sources: A search was performed in PubMed (United States National Library of Medicine) about the sensory abnormalities in subjects (particularly children) with autism spectrum disorder. Summary of the findings: Sensory symptoms are common and often disabling in children with autism spectrum disorder, but are not specific for autism, being a feature frequently described also in subjects with intellectual disability. Three main sensory patterns have been described in autism spectrum disorder: hypo-responsiveness, hyper-responsiveness, and sensory seeking; to these, some authors have added a fourth pattern: enhanced perception. Sensory abnormalities may negatively impact the life of these individuals and their families. An impairment not only of unisensory modalities but also of multisensory integration is hypothesized. Conclusions: Atypical sensory reactivity of subjects with autism spectrum disorder may be the key to understand many of their abnormal behaviors, and thus it is a relevant aspect to be taken into account in their daily management in all the contexts in which they live. A formal evaluation of sensory function should be always performed in these children.

Resumo Objetivo: O quadro clínico de crianças com transtorno do espectro do autismo é caracterizado por déficits de interação social e comunicação, bem como por interesses e atividades repetitivos. As alterações sensoriais são uma característica muito frequente que geralmente não é percebida devido às dificuldades de comunicação desses pacientes. Nesta análise narrativa, resumimos as principais características de alterações sensoriais e as respectivas implicações para a interpretação de vários sinais e sintomas do transtorno do espectro do autismo e, portanto, para seu manejo. Fontes: Fizemos uma busca no PubMed (Biblioteca Nacional de Medicina dos Estados Unidos) sobre as alterações sensoriais em indivíduos (principalmente crianças) com transtorno do espectro do autismo. Resumo dos achados: As alterações sensoriais são comuns e geralmente invalidam as crianças com transtorno do espectro do autismo, porém não são específicas do autismo, sendo uma característica frequentemente descrita também em indivíduos com deficiência intelectual. Três principais padrões sensoriais foram descritos no transtorno do espectro do autismo: hiporreatividade, hiperreatividade e busca sensorial; a eles, alguns autores acrescentaram um quarto padrão: percepção aprimorada. As alterações sensoriais podem afetar negativamente a vida desses indivíduos e de suas famílias. Hipotetizamos uma deficiência não apenas das modalidades não sensoriais, mas também da integração multissensorial. Conclusões: A reatividade sensorial atípica de indivíduos com transtorno do espectro do autismo pode ser a chave para entender muitos de seus comportamentos anormais e, portanto, é um aspecto relevante para ser considerado em seu manejo diário em todos os contextos nos quais eles vivem. Sempre se deve fazer uma avaliação formal da função sensorial nessas crianças.

Balance control is impaired in adults with sickle cell anaemia.

BACKGROUND: Musculoskeletal involvement and cerebrovascular disease are common in sickle cell anaemia (SCA). These changes are potentially important factors that modify the control of balance in this population. OBJECTIVE: To assess balance control in adults with SCA and investigate the associations among balance, posture and muscle function. METHODS: Twenty neurologically intact (i.e. without previous episodes of overt stroke or transient ischaemic attack) adults with SCA and 18 controls were evaluated. All participants underwent static balance measurement through stabilometry, postural evaluation through photogrammetry and assessment of muscle function through handgrip and respiratory muscle strength. RESULTS: Compared to the controls, the adults with SCA exhibited greater displacement of the centre of mass, particularly in the mediolateral direction. Moreover, the adults with SCA exhibited greater postural deviations for the following variables: angles of the right and left hip, horizontal asymmetry of the scapula in relation to T3, angles of the right and left leg-heel and horizontal alignment of the pelvis. Handgrip strength, respiratory muscle strength and haemoglobin (Hb) levels were significantly correlated with postural balance measurements. Significant correlations between balance and posture were only observed between the variables of balance and the postural parameters that involved the angulations calculated from the vertical alignment of the pelvis, hip and ankle. CONCLUSIONS: Neurologically intact adults with SCA exhibit damage in static balance, particularly in the mediolateral direction. These patients present postural deviations due to changes in the hip and ankle joints. In addition, balance control is related to posture, Hb level and muscle function.

Balance performance of children and adolescents with sensorineural hearing loss: Repercussions of hearing loss degrees and etiological factors.

INTRODUCTION: Some studies have demonstrated a parallelism between the extent of hearing loss and the frequency of vestibular dysfunction in children with sensorineural hearing loss (SNHL). Despite this, little is known about the repercussion of degrees of hearing loss and etiological factors on the balance performance in this children. OBJECTIVE: Compare the balance performance between normal hearing (NH) children and those with SNHL, considering the sex and age range of the sample, and analyze balance performance according to the degrees of hearing loss and etiological factors in the latter group. METHODS: Cross-sectional study that assessed 96 children (48 NH and 48 with SNHL), aged between 7 and 18 years old. The balance performance was assessed by the Brazilian version of the Pediatric Balance Scale, validated for Brazilian child population and the Mann-Whitney test used for statistical analysis. RESULTS: The group with SNHL showed lower average balance performance compared to NH (p = 0.000). This was also observed when the children were grouped by sex: female and male (p = 0.001). The same difference occurred when the children were stratified by age group: 7-14 years old (p = 0.000). There were no differences between the balance performance of the groups according to the degrees of hearing loss (p = 0.236) and the children with prematurity or post-natal meningitis as an etiological factor demonstrated the worst balance performance. CONCLUSION: The children with SNHL showed worse balance performance compared to NH of the same sex and age range between seven to fourteen years. There were no differences between balance performance and hearing loss degrees, and those children with prematurity or post-natal meningitis as an etiological factor demonstrated the worst balance performances.

Clinical and Neurophysiological Features of Leprosy Patients with Neuropathic Pain.

Neural pain is a frequent symptom in leprosy disease. There is a paucity of data regarding neural pain diagnostics resulting in common prescriptive errors when neuritis is confused with neuropathic or mixed nociceptive-neuropathic pain. The present study identified important demographic, clinical, and neurophysiological features of 42 leprosy neuropathy patients presenting neuropathic pain (NP). During routine evaluations, patients were selected asking if they had ever experienced neural pain. Data analyses of their pain characteristics, clinical examination results, and both the Douleur Neuropathique 4 Questionnaire and Hamilton Depression Scale scores were used to classify these patients. The most common word they used to describe the sensation of pain for 25 (60%) of these patients was "burning." In the early stages of the disease and before leprosy diagnosis, 19 (45%) had already complained about NP and leprosy treatment was unable to prevent its occurrence in 15 (36%). Leprosy reactions, considered NP risk factors, occurred in 32 (76%) cases. Knowledge of typical NP characteristics could be used to develop more effective therapeutic approaches for a notoriously difficult-to-treat pain condition.