Agudización del síndrome cardiorrenal V en un paciente con COVID-19 / Worsening of cardiorenal syndrome V in a patient with COVID-19

RESUMEN Durante el mes de diciembre de 2019 en Wuhan, China, se detectaron un número de pacientes con enfermedad respiratoria aguda de origen no conocido con evolución desfavorable, identificándose el coronavirus SARS-CoV-2 como agente causal, más conocido por causar enfermedades respiratorias agudas, con neumonía intersticial y alveolar, con afectación a múltiples órganos y sistemas (sistema cardiovascular, tracto gastrointestinal, sistema hematológico, sistema nervioso y riñones). La intervención con terapias de remplazo renal en la lesión renal aguda grado III, o en la enfermedad renal crónica grado IV o V es frecuente en estos enfermos como parte del tratamiento establecido en los protocolos. Se presentó la evolución de un paciente con antecedentes de: diabetes mellitus 2, hipertensión arterial, insuficiencia cardíaca y enfermedad renal crónica, aspectos que desencadenaron un síndrome cardiorrenal V, el cual se agudizó con la exposición al virus SARS-CoV-2; fue tratado con hemodiálisis convencional.

ABSTRACT During the month of December 2019 in Wuhan, China, a number of patients with acute respiratory disease of unknown origin with unfavorable evolution were detected, identifying the SARS-CoV-2 coronavirus as the causal agent, better known for causing acute respiratory diseases, with interstitial and alveolar pneumonia, affecting multiple organs and systems (cardiovascular system, gastrointestinal tract, hematological system, nervous system and kidneys). Intervention with renal replacement therapies in grade III acute kidney injury, or in grade IV or V chronic kidney disease is frequent in these patients as part of the treatment established in the protocols. The evolution of a male patient with antecedents of type 2 diabetes mellitus, arterial hypertension, heart failure and chronic kidney disease was presented, aspects that triggered a cardiorenal syndrome V, which worsened with exposure to the SARS-CoV-2 virus; he was treated with conventional hemodialysis.

Motor skill acquisition during a balance task as a process of optimization of motor primitives.

It has been argued that the central nervous system relies on combining simple movement elements (i.e. motor primitives) to generate complex motor outputs. However, how movement elements are generated and combined during the acquisition of new motor skills is still a source of debate. Herein, we present results providing new insights into the role of movement elements in the acquisition of motor skills that we obtained by analysing kinematic data collected while healthy subjects learned a new motor task. The task consisted of playing an interactive game using a platform with embedded sensors whose aggregate output was used to control a virtual object in the game. Subjects learned the task over multiple blocks. The analysis of the kinematic data was carried out using a recently developed technique referred to as "movement element decomposition." The technique entails the decomposition of complex multi-dimensional movements in one-dimensional elements marked by a bell-shaped velocity profile. We computed the number of movement elements during each block and measured how closely they matched a theoretical velocity profile derived by minimizing a cost function accounting for the smoothness of movement and the cost of time. The results showed that, in the early stage of motor skill acquisition, two mechanisms underlie the improvement in motor performance: 1) a decrease in the number of movement elements composing the motor output and 2) a gradual change in the movement elements that resulted in a shape matching the velocity profile derived by using the above-mentioned theoretical model.

Transcranial direct current stimulation in the treatment of cerebellar ataxia: A two-phase, double-blind, auto-matched, pilot study.

OBJECTIVE: To assess the impact of tDCS on posture, gait and coordination of movements in subjects with cerebellar ataxia. PATIENTS AND METHODS: This is a two-phase, double blind, auto matched, pilot study. Seven people were selected to participate in the study aged from 14 to 57. tDCS and sham-tDCS were applied at different times to all participants for 40 min over five consecutive days so that they were blind to which of the two techniques was applied at any one time. The area stimulated was the bilateral motor cortex. Subjects were evaluated before and after the interventions using the Scale for Assessment and Rating of Ataxia (SARA) and specific tests to measure posture and balance were carried out using the Wii Fit platform and CvMob software. RESULTS: The study indicates a statistically significant improvement in respect of gait parameters and the total score of the SARA scale and Wii Fit platform after tDCS when compared with data obtained from sham-tDCS trials (p: 0,03). The adverse events relating to tDCS were all self-limiting and from mild to moderate intensity. CONCLUSION: Despite the small sample size, tDCS showed positive results in some motor parameters and could be considered a valuable new option for the treatment of cerebellar ataxias.

Complex Upper-Limb Movements Are Generated by Combining Motor Primitives that Scale with the Movement Size.

The hand trajectory of motion during the performance of one-dimensional point-to-point movements has been shown to be marked by motor primitives with a bell-shaped velocity profile. Researchers have investigated if motor primitives with the same shape mark also complex upper-limb movements. They have done so by analyzing the magnitude of the hand trajectory velocity vector. This approach has failed to identify motor primitives with a bell-shaped velocity profile as the basic elements underlying the generation of complex upper-limb movements. In this study, we examined upper-limb movements by analyzing instead the movement components defined according to a Cartesian coordinate system with axes oriented in the medio-lateral, antero-posterior, and vertical directions. To our surprise, we found out that a broad set of complex upper-limb movements can be modeled as a combination of motor primitives with a bell-shaped velocity profile defined according to the axes of the above-defined coordinate system. Most notably, we discovered that these motor primitives scale with the size of movement according to a power law. These results provide a novel key to the interpretation of brain and muscle synergy studies suggesting that human subjects use a scale-invariant encoding of movement patterns when performing upper-limb movements.

Eficácia de um programa de dança para prevenir quedas entre idosos / Efficacy of a dance program in preventing falls among the elderly

s quedas e as fraturas influenciam na capacidade funcional dos idosos. O objetivo deste trabalho foi verificar a eficácia de um programa de dança para diminuir a incidência de quedas entre idosos e melhorar suas próprias avaliações subjetivas de saúde. O desenho metodológico foi um ensaio clínico controlado. A amostra incluiu 30 mulheres maiores de 60 anos, de nível socioeconômico baixo, moradoras de uma área central da cidade de Salvador, Bahia, Brasil. Não foram verificadas diferenças significativas entre os grupos em relação à incidência de quedas nem às avaliações subjetivas de saúde. Conclusivamente, encontrou-se que, para desenvolver ações destinadas a reduzir o risco de quedas, deve-se contemplar uma abordagem multidimensional do problema e não apenas observar os determinantes ligados à saúde física do indivíduo.

Pode dançar provocar dor no joelho? / Can dance provoke knee pain?

A dor no joelho e uma das queixas mais freqüentes entre dançarinos. O objetivo deste trabalho foi estabelecer a prevalência e a incidência cumulativa de dor no joelho para melhor entender a relação entre dançar e o corpo do dançarino. Constituíram a amostra 47 alunos da Escola de Dança da UFBA. Para estabelecer a freqüência de dor no joelho foram escolhidos dois desenhos metodológicos: um estudo prospectivo, para estabelecer a prevalência, e um estudo de coorte, para verificar a incidência cumulativa da variável. Como resultado, verificou-se que a prevalência de dor no joelho entre 47 alunos foi de 31.9 por cento (15 alunos). A incidência representada manteve-se entre 13.3 por cento e 2.2 por cento, apresentando uma gradativa tendência à diminuição.

Hernia de bochdalek: a propósito de un caso / Bochdalek’s hernia: case presentation

Se presentó una paciente que falleció en hipoxia prolongada por insuficiencia respiratoria a los 15 días de nacida, a consecuencia de una hernia diafragmática congénita (hernia de Bochdalek). Se revisó literatura médica y se enfatizó en la necesidad del diagnóstico ultrasonográfico prenatal de esta anomalía congénita, así como la importancia de que el nacimiento de estos pacientes ocurra en una institución apta para efectuar una cirugía temprana y mejorar el pronóstico

Hernia de bochdalek: a propósito de un caso / Bochdaleks hernia: case presentation

Se presentó una paciente que falleció en hipoxia prolongada por insuficiencia respiratoria a los 15 días de nacida, a consecuencia de una hernia diafragmática congénita (hernia de Bochdalek). Se revisó literatura médica y se enfatizó en la necesidad del diagnóstico ultrasonográfico prenatal de esta anomalía congénita, así como la importancia de que el nacimiento de estos pacientes ocurra en una institución apta para efectuar una cirugía temprana y mejorar el pronóstico(AU)