A Case Series of Severe Dengue with Neurological Presentation in Children from a Colombian Hyperendemic Area.

Dengue transmission is sustained in Colombia with increasing prevalence mainly in children. This work aimed to describe a case series of children diagnosed with dengue presenting neurological disease in Huila Province of Colombia. Eleven pediatric febrile patients confirmed for dengue disease and presenting neurological signs were studied in the University Hospital of Neiva, Huila Province. Clinical and laboratory findings, CSF cytochemical analysis, neurology images, and serology and molecular studies were performed. Viral RNA was detected in all patients' sera by RT-PCR. Nine out of 11 were primary infections. Tonic-clonic seizures (73%), consciousness alterations (27%), irritability (27%), and ataxia (18%) were the most frequent neurological signs. None of the patients had plasma leakage, hypovolemic shock, or liver disease, confirming the encephalitis diagnosis. Diagnostic images did not show abnormal findings, but neither bacterial nor fungal infections were detected in CSF analysis. All patients survived without sequelae except for one patient that presented ataxia for months. In conclusion, we described a group of children with neurological signs during severe dengue disease as the main finding, indicating the importance to including dengue as a differential diagnosis in neurological patients from endemic areas.

Whole-Body-Vibration Training and Balance in Recreational Athletes With Chronic Ankle Instability.

CONTEXT: Deficits in the propioceptive system of the ankle contribute to chronic ankle instability (CAI). Recently, whole-body-vibration (WBV) training has been introduced as a preventive and rehabilitative tool. OBJECTIVE: To evaluate how a 6-week WBV training program on an unstable surface affected balance and body composition in recreational athletes with CAI. DESIGN: Randomized controlled clinical trial. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Fifty recreational athletes with self-reported CAI were randomly assigned to a vibration (VIB), nonvibration (NVIB), or control group. INTERVENTION(S): The VIB and NVIB groups performed unilateral balance training on a BOSU 3 times weekly for 6 weeks. The VIB group trained on a vibration platform, and the NVIB group trained on the floor. MAIN OUTCOME MEASURE(S): We assessed balance using the Biodex Balance System and the Star Excursion Balance Test (SEBT). Body composition was measured by dual-energy x-ray absorptiometry. RESULTS: After 6 weeks of training, improvements on the Biodex Balance System occurred only on the Overall Stability Index ( P = .01) and Anterior-Posterior Stability Index ( P = .03) in the VIB group. We observed better performance in the medial ( P = .008) and posterolateral ( P = .04) directions and composite score of the SEBT in the VIB group ( P = .01) and in the medial ( P < .001), posteromedial ( P = .002), and posterolateral ( P = .03) directions and composite score of the SEBT in the NVIB group ( P < .001). No changes in body composition were found for any of the groups. CONCLUSIONS: Only the VIB group showed improvements on the Biodex Balance System, whereas the VIB and NVIB groups displayed better performance on the SEBT.

Effect of 6-weeks WBVT on the behaviour of the lower limb muscle fibres during vertical jumping.

The purpose of the current study was to examine the effect of 6 weeks of whole body vibration training (WBVT) on body composition, muscle activity of the gastrocnemius and vastus lateralis, gastrocnemius muscle architecture (static and dynamic) and ground reaction forces (performance jump) during the take-off phase of a countermovement jump in young healthy adult males. A total of 33 men (23.31 ± 5.62 years) were randomly assigned to a whole body vibration group (experimental group, EGWBVT: n = 17; 22.11 ± 4.97 years) or a control group (CG: n = 16; 24.5 ± 6.27 years). The total duration of the intervention phase (WBVT) was 6 weeks with a frequency of 3 sessions per week. Statistically significant differences were observed (P ≤ 0.05) between pre- and post-test in the power peak (Δ 1.91 W · kg-1; P = 0.001), take-off velocity (0.1 cm · s-1; P = 0.002) and jump height (Δ 0.4 cm; P = 0.002) for EGWBVT. There were no statistically significant differences in any of the body composition and muscle architecture variables. Moreover, no significant differences were found between EGWBVT and CG nor changes in muscle activity during take-off phase of the gastrocnemius and vastus lateralis pre- versus post-training. This study suggests that a 6-week WBVT programme with increasing intensity improves jump performance but does not alter muscle activity nor muscle architecture in healthy young men.

Effects of Synchronous Whole Body Vibration Training on a Soft, Unstable Surface in Athletes with Chronic Ankle Instability.

The aim of this study was to evaluate the effects of a 6-week WBV training program, performed on a soft, unstable surface, on peak torque, reaction time and the electrical activity of ankle muscles in recreational athletes with chronic ankle instability (CAI). 50 recreational athletes with self-reported unilateral CAI were randomly assigned to a vibration group (VIB), non-vibration group (N-VIB) or control group. The VIB and N-VIB groups performed unilateral balance training on the unstable ankle on a BOSU® Balance Trainer 3 times weekly for 6 weeks. The VIB group trained on a vibration platform, and the N-VIB group trained on the floor. Muscle reaction times and electrical activity of the peroneus brevis (PB), peroneus longus (PL) and tibialis anterior (TA) muscles were assessed in response to sudden inversion, isokinetic peak torque and isokinetic strength ratios of the ankle evertor muscles. After 6 weeks of training, a significant improvement was shown in reaction times of the PB (Pre=60.99±9.17 ms, Post1=54.90±6.99 ms, p=0.003), PL (Pre=61.20±10.72 ms, Post1=55.21±9.04 ms, p=0.007) and TA (Pre=65.31±11.78 ms, Post1=59.07±9.99 ms, p=0.007) muscles in the VIB group, whereas no significant changes were found in the N-VIB group or the control group. There were no significant changes in electrical activity, peak torque and eccentric-concentric ratio for any of the groups after training. In conclusion, a 6-week WBV training program on a soft, unstable surface improves the reaction times of the PB, PL and TA muscles in recreational athletes with CAI. Trial registration: ClinicalTrials.gov NCT02794194.

Gender variability in electromyographic activity, in vivo behaviour of the human gastrocnemius and mechanical capacity during the take-off phase of a countermovement jump.

PURPOSE: The purpose of this study was to analyse gender differences in neuromuscular behaviour of the gastrocnemius and vastus lateralis during the take-off phase of a countermovement jump (CMJ), using direct measures (ground reaction forces, muscle activity and dynamic ultrasound). METHODS: Sixty-four young adults (aged 18-25 years) participated voluntarily in this study, 35 men and 29 women. The firing of the trigger allowed obtainment of data collection vertical ground reaction forces (GRF), surface electromyography activity (sEMG) and dynamic ultrasound gastrocnemius of both legs. RESULTS: Statistically significant gender differences were observed in the jump performance, which appear to be based on differences in muscle architecture and the electrical activation of the gastrocnemius muscles and vastus lateralis. So while men developed greater peak power, velocity take-offs and jump heights, jump kinetics compared to women, women also required a higher electrical activity to develop lower power values. Additionally, the men had higher values pennation angles and muscle thickness than women. CONCLUSION: Men show higher performance of the jump test than women, due to significant statistical differences in the values of muscle architecture (pennation angle and thickness muscle), lower Neural Efficiency Index and a higher amount of sEMG activity per second during the take-off phase of a CMJ.

[Adrenal insufficiency in cirrhotic patients]. / Insuficiencia suprarrenal relativa en pacientes cirróticos.

Relative adrenal insufficiency (RAI) is a common finding in cirrhotic patients with severe sepsis, and increased mortality. Its significance is unknown in stable conditions. The aim of this study was to evaluate the prevalence of RAI in stable cirrhotic patients at different stages of the disease. Also, the impact of RAI on the survival was evaluated and basal cortisol levels between plasma and saliva was correlated in control subjects and cirrhotic patients. Forty seven ambulatory patients and 16 control subjects were studied. RAI was defined as a serum cortisol increase of less than 9 υg/dl from baseline after the stimulation with 250 mg of synthetic ACTH. Twenty two had Child-Pugh = 8 and 25 = 9. The prevalence of RAI in patients with stable cirrhosis was 22%. A higher incidence of RAI was observed in patients with a Child-Pugh = 9 (8/32) than in those with = 8 (3/13, p < 0.05). A correlation between salivary cortisol and basal plasma cortisol (r = 0.6, p < 0.0004) was observed. Finally, survival at 1 year (97%) and 3 years (91%) was significantly higher without RAI than those who developed this complication (79% and 51%, p < 0.05, respectively). In summary, the prevalence of RAI is frequent in patients with stable cirrhosis and that it is related to the severity of liver diseaseand increased mortality.

Insuficiencia suprarrenal relativa en pacientes cirróticos / Adrenal insufficiency in cirrhotic patients

La insuficiencia suprarrenal relativa (ISR) es frecuente en pacientes cirróticos con sepsis grave, asociándose a un pobre pronóstico. Se desconoce su importancia en condiciones de enfermedad estable. El objetivo del trabajo ha sido evaluar la prevalencia de la ISR en una serie de pacientes cirróticos estables y su relación con el deterioro de la función hepática. Se determinó el impacto de la ISR en la supervivencia y se correlacionaron los niveles entre el cortisol basal en plasma y saliva en sujetos controles y cirróticos. Fueron incluidos 47 pacientes ambulatorios y 16 controles. La funcionalidad del eje hipotalámico-pituitario-suprarrenal se valoró mediante la prueba de estimulación con 250 μg de ACTH sintética EV, definiendo la ISR como delta cortisol < 9 μg/dl. Respecto al grado de deterioro de la función hepática, 22 tenían un Child-Pugh ≤ 8 y 25 pacientes = 9. La prevalencia de ISR fue de un 22%, siendo significativamente más elevada en aquellos con mayor deterioro de la función hepática (8/32 vs. 3/13, p < 0.05). Se observó correlación entre el cortisol salival y el plasmático basal (r = 0.6, p < 0.0004). Por último, la supervivencia fue más elevada en los pacientes sin ISR al año (97%) y a los tres años (91%) que aquellos que desarrollaron esta complicación (79 % y 51%, p < 0.05, respectivamente). En resumen, la prevalencia de ISR es elevada en los pacientes con cirrosis estable y se relaciona con un deterioro de la función hepática y una mayor mortalidad.

Relative adrenal insufficiency (RAI) is a common finding in cirrhotic patients with severe sepsis, and increased mortality. Its significance is unknown in stable conditions. The aim of this study was to evaluate the prevalence of RAI in stable cirrhotic patients at different stages of the disease. Also, the impact of RAI on the survival was evaluated and basal cortisol levels between plasma and saliva was correlated in control subjects and cirrhotic patients. Forty seven ambulatory patients and 16 control subjects were studied. RAI was defined as a serum cortisol increase of less than 9 μg/dl from baseline after the stimulation with 250 mg of synthetic ACTH. Twenty two had Child-Pugh ≤ 8 and 25 = 9. The prevalence of RAI in patients with stable cirrhosis was 22%. A higher incidence of RAI was observed in patients with a Child-Pugh = 9 (8/32) than in those with ≤ 8 (3/13, p < 0.05). A correlation between salivary cortisol and basal plasma cortisol (r = 0.6, p < 0.0004) was observed. Finally, survival at 1 year (97%) and 3 years (91%) was significantly higher without RAI than those who developed this complication (79% and 51%, p < 0.05, respectively). In summary, the prevalence of RAI is frequent in patients with stable cirrhosis and that it is related to the severity of liver diseaseand increased mortality.

Effects of 6-week whole body vibration training on the reflex response of the ankle muscles: a randomized controlled trial.

BACKGROUND: The ligament sprain of the lateral ankle is the most frequent injury that occurs when participating in sports. Whole body vibration (WBV) is a training method that has been recently introduced as a rehabilitative tool for treatment of athletes. It has been hypothesized that the transmission of mechanical oscillations from the vibrating platform may lead to physiological changes in muscle spindles, joint mechanoreceptors, as well as improve balance. PURPOSE: [corrected] The aim of this study was to assess the effects of a 6-week WBV training program on the reflex response mechanism of the peroneus longus (PL), peroneus brevis (PB) and anterior tibialis (AT) muscles in ankle inversion at 30º from horizontal, in a static position. METHODS: This study was a single-blinded and randomized controlled trial. Forty-four healthy, physically active participants were randomly split into two groups: the experimental group (n = 26) (the WBV training) and control group (n = 18). Reaction time (RT), maximum electromyographic (EMG) peak (peak EMG), time to the maximum peak EMG (peak EMG time) and reflex electrical activity of all the muscles were assessed before and after the WBV training through surface EMG. RESULTS: After 6-weeks WBV training, there were no significant changes in the variables analysed for all the muscles involved. CONCLUSION: A 6-week WBV training does not improve the reflex response mechanism of the lateral stabilizing muscles of the ankle. LEVEL OF EVIDENCE: 1b.

Método de diagnóstico y prevención del esguince crónico de tobillo / Diagnosis and prevention method of chronic ankle sprain

Introducción: El esguince del complejo ligamentoso lateral de la articulación del tobillo es la lesión que se produce con más frecuencia durante la práctica deportiva. Se considera fundamental el papel que juega la musculatura que envuelve la articulación en la protección dinámica de la misma. El propósito de este estudio ha sido comparar el tiempo de reacción de los músculos peroneo largo, peroneo corto y tibial anterior en tobillos funcionalmente inestables y en tobillos sanos. Material y método: Muestra: Formaron parte del estudio un total de 33 participantes distribuidos en dos grupos, GI (n =17) con inestabilidad funcional en uno de sus tobillos, y GC (n = 16) con tobillos sanos. Variables: las variables estudiadas fueron el tiempo de reacción de los tres músculos, el pico electromiográfico máximo durante la inversión, el tiempo hasta la consecución de este valor, la activación muscular media enel momento de la inversión y el tiempo que dura la inversión. También se estudiaron las variables antropométricas (talla, peso, masa musculoesquelética, masa grasa, masa musculoesquelética de la pierna estudiada) de los participantes. Protocolo: primero se realizó el test de composición corporal, para posteriormente realizar los test de contracción voluntaria máxima de los tres músculos y finalizar con el test de inversión de tobillo. Resultados: los participantes que pertenecían al GI tuvieron un tiempo de reacción significativamente mayor en los músculos peroneo largo y peroneo corto (57 ms y 57,2 ms respectivamente) que el GC (46,3 ms y 47,6 ms). No se obtuvieron diferencias significativas en el músculo tibial anterior. Conclusiones: la inestabilidad funcional del tobillo provoca un aumento en los tiempos de reacción de la musculatura estabilizadora de esta articulación, aumentando el riesgo de padecer una nueva lesión (AU)

Introduction: Ankle sprains are very common during sports and occur most commonly those affecting the lateral ligament complex. Once produced this injury, there is a high probability that symptoms during over time, thus becoming a chronic type injury. It is believed that the stabilizing musculature of the joint must be strong enough to counteract the mechanism of this injury. The aim of this study was to compare the reaction time of the peroneus longus, peroneus brevis and tibialis anterior in unstable and healthy functionally ankles. Methods: Subjects: participated in the study a total of 33subjects divided into two groups: GI (n = 17) with instability functional in one of theirs ankles, and GC (n = 16) with healthy ankles. Variables: The variables studied were the reaction time of the three muscles, the maximum peak of EMG during inversion time, the average muscle activation of inversion time and the inversion duration. It examined the anthropometric variables (height, weight, skeletal muscle mass, fat mass, leg skeletal muscle mass under study) of the subjects. Protocol: first we made the body composition test, later to perform the of maximum voluntary contraction of the three muscles test and finally the inversion ankle test.Results: GI had a significantly longer reaction time in the peroneus longus and brevis (57 ms and 57.2 ms respectively)than the CG (46.3 ms and 47.6 ms). There were no significant differences in tibialis anterior. Conclusions: functional ankle instability causes an increase in reaction times of the muscle stabilized ankle, increasing the risk of reinjury (AU)