Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.775
Filtrar
1.
Crit Care ; 24(1): 86, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164739

RESUMO

BACKGROUND: Whereas ICU-acquired weakness may delay extubation in mechanically ventilated patients, its influence on extubation failure is poorly known. This study aimed at assessing the role of ICU-acquired weakness on extubation failure and the relation between limb weakness and cough strength. METHODS: A secondary analysis of two previous prospective studies including patients at high risk of reintubation after a planned extubation, i.e., age greater than 65 years, with underlying cardiac or respiratory disease, or intubated for more than 7 days prior to extubation. Patients intubated less than 24 h and those with a do-not-reintubate order were not included. Limb and cough strength were assessed by a physiotherapist just before extubation. ICU-acquired weakness was clinically diagnosed as limb weakness defined as Medical Research Council (MRC) score < 48 points and severe weakness as MRC sum-score < 36. Cough strength was assessed using a semi-quantitative 5-Likert scale. Extubation failure was defined as reintubation or death within the first 7 days following extubation. RESULTS: Among 344 patients at high risk of reintubation, 16% experienced extubation failure (56/344). They had greater severity and lower MRC sum-score (41 ± 16 vs. 49 ± 13, p < 0.001) and were more likely to have ineffective cough than the others. The prevalence of ICU-acquired weakness at the time of extubation was 38% (130/244). The extubation failure rate was 12% (25/214) in patients with no limb weakness vs. 18% (12/65) and 29% (19/65) in those with moderate and severe limb weakness, respectively (p < 0.01). MRC sum-score and cough strength were weakly but significantly correlated (rho = 0.28, p < .001). After multivariate logistic regression analyses, the lower the MRC sum-score the greater the risk of reintubation; severe limb weakness was independently associated with extubation failure, even after adjustment on cough strength and severity at admission. CONCLUSION: ICU-acquired weakness was diagnosed in 38% in this population of patients at high risk at the time of extubation and was independently associated with extubation failure in the ICU.


Assuntos
Extubação/efeitos adversos , Unidades de Terapia Intensiva , Debilidade Muscular/epidemiologia , Respiração Artificial , Desmame do Respirador , Idoso , Feminino , Humanos , Intubação Intratraqueal/estatística & dados numéricos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Prevalência , Respiração Artificial/estatística & dados numéricos , Resultado do Tratamento , Desmame do Respirador/estatística & dados numéricos
2.
Medicine (Baltimore) ; 99(10): e19337, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150072

RESUMO

OBJECTIVE: To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke. DESIGN: Prospective, randomized controlled trial. SETTING: Tertiary hospital. PARTICIPANTS: The trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups. INTERVENTION: Inspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks. MAIN OUTCOME MEASURES: MIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis. RESULTS: Significant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups. CONCLUSIONS: Altogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria.Clinical trial registration number (Clinical Trial Identifier): NCT03491111.


Assuntos
Exercícios Respiratórios/métodos , Transtornos de Deglutição/terapia , Disartria/terapia , Debilidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Exercícios Respiratórios/normas , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Disartria/etiologia , Disartria/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Estudos Prospectivos , Músculos Respiratórios/fisiopatologia , Estatísticas não Paramétricas , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia
3.
Einstein (Sao Paulo) ; 18: eRC5041, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32074223

RESUMO

The yellow fever is a systemic disease that was under control due to the effective campaigns against the vector and promotion of vaccines programs. However, since 1999, outbreaks appeared because of inefficient control of the vector, and led to the need of amplifying the immunization in large scale against the yellow fever virus, and consequently, raising the risk of adverse reactions to the vaccine. We report a case of previously healthy infant, who was referred to our care service, after 3 days with fever, chills, nausea and vomits, he received support therapy and was discharged from the hospital. After 24 hours of supportive measures, he was discharge. The patient returned to our service with general condition decline, strabismus, inability to control of cervical musculature and reduced force of the legs. The patient vaccine had received all vaccines from the calendar, and he was vaccinated for yellow fever 20 days before symptoms. During the hospitalization, liquor was collected, and ceftriaxone and aciclovir were administered. After negative cultures from the liquor, the antibiotics were suspended. The computed tomography of patient's brain showed no alterations. Research for antibodies against yellow fever was requested, being positive for IgM in the liquor, and confirming the neurotropic disease associated with the yellow fever vaccine. On the fifth day of hospitalization, the patient showed improvement on the strabismus, cervical tonus, and musculature force. On the tenth day of hospitalization, patient showed complete improvement, and his laboratory exams no alterations. Subsequently, patient was discharged. The vaccine against yellow fever is safe, efficient and highly recommended, however it is not completely free from serious adverse reactions, including death.


Assuntos
Doenças do Sistema Nervoso/etiologia , Vacina contra Febre Amarela/efeitos adversos , Humanos , Imunoglobulina M/análise , Lactente , Masculino , Debilidade Muscular/etiologia , Estrabismo/etiologia
4.
Muscle Nerve ; 61(1): 74-80, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31588568

RESUMO

BACKGROUND: Nephropathic cystinosis is a lysosomal storage disorder. Patient survival years after renal transplantation has revealed systemic complications including distal myopathy and dysphagia. METHODS: We evaluated 20 adult patients with nephropathic cystinosis using patient-reported and clinical outcome measures. Standard motor measures, video fluoroscopy swallow studies, and tests of respiratory function were performed. We also used Rasch analysis of an initial survey to design a 16-item survey focused on upper and lower extremity function, which was completed by 31 additional patients. RESULTS: Distal myopathy and dysphagia were common in patients with nephropathic cystinosis. Muscle weakness ranges from mild involvement of intrinsic hand muscles to prominent distal greater than proximal weakness and contractures. CONCLUSIONS: In addition to further characterization of underlying dysphagia and muscle weakness, we propose a new psychometrically devised, disease specific, functional outcome measures for distal myopathy in patients with nephropathic cystinosis.


Assuntos
Cistinose/complicações , Miopatias Distais/diagnóstico , Adulto , Cistinose/psicologia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Miopatias Distais/etiologia , Miopatias Distais/psicologia , Extremidades/fisiopatologia , Feminino , Mãos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Músculo Esquelético/fisiopatologia , Exame Neurológico , Psicometria , Testes de Função Respiratória , Autorrelato , Resultado do Tratamento , Adulto Jovem
8.
BMC Neurol ; 19(1): 301, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775676

RESUMO

BACKGROUND: McLeod syndrome is a rare X-linked recessive acanthocytosis associated with neurological manifestations including progressive chorea, cognitive impairment, psychiatric disturbances, seizures, and sensorimotor axonal polyneuropathy. However, no studies have investigated the functioning of central sensorimotor tracts in patients with McLeod syndrome. CASE PRESENTATION: A 66-year-old man had experienced slowly progressive chorea and gait disturbance due to lower limb muscle weakness since his early fifties. Blood examinations showed erythrocyte acanthocytosis and the reduction of Kell antigens in red blood cells. Brain magnetic resonance imaging showed atrophy of the bilateral caudate nuclei and putamen. The diagnosis of McLeod syndrome was confirmed by the presence of a mutation of the XK gene on the X chromosome. Somatosensory-evoked potential and transcranial magnetic stimulation studies demonstrated that the central sensory and motor conduction times were abnormally prolonged for the lower extremity but normal for the upper extremity. CONCLUSIONS: This is the first report of the involvement of the central sensorimotor tracts for the legs in a patient with McLeod syndrome. The clinical neurophysiological technique revealed the central sensorimotor tracts involvements clinically masked by neuropathy.


Assuntos
Neuroacantocitose/diagnóstico , Idoso , Atrofia , Humanos , Imagem por Ressonância Magnética , Masculino , Transtornos dos Movimentos/etiologia , Debilidade Muscular/etiologia , Mutação
9.
Muscle Nerve ; 60(6): 679-686, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31566774

RESUMO

INTRODUCTION: The purpose of this study was to comprehensively evaluate respiratory muscle function in adults with facioscapulohumeral muscular dystrophy (FSHD). METHODS: Fourteen patients with FSHD (9 men, 53 ± 16 years of age) and 14 matched controls underwent spirometry, diaphragm ultrasound, and measurement of twitch gastric and transdiaphragmatic pressures (twPgas and twPdi; n = 10) after magnetic stimulation of the lower thoracic nerve roots and the phrenic nerves. The latter was combined with recording of diaphragm compound muscle action potentials (CMAPs; n = 14). RESULTS: The following parameters were significantly lower in patients vs controls: forced vital capacity (FVC); maximum inspiratory and expiratory pressure; peak cough flow; diaphragm excursion amplitude; and thickening ratio on ultrasound, twPdi (11 ± 5 vs 20 ± 6 cmH2 O) and twPgas (7 ± 3 vs 25 ± 20 cmH2 O). Diaphragm CMAP showed no group differences. FVC correlated inversely with the clinical severity scale score (r = -0.63, P = .02). DISCUSSION: In FSHD, respiratory muscle weakness involves both the diaphragm and the expiratory abdominal muscles.


Assuntos
Diafragma/fisiopatologia , Debilidade Muscular/fisiopatologia , Distrofia Muscular Facioescapuloumeral/fisiopatologia , Músculos Respiratórios/fisiopatologia , Potenciais de Ação/fisiologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Diafragma/diagnóstico por imagem , Feminino , Humanos , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Distrofia Muscular Facioescapuloumeral/complicações , Condução Nervosa , Nervo Frênico , Raízes Nervosas Espinhais , Espirometria , Vértebras Torácicas , Ultrassonografia , Capacidade Vital
10.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586958

RESUMO

Bilateral symmetrical weakness of acute onset is not very uncommon and the differential varies widely from life-threatening neurological illnesses to metabolic and electrolyte derangements. We report the case of a young female with severe muscle weakness, respiratory distress and hypokalemia who required immediate intubation on arrival to emergency department. During hospital course, even after normalisation of serum potassium and some improvement in limb weakness, patient failed multiple attempts of extubation because of type II respiratory failure. Subsequently, acetyl cholinesterase antibodies were checked which came out positive, and diagnosis of myasthenia gravis and hypokalemic periodic paralysis was made. She was successfully extubated after intravenous pulse steroids, pyridostigmine and plasmapheresis. Patient was finally discharged home on oral steroids, pyridostigmine and azathioprine. In a patient presenting with hypokalemic weakness, the suspicion of a second disorder should be very high if weakness fails to resolve following correction of hypokalemia.


Assuntos
Paralisia Periódica Hipopotassêmica/diagnóstico , Miastenia Gravis/diagnóstico , Insuficiência Respiratória/diagnóstico , Adulto , Análise Química do Sangue , Colinesterases/sangue , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Paralisia Periódica Hipopotassêmica/sangue , Paralisia Periódica Hipopotassêmica/complicações , Infusões Intravenosas , Debilidade Muscular/etiologia , Miastenia Gravis/sangue , Miastenia Gravis/complicações , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/uso terapêutico , Respiração Artificial , Insuficiência Respiratória/complicações
13.
Neurology ; 93(19): e1756-e1767, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31619483

RESUMO

OBJECTIVE: To determine the effects of 10 years of enzyme replacement therapy (ERT) in adult patients with Pompe disease, focusing on individual variability in treatment response. METHODS: In this prospective, multicenter cohort study, we studied 30 patients from the Netherlands and France who had started ERT during the only randomized placebo-controlled clinical trial with ERT in late-onset Pompe disease (NCT00158600) or its extension (NCT00455195) in 2005 to 2008. Main outcomes were walking ability (6-minute walk test [6MWT]), muscle strength (manual muscle testing using Medical Research Council [MRC] grading), and pulmonary function (forced vital capacity [FVC] in the upright and supine positions), assessed at 3- to 6-month intervals before and after the start of ERT. Data were analyzed with linear mixed-effects models for repeated measurements. RESULTS: Median follow-up duration on ERT was 9.8 years (interquartile range [IQR] 8.3-10.2 years). At the group level, baseline 6MWT was 49% of predicted (IQR 41%-60%) and had deteriorated by 22.2 percentage points (pp) at the 10-year treatment point (p < 0.001). Baseline FVC upright was 54% of predicted (IQR 47%-68%) and decreased by 11 pp over 10 years (p < 0.001). Effects of ERT on MRC sum score and FVC supine were similar. At the individual level, 93% of patients had initial benefit of ERT. Depending on the outcome measured, 35% to 63% of patients had a secondary decline after ≈3 to 5 years. Still, at 10 years of ERT, 52% had equal or better 6MWT and/or FVC upright compared to baseline. CONCLUSIONS: The majority of patients with Pompe disease benefit from long-term ERT, but many patients experience some secondary decline after ≈3 to 5 years. Individual variation, however, is considerable. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for the majority of adults with Pompe disease, long-term ERT positively affects, or slows deterioration in, muscle strength, walking ability, and/or pulmonary function.


Assuntos
Terapia de Reposição de Enzimas , Doença de Depósito de Glicogênio Tipo II/tratamento farmacológico , alfa-Glucosidases/uso terapêutico , Adulto , Estudos de Coortes , Feminino , Seguimentos , França , Doença de Depósito de Glicogênio Tipo II/complicações , Doença de Depósito de Glicogênio Tipo II/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Força Muscular , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Países Baixos , Ventilação não Invasiva/estatística & dados numéricos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Resultado do Tratamento , Capacidade Vital , Teste de Caminhada , Cadeiras de Rodas
14.
Muscle Nerve ; 60(6): 724-731, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531865

RESUMO

INTRODUCTION: There is currently little evidence regarding oculopharyngeal muscular dystrophy (OPMD) disease burden reported by patients. In this study we aim to elicit direct patient input regarding OPMD disease burden. METHODS: We conducted semistructured interviews with 25 participants with genetically confirmed OPMD and a wide range of disease duration (15 ± 8 years). Using the Framework Technique, themes and categories were then extracted. RESULTS: Analyses revealed 7 themes (physical impact, mental impact, social impact, perception of progression, treatment perceptions, coping strategies, and access to disease information), encompassing 27 categories of OPMD disease burden. The most frequent categories were related to dysphagia, coping strategies for dysphagia, and impaired mobility. DISCUSSION: This study demonstrates the importance of considering, when providing clinical care, the broad range of coping strategies patients use to deal with OPMD symptoms, especially dysphagia, to properly assess limitations and monitor real disease progression.


Assuntos
Distrofia Muscular Oculofaríngea/fisiopatologia , Distrofia Muscular Oculofaríngea/psicologia , Acesso à Informação , Adaptação Psicológica , Adolescente , Adulto , Idoso , Atitude Frente a Saúde , Transtornos Dismórficos Corporais , Criança , Efeitos Psicossociais da Doença , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Distrofia Muscular Oculofaríngea/complicações , Distrofia Muscular Oculofaríngea/terapia , Dor/etiologia , Dor/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Pesquisa Qualitativa , Participação Social , Distúrbios da Voz/etiologia , Distúrbios da Voz/fisiopatologia , Desempenho Profissional , Adulto Jovem
15.
World Neurosurg ; 132: e162-e168, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31513953

RESUMO

BACKGROUND: Common signs and symptoms of cervical myelopathy (CM) predominantly manifest in the upper extremities and include hand numbness, hand clumsiness, and distal upper extremity weakness. CM manifesting without symptoms in the upper extremities is rare. This study aimed to better understand the incidence and character of such cases. METHODS: A retrospective review of surgeries for CM from disc herniation, spondylosis, or ossification of posterior longitudinal ligament over a 12-year period was performed to identify patients presenting without symptoms in the upper extremities. RESULTS: Of 982 surgically treated patients with CM, 12 (1.2%) had no upper extremity symptoms. All had difficulty ambulating, and 7 of 12 (58%) patients had objective lower extremity weakness. Ten (83%) patients had a history of lumbar degenerative disease. On sensory examination, 4 (33%) patients had a discernible midthoracic pin level, 3 (25%) had loss of sensation from the upper leg and genital area down, and 2 (17%) had only genital/upper thigh area sensory loss. All patients demonstrated neurologic improvement after decompressive surgery. CONCLUSIONS: Patients with CM may rarely present without symptoms in the upper extremities, presenting with numbness perceived from the upper trunk, waist area, or perineum and legs in addition to leg weakness and gait difficulty. All patients had cervical cord compression at either C5-6 or C6-7 level, accounting for 1% of all patients undergoing cervical surgery. Awareness of this atypical pattern of presentation may aid in clinical assessment of a subset of patients with cervical cord compression.


Assuntos
Vértebras Cervicais/cirurgia , Doenças da Medula Espinal/cirurgia , Extremidade Superior , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Descompressão Cirúrgica , Feminino , Humanos , Hipestesia/etiologia , Incidência , Degeneração do Disco Intervertebral/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Debilidade Muscular/etiologia , Estudos Retrospectivos , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/epidemiologia , Compressão da Medula Espinal/cirurgia , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/epidemiologia , Resultado do Tratamento
17.
World Neurosurg ; 132: 309-313, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31525482

RESUMO

INTRODUCTION: Rosai-Dorfman disease (RDD) is a rare disease that can be triggered by either viral or bacterial infection. Several parts of the body can be involved, from the central nervous system to the pelvic regions had been reported. At present, there is a serious lack of guidelines as to how to treat cases of RDD involving the spine. Current trends show that surgery remains the first method of choice to cure this disease, but in refractory or recurrent RDD, repeat surgery cannot guarantee total resection. Under such circumstances, adjuvant therapy can be very useful. Here, we share our experience of treating recurrent spinal RDD. CASE DESCRIPTION: Our patient was a 32-year-old male patient with hepatitis B virus infection. He suffered from lower back pain with lower limb weakness after being hit by a metal pipe. Laminectomy of T11-12 was performed to decompress the spinal cord. The final pathological results demonstrated chronic inflammation. After surgery, the lower limbs improved and the patient recovered quite well. However, he returned 3 years later with the same complaints and was diagnosed with RDD. Durectomy was performed and repaired with an artificial dura. Thalidomide therapy was initiated. Currently, 9 years later, the patient has not experienced recurrence or any form of neurological deficit. CONCLUSIONS: RDD is a rare disease and can be misdiagnosed easily. Although it may resolve spontaneously, recurrence is possible. Hence, extensive follow-up is necessary. Surgery remained the first choice of surgery, however, when encountered recurrent or nonresectable RDD, adjuvant therapy such as corticosteroids, thalidomide, and radiotherapy could help. In this article, we shared our experience using thalidomide in treating nonresectable RDD.


Assuntos
Histiocitose Sinusal/terapia , Imunossupressores/uso terapêutico , Doenças da Coluna Vertebral/terapia , Talidomida/uso terapêutico , Vértebras Torácicas/cirurgia , Adulto , Histiocitose Sinusal/complicações , Histiocitose Sinusal/diagnóstico por imagem , Histiocitose Sinusal/patologia , Humanos , Dor Lombar/etiologia , Extremidade Inferior , Masculino , Debilidade Muscular/etiologia , Recidiva , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/patologia
18.
BMJ Case Rep ; 12(9)2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31537606

RESUMO

Oculopharyngeal muscular dystrophy (OPMD) is a relatively rare, adult-onset disorder characterised by proximal limb weakness, progressive eyelid drooping and swallowing difficulties. Preliminary research suggests there could be a link between OPMD and dementia; however, the current literature is relatively limited and inconsistent. This case study describes a 75-year-old female with OPMD, presenting to an older adults community mental health team with memory problems and word finding difficulties. A neuropsychological assessment was carried out. The results of her assessment were difficult to interpret; she demonstrated impairments in most cognitive domains tested and her presentation did not appear to reflect any typical dementia profile. It was thought she was most likely presenting with a dementia; however, the exact aetiology remains unclear. The dementia could be a result of OPMD, vascular changes or both. This report emphasises the need for further research into the possible causal link between OPMD and dementia/cognitive decline.


Assuntos
Disfunção Cognitiva , Demência/complicações , Distrofia Muscular Oculofaríngea/complicações , Idoso , Blefaroptose/etiologia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Debilidade Muscular/etiologia , Testes Neuropsicológicos
19.
Clin Interv Aging ; 14: 1399-1405, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496667

RESUMO

Purpose: The purpose of this study was to evaluate the association between the early stages of lumbar spinal stenosis (LSS) and the risk of locomotive syndrome, as well as its effect upon muscle strength of the back, upper extremities, and lower extremities. Patients and methods: LSS was diagnosed with a self-administered, self-reported history questionnaire. Participants (n=113) who agreed to be tested by the diagnostic support tool for LSS underwent three risk tests for locomotive syndrome: a stand-up test, a two-step test, and a 25-question Geriatric Locomotive Function Scale (GLFS-25), as well as measurements of the strength of their grip, back extensor, hip flexor, and knee extensor muscles. Results: Twenty-three participants were diagnosed with LSS by the questionnaire. Results of the stand-up test in the LSS group were significantly worse than those in the no-LSS group (P=0.003). The results of the two-step test and the total score on the GLFS-25 in the LSS group were significantly worse than those in the no-LSS group (P=0.002 and P<0.0001, respectively). The stages of locomotive syndrome assessed by the stand-up test, two-step test, and the GLFS-25 were significantly worse in the LSS group than in the no-LSS group (P=0.0004, P=0.0007, and P<0.0001, respectively). Hip flexor and knee extensor strength, but not grip and back extensor strength, in the LSS group were significantly lower than that in the no-LSS group. Conclusions: LSS diagnosed using the self-reported support tool worsened the stage of locomotive syndrome in older people. Furthermore, participants with LSS had significant lower extremity weakness.


Assuntos
Extremidade Inferior/fisiopatologia , Limitação da Mobilidade , Debilidade Muscular/etiologia , Estenose Espinal/complicações , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Estenose Espinal/diagnóstico , Inquéritos e Questionários , Síndrome
20.
Rinsho Shinkeigaku ; 59(9): 579-583, 2019 Sep 25.
Artigo em Japonês | MEDLINE | ID: mdl-31474644

RESUMO

Many cases of acute flaccid paralysis occurred during an enterovirus D68 (EV-D68) outbreak in North America in the fall of 2014, and this epidemic has been newly defined as a distinct disease entity named acute flaccid myelitis (AFM). This disease entity is relatively popular among pediatricians, whereas it remains little-known among neurologists in Japan. We reported a 7-year-old girl with AFM, in whom severe limb weakness and respiratory failure developed five days after appearance of respiratory symptoms. Clinical features of our case were mimicked by those of acute axonal motor neuropathy at early stage of the disease, and this resulted in delayed diagnosis of AFM. DNA of EV-D68 was not detected. There are few reported cases of severe AFM, in which artificial ventilation is needed for a long time including both acute and recovery phases of the illness, and functional prognosis of AFM is discussed by literature.


Assuntos
Mielite Transversa/terapia , Insuficiência Respiratória/terapia , Doença Aguda , Criança , Diagnóstico Tardio , Enterovirus Humano D , Infecções por Enterovirus/complicações , Extremidades , Feminino , Humanos , Debilidade Muscular/etiologia , Mielite Transversa/diagnóstico , Mielite Transversa/etiologia , Respiração Artificial , Insuficiência Respiratória/etiologia , Índice de Gravidade de Doença
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA