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1.
Int J Mol Sci ; 21(21)2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33105809

RESUMO

Intensive care unit-acquired weakness (ICUAW) occurs in critically ill patients stemming from the critical illness itself, and results in sustained disability long after the ICU stay. Weakness can be attributed to muscle wasting, impaired contractility, neuropathy, and major pathways associated with muscle protein degradation such as the ubiquitin proteasome system and dysregulated autophagy. Furthermore, it is characterized by the preferential loss of myosin, a distinct feature of the condition. While many risk factors for ICUAW have been identified, effective interventions to offset these changes remain elusive. In addition, our understanding of the mechanisms underlying the long-term, sustained weakness observed in a subset of patients after discharge is minimal. Herein, we discuss the various proposed pathways involved in the pathophysiology of ICUAW, with a focus on the mechanisms underpinning skeletal muscle wasting and impaired contractility, and the animal models used to study them. Furthermore, we will explore the contributions of inflammation, steroid use, and paralysis to the development of ICUAW and how it pertains to those with the corona virus disease of 2019 (COVID-19). We then elaborate on interventions tested as a means to offset these decrements in muscle function that occur as a result of critical illness, and we propose new strategies to explore the molecular mechanisms of ICUAW, including serum-related biomarkers and 3D human skeletal muscle culture models.


Assuntos
Infecções por Coronavirus/complicações , Cuidados Críticos , Debilidade Muscular/etiologia , Atrofia Muscular/etiologia , Pneumonia Viral/complicações , Animais , Infecções por Coronavirus/terapia , Humanos , Doença Iatrogênica , Debilidade Muscular/fisiopatologia , Debilidade Muscular/prevenção & controle , Atrofia Muscular/fisiopatologia , Atrofia Muscular/prevenção & controle , Pandemias , Pneumonia Viral/terapia
2.
BMJ Case Rep ; 13(9)2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32958554

RESUMO

Clinical manifestations of COVID-19 are known to be variable with growing evidence of nervous system involvement. In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). We present a case of a 58-year-old woman who was initially diagnosed with COVID-19 pneumonia due to symptoms of fever and cough. Two weeks later, after the resolution of upper respiratory tract symptoms, she developed symmetric ascending quadriparesis and paresthesias. The diagnosis of GBS was made through cerebrospinal fluid analysis and she was successfully treated with intravenous immunoglobulin administration.


Assuntos
Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/fisiopatologia , Dor Lombar/fisiopatologia , Debilidade Muscular/fisiopatologia , Parestesia/fisiopatologia , Pneumonia Viral/complicações , Analgésicos/uso terapêutico , Betacoronavirus , Encéfalo/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico , Diagnóstico Diferencial , Feminino , Gabapentina/uso terapêutico , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/terapia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Radiculopatia/diagnóstico , Medula Espinal/diagnóstico por imagem
3.
PLoS One ; 15(9): e0238445, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877421

RESUMO

AIM: Our aim was to determine if synergy weights and activations are altered in Duchenne muscular dystrophy (DMD) and if these alterations could be linked to muscle weakness. METHODS: In 22 children with DMD and 22 typical developing (TD) children of a similar age, surface electromyography (sEMG) of the gluteus medius, rectus femoris (REF), medial hamstrings, tibialis anterior, and medial gastrocnemius (GAS) were recorded during gait. Muscle weakness was assessed with maximal voluntary isometric contractions (MVIC). Synergies were calculated with non-negative matrix factorization. The number of synergies explaining ≥90% of the variance in the sEMG signals (N90), were extracted and grouped with k-means cluster analysis. We verified differences in weights with a Mann-Whitney U test. Statistical non-parametric mapping (Hotelling's T2 test and two-tailed t-test) was used to assess group differences in synergy activations. We used Spearman's rank correlation coefficients and canonical correlation analysis to assess if weakness was related to modifications in weights and activations, respectively. RESULTS: For both groups, average N90 was three. In synergy one, characterized by activity at the beginning of stance, the DMDs showed an increased REF weight (p = 0.001) and decreased GAS weight (p = 0.007). Synergy activations were similar, with only a small difference detected in mid-swing in the combined activations (p<0.001). Weakness was not associated with these differences. CONCLUSION: Despite the apparent weakness in DMD, synergy weights and activations were similar between the two groups. Our findings are in line with previous research suggesting non-neural alterations have limited influence on muscle synergies.


Assuntos
Marcha/fisiologia , Debilidade Muscular/fisiopatologia , Distrofia Muscular de Duchenne/fisiopatologia , Fenômenos Biomecânicos , Criança , Eletromiografia/métodos , Feminino , Transtornos Neurológicos da Marcha/complicações , Humanos , Contração Isométrica , Masculino , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Distrofia Muscular de Duchenne/metabolismo
4.
Eur Rev Med Pharmacol Sci ; 24(15): 8210-8218, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767351

RESUMO

OBJECTIVE: To explore the CT imaging features/signs of patients with different clinical types of Coronavirus Disease 2019 (COVID-19) via the application of artificial intelligence (AI), thus improving the understanding of COVID-19. PANTIENTS AND METHODS: Clinical data and chest CT imaging features of 58 patients confirmed with COVID-19 in the Fifth Medical Center of PLA General Hospital were retrospectively analyzed. According to the Guidelines on Novel Coronavirus-Infected Pneumonia Diagnosis and Treatment (Provisional 6th Edition), COVID-19 patients were divided into mild type (7), common type (34), severe type (7) and critical type (10 patients). The CT imaging features of the patients with different clinical types of COVID-19 types were analyzed, and the volume percentage of pneumonia lesions with respect to the lung lobes (where the lesion was located) and to the whole lung was calculated with the use of AI software. SPSS 21.0 software was used for statistical analysis. RESULTS: Common clinical manifestations of COVID-19 patients: fever was found in 47 patients (81.0%), cough in 31 (53.4%) and weakness in 10 (17.2%). Laboratory examinations: normal or decreased white blood cell (WBC) counts were observed in 52 patients (89.7%), decreased lymphocyte counts (LCs) in 14 (24.1%) and increased C-reactive protein (CRP) levels in 18 (31.0%). CT imaging features: there were 48 patients (94.1%) with lesions distributed in both lungs and 46 patients (90.2%) had lesions most visible in the lower lungs; the primary manifestations in patients with common type COVID-19 were ground-glass opacities (GGOs) (23/34, 67.6%) or mixed type (17/34, 50.0%), with lesions mainly distributed in the periphery of the lungs (28/34, 82.4%); the primary manifestations of patients with severe/critical type COVID-19 were consolidations (13/17, 76.5%) or mixed type (14/17, 82.4%), with lesions distributed in both the peripheral and central areas of lungs (14/17,82.4%); other common signs, including pleural parallel signs, halo signs, vascular thickening signs, crazy-paving signs and air bronchogram signs, were visible in patients with different clinical types, and pleural effusion was found in 5 patients with severe/critical COVID-19. AI software was used to calculate the volume percentages of pneumonia lesions with respect to the lung lobes (where the lesion was located) and to the whole lung. There were significant differences in the volume percentages of pneumonia lesions for the superior lobe of the left lung, the inferior lobe of the left lung, the superior lobe of the right lung, the inferior lobe of the right lung and the whole lung among patients with different clinical types (p<0.05). The area under the ROC curve (AUC) of the volume percentage of pneumonia lesions for the whole lung for the diagnosis of severe/critical type COVID-19 was 0.740, with sensitivity and specificity of 91.2% and 58.8%, respectively. CONCLUSIONS: The clinical and CT imaging features of COVID-19 patients were characteristic to a certain degree; thus, the clinical course and severity of COVID-19 could be evaluated with a combination of an analysis of clinical features and CT imaging features and assistant diagnosis by AI software.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/fisiopatologia , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Inteligência Artificial , Betacoronavirus , Proteína C-Reativa/metabolismo , Infecções por Coronavirus/classificação , Infecções por Coronavirus/metabolismo , Tosse/fisiopatologia , Estado Terminal , Feminino , Febre/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador , Linfopenia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/fisiopatologia , Pandemias/classificação , Pneumonia Viral/classificação , Pneumonia Viral/metabolismo , Estudos Retrospectivos , Índice de Gravidade de Doença , Software , Tomografia Computadorizada por Raios X , Adulto Jovem
5.
Ann Palliat Med ; 9(5): 2993-2999, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32819125

RESUMO

BACKGROUND: To investigate the epidemiology and clinical characteristics of patients infected with coronavirus disease 2019 (COVID-19) in Weifang, China. METHODS: The demographic data of 43 COVID-19 patients identified in Weifang were used to investigate whether they had traveled to epidemic areas and whether they had close contact with confirmed cases. On admission, patients' symptoms and results of laboratory tests and imaging were analyzed. RESULTS: Among the 43 COVID-19 patients. including 9 third generation infected cases, 16 (37.2%) were imported, who infected the rest. Most cases were middle-aged with approximate sex ratio. A "super spreader", Mr. Zhang made it necessary to quarantine 69 medical personnel. Mr. Zhang directly infected six individuals who, in turn, infected another six individuals. Another patient, Mr. Wang, spread the infection to his five family members at a family gathering. Subsequently, the daughter infected her husband. The most common COVID-19 symptoms were fever, weakness, dry cough, and cough sputum. In most patients, white blood cell counts were not elevated and lymphocyte counts were decreased. Elevated C-reactive protein and serum amyloid A protein (SAA) levels were commonly observed. There was no death among the patients or infection among the medical staff. CONCLUSIONS: The infection by the COVID-19 in Weifang was mostly the result of close contact with imported cases. These circumstances underscore the need to comprehensively strengthen the management for patients to prevent and control the spread of the virus.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Quarentena , Doença Relacionada a Viagens , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Proteína C-Reativa/metabolismo , Criança , Pré-Escolar , China/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Tosse/fisiopatologia , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Febre/fisiopatologia , Cefaleia , Humanos , Lactente , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/fisiopatologia , Mialgia/fisiopatologia , Oxigenoterapia , Pandemias , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Proteína Amiloide A Sérica/metabolismo , Tomografia Computadorizada por Raios X , Adulto Jovem
6.
Rheumatol Int ; 40(10): 1539-1554, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32666137

RESUMO

The coronavirus disease-2019 (COVID-19) pandemic is likely to pose new challenges to the rheumatology community in the near and distant future. Some of the challenges, like the severity of COVID-19 among patients on immunosuppressive agents, are predictable and are being evaluated with great care and effort across the globe. A few others, such as atypical manifestations of COVID-19 mimicking rheumatic musculoskeletal diseases (RMDs) are being reported. Like in many other viral infections, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can potentially lead to an array of rheumatological and autoimmune manifestations by molecular mimicry (cross-reacting epitope between the virus and the host), bystander killing (virus-specific CD8 + T cells migrating to the target tissues and exerting cytotoxicity), epitope spreading, viral persistence (polyclonal activation due to the constant presence of viral antigens driving immune-mediated injury) and formation of neutrophil extracellular traps. In addition, the myriad of antiviral drugs presently being tried in the treatment of COVID-19 can result in several rheumatic musculoskeletal adverse effects. In this review, we have addressed the possible spectrum and mechanisms of various autoimmune and rheumatic musculoskeletal manifestations that can be precipitated by COVID-19 infection, its therapy, and the preventive strategies to contain the infection.


Assuntos
Doenças Autoimunes/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Doenças Musculoesqueléticas/fisiopatologia , Pneumonia Viral/fisiopatologia , Doenças Reumáticas/fisiopatologia , Anticorpos Antinucleares/imunologia , Anticorpos Antifosfolipídeos/imunologia , Antivirais/efeitos adversos , Artralgia/etiologia , Artralgia/imunologia , Artralgia/fisiopatologia , Doenças Autoimunes/etiologia , Doenças Autoimunes/imunologia , Betacoronavirus , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/imunologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Reações Cruzadas/imunologia , Armadilhas Extracelulares/imunologia , Produtos de Degradação da Fibrina e do Fibrinogênio , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/imunologia , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Inibidor de Coagulação do Lúpus/imunologia , Mimetismo Molecular , Síndrome de Linfonodos Mucocutâneos/etiologia , Síndrome de Linfonodos Mucocutâneos/imunologia , Síndrome de Linfonodos Mucocutâneos/fisiopatologia , Debilidade Muscular/etiologia , Debilidade Muscular/imunologia , Debilidade Muscular/fisiopatologia , Doenças Musculoesqueléticas/etiologia , Doenças Musculoesqueléticas/imunologia , Mialgia/etiologia , Mialgia/imunologia , Mialgia/fisiopatologia , Miocardite/etiologia , Miocardite/imunologia , Miocardite/fisiopatologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Doenças Reumáticas/etiologia , Doenças Reumáticas/imunologia
7.
Neurol Clin ; 38(3): 553-564, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32703468

RESUMO

Diabetic lumbosacral radiculoplexus neuropathy, also known as diabetic amyotrophy, has a characteristic course of sudden onset of unilateral pain in the thigh and hip, which may spread to the other side in weeks to months and proceeds with progressive lower extremity weakness, often resulting in the inability to walk unassisted. The syndrome is typically monophasic, and most patients will recover at least to some degree. Less typical features include lack of pain, distal predominant weakness, absence of diabetes, and upper extremity involvement. This article provides a series of interesting cases to highlight the diagnostic challenges and discusses management decision making.


Assuntos
Diabetes Mellitus/diagnóstico por imagem , Neuropatias Diabéticas/diagnóstico por imagem , Plexo Lombossacral/diagnóstico por imagem , Debilidade Muscular/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/fisiopatologia , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/fisiopatologia , Feminino , Humanos , Plexo Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/complicações , Debilidade Muscular/fisiopatologia , Síndrome
8.
Medicine (Baltimore) ; 99(20): e20227, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443353

RESUMO

RATIONALE: Although distal nerves located at sites prone to compression are susceptible to autoimmune attack, Guillain-Barre' syndrome (GBS) with exclusive hand muscle involvement is rarely found in clinics. All reported patients presented with a special variant - finger extensor weakness, especially claw hand caused by predominant ulnar extensor involvement. Similar to typical GBS, these patients showed bilateral symmetric onset with rapid clinical progression. PATIENT CONCERNS: A 62-year-old man with GBS was admitted to our hospital with unilateral onset of claw hand. He showed relatively slow progression and did not develop bilateral symmetric claw hands until 6 weeks later. DIAGNOSES: Eventually the patient was diagnosed as having a regional variant of GBS by neuronal electrophysiology and cerebrospinal fluid examinations. INTERVENTIONS: This patient was treated with intravenous thrombolysis within 4.5 hours of onset. Eventually he was diagnosed as having a regional variant of GBS and was treated with gamma-globulin (400 mg/kg/d) for 5 consecutive days via intravenous infusion. OUTCOMES: The patient had a slow recovery with persistent mild finger extensor weakness. LESSONS: This patient presented with unilateral onset of claw hand, and the diagnosis of acute ischemic stroke could not be excluded because of a short time window; hence, he was treated with intravenous thrombolysis within 4.5 hours of onset. Eventually he was diagnosed as having a regional variant of GBS. It is important that GBS should also be considered in patients with unilateral hand weakness and unknown aetiology in the early stages of disease.


Assuntos
Síndrome de Guillain-Barré/complicações , Força da Mão/fisiologia , Debilidade Muscular/fisiopatologia , Adolescente , Adulto , Idoso , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Estudos Retrospectivos
9.
J Sport Health Sci ; 9(3): 283-290, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32444153

RESUMO

BACKGROUND: Evidence shows an association between grip strength and health; however, grip strength cut-offs for the detection of metabolic syndrome (MetS) in Latin American populations are scarce. The purpose of this study was to determine cut-offs of normalized grip strength (NGS) for the detection of MetS in a large nonrepresentative sample of a collegiate student population from Colombia. METHODS: A total of 1795 volunteers (61.4% female; age = 20.68 ± 3.10 years, mean ± SD), ranging between 18 and 30 years of age participated in the study. Strength was estimated using a handheld dynamometer and normalized to body mass (handgrip strength (kg)/body mass (kg)). Anthropometrics, serum lipids indices, blood pressure, and fasting plasma glucose were measured. Body composition was measured by bioelectrical impedance analysis. MetS was defined as including ≥3 of the 5 metabolic abnormalities according to the International Diabetes Federation definition. A metabolic risk score was computed from the following components: waist circumference, triglycerides, high-density lipoprotein cholesterol, glucose, and systolic and diastolic blood pressure. RESULTS: Receiver operating curve analysis showed significant discriminatory accuracy of NGS in identifying the thresholds and risk categories. Lower strength was associated with increased prevalence of MetS. In males, weak, intermediate, and strong NGS values at these points were <0.466, 0.466-0.615, >0.615, respectively. In females, these cut-off points were <0.332, 0.332-0.437, >0.437, respectively. CONCLUSION: Our sex-specific cut-offs of NGS could be incorporated into a clinical setting for identifying college students at cardiometabolic disease risk.


Assuntos
Força da Mão , Síndrome Metabólica/diagnóstico , Adolescente , Adulto , Antropometria , Biomarcadores/sangue , Glicemia/metabolismo , Pressão Sanguínea , Composição Corporal , Colômbia , Estudos Transversais , Feminino , Humanos , Lipídeos/sangue , Masculino , Síndrome Metabólica/sangue , Debilidade Muscular/fisiopatologia , Estudo de Prova de Conceito , Fatores de Risco , Adulto Jovem
10.
Am J Pathol ; 190(8): 1609-1621, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32407731

RESUMO

Alzheimer disease (AD) is characterized by deterioration of cognitive capabilities with an estimated 44 million individuals worldwide living with it. Beyond memory deficits, the most common AD co-morbidities include swallowing defects (muscle), fractures (bone, muscle), and heart failure. The underlying causes of these co-morbidities and their role in AD pathophysiology are currently unknown. This review is the first to summarize the emerging picture of the cardiac and musculoskeletal deficits in human AD. We present the involvement of the heart, characterized by diastolic heart failure, the presence of amyloid deposits, and electrophysiological changes, compared with age-matched control subjects. The characteristic musculoskeletal defects in AD come from recent clinical studies and include potential underlying mechanisms (bone) in animal models. These studies detail a primary muscle weakness (without a loss of muscle mass) in patients with mild cognitive impairment, with progression of cognitive impairment to AD associating with ongoing muscle weakness and the onset of muscle atrophy. We conclude by reviewing the loss of bone density in patients with AD, paralleling the increase in fracture and fall risk in specific populations. These studies paint AD as a systemic disease in broad strokes, which may help elucidate AD pathophysiology and to allow for new ways of thinking about therapeutic interventions, diagnostic biomarkers, and the pathogenesis of this multidisciplinary disease.


Assuntos
Doença de Alzheimer/fisiopatologia , Coração/fisiopatologia , Debilidade Muscular/fisiopatologia , Músculo Esquelético/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Progressão da Doença , Humanos
11.
J Clin Neurophysiol ; 37(3): 208-210, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358247

RESUMO

Patients with intensive care unit-acquired weakness have an increased risk of prolonged mechanical ventilation, which is a risk factor for prolonged stay and mortality. The most common cause of this problem is weakness of the diaphragm, which can derive from phrenic nerve injury associated with critical neuropathy, or with the complex multiorgan failure/systemic respiratory response syndrome causing muscle fiber lesion. Two conventional neurophysiological techniques are useful to investigate the respiratory muscles, phrenic nerve conduction, and needle electromyography of the accessory respiratory muscles and diaphragm. Phrenic nerve stimulation is a standard noninvasive technique; amplitude of the motor response can be reduced because of muscle fiber inexcitability or axonal loss. Electromyography of the diaphragm is an invasive method but is safe if performed as indicated. It can reveal neurogenic or myopathic motor units. Although these neurophysiological methods have limitations in the investigation of intensive care unit patients with severe respiratory involvement, normal phrenic nerve responses should exclude marked axonal loss and indicate a better prognosis.


Assuntos
Cuidados Críticos/métodos , Diafragma/fisiopatologia , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Neurofisiologia/métodos , Eletromiografia/métodos , Feminino , Humanos , Unidades de Terapia Intensiva , Nervo Frênico/fisiopatologia
12.
J Clin Neurophysiol ; 37(3): 211-213, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358248

RESUMO

Even if nerves and muscles are the principal targets of intensive care unit-acquired weakness, the neuromuscular junction may be as well involved. In intensive care units, neuromuscular blocking agents are classically used, and side effects are possible. Sepsis, immobilization, and denervation which are common in intensive care units may be the cause of neuromuscular junction disorders and participate to the pathophysiology of weakness. We propose here a review of end-plate disorders in intensive care units to highlight their mechanisms and propose diagnosis tools.


Assuntos
Cuidados Críticos , Debilidade Muscular/fisiopatologia , Junção Neuromuscular/fisiopatologia , Estado Terminal , Humanos , Unidades de Terapia Intensiva , Debilidade Muscular/etiologia , Sepse/complicações
13.
Muscle Nerve ; 62(2): 214-218, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32367533

RESUMO

BACKGROUND: We assessed clinical predictors of mechanical ventilation in children with Guillain-Barré syndrome (GBS) to help identify patients who require mechanical ventilation. METHODS: We retrospectively collected the clinical, laboratory, and electrophysiological data of 103 children with GBS. Patients were categorized into two groups based on the requirement for mechanical ventilation. Variables that were significantly different between the two groups in univariate analysis were analyzed by multivariate logistic regression models. RESULTS: Time from symptom onset to admission (P = .002), facial or bulbar weakness (P = .001), and axonal type (P = .005) were associated with mechanical ventilation in univariate analysis. In multivariate analysis, facial or bulbar weakness (odds ratio [OR], 7.936; P = .013) and axonal type (OR, 4.582; P = .022) were independent predictors for mechanical ventilation. CONCLUSIONS: Facial or bulbar weakness and axonal type were associated with increased risk for mechanical ventilation in children with GBS.


Assuntos
Síndrome de Guillain-Barré/terapia , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/terapia , Criança , Pré-Escolar , Eletrodiagnóstico , Músculos Faciais/fisiopatologia , Feminino , Síndrome de Guillain-Barré/fisiopatologia , Hospitalização , Humanos , Lactente , Masculino , Debilidade Muscular/fisiopatologia , Condução Nervosa , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
14.
Muscle Nerve ; 62(2): 247-253, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32369630

RESUMO

INTRODUCTION: The best treatment strategy for mild ulnar neuropathy at the elbow (UNE) is not known, due to lack of trials comparing surgery vs conservative treatment. METHODS: We recruited patients with clinical symptoms and signs of mild UNE and an electrophysiologically or sonographically confirmed diagnosis. Patients were randomly allocated to either in situ decompression or conservative treatment. The primary outcome was the proportion of patients with subjective symptom improvement at short-term (3 months) and long-term (6-12 months) follow-up. RESULTS: One hundred seventeen patients were included: 56 and 61 patients were allocated to surgery and conservative treatment, respectively. A larger proportion of surgically treated patients showed improvement at short-term follow-up (85% vs 50%; odds ratio, 5.6; P < .001), but no differences were observed at long-term follow-up. DISCUSSION: In situ decompression for mild UNE may result in faster relief of symptoms when compared with conservative treatment, but at long-term follow-up no differences were observed.


Assuntos
Tratamento Conservador/métodos , Descompressão Cirúrgica/métodos , Cotovelo , Neuropatias Ulnares/terapia , Potenciais de Ação , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletrodiagnóstico , Feminino , Humanos , Hipestesia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/fisiopatologia , Condução Nervosa , Parestesia/fisiopatologia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Neuropatias Ulnares/diagnóstico por imagem , Neuropatias Ulnares/fisiopatologia , Ultrassonografia
15.
Artigo em Inglês | MEDLINE | ID: mdl-32384713

RESUMO

Background: Handgrip strength (HGS) is a convent measure of strength capacity and associated with several age-related health conditions such as functional disability. Asymmetric strength between limbs has been linked to diminished function. Therefore, both HGS asymmetry and weakness could be associated with functional disability. We examined the associations of HGS asymmetry and weakness on functional limitations in a nationally representative sample of older Americans. Methods: Data were analyzed from 2689 adults ≥ 60 years who participated in the 2011-2012 and 2013-2014 waves of the National Health and Nutrition Examination Survey. Weakness was defined as HGS < 26 kg for men and < 16 kg for women. Asymmetry was determined from the ratio of the dominant and non-dominant HGS. Those with HGS ratio 0.9-1.1 were considered as having HGS symmetry, and those outside this range had asymmetry. Results: Compared to those with symmetric HGS and were not weak, those with weakness alone, and both weakness and HGS asymmetry had 2.47 (95% confidence interval [CI]: 1.14-5.35) and 3.93 (CI: 1.18-13.07) greater odds for functional limitations, respectively. However, HGS asymmetry alone was not associated with functional limitations (odds ratio: 0.80; CI: 0.62-1.03). Conclusion: The use of HGS asymmetry in protocols could improve the prognostic value of handgrip dynamometers.


Assuntos
Avaliação Geriátrica/métodos , Força da Mão/fisiologia , Força Muscular/fisiologia , Debilidade Muscular/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Razão de Chances , Estados Unidos
16.
Medicine (Baltimore) ; 99(17): e19863, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332648

RESUMO

BACKGROUND: Pregnancy is one of the main risk factor of pelvic floor muscle dysfunction. Postpartum women with extremely weak muscle strength have difficulty to do voluntary pelvic floor muscle training. This study aims to evaluate the effects of different protocols of electrical stimulation in the treatment of postpartum women with extremely weak muscle strength. METHODS: A total of 67 women were randomized into 2 groups: group A received transvaginal electrical stimulation (TVES) for 5 times, and group B received TVES for 3 times with electromyogram (EMG)-triggered neuromuscular stimulation twice. Subjects were evaluated before and after treatment. Pelvic muscle strength was measured by both digital vaginal palpation and EMG variables, and quality of life was investigated by 4 kinds of pelvic floor disease-related questionnaires. RESULTS: According to the intention-to-treat principle, compared with baseline, in group A, EMG of contractile amplitude of endurance phase was significantly elevated (P = .03), variation of contractile amplitude in tonic phase was more stable after treatment (P = .004), and EMG of mean value of final rest was significantly elevated after treatment (P = .047). After 5 times treatments, the incidence of correct pelvic floor muscle contraction in group A was significantly elevated (P = .045). No significant difference of muscle strength test by digital vaginal palpation was detected between the 2 groups, so did questionnaires. CONCLUSION: For postpartum women with extremely weak muscle strength, TVES for 5 times might be more benefit for control ability of pelvic muscle contractions and elevating muscle strength even in short-time treatment.


Assuntos
Terapia por Estimulação Elétrica/métodos , Debilidade Muscular/fisiopatologia , Debilidade Muscular/reabilitação , Distúrbios do Assoalho Pélvico/fisiopatologia , Distúrbios do Assoalho Pélvico/reabilitação , Período Pós-Parto/fisiologia , Adulto , Protocolos Clínicos , Eletromiografia , Feminino , Humanos , Análise de Intenção de Tratamento , Força Muscular/fisiologia , Estudos Prospectivos , Método Simples-Cego , Adulto Jovem
17.
Phys Ther ; 100(7): 1142-1152, 2020 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-32266379

RESUMO

OBJECTIVE: To date, no attention has been devoted to the employment of eccentric contractions to manage spasticity in multiple sclerosis. This single-system case series aimed to explore the effects of eccentric training on spasticity-related resistance to passive motion in people with multiple sclerosis with elbow flexor spasticity. METHODS: Six people with multiple sclerosis (median Expanded Disability Status Scale score = 4.8, range = 2.0-5.5; Modified Ashworth Scale [MAS] score ≤ 3) underwent a 6-week eccentric strength training of the spastic muscles. Before and after the intervention, the following outcomes were assessed: resistive peak torque (RPT), isometric strength, resting limb position, passive range of motion and active range of motion, severity of hypertonia by MAS, and numerical rating scale. At baseline, the primary outcome (RPT) was tested over 3 time points to ensure a stable measurement. The 2-SD method was used to test pre-post training effects at individual level. Group-level analyses were also performed. RESULTS: Following the intervention RPT decreased by at least 2 SDs in all participants but 1, with a significant reduction at group level of 41.6 (29.6)%. Four people with multiple sclerosis reported a reduction in perceived spasticity severity. No changes in MAS score were detected. Group-level analyses revealed that maximal strength increased significantly in the trained elbow flexors (+30.9 [9.1]%). Elbow flexion at rest was found to be significantly reduced (-35.5 [12.4]%), whereas passive range of motion (+4.6%) and active range of motion (+11.8%) significantly increased. CONCLUSION: Eccentric training is feasible and safe to manage spasticity in people with multiple sclerosis. Preliminary data showed that this protocol can reduce resistance to passive motion, also improving strength, spasticity-free range of motion, and limb positioning. IMPACT: Patients with multiple sclerosis-related spasticity and moderate-to-severe disability can benefit from adding slow submaximal eccentric contractions to the conventional management of spasticity.


Assuntos
Articulação do Cotovelo/fisiopatologia , Esclerose Múltipla/complicações , Espasticidade Muscular/reabilitação , Debilidade Muscular/reabilitação , Treinamento de Resistência , Adulto , Feminino , Humanos , Movimento/fisiologia , Espasticidade Muscular/fisiopatologia , Debilidade Muscular/fisiopatologia , Amplitude de Movimento Articular/fisiologia
18.
Muscle Nerve ; 62(2): 201-207, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32270505

RESUMO

INTRODUCTION: In this study we aimed to document the prevalence and age of onset of motor impairments and other key symptoms in oculopharyngeal muscular dystrophy (OPMD). METHODS: Retrospective chart review of patients followed at the Saguenay Neuromuscular Clinic (Quebec, Canada). RESULTS: A total of 333 participants with the (GCN)13 mutation were included. Before the age of 75 years, 27% of them had walking limitations, 14% could not climb stairs independently, and 14% used a wheelchair for long distances or daily living. The median age of onset was 54 years for ptosis and dysphagia and 58 years for lower limb proximal weakness. Other frequent symptoms included fatigue, pharyngeal pooling of thickened secretions, and dysphonia. The median age at death was 77 years and the main cause was respiratory disease. DISCUSSION: This study provides important information to help anticipatory guidance for affected people and for the development of therapeutic trials in OPMD.


Assuntos
Atividades Cotidianas , Blefaroptose/fisiopatologia , Transtornos de Deglutição/fisiopatologia , Disfonia/fisiopatologia , Fadiga/fisiopatologia , Limitação da Mobilidade , Debilidade Muscular/fisiopatologia , Distrofia Muscular Oculofaríngea/fisiopatologia , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Creatina Quinase/sangue , Progressão da Doença , Eletromiografia , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Distrofia Muscular Oculofaríngea/sangue , Distrofia Muscular Oculofaríngea/genética , Proteína I de Ligação a Poli(A)/genética , Estudos Retrospectivos , Taxa de Sobrevida , Expansão das Repetições de Trinucleotídeos , Cadeiras de Rodas
19.
Muscle Nerve ; 62(1): 111-114, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32291768

RESUMO

BACKGROUND: Increment of compound muscle action potential amplitude is a diagnostic hallmark of Lambert-Eaton myasthenic syndrome (LEMS). Making a diagnosis can be challenging, therefore, a proper cutoff for abnormal increment is highly relevant for improved recognition of this rare disease. METHODS: We determined the sensitivity and specificity of 60% and 100% cutoff values in all consecutive patients who underwent increment testing in our hospital from 1999 to 2016. RESULTS: We included 156 patients, 63 with LEMS and 93 without LEMS. Sensitivity of a 60% cutoff for increment testing was 77.8% (95% confidence interval 65.5%-87.3%) and 58.7% (45.6%-71.0%) for 100%. Specificity was 98.9% (94.2%-100%) and 100% (96.1%-100%) using a threshold of 60% and 100%, respectively. CONCLUSIONS: Lowering the cutoff value for abnormal increment to 60% greatly increases sensitivity to diagnose LEMS without an overt loss in specificity.


Assuntos
Eletrodiagnóstico/métodos , Eletrodiagnóstico/normas , Síndrome Miastênica de Lambert-Eaton/diagnóstico , Síndrome Miastênica de Lambert-Eaton/fisiopatologia , Potenciais de Ação/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Reflexo de Estiramento/fisiologia , Estudos Retrospectivos , Adulto Jovem
20.
J Athl Train ; 55(6): 608-614, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32348153

RESUMO

CONTEXT: After knee-joint injury, pain, effusion, and mechanoreceptor damage alter afferent signaling, which can result in quadriceps inhibition and subsequent weakness. The individual contributions of each factor to inhibition remain unclear due to confounding knee-joint injuries and indirect experimental models. OBJECTIVE: To characterize the influence of naturally occurring knee damage and pain on quadriceps neuromuscular function in individuals with patellar tendinopathy. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty participants who self-reported patellar tendinopathy (PT) and 10 healthy control individuals underwent ultrasonic tendon assessment. Injured participants were dichotomized by an orthopaedic surgeon into groups with (1) pain and structural tendon abnormality and (2) regional pain alone. MAIN OUTCOME MEASURE(S): Quadriceps inhibition was assessed with the Hoffman reflex and the central activation ratio via the superimposed-burst technique. Normally distributed measures were analyzed using a 1-way analysis of variance and post hoc independent t tests. Kruskal-Wallis tests with post hoc Mann-Whitney U tests were used to analyze nonnormally distributed data. An a priori α level of P ≤ .05 was set. RESULTS: Control participants presented with more spinal-reflex excitability (0.37 ± 0.23) than the PT (0.10 ± 0.06; P = .03) and regional-pain (0.18 ± 0.05; P = .02) groups. Knee-extension strength was greater in the control (3.37 ± 0.59 Nm/kg) than in the PT (2.41 ± 0.67 Nm/kg; P = .01) group but not the regional-pain group (3.05 ± 0.66 Nm/kg; P = .24). Control individuals presented with more quadriceps activation (97.93% ± 3.12) than the PT (84.44% ± 16.98; P < .01) and regional-pain (91.17% ± 10.56; P = .01) groups. No differences were present for any measures between the PT and regional-pain groups (P values > .05). CONCLUSIONS: Deficits in spinal-reflex excitability, quadriceps activation, and strength were present in both the PT and regional-pain groups. A combination of pain and structural damage appeared to have the greatest negative effect on quadriceps function, as only the PT group presented with neuromuscular outcomes that failed to meet clinical thresholds.


Assuntos
Traumatismos do Joelho , Debilidade Muscular , Dor Musculoesquelética , Ligamento Patelar/lesões , Músculo Quadríceps , Tendinopatia , Adulto , Estudos Transversais , Feminino , Humanos , Traumatismos do Joelho/complicações , Traumatismos do Joelho/fisiopatologia , Masculino , Mecanorreceptores/fisiologia , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/fisiopatologia , Exame Neurológico/métodos , Avaliação de Resultados em Cuidados de Saúde , Músculo Quadríceps/diagnóstico por imagem , Músculo Quadríceps/fisiopatologia , Tendinopatia/diagnóstico , Tendinopatia/etiologia , Tendinopatia/fisiopatologia , Ultrassonografia/métodos
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