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1.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541995

RESUMO

Presentation of severe pain syndromes prior to onset of motor weakness is an uncommon but documented finding in patients with Guillain-Barré syndrome (GBS). Sciatica in GBS is a difficult diagnosis when patients present with acute radiculopathy caused by herniated disc or spondylolysis. A middle-aged woman was admitted for severe low back pain, symptomatic hyponatraemia, vomiting and constipation. On further investigation, she was diagnosed with radiculopathy, and appropriate treatment was initiated. Brief symptomatic improvement was followed by new-onset weakness in lower limbs, which progressed to involve upper limbs and right extraocular muscles. With progressive, ascending, new-onset motor and sensory deficits and laboratory evidence of demyelination by Nerve Conduction Study, a diagnosis of variant GBS was made. She was treated with intravenous immunoglobulin 2 g/kg over 5 days. The presentation of severe low back pain that was masking an existing aetiology and possible dysautonomia and the unilateral right extraocular muscles instead of bilateral make our case unique and rare.


Assuntos
Diagnóstico Diferencial , Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Miller Fisher/diagnóstico , Síndrome de Miller Fisher/tratamento farmacológico , Músculos Oculomotores/fisiopatologia , Radiculopatia/diagnóstico , Dor nas Costas/etiologia , Feminino , Síndrome de Guillain-Barré/diagnóstico , Hospitais , Humanos , Hiponatremia/etiologia , Extremidade Inferior/fisiopatologia , Pessoa de Meia-Idade , Síndrome de Miller Fisher/complicações
2.
Brasília; CONITEC; fev. 2021.
Não convencional em Português | BRISA/RedTESA | ID: biblio-1178730

RESUMO

INTRODUÇÃO: O linfedema é uma doença crônica progressiva, ocasionada por insuficiência do processo de drenagem linfática, que causa edema tecidual. Não há nenhum tratamento curativo para o linfedema e no âmbito do Sistema Único de Saúde (SUS), estão listados dois procedimentos de manejo do linfedema: o atendimento fisioterapêutico e o tratamento cirúrgico do linfedema. As meias elásticas de compressão seriam uma opção de tratamento autogerido, o que pode reduzir a sobrecarga do sistema por procedimentos eletivos. PERGUNTA: O uso de meias elásticas de compressão é eficaz, efetivo, seguro e custo-efetivo para o tratamento de pacientes com linfedema primário ou secundário? EVIDÊNCIAS CIENTÍFICAS: A busca recuperou duas coortes prospectivas. O estudo de Brambilla et al., 2006 demonstrou diferença estatisticamente significante na redução do volume dos membros inferiores (mensurada por uso de fita métrica em vários pontos dos membros inferiores) entre os pacientes que utilizaram as meias elásticas de compressão em relação aos pacientes do grupo controle (que não usaram as meias). Contudo, as circunferências dos membros inferiores foram reduzidas de maneira irregular, 40% dos pacientes tratados com as meias elásticas de compressão apresentaram aumento do volume do membro e apenas 16,67% das reduções foram consideradas satisfatórias. Já o estudo de Godoy et al., 2017, uma coorte do tipo antes e depois, demonstrou diferença estatisticamente significante entre as meias de compressão de 30/40 mmHg e as de 20/30 mmHg, sendo esta última não efetiva na manutenção do volume dos membros após quatro semanas em relação a linha de base. Porém, nessa última coorte, as meias elásticas de compressão foram utilizadas para manutenção do volume dos membros após redução completa do edema por outros procedimentos terapêuticos. Não foram encontrados estudos referentes à adesão das meias elásticas de compressão na população com linfedema. Nenhum dos estudos incluídos relatou dados de segurança. As duas coortes apresentaram baixa qualidade metodológica, uma vez que receberam 5 estrelas ou menos nas ferramentas de Newcastle-Ottawa. A certeza da evidência de todos os desfechos, avaliada pelo Grading of Recommendations Assessment, Development and Evaluation, foi muito baixa. AVALIAÇÃO ECONÔMICA: Foi conduzida uma avaliação econômica do tipo árvore de decisão, comparando as meias elásticas de compressão com o cuidado convencional, na perspectiva do SUS, em um horizonte temporal de 12 meses. A partir da estratégia escolhida, os indivíduos com linfedema seguem o curso de eventos sequenciais de sucesso terapêutico (redução clinicamente relevante do edema) e de falha terapêutica (redução não satisfatória do edema ou aumento do edema). O desfecho de efetividade foi retirado do estudo Brambilla et al., 2006. A estimativa dos números de sessões de fisioterapia e tratamento cirúrgico do linfedema foram feitas baseadas nos dados de uso dos procedimentos no Departamento de Informática do SUS. Assim, a razão de custo-efetividade incremental (RCEI) foi de R$ 2.155,87 para que um paciente alcance uma redução do volume dos membros inferiores com o uso da intervenção das meias elásticas de compressão, comparado ao cuidado convencional. A análise de sensibilidade mostrou que, independentemente do custo de aquisição das meias elásticas e da frequência de realização dos procedimentos, a intervenção continua sendo dominada pelo cuidado convencional. ANÁLISE DE IMPACTO ORÇAMENTÁRIO: Para um horizonte temporal de 5 anos, a incorporação das meias elásticas de compressão para linfedema ocasionaria um aumento de gastos estimados, em cinco anos, de R$117.900.922,59 a R$136.039.526,07, a depender da prevalência. RECOMENDAÇÕES INTERNACIONAIS: O National Institute for Care Execellence e Canadian Agency for Drugs and Technologies in Health ainda não avaliaram o uso das meias compressivas no tratamento do linfedema de membros inferiores. Não foram encontrados relatos de incorporação das meias de compressão nas agências Scottish Medicines Consortium e Pharmaceutical Benefits Advisory Committee. CONSIDERAÇÕES FINAIS: As evidências disponíveis acerca da efetividade das meias elásticas de compressão em indivíduos com linfedema de membros inferiores são escassas e, de forma geral, de qualidade baixa. A avaliação econômica estimou uma RCEI R$ 2.155,87, ao passo que análise de impacto orçamentário estima um custo acumulado em cinco anos de até R$ 136 milhões no cenário de incorporação das meias elásticas de compressão. Não foram identificadas recomendações sobre o uso de meias elásticas no tratamento do linfedema em agências internacionais de ATS. Dessa forma, recomendações sobre o uso da tecnologia são permeadas de incertezas e devem ser realizadas com cautela. RECOMENDAÇÃO PRELIMINAR DA CONITEC: A Conitec, em sua 92ª reunião ordinária, realizada nos dias 04 de novembro de 2020, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar não favorável à incorporação no SUS das meias elásticas de compressão como parte do tratamento de pacientes com linfedema de membros inferiores. Considerou-se, entre outros fatores, que, há escassez de evidências sobre o uso das meias elásticas de compressão no tratamento do linfedema de membros inferiores. Além disso, as poucas evidências disponíveis foram consideradas frágeis, com baixo número amostral e baixa qualidade, sendo, portanto, insuficientes para determinar com robustez a efetividade, a segurança, a custo-efetividade e o impacto orçamentário decorrente da incorporação das meias de compressão. CONSULTA PÚBLICA: O relatório de recomendação inicial da CONITEC foi disponibilizado para contribuições por meio da consulta pública nº 64/2020 entre os dias 25/11/2020 e 14/12/2020. Foram recebidas 163 contribuições, sendo 93 contribuições de cunho técnico-científico e 70 contribuições de experiência pessoal ou opinião, destas 84,7% discordavam com a recomendação preliminar da Conitec. RECOMENDAÇÃO FINAL: Os membros da Conitec presentes na 94ª reunião ordinária, no dia 03 de janeiro de 2021, deliberaram por unanimidade recomendar a não incorporação das meias elásticas de compressão para o tratamento de pacientes com linfedema. Os membros presentes entenderam que não houve argumentação suficiente para alterar a recomendação inicial. Foi assinado o registro de deliberação nº 585. DECISÃO: Não incorporar as meias elásticas de compressão como parte do tratamento de pacientes com linfedema de membros inferiores, do Sistema Único de Saúde - SUS, conforme Portaria nº 03, publicada no Diário Oficial da União nº 34, seção 1, página 93, em 22 de fevereiro de 2021.


Assuntos
Humanos , Extremidade Inferior/fisiopatologia , Meias de Compressão/provisão & distribução , Linfedema/tratamento farmacológico , Avaliação da Tecnologia Biomédica , Sistema Único de Saúde , Brasil , Análise Custo-Benefício/economia
3.
Medicine (Baltimore) ; 100(3): e24364, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546072

RESUMO

ABSTRACT: Lower limb amputation (LLA) is still a health issue requiring rehabilitation and long-term care even in industrial societies. Several studies on subjects with LLA have been focused on the efficacy of rehabilitation and factors influencing the use of prosthesis. However, literature data on the recovery of ability to walk outdoors, and thus to participate in social life in this population is limited.To investigate potential correlations between socio-demographic and clinical factors, and the use of the prosthesis for indoor and/or outdoor walking referred to as community ambulation (CA) in subjects with LLA.An observational cohort study on 687 LLA subjects was conducted. Socio-demographic and clinical characteristics of 302 subjects who received similar rehabilitative treatment with respect to the standard protocol were collected by a telephone survey with a structured questionnaire. The CA recovery, in terms of patient's autonomy and participation, assessed by Walking Handicap Scale, was considered as the main outcome.The univariate analysis demonstrated statistical significant positive correlation between CA and gender (χ2 = 3.901, P = .048); amputation level (χ2 = 24.657, P < .001); pre-LLA (χ2 = 6.338, P = .012) and current work activity (χ2 = 25.192, P < .001); prosthesis use (χ2 = 187.037, P < .01); and time from LLA (r = 0.183, P < .001); increasing age was negatively correlated with the outcome (r = -0.329, P < .001), while pain intensity was not significant. Being male (75.4%); trans-tibial (TT) amputation level (9.79%); working before (3.81%) and after LLA (7.68%); and the prosthesis use (24.63%) increased the probability of CA recovery. Multivariate binary logistic regression analysis confirmed that the prosthesis use (P < .001) and TT amputation level (P = .042) are predictors of a positive outcome (Walking Handicap Scale 4-6).These findings highlight the importance of the use of prosthesis in people with LLA for the restoration of a good capacity of participation (CA), especially in subjects with TT amputation level. The identification of predictive factors may help tailor-made rehabilitation approaches addressing an earlier reintegration to social life.


Assuntos
Amputação/reabilitação , Extremidade Inferior/lesões , Caminhada/fisiologia , Idoso , Amputação/métodos , Amputados/reabilitação , Estudos de Coortes , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Saúde Pública
4.
J Orthop Sports Phys Ther ; 51(1): 12-26, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33383996

RESUMO

OBJECTIVE: To synthesize results of somatosensory processing tests in people with upper- and lower-limb tendinopathy, compared to controls. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: Four electronic databases (MEDLINE, CINAHL Plus, SPORTDiscus, and Embase) were searched. STUDY SELECTION CRITERIA: Included studies measured a domain of sensory processing and compared a tendinopathy group to a healthy control group. DATA SYNTHESIS: Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Upper- and lower-limb conditions were compared and outcomes were examined by measurement site (local, regional, or remote to location of pain). RESULTS: Of the 30 studies included, 18 investigated lateral elbow tendinopathy. The most commonly assessed outcome measures were pressure pain threshold (PPT) and thermal pain threshold. There was moderate evidence for local and regional reduction of PPT in upper-limb tendinopathies, but not at remote sites. In lower-limb tendinopathies, there was conflicting evidence regarding reduced PPT at local sites and limited evidence of normal PPT at remote sites. There was moderate evidence of sensitization of thermal pain threshold at local sites in upper-limb tendinopathies and limited evidence of no difference in thermal pain threshold in lower-limb tendinopathies. Findings across other domains were variable. CONCLUSION: Sensory processing was different between upper-limb tendinopathy and lower-limb tendinopathy. Upper-limb tendinopathies showed signs consistent with primary and secondary hyperalgesia, but lower-limb tendinopathies did not. There was mixed evidence for primary hyperalgesia and limited evidence against secondary hyperalgesia. J Orthop Sports Phys Ther 2021;51(1):12-26. doi:10.2519/jospt.2021.9417.


Assuntos
Extremidade Inferior/fisiopatologia , Limiar da Dor/fisiologia , Distúrbios Somatossensoriais/fisiopatologia , Tendinopatia/fisiopatologia , Extremidade Superior/fisiopatologia , Humanos
5.
BMC Neurol ; 21(1): 38, 2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504334

RESUMO

BACKGROUND: Ambulatory and balance functions are important for maintaining general health in humans. Gait analysis allows clinicians and researchers to identify the parameters to be focused on when assessing balance and ambulatory functions. In this study, we performed gait analysis with pressure sensors to identify the gait-analysis parameters related to balance and ambulatory functions in hemiplegic stroke patients. METHODS: We retrospectively reviewed the medical records of 102 patients with hemiplegic stroke who underwent gait analysis. Correlations between various temporospatial parameters in the gait analysis and the motor and balance functions assessed using functional ambulation category, modified Barthel index, and Berg balance scale were analyzed. RESULTS: Gait speed/height and the lower-limb stance-phase time/height were the only temporal and spatial parameters, respectively, that showed a statistical correlation with motor and balance functions. CONCLUSIONS: Measurements of walking speed and stance-phase time of the unaffected lower limb can allow clinicians to easily assess the ambulatory and balance functions of hemiplegic stroke patients. Rehabilitative treatment focusing on increasing gait speed and shortening the stance-phase time of the unaffected side may improve the ambulatory and balance functions in these patients.


Assuntos
Análise da Marcha/estatística & dados numéricos , Hemiplegia/fisiopatologia , Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Caminhada/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemiplegia/complicações , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Adulto Jovem
6.
Sports Health ; 13(1): 57-64, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32649842

RESUMO

CONTEXT: Evidence concerning a systematic, comprehensive injury risk assessment in the elite swimming population is scarce. OBJECTIVE: To evaluate the quality of current literature regarding clinical assessment techniques used to evaluate the presence and/or development of pain/injury in elite swimmers and to categorize objective clinical assessment tools into relevant predictors (constructs) that should consistently be evaluated in injury risk screens of elite swimmers. DATA SOURCES: PubMed, Embase, Scopus, CINAHL, SPORTDiscus, PEDro, and the Cochrane Library Reviews were searched through September 2018. STUDY SELECTION: Studies were included for review if they assessed a correlation between clinic-based objective measures and the presence and/or development of acute or chronic pain/injury in elite swimmers. All body regions were included. Elite swimmers were defined as National Collegiate Athletic Association, collegiate, and junior-, senior-, or national-level swimmers. Only cohort and cross-sectional studies were included (both prospective and retrospective); randomized controlled trials, expert opinion, and case reports were excluded, along with studies that focused on interventions, performance, or specific swim-stroke equipment or technology. STUDY DESIGN: Systematic review and qualitative analysis. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were utilized at each phase of review by 2 reviewers; a third reviewer was utilized for tie breaking purposes. Qualitative analysis was performed using the Methodological Items for Non-Randomized Studies (MINORS) assessment tool. RESULTS: A total of 21 studies assessed the presence and/or development of injury/pain in 3 different body regions: upper extremity, lower extremity, and spine. Calculated average MINORS scores for comparative (n = 17) and noncomparative (n = 4) studies were 18.1 of 24 and 10.5 of 16, respectively. Modifiable, objectively measurable injury risk factors in elite swimmers were categorized into 4 constructs: (1) strength/endurance, (2) mobility, (3) static/dynamic posture, and (4) patient-report regardless of body region. CONCLUSION: Limited evidence exists to draw specific correlations between identified clinical objective measures and the development of pain and/or injury in elite swimmers.


Assuntos
Medição de Risco/métodos , Natação/lesões , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/fisiopatologia , Força Muscular , Exame Físico , Postura , Fatores de Risco , Autorrelato , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/fisiopatologia , Extremidade Superior/lesões , Extremidade Superior/fisiopatologia
7.
J Vis Exp ; (163)2020 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-33016940

RESUMO

Computerized dynamic posturography (CDP) is an objective technique for the evaluation of postural stability under static and dynamic conditions and perturbation. CDP is based on the inverted pendulum model that traces the interrelationship between the center of pressure and the center of gravity. CDP can be used to analyze the proportions of vision, proprioception, and vestibular sensation to maintain postural stability. The following characters define chronic ankle instability (CAI): persistent ankle pain, swelling, the feeling of "giving way," and self-reported disability. Postural stability and fibular muscle activation level in individuals with CAI decreased due to lateral ankle ligament complex injuries. Few studies have used CDP to explore the postural stability of individuals with CAI. Studies that investigate postural stability and related muscle activation by using synchronized CDP with surface electromyography are lacking. This CDP protocol includes a sensory organization test (SOT), a motor control test (MCT), and an adaption test (ADT), as well as tests that measure unilateral stance (US) and limit of stability (LOS). The surface electromyography system is synchronized with CDP to collect data on lower limb muscle activation during measurement. This protocol presents a novel approach for evaluating the coordination of the visual, somatosensory, and vestibular systems and related muscle activation to maintain postural stability. Moreover, it provides new insights into the neuromuscular control of individuals with CAI when coping with real complex environments.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Extremidade Inferior/fisiopatologia , Músculos/fisiopatologia , Equilíbrio Postural/fisiologia , Adulto , Doença Crônica , Eletromiografia , Feminino , Humanos , Masculino , Propriocepção/fisiologia
8.
Geriatr Gerontol Int ; 20(10): 980-987, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32886834

RESUMO

AIMS: Sarcopenia is a serious problem because of its poor prognosis. Growth differentiation factor 15 (GDF15) is associated with mitochondrial dysfunction, inflammation, insulin resistance and oxidative stress, which may play crucial roles for the development of sarcopenia. We aimed to examine whether serum GDF15 level is associated with muscle mass, strength and lower extremity function in older patients with cardiometabolic disease. METHODS: Serum GDF15 levels were measured in 257 patients with cardiometabolic diseases (including 133 patients with diabetes) who had visited the frailty clinic, using a latex turbidimetric immunoassay. Appendicular skeletal muscle index, handgrip strength, timed-up-and-go test and gait speed were evaluated. Power, speed, balance and total scores based on the sit-to-stand test were calculated to assess lower extremity function. RESULTS: The highest tertile of serum GDF15 was independently associated with low handgrip strength, low gait speed, long timed-up-and-go time and scores of lower extremity function but not an appendicular skeletal muscle index in multiple logistic regression analyses after adjustment for covariates. Patients in the highest tertile of GDF15 were at the risk of having three to nine times lower grip strength, three times lower gait speed, five to six times lower mobility and five to 11 times reduction in lower extremity function as compared with those in the lowest GDF15 tertile dependent on the models. CONCLUSIONS: Elevated serum GDF15 level was independently associated with low muscle strength and lower extremity function in older patients with cardiometabolic disease. Serum GDF15 could be one of the biomarkers for muscle weakness and low physical performance. Geriatr Gerontol Int 2020; 20: 980-987.


Assuntos
Doenças Cardiovasculares/sangue , Diabetes Mellitus/sangue , Fator 15 de Diferenciação de Crescimento/sangue , Extremidade Inferior/fisiopatologia , Força Muscular/fisiologia , Sarcopenia/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus/fisiopatologia , Feminino , Fragilidade , Força da Mão , Humanos , Masculino , Músculo Esquelético/fisiopatologia , Sarcopenia/fisiopatologia , Estudos de Tempo e Movimento , Velocidade de Caminhada/fisiologia
9.
PLoS One ; 15(9): e0239236, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936828

RESUMO

PURPOSE: A considerable number of diabetic foot ulcer (DFU) patients require amputation every year, which worsens their quality of life, aggravates the social burden, and shortens their life expectancy. Considering these negative effects, it is important to explore the relative risk factors affecting amputation in DFU patients. METHODS: The PubMed, SCIE and Embase databases were comprehensively searched for prospective or retrospective studies published before October 31, 2019. All English language studies involving DFU patients were included, and RevMan 5.3 software was used to analyse the data. RESULTS: This meta-analysis includes 21 studies involving 6505 participants, including 2006 patients who required a lower limb amputation. The following variables were associated with an increased risk of amputation: male sex (odds ratios (OR) = 1.30, 95% confidence interval (CI) = 1.16~1.46, P<0.00001), smoking history (OR = 1.19, 95% CI = 1.04~1.35, P = 0.009), a history of foot ulcers (OR = 2.48, 95% CI = 2.00~3.07, P<0.00001), osteomyelitis (OR = 3.70, 95% CI = 3.02~4.53, P<0.00001), gangrene (OR = 10.90, 95% CI = 5.73~20.8, P<0.00001), a lower body mass index (mean difference IV (MD) = -0.88, 95% CI = -1.30~-0.47, P<0.0001), and a higher white blood cell count (MD = 2.42, 95% CI = 2.02~2.82, P<0.00001). However, age (MD = 1.24, 95% CI = -0.45~2.93, P = 0.15), type of diabetes (OR = 0.96, 95% CI = 0.61~1.52, P = 0.86), hypertension (OR = 1.19, 95% CI = 0.96~1.47, P = 0.12), and HbA1c level (MD = 0.02, 95% CI = -0.28~0.33, P = 0.87) were not associated with amputation in patients with DFU. CONCLUSIONS: Our meta-analysis identified several risk factors for amputation in DFU patients, including the male sex, a smoking history, a history of foot ulcers, osteomyelitis, gangrene, a lower body mass index, and a higher white blood cell count. Once gangrene occurs, the risk of amputation rapidly increases.


Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Pé Diabético/cirurgia , Úlcera do Pé/cirurgia , Extremidade Inferior/cirurgia , Amputação/métodos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/etiologia , Pé Diabético/fisiopatologia , Úlcera do Pé/fisiopatologia , Humanos , Extremidade Inferior/fisiopatologia , Qualidade de Vida , Fatores de Risco
10.
Orv Hetil ; 161(38): 1637-1645, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32924968

RESUMO

INTRODUCTION: Intermittent claudication has a significant negative impact on the patients' quality of life. Revascularization procedures and noninvasive medical therapies can improve walking capacity. Cilostazol has IA recommendation for the treatment of intermittent claudication. AIM: The aim of this study was to evaluate the effect of a three-month cilostazol treatment on the health-related quality of life and on the lower-limb functional capacity in diabetic (DM) and non-diabetic patients (NDM) with intermittent claudication in the clinical practice. METHOD: The study was a multicenter, non-interventional trial; 812 patients with peripheral artery disease (Fontaine II stage, mean age: 67.17 years, male/female: 58.25/41.75%, 318 diabetics) were enrolled, who received cilostazol (50 or 100 mg twice a day) for 3 months. The quality of life was evaluated with the EQ-5D-3L questionnaire, the functional capacity with the WELCH questionnaire. Walking distances, ankle-brachial index were measured at baseline and after 3 months. RESULTS: Upon conclusion of the study, the EQ-5D index improved both in non-diabetic and diabetic patients (baseline: NDM -0.45 ± 0.22, DM -0.48 ± 0.23, 3rd month: -0,24 ± 0.18, -0,27 ± 0.19; respectively; p<0.0001) and there was a significant increase in the WELCH score as well (baseline: NDM 20 ± 14, DM 18 ± 14; 3rd month: 33 ± 19, 29 ± 16, respectively; p<0.0001). Both pain-free and maximal walking distance increased by 59.2% (median: 50.0%), 46.58 (median: 40.51%) in NDM and 42.85% (median: 43.33%), 41.61% (median: 34.68%) in DM patients, respectively (p<0.001). CONCLUSIONS: Three months of cilostazol treatment improved the quality of life and lower-limb functional capacity in diabetic and non-diabetic claudicant patients. The WELCH questionnaire is a useful tool in clinical practice for the evaluation of intermittent claudication treatment. Orv Hetil. 2020; 161(38): 1637-1645.


Assuntos
Cilostazol/uso terapêutico , Diabetes Mellitus/fisiopatologia , Claudicação Intermitente/tratamento farmacológico , Doença Arterial Periférica/complicações , Qualidade de Vida/psicologia , Tetrazóis/uso terapêutico , Vasodilatadores/uso terapêutico , Idoso , Estudos de Casos e Controles , Complicações do Diabetes , Feminino , Humanos , Claudicação Intermitente/psicologia , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/tratamento farmacológico , Resultado do Tratamento , Caminhada
11.
PLoS One ; 15(9): e0238846, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915883

RESUMO

The study aimed at assessing the acute physiological effects of running a 65-km vs a 107-km mountain ultramarathon. Nineteen athletes (15 males and 4 females) from the shorter race and forty three athletes (26 males and 17 females) from the longer race were enrolled. Body weight, respiratory and lower limb strength were assessed before and after the race. Blood samples were obtained before, after and 24-h post-race. Body weight loss did not differ between races. A decrease in squat jump height (p<0.01; d = 1.4), forced vital capacity (p<0.01; d = 0.5), forced expiratory volume in 1 s (p<0.01; d = 0.6), peak inspiratory flow (p<0.01; d = 0.6) and maximal inspiratory pressure (p<0.01; d = 0.8) was observed after the longer race; while, after the shorter race only maximal inspiratory pressure declined (p<0.01; d = 0.5). Greater post-race concentrations of creatine kinase (p<0.01; d = 0.9) and C-reactive protein (p<0.01; d = 2.3) were observed following the longer race, while high-sensitivity cardiac troponin was higher after the shorter race (p<0.01; d = 0.3). Sodium decreased post-competition only after the shorter race (p = 0.02; d = 0.6), while creatinine increased only following the longer race (p<0.01; d = 1.5). In both groups, glomerular filtration rate declined at post-race (longer race: p<0.01, d = 2.1; shorter race: p = 0.01, d = 1.4) and returned to baseline values at 24 h post-race. In summary, expiratory and lower-limb fatigue, and muscle damage and inflammatory response were greater following the longer race; while a higher release of cardiac troponins was observed after the shorter race. The alteration and restoration of renal function was similar after either race.


Assuntos
Biomarcadores/sangue , Fadiga/fisiopatologia , Extremidade Inferior/fisiopatologia , Pulmão/fisiopatologia , Força Muscular , Resistência Física/fisiologia , Corrida , Adulto , Atletas/estatística & dados numéricos , Creatina Quinase/sangue , Creatinina/sangue , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Testes de Função Respiratória , Capacidade Vital
12.
J Rehabil Med ; 52(8): jrm00088, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32778900

RESUMO

OBJECTIVE: To determine the joint position sense of the lower extremities and its relationship with motor function in children with developmental coordination disorder (DCD) and typically developing (TD) children. METHODS: A total of 56 participants were recruited; 28 children with DCD (age 10.86±1.07 years; 13 females, 15 males) and 28 TD children (age 10.96±1.18 years; 12 females, 16 males). Knee and ankle joint position sense were assessed using a Biodex isokinetic dynamometer. Joint position acuity was measured by position error (PE) and position error variability (PEV). Motor function was examined using the 2nd edition of Movement Assessment Battery for children (MABC-2) and quantified via sub-scores from 3 MABC-2 domains. RESULTS: Both PE and PEV at knee and ankle joints were significantly greater in children with DCD compared with TD children. In addition, both PE and PEV were significantly greater at the ankle joints than the knee joints in children with DCD. For children with DCD only, joint position acuity in the lower extremities significantly and negatively correlated with MABC-2 balance sub-score. CONCLUSION: This study verifies that lower limb proprioception is impaired in children with DCD. Also, children with DCD displayed greater proprioceptive deficits at the ankle compared with the knee joint. Children with DCD who had poorer joint position acuity, i.e. greater PE and PEV, in the lower extremities tended to perform less well in balance function.


Assuntos
Extremidade Inferior/fisiopatologia , Transtornos das Habilidades Motoras/fisiopatologia , Propriocepção/fisiologia , Criança , Feminino , Humanos , Masculino
14.
PLoS One ; 15(7): e0236266, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726351

RESUMO

The aim of this study was an evaluation of the musculoskeletal system in women and men with Generalized Joint Hypermobility (GJH). The study included 87 participants- 40 with Generalized Joint Hypermobility (aged 21.2 ±1.8 years) and 47 (aged 21.0 ±1.3 years) in the control group (CG). The study included the Beighton score, the measurements of body composition, muscle flexibility (Straight Leg Raise test, Popliteal Angle test, Modified Thomas Test), and the measurements of muscle strength and muscle power. T-test and Mann-Whitney U Test were applied to assess the differences between independent groups. The study showed that there were no significant differences (p>.05) in the assessed body composition and the muscle flexibility between both women and men with GJH and the participants in the CG. Under isokinetic conditions for the non-dominant lower extremity, men from the CG received significantly higher (p = .02) flexion peak torque at 180°/s angular velocity. Women from the CG received a statistically significantly lower (p = .04) F/E ratio at 180°/s velocity. Under isometric conditions for both women and men with GJH, there were no statistically significant differences (p>.05) in the maximum torques in knee extension and flexion compared to the CG. For women and men with GJH, the maximum power in the lower extremities and jumping ability were not significantly different (p>.05) compared to the CG participants. The body composition, muscle flexibility, muscle strength, and muscle power of adults with Generalized Joint Hypermobility did not differ compared to healthy participants. The fact that there are no differences does not exclude the efficacy of strength training in increasing levels of muscle strength and its impact on body posture and proprioception or coordination.


Assuntos
Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiopatologia , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Adulto , Composição Corporal/fisiologia , Feminino , Humanos , Instabilidade Articular/epidemiologia , Extremidade Inferior/fisiopatologia , Masculino , Amplitude de Movimento Articular/fisiologia , Adulto Jovem
15.
Muscle Nerve ; 62(4): 502-508, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32654212

RESUMO

INTRODUCTION: Inotersen, an antisense oligonucleotide inhibitor of transthyretin (TTR) protein production, demonstrated significant benefit versus placebo in the modified Neuropathy Impairment Score (NIS) +7 neurophysiologic tests (mNIS+7) in patients with hereditary TTR-mediated amyloidosis (hATTR) with polyneuropathy. This analysis assessed the mNIS+7 components by anatomic location and the lower limb function (LLF) test. METHODS: Adults with hATTR in the NEURO-TTR trial (NCT01737398) were randomly assigned to receive weekly doses of subcutaneous inotersen 300 mg or placebo for 65 weeks. The mNIS+7 and LLF were assessed at 35 and 66 weeks. RESULTS: All major mNIS+7 components (muscle weakness, muscle stretch reflexes, sensation) and the LLF showed significant efficacy in patients receiving inotersen versus placebo; however, NIS-reflexes (upper limb), touch pressure (upper and lower limbs), and heart rate during deep breathing did not show significant effects. DISCUSSION: The results of this analysis reinforce the beneficial effect of inotersen on slowing neuropathy progression in patients with hATTR polyneuropathy.


Assuntos
Neuropatias Amiloides Familiares/tratamento farmacológico , Extremidade Inferior/fisiopatologia , Debilidade Muscular/tratamento farmacológico , Oligonucleotídeos Antissenso/uso terapêutico , Oligonucleotídeos/uso terapêutico , Neuropatias Amiloides Familiares/fisiopatologia , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/fisiopatologia , Oligonucleotídeos/farmacologia , Oligonucleotídeos Antissenso/farmacologia , Reflexo/efeitos dos fármacos , Resultado do Tratamento
16.
BMJ Case Rep ; 13(7)2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641309
17.
Health Qual Life Outcomes ; 18(1): 245, 2020 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-32698883

RESUMO

BACKGROUND: Literature on the validity of outcome measurement in lymphedema and lipedema is very sparse. This study aimed to examine the convergent, divergent and discriminant validity of a set of 5 instruments in both conditions. METHODS: Cross-sectional outcome was measured by the generic Short Form 36 (SF-36), the lymphedema-specific Freiburg Quality of Life Assessment for lymphatic disorders, Short Version (FLQA-lk), the knee-specific Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), the Symptom Checklist-90-revised (SCL-90R), and the Six-Minute Walk Test (6 MWT). Construct convergent/divergent validity was quantified by bivariate correlations and multivariate factor analysis, and discriminant validity by standardized mean differences (SMDs). RESULTS: Health was consistently better in lymphedema (n = 107) than in lipedema (n = 96). The highest construct convergence was found for physical health between the SF-36 and KOS-ADL (bivariate correlations up to 0.78, factor loads up to 0.85, explained variance up to 56.8%). The second most important factor was mental health (bivariate correlations up to 0.79, factor loads up to 0.86, explained variance up to 13.3%). Discriminant validity was greatest for the FLQA-lk Physical complaints (adjusted SMD = 0.93) followed by the SF-36 Bodily pain (adjusted SMD = 0.83), KOS-ADL Function (adjusted SMD = 0.47) and SF-36 Vitality (adjusted SMD = 0.39). CONCLUSIONS: All five instruments have specific strengths and can be implemented according to the scope and aim of the outcome examination. A minimum measurement set should comprise: the SF-36 Bodily pain, SF-36 Vitality, FLQA-lk Physical complaints, FLQA-lk Social life, FLQA-lk Emotional well-being, FLQA-lk Health state, KOS-ADL Symptoms, KOS-ADL Function, and the SCL-90R Interpersonal sensitivity.


Assuntos
Lipedema/psicologia , Linfedema/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
18.
Med Care ; 58(7): 658-662, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32520839

RESUMO

BACKGROUND: Single-center comparative effectiveness studies evaluating outcomes that can occur posthospitalization may become biased if outcomes diagnosed at other facilities are not ascertained. Administrative datasets that link patients' records across facilities may improve outcome ascertainment. OBJECTIVE: To determine whether use of linked administrative data significantly augments thromboembolic outcome ascertainment. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: Patients with an acute isolated calf deep vein thrombosis (DVT) diagnosed at 1 Californian center during 2010-2013. MEASURES: Proximal DVT or pulmonary embolism (PE) within 180 days. We ascertained outcomes from linked California hospitalization, emergency department, and ambulatory surgery data and compared this information to outcomes previously identified from review of the center's medical records. RESULTS: Among 384 patients with an isolated calf DVT, 333 could be linked to longitudinal administrative data records. Ten patients had a possible proximal DVT or PE (4 more clearly so) from administrative data; all were unknown from medical record review. Eleven patients with known outcomes from medical record review had no outcome from administrative data. The adjusted odds ratio of proximal DVT or PE with therapeutic anticoagulation attenuated from 0.33 [95% confidence interval (CI), 0.12-0.87] using only medical record review to 0.64 (95% CI, 0.29-1.40) using both medical record review and possible outcomes from administrative data. Restricting the outcome to diagnoses clearly involving proximal DVT or PE, the adjusted odds ratio was 0.46 (95% CI, 0.19-1.10). CONCLUSIONS: Use of linked hospital administrative data augmented detection of outcomes but imperfect linkage, nonspecific diagnoses, and documentation/coding errors introduced uncertainty regarding the accuracy of outcome ascertainment.


Assuntos
Anticoagulantes/uso terapêutico , Organização e Administração/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/normas , Tromboembolia Venosa/tratamento farmacológico , Adulto , Idoso , California , Estudos de Coortes , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Tromboembolia Venosa/prevenção & controle
19.
Ulus Travma Acil Cerrahi Derg ; 26(4): 509-516, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32589239

RESUMO

BACKGROUND: The hypothesis of our study is that sugammadex has protective efficacy against ischemia-reperfusion (I/R) injury in rats. METHODS: Our study included 28 male Wistar Albino rats. The rats were assigned to four groups. The sham group had no procedure other than anesthesia administration. The control group received three hours of ischemia and 24 hours of reperfusion. The Sgdx4 group received 4 mg/kg, and the Sgdx16 group received 16 mg/kg sugammadex intravenously, and then, reperfusion was applied. Histopathological investigation, and serum creatine kinase (CK), lactate dehydrogenase (LDH), and serum and tissue malondialdehyde (MDA) and superoxide dismutase (SOD) analyses were performed. RESULTS: When the sham group and the control group were compared, there were statistically significant differences histopathologically (p<0.01). There was no significant difference between the Sgdx4 group compared with the sham and control groups histopathologically (p>0.01). There was a significant difference between the Sgdx16 group and the sham group histopathologically (p<0.01). There were significant differences between the sham and control groups concerning CK and LDH levels (p<0.01). There was a significant difference in the levels of CK between the control group and Sgdx4 group and in the levels of CK and LDH between the control group and Sgdx16 group (p<0.01). CONCLUSION: In our study, we examined the histological and biochemical protective effects of 4 mg/kg sugammadex on unilateral lower extremity I/R injury in rats. The findings suggest that a 4 mg/kg dose of sugammadex was more effective than a 16 mg/kg dose.


Assuntos
Substâncias Protetoras , Traumatismo por Reperfusão , Sugammadex , Animais , Modelos Animais de Doenças , Extremidade Inferior/fisiopatologia , Masculino , Substâncias Protetoras/administração & dosagem , Substâncias Protetoras/uso terapêutico , Ratos , Ratos Wistar , Traumatismo por Reperfusão/tratamento farmacológico , Traumatismo por Reperfusão/metabolismo , Sugammadex/administração & dosagem , Sugammadex/uso terapêutico
20.
BMC Neurol ; 20(1): 243, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532249

RESUMO

BACKGROUND: Cerebral palsy (CP), which is the leading cause of motor disability during childhood, can produce sensory and cognitive impairments at different degrees. Most recent therapeutic interventions for these patients have solely focused on upper extremities (UE), although more than 60% of these patients present lower extremities (LE) deficits. Recently, a new therapeutic concept, Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE), has been proposed, involving the constant stimulation of UE and LE. Based on motor skill learning principles, HABIT-ILE is delivered in a day-camp setting, promoting voluntary movements for several hours per day during 10 consecutive week days. Interestingly, the effects of this intervention in a large scale of youngsters are yet to be observed. This is of interest due to the lack of knowledge on functional, neuroplastic and biomechanical changes in infants with bilateral CP. The aim of this randomized controlled study is to assess the effects of HABIT-ILE adapted for pre-school children with bilateral CP regarding functional, neuroplastic and biomechanical factors. METHODS: This international, multicentric study will include 50 pre-school children with CP from 12 to 60 months of age, comparing the effect of 50 h (2 weeks) of HABIT-ILE versus regular motor activity and/or customary rehabilitation. HABIT-ILE presents structured activities and functional tasks with continuous increase in difficulty while the child evolves. Assessments will be performed at 3 period times: baseline, two weeks later and 3 months later. The primary outcome will be the Gross Motor Function Measure 66. Secondary outcomes will include Both Hands Assessment, Melbourne Assessment-2, Semmes-Weinstein Monofilament Test, algometry assessments, executive function tests, ACTIVLIM-CP questionnaire, Pediatric Evaluation of Disability Inventory (computer adaptative test), Young Children's Participation and Environment Measure, Measure of the Process of Care, Canadian Occupational Performance Measure, neuroimaging and kinematics. DISCUSSION: The results of this study should highlight the impact of a motor, intensive, goal-directed therapy (HABIT-ILE) in pre-school children at a functional, neuroplastic and biomechanical level. In addition, this changes could demonstrated the impact of this intervention in the developmental curve of each child, improving functional ability, activity and participation in short-, mid- and long-term. NAME OF THE REGISTRY: Evaluation of Functional, Neuroplastic and Biomechanical Changes Induced by an Intensive, Playful Early-morning Treatment Including Lower Limbs (EARLY-HABIT-ILE) in Preschool Children With Uni and Bilateral Cerebral Palsy (HABIT-ILE). TRIAL REGISTRATION: NCT04017871 REGISTRATION DATE: July 12, 2019.


Assuntos
Paralisia Cerebral/reabilitação , Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Canadá , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Extremidade Inferior/fisiopatologia , Masculino , Destreza Motora/fisiologia , Estudos Multicêntricos como Assunto , Extremidade Superior/fisiopatologia
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