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1.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431539

RESUMO

We present a kidney-pancreas transplant recipient who achieved complete recovery from COVID-19. A 45-year-old patient with T3 paraplegia underwent kidney-pancreas transplantation 18 years ago, followed by a subsequent kidney transplant 9 years ago, and presented with fever, hypoxia and hypotension after exposure to two confirmed cases of COVID-19. History of solid organ transplant, pre-existing renal impairment, asthma and an elevated D-dimer were identified as established risk factors for severe COVID-19. Supportive management was provided, baseline immunosuppression with everolimus was continued, and oral prednisolone was increased. A complete recovery was observed. Given the favourable outcome despite risk factors for severe COVID-19, we identify and review the potential mitigating roles of immunosuppression and mammalian target of rapamycin (mTOR) inhibitors in this disease. Further investigation is required to establish whether mTOR inhibitors could be used as therapeutic agents to treat COVID-19, or as alternative immunosuppression implemented early in the COVID-19 disease course.


Assuntos
/complicações , Glucocorticoides/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Rim , Transplante de Pâncreas , Paraplegia/complicações , Acidentes de Trânsito , Asma/complicações , /fisiopatologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/cirurgia , Everolimo/uso terapêutico , Febre/fisiopatologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Hipotensão/fisiopatologia , Hipóxia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Serina-Treonina Quinases TOR/antagonistas & inibidores
2.
Magy Seb ; 73(4): 153-159, 2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310918

RESUMO

Összefoglaló. A thoracoabdominalis aorta kirekesztése a gerincvelo keringésének csökkenését okozza. Az ischemia klinikailag paraparesis, paraplegia formájában jelenik meg. Ez elsosorban nyitott mutétek során jelent aligha kiszámítható szövodményt, de a modern endovascularis technikák sem oldották meg teljes mértékben ennek biztonságos kivédését - bár arányát jelentosen mérsékelték. A javuló eredmények számos tényezore vezethetok vissza, mint a keringés kirekesztési idejének csökkentése, a gerincvelo-funkció és metabolismus ellenorzése. Mesterséges keringésjavító direkt és indirekt eljárások, liquor drainage, hutés mellett a collateralis keringés javítását szolgáló prekondicionáló módszerek kerültek bevezetésre. Kísérletes munkánkban 25-30 kg testsúlyú kutyákon vizsgáltuk - más paraméterek mellett - a distalis perfusio növelésének, a liquornyomás csökkentésének, illetve ezek kombinációjának protektív hatását egyórás thoracoabdominalis aortakirekesztés során. Dolgozatunkban a kísérleti állataink neurológiai végállapotát a keringési paraméterek és szöveti perfusio és a reperfusio változásainak összefüggésein keresztül tárgyaljuk. Megállapítottuk, hogy distalis gerincvelo reperfusiós hyperaemiája szorosan összefügg a neurológiai károsodás mértékével. Summary. Clamping of the thoracoabdominal aorta reduces perfusion of the spinal cord significantly, which clinically may present as paraparesis or paraplegia - devastating and unpredictable complications of open thoracoabdominal aortic surgery. Introduction of monitoring of evoked potentials and/or biochemical markers, methods increasing distal arterial pressure, indirect procedures enhancing residual flow (like liquor drainage), drugs, and use of hypothermia contributed to achieve better outcome. Preconditioning of spinal cord circulation is also a promising method. New endovascular techniques for thoracoabdominal aortic aneurysms and dissections reduced surgical trauma significantly. Despite all these progressions spinal cord ischemic damage is still a significant risk. To address this problem we carried out an experimental work using a canine model focusing on the protective effect of distal arterial perfusion, spinal fluid drainage, and their combination in a one hour setting of thoracoabdominal aortic clamping. In this paper we publish our data of circulatory and specific perfusion parameters of the spinal cord during and after declamping in correlation of final neurologic outcome.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Isquemia/cirurgia , Paraplegia/complicações , Medula Espinal/cirurgia , Animais , Constrição , Cães , Perfusão , Medula Espinal/irrigação sanguínea
3.
Arch Phys Med Rehabil ; 101(11): 1898-1905, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32450062

RESUMO

OBJECTIVE: Individuals with spinal cord injury (SCI) often present signs and symptoms of median nerve (MN) pathology. Preclinical signs identification of MN pathology might facilitate early intervention to prevent or delay carpal tunnel syndrome in SCI. We assessed if ultrasound parameters changed in response to upper extremity (UE) circuit training exercise in individuals with paraplegia and able-bodied individuals. DESIGN: Case-control study. PARTICIPANTS: Adults (N=32) with paraplegia (n=16) and age- and sex-matched able-bodied controls (n=16). INTERVENTION: Circuit training exercise. MAIN OUTCOME MEASURES: MN ultrasound evaluation at the pisiform and radius before and after UE exercise. Ultrasound parameters included cross-sectional area (CSA), and gray scale (GS). Data presented as mean ± SD. RESULTS: Pre-exercise CSAs were larger in SCI at the radius (12.0±2.9 vs 9.0±2.1; P=.003), but not the pisiform (9.8±3.1 vs 9.1±1.7; P=.431). There were no statistical differences in MN response to exercise between groups (all P≥.293). Across participants, CSA changes were inversely associated with their pre-exercise values at the pisiform (r=-0.648; P<.001) and the radius (r=-0.366; P=.043). Participants with pre-exercise CSA values ≥10.00 mm2 at the pisiform responded to exercise with decreases in CSA (mean change ± SD, -2.0±1.5; P=.002) and GS (-2.8±6.2; P=.029). Participants with pre-exercise CSA ≤9.99 mm2 at the pisiform responded to exercise with no change in CSA (mean change ± SD, 0.7±2.5; P=.002) and increased GS (3.2±7.2; P=.029). CONCLUSIONS: CSA exercise response was more strongly related to pre-exercise MN values than presence or absence of SCI.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Nervo Mediano/diagnóstico por imagem , Paraplegia/diagnóstico por imagem , Traumatismos da Medula Espinal/diagnóstico por imagem , Ultrassonografia , Adulto , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/prevenção & controle , Estudos de Casos e Controles , Exercícios em Circuitos , Feminino , Humanos , Masculino , Paraplegia/complicações , Paraplegia/reabilitação , Índice de Gravidade de Doença , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Resultado do Tratamento , Extremidade Superior/inervação , Extremidade Superior/fisiopatologia , Adulto Jovem
4.
Adv Skin Wound Care ; 33(3): 146-154, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32058440

RESUMO

OBJECTIVE: To assess pressure ulcer (PU) risk in persons with mobility impairments using a large data set to identify demographic, laboratory, hemodynamic, and pharmacologic risk factors. METHODS: The cohort of interest was persons with disabilities who have mobility impairments and are diagnostically at risk of PUs. To define this cohort, diagnoses that qualify patients for skin protection wheelchair cushions were used. Data were obtained from the Cerner Health Facts data warehouse. Two cohorts were defined: persons with and without a history of PUs. Analysis included descriptive statistics and multivariate logistic regression modeling. Variables retained in the model were identified using LASSO, gradient boosting, and Bayesian model averaging. MAIN RESULTS: The resulting cohorts included more than 87,000 persons with a history of PUs and more than 1.1 million persons who did not have a PU. The data revealed seven disability groups with the greatest prevalence of PUs: those with Alzheimer disease, cerebral palsy, hemiplegia, multiple sclerosis, paraplegia/quadriplegia, Parkinson disease, and spina bifida. Ulcers in the pelvic region accounted for 82% of PUs. Persons with disabilities who were male or black had a greater prevalence of PUs. Physiologic risk factors included the presence of kidney or renal disease, decreased serum albumin, and increased serum C-reactive protein. CONCLUSIONS: The results indicate that, although persons with disabilities can exhibit a wide functional range, they remain at risk of PUs and should be evaluated for proper preventive measures, including support surfaces and wheelchair cushions.


Assuntos
Avaliação da Deficiência , Limitação da Mobilidade , Lesão por Pressão/epidemiologia , Traumatismos da Medula Espinal/complicações , Cadeiras de Rodas/efeitos adversos , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Data Warehousing , Bases de Dados Factuais , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Paraplegia/complicações , Lesão por Pressão/etiologia , Lesão por Pressão/fisiopatologia , Prevalência , Quadriplegia/complicações , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Traumatismos da Medula Espinal/diagnóstico , Estados Unidos , Cadeiras de Rodas/estatística & dados numéricos
5.
World Neurosurg ; 136: 136-139, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31954899

RESUMO

BACKGROUND: Encephalopathy is reported to have affected 250,000 people in the United States over the last decade, with considerable morbidity and mortality. Baclofen, a gamma-aminobutyric acid-B agonist that acts on the central nervous system, is the drug most widely used to treat spasticity. Baclofen overdose is a potentially deadly condition that can cause encephalopathy and can result from multiple etiologies. Renal disease can contribute to baclofen overdose and encephalopathy, and there are currently no dosing recommendations for patient's on baclofen with renal impairment. CASE DESCRIPTION: We report an unusual case of a man aged 35 years who presented with persistent fevers, seizures, and normal mentation. The patient presented with intrathecal baclofen use and prior exposure to West Nile Virus. He developed acute kidney injury at hospital secondary to vancomycin use, and mental status declined. CONCLUSIONS: This case highlights that patients with baclofen overdose can initially appear to have serious brain injury, however, full patient recovery can occur in <72 hours. This case provides additional insight into the guidelines for the treatment and management for unknown cause encephalopathy. This case also highlights the link between renal disease, baclofen, and encephalopathy through a review of the literature.


Assuntos
Baclofeno/efeitos adversos , Encefalopatias/induzido quimicamente , Agonistas dos Receptores de GABA-B/efeitos adversos , Espasmo/tratamento farmacológico , Lesão Renal Aguda/induzido quimicamente , Adulto , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Baclofeno/administração & dosagem , Encefalopatias/complicações , Encefalopatias/fisiopatologia , Eletroencefalografia , Febre/etiologia , Febre/fisiopatologia , Agonistas dos Receptores de GABA-B/administração & dosagem , Humanos , Bombas de Infusão Implantáveis , Infusão Espinal , Masculino , Meropeném/uso terapêutico , Paraplegia/complicações , Convulsões/etiologia , Convulsões/fisiopatologia , Espasmo/etiologia , Traumatismos da Medula Espinal/complicações , Vancomicina/efeitos adversos
6.
Med. paliat ; 26(4): 318-321, oct.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-190261

RESUMO

Presentamos el caso clínico de una mujer, con antecedente de esquizofrenia paranoide crónica, en tratamiento con diversos antipsicóticos, con fragilidad familiar importante, que consulta a urgencias por paraplejia de días de evolución, siendo finalmente diagnosticada de una compresión medular por neoplasia de pulmón avanzada. Al presentar este caso queremos destacar la importancia en la detección precoz de necesidades y de factores de complejidad para optimizar el abordaje e interrelación de recursos de la comunidad durante el proceso de enfermedad


We report the case of a woman with a history of chronic paranoid schizophrenia on treatment with various antipsychotic drugs and with signifi cant family fragility who presented at the emergency room with paraplegia for the past few days. She was finally diagnosed with spinal cord compression due to advanced lung cancer. In this case report we want to highlight the importance of early identification as regards needs and complexity factors in order to optimize the multidisciplinary approach and resource interrelationships during the disease process


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Paraplegia/complicações , Esquizofrenia/tratamento farmacológico , Cuidados Paliativos/métodos , Determinação de Necessidades de Cuidados de Saúde , Diagnóstico Precoce , Radiografia Torácica , Tomografia Computadorizada por Raios X
7.
BMC Neurol ; 19(1): 256, 2019 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-31656170

RESUMO

BACKGROUND: Spastic paraplegia, optic atrophy and neuropathy (Spoan syndrome) is an autosomal recessive disease with approximately 70 cases recorded in Brazil and Egypt. METHODS: This is a prospective longitudinal study performed with 47 patients affected with Spoan syndrome of seven communities of Rio Grande do Norte (Brazil) to investigate changes in motor function based on comparative data obtained from a 10-year follow-up. RESULTS: The mean age of the participants was 47.21 ± 12.42 years old, and the mean age at loss of ambulation and hand function were 10.78 ± 5.55 and 33.58 ± 17.47 years old, respectively. Spearman's correlation analysis between the score on the Modified Barthel Index and the investigated variables evidenced statistical significance for age (p < 0.001) and right- and left-hand grip strength (p = 0.042 and p = 0.021, respectively). Statistical significance was not evidenced for the remainder of the variables, including age at onset of symptoms (p = 0.634), age at loss of ambulation (p = 0.664) and age at loss of hand function (p = 0.118). CONCLUSIONS: Our analysis allows asserting that the participants exhibited slight dependence until age 35. The greatest losses occurred from ages 35 to 41, and starting at 50, practically all patients become completely dependent. These findings are relevant for determining the prognosis as well as suitable treatment, rehabilitation and assistive technology for these individuals.


Assuntos
Neuropatia Hereditária Motora e Sensorial/complicações , Transtornos Motores/etiologia , Atrofia Óptica/complicações , Paraplegia/complicações , Adolescente , Adulto , Idade de Início , Brasil , Criança , Pré-Escolar , Progressão da Doença , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
8.
Bull Hosp Jt Dis (2013) ; 77(3): 211-215, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487488

RESUMO

INTRODUCTION: Spinal cord injured patients have an estimated 25% to 34% lifetime incidence of sustaining an extremity fracture. The objective of this study is to describe the outcomes of femur fractures treated in patients with pre-existing spinal cord injury (SCI) and lower extremity paraplegia. MATERIALS AND METHODS: An IRB approved retrospective review of patients 18 years of age and older who sustained a femur fracture a minimum of 2 years following spinal cord injury and received treatment at a regional academic level 1 trauma center over a 10-year period was performed. Patients were divided into two groups based on whether they received operative or nonoperative management of the femoral shaft fracture. The primary outcome assessed was re-operation. Additional outcomes including union, infection, implant failure, and mortality were recorded. RESULTS: Twenty-one patients sustaining a total of 25 femur fractures were identified. The most common mechanism of injury was fall during transfer. Sixteen fractures were treated non-operatively and nine were treated operatively. At a mean of 4.1 years of follow-up (range: 1.1 to 12.1 years) six out of nine (66.7%) patients in the operative group required an unplanned secondary surgery compared to two patients (12.5%) in the non-operative group (p = 0.006). Overall, the rate of fracture union was 48%, and there was no difference seen between treatment groups (56.3% in nonoperative group versus 33.3% in operative group, p = 0.28). Six operative patients (66.7%) developed an infection as compared to one patient (6.3%) in the non-operative group (p = 0.002). Three operative patients (33.3%) had failure of fixation with implant cutout. One patient died within 2 years of fracture in the non-operative group (6.3%) as did one patient in the operative group (11.1%), (p = 1.0). CONCLUSIONS: Surgical treatment of femur fractures in patients with a pre-existing SCI and lower extremity paraplegia had a higher rate of complications than nonoperative management in our series. Based on our experience, we recommend non-operative treatment of femur fractures in patients with pre-existing spinal cord injury and lower extremity paraplegia.


Assuntos
Tratamento Conservador , Fraturas do Fêmur , Fixação de Fratura , Paraplegia , Traumatismos da Medula Espinal , Adulto , Tratamento Conservador/efeitos adversos , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Feminino , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Fixação de Fratura/efeitos adversos , Fixação de Fratura/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Paraplegia/complicações , Paraplegia/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia
9.
Acta Dermatovenerol Croat ; 27(3): 184-187, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542063

RESUMO

Bullous pemphigoid (BP) is an autoimmune disorder which is usually chronic, with blistering that predominantly affects the skin and occasionally the mucosa, and which includes several different types. One of them is a very rare dyshidrosiform type which is localized on the hands and feet with small or large blisters on the palmoplantar surfaces. BP resulting from a drug reaction is a relatively rare occurrence, and so far more than 50 different medications have been identified as triggers. The aim of this article was to present the case of a paraplegic patient who developed this rare dyshidrosiform type of BP while he was being neurologically treated with baclofen. In spite of therapy with systemic and topical corticosteroids and other measures, successful treatment was achieved only after eliminating baclofen from the patient's regimen. His general state of health was seriously endangered due to nasal and skin methicillin-resistant Staphylococcus aureus (MRSA), urinary infection, and oral mycosis (soor), and he was at high risk of sepsis and a fatal outcome. Through our efforts, however, we managed to achieve an excellent outcome. According to our knowledge, this was the first case of baclofen-induced dyshidrosiform BP.


Assuntos
Baclofeno/efeitos adversos , Staphylococcus aureus Resistente à Meticilina , Relaxantes Musculares Centrais/efeitos adversos , Penfigoide Bolhoso/induzido quimicamente , Infecções Estafilocócicas/complicações , Infecções Urinárias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Penfigoide Bolhoso/patologia
10.
Ann Otol Rhinol Laryngol ; 128(12): 1194-1197, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31364384

RESUMO

OBJECTIVES: To describe a case of open airway surgery with postoperative respiratory complications in a paraplegic woman and to review the unique respiratory physiology seen in patients with a history of cervical or thoracic spinal cord injury (SCI). METHODS: Case report and literature review. RESULTS: We describe the case of a 25-year-old paraplegic who developed tracheal stenosis after tracheotomy, eventually requiring tracheal resection and re-anastomosis. Her postoperative course was complicated by mucus plugging and severe atelectasis, necessitating reintubation. After extubation, the patient reported difficulty expectorating secretions ever since her SCI, requiring manual abdominal pressure from her family members to assist her when she needed to cough. CONCLUSION: This first report of cricotracheal resection in a patient with paraplegia following SCI highlights the importance of an adequate cough and demonstrates the unique respiratory management necessary for patients with SCI.


Assuntos
Tosse , Paraplegia/complicações , Complicações Pós-Operatórias/terapia , Traumatismos da Medula Espinal/complicações , Estenose Traqueal/cirurgia , Adulto , Extubação , Feminino , Humanos , Muco , Complicações Pós-Operatórias/etiologia , Estenose Traqueal/etiologia , Traqueotomia/efeitos adversos
12.
J Clin Neurosci ; 68: 308-311, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31327592

RESUMO

BACKGROUND: Malignant Intramedullary Spinal Cord Tumor are a relatively uncommon entity affecting patients whose prognosis is quickly and relentlessly dismal. Since the '50s Spinal Cordectomy' has been advocated for the surgical management of these conditions, but to date, no standard operative protocol has been reported yet. OBJECTIVE: Although apparently "easy", burdened by virtually no further risk for the neurological function in paraplegic or severely paraparetic patients, SCt conceals notable pitfalls and surgical problems that are to date not yet completely discussed. The objective of the present paper is therefore to report a detailed stepwise description of the surgical technique. METHODS AND RESULTS: SCt addresses the problem of reaching a surgical radicality in patients whom neurological preoperative conditions have already irreversibly declined to a deep nonfunctional motor impairment and whose preoperative Brain MRI scan rules out intracranial seeding. The dural sac along with the radicular pouches must be considered as possible seeding and recurrence locations therefore such structure should be "en-bloc" removed. The cranial medullary end of the resection should be identified on the ground of the preoperative MRI and intraoperatively confirmed with fresh histological examinations ruling out the presence of tumor cells above the cordectomy. Due to the topographic and functional medullary arterial anatomy, no SCt should be performed above T3. The risk of postoperative sagittal imbalance is high and therefore a concurrent posterior vertebral stabilization is required. CONCLUSION: Spinal Cordectomy is a safe and feasible "last chance" treatment to prolong survival in paraplegic or severely paraparetic patients.


Assuntos
Glioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Paraplegia/complicações , Neoplasias da Medula Espinal/cirurgia , Adulto , Idoso , Feminino , Glioma/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraparesia/complicações , Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Vértebras Torácicas , Resultado do Tratamento
13.
Intern Med ; 58(21): 3163-3165, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292381

RESUMO

A complicated form of spastic paraplegia is a neurodegenerative disorder presenting as progressive spasticity in the bilateral lower limbs accompanied by some clinical features. The present case showed spastic paralysis and hyperreflexia in all extremities as well as lead pipe rigidity in the neck and bilateral upper extremities (R < L), decreased scores on frontal cognitive tests, a decreased accumulation of the right dorsal putamen on a DAT scan, and hypoperfusion of the bilateral frontal lobes on 99mTc-ECD single photon emission computed tomography (SPECT). The present case provides a new spectrum of spastic paraplegia based on the evidence of clinical scores and the findings of brain functional imaging.


Assuntos
Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/complicações , Paraplegia/complicações , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Encéfalo/fisiopatologia , Disfunção Cognitiva/diagnóstico , Tratos Extrapiramidais/diagnóstico por imagem , Tratos Extrapiramidais/fisiopatologia , Lobo Frontal/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Paraplegia/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos
14.
Artigo em Inglês | MEDLINE | ID: mdl-31240120

RESUMO

Spinal cord injury (SCI)-related osteoporosis is common complication in people with tetraplegia or paraplegia. Studies have shown that sublesional regions are severely demineralized. Loss of bone and sequential fractures are major problems in people with SCI that lead to further immobilization and decreasing quality of life. Despite extensive research mechanisms of this bone impairment are inadequately understood. This article discusses basics of bone metabolism physiopathology along with pharmaceutical prevention and treatment approaches to manage acute SCI-related bone loss.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/uso terapêutico , Osteoporose/prevenção & controle , Fraturas por Osteoporose/prevenção & controle , Traumatismos da Medula Espinal/fisiopatologia , Doença Aguda , Densidade Óssea , Humanos , Osteoporose/etiologia , Osteoporose/fisiopatologia , Fraturas por Osteoporose/etiologia , Paraplegia/complicações , Paraplegia/fisiopatologia , Quadriplegia/complicações , Quadriplegia/fisiopatologia , Traumatismos da Medula Espinal/complicações
15.
Top Spinal Cord Inj Rehabil ; 25(2): 150-156, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31068746

RESUMO

Ninety-eight percent of skeletally immature patients with spinal cord injury (SCI) suffer from progressive neuromuscular scoliosis (NMS). Operative treatment has typically been limited to posterior spinal fusion (PSF), but a newer technique as described may be less invasive and preserve more function. A PSF of the entire spine to the pelvis is standard of care. However, maintenance of spinal flexibility, motion, and potential growth is desirable. We present a case for proof-of-concept of utilizing a surgical motion-preserving technique to treat progressive NMS in an 11year-old girl with T10 level (AIS B) paraplegia with a progressive 60° NMS of the lumbar spine. She had anterior scoliosis correction (ASC) from T11-L5 without fusion. Over 24 months, the curve growth-modulated to a residual of 12° with continued modulation to 7° at 3-year follow-up (skeletal maturity).


Assuntos
Doenças Neuromusculares/etiologia , Complicações Pós-Operatórias/etiologia , Escoliose/cirurgia , Traumatismos da Medula Espinal/complicações , Acidentes de Trânsito , Criança , Feminino , Humanos , Vértebras Lombares , Paraplegia/complicações , Escoliose/etiologia
16.
Cerebellum ; 18(4): 781-790, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31104286

RESUMO

Inherited disorders of spasticity or ataxia exist on a spectrum with overlapping causative genes and phenotypes. We investigated the use of whole-genome sequencing (WGS) to detect a genetic cause when considering this spectrum of disorders as a single group. We recruited 18 Korean individuals with spastic paraplegia with or without cerebellar ataxia in whom common causes of hereditary cerebellar ataxia and hereditary spastic paraplegia had been excluded. We performed WGS with analysis for single nucleotide variants, small insertions and deletions, copy number variants (CNVs), structural variants (SVs) and intronic variants. Disease-relevant variants were identified in ABCD1 (n = 3), CAPN1 (n = 2), NIPA1 (n = 1) and PLA2G6 (n = 1) for 7/18 patients (38.9%). A 'reverse phenotyping' approach was used to clarify the diagnosis in individuals with PLA2G6 and ABCD1 variants. One of the ABCD1 disease-relevant variants was detected on analysis for intronic variants. No CNV or SV causes were found. The two males with ABCD1 variants were initiated on monitoring for adrenal dysfunction. This is one of only a few studies to analyse spastic-ataxias as a continuous spectrum using a single approach. The outcome was improved diagnosis of unresolved cases for which common genetic causes had been excluded. This includes the detection of ABCD1 variants which had management implications. Therefore, WGS may be particularly relevant to diagnosing spastic ataxias given the large number of genes associated with this condition and the relatively high diagnostic yield.


Assuntos
Ataxia Cerebelar/diagnóstico , Ataxia Cerebelar/genética , Paraplegia/diagnóstico , Paraplegia/genética , Membro 1 da Subfamília D de Transportadores de Cassetes de Ligação de ATP/genética , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Calpaína/genética , Ataxia Cerebelar/complicações , Criança , Feminino , Dosagem de Genes , Variação Genética , Fosfolipases A2 do Grupo VI/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Proteínas de Membrana/genética , Pessoa de Meia-Idade , Paraplegia/complicações , Linhagem , Polimorfismo de Nucleotídeo Único , Adulto Jovem
17.
Spinal Cord ; 57(7): 603-613, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30988398

RESUMO

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To describe experienced sitting-related health and stability problems among persons with paraplegia (PP) or tetraplegia (TP) and to investigate associations with personal, lesion and wheelchair characteristics as well as satisfaction with sitting posture. SETTING: Dutch community. METHODS: A self-report questionnaire on seating was developed and completed by wheelchair-users living with Spinal Cord Injury (SCI) for ≥10 years (N = 264). Sitting-related problems and satisfaction with sitting posture were compared between participants with PP and TP using Chi-square and t-tests. Logistic regression analyses were performed to investigate associated characteristics. RESULTS: Reported sitting-related problems comprised: sitting to be tiring (regularly to always) (33%), sitting to be painful (28%), pressure ulcers in the last three months (29%), instability while sitting (8%) and instability during reaching (33%). Except for instability during reaching, no differences in occurrence of sitting-problems were found between lesion-group. Persons with TP were more dissatisfied with their sitting posture than persons with PP: 51% vs 36% (p = 0.022) and 51% and 47% respectively thought their sitting posture could be improved (p = 0.670). 'Experienced lack of support in the wheelchair' was associated with most sitting-problems. Pain and instability were associated with dissatisfaction with sitting posture. CONCLUSION: Sitting-related problems and dissatisfaction with sitting posture were frequently reported by persons with long-standing SCI. Sitting problems appeared to associate with lacking support in the wheelchair/seating. A comprehensive feedback from the wheelchair user and a stability check (reach task), as part of the wheelchair/seating-user fitting, may contribute to prevention of sitting-related problems.


Assuntos
Paraplegia , Quadriplegia , Postura Sentada , Traumatismos da Medula Espinal , Cadeiras de Rodas , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Quadriplegia/complicações , Traumatismos da Medula Espinal/complicações , Inquéritos e Questionários , Cadeiras de Rodas/efeitos adversos
18.
Clin Biomech (Bristol, Avon) ; 65: 1-12, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30927682

RESUMO

BACKGROUND: Manual wheelchair users rely on their upper limbs to provide independent mobility, which leads to high muscular demand on their upper extremities and often results in shoulder pain and injury. However, the specific causes of shoulder pain are unknown. Previous work has shown that decreased shoulder muscle strength is predictive of shoulder pain onset, and others have analyzed joint kinematics and kinetics, propulsion technique and intra-individual variability for their relation to shoulder pathology. The purpose of this study was to determine in a longitudinal setting whether there are specific biomechanical measures that predict shoulder pain development in manual wheelchair users. METHODS: All participants were asymptomatic for shoulder pain and categorized into pain and no pain groups based on assessments at 18 and 36 months later. Shoulder strength, handrim and joint kinetics, kinematics, spatiotemporal measures, intra-individual standard deviations and coefficients of variation were evaluated as predictors of shoulder pain. FINDINGS: Individuals who developed shoulder pain had weaker shoulder adductor muscles, higher positive shoulder joint work during recovery, and less trunk flexion than those who did not develop pain. In addition, relative intra-individual variability was a better predictor of shoulder pain than absolute variability, however future work is needed to determine when increased versus decreased variability is more favorable for preventing shoulder pain. INTERPRETATION: These predictors may provide insight into how to improve rehabilitation training and outcomes for manual wheelchair users and ultimately decrease their likelihood of developing shoulder pain and injuries.


Assuntos
Pessoas com Deficiência , Paraplegia/complicações , Dor de Ombro/complicações , Dor de Ombro/diagnóstico , Ombro/fisiopatologia , Cadeiras de Rodas , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Articulação do Ombro/fisiopatologia , Tronco , Extremidade Superior/fisiopatologia
19.
BMJ Open ; 9(2): e022137, 2019 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-30796114

RESUMO

MOTIVATION: Catheter-associated urinary tract infections (CAUTI) are a common and serious healthcare-associated infection. Despite many efforts to reduce the occurrence of CAUTI, there remains a gap in the literature about CAUTI risk factors, especially pertaining to the effect of catheter dwell-time on CAUTI development and patient comorbidities. OBJECTIVE: To examine how the risk for CAUTI changes over time. Additionally, to assess whether time from catheter insertion to CAUTI event varied according to risk factors such as age, sex, patient type (surgical vs medical) and comorbidities. DESIGN: Retrospective cohort study of all patients who were catheterised from 2012 to 2016, including those who did and did not develop CAUTIs. Both paediatric and adult patients were included. Indwelling urinary catheterisation is the exposure variable. The variable is interval, as all participants were exposed but for different lengths of time. SETTING: Urban academic health system of over 2500 beds. The system encompasses two large academic medical centres, two community hospitals and a paediatric hospital. RESULTS: The study population was 47 926 patients who had 61 047 catheterisations, of which 861 (1.41%) resulted in a CAUTI. CAUTI rates were found to increase non-linearly for each additional day of catheterisation; CAUTI-free survival was 97.3% (CI: 97.1 to 97.6) at 10 days, 88.2% (CI: 86.9 to 89.5) at 30 days and 71.8% (CI: 66.3 to 77.8) at 60 days. This translated to an instantaneous HR of. 49%-1.65% in the 10-60 day time range. Paraplegia, cerebrovascular disease and female sex were found to statistically increase the chances of a CAUTI. CONCLUSIONS: Using a very large data set, we demonstrated the incremental risk of CAUTI associated with each additional day of catheterisation, as well as the risk factors that increase the hazard for CAUTI. Special attention should be given to patients carrying these risk factors, for example, females or those with mobility issues.


Assuntos
Infecções Relacionadas a Cateter/etiologia , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Transtornos Cerebrovasculares/complicações , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-30701087

RESUMO

Introduction: Managing neglected spinal cord injury (SCI) patients in a rural setting can be challenging due to a lack of resources and the unique personal and environmental contextual factors that may hinder rehabilitation. This article aims to identify the contextual factors and their impact on successful rehabilitation. Case presentation: A middle-aged man from a rural area had suffered a neglected traumatic SCI and was first seen by the rehabilitation team 17 years post injury. He had a T7 AIS A paraplegia and was bedridden with multiple secondary complications. He was admitted with goals of optimizing his health, initiating basic spinal rehabilitation and improving his functional status. By 1 month, the patient made gradual improvement of his mobility and ADL but requested discharge despite not having achieved his rehab goals. We identified the factors that contributed to his poor motivation to be more functionally independent. Personal factors include poor educational level, his background personality and erratic health-seeking behaviour. Environmental factors included poor family and financial support, physical barriers, lack of work opportunities and facilities for people with disability, poor community support and acceptance and poor healthcare facilities and expertise. Discussion: The patient's personal and environmental factors affected the delivery of SCI management, spinal rehabilitation and management of secondary comorbidities. Awareness of early spinal rehabilitation among the rural community and healthcare authorities is crucial to promote better implementation of policies, services or programs to support people with SCI.


Assuntos
Acesso aos Serviços de Saúde , Motivação , Paraplegia/reabilitação , Aceitação pelo Paciente de Cuidados de Saúde , Traumatismos da Medula Espinal/reabilitação , Acidentes por Quedas , Atividades Cotidianas , Status Econômico , Escolaridade , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Lesão por Pressão/etiologia , Insuficiência Renal Crônica/etiologia , Apoio Social , Traumatismos da Medula Espinal/complicações , Vértebras Torácicas
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