Applying the functional independence measure to the assessment of patients with mucopolysaccharidosis / Test de medida de independencia funcional en la evaluación de pacientes con mucopolisacaridosis

Abstract Objective: To assess the functional independence of a group of patients with mucopolysaccharidosis using the Functional Independence Measure as a tool that accomplishes this purpose. Methods: This is a cross-sectional study of patients with mucopolysaccharidosis. Our data was collected between June 2015 and July 2016. In addition to history of present illness and physical examination each study participant was asked to answer a questionnaire to specifically evaluate their functional independence using the functional independence measure. the internal consistency of the functional independence measure was assessed using Cronbach's alpha coefficient. Results: We collected data on 20 patients with mucopolysaccharidosis. The average age was 10.8 (8.67-13.03) years, the average weight was 23.6 (19.91-27.37) kg and the average height was 1 (0.83-1.17) m. The most prevalent type of mucopolysaccharidosis in the study was type VI (n= 14). The average total functional independence measure score was 104.4 (97.61-111.19), the average for the mobility domain was 73.50 (68.22-78.78) and the average for the cognitive function domain was 30.90 (28.68-33.13). The internal consistency of the entire questionnaire was 0.859, with values of 0.966 for the mobility domain and 0.624 for the cognitive function domain. Conclusion: The lowest functional independence measure scores were obtained in the following sub-domains: self-care, locomotion and cognitive function. The functional independence measure questionnaire demonstrated internal consistency for the evaluation of functional independence in patients with mucopolysaccharidosis, being able to value all the affected sub-domains separately.

Resumen Objetivo: Evaluar la independencia funcional de un grupo de pacientes con mucopolisacaridosis utilizando la Medida de Independencia Funcional como herramienta para lograr este propósito. Métodos: Este es un estudio transversal de pacientes con mucopolisacaridosis. Nuestros datos se recopilaron entre junio de 2015 y julio de 2016. Además de la historia de la enfermedad actual y el examen físico, se pidió a cada participante del estudio que respondiera un cuestionario para evaluar específicamente su independencia funcional utilizando la Medida de Independencia Funcional. la consistencia interna de la Medida de Independencia Funcional se evaluó mediante el coeficiente alfa de Cronbach. Resultados: Recopilamos datos de 20 pacientes con mucopolisacaridosis. La edad promedio fue de 10.8 (8.67-13.03) años, el peso promedio fue de 23.6 (19.91-27.37) kg y la altura promedio fue de 1 m (0.83-1.17). El tipo de mucopolisacaridosis más prevalente en el estudio fue el tipo VI (n= 14). El puntaje promedio de la medida de independencia funcional total fue 104.4 (97.61-111.19), el promedio para el dominio de movilidad fue 73.50 (68.22-78.78) y el promedio para el dominio de función cognitiva fue 30.90 (28.68-33.13). La consistencia interna de todo el cuestionario fue de 0.859, con valores de 0.966 para el dominio de movilidad y 0.624 para el dominio de función cognitiva. Conclusión: Las puntuaciones más bajas de la medida de independencia funcional se obtuvieron en los siguientes subdominios: autocuidado, locomoción y función cognitiva. El cuestionario de medida de independencia funcional demostró consistencia interna para la evaluación de la independencia funcional en pacientes con mucopolisacaridosis, pudiendo valorar todos los subdominios afectados por separado.

Análise fatorial de sintomas depressivos e ocorrência de quedas em idosos / Factor analysis of depressive symptoms and occurrence of falls among the elderly

Objetivos: Determinar a prevalência de sintomas depressivos e correlacionar a ocorrência destes com o autorrelato de quedas em idosos, utilizando a estrutura fatorial da Escala de Depressão Geriátrica de Yesavage-15 (EDG-15).Métodos: Estudo de corte transversal realizado de julho a outubro de 2014. Participaram idosos voluntários, vinculados ao Centro de Convivência do Idoso na cidade de Vitória da Conquista, Bahia, que foram selecionados por amostragem não probabilística e por conveniência e responderam a um questionário à EDG-15, após serem informados sobre a pesquisa e assinarem o termo de consentimento livre e esclarecido. Para verificar a correlação bivariada entre sintomas depressivos e autorrelato de quedas, utilizou-se o teste de Pearson. Foi aplicada estatística multivariada através da técnica de análise fatorial, que verificou a inter-relação dos itens da EDG-15, visando à redução do número de variáveis em fatores explicativos.Resultados: Participaram 68 idosos, com média de idade 73,12±7,1 anos; predominou o gênero feminino, com 41 (60,3%) dos participantes. Foram detectados sintomas depressivos em 35 (51.4%) dos idosos, sendo 23 (33.8%) mulheres. A queda foi autorrelatada por 33 idosos (48,5%). Houve correlação positiva e significativa entre o autorrelato de queda e sintomas depressivos nos participantes (r = 0,383, p<0,001). A consistência interna da EDG-15 foi avaliada pelo teste de Alpha de Cronbach, obtendo valor aceitável (0,73); o teste que verificou a aplicabilidade da escala foi o Kaiser-Meyer-Olkin, cujo coeficiente obtido (0,658) demonstrou a adequação para o método de análise fatorial. Após a aplicação da análise fatorial, destacaram-se dois fatores que agruparam oito itens extraídos da escala, capazes de explicar 68% da variância total da EDG-15.Conclusões: A prevalência da depressão foi relevante na amostra estudada. A maior carga fatorial foi representada nas dimensões de ansiedade, anedonia, medo, isolamento e apatia. A correlação entre autorrelato de quedas e sintomas depressivos foi significativa. Os dados apontam para a necessidade de maior atenção à saúde mental do idoso e enfatizam a importância de intervenções precoces de rastreamento dos sintomas depressivos visando à adoção de medidas preventivas.

Aims: To determine the prevalence of depressive symptoms and correlate them with self-reported falls among the elderly using the Yesavage-15 Geriatric Depression Scale (GDS-15).Methods: A cross-sectional study was conducted from July to October 2014. Elderly volunteers from the Community Center for the Elderly located in Vitória da Conquista, State of Bahia, Brazil, participated in the study. They were selected by non-probability convenience sampling and answered the GDS-15 questionnaire after being informed about the study objectives and signing a free consent form.Results: A total of 68 elderly individuals with a mean age of 73.12±7.1 years were included in the study, and female participants accounted for 60.3% of the sample. Depressive symptoms were detected in 35 (51%) individuals, among which 23 (33.8%) were female. Falls were self-reported by 33 elderly individuals (48.5%). There was a positive and significant correlation (r = 0.383, p <0.001) between self-reported falls and depressive symptoms among the participants. The internal consistency of the GDS-15 was assessed by Cronbach's alpha, which yielded an acceptable value (0.73). The Kaiser-Meyer-Olkin measure of sampling adequacy was used to verify the applicability of the GDS-15, yielding a value of 0.658, which means the scale was adequate for the factor analysis method. Two factors, into which eight items were grouped, stood out after the factor analysis and were able to explain 68% of the total variance of the GDS-15.Conclusions: The prevalence of depression was relevant. The dimensions of anxiety, anhedonia, fear, isolation, and apathy showed the largest factor loads. The correlation between self-reported falls and depressive symptoms was significant. The data indicate it is necessary to pay special attention to the mental health of the elderly and also highlight the importance of the early detection of depressive symptoms, thus allowing for preventive measures.

Risk factors associated with infection in tibial open fractures / Risk factors associated with infection in tibial open fractures.

BACKGROUND: The objective of the treatment of open fracture is to prevent infection, stabilize the bones, and restore function. However, infection is the most important step in achieving the latter aims. OBJECTIVE: The objective of the current paper is to find risk factors associated with infection in a sample of tibial open fractures. PATIENTS AND METHODS: A retrospective analysis was carried out. The study included all patients who underwent to tibial open fracture treatment in the Hospital Geral Roberto Santos-HGRS, Salvador, Bahia, Brasil, from March to October, 2009. Patients under the age of eight, with multiple fractures or suffering from systemic or bone disease were excluded. Clinical and demographic data were collected and Patient outcomes were divided into two groups: Group 1 comprises those without infection whereas group 2 comprises those with lesions which became infected. The two groups were evaluated in search for associated factors that could lead to infection. RESULTS: We studied 50 patients. Our overall infection rate was 14 (28

=15.5-40.5). Infection was significantly associated with place of trauma (OR 3.78; CI95

=1.4-5.5; p=0.02), and time delay superior to 24 hours (OR 3.4; CI95

=1.4-20.8; p=0.03). Fractures graded as Gustilo I, II and IIIA had a lower chance for infection compared to Gustilo IIIB and IIIC (OR 4.32; CI95

=1.3-19.1; p=0.01). Fractures graded Tscherne III and IV had a higher chance for infection, and it was the most significant isolated factor (OR 8.07; CI95

=2.4-47.1; pp<0.00). CONCLUSIONS: We confirmed the relationships between infection with Gustilo classification and as well as between infection and trauma from the countryside of Bahia State. We also presented a new relationship between soft tissue and infection, and another relating time delay of more than 12 hours with infection.

Valor Diagnóstico da Ressonância Magnética na Avaliação da Dor Lombar / Diagnostic significance of magnetic resonance in low back pain

Objetivo: O objetivo deste estudo foi avaliar o valor diagnóstico da ressonância magnética-RM nas doenças da coluna lombar entre observadores com variados níveis de experiência. Metodos: Foram selecionados 20 exames de RM que foram classificados como normais [10] ou alterados [10]. Esta classificação foi chamada de "padrão" e comparada com uma segunda realizada por 15 observadores de variados níveis de experiência, denominada "teste". Resultados: Para identificação de alterações o índice Kappa foi 0,56 com sensibilidade de 96,7 por cento e especificidade de 59,3 por cento. Quando consideramos o acerto diagnóstico, obteve-se índice kappa de 0,19 para hérnia discal; 0,15 para doença degenerativa discal; 0,03 para discite infecciosa; e 0,24 para espondilartrose. Conclusões: Os autores concluíram que a RM é exame de imagem com alta sensibilidade e moderada especificidade para identificação de alterações anatômicas da coluna lombar, contudo não permite que avaliadores com pouca experiência esclareçam satisfatoriamente o diagnóstico etiológico. Por este motivo, acreditamos que a solicitada rotineiramente deste exame por não-especialistas ocasiona aumento desnecessßrio de custos e erros diagnósticos e terapêuticos freqüentes.

Objective: This study was aimed at assessing the diagnostic value of magnetic resonance (MR) in spinal diseases amongst observers having several levels of experience. Methods: A selection was made of 20 MR exams which were classified as being normal [10] or altered [10]; such classification was called "standard" and then compared to a second classification made by 15 observers having varying levels of experience, called "test". Results: The Kappa index was 0,56 (96,7 percent sensitivity and 59,3 percent specificity) for identifying alterations. A 0,19 Kappa index was obtained for disk hernia when diagnostic correctness was considered, 0,15 for degenerative disk disease, 0,03 for infectious diskitis and 0,24 for spondylarthrosis. Conclusions: The authors concluded that MR is an image exam having high sensitivity and moderate specificity for identifying anatomical alterations of the spinal column; however, it does not allow assessors having little experience to satisfactorily explain an aetiological diagnosis. It is thus believed that routine requests for this exam by non-specialists leads to an unnecessary increase in costs and frequent diagnostic and therapeutic errors.

Objetivo: El estudio se propuso evaluar el valor diagnóstico de la resonancia magnética-RM, en enfermedades de la columna lumbar, entre observadores con varios niveles de experiencia. Métodos: Se seleccionaron 20 exßmenes de RM de los cuales 10 fueron clasificados como normales y 10 como alterados. Esta clasificación fue tomada como patrón y fue comparada con una segunda clasificación o "prueba" realizada por 15 observadores con varios niveles de experiencia. Resultados: En la identificación de alteraciones el índice Kappa fue de 0,56 con 96,7 por ciento de sensibilidad y 59,3 por ciento de especificidad. Con diagnóstico correcto el índice de Kappa fue de 0,19 en hernia discal; 0,15 en enfermedad discal degenerativa; 0,03 en disquitis infecciosa; y 0,24 en espondiloartrosis. Conclusiones: La RM es un examen de imagen con alta sensibilidad y moderada especificidad para identificar alteraciones anatómicas de la columna lumbar; sinb embargo, no permite que evaluadores con escasa experiencia esclarezcan satisfactoriamente el diagnóstico etiológico. Por esta razón, el uso cotidiano de este examen por no especialistas incrementa innecesariamente los costos y los errores diagnósticos y terapéuticos.