Estudo transversal da capacidade funcional e força muscular em setuagenários institucionalizados / Transversal study of functional capacity and muscle strength in institutionalized elderly

Introdução: As pessoas estão envelhecendo cada vez mais no Brasil e no mundo. Estudos apontam que o processo de envelhecimento populacional é acompanhado com o aumento de ocorrência de morbidade e incapacidade. Diferentes condições podem ser apresentadas pelo envelhecimento, como: diminuição da capacidade funcional, diminuição da força e da massa muscular, entre outros. Objetivo: Investigar a redução da capacidade funcional, secundária a redução de força muscular de membros inferiores em idosos institucionalizados em duas instituições de longa permanência (ILPI) no município de Nova Iguaçu (RJ/Brasil). Métodos: Trata-se de um estudo transversal, exploratório de caráter quantitativo em duas IAPI em Nova Iguaçu/RJ/ no período do mês de julho e agosto de 2017, em que foram selecionados 60 idosos de ambos os sexos (34 homens e 26 mulheres), com faixa etária ≥ 60 anos. Os voluntários foram avaliados quanto a capacidade funcional e a força muscular. Para a capacidade funcional, foi utilizado a escala de Barthel. Para o teste de força, o presente estudo usou para forma de avaliação a escala de Medical Research Council (MRC). Resultados: Os resultados mostraram que 61,7% dos idosos são classificados como independentes pelo índice de Barthel. Na escala de MRC, 95% dos idosos apresentaram fraqueza muscular. Conclusão: Concluímos que a maior proporção de idosos institucionalizados foram considerados independentes, porém, apresentaram quadro de fraqueza muscular. (AU)

Introduction: People are aging more and more in Brazil and worldwide. Studies show that the process of population aging is accompanied by increased occurrence of morbidity and disability. Different conditions can be presented by aging, such as: decreased functional capacity, decreased strength and muscle mass, among others. Objective: To investigate the reduction of functional capacity, secondary to the reduction of muscular strength of lower limbs in elderly institutionalized in two institutions in the municipality of Nova Iguaçu/RJ Brazil. Methods: This is a quantitative exploratory study in two elderly institutions at Nova Iguaçu during the period of July and August 2017, with 60 elderly men and women (34 males and 26 females), age range ≥ 60 years. The volunteers were assessed for functional capacity and muscle strength. For functional capacity, the Barthel scale was used. For strength testing, the present study used the Medical Research Council (MRC) scale for evaluation. Results: The results of the present study showed that 61.7% of the elderly are classified as independent by the Barthel index. In the MRC scale, 95% of the elderly presented muscular weakness. Conclusion: We concluded that the most proportion of institutionalized elderly was considered independent but presented a picture of muscular weakness. (AU)

A study on therapeutic plasma exchange using apheresis in treatment of Guillain-Barré syndrome in a tertiary care teaching hospital

Background: Therapeutic plasma exchange (TPE) is the separation and removal of plasma from whole blood with replacement by a crystalloid/colloid solution (typically albumin or plasma). The DGHS has established guidelines and recommendations for application of therapeutic apheresis in clinical practice. Guillain-Barré syndrome (GBS) is considered category I indications for TPE. This study was undertaken to establish the effectiveness and safety of therapeutic plasma exchange in GBS which is one of the common indication for TPE at our tertiary care teaching hospital.Methods: A retrospective study of 30 patients admitted to a tertiary care teaching hospital, from January 2014 to December 2016 with clinical signs of Guillain-Barre syndrome (GBS) and/or GBS variants were evaluated for performing TPE. A total of 104 procedures were performed for 30 patients. Replacement of crystalloids and plasma was used. Medical Research Council scale was used to assess the clinical improvement by measuring the grade of muscle power. Information was collected in a structured proforma and statistical analysis was performed using SPSS software (version 20). P value less than 0.05 was considered statistically significant.Results: During the study period, 104 procedures were performed on 30 patients on an average of three procedures per patient. The average age of the patients was 41.4±10.4 years. The mean period of illness at admission was 14.5±5.4 (range 4-32) days. In 23 out of 30 patients, more than three TPE procedures were done, out of which 21 patients clinically improved. The common complications during the procedure were chills (16%), hypotension (10%) and non-hemolytic febrile transfusion reaction (10%) and they were managed accordingly. Two (6.7%) patients who were not ambulatory at discharge had significantly (p <0.05) lower grade of power in lower limbs at admission and all patients recovered fully on follow up.Conclusions: GBS is one of the most commonly occurring clinical paralytic disorders. 76.7% of patients underwent three or more cycles of TPE with 70% had excellent clinical improvement which was comparable with various other studies. Based on results published by various other studies, therapeutic plasma exchange is a comparatively safe and effective procedure

Doenças neuromusculares e instrumentos úteis na avaliação motora em crianças e adolescentes / Neuromuscular diseases and usefull instruments in the motor evaluation of children and adolescents

As doenças neuromusculares acometem a unidade motora, podendo comprometer os neurônios do corno anterior da medula, as raízes nervosas e os nervos periféricos, a junção neuromuscular ou o músculo. Podem ser de origem genética ou adquirida. Na infância predominam as de origem genética, sendo as mais frequentes a distrofia muscular tipo Duchenne e a amiotrofia espinhal progressiva. Vários métodos e escalas foram propostos para a avaliação e acompanhamento aos pacientes com doenças neuromusculares, tais como a escala de força manual, conhecida como medical research counsil (MRC), a goniometria e escalas funcionais. Entre as escalas funcionais, destaca-se a escala medida da função motora (MFM), uma vez que ela pode ser utilizada em qualquer doença neuromuscular,é de fácil aplicação e de baixo custo. O presente estudo é uma revisão bibliográfica não sistemática sobre as doenças neuromusculares mais comuns na infância e os instrumentos de medida úteis na avaliação dos pacientes portadores dessas doenças...

The neuromuscular diseases affect the motor unit, and may compromise the neurons of the anterior horn of the spinal cord, the nerves’ roots and the peripheral nerves, the neuro muscular junction or the muscle. They can have genetic or acquired origin. The genetic origin diseases predominate in childhood, and the most frequent are the Duchenne muscular dystrophy and the spinal muscular atrophy. Several methods and scales were proposed for the assessment and monitoring of patients with neuromuscular diseases, such as the manual strength know as medical research council (MRC), the goniometry and the functional scales. Among the functional scales the motor function measure (MFM) is noteworthy, asit can be used in any neuromuscular disease, is easily applicable and has low cost. This study is a bibliographic review on the most common neuromuscular diseases in childhood and the useful measuring instruments for the assessment of patients with these diseases...