Epidemiology of post-traumatic spinal cord injury in a tertiary hospital / Epidemiologia do lesado medular pós-traumático em um hospital terciário

ABSTRACT Objective: to outline the profile of risk groups for spinal cord injury (SCI) at the Hospital de Clinicas de Campinas by an epidemiological survey of 41 patients with SCI. Methods: Data from patients with SCI were collected and analyzed: demographic data, level of neurological injury, visual analogue scale (VAS), and the current American Spinal Injury Association (ASIA) impairment scale (AIS), using questionnaires, medical records, and imaging tests. Fisher's exact test was used to assess the relationship between categorical variables, Spearman's correlation coefficient was used for numerical variables, and the Mann-Whitney and Kruskal-Wallis tests were used to analyze the relationship between categorical and numerical variables, with significance level of 5%. Results: There was a prevalence of 82.9% of men, a mean age of 26.5 years, and traffic accidents as the cause of SCI in 56.1% of cases. Conclusion: Results suggest the importance of SCI prevention campaigns directed at this population. Level of Evidence II, Retrospective Study.

RESUMO Objetivo: Traçar o perfil dos grupos de risco para trauma raquimedular (TRM) do Hospital das Clínicas de Campinas através de levantamento epidemiológico de 41 pacientes vítimas de TRM. Métodos: Foram coletados e analisados dados demográficos, nível da lesão neurológica, escala visual analógica (EVA) e American Spinal Injury Association impairment scale (AIS) atuais, através da aplicação de questionários, análise de prontuários e de exames de imagem. Para avaliar a relação entre as variáveis categóricas foi utilizado o teste exato de Fisher; para as variáveis numéricas foi utilizado o coeficiente de correlação de Spearman; e para a análise da relação entre variáveis categóricas e numéricas foram utilizados os testes de Mann-Whitney e Kruskal-Wallis, adotando nível de significância de 5%. Resultados: Houve prevalência de 82,9% do sexo masculino, média de idade de 26,5 anos e de 56,1% casos de TRM causados por acidente automobilístico. Conclusão: Os resultados sugerem a importância da realização de campanhas de prevenção ao TRM voltadas para essa população. Nível de Evidência II, Estudo Retrospectivo.

Unraveling quad fever: Severe hyperthermia after traumatic cervical spinal cord injury / 中华创伤杂志(英文版)

PURPOSE@#There are many infectious and inflammatory causes for elevated core-body temperatures, though they rarely pass 40 ℃ (104 ℉). The term "quad fever" is used for extreme hyperpyrexia in the setting of acute cervical spinal cord injuries (SCIs). The traditional methods of treating hyperpyrexia are often ineffective and reported morbidity and mortality rates approach 100%. This study aims to identify the incidence of elevated temperatures in SCIs at our institution and assess the effectiveness of using a non-invasive dry water temperature management system as a treatment modality with mortality.@*METHODS@#A retrospective analysis of acute SCI patients requiring surgical intensive care unit admission who experienced fevers ≥ 40 ℃ (104 ℉) were compared to patients with maximum temperatures < 40 ℃. Patients ≥18 years old who sustained an acute traumatic SCI were included in this study. Patients who expired in the emergency department; had a SCI without radiologic abnormality; had neuropraxia; were admitted to any location other than the surgical intensive care unit; or had positive blood cultures were excluded. SAS 9.4 was used to conduct statistical analysis.@*RESULTS@#Over the 9-year study period, 35 patients were admitted to the surgical intensive care unit with a verified SCI. Seven patients experienced maximum temperatures of ≥ 40 ℃. Six of those patients were treated with the dry water temperature management system with an overall mortality of 57.1% in this subgroup. The mortality rate for the 28 patients who experienced a maximum temperature of ≤ 40 ℃ was 21.4% (p = 0.16).@*CONCLUSION@#The diagnosis of quad fever should be considered in patients with cervical SCI in the presence of hyperthermia. In this study, there was no significant difference in mortality between quad fever patients treated with a dry water temperature management system versus SCI patients without quad fever. The early use of a dry water temperature management system appears to decrease the mortality rate of quad fever.

Intraoral device for sociodigital inclusion of patient with quadriplegia / Dispositivo intraoral para inclusão sócio-digital de paciente com tetraplegia

Introduction: The use of computers, tablets, and cell phones with the Internet by people with quadriplegia from spinal cord injuries is much lower when compared to the general population. The quality of life of these people can be substantially improved through access to these technologies, which would allow a quadriplegic to take advantage of the rapid evolution of information and communication. Many of these individuals have the function of preserved neck and mouth muscles, and it is possible to manipulate intraoral devices as an adaptation tool. Case Report: We report an intraoral device installation in a patient with quadriplegia, a victim of a firearm accident, who had a great desire to reuse the tablet for internet access. A device made of acrylic resin, similar to a myorelaxant plate, was designed to allow the use of a computer that was comfortable and at the same time, the patient could talk and not harm the dental structures. The person responsible agreed to participate in the research and signed the consent form. In addition, the work was submitted to an ethics committee. Considerations: The ideal intra-oral device for patient rehabilitation should be inexpensive, easy to adapt and promote muscle relaxation besides allowing the patient to expand their abilities and digitally increase their autonomy for society.

Introdução: O uso de computadores, tablets e celulares com internet por pessoas com tetraplegia por lesão medular é muito menor quando comparado à população geral. A qualidade de vida dessas pessoas pode ser, substancialmente, melhorada por meio do acesso a essas tecnologias, o que permitiria aos tetraplégicos aproveitar a rápida evolução da informação e da comunicação. Muitos desses indivíduos têm a função de músculos cervicais e bucais preservados, sendo possível a manipulação de dispositivos intraorais como ferramenta de adaptação. Relato de Caso: Relatamos a instalação de um dispositivo intraoral em um paciente com tetraplegia, vítima de acidente com arma de fogo, que tinha grande desejo de reutilizar o tablet para acesso à internet. Um dispositivo feito de resina acrílica, semelhante a uma placa miorrelaxante, foi projetado para permitir o uso de um computador que fosse confortável e, ao mesmo tempo, o paciente pudesse falar e não prejudicar as estruturas dentárias. O responsável concordou em participar da pesquisa e assinou o termo de consentimento. Além disso, o trabalho foi submetido a um comitê de ética. Considerações: O dispositivo intraoral ideal para a reabilitação do paciente deve ser barato, de fácil adaptação e promover o relaxamento muscular, além de permitir que o paciente amplie suas habilidades e aumente sua autonomia pessoal, digitalmente para a sociedade.

Síndrome de Miller Fisher, un desafío diagnóstico de oftalmoplejía: reporte de un caso / Miller Fisher syndrome, a diagnostic challenge of ophthalmoplegia: a case report

El síndrome de Guillain-Barré (SGB), y sus derivados, entre ellos el síndrome de Miller Fisher (SMF); junto a otras patologías de origen neurológico como la Polineuropatía desmielinizante inflamatoria crónica (CIDP), las polineuropatías de causa metabólica, miastenia gravis, esclerosis lateral amiotrófica (ELA), síndrome de Lambert-Eaton, encefalopatía de Wernicke entre otras; presentan signos y síntomas neurológicos de presentación común. De este modo, la importancia del examen neurológico acabado; y los exámenes de apoyo diagnóstico como: laboratorio -destacando el líquido cefalorraquídeo (LCR)-, electromiografía, y toma de imágenes, son cruciales para esclarecer el diagnóstico. Así, es posible ofrecer un tratamiento de forma precoz, basado en la evidencia, y con el objetivo de disminuir la letalidad de la enfermedad. En el presente texto se plasma un subgrupo de patología de SGB, el SMF, el cual posee una incidencia significativamente baja, una clínica característica, y un pronóstico bastante ominoso sin un tratamiento adecuado. En el presente texto se plasma el reporte de un caso abordado en el Hospital San Pablo de Coquimbo, Chile.

Guillain-Barré syndrome (GBS) and its derivatives, including Miller Fisher syndrome (MFS), along others pathologies of neurological origin such as chronic inflammatory demyelinating polyneuropathy (CIDP), metabolic polyneuropathies, myasthenia gravis, amyotrophic lateral sclerosis (ALS), Lambert-Eaton syndrome, Wernicke's encephalopathy and well as others, have common neurological signs and symptoms. In this way, the importance of a thorough neurological examination, and supporting diagnostic tests such as: laboratory, -cerebrospinal fluid (CSF)-electromyography, and imaging, are crucial to clarify the diagnosis. Thus, it is possible to offer early, evidence-based treatment with an aim of reducing the disease's lethality. In the text below we present a subgroup of GBS pathology, MFS, which has a significantly low incidence, a characteristic clinical picture, and a rather ominous prognosis without adequate treatment. In the following text/paper is shown the report of a case approached in San Pablo Hospital, from Coquimbo, Chile.

Eficácia da terapia a laser de tecidos profundos na cicatrização de úlceras por pressão em paciente com tetraplegia: relato de caso / Efficacy of deep tissue laser therapy in pressure ulcer healing in patient with quadriplegia: Case Report

CONTEXTO: Úlceras por pressão (UP) são a complicação mais comum observada em pacientes acamados. O objetivo deste relato de caso é explorar a eficácia da terapia a laser no infravermelho próximo de classe IV no tratamento de úlceras de pressão grandes e graves. DADOS: Um homem de 53 anos com diagnóstico de tetraplegia devido à tuberculose da coluna cervical no nível C5-C6 foi admitido em um hospital com úlcera por pressão instável sobre o sacro e úlceras de pressão do National Pressure Ulcer Advisory Panel estágio 3 sobre a área trocantérica direita para lesão por pressão. Não havia comorbidades associadas, como diabetes mellitus e hipertensão. Utilizou-se o Lite Cure Gallium-Aluminium-Arsenide (GaAlAs) classe IV laser próximo ao infravermelho, sem contato, emissão de feixe contínuo (não pulsante) no comprimento de onda de 980 nm. Os parâmetros de dosagem usados foram: 7,5 - 10 watts de potência; faixa de dosagem 7 J / cm2 - 9 J / cm2; área sacral (13 × 9) cm2 e área trocantérica (10 × 8) cm2; em diferentes densidades de energia; o tempo de tratamento varia entre 8 a 15 minutos para cada úlcera. No total, 19 sessões durante um período de 6 semanas foram administradas para tratar úlceras de pressão. Dimensões (área) e estágio de gravidade da úlcera por pressão foram anotados antes da intervenção e após a conclusão da intervenção. Os dados pós-tratamento revelaram melhora clínica em ambos os desfechos. CONCLUSÃO / SIGNIFICADO CLÍNICO: Este relato de caso demonstra um efeito anti-inflamatório, analgésico e bioestimulante de cicatrização do tratamento com laserterapia Classe IV, apresentando redução nas dimensões e gravidade das úlceras por pressão.

CONTEXT: Pressure ulcers (PU) are the most common complication noted in bed-ridden patients. The purpose of this case report is to explore the efficacy of class IV near-infrared laser therapy in the treatment of large and severe pressure ulcers. FINDINGS: A 53-years-old male diagnosed with quadriplegia due to cervical spine tuberculosis at level C5- C6 was admitted to a hospital with an unstageable pressure ulcer over the sacrum and National Pressure Ulcer Advisory Panel Pressure stage 3 ulcers over the right trochanteric area for pressure injury. No associated comorbidities like diabetes mellitus and hypertension were present. The Lite Cure Gallium-Aluminum-Arsenide (GaAlAs) class IV near-infrared laser, non-contact, continuous beam emission (non-pulsing) at 980nm wavelength, was used. The dosage parameters used were: 7.5 - 10 watts power; dose range 7 J/cm2 - 9 J/cm2; sacral area (13×9) cm2 and trochanteric area (10×8) cm2; at varying energy densities; treatment time ranges between 8 to 15 minutes for each ulcer. Total 19 sessions over 6 weeks were given to treat pressure ulcers. Dimensions (area) and severity stage of pressure ulcer were noted pre-intervention and after the intervention. The post-treatment data revealed the clinical improvement in both outcomes. CONCLUSION/ CLINICAL SIGNIFICANCE: This case report demonstrates the anti-inflammatory, analgesic, and bio-stimulative healing effects of Class IV laser therapy treatment showing a reduction in the dimensions and severity of pressure ulcers.

Orthopedic related comorbidities in spinal cord-injured individuals / Aspectos ortopédicos no paciente lesado medular

ABSTRACT Objective: This study aims to review, identify and study the determinations of the main orthopedic aspects in SCI patients. Methods: A total of 80 articles from PUBMED and three theses (MSc. /DSc.) were examined. Results: The results refer to the most essential joints. There is a chronic overload on the shoulder girdle due to the use of the upper limb as a supporting joint. The elbow presents osteoarthritis, subclinical, acute and chronic pain, mainly in quadriplegic patients. In the hand and wrist joints there are cases of paralysis, osteoporosis and osteoarthritis. Hips are the main weight-bearing joints while sitting which leads to a substantial degenerative process of this joint. Lastly, on the knee, feet and ankles, spasticity, contractures, osteoporosis and deformities can arise. Conclusion: Along with the increase in cases and research that analyze the alterations that spinal cord-injured individuals suffer, it is necessary to recognize the orthopedic changes to understand their limits and identify the relevance of the rehabilitation program to improve the muscle performance. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

RESUMO Objetivo: O objetivo do estudo foi identificar, através de uma revisão sistemática, os aspectos ortopédicos e suas determinações nos pacientes lesados medulares. Métodos: Foram examinados 80 artigos na base Pubmed e três teses de mestrado e doutorado. Resultados: Os resultados obtidos referem-se às principais articulações. No ombro há uma sobrecarga crônica na cintura escapular devido ao uso como articulação de suporte. O cotovelo apresenta alterações osteocartilaginosas e dores subaguda, aguda e crônica principalmente no paciente tetraplégico. Nas articulações da mão e punho, a lesão leva à perda da capacidade de compressão por paralisia, osteoporose e osteoartrite. O quadril constitui a principal articulação de sustentação de peso quando sentado, ocorrendo um processo degenerativo importante nesses pacientes. Nos joelhos, pés e tornozelos surgem espasticidade, contraturas e osteoporose levando a deformidades. Conclusão: Devido ao aumento de casos e de pesquisas que analisam as alterações que os lesados medulares sofrem, se faz necessário o conhecimento das alterações ortopédicas do lesado medular para compreendermos a sua limitação e identificar a relevância do programa de reabilitação para melhora da performance muscular. Nível de Evidência II, Estudos Prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.

Treinamento muscular ventilatório em pacientes tetraplégicos pós lesão medular traumática: revisão integrativa / Ventilatory muscle training in tetraplegic patients after traumatic medal injury: integration review

O Trauma Raquimedular é uma condição clínica incapacitante que pode desencadear a tetraplegia, descrita como paralisia parcial ou completa do tronco, músculos respiratórios e membros, favorecendo o surgimento de complicações, principalmente de caráter respiratório. Diante disso, o Fisioterapeuta pode utilizar treinamento muscular ventilatório(TMV) objetivando aumentar a força e resistência à fadiga dos músculos ventilatórios, além de prevenir complicações respiratórias. OBJETIVO: Descrever quais os dispositivos, protocolos e técnicas mais utilizadas para treinamento muscular ventilatório e os efeitos associados em indivíduos tetraplégicos pós trauma raquimedular. METODOLOGIA: Foi realizado levantamento bibliográfico entre novembro de 2019 e fevereiro de 2020, nas bases de dados Medline, LILACS e SciELO utilizando as palavraschave: Breathing Exercises, Spinal Cord Injuries, Quadriplegia e os sinônimos utilizando os operadores booleanos "AND" e "OR". RESULTADOS: Após consulta nas bases de dados, foram encontrados 3334 artigos, 36 foram selecionados para leitura de resumo, sucedendo que 23 foram excluídos por não atender aos critérios de seleção, restando 12 artigos para a leitura integral, resultando na seleção final de 12 artigos. CONCLUSÃO: Fica evidenciado que protocolos para TMV através de resistores lineares são os mais utilizados tetraplégicos. Além disso, execução de protocolos com resistores lineares a inspiração, empregando intensidade em torno de 30-60% da PImax, apresentou efeitos significativos em PImax. No entanto, percebeu-se que há muitas discordâncias quanto as variáveis de treinamento, principalmente intensidade e número de séries propostos. Contudo, é notório que a utilização do TMV em tetraplégicos apresenta certas divergências, principalmente relacionado a escolha das técnicas e/ou dispositivos adequados.

Spinal trauma is a disabling clinical condition that can trigger quadriplegia, described as partial or complete paralysis of the trunk, respiratory muscles and limbs, favoring the onset of complications, mainly of a respiratory nature. Therefore, the Physiotherapist can use ventilatory muscle training (TMV) in order to increase the strength and fatigue resistance of the ventilatory muscles, in addition to preventing respiratory complications. OBJECTIVE: To describe which devices, protocols and techniques are most used for ventilatory muscle training and the associated effects in quadriplegic individuals after spinal cord trauma. METHODOLOGY: A bibliographic survey was carried out between November 2019 and February 2020, in the Medline, LILACS and SciELO databases using the keywords: Breathing Exercises, Spinal Cord Injuries, Quadriplegia and synonyms using the Boolean operators "AND" and " OR ". RESULTS: After consulting the databases, 3334 articles were found, 36 were selected for reading the summary, with 23 being excluded for not meeting the selection criteria, leaving 12 articles for the full reading, resulting in the final selection of 12 articles. CONCLUSION: It is evidenced that protocols for TMV through linear resistors are the most used quadriplegics. In addition, execution of protocols with linear resistors to inspiration, using intensity around 30-60% of MIP, had significant effects on MIP. However, it was noticed that there are many disagreements the training variables, mainly intensity and number of series proposed. However, it is clear that the use of TMV in quadriplegics presents certain divergences, mainly related to the choice of appropriate techniques and / or devices.

Etiology of cerebral palsy in children below age of 5 years

Background: Cerebral palsy is the most common and costly form of chronic motor disability that begins in childhood. Aims of the study were to identify etiology and risk factors of CP*, to find correlation between the etiology and clinical type of CP* in children below age of 5 years.Methods: analytical study done in indoor patients at civil hospital, Ahmedabad from October 2014 to September 2016.Results: Overall incidence of cerebral palsy in indoor patients was 0.78 per 100 patients. Most common age of presentation is 1-3 years. Majority of cases have perinatal factors as etiology followed by postnatal etiology. Most common type of CP was spastic type. Most common type of topographical CP was spastic quadriplegic. Major symptom for which they admitted in the hospital was convulsion.Conclusions: Majority of cases had perinatal factors as etiology author can prevent CP* by providing primary prevention, specific prevention and improving antenatal and intra-natal care. Disease progression of CP* can be halted by secondary prevention. Maximization of function can be done by tertiary prevention.

Movement Disorder Early in the Presentation of Two Children with Subacute Sclerosing Pan-Encephalitis

Subacute sclerosing panencephalitis(SSPE) is a progressive degenerative disease caused by measles infection with overall poor prognosis in spite multiple modalities of treatment. The course of the disease is characterized by progressive neurological decline in the form of behavioral and personality changes followed by a stage of characteristic periodic myoclonic spasms followed by a stage of quadriplegia movement disorder, vegetative state and frequently early death. Here we report two cases with atypical presentation of early rather than late movement disorder during illness and the unusual association of central precocious puberty preceding the course of illness in one of the cases

A Case of Quadriplegia after Parotidectomy in a Patient with Asymptomatic Cervical Spondylosis / 대한이비인후과학회지

Cervical spondylosis is a common degenerative disease of the cervical spine affecting the cervical vertebral bodies and intervertebral discs. During parotidectomy, the patient is placed in a supine position with the neck extended and head rotated to the contralateral side. This position could exacerbate pre-existing cervical spondylosis and cause cervical myelopathy. We present a case of postoperative quadriplegia secondary to cervical myelopathy after parotidectomy. A 68-year-old man without symptoms of cervical spondylosis underwent partial parotidectomy for a right parotid mass and subsequently developed quadriplegia 8 hours postoperatively. Magnetic resonance imaging revealed severe cervical myelopathy. Emergency laminoplasty was performed, and steroid therapy was initiated. He showed near-complete recovery six months later.

Application of Deep Learning System into the Development of Communication Device for Quadriplegic Patient / 대한신경손상학회지

OBJECTIVE: In general, quadriplegic patients use their voices to call the caregiver. However, severe quadriplegic patients are in a state of tracheostomy, and cannot generate a voice. These patients require other communication tools to call caregivers. Recently, monitoring of eye status using artificial intelligence (AI) has been widely used in various fields. We made eye status monitoring system using deep learning, and developed a communication system for quadriplegic patients can call the caregiver. METHODS: The communication system consists of 3 programs. The first program was developed for automatic capturing of eye images from the face using a webcam. It continuously captured and stored 15 eye images per second. Secondly, the captured eye images were evaluated for open or closed status by deep learning, which is a type of AI. Google TensorFlow was used as a machine learning tool or library for convolutional neural network. A total of 18,000 images were used to train deep learning system. Finally, the program was developed to utter a sound when the left eye was closed for 3 seconds. RESULTS: The test accuracy of eye status was 98.7%. In practice, when the quadriplegic patient looked at the webcam and closed his left eye for 3 seconds, the sound for calling a caregiver was generated. CONCLUSION: Our eye status detection software using AI is very accurate, and the calling system for the quadriplegic patient was satisfactory.

What Causes Severe Myelopathy Resulting in Acute Quadriplegia after a Surgery for Atlantoaxial Subluxation due to Os Odontoideum? A Case Report / 대한신경손상학회지

A case of acute quadriplegia resulting from reduction of atlantoaxial subluxation due to os odontoideum is rare. Patient with os odontoideum are at a greater risk for atlantoaxial instability and resultant spinal cord compression. In our case, the patient exhibited mild myelopathic symptoms before the onset of acute quadriplegia. Owing to the clinical presentations, the spinal cord not only seemed to suffer a mechanical compression but also an insufficiency of blood supply to the spinal artery and its branches. No other report has described the findings from magnetic resonance imaging before and after the onset of acute myelopathy after surgery. The aim of our case report is to highlight the pathophysiology and appropriate management strategy of a patient with severe progressive spinal cord myelopathy after surgery, secondary to chronic atlantoaxial subluxation due to os odontoideum. This case depicts the presence of this rare yet possible complication, and emphasizes the importance of preoperative evaluation in cases with chronic progressive myelopathy. Moreover, urgent postoperative treatment and rehabilitation are important for the recovery of neurological symptoms.

Tecnologia assistiva e qualidade de vida na tetraplegia: abordagem bioética / Assistive technology and quality of life for people with tetraplegia: bioethical approach / Tecnología de asistencia y calidad de vida en la cuadriplejía: abordaje bioético

Resumo O objetivo deste estudo quantitativo e transversal foi avaliar a qualidade de vida de pessoas com tetraplegia e, a partir dos resultados, refletir à luz da bioética sobre ações necessárias para aprimorar práticas de cuidado e acesso a recursos de tecnologia assistiva. Aplicou-se o questionário WHOQOL-bref a 100 indivíduos com tetraplegia, usuários ou não de tecnologias assistivas, e os resultados foram tratados estatisticamente. Os escores mais significativos relacionaram-se a gênero feminino, maiores níveis educacionais, ocupação, maior tempo de lesão e uso de tecnologia assistiva. As reflexões nesse campo, sustentadas pela ética do cuidado de Gilligan e bioética social latino-americana, apontam a necessidade de aprimorar inter-relações da assistência e a formulação de políticas públicas intersetorias de proteção a vulnerabilidades que garantam às pessoas com lesão medular notificação clínica e sociodemográfica, inclusão digital, adaptação domiciliar, acesso a tecnologias e postos de trabalho especiais.

Abstract The objective of this quantitative-transversal study was to evaluate the quality of life of people with tetraplegia and, from its results, to carry out a bioethical reflection directed to the actions necessary to improve care practices and access to assistive technology resources. The WHOQOL-bref questionnaire was applied to 100 individuals with tetraplegia, whether or not users of assistive technologies, and the results were treated statistically. The highest significant scores were related to: female gender, higher educational levels, occupation, longer injury time and use of assistive technology. Bioethical reflections, based on Gilligan's Ethics of Care and Latin American Social Bioethics, have pointed to the need to improve the interrelationships around care and to formulate intersectoral public policies to protect vulnerabilities that would guarantee the following to people with spinal cord injury: clinical and sociodemographic notification, digital inclusion, home adaptation, access to technologies and special jobs.

Resumen El objetivo de este estudio cuantitativo-transversal fue evaluar la calidad de vida de personas con cuadriplejía y realizar una reflexión bioética dirigida a las acciones necesarias para la mejora de las prácticas de cuidado y acceso a recursos de tecnología de asistencia. Se aplicó el cuestionario WHOQOL-bref a 100 individuos con cuadriplejía, usuarios o no de dispositivos de tecnologías de asistencia y los resultados fueron tratados estadísticamente. Los mayores puntajes estuvieron relacionados con: género femenino, mayores niveles educativos, ocupación, mayor tiempo de lesión y uso de tecnología de asistencia. Las reflexiones bioéticas, sostenidas en la Ética del Cuidado de Gilligan y en la Bioética Social latinoamericana, señalaron la necesidad de perfeccionar las interrelaciones en torno a la asistencia y para la formulación de políticas públicas intersectoriales de protección a las vulnerabilidades que garanticen a las personas con lesión medular: notificación clínica y sociodemográfica, inclusión digital, adaptación domiciliaria, acceso a las tecnologías y puestos de trabajo especiales.

Huge Candida albicans normal native tricuspid valve endocarditis

Fungal endocarditis has become an important infection associated with medical progress and the modern lifestyle. In particular, Candida spp. is a rare but important cause of infective endocarditis. We report the case of a 28-year-old woman­quadriplegic and bedridden from birth­who died after repeated episodes of pneumonia treated with different regimens of intravenous antibiotics. A medico legal autopsy was performed, which diagnosed severe Candida native valve infective endocarditis (CIE). This case report illustrates the prolonged use of antibiotic treatment as a possible risk factor for the development of CIE. We also considered how the bedridden condition and the presence of a central venous catheter may be additional risk factors for the development of this entity. Finally, we examined the absence of peripheral embolization in the setting of endocarditis of the right side of the heart.

Perfil epidemiológico dos pacientes com paralisia cerebral atendidos na AACD - São Paulo / Epidemiological profile of patients with cerebral palsy treated in the AACD-SP

Paralisia cerebral (PC) abrange um grupo de síndromes clínicas de causa multifatorial caracterizadas por déficit motor, algumas vezes com disfunção postural. Objetivos: Caracterizar a população dos novos pacientes da clínica de PC na instituição, de Janeiro-2012 a Dezembro-2014. Métodos: Estudo retrospectivo. Avaliados 743 prontuários eletrônicos de pacientes atendidos em consultas iniciais de PC, sendo elegíveis 614 casos. Resultados: Sexo: feminino = 47,4%, masculino = 52,6%. Idade em anos: 29,5% menores de 2; 34% de 2 a 4; 15,5% de 4 a 6; 16,3% de 6 a 12; 4,6% 12 a 18; 0,2% ≥ 18 anos. Ao nascimento 50,7% eram pré-termo e 45% termo. Peso: 9,1% classificados como extremo baixo peso, 16,8% muito baixo peso, 21,8% baixo peso, 43,6% peso adequado, 2,3% macrossômicos. Tipo de parto predominante: cesáreo (56,5%). Classificação clínica e topográfica dos pacientes: 13,4% Hemiparéticos espásticos, 33,9% Diparéticos espásticos, 12,2% Tetraparéticos espásticos, 0,5% Monoparéticos espásticos, 5,9% Discinéticos/atáxicos, 5,7% PC mista, 1% hipotônicos. Em 55,5% das famílias não recebiam auxílio doença. Sobre atendimentos especializados observou-se que para 97,7% dos pacientes tratava-se da primeira consulta com um médico Fisiatra. Conclusão: Maioria das gestantes realizaram pelo menos o número mínimo adequado de consultas de pré-natal. Parto cesariano predominou. Nascimentos pré-termo foi ligeiramente superior comparado com a termo. Tipo de PC predominou o tipo Diparético espástico, com GMFCS nas faixas de 1 a 5 equivalente. Mais da metade das famílias ainda sem acesso a benefício social.

Cerebral palsy (CP) is a group of multifactorial clinical syndromes characterized by motor deficit, sometimes with postural dysfunction. Objective: To characterize a new series of clinical CP patients in the institution from January-2012 to December-2014. Method: Retrospective study of 743 electronic medical records of patients screened at CP outpatient facilities. Results: 614 cases were considered eligible. 47.4% female and 52.6% male subjects. 29.5% were under 2 years of age, 34% were from 2 to 4, 15.5% from 4 to 6, 16.3% from 6 to 12, 4.6% from 12 to 18 and 0.2% were above 18 years of age. At birth, 50.7% were preterm and 45% term. Regarding weight, 9.1% were classified as extreme low weight, 16.8% very low weight, 21.8% low weight, 43.6% adequate weight, 2.3% macrosomic. The predominant type of delivery were cesarean section (56.5%). Regarding clinical and topographic classification, 13.4% had spastic hemiplegia, 33.9% spastic diplegia, 12.2% spastic tetraplegia, 0.5% spastic monoplegia, 5.9% Dyskinetic / ataxic, 5.7% mixed CP, and 1% were hypotonic. In 55.5% of the families they did not receive any social benefits. Regarding specialized care, for 97.7% of the patients that was the first appointment with a Physiatrist. Conclusion: Most pregnant women undertook at least the minimum number of prenatal visits. Cesarean delivery was predominant. Preterm births were slightly higher. The most prevalent type of CP was the spastic diplegic, with GMFCS ranging from 1 to 5. More than half of families did not manage to have access to social benefits.

Efficacy of Virtual Reality in Upper Limb Rehabilitation in Patients with Spinal Cord Injury: A Pilot Randomized Controlled Trial

STUDY DESIGN: Pilot randomized controlled trial. PURPOSE: To compare the efficacy between virtual reality intervention (using Nintendo Wii) along with conventional occupational therapy and conventional occupational therapy alone in improving upper limb function in patients with spinal cord injury (SCI). OVERVIEW OF LITERATURE: The use of virtual reality has gained importance in the rehabilitation sector over the last few years. Nintendo Wii has the potential to encourage upper limb function while engaging in an interesting activity, which is important in long-term interventions, such as the treatment of SCI. METHODS: Overall, 22 patients with SCI participated in the study. They were randomly assigned to two groups. Group I received 30 minutes of virtual reality intervention (using Nintendo Wii) and 30 minutes of conventional therapy, whereas group II received conventional therapy only for 30 minutes. Both groups received therapy 3 days a week for 4 weeks. One hand of each patient was identified as the target hand based on the inclusion criteria. All patients were assessed at baseline, 2 weeks and 4 weeks (post-intervention), and 6 weeks (follow-up). The functional ability of the target hand was assessed using the Capabilities of Upper Extremity (CUE) questionnaire. Gross motor dexterity was assessed using the Box and Block Test (BBT). The level of independence in activities of daily living was assessed by the Spinal Cord Independence Measure-Self Report and quality of life by the World Health Organization Quality of Life-BREF. RESULTS: After 4 weeks of intervention, there was no significant difference in improved hand function between the groups. Mean scores were higher for group I than for group II, with a higher percent change (31.5% in CUE questionnaire and 51.7% in BBT) in group I. CONCLUSIONS: Virtual reality along with conventional therapy produces similar results in upper limb function as does conventional therapy alone.

Risk of prostate cancer in men with spinal cord injury: A systematic review and meta-analysis / 亚洲男科学杂志(英文版)

A lower risk of prostate cancer has been reported in men with spinal cord injury (SCI) as compared to that observed in able-bodied subjects. As injury-related consequences can have opposite effects on prostate pathophysiology, this meta-analysis aimed to (1) establish the existence/quantify the extent of decreased prostate cancer risk following SCI and (2) find out if there is any statistically significant difference in prostate-specific antigen (PSA) levels between SCI and able-bodied subjects. MEDLINE, Cochrane Library, Scopus, CINAHL, and ScienceDirect databases were used. Only studies reporting a prostate cancer diagnosis and/or PSA levels following SCI and in able-bodied controls were included. Five studies provided information about prostate cancer on 35 293 subjects with SCI and 158 140 controls. Six studies were included in PSA analysis which reported information on 391 men with SCI and 1921 controls. Pooled estimates indicated that SCI reduced the prostate cancer risk by approximately 50% as compared to controls, whereas differences in PSA levels were not statistically significant. Funnel plots suggested the presence of publication bias only in PSA analysis. Between-study heterogeneity was established and when, according to meta-regression models, analysis was restricted to studies including men with mean age over 55 years, prostate cancer risk in SCI decreased up to 65.0% than that in controls with no heterogeneity (P = 0.33, I2 = 9%). In conclusion, in men over 55 years old, SCI decreases the prostate cancer risk up to 65.0% than that in controls. The large between-study heterogeneity on PSA confirms its poor reliability as a screening tool for prostate cancer in SCI.

Risk of prostate cancer in men with spinal cord injury: A systematic review and meta-analysis / 亚洲男科学杂志(英文版)

A lower risk of prostate cancer has been reported in men with spinal cord injury (SCI) as compared to that observed in able-bodied subjects. As injury-related consequences can have opposite effects on prostate pathophysiology, this meta-analysis aimed to (1) establish the existence/quantify the extent of decreased prostate cancer risk following SCI and (2) find out if there is any statistically significant difference in prostate-specific antigen (PSA) levels between SCI and able-bodied subjects. MEDLINE, Cochrane Library, Scopus, CINAHL, and ScienceDirect databases were used. Only studies reporting a prostate cancer diagnosis and/or PSA levels following SCI and in able-bodied controls were included. Five studies provided information about prostate cancer on 35 293 subjects with SCI and 158 140 controls. Six studies were included in PSA analysis which reported information on 391 men with SCI and 1921 controls. Pooled estimates indicated that SCI reduced the prostate cancer risk by approximately 50% as compared to controls, whereas differences in PSA levels were not statistically significant. Funnel plots suggested the presence of publication bias only in PSA analysis. Between-study heterogeneity was established and when, according to meta-regression models, analysis was restricted to studies including men with mean age over 55 years, prostate cancer risk in SCI decreased up to 65.0% than that in controls with no heterogeneity (P = 0.33, I2 = 9%). In conclusion, in men over 55 years old, SCI decreases the prostate cancer risk up to 65.0% than that in controls. The large between-study heterogeneity on PSA confirms its poor reliability as a screening tool for prostate cancer in SCI.

Métodos de avaliação do estado nutricional de crianças e adolescentes com Paralisia Cerebral Tetraespástica / Assessment of nutritional status of children and adolescents with spastic quadriplegic cerebral palsy

ABSTRACT BACKGROUND: Due to several factors, such as gastrointestinal's diseases and difficulty in feeding, children with Spastic Quadriplegic Cerebral Palsy tend to present nutritional deficits. OBJECTIVE: To assess the nutritional status of pediatric patients with Spastic Quadriplegic Cerebral Palsy according to reference curves for this population and with the measures of folds and circumferences, obtained by the upper arm circumference and triceps skin fold. METHODS: The data were obtained from: knee-height, estimated height, weight, upper arm circumference, and triceps skin fold. Values of folds and circumferences were compared with Frisancho, and specific curves for these patients were used as reference. The relationship between the values in the growth curve for healthy children, Z-Score, and comparison with the reference curve were verified by Fisher's exact test. We adopted the significance level of 5%. RESULTS: We evaluated 54 patients. The mean age was 10.2 years, and 34 were male, 25 fed by gastrostomy and 29, orally. The frequency of low weight by the reference curve was 22.22%. More than half of the patients presented the parameters indicating lean mass below the 5th percentile. The height of all patients was classified as adequate for the age by the reference curve. CONCLUSION: Low weight was found in 22% of patients, and there is a greater tendency to present reduced muscle mass and increased fat mass, showing the need for evaluation and appropriate interventions for patients with Spastic Quadriplegic Cerebral Palsy.

RESUMO CONTEXTO: Devido a diversos fatores, como doenças do trato gastrointestinal e dificuldade de alimentação, frequentemente crianças com Paralisia Cerebral Tetraespástica apresentam prejuízo no estado nutricional. OBJETIVO: Avaliar o estado nutricional de pacientes pediátricos com Paralisia Cerebral Tetraespástica de acordo com curvas de referência para essa população e comparar com as curvas de referência utilizadas para a população pediátrica em geral. MÉTODOS: Foram obtidos os dados de: altura do joelho, estatura estimada, peso, circunferência braquial e dobra cutânea triciptal. Valores de dobras e circunferências foram comparados com Frisancho e curvas específicas para esses pacientes foram utilizadas como referência. A relação entre os valores plotados na curva de crescimento para crianças saudáveis, Escore-Z e comparação com a curva referencial foram verificados através do teste exato de Fisher. O nível de significância adotado foi de 5%. RESULTADOS: Foram avaliados 54 pacientes. A média de idade foi de 10,2 anos, 34 eram do sexo masculino. Vinte cinco se alimentavam via gastrostomia e 29 via oral. A frequência de baixo peso pela curva referencial foi de 22,22%. Mais da metade dos pacientes apresentaram os parâmetros indicativos de massa magra abaixo do percentil 5. A estatura de todos os pacientes foi classificada como adequada para idade pela curva referencial. CONCLUSÃO: O baixo peso foi encontrado em 22% dos pacientes, e há maior tendência para que esses pacientes apresentem massa muscular reduzida e aumento da massa gorda, mostrando a necessidade de avaliação e intervenções apropriadas para pacientes com Paralisia Cerebral Tetraespástica.

Porfiria aguda. Dilema diagnóstico y manifestaciones neuroendocrinas / Acute porphyria. Diagnostic dilemma and neuroendocrine manifestations

Resumen La porfiria intermitente aguda (PIA) es una enfermedad poco frecuente, considerada huérfana, que se caracteriza por crisis neuroviscerales, el dolor abdominal siendo su síntoma más común, acompañado en muchos casos, de síntomas inespecíficos, haciendo difícil su diagnóstico temprano. El retraso en el diagnóstico y tratamiento de esta entidad puede resultar catastrófico o incluso fatal, provocando daño neurológico a largo plazo o permanente. Reportamos el caso de un adulto joven que consulta en varias ocasiones por dolor abdominal inespecífico y 24 horas después de la admisión desarrolla inestabilidad autonómica simpática con cifras tensionales elevadas y taquicardia. Posteriormente debilidad muscular que evoluciona hasta cuadriplejia e hiponatremia con criterios para secreción inadecuada de hormona antidiurética (SIADH). Estos datos, junto con coloración rojiza en orina, llevan al diagnóstico de porfiria. Presentamos las características clínicas y bioquímicas enfatizando la importancia de incluir la porfiria dentro de los diagnósticos diferenciales de dolor abdominal y disautonomia de causa indeterminada. (Acta Med Colomb 2017; 42: 140-143).

Abstract Acute intermittent porphyria (AIP) is an infrequent and considered orphan disease, characterized by neurovisceral crisis, being abdominal pain the most common symptom, accompanied in many cases by non-specific symptoms, making early diagnosis difficult. The delay in the diagnosis and treatment of this entity can be catastrophic or even fatal, causing long-term or permanent neurological damage. The case of a young adult who attends medical consultation several times for non-specific abdominal pain and 24 hours after admission develops sympathetic autonomic instability with elevated blood pressure and tachycardia is presented. He subsequently presents muscular weakness that evolves to quadriplegia and hyponatremia with criteria for inadequate secretion of antidiuretic hormone (SIADH). These data together with reddish urine staining lead to the diagnosis of porphyria. The clinical and biochemical characteristics emphasizing the importance of including porphyria within the differential diagnoses of abdominal pain and dysautonomia of indeterminate cause are presented. (Acta Med Colomb 2017; 42: 140-143).