Relationship of the sacral slope with early gait derangements in robust older women

Abstract Background: Trunk pelvic dissociation is fundamental to the compensatory mechanism for muscle weakness during body bending. We carried out an early investigation of gait changes in a sample of community-dwelling women ≥60 years without gait complaints. The primary objective was to correlate spine and pelvic angles with performance tests and accelerometry parameters. The secondary objective was to correlate performance tests with accelerometry. Methods: In this cross-sectional study, 54 community-dwelling women ≥60years were subjected to Falls Efficacy Scale-International (FES-I), performance tests (Berg Balance Scale, Timed Up and Go, and Gait analysis), and radiographic analysis of sagittal alignment (Thoracic and Lumbar Cobb, Pelvic Incidence, Sacral Slope, and Pelvic Tilt angles). Gait speed was assessed in a 10-m comfortable walk, and accelerometry parameters were obtained in a 30m walk distance. Results: The sample, aged 72 ±6 years, exhibited moderate correlation between Sacral Slope and Step Length (+ 0.615). Sacral Slope weakly correlated with FES-I (- 0.339), Berg Balance Scale (+0.367), and with further accelerometry data in the AP plane: RMS, (+ 0.439) and Stride Regularity (+ 0.475), p < 0.05, all. Lumbar Cobb weakly correlated with the following accelerometry data in the AP plane: Step Length (+0.405), RMS, (+0.392), and Stride Regularity (+ 0.345), p < 0.05, all. Additionally, Stride Regularity in AP moderately correlated with FES-I (0,561, p < 0.05), among other weak correlations between performance tests and accelerometry data in AP. Conclusions: Early alterations in Sacral Slope and gait abnormalities in the AP plane may provide understanding of the early gait changes in robust older women.

Dentists' knowledge about osteoporosis and their ability to identify the disease

Abstract Background: Osteoporosis is an underdiagnosed condition, and its seriousness is not considered until severe complications arise. This study aimed to evaluate general dentists' knowledge about osteoporosis and their ability to identify patients with this disease by assessing mandibular cortical width (MCW) and mandibular cortical index (MCI) on panoramic dental radiographs using a visual method. Methods: In this cross-sectional study, an email questionnaire regarding the diagnosis and prevention of osteoporosis was sent to 20,773 dentists in 2016. Those who completed the questionnaire were invited to participate in radiomorphometric training and then to analyze the MCI and MCW of 114 panoramic radiographs of postmenopausal women who underwent both panoramic radiography and bone densitometry. Based on the radiomorphometric indices and while blinded to the densitometry results, the dentists determined whether they would indicate densitometry for these patients. Results: The response rate was 2.3%: 485 dentists completed the questionnaire, and 50 evaluated panoramic radiographs using the MCW and MCI. All of them reported some knowledge about osteoporosis, but 41.6% demonstrated a misleading conceptualization of the disease. Approximately 90% reported minimal access to this information during graduation, and only 27.0% were exposed to the topic during their postgraduate studies. Interest in osteoporosis prevention was expressed by 70.7% of the respondents, and interest in learning the radiomorphometric indices was expressed by 99.0%. The sensitivity in the detection of low bone mineral density through the MCW and MCI was 52.9%, and the specificity was 64%. Conclusions: Brazilian dentists demonstrated insufficient knowledge about osteoporosis and a low ability to detect osteopenia or osteoporosis by applying radiomorphometric indices.

Acompanhamento da capacidade funcional de pacientes com artrite reumatoide por três anos / Monitoring the functional capacity of patients with rheumatoid arthritis for three years

Objetivo Quantificar a modificação da capacidade funcional em um período de três anos em um grupo de pacientes com artrite reumatoide (AR), utilizando os inventários HAQ e EPM-ROM. Métodos Quarenta pacientes com AR em tratamento com metotrexato (MTX) como fármaco antirreumático modificador da doença (DMARD) foram acompanhados por até três anos. O estado funcional foi avaliado no início e no final do período por HAQ e EPM-ROM. Resultados Trinta e dois pacientes foram recuperados, com escore HAQ inicial de 1,14 ± 0,49 (média ± DP) e EPM-ROM de 5,8 ± 2,75. Após um período médio de três anos, o HAQ foi de 1,13 ± 0,49 e EPM-ROM em 6,81 ± 3,66. No subgrupo de sete pacientes submetidos a cirurgia ortopédica, o HAQ diminuiu de 0,84 ± 0,72 para 1,64 ± 0,56; e o EPM-ROM, de 5,8 ± 1,80 para 8,3 ± 0,74. No subgrupo de pacientes não operados, o HAQ variou de 1,2 ± 0,45 para 1,07 ± 0,70; e o EPM-ROM, de 5,7 ± 3,06 para 6,4 ± 3,90. Conclusão Em um grupo de pacientes com AR medicados apenas com MTX como DMARD, houve pouca mudança nas pontuações HAQ e EPM-ROM durante o período médio de três anos. Observou-se agravamento da capacidade funcional no grupo de pacientes operados, em comparação com os não operados. Este fato nos alerta para a necessidade do uso de esquemas terapêuticos mais abrangentes e de maior disponibilidade de cirurgias musculoesqueléticas, em tempo hábil, em pacientes com AR. .

Objective To quantify modification of functional capacity in a three-year period in a group of patients with rheumatoid arthritis (RA) using HAQ and EPM-ROM inventories. Methods Forty patients with RA on methotrexate (MTX) as disease-modifying antirheumatic drug (DMARD) were followed for up to three years. The functional status was assessed at the beginning and end of the period by HAQ and EPM-ROM. Results Thirty-two patients were retrieved, with initial HAQ score of 1.14 ± 0.49 (mean ± SD) and EPM-ROM score of 5.8 ± 2.75. After an average period of three years, the HAQ score was 1.13 ± 0.49 and EPM-ROM score, 6.81 ± 3.66. In the subgroup of seven patients submitted to orthopedic surgery, HAQ score decreased from 0.84 ± 0.72 to 1.64 ± 0.56 and the EPM-ROM score, from 5.8 ± 1.80 to 8.3 ± 0.74. In the subgroup of non-operated patients, HAQ score varied from 1.2 ± 0.45 to 1.07 ± 0.70 and EPM-ROM score, from 5.7 ± 3.06 to 6.4 ± 3.90. Conclusion In a group of RA patients in use of only MTX as DMARD, there was little change on HAQ score and EPM-ROM scores over the average period of three years. Worsening functional capacity was observed in the group of operated patients in comparison to the not operated ones. This fact alerts us to the need for use of broader therapeutic regimens availability of musculoskeletal surgeries in a timely manner in patients with RA. .

Passive body heating improves sleep patterns in female patients with fibromyalgia

OBJECTIVE: To assess the effect of passive body heating on the sleep patterns of patients with fibromyalgia. METHODS: Six menopausal women diagnosed with fibromyalgia according to the criteria determined by the American College of Rheumatology were included. All women underwent passive immersion in a warm bath at a temperature of 36 ±1 °C for 15 sessions of 30 minutes each over a period of three weeks. Their sleep patterns were assessed by polysomnography at the following time-points: pre-intervention (baseline), the first day of the intervention (acute), the last day of the intervention (chronic), and three weeks after the end of the intervention (follow-up). Core body temperature was evaluated by a thermistor pill during the baseline, acute, chronic, and follow-up periods. The impact of this treatment on fibromyalgia was assessed via a specific questionnaire termed the Fibromyalgia Impact Questionnaire. RESULTS: Sleep latency, rapid eye movement sleep latency and slow wave sleep were significantly reduced in the chronic and acute conditions compared with baseline. Sleep efficiency was significantly increased during the chronic condition, and the awakening index was reduced at the chronic and follow-up time points relative to the baseline values. No significant differences were observed in total sleep time, time in sleep stages 1 or 2 or rapid eye movement sleep percentage. The core body temperature and Fibromyalgia Impact Questionnaire responses did not significantly change over the course of the study. CONCLUSION: Passive body heating had a positive effect on the sleep patterns of women with fibromyalgia.

Fibromialgia: nível de atividade física e qualidade do sono / Fibromyalgia: level of physical activity and quality of sleep

O objetivo foi identificar o nível de atividade física e sua relação com sonolência excessiva diurna e qualidade de sono em 15 mulheres com fibromialgia, com idade média de 58±7 anos. Foi utilizado o Questionário Internacional de Atividade Física, o Índice de Qualidade de Sono de Pittsburgh e a Escala de Sonolência de Epworth. O programa SPSS Statistics versão 17 foi utilizado para as analises estatísticas e o valor para significância foi de α ≤ 0,05. Os resultados evidenciaram que 33,3% das pacientes classificaram-se inativas e 66,7% minimamente ativas. Observou-se sonolência excessiva diurna em 60% das pacientes. A qualidade ruim de sono foi observada em 55,6% das pacientes minimamente ativas e em 60% das inativas. O tempo médio para adormecer foi 34,3 minutos, a eficiência do sono foi 81% e o tempo total de sono foi 5,9 horas. O baixo nível de atividade física parece ser um dos fatores capazes de piorar a qualidade do sono de mulheres com fibromialgia.

The objective was to identify the level of physical activity and its relation to excessive daytime sleepiness and sleep quality in 15 women with fibromyalgia and mean age 58 ± 7 years. We used the International Physical Activity Questionnaire, the Sleep Quality Index in Pittsburgh and Epworth Sleepiness Scale. We used SPSS Statistics Version 17 and the value for significance was α ≤ 0.05. The results showed that 33,3% of patients rated themselves inactive and 66,7% minimally active. We observed excessive daytime sleepiness in 60% of patients. The poor quality of sleep was observed in 55,6% of patients in minimally active and 60% of inactive. The average time was 34,3 minutes to fall asleep, sleep efficiency was 81% and total sleep time was 5,9 hours. The low level of physical activity seems to be one of the factors that can worsen sleep quality in women with fibromyalgia.

Effects of sildenafil on autonomic nervous function during sleep in obstructive sleep apnea

OBJECTIVE: To evaluate the effects of sildenafil on the autonomic nervous system in patients with severe obstructive sleep apnea. METHODS: Thirteen male patients with severe obstructive sleep apnea (mean age 43±10 years with a mean body mass index of 26.7±1.9 kg/m²) received a single 50-mg dose of sildenafil or a placebo at bedtime. All-night polysomnography and heart rate variability were recorded. Frequency domain analysis of heart rate variability was performed for the central five-minute sample of the longest uninterrupted interval of slow wave and rapid eye movement sleep, as well as for one-minute samples during apnea and during slow wave and rapid eye movement sleep after resumption of respiration. RESULTS: Compared to the placebo, sildenafil was associated with an increase in the normalized high-frequency (HFnu) components and a decrease in the low/high-frequency components of the heart rate variability ratio (LF/HF) in slow wave sleep (p<0.01 for both). Differences in heart rate variability parameters between one-minute post-apnea and apnea samples (Δ= difference between resumption of respiration and apnea) were assessed. A trend toward a decreasing magnitude of ΔLF activity was observed during rapid eye movement sleep with sildenafil in comparison to placebo (p=0.046). Additionally, Δ LF/HF in SWS and rapid eye movement sleep was correlated with mean desaturation (sR= -0.72 and -0.51, respectively, p= 0.01 for both), and Δ HFnu in rapid eye movement sleep was correlated with mean desaturation (sR= 0.66, p= 0.02) and the desaturation index (sR= 0.58, p = 0.047). CONCLUSIONS: The decrease in arousal response to apnea/hypopnea events along with the increase in HFnu components and decrease in LH/HF components of the heart rate variability ratio during slow wave sleep suggest that, in addition to worsening sleep apnea, sildenafil has potentially immediate cardiac effects in patients with severe obstructive sleep apnea.

Estudo da capacidade de manter o alerta em pacientes com fibromialgia por meio do teste da manutenção da vigília / Degree of daytime sleepiness in patients with fibromyalgia through the awakefulness maintenance test

OBJETIVO: Avaliar, de forma objetiva, a capacidade de manter o alerta em pacientes com fibromialgia por meio do teste da manutenção da vigília (TMV). MÉTODO: Foi realizado um estudo caso-controle de 15 pacientes com diagnóstico de fibromialgia com pelo menos 11 de 18 pontos dolorosos e dor difusa nos últimos três meses. O grupo-controle foi constituído de 15 indivíduos hígidos pareados por idade e sexo, selecionados seqüencialmente. Os participantes responderam à escala de sonolência de Epworth e foram submetidos ao TMV. Foram realizadas quatro captações, cada uma com duração mínima de 20 minutos e com intervalo de duas horas. Considerou-se como normal a latência para o início do sono maior do que 20 minutos, e patológica a latência menor que 11 minutos. RESULTADOS: O grupo com fibromialgia apresentou significante redução da latência para o início do sono no TMV, comparado ao grupo-controle 9,9 ± 4,6 e 14,9 ± 5,1, respectivamente, p = 0,01, sendo que em 66,7 por cento dos casos o resultado foi patológico, em comparação com 26,7 por cento no grupo-controle (p = 0,03). Não se observou correlação entre o resultado do TMV e a idade dos pacientes ou a pontuação na escala de sonolência de Epworth. CONCLUSÃO: Neste estudo-piloto, pacientes com fibromialgia apresentam redução da latência do sono no TMV.

OBJECTIVE: To assess in an objective way the degree of alertness in patients with fibromyalgia through the Maintenance Wakefulness Test ( MWT). METHOD: Fifteen patients with fibromyalgia and 15 age and sex- matched healthy controls were sequentially selected. The inclusion criteria for fibromyalgia were the presence of at least 11 of the 18 tender points and diffuse pain during three months prior to evaluation. All participants answered the Epworth Sleepiness Scale (ESS) and underwent four 20 minutes sessions of MWT scheduled at 2-hour intervals. Mean sleep latency higher than 20 minutes or lower than 10 minutes was considered normal or pathological, respectively. RESULTS: Although ESS scores did not differ between fibromyalgia patients and controls, the fibromyalgia group showed a significant decrease in the sleep latency by MWT ( 9.9 ± 4.6 and 14.9 ± 5.1, respectively, p = 0.01). Pathological results were obtained in 66.7 percent of the patients, in comparison to 26.7 percent of the controls ( p = 0.03). CONCLUSION: In this pilot study, patients with fibromyalgia showed decrease in the sleep latency by the Wakefulness Maintenance Test.

Características do sono alfa na fibromialgia / Alpha sleep characteristics in fibromyalgia

OBJETIVO: Caracterizar os padrões eletrencefalográficos do sono alfa e sua associação com manifestações de dor e distúrbios do sono em pacientes com fibromialgia. MÉTODOS: as manifestações de dor e as queixas relacionadas ao sono foram estudadas antes e após o registro noturno do sono em 40 pacientes com fibromialgia e 43 controles saudáveis. A análise da atividade alfa durante o sono não-REM foi realizada de forma cega, por meio de análise por domínio de tempo, análise espectral e análise visual. RESULTADOS: três padrões distintos de atividade alfa foram detectados no sono: alfa fásico (simultâneo à atividade delta) em 50 por cento das pacientes, alfa tônico (contínuo ao longo do sono não-REM) em 20 por cento das pacientes e baixa atividade alfa nas demais 30 por cento das pacientes. O padrão de sono com baixa atividade alfa foi observado em 83,7 por cento das participantes do grupo controle (p < 0,01). Todas as pacientes com fibromialgia que apresentaram atividade alfa fásica no sono relatam piora da dor após o sono, em comparação com 58,3 por cento das pacientes com baixa atividade alfa (p < 0,01) e 25 por cento com alfa tônico (p < 0,01). O aumento no número de pontos de dor após o sono ocorreu em 90 por cento das pacientes com alfa fásico, 41,7 por cento daquelas com baixa atividade alfa e 25 por cento das pacientes com alfa tônico (p < 0,01). Pacientes com alfa fásico apresentavam história de dor com maior duração que as pacientes dos outros subgrupos (p < 0,01). Além disso, as pacientes com alfa fásico apresentaram menor tempo total de sono que as pacientes dos demais subgrupos (p < 0,05), assim como menor eficiência de sono e menor quantidade de sono de ondas lentas (p < 0,05) do que pacientes com alfa tônico. CONCLUSÕES: a intrusão de ondas alfa durante o sono pode ser de diferentes padrões. A atividade fásica de alfa foi o padrão que melhor se correlacionou com as manifestações clínicas da fibromialgia.

Fibromialgia juvenil / Juvenile fibromyalgia

A fibromialgia acomete preferencialmente indivíduos do sexo feminino na faixa etária dos 30 aos 50 anos; no entanto, muitos pacientes referem queixas dolorosas difusas desde a infância. Essa síndrome tem prevalência de 3 a 6,5 por cento tanto em sua forma adulta como juvenil e apresenta grande impacto sobre a qualidade de vida. Tendo em vista necessidade de considerar a fibromialgia como hipótese diagnóstica em crianças com queixas dolorosas crônicas, foram revistas as principais publicaçöes referentes ao tema. De acordo com os mais recentes estudos, observam-se semelhanças clínicas entre as manifestaçöes da fibromialgia juvenil e as da do adulto. As crianças fibromiálgicas têm maior probabilidade de apresentar mäes com diagnóstico coincidente, sendo observado naquelas maior limiar de dor e menor número de pontos dolorosos que nos adultos. Quanto às queixas de sono näo restaurador e aos achados polissonográficos, ambos so menos proeminentes nas crianças que nos adultos. Os distúrbios psicogênicos podem estar associados à fibromialgia juvenil, porém näo atuam como fatores etiopatogênicos. A abordagem terapêutica é multidisciplinar