Rare Case of Botulism and Dysphagia: The Role of Physical and Rehabilitation Medicine.

Botulism is a rare cause of flaccid paralysis resulting from the neurotoxin produced by the bacterium Clostridium botulinum. It is clinically characterized by symmetric proximal-distal paralysis, diplopia, dysarthria, dysphonia, and dysphagia. Definitive diagnosis requires laboratory confirmation through the detection of the toxin in blood, vomit, or stool samples. Treatment with antitoxin should be promptly initiated upon clinical suspicion and in the presence of epidemiological support due to evidence of reduced mortality. Physical and rehabilitation medicine plays a fundamental role in the recovery of deficits and prevention of complications. In this report, the authors describe a 19-year-old patient with botulism with dysphagia, dysphonia, and facial paresis in the rehabilitation ward.

Guillain-Barré Syndrome Following Hand, Foot, and Mouth Disease in an Adult Patient.

Guillain-Barré syndrome (GBS) stands as one of the primary causes of acute flaccid paralysis. It includes acute-onset peripheral nerve lesions and typically follows a monophasic course. Its etiopathogenesis is linked to an immune-mediated response to a prior infection, often respiratory or intestinal. The main variants of GBS are acute inflammatory demyelinating polyneuropathy, which accounts for approximately 90% of cases in the USA and Europe, and acute motor axonal neuropathy, responsible for about 10% of cases in the USA and Europe. From the literature review, only one case of GBS preceded by hand, foot, and mouth disease (HFMD) has been described. The authors report a rare clinical case of typical GBS after HFMD. Recognizing this adult-onset disease as a potential preceding infection of GBS is crucial for early diagnosis and treatment. Additionally, the integration into a rehabilitation program adjusted to the deficits plays an important role in motor and functional recovery.

Idiopathic Scoliosis Trends One Year After COVID-19: A Retrospective Study.

Introduction The reorganization of healthcare services during the COVID-19 pandemic was associated with compromised management of conditions not related to the pandemic. Methods A retrospective descriptive case series study was carried out that included patients followed up at the Spine Deformities (SD) consultation at Centro Hospitalar e Universitário Lisboa Central from January 2019 through December 2021 regarding diagnosis, treatment, referral, and the number of consultations performed. Results Referrals significantly dropped in 2020 (p<0.001). The average number of consultations per patient was found to not vary significantly in 2020 despite the reorganization of our healthcare unit due to the pandemic. 22% of the consultations were performed online. Idiopathic scoliosis (IS) was the primary diagnosis in 50% of the patients observed for the first time during the three-year time period. An increase of 18% was found in the number of IS patients that required bracing in 2021. However, late referrals, defined as the patient meeting surgical criteria at the time of initial presentation, did not increase. Conclusion Despite the significant decrease in primary care referrals during 2020, an overcompensation increase in referrals was not observed in 2021. However, the increase in the percentage of patients needing bracing might reflect a delayed initial presentation to the SD consultation.

Neurological Complications Associated With SARS-CoV-2 Infection: A Single-Centre Experience.

BACKGROUND: The clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can range from mild or moderate disease (80% of the cases) to severe disease (15%) requiring oxygen support, and critical disease (5%), associated with acute respiratory distress syndrome and admission to the intensive care unit (ICU). In critically ill patients, prone positioning can be used to optimize oxygenation. Although there is a favourable response to this strategy, being a life-saving measure, additional associated complications may appear, including compressive neuropathies. Despite respiratory affection being more common, SARS-CoV-2 infection can also attack other systems and can, under certain conditions, affect the central or peripheral nervous system. It has been described that neurological manifestations can result from the neuroinvasive properties of the SARS-CoV-2 or as an indirect consequence of multiorgan dysfunction. AIMS: We intend to report the patients who presented with neurological complications associated with coronavirus disease 2019 (COVID-19) and/or complications of its treatment, followed in our physical and rehabilitation medicine (PRM) service. MATERIALS AND METHODS: A retrospective analysis of patients admitted to the PRM ward with outpatient consultation in the context of post-COVID-19 status between April 2020 and November 2021 (the period of the highest prevalence of infection) was carried out. Patients with neurological complications after SARS-CoV-2 infection and consequently a decline in previous functionality were identified. RESULTS: Thirteen patients (23.6%) admitted to the PRM ward had peripheral neurological complications, documented by electroneuromyography, including Guillain-Barré syndrome, sensory-motor polyneuropathy, peroneal nerve injury, femoral nerve injury, and lumbar plexus injury. The neurological complications of the patients followed in a post-COVID-19 consultation were also evaluated. Eight patients (20%) reported neurological sequelae. Five patients presented peripheral nerve damage (peroneal, accessory, ulnar, and recurrent laryngeal) of undefined aetiology, diagnosed after the acute phase of hospitalization. Two patients had COVID-19 infection followed by ischemic stroke (vertebrobasilar and middle cerebral artery), requiring hospitalization in the acute phase. One patient had COVID-19 infection followed by longitudinal myelitis, with positive anti-myelin oligodendrocyte glycoprotein (MOG). All patients required follow-up by the rehabilitation team with partial recovery of deficits. CONCLUSIONS:  All patients admitted to the PRM ward with neurological manifestations had critical disease and symptoms compatible with peripheral nervous system involvement. Patients admitted to the PRM consultation had different levels of viral disease severity and had sequelae related to peripheral and central nervous system disorders. Identifying the aetiology of these injuries is essential for us to act on their prevention, particularly with regard to indirect complications, such as compressive neuropathies. It will be necessary to maintain the follow-up of these patients to understand the evolution of the neurological consequences associated with COVID-19.

Rehabilitation and Exercise in Dermatomyositis: A Case Report and Narrative Review of the Literature.

Dermatomyositis (DM) is an idiopathic inflammatory myopathy most commonly characterized by proximal, progressive, symmetrical muscle weakness, as well as specific dermatological manifestations. The presence of nuclear matrix protein 2 (NXP-2) autoantibodies is predominantly associated with joint contractures and calcinosis. A 19-year-old female was diagnosed with DM with positive anti-NXP-2 autoantibodies. She had severe joint involvement of the shoulders, elbows, wrists, and ankles, and the presence of calcinosis was documented on radiographs. Concomitantly, she presented with heliotrope erythema on the eyelids and Grotton's papules on the interphalangeal joints of the hands. After performing a diagnostic investigation and beginning targeted therapy, the patient was transferred to an inpatient Physical Medicine and Rehabilitation Department to carry out a rehabilitation program. The patient had a favorable outcome, with improved range of motion and muscle strength, with a Manual Muscle Testing 8 at the time of admission of 73/150, and at discharge from the hospital of 94/150. Regarding the functional scales, she had a Functional Independence Measure at the time of admission of 87/126 and a Barthel Index of 50/100, with an objective improvement at the time of discharge to 118/126 and 90/100, respectively. DM is an insidious chronic disease with multisystemic involvement and can lead to a great loss of independence. Most patients with DM do not recover their previous muscle function, which leads to a negative impact on their quality of life. The institution of an early rehabilitation program seems to have beneficial effects on the functionality and independence of these patients. Its treatment is based on a multidisciplinary approach, and the established rehabilitation program must be individualized and directed to the deficits and limitations of each patient.

Spinal cord disorder due to spinal epidural abscess secondary to thoracic facet joint septic arthritis-a rare case with a surprising evolution.

INTRODUCTION: Septic arthritis of a facet joint (SAFJ) is a relatively rare medical entity and the lumbar segment is its most frequent location. Although unusual, a spinal epidural abscess (SEA) can occur as a complication of SAFJ and possibly damage the spinal cord. CASE PRESENTATION: A 53-year-old woman presented with acute right dorsal pain, fever, loss of sphincters control, and paraparesis without causal factor. Forty-eight hours after the symptoms started, imaging revealed a thoracic posterior epidural collection causing compression of the spinal cord and features suggestive of septic arthritis of right T5-T6 facet joint. She underwent an urgent laminectomy and drainage of the abscess. Both blood and abscess cultures isolated Staphylococcus aureus. A diagnosis of complete paraplegia grade A of the ASIA (American Spinal Injury Association) Impairment Scale (AIS) with neurologic level T10 was made 5 days after surgery. She took 3 months of an intensive rehabilitation program at our Physical and Rehabilitation Medicine ward. With an unexpected favorable evolution, both neurological and functional, she was discharged with an incomplete paraplegia AIS D and functionally independent in all tasks. DISCUSSION: This case reveals an infrequent medical condition on a rarely affected spinal segment. An early diagnosis and proper treatment of SAFJ and SEA are of major importance to avoid severe related consequences. Patients with spinal cord injury with severe neurological deficits due to these conditions greatly benefit from an interdisciplinary rehabilitation program to improve neuromotor and functional status.

Why do patients with myositis die? A retrospective analysis of a single-centre cohort.

OBJECTIVES: Causes of death in inflammatory myopathies have rarely been studied. We have assessed a cohort of myositis patients followed in a single centre over a 37-year period, reviewing the mortality rate, causes of death and predictors of poor prognosis. METHODS: We performed a single-centre, retrospective study on patients aged ≥16 years fulfilling 3 or 4 of the Bohan and Peter criteria, noting their demographic data, clinical features, serology, treatment and outcome. RESULTS: Of 97 patients identified, 74.2% were female. The mean age at diagnosis was 40.5 years (SD 13.2). 38.1% had adult-onset dermatomyositis, 36.1% adult-onset polymyositis and 25.8% overlap myositis. 96.9% had upper and lower limb involvement (UL+/LL+) and 62.9% had a highest CK≥10 times the upper limit of normal. 33% had significant infection(s). The disease course was chronic persistent in 29.9%, relapsing and remitting in 34% and monophasic in 36.1%. All received steroids and 92.8% other immunosuppressant(s). The median follow-up was 9 years (IQR 11.5). The estimated cumulative proportion survival at 5, 10, 15 and 20 years were 94.6%, 82.2%, 72,1% and 66.1%, respectively. 24.7% of patients died, mostly due to infection (29.2%). In univariate analysis, lung involvement (HR 1.78, p=0.013), infection (HR 4.18, p=0.003) and UL+/LL+ (HR 0.13, p=0.010) were statistically significantly associated with the risk of death. In the multivariate analysis infection (HR 3.68, p=0.009) and UL+/LL+ (HR 0.16, p=0.027) were statistically significantly associated with survival. CONCLUSIONS: A good long-term survival is reported. Nevertheless, careful follow-up of myositis patients is important.