Disease-related outcomes influence prevalence of falls in people with rheumatoid arthritis.

BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of falls, with potential adverse outcomes. There is a considerable variation across studies regarding the prevalence of falls and its correlation with clinical data, disease-related outcomes and physical performance tests. OBJECTIVE: The aim of this study was to evaluate the prevalence of falls and its association with clinical data, disease-related outcomes and physical performance tests. METHODS: In this cross-sectional study, 113 RA patients were divided into 3 groups - "non-fallers", "sporadic fallers" and "recurrent fallers" - and compared in terms of clinical data, Clinical Disease Activity Index (CDAI), lower-limb tender and swollen joint count, disability (Health Assessment Questionnaire-Disability Index [HAQ-DI]), Foot Function Index (FFI), Berg Balance Scale (BBS), Timed-up-and-go Test (TUG) and 5-Time Sit Down-To-Stand Up Test (SST5). Logistic regression analysis was performed to analyze the associations between the studied variables and the occurrence of falls, estimating odds ratios (ORs). We also analyzed the correlation between disease outcome measures (HAQ-DI and CDAI) and physical tests (BBS, TUG, SST5). RESULTS: Falls and fear of falling were reported by 59 (52.21%) and 71 (64.5%) patients, respectively. Significant associations were found between "recurrent fallers" and vertigo (OR=3.42; P=0.03), fear of falling (OR=3.44; P=0.01), low income (OR=2.02; P=0.04), CDAI (OR=1.08; P<0.01), HAQ-DI (OR=3.66; P<0.01), Lower-limb HAQ (OR=3.48; P<0.01), FFI-pain (OR=1.24; P=0.03), FFI-total (OR=1.23; P=0.04), lower-limb tender joint count (OR=1.22; P<0.01), BBS score (OR=1.14; P<0.01), TUG score (OR=1.13; P=0.03) and SST5 score (OR=1.06; P=0.02). On multivariate analysis, CDAI was the only significant predictor of recurrent falls (OR=1.08; P<0.01). Physical performance test scores (BBS, TUG, SST5) were correlated with the CDAI and HAQ-DI. CONCLUSION: The prevalence of falls in RA is high, most influenced by disease-related outcomes and linked to worse performance on physical tests (BBS, TUG and SST5).

The effect of foot orthoses in rheumatoid arthritis.

OBJECTIVE: To evaluate the effectiveness of foot orthoses using the foot function index (FFI) in a group of patients with rheumatoid arthritis (RA) during a period of 6 months. METHODS: Thirty-six rheumatoid subjects with foot pain were examined and appropriate foot orthoses were prescribed according to each patient's needs. All the patients were evaluated 30, 90 and 180 days after the baseline visit. FFI values, daily time of wearing the orthoses and adverse effects were noted at each appointment. The Stanford Health Assessment Questionnaire (HAQ) was used at the initial visit to evaluate the influence of physical condition on FFI response. RESULTS: With the use of foot orthoses, FFI values decreased in all subscales (pain, disability and activity limitation). This reduction was noted in the first month and was maintained throughout the trial. Those using EVA (ethyl-vinyl acetate; n = 28) orthoses presented results similar to those for the total group. Patients wearing made-to-measure orthoses (n = 8) exhibited higher initial FFI values and worse evolution during the trial, significant for pain and disability but not for activity limitation. Minor adverse reactions were noted; none required interruption of treatment. There was no relation between HAQ and FFI evolution. CONCLUSIONS: Foot orthoses were effective as an adjuvant in the management of rheumatoid foot. They significantly reduced pain, disability and activity limitation, as measured by the FFI, with minor adverse effects.

Prevalence of pulmonary hypertension in limited and diffuse scleroderma.

STUDY OBJECTIVES: To characterize the prevalence of undiagnosed pulmonary hypertension in patients with limited and diffuse scleroderma. DESIGN: Prospective cross-sectional study. SETTING: University-based outpatient clinic. PATIENTS: Thirty-four consecutive patients with limited (n = 29) or diffuse (n = 5) scleroderma but without the clinical diagnosis of pulmonary hypertension. MEASUREMENTS AND RESULTS: All patients had 12-lead ECGs and two-dimensional and Doppler echocardiograms. The pulmonary artery systolic pressure (PAs) was calculated as the sum of the Doppler transtricuspid pressure gradient and the right atrial pressure as estimated by the caval respiratory index. Thirty-three patients (97%) had adequate spectral signals of tricuspid regurgitation. The velocity of tricuspid regurgitation ranged from 1.6 to 4.5 m/s. The calculated PAs ranged from 15 to 95 (mean +/- SD = 30 +/- 14 mm Hg). Twelve patients (35% of the total cohort) had pulmonary hypertension defined as PAs of 30 mm Hg or greater. CONCLUSIONS: Undiagnosed elevation of PAs is common in patients with scleroderma. Noninvasive assessment of PAs can be performed accurately in most patients independent of clinical signs of pulmonary hypertension. If successful treatment strategies are identified, it may be possible to identify patients early in the development of pulmonary hypertension and intervene before significant end-organ damage occurs.

The use of synthetic plaster casting tape for hand and wrist splints.

In a prospective study, 40 patients were fitted with synthetic plaster splints to assess the use of such material for hand and/or wrist splints. Factors assessed in both splint fabrication and use included molding properties, elastic traction fixation, weight, ventilation, durability, patient comfort, effectiveness, practicability, time, and cost. The patients were divided into three groups according to basic pathology: tendon/nerve injuries; bone and joint disorders; and rheumatoid disease deformities. Recovery of 50-100% of active range of motion was considered a good result. Good results were obtained in 37 patients (92.5%), whereas in the remaining three patients (7.5%) the results were poor. It is suggested that synthetic plaster is a suitable material for the fabrication of splints in hand rehabilitation.

Efficacy of chlorhexidine gluconate use in the prevention of perirectal infections in patients with acute leukemia.

The frequency of rectal infections is increased in patients with acute leukemia. Complications associated with rectal lesions may be severe enough to cause life-threatening septicemia. Clinical research evaluating the effects of preventive perirectal skin care is scarce. This study's purpose was to determine whether using chlorhexidine gluconate (CHG) in a prophylactic perirectal skin-care regimen decreases perirectal infections and whether it produces more skin irritation than a nonmedicated skin cleanser. The sample consisted of 40 patients, 16 of whom were randomized to use chlorhexidine and 24 of whom were randomized to use nonmedicated skin cleanser. Chi-square and t-tests were used to analyze the incidence of skin breakdown and rectal infections; the correlation between the two factors; a positive history of rectal infections, fissures, or hemorrhoids; presence of hemorrhoids; severity of diarrhea; and duration and severity of granulocytopenia. A positive relationship was found between the severity of granulocytopenia and the incidence of rectal infections (p = 0.02). No significant difference was seen in the occurrence of perirectal infections (p = 0.35) or skin breakdown (p = 0.18) between the two groups. The data suggest that CHG does not offer increased protection against perirectal infections in patients undergoing intensive chemotherapy, nor is it more irritating than a nonmedicated skin cleanser. Further studies are needed to examine the efficacy of hygienic measures such as using skin disinfectants to prevent infections in patients who are immunocompromised.

Lung disease in the very immature neonate: radiographic and microscopic correlation.

Radiographic-pathologic correlation of pulmonary patterns has not been performed in very small preterm infants below 28 weeks of gestation. The radiologic findings of linear interstitial densities or generalized airspace opacity coincided with histologic changes of edema and hemorrhage and indicate that this is the most frequent abnormality producing radiographic pulmonary opacification in infants of 23-27 weeks gestation. On occasion, parenchymal immaturity alone results in lung opacification, reflecting the established interpretation of diffuse atelecatasis as the histologic-radiographic finding in respiratory distress syndrome.

Tratamento funcional das fraturas diafisárias do úmero com caneleiras de futebolista / Functional treatment of shaft fractures of the humerus with skin pads

Estäo bem estabelecidos os critérios de tratamento funcional das fraturas segundo Sarmiento e que também säo aplicáveis ao úmero. De novembro de 1982 a outubro de 1984, foram tratados 19 casos de diversos tipos de fratura de diáfise umeral. Após um período de tratamento com enfaixamento tipo Desault ou gesso tipo pinça de confeiteiro até o desaparecimento do edema, säo aplicadas duas caneleiras (jogadores de futebol usam-nas para proteger as pernas) e fixadas com seus cadarços e tiras de esparadrapo. A consolidaçäo ocorreu em todos os casos e desvios em varo entre 10 e 20- em 5 casos. A limitaçäo do ombro e cotovelo presente na retirada das caneleiras foi de poucos graus em 5 pacientes

Nonoliguric acute renal failure in the newborn: a prospective evaluation of diagnostic indexes.

Fifteen newborn babies with azotemia without oliguria were studied. Group A infants had increased BUN levels and decreased creatinine clearance (Ccr) for gestational and postnatal age, and were compared with group B infants, who had increased BUN levels and normal Ccr. The Ccr was 0.35 mL/min in group A and 0.76 mL/min in group B. Urine volume during the same period was 2.45 mL/kg/hr in group A and 4.66 mL/kg/hr in group B. No significant differences in fractional sodium excretion; urine to plasma ratios of creatinine, osmolality, and sodium; and renal failure index were present between the two groups. The results suggest that nonoliguric acute renal failure is a diagnostic entity in the newborn. The Ccr is the most useful indicator for defining renal function in the presence of azotemia and normal urine volume.

Evolution of porencephalic cysts from intraparenchymal hemorrhage in neonates: sonographic evidence.

Ninety-four low-birth-weight neonates were screened consecutively with real-time sonography for evidence of cerebroventricular hemorrhage. Among them, 13 were found to have intraparenchymal hemorrhage beyond the area of the germinal matrix. Weekly follow-up sonograms revealed progression to porencephaly in every surviving infant. Four different sonographic patterns were observed during the evolution from the original hemorrhage to the porencephalic cyst. The size of the mature porencephalic cyst correlated directly with the size of the intraparenchymal hemorrhage. After ventriculoperitoneal shunting, the porencephalic cysts became smaller or remain unchanged. One small cyst was no longer identified after successful shunting, but reappeared with shunt failure.

Angiotensin-I-converting enzyme activity in term and premature infants.

Cord blood angiotensin-I-converting enzyme (ACE) activity was examined in 21 term and 21 premature infants. Values were significantly higher in premature infants than in term infants. Cord blood ACE activity was found to have a significant negative correlation with birth weight and gestational age. ACE activity measured from peripheral blood during the first 24 h of life was higher in premature than term infants but similar to levels in maternal and adult controls. It was not possible to predict those premature infants who would develop respiratory distress syndrome on the basis of cord blood ACE activity. However, ACE may serve as a marker for maturation of the pulmonary vascular endothelial cell.