Desempeño físico en pacientes con esclerosis lateral amiotrófica y su relación con el uso de silla de ruedas y ayuda para la marcha / Physical performance in patients with amyotrophic lateral sclerosis and its relationship with wheelchairs and walking aids use

Introducción y objetivos: El déficit de marcha y las caídas en pacientes con esclerosis lateral amiotrófica (ELA) restringen la movilidad. El objetivo de este estudio es examinar el uso apropiado de dispositivos de ayuda para la marcha y silla de ruedas para deambular basados en el riesgo de caídas y la velocidad de marcha de pacientes con ELA. Métodos: Se incluyeron datos retrospectivos de pacientes de la clínica ELA. Se registraron edad, género, tiempo de evolución, uso de silla de ruedas, dispositivo de ayuda para la marcha, velocidad de marcha y escala de Berg. Se relacionaron las variables categóricas con la prueba de chi cuadrado y test exacto de Fisher. Resultados: Cincuenta y ocho pacientes cumplieron con los criterios de inclusión. Veintisiete (46,55%) tuvieron uso adecuado de silla de ruedas basado en la velocidad de marcha (p=0,50). Esta asociación disminuye al 6% en pacientes que caminaron a velocidad menor a 0,88m/s. Cuarenta y dos (70,69%) tuvieron uso adecuado de dispositivo de ayuda para la marcha basado en el riesgo de caídas (P=0,001). Del subgrupo con puntaje de Berg ≤ 45, el 38% no empleó el dispositivo apropiado (p=0,06). Conclusiones: Los pacientes con severo déficit de equilibrio y de marcha tuvieron un uso inapropiado de dispositivos para caminar y/o silla de ruedas. Los hallazgos del presente estudio pueden significar un aporte que podría ser considerado en las evaluaciones clínicas de pacientes con ELA para minimizar los riesgos y mejorar la participación de este colectivo de personas.

Introduction and objectives: Gait deficits and falls in patients with amyotrophic lateral sclerosis (ALS) restrict mobility. The aim of this study is to examine the appropriate use of walking aids and wheelchairs, based on the risk of falling and walking speed of patients with ALS. Methods: Retrospective data from patients from the ALS clinic were included. Age, gender, evolution time, wheelchair use, walking aids, gait speed and the Berg Balance Scale were registered. Categorical variables were related to the Chi Square test and Fisher's exact test. Results: Fifty eight patients met the inclusion criteria. Twenty-seven (46.55%) had adequate use of a wheelchair based on walking speed (p=.50). This association decreases to 6% in patients who walked at a speed lower than 0.88m/s. Forty-two (70.69%) had adequate use of an assistive device based on the risk of falls (p=.001). Of the subgroup with Berg Balance score ≤ 45, 38% did not use the appropriate device (p=.06). Conclusion: Patients with severe gait and balance deficits had inappropriate use of walking aids and/or wheelchairs. The findings of this study may mean a contribution that could be considered in the clinical evaluations of patients with ALS to minimize risks and improve the participation of this group of people.(AU)

[Physical performance in patients with amyotrophic lateral sclerosis and its relationship with wheelchairs and walking aids use]. / Desempeño físico en pacientes con esclerosis lateral amiotrófica y su relación con el uso de silla de ruedas y ayuda para la marcha.

INTRODUCTION AND OBJECTIVES: Gait deficits and falls in patients with amyotrophic lateral sclerosis (ALS) restrict mobility. The aim of this study is to examine the appropriate use of walking aids and wheelchairs, based on the risk of falling and walking speed of patients with ALS. METHODS: Retrospective data from patients from the ALS clinic were included. Age, gender, evolution time, wheelchair use, walking aids, gait speed and the Berg Balance Scale were registered. Categorical variables were related to the Chi Square test and Fisher's exact test. RESULTS: Fifty eight patients met the inclusion criteria. Twenty-seven (46.55%) had adequate use of a wheelchair based on walking speed (p=.50). This association decreases to 6% in patients who walked at a speed lower than 0.88m/s. Forty-two (70.69%) had adequate use of an assistive device based on the risk of falls (p=.001). Of the subgroup with Berg Balance score ≤ 45, 38% did not use the appropriate device (p=.06). CONCLUSION: Patients with severe gait and balance deficits had inappropriate use of walking aids and/or wheelchairs. The findings of this study may mean a contribution that could be considered in the clinical evaluations of patients with ALS to minimize risks and improve the participation of this group of people.

Toxicity of metal oxide nanoparticles in immune cells of the sea urchin.

The potential toxicity of stannum dioxide (SnO2), cerium dioxide (CeO2) and iron oxide (Fe3O4) nanoparticles (NPs) in the marine environment was investigated using the sea urchin, Paracentrotus lividus, as an in vivo model. We found that 5 days after force-feeding of NPs in aqueous solutions, the three NPs presented different toxicity degrees, depending on the considered biomarkers. We examined: 1) the presence of the NPs in the coelomic fluid and the uptake into the immune cells (coelomocytes); 2) the cholinesterase activity and the expression of the stress-related proteins HSC70 and GRP78; 3) the morphological changes affecting cellular compartments, such as the endoplasmic reticulum (ER) and lysosomes. By Environmental Scanning Electron Microscope (ESEM) analysis, coupled with Energy Dispersive X-ray Spectroscopy (EDS) we found that NPs were uptaken inside coelomocytes. The cholinesterases activity, a well known marker of blood intoxication in vertebrates, was greatly reduced in specimens exposed to NPs. We found that levels of stress proteins were down-regulated, matching the observed ER and lysosomes morphological alterations. In conclusion, this is the first study which utilizes the sea urchin as a model organism for biomonitoring the biological impact of NPs and supports the efficacy of the selected biomarkers.

Treatment of venous ulcers with fibrin sealant derived from snake venom

Venous ulcers of the lower limbs complicated by infection or chronicity represent a serious public health problem. The elevated number of those afflicted burdens the health services, interferes in quality of life and causes absenteeism. Although there are 2,500 items on the market, ranging from the simplest dressing up to the most complex types of dressing, treatment remains a challenge. Among the substances used, fibrin sealant is the one that promotes diminution of bacterial colonization and of edema, controls hemorrhaging, alters the pain threshold by protecting the nerve endings, hydrates the wound bed and forms granulation tissue that favors healing. Its disadvantages include higher cost and utilization of human fibrinogen that can transmit infectious diseases. The Center for the Study of Venoms and Venomous Animals (CEVAP) at São Paulo State University (UNESP) developed a new sealant made up of fibrinogen extracted from large animals and from an enzyme obtained from snake venom. The present study, developed in the Health Education Clinic (CEPS) of Sacred Heart University (USC) aimed to evaluate the effect of the new sealant on the healing process of venous ulcers in 24 adult patients, seven of whom were male and 17 female. Two study groups were formed as follows: Group 1 (G1) - control group of 11 patients treated with essential fatty acid (EFA) and Unna's boot, and Group 2 (G2) - 13 patients treated with essential fatty acid (EFA), fibrin sealant and Unna's boot. The follow-up lasted eight weeks and the sealant was applied at only the first and fourth weeks. The results showed that Group 2 presented worse lesion conditions as to healing, but, when comparing the two groups, it was noteworthy that the the sealant was effective in healing venous ulcers...

Destruction of immunobiologicals and their disposal

The guidelines of the Brazilian National Health System (SUS) state that the municipal authorities are responsible for the vaccination of the population. The present study examined the types of immunobiologicals, amounts and reasons for their destruction and disposal by the Municipal Health Secretariat in the city of Bauru, São Paulo state, Brazil, between 2008 and 2009. This study comprises a descriptive, exploratory and retrospective work that employed search of bibliographic data, collection of secondary data from forms of immunobiologicals disposal and interview of the agent responsible for the disposal of these products in the municipality. It was observed that the total numbers of unused vaccines in 2008 and 2009 were similar (4523 and 4395, respectively), being the most discarded: the diphtheria, tetanus and pertussis (DTP) vaccine in 2008 and DTP, BCG and influenza in 2009. It was found that the amount of discarded vaccines could be reduced since the reasons for that were predictable. Moreover, the current study emphasized that although there is a municipal regulation for the disposal of immunobiologicals, the city still requires a better structure to handle such problem.

Comparison of gait performance on different environmental settings for patients with chronic spinal cord injury.

STUDY DESIGN: Observational cross-section study. OBJECTIVES: The objective of our study was to determine if the influence of a community environment would impact on ASIA D spinal cord injured (SCI) gait performance patients. Our main hypothesis is that an outdoor community environment may influence gait speed and endurance on community ambulating patients. METHODS: Ten-Meter Walking (10MWT) and Six-Minute Walking (6MWT) tests were performed on community ambulating SCI research participants (n=18) in two different environmental conditions: (1) Experimental (indoors Gymnasium) and (2) Natural (community setting). Average gait speed and endurance values were obtained for the two different conditions and analyzed for statistical significance on the nonparametric two-tailed Wilcoxon signed rank test. RESULTS: While no difference was observed on the 10MWT we found an improvement on gait performance on the 6 MWT on a community setting. CONCLUSIONS: Our study showed mixed results on environmental influence on gait speed and endurance on ASIA D patient population. While there is no difference on the 10 MWT, there is an improvement on gait performance on the communitary 6MWT.

Nitinol Carbofilm coated stents for peripheral applications: study in the porcine model.

PURPOSE: Testing the safety and foreign body reaction (FBR) of a nitinol self-expandable carbon-coated stent system in the porcine animal model at different follow-up (FU) periods. METHODS: Fifteen minipigs received 30 carbon-coated self-expandable nitinol stents in iliac arteries. Explants were carried out at 7 (3 animals), 30 (4 animals), 90 (4 animals) and 180 (4 animals) day FU, for evaluation of acute, sub-acute and chronic biological response to the implanted devices. Histological, immunohistochemical, histomorphometric and scanning electron microscopy (SEM) analyses were performed to assess inflammatory reaction, endothelialization process, neointimal growth and cellular composition. RESULTS: Thirty stents were successfully implanted. No mural thrombi were observed at gross examination or by angiography. Histologically no significant inflammatory reaction was detected: the stents appeared covered by a thin monolayer of endothelial cells even at 7 day FU. The neointima presented homogeneous growth and moderate thickness after 30, 90 and 180 days explants (0.38+/- 0.36 mm, 0.33+/- 0.30 mm, 0.27+/- 0.25 mm respectively). Internal and external elastic laminae were intact in 95% of stented arteries. Histological data validations of vessel endothelialization was obtained with SEM for the seven day follow-up group. CONCLUSIONS: This study showed good remarkable technical performances, minimal FBR and biocompatibility comparable with other available pre-clinical experimentations.

Early alteration of bioprosthetic cardiac valves in sheep: influence of the immunological status.

Ten Pericarbon valve bioprostheses were examined after being implanted in tricuspid position in two different groups of animals: group I sheep with increased immunoglobulins, plasma levels, and eosinophilis count of more than 10%, due to parasitic infection, and group II sheep without any parasitic infection, i.e. with normal blood data. The explanted valve follow up was between 60-95 hours in both groups. Microscopic observation of group I valves revealed a massive blood cell (lymphocytes, eosinophilis and large mononuclear cells) infiltration especially around the natural pericardial blood vessels in the region of flexion and attachment. The epipericardial surface was covered by fibrin sheath, and immunofluorescence studies showed a strongly positive reaction for immunoglobulins (IgG and IgE) on leaflet surfaces and lamellar stratification into the fibrosa. Microcalcifications were detected around pericardial blood vessels in the same zones where infiltrated blood cells were found. In group II valves cell infiltration was absent with no signs of calcification and immunofluorescence was negative. Our data suggest that immunoglobulins adherence followed by blood cell infiltration may be one of the early causes of tissue leaflet degeneration and there is a parallel trend between plasma immunoglobulin levels and the early tissue alteration. Our data show that the experimental model for testing bioprostheses in sheep is influenced by the pre-immunological status and it is important to control it before surgery.