Post Hoc Subgroup Analysis of the BCause Study Assessing the Effect of AbobotulinumtoxinA on Post-Stroke Shoulder Pain in Adults.

Botulinum toxin type A is approved for the focal treatment of spasticity; however, the effectiveness of abobotulinumtoxinA (aboBoNT-A) in patients with shoulder pain who have set reduced pain as a treatment goal is understudied. In addition, some patients encounter delays in accessing treatment programs; therefore, the suitability of aboBoNT-A for pain reduction in this population requires investigation. These factors were assessed in aboBoNT-A-naive Brazilian patients in a post hoc analysis of data from BCause, an observational, multicenter, prospective study (NCT02390206). Patients (N = 49, n = 25 female; mean (standard deviation) age of 60.3 (9.1) years; median (range) time since onset of spasticity of 16.1 (0-193) months) received aboBoNT-A injections to shoulder muscles in one or two treatment cycles (n = 47). Using goal attainment scaling (GAS), most patients achieved their goal of shoulder pain reduction after one treatment cycle (72.1%; 95% confidence interval: 57.2-83.4%). Improvements in GAS T-score from baseline, clinically meaningful reductions in pain score at movement, and clinically meaningful increases in passive shoulder abduction angle further improved with repeated treatment more than 4 months later, despite treatment starting at a median of 16.1 months after the onset of spasticity. These findings support the further investigation of aboBoNT-A injections in chronic post-stroke shoulder pain.

The Effectiveness of Botulinum Toxin Type A (BoNT-A) Treatment in Brazilian Patients with Chronic Post-Stroke Spasticity: Results from the Observational, Multicenter, Prospective BCause Study.

Botulinum toxin type A (BoNT-A) is an effective treatment for post-stroke spasticity; however, some patients cannot access treatment until ≥1 year post-stroke. This Brazilian post-marketing study (NCT02390206) assessed the achievement of person-centered goals in patients with chronic post-stroke spasticity after a BoNT-A injection. Patients had a last documented stroke ≥1 year before study entry and post-stroke upper limb (UL) spasticity, with or without lower limb (LL) spasticity. Patients received BoNT-A injections at baseline (visit 1) and visit 2 (3-6 months). Primary endpoint was responder rate (achievement of primary goal from Goal Attainment Scaling (GAS)) at visit 2. Overall, 204 patients underwent GAS evaluation at visit 2, mean (SD) age was 56.4 (13.2) years and 90.7% had LL spasticity. Median (range) time between first stroke and onset of spasticity was 3.6 (0-349) months, onset of spasticity and first injection was 22.7 (0-350) months and waiting time for a rehabilitation appointment was 9.0 (1-96) months. At visit 2, 61.3% (95% CI: 54.4, 67.7) of patients were responders, which was similar for UL and LL primary goals (57.8% [95% CI: 49.9, 65.3] vs. 64.1% [95% CI: 48.4, 77.3]). This study provides evidence to support the effectiveness of BoNT-A treatment for chronic post-stroke spasticity.

Outpatient management of heart valve disease following the COVID-19 pandemic: implications for present and future care.

The established processes for ensuring safe outpatient surveillance of patients with known heart valve disease (HVD), echocardiography for patients referred with new murmurs and timely delivery of surgical or transcatheter treatment for patients with severe disease have all been significantly impacted by the novel coronavirus pandemic. This has created a large backlog of work and upstaging of disease with consequent increases in risk and cost of treatment and potential for worse long-term outcomes. As countries emerge from lockdown but with COVID-19 endemic in society, precautions remain that restrict 'normal' practice. In this article, we propose a methodology for restructuring services for patients with HVD and provide recommendations pertaining to frequency of follow-up and use of echocardiography at present. It will be almost impossible to practice exactly as we did prior to the pandemic; thus, it is essential to prioritise patients with the greatest clinical need, such as those with symptomatic severe HVD. Local procedural waiting times will need to be considered, in addition to usual clinical characteristics in determining whether patients requiring intervention would be better suited having surgical or transcatheter treatment. We present guidance on the identification of stable patients with HVD that could have follow-up deferred safely and suggest certain patients that could be discharged from follow-up if waiting lists are triaged with appropriate clinical input. Finally, we propose that novel models of working enforced by the pandemic-such as increased use of virtual clinics-should be further developed and evaluated.

Etapas da elaboração do Instrumento de Classificação do Grau de Funcionalidade de Pessoas com Deficiência para Cidadãos Brasileiros: Índice de Funcionalidade Brasileiro - IF-Br / Development of a grading instrument of functioning for Brazilian citizens: Brazilian Functioning Index - IF-Br

Os sistemas usados no Brasil para definir a incapacidade variam de acordo com o setor. A partir de uma recomendação da Presidência da República, uma força-tarefa interministerial foi organizada em janeiro de 2011 para desenvolver um modelo único de avaliação e classificação da incapacidade a ser usado em todo o país. O grupo de trabalho partiu de uma avaliação ampla de informações biodemográficas das pessoas com deficiência no Brasil obtidas a partir de fontes como o censo populacional, censo escolar, relação anual de informações sociais e pesquisa de informações básicas municipais, bem como grupos focais realizados com representantes de vários estados da federação, diferentes deficiências e faixas etárias. Por meio de reuniões mensais num período de 8 meses, foi escolhido o modelo conceitual da Classificação Internacional de Deficiências, Incapacidades e Saúde como base teórica e partir do qual foram selecionadas as 41 atividades e fatores ambientais que deveriam ser contemplados no em cada uma delas. A pontuação de cada atividade foi definida numa escala de 25 a 100, de acordo com o nível de independência. Ajustes para crianças foram realizados comparando o instrumento ao desenvolvimento esperado para cada faixa etária de acordo com a descrição presente em outros instrumentos. Além da avaliação quantitativa do grau de incapacidade, foi desenvolvida uma avaliação qualitativa seguindo a lógica fuzzy, específica para as deficiências visual, motora, auditiva e intelectual. A definição de notas de corte não foi efetuada e exige estudos futuros.

The systems used for disability certification in Brazil vary according to the sectors. By recommendation from the Presidency of the Republic, an interministerial task force was organized in January 2011 to develop a single model evaluation and classification of disability to be used throughout the country. The working group began with a comprehensive review of biodemographic information of people with disabilities in Brazil, obtained from sources such as the national census, school census, annual list of social information and research of municipal basic information, as well as focus groups with representatives various states of the federation, as well as data collected from focus groups performed with different disabilities and age groups. Through monthly meetings over a period of eight months, the conceptual model of the International Classification of Impairments, Disability and Health was have chosen as a theoretical basis and from which the 41 activities were selected and the environmental factors should be assessed in each of them. The score was defined for each activity in a ratio from 25 to 100, depending on the level of independence. Adjustments were made for children comparing the expected development for each age group according to the description found in other instruments. In addition to the quantitative assessment of the degree of disability, another questionnaire was developed following a qualitative fuzzy logic, which were specific for visual, motor, auditory and intellectual impairments. The definition of cutoff scores was not performed and requires further study.

Características das vítimas de acidentes motociclisticos atendidas em um centro de reabilitação de referência estadual do sul do Brasil / Characteristics of motorcycle accident victims treated at a leadingrehabilitation center in the south of Brazil

Esta investigação caracteriza os usuários vítimas de acidentes de moto atendidos em um centro de reabilitação de referência estadual do sul do Brasil. É parte de pesquisa voltada ao trauma raquimedular - TRM. Estudo descritivo e quantitativo. Foram investigadas em 207 prontuários: procedência, idade, sexo, data e causa da lesão. Constatou-se que as vítimas de acidentes motociclísticos são homens (81.09%) jovens, dos quais, 10% menores de 18 anos. Metade dos usuários tiveram lesões extremamente ou muito graves – TRM, traumatismo crânio encefálico e amputação de membros inferiores. O coeficiente de mortalidade por acidentes motociclísticos no Brasil e em Santa Catarina cresceu 250% no período de 2000 a 2009, enquanto o crescimento populacional foi de 16%. Os acidentes motociclísticos constituem-se grave problema de saúde pública pelo número cada vez maior de pessoas atingidas e gravidade das lesões. Urge estabelecer políticas públicas – educação, segurança pública e saúde, objetivando inverter esta tendência.

This study outlines the characteristics of motorcycle accident victims treated at a leading rehabilitation center in the south of Brazil. It is a descriptive and quantitative study, which uses results found from research focused on spinal cord injury - SCI. A total of 207 medical records, containing the following information: origin, age, sex, date and cause of injury, were analyzed. The study revealed that victims of motorcycle accidents were most commonly young males (81.09%), 10% of whom were younger than 18 years old. Half of the victims had extremely serious or very serious injuries - SCI, brain injury, or lower limb amputation. The motorcycle accident death rate in in the state of Santa Catarina and in Brazil rose 250% from 2000 to 2009, while the population growth was only 16%. Motorcycle accidents constitute a serious public health problem due to the increase in the number of people injured and the severity of the injuries. Public policies - education, public health and safety, need to be established in order to reverse this trend.

Eficácia dos antidepressivos para dor crônica / Effectiveness of antidepressants for chronic pain

Há evidências de que os antidepressivos tricíclicos säo eficazes para dor neuropática. Entretanto,os efeitos colaterais limitam seu uso. Os inibidores seletivos da recaptaçäo de serotonina e os atípicos causam menos efeitos colaterais. Para avaliar o efeito analgésico dessas medicaçöes foi feita pesquisa (Medline, Cinhah, ,PsycLIT and Cochrane Library) de estudos em lingua inglesa de 1966 a 2000. As medicaçöes avaliadas foram : trazodona, nefazodona, paroxetina, citalopram, sertralina, fluoxetina e venlafaxina. Os estudos säo insuficientes para estabeleceer eficácia dos antidepressivos ISRS e atípicos para alívio da dor.(au)

Trauma raquimedular em crianças diferenças na etiopatogenia, tratamento e evoluçäo quando comparado com adulto: análise de 160 casos / Spinal cord injuries in children etiopathogeny, treatment and evolution differences when comparated with adult: analysis of 160 cases

O traumatismo raquimedular em crianças é uma condiçäo rara e apresenta características diferentes do que ocorre no indivíduo adulto. Estudamos 160 crianças admitidas para tratamento e reabilitaçäo nos últimos 12 anos (1982-1993) no Hospital do Aparelho Locomotor/SARAH Brasília. Este número correspondeu a 6,2 por cento do total de indivíduos com lesäo raquimedular (2596) admitidos no período. As lesöes causadas por projétil de arma de fogo apresentaram um crescimento progressivo, ao longo destes anos, em relaçäo às outras causas, como acidentes de trânsito, mergulho e quedas. O trauma raquimedular na criança apresenta características clínicas distintas, principalmente no grupo etário abaixo de 9 anos de idade. Neste grupo, existe uma grande incidência de lesöes na coluna cervical alta (26 por cento) devido à lassidäo ligamentar, a imaturidade da musculatura paravertebral, ao formato achatado e abaulado do corpo vertebral associado à horizontalizaçäo das articulaçöes facetárias e desproporçäo entre o tamanho do crânio e do tronco. Já, as crianças adolescentes (15 e 16 anos) demonstraram padräo semelhante ao dos adultos. O grupo entre 0 e 9 anos apresentou maior incidência (41,66 por cento) de lesöes medulares sem alteraçöes radiológicas (LMSAR). Estas lesöes se localizaram mais na coluna cervical alta e se apresentaram com envolvimento neurológico mais grave. O prognóstico foi determinado pelo grau inicial da lesäo. Observamos que 16 (15,1 por cento) dos pacientes com lesäo completa, na admissäo, apresentaram melhora. Cinco (4,7 por cento) eram do grupo sem alteraçöes radiológicas. Pacientes com lesäo medular parcial apresentaram melhora em 48,1 por cento dos casos. Ocorreram 3 óbitos durante o período de acompanhamento de 4,5 anos. As complicaçöes mais freqüentes associadas foram as infecçöes urinárias, as escaras de decúbito e as infecçöes respiratórias. As linhas gerais de reabilitaçäo neste grupo etário säo apresentadas na discussäo.