Appendicular lean mass index and motor function in ambulatory patients with Duchenne muscular dystrophy.

INTRODUCTION/AIMS: Appendicular lean mass index (ALMI) has been linked to motor function in patients with Duchenne muscular dystrophy (DMD). However, quantification of the relationship between ALMI and disease-specific clinical outcome assessment trajectories is needed. The purpose of this study was to determine associations between dual-energy x-ray absorptiometry (DXA) derived estimates of ALMI and motor function in ambulatory patients with DMD. METHODS: A retrospective analysis of longitudinal clinical visit data from 137 glucocorticoid-treated patients with DMD collected via structured motor assessment protocol evaluated associations between ALMI and motor function indexed by the North Star Ambulatory Assessment (NSAA) and 10 Meter Walk/run Test (10MWT). Body composition was assessed using DXA. ALMI was calculated by dividing arm and leg lean mass by height in m2; fat mass index (FMI) was calculated by dividing whole body fat mass by height in m2. Linear mixed-effects models were used to estimate associations between ALMI and motor function, controlling for age and FMI. RESULTS: The full prediction model (age, age,2 ALMI, and FMI) explained 57% of the variance in NSAA scores and 63% of the variance in 10MWT speed. A 1 kg/m2 higher ALMI value predicted a 5.4-point higher NSAA score (p < .001) and 0.45 m/s faster 10MWT speed (p < .001). A 1 kg/m2 higher FMI value predicted a 1.5-point lower NSAA score (p < .001) and 0.14 meters/second slower 10MWT speed (p < .001). DISCUSSION: DXA-derived estimates of ALMI and FMI are associated with motor function in DMD and may explain variation in DMD disease progression.

Purpura Fulminans as a Rare Manifestation of Invasive Haemophilus influenzae Disease: A Case Report.

Haemophilus influenzae (Hi) is a bacterium usually found in the upper respiratory tract of humans. Though it is recognized as a naturally occurring element in the human bacterial reservoir, Hi infections have the potential to be severe and even fatal, particularly when they result in conditions such as meningitis or epiglottitis. Because of this, Hi invasive infections are considered a reportable disease in Portugal. We report a case of a 58-year-old female, chronically adrenally suppressed on long-term steroids, who developed an invasive Hi type b infection that led to purpura fulminans and multiorgan failure after an acute episode of epiglottitis. According to our review of the literature, only three previous cases of invasive Hi type b disease-causing purpura fulminans have been described.

Pulmonary Mucormycosis: Beyond Classic COVID-19-Associated Fungal Infections.

Coronavirus disease 2019 (COVID-19) is often linked to a broad range of opportunistic bacterial and fungal infections. The second wave of the COVID-19 pandemic has witnessed an unprecedented surge in mucormycosis cases, predominantly in India, while the disease remained relatively rare in Europe. The authors describe the case of a 62-year-old female patient admitted to the hospital for consolidation therapy with chemotherapy as a part of the treatment protocol for acute myeloid leukemia. During hospitalization, she was diagnosed with nosocomial COVID-19, which later progressed to respiratory deterioration. COVID-19 with bacterial superinfection was presumed, leading to the initiation of empirical antibiotic therapy. A bronchoscopy was performed several days later due to a lack of improvement, revealing an infection by the Rhizopus microsporus complex. Despite antifungal treatment, the patient experienced an unfavorable clinical course and ultimately died. Given the high index of suspicion required to diagnose pulmonary mucormycosis, which can lead to delays in appropriate treatment and increase the burden of disease, the authors are aiming to enhance its awareness.

A Case of Cerebral Air Embolism After Dental Procedure.

Air embolism is a rare and life-threatening event that occurs when air enters the cardiovascular system, usually secondary to iatrogenic vascular procedures. We present a 58-year-old woman who underwent a dental procedure (devitalization of a tooth) under local anesthesia, with a sudden onset of coma during manipulation and documentation of air in the vessels of the right frontal convexity sulci. After cerebral air embolism was confirmed, she received hyperbaric oxygen therapy, with resorption of the gas, but clinically she developed a super-refractory status epilepticus with a persistent coma. The slow clinical course required the exclusion of other etiologies of coma. The pathophysiology is not well known; however, it appears to be related to the injection of air by the high-speed dental drill through the soft tissue adjacent to the roots of the teeth, nearby the bloodstream. We highlight this event because of this unlikely association, which may delay diagnosis and the good results of hyperbaric medicine on prognosis.

O impacto da covid-19 na gestão de centros de fitness / The impact of covid-19 on fitness centers management / El impacto del covid-19 en la gestión en los centros de fitness

Resumo O objetivo do estudo foi analisar impactos e verificar as adaptações realizadas em Centros de Fitness (CF), durante o distanciamento social provocado pela pandemia COVID-19 e as estratégias encontradas após o mesmo. A amostra foi constituída por 10 Diretores Técnicos (DT). O instrumento utilizado foi a entrevista semiestruturada, constituída por 4 dimensões: Gestão Financeira; Digitalização de Serviços; Instalações Esportivas; Gestão de Recursos Humanos. As entrevistas foram presenciais e o anonimato e confidencialidade foram assegurados. Estas foram gravadas e posteriormente transcritas, os dados foram analisados com o auxílio do MaxQda (v20.4.0). Os resultados mostraram que os CF sofreram quebras significativas no volume de negócios. O modelo digital passou a ser central e o aplicativo de gestão interna foi a ferramenta mais usada para monitorizar os espaços. A pandemia da COVID-19 veio provocar danos a curto prazo nos CF, mas comportou a oportunidade de fortalecer e diversificar o setor a médio prazo.

Abstract The aim of this study was to analyze the impacts and verify the adaptations made in Fitness Centers (FC), during the social distance caused by the COVID-19 pandemic and the strategies found afterwards.The sample was composed by 10 FC's Technical Directors (TD). The semi-structured interview was used as a tool and integrated 4 dimensions: Financial Management; Digital Services; Sports Facilities; Human Resource Management. The interviews were all in person inside the Fc's and the anonymity and confidentiality were secured. The interviews were recorded and then transcribed. The data were analyzed using MaxQda (v20.4.0). The results showed that FC´s suffered significant drops in turnover. The digital model became central, and the internal management application was the most used tool to monitor the facilities. Covid-19 pandemic caused damage in a short amount of time within the FC's, but it has provided an opportunity to strengthen and diversify the sector in mid-term.

Resumen El objetivo del estudio analizar los impactos y comprobar las adaptaciones realizadas en Centros de Fitness (CF), durante el distanciamento social por obligación legal y las estrategias utilizadas posteriormente. La muestra estaba formada por 10 directores técnicos (DT). El instrumento utilizado la entrevista semiestructurada, que consta de 4 dimensiones: Gestión Financiera; Digitalización de Servicios; Instalaciones Deportivas; Gestión de Recursos Humanos. Las entrevistas fueron cara a cara y se garantizó el anonimato y la confidencialidad, fueron grabadas y posteriormente transcritas. Los datos analizaron ayuda de MaxQda (v20.4.0). Los resultados mostraron que el FC´s sufrió caídas significativas em la facturación. La maqueta digital pasó a ser central y la aplicación de gestión interna fue la herramienta más utilizada para supervisar los espacios. La pandemia de la COVID-19 causó daños a corto plazo a las FC´s, pero ofreció la oportunidad de fortalecer y diversificar el sector a medio plazo.

Validity and Reliability of a Wearable Fitness Technology Scale in Portugal.

Currently, the use of technological devices for monitoring physical activity and in other mobile applications is widespread among sports users and is continuously growing. The aim of this study was the validation of the reliability of the use of Wearable Fitness Technology (WFT) in the context of fitness through quantitative analysis. Data collection was conducted online during the COVID-19 pandemic period. The sample consisted of 177 members of fitness centres who used MYZONE technology in Portugal. An Exploratory Factor Analysis (EFA) (Factor v10) and a Confirmatory Factor Analysis (CFA) (AMOS v22.0) were used to test the item fit. The results showed adequate fits, identifying a total of 14 items in a single factor to assess WFT in MYZONE users in fitness centres. The reliability of the scale showed adequate indices within the indicated limits. This study extends the current literature on WFT; provides information for providers, managers, and members; and aims to improve the fitness experience by developing a valid and reliable tool to assess the characteristics and incidence of WFT in fitness centres. The complexity of the WFT will affect the degree of user engagement with the fitness centre, highlighting the importance of using staff skills to generate motivational and innovative challenges to improve the service experience. Furthermore, this scale could be used to examine the influences of WFT on managers' and members' perceptions of the service experience in the Portuguese context.

Nosocomial meningitis in intensive care: a 10-year retrospective study and literature review.

BACKGROUND: Nosocomial meningitis is a medical emergency that requires early diagnosis, prompt initiation of therapy, and frequent admission to the intensive care unit (ICU). METHODS: A retrospective study was conducted in adult patients diagnosed with nosocomial meningitis who required admission to the ICU between April 2010 and March 2020. Meningitis/ventriculitis and intracranial infection were defined according to Centers for Disease Control and Prevention guidelines. RESULTS: An incidence of 0.75% of nosocomial meningitis was observed among 70 patients. The mean patient age was 59 years and 34% were ≥65 years. Twenty-two percent of patients were in an immunocompromised state. A clear predisposing factor for nosocomial meningitis (traumatic brain injury, basal skull fracture, brain hemorrhage, central nervous system [CNS] invasive procedure or device) was present in 93% of patients. Fever was the most frequent clinical feature. A microbiological agent was identified in 30% of cases, of which 27% were bacteria, with a predominance of Gram-negative over Gram-positive. Complications developed in 47% of cases, 24% of patients were discharged with a Glasgow coma scale <14, and 37% died. There were no clear clinical predictors of complications. Advanced age (≥65 years old) and the presence of complications were associated with higher hospital mortality. CONCLUSIONS: Nosocomial meningitis in critical care has a low incidence rate but high mortality and morbidity. In critical care patients with CNS-related risk factors, a high level of suspicion for meningitis is warranted, but diagnosis can be hindered by several confounding factors.

Management of child camps: a structured literature review and new directions / Gestão de campos de férias para crianças: uma revisão estruturada da literatura e novas direções / Gestión de campamentos infantiles: una revisión estructurada de la literatura y nuevas direcciones

The study of child camps has grown over the last years. Still, the common use of different terminology and the dispersion of the information in literature regarding camps management, makes it difficult to clarify research and hinder the improvement of managerial practices. This study aims to synthetise existent knowledge in child camps' management, identify inconsistencies and gaps in the literature, and set directions for future research and practice on child camps. A structured review of peer-reviewed articles published between 1950-2021 was conducted. Results indicate that half of the studies used the term "summer camp"; but other ten different terms were also used. Five different management areas were identified: safety, consumer behaviour, human resources, event planning and camp research. Gaps were also identified in the literature. These findings are important to set new research avenues and to improve practice. (AU)

O estudo dos campos de férias para crianças aumentou nos últimos anos. Todavia, a utilização de diferentes termos e a dispersão da informação na literatura acerca da gestão destes eventos dificulta o esclarecimento das diretrizes de pesquisa, por um lado, e dificulta a melhoria das práticas de gestão, por outro. Este estudo visa sintetizar o conhecimento existente na gestão destes eventos, identificar inconsistências e lacunas na literatura, e definir direções para futuras pesquisas e práticas. Foi realizada uma revisão estruturada de estudos publicados entre 1950-2021. Metade dos estudos utilizou o termo "campos de verão"; mas também foram utilizados outros dez termos diferentes. Foram identificadas cinco áreas de gestão: segurança, comportamento do consumidor, recursos humanos, organização de eventos e pesquisa em campos de férias. Foram ainda identificadas lacunas na literatura. Estes resultados são importantes para definir novos caminhos de pesquisa e melhorar a gestão destes eventos. (AU)

El estudio de los campamentos de verano para niños se ha incrementado en los últimos años. Pero, el uso de términos diferentes, y la dispersión de información en la literatura, sobre la gestión de estos eventos, dificulta la clarificación de las directrices de investigación, e impide que los gestores mejoren sus prácticas. Este estudio buscó sintetizar el conocimiento existente en la gestión de estos eventos, identificar inconsistencias y lagunas en la literatura y definir direcciones para futuras investigaciones y prácticas. Se realizó una revisión estructurada de estudios publicados entre 1950-2021. La mitad de los estudios utilizaron "campamento de verano"; pero también se utilizaron otros diez términos diferentes. Se identificaron cinco áreas de gestión: seguridad, comportamiento del consumidor, recursos humanos, organización de eventos y investigación en campamentos de verano. También se identificaron lagunas en la literatura. Estos resultados son importantes para definir nuevos caminos de investigación y mejorar la gestión de estos eventos. (AU)

Predicting Fitness Centre Dropout.

The phenomenon of dropout is often found among customers of sports services. In this study we intend to evaluate the performance of machine learning algorithms in predicting dropout using available data about their historic use of facilities. The data relating to a sample of 5209 members was taken from a Portuguese fitness centre and included the variables registration data, payments and frequency, age, sex, non-attendance days, amount billed, average weekly visits, total number of visits, visits hired per week, number of registration renewals, number of members referrals, total monthly registrations, and total member enrolment time, which may be indicative of members' commitment. Whilst the Gradient Boosting Classifier had the best performance in predicting dropout (sensitivity = 0.986), the Random Forest Classifier was the best at predicting non-dropout (specificity = 0.790); the overall performance of the Gradient Boosting Classifier was superior to the Random Forest Classifier (accuracy 0.955 against 0.920). The most relevant variables predicting dropout were "non-attendance days", "total length of stay", and "total amount billed". The use of decision trees provides information that can be readily acted upon to identify member profiles of those at risk of dropout, giving also guidelines for measures and policies to reduce it.

Oral ulcer as presentation of cavitating pulmonary tuberculosis.

Tuberculosis is an indolent infection that can invade any organ. Although the most frequent form of presentation is pulmonary, it can have an extra-pulmonary presentation, including rare cases of oral tuberculosis. We present a clinical case of a 44 year-old man, active smoker, with an ulcerated lesion on the posterior third of the tongue, initially interpreted as a probable neoplasm. The pathological study of the biopsy performed on the lesion, showed alterations compatible with a chronic granulomatous process and the presence of acid-fast bacilli. The concomitant diagnosis of pulmonary tuberculosis was made in a subsequent study. The patient started therapy with isoniazid, rifampin, pyrazinamide and ethambutol with complete resolution of the oral lesion and pulmonary tuberculosis. This case exemplifies the importance of including tuberculosis in the differential diagnosis of ulcerated and neoformative lesions and the value of performing a microbiological study alongside the pathological one.