Ankle movement alterations during gait in children with acute lymphoblastic leukemia with suspected peripheral mononeuropathy. A cross-sectional study.

BACKGROUND: Peripheral neuropathy due to chemotherapeutic drugs causes alterations in ankle movement during gait. This study aimed to describe the spatiotemporal parameters and ankle kinematics during gait in schoolchildren with acute lymphoblastic leukemia with clinically suspected peripheral neuropathy. METHODS: In children with acute lymphoblastic leukemia in the maintenance phase, we calculated spatiotemporal and kinematic parameters of the ankle during gait using Kinovea® software. Furthermore, we identified alterations in the parameters obtained considering the values of the normality data from a stereophotogrammetry system as the reference values. Finally, we represented the kinematic parameters of the ankles calculated with Kinovea® compared to the normality values of the stereophotogrammetry. FINDINGS: We evaluated 25 schoolchildren; 13 were male (52.0%) with a median age of 88.0months and a median of 60.0 weeks in the maintenance phase, and 54.8% were classified as standard risk. Spatiotemporal parameters: cadence (steps/min), bilateral step length (m), and average gait speed (m/s) in ALL children were significantly lower than reference values (p < 0.001). Except for right mid-stance and bilateral foot strike, initial swing showed that both ankles maintained plantar flexion values during gait, significantly lower in ALL patients (p < 0.05). INTERPRETATION: We identified spatiotemporal and kinematics alterations in schoolchildren with acute lymphoblastic leukemia during all phases of the gait suggestive of alteration in ankle muscles during movement, probably due to peripheral neuropathy; nevertheless, our results should be taken with caution until the accuracy and reliability of Kinovea® software as a diagnostic test compared to the stereophotogrammetric system in children with ALL and healthy peers is proven.

Impairments in fine motor skills in children with Acute Lymphoblastic Leukaemia. A cross-sectional study.

AIM: We evaluated fine motor skills; precision, motor integration, manual dexterity, and upper-limb coordination according to sex and risk stratification in children with Acute Lymphoblastic Leukaemia (ALL). METHODS: We evaluated twenty-nine children in the maintenance phase aged 6 to 12 years with the Bruininks-Oseretsky Test of Motor Proficiency-second edition (BOT-2), and sex and age-specific norm values of BOT-2 were used to compare our results. RESULTS: We found lower scores on the upper-limb coordination subtest, p = 0.003 and on the manual coordination composite, p = 0.008, than normative values. Most boys performed "average" on both the subtests and the composites, but girls showed lower scores with a mean difference of 7.69 (95%CI; 2.24 to 3.14), p = 0.009. Girls' scale scores on the upper-limb coordination subtest were lower than normative values, with mean difference 5.08 (95%CI; 2.35 to 7.81), p = 0.006. The mean standard score difference in high-risk patients was lower than normative on the manual coordination composite, 8.18 (95%CI; 2.26 to 14.1), p = 0.015. High-risk children also performed below the BOT-2 normative on manual dexterity 2.82 (95%CI; 0.14 to 5.78), p = 0.035 and upper limb coordination subtest 4.10 (95%CI; 1.13 to 7.05), p = 0.028. We found a decrease in fine motor precision in children with a higher BMI, rho= -0.87, p = 0.056 and a negative correlation between older age and lower manual dexterity, r= -0.41 p = 0.026; however, we did not find any correlation with the weeks in the maintenance phase. CONCLUSIONS: Fine motor impairments are common in children with ALL in the maintenance phase; it is important to identify these impairments to early rehabilitation.

Differences in the absolute muscle strength and power of children and adolescents with overweight or obesity: a systematic review.

This study aimed to describe absolute muscle strength and power in children and adolescents with obesity, overweight and normal weight, and the assessment tests and tools used. We retrieved observational studies from MEDLINE (PubMed), TripDataBase, Epistemonikos, EBSCO essentials, NICE, SCOPUS, and LILACs up to February 2023. In addition, we recovered data from studies with at least three comparison groups (obesity, overweight, normal weight) and with a description of the absolute muscle strength and power and the assessment tests and instruments used. The methodologic quality of the studies was assessed with the Joanna Briggs checklist, and the review was carried out using the PRISMA 2020 methodology. Eleven studies with 13,451 participants from 6 to 18 years of age were once included, finding that the absolute muscle strength of their upper extremities was greater when they were overweight or obese; however, in the same groups, absolute muscle strength was lower when they carried their body weight. In addition, lower limb absolute muscle strength was significantly lower in obese participants than in normal weight, regardless of age and gender. The most used tools to measure the absolute muscle strength of the upper limbs were the grip dynamometers and push-up exercises. In contrast, different jump tests were used to measure the power of the lower limbs. There are great differences in muscle strength and power between overweight or obese children and adolescents and those with normal weight. Therefore, it is recommended to use validated tests, preferably that assess strength through the load of the patient's body weight, either of the upper or lower limbs, for greater evaluation objectivity that facilitates the management of these children and adolescents.

Steric and Slippage Effects on Mass Transport by Using an Oscillatory Electroosmotic Flow of Power-Law Fluids.

In this paper, the combined effect of the fluid rheology, finite-sized ions, and slippage toward augmenting a non-reacting solute's mass transport due to an oscillatory electroosmotic flow (OEOF) is determined. Bikerman's model is used to include the finite-sized ions (steric effects) in the original Poisson-Boltzmann (PB) equation. The volume fraction of ions quantifies the steric effects in the modified Poisson-Boltzmann (MPB) equation to predict the electrical potential and the ion concentration close to the charged microchannel walls. The hydrodynamics is affected by slippage, in which the slip length was used as an index for wall hydrophobicity. A conventional finite difference scheme was used to solve the momentum and species transport equations in the lubrication limit together with the MPB equation. The results suggest that the combined slippage and steric effects promote the best conditions to enhance the mass transport of species in about 90% compared with no steric effect with proper choices of the Debye length, Navier length, steric factor, Womersley number, and the tidal displacement.

Meningitis aséptica por varicela zóster sin rash vesicular previo en paciente VIH positivo. Presentación de caso / Varicella Zoster aseptic meningitis without previous vesicular rash in VIH positive patient. Case report

Resumen Un cuadro de meningitis aséptica, en el contexto de un paciente inmunosuprimido con diagnóstico de infección por Virus de Inmunodeficiencia Humana (VIH), debe llevar a pensar en múltiples diagnósticos diferenciales. Entre estos, se incluye el virus varicela zóster (VVZ) como uno de los principales agentes causales de meningitis a líquido cefalorraquídeo claro. Su reactivación da lugar a múltiples manifestaciones neurológicas potencialmente mortales en las que se consideraba al rash vesicular, o exantema pápulo/vesículo/ costroso como un signo fundamental para su diagnóstico. No obstante, las lesiones cutáneas están ausentes en más de un tercio de los pacientes con compromiso del sistema nervioso central. A continuación, se presenta el caso de un paciente con infección por VIH que presenta cefalea más fiebre, con hallazgos en líquido cefalorraquídeo de pleocitosis neutrofílica y una prueba molecular confirmatoria para virus varicela zóster, en ausencia de rash vesicular previo que guiara hacia este diagnóstico. MÉD.UIS.2021;34(1): 91-9.

Abstract The clinical presentation of aseptic meningitis in the context of an immunosuppressed patient with a diagnosis of Human Immunodeficiency Virus (HIV) infection, should lead us to consider multiple differential diagnoses. Among these, the Varicella Zoster Virus (VZV) has been found as one of the main causative agents of clear cerebrospinal fluid meningitis. Its reactivation gives rise to multiple life-threatening neurological manifestations in which vesicular rash, or papule / vesicular / crusted rash was considered a fundamental sign for its diagnosis. However, skin lesions are absent in more than a third of patients with central nervous system involvement. Herein, we report a case of an HIV-infected patient with headache, fever and neutrophilic pleocytosis with FilmArray that confirms Varicella Zoster virus infection in an immunocompromised patient in the absence of vesicular rash. MÉD.UIS.2021;34(1): 91-9.

Evaluación de la efectividad de abiraterona en el tratamiento del cáncer de próstata metastásico / Evaluation of the effectiveness of abiraterone in treatment of metastatic prostate cáncer

Objetivo: estudiar el perfil de efectividad y seguridad de abiraterona en la práctica clínica, en pacientes con cáncer de próstata metastásico hormonoresistente. Métodos: se diseñó un estudio descriptivo retrospectivo de los pacientes diagnosticados con cáncer de próstata metastásico que recibieron tratamiento con abiraterona durante los mese de febrero 2012 a abril 2013. Las variables estudiadas fueron sexo, edad, escala del Eastern Cooperative Oncology Group (ECOG), tratamiento previo con docetaxel, antígeno prostático especifico (PSA) y supervivencia libre de progresión. La información se obtuvo de las historias clínicas, el programa de prescripción Savac® y el programa de validación farmacéutica Farmis‒Oncofarm®. Resultados: los 24 pacientes incluidos contaban una mediana de edad de 70 años. El estado funcional fue ECOG<2 en el 58,3 por ciento y ECOG≥2 en el 41,7 por ciento de los pacientes. El PSA disminuyó un 50 por ciento o más de su valor basal en el 52 por ciento de los pacientes. En cuanto a la supervivencia libre de progresión la mediana fue de 166 días (5,5 meses). En los pacientes con un ECOG≤2 la mediana fue de 231 días (7,7 meses) mientras que para los pacientes con ECOG˃2 fue de 106 días (3,5 meses). Abiraterona presentó pocas reacciones adversas por lo que resulta un fármaco seguro, a pesar de presentar algunas reacciones de suma importancia. Conclusiones: los resultados obtenidos en nuestra práctica clínica difieren con los obtenidos en los estudios pivotales. Se observan mayor supervivencia libre de progresión en los pacientes con un ECOG≤1 y en los que nunca habían recibido quimioterapia previa(AU)

Objectives: to study the efficacy and safety profile of abiraterone in clinical practice to treat patients with hormone-resistant metastatic prostate cancer. Methods: retrospective and descriptive study of patients who were diagnosed with metastatic prostate cancer and were treated with abiraterone since February 2012 to April 2013. The studied variables were gender, age, level of Eastern Cooperative Oncology Group (ECOG) scale, prior treatment with docetaxel, prostate specific antigen (PSA), progression-free survival (PFS). Data sources included medical records, the Savac® prescription and the Farmis-Oncofarm® pharmaceutical validation programs. Results: twenty-four patients were included, with average age of 70 years. The ECOG performance status was less than 2 in 58,3 percent of patients whereas 41,7 percent of the patients showed ECOG equal to 2 or higher. The PSA decreased by 50 percent or more its basal value in 52 percent of the patients. As regards to PFS, the median was 166 days (5,5 months) in progression-free survival. In patients with ECOG≤2, the median PFS was 231 days (7,7 months), whereas for patients with ECOG˃2,it was 106 days (3,5 months). Abiraterone has fewer side effects, so it may be considered a safe drug, although some are significant. Conclusions: the results obtained in our clinical practice differ from the ones obtained in the pivotal trials . Increased progression-free survival was observed in patients with an ECOG≤1 or less, and in those who had never received prior chemotherapy(AU)

Respiración periódica y apneas del sueño centrales en pacientes con insuficiencia cardíaca: hallazgos clínicos y fisiológicos

Introducción: los trastornos respiratorios del sueño son frecuentes en la población general y en especial entre los pacientes con insuficiencia cardíaca severa. La ocurrencia de respiración periódica de Cheyne-Stokes con apneas centrales (RPCS-AC) durante el sueño, agrava el pronóstico y aumenta significativamente la mortalidad a corto plazo. El objetivo de este estudio fue determinar la prevalencia de este trastorno y las características clínico-fisiológicas de los pacientes en nuestro medio. Material y método: se estudiaron 35 pacientes con insuficiencia cardíaca, sin respiración periódica en vigilia, a los que se les realizó polisomnografía, ecocardiograma, espirometría, gasometría arterial y evaluación de los resultados funcionales del sueño. Resultados: se diagnosticó RPCS-AC en 13 pacientes (37%). Los pacientes con RPCS-AC tuvieron un sueño significativamente más fragmentado (ID/h = 32,9 ± 19,4 versus 15,8 ± 14,3, p <0,001); más tiempo en sueño superficial (S1-2 = 77,4 ± 20,1% versus 63,0 ± 16,7%, p = 0,029); menos tiempo en sueño paradojal (REM = 9,9 ± 6,3% versus 16,6 ± 9,8%, p = 0,035) y mayor tiempo en hipoxia severa durante el sueño (TA<90% = 28,4 ± 29,0% versus 2,4 ± 4,7%, p = 0,008). No existieron diferencias en la función cardíaca, el ECG, la espirometría, los gases en sangre en vigilia, ni en las repercusiones funcionales del sueño. Conclusiones: la RPCS-AC es un trastorno frecuente en la insuficiencia cardíaca avanzada que determina repercusiones adversas sobre la estructura del sueño y la oxigenación arterial.

Introduction: sleep breathing disorders are common in general population and particularly among patients with severe heart failure. The occurrence of Cheyne Stokes periodic breathing with central apneas (RPCS-AC) during sleep, worsens the prognosis and significantly increases short term mortality. The objective of this study was to determine the prevalence of this disorder and the clinic-physiological features of patients in our hospital. Methods: thirty-five consecutive patients with heart failure, without periodic respiration during wakefulness were studied with polisomnography, echocardiogram, spirometry, arterial blood gases and functional outcomes of sleep. Results: thirteen patients were diagnosed with RPCS-AC (37%). Patients with RPCS-AC had significantly more fragmented sleep (ID)/h = 32,9 ± 19,4 versus 15,8 ± 14,3, p<0,001); more time in superficial sleep (S1-2 = 77,4 ± 20,1% versus 63,0 ± 16,7%, p = 0,029); less time in paradoxical sleep (REM = 9,9 ± 6,3% versus 16,6 ± 9,8%, p = 0,035) and more time in severe hypoxia during sleep (TA<90% = 28,4 ± 29,0% versus 2,4 ± 4,7%, p = 0,008). There were no differences in cardiac function, EGG, spirometry, arterial blood gases during wakefulness, neither in sleep functional outcomes. Conclusions: RPCS-AC is a frequent disorder in advanced heart failure patients, that causes adverse consequences on sleep structure and arterial oxygenation.

Reliability and factor analysis of the Spanish version of the asthma control test.

BACKGROUND: The Asthma Control Test (ACT) has been developed to evaluate asthma control and to reflect its nature. A Spanish version of the test has been widely disseminated to physicians, but it has not yet been validated. OBJECTIVES: To examine the psychometric properties of the Spanish version of the ACT. METHODS: A total of 322 asthmatic patients with a mean (SD) age of 43.8 (17.3) years (range, 12-84 years) with appropriate criteria for inclusion completed the ACT. Spirometric variables were measured and asthma severity was rated by physicians. RESULTS: Internal consistency reliability was 0.79. The ACT showed weak correlation coefficients with forced expiratory volume in 1 second (FEV1) (p = 0.27; P = .01) and asthma severity (p = -0.19; P = .01). Almost 40% of patients with an FEV1 less than 60% of predicted rated their asthma as well or totally controlled; conversely, 70% of patients with asthma well or totally controlled showed an FEV1 less than 80% of predicted. The factor analysis revealed a 2-factor solution: the first component included the 5 items of the ACT (subjective component), and the second component included the spirometric measures (objective component). The 2-factor solution accounted for 66.2% of the total variance. CONCLUSIONS: These data reveal a unidimensional structure of the ACT and do not support the use of this test without spirometry in the management of asthma. Spirometry provides important complementary information about asthma severity that may be used in conjunction with clinical assessments of controlto provide optimal management in many patients.

[Physiologic effects of noninvasive ventilation in patients with chronic obstructive pulmonary disease]. / Efectos fisiológicos de la ventilación no invasiva en pacientes con EPOC.

OBJECTIVE: Noninvasive mechanical ventilation has been of use in the treatment of some forms of chronic and acute respiratory failure. However, the benefits of its use in patients in the stable phase of severe chronic obstructive pulmonary disease (COPD) remain unclear. A combination of continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) may improve respiratory mechanics and alveolar ventilation, and reduce inspiratory muscle effort. In this study, we analyzed the physiologic effects of differing levels of CPAP and CPAP plus PSV in patients with stable severe COPD. PATIENTS AND METHODS: Work of breathing, breathing pattern, oxygen saturation measured by pulse oximetry, PaO2, and PaCO2 were analyzed in a group of 18 patients under the following conditions: a) baseline; b) CPAP, 3 cm H20; c) CPAP, 6 cm H20; d) CPAP 3 cm H20 plus PSV 8 cm H20; and e) CPAP 3 cm H20 plus PSV 12 cm H20. RESULTS: CPAP at pressures of 3 and 6 cm H20 was associated with an increase in tidal volume (VT) from a mean (SD) baseline value of 0.52 (0.04) L to 0.62 (0.04) and 0.61 (0.03) L, respectively. Minute ventilation increased from 8.6 (0.5) L/min to 10.8 (0.6) and 10.9 (0.5) L/min, respectively. Mean inspiratory flow (VT/Ti) increased from 0.35 (0.02) L/s to 0.44 (0.02) and 0.41 (0.02) L/s, respectively, and dynamic intrinsic positive end-expiratory pressure (PEEPi,dyn) was reduced from 1.63 (0.7) cm H20 to 1.1 (0.06) and 0.37 (0.4) cm H20, respectively. CPAP did not reduce the work of breathing. Association of CPAP at 3 cm H20 with PSV of 8 or 12 cm H20 increased VT to 0.72 (0.07) and 0.87 (0.08) L, respectively, while minute ventilation increased to 12.9 (0.8) and 14.9 (1.1) L/s, respectively. Mean inspiratory flow also increased to 0.50 (0.03) and 0.57 (0.03) L/s, respectively. Work of breathing was reduced from 0.90 (0.01) J/L to 0.48 (0.06) and 0.30 (0.06) J/L, respectively, while PEEPi,dyn increased to 1.30 (0.02) and 2.42 (0.08) cm H20, respectively. With combined CPAP of 3 cm H20 and PSV of 12 cm H20, PaCO2 was reduced from a baseline value of 41.2 (1.5) mm Hg to 38.7 (1.9) mm Hg. All of the changes were statistically significant (P< .05). CONCLUSIONS: CPAP of 3 cm H20 in combination with PSV improved breathing pattern, increased alveolar ventilation, and reduced work of breathing. These results offer a rational basis for the use of noninvasive mechanical ventilation in the treatment of patients with stable severe COPD.

Rehabilitación respiratoria en pacientes con EPOC / Respiration rehabilitation in patients with EPOC

Programa de reabilitaçäo respiratória aplicada a pacientes com Doença Pulmonar Crônica irreversível e com limitaçäo e suas funçöes e qualidade de vida

Tratamiento del ronquido y de las apneas del sueño obstructivas con dispositivo de ortosis dental / Treatment of snoring and obstructive sleep apnea with an orthotic device

El propósito de este estudio es comunicar los resultados del tratamiento del ronquido y la apnea del sueño obstructiva con un dispositivo ortósico dental removible utilizado durante el sueño. Se seleccionaron 7 pacientes con diagnóstico de ronquido patológico y apnea del sueño obstructiva de grado leve a moderado (Indice A + H/hora menor de 50), peso corporal normal (IMC 26,3 +- 0.5 K/m2) y maloclusión ostensible. Se estudiaron con polisomnografía nocturna completa, telerradiografía con análisis cefalométrico. El uso del DOD (dispositivo de ortosis dental), disminuyó el ronquido, el índice de apneas y aumentó el porcentaje de tiempo en sueño profundo. Fue bien tolerado en 6 de los 7 pacientes. Se concluye que el DOD es una alternativa de tratamiento efectiva factible, no invasiva y con ventajas sobre otros tratamientos más engorrosos

Prueba de respuesta al broncodilatador a dosis altas en asmáticos en intercrisis / Response test to bronchodilator at high doses in asthmatics in intercrisis

Se estudió la relación entre la dosis de salbutamol y la respuesta fisiológica en un grupo de asmáticos. A 20 asmáticos en período intercrítico cuya espirometría luego de recibir 200 µg de salbutamol por inhalador de dosis medida mostraba persistencia de la obstrucción, se les administró 800 µg de salbutamol o placebo. Se realizó seguimiento espirométrico por las dos horas subsiguientes. La CVF, el VEF1s y el FEF 50 por ciento luego de salb-800 fueron significativamente mayores que luego de placebo a partir de 60 minutos de administrado. Existió una correlación negativa entre el valor basal de VEF1s y la respuesta al salbutamol. Asimismo, el VEF1s inicial se correlacionó positivamente con el porcentaje de broncodilatación posible. Concluimos que la administración a dosis elevada de salbutamol puede ser útil como método de estudio del asmático en el laboratorio de exploración funcional respiratoria