Neuromyelitis optica spectrum disorders (NMOSD) is a rare inflammatory and demyelinating disease of the central nervous system (CNS) more frequent in women and Afro-descendants. No previous ...epidemiological or prognostic study has been conducted in the region of the state of Bahia, Brazilian Northeast.
To evaluate clinical and prognostic aspects in patients with NMOSD from a cohort in northeastern Brazil.
A single-center retrospective study was conducted with consecutive patients diagnosed with NMOSD. Clinical and epidemiological characteristics were described. The degree of disability was expressed by the Expanded Disability Status Scale (EDSS). Worsening disability were analyzed through negative binomial regression adjusted for disease duration.
Ninety-one patients were included, 72 (79.1%) female and 67 (73.6%) afro descendants. Mean age at onset was 36 (± 14) years and 73.3% were anti-aquaporin-4 antibody positive. Isolated transverse myelitis (32.9%) and isolated optic neuritis (22.4%) were the most frequent initial clinical syndromes. After multivariate analysis, optic neuritis (RR = 0.45; 95% CI = 0.23 - 0.88; p = 0.020) and dyslipidemia (RR = 0.40; 95% CI = 0.20 - 0.83; p = 0.014) were associated with slower disease progression. Area postrema involvement (RR = 6.70; 95% CI = 3.31 - 13.54; p < 0.001) and age at onset (RR = 1.03; 95% CI = 1.01 - 1.05; p = 0.003) were associated with faster disease progression.
In the first clinical and prognostic study in northeastern Brazil, we identified area postrema involvement, age at onset, optic neuritis at fist syndrome and dyslipidemia as the main prognostic factors associated with disease progression.
Highlights • We assessed the effect of sagittal pelvis tilt on femur rotation. • There was a relationship between anterior pelvis tilt and internal femur rotation. • There was a relationship between ...posterior pelvis tilt and external femur rotation. • Altered sagittal plane pelvis movement may influence transverse plane femur movement.
To evaluate the effects of pulsed electromagnetic field (PEMF) and exercises in reducing pain and improving function and muscle strength in patients with shoulder impingement syndrome (SIS).
...Double-blind, randomized controlled trial with a 3-month posttreatment follow-up.
Outpatient rehabilitation of a public hospital.
Patients (N=56) between 40 and 60 years of age, with a diagnosis of SIS, were randomly assigned to receive active PEMF (n=26; mean age, 50.1y) or placebo PEMF (n=30; mean age, 50.8y).
After 3 weeks of active or placebo PEMF, both groups performed the same program of exercises that focused on shoulder strengthening.
A visual analog scale, the University of California/Los Angeles shoulder rating scale, the Constant-Murley shoulder score, and handheld dynamometry for muscle strength were used as outcome measures at baseline (pretreatment), at 3 weeks (after active or placebo PEMF), at 9 weeks (postexercise), and at 3 months posttreatment.
Patients in the active PEMF group had a higher level of function and less pain at all follow-up time frames compared with baseline (P<.05). However, the placebo PEMF group had increased function and reduced pain only at the 9-week and 3-month follow-ups (P<.05)-that is, after performing the associated exercises. For the shoulder dynamometry, the active PEMF group had increased strength for lateral rotation at 9 weeks (P<.05), and increased strength for medial rotation at 9 weeks and 3 months (both P<.05) when compared with baseline. There was no significant difference for shoulder strength in the placebo PEMF group (P>.05), as well as no significant differences (P>.05) for all outcome measures.
The combination of PEMF and shoulder exercises is effective in improving function and muscle strength and decreasing pain in patients with SIS. However, these results should be carefully interpreted because of the lack of differences between groups.
•Higher (≥ 1) annualized relapse rate and severe attack prior to azathioprine and mycophenolate mofetil commencement are predictors of unsatisfactory response to these drugs in NMOSD patients.•Black ...ethnicity may be a protective factor for unsatisfactory response to azathioprine and mycophenolate mofetil in NMOSD patients.•Severe attack was more common in patients with unsatisfactory response to azathioprine and mycophenolate mofetil in NMOSD patients.
Relapse rates of 47 % have been reported in patients with neuromyelitis optica (NMOSD) using Azathioprine (AZA) and mycophenolate mofetil (MMF). Prediction of non-responders could help determine which patients are most likely to benefit from newer monoclonal antibody treatments from the outset.
To identify predictors of AZA and MMF treatment response in NMOSD.
Multicenter cohort study of NMOSD patients from Brazil and the United Kingdom, treated with AZA and MMF. An unsatisfactory response was defined as one severe or two non-severe attacks in a year. Cox regression was used to identify predictive factors of unsatisfactory response to AZA and MMF.
103 NMOSD patients, mean age 38 years, 83% female, and 65% of Black ethnic group were included. An unsatisfactory IS response was observed in 42% of patients over 2.5 years (IQR 1.0–8.8) years. A severe preceding attack was more common in non-responders (31.1% x 76.7%, p = <0.001). In multivariable analysis, severe attack (RR 3.13; 95 % CI 1.37-7.18, p = 0.007) or higher annualized relapse rate (RR 4.84; 95 % CI 2.01-11.65, p = < 0.001) predicted an unsatisfactory response. Interestingly, Black NMOSD patients had a lower risk of poor response (RR 0.39, 95 % CI 0.17-0.85, p = 0.019).
Severe attack and a higher annualized relapse rate before AZA or MMF initiation were associated with an unsatisfactory IS response. In patients with these characteristics, treatment with higher-efficacy drugs should be considered from the outset.
Case series.
While the literature has emphasized surgical treatment of acetabular labrum tears, there is a lack of information regarding conservative treatment. The purpose of this case series was to ...describe a nonsurgical program for those with clinical evidence of an acetabular labrum tear, that emphasized hip and lumbopelvic stabilization, correction of hip muscle imbalance, biomechanical control, and sport-specific functional progression.
The 4 patients in this series had clinical evidence and magnetic resonance imaging confirmation of an acetabular labrum tear and underwent a similar treatment protocol consisting of 3 phases. Phase 1 emphasized pain control, education in trunk stabilization, and correction of abnormal joint movement. Phase 2 focused on muscular strengthening, recovery of normal range of motion (ROM), and initiation of sensory motor training. And phase 3 emphasized advanced sensory motor training, with sport-specific functional progression. ROM, flexibility, pain, special tests, and level of function were assessed, and strength was measured with handheld dynamometry.
All patients demonstrated decreased pain, functional improvement, and correction of muscular imbalance. Increased muscle strength, primarily for the hip flexors (1%-39%), abductors (18%-56%), and extensors (68%-139%) was also noted.
All patients responded well to our program. This case series suggests that patients with clinical evidence of an acetabular labral tear confirmed with MRI can show meaningful improvement with nonsurgical intervention.
Therapy, level 4.
Sir, We present the first comprehensive clinical description of a patient with limbic encephalitis associated with small cell lung cancer where three paraneoplastic antibodies were detected. Positron ...emission tomography (PET) showed increased uptake in the right hilar lymph nodes Figure 1c and Figure 1d. Blood and CSF were sent for analyses of paraneoplastic antibodies, and both the samples were positive for Hu, Amphiphysin, and SOX1. Small- cell lung cancer, paraneoplastic cerebellar degeneration and the Lambert-Eaton myasthenic syndrome.
To evaluate the modulation of proinflammatory (interleukin-6, IL-6; tumor necrosis factor-α, TNF-α; and interferon-γ, IFN-γ) and anti-inflammatory cytokines (transforming growth factor-β1, TGF-β1) in ...the inflammation processes in vivo with low-level laser action, 50 isogenic mice were randomly distributed into three groups: control (no surgical procedure,
n
= 10), sham (surgical procedure with three standard cutaneous incisions, followed by an abdominal muscle incision and suture,
n
= 20), and laser (same procedure followed by laser exposure,
n
= 20). The sham group was divided into three subgroups: sham I (euthanasia and evaluation, 36 h after surgical procedure), sham II (euthanasia and evaluation, 60 h after surgical procedure), and sham III (euthanasia and evaluation, 84 h after surgical procedure). The laser group was also divided in three subgroups: laser I (a single laser session, 12 h after surgery), laser II (two laser sessions, 12 and 36 h after surgery), and laser III (three laser sessions, 12, 36, and 60 h after surgery). All animals in the laser groups received three points per session of continuous infrared laser (wavelength of 780 nm, power of 20 mW, fluency of 10 J/cm
2
, exposure time of 20 s per point, and energy of 0.4 J). After euthanasia, spleen mononuclear cells were isolated and cultured for 48 h. Concentrations of IL-6, TNF-α, IFN-γ, and TGF-β1 were obtained by enzyme-linked immunosorbent assay method. There was a significant difference between the IL-6 and TNF-α concentrations in the 60-and 84-h evaluations when the laser and sham groups were compared to the control group (
p
< 0.05), except for laser II in the TNF-α analysis (
p
> 0.05). The IFN-γ concentration analysis showed a significant difference only in sham II when compared to the control group (
p
< 0.05). Thus, there was a modulatory effect of TNF-α and IFN-γ in the laser group, particularly in the 60-h postoperative evaluation. There was no significant difference between the laser, sham, and control groups for TGF-β1 analysis (
p
> 0.05). The low-level laser application decreased the TNF-α and IFN-γ release in vivo of spleen mononuclear cells in mice, especially after two exposure sessions. However, there was no modulation of the IL-6 and TGF-β1 release.
Little is known about stroke patients' awareness about the warning signs of stroke and its therapeutic time window in Brazil.
We interviewed consecutive patients with acute stroke admitted to a ...terciary public hospital in Brazil. Data collected included demographics, mode of arrival, National Institutes of Health Stroke Scale (NIHSS) scores and knowledge of stroke warning signs and therapeutic time window. Early arrival was defined as within 4.5 hours of symptoms onset.
Although 66.2% of patients knew the warning signs of stroke, only 7.8% reported to know that stroke had a limited therapeutic time window. Stroke severity measured by the NIHSS was independently associated with early arrival, but not knowledge of stroke signs and symptoms.
Knowledge about stroke symptoms was not a predictor of early arrival.
The purpose of the study was to compare hip agonist-antagonist isometric strength ratios between females with patellofemoral pain (PFP) syndrome and pain-free control group. One hundred and twenty ...females between 15 and 40 years of age (control group: n = 60; PFP group: n = 60) participated in the study. Hip adductor, abductor, medial rotator, lateral rotator, flexor, and extensor isometric strength were measured using a hand-held dynamometer. Comparisons in the hip adductor/abductor and medial/lateral rotator and flexor/extensor strength ratios were made between groups using independent t-tests. Group comparisons also were made between the anteromedial hip complex (adductor, medial rotator, and flexor musculature) and posterolateral hip complex (abductor, lateral rotator, and extensor musculature). On average, the hip adductor/abductor isometric strength ratio in the PFP group was 23% higher when compared with the control group (p = 0.01). The anteromedial/posterolateral complex ratio also was significantly higher in the PFP group (average 8%; p = 0.04). No significant group differences were found for the medial/lateral rotator ratio and flexor/extensor strength ratios. The results of this study demonstrate that females with PFP have altered hip strength ratios when compared with asymptomatic controls. These strength imbalances may explain the tendency of females with PFP to demonstrate kinematic tendencies that increase loading on the patellofemoral joint (i.e., dynamic knee valgus).
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