Clinical effects of acupuncture and periarticular local infiltration of corticosteroids in the treatment of gonarthrosis

Gonarthrosis is one of the most frequently degenerative diseases. Pain, derange of function and= deformation of joint are dominating clinical signs. Aim of the study: To compare clinical effect obtained with three different therapeutic models: 1. Acupuncture; 2. Local infiltration of corticosteroid; 3. Combination of acupuncture and local infiltration of corticosteroid. Material and methods: An open, prospective, randomized clinical study included 21 female patients in acute phase of gonarthrosis. Diagnosis was made by clinical and radiographic examinations. Patients were divided into three groups: I group: 7 patients, average age 61.0 ± 6.8 years, treated with needle acupuncture (points: Du.20, Ex.31, Ex.32, St.35, UB.40, St.44, UB.60, Li.4, Sp.9,UB.11), 10 treatments. II group: 7 patients, average age 59.0 ± 10.1 years, treated with infiltration of Bethametasonum – Diprophos on the first day of treatment with frontal approach on the medial or the lateral side of m. quadriceps tendon. III group: 7 patients, average age 58 ± 6.07 years, treated with a combination of initial infiltration of Bethametasonum – Diprophos and needle acupuncture, 10 treatments. The evaluation of efficacy parameters were performed by following parameters: 1. Subjective difficulties – pain (VAS 0-100 mm); 2. Sizeof knee, measured across the middle of patella with centimeter band; 3. Range of joint motion (flexion), measured using a goniometer. All of these parameters were measured on 1st, 8th and 21st day of treatment. One way ANOVA, repeated measures ANOVA and post hoc tests were applied for statistic analysis. Results: 1. There were high significant improvements in the parameters of pain intensity and size of knee inside the groups; One way ANOVA test, p=0.000<0.01; 2. There were no significant improvements in the parameter of joint movement inside the groups; One way ANOVA test, p=0.528>0.05; 3. There were high significant improvements in all parameters (pain intensity, size of knee, joint movement) in all three groups; Repeated measures ANOVA test, p=0.000<0.01. Conclusion: Combined treatment of acupuncture and local infiltration of a corticosteroid has better effectiveness in pain intensity, size of knee and improvement of motion in comparison with monotherapy.Gonartrose é uma das doenças degenerativas mais comuns. Dor, deficiência e deformidade articular são os sinais clínicos dominantes. Objetivo do estudo: Comparar o efeito clínico obtido com três diferentesmodelos terapêuticos: 1. Acupuntura; 2. Infiltração local de corticosteróide; 3. Combinação de acupuntura e infiltração local de corticosteróide. Material e Métodos: Um estudo clínico prospectivo, aleatorizado, aberto incluiu 21 pacientes do sexo feminino em fase aguda de gonartrose. O diagnóstico foi feito através de exames clínicos e radiográficos. As pacientes foram divididas em três grupos: Grupo I: 7 pacientes com média de idade de 61,0 ± 6,8 anos, tratadas através de acupuntura com agulhas (pontas: Du20, Ex31, Ex32, St35, UB40, St44, UB60, Li4, Sp9,UB11), 10 tratamentos. Grupo II: 7 pacientes com 59,0 ± 10,1 anos, tratadas com infiltração de Betametasona – Diprofos, no primeiro dia de tratamento com abordagem frontal na parte lateral ou medial do tendão do músculo quadríceps. Grupo III: 7 pacientes, com 58,0 ± 6,07 anos, tratadas com uma combinação de infiltração inicial de Betametasona – Diprofos e acupuntura com agulhas, 10 tratamentos. A avaliação dos parâmetros de eficácia foi feita através dos seguintes parâmetros: 1. Dificuldades subjetivas – dor (Escala visual analógica – EVA de 0 a 100 mm); 2. tamanho do joelho, medido através do meio da patela em centímetros; 3. Amplitude de movimento articular (flexão), medida com um goniômetro. Todos esses parâmetros foram medidos no 1º, 8º e 21º dia de tratamento. ANOVA unifatorial, ANOVA de medida repetida e testes post hoc foram utilizados na análise estatística. Resultados: 1. Houve significativa melhora nos parâmetros de intensidade de dor e tamanho do joelho dentro dos grupos; ANOVA unifatorial,  p<0,01; 2. Não houve melhora significativa no parâmetro de movimento articular dentro dos grupos; ANOVA unifatorial, p=0,528; 3. Houve melhoras significativas em todos os parâmetros (intensidade da dor, tamanho do joelho, movimento articular) nos três grupos; ANOVA de medida repetida, p<0,01. Conclusão: O tratamento combinado de acupuntura e infiltração de corticosteróide tem melhor efetividade em intensidade da dor, tamanho do joelho e melhora do movimento articular em comparação com a monoterapia

Efeitos da reabilitação precoce no desfecho da reabilitação pós-acidente vascular encefálico (AVE) em mulheres com mais de 65 anos e sua correlação com a gravidade do deficit neurológico inicial

Este trabalho visa examinar os efeitos da reabilitação precoce, a curto e longo prazo, no desfecho do acidente vascular encefálico (AVE) em mulheres com mais de 65 anos; estabelecer a correlação entre o impacto da gravidade do déficit neurológico na predição dos re-sultados do tratamento de Reabilitação e, ainda, investigar a possibilidade do acompanhamento de parâmetros individuais da Medição de Independência Funcional (MIF) na predição do desfecho da reabilitação do AVE. Atualmente, o AVE é a terceira maior causa de mortalidade na população mundial, bem como a maior causa de invalidez permanente. No cenário atual, as doenças cardiovasculares e cerebrovasculares - que antes eram tidas como exclusivas da população masculina – têm afetado também as mulheres. Por outro lado, observamos uma correlação linear entre o envelhecimento e a ocorrência destas doenças. Concluímos que a implantação do método de reabilitação precoce conduz a uma aceleração significativa do processo de tratamento e recuperação após o AVE em mulheres com mais de 65 anos. Concluímos também que certos parâmetros da MIF, por apresentarem o mesmo padrão de evolução, podem ser utilizados na predição da recuperação global do paciente.This study aims at verifying the effects of short- and long-term rehabilitation on the outcome of encephalic vascular accident (EVA) in women older than 65 years; establishing the correlation between the impact of the neurological deficit severity on the prediction of the rehabilitation treatment outcome as well as investigating the possibility of the follow-up of individual parameters at the Functional Independence Measure (FIM) when predicting the EVA rehabilitation outcome. The EVA is currently the third major cause of death in the world’s population, as well as the main cause of permanent disability. In the present scenario, cardiovascular and cerebrovascular diseases, which used to be observed almost exclusively in the male population, now affect the female population as well. On the other hand, we observe a linear correlation between aging and the occurrence of these diseases. We conclude that the implementation of early rehabilitation leads to a significant acceleration in the treatment and recovery process post-EVA in women older than 65 years. We also conclude that certain FIM parameters can be used to predict the patient’s overall recovery, as they present the same evolution pattern

Efeito da estimulação elétrica nervosa transcutânea (TENS) no tratamento de dor pós-cirúrgica após amputação de membro inferior: estudo piloto

Transcutaneous electrical nerve stimulation (TENS) is a noninvasive, nonmedical modality.  Objective: To establish the role of TENS for the management of postoperative surgical pain after lower limb amputations. Methods: Randomized controlled trial, which included forty-six subjects who had undergone lower limb amputations, randomly divided into control and treatment group. The control group received standard postoperative care, whereas the treatment group received standard postoperative care plus TENS. Forty subjects successfully completed the study according to the study protocol. The majority of the individuals had undergone transtibial amputation due to complication of diabetes. Five TENS XL-A1 portable devices with four self-adhesive electrodes were used. This was the conventional TENS mode, characterized by the delivery of electrical impulses with a duration of 200 microseconds, frequency of 110 Hz, and amplitude of 44V. Treatment was carried out for 2 hours a day, during 10 days. The evaluation of TENS efficacy was performed using the horizontal VAS (0-100 mm). Student T test was used in the statistical analysis. Results: Pain intensity was significantly diminished in both groups at the tenth in comparison with the first postoperative day. Conclusion: Conventional TENS (dose: 200 microseconds, 110 Hz, 44V), administered two hours a day during ten days, significantly reduced postoperative surgical pain in twenty subjects who had undergone lower limb amputations.A estimulação elétrica nervosa transcutânea (TENS) é uma modalidade não médica e não invasiva. Objetivo: Avaliar o papel da TENS no tratamento de dor cirúrgica pós-operatória após amputação de membro inferior. Métodos: Teste controlado randomizado, conduzido com 46 indivíduos submetidos à amputação de membro inferior, que foram aleatoriamente divididos em grupo controle e grupo tratado. O grupo controle recebeu cuidados-padrão no pós-operatório; o grupo tratado recebeu cuidados-padrão e aplicação de TENS. Quarenta indivíduos completaram efetivamente o estudo de acordo com o protocolo de estudo. A maior parte das amputações consistiu de amputação transtibial devido a complicações da diabete. Foram utilizados cinco dispositivos portáteis Ultima TENS XL-A1 com eletrodos auto-adesivos. Esta é a aplicação convencional da TENS, caracterizada pela aplicação de impulsos elétricos com a duração de 200 microssegundos, freqüência de 110 Hz e amplitude de 44 V. O tratamento foi administrado durante 10 dias, 2 horas por dia. A avaliação da eficácia da TENS foi feita utilizando-se a escala visual analógica (EVA) horizontal (0-100 mm). O teste t de Student foi usado na análise estatística. Resultados: A intensidade da dor estava significantemente diminuída em ambos os grupos no 10º dia em comparação ao 1º dia de pós-operatório.  Conclusão: A TENS convencional (dose: 200 microssegundos, 110 Hz, 44 V), administrada 2 horas por dia, durante 10 dias, significantemente reduziu a dor cirúrgica pós-operatória em 20 indivíduos com amputação de membro inferior

Systemic Lupus Erythematosus and Secondary Antiphospholipid Syndrome after Thymectomy for Myasthenia Gravis - A Case Report

INTRODUCTION: Systemic lupus erythematosus (SLE) and myasthenia gravis (MG) are autoimmune diseases that show some similarities: a higher incidence in young women, relapsing-remitting course and positive anti-nuclear antibodies (ANA). However, they are two different clinical syndromes, which can coexist or precede each other. Thymectomy is a therapeutic option for patients with severe MG or thymoma. There are many cases of SLE after thymectomy described in the literature, so the question arises whether thymectomy predisposes patients to SLE and what are imunopathogenetic mechanisms behind this process.CASE REPORT: We report a case of a patient who was diagnosed with SLE and secondary antiphospholipid syndrome (APS) 28 years after thymectomy for MG. Clinical picture of SLE was characterized by cutaneous and articular manifestations, polyserositis, lupus nephritis and immunological parameters showed positive ANA, anti-ds-DNA, excessive consumption of complement components, positive cryoglobulins. Clinical and laboratory immunological parameters for the diagnosis of secondary APS where also present. The patient was initially treated with glucocorticoids followed by mycophenolate mofetil. During one year follow-up patient was in a stable remission of SLE.CONCLUSION: Thymectomy for MG may predispose SLE development in some patients. Further studies are needed to better understand the connection between these two autoimmune diseases

Systemic Lupus Erythematosus and Antiphospholipid Syndrome

Antiphospholipid syndrome is an autoimmune disorder defined as association of vascular thrombosis and/or pregnancy complications with presence of antiphospholipid antibodies (lupus anticoagulant, anticardiolipin and anti-β2 glycoprotein I). It is the most common cause of acquired thrombophilia, and can occur as an independent entity or in relation with other diseases, especially systemic lupus erythematosus. Presence of antiphospholipid syndrome in systemic lupus erythematosus is additional vaso occlusive factor in already present inflammation, bringing further risk for thrombotic events. Clinical and serological manifestations of antiphospholipid syndrome and systemic lupus erythematosus are very similar, so possible connection for these two autoimmune disorders is assumed

Vitamin D Status in Patients with Systemic Lupus Erythematosus in Serbia: Correlation with Disease Activity and Clinical Manifestations

BACKGROUND: Numerous studies indicate potential role of vitamin D as an important factor in the development of many autoimmune diseases including systemic lupus erythematosus (SLE). Patients with SLE are especially prone to the development of vitamin D deficiency due to the nature of their illness.AIM: The aims of our study were to determine the prevalence of vitamin D insufficiency and deficiency in patients with SLE in Serbia, to identify clinical variables associated with vitamin D status and to examine the impact of vitamin D status on disease activity and presence of specific lupus autoantibodies.MATERIAL AND METHODS: The study included 46 patients with SLE. Serum 25(OH)D concentration was measured by electrohemiluminiscent immunoassay.RESULTS: The mean serum concentration of 25(OH)D was 11.9 ± 7.3 ng/ml. The prevalence of insufficiency was 32.6%, while the prevalence of deficiency was 67.4%. There was no association between vitamin D status and photosensitivity, skin lesions, arthritis and lupus nephritis. Vitamin D status was not associated with the presence of specific autoantibodies. There was no correlation between disease activity assessed by SLEDAI scale with the concentration of 25(OH)D. Patients who used vitamin D supplements and calcium did not have a significantly higher concentration of 25(OH)D.CONCLUSION: In conclusion, vitamin D deficiency is common in patients with SLE

Role of Vitamin D in Systemic Lupus Erythematosus

Vitamin D is a steroid hormone that in addition to its well known role in the metabolism of calcium and phosphorus exerts immunoregulatory properties. Data from animal studies and from prospective clinical trials on patients with rheumatoid arthritis, multiple sclerosis and type 1 diabetes point to the potential role of vitamin D as important environmental factor in the development of autoimmune diseases. Such role of vitamin D in systemic lupus erythematosus (SLE) has not yet been sufficiently studied. This review shows the sources, metabolism and mechanism of action of vitamin D, its effect on the cells of the immune system, prevalence and causes of vitamin D deficiency in patients with SLE, the link between vitamin D status and disease activity as well as recommendations for vitamin D supplementation

Sjögren’s Syndrome and Silicosis – a Case Report

Sjögren’s syndrome is an autoimmune disease of unknown etiology where immune response to self-antigens is believed to result from interactions between genetic and environmental factors. We describe the case of a patient who has been diagnosed with Sjögren’s syndrome based on typical clinical and immunological parameters. The clinical picture was dominated by the respiratory symptoms, and radiographic and multislice computed tomography examination of the chest showed certain changes characteristic of pneumoconiosis. Given that the patient has worked in a foundry where he has been exposed to the silica dust, he was subject to examination by occupational health specialists under the suspicion of lung silicosis, who confirmed the silicosis. This case report points to the possible connection between a professional exposure to silica and Sjögren’s syndrome. Occupational exposure to silica is a possible risk factor for the development of autoimmune diseases, and in the evaluation of patients with connective tissue diseases it is important to consider work-related history

Evaluation of long term effects of acupuncture and therapeutic exercises on frozen shoulder in stroke patients

Aim: To determine how acupuncture and exercise therapy affect motor function and spasticity on the hands of stroke patients 6 months after they had received this kind of therapy. Methods: Prospective, randomized, single blind clinical study of 20 patients, age 60-70 years, in the chronic phase 6 months after stroke. Subjects were divided into two groups: Group A, which was treated with acupuncture and exercise therapy (AP-ET) 6 months ago and Group B, which was treated with exercise therapy (ET) alone 6 months ago. Results: Analyses showed a statistically significant difference in the post-treatment SCORES as compared to 6 months after treatment within each study group for all parameters examined (p<0.01 in all cases) except for MAS. Analyses showed a statistically significant differ-ence in some parameters in the ET group as compared to the AP-ET group with greater mean values recorded in the AP-ET group for MAS and CSDQ. All other parameters showed no statistical differences between the two different therapy groups 6 months after the therapy. Conclusion: The results confirm the hypothesis that acupuncture and exercise therapy are useful in the treatment of frozen shoulder in stroke patients and that their effects are still present after 6 months of therapy, however, given the small patient population, further studies are needed to verify these results.Objetivo: Determinar como a acupuntura e a terapia com exercícios afetam a função motora e espasmodicidade das mãos de pacientes com acidente cerebral vascular 6 meses após eles terem recebido este tipo de terapia. Métodos: Estudo clínico prospectivo, aleatório e cego de 20 pacientes, com idades entre 60-70 anos, na fase crônica de 6 meses após o AVC. Os sujeitos do estudo foram divididos em dois grupos: Grupo A, o qual foi tratado com acu-puntura e terapia de exercícios (AP-ET) 6 meses atrás e Grupo B, o qual foi tratado apenas com terapia de exercícios (ET) 6 meses atrás. Resultados: As análises mostraram uma diferença estatisticamente significativa nos SCORES do pós-tratamento em comparação com 6 meses após o tratamento com cada grupo de estudo, para todos os parâmetros examinados (p<0.01 em todos os casos) exceto pelo MAS. As análises mostraram uma diferença estatisticamente significativa em alguns parâmetros no grupo ET em comparação ao grupo AP-ET com valores médios maiores no grupo AP-ET para MAS e CSDQ. Todos os outros parâmetros não mostraram nenhuma diferença estatística entre os grupos diferentes de terapia 6 meses após a terapia. Conclusão: Os resultados confirmam a hipótese de que a acupuntura e a terapia de exercícios são úteis no tratamento de ombro congelado em pacientes com AVC e que seus efeitos ainda estão presentes após seis meses de terapia, no entanto, dado o pequeno número de pacientes, mais estudos são necessários para verificar estes resultados

Functional electrical therapy for facilitation of motor recovery in a patient with subacute stroke

Objetivo: Determinar a eficácia de um protocolo de Tratamento com Estimulação Elétrica Funcional (FET) administrado a um paciente com acidente cerebrovascular subagudo.Descrição do Caso: Paciente destro, 67 anos, sexo masculino, que sofreu infarto nas regiões occipital esquerda e frontoparietal 6 meses antes de sua admissão neste estudo e que demonstrou grau elevado de motivação para recuperar plenamente a força do braço e o controle adequado dos dedos do membro superior afetado. Intervenção: Trinta minutos de FET, 5 vezes por semana durante 3 semanas (7 ½ horas no total) além da fisioterapia convencional. Principais Medidas de Avaliação de Resultados: A Escala Modificada de Ashworth (MAS), o teste de funcionalidade das extremidades dos membros superiores (UEFT), o Registro de Atividade Motora (MAL), O teste de 6 fases de Brunnstrom, a Medida de Independência Funcional (MIF). Resultados: O paciente apresentou melhora bastante significativa nas escalas quantitativas UEFT e MAL. Ele melhorou de forma específica na atividade de escrever ao obter melhor controle dos dedos e na capacidade de controlar objetos pesados. Também, observou-se o aumento da amplitude ativa de movimento (ROM) dos músculos proximais, embora a estimulação elétrica tenha sido aplicada apenas aos músculos distais. Houve uma melhora na qualidade geral da utilização do braço, conforme mensurado pela escala qualitativa MAL. Conclusões: A terapia com Estimulação Elétrica Funcional (FET) em pacientes com acidente cerebrovascular subagudo com alta motivação para tarefas específicas pode ser um método eficaz para a melhora do funcionamento e da utilização dos braços afetados.Objective: To determine the efficacy of a Functional Electrical Therapy (FET) protocol administered to a patient with subacute stroke. Case description: A 67-year-old right handed man who had infarct in left occipital and frontoparietal regions 6 months before study entry and who exhibited high motivation to get full arm power and fine control of fingers of the affected upper limb. Intervention: Thirty minutes of FET 5 times a week for 3 weeks (7 ½ hours in total) in addition to conventional physiotherapy. Main Outcome Measures: The Modified Ashworth Scale (MAS), the Upper Extremity Function Test (UEFT), Motor Activity Log (MAL), The Brunnstrom’s 6 stages, the Functional Independence Measure (FIM). Results: The patient exhibited substantial improvements on the UEFT and MAL amount scores. He specifically improved in the writing task by getting better fingers control and in ability of controlling heavy objects. Also, his active range of motion (ROM) of proximal muscles increased, although electrical stimulation was applied to distal muscles only. Quality of overall arm use improved, as measured by the MAL how well score. Conclusions: FET may be an efficacious method for improving function and use of the affected arms of subacute stroke patients with high motivation for specific tasks