Low intensity laser (830 nm) functional to recover of the sciatic nerve in rats

OBJETIVO: Avaliar o efeito do laser de baixa intensidade na melhora funcional da marcha de ratos após esmagamento do nervo ciático. MÉTODOS: Foram utilizados 18 ratos divididos alea-to-riamente em dois grupos: controle (sham) e irradiado com densidade de energia de 40J/cm², em 21 dias consecutivos, utilizando o laser 830nm (AsGaAl). Os animais foram submetidos ao esmagamento do nervo ciático direito com o dispositivo portátil de peso morto e avaliados pelo "Índice Funcional do Ciático" (IFC). As pegadas foram coletadas no pré-operatório, 7º, 14º e 21º dias pós-operatório. RESULTADOS: Os resultados do IFC foram significantes quando comparados os grupos no 7º e 14º dia pós-operatório (p<0,05). No 21º dia pós-operatório não houve diferença entre os grupos. Na avaliação intra-grupos houve diferença entre todas as semanas avaliadas (p<0,01). Os animais irradiados apresentaram melhora no padrão da marcha, demonstrada pelos valores do IFC nos períodos iniciais, mas ao final das 3 semanas, houve uma recuperação similar. CONCLUSÃO: A laserterapia de baixa intensidade mostrou ser eficaz no estímulo da aceleração da regeneração nervosa do ciático de ratos após esmagamento.OBJECTIVE: This study aimed to evaluate the effect of low-intensity laser on functional improvement of the walking of rats after sciatic nerve axonotmesis. METHODS: We used 18 rats divided randomly in two groups: control (Sham) and irradiated with an energy density of 40J/cm² for 21 consecutive days, using 830nm laser (AsGaAl). The animals were subjected to right sciatic nerve crushing by a portable device and assessed by the "Sciatic Functional Index" (SFI) at an acrylic platform through video recorded by a digital camera. The footprints were collected preoperatively, and on the 7th, 14th and 21st postoperative days. RESULTS: The results of the SFI were significant when comparing the groups on the 7th and 14th postoperative day (p<0.05). On the 21st postoperative day there was no difference between groups. There were intra-group differences detected in each evaluated week (p<0.01). The irradiated animals showed improvement in motion pattern, shown by the SFI values in the initial periods, but after 3 weeks, there was a similar recovery. CONCLUSION: The low-intensity laser has shown to be effective in accelerating regeneration of the sciatic nerve of rats after crushing.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Prevalence of myofascial dysfunction in patients with low back pain

Objective: This study aimed to examine the prevalence of myofascial dysfunction in patients with low back pain, which is the area most frequently afflicted, and to quantify the pain threshold for these evaluations using an algometer. Method: We evaluated 70 patients with a history of chronic low back pain in search of trigger points that would elicit the patient’s pain. The muscles tested were the quadratus lumborum, iliopsoas, gluteus maximus, medius, minimus, and piriformis. The prevalence of myofascial dysfunction was determined by the percentage of patients with trigger points. The pain threshold was determined by the average of three assessments of pressure for each trigger point. Results: The results showed that 90% of patients had myofascial dysfunction, 76% of whom had trigger points in the quadratus lumborum, 69% in the gluteus medius, 56% in the piriformis, 40% in the gluteus minimus, 31% in the iliopsoas, and 29% in the gluteus maximus. The pressure pain threshold of the quadratus lumborum was 1.71 kg/cm2, 2.39 kg/cm2 for the gluteus medius, 2.34 kg/cm2 for the piriformis, 2.58 kg/cm2 for the gluteus minimus, 2.11 kg/cm2 for the iliopsoas and 2.19 kg/cm2 for the gluteus maximus. Conclusion: Our data demonstrate the high prevalence of this disorder and suggest that it deserves specific attention in the treatment of low back pain in patients with chronic pain.Objetivo: Examinar a prevalência da disfunção miofascial em indivíduos com dor lombar e quantificar limiar de dor destes através do algômetro. Método: Foram avaliados 70 indivíduos com idade média de 48 (± 11,76) com história de dor lombar crônica, sendo investigada a presença de pontos-gatilho nos músculos: quadrado lombar, iliopsoas, glúteos máximo, médio e mínimo, e piriforme. A prevalência foi determinada pela porcentagem de indivíduos com pontos gatilhos presentes e o limiar de dor foi determinado pela média de três avaliações de pressão de cada ponto-gatilho. Resultados: Demonstraram que 90% dos indivíduos apresentaram disfunção miofascial, dentre eles, 76% no músculo quadrado lombar, 69% no glúteo médio, 56% no piriforme, 40% no glúteo mínimo, 31% no íliopsoas e 29% no glúteo máximo. O limiar de dor por pressão dos músculos quadrado lombar foi de 1,71 Kg/cm2, de 2,39 Kg/cm2 para o glúteo médio, de 2,34 Kg/cm2 para o piriforme, de 2,58 Kg/cm2 para o glúteo mínimo, de 2,11 Kg/cm2 para o iliopsoas e de 2,19 Kg/cm2 para o glúteo máximo. Conclusão: Na amostra analisada, os dados deste estudo demonstram a grande prevalência desta disfunção e sugere que a mesma merece atenção específica no tratamento da lombalgia em indivíduos com dor crônica

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

Background: Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome. Methods/Design: Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments (TM) threshold sensibility test, Pinch Gauge T, Boston Carpal Tunnel Questionnaire and two point discrimination test. Discussion: This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome. Trial registration: Brazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184Sao Paulo Research Foundation (FAPESP)Fundacao de Apoio ao Ensino, Pesquisa e Assistencia of Clinics Hospital, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo - FAEP

Correlation between Moberg Pick-Up test and sensation threshold test after median nerve reconstruction

Functional assessment of sensitivity is essential to analyzing the status, recovery, and effectiveness of the treatment program for patients who have suffered losses due to physical and/or sensory disability after peripheral nerve injuries. Such losses of sensation lead to a significant loss of hand function. Objective: The purpose of the present study was to establish a correlation between functional and sensory threshold tests after a peripheral nerve lesion in the hand. Method: Fourteen men aged 18 to 40 years, who had bruises and cut injuries at the volar region of the wrist resulting in median nerve lesion, were selected for study. All the subjects were at least 1-year post-surgery. An esthesiometer SORRI® and a modified Moberg pick-up test were used. The test was divided into two phases, one with eyes open and the other with eyes closed. Also, the same test was performed by two different examiners. It was a “blinded” test that was performed three times, being repeated by the examiners according to a random sequence kept during the entire evaluation. Mean age and standard deviation were obtained during analysis in which Pearson’s coefficient was calculated and the non-parametric Mann-Whitney test was applied at 5% significance. Results: The mean age was 27.14 years with a standard deviation of 6.43 years, with the lesions being more frequently seen in men aged 21 to 30 years. Also, 64% of the cases involved lesion of the dominant hand. Pearson’s coefficient (r) regarding the correlation between sensory threshold test and Moberg pick-up test ranged from 0.5 to 0.7, which was statistically significant. Confidence intervals and p-values obtained from the Mann-Whitney test showed no statistically significant differences. Conclusion: One can conclude, therefore, that despite lacking standardized measures, the Moberg pick-up test correlated with the functional test. However, further studies are needed to support validation and reliability of the two methods.A avaliação funcional da sensibilidade é essencial para analisar o estado, recuperação, e efetividade do programa de tratamento em pacientes que sofreram perdas decorrentes de deficiência motora e/ou sensitiva, após lesões nervosas periféricas. Estas lesões geram a interrupção das sensações ocasionando a perda da sensibilidade e uma significante perda funcional da mão. Objetivo: O objetivo deste estudo foi correlacionar o teste funcional Pick-Up de Moberg com o teste de limiar sensitivo Estesiômetro SORRI® na reconstrução do nervo mediano. Método: Foram analisados 14 homens com idade entre 18 e 40 anos que sofreram ferimento corto-contuso na região volar do punho e tratamento cirúrgico há pelo menos um ano de pós-operatório. Foram utilizados para a avaliação da sensibilidade cutânea o Estesiômetro SORRI® e o teste Pick-Up de Moberg modificado, no qual a avaliação foi dividida em duas fases, olhos abertos e fechados, ambas realizadas com a mão dominante e não dominante, e em duas etapas com diferentes avaliadores, sendo repetidas três vezes em cada mão. A sequência dos avaliadores foi sorteada e mantida durante toda a avaliação. Na análise dos dados foi utilizado o coeficiente de Pearson e aplicado o teste não-paramétrico de Mann-Whitney com o nível de significância α = 0,05. Resultados: A média da idade foi de 27,14 anos (± 6,43), com maior frequência entre 21 a 30 anos sendo que 64% apresentaram lesão na mão dominante. O coeficiente de Pearson (r) entre o Estesiômetro e o Pick-Up foi entre 0,5 e 0,7, com p-valor &lt; 0,05. Os intervalos de confiança e p-valores dos testes de Mann-Whitney não indicaram diferenças estatisticamente significantes. Conclusão: Apesar do teste Pick-Up de Moberg não possuir medidas padronizadas, na amostra estudada pode-se concluir que existe correlação entre o teste funcional e o teste de limiar sensitivo. Novos estudos são necessários para a validação e confiabilidade de ambos os métodos

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world’s largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ~30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death