Rizo tomia e discectomia endoscópica no tratamento da dor lombar crônica e radiculopatia aguda na síndrome da pessoa rígida- relato de caso

Introduction: Stiff Person Syndrome (SPS) is a rare neurological disorder, first described in 1956 by Moersch and Woltman. The clinical picture has an insidious onset of classic findings of episodic painful spasms, hyperreflexia, axial muscle stiffness, progressing slowly to the proximal limb muscles. Painful hyperlordosis due to lumbar spine stiffness is a diagnostic characteristic of SPS. CASE REPORT: Male, 69 years old, with SPS for 40 years, referred by the neurologist to the spine surgeon because of failure to conservative management of chronic low back pain, progressively acute leg and gait impairment.  Physical examination is difficult to perform in SPS because it triggers spasms. MRI presented zygoapophyseal joint, intervertebral discs and muscle degeneration, including a L4L5 cranial migrated herniated disc. Once there were no other effective ways to manage his axial and radicular pain, it was decided to perform percutaneous transforaminal endoscopic discectomy for L4L5 decompression, L3 to S1 dorsal ganglion root medial branch ablative radiofrequency rhizotomy to relieve facet pain and L2 dorsal sensory ganglion pulsed radiofrequency rhizotomy for modulation of chronic low back pain. One year postoperative follow up, the patient has showed improvement in the VAS and SF-36. CONCLUSION: Chronic pain reported by a patient must be addressed in the biological, psychological and social dimensions. Understanding the multidimensionality of the factors involved with pain allows planning less aggressive and highly efficient strategies in uncommon and off label patients, as in the case of SPS.Introdução: A síndrome da pessoa rígida (SPR) é um distúrbio neurológico raro, descrito pela primeira vez em 1956 por Moersch e Woltman. O quadro clínico apresenta início insidioso de achados clássicos de espasmos dolorosos episódicos, hiperreflexia, rigidez muscular axial, progredindo lentamente para os músculos proximais dos membros. A hiperlordose dolorosa devido à rigidez da coluna lombar é uma característica diagnóstica do SPS. RELATO DO CASO: Homem, 69 anos, com SPS há 40 anos, encaminhado pelo neurologista ao cirurgião de coluna por falha no manejo conservador da lombalgia crônica, dor radicular progressivo na perna e alteração da marcha. O exame físico é difícil de realizar na SPR porque desencadeia espasmos. A ressonância magnética apresentou degeneração nas articulações zigapofisárias, nos discos intervertebrais e muscular, incluindo hérnia discal L4L5 com migração cranial. Uma vez que não havia outras maneiras eficazes de gerenciar sua dor axial e radicular, foi decidido realizar discectomia endoscópica transforaminal percutânea para descompressão de L4L5, rizotomia de radiofrequência ablativa do ramo medial do gânglio dorsal de L3 a S1 para aliviar a dor facetaria e rizotomia de radiofrequência pulsada do gânglio sensitivo dorsal L2 para modulação da dor lombar crônica. Após um ano de pós-operatório, o paciente apresentou melhora na EVA e no SF-36. CONCLUSÃO: A dor crônica relatada pelo paciente deve ser tratada nas dimensões biológica, psicológica e social. Compreender a multidimensionalidade dos fatores envolvidos com a dor permite planejar estratégias menos agressivas e altamente eficientes em pacientes incomuns e off label, como no caso do SPS

Between a Rock and a Hard Place: Habitat Selection in Female-Calf Humpback Whale (Megaptera novaeangliae) Pairs on the Hawaiian Breeding Grounds

The Au'au Channel between the islands of Maui and Lanai, Hawaii comprises critical breeding habitat for humpback whales (Megaptera novaeangliae) of the Central North Pacific stock. However, like many regions where marine mega-fauna gather, these waters are also the focus of a flourishing local eco-tourism and whale watching industry. Our aim was to establish current trends in habitat preference in female-calf humpback whale pairs within this region, focusing specifically on the busy, eastern portions of the channel. We used an equally-spaced zigzag transect survey design, compiled our results in a GIS model to identify spatial trends and calculated Neu's Indices to quantify levels of habitat use. Our study revealed that while mysticete female-calf pairs on breeding grounds typically favor shallow, inshore waters, female-calf pairs in the Au'au Channel avoided shallow waters (<20 m) and regions within 2 km of the shoreline. Preferred regions for female-calf pairs comprised water depths between 40–60 m, regions of rugged bottom topography and regions that lay between 4 and 6 km from a small boat harbor (Lahaina Harbor) that fell within the study area. In contrast to other humpback whale breeding grounds, there was only minimal evidence of typical patterns of stratification or segregation according to group composition. A review of habitat use by maternal females across Hawaiian waters indicates that maternal habitat choice varies between localities within the Hawaiian Islands, suggesting that maternal females alter their use of habitat according to locally varying pressures. This ability to respond to varying environments may be the key that allows wildlife species to persist in regions where human activity and critical habitat overlap

Determinants of the use of health and fitness mobile apps by patients with asthma: secondary analysis of observational studies

Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use