Evaluation of quality of life in patients with type 2 diabetes Mellitus with symptomatic distal symmetric polyneuropathy / Avaliação da qualidade de vida em doentes com diabetes Mellitus tipo 2 com polineuropatia simétrica distal sintomática

INTRO/BACKGROUND The complications of Diabetes Mellitus (DM) are traditionally categorized as micro and macrovascular disorders. Among them, diabetic polyneuropathy (DPN) is one of the most common, presenting with or without associated neuropathic pain, and its morbidity exerts a significant impact on the quality of life (QOL) of these patients. About 50% of individuals with type 2 DM (T2DM) suffer from this condition and the distal symmetric polyneuropathy (DSPN) constitutes its most frequent clinical form.  OBJECTIVE: To demonstrate the effect of symptomatic DSPN on the QOL of T2DM patients in a sample of the Brazilian population, correlating clinical and electrophysiological findings, besides comparing the results obtained by the Medical Outcomes Study Questionaire 36-Item Short Form Health Survey (SF-36) among patients with painful and non-painful diabetic DSPN. METHODS: This study comprised 25 outpatients with DSPN and T2DM submitted to a detailed anamnesis to identify clinical and demographic characteristics, besides comorbidities and complications of DM. Clinical evaluation was performed through neurological physical examination, in addition to specific scales for neuropathy as the Neuropathy Disability Score (NDS). In order to assess the health-related quality of life (HRQoL) of these patients, the SF-36 translated and adapted for the Brazilian population was applied. Nerve conduction study (NCS) was performed for the examined nerves (motor part of peroneal nerve and sensory part of the sural nerve). The following parameters were assessed: motor conduction velocity (MCV), amplitude of the compound muscle action potentials (CMAP) and amplitude of the sensory nerve action potentials (SNAP). RESULTS: Role Physical (RP) domain of SF-36 was significantly related to some of the clinical and electrophysiological factors measured. RP had an inverse and significant relationship with the NDS values (Rho: -0.44), showing the impact of neuropathy severity on these patients’ QOL. The sural nerve SNAP and peroneal nerve MCV showed a significant and positive relationship with RP (Rho: 0,52 and 0,36, respectively). The Mental Health (MH) domain showed a statistically significant difference between those patients with pain and without pain (p = 0.002), and patients without pain had higher mean values, as well as a higher minimum and maximum value. The Role Emotional (RE) domain also showed a significant difference between patients with and without pain, and patients with pain had a lower mean value (p = 0.04). For all other domains, patients with pain showed lower mean values than those without pain, however without statistical difference in the test performed. Between DM complications, only nephropathy presented statistically different RP scores from those without nephropathy (p = 0.02). CONCLUSION: There was a significant inverse relationship between the severity of DSPN and the QOL of the evaluated patients, as evidenced by lower values in the SF-36 specific RP domain, as polyneuropathy becomes more severe. This domain also presented significantly lower values in patients with associated nephropathy. The presence of pain negatively affected the QOL of patients with painful DPN, who presented significantly lower mean values in the MH and RE domains when compared to patients without pain

O Uso de CFD na previsão da dispersão de gases em plataformas offshore

O sistema de detecção de gases em plataformas marítimas de exploração de petróleo é normalmente formado por dois subsistemas: um para detecção de gases inflamáveis e outro para detecção de gases tóxicos, especialmente H2S. Os dois sistemas monitoram as concentrações destes gases para preservar a vida humana e minimizar danos à estrutura e aos equipamentos da plataforma. O projeto do sistema de detecção é baseado em normas e notas técnicas que não fornecem toda a informação necessária para determinar o número ótimo de detectores. Elas recomendam que os sensores devem ser localizados perto de possíveis pontos de vazamento, não estabelecendo distâncias, metodologias para considerar a influência de variáveis externas, o número mínimo de detectores e a confiança do detector e/ou do sistema. Devido a estas incertezas é necessário substituir critérios genéricos por uma análise quantitativa, baseada em critérios de engenharia. A metodologia adotada neste trabalho é o uso de Fluidodinâmica Computacional (CFD) para prever os locais onde as concentrações de gases, acima do limite detectável, irão ocorrer e onde a localização do detector será mais efetiva. Empregando este tipo de solução computacional é possível substituir as tradicionais ferramentas de cálculo de dispersão de gases. Estes modelos são inadequados para solução de dispersão de gases em plataformas offshore, porque são válidos para distâncias acima de cem metros, e não consideram a presença de obstáculos reais. Desta forma, o objetivo principal do trabalho foi modelar e analisar o comportamento de nuvens de gás geradas por vazamento na planta de processo da plataforma, baseada em simulação computacional de dispersão gasosa. As simulações foram conduzidas baseando-se no layout de uma plataforma típica e nas condições meteorológicas da região no entorno da plataforma. Os resultados da simulação computacional foram usados para desenvolver um projeto de alta confiabilidade para o sistema de detecção de gás em uma plataforma offshore

Guillain-Barré syndrome: advances and future perspectives

The first case of Guillain-Barré syndrome was described in 1916. Since then, knowledge about the pathophysiology and immunogenesis of this acquired inflammatory polyradiculoneuropathy has been growing steadily, especially after the advent of nerve conduction studies and the discovery of pathogenic autoantibodies. In the present study, we conducted a review of the main information available in the literature to date about the syndrome, including its diagnosis and management

Familial Amyloid Polyneuropathy: A Proposal for an Epidemiological Study Through the Creation of a Virtual Platform

Amyloidosis are characterized by mutations in the gene coding for transthyretin (TTR), located on chromosome 18. TTR is a set of four 127-aminoacid polypeptides structured as homotetrameric protein of 56 kDa with a secondary ß sheet structure. It plays the role of thyroxin (T4) carrier, and has a bindingdomain for retinol (vitamin A). It is synthesized in the liver, although a small quantity is also produced by the choroid plexus, and retinal cells. Mutations of this gene result in loss of tetramer stability. Insoluble amyloid fibrils (AF) are formed and deposited in tissues and organs. The abnormal aggregation ofTTR protein trigger several syndromes, such as familial amyloid polyneuropathy (FAP-TTR), cardiomyopathies (CMP), and senile systemic amyloidosis (SSA). It is estimated there are 5,000 to 10,000 cases of FAP-TTR globally. Objective: The study intends to develop an online platform for the diagnosis of FAP-TTR. The aim is to facilitate the diagnosis process and promote a tool for epidemiological study.Methods: The project was based on a literature review featuring clinical and epidemiological evidence for the development of a practical platform (applied research). Results: It was elaborated a platform containing a questionnaireto allow a more dynamic, cheaper, and efficient operation, mediated by a better characterization of the disease to enable its early diagnosis. Conclusion: The platform might become a valuable resource for the characterization, diagnosis, and future epidemiological study of FAP-TTR

Evaluation of clinical, epidemiological and electrophysiological variables for early diagnosis of amyotrophic lateral sclerosis

Motor neuron disease (MND) is a systemic disease with a broad clinical spectrum. It is characterized by primary involvement of the lower or upper motor neuron (UMN), or both, simultaneously, represented by the most common form, amyotrophic lateral sclerosis (ALS). ALS is rapidly progressive and fatal disease that evolve to death due to respiratory failure, on average, in three to five years since the onset of symptoms. This fact attends to the early and correct diagnosis of the disease. Objective: To evaluate clinical, epidemiological and electrophysiological variables for the early diagnosis of ALS. Methods: This is an observational, descriptive and retrospective study, conducted from the collect of the database, in which the variables were submitted to statistical analysis: Mann-Whitney test and Fisher's exact test. Results: When correlating clinical, epidemiological and electrophysiological findings of patients with ALS and other forms of MND, the variables: age of onset of symptoms (P=0,02) hyperreflexia (P=0,001), presence of bulbar symptoms/signs (P0,001), pathological reflexes (P=0.001), and presence of fasciculation in electromyography (P=0,001) presented statistical significance for the diagnosis of ALS. Conclusion: Despite the small sample size, the findings reinforce the importance of well- done neurological examination, to search for signs of involvement of the UMN, in the first evaluation of patients with suspected MND. And that more research is needed to better understand the different phenotypes of the disease in order to obtain an increasingly early diagnosis to offer improvements in the quality of life of thesepatients

Revisiting the term neuroprotection in chronic and degenerative diseases

Thanks to the development of several new researches, the lifetime presented a significant increase, even so, we still have many obstacles to overcome - among them, manage and get responses regarding neurodegenerative diseases. Where we are in the understanding of neuroprotection? Do we really have protective therapies for diseases considered degeneratives such as amyotrophic lateral sclerosis and its variants, Parkinson's disease, Alzheimer's disease and many others? Neuroprotection is defined by many researches as interactions and interventions that can slow down or even inhibit the progression of neuronal degeneration process. We make some considerations on this neuroprotective effect.Department of Neurology, Antonio Pedro University Hospital, Fluminense Federal University , NiteróiNeurology Service, Nova Iguaçu Hospital , PosseBrain Mapping Laboratory and Electroencephalogram, Federal University of Rio de JaneiroBrain Mapping and Functionality Laboratory, Federal University of PiauíSeverino Sombra University Center, School of Medicine , VassourasDepartment of Neurology, Federal University of São Paulo , BrazilDepartment of Neurology, Federal University of São Paulo , BrazilWeb of Scienc

Currents issues in cardiorespiratory care of patients with post-polio syndrome

Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method: A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. Results and Discussion: Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion: Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.Ctr Univ Augusto Motta, Programa Posgrad Ciencias Reabilitacao, Rio De Janeiro, RJ, BrazilUniv Severino Sombra, Fac Med, Vassouras, RJ, BrazilUniv Fed Rio de Janeiro, Inst Psiquiatria, Lab Mapeamento Cerebral & EEG, BR-22290140 Rio De Janeiro, RJ, BrazilUniv Fed Fluminense, Hosp Univ Antonio Pedro, Niteroi, RJ, BrazilInst Fed Educ Ciencia & Tecnol Rio de Janeiro, Curso Fisioterapia, Rio De Janeiro, RJ, BrazilUniv Fed Piaui, Parnaiba, PI, BrazilUniv Fed Sao Paulo, Dept Neurol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Neurol, Sao Paulo, SP, BrazilWeb of Scienc

Definição e diagnóstico de neuropatia de fibras finas: consenso do Departamento Científico de Neuropatias Periféricas da Academia Brasileira de Neurologia

The aim of this study was to describe the results of a Brazilian Consensus on Small Fiber Neuropathy (SFN). Fifteen neurologists (members of the Brazilian Academy of Neurology) reviewed a preliminary draft. Eleven panelists got together in the city of Fortaleza to discuss and finish the text for the manuscript submission. Small fiber neuropathy can be defined as a subtype of neuropathy characterized by selective involvement of unmyelinated or thinly myelinated sensory fibers. Its clinical picture includes both negative and positive manifestations: sensory (pain/ dysesthesias/pruritus) or combined sensory and autonomic complaints, associated with an almost entirely normal neurological examination. Standard electromyography is normal. A growing list of medical conditions is associated with SFN. The classification of SFN may also serve as a useful terminology to uncover minor discrepancies in the normal values from different neurophysiology laboratories. Several techniques may disclose sensory and/or autonomic impairment. Further studies are necessary to refine these techniques and develop specific therapies.O objetivo deste estudo é descrever os resultados de um Consenso Brasileiro sobre Neuropatia de Fibras Finas (NFF). Quinze neurologistas (membros da Academia Brasileira de Neurologia) revisaram uma versão preliminar do artigo. Onze panelistas se reuniram na cidade de Fortaleza para discutir e terminar o texto para a submissão do manuscrito. NFF pode ser definida como um subtipo de neuropatia caracterizada pelo envolvimento seletivo de fibras sensitivas amielínicas ou pouco mielinizadas. Seu quadro clínico inclui manifestações negativas e positivas: sensitivas (dor/disestesias/prurido) ou queixas sensitivas e autonômicas combinadas, associadas a exame neurológico quase totalmente normal. A eletromiografia convencional é normal. Uma lista crescente de condições médicas causa NFF. NFF também pode servir como uma terminologia útil para referenciar pequenas discrepâncias nos valores normais de diferentes laboratórios de neurofisiologia. Diferentes técnicas podem evidenciar anormalidades sensitivas e/ou autonômicas. São necessários mais estudos para refiná-las e para o desenvolvimento de terapias específicas.Univ Fed Ceara, Fac Med, Hosp Univ Walter Cantidio, Fortaleza, CE, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Dept Neurociencias & Hosp Clin, Ribeirao Preto, SP, BrazilUniv Fed Santa Catarina, Florianopolis, SC, BrazilUniv Fed Rio de Janeiro, Dept Neurol, Rio De Janeiro, RJ, BrazilUniv Fed Cariri, Barbalha, CE, BrazilUniv Fed Fluminense, Fac Med, Dept Neurol, Niteroi, RJ, BrazilUniv Estadual Campinas, Dept Neurol, Campinas, SP, BrazilUniv Regiao Joinville, Joinville, SC, BrazilUniv Fed Sao Paulo, Dept Neurol, Sao Paulo, SP, BrazilUniv Fed Uberlandia, Fac Med, Uberlandia, MG, BrazilHosp Moinhos De Vento, Porto Alegre, RS, BrazilUniv Fed Sao Paulo, Dept Neurol, Sao Paulo, SP, BrazilWeb of Scienc

Currents issues in cardiorespiratory care of patients with post-polio syndrome

ABSTRACT Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned