RESUMO
STUDY OBJECTIVES: The objective of this study was to discern distinguishing characteristics of sleep-related breathing disorders in individuals with chronic spinal cord injury (CSCI) compared with participants without CSCI. Additionally, the study investigated factors associated with sleep-related breathing disorder severity. METHODS: This is a cross-sectional analysis of 123 individuals without CSCI, 40 tetraplegics, and 48 paraplegics who underwent attended or partially supervised full polysomnography for suspected sleep-related breathing disorders in a rehabilitation center. Polysomnographic, transcutaneous capnography, and clinical data were collected and compared between the groups. RESULTS: Among tetraplegics, apnea-hypopnea index ≥ 30 events/h (67.5%, P = .003), central apnea (17.5%, P = .007), and higher oxygen desaturation index (80.0%, P = .01) prevailed. Sleep-related hypoventilation was present in 15.4% of tetraplegics and 15.8% of paraplegics, compared with 3.2% in participants without CSCI (P = .05). In the group without CSCI and the paraplegic group, snoring and neck circumference were positively correlated with obstructive sleep apnea (OSA) severity. A positive correlation between waist circumference and OSA severity was identified in all groups, and multivariate logistic regression analysis showed that loud snoring and waist circumference had the greatest impact on OSA severity. CONCLUSIONS: Severe OSA and central sleep apnea prevailed in tetraplegic participants. Sleep-related hypoventilation was more common in tetraplegics and paraplegics than in participants without CSCI. Loud snoring and waist circumference had an impact on OSA severity in all groups. We recommend the routine implementation of transcutaneous capnography in individuals with CSCI. We underscore the significance of conducting a comprehensive sleep assessment in the rehabilitation process for individuals with CSCI. CITATION: Souza Bastos P, Amaral TLD, Yehia HC, Tavares A. Prevalences of sleep-related breathing disorders and severity factors in chronic spinal cord injury and abled-bodied individuals undergoing rehabilitation: a comparative study. J Clin Sleep Med. 2024;20(7):1119-1129.
Assuntos
Polissonografia , Índice de Gravidade de Doença , Síndromes da Apneia do Sono , Traumatismos da Medula Espinal , Humanos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/epidemiologia , Masculino , Feminino , Estudos Transversais , Adulto , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/complicações , Prevalência , Pessoa de Meia-Idade , Doença Crônica , Paraplegia/complicações , Paraplegia/epidemiologia , Quadriplegia/complicações , Quadriplegia/epidemiologiaRESUMO
Ophthalmological abnormalities may occur in specific subtypes of hereditary spastic paraplegia (HSP) and in genetic diseases that present with spastic paraplegia mimicking HSP. These ophthalmological changes may precede the motor symptoms and include pigmentary retinal degeneration, ophthalmoplegia, optic atrophy, cataracts and nystagmus. Some ophthalmological abnormalities are more prevalent in specific forms of HSP. Considering that the diagnosis of HSP is usually difficult and complex, specific ophthalmological changes may guide the genetic testing. There are other genetic diseases such as autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS), X-linked adrenoleukodystrophy and spastic paraplegia, optic atrophy and neuropathy (SPOAN) that may mimic HSP and also may present with specific ophthalmological changes. In this article, we review the main ophthalmological changes observed in patients with HSP and HSP-like disorders.
Assuntos
Técnicas de Diagnóstico Oftalmológico , Oftalmopatias/diagnóstico por imagem , Oftalmopatias/genética , Paraplegia Espástica Hereditária/diagnóstico por imagem , Paraplegia Espástica Hereditária/genética , Oftalmopatias/epidemiologia , Humanos , Espasticidade Muscular/diagnóstico por imagem , Espasticidade Muscular/epidemiologia , Espasticidade Muscular/genética , Atrofia Óptica/diagnóstico por imagem , Atrofia Óptica/epidemiologia , Atrofia Óptica/genética , Paraplegia/diagnóstico por imagem , Paraplegia/epidemiologia , Paraplegia/genética , Paraplegia Espástica Hereditária/epidemiologia , Ataxias Espinocerebelares/congênito , Ataxias Espinocerebelares/diagnóstico por imagem , Ataxias Espinocerebelares/epidemiologia , Ataxias Espinocerebelares/genéticaRESUMO
The last case of paralytic poliomyelitis caused by wild poliovirus in Brazil occurred in 1989. The interruption of the indigenous poliovirus transmission was obtained through mass immunization campaigns to eligible children and an active epidemiological and laboratorial surveillance of all cases of acute flaccid paralysis (AFP) among children under 15 y of age. This paper describes and evaluates the performance of the AFP surveillance system in different geographic areas of Brazil between 2005 and 2014, using indicators recommended by WHO. AFP surveillance indicators as well as virological investigation of polio and non-polio enteroviruses in stool samples received in the laboratory were assessed from 2005-2014. During the period, 5463 cases of AFP were investigated. Of these, 55% were males and 45% were females. Those under 5 y of age represented 48% of all cases reported and investigated. AFP notification rate was within the acceptable values with mean value of 1.3 (North), 1.4 (Northeast), 1.1 (Southern), 1.0 (Southeast) and 1.4 (Midwest) cases of AFP per 100.000 population aged 15 y as well as the adequacy of fecal specimens received in the laboratory. Sabin- related polioviruses accounted for 1.7% of the isolates while, 6.7% were non-polio enterovirus with the values ranging from 5.0% to 8.9 %. No wild-type polio was found. The AFP epidemiological and laboratorial surveillance activities have been kept at appropriate levels in Brazil. These data are a very strong indication, which supports the status of country free of polio.
Assuntos
Enterovirus/classificação , Enterovirus/isolamento & purificação , Monitoramento Epidemiológico , Fezes/virologia , Paraplegia/epidemiologia , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
The family Picornaviridae is a large and diverse group of viruses that infect humans and animals. Picornaviruses are among the most common infections of humans and cause a wide spectrum of acute human disease. This study began as an investigation of acute flaccid paralysis (AFP) in a small area of eastern Bolivia, where surveillance had identified a persistently high AFP rate in children. Stools were collected and diagnostic studies ruled out poliovirus. We tested stool specimens from 51 AFP cases and 34 healthy household or community contacts collected during 2002-2003 using real-time and semi-nested reverse transcription polymerase chain reaction assays for enterovirus, parechovirus, cardiovirus, kobuvirus, salivirus and cosavirus. Anecdotal reports suggested a temporal association with neurological disease in domestic pigs, so six porcine stools were also collected and tested with the same set of assays, with the addition of an assay for porcine teschovirus. A total of 126 picornaviruses were detected in 73 of 85 human individuals, consisting of 53 different picornavirus types encompassing five genera (all except Kobuvirus). All six porcine stools contained porcine and/or human picornaviruses. No single virus, or combination of viruses, specifically correlated with AFP; however, the study revealed a surprising complexity of enteric picornaviruses in a single community.
Assuntos
Infecções por Picornaviridae/epidemiologia , Infecções por Picornaviridae/virologia , Picornaviridae/classificação , Picornaviridae/genética , Adolescente , Animais , Bolívia/epidemiologia , Criança , Pré-Escolar , Fezes/virologia , Feminino , Humanos , Lactente , Masculino , Epidemiologia Molecular , Dados de Sequência Molecular , Paraplegia/epidemiologia , Paraplegia/virologia , Picornaviridae/isolamento & purificação , Infecções por Picornaviridae/veterinária , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , População Rural , Análise de Sequência de DNA , Suínos , Doenças dos Suínos/epidemiologia , Doenças dos Suínos/virologia , Adulto JovemRESUMO
STUDY DESIGN: Clinical and radiographic evaluation of the shoulders of tetraplegic and paraplegic patients who attend rehabilitation program. OBJECTIVES: The objective of this study is to establish the usefulness of radiography as a trial exam for shoulder pain in spinal cord injured patients. SETTING: Hospital das Clinicas-UNICAMP. Campinas, Sao Paulo, Brazil. METHODS: Thirty-two shoulders of 16 patients were evaluated by clinical exam and radiography. Patients were divided into two groups: paraplegic and tetraplegic. A control group of 16 normal volunteer subjects was selected. RESULTS: Shoulder pain was reported in 88.89% of tetraplegic and 42.85% of paraplegic. The time of injury ranged from 1.5-22 years (mean 7.88 years); patients had a mean age of 34.68 years (range, 21-57 years). The acromioclavicular joint (ACJ) space ranged from 0.03-0.7 cm on the right side and 0.15-0.7 cm on the left side, with a mean of 0.37 and 0.41 cm, respectively. No correlation was found between shoulder pain and gender, age or time since injury. There was a trend to correlation between shoulder pain and type of injury with tetraplegic having a tendency to pain symptoms. On average, tetraplegic had smaller ACJ. CONCLUSIONS: The small number of patients in this study did not allow us to confirm the hypothesis that X-ray finding may indicate risk for shoulder pain in spinal cord injury patients. A work with a greater number of subjects could demonstrate association between shoulder pain and the reduced acromioclavicular distance, making plain radiography a trial exam for spinal cord-injured patients.
Assuntos
Paralisia/epidemiologia , Dor de Ombro/diagnóstico por imagem , Dor de Ombro/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Adulto , Comorbidade/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia/diagnóstico por imagem , Paralisia/reabilitação , Paraplegia/diagnóstico por imagem , Paraplegia/epidemiologia , Quadriplegia/diagnóstico por imagem , Quadriplegia/epidemiologia , Radiografia , Dor de Ombro/fisiopatologia , Traumatismos da Medula Espinal/diagnóstico por imagem , Adulto JovemRESUMO
The evaluation of the contribution of neurological dengue in suspected central nervous system (CNS) viral infections is essential to better understand the impact of neurological dengue on morbidity and mortality in dengue endemic regions such as Jamaica. For this study, 401 cases of suspected viral CNS infections were investigated for evidence of dengue infection. The frequency of neurological dengue among these CNS cases was found to be 13.5% (54/401). Fifty-three cases were confirmed serologically by haemagglutination inhibition assay (HI) and IgM antibody (ELISA) and the virus was isolated in one case only. Clinical manifestations among dengue positive CNS cases included encephalitis in 51.8% (28/54), meningitis in 33.3% (18/54), seizures in 11.1% (6/54) and acute flaccid paralysis/Guillain-Barré syndrome in 3.7% (2/54). The clinical diagnosis of dengue neurological infection corresponded with laboratory confirmation in 22.2% (12/54) of cases only. Deaths occurred in 3.7% (2/54) of cases and were associated with patients with dengue neurological infection. The high risk of dengue among patients with suspected viral CNS infections in this study supports the need for an increased index of suspicion of dengue in patients presenting with neurological manifestations in dengue endemic countries.
La evaluación de la contribución del dengue neurológico en las infecciones virales sospechadas del sistema nervioso central (SNC) resulta esencial para un mejor entendimiento del impacto del dengue neurológico en la morbilidad y mortalidad en regiones donde el dengue es endémico tales como Jamaica. Para este estudio 401 casos de infecciones virales sospechadas del SNC fueron investigados en busca de evidencia de infección por dengue. Se haló entonces que la frecuencia del dengue neurológico entre estos casos de SNC, fue de 13.5% (54/401). Cincuenta y tres casos fueron confirmados por serología mediante ensayos de inhibición de hemaglutinación (IH) y ELISA para la detección de anticuerpos IgM, siendo el virus aislado sólo en un caso. Las manifestaciones clínicas entre los casos que resultaron positivos al dengue, incluyeron encefalitis en 51.8 % (28/54), meningitis en 33.3% (18/54), convulsiones en 11.1% (6/54) y parálisis facial aguda/síndrome Barré Guillain en 3.7% (2/54). El diagnóstico clínico de infección neurológica por dengue estuvo en correspondencia con la confirmación del laboratorio sólo en el 22.2% (12/ 54) de los casos. Se produjeron muertes en el 3.7% (2/54) de los casos, las cuales estuvieron asociadas con pacientes con infección neurológica por dengue. El alto riesgo de dengue entre los pacientes con sospecha de infecciones virales de SNC en este estudio, apunta a la necesidad de aumentar el índice de sospecha de dengue en pacientes que se presentan con manifestaciones neurológicas en países donde el dengue es endémico.
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Dengue/complicações , Dengue/epidemiologia , Dengue/fisiopatologia , Encefalite/epidemiologia , Encefalite/etiologia , Encefalite/virologia , Síndrome de Guillain-Barré/epidemiologia , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/virologia , Imunoglobulina M/sangue , Jamaica/epidemiologia , Meningite/epidemiologia , Meningite/etiologia , Meningite/virologia , Paraplegia/epidemiologia , Paraplegia/etiologia , Paraplegia/virologia , Fatores de Risco , Convulsões/epidemiologia , Convulsões/etiologia , Convulsões/virologiaRESUMO
The evaluation of the contribution of neurological dengue in suspected central nervous system (CNS) viral infections is essential to better understand the impact of neurological dengue on morbidity and mortality in dengue endemic regions such as Jamaica. For this study 401 cases of suspected viral CNS infections were investigated for evidence of dengue infection. The frequency of neurological dengue among these CNS cases was found to be 13.5% (54/401). Fifty-three cases were confirmed serologically by haemagglutination inhibition assay (HI) and IgM antibody (ELISA) and the virus was isolated in one case only. Clinical manifestations among dengue positive CNS cases included encephalitis in 51.8% (28/54), meningitis in 33.3% (18/54), seizures in 11.1% (6/54) and acute flaccid paralysis/Guillain-Barré syndrome in 3.7% (2/54). The clinical diagnosis of dengue neurological infection corresponded with laboratory confirmation in 22.2% (12/54) of cases only. Deaths occurred in 3.7% (2/54) of cases and were associated with patients with dengue neurological infection. The high risk of dengue among patients with suspected viral CNS infections in this study supports the need for an increased index of suspicion of dengue in patients presenting with neurological manifestations in dengue endemic countries.
Assuntos
Dengue/complicações , Dengue/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Dengue/fisiopatologia , Encefalite/epidemiologia , Encefalite/etiologia , Encefalite/virologia , Feminino , Síndrome de Guillain-Barré/epidemiologia , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/virologia , Humanos , Imunoglobulina M/sangue , Lactente , Jamaica/epidemiologia , Masculino , Meningite/epidemiologia , Meningite/etiologia , Meningite/virologia , Pessoa de Meia-Idade , Paraplegia/epidemiologia , Paraplegia/etiologia , Paraplegia/virologia , Fatores de Risco , Convulsões/epidemiologia , Convulsões/etiologia , Convulsões/virologia , Adulto JovemAssuntos
Botulismo/veterinária , Doenças dos Bovinos/epidemiologia , Surtos de Doenças/veterinária , Paraplegia/veterinária , Tétano/veterinária , Animais , Botulismo/complicações , Botulismo/epidemiologia , Bovinos , Doenças dos Bovinos/microbiologia , Doenças dos Bovinos/mortalidade , Colômbia/epidemiologia , Fezes/microbiologia , Conteúdo Gastrointestinal/microbiologia , Fígado/microbiologia , Camundongos , Paraplegia/epidemiologia , Paraplegia/microbiologia , Paraplegia/mortalidade , Rúmen/microbiologia , Tétano/complicações , Tétano/epidemiologiaRESUMO
Os autores apresentam dados sobre as principais causas de lesoes traumaticas da coluna vertebral, em particular aquelas que provoquem tetraplegia ou paraplegia em virtude da lesao medular associada. Entre as causas mais frequentes sao observados os acidentes de transito, os ferimentos por arma de fogo, as quedas e os acidentes por mergulho. Salientam que o mais evitavel destas causas e o acidente por mergulho, sendo apresentado o material da campanha de prevencao deste tipo de lesao que vem sendo desenvolvida pelo Departamento de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de Sao Paulo