Adductor Pollicis Research Articles

When age matters: boys with Duchenne muscular dystrophy have growth delay and a fat mass accumulation, as they get older

Anthropometry and body composition evaluation in boys with Duchenne muscular dystrophy (DMD) are challenging, but crucial methods to evaluate the nutritional status, and better anthropometric reference values and body composition predictive equations are needed for this population. Based on these aspects, this study aimed to investigate the hypothesis that changes in anthropometric parameters and body composition of boys with DMD occur according to age. A cross-sectional study with 49 individuals diagnosed with DMD at the neurological outpatient facility at the Onofre Lopes University Hospital in Natal, Brazil, was performed between September 2016 and March 2019. These individuals underwent anthropometric and body composition evaluation. According to age, the participants were divided into four groups: G1 (2.6 - 8.2y), G2 (8.5 - 10.8y), G3 (11.0 - 14.0y), and G4 (15.9 - 23.0y). The parameters weight-for-age (W/A) (p=0.025), tricipital skinfold (TSF) (p=0.027), adductor pollicis muscle (p=0.041), and corrected arm muscle area (cAMA) (p=0.005) were different among the groups. Regarding anthropometric parameters, was prevalence in the categories of appropriate W/A and a height-for-age (H/A), and eutrophy for body mass index-for-age (BMI/A). For the TSF, there was a higher frequency of severe malnutrition or obesity. The cAMA indicated severe malnutrition in most individuals. As for %FM, high adiposity was more frequent, increasing over age groups (G1 to G4). The boys with DMD presented different patterns of anthropometric and body composition parameters. An increase of fat mass and a decrease of lean mass with age/disease progression were observed.

Immediate Effects of Dry Needling on the Autonomic Nervous System and Mechanical Hyperalgesia: A Randomized Controlled Trial.

Background: Dry needling (DN) is often used for the treatment of muscle pain among physiotherapists. However, little is known about the mechanisms of action by which its effects are generated. The aim of this randomized controlled trial was to determine if the use of DN in healthy subjects activates the sympathetic nervous system, thus resulting in a decrease in pain caused by stress. Methods: Sixty-five healthy volunteer subjects were recruited from the University of Alcala, Madrid, Spain, with an age of 27.78 (SD = 8.41) years. The participants were randomly assigned to participate in a group with deep DN in the adductor pollicis muscle or a placebo needling group. The autonomic nervous system was evaluated, in addition to local and remote mechanical hyperalgesia. Results: In a comparison of the moment at which the needling intervention was carried out with the baseline, the heart rate of the dry needling group significantly increased by 20.60% (SE = 2.88), whereas that of the placebo group increased by 5.33% (SE = 2.32) (p = 0.001, d = 1.02). The pressure pain threshold showed significant differences between both groups, being significantly higher in the needling group (adductor muscle p = 0.001; d = 0.85; anterior tibialis muscle p = 0.022, d = 0.58). Conclusions: This work appears to indicate that dry needling produces an immediate activation in the sympathetic nervous system, improving local and distant mechanical hyperalgesia.

Older adults are not more susceptible to acute muscle atrophy after immobilisation compared to younger adults: a systematic review

PurposeTo identify if older adults are more susceptible to acute muscle atrophy compared to younger adults.MethodsAll studies whose design involved a period of enforced immobilisation and a comparison between an older (> 40) and a younger cohort (< 40) were included. Outcome of interest was change in muscle mass, measured by radiological techniques or histological analysis of fibre size. Medline, Embase and Cochrane databases were systematically searched and records screened by two independent reviewers. Studies selected for inclusion were critically appraised and individually assessed for risk of bias. GRADE framework guided the assessment of quality of studies.ResultsEight articles were included (193 participants). 14 (7.3%) were female and 102 (52.8%) were in older groups. Mean age for older adults was 66.3 years and for younger adults 23.3 years. Immobilisation periods spanned 4–14 days as simulated by bed rest, limb brace or limb cast. Studies measured muscle mass by DXA, CT, MRI or fibre cross-sectional area, or a combination of each. Muscles studied included quadriceps, adductor pollicis, vastus lateralis or combined lean leg mass.Of the radiological measures, three studies (74 participants) reported greater atrophy in the older group, three studies (76 participants) reported greater atrophy in the younger group. Reduction in muscle mass varied in older adults between 0.19 and 0.76% per day, and for younger adults between 0.06 and 0.70% per day. Due to substantial heterogeneity, a meta-analysis was not performed. Five studies reported fibre size. Change in fibre size varied considerably between each study, with no convincing overall trend for either older or younger groups.ConclusionThe current literature suggests that there is no difference in the rate of muscle atrophy after immobilisation in older people compared to younger people, and therefore that older people are not more susceptible to atrophy in the acute setting. However, the findings are inconsistent and provide statistically significant but opposing results. There is a lack of high-quality research available on the topic, and there is a paucity of literature regarding atrophy rates in women.

Outcomes and Complications of Tendon Transfers to Address Pinch and Grasp Weakness: A Systematic Review of the Operative Management of Ulnar Nerve Paralysis.

Patients with ulnar nerve paralysis note difficulties performing activities of daily living because of weakness of pinch and altered grasp mechanism. This review investigates outcomes of tendon transfers for ulnar nerve paralysis to assist in shared decision-making with patients during preoperative counseling and to inform operative choices. A systematic review was conducted to identify studies reporting outcomes following tendon transfer for ulnar nerve palsy. Studies were screened according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and inclusion and exclusion criteria were applied. Primary outcome measures included postoperative pinch strength and mechanism of grasp. A total of 26 studies (687 patients) met criteria for inclusion. After pooled analysis, the flexor digitorum superficialis lasso procedure yielded the highest rate of complete correction of claw deformity (60.6 percent), followed by flexor digitorum superficialis four-tail operation (31.4 percent). The extensor carpi radialis longus four-tail operation yielded the greatest improvement in grip strength (3.8 kg). The extensor carpi radialis brevis four-tail operation resulted in the best open hand assessment and mechanism of closing scores; however, these studies did not objectively evaluate grip strength. The greatest increase in pinch strength was following tendon transfer to adductor pollicis alone. Despite the heterogeneous data, if the primary goal is improvement in the appearance of claw deformity, the evidence supports flexor digitorum superficialis lasso transfer. However, if the primary concern is grip strength, the data favor extensor carpi radialis longus four-tail transfer. When pinch strength is functionally limiting, adductorplasty alone is most effective. These data will assist providers in appropriately informing patients of common risks and complications and setting realistic expectations following tendon transfer procedures.

Comparison of muscle activity while using different input devices in digital pathology

IntroductionThe high prevalence of musculoskeletal disorders in pathologists, together with the current trend towards the digitization of pathology, prompted us to study the different types of input devices employed during the revision of whole slide images, in order to investigate the pattern and extent of muscle activity involved in their use. Material and methodsA comparative study was made of 10 input devices (conventional and vertical mouse, three trackballs, the Ergopointer™, the Rollermouse™, an optical pen mouse, a touchpad, and the Leap Motion™). Six medical students performed a standardized circuit using a Fitts’ Law based tissue array, digitized. The electrical activity of seven upper limb muscles (adductor pollicis, extensor pollicis longus, extensor digitorum, flexor digitorum, middle deltoid, upper trapezius, and middle trapezius) was measured using surface electromyography. ResultsStatistically significant differences in the overall electrical activity among the different input devices, both absolute values in mV as well as normalized values to the upper limb at rest, were observed (p<0.001); the Rollermouse™ (0.1027mV; 139%), Logitech M570 trackball (0.1053mV; 145%), Ergopointer™ (0.1151mV; 167%), conventional mouse (0.1251mV; 191%), and vertical mouse (0.1312mV; 205%) required less activity, while the optical pen mouse (0.1717mV; 299%), Leap Motion™ (0.1803mV; 319%), Expert Mouse trackball (0.1845mV; 329%), EIGIIS trackball (0.2442mV; 468%) and the touchpad (0.2560mV; 496%) required greater muscle mobilization. ConclusionWe designed a system based on Fitts’ Law to compare input devices in digital pathology.Variability between compared devices and muscle activity was found. Long-term use could result in different muscular fatigue patterns.Even though the selection of an input device is a matter of personal preference, its impact on ergonomics should be considered.

Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan.

Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.

Comparison of the TetraGraph and TOFscan for monitoring recovery from neuromuscular blockade in the Post Anesthesia Care Unit

Study objectiveComparison of the TetraGraph (TG) and TOFscan (TS) for monitoring recovery from neuromuscular blockade in the Post Anesthesia Care Unit (PACU). DesignRandomized, multicenter trial. SettingPACU in three tertiary care hospitals. Patients120 patients (40 per site) receiving neuromuscular blockade during elective surgery. InterventionsPatients were enrolled preoperatively and intraoperative neuromuscular blockade management was at the discretion of the anesthesiologist. Upon arrival to the PACU, patients were randomized to have either TG or TS placed on their dominant hand. The alternate device (TS or TG) was placed on the non-dominant hand. Following simultaneous ulnar nerve stimulation on each arm, the response of the adductor pollicis was measured. MeasurementsTrain-of-four ratios (TOFRs) were obtained upon arrival to the PACU (t = 0), after 5 min (t = + 5) and after +10 min (t = + 10). Main resultsThere was there was no significant difference in the mean TOFRs obtained with the TG and TS at t = 0 (0.97 ± 0.18 vs 0.94 ± 0.13, P = 0.06, respectively) and t = + 5 (0.96 ± 0.20 vs 0.95 ± 0.12, P = 0.29, respectively). At (t = + 10), there was a statistically significant difference in mean TOFRs obtained with the TG and TS, (0.99 ± 0.14 vs 0.94 ± 0.12, P < 0.001, respectively). The bias between devices at t = 0 was estimated to be 0.03 (95% CI, −0.29 to 0.35, P = 0.26); at t = + 5 min, it was estimated to be 0.02 (95% CI, −0.36 to 0.40, P = 0.54); and at t = +10 min, it was estimated to be 0.05 (95% CI, −0.25 to 0.36, P = 0.77). ConclusionsTS and TG provide interchangeable quantitative measurements once the TOF ratio has returned to a value of 0.90 or greater in the PACU.

Modeling and Reproducibility of Twin Concentric Electrical Impedance Myography.

Electrical impedance myography (EIM) is a recent technology to assess muscle health. As of today, the clinical application of EIM has been applied only to evaluate muscle condition using non-invasive surface electrodes in contact with the skin; however, intermediate tissues at the recording site introduce confounding artifacts which reduce the technique's performance as a biomarker of neuromuscular disorders (NMD). Here, we develop and test in humans a new approach using two concentric needles for intramuscular EIM recordings. First, we study the recording characteristics of dual concentric needle EIM via analytical models and finite element models (FEMs). Next, the validity of the models is verified by performing experiments on saline and agar phantoms. Finally, 8 subjects with various neuromuscular diseases were studied measuring tibialis anterior, biceps, deltoid, adductor pollicis brevis, first dorsal interosseous and flexor carpi radialis muscles. Analytical and FEM simulations are in good agreement with a maximum experimental discrepancy 8% and 9% using gauge needles 26 and 30, respectively. The inter-session reproducibility, as measured by the intraclass correlation coefficients for all muscles studied, was 0.926, which is comparable or exceeds the reproducibility of other well-established electrophysiological tests to assess muscle health. The reproducibility of the technique support future clinical validation of needle EIM for assessment of disease status, either as part of standard patient care or as biomarker measure in clinical trials. Needle EIM has the potential of becoming a valuable diagnostic tool to evaluate NMD in adult population.

Soft tissue abnormalities in Wassel Type VI radial polydactyly: a detailed anatomical study.

Wassel VI radial polydactyly is associated with metacarpal adduction and radial deviation of the metacarpophalangeal joint of the ulnar duplicate. The soft tissue abnormalities responsible for these deformities were characterized using preoperative multi-planar three-dimensional ultrasound and intraoperative observation in four patients. In all patients, the abductor pollicis brevis and superficial head of the flexor pollicis brevis inserted into the radial first metacarpal, whereas the adductor pollicis and deep head of the flexor pollicis brevis inserted into the ulnar thumb. Aberrant location of the flexor pollicis longus and absence of the A1 pulley system was associated with severe radial deviation. An additional superficial thenar muscle along the ulnar metacarpal was associated with minimal metacarpal adduction. Uneven forces on the ulnar duplicate could be associated with these characteristic deformities and joint instability. Knowledge of these abnormalities allows better planning of surgery and further insight into this rare radial polydactyly configuration.Level of evidence: II.

Métodos para avaliação da sarcopenia em pacientes hospitalizados com câncer do trato gastrointestinal

Introduction: Sarcopenia is characterized by the association of loss of lean mass and functionality, and in cancer patients it is a frequent situation. Thus, the study aims to assess the presence of sarcopenia in hospitalized patients with cancer of the gastrointestinal tract using alternative assessments to analyse the patient’s strength and functionality. Methods: To assess sarcopenia in cancer patients, the thickness of the adductor pollicis muscle (APM), dynamometry to assess handgrip strength and the Barthel Scale to analyse functionality were collected, associating APM and dynamometer and MAP. with Barthel scale in cancer patients. Results: Twenty patients participated in the study, with moderately malnourished patients showing greater strength in the dynamometer in relation to the well-nourished ones and that obese individuals had greater APM in relation to other nutritional states. Regarding functionality, most patients 80% were classified as independent. Patients with esophageal cancer had MAP inferior to the other locations of the body evaluated, but compared with the dynamometer they presented better results. Conclusions: There was no high prevalence of sarcopenia among patients with cancer of the gastrointestinal tract using the methods used APM, dynamometer and Barthel Scale.

A espessura do músculo adutor do polegar não está associada a Proteína C Reativa em pacientes com câncer hospitalizados

Objective: To evaluate the association between blood of C-reactive protein concentrations and an indicator of muscle mass in hospitalized cancer patients. Methods: A cross-sectional study carried out with 110 patients of both sexes, aged ≥18 years, with solid and/or liquid cancer undergoing clinical and/or surgical treatment. Clinical and socioeconomic data were obtained from medical records. The adductor pollicis muscle thickness was obtained using skinfold caliper. Patients were divided into two groups: altered adductor pollicis muscle thickness (&lt;13.4 mm) and normal adductor pollicis muscle thickness (≥13.4 mm). Logistic regression was performed to verify the association between adductor pollicis muscle thickness and C-reactive protein. Results: It was observed that 90% (n = 100) of the patients were classified with reduced adductor pollicis muscle thickness, higher prevalence of the solid tumor, low usual weight, current weight, and body mass index. The logistic regression analysis showed no association between the adductor pollicis muscle thickness and C-reactive protein concentrations, in any of models used: model without adjustment (OR: 1.01; 95% CI [0.94-1.09], p = 0.65); adjusted for sex and age (OR: 1.01; 95% CI [0.94-1.09], p = 0.61); and adjusted model for sex, age and body mass index (BMI) (OR: 1.04; 95% CI [0.96-1.13], p = 0.29). Conclusion: Although adductor pollicis muscle thickness is validated method for nutritional assessment, we did not find an association with the inflammation marker (C-reactive protein).

CORRELATION OF BODY MASS INDEX WITH THE HAND GRIP STRENGTH AND ADDUCTOR POLLICIS MUSCLE THICKNESS IN ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS AND SYSTEMIC LUPUS ERITEMATOSUS IN A BRAZIL NORTHEAST REFERENCE CENTER

Introduction: Rheumatoid arthritis and systemic lupus erythematosus are autoimmune, chronic and progressive diseases, which can be get worst in the presence of muscle mass loss due to physical inactivity and continuous inflammatory. Therefore, estimate body composition can assist in the treatment of these diseases. Objective: To evaluate the correlation of body mass index with handgrip strength and adductor pollicis muscle thickness in elderly patients with rheumatoid arthritis and systemic lupus erythematosus followed in a reference center in Brazil. Material and Methods: Cross-sectional study carried out in a rheumatology outpatient clinic in a reference center in Northeastern Brazil (Recife / PE). Elderly patients with rheumatoid arthritis and systemic lupus erythematosus. Anthropometric measurements of weight, height and Body Mass Index (BMI) were taken, in addition to the measurement of body composition: calf circumference (CC), arm circumference (MUAC), adductor pollicis muscle thickness (APMT) and strength of hand grip (HGS). The data were treated using the SPSS version 17.0 for Windows and Excel 2010. Pearson correlation and the Chi-square test were used for analysis. The level of significance was set at 5%. The IMIP Research Bioethics Committee approved the present study under No. 19163619.1.0000.5201 the participants’ guardians signed the Free and Informed Consent Form (ICF). Results: The study included 19 patients aged 60 to 85 years and a mean age of 70.05 years +/- 8.47 SD, 94.74% of whom were female. The BMI, MUAC, CC, APMT and HGS mean of (26.93g / m2 ± 5.75DP), (28.85 ± 4.06DP), (34.79 ± 3.62DP), (11.52 ± 4.437DP) and (10.81 ± 6.77DP) respectively. The BMI showed that 31.26 were overweight, while HGS showed that 66.7% had a deficit in handgrip strength justified by the high prevalence of depletion of the adductor pollicis muscle, which identified that 97.4% showed signs of depletion of this musculature. There was a moderate correlation between BMI, MUAC and CC (r = 0.453) and (r = 0.426), respectively, while for BMI and APMT the correlation was weak (r = 0.348), as well as the correlation between BMI and HGS was r = 0.005. Conclusions: There was a prevalence of eutrophic and overweight elderly people, however with loss of muscle mass and decreased hand grip strength. This may suggest a greater risk for the development of senile sarcopenia.

Association of adductor pollicis muscle thickness and handgrip strength with nutritional status in hospitalized individuals.

Background: malnutrition is common in hospitalized patients and early diagnosis can contribute to better clinical and nutritional outcomes. Adductor pollicis muscle thickness (APMT) and handgrip strength (HGS) have been used to identify reductions in strength and muscle mass, associated or not with conventional methods. Objective: we aimed to correlate APMT and HGS with conventional anthropometric variables in hospitalized patients, and assess their relationship with nutritional status as evaluated by the Patient-Generated Subjective Global Assessment (PG-SGA) method. Methods: a cross-sectional study was conducted in patients of both sexes admitted to a University Hospital in Brazil. APMT, HGS, and conventional measures were used for anthropometric assessment. PG-SGA was used for the assessment of nutritional status. Results: the sample included 73 patients (66.9 ± 9.6 years). Most patients were admitted for surgery procedures (53.4 %) and had an adequate body mass index (BMI) (47.9 %), while according to PG-SGA most patients (67.1 %) had some degree of malnutrition (B and C). Right-hand (R) APMT was significantly correlated with corrected arm muscle area (cAMA), calf circumference (CC), and HGS. Left-hand (L) APMT was significantly correlated with cAMA, arm circumference (AC), CC, PG-SGA score, and HGS. Both HGS values (R/L) were significantly correlated with CC, PG-SGA score, and APMT. Conclusions: APMT and HGS were significantly correlated with the conventional anthropometric measure CC. In addition, the significant correlation observed between HGS, APMT, and PG-SGA highlights them as complementary assessments of nutritional status in clinical practice and for research purposes.

Avaliação antropométrica e sintomas gastrointestinais de pacientes em tratamento oncológico em uma cidade do interior de São Paulo

Introduction: Cancer and its treatment modalities have a negative impact on the nutritional status of patients. The purpose of this study is to evaluate anthropometric measurements and the presence of gastrointestinal symptoms in patients undergoing cancer treatment. Methods: This is a study carried out with 50 patients over 18 years of age undergoing cancer treatment. For anthropometric assessment, weight and height measurements were performed to calculate the body mass index (BMI) and the measurements of the adductor pollicis muscle thickness (APMT), arm (AC) and calf (CC) circumference, in addition to the triceps skin fold (TSF). Gastrointestinal symptoms were questioned in an interview. Results: Most participants were female (72%), aged 60 years or over. According to the BMI, 46% of the patients were overweight. The lowest mean BMI was found in individuals with colon and rectal neoplasia (23.2 ± 3.9 kg/m²) and this measure was correlated to the other anthropometric measures: AC (r = 0.84; p = 0.001); CC (r = 0.75; p = 0.009) and TSF (r = 0.72; p = 0.012). APMT revealed 92% of inadequacy, while AC and CC measurements indicated 40% and 24% of inadequacy, respectively. The most prevalent gastrointestinal symptoms were: hyporexia, nausea, vomiting, diarrhea and constipation. Conclusion: The present study identified a high prevalence of nutritional risk, characterized by excess weight and muscle depletion, in patients undergoing cancer treatment. Patients with colorectal cancer had their nutritional status even more impaired and a higher frequency of gastrointestinal symptoms.

Adductor pollicis muscle thickness and the nutritional and functional status in individuals with COPD submitted to pulmonary rehabilitation: a pilot study

Adductor pollicis muscle thickness and the nutritional and functional status in individuals with COPD submitted to pulmonary rehabilitation: a pilot study

Associação do músculo adutor do polegar com o estado nutricional de pacientes hospitalizados

Introduction: The measurement of the thickness of the adductor pollicis muscle (EMAP) has been of great importance in clinical practice, as a method of assessing the nutritional status of hospitalized patients, being a good measure to obtain a diagnosis of catabolic diseases, such as malnutrition, associated with other parameters. The purpose of this study is to associate the MAP thickness with the nutritional status of hospitalized patients in a public hospital in the city of Juazeiro-BA. Methods: Cross-sectional and quantitative study, with 221 patients admitted to the medical and emergency clinics of the Hospital Regional de Juazeiro (HRJ). The EMAP, weight, height, arm circumference (AC), abdomen circumference (AbC), calf circumference (CC) and triceps skinfold (TSF) were measured; as well as calculated the body mass index (BMI). Data analysis was performed using the software Statistical Package for Social Science 13.0, significance level of 5%. Results: There was an association between the EMAP and the other classic anthropometric measures, reflecting the relationship with nutritional status, and a higher correlation with CC (p = 0.482), and a lower correlation with AbC (p = 0.315). Conclusion: The EMAP can be correlated to the nutritional status of hospitalized patients, since it presented lower values in patients with muscular depletions and can be used in clinical practice as a good method of nutritional risk assessment associated with other parameters.

Músculo adutor do polegar e força de preensão palmar: métodos potenciais de avaliação nutricional em pacientes cirúrgicos

Measurements of the adductor pollicis muscle thickness (APMT) and handgrip strength (HGS) are easy and quick to apply, low cost, and may detect changes in nutritional status in the short term. The use of these measurements would speed up the nutritional diagnosis and optimize the care of hospitalized patients. The aim of this study was to evaluate the association between APMT and HGS with anthropometric parameters, subjective global assessment (SGA), and biochemical markers in patients admitted for digestive tract and adnexal organ surgery. This is a cross-sectional study in which body mass index (BMI), arm circumference (AC), triceps skinfold thickness, arm muscle circumference, APMT, HGS, SGA and biochemical variables were evaluated. A total of 56 patients participated, showing that the increase of one unit in the AC promoted an increase of 0.73 kgf in the HGS (95%CI: 0.30;1.17, p=0.002). A one-unit increase in normal weight, AC, and serum albumin adjusted for height, age, and gender was associated with higher APMT values (normal weight: 0.92 mm, 95%CI: 0.18;1.66, p=0.017; AC: 0.69 mm, 95%CI: 0.27;1.11, p=0.006; serum albumin 1.83 mm, 95%CI: 0.10;3.57, p=0.039). On the other hand, the increase of one unit in weight loss (%) and BMI resulted in a reduction of 0.85 mm (95%CI: -1.46;-0.25, p=0.008) and 2.80 mm in the APMT (95%CI: -4.73;-0.88, p=0.006), respectively. There is a positive association between HGS and AC and between APMT, normal weight, AC, and serum albumin, and an inverse association between APMT, BMI, and percentage of weight loss.

Charcot identifies and illustrates amyotrophic lateral sclerosis.

Jean-Martin Charcot described what he called amyotrophic lateral sclerosis in his 12th and 13th lessons published in 1873 by Bourneville. He distinguished the symptoms that were related to the lesion of the anterior horn of the spinal cord and those that were due to the degeneration (that he named "sclerosis") of its lateral column. He thought that "inflammation" progressed from the lateral column to the anterior horn (but the term inflammation is not to be taken in the current meaning): the lesion of the anterior horn was thus "deuteropathic". An album containing drawings made by Charcot is kept in La Salpêtrière Neuropathology Department. Four drawings are pasted on one of its pages, showing the degeneration of the pyramidal tract. They constitute the original of the engravings illustrating Charcot's 12th lesson. The illustration of the fascicular atrophy of the adductor pollicis presented in the album does not appear in the lessons, even though this alteration is widely discussed and linked to the lesion of the anterior horn, which was supposed to ensure the "nutrition" of the muscle. The technique used by Charcot and his interpretation of the microscopic pictures, as exposed in his lessons, are discussed.

RELAÇÃO ENTRE A MEDIDA DA ESPESSURA DO MÚSCULO ADUTOR DO POLEGAR E O PERCENTUAL DE CONSUMO ALIMENTAR EM PACIENTES HOSPITALIZADOS

A avaliação nutricional é um processo sistemático, sendo o primeiro passo da assistência nutricional, a fim de identificar problemas ligados à nutrição, o Nutrition Risk Screening – NRS 2002 entra como instrumento de avaliação nutricional, e pode ser aplicado independentemente da doença e da idade, sendo um dos mais recomendados, em âmbito hospitalar. O presente artigo teve por objetivo avaliar a relação entre a medida da Espessura Do Músculo Adutor Do Polegar (EMAP) com o percentual de consumo alimentar em pacientes hospitalizados. A coleta foi submetia em pacientes acima de vinte anos, homens e mulheres, alimentando-se oralmente em um hospital da cidade de Cascavel. Os dados concluem que os indivíduos com risco nutricional, possuem um consumo alimentar menor do que indivíduos sem risco nutricional, sendo possível compreender a relevância e a influência direta do consumo alimentar diante dos dados antropométricos, como perda muscular e de outros tecidos.

MALNUTRITION IN CIRRHOSIS: ASSOCIATION WITH ETIOLOGY AND HEPATOCELLULAR DYSFUNCTION.

The protein-energy malnutrition alters the prognosis of patients with cirrhosis. Its prevalence may vary according to the etiology of liver disease, it´s severity and the evaluation of the method applied. The infection by the hepatitis C virus (HCV) and alcoholism are the main etiologies of cirrhosis and result in a significant morbidity and mortality. To evaluate the nutritional status of patients with cirrhosis according the liver disease etiology and severity. It is a prospective study, in which the sample was for convenience and consisted of patients with cirrhosis, infected by HCV or alcoholic etiology. The nutritional status evaluation was carried out through anthropometry, food consumption, bioelectrical impedance (BIA) and subjective global assessment (SGA). The anthropometric data evaluated were weight, height, body mass index (BMI), triceps skinfold (TSF), circumference of the arm (CA), non-dominant handshake strength (FAM) and the adductor pollicis muscle thickness (APM). Patients were classified according to the severity of liver disease, using the Child-Pugh and Model for End-stage Liver Diseases (MELD) scores. Ninety patients with cirrhosis were evaluated, 47 with HCV and 43 with alcoholic etiology. The prevalence of protein-calorie malnutrition ranged from 10.9% to 54.3% in the HCV group and from 4.7% to 20.9% in the alcoholic group, depending on the method used for evaluation. The group with HCV infection presented a higher malnutrition prevalence in comparison to the alcoholic in the following evaluations: TSF (P<0.001), phase angle (PA) (P=0.016) and SGA (P=0.010). PA values were lower in patients with viral cirrhosis (5.68±1.05) when compared to those with alcoholic etiology (6.61±2.31) (P=0.016). When all patients were analyzed, regardless of etiology, an inversely correlation was observed among Child-Pugh score and PA values (P=0.018). HCV cirrhosis showed worse nutritional parameters in comparison to alcoholic etiology; however, the PA was associated with worse liver function in both etiologies.