Permanent Physical Disability Research Articles

MicroRNAs as Biomarkers for Predicting Complications following Aneurysmal Subarachnoid Hemorrhage.

Aneurysmal subarachnoid hemorrhage (aSAH) is a high mortality hemorrhagic stroke that affects nearly 30,000 patients annually in the United States. Approximately 30% of aSAH patients die during initial hospitalization and those who survive often carry poor prognosis with one in five having permanent physical and/or cognitive disabilities. The poor outcome of aSAH can be the result of the initial catastrophic event or due to the many acute or delayed neurological complications, such as cerebral ischemia, hydrocephalus, and re-bleeding. Unfortunately, no effective biomarker exists to predict or diagnose these complications at a clinically relevant time point when neurologic injury can be effectively treated and managed. Recently, a number of studies have demonstrated that microRNAs (miRNAs) in extracellular biofluids are highly associated with aSAH and complications. Here we provide an overview of the current research on relevant human studies examining the correlation between miRNAs and aSAH complications and discuss the potential application of using miRNAs as biomarkers in aSAH management.

Analisis Penyebaran Penyakit Filariasis Menggunakan Model SEIR Di Provinsi Sumatera Utara

North Sumatra is one of the endemic areas of tropical diseases, one of which is filariasis. Filariasis or elephantiasis is a disease transmitted through mosquitoes and can cause permanent physical disability for sufferers. In 2015, there were 127 filariasis sufferers. This number has increased to 164 patients in 2017. As a prevention effort, the government provides mass treatment for people living in endemic areas of the disease. Therefore, this study aims to determine the model of spread and the effect of treatment on these communities. This study uses an SEIR model consisting of susceptible humans (S_h), infected humans (E_h), infected humans (I_h), and immune humans (R_h). The data used is data on filariasis sufferers in North Sumatra in 2010-2019, obtained from the North Sumatra Health Office. The data were analyzed based on the equilibrium point, stability, basic reproductive ratio, and numerical simulation. The results showed that based on the SEIR model, filariasis treatment could suppress transmission in endemic areas.

Traumatic Spinal Cord Injury and Risk of Early and Late Onset Alzheimer’s Disease and Related Dementia: Large Longitudinal Study

ObjectiveTraumatic spinal cord injury (TSCI) is a life altering event most often causing permanent physical disability. Little is known about the risk of developing Alzheimer disease and related dementia (ADRD) among middle-aged and older adults living with TSCI. Time to diagnosis of and adjusted hazard for ADRD was assessed. DesignCohort study. SettingUsing 2007-2017 claims data from the Optum Clinformatics Data Mart, we identified adults (45+) with diagnosis of TSCI (n=7019). Adults without TSCI diagnosis were included as comparators (n=916,516). Using age, sex, race/ethnicity, cardiometabolic, psychological, and musculoskeletal chronic conditions, US Census division, and socioeconomic variables, we propensity score matched persons with and without TSCI (n=6083). Incidence estimates of ADRD were compared at 4 years of enrollment. Survival models were used to quantify unadjusted, fully adjusted, and propensity-matched unadjusted and adjusted hazard ratios (HRs) for incident ADRD. ParticipantsAdults with and without TSCI (N=6083). InterventionNot applicable. Main Outcomes MeasuresDiagnosis of ADRD. ResultsBoth middle-aged and older adults with TSCI had higher incident ADRD compared to those without TSCI (0.5% vs 0.2% and 11.7% vs 3.3% among 45-64 and 65+ y old unmatched cohorts, respectively) (0.5% vs 0.3% and 10.6% vs 6.2% among 45-64 and 65+ y old matched cohorts, respectively). Fully adjusted survival models indicated that adults with TSCI had a greater hazard for ADRD (among 45-64y old: unmatched HR: 3.19 [95% confidence interval, 95% CI, 2.30-4.44], matched HR: 1.93 [95% CI, 1.06-3.51]; among 65+ years old: unmatched HR: 1.90 [95% CI, 1.77-2.04], matched HR: 1.77 [1.55-2.02]). ConclusionsAdults with TSCI are at a heightened risk for ADRD. Improved clinical screening and early interventions aiming to preserve cognitive function are of paramount importance for this patient cohort.

Snakebite Envenoming a Challenging Diagnosis for the Forensic Pathologist: A Systematic Review.

Snakebite envenoming (SBE) is a public health issue in developing countries. The estimated annual global incidence of snakebites is about 5.4 million snakebites per year, resulting from 1.8 to 2.7 million cases of SBE and from 81,000 to 138,000 deaths with 400,000 survivors suffering permanent physical and psychological disabilities. There are more than 3000 species of snakes around the world: 600 are venomous and over 200 are considered to be medically important because of their clinical effects. The severity of SBE depends on several factors among which bite localization, snake’s size, condition of glands and teeth, bite angle and bite duration, the microflora of the snake’s mouth and victim’s skin, age of the victim, weight, health status, and victim’s activity after a bite. Snake venoms are mixtures of protein families, and each of these families contains many different toxins or toxin isoforms. Based on their effects, snake venoms can be classified as hemotoxic, neurotoxic, or cytotoxic and they can all act together involving multiple tissues and organs. When the bite is fatal, the mechanism of death is primarily related to the paralysis of respiratory muscles, which causes asphyxia and hypoxic-ischemic encephalopathy, but also anaphylactic shock, hemorrhagic shock, cardiomyopathy, acute tubular necrosis (ATN). The purpose of this literature review is to evaluate epidemiological and post-mortem examination findings in fatal SBEs in order to better understand the pathophysiological mechanisms, thus helping pathologists in defining the correct diagnosis.

Disability Burden Due to Neurological Disorders: A matter of Future Concern

Aim: To study disability burden due to common prevalent neurological disorders. Material and Methods: Study from a tertiary care neuropsychiatry hospital from North India. Cases had been collected with all detailed demographic and relevant findings from the year 2009 to 2018; almost 10 years of data were collected and recorded. The detailed analyses of the cases were done. All the cases which lead to permanent disability leading to Locomotors, cognitive and other deficits from the Neurological disorder were included and recorded. Cases leading to temporary disability were excluded from the study. Results: Total numbers of patients around ten tears were 1203 in number, Out of which 1001 were males and 202 were females. Stroke accounted for the largest proportion of disability among all neurological disorders analysed. Cerebral palsy, post enchephalitis sequalae and mental Retardation with Epilepsy were the second, third, and fourth largest contributors of permanent physical or cognitive disability. The proportional contributions of the other neurological disorders analysed were less substantial and varied from 0.4% for Multiple sclerosis to round 5% for tuberculosis of Brain. Among the largest number Stroke Cerebrovascular accident is the largest group comprises of round 44 % of the permanent disability followed by Cerebral palsy, (22.8%) Post encephalitis, sequalae (11.8%) and mental Retardation with Epilepsy (9.2%). Other groups comprises of Tuberculosis of brain (5.2%), Motor Neuron diseases (3.5%) and small number of cases of myelopathy, dementia and Multiple sclerosis and related disorders. Stroke the number of male patients are more as compared to females. The age pattern varied between the various neurological disorders for disability .The age group range for CVA varies grom 30 to 80, mostly in elderly, whereas cerebral palsy, post encephalitis sequale, mental retardation and Epilepsy prevailed in younger age group. Conclusion: The burden due to Neurological disorders is increasing in India and leading to further disability. In developing countries were most of the population belongs to middle or low socio-economic status against increase the burden as the sole family member get disabled and the whole family is dependent on their livelihood.

Finite Element Modeling Application in Forensic Practice: A Periprosthetic Femoral Fracture Case Study.

The incidence of periprosthetic fractures has rapidly increased in the last two decades and has been the cause of a large number of revision surgeries and permanent physical disability for many patients, as well as a significant socioeconomic burden for many nations. This research deals with a periprosthetic femur fracture real event, occurred following a total hip arthroplasty and treated with one of the most widespread internal fixation methods: the implant of a periprosthetic femur plate system. A Finite Element analysis was performed to investigate the implanted femur plate break after a short follow-up and to understand the plate break causes. Such events are currently object of forensic debate as more and more often hospitals, surgeons, and medical device manufacturers are denounced by patients to whom similar events occur. In this work, different load situations acting on the femur during daily and incidental activities were simulated, in order to validate the correct behavior of the plate, according to the intended use recommended by the manufacturer. The analysis demonstrates that the plate failure can occur in situations of unconventional loading such as that caused by stumbling and in presence of incomplete bone healing.

Permanent physical disfigurement and disability due to burns injury: Case series

Rohingya refugees are displaced from their home or country as a result from continuous oppression and persecutions. Whilst the nation is aware of the massacre, the effects and aftermath towards refugees is under reported. We highlight a case series of burn injuries in refugees as a result of human violence. The various clinical presentation and complications were described.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 319-321

Unraveling a new player in multiple sclerosis pathogenesis: The RNA-binding protein HuR

BackgroundELAV-like proteins are a small family of RNA-binding proteins that are fundamental players in post-transcriptional mechanisms and are involved in the pathogenesis of neurologic and psychiatric disorders. HuR, the ubiquitously expressed member of the family, is also implicated in sustaining inflammation and inflammatory diseases, supporting the production of pro-inflammatory cytokines. Inflammation plays a central role in Multiple Sclerosis (MS), which represents the most common cause of permanent physical disability in young adults. MS is a chronic autoimmune disease affecting the Central Nervous System, with a complex aetiology involving genetic, environmental and epigenetic factors. No data are available on the potential entanglement of HuR in MS pathogenesis in patients. In the present work, we aimed at exploring HuR protein levels in peripheral blood mononuclear cells (PBMCs) from MS patients, compared to healthy controls. To further elucidate the possible involvement of HuR in MS, we also investigated the relationship between this specific RNA-binding protein and HSP70-2 protein, also considering the HSP70-2 rs1061581 polymorphism, given that HSP70-2 mRNA has been reported as a HuR target and this specific polymorphism to be associated with MS risk. MethodsAlleles and genotypes for HSP70-2 rs1061581 polymorphism were assessed, by using a Polymerase Chain Reaction-Restriction Fragment Length Polymorphism, followed by digestion with restriction enzyme, in MS patients and healthy controls. PBMCs from a subgroup of patients and controls were used to evaluate HuR and HSP70-2 protein content by Western blot. ResultsPBMCs from 52 MS patients had a lower HuR and higher HSP70-2 protein content compared to 43 healthy controls. An increase of 100 units of HuR significantly decreased the risk of developing MS by 9.8% (OR: 0.902, 95% CI: 0.83–0.98), controlling for HSP70-2 protein expression, HSP70-2 rs1061581 genotype, age and sex. Moreover, holding HuR levels, an increase of 100 units of HSP70-2 protein significantly increased the MS risk by 18.1% (OR: 1.181, 95% CI: 1.03–1.36) and the genetic susceptibility of developing MS for HSP70-2 rs1061581 GG carriers is confirmed. Of interest, MS patients with a moderate to severe form of MS (MSSS ≥ 3) showed a trend towards a reduction of HuR protein levels compared to patients with mild disease severity (MSSS < 3). ConclusionsHuR protein levels are reduced in MS patients compared to healthy subjects, and the protein amount may continue to decline with disease progression, suggesting a putative role of this RNA-binding protein. Moreover, our results suggest that MS pathology may have disrupted the link between HuR and its target transcript HSP70-2. It will be important to further explore the exact role of HuR in MS, considering the complex interplay with other RNA-binding factors and target mRNAs.

The Wounded Male Body: Masculinity and Disability in Wartime and Post-WWI Italy

Abstract This article examines the variety of ways in which Italian soldiers responded to the experience of incurring a permanent physical disability during the First World War. It also describes the potentially unsettling presence of soldiers’ disabled bodies in Italian society, where they were perceived as being disruptive to cultural understandings of male embodiment and hegemonic masculinities. By analyzing different intimate and social exchanges, as well as emotional bonds, this article attempts to disentangle historically the intersection between masculinity and disability. In so doing, it will expose the implications of normative expectations of masculinity, the anxiety that arose from attempts to challenge these norms, and the relevance of context and life phase in understanding the impact of disability on male identity. Drawing on both theories of masculinity and literature on disability, this article will ultimately illustrate how and to what extent disabled veterans in post–First World War Italy negotiated and shaped their gendered identities. It will conclude by considering the role of Fascism in promoting a model of hegemonic masculinity, to which the war disabled could also conform. “Will you still want me if I come back like Vincenzo Bellu?” “With only one arm? Of course, because they’ll give you the Order of Vittorio Veneto and I’ll be your lady! [. . .]” “I’m not joking. Would you still want me if I was a cripple? Deafened by a grenade or with no legs like Luigi Barranca?” “I’d want you back in any condition, as long as you’re still alive. [. . .]” “Maybe you can imagine having me back as a worm, but I’d rather die full of life ten times over than have to live ten years like a dead man. If that happens to me I shall do what Barranca did and shoot myself.”1

Variation in Patient-Reported Advance Care Preferences in the Preoperative Setting.

High-quality shared decision-making for patients undergoing elective surgical procedures includes eliciting patient goals and treatment preferences. This is particularly important, should complications occur and life-sustaining therapies be considered. Our objective was to determine the preoperative care preferences of older higher-risk patients undergoing elective procedures and to determine any factors associated with a preference for limitations to life-sustaining treatments. Cross-sectional survey conducted between May and December 2018. Patients ≥55 years of age presenting for a preprocedural evaluation in a high-risk anesthesia clinic were queried on their desire for life-sustaining treatments (cardiopulmonary resuscitation, mechanical ventilation, dialysis, and artificial nutrition) as well as tolerance for declines in health states (physical disability, cognitive disability, and daily severe pain). One hundred patients completed the survey. The median patient age was 68. Most patients were Caucasian (87%) and had an American Society of Anesthesiologists (ASA) score of III (88%). The majority of patients (89%) desired cardiopulmonary resuscitation. However, most patients would not accept mechanical ventilation, dialysis, or artificial nutrition for an indefinite period of time. Similarly, most patients (67%-81%) indicated they would not desire treatments to sustain life in the event of permanent physical disability, cognitive disability, or daily severe pain. Among older, higher-risk patients presenting for elective procedures, most patients chose limitations to life-sustaining treatments. This work highlights the need for an in-depth goals of care discussion and establishment of advance care preferences before a procedure or operative intervention.

FACTORS AFFECTING SUBJECTIVE WELL BEING OF TRANSFEMORAL PROSTHESIS USER IN INDONESIA

Study Design: This research is Quantitative Research using analytic observational with a cross-sectional approach. Background: Amputation hurts patients physically, psychologically and socially. Permanent physical disability due to amputation affects the thought, feeling and behavior of the patient, because patient will have the negative feeling on body image that can cause a feeling that he is not useful, worry about losing his job, pessimistic about the future and limit social relationships with self-withdrawal, so that patient will experience depression. Objectives: This research is to determine the factor affecting the subjective well being of transfemoral prosthesis users in Indonesia. Methods: The sample in this study was 110 users of the transfemoral prosthesis with a simple random sampling technique. The Data collection technique is using questionnaires and documentation. It was used Structural Equation Modeling (SEM) to analyze the data. Results: The result of this study had a statistically significant effect between motivation (p = 0.031), self-efficacy (p = 0.030), religiosity (p = 0.020), social support (p = 0.027), and optimism (p = 0.033) toward subjective well being. Conclusions: motivation, self-efficacy, religiosity, social support and optimism are the factors affecting the subjective well being of transfemoral prosthesis users in Indonesia. Clinical Relevance: Patient who had undergone amputation will have an effect on their subjective well being. It is important to know the factor affecting subjective well being of above knee amputation that use prosthesis. The factors are motivation, self-efficacy, religiosity, social support and optimism.

SOCIOECONOMIC IMPACT OF MOTORCYCLE ACCIDENT VICTIMS IN THE EMERGENCY ROOM OF A HOSPITAL (PART 2).

ABSTRACTObjective:To evaluate the socioeconomic impact of motorcycle accidents of a metropolis with one million inhabitants treated by a university hospital in 2017. To study hospital cost and time of victims, evaluate definite and incapacitating sequelae, and analyze patient’s insertion in the labor market six months after the accident.Methods:Retrospective study of 62 victims of motorcycle accidents treated in the emergency room and referred for surgical procedure in a university hospital. Data were collected from medical records and answers via telephone six months after the trauma.Results:Injuries related to motorcycle accident resulted in high hospital costs. Average loss per patient was R$ 17,555. Of those who answered the functional impact questionnaire, 64% were on paid leave by INSS and 84% presented partial or permanent physical disabilities after the accident. Only 9 people (36%) received any kind of financial benefit from public authorities.Conclusion:High costs are directly related to hospitalization time and surgical needs. Most victims needed financial help and had their social lives aggravated. Investments in motorcyclists’ awareness of traffic laws and use of safety equipment are needed, as well as in road infrastructure. Level of evidence II, Prognostic studies.

Disability Burden Due to Neurological Disorders: A matter of Future Concern

Aim: To study disability burden due to common prevalent neurological disorders. Material and Methods: Study from a tertiary care neuropsychiatry hospital from North India. Cases had been collected with all detailed demographic and relevant findings from the year 2009 to 2018; almost 10 years of data were collected and recorded. The detailed analyses of the cases were done. All the cases which lead to permanent disability leading to Locomotors, cognitive and other deficits from the Neurological disorder were included and recorded. Cases leading to temporary disability were excluded from the study. Results: Total numbers of patients around ten tears were 1203 in number, Out of which 1001 were males and 202 were females. Stroke accounted for the largest proportion of disability among all neurological disorders analysed. Cerebral palsy, post enchephalitis sequalae and mental Retardation with Epilepsy were the second, third, and fourth largest contributors of permanent physical or cognitive disability. The proportional contributions of the other neurological disorders analysed were less substantial and varied from 0.4% for Multiple sclerosis to round 5% for tuberculosis of Brain. Among the largest number Stroke Cerebrovascular accident is the largest group comprises of round 44 % of the permanent disability followed by Cerebral palsy, (22.8%) Post encephalitis, sequalae (11.8%) and mental Retardation with Epilepsy (9.2%). Other groups comprises of Tuberculosis of brain (5.2%), Motor Neuron diseases (3.5%) and small number of cases of myelopathy, dementia and Multiple sclerosis and related disorders. Stroke the number of male patients are more as compared to females. The age pattern varied between the various neurological disorders for disability .The age group range for CVA varies grom 30 to 80, mostly in elderly, whereas cerebral palsy, post encephalitis sequale, mental retardation and Epilepsy prevailed in younger age group. Conclusion: The burden due to Neurological disorders is increasing in India and leading to further disability. In developing countries were most of the population belongs to middle or low socio-economic status against increase the burden as the sole family member get disabled and the whole family is dependent on their livelihood.

Histomorphological Study of Leprosy with Clinical Correlation in Kumaon Region

Background: Leprosy is a leading cause of permanent physical disability. Approx 60% of global burden of leprosy is represented by India. Histopathological examination is still considered gold standard for accurate categorization of leprosy so that timely treatment can be started.&#x0D; Objectives: To categorize and correlate types of leprosy clinically and histomorphologically in Kumaon region.&#x0D; Methods: The present cross-sectional study of 62 cases was conducted in the Department of Pathology &amp; Skin and V.D in a tertiary care centre of Kumaon region from August 2016 to April 2018. The cases were clinically examined and categorized according to Ridley-Jopling classification. Skin Biopsy and Slit-Skin Smear (SSS) were taken for accurate histomorphogical categorization of leprosy and assessment of bacterial index, followed by clinico-histomorphological correlation. Statistical analysis was done in term of chi-square test. Kappa test was used as agreement test for clinical versus histological classification of different type of leprosy.&#x0D; Results: A total of 62 clinically diagnosed leprosy cases evaluated histopathologically. Clinically, lepromatous leprosy (LL) was the most common type of leprosy (38.70%), followed by borderline tuberculoid (30.64%). On histopathological examination, indeterminate leprosy (IL) (21 cases; 33.90%) was the most common followed by lepromatous leprosy (16 cases; 25.80%). Overall clinico-histopathological correlation was seen in 36 cases (58. 06%) with maximum correlation seen in indeterminate leprosy (100%) and tuberculoid leprosy (TT) (100%). Conclusion: This study concludes that correlation of clinical and histopathological features along with bacterial index is more useful for accurate typing of leprosy than considering any of the single parameter alone so that early and appropriate treatment could be started.

A pilot study on salivary cortisol secretion and auditory P300 event-related potential in patients with physical disability-related stress

Objective: To evaluate the stress level and attention in workers with physical disabilities-related stress.Methods: Morning salivary cortisol was used as a stress marker while the event-related potential during the performance of the auditory oddball paradigm was conducted to investigate the attentive ability to sound stimuli. Eighteen injured workers (IP) and eighteen unaffected healthy adults (CP) were recruited for this study with half being men and the other half women (aged 21–55). Behavioral performance measures including reaction time (RT), accuracy rate, and commission error as well as the latency and amplitude of P300 wave over the central (Cz), centroparietal (CPz), and parietal (Pz) electroencephalogram electrode sites were used to compare the two groups.Results: This study demonstrated significantly higher salivary cortisol levels, longer RT, less accuracy to respond to the target during the auditory oddball paradigm in the IP group as compared to CP group. In addition, a significant prolongation of the peak latency of auditory P300 wave over CPz electrodes was also detected in IP group.Conclusion: The increased cortisol levels found in the IP group reflect the alteration of the basal hypothalamic-pituitary-adrenal axis as a result of the stresses of living with a physical disability. Delayed RT and the decreased in accuracy together with changing in peak latencies of auditory P300 wave indicate the impairment of attention networks in IP. Our study revealed that the patients with permanent physical disability.

The Trends in Global, Regional, and National Incidence of Pneumoconiosis Caused by Different Etiologies: An Analysis from the Global Burden of Disease Study 2017

Background: Pneumoconiosis has the potential to cause progressive and permanent physical disability. And continues to be one of major public health concern across the world. Accurate data on the incidence of pneumoconiosis is critical for health resource planning and health policy development. We therefore aimed to determine the pattern of pneumoconiosis incidence and temporal trends. Methods: Annual incident cases and age standardized incidence rates on pneumoconiosis etiology between 1990-2017 were collected from the Global Burden of Disease Study 2017. We calculate the average annual percentage changes of age standardized incidence rates by sex, region, and etiology to determine incidence trends of pneumoconiosis. Findings: Globally, the number of pneumoconiosis cases increased 66*0% from 36,186 in 1990 to 60,055 in 2017. The overall ASIR decreased by an average 0*6% (95% CI 0*5% to 0*6%) per year in the same period. The ASIR of silicosis, asbestosis, and other pneumoconiosis decreased between 1990 and 2017. The corresponding AAPCs were -0*8 (95% CI -0*9 to -0*7), -0*9 (95% CI -0*9 to -0*8), and -0*5 (95% CI -0*5 to -0*5), respectively. The ASIR of asbestosis displayed an increasing trend (AAPC = 0*6; 95% CI 0*5 to 0*6). At the same time, we also found a significant negative association was found between AAPCs and SDIs when the SDI above 0*7. Interpretation: Pneumoconiosis remains a major occupational health illnesses in the world. Incidence patterns of pneumoconiosis caused by different etiologies were heterogeneous across regions and countries. We observed an unfavorable trend that asbestosis was predominant in countries with a high socio-demographic index, though we have attained great achievements in silicosis and coal workers' pneumoconiosis prevention. The information in this study suggests that some countries should establish more targeted and specific strategies to forestall the increase in pneumoconiosis. Funding: National Natural Science Foundation of China. Declaration of Interest: All authors have no actual or potential competing financial interest. Ethical Approval Statement: Not required.

Ainhum, a rare mutilating dermatological disease in a female Cameroonian: a case report

BackgroundAinhum is an idiopathic dermatological disease characterized by a progressive constricting ring usually on the fifth toe, which may lead to spontaneous auto-amputation of the affected toe. Timely diagnosis and treatment are the key elements to avert amputations with resultant mutilating deformities, permanent handicaps and psychological sequelae. Though common in African descents, this pathology has not been described in the Cameroonian literature. Herein, we report the case of an adult Cameroonian woman presenting with ainhum.Case presentationA 54-year old Cameroonian was admitted to our primary healthcare centre with a 6-month history of a painful constriction band developing at the base of her right fifth toe. Her past history was uneventful. Based on the absence of trauma and spontaneous onset of the condition, the diagnosis of ainhum was most suggestive. She was managed surgically by excision of the band, disarticulated at right fifth metatarsophalangeal joint and skin closure. Her post-operative course after 1 year was uneventful.ConclusionHere we presented a case of ainhum, a rare dermatological disease with few reports. In view of the serious complications of ainhum such as mutilating deformities with permanent physical disabilities and psychological trauma, we draw clinicians’ attention, especially wound care specialists to this rare but potentially handicapping disease, for timely diagnosis and management.

Evaluation of biomechanical gait parameters of patients with Cerebral Palsy at three different levels of gait assistance using the CPWalker

BackgroundCerebral Palsy (CP) is the most common cause of permanent serious physical disability in childhood. Although many platforms have been developed, so far there are still not precise guidelines for the rehabilitation of the population with CP. The CPWalker is a robotic platform for the rehabilitation of children with CP, through which they can start experiencing autonomous locomotion in the rehabilitation environment. It allows the possibility of free movement and includes physical and cognitive interfaces into the therapy. The main objective of this work is to evaluate the effects of the CPWalker-based rehabilitation intervention in children with CP by comparing different gait parameters before, during and after the use of the platform.FindingsThe evaluation was divided in three stages where the gait parameters and symmetry indexes of eight subjects with CP were evaluated. In the first stage patients walked only with the help they receive normally in daily life. During the second stage they walked with the CPWalker and finally, in the third stage, they repeated their gait without the platform. In all stages they wore an inertial G-Sensor Ⓡ while walking through the hospital facilities. The results showed statistical significant differences in several spatio-temporal parameters, pelvic angles and general gait cycle parameters, with and without the use of the robotic device. For the eight patients: cadence, speed and stride length presented similar values when comparing before and after the therapy. However, they decreased during the intervention (both means and standard deviations). No significant differences were found in the symmetry indexes with the use of the platform. In spite of this, a reduction in the pelvic angles ranges and propulsion was observed.ConclusionsThe effect of using the device was analyzed for spatio-temporal parameters, pelvic girdle angles and general gait cycle parameters. Among the eighteen initial parameters, seven presented a statistical significant difference when comparing stage 2 of the intervention with stages 1 and 3. Those changes showed the potential of the CPWalker to improve muscular strength and gait patterns of the patients with CP in the long term and to provide useful information for the design of the future generations of rehabilitation robotic devices.

Leprosy in children under 15 years of age in Brazil: A systematic review of the literature.

BackgroundLeprosy is a chronic infectious disease neglected, caused by Mycobacterium leprae, considered a public health problem because may cause permanent physical disabilities and deformities, leading to severe limitations. This review presents an overview of the results of epidemiological studies on leprosy occurrence in childhood in Brazil, aiming to alert health planners and managers to the actual need to institute special control strategies.Methodology/Principal findingsData collection consisted of an electronic search for publications in eight databases: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), PuBMed, Biblioteca Virtual em Saúde (BVS), SciVerse Scopus (Scopus), CAPES theses database, CAPES journals database and Web of Science of papers published up to 2016. After apply selection criteria, twenty-two papers of studies conducted in four different regions of Brazil and published between 2001 and 2016 were included in the review. The leprosy detection rate ranged from 10.9 to 78.4 per 100,000 inhabitants. Despite affecting both sexes, leprosy was more common in boys and in 10-14-year-olds. Although the authors reported a high cure proportion (82–90%), between 1.7% and 5.5% of the individuals developed a disability resulting from the disease.Conclusions/SignificanceThe findings of this review shows that leprosy situation in Brazilian children under 15 years is extremely adverse in that the leprosy detection rate remains high in the majority of studies. The proportion of cases involving disability is also high and reflects the difficulties and the poor effectiveness of actions aimed at controlling the disease. The authors suggest the development of studies in spatial clusters of leprosy, where beyond the routine actions established, are included news strategies of active search and campaigns and actions of educations inside the clusters of this disease. The new agenda needs to involve the precepts of ethical, humane and supportive care, in order to achieve a new level of leprosy control in Brazil.

Astrocytes and the Warning Signs of Intracerebral Hemorrhagic Stroke.

Two decades into the two thousands, intracerebral hemorrhagic stroke (ICH) continues to reap lives across the globe. In the US, nearly 12,000 people suffer from ICH every year. Half of them survive, but many are left with permanent physical and cognitive disabilities, the severity of which depends on the location and broadness of the brain region affected by the hemorrhage. The ongoing efforts to identify risk factors for hemorrhagic stroke have been instrumental for the development of new medical practices to prevent, aid the recovery and reduce the risk of recurring ICH. Recent efforts approach the study of ICH from a different angle, providing information on how we can limit brain damage by manipulating astrocyte receptors. These results provide a novel understanding of how astrocytes contribute to brain injury and recovery from small ICH. Here, we discuss current knowledge on the risk factors and molecular pathology of ICH and the functional properties of astrocytes and their role in ICH. Last, we discuss candidate astrocyte receptors that may prove to be valuable therapeutic targets to treat ICH. Together, these findings provide basic and clinical scientists useful information for the future development of strategies to improve the detection of small ICH, limit brain damage, and prevent the onset of more severe episodes of brain hemorrhage.