RESUMEN
BACKGROUND: Patients with end-stage renal disease undergoing dialysis suffer from muscle cramps, a prevalent and burdensome symptom for which there is a paucity of efficient and safe treatments. AIM: What is the efficacy and safety of pharmacological interventions for the treatment of dialysis-related muscle cramps? DESIGN: A systematic review was conducted in OVID, CINAHL, PubMed, Web of Science, and Central Cochrane databases up to August 25, 2023. DATA SOURCES: Experimental studies reporting on a pharmacological intervention for the treatment of dialysis-related muscle cramps were included. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and the studies quality was assessed with the RoB2 tool. RESULTS: A total of 4660 studies were retrieved, and 13 articles were included. The studies reported on nine interventions: vitamin C, vitamin E, vitamin K2, vitamin B7, dextrose solutions, gabapentin, sodium chloride, creatine monohydrate, and L-carnitine. The studies testing L-carnitine and creatine monohydrate were the only ones deemed to have a low risk of bias. Side effects were reported in only two trials, consisting primarily of gastrointestinal discomfort and hyperglycemia. Vitamins C and E are the two most studied interventions that showed positive results in reducing the frequency, severity, and duration of dialysis-related muscle cramps. L-carnitine is a promising intervention that warrants further investigation. CONCLUSION: Our review consolidates the existing evidence, elucidating the range of treatments along with their potential benefits and limitations. Future studies should uphold high-quality standards, incorporate patient-reported outcomes, and utilize well-defined, robust samples to improve patient care.
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Fallo Renal Crónico , Calambre Muscular , Diálisis Renal , Humanos , Calambre Muscular/etiología , Calambre Muscular/tratamiento farmacológico , Calambre Muscular/terapia , Diálisis Renal/efectos adversos , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicacionesRESUMEN
Objective: To describe clinical, laboratory, and genetic characteristics of three unrelated cases from Chile, Portugal, and Saudi Arabia with severe insulin resistance, SOFT syndrome, and biallelic pathogenic POC1A variants. Design: Observational study. Methods: Probands' phenotypes, including short stature, dysmorphism, and insulin resistance, were compared with previous reports. Results: Cases 1 (female) and 3 (male) were homozygous for known pathogenic POC1A variants: c.649C>T, p.(Arg217Trp) and c.241C>T, p.(Arg81*), respectively. Case 2 (male) was compound heterozygous for p.(Arg217Trp) variant and the rare missense variant c.370G>A, p.(Asp124Asn). All three cases exhibited severe insulin resistance, acanthosis nigricans, elevated serum triglycerides and decreased HDL, and fatty liver, resembling three previously reported cases. All three also reported severe muscle cramps. Aggregate analysis of the six known cases with biallelic POC1A variants and insulin resistance showed decreased birth weight and length mean (s.d.): -2.8 (0.9) and -3.7 (0.9) SDS, respectively), severe short stature mean (s.d.) height: -4.9 (1.7) SDS) and moderate microcephaly (mean occipitofrontal circumference -3.0 (range: -4.7 to -1.2)). These findings were similar to those reported for patients with SOFT syndrome without insulin resistance. Muscle biopsy in Case 3 showed features of muscle involvement secondary to a neuropathic process. Conclusions: Patients with SOFT syndrome can develop severe dyslipidaemic insulin resistance, independent of the exonic position of the POC1A variant. They also can develop severe muscle cramps. After diagnosis, patients should be regularly screened for insulin resistance and muscle complaints.
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Enanismo , Resistencia a la Insulina , Proteínas de Ciclo Celular/genética , Proteínas del Citoesqueleto/genética , Enanismo/genética , Femenino , Humanos , Resistencia a la Insulina/genética , Masculino , Calambre MuscularRESUMEN
Fasciculations and cramps originate in the motor unit, a functional unit that includes the lower motor neuron and their innervated muscle fibres. Both are common complaints in outpatient practice. These symptoms can be secondary to neurological or medical pathology, presenting a broad differential diagnosis and a complex approach. Recent neurophysiological studies have increased the knowledge of their origin mainly in amyotrophic lateral sclerosis. The symptomatic management of fasciculations and cramps depends on their etiology and includes pharmacological and non-pharmacological treatments. This article aims to present an updated review of the most relevant aspects of physiopathology, clinical approach, and differential diagnosis of both phenomena.
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Humanos , Fasciculación/diagnóstico , Fasciculación/etiología , Fasciculación/terapia , Esclerosis Amiotrófica Lateral/complicaciones , Esclerosis Amiotrófica Lateral/diagnóstico , Esclerosis Amiotrófica Lateral/terapia , Electromiografía/efectos adversos , Neuronas Motoras/fisiología , Calambre Muscular/diagnóstico , Calambre Muscular/etiología , Calambre Muscular/terapiaRESUMEN
To evaluate the availability and characteristics of exercise training during hemodialysis in Brazil and to identify the reported barriers to exercise program implementation and maintenance. All dialysis units were assessed for eligibility using the database of the Brazilian Society of Nephrology. Each dialysis unit was contacted by telephone and the questions were administered. In dialysis units with exercise training, questions related to personnel involved, exercise components, and program delivery were included. Additionally, the barriers to exercise program implementation and maintenance were evaluated. This study included 261 dialysis units that responded to the survey. Forty-one dialysis units reported exercise training during hemodialysis in Brazil (prevalence of 15.7%). We identified 66 physiotherapists and 10 exercise physiologists in dialysis units with exercise training. Resistance training was the most common program component (92.7%). Hypotension (90.5%) and muscle cramps (85.7%) were the most common adverse events reported. In dialysis units with exercise training, poor patients' adherence to exercise was the most commonly reported barrier. The most prevalent barrier in dialysis units that tried or never tried to implement the exercise programs was a lack of resources. The number of dialysis units that have exercise training during hemodialysis in Brazil is low, and the most common program component is resistance training. A lack of resources was the most prevalent barrier in dialysis units that tried or never tried to implement the exercise programs.
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Ejercicio Físico/estadística & datos numéricos , Diálisis Renal , Instituciones de Atención Ambulatoria/organización & administración , Brasil , Estudios Transversales , Ejercicio Físico/efectos adversos , Humanos , Hipotensión , Calambre Muscular , Insuficiencia Renal Crónica/terapia , Entrenamiento de Fuerza/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
Fasciculations and cramps originate in the motor unit, a functional unit that includes the lower motor neuron and their innervated muscle fibres. Both are common complaints in outpatient practice. These symptoms can be secondary to neurological or medical pathology, presenting a broad differential diagnosis and a complex approach. Recent neurophysiological studies have increased the knowledge of their origin mainly in amyotrophic lateral sclerosis. The symptomatic management of fasciculations and cramps depends on their etiology and includes pharmacological and non-pharmacological treatments. This article aims to present an updated review of the most relevant aspects of physiopathology, clinical approach, and differential diagnosis of both phenomena.
Asunto(s)
Esclerosis Amiotrófica Lateral , Fasciculación , Esclerosis Amiotrófica Lateral/complicaciones , Esclerosis Amiotrófica Lateral/diagnóstico , Esclerosis Amiotrófica Lateral/terapia , Electromiografía/efectos adversos , Fasciculación/diagnóstico , Fasciculación/etiología , Fasciculación/terapia , Humanos , Neuronas Motoras/fisiología , Calambre Muscular/diagnóstico , Calambre Muscular/etiología , Calambre Muscular/terapiaRESUMEN
RESUMO: A atrofia óptica autossômica dominante (ADOA) é uma das formas mais comuns de atrofias ópticas hereditárias, e causada por mutações no gene OPA1. Os pacientes afetados por essa doença geralmente apresentam perda visual na primeira década de vida, podendo apresentar manifestações extraoftalmológicas no decorrer dos anos, configurando uma síndrome chamada OPA1 plus ou ADOA-plus. Objetivos: Relatar caso de paciente portadora da síndrome ADOA-plus, estabelecendo correlações com casos descritos na literatura. Relato de caso: Paciente feminino, 30 anos, foi encaminhada para avaliação de quadro de atrofia óptica progressiva associada a sintomas de neuropatia periférica. Aos dois anos, foi diagnosticada com perda visual parcial em consulta de puericultura. Não relatou outros sintomas associados durante a infância e a adolescência. Aos 20 anos, apresentou dificuldades de deambular, fraqueza em membros inferiores e falta de equilíbrio. Aos 25 anos, após extensa investigação, foi identificada, através de sequenciamento de exoma, mutação patológica no gene OPA1 confirmando o diagnóstico ADOA-plus e iniciado tratamento com Coenzima Q10. Atualmente a paciente relata ataxia sensitiva, diminuição da acuidade visual progressiva, fasciculações e câimbras em MMII, disfagia e dispneia. Discussão: Muitos pacientes com ADOA-plus apresentam surdez neurossensorial como sintoma extraoftalmológico mais comum, além de quadros de parkinsonismo e demência, ataxia e ptose. Paciente relatada constitui um caso de atrofia óptica associado à neuropatia periférica, ataxia e miopatia. Devido à ampla variabilidade clínica dessa doença, deve-se investigar mutações no OPA1 em casos de paraparesia espástica progressiva associada à atrofia óptica, visto que possibilidade de tratamento com Coenzima Q10. (AU)
ABSTRACT: Introduction: Autosomal dominant optic atrophy (ADOA) is one of the most common forms of inherited optic atrophies and is caused by mutations in the OPA1 gene. Patients affected by this disease usually present visual loss in the first decade of life, and may present extra-ophthalmologic manifestations over the years, configuring a syndrome called OPA1 plus or ADOA-plus. Objectives: to report the case of a patient with ADOA-plus syndrome, establishing correlations with cases described in the literature, Case report: a 30-year-old female patient was referred for evaluation of progressive optic atrophy associated with symptoms of peripheral neuropathy. At two years of age, she was diagnosed with partial visual loss during a childcare visit. She reported no other associated symptoms during childhood and adolescence. At the age of 20, she presented with difficulty walking, lower limb weakness, and poor balance. At 25, after extensive investigation, a pathological mutation in the OPA1 gene was identified through exome sequencing, confirming the diagnosis of ADOA-plus, and treatment with Coenzyme Q10 was initiated. Currently the patient reports sensory ataxia, progressive decrease in visual acuity, fasciculations and cramps in the lower limbs, dysphagia and dyspnea. Discussion: Many patients with ADOA-plus present sensorineural deafness as the most common extra-ophthalmologic symptom, in addition to parkinsonism and dementia, ataxia and ptosis. The patient reported is a case of optic atrophy associated with peripheral neuropathy, ataxia and myopathy. Due to the wide clinical variability of this disease, OPA1 mutations should be investigated in cases of progressive spastic paraparesis associated with optic atrophy, since the possibility of treatment with Coenzyme Q10. (AU)
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Humanos , Femenino , Adulto , Ataxia , Trastornos de Deglución , Agudeza Visual , Coenzimas , Enfermedades del Sistema Nervioso Periférico , Trastornos Parkinsonianos , Paraparesia Espástica , Atrofia Óptica Autosómica Dominante , Pérdida Auditiva Sensorineural , Calambre MuscularRESUMEN
BACKGROUND: Oral magnesium for leg cramps treatment in pregnancy is a controversial issue according to recent Cochrane systematic review. This study aims to evaluate the efficacy of Mg++ supplementation in leg cramps treatment in pregnancy. METHODS: This observational clinical trial studied 132 pregnant women with leg cramps in the first trimester of pregnancy. At baseline, 74 (56.3%) had two leg cramps episodes per week, 28 (21.1%) three episodes, 13 (9.8%) four episodes and 9 (6.8%) five or more episodes. They were randomized 1:1 to 300 mg/day of oral Mg++ citrate (n = 66) or placebo (n = 66). The primary outcome was the frequency of leg cramps episodes per week reported by pregnant women. Secondary outcomes were the ocurrence of leg cramps and oral magnesium side effects. RESULTS: 130 pregnant women completed the study and the two groups were comparable according to some sociodemographic and clinical characteristics. After 4 weeks of intervention it was observed a 28.4% (39/132) (CI 95%: 20.9-37.0) reduction of leg cramps in all participants and no difference between the two groups was found; reduction of 27.2% (18/66) (CI 95%: 17.0-39.6) in Mg++ group and 32.8% (21/66) (CI 95%: 21.6-45.7) in the placebo group. The OR of leg cramps was 1.3 (CI 95%: 0.6-2.9), p = 0.527, taking the placebo group as reference. Among pregnant women who remained with leg cramps the mean of leg cramps episodes per week showed no significance difference between the Mg++ and placebo groups; t-student test: p = 0.408. Four pregnant women showed gastrointestinal side effects; 2 in each group had nauseas and diarrhoea. CONCLUSION: Oral magnesium supplementation during pregnancy did not reduce the ocurrence and frequency of episodes of leg cramps.
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Ácido Cítrico/administración & dosificación , Calambre Muscular/prevención & control , Compuestos Organometálicos/administración & dosificación , Administración Oral , Adulto , Ácido Cítrico/efectos adversos , Suplementos Dietéticos , Esquema de Medicación , Femenino , Enfermedades Gastrointestinales/etiología , Humanos , Compuestos Organometálicos/efectos adversos , Efecto Placebo , Embarazo , Adulto JovenRESUMEN
Fundamento: el síndrome de Hoffmann es definido como la combinación de hipotiroidismo con miopatía, rigidez, calambres e hipertrofia muscular. Dicha forma de miopatía tiroidea es rara y por lo general acompaña a los pacientes con hipotiroidismo severo y de larga evolución. Objetivo: describir un caso con características clínicas, hormonales y musculares de un síndrome de Hoffmann, como manifestación excepcional del hipotiroidismo. Caso clínico: paciente femenina, de 16 años de edad comienza a sentir molestias musculares dadas por dolores y fatiga, las cuales se incrementaron de manera progresiva, las mialgias se tornaron intensas al punto que no le permitían realizar esfuerzo físico alguno, con astenia marcada y luego se agregaron contracciones musculares dolorosas, lo que la motivó asistir a consulta médica. Asociadas a estas manifestaciones se encontraron niveles muy elevados de enzimas musculares. Se comprueba aumento de volumen de la glándula tiroides, así como síntomas y signos sugestivos de hipotiroidismo, el cual se confirma tras dosificaciones de la tirotropina, tiroxina y triyodotironina. Conclusiones: el caso que se presentó es característico del síndrome de Hoffmann, cuya historia clínica detallada y meticulosa evidenció la presentación del hipotiroidismo(AU)
Background: Hoffmann syndrome is defined as the combination of hypothyroidism with myopathy, rigidity, cramps and muscle hypertrophy. This form of thyroid myopathy is rare and usually accompanies patients with severe and long-evolving hypothyroidism.Objective: to describe a case with clinic, hormonal and muscle characteristics of a Hoffmann syndrome, as an exceptional manifestation of hyperthyroidism. Clinical case:16-year-old, female patient begins to feel muscular discomfort due to pain and fatigue, which gradually increased, the myalgia became intense to the point that did not allow any physical effort, with marked asthenia and later contractions were added painful muscles, motivating her attendance to medical consultation. Associated with these manifestations were very high levels of muscle enzymes. Increased thyroid volume and symptoms and signs suggestive of hypothyroidism are confirmed, which is confirmed after dosages of thyrotropin, thyroxine and triiodothyronine. Conclusions: the presented case constitutes a characteristic example of the Hoffmann syndrome, which thanks to a detailed and meticulous clinical history showed the presentation of hypothyroidism(AU)
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Humanos , Femenino , Adolescente , Hipotiroidismo/clasificación , Hipotiroidismo/diagnóstico , Hipotiroidismo/epidemiología , Hipotiroidismo/terapia , Calambre Muscular/complicaciones , Calambre Muscular/etiología , Distrofias Musculares/complicaciones , Distrofias Musculares/etiología , Enfermedades Musculares/complicacionesRESUMEN
OBJECTIVE: To ascertain the presenting symptoms of children with skeletal muscle channelopathies to promote early diagnosis and treatment. STUDY DESIGN: Retrospective case review of 38 children with a skeletal muscle channelopathy attending the specialist pediatric neuromuscular service at Great Ormond Street Hospital over a 15-year period. RESULTS: Gait disorder and leg cramps are a frequent presentation of myotonic disorders (19 of 29). Strabismus or extraocular myotonia (9 of 19) and respiratory and/or bulbar symptoms (11 of 19) are common among those with sodium channelopathy. Neonatal hypotonia was observed in periodic paralysis. Scoliosis and/or contractures were demonstrated in 6 of 38 children. School attendance or ability to engage fully in all activities was often limited (25 of 38). CONCLUSIONS: Children with skeletal muscle channelopathies frequently display symptoms that are uncommon in adult disease. Any child presenting with abnormal gait, leg cramps, or strabismus, especially if intermittent, should prompt examination for myotonia. Those with sodium channel disease should be monitored for respiratory or bulbar complications. Neonatal hypotonia can herald periodic paralysis. Early diagnosis is essential for children to reach their full educational potential.
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Canalopatías/complicaciones , Trastornos Miotónicos/diagnóstico , Canales de Sodio/genética , Absentismo , Adolescente , Obstrucción de las Vías Aéreas , Canalopatías/diagnóstico , Niño , Preescolar , Contractura/etiología , Diplopía/etiología , Femenino , Trastornos Neurológicos de la Marcha , Humanos , Lactante , Recién Nacido , Masculino , Calambre Muscular/etiología , Hipotonía Muscular/etiología , Trastornos Miotónicos/genética , Canal de Sodio Activado por Voltaje NAV1.4/genética , Ruidos Respiratorios/etiología , Estudios Retrospectivos , Escoliosis/etiología , Estrabismo/etiologíaRESUMEN
The characterization of prodromal stages in neurodegenerative disorders is becoming increasingly important because of the need for early neuroprotective therapies. Research during the past 3 decades in spinocerebellar ataxia type 2 has revealed a large body of evidence suggesting that many disease features precede the manifest cerebellar syndrome, which delineates the prodromal stage of this disorder. This stage is defined by clinical, imaging, and functional criteria, which are supported by early molecular events demonstrated in animal models. Knowledge regarding prodromal spinocerebellar ataxia type 2 provides insight into the mechanisms underlying neurodegeneration from the early stages, which enables the design of promising disease-modifying clinical trials through the identification of the optimum moment to begin the therapies, the appropriate selection of individuals, and the identification of sensitive outcome measures. The management of patients in prodromal spinocerebellar ataxia type 2 may raise ethical dilemmas related to predictive diagnosis and early interventions, which impose new challenges to clinical and therapeutic research. © 2017 International Parkinson and Movement Disorder Society.
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Diagnóstico Precoz , Intervención Médica Temprana/métodos , Síntomas Prodrómicos , Ataxias Espinocerebelosas/diagnóstico , Ataxina-2/genética , Encéfalo/diagnóstico por imagen , Intervención Médica Temprana/ética , Ética Médica , Potenciales Evocados Auditivos del Tronco Encefálico , Potenciales Evocados Somatosensoriales , Medidas del Movimiento Ocular , Pruebas Genéticas , Humanos , Calambre Muscular/fisiopatología , Conducción Nerviosa , Trastornos del Olfato/fisiopatología , Polisomnografía , Disautonomías Primarias/fisiopatología , Reflejo Anormal , Ataxias Espinocerebelosas/genética , Ataxias Espinocerebelosas/fisiopatología , Ataxias Espinocerebelosas/terapia , Estimulación Magnética TranscranealRESUMEN
Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare autosomal-dominant disorder that most commonly produces recurrent painless focal sensory and motor neuropathies often preceded by minor, mechanical stress, or minor trauma. Herein, we report 2 pediatric cases of HNPP with atypical presentations; isolated muscle cramping and toe walking. Electrophysiologic testing disclosed multifocal sensorimotor polyneuropathy with slowing of sensory conduction velocities in both cases, which prompted PMP 22 gene deletion testing. Multifocal sensorimotor electrophysiologic abnormalities, with slowing of sensory conduction velocities should raise consideration of HNPP in childhood. These case reports emphasize that the diagnosis of HNPP in children requires a high index of suspicion.
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Artrogriposis/diagnóstico , Neuropatía Hereditaria Motora y Sensorial/diagnóstico , Calambre Muscular/fisiopatología , Músculo Esquelético/fisiopatología , Conducción Nerviosa/fisiología , Adolescente , Artrogriposis/fisiopatología , Electrodiagnóstico , Femenino , Neuropatía Hereditaria Motora y Sensorial/fisiopatología , Humanos , Masculino , FenotipoRESUMEN
Estudo tevepor objetivo analisar os eventos associados ao cotidiano de hemodiálise e as percepções de incômodo de idosos renais crônicos em tratamento hemodialítico. Estudo transversal, analítico de abordagem quantitativa realizado com 35 idosos em hemodiálise em uma Unidade Nefrológica do noroeste do Rio Grande do Sul. A coleta de dados ocorreu nos meses de maio, junho e julho de 2010, por meio de formulário de caracterização sociodemográfica/clínica o Kidney Disease and Quality of Live-Short Form(KDQOL-SFTM). Os dados foram analisados pela estatística descritiva e Correlação de Spearmann. Quanto às características sociodemográficas, 74,3% eram homens, 65,7% com idade entre 60 e 70 anos, 60% casados. Quanto aos eventos associados ao tratamento hemodialítico, câimbras (60%) e fraqueza (57,1%) foram os mais apontados pelos idosos. Em relação às percepções dos idosos sobre os problemas que os incomodaram "extremamente" durante as quatro últimas semanas, os com maiores percentuais foram fraqueza ou tontura, esgotamento e dores musculares. Verificou-se correlação estatisticamente significativa (p<0,05) entre dores musculares, dor no peito, esgotamento e fraqueza/tontura e interferência da doença renal em suas vidas. Conclui-se que esses resultados permitem compreender aspectos peculiares envolvidos no cuidado de enfermagem e proporciona aos profissionais maiores subsídios para embasar sua atuação.
This study aimed to analyzing the events associated with daily hemodialysis and the perceptions of nuisance in elderly CKD on hemodialysis. Cross-sectional analytical study of quantitative approach carried out with 35 elderlies under hemodialysis in a northwestern Nephrological Unit of Rio Grande do Sul. Data collection took place during the months of May, June and July 2010, through a socio-demographic/clinical form, the Kidney Disease and Quality of Live-Short Form (KDQOL-SFTM). Data were analyzed usingdescriptive statistics and Spearman Correlation. Regarding the socio-demographic characteristics 74,3% were men, 65,7% aged 60 to 70 years old, 60% were married. In respect for the events associated with hemodialysis, cramps (60%) and weakness (57,1%) were the most frequently reported by the elderly. Regarding perceptions of the elderly about the problems that bother "extremely" during the last four weeks, with the highest percentages were weakness or dizziness, exhaustion and muscle pain. Statistically significant correlation was found (p<0,05) muscle aches, chest pain, exhaustion and weakness/dizziness and interference of renal disease in their lives. In conclusion, these results allow us to understand specific aspects involved in nursing care and providethe largest professional knowledge to sustain their actions.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano , Actividades Cotidianas/psicología , Diálisis Renal/enfermería , Familia , Enfermería , Debilidad Muscular , Mareo/enfermería , Enfermedades Renales/enfermería , Calambre Muscular , Atención de EnfermeríaAsunto(s)
Adulto , Humanos , Masculino , Calambre Muscular/diagnóstico , Calambre Muscular/metabolismo , Creatina Quinasa/metabolismo , Electromiografía , Calambre Muscular/genética , Neuroimagen , Receptores Androgénicos/genética , Repeticiones de Trinucleótidos/genética , Grabación de Cinta de VideoRESUMEN
INTRODUCTION: Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief in dysmenorrhea. A feasible advantage would be the study of a portable device. The purpose of the study was to evaluate the effectiveness and safety of a new portable TENS device (TANYX®) for menstruation cramps. MATERIALS AND METHODS: Forty women were evaluated in a double-blind, prospective, randomized fashion, divided into sham and active groups. TENS was applied medially at the suprapubic region, for 30-min duration at eight-hour intervals, up to seven days. The placebo group (PG) received sham device. The TENS group (TG) applied an active 85 Hz frequency TENS. Efficacy measures were pain relief evaluated on a visual analog scale (VAS) and diclofenac intake, and quality of life represented by: 1) capacity to get out of the bed, 2) food or drink intake, 3) missing routine daily activities such as work or school, and 4) quality of sleep. RESULTS: The active TENS device induced a prompt onset of pain relief in a strictly segmental manner nearby the dermatomes where the TENS was applied at the skin, and there was a drop in mean pain score from 8 to 2 cm (p < 0.001). Diclofenac consumption was also significantly reduced (p < 0.01), compared with the PG. Quality of life improved significantly in TG when compared with PG (p < 0.05). Three months after the beginning of the study, 14/20 of the women were still using the active device regularly. No adverse effects were observed. CONCLUSIONS: The portable, disposable, active TENS device induced a prompt onset of pain relief and improved the quality of life, without adverse effects, in patients with painful cramps associated with dysmenorrhea.
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Dismenorrea/terapia , Calambre Muscular/terapia , Estimulación Eléctrica Transcutánea del Nervio/métodos , Adolescente , Biofisica , Dismenorrea/complicaciones , Dismenorrea/psicología , Femenino , Humanos , Calambre Muscular/etiología , Dimensión del Dolor , Calidad de Vida , Estadísticas no Paramétricas , Estimulación Eléctrica Transcutánea del Nervio/instrumentación , Resultado del Tratamiento , Adulto JovenRESUMEN
Sugarcane harvesting has been associated with an epidemic of chronic kidney disease in Central America mainly affecting previously healthy young workers. Repeated episodes of acute kidney dysfunction are hypothesized to be one of the possible mechanisms for this phenomenon. Therefore, this exploratory study aimed to assess the acute effects of burnt sugarcane harvesting on renal function among 28 healthy non-African Brazilian workers. Urine and blood samples were collected at the beginning and at the end of the harvesting season and before and at the end of a harvesting workday. All individuals decreased their estimated glomerular filtration rate by â¼20% at the end of the daily shift, and 18.5% presented with serum creatinine increases consistent with acute kidney injury. Those changes were associated with increased serum creatine phosphokinase (a known marker for exertional rhabdomyolysis) and oxidative stress-associated malondialdehyde levels, increased peripheral blood white cell counts, decreased urinary and serum sodium, decreased calculated fractional sodium excretion, and increased urine density. Thus, burnt sugarcane harvesting caused acute renal dysfunction in previously healthy workers. This was associated with a combination of dehydration, systemic inflammation, oxidative stress, and rhabdomyolysis.
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Lesión Renal Aguda/fisiopatología , Agricultura , Enfermedades Profesionales/fisiopatología , Exposición Profesional/efectos adversos , Saccharum , Lesión Renal Aguda/etiología , Adulto , Brasil , Creatina Quinasa/sangre , Creatinina/sangre , Tasa de Filtración Glomerular , Humanos , Recuento de Leucocitos , Masculino , Malondialdehído/sangre , Calambre Muscular/sangre , Enfermedades Profesionales/etiología , Estudios Prospectivos , Sodio/sangre , Sodio/orina , Gravedad Específica , Urinálisis , Adulto JovenRESUMEN
Myopathy is a known complication of hypothyroidism, commonly characterized by an elevation in Creatine Kinase (CPK) due to increase capillary permeability proportional to the hypothyroid state. Thyroid hormone is important for the expression of fast myofibrillar proteins in the muscle. In hypothyroidism the expression of these proteins are deficient and there is an increase accumulation of slow myofibrillar proteins. A rapid or abrupt descend in thyroid hormones caused by radioiodine therapy after prolonged hyperthyroidism can lead to local hypothyroid state within the muscle tissue, resulting in CPK elevation and hypothyroid myopathy. Hormone replacement leads to resolution of symptoms and normalization of muscle enzymes serum levels.
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Enfermedad de Graves/radioterapia , Hipotiroidismo/etiología , Radioisótopos de Yodo/efectos adversos , Calambre Muscular/etiología , Debilidad Muscular/etiología , Diagnóstico Diferencial , Edema/etiología , Electromiografía , Urgencias Médicas , Femenino , Terapia de Reemplazo de Hormonas , Humanos , Hipertiroidismo/diagnóstico , Hipotiroidismo/diagnóstico , Hipotiroidismo/tratamiento farmacológico , Radioisótopos de Yodo/uso terapéutico , Imagen por Resonancia Magnética , Metimazol/uso terapéutico , Propranolol/uso terapéutico , Reflejo Anormal , Hormonas Tiroideas/sangre , Hormonas Tiroideas/fisiología , Tiroxina/uso terapéutico , Adulto JovenRESUMEN
Spinocerebellar ataxia type 3 or Machado-Joseph disease is the most common spinocerebellar ataxia worldwide, and the high frequency of nonmotor manifestations in Machado-Joseph disease demonstrates how variable is the clinical expression of this single genetic entity. Anatomical, physiological, clinical, and functional neuroimaging data reinforce the idea of a degenerative process involving extracerebellar regions of the nervous system in Machado-Joseph disease. Brain imaging and neuropathologic studies have revealed atrophy of the pons, basal ganglia, midbrain, medulla oblongata, multiple cranial nerve nuclei, and thalamus and of the frontal, parietal, temporal, occipital, and limbic lobes. This review provides relevant information about nonmotor manifestations and extracerebellar symptoms in Machado-Joseph disease. The main nonmotor manifestations of Machado-Joseph disease described in previous data and discussed in this article are: sleep disorders, cognitive and affective disturbances, psychiatric symptoms, olfactory dysfunction, peripheral neuropathy, pain, cramps, fatigue, nutritional problems, and dysautonomia. In addition, we conducted a brief discussion of noncerebellar motor manifestations, highlighting movement disorders. © 2013 Movement Disorder Society.