Alexandra Siqueira Colombo

Reliability of photogrammetry in the evaluation of the postural aspects of individuals with structural scoliosis

PURPOSE The purpose of this study was to investigate the reliability of photogrammetry in the measurement of the postural deviations in individuals with idiopathic scoliosis. METHODS Twenty participants with scoliosis (17 women and three men), with a mean age of 23.1 ± 9 yrs, were photographed from the posterior and lateral views. The postural aspects were measured with CorelDRAW software. RESULTS High inter-rater and test-retest reliability indices were found. It was observed that with more severity of scoliosis, greater were the variations between the thoracic kyphosis and lumbar lordosis measures obtained by the same examiner from the left lateral view photographs. A greater body mass index (BMI) was associated with greater variability of the trunk rotation measures obtained by two independent examiners from the right, lateral view (r = 0.656; p = 0.002). The severity of scoliosis was also associated with greater inter-rater variability measures of trunk rotation obtained from the left, lateral view (r = 0.483; p = 0.036). CONCLUSIONS Photogrammetry demonstrated to be a reliable method for the measurement of postural deviations from the posterior and lateral views of individuals with idiopathic scoliosis and could be complementarily employed for the assessment procedures, which could reduce the number of X-rays used for the follow-up assessments of these individuals.

Reliability and Validity of the Photogrammetry for Scoliosis Evaluation: a Cross-Sectional Prospective Study

OBJECTIVE The purpose of this study was to investigate the reliability and validity of photogrammetry in measuring the lateral spinal inclination angles. METHODS Forty subjects (32 female and 8 males) with a mean age of 23.4 +/- 11.2 years had their scoliosis evaluated by radiographs of their trunk, determined by the Cobb angle method, and by photogrammetry. The statistical methods used included Cronbach alpha, Pearson/Spearman correlation coefficients, and regression analyses. RESULTS The Cronbach alpha values showed that the photogrammetric measures showed high internal consistency, which indicated that the sample was bias free. The radiograph method showed to be more precise with intrarater reliabilities of 0.936, 0.975, and 0.945 for the thoracic, lumbar, and thoracolumbar curves, respectively, and interrater reliabilities of 0.942 and 0.879 for the angular measures of the thoracic and thoracolumbar segments, respectively. The regression analyses revealed a high determination coefficient although limited to the adjusted linear model between the radiographic and photographic measures. It was found that with more severe scoliosis, the lateral curve measures obtained with the photogrammetry were for the thoracic and lumbar regions (R = 0.619 and 0.551). CONCLUSIONS The photogrammetric measures were found to be reproducible in this study and could be used as supplementary information to decrease the number of radiographs necessary for the monitoring of scoliosis.

Changes in plasma free fatty acid levels in septic patients are associated with cardiac damage and reduction in heart rate variability

Free fatty acids (FFAs) have been shown to produce alteration of heart rate variability (HRV) in healthy and diabetic individuals. Changes in HRV have been described in septic patients and in those with hyperglycemia and elevated plasma FFA levels. We studied whether sepsis-induced heart damage and HRV alteration are associated with plasma FFA levels in patients. Thirty-one patients with sepsis were included. The patients were divided into two groups: survivors (n = 12) and nonsurvivors (n = 19). The following associations were investigated: (a) troponin I elevation and HRV reduction; and (b) clinical evolution and HRV index, plasma troponin, and plasma FFA levels. Initial measurements of C-reactive protein and gravity Acute Physiology and Chronic Health Evaluation scores were similar in both groups. Overall, an increase in plasma troponin level was related to increased mortality risk. From the first day of study, the nonsurvivor group presented a reduced left ventricular stroke work systolic index and a reduced low frequency (LF) that is one of the HRV indexes. The correlation coefficient for LF values and troponin was r2 = 0.75 (P < 0.05). All patients presented elevated plasma FFA levels on the first day of the study (5.11 ± 0.53 mg/ml), and this elevation was even greater in the nonsurvivor group compared with the survivors (6.88 ± 0.13 vs 3.85 ± 0.48 mg/ml, respectively; P < 0.05). Cardiac damage was confirmed by measurement of plasma troponin I and histological analysis. Heart dysfunction was determined by the left ventricular stroke work systolic index and the HRV index in nonsurvivor patients. A relationship was found between plasma FFA levels, Lfnu index, troponin levels, and histological changes. Plasma FFA levels emerged as a possible cause of heart damage in sepsis.

Is the widening of the QTc associated with mortality in sepsis

The widening of the QTc is a mortality predictor in acute coronary syndromes and cerebral vascular accident.

Acute effect of low-dose corticosteroids on muscle function in patients with severe sepsis and septic shock

The rationale for the use of glucocorticoids in severe sepsis and septic shock can be attributed to well-defined anti-inflammatory and hemodynamic effects recognized for decades. However, with the introduction of corticosteroid therapy for a variety of conditions, it was reported that this treatment could induce a myopathy. Animal studies have confirmed that the administration of high doses of corticosteroid can produce myopathy affecting both ventilatory and peripheral skeletal muscles. Actually, it remains uncertain whether doses of corticosteroid, typically used to manage patients with severe sepsis and septic shock, do in fact cause peripheral and respiratory muscle weakness.

Predictive factors of noninvasive ventilation failure in a pediatric ICU.

Noninvasive ventilation (NIV) has been developed to reduce complications associated with tracheal intubation and conventional mechanical ventilation. The aim of NIV is to gain control of acute respiratory failure, avoiding intubation; however, when intubation is required, its application should not be delayed, as this may result in a worse prognosis. This is the main reason to look for reliable failure signs of the technique.