Epitácio Leite Rolim Filho

Congenital Zika syndrome with arthrogryposis: retrospective case series study

Objective To describe the clinical, radiological, and electromyographic features in a series of children with joint contractures (arthrogryposis) associated with congenital infection presumably caused by Zika virus. Design Retrospective case series study. Setting Association for Assistance of Disabled Children, Pernambuco state, Brazil. Participants Seven children with arthrogryposis and a diagnosis of congenital infection presumably caused by Zika virus during the Brazilian microcephaly epidemic. Main outcome measures Main clinical, radiological, and electromyographic findings, and likely correlation between clinical and primary neurological abnormalities. Results The brain images of all seven children were characteristic of congenital infection and arthrogryposis. Two children tested positive for IgM to Zika virus in the cerebrospinal fluid. Arthrogryposis was present in the arms and legs of six children (86%) and the legs of one child (14%). Hip radiographs showed bilateral dislocation in seven children, subluxation of the knee associated with genu valgus in three children (43%), which was bilateral in two (29%). All the children underwent high definition ultrasonography of the joints, and there was no evidence of abnormalities. Moderate signs of remodeling of the motor units and a reduced recruitment pattern were found on needle electromyography (monopolar). Five of the children underwent brain computed tomography (CT) and magnetic resonance imaging (MRI) and the remaining two CT only. All presented malformations of cortical development, calcifications predominantly in the cortex and subcortical white matter (especially in the junction between the cortex and white matter), reduction in brain volume, ventriculomegaly, and hypoplasia of the brainstem and cerebellum. MRI of the spine in four children showed apparent thinning of the cord and reduced ventral roots. Conclusions Congenital Zika syndrome should be added to the differential diagnosis of congenital infections and arthrogryposis. The arthrogryposis was unrelated to the abnormalities of the joints themselves, but was possibly of neurogenic origin, with chronic involvement of central and peripheral motor neurones leading to deformities as a result of fixed postures in utero. Based on the neurophysiological observations, we suggest two possible mechanisms: tropism of neurones, with involvement of peripheral and central motor neurones, or a relation with vascular disorders.

Virtual Reality Immersion: An Important Tool for Diagnostic Analysis and Rehabilitation of People with Disabilities

This paper sets out the case for the importance of using virtual reality immersion for diagnostic analysis and rehabilitating people with disabilities. To do so, a review of the literature was undertaken by examining articles published between 2000 and 2012. The results show that browsing in virtual immersion environments simulates real-world situations, with the advantage that this enables there to be full control over the variables analyzed and consequently over the health aspects involved. Furthermore, when using multisensory channels, the human-task-system interface tools enable there to be simultaneous treatment of multiple morbidities, which characterizes there having been an important advance made in the functional independence of people with disabilities.

Effect of autologous stem cells on regenerated bone during distraction osteogenesis by Ilizarov technique in the radius of dogs: histomorphometric analysis

PURPOSE To investigate by histomorphometry the distraction osteogenesis by Ilizarov technique in dog radius with the use of autologous stem cells in regenerated bone. METHODS Ten dogs (20 radiuses) underwent the osteotomy of 20% of extension of their radiuses, and osteogenic distraction using the Ilizarov technique after this procedure at rate of 1mm per day divided into 0.5mm every 12 hours. The elongation was performed until the regeneration reached 20% of the total length of the radius. The stem cells were isolated, concentrated and injected in the regenerated bone, when it reached 10% of the length of the entire radius. The regenerated bone was evaluated using histomorphometric analysis when the elongation was 20% the size of radius. RESULTS The bone formation was evidenced by histomorphometric indices were significantly greater in the study group. In the histology evaluation the type of healing was mixed in 80% (intra membrane and endocondral) in both groups; the osteoblastic activity from moderate to intense was greater in the study group; and the space occupied by the newly-formed bone tissue was more evident in the study group. CONCLUSIONS The histomorphometric indices in this study expressing the microarchitecture, trabecular thickness, trabecular spacing, number of trabecula and quantity of bone that was significant in the group study. These data suggest that the use of undifferentiated stem cells autologous bone marrow in the regenerate bone induces osteogenesis and bone quality.

Congenital Zika Syndrome: Clinical Aspects

Microcephaly is a condition in which a baby has a smaller head compared to other babies of the same sex and age. An infant is considered to have microcephaly when the head circumference (also known as occipitofrontal circumference) is less than a specific cutoff value compared to head circumference reference standards for boys or girls of equivalent gestational or postnatal age. Head circumference reflects intracranial volume, and it is an important measurement to monitor a child’s brain growth.

PROSPECTIVE STUDY OF ASPIRIN FOR THROMBOEMBOLISM PROPHYLAXIS IN TOTAL HIP ARTHROPLASTY

ABSTRACT Objectives: To evaluate the effectiveness of aspirin as prophylaxis for deep venous thrombosis (DVT) in patients undergoing total hip arthroplasty (THA), and to analyze the incidence of bleeding during the post-operative period. Methods: This prospective study carried out in 2017 consisted of 37 patients indicated for THA with high risk for DVT. Immediately after the procedure, aspirin, elastic compression socks and early deambulation were initiated. Doppler ultrasound was performed in the legs 6 days and 6 weeks post-procedure to rule out venous thromboembolism. Hematometric variables and clinical criteria were used to detect bleeding. Results: The incidence of VTE (venous thromboembolism) 6 days post-procedure was 21.6%. By 6 weeks post-procedure, it dropped to 8.1%, (p = 0.102). Only 2.7% were diagnosed with VTE, 6 days and also 6 weeks post-procedure. Within the immediate postoperative period, hemoglobin was lower (p < 0.001), in contrast to 6 weeks after surgery, when it returned to baseline levels. Conclusion: Aspirin was an effective chemical prophylaxis for venous thromboembolism in high-risk patients who underwent THA. There was no clinical record of postoperative bleeding and hematometric levels suggested that there was no chronic bleeding. Level of Evidence II; Prospective study.

SIMPLIFIED CALCULATION FOR CORRECTIVE OSTEOTOMIES OF LONG BONES

ABSTRACT Objectives: To present a simplified calculation for the measurement of osteotomy wedges used for the correction of angular uniplanar deformities of long bones and to compare the simplified calculation proposed (circumferential calculation) with the classical trigonometric calculations, as well as with the exact calculation performed by computer software AutoCADtm. Methods: The software AutoCADtm was used to calculate the bone wedges, for mathematical comparison of the three main groups, each one of them containing 18 hypothetical bone deformities which angles ranging from 5 to 90 degrees, with 5 degrees intervals between them. Results: In the analysis of 18 deformities, the hypothetical angular bone, the average lengths of the corrective wedges obtained by the trigonometric, circumferential and the exact metods were, respectively, 32.21 ± 16.81 mm, 33.16 ± 18.63 mm and 35.22 ± 23.52 mm. There was no statistically significant difference between the three calculation methods (p>0.05). Conclusion: The circumferential calculation proposed in this study is useful for being accurate and simple, not requiring any trigonometric knowledge. Level of Evidence II, Experimental Study.

Use of Immersive Reality and Haptic Devices in Rehabilitation after Cerebral Vascular Accident: Clinical Perspectives and Neuro-Image Evidence

This paper sets out how immersion virtual reality is used to rehabilitate people affected by a stroke. To do so, we carried out a review of the literature after collecting articles published between 2000 and 2013. The results indicate that the use of virtual environments is a trend in rehabilitation and that neuroimaging studies have demonstrated the success of doing so. However, many challenges remain to be overcome. The greatest difficulties lie in characterizing the sample population. Many studies that specifically focus on post-stroke rehabilitation are conducted on individuals without declaring what the disability is and use a non-significant number participants.