Clinical and laboratory description of a series of cases of acute viral myositis

Describe the clinical and laboratory profile, follow-up, and outcome of a series of cases of acute viral myositis. A retrospective analysis of suspected cases under observation in the emergency department was performed, including outpatient follow-up with the recording of respiratory infection and musculoskeletal symptoms, measurement of muscle enzymes, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), transaminases (AST and ALT), blood count, C-reactive protein, and erythrocyte sedimentation rate in the acute phase and during follow-up until normalization. Between 2000 and 2009, 42 suspected cases were identified and 35 (27 boys) were included. The median age was 7 years and the diagnosis was reported in 89% in the first emergency visit. The observed respiratory symptoms were cough (31%), rhinorrhea (23%), and fever (63%), with a mean duration of 4.3 days. Musculoskeletal symptoms were localized pain in the calves (80%), limited ambulation (57%), gait abnormality (40%), and muscle weakness in the lower limbs (71%), with a mean duration of 3.6 days. There was significant increase in CPK enzymes (5507±9180U/L), LDH (827±598U/L), and AST (199±245U/L), with a tendency to leukopenia (4590±1420) leukocytes/mm(3). The complete recovery of laboratory parameters was observed in 30 days (median), and laboratory and clinical recurrence was documented in one case after 10 months. Typical symptoms with increased muscle enzymes after diagnosis of influenza and self-limited course of the disease were the clues to the diagnosis. The increase in muscle enzymes indicate transient myotropic activity related to seasonal influenza, which should be considered, regardless of the viral identification, possibly associated with influenza virus or other respiratory viruses.

Comparison of frequency and time domain electromyography parameters in women with patellofemoral pain

Despite its high incidence, patellofemoral pain etiology remains unclear. No prior study has compared surface electromyography frequency domain parameters and surface electromyography time domain variables, which have been used as a classic analysis of patellofemoral pain. Thirty one women with patellofemoral pain and twenty eight pain-free women were recruited. Each participant was asked to descend a seven step staircase and data from five successful trials were collected. During the task, the vastus medialis and vastus lateralis muscle activities were monitored by surface electromyography. The data were processed and analyzed in four variables of the frequency domain (median frequency, low, medium and high frequency bands) and three time domain variables (Automatic, Cross-correlation and Visual Onset between the vastus medialis and vastus lateralis muscles). Reliability, Receiver Operating Characteristic curves and regression models were performed. The medium frequency band was the most reliable variable and different between the groups for both muscles, also demonstrated the best values of sensitivity and sensibility, 72% and 69% for the vastus medialis and 68% and 62% for the vastus lateralis, respectively. The frequency variables predicted the pain of individuals with patellofemoral pain, 26% for the vastus medialis and 20% for the vastus lateralis, being better than the time variables, which achieved only 7%. The frequency domain parameters presented greater reliability, diagnostic accuracy and capacity to predict pain than the time domain variables during stair descent and might be a useful tool to diagnose individuals with patellofemoral pain.

Reliability and differentiation capability of dynamic and static kinematic measurements of rearfoot eversion in patellofemoral pain

Excessive rearfoot eversion is thought to be a risk factor for patellofemoral pain development, due to the kinesiological relationship with ascendant adaptations. Individuals with patellofemoral pain are often diagnosed through static clinical tests, in scientific studies and clinical practice. However, the adaptations seem to appear in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Thus, the aim of this study was to determine the reliability and differentiation capability of three rearfoot eversion measures: rearfoot range of motion, static clinical test and static measurement using a three-dimensional system. A total of 29 individuals with patellofemoral pain and 25 control individuals (18-30 years) participated in this study. Each subject underwent three-dimensional motion analysis during stair climbing and static clinical tests. Intraclass correlation coefficient and standard error measurements were performed to verify the reliability of the variables and receiver operating characteristic curves to show the diagnostic accuracy of each variable. In addition, analyses of variance were performed to identify differences between groups. Rearfoot range of motion demonstrated higher diagnostic accuracy (an area under the curve score of 0.72) than static measures and was able to differentiate the groups. Only the static clinical test presented poor and moderate reliability. Other variables presented high to very high values. Rearfoot range of motion was the variable that presented the best results in terms of reliability and differentiation capability. Static variables do not seem to be related to patellofemoral pain and have low accuracy values.

Reduced knee flexion is a possible cause of increased loading rates in individuals with patellofemoral pain

Stair ascent is an activity that exacerbates symptoms of individuals with patellofemoral pain. The discomfort associated with this activity usually results in gait modification such as reduced knee flexion in an attempt to reduce pain. Although such compensatory strategy is a logical approach to decrease pain, it also reduces the normal active shock absorption increasing loading rates and may lead to deleterious and degenerative changes of the knee joint. Thus, the aims of this study were (i) to investigate whether there is reduced knee flexion in adults with PFP compared to healthy controls; and (ii) to analyze loading rates in these subjects, during stair climbing. Twenty-nine individuals with patellofemoral pain and twenty-five control individuals (18-30years) participated in this study. Each subject underwent three-dimensional kinematic and kinetic analyses during stair climbing on two separate days. Between-groups analyses of variance were performed to identify differences in peak knee flexion and loading rates. Intraclass correlation coefficient was performed to verify the reliability of the variables. On both days, the patellofemoral pain group demonstrated significantly reduced peak knee flexion and increased loading rates. In addition, the two variables obtained high to very high reliability. Reduced knee flexion during stair climbing as a strategy to avoid anterior knee pain does not seem to be healthy for lower limb mechanical distributions. Repeated loading at higher loading rates may be damaging to lower limb joints.

Q-angle static or dynamic measurements, which is the best choice for patellofemoral pain?

The elevated Q-angle seems to be one of the most suggested factors contributing to patellofemoral pain. Females with patellofemoral pain are often evaluated through static clinical tests in clinical practice. However, the adaptations seem to appear more frequently in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Therefore, the aim of this study was to determine the reliability and discriminatory capability of three Q-angle measurements: a static clinical test, peak dynamic knee valgus during stair ascent and a static measurement using a three-dimensional system. Twenty-nine females with patellofemoral pain and twenty-five pain-free females underwent clinical Q-angle measurement and static and dynamic knee valgus measurements during stair ascent, using a three-dimensional system. All measurements were obtained and comparisons between groups, reliability and discriminatory capability were calculated. Peak dynamic knee valgus was found to be greater in the patellofemoral pain group. On the other hand, no significant effects were found for static knee valgus or clinical Q-angle measurements between groups. The dynamic variable demonstrated the best discriminatory capability. Low values of reliability were found for clinical Q-angle, in contrast to the high values found for the three-dimensional system measurements. Based on our findings, avoiding or correcting dynamic knee valgus during stair ascent may be an important component of rehabilitation programs in females with patellofemoral pain who demonstrate excessive dynamic knee valgus. Q-angle static measurements were not different between groups and presented poor values of discriminatory capability.

Postoperative pain control in cats: clinical trials with pre-emptive lidocaine epidural co-administered with morphine or methadone

To evaluate the effectiveness of epidural lidocaine in combination with either methadone or morphine for postoperative analgesia in cats undergoing ovariohysterectomy. Under general anesthesia, 24 cats that underwent ovariohysterectomy were randomly allocated into three treatments groups of eight each. Treatment 1 included 2% lidocaine (4.0 mg/kg); treatment 2 included lidocaine and methadone (4.0 mg/kg and 0.3 mg/kg, respectively); and treatment 3 included lidocaine and morphine (4.0 mg/kg and 0.1 mg/kg, respectively). All drugs were injected in a total volume of 0.25 ml/kg via the lumbosacral route in all cats. During the anesthetic and surgical periods, the physiological variables (respiratory and heart rate, arterial blood pressure and rectal temperature) were measured at intervals of time zero, 10 mins, 20 mins, 30 mins, 60 mins and 120 mins. After cats had recovered from anesthesia, a multidimensional composite pain scale was used to assess postoperative analgesia at 2, 4, 8, 12, 18, and 24 h after epidural. The time to first rescue analgesic was significantly (P <0.05) prolonged in cats that received both lidocaine and methadone or lidocaine and morphine treatments compared with those that received the lidocaine treatment. All cats that received lidocaine treatment alone required rescue analgesic within 2 h of epidural injections. All treatments had significant cardiovascular and respiratory changes but they were within acceptable range for healthy animals during the surgical period. The two combinations administered via epidural allowed ovariohysterectomy with sufficient analgesia in cats, and both induced prolonged postoperative analgesia.

Electrical activities and pressure pain threshold in oral contraceptives users and nonusers

The aim is to evaluate the influence of oral contraceptive intake and menstrual cycle on the electrical activity and pressure pain threshold from anterior temporal and masseter muscles. Twenty-eight women on reproductive age were selected, 13 OC users and 15 nonusers. They were weekly submitted to electromyography and algometry of the anterior temporal and masseter muscles during three consecutive menstrual cycles. Electrical activities at rest position and PPTs of temporal and masseter muscles were not affected by menstrual cycle or by OCs uses. Comparison between groups demonstrated that working side electrical activity was increased in OC users in both muscles, except during lutheal phase for the anterior temporal. However, comparison within weeks did not demonstrate statistical difference. It was suggested that, in healthy women, oral contraceptive use may influence electrical activity, but different phases of the cycle may not.

Postura de trabalho relacionada com as dores na coluna vertebral em trabalhadores de uma indústria de alimentos: estudo de caso

This study has as main objective to identify the complains occurrences about pain in the spine segments, that are related to work standing posture, adopted by the collaborators in the production section of a food industry, in the city of Marília São Paulo state. A descriptive research and studying case was made, using 30 employees as a sample. It was used as methodological procedure, a questionnaire to obtain information on professional and personal data, posture to remain standing, the most uncomfortable postures in the work environment (signed by the form of Ranney, 2000) and pain (pointed out by Corllet and Manenica Diagram, 1980). It was also used the Nordic questionnaire (Kuorioka et al.,1986), validated in the Brazilian culture by Barros e Alexandre (2003) and adapted for the study, the direct evaluation and, a direct observation was made in the production work, a posture analysis using the OWAS Method. It was noticed that the posture of standing up is adopted during work, and 73.3% of the people that was interviewed said that they felt tired in consequence of this posture, especially when associated with trunk twists, trunk inclination and elevation of their arms above their heads. Most complains regarding pain through their bodies, by Corllet e Manenica (1980) pointed to the lumbar region, followed in the dorsal area and legs and in the neck area, shoulders and right thigh. The adapted Nordic questionnaire reveled the lumbar area, in 10 interviewed people (33.3%) as the area mostaffected by musculoskeletal symptoms, next in the dorsal area, with five people interviewed (16.7%) and one of them (3.3%) felt pain in the cervical area, none reported pain in the hips area. The postural analysis was applied using OWAS method, and it was identified the postures that demanded more effort in the four levels of musculoskeletal injuries. As conclusion, the standing up posture and the asymmetric and incorrect movements are related to pain in the spine, mostly in the lumbar area.

Sensação térmica do pedestre

This study has as main objective to identify the complains occurrences about pain in the spine segments, that are related to work standing posture, adopted by the collaborators in the production section of a food industry, in the city of Marília São Paulo state. A descriptive research and studying case was made, using 30 employees as a sample. It was used as methodological procedure, a questionnaire to obtain information on professional and personal data, posture to remain standing, the most uncomfortable postures in the work environment (signed by the form of Ranney, 2000) and pain (pointed out by Corllet and Manenica Diagram, 1980). It was also used the Nordic questionnaire (Kuorioka et al.,1986), validated in the Brazilian culture by Barros e Alexandre (2003) and adapted for the study, the direct evaluation and, a direct observation was made in the production work, a posture analysis using the OWAS Method. It was noticed that the posture of standing up is adopted during work, and 73.3% of the people that was interviewed said that they felt tired in consequence of this posture, especially when associated with trunk twists, trunk inclination and elevation of their arms above their heads. Most complains regarding pain through their bodies, by Corllet e Manenica (1980) pointed to the lumbar region, followed in the dorsal area and legs and in the neck area, shoulders and right thigh. The adapted Nordic questionnaire reveled the lumbar area, in 10 interviewed people (33.3%) as the area mostaffected by musculoskeletal symptoms, next in the dorsal area, with five people interviewed (16.7%) and one of them (3.3%) felt pain in the cervical area, none reported pain in the hips area. The postural analysis was applied using OWAS method, and it was identified the postures that demanded more effort in the four levels of musculoskeletal injuries. As conclusion, the standing up posture and the asymmetric and incorrect movements are related to pain in the spine, mostly in the lumbar area.

Association between neuropathic pain and A-Waves in Leprosy patients with type 1 and 2 reactions

Summary: Neuropathic pain (NP) is a well-recognized feature of leprosy neuropathy. However, the diagnosis of NP is difficult using only clinical criteria. In the study reported here, by means of conventional nerve conduction studies, the authors sought for an association between long-latency responses and NP complaints in leprosy patients with type 1 and 2 reactions. Of the 27 ulnar nerves of leprosy patients, 18 with type 1 reaction (T1R) and 9 with type 2 reaction (T2R) were followed-up for 6 months before and after steroid treatment. Clinical characteristics of pain complaints and clinical function were assessed, as well as the presence of F- and A-waves of the ulnar nerve using nerve conduction studies. The clinical and the neurophysiologic findings were compared to note positive concordances (presence of NP and A-waves together) and negative concordances (absence of NP and A-waves together) before and after treatment. Both reactions presented a high frequency of A-waves (61.1% in T1R and 66.7% in T2R, P < 0.05) and prolonged F-waves (69.4% in T1R and 65.8% in T2R, P = 0.4). No concordances were seen between pain complaints and F-waves. However, significant concordances between NP and A-waves were observed, although restricted to the T2R group ([chi]2 = 5.65, P = 0.04). After treatment, there was a significant reduction in pain complaints, as well as the presence of F- and A-waves in both groups (P < 0.05 for all comparisons). In conclusion, the presence of A-waves correlates well with pain complaints of neuropathic characteristics in leprosy patients, especially in those with type 2 reaction. Probably, such response shares similar mechanisms with the small-fiber dysfunction seen in these patients with NP, such as demyelination, intraneural edema, and axonal sprouting. Further studies using specific tools for small-fiber assessment are warranted to confirm our findings.

Characterization of the patellofemoral pain syndrome by frequency parameters of EMG signal

Patellofemoral pain syndrome (PFPS) is the most frequent complaint in orthopedic clinics; although, its etiology remains unclear [Bolgla, 2010; Felicio, 2011]. Trying to understand its causes has been used time analysis of electromyography (EMG), but this method shows controversies. The aim of this study was to apply a method of processing the EMG signal in the frequency domain of the vastus lateralis (VL) and vastus medialis (VM) muscles for the characterization of PFPS.

Onset of quadriceps and torque variation in individuals with patellofemoral pain during stair ascent

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Diagnostic accuracy of the EMG parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome

Objective To assess the diagnostic accuracy of the surface electromyography (sEMG) parameters associated with referred anterior knee pain in diagnosing patellofemoral pain syndrome (PFPS). Design Sensitivity and specificity analysis. Setting Physical rehabilitation center and laboratory of biomechanics and motor control. Participants Pain-free subjects (n=29) and participants with PFPS (n=22) selected by convenience. Interventions Not applicable. Main Outcome Measure The diagnostic accuracy was calculated for sEMG parameters’ reliability, precision, and ability to differentiate participants with and without PFPS. The selected sEMG parameter associated with anterior knee pain was considered as an index test and was compared with the reference standard for the diagnosis of PFPS. Intraclass correlation coefficient, SEM, independent t tests, sensitivity, specificity, negative and positive likelihood ratios, and negative and positive predictive values were used for the statistical analysis. Results The medium-frequency band (B2) parameter was reliable (intraclass correlation coefficient=.80–.90), precise (SEM=2.71–3.87 normalized unit), and able to differentiate participants with and without PFPS (P<.05). The association of B2 with anterior knee pain showed positive diagnostic accuracy values (specificity, .87; sensitivity, .70; negative likelihood ratio, .33; positive likelihood ratio, 5.63; negative predictive value, .72; and positive predictive value, .86). Conclusions The results provide evidence to support the use of EMG signals (B2 – frequency band of 45–96Hz) of the vastus lateralis and vastus medialis muscles with referred anterior knee pain in the diagnosis of PFPS.

Dor femoropatelar: uma contribuição considerando aspectos da dor e sua influência em parâmetros eletromiográficos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)