Repositório RCAAP

Abstract Background: Chagas disease continues to be a serious public health problem, and accounts for 25-30% of the indications for cardiac stimulation in Brazil. Objective: To assess clinical and epidemiological characteristics of patients with Chagas disease, younger than 18 years, who had undergone pacemaker implantation in Brazil between 1994 and 2011, and its temporal trend. Methods: This was a cross-sectional analysis of data from the Brazilian Pacemaker Registry database. The following variables were analyzed: year when pacemaker was implanted, location, age, sex, ethnic group, functional class and the main electrocardiographic findings at baseline. Results: In a total of 183,123 implants performed between 1994 and 2011, 214 implants of cardiac stimulation device in Chagas disease patients aged younger than 18 years were identified. Mean age at implantation was 5.6 ± 6.2 years. Second- and third-degree atrioventricular blocks corresponded to 71% of indications for pacemaker implantation. Fifty-six percent of the procedures were performed in the southeast region. Regarding the total number of pacemaker implants per year, there was a remarkable increase in the implants for all causes. However, time series analysis of the implants in Chagas disease patients younger than 18 years revealed a significant reduction in the annual number of implants. Conclusion: There has been an important reduction in the number of pacemaker implantations among children and adolescents with Chagas disease, suggesting a reduction in the vertical transmission of the parasite.

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ABSTRACT Objective: To evaluate the postoperative outcomes of minimally invasive technique for treating lumbar disc herniation in patients undergoing percutaneous endoscopic nucleoplasty with radiofrequency in the center of minimally invasive procedures Veracruz (CEMIVER) of the HRAEV.. Methods: A descriptive, comparative, ambispective and longitudinal study. The clinical records of patients who underwent herniated disc surgery were reviewed from March 2010 to March 2015. Inclusion criteria were individuals of both sexes, aged 18-65 years, with disc herniation diagnosis by MRI, evocative discography (pain) and clinical evaluation. The variables were analyzed by VAS, Oswestry disability index for functional assessment and Macnab criteria for modified retrospective cross clinical classification. Results: 161 patients were included, 81 female and 80 male, aged between 18 and 65 years with severe (83.8%) and moderate (16.2%) disability according to the Oswestry disability index; the total of excellent results was 83.8%, 9.5% were good, 4.8% were median and 1.9% were poor results, according to the Macnab criteria; the average time of surgery was 84 minutes per procedure, and the postoperative average bleeding was 65 ml. Of the total, 87.4% of the patients were on an outpatient basis and 7.6% had a short hospital stay.. Conclusion: It was found that percutaneous endoscopic nucleoplasty with radiofrequency technique is a procedure that offers great benefits for patients with lumbar disc herniation, including performing it under local anesthesia, with clear visualization of the surgical field, minimal pain, little bleeding, shorter operative time, does not cause instability of anatomical structures and has minimal rate of complications.

ABSTRACT Objective: Evaluate the nutritional status, vitamin D, the serum albumin, and the nasal colonization by bacteria in a Brazilian population sample that included specifically patients undergoing spine surgery Methods: The serum albumin and vitamin D tests were performed on blood samples; nasal microbiological research was performed by swab and demographic information was collected. We studied the correlation between the tests and gender and age groups of patients. Results: Seventy-five patients were included. Of this total, 74 patients underwent testing of albumin levels, 64 of vitamin D and 41 underwent nasal swab. The mean of serum albumin was 3.76 g/dl (SD = 0.53 g/dl); 70.3% of subjects were considered normal and 29.7% showed hypoalbuminemia. Regarding vitamin D, the mean was 16.64 ng/ml (SD: 7.43 ng/ml); 64.1% of patients were considered deficient, 32.8% insufficient, and 3.1% were considered normal. There was significant difference between albumin and age (p=0.007), being that the greater the age, the lower the albumin. Hypoalbuminemia was significantly more frequent over 60 years (p<0.001). There was no correlation between vitamin D or nasal swab and age (p=0.603 and 0.725, respectively). The correlation between the tests and gender showed no significant difference in any of the parameters. Conclusion: The serum albumin and vitamin D levels and results of nasal swab were presented for a Brazilian sample of patients undergoing spine surgery. It was found correlation between hypoalbuminemia (inferring malnutrition) and age group of patients. Almost all the patients had some degree of vitamin D deficiency, with no correlation with age.

ABSTRACT Objective: To identify whether the use of prophylactic intrasite vancomycin as an adjuvant is a protective factor against deep tissue infection of the surgical site. Methods: Retrospective, descriptive, case-control study evaluating 210 patients, of whom 70 received intrasite vancomycin (case group) and 140 were controls. It was made a follow up for at least one year, reviewing the physical and electronic records. Data were tabulated in spreadsheets (Excel) including all variables and the statistical analysis was made with Epi InfoTM 7 to calculate the odds ratio. Results: Seven cases of deep infection occurred in the control group and none was found in the case group (odds ratio [95% confidence interval]: 0.1262 [0.007-2.24], P = 0.1585). Among the predisposing factors, diabetes and surgical time were the most relevant. Conclusions: Intrasite use of vancomycin has a protective effect against deep infection in patients undergoing lumbar fusion surgery without presenting considerable side effects.

ABSTRACT Objective: To evaluate whether performing surgery in degenerative diseases of the lumbar spine modify the spinopelvic balance and influences the clinical outcome and the quality of life of patients. Methods: The spinopelvic balance was evaluated in 25 patients using plain radiographs of the lumbosacral region including the proximal femur, as well as evaluating the quality of life on two separated occasions. Results: The measure of spinopelvic balance was obtained by averaging the angles of sacral slope, pelvic version and pelvic incidence. Mean preoperative angles were 59.88º, 22.84º, and 37.44º, respectively, and the mean postoperative values were 61.56º, 24.64º, and 37.32º, respectively. Regarding the questionnaires on quality of life, the Oswestry index showed mean preoperative values of 46.24, characterized as severe disability and mean postoperative values of 13.29 denoting satisfactory response after surgical treatment. The SF-36 questionnaire showed important and significant improvement in quality of life in different domains, with the exception of physical limitation and social aspects, with a p-value of 0.02 and 0.025, respectively. Conclusion: Patients undergoing surgical treatment of degenerative lumbar diseases showed no significant changes in the spinopelvic balance, but showed significant improvement in quality of life after surgery.

ABSTRACT Objective: Evaluates which radiographic parameters of the sagittal and spinopelvic balance influence the clinical and functional outcomes of a sample of patients undergoing spinal fusion. Methods: We studied 32 patients who underwent spinal fusion. Radiographs of the total spine were obtained from all patients. The clinical and functional parameters studied were analysis of pain by visual analogic scale (VAS) and Oswestry and SRS-30 questionnaires. We analyzed the correlation between the clinical and functional parameters and radiographic parameters of the sagittal and spinopelvic balance. Results: There was no significant correlation between parameters pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL) and difference between PI and LL (PI-LL) and clinical parameters (p > 0.05 and r <0.2). Significant correlation were identified only between Sagittal Vertical Axis (SVA) and Satisfaction with Treatment domain of SRS-30 (r = 0.402 e p = 0.023) and between thoracic kyphosis (TK) and the total SRS-30 (r = 0.419 and p = 0.017). Conclusions: According to the study results, it was not possible to precisely characterize the role of the parameters of the sagittal and spinopelvic balance in the post-operative analysis of the clinical outcome of spinal fusion. There was a significant correlation only between SVA and the Satisfaction with Treatment domain of SRS-30 and between TK and total SRS-30.

ABSTRACT Objective: Evaluate the results after decompression and stabilization of craniocervical junction in patients with mucopolysaccharidosis (MPS). Method: Retrospective study of 10 patients with MPS through the analysis of medical records and additional tests. Result: All patients with mid-term and long-term follow-up achieved consolidation of the arthrodesis and 87.5% had neurological improvement of Nurick score. Conclusion: Early diagnosis and intervention in cases of stenosis and/or craniocervical instability of patients with MPS provide patients a good recovery of neurological function, despite the great technical difficulty and risk of complications.

ABSTRACT Objective: Analysis of the use of polyetheretherketone (PEEK) cages for atlantoaxial facet realignment and distraction for treatment of basilar invagination by Goel technique. Method: Retrospective descriptive statistical analysis of the neurological status, pain, presence of subsidence and bone fusion with the use of PEEK cages in 8 atlantoaxial joints of 4 patients with basilar invagination. All patients were treated with atlantoaxial facet distraction and realignment and subsequent arthrodesis C1-C2 by the technique of Goel modified by the use of PEEK cage. Results: All patients showed improvement in Nurick neurological assessment scale and Visual Analogue Scale (VAS) of pain. There were no cases of subsidence, migration, or damage to the vertebral artery during the insertion of the cage. All joints evolved with bone fusion, assessed by dynamic radiographs, and computed tomography. Two patients developed neuropathic pain in dermatome of C2 and one patient had unilateral vertebral artery injury during C2 instrumentation treated with insertion of pedicle screw to control the bleeding. Conclusion: The results of the treatment of basilar invagination by the Goel technique with the use of PEEK cages shown to be effective and safe although further studies are needed to confirm this use.

ABSTRACT Objective: To analyze the incidence of spinal injuries between 2000-2010 due to motorcycle accidents and the relation to the increase in motorcycle sales in the same period, as well as the anatomical distribution of these spinal injuries. Methods: Data were collected from 1,295 records of patients who have suffered spinal injury resulting from motorcycle accidents admitted to the ward TRM (Spinal Cord Trauma) of the Hospital Geral do Estado da Bahia from 2000 to 2010 in this retrospective study. We selected 110 medical records and collected information on sex, age, neurological deficit on admission (according to Frankel scale), diagnosis, and level of injury. Results: Between 2000 and 2010 there was an increase of almost five times in the incidence of patients who have suffered spinal injury due to motorcycle accidents. More than half (51.4%) had cervical spine injury, 37.2% thoracic spine injury and 11.34% had lumbar spine injury. Only 34.3% of patients had no neurological deficit on admission and patients with thoracic spine fracture had a higher incidence and severity of lesion. The average age of patients was 30 years. Conclusions: The increased incidence of spinal injuries due motorcycle accidents occurred in the same period in which there was an increase in motorcycle sales in the country. Patients who have suffered those injuries were young, with higher incidence in the cervical and thoracic spinal levels and high rates of neurological deficit.

ABSTRACT Objective: To evaluate the correlation between structural changes in burst fractures of thoracic and lumbar spine with clinical outcome of the treatment. Methods: A retrospective study in 25 patients with fractures of thoracic and lumbar spine burst fractures without neurological deficit. Eleven patients underwent conservative treatment and for the remaining the treatment was surgical. All patients were followed up for at least 24 months. The cases were evaluated by a protocol that included: posttraumatic measurement of kyphosis, vertebral body collapse and narrowing of the spinal canal, the visual analog scale of pain, and the quality of life questionnaire SF-36 at the follow-up. For statistical analysis, the significance level was 5% and the software SPSS 18.0 was used. Results: No statistically significant difference was observed when comparing the clinical outcomes of one treatment over another. Similarly, there was no statistically significant correlation between kyphosis and post-traumatic narrowing of the spinal canal with clinical worsening in the follow-up, regardless of the treatment used. We found a positive correlation (p<0.05) between initial collapse and SF-36 domains in both groups (operated and non-operated). Conclusion: There was no significant superiority of one treatment over the other, and no correlation was found between kyphosis and spinal canal narrowing in burst fractures of the thoracic and lumbar spine without neurological deficit. However, there was correlation between initial collapse and clinical outcome in some domains of the SF-36 questionnaire.

ABSTRACT Scoliosis is characterized by three-dimensional changes of the spine and is estimated to be present in 4% of the population worldwide. The most common form is the adolescent idiopathic. The purpose of this study is to identify the major muscle abnormalities found in patients with adolescent idiopathic scoliosis through a literature review. We conducted an electronic search of the national databases PubMed, Lilacs, PEDro, and EMBASE using the keywords "scoliosis", "biomechanics", "exercise", "physical therapy specialty", "idiopathic", and "muscles", from January 2003 to April 2015. The most relevant articles in English, Portuguese and Spanish were selected by title and abstract. It was also performed a manual search of the references of the selected articles. From a total of 4,319 articles, 11 were selected. We conclude that individuals with AIS have changes in the paraspinal muscles, with a difference in activation between the concave and convex sides, suggesting an increase in EMG activity on the convex side, although there is still no consensus among the authors.

ABSTRACT The number of fixed segments in the surgical treatment of thoracolumbar burst fractures remains controversial. This study aims to compare the results of short and long fixation in thoracolumbar burst fractures through a meta-analysis of studies published recently. MEDLINE and Cochrane databases were used. Randomized controlled trials and non-randomized comparative studies (prospective and retrospective) were selected. Data were analyzed with the software Review Manager. There was no statistically significant difference in the Cobb angle of preoperative kyphosis. Long fixation showed lower average measurements postoperatively (MD = 1.41; CI = 0.73-2.08; p<0.0001) and in the last follow-up (MD = 3.98; CI = 3.22-4.75; p<0.00001). The short fixation showed the highest failure rates (RD = 4.03; CI = 1.33-12.16; p=0.01) and increased loss of height of the vertebral body (MD = 1.24; CI = 0.49-1.98; p=0.001), with shorter operative time (MD = -24.54; CI = -30.16 - -18.91; p<0.00001). There was no significant difference in blood loss and clinical outcomes. The high rates of kyphosis correction loss with short fixation and the lower correction rate in the immediate postoperative period were validated. There was no significant difference in the blood loss rates because arthrodesis was performed in a short segment in the analyzed studies. The short fixation was performed in a shorter operative time, as expected. No study has shown superior clinical outcomes. The short fixation had worse rates of kyphosis correction in the immediate postoperative period, and increased loss of correction in long-term follow-up, making the long fixation an effective option in the management of this type of fracture.

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