Epitácio Leite Rolim Filho

Background/Objectives: In recent years, the role of vitamin D in the etiology of central and peripheral neurological diseases has been widely investigated, and evidence suggests benefits of vitamin D replacement therapy. However, few studies have evaluated the relationship between serum vitamin D levels and patients with spinal muscular atrophy (SMA). Therefore, this study aimed to analyze serum vitamin D levels in patients with SMA and their relationship with disease type, degree of motor impairment, and the presence of musculoskeletal deformities. Methods: This was a cross-sectional analytical study conducted with patients diagnosed with SMA who were treated at a Rare Diseases Reference Service in Recife, Pernambuco, Brazil. Serum vitamin D levels and their association with clinical characteristics of the disease, including SMA type, motor impairment, and the presence of musculoskeletal deformities were evaluated. Motor impairment was classified according to functional capacity, and an ordinal score was used for correlation analysis. Results: The sample consisted of 36 patients with SMA. The mean serum 25(OH)D concentration was 28.95 ± 10.28 ng/mL, with values ranging from 8.3 to 49.4 ng/mL. Based on the predefined cutoff of 30 ng/mL, 58.3% of participants had serum 25(OH)D concentrations below 30 ng/mL, whereas 41.7% had concentrations ≥30 ng/mL. Serum 25(OH)D concentrations differed significantly across motor function groups (p = 0.002). However, correlation analysis showed a weak and non-significant correlation between motor impairment and serum 25(OH)D concentrations (Spearman r = −0.136; p = 0.431; (n = 36). An association between hypovitaminosis D and the presence of musculoskeletal deformities was also observed. Conclusions: Hypovitaminosis D showed a high prevalence in patients with SMA. Although serum 25(OH)D concentrations differed significantly across motor function groups, the correlation between motor impairment and serum 25(OH)D concentrations was weak and non-significant. These findings reinforce the importance of monitoring serum vitamin D levels and adopting clinical and nutritional follow-up strategies in this population.

This study aimed to analyze the relationship between alcohol consumption and speeding at the time of the crash among motorcyclists admitted to a trauma hospital in northeastern Brazil. This analytical cross-sectional study was conducted from February 2023 to January 2024 with motorcyclists who experienced traffic crashes and were admitted to the Traumatology department of a public hospital in Recife (northeastern Brazil). Upon collecting the victims' sociodemographic data (e.g., sex, age, race, level of education, parental status, and income), we analyzed the association between alcohol consumption and speeding at the time of the crash, crude odds ratios (OR) and their corresponding 95% confidence intervals (CIs). The OR was also adjusted for sociodemographic variables. Of the 303 participants, 95.7% (n = 290) were male, 71.1% (n = 209) were aged 18-39 years, 66% (n = 200) had no children, 75.3% (n = 228) identified as being black or brown, and, among those that informed their income (n = 290), 83.8% (n = 243) earned less than Brazilian two minimum wages. Our findings also showed that the association between alcohol consumption on the day of the crash and speeding was positive and statistically significant (OR = 9.63, 95% CI = 5.37-17.26). After adjusting for confounding variables (age, parental status, and income), motorcyclists who consumed alcohol were ten times more likely to speed (OR = 10.03, 95% CI = 5.19-19.37). Riding a motorcycle under the influence of alcohol is associated with an increased likelihood of speeding at the time of the crash.

Resumo: Objetivo Informar as alterações mais prevalentes no quadril em crianças com síndrome congênita do Zika vírus (SCZ) acima de 5 anos de idade por meio de exames clínicos e radiográficos. Métodos Estudo transversal e retrospectivo em 62 pacientes com SCZ, com mais de 5 anos de idade durante o estudo. Os dados clínicos como valores de abdução máxima, contratura em flexão do quadril e nível do sistema de classificação da função motora grossa (SCFMG), assim como os dados radiográficos índice de Reimers (IR), ângulo colodiafisário (ACD) e índice acetabular (IA), foram extraídos de prontuários e radiografias e avaliados estatisticamente. Resultados Idade média de 65,6 ± 4,1 meses. Prevalência de SCFMG IV e V foi 95,2%. A abdução lenta do quadril foi 41,2 ± 19,5°. O teste de Thomas revelou média de 16,1 ± 14,9°. Os valores médios do IR, ACD e IA, foram 54,1 ± 34,1%, 158 ± 11,9° e 26,0 ± 8,12°, respectivamente. Pacientes com SCFMG III e IV apresentaram IR e IA menores do que aqueles com V. Quanto ao ACD, não foi observada diferença estatística entre os grupos. Pacientes submetidos à tenotomia dos músculos adutores do quadril apresentaram abdução maior, mas sem diferença radiográfica relevante. Conclusão Observa-se maior incidência de pacientes com luxação dos quadris e graus funcionais mais comprometidos (SCFMG IV e V), aumento do IR e IA no V. Pacientes operados tiveram ganho de abdução, porém sem melhora radiográfica. Estudos de longo prazo são necessários para a real avaliação das deformidades do quadril.

Limb amputation is one is one of the main causes of human physical disability. Objective: Here, we carried out a functional and quality of life assessment of 172 lower limb amputees treated at a large outpatient clinic in Brazil. Method: This quantitative study was based on The Functional Measure for Amputees questionnaire (FMA) applied during medical consultations. Results: Most patients, particularly males, younger individuals and those with below-the-knee amputations, were able to independently perform daily tasks at home while using prostheses. In community ambulation, the use of support such as a cane and crutches were common, especially by women. Conclusion: Rehabilitation proved effective, leading to an average prosthesis usage of over 11 hours per day. The primary limitations to prosthesis use were perceptions of insufficient speed, fatigue, long distances to be covered and fear of falling.

Resumo: Objetivo Avaliar e determinar, através de análise tridimensional (3D) instrumentada da marcha, o perfil cinético, cinemático e eletromiográfico de pacientes com mucopolissacaridose (MPS) IV e VI. Métodos Foi realizado um estudo transversal com 11 pacientes atendidos em um serviço de referência em doenças raras, avaliados em laboratório de análise do movimento. Foram coletados dados clínicos, do exame físico e dados cinéticos, cinemáticos e eletromiográficos através de sistema 3D de movimento, entre junho de 2020 e janeiro de 2021. Resultados Havia 5 pacientes (45,5%) do gênero feminino e 6 (54,5%) do masculino. Adicionalmente, 9 (81,8%) tinham MPS VI e 2 (18,2%) IV. A idade média foi de 14,6 anos. A velocidade média (m/s) foi de 0,68 (±0,21) e o comprimento da passada de 0,66 (±0,15). Os ângulos estáticos mais alterados foram a abdução-adução dos quadris, o arco de movimento dos joelhos e o ângulo de progressão do pé. Um padrão de marcha em flexão e adução dos quadris e flexão dos joelhos foi identificado na maioria dos casos. O Gait Profile Score (GPS) foi de 14,58 (±6,72) à direita e 11,71(±3,39) à esquerda. O Gait Deviation Index (GDI) foi de 73,23 (±14,50) à direita e de 80,45 (±17,05) à esquerda. A atividade muscular seguiu aproximadamente o modelo corrente. Conclusão Os pacientes apresentaram uma velocidade média e comprimento da passada diminuídos. Um padrão de marcha em flexão e adução dos quadris e flexão dos joelhos foi identificado na maioria dos casos. Tanto GPS quanto GDI mostraram desvio importante da normalidade.

Introduction: The three-dimensional evaluation of patients in the gait laboratory is a diagnostic method that is gaining ground in various orthopedic pathologies and, in the case of ankle fractures, can more accurately detail the degree of joint limitation. Objective: To present the importance of laboratory gait studies in the postoperative period of ankle fractures associated with syndesmosis ligament injuries, increasing the arsenal for assessing whether the surgical approach and outcome were satisfactory. Methods: Case series of 13 patients who underwent surgical treatment for ankle fractures associated with syndesmosis injuries, evaluated postoperatively in the gait clinic using the BTS GAITLAB hardware program. Kinetic and kinematic data using a three-dimensional movement system were collected and analyzed. Results: Alterations were found in the Temporal and Spatial Parameters and in the Statistical Angles of the lower limb joints, comparing the operated limb with the non-operated limb. Conclusion: The results of the study suggest that, despite subtle variations between the limbs assessed, the program was able to identify these differences in a significant way, demonstrating that gait assessments bring great benefits in understanding biomechanical limitations, and make more effective and individualized rehabilitation protocols possible. Level of evidence IV, Case series.

RESUMO Introdução: Na literatura, diversos artigos apresentam a satisfação dos pacientes e a melhor clareza de entendimento acerca das informações transmitidas pela equipe médica, com o auxílio de peças tridimensionais. A educação e a saúde são práticas inseparáveis e interdependentes, sempre estiveram articuladas, consideradas elementos fundamentais no processo de atuação dos profissionais da saúde. Assim, professores e alunos do curso de Medicina da Universidade Federal de Pernambuco criaram uma extensão universitária, que objetivava o uso de modelos anatômicos, impressos em 3D, para educação dos pacientes do ambulatório de ortopedia e traumatologia. Relato de experiência: Ao longo dos seis meses de projeto, foram assistidos 77 pacientes, e o projeto contou com o trabalho de três professores e 18 alunos da graduação, totalizando 98 pessoas envolvidas no projeto. As ações foram divididas em dois blocos. O primeiro consistiu na capacitação dos alunos. No segundo, os discentes realizavam visitas ao ambulatório, acompanhados por um médico especialista responsável, usavam peças impressas pelos próprios alunos, para orientar os pacientes quanto à sua respectiva condição, e davam orientações sobre a terapêutica valendo-se dessas peças impressas. Discussão: A possibilidade de utilização dessa ferramenta como auxílio na comunicação médica abre um vasto horizonte de aplicação da impressão 3D na educação popular em saúde. Isso, por sua vez, propicia o aperfeiçoamento da promoção da saúde de regiões menos desenvolvidas, uma vez que essa interação entre equipe de saúde e comunidade permite a promoção, a proteção e a recuperação da saúde, a partir de um diálogo horizontal, valorizando e respeitando o usuário do sistema de saúde, de maneira a torná-lo agente e protagonista do processo saúde e doença. Conclusão: Projetos de extensão desse tipo têm um enorme potencial para gerar impactos na medicina, na comunidade acadêmica e na população assistida, sobretudo a menos instruída.

Introduction: In the literature, several articles demonstrate patient satisfaction and better understanding of the information transmitted by the medical team, with the aid of three-dimensional pieces. Education and health are inseparable and interdependent practices, they have always been articulated, and considered crucial elements in the action process of health professionals. Thus, teachers and students of the medicine course at Universidade Federal de Pernambuco created a university extension project that aimed at the use of anatomical models printed in 3D, for the education of patients in the orthopedics and traumatology outpatient clinic. Experience Report: Over the six months of the project, 77 patients were assisted and the project employed the work of 3 teachers and 18 undergraduate students, totaling 98 people involved in the project. The actions were divided into 2 blocks: the first consisted of training the students and, in the second, the students visited the outpatient clinic, accompanied by a specialist physician in charge and used pieces printed by the students themselves, to guide the patients regarding their respective condition and provided guidance on therapy using these printed pieces. Discussion: the possibility of using this tool as an aid in medical communication opens up a vast horizon of application of 3D printing in health education. This, in turn, favors the improvement of health promotion in less developed regions, since this interaction between the health team and the community allows the promotion, protection and recovery of health, based on a horizontal dialogue, valuing and respecting the users of the health system, aiming to make them an agent and protagonist of the health and disease process. Conclusion: It can be concluded, therefore, that extension projects such as this one have enormous potential to generate impacts on medicine, the academic community and the assisted population, especially the less educated ones.

Keywords: Osteotomy/methods. Bone and bones/abnormalities. Surgical procedures; operative.