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de Souza Costa ÁD, Vermeulen-Serpa KM, Batista Marinho KM, Carvalho Xavier de Medeiros CA, Antunes de Araújo A, Teixeira Dourado-Junior ME, Brandão-Neto J, Lima Maciel BL, Helena de Lima Vale S. Persistent inflammation and nutritional status in Duchenne muscular dystrophy. Clin Nutr ESPEN 2024; 61:393-398. [PMID: 38777460 DOI: 10.1016/j.clnesp.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/16/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Duchenne muscular dystrophy (DMD) involves muscle fragility, sarcolemma instability, and chronic inflammation. This study aims to identify the inflammatory profile of DMD patients and evaluate associations between clinical and nutritional variables. METHODS We performed a cross-sectional study nested in a cohort to obtain sociodemographics, illness time, use of medications, and supplement data through interviews and the patient's medical records. Then, we assessed the relationships between illness time, cytokine levels, and nutritional status. RESULTS Forty-four male participants, aged 4.3-24.2 years, were evaluated. Concerning nutritional status, 18 participants were eutrophic. The fat mass increased and the lean mass decreased from the beginning of the first signs of DMD. Cytokines levels in DMD patients, even under corticosteroids therapy, are higher than values described in the literature on healthy subjects. The regression models demonstrated that illness time and BMI/A z-scores are associated with higher values of interleukin-6. CONCLUSIONS A persistent inflammatory profile was observed in the patients evaluated. The data suggest that maintaining adequate nutritional status and body composition is important for determining the inflammation presented by individuals with DMD.
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Affiliation(s)
| | | | | | - Caroline Addison Carvalho Xavier de Medeiros
- Postgraduate Program in Biological Sciences/ Postgraduate Program in Biotechnology RENORBIO, Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil.
| | - Aurigena Antunes de Araújo
- Postgraduate Program Public Health/ Postgraduate Program in Pharmaceutical Sciences, Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil.
| | | | - José Brandão-Neto
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
| | - Bruna Leal Lima Maciel
- Postgraduate Program in Nutrition, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte Natal, Brazil.
| | - Sancha Helena de Lima Vale
- Postgraduate Program in Nutrition, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte Natal, Brazil.
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Malaga M, Rodriguez-Calienes A, Chavez-Ecos FA, Huerta-Rosario A, Alvarado-Gamarra G, Cabanillas-Lazo M, Moran-Ballon P, Velásquez-Rimachi V, Martinez-Esteban P, Alva-Diaz C. Clinical practice guidelines for the diagnosis and management of Duchenne muscular dystrophy: a scoping review. Front Neurol 2024; 14:1260610. [PMID: 38249725 PMCID: PMC10797703 DOI: 10.3389/fneur.2023.1260610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/30/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Our objective was to identify recent CPGs for the diagnosis and management of DMD and summarize their characteristics and reliability. Methods We conducted a scoping review of CPGs using MEDLINE, the Turning Research Into Practice (TRIP) database, Google Scholar, guidelines created by organizations, and other repositories to identify CPGs published in the last 5 years. Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses for scoping reviews. To assess the reliability of the CPGs, we used all the domains included in the Appraisal of Guidelines Research and Evaluation II. Results We selected three CPGs published or updated between 2015 and 2020. All the guidelines showed good or adequate methodological rigor but presented pitfalls in stakeholder involvement and applicability domains. Recommendations were coherent across CPGs on steroid treatment, except for minor differences in dosing regimens. However, the recommendations were different for new drugs. Discussion There is a need for current and reliable CPGs that develop broad topics on the management of DMD and consider the challenges of developing recommendations for RDs.
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Affiliation(s)
- Marco Malaga
- Facultad de Medicina Humana de la Universidad de San Martín de Porres, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
| | - Aaron Rodriguez-Calienes
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | - Fabian A. Chavez-Ecos
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de Ica, Universidad Nacional San Luis Gonzaga, Ica, Peru
| | - Andrely Huerta-Rosario
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Facultad de Medicina Humana, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Giancarlo Alvarado-Gamarra
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Instituto de Investigación Nutricional, Lima, Peru
- Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Miguel Cabanillas-Lazo
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Sociedad Científica de San Fernando, Lima, Peru
| | - Paula Moran-Ballon
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Sociedad Científica Universidad San Martín de Porres, Lima, Peru
| | - Victor Velásquez-Rimachi
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | | | - Carlos Alva-Diaz
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Universidad Señor de Sipán, Chiclayo, Peru
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
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Schneider NB, Roos EC, Staub ALP, Bevilacqua IP, de Almeida AC, de Camargo Martins T, Ramos NB, Loze P, Saute JAM, Etges APBDS, Polanczyk CA. Estimated costs for Duchenne muscular dystrophy care in Brazil. Orphanet J Rare Dis 2023; 18:159. [PMID: 37349725 DOI: 10.1186/s13023-023-02767-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/04/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The economic burden of rare diseases on health systems is still not widely measured, with the generation of accurate information about the costs with medical care for subjects with rare diseases being crucial when defining health policies. Duchenne Muscular Dystrophy (DMD) is the most common form of muscular dystrophy, with new technologies recently being studied for its management. Information about the costs related to the disease in Latin America is scarce, and the objective of this study is to evaluate the annual hospital, home care and transportation costs per patient with DMD treatment in Brazil. RESULTS Data from 27 patients were included, the median annual cost per patient was R$ 17,121 (IQR R$ 6,786; 25,621). Home care expenditures accounted for 92% of the total costs, followed by hospital costs (6%) and transportation costs (2%). Medications and loss of family, and patient's productivity are among the most representative consumption items. When disease worsening due to loss of the ability to walk was incorporated to the analysis, it was shown that wheelchair users account for an incremental cost of 23% compared with non-wheelchair users. CONCLUSIONS This is an original study in Latin America to measure DMD costs using the micro-costing technique. Generating accurate information about costs is crucial to provide health managers with information that could help establish more sustainable policies when deciding upon rare diseases in emerging countries.
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Affiliation(s)
- Nayê Balzan Schneider
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Erica Caetano Roos
- Programa de Pós-Graduação em Engenharia de Produção, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Lúcia Portella Staub
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Neurogenética, Porto Alegre, Brazil
| | | | | | | | | | - Priscilla Loze
- Produtos Roche Químicos e Farmacêuticos S/A, São Paulo, SP, Brazil
| | - Jonas Alex Morales Saute
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Neurogenética, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ana Paula Beck da Silva Etges
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Carisi Anne Polanczyk
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
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Lazzarin MC, Dos Santos JF, Quintana HT, Pidone FAM, de Oliveira F. Duchenne muscular dystrophy progression induced by downhill running is accompanied by increased endomysial fibrosis and oxidative damage DNA in muscle of mdx mice. J Mol Histol 2023; 54:41-54. [PMID: 36348131 DOI: 10.1007/s10735-022-10109-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Duchenne muscular dystrophy (DMD) is characterized by progressive muscle necrosis. One of the major challenges for prescribing physical rehabilitation exercises for DMD patients is associated with the lack of a thorough knowledge of dystrophic muscle responsiveness to exercise. This study aims to understand the relationship between myogenic regulation, inflammation and oxidative stress parameters, and disease progression induced by downhill running in the skeletal muscle of an experimental model of DMD. Six-month-old C57BL/10 and C57BL/10-DMDmdx male mice were distributed into three groups: Control (C), mdx, and mdx + Exercise (mdx + Ex). Animals were trained in a downhill running protocol for seven weeks. The gastrocnemius muscle was subjected to histopathology, muscle regeneration (myoD and myogenin), inflammation (COX-2), oxidative stress (8-OHdG) immunohistochemistry markers, and gene expression (qPCR) of NF-kB and NADP(H)Oxidase 2 (NOX-2) analysis. In the mdx + Ex group, the gastrocnemius muscle showed a higher incidence of endomysial fibrosis and a lower myonecrosis percentage area. Immunohistochemical analysis revealed decreased myogenin immunoexpression in the mdx group, as well as accentuated immunoexpression of nuclear 8-OHdG in both mdx groups and increase in cytoplasmic 8-OHdG only in the mdx + Ex. COX-2 immunoexpression was related to areas of regeneration process and inflammatory infiltrate in the mdx group, while associated with areas of muscle fibrosis in the mdx + Ex. Moreover, the NF-kB gene expression was not influenced by exercise; however, a NAD(P)HOxidase 2 increase was observed. Oxidative stress and oxidative DNA damage play a significant role in the DMD phenotype progression induced by exercise, compromising cellular patterns resulting in increased endomysial fibrosis.
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Affiliation(s)
- Mariana Cruz Lazzarin
- Department of Biosciences, Federal University of São Paulo - UNIFESP, Rua Silva Jardim, 136 - Lab 328, Santos, SP, CEP: 11015-020, Brazil.,Laboratory of Pathophysiology, Institute Butantan, São Paulo, SP, Brazil
| | - José Fontes Dos Santos
- Department of Biosciences, Federal University of São Paulo - UNIFESP, Rua Silva Jardim, 136 - Lab 328, Santos, SP, CEP: 11015-020, Brazil
| | - Hananiah Tardivo Quintana
- Department of Biosciences, Federal University of São Paulo - UNIFESP, Rua Silva Jardim, 136 - Lab 328, Santos, SP, CEP: 11015-020, Brazil
| | - Flavia Andressa Mazzuco Pidone
- Department of Biosciences, Federal University of São Paulo - UNIFESP, Rua Silva Jardim, 136 - Lab 328, Santos, SP, CEP: 11015-020, Brazil
| | - Flavia de Oliveira
- Department of Biosciences, Federal University of São Paulo - UNIFESP, Rua Silva Jardim, 136 - Lab 328, Santos, SP, CEP: 11015-020, Brazil.
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Creatine kinase test diagnostic accuracy in neonatal screening for Duchenne Muscular Dystrophy: A systematic review. Clin Biochem 2021; 98:1-9. [PMID: 34626608 DOI: 10.1016/j.clinbiochem.2021.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES to evaluate the accuracy of the creatine kinase test in neonatal screening for Duchenne Muscular Dystrophy. METHODS Investigations were carried out in six databases, gray literature and manual search. All studies and data extraction eligibility processes were carried out in paired mode. The methodological stringency of the studies was assessed using the modified QUADAS 2 tool. The performance measures of the test were calculated using the Meta-DiSc software, version 1.4. RESULTS 11 studies were included, with a total sample of 1,416,123 newborns. The positive likelihood ratio was more than 10 in these studies. On the other hand, the negative likelihood ratio was up to 0.2 in 9/10 studies; however, when considering the upper limit of the confidence interval, only 4/10 studies showed a negative likelihood ratio less than 0.2 and in 6/11 it was greater than 0.5. Specificity was close to 1 in studies. The sensitivity was equal to or greater than 0.81 in 10/11 studies; however, when considering the reliability's minimum interval limit, only 6/10 studies showed sensitivity equal to or greater than 0.7. Ten studies were summarized on a ROC curve indicating good performance (Area under the curve = 0.9980 and Q index = 0.9846). CONCLUSIONS the creatine kinase test showed good accuracy in screening for cases of Duchenne Muscular Dystrophy and may be a useful alternative in the early diagnosis of the disease followed by confirmatory genetic testing.
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de Souza F, Bittar Braune C, Dos Santos Nucera APC. Duchenne muscular dystrophy: an overview to the cardiologist. Expert Rev Cardiovasc Ther 2020; 18:867-872. [PMID: 32985912 DOI: 10.1080/14779072.2020.1828065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in children, affecting approximately one in 3,500-5,000 liveborn boys. The main signs and symptoms include gait disturbances beginning in early childhood, with later onset of respiratory and cardiac function disorders, both directly affecting the prognosis. AREAS COVERED The recent improvement of mechanical ventilation increased the mean DMD survival age; however, there has been little progress in the treatment and prevention of cardiac complications, which currently predominantly impact survival. Cardiological evaluation with imaging methods, such as echocardiography and magnetic resonance imaging, can improve the understanding and detect changes in cardiac function early. EXPERT OPINION Close monitoring by the cardiologists and early treatment, with adequate heart disease stratification, may be the key to prolong the lives of these patients until more promising therapies are available and can predict DMD prognosis and progression more accurately. The objective of this brief review is to update the cardiologists by highlighting the most relevant aspects of treatment and follow-up, in a practical and concise way.
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Affiliation(s)
- Fabio de Souza
- Cardiology Section, Department of Specialized Medicine, School of Medicine and Surgery, Federal University of the State of Rio De Janeiro , Rio de Janeiro, Brazil
| | | | - Ana Paula Cassetta Dos Santos Nucera
- Cardiology Section, Department of Specialized Medicine, School of Medicine and Surgery, Federal University of the State of Rio De Janeiro , Rio de Janeiro, Brazil
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7
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Can simple and low-cost motor function assessments help in the diagnostic suspicion of Duchenne muscular dystrophy? JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Pereira AC, Araújo APDQC, Ribeiro MG. Can simple and low-cost motor function assessments help in the diagnostic suspicion of Duchenne muscular dystrophy? J Pediatr (Rio J) 2020; 96:503-510. [PMID: 31009620 PMCID: PMC9432257 DOI: 10.1016/j.jped.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/25/2019] [Accepted: 02/18/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Duchenne muscular dystrophy, an X-linked genetic disease, leads to progressive muscle weakness mainly in the lower limbs. Motor function tests help to monitor disease progression. Can low-cost, simple assessments help in the diagnostic suspicion of Duchenne muscular dystrophy? The authors aim to define the sensitivity of time to rise from the floor, time to walk 10meters, and time to run 10meters, evaluating them as eventual diagnostic screening tools. METHODS This is an analytical, observational, retrospective (1998-2015), and prospective study (2015-2018). Cases were recruited from the database of the pediatric neurology department and the healthy, from child care consultations, with normal gait development (up to 15 months) and without other comorbidities (neuromuscular, pulmonary, heart diseases) from the same university hospital. RESULTS 128 Duchenne muscular dystrophy patients and 344 healthy children were analyzed, equally distributed in age groups. In Duchenne muscular dystrophy, there is a progressive increase in the means of the times to perform the motor tests according to the age group, which accelerates very abruptly after 7 years of age. Healthy children acquire maximum motor capacity at 6 years and stabilize their times. The time to rise showed a p-value <0.05 and a strong association (effect size [ES] >0.8) in all age groups (except at 12 years), with time to walk 10 meters from 9 years, and with time to run 10 meters , from 5 years. The 100% sensitivity points were defined as follows: time to rise, at 2s; time to walk 10 meters, 5s; time to run 10 meters, 4s. CONCLUSIONS Time to rise is a useful and simple tool in the screening of neuromuscular disorders such as Duchenne muscular dystrophy, a previously incurable disease with new perspectives for treatment.
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Affiliation(s)
- Aline Chacon Pereira
- Universidade Federal do Rio de Janeiro (UFRJ), Departamento de Pediatria, Neuropediatria, Rio de Janeiro, RJ, Brazil.
| | | | - Márcia Gonçalves Ribeiro
- Universidade Federal do Rio de Janeiro (UFRJ), Departamento de Pediatria, Genética Clínica, Rio de Janeiro, RJ, Brazil
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Clay A, Hearle P, Schadt K, Lynch DR. New developments in pharmacotherapy for Friedreich ataxia. Expert Opin Pharmacother 2019; 20:1855-1867. [PMID: 31311349 DOI: 10.1080/14656566.2019.1639671] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Friedreich ataxia (FRDA), a rare disease caused by the deficiency of the mitochondrial matrix protein frataxin, affects roughly 1 in 50,000 individuals worldwide. Current and emerging therapies focus on reversing the deleterious effects of such deficiency including mitochondrial augmentation and increasing frataxin levels, providing the possibility of treatment options for this physiologically complex, multisystem disorder. Areas covered: In this review article, the authors discuss the current and prior in vivo and in vitro research studies related to the treatment of FRDA, with a particular interest in future implications of each therapy. Expert opinion: Since the discovery of FXN in 1996, multiple clinical trials have occurred or are currently occurring; at a rapid pace for a rare disease. These trials have been directed at the augmentation of mitochondrial function and/or alleviation of symptoms and are not regarded as potential cures in FRDA. Either a combination of therapies or a drug that replaces or increases the pathologically low levels of frataxin better represent potential cures in FRDA.
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Affiliation(s)
- Alexandra Clay
- Division of Neurology, Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Patrick Hearle
- Division of Neurology, Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Kim Schadt
- Division of Neurology, Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - David R Lynch
- Division of Neurology, Children's Hospital of Philadelphia , Philadelphia , PA , USA
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Vermeulen KM, Lopes MMGD, Grilo EC, Alves CX, Machado RJA, Lais LL, Brandão-Neto J, Vale SHL. Bioelectrical impedance vector analysis and phase angle in boys with Duchenne muscular dystrophy. Food Nutr Res 2019; 63:1615. [PMID: 31007651 PMCID: PMC6458958 DOI: 10.29219/fnr.v63.1615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/14/2022] Open
Abstract
Background Duchenne muscular dystrophy (DMD) is a disease characterized by progressive loss of functional muscle mass followed by changes in body composition. Objective This study aimed to describe and evaluate bioimpedance parameters in boys with DMD. Design This cross-sectional, descriptive study investigated children and adolescents diagnosed with DMD. Age, weight, height, resistance, and reactance data were collected. Phase angle and bioelectrical impedance vector analysis were calculated based on resistance and reactance values. Results We analyzed 43 boys aged between 2.7 and 19.8 years. Low-phase angle values were observed during the investigation of bioimpedance parameters. Bioelectrical impedance vector analysis showed that approximately 87% of the subjects presented vectors outside the tolerance ellipses, and only one patient presented vectors located within the 50% tolerance ellipse, indicating normally hydrated and a good body cell mass. Compared with the reference population, boys with DMD had lower levels of body cell mass. Conclusion Based on the evidence, compared with the reference population, patients with DMD had lower levels of body cell mass. This evidence points to bioimpedance parameters as useful tools for the nutritional evaluation and clinical management of patients with DMD.
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Affiliation(s)
- Karina M Vermeulen
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Márcia M G D Lopes
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Evellyn C Grilo
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Camila X Alves
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Richele J A Machado
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Lucia L Lais
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - José Brandão-Neto
- Departament of Internal Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Sancha H L Vale
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
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Aartsma-Rus A, Hegde M, Ben-Omran T, Buccella F, Ferlini A, Gallano P, Howell RR, Leturcq F, Martin AS, Potulska-Chromik A, Saute JA, Schmidt WM, Sejersen T, Tuffery-Giraud S, Uyguner ZO, Witcomb LA, Yau S, Nelson SF. Evidence-Based Consensus and Systematic Review on Reducing the Time to Diagnosis of Duchenne Muscular Dystrophy. J Pediatr 2019; 204:305-313.e14. [PMID: 30579468 DOI: 10.1016/j.jpeds.2018.10.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Annemieke Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Madhuri Hegde
- Department of Human Genetics, Emory University School of Medicine/School of Biological Sciences, Georgia Institute of Technology/Perkin Elmer Genetics, Atlanta, GA
| | - Tawfeg Ben-Omran
- Clinical and Metabolic Genetics, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Pia Gallano
- U705 CIBERER, Servei de Genetica, Hospital de Sant Pau, Barcelona, Spain
| | | | - France Leturcq
- Department of Genetics and Molecular Biology, Hospitalier Universitaire Paris Centre, Cochin Hospital, Paris, France
| | - Ann S Martin
- Parent Project Muscular Dystrophy, Hackensack, NJ
| | | | - Jonas A Saute
- Medical Genetics and Neurology Services, Hospital de Clinicas de Porto Alegre/Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Wolfgang M Schmidt
- Neuromuscular Research Department, Medical University of Vienna, Vienna, Austria
| | - Thomas Sejersen
- Department of Women's and Children's Health, Karolinska Institute/Astrid Lindgrens Barnsjukhus, Karolinska University Hospital, Stockholm, Sweden
| | - Sylvie Tuffery-Giraud
- Laboratory of Rare Genetic Diseases (LGMR), University of Montpellier, Montpellier, France
| | - Zehra Oya Uyguner
- Department of Medical Genetics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Shu Yau
- Viapath Analytics, Guy's Hospital, London, United Kingdom
| | - Stanley F Nelson
- Department of Human Genetics, University of California, Los Angeles, CA.
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Araujo APQC, Nardes F, Fortes CPDD, Pereira JA, Rebel MF, Dias CM, Barbosa RDCGA, Lopes MVR, Langer AL, Neves FR, Reis EF. Brazilian consensus on Duchenne muscular dystrophy. Part 2: rehabilitation and systemic care. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:481-489. [DOI: 10.1590/0004-282x20180062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 04/30/2018] [Indexed: 12/19/2022]
Abstract
ABSTRACT Significant advances in the understanding and management of Duchenne muscular dystrophy (DMD) have occurred since the publication of international guidelines for DMD care in 2010. Our objective was to provide an evidence-based national consensus statement for multidisciplinary care of DMD in Brazil. A combination of the Delphi technique with a systematic review of studies from 2010 to 2016 was employed to classify evidence levels and grade of recommendations for the guideline. Our recommendations were divided in two parts. Guideline methodology and overall disease concept descriptions are found in Part 1. Here we present Part 2, where we provide the results and recommendations on rehabilitation and systemic care for DMD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Edna Fátima Reis
- Associação Brasileira de Distrofia Muscular Viver Bem sem Limite, Brasil; Associação de Assistência à Criança Deficiente, Brasil
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