Introduction: Motor neuron disease is neurodegenerative and the understanding of its prognostic factors is crucial promoting better quality of life for patients. Epidemiological, clinical and nutritional factors have been described as influencing disease progression. Objectives: To describe prognostic factors in patients with Motor Neuron Disease at a specialized outpacient care center in Bahia. Methods: This is an observational, and cross-sectional study, carried out by collecting data from medical records of patients with diagnosis of amyotrophic lateral sclerosis (ALS), using forms to acess epidemiology data, clinical characteristics, and nutritional assessment in the beginning of treatment and the time of assessment. The time from the first symptoms until the application of palliative measures was also recorded. Results: 27 patients were enrolled in the study, 51.8% men and 41.8% women, with an average age of 55±11.1 years at diagnosis. No patients were diagnosed with frontotemporal dementia (FTD) and 3.7% had family history of ALS. Weight loss was observed in 95.8% of patients. Among the elderly population, 9% were classified as low weight at the first evaluation, and 81% were classified as such during data collection. Among the adult population, 8.3% were classified as malnourished at their first evaluation, and 27% during data collection. About 81% of the population used some palliative measure. The time between symptoms these measures were of 32 ± 18.6 months for gastrostomy, 38 ± 41.1 months for AMBU use and 49 ± 43.9 months for BiPAP use. Conclusion: A similar distribution of prognostic factors compared with literature was observed, with some particularities such as earlier age of onset, low prevalence of familial ALS and absence of FTD. Significant weight loss was observed, especially in those with bulbar ALS and in the elderly population, which is associated with a poor prognosis. Time from symptoms to palliative measures varied, but was shorter on average in patients with the bulbar form of the disease.
Background Human T-lymphotropic virus type-1 (HTLV-1) causes a variety of sicca symptoms, including xeroderma, xerostomia, and xerophthalmia. Aim We sought to evaluate vaginal dryness via the degree of perceived vaginal lubrication, vaginal hormonal cytology, and direct measurements of vaginal wetting. Methods The research was designed as a cross-sectional study. Vaginal dryness was assessed by scores in the lubrication domain of the Female Sexual Function Index (FSFI) questionnaire and the Vaginal Maturation Index (VMI) determined by vaginal hormonal cytology, as well as the measurement of vaginal lubrication using Schirmer strips placed at the anterior vaginal wall. Medians (25th-75th percentiles) were calculated for each group and compared using a nonparametric Kruskal-Wallis test and the Dunn-Bonferroni post hoc method. Outcomes Outcomes were detection of the presence of vaginal dryness in women who were infected or noninfected with HTLV-1. Results HTLV-1–infected women (n = 72, 57 asymptomatic and 15 with HTLV-1–associated myelopathy/tropical spastic paraparesis [HAM/TSP]) and uninfected women (n = 49) were studied. Women with HAM/TSP had significantly lower FSFI lubrication scores than asymptomatic and uninfected women (P = .032). In addition, women with HAM/TSP had significantly lower VMI compared with the asymptomatic and uninfected groups (P = .027 and P = .039, respectively). Clinical Implications The results of this study show a reduction in vaginal lubrication in HTLV-1-infected women diagnosed with HAM/TSP compared with asymptomatic and uninfected women. Strengths and Limitations The lack of a gold standard test for the diagnosis of vaginal dryness and the fact that no assessment of vaginal pH was performed were limitations of this study. The strength of the study was the comprehensive assessment of vaginal dryness from several perspectives: subjective (perception of vaginal lubrication according to the vaginal lubrication domain of the FSFI), hormonal (vaginal hormonal cytology to assess local hormone status), and the degree of vaginal moisture (direct measurement of vaginal dryness with an instrument, the Schirmer strip, already used to measure the presence of dry eye). Conclusion HTLV-1-infected women with HAM/TSP have decreased vaginal lubrication compared with asymptomatic and uninfected women after adjusting for age.
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