ObjectiveTo evaluate bone mineral density among patients with neuromuscular scoliosis secondary to quadriplegic cerebral palsy.MethodsThis was a descriptive prospective study in which both bone densitometric and anthropometric data were evaluated. The inclusion criteria used were that the patients should present quadriplegic cerebral palsy, be confined to a wheelchair, be between 10 and 20 years of age and present neuromuscular scoliosis.ResultsWe evaluated 31 patients (20 females) with a mean age of 14.2 years. Their mean biceps circumference, calf circumference and body mass index were 19.4 cm, 18.6 cm and 16.9 kg/m2, respectively. The mean standard deviation from bone densitometry was −3.2 (z-score), which characterizes osteoporosis.ConclusionThere is high incidence of osteoporosis in patients with neuromuscular scoliosis secondary to quadriplegic cerebral palsy.

OBJECTIVE: To evaluate bone mineral density in patients with neuromuscular scoliosis secondary to spastic quadriplegic cerebral palsy. METHODS: A prospective descriptive study in which, in addition to bone densitometry, the anthropometric data of the patients were assessed. As inclusion criterion we adopted patients with spastic quadriplegic cerebral palsy, wheelchair users, aged between 10 and 20 years and with neuromuscular scoliosis. RESULTS: We evaluated 31 patients, 20 female, whose average age was 14.2 years. The mean bone density was -3.2 standard deviation (Z-score), with mean biceps circumference of 19.4 cm, calf circumference 18.6 cm and BMI of 13.6 kg/m². CONCLUSION: There is a high incidence of osteoporosis in patients with neuromuscular scoliosis secondary to spastic quadriplegic cerebral palsy.

r e v b r a s o r t o p . 2 0 1 5;5 0(1):68-71 w w w . r b o . o r g . b r Artigo Original Avaliação da densidade mineral óssea em pacientes portadores de escoliose neuromuscular secundária a paralisia cerebral ଝ informações sobre o artigo Histórico do artigo: Recebido em 3 de outubro de 2013 Aceito em 25 de novembro de 2013 On-line em 1 de agosto de 2014 Palavras-chave: Escoliose Neuromuscular Osteoporose r e s u m o Objetivo: avaliar a densidade mineral óssea em pacientes portadores de escoliose neuromuscular secundária à paralisia cerebral tetraespástica. Métodos: estudo prospectivo, descritivo, em que se avaliaram, além da densitometria óssea, dados antropométricos. Como critério de inclusão, adotamos pacientes com paralisia cerebral tetraespástica, cadeirantes, entre 10 e 20 anos e com escoliose neuromuscular. Resultados: avaliamos 31 pacientes, 20 do sexo feminino, cuja média de idade foi de 14,2 anos. A média da circunferência bicipital, da panturrilha e do IMC foi de 19,4 cm, 18,6 cm e 16,9 Kg/m 2 , respectivamente. O desvio padrão médio encontrado na densitometria óssea foi de -3,2 (z-score), o que caracteriza osteoporose. Conclusão: existe elevada incidência de osteoporose em pacientes portadores de escoliose neuromuscular secundária à paralisia cerebral tetraespástica. © 2014 Sociedade Brasileira de Ortopedia e Traumatologia. Publicado por Elsevier Editora Ltda. Todos os direitos reservados. Bone mineral density evaluation among patients with neuromuscular scoliosis secondary to cerebral palsy Keywords:Scoliosis Neuromuscular Osteoporosis a b s t r a c t Objective: to evaluate bone mineral density among patients with neuromuscular scoliosis secondary to quadriplegic cerebral palsy.Methods: this was a descriptive prospective study in which both bone densitometric and anthropometric data were evaluated. The inclusion criteria used were that the patients should present quadriplegic cerebral palsy, be confined to a wheelchair, be between 10 and 20 years of age and present neuromuscular scoliosis.

Background: Reactivation of Cytomegalovirus (CMV) is frequent after allogeneic hematopoietic stem cell transplantation (HSCT), occurring in approximately 70% of CMV seropositive patients. CMV reactivation is associated with higher non-relapse mortality (NRM) and worse overall survival (OS), but data in patients from Latin American countries, in which seroprevalence of CMV is higher, are lacking. Objectives: We analyzed the potential risk factors for CMV reactivation and the possible impact of CMV reactivation or primo-infection on HSCT outcomes. Patients and Methods: We performed an observational, retrospective study in 262 consecutive adult patients who underwent HSCT between April 2007 and April 2020 in two centers. The median follow-up was 30 months. Results: The median age was 50 years (range 18 to 83), most patients (58%) were male, had acute leukemia (acute myeloid leukemia in 40%, and acute lymphoblastic leukemia in 19%), and received transplants from alternative donors (matched unrelated in 32% and haploidentical in 36%). Most transplants were from peripheral blood stem cells (73%), with reduced-intensity conditioning regimens (76%). T-cell depletion was performed in 71% (post-transplant cyclophosphamide in 40%, antithymocyte globulin - ATG in 29%, and alemtuzumab in 2%). Pre-HSCT CMV IgG serostatus of donor (D) and recipient (R) was as follows: D+/R+ in 64%, D-/R+ in 22%, D+/R- in 8%, and D-/R- in 6% only. No patient received primary CMV prophylaxis. CMV reactivations were observed in 164 patients (63%), and all received preemptive therapy at the discretion of the treating physician. The CI for CMV reactivation at 100 days (CICMV) was 74% in D-/R+, 65% in D+/R+, 30% in D+/R-, and 0% in D-/R-, p<0.01, Figure 1). The CICMV was higher in patients receiving transplants with T-cell depletion (67% vs. 47% without T-cell depletion, p<0.01), and in patients with acute graft-versus-host disease (GVHD, 91% vs. 53% without GVHD, p=0.01). By multivariate analyses, all three factors remained associated with the CMV reactivation: pre-HSCT positive CMV serostatus (Hazard Ratio - HR: 6.06; 95% Confidence Interval - 95%CI 2.76.-13.35), T-cell depletion (HR 1.65, 95%CI 1.20-2.27), and acute GVHD (HR 1.67, 95%CI 1.31-2.14). By multivariate analysis, there was no significant association between CMV reactivation and the risk of acute GVHD, chronic GVHD, mortality, relapse, or survival. Conclusion: An increased frequency of CMV reactivation was observed in recipients with positive CMV serostatus, T-cell depletion, and acute GVHD. CMV reactivation had no significant impact on HSCT outcomes. Our findings may help to identify a group of patients who could benefit from closer monitoring and possibly primary prophylaxis with novel agents, such as letermovir. Disclosures No relevant conflicts of interest to declare.

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