Construct validity of the Capacity Profile in preschool children with cerebral palsy

The Capacity Profile (CAP) classifies additional care needs, subdivided into five domains of body functions (physical health, motor, sensory, mental, and voice/speech) of children with stable conditions. Construct validity of the CAP was established in 72 children (56 males, 16 females) with cerebral palsy (CP); median age 2 years 7 months, range 2 years 6 months to 3 years; 34 unilateral and 37 bilateral spastic-type CP, one dyskinetic-type CP. Gross Motor Function Classification System (GMFCS) classification was 24 in level I, eight in level II, 18 in level III, 14 in level IV, and eight in level V. All CAP domains were significantly associated ( p <0.001) with the Functional Skills (rho=−0.42 to −0.85) and Caregiver Assistance scales (rho=−0.42 to −0.82) of the Dutch Paediatric Evaluation of Disability Inventory. The CAP-motor domain and GMFCS were strongly correlated (rho=0.91, p <0.001). Stepwise regression analysis demonstrated that the CAP domains contributed 74% to mobility (CAP-motor 66%, mental 6%, voice 2%); 75% to self-care (CAP-voice 61%, mental 12%, physical 2%); and 70% to social functionality (CAP-mental 68%, voice 2%). CAP demonstrated good construct validity in young children with CP. The independent contribution of CAP domains to daily function underscores the importance of comprehensive assessment with regard to all domains of body functions in heterogeneous conditions like CP.     

Induced abortions in Bulgaria: Trends during the period 1986-1996

Background: Bulgaria is in a state of socioeconomic transition.Along with the political, economic and social system, the currentchanges affect the health care sector. The present article focuseson the issue of induced abortions. Bulgaria has one of the highestabortion rates in Europe, and this poses an important publichealth concern. Methods: Data were collected from the BulgarianMinistry of Health, the Bulgarian National Statistical Institute,articles and the reports of WHO, UNDP, UNICEF, and AIHA. Thedata was analysed by stratifying abortion rates according toage, marital status, parity, socio-economic status, level ofeducation, and ethnicity. In addition, possible contributingfactors were reviewed. The main factors included were demographiccharacteristics of the country; legislation related to inducedabortions; financing of the health care system; organizationof family planning services; and data on contraceptive prevalenceand practices. Results: Abortion rates show a general trendof shift towards younger age groups, as well as to single nulliparawomen. Definite associations with ethnicity, level of educationand socio-economic status could not be established, maily becausesufficient data was not available. The observed cases of multipleabortions indicate the inadequacy of the post-abortion counselling.The new financing system is expected to make the family planningservices more effective. The objective of this review is tocontribute to a better understanding of the problem of highrates of induced abortions in Bulgaria. Detailed analysis ofassociations between different factors related to the problemwould be important for developing adequate strategies for intervention,i.e. reduction of the number of induced abortions. This wouldundoubtedly be of social, financial and public health benefitfor Bulgaria.     

Improved Survival in Multiple Myeloma with Renal Failure

ABSTRACT. Forty-four myeloma patients with large tumour cell mass and impairment of renal function (S-creatinine >2 mg/dl, stage III B) were studied. Seven patients, who received no active treatment, neither cytostatics nor plasmapheresis, survived for >1 month (median). Twenty-one patients who were treated with chemotherapy combination (M-2 protocol: melphalan, vincristine, BCNU, cyclophosphamide, prednisone) plus plasma exchanges for three days at the start of each 5-week cycle survived longer (median 17 months, p<0.01) than 16 pateints who were treated with melphalan-prednisolone alone (median 2 months). However, better supportive care, dialysis, and improved antibiotic treatment may also have contributed to the improved results. It is concluded that intensive chemotherapy in full dosage, plasmapheresis, and active uremia treatment including dialysis should be considered in patients with advanced myeloma and renal failure.     

Salivary gland extract from Ixodes ricinus ticks inhibits production of interferon-γ by the upregulation of interleukin-10

Tick saliva has been shown to modulate host immunity by a so far unknown mechanism. We have demonstrated an inverted effect of salivary gland extract (SGE), derived from partially fed Ixodes ricinus females, on the production of two cytokines, interferon (IFN)-gamma and interleukin (IL)-10, in vitro. While SGE markedly suppressed the elaboration of IFN-gamma by mouse splenocytes stimulated with lipopolysaccharide (LPS), the production of IL-10 was increased in comparison with SGE-untreated cultures. The suppressive effect of SGE could be abolished by the addition of an IL-10 neutralizing monoclonal antibody to splenocyte cultures. Similar results were obtained when live Borrelia afzelii spirochetes, which are transmitted in Europe by I. ricinus ticks, were used for the cytokine induction. These results suggest that tick saliva can upregulate the IL-10 production at the tick feeding site, which consecutively inhibits the elaboration of pro-inflammatory cytokines, for example IFN-gamma. This immunosuppression may facilitate the establishment of tick-transmitted pathogens in the host.     

Infantile seborrhoeic dermatitis and Pityrosporum ovale

Twenty children (mean age 9 weeks) with infantile seborrhoeic dermatitis (ISD) were investigated with cultures for bacteria, Pityrosporum ovale and other fungi, and 20 healthy children served as controls. P. ovale and Staphylococcus aureus were the dominant organisms. P. ovale was cultured in 18 of 20 infants with ISD as compared to 4 of 20 controls. S. aureus was cultured in 14 of 20 infants with ISD as compared to 1 of 20 controls. The role of S. aureus in ISD is not known, but it could be a secondary invader as is supposed in atopic dermatitis (AD). Even if P. ovale may be suspected as the aetiological agent of ISD further studies are needed to clarify the exact role of the organism in ISD.     

Incidence of Deep Vein Thrombosis in Bedridden Non-surgical Patients

ABSTRACT. In order to detect deep vein thrombosis (DVT), 101 patients with acute medical or infectious disorders were examined with the ¹²⁵I-fibrinogen uptake test. All patients were bedridden on admission and were scanned daily from the second to the eighth day. Thirteen patients developed a positive fibrinogen uptake test. Thus, if a positive test is interpreted as DVT, the incidence of DVT was 13% in our bedridden patients. Of the patients admitted because of heart disease or pneumonia 20% had DVT, but only 4% of those admitted with other diagnoses. Other clinical “risk factors” studied, could not identify patients who developed DVT.     

Short-Term and Long-Term Changes of Left Ventricular Volumes During Rate-Adaptive and Single-Rate Pacing

To evaluate the adaptation of the heart to exercise during pacing, 15 patients with permanent endocardial pacemakers were studied; nine patients had atrioventricular universal (DDD) pacemakers (Symbios 7005) and six patients had activity detecting rate-responsive ventricular (VVIR) pacemakers (Activitrax 8403). Left ventricular function in each patient during rate variable pacing was compared to ventricular function during VVI single-rate pacing. End-systolic and end-diastolic volume changes during exercise were measured by radionuclide angiography and the amount of volume change was used to assess left ventricular function. Both short-term (within 4 hours) and long-term measurements (after at least 4 weeks) were made at rest and at 50% of the maximal exercise capacity in DDD or VVIR mode and were compared with VVI single-rate pacing. All patients, when changed from DDD or VVIR mode to VVI single-rate pacing showed a significant increase of the end-diastolic volume during exercise, which increased even more after long-term VVI pacing. During long-term rate variable pacing, there was no increase of the end-diastolic volume during exercise. DDD or VVIR pacing initially showed a substantial increase of the end-systolic volume during exercise combined with a decrease of left ventricular ejection fraction, suggesting a decrease of the left ventricular contractility. After 4 weeks, contractility improved both with DDD and VVIR pacing. We conclude that short-term DDD and VVIR pacing induces a temporary impairment of left ventricular function that improves after 4 weeks, whereas long-term VVI pacing is associated with left ventricular dilatation even at moderate levels of exercise.     

Noise Reversion of a Dual Chamber Pacemaker without Noise

Three patients are reported whose DDD pacemakers reverted to the asynchronous mode in the absence of skeletal muscle or electromagnetic (EMI) interference. In all three cases, the basic cardiac rhythm was atrial fibrillation with fast ventricular response due to intrinsic AV conduction. Noise reversion was triggered by the patients' own ventricular activity at cycle lengths shorter than the ventricular refractory period of the pulse generator. In one patient, asynchronous AV sequential pacing during atrial fibrillation was noted shortly after resuscitation from ventricular fibrillation; however, the initiation of the malignant ventricular arrhythmia by the pacemaker remains unproven. The mechanism of noise reversion by rapid cardiac activity and possible solutions to the problem by adequate pacemaker design are discussed.     

Efficacy and Safety of Rate Responsive Pacing in Patients with Coronary Artery Disease and Angina Pectoris

The present study included 17 patients with angina pectoris and coronary artery disease in whom a rate responsive ventricular pacemaker (Medtronic Activitrax) had been implanted. All patients had an exclusively paced rhythm. Single blinded, random, cross-over treadmill tests in the rate responsive pacing mode (VVIR) and in the fixed-rate demand mode (VVI) were performed, with an interval of 4-6 weeks. Mean exercise duration increased by 25% during VVIR pacing. Maximal heart rate increased significantly during VVIR compared to VVI pacing (VVI = 74 +/- 2 bpm, VVIR = 116 +/- 8 bpm, P less than 0.001) as did the rate-pressure product (VVI = 10.850 +/- 1,124, VVIR = 16.628 +/- 2,110, P less than 0.001). Despite improved performance, the number of anginal attacks per week and the nitroglycerin consumption did not show a significant difference between the two pacing modes. It is concluded that rate responsive pacing is beneficial and safe in patients with angina pectoris and coronary artery disease.