Relationship between pain and upper limb movement in patients with chronic sternal instability following cardiac surgery

Physiotherapists routinely prescribe upper limb exercises for patients who have undergone a median sternotomy during cardiac surgery. It is not currently known whether upper limb exercises should be unilateral or bilateral and conducted with or without additional loading to minimise pain and further sternal separation in patients with sternal instability. Eight patients who had chronic sternal instability after cardiac surgery were included in this study. During a selected regimen of upper limb exercises, the amount of sternal separation at different vertical points on the sternum was measured by ultrasound. The amount of sternal separation was not related to type of upper limb activity, but both unilateral and unilateral loaded positions were found to be significantly associated with sternal pain (p = 0.009). In this group of patients with chronic sternal instability, bilateral upper limb movements were significantly less associated with sternal pain than unilateral movements.     

Control of separation in sternal instability by supportive devices: a comparison of an adjustable fastening brace, compression garment, and sports tape

El-Ansary D, Waddington G, Adams R. Control of separation in sternal instability by supportive devices: a comparison of an adjustable fastening brace, compression garment and sports tape.

Objective

To evaluate the effectiveness of 3 supportive devices in controlling sternal separation.

Design

A cross-sectional, randomized intervention study.

Setting

Participants were from the general community who were referred to the study by their cardiac surgeon or cardiologist.

Participants

Fifteen patients (12 men, 3 women) between 49 and 80 years of age with sternal instability after a median sternotomy.

Interventions

Not applicable.

Main Outcome Measures

Support from sports tape, a compression garment, and an adjustable fastening brace was assessed by an ultrasound-based measure of sternal separation contingent on movement and by self-report measures of comfort, pain, feeling of support, ease of upper-limb movement, and ease of breathing.

Results

For both sternal separation and self-report data, some support was better than no support, and a supportive device worn on the body was better than sports tape. Wearing an adjustable fastening brace was better than a compression garment and, compared with no support, closed the sternal gap by 20% or 2.7mm (95% confidence interval, 1.5-3.9mm). The effects of wearing the different supportive devices on visual analog scale ratings of comfort, pain, support, ease of breathing, and movement mirrored the results obtained for sternal separation, thus providing agreement between self-report and objective measures.

Conclusions

Supportive devices may be useful in the management of patients with sternal instability because wearing one resulted in a reduction of both sternal separation and pain report after movement. The largest effect was obtained from wearing an adjustable fastening brace.     

A novel study on amyloid β peptide 40, 42 and 40/42 ratio in Saudi autistics

Objectives  

We examined whether plasma concentrations of amyloid beta (Aβ) as protein derivatives play a central role in the etiology of autistic features.     

Diagnostic and Severity-Tracking Biomarkers for Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder afflicting about one in every 68 children. It is behaviorally diagnosed based on a triad of symptoms, including impairment in communication, impairment in sociability and abnormal and stereotypic behavior. The subjectivity of behavioral diagnosis urges the need for clinical biomarker tests to improve and complement ASD diagnosis and treatment. Over the past two decades, researchers garnered a broad range of biomarkers associated with ASD and often correlating with the severity of ASD, which includes metabolic and genetic biomarkers or neuroimaging abnormalities. Metabolic biomarkers are either involved in key pathways such as a trans-sulfuration pathway or produced due to the derangement of these pathways in the case of oxidative stress. Recent studies reported several genetic abnormalities related to ASD, encompassing various mechanisms, from copy number variations (CNVs) and single nucleotide polymorphisms (SNPs) to chromosomal anomalies. However, it is still premature to consider these genetic variants as true biomarkers for ASD, due to their low reproducibility and regional-specific nature. Herein, we comprehensively review state of the art about major biomarkers reported in ASD and the association of some biomarkers with ASD symptoms and severity. It is important to establish those biomarkers to be able to help in the diagnosis and to optimize the treatment of ASD.     

Permanent pacing in infants and children: A single center experience in implantation and follow up

BackgroundPermanent pacing in pediatric population has been growing in Egypt. The aim of this study is to present one center experience in pediatric pacing including implantation procedures and long-term outcome.Methods and resultsDuring the period from 1996 to 2010, we collected the data of 32 children (18 males) with a mean age of 5.7 ± 3.8 years that underwent permanent pacemaker (PPM) implantation. Their mean weight was 21.6 ± 13.8 kg, and median body surface area (BSA) was 0.7 m². Twenty-five patients (78.1%) had congenital heart disease (CHD). Pacing was done via subclavian vein puncture while epicardial pacing was done via standard surgical techniques. All patients were followed up for 0.25–14 years (median: 2.5 years). Suboptimal pacing parameters were defined by one or more of the following: R/P wave malsensing, pacing threshold >2 V, or battery longevity of <1 year. The first PPM was endocardial in 21 patients (65.6%) and epicardial in 11 patients (34.4%). VVI PPMs were implanted in 8 cases (25%), VVIR in 20 cases (62.5%) and DDD in 4 cases (12.5%). A total of 46 procedures were done during the period of study, and total of 44 pulse generators and 46 leads (31 endocardial) were implanted. Fourteen patients (43.7%) required 2nd ± 3rd procedures. During follow up, suboptimal pacing parameters or pacing system failure were reported in 12 patients (37.5%) who had significantly lower age, weight and BSA (P = 0.048, 0.023, and 0.032, respectively). The overall battery survival was 60% at 125 months, and ventricular lead survival was 63% at 125 months, with no significant difference in survival between epicardial and endocardial leads (P > 0.05).ConclusionPermanent pacing in pediatric age group is relatively safe. However, there is substantial higher incidence of suboptimal pacing parameters and pacing system failures especially in younger and smaller children. Epicardial steroid eluting leads are comparable to endocardial steroid eluting leads in performance.     

Heterogeneity and New Epitopes of Hepatitis C Virus Genotype 4

Background

Hepatitis C virus (HCV) was found to have a major role in human liver disease by its ability to face the host-cell defenses and the immune system. Heterogeneity of HCV was the key for its adaptation to its host and represented a significant hurdle for the development of both effective vaccines as well as for novel therapeutic interventions.

Objectives

Due to the heterogeneity of HCV virus because of both high replication and high mutation rate in vivo, this study was conducted to analyze different isolates of Egyptian patients of genotype 4, of the most mutant regions of the virus (E1 and E2) as they played an important role in viral persistence by escaping from the immune system of the host body.

Patients and Methods

This study was conducted through PCR amplification of E1 and E2 regions, sequencing and phylogenetic analysis, calculating synonyms and non-synonyms substitutions, finding the possible glycosylation sites and different epitope domains.

Results

The present work figured out that the heterogeneity of the quasispecies of our local strains 4a was high showing up 15% diversity. This study also showed four glycosylation sites that play an important role in the entry of the virus and protein folding. Besides, different epitpoes were identified in different regions of the E1 and E2 domains; a finding which would help in determining the neutralizing and non- neutralizing antibodies.

Conclusions

This study would help in understanding the driving forces of genetic diversity and would be fundamental for representing potential candidate targets for antibodies and the development of vaccine trials.     

FcγRIIa and FcγRIIIa genetic polymorphisms in a group of pediatric immune thrombocytopenic purpura in Egypt

Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder caused by the production of antiplatelet antibodies. The current case-control study aimed at detecting the frequency of FcγRIIa-131H/R and FcγRIIIa-158F/V genes polymorphism in Egyptian children with ITP as genetic markers for ITP risk, and to clear out their possible role in choosing the treatment protocols of ITP. To achieve this aim, FcγRIIa genotyping was tested by PCR-restriction fragment length polymorphism (RFLP) technique, whereas FcγRIIIa genotyping was tested by nested PCR followed RFLP analysis. The current case-control study was conducted on 92 children with ITP; 12 acute and 80 chronic cases and 90 controls. The V allele and FcγRIIIa FV heterotype were significantly higher in ITP patients and conferred increased ITP risk [odds ratio (OR) = 1.96 and 2.55, respectively]. The frequency of FcγRIIa H allele was significantly higher among chronic ITP patients. In conclusion, FcγRIIIa gene polymorphism may contribute to susceptibility to ITP. Moreover, analysis of the FcγR polymorphisms in ITP patients could influence the effectiveness of medications and selection of the line of treatment.     

Atherosclerosis in chronic hepatitis C virus patients with and without liver cirrhosis

Background

Chronic Hepatitis C virus (HCV) infection and liver cirrhosis may be associated with atherosclerosis and coronary artery disease (CAD). There are two phases to atherosclerosis, Subclinical and Clinical. Assessment of atherosclerosis may be started at its Subclinical phase by the evaluation of Epicardial Fat Thickness (EpFT) and Carotid Intima Thickness (CIMT).