Reversible airway obstruction in rheumatic mitral valve disease

Lung function was studied in 24 patients with advanced mitral stenosis scheduled for mitral valve replacement (MVR), and revealed an obstructive ventilatory pattern [rewording of this sentence OK] . Forty per cent of the patients had a forced expiratory volume in 1 s (FEV₁)<60% of that predicted in the preoperative period. Twenty-five per cent of those operated upon showed a similar pattern up to 110 weeks postoperatively. A blind study of the effect of placebo and β₂ agonist (salbutamol) inhalation was performed preoperatively and 6 months postoperatively, to evaluate the reversibility of airflow obstruction in these patients, flow volume curve and body plethysmographic measurement of airway resistance (Rex) and intrathoracic gas volume (VTG). Patients in the pre and postoperative period showed a significant difference between the placebo and the β₂ agonist responses for FEV₁, FEV₁ as percentage of FVC (FEV₁% FVC), peak expiratory flow rate (PEFR), flow rate of 50% of expiratory vital capacity ([¨max₅₀), Rex and VTG (P<0.001). We conclude that salbutamol inhalation improves obstructive impairment in patients with MVR pre- and postoperatively.     

COMBINATION TAPING TECHNIQUE VERSUS ANKLE FOOT ORTHOSIS ON IMPROVING GAIT PARAMETERS IN SPASTIC CEREBRAL PALSY: A CONTROLLED RANDOMIZED STUDY

BackgroundOne of the important goals in the treatment of spastic cerebral palsy is to maintain efficient and effective walking in order to be independent in activities and participate in society.ObjectiveTo compare the efficacy of foot combination taping of kinesio tape and athletic tape vs ankle foot orthosis in correcting spatiotemporal gait parameters in children with spastic diplegia.MethodsThirty-six children with spastic diplegia were randomly assigned into 3 groups; control, combination taping, and ankle foot orthosis groups. Children in the control group, in addition to those in both experimental groups, continued with conventional physical therapy, 1 h, 3 times per week for 4 weeks. Spatiotemporal gait parameters were assessed with the GAITRite system before and after the application of interventions.ResultsThere were significant increases in walking velocity, step length, stride length, right single support duration, and left single support duration of the ankle foot orthosis and combination taping groups compared with pre-intervention values. Moreover, the post-intervention values of the double support duration of the ankle foot orthosis and combination taping groups were significantly lower than pre-intervention values. There were no significant differences between the post-intervention values of the ankle foot orthosis and combination taping groups for all parameters.ConclusionThe results demonstrated that combination taping is an effective alternative technique to ankle foot orthosis to improve spatiotemporal parameters in children with spastic diplegic in combination with conventional physiotherapy.LAY ABSTRACTChildren with cerebral palsy have abnormal patterns of walking secondary to spasticity, which can negatively affect their functional abilities and quality of life. Several therapeutic interventions are used, with the aim of improving gait quality in those children so that they become independent in functional activities and can participate in society. This study compared the effectiveness of ankle bracing with the application of a combination taping on gait parameters. The results showed that both interventions are equally effective. Combination taping might be considered a promising alterative to ankle joint bracing, as it is a more functional and less aggressive technique.Key words: combination taping, ankle foot orthosis, gait parameters, cerebral palsy

Cerebral palsy (CP) is a lifelong motor impairment caused by an early brain injury. Depending on the dominant neurological signs of children with CP, the condition is classified as spastic, ataxic, athetoid, or flaccid (1). More than 70% of children with CP are spastic (2). Gait in children with spastic CP is frequently associated with abnormal gait kinematics, linked to increased walking energy cost, which may lead to activity limitations (3).Plantar flexion in the ankle at the beginning of standing and in all phases of walking is one1 of the most common dynamic musculoskeletal deformities in children with spastic CP, which could be accompanied by additional abnormal joint positions of the lower extremities (4). The ability to maintain proper joint alignment of the lower extremity, and monitor the position of the foot while standing and walking, are critical prerequisites for gait in children with CP (5).Lower extremity orthosis, such as ankle foot orthosis (AFO) is widely recommended in children with spastic CP to prevent the progression of the deformity and to improve the child’s gait efficiency (6). The solid AFO maximizes control by restricting both plantarflexion and dorsiflexion movements in the stance and swing phases. Its rigid structure prevents ankle rocker function and reduces excessive plantarflexion during the stance phase, thus facilitating clearance of the toes during the swing phase (7). The benefits of wearing an AFO on gait parameters in children with spastic CP have already been documented in the literature (8).Athletic and Kinesio tapes are the 2 most common types of tape used in clinical settings. Both can be used on patients with orthopaedic or neurological dysfunctions. Athletic tape is a rigid/inelastic tape that restricts movement, while Kinesio tape is a form of flexible/elastic tape. Researchers have used them for similar purposes, such as spasticity control, muscle function facilitation, and joint stabilization (9). Furthermore, studies suggest that rigid tape is more effective than elastic tape at controlling joint mobility (10).The use of Kinesio taping in paediatric rehabilitation has become increasingly popular in recent years. Recent systematic reviews reported moderate evidence that Kinesiology taping is a valuable complement to physiotherapy treatment in better-performing children with CP (11, 12). Combination taping is a technique first introduced by Kenzo et al. (13), in which Kinesio tape is combined with rigid athletic tape to maximize the treatment benefits. This approach remains briefly addressed in the literature with no prior studies has examined the effects of combination tapings of Kinesio tape and athletic tape in the CP paediatric population. Hence, this study was conducted to compare the effectiveness of foot combined taping vs AFO in correcting spatiotemporal gait parameters in spastic CP children with equinus deformity.     

Attenuation Effect of UV on Haemonchus contortus Larvae in Experimentally Infected Goats

Background

Haemonchus contortus causes severe economic losses in small ruminants, so this study was conducted to study the UV effect on H. contortus larvae and its protective effect.

Methods

Sixteen male goats were divided into 5 groups, control infected, control uninfected and UV 30 minutes exposure; UV 60 minutes exposure and UV booster 60 minutes exposure. The UV groups were exposed to UV irradiation at wave length 254 nm for 30 and 60 minutes. The UV booster 60 min was administrated 2 doses of exposed larvae with an interval of one month. All groups except the control negative one were challenged for 42 days from the beginning.

Results

In UV booster 60 min had reduction in egg count per gram feces and worm burden (93% & 34 % respectively). The establishment rate and relative fertility declined in comparison with other groups. These parameters were similar in control infected, UV 30 min and UV 60 min groups. PCV value of UV booster 60 min group was similar to uninfected group. After two weeks from the booster dose of irradiated larvae, increased levels of antibody were found in goats of UV booster 60 min group.

Conclusion

Two doses of UV 60 min exposure, with an interval of one month, gave reduction not only in egg per gram feces but in worm burden as well.     

TINEA VERSICOLOR: HISTOLOGIC AND ULTRASTRUCTURAL INVESTIGATION OF PIGMENTARY CHANGES

A comparative histopathologic study is made between the hypopigmented and hyperpigmented skin lesions of pityriasis versicolor and normal skin areas utilizing histochemical stains and electron microscopy. There were no differences found between the population of Dopa-positive melanocytes within the hypopigmented and hyperpigmented lesions and the normal skin areas. The total epidermal pigmentation was diminished in hypopigmented lesions. The keratin layer was found to be significantly thicker in hyperpigmented lesions and contained more organisms. In hypopigmented lesions, melanocytes contained fewer and smaller melanosomes and exhibited signs of degenerative cellular changes.     

Brucella Meningitis: Presentation, Diagnosis and Treatment - A Prospective Study of Ten Cases

Diagnosis of brucella meningitis was made in 10 patients byserological tests on blood and cerebrospinal fluid using RoseBengal, standard agglutination, indirect immunofluorescent andenzyme-linked immunosorbent assay (ELISA) tests and by bloodand CSF culture. All patients had significantly elevated antibodytitres. In three Br. melitensis was isolated both from bloodand CSF and in a further three from blood only. Eight patientswere 30 years old or less and seven were female. Seven patientshad a history of contact with livestock and had consumed rawmilk. Meningitis occurred in five, meningoencephalitis withhemiplegia in one, paraplegia and cranial nerve palsies in oneand psychosis and/or nightmares in three. Transient Parkinsonismwas seen in one patient and generalized rigidity and non-Parkinsoniantremors in another. Computerized tomography revealed ventriculardilation in one patient and punctate hyperdense, non-enhancingshadows in the lentiform nuclei in two others. Treatment witha combination of tetracycline, rifampicin and streptomycin wassuccessful.     

International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer

Summary. Background: Guidelines addressing the management of venous thromboembolism (VTE) in cancer patients are heterogeneous and their implementation has been suboptimal worldwide. Objectives: To establish a common international consensus addressing practical, clinically relevant questions in this setting. Methods: An international consensus working group of experts was set up to develop guidelines according to an evidence‐based medicine approach, using the GRADE system. Results: For the initial treatment of established VTE: low‐molecular‐weight heparin (LMWH) is recommended [1B]; fondaparinux and unfractionated heparin (UFH) can be also used [2D]; thrombolysis may only be considered on a case‐by‐case basis [Best clinical practice (Guidance)]; vena cava filters (VCF) may be considered if contraindication to anticoagulation or pulmonary embolism recurrence under optimal anticoagulation; periodic reassessment of contraindications to anticoagulation is recommended and anticoagulation should be resumed when safe; VCF are not recommended for primary VTE prophylaxis in cancer patients [Guidance]. For the early maintenance (10 days to 3 months) and long‐term (beyond 3 months) treatment of established VTE, LMWH for a minimum of 3 months is preferred over vitamin K antagonists (VKA) [1A]; idraparinux is not recommended [2C]; after 3–6 months, LMWH or VKA continuation should be based on individual evaluation of the benefit‐risk ratio, tolerability, patient preference and cancer activity [Guidance]. For the treatment of VTE recurrence in cancer patients under anticoagulation, three options can be considered: (i) switch from VKA to LMWH when treated with VKA; (ii) increase in LMWH dose when treated with LMWH, and (iii) VCF insertion [Guidance]. For the prophylaxis of postoperative VTE in surgical cancer patients, use of LMWH o.d. or low dose of UFH t.i.d. is recommended; pharmacological prophylaxis should be started 12–2 h preoperatively and continued for at least 7–10 days; there are no data allowing conclusion that one type of LMWH is superior to another [1A]; there is no evidence to support fondaparinux as an alternative to LMWH [2C]; use of the highest prophylactic dose of LMWH is recommended [1A]; extended prophylaxis (4 weeks) after major laparotomy may be indicated in cancer patients with a high risk of VTE and low risk of bleeding [2B]; the use of LMWH for VTE prevention in cancer patients undergoing laparoscopic surgery may be recommended as for laparotomy [Guidance]; mechanical methods are not recommended as monotherapy except when pharmacological methods are contraindicated [2C]. For the prophylaxis of VTE in hospitalized medical patients with cancer and reduced mobility, we recommend prophylaxis with LMWH, UFH or fondaparinux [1B]; for children and adults with acute lymphocytic leukemia treated with l ‐asparaginase, depending on local policy and patient characteristics, prophylaxis may be considered in some patients [Guidance]; in patients receiving chemotherapy, prophylaxis is not recommended routinely [1B]; primary pharmacological prophylaxis of VTE may be indicated in patients with locally advanced or metastatic pancreatic [1B] or lung [2B] cancer treated with chemotherapy and having a low risk of bleeding; in patients treated with thalidomide or lenalidomide combined with steroids and/or chemotherapy, VTE prophylaxis is recommended; in this setting, VKA at low or therapeutic doses, LMWH at prophylactic doses and low‐dose aspirin have shown similar effects; however, the efficacy of these regimens remains unclear [2C]. Special situations include brain tumors, severe renal failure (CrCl < 30 mL min^?1), thrombocytopenia and pregnancy. Guidances are provided in these contexts. Conclusions: Dissemination and implementation of good clinical practice for the management of VTE, the second cause of death in cancer patients, is a major public health priority.