Does interhemispheric communication relate to the bilateral function of muscles? A study of scapulothoracic muscles using transcranial magnetic stimulation

Interhemispheric connections have been demonstrated between the motor cortex controlling muscle pairs. However, these investigations have tended to concentrate upon hand muscles. We have extended these investigations to proximal muscles that control the scapula upon the trunk and help to move and stabilise the shoulder. Using a paired pulse transcranial magnetic stimulation protocol, the interhemispheric interactions between different shoulder girdle muscle pairs, serratus anterior, upper trapezius and lower trapezius were investigated. Test motor evoked potentials were conditioned using conditioning pulse intensities of 80% and 120% of active motor threshold at three different condition-test intervals, during three different tasks. Interhemispheric inhibition was observed in upper trapezius using a conditioning intensity of 120% and condition-test interval of 8 ms (17 ± 18%, p < 0.007). A trend towards inhibition was observed in lower trapezius and serratus anterior using a conditioning intensity of 120% and a condition-test interval of 8 ms (13 ± 22%; p < 0.07 and 10 ± 19% respectively; p < 0.07). No interhemispheric facilitation was evoked. The study demonstrates that a low level of interhemispheric inhibition rather than interhemispheric facilitation could be evoked between these muscle pairs.

Postinfectious bronchiolitis obliterans in children: clinical and pulmonary function findings

AIM

Postinfectious bronchiolitis obliterans (PIBO) is an infrequent yet potentially severe disorder following acute lower pulmonary infection (ALRI) in children. In infants and young children PIBO have been strongly associated with Adenovirus (Ad). The purpose of this study was to analyze the clinical features and pulmonary function findings in children with PIBO. Cases caused by Ad were compared with cases in which no viral agent was identified.

METHODS

Fifty-eight children with PIBO were prospectively studied. Clinical data and pulmonary function tests (spirometry and plethysmography) were evaluated. Patients were divided in two groups according to the identification of the causal agent. Group 1 (G1): Adenovirus (+) Group 2: No etiologic agent identified.

RESULTS

Fifty-eight patients (male/female ratio 3.4:1); median age 8 years; mean age at initial injury 11 months; median time of hospitalization at acute stage of disease 60 days. Spirometry: FVC 68 ± 13%, FEV1 40.5 ± 11%, FMMF(25-75%) 16.7 ± 7.5%. Pletysmography: TLC 136 ± 22%, FRC 208 ± 50%, RV 343 ± 102%, RV/TLC 59 ± 10, SGaw 0.05 ± 0.02. When clinical, spirometric and plethysmographic data were compared, no statistically significant difference was found between the two groups.

CONCLUSIONS

PIBO is an extremely crippling lung disease with significant obstructive pattern in PFT. Both analyzed groups shared similar characteristics in the acute phase of the disease and in the severity of the sequelar pulmonary disease.

Acute lower respiratory infection in Argentinian children: a 40 month clinical and epidemiological study

In a total of 1,003 children (805 inpatients and 198 outpatients) with acute lower respiratory infections (ALRI), clinical, social, and environmental data were analyzed. The major clinical entities were bronchiolitis, pneumonia, bronchitis, and laryngitis. The first two of these predominated in inpatients; pneumonia and bronchitis were more common in older children, while bronchiolitis was observed in infants. Respiratory rates of > 50/min. were more common in younger children and in cases with bronchiolitis and bronchitis. Retractions showed markedly less age-dependent variations and were present in all severe cases with different clinical diagnoses. Retractions alone or associated with cyanosis were the best indicators for severity of ALRI. Among outpatients, fever and wheezing were more common; inpatients were younger, more frequently malnourished, and from a lower socioeconomic level; family history of chronic bronchitis, crowding, and parental smoking also prevailed in this group. Family asthma and exposure to domestic aerosols was more common among outpatients. Prematurity rate (17 and 15%) of all ALRI cases was twice that of the general pediatric population and a significant difference existed between in- and outpatients under 6 months of age when perinatal respiratory pathologies predominated among inpatients. It is suggested to consider the need for assessing personal, family, and environmental risk factors in addition to clinical signs and symptoms when severe cases of ALRI are evaluated.

Adenovirus type 7h respiratory infections: a report of 29 cases of acute lower respiratory disease

Twenty-nine cases of pediatric acute lower respiratory disease associated with adenovirus genome type 7h were evaluated retrospectively. They constituted 2.4% of 1233 cases of acute respiratory infections treated in five hospitals in Buenos Aires, between September 1984 and September 1988. Pneumonia and bronchiolitis were the principal diagnoses. The mean age of patients was 8.8 months and 82.7% of the children were less than one year of age. None of the patients had previously been exposed to measles or was immunocompromised. A mixed infection, viral or bacterial, was demonstrated in 8 of the 29 patients. Sixteen children developed a severe pulmonary disease which required intensive care. Ten with a clinical diagnosis of multifocal pneumonia and necrotizing bronchiolitis died. Extrapulmonary manifestations were observed in the most severe cases. Observations suggest a possible high pathogenicity of adenovirus type 7h and emphasize the need for adequate control and case management programs.

Etiologic, clinical, and pathologic analysis of 31 fatal cases of acute respiratory tract infection in Argentinian children under 5 years of age

During a 3-year survey of 805 children with acute lower respiratory tract infection (ALRI) who were admitted to three hospitals in Buenos Aires, 31 fatal cases were recorded--a fatality rate of 3.8%. Of the 31 children who died, 77% were less than 1 year of age, 48% were boys, 58% were malnourished, 29% had previous respiratory disease, and 22% had previous congenital disease. All children who died had clinical diagnoses of pneumonia (71%) or bronchiolitis (29%). Autopsies were performed in 14 of the cases. Viral etiology was determined by both cell culture and indirect immunofluorescence (IIF) assay of either nasopharyngeal aspirates (NPA) or lung tissue and bacterial etiology was determined by isolation of organisms from blood, lung tissue, and/or pleural fluid. NPA was examined for Bordetella pertussis by IIF. Pathogens were identified in 65% of fatal cases. Seven cases were bacterial; seven cases were viral; and six cases resulted from mixed infections. Lung tissue yielded positive etiologic results in 10 of 13 cases. Histopathologic examination performed on specimens from the 14 autopsied children revealed necrotizing bronchiolitis with intranuclear inclusions (n = 5) and multifocal pneumonia (n = 9).

Etiologic and clinical evaluation of acute lower respiratory tract infections in young Argentinian children: an overview

This paper summarizes the first study on clinical, etiologic, and epidemiologic features of acute lower respiratory tract infection (ALRI) in children in Argentina. A total of 1,003 children less than 5 years of age (805 inpatients and 198 outpatients) presenting with ALRI were studied during a 40-month period. Nasopharyngeal aspirate (NPA), blood, urine, and throat-swab samples were collected when each child was first seen for care. Virologic studies were performed on the NPA by means of indirect immunofluorescence and isolation of virus in cell culture. Bacteriologic studies primarily were done by means of culture of blood or pleural fluid (when available); Bordetella pertussis and Mycoplasma pneumoniae, however, were searched for by the use of immunofluorescence and complement-fixation testing, respectively, in paired sera. Respiratory syncytial virus was the most commonly isolated virus, followed by adenovirus, parainfluenza virus, and influenza virus. Streptococcus pneumoniae was the most frequently isolated bacterium, followed by B. pertussis and Haemophilus influenzae type b. Overall, the patient fatality rate was 3.8% among inpatients with pneumonia or bronchiolitis.

Epidemiologic risk factors for children with acute lower respiratory tract infection in Buenos Aires, Argentina: a matched case-control study

The risk factors that predisposed 516 hospitalized and 154 ambulatory patients to acute lower respiratory tract infection (ALRI) are examined in a matched case-control study. The control group was selected from children attending immunization and well-baby clinics at the same institution that was treating the children with ALRI. Sex, age, nutritional status, socioeconomic level, as well as season and place of residence were used as matching criteria. Because of their distinct profiles, hospitalized and outpatient groups were analyzed separately. However, the four variables with the highest odds ratios (incidence ratios or relative risk) were found to be the same for both groups. These variables were related to the host's condition (bronchial hyperreactivity, presence of persistent symptoms of the upper respiratory tract), family (presence of acute respiratory tract disease in household members), and environment (indoor contaminants).

Comparison between parental report and results of microbiologic agar assay for presence of antibiotic in urine of Argentinian children with acute lower respiratory tract infection

This study compares two sources of information on prior use of antibiotics in children with acute lower respiratory tract infection. The presence of antibiotics in respiratory specimens complicates recovery of bacterial pathogens and the selection of appropriate antibiotic treatment. The first source of information is the parents, who are asked about recent use of antibiotics by their child. The second source is an agar diffusion assay that detects antibiotics in urine specimens. In Argentina, where antibiotics are readily available without prescription, parental information about a child's recent antibiotic therapy was found to be relatively reliable only when their answer was affirmative.

A new genome type of adenovirus 3 associated with severe lower acute respiratory infection in children

Adenovirus 3 was found associated with ten cases of infantile lower acute respiratory infection in patients aged 2-18 months. Of these, five had a fatal outcome, with severe lung damage. Restriction enzyme analysis with Bam HI, Bcl I, Bgl II, Bst E II, Hind III, Sal I, Sma I, Xba I, and Xho I revealed the presence of the same genome type in all ten specimens. The genomic variant was different from those previously reported for serotype 3 and therefore was tentatively denominated 3f.

Are you in control?

Overcramped conditions and lack of available storage space are usually the instigating factors for implementation of a micrographics system, but there are many other benefits to be gained, It is critical that a system be well planned and carefully researched to assure that you are indeed in control. If your only goal is to microfilm records to make more space, this space will also be "jammed" within a short period of time and you will have accomplished nothing. A good micrographics system can, and should, improve the integrity of the records, in addition to saving space. It should and will provide control of the records, while at the same time making the information readily available to all users. The system can be combined with an existing computer system within the facility and/or be shared with other departments. An ill-planned micrographics system will ultimately lead to one that is neither cost-effective nor efficient.