Aerobic capacity and muscle strength in juvenile-onset mixed connective tissue disease (MCTD).

OBJECTIVES: To study the aerobic capacity and muscle strength in children and adolescents with mixed connective tissue disease (MCTD). Frequently reported clinical symptoms include joint swelling, muscle weakness, fatigue, decreased stamina/exercise tolerance, and shortness of breath. The exercise capacity of patients with MCTD has not been studied systematically in this detail before. METHODS: Eleven children and adolescents diagnosed with MCTD (mean age 15.7 years, range 11.3­19.9 years) were studied. Maximal exercise testing on a cycle ergometer was used to determine the peak oxygen uptake (VO2peak) and a hand-held dynamometer was used to measure muscle strength. Cardiac and pulmonary function tests (ultrasonography, electrocardiography, spirometry) were used to measure cardiac function and obstructive or restrictive respiratory impairment. Complementary data (e.g. disease duration and concurrent symptoms) were collected from a medical chart review. RESULTS: VO2peak was significantly lower in patients with MCTD compared to the VO2peak of healthy subjects (Z-score ­1.9, p = 0.008). The strength of the proximal muscles (hip flexors, shoulder abductors, knee extensors) of the patients was significantly lower than in the controls, whereas the strength of the distal muscles (dorsal flexors of the foot and handgrip strength) showed no differences. In eight children, arthritis was observed. No clinically relevant impairment in cardiac or pulmonary function was observed. CONCLUSIONS: Aerobic capacity and also proximal muscle strength were significantly impaired in our sample of children and adolescents with MCTD. Because respiratory problems were non-dominant in our patient group, the decreased aerobic capacity and muscle strength were probably caused by musculoskeletal impairments. Further studies in larger multicentre samples are warranted to confirm our findings.

Knowledge and attitudes about emergency contraception in a military population.

OBJECTIVE: To assess knowledge and attitudes about reproductive issues and emergency contraception among active duty military members. METHODS: A survey was distributed to 302 active duty members of the United States Air Force. Descriptive and Pearson chi(2) statistical analyses were used to evaluate findings. RESULTS: There was a general lack of knowledge about reproductive issues and the Yuzpe emergency contraception method. Eighty-five percent of respondents were sexually active, but only 62% used birth control. Only 40% knew when pregnancy was most likely to occur. Sixty-four percent had heard of emergency contraception, but only 15% were aware of the correct time to take it. Fifty-five percent said they would use emergency contraception if needed, with younger or unmarried individuals most willing. CONCLUSION: Knowledge deficits must be addressed to keep women deployable. Educational materials and emergency contraception kits should be standard issue items. That might prevent unwanted pregnancies and produce significant savings in reproductive health and emotional costs.

Autologous haemopoietic stem-cell transplantation in four patients with refractory juvenile chronic arthritis.

BACKGROUND: Autologous haemopoietic stem-cell transplantation (AHSCT) had been described as a possible treatment for severe autoimmune disease refractory to conventional treatment. We report the first four children with severe forms of juvenile chronic arthritis (JCA) treated with AHSCT. METHODS: We studied three children with systemic JCA and one child with polyarticular JCA. Unprimed bone marrow was taken 1 month before AHSCT. T-cell depletion of the graft was done with CD2 and CD3 antibodies. We used a preparative regimen of antithymocyte globulin (20 mg/kg), cyclophosphamide (200 mg/kg) and low-dose total body irradiation (4 Gy). Methotrexate and cyclosporin were stopped before AHCST, prednisone was tapered after 2 months. FINDINGS: Our patients showed a drug-free follow-up of 6-18 months with a marked decrease in joint swelling, pain, and morning stiffness. Erythrocyte sedimentation rate, C-reactive protein, and haemoglobin returned to almost normal values within 6 weeks. Despite T-cell depletion there was a rapid immune reconstitution in three out of four children. Two patients developed a limited varicella zoster virus eruption, which was treated by aciclovir. INTERPRETATION: AHSCT for severe JCA was well tolerated and induced a remission of disease in four children with JCA that was resistant to conventional treatment. Prolonged prednisone-free growth catch-up and general well-being is a major therapeutic gain in such children. The actual follow-up is too short, however, for us to conclude that these children are completely cured of their disease.