Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children: An observational study.

ABSTRACT: The use of local antibiogram in guiding clinical decisions is an integral part of the antimicrobial stewardship program. Conventional antibiograms are not disease-specific, ignore the distribution of microorganisms, obscure the in-vitro efficacy interrelationships, and have limited use in polymicrobial infections.We aimed to develop an in-house empiric, disease-specific, antimicrobial prescription auxiliary for the treatment of hospitalized pediatric pneumonia patients and to present the methods which help to choose the first and the second line antimicrobial therapy, while accounting for cost and safety aspects.A retrospective single center observational study was conducted on bronchoscopy obtained sputum culture. Analysis of probabilities, variance minimization, Boolean network modeling, and dominance analysis were applied to analyze antibiogram data. The Kirby-Bauer disk diffusion method was used to test the susceptibility of all isolates. Final optimization analysis included local drug acquisition cost (standardized to price per DDD) and safety profile.Data of 145 pediatric patients hospitalized with pneumonia with 218 isolates over 5 years was collected. A combination of statistical methods such as probabilities of drug efficacy, variance minimization, Boolean network modeling, and dominance analysis can help to choose the optimal first-line and the second-line antimicrobial treatment and optimize patient care. This research reveals that ampicillin is the optimal choice as the first-line drug and piperacillin-tazobactam is the second-line antimicrobial drug if the first one is not effective, while accounting for cost and safety aspects.The paper proposes a new methodology to adapt empiric antimicrobial therapy recommendations based on real world data and accout for costs and risk of adverse events.

Evaluation of the association between postural control and sagittal curvature of the spine.

INTRODUCTION: Balance is key to controlling body posture. Balance is typically assessed by measures of the body's vertical orientation, obtained by balancing out the forces acting on different body segments. The ability to maintain balance is assessed by evaluating centre of pressure (CoP) displacement; such assessments are typically used to evaluate responses to a treatment process. PURPOSE OF STUDY: This study evaluated the efficiency of compensatory reactions in children according to the extent of thoracic kyphosis and lumbar lordosis. MATERIALS AND METHOD: The study enrolled 312 children aged 8‒12 years, including 211 patients with postural disorders: thoracic kyphosis outside the 47‒50-degree range and lordosis outside the 38‒42-degree range (study group). A control group was also recruited and comprised 101 children without postural disorders. The DIERS formetric 4D system was used to assess posture and CoP displacement. RESULTS: Children in the study group showed a significantly greater range of CoP displacement than children in the control group. The kyphosis angle correlated with the maximum CoP displacement in the coronal plane and the maximum CoP displacement in the sagittal plane during gait. The kyphosis angle also correlated with the maximum CoP displacement back in the static test. The size of the lordosis angle correlated with the maximum displacement of CoP in the coronary plane during gait, and with the maximum displacement of CoP toward the left, forward, and backward in the static test. The correlation coefficient of the lordosis angle with displacement of the CoP in the sagittal plane was 0.999. CONCLUSIONS: We found an association between kyphosis and lordosis and the amplitude of CoP displacement, which may reflect the postural control system's response to biomechanical destabilisation caused by changes in kyphosis and lordosis.The lordosis angle correlation strength for displacement of CoP in sagittal plane is 0.999 and adopts a linear value.

The Effect of an Innovative Biofeedback SKOL-AS® Treatment on the Body Posture and Trunk Rotation in Children with Idiopathic Scoliosis-Preliminary Study.

Background and Objectives: The deformity in idiopathic scoliosis (IS) is three dimensional and effective correction involves all three planes. Recently, the biofeedback method has been implemented in the treatment of scoliosis. The aim of this study was to evaluate the effectiveness of an innovative biofeedback SKOL-AS® postural training among children with scoliosis. Materials and Methods: The target population for this study was 28 patients (25 girls and 3 boys) aged between 5 and 16 years old diagnosed and treated with progressing low-grade scoliosis. The postural diagnosis consisted of anthropometric measurements, posterior-anterior X-ray imaging, SpinalMeter® postural assessment and the angle of trunk rotation (ATR) assessment. The SKOL-AS® treatment comprised of 24 sessions conducted in lying and sitting positions, two times a week. Results: It has been shown that the postural training resulted in the decrease in the ATR value (pre- vs. post-exercise in younger: 5.55 vs. 3.0 and older patients: 5.2 vs. 3.0). The increase in height of the subjects seemed to confirm a positive effect of SKOL-AS® elongation treatment. In the posterior view, a statistically significant decrease in shoulder asymmetry in the sitting position in younger children has been observed. In the anterior view, the changes in the head position (based on mouth and eye symmetry) have been observed. The statistically significant increase in acromion-heel, acromion-iliac crest and posterior superior iliac spine (PSIS)-heel length values has been shown in younger children on the left side of the body. After treatment, older subjects had higher acromion-iliac crest and PSIS-heel values on the left side of the body. On the right side only PSIS-heel length was higher. In a sitting position, only a small increase in acromion-iliac crest length value has been observed. Conclusions: The SKOL-AS® biofeedback method could teach good postural habits and teach patients the auto-correction of the spine.

The Influence of Solution pH on the Kinetics of Resorcinol Electrooxidation (Degradation) on Polycrystalline Platinum.

Electrochemical oxidation of resorcinol on a polycrystalline platinum electrode was investigated in five different solutions, namely 0.5 and 0.1 M H2SO4, 0.5 M Na2SO4, 0.5 and 0.1 M NaOH. The rates of electrochemical degradation of resorcinol were determined based on the obtained reaction parameters, such as resistance, capacitance and current-density. The electrochemical analyses (cyclic voltammetry and a.c. impedance spectroscopy) were carried-out by means of a three-compartment, Pyrex glass cell. These results showed that the electrochemical oxidation of resorcinol is strongly pH-dependent. In addition, the energy dispersive X-ray (EDX) spectroscopy technique was employed for Pt electrode surface characterization. Additionally, the quantitative determination of resorcinol removal was performed by means of instrumental high-performance liquid chromatography/mass spectrometry (HPLC/MS) methodology.

Review of the Current Knowledge on the Role of Stem Cell Transplantation in Neurorehabilitation.

The management involving stem cell (SC) therapy along with physiotherapy offers tremendous chance for patients after spinal cord injury (SCI), traumatic brain injury (TBI), stroke, etc. However, there are still only a limited number of reports assessing the impact of stem cells (SCs) on the rehabilitation process and/or the results of the simultaneous use of SC and rehabilitation. Additionally, since there is still not enough convincing evidence about the effect of SCT on humans, e.g., in stroke, there have been no studies conducted concerning rehabilitation program formation and expected outcomes. It has been shown that bone marrow-derived mesenchymal stem cell (BMSCs) transplantation in rats combined with hyperbaric oxygen therapy (HBO) can promote the functional recovery of hind limbs after SCI. An anti-inflammatory effect has been shown. One case study showed that, after the simultaneous use of SCT and rehabilitation, an SCI patient progressed from ASIA Grade A to ASIA Grade C. Such promising data in the case of complete tetraplegia could be a breakthrough in the treatment of neurologic disorders in humans. Although SCT appears as a promising method for the treatment of neurological conditions, e.g., complete tetraplegia, much work should be done towards the development of rehabilitation protocols.

The Duration of the correction loss after removing cheneau brace in patients with adolescent idiopathic scoliosis.

OBJECTIVE: The aim of the study was to evaluate the loss of truncal rotation over 54 hours after removing Chêneau brace. METHODS: The studied groups consisted of 39 girls aged 10-18 years old, diagnosed with adolescent idiopathic scoliosis (AIS) and treated with Chêneau brace (CAST) and 20 AIS girls aged 10-18 years old, not treated with bracing. Posterior-anterior radiographs were obtained from the clinical assessment of all subjects and were subsequently used to determine Cobb angles. The measurements of the angle of trunk rotation (ATR) were taken with the Scoliometer® and back-contour device during Adams forward bending test by the two evaluators. The changes in ATRs during 54 hours of observation were performed after the brace had been taken off (0, 2, 24, 30, 48 and 54 hours after debracing). This was described using VATR variable, defined as the change in the absolute Scoliometer® readings in the time intervals against the time interval Δt between the measurements. During back-contour assessment the differential factor (kra) has been used for the digital analysis. The changes in kra over 54 hours of observation were expressed as Vkra factor, defined as the difference in the absolute value of the amplitude differential factor (kra) in the time intervals against the time interval Δt between the measurements. RESULTS: The highest changes were observed in the thoracic as well as in lumbar spine in patients with Cobb angle ≥30°, axial rotation of the apical vertebrae within 5-15°, Risser sign 0-2. The biggest change in the trunk rotation after Chêneau brace had been taken off was noted within the first two hours of observation. CONCLUSION: The patients should be advised to take the brace off for a minimum of two hours before the scheduled x-ray, to allow full relaxation of the trunk in order to obtain reliable radiological images of the deformation. LEVEL OF EVIDENCE: Level III Therapeutic study.

Early detection of idiopathic scoliosis - analysis of three screening models.

INTRODUCTION: The prevalence of lateral curvatures of the spine ranges from 0.3% to 15.3% in the general population. The aim of the study was to develop and compare three different screening tests for idiopathic scoliosis (IS) with respect to their effectiveness and costs. MATERIAL AND METHODS: The Delphi method was used to assess the efficacy of each screening algorithm in detecting IS in the population. An economic analysis was also performed. RESULTS: Diagnostic Algorithm 1 for IS comprised a screening examination performed by nurses and a general practitioner (GP) with verification by specialists. The unit cost of carrying out diagnostic work-up for IS in Algorithm 1 was €94 per child. The second algorithm involved the use of the moiré computer method, followed by verification by a specialist. The lower unit cost of €86 per child of diagnostic work-up according to Algorithm 2 was due to fewer stages compared to Algorithm 1. The highest effectiveness with the highest costs were found for the third algorithm, with only one stage, a specialist's consultation (cost €153 per child). CONCLUSIONS: The number of stages in an algorithm does not correlate positively with its efficacy or cost. The recommended scheme is Algorithm 3, where children are examined by rehabilitation specialists or a physiotherapist using a scoliometer and an inclinometer. The use of the apparently most expensive scheme (Algorithm 3) should result in lowering the costs of treatment of established idiopathic scoliosis and, in the long term, prove to be the most cost-effective solution for the health care system.

Objective parallel-forms reliability assessment of 3 dimension real time body posture screening tests.

BACKGROUND: Screening tests play a significant role in rapid and reliable assessment of normal individual development in the entire population of children and adolescents. Body posture screening tests carried out at schools reveal that 50-60% of children and adolescents demonstrate body posture abnormalities, with 10% of this group at risk for progressive spinal deformities. This necessitates the search for effective and economically feasible forms of screening diagnosis. The aim of this study was to assess the reliability of clinical evaluation of body posture compared to objective assessment with the Zebris CMS-10 system (Zebris Medical GmbH). METHODS: The study enrolled 13-15-year-old pupils attending a junior secondary school (mean age 14.2 years). The study group consisted of 138 participants, including 71 girls and 67 boys, who underwent a clinical evaluation of the body posture and an examination with the Zebris CMS 10 system. RESULTS: Statistically significant discrepancies between the clinical and objective evaluation were noted with regard to lumbar lordosis in boys (n = 67) and thoracic kyphosis in girls (n = 71). No statistically significant differences in both groups were noted for pelvic rotation and trunk position in the frontal plane. CONCLUSIONS: 1. The finding of significant discrepancies between the results of assessment in the sagittal plane obtained in the clinical examination and Zebris CMS-10-based assessment suggests that clinical evaluation should be used to provide a general estimation of accentuation or reduction of spinal curvatures in the sagittal plane.2. The clinical evaluation of posture is reliable with regard to assessment in the frontal plane.3. The Zebris CMS-10 system makes the clinical examination significantly more objective with regard to assessment of the physiological curvatures and may be used to make screening tests more objective with regard to detecting postural defects.

Arthrogryposis in infancy, multidisciplinary approach: case report.

BACKGROUND: Arthrogryposis multiplex congenita is an etiopathogenetically heterogeneous disorder characterised by non-progressive multiple intra-articular contractures, which can be recognised at birth. The frequency is estimated at 1 in 3,000 newborns. Etiopathogenesis of arthrogryposis is multifactorial. CASE PRESENTATION: We report first 26 weeks of life of a boy with severe arthrogryposis. Owing to the integrated rehabilitation approach and orthopaedic treatment a visible improvement in the range of motion as well as the functionality of the child was achieved. This article proposes a cooperation of various specialists: paediatrician, orthopaedist, specialist of medical rehabilitation and physiotherapist. CONCLUSIONS: Rehabilitation of a child with arthrogryposis should be early, comprehensive and multidisciplinary. Corrective treatment of knee and hip joints in infants with arthrogryposis should be preceded by the ultrasound control. There are no reports in the literature on the ultrasound imaging techniques which can be used prior to the planned orthopaedic and rehabilitative treatment in infants with arthrogryposis. The experience of our team indicates that such an approach allows to minimise the diagnostic errors and to maintain an effective treatment without the risk of joint destabilisation.

The influence of self-stretching based on postisometrical relaxation, static stretching combined with stabilizing exercises, and stabilizing exercises only on the flexibility of one-joint and two-joint hip flexors.

BACKGROUND AND OBJECTIVE. The limitations of muscle flexibility are a common dysfunction of the musculoskeletal system. Therefore, various therapeutic techniques are used in rehabilitation programs to increase their flexibility. The aim of this prospective, randomized, single-blind study was to evaluate the changes in the flexibility of hip flexors in children who participated in a 6-week therapeutic program consisting of one physiotherapy session per week with a physiotherapist and daily home exercises. MATERIAL AND METHODS. A total of 94 children aged 10-13 years were randomly assigned to 3 experimental groups: postisometrical relaxation group (PIR group), static stretching combined with stabilizing exercise group (SE/SS group), and stabilizing exercise group (SS group). To assess the flexibility of one- and two-joint hip flexors, the modified Thomas test was used. The examination was conducted by blinded observers. RESULTS. A significant improvement in the flexibility of one-joint hip flexors was documented in all 3 groups (P<0.01). The flexibility of two-joint hip flexors increased significantly only in the SS/SE group (P<0.05). After the program, the highest range of motion of the hip extension (test for one-joint hip flexors) was recorded in the SS/SE group (20.6° ± 4.5°), and it was significantly greater than in the SE group (16.6° ± 4.0°, P<0.05). There were no significant differences in the knee flexion (test for two-joint hip flexors) among all 3 groups (P>0.05). CONCLUSIONS. The 6-week therapeutic program regardless of the technique applied (postisometrical muscle relaxation, static stretching with stabilizing exercises, and stabilizing exercises only) resulted in the increased flexibility of one-joint hip flexors. Only static stretching combined with stabilizing exercises led to a significant increase in the flexibility of two-joint hip flexors.

Assessment of visual perception in adolescents with a history of central coordination disorder in early life - 15-year follow-up study.

INTRODUCTION: Central nervous system damage in early life results in both quantitative and qualitative abnormalities of psychomotor development. Late sequelae of these disturbances may include visual perception disorders which not only affect the ability to read and write but also generally influence the child's intellectual development. This study sought to determine whether a central coordination disorder (CCD) in early life treated according to Vojta's method with elements of the sensory integration (S-I) and neuro-developmental treatment (NDT)/Bobath approaches affects development of visual perception later in life. MATERIAL AND METHODS: The study involved 44 participants aged 15-16 years, including 19 diagnosed with moderate or severe CCD in the neonatal period, i.e. during the first 2-3 months of life, with diagnosed mild degree neonatal encephalopathy due to perinatal anoxia, and 25 healthy people without a history of developmental psychomotor disturbances in the neonatal period. The study tool was a visual perception IQ test comprising 96 graphic tasks. RESULTS: The study revealed equal proportions of participants (p < 0.05) defined as very skilled (94-96), skilled (91-94), aerage (71-91), poor (67-71), and very poor (0-67) in both groups. These results mean that adolescents with a history of CCD in the neonatal period did not differ with regard to the level of visual perception from their peers who had not demonstrated psychomotor development disorders in the neonatal period. CONCLUSIONS: Early treatment of children with CCD affords a possibility of normalising their psychomotor development early enough to prevent consequences in the form of cognitive impairments in later life.

Effectiveness of Chêneau brace treatment for idiopathic scoliosis: prospective study in 79 patients followed to skeletal maturity.

BACKGROUND: Progressive idiopathic scoliosis can negatively influence the development and functioning of 2-3% of adolescents, with health consequences and economic costs, placing the disease in the centre of interest of the developmental medicine. The aim of this study was to evaluate the effectiveness of Chêneau brace in the management of idiopathic scoliosis. METHODS: A prospective observational study according to SOSORT and SRS recommendations comprised 79 patients (58 girls and 21 boys) with progressive idiopathic scoliosis, treated with Chêneau brace and physiotherapy, with initial Cobb angle between 20 and 45 degrees, no previous brace treatment, Risser 4 or more at the final evaluation and minimum one year follow-up after weaning the brace. Achieving 50° of Cobb angle was considered surgical recommendation. RESULTS: At follow-up 20 patients (25.3%) improved, 18 patients (22.8%) were stable, 31 patients (39.2%) progressed below 50 degrees and 10 patients (12.7%) progressed beyond 50 degrees (2 of these 10 patients progressed beyond 60 degrees). Progression concerned the younger and less skeletally mature patients. CONCLUSION: Conservative treatment with Chêneau orthosis and physiotherapy was effective in halting scoliosis progression in 48.1% of patients. The results of this study suggest that bracing is effective in reducing the incidence of surgery in comparison with natural history.

Conservative management of idiopathic scoliosis--guidelines based on SOSORT 2006 Consensus.

BACKGROUND: Idiopathic scoliosis, defined as a lateral curvature of the spine of above 10 degrees (Cobb angle), is seen in 2-3% of the growing age population, while curves above 20 degrees , requiring conservative treatment, are found in 0.3-0.5%. In our observation, both under-treatment of progressive curves and over-treatment of stable cases are common during conservative management of scoliosis. MATERIAL AND METHODS: A model of therapeutic management is presented based on the experience of Polish clinicians specialising in the treatment of scoliosis as well as the effects of work of a panel of experts of SOSORT (Society on Scoliosis Orthopaedic and Rehabilitation Treatment). The model comprises the indications for conservative treatment according to age, curve type and size and Risser grading. The aetiology, classifications, usefulness of the Lonstein and Carlson factor of progression and other methods of determining the probability of scoliosis progression, as well as the psychological aspects of conservative management are presented. RESULTS: Based on the knowledge of the natural history of idiopathic scoliosis, factors of progression and on the SOSORT experts' opinion, guidelines are proposed for clinicians treating children and adolescents with idiopathic scoliosis, including the timing and course of brace treatment and the types of exercises. CONCLUSIONS: Uniform practical guidelines developed by experts may represent an essential step towards establishing standards of conservative scoliosis care in our country.

Sources of porcine longissimus dorsi muscle (LDM) innervation as revealed by retrograde neuronal tract-tracing.

The aim of the present study was to establish the origin of the motor, autonomic and sensory innervation of the L1-L2 segment of the porcine longissimus dorsi muscle (LDM), in order to provide morphological basis for further studies focusing on this neural pathway under experimental conditions, e.g. phototerapy and/or lateral electrical surface stimulation. To reach the goal of the study, multiple injections of the fluorescent neuronal tracer Fast Blue (FB) were made into the LDM region between the spinal processes of the vertebrae L1 and L2. The spinal cord (Th13-S1 segments) as well as the sensory and autonomic ganglia of interest, i.e., dorsal root (DRG) and sympathetic chain ganglia from corresponding spinal cord levels were collected three weeks later. FB-positive (FB+) motoneurons were observed exclusively within the nucleus ventromedialis at L1 and L2 spinal cord level, forming the most ventro-medially arranged cell column within this nucleus. Primary sensory and sympathetic chain neurons were found in appropriate ipsilateral ganglia at Th15-L3 levels. The vast majority of retrogradely traced neurons (virtually all motoneurons, approximately 76% of sensory and 99.4% of sympathetic chain ganglia neurons) was found at the L1 and L2 levels. The morphometric evaluation of FB-labeled DRG neurons showed that the majority of them (approximately 66%) belonged to the class of small-diameter perikarya (10-30 microm in diameter), whereas those of medium size (30-80 microm in diameter) and of large diameter (more than 80 microm) constituted 22.6% and 11.5% of all DRG neurons, respectively. The results of the present study demonstrated that the nerve terminals supplying porcine LDM originated from different levels of the spinal cord, dorsal root and sympathetic chain ganglia. Thus, the study has revealed sources and morphological characteristic of somatic, autonomic and spinal afferent neurons supplying porcine LDM, simultaneously pointing out the characteristic features of their distribution pattern.

Ultrastructural features of supraspinal muscles in rabbits after long-term transcutaneous lateral electrical surface stimulation (LESS).

Lateral electrical surface stimulation is one of methods used in the therapy of the progressive form of idiopathic scoliosis (IS) in children and youth. However, there are data suggesting that this method may lead to serious adverse side effects, when used for a too long period of time per day. To clarify this issue, the present study was aimed at disclosing possible changes in the ultrastructural appearance of rabbit supraspinal muscles undergoing long-term stimulation (9 h per day, 3 months), an animal model successfully used to mimic the situation in humans. In comparison to the control animals, muscles of "overstimulated" rabbits exhibited clear signs of microscopical lesions, including depletion and disintegration of myofilaments, proliferation, dilatation and, sometimes, swelling of sarcoplasmic reticulum and/or mitochondria, as well as signs of destruction of the Z line. The above-mentioned abnormalities, especially the signs of degenerative processes associated with the Z line and the observed microlesions strongly suggest that the failure of the long-term LESS therapy of the IS may be attributable to these ultrastructural lesions.

The influence of tensometric evaluation of the pain threshold on the nature of resistance exercising in disorders of the knee joint.

Background. We evaluated the usefulness of tensometric examination of the quadriceps as a means of assessing the pain threshold for the subcartilage layer in the patellofemoral joint and the knee joint. Material and methods. Our study, carried out from 2000 to 2003, included 131 patients, 77 men and 54 women, age 12-52. The examination results were compared with those for the unaffected leg. After each examination a new level of exercise workload was established, always just below the pain threshold. Examinations were repeated after one, three and six months. Results. The level of the pain threshold in most cases excluded workloads involving flexion of the knee at 90 degrees , 45 degrees , and 0 degrees . Training with a load adapted to the pain threshold served as endurance training, and should be regarded as a way to harden the cartilage. When the exercise load was adjusted in accordance with tensometric examination results, cartilage resistance to pressure increased. This kind of training allows the patient to achieve painlessly 80-90% strength in the quadriceps (compared to the healthy leg) in 6-12 months. Conclusions. Tensometric examination of the knee is a useful instrument in the evaluation of sensitivity to pain in the subcartilage layer, enabling the evaluation of the range of pressure that does not induce subcartilage pain when the joint is under load by working muscles. Properly selected workloads have a favorable impact on resistance to pressure and cause a virtually complete restoration of quadriceps strength after 6-12 months of rehabilitation.

Pathomorphological pattern of paravertebral muscles of rabbits after long-term experimental electrostimulation.

The objective of this study was to identify the histopathological features of paravertebral muscles after long-term Lateral Electrical Surface Stimulation (LESS). LESS has been applied for the treatment of idiopathic scoliosis in children and adolescents. Former studies reported the negative effect on the mental state of treated patients, as well as functional disturbances of organs, endocrine glands, and muscle metabolism. The experiment was performed on rabbits (aged 3.5 months), (n = 5 in treated, n = 5 in non-treated group). Stimulation was performed using electrical stimulator SCOL-2. The rabbits were stimulated with the traditional long-term lateral electrical surface stimulation (LESS) method as in clinical applications for children and adolescents. After microscopic examination, atrophy of fibers and cross striation of paravertebral muscles were seen, as well as degenerative lesions, necrosis, and hyperemia. Furthermore, proliferation of nuclei and infiltration of monocytogenic phagocytes mononuclear cells were observed, as well as a wide differentiation of glycosoaminoglycanes in muscle fibers on the stimulated side. However, within the tissue undergoing regression, this resulted in a clear decrease in glycosoaminoglycane levels. The observed lesions may indicate that the damage to the neuromuscular system is an effect of long-term LESS application. Thus, standard LESS therapy may deepen idiopathic scoliosis.