RESUMEN
PURPOSE: Stroke-related changes in foot structure and function affect balance and mobility and quantifying foot function following stroke could offer clinically useful information to inform rehabilitation. The aim of this work was to explore the feasibility of undertaking plantar pressure assessment during barefoot walking in people with stroke, and evaluate the repeatability of the assessment protocol and regional footprint analysis as a measure of dynamic foot characteristics. MATERIALS & METHODS: Plantar pressure analysis was undertaken using a pressure platform (Tekscan HR Mat) on two test sessions, approximately two weeks apart (mean = 15.64 ± 11.64 days). Peak plantar pressure (kPa) and contact area (cm2) for foot regions were extracted and repeatability analysis undertaken. Descriptive evaluation of field notes and experiences of the participants was undertaken to inform the feasibility of the data collection protocol. RESULTS: Twenty-one participants (61.8 ± 9.2 years; 11 male, 10 female; 8 right-sided, 13 left-sided stroke) were recruited and 18 returned for retesting. Full data capture was achieved from 14 participants. Peak pressure and contact area demonstrated moderate to good repeatability for at the toes (ICC 0.76 and 0.58 respectively) and good to excellent repeatability for the other foot regions (ICC ≥ 0.82). CONCLUSION: The protocol adopted in this study was feasible and yielded good to excellent repeatability for the foot regions, except the toes. The challenges with data collection in our study cohort could help inform future studies adopting similar protocols. This work also has relevance for use of pressure technology in clinical practice for assessing and monitoring foot function following stroke.
Asunto(s)
Acelerometría/estadística & datos numéricos , Evaluación de la Discapacidad , Accidente Cerebrovascular/fisiopatología , Caminata/fisiología , Anciano , Fenómenos Biomecánicos , Estudios de Factibilidad , Femenino , Pie/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Placa Plantar/fisiopatología , Presión , Reproducibilidad de los ResultadosRESUMEN
Good foot health throughout childhood is important but remains poorly understood with few studies exploring this topic. The aim of this study was to define parents' knowledge, practices and health-related perceptions of children's feet. A qualitative design was adopted. Semi-structured, one-to-one interviews were carried out with parents of children aged five years and under, recruited from South East and North West of England. Interviews explored parents' views, beliefs and understanding of foot health in infancy and early childhood. Transcripts of the interviews were analysed using thematic analysis. Eighteen interviews were conducted. Seven themes were identified relating to (1) parents belief and knowledge about children's foot health; (2) how parents use and share foot health information; (3) activities for supporting foot health and development; (4) footwear choices, beliefs and influences; (5) the way they access health professionals; (6) the way they search for foot health information and (7) developing practice(s) to support parents. The study provides the first insight into how parents view foot health in early infancy and childhood. The findings highlight the key foot health beliefs important to parents, how they learn about and what influences their decision-making about caring for children's feet, the way parents receive and seek information, and how they access support for foot health concerns. The findings highlight the need for accurate, clear and consistent foot health messages, and the important role health professionals have in signposting parents towards reliable and informative sources on foot health.
Asunto(s)
Salud Infantil , Pie/fisiología , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Padres , Adulto , Preescolar , Inglaterra , Femenino , Humanos , Lactante , Difusión de la Información , Entrevistas como Asunto , Masculino , Investigación CualitativaRESUMEN
BACKGROUND: Evidence suggests that specific allergen sensitizations are associated with different allergic diseases which may reflect different underlying immune profiles. We aimed to examine the cytokine profiles of individuals sensitized to eight common aeroallergens. METHODS: We used data from the Tasmanian Longitudinal Health Study a population-based cohort study of 45-year-olds. Serum cytokines (IL-4, IL-5, IL-6, IL-8, IL-10, TNF-α) were measured in 1157 subjects using the LINCOplex assays. Participants underwent skin prick testing for house dust mite, cat, grasses and moulds. Multivariable linear regression was used to compare serum cytokine levels between sensitized and nonatopic subjects. RESULTS: The prevalence of allergic sensitization to any aeroallergen was 51% (95% CI 47-54). Being sensitized to any aeroallergen was strongly associated with current asthma (OR = 3.7, 95% CI 2.6-5.3), and being sensitized to any moulds was associated with a very high risk of current asthma (OR = 6.40, 95% CI 4.06-10.1). The geometric mean (GM) levels of Th2 cytokines (IL-4, IL-5 and IL-6) for adults sensitized to Cladosporium were significantly lower than the levels for nonatopic individuals (IL-4 ratio of GMs = 0.25, 95% CI 0.10-0.62, P = 0.003; IL-5 GM = 0.55, 95% CI 0.30-0.99, P = 0.05; and IL-6 GM = 0.50, 95% CI 0.24-1.07, P = 0.07). Individuals sensitized to other aeroallergens all showed elevated Th2 cytokine levels. CONCLUSION: Our study is the first large population-based study to demonstrate reduced Th2 cytokines levels in people sensitized to mould. Underlying biological mechanisms driving allergic inflammatory responses in adults sensitized to moulds may differ from those sensitized to other aeroallergens. These findings suggest that it may be necessary to tailor treatments in individuals sensitized to moulds compared with other aeroallergens in order to optimize outcomes.
Asunto(s)
Alérgenos/inmunología , Asma/inmunología , Asma/metabolismo , Citocinas/metabolismo , Células Th2/inmunología , Células Th2/metabolismo , Asma/diagnóstico , Asma/epidemiología , Citocinas/sangre , Femenino , Humanos , Hipersensibilidad Inmediata/epidemiología , Hipersensibilidad Inmediata/inmunología , Hipersensibilidad Inmediata/metabolismo , Inmunización , Estudios Longitudinales , Masculino , Oportunidad Relativa , Prevalencia , Factores de RiesgoRESUMEN
BACKGROUND: Cytokines play a pivotal role in regulating the development and persistence of the inflammatory process in asthma. Our aim was to investigate whether asthma persistence or remission is associated with a specific cytokine profile. METHODS: The Tasmanian Longitudinal Health Study followed participants from 7 to 44 years of age. Serum concentrations of interleukin (IL)-4, IL-5, IL-6, IL-8, IL-10 and tumor necrosis factor-alpha (TNF-α) were measured at age 44 years. Participants were categorized into five phenotypes (early-onset noncurrent asthma, early-onset current asthma, late-onset noncurrent asthma and late-onset current asthma). Those who had never had asthma formed the reference group. Multivariable linear regression was used to compare serum cytokine concentrations between each phenotype and the reference group. RESULTS: IL-10 concentrations were significantly lower in serum from the early-onset current asthma group than in the reference group (ratio of geometric means 0.58; 95% confidence interval 0.33-0.99; p = 0.048). IL-6 concentrations for the late-onset remitted group were also significantly lower than in the reference group (p = 0.009). The TNF-α concentrations were significantly lower for both early-and late-onset remitted asthma phenotypes when compared with the reference group. No associations were detected between serum concentrations of IL-4, IL-5 or IL-8 and these specific longitudinal asthma phenotypes. CONCLUSION: Our findings suggest a possible role for deficient IL-10 responses in the persistence of early-onset asthma. Lower IL-6 and TNF-α concentrations in serum from those with remitted asthma suggest that these proinflammatory cytokines may be actively suppressed during asthma remission.
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Asma/epidemiología , Asma/inmunología , Citocinas/sangre , Mediadores de Inflamación/sangre , Adolescente , Adulto , Edad de Inicio , Niño , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Remisión Espontánea , Tasmania/epidemiología , Adulto JovenAsunto(s)
Índice de Masa Corporal , Marcha/fisiología , Niño , Femenino , Humanos , Masculino , Factores de TiempoAsunto(s)
Dolor Abdominal/diagnóstico por imagen , Dolor Abdominal/etiología , Deshidratación/etiología , Gastroenteritis/complicaciones , Infecciones por Rotavirus/complicaciones , Deshidratación/diagnóstico , Deshidratación/terapia , Embolia Aérea , Fluidoterapia , Gases , Gastroenteritis/diagnóstico , Gastroenteritis/virología , Humanos , Lactante , Hígado/diagnóstico por imagen , Hígado/patología , Masculino , Vena Porta , Infecciones por Rotavirus/diagnóstico , UltrasonografíaRESUMEN
The finding of a colo-colic intussusception with pneumatosis intestinalis is described with imaging. This was confirmed at surgery together with pathological confirmation of pneumatosis intestinalis. This rare association occurred in an infant with Peters' anomaly who was taking oral steroids.
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Enfermedades del Colon/complicaciones , Intususcepción/complicaciones , Neumatosis Cistoide Intestinal/complicaciones , Colon/patología , Enfermedades del Colon/diagnóstico , Humanos , Lactante , Intususcepción/diagnóstico , Neumatosis Cistoide Intestinal/diagnósticoRESUMEN
Increasing use of sonography for imaging the abdomen of neonates has brought greater recognition of its value in diagnosing and monitoring complications of necrotizing enterocolitis. We describe a case in which pneumatosis of the bladder wall was visualized by sonography in a neonate with Down syndrome and necrotizing enterocolitis.
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Enterocolitis Necrotizante/complicaciones , Enfermedades de la Vejiga Urinaria/etiología , Síndrome de Down/complicaciones , Enfisema/diagnóstico por imagen , Enfisema/etiología , Cardiopatías Congénitas/complicaciones , Humanos , Recién Nacido , Neumatosis Cistoide Intestinal/complicaciones , Vena Porta/diagnóstico por imagen , Ultrasonografía , Enfermedades de la Vejiga Urinaria/diagnóstico por imagenRESUMEN
OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy of graded compression sonography with that of helical CT for the diagnosis of appendicitis in a pediatric and young adult population. SUBJECTS AND METHODS: Between June 1996 and April 1999, 386 pediatric and young adult patients with suspected appendicitis were examined using sonography, CT, or both: 233 underwent sonography only, 71 underwent CT only, and 82 underwent sonography and CT. All sonograms and CT scans were prospectively interpreted as showing positive or negative findings for appendicitis by one of six pediatric radiologists. CT and sonographic findings were correlated with surgical and histopathologic findings or findings at clinical follow-up. RESULTS: Helical CT had a significantly higher sensitivity (95% versus 78%, p = 0.009) and accuracy (94% versus 89%, p = 0.05) than graded compression sonography for the diagnosis of appendicitis in children, adolescents, and young adults. The specificity of both techniques was 93%. Twenty of 82 patients who underwent both sonography and CT had discordance between the findings of the two examinations. The CT results were correct in a significantly greater number of patients with discordant examinations (17/20 patients [85%]). CONCLUSION: Helical CT has a significantly higher sensitivity and accuracy than graded compression sonography for the diagnosis of appendicitis in a pediatric and young adult population, particularly in children more than 10 years old.
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Apendicitis/diagnóstico , Tomografía Computarizada por Rayos X , Ultrasonografía , Adolescente , Adulto , Apendicitis/patología , Apendicitis/cirugía , Apéndice/patología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Valor Predictivo de las PruebasRESUMEN
PURPOSE: To evaluate the accuracy of helical computed tomography (CT) for the diagnosis of appendicitis in children and to assess the utility of CT in establishing alternative diagnoses. MATERIALS AND METHODS: The medical records of 154 children (median age, 12 years; age range, 1-20 years) who were suspected to have appendicitis and who underwent CT were reviewed. The gastrointestinal tract was opacified in 151 of 154 patients: Only orally administered contrast material was used in 126 patients; only rectally administered contrast material, in 21 patients; and both oral and rectal contrast material, in four patients. CT findings were correlated with surgical and histopathologic findings or with clinical follow-up findings. RESULTS: Sixty-four CT scans were interpreted as positive for appendicitis and included 58 true-positive and six false-positive scans. Ninety scans were interpreted as negative and included 87 true-negative and three false-negative scans. CT had a sensitivity of 95% and a specificity of 94% for the diagnosis of appendicitis. In addition, in 32 (34%) of 93 patients without appendicitis, an alternative diagnosis was established on the basis of CT findings. CONCLUSION: Helical CT is useful in a pediatric population to diagnose or exclude appendicitis and to establish an alternative diagnosis.
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Apendicitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Administración Oral , Administración Rectal , Adolescente , Adulto , Apendicitis/patología , Apendicitis/cirugía , Niño , Preescolar , Medios de Contraste/administración & dosificación , Diagnóstico Diferencial , Estudios de Evaluación como Asunto , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Lactante , Laparotomía , Masculino , Valor Predictivo de las Pruebas , Intensificación de Imagen Radiográfica , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
The radiographic observation of stippled calcification in cartilage defines the chondrodysplasia punctata group of bone dysplasias. Several other diseases may be associated with the radiographic finding of punctate epiphyses, usually uncommonly - for example, trisomy 21. Other more subtle chromosomal abnormalities also associated with punctate epiphyses include microdeletions of the X chromosome. A case of Turner syndrome with punctate calcification of the epiphyses is described.
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Condrodisplasia Punctata/diagnóstico por imagen , Epífisis/diagnóstico por imagen , Enfermedades Fetales/diagnóstico por imagen , Síndrome de Turner/complicaciones , Adulto , Condrodisplasia Punctata/congénito , Epífisis/embriología , Femenino , Enfermedades Fetales/genética , Humanos , Embarazo , Diagnóstico Prenatal , Radiografía , Aberraciones Cromosómicas Sexuales , Síndrome de Turner/genética , Cromosoma XAsunto(s)
Vaciamiento Gástrico , Intestino Delgado/anomalías , Intestino Delgado/diagnóstico por imagen , Estómago/anomalías , Estómago/diagnóstico por imagen , Niño , Reflujo Gastroesofágico/diagnóstico por imagen , Reflujo Gastroesofágico/etiología , Humanos , Cintigrafía , Radiofármacos , Azufre Coloidal Tecnecio Tc 99mRESUMEN
Renal cortical imaging with 99mTc-dimercaptosuccinic acid (DMSA) has become the imaging test of choice for the diagnosis of acute pyelonephritis. An unusual uptake pattern was observed in a child receiving chemotherapy for a bladder rhabdomyosarcoma. Chemotherapy from ifosfamide produces a specific pattern of injury to the renal tubule that alters uptake of DMSA.
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Antineoplásicos Alquilantes/efectos adversos , Ifosfamida/efectos adversos , Enfermedades Renales/inducido químicamente , Enfermedades Renales/diagnóstico por imagen , Túbulos Renales/efectos de los fármacos , Radiofármacos , Ácido Dimercaptosuccínico de Tecnecio Tc 99m , Antineoplásicos Alquilantes/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Femenino , Humanos , Ifosfamida/administración & dosificación , Lactante , Pielonefritis/diagnóstico por imagen , Cintigrafía , Rabdomiosarcoma Embrionario/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/tratamiento farmacológicoAsunto(s)
Enfermedades del Ano/diagnóstico , Celulitis (Flemón)/diagnóstico , Imagen por Resonancia Magnética , Miositis/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Streptococcus pyogenes , Enfermedades del Ano/complicaciones , Celulitis (Flemón)/complicaciones , Celulitis (Flemón)/microbiología , Niño , Estreñimiento/etiología , Humanos , Masculino , Miositis/microbiologíaAsunto(s)
Bronquios/anomalías , Bronquios/patología , Imagen por Resonancia Magnética , Arteria Pulmonar/anomalías , Arteria Pulmonar/patología , Tráquea/patología , Estenosis Traqueal/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Humanos , Lactante , Masculino , Estenosis Traqueal/complicacionesRESUMEN
Technologic improvement in ultrasound equipment, together with new clinical information, has altered the imaging of the abdomen in infants. Improvements in ultrasound equipment have allowed this to become the diagnostic test of choice for hypertrophic pyloric stenosis. Barium upper gastrointestinal radiography still remains the diagnostic test of choice for malrotation. New technologies for reduction of intussusception include air reduction and saline enemas with ultrasound monitoring. Controversies surrounding the different technologies and imaging strategies are discussed.
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Abdomen , Enfermedades Fetales/diagnóstico , Abdomen/diagnóstico por imagen , Abdomen/embriología , Humanos , Radiografía Abdominal , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
OBJECTIVE: To determine the prevalence and spectrum of pulmonary abnormalities in patients with rheumatoid arthritis (RA) in a developing country. DESIGN: This was a prospective hospital-based survey of a randomly selected group of patients with RA who were seen in a rheumatic diseases unit. SETTING: Groote Schuur Hospital and Princess Alice Orthopaedic Hospital, Cape Town. PATIENTS: A group of 104 patients with RA were randomly selected from a total of 330 patients with RA who were seen in the rheumatic diseases unit. All the patients were interviewed and a clinical assessment, chest radiographs and pulmonary function tests were performed. RESULTS: Fifty-six patients (53.8%) had evidence of one or more current or previous pulmonary diseases: rheumatoid nodule in 1 (1%), bronchiectasis in 2 (1.9%), fibrosing alveolitis in 5 (4.8%), pneumonia in 5 (4.8%), asthma in 9 (8.7%), pleural disease in 17 (16.3%) and tuberculosis in 25 (24%). Excluding patients who were smokers or ex-smokers or who had coexistent pulmonary disease, there were 20 patients (19.2%) who had pulmonary abnormalities that could be attributed to RA: rheumatoid nodule in 1 (1%), fibrosing alveolitis in 5 (4.8%) (1 of whom also had pleural disease), pleural disease alone in 8 (7.7%), diffusion defect in 5 (4.8%) and airways obstruction in 1 (1%). CONCLUSION: This study provides clinical and lung function criteria that allow a clinically useful stratification of abnormalities in relation to a spectrum of common causes of pulmonary dysfunction that need to be distinguished from pulmonary abnormalities caused by RA. Pulmonary abnormalities are common and about 20% of RA patients may have an abnormality related to RA.