[Validity and reliability of the Tardieu scale for assessing upper limb spasticity in adults with cerebrovascular disease. Systematic review]. / Validez y fiabilidad de la escala de Tardieu para evaluar la espasticidad en miembro superior en adultos con enfermedad cerebrovascular. Revisión sistemática.

INTRODUCTION: The increase in the number of people with upper limb spasticity as a sequela of cerebrovascular disease, which negatively impacts their autonomy, functional independence and participation, and affects their quality of life, calls for the application of precise and objective instruments for its measurement and evaluation. OBJECTIVE: To assess the validity and reliability of the Tardieu scale in the evaluation of upper extremity spasticity in adults with cerebrovascular disease. MATERIALS AND METHODS: The search strategy was implemented in eight databases; the systematic review protocol was registered beforehand in INPLASY (with registration no. 2023110076). The evidence was synthesised in three phases: a tabular presentation of results, an evaluation of the quality of the articles, and a narrative synthesis of the findings. RESULTS: Only three of the 33 articles identified fulfilled the variables that enable the validity and reliability of the Tardieu scale to be established. The measurements of angles and velocities R1, R2 and R2-R1 were analysed. Student's t-test to assess the reliability between the measurements of R1 and R2; and angles R2 and R2-R1 showed statistical significance, which confirmed the reliability of the scale. CONCLUSIONS: The Tardieu scale proved robust. It is important to note that the sample size, the time of evolution of the disease and the age of the patients may influence the results of the scale.

TITLE: Validez y fiabilidad de la escala de Tardieu para evaluar la espasticidad en miembro superior en adultos con enfermedad cerebrovascular. Revisión sistemática.Introducción. El incremento en el número de personas con espasticidad en los miembros superiores como secuela de una enfermedad cerebrovascular, que impacta negativamente en la autonomía, la independencia funcional y la participación, y afecta a la calidad de vida de las personas, demanda la aplicación de herramientas clínicas precisas y objetivas para su medición y evaluación. Objetivo. Evaluar la validez y la fiabilidad de la escala de Tardieu en la evaluación de la espasticidad en las extremidades superiores de adultos con enfermedad cerebrovascular. Materiales y métodos. La estrategia de búsqueda se implementó en ocho bases de datos; el protocolo de revisión sistemática se registró previamente en INPLASY (registro n.o 2023110076). La síntesis de la evidencia se llevó a cabo en tres fases: presentación tabular de resultados, evaluación de la calidad de los artículos y síntesis narrativa de los hallazgos. Resultados. De los 33 artículos identificados, sólo tres cumplieron con las variables que permiten establecer la validez y la fiabilidad de la escala de Tardieu. Se analizaron las medidas de los ángulos y velocidades R1, R2 y R2-R1. La prueba de la t de Student para evaluar la fiabilidad entre las medidas de R1 y R2; los ángulos R2 y R2-R1 mostraron significancia estadística, lo que confirmó la confiabilidad de la escala. Conclusiones. La escala de Tardieu demostró robustez. Es importante considerar que el tamaño de la muestra, el tiempo de evolución de la enfermedad y la edad de los pacientes pueden influir en los resultados de la escala.

[Distribution of capsular types and antimicrobial susceptibility of Streptococcus agalactiae causing infections in Argentina]. / Distribución de tipo capsular y sensibilidad antimicrobiana de Streptococcus agalactiae productores de infecciones en Argentina.

Streptococcus agalactiae is an endogenous bacterium that has emerged in the last 20 years as an etiological agent in both neonatal and perinatal infections, and in immunocompromised patients. The differentiation of the capsular polysaccharide, the presence of surface proteins c, X, R, and molecular methods allow classification in serotypes and genotypes. This identification is a useful tool for epidemiological purposes and virulence studies in this bacterium. The objective of this work was to study the serotypes and the antimicrobial susceptibility of isolates recovered from invasive diseases in different areas of Argentina. In the analyzed sample a fair predominance of Ia and III serotypes was recovered, followed by II and IV serotypes. All the isolates were found to be sensitive to penicillin. A 6% of resistance to erythromycin and a 4.5% to clindamycin were detected. In three of the isolates, constitutive MLS phenotype (resistance to macrolides, lincosamins and streptogramins) was founded, while in the remaining one, inducible MLS phenotype was detected. These results stress the importance of conducting a surveillance of the prevalent serotypes in our country with the goal of future prevention of this disease with an effective vaccine. The knowledge of the antimicrobial susceptibility profile will be also important to obtain therapeutic success in the treatment.

Cytomegalovirus pneumonia after bone marrow transplantation: high resolution CT findings.

Cytomegalovirus (CMV) pneumonia is one of the most common pulmonary complications after bone marrow transplantation (BMT). We describe the high resolution CT (HRCT) findings of 13 patients with CMV pneumonia diagnosed after allogenic BMT. The study included 13 consecutive patients who developed CMV pneumonia after BMT and who had HRCT of the chest performed within 24 h of the onset of symptoms. HRCT scans were reviewed by two radiologists who assessed pattern and distribution of findings. There were nine male and four female patients, ranging from 9 years to 56 years of age (mean age 33 years). BMT was performed for treatment of chronic myelogenous leukaemia (54%), severe aplastic anaemia (23%), acute myelogenous leukaemia (15%) and Fanconi's anaemia (8%). The time elapsed until diagnosis ranged from +18 days to +405 days (median of 54 days, mean +81.6 days). The predominant patterns of abnormality on HRCT scans were ground-glass opacities (69%), small centrilobular nodules (69%) and air-space opacities (54%). The abnormalities were distributed in the central and peripheral zones of the lungs in six cases, only in the periphery in four cases, and only in the central zone in three cases. In all cases the lung lesions were bilateral, and asymmetry was observed in seven cases. The authors conclude that the most common HRCT findings in patients with CMV pneumonia after BMT consist of bilateral asymmetric ground-glass, air-space opacities and small centrilobular nodules.

Distribución de tipo capsular y sensibilidad antimicrobiana de Streptococcusagalactiae productores de infecciones en Argentina / Distribution of capsular types and antimicrobial susceptibility of Streptococcus agalactiae causing infections in Argentina

Streptococcus agalactiae es una bacteria colonizante que ha emergido en los últimos años como causante de infecciones neonatales, perinatales y en pacientes con compromiso inmunológico. La caracterización del polisacárido capsular, de las proteínas de superficie (c, X, R), así como el análisis de marcadores moleculares, permiten su clasificación en serotipos y genotipos. Esto resulta de utilidad para fines epidemiológicos y para estudios de virulencia de la bacteria. El objetivo de este trabajo fue conocer los serotipos prevalentes y la sensibilidad antimicrobiana de aislamientos provenientes de procesos infecciosos en pacientes de distintas zonas de Argentina. En la muestra analizada se obtuvo predominio de los serotipos Ia y III, seguido de II y IV. Todas las cepas resultaron sensibles a penicilina. Se observó 6% de resistencia a eritromicina y 4,5% a clindamicina. En 3 de las cepas se detectó fenotipo MLS (resistencia a macrólidos, lincosaminas y estreptograminas) constitutiva y en una cepa, resistencia MLS inducible. Los resultados logrados en este estudio destacan la importancia de efectuar un relevamiento de los serotipos más frecuentes en nuestro país en vistas a la prevención de esta infección con una vacuna que realmente sea eficaz, como así también el conocimiento de la sensibilidad antimicrobiana para lograr éxito terapéutico en los tratamientos.

Streptococcus agalactiae is an endogenous bacterium that has emerged in the last 20 years as an etiological agent in both neonatal and perinatal infections, and in immunocompromised patients. The differentiation of the capsular polysaccharide, the presence of surface proteins c, X, R, and molecular methods allow classification in serotypes and genotypes. This identification is a useful tool for epidemiological purposes and virulence studies in this bacterium. The objective of this work was to study the serotypes and the antimicrobial susceptibility of isolates recovered from invasive diseases in different areas of Argentina. In the analyzed sample a fair predominance of Ia and III serotypes was recovered, followed by II and IV serotypes. All the isolates were found to be sensitive to penicillin. A 6% of resistance to erythromycin and a 4.5% to clindamycin were detected. In three of the isolates, constitutive MLS phenotype (resistance to macrolides, lincosamins and streptogramins) was founded, while in the remaining one, inducible MLS phenotype was detected. These results stress the importance of conducting a surveillance of the prevalent serotypes in our country with the goal of future prevention of this disease with an effective vaccine. The knowledge of the antimicrobial susceptibility profile will be also important to obtain therapeutic success in the treatment.

Distribución de tipo capsular y sensibilidad antimicrobiana de Streptococcus agalactiae productores de infecciones en Argentina. / [Distribution of capsular types and antimicrobial susceptibility of Streptococcus agalactiae causing infections in Argentina]

Streptococcus agalactiae is an endogenous bacterium that has emerged in the last 20 years as an etiological agent in both neonatal and perinatal infections, and in immunocompromised patients. The differentiation of the capsular polysaccharide, the presence of surface proteins c, X, R, and molecular methods allow classification in serotypes and genotypes. This identification is a useful tool for epidemiological purposes and virulence studies in this bacterium. The objective of this work was to study the serotypes and the antimicrobial susceptibility of isolates recovered from invasive diseases in different areas of Argentina. In the analyzed sample a fair predominance of Ia and III serotypes was recovered, followed by II and IV serotypes. All the isolates were found to be sensitive to penicillin. A 6

of resistance to erythromycin and a 4.5

to clindamycin were detected. In three of the isolates, constitutive MLS phenotype (resistance to macrolides, lincosamins and streptogramins) was founded, while in the remaining one, inducible MLS phenotype was detected. These results stress the importance of conducting a surveillance of the prevalent serotypes in our country with the goal of future prevention of this disease with an effective vaccine. The knowledge of the antimicrobial susceptibility profile will be also important to obtain therapeutic success in the treatment.

Intoxication of Crotalaria pallida seeds to growing broiler chicks.

The adverse effects of feeding Crotalaria pallida (CP) seeds to chicks was investigated in a 21-day randomized trial of 4 dietary treatments (control, 1,2 and 3% ground CP seeds). Mortality rates in birds fed 0, 1, 2, and 3% dietary CP were 0, 2.1, 6.2, and 16.7%, respectively. Body weight gain and feed efficiency were adversely affected by all levels of inclusion of CP seeds, but feed intake was decreased only by dietary levels of 2 and 3%. Dietary CP of 2 and 3% increased the relative weight of lung, heart and spleen. Relative liver weight was increased by 2% dietary CP, but decreased by 3% CP. At day 14, serum GGT was increased by 2 and 3% dietary CP; serum ALT was significantly increased by 3% CP. No differences in ALT, AST or GGT were observed at day 21. Dietary levels equal to or greater than 1% CP are toxic for growing broiler chicks.

[Industrial pollution due to organic solvents as a cause of teratogenesis]. / Contaminación industrial con solventes orgánicos como causa de teratogénesis.

OBJECTIVE: To inform of a new teratogenic syndrome in human beings and its confirmation in rats. MATERIAL AND METHODS: The study comprised three phases: a field study; a case-control study; and a genetic epidemiology study, aiming at identifying the causes of the occurrence of congenital malformations and psychomotor retardation in the city of Matamoros, Tamaulipas. The second-phase clinical multidisciplinary study was carried out at a general hospital, to conduct a comprehensive evaluation of patients identified during the first phase and offer them the necessary treatment. The third-phase experimental study was done in rats in order to confirm the teratogenic effect of the agents detected in the first phase. RESULTS: A total of 44 patients had a peculiar phenotype and mental retardation of varying degrees, all children of ex-workers of the same factory who were in direct contact, without protection, with organic solvents (methyl cellosolve and ethylene glycol). In the clinical study a syndrome was delineated, previously unreported, consisting of a peculiar facies, mental retardation, and musculo-skeletal and sensorial abnormalities. In the experimental study it was demonstrated that both methyl cellosolve and ethylene glycol cause cranio-facial, musculo-skeletal and central nervous system abnormalities, which confirmed the teratogenic effect of these solvents. CONCLUSIONS: The results of this study establish the existence of a new teratogenic syndrome in humans, produced by methyl cellosolve and ethylene glycol, whose teratogenic capacity had not been reported previously.

[Immunosuppressive treatment of patients with chronic active HBsAg positive hepatitis]. / Tratamiento inmunodepresor en pacientes con hepatitis crónica activa HBs Ag positivo.

Sixty four CAH type B patients were studied, they were simultaneously treated with corticosteroids and azathioprine for an average period of 52 months. The patients were classified into two groups: CAH without cirrhosis (45) and CAH with cirrhosis (19). Patients were initially treated with doses of 40 mg prednisone and 50 mg azathioprine. The reduction of steroids was done according to ASAT level; medication being discontinued when there were not signs of activity in liver biopsy. Therapy was readministered due to elevation of ASAT (5 fold) and the liver biopsy shown pattern of CAH. 49% of CAH patients without cirrhosis improve histology and discontinue treatment; half of them had to resume therapy because of relapse. 14% of the patients died (4); three of them belonging to the group who continued taking the drugs. In the CAH group with cirrhosis, 6 were in remission and withdrawn-from treatment, but 5 had to resume it. The mortality rate of this group was of 69% (13), all patients belonging to the group where were not able to discontinue medication. In both groups ASAT was a good parameter of activity. Complications were more frequent in the group with cirrhosis (42%) than in the one without cirrhosis (17%) (p less than 0.01). In patients with CAH type B, the best therapeutic response was associated to those cases without cirrhosis. Mortality rate is high in patients with cirrhosis at onset of therapy.

Tratamiento inmunodepresor en pacientes con hepatitis crónica activa HBs Ag positivo. / [Immunosuppressive treatment of patients with chronic active HBsAg positive hepatitis]

Sixty four CAH type B patients were studied, they were simultaneously treated with corticosteroids and azathioprine for an average period of 52 months. The patients were classified into two groups: CAH without cirrhosis (45) and CAH with cirrhosis (19). Patients were initially treated with doses of 40 mg prednisone and 50 mg azathioprine. The reduction of steroids was done according to ASAT level; medication being discontinued when there were not signs of activity in liver biopsy. Therapy was readministered due to elevation of ASAT (5 fold) and the liver biopsy shown pattern of CAH. 49

of CAH patients without cirrhosis improve histology and discontinue treatment; half of them had to resume therapy because of relapse. 14

of the patients died (4); three of them belonging to the group who continued taking the drugs. In the CAH group with cirrhosis, 6 were in remission and withdrawn-from treatment, but 5 had to resume it. The mortality rate of this group was of 69

(13), all patients belonging to the group where were not able to discontinue medication. In both groups ASAT was a good parameter of activity. Complications were more frequent in the group with cirrhosis (42

) than in the one without cirrhosis (17

) (p less than 0.01). In patients with CAH type B, the best therapeutic response was associated to those cases without cirrhosis. Mortality rate is high in patients with cirrhosis at onset of therapy.

Pioderma gangrenoso

Se presenta un caso de pioderma gangrenoso de 11 años de evolución en un joven de 17 años de edad. Relacionamos la patología con: hipoproteinemia, consecuencia de una mala alimentación; con hipogonadismo, una inmunidad celular deprimida y una disminución del complemento en sangre. Encontramos resultados terapéuticos favorables con una triple asociación: corticoides por vía general, minociclina y curas locales diarias.