Current opinion on laryngeal electromyography.

PURPOSE: This study evaluates expert opinion on laryngeal electromyography (LEMG). METHODS: A cross-sectional design was used to conduct an online survey of LEMG experts in 2021. They were questioned about the number LEMG performed annually, type of electrodes used, sector worked in, pain during the test, placement of the needle electrodes, interpretation of electrical muscle parameters, diagnosis of neuromuscular injury, prognostic sensitivity in vocal fold paralysis (VFP), laryngeal dystonia, tremor and synkinesis and quantifying LEMG. RESULTS: Thirty-seven professionals answered (23 Spanish and 14 from other countries), with a response rate of 21.56%. All physicians used LEMG. 91.9% had one- or two-years' experience and 56.8% performed 10-40 LEMG per year. 70.3% were otolaryngologists and 27%, neurologists. In 89.1% of cases, a team of electrodiagnostic physician and otolaryngologist performed LEMG. 91.3% of Spanish respondents worked in Public Health, 7.14% of other nationalities; 37.8% in a university department. Bipolar concentric needles electrodes were used by 45.9% and monopolar concentric by 40.5%. 57% professionals considered good patients' tolerance to the test. LEMG sensitivity was regarded as strong, median and interquartile range were 80.0 [60.0;90.0] to diagnose peripheral nerve injuries, less for other levels of lesions, and strong to evaluate prognosis, 70.0 [50.0;80.0]. Respondents believe locate the thyroarytenoid and the cricothyroid muscles with the needle, 80.0 [70.0;90.0], as opposed to 20.0 [0.00;60.0] the posterior cricoarytenoid. The interpretation of the electrical parts of the LEMG was strong, 80.0 [60.0;90.0]. LEMG identify movements disorders, 60.0 [20.0;80.0], and synkinesis, 70.0 [30.0;80.0]. The professionals prefer quantitative LEMG, 90.0 [60.0;90.0]. CONCLUSIONS: The experts surveyed consider LEMG that is well tolerated by patients. The insertional and spontaneous activity, recruitment and waveform morphology can be assessed easily. LEMG is mainly useful in the study of peripheral nerve injuries, and its value in VFP prognosis is considered strong.

El amplio diagnóstico diferencial de los vómitos: un caso de acalasia / The broad differential diagnosis of vomiting: a case of achalasia

Los vómitos constituyen un motivo de consulta muy frecuente en Pediatría. Su abordaje requiere un amplio diagnóstico diferencial, ya que pueden ser síntoma tanto de un trastorno funcional como de patología orgánica importante. Presentamos el caso de una niña de 13 años que debuta con vómitos como síntoma guía de una acalasia. La acalasia es un trastorno motor esofágico que provoca una retención de los alimentos en el segmento distal del esófago debido a un fallo de la peristalsis y una ausencia de relajación del esfínter esofágico inferior (EEI) tras la deglución. Aunque se trata de una patología infrecuente, es necesario incluirla en el diagnóstico diferencial de síntomas gastrointestinales como los vómitos, precisando un alto grado de sospecha para su diagnóstico (AU)

Vomiting is a very frequent reason for consultation in pediatrics. Their approach requires a wide differential diagnosis since they can be a symptom of both a functional disorder and important organic pathology. We present the case of a 13-year-old girl who debuted with vomiting as a guiding symptom of achalasia. Achalasia is an esophageal motor disorder that causes retention of food in the distal segment of the esophagus due to a failure of peristalsis and a lack of relaxation of the lower esophageal sphincter after swallowing. Although it is an infrequent pathology, it is necessary to include it in the differential diagnosis of gastrointestinal symptoms such as vomiting, requiring a high degree of suspicion for its diagnosis. (AU)

Evaluation of the Cell Concentration in Suspensions of Human Leukocytes by Ultrasound Imaging: The Influence of Size Dispersion and Cell Type.

This work focuses on the use of ultrasound imaging to evaluate the cell concentration of dilute leukocyte suspensions in the range of 10-3000 cells/µL. First, numerical simulations were used to study the influence of the size dispersion and the leukocyte type on the performance of the concentration estimation algorithms, which were developed in previous works assuming single-sized scatterers. From this analysis, corrections to the mentioned algorithms were proposed and then the performance of these corrections was evaluated from experiments. For this, ultrasound images were captured from suspensions of lymphocytes, granulocytes, and their mixtures. These images were obtained using a 20 MHz single-channel scanning system. Results confirmed that concentration estimates provided by conventional algorithms were affected by the size dispersion of cells, leading to a remarkable underestimation of results. The proposed correction to compensate for cell size dispersion obtained from simulations improved the concentration estimation of these algorithms, for the cell suspensions tested, approaching the results to the reference optical characterization. Moreover, it was shown that these models provided a total leukocyte concentration from the ultrasound images which was independent of the relative populations of different white blood cell types.

Telemedicina en el control de la hipertensión arterial

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Introduction: Arterial hypertension is the great challenge of health policies in the world. Its high prevalence, the lack of control (linked to poor adherence to antihypertensive treatment) and its high "burden" (as a non-communicable disease) are responsible for the increase in cardiovascular morbidity and mortality. Objetive: To evaluate, as a pilot test, the benefit of real-time telemonitoring applied to blood pressure (BP) control. Metodology: Inclusion criteria: Diagnosed hypertensives, under pharmacological treatment, assisted in the Maciel Hospital polyclinic in the period June-October 2019. Exclusion criteria: pregnancy and upper arm circumference less than 22 cm or greater than 42 cm. Home blood pressure monitoring was implemented, using a validated electronic blood pressure monitor and a smart cell phone connected to a private web platform in real time. Analytical, experimental, prospective study. Qualitative variables were expressed in absolute frequency and percentage relative frequency. Quantitative variables were expressed as mean and standard deviation. The normality of the distribution was verified using the Kolmogorov Smirnov test. Results: Of a total of 57 patients, the mean age was 59 ± 12.8 years, female sex 64.9%. Presenting 22.8% poor knowledge of the disease. Regarding the control of BP figures, 31.6% reported not checking regularly. Adherence to pharmacological treatment at the beginning of the monitoring was 33.3%. Figures lower than those described by RENATA-2, where half of the treated hypertensives complied with the treatment. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed at the beginning and end of the study. Pre-monitoring measurements were mean SBP: 138.6 ± 17.8 mmHg and mean DBP: 85.4 ± 14.8 mmHg. The records at the end of the immediate monitoring were 131.5 ± 19.9 mmHg and 81.5 ± 14.2 mmHg for PAS and PAD, respectively. Finding a significant difference between the means of the PAS (p 0.019), but not between the means of the DBP (p 0.06). Discussion: Although the percentage of patients achieving good BP control was significant, these results may be closely related to a subtype of observed performance bias, rather than the outcome of the intervention. The mean days of telemonitoring were 8, 85, number of shots was 34.12, and number of interventions performed by the observer (medication change) was 0.30. User satisfaction with the method used was 96.4%, and 100% considered it Easy or very easy to use. 87.5% would use it for long periods of time, including older adults. Conclusions: The studied method shows potential benefits for the control of BP figures, with a wide acceptance by users, facilitating access to the health system, and quality medical care.

Introdução: A hipertensão arterial é o grande desafio das políticas de saúde no mundo. Sua alta prevalência, o descontrole (ligado à baixa adesão ao tratamento anti-hipertensivo) e sua alta "carga" (como doença não transmissível) são responsáveis ​​pelo aumento da morbimortalidade cardiovascular. Objetivo: foi avaliar como teste piloto, o benefício do telemonitoramento em tempo real, aplicado ao controle da pressão arterial (PA). Metodologia: Critérios de inclusão: Hipertensos diagnosticados, em tratamento farmacológico, atendidos na policlínica do Hospital Maciel no período de junho a outubro de 2019. Critérios de exclusão: gravidez e circunferência do braço menor que 22 cm ou maior que 42 cm. Foi implementado o monitoramento domiciliar da pressão arterial, utilizando um monitor eletrônico de pressão arterial validado e um telefone celular inteligente conectado a uma plataforma web privada em tempo real. Estudo analítico, experimental, prospectivo.As variáveis ​​qualitativas foram expressas em frequência absoluta e frequência relativa percentual. As variáveis ​​quantitativas foram expressas como média e desvio padrão. A normalidade da distribuição foi verificada por meio do teste de Kolmogorov Smirnov. Resultados: De um total de 57 pacientes, a média de idade foi de 59 ± 12,8 anos, sexo feminino 64,9%. Apresentando 22,8% conhecimento ruim sobre a doença. Em relação ao controle dos valores da PA, 31,6% relataram não verificar regularmente. A adesão ao tratamento farmacológico no início do acompanhamento foi de 33,3%, valores inferiores aos descritos pelo RENATA-2, onde metade dos hipertensos tratados aderiu ao tratamento. A pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD) foram analisadas no início e no final do estudo. As medições de pré-monitoramento foram PAS média: 138,6 ± 17,8 mmHg e PAD média: 85,4 ± 14,8 mmHg. Os registros ao final do monitoramento imediato foram de 131,5 ± 19,9 mmHg e 81,5 ± 14,2 mmHg para PAS e PAD, respectivamente. Encontrando diferença significativa entre as médias do PAS (p 0,019), mas não entre as médias do DBP (p 0,06). Discussão: Embora a porcentagem de pacientes que alcançaram um bom controle da PA tenha sido significativa, esses resultados podem estar intimamente relacionados a um subtipo de viés de desempenho observado, e não ao resultado da intervenção. A média de dias de telemonitoramento foi 8, 85, o número de disparos foi 34,12, e o número de intervenções realizadas pelo observador (mudança de medicação) foi de 0,30. A satisfação dos usuários com o método utilizado foi de 96,4%, sendo que 100% consideraram fácil ou muito fácil de usar. 87,5% usariam por longos períodos de tempo, inclusive idosos adultos. Conclusões: O método estudado apresenta potenciais benefícios para o controle dos valores da PA, com ampla aceitação pelos usuários, facilitando o acesso ao sistema de saúde e assistência médica de qualidade.

Contribution of PEPFAR-Supported HIV and TB Molecular Diagnostic Networks to COVID-19 Testing Preparedness in 16 Countries.

The US President's Emergency Plan for AIDS Relief (PEPFAR) supports molecular HIV and tuberculosis diagnostic networks and information management systems in low- and middle-income countries. We describe how national programs leveraged these PEPFAR-supported laboratory resources for SARS-CoV-2 testing during the COVID-19 pandemic. We sent a spreadsheet template consisting of 46 indicators for assessing the use of PEPFAR-supported diagnostic networks for COVID-19 pandemic response activities during April 1, 2020, to March 31, 2021, to 27 PEPFAR-supported countries or regions. A total of 109 PEPFAR-supported centralized HIV viral load and early infant diagnosis laboratories and 138 decentralized HIV and TB sites reported performing SARS-CoV-2 testing in 16 countries. Together, these sites contributed to >3.4 million SARS-CoV-2 tests during the 1-year period. Our findings illustrate that PEPFAR-supported diagnostic networks provided a wide range of resources to respond to emergency COVID-19 diagnostic testing in 16 low- and middle-income countries.

Near infrared spectroscopy for the pre-cure freezing discrimination of Montanera Iberian dry-cured lomito.

The time lapse between the moment Montanera dry-cured products become available in the market and the consumers purchase could be overcome by freezing the raw meat prior to its curing technological process, i.e. the pre-cure freezing. This study is an attempt to assess the suitability of using Near Infrared Spectroscopy (NIRS) for the pre-cure freezing discrimination in Montanera Iberian dry-cured lomitos (the commercial name given to the Iberian dry-cured presa, Serratus ventralis muscle). The best fitting models developed through Partial Least Square-Discriminant Analysis (PLS-DA) offered a highly-discriminatory capacity, with sensitivity and specificity over 85%. The classification performance decreased in Soft Independent Modelling of Class Analogies (SIMCA) models due to the decrease of the specificity. These findings suggest that NIRS technology in combination with PLS-DA, may be useful for the control of the pre-cure freezing practice.

Near-Infrared Spectroscopy (NIRS) as a Tool for Classification of Pre-Sliced Iberian Salchichón, Modified Atmosphere Packaged (MAP) According to the Official Commercial Categories of Raw Meat.

This study evaluates near-infrared spectroscopy (NIRS) feasibility in combination with various pre-treatments and chemometric approaches for pre-sliced Iberian salchichón under modified atmosphere (MAP) classification according to the official commercial category (defined by the combination of genotype and feeding regime) of the raw material used for its manufacturing (Black and Red purebred Iberian and Iberian × Duroc crossed (50%) pigs, respectively, reared outdoors in a Montanera system and White Iberian × Duroc crossed (50%) pigs with feed based on commercial fodder) without opening the package. In parallel, NIRS feasibility in combination with partial least squares regression (PLSR) to predict main quality traits was assessed. The best-fitting models developed by means of partial least squares discriminant analysis (PLS-DA) and linear discriminant analysis (LDA) yielded high discriminant ability and thus offered a tool to support the assignment of pre-sliced MAP Iberian salchichón according to the commercial category of the raw material. In addition, good predictive ability for C18:3 n-3 was obtained, which may help to support quality control.

Quality Traits of Montanera Iberian Dry-Cured lomito as Affected by Pre-Cure Freezing Practice.

The seasonality to which dry-cured products from Iberian breed pigs finished in Montanera (free-range rearing system with feed based exclusively on ad libitum consumption of natural resources; acorns and grass) are subjected could be overcome by pre-cure freezing. Three sets of Montanera Iberian presas (Serratus ventralis muscle)(n = 15) were established to assess the impact of frozen storage -0, or non-frozen, 3 and 6 months-previous to the technological process of curing-on the quality traits of the dry-cured product Montanera Iberian dry-cured lomito. Similar seasoning and curing processing conditions were applied to all sets. Lower productive performance due to higher weight loss during curing, and lower colour intensity were observed in pre-frozen dry-cured lomitos. The fatty acid profile was more saturated, and the oxidative status increased as a result of pre-cure freezing. On the matter of texture, all parameters were modified, highlighting the higher values of hardness and shear force of pre-frozen dry-cured lomitos. The time that raw material was frozen exerted a slight, thus helping manufacturers to better address the gap between industry and consumer demand with minimal effect on quality traits.

Factors associated with depression during pregnancy in women from a low socioeconomic level: A hierarchical model approach.

The objectives of this cross-sectional study were to estimate the prevalence of depressive symptoms and affective disorders during pregnancy in a maternity hospital in Argentina and to explore potential risk factors. Symptoms of depression were measured with the Edinburgh Postnatal Depression Scale (EPDS), and the Mini International Neuropsychiatric Interview (MINI) for diagnosis at mid-pregnancy. 50.7%, 95% CI: 43.7; 57.8 screened positive using a score ≥ 10 and 23% of pregnant women were diagnosed with affective disorders, 11% unipolar, and 12% bipolar. Personal and family depression history were main risk factors. It is advised to routinely screen for depression during pregnancy.

Apendicitis recurrente / Recurrent appendicitis

La apendicitis crónica es una entidad poco frecuente, que se manifiesta como dolor abdominal recurrente en la fosa iliaca derecha. Las pruebas complementarias (hemograma, proteína C reactiva y ecografía) pueden ser normales, por lo que sería necesario realizar una laparoscopia con apendicectomía para el diagnóstico. El estudio histológico muestra cambios inflamatorios crónicos no ocasionados por otros procesos infecciosos ni compatibles con una enfermedad inflamatoria intestinal. Se presenta el caso de un niño de 12 años con episodios autolimitados de dolor abdominal agudo en el transcurso de dos años, al que se le realizó tratamiento quirúrgico con diagnóstico definitivo de apendicitis crónica

Chronic appendicitis is a rare entity, manifested by episodes of recurrent abdominal pain located in the right iliac fossa. Complementary tests (blood count, C-reactive protein and ultrasound) may be normal, so it would be necessary a laparoscopy with appendectomy for diagnosis. The histological study shows chronic inflammatory changes, not caused by other infectious processes and not compatible with an inflammatory bowel disease. We present the case of a 12-year-old boy with self-limited episodes of acute abdominal pain during the course of two years. It was necessary a surgical treatment, with a definitive diagnosis of chronic appendicitis

Whole-gene analysis of inter-genogroup reassortant rotaviruses from the Dominican Republic: Emergence of equine-like G3 strains and evidence of their reassortment with locally-circulating strains.

Inter-genogroup reassortant group A rotavirus (RVA) strains possessing a G3 VP7 gene of putative equine origin (EQL-G3) have been detected in humans since 2013. Here we report detection of EQL-G3P[8] RVA strains from the Dominican Republic collected in 2014-16. Whole-gene analysis of RVA in stool specimens revealed 16 EQL-G3P[8] strains, 3 of which appear to have acquired an N1 NSP1 gene from locally-circulating G9P[8] strains and a novel G2P[8] reassortant possessing 7 EQL-G3-associated genes and 3 genes from a locally-circulating G2P[4] strain. Phylogenetic/genetic analyses of VP7 gene sequences revealed nine G3 lineages (I-IX) with newly-assigned lineage IX encompassing all reported human EQL-G3 strains along with the ancestral equine strain. VP1 and NSP2 gene phylogenies suggest that EQL-G3P[8] strains were introduced into the Dominican Republic from Thailand. The emergence of EQL-G3P[8] strains in the Dominican Republic and their reassortment with locally-circulating RVA could have implications for current vaccination strategies.

Rendimiento diagnóstico de la tomografía de cráneo en pacientes con delirium / Clinical yield of computed tomography brain scan in patients with delirium

RESUMEN Objetivos: Determinar el rendimiento de la tomografía axial computada de cráneo en el diagnóstico etiológico de delirium y qué factores son predictores de causa intracraneana del mismo. Material y métodos: Estudio transversal, observacional. Criterios de inclusión: pacientes con diagnóstico de delirium a los cuales se les haya realizado una Tomografía de cráneo como parte de la valoración etiológica. Criterios de exclusión: factores que imposibiliten la entrevista. Como herramienta diagnóstica se utilizó el CAM (Confusion Assesment Method). Resultados: Se incluyeron en el estudio 114 pacientes. La tomografía confirmó la causa de delirium en 18,4 % de los casos. Las variables que se asociaron con tomografía alterada fueron déficit focal neurológico y antecedentes de Trauma de cráneo. En 2.6% de los pacientes la tomografía confirmó una causa intracraneana de delirium a pesar de no tener signos focales neurológicos ni antecedente de traumatismo de cráneo. Conclusiones: La tomografía de cráneo es una herramienta de gran valor, pero no debería realizarse de urgencia, en forma rutinaria, en todos los pacientes con delirium. La tomografía debe indicarse de urgencia cuando existe antecedente de traumatismo de cráneo, hallazgo de signos focales neurológicos al examen o no se encuentra un factor precipitante. En los pacientes ancianos y/o con deterioro cognitivo previo debe tenerse presente que los factores precipitantes de delirium más frecuentes son extra-craneanos.

ABSTRACT Objectives: To determine the yield of computed tomography brain scan in the etiological diagnosis of delirium, and to determine which factors are predictors of the intracranial cause of delirium. Material and methods: Cross-sectional study, observational. Inclusion criteria: Patients diagnosed with delirium that have undergone a cranial tomography as part of etiological assessment. Exclusion criteria: Factors that prevent the interview. The CAM (Confusion Assessment Method) has been used as a diagnostic tool. Results: 114 patients were included in the study. The tomography confirmed the cause of delirium in 18% of the cases. The variables that were associated with altered tomography were focal neurological deficit and a history of head trauma. 2.6% of patients’ tomography confirmed an intracranial cause of delirium in spite of not having focal neurological signs or history of head trauma. Conclusions: The tomography is a valuable tool, but it should not be made urgently, routinely, in all patients with delirium. The tomography should be requested urgently when there is a history of head trauma, findings of focal neurological signs or a precipitating factor is not found. It should be noted that in elderly patients with previous cognitive impairment, the most common precipitating factors of delirium are nonintracranial.

Agomelatine for Depression in Parkinson Disease: Additional Effect on Sleep and Motor Dysfunction.

Depression and sleep disorders are among the most prevalent nonmotor symptoms of Parkinson disease (PD). Because agomelatine acts as a MT1 and MT2 agonist and as a 5HT2c antagonist, this study was designed to assess the efficacy of agomelatine in treating depressive symptoms in PD patients, and the potential changes both in sleep quality and motor symptoms. Depressed patients with PD were treated with agomelatine for 6 months, and they were evaluated with an array of scales. Completed nocturnal video-polysomnography was performed at baseline and week 12. The efficacy analysis population included 24 patients (12 men). The mean (SD) age was 75.2 (8.3) years. The mean (SD) daily dose of agomelatine was 25.00 (10.43) mg at 24 weeks. No changes in dopamine replacement therapy were made. There was a significant decrease in the 17-item Hamilton Depression Scale score over the course of the study (P < 0.0005). The Scales for Outcomes in Parkinson disease Sleep Questionnaire showed a statistically significant improvement over time in each of its subscales: nighttime sleep (P < 0.005), last month nighttime sleep (P < 0.0005), and daytime sleepiness (P < 0.0005). Surprisingly, changes over time in the motor subscale of Unified Parkinson Disease Rating Scale were statistically significant (P < 0.0005). Periodic limb movements and awakenings measured by polysomnography improved significantly (P < 0.005 and P < 0.05, respectively). We concluded that the use of agomelatine in PD depressed patients may have a considerable therapeutic potential because of its dual action for treating both symptoms of depression and disturbed sleep given its secondary beneficial effects regarding the reduction of extrapyramidal symptoms.

Peduncular hallucinosis in a patient with subclavian steal syndrome: usefulness of Doppler ultrasonography.

The subclavian steal syndrome is characterized by retrograde flow within a vertebral artery ipsilateral to proximal subclavian artery high-grade stenosis or occlusion. It can cause vertebrobasilar insufficiency and hence diverse brainstem symptoms. Peduncular hallucinosis consists of visual images of brief duration that are related to thalamic or rostral brainstem lesions. We describe a patient with peduncular hallucinosis in the setting of subclavian steal syndrome. Inducing a hemodynamic challenge to the vertebrobasilar circulation elicited the patient́s visual symptoms. Thus, careful ultrasonographic evaluation with dynamic testing contributed to explain the physiopathology of the clinical symptoms.

The somatosensory blink reflex in upper and lower brainstem lesions.

The brainstem pathways that mediate the somatosensory blink reflex (SBR) are not completely understood. We hypothesized that the circuits of the SBR might be affected separately from those of the trigeminal blink reflex (TBR). We examined 7 patients with mesencephalic lesions and 8 patients with medullary lesions. The SBR was elicited by median nerve stimulation. The TBR was elicited by supraorbital nerve stimulation. In patients with upper brainstem lesions, the TBR was normal, whereas the SBR was generally abnormal. The SBR was either absent or small and was significantly delayed with respect to control subjects. The opposite was the rule in patients with lower brainstem lesions who had delayed or absent TBR and no abnormal findings in the SBR. The SBR is mediated through circuits in the upper brainstem. Study of the SBR can be helpful in the neurophysiological assessment of patients with mesencephalic lesions.

The startle reaction to somatosensory inputs: different response pattern to stimuli of upper and lower limbs.

Unexpected sensory inputs can generate a patterned startle reaction, aimed at protection and defense. Experimentally, it is usually triggered by auditory stimuli while the startle reaction to somatosensory inputs (SSS) has not received much attention so far. This may be in part due to the fact that somatosensory inputs inevitably cause local reactions, such as short and long latency reflexes and withdrawal reactions, which could interfere with recognition of the startle-related activity. Therefore, we have undertaken a study aimed at separating the SSS from other responses by exploring the responses that are common to somatosensory stimuli applied to different sites and examining the inhibitory effects of prepulse stimuli. In 13 healthy naive subjects, we applied electrical stimuli to the median nerve at the wrist (MW) or the posterior tibial nerve at the ankle (PT) and recorded from orbicularis oculi (OOC), masseter (MAS), sternocleidomastoid (SCM) and representative muscles of the limbs being stimulated (flexor carpi radialis for MW and tibialis anterior for PT). In random trials, we also applied prepulse stimuli, either a low-intensity auditory stimulus or low-intensity electrical stimuli, 100 ms before the SSS-eliciting stimulus. The pattern of SSS was different for upper and lower limb stimuli. While stimuli applied to MW induced a prominent reaction of the OOC, at a mean latency of 61.1 ms (SD = 16.3 ms), followed by the SCM at a mean latency of 83.3 ms (SD = 28.6 ms), those applied to the PT caused a small or absent response in the OOC and a consistent response of the SCM at a mean latency of 89.7 ms (SD = 30.1 ms). Prepulse stimuli effectively inhibited the responses of facial and neck muscles but only partially those of the wrist flexors to MW or the tibialis anterior to PT. Our results indicate that, although there are common neck and facial muscle reactions to somatosensory stimuli applied to upper and lower limbs, the pattern of the SSS differs according to the source of the input. Prepulse inhibition is more effective on the responses of neck and facial muscles than on the responses of limb muscles to somatosensory stimuli. These results could help in distinguishing between withdrawal and SSS reactions.

Skin autonomic reactivity to thermoalgesic stimuli.

OBJECTIVE: Quantitative sensory testing (QST) is a subjective method of assessing thermal sensation, but it does not provide an objective measure of physiological changes. Our aim was to establish whether fluctuations in sudomotor autonomic activity correlate with warmth and heat pain (thermoalgesic) perception. METHODS: We conducted various thermal stimuli protocols in 22 healthy volunteers and recorded the visual analog scale (VAS) and sudomotor activity using surface electrodes attached to the hand. Sympathetic skin responses (SSR) and the mean level of electrodermal activity (EDA) were measured. EDA was analyzed by looking at the four VAS-based phases, which were divided into segments defined by the relevant psychophysical markers. RESULTS: In all stimuli paradigms, the mean delay time of the SSR was 1.6 s after the warmth or pain sensation. There was an association between the low amplitude (predominantly negative) SSR and warm stimuli, and the large amplitude (predominantly positive) SSR and heat pain stimuli (chi-square; P < 0.05). Mean EDA was significantly higher during the pain phase in comparison with pre-perception, warmth and post-perception phases. INTEPRETATION: Thermoalgesic stimuli induce reflex changes in sudomotor activity that correlate with subjective perception of warmth and heat pain sensations. This association may be useful in clinical practice.

Transient decrease of sensory perception after thermoalgesic stimuli for quantitative sensory testing.

Transient decrease in the excitability of a reflex circuit following its activation by appropriate stimuli is a well-recognized phenomenon, but it is unclear how this applies to thermoalgesic stimuli during quantitative sensory testing (QST). We examined the effects induced by a thermoalgesic (conditioning) stimulus on the response to a subsequent (test) stimulus of the same characteristics. All tests were done using a Peltier thermode with a surface area of 12.5 cm(2) using ramp rates of 2 degrees C/s and variable interstimulus intervals (ISIs) ranging from 10 to 60 s. Perception was measured with an electronic visual analog scale. No changes were observed in latency of pain perception. However, latency of warm perception was significantly delayed and pain perception intensity was significantly reduced with respect to conditioning stimuli at ISIs below 60 s. Our results indicate a transient saturation of warm and heat pain perception systems after a thermoalgesic stimulus. We therefore recommend that time intervals of >1 min be used between two consecutive thermoalgesic stimuli when examining QST.

[Knowledge of flowmetry among asthmatic children and adolescents]. / Conocimiento de la flujometría en niños y adolescentes asmáticos.

BACKGROUND: The correct control of asthmatic children and teenagers substantially improves their quality of life. The use of the peak flowmeter permits to monitor the pulmonary function and to control this disease. OBJECTIVE: To gather information about the use of the peak flowmeter in asthmatic children and teenagers. MATERIAL AND METHODS: It was a descriptive and observational study done in 81 asthmatic children and teenagers who attended a summer camp. They answered a questionnaire in order to know their knowledge about the peak flowmeter's use. RESULTS: The age of the studied group ranked from five to 18 years (54.3% between five to 10 years). Out of the 81 children and teenagers, 64 knew about the peak flow. In spite of the knowledge, only 38 (46.9%) had used it in at least one occasion and 20 (24.7%) in an ambulatory manner (16 used it when they feel bad, and four, every day). Only nine of these 20 children knew the correct way to use it, to interpret the results and what the normal peak flow was. All of these children and teenagers were under medical control. Allergists were attending 66.7%. Independently of the specialty of their doctors, the average of the children that didn't use the peak flowmeter in their control of asthma was always over than 50%. CONCLUSIONS: In spite that all these children and teenagers were on medical care, the knowledge of the peak flowmeter usage was not enough to take advantage.

Effects of a startle on heart rate in patients with multiple system atrophy.

The patient cooperation usually required for neurophysiological assessment of autonomic cardioregulatory function is difficult to obtain from patients with bradykinesia. A particularly interesting condition occurs in multiple system atrophy (MSA), which features both bradykinesia and autonomic dysfunction. Another characteristic of patients with MSA is their normal motor reaction to a startling stimulus. We used startle as a stimulus for testing autonomic cardioregulatory function in patients with MSA, thus avoiding the need for patient cooperation. In 10 healthy volunteers and 8 MSA patients, we recorded the electrocardiographic QRS complex with surface electrodes attached over the chest and delivered an acoustic startle stimulus after 8 seconds of baseline recording. We calculated the ratio between the pre-stimulus and the post-stimulus heart beat intervals (R-R ratio) by dividing the mean prestimulus R-R interval by the shortest R-R interval obtained within 10 seconds poststimulus. Healthy volunteers had a significant shortening of the R-R interval. The peak of the effect occurred after 2 to 5 seconds, with a mean R-R ratio of 1.14 (S.D. = 0.09). In contrast, R-R shortening was markedly reduced in patients, even though they had a normal motor response. The mean R-R ratio in patients was 1.03 (S.D. = 0.03), significantly lower than in healthy volunteers (P < 0.01). Our results demonstrate an abnormally reduced modulation of the heart beat frequency in patients with MSA, compatible with a dysfunction on pathways responsible for autonomic regulation. The method described here may be useful in the assessment of cardioregulatory function in poorly cooperative patients with normal startle responses.