Effects of peripheral and different inspiratory muscle training methods in coronary artery disease patients with metabolic syndrome: A randomized-controlled trial.

Background OBJECTIVE: To investigate the effects of peripheral muscle training (PMT) and different inspiratory muscle training (IMT) methods on respiratory functions, exercise capacity, and biochemistry parameters in coronary artery disease patients with metabolic syndrome. METHODS: This prospective, single-blind, randomized-controlled study included 60 patients of stable coronary artery disease with metabolic syndrome (New York Heart Association [NYHA] Class I-II, left ventricular ejection fraction >40%). Patients were randomly divided into three groups: neuromuscular electrical stimulation (NMES) plus PMT group (NMES + PMT group, n = 20), IMT plus PMT group (IMT + PMT group, n = 20) and PMT group (PMT group, n = 20). Treatment continued for six weeks for all groups. The NMES was applied to rectus abdominis, IMT was applied with 30% of maximal inspiratory pressures, and PMT was applied at home. Spirometry, maximal inspiratory and expiratory pressure, dyspnea scores, exercise stress test, and biochemistry parameters were measured before and after training. RESULTS: There were significant improvements in spirometric tests, respiratory muscle strength, dyspnea scores, exercise capacity, fasting blood glucose, and antistreptolysin O after treatment in all groups (p < 0.05). Significant improvements in C-reactive protein and erythrocyte sedimentation rate were observed in NMES + PMT and IMT + PMT groups (p < 0.05). Among the groups, there was a significant difference in maximal inspiratory pressure (p = 0.02) and erythrocyte sedimentation rate (p = 0.037) in favor of NMES + PMT group (p < 0.05). CONCLUSION: Our study results showed significant improvements in respiratory functions, exercise capacity, and biochemistry markers in all groups. Different IMT methods can be used in cardiopulmonary rehabilitation to improve exercise intolerance in coronary artery disease patients with metabolic syndrome. CLINICAL TRIAL REGISTRATION NUMBER: NCT03523026.

Faringitis estreptocócica en niños menores de tres años. Algunas consideraciones / Streptococcal pharyngitis in toddlers. Some details

La faringoamigdalitis aguda (FAA) es una de las enfermedades más comunes en la infancia. En las guías clínicas el límite de edad para considerar realizar una prueba de detección rápida es a partir de los tres años, ya que se ha visto que por debajo de esta edad, salvo en casos seleccionados, la probabilidad de infección bacteriana es baja, y los riesgos de fiebre reumática al no tratar son inexistentes. Existe una salvedad a esta situación, que queremos recalcar, y son los pacientes menores de tres años sintomáticos, que tienen contacto próximo (familiar o guardería) afecto de faringoamigdalitis estreptocócica. Creemos importante considerar y tener en cuenta la realización de test diagnóstico y posterior tratamiento a este grupo de pacientes, no para prevenir complicaciones, si no para disminuir el riesgo de diseminación de la infección (AU)

Acute pharyngitis is one of the most common childhood diseases. Guidelines on the diagnosis of children with streptococcal pharyngitis sugges that the most recommended age to perform a rapid antigen detection is more than three years old, because among children younger than this age the possibility/likelihood of bacterial infection is very low and the risk of acute rheumatic fever is also very low. There is an exception of this situation that we want to remark: patients younger than 3 years old, symptomatic, with a close contact (sibling or kindergarten) with group A Streptococcal pharyngitis. It’s important considering the performance of a rapid antigen detection test and the treatment if positive, not just to prevent complications, but also for the reduction in the transmission of the disease to family members, classmates and other close contacts of the patient (AU)

Neuronal antibody biomarkers for Sydenham's chorea identify a new group of children with chronic recurrent episodic acute exacerbations of tic and obsessive compulsive symptoms following a streptococcal infection.

Several autoantibodies (anti-dopamine 1 (D1R) and 2 (D2R) receptors, anti-tubulin, anti-lysoganglioside-GM1) and antibody-mediated activation of calcium calmodulin dependent protein kinase II (CaMKII) signaling activity are elevated in children with Sydenham's chorea (SC). Recognizing proposed clinical and autoimmune similarities between SC and PANDAS (pediatric autoimmune neuropsychiatric disorder associated with a streptococcal infection), we sought to identify serial biomarker changes in a slightly different population. Antineuronal antibodies were measured in eight children (mean 11.3 years) with chronic, dramatic, recurrent tics and obsessive-compulsive disorder (OCD) associated with a group A ß-hemolytic streptococcal (GABHS) respiratory tract infection, but differing because they lacked choreiform movements. Longitudinal serum samples in most subjects included two pre-exacerbation samples, Exac), one midst Exac (abrupt recurrence of tic/OCD; temporally association with a GABHS infection in six of eight subjects), and two post-Exac. Controls included four groups of unaffected children (n = 70; mean 10.8 years) obtained at four different institutions and published controls. Clinical exacerbations were not associated with a significant rise in antineuronal antibody titers. CaMKII activation was increased at the GABHS exacerbation point in 5/6 subjects, exceeded combined and published control's 95th percentile at least once in 7/8 subjects, and median values were elevated at each time point. Anti-tubulin and anti-D2R titers did not differ from published or combined control group's 95th percentile or median values. Differences in anti-lysoganglioside-GM1 and anti-D1R titers were dependent on the selected control. Variances in antibody titers and CaMKII activation were identified among the institutional control groups. Based on comparisons to published studies, results identify two groups of PANDAS: 1) a cohort, represented by this study, which lacks choreiform movements and elevated antibodies against D2R; 2) the originally reported group with choreiform movements and elevated anti-D2R antibodies, similar to SC. Increased antibody mediated CaMKII activation was found in both groups and requires further study as a potential biomarker.

Streptococcus induces circulating CLA(+) memory T-cell-dependent epidermal cell activation in psoriasis.

Streptococcal throat infection is associated with a specific variant of psoriasis and with HLA-Cw6 expression. In this study, activation of circulating psoriatic cutaneous lymphocyte-associated antigen (CLA)(+) memory T cells cultured together with epidermal cells occurred only when streptococcal throat extracts were added. This triggered the production of Th1, Th17, and Th22 cytokines, as well as epidermal cell mediators (CXCL8, CXCL9, CXCL10, and CXCL11). Streptococcal extracts (SEs) did not induce any activation with either CLA(-) cells or memory T cells cultured together with epidermal cells from healthy subjects. Intradermal injection of activated culture supernatants into mouse skin induced epidermal hyperplasia. SEs also induced activation when we used epidermal cells from nonlesional skin of psoriatic patients with CLA(+) memory T cells. Significant correlations were found between SE induced upregulation of mRNA expression for ifn-γ, il-17, il-22, ip-10, and serum level of antistreptolysin O in psoriatic patients. This study demonstrates the direct involvement of streptococcal infection in pathological mechanisms of psoriasis, such as IL-17 production and epidermal cell activation.

Acute and chronic corticosteroid treatment of ten patients with paralytic form of Sydenham's chorea.

AIMS: To determine efficacy and safety of corticosteroid treatment in patients with severe Sydenham's chorea paralytic form. METHODS: This is a 4 years observational study on ten patient with severe paralytic form of Sydenham's chorea unresponsive to neuroleptics and antiepileptics agents, treated with intravenous methylprednisolone followed by oral deflazacort therapy. Chorea paralytica patients were bedridden, unable to take independent steps, showed severe generalized hypotonia and were hospitalized for 3-4 weeks. Additional clinical evaluations were undertaken at 1, 3 and 6 months and 1, 2 and 4 years from onset of chorea. Severity chorea at the onset and during follow up was rated according to Universidade Federal de Minas Gerais (UFMG) Sydenham's Chorea Rating Scale (USCRS). In all children video-recording was performing at onset and during clinical follow-up. RESULTS: We reported a significant improvement in swallowing and chewing with partial recovery of language 2-3 days after starting intravenous methylprednisolone treatment and complete disappearance of movement disorders after 3-4 weeks of treatment. All our patients were followed for 4 years from onset and none experienced relapse of chorea, other movement disorders or psychiatric disturbances. The treatment with deflazacort was well-tolerated in all children with no significant side effects reported. CONCLUSION: Our data showed that high dose of methylprednisolone intravenously followed by deflazacort therapy may be effective and well-tolerated in children with severe paralytic form of Sydenham's chorea.

Interferencia en la medida inmunoturbidimétrica de antiestreptolisina-O por un componente monoclonal IgM-kappa en 3 pacientes / Interference in the immunoturbidimetric assay of antistreptolysin-O by monoclonal IgM-Kappa in 3 patients

El hallazgo casual de resultados discrepantes en la determinación de un parámetro bioquímico cuando se realiza en distintas diluciones de la misma muestra, puede orientar hacia una interferencia analítica. Se presenta el estudio de 3 pacientes en los que se demostró una interferencia positiva en la medida inmunoturbidimétrica de antiestreptolisina-O debido a la presencia de una inmunoglobulina monoclonal IgM-k(AU)

The casual finding of disparate results in the determination of an analyte when it is measured at different dilutions on the same sample can lead us to suspect the presence of analytical interference. We present the study of 3 patients in whom a positive interference was proved on the immunoturbidimetric measurement of antistreptolysin-O due to the presence of a monoclonal immunoglobulin IgM Kappa(AU)

[The value of serologic inflammatory parameters in the diagnosis of alopecia areata]. / Die Wertigkeit serologischer Entzündungsparameter in der Diagnostik der Alopecia areata.

Even recently, focal processes or inflammatory diseases have repeatedly been discussed as the possible causes of alopecia areata (AA) and corresponding diagnostic measures are still recommended. Therefore, we initially attempted to find definite indications of processes like these in AA patients by means of serologic parameters of inflammation and ESR as well as supplementary clinical focal diagnostics. The data obtained revealed increased titers of antistreptolysin in 2.9% and antistreptococcal DNase B in 25.7%, positive C-reactive protein in 8.6%, positive rheumatoid factor in 4.3%, and elevated ESR in 11.7% of the cases. After these data had carefully been compared to those in healthy persons, only the titer of antistreptococcal DNase B and the ESR were found to be increased. In the majority of the cases, these elevations correlated with concomitant bacterial infections detected by clinical focal diagnostics. Antistreptococcal DNase B titer and ESR seem to be the most appropriate of all our test parameters to provide some indications of a focal process or concomitant inflammatory diseases. The remaining parameters are not indicated in AA.

[Renal involvement in anaphylactoid purpura with particular reference to serum immunoglobulin].

Eighty-eight children of anaphylactoid purpura were studied in the Department of Pediatrics from September 1979 to September 1987. Fifty-one children without renal involvement recovered rapidly. Seven children with hematuria or proteinuria and fourteen children with both manifestations recovered fully within six weeks also. Two patients with hematuria and proteinuria recovered two months and four months, respectively, after diagnosis. Ten children had persistent hematuria and proteinuria lasting for more than six months; of these five children recovered and four improved; one child died of intracranial hemorrhage and severe infection. Nephrotic syndrome was noted in five children. Most of them (greater than 80%) had persistent proteinuria more than six months. Incidence of renal involvement was correlated with age. Older children especially those of more than nine years old had a higher incidence rate (p less than 0.005). Serum immunoglobulin A (IgA) and immunoglobulin E (IgE) levels were significantly elevated in 44.7% and 36.4% of patients respectively, but neither influenced the incidence of renal involvement or prognosis of renal disease. Elevated serum IgA and IgE levels in acute stage were significantly reduced in 100% and 83% of children when they were followed in convalescent stage (p less than 0.05). The role of IgE deserves further study. Antinuclear antibody was positive in two children without nephritis. Hypertension was noted in fifteen children, all with renal involvement. Hypertension appears to be a good indicator for renal involvement. Antistreptolysin O titer was elevated in 31.7% of children, but had no significant correlation with incidence of renal involvement.

Post-streptococcal glomerulonephritis in Hong Kong.

Of 74 paediatric inpatients with acute glomerulonephritis, 58 (78%) had a raised (greater than 1/200) antistreptolysin O titre. Serum C3 concentration was low in 73, but returned to normal within six weeks. Streptococcal infection remains the commonest cause of acute nephritis in children in Hong Kong, possibly due to overcrowded living conditions.

[Therapy of severe stenocardia with ultraviolet blood irradiation (UVB) and various action mechanisms of this therapy]. / Zur Therapie schwerer Stenokardien mittels Ultraviolettbestrahlung des Blutes (UVB) und zu einigen Wirkungsmechanismen dieser Therapie.

We observed 70 male patients with a seriously proceeding Chronic myocardial ischemia. They were hospitalised because of frequent, permanent and serious attacks of stenocardia at rest and in stress situations. More than 2/3 of these patients had suffered from a myocardial infarct. In the course of two weeks an intensive therapy with all modern preparations for vasodilatation was made. This therapy proved to be unsuccessful. Nearly all patients were administered more than 10 tables of nitroglycerin per day and, in addition, they were injected analgetics as a compensation of attack. The ultraviolet own blood irradiation (UVB) had a positive therapeutic effect in all patients. There was a good success in 46 patients, in all patients satisfactory results could be registered. The effect of therapy was evident by the decrease of administration of nitroglycerin required, by an increase in the degree of stress capacity, and by an easier treatment of stenocardia attacks. The observation time for patients amounted to 2-8 months. The success of therapy remained in 38 patients. After this time the success of therapy could partially be regained by a repeated number of irradiation series. Then, it remained positive in 9 of 22 patients who had been followed-up for 10 months. The half decay period of eliminating 131I from an intradermal depot could be normalised under the influence of ultraviolet own blood irradiation. This ultraviolet own blood irradiation had no significant influence on the fibrinogen level, fibrinolytic activity, and erythrocyte aggregation (examined in 11 patients). A 2 1/2-fold diminution of monomer fibrin complexes in the blood could be observed. The titre of antistreptolysin-O was increased in all patients who had got over the infarct. It had completely normalised a week after finishing the ultraviolet own blood irradiation. Spectroscopic examinations of the blood and plasma made after ultraviolet own blood irradiation revealed that this irradiation will not only affect the properties of Hb, but will also cause a photochemical transformation accompanied by a destruction of some plasma proteins, of the membrane of formed blood elements, and a photosynthesis of biochemically active compounds. The mechanism of action of ultraviolet own blood irradiation is complicated and requires further exact investigations. Even today, however, this method can be recommended as a complex therapy in patients with severe myocardial ischemia.

Polyene antibiotics in assessing significance of antistreptolysin O activity.

Antistreptolysin O activity in serum is due either to antibody or to altered lipoprotein molecules. The latter can be inhibited by performing antistreptolysin tests using a polyene antibiotic such as amphotericin B as diluent.

Antihyaluronidase level in children with rheumatic fever and other streptococcal infection.

1) The serum ASO and AH assays were performed and compared in a series of 90 healthy children and 7 pediatric patients with rheumatic fever and other disorders related to hemolytic streptococcus infection. 2) The upper physiological limit of serum AH titer was estimated to be 256X for children. 3) In rheumatic fever, sometimes the serum AH level rises earlier than elevation of serum ASO and remains to be high over a long period even after the serum ASO has returned to normal level. 4) The results suggest importance of the serum AH determination in the serologic diagnosis of rheumatic fever and other conditions of hemolytic streptococcus infection.

Group A streptococcal infections as related to rheumatic fever.

Beta-hemolytic streptococci were recovered frequently, particularly from the throats of children, and the same type of group A strains was isolated from both throats and tonsils. A significant antibody response to streptolysin O was observed in 44.8 to 43.5 % of the children whom group A streptococci were recovered. It is considered that these children had the definite evidence of acute streptococcal infections, and administration of josamycin, penicillin G, and benzyl penicillin V benzathine decreases the frequency of recovery of beta-hemolytic streptococci and prevents rheumatic fever.