Radiographic aspects in individuals infected by human T-lymphotropic virus type 1 (HTLV-1) with joint pain.

BACKGROUND: Joint pain in the absence or with little synovitis is observed in a large percentage of HTLV-1 infected subjects. As the virus infect CD4 + and CD8 + positive, macrophages and B cells an exaggerated production of pro-inflammatory cytokines is detected in these patients. However, the possible association of HTLV-1 infection with autoimmune diseases has not been documented definitively and the clinical characteristics of HTLV-1 associated arthropathy has not been defined. The objective this study is to describe clinic and radiographic features in HTLV-1-infected individuals with complaints of joint pain. METHODS: Cross-sectional study enrolling HTLV-1-infected individuals with chronic joint pain, aged up to 75 years, both genders and seronegative controls with osteoarthritis. All participants underwent conventional radiography of the hips, knees and ankles. RESULTS: Eighty-one HTLV-1 infected patients and 30 subjects with osteoarthritis participated in the study. Polyarticular and symmetrical arthritis prevailed in the HTLV-1 positive group (54%), while oligoarticular and asymmetrical (44%) were more common in controls (p < 0.05). The frequency of enthesophytes (90%) in HTLV-1-infected patients was greater than in the control group (73%) (p < 0.05). Radiographic features were similar in HTLV-1 carriers and in patients with probable or definite HTLV-1 associated myelopathy. The presence of enthesophytes in the absence of joint space reduction or osteophytes was only observed in HTLV-1-infected individuals (p < 0.001). Magnetic resonance imaging of the ankles of five HTLV-1-infected patients and five controls demonstrated a higher frequency of enthesitis, bursitis and osteitis in the HTLV-1 infected group. CONCLUSION: HTLV-1-associated arthropathy is clinically characterized by symmetrical polyarthralgia and the main radiological finding is the presence of enthesophytes in the absence of osteophytes and joint space narrowing.

Radiographic aspects in individuals infected by human T-lymphotropic virus type 1 (HTLV-1) with joint pain

Abstract Background: Joint pain in the absence or with little synovitis is observed in a large percentage of HTLV-1 infected subjects. As the virus infect CD4 +and CD8 +positive, macrophages and B cells an exaggerated production of pro-inflammatory cytokines is detected in these patients. However, the possible association of HTLV-1 infection with autoimmune diseases has not been documented definitively and the clinical characteristics of HTLV-1 associated arthropathy has not been defined. The objective this study is to describe clinic and radiographic features in HTLV-1-infected individuals with complaints of joint pain. Methods: Cross-sectional study enrolling HTLV-1-infected individuals with chronic joint pain, aged up to 75 years, both genders and seronegative controls with osteoarthritis. All participants underwent conventional radiography of the hips, knees and ankles. Results: Eighty-one HTLV-1 infected patients and 30 subjects with osteoarthritis participated in the study. Polyarticular and symmetrical arthritis prevailed in the HTLV-1 positive group (54%), while oligoarticular and asymmetrical (44%) were more common in controls ( p < 0.05). The frequency of enthesophytes (90%) in HTLV-1-infected patients was greater than in the control group (73%) ( p < 0.05). Radiographic features were similar in HTLV-1 carriers and in patients with probable or definite HTLV-1 associated myelopathy. The presence of enthesophytes in the absence of joint space reduction or osteophytes was only observed in HTLV-1-infected individuals ( p < 0.001). Magnetic resonance imaging of the ankles of five HTLV-1-infected patients and five controls demonstrated a higher frequency of enthesitis, bursitis and osteitis in the HTLV-1 infected group. Conclusion: HTLV-1-associated arthropathy is clinically characterized by symmetrical polyarthralgia and the main radiological finding is the presence of enthesophytes in the absence of osteophytes and joint space narrowing.

[Exercise-induced asthma as perceived by pediatric patients and their parents]. / Asma inducida por ejercicio: Diferencias en la percepciónde síntomas entre pacientes pediátricos y sus padres.

BACKGROUND: Exercise is a frequent trigger of symptoms in asthmatic children and it worsens their quality of life. AIM: To compare the perception about exercise among asthmatic pediatric patients and their parents. MATERIAL AND METHODS: Asthmatic patients with symptoms related to exercise, were tested with an exercise challenge test following the Tal protocol. Before testing, a questionnaire about symptoms triggered by exercise was answered by children and their parents. The data was analyzed with a Kappa correlation test. RESULTS: Seventy five patients, aged 6 to 15 years, were studied. Forty one percent exercised less than one hour per week. Although 64% reported to experience respiratory difficulty and 80% cough during exertion, 87% were willing to perform more exercise. Forty percent of all patients had a positive challenge test for exercise-induced asthma. Correlation between patient's and parent's answers about the effect of physical activity exercise was low, with a kappa of 0.53. There was no correlation between exercise test and the answers to the questionnaire. CONCLUSIONS: Children with asthma frequently have exercise-associated symptoms and parental perception about this problem is very low.

Response to bronchodilator in infants with bronchiolitis can be predicted from wheeze characteristics.

OBJECTIVE: Lung sounds analysis has been used for clinical care. Our objectives were to characterize the spectral pattern of lung sounds and their relation to bronchodilator effects in acute bronchiolitis (AB). We hypothesized that patients with sinusoidal wheezes (SW) would show a more significant bronchodilator response. METHODOLOGY: We studied 22 asleep hospitalized infants (14 boys, eight girls), aged 5.2 +/- 1 months, 16 with a positive respiratory syncytial virus test, during their first 3 days after admission. Patients breathed spontaneously through a face mask connected to a pneumotachograph during normal breathing, and only target flows of 0.1 +/- 0.02 L/s were analyzed. Sounds were obtained using two contact sensors attached over both posterior lower lobes. For inspiratory and expiratory sounds, we determined the frequencies below which 25% (F25), 50% (F50), 75% (F75) and 99% (SEF99) of the spectral power between 100 and 1000 Hz was contained. We repeated the measurements 20 min after bronchodilator therapy in all patients. RESULTS: We found classic SW in 11 patients, while the other 11 had complex wheezes (CW). There were positive bronchodilator responses in 9/11 with SW and 3/11 with CW (P < 0.01). Patients who responded to salbutamol showed an increase in power at low frequencies after medication (P < 0.01), and a positive correlation between wheezing and the increase in the power spectra measured by F50 and SEF99 (P < 0.001). CONCLUSIONS: We conclude that sinusoidal and complex wheezes occur in patients with AB, that a positive response to bronchodilator is significantly more common in those with classic SW and that lung sounds analysis is a reproducible, safe and non-invasive method for assessing wheeze in infants.

[Skin prick test of immediate hypersensitivity in a selected Chilean pediatric population sample]. / Pruebas cutáneas de hipersensibilidad inmediata en una población pediátrica seleccionada.

BACKGROUND: Skin prick test (SPT) of immediate hypersensitivity is a main instrument in the diagnosis of allergy. AIM: To demonstrate the applicability of skin prick test in different age groups. PATIENTS AND METHODS: We studied children and adolescents with the diagnosis of allergy in the Pediatric Respiratory Laboratory of the Catholic University of Chile, from January 2001 to March 2002. The SPT was performed using a standardized technique. The allergens were applied on the volar surface of the forearm in children older than 4 years of age and in younger children it was applied on their back. For study purposes we separated them into three age groups: GI < or =2 years and 11 months, GII from 3 to 4 years and 11 months, GIII > or =5 years. RESULTS: We studied 408 children, aged between 8 months and 15 years. The SPT was applied to all patients with no adverse effects of any kind. There was a positive reaction in 57.7% of children. The reaction was positive in 37% in G1, 39% in GII and 65% in GIII (p <0.001). The predominant allergens for each group were dust mites (Dermatophagoides pteronissinus and farinae). CONCLUSIONS: SPT was useful when used on a selected pediatric population. The frequency of sensitization increased significantly with age. However, more than one third of children between 2 and 4 years of age tested positive to one or more allergen, demonstrating its applicability in this age group.

[Comparison of spirometric reference values in Chilean children]. / Aplicación clínica de los valores de referencia de espirometría realizados en niños Chilenos.

BACKGROUND: The interpretation of lung function tests must be based on reference normal values obtained in the same population. In Chile an expert panel recommended the use of values obtained by, Gutierrez el al locally, that are higher than those obtained by Knudson, for forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1). AIM: To analyze the clinical application of both reference values in a selected population. MATERIAL AND METHODS: Retrospective review of 499 spirometries done in our laboratory to 285 males and 214 females, aged 4.5 to 18 years. The reports using either Gutierrez (G) or Knudson (K) reference values were compared. The 5th percentile was considered the inferior limit for normality. RESULTS: The height range of patients was 110-178 cm (median 130, 3rd quartile 143). Referral diagnoses were probable asthma in 349 (70%), asthma in 119 (24%), to rule out restrictive disease in 12 (2%) and others 19 (4%). FEV1/FVC ratio was > or =84% in 290 patients. Using K values, lung function was interpreteed as within normal limtits in 321 patients (64.3%), as mild obstructive disease (MOD) in 171 (34.3%), as combined limitation (CL) in 2, mild restrictive disease (MRD), moderate restrictive disease (MR) and severe restrictive disease (SRD) in 1 patient each. Using G values, lung function was interpreted as within normal limits in 133 patients (26.7%), MOD in 343 (68.7%), MRD in 6, CL. in 4 and MR in 2. In 193 spirometries (39%) there was lack of concordance between the interpretations using K or G values. CONCLUSIONS: There is a wide rante of variability when G or K values are used to interpret lung function in children in Chile. Redefinition of local standards would be necessary.