ABSTRACT
OBJECTIVE: To correlate ultrasound characteristics of spastic muscles with clinical and functional measurements in chronic stroke survivors. METHODS: Ultrasound assessment and clinical and functional assessments were performed in 28 ambulatory stroke survivors (12 females, mean age 57.8 ± 11.8 years, 76 ± 45 months after stroke). RESULTS: Muscle thickness in the affected side was decreased compared with the contralateral side (p < 0.001). The decrease was more evident in the upper limb muscles. On the affected side, the modified Heckmatt scale score was lowest (closer to normal) in the rectus femoris (RF) muscle compared with other muscles (biceps brachii (BB), flexor carpi ulnaris (FCU) and medial gastrocnemius (MG)). Muscle thickness and echogenicity of spastic muscles did not correlate with spasticity, as measured with the modified Ashworth scale (MAS), Fugl-Meyer motor assessment scores, age, or time since stroke. There was a significant negative correlation between grip strength and percentage decrease in muscle thickness for the spastic FCU muscle (r = -0.49, p = 0.008). RF muscle thickness correlated with ambulatory function (Timed Up and Go test (r = 0.44, p = 0.021) and 6-metre walk test (r = 0.41, p = 0.032)). There was no significant correlation between echogenicity and functional assessments Conclusion: Ambulatory chronic stroke survivors had function-dependent changes in muscle thickness on the affected side. Muscle thickness and echogenicity of spastic muscles did not correlate with spasticity, Fugl-Meyer motor assessment scores, age, or time since stroke.
Subject(s)
Stroke Rehabilitation , Stroke , Female , Humans , Middle Aged , Aged , Muscle Spasticity/diagnostic imaging , Muscle Spasticity/etiology , Postural Balance , Time and Motion Studies , Stroke/diagnostic imaging , Muscle, Skeletal/diagnostic imaging , Ultrasonography , SurvivorsABSTRACT
The use of metals as biosignatures in the fossil stromatolite record requires understanding of the processes controlling the initial metal(loid) incorporation and diagenetic preservation in living microbialites. Here, we report the distribution of metals and the organic fraction within the lithifying microbialite of the hypersaline Big Pond Lake (Bahamas). Using synchrotron-based X-ray microfluorescence, confocal, and biphoton microscopies at different scales (cm-µm) in combination with traditional geochemical analyses, we show that the initial cation sorption at the surface of an active microbialite is governed by passive binding to the organic matrix, resulting in a homogeneous metal distribution. During early diagenesis, the metabolic activity in deeper microbialite layers slows down and the distribution of the metals becomes progressively heterogeneous, resulting from remobilization and concentration as metal(loid)-enriched sulfides, which are aligned with the lamination of the microbialite. In addition, we were able to identify globules containing significant Mn, Cu, Zn, and As enrichments potentially produced through microbial activity. The similarity of the metal(loid) distributions observed in the Big Pond microbialite to those observed in the Archean stromatolites of Tumbiana provides the foundation for a conceptual model of the evolution of the metal distribution through initial growth, early diagenesis, and fossilization of a microbialite, with a potential application to the fossil record.
Subject(s)
Environmental Microbiology , Fossils , Metals/analysis , Microbiota , Salinity , Bahamas , Chemistry Techniques, AnalyticalABSTRACT
OBJECTIVE: The proportion of the Latin American population aged >60 years is expected to double during the next few decades. Metabolic syndrome (MetS) is associated with high morbidity and mortality worldwide. However, little is known about MetS in Latin America in general, and in Ecuador in particular. The present study aimed to examine the prevalence of MetS and its association with blood micronutrient, homocysteine (Hcy) and C-reactive protein (CRP) concentrations in the elderly living in a low-income urban area. DESIGN: We performed a cross-sectional study. MetS, using the International Diabetes Federation definition, dietary intake and plasma micronutrient, CRP and Hcy concentrations were assessed. SUBJECTS: A total of 352 elderly (≥65 years) Ecuadorians. SETTING: Quito, Ecuador. RESULTS: MetS was prevalent (40%)--considerably more so among women (81%) than men (19%; χ² = 32·6, P < 0·0001). Further, 53 % of those without MetS exhibited two or more of its components. Micronutrient deficiencies were prevalent, including those of vitamin C, zinc, vitamin B12 and folate. Vitamin C and E concentrations were inversely (OR = 0·78, 95% CI 0·71, 0·86; OR = 0·16, 95% CI 0·03, 0·81, respectively) and CRP (OR = 1·79, 95 % CI 1·04, 3·06) was positively associated with MetS. CONCLUSIONS: The coexistence of MetS with micronutrient deficiencies suggests that elderly Ecuadorians suffer from the double burden of diseases that are increasingly being observed in less developed countries. More research is needed to determine the causal factors, but results presented suggest that these older adults would benefit from interventions to reduce the risk factors for MetS, in particular higher consumption of micronutrient-rich foods.
Subject(s)
C-Reactive Protein/metabolism , Homocysteine/blood , Metabolic Syndrome/blood , Metabolic Syndrome/epidemiology , Micronutrients/blood , Aged , Cross-Sectional Studies , Ecuador/epidemiology , Female , Humans , Male , Micronutrients/deficiency , Sex FactorsABSTRACT
The proportion of the Latin American population above age 65 y is expected to rise substantially. To better define the prevalence of infectious diseases and micronutrient deficiencies, assess immunological status, and evaluate associations between nutritional status and infection, we performed a cross-sectional study of elderly Ecuadorians in a low-income peri-urban community in Quito, Ecuador. Culturally adapted questionnaires, delayed type hypersensitivity (DTH) skin response, micronutrient, and immunological assays were performed in randomly selected Ecuadorians aged > or = 65 y. Multiple linear and logistic regression models were developed to assess relationships between micronutrient concentrations and history of infection, DTH, and immune function. Participants (n = 352; mean age +/- SD, 74.4 +/- 6.4 y) recalled recent episodes of colds/influenza-like syndromes (62.8%), cough (61.0%), urinary tract infection (37.9%), diarrhea (32.2%), fever (24.1%), and pneumonia (3.5%). A prospective substudy of respiratory infections (RI) in 203 elderly revealed similar findings. Colds and pneumonia occurred in 42.8 and 7.9% of participants, respectively, during 737 person-weeks of observation (3.6 +/- 1.1 wk per person). Anemia and micronutrient deficiencies, especially for vitamins C, D, B-6, and B-12 and folic acid and zinc, were common. Plasma vitamin C was associated with interferon-gamma (IFNgamma) (P < 0.01) and zinc with IFNgamma and interleukin-2 (each P < 0.0001). RI history was associated with any micronutrient deficiency (P < 0.001). The burden of infectious diseases, micronutrient deficiencies, and anemia was substantial in this elderly Ecuadorian population. Deficiencies of essential vitamins and minerals place these elderly adults at risk for infections through their negative impact on immune function.
Subject(s)
Micronutrients/deficiency , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/immunology , Aged , Aged, 80 and over , Cross-Sectional Studies , Data Collection , Diarrhea/complications , Ecuador , Female , Humans , Hypersensitivity, Delayed/epidemiology , Hypersensitivity, Delayed/immunology , Immunity, Innate , Logistic Models , Male , Malnutrition , Micronutrients/blood , Odds Ratio , Respiratory Tract Infections/complications , Skin Tests , Surveys and QuestionnairesABSTRACT
BACKGROUND: Actinomycetoma is a chronic occupational condition that occurs frequently in tropical regions. In Mexico 85% of cases are caused by Nocardia brasiliensis. There are two treatments of choice for these cases: a regimen of dapsone plus trimethoprim-sulfamethoxazole (co-trimoxazole) and, recently, amikacin, either alone or combined. However, not all cases respond properly to these therapies. OBJECTIVES: To report a retrospective, 11-year study of cases of actinomycetomas caused by Nocardia spp., treated with amoxicillin-clavulanate (co-amoxiclav). METHODS: All cases were identified clinically and microbiologically and had previously failed standard therapies. Oral co-amoxiclav 875/125 mg was administered every 12 h. Clinical, microbiological and laboratory follow up was performed every 2 months during the treatment period. RESULTS: Twenty-one cases of actinomycetoma were included, 19 caused by N. brasiliensis and one each by N. asteroides and N. otitidiscaviarum. Clinical and microbiological cure occurred in 15 of 21 cases (71%); two cases improved (10%) and four failed (19%). Mean treatment period was 9.6 months, during which neither side-effects nor laboratory test alterations were reported. CONCLUSIONS: Treatment with co-amoxiclav represents an alternative or rescue treatment for cases that have previously failed standard therapies.
Subject(s)
Amikacin/therapeutic use , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Anti-Bacterial Agents/therapeutic use , Dapsone/therapeutic use , Nocardia Infections/drug therapy , Skin Diseases, Bacterial/drug therapy , Adult , Aged , Drug Therapy, Combination , Follow-Up Studies , Humans , Male , Mexico , Middle Aged , Retrospective Studies , Skin Diseases, Bacterial/microbiology , Treatment OutcomeABSTRACT
OBJECTIVES: Testicular microlithiasis (TM) occurs with benign as well as with pathological conditions, such as testicular cancer. Since Down syndrome (DS) may be associated with increased frequency of testicular cancer, we determined the prevalence of TM in DS in patients from a DS clinic and evaluated the prevalence by age group. STUDY DESIGN: We compared results of research scrotal ultrasounds obtained from 1998 to 2001 from 92 Latino patients with DS (ages newborn to 29.7 years) and clinical ultrasounds obtained from 1998 to 2004 from 200 Latino patients without DS (ages newborn to 18.3 years). We also reviewed the medical records. RESULTS: The prevalence of TM in DS was 29%, significantly higher than the 7% found in patients without DS (P < .0001). Twenty of the 27 patients with DS and TM had no testicular pathology clinically or by history. The TM prevalence in the entire group of patients with and without DS increased with advancing age. CONCLUSIONS: We found a significantly increased prevalence of TM in DS. The clinical significance of TM needs to be investigated further.
Subject(s)
Down Syndrome/epidemiology , Lithiasis/epidemiology , Testicular Diseases/epidemiology , Adolescent , Adult , Biopsy , Child , Child, Preschool , Follow-Up Studies , Humans , Infant , Infant, Newborn , Lithiasis/diagnosis , Male , Prevalence , Prospective Studies , Scrotum/diagnostic imaging , Seminiferous Tubules/pathology , Testicular Diseases/diagnosis , UltrasonographyABSTRACT
This is a study of 51 cases of chromoblastomycosis detected in a 17-year period, all of which were clinically and mycologically proven by direct examinations, cultures and biopsies. The therapeutic results of the various treatments used are reported. Most cases were males (36 of 51; 70%), the mean age was 35 years and farmers predominated (74%); the most frequent lesions were in the lower limbs (54%). Major clinical presentations were nodular (41%) and verrucous (26%). The principal aetiologic agent isolated was Fonsecaea pedrosoi (90%). Overall results of the various treatments were as follows: 31% were cured, 57% improved and 12% failed. The best results were obtained with cryosurgery for small lesions, with itraconazole for large ones, and in some cases the combination of both treatments.
Subject(s)
Antifungal Agents , Chromoblastomycosis , Dermatomycoses , Adolescent , Adult , Aged , Aged, 80 and over , Antifungal Agents/therapeutic use , Child , Chromoblastomycosis/drug therapy , Chromoblastomycosis/epidemiology , Chromoblastomycosis/microbiology , Chromoblastomycosis/pathology , Cryosurgery , Dermatomycoses/drug therapy , Dermatomycoses/epidemiology , Dermatomycoses/microbiology , Dermatomycoses/pathology , Female , Fungi/isolation & purification , Humans , Male , Phialophora/isolation & purification , Retrospective StudiesABSTRACT
BACKGROUND: Chromoblastomycosis is a subcutaneous mycosis, seen frequently in tropical areas, and caused by dematiaceous fungi. It produces nodulo-verrucous lesions in the arms and legs. There is no treatment of choice for this disease and sometimes a combination of chemotherapy and physical therapy is necessary. METHODS: The study included 12 patients diagnosed with chromoblastomycosis by means of fungal and histopathologic tests. The patients were assigned to three treatment groups: patients with small lesions, not greater than 15 cm2 in area, were assigned to Group 1, in which the treatment consisted of itraconazole 300 mg/day, or to Group 2, in which the treatment consisted of one or more sessions of open-spray cryosurgery. Patients with large lesions were assigned to Group 3 and started treatment with itraconazole 300 mg/day, until a maximal reduction of lesions occurred, and then underwent one or several cryosurgery sessions. Clinical, fungal, and laboratory tests were performed in each group before, during, and at the completion of treatment. RESULTS: Positive cultures of Fonsecaea pedrosoi were obtained in 11 out of 12 patients. Two out of four patients in Groups 1 and 3 had a clinical and fungal cure and the remaining patients experienced significant improvement. All four patients included in Group 2 achieved a cure. No important side-effects were seen among the patients included in any of the two itraconazole groups, and only two out of eight patients reported gastric discomfort. The cryosurgery group reported only normal complications of the process, such as edema and pain; two out of eight patients had a superimposed infection. CONCLUSIONS: The results of itraconazole and cryosurgery were good in cases with small lesions; antifungal therapy being more appropriate for flexion areas. The combination of itraconazole, to reduce the size of the lesions, with subsequent treatment of the remaining lesions with cryosurgery, represents a new alternative in the treatment of patients with large lesions. Both types of therapy are considered safe, with few side-effects.
Subject(s)
Antifungal Agents/therapeutic use , Chromoblastomycosis/therapy , Cryosurgery/methods , Itraconazole/therapeutic use , Mitosporic Fungi/isolation & purification , Administration, Oral , Adult , Aged , Antifungal Agents/administration & dosage , Chromoblastomycosis/diagnosis , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Itraconazole/administration & dosage , Male , Middle Aged , Treatment OutcomeABSTRACT
Fifty (13 men and 37 women) consecutive patients, attending the Dermatology. Department of the General Hospital of Mexico, with mycologically proven onychomycosis of the finger and toenails were included in an open clinical trial. These patients received a pulse regimen of itraconazole (200 mg twice daily) given after meals during the first week of each month, for 3 consecutive months. After the last dose, the drug was discontinued, and patients were followed-up for 9 months. Initially, the patients underwent a clinical and fungal evaluation. The study included those with positive potassium hydroxide (KOH) preparation and mycologic cultures, who had not been treated either with a systemic antifungal agent for a period of 3 months prior to the study or with a topical agent for a 1-month period prior to the study. Complete blood count and liver test functions that included transaminase, total bilirubin, alkaline phosphatase, and lactic dehydrogenase were carried out at the beginning of the study, after the first half of the study (second pulse), and 2 weeks after completion of treatment. Exclusion criteria were pregnant or lactating women, patients receiving antimycotic treatment during the 3 previous months or patients under treatment for gastric hyperacidity. Three mycologic examinations were carried out: before starting treatment in order to identify the fungal species; after the third pulse; and 3, 6, and 9 months after the last drug administration. The effectiveness of the drug was evaluated based on Zaias' method to estimate the reduction of the affected area. A 400 mg/day dose of oral itraconazole was administered in two takes: 200 mg after breakfast and 200 mg after dinner for 1 week (first pulse). The drug was discontinued for a 3-week period and this regimen was applied twice. This meant that only three treatment periods or pulses were carried out. Follow-up visits were scheduled at 6 months after completion of treatment for handnails and 9 months for toenails. At the end of the study, a correlation between clinical-mycologic outcome and liver function tests were carried out to assess the effectiveness and safety of the proposed treatment regimen.