Aleksandra Mikov

Vitiligo In Children

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Botulinum toxin type A for the treatment of spasticity in children with cerebral palsy

BACKGROUND/AIM Cerebral palsy (CP) is the most common physical disability in childhood. Children have problems with motor functions as a result of limbs spasticity, which leads to severe contractures and limbs deformity. There is a growing interest in the therapeutic role of botulinum toxin type A (BTA) in CP. The aim of this study was to examine the effects of BTA on spasticity, active range of motion and functional motor outcomes in children with CP. METHODS This study included 42 children of both sexes, aged 2-6 years, with spastic CP, divided into two groups: group I (21 child) treated with BTA and physical therapy, and group II (21 child) treated with physical therapy only. The following parameters were analyzed: spasticity; active range of motion of the hip, knee and ankle, and functional motor outcome. These parameters measurements were carried out four times in both groups: before the treatment, three, eight and 16 weeks after the beginning of the treatment. The obtained results were statistically processed and compared. RESULTS There was no evidence of any significant difference between the groups before the treatment. After eight weeks there was a remarkable difference concerning spasticity reducing on behalf of the group I (group I -- 0.76 +/- 0.51 vs. II group -- 2.17 +/- 0.64; p < 0.0001). There was statistically significant difference concerning active range of motion increasing on behalf of the group I (hip abduction: group I --44.37 +/- 1.13(0) vs. group II -- 32.61 +/- 8.07(0),p < 0,01; knee extension: group I -- 0.77 +/- 1.82(0) vs. II group -- 14.99 +/- 7.61(0), p < 0.01; dorsiflexion of the foot: group I -- 11.50 +/- 6.08(0) vs. group II -- 8.98 +/- 7.85(0), p < 0.01). A statistically significant difference was found after 16 weeks in functional motor outcome as well, on behalf of the group I: functional motor abilities level in the group I was 1.86 vs. 2.71 in the group II, p < 0.05. CONCLUSION Botulinum toxin type A application leads to an important spasticity decreasing, active range of motion increasing, as well as to functional abilities in children with CP.

Assessment of general movements and heart rate variability in prediction of neurodevelopmental outcome in preterm infants

BACKGROUND Adverse neurologic outcome in preterm infants could be associated with abnormal heart rate (HR) characteristics as well as with abnormal general movements (GMs) in the 1st month of life. AIMS To demonstrate to what extent GMs assessment can predict neurological outcome in preterm infants in our clinical setting; and to assess the clinical usefulness of time-domain indices of heart rate variability (HRV) in improving predictive value of poor repertoire (PR) GMs in writhing period. STUDY DESIGN Qualitative assessment of GMs at 1 and 3 months corrected age; 24h electrocardiography (ECG) recordings and analyzing HRV at 1 month corrected age. SUBJECTS Seventy nine premature infants at risk of neurodevelopmental impairments were included prospectively. OUTCOME MEASURES Neurodevelopmental outcome was assessed at the age of 2 years corrected. Children were classified as having normal neurodevelopmental status, minor neurologic dysfunction (MND), or cerebral palsy (CP). RESULTS We found that GMs in writhing period (1 month corrected age) predicted CP at 2 years with sensitivity of 100%, and specificity of 72.1%. Our results demonstrated the excellent predictive value of cramped synchronized (CS) GMs, but not of PR pattern. Analyzing separately a group of infants with PR GMs we found significantly lower values of HRV parameters in infants who later developed CP or MND vs. infants with PR GMs who had normal outcome. CONCLUSIONS The quality of GMs was predictive for neurodevelopmental outcome at 2 years. Prediction of PR GMs was significantly enhanced with analyzing HRV parameters.

Osteosynthesis with Kirschner wires in treatment of unstable supracondylar fractures of the humerus in children

Introduction Elbow fractures account for 7-9% of all fractures in childhood, while the supracondylar type is the most common (up to 70%). 84% of all supracondylar elbow fractures occur under the age of 10 years (most often between the age of 5 and 8). The aim of this study was to present the technique and results of treatment of supracondylar fractures with grade III fragment dislocation in pediatric population. Treatment included orthopedic repositioning and percutaneous pin fixation. Material and methods Over the period 1991-2000, 255 patients were hospitalized due to supracondylar fracture of the humerus with grade III fragment dislocation at the Pediatric Surgery Clinic in Novi Sad. All patients were aged 3-15 years. Orthopedic repositioning and percutaneous pin fixation under X-ray control was performed in 243 patients (95.29%). Results This study included 167 (65.5%) patients with full documentation. Extensor type of fracture was verified in 151 patients (90.42%). Male patients predominated over female patients - 119:48. The average follow-up period was 4,5 months. On the basis of clinical examination, and after completed rehabilitation, satisfactory results were obtained in 158 patients (94.6%), while in 9 patients the final outcome was unsatisfactory. Discussion Literature analysis points to advantages of orthopedic repositioning and percutaneous pin fixation, with certain modifications in the treatment of supracondylar elbow fractures with grade III dislocation. Conclusions Obtained results of treatment, advantages of this procedure, and our experience, suggest that orthopedic repositioning and percutaneous pin fixation is a procedure of choice in treatment of supracondylar elbow fractures with third III dislocation in children.

Probability of breech presentation and its significance

Existing data related to the probability of breech presentation suggest that the breech presentation is a consequence of mere filling of the intrauterine space, with the same probability of breech and cephalic presentation. As a consequence, group of cephalic presenting fetuses is heterogenous. Some fetuses randomly assume the cephalic presentation while others assume cephalic presentation ‘intentionally’ for a reason. Before comparing breech and cephalic presenting fetuses/newborns, bias should be eliminated by subtracting from the cephalic-presenting group the number of fetuses/newborns that is identical with the number of breech-presenting fetuses/newborns with identical characteristics. The subtracted group should be added to the breech-presenting group before comparison with the remaining cephalic-presenting fetuses/newborns. The comparison should be corrected for the gestational age and according to data that are not influenced by delivery. Data suggest that the physiological process that accounts for 92% of cephalic-presenting human fetuses at delivery should be sought from the 25th gestational week onwards.

Effect of Simultaneous Exposure to Benzene and Ethanol on Urinary Phenol Excretion in Mice

Benzene has been widely used as a solvent, but its use is declining in most developed countries because it is a well established human carcinogen. An association between occupational exposure to benzene and health effects such as aplastic anaemia and leukaemia has been reported in studies of workers in various industries. For many solvent uses benzene has been replaced by other less toxic organic solvents and is considered a toxic impurity in other industrial solvents, but it is still used as a starting material in numerous chemical syntheses. In addition to industrial sources, benzene is present in the environment as a component of cigarette smoke and automobile emissions. Benzene induces hematotoxicity as a result of chronic exposure. Acute exposure to benzene causes neurotoxic and hepatotoxic effects. Toxic effects of benzene, chronic as well as acute, are the consequence of the unknown reactive metabolite produced by cytochrome P-450. Benzene is metabolized mainly by ethanol inducible cytochrome P-4502E1 (CYP2E1) in animal and human liver microsomes. Ethanol is consumed worldwide in tremendous amounts and is an effective inducer of hepatic xenobiotic metabolism, especially involving pathways accomplished by the isoform CYP2E1 of cytochrome P-450. Therefore, whenever xenobiotics that are substrates of CYP2E1, such as many organic solvents, are taken in by an individual who is also chronically consuming ethanol, the accelerated metabolism of these agents has to be considered. In contrast to the long-term consumption of ethanol, which induces the hepatic metabolism of xenobiotics, short-term consumption inhibits their metabolism because of direct competition for CYP2E1. Ethanol, when given to a living body, exerts dual effects on the xenobiotic metabolizing enzymes, i.e., inhibition and stimulation. Which one is more predominant over the other depends on the time that has elapsed after ethanol ingestion. In an early period when ethanol exists in the body in high concentrations, it may preferentially act as an inhibitor . In this study, effect of simultaneous exposure to benzene and ethanol on benzene metabolism in mice were investigated by measuring the concentration of phenol, the main metabolite of benzene.

Hypoglycemic effect of herbicide 2,4-dichlorophenoxyacetic acid (2,4-D).

Herbicide 2,4-dichlorophenoxyacetic acid (2,4-D), a synthetic auxin which promotes uncontrolled plant growth is widely used. The aim of our study was to investigate, using an experimental model, the effect of herbicide 2,4-D on liver function tests, enzyme a amylase and glucose blood level. BALB/C mice were treated i.p. with the herbicide (30 mg/ kg 2,4-D) for four consecutive days. Twenty-four hours after the last injection, the treated and the control animals were weighed and sacrificed for biochemical analysis: haematocrit, glucose blood level, serum activities of enzymes alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, and a amylase, as well as liver reduced glutathione. Herbicide 2,4-D significantly decreased glucose blood level in mice. There were no changes in liver function tests or activity of enzyme a amylase. In this study on mice we confirmed the results obtained in the previous study, which showed a hypoglycemic effect of herbicide 2,4-D on agricultural workers. To elucidate the mechanism of this effect, a further research is needed.

Incidence and outcomes of breech presentation at term in newborns with congenital postural deformities.

The increased incidence of congenital postural deformities among newborns with breech presentation may be associated with causes of breech presentation rather than the presentation itself.

Effect of Simultaneous Exposure to Benzene and Ethanol on Urinary Thioether Excretion

Abstract The toxicity of benzene is not an issue of the past, especially in developing countries. Bone marrow toxicity is demonstrated among workers. In this study, the effect of simultaneous exposure to benzene and ethanol on benzene metabolism in mice was investigated by measuring the excretion of thioethers in urine. Urinary thioether excretion significantly decreased in the mice receiving both benzene and ethanol compared with the animals receiving benzene only. The assay of determining thioethers in urine samples in this study is a simple and low-cost method, thus suitable for routine use, especially in developing countries, not only for benzene, but also for other alkilating agents, which can be found during occupational exposure. Our results suggest that further research is needed to elucidate the mechanisms of decreased urinary excretion of thioether after simultaneous exposure to benzene and ethanol.

The role of physical therapy in the treatment of post-traumatic contracture of the elbow in children

Post-traumatic joint contractures are the most common complication of the locomotor apparatus injuries. A 50% reduction of elbow range of motion can decrease the upper extremity function by nearly 80% [1]. Elbow fractures account for 7–9% of all fractures in children, while supracondylar humeral fractures are the most common fractures in the elbow joint region. Most of these fractures are seen in children between 5 and 8 years of age [1, 2].