Selektywna rizotomia grzbietowa w leczeniu spastyczności u pacjentów z mózgowym porażeniem dziecięcym

W artykule przedstawiono możliwości wykorzystania selektywnej rizotomii grzbietowej (SDR, selective dorsal rhizotomy) w leczeniu spastyczności u pacjentów z mózgowym porażeniem dziecięcym (MPD). W tym celu dokonano przeglądu literatury, wykorzystując bazy danych Medline, Embase, PEDro, Cochrane. Użyto słów kluczowych „selektywna rizotomia grzbietowa” (selective dorsal rizhotomy) w połączeniu z „mózgowe porażenie dziecięce” (cerebral palsy). Wyniki wybranych przez autorów badań przedstawiono zgodnie z Międzynarodową Klasyfikacją Funkcjonowania, Niepełnosprawności i Zdrowia (ICF, International Classification of Functioning, Disability and Health), w domenie struktury i funkcji, aktywności oraz uczestnictwa w życiu codziennym. Podsumowano również wskazania do wykonania zabiegu oraz jego najczęstsze efekty uboczne. Metoda SDR jest interwencją operacyjną, której poziom skuteczności pozwala na jej rekomendację w leczeniu spastyczności. Zabieg SDR pozytywnie wpływa na wszystkie domeny życia pacjentów z MPD opisane w klasyfikacji ICF

Normative Values for Heart Rate Variability Parameters in School-Aged Children: Simple Approach Considering Differences in Average Heart Rate

Background: Heart rate variability (HRV) analysis is a clinical tool frequently used to characterize cardiac autonomic status. The aim of this study was to establish normative values for short-term HRV parameters by considering their main determinants in school-aged children.Methods: Five-minute electrocardiograms were taken from 312 non-athlete children (153 boys) at age of 6 to 13 years for computation of conventional time- and frequency-domain HRV parameters. Heart rate (HR), respiratory rate, age, body mass index, and sex were considered as their potential determinants. Multiple regression analysis revealed that HR was the principal predictor of all standard HRV indices. To develop their universal normative limits, standard HRV parameters were corrected for prevailing HR.Results: The HRV correction for HR yielded the parameters which became independent on both sex and HR, and only poorly dependent on age (with small effect size). Normal ranges were calculated for both time- and frequency-domain indices (the latter computed with either fast Fourier transform and autoregressive method). To facilitate recalculation of standard HRV parameters into corrected ones, a calculator was created and attached as a Supplementary Material that can be downloaded and used for both research and clinical purposes.Conclusion: This study provides HRV normative values for school-aged children which have been developed independently of their major determinants. The calculator accessible in the Supplementary Material can considerably simplify determination if HRV parameters accommodate within normal limits

Electrocardiograms in school-aged healthy Polish children — an observational study

Background: Electrocardiographic (ECG) examination has long been used to assess cardiovascular function in clinical practice. Age-related ECG changes are observed as the cardiovascular system matures from the neonatal period to adolescence.  Aim: This study aimed to evaluate the effects of sex and age on ECG parameters in healthy schoolchildren. Methods: The study included 336 healthy participants aged 5–12 years from Masovian voivodeship. Children were divided into age groups of 5–8 and 9–12 years. Values for heart rate (HR), time intervals and amplitudes of P and QRS waves, and QRS axis for pediatric ECGs were estimated. Results: Significant differences between boys and girls aged 5–8 years old were discovered for such parameters as PR interval, R-wave, and S-wave, R/S ratio. Age-related decline in HR, Q-wave in V5, and V6, R-wave in V1–V4, and increase in QRS duration were noted. Girls presented higher HR and shorter QRS than boys. HR, QRS axis, P wave amplitude in the II lead, and amplitude of R and S in the precordial leads were different in our population than previously reported. Conclusions: Pediatric ECG tracings were estimated for the first time for school-aged Polish healthy children. Sex-related differences in selected ECG parameters in the younger age group were noticed. Several parameters differed from those previously reported in other ethnic populations. These findings are clinically significant and suggest that diagnostic criteria for pediatric ECG should be revised to establish if they are justifiable for the entire population

Ocena poziomu aktywności fizycznej osób zatrudnionych w sektorze IT podczas pandemii COVID-19

Introduction. Assessing the physical activity of IT workers during the COVID-19 pandemic can help to discern its hypothetical relationship with gender, the form of work, or other factors.Material and methods. The study lasted from July 29, 2021 to September 14, 2021. For the assessment, a questionnaire was conducted based on the IPAQ-SF (International Physical Activity Questionnaire — Short Form) and original questions about the impact of the COVID-19 pandemic on lifestyle, including physical activity assessed on the scale –3/0/3. 363 employees of the IT sector (63 women, 300 men; average age: 29; average BMI 26.17) met the conditions for inclusion in the study.Results. In total, 26.17% were in the insufficient group, 54% in the sufficient group and 19.83% in the high physical activity group. Overall, 51.24% estimated that the pandemic had a negative effect on their physical activity, 31.40% had no effect, and 17.36% had a positive impact.Conclusions. IT sector employees are mostly characterized by low physical activity. Therefore, they meet the WHO guidelines for the amount of physical activity with a positive effect on health. There are no interactions in mentioned population between undertaking various types and intensities of physical activity and gender, working shifts and working methods. In future research on physical activity, it is worth considering other factors that may be behind it.Wstęp. Ocena aktywności fizycznej pracowników sektora IT podczas pandemii COVID-19 może pomóc dostrzec jej hipotetyczny związek z płcią, formą pracy czy innymi czynnikami. Materiał i metody. Badanie trwało od 29 lipca 2021 do 14 września 2021. W celu dokonania oceny przeprowadzono ankietę opartą o IPAQ-SF (International Physical Activity Questionnaire — Short Form) oraz autorskie pytania dotyczące wpływu pandemii COVID-19 na styl życia, w tym aktywność fizyczną ocenianą w skali –3/0/3.Warunki włączenia do badania spełniło 363 pracowników sektora IT (63 kobiety, 300 mężczyzn, średni wiek: 29 lat, średni wskaźnik masy ciała: 26,17 kg/m2). Wyniki. Łącznie 26,17% badanych znajdowało się w grupie niewystarczającej, 54% w grupie dostatecznej i 19,83% w grupie wysokiej aktywności fizycznej. Oszacowano, że pandemia miała negatywny wpływ na aktywność fizyczną wśród 51,24% badanych, brak wpływu — 31,40%, a pozytywny wpływ u 17,36%. Wnioski. Wśród badanych pracowników sektora IT, większość wykazywała niską aktywność fizyczną. W związku z tym spełniają oni warunki wytycznych Światowej Organizacji Zdrowia dotyczące podejmowanej aktywności fizycznej o pozytywnym wpływie na zdrowie. Wśród tej populacji nie dostrzeżono powiązania między podejmowaniem aktywności fizycznej różnego rodzaju i o różnej intensywności a płcią, formą pracy ani zmianą, podczas której się pracuje. W kolejnych badaniach dotyczących aktywności fizycznej warto rozważyć wzięcie pod uwagę innych czynników, które mogą to determinować

Subclinical left ventricular systolic dysfunction in patients with naive acromegaly — assessment with two-dimensional speckle-tracking echocardiography: retrospective study

Introduction: The aim of the study was to evaluate global longitudinal strain (GLS) in patients with naive acromegaly with normal left ventricular (LV) ejection fraction (EF). Material and methods: Forty-three consecutive patients with naive acromegaly with normal LV systolic function as measured by EF, examined from 2008 to 2016, and 52 patients of a control group matched for age and sex underwent two-dimensional speckle-tracking echocardiography to assess GLS. Results: The median GLS was significantly lower in the acromegaly group than in the control group (in %, –16.6 vs. –20.7; p < 0.01). The majority of acromegalic patients (n = 26; 60.5%) had abnormal GLS. Patients with impairment in GLS had a longer median duration of acromegaly symptoms (in years, 10.0 vs. 5.0; p < 0.05) and greater LV thickness (posterior wall in mm, 12.5 vs. 12.0; p < 0.05) compared to those with normal GLS. Patients with abnormal GLS had higher IGF-1 concentration, but without statistical significance. Diabetes mellitus and arterial hypertension, which are more common in acromegaly, were not significant determinants of abnormal GLS. The mean left ventricular mass index (LVMI) was increased in the acromegaly group compared to controls (in g/m2, 136 vs. 97; p < 0.01). There wasa significant negative correlation between LVMI and GLS (R = –0.47; p < 0.01). Conclusions: Naive acromegalic patients presented abnormal GLS, which indicates subclinical systolic dysfunction in these patients. It has not been proven that arterial hypertension and diabetes mellitus are significant determinants of abnormal GLS

Validity of the Pneumonitor for RR intervals acquisition for short-term heart rate variability analysis extended with respiratory data in pediatric cardiac patients

BACKGROUND: Breathing pattern alterations change the variability and the spectral content of the RR intervals (RRi) from electrocardiogram (ECG). However, actually there is no solution on how to record and control participant’s breathing without influencing its natural rate and depth in heart rate variability (HRV) studies. AIM: The aim of the study was to assess the validity of the Pneumonitor for acquisition of short-term (5 min) RRi in comparison to the reference ECG method for analysis of heart rate (HR) and HRV parameters in the group of pediatric patients with cardiac disease. METHODS: Nineteen patients of both sexes participated in the study. ECG and Pneumonitor were used to record RRi from 5 min static rest conditions, the latter also to measure the relative tidal volume and respiratory rate. The validation comprised the Student’s t-test, Bland-Altman analysis, Intraclass Correlation Coefficient and Lin’s concordance correlation. The possible impact of the respiratory activity on the agreement between ECG and Pneumonitor was also assessed. RESULTS: Acceptable agreement for number of RRi, mean RR, HR and HRV measures calculated based on RRi acquired using ECG and Pneumonitor was presented. There was no association between breathing pattern and RRi agreement between devices. CONCLUSIONS: Pneumonitor might be considered appropriate for cardiorespiratory studies in the group of pediatric cardiac patients in rest condition

Daily sunshine hours as determinant of 25-hydroxyvitamin D concentration among diabetic cardiac patients who experienced myocardial infarction hospitalized due to acute coronary syndrome: a cross-sectional study

Wstęp. Niedobór witaminy D jest problemem ogólnoświatowym o różnych konsekwencjach zdrowotnych. Witamina D może obniżać ryzyko niewydolności serca, jednak dowody świadczące o skuteczności suplementacji witaminą D na utrzymanie zdrowia układu sercowo-naczyniowego są sprzeczne z powodu braku odpowiedniej liczby i jakości badań klinicznych. Przyczyny braku jednoznacznych efektów potwierdzających pozytywny wpływ suplementacji witaminy D mogą być co najmniej trzy: 1) suplementacja zbyt małą ilością witaminy D lub 2) brak włączenia do badania tylko populacji z ciężkim niedoborem witaminy D, lub 3) czas trwania suplementacji. Celem pracy była charakterystyka grupy pacjentów kardiologicznych, u których stwierdzono w poprzednich badaniach najniższe stężenia 25-hydroksywitaminy D [25(OH)D].Materiał i metody. Analizie poddano wyniki 92 chorych kardiologicznych z cukrzycą w wieku 41–89 lat, którzy przeżyli zawał serca z istotnymi zmianami w tętnicach wieńcowych, hospitalizowanych z powodu ostrego zespołu wieńcowego, mieszkających w Warszawie.Wyniki. Mediana stężenia 25(OH)D w badanej populacji wyniosła 11 ng/ml (zakres: 4–28 ng/ml). Jedynym istotnym determinantem stężenia 25(OH)D był okres badania; stężenie było wyższe latem niż zimą.Wnioski. Leczenie witaminą D u polskich pacjentów kardiologicznych w celu osiągnięcia optymalnego stężenia, tj. 30 ng/ml (75 nmol/l), wydaje się konieczne i powinno być jak najszybciej wdrożone.Introduction. Vitamin D deficiency is a worldwide problem with a variety of health consequences. Vitamin D may reduce the risk of heart failure, however, evidence of the impact of vitamin D treatment on maintenance of cardiovascular health (i.e., preventing cardiovascular diseases) is conflicting due to lack of support from clinical trials. The reason for the failure of clinical trials to confirm an effect of vitamin D supplementation could be at least threefold: 1) too little vitamin D given to the participants or 2) lack of inclusion of only severely vitamin D-deficient populations or 3) study duration. The aim of this study was to characterize a group of cardiac patients who presented the lowest concentrations of 25-hydroxyvitamin D [25(OH)D]. Material and methods. Results of 92 diabetic cardiac patients aged between 41 and 89 years who experienced myocardial infarction, with significant coronary arteries changes, hospitalized due to acute coronary syndrome living in Warsaw were analyzed. Results. Patients presented median 25(OH)D concentration value of 11 ng/mL (range: 4–28 ng/mL). The only significant determinant of 25(OH)D concentration was the date of examination, with higher concentrations in summer than in winter. Conclusions. Vitamin D treatment in Polish cardiac patients aimed at reaching the optimal level of 30 ng/mL (75 nmol/L) seems to be necessary and implemented as soon as possible

COVID-19 and athletes: Endurance sport and activity resilience study—CAESAR study

Background: The COVID-19 pandemic and imposed restrictions influenced athletic societies, although current knowledge about mild COVID-19 consequences on cardiopulmonary and physiologic parameters remains inconclusive. This study aimed to assess the impact of mild COVID-19 inflection on cardiopulmonary exercise test (CPET) performance among endurance athletes (EA) with varied fitness level.Materials and Methods: 49 EA (nmale = 43, nfemale = 6, mean age = 39.94 ± 7.80 yr, height = 178.45 cm, weight = 76.62 kg; BMI = 24.03 kgm−2) underwent double treadmill or cycle ergometer CPET and body analysis (BA) pre- and post-mild COVID-19 infection. Mild infection was defined as: (1) without hospitalization and (2) without prolonged health complications lasting for >14 days. Speed, power, heart rate (HR), oxygen uptake (VO2), pulmonary ventilation, blood lactate concentration (at the anaerobic threshold (AT)), respiratory compensation point (RCP), and maximum exertion were measured before and after COVID-19 infection. Pearson’s and Spearman’s r correlation coefficients and Student t-test were applied to assess relationship between physiologic or exercise variables and time.Results: The anthropometric measurements did not differ significantly before and after COVID-19. There was a significant reduction in VO2 at the AT and RCP (both p < 0.001). Pre-COVID-19 VO2 was 34.97 ± 6.43 ml kg·min−1, 43.88 ± 7.31 ml kg·min−1 and 47.81 ± 7.81 ml kg·min−1 respectively for AT, RCP and maximal and post-COVID-19 VO2 was 32.35 ± 5.93 ml kg·min−1, 40.49 ± 6.63 ml kg·min−1 and 44.97 ± 7.00 ml kg·min−1 respectively for AT, RCP and maximal. Differences of HR at AT (p < 0.001) and RCP (p < 0.001) was observed. The HR before infection was 145.08 ± 10.82 bpm for AT and 168.78 ± 9.01 bpm for RCP and HR after infection was 141.12 ± 9.99 bpm for AT and 165.14 ± 9.74 bpm for RCP. Time-adjusted measures showed significance for body fat (r = 0.46, p < 0.001), fat mass (r = 0.33, p = 0.020), cycling power at the AT (r = −0.29, p = 0.045), and HR at RCP (r = −0.30, p = 0.036).Conclusion: A mild COVID-19 infection resulted in a decrease in EA’s CPET performance. The most significant changes were observed for VO2 and HR. Medical Professionals and Training Specialists should be aware of the consequences of a mild COVID-19 infection in order to recommend optimal therapeutic methods and properly adjust the intensity of training

Heart Rate Variability in Individuals with Down Syndrome: A Scoping Review with Methodological Considerations

Individuals with Down syndrome (DS) present similar heart rate variability (HRV) parameters at rest but different responses to selected movement maneuvers in comparison to individuals without DS, which indicates reduced vagal regulation. The present study undertakes a scoping review of research on HRV in individuals with DS, with special attention paid to the compliance of the studies with standards and methodological paper guidelines for HRV assessment and interpretation. A review was performed using PubMed, Web of Science and CINAHL databases to search for English language publications from 1996 to 2020 with the MESH terms “heart rate variability” and “down syndrome”, with the additional inclusion criteria of including only human participants and empirical investigations. From 74 studies, 15 were included in the review. None of the reviewed studies met the recommendations laid out by the standards and guidelines for providing the acquisition of RR intervals and necessary details on HRV analysis. Since authors publishing papers on this research topic do not adhere to the prescribed standards and guidelines when constructing the methodology, results of the research papers on the topic are not directly comparable. Authors need to design the study methodology more robustly by following the aforementioned standards, guidelines and recommendations

Music therapy as a method supporting rehabilitation of patients with cerebral palsy - review

Mózgowe porażenie dziecięce (MPD) to jedno z najczęściej występujących zaburzeń rozwijającego się układu nerwowego, powodujących w konsekwencji nieprawidłowości w rozwoju ruchu i postawy towarzyszące pacjentom przez całe życie. Dysfunkcjom w obrębie narządu ruchu towarzyszą często różnego rodzaju zaburzenia dodatkowe takie jak m.in.: zaburzenia czucia, padaczka oraz wtórne problemy układu mięśniowo- szkieletowego. Proces rehabilitacji pacjentów z MPD powinien być wielowymiarowy, włączać specjalistów z wielu dziedzin medycyny. Istnieje wiele alternatywnych, wspomagających metod rehabilitacji stosowanych wśród pacjentów z MPD. Jedną z nich jest muzykoterapia, obejmująca szeroko pojęte działanie muzyki wpływające na stan zdrowia i jakość życia pacjentów. W niniejszej pracy przedstawiono przegląd wyselekcjonowanego piśmiennictwa dotyczącego zastosowania muzykoterapii w rehabilitacji pacjentów z MPD. Materiał i metody: Przeszukano bazy danych PubMed oraz Google Scholar używając słów kluczowych: „mózgowe porażenie dziecięce” w połączeniu ze słowami „muzykoterapia” oraz/lub „muzyka”. Zgodnie z ustalonymi kryteriami, wstępnie zidentyfikowano 28 publikacji, wyniki siedmiu prac spełniających kryteria włączenia zostały poddane szczegółowej analizie i interpretacji. Wyniki: Muzykoterapia ma różnorodny wpływ na stan pacjentów z MPD, tj. może pozytywnie wpływać na naukę chodu, kontrolę tułowia oraz kończyn, a także czucie wibracji w przypadku terapeutycznego grania na instrumentach muzycznych oraz zmniejszenie liczby napadów padaczkowych wśród pacjentów, u których objawem towarzyszącym była padaczka. Wnioski: W zależności od stosowanej techniki muzykoterapii, jej działanie może wspomagać rehabilitację pacjentów z MPD. Dzięki szerokiemu zakresowi interwencji, może być metodą wspomagającą podstawowe metody rehabilitacji pacjentów z MPD.Cerebral Palsy (CP) is one of the most common permanent disorders of the developing nervous system leading to the movement and posture anomalies. The motor disorders are often accompanied by different neurodevelopmental impairments such as disturbances of sensation, epilepsy or secondary musculoskeletal problems. The process of rehabilitation in CP should be multidimensional and guided by specialists from different fields of medicine, including many alternative and unconventional methods of therapy. Music therapy (MT) is one of the methods that applies a wide range of music to enhance health and the quality of patient’s life. This article presents a review of the literature concerning the use of music therapy for rehabilitation in CP. The study aimed to present MT as an approach to rehabilitation in CP and evaluate its safety and efficacy. Material and methods: The medical databases PubMed and Google Scholar were searched with keywords: “cerebral palsy” in combination with “music” and “music therapy”. Initially, 28 identified publications had been selected for the analysis from which 7 met the inclusion criteria and were analyzed in details. Results: Music therapy has a varied impact on CP patients health status, such as positive influence on gait performance, trunk and extremities control, vibratory perception as the result of playing the musical instrument therapeutically and reduction in the total number of seizures in patients with epilepsy. Conclusions: Depending on which MT technique was used in the process of rehabilitation in patients with CP, it may have a positive impact on their health status and quality of life. Owing to the wide range of MT interventions it could be beneficial for the rehabilitation of patients with CP