Vesna D. Živković, Ivona Stanković, Lidija Dimitrijević, Hristina Čolović, Marija Spalević and Nataša Savić
Congenital brachial palsy (CBP) can have long-term consequences such as deformities, contractures and growth imbalance of the affected arm and shoulder girdle that can lead to severe handicap. The aim of the paper was to determine the effectiveness of early habilitation in infants with CBP. This retrospective clinical study included 34 infants who were habilitated in the Physical Medicine and Rehabilitation Clinic, Clinical Center Niš, during the period from 2000 to 2017. The protocol consisted of passive and active-assisted range of motion exercises for the affected arm, neurodevelopmental treatment, warm packs and electrotherapy, starting from the 3rd week of life. At the Clinic, 20 sessions were conducted and parents were educated with handling and home exercise program. The infants were re-evaluated each month during the first year of life. The modification of the manual muscle test (MMT) was used to assess the muscle strength (grades 0- 3). At 6 and 12 months of age, the outcome was defined as a full recovery (grade 3 of the affected muscles) and partial recovery (grades 1-2). Male sex predominated (56%). The right arm was more commonly affected (65%). Birth weight was over 4000g in 65% of infants. Fifty-nine percent of infants had upper, 26.5% "extended" and 14.5% had complete root palsy. Associated injuries were noted in 10 infants. The habilitation started in the first month of life in 64.7% of infants. At 6 months of age, full recovery was achieved only in one infant, while at 12 months, 56% of infants were fully recovered (p < 0.05). The majority of fully recovered infants was from the group with the upper type of lesion (p < 0.05). Early habilitation program is effective in infants with CBP. It is especially effective in the upper root palsy.
Lidija Savic, Igor Mrdovic, Milika Asanin, Sanja Stankovic, Gordana Krljanac and Ratko Lasica
Background: A significant proportion of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (MVD), and they are at high risk for recurrent cardiac events. The aim of the present study was to analyze the impact of MVD on long-term cardiovascular mortality in STEMI patients treated with primary percutaneous coronary intervention (pPCI). Method: This study included 3,115 consecutive STEMI patients hospitalized in the Coronary Care Unit of the Clinical Centre of Serbia, between November 2005 and January 2012. Patients were divided in two groups: MVD and no MVD. MVD disease was defined as stenosis greater than 50% by visual assessment in more than one major coronary artery. Primary PCI was limited to the infarct-related artery (IRA). Cardiovascular mortality was defined as any death from cardiovascular reason (myocardial reinfarction, low-output heart failure, and sudden death). Patients presenting with cardiogenic shock were excluded. Patients were followed-up for 6 years after enrollment. Results: Among 3,115 analyzed patients, 1,352 (43.4%) patients had no MVD and 1,763 (56.6%) had MVD; among patients with MVD, 926 (52.6%) had two-vessel disease and 837 (47.4%) had three-vessel disease. Compared with patients with single-vessel disease, patients with MVD were older, had longer pain duration, and presented more often with heart failure; they were more likely to have previous coronary artery disease, diabetes, hypertension, and chronic kidney disease; post-procedural flow TIMI <3 was more frequently observed in patients with MVD than in patients with no MVD (5.9% vs. 3.1%, p <0.001). Patients with MVD had lower left ventricular ejection fraction than patients with single-vessel disease: 45% (interquartile range [IQR] 40¬–55%) vs. 50% (IQR 43–55%), p <0.001. Revascularization of non-IRA lesions was performed at index hospitalization in 1,075 (61%) patients, and in 602 (34.1%) patients revascularization was performed in the first few months after pPCI (median 1.5 months, IQR 1–2.5 months); coronary artery bypass grafting was performed in 291 (18.4%) patients and PCI (with stent implantation) in 1,368 (81.6%) patients. Six-year cardiovascular mortality was significantly higher in patients with MVD than in patients with single-vessel disease (10.4% vs. 4.6%, p <0.001). In multivariate Cox regression analysis, MVD remained an independent predictor for 6-year cardiovascular mortality (HR 1.55, 95% CI 1.11–2.06, p = 0.041). Conclusion: In STEMI patients treated with pPCI, the presence of MVD remained an independent predictor for higher long-term cardiovascular mortality despite early revascularization of the remaining stenosis in non-IRA.