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Clinical Case Reports Jan 2024Unilateral opercular lesions can result in Foix-Chavany-Marie syndrome, which is marked by acute anarthria, automatic-voluntary movement dissociation-most notably the...
KEY CLINICAL MESSAGE
Unilateral opercular lesions can result in Foix-Chavany-Marie syndrome, which is marked by acute anarthria, automatic-voluntary movement dissociation-most notably the absence of voluntary facial and tongue movements-and a generally better prognosis. Better patient outcomes are mostly dependent on early detection, management, and rehabilitation.
ABSTRACT
Opercular syndrome is a rare neurological disorder caused by bilateral or unilateral lesions of the operculum that result in symptoms related to speech and swallowing difficulties with dissociation of automatic-voluntary movements in affected muscles. 78-year-old female presented with acute onset dysarthria, left sided facial deviation and difficulties in chewing, speaking, and swallowing. CT head revealed ischemic changes in left frontal operculum and was diagnosed with the unilateral opercular syndrome. The case was managed according to ischemic stroke protocol. The patient was discharged after 7 days of hospital stay, with MRS 2, NIHSS 9 and secondary stroke preventive measures. At 4 months follow-up, her MRS was 1, with mild dysarthria, that could be understood, and her swallowing improved to some amount of drooling while feeding. Early recognition, treatment, and rehabilitation play important role in prompt improvement of symptoms.
PubMed: 38173897
DOI: 10.1002/ccr3.8392 -
Botulinum Toxin for Drooling in Adults with Diseases of the Central Nervous System: A Meta-Analysis.Healthcare (Basel, Switzerland) Jul 2023(1) Background: The purpose of this study was to determine whether the drooling of adult patients with diverse central nervous system diseases can be treated with...
(1) Background: The purpose of this study was to determine whether the drooling of adult patients with diverse central nervous system diseases can be treated with botulinum toxin type A. (2) Methods: The Cochrane Library, MEDLINE, and Embase were all searched for studies that fit the inclusion criteria. The patients in the studies had to be adults (>18 years old), and the studies had to be randomized placebo-controlled trials, controlled trials, or prospective studies. Each study had to have enough quantifiable data available for meta-analysis. The primary outcome measure was the Drooling Severity and Frequency Scale (DSFS). (3) Results: The meta-analysis comprised three studies. A statistically significant difference in DSFS score between the treatment and control groups was observed in the meta-analysis, with an overall standardized mean difference of -0.9377 (95% CI, -1.2919 to -0.5836; < 0.0001). A total of seven studies were ineligible for inclusion in the meta-analysis and were only assessed as qualitative data. All qualitative studies showed a significant reduction in DSFS score a few weeks or months after the injection of botulinum toxin. (4) Conclusions: Botulinum toxin type A is safe and effective as a treatment for drooling in adult patients with central nervous system diseases.
PubMed: 37444790
DOI: 10.3390/healthcare11131956 -
TheScientificWorldJournal 2024To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay.
OBJECTIVE
To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay.
MATERIALS AND METHODS
We conducted a retrospective study among patients operated for maxillofacial infections at our center from 2010 to 2020. Information collected from the records were age, sex, type and number of spaces involved, clinical signs and symptoms (pain, swelling, toothache, sore throat, otalgia, hoarseness, headache, cough, neck swelling, rancid breath, sialorrhea, gingival swelling, muffled voice, trismus, fever, dysphagia, odynophagia, malaise, lymphadenopathy, dyspnoea, pus discharge), treatment modality, total leukocyte count, evidence of bacterial growth, comorbidities, complications if any and length of hospital stay.
RESULTS
A total of 128 medical records were examined, out of which 59 were female. The mean age was 38.59 ± 19.7 and the length of hospital stay was 7.56 ± 3.8 days. The most commonly involved space was submandibular space (46.1%) and the common symptoms reported were swelling (99.2%), pain (86.7%), and trismus (68%). Four patients had complications like necrotizing fasciitis (1.6%), pneumonia (0.8%), and death in one patient (0.8%). Logistic regression showed that patients more than 36 years of age, male sex, evidence of bacterial growth, and diabetics had higher odds of increased hospital stay (>6 days). Multiple logistic regression analysis showed that age ( = 0.015; OR: 2.98) and evidence of bacterial culture ( = 0.001; OR:6.64) were potential predictors associated with increased hospital stay.
CONCLUSION
Our study showed that the age of the patient and evidence of bacterial culture were potential predictors of prolonged hospital stay among patients operated for maxillofacial space infections.
Topics: Humans; Male; Female; Adolescent; Young Adult; Adult; Middle Aged; Infant, Newborn; Trismus; Retrospective Studies; Risk Factors; Headache; Pain
PubMed: 38633105
DOI: 10.1155/2024/9304671 -
Revista Da Associacao Medica Brasileira... 2024
Topics: Humans; Sialorrhea; Child
PubMed: 38655996
DOI: 10.1590/1806-9282.20230971 -
Molecular Syndromology Dec 2023Synaptotagmin 1 (SYT1), the predominant SYT isoform in the central nervous system, likely acts by promoting vesicle docking, deforming the plasma membrane via...
INTRODUCTION
Synaptotagmin 1 (SYT1), the predominant SYT isoform in the central nervous system, likely acts by promoting vesicle docking, deforming the plasma membrane via Ca-dependent membrane penetration.
CASE PRESENTATION
Here, we describe a 21-year-old woman harboring a novel variant in the gene, who presents with a complex phenotype, featuring severe intellectual disability, absent speech, behavioral abnormalities, motor stereotypies, dystonic posturing of her hands, a hyperkinetic movement disorder in her childhood, infantile hypotonia, sialorrhea, mild dysmorphic features, epilepsy, peculiar EEG findings, and severe scoliosis.
DISCUSSION
Based on our case and literature review on the 22 previously described patients, we can confirm a complex neurodevelopmental disorder in which, unlike other synaptopathies, epilepsy is present in a subset of cases (including our patient: 5/23, 22%), although characteristic EEG changes are far more common (10/23, 43.5%). Our patient's age allows us to provide long-term follow-up data and thus better delineate the -related clinical phenotype.
PubMed: 38058756
DOI: 10.1159/000530586 -
Turkish Journal of Physical Medicine... Dec 2023This study aimed to investigate the short- and long-term effects of kinesiotaping (KT) on dysphagia in children with cerebral palsy (CP).
OBJECTIVES
This study aimed to investigate the short- and long-term effects of kinesiotaping (KT) on dysphagia in children with cerebral palsy (CP).
PATIENTS AND METHODS
One hundred one CP patients (59 males, 42 females; mean age: 49.3±18.8 years; range, 2 to 6 years) with dysphagia referred between October 2017 and January 2020 were enrolled in the randomized controlled study. Children who met the study criteria were randomly assigned to the kinesiotape group (n=54) or the sham group (n=47). Specific swallowing evaluations were performed on all patients before the therapy. The KT or sham application protocole combined with conventional rehabilitaion therapy was conducted for six weeks. Evaluation parameters were repeated at 6 and 18 weeks. The evaluated parameters were compared within and between groups.
RESULTS
Drooling, weak tongue movement, chewing difficulty, coughing/choking and retching/vomiting during/after feeding, functional oral intake score, and meal time were found to be significantly improved at six weeks in the kinesiotape group compared to the sham group, and the clinical improvements were present at 18 weeks (p<0.05). There was no statistically significant difference in any parameter in the sham group at 6 and 18 weeks compared to the pretreatment (p>0.05).
CONCLUSION
The addition of KT to a home exercise program is an effective method for dysphagia in CP.
PubMed: 38766591
DOI: 10.5606/tftrd.2023.11066 -
Journal of Clinical Medicine Aug 2023Sialorrhea is common in children with neurodevelopmental disabilities (NDD) and is reported in >40% of children with cerebral palsy (CP). It causes a range of...
Sialorrhea is common in children with neurodevelopmental disabilities (NDD) and is reported in >40% of children with cerebral palsy (CP). It causes a range of complications, including significant respiratory morbidity. This single-center retrospective chart review aims to document sublingual atropine (SLA) utilization to guide further study in establishing its role in secretion management for children with NDD. A chart review was completed for patients with NDD ≤ 22 years of age treated with SLA at a free-standing children's hospital between 1 January 2016 and 1 June 2021. Descriptive statistics were generated to summarize findings. In total, 190 patients were identified, of which 178 met inclusion criteria. The average starting dose for SLA was 1.5 mg/day, or 0.09 mg/kg/day when adjusted for patient weight. Eighty-nine (50%) patients were prescribed SLA first line for secretion management while 85 (48%) patients tried glycopyrrolate prior to SLA. SLA was used after salivary Botox, ablation, and/or surgery in 16 (9%) patients. This study investigates SLA as a potential pharmacologic agent to treat sialorrhea in children with NDD. We identify a range of prescribing patterns regarding dosing, schedule, and place in therapy, highlighting the need for further evidence to support and guide its safe and efficacious use.
PubMed: 37629280
DOI: 10.3390/jcm12165238 -
Cureus Dec 2023Antipsychotics are the mainstay for the treatment of schizophrenia and other psychotic disorders; however, these agents are associated with an extensive side effect...
Antipsychotics are the mainstay for the treatment of schizophrenia and other psychotic disorders; however, these agents are associated with an extensive side effect profile that may complicate treatment outcomes. We present the case of a 35-year-old woman with a history of schizoaffective disorder and five prior psychiatric hospitalizations. The patient first presented to the hospital for disorganized behavior, in addition to poor sleep, auditory hallucinations, and racing thoughts in the context of medication nonadherence. She received two loading doses of intra-muscular paliperidone with fair symptomatic improvement. After discharge, she was scheduled to receive a monthly dose of paliperidone, which she missed, resulting in decompensation, re-emergence of psychosis, and another hospitalization two months later. She was given the missed dose with no improvement and progressive deterioration, for which alternative agents were tried. She received olanzapine and was tried briefly on quetiapine and haloperidol as well, with no benefit, and she also developed abnormal perioral movements. She was reloaded with paliperidone, and her psychotic symptoms improved, although she developed akathisia and hyperprolactinemia. The patient returned to the hospital two days later after being discharged, due to disorganized behavior and multiple delusions. Clozapine was started and titrated to 100 mg qam and 200 mg qhs. While on clozapine, she developed profuse sialorrhea that was treated with sublingual atropine drops, and by the time of discharge psychotic symptoms had markedly improved, perioral movements diminished, and prolactin level trended down. The patient maintained stability for over a year after the last admission. Identifying antipsychotics to successfully treat refractory psychosis and managing their multiple potential side effects is challenging but can result in better quality of life for patients as well as improved treatment adherence. This case report is unique in the way it illustrates this point, while discussing different approaches to managing multiple side effects that can happen simultaneously.
PubMed: 38186486
DOI: 10.7759/cureus.50063 -
Clinical Chemistry and Laboratory... May 2024Many reverse transcription polymerase chain reaction (RT-PCR) methods exist that can detect SARS-CoV-2 RNA in different matrices. RT-PCR is highly sensitive, although... (Comparative Study)
Comparative Study
A high throughput immuno-affinity mass spectrometry method for detection and quantitation of SARS-CoV-2 nucleoprotein in human saliva and its comparison with RT-PCR, RT-LAMP, and lateral flow rapid antigen test.
OBJECTIVES
Many reverse transcription polymerase chain reaction (RT-PCR) methods exist that can detect SARS-CoV-2 RNA in different matrices. RT-PCR is highly sensitive, although viral RNA may be detected long after active infection has taken place. SARS-CoV-2 proteins have shorter detection windows hence their detection might be more meaningful. Given salivary droplets represent a main source of transmission, we explored the detection of viral RNA and protein using four different detection platforms including SISCAPA peptide immunoaffinity liquid chromatography-mass spectrometry (SISCAPA-LC-MS) using polyclonal capture antibodies.
METHODS
The SISCAPA-LC MS method was compared to RT-PCR, RT-loop-mediated isothermal amplification (RT-LAMP), and a lateral flow rapid antigen test (RAT) for the detection of virus material in the drool saliva of 102 patients hospitalised after infection with SARS-CoV-2. Cycle thresholds (Ct) of RT-PCR ( gene) were compared to RT-LAMP time-to-positive (TTP) ( and genes), RAT optical densitometry measurements (test line/control line ratio) and to SISCAPA-LC-MS for measurements of viral protein.
RESULTS
SISCAPA-LC-MS showed low sensitivity (37.7 %) but high specificity (89.8 %). RAT showed lower sensitivity (24.5 %) and high specificity (100 %). RT-LAMP had high sensitivity (83.0 %) and specificity (100.0 %). At high initial viral RNA loads (<20 Ct), results obtained using SISCAPA-LC-MS correlated with RT-PCR (R 0.57, p-value 0.002).
CONCLUSIONS
Detection of SARS-CoV-2 nucleoprotein in saliva was less frequent than the detection of viral RNA. The SISCAPA-LC-MS method allowed processing of multiple samples in <150 min and was scalable, enabling high throughput.
Topics: Humans; Saliva; SARS-CoV-2; COVID-19; RNA, Viral; Mass Spectrometry; Nucleic Acid Amplification Techniques; Reverse Transcriptase Polymerase Chain Reaction; Male; Sensitivity and Specificity; Female; Middle Aged; Phosphoproteins; Coronavirus Nucleocapsid Proteins; Antigens, Viral; Adult; Chromatography, Liquid; Molecular Diagnostic Techniques
PubMed: 38253336
DOI: 10.1515/cclm-2023-0243 -
Cureus Nov 2023Foreign body ingestion (FBI) among the pediatric age group is considered a major clinical problem that can cause life-threatening complications, as it can obstruct the...
BACKGROUND
Foreign body ingestion (FBI) among the pediatric age group is considered a major clinical problem that can cause life-threatening complications, as it can obstruct the airway due to poor/immature airway protection reflexes.
OBJECTIVE
In this study, we aimed to retrospectively describe the epidemiology, clinical characteristics, and outcomes of FBI among the pediatric age group in Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.
METHODS
We conducted a retrospective study of pediatric patients (0-14 years) presenting to a tertiary care hospital in Jeddah, Saudi Arabia, from January 2019 to October 2022. The study reviewed records of patients with FBI in the emergency department. Data collection included age, gender, comorbidities, foreign body (FB) type, anatomical location, presenting symptoms, time to emergency room (ER) presentation, need for endoscopy, and complications. We performed a statistical analysis using the Statistical Package for Social Sciences (SPSS) 25 (IBM SPSS Statistics, Armonk, NY), where p<0.05 was considered statistically significant.
RESULTS
We identified 244 FBI cases, with most cases being male (62.7%). The most common site of FB impaction was the stomach (38.9%), followed by the upper esophagus (29.1%). Clinical presentation was variable, with 20.5% of cases experiencing vomiting, 13.5% experiencing drooling, and 9.4% experiencing dysphagia. Out of 244 cases, 132 (54.1%) were referred to gastroenterology for urgent FB removal by endoscopy. A total of 186 cases (76.2%) did not have complications, whereas 3.6% had serious sequela. The association between age and FBI was statistically significant (p=0.00), whereas there was no association between gender and FBI.
CONCLUSION
Our results showed that FB ingestion was prevalent among children at our tertiary care hospital, with urgent endoscopy being the most common removal procedure. Early detection and immediate presentation to the emergency room are crucial for preventing complications. Common FBI included coins and batteries, with most incidents in 1-3-year-old males. Parents should be aware of the dangers of FBI and implement preventive measures to reduce its incidence.
PubMed: 38046744
DOI: 10.7759/cureus.48113