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Cureus Oct 2022Multiple sclerosis (MS) is a chronic neurological disease that has an impact when they are at the most susceptible aspects of personal, professional, and social... (Review)
Review
Multiple sclerosis (MS) is a chronic neurological disease that has an impact when they are at the most susceptible aspects of personal, professional, and social development. MS affects about 2.2 million individuals worldwide, with the majority of individuals experiencing relapses regularly. The progression of the disease's complex nature, the challenges in selecting the appropriate intervention, and a multitude of symptoms necessitate a systematic approach to the individual that includes both pharmacology and neurorehabilitation. Kinesiotherapy, exercise rehabilitation, massage, and hydrotherapy are all forms of physiotherapy that are used as part of rehabilitation. Physical exercise will mitigate the potential effects of akinesia and so enhance the functioning capacities of all bodily systems, regardless of the severity of the illness. An early examination by a physical therapist who is familiar with MS is advised to develop a customized training and/or lifestyle physical exercise program. Although hospital-based rehabilitation programs appear to have a higher impact, numerous studies have found that home-based rehabilitation is helpful. The constraint imposed by COVID-19 has an influence on the well-being of persons with multiple sclerosis. People with MS would be particularly affected, since they might be considered an at-risk group for serious COVID-19 in a variety of ways, and MS health-related data requirements increased significantly.
PubMed: 36447691
DOI: 10.7759/cureus.30779 -
Journal of Cardiovascular Medicine... Aug 2020: Echocardiography plays an important role both in the diagnosis and the treatment/prevention of embolic stroke of undetermined source and should be performed as soon as... (Review)
Review
: Echocardiography plays an important role both in the diagnosis and the treatment/prevention of embolic stroke of undetermined source and should be performed as soon as possible for preventing ischemic stroke recurrencies, which occur more frequently during the first week after the first ischemic event. Early identification of the cause of a transient ischemic attack or stroke is indeed a primary goal for the neurologist in the Stroke Unit and requires specific diagnostic strategies. Echocardiography, together with other diagnostic tools such as carotid and transcranial ultrasounds, provides this information promptly. In particular, echocardiography might be able to detect the main sources of the embolic stroke, such as atrial fibrillation, ventricular akinesia, aortic atheroma plaques and/or cardiac shunts. The present review discusses the importance and the practical role of echocardiography as a crucial diagnostic tool for detecting the main source of emboli in the setting of the acute stroke.
Topics: Early Diagnosis; Echocardiography; Embolic Stroke; Heart Diseases; Humans; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors
PubMed: 32628421
DOI: 10.2459/JCM.0000000000001023 -
Der Ophthalmologe : Zeitschrift Der... Apr 2021The range of anesthesiological procedures in ophthalmology has not changed significantly over the last decades, with local anesthesia clearly coming to the fore. The...
The range of anesthesiological procedures in ophthalmology has not changed significantly over the last decades, with local anesthesia clearly coming to the fore. The development of minimally invasive surgical techniques requires significantly less analgesia and economic constraints to shorten operating times. The increasing proportion of outpatient ophthalmic surgery requires a short analgesia of the surgical area with as few complications as possible. Nevertheless, the selection of the procedures, which are described here in detail, must be made individually for each patient. General anesthesia continues to have its place, especially in cases of reduced compliance and difficult surgical conditions. The close cooperation between anesthetists and ophthalmic surgeons, e.g. for analgosedation in the outpatient area, can create a very pleasant surgical experience for the patient. An important goal should always be sufficient anxiolysis, analgesia and, in special operations, sufficient akinesia.
Topics: Anesthesia, General; Anesthesia, Local; Humans; Ophthalmology; Pain
PubMed: 33651138
DOI: 10.1007/s00347-021-01334-3 -
Archive of Clinical Cases 2022As marijuana, the most widely-used illicit drug in adolescents and adults, has some unknown side effects, marijuana abuse has become a public health concern. Also,...
As marijuana, the most widely-used illicit drug in adolescents and adults, has some unknown side effects, marijuana abuse has become a public health concern. Also, marijuana affects different organs such as heart in its rate, rhythm and coronary flow; it eventually leads to events such as myocardial infarction and rarely myocarditis. A 24-year-old man without any medical history or cardiovascular risk factors presented with chest pain after marijuana consumption. Based on electrocardiogram, myocardial cytolysis and transthoracic echocardiography acute myocarditis diagnosis was established. A few days later, transthoracic echocardiography showed a small clot in apex with reduced left ventricle ejection fraction, in the absence of local akinesia. The patient was discharged with oral anticoagulant stable and without any symptoms. The myocarditis after marijuana abuse is rare. The physicians should include acute myocarditis in differential diagnosis of a patient with chest pain after using marijuana.
PubMed: 35813492
DOI: 10.22551/2022.35.0902.10206 -
Neurorehabilitation and Neural Repair Jul 2022Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique that has been closely examined as a possible treatment for Parkinson's disease (PD).... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique that has been closely examined as a possible treatment for Parkinson's disease (PD). Owing to various rTMS protocols and results, the optimal mode and suitable PD symptoms have yet to be established.
OBJECTIVES
This study intends to systematically evaluate the efficacy of rTMS intervention and identify optimal stimulation protocol of rTMS for specific motor symptoms.
METHODS
PubMed and web of Science databases were searched before January 2022. Eligible studies included sham-controlled and randomized clinical trials of rTMS intervention for motor dysfunction in patients with PD. Standard mean difference (SMD) was calculated with random-effects models. The effects of rTMS on motor symptoms were mainly estimated by the UPDRS-III.
RESULTS
A total of 1172 articles were identified, of which 32 articles met the inclusion criteria for meta-analysis. The pooled evidence suggested that rTMS relieves motor symptoms of patients with PD (SMD 0.64, 95%CI [0.47, 0.80]). High frequency stimulation on M1 is the most effective mode of intervention (SMD 0.79, 95%CI [0.52, 1.07]). HF rTMS has significant therapeutic effects on limbs motor function (SMD 1.93, 95%CI [0.73, 3.12] for upper limb function and SMD 0.88, 95%CI [0.43, 1.33] for lower limb function), akinesia (SMD 1.17, 95%CI [0.43, 1.92), rigidity (SMD 1.02, 95%CI [0.12, 1.92]) and tremor(SMD 0.91, 95%CI [0.15, 1.67]).
CONCLUSION
rTMS therapy is an effective treatment for motor symptoms of PD and the individualized stimulation protocols for different symptoms would further improve its clinical efficacy.
Topics: Databases, Factual; Humans; Lower Extremity; Parkinson Disease; Transcranial Magnetic Stimulation; Treatment Outcome
PubMed: 35616427
DOI: 10.1177/15459683221095034 -
Anesthesia and Analgesia May 2020Ophthalmic pediatric regional anesthesia has been widely described, but infrequently used. This review summarizes the available evidence supporting the use of conduction... (Review)
Review
Ophthalmic pediatric regional anesthesia has been widely described, but infrequently used. This review summarizes the available evidence supporting the use of conduction anesthesia in pediatric ophthalmic surgery. Key anatomic differences in axial length, intraocular pressure, and available orbital space between young children and adults impact conduct of ophthalmic regional anesthesia. The eye is near adult size at birth and completes its growth rapidly while the orbit does not. This results in significantly diminished extraocular orbital volumes for local anesthetic deposition. Needle-based blocks are categorized by relation of the needle to the extraocular muscle cone (ie, intraconal or extraconal) and in the cannula-based block, by description of the potential space deep to the Tenon capsule. In children, blocks are placed after induction of anesthesia by a pediatric anesthesiologist or ophthalmologist, via anatomic landmarks or under ultrasonography. Ocular conduction anesthesia confers several advantages for eye surgery including analgesia, akinesia, ablation of the oculocardiac reflex, and reduction of postoperative nausea and vomiting. Short (16 mm), blunt-tip needles are preferred because of altered globe-to-orbit ratios in children. Soft-tip cannulae of varying length have been demonstrated as safe in sub-Tenon blockade. Ultrasound technology facilitates direct, real-time visualization of needle position and local anesthetic spread and reduces inadvertent intraconal needle placement. The developing eye is vulnerable to thermal and mechanical insults, so ocular-rated transducers are mandated. The adjuvant hyaluronidase improves ocular akinesia, decreases local anesthetic dosage requirements, and improves initial block success; meanwhile, dexmedetomidine increases local anesthetic potency and prolongs duration of analgesia without an increase in adverse events. Intraconal blockade is a relative contraindication in neonates and infants, retinoblastoma surgery, and in the presence of posterior staphylomas and buphthalmos. Specific considerations include pertinent pediatric ophthalmologic topics, block placement in the syndromic child, and potential adverse effects associated with each technique. Recommendations based on our experience at a busy academic ophthalmologic tertiary referral center are provided.
Topics: Anesthesia, Conduction; Anesthetics, Local; Child; Child, Preschool; Humans; Infant; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Pediatrics
PubMed: 30676353
DOI: 10.1213/ANE.0000000000004012 -
Neurological Sciences : Official... Apr 2022Parkinson's disease is incurable, idiopathic, degenerative, and progressive, and affects about 1% of the elderly population. Multidisciplinary clinical treatment is the...
BACKGROUND
Parkinson's disease is incurable, idiopathic, degenerative, and progressive, and affects about 1% of the elderly population. Multidisciplinary clinical treatment is the best and most adopted therapeutic option, while surgical treatment is used in less than 15% of those affected. In practice, there is a lack of reliable and validated scales for measuring motor impairment, and monitoring and screening for surgical indications.
OBJECTIVE
To develop and validate an instrument for measuring parkinsonian motor impairment in candidates for neurosurgical treatment.
METHOD
The development and validation methods followed published guidelines. The first part was the choice of domains that would make up the construct: cardinal signs of disease (tremor, rigidity (stiffness), posture/balance/gait, hypokinesia/akinesia, and speech), along with pain and dyskinesia. A multi-professional working group prepared an initial pilot instrument. Ten renowned specialists evaluated, judged, and suggested modifications to the instrument. The second phase was the evaluation of the content of each domain and the respective ability to classify commitment intensity. The third phase was the correction of the main flaws detected and new submission to the board. The instrument was applied to 41 candidates for neurosurgical treatment in two situations: with and without medication RESULTS: The final form received 100% agreement from the judges. Its average time for application was 8 min. It was very responsive (p = 0.001, Wilcoxon) in different situations (On-Off).
CONCLUSION
TRASP-D is a valid instrument for measuring motor impairment in patients with Parkinson's disease who are candidates for neurosurgical treatment. It allows measurement in multiple domains with reliability and sensitivity.
Topics: Aged; Humans; Hypokinesia; Motor Disorders; Parkinson Disease; Reproducibility of Results; Tremor
PubMed: 34709480
DOI: 10.1007/s10072-021-05533-3 -
European Heart Journal. Case Reports Jul 2023Catecholamine-induced Takotsubo Syndrome (cat-TS) is a type of secondary Takotsubo syndrome, characterized by rapid onset of symptoms, high rate of complications during...
BACKGROUND
Catecholamine-induced Takotsubo Syndrome (cat-TS) is a type of secondary Takotsubo syndrome, characterized by rapid onset of symptoms, high rate of complications during the acute phase, good short-term prognosis, and frequent apical sparing at echocardiogram. We present two clinical cases of cat-TS treated in our department.
CASE SUMMARY
Case one: 78-year-old man, admitted to Ear Nose and Throat Unit for surgical removal of oral squamous cellular carcinoma. During surgery, the occurrence of hypotensive episode was treated with catecholamines. After surgery, the occurrence of atrial fibrillation was followed by evidence of phasic increase of troponin levels and akinesia of midventricular segments. Angiography showed the absence of significant coronary stenoses, and during hospital stay, we observed rapid recovery of wall motion abnormalities. Case two: 64-year-old woman, admitted for hysteropexy surgery, during which cardiac arrest occurred, treated with epinephrine i.v.1 mg and DC shock. Two hours after resuscitation, the patient developed pulmonary oedema, troponin levels increased progressively, and the echocardiogram demonstrated hypokinesia in all midventricular segments with apical sparing. Afterwards, an urgent angiography highlighted normal coronary anatomy. Cardiac magnetic resonance imaging (MRI) revealed oedema corresponding to hypokinetic areas. On the seventh day, echocardiogram showed a complete remission of wall motion abnormalities.
DISCUSSION
These cases warn the physicians about the importance of routinely screening myocardial impairment through clinical assessment, electrocardiogram (ECG) monitoring, and serial cardiac troponin testing after catecholamine i.v. bolus administration. In case of alterations of these exams, performing a prompt echocardiogram allows early detection of cat-TS, to provide immediate suitable medical support and avoid complications.
PubMed: 37457052
DOI: 10.1093/ehjcr/ytad284 -
Sensors (Basel, Switzerland) Sep 2020In Parkinson's disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which... (Review)
Review
In Parkinson's disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which significantly impact quality of life. In PD patients, these nocturnal disturbances can reflect disease-related complications (e.g., nocturnal akinesia), primary sleep disorders (e.g., rapid eye movement behaviour disorder), or both, thus requiring different therapeutic approaches. Wearable technologies based on actigraphy and innovative sensors have been proposed as feasible solutions to identify and monitor the various types of abnormal nocturnal movements in PD. This narrative review addresses the topic of abnormal nocturnal movements in PD and discusses how wearable technologies could help identify and assess these disturbances. We first examine the pathophysiology of abnormal nocturnal movements and the main clinical and instrumental tools for the evaluation of these disturbances in PD. We then report and discuss findings from previous studies assessing nocturnal movements in PD using actigraphy and innovative wearable sensors. Finally, we discuss clinical and technical prospects supporting the use of wearable technologies for the evaluation of nocturnal movements.
Topics: Actigraphy; Humans; Hyperkinesis; Hypokinesia; Movement; Parkinson Disease; Quality of Life; Sleep; Sleep Wake Disorders; Wearable Electronic Devices
PubMed: 32927816
DOI: 10.3390/s20185171 -
Neurotherapeutics : the Journal of the... Oct 2023Traumatic brain injury (TBI), a neurovascular injury caused by external force, is a common diagnosis among veterans and those experiencing homelessness (HL). There is a... (Review)
Review
Traumatic brain injury (TBI), a neurovascular injury caused by external force, is a common diagnosis among veterans and those experiencing homelessness (HL). There is a significant overlap in the veteran and homeless population, possibly accounting for the two to seven times greater incidence of TBI among those experiencing HL than the general population. Despite these statistics, individuals experiencing HL are often underdiagnosed and ineffectively treated for TBI. We introduced a novel model of HL. Over 5 weeks, adult Sprague-Dawley rats were randomly assigned to one of the following conditions: TBI only, HL only, TBI + HL, or control (n = 9 per group). To emulate HL, animals (2 animals per cage) were exposed to soiled beddings for 5 weeks. Subsequently, animals were introduced to TBI by using the moderate controlled cortical impact model, then underwent 4 consecutive days of behavioral testing (beam walk (BW), elevated body swing test (EBST), forelimb akinesia (FA), paw grasp (PG), Rotorod, and elevated T-maze). Nissl staining was performed to determine the peri-impact cell survival and the integrity of corpus callosum area. Motor function was significantly impaired by TBI, regardless of housing (beam walk or BW 85.0%, forelimb akinesia or FA 104.7%, and paw grasp or PG 100% greater deficit compared to control). Deficits were worsened by HL in TBI rats (BW 93.3%, FA 40.5%, and PG 50% greater deficit). Two-way ANOVA revealed BW (F(4, 160) = 31.69, p < 0.0001), FA (F(4, 160) = 13.71, p < 0.0001), PG (F(4, 160) = 3.873, p = 0.005), Rotorod (F(4, 160), p = 1.116), and EBST (F(4, 160) = 6.929, p < 0.0001) showed significant differences between groups. The Rotorod and EBST tests showed TBI-induced functional deficits when analyzed by day, but these deficits were not exacerbated by HL. TBI only and TBI + HL rats exhibited typical cortical impact damage (F(3,95) = 51.75, p < 0.0001) and peri-impact cell loss compared to control group (F(3,238) = 47.34, p < 0.0001). Most notably, TBI + HL rats showed significant alterations in WM area measured via the corpus callosum (F(3, 95) = 3.764, p = 0.0133). Worsened behavioral outcomes displayed by TBI + HL rats compared to TBI alone suggest HL contributes to TBI functional deficits. While an intact white matter, such as the corpus callosum, may lessen the consequent functional deficits associated with TBI by enhancing hemispheric communications, there are likely alternative cellular and molecular pathways mitigating TBI-associated inflammatory or oxidative stress responses. Here, we showed that the environmental condition of the patient, i.e., HL, participates in white matter integrity and behavioral outcomes, suggesting its key role in the disease diagnosis to aptly treat TBI patients.
Topics: Humans; Adult; Rats; Animals; Rats, Sprague-Dawley; Brain Injuries, Traumatic; White Matter; Ill-Housed Persons; Comorbidity
PubMed: 37639189
DOI: 10.1007/s13311-023-01419-8