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BMJ Open Jul 2024Poststroke spasticity (PSS) affects up to 40% of patients who had a stroke. Botulinum neurotoxin type A (BoNT-A) has been shown to improve spasticity, but the optimal... (Observational Study)
Observational Study
Comprehensive Observational and Longitudinal study on the Outbreak of Stroke-related Spasticity focusing on the Early Onset management with Botulinum NeuroToxin (COLOSSEO-BoNT): protocol for a real-world prospective observational study on upper limb spasticity.
INTRODUCTION
Poststroke spasticity (PSS) affects up to 40% of patients who had a stroke. Botulinum neurotoxin type A (BoNT-A) has been shown to improve spasticity, but the optimal timing of its application remains unclear. While several predictors of upper limb PSS are known, their utility in clinical practice in relation to BoNT-A treatment has yet to be fully elucidated. The COLOSSEO-BoNT study aims to investigate predictors of PSS and the effects of BoNT-A timing on spasticity-related metrics in a real-world setting.
METHODS AND ANALYSIS
The recruitment will involve approximately 960 patients who have recently experienced an ischaemic stroke (within 10 days, V0) and will follow them up for 24 months. Parameters will be gathered at specific intervals: (V1) 4, (V2) 8, (V3) 12, (V4) 18 months and (V5) 24 months following enrolment. Patients will be monitored throughout their rehabilitation and outpatient clinic journeys and will be compared based on their BoNT-A treatment status-distinguishing between patients receiving treatment at different timings and those who undergo rehabilitation without treatment. Potential predictors will encompass the Fugl-Meyer assessment, the National Institute of Health Stroke Scale (NIHSS), stroke radiological characteristics, performance status, therapies and access to patient care pathways. Outcomes will evaluate muscle stiffness using the modified Ashworth scale and passive range of motion, along with measures of quality of life, pain, and functionality.
ETHICS AND DISSEMINATION
This study underwent review and approval by the Ethics Committee of the Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy. Regardless of the outcome, the findings will be disseminated through publication in peer-reviewed journals and presentations at national and international conferences.
TRIAL REGISTRATION NUMBER
NCT05379413.
Topics: Humans; Muscle Spasticity; Botulinum Toxins, Type A; Prospective Studies; Neuromuscular Agents; Upper Extremity; Longitudinal Studies; Stroke; Stroke Rehabilitation; Observational Studies as Topic; Female; Male
PubMed: 38950995
DOI: 10.1136/bmjopen-2024-085484 -
Journal of Movement Disorders Jul 2024Functional movement disorder(FMD) is a type of functional neurological disorder(FND) that is common, but often difficult to diagnose or manage. FMD can present as...
Functional movement disorder(FMD) is a type of functional neurological disorder(FND) that is common, but often difficult to diagnose or manage. FMD can present as various phenotypes including tremor, dystonia, myoclonus, gait disorders and Parkinsonism. Conducting a clinical examination appropriate for the assessment of a patient with suspected FMD is important, and various diagnostic testing maneuvers may also be helpful. Treatment involving a multi-disciplinary team, either outpatient or inpatient, has been found to be most effective. Examples of such treatment protocols are also discussed in this review. While recognition and understanding of the disorder appears to have improved over the past few decades, as well as development of treatments, it is not uncommon for patients and physicians to continue to experience various difficulties when dealing with this disorder. In this review, I provide a practical overview of FMD and discuss how the clinical encounter itself can play a role in patients' acceptance of the diagnosis. Updates on recent neuroimaging studies that aid in the understanding of the pathophysiology are also discussed.
PubMed: 38950896
DOI: 10.14802/jmd.24126 -
Cardiology Journal Jul 2024Predictors of heart failure with recovered ejection fraction (HFrecEF) remain to be fully elucidated. This study investigated the impact of heart rate and its change on...
INTRODUCTION
Predictors of heart failure with recovered ejection fraction (HFrecEF) remain to be fully elucidated. This study investigated the impact of heart rate and its change on the recovery of left ventricular ejection fraction (LVEF) in heart failure with reduced ejection fraction (HFrEF).
MATERIAL AND METHODS
From 398 outpatients who had a history of hospitalisation for heart failure, 138 subjects diagnosed as HFrEF (LVEF < 40%) on heart failure hospitalisation were enrolled and longitudinally surveyed. During follow-up periods more than one year, 64 and 46 patients were identified as HFrecEF (improved LVEF to ≥ 40% and its increase of ≥ 10 points) and persistent HFrEF, respectively.
RESULTS
In the overall subjects, the reduction of heart rate through the observation periods was closely correlated with the improvement of LVEF (r = -0.508, p < 0.001). Heart rate on hospital admission for heart failure was markedly higher in patients with HFrecEF (112 ± 26 bpm) than in those with persistent HFrEF (90±18 bpm). Whereas heart rate at the first outpatient visit after discharge was already lower in the HFrecEF group (80 ± 13 vs. 85 ± 13 bpm in the persistent HFrEF group). A multivariate logistic regression analysis revealed that the decrease in heart rate from admission to the first visit after discharge was a significant determinant of HFrecEF (p < 0.001), independently of confounding factors such as ischemic heart disease and baseline LVEF and left ventricular dimension.
CONCLUSIONS
Our findings suggest that heart rate reduction in the early phase after heart failure onset is a powerful independent predictor of the subsequent recovery of LVEF in HFrEF patients.
PubMed: 38949392
DOI: 10.5603/cj.97021 -
JPMA. the Journal of the Pakistan... Jun 2024To assess short-term and long-term outcomes of endoscopic pilonidal sinus treatment for pilonidal sinus disease.
OBJECTIVES
To assess short-term and long-term outcomes of endoscopic pilonidal sinus treatment for pilonidal sinus disease.
METHODS
The prospective study was conducted at Shifa International Hospital, Islamabad, Pakistan, from July 2015 to July 2021, and comprised all pilonidal sinus cases undergoing minimal invasive endoscopic pilonidal sinus treatment who were treated by a single surgical team. The primary outcomes were duration of healing, post-operative morbidities, persistence of discharge and recurrence at 1-7 years. The secondary outcomes were operative time, return to work, cosmetic results and patient satisfaction. The patients were observed for wound healing and discharge on follow-up in the out-patient department at 1, 3, 6 and 24 weeks. They were further followed up every year through telephonic survey for persistence or recurrence of symptoms. Patient satisfaction was assessed using the 36-item Short Form Survey questionnaire filled at admission and then at 6 weeks post-surgery. Data was analysed using SPSS 23.
RESULTS
Of the 67 patients, 55(82%) were males and 12(18%) were females. The overall mean age was 25.69±8.305 years. There were 13(19.4%) patients with a history of recurrent disease and previous procedures for pilonidal sinus, while 54(80.6%) had no previous surgery. The median operative time was 35 minutes (interquartile range: 20-45 minutes). Complete wound healing was achieved in 60(89.6%) patients, while recurrence was seen in 7(10.4%). The median time off work was 2.5 days (interquartile range: 1-3 days). Patient satisfaction with the procedure was significantly high (p<0.05).
CONCLUSIONS
Endoscopic pilonidal sinus treatment appeared to be a good minimally invasive surgical technique for the treatment of pilonidal sinus disease in terms of both short-term and long-term outcomes.
Topics: Humans; Pilonidal Sinus; Female; Male; Adult; Endoscopy; Prospective Studies; Patient Satisfaction; Recurrence; Young Adult; Operative Time; Wound Healing; Sacrococcygeal Region; Treatment Outcome; Adolescent; Pakistan; Postoperative Complications; Return to Work
PubMed: 38948976
DOI: 10.47391/JPMA.9948 -
JPMA. the Journal of the Pakistan... Jun 2024To evaluate serum prolactin and macroprolactin levels in patients on long-term proton pump inhibitors therapy.
OBJECTIVES
To evaluate serum prolactin and macroprolactin levels in patients on long-term proton pump inhibitors therapy.
METHODS
The cross-sectional study was conducted from January 2018 to November 2019 after approval from the ethics review committee of the Commission on Science and Technology for Sustainable Development in the South University, Abbottabad, Pakistan. The study included patients from two gastroenterology outpatient clinics in the Khyber Pakhtunkhwa province using proton pump inhibitors for ≥3 months either alone or in combination with either histamine receptor antagonists or prokinetics. Blood samples were collected from each patient for hormonal screening. Data was analysed using SPSS 25.
RESULTS
Of the 166 patients, 101(60.8%) were females and 65(39.2%) were males. The overall mean age was 42.5±14.2 years, and the median serum prolactin level was 23.2ng/ml (interquartile range: 14.0-38.0ng/ml). There were 96(58%) patients with normoprolactinaemia and 70(42%) with hypreprolactinaemia. There were 19(11.4%) patients using combination therapy, while the rest were on proton pump inhibitors monotherapy. There was a significant increase in serum prolactin level with combination therapy compared to monotherapy (p=0.001). Patients having treatment duration 11-20 months (p=0.006) and >40 months (p=0.001) were at high risk of developing hyperprolactinaemia.
CONCLUSIONS
Long-term use of proton pump inhibitors could increase serum prolactin levels, and appropriate evaluation is essential for clinical management.
Topics: Humans; Proton Pump Inhibitors; Female; Cross-Sectional Studies; Male; Hyperprolactinemia; Prolactin; Adult; Middle Aged; Pakistan; Prevalence
PubMed: 38948973
DOI: 10.47391/JPMA.9541 -
Clinical Ophthalmology (Auckland, N.Z.) 2024An estimated 13 million Australians live with one or more chronic eye conditions, with prevalence increasing. Eye care services today and in the future rely on effective...
PURPOSE
An estimated 13 million Australians live with one or more chronic eye conditions, with prevalence increasing. Eye care services today and in the future rely on effective workforces, in which nurses play a pivotal role. Despite nurse involvement in eye care, there is no information describing their engagement, deployment, training, and opinion. This paper offers the first review of nurse engagement in eye care in Australia.
METHODS
We conducted an e-survey on Australian nurse engagement in eye care. Quantitative questions were analysed by descriptive, chi-square and bivariate correlation coefficients with assumed power of 0.80, and significance of =0.05. Grounded theory, sentiment and saturation analysis extracted key themes, meaning and opinion from the qualitative questions.
RESULTS
There were n=238 Australian nurse participants. Results indicated they were satisfied with their role, engaged in a wide range of healthcare and eye care setting and organisations, and adapted to their employer. Task-shifting "to" and "from" nurses was not universally supported but recognised by participants as necessary. Of concern, the results suggested that 68.6% of our participants would exit eye care over the next ten years, with insufficient entry pathways into the field for graduate and early-career nurses.
CONCLUSION
For Australia to meet and sustain eye care services for its population, steps must be taken to improve exposure and entry to the field for students, graduates, and early-career nurses. Strategies to train and prepare nurses for task-shifting are urgently required and the eye care nursing sector must professionalise to achieve positive change.
PubMed: 38948343
DOI: 10.2147/OPTH.S463743 -
Imaging Science in Dentistry Jun 2024The aim of this study was to explore the correlations of cone-beam computed tomographic findings with the apnea-hypopnea index in patients with obstructive sleep apnea.
PURPOSE
The aim of this study was to explore the correlations of cone-beam computed tomographic findings with the apnea-hypopnea index in patients with obstructive sleep apnea.
MATERIALS AND METHODS
Forty patients with obstructive sleep apnea were selected from the ear-nose-throat (ENT) outpatient clinic, Faculty of Medicine, Mansoura University. Cone-beam computed tomography was performed for each patient at the end of both inspiration and expiration. Polysomnography was carried out, and the apnea-hypopnea index was obtained. Linear measurements, including cross-sectional area and the SNA and SNB angles, were obtained. Four oral and maxillofacial radiologists categorized pharyngeal and retropalatal airway morphology and calculated the airway length and volume. Continuous data were tested for normality using the Kolmogorov-Smirnov test and reported as the mean and standard deviation or as the median and range. Categorical data were presented as numbers and percentages, and the significance level was set at <0.05.
RESULTS
The minimal value of the cross-sectional area, SNB angle, and airway morphology at the end of inspiration demonstrated a statistically significant association (<0.05) with the apnea-hypopnea index, with excellent agreement. No statistically significant difference was found in the airway volume, other linear measurements, or retropalatal airway morphology.
CONCLUSION
Cone-beam computed tomographic measurements in obstructive sleep apnea patients may be used as a supplement to a novel radiographic classification corresponding to the established clinical apnea-hypopnea index classification.
PubMed: 38948186
DOI: 10.5624/isd.20230249 -
Endoscopic Ultrasound 2024EUS-guided portal pressure gradient (PPG) is a novel technique that permits a true, direct measure of portal vein pressure and hepatic vein pressure. This article...
BACKGROUND AND OBJECTIVES
EUS-guided portal pressure gradient (PPG) is a novel technique that permits a true, direct measure of portal vein pressure and hepatic vein pressure. This article details our experience and lessons learned from 20 consecutive outpatient EUS-PPG procedures performed at a single center, along with simultaneous EUS-guided liver biopsy, variceal screening, and variceal banding.
METHODS
Data on the first 20 patients who underwent EUS-PPG at a single center were retrospectively viewed and analyzed. The effects of various liver diseases or other patient-related factors on the clinical and technical success of EUS-PPG measurements, as well as EUS-guided liver biopsy (EUS-LB), were evaluated. During the procedure, if esophageal varices were encountered, they were assessed, and if felt to be clinically indicated, endoscopic variceal ligation was performed.
RESULTS
The 20 patients included 10 male and 10 female patients. All procedures were technically successful. In all patients, the portal vein and hepatic veins could be easily identified. One adverse event of bleeding occurred during the EUS-PPG measuring procedure. All 20 EUS-LBs were technically successful and yielded adequate samples for histological evaluations, with an average of 25 complete portal tracts per sample. Among patients with esophageal varices, 40% of patients underwent banding. The mean EUS-PPG among 5 patients with esophageal varices was 11.6 mm Hg, compared with 3.2 mm Hg among 15 patients without esophageal varices.
CONCLUSION
This study demonstrates that EUS-PPG is a novel, safe, reproducible, and effective technique. Also, the fact that EUS-PPG, EUS-LB, variceal screening, and variceal banding could be performed in 1 session and on an outpatient basis speaks to the growing relevance and impact of the nascent field of endohepatology.
PubMed: 38947750
DOI: 10.1097/eus.0000000000000030 -
IJID Regions Jun 2024We present a case report about a 26-year-old female with a surgical site infection after bilateral breast augmentation. In a unique approach compared with previously...
We present a case report about a 26-year-old female with a surgical site infection after bilateral breast augmentation. In a unique approach compared with previously reported cases, the patient was successfully treated in an outpatient setting using only orally administered cotrimoxazole (trimethoprim-sulfamethoxazole) and ciprofloxacin with one-sided preservation of the breast prothesis. We also provide a comprehensive overview of all report cases of infections available in the PubMed database until December 2023 and compare the different diagnostic and therapeutic approaches.
PubMed: 38947736
DOI: 10.1016/j.ijregi.2024.100378 -
Heliyon Jun 2024A middle-aged gentleman, presented to our outpatient department with painful skin lesions suggestive of disseminated herpes zoster. Further examination revealed...
A middle-aged gentleman, presented to our outpatient department with painful skin lesions suggestive of disseminated herpes zoster. Further examination revealed bilateral cerebellar signs. He had a history of receiving a third dose of AZD1222 vaccine fourteen days prior to the onset of skin lesions but had no other significant medical history. The patient was also evaluated for retroviral infection and other immunodeficient states, workup for which were negative. The patient was initially treated with intravenous acyclovir 7.5 mg/kg/q8H; however, the patient developed varicella encephalitis on treatment, which was followed by pneumonia and haemorrhagic cystitis. Subsequently, treatment was started with acyclovir 10 mg/kg/q8H for 14 days, followed by valacyclovir for eight days, following which there was near-complete resolution of symptoms with the persistence of minimal rigidity. Although there have been several reports of herpes zoster following SARS-CoV-2 vaccination, we found few reports of varicella zoster with systemic manifestations following ChAdOx1 nCoV-19 (AZD1222) vaccination. This case highlights the importance of considering varicella zoster reactivation in a patient presenting with encephalitis or pneumonia post SARS-CoV-2 vaccination.
PubMed: 38947434
DOI: 10.1016/j.heliyon.2024.e32248