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Schizophrenia Research Jan 2024Catatonia is a complex psychomotor disorder characterized by motor, affective, and behavioral symptoms. Despite being known for almost 150 years, its pathomechanisms...
BACKGROUND
Catatonia is a complex psychomotor disorder characterized by motor, affective, and behavioral symptoms. Despite being known for almost 150 years, its pathomechanisms are still largely unknown.
METHODS
A systematic research on PubMed, Web of Science, and Scopus was conducted to identify neuroimaging studies conducted on group or single individuals with catatonia. Overall, 33 studies employing structural magnetic resonance imaging (sMRI, n = 11), functional magnetic resonance imaging (fMRI, n = 10), sMRI and fMRI (n = 2), functional near-infrared spectroscopy (fNIRS, n = 1), single positron emission computer tomography (SPECT, n = 4), positron emission tomography (PET, n = 4), and magnetic resonance spectroscopy (MRS, n = 1), and 171 case reports were retrieved.
RESULTS
Observational sMRI studies showed numerous brain changes in catatonia, including diffuse atrophy and signal hyperintensities, while case-control studies reported alterations in fronto-parietal and limbic regions, the thalamus, and the striatum. Task-based and resting-state fMRI studies found abnormalities located primarily in the orbitofrontal, medial prefrontal, motor cortices, cerebellum, and brainstem. Lastly, metabolic and perfusion changes were observed in the basal ganglia, prefrontal, and motor areas. Most of the case-report studies described widespread white matter lesions and frontal, temporal, or basal ganglia hypoperfusion.
CONCLUSIONS
Catatonia is characterized by structural, functional, perfusion, and metabolic cortico-subcortical abnormalities. However, the majority of studies and case reports included in this systematic review are affected by considerable heterogeneity, both in terms of populations and neuroimaging techniques, which calls for a cautious interpretation. Further elucidation, through future neuroimaging research, could have great potential to improve the description of the neural motor and psychomotor mechanisms underlying catatonia.
Topics: Humans; Brain; Catatonia; Cerebellum; Magnetic Resonance Imaging; Motor Cortex
PubMed: 36404217
DOI: 10.1016/j.schres.2022.11.002 -
JAMA Pediatrics Dec 2022Short-course antibiotic therapy could enhance adherence and reduce adverse drug effects and costs. However, based on sparse evidence, most guidelines recommend a longer... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Short-course antibiotic therapy could enhance adherence and reduce adverse drug effects and costs. However, based on sparse evidence, most guidelines recommend a longer course of antibiotics for nonsevere childhood community-acquired pneumonia (CAP).
OBJECTIVE
To determine whether a shorter course of antibiotics was noninferior to a longer course for childhood nonsevere CAP.
DATA SOURCES
MEDLINE, Embase, Web of Science, the Cochrane Library, and 3 Chinese databases from inception to March 31, 2022, as well as clinical trial registries and Google.com.
STUDY SELECTION
Randomized clinical trials comparing a shorter- vs longer-course therapy using the same oral antibiotic for children with nonsevere CAP were included.
DATA EXTRACTION AND SYNTHESIS
Random-effects models were used to pool the data, which were analyzed from April 15, 2022, to May 15, 2022. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence.
MAIN OUTCOMES AND MEASURES
Treatment failure, defined by persistence of pneumonia or the new appearance of any general danger signs of CAP (eg, lethargy, unconsciousness, seizures, or inability to drink), elevated temperature (>38 °C) after completion of treatment, change of antibiotic, hospitalization, death, missing more than 3 study drug doses, loss to follow-up, or withdrawal of informed consent.
RESULTS
Nine randomized clinical trials including 11 143 participants were included in this meta-analysis. A total of 98% of the participants were aged 2 to 59 months, and 58% were male. Eight studies with 10 662 patients reported treatment failure. Treatment failure occurred in 12.8% vs 12.6% of participants randomized to a shorter vs a longer course of antibiotics. High-quality evidence showed that a shorter course of oral antibiotic was noninferior to a longer course with respect to treatment failure for children with nonsevere CAP (risk ratio, 1.01; 95% CI, 0.92-1.11; risk difference, 0.00; 95% CI, -0.01 to 0.01; I2 = 0%). A 3-day course of antibiotic treatment was noninferior to a 5-day course for the outcome of treatment failure (risk ratio, 1.01; 95% CI, 0.91-1.12; I2 = 0%), and a 5-day course was noninferior to a 10-day course (risk ratio, 0.87; 95% CI, 0.50-1.53; I2 = 0%). A shorter course of antibiotics was associated with fewer reports of gastroenteritis (risk ratio, 0.79; 95% CI, 0.66-0.95) and lower caregiver absenteeism (incident rate ratio, 0.74; 95% CI, 0.65-0.84).
CONCLUSIONS AND RELEVANCE
Results of this meta-analysis suggest that a shorter course of antibiotics was noninferior to a longer course in children aged 2 to 59 months with nonsevere CAP. Clinicians should consider prescribing a shorter course of antibiotics for the management of pediatric nonsevere CAP.
Topics: Humans; Male; Child; Female; Community-Acquired Infections; Pneumonia; Anti-Bacterial Agents; Fever; Randomized Controlled Trials as Topic
PubMed: 36374480
DOI: 10.1001/jamapediatrics.2022.4123 -
Epilepsy Research Oct 2022The association of catatonia with epileptic seizures is a rare phenomenon that is poorly understood and needs more clinical research. This systematic review included all... (Review)
Review
The association of catatonia with epileptic seizures is a rare phenomenon that is poorly understood and needs more clinical research. This systematic review included all published case reports of patients with catatonia meeting ICD-11 criteria associated with epileptic seizures, published until December 2021 in PubMed. Case reports were synthesized and results were expressed as percentages. In total, 42 articles with 52 case reports were included. Most patients were adults with a dispersed age (mean age 44.9 ± 19.3), slightly more males (59.6 %), with psychiatric history (76.9 %) of affective disorders (26.9 %) or psychotic episodes (13.5 %) and/or neurological history (61.5 %) of epileptic seizures (38.5 %) or head trauma (13.5 %). Their clinical presentation consisted mostly of decreased psychomotor activity (mutism: 94.2 %; stupor: 78.8 %; staring: 57.7 %; negativism: 36.5 %) with some abnormal psychomotor activity (catalepsy: 40.4 %; rigidity: 40.4 %; waxy flexibility: 23.1 %; posturing: 21.2 %) and half had clinical epileptic seizures (51.9 %), mostly generalized tonic-clonic (23.1 %). Almost all electroencephalograms (97.9 %) and half of brain imaging exams (47.4 %) performed had abnormal findings. The epileptic activity was mainly generalized (50 %) and associated with primary epilepsy (30.8 %), iatrogenesis (23.1 %), other secondary aetiologies (25 %) or unknown causes (21.2 %). Most improved with antiepileptic therapy (87.5 %) and had a complete remission (86.5 %). Catatonia secondary to epileptic seizures often has a nonspecific clinical presentation and appears in patients with previous psychiatric diagnoses, so any patient with catatonia should be properly investigated to avoid misdiagnosis and ineffective treatments.
Topics: Adult; Anticonvulsants; Catatonia; Electroencephalography; Epilepsy; Humans; Male; Middle Aged; Seizures
PubMed: 36116265
DOI: 10.1016/j.eplepsyres.2022.107016 -
Frontiers in Genetics 2022Due to nonspecific symptoms, rare dyslipidaemias are frequently misdiagnosed, overlooked, and undertreated, leading to increased risk for severe cardiovascular disease,...
Due to nonspecific symptoms, rare dyslipidaemias are frequently misdiagnosed, overlooked, and undertreated, leading to increased risk for severe cardiovascular disease, pancreatitis and/or multiple organ failures before diagnosis. Better guidelines for the recognition and early diagnosis of rare dyslipidaemias are urgently required. Genomic DNA was isolated from blood samples of a Pakistani paediatric patient with hypertriglyceridemia, and from his parents and siblings. Next-generation sequencing (NGS) was performed, and an expanded dyslipidaemia panel was employed for genetic analysis. The NGS revealed the presence of a homozygous missense pathogenic variant c.230G>A (NM_178172.6) in exon 3 of the (glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1) gene resulting in amino acid change p.Cys77Tyr (NP_835466.2). The patient was 5.5 years old at the time of genetic diagnosis. The maximal total cholesterol and triglyceride levels were measured at the age of 10 months (850.7 mg/dl, 22.0 mmol/L and 5,137 mg/dl, 58.0 mmol/L, respectively). The patient had cholesterol deposits at the hard palate, eruptive xanthomas, lethargy, poor appetite, and mild splenomegaly. Both parents and sister were heterozygous for the familial variant in the gene. Moreover, in the systematic review, we present 62 patients with pathogenic variants in the gene and clinical findings, associated with hyperlipoproteinemia. In a child with severe hypertriglyceridemia, we identified a pathogenic variant in the gene causing hyperlipoproteinemia (type 1D). In cases of severe elevations of plasma cholesterol and/or triglycerides genetic testing for rare dyslipidaemias should be performed as soon as possible for optimal therapy and patient management.
PubMed: 36051701
DOI: 10.3389/fgene.2022.983283 -
Late epileptic seizures following cerebral venous thrombosis: a systematic review and meta-analysis.Neurological Sciences : Official... Sep 2022Identifying late epileptic seizures (LS) following cerebral venous thrombosis (CVT) can be useful for prognosis and management. We systematically reviewed the literature... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Identifying late epileptic seizures (LS) following cerebral venous thrombosis (CVT) can be useful for prognosis and management. We systematically reviewed the literature to identify risk factors for LS due to CVT.
METHODS
We systematically searched PubMed, Scholar, and Scopus databases (May 2021) to identify studies reporting data on prevalence and risk factors for CVT-LS. The methodological quality was assessed with the Ottawa-Newcastle Scale. The risk of developing CVT-LS was summarized in meta-analyses and expressed as odds ratio (OR) and corresponding 95% confidence intervals (CIs) using random-effects models.
RESULTS
Out of the 332 records retrieved, four studies were eventually included with a total of 1309 patients with CVT and 142 (11%) with CVT-LS. The most relevant predictors of CVT-LS were symptomatic seizures (OR 5.66, 95% CI 3.83-8.35), stupor/coma (OR 6.81, 95% CI 1.18-39.20), focal neurologic signs (OR 6.81, 95% CI 1.18-39.2), hemorrhagic component (OR 3.52, 95% CI 2.45-5.06), and superior sagittal sinus involvement (OR 1.52, 95% CI 1.04-2.21).
CONCLUSION
There are several risk factors for CVT-LS that should be considered in clinical practice. Further high-quality studies are warranted to develop predictive models for individualized risk stratification and prediction of CVT-LS.
Topics: Epilepsy; Humans; Intracranial Thrombosis; Risk Factors; Seizures; Venous Thrombosis
PubMed: 35639217
DOI: 10.1007/s10072-022-06148-y -
Clinical Toxicology (Philadelphia, Pa.) Aug 2022Xylazine is an alpha-2-adrenergic agonist used for its sedative and analgesic properties in veterinary medicine. While not approved by the Food and Drug Administration...
PURPOSE
Xylazine is an alpha-2-adrenergic agonist used for its sedative and analgesic properties in veterinary medicine. While not approved by the Food and Drug Administration for use in humans, anecdotal evidence suggests that exposures in humans is on the rise. We sought to systematically review and synthesize the evidence on xylazine exposure in humans focusing on the clinical presentation, management, and outcomes.
METHODS
We conducted a systematic review of the literature including PubMed, Embase, and Scopus from their inception to September 9, 2021. We searched abstracts from selected emergency medicine and toxicology conferences from 2011 through 2021. We included clinical reports of xylazine exposure in humans. We excluded animal studies, studies, laboratory studies, or articles in a language other than English. From each included article, we extracted subjective and objective data that focused on clinical presentation, management, and outcomes of patients exposed to xylazine.
RESULTS
We evaluated a total of 1409 records, rendering a final set of 17 articles and 2 abstracts meeting inclusion criteria. We identified a total of 98 patients amongst reports ranging from 1979 to 2020 and across nine countries. The most common types of xylazine exposures reported were unintentional exposure and intentional misuse/abuse. Common symptoms on presentation included hypotension, bradycardia, drowsiness, lethargy, while apnea with intubation and death were less frequently reported.
CONCLUSION
Human exposure to xylazine appears to be a rising concern within the prehospital and emergency medicine setting. Although a standardized treatment algorithm cannot be recommended at this time, further research is needed to improve the care of patients exposed to xylazine.
Topics: Adrenergic Agonists; Bradycardia; Humans; Hypnotics and Sedatives; Hypotension; United States; Xylazine
PubMed: 35442125
DOI: 10.1080/15563650.2022.2063135 -
Obesity Surgery May 2022This study review the prevalence of selenium deficiency after bariatric surgery, incidence, and symptoms. A systematic literature search and meta-analysis was performed... (Meta-Analysis)
Meta-Analysis Review
This study review the prevalence of selenium deficiency after bariatric surgery, incidence, and symptoms. A systematic literature search and meta-analysis was performed in PubMed and Scopus for articles published by November 1, 2021, including the keywords "Roux-en Y gastric bypass", "RYGB", "Omega bypass", "Mini bypass", "One anastomosis gastric bypass", "Bariatric surgery", "Weight loss surgery", "Metabolic surgery", "Gastric bypass", "Loop gastric bypass", "Selenium", "Selenium deficiency", or a combination of aimed tothem in the title or abstract. In this review, nine studies examining a total of 1174 patients were included in this meta-analysis. The mean age of the patients was 41.14 ± 7.69 years. The mean interval between bariatric surgery and selenium deficiency was 40.36 ± 43.29 months. Mean BMI before surgery and at the time of selenium deficiency was 43.68 ± 4.91 kg/m and 28.41 ± 9.09 kg/m, respectively. Additionally, the results showed a prevalence of 16% and 2% of selenium deficiency at 1- and 2-year follow-up after bariatric surgery, respectively. Symptoms included weakness, myopathy, and cardiomyopathy, loss of muscle mass, erythematous desquamating eruption, lethargy, dyspnea, and bilateral lower extremity pitting edema. Forty percent of studies reported "Selenium orally (100 μg once daily)" as treatment option. A multidisciplinary team of healthcare professionals, including dietitians, should be involved in the bariatric patient's care. As a result, clinicians should encourage patients to take supplements for the rest of their lives, and patients should be monitored after surgery if necessary.
Topics: Adult; Bariatric Surgery; Gastric Bypass; Humans; Incidence; Malnutrition; Middle Aged; Obesity, Morbid; Retrospective Studies; Selenium; Treatment Outcome
PubMed: 35218005
DOI: 10.1007/s11695-022-05932-1 -
Medical Journal of the Islamic Republic... 2021Diarrhea-associated-hemolytic-uremic-syndrome (D+HUS) is a common from of HUS. Central-nervous-system (CNS) involvement is one of the most common extrarenal organ...
Diarrhea-associated-hemolytic-uremic-syndrome (D+HUS) is a common from of HUS. Central-nervous-system (CNS) involvement is one of the most common extrarenal organ involvements in children with D+HUS. This systematic review and meta-analysis aim to recognize the frequency of neurological complications in pts with HUS. Databases of PubMed, Embase, and Web of Science were searched systematically to find the papers on neurological involvement in HUS pts. Two researchers independently assessed the papers' quality and extracted data. CMA v. 2.2.064. was used for data analysis. Heterogeneity was evaluated using the I-squared (I2) test, and a fixed/random-effects model was used when appropriate. In this review, 21 studies including 2,189 participants with a median age between 1.3-40-year-old, entered the meta-analysis. The meta-analysis in D+HUS patients indicated 27.0% with neurological complications (95% CI, 22.0%-32.6%), 25.5% of symptoms weren't categorized (95% CI, 15.9%-38.3%), 20.8% of them developed the seizures (95% CI, 2.3%-74.4%). In D-HUS pts, 20.8% of them were presented neurological symptoms (95% CI, 17.9%-24.0%), of which 29.0% weren't categorized (95% CI, 19.2%-41.2%), 17.5% of pts got into coma (95% CI, 9.6%-29.7%), 5.6 % showed hemiparesis (95% CI, 2.8%-10.9%), 17.2% experienced lethargy (95% CI, 5.2%-44.1%), 30.5% developed the seizures (95% CI, 18.2%-46.2%), 7.4% manifested speech abnormalities (95% CI, 0.2%-7.22%), 6.4% of D-HUS pts presented visual-disturbances (95% CI, 3.4%-11.6%). This systematic review and meta-analysis indicated more than one-fourth of both D+HUS and D-HUS patients were presented with neurological symptoms, and the most prevalent symptoms were seizures, which can lead to an epilepsy sequel.
PubMed: 34956937
DOI: 10.47176/mjiri.35.91 -
Turkish Neurosurgery 2022To systematically evaluate the medication safety and effectiveness of Oxcarbazepine (OXC) and carbamazepine (CBZ) for the treatment of post-stroke epilepsy (PSE). (Meta-Analysis)
Meta-Analysis
AIM
To systematically evaluate the medication safety and effectiveness of Oxcarbazepine (OXC) and carbamazepine (CBZ) for the treatment of post-stroke epilepsy (PSE).
MATERIAL AND METHODS
We searched Medline and other databases to identify the randomized controlled trials (RCTs) that compare the efficacies of OXC and CBZ in treating PSE. Two authors extracted and analyzed the data independently with Revman 5.3 software. The Q-test and I2 were used to test the statistical heterogeneity. The fixed or random effect models were selected according to heterogeneity.
RESULTS
Eight RCTs that include 671 patients were involved in this study. The meta-analyses result showed that the overall efficiency of OXC was significantly better than that of CBZ (OR=4.55, 95% confidence interval (CI) (3.04?6.81)), the overall adverse events (OR=0.27, 95% CI (0.18?0.42), and the incidence of vomiting (OR=0.28, 95% CI (0.09?0.85)) of OXC was significantly less than that of CBZ. No significant differences in the incidence of rash (OR=0.45, 95% CI (0.19?1.07)), lethargy (OR=0.49, 95% CI (0.16?1.45)), and dizziness (OR=0.51, 95% CI (0.20?1.35)) were detected between OXC and CBZ.
CONCLUSION
OXC seems to be superior to CBZ in the treatment of PSE, with higher efficacy, and safety than the latter. However, more research on OXC and CBZ in the treatment of PSE is required in the later stage due to the sample size limitation of our study.
Topics: Anticonvulsants; Carbamazepine; Epilepsy; Humans; Oxcarbazepine
PubMed: 34936076
DOI: 10.5137/1019-5149.JTN.34664-21.3 -
Stroke Feb 2022Women have worse outcomes than men after stroke. Differences in presentation may lead to misdiagnosis and, in part, explain these disparities. We investigated whether... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Women have worse outcomes than men after stroke. Differences in presentation may lead to misdiagnosis and, in part, explain these disparities. We investigated whether there are sex differences in clinical presentation of acute stroke or transient ischemic attack.
METHODS
We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, or randomized controlled trial design; (2) admission for (suspicion of) ischemic or hemorrhagic stroke or transient ischemic attack; and (3) comparisons possible between sexes in ≥1 nonfocal or focal acute stroke symptom(s). A random-effects model was used for our analyses. We performed sensitivity and subanalyses to help explain heterogeneity and used the Newcastle-Ottawa Scale to assess bias.
RESULTS
We included 60 studies (n=582 844; 50% women). In women, headache (pooled odds ratio [OR], 1.24 [95% CI, 1.11-1.39]; I=75.2%; 30 studies) occurred more frequently than in men with any type of stroke, as well as changes in consciousness/mental status (OR, 1.38 [95% CI, 1.19-1.61]; I=95.0%; 17 studies) and coma/stupor (OR, 1.39 [95% CI, 1.25-1.55]; I=27.0%; 13 studies). Aspecific or other neurological symptoms (nonrotatory dizziness and non-neurological symptoms) occurred less frequently in women (OR, 0.96 [95% CI, 0.94-0.97]; I=0.1%; 5 studies). Overall, the presence of focal symptoms was not associated with sex (pooled OR, 1.03) although dysarthria (OR, 1.14 [95% CI, 1.04-1.24]; I=48.6%; 11 studies) and vertigo (OR, 1.23 [95% CI, 1.13-1.34]; I=44.0%; 8 studies) occurred more frequently, whereas symptoms of paresis/hemiparesis (OR, 0.73 [95% CI, 0.54-0.97]; I=72.6%; 7 studies) and focal visual disturbances (OR, 0.83 [95% CI, 0.70-0.99]; I=62.8%; 16 studies) occurred less frequently in women compared with men with any type of stroke. Most studies contained possible sources of bias.
CONCLUSIONS
There may be substantive differences in nonfocal and focal stroke symptoms between men and women presenting with acute stroke or transient ischemic attack, but sufficiently high-quality studies are lacking. More studies are needed to address this because sex differences in presentation may lead to misdiagnosis and undertreatment.
Topics: Cohort Studies; Cross-Sectional Studies; Diagnostic Errors; Female; Humans; Intracranial Hemorrhages; Ischemic Attack, Transient; Male; Sex Characteristics; Stroke; Treatment Outcome
PubMed: 34903037
DOI: 10.1161/STROKEAHA.120.034040