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Seizure Mar 2013Urinary incontinence may occur both in epileptic seizures (ES) and in non-epileptic events (NEE) such as psychogenic nonepileptic events (PNEEs) and syncope. A... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Urinary incontinence may occur both in epileptic seizures (ES) and in non-epileptic events (NEE) such as psychogenic nonepileptic events (PNEEs) and syncope. A comprehensive search of the literature to determine the accuracy of this physical finding and its prevalence in epileptic seizures and syncope is still lacking. To undertake a systematic review to determine sensitivity, specificity and likelihood ratios (LR) of urinary incontinence in the differential diagnosis between ES and NEEs (including syncope and PNEEs).
METHODS
Studies evaluating the presence of urinary incontinence in ES and NEEs were systematically searched. Sensitivity, specificity, positive and negative likelihood ratio (pLR, nLR) of incontinence were determined for each study and for the pooled results.
RESULTS
Five studies (221 epilepsy patients and 252 subjects with NEEs) were included. Pooled accuracy measures of urinary incontinence (ES versus NEEs) were: sensitivity 38%, specificity 57%, pLR 0.879 (95% CI 0.705-1.095) and nLR 1.092 (95% CI 0.941-1.268). For each comparison (epileptic seizures versus NEEs; ES versus syncope; ES versus PNEEs), pooled accuracy measures for urinary incontinence showed a statistically not significant pLR (the 95% CI of the pooled value included 1, and the LR value of 1 has no discriminatory value).
CONCLUSIONS
A pooled analysis of data from the literature shows that urinary incontinence has no value either in the differential diagnostic between ES and syncope/PNEEs. Systematic reviews with pooled analyses of data from the literature allow an increase in statistical power and an improvement in precision, representing a useful tool to determine the accuracy of a certain physical finding in the differential diagnosis between ES and other paroxysmal events.
Topics: Diagnosis, Differential; Humans; Prospective Studies; Retrospective Studies; Seizures; Syncope; Urinary Incontinence
PubMed: 23142708
DOI: 10.1016/j.seizure.2012.10.011 -
Pediatric Research Apr 2022The objective of this study is to test how certain signs and symptoms related to COVID-19 in children predict the positivity or negativity of the SARS-CoV-2... (Review)
Review
BACKGROUND
The objective of this study is to test how certain signs and symptoms related to COVID-19 in children predict the positivity or negativity of the SARS-CoV-2 nasopharyngeal swab in children.
METHODS
We review the data of children who were tested for SARS-CoV-2 for a suspected infection. We compared the clinical characteristics of the subjects who tested positive and negative, including the sensibility, positive and negative predictive value of different combination of signs and symptoms.
RESULTS
Of all the suspected infected, 2596 tested negative (96.2%) and 103 tested positive (3.8%). The median age was 7.0 and 5.3 years for the positive and negative ones, respectively. The female to male ratio was ~1:1.3. Fever and respiratory symptoms were mostly reported. Most positive children had a prior exposure to SARS-CoV-2-infected subjects (59.2%). A total of 99.3% of patients without fever nor exposure to the virus proved negative to the SARS-CoV-2 test.
CONCLUSIONS
Our study suggests that a child without fever or contact with infected subjects is SARS-CoV-2 negative. If this were to be confirmed, many resources would be spared, with improved care of both COVID-19 and not COVID-19-affected children.
IMPACT
Key message: lack of fever and exposure to SARS-CoV-2-infected people highly predicts a negative results of the SARS-CoV-2 nasopharyngeal swab in the paediatric population. Added value to the current literature: this is the first article to prove this point.
IMPACT
reduction of emergency department accesses of children with suspected SARS-CoV-2 infection; increased outpatient management of children with cough or other common respiratory symptoms of infancy; sparing of many human and material health resources.
Topics: COVID-19; Child; Cough; Emergency Service, Hospital; Female; Fever; Humans; Male; SARS-CoV-2
PubMed: 34117360
DOI: 10.1038/s41390-021-01585-5 -
PM & R : the Journal of Injury,... May 2013Electrophysiology remains an important tool in the evaluation of patients presenting with signs and symptoms of motor neuron disease. The electrodiagnostic study should... (Review)
Review
Electrophysiology remains an important tool in the evaluation of patients presenting with signs and symptoms of motor neuron disease. The electrodiagnostic study should include peripheral nerve conduction studies and needle electromyography to both exclude treatable disease and gather evidence regarding a diagnosis of amyotrophic lateral sclerosis (ALS). The recent changes in the revised El Escorial criteria, recommended by the Awaji-shima consensus group, have increased the diagnostic significance of fasciculation potentials to equal that of fibrillation and positive sharp-wave potentials in the needle electromyography examination of patients suspected of having ALS. In addition, electrophysiologic evidence is now considered equivalent to clinical signs and symptoms in reaching a diagnostic certainty of ALS. These changes, strategies for the design, and implementation of an effective electrodiagnostic evaluation, in addition to electrophysiologic techniques and their relationship to the evaluation of a patient with ALS, are reviewed and discussed.
Topics: Amyotrophic Lateral Sclerosis; Diagnosis, Differential; Electromyography; Humans; Neural Conduction
PubMed: 23523708
DOI: 10.1016/j.pmrj.2013.03.020 -
NeuroImage. Clinical 2023In recent years in vivo visualization of tau deposits has become possible with various PET radiotracers. The tau tracer [F]PI-2620 proved high affinity both to...
In recent years in vivo visualization of tau deposits has become possible with various PET radiotracers. The tau tracer [F]PI-2620 proved high affinity both to 3-repeat/4-repeat tau in Alzheimer's disease as well as to 4-repeat tau in progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). However, to be clinically relevant, biomarkers should not only correlate with pathological changes but also with disease stage and progression. Therefore, we aimed to investigate the correlation between topology of [F]PI-2620 uptake and symptomatology in 4-repeat tauopathies. 72 patients with possible or probable 4-repeat tauopathy, i.e. 31 patients with PSP-Richardson's syndrome (PSP-RS), 30 with amyloid-negative CBS and 11 with PSP-non-RS/CBS, underwent [F]PI-2620-PET. Principal component analysis was performed to identify groups of similar brain regions based on 20-40 min p.i. regional standardized uptake value ratio z-scores. Correlations between component scores and the items of the PSP Rating Scale were explored. Motor signs like gait, arising from chair and postural instability showed a positive correlation with tracer uptake in mesial frontoparietal lobes and the medial superior frontal gyrus and adjacent anterior cingulate cortex. While the signs disorientation and bradyphrenia showed a positive correlation with tracer uptake in the parietooccipital junction, the signs disorientation and arising from chair were negatively correlated with tau-PET signal in the caudate nucleus and thalamus. Total PSP Rating Scale Score showed a trend towards a positive correlation with mesial frontoparietal lobes and a negative correlation with caudate nucleus and thalamus. While in CBS patients, the main finding was a negative correlation of tracer binding in the caudate nucleus and thalamus and a positive correlation of tracer binding in medial frontal cortex with gait and motor signs, in PSP-RS patients various correlations of clinical signs with tracer binding in specific cerebral regions could be detected. Our data reveal [F]PI-2620 tau-PET topology to correlate with symptomatology in 4-repeat tauopathies. Longitudinal studies will be needed to address whether a deterioration of signs and symptoms over time can be monitored by [F]PI-2620 in 4-repeat tauopathies and whether [F]PI-2620 may serve as a marker of disease progression in future therapeutic trials. The detected negative correlation of tracer binding in the caudate nucleus and thalamus with the signs disorientation and arising from chair may be due to an increasing atrophy in these regions leading to partial volume effects and a relative decrease of tracer uptake in the disease course. As cerebral regions correlating with symptomatology differ depending on the clinical phenotype, a precise knowledge of clinical signs and symptoms is necessary when interpreting [F]PI-2620 PET results.
Topics: Humans; Supranuclear Palsy, Progressive; Pyridines; Movement Disorders; Confusion; tau Proteins; Positron-Emission Tomography
PubMed: 37087820
DOI: 10.1016/j.nicl.2023.103402 -
Minerva Anestesiologica Dec 2020Chronic musculoskeletal pain is a highly prevalent condition that is commonly encountered in both general and specialist practice. Nonetheless, it still represents a... (Review)
Review
Chronic musculoskeletal pain is a highly prevalent condition that is commonly encountered in both general and specialist practice. Nonetheless, it still represents a significant challenge to the practitioners because of the lack of substantial evidence-based guidance. This review aimed to summarize the main pathophysiological mechanisms of chronic pain offering a mechanism-oriented approach to diagnosis and management. We believe that a basic knowledge of the physical signs and symptoms of these mechanisms could empower the clinician to choose appropriate medication and identify high-risk pain patients. Central sensitization and neuropathic features may arise in previously nociceptive and inflammatory pain syndromes. Central sensitization is a functional remodeling of the spinal cord, where light touch afferents are recruited by nociceptive second-order neurons. Neuropathic features include both negative signs, such as reduced perception of vibration and touch, and positive symptoms, such as paroxysmal electric shock pain, due to ectopic discharge. These phenomena are the neurobiological basis of the commonly defined refractory chronic pain. Early detection and specific treatment of these mechanisms are required in order to restrain the reinforcement of pronociceptive remodeling of the nervous system.
Topics: Chronic Pain; Humans; Musculoskeletal Pain; Neurophysiology; Pain Measurement; Peripheral Nervous System Diseases
PubMed: 33337120
DOI: 10.23736/S0375-9393.20.14573-5 -
Current Opinion in Otolaryngology &... Oct 2013To review benign paroxysmal positional vertigo (BPPV) and some of the recent literature. As BPPV is such a common diagnosis, it is important to understand the disorder... (Review)
Review
PURPOSE OF REVIEW
To review benign paroxysmal positional vertigo (BPPV) and some of the recent literature. As BPPV is such a common diagnosis, it is important to understand the disorder and treatment considerations.
RECENT FINDINGS
Although BPPV is typically an easy diagnosis to make, one must be aware of the differential diagnosis. An unusual entity, convergence spasm, is recently presented and discussed as an addition to the differential diagnosis. The recent literature confirms the efficacy of treatment of BPPV. Large studies of horizontal canal BPPV support the success of the barbeque roll and present the simple head shake as a possible treatment in the apogeotropic form. There is reported success with the less often discussed Gufoni (and its variations) maneuver. The presence of orthoptic nystagmus during treatment has positive predictive value for the success of the maneuver. Although uncommon, canal conversion is important to recognize during treatment as it can be readily treated.
SUMMARY
BPPV is a very common cause of dizziness and generally straightforward to identify and treat. Awareness of possible horizontal canal variants and nonvestibular differential diagnosis possibilities is important. Repositioning maneuvers of various types are typically successful and understanding the nuances is important in assuring successful outcomes.
Topics: Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Humans; Physical Examination; Posture; Prognosis; Vertigo
PubMed: 23995328
DOI: 10.1097/MOO.0b013e32836463d6 -
Emotion (Washington, D.C.) Sep 2022Depression is characterized by a pattern of maladaptive emotion regulation. Recently, researchers have begun to focus on associations between depression and two positive... (Randomized Controlled Trial)
Randomized Controlled Trial
Depression is characterized by a pattern of maladaptive emotion regulation. Recently, researchers have begun to focus on associations between depression and two positive affect regulation strategies: savoring and dampening. Savoring, or upregulation of positive affect, is positively associated with well-being and negatively associated with depression, whereas dampening, or downregulation of positive affect, is positively associated with depression, anhedonia, and negative affect. To date, no research has examined whether savoring or dampening can affect neurophysiological reactivity to reward, which previous research has shown is associated with symptoms of depression. Here, we examined associations between psychophysiological reward processing-primarily captured by the Reward Positivity (RewP), an event-related potential (ERP) deflection elicited by feedback indicating reward (vs. nonreward)-positive affect regulation strategies, and symptoms of depression. One hundred undergraduates completed questionnaires assessing affect, emotion regulation, and depressive symptoms and completed a computerized guessing task, once before and again after being randomly assigned to emotion-regulation strategy conditions. Results indicate that (a) the relationship between RewP amplitude and depressive symptoms may, in part, depend upon positive affect regulation strategies and (b) the RewP elicited by reward appears sensitive to a savoring intervention. These findings suggest that mitigating depressive symptoms in emerging adults may depend on both top-down (i.e., savoring) and bottom-up (i.e., RewP) forms of positive affect regulation and have important implications for clinical prevention and intervention efforts for depressive symptoms and disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Adult; Anhedonia; Depression; Electroencephalography; Emotional Regulation; Evoked Potentials; Humans; Reward
PubMed: 33252936
DOI: 10.1037/emo0000914 -
Indian Journal of Ophthalmology Oct 2023In Humphrey visual field analyzer, the false-positive (FP) responses imply that the patient has pressed the response button despite no stimulus being seen at the time of...
BACKGROUND
In Humphrey visual field analyzer, the false-positive (FP) responses imply that the patient has pressed the response button despite no stimulus being seen at the time of response and FP rates >15% are flagged. The classical "Trigger happy" visual field has increased fixation loss, very high threshold retinal sensitivity with the values in supernormal range, "white scotoma" on grayscale map, high positive mean deviation (MD), glaucoma hemifield test (GHT) gives classification of "abnormally high sensitivity, 'Excessive high false positive' message is displayed," and pattern deviation probability plot has more defects than total deviation probability plot known as "reverse cataract pattern." However, these classical findings are not seen in all the cases of FP as the same thumb rule cannot be applied to all the visual fields with high FP.
PURPOSE
This video emphasizes the significance of careful examination of all the parameters in a visual field printout of high FP to interpret the test results and the caution needed when an FP response is seen in a patient with advanced glaucoma.
SYNOPSIS
The video presents some interesting visual fields in normal and glaucoma patients and the effect of high FP responses on MD, the different classification messages displayed for GHT, patterns of total deviation probability plot and pattern deviation probability plot, and how to identify the hidden FP.
HIGHLIGHTS
This video highlights the importance of careful examination of all the parameters in a visual field printout to interpret the test results. One should be especially cautious when an FP response is noted in a patient with advanced glaucoma, as the retinal sensitivity values may not be in supernormal range but are significantly affected by the increased FP. Clinician should be able to identify this and repeat the test as high FP reponses can lead to underestimation of visual field loss.
VIDEO LINK
https://youtu.be/T2SGZf16UzA.
Topics: Humans; Visual Field Tests; Visual Fields; Glaucoma; Scotoma; Vision Disorders
PubMed: 37787253
DOI: 10.4103/IJO.IJO_601_23 -
Canadian Medical Association Journal Apr 1963Foregut cysts frequently cause symptoms in the first three decades of life. The symptoms consist of dyspnea, wheezing, cough and sputum, dysphagia, stridor, and those...
Foregut cysts frequently cause symptoms in the first three decades of life. The symptoms consist of dyspnea, wheezing, cough and sputum, dysphagia, stridor, and those associated with right heart strain. Symptoms and the radiological appearance of the uncomplicated cyst mimic mediastinal tumour and mediastinal obstruction. The symptoms and radiological appearance of the ruptured infected cyst simulate those of lung abscess, diaphragmatic hernia, ruptured hydatid cyst, cavitated peripheral carcinoma and pulmonary tuberculosis. In this series the differentiation from other cysts was made thus: with intralobar sequestration, a systemic arterial blood supply was demonstrated; with hydatid cyst, there was a positive intradermal skin test and (radiologically) following rupture, the appearance of a pericystic pneumatocele followed by the water-lily sign was diagnostic; with emphysematous cysts, the signs of associated bronchitis were present; in the presence of pseudocysts, there was a previous history of lung abscess, staphylococcal infection or tuberculosis. Cysts should be removed when first diagnosed.
Topics: Animals; Bronchitis; Cough; Cysts; Dyspnea; Echinococcosis; Echinococcus; Hernia, Hiatal; Humans; Lung Abscess; Mediastinum; Radiology; Respiratory Sounds; Rupture; Sputum; Tuberculosis, Pulmonary
PubMed: 13974421
DOI: No ID Found -
Pediatric Rheumatology Online Journal Feb 2021Active pediatric COVID-19 pneumonia and MIS-C are two disease processes requiring rapid diagnosis and different treatment protocols.
IMPORTANCE
Active pediatric COVID-19 pneumonia and MIS-C are two disease processes requiring rapid diagnosis and different treatment protocols.
OBJECTIVE
To distinguish active pediatric COVID-19 pneumonia and MIS-C using presenting signs and symptoms, patient characteristics, and laboratory values.
DESIGN
Patients diagnosed and hospitalized with active COVID-19 pneumonia or MIS-C at Children's of Alabama Hospital in Birmingham, AL from April 1 through September 1, 2020 were identified retrospectively. Active COVID-19 and MIS-C cases were defined using diagnostic codes and verified for accuracy using current US Centers for Disease Control case definitions. All clinical notes were reviewed for documentation of COVID-19 pneumonia or MIS-C, and clinical notes and electronic medical records were reviewed for patient demographics, presenting signs and symptoms, prior exposure to or testing for the SARS-CoV-2 virus, laboratory data, imaging, treatment modalities and response to treatment.
FINDINGS
111 patients were identified, with 74 classified as mild COVID-19, 8 patients as moderate COVID-19, 8 patients as severe COVID-19, 10 as mild MIS-C and 11 as severe MIS-C. All groups had a male predominance, with Black and Hispanic patients overrepresented as compared to the demographics of Alabama. Most MIS-C patients were healthy at baseline, with most COVID-19 patients having at least one underlying illness. Fever, rash, conjunctivitis, and gastrointestinal symptoms were predominant in the MIS-C population whereas COVID-19 patients presented with predominantly respiratory symptoms. The two groups were similar in duration of symptomatic prodrome and exposure history to the SARS-CoV-2 virus, but MIS-C patients had a longer duration between presentation and exposure history. COVID-19 patients were more likely to have a positive SAR-CoV-2 PCR and to require respiratory support on admission. MIS-C patients had lower sodium levels, higher levels of C-reactive protein, erythrocyte sedimentation rate, d-dimer and procalcitonin. COVID-19 patients had higher lactate dehydrogenase levels on admission. MIS-C patients had coronary artery changes on echocardiography more often than COVID-19 patients.
CONCLUSIONS AND RELEVANCE
This study is one of the first to directly compare COVID-19 and MIS-C in the pediatric population. The significant differences found between symptoms at presentation, demographics, and laboratory findings will aide health-care providers in distinguishing the two disease entities.
Topics: Abdominal Pain; Adolescent; Black or African American; Asthma; C-Reactive Protein; COVID-19; Case-Control Studies; Child; Child, Preschool; Comorbidity; Conjunctivitis; Coronary Artery Disease; Diabetes Mellitus; Diarrhea; Dilatation, Pathologic; Echocardiography; Exanthema; Female; Fever; Heart Defects, Congenital; Hispanic or Latino; Humans; Hyponatremia; Male; Nausea; Neoplasms; Neurodevelopmental Disorders; Obesity; SARS-CoV-2; Severity of Illness Index; Sex Distribution; Stroke Volume; Systemic Inflammatory Response Syndrome; Time Factors; Vomiting
PubMed: 33627147
DOI: 10.1186/s12969-021-00508-2