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BACKGROUND/AIMS: The antiseizure medication, vigabatrin, is associated with visual field loss (VAVFL). However, the fields can be challenging to interpret due to unfamiliarity with the characteristics of the defect and/or to difficulty in obtaining a reliable examination, particularly in patients with cognitive limitations associated with the epilepsy. Two machine-learning pattern recognition algorithms were developed to identify VAVFL, objectively. METHODS: The algorithms adhered to the European Medicines Agency-approved protocol for the detection of VAVFL (Three Zone Age Corrected Full Field 135 Screening Test (FF135) and the Central C30-2 Threshold Test (C30-2T) with the Humphrey Field Analyzer). Each algorithm compared the similarity of the measured field from each eye to that of modelled reference patterns of VAVFL, matched for equivalent severity, and objectively derived from a previously described case series of 123 adults. The algorithms were augmented by the optional inclusion of symmetrisation, a signal-to-noise enhancement technique based on the between-eye mirror image symmetry of VAVFL. Utility of the algorithms for identifying VAVFL was evaluated against a case series of 89 consecutively identified individuals stratified across six diagnostic categories including homonymous and glaucomatous losses. RESULTS: The algorithms exhibited excellent agreement with a 'gold standard' clinical interpretation (sensitivity and specificity: FF135, 22/23; 30/30; C30-2T, 17/18; 48/51). Symmetrisation was particularly useful in identifying VAVFL when perimetric learning or fatigue influenced the outcome for one eye and for visualisation in the presence of concomitant homonymous loss. CONCLUSION: The directly interpretable machine-learning outcome correctly identified VAVFL and could assist patient management in community (neuro-)ophthalmology.

BACKGROUND: Pakistan faces profound mental health challenges, which necessitate the urgent need for a comprehensive assessment of its mental healthcare system. A holistic understanding of the mental health landscape is essential to identify strengths, weaknesses, and existing gaps within the system, which can inform targeted interventions and policy enhancements to improve mental healthcare accessibility. OBJECTIVE: The primary objective of this desk research is to conduct an in-depth analysis of Pakistan's mental healthcare system across various dimensions, guided by the World Health Organization's Assessment Tool for Mental Health Systems (WHO-AIMS). METHODS: Data for this desk research and scoping was obtained through desk research, including an examination of existing policies and legislation and consultations with various health facilities across Pakistan. This comprehensive analysis focused on six critical domains within the WHO-AIMS framework: policy and legislation, mental health services, integration of mental health into primary care, public awareness and collaboration with other sectors, human resources, and monitoring and research initiatives. RESULTS: The findings provides a snapshot of strength and opportunities for improvement in Pakistan's mental healthcare system that can serve as the foundation for revising and updating national priorities. Key areas of focus include enhancing policy and legislation, expanding access to mental health services, improving existing initiatives for better integration of mental health into primary care, improving public awareness and sector collaboration, addressing human resource challenges, and strengthening monitoring and research initiatives. CONCLUSION: This desk research provides a roadmap for refining and enhancing Pakistan's mental health ecosystem and informs the prioritization of mental health campaigning efforts.

Since the 1970s, the utility of nailfold capillaroscopy (NFC) in diagnosing rheumatological disorders such as systemic sclerosis has been well established. Further studies have also shown that NFC can detect non-rheumatic diseases such as diabetes, glaucoma, dermatitis, and Alzheimer disease. In the past decade, nailfold capillary morphological changes have also been reported as symptoms of unhealthy lifestyle habits such as poor diet, smoking, sleep deprivation, and even psychological stress, all of which contribute to slow blood flow. Therefore, studying the relationships between the morphology of nailfold capillaries and lifestyle habits has a high potential to indicate unhealthy states or even pre-disease conditions. Simple, inexpensive, and non-invasive methods such as NFC are important and useful for routine medical examinations. The present study began with a systematic literature search of the PubMed database followed by a summary of studies reporting the assessment of morphological changes detected by NFC, and a comprehensive review of NFC's utility in clinical diagnosis and improving unhealthy dietary lifestyles. It culminates in a summary of dietary and lifestyle health promotion strategy, assessed based on NFC and other related measurements that indicate healthy microvascular blood flow and endothelial function.

Abstract Background and Aim The aim of this study is to compare the effects of osteopathic manipulative therapy home program (OMT‐H) versus abdominal massage home program (AMHP) in treating constipation in children with cerebral palsy (CP). Methods Twenty‐nine children with CP with a mean age of 12.2 ± 3.76 years, who were constipated and were not on medication, were divided into three randomized groups: (i) control group ( n = 10), (ii) AMHP ( n = 10), and (iii) OMT‐H ( n = 9). In AMHP and OMT‐H groups, treatment was applied as 20‐min sessions every other day for 10 sessions for 3 weeks. Modified Constipation Assessment Scale (MCAS), Rome III criteria, and the Bristol Stool Form Scale (BSFS) were used for evaluation before treatment and once a week during treatment. Results While there was no change in constipation symptoms in the control group, there was an improvement in constipation symptoms after treatment in the AMHP and OMT‐H groups (AMHP, P = 0.003; OMT‐H, P = 0.000014). While the treatment showed to be effective from the first week in the OMT‐H group, the change in BSFS ( P = 0.026) and MCAS sub‐parameters was found to be superior. Conclusion AMHP and OMT‐H are effective and beneficial in treating constipation. In children with CP, OMT‐H was found to be quicker and more successful compared with AMHP. The OMT‐H can be effectively used in clinical practice in relieving constipation in CP.

Annotated bibliography of genetic addiction risk severity (GARS) publications, pro-dopamine regulation in nutraceuticals (KB220 nutraceutical variants), and policy documents. Further research is required to encourage the field to consider "Reward Deficiency Syndrome (RDS) Anti-addiction Modeling" which involves early risk identification by means of genetic assessment similar to GARS, followed by induction of dopamine homeostasis by means of genetically guided pro-dopamine regulation similar to KB220. These results suggest that genetically based treatments may be a missing piece in the treatment of substance use disorder (SUD).

Objectives: The opioid crisis in the last few decades has mounted to a global level, impacting all areas of socioeconomic, demographic, geographic, and cultural boundaries. Traditional treatments have not been deemed to show the degree of efficacy necessary to address the crisis. The authors of this review paper have set forth an unprecedented and in-depth look into multi-factorial determinants that have contributed to the opioid crisis becoming global and multi-faceted. Methods: For this narrative review/opinion article, we searched PsychINFO, PubMed, Google Scholar, and Web of Science databases to identify relevant articles on topics including the "opioid crisis," "opioid mechanisms," "genetics and epigenetics," "neuropharmacology," and "clinical aspects of opioid treatment and prevention." Since this was not a systematic review the articles selected could represent unitential bias. Results: Despite some success achieved through Opioid Substitution Therapy (OST) in harm reduction, the annual mortality toll in the US alone surpasses 106,699 individuals, a figure expected to climb to 165,000 by 2025. Data from the Substance Abuse and Mental Health Services Administration's (SAMHSA) National Survey on Drug Abuse and Health (NSDUH) reveals that approximately 21.4% of individuals in the US engaged in illicit drug use in 2020, with 40.3 million individuals aged 12 or older experiencing a Substance Use Disorder (SUD). Provisional figures from the Centers for Disease Control and Prevention (CDC) indicate a troubling 15% increase in overdose deaths in 2021, rising from 93,655 in 2020 to 107,622, with opioids accounting for roughly 80,816 of these deaths. Conclusions: We advocate reevaluating the "standard of care" and shifting towards inducing dopamine homeostasis by manipulating key neurotransmitter systems within the brain's reward cascade. We propose a paradigm shift towards a novel "standard of care" that begins with incorporating Genetic Addiction Risk Severity (GARS) testing to assess pre-addiction risk and vulnerability to opioid-induced addiction; emphasis should be placed on inducing dopamine homeostasis through safe and non-addictive alternatives like KB220, and comprehensive treatment approaches that address psychological, spiritual, and societal aspects of addiction through Awareness Integration Therapy (AIT).

Microorganisms are the predominant life form on earth and can be found in virtually every location on, above, and/or below the earth’s surface. In the process of building complex biological networks [1,2], microorganisms form a superstructure of communication that has been termed “The Internet of Microbes” [3].

SUMMARY. The article application of H-reflexometry in the study of the central mechanisms of random human movements, which is mainly carried out on healthy subjects, is demonstrated. It has been shown that the results of clinical trials performed by H-reflexometry with the participation of injured people or people with neurological disorders provide additional information about these mechanisms, reveal the causes of human motor function disorders, contribute to the improvement of methods of their study and provide opportunities for the implementation of rehabilitation measures.
 The aim – to evaluate the prospects of using H-reflexometry in the study of central mechanisms of movements and means of restoring and maximizing the motor capabilities of people.
 Material and Methods. The analysis was carried out using the scientific biological and medical information search system PubMed.
 Results. H-reflexometry was used both for the study of motor functions of healthy people and patients with injuries and neurological disorders. The authors studied mainly H-reflexes m.soleus, m. flexor carpi radialis, m. quadriceps. The total number of publications with the results of studies performed on other muscles indicates the possibility of a wider use of H-reflexometry in the study of motor functions in humans than is generally accepted and currently implemented. It was found that H-reflexometry was used to the greatest extent in the researches of the mechanisms of motor disorders arising as a result of stroke and spinal cord injuries.
 Conclusions. The results of the review indicate that H-reflexometry provides ample opportunities to study human motor function in normal and pathological conditions, and it may be especially promising at present to examine injured people using this method, to implement and monitor their rehabilitation measures.

Darbo autorius: Rugilė Klimaitė Darbo pavadinimas: Hornerio sindromo priežastys ir klinikiniai ypatumai Tyrimo tikslas: Įvertinti pacientų, kuriems diagnozuotas Hornerio sindromas, su rega susijusius simptomus bei dažniausias priežastis. Tyrimo uždaviniai: 1. Nustatyti dažniausias Hornerio sindromą sukeliančias priežastis. 2. Įvertinti regos funkcijos sutrikimus bei su rega susijusius simptomus sergant Hornerio sindromu. 3. Nustatyti kitų organų sistemų pažeidimų sukeltus simptomus pacientams, kuriems diagnozuotas Hornerio sindromas. Tyrimo dalyviai: Pacientai, kuriems 2018 – 2022 m. diagnozuotas Hornerio sindromas LSMUL KK. Tyrimo metodika: Tyrime nagrinėti retrospektyvūs ligos istorijų duomenys. Naudojantis LSMUL KK duomenų baze buvo atrinkti pacientai, gydyti LSMUL KK Akių ligų ar Neurochirurgijos klinikose, kuriems 2018 – 2022 m. diagnozuotas Hornerio sindromas (G90.2), vyzdžio funkcijos sutrikimai (H57.0) ir vyzdžio funkcijos sutrikimai sergant ligomis, klasifikuojamomis kitur (H58.0). Tyrimo rezultatai: Tyrime dalyvavo 35 moterys ir 16 vyrų. Pacientų amžiaus vidurkis – 44,51 ± 25,99 m. Hornerio sindromo priežastis nebuvo nustatyta 29,4 proc. tiriamųjų. Suaugusiųjų dažniausios Hornerio sindromo priežastys buvo kaklo, krūtinės ir veido srities operacijos (15,4 proc.) bei traumos (15,4 proc.). Vaikams dažniausiai pasireiškė įgimtas Hornerio sindromas (50,0 proc.). Suaugusiems dažniausiai buvo pažeistas antros eilės neuronas (25,6 proc.), o didžiajai daliai vaikų pažeidimo vieta nebuvo nustatyta (71,4 proc.). Visiems pacientams pasireiškė vieno vyzdžio miozė, vieno voko ptozė pasireiškė 78,4 proc., o vienos veido pusės anhidrozė – 9,8 proc. tiriamųjų. Vertinant kitų organų sistemų pažeidimo sukeltus simptomus, pacientai dažniausiai nurodė skausmą (43,3 proc.), ypač galvos skausmą (27,5 proc.). Išvados: 1) Dažniausios suaugusių pacientų Hornerio sindromą sukeliančios priežastys yra kaklo, krūtinės ir veido srities operacijos bei traumos. Vaikams dažniausiai pasireiškė įgimtas Hornerio sindromas. 2) Hornerio sindromo metu dažniausiai pasireiškia vienos veido pusės vyzdžio miozė, voko ptozė. 3) Hornerio sindromą turintiems pacientams kitų organų sistemų pažeidimų sukelti simptomai yra galvos, krūtinės, kaklo, peties srities skausmas, viršutinių kvėpavimo takų infekcijos simptomai, insulto požymiai.

Darbo autorius: Rugilė Klimaitė Darbo pavadinimas: Hornerio sindromo priežastys ir klinikiniai ypatumai Tyrimo tikslas: Įvertinti pacientų, kuriems diagnozuotas Hornerio sindromas, su rega susijusius simptomus bei dažniausias priežastis. Tyrimo uždaviniai: 1. Nustatyti dažniausias Hornerio sindromą sukeliančias priežastis. 2. Įvertinti regos funkcijos sutrikimus bei su rega susijusius simptomus sergant Hornerio sindromu. 3. Nustatyti kitų organų sistemų pažeidimų sukeltus simptomus pacientams, kuriems diagnozuotas Hornerio sindromas. Tyrimo dalyviai: Pacientai, kuriems 2018 – 2022 m. diagnozuotas Hornerio sindromas LSMUL KK. Tyrimo metodika: Tyrime nagrinėti retrospektyvūs ligos istorijų duomenys. Naudojantis LSMUL KK duomenų baze buvo atrinkti pacientai, gydyti LSMUL KK Akių ligų ar Neurochirurgijos klinikose, kuriems 2018 – 2022 m. diagnozuotas Hornerio sindromas (G90.2), vyzdžio funkcijos sutrikimai (H57.0) ir vyzdžio funkcijos sutrikimai sergant ligomis, klasifikuojamomis kitur (H58.0). Tyrimo rezultatai: Tyrime dalyvavo 35 moterys ir 16 vyrų. Pacientų amžiaus vidurkis – 44,51 ± 25,99 m. Hornerio sindromo priežastis nebuvo nustatyta 29,4 proc. tiriamųjų. Suaugusiųjų dažniausios Hornerio sindromo priežastys buvo kaklo, krūtinės ir veido srities operacijos (15,4 proc.) bei traumos (15,4 proc.). Vaikams dažniausiai pasireiškė įgimtas Hornerio sindromas (50,0 proc.). Suaugusiems dažniausiai buvo pažeistas antros eilės neuronas (25,6 proc.), o didžiajai daliai vaikų pažeidimo vieta nebuvo nustatyta (71,4 proc.). Visiems pacientams pasireiškė vieno vyzdžio miozė, vieno voko ptozė pasireiškė 78,4 proc., o vienos veido pusės anhidrozė – 9,8 proc. tiriamųjų. Vertinant kitų organų sistemų pažeidimo sukeltus simptomus, pacientai dažniausiai nurodė skausmą (43,3 proc.), ypač galvos skausmą (27,5 proc.). Išvados: 1) Dažniausios suaugusių pacientų Hornerio sindromą sukeliančios priežastys yra kaklo, krūtinės ir veido srities operacijos bei traumos. Vaikams dažniausiai pasireiškė įgimtas Hornerio sindromas. 2) Hornerio sindromo metu dažniausiai pasireiškia vienos veido pusės vyzdžio miozė, voko ptozė. 3) Hornerio sindromą turintiems pacientams kitų organų sistemų pažeidimų sukelti simptomai yra galvos, krūtinės, kaklo, peties srities skausmas, viršutinių kvėpavimo takų infekcijos simptomai, insulto požymiai.

Apical hypertrophic cardiomyopathy (AHCM) is a rare phenotypic variant of hypertrophic cardiomyopathy (HCM), most commonly seen in Asian men (Yamaguchi syndrome). It is characterized by hypertrophy, predominantly affecting the cardiac apex, with an "ace of spades"-shaped left ventricular (LV) cavity best seen on the 4-chamber view of a transthoracic echocardiogram (TTE). However, TTE can be falsely negative in 30% of AHCM cases, largely due to difficulties in delineating endocardial border. The diagnostic criteria for apical cardiac hypertrophy are: 1) asymmetric LV hypertrophy - predominantly at the apex of the ventricle; 2) LV wall thickness of 15 mm or more during diastole; and 3) apical to posterior wall thickness ratio of 1.5 or more determined by 2-dimensional echocardiography or cardiac magnetic resonance imaging. Here, we are presenting a case of elderly male who visited our cardiac OPD for a check-up due to atypical chest pain, cough and mild fever for 5 days. His resting ECG showed left ventricular hypertrophy with deep T wave inversion in precordial leads V2-V6, consistent with AHCM. An exhaustive transthoracic echocardiography (TTE) with contrast study (CS) and speckle tracking imaging by 4Dimensional XStrain speckle tracking echocardiography (STE) was performed to provide a clinching diagnosis. Keywords: Hypertrophic cardiomyopathy, Apical hypertrophic cardiomyopathy, Ace of spades, Strain echocardiography, Contrast imaging in apical hypertrophic cardiomyopathy, Yamaguchi syndrome, 4Dimensional XStrain echocardiography.

Introduction. Increased monocyte and macrophage inflammatory state and pro-inflammatory cytokine production are linked to type 2 diabetes (T2D). Research design and Methods. This is a case-control study aimed to examine the expression of 23 monocyte genes related to inflammation, adhesion, and repair in individuals with mild (mean HbA1c 7.3%, illness duration 5.6 years) and severe type 2 diabetes (mean HbA1c 8.4%, disease duration 14.2 years) compared also with lean and obese controls. In addition, we determined a set of serum inflammatory cytokines and growth factors. Results. The monocytes of mild T2D patients (who were in general overweight/obese) showed overexpression of a subset of genes related to adhesion (CD9), vascular repair and growth (HGF). The monocytes of the severe T2D patients showed in contrast an upregulation of many of the pro-inflammatory genes, without a significantly increased expression of the repair gene HGF and the adhesion gene CD9. Serum cytokine expression in the severe T2D patients supported the increased inflammatory state of the patients showing high levels of IL-6, IL-1β, and TNF-α. Conclusions. This study, therefore, shows a pro-inflammatory gene expression profile of monocytes of severe T2D patients, while patients with mild T2D did not show such monocyte profile.

Several websites have offered patients opportunities to find out whether they meet the case definitions for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The current study describes a new online screener that can be completed by individuals who might like to determine if they meet the current ME/CFS criteria. The website is available for anyone to use, and the feedback is more comprehensive than other site, particularly in providing data on how the participants’ data compares with a large ME/CFS patient population, as well as whether the current ME and ME/CFS case definitions are met.

Neurons are the basic building blocks of the human body's neurological system. Atrophy is defined by the disintegration of the connections between cells that enable them to communicate. Peripheral neuropathy and demyelinating disorders, as well as cerebrovascular illnesses and central nervous system (CNS) inflammatory diseases, have all been linked to brain damage, including Parkinson's disease (PD). It turns out that these diseases have a direct impact on brain atrophy. However, it may take some time after the onset of one of these diseases for this atrophy to be clearly diagnosed. With the emergence of the Coronavirus disease 2019 (COVID-19) pandemic, there were several clinical observations of COVID-19 patients. Among those observations is that the virus can cause any of the diseases that can lead to brain atrophy. Here we shed light on the research that tracked the relationship of these diseases to the COVID-19 virus. The importance of this review is that it is the first to link the relationship between the Coronavirus and diseases that cause brain atrophy. It also indicates the indirect role of the virus in dystrophy.

This study sought to ascertain the prevalence of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) among a sample of 465 patients with Long COVID. The participants completed three questionnaires: (1) a new questionnaire measuring both the frequency and severity of 38 common symptoms of COVID and Long COVID, (2) a validated short form questionnaire assessing ME/CFS, and (3) a validated questionnaire measuring post-exertional malaise. The population was predominantly white, female, and living in North America. The mean duration since the onset of COVID-19 symptoms was 70.5 weeks. Among the 465 participants, 58% met a ME/CFS case definition. Of respondents who reported that they had ME/CFS only 71% met criteria for ME/CFS and of those who did not report they had ME/CFS, 40% nevertheless did meet criteria for the disease: both over-diagnosis and under-diagnosis were evident on self-report. This study supports prior findings that ME/CFS occurs with high prevalence among those who have persistent COVID-19 symptoms.

Objective: The aim of this study is to evaluate the effects of the Coronavirus disease 2019 on sonographic optic nerve sheath diameter measurement and thus avoid possible misleading results in clinical practice.
 Material and Method: Each volunteer was first evaluated using carotid system color Doppler ultrasonography. Patients with a history of PCR-confirmed Coronavirus disease 2019 infection were classified as group 1 and patients without a history of Coronavirus disease 2019 infection were classified as group 2, and sonographic optic nerve sheath diameter values of both groups were analyzed.
 Results: Of the 123 patients included in the study, 70 (56.9%) were female and 58 (43.1%) were male. 83 (67.5%) of the patients included in the study were in group 1 and 40 (32.5%) were in group 2. The mean sonographic optic nerve sheath diameter values for the groups were 3.53 mm and 3.46 mm, respectively. The sonographic optic nerve sheath diameter differences between the two eyes for the groups were determined to be 0.203±0.139 mm and 0.282±0.2 mm.
 Conclusion: Due to the variable effects of Severe Acute Respiratory Syndrome Coronavirus-2, the use of sonographic optic nerve sheath diameter measurement in current standards for critical patient management may lead to false-positive or false-negative results.

Background: Anatomical variations of the nose and paranasal sinuses are one of the contributing factors in developing Chronic Rhinosinusitis (CRS) predisposing factor and complications during surgery complicating factors.CT Scan has an important role in diagnosing.One of the tools used to identify and detecting thesediagnose anatomical variations. in patients is CT scans.Objectives : To study theexamine prevalence of anatomical variations of the nose and paranasal sinuses found on CT Scanscans images of adult chronic rhinosinusitis patients.with CRS.Methods: The research conduct through aA retrospective descriptive studyresearch was conducted using CT scans images of 43 nose and paranasal sinuses CT Scans of the adult CRS patients who went tovisited the Allergy Rhinology Polyclinic at Dr. Hasan Sadikin hospital,Hospital in Bandung; on 1 between January-31 1 and December 31, 2019.Anatomical variations assessment of the nosewere assessed and paranasal sinuses divided into:categorized as CRS predisposing and surgery-complicating factors.CRS factors include septal deviation, Agger nasi, frontal bullae, concha hypertrophy, bullae ethmoid, pneumatized septum, concha

BACKGROUND: Multiple sclerosis (MS) is a neurological condition whose symptoms, severity, and progression over time vary enormously among individuals. Ideally, each person living with MS should be provided with an accurate prognosis at the time of diagnosis, precision in initial and subsequent treatment decisions, and improved timeliness in detecting the need to reassess treatment regimens. To manage these three components, discovering an accurate, objective measure of overall disease severity is essential. Machine learning (ML) algorithms can contribute to finding such a clinically useful biomarker of MS through their ability to search and analyze datasets about potential biomarkers at scale. Our aim was to conduct a systematic review to determine how, and in what way, ML has been applied to the study of MS biomarkers on data from sources other than magnetic resonance imaging. METHODS: Systematic searches through eight databases were conducted for literature published in 2014-2020 on MS and specified ML algorithms. RESULTS: Of the 1, 052 returned papers, 66 met the inclusion criteria. All included papers addressed developing classifiers for MS identification or measuring its progression, typically, using hold-out evaluation on subsets of fewer than 200 participants with MS. These classifiers focused on biomarkers of MS, ranging from those derived from omics and phenotypical data (34.5% clinical, 33.3% biological, 23.0% physiological, and 9.2% drug response). Algorithmic choices were dependent on both the amount of data available for supervised ML (91.5%; 49.2% classification and 42.3% regression) and the requirement to be able to justify the resulting decision-making principles in healthcare settings. Therefore, algorithms based on decision trees and support vector machines were commonly used, and the maximum average performance of 89.9% AUC was found in random forests comparing with other ML algorithms. CONCLUSIONS: ML is applicable to determining how candidate biomarkers perform in the assessment of disease severity. However, applying ML research to develop decision aids to help clinicians optimize treatment strategies and analyze treatment responses in individual patients calls for creating appropriate data resources and shared experimental protocols. They should target proceeding from segregated classification of signals or natural language to both holistic analyses across data modalities and clinically-meaningful differentiation of disease.