Clinical Assessment Of Patients Research Articles

Australian Naturopaths Approach to the Clinical Management of Patients Presenting with Sleep Disorders.

Objective: Naturopathic practitioners consult an estimated 6.2% of Australian adults, equating to 1,550,000 people receiving their care each year. Sleep is now recognized as a key pillar of health; however, nearly half of all Australian adults report inadequate sleep. Evidence suggests that many Australians consult naturopaths (NPs) for sleep-related problems and use complementary medicines (CMs) to manage these. However, NPs' clinical approach to caring for people living with sleep disorders has not been reported. Therefore, the aim of this study was to describe and understand the clinical assessment and treatment approaches used by NPs in their care of people living with sleep disorders. Materials and Methods: A cross-sectional online survey with a purposively sought sample. NPs were recruited via the practitioner research-based network. The participants received an email invitation containing a link to the survey along with a Participant Information Sheet. The online survey (Research Electronic Data Capture-see Supplementary Data S1) comprised multiple-choice, binary (yes/no) questions, or 5-point Likert scale-type questions structured across four sections related to: clinical assessment of patients, treatments used, interprofessional communication with conventional doctors, and demographics. Results: Sixty-seven complete data sets were analyzed. Most survey participants treated-one to three patients with sleep disorders weekly, being consulted primarily for insomnia (82%) and its treatment (98.5%). Comprehensive sleep health histories were commonly assessed. Additionally, 69% of participants reported that patients sought their services to complement conventional care. The most frequently used complementary medicine (CM) approaches included sleep hygiene counseling (75%) and meditation (64.7%). Vitamins, minerals, herbal medicines, and nutritional supplements were the most recommended CM medicines (92.6%). Referrals to conventional medicine professionals were minimal. Conclusion: Australian NPs are frequently consulted by people living with sleep disorders who are also using conventional medicines. Our study highlights the need for integrated models of health care tailored to patient needs that maximize potential benefits and reduce any harms associated with drug-CMs interactions. The provision of training to the Australian health care workforce of NPs that focuses on evidence-based behavioral treatments can improve access to these treatments for patients.

Usefulness of Cerebrospinal Fluid Alzheimer's disease biomarkers in older patients: Evidence from a national multicenter prospective study.

The use of cerebrospinal (CSF) biomarkers in the diagnosis of Alzheimer's disease (AD) has been gaining interest in clinical practice. Although their usefulness has been demonstrated, their potential value in older patients remains debated. To assess whether knowledge of the results of CSF AD biomarkers was associated with the same gain in diagnostic confidence in older adults > 80 than in younger patients. Prospective multicenter study, including memory clinics physicians who completed a two-part questionnaire for all their patients addressing the requirement for assessment of Alzheimer's disease biomarkers in CSF proposed as part of routine care during the study period. 30 secondary or tertiary memory clinics in France. Clinicians indicated their diagnosis hypothesis and an estimate of their diagnostic confidence [scale 1-10]. Receiver operating characteristic (ROC) analysis, including the calculation of the area under the curve (AUC), was conducted using logistic regression to evaluate the diagnostic performance of CSF AD biomarkers. In 813 consecutive patients, median age 70 [interquartile range (IQR) = 63 - 77] including 132 patients over 80 years, we observed a similar confidence gain in CSF biomarkers between older and younger patients, both for AD and non-AD diagnoses. In older patients, the added value of CSF biomarkers was greater when CSF biomarkers indicated AD profile whereas the initial hypothesis was "non-AD", leading to a final diagnosis of AD (2.4 ± 1.6 versus 1.1 ± 2.1, p-value, p = 0.03). ROC analyses showed similar performance of AD CSF biomarkers in older and younger patients. CSF AD biomarkers added substantial value to clinical assessment in patients over 80. Their use seems crucial in the diagnostic process for older adults referred to memory clinics.

Causes of chronic pain unrelated to surgical trauma after groin hernia repair: a prospective cohort study

BackgroundChronic inguinal pain (CIP) can be caused by musculoskeletal or neurological pathologies and by surgical trauma after inguinal hernia repair among other. The aim of this prospective cohort observational study was to find the incidence and causes of CIP unrelated to surgical trauma 12 months after inguinal hernia repair.MethodsDuring sixteen months patients consulting a hernia center for groin-related symptoms were included in the study. Patients were evaluated by surgeons and filled out preoperatively the Inguinal Pain Questionnaires and a Numerical Rating Scale pain-questionnaire. For patients undergoing inguinal hernia repair, postoperative questionnaires similar to the pre-operative ones were sent out at 12 months. Patients scoring pain on pain questionnaires were evaluated by phone and physical examination.Results289 patients (78.1%) of 370 repaired patients filled in the postoperative questionnaires. 62 (21.4%) patients scored pain, of these patients 5 (1.7%, 5/289) answered incorrectly in the pain questionnaires and 14 (4.8%, 14/289) had non-surgical trauma causes of pain: 5 musculoskeletal, 4 neurological and 3 other medical pathologies.ConclusionsThis cohort study found CIP unrelated to surgical trauma in 4.8% of patients undergoing a groin hernia repair. Most causes of pain unrelated to surgical trauma were musculoskeletal and neurological pathologies. Nearly a third of patients scoring inguinal pain on pain-questionnaires did not have chronic post-surgical pain (CPSP), therefore incidence of CPSP should not be based solely on pain questionnaires. Clinical assessment of patients with pain is necessary to excluded CIP unrelated to the surgical trauma.

MULTUM IN PARVO-THE GLASGOW COMA SCALE

Introduction Coma assessment scales have been developed to facilitate ease of communication between emergency team members and to facilitate ease of clinical assessment for patients with severe impairment of consciousness. In 1974 Graham Teasdale and Bryan Jennett published in the Lancet a scale which theoretically helped physicians get a quick and accurate status of comatose patients. The scale they described assessed patient behaviour regarding three key aspects – motor reactivity, verbal communication and eye opening. As the two authors were working in Glasgow, the scale was dubbed the Glasgow Coma Scale (GCS) a name which all neurologists and neurosurgeons are well-accustomed with. Material The use of the GCS is based on the patient’s capacity to react using language and motion to external stimuli. Eye movement (1-4 points), Speech (1-5 points) and Motion (1-6 points) for a maximum total of 15 points or a minimum total of 3 points. A patient with a Glasgow Coma Score of 3 is completely non-reactive, while a patient with a Glasgow Coma Score of 15 is perfectly aware. This scale introduced in neurotrauma has simplified enormously the communication in neurosurgery, accompanying neurotrauma to the whole spectrum of neurosurgical pathology. Despite its wide use today, the GCS has been seriously criticised due to its incapacity to determine the functional status of brainstem structures. Therefore, various improvements and updates were performed for the Glasgow Coma Scale. Conclusions Over the years, the use of the GCS extended in the entire medical meme despite its criticism. The simplicity and ease of use which characterize the GCS made it a very useful instrument for neurological examination since the first moment a patient is seen by a medical professional. The Glasgow Coma Scale which recently reached its 50th birthday became a universal language for physicians. Since it has been in use neurological status can be expressed with great ease and without loss of meaning.

Abstract 4122543: Can We Diagnose Ticagrelor-induced Dyspnea After Urgent Percutaneous Coronary Intervention with Cardiopulmonary Exercise Testing?

Background: Ticagrelor has been reported to cause shortness of breath (SOB) in 6 to 9 % of patients. Precise mechanisms are not enirely understood. We hypothesize that cardiopulmonary exercise testing (CPET) may be helpful in clinical assessment of patients reporting SOB on ticagrelor. Case presentation: 66-yo female with history of arterial hypertension, DM type 2 and prior MI presented with STEMI and successfully underwent urgent PCI of RCA and LAD. The patient received ticagrelor in loading dose followed by 90 mg b.i.d plus low-dose aspirin. Just after PCI she developed SOB with no evidence of acute cardiac or respiratory compromise. After discharge the patient continued to experience SOB impairing daily activities. In 6 months she was re-assessed. Clinical investigation (physical exam, blood tests, echo, CXR, spirometry) showed no abnormalities that could explain SOB. CPET despite good effort showed low VO 2 peak (7,8 ml*min/kg; 49% from predicted), undetectable anaerobic threshold (AT), severely impaired ventilatory efficacy (VE/VCO 2 =50,1) and marked hyperventilation (resting RER=1,0; PetCO 2 =18,0 mmHg at rest and 22,4 mmHg at peak load). Exercise EKG, blood pressure response, SpO 2 and breathing reserve were normal. Once the patient was switched from ticagrelor to clopidogrel she reported significant improvement. CPET one week after showed increase in VO 2 peak up to 12,5 ml/kg/min., AT of 11,1 ml*min/kg, better ventilatory efficacy (VE/VCO 2 =37,1) and less hyperventilation (PetCO 2 28,1 mmHg at rest and 28,8 mmHg at peak load). CPET performed one month later showed further improvement in VO 2 peak to 13,2 ml*min/kg, normal VE/VCO 2 and no signs of hyperventilation. Discussion: it is believed that ticagrelor-induced dyspnea can be driven by 2 potential mechanisms, first related to inhibition of adenosine reuptake, second - to sensory neuron P2Y12 inhibition. It occurs early after starting the medication and is not associated with structural cardiopulmonary abnormalities. Previous small data showed evidence of Cheyne-Stokes respiration during both night and day related to ticagrelor. Symptoms usually are dose-dependent and disappear after discontinuation of ticagrelor. In our case the patient demonstrated reversible hyperventilation and reduced exercise capacity associated with ticagrelor that was confirmed with CPET. Conclusion: CPET allows differentiating SOB in patients treated with ticagrelor. Further investigations are required to confirm this hypothesis.

Prognostic Value of Red Cell Distribution Width in Outcome of Acute Ischemic Stroke

Background: Red cell distribution width (RDW) is a haematological parameter that indicates the range of sizes of red blood cells. It is now widely acknowledged as a prognostic indicator for ischaemic stroke. Aim and Objective: To Study theprognostic value of red cell distribution width (RDW) in outcome of acute ischemic stroke. Materials and Method: The cross-sectional study was undertaken at Aarupadi Veedu Medical College in Puducherry. It included 61 patients, aged 18-80 years, who were diagnosed with acute ischemic stroke within 48 hours. Clinical assessment of patient by NIHSS Score and measuring the outcome by modified Rankin scale. The study took place in both the Outpatient and Inpatient in Department of General Medicine. Results: The study indicates a notable proportion of male more than female ,older participants (64.0% aged 56 years and above), There is a significant occurrence of hypertension (62.3%) and diabetes mellitus (63.9%) a substantial frequency of individuals who do not smoke (63.9%), and a majority of participants who do not use alcohol (77.0%). Levels of RDW exhibited significant positive relationships with stroke severity. Conclusion: The study highlights the potential of Red Cell Distribution Width (RDW) as a helpful predictive indicator in outcome of ischemic stroke. Increased RDW levels were observed to have a substantial correlate with more severe stroke and disability, as indicated by strong associations with NIHSS and mRS scores. The study emphasizes the usefulness of RDW in assessing the severity of ischaemic stroke and emphasizes the need for additional research to improve its clinical use.

Creation and Validation of the MMQ-9: A Short Version of the Multifactorial Memory Questionnaire for Middle-Aged and Older Adults

ABSTRACT Objectives Memory concerns are common among older adults. The Multifactorial Memory Questionnaire (MMQ) is a well-validated participant-reported measure consisting of 57 items across three subscales assessing satisfaction with memory, self-perceived memory ability, and memory strategy use, respectively. Because short scales are often desired to accommodate clinical time constraints and reduce respondent burden, we created and evaluated 9-item versions of each subscale (MMQ-9). Methods In Study 1, we used an optimization strategy to identify subsets of items that maximized subscale reliability in a sample of 560 adults ages 50–90. In Study 2, we examined psychometric properties of the MMQ-9 in an independent sample of 638 adults ages 51–95. Results Internal consistency, test–retest reliability, and convergent and discriminant validity of each subscale met published criteria for good measurement properties. Confirmatory factor analysis validated the original factor structure. A hierarchical series of invariance models showed excellent fit, confirming robust measurement invariance across age, gender, and education. Conclusions The shortened MMQ-9 is a reliable, valid, and invariant measure of metamemory in middle-aged and older adults. Clinical Implications The MMQ-9 is a reasonable instrument of choice when brief yet psychometrically strong measures of participant-reported memory are required for clinical assessment of patients with memory concerns.

Utility of CT perfusion in seizures and rhythmic and periodic patterns

ObjectiveCT hyper-perfusion has been reported in non-convulsive status epilepticus (NCSE), while its occurrence and relevance after single seizures or with rhythmic and periodic patterns (RPPs) that lie along the ictal-interictal continuum (IIC), remain unclear. The goal of the study is to assess the role of CT perfusion (CTP) in diagnosing patients with clinical seizures, subclinical seizures, or RPPs that lie along the IIC, to help in the clinical assessment of these entities. MethodsWe retrospectively reviewed inpatients who underwent a CTP and an EEG within 6 h of each other. CTP and EEGs were blindly reviewed independent of electronic medical records. ResultsOut of 103 patients, 15 patients (15 %) demonstrated hyper-perfusion, 40 patients (39 %) had hypo-perfusion, while 48 patients (47 %) had normal CTP. Patients with focal CTP hyperperfusion were more likely to have clinical seizures, electrographic seizures, and/or lateralized rhythmic periodic patterns (RPPs) compared to those without CTP hyperperfusion. Focal CTP hyper-perfusion had 34 % sensitivity and 96 % specificity for identifying patients with clinical seizures, and a 40 % sensitivity and 92 % specificity for identifying patients with electrographic seizures or lateralized RPP. Although the numbers were small, none of the patients with generalized periodic discharges or generalized rhythmic delta activity had CTP hyper-perfusion. ConclusionsFocal CTP hyper-perfusion has low sensitivity but high specificity for identifying patients with seizures and lateralized RPPs, and may be considered in the clinical assessment of patients where the clinical information are unclear or insufficient. SignificanceThe presence of CTP hyper-perfusion should alert the physician to the possibility of an ictal related etiology accounting for the patient’s symptoms.

Deep phenotyping of 11 individuals with pathogenic variants in RNU4-2 reveals a clinically recognizable syndrome

PurposeDespite ever-increasing knowledge of the genetic etiologies of neurodevelopmental disorders, approximately half remain undiagnosed after exome or genome sequencing. Here, we provide a deep clinical characterization of 11 previously unreported patients with a recently described neurodevelopmental disorder (NDD) due to pathogenic variants in RNU4-2. MethodsThe 11 patients were identified in a pool of 70 patients selected for targeted RNU4-2 sequencing on the basis of their clinical phenotypes from a cohort of 1032 individuals with a NDD and without a prior genetic diagnosis. ResultsThe 11 patients were aged between 13 months and 36 years. All patients showed moderate to severe developmental delay and/or intellectual disability. Height and weight were below 10th percentile and most showed microcephaly. In almost 50% of the patients, intrauterine growth retardation was detected. All patients showed a distinctive pattern of dysmorphic features, including hooded upper eyelid and epicanthus, full cheeks, tented philtrum, mouth constantly slightly open with an everted lower lip vermilion, high palate, and profuse drooling. Of 11 patients, 64% also presented with ophthalmological problems (mainly strabismus, nystagmus, and refraction errors) and 64% had musculoskeletal features (joint hypermobility, mild scoliosis, and easy fractures). ConclusionThis work provides an improved characterization of the phenotypic spectrum of RNU4-2 syndrome across different age groups and demonstrates that thorough clinical assessment of patients with an NDD can be enhanced significantly for this novel syndrome.

Comprehensive Clinical Assessment of Patients With Acute Organophosphorus Poisoning in a Tertiary Care Hospital.

Background The use of organophosphorus (OP) compounds as pesticides is widespread, particularly in developing nations such as India. These substances are easily accessible and often linked to suicide poisoning incidents, especially among distressed farmers. In India, OP poisoning remains a significant cause of emergency hospital admissions. This study aims to analyze the clinical profile of patients admitted with OP poisoning, focusing on the various clinically significant characteristics and aspects associated with these cases. Methods Throughout the course of two years (from June 2022 to May 2024), five hospitals with critical care units participated in this prospective observational study. These hospitals referred patients to the Prathima Institute of Medical Sciences, which served as the central facility for the study. The study focused on individuals who arrived at the emergency room within 24 hours of acute exposure to organophosphate pesticides. A total of 150 patients meeting the inclusion criteria were enrolled. Data collection included a comprehensive clinical examination, detailed patient history, and monitoring of the response to intravenous atropine. The severity of the poisoning was evaluated using the Peradeniya Organophosphorus Poisoning (POP) scale, adapted for this study. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York), with descriptive statistics used to summarize the categorical and continuous variables. Results The results of the study demonstrated a notable relationship between the arrival time at the health facility and mortality rates among patients with OPpoisoning. Patients who arrived within three hours had a mortality rate of 13.2% (five out of 38 cases), while those arriving between three and six hours had a slightly higher rate of 14.3% (10 out of 70 cases). The mortality rate sharply increased to 28.6% (12 out of 42 cases) for patients who arrived after six hours. Among the OP compounds, monocrotophos showed the highest mortality rate at 80% (eight out of 10 cases), followed by dimethoate with 42.9% (12 out of 28 cases) and dichlorvos with 62.5% (five out of eight cases). The overall mortality rate in the study was 22.7% (34 out of 150 cases). Conclusions Poisoning with OP has primarily impacted young, productive men. Considerable mortality results from a disease condition that is more severe at presentation. It is advised to selectively outlaw the riskier substances that account for a larger percentage of fatalities.

Mavacamten for Obstructive Hypertrophic Cardiomyopathy: Rationale for Clinically Guided Dose Titration to Optimize Individual Response.

Mavacamten is the first and only cardiac myosin inhibitor approved in 5 continents for the treatment of adults with symptomatic New York Heart Association class II and III obstructive hypertrophic cardiomyopathy. An evidence-based rationale was used to develop individualized mavacamten dosing, guided by commonly used clinical parameters. Echocardiography is recommended as part of routine clinical assessment of patients with hypertrophic cardiomyopathy, and left ventricular (LV) outflow tract gradient and LV ejection fraction are parameters that can be readily assessed and monitored by echocardiography. Therefore, an echocardiography-based, clinically guided dose-titration strategy was developed to optimize patient benefit from mavacamten for the treatment of symptomatic obstructive hypertrophic cardiomyopathy while minimizing the risk of LV ejection fraction reduction. Results from clinical trials paired with extensive modeling and simulation analyses support a dose-titration and monitoring strategy based on serial echocardiographic measures of Valsalva LV outflow tract gradient and LV ejection fraction. This dosing approach allows for the identification of the lowest individualized mavacamten dose and exposure required to provide improvements in LV outflow tract obstruction, functional capacity, and symptoms. Mavacamten is primarily metabolized by CYP2C19 (cytochrome P450 2C19), and CYP2C19 metabolizer phenotype has an effect on mavacamten exposure. Therefore, this approach has also been demonstrated to provide a favorable safety profile irrespective of patients' CYP2C19 metabolizer status. The dose-titration strategy includes additional considerations for the potential onset of systolic dysfunction in the context of intercurrent illness, and for the potential of drug-drug interactions with inhibitors and substrates of cytochrome P450 enzymes. This posology is reflected in the mavacamten US prescribing information.

NANO-LM: An updated scorecard for the clinical assessment of patients with leptomeningeal metastases.

There are no validated tools for the clinical neurological assessment of patients with leptomeningeal metastases (LM). However, clinical examination during the course of the disease guides medical management and is part of response assessment in clinical trials. Because neuroimaging may not always be obtained owing to rapid clinical deterioration, clinical neurological assessment of LM is essential, and standardization Is important to minimize rater disagreement. The RANO-LM group launched a 2-steps process, aiming at improving and standardizing the clinical assessment of patients with LM. We report here on the first step: the establishment of a consensus scorecard. The task force had 9 virtual meetings to define general recommendations on neurological assessment and selected domains of interest that should be tested. Fourteen domains of neurological symptoms and signs were selected: level of consciousness, cognition, nausea and vomiting, vision, eye movement, facial strength, hearing, swallowing, speech, limb strength, limb ataxia, walking, bladder bowel functions. For each item, a clear instruction on how to perform the assessment is provided with scoring criteria between 0 and 2. The general clinical status of the patient and use of steroids, pain medications, and anti-emetics should be documented. Neurological sequelae from previous brain metastases or cancer treatment should be rated at the baseline evaluation; it should be specified when symptoms or signs may be related to a condition other than LM. A revised NANO-LM consensus scorecard for clinical assessment has been established. An international prospective validation study of the proposal is currently ongoing (NCT06417710).

Clinical assessment and striatal dopaminergic activity in healthy controls and patients with Parkinson's disease: a Bayesian approach.

We aimed to evaluate correlations between striatal dopamine transporter (DAT) uptake and clinical assessments in both patients with Parkinson's disease (PD) and healthy controls. This study enrolled 193 healthy controls, and 581 patients with PD. They underwent various clinical assessments and 123I-FP-CIT SPECT scans. After reconstruction, attenuation correction, and normalization of SPECT images, counts were measured from the bilateral caudate and putamen, and the occipital cortex for reference. Count densities for each region were extracted and used to calculate striatal binding ratios (SBRs) for each striatal region. SBR is calculated as (target region/reference region)-1. After logarithmic transformation of striatal SBRs, we analyzed the effects of clinical assessments on striatal SBRs using Bayesian hierarchical modeling. MDS-UPDRS total score, part I, part II, part III, Epworth Sleepiness Scale, REM sleep behavior disorder screening questionnaire, SCOPA-AUT total score were negatively associated with striatal SBR in patients with PD. Also, HVLT recognition discrimination was positively associated with striatal SBR in both healthy controls and patients with PD. In healthy control, MDS-UPDRS part II, MOCA, SCOPA-AUT total score were positively associated with striatal SBR. We demonstrated that motor symptom, sleep disturbance, autonomic symptom, and cognition of patients with PD were associated with striatal dopaminergic activity. In healthy controls, motor symptoms, autonomic symptom, and cognition were associated with striatal dopaminergic activity, some of which showing the opposite direction with patients with PD. This result might provide new insight to underlying mechanism of dopamine system with motor and non-motor assessments.

Consensus paper on the assessment of adult patients with traumatic brain injury with Glasgow Coma Scale 13-15 at the emergency department: A multidisciplinary overview.

Traumatic brain injury (TBI) is a common reason for presenting to emergency departments (EDs). The assessment of these patients is frequently hampered by various confounders, and diagnostics is still often based on nonspecific clinical signs. Throughout Europe, there is wide variation in clinical practices, including the follow-up of those discharged from the ED. The objective is to present a practical recommendation for the assessment of adult patients with an acute TBI, focusing on milder cases not requiring in-hospital care. The aim is to advise on and harmonize practices for European settings. A multiprofessional expert panel, giving consensus recommendations based on recent scientific literature and clinical practices, is employed. The focus is on patients with a preserved consciousness (Glasgow Coma Scale 13-15) not requiring in-hospital care after ED assessment. The main results of this paper contain practical, clinically usable recommendations for acute clinical assessment, decision-making on acute head computerized tomography (CT), use of biomarkers, discharge options, and needs for follow-up, as well as a discussion of the main features and risk factors for prolonged recovery. In conclusion, this consensus paper provides a practical stepwise approach for the clinical assessment of patients with an acute TBI at the ED. Recommendations are given for the performance of acute head CT, use of brain biomarkers and disposition after ED care including careful patient information and organization of follow-up for those discharged.

Diffusion tensor imaging biomarkers and clinical assessments in amyotrophic lateral sclerosis (ALS) patients: an exploratory study.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive loss of upper and lower motor neurons. Biomarkers are needed to improve diagnosis, gauge progression, and evaluate treatment. Diffusion tensor imaging (DTI) is a promising biomarker for detecting microstructural alterations in the white matter tracts. This study aimed to assess DTI metrics as biomarkers and to examine their relationship with clinical assessments in patients with ALS. Eleven patients with ALS and 21 healthy controls (HCs) underwent 3T MRI with DTI. DTI metrics, including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD), were compared between key motor and extra-motor tract groups. Group comparisons and correlations between DTI metrics also correlated with clinical scores of disability (ALSFRS-R), muscle strength (dynamometry), and motor unit loss (MUNIX). Widespread differences were found between patients with ALS and HCs in DTI metrics, including decreased FA and increased diffusivity metrics. However, MD and RD are more sensitive metrics for detecting white matter changes in patients with ALS. Significant interhemispheric correlations between the tract DTI metrics were also observed. DTI metrics showed symmetry between the hemispheres and correlated with the clinical assessments. MD, RD, and AD increases significantly correlated with lower ALSFRS-R and MUNIX scores and weaker dynamometry results. DTI reveals microstructural damage along the motor and extra-motor regions in ALS patients. DTI metrics can serve as quantitative neuroimaging biomarkers for diagnosis, prognosis, monitoring of progression, and treatment. Combined analysis of imaging, electrodiagnostic, and functional biomarkers shows potential for characterizing disease pathophysiology and progression.

Dysrhythmia as a prominent feature of Parkinson's disease: An app-based tapping test

IntroductionSmartphone applications (apps) are instruments that assist with objective measurements during the clinical assessment of patients with movement disorders. We aim to test the hypothesis that Parkinson's disease (PD) patients will exhibit an increase in tapping variability and a decrease in tapping speed over a one-year period, compared to healthy controls (HC). MethodsData was prospectively collected from participants enrolled in our Cincinnati Cohort Biomarker Program, in 2021–2023. Participants diagnosed with PD and age-matched HC were examined over a one-year-interval with a tapping test performed with customized smartphone app. Tapping speed (taps/s), inter-tap intervals and variability (movement regularity), and sequence effect were measured. ResultsWe included 295 PD patients and 62 HC. At baseline, PD subjects showed higher inter-tap variability than HC (coefficient-of-variation-CV, 37 ms [22–64] vs 26 ms [8–51]) (p = 0.007). Conversely, there was no difference in inter-tap intervals (411 ms [199–593] in PD versus 478 ms [243–618] in HC) and tapping speed (3.42[2.70–4.76] taps/s in PD versus 3.21 taps/s [2.57–4.54] in HC) (p > 0.05). Only PD subjects (n = 135), at the one-year follow-up, showed a decreased tapping speed vs baseline (3.44 taps/s [2.86–4.81] versus 3.39 taps/s [2.58,4.30]) (p = 0.036), without significant changes in inter-tap variability (CV, 32 ms [18,55] baseline versus 34 ms [22,59] follow-up) (p = 0.142). No changes were found in HC at the one-year follow up (all p values>0.05). ConclusionsInter-tap variability (dysrhythmia) but no inter-tap intervals or tapping speed are reliably distinctive feature of an app-based bradykinesia assessment in PD.

Assessment and examination of the respiratory system.

This article aims to outline the fundamental principles of consultations with and clinical assessments of patients with symptoms that may be indicative of respiratory system pathology. The article explores how to perform a respiratory system-focused patient history and physical examination. An evaluation of clinical 'red flags' to reduce the risk of omitting serious illness is also considered, alongside the exploration of features of respiratory pathology and evidence-based clinical decision-making tools that may be used to support clinical diagnosis.

A real-life ImmunoCAT study: impact of molecular diagnosis through ImmunoCAPTM ISAC 112 on immunotherapy prescription in pollen-polysensitized patients in Catalonia, Spain.

Molecular diagnosis in allergology helps to identify multiple allergenic molecules simultaneously. The use of purified and/or recombinant allergens increases the accuracy of individual sensitization profiles in allergic patients. To assess the impact of molecular diagnosis through the ImmunoCAPTM ISAC 112 microarray on etiological diagnosis and specific immunotherapy (SIT) prescription. This was compared to the use of conventional diagnoses in pediatric, adolescent, and young adult patients with rhinitis or rhinoconjunctivitis and/or allergic asthma, sensitized to three or more pollen allergens of different botanical species. A multicenter, prospective, observational study was conducted in patients aged 3-25 years who received care at the Allergology service of 14 hospitals in Catalonia from 2017 to 2020. Allergology diagnosis was established based on the patient's clinical assessment and the results of the skin prick test and specific immunoglobulin E assays. Subsequently, molecular diagnosis was conducted using ImmunoCAPTM ISAC® 112 to recombinant and/or purified allergen components. A total of 109 patients were included; 35 (32.1%) were pediatric patients and 74 (67.9%) were adolescents or young adults (mean age: 18 years), with 58.0% being females. A change of 51.0% was observed in SIT prescription following molecular etiological diagnosis by means of a multi-parameter microarray. Molecular diagnosis by means of multi-parameter tests increases the accuracy of etiological diagnosis and helps to define an accurate composition of SIT.

Multimodal imaging evaluation of early neurological deterioration following acute ischemic stroke.

Early neurologic deterioration occurs in up to one-third of patients with acute ischemic stroke (IS), often leading to poor functional outcomes. At present, few studies have applied amide proton transfer (APT) imaging to the evaluation of early neurological deterioration (END). This study analyzed the value of computed tomography perfusion (CTP) combined with multimodal magnetic resonance imaging (MRI) in patients with acute IS with END. This retrospective study included patients with acute IS who were admitted to the neurology inpatient department in a tertiary hospital from October 2021 to June 2023. Patients with acute IS underwent CTP within 24 hours of stroke onset and MRI [arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), and APT] within 7 days. END was defined as an elevation of ≥2 points on the National Institute of Health Stroke Scale (NIHSS) within 7 days of stroke onset. Univariable and multivariable analyses were used to compare clinical and imaging biomarkers in patients with acute IS with and without END. The performance of potential biomarkers in distinguishing between the two groups was evaluated using receiver operating characteristic (ROC) curve analysis. Among the 70 patients with acute IS, 20 (29%) had END. After conducting univariable analysis, variables were selected for entry into a binary logistic regression analysis based on our univariable analysis results, previous research findings, clinical experience, and methodological standards. The results indicated that relative cerebral blood volume (CBV) on CTP, relative cerebral blood flow (CBF) on ASL, and relative signal intensity on amide proton transfer-weighted (APTw) imaging were independent risk factors for END. The areas under the ROC curves for these risk factors were 0.710 [95% confidence interval (CI): 0.559-0.861, P=0.006], 0.839 (95% CI: 0.744-0.933, P<0.001), and 0.804 (95% CI: 0.676-0.932, P<0.001), respectively. The combined area under the curve (AUC), sensitivity, and specificity of the four indices (0.941, 100%, and 78%, respectively) were higher than those of the four indices alone. CTP combined with multi-modal MRI better evaluated hemodynamics, tissue metabolism, and other relevant patient information, providing an objective basis for the clinical assessment of patients with acute IS with END and facilitating the development of accurate and personalized treatment plans.

Comparative Review of the Socioeconomic Burden of Lower Back Pain in the United States and Globally.

Internationally, the United States (U.S.) cites the highest cost burden of low back pain (LBP). The cost continues to rise, faster than the rate of inflation and overall growth of health expenditures. We performed a comprehensive literature review of peer-reviewed and non- peer-reviewed literature from PubMed, Scopus, and Google Scholar for contemporary data on prevalence, cost, and projected future costs. Policymakers in the U.S. have long attempted to address the high-cost burden of LBP through limiting low-value services and early imaging. Despite these efforts, costs (~$40 billion; ~$2,000/patient/yr) continue to rise with increasing rates of unindicated imaging, high rates of surgery, and subsequent revision surgery without proper trial of non-pharmacologic measures and no corresponding reduction in LBP prevalence. Globally, the overall prevalence of LBP continues to rise largely secondary to a growing aging population. Cost containment methods should focus on careful and comprehensive clinical assessment of patients to better understand when more resource-intensive interventions are indicated.