Sensory Deficits Research Articles

The Dynamicity of the Oxytocin Receptor in the Brain May Trigger Sensory Deficits in Autism Spectrum Disorder

Sensory processing abnormalities have been noted since the first clinical description of autism in 1940. However, it was not until the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 that sensory challenges were considered as symptoms of autism spectrum disorder (ASD). Multisensory processing is of paramount importance in building a perceptual and cognitive representation of reality. For this reason, deficits in multisensory integration may be a characteristic of ASD. The neurohormone oxytocin (Oxt) is involved in the etiology of ASD, and there are several ongoing clinical trials regarding Oxt administration in ASD patients. Recent studies indicate that Oxt triggers muscle contraction modulating thermogenesis, while abnormal thermoregulation results in sensory deficits, as in ASD. Activation of the Oxt system through exposure to cold stress regulates the expression of oxytocin receptor (Oxtr) in the brain and circulating Oxt, and if this mechanism is pathologically disrupted, it can lead to sensory processing abnormalities since Oxt acts as a master gene that regulates thermogenesis. This review will describe the sensory deficits characteristic of ASD together with the recent theories regarding how the modulation of Oxt/Oxtr in the brain influences sensory processing in ASD.

Страх падения у лиц пожилого возраста с различными заболеваниями

<p>Fear of falling is a significant problem among the elderly population, leading to a decrease in quality of life. Research on this phenomenon has been actively conducted abroad since the 1990s, starting with the works of N. Lach, M. Lachman, and M. Tinetti. In Russia, there is practically no research on the fear of falling. <strong>Objective</strong>. This study is dedicated to systematizing and summarizing existing data on the fear of falling among the elderly with various health conditions. <strong>Methods</strong>. Theoretical analysis of contemporary research on the fear of falling among the elderly. <strong>Results and Conclusions</strong>. It was found that there is no reliable data on the correlation between sensory deficits and fear of falling, although reduced vision, hearing, and proprioceptor sensitivity increase the risk of falling. Fear of falling can develop in physically well-functioning elderly individuals with high levels of anxiety, and depression is secondary to fear of falling. The presence of pronounced character accentuations can contribute to the development of fear of falling and even panic attacks. In Parkinson`s disease, the risk of falling increases in cognitively intact patients, and fear of falling is associated with catastrophizing. In Alzheimer`s disease with mild cognitive impairment, fear of falling indicators are almost indistinguishable from those of healthy individuals. Data across various clinical groups are heterogeneous, and the phenomenon of fear of falling requires more thorough investigation. This could be beneficial in developing psychocorrection programs for elderly patients and reducing the risk of falling.</p>

Tuberculous longitudinal extensive transverse myelitis: 2 cases and literature review

Context This study aimed to investigate the characteristics, diagnosis, and management of tuberculous longitudinally extensive transverse myelitis (TB-LETM), a rare manifestation of tuberculosis. Findings We analyzed two rare cases of TB-LETM and discussed their clinical manifestations and imaging findings in the context of the relevant literature. Patient 1, a 23-year-old female, presented with quadriplegia and dysuria, and spinal magnetic resonance imaging (MRI) revealed lesions extending from C1 to T3. Patient 2, an 18-year-old female, reported acute-onset numbness and weakness in both lower limbs, with MRI showing lesions from T1 to T4, along with multiple intracranial leptomeningeal enhancements. Both patients had elevated cerebrospinal fluid (CSF) cell counts and protein levels, and positive blood T-cell spot test (T-SPOT.TB), but no microbiological evidence of Mycobacterium tuberculosis was found. Diagnosis was based on clinical presentation, medical history, chest computed tomography (CT) findings, and CSF analysis. Over the past decade, 14 cases of TB-LETM have been reported. Common symptoms include fever, acute paralysis, sensory deficits in the lower limbs, and dysuria. Elevated CSF protein, lymphocytosis, and decreased glucose levels are essential for differentiating TB-LETM from autoimmune disorders. Conclusion Longitudinally extensive transverse myelitis (LETM), especially when involving the cervical and thoracic cords, should be considered a potential manifestation of tuberculosis infection. Analysis of cerebrospinal fluid, MRI findings, and T-SPOT testing can provide crucial diagnostic insights. A combination of anti-tuberculosis therapy and corticosteroids has proven clinically effective in managing this condition.

MANAGEMENT OF TRAUMATIC QUADRIPARESIS (ABHIGHĀTAJA SARVĀṄGA VĀTA) WITH PAÑCAKARMA THERAPIES - A CASE STUDY

Globally, 15 million people are living with spinal injuries. Spinal injury Percentage of total Neurological disorders disease burden in India is 1.9.The following is a case managed in Dept of Pañchakarma, S.V. Ayurvedic Hospital, Tirupati, depicting the success of various Pañchakarma therapies. A 65-year-old male patient with a chief complaint of loss of sensations from below the neck and weakness in both upper and lower limbs, giving the history of a road traffic accident in the year 2015 and underwent Microscopic anterior cervical C3 - C4 discectomy and fusion surgery after the accident. He has been treated with Sarvāṅga Abhyaṅga and Nāḍī swedam for 3 days, Mātrāvasti with Nirguṇḍītailam for 7 days, Kālavasti with Vājigandhādiyoga for Āsthāpana and Nirguṇḍī tailam for Anuvāsana for 16 days. The ASIA scale score recorded at the outset was 78/324, Which improved to 205/324 after the completion of therapies. The patient ultimately regained his sensations and had moderate improvement in motor power of muscles, which was reflected in the ASIA scale. Sarvāṅga Abhyaṅga and Nāḍī swedam administered initially have been considered as the first-line therapies in the management of vitiated Vāta. The Mātrāvasti administered afterwards has tremendous Vātahara property. The Vājigandhādi yoga, which has been explained in Vaṅgasena for the management of Gṛdhrasīvāta, is tried here in Kālavasti format. The abovestated Pañchakarma therapies have shown significant amelioration in both sensory and motor deficits. More over they proved safe during the entire length of course.

Detection of sensory deficits in fine nerve fibres in leprosy diagnosis.

The purpose of this study was to determine reference points for thermal perception in cutaneous lesions of leprosy, a disease caused by Mycobacterium leprae characterised by hypoesthesia in skin lesions due to nerve and Schwann cell infection. Early diagnosis is essential to control transmission and effectively treat the disease. Quantitative thermal testing (QTT) has been proposed as a valuable tool for early detection of the disease, initiation of treatment, and monitoring of nerve damage. A thermal analyser was used to determine warm and cold perception thresholds (WPT and CPT, respectively) in skin lesions of 42 leprosy patients and 22 healthy controls. The thresholds were determined using a 0.25 cm2 thermal stimulator, the method of limits, and the receiver operating characteristic (ROC) curve. Thermal thresholds were higher in patients' skin lesions compared to unaffected areas and controls. The reference points calculated for the WPT and CPT were 36.55 and 26.35°C, respectively, with high sensitivity and specificity. The nerve fibres affected by leprosy caused altered thermal sensitivity in the patients' lesions, especially in warm sensation. A smaller thermal stimulator and the method of limits were effective in detecting early sensory deficits in nerve fibres, demonstrating the potential for early detection of the disease.

Effectiveness of Perioperative Finger Sensory Rehabilitation in Patients Undergoing Fingertip Amputation and Reimplantation: A Retrospective Study.

Finger reimplantation is an effective method for the treatment of amputated fingertips. However, there are several shortcomings in traditional postoperative rehabilitation programs, which may affect a patient's functional recovery after surgery. Finger sensory rehabilitation is a comprehensive program that helps patients restore sensory and motor function to their fingers through the use of specific training methods and equipment. Thus, this study aimed to analyze the effect of finger sensory rehabilitation on a group of patients who had undergone fingertip amputation and reimplantation. The medical records of 106 patients having undergone fingertip amputation and reimplantation from January 2022 to January 2024 were retrospectively analyzed. The patients were classified into experimental group (n = 52, receiving conventional rehabilitation training + finger sensory rehabilitation training) and the control group (n = 54, receiving only conventional rehabilitation training). Patients in both groups participated in a 20-week rehabilitation training, and the Semmes-Weinstein monofilament test was used to evaluate the finger touch pressure sensation after completing the rehabilitation training in both groups, and the Visual Analogue Scale (VAS) score, Generic Quality of Life Inventory-74 (GQOLI-74) score to evaluate their pain sensation and quality of life on the 2nd postoperative day and at the end of rehabilitation training. After completing rehabilitation, a specialized method for assessing the patient's tactile sensory deficits was used, showing that the number of cases with light tactile hypoesthesia to single-fiber sensation in the reimplanted fingertips was higher in the experimental group than in the control group (p < 0.01), while there was no significant difference in the number of cases of protective hypoesthesia between the two groups (p > 0.05), the number of cases of protective sensory loss was significantly lower in the experimental group than in the control group (p < 0.01). There was no significant difference in the pain scores and comfort scores between the two groups before management (p > 0.05). However, the pain level of the two groups after management was significantly lower than that before management (p < 0.01), whereas the post-management comfort scores of both groups were significantly higher than that before management (p < 0.001). The experimental group's degree of improvement was significantly higher than that of the control group (p < 0.001). The pre-management GQOLI-74 scores were not significantly different between the groups (p > 0.05), whereas after management, the experimental group outperformed the control group in all dimensions of the scores, except in thinking ability (p < 0.01). Although not statistically significant (p > 0.05), the total perioperative complication rate of the experimental group was lower than that of the control group. The implementation of finger sensory rehabilitation training is effective for restoring tactile function, reducing pain levels, and improving quality of life among patients who had undergone fingertip amputation and reimplantation. This finding can inform the development and selection of subsequent rehabilitation programs.

High-frequency epidural electrical stimulation reduces spasticity and facilitates walking recovery in patients with spinal cord injury.

Spinal cord injury (SCI) causes severe motor and sensory deficits, and there are currently no approved treatments for recovery. Nearly 70% of patients with SCI experience pathological muscle cocontraction and spasticity, accompanied by clinical signs such as patellar hyperreflexia and ankle clonus. The integration of epidural electrical stimulation (EES) of the spinal cord with rehabilitation has substantial potential to improve recovery of motor functions; however, abnormal muscle cocontraction and spasticity may limit the benefit of these interventions and hinder the effectiveness of EES in promoting functional movements. High-frequency excitation block introduced in peripheral nerve stimulation could reduce abnormal activity and lead to more physiological activation patterns. Here, we evaluated the application of high-frequency EES (HF-EES) in alleviating undesired muscular cocontraction and spasticity in two patients with motor incomplete SCI implanted with a commercial 32-channel EES paddle commonly used for pain therapy. To design custom HF-EES protocols, we first mapped the muscles targeted by different EES configurations. Our results showed that HF-EES substantially reduced patellar reflex in one participant and eliminated both patellar reflex and ankle clonus in the other participant. By combining HF-EES and low-frequency EES (LF-EES) to enhance functional movements with intensive rehabilitation, we observed notable improvements in lower limb kinematics, muscle strength, and clinical lower limb motor assessments over the trial period. This study suggests that HF-EES could be an important supplementary tool in SCI treatment, emphasizing the importance of personalized rehabilitation approaches and advanced tools to optimize EES treatments and offering hope for individuals with SCI-related motor deficits.

Psychometric properties of Child Sensory Profile-2 (CSP-2) among children with spastic cerebral palsy.

According to the findings of our study, the CSP-2 is a valid and reliable measure for evaluating sensory processing in children with spastic CP. Additionally, it may be an appropriate tool for accurately assessing this population's sensory processing deficits. •Sensory processing deficits commonly concur with motor deficit in children with CP. Overall prevelance of sensoryprocessing deficit was 83% in children with CP. •Child Sensory Profile-2 is a reliable and valid tool for measuring sensory processing abilities in children with CP.

Enhanced CB1 receptor function in GABAergic neurons mediates hyperexcitability and impaired sensory-driven synchrony of cortical circuits in Fragile X Syndrome model mice.

Electroencephalographic (EEG) recordings in individuals with Fragile X Syndrome (FXS) and the mouse model of FXS ( Fmr1 KO) display cortical hyperexcitability at rest, as well as deficits in sensory-driven cortical network synchrony. A form of circuit hyperexcitability is observed in ex vivo cortical slices of Fmr1 KO mice as prolonged persistent activity, or Up, states. It is unknown if the circuit mechanisms that cause prolonged Up states contribute to FXS-relevant EEG phenotypes. Here we examined the role of endocannabinoids (eCB) in prolonged Up states in slices and resting and sensory-driven EEG phenotypes in awake Fmr1 KO mice. Bidirectional changes in eCB function are reported in the Fmr1 KO that depend on synapse type (excitatory or inhibitory). We demonstrate that pharmacological or genetic reduction of Cannabinoid Receptor 1 (CB1R) in GABAergic neurons rescues prolonged cortical Up states and deficits in sensory-driven cortical synchrony in Fmr1 KO mice. In support of these findings, recordings from Fmr1 KO cortical Layer (L) 2/3 pyramidal neurons revealed enhanced CB1R-mediated suppression of inhibitory synaptic currents. In contrast, genetic reduction of Cnr1 in glutamatergic neurons did not affect Up state duration, but deletion of Fmr1 in the same neurons was sufficient to cause long Up states. These findings support a model where loss of Fmr1 in glutamatergic neurons leads to enhanced CB1R-mediated suppression of GABAergic synaptic transmission, prolonged cortical circuit activation and reduced sensory-driven circuit synchronization. Results suggest that antagonism of CB1Rs as a therapeutic strategy to correct sensory processing deficits in FXS.

Activities of Daily Living in a Iranian Man With Cervical Spinal Cord Injury Based on the Model of Human Occupation

Background and Objectives: Since all aspects of occupational performance are affected by cervical spinal cord injury (SCI), one of the goals of occupational therapy for these clients is to restore the abilities and routines necessary for independence in activities of daily living (ADL). The model of human occupation (MOHO) seems to help occupational therapists develop a framework for clinical reasoning about the living conditions of people with cervical SCI emphasizing the interaction between volition, habituation, and performance capacity. This study aims to investigate the use of MOHO in occupational therapy for cervical SCI and focuses on the significance of comprehending and adjusting to these specific needs to improve their participation in purposeful daily activities leading to occupational adaptation. Case Presentation: The focus of this study is on a 26-year-old man who experienced a cervical SCI at the C6 level due to a diving accident. He exhibits varying degrees of motor and sensory deficits, characterized by partial upper extremity function and complete loss of function in the lower extremities. The client expresses a strong desire to develop skills for safe and effective transfers, the need for strategies that promote community reintegration and social interaction, and adaptive strategies and utilize assistive devices that will enable him to perform ADLs with greater independence. Conclusion: Because in a person with cervical SCI, values and interests, internalized roles, and performance capacities are affected by impairment, designing a program based on the MOHO will help occupational therapists perform more effectively.

Analysis of the behavior of children with ASD during physical activity

Interventions in physical activity for children with ASD (Autism Spectrum Disorder) remain a challenge for educators for the following reasons: first, information processing, an essential foundation for physical practice, is a persistent impairment for this population due to the sensory deficits associated with this condition. Second, their reluctance to engage and participate in physical activity due to challenging behaviors. The aim of the present study toward quantitatively measuring the behaviors of children with ASD in relation to motor task design during a physical activity session.Eight children were recruited for this study (6 boys; 2 girls), aged between 6 and 12 years (mean = 10.0 1.5 years). All participants were classified at level 2 (moderate) according to the APA (2015), which takes into account the amount of support the child needs to function in their environment. The inclusion criteria adopted in this study were as follows: regular, full-time attendance at the association where the study was conducted, absence of regular participation in extracurricular sports activities, absence of comorbidities that would impair physical activity (e.g., visual impairment), and absence of medical treatment (e.g., psychotropic medications) likely to influence the study's outcomes. Three types of motor tasks (closed, play-based, and interaction-based) were designed in this study to assess their impact on the behaviors of children with ASD. Live and video scoring allowed us to evaluate both positive and problematic behaviors of the participants.The results revealed that task design plays a crucial role in the emergence of behaviors in children with ASD. Specifically, the more task is tailored to their unique characteristics, the more problematic behaviors decrease and positive behavior increase. This is particularly true for play-based tasks, which demonstrated a more pronounced effect and a preferential advantage compared to other tasks. Indeed these tasks led to significant improvements in most items (5 out of 7 items), due to their approach rootes in unconscious learning, which proved to be beneficial for these children during physical activity.The findings of this study may provide a promising pathway for the development of programs and the design of physical activity learning situations for this community with very specific needs.

Assessing Donor Site Morbidity and Impact on Quality of Life in Free Flap Microsurgery: An Overview

Donor site morbidity remains a significant concern in free flap microsurgery, with implications that extend beyond immediate postoperative outcomes to affect patients’ long-term quality of life. This review explores the multi-faceted impact of donor site morbidity on physical, psychological, social, and occupational well-being, synthesizing findings from the existing literature. Particular attention is given to the functional limitations, sensory deficits, aesthetic outcomes, and chronic pain associated with commonly utilized free flaps. Advancements in surgical techniques, including nerve-sparing and muscle-sparing methods, as well as innovations, like perforator flaps, have demonstrated the potential to mitigate these morbidities. Furthermore, the integration of regenerative medicine strategies, such as stem cell therapy and fat grafting, and technological innovations, including virtual reality rehabilitation and biofeedback devices, has shown promise in enhancing recovery and minimizing long-term complications. Despite these advances, challenges persist in standardizing QoL assessments and optimizing donor site management. This review emphasizes the need for a holistic, patient-centered approach in reconstructive microsurgery, advocating for further research to refine current strategies, improve long-term outcomes, and develop robust tools for QoL evaluation. By addressing these gaps, reconstructive surgeons can better align surgical objectives with the comprehensive well-being of their patients.

Olfactory Evoked Potentials and Brain MRI Outcomes in Multiple Sclerosis Patients: A Cross-Sectional Study.

Background: Olfactory dysfunction (OD) is an underestimated symptom in multiple sclerosis (MS). Multiple factors may play a role in the OD reported by MS patients, such as ongoing inflammation in the central nervous system (CNS), damage to the olfactory bulbs due to demyelination, and the presence of plaques in brain areas associated with the olfactory system. Indeed, neuroimaging studies in MS have shown a clear association of the OD with the number and activity of MS-related plaques in frontal and temporal brain regions. However, these studies have used only psychophysical tests to evaluate the OD in MS patients. Olfactory Event-Related Potentials (OERPs) are a method to assess olfaction with the clear advantage of its objectivity in comparison with psychophysical tests. The aim of this study was to investigate the association between the parameters of OERP components (latency and amplitude) and the lesion load of the brain regions which are involved in olfaction in a cohort of relapsing-remitting (RR) MS patients. Methods: In this cross-sectional study, we enrolled 30 RRMS patients and 30 healthy controls. The parameters of OERP components and magnetic resonance imaging data (lesions in the CNS) were analyzed in RRMS patients. Results: The association found between the RRMS patient groups with and without OERPs and the number of lesions in the frontal area as well as the correlation between the lesion load in the temporal area and OERP parameters suggest how brain alterations may impact on olfactory performance in MS. In addition, the predictive value of the number of lesions in the frontal and parietal areas for P2 amplitude also highlights the potential for OERP measures to serve as markers for disease progression in MS. Conclusions: This approach to assess the olfaction in MS could improve our understanding of the disease's neurological impact and contribute to the development of new targeted interventions to mitigate olfactory sensory deficits.

Prevalence and Pattern of Traumatic Dental Injuries in Children and Adolescents With Severe to Profound Hearing Impairment: A Hospital-Based Cross-Sectional Study.

Traumatic Dental Injuries (TDIs) are an emerging public health problem and a realm of research for oral health enthusiasts. Certain populations can be more vulnerable to injuries such as those with a sensory deficit. Nevertheless, literature is scarce, especially for those with hearing impairment. Therefore, the aim of the study was to compare the prevalence and patterns of TDI in children and adolescents with severe-to profound hearing impairments and children without hearing impairments. Three hundred and ninety participants (195 severe to profound hearing impaired and 195 age and sex-matched controls) between 4 and 18 years were recruited from a tertiary care setting. A single calibrated examiner evaluated TDI for both groups. Among those with TDI, a vestibular function test (VFT) was also performed to assess postural balance. A single examiner from the Department of Otorhinolaryngology evaluated the VFT results. The overall prevalence of TDI was found to be 12.82% among the severe to profound hearing-impaired individuals, and 11.79% in controls. The majority of participants were aged between 7 and 13 years, in the mixed dentition stage, and were males. Among the cases, the majority had profound hearing loss (≥ 91 dB HL) and bilateral ear involvement. The most common type of TDI was uncomplicated crown fractures. Falls were identified as the most common cause of TDI in both groups. Vestibular dysfunction and loss of postural control were identified in 12 out of 14 patients tested with VFT. A significant association was found between TDI and the dentition type, that is, primary dentition was more affected among the severe to profound hearing impaired as compared to controls (p < 0.05). There was no significant association between the severity of hearing impairment and the prevalence of dental trauma in children and adolescents with severe to profound hearing impairment. However, hearing-impaired individuals were susceptible to trauma at an early age compared to their healthy counterparts.

A research protocol to study the critical time window for rehabilitation after incomplete spinal cord injury: early vs. late locomotor training

Spinal cord injury (SCI) often results in severe motor and sensory deficits, leading to significant disability. Preclinical studies and retrospective studies suggest that a critical window of enhanced neuroplasticity may exist immediately after SCI, during which therapeutic interventions could yield greater functional improvements. The impact of time interval since SCI on efficacy of rehabilitation has not been directly assessed and is the focus of this clinical trial. This study will compare the efficacy of high-intensity gait training, initiated at different time intervals post-injury, on walking performance in individuals with SCI. We hypothesize that early intervention will yield the greatest improvements in walking ability and community ambulation, compared to training initiated at 3 or 6 months after SCI, or standard of care. This randomized, multi-site clinical trial will enroll 108 participants with acute, traumatic SCI. Participants will be randomized to receive 20 h of high-intensity gait training that will be initiated either early (< 60 days post-SCI), sub-acute (3 months), chronic (6 months), or to a control group receiving standard of care. Primary outcomes include gait speed (10 m Walk Test) and walking endurance (6-Minute Walk Test). Secondary outcomes include daily step count via wearable sensors, lower extremity strength, and quality of life measures. Assessments will occur at baseline, pre/post-intervention, and at 3, 6, 9, and 12 months post-SCI. This study will provide insights into the optimal timing of rehabilitation post-SCI and could have profound effects on our approach to training individuals with SCI in the healthcare setting as well as long term recovery outcomes.Trial registration ClinicalTrials.gov NCT06176833 was completed on 12/11/2023.

Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) is a rare immune-mediated polyradiculoneuropathy. Patients typically develop rapidly progressive weakness and sensory deficits that can result in complete paralysis requiring mechanical ventilation. GBS is usually a monophasic disease in which an aberrant immune response to an infection or other trigger damages the peripheral nerves. For example, in patients with preceding Campylobacter jejuni infection, molecular mimicry causes a cross-reactive antibody response to nerve gangliosides. Diagnosis is based on clinical features, supported by cerebrospinal fluid analysis and nerve conduction studies. Effective treatments include plasma exchange and intravenous immunoglobulins. However, ~20% of patients who received treatment are unable to walk after 6 months and ~5% die as a consequence of GBS. Important knowledge gaps in GBS include its pathogenesis, especially after viral infections. In addition, there is a lack of specific biomarkers to improve thediagnosis, monitor thedisease activity, and predict the clinical course and outcome of GBS. Major challenges for the future include finding more effective and personalized treatments, which are affordable in low-income and middle-income countries, and preparation for outbreaks of infections as potential triggers for GBS.

Comparison of Postoperative Outcomes in Two Lip-Splitting Approaches for Buccal Squamous Cell Carcinoma Ablation.

The choice of surgical access for resection and reconstruction of buccal squamous cell carcinoma (BSCC) with the lip-splitting incision is controversial. Thus, this study aimed to evaluate the clinical and functional outcomes of midline lip split with lazy-S incision (MLSI) against the lateral lip-splitting incision (LLSI). A retrospective review was conducted on 41 patients with primary BSCC who underwent resection and reconstruction using MLSI approach (n = 19) and LLSI approach (n = 22) between 2022 and 2024. Functional outcomes, including skin sensitivity testing, oral competency, lip movement, cold perception, and other relevant measures, were evaluated with appropriate scales. Functional satisfaction and Patient and Observer Scar Assessment Scale (POSAS) were analyzed. None of the patients in either group demonstrated differences in sensation to light touch from baseline at 6 months postoperatively. Patients with MLSI approach reported higher lip function satisfaction (p = 0.037), and no patients in either group reported drooling. Besides, groove formation was significantly more common in the LLSI compared to the MLSI groups (50% vs. 15.8%, respectively; p = 0.046). A statistically significant difference was also observed in the self-assessment of mouth-opening movement among MLSI patients (p = 0.041). No significant differences were found in the mean POSAS scores, except that irregularity and surface area parameters were better in the MLSI group. Objective sensation deficits are reversible and do not impact long-term daily activities. The MLSI approach provides better postoperative outcomes and low disfigurement perception.

An Epigenetic Locus Associated with Loss of Smell in COVID-19.

Loss of smell, also known as anosmia, is a prevalent and often prolonged symptom following infection with SARS-CoV-2. While many patients regain olfactory function within weeks, a significant portion experience persistent anosmia lasting over a year post-infection. The underlying mechanisms responsible for this sensory deficit remain largely uncharacterized. Previous studies, including genome-wide association studies (GWAS), have identified genetic variants near the UGT2A1 and UGT2A2 genes that are linked to anosmia in COVID-19 patients. However, the role of epigenetic changes in the development and persistence of smell loss has not been well explored. In this study, we aimed to investigate epigenetic alterations in the form of DNA methylation in the UGT1A1 gene, which is a locus associated with olfactory dysfunction in COVID-19 patients. We analysed DNA methylation patterns in blood samples from two carefully matched cohorts of 20 COVID-19 patients each, which are differentiated by their olfactory function-those with normal smell (normosmia) and those suffering from smell loss (anosmia). The cohorts were matched for age and sex to minimize potential confounding factors. Using quantitative analysis, we found significantly lower levels of DNA methylation in the UGT1A1 locus in the anosmia group compared to the normosmia group, with a 14% decrease in median methylation values in patients with smell loss (p < 0.0001). These findings highlight potential epigenomic alterations in the UGT1A1 gene that may contribute to the pathogenesis of anosmia following COVID-19 infection. Our results suggest that the methylation status at this locus could serve as a biomarker for olfactory dysfunction in affected individuals. This study is among the first to describe epigenetic changes associated with smell loss in COVID-19, providing a foundation for future research into targeted interventions and potential therapeutic strategies aimed at reversing persistent anosmia. Further investigations involving larger cohorts and additional loci may help elucidate the complex interaction between genetic, epigenetic, and environmental factors influencing long-term sensory impairment post-COVID-19.

Risk Factors and Pain Management in the Incidence of Postoperative Delirium in Elderly Patients: A Retrospective Study.

Background: Postoperative delirium (POD) is a common surgical complication that increases hospital stay duration, hospitalization costs, readmission rates and mortality. This study aims to describe the incidence of POD in an elderly patient population and to investigate pain assessment as a risk factor for postoperative confusion. Additionally, we aim to determine a predictive model for POD. Methods: We conducted a retrospective, observational, single-center study at La Timone Hospital between September 2020 and September 2021. We included patients aged 65 or older, admitted for scheduled or emergency surgical care, with an expected postoperative stay of three days or more and no history of dementia. Data were collected in three stages of hospitalization: preoperative, perioperative, and postoperative. Preoperative data included medical history and lifestyle; perioperative data included surgical and anesthesia characteristics, and postoperative data were collected. Results: Of the 531 patients admitted for surgical care, we analyzed 109 patients. Among these, 24 (22%) experienced a POD episode within the first three postoperative days. Age, preoperative cognitive impairments, preoperative sensory deficits, and long-term benzodiazepine use were identified as risk factors for POD. A significant difference in pain levels was also observed for all NRS scores during the first three postoperative days. After multivariate analysis, we retained two predictive models for POD. Conclusions: This study identified risk factors for POD and proposed predictive models based on these factors. Two models were particularly notable for their potential use in anesthesia consultations and patient follow-up services to quickly detect patients at risk of POD.

Assessing axonal pathology and disease progression in chronic inflammatory demyelinating polyneuropathy using corneal confocal microscopy

ObjectiveChronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an autoimmune neuropathy characterized by progressive or relapsing–remitting weakness and sensory deficits. This study aims to evaluate the utility of corneal confocal microscopy (CCM) in diagnosing and monitoring CIDP.MethodsWe analysed 100 CIDP patients and 31 healthy controls using CCM to measure corneal nerve fiber density (CNFD), length (CNFL), and branch density (CNBD). Standardized clinical and electroneurographic evaluation were conducted, and statistical analyses were performed to compare CCM parameters between groups and across disease stages.ResultsCIDP patients and subgroups exhibited significant reduction in CNFD, CNFL, and CNBD compared to controls. This reduction was observed in late disease stages and severe overall disability sum score (ODSS), and Inflammatory Neuropathy Cause and Treatment Sensory Sum Score (ISS). CCM parameters correlated with axonal pathology in electroneurography of sensory, but not motor nerves. Despite the significant differences, the diagnostic sensitivity (41%) and specificity (77%) of CCM parameters were limited.ConclusionWhile CCM effectively differentiates CIDP patients from healthy controls and was associated with disease severity, its diagnostic accuracy for routine clinical use is a posteriori. However, CCM shows promise as a non-invasive tool for monitoring sensory axonal pathology in CIDP.