Degree Of Disability Research Articles

Electrodiagnostic evaluation of autonomic dysfunction in patients with multiple sclerosis

Abstract Background: Autonomic dysfunction frequently affects multiple organs and systems in people with multiple sclerosis (PwMS), including the heart, bladder, and bowels, as well as sudomotor and sexual functions, and can have a significant negative impact on the quality of life. Aim: to assess the effect of MS on autonomic nervous system (ANS) functions by electrodiagnostic measures and investigate the relationship of these measures with different demographic and clinical factors such as age, sex, duration of disease, type of treatment, the Expanded Disability Severity Scale (EDSS) score, and the Composite Autonomic Symptom Score-31 (COMPASS-31) score. Methods: forty patients with a definite diagnosis of relapsing-remitting MS and 35 age- and sex-matched controls. The EDSS to assess disease severity and the COMPASS-31 questionnaire to test for degree of clinical autonomic disability, Ewing’s cardiovascular autonomic tests, and sympathetic skin response (SSR) as electrophysiologic tests for autonomic dysfunction were done. Results: The heart rate during normal (HRNB), HR response to deep breathing (HRDB), and systolic blood pressure (BP) drop from supine to standing position were significantly different in the PwMS relative to the controls. Moreover, PwMS exhibited prolonged palmar SSR latency and reduced plantar SSR amplitude. Disease duration was negatively correlated with HRNB, HRDB, and heart rate during the Valsalva manoeuvre (HTVals). EDSS is also negatively correlated with HRNB and HRDB. Furthermore, COMPASS-31 also shows a negative correlation with HRDB. On the contrary, systolic PB drop and planter SSR amplitude were positively correlated with EDSS. Conclusion: In MS, cardiac autonomic dysfunction affects both the parasympathetic and sympathetic NS. Alongside the cardiovascular system, the sympathetic sudomotor system is also impacted. The length and severity of the disease were correlated by parasympathetic abnormalities. No correlation was observed within the patient group between any autonomic function tests and age, sex, treatment type, or family history of MS. Keywords: Multiple sclerosis, EDSS, autonomic function tests, COMPASS-31

Costs during the first year after stroke by degree of functional disability: A societal perspective.

The aim of this study was to estimate societal costs during the first year after stroke by degree of functional disability. Descriptive study of the cumulative costs incurred during 1-year follow-up of a cohort of patients with stroke in Catalonia (Spain) participating in a multicentre, population-based, cluster-randomised trial (RACECAT). Patients were recruited between September 2017 and January 2019. Costs were collected for each patient from stroke onset to 1-year follow-up through hospital accounting records, electronic healthcare records and structured telephone-based interviews at 6 and 12-months follow-up. Disability was assessed using the 90-day modified Rankin Scale (mRS). Healthcare, community care, and patient/family costs were included. We used complete data from 567 eligible participants. Cost data were analysed using generalised linear models (GLMs) with gamma distributions and log link functions. For variables with >10% zero values, two-part models were applied. We performed sensitivity analyses modifying unit costs for patient/family costs. Of the 567 patients included, 53% had ischaemic large vessel oclusion (LVO) stroke, 24% intracranial haemorrhage and 23% ischaemic non-LVO stroke. Mean cost per patient during the first year after stroke was €29,673 ± 28,632, and increased with degree of disability (mRS 0-2: €18,568 ± 12,244; mRS 3: €38,214 ± 28,172; mRS 4-5: €52,859 ± 36,383). Healthcare costs represented the highest proportion of total costs (63%; €18,724/patient) across all disability levels, with index hospitalisation being the highest (€12,319 ± 17,675); however, community care and patient/family costs represented over 40% of total cost in patients with higher disability levels. Our results are in line with other studies; the costs during the first year after stroke are high and increase with disability. These results are valuable for calculating the cost of severe stroke cases.

A Combined Extract Derived from Black Sticky Rice and Dill Improves Clinical Symptoms and Ischemic Stroke Biomarkers in Transient Ischemic Attack and Ischemic Stroke Patients.

Currently, the adjuvant therapy to optimize the restorative process after stroke is required due to the unsatisfied therapeutic efficacy. A combined extract of black sticky rice and dill showed potential in the preclinical state, so we hypothesized that it could provide clinical benefits. A three-arm, randomized, placebo-controlled study was set up to elucidate this issue. Both males and females (18-80 years old) who had experienced transient ischemic attacks or ischemic strokes within the last 5-10 days with an NIHSS score ≤ 7 and received standard treatment were randomly assigned to receive either a placebo or capsule containing a combined extract of black sticky rice and dill at a dose of 600 or 1200 mg per day. The safety parameters, movement control, and degree of disability were assessed 1, 2, and 6 weeks after the intervention, and serum stroke biomarkers were assessed at the mentioned time points, except at 2 weeks. After week 1, the high-dose (1200 mg/day) treatment group had improved NIHSSS, VCAM1, and MMP-9. Both S100β and VCAM1 also improved at week 6, while the low-dose treatment group (600 mg/day) only exhibited improved VCAM1. Therefore, a high dose of the developed adjuvant supplement improves stroke recovery by improving motor impairment by reducing endothelial dysfunction and inflammation.

Post-intensive-care morbidity among pediatric patients in Thailand: prevalence, risk factors, and the importance of the post-intensive-care clinic.

Long-term survival data for critically ill children discharged to post-intensive care clinics are scarce, especially in Asia. The main objective of this study was to assess the prevalence of post-intensive-care morbidity among pediatric intensive care unit (PICU) survivors at 1 month and 1 year after hospital discharge and to identify the associated risk factors. We conducted a retrospective chart review of all children aged 1 month to 15 years who were admitted to the PICU for >48 hours from July 2019 to July 2022 and visited a post-intensive-care clinic 1 month and 1 year after hospital discharge. Post-intensive care morbidity was defined using the Pediatric Cerebral Performance Category (PCPC). Descriptive statistics, univariate, and multivariate analyses were conducted. A total of 111 children visited the clinic at 1 month, and 100 of these children visited the clinic at 1 year. Only 39 of 111 children (35.2%) had normal PCPC assessments at 1 month, while 54 of 100 (54.0%) were normal at 1 year. Baseline developmental delays were significantly associated with any degree of disability and at least moderate disability at both time points. Mechanical ventilation for >7 days was associated with at least moderate disability at both time points, while PICU stay >7 days was significantly associated with moderate disability at 1 month and any degree of disability at 1 year. A substantial percentage of PICU survivors had persistent disabilities even 1 year after critical illness. A structured multidisciplinary post-intensive-care follow-up plan is warranted to provide optimal care for such children.

Analysis of clinical characteristics and genetic variants in two pedigrees affected with Autosomal dominant intellectual developmental disorder 49

To explore the clinical and genetic features of two Chinese pedigrees affected with Autosomal dominant intellectual developmental disorder 49 (MRD49). Two MRD49 pedigrees which were admitted to the Children's Hospital Affiliated to Shandong University respectively on January 28, 2021 and November 10, 2022 were selected as the study subjects. Clinical data of the two pedigrees were collected and analyzed. Genomic DNA was extracted from peripheral blood samples of the probands and their family members. The probands were subjected to mutational analysis by high-throughput sequencing. Candidate variants were validated using real-time fluorescence quantitative PCR (q-PCR) or Sanger sequencing and bioinformatic analysis. This study was approved by the Medical Ethics Committee of the Children's Hospital Affiliated to Shandong University (Ethics No. SDFE-IRB/T-2022002). Proband 1 had presented with language delay, motor retardation and intellectual disability, and his maternal grandmother, mother, aunt and cousin all had various degrees of intellectual disability. Sequencing results showed that proband 1 had deletion of exons 3 ~ 7 of the TRIP12 gene. q-PCR verification showed that his mother, aunt, maternal grandmother and cousin had all harbored the same deletion. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was classified as pathogenic (PVS1+PM2_Supporting+PP1). Proband 2, who had mainly presented with language delay, motor retardation and intellectual disability, and was found to harbor a heterozygous c.3010C>T (p.Arg1004*) variant of the TRIP12 gene, which was verified to be de novo in origin. Based on the guidelines from the ACMG, the variant was classified as pathogenic (PVS1+PS2+PM2_Supporting). This study had diagnosed two MRD49 families through high-throughput sequencing. Above findings have enriched the phenotypic and mutational spectrum of MRD49 in China, which has also facilitated genetic counseling for the two pedigrees.

지체장애 특수학교에서의 스마트기기 활용 및 교사 인식 현황

Purpose: We want to understand the level of sensory movement and AAC use of students with physical disabilities and how much special teachers use smart devices for the education of students with physical disabilities, and investigate the perceptions and requirements of education using smart devices. Method: For 115 special teachers working at special schools with physical disabilities, students' sensory performance, complementary and alternative communication skills, smart device usage, and perception of smart device usage were investigated. For frequency analysis of student characteristics and utilization status, and cross-analysis of teacher variables and smart device use, Excel 2021 and SPSS 27.0 were statistically processed. Results: The degree of moderate disability was confirmed in physical disabilities special schools. It was found that a significant number of teachers in special schools with physical disabilities use smart devices in class at least once a week, often for motivation purposes, and mainly use video content. Smart devices are recognized as helpful and they are expected to be effective in communication and leisure use. They asked development of various contents and improvement of access to smart devices. Conclusion: It is necessary to develop various contents at the national level to use smart devices for students with physical disabilities, and several follow-up studies are needed to increase the accessibility of students with physical disabilities to smart devices. Customized teacher training for guidance of students with physical disabilities and support for active use of smart devices as AAC are needed.

Free Kappa light chain in a sample of Egyptian multiple sclerosis patients (a pilot study)

BackgroundMultiple sclerosis is a chronic autoimmune-mediated demyelinating disease of the central nervous system that is usually associated with varying degrees of progressive disability. Free Kappa light chain (FKLC) has attracted growing attention as a significant diagnostic marker of MS. Our aim was to study the diagnostic utility of cerebrospinal fluid free Kappa light chain and related indices in a sample of Egyptian MS patients vs. CSF IgG oligoclonal bands. It was a prospective case–control study of MS patients carried in our hospital during the period from January 2021 till January 2022. Our study carried on 30 patients with multiple sclerosis and other inflammatory neurologic diseases and 20 age and sex matched controls. The study measured FKLC in the CSF and serum sample pairs of patients and control group. Indices calculated using FKLC measured in CSF and serum included; FKLC index, FKLC intrathecal fraction and quotient of FKLC. Indices were used to assess intrathecal synthesis of FKLC considering blood–CSF barrier function. Receiver operating characteristic curve analysis was used to determine diagnostic performance of FKLC and related indices in comparison to CSF–OCB testing.ResultsMeasured FKLC levels as well as its calculated indices have shown statistically significant higher values among MS patients against OIND patients and healthy control group. Both FKLC index and FKLC IF were similarly showing 100% diagnostic sensitivity and 100% diagnostic specificity for MS diagnosis.ConclusionsFKLC biomarkers are proposed to be highly sensitive and easy to detect first-line markers of intrathecal immunoglobulin synthesis with accurate performance and low cost that might prove to be promising diagnostic markers of MS.

A novel MAOA gene variant: Brunner syndrome, a rare syndrome, is associated with a wide range of psychiatric symptoms.

Brunner syndrome is a rare genetic disorder that associated with mutations in the MAOA gene. It has been linked to a number of psychiatric disorders. We present detailed information on psychiatric evaluation of a case carrying a novel MAOA gene variant of p.(Thr408Met). The patient was referred to our clinic with a history of attention problems, motor coordination difficulties and a tendency to bite objects. Following a comprehensive psychiatric evaluation, the patient was diagnosed with developmental coordination disorder, articulation disorder and attention deficit hyperactivity disorder (ADHD). MAOA mutations are rarely reported in the literature. To date, a total of 23 MAOA gene variants, mostly missense variants, have been reported through the HGMD database (Professional 2023.4). Neurodevelopmental symptoms may vary in severity and diversity among patients with Brunner syndrome. Different degrees of intellectual disability have been found in previously reviewed cohorts of Brunner syndrome. In our affected patient, cognitive development and academic achievement were at a similar level to his peers. Additionally, our patient exhibited symptoms suggestive of developmental coordination disorder. Our findings show that genetic mutations in MAOA can lead to a wide range of clinical symptoms and underline the need for comprehensive genetic and clinical evaluations.

Efficacy and safety of very early rehabilitation for acute ischemic stroke: a systematic review and meta-analysis.

Early rehabilitation after acute ischemic stroke (AIS) contributes to functional recovery. However, the optimal time for starting rehabilitation remains a topic of ongoing investigation. This article aims to shed light on the safety and efficacy of very early rehabilitation (VER) initiated within 48 h of stroke onset. A systematic search in PubMed, Embase, Cochrane Library, and Web of Science databases was conducted from inception to January 20, 2024. Relevant literature on VER in patients with AIS was reviewed and the data related to favorable and adverse clinical outcomes were collected for meta-analysis. Subgroup analysis was conducted at different time points, namely at discharge and at three and 12 months. Statistical analyses were performed with the help of the Meta Package in STATA Version 15.0. A total of 14 randomized controlled trial (RCT) studies and 3,039 participants were included in the analysis. VER demonstrated a significant association with mortality [risk ratio (RR) = 1.27, 95% confidence interval (CI) (1.00, 1.61)], ability of daily living [weighted mean difference (WMD) = 6.90, 95% CI (0.22, 13.57)], and limb motor function [WMD = 5.02, 95% CI (1.63, 8.40)]. However, no significant difference was observed between the VER group and the control group in adverse events [RR = 0.89, 95% CI (0.79, 1.01)], severity of stroke [WMD = 0.52, 95% CI (-0.04, 1.08)], degree of disability [RR = 1.06, 95% CI (0.93, 1.20)], or recovery of walking [RR = 0.98, 95% CI (0.94, 1.03)] after stroke. Subgroup analysis revealed that VER reduced the risk of adverse events in the late stage (at three and 12 months) [RR = 0.86, 95% CI (0.74, 0.99)] and degree of disability at 12 months [RR = 1.28, 95% CI (1.03, 1.60)], and improved daily living ability at 3 months [WMD = 4.26, 95% CI (0.17, 8.35)], while increasing severity of stroke during hospitalization [WMD = 0.81, 95% CI (0.01, 1.61)]. VER improves activities of daily living (ADLs) and lowers the incidence of long-term complications in stroke survivors. However, premature or overly intense rehabilitation may increase mortality in patients with AIS during the acute phase. PROSPERO registration number: CRD42024508180. This systematic review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/). PROSPERO registration number: CRD42024508180.

Assessment of Depression, Anxiety, Stress, Quality of Life, and Fatigue in Patients After a Cerebrovascular Accident.

Background A cerebrovascular accident, or stroke, is a neurological disorder. Those who suffer from a stroke not only face physical disabilities but also a range of psychological issues resulting from concerns about their current situation. The purpose of this study was to assess depression, anxiety, stress, and fatigue after a stroke, along with its effects on quality of life (QoL), degree of disability, and prevalence of various risk factors of stroke. Materials and methods Adult male and female patients who had experienced a stroke and came to the psychiatry or neurology outpatient departments were evaluated. A detailed stroke history was taken for them. The Stroke-Specific Quality of Life Scale (SSQOL) Scale, Depression Anxiety Stress Scale 21, Alcohol Use Disorders Identification Test C (AUDIT C) scale, Suicide Behaviors Questionnaire-Revised (SBQ-R) scale, Fatigue Severity Scale (FSS), and Modified Rankin Scale (mRS) were applied to assess the QoL, depression, anxiety, stress, alcohol use, suicidal behavior, fatigue, and the degree of disability, if any, after stroke. Results The study involved 100 stroke patients aged 18-60 years, with 82 males and 18 females. The mean age was 45.76 ± 8.54 years. 88% experienced an ischemic stroke, and 12% a hemorrhagic stroke. 68% had comorbidities, and alcohol use was present in 48% of patients. The QoL was lowest in the domains of social roles, upper extremity, family roles, and productivity. The study revealed that 67% of patients experienced depression, 63% anxiety, and 62% stress, with 40% having a high risk of suicidal behavior, 57% experiencing fatigue, and 67% disability. There was a significant positive correlation between lower QoL scores, higher depression, anxiety, stress, disability, suicidal ideation, fatigue, and factors such as increased age, female gender, recurrent stroke, psychiatric illness history, multiple comorbidities, and substance use. Conclusion Neuropsychiatric problems following a stroke are common and have serious consequences that significantly influence stroke survivors' QoL and ability to recover.

Airway management algorithm during circular tracheal resection in adult patients with cicatricial stenosis (a single-center study)

The objective was to present the experience of airway management algorithm in patients with different localization of stenosis during circular tracheal resection.Materials and methods. The retrospective analysis included 84 patients with grade II cicatricial stenosis who underwent circular tracheal resection at the period from 2018 to 2023. The patients were divided into two groups: group 1 with long-segment tracheal stenosis and group 2 with short-segment tracheal stenosis (39 and 45 patients, respectively). The age of patients in group 1 was 43 years [28–55] versus 48 [35–61] years in group 2 (p = 0.19). The patients in the groups were comparable in terms of the main parameters: gender, the ratio of women to men, BMI, class of cardiological risk, degree of risk of respiratory complications and pneumonia, degree of disability. Airway management control during surgery was provided by tracheal intubation with the installation of an endotracheal tube (ETT) proximal to tracheal stenosis or with a supraglottic airway device (laryngeal mask) i-gel (LM) before the main stage, followed by the application of the «apnea-ventilation-apnea» technique at the main stage. In patients with tracheostomy, airway management was performed by inserting endotracheal tube (ETT) into the tracheostomy opening using the «apnea-ventilation-apnea» technique until the completion of the main stage, followed by tracheal intubation through the mouth using a bronchoscope. All patients included in this study underwent tracheoplasty; patients with preserved tracheostomy were not included in the study. The choice of the method of airway management was determined after a joint discussion of the patient with the operating surgeon, endoscopists, as well as after evaluating the predictors of difficult airways and the presence of a tracheostomy in the patient.Results. The incidence of patients with tracheostomy in group 1 – 23 (59%) was higher than in group 2 – 9 (16%) (OR 5.75, 95% CI 2.18–15.17; p < 0.0001), which influenced the choice of tactics for airway management, since LM tracheostomy was not used in this group of patients. The choice of tactics for airway management algorithm also depended on the extent of stenosis, so LM was used more often in group 2 – 28 (62.2%) than in group 1 – 12 (30.8%) (p = 0.004). We associate such differences with the presence of a large number of patients with tracheostomy in group 1. For airway management during surgery, LM was used in 90% of cases with cervical localization of stenosis. In group 1, the time of anesthesia and mechanical ventilation increases compared to group 2: 245 [210–275] versus 215 [180–240] min (p = 0.022) and 265 [220–400] versus 210 [180–320] min (p = 0.015), respectively. The frequency of waking up in the operating room and regaining the ability to breathe independently was higher in patients in group 2: 35 (77.8%) than in group 1 22 (56.4%) (OR 2.7, 95% CI 1.05–6.97; p = 0.036). No difference in length of hospital stay was observed in the extent of stenosis and the chosen airway management algorithm.Conclusion. The choice of airway management algorithm during circular tracheal resection in patients with grade II cicatricial stenosis is depended on the localization and extent of tracheal stenosis. The choice of laryngeal mask i-gel as the airway management algorithm is safe and alternative algorithm with tracheal intubation with short-segment cervical stenosis and absence of tracheostomy.

Hypoxia-inducible Factor-1α Pathway in Cerebral Ischemia: From Molecular Mechanisms to Therapeutic Targets.

Ischemic injury to the brain can result in a variety of life-threatening conditions, mortality, or varying degrees of disability. Hypoxia-inducible factor 1α (HIF 1α), an oxygen- sensitive transcription factor that controls the adaptive metabolic response to hypoxia, is a critical constituent of cerebral ischemia. It participates in numerous processes, such as metabolism, proliferation, and angiogenesis, and plays a major role in cerebral ischemia. Through the use of a number of different search engines like Scopus, PubMed, Bentham, and Elsevier databases, a literature review was carried out for investigating the pharmacological modulation of HIF-1α pathways for the treatment of cerebral ischemia. Various signalling pathways, such as Mitogen-activated protein kinase (MAPK), Janus kinase/ signal transducers and activators (JAK/STAT), Phosphoinositide-3-kinase (PI3-K), and cAMPresponse element binding protein (CREB) play a vital role in modulation of HIF-1α pathway, which helps in preventing the pathogenesis of cerebral ischemia. The pharmacological modulation of the HIF-1α pathway via various molecular signalling pathways, such as PI3-K, MAPK, CREB, and JAK/STAT activators, offer a promising prospect for future interventions and treatment for cerebral ischemia.

Comorbidity in in patients with relapsing-remitting multiple sclerosis

Multiple sclerosis is a chronic autoimmune inflammatory disease that affects the brain and spinal cord. The most common form of this disease according to the type of its course is relapsing-remitting multiple sclerosis. Comorbidity in multiple sclerosis is an urgent problem of modern neurology, since it can influence such factors as the time of diagnosis, the rate of disease progression and the rate of patient disability, the number of exacerbations and the patient’s quality of life. The purpose of the work was to study and characterize comorbidity in patients with relapsing multiple sclerosis. To conduct this study 105 patients with a diagnosis of relapsing-remitting multiple sclerosis were enrolled. All patients were assessed using the Multiple Sclerosis Neurological Disability Severity Scale (EDSS). Study participants were divided into two groups – Group 1 and Group 2 – based on EDSS scores. Separately, study participants were divided into groups based on the principle of receiving pain-modifying therapy. In the 1st study group, concomitant diseases were in 57 (78.1%) patients, in the 2nd group – in 100% (p=0.010). In patients who did not receive pain-modifying therapy, 57 (98.3%) of those examined had concomitant diseases, in those who received such treatment – in 32 (68.1%), which was statistically significantly less (p<0.001). In the first place in terms of the frequency of concomitant pathology among all examined patients were diseases of the gastrointestinal tract, which also dominated in the 1st and 2nd observation groups, in the second place – diseases of the urinary system, in the third place – eye diseases, and in the last place, by the frequency of concomitant diseases – cardiovascular diseases. Comorbidity in multiple sclerosis is an extremely relevant problem in modern neurology due to its significant impact on the clinical picture of the disease, its course and the degree of disability of the patient. Digestive system disease is one of the most common comorbid conditions in multiple sclerosis. The number of patients with comorbid conditions is higher among patients with a moderate degree of disability and among patients not taking disease-modifying therapy, but the relationship between the degree of disability, treatment and comorbid conditions requires further study.

Sensorineural hearing loss in post-COVID-19 patients

<b>Background: </b>Hearing loss (HL) is one of the most common chronic conditions after hypertension and arthritis. Mounting indices suggest that sensorineural hearing loss (SNHL) may be one of the adverse effects of severe acute respiratory syndrome coronavirus 2.<br /> <b>Objective: </b>This work aimed at studying SNHL in post-COVID-19 patients, alongside with exploring the relationship between severity of the disease and degree of hearing disability.<br /> <b>Materials and methods: </b>This prospective cross-sectional study was conducted at Al-Azhar University Hospitals, Cairo, Egypt. It included 100 post-COVID-19 patients selected according to the study inclusion and exclusion criteria. Pure tone audiometry was done to confirm the presence of HL and to determine its degree.<br /> <b>Results: </b>Hundred patients with recent oncent hearing symptoms after documented COVID-19 infection were included. Males (71%) were more affected than females (29%). The most of our cases had bilateral moderate HL (45%). Tinnitus was the most frequently associated otological symptom (96.96%). The time of HL onset varied from days to weeks (55% had time onset between 11-30 days post-confirmed infection). Higher thresholds were detected in all frequencies of affected ears with more deterioration of hearing as frequencies increase. All degrees of HL were detected; mild, moderate, severe and profound. There was no significant correlation between severity of COVID-19 infection and severity of HL.<br /> <b>Conclusions: </b>SNHL is one of the extrapulmonary complications of COVID-19. COVID-19 patients may develop hearing affection regardless the severity of the infection. It is recommended to assess hearing functions in patients after COVID-19 for early detection and proper management.

Unveiling inflammatory biomarkers in multibacillary leprosy: the role of lymphocyte-platelet ratio in predicting leprosy reactions.

Leprosy is a neglected contagious disease that causes physical disability and episodes of inflammation, called leprosy reactions. There are currently no consolidated laboratory markers that can predict or confirm the diagnosis of leprosy reactions, negatively impacting the progression of the disease. The aim of this study was to analyze the behavior of inflammatory biomarkers in a population of patients with multibacillary leprosy. This prospective study in a northeastern capital involved 67 new cases of multibacillary leprosy, assessing inflammatory biomarkers at diagnosis. Histopathology, qPCR, slit skin smear microscopy, and laboratory tests, including CRP-albumin, neutrophil-lymphocyte, lymphocyte-monocyte, platelet-lymphocyte ratios, and systemic immune-inflammation index, were conducted. Statistical analysis utilized Stata version 16.0®, employing Chi-square, Kruskal-Wallis, and Poisson regression (5% significance). The population, mainly young brown men with low socioeconomic status, borderline leprosy, and and degree of physical disability one, saw 19.4% experiencing leprosy reactions. Standard multibacillary multidrug therapy was administered to all. Ratios and index values exceeding medians were prevalent (46.3-47.8%). Assessing biological markers against leprosy reactions revealed a positive relation between reactions and lymphocyte-platelet ratio (p = 0.05) and a positive trend with the systemic immune-inflammation index (p = 0.06). Patients with reactions were 1.3 times more likely to exhibit an elevated lymphocyte-platelet ratio. The lymphocyte-platelet ratio emerged as a potential indicator for recognizing leprosy reactions. Further research is essential to validate these findings, aiming for earlier detection of leprosy reactions.

Aging Skeletal Muscles: What Are the Mechanisms of Age-Related Loss of Strength and Muscle Mass, and Can We Impede Its Development and Progression?

As we age, we lose muscle strength and power, a condition commonly referred to as sarcopenia (ICD-10-CM code (M62.84)). The prevalence of sarcopenia is about 5–10% of the elderly population, resulting in varying degrees of disability. In this review we emphasise that sarcopenia does not occur suddenly. It is an aging-induced deterioration that occurs over time and is only recognised as a disease when it manifests clinically in the 6th–7th decade of life. Evidence from animal studies, elite athletes and longitudinal population studies all confirms that the underlying process has been ongoing for decades once sarcopenia has manifested. We present hypotheses about the mechanism(s) underlying this process and their supporting evidence. We briefly review various proposals to impede sarcopenia, including cell therapy, reducing senescent cells and their secretome, utilising targets revealed by the skeletal muscle secretome, and muscle innervation. We conclude that although there are potential candidates and ongoing preclinical and clinical trials with drug treatments, the only evidence-based intervention today for humans is exercise. We present different exercise programmes and discuss to what extent the interindividual susceptibility to developing sarcopenia is due to our genetic predisposition or lifestyle factors.

Disability and its impact on life expectancy: heterogeneity across Mexican states

BackgroundThe percentage of the world’s population with disabilities is estimated to be 16%, although its distribution and intensity varies within nations. We aim to disentangle the degree and types of disabilities, estimate the years spent with more severe disabilities, and analyze their distribution across states and between sexes in Mexico.MethodsThe Mexican Census of 2020 includes information on disabilities, which allows the study of its national distribution. We used life tables and the Sullivan method to calculate the number of years spent with disability (NYSD) and its percentage with respect to life expectancy for each state and each sex.ResultsIn Mexico, the population with disabilities is estimated to be 16.5%. Of this total, 69% have milder disabilities, while the remaining 31% have more severe disabilities. At age eighteen, there is a higher NYSD from more severe disabilities for females with 5.67 years (95% CI 5.66 to 5.69) as opposed to males with 3.66 years (95% CI 3.65 to 3.67). Across states, a more homogeneous distribution with lower NYSD is observed for men (between 2.44 and 5.69 years) than for women (4.14 and 8.08 years). A north-south division can also be observed, with particularly notorious disadvantages among coastal states, which is more distinctive among women.ConclusionsThis study shows that comparing the number of years spent with disability and the total life expectancy between subpopulations is essential for monitoring the well-being of aging populations, guiding policy decisions, and promoting a society that values and supports all individuals, regardless of their abilities.

Level of disability in stroke survivors in the greater accra region of ghana: a cross-sectional study

Abstract Background Many stroke survivors in low- and middle-income countries such as Ghana live with various degrees of disabilities. Insight into the level of disability and its determinants in stroke survivors has become very important. This study aimed to assess disability and determinants in stroke survivors in the Greater Accra Region of Ghana. Methods One hundred and eight community-dwelling stroke survivors undergoing outpatient physiotherapy rehabilitation were sampled for the study. The World Health Organization disability assessment schedule (WHODAS) questionnaire was used to assess the level of disability in the participants. Sociodemographic and clinical data were gathered to help assess the determinants of disability. Association between sociodemographics and disability, and clinical characteristics and disability were determined using chi-square/Fisher’s exact test. p values less than 0.005 were considered statistically significant. Results Most of the study participants were reported to have moderate to severe disabilities in their bodily function. Age, gender, marital status, and employment status were found to be associated with the level of disability in stroke survivors. Conclusion Disability and its determinants in stroke need to be given much attention as disability affects the ability of stroke survivors to function independently.

Assessment of the Degree of Neurofunctional Disability in Leprosy Patients in a Municipality in Bahia, Brazil

Introdução: Mycobacterium leprae é um bacilo intracelular com tropismo pelas células de Schwann. O processo inflamatório, decorrente da invasão do bacilo, promove desmielinização, degeneração axonal e perda da função neural, condição conhecida como neuropatia hansênica e que repercute no paciente por meio de deformidades e incapacidades físicas. Assim, o objetivo desse estudo foi avaliar o grau de incapacidade física e o comprometimento neurológico dos pacientes acometidos pela hanseníase em uma região endêmica da Bahia, Brasil. Métodos: Trata- -se de um estudo descritivo retrospectivo baseado em dados secundários obtidos de pacientes com hanseníase tratados em um centro de referência em Paulo Afonso, Bahia, entre 2009 e 2020. Os dados foram obtidos mediante consulta às fichas de notificação e prontuários médicos, tabulados e analisados. Resultados: Foram analisados 194 casos de hanseníase, sendo que 39,7% apresentaram algum grau de incapacidade física e 49,5% foram classificados como multibacilares. Houve uma associação estatística entre o desenvolvimento de incapacidade física e os pacientes acometidos pela hanseníase com baixa escolaridade (analfabetos ou com ensino fundamental incompleto), sexo masculino, idade igual ou superior aos 60 anos, casos multibacilares, com forma clínica dimorfa ou virchowiana, com mais de cinco lesões de pele, pelo menos um nervo afetado e baciloscopia positiva. Além disso, o nervo ulnar foi o principal tronco nervoso afetado, embora o principal local de incapacidades físicas tenha ocorrido nos membros inferiores. Conclusão: A alta prevalência de incapacidades físicas e o comprometimento neurológico entre pacientes com hanseníase nesta região endêmica destaca a necessidade de melhorar a educação em saúde, o diagnóstico precoce e estratégias para prevenir deformidades e incapacidades. Uma melhor compreensão dos fatores de risco e das medidas preventivas pode ajudar a reduzir o impacto da neuropatia hansênica na vida dos pacientes.

The relationship of hematologic parameters and lipid profile with acute ischemic stroke

Objective: This study aims to investigate the effect of routine laboratory parameters on clinical outcomes in patients with acute ischemic stroke (AIS). Materials and Methods: Our study was designed as retrospective and cross-sectional. 94 patients with AIS who received inpatient treatment in our clinic with a diagnosis of AIS were included in the study. Laboratory data, demographic, and clinical characteristics were recorded at the time of admission. Neurological disabilities of the patients 3 months after treatment were evaluated with the modified Rankin Scale (mRS). Patients were divided into two groups (good prognosis (mRS 0-2) and poor prognosis (mRS 3-6)). Results:Of the 94 patients included in the study, 47 were men and 47 were women. The mean age was 71.18±11.92 years. Laboratory parameters hemoglobin, eosinophil, triglyceride, total-cholesterol, and ldl-cholesterol values were significantly lower in the group with mRS≥3. As a result of ROC analysis, the area under the curve of hemoglobin, eosinophil, total-cholesterol, ldl-cholesterol, and triglyceride was significantly higher[(AUC: 0.710 95%CI: 0.60-0.81); Sensitivity=67.6%, Specificity=67.9%, p=0.001]. In the multivariable logistic regression model, only the NIHSS score (National Institutes Of Health Stroke Scale Scores) was independently associated with the degree of disability (p=0.001). NIHSS is an independent factor in predicting stroke outcomes. Conclusion: It was determined that there was a significant inverse relationship between the routine laboratory parameters hemoglobin level, eosinophil level, LDL and total cholesterol levels, and infarct volume with the NIHSS scores of hemoglobin and LDL-cholesterol.