Disability Grade Research Articles

Leprosy-related disability in children and adolescents under 15 years old in Brazil: evaluation of macro-regional disparities from 2001 to 2022

Objectives: to investigate macro-regional disparities in the incidence of leprosy in children and adolescents under 15 years old in Brazil from 2001 to 2022, with a focus on leprosy-related disabilities. Methods: an ecological study was carried out with data from the Brazilian Notifiable Diseases Information System (SINAN). The annual number of leprosy cases was normalized to every 100,000 residents in each macro-region (incidence), stratified by leprosy-related disability (grade 0, 1 and 2). The significance level was set at 5%, and Poisson regression adjusted for a robust dispersion was used to estimate the incidence ratio. Results: approximately 14% (7,694) of all leprosy cases in this age group were notified with grade 1 (78.9%) or 2 (21.1%) disability. Moreover, in grade 1 and 2, the incidence of leprosy was significantly higher in the North, Northeast and Central-West macro-regions when compared to the national estimate, as well as significantly lower in the Southeast and South (p-value <0.05). Conclusion: macro-regional disparities were observed in the incidence of leprosy in children and adolescents under 15 years old with grade 1 or 2 disability in Brazil from 2001 to 2022.

Relationship Between Gross Motor Function and Nutritional Status of Children with Cerebral Palsy-A cross-sectional study in a Tertiary Care Hospital of Bangladesh

Background: Cerebral Palsy (CP) is one of the most common causes of chronic disability in children. Childhood malnutrition is a major public health issue in low- and middle-income countries. The gross motor function of children with CP can easily be assessed by the tool Gross Motor Function Classification System- Expanded &Revised (GMFCS-E&R). This study aimed to determine the relationship between GMFCS and nutritional status in children with cerebral palsy. Method: This cross-sectional observational study was conducted in the Department of Pediatric Neurology, IPNA, BSMMU from October 2019 to August 2020. All the patients aged 2-12 years were diagnosed as CP by clinical criteria and classified by GMFCS. Nutritional status (weight for age, height for age, weight for height, BMI) is assessed and classified according to the World Health Organization growth charts. Then linear and multinomial logistic regression methods to determine the associations between GMFCS and nutritional status. The correlation between motor function and nutritional status was assessed. Results: Among the 50 children 68% were male and 32% were female. The mean age of the CP children was 4.90±3.05 years. Most patients (66.0%) came from poor families followed by 24% from the middle class. Functionally majority of patients were in GMFCS level IV (28.0% ) and level V (20.0%). Maximum patients in spastic quadriplegia 42%, spastic hemiplegia 16%. The level of GMFCS was associated with nutritional status, as determined by anthropometry. Moderate and severe underweight significantly related with GMFC level IV and V. Moderate and severe stunted was significantly related with IV and V GMFC level. Moderate wasted was significantly related to GMFC levels III and IV. Mild malnutrition was significantly with GMFC level II and III. Severe malnutrition is significantly related to GMFC level IV and V. Conclusion: This study showed majority of cerebral palsy cases had severe functional gross motor disability and also severe grade of malnutrition. A significant association between severe grade of malnutrition and severe grade of motor disability was found. J Bangladesh Coll Phys Surg 2024; 42: 342-349

Knowledge and Misconceptions About the Causes of Disabilities and Functioning in Children and Preadolescents: Mixed-Models Analyses.

Accurate knowledge of disabilities is connected to social acceptance and a high chance of initiating and facilitating meaningful social interactions with students with disabilities. The present study investigated the effect of type of disability and school grade level on knowledge of the causes of four disabilities (i.e., hearing, visual, motor and intellectual), misconceptions about the causes of these disabilities and knowledge of the functioning of peers with disabilities. A sample of 868 Italian students (Mage = 9.92, SD = 2.33; school grade levels 1-8; 436 boys and 432 girls) was interviewed about their knowledge of causes of four disabilities, potential misconceptions and the knowledge of functioning of peers with disabilities. Mixed-effects models were applied with the GAMLj module of the JAMOVI statistical platform. The effects of type of disability and school grade level and their interaction were estimated as fixed effects, and gender was introduced as a control variable. Mixed-model analyses found a main effect of type of disability for knowledge and misconceptions about the causes of disabilities and knowledge of the functioning of peers with disabilities. A main effect for school grade level was also found, showing a progressive growth trend in knowledge of the causes of disabilities and of the functioning of peers with disabilities and a decrease in misconceptions with the increase in school grade levels. Lastly, a significant interaction effect of Type of Disability × School Grade Level was found for knowledge and misconceptions about the causes of disabilities, suggesting that the effect of school grade level varied across the type of disability. Overall, the study found that children and preadolescents have a rudimentary and limited understanding of disabilities, suggesting the necessity for a specific formal education about disabilities during the school years for children and preadolescents.

Trends in case detection rate for leprosy and factors associated with disability among registered patients in Zanzibar, 2018–2021

BackgroundLeprosy is still a disease of public health concern. Globally, 2–3 million people are thought to be affected by leprosy’s disease-related disabilities. Regarding leprosy status in Zanzibar, limited information is available. Determining changes in detection rates and factors associated with disability is crucial for treatment and preventative strategies for this debilitating disease. This study aimed to determine trends in case detection rate for leprosy and risk factors for disability among registered patients in Zanzibar, from 2018 to 2021. The study included all leprosy patients who received treatment in Zanzibar's 11 districts between 2018 and 2021. The study design used was an analytical cross-sectional. Prevalence and new case detection rate (NCDR) were calculated. Multivariable Poisson regression analyses were used to identify factors associated with leprosy disability. Crude and adjusted prevalence ratios (APR) and their respective 95% confidence intervals (CI) were reported. P-values ≤ 0.05 were considered significant.ResultsOf the 490 leprosy cases reported between 2018 and 2021, 469 (95.7%) were new patients, and 349 (71.2%) were multi-bacillary. The disease was found to be more common in males 296 (60.4%). The average prevalence was 7/100,000 population, while the average NCDR was 7/100,000 from 2018 to 2021. There was a significant decrease in disability grades from diagnosis to the end of treatment over 4 years (P < 0.001). Male sex (APR 1.55; 95% CI 1.18–2.04), advanced age (APR 5.01; 95% CI 1.91–13.17), multi-bacillary (APR 6.99; 95% CI 3.16–15.44) and HIV negative patients (APR 1.51; 95% CI 1.11–2.06) were more likely to develop physical disability.ConclusionThis study found that leprosy disability grades at diagnosis compared to the end of treatment declined during 4 years. There was no significant change in point prevalence and NCDR during the 4-year study period. Disability was associated with male sex, advanced age, multi-bacillary, and HIV-negative patients. To prevent leprosy-related disability and transmission, health education, early case detection, and adequate multidrug therapy should be prioritized.

Epidemiology and Prevalence of Musculoskeletal Disabilities Following Motor Vehicle Accidents in Aljouf Region, Saudi Arabia

Background and Objectives: Motor vehicle accidents (MVAs) are the leading cause of disability, particularly among young adults in Saudi Arabia. Persistent disabilities account for around 7% of all injuries attributed to MVAs in Saudi Arabia in the last twenty years. Limited studies on musculoskeletal disabilities following MVAs have been carried out in Saudi Arabia. This study aims to explore the epidemiology and prevalence of musculoskeletal disabilities in motor vehicle accident (MVA) patients in the Aljouf region, Saudi Arabia. Materials and Methods: This retrospective cross-sectional study evaluated all MVA victims treated in the Aljouf region, Saudi Arabia, from January 2020 to December 2022. A total of 3252 medical records were collected, with 731, 1197, and 1324 musculoskeletal injury cases per year, of which 88, 168, and 153 records from 2020, 2021, and 2022 were analysed, respectively. Results: The study found that patients aged 25–34 and 35–44 years were the most likely to experience disability following MVAs. The difference between age groups during a single year was statistically significant (p &lt; 0.001). Most patients were male (89.8%, 82.7%, and 79.7%) during 2020, 2021, and 2022, respectively. The majority of injuries involved the upper extremities (38.6%, 36.9%, and 40.5%), followed by lower extremities (36.4%, 35.7%, and 34.6%), head and neck (21.6%, 26.2%, and 34.6%), thoracic region (20.5%, 24.4%, and 17%), and finally lumbosacral spine (6.8%, 5.4%, and 6.5%) during 2020, 2021, and 2022, respectively, with a significant difference for each year (p &lt; 0.001). The study found a link between the likelihood of developing high disability grades and injury severity scores. The patients with very severe ISS ≥ 25 (OR: ∞ CI 95%: 39.81–∞; p &lt; 0.001), severe ISS = 16–24 (OR: ∞ CI 95%: 20.90–∞; p &lt; 0.001), and moderate ISS = 9–15 (OR: ∞ CI 95%: 1.2–∞; p = 0.02) were at greater risk of developing high grades of disability. Conclusions: This study highlighted the musculoskeletal disabilities in the Aljouf region following MVAs. Severe musculoskeletal disabilities were rare, but fractures were the most common following MVAs. More efforts should be directed towards education on early transportation and transfer to the nearest medical centres, seeking assistance immediately after MVAs for patient safety, and disability prevention.

How differentiated can a new tablet-based reading screening measure the reading proficiency of students with intellectual disabilities? Comparing the impact of disability, disability type and grade level on reading skills.

All people have the right to learn reading. Understanding the factors influencing reading proficiency among students with intellectual disabilities is important for developing effective instructions. To accurately assess reading, suitable assessments that can effectively differentiate between low performance levels are necessary. We analyse results of 400 students (43 students with intellectual disabilities) in a digital reading screening and investigate the influence of disability severity, grade level and special educational needs status on the reading abilities of students with intellectual disabilities. The results indicate that the screening is suitable for assessing students with intellectual disabilities. A newly developed digital screening test for flash reading measures reliably. All presumed factors significantly impact the reading proficiency. However, substantial overlap exists between students with intellectual disabilities and those with other special needs. The necessity for structured reading interventions, irrespective of the disability label, and the importance of appropriate assessments for all students are discussed.

Data profile: the Korean Workers' Compensation-National Health Insurance Service (KoWorC-NHIS) cohort.

The Korean Workers' Compensation-National Health Insurance Service (KoWorC-NHIS) cohort was established to investigate the longitudinal health outcomes of Korean workers who have been compensated for occupational injuries or diseases. This cohort study, which utilized data spanning from 2004 to 2015, merged workers' compensation insurance claim data with the National Health Insurance Database (NHID), encompassing 858,793 participants. The data included socio-demographic factors such as age, sex, income, address, insurance type, and disability grade. It also covered the types of occupational accidents, International Classification of Diseases, 10th revision codes for diseases or accidents, work tenure, industry, occupation code, and company size. Additional details such as the occupational hire date, date of claim, date of recognition, and affected body parts were recorded. The cohort predominantly consisted of male workers (80.0%), with the majority experiencing their first occupational accident in their 40s (27.6%) or 50s (25.3%). Notably, 93.1% of the cases were classified as occupational injuries. By integrating this data with that from the NHID, updates on health utilization, employment status, and income changes were made annually. The follow-up period for this study is set to conclude in 2045.

The relationship between childhood education and adult learner characteristics

AbstractChildhood education affects how individuals adapt to the challenges of adulthood. Although various generalizations are made relating childhood educational experiences to characteristics of adults, there is scant evidence to support those assertions for adult literacy learners in the United States. This study investigates the relationship of childhood educational attainment to other characteristics of adult learners. In this study, 201 native English-speaking adult learners in the United States who read at the 3.0–7.9 grade equivalency levels were administered surveys and tests to better understand the relationships between childhood educational attainment and the following characteristics: childhood school disability status and grade repetition; as well as adult characteristics including current reading-related skills, reading avoidance behaviors, reading practices for informational and digital texts, employment status, and Readiness-to-Learn. Results indicated that only school disability status was correlated with educational attainment (Cramer’s V test, V = 0.279, p = 0.004). The results contribute to the body of knowledge about adult learners who want to develop literacy skills and the nuances of childhood schooling experiences in this population. Based on these results, caution should be exercised when treating educational attainment as a signal of other characteristics, including reading skills, among adult literacy students. These findings align with other international research findings.

The International Classification of Functioning, Disability and Health to map leprosy-related disability in rural and remote areas in Indonesia.

The International Classification of Function, Disability, and Health (ICF-WHO, 2001) recognizes several dimensions of disability, such as body structure and function (and impairment thereof), activity (and activity restrictions) and participation (and participation restriction) and their interactions with contextual factor (personal and environmental). In this study, we map and analyse the relationship between the components of ICF in leprosy patients from two rural areas in Indonesia: Lewoleba (East Nusa Tenggara) and Likupang (North Minahasa). This study was part of a community outreach program by the KATAMATAKU team from Universitas Indonesia. The body structure was graded using the WHO hand and feet disability grade and the number of enlarged nerves, while the body function was measured by the Jebsen Taylor Hand Function Test (JTT) and Timed-up and Go (TUG). Activity limitation and participation restriction were measured using the Screening Activity Limitation Safety Awareness (SALSA) Scale and Participation Scale (P-scale), respectively. There were 177 leprosy patients from the two regions and 150 patients with complete data were included in the analysis. We found 82% (95% CI: 75.08%-87.32%) of subjects with multibacillary leprosy, 10.67% (95% CI: 6.67%-16.62%) of subjects with grade 2 WHO hand disability, and 9.33% (95% CI: 5.64%-15.06%) of subjects with grade 2 WHO foot disability. Assessment using the SALSA Scale showed 29.33% of subjects with limitation activity and 11.33% with participation restriction. Age was shown to have positive correlations with SALSA, JTT, and TUG. Inter-dimensional analysis showed that the SALSA scale had significant positive correlations with the number of nerve enlargements, P-scale, JTT, and TUG. SALSA scores of grade 2 WHO hand and foot disability were also significantly higher than grades 1 and 0. The participation scale also had a positive correlation with JTT but not TUG. Hand disability seemed to affect societal participation while foot did not. We used the ICF to describe and analyse dimensions of leprosy-related disability in Indonesia.

Analysis of disease burden of welder's pneumoconiosis in Jiangsu Province

Objective: To investigate the current status of disease burden and its influencing factors among welder's pneumoconiosis patients, and provide scientific basis for taking targeted intervention measures. Methods: From June 2022 to June 2023, the patients with welder's pneumoconiosis in Jiangsu Province were selected from 1956 to 2020 as the research objects, and disability adjusted life years (DALY) were used as the comprehensive index to study the disease burden. The direct and indirect economic losses caused by the diseases were calculated, and the factors affecting the disease burden were discussed by multiple linear regression method. Results: A total of 974 cases of welder's pneumoconiosis were reported in Jiangsu Province, the cumulative loss of DALY was 6300.73 person-years, and the per capita loss was 6.47 person-years. Among them, the healthy life years lost due to disability (YLD) was 6156.50 person-years (97.71%) , and the healthy life years lost due to premature death (YLL) was 144.23 person-years (2.29%) . Multiple linear regression analysis showed that the main factors affecting DALY were disability grade, diagnostic age, pneumoconiosis grade and length of dust exposure (P<0.05) . The total economic loss caused by 974 welder's pneumoconiosis patients was 1831838160.18 yuan, and the per capita loss was 1880737.33 yuan. Among them, the direct economic loss was 970917563.75 yuan (53.00%) , and the indirect economic loss was 860920596.43 yuan (47.00%) . Conclusion: Welder's pneumoconiosis causes serious disease burden to patients, and at the same time causes huge economic losses to individuals and society, which seriously hinders the development of society. Taking effective control measures to prevent the incidence of welder's pneumoconiosis is the key to reduce the disease burden.

Headache in systemic lupus erythematosus: The LUNA registry cross-sectional study.

This study investigated the clinically relevant factors for headaches in patients with systemic lupus erythematosus (SLE) using a registry from a Japanese multicenter cohort. This cross-sectional study analysed the clinical information of patients with SLE who experienced headache episodes using the Migraine Disability Assessment (MIDAS) questionnaire. Significant findings in the comparisons between patients with headache (HA patients) and those without headache (non-HA patients) and in the comparisons depending on the grades of headache-induced disability in daily life based on the MIDAS scores were evaluated. Multivariate logistic regression analyses were performed to identify the relevant factors for headache. We analyzed 369 patients (median age, 45 years; female, 90.8%), including 113 HA patients who were significantly younger than non-HA patients (p < .005). HA patients had significantly higher frequencies of photosensitivity, rashes, and mucosal ulcers than non-HA patients (p < .05). Age and photosensitivity were significantly associated with headache (odds ratio (OR) 0.93, 95% confidence interval (CI) 0.95-0.99; OR 2.11, 95% CI 1.29-3.49, respectively). In the HA patients, hypocomplementemia was significantly associated with a disability of more than mild grade (OR 2.89, 95% CI 1.14-7.74), while rash was significantly observed in those presenting with moderate and severe disability. This study suggests that photosensitivity is a relevant manifestation of headache in patients with SLE. Persistent hypocomplementemia can contribute to headache-induced disability in daily life, whereas a rash may be a dominant manifestation in patients presenting with moderate/severe headache-induced disability.

Prevalence of Low Back Pain, Disability Among Dentists In Saudi Arabia: A Cross Sectional Study

Background: Low back pain (LBP) is a major global health condition which affects individuals across various occupational groups. Dentists, specifically, are prone to experiencing LBP due to the physically demanding nature of their work. This study aims to investigate the prevalence and determinants of LBP among dentists. Methodology: This cross-sectional study was carried out among dentists working in different regions in Saudi Arabia. Sociodemographic characteristics, Modified Oswestry Low Back Pain Disability grading, self-perceived health were collected. SPSS version 20 was used to calculate frequency, percentage and p values. Results: Among 116 participants, majority 66 (56.9%) were males, 83 (71.5%) had Low back pain. Onset of LBP was gradual in 111(95.7%), majority (37%) have worked in health care profession for 6 to 10 years. Majority 52 (44.8%) work 5 days a week, 67 (80.7) had mild LBP. Conclusion: The prevalence of LBP was 71.5%. Occupational prevention activities should be planned to alleviate the presence of LBP among dentists.

Nurick Grades and Quality of Life Outcome in Cervical and Lumbar Spine Pathologies: A Cross-Sectional Study

Background: It is not known to what extent differences in radiological findings of individuals with spinal pathologies may be associated with their quality of life (QOL) and the degree of disabilities. Objective: This study aimed at determining if QoL and degree of disabilities differs in individuals with cervical and lumbar spine pathology with different magnetic resonance imaging (MRI) findings. Methods: This cross-sectional study of 185 purposively sampled patients was carried out at Radiological facilities in Rivers State, Nigeria. Magnetic resonance images were assessed for pathological findings, Nurick grade scales and Short Form Health survey (SF-36) QoL questionnaire were used to assess participant’s disability grade and QoL respectively. Results: Majority of the participants with cervical (n=49, 64%) and lumbar (n=86, 79.8%) spine pathologies were males. Degenerative spine pathology was the most common in both the cervical (75%) and lumbar (80.7%) spine regions. The patients with cervical (n=30, 39.5%) and lumbar (n=56, 50.5%) spine pathologies had Nurick grade I and Nurick grade II respectively. There were statistically significant differences in the physical functioning domain (k=12.27, p = 0.03) and role limitations due to emotional problem domain (k= 13.03, p = 0.02) among individuals with different Nurick grades. Conclusion: Males were commonly affected by the spinal pathologies. Degenerative spinal pathology was the most common in both the cervical and lumbar spine regions. The most prevalent degree of disabilities associated with cervical and/or lumbar spine pathologies was Nurick grade I and II respectively. Keywords: Disabilities, Pathology, Quality of life

Persons with multiple sclerosis older than 55 years: an analysis from the German MS registry

BackgroundPersons with MS (PwMS) ≥ 55 years are underrepresented in therapy studies leading to a lack of evidence.Objective and methodsTo study the subgroup of PwMS ≥ 55 years in the German MS registry in comparison with PwMS < 55 years. Endpoints of interest were the grade of disability, leading symptoms, clinical and magnetic resonance imaging activity, and use of disease modifying therapy.ResultsAt the time of analysis, data from 40,428 PwMS were available for analysis. In PwMS aged ≥ 65 and PwMS aged ≥ 55 to 64 years, compared with PwMS aged < 55 years, the mean Expanded Disability Status Scale Scores were higher (5.3, 4.2 and 2.7, respectively), while the proportion of individuals with current use of disease modifying therapy was lower (42.6%, 60.9% and 76.7%, respectively). The older patient groups were more likely to be labeled with progressive MS and the frequency of occupational invalidity was high (38.8% in PwMS aged ≥ 55 to 64 years). Gait disorder, fatigue, bladder dysfunction, and spasticity were among the leading symptoms in PwMS aged ≥ 55 years.ConclusionPwMS ≥ 55 years have a high degree of disability, but a large proportion do not receive disease modifying therapy, exposing an unmet need.

APPLICATION AND EVALUATION OF A MULTI-SCALE ASSESSMENT MODEL FOR ELDERLY DISABILITY

As the aging population continues to grow, the increasing number of disabled elderly individuals poses ongoing challenges to society in terms of healthcare and medical burdens. Grading disability is of significant importance for improving medical services and allocating social resources. Traditional grading methods using a single assessment scale tend to be subjective and cannot comprehensively and accurately reflect the real situation. This paper presents the NES (Needs assessment of Elderly care in Shanghai) scale, based on 33 quantified scoring items from basic surveys, to enhance the objectivity and accuracy of disability grading. Correlation analysis of observed items using the C4.5 decision tree algorithm is conducted, followed by an analysis and evaluation of the scale’s performance. The data used in this study are derived from 266 questionnaires collected from eight regions in Shanghai and categorized into three classes: physiological (JKOM/BADL), psychological (BDI/SDS/SAS), and cognitive (CDR). The analysis results show that the NES scale exhibits better robustness in physiological assessment compared to the BADL and JKOM scales. In psychological assessment, the NES scale performs similarly to the SDS and SAS scales. In cognitive assessment, the NES scale’s grading level is slightly higher than that of the CDR scale, demonstrating good comprehensive disability assessment capabilities.

Surgical management of ventrally located cervical epidural abscess: A comparative analysis between patients aged 18–64 years and ≥65 years

BackgroundWe aimed to compare the clinical course of patients aged 18–65 years and ≥65years who underwent anterior cervical discectomy and fusion (ACDF) or corpectomy for ventrally located CSEA. MethodsClinical and imaging data were retrospectively collected from the institutional database between September 2005 and December 2021. ResultsA total of 35 and 26 patients aged 18–64 and ≥ 65 years, respectively who were diagnosed with ventrally located CSEA were included. The overall mean age was 63.9 ± 3.2 years, with a predominance of the male sex (n = 43/61, 70.5%). Patients aged ≥65 years presented with significantly higher rates of comorbidities (10.3 ± 2.8), as indicated by the CCI, than their younger counterparts (18–64 years: 6.2 ± 2.6; p < 0.001). No differences in the surgical approach or characteristics were observed among the groups. Notably, patients aged ≥65 years had a significantly longer intensive care unit as well as overall hospital stay. In-hospital and 90-day mortality were similar across both groups. Following both types of surgery, a significant improvement was observed in the blood infection parameters and neurological status at discharge compared with the baseline measurements. Older age, higher rates of comorbidities, and higher grades of disability were significant predictors for mortality. ConclusionsEmergency surgical evacuation should be undertaken for CSEA in the presence of acute neurological deterioration regardless of the age. Factors, such as age, comorbidities, and neurological status on admission appear to be important predictors of disease outcomes. However, the risk profile of younger patients should not be underestimated.

Effect of Infliximab on Chronic Progressive Neuro-Behçet's Disease: Influence of the Timing of Introduction on the Patient Outcome.

Objectives Chronic progressive neuro-Behcet's disease (CPNB) is characterized by progressive deterioration leading to disability. Methotrexate (MTX) has been shown to have beneficial effects on CPNB. However, while infliximab has been found to be effective for patients with inadequate responses to MTX, the appropriate timing for the introduction of infliximab remains unclear. We explored the effects of intervals before the introduction of infliximab on the functional outcome. Methods A retrospective analysis was performed for patients with CPNB who received infliximab and were followed up until October 2015. Functional disability was rated by the Steinbrocker functional classification as used in rheumatoid arthritis. Correlations between the outcomes and intervals before the introduction of infliximab were then analyzed by Spearman's rank correlation test. Patients Eleven patients with CPNB [8 men, 3 women, age 35.2±9.3 years old (mean±standard deviation)] who met the international classification criteria for Behcet's disease were included. Results All 11 patients had received MTX prior to infliximab. The intervals from the onset to the introduction of infliximab and the follow-up periods were 26.6±35.1 months and 65.2±43.6 months [mean±standard deviation], respectively. Among the 11 patients, 2 still showed progression after the introduction of infliximab. The functional disability grades after infliximab treatment were significantly correlated with the intervals from the onset of CPNB to the introduction of infliximab (r=0.6177, p=0.0476). Conclusion The results indicate that the delayed introduction of infliximab leads to irreversible functional disability in CPNB. Thus, it is recommended that infliximab be administered as soon as possible for CPNB patients with inadequate responses to MTX.

Validity and reliability of Arabic version of pediatric migraine disability assessment scale (Child Self-Report versus Parent Proxy-Report): a multi-center study

BackgroundPediatric Migraine Disability Assessment (PedMIDAS) is one of the most frequently used questionnaires to assess disability from migraine in pediatric patients. This work aimed to evaluate the validity and test–retest reliability of the Arabic version of the child self-report versus the parent proxy report PedMIDAS. We also aimed to test the agreement between children's and parents' reports of the scale.MethodsPedMIDAS was subjected to translation and back-translation, then applied to 112 pediatric patients fulfilling the migraine diagnostic criteria. This cross-sectional study was conducted on two visits, one week apart. At visit 1, the following data were obtained from the included pediatric patients: disease duration, migraine type, current treatment regimen, monthly migraine days (MMD) during the last month preceding the enrollment, and migraine intensity using the visual analogue scale. Then, each child and his parent were independently asked to fill out PedMIDAS and Child Self-Report of the Pediatric Quality of Life Inventory™ 4.0 (PedsQL™) to test the convergent validity of PedMIDAS. At visit 2, each child was requested to complete PedMIDAS again, and so was the parent to evaluate test–retest reliability.ResultsCronbach’s alpha was estimated to be 0.94 for each instrument. For the child-self report PedMIDAS, the average measure intraclass correlation coefficient (ICC) value was 0.992 (95%CI = 0.989–0.995), while it was estimated to be 0.990 for the parent-proxy report with 95%CI = 0.985–0.993, indicating excellent test–retest reliability for both instruments. The child-self report and the parent-proxy report PedMIDAS scores were significantly correlated with MMD, VAS, and all domains of the corresponding PedsQL, supporting convergent validity for both instruments. Agreement between parent and child on disability grading categories of PedMIDAS was substantial (κ = 0.644).ConclusionThe Arabic version of PedMIDAS was a valid and reliable instrument to assess disability from migraine in Arabic-speaking pediatric patients with migraine. Parent reports can be valuable as a complement to child reports for a comprehensive assessment of migraine.

Advanced Glycation End-Products in Blood Serum-Novel Ischemic Stroke Risk Factors? Implication for Diabetic Patients.

New predictors of ischemic incidents are constantly sought since they raise the awareness of patients and their doctors of stroke occurrence. The goal was to verify whether Advanced Glycation End Products (AGEs), in particular AGE10, could be one of them. The AGE10 measurement was conducted using a non-commercial ELISA assay in the blood serum of neurological patients without cerebrovascular event (n = 24), those with transient brain attack (TIA) (n = 17), and severe ischemic stroke (n = 35). Twice as many of the people with TIA or severe stroke presented high AGE10 serum concentrations compared to the patients with other neurological conditions (χ2 = 8.2, p = 0.004; χ2 = 8.0, p = 0.005, respectively). The risk of ischemic incident was significantly risen in people with higher levels of AGE10 (OR = 6.5, CI95%: 1.7-24.8; OR = 4.7, CI95%: 1.5-14.5 for TIA and stroke subjects, respectively). We observed a positive correlation (r = 0.40) between high AGE10 levels and diabetes. Moreover, all the diabetic patients that had a high AGE10 content experienced either a severe ischemic stroke or TIA. The patients with high levels of AGE10 exhibited higher grades of disability assessed by the NIHSS scale (r = 0.35). AGE10 can be considered a new biomarker of ischemic stroke risk. Patients with diabetes presenting high AGE10 levels are particularly prone to the occurrence of cerebrovascular incidents.

Analysis of Unique Disability Identification Card (UDID) Associated Visual Handicap Certificates at a Tertiary Care Center in Northern Maharashtra

Purpose: To analyze blindness certificates to find causes of visual impairment, low vision, and blindness in a tertiary care hospital in northern Maharashtra. Methods: A retrospective study of all visually impaired patients applying for disability certification between January and June 2023 (6 months period) was performed from the medical record. The demographics, aetiologies, grades and classification of visual impairment according to the new guidelines provided in the Gazette of India published in 2018 of the study subjects were analyzed. Results were compared with data from studies on blindness certificates and population-based studies. Results: A total of 771 patients were included in the study. The mean age was 39.42 ± 19 years (range: 1–85 years). Most patients were in the 41–64 years age group (40.98%). Males were involved more commonly (67.70%). According to the grade and percentage of disability, grade II (30%) was most commonly seen in 35.02% of individuals followed by low vision, grade III a–III e, (40%–80%) seen in 27.37% individuals. Blindness, grade IV a–IV b (90%–100%) was seen in 33.46% individuals. Overall, the most common cause of visual impairment among one-eyed, low-vision and blind individuals was phthisis bulbi/hereditary globe condition/coloboma. Among one.eyed and minimal disability individuals, rest common causes included amblyopia, squint and contracted socket post-evisceration. In patients with low vision and blindness, other common causes included retinitis pigmentosa, optic atrophy and pathological myopia. Conclusion: Analysis of blindness certificates provides valuable information regarding different causes of visual disability and provides an insight into the overall trends in visual disability profile and help in rehabilitation.