Form Of Paralysis Research Articles

Burnout and Coping Strategies in Integrative Psychotherapists: Findings from Qualitative Interviews.

Burnout among psychotherapists is a pervasive challenge affecting both professional well-being and client care. This study aims to explore the experience of burnout among integrative psychotherapists and examine the strategies they employ to cope with this phenomenon. Interviews were conducted with 17 integrative psychotherapists, and the data were analyzed using Braun and Clarke's six-step thematic analysis. Through this analysis, two themes were identified: (1) work-related pressures and burnout manifestations and (2) strategies for maintaining optimal functioning. Fatigue, headaches, challenges in decision-making or session planning, numbness in the form of paralysis, and disconnection from clients emerged as primary symptoms, impacting therapeutic efficacy. Participants' intense sense of responsibility toward clients and their self-worth validation through client progress intensified burnout risks, particularly among novices. Personal therapy and clinical supervision emerged as pivotal in mitigating burnout, offering support, and enhancing therapist resilience. Additionally, peer support and organizational interventions were deemed crucial during crises, emphasizing the need for structured support systems within professional bodies. These findings contribute to a deeper understanding of burnout in psychotherapy and highlight the need for targeted interventions to enhance professionals' resilience and sustain effective client outcomes.

Probable paralytic rabies in a dog: ante-mortem clinical diagnosis implications in limited resource settings.

Rabies is a dreadful zoonotic viral disease that affects animals and humans with a fatality rate of 100%. This report aims to create awareness among the veterinarians and general public about the paralytic form of rabies in order to understand the antemortem clinical diagnosis implications in limited resource settings, so as to follow the post-exposure prophylaxis at the golden hour period of rabies transmission. A one-year-old female dog was presented to the Ambulatory Clinic Unit, Veterinary Clinical Complex, Veterinary College and Research Institute, Theni, Tamil Nadu, India with the ailment of a dropped jaw and was unable to swallow food and water for the past three days. Epidemiological investigations revealed that the animal had dog-bitten wounds from a week ago. On clinical examination, facial distortion, changes in the vocal cord, and paralysis of the throat muscle were noticed. Based on the anamnesis, clinical, and epidemiological investigations, the animal was diagnosed to be a probable case of paralytic form of canine rabies. In the limited resource settings, antemortem clinical diagnosis was practiced to suspect rabies-infected dogs. Further, the owner was advised to implement preventive measures to safeguard against rabies infection. The dog was kept under isolation and succumbed on day two with evidence of progressive paralytic signs. This report emphasizes the importance of paralytic rabies, alongside of furious form of rabies, further creating awareness among the general public about the antemortem clinical diagnosis under limited resource settings.

First-line treatment of EGFR mutation adenosquamous carcinoma of the lung with aumolertinib: A multicenter, single-arm, prospective study (ARISE Study).

e20541 Background: Adenosquamous carcinoma of the lung (ASC), which composed of squamous cell carcinoma and adenocarcinoma, is a rare lung cancer. In Asian population, the mutation rate of epidermal growth factor receptor (EGFR) in ASC is approximately 15.4% to 44%. There were no large prospective clinical studies using EGFR tyrosine kinase inhibitors (TKI) to treat ASC. Methods: We conducted a prospective, multicenter, single-arm clinical trial, designed to evaluate the efficacy and safety of Aumolertinib for ASC patients with EGFR mutations without prior systemic therapy (originally designed as a randomized controlled study versus chemotherapy; the protocol was revised to single-arm study due to insufficient enrollment; Clinical Trial Registry No. NCT04354961). Eligible participants of stage IIIB/IV ASC with EGFR mutations from six Chinese medical centers received Aumolertinib 110mg orally once daily. Follow-up were performed every 6 weeks conducted by independent central review (ICR), based on the RECIST 1.1 criteria. Primary endpoints was progression-free survival (PFS), while secondary endpoints included objective response rate (ORR), disease control rate (DCR), duration of response (DoR) and safety. Results: Of the 18 patients recruited, 12 were evaluated for efficacy and safety. The median follow-up was 13.3 months, with 17 (range 4-26) doses of Aumolertinib treatment. The median PFS was 6.2 months (95% CI 5.0-8.2), while the median OS has not been reached. Of the 12 patients, 7 (58.3%) achieved PR, 3 (25.0%) achieved SD, and 2 (16.7%) were PD. The ICR-confirmed ORR and DCR were 58.3% (95% CI: 62.6%-74.6%) and 83.3% (95% CI: 89.6%-96.2%), respectively. A total of 9 patients (75%) experienced at least one treatment-related adverse events (TRAEs). the most common TRAEs were anemia (27.3%) and elevated aminotransferase (18.2%). three patients (25%) experienced grade 3-4 TRAEs in the form of paralysis, neutropenia and hypokalemia. No treatment-related deaths occurred. Conclusions: This is the first prospective clinical study showing that Aumolertinib is an effective and well-tolerated third-generation EGFR TKI for ASC with EGFR mutations, with favorable ORR and general PFS. In future, head-to-head comparisons of EGFR TKI with chemotherapy and combination therapy would be needed to be explored. Clinical trial information: NCT04354961 .

The algorithm of diagnosis and surgical treatment of Brown’s syndrome

Introduction. Brown’s syndrome (BS) is a rare type of unconcomitant strabismus, which is often interpreted by practicing ophthalmologists as a paralytic form. The difficulty of diagnosis is due to the similarity of clinical manifestations with a number of other oculomotor disorders. This leads to a late, and most importantly, tactically incorrect choice of surgical treatment method. Purpose: Development of an algorithms for differential diagnosis and surgical treatment of Brown syndrome. Materials and methods. The authors analyzed the experience of diagnosing and treating 99 patients with Brown’s syndrome. The follow-up period was 13 years, from May 2010 to May 2023. Among the examined patients, 35 (35 %) were male and 64 (65 %) were female. The median age was 7.19 ± 0.87 years, the oldest at the time of the study was 45 years old, and the youngest was 1.5 years old. All patients underwent standard ophthalmologic and strabismal examinations. In patients of verbal age, the nature of vision was examined (Worth test, Bagolini test, double Maddox test). All operated patients underwent a cyclotorsion test intraoperatively under general anesthesia to confirm the diagnosis and choose a surgical method. Surgical treatment was carried out in 60 cases of unilateral and 5 cases of bilateral BS (a total of 65 patients aged 2 to 45 years; 69 eyes). Tenotomy and tenectomy of the superior oblique muscle (ECM) were performed in 53 cases, prolongation and recession with prolongation of the ECM in 16 cases. Results. Clinical signs have been systematized, algorithms for differential diagnosis and surgical treatment have been developed, which make it possible to timely identify Brown’s syndrome and carry out stage-by-stage pathogenetically based surgical treatment. The results are presented in the form of sequential action schemes (algorithms) that will help practitioners in making a diagnosis and determining the correct tactics of surgical treatment. Conclusions. Brown syndrome has characteristic differential features and requires staged surgical treatment. Developed algorithms to obtain high functional and cosmetic results.

Retrospective analysis of the management of pelvic decubitus ulcers and their outcomes.

Many patients with decubitus-related osteomyelitis are ineligible for myocutaneous flapping, and optimal management in this population is unknown. We describe treatments and outcomes of hospitalized patients with decubitus ulcer-related osteomyelitis who did not undergo surgical reconstruction or coverage. We systematically identified hospitalized patients with diagnoses of pelvic, sacral, or femoral osteomyelitis due to decubitus ulceration between 1 January 2018 and 31 December 2018. Demographics, comorbidities, laboratory data, and outcomes were collected by manual chart review. T-tests or Chi-square tests were used for descriptive statistical comparisons; logistic regressions were used to explore the odds of readmission, osteomyelitis-related readmission, and death. Of 89 patients meeting inclusion criteria, 34 (38%) received surgical debridement and ⩾6 weeks of antibiotics; 55 (62%) received either antibiotics alone or debridement and <6 weeks of antibiotics. Mean age was 55 (standard deviation 18) years, 55% of patients were male, and 69% had spinal cord injury or other form of paralysis. Within 1 year, 56 (63%) patients were readmitted, 38 (44%) patients were readmitted due to complications from osteomyelitis, and 15 (17%) died. We found no significant differences in readmission (OR = 1.33, 95% CI: 0.54-3.21, p = 0.53), readmission related to osteomyelitis (OR = 1.64, 95% CI: 0.69-4.04, p = 0.27), subsequent sepsis (OR = 2.27, 95% CI: 0.83-6.93, p = 0.13), or death (OR = 2.88, 95% CI: 0.83-13.4, p = 0.12) by treatment group. Among patients with decubitus-related osteomyelitis who did not undergo myocutaneous flapping, outcomes were generally poor regardless of treatment, and not significantly improved with prolonged antibiotics. Prospective studies are needed to assess best practice strategies for this challenging patient population.

Immunohistochemical localisation of Glutamate ammonia ligase (GLUL) in cerebrum in different clinical forms of canine rabies

Rabies, one of the earliest known diseases reported in the history of mankind, is a fatal acute viral disease of the central nervous system. Despite numerous studies on etiology of rabies, its exact mechanism of neuropathogenesis remains unidentified. Glutamate ammonia ligase (GLUL) is a protein present in brain which play an important role in the pathogenesis of many neurological conditions. GLUL was identified to be over expressed in brain of human rabies. Cerebral cortex is the part of brain primarily responsible for coordination of movements and behaviour in animals and humans. Hence the work was designed to study the immunohistochemical localisation of GLUL in cerebrum in rabid carcasses in order to elucidate its role in the pathology of this deadly viral infection. The carcasses of 219 rabies suspected dogs that were brought to the Department of Veterinary Pathology, CVAS, Mannuthy, for necropsy between January 2021 and August 2022 formed the materials for the study. One hundred and thirty-three cases were found positive for rabies using the gold standard test for rabies - Direct Fluorescent Antibody Test (dFAT) which was further confirmed by polymerase chain reaction targeting N gene with amplicon size 533 bp. Among these 133 confirmed cases, 30 selected samples (frontal, occipital, temporal, parietal lobes of cerebrum) were further processed for histopathological and immunohistochemical (IHC) studies. The IHC signals of GLUL obtained were compared with the clinical form of rabies. Immunohistochemical staining revealed localisation of GLUL in glial cells with different staining intensity in encephalitic and paralytic form of rabies. The study concluded that the IHC signals for GLUL were stronger for furious form of rabies and weak for dumb form of the disease.

Mitochondrial function in spinal cord injury and regeneration.

Many people around the world suffer from some form of paralysis caused by spinal cord injury (SCI), which has an impact on quality and life expectancy. The spinal cord is part of the central nervous system (CNS), which in mammals is unable to regenerate, and to date, there is a lack of full functional recovery therapies for SCI. These injuries start with a rapid and mechanical insult, followed by a secondary phase leading progressively to greater damage. This secondary phase can be potentially modifiable through targeted therapies. The growing literature, derived from mammalian and regenerative model studies, supports a leading role for mitochondria in every cellular response after SCI: mitochondrial dysfunction is the common event of different triggers leading to cell death, cellular metabolism regulates the immune response, mitochondrial number and localization correlate with axon regenerative capacity, while mitochondrial abundance and substrate utilization regulate neural stem progenitor cells self-renewal and differentiation. Herein, we present a comprehensive review of the cellular responses during the secondary phase of SCI, the mitochondrial contribution to each of them, as well as evidence of mitochondrial involvement in spinal cord regeneration, suggesting that a more in-depth study of mitochondrial function and regulation is needed to identify potential targets for SCI therapeutic intervention.

Astrocytic reaction in furious and paralytic forms of rabies with reference to GFAP expression in dog brain samples positive for rabies

The aim of this study was to evaluate the astrocytic reaction in infected brains of dogs in that had been afflicted with the furious and paralytic form of rabies. Brain samples from 23 dogs that were positive for rabies were collected along with six brain samples that were negative for rabies. GFAP (Glial fibrillary acidic protein), specific astrocytic marker was used to differentially analyse the immunoreactivity of astrocytes to GFAP in specific brain regions in two the clinical forms of rabies viz, the furious and paralytic forms. The study showed the extent of astrogliosis in specific regions of brain in the two forms of rabies and also the intensity of GFAP expression. Region wise astrogliosis, was more diffuse in the brains of animals afflicted with the furious form of rabies but were more localized in the brains of animals with the paralytic form, specifically into the white matter of cerebellum.

Lyssaviruses and the Fatal Encephalitic Disease Rabies.

Lyssaviruses cause the disease rabies, which is a fatal encephalitic disease resulting in approximately 59,000 human deaths annually. The prototype species, rabies lyssavirus, is the most prevalent of all lyssaviruses and poses the greatest public health threat. In Africa, six confirmed and one putative species of lyssavirus have been identified. Rabies lyssavirus remains endemic throughout mainland Africa, where the domestic dog is the primary reservoir – resulting in the highest per capita death rate from rabies globally. Rabies is typically transmitted through the injection of virus-laden saliva through a bite or scratch from an infected animal. Due to the inhibition of specific immune responses by multifunctional viral proteins, the virus usually replicates at low levels in the muscle tissue and subsequently enters the peripheral nervous system at the neuromuscular junction. Pathogenic rabies lyssavirus strains inhibit innate immune signaling and induce cellular apoptosis as the virus progresses to the central nervous system and brain using viral protein facilitated retrograde axonal transport. Rabies manifests in two different forms - the encephalitic and the paralytic form - with differing clinical manifestations and survival times. Disease symptoms are thought to be due mitochondrial dysfunction, rather than neuronal apoptosis. While much is known about rabies, there remain many gaps in knowledge about the neuropathology of the disease. It should be emphasized however, that rabies is vaccine preventable and dog-mediated human rabies has been eliminated in various countries. The global elimination of dog-mediated human rabies in the foreseeable future is therefore an entirely feasible goal.

Variants in relation to clinical manifestation of rabies in dogs

Rabies is one among the most dangerous diseases reported to have a wider range of incubation period and clinical signs. The disease is manifested as furious or paralytic forms in dogs. The combined effects of virulence and pathogenicity of the virus along with host immune factors are the main variables leading to variation in manifestation of the disease. This paper reports the finding of a study conducted in rabies positive canine cases to correlate the role of pathophysiological factors in clinical manifestation of rabies. A total of 23 rabies positive cases were studied and their anamnesis collected. Male dogs less than 5 years of age constituted major proportion of rabies positive cases. Site of bite was observed as a critical factor in disease manifestation. Anti-rabies prophylactic vaccination had significant effect as none of the vaccinated animals developed furious form of rabies. But paralytic form was found in irregularly vaccinated dogs, probably due to effect of vaccination imparting partial immune response in these animals.

Historical Features Regarding the Neuropathic Outbreaks in Brazilian Troops in the Paraguayan War.

During the Paraguayan War, Brazilian army and navy officers attributed outbreaks of combatant limb weakness with particular features such as tingling to palustrian causes. A dietary basis was not fully suspected at the time, and the popular name beriberi had not been coined. During wartime, there was a shortage in the food supply in addition to poor environmental conditions and diarrheal diseases, and many reports of "palustrian cachexia" were made. There are also reports of the use of native flora to feed troops, as well as alcoholism. There are also accounts of the death of horses with symptoms similar to those of combatants. It was reported that black soldiers were more resistant to "palustrian cachexia." This article presents the disease ecology and clinical manifestations of beriberi at wartime, linked to starvation and consumption of pickled food and native flora. These military explorations and operations in the Paraguayan War happened more than 150 y ago and present some aspects of wilderness medicine in the past.

AN INTELLIGENT WEARABLE ROBOTIC DEVICE FOR KNEE REHABILITATION

Around the globe, the population suffered with stroke and spinal cord injury are rapidly increasing who are in need of an effective and efficient solution for their day to day life management. Paraplegia is a form of paralysis in which function is substantially impeded from the waist down or lower extremities but not the arms and it is sometimes called as partial paralysis. More than 73% people with paraplegia have perfectly healthy legs. The main aim of this proposed study is to develop an efficient rehabilitation system to treat paralysis patients of paraplegia. In this proposed research work, an assistive knee exoskeleton is designed and developed as a wearable robot with One Degree of Freedom (ODF) movement. This system is attached with the disabled limb with the aim of delivering appropriate motion and pragmatic functionality to the affected knee for suitable rehabilitation. This exoskeleton knee is controlled by the instrumented cane as a wearable sensory system to establish the coordinated movement through patient’s motion task estimation in order to control the trajectory of ODF exoskeleton robot. The computational intelligent control systems provides assisted rehabilitation motion in coherence with the motion of other unassisted upper limbs through the wearable sensors and switches in the instrumented cane. The instrumented cane is a helpful assistive device for rehabilitation in terms of balance and movement for those who suffering neurological disorders, in particular stroke and spinal cord injury. The pilot study on a subject using the proposed system describes utilization of instrumented cane as a feasible interface between the patient and exoskeleton to improve in terms of motion in their day-to-day activities. Also, the system is designed with inertial measurement module integrated with wireless communication device in order to assist real-time control of exoskeleton. The outcomes of the proposed research work validated and appreciated by the expert physicians and therapists. This study strives the purpose of an instrumented cane that able to contribute to the cognitively assisted locomotion technology as well as improves the mobility of physically challenged people.

Clinical manifestations, diagnosis, and surgical treatment of compressive common peroneal neuropathy at the level of the fibular head

Common peroneal neuropathy (CPN) is the most common tunnel neuropathy in the lower extremities, many issues of diagnosis and treatment of which require further study.Objective: to analyze the clinical manifestations of CPN, methods of its diagnosis and treatment results.Patients and methods. Eighty patients (31 women and 49 men) aged 18 to 82 years (mean age, 51 years) with compressive CPN were followed up during 2012–2018. Unilateral CPN and bilateral CPN were found in 76 and 4 patients, respectively. Eighty-four common peroneal nerve decompression operations were performed.Results and discussion. There was paralytic CPN in 73 (87%) surgical cases, painful CPN in 8 (9.5%), and intermittent CPN in 3 (3.5%). Diagnostic errors (when CPN was regarded as discogenic radiculopathy or lumbar stenosis) were noted in the painful and intermittent forms of the disease. After surgical treatment, complete recovery of peroneal nerve function was observed in 61 (72.6%) of the 84 surgical cases; its partial recovery in 15 (17.9%). Positive results were seen in all cases of painful and intermittent CPN, whereas they were more often observed in paralytic CPN if the operation was performed early (up to 12 months) after the onset of the disease.Conclusion. Common peroneal nerve decompression is an effective and safe therapeutic method that, in painful and intermittent CPN, leads to complete reversal of symptoms and, in the paralytic form of the disease, it is most effective in the early stages of the disease.

Neuroimaging Findings in Rabies Encephalitis.

Rabies encephalitis is a near-fatal zoonotic disease that is usually diagnosed on clinical grounds in conjunction with characteristic history. Owing to its rapidly progressive nature, imaging is seldom performed, and hence a description of imaging findings in rabies encephalitis is anecdotal and limited. We describe MRI findings in eight confirmed rabies cases that presented to our institute over the last 21 years. Most of the patients' imaging patterns are in concordance with the described literature. However, we hereby demonstrate the involvement of novel structures like dentate nuclei, cranial nerves, and meninges besides the hot cross bun sign in the pons and the presence of diffusion restriction in many gray and white matter structures of the brain. Knowledge of the broad imaging spectrum of rabies may expedite the diagnosis, especially the paralytic form, which is prone to clinical misdiagnosis as Guillain-Barre syndrome or acute disseminated encephalomyelitis.

Physiotherapy management of Bell’s palsy - A review of evidenced based physiotherapy practice

Bell’s palsy (BP) or otherwise known as idiopathic facial nerve palsy is a form of paralysis or weakness of one side of the face. Physiotherapy interventions accelerate recovery, improve facial function and reduce the occurrence of complications. The aim of this review was to study in the modern literature the effect of different physiotherapy interventions for the treatment and improvement of BP symptoms. Method: We reviewed the literature in all modern databases, for the period 2015 - 2021, for studies related to the effect of different physiotherapy interventions on the symptoms of patients with BP. Inclusion criteria were: to refer to patients with BP, to contain experimental and control groups and the studies to be clinical trials. Results: Out of the 114 papers that included in their title and abstract the search terms, only 10 were included in our literature review. In the studies, the average sample was 41.2 patients with a distribution of 10 to 94 individuals. Conclusions: The results of the studies showed a great improvement of the facial function, faster recovery and in particular an improvement of the facial symmetry when a program of the Proprioceptive Neuromuscular Facilitation (PNF) method or the Kabat technique is applied in combination with nerve stimulation. In general, facial exercises seem to play an important role in improving the functioning of facial muscles when combined with other techniques or methods, while the application of acupressure massage seems to significantly reduce the underlying symptoms of paralysis and help improve the affected side.

Adenot. — Traumatic Paralysis by Compression of the Sacral plexus during Labor. (Americ. Journ. Of Obstetries etc., 1894, I / V, p. 570; Nouv. Arch. D'Obst. Et de Gyn., 1893, XI). Traumatic paralysis due to compression of the sacral nerve plexus during childbirth

This form of paralysis occurs even more often with hemiplegia, paraplegia, and personal paralysis due to kidney damage, depending on pregnancy. Some of them deny such an origin of paralysis (Churchill); others, without denying their existence, attribute the paralysis not to the pressure of the head, but to the forceps. The erroneousness of the last opinion is proved by the case of Bianchi, in which a woman in labor complained of an onset of her legs 4 hours before the imposition of forceps. Burns and Jaccoud observed similar paralysis and post-normal childbirth.

Wearable and Comfortable e-Textile Headband for Long-Term Acquisition of Forehead EEG Signals

Electroencephalography (EEG) has a wide range of applications in medical diagnosis, and novel form of Human Machine Interfaces (HMI) for controlling prosthetic implants, wheelchairs, and home appliances in various forms of paralysis. However, the current EEG setups are composed of many wires hanging down from the system, and individual electrodes that must be set manually, which is time-consuming. As a result, the overall system is neither comfortable, nor aesthetically appealing. Here, we introduce for the first time, a comfortable textile-based EEG headband system that is soft, conformal to the skin, and comfortable. We present materials and methods for fabrication of multi-layer stretchable e-textile, that interfaces the human epidermis from one side through printed electrodes, and interfaces a rigid PCB island on the second layer. We as well demonstrate a method that allows creation of VIAs (vertical interconnect access) between the layers, using a CO2 laser. All Electrodes are integrated into the headband, and thus there is no need for individual electrode placement, and individual wiring. By screen printing a home-made conductive stretchable ink, patient-specific EEG headbands can be tailor made considering the optimal positioning of the electrodes for each patient. We show that these printed electrodes benefit from a very low skin-electrode impedance, comparable to gold standard Ag/AgCl, or gold cup electrodes, thanks to the high surface area silver flakes used in this work. The e-textile headband interfaces with an EEG acquisition device that captures, amplifies, and transmits the data to an external mobile phone or a PC. Furthermore, the integrated amplification in the textile and the use of an EMF rejection layer on top of the electrodes were shown to reduce the unwanted EM noise that is picked up by the system. We as well show application of the developed headband for usage in Human Machine Interfaces and Sleep Data Acquisition. Altogether, this device is step toward wider use of EEG acquisition devices for daily-use applications.

Equine Rabies in the Southern Region of Piauí State

Background: Rabies is an infectious disease that is important in the "One Health" worldwide with high lethality rate. The etiological agent is a neurotropic virus, genus Lyssavirus, transmitted mainly through the saliva of infected animals. For equines, the bite of hematophagous bats is the main source of infection. Piauí is an important state for equestrian sports and the increase in the number of horses with neurological clinical signs without diagnosis has increased in recent years. In this context, the aim of this study is to report to the scientific community a confirmed case of equine rabies in the Santa Luz county, Southernmost state of Piauí, Brazil.Case: A 3-year-old female non-defined breed horse, was admitted to the Hospital Veterinário da Universidade Federal do Piauí (UFPI/CPCE). The equine had difficulty walking 2 days ago, in the panoramic inspection was restless and disoriented in the paddock. Rectal temperature of 38.2oC, heart rate of 60 bpm, respiratory rate of 40 mpm, congested mucosa and dyspnea were verified. With the progression of the neurological signals, it positioned itself in a lateral decubitus with pedaling movements, hyperesthesia, dysphagia and paralysis of the hindlimbs. The clinical suspicion was rabies and the Agência de Defesa Agropecuária do Piauí (ADAPI) was communicated to euthanize the animal and collect samples for diagnosis in accordance with official standards of the Ministério da Agricultura, Pecuária e Abastecimento (MAPA). At necropsy, there was slight brain hyperemia, with no other significant organ changes. Fragments of the cerebellum, cortex, hippocampus and spinal cord were collected and sent at a temperature of 4oC to perform the Direct Immunofluorescence (DIF) assay. Samples for histopathology were not collected because they do not include assay for confirmatory diagnosis of rabies. The DIF technique with antigen-labeled antibodies were performed in the imprint lamina of these fragments. The fragments were treated according to specific protocol. The results were negative for DIF in the collected equine fragments. For complementary exam, the samples were homogenized, clarified and inoculated intracranial in BALB/C mice, being observed for up to 30 days. The samples were positive after the bioassay.Discussion: Piauí is a state with great equestrian activity that expose the animals to the risks of transmission of infectious diseases. Among these diseases, rabies is important for affecting horses, but also humans (veterinarians and owners). In the present report, the equine showed clinical signs of furious rabies for a short period, rapidly evolving to paralytic form. This clinical aspect must be carefully evaluated by the veterinarian, in order to avoid false clinical suspicions such as tetanus or other non-infectious diseases. The official diagnosis of the rabies is DIF technique, with high sensitive (80-100%). According to the results of the DIF technique, it was possible to confirm the clinical suspicion of rabies in mice previously inoculated with emulsion of fragments of the equine central nervous system (CNS). This fact demonstrates that in negative results for CNS samples from the horse, the bioassay increases the sensitivity of the test and avoids false negative diagnoses. Thus, it was possible to prove that rabies is affecting the equines in the southern region of Piauí state and alerts the breeders and the community to intensify surveillance and control of the hematophagous bats. For the authors, this is the first scientific report of rabies in the region studied.

Random forest-based classsification and analysis of hemiplegia gait using low-cost depth cameras.

Hemiplegia is a form of paralysis that typically has the symptom of dysbasia. In current clinical rehabilitations, to measure the level of hemiplegia gaits, clinicians often conduct subject evaluations through observations, which is unreliable and inaccurate. The Microsoft Kinect sensor (MS Kinect) is a widely used, low-cost depth sensor that can be used to detect human behaviors in real time. The purpose of this study is to investigate the usage of the Kinect data for the classification and analysis of hemiplegia gait. We first acquire the gait data by using a MS Kinect and extract a set of gait features including the stride length, gait speed, left/right moving distances, and up/down moving distances. With the gait data of 60 subjects including 20 hemiplegia patients and 40 healthy subjects, we employ a random forest-based classification approach to analyze the importances of different gait features for hemiplegia classification. Thanks to the over-fitting avoidance nature of the random forest approach, we do not need to have a careful control over the percentage of patients in the training data. In our experiments, our approach obtained the averaged classification accuracy of 90.65% among all the combinations of the gait features, which substantially outperformed state-of-the-art methods. The best classification accuracy of our approach is 95.45%, which is superior than all existing methods. Additionally, our approach also correctly reveals the importance of different gait features for hemiplegia classification. Our random forest-based approach outperforms support vector machine-based method and the Bayesian-based method, and can effectively extract gait features of subjects with hemiplegia for the classification and analysis of hemiplegia. Graphical Abstract Random Forest based Classsification and Analysis of Hemiplegia Gait using Low-cost Depth Cameras. Left: Motion capture with MS Kinect; Top-right: Random Forest Classsification based on the extracted gait features; Bottom-right: Sensitivity and specificity evaluation of the proposed classification approach.

Acute Paralytic Post-Bariatric Surgery Axonal Polyneuropathy: Clinical Features and Outcome

Introduction: The syndrome of post-bariatric surgery axonal polyneuropathy (PAP) may present with various sensory and motor symptoms including paralysis. We aim to describe the diagnostic features and outcome of treatment of the acute paralytic form of PAP (acute paralytic PAP [APPAP]) as it was not described in a separate cohort previously. Methods: We retrospectively reviewed medical charts and described the clinical, electrodiagnostic features, treatment, and outcome for patients who presented to our clinical neurophysiology unit with disabling weakness within 24 months post-bariatric surgery. The main outcome measure was the percent of patients who are able to walk independently at the last visit and comparing the group who resumed walking independently at 6 months to the group who did not, in regards to the use of intravenous immunoglobulin (IVIg). Results: Thirteen patients were included (10 women and 3 men) with a mean age of 29.8 years (SD 12.5). All presented with loss of ambulation resembling Guillain-Barre Syndrome. The median time of onset was 4 months (interquartile range [IQR] 3–6) post-surgery, and the median time to weakness nadir was 3 weeks (IQR 3–3.5) with an average weight loss of 38.6 kg (SD 17.09). All patients regained their ability to ambulate; however, the ability to walk independently was achieved in 66.7% of patients. The percent of patients who were able to ambulate independently at 6 months were 16% with IVIg versus 66.7% without IVIg. Conclusion: The syndrome of ­APPAP develops in the first-year post-bariatric surgery. The majority of patients regain independent ambulation.