Impairment In Adult Patients Research Articles

AB0798 Is pain a main factor of activity impairments in adult patients with ehlers danlos hypermobility type?

BackgroundEhlers Danlos Syndrome, hypermobility type(EDS-HT) is characterized by overall connective tissue laxity and associated with chronic pain, fatigue and subsequent disability. Literature reports that EDS-HT also has profound effects on...

Severe Renal Function Impairment in Adult Patients Acutely Poisoned with Concentrated Acetic Acid

Acetic acid is a widely used organic acid with corrosive properties that depend on its concentration. If acetic acid is ingested in concentrations above 30 % it may severely damage the upper gastrointestinal tract and cause intravascular haemolysis, which can result in severe kidney and liver disorders and disseminated intravascular coagulation. In this retrospective study, we analysed acetic acid ingestion data collected at the University Clinic for Toxicology of Skopje, Macedonia from 1 January 2002 to 31 December 2011. The analysis included systemic complications, kidney damage, and the outcomes in particular. Over the ten years, 84 patients were reported at the Clinic to have ingested highly concentrated acetic acid. Twenty-eight developed kidney disorders, while the remaining 56 had no complications. Fatal outcome was reported for 11 patients, seven of whom had systemic complications and four severe gastrointestinal complications.

Visual Impairment: A Common Sequela of Preterm Birth

Improvements in survival rates of premature infants over the past several years have resulted in an increasing number of children with brain injury. Cerebral visual impairment (CVI) is among the most common sequelae of a preterm birth and usually arises from hypoxic ischemic injury to watershed areas of the brain. The term was introduced by Whiting more than 20 years ago to replace the inappropriate term “cortical blindness” used to describe permanent visual impairments in adult patients. CVI includes all visual dysfunctions “caused by damage to, or malfunctioning of, the retrogeniculate visual pathways (optic radiations, occipital cortex, and associative visual areas) in the absence of any major ocular disease.” The existence of many different causes and symptoms makes CVI difficult to define and detect, especially when a child exhibits milder forms of visual impairment that could contribute to difficulties with self-care and academic skills during school age. It is important for pediatricians to identify and recognize CVI as a common cause of visual developmental delay in children with premature birth or pre-, peri-, or postnatal insults because recognizing CVI early is the first step toward prevention and rehabilitation.

Chronic cognitive sequelae after traumatic brain injury are not related to growth hormone deficiency in adults

The objective of the study was to asses the possible influence of hypothalamo-pituitary deficiencies, and growth hormone (GH) deficiency in particular, on cognition in adult patients with traumatic brain injury (TBI). TBI is a recently identified risk factor for cognitive deficits and hypopituitarism. Even the patients with favorable outcome after TBI may present with persistent bodily, psychosocial, and cognitive impairments, resembling patients with untreated partial or complete pituitary insufficiency. We performed retrospective and cross-sectional study of endocrine and cognitive function in TBI in 61 patients (aged 37.7 +/- 1.7 years) of both sexes (44 m,17 f), at least 1 year after TBI (3.9 +/- 0.6 years). Serum insulin-like growth factor 1 (IGF-I), thyroxin, thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (in men), prolactin, and cortisol were measured, and GH secretion was assessed by growth hormone releasing hormone (GHRH) + growth hormone releasing peptide-6 (GHRP-6) test. Cognitive function was assessed by using a standard neuropsychological battery. GH deficiency (GHD) and GH insufficiency (GHI) were found in 20 patients (32.8%). After adjustment for confounders [age, body mass index (BMI), education level, time elapsed from TBI], there were no significant differences in results of neuropsychological tests between patients with TBI with GHD, GHI, and normal GH secretion. There were no correlations of neuropsychological variables with stimulated peak GH secretion or IGF-I level. GHD persists long after the TBI, independently of trauma severity and age at traumatic event. GH secretion is more sensitive to TBI than other pituitary hormones. No evidence is found for an association of cognitive function impairment and somatotropic axis impairment in adult patients tested more than 1 year after the TBI.

The Effect of Ondansetron, a 5-HT3Receptor Antagonist, in Chronic Fatigue Syndrome

Accumulating data support the involvement of the serotonin (5-hydroxytryptamine [5-HT]) system in the pathophysiology of chronic fatigue syndrome. Neuropharmacologic studies point to a hyperactive 5-HT system, and open-label treatment studies with 5-HT(3) receptor antagonists have shown promising results. In this randomized controlled clinical trial, the effect of ondansetron, a 5-HT(3) receptor antagonist, was assessed on fatigue severity and functional impairment in adult patients with chronic fatigue syndrome. A randomized, placebo-controlled, double-blind clinical trial was conducted at Radboud University Nijmegen Medical Centre, The Netherlands. Sixty-seven adult patients who fulfilled the US Centers for Disease Control and Prevention (CDC) criteria for chronic fatigue syndrome and who were free from current psychiatric comorbidity participated in the clinical trial. Participants received either ondansetron 16 mg per day or placebo for 10 weeks. The primary outcome variables were fatigue severity (Checklist Individual Strength fatigue severity subscale [CIS-fatigue]) and functional impairment (Sickness Impact Profile-8 [SIP-8]). The effect of ondansetron was assessed by analysis of covariance. Data were analyzed on an intention-to-treat basis. All patients were recruited between June 2003 and March 2006. Thirty-three patients were allocated to the ondansetron condition, 34 to the placebo condition. The 2 groups were well matched in terms of age, sex, fatigue severity, functional impairment, and CDC symptoms. Analysis of covariance showed no significant differences between the ondansetron- and placebo-treated groups during the 10-week treatment period in fatigue severity and functional impairment. This clinical trial demonstrates no benefit of ondansetron compared to placebo in the treatment of chronic fatigue syndrome. www.trialregister.nl: ISRCTN02536681.

The association of child abuse and neglect with adult disability in schizophrenia and the prominent role of physical neglect

Objective To assess long-lasting effects of childhood trauma on the functional outcome of adult patients diagnosed with schizophrenia. Method Ninety-nine stable patients with schizophrenia followed in an outpatient program at a public university hospital in Porto Alegre, southern Brazil, were investigated for childhood traumatic experiences by the Childhood Trauma Questionnaire (CTQ) and for functional impairment by the World Health Organization Disability Assessment Schedule (WHO/DAS). The schizophrenia diagnosis was assessed by ICD-10 and DSM-IV criteria according to the Operational Criteria Checklist for Psychotic Illness (OPCRIT). Results Childhood trauma in general was associated with increased disability in adulthood, reflected by impaired Overall Behavior ( p = .023) and Global Evaluation ( p = .032). Analysis of specific traumatic domains revealed that increased childhood physical neglect was associated with functional impairment in Overall Behavior ( p < .000), Social Role Performance ( p = .037) and Global Evaluation ( p = .014). Higher emotional abuse was associated with impaired Overall Behavior ( p = .026), and higher emotional neglect with poor Global Evaluation ( p = .047). Additionally, earlier onset of illness was associated with lower level of functioning evidenced by impairment in Overall Behavior ( p = .042). Linear regression using WHO/DAS sections (Overall Behavior, Social Role Performance and Global Evaluation) as dependent variables and CTQ subscales indicated that only physical neglect had an effect on adult functionality. Conclusions Childhood trauma was associated with functional and social impairment in adult patients with schizophrenia. Specific types of abuse and neglect, such as physical neglect and emotional abuse and neglect, influenced disability, and the most robust association was physical neglect. Studies involving more patients, with normal controls and additional measurements of biological liability, should be conducted to confirm this association and to increase the understanding of gene-environment relationship in schizophrenia and pathways to disability. Practice implications Further investigation is warranted to clarify the association between childhood trauma and disability in schizophrenia, as well as to develop standardized instruments for the assessment of trauma and earlier detection of risk along with education of patients and families about adequate care, in an effort to reduce the incidence of disability in schizophrenia.

Visuoperceptive impairment in adult patients with occipital lobe epilepsies

The aim of the study was to verify whether adult patients with occipital lobe epilepsy (OLE) are at risk for cognitive impairment compared with controls. Twenty patients with OLE and 20 controls, matched as closely as possible to the epilepsy group in terms of gender, age, education, and intelligence, were administered a battery of tests based on visuoperceptive domains. None of the participants was affected by progressive pathologies, received any medication other than antiepileptic drugs, nor had a psychiatric background. We noted a statistically significant difference between patients with OLE and controls in the following tasks: Perceptive Differences Test, and Object Denomination Test, and Famous Faces Test ( P < 0.05). No difference was noted between symptomatic and nonsymptomatic patients with respect to neuropsychological results ( P > 0.05). The linear regression analysis performed did not show any statistically significant contribution by clinical variables. Our data confirm that patients with OLE manifest subtle difficulties in processing and mental manipulation of visual spatial data.

Neuropsychological impairment in adult patients with cystic fibrosis

Neuropsychological impairment in adult patients with cystic fibrosis

Neuropsychologic impairment in adult bone marrow transplant candidates.

Long-term cognitive impairment has been reported in adult bone marrow transplant (BMT) recipients. However, the degree to which such impairment is attributable to the procedure or is a condition existing before BMT is not known. The presence, nature, and correlates of neuropsychologic impairment were investigated in 55 adult BMT candidates, all of whom had a malignant condition. Impairment was assessed using a screening battery of standardized neuropsychologic tests. Results indicated that: (1) neuropsychologic performance was associated with specific disease and treatment risk factors, in particular a history of cranial radiation or central nervous system disease treated with intrathecal chemotherapy; (2) performance on tests reflecting memory or higher cognitive processing was more likely to be impaired; and (3) the risk of impairment increased as the number of disease and treatment risk factors for cognitive impairment in the patient increased. It was concluded that neuropsychologic impairment occurs in a significant minority of adult patients before BMT. Research is necessary to determine the extent to which such impairment significantly compromises patients' abilities to: (1) make decisions regarding undergoing BMT or participating in research protocols and (2) understand and execute self-care behaviors after BMT. More broadly, greater attention should be devoted to investigating the presence of long-term neuropsychologic impairment in adult patients with cancer.

Norms Developed

Norms were established for the Halstead Neuropsychological Test Battery for Children and the Reitan-Indiana Neuropsychological Test Battery for Children in the Laboratory of Medical Psychology at the University of Chicago, based on data collected between 1960 and 1969. Samples for the HNTBC included children age 9 to 15 (N=170) and for the RINTBC children age 5 to 9 (N=43), drawn from a normal urban population. Validation of the norms was established by comparison with the mean scores of clinical referrals, and a population described as “cerebral dysfunction.” These norms offer reference points and contribute to the assessment of the degree of neuropsychological impairment in individual cases ranging from age 5 through age 15, as measured by these tests. From 1935 to 1969 Ward C. Halstead conducted a long series of inquiries into higher human brain functions at his laboratory at the University of Chicago. He termed this field of study “medical psychology.” and “biopsychology.” The set of tests which he developed, the Halstead Battery of Neuropsychological Tests, proved to be valid, reliable and sensitive to various types of brain dysfunctions or impairment in adult patients and has shown some usefulness in discriminating among levels of brain-behavior functioning in normal adult populations (Chapman and Wolfe, 1959; Halstead, 1947; Reitan, 1955;Shure, 1958). In 1953 Ralph Reitan at Indiana University Medical Center modified Halstead's tests, simplifying them while maintaining the same basic tasks, so as to create a battery appropriate for younger subjects, ages 9 to 14. The Halstead Neuropsychological Test Battery for Children (NHTBC) yielded highly significant results in comparison of normal and brain-damaged children (Reed, Reitan and Klove, 1965) and was used in a number of investigations including studies of blind children (Norris, Spaulding and Brodie, 1957), cerebral dysfunction (Halstead and Rennick, 1966), very low birthweight prematures (Hughes, Note 1), and cerebral lesions in young children (Reitan, 1974). The utility of the HNTBC suggested the extension of the methodology to even younger age groups. Reitan also undertook this task and in 1958 he developed functionally equivalent tests for younger children, ages 5 to 9. The battery of necessity varied considerably in content as well as in difficulty, but was designed to provide measurements of abilities comparable to those required by the Halstead batteries. The Reitan-Indiana Neuropsychological Test Battery for Children (RINTBC) included the Tapping test, a simplified Category Test (with responses keyed to four colors rather than numerals), and nine simple tests of spatial-perceptual ability, eye-hand coordination, and shape and size discrimination. The nine tests are: Progressive Figures Test, Matching Figures, Matching V's, Matching Pictures, Target Test Color Form Test, Marching Star and Concentric Squares. A rather simple examination for aphasia was also routinely given to children in both age ranges; the test represents a modification of the Halstead-Wepman Aphasia Screening Test. In addition, a series of tests for evaluating sensory-perceptual functions, across modalities of tactile, auditory, and visual functions, was included. A brief description of these various tests was provided by Reitan and Heineman(1968). These modifications were used routinely in the Halstead Laboratory of Medical Psychology at the University of Chicago, and during the decade of the sixties, considerable case material which had accumulated was studied, providing the data to be reported here. In Chicago, we referred to the tests by the convenient shorthand terms: “the Intermediate Battery” (for HNTBC, ages 9 to 14) and the “Child Battery” (for RINTBC, ages 5 to 9).