Neurological Factors Research Articles

Cognitive behavioural therapy for psychogenic nonepileptic seizures (PNES) in an adult with a learning disability: A case study

AbstractBackgroundPsychogenic nonepileptic seizures (PNES) are attacks that often look like epileptic seizures (ES). Unlike ES, PNES are not triggered by underlying neurological factors. PNES are relatively rare in the general population; however, their prevalence in people with learning disabilities is much higher—up to 10%. Individuals with PNES and learning disabilities often have psychiatric comorbidities, such as anxiety disorders, depression and posttraumatic stress disorder. There are currently no treatment guidelines for PNES in people with or without learning disabilities. However, talking therapies, such as cognitive‐behavioural therapy (CBT), are recommended. This study explores the effectiveness of CBT for the treatment of PNES in a woman (Susan) with PNES and learning disabilities.MethodsWe used a single‐case experimental design (SCED) to investigate the effectiveness of CBT intervention. Specifically, the withdrawal (also known as ABA) design was applied. The patient's average PNES frequency, as well as idiosyncratic mood measure and standardised outcome measures for people with learning disabilities (Glasgow Anxiety Scale for People with an Intellectual Disability and Mini‐Maslow Assessment of Needs Scale‐Learning Disabilities), were used to assess the effectiveness of treatment.FindingsResults show that Susan's monthly PNES frequency reduced from phase A1 (assessment phase) to phase B (treatment phase), and this persisted to the follow‐up phase (phase A2). However, the reduction was not statistically significant. The intervention was associated with improvements in Susan's mood, anxiety and quality of life. Reduction of Susan's anxiety was clinically significant.ConclusionsThis SCED study demonstrates that CBT might be associated with reduction of PNES frequency and improvements in general functioning in people with PNES and learning disabilities; however, further research, especially around confounding variables is needed.

Sarcopenia and Cognitive Decline in Older Adults: Targeting the Muscle-Brain Axis.

Declines in physical performance and cognition are commonly observed in older adults. The geroscience paradigm posits that a set of processes and pathways shared among age-associated conditions may also serve as a molecular explanation for the complex pathophysiology of physical frailty, sarcopenia, and cognitive decline. Mitochondrial dysfunction, inflammation, metabolic alterations, declines in cellular stemness, and altered intracellular signaling have been observed in muscle aging. Neurological factors have also been included among the determinants of sarcopenia. Neuromuscular junctions (NMJs) are synapses bridging nervous and skeletal muscle systems with a relevant role in age-related musculoskeletal derangement. Patterns of circulating metabolic and neurotrophic factors have been associated with physical frailty and sarcopenia. These factors are mostly related to disarrangements in protein-to-energy conversion as well as reduced calorie and protein intake to sustain muscle mass. A link between sarcopenia and cognitive decline in older adults has also been described with a possible role for muscle-derived mediators (i.e., myokines) in mediating muscle-brain crosstalk. Herein, we discuss the main molecular mechanisms and factors involved in the muscle-brain axis and their possible implication in cognitive decline in older adults. An overview of current behavioral strategies that allegedly act on the muscle-brain axis is also provided.

Dance Is a Healing Art.

The purpose of this review is to evaluate the health benefits of dance and dance therapy in various health domains. Dance interventions included movement therapy with certified therapists, common dances such as ballroom dancing, salsa, and cha-cha as well as ethnic dances, such as the Chinese Guozhuang Dance and the Native American jingle dance. The health domains included depression, cognitive function, neuromotor function, dementia, balance, neurological growth factors, and subjective well-being. The National Library of Medicine, Congress of Library, and the Internet were searched using the terms: dance, dance movement therapy, health, cognitive function, healing, neurological function, neuromotor function, and affective disorders from 1831 to January 2, 2023. Two-thousand five hundred and ninety-one articles were identified. Articles were selected if they provided information on the health benefits of dance in one or more of the above domains as compared to a "non-dance" control population. Studies included systematic reviews, randomized controlled studies, and long-term perspective studies. Most of the subjects in the studies were considered "elderly," which was generally defined as 65years or older. However, the benefits of DI on executive function were also demonstrated in primary school children. Overall, the studies demonstrated that DI provided benefits in several physical and psychological parameters as well as executive function as compared with regular exercise alone. Impressive findings were that dance was associated with increased brain volume and function and neurotrophic growth function. The populations studied included subjects who were "healthy" older adults and children who had dementia, cognitive dysfunction, Parkinson's disease, or depression.

Shared Neurological and Cognitive Factors in COVID-19 and Alzheimer’s Disease: A Literature Review

Introduction: The neuropathological etiology of COVID-19 suggests infection may increase the risk of neurodegenerative disorders, most notably Alzheimer’s disease (AD). Despite some overlap between COVID-19 and AD, the current research on this relationship is developing and evidence has been mixed. This review aims to assess the literature on how the neurological and cognitive sequalae associated with COVID-19 infection affect risk for AD and its associated symptoms, and vice versa. Methods: Articles were found by searching through the PubMed database with the terms (sensory OR cognitive OR neurological OR neuroimaging) AND (Alzheimer’s disease OR Alzheimer’s OR dementia) AND (COVID-19 OR SARS-CoV-2 OR COVID). Search inclusion criteria required the papers be written in English, be published in 2020 or later, and pertain to COVID-19 and/or AD specifically. This process was supplemented by manual searching. The articles used for this review include meta-analyses, literature reviews, and prospective and retrospective empirical studies. Results: Various well-known AD risk factors and outcomes may be observed in COVID-19 patients, and vice versa. These include amyloid precursor protein (APP) buildup, tau hyperphosphorylation, the apolipoprotein E (APOE) e4e4 genotype, angiotensin converting enzyme 2 (ACE2) gene expression, cholinergic functioning, delirium, cognitive decline, and deleterious effects on brain structure and function. Discussion: COVID-19 may increase AD risk and development by increasing protein build-up and damaging AD-related brain regions, which may underlie sensory and cognitive deficits. Furthermore, COVID-19 and AD may interact in positive feedback loops to worsen the development of both. These interactions may be mediated by demyelination, inflammation, APOE e4e4 genotype, and ACE2 expression. Clinical implications for those with COVID-19 and/or AD include the possibility of treatments aimed at cholinergic functioning, as well as high flow oxygen therapy. Conclusion: COVID-19 may increase the risk for and development of AD. AD, in turn, may also increase risk for COVID-19 infection, acting in a positive feedback loop. Future directives include further research on tau pathology, delirium, and amyloid precursor protein processing. Additionally, studies could benefit from telemedicine. Lastly, assessment of AD risk due to COVID-19 could integrate delirium and subjective reports of “brain fog” as measures for underlying risk factors.

Dysfunctional elimination syndrome: a short review of the literature.

The combination of the functional disorders of urination and defecation constitutes the Dysfunctional Elimination Syndrome (DES). DES refers to an abnormal pattern of elimination of unknown etiology characterized by bowel and bladder incontinence and withholding, with no underlying anatomic or neurologic abnormalities. Essential precondition for a child to be subsumed under this entity is the exclusion of either anatomical or neurological causative factors. In the present review study the individual entities of dysfunctional filling, such as the unstable or lazy bladder, or dysfunctional urination, such as the detrusor sphincter dyssynergia and the functional constipation are being described comprehensively. Subsequently, the analysis of the pathophysiological effects of the dysfunctional elimination syndrome such as incontinence, urinary tract infections and the conservation or the deterioration of vesicoureteric reflux, is being accentuated. With the documentation of DES, the therapeutic strategy should aim at treating both the functional disorder of the vesicourethral unit and the functional constipation. The first part does not specify depending on the type of this disorder. Rarely, surgical treatment of functional urinary disorders may be required.

Artesunate alleviates intracerebral haemorrhage secondary injury by inducing ferroptosis in M1-polarized microglia and suppressing inflammation through AMPK/mTORC1/GPX4 pathway.

Intracerebral haemorrhage (ICH) is a catastrophic subtype of stroke with severe morbidity and mortality. However, little progress has been made in the subsequent secondary injury. Artesunate, a water-soluble semi-synthetic derivative of artemisinin, exhibits remarkable pharmacological effects on anti-neuroinflammation. However, the effects of artesunate on ICH remain unknown. In the present study, haemoglobin (Hb) treatment in BV2 cell and collagenase type IV intracerebroventricular injection in Sprague-Dawley rats were used to establish in vitro and in vivo ICH models, respectively. For in vivo, the neurological scores, haematoma volume, brain oedema, inflammatory factors and iron deposition were evaluated. Besides, lipopolysaccharide (LPS) was used in in vitro to polarize BV2 cell to M1 phenotype. Cell viability, cellular reactive oxygen species (ROS), Fe2+ concentration, and lipid peroxidation levels, ferroptosis-associated proteins and mRNA, morphological of mitochondria were measured in vitro. Additionally, the AMP-activated protein kinase (AMPK)/mammalian/mechanistic target of rapamycin (mTOR) pathway were measured by western blot and immunofluorescence staining. The present in vivo results indicated that artesunate significantly ameliorated neurological deficits, haematoma volume and brain oedema in ICH rats. Besides, artesunate suppressed the M1-microglia relative inflammatory factors and up-regulated iron deposition. For in vitro, artesunate significantly selectively decreased the viability of LPS-stimulated BV2 cell. Furthermore, ROS and lipid peroxidation levels were up-regulated. And the glutathione peroxidase 4 (GPX4) were silenced via the AMPK/mTORC1 axis. Our finding supports that artesunate ameliorates the ICH secondary injury both in vitro and in vivo by inducing ferroptosis in microglia and further inhibiting inflammation mainly through the AMPK/mTORC1/GPX4 pathway. This finding may provide a novel target for ICH treatment.

Anti-proliferative effects of cabergoline nano conjugated form on lung cancer cells

Lung cancer is one of the deadliest and most drug-resistant cancers in the world. In this type of cancer, the effect of neurological factors and disruption of neurotransmitter pathways is significant. Cabergoline (CAB) is a specific dopamine receptor (DR) agonist that suppresses tumor cell proliferation and induces cell death. Since the high doses of this drug cause metabolic effects in patients, drug delivery methods have helped bring about better effects of the drug at lower doses. This study aimed to compare the effect of CAB and its nanofluid sample on the expression of DR genes on a lung cancer cell line (A549). Multi-wall carbon nanotubes conjugated with CAB were prepared using a reflux system and evaluated qualitatively. Nanofluid-containing nanodrug was delivered to lung cancer cells (A549) and normal cells (MRC-5) and evaluated by an MTT assay and flow cytometry. Then, the expression of DR genes was studied by real-time polymerase chain reaction before and after the treatment by drug and nanodrug. The findings revealed that nanodrug has a significant lethal influence on cancer cells. In addition, the findings showed the death of cancer cells located in the lung at a lower dose than the pure drug; however, it was not toxic to MRC-5 cells. The design of this nano-targeted drug delivery system showed that it could be a new strategy for the treatment of non-small-cell lung cancer, increase drug delivery efficiency, and consequently induce apoptosis in cancer cells while reducing drug-induced side effects in normal cells.

Analysis of urinary 8-hydroxy-2-deoxyguanosine as a biomarker of oxidative DNA damage in pediatric children with autism spectrum disorder

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental condition that manifests itself in infancy. While genetic factors are the most important in its development, numerous other variables, as neurological, environmental, and immunological factors, have been found. The imbalance of oxidants and antioxidants has a role in the pathogenesis of ASD. We evaluated children with autism for the presence of oxidative DNA damage (ODD) biomarker 8-hydroxy-2-deoxyguanosine (8OHdG) and assessed its association with disease severity, and omega 3 supplementation. MethodsA total of 102 children (51 children with ASD and 51 typically developed children) were recruited for this observational controlled cross-sectional study. Childhood Autism Rating Scale (CARS) was used to measure the severity of autism. The urinary 8-OH-dG was determined by using the ELISA method. Resultsurinary 8-OH-dG/creatinine levels were significantly higher in children with autism compared to their healthy peers (P < 0.001) with positive significant association with disease duration, severity, and positive family history (P = 0.03, P < 0.001, P = 0.03 respectively). Using a cut-of value of > 1.7, urinary 8-OHdG/creatinine ratios showed sensitivity and specificity of 80.39% and 74.51% respectively as a good discriminating power between normal and autistic children. Additionally, statistically lower significant urinary 8-OHdG/creatinine was found among ASD children received omega 3 than those who didn’t receive it (p < 0.001). ConclusionIncreased urinary 8-OHdG/creatinine levels indicate an important role of oxidative DNA damage in ASD, and its significant higher level in ASD children with severe social impairment may be used as a potential non-invasive biomarker for disease severity.

Activation of the sirtuin silent information regulator 1 pathway inhibits pathological myocardial remodeling.

Myocardial remodeling refers to structural and functional disorders of the heart caused by molecular biological changes in the cardiac myocytes in response to neurological and humoral factors. A variety of heart diseases, such as hypertension, coronary artery disease, arrhythmia, and valvular heart disease, can cause myocardial remodeling and eventually lead to heart failure. Therefore, counteracting myocardial remodeling is essential for the prevention and treatment of heart failure. Sirt1 is a nicotinamide adenine dinucleotide+-dependent deacetylase that plays a wide range of roles in transcriptional regulation, energy metabolism regulation, cell survival, DNA repair, inflammation, and circadian regulation. It positively or negatively regulates myocardial remodeling by participating in oxidative stress, apoptosis, autophagy, inflammation, and other processes. Taking into account the close relationship between myocardial remodeling and heart failure and the involvement of SIRT1 in the development of the former, the role of SIRT1 in the prevention of heart failure via inhibition of myocardial remodeling has received considerable attention. Recently, multiple studies have been conducted to provide a better understanding of how SIRT1 regulates these phenomena. This review presents the progress of research involving SIRT1 pathway involvement in the pathophysiological mechanisms of myocardial remodeling and heart failure.

The effect of the COVID-19 pandemic on pediatric physiatric health care in Croatia among children with neurological risk: A retrospective study.

Since the start of COVID pandemic, the Croatian government issued many recommendations and guidelines, imposed reorganization of health care system, and ordered two lock-downs to mitigate the spread of the disease. All of this may have had an unwanted effect on the standard of health care for non-COVID-19 patients, including children with neurological risk factors. To highlight the possibility that measures taken to mitigate the COVID-19 pandemic may lead to a substantial delay of examination by physical medicine specialists and timely rehabilitation programs for children with neurological risks. A retrospective medical history-based study between 2020 and 2021. The study was performed in Department of Physical and Rehabilitation Medicine at the University Hospital Centre of Split, Croatia. Children with neurological risk examined by pediatric physical rehabilitation specialists in the Department of Physical and Rehabilitation Medicine between January 2017 and December 2021. Case records of patients were reviewed, dividing them into groups according to severity of neurological risk and their age at the time of first examination. We also noted in what months of the year those examinations were performed. The outcome was change in the number of the first examinations and the age of the patients when the examination was first performed. During the pandemic year 2020, the total number of first examinations was lower by 244 (38%; 95% confidence interval [CI]: 34%-42%), and the number of first examinations of children with neurological risks was lower by 216 (36%; 95% CI: 33%-40%).On the contrary, in 2021, there was an increase in the total number of first examinations by 114 (18%; 95% CI: 15%-21%) and first examinations of children with neurological risks compared to the pre-pandemic years by 97 (16%; 95% CI: 13%-20%). Furthermore, the division of patients according to age at the time of first examination significantly differed in the pre-pandemic and pandemic 2021 periods (λ =11.8; p=.018). The greatest contributing factor to this difference was the group of patients older than 12 months. The study suggests that the chaotic initial stages of the COVID-19 pandemic during 2020 caused delay in examinations by physical medicine specialists for children with neurological risks that could potentially affect neurodevelopmental outcomes.

Acute posterior multifocal placoid pigment epitheliopathy: clinical presentation and risk of stroke and transient ischaemic attack

Background/aimsAcute posterior multifocal placoid pigment epitheliopathy is a rare but important disease that can be associated with life-threatening complications due to cerebral vasculitis. The primary objective was to determine the...

Visual Contribution to Motor Skill DCD Disorders &amp; Walking Physiology Using Spatial Cognition and Linear Geometries as Landmark Coordination Cues

Problem: Awareness of children, who experience movement, particularly motor coordination difficulties, has increased dramatically over the last ten years. These motor coordination problems of children with Developmental Coordination Disorder (DCD) or/and Attention-Deficit / Hyperactivity Disorder (ADHD) have been frequently associated with poor visual and spatial eye-vision processing.&#x0D; Background: Motor control difficulties for DCD and ADHD children have been discussed in detail. However, just a little is known about the influence of the natural environment on these disorders. Even more, the built environment’s impact as a spatial cognition and coordination functionality has never been considered.&#x0D; Aim: This pilot and innovative study aim to identify the correlation between and evaluate the visual contribution of the so-called “spatial compound linear geometries” and DCD children’s motor/walking control.&#x0D; Methodology: Twenty children aged 5 to 8 years with DCD difficulties (two intervention groups, one with 10 boys and the other one with 10 girls) were assessed by a statistical structural evaluation in three built environments (two urban parks and one pocket park), under two conditions (rich or not in trees, flora, and PnP linear geometries), and different motor coordination control situations (static balance, dynamic balances, dark condition).&#x0D; Results: The worst performances (regarding movement disorders and motor coordination problems) were observed for both groups with DCD children playing in parks poor in or without trees, flora, and spatial compound linear geometries. Instead, a significant performance (strong statistical correlation) was found for the same intervention group (DCD children’s boys or girls) playing in parks rich in trees, flora, and vegetation (natural environment). The best performance (very strong statistical correlation) was detected in parks rich in a natural environment and linear geometries. &#x0D; Conclusions: While the natural environment contribution is bibliographically known, the best performance finding of the visual contribution of the spatial compound linear geometries, as spatial landmarks enriching the visual-spatial motor/walking functionalities for Children with DCD disorder, could provide new cognitive approaches towards an understanding of children’s Developmental Coordination Disorder and walking physiology. DCD children’s performance, scores, and cues were related to both the natural environment and the spatial compound linear geometries as spatial landmark motor coordination cues and spatio-temporal clues. The significant variability in sensory processing among children with DCD, ADHD, and co-occurring symptoms can contribute to understanding how neurological and social factors correlate across diagnoses. Also, derived observations for stepping errors, Gait analysis (variables), and spatio-temporal clues conclude that visual eye-based processing interrelates with motor coordination problems, performance, inattention, environmental conditions (dark), sex identity (boys, girls), and DCD hyperactivity. &#x0D; Applications: Development of interactive visual applications for (i) human spatial cognition and movement improvement; and (ii) children’s motor control and coordination refinement.

Neurological Involvements in COVID-19: A hospital-based study.

The SARS-CoV-2 pandemic is the most challenging crisis in the contemporary world. Besides severe pulmonary involvement, the disease also has several extrapulmonary manifestations, and new signs and symptoms are associated with it every dayThe present study aimed to inquire about the frequency of neurological manifestations and risk factors of COVID-19. This retrospective, descriptive study included patients with neurological involvement admitted to the Alborz University of Medical Sciences academic hospitals from March 2020 to July 2020 with confirmed COVID-19 infection. The data included in the analysis were the patient's demographic information, underlying diseases, neurological manifestations, and laboratory findings. The study included ninety-five patients with a mean age of fifty-nine. Neurological symptoms and signs were observed in 91.6% and 10.5% of the patients, respectively. The most frequently associated neurological symptoms of COVID-19 were fatigue (49.5%), headache (47.4%), and dizziness (45.3%). Furthermore, the most common neurological involvements included gait disorders (6.3%), cerebellar dysfunction (4.2%), and cerebrovascular accidents (3.15%). Positive troponin was shown to be the strongest predictor of neurological signs (OR=21, P=0.017), followed by WBC≥15,000 (OR = 20.75, P=0.018) and a history of respiratory disease (OR=7.42, P=0.007). Neurological symptoms were observed in more than 91% of the patients, while neurological signs were present in 10.5% of the COVID-19 patients. Additionally, positive troponin, WBC≥15,000, and a history of respiratory disease were the strongest predictors of neurological signs.

The epidemiological and neurological risk factors of Japanese encephalitis virus in the population of Assam, Northeast India

Japanese encephalitis is one of the world's most common public health issues, particularly it is prevalent in the north-eastern Indian states of Assam. This study aimed to find out the risk factors linked to clinical and epidemiological characteristics. A total of 245 cases were found as PCR-positive in Assam. The most common clinical symptoms were fever (87%), seizure (65%), altered sensorium (60%), cold with shivering (74%), vomiting (68%), throat irritation (31%), cough (67%), chest pain (10%), joint pain (18%), mouth ulcer (18%), diarrhea (29%), pain in the abdomen (42.9%), runny nose (64%), redness in eyes (78%), jaundice (25%), and blood in the sputum (25%). Further, the neurological symptoms included vision problems (66.5%), hearing difficulties (55 %), neck stiffness (62%), limb numbness (65%), dizziness (77%), headaches (75.5%), speaking difficulties (63%), hydrophobia (47%), and abnormal behavior (66%). The epidemiological risk factors included contact with pigs (57%), bats (21%), cattle (32%), and rates (66%). In addition, 24.5% of patients observed the death of animals/birds. The protection measure included window screening, sleeping under a mosquito net, and use of insect repellent while sleeping in open compounds (29%) and floods (63%) are considered important risk factors. JE-positive cases include daily habits like working in agriculture fields (28%), in standing water (16%), swimming in nearby lakes (24%), traveling outside their village (40%), and wearing shirts while working in the field (20%), storing water in open containers in or outside the house (62%). These were the epidemiological factors that affected the abundance of the potential mosquito vectors of the JE infection.

21. yüzyılın en önemli sağlık problemi: Yaşam dönemlerine göre obezitenin incelenmesi

Obesity is a complex disease involving an excessive amount of body fat and an important public health problem affecting all ages in both men and women. It has been shown that obesity is responsible for many genetic, environmental, neurological, physiological, biochemical, cultural and spiritual factors. World Health Organization (WHO) recommends Body Mass Index (BMI) for obesity classification due to its simplicity, cost-effectivity, and high accuracy. Apart from BMI, waist circumference measurement, weight-to-height, skinfold thickness, and circumference measurements are also used. According to the WHO, 2.8 million people die every year due to obesity. Although obesity affects all ages and social groups, women have been more overweight compared to men since and has been linked to many biological factors. However, even with the medical problems, obese women live longer than men, but not without higher healthcare costs. In this review, the effects of obesity on women's health and life will be discussed.

Post-COVID-19 prolonged neurological symptoms and characteristics: A face-to-face survey study

Background: COVID-19 was declared as a pandemic by World Health Organization on March 11, 2020, and still constitutes a serious health problem affecting millions of people across the world. The evaluation and follow-up of ongoing and/or newly developing neurological involvement after recovery from COVID-19 are important. This study aims to reveal post-COVID-19 neurological symptoms and risk factors for their development. Methods: Patients over the age of 18 years who applied to centers, at least 4 weeks after COVID-19 infection and agreed to participate in the study were included in this cross-sectional study between January 20 and March 15, 2021. The patients were evaluated face to face, and their sociodemographic data, medical history, post-COVID-19 neurological symptoms, treatments, and Beck Depression Inventory scores were recorded. All statistical analyses were performed using SPSS 23 for Windows software package (SPSS Inc., Chicago, IL). Results: Four hundred patients were included in this study, an average of 108+5.12 days had passed after the onset of COVID-19. The rate of post-COVID-19 neurological involvement was 73.3%, and the top 3 most common symptoms were headache (47%), myalgia (43%), and sleep disturbance (39%). Having depression (OR: 4.54, 95% Cl :1.88-10.96), female gender (OR:2.18, 95% Cl :1.36-3.49), hospitalization (OR: 2.01, 95% Cl :103-3.64), and usage of favipiravir (OR:2.07 95 Cl :1.15-3.72) were determined as independent predictors of developing prolonged neurological symptoms. Conclusion: The long-term consequences of COVID-19 remain uncertain. It should be remembered that neurological symptoms are very common in post-infectious patients and long-term follow-up may be required in the management of this condition.

Predictive value of sequential organ failure assessment on 28-day mortality in patients with post-cardiac arrest syndrome

To evaluate the predictive value of sequential organ failure assessment (SOFA) for 28-day mortality in patients with post-cardiac arrest syndrome (PCAS). Retrospective analysis of 125 patients with PCAS who were treated in Emergency Intensive Care Unit (EICU) of Wenzhou People's Hospital from July 2016 to July 2021. Clinical data were collected, including age, gender, underlying diseases, acute physiology and chronic health evaluation II (APACHE II), SOFA score on admission to EICU and 28-day mortality. Univariate and multivariate Logistic regression model was constructed to analyze the influencing factors of PCAS patients, which was used to examine the independent correlation between SOFA score and 28-day mortality. Receiver operator characteristic curve (ROC curve) was used to determine the best predictive value of SOFA score and 28-day mortality in PCAS patients. Among the 125 PCAS patients, there were 91 males and 34 females with an average age of (58.7±15.1) years old, and 97 died and 28 survived within 28 days. The overall SOFA score ranged from 7 to 15 points, with an average of 10.9 (10.0, 12.0) points. The SOFA score of non-survival group was significantly higher than that of the survival group [points: 11.0 (10.0, 12.0) vs. 9.5 (9.0, 10.0), P < 0.05]. This difference between SOFA score mainly caused by the neurological and cardiovascular systems. After excluding neurological factors, the SOFA score of the non-survival group was still significantly higher than that of the survival group [points: 8.0 (6.0, 8.0) vs. 6.5 (6.0, 7.0), P < 0.05]. SOFA score was found to be an independent risk factor for 28-day mortality in PCAS patients by multifactorial Logistic regression analysis [odds ratio (OR) = 1.97, 95% confidence interval (95%CI) was 1.24-3.04]. The correlation between neurological score and mortality was the highest in subgroups (OR = 3.47, 95%CI was 1.04-11.52). The area under the ROC curve (AUC) predicted by SOFA score was 0.81 (95%CI was 0.73-0.89). When SOFA score cut-off value was 10.5 points (10 or 11 points), the sensitivity and specificity of SOFA score for predicting 28-day mortality in patients with PCAS were 67.0% and 82.1%, respectively. The SOFA score is quite accurate in predicting 28-day mortality in patients with PCAS.

Past and Current Issues in Functional Voice Disorder Classification

ABSTRACT This review article examines past and current issues related to Functional Voice Disorders (FVDs) and their classification. FVDs are commonly seen in voice clinics but are diagnosed by exclusion of other pathology. Because of this, FVD etiology is unclear and frequently debated, resulting in inconsistent classification methods. Voice teachers frequently encounter vocalists with FVDs, so a thorough understanding of FVD symptoms is crucial, in order to aid in referral to specialized care and to be supportive when vocalists are undergoing treatment. A narrative literature review of FVD labels and contributing factors is provided, along with new findings and issues with traditional classification systems. Direction on addressing these conditions holistically is provided. Traditional classification systems for FVDs based on supraglottic muscle tension or psychological factors often do not sufficiently explain FVDs for the entirety of this patient population. New studies on neurological underpinnings for FVDs are intriguing, but not enough is known yet to apply them clinically. This review provides insight into the ongoing FVD classification discussion. Further research should center on neurological factors in FVDs and ways to approach FVDs as multifactorial conditions. Further discussions on accurate FVD diagnostic criteria and labels should continue.

Older patients with COVID-19 and neuropsychiatric conditions: A study of risk factors for mortality.

Little is known about risk factors for mortality in older patients with COVID-19 and neuropsychiatric conditions. We conducted a multicentric retrospective observational study at Assistance Publique-Hôpitaux de Paris. We selected inpatients aged 70 years or older, with COVID-19 and preexisting neuropsychiatric comorbidities and/or new neuropsychiatric manifestations. We examined demographics, comorbidities, functional status, and presentation including neuropsychiatric symptoms and disorders, as well as paraclinical data. Cox survival analysis was conducted to determine risk factors for mortality at 40 days after the first symptoms of COVID-19. Out of 191 patients included (median age 80 [interquartile range 74-87]), 135 (71%) had neuropsychiatric comorbidities including cognitive impairment (39%), cerebrovascular disease (22%), Parkinsonism (6%), and brain tumors (6%). A total of 152 (79%) patients presented new-onset neuropsychiatric manifestations including sensory symptoms (6%), motor deficit (11%), behavioral (18%) and cognitive (23%) disturbances, gait impairment (11%), and impaired consciousness (18%). The mortality rate at 40 days was 19.4%. A history of brain tumor or Parkinsonism or the occurrence of impaired consciousness were neurological factors associated with a higher risk of mortality. A lower Activities of Daily Living score (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.58-0.82), a neutrophil-to-lymphocyte ratio≥9.9 (HR 5.69, 95% CI 2.69-12.0), and thrombocytopenia (HR 5.70, 95% CI 2.75-11.8) independently increased the risk of mortality (all p<.001). Understanding mortality risk factors in older inpatients with COVID-19 and neuropsychiatric conditions may be helpful to neurologists and geriatricians who manage these patients in clinical practice.

Etiological factors of voiding disorders in females

Background. Voiding disorders in females are a serious medical and social problem. Various urological, gynecological, and neurological factors contribute to the development of these disorders.&#x0D; Aim. To study etiological factors of voiding disorders in females.&#x0D; Materials and methods. A total of 52 women 19 to 81 years of age with various voiding disorders were inspected. Examination algorithm included collection of a comprehensive medical history, filling in voiding diaries, gynecological exam, various laboratory tests (including PCR-diagnostics of urethral scrapings; ELISA tests for IgM and IgG to herpes simplex virus types 1 and 2, Varicella Zoster virus, EpsteinBarr virus, cytomegalovirus; vaginal discharge culture for flora and sensitivity to antibiotics, with mandatory determination of the lactobacilli count) and diagnostic methods, as well as consultations by related specialists.&#x0D; Results. Chronic herpesvirus infection contributed to urinary dysfunction in 28 (53.8%) women, bacterial urinary tract infection in 15 (28.8%), bacterial vaginosis in 15 (28.8%), papillomavirus infection in 12 (23.1%), and interstitial cystitis in 10 (19.2%) patients. Thirty-five (76.9%) women had several simultaneous factors that contributed to the development of voiding disorders.&#x0D; Conclusion. The combination of disorders of the vaginal microflora with viral and/or bacterial infections most often contributes to the development of voiding disorders.