Neurological Unit Research Articles

The Utility and Value of The Physiotherapy eSkills Training Online Resource During Work-integrated learning: A mixed methods study.

Purpose: The purpose of this study was to determine the use and value of the Physiotherapy eSkills Training Online resource during work-integrated learning in naïve physiotherapy students. Method: A mixed methods study design was used. Participants: Forty-four final year physiotherapy students participating in neurological work-integrated learning units of study participated in this study. Intervention: Students had access to the Physiotherapy eSkills Training Online resource during their 6-week neurological work-integrated learning unit of study, which includes video footage and written information about 25 practical skills related to the physiotherapy management of stroke. Outcome Measures: Use of the Physiotherapy eSkills Training Online resource was examined by recording the number of hits on the resource, the number of students who accessed it, the number of times each student accessed it, and the time it was accessed. Students’ perception of the value of the resource was explored through semi-structured interviews. Results: There were 46 hits on the resource, by 13 (30%) students during the neurological work-integrated learning unit of study. Ten students accessed the resource twice or more. Double the number of hits occurred outside of work hours compared with during work hours. Qualitative analysis revealed five themes regarding the low usage of the resource by students: content of the resource; learning style; learning behavior and expectations; technical issues; and practical issues. Conclusion: Use of the resource was low, with only a small number of students using the resource on a few occasions. Value of the resource could not be clearly established.

Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR.

Preventable adverse events continue to be a threat to hospitalized patients. Clinical decision support in the form of dashboards may improve compliance with evidence-based safety practices. However, limited research describes providers' experiences with dashboards integrated into vendor electronic health record (EHR) systems. This study was aimed to describe providers' use and perceived usability of the Patient Safety Dashboard and discuss barriers and facilitators to implementation. The Patient Safety Dashboard was implemented in a cluster-randomized stepped wedge trial on 12 units in neurology, oncology, and general medicine services over an 18-month period. Use of the Dashboard was tracked during the implementation period and analyzed in-depth for two 1-week periods to gather a detailed representation of use. Providers' perceptions of tool usability were measured using the Health Information Technology Usability Evaluation Scale (rated 1-5). Research assistants conducted field observations throughout the duration of the study to describe use and provide insight into tool adoption. The Dashboard was used 70% of days the tool was available, with use varying by role, service, and time of day. On general medicine units, nurses logged in throughout the day, with many logins occurring during morning rounds, when not rounding with the care team. Prescribers logged in typically before and after morning rounds. On neurology units, physician assistants accounted for most logins, accessing the Dashboard during daily brief interdisciplinary rounding sessions. Use on oncology units was rare. Satisfaction with the tool was highest for perceived ease of use, with attendings giving the highest rating (4.23). The overall lowest rating was for quality of work life, with nurses rating the tool lowest (2.88). This mixed methods analysis provides insight into the use and usability of a dashboard tool integrated within a vendor EHR and can guide future improvements and more successful implementation of these types of tools.

Utility of the EAT-10 in the detection of dysphagia in high-risk hospitalisation units at a university hospital: a cross-sectional study.

Introduction: the objective was to assess the utility of the Eating Assessment Tool (EAT-10) in hospitalisation units with patients at high risk of dysphagia. Patients and methods: a cross-sectional study was conducted in the Neurology and Internal Medicine wards; patients with admission < 24 hours and in a terminal stage of disease were excluded. In the first 24-48 hours of admission the presence of dysphagia as assessed with the EAT-10, the risk of malnutrition as assessed with the Malnutrition Universal Screening Tools (MUST), and comorbidities using the Charlson index were screened. Results: a total of 169 patients were recruited (76.0 years, 52 % women); 19.5 % were at risk of malnutrition. The EAT-10 instrument could be administered in 80.6 % of the patients, and was positive in 26.6 % (women 34.1 % vs. men 18.4 %; p = 0.025). When comparing patients with higher comorbidity with those with a lower Charlson index, a lower response rate to EAT-10 was observed (78.4 % vs. 93.9 %; p = 0.038), without differences in screening positivity (28.3 % vs. 19.4 %; p = 0.310). The prevalence of dysphagia risk was higher in the Internal Medicine unit than in the Neurology unit (30.4 % vs. 19.6 %; p = 0.133), as was the percentage of cases in which screening could not be performed (21.1 % vs. 11.1 %; p = 0.011). There were no significant differences in risk of malnutrition, mortality, hospital stay, or readmission according to the EAT-10. Conclusions: The EAT-10 has limited utility in the studied hospitalisation units due to a high rate of unfeasible tests, especially among patients at higher risk of dysphagia.

Assessment of Addicted Cases Admitted to Addiction Management Unit of Neurology and Psychiatry Hospital at Assiut University.

Background: Substance abuse is a major challenge in Egypt due to changing pattern of abuse and its threating to health, social and economic build of the community. Aim of the work: the present work aims to demonstrate the pattern of substance abuse in Assiut governorate. Also to study the liver, kidney functions and electrocardiographic changes among addicted patients admitted to Addiction Management Unit of Neurology and Psychiatry Hospital at Assiut University. Patients and methods: the study was done on 80 male in-patients, who are addicted for at least one year and 41 healthy non-abusers. All Patients fulfilled a questionnaire of drug dependence and were subjected to a thorough clinical examination beside measurement of liver functions, kidney functions, electrocardiogram recordings, and urine toxicological screen. Results: Forty-three patients (53.75%) were 25–35 years of age. Their mean of age was 30.47±6.91 years. Multiple substance abuse represented 57.5% (46 cases) and tramadol was the most commonly abused drug. Tramadol was abused alone in 32.5% (26 cases). The technical school (47.5%) was the most common educational level. Family history of abuse was positive in 47.5% of cases. HCV was positive in 15 (18.75%) of cases, 13 of HCV positives cases used injection for substance abuse. There was no significant association between liver and kidney functions changes and addiction duration. However, a correlation was established between liver functions changes and infective hepatitis. There was a high percentage of ECG abnormalities among abusers (53.75%), those abnormalities were in the form of an inverted T wave in 13 patients (30.23%). Conclusion: This research shows that ECG abnormalities are frequently encountered in substance abusers. The results also point out the risk of hepatic damage due to infective hepatitis in injection drug users. Measures to control the spread of substance abuse should be implemented.

Risk Factors of Behavioral Problems in Pediatric Epilepsy

Background: Epilepsy is the most common neurological disorders in children and the number of case for epilepsy still incre­asing. Epilepsy can affect children and their growth physically, psy­cho­logi­cally, and socially, yet the treatment of behavioral problems in pediatric epilepsy is still lacking. This stu­dy aimed to investigate the association of frequency of seizure, type of seizure, duration of illness, and use of antiepileptic drug with behavioral dis­order in children with epilepsy. Subjects and Method : This was an analytical observational study with a cross sectional design. The study was conducted at Pediatric Neurology Unit of Dr. Moewardi hospital, Sura­karta, from September to October 2016. A sample of 50 pediatric patients with epilepsy was selected for this study. Parents or care­givers completed behavioral problems screen­ing tool Pediatric Symptom Checklist-17 (PSC-17) and were interviewed about frequency of seizure, type of seizure, duration of illness, and use of antiepileptic drug. The data were ana­lyzed by a multiple logistic regres­sion. Results: Frequent seizure (OR= 3.09; 95% CI= 0.89 to 10.59; p= 0.068) increased beha­vioral problem. Being treated with ≥1 anti-epileptic drugs (OR= 1.58; 95% CI= 0.44 to 5.71; p= 0.521) increased beha­vioral problem, but it was statistically non-significant. Type of seizure (OR= 1.01; 95% CI= 0.32 to 3.20; p= 0.991) and duration of illness ≥1 year (OR= 1.03; 95% CI= 0.22 to 4.89; p= 1.000) were not associated with behavioural problem. Conclusion: Frequent seizure increase beha­vioral problem Keyword s : epilepsy, behavioral problems, pediatrics Correspondence: Fadhilah Tia Nur. Department of Child Health, Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: fadhilah.harris@gmail.com Indonesian Journal of Medicine (2020), 05(02): 162-169 https://doi.org/10.26911/theijmed.2020.05.02.11

2019 Visionary Leader Iesha Bethley.

The following manuscript is the winning 2019 Richard Hader Visionary Leader Award entry submitted to Nursing Management in recognition of Iesha Bethley, MSN, RN, CMSRN, neurology unit nurse manager at Our Lady of the Lake Regional Medical Center in Baton Rouge, La. Iesha was formally recognized for her achievements before the Keynote Address on October 17 at Congress2019 in New Orleans, La., where she received the award, sponsored by Hackensack Meridian Health.

Association of Hyperuricemia With Acute Kidney Injury: Case Series Report Among Patients Hospitalized With General Tonic-Clonic Seizures.

Background:Urate nephropathy is a rare cause of acute kidney injury. Although most risk factors are associated with chemotherapy, tumor lysis syndrome or rhabdomyolysis, occurrence following severe seizure has also been reported. Uric acid measurement following convulsion is rarely performed and, therefore, the incidence of hyperuricemia in this context is unknown.Objective:The objective is to present a case of urate nephropathy following generalized tonic-clonic seizure (GTCS) and to investigate the kinetics of serum uric acid and creatinine levels in a series of patients admitted for severe seizures.Design:Retrospective case report and prospective case series.Setting:Emergency room department and neurology unit of a tertiary care hospital.Patients:The study included 13 hospitalized patients for severe GTCS.Measurements:Type, timing, and duration of seizure episodes were documented. Demographic data, weight, hypouricemic therapy, and baseline serum creatinine were recorded. Blood samples (uric acid, creatinine, blood gas, lactate, and creatinine kinase) and urine samples (uric acid, creatinine, and dipstick) were prospectively collected at Day 0, 1, 2, and 3 following the GTCS episode.Methods:We identified and described one rare case of urate nephropathy following GTCS. Then, we presented the kinetic of uric acid and creatinine levels and the acute kidney injury incidence over the follow-up period. All analyses were using descriptive statistics.Results:During the study period, 13 patients with a median tonic-clonic seizure duration of 5.0 minutes (interquartile range [IQR], 2.0–12.5) were included. From day 0 to day 3, the median serum uric acid level decreased from 346.0 µmol/L (IQR, 155.0–377.5) to 178.0 µmol/L (IQR, 140.0–297.5) and median serum creatinine from 73.0 µmol/L (IQR, 51.0–80.0) to 57.0 µmol/L (IQR, 44.0–70.0). Acute kidney injury occurred in four patients.Limitations:This is a single-center observational study with small sample size, which does not allow us to demonstrate causality between the increase of uric acid levels observed and the occurrence of acute kidney injury. A delay between the first sampling and seizure episodes was observed and could explain the limited increase of uric acid levels captured.Conclusions:There is a signal for an acute increase of uric acid levels following a severe seizure before returning to baseline within 3 days. During that period, there might be an increased risk of acute kidney injury, although these changes seem to be usually mild and reversible. Our findings suggest that routine serum uric acid measurement in patients presenting with GTCS could help to identify those patients at risk of developing acute kidney injury as a result of acute hyperuricemia. Further larger studies are required to confirm the effectiveness of such screening in acute kidney injury prevention.Trial Registration:As an observational noninterventional study, no registration was required.

Spectrum of Neurological Diseases in Tertiary Care Centre of Nepal

Neurological cases in Nepal are not reported much. Neurological diseases are associated to poor health outcomes including mortality, disability and hospitalization. Epidemiology and clinical pattern of neurological disorders in developing countries remain largely unknown. This is a descriptive study to understand the burden of disease faced by neurologists and internists in a hospital of Nepal. This is a retrospective study of medical records of patients admitted in the Neurology unit of medical ward of Dhulikhel Hospital. A total of 318 patients were admitted during the period of July 2014to January 2015. Diagnosis was established by clinical, radiological, nerve conduction studies, electroencephalography and cerebrospinal fl uidanalysis. A total of 318 patients records during the above mentioned period were reviewed. Common neurological diseases identified were vascular: 138(43.40%); seizure: 60(18.87%); infectious: 20(6.29%); demyelinating: 12(3.77%); degenerative: 14(4.40%); peripheral neuropathy:14(4.40%); and others (mass lesion, ataxia, myelopathy) 60(18.87%). Cerebrovasculardisease is the most common cause of admission of patients in the neurological unit of the hospital. There are differences in the neurological diseases with respect to age, gender and ethnicity.

Good for Nurses, Good for Patients:: Creating a Healthy Work Environment in a Pediatric Acute Care Setting

Disruptive behaviors are widespread in nursing, and have significant potential to negatively impact patient and nurse outcomes. Nursing leaders at Nicklaus Children’s Hospital, a Magnet®-recognized, free-standing pediatric hospital received feedback from their nursing staff regarding an increase in bullying and incivility. To address negative behaviors and create a foundation for professionalism, a strategic plan was developed to assess and improve issues in the nursing work environment. By employing a structured approach to addressing disruptive behavior in the pediatric acute care setting, the organization has been able to achieve meaningful improvements in self-reports of nurse experience, satisfaction, and patient experience. Disruptive behaviors are widespread in nursing, and have significant potential to negatively impact patient and nurse outcomes. Nursing leaders at Nicklaus Children’s Hospital, a Magnet®-recognized, free-standing pediatric hospital received feedback from their nursing staff regarding an increase in bullying and incivility. To address negative behaviors and create a foundation for professionalism, a strategic plan was developed to assess and improve issues in the nursing work environment. By employing a structured approach to addressing disruptive behavior in the pediatric acute care setting, the organization has been able to achieve meaningful improvements in self-reports of nurse experience, satisfaction, and patient experience. Danielle Altares Sarik, PhD, APRN, CPNP-PC, is Research Nurse Scientist at Nicklaus Children’s Hospital in Miami, Florida. She can be reached at [email protected] Renee Thompson, DNP, RN, CSP, is CEO & Founder, The Healthy Workforce Institute. Jennifer Cordo, MSN, APRN, NE-BC, is Nursing Excellence Manager and Magnet Program Director at Nicklaus Children’s Hospital. Ivette Nieves Roldan, MSN, RN, CPN, is Nurse Manager, Neurology and Neurosurgery Unit at Nicklaus Children's Hospital. Jackie L. Gonzalez, DNP, APRN, MBA, NEA-BC, FAAN, is Senior Vice President and CNO at Nicklaus Children’s Hospital.

INDIVIDUAL PSYCHOLOGICAL MARKERS OF TRANSIENT ISCHEMIC ATTACKS IN RESIDENTS OF THE REPUPLK OF KARELIA

The aim is to identify the role of systemic psychodiagnostics using a biopsychosocial approach for a multidimensional comprehensive study of the influence of individual psychological factors on the occurrence and course of transient ischemic attacks (TIA) among residents of the Republic of Karelia. Studied: personality premorbid and psychological symptomatic status in patients of stroke neurological unit of the Republican Hospital of Petrozavodsk suffering from TIA (n = 60; average age (56.9 ± 18.5) years; gender index 1: 1). The comparison group included individuals without TIA (n = 32; average age (52.4 ± 6.5) years; gender index 1:1; p = 0.06). Methods: the "Questionnaire for the intensity of psychopathological symptoms" (Symptom CHECKLIST-90-REVISED - SCL-90-R) and the Freiburg Multifactor Personality Questionnaire (Freiburg Personality Inventory - FPI) were used. Results. It was revealed that the personality premorbid of residents of the republic with TIA is characterized by neuroticism and shyness (high walls: (7.27 ± 2.60) and (7.10 ± 1.75) FPI points, respectively). The somatogenic effect of TIA on the psyche of patients consists of anxiety and depression in combination with somatization and phobias (average values for SCL-90-R: (0.56 ± 0.45); (0.65 ± 0.19); (0, 97 ± 0.27); (0.32 ± 0.19) points for the indicated psychopathological symptoms, respectively). Conclusions: patients with TIA in the Republic of Karelia are characterized by markers of psychological distress, which requires an individual psychological and psychotherapeutic correction.

Treatment of Pediatric Brain Tumors in Brazzaville (Congo) about a Case Series

Introduction: Tumors of the central nervous system are the most common group of solid neoplasm in children and account for 20% to 25%. They are common in Sub-Saharan countries, despite the insufficiency of histological diagnosis. No study has been performed concerning the pediatric brain tumors in the Republic of Congo. The aim of this study was to describe the conditions of neurosurgical management of pediatric tumors in Brazzaville. Materials and Methods: We performed a retrospective and descriptive study, from January 2014 to December 2017 (48 months), into the neurological unit of the surgical department of Brazzaville. We included all patients aged from 17 years old and below, hospitalized for a brain tumor. Results: We have identified 11 cases of brain tumors. The average age was 8.1 ± 4.3 years old, a sex ratio of 0.57. Ten out of the eleven patients of our series have intracranial hypertension. We found six cases of infratentorial tumors and five of supratentorial location. Only three cases had histology. Ten patients were operated, limited by ventriculoperitoneal shunt in 6 cases, surgical resection in three cases, biopsy in one case. There were no possibilities of radiotherapy and chemotherapy during this period of study. Conclusion: A multidisciplinary team must be organized to improve the management of pediatric brain tumors in our context. Histological diagnosis and possibilities of radiotherapy are imperatively needed.

Exploring the phenotype and genotype of multi-drug resistant Klebsiella pneumoniae harbouring blaCTX-M group extended-spectrum \u03b2-lactamases recovered from paediatric clinical cases in Shenzhen, China

BackgroundEmergence and spread of β-lactamase resistant Klebsiella pneumoniae have posed a serious threat, especially in paediatric patients globally. The present study focuses on explore drug resistance profile and molecular characterization of carbapenemase and extended-spectrum β-lactamase producing K. pneumoniae isolated from paediatric patients in Shenzhen, China.MethodsPresent study, a total of 31 isolates of multi-drug resistant K. pneumoniae were collected from Shenzhen Children’s Hospital, China during Jan 2014 to December 2015. ESBLs production was confirmed by using the combination disc diffusion method followed by antimicrobial susceptibility. In addition, β-lactamase encoding genes were determined by PCR assay and sequencing. The genotypic diversity and phylogenetic relationship were determined by multi-locus sequence typing (MLST) method and pulsed-field gel electrophoresis (PFGE).ResultsWe examined 31, unique K. pneumoniae isolates collected from 2014 and 2015 in Shenzhen Children’s Hospital, China. All the 31 isolates 100% were resistant to ceftazidime, ertapenem, ampicillin, cefazolin and ampicillin-sulbactam followed by ceftriaxone 94% (n = 29), aztreonam 89% (n = 26), cefepime 84% (n = 26), nitrofurantoin 75% (n = 24), piperacillin 52% (n = 16), and levofloxacin 49% (n = 15). Of the 31 β-lactamase gene coding isolates, blaCTX-M was mainly detected in about 100% (n = 31), followed by blaKPC 71% (n = 22), blaSHV 61% (n = 19), blaNDM 25% (n = 8), blaCYM 13% (n = 4), blaOXA-48 9% (n = 3), blaGES 9% (n = 3) and blaTEM 6% (n = 2). Seventeen distinct sequences type were observed with ST20 being mostly identified 16% (n = 5). Pulsed-field gel electrophoresis (PFGE) typing showed that identical profile for the isolates recovered from the Department of Intensive Care Unit and Department of Neurology of our hospital. Plasmid replicon typing result indicates the presence of IncFIS type as highest in all isolates as 61% (n = 19), followed by IncFIB 23% (n = 7), IncFIA and IncFIC 16% (n = 5) each.ConclusionOur study reports the occurrence and spread of extended β-lactamase K. pneumoniae ST20 and ST2407 for the first time, in Shenzhen, particularly in paediatric patients. To prevent and control the infection by limiting the spread of infection-causing organisms it is very crucial to detect the presence of resistant genes at an early stage.

Acute Stroke in Diabetes Mellitus: A Prospective Observational Study Evaluating the Course and Short-Term Outcome in Basrah, Southern Iraq.

IntroductionStroke and diabetes mellitus (DM) are distinct conditions with many aspects in common. Both conditions are prevalent and associated with various vascular risk factors such as dyslipidemia and hypertension. This study was conducted to evaluate the association between stroke and DM regarding the course (i.e., type, recurrence, aspirin failure, and degree of disability) of stroke and short-term outcomes in patients with diabetes who suffer an acute stroke.Patients and methodsWe conducted a prospective observational study of 210 acute stroke patients admitted to the Neurology Unit of Al-Basrah Teaching Hospital in Basrah City in Southern Iraq from May 2014 to September 2015. Our study included 124 men (59%) and 86 (41%) women, and our study population had a mean age of 64 ± 11 years. The study participants were separated into two groups of 105 patients according to their diabetes status, and we evaluated each patient’s type of stroke, recurrence, aspirin failure, and degree of neurological disability according to the National Institutes of Health stroke scale. We assessed short-term outcomes (i.e., four weeks' mortality) following acute stroke.ResultsIschemic stroke was the primary stroke experienced by patients with diabetes (94.3%), which is highly significant and associated with an increased risk of previous recurrent ischemic stroke (55.2%; P=0.003, <0.001, respectively). We noted a higher rate of loss of antiplatelet activity from aspirin in patients with DM rather than those without DM (p<0.001), and we noted more severe disability in outcomes in patients with DM. In the group of stroke patients with diabetes, 46 patients (59%) died, while 32 patients (41%) without diabetes died (p=0.046).ConclusionDM is associated with a heavier burden for acute stroke along with poorer outcomes than patients without DM. Our findings suggest acute stroke in patients with diabetes may be considered a distinct entity separate from acute stroke in patients without diabetes. The treatment of acute stroke in patients with diabetes warrants further investigation.

Medical awareness of risk factors of cardiovascular diseases in different types of hospitalized patients (part 2)

To study medical awareness of cardiovascular risk factors (RFs) in different types of hospitalized patients (pts). A total of 150 pts from neurological, endocrinological and cardiac units one of Moscow city hospital were enrolled into the survey (50pts in each unit). The pts were interviewed during the I-II days of the hospitalization. A special questionnaire was developed in‑ cluding socio-demographic and clinical indicators, open questions on the awareness of traditional cardiovascular RFs and their target values. Pts of three units did not differ in gender and age. The range of diagnoses corresponded to the profile of the unit. The survey revealed an extremely low awareness of major cardiovascular RFs of pts in all 3 units: almost none of them pointed to elevatedcholesterol (0%, 4% and 0%, respectively) and blood pressure (2%, 2% and 0%) respectively) as RF of cardiovascular diseases. The pts of the three units most often referred to stress (64%, 56% and 66%, respectively) and unhealthy diet (50%, 56% and 64%, respectively) as the main cardiovascular RFs. On average, pts in three units correctly indicated only 2 RFs. The survey revealed a low awareness of cardiovascular RFs in different types of medical pts, including cardiac pts, at time of hospital admission.

Outcome of cardio-embolic stroke by atrial fibrillation: Lesson from Subsaharan Africa setting

Atrial fibrillation (AF) is the leading cause of cardio-embolic stroke (CES) but data in Subsaharan African were scarce. The aim of this study was to describe the clinical pattern and to evaluate the outcome of CES due to AF. A 8-year retrospective cohort study was carried out in the Neurological Unit and the Intensive Care Unit of the Douala General Hospital. Were included all the files of patient admitted with established diagnosis of CES due to AF confirmed respectively by CT scan and ECG. Standard scores (CHA2DS2-VASc > 2, HAS-BLED≥3 and modified Rankin Score>2) were used respectively to evaluate embolic risk, risk of bleeding and poor functional outcome. Survival was determined using Kaplan Meier curve. 85 files CES due to AF were included (52% women) with a mean age of 69±11,96 years. 34.9% of patients have pre-existing AF. Embolic and hemorrhagic risks were classified high in 91.3% and 94.1% respectively. Antithrombotic treatment was introduced in 95.5% during hospitalisation. In-hospital mortality rate was 24.7% and the survival rate at 2 years was 19.1%. Stroke recurrency was found in 7 (11%) in a mean delay of 3.4 months post-stroke and was associated with preexisting AF, the absence of antithrombotic medication for AF (P < 0.001). Functional outcome was poor in 55.2% at hospital release. CES due to AF affects mostly old-patients in Subsaharan Africa and are associated with high mortality and recurrency rates. Short term functional outcome is poor on 1 patient over 2.

Electrocardiographic changes during the acute phase of stroke at the neurology Unit of Befelatanana Hospital, Antananarivo, Madagascar

Electrocardiographic changes are common during the acute phase of stroke. The interpretation of these results is still difficult in practice because this has an impact on the treatment of patients who often remains discordant To determine the incidence of electrical changes and to describe the electrocardiographic aspects of patients during the acute phase of stroke. A retrospective descriptive, cross-sectional, single-centric study was conducted between July 2016 and July 2018. Only records of patients with stroke with evidence electrocardiogram (ECG) and CT scan were included in the study. We selected 226 files. The mean age was 58.66 years with a sex ratio of 1. Arterial hypertension was the main risk factor for cardiovascular disease (83.63%), followed by smoking (24.78%). Our patients had ischemic stroke in 74, 85% of cases. Patient ECGs were abnormal in 67.7% of cases. The main ECG abnormalities that we found were dominated by ST segment alteration in 23.00% of cases, incomplete left bundle block in 14, 16% of cases, and left ventricular hypertrophy in 9.73% of cases. We could not find a significant relationship between stroke type and electrocardiographic abnormalities. Repolarization disorders are not negligible during the acute phase of cerebrovascular accidents. These changes may mask underlying myocardial ischemia that will require further investigation to confirm.

Detection of duplication of PMP22 gene by fluorescent in situ hybridization (fish) in Charcot Marie tooth type 1 in public hospital of south of Chile

The genotypic diagnosis in CMT is a public health need. In our country, a genetic study is carried out in a single laboratory (INTA) with restricting of access to public patients. To determine presence of duplication of the PMP22 gene in patients with CMT1 by FISH of the Neurology Unit of the Hospital Regional de Concepcion. CMT1 it is produced by a duplication of 1.5mb on chromosome 17p11.2detectable by FISH and correlated with "classic" phenotype (onset development of symptoms in the first 2 decades, slow and progressive course, characteristic orthopedically alterations and decrease in the speed of nerve conduction of arms 16 patients are included M38% F62% with average age 38(16–63), clinically grouped i 4 CLASSIC PENOTHYPE OF CMT1, 7 other HEREDITARY NEUROPATHIES and 5 DEMYELINATING NEUROPATHIES ACQUIRED In FISH assay, presence of more than 40% nuclei with 3 signals of the PMP22 gene and 2 corresponding to the centromere of chromosome 17 was considered positive. We found 4 positive cases, 3 in CMT1 group and 1 in OTHER HEREDITARY NEUROPATHIES (case of Hereditary neuropathy with Liability to pressure palsies and none in DEMYELINATING NEUROPATHIES ACQUIRED Three counter samples (1Positive/2Negative) were analyzed in INTA using MLPA and FISH having concordance in everyone case. Technique of FISH is reliable in the detection of the duplication responsible for CMT1 and increasing the number of cases it is feasible to validate the method in our place and implement this genetic diagnosis in our public care system.

Causes and outcome of non-traumatic spinal cord diseases at the neurology unit of Befelatanana hospital, Antananarivo, Madagascar

Background Etiology confirmation of non-traumatic spinal cord diseases are still a problem in Africa and so their treatment and management of neurological disabilities. In Madagascar, only two cases of myelitis have been published until now. Objective To describe causes and outcome of spinal cord diseases to rise the etiology diagnosis challenge and improvement of our management. Methods A prospective descriptive study was conducted between November 2017 and March 2019. It included any patient with spinal cord disease semiology. Auxillary findings with biology and spinal MRI were prescribed. Outcome was evaluated by the Lipton and Taesdall scale. Results Twenty-two of 1149 patients were included. Fifteen performed spinal MRI. Seven infectious etiology: 03 schistosomiasis and 04 tuberculosis. Six non-infectious etiology: 02 myelitis, 01 vascular malformation, 02 metastatic spinal cord disease, 01 meningioma. No etiology found in 09 patients. Thirteen benefited corticosteroid bolus. Specific management for those with etiology. Functional rehabilitation for all. Disabilities outcome didn't worsen for the majority of cases that was managed at the disease starting. Only 02 patients developed a bedsore and phlebitis of the lower limbs. Conclusion In poor settings as Madagascar, diagnosis tools and drug options for spinal cord diseases are often nonavailable or nonaffordable. Results of this study rise the point of challenge with local facilities and financial features versus skills of Malagasy neurologist well trained worldwide. International collaboration with other specialities for training, care and research are useful and encouraged for nervous system disease management in poor settings.

Seizure types and electroencephalographic changes among attendees at tertiary care neurology unit in Oman with idiopathic generalized epilepsy (IGE)

Seizure types and electroencephalographic changes among attendees at tertiary care neurology unit in Oman with idiopathic generalized epilepsy (IGE)

Neural Correlates of Urinary Retention in Lateral Medullary Infarction.

PurposeThe brainstem plays an important role in the control of micturition, and brainstem strokes are known to present with micturition dysfunction. Micturition dysfunction in cases of lateral medullary infarction (LMI) is uncommon, but often manifests as urinary retention. In this study, we investigated the neuro-anatomical correlates of urinary retention in patients with LMI.MethodsThis was a hospital-based retrospective study conducted in the neurology unit of a quaternary-level teaching hospital. Inpatient records from January 2008 to May 2018 were searched using a computerized database. Cases of isolated LMI were identified and those with micturition dysfunction were reviewed. MRI brain images of all patients were viewed, and individual lesions were mapped onto the Montreal Neurological Institute (MNI) space manually using MRIcron. Nonparametric mapping toolbox software was used for voxel-based lesion-symptom analysis. The Liebermeister test was used for statistical analysis, and the resultant statistical map was displayed on the MNI template using MRIcron.ResultsDuring the study period, 31 patients with isolated LMI were identified. Their mean age was 48 years and 28 (90%) were male. Six of these patients (19%) developed micturition dysfunction. All 6 patients had urinary retention and 1 patient each had urge incontinence and overflow incontinence. In patients with LMI, the lateral tegmentum of the medulla showed a significant association with urinary retention.ConclusionsIn patients with isolated LMI, we postulate that disruption of the descending pathway from the pontine micturition centre to the sacral spinal cord at the level of the lateral tegmentum results in urinary retention.