Neurological Center Research Articles

Awareness and care practices for rare neurologic diseases among senior neurologists: A global survey.

Rare neurologic diseases (RNDs) are difficult to diagnose and treat due to their low prevalence and complex nature. This survey evaluated awareness and current care status of RNDs among esteemed neurologists affiliated with the World Federation of Neurology (WFN). A 34-question survey was distributed to renowned neurologists, including delegates from national neurology societies in the WFN Assembly, various WFN committees, and members of the Rare Neurologic Diseases Specialist group. Responses were stratified by geographical regions, including Africa, the Americas, Asia/Oceania, and Europe, and into four income groups based on the World Bank Indicator. Descriptive statistics summarized responses, stratified by geographical regions or income groups, and significant differences were assessed by Fisher's exact test. Of 190 invited neurologists, 64 responded (34% response rate). Among respondents, 89% agreed that RND patients should receive timely and effective care on par with more common neurological conditions. Additionally, 77% of respondents overall thought most RNDs could be accurately diagnosed in their country. However, there were significant differences in the perceived ability of respondents' country of practice to diagnose RNDs by region, specifically in Africa (25%), and by income of country of practice, specifically in the lower-income group (17%). This global survey highlights varying RND diagnosis and care by country socioeconomic status, suggesting potential disparities in resources and preparedness. To improve outcomes and quality-of-life for RND patients, efforts should focus on improving diagnostic capabilities, fostering collaboration among neurology centers, and promoting education on the unique challenges and treatment options of RNDs.

Genetic spectrum of neuronal ceroid lipofuscinosis & its genotype-phenotype correlation -A single centre experience of 56 cases.

Neuronal ceroid lipofuscinoses (NCLs) are progressive, autosomal recessive lysosomal storage disorders primarily affecting children, marked by seizures, cognitive decline, motor regression, and visual impairment. Limited genetic data exist for South Asian populations, with most studies relying on enzymatic assays or electron microscopy. This study explores the genetic spectrum of NCL and genotype-phenotype correlations in a cohort from South India. A retrospective analysis was conducted on 56 genetically confirmed NCL patients diagnosed between January 2018 and June 2024 at a specialized neurological center in South India. Genetic analysis using next-generation sequencing (NGS) were performed, with variants classified as per ACMG guidelines. Clinical, electroencephalographic (EEG), imaging, and electron microscopy (EM) findings were reviewed, and genotype-phenotype correlations were analyzed. The cohort (33 males, 23 females) had a median age of onset of 36 months and a median disease duration of 65.5 months. Eight genetic subtypes were identified, with predominant mutations in TPP1 (19.64%), CLN6, MFSD8, and CLN8 (16.07% each). Seizures (75%), regression of milestones (87.5%), visual impairment (33.9%), and ataxia (57.1%) were common. EEG abnormalities were found in 76.3%, MRI revealed cerebellar atrophy in 89.13%, and thalamic T2 hypo-intensity in 91.3%. EM showed curvilinear and fingerprint profiles. Of the identified variants, 31 were previously reported, while 29 were novel. This is the largest single-center NCL cohort in South Asia, highlighting a diverse genetic spectrum and significant novel variants, underscoring the importance of genetic testing for diagnosis and future therapies.

A multimodal approach to the treatment of painful diabetic neuropathy. Case report

In painful diabetic polyneuropathy (DPN), an integrated approach is effective, including kinesiotherapy, sleep hygiene, an educational program, and pharmacological agents if indicated. A case of a patient with type 1 diabetes mellitus and a painful DPN is presented. The patient received metabolic therapy for a long time, an anticonvulsant at doses that are not the safest in diabetic nephropathy. At the neurological center, the patient's dosage of analgesics was adjusted, and a complex therapy was tailored to improve comorbidities. After 3 months, during therapy, the patient reported decreased neuropathic pain in the legs, decreased hypodynamia level, partial normalization of her emotional state, and normalization of sleep quality. Risk factors for developing neuropathic pain in DPN and effective methods for its treatment as part of a multidisciplinary approach are discussed.

Myelin basic protein and TREM2 quantification in the CSF of patients with Multiple System Atrophy and other Parkinsonian conditions

BackgroundIt is well known that myelin disruption and neuroinflammation are early and distinct pathological hallmarks in multiple system atrophy (MSA) as well as in idiopathic Parkinson’s disease and in other atypical Parkinsonian syndromes. The objective of this study was to assess the value of non-neuronal biomarker candidates that reflect myelin disruption and neuroinflammation.MethodsMyelin basic protein (MBP) and the soluble form of TREM2 were quantified in a comprehensive movement disorder cohort from two different neurological centers, comprising a total of 171 CSF samples. Commercially available ELISA systems were employed for quantification.ResultsThe results of the MBP analysis revealed a significant increase in cerebrospinal fluid (CSF) MBP levels in all atypical Parkinsonian conditions compared to PD. This differentiation was more pronounced in the MSA-c subtype compared to MSA-p. Receiver operating characteristic (ROC) analysis revealed a significant discrimination between PD and MSA (p = 0.032, AUC = 0.70), PD and DLB (p = 0.006, AUC = 0.79) and PD and tauopathies (p = 0.006, AUC = 0.74). The results of the TREM2 analysis demonstrated no significant differences between the PD and atypical Parkinsonian groups if not adjusted for confounders. After adjusting for age, sex, and disease duration, the PD group exhibited significantly higher TREM2 levels compared to the DLB group (p = 0.002).ConclusionsIn conclusion, MBP, but not TREM2, is elevated in the CSF of not only MSA but in all atypical Parkinsonian conditions compared to idiopathic Parkinson’s disease. This highlights the value of the evaluation of myelin/oligodendrocyte-associated markers in neurodegenerative movement disorders.

Apomorphine for prolonged disorders of consciousness: a multimodal open-label study

Apomorphine is a dopaminergic candidate therapy to improve recovery in patients with prolonged disorders of consciousness (PDoC). Behavioural improvements were previously described in non-controlled case series, but its efficacy and neural mechanisms remain largely unknown. This open-label controlled study using multimodal outcome measures investigates the action of apomorphine in severely brain-injured patients. Thirteen PDoC patients received 30-day subcutaneous apomorphine treatment (n=6) or standard care (control group, n=7) in a neurological rehabilitation centre between February 2018 and January 2021. The apomorphine group was monitored 30 days before treatment initiation, during treatment and one year after treatment. Primary outcome measure was defined as changes in behavioural diagnosis using the Coma Recovery Scale-Revised (CRS-R). CRS-R index, recovery of new conscious behaviours, DoC-feeling scores, high-density electroencephalography, and fluorodeoxyglucose positron emission tomography were employed as secondary outcome measures. The control group was monitored with repeated CRS-R only. Registration: EudraCT 2018-003144-23; Clinicaltrials.govNCT03623828. Groups (apomorphine vs. control: odds ratio 8.9, 95% CI 3.3-17.8) and study phase (treatment vs. baseline, apomorphine group only: odds ratio 3.9, 95% CI 1.5-10.1) significantly influenced positive changes in behavioural diagnosis. At one-year post-injury, 4/6 patients in the apomorphine group and 1/7 patients in the control group had improved their diagnosis. Similarly, CRS-R index was significantly influenced by study phase (treatment vs. baseline). All items on the DoC-feeling score were rated higher after treatment than before by both family and medical staff. Patients in the apomorphine group recovered more conscious behaviours than control patients. Alpha-band whole-brain connectivity and participation coefficient, as well as alpha-band parieto-temporal connectivity and frontal participation coefficient were higher after treatment than at baseline. Whole-brain metabolism increased by a relative mean of 13.8% after treatment compared to baseline, with a significant effect of timing (pre-vs. post-treatment scans) on regional SUV. Long-lasting consciousness improvements were observed in patients treated with apomorphine, compared to controls and compared to baseline. Changes in brain connectivity and metabolism were observed after treatment, providing insights into possible neurophysiological mechanisms and target areas. This open-label study confirmed the feasibility and safety of apomorphine treatment, which may represent a key therapeutic option for PDoC. University and University Hospital of Liege, Belgian National Funds for Scientific Research, Fund Generet of the King Baudouin Foundation, AstraZeneca Foundation, Leon Fredericq Foundation and NeuroHealing Pharmaceuticals Inc.

TabCAT Brain Health Assessment: Preliminary validation in a multicultural Israeli population

AbstractBackgroundThe Israeli population, primarily comprised of Israeli Jews (74%) and Arabs (21%), is one of the most diverse aging societies around the world. The need for brief, accurate, and culturally appropriate cognitive measures in Israel is high, as they can facilitate early detection of cognitive disorders across clinical settings. We examined the discrimination accuracy and concurrent validity of the brief Tablet‐based Cognitive Assessment Tool (TabCAT) Brain Health Assessment (BHA) battery in a multicultural Israeli sample.MethodsParticipants were 79 Hebrew and Arabic speaking older adults (age: 67±6; 58% female; education: 15±4). Clinically normal participants (n = 63) were community‐dwelling individuals with no self‐ or informant‐reported cognitive symptoms or functional decline. Cognitively impaired participants (n = 16) with diagnoses of mild cognitive impairment (n = 15) or dementia (n = 1) were recruited from a large neurology center. Diagnoses were based on the published clinical criteria, and all patients underwent comprehensive neurological and neuropsychological evaluations independent of study procedures. All participants completed the TabCAT‐BHA and the Montreal Cognitive Assessment (MoCA) in their primary language. Logistic regressions with ROC curves were used to examine discrimination accuracy, controlling for age, sex, education, and testing language. Concurrent validity was evaluated against the MoCA indices for the same domains.ResultsThe TabCAT‐BHA battery showed excellent discrimination accuracy (AUC = .99, sensitivity = .81, and specificity = .95) outperforming the MoCA (AUC = .94, sensitivity = .63, specificity = 0.97). Moderate associations were observed between TabCAT Favorites (associative memory) and MoCA Memory Index (r = .49, P < .001), and between TabCAT Match (executive functions) and MoCA Executive Index (r = .64, P < .001). Weaker associations were found between TabCAT Line Orientation (visuospatial skills) and MoCA Visuospatial Index (r = ‐.27, P = .02).ConclusionsOur preliminary findings support the validity of the 10‐minute TabCAT‐BHA battery in culturally diverse Israeli older adults. The battery exhibited excellent performance in detecting cognitive impairment in our sample outperforming a widely used brief cognitive assessment tool, the MoCA. Future studies, including development of Israel‐specific normative data and replication of these results in larger samples, are ongoing.

Knowledge about Disease and Health Behaviours in Elderly Stroke Survivors as a Context of Occupational Therapy Implementations

Abstract Knowledge the risk factors and symptoms of strokes is important in the context of a quick response to first signals and secondary prevention, and health education is one of the tasks of the neurological occupational therapist. To carry out this task, the therapist needs information about patients’ health behaviours and knowledge about the disease. This study aimed to determine: 1. elderly patients’ knowledge about strokes and the channels of knowledge transmission; 2. differences between their pre- and post-stroke health behaviours; 3. differences in knowledge and health behaviours depending on the respondent’s gender, age and education. The study involved 34 patients of a neurological rehabilitation centre, aged 60–85, with a stroke diagnosis within the last six months. The data were collected during a face-to-face questionnaire interview constructed for the purpose of the study. Preventive campaigns reach risk groups to a limited extent and the level of respondents’ knowledge about stroke symptoms and risk factors was considered unsatisfactory. According to the respondents, the most effective channel of communication is television, and the most reliable sources of knowledge are doctors and other healthcare workers. Relationships were found between knowledge about strokes and age, gender, education and health behaviours before the stroke. It is necessary to educate patients about the symptoms and risk factors of strokes. Communication channels should be better profiled in terms of the capabilities of people at risk of stroke. For planned health behaviour change to be effective, patients need education, advice and support from an occupational therapist and other health professionals.

Enhancing variant of uncertain significance (VUS) interpretation in neurogenetics: collaborative experiences from a tertiary care centre

BackgroundThe findings of variants of uncertain significance (VUS) on a clinical genetic testing report pose a challenge for attending healthcare professionals (HCPs) in patient care. Here, we describe the outcomes...

Các yếu tố tiên lượng của bệnh nhân chảy máu não cấp vùng trên lều do tăng huyết áp

Objectives: Comments on the relationship of prognostic factors in patients with acute supratentorial cerebral hemorrhage due to hypertension. Subjects and method: A cross-sectional, prospective descriptive study was conducted on 150 patients diagnosed with acute supratentorial cerebral hemorrhage due to hypertension, admitted for inpatient treatment at the Neurology Center, Bach Mai Hospital from August 1, 2023 to July 31, 2024. Results: The rate of patients with good outcome after 3 months (73.3%). In terms of prognostic factors, the study showed that in the age group ≤ 60 years old, the rate of poor outcome was 18.1%, the group > 60 years old had a rate of poor outcome of 34.6%. Thus, in the age group > 60 years old, the outcome was worse, this difference was statistically significant with p<0.05. In our study, there was no statistically significant difference in outcome at day 90 between patients with a history of hypertension, diabetes, coronary artery disease, antiplatelet drugs, smoking, alcohol consumption and patients without this history. In the group without cerebral hemorrhage, the rate of patients with poor outcome was 18.8%; while in the group with cerebral hemorrhage, this rate was 36.9%, this difference was statistically significant with p<0.05. In the group with no hematoma volume < 30 ml, the rate of patients with poor outcome was 14.1%; meanwhile, in the group with hematoma volume ≥ 30 ml, this rate was 100%, this difference was statistically significant with p < 0.01. In the group with Glasgow score at admission ≥ 14 points, the rate of patients with poor outcome was 14.4%; meanwhile, in the group with Glasgow score at admission < 14 points, the rate of patients with poor outcome was 71.9%, this difference was statistically significant with p < 0.01. Conclusion: Studying 150 patients with acute supratentorial cerebral hemorrhage due to hypertension treated at the Neurology Center - Bach Mai Hospital from August 1, 2023 to July 31, 2024, we drew the following conclusions: factors leading to poor outcomes for patients with acute cerebral hemorrhage due to hypertension include age > 60, hematoma volume ≥ 30 ml, Glasgow score at admission below 14 points, and intraventricular hemorrhage.

Viêm tĩnh mạch tại vị trí lưu kim luồn tĩnh mạch ngoại biên và một số yếu tố liên quan tại Trung tâm Thần kinh, Bệnh viện Bạch Mai

Introduction: Peripheral venous catheter-related phlebitis is a common complication in healthcare facilities, causing pain, disrupting treatment, and potentially leading to severe complications.Objective: This study investigates the incidence and risk factors associated with peripheral intravenous catheter-related phlebitis. Method: A prospective cross-sectional descriptive study was conducted using a self-designed questionnaire and the Visual Infusion Phlebitis (VIP) Scale to assess the degree of phlebitis. The study included 347 inpatients treated in the Emergency and Intensive Care Unit, Neurology Center, at Bach Mai Hospital. Data were collected from medical records and clinical observation. Results: Among the studied patients, the incidence of phlebitis was 17.6%, and 4.3% of catheter insertion sites exhibited signs of inflammation. Grade 1 and 2 were the most common phlebitis (43.1% and 54.2%), with a small number of grade 3 cases (2.8%) and no cases of grade 4 or 5. Factors such as catheter insertion sites in the forearm, elbow, or ankle; underlying conditions like hypertension, cerebral hemorrhage, pneumonia; paralysis; continuous fluid infusion; and certain intravenous medications were identified as being associated with an increased risk of phlebitis. Conclusion: Phlebitis at the PVC site is a significant concern during treatment in ICU and Neurology centers. Proper catheter site selection and effective management of underlying conditions can help reduce the risk of phlebitis. These findings may assist in developing clinical guidelines to improve patient care quality.

Kết quả điều trị và một số yếu tố liên quan ở người bệnh nhược cơ sau phẫu thuật cắt tuyến ức

Objective: To evaluate the treatment outcomes and associated factors in myasthenia gravis patients after thymectomy. Subjects and Methods: The study included 66 myasthenia gravis patients who underwent thymectomy at the Neurology Center and Thoracic Surgery Department of Bach Mai Hospital from October 2019 to January 2023. Results: The rate of improvement after thymectomy was 77.3%. The long-term stable rate was 33.3%; pharmacologically stable rate was 18.4%; minimal manifestation rate was 25.8%; 10.6% of patients showed no improvement, 7.6% had worsening conditions, and 4.6% of patients died. The average time to improvement was 20.25 months, with a median of 18 months. The likelihood of improvement in patients who underwent surgery within one year of symptom onset was 5.04 times higher than those who had surgery after one year, with p<0.05. Patients without bulbar or respiratory symptoms had a higher likelihood of improvement compared to those with symptoms. Specifically, patients without dysphagia had a significant improvement (p<0.05, OR=9.80, 95%CI: 1.20–80.35), and patients without dyspnea had an OR=5.00 (95%CI: 1.31–19.07), both showing statistically significant relationships with p<0.05. Patients in clinical stages I and IIA (mild stage) had a higher likelihood of improvement compared to those in stage III (p<0.05, OR=14.67, 95%CI: 1.16–185.23; OR=12.67, 95%CI: 1.56–102.30). Patients in the mild clinical stage had a significantly higher likelihood of improvement compared to those in moderate and severe stages (p<0.05, OR=164.50, 95%CI: 152.3–708.50). Conclusion: The majority of patients showed improvement after surgery, with an average improvement time of 20.22 months. Factors associated with improvement after thymectomy included: surgery performed within one year of symptom onset, absence of bulbar and respiratory symptoms, and mild clinical stages (I, IIA).

Một số đặc điểm về tuân thủ sử dụng thuốc kháng động kinh của người bệnh động kinh tại Trung tâm Thần kinh Bệnh viện Bạch Mai

Epilepsy is a common disease, affecting about 65 million people in the world, accounting for 1% of the global burden of disease. Many aspects are affected such as: Economic, social and especially the quality of life. Some researches have shown that the quality of life of people with epilepsy is much lower than that of healthy people. Treatment of epilepsy is necessary. However, epilepsy treatment is difficult with a high rate of seizure recurrence. One of the important causes of seizure recurrence is the medication non-adherence that even making the disease more difficult to control. Objective: Describe the characteristics of medication adherence in epilepsy patients at the Bach Mai neurology center and analyze some related factors. Subjects and methods: Cross-sectional descriptive study on patients who were diagnosed and treated for outpatient epilepsy, came for follow-up examination at the neurology center of Bạch Mai hospital. Patient classification based on medication adherence characteristics and patients beliefs about drug use, through MMAS-8 scale and BMQ scale. Results: Out of 193 patients, 80.5% of them often had difficulty remembering to take medication, 11.4% felt bothered when adhering to treatment. 0% of patients achieved a high level of compliance, 27.5% at average level and 72.5% at low level). Conclusion: The majority of patients have a moderate level of knowledge about epilepsy, with most of them understanding that epilepsy can be cured, the available treatment methods, and the necessity of adhering to medication. However, they also recognize the serious issue of using stimulants. Despite this, none of the patients achieved a high level of adherence, with most showing low adherence to treatment, primarily due to occasionally forgetting to take their medication.

Một số yếu tố ảnh hưởng đến thời gian nhập viện ở bệnh nhân nhồi máu não cấp

Object: Some factors affect hospitalization time in patients with acute cerebral infarctionMethod: Cross-sectional, retrospective descriptive study including 150 patients with acute cerebral infarction treated at the Neurology Center and Stroke Center, Bach Mai Hospital from January 2023 to December 2023.Result: The average hospital admission time was 661.5 minutes (11 hours); Only 26 patients were hospitalized early before 4.5 hours, accounting for 17.3%; Factors affecting the early hospitalization time of patients are high educational level (OR: 2.362; 95% CI [1.002-5.565]), daytime onset time (OR: 3.787; 95% CI [ 0.081-0.996]), having a witness at the time of symptom onset (OR: 5.928; 95% CI [1.336-26.308]), using ambulance transportation (OR: 32.445; 95% CI [9,916-106,223]), history of stroke or TIA (OR: 5.9; 95% CI [1.73-20,121]), recognition of symptoms of stroke (OR: 256.82; 95% CI [31] ,69-2081.44]) and knowledge of fibrinolytic drugs (OR: 83.18; 95% CI [16.81-411.69]); Factors affecting the patient's late hospitalization time include: distance to the hospital >15km (OR: 0.33; 95% CI [0.117-0.931]), admission to a front-line medical facility (OR: : 0.165; 95% CI [0.054-0.507]).Conclusion: Factors affecting the patient's early hospitalization time include: high educational level, time of illness onset during the day, presence of witnesses at the time of symptom onset, use of public transport ambulance, history of stroke or TIA, recognition of stroke symptoms and knowledge of thrombolytic drugs.

Gender differences and mental distress during COVID-19: a cross-sectional study in Japan

BackgroundTo identify risk factors for mental distress and investigate whether the factors were different between men and women during the coronavirus disease 2019 (COVID-19), using KOKOROBO data, which is an online platform that aims to facilitate access to mental health services.MethodsWe used baseline data on KOKOROBO users 13 years of age or older in Japan who accessed it from October 11, 2021, to April 6, 2023, excluding those receiving treatment for mental health problems. Global severity, based on the most severe measure on Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI), was analyzed using multivariable logistic regression with baseline characteristics for each gender, and for under 30 and 30 years of age or older in women. We conducted the same analysis of suicidal ideation for each gender.ResultsIn the 686 men and 1274 women, 117 (17.1%) and 100 (7.8%) had minimal global severity respectively, and the rest suffered from mental distress to some extent. For women, ages under 30 years (adjusted OR (aOR): 0.352, 95%CI: 0.231–0.539, P < 0.001), marriage (aOR: 0.453, 95%CI: 0.274–0.746, P = 0.002), and concerns about COVID-19 infection were associated with global severity, while having children (aOR: 0.509, 95% CI: 0.284–0.909, P = 0.023) and decrease of going out during the COVID-19 pandemic had a protective effect on global severity and suicidal ideation for men, respectively. Living with family was a risk factor for mental distress in unmarried women over 30 years of age. Less communication with family or others and responding to the questionnaire late at night (00:00–05:59) were associated with severe global severity in both genders.ConclusionsAge, living arrangement, marriage, having children, concerns about COVID-19 infection, and lifestyle changes during the COVID-19 pandemic had gender-specific effects on mental distress, while frequent communication and regular life rhythm maintained mental health in both genders. Young women and, unmarried middle-aged women living with their families tended to experience mental distress during the COVID-19 pandemic.Trial registrationThe Ethics Committee of the National Center of Neurology and Psychiatry approved this study (approval number B2020141) on April 15, 2021.

Barriers and facilitators to conducting randomised controlled trials within routine care of neurorehabilitation centres: a qualitative study

BackgroundRandomised controlled trials (RCTs) are considered the gold standard for generating clinical evidence. The focus on high internal validity in RCTs challenges the external validity and generalisability of findings, potentially hindering their application in routine care. In neurorehabilitation, limited literature addresses conducting RCTs feasibly and efficiently. We investigated barriers and facilitators to conducting RCTs within routine care of neurorehabilitation centres from the perspective of stakeholders in neurorehabilitation in Germany and Austria.MethodsWe conducted semi-structured interviews with stakeholders in neurorehabilitation from four centres in Germany and Austria, informed by the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation and Behaviour model (COM-B). Employing a hybrid approach, the interview analysis integrated both deductive, theory-driven analysis based on the TDF domains and COM-B model and inductive, reflexive thematic analysis.ResultsTwelve stakeholders (4 physicians, 4 therapy managers, 4 therapists; 5 females, 7 males; with research experience spanning 0–40 years) were interviewed. Key barriers to conducting RCTs in neurological rehabilitation centres include limited financial, human, and time resources, high clinical workloads, and a lack of interest of some therapists. Ineffective leadership, perceived lack of research expertise, and communication issues were also significant barriers. Social influence factors such as lack of employer support and inadequate training access further contributed to the challenges. Additionally, barriers included insufficient research infrastructure, limited space, internal power struggles, and rigid cost bearer specifications. Key facilitators included physicians’ and therapists’ motivation to advance the field, contribute to knowledge, and to prioritise patient health. Support from supervisors, joint decision-making, and efficient organisation were crucial facilitators. Flexible therapy planning, mutual support, and interdisciplinary collaboration also played important roles.ConclusionOur results suggest that increasing professional development and understanding, along with providing adequate financial, human, time, and spatial resources to support research endeavours, implementing effective communication strategies to enhance interdisciplinary collaboration and coordination among team members may contribute to increased motivation and facilitate RCTs within the setting of neurorehabilitation centres.Trial registrationThis study was prospectively registered with the German Clinical Trials Register (08.04.2021 DRKSID DRKS00024982).

Perceptions of Lactation Experience Among Neurology Faculty and Impact of Lactation Time on Academic Achievement at U.S. Academic Medical Centers.

Objective: To investigate the perceptions of lactation experiences of neurology faculty and the impact of lactation time on academic achievement. Materials and Methods: This was a cross-sectional study utilizing a survey administered across 19 academic neurology centers in the United States. Respondents self-identified as having children and answered questions about lactation at work. Demographic information; academic achievement including publications, guest speakerships, awards, leadership roles, and funding; and perception of lactation experience were analyzed. Results: Among 162 respondents, 83% took lactation time at work. Thirty-seven percent reported lack of employer support for lactation, 46% were dissatisfied with their lactation experience, 59% did not receive compensation for lactation time, 62% did not have blocked clinical time, 73% reported relative value units were not adjusted to accommodate lactation, and 43% reported lack of access to private lactation space. Women spent on average 9.5 months lactating per child and desired 2.4 further months of lactation. There was no difference in all measures of self-reported academic achievement between women who did and did not take lactation time when measured across all career stages. Conclusions: Although a majority of respondents took lactation time at work, perceptions of employer support for lactation were low, and expectations for work productivity were not adjusted to accommodate lactation time. Taking lactation time at work did not decrease self-reported academic achievement. System-level best practices designed to support lactating faculty should be developed to guide academic institutions.

Social Frustration Level Questionnaire: Substantiation, Design, and Probation

The current preventive trends in clinical examination draw attention to the role of the external factors and stressful circumstances in psychodiagnostic research. Social frustration is an incapacity to fulfill relevant social needs because of a current situation. This term makes it possible to qualify criteria for the potential stress related to social functioning among family members, colleagues, and peers. The authors rationalized and tested a formalized questionnaire of Social Frustration Level developed at Bekhterev National Medical Research Centre for Psychiatry and Neurology in 2004 for patients with social adjustment disorders. The experiment justified the criterion validity of the Social Frustration Level Questionnaire. The article describes the structure of social frustration regarding the key spheres of activity attributed to internal and external frustration. The pilot study involved 45 patients with adjustment disorders, who showed significant frustration related to health problems and socio-economic status accompanied with relative satisfaction with interpersonal relations, i.e., family, friends, colleagues, and strangers. The research relied on the method of clinical psychological interview, as well as the Questionnaire of Social Frustration Level and the Integrative Anxiety Test. Personal anxiety and actual anxiety experiences proved to correlate with social frustration. The internal social frustration prevailed over the external one. The Questionnaire of Social Frustration Level proved to be an efficient practical tool to be used in systematic medical psychodiagnostics research, programs of disorder prevention, and psychotherapy.

Apraxia phenotypes and frontotemporal lobar degeneration

BackgroundApraxia has been identified in all clinical forms of frontotemporal lobar degeneration (FTLD). The characteristics of apraxia symptoms and their underlying cognitive/motor basis are not fully understood. This study investigated apraxia in pathological subtypes of FTLD.MethodsThe study constituted a retrospective review of 115 pathologically confirmed cases of FTLD from a single cognitive neurology centre. Patients in whom apraxia had been documented as a notable clinical characteristic were identified. Apraxia features, demographic, cognitive, neurological, and imaging findings were recorded.ResultsEighteen patients were identified: 12 with FTLD-tau pathology (7 corticobasal degeneration (CBD), four Pick type and one progressive supranuclear palsy (PSP)) and six with FTLD-TDP pathology, all type A and four linked to progranulin gene mutations. Apraxia as a dominant presenting feature was typically associated with tau pathologies, whereas it emerged in the context of aphasia in TDP pathology. Apraxia typically predominated in one body part (face or limb) in tau but not TDP pathology. Relatively preserved activities in daily life were associated with TDP. Apraxia of speech was associated with tau pathology. Pick-type pathology was linked to symmetrical atrophy and late development of limb rigidity.ConclusionApraxia in FTLD subtypes has variable characteristics. Apraxia associated with CBD pathology conformed to criteria for probable corticobasal syndrome (CBS), whereas apraxia with Pick-type pathology did not. Apraxia in patients with TDP-A pathology was interpreted as one manifestation of their generalised communication disorder. Apraxia in FTLD may have distinct cognitive and motor substrates that require prospective investigation.

Effect of Covid-19 on the Pattern of the Patients Referring to the Emergency Department of Shahid Sadoughi Hospital in Yazd in 2019-2021

Background: Covid-19 was first declared to be a pandemic in 2020. Once it occurred, hospitals as well as emergencies were encountered scores of challenges, including a large number of patients with a new contagious viral disease on the one hand, and the importance of continuing to provide adequate and complete services to non-covid patients who daily referred to the emergencies, on the other. Moreover, as a result of the emerging crisis, the pattern and rate of visits to the emergency department by non-covid patients underwent several alterations. Therefore, the current study was designed to evaluate the effect of covid-19 on the referral pattern of non-covid patients to the emergency department of Shahid Sadoughi Hospital in Yazd. Methods: This is an analytical cross-sectional investigation through which all the patients referred to the emergency department of Shahid Sadoughi Hospital in Yazd in April, August and November of 2018 and 2019 (before and after the outbreak of Covid-19) were examined. The variables of the study included age, gender, reason for the patient's visit, hospital service, type of discharge from the emergency room, status and time of the visit. The collected data were then entered into SPSS26 and analyzed using Chi-square and T-test. Results: The study included 11,587 patients aged 1 to 101 years, 58.4% men and 41.6% women. The number of emergency ward visits decreased significantly following the outbreak of the covid-19 disease. A statistically significant difference was identified between the frequency distribution of all the investigated variables at the desired times (P-value=0.002 for gender and P-value=0.0001 for other variables). Therefore, the number of the male patients within the age range of 20 to 65 years in infectious and pulmonary wards increased, but hospitalization in the orthopedics and internal neurology centers and referrals due to headache, abdominal pain, and nervous tension faced the greatest decrease. Among the types of discharge, hospitalization in and transfer to the ward lowered the most. Conclusion: Predicated on the current study, the emergence of covid-19 has triggered a significant reduction in the number of patients visiting the emergencies; the findings of this study can thus assist senior managers how to make policies as new epidemics arise in order to treat the patients and decrease mortality.

Analysis of the Recovery Process and Activities of Daily Living Independence in Pusher Behavior and Unilateral Spatial Neglect

ObjectiveTo investigate the recovery processes of pusher behavior (PB) and unilateral spatial neglect (USN) based on the severity of PB and USN, and to determine the relationship between activities of daily living (ADL) independence levels. DesignThis retrospective study aimed to examine the temporal changes and their association with ADL independence levels based on the severity of PB and USN. SettingRecovery ward of Moriyama Neurological Center Hospital between March 2017 and October 2022. ParticipantsWe included all patients with cerebrovascular disease admitted to the recovery ward of Moriyama Neurological Center Hospital between March 2017 and October 2022. A total of 174 patients with PB and USN were classified into 4 groups as follows: severe PB and severe USN (Group A), severe PB and mild USN (Group B), mild PB and severe USN (Group C), and mild PB and mild USN (Group D). InterventionsNot applicable. Main Outcome MeasuresKaplan-Meier survival analysis was used to determine whether the time to recovery from PB or USN (SCP: ≤1.75 points; Catherine Bergego Scale: 0 points) differed between groups. In addition, group differences in functional independence measure (FIM) scores and efficiencies were examined. ResultsThere were significant differences among Groups A and B, and Groups A and C, as determined by the log-rank test (P<.05), and recovery was prolonged when both PB and USN were severely impaired. Similarly, FIM scores and efficiencies were lower in Group A (P<.05). When PB and USN were severely impaired, ADL was adversely affected, and the recovery process was prolonged. In addition, when 1 of the 2 symptoms was severe and the other was mild, each recovery course tended to show improvement, suggesting that they exerted a mutual influence on each other. ConclusionsThese findings indicate that severity classification may help to determine functional prognosis in patients with PB and USN.