Neurological Unit Research Articles

Impact of COVID-19 on the mental health in a cohort of Italian rehabilitation healthcare workers.

The COVID‐19 pandemic has had a strong impact on healthcare workers (HCWs), affecting their physical and mental health. In Italy, HCWs have been among the first exposed to unprecedented pressure, dealing with large numbers of infections during the first pandemic wave. However, the severe psychological consequences on HCWs find little evidence in the literature, especially in terms of comparison to the status quo ante pandemic. The aim of this study was to provide an assessment of the mental health burden in a cohort of Italian HCWs during the COVID‐19 pandemic, comparing their condition with that before the emergency, to direct the promotion of mental well‐being among HCWs worldwide. In this retrospective study, we included physicians, physical therapists, and nurses working in the Respiratory Intensive Care Unit, Neurology Unit, and Rehabilitation Unit from a Southern Italy University Hospital. All study participants underwent a battery of psychological tests, aimed at verifying their state of mental health during the COVID‐19 emergency and before it. Depressive, anxiety, and burnout symptoms were assessed using the following questionnaires: Maslach Burnout Inventory, Patient Health Questionnaire‐9 (PHQ‐9), and General Anxiety Disorder‐7. Depressive, anxiety, and burnout clinical relevance symptoms were present in HCWs during the COVID‐19 pandemic more than those before the emergency. Fifty percent of the HCWs obtained a score clinically significant during the emergency. Moreover, a depersonalization factor showed a statistically significant increase in average scores (p < 0.0001). The PHQ‐9 scale showed that 47.1% of the operators reported depressive state presence. The number of operators scoring above the cut‐off for the anxiety scale tripled during the emergency (p < 0.0001). The female gender conferred greater risks for depression. Taken together, the findings of this study showed that our sample of Italian HCWs showed a greater risk for depression, anxiety, and stress during the COVID‐19 pandemic. These data might be a starting point to plan mental health monitoring and prevention programs for HCWs, thus ensuring patients receive the best possible care performances even during healthcare crises such as the current pandemic.

Effectiveness of Training Program Regarding Gullian Baree Syndrome Maneuver on Pediatric Nurses’ Knowledge and Practices

Background: Guillain-Barre syndrome is an acquired inflammatory polyneuropathy characterized byrapidly progressive symmetrical flaccid limb weakness and a reflexia.Design. A quasi-experimental design was used to guide this study. The study included a sample of 30 nurseswho work at pediatric intensive care and neurology unit in Assuit University Children Hospital.Data were collected using a questionnaire and an observation checklist, used in pre-post testing to measurethe effectiveness of the training program among nurses.Results: The study revealed deficiency in pre-intervention nurses’ knowledge and practices. Statisticallysignificant improvements on knowledge and practices were demonstrated at the post-intervention time forthe studied nurses. Statistically significant relations were shown between knowledge and practices amongstudied nurses.Conclusion: Implementation of the training program significantly improved nurses’ knowledge and practice.More experienced and aged nurses had better knowledge.

Occupational Therapist Treatment of Patients in the Neurological Critical Care Unit: Utilization and Patient Characteristics.

Occupational therapy use in the neurological critical care unit (NCCU) may relate to patient factors, but data about these relationships remain unpublished. To examine how patient factors predict NCCU occupational therapy use and intervention types. Retrospective cohort study of electronic health records data from adults admitted to the NCCU between May 2013 and September 2015. NCCU in a large, urban academic hospital. Adults (age ≥18 yr; N = 1,134) admitted to the NCCU. Using length of stay (LOS), number of comorbidities, Glasgow Coma Scale (GCS) score, gender, age, and racial-ethnic minority status as independent variables, separate regression models identified predictors for each dependent variable: receipt of NCCU occupational therapy, occupational therapy onset (days after admission), and receipt of self-care or home management (ADL-Home); functional activities or cognitive training (Func-Cog); and therapeutic exercise (Ther-Ex). Four hundred twenty patients (37.0%) received occupational therapy in the NCCU. Receipt of occupational therapy was positively associated with LOS, number of comorbidities, GCS score, and age. Earlier occupational therapy onset was associated with higher GCS score and shorter LOS. Receipt of ADL-Home or Func-Cog interventions was significantly predicted by number of occupational therapy sessions, but patients with longer LOS were less likely to receive ADL-Home interventions. Receipt of Ther-Ex interventions became less likely as GCS score increased. Patients are more likely to receive occupational therapy services if they are older and have a longer NCCU LOS, more comorbidities, and a higher level of consciousness. What This Article Adds: A patient's level of consciousness is clearly associated with occupational therapy utilization and hospital outcomes, but it should not be the only factor considered when prioritizing patients for NCCU occupational therapy services. Compared with patients who were more awake and alert, patients with a lower level of consciousness had a later onset of occupational therapy, which suggests an opportunity for NCCU occupational therapists to collaborate with physicians in the modification of sedation protocols to enable early rehabilitation.

Seroprevalence of Cysticercosis among Epileptic Patients Attending Neurological Units in the Urban Area of Abidjan

Cysticercosis is one of the main causes of secondary epilepsy in sub-Saharan Africa. To estimate the seroprevalence of cysticercosis among epileptic patients, we conducted a cross-sectional study of patients attending neurology consultation in Abidjan, Côte d’Ivoire. Methods: Patients’ socio-demographic and lifestyle data were collected as well as blood samples for serological testing using ELISA and Western blot based on IgG antibodies detection. For qualitative variables comparison, Chi2 or Fisher tests were used; a Student’s t-test was used to compare quantitative variables. A multivariate logistic regression model was fit to identify risks factors. Results: Among 403 epileptic patients included in the study, 55.3% were male; the median age was 16.9 years; 77% lived in Abidjan; 26.5% were workers. Most patients included in the study had tonic-clonic seizures (80%), and 11.2% had focal deficit signs. The seroprevalence of cysticercosis was 6.0%. The risk was higher in patients over 30 years old (aOR = 5.1 (1.3–20.0)) than in patients under 16. The risk was also considerably high in patients who reported epileptics in the family (aOR = 5 (1.7–14.6)). The risk was three-fold less in females than in males. Conclusions: This study highlighted the exposure of epileptic patients to Taenia solium larvae in an urban area. The risk of positive serology was increased with age, male gender, and family history of epilepsy.

Migraine and premenstrual syndrome: comorbid disorders?

IntroductionHeadache is a common symptom among women, including during the menstrual cycle. The migraine frequency in women who present migraine associated with the menstrual period ranges from 50% to 70%. Premenstrual syndrome (PMS) is prevalent among women, affecting 80% to 90% of them throughout their lives.ObjectiveThe objectives of this study were to verify PMS prevalence and its characteristics among women who present with cephalalgia in the neurology ambulatory care unit and show the prevalence of headache and its association with PMS in the gynecology ambulatory care unit.MethodsIt is a descriptive and qualitative study which was carried out at Emilio Carlos Teaching Hospital in the neurology and gynecology ambulatory care units with women aged 18 to 52 years old. Eighty-seven questionnaires were distributed and self-applied throughout the year of 2018 for data collection. Each questionnaire consisted of 27 questions about the life cycle of the women and their headache episodes. The diagnostic criteria for headache and migraine from the International Headache Society were used. Criteria for PMS were met according to the quality of life questionnaire.ResultsIn gynecology unit group, 9% of the women did not present headache, 76% had PMS and 94% presented with headache during PMS. In neurology, 79% of the women had PMS and 79% of the women who presented with cephalalgia also had PMS.ConclusionThere is a large percentage of PMS in both groups, i.e. neurological unit and gynecological unit, showing it is not a spurious correlation.

Patient experience and self-perceived biopsychosocial burden of people living with multiple sclerosis: An epidemiological survey (BPS-MuScle study) in Spain

BackgroundUpdated information on the self-perceived biopsychosocial burden and the healthcare experience among people living with multiple sclerosis in Spain is scarce.We aim to describe the self-reported disease experience of patients diagnosed with MS in Spain and to estimate their biopsychosocial burden. MethodsMulticentre epidemiological study based on a cross-sectional nationwide survey completed by a geographically stratified sample of MS patients in Spain. ResultsA total of 490 surveys completed at 61 neurology units across Spain were analysed. Mean age was 43.7 ± 10.0 years (range:21–72), 71.4% were women. Most patients identified themselves as having relapsing-remitting MS (77.1%), 81.9% retained independent mobility. Most patients considered their health condition to be good (39.4%) or very good (13.1%). Mean EuroQoL questionnaire score was 69.2 ± 21.5. Most patients expressed high level of satisfaction with access to and quality of health care. However, 53.7% considered that sadness or depression interfered with their daily life. Concerns about social support were also mentioned. ConclusionMost people living with MS in Spain consider that their health condition is at least good but more psychological support and social protection measures are needed. Insights obtained from this study may help to better manage the condition in the future.

Editorial introductions.

Current Opinion in Neurology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of neurology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Massimo FilippiMassimo FilippiMassimo Filippi is currently Full Professor of Neurology at Vita-Salute San Raffaele University, Milan, Italy; Director of the Residency School in Neurology, and President of the Bacherlor's Degree in Physiotherapy at the same University. He is also Chair of the Neurology and Neurorehabilitation Units, Director of the MS Center, Director of the Neurophysiology Service, and Director of the Neuroimaging Research Unit at the IRCCS Scientific Institute San Raffaele, Milan. His research activity has always focused on the definition of the mechanisms leading to progressive accumulation of irreversible physical disability and cognitive impairment in various neurological conditions. He is member of various national and international Scientific Societies and Boards where he covered or is covering institutional roles. He is author of over 1200 papers, Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, and member of the Editorial Boards of many international scientific journals. He is very often requested as speaker and/or chairman in national and international neurological congresses. In 2001, Prof. Filippi was awarded the Rita Levi Montalcini Prize for his outstanding contributions to the study of MS. Per SvenningssonPer SvenningssonPer Svenningsson is Professor in Neurology at the Karolinska Institutet, Sweden. He received his MD and PhD from Karolinska Institutet in 1998. He then did his postdoctoral training in the laboratory of the Nobel laureate Paul Greengard at the Rockefeller University, USA, between 1999 and 2003. His studies concerned GPCR neuropharmacology and signal transduction and included the discovery of p11 as an important modulator of serotonin neurotransmission. He performed his residency in Neurology at Karolinska University Hospital and became Professor in 2012 and senior consultant in 2016. Since 2018, he is also part time Professor of Neurodegeneration at King's College London, UK. His research interests include GPCR pharmacology, Parkinson's disease both its motor and non-motor aspects and atypical parkinsonism. Studies are conducted both in preclinical models and in specimens from patients. The goal is to identify novel targets for improved diagnostics and pharmacological receptor-based treatments. Biochemical, histological, pharmacological, molecular biological and behavioral techniques are used. In the clinics, he is conducting clinical trials with therapies aiming to slow down progression of Parkinson's disease or to treat debilitating symptoms of the disease. He has published more than 300 articles. Since 2014, he is member of the Nobel Assembly annually awarding the Nobel Prize in Physiology or Medicine. He delivered the Eurolife Distinguished Medal Lecture in Barcelona in 2017 and was awarded the Arvid Carlsson Prize in 2020.

Very early and early neurophysiological abnormalities in Guillain-Barré syndrome: A 4-year retrospective study.

Background and purposeIn its initial stages, Guillain–Barré syndrome (GBS) is difficult to identify, because diagnostic criteria may not always be fulfilled. With this retrospective study, we wanted to identify the most common electrophysiological abnormalities seen on neurophysiological examination of GBS patients and its variants in the early phases.MethodsWe reviewed the clinical records of patients admitted to our Neurology Unit with a confirmed diagnosis of GBS. The study sample was divided in two subgroups according to whether the neurophysiological examination was performed: within 7 days (very early group) or within 7–15 days (early group). H reflex, F waves, and motor and sensory conduction parameters were judged abnormal if they were outside the normal range for at least two nerves. We evaluated neurophysiological findings in Miller–Fisher syndrome (MFS) separately.ResultsThe study sample comprised 36 patients. In GBS, the most frequent abnormal neurophysiological parameter was the bilateral absence of the H reflex, followed by F wave abnormalities. Motor conduction parameters were altered in less than 50% of patients, and even less common were sensory nerve action potential reduction and the "sural‐sparing" pattern. In MFS, H reflex was absent bilaterally in 100% of patients, followed by a predominant peripheral sensory involvement, whereas motor conduction parameters were frequently normal.ConclusionsBilateral absence of the H reflex is the most sensitive parameter in early diagnosis of GBS and its variants.

Abnormal sweating and “skin flushing” as possible predictive factor for treatment related fluctuations in Guillain-Barré syndrome: a case series and a review of the literature

Treatment related fluctuations (TRFs) in Guillain-Barré Syndrome (GBS) are described as one or more episodes of deterioration manifesting within two months after disease onset and following an initial improvement or stabilisation after treatment. They may be encountered in 8% to 16% of patients, but currently predictive factors of TRF occurrence and severity are poorly known. To this end, we evaluated the frequency and clinical features of TRFs in a cohort of GBS patients admitted to the Neurological unit of Sant'Andrea Hospital (La Spezia, Italy) from January 1st, 2003 to December 31st, 2017.Among the 98 GBS collected patients, five (5.1%) developed a TRF during disease course. Consistently with the literature, the majority of our GBS patients who developed a TRF did not report a preceding diarrhoea, had a predominant proximal weakness and all of them had sensory disturbances at the clinical onset. Interestingly, 80% of our TRF patients manifested since GBS onset an autonomic dysfunction with abnormal sweating and a peculiar ‘skin flushing’ in face, neck and chest. Two patients developed respiratory insufficiency at the TRF time, and they both died.We would advise to pay attention to GBS patients with particular ‘skin flushing’ in face, neck and chest and abnormal sweating, because these findings could be a red flag for TRF.

Renal Involvement in Hereditary Transthyretin Amyloidosis: An Italian Single-Centre Experience.

Objective: Hereditary transthyretin amyloidosis (ATTRv) represents a diagnostic challenge considering the great variability of clinical presentation and multiorgan involvement. In the present study, we report the prevalence of kidney involvement and kidney function over time in a cohort of ATTRv patients with different transthyretin gene mutations. Patients and Methods: For this study, we systematically collected data from all patients with a diagnosis of ATTRv followed at the Neurology Unit of Fondazione Policlinico Universitario A. Gemelli IRCCS. Kidney involvement was defined as presence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 obtained with CKD-EPI equation, abnormal urinary protein excretion (UPE) (>150 mg/24 h) and/or albuminuria > 30 mg/24 h (or mg/g creatinine). The analysis included data from 46 patients with 122 measurements of serum creatinine. Results: Among the 46 patients included in the analysis, kidney involvement was present in 37%, with 15% showing reduced eGFR and 22% abnormal UPE (63% of patients with available UPE data). No single predictor was associated with either eGFR values or its slope over time. Conclusions: Kidney involvement is quite common in patients with ATTRv regardless of the underlying genetic variant. In particular, abnormal UPE appears to be a common feature of the disease.

Characterization of a Temporal Profile of Biomarkers as an Index for Ischemic Stroke Onset Definition.

Background and purpose: Stroke is a dynamic process in terms of molecular mechanisms, with prominent glutamate-mediated excitotoxicity at the onset of symptoms followed by IL-6-mediated inflammation. Our aim was to study a serum glutamate/IL-6 ratio as an index for stroke onset definition. Methods: A total of 4408 ischemic stroke patients were recruited and then subdivided into four quartiles according to latency time in minutes (0–121, 121–185, 185–277 and >277). Latency time is defined as the time between stroke onset and treatment at the neurological unit. The primary endpoint of the study was the association of early latency times with different clinical aspects and serum markers. Serum glutamate and interleukin-6 (IL-6) levels at admission were selected as the main markers for excitotoxicity and inflammation, respectively. Results: Glutamate serum levels were significantly higher in the earlier latency time compared with the higher latency times (p < 0.0001). IL-6 levels were lower in early latency times (p < 0.0001). Patients with a glutamate/IL-6 index on admission of >5 were associated with a latency time of <121 min from the onset of symptoms with a sensitivity of 88% and a specificity of 80%. Conclusions: The glutamate/IL-6 index allows the development of a ratio for an easy, non-invasive early identification of the onset of ischemic stroke symptoms, thus offering a new tool for selecting early stroke patient candidates for reperfusion therapies.

P-PN029. Clinical and electrophysiological profile of patients with Guillain-Barré Syndrome with conduction blocks

Introduction . Clinical data is limited in patients with Guillain Barre syndrome (GBS) who show conduction block (CB) on nerve conduction study (NCS). We aim to describe the clinical and electrophysiological profiles of GBS with CB. Methods . Between 2017 and 2020, 111 patients fulfilling the National Institute of Neurological Disorders and Stroke (NINDS) criteria for GBS and Brighton level of certainty one or two were seen in a single neurology unit. NCS of three motor (median, ulnar and common peroneal (CP)) and three sensory (median, ulnar and sural) nerves were performed. Definite and probable CBs were defined as proximal/distal latency of 20% of lower limit of normal (LLN). Results . Mean interval from symptom-onset to NCS was 9.4±6.5 days. Twenty patients had CB (one nerve: 15, two nerves: 4, three nerves: 1). This included probable CB in median (n=3), ulnar (n=2) and CP (n=4) nerves, and definite CB in median (n=5), ulnar (n=6) and CP (n=6) nerves. Electrophysiological subtypes included demyelinating (n=11), axonal (n=4) and equivocal (n=5). Demographic and clinical features included M:F of 3:1, mean age of 38.5±19.9 years, facial weakness (n=8), ophthalmoparesis (n=1), respiratory muscle weakness (n=2) and antecedent infection (n=12). At the time of peak neurological deficits, the mean Medical Research Council (MRC) sum score was 35.4±14.9 and Hughes disability score (HDS) was 3.5±0.8. The mean duration of hospital stay was 14.7±15.9 days. At the time of discharge, the mean MRC sum score was 39.8±15.2 and mean HDS was 3.1±0.7. Conclusion . We report CBs across non-entrapment sites in both demyelinating and axonal sub-types of GBS. Interruption of saltatory conduction due to distortion of paranodal myelin leads to reversible conduction failure and rapid recovery as noted in the present study.

P-NJ005. Clinical profile and outcome of childhood-onset Myasthenia gravis

Introduction . Myasthenia gravis (MG) is an autoimmune disease with peak incidence in fourth decade. Childhood-onset MG is uncommon. We aim to describe the clinical profile and outcome of childhood-onset MG. Methods . Retrospective chart review of 27 patients (M:F 13:14) with childhood-onset MG seen in a single neurology unit between 2000 and 2019. Diagnosis was established by decremental response in repetitive nerve stimulation, response to neostigmine, and/or antibody positivity. Congenital Myasthenic syndromes were excluded. Results . Demographic and clinical features included: mean onset-age of 12.81±4.63 years, mean symptom-duration of 23.63±36.49 months, ptosis (100%), ophthalmoplegia (63%), facial weakness (55.55%), chewing difficulty (40.74%), dysphagia (48.14%), dysarthria (14.81%), neck weakness (25.92%), shoulder-girdle weakness (44.44%), pelvic-girdle weakness (48.14%), and respiratory weakness (14.81%). Myasthenia Gravis Foundation of America (MGFA) grade at first evaluation was I (n = 11), IIa (n = 7), IIb (n = 2), IIIa (n = 4), IIIb (n = 2), and IVb (n = 1). Two patients developed myasthenic crisis during course of illness. Associated illnesses included seizure disorder (n = 2), diabetes (n = 1), hypothyroidism (n = 1), and psychiatric illnesses (n = 4). Acetylcholine receptor antibody was positive in 12 patients while MuSK was positive in one patient. Chest computed tomography (CT) showed thymic hyperplasia in 12 patients and was normal in 6 patients. Thymectomy was performed in 9 patients (hyperplasia in 7, normal histology in 2). Time from MG onset to initiation of pyridostigmine was 13.80 ± 27.83 months and mean maximum dose of pyridostigmine was 172.22 ± 127.50 mg/day. Immunosuppressants administered in 22 patients included intravenous immunoglobulin (n = 3), plasma exchange (n = 5), steroids (n = 22), azathioprine (n = 4), mycophenolate (n = 2), methotrexate (n = 3), cyclophosphamide (n = 2), and rituximab (n = 1). Of 20 patients with follow- up details, remission was achieved in 17, of which 12 could stop pyridostigmine. Conclusion . In our cohort, majority had mild-moderate MG and myasthenic crises were uncommon. Treatment response was good. Remission was achieved in majority and in many of them, pyridostigmine was discontinued.

P-NJ006. Rituximab in myasthenia gravis: Experience from a low – and middle – income country

Introduction . Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction with 10% being refractory to conventional immunosuppressants. Rituximab is a potential therapeutic option for these patients. We aim to describe the response to rituximab and safety profile in MG. Methods . Retrospective chart review of 12 patients (M:F = 5:7, mean age: 41.08 ± 10.96 years) with MG treated with rituximab and followed up in a single neurology unit at the National Institute of Mental Health and Neurosciences, Bangalore, between 2017 and 2020. Results . Mean duration of MG was 105.16 ± 71.8 months (range 6–260 months). Pre-rituximab treatment included steroids, azathioprine, methotrexate, mycophenolate, cyclophosphamide, and thymectomy. Pre-rituximab MGFA grading included: IIa (n = 1), IIb (n = 1), IIIa (n = 2), IIIb (n = 5), IVb (n = 1), and V (n = 2). Reasons for initiation of rituximab included poor response to steroids (n=10), comorbid illnesses limiting the use of other drugs (n = 4), and drug-induced side effects (n = 2). The mean duration of follow-up was 20.33 ± 13.64 months (range 3-37 months). Two patients developed myasthenic crisis after the induction phase of rituximab and one patient died. Another patient died after 25 months of rituximab therapy due to an unrelated cause. The rest improved, pyridostigmine dose was reduced in four and was stopped in six patients. Other immunosuppressants were continued in all but one patient. Complete stable remission and pharmacological remission were achieved in one and four patients respectively while five patients had minimal manifestations. No infusion-related adverse events were noted. One patient developed transient asymptomatic neutropenia three weeks after rituximab infusion. Conclusion . Rituximab appears to be a safe and effective therapeutic option for patients with refractory MG. however, a proportion does develop worsening similar to steroid-induced exacerbation. Most of the patients in our cohort had a good response with infrequent side effects.

Effect of acupuncture combined with rehabilitation on cognitive and motor functions in poststroke patients.

The aim of the study was to explore the effect of acupuncture combined with rehabilitation on cognitive and motor functions in poststroke patients. All patients were divided into Group A and Group B based on different interventions (Group A: acupuncture + conventional rehabilitation, Group B: conventional rehabilitation alone). Acupuncture was conducted once a day, five times a week for 8 weeks, and rehabilitation (including physical therapy and occupational therapy) was conducted for 2 hr per session, once a day, five times a week for 8 weeks. Mini-mental State Examination (MMSE) and Fugl-Meyer Assessment (FMA) were used to assess the motor and cognitive functions at baseline and the end of 8 weeks. After the intervention, FMA and MMSE scores were improved significantly in the two groups (p <.05), compared with the scores prior to intervention. After 8 weeks of intervention, a statistically significant difference in the FMA and MMSE scores was observed between the Group A and the Group B. The results suggested that the combined intervention is more effective than the conventional rehabilitation alone in improving cognitive and motor functions in poststroke patients.

CLINICAL SPECTRUM AND OUTCOME OF PATIENTS WITH TUBERCULOUS MENINGITIS AT A TERTIARY CARE HOSPITAL OF PAKISTAN

Objective: To assess the clinical profile and outcome of patients admitted with the diagnosis of tuberculous meningitis (TBM) at neurology unit of a tertiary care teaching hospital of Pakistan.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Neurology department, Pak Emirates Military Hospital Rawalpindi, from Dec 2018 to Jun 2019.&#x0D; Methodology: This study was conducted on 69 patients of tuberculous meningitis admitted. Demographic profile included age, gender, and the symptoms with which the patient presented. Neurological complications were also documented among the target population. Outcomes included recovery, shifting to intensive care unit and death.&#x0D; Results: A total of 69 patients admitted in neurology ward diagnosed and managed as tuberculous meningitis in the study duration time. Male to female ratio was 1.4:1. Mean age of patients diagnosed with tuberculous meningitis in our study was 34.23 ± 3.915 years. Most of the patients presented with the fever followed by headache. Out of 69 patients, 41 (59.4%) recovered, 22 (31.9%) were shifted to the intensive care unit and 6 (8.7%) died. Seizures were the commonest neurological complication faced by the patients followed by cranial nerve palsies.&#x0D; Conclusion: Fever and headache were common symptoms with which patients of tuberculous meningitis presented in our study population. Most of the patients recovered in the ward but a high percentage required intensive care unit admission as well. Seizures and cranial nerve palsies were commonly experienced complication by patients included in our study.

Exploring omissions in nursing care using retrospective chart review: An observational study

BackgroundOmissions in nursing care can compromise patient safety. To date, this phenomenon has been investigated almost exclusively via nurse surveys. However, such surveys restrict the range of activities which can be assessed for omissions, and patient level analysis. As an alternative, retrospective chart review methodology has been used successfully in other research fields, but not yet for omitted nursing care. ObjectivesTo describe characteristics and frequency of omitted nursing care using a retrospective chart review methodology. Design, setting and participantsObservational single center study in two German neurological inpatient units. A random sample of 100 patient admissions was used. MethodsA structured chart review protocol to detect nursing omissions was developed and applied. The full range of expected nursing care activities were assessed regarding the importance of documenting them and whether they had been fully or partially omitted. Vital sign measurements were assessed regarding both the measurement target number and the number of measurements recorded. ResultsIn total, 1885 activities—a mean of 19 per patient—were identified. Of the reviewed activities, 52% (n = 971) were fully or partially omitted. Patients experienced between one and 22 omitted nursing care activities during their hospital stay (8–84% of expected care activities). Ranging from 6% to 100% some activities were more commonly omitted than others during admission. The most frequently omitted nursing activity was giving emotional care (88%, n = 66); the least frequently omitted was teaching (10%, n = 29). Vital signs were recorded only 50% (n = 141) of the targeted number of times. ConclusionsUsing a retrospective chart review protocol to identify omissions in nursing care allows the assessment of a broad range of nursing activities. Additionally, this is the first-time patient-level data on a broad range of activities have been analyzed. The newly developed chart review methodology can complement established survey methods and provide a new perspective on the phenomenon of omitted nursing care.

Lumbar Disc Herniation: Comparing Pain Relief After Medical and Surgical Intervention.

IntroductionThe most common degenerative abnormality of the lumbar spine is lumbar disc herniation. There are two options of treatment, i.e. medical and surgical. Due to the scarcity of literature, it is a need of the hour to further study and evaluate the benefits and efficacy of early surgical intervention versus conservative management of lumbar disc herniation.MethodsThis study was conducted in the neurology unit of a tertiary care hospital in Pakistan from April 2019 to March 2021. After obtaining informed consent, 250 patients with a lumbar disc herniation, between the ages of 20 and 50 years, were enrolled in the study. Out of them, 81 participants chose surgical intervention while 169 participants chose medical intervention. Before the intervention, the patient’s pain score was noted on the visual analog scale (VAS). The pain was assessed again 14 days after surgical intervention and 90 days after the start of medical intervention.ResultsThere was a significant difference in the pain score in the post-intervention period in both the medical (7.01 ± 1.05 vs. 3.54 ± 0.51; p-value: <0.0001) and surgical intervention groups (6.92 ± 0.95 vs. 2.41 ± 0.42; p-value: <0.0001). Post-intervention, the VAS pain score was significantly lower in the surgical group as compared to the medical group (2.41 ± 0.42 vs. 3.54 ± 0.51; p-value: <0.0001).ConclusionIn this study, there was a significant decline in pain in both groups; however, the reduction was more significant in the surgical group. Patients should be given both options for management of lumbar disc herniation and should be explained the pros and cons of each treatment option.

Clinical characteristics and neuroimaging findings of seven patients with Dyke Davidoff Masson syndrome

BackgroundDDMS is a rare disease diagnosed by clinical and radiological characteristics. But the complexity of radiological and clinical manifestations of DDMS has become a challenge diagnostically. To date, the reported cases with DDMS had highly varied clinical manifestations including seizures, contralateral hemiplegia/hemiparesis, facial asymmetry, mental retardation, etc. In addition to typical clinical findings, some new characteristics have been recently added to the spectrum of DDMS. However, few cases have been reported to be associated with neuropsychiatric symptoms according to the literature. This study aimed to investigate the neuropsychiatric manifestations associated with Dyke-Davidoff-Masson syndrome (DDMS) and related imaging findings.MethodsThis study included 7 patients diagnosed with DDMS between 2014 and 2020. The clinical characteristics, neuropsychiatric manifestations, and radiological results were retrospectively evaluated.ResultsSeven patients (five males and two females) with a mean age of 28.0 ± 9.73 (range 15.0–41.0) years were included. Five patients were admitted to the psychiatric unit due to psychological and behavioral disorders. Two patients were referred to the neurology unit mainly due to epilepsy. Six patients had epileptic seizures, 4 had hemiplegia, 3 had mental retardation, 2 patients had external ear deformities, and 2 had facial asymmetry. Neuropsychiatric symptoms were presented in 6 (85.7 %) cases. Cases 2–6 developed affective disorders. Deficits in verbal communication, impairment of social interaction, lack of insight, adulia and hypobulia appeared in cases 1–4. Schizophrenia with apathy, and epileptic schizoid psychosis were observed in cases 4 and 5 respectively. Case 6 had behavioral disorders, hyperactivity, tic disorder, mental retardation, anxiety, catatonic symptoms and suicidal tendency. Case 7 had seizures and mental retardation, and no psychiatric symptoms were presented. Radiological examinations showed unilateral cerebral atrophy, enlarged lateral ventricles, and various compensatory hypertrophy of the skull in all cases. The midline structure has shifted to the affected side in 5(71.4 %) cases. Atrophy of the basal ganglia or brain stem was observed in 4(57.1 %) cases.ConclusionsThe hallmark imaging manifestations of DDMS facilitated the diagnosis in most cases. This study illustrated that a variety of psychoneurotic disorders and ear abnormalities were correlated with DDMS.

Monitoring Parkinson's disease progression based on recorded speech with missing ordinal responses and replicated covariates

Monitoring Parkinson's Disease (PD) progression is an important task to improve the life quality of the affected people. This task can be performed by extracting features from voice recordings and applying specifically designed statistical models, leading to systems that improve the ability of monitoring the progression of PD in an objective, remote, non-invasive, fast, and economically sustainable way. An experiment has been conducted with 36 subjects to study the progression of the PD over 4 years by using the Hoehn and Yahr (HY) scale and features extracted from the phonation of the vowel/a/. The collected dataset had many missing data, which should be addressed jointly with the non-decreasing nature of the disease and the within-subject variability due to the use of replicated features. In order to handle these issues, a Hidden Markov model for longitudinal data was designed and implemented by using a data augmentation scheme based on different latent variables. Markov chain Monte Carlo methods were used to generate from the posterior distribution. The proposed approach has been tested on simulated data, providing good accuracy rates in the context of a multiclass problem. It also has been applied to the real data obtained from the conducted experiment, providing imputed and predicted HY stages compatible with the progression of PD. The conducted experiment and the proposed approach contribute to fill a gap in the scientific literature on experiments and methodologies for tracking PD progression based on acoustic features and the HY scale. This would help to derive an expert system that can be integrated into the protocols of neurology units in hospital centers.