Neurology Ward Research Articles

Classification of Neurological Patients to Identify Fallers Based on Spatial-Temporal Gait Characteristics Measured by a Wearable Device.

Neurological patients can have severe gait impairments that contribute to fall risks. Predicting falls from gait abnormalities could aid clinicians and patients mitigate fall risk. The aim of this study was to predict fall status from spatial-temporal gait characteristics measured by a wearable device in a heterogeneous population of neurological patients. Participants (n = 384, age 49–80 s) were recruited from a neurology ward of a University hospital. They walked 20 m at a comfortable speed (single task: ST) and while performing a dual task with a motor component (DT1) and a dual task with a cognitive component (DT2). Twenty-seven spatial-temporal gait variables were measured with wearable sensors placed at the lower back and both ankles. Partial least square discriminant analysis (PLS-DA) was then applied to classify fallers and non-fallers. The PLS-DA classification model performed well for all three gait tasks (ST, DT1, and DT2) with an evaluation of classification performance Area under the receiver operating characteristic Curve (AUC) of 0.7, 0.6 and 0.7, respectively. Fallers differed from non-fallers in their specific gait patterns. Results from this study improve our understanding of how falls risk-related gait impairments in neurological patients could aid the design of tailored fall-prevention interventions.

Comparison of phenobarbital and sodium valproate for the treatment of status epilepticus in children.

Objectives: Seizure is considered to be one of the commonest emergency involving more than half of the admissions in Pediatric Neurology wards. It has been well documented that proper management not only improves the prognosis but also decrease complications in these children. This study was planned to compare phenobarbital against sodium valproate for the treatment of status epilepticus (SE) in children. Study Design: Randomized clinical trial. Setting: Emergency Department of Pediatrics Medicine, the Baqai University and Medical College, Karachi. Period: 15th July 2018 to 31st December 2018. Material & Methods: A total of 100 children (50 in each group) with seizure lasting longer than 5 minutes, aged 6 months to 12 years, did not respond to diazepam (0.2mg/kg) within five minutes, were enroll. Randomization was done using lottery system where Group A was nominated who used sodium valproate and Group B, phenobarbital. Good response was labeled if a child’s seizure was controlled within 20 minutes of treatment. Results: Out of total of 100 children included in the present study, there were 60 (60.0%) male and 40 (40.0%) female. Mean age of the children was 5.4 years with standard deviation of 2.2 years. As far as type of seizures are concerned, there were 43 (43.0%) children presented with febrile convulsions (FC) while 57 (57.0%) with SE. Overall, positive response was noted in 69 (69.0%) children. Response in between both the groups turned out to be of statistical significance as more children, 40 (80.0%) showed positive response in Group B in comparison to 29 (58.0%) in Group A (p value = 0.017). Amongst children with positive response, the difference between both the study groups was significant in relation to seizure types as 75.9% of children with SE showed positive response with sodium valproate while 52.5% children with FC showed positive response in Group B (p value=0.018). Conclusion: Overall, both study drugs showed good positive response but phenobarbital when compared to sodium valproate is a better choice for controlling seizure in pediatric population. Sodium valproate showed greater effectiveness when used in children with SE while phenobarbital was comparatively more effective in febrile convulsion.

Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan

IntroductionThe overload of the healthcare system and the organisational changes made in response to the COVID-19 pandemic may be having an impact on acute stroke care in the Region of Madrid. MethodsWe conducted a survey with sections addressing hospital characteristics, changes in infrastructure and resources, code stroke clinical pathways, diagnostic testing, rehabilitation, and outpatient care. We performed a descriptive analysis of results according to the level of complexity of stroke care (availability of stroke units and mechanical thrombectomy). ResultsThe survey was completed by 22 of the 26 hospitals in the Madrid Regional Health System that attend adult emergencies, between 16 and 27 April 2020. Ninety-five percent of hospitals had reallocated neurologists to care for patients with COVID-19. The numbers of neurology ward beds were reduced in 89.4% of hospitals; emergency department stroke care pathways were modified in 81%, with specific pathways for suspected SARS-CoV2 infection established in 50% of hospitals; and SARS-CoV2-positive patients with acute stroke were not admitted to neurology wards in 42%. Twenty four hour on-site availability of mechanical thrombectomy was improved in 10 hospitals, which resulted in a reduction in the number of secondary hospital transfers. The admission of patients with transient ischaemic attack or minor stroke was avoided in 45% of hospitals, and follow-up through telephone consultations was implemented in 100%. ConclusionsThe organisational changes made in response to the COVID-19 pandemic in hospitals in the Region of Madrid have modified the allocation of neurology department staff and infrastructure, stroke units and stroke care pathways, diagnostic testing, hospital admissions, and outpatient follow-up.

Characteristics of drug-related problems among hospitalized ischemic stroke patients in China.

Background Patients with ischemic stroke are often taking multiple medications and are at increased risk for drug-related problems (DRPs). However, the prevalence and nature of DRPs in these patients in China and the impact of pharmacist interventions to resolve DRPs in this population are unknown. Objective To investigate the prevalence and nature of DRPs in ischemic stroke patients. Setting A neurology ward at an academic teaching hospital in Shanghai, China. Methods This was a prospective observational study conducted from September to November 2017. A total of 274 ischemic stroke adult patients were included. Pharmacists provided pharmaceutical care activities in the multi-disciplinary team. DRPs were categorized by the Pharmaceutical Care Network Europe classification V8.0. Main outcome measure The number, types, and causes of DRPs. Results We identified 88 DRPs related to 89 causes, an average rate of 0.32 DRP per patient. The rates of DRPs were higher in patients with renal impairment (0.91), liver impairment (0.65), or patients younger than 60years (0.39). The primary cause of the DRPs was drug selection (66.3%), and the most common problem was treatment safety (60.2%). Among the top medications associated with DRPs were proton pump inhibitors (17.2%) followed by cerebrovascular/nootropics (16.1%) and sedative-hypnotics (13.9%). The acceptance rate of pharmacists' inventions reached 94.0%, and 90.0% of these accepted inventions were fully implemented (DRP status solved). Conclusion Drug-related problems are relatively common in hospitalized ischemic stroke patients in China, and treatment safety is the major DRP type. Pharmacist intervention can identify and resolve pertinent DRPs to optimize medication therapy.

Retrospective Analysis of Patients in the Aspect of the Prevalence of Alcohol Abuse Among Patients with Stroke Treated in the Department of Neurology

Introduction. Alcohol is a drug that is harmful to many organs, especially the brain, and may contribute to worse recovery in stroke patients treated in a neurological ward. There are few works in the literature dealing with alcohol-related problems in patients with stroke.Aim. Assessment of the prevalence of alcohol abuse in stroke and its impact on the diagnostic and therapeutic process in groups of patients diagnosed with harmful alcohol consumption or alcohol dependence syndrome.Material and Methods. The material consisted of 2770 medical records of patients hospitalized in the Department of Neurology with the Stroke Treatment Sub-Department at the Specialist Hospital of Stanisław Staszic in Piła from January 1 to December 31, 2015, which were analysed in terms of alcohol abuse by patients. Patients with stroke (40 people) were analysed in detail. The results of laboratory tests, risk factors, gender and age of the patients were analysed. The following methods of scientific research were used in the study: analysis of medical records, statistical analysis of quantitative and qualitative data with the use of STATISTICA v. 13.3 computer program by StatSoft.Results. There were 40 patients with ischemic and haemorrhagic stroke who abused alcohol in total (29.85%). Among patients with stroke, 70% presented harmful drinking, 30% — alcohol dependence syndrome. More than two risk factors for stroke were reported more frequently in the group of patients with stroke who abused alcohol than in those with stroke but did not abuse alcohol (38.8% vs. 30.0%; p = 0.0561). In laboratory studies, stroke patients who abused alcohol compared to non-drinkers had a statistically significantly higher red blood cell (MCV) volume, higher levels of the liver enzymes ASPAT and ALAT; p < 0.05.Conclusions. The lack of real information on the amount of alcohol consumed by a patient can make the diagnostic and therapeutic process very difficult, and thus delay the full diagnosis and implementation of the appropriate therapy. The study should be extended to include a prospective assessment. In order to increase the detection of alcohol abuse in patients, an objective interview, psychological assessment focused on the problem would be necessary, and the use of questionnaires with short, simple but precise questions that would allow to quantify the alcohol problem in a patient. (JNNN 2020;9(4):145–151)

Prevalence and Associated Factors of Depressive Disorder in Caregivers of Individuals With Parkinson Disease.

Parkinson disease (PD) is a debilitating neurodegenerative disease. Caring for an individual with PD can have a variety of negative physical and psychological effects on caregivers which may challenge their ability to continue in their caretaking role. The aim of this study was to assess the prevalence and associated factors of depressive disorders in caregivers of individuals with PD using standardized instruments. This study used a cross-sectional design with consecutive sampling. Study participants were recruited from the neurological ward or neurological outpatient clinic of a medical center from August 2018 to July 2019. Caregivers of persons with PD were enrolled and assessed using the Mini International Neuropsychiatric Interview, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Beck Hopelessness Scale, Brief Fatigue Inventory, Connor-Davidson Resilience Scale, and Big Five Inventory-10. Of the 162 caregivers that completed the study, 67.3% (n = 109) were females. The most common psychiatric diagnosis was depressive disorder (11.1%), followed by insomnia disorder (7.4%) and anxiety disorder not otherwise specified (4.3%); 28% of the caregivers had a psychiatric diagnosis. Using logistic regression analysis, it was found that duration of caregiving (odds ratio [OR] = 1.28; 95% CI, 1.05-1.58), severity of anxiety (OR = 1.86; 95% CI, 1.36-2.53), and severity of fatigue (OR = 1.08; 95% CI, 1.01-1.16) were 3 significant associated factors for the development of depression. Depression was the most prevalent psychiatric diagnosis in caregivers of people with PD. Early diagnosis of these caregivers is crucial to the offering of suitable support and treatment and might improve caregivers' quality of life.

Teaching the National Institutes of Health Stroke Scale to Paramedics (E-Learning vs Video): Randomized Controlled Trial.

BackgroundPrompt and accurate identification of stroke victims is essential to reduce time from symptom onset to adequate treatment and to improve neurological outcomes. Most neurologists evaluate the extent of neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), but the use of this scale by paramedics, the first healthcare providers to usually take care of stroke victims, has proven unreliable. This might be, at least in part, due to the teaching method. The video used to teach NIHSS lacks interactivity, while more engaging electronic learning (e-learning) methods might improve knowledge acquisition.ObjectiveThis study was designed to evaluate whether a highly interactive e-learning module could enhance NIHSS knowledge acquisition in paramedics.MethodsA randomized controlled trial comparing a specially designed e-learning module with the original NIHSS video was performed with paramedics working in Geneva, Switzerland. A registration number was not required as our study does not come into the scope of the Swiss federal law on human research. The protocol was nevertheless submitted to the local ethics committee (Project ID 2017-00847), which issued a “Declaration of no objection.” Paramedics were excluded if they had prior knowledge of or previous training in the NIHSS, or if they had worked in a neurology or neurosurgery ward. The primary outcome was overall performance in the study quiz, which contained 50 questions. Secondary outcomes were performance by NIHSS item, time to course and quiz completion, user satisfaction regarding the learning method, user perception of the course duration, and probability the user would recommend the course to a colleague.ResultsThe study was completed by 39 paramedics. There was a better overall median score (36/50 vs 33/50, P=.04) and a higher degree of satisfaction regarding the learning method in the e-learning group (90% vs 37%, P=.002). Users who had followed the e-learning module were more likely to recommend the course to a colleague (95% vs 63%, P=.02). Paramedics in the e-learning group took more time to complete the course (93 vs 59 minutes, P<.001), but considered the duration to be more adequate (75% vs 32%, P=.01). Time to quiz completion was similar between groups (25 vs 38 minutes, P=.12).ConclusionsUse of an e-learning module shows promising results in teaching the NIHSS to paramedics.

A Descriptive Study of Suffered and Witnessed Aggressions in Two Rehabilitative Italian Units.

Aggression issues experienced on the workplace has been globally recognized as a public health issue. Nurses are exposed to a very high risk of becoming victims of workplace aggression.ObjectiveThe study describes this phenomenon from nurses perspective in two units resulted to be the more exposed to aggressive behaviour at San Raffaele Hospital in Milan.MethodWe applied a semi-structured interview to volunteer staff members of the rehabilitative psychiatric and neurological wards of San Raffaele Hospital in Milan. We collected general data on 55 workers, their previous experiences of suffered or witnessed aggression, locations and timing of attacks, methods used to report attacks, subjective opinion about drives, management modalities of aggressive phenomena and any physical and/or psychological impacts.Results85% suffered and 80% witnessed aggressions, especially non-physical, mostly in the corridor at 7.00-8.00 pm. The 78.7% reported no emotional trauma whereas the 21.3% reported physical injury. Aggressive behaviours linked to the patient’s pathology were more easily tolerated. According to participants opinion, the interaction between psychopathological aspects and environmental features increase the risk of an aggressive behaviour. The 81% of interviewed reported to be able to manage patients’ aggressiveness considering their previous experiences more helpful than training.DiscussionWe confirm literature data about high percentage of witnessed and suffered aggression and the well-known healthworkers tendency to consider violent and aggressive behaviours as “part of the job” . Professional figures need to be formed with specific trainings focused on early identification, communication strategies, and de-escalation techniques.

Impacto de la pandemia de COVID-19 en la organización asistencial del ictus. Plan Ictus Madrid

IntroductionThe overload of the healthcare system and the organisational changes made in response to the COVID-19 pandemic may be having an impact on acute stroke care in the Region of Madrid. MethodsWe conducted a survey with sections addressing hospital characteristics, changes in infrastructure and resources, code stroke clinical pathways, diagnostic testing, rehabilitation, and outpatient care. We performed a descriptive analysis of results according to the level of complexity of stroke care (availability of stroke units and mechanical thrombectomy). ResultsThe survey was completed by 22 of the 26 hospitals in the Madrid Regional Health System that attend adult emergencies, between 16 and 27 April 2020. Ninety-five percent of hospitals had reallocated neurologists to care for patients with COVID-19. The numbers of neurology ward beds were reduced in 89.4% of hospitals; emergency department stroke care pathways were modified in 81%, with specific pathways for suspected SARS-CoV2 infection established in 50% of hospitals; and SARS-CoV2-positive patients with acute stroke were not admitted to neurology wards in 42%. Twenty-four hour on-site availability of mechanical thrombectomy was improved in 10 hospitals, which resulted in a reduction in the number of secondary hospital transfers. The admission of patients with transient ischaemic attack or minor stroke was avoided in 45% of hospitals, and follow-up through telephone consultations was implemented in 100%. ConclusionsThe organisational changes made in response to the SARS-Co2 pandemic in hospitals in the Region of Madrid have modified the allocation of neurology department staff and infrastructure, stroke units and stroke care pathways, diagnostic testing, hospital admissions, and outpatient follow-up.

Management of Advanced Therapies in Parkinson's Disease Patients in Times of Humanitarian Crisis: The COVID-19 Experience.

Although the COVID-19 pandemic is affecting a relatively small proportion of the global population, its effects have already reached everyone. The pandemic has the potential to differentially disadvantage chronically ill patients, including those with Parkinson's disease (PD). The first health care reaction has been to limit access to clinics and neurology wards to preserve fragile patients with PD from being infected. In some regions, the shortage of medical staff has also forced movement disorders neurologists to provide care for patients with COVID-19. To share the experience of various movement disorder neurologists operating in different world regions and provide a common approach to patients with PD, with a focus on those already on advanced therapies, which may serve as guidance in the current pandemic and for emergency situations that we may face in the future. Most of us were unprepared to deal with this condition given that in many health care systems, telemedicine has been only marginally available or only limited to email or telephone contacts. In addition, to ensure sufficient access to intensive care unit beds, most elective procedures (including deep brain stimulation or the initiation of infusion therapies) have been postponed. We all hope there will soon be a time when we will return to more regular hospital schedules. However, we should consider this crisis as an opportunity to change our approach and encourage our hospitals and health care systems to facilitate the remote management of chronic neurological patients, including those with advanced PD.

Kemampuan mobilitas dan derajat luka tekan pasien rawat inap

The occurrence of pressure ulcer is directly related to the duration of immobility. If the suppression continues for a long time, small vascular thrombosis and tissue necrosis will occur. In bone protrusions that hold weight are more susceptible to pressure sores and are often found in people with limited movement because they are unable to change positions to remove pressure. Objective is to determine the relationship of mobility ability with the degree of pressure ulcer on inpatients at Wonosari Hospital in Gunungkidul Regency. This research was non-experimental research with cross-sectional design. The samples in this study were patients treated in the surgical, internal and neurological ward of Wonosari Hospital in Gunungkidul Regency. The sampling technique used the simple random sampling technique. While the statistical test used the Pearson test. Results showed that the average scale of mobility ability of inpatients was 3 scale (mean 2,70), while the average value of the degree of pressure ulcer in the inpatient ward of Wonosari Hospital was degree I (mean 1,32). Conclusion of this research was there was a significant correlation between mobility ability and the degree of pressure ulcer of the patient in the inpatient room at Wonosari Hospital in Gunungkidul Regency with a significance value of 0.000 (ρ &lt; 0,05).

Sheltering under a shield of love-A phenomenological-hermeneutic study of relatives' experiences in an acute neurological ward.

AimTo investigate the lived experience of being a relative to a patient admitted to an acute neurological ward to bring knowledge of what is essential to them.DesignThe study takes a phenomenological–hermeneutic approach.MethodsData were gathered through six individual semi‐structured interviews with relatives from an acute neurological ward. A three‐levelled analysis and interpretation inspired by Paul Ricoeur's philosophy was applied.ResultsTwo main themes were identified: To make yourself strong while feeling vulnerable inside and To live in a changed everyday life. Within these themes, the connection between the relatives and the patients appeared to be a relationship of love. In this relationship, the relatives experience existential vulnerability. The lives of relatives undergo a difficult upheaval, which is challenged by deep emotional feelings. However, to be able to be there for their loved ones they are sheltering under a shield of love.

Cerebrovascular disease: how serum phosphorus, vitamin D, and uric acid levels contribute to the ischemic stroke

BackgroundAssociations between serum phosphorus level and the incidence of ischemic stroke are not clear. This study aimed to measure serum phosphorus, vitamin D3, and uric acid levels in ischemic stroke patients compared to a population without ischemic stroke.MethodsIn this cross-sectional study, 133 patients admitted to a neurology ward with the diagnosis of ischemic stroke were compared with a control group comprising 133 age- and gender-matching individuals. The presence of ischemic stroke was confirmed by a neurologist based on clinical signs, symptoms, brain CT scan, and MRI. Blood samples were taken from all patients in the first 24 h of admission to measure serum phosphorus, vitamin D3, calcium, and uric acid levels.ResultsAccording to the results of this study, uric acid medians in patients with stroke and controls were 4.9 [3.8–6.4] and 3.9 [3.5–4.9] mg/dL, respectively (p < 0.001). Median phosphorus and vitamin D levels were significantly lower in stroke patients than the controls (3.6 [3.02–4.21] vs. 4.2 [3.8–4.6]) and (15.1 [8.2–27.9] vs. 22.7 [10.4–39.2]), respectively. Multiple logistic regression analysis showed that the ischemic stroke was positively associated with the vitamin D level and negatively correlated with the uric acid level. The phosphorus level was not significantly predictive of ischemic stroke.ConclusionLower serum levels of vitamin D3 and higher levels of uric acid were associated with ischemic stroke. There are still unknowns about the role of these indicators on ischemic stroke and it requires further studies.

Clostridium difficile in patients with nosocomial diarrhea, Northwest of Iran.

Background: Clostridium difficile is known as a prevalent pathogen leading to infections ranging from mild diarrhea to severe disease and death. The aim of the present study was to evaluate the incidence of C. difficile from inpatients with nosocomial diarrhea hospitalized in different wards in the northwest region of Iran. Methods: In this cross-sectional study, 485 diarrheal stool samples were collected from 384 patients referred from different wards of Imam Reza, Sina and Pediatric hospitals, Tabriz and transferred to the laboratory from 25 March 2015 till 1 March 2018. Immuno-chromatographicassay for detection of toxins A and B of C. difficile was used for identification. Results: Clostridium difficile was isolated from 24 (4.7%) out of 485 samples. Fifteen patients(62.5%) were males and 9 were females (37.5%). Twelve positive patients were from the gastrointestinal ward (50%), 5 patients (20.8%) from surgery ward, 3 patients from infectious disease ward (12.5%), 3 patients from rheumatology ward (12.5%) and 1 patient (4.1%) were collected from neurology ward. 95.3% of diarrhea samples had no signs from toxin A and B. Conclusion: These results indicate most of infected patients were from the gastrointestinaland surgery wards which show a different pattern of infection compared to previous studies.The neurology department had the lowest rate of infection. C. difficile is a health threat afterantibiotic consumption and for health promotion, developing strategies for less antibioticconsumption and preventing these emerging infections is critical. The low rate of this infection shows improvement in knowledge and effect of stewardships in physicians.

Application of Video-EEG Monitoring in a Baby with a Paroxysmal Condition

Objective: to justify the application of video-EEG monitoring in babies with paroxysmal conditions based on the description of a clinical case of a paroxysmal condition in an 11-monthold baby.Material and methods. The 11-monthold patient Ilya K. having a paroxysmal condition of unknown etiology was directed to be examined at the Neurological Ward of Gomel Regional Children`s Clinical Hospital. According to the data of video-EEG monitoring prescribed to the patient to clarify the nature of the paroxysmal events, the child had had an attack that had occurred suddenly and had been accompanied by impaired consciousness.Results. Based on the description of the clinical case of the baby examined on the subject of convulsive syndrome of unspecified genesis, the application of video-EEG monitoring has been proved to be as a highly informative and high-tech method for the diagnosis of paroxysmal conditions in pediatrics and pediatric neurology, which makes it possible to make differential diagnosis of seizures in children, thereby verifying the diagnosis.Conclusion. The diagnosis of paroxysmal conditions in children remains a difficult task for pediatric neurologists and pediatricians and requires an integrated approach, in-depth examination of patients with the application of modern neuroimaging functional methods for the examination of the brain, and video-EEG monitoring can be fundamental in the diagnosis verification. It is necessary to widely introduce this research method in medicine, in particular in functional diagnostics in pediatrics and pediatric neurology, which will help optimize approaches in the diagnosis and management of patients with paroxysmal conditions. The application of video-EEG monitoring will allow to make high quality diagnosis of the disease, and therefore contribute to the rational choice of therapy, including the timely and adequate prescription of antiepileptic therapy.

The Effectiveness of CBTAC Protocol on Burdens of Alzheimer’s Disease on Caregivers and their Sense of Coherence

Background: Alzheimer’s disease is predicted to increase dramatically in the near future. Alzheimer’s caregiving brings about severe problems for caregivers. Considering the corrosive consequences of Alzheimer’s disease on Alzheimer’s caregivers, finding an effective intervention is necessary. Thus, the present research conducted by the aim of investigating the effectiveness of cognitive-behavioral treatment for Alzheimer’s disease patients and their caregiver’s protocol on burdens of Alzheimer’s disease on caregivers and their sense of coherence (SOC). Methods: This study was a quasi-experimental research with a pretest-posttest control group design. The target population included all mild Alzheimer’s disease patients and their caregivers referred to the neurology ward of the hospitals in Rasht during summer 2018. According to the medical records and results of screening, 40 mild Alzheimer’s disease, patients and their caregivers recruited by convenience sampling method. After sampling, research participants randomly assigned into two experimental (n= 20) and waitlist control (n=20) groups. The Impact of Alzheimer’s Disease on Caregiver Questionnaire and SOC scale were used to measure the burdens of Alzheimer’s disease on caregivers and caregivers’ SOC. The CBTAC provided for the experimental group participants in 25 sessions of 90-minutes. In the end, the data analyze has done by multivariate analysis of covariance (MANCOVA) and using SPSS24 software. Results: The findings indicated that the CBTAC had a significant effect on the burdens and SOC of Alzheimer’s caregivers in the experimental group (P&lt;0.01). In other words, the CBTAC decreases burdens and increase the SOC of Alzheimer’s caregivers significantly (P&lt;0.01). Conclusion: Based on the research results, the CBTAC is an effective intervention in decreasing caregiving burden and the increasing SOC of Alzheimer’s caregivers. Therefore, CBTAC is a multicomponent intervention that can be used to improve the competency and mental health of Alzheimer’s caregivers.

The Effect of High- and Low-Frequency Repetitive Transcranial Magnetic Stimulation Therapy on Serum Brain-Derived Neurotropic Factor Level and Motor Ability in Ischemic Stroke Patients: A Single-Center Study

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is widely used in various neurological cases. rTMS is an effective method of restoration in patients with disability due to central nervous system disorder.&#x0D; AIM: This study aimed to determine the effect of high and low frequency of rTMS on serum brain-derived neurotropic factor (BDNF) levels and motoric abilities in ischemic stroke patients.&#x0D; METHODS: The study design was an experiment with a purposive sampling consecutive on 27 samples with the onset of ischemic stroke 6 months. The study was conducted from February to October 2018; samples were recruited from Neurology Ward of Wahidin Sudirohusodo hospital and its affiliating centers. The serial of rTMS intervention was delivered in “Brain” Clinic center. After fulfilling the inclusion criteria and the initial examination of serum BDNF and motor ability, samples were randomly divided into two groups, intervention group who received standard therapy with rTMS therapy (n = 14) and the control group who only received standard therapy (n = 13). rTMS was given for 2 min frequency of 1 Hertz (Hz) contralesion and 5 Hz ipsilesion every day for 10 days. Assessment of serum BDNF levels and motor skills was conducted on days 1 and 10 of the study. Serum BDNF levels were measured by the monoclonal antibody ELISA technique while motor skills were measured based on the score of the Stroke Rehabilitation Assessment of Movement (STREAM). Serum BDNF values and the STREAM delta score were compared between the two groups of samples.&#x0D; RESULTS: The results showed significant changes only occurred in motor abilities in both groups of samples after 10 days of rTMS therapy with the Wilcoxon test (p &lt; 0.5). The Mann–Whitney U-test showed a more significant change (p &lt; 0.5) in the treatment group than in the control (p = 0.5).&#x0D; CONCLUSION: rTMS has an effect on improving motor ability in ischemic stroke patients. This change in motor abilities is not related to serum BDNF levels in this study.

In-hospital Mortality Among Neurological Patients over the Period of 5 years — a Retrospective, Single-center Study

Introduction. Neurological disorders have been considered for many years dangerous and are associated with higher risk of in-hospital death. Brain vascular disorders are widely considered as the most severe and related to the highest mortality rate.Aim. The aim of the study was to assess the mortality rate in subjects hospitalized in the Neurology ward within 5 years, in particular the etiology, direct cause and predictability of deaths.Material and Methods. This study is retrospective. The documentation analysis concerned the last 5 years, i.e. from 2015 to 2019. From among the entire database of 8247 patients hospitalized in the Neurology Clinic of the University Hospital No. 1 in Bydgoszcz, 429 deaths were reported and analyzed.Results. The mortality rate was 5.2% among all subjects, 6.6% among all vascular patients and 1.16% among non-vascular subjects. The highest mortality was reported among hemorrhagic stroke (28.4%) and it was significantly higher compared to ischemic stroke (OR = 6.25, 95% CI 4.9–7.8, p &lt; 0.0001). Patients with stroke had significantly higher mortality compared to other neurological disorders (OR = 11.08 95% CI 7.7–15.9, p &lt; 0.0001). The main direct reason of death (80%) was primary cerebral as a result of baseline disease. 7% of deaths were considered as sudden, unexpected and 10.7% were related to complications developed during hospitalization.Conclusions. Stroke, especially hemorrhagic subtype, still remains the cause of the highest in-hospital mortality rate in the Neurology Ward. It is worth to notice that special attention should be paid to patients with coexisting infectious diseases, that contribute to higher mortality risk. (JNNN 2020;9(1):20–26)

Intrarater reliability of multipad interface pressure sensor in clinical setting

The purpose of this study is to identify the reliability of interface pressure measurement performed by nurses in detecting the risk of pressure injury. This research was a cross-sectional study conducted at the Central General Hospital in eastern Indonesia, pressure assessment measured with interface pressure (the Palm Q, Cape Co. Ltd., Yokosuka, Japan) with five sensors. Data were analyzed using IBM SPSS 24 statistical test to evaluate the value of interclass correlation coefficients (ICC). The intrarater reliability test between three different measurements discovered a good reliability between nurses at three different wards. Regarding to working experience, the intrarater reliability test between three different measurements also found a satisfied reliability, except in neurology ward. Palm Q sensor has an excellent reliability as interface pressure sensor in clinical setting.

Effect of methylprednisolone shock therapy on immune function of electrical status epilepticus during sleep in children

Objective To study the effect of methylprednisolone shock therapy on electrical status epilepticus during sleep (ESES) in children and the changes of immune function before and after methylprednisolone shock therapy. Methods Thirty-five children hospitalized in pediatric neurology ward of Shengjing Hospital of China Medical University from October 2017 to October 2018 were selected, including 19 children with newly diagnosed temporal lobe epilepsy (TLE group) and 16 children with initial diagnosis of TLE with ESES (ESES group), and 21 healthy children in the same period were selected as normal control group.A total of 32 cases with ESES who were taken oral administration of more than 2 anti-epileptic drugs(AEDs)ineffective were given methylprednisolone shock treatment for 3 days.Changes of lymphocyte subsets and cytokines among groups were compared. Results The longer the course of disease, the worse the prognosis of children with ESES.Compared with normal control group, the NK cell activity were significantly lower in children of ESES group(P<0.05). The levels of IL-6 were higher in children of ESES group compared with that in children of TLE group, and there was significant difference between two groups(P<0.05). In children with ESES who had poor therapeutic effect of oral AEDs, the proportion of peripheral blood B lymphocytes increased after methylprednisolone shock treatment, and the proportion of T lymphocyte subsets and NK cells decreased, and the differences were statistically significant(P<0.05). The levels of IL-2, IL-4 and IL-10 were higher than those before treatment, the levels of IL-6, IL-17, INF-γ and TNF were lower than those before treatment, and the difference between the level of IL-6 before and after treatment was statistically significant(P<0.05). EEG spike waves index decreased significantly after treatment, some children′s growth and development and cognitive function improved, all children had no serious infection, high blood pressure, electrolyte imbalance and other adverse reactions.The correlation between therapeutic effect and changes of immune indexes was statistically significant in levels of NK cells(r=0.50, P<0.01), B lymphocytes (r=0.35, P=0.04) and IL-6(r=0.46, P=0.01), and all of them were positively correlated(P<0.05). Conclusion Children with ESES have immune dysfunction and may have excessive inactivation of NK cells and elevated levels of IL-6.Congenital immunity and adaptive immunity may play a role in the pathogenesis and pathophysiology of ESES syndrome.Methylprednisolone shock therapy could significantly reduce the non-rapid eye movement discharge index in children with ESES.The mechanism may be related to the significant decrease of IL-6 level.It may also be related to redistribution of lymphocyte subsets, affecting cell differentiation and balancing various cytokines. Key words: Electrical status epilepticus during sleep; Lymphocyte; Cytokines; Methylprednisolone