Non-neurological Group Research Articles

Urogenital dysfunction and quality of life in women after stroke: Pilot study

Introduction: Research shows that urinary and sexual dysfunction is very common neurological sequelae of stroke with a markedly significant impact on body self-image and quality of life. Still, there is a lack of recent research to address this problem in female stroke survivors. The study aimed to examine the existence and level of urinary and sexual dysfunction, quality of life, and self-reported body image in a group of women after stroke and compare findings with those found in a group of women with other chronic non-neurological diseases. Methods: This study’s sample consisted of 30 females; two groups composed of 15. The stroke group consisted of subjects after stroke and the non-neurological group with different chronic non-neurological, mainly muscle-skeletal conditions. This study’s specific interest data were collected from respondents through pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), female sexual function index (FSFI), and an eight-item body image scale (BIS). The SPSS v.26 program was used for statistical processing. Results: Results show a statistically higher scores in stroke group (M = 219.65 ± 34.573) on PFDI-20 than in non-neurological group (M = 118.54 ± 27.734). Furthermore, statistically significant higher scores were found in stroke group in PFIQ-7 (Mdn = 233.33) and BIS (Mdn = 16.00) than in non- neurological group (Mdn = 28.57) – PFIQ-7; (Mdn = 11.00) – BIS. Also, statistically significant lower scores were found in stroke group (Mdn=10.40) on FSFI index than in non-neurological group (Mdn=24.60). Conclusions: Women after stroke show significantly more urinary and sexual dysfunction, lower quality of life, and poorer body self-image than the non-neurological group of chronic non-neurological conditions. There is a clear need for research on this issue in women after stroke.

Incidence and safety outcomes associated with active stone removal procedures (ASRP): a comparison between neurological and non-neurological patients using the French National Health Data Base.

To compare the incidence and the safety outcomes associated with active stone removal procedure (ASRP) between neurological and non-neurological patients. The present study was conducted using the data issued from the French National Health Data Base. All patients that have been hospitalized to undergo an ASRP between January 1 2012 and December 31 2018 were included and allocated to four neurological groups (multiple sclerosis, spinal dysraphism, paraplegia, tetraplegia) and one non-neurological group. The primary outcome was the rate of patients hospitalized at least once to undergo an ASRP over the study period. The secondary outcomes included the type of ASRP performed, the length of hospital stay, the rates of post-operative UTI, of early re-admission and re-treatments. Multivariate logistic regression was used to estimate odd ratios, the four neurological groups being compared to the non-neurological group. During the study period, 45,745,055 patients were hospitalised, with 151,850 of them presenting with an underlying neurological disease. Among the non-neurological patients, 0.89% underwent an ASRP, while 1.39% neurological patients did. Neurological patients presented with a lower rate of ESWL associated with a higher rate of PCNL, while the length of hospital stay, the rate of post-operative UTI, of early re-admission and of re-treatment were systematically increased (p < 0.001), when compared to non-neurological patients, regardless of the type of ASRP considered. The results presented here confirm and clarify the incidence and the safety outcomes associated with ASRP within the neurological population and advocate for the emergence of a dedicated research field focusing on neuro-urolithiasis.

Investigation into attitudes toward epilepsy among non-/neurological doctors and nurses in southern China

PurposeTo assess attitudes concerning epilepsy among non-/neurological medical personnel from basic-level hospitals in southern China and identify significant predictive factors for future stigma reduction interventions. MethodThe Chinese Public Attitudes Toward Epilepsy (CPATE) scale was administered to 184 neurological and 264 non-neurological medical staff members from basic-level hospitals in southern China. Positively stated items in the PATE scale were reversely scored; in this case, a higher score would indicate a more negative attitude. ResultsThe mean score of each item among the neurological group was statistically lower than that of the non-neurological group. The mean scores in both the general and personal domains of the CPATE scale were significantly lower among the doctors as compared to nurses. ConclusionsThis was the first study to evaluate the attitudes toward epilepsy among medical personnel with different characteristics in basic-level hospitals in China. Health education can be a new model for stigma-reducing public interventions in China. Future strategies should first focus on improving access to correct knowledge about epilepsy among non-neurological medical staffs. This would be a vital breakthrough point to improve attitudes toward epilepsy in the whole society to help ease the disease burden on people with epilepsy, their families and the community in the years to come.

588 Efficacy and safety of Holmium laser enucleation of prostate (HoLEP) in patients with underlying neurologic disease

Neurologic disease can cause the neurogenic bladder which can compromise the treatment outcome of HoLEP in patients with benign prostatic hyperplasia (BPH). Moreover, anticoagulants are frequently administered in those patients. We compared the efficacy and safety outcomes of HoLEP in BPH patients with or without neurologic disease. We retrospectively reviewed the medical records, and pre-operative urodynamic study (UDS) results of BPH patients who underwent HoLEP between June 2009 and December 2015. Of the 317 patients who received the HoLEP, 26 (8.2%) patients had underlying neurologic diseases. Neurologic disease group was more frequently administered anticoagulants than non-neurologic group (69.2 vs. 18.6%; p <0.001). However, neurologic disease group demonstrated similar patient characteristics and pre-operative urologic findings with non-neurologic disease group as shown in the Table. Two groups demonstrated similar operation time (non-neurologic disease group vs. neurologic disease group; 116.2 vs. 107.8 min, p=0.291), transfusion rate (0.3 vs. 0.0%, p=0.765), hospital stay (6.1 vs. 5.6 days, p=0.245), catheter duration (3.3 vs. 3.5 days, p=0.593), re-catheterization rate (5.2 vs. 0.0%, p=0.236). At median follow-up of 6 months, two groups demonstrated similar outcome parameters such as Qmax (19.6 vs. 16.6 mL/sec, p=0.088), PVR (27.9 vs. 35.2 mL, p=0.467), IPSS-emptying (3.1 vs. 3.6, p=0.645), IPSS-storage (4.3 vs. 3.3, p=0.219), and IPSS-QoL (1.6 vs. 2.0, p=0.470). Rates of complications such as incontinence (6.7 vs. 9.1%, p=0.671), urinary tract infection (0.8 vs. 0.0%, p=0.667), urethral stricture (1.7 vs. 4.5%, p=0.347) were not also different between two groups.

MP27-02 EFFICACY AND SAFETY OF HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP) IN PATIENTS WITH UNDERLYING NEUROLOGIC DISEASE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2017MP27-02 EFFICACY AND SAFETY OF HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP) IN PATIENTS WITH UNDERLYING NEUROLOGIC DISEASE Myong Kim, Myung-Soo Choo, and Tai Young Ahn Myong KimMyong Kim More articles by this author , Myung-Soo ChooMyung-Soo Choo More articles by this author , and Tai Young AhnTai Young Ahn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.794AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neurologic disease can cause the neurogenic bladder which can compromise the treatment outcome of HoLEP in patients with benign prostatic hyperplasia (BPH). Moreover, anticoagulants are frequently administered in those patients. We compared the efficacy and safety outcomes of HoLEP in BPH patients with or without neurologic disease. METHODS We retrospectively reviewed the medical records, and preoperative urodynamic study (UDS) results of BPH patients who underwent HoLEP between June 2009 and December 2015. RESULTS Of the 317 patients who received the HoLEP, 26 (8.2%) patients had underlying neurologic diseases. Neurologic disease group was more frequently administered anticoagulants than non-neurologic group (69.2 vs. 18.6%; p <0.001). However, neurologic disease group demonstrated similar patient characteristics and pre-operative urologic findings with non-neurologic disease group as shown in the Table. Two groups demonstrated similar operation time (non-neurologic disease group vs. neurologic disease group; 116.2 vs. 107.8 min, p=0.291), transfusion rate (0.3 vs. 0.0%, p=0.765), hospital stay (6.1 vs. 5.6 days, p=0.245), catheter duration (3.3 vs. 3.5 days, p=0.593), re-catheterization rate (5.2 vs. 0.0%, p=0.236). At median follow-up of 6 months, two groups demonstrated similar outcome parameters such as Qmax (19.6 vs. 16.6 mL/sec, p=0.088), PVR (27.9 vs. 35.2 mL, p=0.467), IPSS-emptying (3.1 vs. 3.6, p=0.645), IPSS-storage (4.3 vs. 3.3, p=0.219), and IPSS-QoL (1.6 vs. 2.0, p=0.470). Rates of complications such as incontinence (6.7 vs. 9.1%, p=0.671), urinary tract infection (0.8 vs. 0.0%, p=0.667), urethral stricture (1.7 vs. 4.5%, p=0.347) were not also different between two groups. CONCLUSIONS Efficacy and safety outcomes of HoLEP in patients with underlying neurologic diseases did not compromise compared to those of patient without neurologic diseases. HoLEP can be a good treatment option for BPH patients with underlying neurologic disease. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e328 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Myong Kim More articles by this author Myung-Soo Choo More articles by this author Tai Young Ahn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Role of Fibreoptic Endoscopy in Evaluating Swallowing Disorders

Objective: The objective is to assess patients complaining of dysphagia with fibreoptic endoscopic evaluation of swallowing [FEES]. Study design: It is a prospective study. Setting: The study is conducted at Tertiary referral hospital. Methods: In our study, twenty patients with complaints of dysphagia were evaluated with fibreoptic endoscopic evaluation of swallowing. Patients with pharyngeal cause of dysphagia were identified and recommended dietary modifications or positional manoeuvre. Results: A total of twenty patients were evaluated with FEES. Patients were categorised into two groups based on the etiological factor: neurological and non-neurological patients. In eleven of the neurological patients, premature spillage was seen in four patients. Pooling for solids was seen in one patient and for liquids in four patients, pooling for both solids and liquids was seen in six patients, penetration was seen in 1 patient and aspiration in one patient. All these patients were diagnosed to have a pharyngeal cause of dysphagia. In the nine of the non-neurological group, pooling of liquids was seen in four patients, and aspiration was seen in one patient. None of the patients of this group had spillage. One patent had penetration. Five patients had pharyngeal cause of dysphagia. Remaining four patients had normal study. These patients with pharyngeal cause were advised dietary modification or positional manoeuvre or a combination of both. Conclusion: FEES is an effective and valuable tool for evaluating pharyngeal dysphagia, and is helpful in guiding the patients for diet and rehabilitation. It is essential to assess the safety of swallowing in patients to prevent silent aspiration and aspiration pneumonia.

Molecular findings among patients referred for clinical whole-exome sequencing.

Clinical whole-exome sequencing is increasingly used for diagnostic evaluation of patients with suspected genetic disorders. To perform clinical whole-exome sequencing and report (1) the rate of molecular diagnosis among phenotypic groups, (2) the spectrum of genetic alterations contributing to disease, and (3) the prevalence of medically actionable incidental findings such as FBN1 mutations causing Marfan syndrome. Observational study of 2000 consecutive patients with clinical whole-exome sequencing analyzed between June 2012 and August 2014. Whole-exome sequencing tests were performed at a clinical genetics laboratory in the United States. Results were reported by clinical molecular geneticists certified by the American Board of Medical Genetics and Genomics. Tests were ordered by the patient's physician. The patients were primarily pediatric (1756 [88%]; mean age, 6 years; 888 females [44%], 1101 males [55%], and 11 fetuses [1% gender unknown]), demonstrating diverse clinical manifestations most often including nervous system dysfunction such as developmental delay. Whole-exome sequencing diagnosis rate overall and by phenotypic category, mode of inheritance, spectrum of genetic events, and reporting of incidental findings. A molecular diagnosis was reported for 504 patients (25.2%) with 58% of the diagnostic mutations not previously reported. Molecular diagnosis rates for each phenotypic category were 143/526 (27.2%; 95% CI, 23.5%-31.2%) for the neurological group, 282/1147 (24.6%; 95% CI, 22.1%-27.2%) for the neurological plus other organ systems group, 30/83 (36.1%; 95% CI, 26.1%-47.5%) for the specific neurological group, and 49/244 (20.1%; 95% CI, 15.6%-25.8%) for the nonneurological group. The Mendelian disease patterns of the 527 molecular diagnoses included 280 (53.1%) autosomal dominant, 181 (34.3%) autosomal recessive (including 5 with uniparental disomy), 65 (12.3%) X-linked, and 1 (0.2%) mitochondrial. Of 504 patients with a molecular diagnosis, 23 (4.6%) had blended phenotypes resulting from 2 single gene defects. About 30% of the positive cases harbored mutations in disease genes reported since 2011. There were 95 medically actionable incidental findings in genes unrelated to the phenotype but with immediate implications for management in 92 patients (4.6%), including 59 patients (3%) with mutations in genes recommended for reporting by the American College of Medical Genetics and Genomics. Whole-exome sequencing provided a potential molecular diagnosis for 25% of a large cohort of patients referred for evaluation of suspected genetic conditions, including detection of rare genetic events and new mutations contributing to disease. The yield of whole-exome sequencing may offer advantages over traditional molecular diagnostic approaches in certain patients.

Anesthesia Literature Review

Anesthesia Literature Review

Repeated Ice Water Tests and Electrical Perception Threshold Determination to Detect a Neurologic Cause of Detrusor Overactivity

To explore the added value of a repeated ice water test (IWT) and electrical perception threshold (EPT) measurement in the search for a neurologic cause of idiopathic detrusor overactivity (DOA). The IWT, if originally negative, was repeated up to three times, and EPT measurements were done in 63 patients with neurologic DOA, 117 patients with idiopathic DOA without outflow obstruction, and 30 women with stress urinary incontinence without DOA. Although the IWT was positive in 46% of the neurologic patients if used once, this percentage became 86% when the IWT was repeated. In nonneurologic patients, one IWT was positive in only 7% and when repeated, the positive test rate increased to 24%. IWT, even repeated, remained negative in the women with stress urinary incontinence. The EPTs were not significantly different between the neurologic and nonneurologic patients with a positive IWT, except after the third instillation. In those with negative IWTs, the EPTs were significantly different between the neurologic and nonneurologic patients, independent of the number of IWTs done. If the EPTs were compared within each group between those with positive and negative IWTs, the difference was not significant at the first IWT. However, the difference became statistically significant after two IWTs for the nonneurologic group and after three IWTs for both groups. Our results have shown that repeating the IWT will increase its positivity. Combining the IWT and EPT will reinforce the results of both tests and can indicate more clearly the possibility of an unsuspected neurologic pathologic finding in patients with idiopathic DOA.

Nonneurologic hand pain versus carpal tunnel syndrome: do psychological measures differentiate?

To determine whether psychological measures would differentiate a group of patients with physician-diagnosed nonneurologic hand pain from patients with carpal tunnel syndrome (CTS). Many patients, who also displayed symptoms of psychological distress, were referred to an electrodiagnostic clinic with a diagnosis of possible CTS; they subsequently had normal nerve conduction studies. Sixty patients with hand pain were referred to either of two university clinics for electrophysiologic testing, were assigned to either the CTS or nonneurologic group, and were compared on a series of psychometric tests. The Beck Depression Inventory and McGill Pain Questionnaire showed that the physician-assigned nonneurologic patients have a greater degree of depression, use more affective adjectives, and choose more words on the McGill Pain Questionnaire than the physician-assigned CTS group. The nonneurologic group also scored higher on indices of self-reported disability on the Pain Disability Inventory in five of seven categories. Although the CTS group perceived more control over their pain, no differences were observed in the types of coping strategies used on the Coping Strategy Questionnaire. Finally, the nonneurologic group had more Workers' Compensation Board claims. Evidence of important psychological issues in some patients with hand pain suggests a need for greater awareness among treating physicians.

Selective sacral cryoneurolysis in the treatment of patients with detrusor instability/hyperreflexia and hypersensitive bladder

AbstractUsing selective sacral cryoneurolysis, we treated 28 patients with detrusor instability (DI), hypersensitive bladder (HSB), or detrusor hyperreflexia (DH). A cystometrogram (CMG) was done before and after percutaneous, transsacral infiltration of a sacral nerve root with bupivacaine until a dominant root was identified as judged by a 50% or greater increase in the maximum cystometric capacity (MCC), and/or a 50% or greater decrease in the peak intravesical pressure at the time of the first unstable contraction (P1). The volume at first desire to void (VDV) was also noted. The dominant root was then blocked with a cryoprobe.In the non‐neurologic group (20), the mean MCC was increased by 61% and the mean P1 decreased by 21%. The VDV was increased significantly. Clinically, 16 out of 17 patients had good or excellent results and one had poor results when followed from 1 to 10 months. The mean duration of effect was 4.8 months. Eleven patients had repeat neurolysis, usually with comparable results. In the neurological patients (8) there was a 165% increase in mean MCC and a 40% fall in P1. In six patients followed up for 1.5–10 months the results were good or excellent in five and poor in one with a mean duration of effect of 3.6 months. Transient sensory side effects were common in the non‐neurological patients, and this combined with the need for repeat treatments may have affected patient compliance.It is concluded that selective sacral cryoneurolysis has a useful role in the management of the patient with DI/DH or HSB who has failed to respond to pharmacotherapy.

Upper gastrointestinal bleeding as a complication of intracranial disease.

✓ Review of 2206 consecutive necropsies showed evidence of hemorrhagic ulceration of the upper gastrointestinal tract in 7.2%. The incidence in patients dying from intracranial disorders was found to be twice that of those dying from all other causes (12.5% vs 6.0%). The distribution of lesions within the two groups was also different in that esophageal ulceration was more common in the neurological group (p &lt; .001), while duodenal ulcers were more common in the non-neurological group (p &lt; .001).