Permanent Impairment Research Articles

Alzheimer' disease prediction and classification using CT images through machine learning.

Numerous surveys using different techniques have been conducted in recent years to accurately classify Alzheimer's disease (AD). This research emphasized the identification of AD through neuroimaging data. However, it is important to identify symptoms as soon as possible when the disease-modifying medications function best during infection before a permanent cognitive impairment develops. The use of automated algorithms to detect the early symptom of AD to this information was very important. Machine Learning (ML) has been proposed for the evaluation of various image segmentation and database techniques. In addition, Visual Geometry Group (VGG)-16 et Improved Faster Recurrent Convolutional Neural Network (IFRCNN) method developed for the ImageNet database utilizing the mathematical model based on action recognition as a feature extractor for categorization work. Experiments are being conducted on the Alzheimer's Neuroimaging Initiative (ADNI) dataset, and the proposed system achieves the 98.32 % accuracy level (Tab. 6, Fig. 4, Ref. 34). Text in PDF www.elis.sk. Keywords: mild cognitive impairment, deep learning, Alzheimer's disease, expected risk.

The Role of Physical Therapy in the Management of Rheumatoid Arthritis

Rheumatoid arthritis is a persistent and severe clinical condition that causes gradual joint degeneration, impairs quality of life, and shortens life expectancy. Even mild inflammation is responsible for causing permanent disability and impairment. Patients with rheumatoid arthritis may experience an intermittent or progressive clinical course, depending on their symptoms. The primary objective of managing rheumatoid arthritis is to relieve discomfort while avoiding joint deterioration and functional loss. Physical therapy plays a vital role in the management of rheumatoid arthritis, as physical therapy considerably supplements pharmacological therapy by enhancing the management of rheumatoid arthritis and lowering the limitations on daily life for rheumatoid arthritis patients. Among physical therapy modalities, physiotherapy treatments are frequently employed, which include hydrotherapy, electrical stimulation, and cold/hot treatments. Furthermore, it has been demonstrated that exercise training for rheumatoid arthritis patients is effective in reversing cachexia, significantly increasing function without escalating disease activity, and likely lowering cardiovascular risk. For rheumatoid arthritis patients, physical therapy, including exercise, is safe and effective. Exercise and increased physical activity have been shown to reduce disease symptoms such as pain and exhaustion, enhance physical function, and improve mental health, ultimately leading to an improved quality of life. The purpose of this research is to review the available information about the role of physical therapy in the management of rheumatoid arthritis

Clinical Profile of Ocular Chemical Injuries in a Tertiary Care Centre of Kolar, Karnataka, India: A Retrospective Study

Introduction: Ocular chemical injury is a true ophthalmic emergency which needs immediate assessment and management. They cause extensive damage to the ocular surface resulting in permanent visual impairment. The majority of victims are young and the exposure occurs at home, work place and with assaults. Aim: To analyse the clinical characteristics, grade and visual outcome in patients with ocular chemical injuries. Materials and Methods: This retrospective study was conducted on patients with chemical eye injuries who presented at Ophthalmology Department in Kolar tertiary care centre in the past five years. Medical records of 127 patients who presented from January 2017 to December 2021 with chemical eye injuries were assessed for age, gender, history of the mode of injury, pattern and grade of damage, visual outcome and treatment methods during the acute phase and at one month follow-up. Paired t-test and one-way Analysis of Variance (ANOVA) with post-hoc test was the statistical method used for analysis. Results: Out of 127 chemical injury cases, 104 (81.9%) were males and 23 (18.1%) were females. The incidence of chemical injury was found to be 51 (40.2%) in the age group of 31-45 years and 38 (29.9%) in 15-30 years with 74 (58.3%) cases affected by alkali and 27 (21.3%) cases by acids and 26 (20.4%) unknown injury. A total of 43 (34%) cases had grade I, 75 (59%) had grade II and 9 (7%) had grade III injury and the common clinical finding was conjunctival congestion in 147 (93.6%) and epithelial defect in 107 (68.1%). Significant improvement in the visual acuity was observed after the initial management and subsequently at one month follow-up (p-value<0.001). Conclusion: Male dominance and fields and workplace injuries were most common in the study. Initiation of immediate irrigation with tap water and early reporting to the hospital can reduce serious complications with early restoration of vision. It also emphasises the promotion of necessary protective measures to avoid workplace based accidental injuries.

Review of Neurofilaments as Biomarkers in Sepsis-Associated Encephalopathy.

Sepsis is a common and fatal disease, especially in critically ill patients. Sepsis-associated encephalopathy (SAE) is a diffuse brain dysfunction with acute altered consciousness, permanent cognitive impairment, and even coma, accompanied by sepsis, without direct central nervous system infection. When managing SAE, early identification and quantification of axonal damage facilitate faster and more accurate diagnosis and prognosis. Although no specific markers for SAE have been identified, several biomarkers have been proposed. Neurofilament light chain (NFL) is a highly expressed cytoskeletal component of neurofilament (NF) proteins that can be found in blood and cerebrospinal fluid (CSF) after exposure to axonal injury. NFs can be used as diagnostic and prognostic biomarkers for sepsis-related brain injury. Phosphorylation of NFs contributes to the maturation and stabilization of cytoskeletal structures, especially axons, and facilitates axonal transport, including mitochondrial transport and energy transport. The stability of NF proteins can be assessed by monitoring the expression of NF genes. Furthermore, phosphorylation levels of NFs can be monitored to determine mitochondrial axonal transport associated with cellular energy metabolism at distal axons to assess progression during SAE treatment. This paper provides new insights into the biological characteristics, detection techniques, and scientific achievements of NFs, and discusses the underlying mechanisms and future research directions of NFs in SAE.

An Assessment of the Relationship between Built Environment and Socioeconomic Factors with the Incidence of Meningococcal Meningitis in Kaduna Urban Area, Nigeria

Meningococcal meningitis is an airborne disease that has been a threat to human life in many regions of the world, especially in West Africa. The disease has caused permanent physical impairment to some of its victims and many lives have been lost due to the disease. Factors that are associated with the incidence of the disease which are geographically referenced include built environment, geographical location and climatic conditions. Others are socioeconomic and demographic factors. This study established the relationship between built environment and socioeconomic factors with the incidence of the disease. Data that were used include the incidences of the disease from 2007 to 2011, housing conditions, population density, number of house ownership, employment, income level, and the number of hospitals, schools and refuse dumps. Neighborhoods were used as the unit of analysis in the study. The method of analyzing the data includes factor analysis and some statistical techniques in Geographical Information System such as the Ordinary Least Square (OLS). The findings of the study reveal the spatial variations of the incidence of Meningococcal meningitis in Kaduna Urban Area (KUA). The study recommends that there should be strict observance of the development control regulations especially at the high density residential neighborhood. The model can also be used for other communicable disease to ensure the health of the public.

Awareness and Perceptions of University Nursing Students in Samoa Towards Childhood Hearing Impairment and Hearing Healthcare: A Cross-Sectional Study.

Pacific Islands have among the highest prevalence of pediatric hearing impairment in the world. Given the limited availability of ear and hearing specialists in the Pacific region, the broader health professional community plays a vital role in the prevention of avoidable pediatric hearing impairment. Nurses emerge as one of the ideal candidates for task-sharing in the administration of ear and hearing care at the public and primary healthcare levels. The aim of this study is to evaluate the awareness and perceptions of university nursing students in Samoa to pediatric hearing impairment and hearing healthcare. This study employed a cross-sectional study design. A 10-item questionnaire was administered to university nursing students in Samoa (N = 100). The statements aimed to evaluate perceptions towards childhood hearing impairment, as well as awareness of causal factors of permanent childhood hearing loss and available hearing healthcare. Participants were required to provide a response based on the five-point Likert scale "Strongly Agree," "Agree," "Neutral/Don't know," "Disagree," and "Strongly Disagree." Overall, 79% of participants responded "Disagree/Strongly Disagree" to the item "Hearing loss is not that important because it does not kill." Overall, 52% of respondents were aware of hearing impairment as a public health concern in Samoa. Early identification and intervention services for newborns with hearing impairment are nonexistent in Samoa, and awareness was low for the importance of early detection (62%) and amplification suitability for babies (49%). Overall, awareness was also low for causal factors of permanent sensorineural hearing loss. A borderline neutral/positive perception was found among our future nursing professionals to engage with pediatric hearing impairment in Samoa. Awareness regarding the causes of permanent childhood hearing impairment, as well as early identification and intervention services, could be integrated in the university curriculum.

A Shift Left-Based Accessibility Model for Software Development Process Improvement

Accessibility modifications are required for individuals with situational, temporary, or permanent impairments to properly interact with web applications. Incorporating accessibility guidelines, such as the Web Content Accessibility Guidelines (WCAG), into software development, along with the software development life cycle and other paradigms, poses challenges. The linear progression of steps in a conventional software development process leads to the identification of problems at a later stage because testing is typically conducted toward the end. Limited attention to accessibility until the final development phase results in prolonged efforts, increased resource allocation, and higher expenses to address accessibility issues. Consequently, numerous software applications remain inaccessible to users with impairments. This study focuses on a Shift Left-based model to improve accessibility in the software development process. Employing the Shift Left a11y Model that emphasizes early integration for accessibility and coupling it with the Extreme Programming Development Life Cycle would enhance the integration of various testing practices and facilitate the development of software that is accessible to all users, including those with impairments. Keywords: Accessibility, accessible software, shift-left, model, methodology for accessible software

Medications Damaging Retinal Pigment Epithelium and Photoreceptor Complex-4: Pathogenesis, Diagnosis, and Treatment (Dideoxynosine, MEK Inhibitors, Sildenafil, Corticosteroids, Poppers/Alkyl Nitrate, Cisplatin, Carmustine)

Systemic, topical, and intravitreal medications could induce retinal toxicity. Disruption of the retina and retinal pigment epithelium, vascular damage, cystoid macular edema, retinal folds, crystalline retinopathy, uveitis, and miscellaneous are patterns of retinal toxicity. Medications that could generate permanent impairment, and damage RPE and photoreceptor cells are significant. This article outlines pathogenesis, current diagnosis, and treatments of widely used dideoxyinosine, MEK inhibitors, sildenafil, corticosteroids, poppers/alkyl nitrate, cisplatin, and carmustine causing RPE and photoreceptor cells damage.

Das soziale Gehirn – 2. Bedeutung von erworbenen Hirnschädigungen für das Sozialverhalten: Klinik, Diagnostik und Therapie

Nach erworbenen Hirnschädigungen führen Störungen der sozialen Kognition und der sozialen Kompetenz häufig zu erheblichen Einschränkungen in der sozialen Teilhabe, zu sozialem Rückzug und Isolation. Infolge erhöhter Morbidität und Mortalität sind diese Störungen auch sozialmedizinisch relevant. Allerdings besteht ein Mangel sowohl an Diagnostik als auch an Angeboten therapeutischer oder rehabilitativer Interventionen. Die vorliegende Literaturübersicht plädiert nach einem Überblick über die Studienlage für eine systematischeren Erfassung von Störungen der sozialen Kognition und Kompetenz nach erworbener Hirnschädigung sowie für die Entwicklung und Überprüfung weiterer therapeutische Interventionen zu ihrer Behandlung. Schlüsselwörter: soziale Kognition, soziale Kompetenz, erworbene Hirnschädigung, Schädel-Hirn-Trauma, Schlaganfall, Teilhabe, Rehabilitation

Recent Revisions to Chapter 13 for the AMA Guides, Sixth Edition, 2023

Abstract The sixth edition (2023) of the AMA Guides® to the Evaluation of Permanent Impairment (AMA Guides) adopted the terminology and conceptual framework of disablement as put forward by the International Classification of Functioning, Disability, and Health. The sixth edition focuses on diagnosis-based impairments (6th ed, 2). In the AMA Guides, Sixth Edition (2008), Chapter 13, The Central and Peripheral Nervous System, had significant rating-process discrepancies with other chapters. This article identifies the discrepancies and explains the revisions made to Chapter 13 and its new title of “The Nervous System,” so that it is congruent with other chapters in the AMA Guides.

PSIs of EEG with Refined Frequency Decomposition Could Prognose Motor Recovery Before Rehabilitation Intervention.

Stroke often leads to permanent impairment in motor function. Accurate and quantitative prognosis of potential motor recovery before rehabilitation intervention can help healthcare centers improve resources organization and enable individualized intervention. The context of this paper investigated the potential of using electroencephalography (EEG) functional connectivity (FC) measures as biomarkers for assessing and prognosing improvement of Fugl-Meyer Assessment in upper extremity motor function (ΔFMU) among participants with chronic stroke. EEG data from resting and motor imagery task were recorded from 13 participants with chronic stroke. Three functional connectivity methods, which were Pearson correlation measure (PCM), weighted Phase Lag Index (wPLI) and phase synchronization index (PSI), were investigated, under three regions of interest (inter-hemispheric, intra-hemispheric, and whole-brain), in two statues (resting and motor imagery), with 15 refined center frequencies. We applied correlation analysis to identify the optimal center frequencies and pairs of synchronized channels that were consistently associated with ΔFMU. Predictive models were generated using regression analysis algorithms based on optimized center frequencies and channel pairs identified from the proposed analysis method, with leave-one-out cross-validation. We found that PSI in the Alpha band (with center frequency of 9Hz) was the most sensitive FC measures for prognosing motor recovery. Strong and significant correlations were identified between the predictions and actual ΔFMU scores both in the resting state (R2=0.79, P<0.001, N=13) and motor imagery (R2=0.65, P<0.001, N=13). Our results suggested that EEG connectivity measured with PSI in resting state could be a promising biomarker for quantifying motor recovery before motor rehabilitation intervention.

Evaluation of skin natural change function in split-thickness skin graft

Treatment for severe burns has improved rapidly in the last 20 years. Nowadays, patients can survive with burns covering up to approximately 90% of the body, although they often face permanent physical impairment. This type of research is a literature review. A literature review was conducted to gather information regarding the evaluation of skin natural change function in the split-thickness skin graft. This research is a type of review article that aims to obtain information about acne based on bio-markers. Source of data used secondary sources. The method of data collection through collecting data was from research articles taken within the last five years. Skin grafting remains an essential step on the reconstructive surgeon ladder. Meanwhile, the basic premise has remained similar results over the years. New techniques and devices have contributed to significantly improved functional and aesthetic results. Advances in the production of skin substitutes have provided better options to treat patients and will continue to be an essential and dynamic component of this field in the future.

IL-4 induces reparative phenotype of RPE cells and protects against retinal neurodegeneration via Nrf2 activation

Retinal degeneration is a kind of neurodegeneration characterized by progressive neuronal death and dysfunction of retinal pigment epithelium (RPE) cells, leading to permanent visual impairment. It still lacks effective therapeutic options and new drugs are highly warranted. In this study, we found the expression of IL-4, a critical regulator of immunity, was reduced in both patients and mouse models. Importantly, exogenous intravitreal IL-4 application could exert a novel neuroprotective effect, characterized by well-preserved RPE layer and neuroretinal structure, as well as amplified wave-amplitudes in ERG. The RNA-seq analysis revealed that IL-4 treatment suppressed the essential oxidative and pro-inflammatory pathways in the degenerative retina. Particularly, IL-4 upregulated the IL-4Rα on RPE cells and induced a reparative phenotype via the activation of Nrf2 both in vitro and in vivo. Furthermore, the Nrf2-/- mice displayed no recovery in response to IL-4 application, highlighting a significant role of Nrf2 in IL-4-mediated protection. Our data provides evidence that IL-4 protects against retinal neurodegeneration by its antioxidant and anti-inflammatory property through IL-4Rα upregulation and Nrf2 activation in RPE cells. The IL-4/IL-4Rα-Nrf2 axis maybe the potential targets for the development of novel therapies for neurodegenerative diseases.

Sensory change and recovery of infraorbital area after zygomaticomaxillary and orbital floor fractures.

To compare the sensory change and recovery of infraorbital area associated with zygomaticomaxillary and orbital floor fractures and their recoveries and investigate the factors that affect them. We retrospectively reviewed 652 patients diagnosed with zygomaticomaxillary (n= 430) or orbital floor (n= 222) fractures in a single center between January 2016 and January 2021. Patient data, including age, sex, medical history, injury mechanism, Knight and North classification (in zygomaticomaxillary fracture cases), injury indication for surgery (in orbital floor cases), combined injury, sensory change, and recovery period, were reviewed. The chi-square test was used for statistical analysis. Orbital floor fractures occurred more frequently in younger patients than zygomaticomaxillary fractures (p< 0.001). High-energy injuries were more likely to be associated with zygomaticomaxillary fractures (p< 0.001), whereas low-energy injuries were more likely to be associated with orbital floor fractures (p< 0.001). The sensory changes associated with orbital floor and zygomaticomaxillary fractures were not significantly different (p= 0.773). Sensory recovery was more rapid and better after orbital floor than after zygomaticomaxillary fractures; however, the difference was not significantly different. Additionally, the low-energy group showed a higher incidence of sensory changes than the high-energy group, but the difference was not statistically significant (p= 0.512). Permanent sensory changes were more frequent in the high-energy group, the difference was statistically significant (p= 0.043). The study found no significant difference in the incidence of sensory changes associated with orbital floor and zygomaticomaxillary fractures. In case of orbital floor fractures and high-energy injuries, the risk of permanent sensory impairment should be considered.

Biomechanics in crutch assisted walking

Crutch-assisted walking is very common among patients with a temporary or permanent impairment affecting lower limb biomechanics. Correct crutches’ handling is the way to avoid undesired side effects in lower limbs recovery or, in chronic users, upper limbs joints diseases. Active exoskeletons for spinal cord injured patients are commonly crutch assisted. In such cases, in which upper limbs must be preserved, specific training in crutch use is mandatory. A walking test setup was prepared to monitor healthy volunteers during crunch use as a first step. Measurements were performed by using both a motion capture system and instrumented crutches measuring load distribution. In this paper, we present preliminary tests results based on different subjects - having a variety of anthropometrical characteristics - during walking with parallel or alternate crutches, the so-called three and two-points strategies. Tests results present inter and intra subject variabilities and, as a first goal, influencing factors affecting crutch loads have been identified. In the future we aim to address crutch use errors that could lead to delayed recovery or upper limbs suffering in patients, giving valuable information to physicians and therapists to improve user’s training.

Is It Possible to Analyze Kidney Functions, Electrolytes and Volemia Using Artificial Intelligence?

Markers used in everyday clinical practice cannot distinguish between the permanent impairment of renal function. Sodium and potassium values and their interdependence are key parameters in addition to volemia for the assessment of cardiorenal balance. The aim of this study was to investigate volemia and electrolyte status from a clinical cardiorenal viewpoint under consideration of renal function utilizing artificial intelligence. In this paper, an analysis of five variables: B-type natriuretic peptide, sodium, potassium, ejection fraction, EPI creatinine-cystatin C, was performed using an algorithm based on the adaptive neuro fuzzy inference system. B-type natriuretic peptide had the greatest influence on the ejection fraction. It has been shown that values of both Na+ and K+ lead to deterioration of the condition and vital endangerment of patients. To identify the risk of occurrence, the model identifies a prognostic biomarker by random regression from the total data set. The predictions obtained from this model can help optimize preventative strategies and intensive monitoring for patients identified as at risk for electrolyte disturbance and hypervolemia. This approach may be superior to the traditional diagnostic approach due to its contribution to more accurate and rapid diagnostic interpretation and better planning of further patient treatment.

Emergency Department visits due to firework accidents in the Reykjavik capital area from 2010 to 2022

Public use of fireworks is widespread in Iceland, and unfortunately associated with injuries. No prior comprehensive research has been done on firework accidents in Iceland. The goal of this study was to gather information about the extent, cause, and impact of firework accidents in the Reykjavik capital area. Text search was conducted in medical records to find visits to the Emergency Department (ED) resulting from fireworks accidents over the period December 2010 to January 2022. Medical records were reviewed for details of events and injury. Over the period 248 patients came to the ED after a firework related injury, 73% male. The age range was from 9 months to 79 years of age. Children were 114, 12 were younger than 6 years. There where overall 54 secondary accidents. In total 96 (39%) accidents were traced to a faulty firework. Rockets caused the most accidents 56 (23%), cakes 43 (17%) and handheld candles 32 (13%). Type of firework was not reported in 62 (25%) cases. 157 sustained a burn injury, of which 104 where on hands. Eye injury was found on 67 patients and 97 individuals had open wounds. 22 where admitted to the hospital for a total of 91 days. Nobody died but at least 13 sustained permanent physical impairment due to fireworks. Over the past decade, 21 patients on average presented to the ED annually with firework injury. 73% of those injured by fireworks are male. Children make up one half of the injured and one child 5 years of age or younger sustains a firework injury every year on average. Preventive measures against firework accidents should be expanded and more restrictive regulations on their use should be considered.

Practical measures for disabled’s empowerment- Time for economic growth!

The objective of this paper is to advocate for Persons with disabilities’ (PWD) rights, to discuss issues solutions, social awareness and to promote diversity and inclusion. &#x0D; The word ‘Disability’ covers a wide range of irreversible permanent impairments including physical and mobility difficulties, hearing, visual impairment, specific learning disabilities including dyslexia, medical conditions and mental health problems that may hinder their full and effective participation in society on an equal basis with others.1 Handicap is the condition of being unable to perform due to physical or mental unfitness.

Pharmacogenetics and pharmacogenomics in glaucoma therapeutics: the way to personalized therapy.

Pharmacogenetics and pharmacogenomics in glaucoma therapeutics: the way to personalized therapy.

Microvascular decompression in trigeminal neuralgia - a prospective study of 115 patients

BackgroundTrigeminal neuralgia is a severe facial pain disorder. Microvascular decompression is first choice surgical treatment of patients with classical TN. There exist few prospective studies with an independent evaluation of efficacy and complications after MVD.ObjectivesWe aimed to assess outcome and complications after microvascular decompression from our center.MethodsWe prospectively recorded clinical characteristics, outcome, and complications from consecutive patients with either classical or idiopathic (only patients with a neurovascular contact) trigeminal neuralgia undergoing microvascular decompression. Neurovascular contact was evaluated by 3.0 Tesla MRI. Patients were assessed before and 3, 6, 12, and 24 months after surgery by independent assessors.ResultsOf 115 included patients, 86% had a clinically significant outcome (i.e., BNI I – BNI IIIb). There was a significant association between an excellent surgical outcome and the male sex (OR 4.9 (CI 1.9–12.8), p = 0.001) and neurovascular contact with morphological changes (OR 2.5 (CI 1.1–6.0), p = 0.036). Significantly more women (12/62 = 19%) than men (2/53 = 4%) had a failed outcome, p = 0.019. The most frequent major complications were permanent hearing impairment (10%), permanent severe hypoesthesia (7%), permanent ataxia (7%), and stroke (6%). Most patients (94%) recommend surgery to others.ConclusionMicrovascular decompression is an effective treatment for classical and idiopathic (only patients with a neurovascular contact) trigeminal neuralgia with a high chance of a long-lasting effect. The chance of an excellent outcome was highest in men and in patients with classical trigeminal neuralgia. Complications are relatively frequent warranting thorough patient evaluation and information preoperatively.Trial registrationClinical.trials.gov registration no. NCT04445766.