Possibility Of Spontaneous Recovery Research Articles

PHRENIC NERVE PALSY: A RARE CAUSE OF RESPIRATORY DISTRESS IN NEWBORN

Phrenic nerve palsy is a rare cause of respiratory distress in newborns, and often under-diagnosed, It is often accompanied by brachial plexus palsy. The possibility of spontaneous recovery should be considered before choosing surgery. This rare cause of respiratory distress of the newborn can be easily overlooked among the many common etiologies of respiratory distress of the newborn if this entity is not kept in mind and a thorough workup is not performed.We report a newborn who was admitted to the neonatal unit with respiratory distress and paresis of the right upper limb. He had a dystocia labor. Chest x-ray and ultrasound showed an elevation of the right diaphragmatic dome. The diagnosis was phrenic nerve palsy associated with brachial plexus palsy secondary to birth trauma. The newborn was treated with continuous positive airway pressure (CPAP) ventilation without surgical intervention.The outcome was favorable with spontaneous recovery at the age of 2 months.The management of this association is not yet codified.Further investigations will be necessary to develop more definitive guidelines for the treatment of this condition.

Evaluation of Role of Prognostic Factors on Hearing Outcome in Unilateral Idiopathic Sudden Onset Sensorineural Hearing Loss

Introduction: Owing to its uncertain and multiple possible etiologies, use of multiple empirical treatment regimens and possibility of spontaneous recovery, it becomes important to look for the possible prognostic factors affecting the outcome of sudden sensorineural hearing loss (SSNHL). Material and methods: This prospective observational study was conducted with the primary aim of analyzing the role of various possible prognostic factors on the outcome of idiopathic SSNHL including demographic (Age, gender), audio-vestibular (Pre-treatment hearing loss in the affected ear, hearing in the contralateral ear, time elapse between onset of hearing loss and start of treatment, type of hearing loss in term of frequencies affected), presence of tinnitus / vertigo and Comorbidities (Diabetes, Hypothyroidism & Deranged lipid profile/ dyslipidemia). Result: The absence of vertigo and tinnitus led to better hearing outcomes while raised HbA1c levels, deranged lipids and thyroid profiles adversely affected the outcome. Conclusion: Vertigo, tinnitus, raised HbA1c levels, deranged lipids and thyroid profiles are possible negative prognostic factors. Better pretreatment hearing levels in the affected and unaffected ears prompted improved recovery.

Traumatic peripheral nerve injuries: a classification proposal

BackgroundPeripheral nerve injuries (PNIs) include several conditions in which one or more peripheral nerves are damaged. Trauma is one of the most common causes of PNIs and young people are particularly affected. They have a significant impact on patients’ quality of life and on the healthcare system, while timing and type of surgical treatment are of the utmost importance to guarantee the most favorable functional recovery. To date, several different classifications of PNIs have been proposed, most of them focusing on just one or few aspects of these complex conditions, such as type of injury, anatomic situation, or prognostic factors. Current classifications do not enable us to have a complete view of this pathology, which includes diagnosis, treatment choice, and possible outcomes. This fragmentation sometimes leads to an ambiguous definition of PNIs and the impossibility of exchanging crucial information between different physicians and healthcare structures, which can create confusion in the choice of therapeutic strategies and timing of surgery.MaterialsThe authors retrospectively analyzed a group of 24 patients treated in their center and applied a new classification for PNI injuries. They chose (a) five injury-related factors, namely nerve involved, lesion site, nerve type (whether motor, sensory or mixed), surrounding tissues (whether soft tissues were involved or not), and lesion type—whether partial/in continuity or complete. An alphanumeric code was applied to each of these classes, and (b) four prognostic codes, related to age, timing, techniques, and comorbidities.ResultsAn alphanumeric code was produced, similar to that used in the AO classification of fractures.ConclusionsThe authors propose this novel classification for PNIs, with the main advantage to allow physicians to easily understand the characteristics of nerve lesions, severity, possibility of spontaneous recovery, onset of early complications, need for surgical treatment, and the best surgical approach.Level of evidence: according to the Oxford 2011 level of evidence, level 2.

Adhesive Capsulitis of Hip-A Systematic Review of Literature.

Adhesive capsulitis is clinically characterized by the gradual progressive painful loss of active and passive motion caused by the formation of adhesions of the joint capsule. Adhesive Capsulitis of the Hip (ACH) is not a well-explored clinical condition when compared to adhesive capsulitis of shoulder because of the underdiagnosis and rarity of this condition. Cochrane, Scopus, Pubmed, Embase, and Web of Science databases were searched for original studies on ACH till December 2021 following Cochrane and PRISMA guidelines. Year of publication, authors, number of cases, baseline characteristics of the studies, causes described, presentation, associated conditions, method of diagnosis, treatment to be given, functional outcomes, and complications was extracted from each study. 16 articles were included in this review. 3 of the included studies were retrospective case-control studies, 6 were case series and the remaining 7 were case reports. A total of 224 ACH cases were recorded. Pain and stiffness of the hips were the most common clinical features. Investigations like serology, radiograph, and MRI have been used to rule out other conditions. Arthrography has been used to confirm the diagnosis in 7 studies. Spontaneous recovery is expected in one to two years. Management has been in the form of physiotherapy, intra-articular injection, and arthroscopy. Literature on ACH is limited because of the rarity of the condition. The disease has a favorable prognosis with the possibility of spontaneous recovery. Physiotherapy has been the first line of management. Intractable cases require surgical intervention. The online version contains supplementary material available at 10.1007/s43465-022-00808-z.

Another look at the extinction of conditioned flavor preferences: Amount of training and tests for spontaneous recovery.

A conditioned flavor preference develops when hungry or thirsty rats experience a neutral flavor mixed in solution with a nutrient. In two sets of studies, we previously demonstrated that this learned preference is highly sensitive to flavor nonreinforcement (i.e., exposure to the flavor without the nutrient) either prior to (latent inhibition), during (partial reinforcement), or following (extinction) flavor-nutrient pairings. In each of these studies we employed a nutrient devaluation procedure to assess the integrity of specific flavor-nutrient associations following extinction, but more recently Gonzalez, Morillas, and Hall (Journal of Experimental Psychology: Animal Learning & Cognition, 42, 380-390, 2016) observed that sensitivity to extinction in thirsty rats in this preparation may depend upon use of a post-conditioning nutrient devaluation procedure. To assess the generality of our earlier results, but without including a post-conditioning nutrient devaluation phase, we assessed in three experiments the role of the number of flavor-nutrient pairings given prior to extinction and the possibility of spontaneous recovery following a 3-week delay. We observed that extinction consistently weakened the flavor preference in thirsty rats (in spite of the absence of a nutrient devaluation procedure) and also found no evidence for spontaneous recovery. These results establish that our prior findings that conditioned flavor preferences are weakened by extinction are quite robust in thirsty rats and that these extinction effects may be fairly permanent.

NEUROTOXIC EFFECT OF ASPARTAME ON THE SCIATIC NERVE OF ADULT MALE ALBINO RAT AND THE POSSIBILITY OF SPONTANEOUS RECOVERY: LIGHT AND ELECTRON MICROSCOPIC STUDY

Background: Aspartame is considered the most widely used nocaloric artificial sweetener. It is used in a variety of food products and beverages. However, the consumption of aspartame has been controversial as several studies have reported an association between its use and many serious diseases. Aim of the work: The aim of the present study was to evaluatethe potential neurotoxic effect of long duration aspartame consumption on the sciatic nerve of the adult male albino rats and the possibility of spontaneous recovery following cessation of its administration. Material and methods: Thirty adult male albino rats were used in this study, aged from 6-8 months, weighting 180 -200 gm. Rats were randomly divided into three groups: Group I: ten rats that received nothing except food and water, Group II: ten rats that received aspartame (250 mg/kg/d) for 12 weeks and Group III: ten rats that received aspartame as in group II then left for four weeks to recover. Results: The present work revealed that aspartame induced histological changes of rats’ sciatic nerves in the form of irregular nerve structure with wide separation of myelinated nerve fibers and dark elongated Schwann cells. Ultrastructural examination of group II showed separated myelin lamellae and excessive in folding with myelin loops formation. The recovery group showed histological improvement when compared to group II, yet it didn’t reach completely to the histological picture of the control group. Conclusion: The results supported the neurotoxic effect of aspartame on rats’ sciatic nerves when consumed regularly for a long period and proved that the spontaneous recovery wasn’t complete.

Coexistence of Major Complications in Pancreatic Pseudocyst: Case report

Pancreatic pseudocyst is the most common cystic lesion of the pancreas seen following acute and chronic pancreatitis in 2-10% and 10-30%, respectively. Imaging findings vary depending on the age and severity of the attack. Infection, hemorrhage and rupture are the most frightening complications. The possibility of spontaneous recovery is consider­ably low. A 63-year old male patient who has history of longstanding alcohol consumption presented to the emer­gency department with complaints of abdominal pain. On computerized tomography (CT), an encapsulated and round peripancreatic collection with a size of approximately 8.5x7.5 cm was detected in pancreatic head. In the literature, no article is published mentioning coexistence of complication such as infection, hemorrhage and rupture. We present the association of these three complications observed in our case.

Congenital Bilateral Vocal Fold Paralysis in a Two-Year-Old Girl

Congenital Bilateral Vocal Fold Paralysis in a Two-Year-Old Girl

Steroid treatment of posttraumatic anosmia

The objective of this study was to treat posttraumatic anosmia with oral steroid and evaluate its effect. One-hundred sixteen posttraumatic patients whose olfactory thresholds were -1.0 by the phenyl ethyl alcohol threshold test assembled in our department. They were treated with a course of high-dose steroid, and followed up for at least 3 months. During the latter period of this study, magnetic resonance imaging was performed to measure the volumes of olfactory bulbs and to detect subfrontal lobe damage. Among them, 19 (16.4%) patients' olfactory thresholds improved after steroid treatment, but the other 97 patients' thresholds did not change. The incidences of loss of consciousness and intracranial hemorrhage after head injury, the ratios of admission and craniotomy, the intervals between head injury and steroid treatment, the volumes of olfactory bulbs, and the incidences of subfrontal lobe damage were not significantly different between patients whose thresholds improved and those whose thresholds did not improve. However, patients with olfactory improvement were significantly younger than those who remained unchanged. Our study showed that oral steroid treatment might improve olfactory acuity in some patients with posttraumatic anosmia, but the possibility of spontaneous recovery cannot be ruled out.

Tratamiento rehabilitador en la esclerosis múltiple

To review the rehabilitation therapy and rating scales used in multiple sclerosis (MS), as well as the clinical studies conducted to evaluate the effectiveness of rehabilitation therapy and the most common symptoms.MS has a number of very specific features that will have to be taken into account when undertaking rehabilitation therapy. It is a disease that progresses in a fluctuating and unpredictable manner and, to date, there is no treatment to cure it. There is a possibility of spontaneous recovery, especially in the early stages of the disease. Evaluation of the effectiveness of rehabilitation in MS must be performed on different levels that take into account both particular aspects of rehabilitation and an overall assessment of the treatment being provided. Most studies report improvements in disability and quality of life, while deficit remains unchanged. Any improvements that are achieved tend to decline over time, which makes it necessary to perform a follow-up after rehabilitation therapy ends. Certain symptoms such as fatigue, spasticity, ataxia and sphincteric disorders will benefit from suitable pharmacological treatment applied together with the rehabilitation therapy.The value of rehabilitation therapy for MS patients lies in its ability to improve disability and the quality of life; since its effects decline over time, regular check-ups will be essential. Proving the effectiveness of rehabilitation in a heterogeneous pathology that develops progressively, such as MS, is a complex matter and further research with better designs and rating scales needs to be conducted.

How effective is therapy for childhood stuttering? Dissecting and reinterpreting the evidence in light of spontaneous recovery rates

Similar positive results (e.g. immediate decreases in stuttering frequency and a 60-80% recovery rate from stuttering) have been reported for numerous therapeutic protocols for treating childhood stuttering, many of which have been diametrically opposite in their orientations and implementations. For example, Johnson advocated indirect treatments that simply advocated refraining from drawing any negative attention to childhood disfluencies as persistent and chronic stuttering was thought to progress via negative parental reactions to normal disfluencies. In contrast, direct interventionists sought immediately to eliminate stuttered speech patterns by training 'corrected' speech models that usually involved some form of prolonged speech. However, reports from speech and language therapists around North Carolina, USA, suggest much lower recovery rates in the children they treat (i.e. 13.9% over a median therapeutic period of 3 years, which to the present authors is an indicator of therapeutic inefficiency and ineffectiveness). The discrepancy between these recovery rates calls for a re-examination of the efficacy of stuttering therapy for children, especially in light of recent statements from some therapies suggesting that therapy might be curative in nature. Spontaneous and complete recovery (removing all overt and covert markers of the pathology) occurs in 60-80% of all children who display incipient stuttering behaviours. As such, it appears that many claims of therapeutic success in children who stutter are confounded by the possibility of spontaneous recovery during the testing and intervention period. Simply put, it is impossible to discriminate between recovery that would occur naturally over time, and what may have been simply accelerated via therapy. Based on stable prevalence rates and the data in the present paper, it is suggested that therapy does little to boost recovery rates from incipient stuttering. Therapy can provide 'inhibitory' symptomatic relief with varying degrees of success with respect to decreasing stuttering severity and the need for continued therapy. However, it must be made clear that curing stuttering is not a likely outcome of therapy, although successful management can decrease the severity of the problem. It is argued that all forms of stuttering inhibition, including those at work during spontaneous recovery, are all mediated by the degree of mirror neuron engagement in the brain. It is proposed that in children who stutter, the best source of relief from stuttering is in the effective and efficient engagement of mirror neurons via methods that best replicate choral speech. In order to induce natural sounding, fluent speech, it is suggested that one uses primarily derivations of choral speech such as altered auditory feedback. Motoric techniques might also be used synergistically to provide supplementary sources of mirror neuron engagement.

Subacute, reversible motor neuron disease

Four patients with a clinical syndrome closely resembling amyotrophic lateral sclerosis recovered completely, without treatment, 5 to 12 months after onset. Electrodiagnostic tests revealed acute and chronic denervation, with normal motor and sensory nerve conduction studies. The CSF was normal, and tests for paraproteinemia, heavy metal intoxication, and systemic illness were negative. Although such cases are rare, the possibility of spontaneous recovery should always be considered when counseling patients with suspected ALS.

Cutaneous Leishmaniasis In India

Fifteen patients with cutaneous leishmaniasis were randomly selected for clinical trials with itraconazole. A single daily itraconazole dose of approximately 4 mg per 1 kg of body weight was administered to each patient with breakfast for 6 weeks. Five patients served as controls. On completion of therapy, ten cases in the study group (66.6%) were considered to be cured. No major adverse effects were reported. No significant changes were seen in the controls at the end of the study. The possibility of spontaneous recovery will be discussed in this report even though it is considered to be unlikely. Itraconazole has promising potential in cutaneous leishmaniasis therapy.

CHEST RADIOGRAPHY OF PREMATURES

The chests of 104 unselected, newborn prematures were studied by roentgenogram in the first 72 hours of life in a routine manner which yielded satisfactory roentgenograms and involved minimal disturbance of the patients. Nineteen of the infants showed clinical signs of dyspnea sufficient to suggest that they were suffering from some degree of the respiratory distress syndrome. Thirty-five of the total number presented roentgenographic pictures compatible with hyaline membrane syndrome. Twenty-five of the infants died within the first 8 days of life. Of the 23 in this fatal group who came to necropsy, 10 had hyaline membranes: Eight of these had shown during life both respiratory distress and pulmonary roentgenographic appearance of bilateral diffuse increased reticulogranularity. In statistical analyses, this association is found to be highly significant (p < 0.006). That several infants with both these abnormalities survived indicates that prematures may recover from the respiratory distress syndrome. Until the diagnosis can be established with greater certainty during life, the possibility of spontaneous recovery must be considered in the evaluation of therapeutic measures. In the individual case, a premature who has a high retraction score and pulmonary roentgenograms demonstrating increased reticulogranularity has a greater chance of dying with hyaline membrane formation than does the infant who fails to show these symptoms and signs during life.