Presence Of Neurological Disorders Research Articles

Clinical predictors of late left ventricle recovery in tako-tsubo syndrome

Abstract Funding Acknowledgements None. Introduction Tako-Tsubo syndrome (TTS) or stress cardiomyopathy is characterized by transient dysfunction of the left ventricle (LV) and a clinical presentation that can mimic an acute coronary syndrome. Recovery from contraction abnormalities may occur hours to weeks after the acute event. Although traditionally considered a disease with a favorable prognosis, it has been observed to have a complication rate during hospitalization similar to acute myocardial infarction and a significant mortality rate during follow-up (greater than 5% per patient-year). The recovery time of LV function has demonstrated important prognostic value. Purpose The aim of this work was to determine the clinical predictors of late left ventricular recovery in TTS. Methods Data from the multicenter national registry on Takotsubo Syndrome (RETAKO) were utilized. Clinical, laboratory, echocardiographic, and other imaging test characteristics, as well as events during hospitalization and follow-up, were collected. Recovery within the first days after the acute event was considered early recovery. Patients who died within the first 10 days after the acute event were excluded. Results A total of 1,463 patients were analyzed, of whom 373 (25.5%) had late recovery. The mean age was 71 years, and 86.6% were women. In the late recovery group, factors more common were age over 75 years, male gender, neurological disease, lung disease, peripheral arterial disease, active cancer, physical trigger, initial presentation as dyspnea or syncope, presence of shock, greater left ventricular dysfunction at diagnosis, and higher levels of proBNP. In multivariate analysis, the presence of neurological disease, active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger were associated with late recovery. Conclusions Patients with TTS showing late recovery of LV function have different clinical characteristics and disease presentation compared to those with early recovery. Late recovery was associated with the presence of neurological disease or active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger.

Early Detection of Parkinson Disease Throughbiomedical Speech and Voice Analysis

Parkinson's disease, widely recognized as a neurodegenerative condition characterized by subtle changes in voice, has spurred an investigation into voice analysis for diagnostic purposes. This study is dedicated to the early detection of Parkinson's disease through a comprehensive examination of biomedical speech attributes. Parameters such as fundamental frequency range, jitter, shimmer, noise-to-harmonics ratio, and features derived from nonlinear analysis are considered, alongside variables like status, indicating the presence of neurological disorders, and class for classification purposes. Together, these attributes provide a detailed representation of voice signals, offering valuable insights into both neurological and voice disorders for research purposes. The dataset exhibits promising potential for applications in medical diagnostics and voice analysis. In the pursuit of accurate disease detection, various machine learning methodologies are employed, including Support Vector Machines (SVM), Random Forest (RF), Decision Tree (DT), Neural Networks (NN), and state- of-the-art Convolutional Neural Networks (CNNs). The incorporation of CNNs is pivotal, signifying a significantleap in accuracy of 100%for disease detection. The results showcase a model adept at discerning subtle changesassociated with Parkinson's disease, with SVM achieving 96%, Decision Tree demonstrating a perfect 100%, Neural Network attaining 98%, and Random Forest showcasing an accuracy of 99%. This innovative approach not only transforms early Parkinson's disease identification through voice analysis, setting a precision benchmark, but also underscores the transformative potential of cutting-edge technologies in healthcare practices. The study positions the model as a reliable diagnostic tool, capable of advancing medical diagnosticsthrough the seamless integration of biomedical research and machine learning, contributing to the broader fieldof neurodegenerative disease diagnostics.

Neurophysiological approach to the assessment of spinal cord function in kyphotic spinal deformity

The results of a comprehensive (clinical-radiological and neurophysiological) study performed in two clinical groups of patients (n = 64) with kyphotic spinal deformity of II–IV degree of severity of the thoracic and lumbar spine of various etiologies were analysed. With the progression of kyphotic spine deformity, the spinal cord (SC) located inside the spinal canal becomes involved in the pathological process. This period of dysfunction is preceded by a state of latent SM changes that are not detected clinically (prodromal period). The presence of neurological disorders is considered as a factor of increased risk of intra- and postoperative complications in the surgical treatment of kyphosis. Based on the registration and analysis of the parameters of somatosensory evoked potentials and motor responses during transcranial magnetic stimulation, electrophysiological signs of sensorimotor insufficiency of the SС nerve tracts were revealed, which correlate with the kyphotic arch value. The established electrophysiological criteria allow to verify the level of conductive lesion at the level of thoracic and lumbar SC segments, to determine its severity, to monitor recovery processes and to predict the functional outcome.

Alteration of intracerebral metabolites and subjective sleepiness by acute caffeine administration in adults.

Caffeine is the most widely consumed psychostimulant. Despite this, the effects of acute caffeine intake on brain metabolite levels remain largely unknown. We aimed to investigate the effect of acute caffeine intake on brain metabolite concentrations in different caffeine consumption habit groups and to explore the association between metabolite changes and sleepiness. Forty-five healthy adults were divided into groups based on their daily caffeine consumption: ≥1 cup/day, <1 cup/day, and no consumption. The exclusion criteria were the presence of neurological disorder, habitual consumption of mind-altering substances, and individuals who were unable to undergo magnetic resonance imaging. Mescher-Garwood point resolved spectroscopy and conventional spectroscopy data were acquired at 3 Tesla from voxels in the thalamus and posterior cingulate cortex (PCC). Subjective sleepiness was measured with the Karolinska Sleepiness Scale. The results of two-way repeated measures analysis of variance indicated a significant interaction effect between time and group for glutamate, glycerylphosphocholine and phosphocholine (GPC + PCH), myo-inositol, glutamate + glutamine (Glx), and creatine and phosphocreatine (Cr + PCr) of the thalamus (all P<0.01), and glutamate (P<0.0001), GPC + PCH (P=0.016), and Glx (P<0.0001) of the PCC. The change between pre- and post-caffeine intake results with significant reductions in γ-aminobutyric acid-positive macromolecule (GABA+) (thalamus, P=0.011), Glx (thalamus, P=0.002), glutamate (PCC, P<0.0001), and significant increments in GPC + PCH (thalamus, P=0.012 and PCC, P<0.0001), myo-inositol (thalamus, P=0.009), and Glx (PCC, P<0.0001). The change among the groups, with the ≥1 cup/day was significantly higher than the <1 cup/day or no consumption for glutamate (PCC, P=0.028), GPC (thalamus, P=0.001; PCC, P=0.026), and Cr + PCr (PCC, P=0.035); ≥1 cup/day was significantly lower than <1 cup/day and no consumption for glutamate (thalamus, P<0.0001), Cr + PCr (thalamus, P=0.003), Glx (thalamus, P=0.014), and myo-inositol (PCC, P=0.009). Bivariate correlation analysis revealed that GABA+ in the thalamus voxel (r=-0.7676; P<0.0001) was negatively correlated with subjective sleepiness. Higher caffeine consumption had a significant impact on brain metabolites. Magnetic resonance spectroscopy was sensitive in measuring brain metabolite fluctuations after caffeine intake, particularly the levels of GABA+ in the thalamus, which was significantly correlated with sleepiness.

Early detection of neurodevelopmental disorders in African children living in informal settlements in Nairobi

BackgroundChildren in low-income and middle-income countries (LMICs) are at a substantially increased risk of delayed physical, emotional and sociocognitive outcomes, with consequential neurodevelopmental disorders. Evidence based, cost-effective and culturally appropriate...

Neuroprognostication value of serum neurofilament light chain for out-of-hospital cardiac arrest: A systematic review and meta-analysis.

Neurofilament light chain (NfL) is a novel biomarker for the assessment of neurological function after cardiac arrest (CA). Although meta-analysis has confirmed its predictive value, it has not conducted a more detailed analysis of its research. We conducted a meta-analysis to evaluate the relationship between serum NfL level and neurological prognosis in patients with spontaneous circulation recovery after CA, and subgroup analysis was conducted according to sample collection time, time to assess neurological function, study design, whether TTM was received, the method of specimen determination, and the presence of neurological disease in patients. To analyze the influence of these factors on the predictive value of serum NfL. Published Cochrane reviews and an updated, extended search of MEDLINE, Cochrane Library, Embase, Scopus, ClinicalKey, CINAHL, and Web of Science for relevant studies until March 2022 were assessed through inclusion and exclusion criteria. The standard mean difference and 95% confidence interval were calculated using the random-effects model or fixed-effects model to assess the association between one variable factor NfL level and the outcome of CA patients. Subgroup analysis according to sample collection time was performed. The prognosis analysis and publication bias were also assessed using Egger's and Begg's tests. Among 1209 related articles for screening, 6 studies (1360 patients) met the inclusion criteria and were selected for meta-analysis. The level of serum NfL in the good prognosis group (CPC1-2, CPC: cerebral performance category score) was significantly lower than that in the poor prognosis group (CPC3-5)SMD(standardized mean difference) = 0.553, 95%CI(confidence interval) = 0.418-0.687, I2 = 65.5% P<0.05). And this relationship also exists at each sampling time point (NfL specimens were collected on admission: SMD:0.48,95%CI:0.24-0.73; Samples were collected 24 hours after CA: SMD:0.60,95%CI:0.32-0.88;Specimens were obtained 48 hours after CA: SMD:0.51, 95%CI:0.18-0.85;Specimens were obtained 72 hours after CA: SMD:0.59, 95%CI:0.38-0.81). NfL may play a potential neuroprognostication role in postcardiac arrest patients with spontaneous circulation, regardless of when the sample was collected after CA.

The role of ASA score and Charlson comorbidity index in predicting in-hospital mortality in geriatric hip fracture patients.

We aimed to determine the role of American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index (CCI) in determining in-hospital mortality and other factors associated with mortality in patients over 65 years of age who underwent surgery for hip fracture during our study, including the COVID-19 process. Between January 1st, 2020, and December 31st, 2021, 200 patients over 65 years of age who underwent hemiarthroplasty or internal fixation for hip fracture after low-energy trauma were retrospectively evaluated. Of the 200 patients included in the study, 130 were female and 70 were male. The median ASA score was 3 (IQR: 2-3), and the median CCI was 3 (IQR: 5-7). Forty-two of 137 (68.5%) patients with intertrochanteric fractures and 22 of 63 (31.5%) patients with femoral neck fractures (34.4%) died. The median time to surgery was 4 days (IQR: 3-6). Among chronic diseases, cardiac pathologies were the most common (57%, n=114). There were statistically significant differences in ASA scores (p=0.0001 [z=-5.472]), CCI scores (0.0001 [z=-6.156]), presence of cardiac disease [p=0.0001 (χ²=32.155)] and presence of neurological disease [p=0.045 (χ²=4.007)] compared to mortality. ASA and CCI scores were significantly higher in people with mortality. As a result of the multivariate model established with these factors, which were found to be significant in univariate analyses, only the presence of cardiac disease (p=0.0001) and the increase in CCI scores (p=0.0001) were found to have a statistically significant increasing effect on mortality. CCI and cardiac pathology were associated with mortality. The type of hip fracture, surgical method, and anesthesia method were not associated with mortality.

Comorbidities associated with COVID-19 mortality in adults in Lima, Peru: a retrospective cohort study.

Motivation for the study. During the COVID-19 pandemic, the mortality rate from this disease was higher in adults and the elderly. Therefore, it is important to identify the factors that were associated with mortality from COVID-19 in adults, by age group. Main findings. Chronic neurological disease, kidney disease, liver disease, and cancer increased the risk of dying from COVID-19 in the three age groups we analyzed, which were made up of hospitalized patients from Lima and Callao. The risk of mortality associated with comorbidities was higher in patients aged 18 to 29. Implications. This study helps to identify the groups of patients with the highest risk of death from COVID-19, according to age group and type of comorbidity. . To evaluate comorbidities associated with mortality in adult patients hospitalized due to COVID-19 in hospitals in Lima and Callao. In this retrospective cohort study, we analyzed data from adult patients hospitalized due to COVID-19 reported to the National Epidemiological Surveillance System of the Peruvian Ministry of Health from March to October 2020. We estimated relative risks with 95% confidence intervals using Poisson regression models with robust variance to assess comorbidities associated with mortality by age group: young adults (18-29 years), adults (30-59 years) and older adults (≥60 years). We included 2366 young adults, 23,781 adults and 25,356 older adults. Older adults had the highest mortality (63.7%) compared to adults (27.1%) and young adults (8.5%). Regardless of age group, the presence of neurological disease, renal disease, liver disease, and cancer was associated with an increased risk of mortality. Additionally, cardiovascular disease was also a risk factor in young adults; obesity, diabetes, cardiovascular disease, chronic lung disease, and immunodeficiency in adults; and obesity and chronic lung disease in the elderly. Regardless of age groups, individuals with chronic neurologic disease, renal disease, liver disease, and cancer were at high risk of death from COVID-19.

Factors associated with postural balance in patients with end-stage renal disease on hemodialysis

BackgroundPatients with end-stage renal disease on hemodialysis have postural balance impairments due to uremic syndrome and hemodialysis complications. This study evaluated the factors associated with postural balance in patients on hemodialysis. MethodsThis cross-sectional study included patients on hemodialysis [n = 93, 62.0 (16.0) years]. Postural balance was evaluated using a force plate in a static position with eyes opened and eyes closed on a firm surface and with eyes opened on a foam surface to register the center of pressure path length. Physical function was assessed by isometric handgrip force, the 5-repetition sit-to-stand test, and gait speed. The level of physical activity and quality of life were evaluated by accelerometry and the 36-Item Short Form Health Survey, respectively. FindingsAfter adjustment for potential confounders, the multiple linear regression analysis showed that the presence of diabetes mellitus and neurological disease and gait speed were significantly associated with the center of pressure path length in the eyes opened test (R2 = 0.263; p < 0.001). The center of pressure path length in the eyes closed test was significantly associated with the presence of neurological disease (R2 = 0.177; p = 0.002). The center of pressure path length in the eyes opened on a foam surface test was significantly associated with the presence of diabetes mellitus (R2 = 0.223; p < 0.001). InterpretationPoor postural balance was associated with the presence of diabetes mellitus and neurological disease and a slower gait speed in patients on hemodialysis.

Riga-Fede disease: a review of the literature and a description of clinical cases

Relevance. Riga-Fede disease (RFD) is a rare pathology that develops as a result of trauma to the mucous membrane of the tongue ventral surface with sharp edges of natal, neonatal or primary teeth erupting in time and manifests in the form of erosion or sublingual fibrous lesion with an ulcerated surface.Purpose. To analyze the literature and present our own RFD clinical cases.Material and methods. A search was performed of articles published in 2001-2023 on the research topic in the main scientific literature databases (PubMed, E-library, Google Scholar, etc.). We analyzed the data from 68 publications and presented three of our own clinical cases of RFD in children aged 5, 6 and 9 months.Results. Analysis of literature data revealed different approaches to the diagnosis and treatment of RFD in children. The diagnosis of RFD should rely on the clinical picture and exclude additional trauma to children by histological examination and lesion excision. Pronounced tooth mobility, ineffective infant feeding and the presence of neurological diseases in patients were the main indications for the extraction of teeth, which caused RFD development. In the absence of tooth mobility, non-surgical treatment methods should be preferable. In the presented clinical cases, erupted primary teeth caused BRF. In two cases, the treatment consisted of smoothing the sharp edges of the teeth and restoration with glass ionomer cement; in one case, a child with a neurological disease experienced extraction of lower central incisors. In all cases, recovery was within 3-4 weeks.Conclusion. Once clinically diagnosed with RFD, treatment method choice should consider tooth mobility and the child's overall health.

Assessing sensory complaints in the outpatient clinic: predicting neurologic disease versus idiopathic sensory phenomena (S49.006)

<h3>Objective:</h3> To determine which features of sensory complaints can predict the presence of neurologic disease in the outpatient setting. <h3>Background:</h3> Sensory symptoms are common chief complaints in the neurology outpatient clinic. Not all cases are due to neurologic disease. Clinicians should risk stratify patients to determine whether additional testing is warranted. We hypothesized that predictors of neurologic disease (ND) rather than idiopathic sensory phenomena (ISP) would include numbness rather than paresthesias, persistent rather than intermittent symptoms, and focal rather than generalized symptoms. <h3>Design/Methods:</h3> Outpatient visits between 2015–2018 were queried for mentions of the keywords “tingling”, “numbness”, and “paresthesia”. Adult patients with at least one year of follow-up were included. Pre-existing neurologic conditions or prior neuroimaging/electrophysiologic studies were exclusionary. We extracted demographic data and the following symptom features: symptom quality (numbness, tingling), timing (intermittent, persistent), location (generalized, focal, bilateral limbs), and exam findings (normal, abnormal). Patients were categorized as having either ISP or ND based on ICD 10 codes. Relationships between presenting features and odds of ND were evaluated by logistic regression, controlling for demographic variables. <h3>Results:</h3> A total of 1819 cases were reviewed, of which 72 cases were included. Fifty-five patients had ND and seventeen had ISP. Categories of ND included: neuromuscular (53%), demyelinating (19%), headache (12%), and other (15%). The presence of focal symptoms, at least one concerning historical feature, or abnormal exam increased the odds of ND (OR 5.27, p=0.012; OR 21.0, p=0.006; OR 14.9, p=0.005; respectively). Symptom quality and timing were not independently associated with ND. When considering all symptom features and exam together, only abnormal exam was associated with ND (OR 32.13, p=0.011). <h3>Conclusions:</h3> This study quantifies the relative importance of historical features and exam findings that physicians typically consider when evaluating sensory complaints. Focal symptoms and abnormal exam most strongly predict presence of ND and should prompt further workup. <b>Disclosure:</b> Dr. Zuroff has received personal compensation in the range of $500-$4,999 for serving as a Speaker with EMD Serono. Miss Alexis has nothing to disclose. Dr. Do has nothing to disclose.

The Specificities of Thrombotic Thrombocytopenic Purpura at Extreme Ages: A Narrative Review.

Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy (TMA) related to a severe ADAMTS13 deficiency, the specific von Willebrand factor (VWF)-cleaving protease. This deficiency is often immune-mediated (iTTP) and related to the presence of anti-ADAMTS13 autoantibodies that enhance its clearance or inhibit its VWF processing activity. iTTP management may be challenging at extreme ages of life. International cohorts of people with TTP report delayed diagnoses and misdiagnoses in children and elderly people. Child-onset iTTP shares many features with adult-onset iTTP: a female predominance, an idiopathic presentation, and the presence of neurological disorders and therapeutic strategies. Long-term follow-ups and a transition from childhood to adulthood are crucial to preventing iTTP relapses, in order to identify the occurrence of other autoimmune disorders and psychosocial sequelae. In contrast, older iTTP patients have an atypical clinical presentation, with delirium, an atypical neurological presentation, and severe renal and cardiac damages. They also have a poorer response to treatment and prognosis. Long-term sequelae are highly prevalent in older patients. Prediction scores for iTTP diagnoses are not used for children and have a lower sensitivity and specificity in patients over 60 years old. ADAMTS13 remains the unique biological marker that is able to definitely confirm or rule out the diagnosis of iTTP and predict relapses during follow-ups.

Sex, Age, and Comorbidities Are Associated with SARS-CoV-2 Infection, COVID-19 Severity, and Fatal Outcome in a Mexican Population: A Retrospective Multi-Hospital Study.

People with comorbidities and the male sex are at a higher risk of developing severe COVID-19. In the present study, we aim to investigate the associated factors for infection, severity, and death due to COVID-19 in a population from Nuevo León, México. Epidemiological COVID-19 data were collected from 65 hospitals from December 2020 to May 2022. A total of 75,232 cases were compiled from which 25,722 cases were positive for SARS-CoV-2. Male sex, older age, diabetes, obesity, and hypertension were associated with infection. In addition to the above-mentioned factors, renal disease, cardiovascular disease, and immunosuppression were found to be associated with increased COVID-19 severity. These factors, as well as neurological diseases, are also associated with death due to COVID-19. When comparing the different variants of SARs-CoV-2, the variant B1.1.519 increased the probability of death by 2.23 times compared to the AY.20 variant. Male sex, older age, diabetes, obesity, and hypertension are associated with SARS-CoV-2 infection, severity, and death. Along with the aforementioned comorbidities, renal disease, cardiovascular disease, and immunosuppression are also associated with severity and death. Another factor associated with death is the presence of neurological disease. The SARS-CoV-2 B1.1.519 variant increases the odds of death compared to the SARS-CoV-2 AY.20 variant.

Fitness to re-join job: Neuropsychiatric perspective.

Evaluating "Fitness to Re-join Job" and certification in persons with Neuro-Psychiatric Disorders is an indispensable professional responsibility. However, there is little documented guidance on clinically approaching this particular issue. This study aimed to study the sociodemographic, clinical, and employment profile of patients who sought fitness to re-join their job from the tertiary neuropsychiatric center. This study was carried out at the National Institute of Mental Health and Neurosciences in Bengaluru, India. A retrospective chart review was adapted for the purpose. One hundred and two case files referred to medical board for fitness to rejoin the duty were reviewed from January 2013 to December 2015. Apart from the descriptive statistics, the Chi-square test or Fisher exact test was used to test the association between categorical variables. Patients' mean (standard deviation) age was 40.1 (10.1) years; 85.3% were married, and 91.2% were male. Common reasons for seeking "fitness certification" were work absenteeism (46.1%), illness affecting the work (27.4%), and varied reasons (28.4%). The presence of neurological disorders, sensory-motor deficits, cognitive decline, brain damage/insult, poor drug compliance, irregular follow-ups, and poor or partial treatment response were associated with an unfitness to rejoin the job. This study shows that work absenteeism and the impact of illness on work are common reasons for referral. Irreversible neurobehavioural problems and deficits impacting work are common reasons for unfitness to rejoin the job. There is a need for a systematic schedule to assess the fitness for the job in patients with neuropsychiatric disorders.

Evolution of Pediatric Migraine Patients Admitted at an Emergency Department after a 10-Year Follow-Up.

Despite its high prevalence, the clinical course of pediatric migraine has not been fully understood, and previous studies present conflicting results. We present here the findings of a 10-year follow-up study involving children with severe migraine pain admitted to our emergency department. Furthermore, all studies were carried out on selected outpatient clinical case studies. Our aim was to evaluate a population of migraine children admitted to an emergency department because of increased severity or frequency of pain or even because of very anxious parents concerning their child's headache in order to describe their long-term outcomes, whether it differed from that of outpatient populations and to identify possible predictors of prognosis. We recruited 80 subjects with migraine headaches (mean age 8 years with a range of 4-14 years, 50% females), attending the baseline examination of a population admitted for a headache to the Emergency Department in the first half year of 2012. Of the 80 subjects, 48 (60%) were eligible for follow-up in 2022. We included in our study only patients diagnosed with migraine, according to the diagnostic criteria of the International Classification of Headache Disorders. All were contacted by telephone, and a semi-structured questionnaire was provided to them by email. The association between several possible prognostic factors (gender, familiar neurologic disorders, prenatal and perinatal disorders, social activities, sleep disorders, etc.) and the long-term persistence of migraine headaches were explored using logistic regression analysis. Of 48 subjects with migraine headaches at baseline, 31 (65%) had persistent migraine, and 17 (35%) experienced remission. The preliminary results showed that the presence of neurologic disorders in parents (p < 0.01-odds ratio 9.34 (2.53-41.64) and sleep disorders (p < 0.01-odds ratio 13.18 (2.25-252.74) significantly predicted the 10-year persistence of migraine headaches, while the other considered predictors were found not to influence prognosis. To our knowledge, this was the first study conducted on a selected pediatric population upon admission to the emergency room. Our study suggests that a population of pediatric migraine selected for admission to the emergency department also shows a favorable long-term prognosis, like the studies conducted in the outpatient sample. Familial neurological comorbidity and sleep disorders were unfavorable factors for predicting good outcomes.

Is Circulating Vitamin D Status Associated with the Risk of Venous Thromboembolism? A Meta-Analysis of Observational Studies.

Although vitamin D is antithrombotic, associations between serum vitamin D status and the risk of venous thromboembolism (VTE) remain inconsistent. We searched the EMBASE, MEDLINE, Cochrane Library, and Google Scholar databases from inception to June 2022 to identify observational studies examining associations between vitamin D status and VTE risk in adults. The primary outcome presented as odds ratio (OR) or hazard ratio (HR) was the association of vitamin D levels with the risk of VTE. Secondary outcomes included the impacts of vitamin D status (i.e., deficiency or insufficiency), study design, and the presence of neurological diseases on the associations. Pooled evidence from a meta-analysis of sixteen observational studies, including 47648 individuals published from 2013 to 2021, revealed a negative relationship between vitamin D levels and the risk of VTE either based on OR (1.74, 95% confidence interval (CI): 1.37 to 2.20, p < 0.00001; I2 = 31%, 14 studies, 16074 individuals) or HR (1.25, 95% CI: 1.07 to 1.46, p = 0.006; I2 = 0%, 3 studies, 37,564 individuals). This association remained significant in subgroup analyses of the study design and in the presence of neurological diseases. Compared to individuals with normal vitamin D status, an increased risk of VTE was noted in those with vitamin D deficiency (OR = 2.03, 95% CI: 1.33 to 3.11) but not with vitamin D insufficiency. This meta-analysis demonstrated a negative association between serum vitamin D status and the risk of VTE. Further studies are required to investigate the potential beneficial effect of vitamin D supplementation on the long-term risk of VTE.

Patients with psychogenic nonepileptic seizures and suspected epilepsy: An antiseizure medication reduction study

ObjectiveTo examine predictors of ASM reduction/discontinuation and PNES reduction/resolution in patients with PNES with a confirmed or strong suspicion of comorbid ES. MethodsA retrospective analysis of 271 newly diagnosed Patients with PNESs admitted to the EMU between May 2000 and April 2008, with follow-up clinical data collected until September 2015. Forty-seven patients met our criteria of PNES with either confirmed or probable ES. ResultsPatients with PNES reduction were significantly more likely to have come off all ASMs by the time of final follow-up (21.7 vs. 0.0%, p = 0.018), while documented generalized (i.e. epileptic) seizures were much more common in patients with no reduction in PNES frequency (47.8 vs 8.7%, p = 0.003). When comparing patients that reduced their ASMs (n = 18) with those that did not (n = 27), the former were more likely to have neurological comorbid disorders (p = 0.004). When comparing patients with PNES resolution (n = 12) vs not (n = 34), those with PNES resolution were more likely to have a neurological comorbid disorder (p = 0.027), had a younger age at EMU admission (29.8 vs 37.4, p = 0.05) and a greater proportion of patients with ASMs reduced in EMU (66.7% vs 30.3%, p = 0.028). Similarly, those with ASM reduction had more unknown (non-generalized, non-focal) seizures (33.3 vs 3.7%, p = 0.029). On hierarchical regression analysis, a higher level of education and absence of generalized epilepsy remain as positive predictors of PNES reduction (p = 0.042, 0.015), while the presence of some other neurological disorder besides epilepsy (p = 0.04) and being on more ASMs at EMU admission (p = 0.03) were positive predictors of ASM reduction by final follow-up. SignificancePatients with PNES and epilepsy have distinct demographic predictors of PNES frequency and ASM reduction by final follow-up. Patients with PNES reduction and resolution had higher level education, less generalized epileptic seizures, younger age at EMU admission, more likely to have presence of a neurological disorder besides epilepsy, and a greater proportion of patients had a reduction in the number of ASMs in the EMU. Similarly, patients with ASM reduction and discontinuation were on more ASMs at initial EMU admission and also were more likely to have a neurological disorder besides epilepsy. The positive relationship between reduction in psychogenic nonepileptic seizure frequency and discontinuation of ASMs at final follow-up elucidates that tapering medication in a safe environment may reinforce psychogenic nonepileptic seizure diagnosis. This can be reassuring to both patients and clinicians, resulting in the observed improvements at the final follow-up.

Dichotomous outcomes vs. survival regression models for identification of predictors of mortality among patients with severe acute respiratory illness during COVID-19 pandemics.

As the studies predicting mortality in severe acute respiratory illness (SARI) have inferred associations either from dichotomous outcomes or from time-event models, we identified some clinical-epidemiological characteristics and predictors of mortality by comparing and discussing two multivariate models. To identify factors associated with death among all SARI hospitalizations occurred in Botucatu (Brazil)/regardless of the infectious agent, and among the COVID-19 subgroup, from March 2020 to 2022, we used a multivariate Poisson regression model with binomial outcomes and Cox proportional hazards (time-event). The performance metrics of both models were also analyzed. A total of 3,995 hospitalized subjects were included, of whom 1338 (33%) tested positive for SARS-CoV-2. We identified 866 deaths, of which 371 (43%) were due to the COVID-19. In the total number of SARI cases, using both Poisson and Cox models, the predictors of mortality were the presence of neurological diseases, immunosuppression, obesity, older age, and need for invasive ventilation support. However, the Poisson test also revealed that admission to an intensive care unit and the COVID-19 diagnosis were predictors of mortality, with the female gender having a protective effect against death. Likewise, Poisson proved to be more sensitive and specific, and indeed the most suitable model for analyzing risk factors for death in patients with SARI/COVID-19. Given these results and the acute course of SARI and COVID-19, to compare the associations and their different meanings is essential and, therefore, models with dichotomous outcomes are more appropriate than time-to-event/survival approaches.

Clinical Characteristics and Outcomes of Children With SARS-CoV-2 Infection During the Delta and Omicron Variant-Dominant Periods in Korea.

Data on the clinical characteristics of pediatric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant infection are limited. We aimed to evaluate the clinical features and outcomes of children with SARS-CoV-2 infection before and after omicron variant dominance in Korea. A multicenter retrospective cohort study was conducted in hospitalized patients aged ≤ 18 years with laboratory-confirmed SARS-CoV-2 infection at five university hospitals in South Korea. The study periods were divided into the delta (from August 23, 2021 to January 2, 2022) and omicron (from January 30 to March 31, 2022). In total, 612 hospitalized patients were identified (211, delta; 401, omicron). During the omicron and delta periods, the proportions of individuals with serious illness (moderate, severe, and critical severity) were 21.2% and 11.8%, respectively (P = 0.034). Compared with the delta period, the proportions of patients with moderate illness increased significantly in the age groups of 0-4 years (14.2% vs. 3.4%) and 5-11 years (18.6% vs. 4.2%) during the omicron period. During the two periods, the proportions of patients with complex chronic diseases (delta, 16.0% vs. 4.3%, P = 0.040; omicron, 27.1% vs. 12.7%; P = 0.002), respiratory diseases except for asthma (delta, 8.0% vs. 0.0%, P = 0.013; omicron, 9.4% vs. 1.6%; P = 0.001), and neurologic diseases (delta, 28.0% vs. 3.2%, P < 0.001; omicron, 40.0% vs. 5.1%, P < 0.001) were significantly higher in patients with serious illness than in those with non-serious illness. During the delta period, the risk for serious illness was higher among patients with obesity (adjusted odds ratio [aOR], 8.18; 95% confidence interval [CI], 2.80-27.36) and neurologic diseases (aOR, 39.43; 95% CI, 6.90-268.3) and aged 12-18 years (aOR, 3.92; 95% CI, 1.46-10.85). However, the presence of neurologic disease (aOR, 9.80; 95% CI, 4.50-22.57) was the only risk factor for serious illness during the omicron period. During the omicron period, the proportions of patients with croup (11.0% vs. 0.5%) and seizures (13.2% vs. 2.8%) increased significantly compared with the delta period. Compared with the delta period, the proportions of young children and patients with complex comorbidities were higher during the omicron period in Korea. Patients with complex chronic diseases, especially neurologic diseases, had a high risk of severe coronavirus disease 2019 in the two distinct variant-dominant periods.

Evaluation of Biomarkers and Clinical Course in Patients Developing Neurologic Disorders due to COVID-19

COVID-19 is a highly contagious and deadly disease. It may present with neurologic symptoms as well as respiratory symptoms. In this study, the existence of different biomarkers in the development and evaluation of neurologic symptoms and complications in patients with COVID-19 and the relationship between clinical course and neurologic disorders were investigated. In this prospective randomized study, the study group included 133 patients with a diagnosis of COVID-19 who were admitted to the neurology clinic and intensive care unit managed by expert neurologists during the pandemic period. Patients were classified as those without neurological disorders associated with COVID-19, those with mild neurologic disorders, and those with severe neurological disorders. The demographic characteristics, laboratory values, lung tomography, and clinical features of these patients were examined and the relationship between them was investigated. Of the patients, 54.9% were male, 45.1% were female, and the mean age was 60.85±18.38 (min-max: 19-91) years. As the age increased, a moderately significant positive correlation was found between the presence of neurologic disorders and disease severity. Myalgia (39.1%) and headache (34.6%) were the most common neurologic symptoms. In patients with severe neurologic disorders, the most common neurologic symptom was unconsciousness (n=22, 64.7%). Hemoglobin levels, hematocrit, lymphocyte counts, and procalcitonin levels were decreased (p=0.010, p=0.018, p=0.001, and p=0.021, respectively) in patients with neurologic disorders, neutrophil count, C-reactive protein, D-dimer, and interleukin-6 levels were increased (p=0.039, p=0.020, p&lt;0.001, and p=0.001, respectively). An increase in the presence and severity of neurologic disorders was observed in patients in parallel with an increase in lung computed tomography scores and O2 requirement (p&lt;0.001 and p&lt;0.001, respectively). As the severity of the neurologic disorders of the patients increased, the rate of discharge decreased (p&lt;0.001). Our results suggested that some biomarkers associated with the severity of the disease could also be shown in patients with neurologic disorders, and patients with COVID-19 had severe disease in the presence of neurologic disorders. To define the existence of an independent biomarker, there is a need for large-scale studies in which neurologic disorders are handled separately.