Severity Of Disability In Patients Research Articles

Are we asking the right questions to people with Achilles tendinopathy? The best questions to distinguish mild versus severe disability to improve your clinical management

ObjectiveDetermine the capacity of individual items on the Tendinopathy Severity Assessment – Achilles (TENDINS-A), Foot and Ankle Outcome Score (FAOS), and Victorian Institute of Sports Assessment – Achilles (VISA-A) to differentiate patients with mild and severe tendon-related disability in order to provide clinicians the best questions when they are consulting patients with Achilles tendinopathy. DesignCross-sectional. ParticipantsSeventy participants with Achilles tendinopathy (61.4% mid-portion only, 31.4% insertional only, 7.2% both). Outcome measuresThe discrimination index was determined for each TENDINS-A, FAOS, and VISA-A item to determine if items could discriminate between mild and severe disability. A Guttman analysis for polytomous items was conducted. ResultsAll 62 tems from the TENDINS-A, FAOS, and VISA-A were ranked with the best items relating to pain with physical tendon loading, time for pain to settle following aggravating activities and time for the tendon to ‘warm-up’ following inactivity. ConclusionsPain with loading the Achilles tendon, time for pain to settle following aggravating activity, as well as time taken for the tendon symptoms to subside after prolonged sitting or sleeping are the best questions indicative of the severity of disability in patients with Achilles tendinopathy. These questions can assist clinicians with assessing baseline severity and monitoring treatment response.

A systematic review of randomized controlled trials of endovascular therapy for stroke on mortality and disability

BackgroundEndovascular treatment (EVT) has become standard of care for patients with anterior circulation large vessel occlusion (LVO) stroke, with indications having recently expanded to late time-window and large ischemic core patients. There is conflicting evidence on whether EVT reduces mortality or only disability. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effect of EVT on mortality and severe disability. MethodsWe systematically searched PubMed, Web of Science, Scopus, and Embase on November 15, 2023, to identify phase 3 RCTs comparing EVT to best medical treatment (BMT) in patients with anterior circulation LVO stroke in a common effects meta-analysis. The primary outcome was mortality at 3 months. Secondary outcomes were moderately severe or severe disability (modified Rankin Scale (mRS) score 4–5) at 3 months. Results18 studies comparing EVT to BMT were included, with a total of 4309 patients; 2159 that were treated with EVT, and 2150 treated with BMT. Mortality was significantly lower in the EVT group than in the BMT group (odds ratio (OR): 0.81, 95% CI: 0.70–0.94). Proportions of moderately severe or severe disability (OR: 0.55, 95% CI: 0.48–0.62) were also significantly lower in patients treated with EVT. ConclusionsThis meta-analysis suggests that EVT reduces both mortality and moderately severe or severe disability in patients with anterior circulation LVO stroke.

Reliability and validity of Oswestry Disability Index among patients undergoing lumbar spinal surgery

BackgroundThe objective of this study was to explore the internal consistency and factor structure of the Oswestry Disability Index among patients undergoing spinal surgery. The sample consisted of 1,515 patients who underwent lumbar spinal surgery at a university hospital between 2018 and 2021.MethodsThe patients responded to the Oswestry Disability Index within 2 months before surgery. Cronbach’s alpha was used to assess the internal consistency. The factor structure was evaluated using exploratory and confirmatory factor analyses.ResultsThe average age of 1,515 patients was 58.5 (SD 15.8) years and 53% were women. The mean ODI score was 43.4% (SD 17.4%). Of the patients, 68% underwent microsurgical excision of the lumbar intervertebral disc displacement or decompression of the lumbar nerve roots. The internal consistency of the Oswestry Disability Index was found to be good, with an alpha of 0.87 (95% CL 0.86 to 0.88). Exploratory factor analysis resulted in unidimensional structure. Item loadings on this retained factor were moderate to substantial for all 10 items. One-factor confirmatory factor analysis model demonstrated an acceptable fit. The correlations between the main factor “disability” and the individual items varied from moderate (0.44) to substantial (0.76). The highest correlations were observed for items “traveling”, “personal care”, and “social life”. The lowest correlations were observed for the item “standing”.ConclusionsThe Oswestry Disability Index is a unidimensional and internally consistent scale that can be used to assess the severity of disability in patients undergoing lumbar spinal surgery. In the studied population, “traveling,” “social life,” “sex life” and “personal care” were the most important items to define the severity of disability, while “walking” and “standing” were the least important items. The generalizability of the results might be affected by the heterogeneity and modest size of the studied cohort.Trial registrationNot applicable.

Анализ результатов терапии препаратом окрелизумаб пациентов с рассеянным склерозом в Воронежской области

Aim. Analysis of own results of ocrelizumab therapy in patients with multiple sclerosis (MS) in the Voronezh region. Materials and methods. This work was a cross-sectional study based on the Voronezh Regional Clinical Hospital № 1. The study included 61 patients (34 women and 27 men) with MS with an average age of 38.5±2.6 years. All patients received ocrelizumab (Ocrevus) intravenously according to the scheme: an initial dose of 300 mg with an interval of 2 weeks, then 600 mg every 6 months. The effectiveness of therapy was assessed according to the NEDA-2 (no evidence of disease activity), NEDA-3 and NEP (no evidence of progression) criteria. Results. Ocrelizumab has shown high efficacy in stopping the progression of all considered types of MS. The NEDA-2 and NEP criteria were achieved by the patients as early as 6 months after the start of therapy. NEDA-3 criteria for highly active MS – by 12 months of therapy, for secondary progressive MS with exacerbations – by 18 months of therapy. The highest efficiency of treatment with ocrelizumab was shown in the group of patients with highly active MS, where not only the cessation of disease progression was noted, but also a significant decrease in the degree of disability according to the EDSS scale. Conclusion. It is necessary to start therapy with ocrelizumab at an earlier time: in primary progressive MS immediately after confirmation of the diagnosis, in relapsing MS – when signs of high disease activity and/or suboptimal response to the first of the drugs of disease modifying treatment appear. Timely initiation of ocrelizumab treatment may avoid severe disability in patients.

Factors influencing the degree of disability in patients with neuromyelitis optica spectrum disorders

ObjectiveTo investigate the factors influencing the degree of disability in patients with neuromyelitis optica spectrum disorder (NMOSD) and provide evidence for disease monitoring and clinical intervention.MethodsEighty-four patients with NMOSD at Xuanwu Hospital Capital Medical University were enrolled in this retrospective study. Before treatment, blood was collected from all patients, and their expanded disability status scores were assessed.ResultsOf the 84 patients assessed, 66 (78.57%) had an expanded disability status scale score < 7, and 18 (21.43%) had scores ≥ 7. The univariate analysis showed that the total bilirubin (TBil), cerebrospinal fluid albumin (CSF ALB), cerebrospinal fluid immunoglobulin G (CSF IgG), QALB, and QIgG levels in the group with scores ≥ 7 were significantly different from those with scores < 7 (P < 0.05). In addition, Spearman’s correlation analysis showed a significant correlation between ALB and expanded disability status scores in patients with NMOSD (P < 0.05), and the multivariate logistic regression analysis showed that TBil was an independent factor influencing the degree of disability in patients with NMOSD (P < 0.05). The receiver operating characteristic curve was constructed using TBil values; the area under the curve of TBil was 0.729 (P < 0.01), and the best cut-off value was 11.015 g/L. Its sensitivity in predicting the severity of disability in NMOSD patients was 51.5% while its specificity was 88.9%.ConclusionTBil is an independent factor that influences the severity of disability in patients with NMOSD. In addition, ALB is closely related to NMOSD severity, and some factors associated with the BBB are significantly increased in severely disabled NMOSD patients.

Outcomes in Patients With Poststroke Seizures

Published data about the impact of poststroke seizures (PSSs) on the outcomes of patients with stroke are inconsistent and have not been systematically evaluated, to the authors' knowledge. To investigate outcomes in people with PSS compared with people without PSS. MEDLINE, Embase, PsycInfo, Cochrane, LILACS, LIPECS, and Web of Science, with years searched from 1951 to January 30, 2023. Observational studies that reported PSS outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for abstracting data, and the Joanna Briggs Institute tool was used for risk-of-bias assessment. Data were reported as odds ratio (OR) and standardized mean difference (SMD) with a 95% CI using a random-effects meta-analysis. Publication bias was assessed using funnel plots and the Egger test. Outlier and meta-regression analyses were performed to explore the source of heterogeneity. Data were analyzed from November 2022 to January 2023. Measured outcomes were mortality, poor functional outcome (modified Rankin scale [mRS] score 3-6), disability (mean mRS score), recurrent stroke, and dementia at patient follow-up. The search yielded 71 eligible articles, including 20 110 patients with PSS and 1 166 085 patients without PSS. Of the participants with PSS, 1967 (9.8%) had early seizures, and 10 605 (52.7%) had late seizures. The risk of bias was high in 5 studies (7.0%), moderate in 35 (49.3%), and low in 31 (43.7%). PSSs were associated with mortality risk (OR, 2.1; 95% CI, 1.8-2.4), poor functional outcome (OR, 2.2; 95% CI, 1.8-2.8), greater disability (SMD, 0.6; 95% CI, 0.4-0.7), and increased dementia risk (OR, 3.1; 95% CI, 1.3-7.7) compared with patients without PSS. In subgroup analyses, early seizures but not late seizures were associated with mortality (OR, 2.4; 95% CI, 1.9-2.9 vs OR, 1.2; 95% CI, 0.8-2.0) and both ischemic and hemorrhagic stroke subtypes were associated with mortality (OR, 2.2; 95% CI, 1.8-2.7 vs OR, 1.4; 95% CI, 1.0-1.8). In addition, early and late seizures (OR, 2.4; 95% CI, 1.6-3.4 vs OR, 2.7; 95% CI, 1.8-4.1) and stroke subtypes were associated with poor outcomes (OR, 2.6; 95% CI, 1.9-3.7 vs OR, 1.9; 95% CI, 1.0-3.6). Results of this systematic review and meta-analysis suggest that PSSs were associated with significantly increased mortality and severe disability in patients with history of stroke. Unraveling these associations is a high clinical and research priority. Trials of interventions to prevent seizures may be warranted.

Prevalencia y factores asociados de la discapacidad moderada y severa en pacientes con enfermedad cerebrovascular aguda y fibrilación auricular en un hospital universitario de Bogotá

Introducción: Existe escasa información en Colombia acerca de la discapacidad en enfermedad cerebrovascular isquémica (ECVi) y fibrilación auricular (FA).&#x0D; Objetivo: Determinar la prevalencia y los factores asociados a discapacidad moderada a severa en pacientes con ECVi y FA.&#x0D; Materiales y métodos: Se analizó una serie consecutiva de pacientes con ECVi y FA, que ingresó de julio de 2013 a febrero de 2014, con estancia hospitalaria de 11,88 ± 8,1 días. Analizamos la prevalencia puntual, discapacidad (eRm) y mortalidad al egreso.&#x0D; Resultados: Pacientes con ECVi: 368; de ellos, 63 (17%) con FA (54% hombres; 77,6 ± 10,25 años), hipertensión arterial (77,8%), ECVi previo (58,7%), cardiopatía dilatada (46%), antiplaquetarios o anticoagulantes previos (58,7%), arteria cerebral media (74,6%), infartos parciales circulación anterior (PACI) (47,6%), dilatación auricular (60,3%), afasia (36,5%), convulsión (7,9%), discapacidad moderada a severa (eRm 3-5) (41,3%) y mortalidad (17,4%). Observamos que el sexo femenino (OR 3,68; IC 1,01-13,39; p = 0,048), ECVi previo (OR 3,94; IC 1,15-13,57; p = 0,03) y afasia (OR 6,86; IC 1,7-27,66; p = 0,007) fueron factores asociados independientes para discapacidad moderada-severa y mortalidad.&#x0D; Conclusión: En esta serie el sexo femenino, antecedente de ECVi previo y afasia, son los principales factores asociados a morbimortalidad en nuestros pacientes.

Relationship Between Pain and Disability Among Stroke Patients.

Stroke is prevalent in Iran, and its complications can decline patients' quality of life and psychological state. This study aimed to investigate the relationship between pain following stroke (PFS) and disability in stroke patients. The current case-control study was conducted on 184 stroke patients (92 cases and 92 controls). Data collection tools included a demographic questionnaire, the Visual Analog Scale (VAS), and the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. Based on the medical files of all patients with stroke, eligible ones were invited to participate in the study via phone calls. The collected data were then analyzed. The disability rate was higher in the case group of patients with a history of hemorrhagic stroke, smoking, stroke, and diabetes (P < 0.05). The mean ± SD age was 72.45 (11.54). Also, the level of disability in patients increased with age (P = 0.000). The mean ± SD disability score was 78.63 (6.92) in patients with PFS and 54.9 (10.87) in patients without PFS. Also, R = 0.795 and R2= 0.631 indicated the significance of disability severity in patients with PFS. The prevalence of disability was higher in patients with higher PFS levels. Hence, drug interventions or rehabilitation programs can be used to reduce the disability of stroke patients.

Endovascular therapy for basilar occlusion: Is there robust evidence?

The combined rate of mortality and severe disability for patients with acute basilar artery occlusion is as high as 90% [1,2]. Observational studies report that with revascularization therapies this rate decreases by about 75% [2,3]. To this regard, four randomized trials were carried out to investigate the association between revascularization therapy and any benefit in patients with basilar artery occlusion and their results were recently published [4–7]. The meta-analysis by Lin et al. [8], published in this issue of the Journal, includes the results of these trials with a total of 988 patients (12 with bilateral vertebral occlusion) and concludes that, in patients with acute basilar occlusion, endovascular therapy, compared with best medical management, might be associated with significant increased rates of ambulation, independence and survival, but also with an increased risk of symptomatic intracranial hemorrhage.

The Effect of Self-Care on the Severity of Disability of Leprosy Patients in the Work Area Galis Health Center

Background: People with leprosy tend to have dry skin due to damage. Purpose: This study aims to analyze differences in the severity of disability in patients before and after self-care in the treatment group and the control group. Methods: This research used a Quasy experiment pretest posttest with a control group design. The population was 52 respondents, with a sample of 34 respondents. The sampling technique used purposive sampling. Results: The results of the study using the Wilcoxon test showed that there was a difference in the severity of disability in the treatment group with a p-value of 0,00 &lt; 0.05 and no difference in the severity of disability in the control group with a p-value of 0,105 &gt; 0.05. Based on the results of the Mann-Whitney test, it was found that there were differences in the severity of disability in the treatment group and the control group before and after self-care with a p-value of 0,00 &lt; 0,05. Conclusion: The researcher suggests that sufferers can continue to improve efforts to prevent the severity of leprosy disability by taking regular self-care.

Glucocorticoids induce osteonecrosis of the femoral head in rats via PI3K/AKT/FOXO1 signaling pathway.

BackgroundSteroid-induced osteonecrosis of the femoral head (SONFH) is a disorder that causes severe disability in patients and has a high incidence worldwide. Although glucocorticoid (GC)-induced apoptosis of osteoblasts is an important cytological basis of SONFH, the detailed mechanism underlying SONFH pathogenesis remains elusive. PI3K/AKT signaling pathway was reported to involve in cell survival and apoptosis.ObjectiveWe explored the role of PI3K/AKT/FOXO1 signaling pathway and its downstream targets during glucocorticoid -induced osteonecrosis of the femoral head.MethodsWe obtained gene expression profile of osteoblasts subjected to dexamethasone (Dex) treatment from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were screened out and functional enrichment analysis were conducted by bioinformatics analysis. In vitro, we analyzed Dex-induced apoptosis in MC3T3-E1 cells and explored the role of PI3K/AKT/FOXO1 signaling pathway in this phenomenon by employing siRNA-FOXO1 and IGF-1(PI3K/AKT agonist). Finally, we verified our results in a rat model of SONFH.ResultsIn Dex-treated osteoblasts, DEGs were mainly enriched in the FOXO signaling pathway. Dex inhibited MC3T3-E1 cell viability in a dose-dependent effect and induced apoptosis by increasing the expression levels of FOXO1, Bax, cleaved-Caspase-3, and cleaved-Caspase-9, while reducing the expression of Bcl-2. Notably, these results were reversed by siRNA-FOXO1 treatment. Dex inhibited PI3K/AKT signaling pathway, upregulated FOXO1 expression and increased FOXO1 nuclear translocation, which were reversed by IGF-1. Compared to normal rats, the femoral head of SONFH showed increased expression of FOXO1, increased number of apoptotic cells, and empty osteocytic lacunas, as well as decreased bone tissue content and femoral head integrity. Significantly, the effects of GC-induced SONFH were alleviated following IGF-1 treatment.ConclusionDex induces osteoblast apoptosis via the PI3K/AKT/FOXO1 signaling pathway. Our research offers new insights into the underlying molecular mechanisms of glucocorticoid-induced osteonecrosis in SONFH and proposes FOXO1 as a therapeutic target for this disease.

P 92 Limbic encephalitis with Contactin-associated protein like-2 (CASPR2) -antibodies: acute psychosis with late onset and abnormal EEG

Introduction: Contactin-associated protein like-2 (CASPR2)- autoantibodies are associated with distinctive syndromes 1 , such as agrypnia excitata, psychosis, neuromytonia and limbic encephalitis. All of them are highly responsive to immunotherapy. The target of these directly pathogenetic autoantibodies are surface-exposed domains of CASPR2 2 . Due to the fact of multiple variations of clinical presentations, it may be challenging to distinguish particular an autoimmune encephalitis associated with anti-neuronal autoantibodies, from primary psychiatric disorders such as psychosis. First medical treatment should be immediate immunotherapy, such as steroids, intravenous antibodies or plasma exchange given fast diagnosis of encephalitis is made. In our case the EEG showed focal slow waves with the clinical presentation of an acute psychosis which leaded to an admission to the neurology ward and further investigations. Patient and methods: A 75-years-old man was hospitalized on a psychiatric ward for psychotic symptoms characterized by psychomotor agitation, thought disorganization, persecutory delusions and auditory hallucinations with commanding voices and global insomnia. Cerebral Imaging with cMRI and cCT scan showed no acute abnormalities. EEG showed focal intermittent slow delta-theta wave activity (4-6 Hz) on the left temporal lobe, reactive to visual stimuli and provided focal cerebral dysfunction and pathology. CSF did not reveal any evidence of infection, but CASPR2- autoantibodies (1:10.000) were indentified and the diagnosis of limbic encephalitis with CASPR2-antibodies was made. Treatment with high dose dexamethasone and intravenous immunoglobulin (IVIG) was made and the clinical conditions improved. Conclusion: Fast and first medical treatment of autoimmune encephalitis should be initiated in early stages. To avoid an unnecessary delay in diagnosis and treatment, EEG, cMRI and expanded CSF examination should be performed as soon as possible to prevent severe disability in patients with limbic encephalitis with CASPR2-antibodies.

Impact of Fremanezumab on Disability Severity in Patients With Episodic and Chronic Migraine: Pooled Results of 3 Randomized, Double-blind, Placebo-controlled Phase 3 Studies (2254)

Impact of Fremanezumab on Disability Severity in Patients With Episodic and Chronic Migraine: Pooled Results of 3 Randomized, Double-blind, Placebo-controlled Phase 3 Studies (2254)

Pregravid preparation, pregnancy and childbirth, especially the course of the postpartum period in patients with multiple sclerosis (literature review)

Multiple sclerosis (MS) is a chronic autoimmune disease characterized by the formation of lesions in the white matter as a result of autoimmune inflammation, neurodegeneration and demyelination and leading to severe disability of patients. Women get sick more often than men; young women of reproductive age account for about 2/3 of all MS patients. It was established that pregnancy and childbirth with MS have a beneficial effect on the course of the disease, however, patients with MS need pregravid preparation, which will reduce the risk of exacerbations. Exacerbations are observed in most cases during the first 36 months of the postpartum period, which is associated with a change in hormonal status, emotional and physical stress on the womans body, and also with the cessation of physiological immunosuppression in a pregnant woman. The analysis of modern literature sources on the issues of pregravid preparation, pregnancy and childbirth, and the features of postpartum period in multiple sclerosis, as well as new ideas concerning the disease etiology and pathogenesis. 47 literature sources (national and foreign) were analyzed using various databases (PubMed, PubMed Central, Google Scholar, UpToDate).

Conventional cementless total hip arthroplasty in patients with dwarfism with height less than 140 cm and minimum 10-year follow up: A clinical study

BackgroundOrthopedic complications can cause issues and severe disability in patients with dwarfism. Thus, these individuals frequently undergo total hip arthroplasty to mitigate decline in daily functioning. Although studies have reported on the difficulties of orthopedic surgery in patients with dwarfism, many do not clearly define dwarfism and have a short follow-up period. We aimed to retrospectively investigate the clinical and radiographic results of total hip arthroplasty for patients with dwarfism. MethodsA total of 68 hips of 49 patients with height <140 cm and at least 10-year follow-up periods were enrolled. All patients had conventional cementless implants. All hips were evaluated using the Japanese Orthopaedic Association hip score. ResultsThe main hip disease etiologies were primary hip osteoarthritis (58%) and secondary osteoarthritis due to developmental dysplasia (31%). Rheumatoid arthritis, rapidly destructive coxarthrosis, spondyloepiphyseal dysplasia, childhood infection, and femoral head aseptic necrosis were also causative pathologies. Hip scores significantly improved from 44 to 82 out of 100. Overall implant-associated survival rate after 10 years was 94.1%. Cup loosening was observed in 2 hips, and subsidence >5 mm was observed in 9 hips. Presence of Crowe IV in hips was a significant risk factor for total hip arthroplasty in patients with dwarfism (p < 0.05); leg lengthening had a weak but significant correlation (r = 0.253, p < 0.05). ConclusionsTotal hip arthroplasty using conventional cementless implants for patients with dwarfism shows good clinical and radiological outcomes and has a relatively low perioperative risk.

The effect of curcuma, black peper, ginger on pain and performance of the patient with chronic knee osteoarthritis in comparison with Naproxen drug

Background: Osteoarthritis is the most common arthritis that can lead to chronic pain and severe disability in patients. Researchers are looking for new treatments that are effective with fewer side effects. Curcumin is a beneficial ingredient in turmeric with anti-inflammatory properties and plays an important role in the protection of the joints against destructive factors. Gingerol and piperine are the effective ingredients of ginger and black pepper, respectively, that may lead to the reinforcement and continuation of the effect of curcumin. The aim of the present study was to determine the efficacy of turmeric, ginger, and black pepper extracts in pain and functional improvement of patients with chronic knee osteoarthritis in comparison to that reported for naproxen.

The Relationship Between Demographic and Occupational Characteristics and Disability Severity in Patients With Knee Osteoarthritis

Purpose: Osteoarthritis is a progressive disease and the most common form of joint inflammation. Moreover, it is the most common cause of functional disability in the elderly. Among the multiple and predisposing factors influencing the disease are demographic indicators and occupational factors. The present study aimed to investigate the relationship between age, pain severity, Body Mass Index (BMI), occupation, and educational level, and the severity of functional disability in patients with Knee Osteoarthritis (KO). Methods: This descriptive study was performed on 97 KO patients referring to the Novin private physiotherapy clinic of Semnan University of Medical Sciences from April to March 2017. The study participants were selected through a simple nonprobability sampling technique. Literate individuals with the educational level of guidance school and above and diagnosed with KO were included in the study. Individuals with a history of inflammatory arthritis diseases, such as rheumatoid arthritis, soft tissue rheumatoid arthritis, fibromyalgia syndrome, bursitis, tendonitis, the neurological and vascular conditions of the lower extremity, mental problems, and malignancy were excluded from this research. The data related to the variables such as age, gender, occupation, history of osteoarthritis, pain intensity, involved side, educational level, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for knee disability were collected by a self-report questionnaire. This study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences. Using SPSS, Spearman’s correlation coefficients were calculated to examine the relationship between the study variables. Results: Spearman’s correlation coefficients revealed no significant correlation between the KOOS scores and age, occupation, and educational level. The obtained results suggested a poor significant association between KOOS and BMI; however, there was a strong significant correlation between KOOS and pain intensity Visual Analogue Scale (VAS) (P&lt;0.05). Conclusion: The severity of functional disability in patients with KO based on KOOS questionnaire scores, was well correlated with pain severity, but poorly associated with age and BMI. The obtained data indicated no significant relationship between disability and occupation and educational level.

Timing of Direct Enteral Tube Placement and Outcomes after Acute Stroke

Background: Direct enteral feeding tube (DET) placement for dysphagia after stroke is associated with poor outcomes. However, the relationship between timing of DET placement and poststroke mortality and disability is unknown. We sought to determine the risk of mortality and severe disability in patients who receive DET at different times after stroke. Methods: We used the Ontario Stroke Registry and linked administrative databases to identify patients with acute ischemic stroke or intracerebral hemorrhage between 2003 and 2013 who received DET (gastrostomy or jejunostomy) during their hospital admission. We grouped patients by week of DET placement and evaluated mortality at 30 days and 6 months after DET insertion, and disability at discharge. We used Cox proportional hazard models and multiple logistic regression to determine the association between time from admission to DET placement and outcomes, adjusting for patient and hospital factors. Results: In the study sample of 1367 patients, the median time from admission to DET placement was 17 days. After adjustment, each week of delay to DET placement was associated with lower mortality at 30 days (adjusted hazard ratio [aHR] .88, 95% confidence interval [CI] .79-.98), but not at 6 months (aHR .98, 95% CI .91- 1.05), and a higher likelihood of severe disability at discharge (adjusted odds ratio 1.35, 95% CI 1.13- 1.60). Conclusions: Later DET placement after stroke was associated with lower 30-day mortality but higher severe disability at discharge. Further research is needed to understand the reasons for these observations and to optimize patient selection and timing of DET.

Functional stroke outcomes after mobile stroke unit deployment \u2013 the revised protocol for the Berlin Prehospital Or Usual Delivery of acute stroke care (B_PROUD) part 2 study

BackgroundStudies investigating the Mobile Stroke Unit (MSU) concept have shown increased thrombolysis rates, reduced alarm-to-treatment times and improved prehospital triage. Yet, so far, there is no definite scientific proof of better functional outcome after MSU deployment compared to regular ambulances.MethodsWe provide a revised protocol for the second part of the B_PROUD trial as organization of the MSU dispatch did not meet the anticipated standards in the first part. B_PROUD is a pragmatic, prospective study comparing functional outcomes of treatment candidates with or without MSU care. Treatment candidates are defined as patients with a final diagnosis of ischemic stroke or transient ischemic attack, onset-to-dispatch-times ≤4 h, disabling symptoms not resolved at time of ambulance arrival, and the ability to ambulate prior to the qualifying event. These patients are included if their emergency call prompted a stroke alarm at the dispatch center during MSU operation hours (7 am–11 pm, Monday-Sunday) and if the emergency is located within the MSU operation area in Berlin, Germany. The intervention group consists of patients who are cared for by the MSU. When the MSU is already in operation for another emergency, MSU dispatches are handled by regular ambulances (about 45%). These dispatches create the control group. Blinded stroke physicians assess the modified Rankin Scale (mRS) score in recorded structured interviews 3 months after stroke. The primary outcome is the degree of disability and death over the full range of the mRS. As a change to the previously published protocol and only pertinent in case of more than 9% lost-to-follow-up, a co-primary outcome was introduced consisting of the proportions of death, new institutional care or severe disability in patients with additional use of information from registration offices.PerspectiveThe results will inform parties involved in acute stroke care organization on the effectiveness of the MSU concept.Trial registrationThe protocol is registered in (NCT03931616) and has been approved by the ethical review committee of the Charité – University Medicine Berlin (EA4/109/15) on September 2, 2015. The study protocol of B_PROUD part 1 had been published in the International Journal of Stroke as “Berlin Prehospital Or Usual Delivery of acute stroke care (B_PROUD) – study protocol” (doi: https://doi.org/10.1177/1747493017700152) on March 22, 2017 [1] previous to first patient’s registration.

Neuroimmunology of Human T-Lymphotropic Virus Type 1-Associated Myelopathy/Tropical Spastic Paraparesis.

Human T-lymphotropic virus type 1 (HTLV-1) is the etiologic agent of both adult T-cell leukemia/lymphoma and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HAM/TSP is clinically characterized by chronic progressive spastic paraparesis, urinary incontinence, and mild sensory disturbance. Given its well-characterized clinical presentation and pathophysiology, which is similar to the progressive forms of multiple sclerosis (MS), HAM/TSP is an ideal system to better understand other neuroimmunological disorders such as MS. Since the discovery of HAM/TSP, large numbers of clinical, virological, molecular, and immunological studies have been published. The host-virus interaction and host immune response play an important role for the development with HAM/TSP. HTLV-1-infected circulating T-cells invade the central nervous system (CNS) and cause an immunopathogenic response against virus and possibly components of the CNS. Neural damage and subsequent degeneration can cause severe disability in patients with HAM/TSP. Little progress has been made in the discovery of objective biomarkers for grading stages and predicting progression of disease and the development of molecular targeted therapy based on the underlying pathological mechanisms. We review the recent understanding of immunopathological mechanism of HAM/TSP and discuss the unmet need for research on this disease.