Treatment Of Secondary Complications Research Articles

Robotic locomotor training for spasticity, pain, and quality of life in individuals with chronic SCI: A pilot randomized controlled trial.

The prevention and treatment of secondary complications is a key priority for people with spinal cord injury and a fundamental goal of rehabilitation. Activity-based Training (ABT) and Robotic Locomotor Training (RLT) demonstrate promising results for reducing secondary complications associated with SCI. However, there is a need for increased evidence through randomized controlled trials. Therefore, we aimed to investigate the effect of RLT and ABT interventions on pain, spasticity, and quality of life in individuals with spinal cord injuries. Participants with chronic motor incomplete tetraplegia (n = 16) were recruited. Each intervention involved 60-minute sessions, 3× per week, over 24-weeks. RLT involved walking in an Ekso GT exoskeleton. ABT involved a combination of resistance, cardiovascular and weight-bearing exercise. Outcomes of interest included the Modified Ashworth Scale, the International SCI Pain Basic Data Set Version 2, and the International SCI Quality of Life Basic Data Set. Neither intervention altered symptoms of spasticity. Pain intensity increased from pre-post intervention for both groups, with a mean increase of 1.55 [-0.82, 3.92] (p = 0.03) and 1.56 [-0.43, 3.55] (p = 0.02) points for the RLT and ABT group, respectively. The ABT group had an increase in pain interference scores of 100%, 50%, and 109% for the daily activity, mood, and sleep domain, respectively. The RLT group had an increase in pain interference scores of 86% and 69% for the daily activity and mood domain respectively, but no change in the sleep domain. The RLT group had increased perceptions of quality of life with changes of 2.37 [0.32, 4.41], 2.00 [0.43, 3.56] and 0.25 [-1.63, 2.13] points, p = 0.03, for the general, physical, and psychological domains, respectively. The ABT group had increased perceptions of general, physical and psychological quality of life with changes of 0.75 [-1.38, 2.88], 0.62 [-1.83, 3.07] and 0.63 [-1.87, 3.13] points, respectively. Despite increased pain ratings and no change in symptoms of spasticity, there was an increase in perceived quality of life for both groups over 24-weeks. This dichotomy warrants additional investigation in future large-scale randomized controlled trials.

Вроджений нефротичний синдром у практиці лікаря-неонатолога (клінічний випадок)

Congenital nephrotic syndrome (CNS) is an inherited disease that is caused by gene mutations and is inherited by an autosomal-recessive mechanism. In most cases, it is associated with genetically mediated defects in the components of the glomerular filtration barrier, especially nephrine and podocytes, with a typical histological picture of diffuse mesenteric sclerosis or focal-segmental glomerulosclerosis. According to genetic research, the primary CNS caused by gene mutations in one of the five genes (NPHS1, NPHS2, WT1, LAMB2, PLCE1) or chromosomal abnormalities. Secondary CNS is combined with other diseases of systemic or renal origin. The onset of the disease manifestation is possible in the antenatal period or during the first three months of life. CNS is manifested by significant hypoproteinemia, proteinuria and diffuse edema. Treatment of congenital nephrotic syndrome is mainly symptomatic therapy, such as: control of edema, azotemia, thyroid function, prevention and treatment of secondary complications (infections and thrombosis). Molecular genetic testing is the «gold» standard for genotyping of this disease. The course of СNS is unfavorable due to the rapid development of end3stage chronic renal failure. The purpose of article is to expand the knowledge of pediatricians and neonatologists about the clinical, laboratory, instrumental and pathomorphological features of Finnish type of СNS in the neonatal age. Clinical case. The article presents clinical, laboratory, instrumental, pathomorphological and molecular-genetic features of the Finnish type of CNS with the manifestation in the early neonatal period. Conclusions. The example of this case shows the necessity of a comprehensive approach at the examination of children suffered from CNS to verify the type of disease, determine the prognosis and treatment tactics. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: congenital nephrotic syndrome, newborn, molecular genetic testing.

CME/Answers: Hypocalcemia and Hypoparathyroidism

CME/Answers: Hypocalcemia and Hypoparathyroidism Abstract. Dyselectrolytemias are common, but not immediately clearly assignable. In addition to hyponatremia, hypercalcemia plays an important role in clinical practice. Clinically no less relevant are hypocalcemias and a frequently underlying primary hypoparathyroidism, which in most cases is iatrogenic - caused by thyroid surgery. The therapeutic goal includes not only adequate calcium control but also the detection and treatment of secondary complications in cases of chronic hypoparathyroidism.

CME: Hypocalcemia and Hypoparathyroidism

CME: Hypocalcemia and Hypoparathyroidism Abstract. Dyselectrolytemias are common, but not immediately clearly assignable. In addition to hyponatremia, hypercalcemia plays an important role in clinical practice. Clinically no less relevant are hypocalcemias and a frequently underlying primary hypoparathyroidism, which in most cases is iatrogenic - caused by thyroid surgery. The therapeutic goal includes not only adequate calcium control but also the detection and treatment of secondary complications in cases of chronic hypoparathyroidism.

Complications after stroke : Clinical challenges in stroke aftercare

Besides the treatment of cardiovascular risk factors, the prevention and treatment of secondary complications is the main focus of outpatient poststroke care. The spectrum of noteworthy complications after astroke changes during the course of the treatment and constitutes aspecific challenge of outpatient poststroke care. This article provides references to the importance, management, diagnosis and treatment of the wide spectrum of nonvascular complications after stroke in the context of outpatient stroke aftercare. Poststroke depression (PSD), anxiety disorders and post-stroke fatigue are common complications after stroke, which require a timely diagnosis and treatment. Furthermore, the incidence of newly diagnosed dementia is 20% within the first 6 months after astroke. Here too, therapeutic and preventive strategies especially in the early stage can delay the subsequent burden of the disease and the dependency on care. About half of every newly diagnosed epilepsy in patients older than 60years is the result of astroke. Falls and subsequent injuries are another important complication and a common reason for rehospitalization after astroke. Although nearly 50% of patients suffer from chronic pain after astroke this is often not sufficiently recognized. The wide spectrum of secondary complications after astroke constitutes acomplex, sustained and multidisciplinary challenge, which requires across-sectoral interaction of various and numerous actors in outpatient poststroke care.

Pharmacological treatment strategies and surgical options for uveitis

Modern treatment of uveitis aims at acomplete control of inflammatory activity, preservation of visual function and the prevention of secondary organ damage as a consequence of the underlying inflammatory disease and its treatment. This article gives an update about the strategies of pharmacological and surgical options for uveitis. The outcomes reported here are based on aPubMed search using the terms <"uveitis" AND "therapy"> and <"uveitis" AND "surgery" OR "surgical treatment">. All prospective studies and case series with more than 20cases as well as review articles from the last 5years along with cited cross-references were evaluated. Local and systemic corticosteroids form the foundation of treatment after exclusion of an infectious etiology. If uveitis activity is not controlled within 6 weeks or if the daily corticosteroid dosage is unacceptably high, atreatment escalation using immunomodulatory drugs is required. If acomplete control of inflammatory activity is not achieved, in a third phase treatment is supplemented by antibody-based treatment or cytokines, so-called biologics, with the aim of complete long-term freedom from disease without local or systemic steroid treatment. This target is achieved in 65-80% and guarantees long-term functional stability and anatomical integrity. Early treatment escalation in cases of persisting or recurrent activity as a rule prevents new secondary organ damage. Surgical options are utilized for diagnostic purposes, the administration of intravitreal drugs and for treatment of secondary complications. Just like the majority of immunological diseases, uveitis is achronic disease requiring long-term and possibly lifelong treatment and remission (absence of inflammation without treatment) is achieved in only <20%. Surgical interventions can be performed with agood prognosis, if the optic nerve head and macula are not involved. They have asubstantially lower complication rate when freedom from symptoms exists preoperatively for at least 3 months.

Effective inhibition of protein glycation by combinatorial usage of limonene and aminoguanidine through differential and synergistic mechanisms

Protein glycation is a major mechanism for establishing secondary complication in diabetes mellitus. Effective inhibition of this process can prevent progression of the disorder into secondary complications. Aminoguanidine (AMG) and limonene (LM) are known protein glycation inhibitors. The aim of the present study was to demonstrate their differential mechanisms of action and to study whether combinatorial therapy can act synergistically and lower dosage, and thereby lower toxicity in treatment of secondary complications in diabetes. Glycation in the presence of 2M urea was inhibited by 23% with AMG and by 66% with LM. AMG is more effective than LM in reducing protein carbonyl formation. SPR studies revealed binding of LM reduces affinity of BSA for glucose. LM demonstrated an increase by 2°C in thermal transition in DSC studies as against reduction by 0.4°C by AMG proving that LM can effectively stabilize the protein structure. Combinatorial treatment of AMG and LM prevented α-helix to β-sheet transitions in BSA at 100μM and inhibited AGE related fluorescence and pentosidine formation by 80 and 90% respectively. The combination can reduce dosage of AMG by almost twenty times, paving the way for effective protein glycation inhibition without toxicity.

Aldose reductase inhibitory potential of different fractions of Houttuynia cordata Thunb

ObjectiveTo evaluate the aldose reductase (AR) inhibitory activity of different fractions from Houttuynia cordata (H. cordata) which used as a medicinal salad for lowering of blood sugar level. MethodsAR inhibitory activity along with protein content was evaluated in vitro in rat lens. Total phenol and flavonoid contents were also determined in all the fractions. ResultsAll the four fractions were found to inhibit lens AR activity, but to different extent. From dose response curve (DRC), aqueous fraction (AQ) was found to be the most effective AR inhibitor followed by ethyl acetate (EA), chloroform (CL) and hexane fraction (HEX). The IC50 values of AQ, EA, CL and HEX were calculated to be (64.62±3.90), (90.69±7.50), (134.59±4.90) and (151.58±3.30) μ g/mL respectively. Quercetin was taken as positive control which exhibited AR inhibition with an IC50 value of (3.21±0.60) μ g/mL in a non-competitive manner. ConclusionThese findings indicated that, AQ fraction of H. cordata exhibited significant inhibitory effect on AR in a non-competitive manner, which may be attributed to the presence of high phenolic and flavonoid contents. Thus, the plant H. cordata may act as a promising source in the treatment of secondary complications like cataract associated with diabetes.

Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy

Background The aim of the present study was to highlight the advantages of treatment of bile duct injury (BDI) occurring during cholecystectomy on the basis of a multidisciplinary cooperation of expert surgeons, radiologists, and endoscopists. Methods Sixty-six patients had major BDIs or short- or long-term failures of repair. BDI was diagnosed intraoperatively in 27 patients (40.9%) and postoperatively in 39 (59.1%) patients. Among referred patients, 30 had complications from bile leak, 15 from obstructive jaundice, and 20 from recurrent cholangitis. Two patients died from sepsis after delayed referral before repair was attempted. Eleven additional patients had minor BDIs with bile leak both with and without choleperitoneum. Results Of patients with major BDI, surgical repair was performed in 41 (64.1%). Postsurgical morbidity rate was 15.8%, and there was no mortality. The rate of excellent or good results after surgical repair was 78.0% (32 of 41 patients), and this increased to 87.8% (36 of 41 patients) by continuing treatment with stenting in postsurgical strictures. Biliary stenting alone was performed in 23 patients (35.9%), with excellent or good results in 17 (73.9%). More than 200 endoscopic and percutaneous procedures were performed for initial assessment, treatment of sepsis, nonsurgical repair, contribution to repair, and follow-up. Patients with minor BDIs underwent various combinations of surgical and endoscopic or percutaneous treatments, always with good results. Conclusions A multidisciplinary approach was of paramount importance in many phases of treatment of BDI: initial assessment, treatment of secondary complications, resolution of sepsis, percutaneous stenting before surgical repair, dilatation of strictures after repair, final treatment in patients not repaired surgically, and follow-up.

Rehabilitation Research and Training Center for the Prevention and Treatment of Secondary Complications of Spinal Cord Injury

Rehabilitation Research and Training Center for the Prevention and Treatment of Secondary Complications of Spinal Cord Injury