Type Of Onset Research Articles

383. Obese primiparous women undergoing induction of labour have a higher caesarean section rate: An analysis using the Robson 10-group classification system

Obesity in pregnant women is rising rapidly, and is associated with increased rates both elective and emergency caesarean sections, the most frequently performed sugical procedure globally, and this has implications on short and long term maternal and perinatal health. To evaluate the effect of maternal obesity on CS rates and identify the key patient categories according to the Robson Ten-Group Classification System (TGCS) contributing to the high CS rates. Retrospective analysis of obese gravidas (BMI > 30 kg/m2) who delivered in our unit from 1 January 2010 to 31 December 2017. Parameters of parity, number of fetuses, fetal presentation, gestational age, type of onset of labour and mode of delivery were collected to form the 10 patient groups. Non-obese gravidas who delivered during the same period were controls. There were 6115 deliveries, with 740 (12.1%) obese. Overall CS rate in the obese group was 42%, compared to 32% in the control group (P < 0.05). The largest contributor to the overall CS rate was Group 5 (term multiparous singelton pregnancies with at least a previous uterine scar). Among the obese with unscarred uteri, Group 2a (term nulliparous singleton cephalic, induced labour) and Group 10 (all singleton women with preterm deliveries) were the top contributors to the overall CS rate. Induced obese primigravida had a higher CS rate (43.5%) compared to induced obese multigravidas (6.9%) (p < 0.05). Maternal obesity is a significant risk factor for CS, with almost 1 in two obese women having a CS. Parity has an important influence on the success of induction of labour in obesity, with primparity conferring a 6-fold increased risk for CS. The high contribution of pretem CS delivery reflects the association of maternal obesity with high risk obstetric complications such as pre-eclampsia, gestational diabetes and fetal growth disorders.

Acute stress and substance use as predictors of suicidal behaviour in acute and transient psychotic disorders

Several authors have reported high rates of suicidal behaviour in acute and transient psychotic disorders (ATPD). However, the literature in this area remains scarce. We wanted to find out whether there are predictors of suicidal behaviour in ATPD. Of 1032 psychosis admissions examined over a five-year period, ATPD was confirmed in 39 patients according to the International Classification of Diseases (ICD-10) diagnostic criteria. These patients were classified as suicidal behaviour (20.5%) or non-risk (79.5%) using a structured interview to assess suicidal risk. The following variables were analysed: previous history of suicide attempt or deliberate self-harm, history of depressive episodes, previous substance use history, education, ATPD subtype (polymorphic vs. non-polymorphic), type of onset (abrupt vs. acute), and presence of associated acute stress. Multivariate analysis revealed that acute stress and substance use are significantly associated with suicidal behaviour in ATPDs. To our knowledge, this is the first study identifying independent risk factors that could predict suicidal behaviour in individuals with ATPD.

Motion onset really does capture attention.

Several properties of visual stimuli have been shown to capture attention, one of which is the onset of motion. However, whether motion onset truly captures attention has been debated. It has been argued that motion onset only captured attention in previous studies because properties of the animated motion used in those experiments caused it to be "jerky" (i.e., there were gaps between successive images during animated motion). The present study sought to determine whether natural motion onset captures attention. Additionally, the present study further examined the circumstances under which animated motion onset, the only type of motion onset that can be produced on a computer display, does and does not capture attention. In Experiment 1, participants identified target letters in search arrays containing distinct animated motion types, either accompanied or unaccompanied by a new object. Animated motion onset captured attention, but not when the motion onset was accompanied by a new object, indicating that prior failures to replicate capture by animated motion onset were limited because a new object had always been included in the display. Experiment 2 employed natural motion rather than animated motion and found that participants were fastest at identifying motion-onset targets compared to other target types. These results provide further support for the claim that motion onset captures attention.

Epidemiology of para-athletic injuries: A cohort study

Athletics practiced at high intensity is a source of injuries because of constraints on musculo-skeletal structures. Social and health interests of physical activities amongst disabled patients are demonstrated. In the last few years, popularization of paralympic sports implies an increased number of participants and injuries. These injuries can have functional consequences and alter the quality of life. The aim of this study was to measure the prevalence of para-athletics’ injuries during an entire sports season and to characterize them by types, location and modes of onset. Moreover, this study identifies risk factors and proposes a prevention program. A cohort study was undertaken of 210 athletes, who took part in one of four french national competitions in the 2016–2017 para-athletics season. Data were collected with help of medical staff during the competitions and identified athletes’ impairments, location, type and mode of onset. Prevalence of injuries during the 2016–2017 season was 19% (9,4 for 100 athlete-days). Athletes with visual impairments experienced the highest number of injuries (42,5%, 16,8 for 100 athlete-days) followed by amputee athletes (23,8%, 10,8 for 100 athletes-days). The large majority of the injuries affected the thigh (39%) and were muscle strains (56%). This cohort study brings new data about para-athletics traumatology. Athletes with visual impairment experienced the highest rate of injuries and prevention programs must focus on hamstring strains.

Factors Associated with Self Care Practices among Patients with Hepatitis C Virus

Hepatitis C virus (HCV) is an important public health problem both in developed and developing countries. Living with hepatitis C involves learning to live with the physical, emotional, social and financial consequences of the disease. All of these changes can affect patient's ability to cope with chronic HCV with profound negative impacts on self-care practices. Self-care as a part of daily living is the care taken by individuals towards their own health and well-being, which includes the care extended to their children, family, friends and others in neighborhoods and local communities. Self-care practices play an important role in disease management, treatment and achieving better health outcome. Objective: Identify factors associated with self-care practices among patients with hepatitis C virus. Setting: The study was conducted at outpatient clinic of Liver Institute in Kafr El-Sheikh (Ministry of Health). Subjects: 340 adult patients diagnosed with HCV infection. Tools: Three tools were utilized for the purpose of data collection; socio-demographic and clinical data interview schedule, hepatitis C virus patients' knowledge structured interview questionnaire, and hepatitis C Virus self-care practices structured interview questionnaire. Results: There were multiple factors influencing patients' self-care practices including age, sex, educational level, marital status, type of work, income, residence and clinical onset and duration of disease, history of associated diseases and taking medications for these associated diseases. Conclusion: There were four factors together statistically significant influence patients self-care practices including educational level, age, income and residence. Recommendations: Development of health education programs for HCV patients and their families to teach them how to apply self-care practices and how to deal with factors affecting patients' self-care practices to avoid subsequent complications of HCV.

L’intuition délirante comme phénomène élémentaire de la psychose

AimsThis article sets out to delineate and understand more fully the concept of delusional intuition from the standpoints of psychiatry and psychoanalysis. We question the term of “intuition” itself, and wonder if it should be retained. We also ask whether delusional intuition is specific to a particular form of psychosis. MethodsWe start with a review of the psychiatric and psychoanalytic literature. This retrospective approach enables us to draw away from the phenomenon of delusional intuition as such, and to explore it as an element in the psychotic structure that breaks into reality. ResultsThe contributions of psychoanalysis enable delusional intuition to be seen as an elementary phenomenon, a very specific triggering moment in the onset of psychosis. This sudden occurrence – which does not produce the classic unsettling effects – appears to immediately satisfy the subject and provide him or her with an answer, a solution, in the form of a revelation or illumination, requiring no further delusional explanation, justification or interpretation. DiscussionThe discussion, which calls on psychoanalytic references, explores the relationships between delusional intuition and the type of psychosis, between intuition and interpretation, between the classic onset (which, roughly, proceeds from enigma to perplexity and on to certainty) and this particular type of onset which seems to proceed in the opposite direction. ConclusionDelusional intuition is an elementary phenomenon that imposes itself on the subject with the full weight of its certainty, with an obviousness that is sometime described as a moment of illumination. The phenomenon is often backed up by delusional interpretations. This type of onset of psychosis is particular in that it does not result in an unsettling of structure. Its function appears allied to that of a prosthesis protecting the subject from the risk of disorganization, immediate, taking the form of a revelation of the meaning of objects and of the world in general.

Comprehensive Clinical Profile of Mal De Debarquement Syndrome.

There has been increasing awareness that post-motion triggered rocking self-vertigo can last for months or years, a disorder known as Mal de Debarquement Syndrome (MdDS). A similar feeling of oscillating self-motion can occur without a motion trigger in some individuals, leading to controversy about whether motion triggered (MT) and non-motion triggered (non-MT) symptoms ultimately represent the same disorder. Recognizing the similarities and differences between MT and non-MT MdDS can prevent unnecessary diagnostic testing and lead to earlier and more effective treatments. Standardized questionnaire assessment and follow-up interviews of individuals with persistent MT or non-MT MdDS (>1 month) examined at a University Dizziness Clinic. Questionnaires were available on 80 individuals with persistent MT MdDS and 42 with non-MT MdDS. Sex distribution (81% female) and age of onset (mean 43.4 ± 12.2 years MT; 42.1 ± 15.2 years non-MT) were comparable between MT and non-MT MdDS (p > 0.05). Mean duration of illness was significantly longer in the non-MT group (82.8 ± 64.2 months) than the MT group (35.4 ± 46.4 months) (p < 0.001). There was no correlation between trigger type and age of onset or duration of illness for MT MdDS. Improvement with re-exposure to motion (driving) was typical for both (MT = 89%, non-MT = 64%), but non-MT individuals more frequently had symptoms exacerbated with motion (MT = 0%; non-MT = 10%). Peri-menstrual and menstrual worsening of symptoms was typical in both MT and non-MT MdDS (each 71%). Both MT and non-MT MdDS exhibited a higher population baseline prevalence of migraine (23% and 38%, respectively). Benzodiazepines and SSRI/SNRIs were helpful in both subtypes of MdDS (>50% individuals with a positive response). Physical therapy was modestly helpful in the MT (56%) subtype but not in non-MT (15%). Vestibular therapy made as many individuals worse as better in MT and none improved in the non-MT group. General demographic characteristics and exacerbating factors are similar in MT and non-MT MdDS, but there are differences in the duration of illness, effect of motion on symptoms, and response to therapy. Recognizing clinical features of MdDS subtypes may allow for better tailoring of therapy and potentially serve as classification criteria for new clinical designations.

Electromyographic Study of Thoracic Paraspinal and Rectus Abdominis Muscles in Amyotrophic Lateral Sclerosis.

The aim of our study was the comparison of active denervation (fibrillation and/or positive sharp wave potentials) in thoracic paraspinal muscles with rectus abdominis in patients with definite amyotrophic lateral sclerosis. Ninety-five consecutive patients with clinically definite amyotrophic lateral sclerosis according to the revised El Escorial criteria were studied prospectively over a 5-year period. Concentric needle electromyogram was performed in thoracic paraspinal muscles, in the rectus abdominis at the T9 level, and in limb muscles. Active denervation was present in thoracic paraspinal muscles in 75 patients (79%) and in rectus abdominis in 62 patients (65.3%) (P = 0.02). No significant difference was found between the two muscles regarding the type of onset (bulbar, upper, and lower limbs), amyotrophic lateral sclerosis functional rating scale values, and creatine phosphokinase levels. Thoracic paraspinal muscles are the first to be tested in patients with amyotrophic lateral sclerosis. Absence of active denervation in T-PSM is rarely associated with active denervation in rectus abdominis.

BS04. Characteristics of respiratory dysfunction in amyotrophic lateral sclerosis: A clinical study in 159 cases

Amyotrophic lateral sclerosis(ALS) is a neurodegenerative disorder involving both upper and lower motor neurons with an average survival time of 3–5 years. Respiratory deterioration is the main cause of ALS and affects almost all ALS patients in different courses. Currently, it is still controversial of the characteristics of respiratory deterioration in ALS patients, including the effect of the type of disease onset, as well as the progression rates. We performed a retrospective cohort study including 159 ALS patients at Peking Union Medical College Hospital from June 2014 to April 2017. Age at symptom onset, sex, time form onset to PFT, ALSFRS-R score, onset and area involved were recorded. All patients were followed in March 2016 and Jun 2017 separately. Depending on the pattern of onset, patents were subdivided into two groups. One included patients with bulbar-onset ALS and the other included those with limb-onset. The mean age at symptom onset of 159 cases included was 52.9 ± 10.1 years old; the male: female ratio was 1.24:1. Bulbar-onset of symptoms was seen in 17.0% patients, while 81.6% presented with limb-onset. The time from symptom onset to PFT was shorter in the bulbar-onset group (7.0 vs. 11.5 m, p = 0.004), as well as the time from symptom onset to diagnosis (8.0 vs. 12.0 m, p = 0.027). Significant differences were showed of the age at symptom onset (p = 0.025), time form symptom onset to diagnosis (p = 0.026) and ALSFRS-R scores (p = 0.004) between the two groups. The PFT parameters revealed a main characteristic restrictive type of dysfunction. Only 26.0% patients of respiratory dysfunction from PFT parameters had respiratory complaints. Mean FVC% and FEV1%value was 86.7% ± 22.2%, 85.6% ± 19.2% respectively. After adjusting for sex, ALSFRS-R score, time from symptom onset to diagnosis, BMI and age at symptom onset, no significant difference was observed for patients with time form symptom onset to PFT less than 14 mouths. In contrast, for those with time more than 14 mouth, bulbar-onset group showed worse PFT values than the limb-onset group, with differences was 27.5% (95%CI: 4.3%, 50.7%), 24.7% (95%CI: 4.3%, 45.2%) and 42.0% (95%CI: 17.7%, 66.4%) separately. The decline rates for FVC% and FEV1% were 0.7% per mouth and 0.8% per mouth. No difference was found between the two groups. ΔFVC% and ΔFEV1% of patients in bulbar-involved group were 1.5% (95%CI: 0.0–18.5%) and 1.4% (95%CI: 0.0–9.8%), which were significantly higher than those in limb-involved group of 0.2% (95%CI: 0.0–10.4) and 0.5%(95%CI: 0.0–8.0%) (p < 0.001, p < 0.001). The main type of pulmonary dysfunction was restrictive pattern. Bulbar involvement predicted poorer respiratory function in ALS patients compared with limb-only involvement, no matter whether the involvement was the onset symptom.The progression rate was higher in the bulbar involved patients than those with limb-only involvement.

T61. Sensitivity of seizure automatic detectors in prolonged ambulatory EEGs

Introduction Visual screening of prolonged continuous EEG tracings can be time-consuming, and therefore automatic seizure detection softwares have been developed to facilitate the reading. In this study we aim to investigate the frequency of recorded seizures and the sensitivity of automatic seizure detectors used for ambulatory EEG recordings. The goal was to evaluate whether the review of pre-selected seizure files might be sufficiently accurate to detect at least one seizure per study, and therefore highlight a “high risk” tracing, or if the reading of continuous data is needed. Methods We included all the prolonged ambulatory EEGs (>24 h) read at the Northwestern Memorial Hospital from January 2013 to October 2017, which included studies performed in house as well as through outside agencies. The complete EEG tracings were reviewed by a neurophysiology fellow under the supervision of a board certified neurophysiologist. The first study of each patient was selected. Each study was processed through one of three different commercially available detection softwares (Persyst® 11, Persyst® 12 and Gotman TM Event Detection). We then calculated the proportion of patients in which at least one electrographic seizure was corrected identified by the automatic detector, and evaluated if the type of EEG seizure onset could predict the chances of being detected. Results We continuously reviewed 1478 ambulatory EEG studies (2323 days of EEG recording; average 1.6 days/study). Among the first study of each patient (1257 studies), electrographic seizures were found in 76 (6%) studies. For the comparison with the automatic seizure detectors, we excluded one patient with brief seizures ( Conclusion Regardless of the indication for an ambulatory EEG, electrographic seizures were found in 6% of the studies. The sensitivity of the seizure detectors for correct identification of at least one electrographic seizure was only 51%. They performed better detecting seizures with generalized EEG onsets than with focal onsets. Given the low sensitivity for seizure detection, the review of ambulatory recordings should not be limited to automatically selected segments, particularly when focal seizures are suspected.

Labor Onset, Oxytocin Use, and Epidural Anesthesia for Vaginal Birth after Cesarean Section and Associated Effects on Maternal and Neonatal Outcomes in a Tertiary Hospital in China: A Retrospective Study.

Background:In the mainland of China, the trial of labor after cesarean section is still a relatively new technique. In this study, we aimed to investigate the effects of labor onset, oxytocin use, and epidural anesthesia on maternal and neonatal outcomes for vaginal birth after cesarean section (VBAC) in a tertiary hospital in China.Methods:This was a retrospective study carried out on 212 VBAC cases between January 2015 and June 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Relevant data were acquired on a form, including maternal age, gravidity and parity, body mass index before pregnancy, weight gain during pregnancy, type of labor onset, gestational age, the use of oxytocin and epidural anesthesia, birth mode, the duration of labor, and neonatal weight. The factors affecting maternal and neonatal outcomes for cases involving VBAC, especially with regards to postpartum hemorrhage (PPH) and fetal distress, were evaluated by univariate analysis and multivariable logistic regression.Results:Data showed that 36 women (17.0%) had postpartum hemorrhage (PPH) and 51 cases (24.1%) featured fetal distress. Normal delivery took place for 163 infants (76.9%) while 49 infants (23.1%) underwent operative vaginal deliveries with forceps. There were 178 cases (84.0%) of spontaneous labor and 34 cases (16.0%) required induction. Oxytocin was used in 54 cases (25.5%) to strengthen uterine contraction, and 65 cases (30.7%) received epidural anesthesia. The rate of normal delivery in cases involving PPH was significantly lower than those without PPH (61.1% vs. 80.1%; χ2 = 6.07, P = 0.01). Multivariate logistic analysis showed that the intrapartum administration of oxytocin (odds ratio [OR] = 2.47; 95% confidence interval [CI] = 1.07–5.74; P = 0.04) and birth mode (OR = 0.40; 95% CI = 0.18–0.87; P = 0.02) was significantly associated with PPH in VBAC cases. Operative vaginal delivery occurred more frequently in the group with fetal distress than the group without (49.0% vs. 14.9%, χ2 = 25.36, P = 0.00). Multivariate logistic analysis also revealed that the duration of total labor (OR = 1.01; 95% CI = 1.00–1.03; P = 0.04) and the gestational week of delivery (OR = 1.08; 95% CI = 1.05–1.11; P = 0.00) were significantly associated with fetal distress in VBAC.Conclusions:The administration of oxytocin during labor and birth was identified as a protective factor for PPH in VBAC while birth mode was identified as a risk factor. Finally, the duration of total labor and the gestational week of delivery were identified as risk factors for fetal distress in cases of VBAC. This information might help obstetricians provide appropriate interventions during labor and birth for VBAC.

Correlation between bulbar functionality and laryngeal penetration and/or laryngotracheal aspiration on motor neuron disease.

Describe and correlate bulbar functionality with laryngeal penetration and/or laryngotracheal aspiration for different food consistencies in Motor Neuron Disease (MND). Study participants were 18 individuals diagnosed with MND regardless of the type and time of onset of disease. The Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised/BR (ALSFRS-R/BR) was applied, and only the bulbar parameter, which includes speech, salivation and swallowing, was analyzed, with scores raging from 0 (disability) to 12 (normal functionality). Swallowing videofluoroscopy was performed using the Penetration-Aspiration Scale (PAS) described by Rosenbek et al. (1996). The Pearson correlation test was used for data analysis. According to food consistency, the PAS level ranged from 1 to 5 for puree consistency, 1 to 4 for thickened liquid, and 1 to 3 for liquid, and no laryngotracheal aspiration was observed. Negative correlation between bulbar functionality and laryngeal penetration was observed for all food consistencies (pasty: r=-0.487, p=0.041; thickened liquid: r=-0.442, p=0.076; liquid r=0.460, p=0.073), but statistically significant difference was found only for the puree consistency, that is, individuals with poor bulbar functionality presented higher levels of laryngeal penetration. Negative correlation was observed between bulbar functionality and laryngeal penetration in MND. The bulbar parameters of the ALSFRS-R/BR are significant for predicting risk of laryngotracheal aspiration for pasty consistency in MND.

Association study of methylenetetrahydrofolate reductase genetic polymorphism 677C>T with schizophrenia in hospitalized patients in population of European Russia.

The purpose of the research was to investigate the association of methylenetetrahydrofolate reductase (hereinafter MTHFR) genetic polymorphism 677C>T with schizophrenia in the Russian population in comparison with the control group of healthy blood donors. Also some characteristics of schizophrenia were examined in patients with/without defective T-allele of MTHFR677C>T polymorphism. 500 patients with schizophrenia and 499 blood donors were examined for T-allele carriage of polymorphism MTHFR677C>T by PCR method. 150 archival medical records were studied (in the first patients included in the study). The carriage of T-allele of genetic polymorphism MTHFR677C>T was significantly more common in patients than in healthy donors: 255/500 versus 219/499 (p=0,0287, χ2=4,79; OR=1,33, 95%CI [1037; 1707]). The number of patients with chronic type of schizophrenia onset was significantly more among T-allele carriers (n=77) than among normal CC-genotype carriers (n=73): р=0.038. The number of "incapacitated" persons in the group of patients with defective T-allele (n=77) was significantly higher than in patients with normal genotype (n=73, p=0.0439; OR=2.878, 95%CI=1.111-7.456). The results suggest that T-allele of genetic polymorphism MTHFR677C>T in the population of European Russia may increase the risk of developing schizophrenia and its unfavorable prognosis, which requires further investigation.

Clinico-etiological profile of seizures in term and near-term neonates: tertiary care hospital based observational study

Background: Neonatal period is very important for development of immature brain and it is also most vulnerable period for development of seizures. Seizures have varied etiology as well as presentation during neonatal period. Considering this we planned this study with objective of finding incidence, etiology, type and time of onset of seizures and their correlation along with short term outcome.Methods: It is a prospective observational study done in level 2 NICU set up of Government Medical College from November 2008 to September 2009. Total 115 term and near term neonates (≥35 weeks of gestation) presenting in NICU with seizures were enrolled in study. All relevant details were recorded on performa and investigations were sent. Data was described as mean±SD and %. SPSS 13 software was used as data analysis.Results: Incidence of seizures came out to be 6.1% of total NICU admission, which was more in male appropriate for gestational age (AGA) babies and those who were born vaginally, extramural and to primiparous mother. Birth asphyxia was most common etiology of seizures and majority presented within 24 hours of birth and meningitis was most important cause of seizure after 7 days of life. Subtle seizures were most common clinical type of seizure in the present study. Risk factor for poor neurological outcome came out to be Hypoxic Ischemic Encephalopathy (HIE). Conclusions: Hypoxic ischemic encephalopathy was most important etiology of neonatal seizures and most important risk factor for poor neurological outcome and subtle seizures being most common clinical type of seizure.

Wide Range of Carbapenem-resistant Enterobacteriaceae Incidence and Trends in Emerging Infections Program Surveillance, 2012–2015

BackgroundCarbapenem-resistant Enterobacteriaceae (CRE) are an urgent threat in the United States because of high morbidity and mortality, few treatment options, and potential for rapid spread among patients. To assess for changes in CRE epidemiology and risk among populations, we analyzed CDC Emerging Infections Program (EIP) 2012–2015 surveillance data for CRE.MethodsActive, population-based CRE surveillance was initiated in January 2012 at 3 EIP sites (GA, MN, OR) and expanded to 5 additional sites (CO, MD, NM, New York, TN) by 2014. An incident case was the first Escherichia coli, Enterobacter, or Klebsiella isolate (non-susceptible to at least one carbapenem and resistant to all third-generation cephalosporins tested) collected from urine or a normally sterile body site from a patient during a 30-day period. Data were collected from patients’ medical records. Cases were hospital-onset (HO) or long-term care facility (LTCF) onset if patients were in the respective facility ≥3 days prior to culture or at the time of culture; and community-onset (CO) otherwise. We calculated incidence rates based on census data for EIP sites and described by type of infection onset.ResultsA total of 1,582 incident CRE cases were reported in 2012–2015. Most cases (88%) were identified through urine cultures; 946 (60%) were female, and median age was 66 years (interquartile range: 55–77). The median incidence by site was 2.95 per 100,000 population (range: 0.35–8.98). Among the three sites with four full years of data, a different trend was seen in each (Figure). Trends in GA and MN were statistically significant, and no significant trend was seen in OR. Overall, 480 cases (30%) were HO, 524 (33%) were LTCF onset, and 578 (37%) were CO. Of CO cases, 308 (53%) had been hospitalized, admitted to a long- term acute care hospital or were a LTCF resident in the prior year.ConclusionCRE incidence varied more than 20-fold across surveillance sites, with evidence of continued increases in MN. Measuring impact of programs aimed at reducing CRE transmission in other regions will require obtaining local data to identify cases occurring during and after healthcare facility discharge. Further study of changes in incidence in some settings and areas might offer opportunities to refine and expand effective control strategies.Disclosures All authors: No reported disclosures.

Spatial distribution of early red lesions is a risk factor for development of vision-threatening diabetic retinopathy

Aims/hypothesisDiabetic retinopathy is characterised by morphological lesions related to disturbances in retinal blood flow. It has previously been shown that the early development of retinal lesions temporal to the fovea may predict the development of treatment-requiring diabetic maculopathy. The aim of this study was to map accurately the area where lesions could predict progression to vision-threatening retinopathy.MethodsThe predictive value of the location of the earliest red lesions representing haemorrhages and/or microaneurysms was studied by comparing their occurrence in a group of individuals later developing vision-threatening diabetic retinopathy with that in a group matched with respect to diabetes type, age, sex and age of onset of diabetes mellitus who did not develop vision-threatening diabetic retinopathy during a similar observation period.ResultsThe probability of progression to vision-threatening diabetic retinopathy was higher in a circular area temporal to the fovea, and the occurrence of the first lesions in this area was predictive of the development of vision-threatening diabetic retinopathy. The calculated peak value showed that the risk of progression was 39.5% higher than the average. There was no significant difference in the early distribution of lesions in participants later developing diabetic maculopathy or proliferative diabetic retinopathy.Conclusions/interpretationThe location of early red lesions in diabetic retinopathy is predictive of whether or not individuals will later develop vision-threatening diabetic retinopathy. This evidence should be incorporated into risk models used to recommend control intervals in screening programmes for diabetic retinopathy.

Early predictive factors of disability in CIDP

The objective of this study was to identify early clinical, biochemical and electrophysiological prognostic factors of disability in CIDP. We evaluated a dataset from 60 CIDP patients that included sex, age of onset, type of onset, phenotype, disease duration, response to treatment, disability at the time of diagnosis assessed using the modified Rankin Scale (baseline mRS), cerebrospinal fluid protein levels and electrophysiological data. All patients had clinical assessment of disability through the mRS within the last 6months (last mRS) before enrollment in the study. Stepwise forward logistic regression model was applied to evaluate the impact of clinical, biochemical and electrophysiological parameters on the last mRS, considered as binary outcome (absence or presence of severe disability, i.e., <4/≥4 mRS). Moreover, we used Spearman's rank correlation coefficient to evaluate the relationship between disease duration and last mRS. We observed a significant relationship between last mRS and baseline mRS [p=0.015, z=2.44, OR 5.15 (CI 1.38-19.22)] and age of onset [p=0.017, z=2.39, OR 1.13 (CI 1.02-1.27) per additional year of age of onset]. There was no correlation between disease duration and last mRS. Our data suggest that a worse clinical status at the beginning of disease and an older age at onset may be negative prognostic factors of long-term disability independent from disease duration.

Neck and back problems in adults with idiopathic scoliosis diagnosed in youth: an observational study of prevalence, change over a mean four year time period and comparison with a control group

BackgroundThe knowledge is sparse concerning neck problems in patients with idiopathic scoliosis. This is an observational study including a control group which aims to describe the prevalence of neck problems and the association with back problems among adult individuals with and without idiopathic scoliosis.MethodsOne thousand sixty-nine adults with a mean age of 40 years, diagnosed with idiopathic scoliosis in youth, answered a questionnaire on neck and back problems. Eight hundred seventy of these answered the same questionnaire at a second occasion in a mean of 4 years later. Comparisons were made with a cross-sectional population-based survey of 158 individuals. Statistical analyses were made with logistic regression or analysis of variance, adjusted for age, smoking status, and sex.ResultsIndividuals with scoliosis were previously untreated (n = 374), brace treated (n = 451), or surgically treated (n = 244). Of the individuals with scoliosis, 42% (n = 444) had neck problems compared to 20% (n = 32) of the controls (p = 0.001). The prevalence of neck problems was not affected by the type of treatment (p = 0.67) or onset of scoliosis; juvenile (n = 159) or adolescent (n = 910; p = 0.68). Neck and/or back problems were experienced by 72% of the individuals with scoliosis and 37% of the controls (p < 0.001). Of the individuals with scoliosis having neck problems, 81% also reported back problems, compared to 59% of the individuals in the control group (p < 0.001). The prevalence of neck and back problems was similar at the second survey.ConclusionsNeck problems are more prevalent and more often coexist with back problems in individuals with idiopathic scoliosis than in controls. The majority of individuals have persisting problems over time.

Cumulative Impact of Stressful Life Events on the Development of Takotsubo Cardiomyopathy.

The role of stressful life events in the onset of Takotsubo cardiomyopathy (TC) is unclear. This study sought to examine associations between type, timing, and number of stressful life events and onset of TC. A case-control study conducted among consecutive incident female TC cases and myocardial infarction (MI) controls admitted to two emergency departments in New England. Healthy female controls (HC) were recruited from a volunteers' registry. Information about the timing, type, and number of triggers during the 6months preceding hospitalization was systematically collected using the PERI Life Events Scale about 1month post-discharge. Group differences were evaluated using ANOVA, chi-square, and Kruskal-Wallis statistics. Generalized linear models were used to adjust for confounding variables. Between March 2013 and October 2015, 107 women were enrolled (45 TC, 32 MI, and 30 HC). Specific stressful events (death of a relative or close friend (p=0.006); illness or injury to a relative or close friend (p=0.001) were more prevalent in TC cases than MI and HC controls. The onset of TC was associated with exposure to multiple stressful life events during the 6months preceding the index hospitalization (p<0.001) but not with exposure to an acute, recent event (p=0.96). TC onset was associated with specific life events (death or illness to close relative or friend) and with the number of stressful life events occurring in the 6months preceding hospitalization. These findings suggest that grief and cumulative stress could play a major role in the onset of TC.

Management and Outcome of Infantile Hydrocephalus in a Tertiary Health Institution in Nigeria.

Background:Hydrocephalus is a leading cause of disability among children worldwide. The outcome depends on morphology and whether insult is pre- or post-natal. There has been improvement in morbidity in developed countries due to improved surgical care. A paucity of trained personnel impacts negatively on care and outcome of infants with hydrocephalus in many low-income countries resulting poorer outcome. We conducted an audit of patients with hydrocephalus managed in our institution to determine common etiology and outcome.Object:The objective of this retrospective review was to conduct an audit of hydrocephalus care in our institution.Materials and Methods:Information was retrieved from case notes, ward records, imaging results, operation notes, and follow-up clinic charts. Type of hydrocephalus, onset, treatment offered, outcome, complications, and follow-up duration were documented.Results:Management of 58 infants with complete data was analyzed. Most hydrocephalus 40 (69%) were congenital with 14 (35%) occurring in association with myelomeningocele and 8 patients confirmed with aqueductal stenosis. Ventriculoperitoneal shunts insertion 53 (91%) was the most common treatment modality.Conclusions:There is need to improve surgical intervention in the form of endoscopic third ventriculostomy in suitable patients. Subsiding cost of care may be considered for indigent patients.