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Neurological Illness

Suresh Bokoliya, Shripad Patil, Madhu Nagappa, Arun Taly
Objective: To assess the practicality of dot-blot testing for rapid and sensitive detection of the antiacetylcholine receptor (anti-AChR) antibodies in myasthenia gravis (MG). Methods: In this case-control study, we tested serum specimens of 85 patients with MG, 85 healthy control individuals, and 85 patients without MG who have other autoimmune and neurological illnesses. All the serum specimens were tested for anti-AChR antibodies using 3 assays: in-house enzyme-linked immunosorbent assay (ELISA), the dot-blot assay, and commercial ELISA...
December 7, 2018: Laboratory Medicine
Menbeu Sultan, Gelila Mengistu, Finot Debebe, Aklilu Azazh, Indi Trehan
Introduction: Given the scarcity of critical care hospital beds in Africa, emergency centres (ECs) are increasingly charged with caring for critically ill patients for extended periods of time. The objective of this study was to improve the understanding of the nature and outcomes of critically ill patients with prolonged treatment times of more than six hours in two ECs in Addis Ababa, Ethiopia. Methods: This study was conducted over three months in two ECs of urban tertiary care hospitals in Addis Ababa...
December 2018: African Journal of Emergency Medicine Revue Africaine de la Médecine D'urgence
Atul Phillips, Gautam Rai Aggarwal, Vishal Mittal, Gurpreet Singh
Scrub infection is an important differential of undifferentiated febrile illness in the subtropical and tropical countries. Neurological complications of scrub infection have a varied spectrum of presentation involving both the central nervous system, among which meningitis and meningoencephalitis are the most common presentations. The peripheral nervous system manifestations include Guillain-Barre syndrome (GBS) is not commonly reported. The coexistence of both central and peripheral involvement is rare, and we would like to report a case of a patient who was diagnosed with scrub infection and presented with meningoencephalitis and later developed GBS in the course of the disease on treatment for scrub infection...
October 2018: Annals of Indian Academy of Neurology
Roop Gursahani, Raj K Mani, Sri Nagesh Simha
The recent supreme court of India judgment on autonomy makes it necessary for all practicing neurologists to appraise themselves of the changing legal framework for End-of-Life decision-making in India. A pathway has been prescribed for advance care planning and medical futility decision-making. This is an evolving landscape and in a diverse country may vary substantially by geography. Living wills and advance medical directives can be prepared by our patients, and we will be required to honor these instruments...
October 2018: Annals of Indian Academy of Neurology
Mark Howard, Christina Ramsenthaler
BACKGROUND: Driving is a complex activity that requires physical abilities and adequate executive and cognitive functioning. There is concern among specialist palliative care services about patients continuing to drive despite having progressive incurable illnesses, comorbidities and medications to manage their symptoms. OBJECTIVES: To determine the quality of literature available about driving that would apply to palliative care patients, specifically in relation to road test or simulated driving scores and neurocognitive testing...
December 6, 2018: BMJ Supportive & Palliative Care
Daniela Gardiol, Federico Marziali, María Paula Dizanzo, Ana Laura Cavatorta
Human Disc large (DLG1) is a scaffolding protein that through the interaction with diverse cell partners participates in the control of key cellular processes such as polarity, proliferation and migration. Experimental data have mainly identified DLG1 as a tumor suppressor. An outstanding point for DLG1 protein is that altered DLG1 expression and DLG1 gene mutations were observed in different pathologies, including cancer and neurological and immunological disorders. Evident changes in DLG1 abundance and/or cell localization were identified in a number of studies suggesting its participation in molecular mechanisms responsible for the development of such illnesses...
December 1, 2018: Biological Chemistry
Marc R Nuwer, Paul M Vespa
Coding specifies the work performed when providing patient care. Critical care services mostly use code 99291, and other codes specify additional time and procedures. Current Procedural Terminology defines critically ill as "a high probability of imminent or life-threatening deterioration in the patient's condition," a condition necessary for use of the critical care code. A patient may be critically ill for neurologic reasons even when stable from a cardiorespiratory status. Rules govern who can use these codes, whether they can be used by more than one physician, the locations where the code may be used, and what services are included and excluded...
December 2018: Continuum: Lifelong Learning in Neurology
Diana Greene-Chandos, Michel Torbey
PURPOSE OF REVIEW: Weakness is a common reason patients are seen in neurologic consultation. This article reviews the differential diagnosis of neuromuscular disorders in the intensive care unit (ICU), discusses the intensive care needs and evaluation of respiratory failure in patients with neuromuscular disorders, and provides a practical guide for management. RECENT FINDINGS: Although primary neuromuscular disorders used to be the most common cause for weakness from peripheral nervous system disease in the ICU, a shift toward ICU-acquired weakness is observed in today's clinical practice...
December 2018: Continuum: Lifelong Learning in Neurology
Li Kong, Huiru Cui, Tianhong Zhang, Ya Wang, Jia Huang, Yikang Zhu, Yingying Tang, Christina J Herold, Johannes Schröder, Eric F C Cheung, Raymond C K Chan, Jijun Wang
Neurological soft signs (NSSs), conventionally defined as subtle neurological abnormalities, are frequently found in individuals with schizophrenia. Many neuroimaging studies have also reported that NSSs are associated with grey matter changes in patients with schizophrenia at different stages of the illness. However, these findings may be confounded by the effect of antipsychotic medications, chronicity, and duration of untreated psychosis. Examining NSSs in individuals with ultra-high risk (UHR) for psychosis may help to identify the neuroanatomical substrates of NSSs related to the illness itself and to avoid these potential confounding effects...
December 4, 2018: PsyCh Journal
Ting Xia, Alex Collie
Objective Health and social care workers have a significantly higher rate of work-related injury and illness than workers in other industries. The objective of this study was to examine the rate and distribution of work-related injury and illness in the Victorian health and social care sector by demographic, occupation and injury characteristics. Methods A retrospective cohort analysis was conducted of population-level workers' compensation claim records, including 43910 claims from the Victorian health and social care over a 10-year period from 2006 to 2015...
December 5, 2018: Australian Health Review: a Publication of the Australian Hospital Association
Johann Steiner, Harald Prüss, Stephan Köhler, Thomas Frodl, Alkomiet Hasan, Peter Falkai
OBJECTIVES: Despite intensive research, schizophrenia and schizoaffective disorders continue to be theoretical constructs that describe clinical syndromes and no pathophysiologically defined diseases. Moreover, there are no clear biomarkers at hand. Therefore, these diagnoses are still set up based on clinical ICD-10 / DSM-5 criteria and the exclusion of alcohol- / drug-associated, systemic or other brain organic causes. METHODS: Recently, autoimmune encephalitis with psychotic symptoms caused by specific antineuronal antibodies has been identified as rare, but potentially treatable differential diagnosis...
December 4, 2018: World Journal of Biological Psychiatry
Brian W Powers, Jiali Yan, Jingsan Zhu, Kristin A Linn, Sachin H Jain, Jennifer L Kowalski, Amol S Navathe
BACKGROUND: There is a growing focus on improving the quality and value of health care delivery for high-cost patients. Compared to fee-for-service Medicare, less is known about the clinical composition of high-cost Medicare Advantage populations. OBJECTIVE: To describe a high-cost Medicare Advantage population and identify clinically and operationally significant subgroups of patients. DESIGN: We used a density-based clustering algorithm to group high-cost patients (top 10% of spending) according to 161 distinct demographic, clinical, and claims-based variables...
December 3, 2018: Journal of General Internal Medicine
Sara Jalali-Farahani, Fahimeh Alsadat Shojaei, Parnian Parvin, Parisa Amiri
BACKGROUND: Health-related quality of life (HRQoL) has frequently been compared between both healthy and obese children and healthy and chronically ill children; however, there is glaring lack of evidence regarding comparison of HRQoL in obese children with their counterparts with chronic diseases. Therefore, this study aimed to compare HRQoL among healthy, obese and chronically ill children. METHODS: This cross sectional study was conducted among 802 children (8-12 years) who were recruited via convenience sampling method...
December 4, 2018: BMC Public Health
David Robinson, Stephanie Thompson, Andrew Bauerschmidt, Kara Melmed, Caroline Couch, Soojin Park, Sachin Agarwal, David Roh, E Sander Connolly, Jan Claassen
BACKGROUND: Delirium is a frequent complication of critical illness, but its diagnosis is more difficult in brain-injured patients due to language impairment and disorders of consciousness. We conducted a prospective cohort study to determine whether Richmond Agitation and Sedation Scale (RASS) scores could be used to reliably diagnose delirium in the setting of brain injury. We also examined clinical factors associated with delirium in patients with subdural hematomas (SDH) and assessed its impact on functional outcome at discharge...
November 30, 2018: Neurocritical Care
Tetsuo Nakayama
Vaccine adverse events and controversial safety issues have occurred in recent decades in Japan: aseptic meningitis following the measles-mumps-rubella combined vaccine (MMR), anaphylaxis after immunization with live virus vaccines and inactivated split influenza vaccine, an increased incidence of febrile illness following the simultaneous administration of inactivated vaccines, and chronic pain with neurological illness after immunization with the human papilloma virus vaccine (HPV). Vaccine adverse events are a matter of concern for the public as well as general practitioners; some are within the range of assumptions that adverse reactions after live attenuated vaccines are related to the nature of their parental wild-type viruses...
November 29, 2018: Vaccine
Forgive Avorgbedor, Susan Silva, Elizabeth Merwin, James A Blumenthal, Diane Holditch-Davis
OBJECTIVE: To compare the health, physical growth, and developmental outcomes in preterm infants of women with and without hypertensive disorders of pregnancy (HDP). DESIGN: Cross-sectional analysis of health outcomes; physical growth (head circumference, height, and weight) collected at birth and 2 months, corrected for prematurity; and cognitive, language, and motor skills of preterm infants of women with and without HDP. SETTING: Four NICUs in the United States...
November 28, 2018: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
(no author information available yet)
Aneurysmal rupture can result in devastating neurological consequences and can be complicated by comorbid disease processes. Patients with autosomal recessive polycystic kidney disease (ARPKD) have a low rate of reported aneurysms, but this may be due to the relative high rate of end-stage illnesses early in childhood. Authors here report the case of a 10-year-old boy with ARPKD who presented with a Hunt and Hess grade V subarachnoid hemorrhage requiring emergency ventriculostomy, embolization, and decompressive craniectomy...
October 1, 2018: Journal of Neurosurgery. Pediatrics
Dalma Tényi, Beáta Bóné, Réka Horváth, Sámuel Komoly, Zsolt Illés, Christoph P Beier, Anna Kelemen, Norbert Kovács, Gergely Darnai, József Janszky
PURPOSE: To comprehensively analyze ictal piloerection (IP) in a large number of subjects. METHODS: We performed a systematic review on case report studies of patients diagnosed with IP (1929-2017) with additional cases included from the Department of Neurology of University of Pécs, the National Institute of Clinical Neurosciences, and Odense University Hospital. Each included case was characterized regarding patient history, IP seizure characteristics, diagnostic work-up, and therapy...
November 22, 2018: Seizure: the Journal of the British Epilepsy Association
Borna E Tabibian, Arsalaan A Salehani, Elizabeth N Kuhn, Matthew C Davis, Christopher D Shank, Winfield S Fisher Iii
BACKGROUND: Involvement of the palliative care service has potential for patient and family benefit in critically ill patients, regardless of etiology. Anecdotally, there is a lack of involvement of the palliative care (PC) service in the neuro-intensive care unit (neuro-ICU), and its impact has not been rigorously investigated in this setting. OBJECTIVE: This study aims at assessing the effect of early involvement of the PC service on end-of-life care in the neuro-ICU...
November 29, 2018: Journal of Palliative Medicine
W Druml
Fever, arbitrarily defined as a core body temperature >38.3 °C, is present in 20-70 % of intensive care unit patients. Fever caused by infections is a physiologic reset of the thermostatic set-point and is associated with beneficial consequences, but may have negative sequelae with temperatures >39.5 °C. Fever of non-infectious and neurologic origin affects about 50 % of patients with elevated body temperature, presents as a pathologic loss of thermoregulation, and may be associated with untoward side effects at temperatures above 38...
November 28, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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