A pilot study on the functional outcome using markerless motion analysis tool and surface emg of nerve transfers for upper trunk brachial plexus injuries

INTRODUCTION@#Brachial plexus injuries (BPI) have devastating functional effects. Clinical outcomes of BPI reconstruction have been documented in literature; however, these do not use EMG and quantitative kinematic studies.@*OBJECTIVE@#This study aims to use a markerless motion analysis tool (KINECT) and surface EMG to assess the functional outcomes of adult patients with traumatic upper trunk BPI who have undergone nerve transfers for the shoulder and elbow in comparison to the normal contralateral limb.@*METHODS@#This is an exploratory study which evaluated three participants with BPI after nerve reconstruction. KINECT was used to evaluate the kinematics (range of motion, velocity, and acceleration) and the surface EMG for muscle electrical signals (root mean square, peak EMG signal, and peak activation time) of the extremities. The means of each parameter were computed and compared using t-test or Mann-Whitney U test.@*RESULTS@#Participant C, with the best clinical recovery, showed mostly higher KINECT and EMG values for the BPI extremity. There was a significant difference between the KINECT data of Participants A and B, with lower mean values for the BPI extremity. Most of the EMG results showed lower signals for the BPI extremity, with statistical significance.@*CONCLUSION@#The KINECT and surface EMG provide simple, cost-effective, quick, and objective assessment tools. These can be used for monitoring and as basis for formulating individualized interventions. A specific algorithm should be developed for the KINECT sensors to address errors in data collection. A fine needle EMG may be more useful in evaluating the muscles involved in shoulder external rotation.

The efficacy of low dose short-term prednisone therapy for remission induction in newly diagnosed rheumatoid arthritis patients

Abstract Background: The ACR/EULAR recommendations endorse the use of glucocorticoids (GCs) for rheumatoid arthritis (RA) patients' flares and as a bridge to a DMARD. However, the recommendation of low dose short-term monotherapy with (GCs) remains open to the discretion of the clinician. The aim of this study was to assess whether a short-term use of low dose prednisone monotherapy was effective in inducing remission in newly diagnosed RA patients. Methods: A retrospective analysis of patients newly diagnosed with RA at a Community Health Center in North Dakota was performed based on the ACR/EULAR RA classification criteria. Demographic and clinical data were abstracted from patients' medical charts. Patients treated with (≤ 10 mg/day) of prednisone up to 6 months were included. Response to prednisone was analyzed according to pre- and post-treatment DAS28-ESR score and EULAR response criteria. Results: Data on 201 patients were analyzed. The mean prednisone dose was 8 mg/day (range: 5-10; SD = 1.2) and the mean treatment duration was 42.2 days (12-177; 16.9). Disease severity significantly improved from baseline to follow-up for: tender joint count (8.6 ± 4.8 vs. 1.5 ± 3.3; P < 0.001), swollen joint count (6.2 ± 5.0 vs. 1.4 ± 3.0; P < 0.001), and visual analog pain score (4.8 ± 2.6 vs. 2.1 ± 2.5; P < 0.001). DAS28-ESR disease severity significantly improved from baseline to follow-up: (5.1 ± 1.2 vs. 2.7 ± 1.3; P < 0.001). Per EULAR response criteria, 69.7% of patients showed good response to treatment and 20.4% showed moderate response. 54.2% of patients reached remission. Conclusion: Short-term use of low dose prednisone monotherapy induced disease remission and improved clinical severity of RA in the majority of newly diagnosed patients.

The correlation of doxorubicin related cardiotoxicity with B-type natriuretic peptide levels in South Indian population

Background: Anthracyclines represent the greatest risk for development of cardiotoxicity. Cardiotoxicity of anthracyclines may develop during the treatment (acute cardiotoxicity) and during the follow-up (chronic and late cardiotoxicity). Natriuretic peptides - Atrial Natriuretic Peptide (ANP), B-type Natriuretic Peptide (BNP) and N-terminal pro B-type natriuretic peptide (NT-pro-BNP) are released by myocardium in response to wall strain and pressure overload. The applicability of natriuretic peptides (ANP, BNP, NT-pro-BNP) as markers for Anthracycline-induced cardiotoxicity has been investigated only in a few studies and there is scarcity of data from India. Aims and Objectives: To observe correlation of NT-pro-BNP levels with cardiotoxicity in patients receiving doxorubicin. Methods and Materials: Eighty patients who were planned for treatment with Doxorubicin > 200 mg/m2 were included in this study. Each patient was assessed clinically (History, Pulse rate, Blood pressure) along with ECG, ECHO and NT-pro-BNP levels prior to initiation of chemotherapy, after completion of 200 mg/m2 of Doxorubicin, 3 months and 6 months after chemotherapy. Result: There were total of 80 patients in the study and they received a total of 384 cycles of Doxorubicin containing regimens according to respective protocols. The median number of cycles was four (range four to six cycles). The mean cumulative dose of doxorubicin was 267.75 mg/m2. As none of the patients developed any cardiac symptoms during or after the planned chemotherapy nor was there a drop in Ejection Fraction on serial ECHO, correlation with BNP levels was not possible. There were 4 patients who had very high values of NT-pro-BNP (>300 pg/ml) and 4 patients with moderate elevation of NT-pro-BNP (200-300 pg/ml) prior to the initiation of chemotherapy. 14 patients had serially increasing values of NT-pro-BNP in the 6 months follow-up. Conclusion: Based on the findings in this study it can be concluded that high upfront BNP values or increasing values of BNP does not correlate with the incidence of acute and early onset chronic cardiotoxicity. Whether or not the BNP values correlate with the incidence of late onset cardiotoxicity can be concluded only with a longer follow-up of these patients.

Mania associated with interferon alpha2b treatment.

Neuropsychiatric side effects are common with Interferon a 2b. Psychosis and depression have been reported. Several cases of mania have been reported but only few have been associated with treatment for hepatitis B. We report a case of mania with psychotic symptoms in a 21-year-old female diagnosed to have hepatitis-B infection, who was receiving interferon. The report supports the view that dose reductions or pauses during interferon treatment can cause mania. Family history of mood disorder could be a risk factor. Atypical presentations are common in interferon-induced mania. Mania induced by interferon responds well to antimanic drugs. Since the use of interferon is increasing in developing countries, the need for awareness of side effects and management issues are important and these are highlighted.

Oligodendroglioma: clinical profile and treatment results.

Oligodendrogliomas are rare glial tumors with a long natural history. Radical surgery, postoperative radiotherapy, chemotherapy and observation have been suggested as part of primary management. This series reports the presentation and outcome in 34 patients with histologically verified pure oligodendrogliomas treated between 1983 and 1993. All patients were treated at the time of initial diagnosis with surgery, with or without additional radiotherapy. The overall survival and progression free survival rates at five years were 69.8% and 55% respectively. There was no tumor or treatment related factor influencing survival significantly.

Other uses of tube changer.

Traditionally major surgical procedures are contemplated in tracheobronchial pathology as the first line of management. Efficient and skillful use of airway equipment can help in the management and prevention of significant perioperative morbidity. Three cases of airway pathology (tracheal stenosis, bronchial stenosis and tracheal tumour) which were managed with the help of airway equipment such as fibreoptic bronchoscope, Cook's and Patil tube changers are presented. The techniques are simple and safe and may help the surgeons to 'buy' time to plan definitive treatment.

Surgical management of coarctation of aorta.

Between 1961 and 1988, 68 patients underwent operation for coarctation of the aorta. The average age of presentation of these subjects was higher than in other series. 7.1 percent were asymptomatic, a finding which is not seen in reports from the west. Operative procedures included resection and end to end anastomosis, resection and graft interposition, bypass grafting, patch aortoplasty and subclavian flap aortoplasty. However, the technique of patch aortoplasty, routinely performed in the last 24 years of this series seemed by far the most satisfactory procedure. Subclavian flap aortoplasty was carried out in a selected group of younger children. Associated cardiac anomalies influenced the results adversely. The overall operative mortality was 5.8 percent. Hypertension did not regress in 11.7 per cent of patients inspite of a successful operation as judged by the return of peripheral pulses in the lower limbs. Re-coarctation was not seen in this series. The overall results of operation for coarctation of the aorta have been very satisfactory and comparable with those in other published series.