Incisional Hernia with Loss of Domain as a Consequence of Botulinum Toxin a and the Covid-19 Pandemic

Introduction: Abdominal wall surgery has been one of the major victims of the COVID-19 pandemic, with a large number of patients who have seen their surgery delayed and many are still waiting to be operated on today. On the other hand, botulinum toxin is one of the main protagonists in optimizing abdominal wall surgery, especially important in complex hernia, but we must not forget that it can have adverse effects. Case report: We present the case of a 54-year-old man with a history of obesity, diabetes, hypertension, chronic renal failure and kidney transplant in 2000, who presented a midline incisional hernia as a result of an epigastric hernia operated on in 2006 and subsequently two onlay permanent synthetic mesh in 2010 and 2015. In February 2020 he presented an incisional hernia M2-4W3R3 with a volume of 35%, botox was infiltrated as optimization for surgery and while awaiting placement of a pneumoperitoneum catheter, the surgery was suspended due to the COVID-19 situation. He returns to our clinics in 2022 with a growth of the hernia and a volume of 95%. Weight loss, botulinum toxin and preoperative pneumoperitoneum were indicated. We performed a reconstruction of the abdominal wall with bilateral transversus abdominal release and preperitoneal 45x60cm polyvinylidene fluoride mesh and abdominoplasty. Discussion(s): Botulinum toxin can facilitate abdominal surgery, especially in complex hernias, but we must not forget that blocking the abdominal muscles can have adverse effects. The COVID-19 pandemic has been especially hard on surgical waiting lists, delaying surgeries and aggravating pathologies.

Botulinum toxin injections during the COVID-19 epidemic: A retrospective chart review

BACKGROUND AND AIM: Clinical services were severely affected globally during the COVID-19 pandemic. This study aimed to characterize the clinical experience of using botulinum toxin (BTX) injections during the COVID-19 pandemic. Method(s): This is a retrospective chart review of patients who received BTX injections from April 2019 to January 2022. Result(s): A total of 105 patients received an BTX injections, out of which 76 (72.4%) were men. The mean age of the patients was 47.9 +/- 15.1 years. The most common indication for receiving BTX injections was dystonia (n = 79;75.2%), followed by hemifacial spasm (n = 22;21%) and miscellaneous movement disorders (n = 4;3.8%). Focal dystonia (n = 45;57%) was the most frequent form of dystonia, followed by segmental dystonia (n = 24;30%). The percentage of generalized dystonia and hemidystonia was 12% and 1%, respectively. Cervical dystonia (44.4%), blepharospasm (17.8%), and writer's cramp (15.6%) were the most frequent forms of focal dystonia. The miscellaneous group included four patients (3.8%) with trigeminal neuralgia, Holmes tremor, dystonic tics, and hemimasticatory spasm. The mean ages of patients in the dystonia, hemifacial spasm, and the miscellaneous groups were 47.7 +/- 14.9 years, 49.2 +/- 14.0 years, and 44.2 +/- 26.0 years, respectively. The mean BTX dose was 131.6 +/- 104.1 U. The mean BTX doses for the dystonia group, hemifacial spasm, and the miscellaneous group were 158.7 +/- 105.3 U, 40.1 +/- 11.3 U, and 100.0 +/- 70.7 U, respectively. Conclusion(s): Most patients in our cohort had dystonia, followed by hemifacial spasm. Among the patients with dystonia, most had focal dystonia, with cervical dystonia being the most common movement disorder. The data obtained in our study is important to increase awareness of the effectiveness of BTX injections in patients with chronic disorders.Copyright © 2023 Annals of Movement Disorders.

Impact of the suspension of neurogenic detrusor overactivity treatment with botulinum toxin due to the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic has imposed an additional pressure on health systems worldwide. Patients with neurogenic detrusor overactivity (NDO) were especially vulnerable to inadequate care. This study aims to evaluate the impact of the suspension of NDO treatment with Botulinum Toxin (BONT-A) due to the COVID-19 pandemic. METHODS: Cross-sectional study of patients with spinal cord injury and NDO, who underwent BONT-A treatment in 2018 or 2019 and, whose administration programed for 2020 or 2021 was suspended. The study protocol was divided into two parts. Phase 1 consisted of data collection from the clinical processes and in phase 2 a standardized telephone questionnaire was applied. Information was collected at 3 time points: (1) before the last BONT-A treatment, (2) after the last BONT-A treatment and (3) at the time of the telephone call. Statistical analysis used the McNemar and the Wilcoxon test with a p-value ⩽ 0.05 as level of significance. RESULTS: 21 patients with mean age of 42.0 years and disease duration of 16.9 years were included. On average patients were undergoing treatment with BONT-A for 7.6 years and mean inter-treatment frequency was 2.3 years. Mean time since the last BONT-A administration was 2.3 years and mean reported BONT-A effect duration was 11.9 months. A significant increase in the percentage of patients with involuntary urinary loss (p = 0.004) and urgency (p = 0.031) was found. A significant decrease in mean catheterization interval from 4.5 to 3.6 h (p = 0.002) and an increase in daily oxybutynin dosage from 8.5 to 12.1 mg (p = 0.002) was also found. DISCUSSION: The COVID-19 pandemic originated clinical worsening of patients undergoing regular BONT-A treatment for NDO. These patients presented a significant increase in involuntary urinary loss, urgency and medication dosage and a decrease in catheterization interval. Thus, interruption of intravesical BONT-A treatment severely affected these patients and needs to be avoided.

Successful Administration of Preoperative Botox for Giant Omphalocele Repair With Ultrasound Guidance.

We present a case of a four-year-old male with a history of giant omphalocele who underwent ultrasound-guided Botox injection to bilateral anterior abdominal wall musculature in preparation for definitive repair. Botox administration was successfully combined with preoperative subfascial tissue expanders to achieve definitive midline closure of the anterior abdominal wall defect. Our experience suggests that Botox can be safely used as part of the treatment plan for giant omphalocele repair.

Rare Case of Immune-Mediated Necrotizing Myopathy With Isolated Dysphagia as Presenting Symptom

Introduction: Immune mediated necrotizing myopathy (IMNM) is a rare, but progressive disease that accounts for about 19% of all inflammatory myopathies. Dysphagia occurs in 20-30% of IMNM patients. It often follows proximal muscle weakness and ensues in the later stages of the disease. We report a rare case of IMNM, presenting with dysphagia as the initial symptom, followed by proximal muscle weakness. Case Description/Methods: A 74-year-old male with a past medical history of coronary artery disease, hypertension, and hyperlipidemia presented to the ED with 2-3 weeks of intractable nausea, vomiting, and dysphagia for solids and liquids. Vital signs were stable, and initial labs displayed an AST of 188 U/L and ALT of 64 U/L with a normal bilirubin. Computed tomogram of the chest, abdomen, and pelvis were negative. An esophagram showed moderate to severe tertiary contraction, no mass or stricture, and a 13 mm barium tablet passed without difficulty. Esophagogastroduodenoscopy exhibited a spastic lower esophageal sphincter. Botox injections provided no significant relief. He then developed symmetrical proximal motor weakness and repeat labs demonstrated an elevated creatine kinase (CK) level of 6,357 U/L and aldolase of 43.4 U/L. Serology revealed positive PL-7 autoxantibodies, but negative JO-1, PL-12, KU, MI-2, EJ, SRP, anti-smooth muscle, and anti-mitochondrial antibodies. Muscle biopsy did not unveil endomysial inflammation or MHC-1 sarcolemmal upregulation. The diagnosis of IMNM was suspected. A percutaneous endoscopic gastrostomy feeding tube was placed as a mean of an alternative route of nutrition. He was started on steroids and recommended to follow up with outpatient rheumatology. He expired a month later after complications from an unrelated COVID-19 infection. Discussion(s): The typical presentation of IMNM includes painful proximal muscle weakness, elevated CK, presence of myositis-associated autoantibodies, and necrotic muscle fibers without mononuclear cell infiltrates on histology. Dysphagia occurs due to immune-mediated inflammation occurring in the skeletal muscle of the esophagus, resulting in incoordination of swallowing. Immunotherapy and intravenous immunoglobulin are often the mainstay of treatment. Our patient was unique in presentation with dysphagia as an initial presenting symptom of IMNM, as well as elevated enzymes from muscle breakdown. It is critical as clinicians to have a high degree of suspicion for IMNM due to the aggressive nature of the disease and refractoriness to treatment.

Ambulatory Botulinum Neurotoxin Injections for Dystonia, Spasticity, and Hemifacial Spasms: Predictors of Adherence a Year Before, During, and Late Covid-19 Pandemic

Objective: The relevance of the study is to primarily determine the predictors of adherence (distance, socio-economic status, disease status, and treatment schedule) of patients with dystonia, spasticity, and hemifacial spasms in a single center Botulinum neurotoxin injection (BoNT) study. Background(s): In December 2019, there was a new type of coronavirus identified in Wuhan, China which rapidly escalated to all parts of the world, the Philippines included. The COVID 19 pandemic did not only affect the patients contracted with the disease, but also those who have non-communicable diseases including dystonia, spasticity, and hemifacial spasm. BoNT is a chemodenervating agent that reduces muscle hyperactivity and spasms. Continuation of outpatient treatment may be affected due to the following reasons: lack of access to the health care system because of travel restrictions or lockdowns;fear of contracting the virus;and finances, which has a bigger impact on lower income patients. Method(s): This study utilized a cross-sectional research design with a total of 120 samples. Inclusion and exclusion criteria were met. Consent was secured. Data was gathered through chart reviews, telecommunications, and evaluation after receiving BoNT treatment in three different timelines-a year before (March 1, 2019 to February 29, 2020), during (March 1, 2020 to February 28, 2021), and late COVID 19 pandemic (March 1, 2021 to February 28, 2022). Result(s): The result of this study using percentages and p-values demonstrated a higher percentage in the distance and socio-economic status, as well as in the lost to follow up rate when compared to the other group. Distance and patients lost to follow up had p-values of less than 0.05. Therefore, only distance was noted to be a significant factor to the adherence status of patients. Furthermore, the lost to follow up rate in the COVID 19 pandemic period is also significantly higher when compared to that of the other group. Conclusion(s): It is concluded that patients with closer distance to the facility had better adherence hence the researchers recommend having an affiliate clinic or a referral facility for patients residing outside Metro Manila for better adherence.

Evaluation of expression and titration of recombinant nucleocapsid protein as an immunogenic candidate against SARS-CoV2.

Introduction: Covid-19 epidemic results from an infection caused by SARS-CoV2. Evolution-based analyses on the nucleotide sequences show that SARS-CoV2 is a member of the genus Beta-coronaviruses and its genome consists of a single-stranded RNA, encoding 16 proteins. Among the structural proteins, the nucleocapsid is the most abundant protein in virus structure, highly immunogenic, with sequence conservatory. Due to a large number of mutations in the spike protein, the aim of this study was to investigate bioinformatics, expression of nucleocapsid protein and evaluate its immunogenicity as an immunogenic candidate Material(s) and Method(s): B and T cell epitopes of nucleocapsid protein were examined in the IEDB database. The PET28a-N plasmid was transferred to E. coli BL21(DE3) expression host, and IPTG induced recombinant protein expression. The protein was purified using Ni-NTA column affinity chromatography, and the Western blotting method was utilized to confirm it. Finally, mice were immunized with three routes of purified protein. Statistical analysis of the control group injection and test results was carried out by t-test from SPSS software. Result(s): The optimized gene had a Codon adaptation index (CAI) of 0/97 Percentage of codons having high-frequency distribution was improved to 85%. Expression of recombinant protein in E.coli led to the production of BoNT/B-HCC with a molecular weight of 45 kDa. The total yield of purified protein was 43 mg/L. Immunization of mice induced serum antibody response. Statistical analysis showed that the antibody titer ratio was significantly different compared to the control sample and the antibody titer was acceptable up to a dilution of 1.256000 Conclusion(s): According to the present study results, the protein can be used as an immunogenic candidate for developing vaccines against SARS-CoV2 in future research.Copyright © 2022, Semnan University of Medical Sciences. All rights reserved.

Evaluation of expression and titration of recombinant nucleocapsid protein as an immunogenic candidate against SARS-CoV2.

Introduction: Covid-19 epidemic results from an infection caused by SARS-CoV2. Evolution-based analyses on the nucleotide sequences show that SARS-CoV2 is a member of the genus Beta-coronaviruses and its genome consists of a single-stranded RNA, encoding 16 proteins. Among the structural proteins, the nucleocapsid is the most abundant protein in virus structure, highly immunogenic, with sequence conservatory. Due to a large number of mutations in the spike protein, the aim of this study was to investigate bioinformatics, expression of nucleocapsid protein and evaluate its immunogenicity as an immunogenic candidate Material(s) and Method(s): B and T cell epitopes of nucleocapsid protein were examined in the IEDB database. The PET28a-N plasmid was transferred to E. coli BL21(DE3) expression host, and IPTG induced recombinant protein expression. The protein was purified using Ni-NTA column affinity chromatography, and the Western blotting method was utilized to confirm it. Finally, mice were immunized with three routes of purified protein. Statistical analysis of the control group injection and test results was carried out by t-test from SPSS software. Result(s): The optimized gene had a Codon adaptation index (CAI) of 0/97 Percentage of codons having high-frequency distribution was improved to 85%. Expression of recombinant protein in E.coli led to the production of BoNT/B-HCC with a molecular weight of 45 kDa. The total yield of purified protein was 43 mg/L. Immunization of mice induced serum antibody response. Statistical analysis showed that the antibody titer ratio was significantly different compared to the control sample and the antibody titer was acceptable up to a dilution of 1.256000 Conclusion(s): According to the present study results, the protein can be used as an immunogenic candidate for developing vaccines against SARS-CoV2 in future research.Copyright © 2022, Semnan University of Medical Sciences. All rights reserved.

Management of Extremely Complex Constipation Patients in a Nurse-Led Clinic with Health Play Specialist Involvement

Introduction Children with idiopathic chronic constipation are extremely challenging to manage. Before review by tertiary specialist teams, Children have suffered for years with constipation, which leads to significant behaviour related issues around toileting, despite adequate medical treatment. The involvement of the health play specialist (HPS) in the nurseled constipation clinic is to address behaviours around toileting. Aims To demonstrate involvement of HPS in the clinic led to improved outcomes for children and families. This will be identified through the use of parental satisfaction questionnaires and four case studies. Case Studies We demonstrate four extremely complex constipation cases referred to clinic and successfully managed by HPS with unique individualised approach with support and plans for parents and school. 9-year-old boy with history of sexual abuse, with soiling and wetting accidents. 5 sessions with the HPS, focusing on toileting behaviours. Sessions involved desensitizing play around the body, use of toilet related games/activities, videos and mobile apps. All issues resolved. 5-year-old boy: Stool with-holding, will only pass stools in a nappy and soiling. 8 sessions with HPS - Intense toilet training for 2-4 days with hourly sits. Reward charts to compliment interests, targets adjusted when goal reached, prizes given. Desensitization play around toileting behaviours. Using analogies to improve behaviour, he loved dustbin lorries - body empties the waste (poo) just like the bin men collecting the rubbish to get rid of it from home. No more accidents, independent toileting achieved 5-year-old girl Issues with constipation, soiling and toilet refusal. All bowel movements in knickers. Complete HPS treatment virtually, secondary to COVID restrictions. 6 Video call sessions- individualised plan of regular sits to relax, with no pressure to perform. To do an activity whilst on the toilet. Visual pictures/videos explaining how the body works and the plan was adjusted on the video. Rewards when child reached the target, and prize sent in post. Outcome -no fear of the toilet, bowels open on the toilet, no accidents. 8 year old boy premature 33 + 5 weeks. Constipation with overflow since birth. Referred to surgeons for rectal biopsies and botox injections at the age of 3 but no improvement. Age 4 admitted to the ward for 1 week for observation, transit marker study and toilet training was unsuccessful. Referred to another unit for second opinion at parental request. Started to refuse medications. ACE surgery discussed. Diagnosed with Autism at 7 years. Invited for a week of intense toileting with HPS, hourly sits and desensitization activities on medication taking, toileting, with-holding, signs and signals of body. Reward system in place, when reached expectations, reward given by hospital. Outcome bowels open daily in the toilet, wears pants all the time. Satisfaction questionnaires were given to parents and feedback was extremely positive. Conclusion The health play specialist involvement in the nurse led constipation clinic allows for individualised intervention guided by the child's needs. Pharmacological interventions alone may be unsuccessful without addressing behavioural needs.

Female LUTS adaptations to COVID era: Lessons learned from the ICS TURNOVER (Transition of fUnctional uRology to New COVID ERa).

Introduction: The COVID-19 pandemic has dramatically affected the Female and Functional Urology (FFU) practice, leading to massive waiting lists, while patients' quality of life remains severely impaired. The aim of the present study is to develop consensual recommendations to guide clinicians on the management of FFU patients. The present paper focuses on female LUTS. Methods: The authors used the Delphi methodology to develop a robust survey questionnaire, covering the principal topics in FFU, based on literature review and expert opinions. Regarding female LUTS, a 98-question survey was distributed among FFU specialists to obtain optimized recommendations, under the auspicious of the International Continence Society (TURNOVER, ICS project). A quantitative analysis of the data was performed, categorizing the mean value from 0-10. Consensus achievement was defined as attaining ≥ 70% agreement. Results: 98 ICS members completed the F-LUTS survey. Recommendations for the diagnosis and management of female LUTS are summarized. Video-consultation should be used for initial assessment, sending questionnaires and bladder diaries in advance to the patient to be filled out before the consultation. However, face-to-face visits are mandatory if POP or continuous incontinence are suspected, and prior to any surgical procedure, regardless of the health alert. Moreover, prescribing medications such as anticholinergics or ß 3 agonists in a telemedicine setting is not considered a safe practice. Follow-up teleconsultations can be used to assess the efficacy and treatment-related adverse events.Urodynamic testing should be only performed if consequences on F-LUTS treatment are expected. The study should be postponed until the pandemic local behaviour flattens.Invasive procedures should be postponed during a high alert. In case surgery is scheduled, outpatient clinics and local anaesthesia should be prioritized. Every patient should be screened for SARS-CoV-2 infection before invasive tests or procedures, following local authorities' guidance. Conclusions: During a pandemic, telemedicine offers a novel way of communication, maintaining medical care while preventing viral transmission. Non-urgent procedures should be postponed until the pandemic curve flattens. Ambulatory procedures under regional or local anaesthesia should be prioritized, aiming to reduce bed occupancy and risk of transmission.

Emerging Concepts and Evidence in Telematics Novel Approaches or Treatments for Spasticity Management After Botulinum Injection.

There is a strong recommendation for the use of intramuscular botulinum toxin in patients with persistent or progressive spasticity affecting one or more joints and who have an identifiable therapeutic target. After a botulinum toxin injection, a stretching intervention improves the results of the treatment, and it should be performed by patients and/or caregivers after being trained by a therapist. Adherence to this recommendation remains low once the therapist stops following the patient. The COVID-19 pandemic has increased the use of telemedicine with different approaches to treat patients. There has been an increased use of motivational applications, with virtual reality software and real-life videos, which provide a gaming experience that increases adherence. There are programs with synchronous telehealth exercises guided by physical therapists or software with sensor-based technology that shows the range of motion (ROM) and strength of the muscles of a particular joint. These new approaches to patient follow-up appear to increase adherence to exercise because they need to be "watched and controlled" is achieved.

Efficacy and safety of 2 doses of onabotulinumtoxin A for the treatment of masseter muscle prominence: 6-month results from a randomized, phase 2b placebo-controlled study

Purpose: Evaluate efficacy and safety of onabotulinumtoxin A compared with placebo for treating masseter muscle prominence (MMP). Methods: Adults with bilateral grade 4 (Marked) or 5 (Very marked) MMP on the 5-grade clinician-assessed MMP Scale (MMPS) received onabotulinumtoxinA 72 U, 48 U, or placebo. Primary efficacy endpoint was participants achieving MMPS grade ≤3 at day 90. Participants with grade ≤3 for the MMPS and Participant MMPS (MMPS-P), and participants achieving grade ≥2 in the Participant Self-Assessment of Change (PSAC), were evaluated until day 180. Results: Of 150 participants randomized, 34 (22.7%) discontinued (12 [8.0%] due to COVID-19). The modified intent-to-treat population included 145 participants (mean age, 39.3 years;mean BMI, 24.1 kg/m2;89.7% female;75.9% White). MMPS and MMPS-P responder rates were higher for onabotulinumtoxinA 72 U and 48 U than placebo at days 90 (MMPS: 91.3% and 90.6% vs 21.7%;MMPS-P: 93.5% and 96.2% vs 47.8%;both P <.0001) and 180 (MMPS: 71.7% and 56.6% vs 26.1%;MMPS-P: 87.0% and 86.8% vs 60.9%;both P <.01). More onabotulinumtoxinA 72 U and 48 U participants achieved PSAC grade ≥2 than placebo at days 90 (73.9% and 90.6% vs 21.7%;P <.0001) and 180 (76.1% and 66.0% vs 28.3%;P <.001). Treatment-related adverse events occurred in onabotulinumtoxinA 72 U and 48 U groups (12.2% and 9.4%) vs none in placebo;the majority were mild in severity. Conclusion: A single treatment of onabotulinumtoxinA (72 U and 48 U) reduced MMP and improved lower face contour for up to 6 months. Both dose groups demonstrated favorable safety profiles.

Botulinum toxin infiltration as an option for treatment of persistent headache associated with COVID-19. Case report

Background and AimsDifferent descriptions of long COVID have already been proposed, and the most common description includes symptoms lasting for over three months after the first symptom onset. One of the most frequent symptoms identified, besides fatigue and dyspnoea, is a new daily persistent headache.1MethodsWe describe a case of persistent headache associated with COVID-19, which had a poor response to pharmacological treatment. The patient scored a pain of 8 points in Visual Analog Scale (VAS). It was a widespread—affecting frontal, temporal, and occipital area—pulsating quality headache that worsened with mild physical activity.Since Botulinum toxin type A has been used to treat chronic migraine for over a decade, we decided to try this therapeutic option after proving that the response to local anesthetics was positive.ResultsShe responded satisfactorily to bilateral greater occipital nerve block and infiltration of the frontal and temporal muscles with local anesthetic and corticosteroids, with an improvement during approximately 48 hours.Two weeks later, we administered by ultrasound guidance 20 IU of botulinum toxin near the greater occipital nerve, and performed a mapping with botulinum toxin by administering it at different points: both trapezius, splenius, frontal muscles, bilateral orbicularis and bilateral temporal and parietal muscles. After seven days, the patient reported improvement of the symptoms (VAS 3) that were still present one month later.ConclusionsIn conclusion, we propose that botulinum toxin can be a therapeutic option for persistent headaches associated with COVID-19. However, future research studies are required to clarify this possibility.

The impact of the reclusion on patients with blepharospasm during the COVID19 pandemic.

BACKGROUND: Blepharospasm (BS) is a focal dystonia that can be treated successfully with Botulinum toxin (BoNT). During the reclusion due to the Covid 19 pandemic many patients missed the scheduled treatment. OBJECTIVES: Aim of the study is to evaluate Level of Disability (LoD) related to BS during the lockdown period. METHODS: LoD was assessed by an adapted version of Blepharospasm Disability Index (4iBSDI) during reclusion (T1), and three months after the first injection following the lock down phase (T2). 4iBSDI scores were compared between T1 and T2, a correlation between the change of LoD in the two periods (t-delta) and patients' clinical data was analyzed. RESULTS: LoD was not modified between the two periods in most of the patients and it was reduced at T1 in almost one third of the participants. No correlation between t-delta and clinical data was found. CONCLUSIONS: LoD did not increase during the lock down period in most of BS patients although BoNT treatment was suspended. Environmental and psychosocial factors may contribute to determine the LoD due to BS.

Video consultation in the diagnosis and therapy of patients with facial palsy

Introduction Telemedicine can reduce poor health care access and improve the diagnosis and treatment of rare diseases. COVID-19 has also helped telemedicine to become more widely used in Germany. Since April 2020, the Facial Nerve Center Jena also offers virtual consultation hours. Material and Methods We analyzed in retrospect all initial encounters of patients with the Facial Nerve Center Jena between April 2020 and October 2021. 33 patients (20 f, 13 m) aged 9 to 69 years (median: 42) were treated. Results In 28 of 33 cases, a diagnosis of facial palsy was made at initial presentation (duration of paresis: 1 - 512 months, median: 11.5 months), 20 of which showed defect healing and synkinesis. In 4 cases, there was no evidence of facial palsy and further diagnostics were recommended. In one patient, a definite diagnosis could not be made due to technical problems with video transmission. Psychoeducation was given to 28 patients. 20 patients were counseled about a possible injection of botulinum toxin to reduce synkinesis. In 10 cases, we gave recommendation and instruction on corneal protection. Day-care treatment was indicated in 16 patients, and telemedicine biofeedback training was indicated in 8. Travel distances would have ranged from 40 to 1570 km (median: 360 km). Discussion Telemedicine is well suited for diagnosis and therapy of facial nerve palsies and subsequent defect healing, in part, because webcams are optimized to display faces. We see potential in video consultations to provide highly specialized care nationwide, to minimize travel distances, and to simplify second opinion consultations.

The COVID-19 Pandemic: a Study on Its Impact on Patients with Dystonia and Related Conditions Treated with Botulinum Toxin in a Tertiary Centre in Romania

Background and Objectives: The COVID-19 pandemic triggered significant delays in the treatment of people with movement disorders who depend on face-to-face clinic encounters for receipt of their regular botulinum toxin injections. Against this background, it was the aim of this study to look into pandemic-related characteristics of patients with dystonia and hemifacial spasm treated with botulinum toxin at a tertiary centre in Romania and identify potential correlations between delays in treatment and health perceptions. Materials and Methods: A cross-sectional, questionnaire-based, study was conducted between May-September 2021 on the 175 patients in the centre’s botulinum toxin database. Results: Of the 90 patients who qualified for inclusion most were late middle-aged females with long-standing dystonia, of which torticollis and blepharospasm were the most common phenotypes. Treatment was delayed by an average of 8.5 months, whereas the overall quality-of-life health score was 61.1, with 60% of respondents rating themselves above 50. No statistically significant correlation was identified between delays in treatment and overall healthscores. Instead, statistically significant differences were uncovered based on type of disorder (dystonia vs. hemifacial spasm). Conclusion: The results of this study may go on to show that, in the event of similar pandemic surges, patient micromanagement by type of disorder may be part of a well-balanced restriction-cum-access health policy. © 2022 Medicina Moderna. All rights reserved.

How did the COVID-19 pandemic countermeasures affect children with cerebral palsy receiving Botulinum toxin therapy: A single-center study

Introduction: The COVID-19 pandemic caused disruption of follow-up evaluations, physiotherapy and Botulinum toxin treatment (BoNT A) in children with cerebral palsy (CP). The aim of this study was to determine the changes in pain, spasticity level and range of motion in children with spastic CP after the COVID-19 stay-at- home period. Patients and methods: Fifteen children (GMFCS level I-IV, aged 4-12 years) with spastic CP were enrolled in this study. All received BoNT A treatment in October/November 2019, which was followed by physiotherapy. Their next appointments were scheduled for March and April 2020. Due to the COVID-19 outbreak, all of the treatments were canceled, and the children were sent home and advised to perform home-based exercise programs. The children were able to have their next regular check-up in October 2020. Assessments of range of motion (ROM), spasticity and pain levels were done, and the data was compared with data from 2019. Results: The pain and spasticity severity of the participants were significantly increased during the 10-12 months stay-at- home period. Range of motion was significantly decreased, especially dorsiflexion of the foot. Joint contractures and hip dislocation were noted in three cases. Conclusion: The study participants did not comply with the home exercise program in a satisfactory manner. The COVID-19 pandemic has made a detrimental effect on ROM, spasticity and pain in children with CP. Telerehabilitation and online communication with health professionals should be at a higher level in Serbia.

Prescrire's ratings of new drugs in 2021: A brief review

Three new drugs, all based on messenger RNA or small interfering RNA technology, represented a major therapeutic advance in 2021. But the bigger picture is that most of the new authorisations that advanced patient care were adaptations of existing drugs. And that more than half of this year's new authorisations were not advances, and in fact about one-tenth represented a step backwards compared to existing options.

ASSESSMENT OF DETERMINANTS OF PRACTICES REGARDING USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) AMONG MEDICAL STUDENTS

Objective: To assess the knowledge, attitudes regarding hygienic and personal protective practices and to evaluate the factors associated with the knowledge regarding use of PPE among medical college students. Study Design: A descriptive cross-sectional study. Place and Duration of Study: Foundation University, Islamabad Pakistan, from Mar to May 2021. Methodology: Using non-probability consecutive sampling, a self-administered questionnaire will be given to students. Questions will be asked about their knowledge of the types of PPE and its correct use and analyzed in SPSS-20. Results: Out of 289 respondents, one hundred and sixty-eight (58%) belongs to 1st - 3rd year of MBBS and one hundred and twenty-one (42%) were in 4th and final year. Majority (68%) were females and ninety-two (32%) males. Two hundred and forty-three (84%) of them agreed that main goal of infection control is to prevent infection among patients and health care workers. Two hundred and twenty-eight (79%) of them had knowledge regarding correct duration of hand washing and ninety-eight (34%) agreed that use of gloves replaced the need of hand washing. More than half (78%) had knowledge that hand washing is indicated after removal of gloves. Majority (92%) knows that PPE provides barrier against infection. About half (53%) and (48%) had correct knowledge regarding donning and doffing of PPE respectively. Regarding attitudes, half of the respondent (50%) strongly agrees towrds correct use of PPE and hand hygiene. Conclusion: The levels of self-reported PPE information and Infection prevention and control training are sub-optimal in medical students of FFH which significantly correlates to COVID-19 and other infectious diseases-related anxiety.