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1.
Multiple Sclerosis Journal ; 28(3 Supplement):918-919, 2022.
Article in English | EMBASE | ID: covidwho-2138825

ABSTRACT

Introduction: During the Covid-19 pandemic, the provision of rehabilitation care to people with MS was significantly reduced (in addition, many patients were afraid to visit medical and sports facilities). An alternative (in these cases) could be telerehabilitation (ie the provision of rehabilitation services at a distance). The aim of our pilot study was to evaluate the feasibility of this form of rehabilitation in people with MS with balance disorders. Method(s): Our pilot study included 20 patients with MS with balance disorders. The intervention lasted 12 weeks. The experimental group underwent individual telerehabilitation (twice a week, 45 individual telerehabilitation), which consisted of balance and strength exercises with a physiotherapist, using the Homebalance system and other simple tools). The control group received regular rehabilitation care (outpatient individual physiotherapy). Functional tests were selected to assess the gait and balance disorders: Timed Up and Go (TUG), TUG with dual cognitive task and Berg Balance Scale (BBS). Subjective perceptions of gait, balance and fatigue disorders were evaluated with standardized questionnaires: Modified Fatigue Impact Scale (MFIS), Multiple Sclerosis Walking Scale-12 (MSWS-12), Falls Efficacy Scale International (FES-I), Activity Balance Confidence Scale (ABC Scale ). Result(s): The mean age of participants was 51 years (34-65 years), with the mean disease duration was 17 years (4-29 years) with a median neurological disability EDSS 5 (3-6.5). There was a significant improvement in the experimental group in the functional mobility test-TUG (p=0.048), balance-BBS (p=0.002) and in the standardized ABC Scale questionnaire (p=0.041). Conclusion(s): The results of the pilot study suggest that individual telerehabilitation could be an alternative to routine rehabilitation care for the treatment of balance and mobility disorders in patients with MS (suitable, for example, for people with a more distant place of residence or in case of new pandemic restrictions).

2.
PM and R ; 14(Supplement 1):S173, 2022.
Article in English | EMBASE | ID: covidwho-2127992

ABSTRACT

Case Diagnosis: A 10-year-old boy with postvaccination Guillain-Barre Syndrome (GBS) and Bell's Palsy Case Description or Program Description: A 10-year-old white Hispanic boy without significant past medical history presented to the emergency room (ER) with new right facial droop two weeks following his second dose of the Pfizer COVID-19 vaccine. He was diagnosed with Bell's Palsy and received a five-day course of steroids. He returned to the ER ten days later with a four-day history of bilateral lower extremity pain, weakness, and progressively worsening gait. His examination was notable for less than antigravity strength throughout the major muscle groups of both lower limbs, in which he also had impaired light touch sensation and areflexia. Setting(s): Pediatric unit of acute care hospital Assessment/Results: Cerebrospinal fluid analysis was notable for elevated protein levels. In the setting of areflexia in the bilateral lower limbs, a presumptive diagnosis of GBS was made and a 5-day course of intravenous immunoglobulin (IVIg) was initiated, with improvement. At time of discharge, he was able to ambulate independently without use of an assistive device. Discussion (relevance): Both GBS and Bell's palsy have been reported following vaccinations. This case is unique in that both occurred sequentially in a pediatric patient within 1 month of the second dose of the Pfizer COVID-19 vaccine. Conclusion(s): Neurological complications of the COVID-19 vaccine include both Bell's Palsy and GBS, which as in this case, may occur sequentially. Prompt initiation of IVIg, steroids, and rehabilitation may result in good recovery.

3.
PM and R ; 14(Supplement 1):S159-S160, 2022.
Article in English | EMBASE | ID: covidwho-2127988

ABSTRACT

Case Diagnosis: A 66-year-old man with past medical history significant for alcohol use disorder, thoracic aortic aneurysm, and alcohol-induced peripheral neuropathy presented with transverse myelitis following COVID-19 mRNA-1273 vaccination. Case Description or Program Description: The patient presented with a 3 week history of gait dysfunction and bilateral lower extremity weakness while walking, following the second dose of his COVID-19 vaccination. The patient described his leg symptoms as a "squeezing" heaviness that caused tightness, pain, and weakness with walking, without paresthesias. Thoracic spine MRI demonstrated a probable demyelinating process at the T2-T4 levels. Setting(s): Tertiary care hospital Assessment/Results: This patient was diagnosed with transverse myelitis. By day 3 of his hospital stay, the patient started twice daily IV methylprednisolone. By day 4 of his hospital course, the patient's symptoms had improved (normal neurologic exam), and he underwent a diagnostic lumbar puncture showing no abnormalities. By day 7, the patient was discharged home with home health PT. Discussion (relevance): The patient's onset of bilateral lower extremity weakness and stiffness following a vaccination, accompanied by imaging suggestive of thoracic spine demyelination, all suggests a diagnosis of transverse myelitis following his COVID-19 vaccination. Transverse myelitis following COVID-19 vaccination exists as a rare but important adverse event, with 21 cases occurring to date after the mRNA-1273 vaccine, and neurologic symptoms making up 2.69% of all COVID-19 vaccination adverse effects. These events may occur due to several mechanisms observed in neurologic effects of other viral vaccines, such as vaccine-induced elevations in IL-6 & IL-17 levels or adjuvant proteins causing MHC class 1 reactivity to the spinal cord. Conclusion(s): Transverse myelitis is a rare yet severe adverse event after the mRNA-1273 COVID-19 vaccine. As this vaccine approaches FDA approval, further study is needed to characterize the mechanism of the event and the susceptibility of specific populations to that mechanism.

4.
PM and R ; 14(Supplement 1):S20, 2022.
Article in English | EMBASE | ID: covidwho-2127982

ABSTRACT

Case Diagnosis: A 65-year-old woman who developed multiple system atrophy as a sequelae of COVID-19 infection Case Description or Program Description: The patient developed progressive dizziness, blurriness, and unsteady gait immediately following hospitalization for COVID-19 infection. Formal evaluation noted rightward nystagmus, mild resting tremor of the right hand, slowed finger tapping test bilaterally, overshooting on right finger to nose, and shuffling gait. MRI of the brain revealed moderate cerebellar and pontine volume loss with crossed hyperintensity of the pons, or "hot cross bun sign", raising suspicion for degenerative disease. Lumbar puncture analysis was normal. The patient was diagnosed with multiple system atrophy with parkinsonism features and started on a trial of amantadine and carbidopa/levodopa. Videonystagmography confirmed cerebellar etiology of her symptoms. Vestibular rehabilitation and meclizine was initiated with subsequent improvement in dizziness and functionality. Setting(s): Acute inpatient rehabilitation facility. Assessment/Results: After 20 days of acute inpatient rehabilitation including vestibular therapy, amantadine, carbidopa/levodopa, and meclizine, there was improvement of dizziness, dysarthria, tremor, weakness, and gait. The therapy team noted good progress since admission regarding performance of self-care tasks as well as transfers and mobility. The patient was discharged home with outpatient vestibular therapy. Discussion (relevance): This is a case of newly diagnosed multiple system atrophy associated with "hot cross buns sign" on MRI with COVID19 infection as the implicated etiology. To our knowledge, this is the first case of central cerebellopontine degeneration associated with COVID19. Conclusion(s): New onset multiple system atrophy may be a sequelae of COVID19 infection.

5.
Annals of Neurology ; 92(Supplement 29):S142, 2022.
Article in English | EMBASE | ID: covidwho-2127551

ABSTRACT

Objective: To discuss neuro-immunologic complications of mRNA vaccinations. Background(s): Neuro-immunologic complications are a known risk of various types of vaccines, but little is known about complications after mRNA vaccines. Method(s): We present a series of four patients from a single institution who developed severe neurologic complications after mRNA COVID-19 vaccinations. Result(s): Case One: A 31-year-old female developed arm paresthesias, leg weakness and urinary retention one week following her first dose. MRI demonstrated T2 hyperintensity at T5 and T8-T9 with enhancement. She received five days methylprednisolone and IVIG. She remains wheelchair bound with urinary retention. Case Two: A 31-year-old male developed paresthesias in legs and urinary retention four weeks following his second dose. A year prior, he contracted COVID-19 and had transient leg paresthesias. MRI demonstrated T2 hyperintensity from lower medulla to the conus. He received five days of intravenous methylprednisolone followed by oral prednisone. He remains symptomatic requiring gabapentin, baclofen and tamsulosin. Case Three: A 75-year-old female with hypertension, diabetes mellitus and Crohn's disease developed leg weakness, complicated by respiratory failure, three days after her first dose. Guillian- Barre Syndrome was diagnosed based on nerve conduction studies. She received PLEX followed by IVIG. She can now ambulate with a walker. Case Four: A 59-year-old healthy female developed urinary retention, saddle anesthesia and leg weakness four weeks following her second dose. MRI spine demonstrated patchy T2 hyperintensities throughout the pons, C- and T-spine. She continues to have gait imbalance and urinary incontinence. Other causes of transverse myelitis including neuromyelitis optica and myelin oligodendrocyte associated disease were ruled out in Case 1, 2 and 4. CSF analysis in all were compatible with neuro-inflammation. Conclusion(s): These cases raise concern that mRNA vaccinations may be associated with neurologic complications due to heightened immune reactivity. Further studies are needed to understand the risk associated with mRNA vaccinations.

6.
On - Line Journal of Nursing Informatics ; 26(2), 2022.
Article in English | ProQuest Central | ID: covidwho-2112136

ABSTRACT

Background: Older adults face an increased risk for falling and resulting injury due to age-related physiological changes (Sharif et al., 2018). Effective fall risk screening programs in the primary care setting may be a promising approach to reduce the incidence of falls within this population (Siegrist et al., 2016). The use of technology can be beneficial in supporting care delivery and further reducing the risk. Purpose: This article discusses the implementation of a fall risk screening and reduction program in a primary care setting. The program uses resources of the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) Initiative and the development of an Audio Computer-Assisted Self-Interview (ACASI). This study aimed to increase community-dwelling older adult safety by identifying and reducing fall risk. Clinical Relevance: ACASI is an effective alternative to traditional interview methods due to its speed in data capture and the potential for increased accuracy of self-reported data. Introducing ACASI technology in nursing practice is an innovative approach to collecting patient data in a manner that limits physical interaction, reduces bias, and promotes safe social practices, especially when considering the current COVID-19 pandemic. Approach: Participants were recruited from an outpatient facility and consented to participate in the study. Chart reviews were conducted to identify eligible participants. To determine the baseline fall risk scores, questionnaires were presented to participants in the form of an ACASI. This technology was used to communicate the assessment questions and facilitate data collection. Evidence-based informational materials were administered to participants to provide education on fall prevention safety and limiting fall risk. Eight weeks after receiving education on fall risk reduction behavioral and environmental modifications, a follow-up, ACASI- formatted questionnaire was administered to assess for a change in fall risk scores. Results: The research findings demonstrated a significant reduction in fall risk scores (t (40) = -2.220, p =.032) from pre- to post-assessment. Overall fall risk scores among the participants decreased by 43% within a 12-week timeframe. One in four adults age 65+ report falling, resulting in over 50% of all injury-related deaths (Haddad et al., 2018). Individuals who suffer from falls are not only predisposed to injury and untimely death, but also decreased mobility, decreased independence, hospitalization, and nursing home placement (Phelan et al., 2016). The cost to medically treat a fall is approximately $10,000 in direct fees (Dellinger, 2017). Costs associated with caring for fall-related injuries exceed $30 billion each year (Phelan et al., 2016).  The National Patient Safety Goals, established by The Joint Commission (TJC) in 2003, is a safety and quality improvement program to help healthcare organizations target concerning areas of need (The Joint Commission, 2022a). Sentinel Event Alerts, which warn healthcare organizations about risks to patient safety, are included with the safety goal reports. Injurious patient falls have regularly ranked in the top 10 among the TJC’s list of Sentinel Events (The Joint Commission, 2022b). Most falls among older adults result from a combination of risk factors. Approaches to assess and manage modifiable risk factors have been identified as effective interventions for individuals at risk of falling (Phelan et al., 2016). Primary care practitioners can play a key role in identifying and reducing fall risk among patients by identifying and discussing risk factors during regular office visits. The physiologic changes and high incidence of falls in the elderly make it necessary to conduct regular fall risk assessments and interventions among this population (Siegrist et al., 2016). Among the leading fall risk assessment resources that have recently been developed is the Centers for Disease Control and Prevention’s (CDC) STEADI (Stopping Elderly Accide ts, Deaths & Injuries) Initiative (Centers for Disease Control and Prevention, 2017c). STEADI offers healthcare providers a standardized approach to conduct fall risk screenings, assessments, and interventions for older adults (Howland et al., 2018). Technology can assist in screening patients for fall risk in the form of an Audio Computer-Assisted Self-Interview (ACASI). An ACASI-administered survey is a method of data collection that allows participants to complete interviews on their own without the presence of a human interviewer. Questions and response options are displayed as digital text on a personal electronic device and read aloud to participants. The participants listen to the pre-recorded questions and respond by selecting their answers directly on the screen. ACASI is believed to improve the quality of data collection by minimizing data entry errors. Additional benefits of using ACASI, as opposed to traditional survey questionnaires, include increased privacy for participants, accessibility for illiterate participants, reduced staff time for interviewing, and increased data validity for sensitive questions (Kane et al., 2016). In this study, an ACASI was developed and administered to participants in tandem with CDC STEADI (2017c) resources, as part of a fall risk screening and reduction program to identify and reduce the risk of falling among community-dwelling older adults.

7.
Pilot Feasibility Stud ; 8(1): 239, 2022 Nov 12.
Article in English | MEDLINE | ID: covidwho-2115804

ABSTRACT

BACKGROUND: Gait impairment limiting mobility and restricting activities is common after stroke. Auditory rhythmical cueing (ARC) uses a metronome beat delivered during exercise to train stepping and early work reports gait improvements. This study aimed to establish the feasibility of a full scale multicentre randomised controlled trial to evaluate an ARC gait and balance training programme for use by stroke survivors in the home and outdoors. METHODS: A parallel-group observer-blind pilot randomised controlled trial was conducted. Adults within 2 years of stroke with a gait-related mobility impairment were recruited from four NHS stroke services and randomised to an ARC gait and balance training programme (intervention) or the training programme without ARC (control). Both programmes consisted of 3x30 min sessions per week for 6 weeks undertaken at home/nearby outdoor community. One session per week was supervised and the remainder self-managed. Gait and balance performance assessments were undertaken at baseline, 6 and 10 weeks. Key trial outcomes included recruitment and retention rates, programme adherence, assessment data completeness and safety. RESULTS: Between November 2018 and February 2020, 59 participants were randomised (intervention n=30, control n=29), mean recruitment rate 4/month. At baseline, 6 weeks and 10 weeks, research assessments were conducted for 59/59 (100%), 47/59 (80%) and 42/59 (71%) participants, respectively. Missing assessments were largely due to discontinuation of data collection from mid-March 2020 because of the UK COVID-19 pandemic lockdown. The proportion of participants with complete data for each individual performance assessment ranged from 100% at baseline to 68% at 10 weeks. In the intervention group, 433/540 (80%) total programme exercise sessions were undertaken, in the control group, 390/522 (75%). Falls were reported by five participants in the intervention group, six in the control group. Three serious adverse events occurred, all unrelated to the study. CONCLUSION: We believe that a definitive multicentre RCT to evaluate the ARC gait and balance training programme is feasible. Recruitment, programme adherence and safety were all acceptable. Although we consider that the retention rate and assessment data completeness were not sufficient for a future trial, this was largely due to the UK COVID-19 pandemic lockdown. TRIAL REGISTRATION: ISRCTN, ISRCTN10874601 , Registered on 05/03/2018.

8.
Intern Med ; 2022 Oct 05.
Article in English | MEDLINE | ID: covidwho-2054685

ABSTRACT

We encountered a 55-year-old woman with possible autoimmune encephalitis associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant. She was not vaccinated against coronavirus disease 2019 (COVID-19). Consciousness disturbance, myoclonic-like movements and gait disturbance occurred 10 days after the COVID-19 symptom onset. Her neurological symptoms improved two days after methylprednisolone pulse therapy. Cerebrospinal fluid (CSF) was negative for SARS-CoV-2 reverse transcription-polymerase chain reaction, the CSF-to-serum albumin quotient was mildly elevated, and interleukin 6 and 8 levels were normal in serum but mildly elevated in CSF. Omicron variant infection may increase blood-brain barrier permeability and intrathecal inflammation, causing autoimmune encephalitis.

9.
Drug Safety ; 45(10):1157-1158, 2022.
Article in English | ProQuest Central | ID: covidwho-2044975

ABSTRACT

Introduction: Gastrointestinal stromal tumors (GISTs), soft tissue sarcomas of the digestive tract, are associated with oncogenic mutations that led to the approval of tyrosine kinase inhibitors (TKIs) [1-2]. Considering the increased use of TKIs in clinical practice, it may be useful to identify unexpected adverse drug reactions (ADRs). Objective: The aim of this study was to describe better ADRs and to identify unexpected potential safety signals through the analysis of individual case safety reports (ICSRs) among TKIs approved for GIST collected into the European Spontaneous Reporting System (SRS) database. Methods: All ICSRs recorded starting from the drug approval up to 31 December 2021 with one of the following TKIs reported as suspected drug were included: imatinib (IM), sunitinib (SU), avapritinib (AVA), regorafenib (REG), and ripretinib (RIP). A descriptive analysis was conducted to assess all demographic characteristics. Moreover, a disproportionality analysis was performed using the Reporting Odds Ratio (ROR) with the corresponding 95% Confidence Interval (CI) to evaluate the frequency of ADRs for each TKI compared to all other TKIs. Results The number of analyzed ICSRs was 8,512 (Figure 1 Flowchart of ICSRs selection process): the 57.9% were related to IM, followed by SU (24.2%), AVA (13.1%), REG (2.7%), and RIP (2.1%). ICSRs were mainly serious (87.5%), related to males (51.7%), and to adults (44.7%);moreover, the 25.5% were fatal. The disproportionality analysis showed a higher reporting frequency of some unexpected ADRs for each TKI: gait disturbance (ROR 2.86;95% CI 1.90-4.29), hyperhidrosis (2.57;1.06-6.20), and hyperammonemia (3.92;1.05-14.60) for SU;cerebrovascular accident (6.23;2.18-17.84), hemoglobin decreased (2.23;1.08-4.61), and internal haemorrhage (14.44;3.94-52.92) for RIP;gastrointestinal ulcer (10.88;2.98-39.81) for REG;hepatic and lung cancer for IM (12.79;8.04-20.37 and 7.71;3.33-17.84, respectively);hallucination (24.33;9.02-65.68), mood swings (8.02;2.44-26.33), and stress (6.68;1.93-23.11), nephrolithiasis (6.69;2.15-20.77), pollakiuria (3.08;1.17-8.13), and dialysis (6.68;1.67-26.73), sinusitis (3.34;1.14-9.78), cellulitis (4.17;1.36-12.78), and COVID-19 (7.25;3.40-15.45), chills (2.36;1.22-4.58), limb fracture (3.53;1.63-7.60), hernia (9.23;3.71-23.00), diabetes mellitus (5.02;2.11-11.95), hyposideraemia (5.02;2.11-11.95), tinnitus (3.64;1.34-9.87), parosmia (5.00;1.12-22.38), Raynaud's phenomenon (5.00;1.12-22.38), and thyroid function test abnormal (8.90;1.99-39.83) for AVA. Conclusion: This study is largely consistent with results from literature but some unexpected ADRs were shown. Further studies are necessary to increase the awareness about the safety profiles of new TKIs approved for GISTs.

10.
Journal of Neuromuscular Diseases ; 9:S183-S184, 2022.
Article in English | EMBASE | ID: covidwho-2043382

ABSTRACT

The past two years have been significantly overshadowed by the respiratory virus Covid-19. This has shown a relevant impact on health care systems, so that at a specialized neuromuscular center, we experienced a shortness of personnel and time, and in parallel, we were facing many unanswered questions addressed to us by patients with rare diseases. In this study, we developed a new questionnaire to assess patient needs, concerns, and symptoms confronting the global pandemic. We included individuals with hereditary neuropathies (n=15), autoimmune-inflammatory neuropathies (n=26), or idiopathic small fiber neuropathies (n=45). For validation, we used previous clinical examination reports. Forty-six percent of the included patients were female, 52% male, and one patient diverse. The mean age at examination was 52.67±13.37 years (range: 19-79 years). Most of the patients (59%) reported mild to moderate limitations in their daily life activities due to Covid-19. Severe impairment was reported in 28%. Due to the pandemic, 54% of the patients reported to be concerned about their own and 76% about their relatives' health. Patients with a positive family history were 2.4x more likely to be seriously worried about other family members. We observed that patients with more wide-spread sensory loss reported higher impairment levels than those with distal sensory loss only. Overall, 37% of the patients said that contracting Covid-19 was their main concern, including the presumed risk of a severe course. Further 34% were worried that their neuropathy might worsen if they ever contracted Covid-19. Thirtythree percent of the patients experienced limitations in their treatment options, e.g. by not being able to continue their physical therapy. Seven percent were concerned about social distancing, as daily care required direct interactions with others. Whereas 65% of the included individuals confirmed that they felt appropriately informed by their treating physicians, 21% wished to receive more information. Sixteen percent, however, said that they did not dare to ask their questions in order to not disturb the health care personnel amidst the crisis. Patients with hereditary, autoimmune, or small fiber neuropathies did not show any differences in their Covid-related dailylife impairment. Previous clinical results correlated with patient-reported sensory levels;and gait unsteadiness was reported significantly more often in patients with afferent ataxia. We conclude that Covid-19 imposes a relevant daily-life burden on neuropathy patients. Patient-reported outcome measures are a valid remote strategy if in-person visits are not possible.

11.
Journal of Neuromuscular Diseases ; 9:S38-S39, 2022.
Article in English | EMBASE | ID: covidwho-2043375

ABSTRACT

The Covid-19 pandemic has highlighted the diffi- culty in the management of neuromuscular patients and the need for continued implementation of the standard of care. With the new pandemia psychometrically robust but quick outcome measures are needed to monitor patients' clinical status. The slow progressive nature of several muscle disorders and the wide pattern of involvement in muscular dystrophies and myopathies make it difficult to establish the prognosis, predict clinical evolution and perform trials and define the impact of natural history, and use new therapies that are becoming available. We constructed a motor function test that is easy and quick to use. This quick Motor Function test: Gait, Stair, Gower's, Chair (GSGC) was constructed based on the clinical expertise of several physicians involved in the care of DMD;LGMD, and Pompe patients. The GSGC score can be integrated by the use of the motor function of the upper motor limbs with the arm function test (GSGCA). It consists of a simple standardized functional test which grades the ability of the patient to raise their upper arms over the head. Grade 0 corresponds to a full circle of arm abduction, while with grade 6 the patients cannot raise their arms to their mouth and effectively use their hands. The Gardner-Medwin Walton (GMW) scale even modifi ed appears in comparison rather insensitive. The GSGC test includes 4 items. The test provides a detailed picture of motor function by including a quantitative measure of four performances i.e. time to perform four activities: Gait =walking for 10 meters, S=climbing 4 steps on a Stair, G= Gower's maneuver, C= rising from a Chair (Figure) The GSGC final score is obtained by adding the grades of the four functional tests and ranges from a minimum of 4 (normal performance) to a maximum of 27 (worst performance).GSGCA test includes 5 tests (total score from 5 to 32). Validity and test reliability were determined in a cohort of 9 adult Pompe patients (15 to 54 years of age) and then validated in 40 LOPD cases by a collaborative group. The responsiveness of the GSGCA scale to changes in clinical course over time was examined in a subgroup of 13 LGMD 2B/R2 untreated patients. Interrater and intrarater reliabilities were most usually confirmatory. The motor outcomes are different in various myopathies and depend on a correct diagnosis, while exercise in myopathy patients should be moderate, but not necessarily discouraged. The muscle MRI imaging might be helpful for follow-up of the proximal or distal muscle involvement, to detect fat, and connective tissue replacement, which might be usually absent in metabolic myopathies, except for LOPD. Diet and exercise in LOPD might be an additional therapeutic option synergistic to ERT. In this presentation, we examine the use of the GSGC scale in LOPD, DMD, and GSGCA scales in the natural history of LGMD R2. The development of smart care using telemedicine and eHealth technologies to share images, clinical data, reports, and video meetings of collaborative groups should be implemented. Keywords: GSGC scale, Covid-19, DMD, LGMD, Pompe.

12.
Telehealth and Medicine Today ; 6(2), 2021.
Article in English | ProQuest Central | ID: covidwho-2026471

ABSTRACT

Objective: During the coronavirus-2019 (COVID-19) times, we have all learned to appreciate the advantages of communicating with each other on the digital or virtual format. This included both social, commercial and professional settings. This was necessitated through the restrictions on direct physical contact mandated by the pandemic. Through innovations and adaptations, the practice of medicine has also changed with telemedicine, triggered by ‘necessity is the mother of invention’ concept being embraced by both patients and physicians. Neurology, traditionally seen as a complex speciality and the preserve of a couple of thousand practising neurologists in the country, has opened itself up to the telemedicine or tele-neurology format very easily in the anecdotal and a few pilot studies conducted globally and in India. Design: Despite the initial misgivings and anticipation of patient reluctance to adopt this technology, the real-world experience has been, to the contrary, where both young and old patients have readily embraced the new medium and cooperated with the neurologists to improve their care, which would otherwise have been severely restricted in the COVID-19 times. The neurologists have also adapted to the new way of working to deliver optimum diagnosis and care plans. Outcome measures: There have been technical glitches (in form of internet connectivity, smartphone hardware and software problems and lighting and camera angle and image stabilization issues to name a few), which have been reduced with practice and innovation. Feedback from neurologists, patients, and their carers via regular audits and questionnaires are being circulated, and practice parameters are being improved (IFNR survey- Ref 5). The contribution of national regulatory agencies, such as the Ministry of Health and Family Welfare (MoHFW), and stakeholders, such as the Telemedicine Society of India (TSI), has been phenomenal to facilitate the tele-neurology practice and make it safe for all stakeholders. Results: In a country of 1.37 billion population and only 2,500 accredited neurologists, there is a need for tele-neurology to be able to serve patients living in remote areas in mountains and coastal areas, and also in poorly connected areas on the plains. This becomes paramount for patients requiring specialised acute neurological care and to improve access, which now becomes a practical feasibility on the digital format to bring neurology to the doorsteps of the people. Follow-up care of patients, epidemiological studies of various neurological chronic illnesses and their audit will become realities cutting down on costs and time to access quality neurological care using the digital format for 21st-century India. Conclusions: Tele-neurology is no longer a vision, but a reality precipitated by the pandemic, the needs and aspirations of the Indian population, and the technological infrastructure India has achieved in the last 20 years.

13.
Emerging Science Journal ; 6(5):1086-1099, 2022.
Article in English | Scopus | ID: covidwho-2026408

ABSTRACT

Gait recognition is the behavioral biometric trait that tracks humans based on their walking motion. It has gained attention because of its non-invasive and unobtrusive behaviors and applicable to the different application area. In this paper, we target model-free gait recognition with the deep learning approach for the Muslim community in the COVID-19 pandemic. The different convolutional neural network architectures (CNN) are examined by using the spatio-temporal gait representation called Gait Energy Images (GEI). We explored both the identification and verification problems to determine the suitability of the proposed CNN frameworks. In gait recognition, the intraclass variation is larger than the inter-class variation because of the shooting view, the walking speed, the wearing condition, and so on. To tackle this challenge, the verification framework is more suitable for the 1:1 association of gait recognition. As for the verification problem, we implemented the Siamese network with the parallel CNN architecture. All the proposed methods are tested against the public gait datasets called OUISIR-LP and OUISIR-MVLP to determine the identification and verification performance in terms of recognition accuracy and error rate. © 2022 by the authors. Licensee ESJ, Italy.

14.
Chiropr Man Therap ; 30(1): 33, 2022 08 31.
Article in English | MEDLINE | ID: covidwho-2009434

ABSTRACT

BACKGROUND: Falling is a major trauma that can occur with aging, leading to very significant psychological and physical health effects with financial and societal consequences. It is therefore essential to explore therapeutic treatments that can reduce this risk. Some recognized effective treatments exist, concerning in particular the re-education of the muscles of the lower limbs. However, to our knowledge, none of them focus on the cervical spine although the latter is located at an essential physiological crossroads. Manual therapy, which has already demonstrated its impact on pain and balance parameters in the elderly, could be a painless and non-invasive tool of choice in addressing this problem. METHODS: Interventional study (not related to a health product), monocentric, prospective, controlled, randomized double-blind (patient and evaluator performing the measurements). The experiment will take place over three measurement periods on D0, D7 and D21. On D0 subjects will be randomized in 2 groups: experimental and placebo group. Both groups will be assessed on: Short Physical Performance Battery test score, walking speed, lower limb strength, balance, heart rate variability and cervical spine strength and mobility. Then the experimental group will receive a myofascial release protocol applied to the cervical spine and the placebo group will receive a placebo light touch protocol. The intervention will be followed by the same measurements as before. This schedule will be reproduced on D7. On D21, only one assessment will be done. DISCUSSION: This study started in 2020 but could not go beyond the inclusion phase due to the COVID pandemic. It is envisaged that recruitment could resume during 2022. TRIAL REGISTRATION: Registered by the Comité de Protection des Personnes-Sud Méditerranée; under the title "Prévention des troubles de l'équilibre chez le senior: influence de la thérapie manuelle appliquée au rachis sur les paramètres statiques et dynamiques¼, n° 19.12.27.47.259 in date of February 4, 2020. Registered by ClinicalTrials.gov ID: NCT05475652; under the title « The Influence of Manual Therapy Applied to the Cervical Spine in the Prevention of Balance Disorders in the Elderly (ManEq)".


Subject(s)
COVID-19 , SARS-CoV-2 , Aged , Cervical Vertebrae , Humans , Pandemics/prevention & control , Prospective Studies , Randomized Controlled Trials as Topic
15.
Annals of the Rheumatic Diseases ; 81:1075-1076, 2022.
Article in English | EMBASE | ID: covidwho-2008847

ABSTRACT

Background: Giant cell arteritis-related stroke is rare, with high early mortality and major morbidity in survivors. Objectives: To increase the awareness of coexistence of giant cell arteritis-re-lated stroke and rheumatoid arthritis. Methods: A case report and discussion. Results: A 73 year-old man with seronegative elderly-onset rheumatoid arthritis (EORA) presented to the emergency department (ED) with a one week history of frontal headache, vomiting and dizziness. He had multiple cardiovascular comor-bidities and took multiple medications, including methotrexate and sulfasalazine. He also had long-standing history of thrombocytopenia without requiring any treatment. Neurological examination performed in the ED was unremarkable. His C-reactive protein (CRP) was 69mg/L and erythrocyte sedimentation rate (ESR) 82mm/hour. Computed tomography (CT) of the brain was normal. The headache settled with analgesia. A diagnosis of probable tension-type headache, with underlying active EORA, was made. One month later, he presented to an ophthalmologist with recurrence of headache associated with visual disturbance and was diagnosed with giant cell arteritis (GCA). Both CRP (77mg/L) and ESR (85mm/hour) remained raised. Neither temporal artery biopsy nor temporal artery ultrasound were possible due to the coronavirus disease 2019 (COVID-19) pandemic. The headache and visual symptoms resolved completely a week after prednisolone 60mg daily was prescribed. In parallel, the CRP dropped to 2mg/L and ESR 16mm/hour. The patient's glucocorticoid dose was then tapered. While on prednisolone 20mg daily, about 3 weeks later, he developed slurred speech and generalized weakness. Examination showed cerebellar signs and MRI brain showed acute cerebellar infarct. He was treated pragmatically as an atherosclerotic stroke with clopidogrel, and the steroid was rapidly tapered in view of absence of headache and normalization of infammatory markers. Four weeks later, he was noted to have persistent confusion and unsteadiness of gait. CRP was elevated at 92mg/L. An urgent positron emission tomography-CT (PET-CT) scan showed infammation in the vertebral arteries [Figure 1] and cerebellar stroke. Prednisolone 40mg daily was restarted which led to a rapid improvement in his symptoms and normalization of infammatory markers. The glucocorticoids were tapered in a slower manner this time. A diagnosis of GCA-related cerebellar stroke with vertebral vasculitis was made and, with glucocorticoids, the patient made a good clinical recovery. His infam-matory joints pain also improved in parallel. Conclusion: Stroke or transient ischemic stroke are rare complications, reported in 2.8-16% of patients with active GCA. Most studies report strokes as occurring between the onset of GCA symptoms and 4 weeks after commencement of glucocorticoids1-3. Vertebrobasilar territory is involved in 60-88% of cases of GCA-related stroke1-3. In contrast, the vertebrobasilar territory is affected only in 15-20% of atherosclerotic strokes1,2. One study reported fatal outcomes in 11 out of 40 patients (28%) with GCA-related stroke, 7 within 2-13 days of stroke2. To conclude, this case demonstrates that high-dose glucocorticoids with slower tapering were able to control GCA-related stroke due to vertebral vasculitis in patient with EORA on background methotrexate and sulfasalazine.

16.
Journal of Neuroimaging ; 32(4):767-768, 2022.
Article in English | EMBASE | ID: covidwho-2008752

ABSTRACT

Background and Purpose: Balo's concentric sclerosis (BCS) is a rare inflammatory demyelinating disorder of the central nervous system (CNS) characterized pathologically and radiologically by concentric lamella of alternating demyelinated and partially myelin-preserved white matter. Whether BCS is a variant of multiple sclerosis (MS) or a distinct entity remains debatable. Here, we report an unusual case of MS complicated by Balo's lesions, post-Coronavirus disease 2019 (COVID-19), focusing on the evolution ofMRI findings. Methods: Single-case study. Results: The patient is a 42-year-old woman with relapsing-remitting MS diagnosed at age of 19 who was treated with teriflunomide for the past 5 years. She developed a febrile illness and arthralgia for a week;however, COVID-19 testing was deferred. Two weeks later, she presented with vertigo followed by profound right-hemiparesis, gait impairment, and encephalopathy. Cerebrospinal fluid analysis revealed a protein of 56 mg/dl, increased immunoglobulinG(IgG) index, and>l10 unique oligoclonal bands. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG was detected in serum, but viral ribonucleic acid was absent in the CSF. BrainMRI demonstrated, for the first time, several Balo-like and tumefactive lesions, with contrast enhancement and restricted diffusion. She received plasma exchange alternating with pulse steroids, yet was left with ataxic hemiparetic gait. She was later switched to an anti-CD20 monoclonal antibody therapy. Followup brain MRIs showed continuous regression of the tumefactive and Balo-like lesions. Conclusion: This case adds to the emerging spectrum of COVID-19- associated radiological findings regarding inflammatory demyelination in the CNS. It remains unknown whether potential neurotropism of SARS-CoV-2 or parainfectious mechanisms might have contributed to the fulminant disease in our patient.

17.
New Zealand Medical Journal ; 135(1557):102-103, 2022.
Article in English | EMBASE | ID: covidwho-2003077

ABSTRACT

Parkinson's disease is a movement disorder that increases fall risk. Clinicians administer several validated gait and balance tests for people with Parkinson's disease in person. COVID-19 has reduced healthcare access, and this has disproportionately affected older populations. We tested the reliability of remote gait and balance assessments of people with Parkinson's disease using face-to-face as the comparator. Fifteen people with Parkinson's disease (aged 57-82, 11 males) performed 14 tests of gait and balance twice: (i) face-to-face, and (ii) remotely, via videoconference between 7 and 14 days after. A trained physiotherapist rated participant performance. The tests included items from the Berg Balance Scale, Functional Gait Assessment, and the Timed-Up- And-Go. These assessments have been validated face-to-face for people with Parkinson's disease. The videoconference assessment was recorded. We compared face-to-face and live videoconference performance to obtain assessment reliability. The physiotherapist rated the recording at least two weeks after the live videoconference to obtain intrarater reliability. A second rater assessed the recording, and we compared live and recorded telehealth assessments to obtain inter-rater reliability. Reliabil ity was measured using either intraclass correlation (ICC) two-way mixed with absolute agreement (continuous measures) or Fleiss multi-rater Kappa test (ordinal measures). Most tests showed moderate to very good assessment reliability between face-to-face and live telehealth (ICC=0.5-1), between face-to-face and recorded telehealth (ICC=0.5-1) and good to very good inter-rater reliability between the recorded telehealth assessments (ICC=0.63-1). Reliability appeared to be higher in tests involving quantitative, rather than qualitative, measures of performance. A ceiling effect was noted in some tests where all participants completed tests with maximum scores in both face-to-face and remote assessments. This study supports the feasibility of remote assessment in clinical practice for people with Parkinson's disease. Further research with a larger cohort and adjustment of the assessments to avoid ceiling effects is necessary.

18.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003031

ABSTRACT

Introduction: Transient synovitis is a common cause of hip pain in children. Patients present with acute limp, hip pain or referred pain to the knee. The mainstay of treatment consists of antiinflammatory medications and activity limitations. While the exact etiology of transient synovitis is unknown, there has been a noted relationship with an antecedent viral illness. We present one of the first reported cases of transient synovitis caused by COVID-19. Case Description: A 10-year-old male presented with concerns for left knee pain and limp. Five days prior, the patient developed general URI symptoms and was diagnosed with COVID-19, via rapid testing. His maximum temperature was 38.5°C at home and his respiratory symptoms resolved. Two days prior to presentation, he complained of left knee pain, which progressed to limp, and refusal to bear weight. He denied known injuries, trauma, visible bruising, swelling, redness, or warmth. He was afebrile and non-weight-bearing on his left leg, otherwise in no apparent distress. On physical exam, he exhibited full, painless range of motion of left knee, no bony tenderness, effusion, or cutaneous changes. There was refusal to bear weight on left leg, and significant pain with internal rotation of left hip. Lab work revealed there was no leukocytosis. C-reactive protein level and sedimentation rate were unremarkable. Radiographs of bilateral hip and pelvis, and left knee were obtained, which revealed no osseous abnormalities or significant effusion. Patient was given ibuprofen and on follow up exam he exhibited improved discomfort and willingness to bear weight. With a negative workup and clinical improvement, he was discharged with crutches, instructions for supportive care, and outpatient follow-up. Mother reported no complications during his recovery. He was able to wean from the crutches within a few days and returned to his usual gait within 3 weeks. Discussion: Transient synovitis can be clinically distinguished from septic arthritis with features of overall well appearance, lack of swelling or redness to the joint, and normal range of motion with mild pain. For our patient, Kocher criteria were helpful in distinguishing transient synovitis from septic arthritis, as well as the clinical improvement with NSAIDs. A clinical dilemma could occur if elevated inflammatory markers were present, as one might expect with acute COVID-19. Though transient synovitis is thought to be related to a viral etiology, there does not appear to be an increase in cases amidst the pandemic described in published literature. Conclusion: This case illustrates a patient who had COVID-19 with transient synovitis, a previously unreported sequela. When evaluating similar patients, providers should consider the possibility of COVID-19 and ensure appropriate testing and isolation.

19.
Journal of General Internal Medicine ; 37:S390, 2022.
Article in English | EMBASE | ID: covidwho-1995825

ABSTRACT

CASE: A 64-year-old woman was brought in by husband for inability to care for patient. Previously active, she developed gait instability, slurred speech, and memory lapse to the point of selective mutism and being bed-bound within three months. Her medical history was notable for hypertension and Covid four months prior. She had had mild upper respiratory symptoms and recovered in ten days. Examination revealed general encephalopathy, dysarthria, limited ability to follow commands. She had decreased strength but increased tone and rigidity in all extremities. She had rhythmic jaw movement and bradykinesia with scatter myoclonic movements. Cerebellar exam was notable for ataxia, but she had normal cranial nerve and sensory exams and normal reflexes. MRI of the brain revealed restricted diffusion and T2/Flair signal abnormality involving bilateral basal ganglia, ventral medial thalami, hippocampi, and cerebral cortices. Toxic metabolic workup was unrevealing. CSF was positive for 14-3-3 protein and elevated total tau protein, confirming Creutzfeldt-Jakob disease. IMPACT/DISCUSSION: Creutzfeldt-Jakob Disease (CJD) is a prion disease with one in a million prevalence. Patients present with rapidly progressing dementia, myoclonus, and signs of cerebellar, corticospinal and extrapyramidal involvement including nystagmus, ataxia, hyperreflexia, spasticity, hypokinesia, bradykinesia, dystonia, and rigidity. CJD is fatal within months to two years. Patients with end stage disease may have akinetic mutism. Magnetic resonance imaging (MRI), electroencephalogram (EEG), and cerebrospinal fluid (CSF) analysis are important for evaluation of CJD. Most sensitive in early stages, MRI Brain commonly shows hyperintense signal involving the cerebral cortex, corpus striatum, caudate, and putamen. EEG may capture pattern of periodic bi-or triphasic period sharp wave complexes. CSF might detect 14-3-3 protein with elevation of tau protein but real-time quaking-induced conversion (RT-QuIC) has the highest specificity for diagnosis for CJD. Though brain biopsy is the sole method of definitive diagnosis, results of MRI, EEG, and CSF analysis along with presenting signs and symptoms are sufficient for clinical diagnosis of CJD. Our patient's dementia, myoclonus, ataxia, hypokinesia, bradykinesia, dystonia, and rigidity all progressing to akinetic mutism within three months are classic presentation of CJD. EEG was normal, but MRI with hyperintensity of basal ganglia and cerebral cortices and CSF analysis with positive 14-3-3 and elevated tau proteins are all lead to diagnosis of CJD. CONCLUSION: This case illustrates a classic case of a Creutzfeldt-Jakob Disease, a rare prion disease marked by rapidly progressive dementia with neuropsychiatric features.

20.
Journal of General Internal Medicine ; 37:S536, 2022.
Article in English | EMBASE | ID: covidwho-1995721

ABSTRACT

CASE: The patient is a 66-year-old male presenting with progressive ambulatory dysfunction and lower extremity weakness that began ten days ago. Notably, the patient was admitted to the hospital two months prior with similar complaints. At that time, he was diagnosed with transverse myelitis after MRI showed a spinal cord lesion concerning for demyelination at T3-T4. The patient was treated with IV steroids and discharged. Neurology impression at time of discharge was transverse myelitis possibly related to Covid vaccination two weeks prior to admission. The patient states he was doing fine after initial discharge before recurrence of his progressive weakness and difficulty walking that led to the current admission. He denies fever, chest pain, abdominal pain, and bladder/ bowel incontinence. The patient is a former smoker and denies current alcohol or drug use. Past medical history includes WPW status post ablation, stable thoracic aortic aneurysm, peripheral neuropathy secondary to past alcohol abuse, osteoarthritis, GERD, and anxiety. Family history is remarkable for cancer, coronary artery disease, and diabetes in his father. Medications include metoprolol, tamsulosin, pantoprazole, olanzapine, and venlafaxine. Neurological exam is positive for atrophy and decreased vibratory sensation in bilateral lower extremities. His gait is not assessed due to safety concerns, but the patient notes he has begun using a cane to assist with ambulation. Otherwise, physical exam is unremarkable. Imaging studies include MRI showing T3-T4 hyperintensity, as seen during previous admission two months prior. Labs including ANA, rheumatoid factor, SPEP, CSF studies, and AQP-4 were negative. After an unrevealing workup, the patient experienced symptomatic improvement with IV steroids and was discharged home. IMPACT/DISCUSSION: Our case illustrates a clinical picture of Covid-19 vaccine-related transverse myelitis, a rare but serious complication of the vaccine. The prolonged course of this patient's complications is concerning, although the benefit of receiving the vaccine remains unquestionable. Furthermore, although the timing of symptom onset and vaccination suggests a relation, there are other diagnoses that could explain the presentation and further research is needed regarding vaccine-related side effects. This case emphasizes the importance of maintaining a high index of suspicion for neurological issues of unclear etiology following recent Covid-19 vaccination despite their rare occurrence. CONCLUSION: Teaching points: Diagnostic criteria for transverse myelitis includes sensory, motor, or autonomic dysfunction attributable to spinal cord, no evidence of cord compression, bilateral symptoms with clear sensory level, and inflammation defined by CSF analysis, elevated IgG, or MRI enhancement. Neurological complications of the Covid vaccine include general symptoms such as headache, fever, and fatigue, Bell's palsy, encephalomyelitis, myelitis, and cerebral venous sinus thrombosis.

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