Metabolic control of type 1 diabetes in youth with autism spectrum disorder: A multicenter Diabetes-Patienten-Verlaufsdokumentation analysis based on 61 749 patients up to 20 years of age.

BACKGROUND: A paucity of reports in the literature exists concerning the co-existence between autism spectrum disorder (ASD) and type 1 diabetes (T1D). OBJECTIVE: To compare clinical characteristics, diabetes management and metabolic control in youth with T1D and ASD (T1D-ASD) with youth without ASD (T1D-non ASD). METHODS: Using the German/Austrian diabetes patient follow-up registry, this study analyzed aggregated data from the last available year of observation for each patient with T1D, ages 1-20 with consistent data on insulin regimen and glycated hemoglobin (A1C), between January, 2005 and March, 2017. RESULTS: From 61 749 patients, 150 (0.24%) were identified as T1D-ASD. Non-adjusted comparisons showed similar results for mean age at onset and duration of diabetes, but not for gender (male: T1D-ASD: 85.3%; T1D-non ASD: 52.8%; P < .001). Unadjusted comparisons showed no difference for severe hypoglycemia, diabetic ketoacidosis, insulin doses, insulin pump therapy, and body mass index. A statistical difference was observed for A1C (P-value .01) and in the number of blood glucose (SMBG) tests/day (median [interquartile range]: T1D-ASD 6.0 [4.4-7.0]; T1D-non ASD 5.0 [4.4-7.0]; P-value < .001). After adjusting for age, gender, duration of diabetes, and year of observation, only SMBG remained significant (P-value .003). T1D-ASD used psycho-stimulants (15.3% vs 2.2%; P-value < .001), antipsychotics (10.7% vs 0.6%; P-value < .001), and antidepressive medications (3.6% vs 0.7%; P-value < .001) more frequently. CONCLUSION: Metabolic control was similar in the T1D-ASD group compared to T1D-non ASD despite their comorbidity. Awareness of ASD remains important in T1D treatment, as both conditions require long-term multi-disciplinary medical follow-up for optimal outcomes.

Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale.

STUDY DESIGNS: Longitudinal and correlational study with repeated measures. OBJECTIVES: The aim of this study was to test the concurrent validity of the Berg Balance Scale (BBS) for a spinal cord injury (SCI) population. PARTICIPANTS: A total of 32 individuals with an ASIA D SCI walking 10 m independently, with or without walking assistive devices. SETTING: An intensive rehabilitation center in Montréal, Canada. METHODS: Subjects were evaluated on the BBS, the Walking Index for Spinal Cord Injury (WISCI II), the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), the 10-m walk test (10MWT) and the Timed Up and Go (TUG). Individuals were reassessed during rehabilitation when progressing to a device providing less support or to unassisted gait. RESULTS: All walking tests were highly correlated with the BBS (0.714

Introduction of the multiple mini interview into the admissions process at the University of Calgary: acceptability and feasibility.

The MMI was introduced into the medical admissions process at the University of Calgary (UofC) in 2006. This report outlines the steps which were involved in its development and our evaluation of the process. The MMI allowed us to interview applicants in one weekend, with fewer interviewers and less time required per interviewer compared to our previous interview process. Most importantly, more than 90% of both the applicants and interviewers found the process to be very acceptable. This process allowed us to ensure that the interview process focused on the non-cognitive traits we are looking for in the students we admit to the UofC.

What do nurses and residents know about childhood asthma?

OBJECTIVES: To assess residents' and pediatric nurses' basic knowledge of childhood asthma and to identify areas needing educational reinforcement. DESIGN: Survey using a validated self-administered questionnaire containing 25 true-false and six short open-ended questions. PARTICIPANTS: Pediatric residents and family medicine residents who were on rotation at a tertiary care pediatric hospital over a six-month period, and pediatric nurses on duty in the emergency department, on the wards and on the pediatric intensive care unit over a month period. RESULTS: The participation rate was 80% (28 of 35) of pediatric residents, 89% (33 of 37) of family medicine residents, and 50% (81 of 163) of pediatric nurses. The mean score (+/- standard deviation) on the 31-point questionnaire was 27.7+/-1.8 for pediatric residents, 25.5+/-3.6 for family medicine residents, and 22.3+/-3.8 for pediatric nurses (ANOVA, P<0.001). Most (at least 75%) participants correctly identified bronchospasm and airway inflammation as two potential mechanisms of asthma and were able to list three routinely used drugs to treat exacerbations. However, 32% of pediatric residents, 12% of family medicine residents and 72% of pediatric nurses failed to identify all three main symptoms of asthma (wheezing, cough, dyspnea). Although most participants recognized that children with frequent exacerbations should receive prophylactic therapy, 25% of pediatric residents, 52% of family medicine residents and 81% of pediatric nurses were unable to name at least two preventive asthma medications. More than 50% of participants could not name two drugs used in the prevention of exercise-induced asthma. CONCLUSIONS: Residents and nurses had adequate basic knowledge of the treatment of acute exacerbations. However, most individuals needed reinforcement in preventive asthma therapy and daily management.

Description of a new motor re-education programme for the paretic lower limb aimed at improving the mobility of stroke patients.

OBJECTIVE: To describe and examine the feasibility of a new treatment approach for the paretic lower limb and to explore its effectiveness in one chronic hemiparetic stroke subject. DESIGN: Case report. The treatment was conducted three times per week over a period of six weeks. The mobility of the patient was assessed prior to the treatment, at the end of the treatment and at a six-week follow-up. SETTINGS: The study was carried out at the research centre of the Institut de réadaptation de Montréal. The treating therapist was an experienced rehabilitation professional as was the assessor, who worked at a different rehabilitation centre. INTERVENTIONS: The motor re-education programme was based on the use of a static dynamometer that measures the linear external forces produced at the ankle level. A computer program provided the subject with constant feedback on the direction and intensity of the applied force. In each treatment session, the subject was asked to produce several submaximal efforts in 16 specific directions. Both the intensity and the number of repetitions were gradually increased. OUTCOME MEASURES: In addition to force production measurements, three clinical assessments of mobility were used: the Timed 'Up and Go', the comfortable gait speed and a 2-minute walk test. RESULTS: The maximal static linear forces produced by the subject increased through the treatment for all directions of effort, but differences were observed amongst directions. During the treatment programme, the subject improved his performance at the three clinical assessments. Even if some of the functional gain was lost at the follow-up, the mobility was still considerably improved as compared to baseline values. CONCLUSION: This study demonstrated the applicability of the treatment programme to a stroke subject. The results seem very promising and encourage further investigation in order to assess more rigorously the effectiveness of this new approach.

A motor reeducation program aimed to improve strength and coordination of the upper limb of a hemiparetic subject.

The objective of the study is to describe a new reeducation program based on a multi-directional and multi-articular dynamometer and to evaluate its applicability in one chronic right hemiparetic subject. The treatment sessions lasted 1 h and were conducted three times per week for a period of 8 weeks. During these sessions, the subject was asked to exert 10 repetitions of 16 torque combinations exerted at the shoulder, elbow and forearm or combined with handgrip exertion. The sequence of torques and force progressed from proximal to distal joints, and were realized in and out of the typical 'synergy patterns' described in this population. In addition, the levels of torque and force requested were increased progressively throughout the treatment period. The coordination of both upper extremities, tested using the finger to nose test, and the dexterity of the affected side, evaluated using the Box and Blocks assessment, tended to improve as treatments progressed. These results indicate the feasibility of this approach and suggest that it may be worthwhile examining the effectiveness of this approach on improving the functional performance of the upper extremity in a larger population of hemiparetic subjects.

Hyperammonemia-hyperornithinemia-homocitrullinuria syndrome: neurologic, ophthalmologic, and neuropsychologic examination of six patients.

We report the clinical, electrophysiologic, ophthalmologic, and neuropsychologic features of six patients with hyperammonemia-hyperornithinemia-homocitrullinuria syndrome, an inborn error of ornithine metabolism. Pyramidal signs, decreased vibration sense, bucco-facio-lingual dyspraxia, and learning difficulties or subnormal intelligence were found in the majority. Anomalies of peripheral nerve conduction velocity and of evoked potentials were common, and one patient had markedly abnormal white matter images on cranial magnetic resonance imaging. One patient had retinal depigmentation and chorioretinal thinning. The clinical severity varied greatly among patients; in general, the three younger patients had less neurologic and intellectual impairment than did the three older patients. Only two of our patients have had episodes of symptomatic hyperammonemia. We conclude that hyperammonemia-hyperornithinemia-homocitrullinuria syndrome can be associated with widespread manifestations in the central and peripheral nervous systems. Although the control of hyperammonemia is an essential element in the treatment of these patients, the relationship of hyperammonemia to the chronic neuropsychologic problems of these patients is unclear.