Uhthoff`s phenomenon 125 years later - what do we know today?

125 years have passed since Wilhelm Uhthoff reported the symptoms he observed after an increased body temperature from physical exertion. Those symptoms, which might have led to the transient impairment of vision in patients with Multiple Sclerosis and also observed in optic neuritis, were later named after him "Uhthoff's phenomenon". This has defined the strategy of rehabilitation procedures in Multiple Sclerosis for more than 100 years, restricting the use of thermal treatments and the possibility of aerobic exercises. The current state of knowledge concerning the Uhthoff's phenomenon and its influence on comprehensive rehabilitation in Multiple Sclerosis were presented in the current review report.

Association of seasonal serum 25-hydroxyvitamin D levels with disability and relapses in relapsing-remitting multiple sclerosis.

BACKGROUND/OBJECTIVES: The aim of this study was to evaluate the association of serum 25-hydroxyvitamin D (25(OH)D) with disability and frequency of relapses in relapsing-remitting multiple sclerosis (MS) patients. SUBJECTS/METHODS: The study included 184 patients with relapsing-remitting MS who were receiving immune-modulating drugs and no vitamin D supplementation. The concentration of 25(OH)D was measured in February and August 2014. The level of disability was assessed twice according to the Expanded Disability Status Scale (EDSS). The patients were divided into two groups: EDSS 0.0-2 and 2.5-4. The control group comprised 58 age- and sex-matched healthy subjects. The 25(OH)D levels were compared with the occurrence of relapses and the level of disability. RESULTS: Mean serum 25(OH)D concentrations were significantly lower in winter in both MS patients and controls. Winter level of 25(OH)D was significantly lower in severe MS cases (EDSS 2.5-4.0) than in mild cases (EDSS 0.0-2.0) (P=0.022), and in the controls (P=0.008), especially in females (r=0.38, P=0.0015). Logistic regression analysis showed the winter serum 25(OH)D was significantly associated with MS (odds ratio 0.925; 95% confidence interval, 0.822-0.970). Serum 25(OH)D levels were significantly lower in MS patients with relapses than in those without relapses both in winter, and in summer. CONCLUSIONS: Hypovitaminosis D was more prevalent during winter than summer, both in the sample group and the control, especially in female MS patients with higher levels of disability. Low vitamin D levels are associated with a more severe course of disease and an increased number of relapses.

Déterminants de la réponse à l'intradermoréaction à la tuberculine à Kisangani, RDC

Introduction: Le diagnostic de la primo-infection tuberculeuse de l'enfant est difficile en situation de ressources limitées et c'est généralement à la tuberculine qu'on a recours. Le but de cette étude est de déterminer les facteurs qui peuvent influencer la réponse positive de l'intradermoréaction à la tuberculine en situation d'endémie Matériel et Méthode: Etude transversale analytique réalisée à Kisangani du 05 mars 2012 au 27 décembre 2013 chez 593 enfants d'âge compris entre 6 mois et 15 ans suivis au «Village de Pédiatrie». Chacun a subi l'intradermoréaction à la tuberculine et la lecture était faite 72 heures après. Le Chi-carré de tendance et le Test exact de Ficher, où c'est approprié, ont été utilisés Résultat: A Kisangani, le taux de prévalence de l'intradermoréaction positive (IDR+) s'élève à 31,53%. Il est identique dans les deux sexes. Celui-ci décroit significativement avec l'âge (p<0,0002): 38,0% entre 6 et 11mois, 26,4% entre 12 et 24mois, 21,4% entre 6 et 10ans puis remonte à partir de 11ans (47,0%). La positivité de l'IDR augmente avec la notion de BCG dans 69,7% de cas (p<0,0017) et avec la notion de contage tuberculeux (p<0,006) Conclusion: A Kisangani, le taux de prévalence de l'intradermoréaction positive est similaire à celui décrit en situation d'endémie. Le taux de positivité décroit avec l'âge. La cicatrice BCG et la notion de contage augmentent la positivité de l'IDR+

Clinimetric measurement in traumatic brain injuries.

Traumatic brain injury is a leading cause of death and disability worldwide. Every year, about 1.5 million affected people die and several millions receive emergency treatment. Most of the burden (90%) is in low and middle-income countries. The costs of care depend on the level of disability. The burden of care after traumatic brain injury is caused by disability as well as by psychosocial and emotional sequelae of injury. The final consequence of brain injury is the reduction of quality of life. It is very difficult to predict the outcome after traumatic brain injury. The basic clinical model included four predictors: age, score in Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. These are the neuroradiological markers of recovery after TBI (CT, MRI and PET) and biomarkers: genetic markers of ApoE Gene, ectoenzyme CD 38 (cluster of differentiation 38), serum S100B, myelin basic protein (MBP), neuron specific endolase (NSE), and glial fibrillary acidic protein (GPAP). These are many clinimetric scales which are helpful in prognosing after head injury. In this review paper, the most commonly used scales evaluating the level of consciousness after traumatic brain injury have been presented.

Activities of daily living and quality of life in Alzheimer disease.

Alzheimer's disease is known for placing a significant burden on caregivers, which includes social, psychological, physical or economic aspects. The disease decreases patients' capacity for activities of daily living and quality of life. Information about functional status is useful in the interpretation of the quality of life assessment results. In this paper the most commonly used scales evaluating activities of daily living and quality of life in Alzheimer's disease, either generic or specific, is presented.

Quality of life in Parkinson's disease.

In this review report, current possibilities of evaluation of quality of life in Parkinson's disease have been critically presented. Health Related Quality of Life (-HRQoL) comprises a wide spectrum of consequences of the disease. Measurement of quality of life has become increasingly relevant as an outcome parameter, especially in long-term trials. Most of the available QoL instruments depend on patient self-reports. The data can be collected by written questionnaires. There are universal questionnaires of QoL--for many diseases and the specific ones--specially created for one disease. Among universal questionnaires, the Sickness Impact Profile (SIP) and the Short-Form Health Status Survey (SF-36) are the most popular in Parkinson's disease. As for specific questionnaires: the Parkinson`s Disease Questionnaire (PDQ-39) and the Parkinson's Disease Quality of Life Questionnaire (PDQL) have been described.

EFNS guideline on diagnosis and management of post-polio syndrome. Report of an EFNS task force.

Post-polio syndrome (PPS) is characterized by new or increased muscular weakness, atrophy, muscle pain and fatigue several years after acute polio. The aim of the article is to prepare diagnostic criteria for PPS, and to evaluate the existing evidence for therapeutic interventions. The Medline, EMBASE and ISI databases were searched. Consensus in the group was reached after discussion by e-mail. We recommend Halstead's definition of PPS from 1991 as diagnostic criteria. Supervised, aerobic muscular training, both isokinetic and isometric, is a safe and effective way to prevent further decline for patients with moderate weakness (Level B). Muscular training can also improve muscular fatigue, muscle weakness and pain. Training in a warm climate and non-swimming water exercises are particularly useful (Level B). Respiratory muscle training can improve pulmonary function. Recognition of respiratory impairment and early introduction of non-invasive ventilatory aids prevent or delay further respiratory decline and the need for invasive respiratory aid (Level C). Group training, regular follow-up and patient education are useful for the patients' mental status and well-being. Weight loss, adjustment and introduction of properly fitted assistive devices should be considered (good practice points). A small number of controlled studies of potential-specific treatments for PPS have been completed, but no definitive therapeutic effect has been reported for the agents evaluated (pyridostigmine, corticosteroids, amantadine). Future randomized trials should particularly address the treatment of pain, which is commonly reported by PPS patients. There is also a need for studies evaluating the long-term effects of muscular training.

[Possibilities of subjective and objective evaluation of spasticity]. / Mozliwosci subiektywnej i obiektywnej oceny spastycznosci.

In this paper the most commonly used methods of assessment patients with spasticity has been presented. "Measuring" of spasticity is necessary for evaluation of new methods of treatment. This could be made directly or indirectly--in that case the sequela of spasticity is measured. In this elaboration as well subjective as objective methods of examination in spasticity has been described. The tone intensity scales, spasm frequency scores, global scales of motor impairment, ADL scales, upper extremity dexterity and strength testing, examination techniques and maneuvers to differentiate rectus femoris from iliopsoas and gastrocnemius from soleus tightness, clinical gait scores, EMG and goniometric pendulum test has been mentioned.

[Possibilities of objective evaluation of treatment and rehabilitation effects after the stroke]. / Mozliwosci obiektywnej oceny wyników leczenia i rehabilitacji chorych po udarze mózgowym.

The development of scoring scales has been initiated because of the need of documentation of results as well treatment as rehabilitation of stroke hemiplegic patients. Directly after onset at stroke unit there is demand for defining of prognosis. In rehabilitation the interest in stroke scales has been aroused from the need of evaluation of functional state (activities of daily living), disability, handicap, quality of life, statement of capacity for work or need of home-care. For evaluation of outcome after rehabilitation the most usefull seem to be functional scales (ADL) and quality of life measures (QOL). It is also suitable to mention the scales that evaluate motor function--those functions are the most important task in poststroke rehabilitation.

Prediction of pharmacokinetic parameters and the assessment of their variability in bioequivalence studies by artificial neural networks.

PURPOSE: The methodology of predicting the pharmacokinetic parameters (AUC, cmax, tmax) and the assessment of their variability in bioequivalence studies has been developed with the use of artificial neural networks. METHODS: The data sets included results of 3 distinct bioequivalence studies of oral verapamil products, involving a total of 98 subjects and 312 drug applications. The modeling process involved building feedforward/backpropagation neural networks. Models for pharmacokinetic parameter prediction were also used for the assessment of their variability and for detecting the most influential variables for selected pharmacokinetic parameters. Variables of input neurons based on logistic parameters of the bioequivalence study, clinical-biochemical parameters, and the physical examination of individuals. RESULTS: The average absolute prediction errors of the neural networks for AUC, cmax, and tmax prediction were: 30.54%, 39.56% and 30.74%, respectively. A sensitivity analysis demonstrated that for verapamil the three most influential variables assigned to input neurons were: total protein concentration, aspartate aminotransferase (AST) levels, and heart-rate for AUC, AST levels, total proteins and alanine aminotransferase (ALT) levels, for cmax, and the presence of food, blood pressure, and body-frame for tmax. CONCLUSIONS: The developed methodology could supply inclusion or exclusion criteria for subjects to be included in bioequivalence studies.

["Repty" stroke scale . "Repty" Scale for the evaluation of the degree of injury after cerebral stroke. Part I]. / Skale udarów "Repty". Skala "Repty" dla oceny stopnia uszkodzenia mózgu po udarze. Czesc I.

Own modification of stroke scale, which enables evaluation of impairment in hemiplegic patients is presented. The scale named "Repty" consists of 15 items, including bowel and bladder function, enables precise evaluation of neurological impairments. The comparison between "Repty" scale and Orgogozo scale was carried out. Interobserver agreement and correlation between both scales was calculated.

["Repty" scales of strokes. Functional index "Repty" for the evaluation of ADL in hemiplegic patients after cerebral stroke. Part II]. / Skale udarów "Repty". Wskaznik funkcjonalny "Repty" dla oceny czynnosci zycia codziennego u chorych z niedowladem polowiczym po udarze mózgowym. Czesc II.

Own modification of the Functional Independence Measure, which enables evaluation of activities of daily living in hemiplegic stroke patients is presented. The index of function "Repty", shorter and simpler, consists of 15 items, and makes possible exact estimation of functional state. This is useful in evaluation of the effects of treatment, and rehabilitation, and state of disability as well. The advantage of the "Repty" index over Barthel index results from evaluation of verbal communication and more extended scoring system.

[Comprehensive rehabilitation of multiple sclerosis patients]. / Kompleksowa rehabilitacja chorych ze stwardnieniem rozsianym.

Rehabilitation of Multiple Sclerosis patients is one of the most specific problems because of its variable and unforeseeable course. Rehabilitation procedures of those patients must be performed individually and very elastic in every case. In this elaboration the most commonly appeared forms and course of MS have been presented. According to it the planing of the rehabilitation has been adapted. Basic rules of the exercises during the relapse and during the remission have been presented. The greatest attention has been paid to the problems of managing spasticity and the reeducation of neurogenic bladder.

[Clinimetrics in parkinsonism]. / Klinimetria w parkinsonizmie.

Clinimetrics, which has been developed beginning from stroke scales, nowadays is used in evaluation of many other diseases. It is needed as well for evaluation of impairment and functional state as for clinical assessment of new drugs. Lately one can observe shifting of attention to psychosocial issues. In this paper the most commonly used scales for evaluation of impairment, activities in daily living and quality of life in parkinsonism have been critically presented. Those scales are reliable and valid in the assessment of treatment, prognosis, classification of invalidity and social care decisions.

The deadly quartet--the insulin resistance syndrome.

BACKGROUND: Obesity, non-insulin-dependent diabetes mellitus, hypertension, and dyslipidemia (syndrome X, "the deadly quartet") are common metabolic disorders that predispose to early cardiovascular disease. We examine the relationship between insulin resistance and the deadly quartet and address therapeutic implications. METHODS: We review the literature on insulin resistance, using MEDLINE files from 1975 to the present. Fifty references were reviewed. RESULTS: Insulin resistance consists of a cluster of disorders and biochemical abnormalities. We discuss the mechanisms responsible for the defects in insulin-mediated glucose utilization, as well as the relation of insulin resistance to obesity, hypertension, and dyslipidemia. We review the current strategies used in light of this pathophysiologic approach. CONCLUSIONS: This extremely common syndrome contributes excessively to mortality and morbidity of millions of Americans and generates enormous costs to the health care system. Better molecular understanding of insulin resistance is leading to improved treatment of all components of the syndrome.

Factors associated with elective Norplant removal in black and white women.

Premature removal of contraceptive implants (Norplant [levonorgestrel implants], Wyeth-Ayerst Laboratories, Philadelphia, Pennsylvania) is a cause of a sizable national medical expenditure in the United States. Understanding the factors that influence the decision to remove the implants and being able to predict which users are likely to elect discontinuation prematurely could provide useful information for counseling patients as they are considering contraceptive implants so that potentially enormous long-term savings could be achieved. This study surveyed 98 women who had Norplant inserted and removed between January 1991 and December 1994. Data were collected from chart review, and when necessary, a questionnaire was used to extract information not found in the chart. The chi-squared statistic and t-test were used to compare demographic variables. All but one subject received comprehensive pre-implant counseling. The main reason given for electively removing the Norplant prematurely was irregular menstrual bleeding (60%). Pre-implant counseling did not influence the decision for removal. These results indicate the importance of clarifying patients' doubts regarding menstrual bleeding irregularities during follow-up visits rather than relying on the information patients received during preimplant counseling.

PIP: Premature removal of contraceptive implants (Norplant) is a cause of a sizable national medical expenditure in the US. Understanding the factors that influence the decision to remove the implants and being able to predict which users are likely to elect discontinuation prematurely could provide useful information for counseling patients as they are considering contraceptive implants so that potentially enormous long-term savings could be achieved. This study surveyed 98 women who had Norplant inserted and removed between January 1991 and December 1994. Data were collected from chart review, and, when necessary, a questionnaire was used to extract information not found in the chart. The chi-squared statistic and t-test were used to compare demographic variables. All but one subject received comprehensive pre-implant counseling. The main reason given for electively removing the Norplant prematurely was irregular menstrual bleeding (60%). Pre-implant counseling did not influence the decision for removal. These results indicate the importance of clarifying patients' doubts regarding menstrual bleeding irregularities during follow-up visits rather than relying on the information patients received during pre-implant counseling.

[Functional marker "Repty" for evaluation of independence in patients with paraplegia]. / Wskaznik funkcjonalny "Repty" dla oceny samodzielnosci chorych z paraplegia.

The use of "Repty" index for functional assessment of treatment results in 40 patients with paraplegia aged 13-65 (mean 37) is presented. The outcome has been compared with Barthel Index- the oldest scale assessing activities of daily living. High correlation of both scales sensitivity was found; in some functional parameters "Repty" index was more sensitive.