ABSTRACT
Aims: to assess occurrence and clinical correlates of neurogenic heterotopic ossifications (NHO) in patients with prolonged disorder of consciousness (DoC).Design: multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 287 patients with prolonged disorder of consciousness (DoC; 150 in vegetative state, VS, and 128 in minimally conscious state, MCS) of different etiology (vascular = 125, traumatic = 83, anoxic = 56, others = 14).Main Measures: clinical evidence of NHO confirmed by standard radiological and/or sonographic evaluation; Coma Recovery Scale-Revised; Disability Rating Scale (DRS); Early Rehabilitation Barthel Index; presence of ventilator support, spasticity, bone fractures and paroxysmal sympathetic hyperactivity.Results: 31 patients (11.2%) presented NHO. Univariate analyses showed that NHO was associated with VS diagnosis, traumatic etiology, high DRS category and total score, and high occurrence of limb spasticity and bone fractures. A cluster-corrected binary logistic regression model (excluding spasticity available in a subset of patients) showed that only lower DRS total score and presence of bone fractures were independently associated with NHO.Conclusions: NHO are relatively frequent in patients with DoC, and are independently associated with functional disability, bone fractures and spasticity. These findings contribute to identifying patients with DoC prone to develop NHO and requiring special interventions to improve functional recovery.
Subject(s)
Consciousness , Ossification, Heterotopic , Consciousness Disorders/etiology , Cross-Sectional Studies , Humans , Ossification, Heterotopic/etiology , Persistent Vegetative State/etiologyABSTRACT
Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state- MCS) and in different etiologies..Design: Multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury.Main Measures: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications.Results: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology.Conclusion: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.
Subject(s)
Brain Injuries , Consciousness , Consciousness Disorders/etiology , Cross-Sectional Studies , Humans , Persistent Vegetative State/etiologyABSTRACT
El conocimiento de las especies de ectoparásitos presentes en los animales de compañía tiene implicancias tanto en medicina veterinaria como en salud humana, ya que varios agentes tienen la potencialidad de transmitirse del animal al humano y viceversa. Se revisaron 466 garrapatas remitidas al Centro de Investigación en Parasitología Regional (CIPaR) durante los años 2010 y 2013, recolectadas en 217 perros de zonas urbanas de la provincia de Mendoza. El 83,5% (n=385) fueron identificadas como Rhipicephalus sanguineus sensu lato (84 machos y 199 hembras - relación 1:2,37 -, 65 ninfas y 37 larvas), mientras que el 16,5% (n=76) fue identificado como Amblyomma tigrinum (10 machos y 61 hembras - relación 1:6,1 -, y cinco ejemplares adultos en mal estado, imposibilitando su sexado). Adicionalmente, cinco ejemplares adultos sólo se identificaron como pertenecientes al género Amblyomma, ya que por encontrarse ingurgitados no se pudo realizar la determinación de especie. Éste registro es un importante aporte al conocimiento de las especies de garrapatas presentes en perros (Canis familiaris) en la provincia de Mendoza.
Knowledge of the ectoparasitic agents of pets has implications both in veterinary medicine and public health since several agents have the potential to spread from animal to human and vice versa. Ticks sent to the Centro de Investigación en Parasitología Regional (CIPaR) during 2010 to 2013 were analysed. 466 adult ticks were collected from 217 dog in urban areas from Mendoza province, Argentina. Of these, 83.5% (n=385) specimens were identified as Rhipicephalus sanguineus s.l. (84 male and 199 female - ratio 1:2.37 -, 65 nymphs and 37 larvae), while 16.5% (n = 76) were identified as Amblyomma tigrinum (10 males and 61 females - ratio 1:6.1 -, and five adults in bad condition, which precluded their sexing). In addition, five adult specimens, identified as Amblyomma, were not identified to the species level since they were fully engorged. This report is an important contribution to the knowledge of the species of ticks in dogs (Canis familiaris) in the province of Mendoza.
ABSTRACT
The purpose of this paper was to offer a review of the rationale, methods, biological and clinical results of human fetal striatal transplantation (HFST) in the treatment of Huntington's disease (HD). HD is a heritable neurodegenerative disease in which degeneration of neurons in the striatum leads to motor, psychiatric and cognitive deficits. The disease is progressive and inexorably lethal. At present there are no curative treatments for HD. A restorative therapy based on the intrastriatal transplantation of striatal neuroblasts taken from human fetus is currently being explored as potential treatment in selected HD patients. Pilot clinical trials of HFST have been started in few neurosurgery restorative centres. Results demonstrated that HFST is feasible and safe without relevant adverse effects; grafted neuroblasts survive, grow without evidence of neoplasia or teratoma, build new tissue with striatal-like imaging features, and move into the host brain towards short and long-distance cortical and sub-cortical targets. HFST delays disease progression and provides a period of improvement and stability. Even though larger-scale studies are still necessary to establish the true value of such a treatment, at this time, HFST represents a promising experimental therapy for patients with HD and one of the most interesting clinical application of restorative neurosurgery.
