Efficacy and Safety of Mirabegron Add-on Therapy After Failure With Solifenacin in Multiple Sclerosis Patients With Overactive Bladder: A Pilot Study.

OBJECTIVES: Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative progressive disease of central nervous system that mostly affects young adults. (1) Because of involvement of spinal cord and brain, lower urinary dysfunction symptoms are commonly encountered. MS patients mostly show overactive bladder symptoms like urgency, frequent daytime urination, and urgency incontinence. Among MS patients, antimuscarinic therapy is the first-line treatment with overactive bladder symptoms as well as in general population yet 30% of the patients show insufficient improvement or intolerance to the treatment (2). In our study, our aim is to evaluate the efficacy and safety of mirabegron add-on treatment in MS patients after inadequate response to antimuscarinic monotherapy. METHODS: University of Kyrenia and Dr Burhan Nalbantoglu State hospital's databases were screened for the study. Seventy patients who were residents diagnosed with MS according to McDonald criteria were questioned. Among these patients, a total of 22 of them were included in the study. Inclusion criteria was at least 3 years of MS diagnosis, score of <6 at Expanded Disability Status Scale, and a score of ≥3 at Overactive Bladder Symptom Score Scale. RESULTS: Among selected patients, 10 mg solifenacin treatment was daily started and followed for 4 weeks. Mirabegron add-on treatment was initiated to the 11 patient who had inadequate improvement in overactive bladder symptom score. After mirabegron add-on treatment among 11 patient, there was a sufficient improvement in overactive bladder symptom score (P < 0.008). CONCLUSIONS: In our study, we have found that antimuscarinic and mirabegron combination causes improved efficacy for overactive bladder in MS population.

Comparison of SARS-CoV-2 anti-spike receptor binding domain IgG antibody responses after CoronaVac, BNT162b2, ChAdOx1 COVID-19 vaccines, and a single booster dose: a prospective, longitudinal population-based study.

BACKGROUND: Vaccination is an efficient strategy to control the COVID-19 pandemic. In north Cyprus, vaccine distribution started with CoronaVac followed by BNT162b2, and ChAdOx1 vaccines. An option to obtain a third booster dose with BNT162b2 or CoronaVac was later offered to people fully inoculated with CoronaVac. There are few simultaneous and comparative real-world antibody data for these three vaccines as well as boosters after CoronaVac vaccination. Our study was aimed at evaluating antibody responses after these vaccination schemes. METHODS: We did a prospective, longitudinal population-based study to measure SARS-CoV-2 anti-spike receptor binding domain (RBD) IgG concentrations, assessed by assaying blood samples collected, in participants in north Cyprus who had received the BNT162b2, ChAdOx1, or CoronaVac vaccine at 1 month and 3 months after the second dose. Participants were recruited when they voluntarily came to the laboratory for testing after vaccination, solicited from health-care access points, or from the general population. We also evaluated antibody responses 1 month after a booster dose of BNT162b2 or CoronaVac after primary CoronaVac regimen. Demographics, baseline characteristics, vaccination reactions, and percentage of antibody responders were collected by phone interviews or directly from the laboratory summarised by vaccine and age group. Antibody levels were compared between groups over time by parametric and non-parametric methods. FINDINGS: Recruitment, follow-up, and data collection was done between March 1 and Sept 30, 2021. BNT162b2 induced the highest seropositivity and anti-spike RBD IgG antibody titres, followed by ChAdOx1, and then by CoronaVac. In addition, the rate of decline of antibodies was fastest with CoronaVac, followed by ChAdOx1, and then by BNT162b2. For the older age group, the rate of seropositivity at 3 months after the second dose was 100% for BNT162b2, 90% for ChAdOx1, and 60% for CoronaVac. In the multivariate repeated measures model, lower antibody titres were also significantly associated with male sex, older age, and time since vaccination. Boosting a two-dose CoronaVac regimen at 6 months with a single BNT162b2 dose led to significantly increased titres of IgG compared with boosting with CoronaVac; for the 60 years and older age group, the geometric mean fold rise in antibody titre after the booster relative to 1 month post-baseline was 7·9 (95% CI 5·8-10·8) in the BNT162b2 boost group versus 2·8 (1·6-5·0) in the CoronaVac group. INTERPRETATION: These longitudinal data can help shape vaccination strategies. Given the low antibody titres and fast decline in the CoronaVac group in individuals 60 years or older, more potent vaccine options could be considered as the primary vaccination or booster dose in these high-risk populations to sustain antibody responses for longer. FUNDING: Crowdfunded in north Cyprus.

Effect of clinical Pilates training on balance and postural control in patients with Parkinson's disease: a randomized controlled trial.

Background: Clinical pilates exercises have been shown to improve balance. Our study aims to compare effects of clinical Pilates and conventional physiotherapy exercises on balance and postural control in Parkinson's disease patients. Materials & methods: Forty patients were randomly assigned into either clinical Pilates (CLP) or conventional physiotherapy (COP) group. Exercises were performed twice a week for 8 weeks. Balance, lower-extremity strength, fall risk and functional mobility were assessed at the beginning and end of the exercise period. Results: All measurements indicated significant increase in two groups (p < 0.05). Compared with the COP group, the CLP group showed significant improvement in dynamic balance values (p < 0.05). Conclusion: CLP was as effective as COP, with better dynamic balance results, and could be used in rehabilitation for patients with Parkinson's disease. Clinical trial registration number: NCT04063605.

The effect of clinical pilates-based physiotherapy program for a Stiff Person Syndrome patient: a case report.

The aim of the present report is to show the effects of a clinical pilates-based physiotherapy training program on physical functioning, including balance ability, flexibility, muscle strength, and pain severity in a case with Stiff Person Syndrome (SPS). A 43-year-old female with a 3-year history of SPS participated in the study. Clinical pilates training exercises were performed two times per week during 8 weeks. Static balance was evaluated with One Leg Stance Test and Tandem Stance Test, dynamic balance with Functional Reach Test and lower extremity strength and endurance measured by 30-s Chair Stand Test. Berg Balance Scale was used to assess balance and fall risk, and Timed Up and Go Test was used to assess functional mobility. Pain evaluation was done by Pain Quality Assessment Scale. Flexibility was measured with tape measure, range of motion with goniometer and muscle strength with manual muscle test. Among the balance and functional mobility tests, progress has been observed in all tests, except for 30-s Chair Stand test. Improvements have been observed in patient's range of motion, flexibility, strength, pain and balance parameters. Clinical pilates-based physiotherapy program had positive effects on many physical and functional parameters of the patient and can be used as a safe exercise method in physiotherapy rehabilitation of SPS.

Evaluation of respiratory functions and quality of life in multiple sclerosis patients.

The aim of this study was to evaluate respiratory muscle strength, respiratory functions and quality of life in multiple sclerosis (MS) patients and compare the results with the healthy volunteers. The study included a group of 24 patients diagnosed with MS (16 women, 8 men) with an EDSS score of ≤ 5, who were without clinical respiratory impairment. MS patients were compared with the healthy volunteer group (16 women, 8 men). Respiratory muscle strength and respiratory functions were evaluated with specific devices. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) parameters were measured for the muscle strength. Forced vital capacity (FVC), forced expiratory volume (FEV1), FEV1/FVC, peak expiratory flow, and forced expiratory flow (FEF25-75) parameters were measured for the respiratory functions. Questionnaire SF-36 was applied to evaluate health-related quality of life. A total of 24 MS patients' respiratory function test results were compared with healthy volunteers and significant changes were found at MIP, MEP, and FEV1 parameters. Quality of life was compared between the groups and there was a significant difference in parameters related with physical performance and physical-health-related role limitations. There is an early involvement of the respiratory muscles in patients with MS, yet clinical symptoms appear in later stages. Respiratory functions should be evaluated at the earlier stage of the disease so that rehabilitation can be planned in order to reduce respiratory complications and improve the quality of life in patients.

Sudden onset of oromandibular dystonia after cerebellar stroke.

BACKGROUND: We present the case of a 65-year-old female with sudden-onset involuntary mouth opening, deviation of the jaw, facial grimacing, and tongue movements that started 6 months prior to her admission. CASE REPORT: She was diagnosed with oromandibular dystonia. Differential diagnosis of oromandibular dystonia and various etiologies were investigated. Neuroimaging studies revealed a left cerebellar infarction. DISCUSSION: To our knowledge, this case is the first oromandibular dystonia presenting with cerebellar ischemic stroke. Possible roles of the cerebellum for the pathophysiology of oromandibular dystonia are discussed.

A case of traumatic bilateral abducens and unilateral hypoglossal nerve palsy.

PATIENT: Female, 47 FINAL DIAGNOSIS: Traumatic bilateral abducens • unilateral hypoglossal nerve palsy SYMPTOMS: Diplopia Medication: - Clinical Procedure: - Specialty: Neurology Objective: Rare disease. BACKGROUND: Incidence of unilateral abducens palsy from head trauma has been reported to be as high as 1% to 2.7%, but bilateral abducens nerve palsy is extremely rare. CASE REPORT: We present a case in which bilateral abducens nerve and unilateral hypoglossal nerve palsy developed with a high Glasgow Coma Score (GCS) 3 hours after head trauma due to a motor vehicle crash. CONCLUSIONS: This case highlights the occurrence and management of posttraumatic bilateral sixth nerve palsy.

Pupillary Involvement in Miller Fisher Syndrome.

Miller Fisher Syndrome is characterised by the classical triad of ophthalmoplegia, ataxia, and areflexia. Ophthalmoparesis without ataxia, without areflexia, or with neither have been attributed as atypical forms of MFS. We report two patients with MFS who had tonic pupils and raised anti-GQ1b antibody titres. Bilateral dilated pupils (either tonic or fixed) can be a manifestation of MFS and anti-GQ1b immunoglobulin G (IgG) antibodies are useful to confirm the diagnosis in unexplained cases. The site of involvement is thought to be the ciliary ganglion or short ciliary nerves.

An unusual case of neurobrucellosis presenting with unilateral abducens nerve palsy: clinical and MRI findings.

Brucellosis is an endemic zoonotic disease in which neurobrucellosis occurs in 5-10% of cases. Variable clinical and radiological manifestations of neurobrucellosis can mimic those of other diseases. In this report, we present unusual clinical and magnetic resonance imaging (MRI) findings in a patient with neurobrucellosis and unilateral abducens nerve palsy. Her MRI showed punctate leptomeningeal enhancement of the cerebellum on contrast-enhanced T1-weighted images, and a focal area of hyperintensity in the splenium of the corpus callosum on T2-weighted images.