Manual push technique, an alternative route of subcutaneous immunoglobulin administration in chronic inflammatory demyelinating polyradiculoneuropathy: A proof-of-concept study.

OBJECTIVE: Subcutaneous immunoglobulin (SCIg) administered through infusion pump has been reported as effective in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients. In this study we evaluate an alternative technique of SCIg administration, based on the delivery of lower volumes administered daily using manual push technique (MPT) in 10 CIDP patients. METHODS: In this randomized, controlled, two-arm, crossover clinical trial, CIDP patients were randomly assigned 1:1 to receive SCIg either by MPT or pumps for 4 consecutive months with crossover to the other. The primary objective was to assess whether MPT had the same effectiveness as pumps. The secondary objectives were to assess whether MPT resulted in greater plasma IgG levels and improved quality of life (QoL). RESULTS: Ten patients (mean age = 48.3) were enrolled. No significant changes were observed in the efficacy parameters (INCAT, MRC, R-ODS, and GS scales). A positive mean variation of 5.4 % in plasma IgG levels in the group treated with MPT was observed at the end of MPT periods. Treatment interference, which is one of the dimensions of the Life Quality Index, showed a significant improvement in the MPT periods. CONCLUSION: In CIDP patients, the MPT technique was as effective as pump infusion, allowed comparable, slightly increases plasma IgG levels, and also improved the QoL.

Oral manifestations in drug users: A review.

BACKGROUND: In the dental environment there is not much talk about the oral manifestations resulting from the use of drugs, because in general the issue of drugs is a very difficult subject to deal with. Therefore, the objective of this work is to understand what are the most obvious manifestations in the oral cavity and as the dentist can detect them. MATERIAL AND METHODS: In order to carry out this bibliographical review, a scientific article search was made by consulting the PubMed database. The abstracts were read to recruit only what was consistent with the chosen topic. RESULTS: The 23 sources of information affirmed the relationship between a bad state of general health, and more in the specific, bad state of oral cavity. CONCLUSIONS: The most relevant manifestations were: decay, loss of teeth and precancerous lesions. These manifestations were present in most of the cases studied. All this is a consequence of the drug and the lifestyle acquired by the drug users studied. Key words:Drug, caries, meth mouth, periodontitis, xerostomia.

Feasibility of home exercises to enhance the benefits of tango dancing in people with Parkinson's disease.

BACKGROUND: A style of dance called tango translates clinical practice into a new philosophy and rehabilitative approach for individuals with Parkinson's disease (PD). The style of dance mixes music, self-generated and external cued strategies and social and emotional recovery. In recent years, there has been an increase in the number of studies reporting health benefits for people diagnosed with PD who dance tango. However, there are some organisational limitations to people participating in dance classes, including having trained Tango teachers, an appropriate space for dancing, and schedule that allows for participants with motor inabilities. METHODS: This pilot study involved the observation of PD patients who completed four days of home exercise plus a tango dance lesson each week for five weeks. RESULTS: Ten PD patients improved their quality of life, their motor score on the Unified Parkinson's Disease Rating Scale and their kinematic performances. CONCLUSIONS: We propose a protocol of exercises that has been derived from the tango dance and that can be performed in a patient's home.

Once you feel it, you see it: insula and sensory-motor contribution to visual awareness for fearful bodies in parietal neglect.

The interplay between the neural mechanisms of visual awareness and those involved in emotion processing and the mapping of related somatic changes remains unclear. To address this issue we studied one patient with visual extinction following right parietal damage, in a combined behavioral, psychophysiological and neuroimaging experiment. Patient M.P. was presented with neutral and fearful bodily expressions, either unilaterally in the left (LVF) or right visual field (RVF), or in both visual fields simultaneously. Fearful expressions presented in the left visual field simultaneously with neutral bodies in the RVF were detected more often than left-side neutral bodies. Signal detection analysis showed that the preferential access of fearful bodies to visual awareness is related to higher perceptual sensitivity for these stimuli during attentional competition. Pupil dilation, which indexes autonomic arousal, increased for fearful more than for neutral bodies. Moreover, dilation for extinguished fearful bodies was bigger than for consciously perceived fearful bodies. This decoupling between (increased) arousal and (lack of) conscious visual experience argues against a direct relationship between visual awareness of emotional signals and peripheral changes. Neuroimaging results showed that fearful bodies activated the left amygdala and extrastriate cortex when consciously perceived as well as when extinguished. Critically, however, conscious perception of fearful bodies was uniquely associated with activity in the anterior insula, somatosensory, motor and premotor cortex (PMC), and the cerebellum. This suggests that the integration between peripheral arousal and the moment-to-moment mapping at the central neural level of these bodily changes is critical for the conscious visual experience of emotional signals.

Clinical and electrophysiological correlations in type 2 diabetes mellitus at diagnosis.

The purpose of this study was to evaluate, in newly diagnosed type 2 diabetes mellitus (DM): (1) the prevalence and staging of peripheral neuropathy, as well as its possible relationship with metabolic profile; (2) the clinical value of both the Diabetic Neuropathy Index (DNI) and the Diabetic Neuropathy Score (DNS), and their reciprocal concordance, as a screening method for neuropathy. Thirty-nine newly diagnosed DM subjects underwent: neurological examination, nerve conduction studies (NCS), quantitative sensory system and cardiovascular autonomic function assessments. Peripheral neuropathy was observed in 72% of the subjects (its staging was similar to that of patients with longer disease history), while another 10% of them showed a borderline neuropathy. The Deep Breathing test was abnormal in 28% of the patients; postural hypotension was found in 6%. The same proportion (82%) of subjects who scored positively on the DNI showed altered NCS, while the quantitative sensory system assessments had a low sensitivity in order to detect the neuropathy. No correlation was found between metabolic indexes and DNI/DNS parameters. The high prevalence of peripheral and autonomic function alterations suggests that each newly diagnosed diabetic subject should be screened for neuropathy by the DNI, to reduce the negative prognostic influence of this complication.

Posttraumatic epilepsy: neuroradiologic and neuropsychological assessment of long-term outcome.

PURPOSE: We sought to detect the incidence and the risk factors of posttraumatic epilepsy (PTE) in rehabilitation patients; to define the influence of PTE for late clinical and functional outcome; and to assess the cognitive and behavioral features of the patients with PTE. METHODS: Patients were examined with (a) cognitive and behavioral examinations, which included a clinical interview and psychometric tests performed by an expert clinical psychologist; (b) single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI); and (c) functional evaluation including the Glasgow Outcome Scale (GOS) and the Functional Independence Measure (FIM). RESULTS: Of the 143 patients examined in this study, in 27 (19%), seizures developed after a mean time from trauma of 11.9 +/- 8.6 months. The occurrence of PTE was significantly correlated with the hypoperfusion in temporal lobes (p < 0.004), the degree of hydrocephalus (p < 0.04), the evidence of intracerebral hematoma (p < 0.01), and operative brain injury (p < 0.001). Patients with epilepsy showed a significantly higher incidence of personality disorders than did patients without epilepsy. The uninhibited behavior, irritability, and agitated and aggressive behavior were significantly more frequent and severe in PTE patients. The psychometric tests intended to explore memory, language, intelligence, attention, and spatial cognition did not show any significant difference between those with and without epilepsy. PTE also was significantly correlated with a worse functional outcome 1 year after the trauma. CONCLUSIONS: The degrees of hydrocephalus and of hypoperfusion in the temporal lobes are significant risk factors for late PTE. Another main finding of our study is the absence of influence of epilepsy on cognitive disorders; its influence on neurobehavioral disorders and functional outcome is discussed.