Tacrolimus-Associated Posterior Reversible Encephalopathy Syndrome in Renal Transplant Recipient in Early Posttransplant Period: Case Report.

Posterior reversible encephalopathy syndrome is an emergency medical condition with varied causes presenting as reversible subcortical vasogenic brain edema caused by endothelial injury, resulting from changes in blood pressure or direct effects of cytokines on endothelium. Posterior reversible encephalopathy syndrome is manifested by neurologic symptoms. Common causes include hypertensive emergency, renal disease, preeclampsia, eclampsia, and immunosuppressive drugs. In this case report, a 17-year-old female patient on hemodialysis as a result of lupus nephritis who had previously undergone deceased donor organ transplant and was on triple immunosuppression presented with neurological symptoms of posterior reversible encephalopathy syndrome in the early posttransplant period. She was normotensive, and tacrolimus level was in desired level. She improved after cessation of tacrolimus from immunosuppression with complete resolution of radiological lesions. Posterior reversible encephalopathy syndrome can occur in solid-organ transplant recipients who are on tacrolimus as a part of immunosuppression.

Computational investigation of the impact of potential AT2R polymorphism on small molecule binding.

For more than a century, the renin-angiotensin system (RAS) has been acknowledged for playing a crucial part in the physiological control of arterial pressure, as well as sodium and fluid balance. It is now generally acknowledged that one of the receptor of RAS system i.e. angiotensin type 2 receptor (AT2R) functions as a repair system during pathophysiologic circumstances and performs a significant protective role. Efforts have been made previously to design suitable agonist and antagonist molecules to potentially modulate AT2R. One of the agonists and antagonists, named C21 and EMA401, has been studied in a number of pathological conditions. Additionally, a wide panel of single nucleotide polymorphisms (SNPs) has been reported for AT2R, which might potentially affect the efficacy of these molecules. Therefore, computational investigations have been carried out to analyze all the SNPs (1151) reported in NCBI to find potential SNPs affecting the active site of AT2R, as this domain is still unexplored. Structures of these polymorphic forms were modeled, and in silico drug interaction studies with C21 and EMA401 were carried out. The two mutants (rs868939201 and rs1042852794) that significantly affect the binding affinity as that of the wild type were subjected to molecular dynamics simulations. Our analysis of native and mutant AT2R and their complexes with C21 and EMA401 indicated that the occurrence of these mutations affects the conformation of the protein and has affected the binding of these ligand molecules. The study's findings will aid in the development of better, more versatile medications in the near future, and also in vitro and in vivo studies might be planned in accordance with recent findings.Communicated by Ramaswamy H. Sarma.

Migration Study of Dielectrophoretically Manipulated Red Blood Cells in Tapered Aluminium Microelectrode Array: A Pilot Study.

Dielectrophoresis (DEP) is one of the microfluid-based techniques that can manipulate the red blood cells (RBC) for blood plasma separation, which is used in many medical screening/diagnosis applications. The tapered aluminium microelectrode array (TAMA) is fabricated for potential sensitivity enhancement of RBC manipulation in lateral and vertical directions. In this paper, the migration properties of dielectrophoretically manipulated RBC in TAMA platform are studied at different peak-to-peak voltage (Vpp) and duration supplied onto the microelectrodes. Positive DEP manipulation is conducted at 440 kHz with the RBC of 4.00 ± 0.2 µm average radius attracted to the higher electric field intensity regions, which are the microelectrodes. High percentage of RBC migration occurred at longer manipulation time and high electrode voltage. During DEP manipulation, the RBC are postulated to levitate upwards, experience the electro-orientation mechanism and form the pearl chains before migrating to the electrodes. The presence of external forces other than the dielectrophoretic force may also affect the migration response of RBC. The safe operating limit of 10 Vpp and manipulation duration of ≤50 s prevent RBC rupture while providing high migration percentage. It is crucial to define the safe working region for TAMA devices that manipulate small RBC volume (~10 µL).

A scoping review on the relationship between mental wellbeing and medical professionalism.

BACKGROUND: Mental wellbeing issues among medical students are common, and their relationship to medical professionalism is debated. Few studies have attempted to link such issues with undergraduate medical education. This review aimed to advance the knowledge on this matter by exploring the relationship between mental wellbeing and medical professionalism in undergraduate medical education. METHODS: We collected the literature about mental wellbeing and medical professionalism (published from 1 January 1986 to 31 March 2021) from the Web of Science, PubMed, Scopus and ScienceDirect databases using the search terms 'mental wellbeing' and 'medical professionalism'.We included all peer-reviewed articles in which mental wellbeing and medical professionalism in the undergraduate medical education context were the central topics regardless of the age range, nationality, race and gender of the participants. RESULTS: From the 13,076 Iinitially found articles, 16 were included. These 16 articles were from nine countries in four different continents, which all together helped us find answer to our research question using extracted points relating to the main study themes (mental wellbeing and medical professionalism). Under theme 1 (mental wellbeing), six subthemes emerged: burnout, stress, depression, disappointment, depersonalisation and conscientiousness. Theme 2 (medical professionalism), on the other hand, had five subthemes: empathy, academic performance, compassion, unprofessional behaviour and professionalism. A significant inverse association was found between empathy and burnout. Academic performance was also related to burnout. At the same time, empathy was found to have a varied association with stress. Moreover, compassion was found to alleviate burnout and nurture professional gratification. CONCLUSION: The medical professionalism attributes were found to deteriorate as the mental wellbeing issues grow. This can harm medical students' overall health, current learning abilities and future attitudes towards their patients. Explicit primary research is thus required to examine and intervene in the cause-effect relationship between medical professionalism and mental wellbeing.

A Novel Method for Rubidium Bulb Bonding and Key Characterization for Future Space Clocks.

RF-discharge lamp is a key component in space- and ground-based compact and portable atomic clocks, such as rubidium atomic frequency standards (RAFSs). Precise thermal, structural design, and control of a rubidium (Rb) bulb is of crucial importance for long-term reliable operation of the onboard clocks. An important aspect is the potting material that is used to mount the Rb bulb. Potting material directly determines the thermal contact between liquid Rb pool inside glass bulb enclosure and the heating element, which is the only path to control the Rb bulb's temperature. Failure or degradation of thermal contact of the Rb bulb with its metallic base will lead to Rb clock degradation or failure. Considering this, we have successfully designed, simulated, implemented, characterized, and tested the use of indium metal as a replacement to epoxy for the Rb bulb bonding that can be implemented in future space Rb atomic clocks. Its thermal advantage over other routine space-qualified epoxies and flexibility for multiple bonding and unbonding mechanisms make it ideal for such applications. The usefulness of key properties of indium for various other space and ground applications is discussed.

Effective coping strategies utilised by medical students for mental health disorders during undergraduate medical education-a scoping review.

BACKGROUND: Coping denotes cognitive, emotional and behavioural struggles to tackle a troubled person-environment association. Therefore, coping strategies (CSs) are vital for mental well-being. Widespread research studies have explored this domain, targeting caregivers, nurses, physicians and medical teachers, but limited research has been done to explore the common CSs utilised by medical students at the undergraduate medical education level. Therefore, we aimed to identify the frequently occurring CSs and their effects on mental health disorders (MHDs) through the evidence available in the existing literature. METHODS: For this scoping review, we searched the available literature (articles published from January 1, 1986, to March 31, 2021) on CSs at Google Scholar, PubMed and Scopus using the terms coping, medical students and undergraduate medical education. We included in our search all peer-reviewed journal articles whose central topics were the CSs employed by undergraduate medical students of any age, nationality, race and gender. RESULTS: From among the 2,134 articles that were found, 24 were ultimately included in the study. The articles were authored in 14 countries, allowing us to gather broader data to answer our research question. The first identified theme (MHDs) had four subthemes: stress (55% of the articles), depression (30%), anxiety (25%) and burnout (15%). The second theme (CSs), on the other hand, had eight subthemes: support seeking (60%), active coping (40%), acceptance (40%), avoidance/denial (40%), substance abuse (35%), faith/religion (25%), sports (25%) and miscellaneous (40%). CONCLUSIONS: Themes and subthemes were identified about the most common CSs utilised by undergraduate medical students to tackle common MHDs in the context of medical education. Among the most used CSs was support (social and emotional) seeking. Teaching medical students how to cope with challenging times is essential.

Relationships between Antiretroviral Therapy Adherence with Personality Traits and Presence of Psychological Distress among Adults with Human Immunodeficiency Virus in Northwest Peninsular Malaysia: A Cross-Sectional Study

@#Introduction: Treatment adherence with antiretroviral therapy (ART) and its related factors have hitherto been the subject of clinical concern. However, research focusing on the relationships between ART adherence and the presence of psychological distress and selected personality traits have yet to be concluded. Therefore, our study aimed to remedy this. Methods: A multicentre hospital-based cross-sectional study was conducted in northwest Peninsular Malaysia on HIV outpatients given ART from July 1st, 2018, till April 31st, 2020. Participants were recruited via purposive sampling. Data were collected through an interviewer-guided questionnaires: Hospital Anxiety and Depression Scale (HADS) and Zuckerman-Kuhlman personality test (ZKPQ-M-40-CC), and interviewer-guided Timeline Follow-back (TLFB) for the assessment of adherence to ART. Results: A total of 229 patients completed the study. Majority (n=220, 96.1%) were considered adherent to ART. Among those who were non-adherent, two (22.2%) had anxiety disorder and five (55.6%) had depressive disorder. There was no significant association between treatment adherence and the presence of anxiety nor depression. However, sociodemographic factors determined that age group (p=0.033) and marital status (p=0.044) were significantly associated with treatment adherence. Multivariate analysis determined that ‘Active’ personality trait increases the likelihood to better treatment adherence by 1.14 times (95% CI: 1.02, 1.28, p=0.018). Conclusion: We did not find any association between treatment adherence and the presence of anxiety or depression. However, higher scores in ‘Active’ personality trait increases the likelihood of better treatment adherence among adult HIV on ART.

Knowledge and Attitude towards Dental Unit Waterline System Decontamination among Undergraduate and Postgraduate Dental Students in Universiti Sains Malaysia

@#Introduction: Dental unit waterline system (DUWLS) decontamination is an important infection control in dental practice. This study aimed to determine knowledge and attitude towards DUWLS decontamination and its associated factors among undergraduate and postgraduate dental students in Universiti Sains Malaysia. Methods: A cross-sectional study was conducted using a validated questionnaire administered online using Google Forms to assess the knowledge and attitude of dental students towards DUWLS decontamination. Descriptive and inferential statistics using independent t-test, Pearson, and Spearman correlation were carried out using SPSS version 24.0. Results: A total of 169 dental students participated in the study, and the majority were female (71.6%) and Malay (59.2%). The mean (SD) age was 23.2 (0.93) and 34.4 (2.65), for the undergraduates and postgraduates, respectively. The mean (SD) knowledge scores for the undergraduates and postgraduates were 11.6 (4.23) and 18.0 (2.82), respectively, whereas the mean attitude scores were 51.3 (7.86) and 54.6 (4.74), respectively. The postgraduates had significantly higher mean knowledge and attitude scores than the undergraduates (p<0.001). The significant factors associated with the undergraduates’ knowledge were received information and guidance and their personal experience in managing DUWLS (p<0.05). However, only received information on DUWLS was significantly associated with the postgraduate’s knowledge score (p=0.011). Age factor had a significant association with the attitude score among the postgraduates (p=0.014). Conclusion: The knowledge regarding DUWLS decontamination was relatively moderate in both groups. However, both groups showed a favourable attitude towards DUWLS decontamination. Significantly higher knowledge and attitude scores were presented among the postgraduates than the undergraduates.

Psychological Well-Being of Malaysian University Students during COVID-19 Pandemic: Do Religiosity and Religious Coping Matter?

The COVID-19 pandemic and the restrictions imposed that changed the teaching and learning activities may add a psychological impact to the existing academic stress faced by university students. Past studies have associated low levels of psychological disorder with high religiosity and positive religious coping (RC). This study aimed to determine the level of psychological disorder among university students in Malaysia during the COVID-19 pandemic and measure their association with religiosity and religious coping (RC). An online cross-sectional survey was conducted between March and June 2020 involving 450 students. The survey instruments consisted of sociodemographic proforma, Duke University Religious Index (DUREL) for religiosity, Brief RCOPE Scale for RC and General Health Questionnaire-12 (GHQ-12) for psychological disorder; 36% of the participants experienced psychological disorder. Younger age, being a Muslim, living in the Green/Yellow zone and higher negative RC were significantly associated with psychological disorder. Higher positive RC was found to be protective against psychological disorder. However, the level of religiosity had no significant association with psychological disorder. In conclusion, the level of psychological disorder among university students has been high during the pandemic. Measures and interventions focusing on positive RC and reducing negative RC are recommended to improve the psychological well-being.

Scoping Review of frequently highlighted attributes of Medical Professionalism in an Undergraduate Medical Education Context.

BACKGROUND AND OBJECTIVES: Medical Professionalism (MP) establishes the trust between society and doctors. We aimed at finding frequently highlighted qualities of MP in the literature. METHODS: We searched PubMed and Scopus for attributes of MP, using terms, "Professionalism," "Medical Students," and "Undergraduate Medical Education". We included English language, original research articles with MP attributes from the perspective of undergraduate medical education, any nationality, race, gender, and age range, as the central topic of the article. Papers published from January 1st 1986 to 29th February 2020 were included. RESULTS: From 1349 identified articles, finally, 18 were included, authored in 10 countries, collectively contributing to answering the scoping review question. Two themes were identified: (1) Nurturing of MP, 11 (61.11%) out of 18 included articles, highlighted "respect" as the most dominant attribute as it appeared in 6 (54.55%) out of 11 reviews, "communication" 5 (45.45 %) studies and "honesty" and "integrity" 4 (36.36%). (2) Assessment of MP, 7 (38.89%) studies, and majority, 4 (57.14 %) assessed MP using American Board of Internal Medicine's elements of MP, viz, "altruism, accountability, excellence, duty, honor and integrity, respect for others." CONCLUSIONS: Themes exemplified MP's most discoursed issues. The attributes are frequently used worldwide. MP deliberates as a commitment toward the individual patient, society, and necessitates transforming from its present generic form to more explicit details.

The roles of emotional intelligence, neuroticism, and academic stress on the relationship between psychological distress and burnout in medical students.

BACKGROUND: Stress and burnout commonly threaten the mental health of medical students in Malaysia and elsewhere. This study aimed to explore the interrelations of psychological distress, emotional intelligence, personality traits, academic stress, and burnout among medical students. METHODS: A cross-sectional study was conducted with 241 medical students. Validated questionnaires were administered to measure burnout, psychological distress, emotional intelligence, personality traits, and academic stress, respectively. A structural equation modelling analysis was performed by AMOS. RESULTS: The results suggested a structural model with good fit indices, in which psychological distress and academic stress were noted to have direct and indirect effects on burnout. The burnout levels significantly increased with the rise of psychological distress and academic stress. Neuroticism was only found to have significant indirect effects on burnout, whereby burnout increased when neuroticism increased. Emotional intelligence had a significant direct effect on lowering burnout with the incremental increase of emotional intelligence, but it was significantly reduced by psychological distress and neuroticism. CONCLUSION: This study showed significant effects that psychological distress, emotional intelligence, academic stress, and neuroticism have on burnout. Academic stress and neuroticism significantly increased psychological distress, leading to an increased burnout level, while emotional intelligence had a significant direct effect on reducing burnout; however, this relationship was compromised by psychological distress and neuroticism, leading to increased burnout. Several practical recommendations for medical educators, medical students, and medical schools are discussed.

Clinoptilolite augmented electrocoagulation process for the reduction of high-strength ammonia and color from stabilized landfill leachate.

The high-strength leachate produced from sanitary landfill is a serious issue around the world as it poses adverse effects on aquatic life and human health. Physio-chemical technology is one of the promising options as the leachate normally presents in stabilized form and not fully amendable by biological treatment. In this research, the effectiveness of natural zeolite (clinoptilolite) augmented electrocoagulation process (hybrid system) for removing high-strength ammonia (3,442 mg/L) and color (8,427 Pt-Co) from naturally saline (15 ppt) local landfill leachate was investigated. A batch mode laboratory-scale reactor with parallel-monopolar aluminum electrodes attached to a direct current (DC) electric power was used as an electrocoagulation reactor for performance enhancement purpose. Optimum operational conditions of 146 g/L zeolite dosage, 600 A/m2 current density, 60 min treatment time, 200 rpm stirring speed, 35 min settling duration, and pH 9 were recorded with up to 70% and 88% removals of ammonia and color, respectively. The estimated overall operational cost was 26.22 $/m3 . The biodegradability of the leachate had improved from 0.05 to 0.27 in all post-treatment processes. The findings revealed the ability of the hybrid process as a viable option in eliminating concentrated ammonia and color in natural saline landfill leachate. PRACTITIONER POINTS: Clinoptilolite was augmented on the electrocoagulation process in saline and stabilized landfill leachate (15 ppt). The high strength NH3 -N (3,442 mg/L) and color (8,427 Pt-Co) were 70% and 88% removed, respectively. The optimum conditions occurred at 140 g/L zeolite, 60 mA/cm2 current density, 60 min, and final pH of 8.20. The biodegradability of the leachate improved from 0.05 to 0.27 after the treatment. This hybrid treatment was simple, faster, and did not require auxiliary electrolyte.

The Proportion of Non-retention and Its Associated Factors Among Clients Receiving Methadone Maintenance Therapy in Kelantan, Malaysia

@#Introduction: Methadone maintenance therapy (MMT) requires a client to take a daily dose of methadone to reduce cravings for opioid and suppress withdrawal syndrome. Non-retention in the MMT will seriously expose more risk rather than the benefits of the program. Hence, determining the factors associated with non-retention to the MMT is essential. Thus, the present study was conducted to determine the proportion of non-retention and its associated factors among clients receiving MMT in Kelantan, Malaysia. Methods: By using a retrospective record review analysis, the required information of the clients was obtained from fourteen MMT clinics in Kelantan, Malaysia. A total of 155 clients were selected in this study using systematic random sampling. Multiple logistic regression analysis was performed to determine the factors associated with non-retention among clients receiving MMT. Results: It was found that the proportion of non-retention to the MMT in Kelantan, Malaysia was 21.9%. Clients with advanced age, taking daily direct observed therapy, and no underlying HIV were the predictors of non-retention among clients receiving MMT in Kelantan, Malaysia. Conclusion: The findings highlight a relatively high proportion of non-retention among the MMT clients. There is a need for an integrated, culturally relevant approach towards tackling the factors associated with non-retention in the future to keep this program sustainable and effective.

Rapid, accurate, nucleobase detection using FnCas9

Rapid detection of pathogenic sequences or variants in DNA and RNA through a point-of-care diagnostic approach is valuable for accelerated clinical prognosis as has been witnessed during the recent COVID-19 outbreak. Traditional methods relying on qPCR or sequencing are difficult to implement in settings with limited resources necessitating the development of accurate alternative testing strategies that perform robustly. Here, we present FnCas9 Editor Linked Uniform Detection Assay (FELUDA) that employs a direct Cas9 based enzymatic readout for detecting nucleotide sequences and identifying nucleobase identity without the requirement of trans-cleavage activity of reporter molecules. We demonstrate that FELUDA is 100% accurate in detecting single nucleotide variants (SNVs) including heterozygous carriers of a mutation and present a simple design strategy in the form of a web-tool, JATAYU, for its implementation. FELUDA is semi quantitative, can be adapted to multiple signal detection platforms and can be quickly designed and deployed for versatile applications such as infectious disease outbreaks like COVID-19. Using a lateral flow readout within 1h, FELUDA shows 100% sensitivity and 97% specificity across all range of viral loads in clinical samples. In combination with RT-RPA and a smartphone application True Outcome Predicted via Strip Evaluation (TOPSE), we present a prototype for FELUDA for CoV-2 detection at home. Single sentence summaryA method to identify nucleotide sequence or nucleobase identity using FnCas9 and its implementation in the rapid and accurate diagnosis of SARS-CoV-2

Real-Time Stress Assessment Using Sliding Window Based Convolutional Neural Network.

Mental stress has been identified as a significant cause of several bodily disorders, such as depression, hypertension, neural and cardiovascular abnormalities. Conventional stress assessment methods are highly subjective and tedious and tend to lack accuracy. Machine-learning (ML)-based computer-aided diagnosis systems can be used to assess the mental state with reasonable accuracy, but they require offline processing and feature extraction, rendering them unsuitable for real-time applications. This paper presents a real-time mental stress assessment approach based on convolutional neural networks (CNNs). The CNN-based approach afforded real-time mental stress assessment with an accuracy as high as 96%, the sensitivity of 95%, and specificity of 97%. The proposed approach is compared with state-of-the-art ML techniques in terms of accuracy, time utilisation, and quality of features.

Influence of DRD2 Polymorphisms on the Clinical Outcomes of Opioiddependent Patients on Methadone Maintenance Therapy.

INTRODUCTION: Dopamine receptor D2 (DRD2) is one of the dopamine receptors that have been studied in relation to opioid dependence. It is possible, therefore, that DRD2 gene (DRD2) polymorphisms influence treatment outcomes of patients with opioid dependence. The objective of this study was to investigate the influence of DRD2 polymorphisms on the clinical outcomes of opioid-dependent patients on methadone maintenance therapy (MMT). MATERIALS AND METHODS: Patients with opioid dependence (n = 148) were recruited from MMT clinics. Pain sensitivity, severity of the opiate withdrawal syndrome, and sleep quality were assessed using cold pressor test (CPT), Subjective Opiate Withdrawal Scale (SOWS-M), and Pittsburgh Sleep Quality Index (PSQI)-Malay, respectively. Deoxyribonucleic acid (DNA) was extracted from whole blood, and then was used for genotyping of Val96Ala, Leu141Leu, Val154Ile, Pro310Ser, Ser311Cys, TaqI A, -141C Ins/Del, and A-241G polymorphisms. RESULTS: Among 148 patients, 8.1% (n = 12), 60.8% (n = 90), 27.7% (n = 41), and 29.1% (n = 43) had at least one risk allele for Ser311Cys, TaqI A, -141C Ins/Del, and A-241G polymorphisms, respectively. There were no significant differences in pain responses (pain threshold, tolerance, and intensity), SOWS, and PSQI scores between DRD2 polymorphisms. CONCLUSION: The common DRD2 polymorphisms are not associated with pain sensitivity, severity of the opiate withdrawal syndrome, and sleep quality in patients with opioid dependence on MMT. However, this may be unique for Malays. Additional research should focus on investigating these findings in larger samples and different ethnicity.

Validation of the Malay Version of Mini-IPIP among Substance Use Disorder Patients Attending Methadone Clinics in Malaysia.

There has been an increasing interest in personality study over the years. This has led to the necessity for personality measures with good psychometric properties. However, good personality measures are usually too cumbersome to apply in real practical settings due to their length. This study aims to validate a commonly used short personality measure of the Big Five model, i.e., Mini-IPIP (Mini International Personality Item Pool), which has never been validated and used in the substance abuse population in the local setting. The participants were 239 individuals attending one of the six methadone clinics in Malaysia. Structural analysis was conducted using confirmatory factor analysis. Results showed a good model fit for Mini-IPIP when item-parcelling and adding-in correlated uniqueness items were applied (fit indices: Comparative Fit Index = 0.949, Standardised Root Mean Residual = 0.044). Our study supported the five-factor solution for the Mini-IPIP. It is valid and reliable to be used among individuals with drug abuse in Malaysia.

The effects of foot position on lower extremity kinematics during single leg squat among adolescent male athletes.

OBJECTIVES: The purpose of this study was to investigate the effect of transverse plane foot position on lower limb kinematics during a single leg squat. METHODS: This was a cross-sectional study conducted among highly-trained male athletes. Only participants who showed normal knee valgus during a drop landing screening test were recruited. Twelve junior athletes performed single leg squats while maintaining a knee flexion angle of 60°. The squats were executed in three foot positions: neutral (0°), adduction (-10°), and abduction (+10°). Three-dimensional motion analysis was used to capture the lower extremity kinematics of the participants' preferred limb. The hip and knee kinematics in the sagittal, frontal, and transverse planes during squatting were compared across the three foot positions using one-way ANOVA. RESULTS: The participants showed a normal range of dynamic knee valgus (5.3°±1.6). No statistically significant differences were observed in hip flexion (p = 0.322), adduction (p = 0.834), or internal rotation (p = 0.967) across different foot positions. Similarly, no statistically significant differences were observed in knee flexion (p = 0.489), adduction (p = 0.822), or internal rotation (p = 0.971) across different foot positions. CONCLUSION: Small changes in transverse plane foot position do not affect lower extremity kinematics during single leg squat in highly trained adolescent males with normal dynamic knee valgus. Our findings may provide guidance on safer techniques for landing, pivoting, and cutting during training and game situations.

Neurological Recovery Pattern in Cervical Spondylotic Myelopathy after Anterior Surgery: A Prospective Study with Literature Review.

STUDY DESIGN: Prospective clinical study. PURPOSE: The present study aimed to examine the neurological recovery pattern in cervical spondylotic myelopathy (CSM) after anterior cervical decompression and compare it with the existing reports in the literature. OVERVIEW OF LITERATURE: Neurological recovery and regression of myelopathy symptoms is an important factor that determines the outcomes of surgical decompression. The present findings contribute to the literature on the pattern of neurological recovery and patient prognosis with respect to the resolution of myelopathy symptoms after surgery. METHODS: This prospective study was conducted in Government Medical College in Jammu, North India between November 2012 and October 2014, a total of 30 consecutive patients with CSM were included and treated with anterior decompression and stabilization. They were prospectively followed up for 1 year and were evaluated for their neurological recovery pattern. The postoperative outcome was evaluated using the modified Japanese Orthopaedic Association (mJOA) score. The recovery rate was calculated using Hirabayashi's method. The JOA score was assessed before the operation and postoperatively at 1 week, 2 weeks, 1 month, 3 months, 4 months, 6 months, and 1 year. RESULTS: The postoperative mJOA score was 0 in the 1st month, 12.90±3.57 in the 3rd month, 13.50±3.55 in the 4th month, 14.63±3.62 in the 6th month, and 14.9±3.24 at the final follow-up of 1 year. The average recovery rate during the 1st month followup was 0%, and that during the 3rd month follow-up was 12.91% with a range of 0%-50%. The average recovery rate during the 4th month was 32.5%, with a range of 0%-60%, while that during the 6th month was 72.83%, with a range of 0%-100%. The average recovery rate during the final follow-up of 1 year was 54.3%. CONCLUSIONS: Neurological recovery after surgical decompression starts from the 3rd postoperative month and progresses until the 6th postoperative month; thereafter, it gradually plateaus over the subsequent 6 months until it steadies. Symptom duration is an important factor that requires consideration while determining postoperative neurological recovery.