Comorbidities and COVID-19 hospitalization, ICU admission and hospital mortality in Austria : A retrospective cohort study.

BACKGROUND: The protection of vulnerable populations is a central task in managing the Coronavirus disease 2019 (COVID-19) pandemic to avoid severe courses of COVID-19 and the risk of healthcare system capacity being exceeded. To identify factors of vulnerability in Austria, we assessed the impact of comorbidities on COVID-19 hospitalization, intensive care unit (ICU) admission, and hospital mortality. METHODS: A retrospective cohort study was performed including all patients with COVID-19 in the period February 2020 to December 2021 who had a previous inpatient stay in the period 2015-2019 in Austria. All patients with COVID-19 were matched to population controls on age, sex, and healthcare region. Multiple logistic regression was used to estimate adjusted odds ratios (OR) of included factors with 95% confidence intervals (CI). RESULTS: Hemiplegia or paraplegia constitutes the highest risk factor for hospitalization (OR 1.61, 95% CI 1.44-1.79), followed by COPD (OR 1.48, 95% CI 1.43-1.53) and diabetes without complications (OR 1.41, 95% CI 1.37-1.46). The highest risk factors for ICU admission are renal diseases (OR 1.76, 95% CI 1.61-1.92), diabetes without complications (OR 1.57, 95% CI 1.46-1.69) and COPD (OR 1.53, 95% CI 1.41-1.66). Hemiplegia or paraplegia, renal disease and COPD constitute the highest risk factors for hospital mortality, with ORs of 1.5. Diabetes without complications constitutes a significantly higher risk factor for women with respect to all three endpoints. CONCLUSION: We contribute to the literature by identifying sex-specific risk factors. In general, our results are consistent with the literature, particularly regarding diabetes as a risk factor for severe courses of COVID-19. Due to the observational nature of our data, caution is warranted regarding causal interpretation. Our results contribute to the protection of vulnerable populations and may be used for targeting further pharmaceutical interventions.

Alternating Hemiplegia of Childhood: neurological comorbidities and intrafamilial variability.

BACKGROUND: Alternating of Childhood (AHC) is an uncommon and complex disorder characterized by age of onset before 18 months with recurrent hemiplegia of one or either sides of the body or quadriplegia. The disorder is mainly caused by mutations in ATP1A3 gene, and to a lesser extent in ATP1A2 gene. In AHC neurological co-morbidities are various and frequently reported including developmental delay, epilepsy, tonic or dystonic spells, nystagmus,autonomic manifestations with intrafamilial variability. CASE PRESENTATION: Clinical and genetic findings of a couple of twins (Family 1: Case 1 and Case 2) and a couple of siblings (Family 2: Case 3 and Case 4) coming from two different Italian families affected by AHC were deeply examined. In twins of Family 1, a pathogenic variant in ATP1A3 gene (c.2318A>G) was detected. In siblings of Family 2, the younger brother showed a novel GRIN2A variant (c.3175 T > A), while the older carried the same GRIN2A variant, and two missense mutations in SCNIB (c.632 > A) and KCNQ2 (1870 G > A) genes. Clinical manifestations of the four affected children were reported along with cases of AHC drawn from the literature. CONCLUSIONS: Hemiplegic episode is only a sign even if the most remarkable of several and various neurological comorbidities in AHC affected individuals. Molecular analysis of the families here reported showed that clinical features of AHC may be also the result of an unexpected genetic heterogeneity.

Comprehensive Exonic Sequencing of Hemiplegic Migraine-Related Genes in a Cohort of Suspected Probands Identifies Known and Potential Pathogenic Variants.

Hemiplegic migraine (HM) is a rare migraine disorder with aura subtype including temporary weakness and visual, sensory, and/or speech symptoms. To date, three main genes-CACNA1A, ATP1A2, and SCN1A-have been found to cause HM. These encode ion channels or transporters, important for regulating neuronal ion balance and synaptic transmission, leading to HM being described as a channelopathy. However, <20% of HM cases referred for genetic testing have mutations in these genes and other genes with roles in ion and solute transport, and neurotransmission has also been implicated in some HM cases. In this study, we performed whole exome sequencing for 187 suspected HM probands referred for genetic testing, but found to be negative for CACNA1A, ATP1A2, and SCN1A mutations, and applied targeted analysis of whole exome sequencing data for rare missense or potential protein-altering variants in the PRRT2, PNKD, SLC1A3, SLC2A1, SLC4A4, ATP1A3, and ATP1A4 genes. We identified known mutations and some potentially pathogenic variants in each of these genes in specific cases, suggesting that their screening improves molecular diagnosis for the disorder. However, the majority of HM patients were found not to have candidate mutations in any of the previously reported HM genes, suggesting that additional genetic factors contributing to the disorder are yet to be identified.

Acute hemiplegia: aetiology and outcome in Nigerian children.

INTRODUCTION: acute hemiplegia of childhood is a postnatally acquired nonspecific clinical response of the brain to various aetiological insults in a child who was neurologically normal at birth. This study aims at evaluating the aetiology and outcome of acute hemiplegia in children admitted into the University of Calabar Teaching Hospital (UCTH), Nigeria. METHODS: a 5-year retrospective review of all children admitted to the Neurology Unit of the Department of Paediatrics of UCTH with a diagnosis of acute hemiplegia. The demographic characteristics of the children and the clinical features were noted. Investigations including neuroimaging of the brain and haemoglobin genotype were documented. The outcomes of the patients were recorded as either dead, recovered with deficit or loss to follow up. Data obtained was analysed using the SPSS version 24. Simple tables were used to display the results in number and percentages. RESULTS: twenty-five children with diagnosis of hemiplegia were admitted. Associated clinical features were prolonged seizures (68%), speech defect (32%), cranial nerve deficit (36%) and loss of consciousness (12%). Viral encephalitis was the common aetiology in 11(44%) of the patients, followed by meningitis and sickle cell anaemia in 6(24%) patients each. Four(16%) of the patients recovered completely within the follow up period of three month, 19(76%) had varying degrees of weakness; 2(8%) died. Twelve (48%) were lost to follow-up. CONCLUSION: central nervous system infections and sickle cell disease as dominant aetiological factors of acute hemiplegia in Nigerian children. This calls for effective infection control and genetic counselling.

Incidence, Prevalence, and Risk Factors of Hemiplegic Shoulder Pain: A Systematic Review.

The current systematic review aimed to investigate the incidence, prevalence, and risk factors causing hemiplegic shoulder pain (HSP) after stroke. Two independent authors screened titles and abstracts for the eligibility of the included studies in the electronic databases PubMed and Web of Science. Studies which reported the incidence, prevalence, and risk factors of HSP following stroke were included. The included studies were assessed using the Newcastle-Ottawa Scale for evaluating the quality of nonrandomized studies in meta-analyses. Eighteen studies were included in the final synthesis. In all studies, the number of patients ranged between 58 and 608, with the mean age ranging from 58.7 to 76 years. Seven included studies were rated as "good "quality, while one study rated "fair" and 10 studies rated "poor" quality. Eight studies reported incidence rate while 11 studies reported the prevalence of HSP following a stroke. The incidence of HSP was ranging from 10 to 22% in the metanalysis of the included studies. The prevalence of HSP was ranging from 22 to 47% in the metanalysis of the included studies. The most significant predictors of HSP were age, female gender, increased tone, sensory impairment, left-sided hemiparesis, hemorrhagic stroke, hemispatial neglect, positive past medical history, and poor National Institutes of Health Stroke Scale score. The incidence and prevalence of HSP after stroke vary considerably due to various factors. Knowledge of predictors is important to minimize the risk of developing HSP following a stroke.

Interrelated Pathogenesis? Neuronal Intranuclear Inclusion Disease Combining With Hemiplegic Migraine.

BACKGROUND: Neuronal intranuclear inclusion disease (NIID) is considered a heterogeneous disease because of its highly variable clinical manifestations. To date, there are no reports of NIID patients presenting with hemiplegic migraine (HM)-like headache, or of HM and NIID co-occurring as comorbidity, and the connection between these 2 seemingly unrelated clinical conditions has yet to be established. METHOD: We present a patient with NIID who was previously diagnosed with HM. To determine the pathogenesis of HM in this NIID patient, we systematically reviewed published NIID and HM cases and cataloged them based on their clinical manifestations. RESULT: The clinical manifestations of NIID is highly various; however, there is no case reported to date that shows HM-like symptoms or cerebral edema. All documented symptomatic HM cases show vascular dysfunction to various degrees, but none of them has been shown to be correlated with NIID. CONCLUSION: Our patient is the first documented case in which HM and NIID occur simultaneously. Vascular dysfunctions that cause cerebral hypoperfusion and glucose hypometabolism, two of the dominant causes of symptomatic HM, may be associated with the accumulation of eosinophilic hyaline inclusions that cause NIID. However, the existence of inclusions may also alter neuronal behavior and indirectly cause cerebral hypoperfusion and glucose hypometabolism. Further research and observations are needed to examine the relationship between HM and NIID.

Terapia de movimiento inducido por restricción en hemiplejía infantil. Revisión sistemática de la literatura / Constraint induced movement therapy in the hemiplegic child. Systematic Review

Objetivos: Analizar la literatura científica actual disponible sobre la terapia de movimiento inducido por restricción en niños con hemiplejía y determinar la calidad metodológica de los estudios incluidos en esta revisión. Material y métodos: Revisión sistemática de la literatura científica publicada en los últimos 5 años en las bases de datos Medline (a través de Pubmed), la Biblioteca Cochrane y PEDro entre los meses de febrero y marzo de 2018. Se utilizó la escala PEDro para valorar la calidad metodológica de los ensayos clínicos y la escala AMSTAR para valorar las revisiones. La mayoría de los estudios incluían diferentes variables de resultado empleadas para medir la efectividad de esta terapia, siendo el incremento de la funcionalidad del miembro superior el objetivo general de todos ellos. Resultados: Se seleccionaron 14 estudios: 7 ensayos clínicos aleatorizados, una revisión sistemática, 4 estudios piloto, un estudio exploratorio de diseño aleatorizado y un ensayo clínico no controlado que cumplían con los criterios de inclusión. La puntuación media obtenida según la escala PEDro para valorar la calidad metodológica de los ensayos clínicos y estudios piloto fue 5/10. La revisión presentó una calidad de 7/11 según la escala AMSTAR. Conclusiones: La efectividad de la terapia de movimiento inducido por restricción parece tener su base en la alta intensidad de esta, y no en la aplicación de un método restrictivo en el MS menos afecto del niño con hemiplejía. Sería conveniente crear un híbrido entre la terapia de movimiento inducido por restricción y la terapia bimanual para obtener mejores resultados

Objectives: To analyse the currently available scientific literature on constraint-induced movement therapy in children with hemiplegia, and to determine the methodological quality of the studies included in this review. Material and methods: Systematic Review of the scientific literature published during the past 5 years in the Medline databases (through PubMed), the Cochrane Library, and PEDro between the months of February and March 2018. The PEDro scale was used to assess the methodological quality of the clinical trials, and the AMSTAR (A Measurement Tool to Assess Systematic Reviews) scale to assess the reviews. Most studies included different variables used to measure the effectivity of this therapy, with improving the functionality of the upper limb being the main aim in all of them. Results: Of the 14 studies selected, 7 were randomised clinical trials, 1 systematic review, 4 pilot studies, 1 randomised design exploratory study, and 1 uncontrolled clinical trial that met the inclusion criteria. The mean score obtained according to the PEDro scale to assess the methodological quality of the clinical trials and pilot studies was 5/10. The review had a quality of 7/11 according to the AMSTAR scale. Conclusions: The effectiveness of constraint-induced movement therapy seems to be based on the high intensity of its use, and not on the application of a constraint method in the less affected upper limb of the child with hemiplegia. It would be convenient to create a hybrid between constraint-induced movement therapy and bimanual therapy to obtain better results

Leptomeningeal Enhancement Is Associated with Transient Neurologic Deficits after Flow Diversion of Intracranial Aneurysms.

OBJECTIVE: To evaluate the relationship between blood-brain barrier disruption and transient neurologic deficits (TNDs) after neuroendovascular interventions (NEIs) using postcontrast T2/FLAIR (pcFLAIR) imaging. METHODS: This is a prospective study of 41 consecutive patients undergoing flow diversion therapy for unruptured aneurysm treatment. Patients underwent postprocedural magnetic resonance imaging within 24 hours of the procedure, including diffusion-weighted imaging (DWI) and pcFLAIR sequences. Regression analyses were performed to identify risk factors for developing TNDs. RESULTS: In total, 13 patients (31.7%) developed neurologic complications ranging from visual field defects to dense hemiplegia. All deficits were transient, resolving spontaneously within 72 hours. Five of 13 patients (38.5%) with TNDs had presence of lesions on DWI whereas the remaining 8 patients (61.5%) did not. In contrast, all patients who developed TNDs had leptomeningeal enhancement on pcFLAIR imaging, and no patient with normal pcFLAIR imaging developed TNDs. Regression analysis revealed the extent of pcFLAIR enhancement is associated with development of postprocedure neurologic deficits (P < 0.0001). Video electroencephalography monitoring was performed in 4 symptomatic patients manifesting severe deficits. In all instances electroencephalography demonstrated ipsilateral hemispheric slowing and eventual resolution corresponding to ensuing clinical improvement. Only 1 of these 4 patients presented with a lesion on DWI. CONCLUSIONS: This study challenges conventional dogma that TNDs are ischemic in etiology and suggests blood-brain barrier impairment may be a potential alternative mechanism. These findings are applicable to stroke and other reversible neurologic diseases.

Outcomes of Rotator Cuff Repair in Patients with Comorbid Disability in the Extremities.

BACKGROUND: Rehabilitation and overuse of the shoulder after rotator cuff repair are a concern in patients with comorbid disability in other extremities. Improvement of outcomes can be hampered in this situation. This study was to describe the clinical outcomes of rotator cuff repair in patients with comorbid disability in other extremities. METHODS: In two tertiary institutions, 16 patients with comorbid disability (9 men and 7 women; mean age of 57.1 years [range, 45 to 71 years]; 14 dominant arms; mean follow-up of 18 months [range, 12 to 38 months]) underwent rotator cuff repair. There were 5 massive tears, 1 large tear, 9 medium tears, and 1 small tear. Open repair was performed in 3 patients and arthroscopic repair in 13. The most common comorbid condition was paralysis (n = 7). Eight patients walked with crutches preoperatively. Anatomical outcome was investigated in 12 patients using either magnetic resonance imaging or ultrasonography at least 6 months postoperatively. RESULTS: Range of motion, visual analogue scale for pain and satisfaction, and all functional scores improved significantly. Healing failure occurred in 4 patients (2 large-to-massive and 2 medium size tears), but none required revision surgery. All 4 retears involved the dominant side, and 3 patients were crutch users. CONCLUSIONS: The current data suggested favorable outcome of rotator cuff repair in patients with comorbid disability. Careful surgical planning and rehabilitation is particularly important for crutch users and in the case of dominant arm involvement in disabled patients.

Prevalence of anxiety disorder in patients with type 2 diabetes: a nationwide population-based study in Taiwan 2000-2010.

This study investigates the prevalence of anxiety disorder (AD) in Taiwanese patients with type 2 diabetes (T2D). Study participants were identified based on at least one service claim for ambulatory or inpatient care with a principal diagnosis of AD and at least 2 service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of T2D, as listed in the National Health Insurance database of Taiwan. The prevalence of AD decreased from 13.75 to 11.00 % in patients with T2D, whereas it increased from 4.17 to 6.09 % in the general population during the 2000-2010 period. A high prevalence of AD in patients with T2D was associated with age >30 years, the female sex, living in the northern region, comorbidities of congestive heart failure, peripheral vascular disease, cerebrovascular disease, and depression disorder, and a Charlson participant comorbidity index of ≥1. A low prevalence of AD in patients with T2D was associated with residency in urban areas, the comorbidity of hemiplegia or paraplegia, the usage of metformin and sulfonylureas, and rapid-acting insulin injection therapy. The prevalence of AD was higher in patients with T2D than in the general population. Therefore, more public health emphasis is required for preventing and treating AD in patients with T2D, specifically those with the mentioned risk factors.

Prevalence of Genu Recurvatum during Walking and Associated Knee Pain in Chronic Hemiplegic Stroke Patients: A Preliminary Survey.

BACKGROUND: Although genu recurvatum during walking is a well-known issue in stroke rehabilitation, there are no reliable epidemiological data on its prevalence. The aim of the study was to investigate the prevalence of genu recurvatum during walking and associated knee pain among ambulatory community-dwelling patients with chronic hemiplegic stroke. METHODS: Questionnaires were sent to physical therapists working at 223 adult day care facilities in Chiba Prefecture, Japan. The number of all chronic stroke patients attending the day care who could walk without human assistance, including those who used a walking aid and/or an orthosis; the number of patients with genu recurvatum in the paretic limb during walking; and the number of patients with genu recurvatum who had experienced any knee pain in the last month were investigated. Physical therapists were also asked whether they considered genu recurvatum in stroke patients to be problematic. RESULTS: Sixty-four facilities (28.7%) responded, providing data on 1110 ambulatory stroke patients, of whom 217 (19.5%) showed genu recurvatum. Of the patients with genu recurvatum, 25 (11.5%) experienced knee pain in the paretic limb. Of 45 physical therapists who gave an opinion on whether genu recurvatum was problematic, 26 (57.8%) thought it was problematic whereas 19 thought it was not problematic. CONCLUSION: Rates of genu recurvatum and associated knee pain were relatively low among ambulatory community-dwelling stroke survivors attending adult day care.

Tibial somatosensory evoked potential can prognosticate for ambulatory function in subacute hemiplegic stroke.

Early prediction of expected recovery in stroke can help in planning appropriate medical and rehabilitation interventions. Recovery of ambulation is one of the essential endpoints in stroke rehabilitation. However, the correlation of somatosensory evoked potentials (SSEP) with clinical parameters and their predictive significance are not clearly defined. We aimed to examine the association between tibial nerve SSEP and ambulatory outcomes in subacute hemiplegic stroke patients. We reviewed medical records for hemiplegic patients with first-ever stroke who received inpatient rehabilitation from January 2009 to May 2013. We excluded patients with diabetes mellitus, quadriplegia, bilateral lesions, brainstem lesions, those aged over 80 years, and those with severe musculoskeletal problems. Tibial nerve SSEP were performed when they were transferred to the rehabilitation department. SSEP findings were divided into three groups; normal, abnormal and absent response. Berg balance scale and functional ambulation category (FAC) at discharge were compared with initial tibial SSEP findings using one-way analysis of variance. Thirty-one hemiplegic patients were included. Berg balance scale and FAC were significantly different according to the SSEP (P<0.001). Post hoc analysis showed a significant difference between normal and absent response in Berg balance scale (P<0.001) and FAC (P<0.001), and between abnormal and absent response in Berg balance scale (P=0.012) and FAC (P=0.019). Functional outcomes of the normal response group were better than the abnormal response group, but there was no statistical significance. These findings suggest that initial tibial nerve SSEP may be a useful biomarker for prognosticating functional outcomes in hemiplegic patients.

[Common factors for ischemic cerebral stroke in coronary artery bypass grafting in patients with concomitant carotid and coronary artery severe stenosis].

OBJECTIVE: To analyze two common factors for perioperative ischemic stroke in patients with concomitant carotid and coronary artery severe stenosis and to improve the therapeutic effect.
 Methods: A total of 44 patients with multi-vessel coronary artery disease combined with carotid stenosis, who admitted to the Department of Cardiac Surgery, the First Affiliated Hospital of Xiamen University from 2008 to 2014, were enrolled in this study. Among them, 32 cases were male, 12 cases was female. All patients received coronary artery bypass grafting after treatment of neck diseases. The surgical outcomes and follow-up results were analyzed retrospectively.
 Results: One patient received carotid endarterectomy suffered hemiplegia, whose symptoms were improved after positive clinical treatment. One patient suffered transient ischemic attack, and 5 patients displayed the cerebrovascular syndromes a week later after surgery. Twelve patients suffered nerve function damage 48 hours later after surgery. Nine patients received intra-aortic ballon pump, 1 patient received thoracotomy hemostasis, 3 patients suffered sternal dehiscence; 27 patients showed atrial fibrillation. Two patients died after surgery. The follow-up duration ranged from 1-7 years and the follow-up rate was 90%. The ischemic symptoms were improved in 44 patients. Six patients complained the recurrence of angina, but no abnormalities were found in coronary angiography or computed tomography angiography. One patient died of malignant tumor during the follow-up duration.
 Conclusion: For patients with concomitant carotid and coronary artery severe stenosis, it is more likely to suffer ischemic cerebral stroke. However, carotid stenosis is not the only factor, other key factors relevant to ischemic cerebral stroke shouldn't be ignored either.

Merging and Fractionation of Muscle Synergy Indicate the Recovery Process in Patients with Hemiplegia: The First Study of Patients after Subacute Stroke.

Loss of motor coordination is one of the main problems for patients after stroke. Muscle synergy is widely accepted as an indicator of motor coordination. Recently, the characteristics of muscle synergy were quantitatively evaluated using nonnegative matrix factorization (NNMF) with surface electromyography. Previous studies have identified that the number and structure of synergies were associated with motor function in patients after stroke. However, most of these studies had a cross-sectional design, and the changes in muscle synergy during recovery process are not clear. In present study, two consecutive measurements were conducted for subacute patients after stroke and the change of number and structure of muscle synergies during gait were determined using NNMF. Results showed that functional change did not rely on number of synergies in patients after subacute stroke. However, the extent of merging of the synergies was negatively associated with an increase in muscle strength and the range of angle at ankle joint. Our results suggest that the neural changes represented by NNMF were related to the longitudinal change of function and gait pattern and that the merging of synergy is an important marker in patients after subacute stroke.

Outcomes of endovascular occlusion and stenting in the treatment of carotid blowout.

BACKGROUND AND PURPOSE: Carotid blowout is a life threatening complication of invasive head and neck cancers and their treatments. This is commonly treated with endovascular embolization and carotid stenting. Using the Nationwide Inpatient Sample, we report the immediate clinical results of patients receiving embolization and/or stenting for treatment of carotid blowout associated with head and neck cancer. MATERIALS AND METHODS: Using the Nationwide Inpatient Sample from the period 2003-2011, we defined carotid blowout patients as those with head and neck malignancies receiving carotid stenting and/or endovascular embolization without open surgery. Outcomes studied included mortality, acute ischemic stroke, hemiplegia/paresis, and other post-operative neurologic complications. Outcomes for the endovascular embolization and carotid stenting group were compared. RESULTS: A total of 1218 patients underwent endovascular treatment for carotid blowout. Of these, 1080 patients (88.6%) underwent embolization procedures and 138 patients (11.4%) underwent carotid stenting. The mortality rate of endovascular embolization patients was similar to that of carotid stenting patients (8.0%, 95% confidence interval (CI) = 6.5%-9.7% versus 10.2%, 95% CI=6.0%-16.4%, p = 0.36). Stroke rate was similar between embolization patients and stenting patients (2.3%, 95% CI=1.6%-3.4% vs. 3.4%, 95% CI=1.3%-8.4%, p = 0.43). Hemiplegia rates were significantly higher rate in stenting patients compared with endovascular occlusion patients (3.8%, 95% CI=1.3%-8.4% vs. 1.4%, 95% CI=1.4%-2.4%, p = 0.05). The rate of post-operative neurologic complications was higher in stenting patients compared with embolization patients (6.5%, 95% CI=3.3%-12.1% vs. 1.4%, 95% CI=0.9%-2.4%, p < 0.0001). CONCLUSIONS: Given the natural history of carotid blowout, carotid stenting and endovascular embolization are acceptable means of treating this disease. Endovascular embolization remains the most common treatment among patients with head and neck cancers with lower overall rates of post-operative neurologic complications, including hemiplegia/paresis and stroke.

Clinical characteristics of patients with asymptomatic intracranial meningiomas and results of their surgical management.

Surgery performed during the asymptomatic phase of meningioma remains controversial. The effects of surgery and the factors associated with postsurgical complications and patient prognosis were studied to optimize surgical decisions for clinicians who treat asymptomatic patients. The medical records of 513 patients with meningiomas (112 patients were asymptomatic) treated at our hospital from May 2007 to April 2012 were retrospectively reviewed. The results were analyzed with univariate and multivariate analyses. Asymptomatic meningiomas were characterized by a more common cerebral hemispheric location, a smaller size, and a lack of peritumoral edema. A significantly higher Simpson I resection rate of 95.2 % was achieved in tumors located in the cerebral hemisphere; in contrast, a rate of 66.7 % was obtained in tumors located at the skull base (P = 0.003). The overall postsurgical complication rate was 13.6 %, which was lower than the rate of 21.7 % in the symptomatic patients. Hemiplegia was the most common complication, which occurred most often in the patients with tumors in parietal locations (P = 0.015). Ninety-two percent of the asymptomatic patients achieved a Glasgow Outcome Scale (GOS) score of 5 1 year after the operation, and significantly more patients younger than 60 years of age obtained a GOS score of 5 compared with patients older than 60 years of age (P = 0.006). To achieve maximal tumor resection and good patient recovery, tumor location and patient age should be carefully considered prior to choosing to perform surgery in asymptomatic patients.

Afecciones Morfofisiológicas más frecuentes asociadas al uso prematuro del bastón en pacientes hemipléjicos / Most frequent morphophysiologic affections associated to the premature use of the cane in hemiplegic patients

Se realizó un estudio analítico-transversal en el Policlínico René Vallejo Ortíz de Bayamo con el objetivo de analizar las afecciones morfo- fisiológicas más frecuentes asociadas al uso prematuro del bastón en pacientes hemipléjicos. En los resultados obtenidos se pudo observar que en la etapa de rehabilitación de la marcha que más incidencia hubo, fue en la coordinación simple (2da etapa) con un 55 por ciento (6 pacientes) de una muestra de 11, con predominio en el sexo masculino con 4 pacientes - 36.6 por ciento, en cuanto a la postura la línea de gravedad más afectada fue desde la vista anterior con 7 para un 64 por ciento, apreciándose una desviación de esta hacia el lado sano cayendo entre este y el bastón disminuyendo la funcionabilidad del lado afectado, 5 de estos pacientes son totalmente dependientes del bastón para la marcha (45.4 por ciento), en cuanto a la biomecánica de la marcha se puede observar que todos los patrones se afectan en estrecha relación con la postura del paciente. El uso prematuro del bastón provoca alteraciones de la simetría, dependencia del bastón para la marcha así como alteraciones de la biomecánica para la misma, lo que entorpece el proceso de rehabilitación de dichos pacientes(AU)

It was performed a transversal- analytical study at René Vallejo Ortiz Polyclinic in Bayamo with the purpose to analyze the most frequent morphophysiologic affections associated to the premature use of the cane in hemiplegic patients. In the results obtained it was observed that in the rehabilitation stage there was more incidence in the simple coordination (2nd stage) with a 55 percent (6 patients) in a sample of 11, prevailing the male sex with 4 patients - 36.6 percent, regarding the position the most affected line of gravity was from the previous sight with 7 for 64 percent, appreciating a deviation to the healthy side, between this one and the cane, diminishing the functionality of the side affected, 5 of these patients were totally dependent of the cane to walk (45.4 percent), regarding the biomechanics it could be observed that all of the patterns were affected in relation with the position of the patient. The premature use of the cane causes alterations of the symmetry, dependency of the cane to walk as well as alterations of the biomechanics, what difficult the rehabilitation process of the patient(EU)

Antihypertensive medication adherence and mortality according to ethnicity: a cohort study.

BACKGROUND: Few studies have evaluated adherence to antihypertensive medication in Chinese and South Asian populations and little is known about the long-term outcome. Our objectives were to compare adherence to antihypertensive medications and assess the association of adherence and long-term mortality in Chinese, South Asian, and white patients with newly diagnosed hypertension. METHODS: We conducted a retrospective cohort study of patients with hypertension who were new users of antihypertensive medications (1997-2005) using administrative data and a province-wide prescription database from British Columbia, Canada. Antihypertensive medication adherence within 1 year from the date of the first antihypertensive drug prescription was assessed using the 'proportion of days covered' metric. Proportion of days covered ≥ 80% indicated optimal adherence. Patients were followed for up to 10 years for mortality. RESULTS: There were 16,471 (11.1%) Chinese, 6099 (4.1%) South Asian, and 126,081 (84.8%) white patients who were prescribed antihypertensive medications. Compared with white patients, Chinese (odds ratio, 0.69; 95% confidence interval [CI], 0.67-0.72) and South Asian patients (odds ratio, 0.38; 95% CI, 0.36-0.40) were less likely to be optimally adherent to antihypertensive medications. Optimal adherence was associated with reduced mortality in white patients (risk-adjusted hazard ratio [aHR], 0.89; 95% CI, 0.85-0.93) but not associated with mortality in Chinese (aHR, 0.98; 95% CI, 0.83-1.17) and South Asian patients (aHR, 1.10; 95% CI, 0.84-1.44). CONCLUSIONS: Chinese and South Asian patients with newly diagnosed hypertension were significantly less likely to adhere to antihypertensive medications than their white counterparts. However, optimal adherence in Chinese and South Asian patients was not associated with mortality.

Heart rate variability in children with cerebral palsy: review of the literature and meta-analysis.

OBJECTIVE: A systematic review which aims to assess the evidence regarding the function of the autonomic heart rate regulation system among children with cerebral palsy (CP). METHODS: The target population included children with CP of diverse severity, aged 1.5 to 18 years. Databases searched for English language studies from 1960 to 2013: PubMed, EMBASE, CINAHL, Cochrane Library, The Physiotherapy Evidence Database (PEDro), and ClinicalTrials.gov site. Search terms included 'cerebral palsy' or 'spastic diplegia' or 'hemiplegia' or 'quadriplegia' and 'autonomic nervous system' or 'heart rate variability' or 'sympathetic' or 'para sympathetic'. Twenty five articles were identified and included if (1) participants were less than 18 years of age, (2) diagnosis of CP was made after the age of 18 months (3) more than 80% of cases had a diagnosis of CP and (4) autonomic cardiac heart rate regulation system state or response to a stimuli was described for all the participants. Six articles met the criteria for inclusion. RESULTS: Evidence suggests that reduced Heart Rate Variability (HRV) time domain parameters close to birth are associated with a CP diagnosis at the age of three years. In addition, HRV parameters' mean values, are significantly lower among children with CP compared to typically developed (TD) control. While performing head up, tilt or standing position, HRV was significantly reduced only among TD control, but no effect was seen in those variables among children with CP. CONCLUSION: Further studies are needed to assess the potential to predict CP by assessing HRV parameters among newborn children. In addition, assessing HRV among children with CP may improve our understanding of the heart rate autonomic system and its response to different stimulus such as muscle contraction, paced breathing and aerobic training.

Alternating hemiplegia of childhood: new diagnostic options.

A syndrome of alternating hemiplegia of childhood (AHC) is a rare disorder first presented in 1971. AHC is characterized by transient episodes of hemiplegia affecting either one or both sides of the body. Age of onset is before 18 months and the common earliest manifestations are dystonic or tonic attacks and nystagmus. Hemiplegic episodes last minutes to days and the frequency and duration tend to decrease with time. Motor and intellectual development is affected, deficits may also develop later. Epileptic seizures occur in some patients. Neuroimaging of the brain usually reveals no abnormalities. The variability of individual clinical presentations and evolution of symptoms have made diagnosis difficult. Therefore the problems of misdiagnosis could account for the low prevalence of this syndrome. This paper hopes to present actual data on AHC, especially of the results of genetic research and new diagnostic tools.