In 70% of cases, the course and prognosis of idiopathic neuropathy of the facial nerve (NFN) are favorable.
However, in 30% of the patients, health recoveryis incomplete, with the formation of contracture of the facial muscles and development of pathological synkinesis. Many patients with NFN have chronic somatic pathology, with cardiovascular diseases being the most common. We evaluated the clinical and neurological criteria for the formation of facial nerve contractures at different stages of the disease in patients with comorbid conditions, for which there were surveyed50 (100 ± 0.0%) patients with NFN, 22 of them (44.0 ± 7.0%) patients with NFN without somatic pathology, 28 (56.0 ± 7.0%) patients are comorbid and have coronary artery disease, diabetes and obesity of 2 nd – 3 rd stage. The work studied the psycho-emotional background of patients, conducted questionnaire assessment of the quality of life. It has been proven that the clinicalcourse of facial nerve neuropathy is
Purpose: The aim of this study was to investigate whether the day of starting oral intake affects the clinicalcourse of patients with aspiration pneumonia.
Patients and methods: We conducted a retrospective cohort study of 392 patients who were hospitalized for aspiration pneumonia but tolerated oral intake. Patients were divided into two groups according to the day of starting oral intake: Monday to Friday (midweek group) and Saturday or Sunday (weekend group). Underlying diseases, severity of pneumonia, time to oral intake, hospital duration, discontinuation of oral intake, and death during hospitalization were compared between the groups. Multivariate analysis was performed using hospital duration and discontinuation of oral intake due to aspiration as the dependent variables.
Introduction: With the advancement of therapeutics, newer antiepileptic drugs (AEDs) like Levetiracetam (LEV), with good therapeutic efficacy and tolerability are available. But unfortunately, therapeutic drug monitoring is not routinely done in India for these drugs. Objectives: The objective of this study is to determine the range of serum levels of LEV in patients at stabilized doses and correlate them with their clinicalcourse. Materials and Methods: Patients with epilepsy and started on LEV were enrolled from the Neurology Department after the Ethics Committee approval. Serum levels of LEV were estimated using high‑performance liquid chromatography and correlated with patient demographics, dosage, dosage forms, concomitant AEDs, compliance of the patient, therapeutic effect, adverse drug reactions (ADRs), and suspected toxicity. Results: Serum levels of LEV ranged from 0.4 to 102.2 µg/ml at different time points and demonstrated a negligible positive correlation with age of the patients (r = 0.12) but negligible negative correlation with bodyweight (r = −0.19). No conclusive relationship could be established for dose, gender, dosage forms, clinical efficacy (seizure frequency), ADRs, and toxicity. Compliance was verified in all the patients. Levels were found to reduce with the use of concomitant enzyme inducer drugs (56.78%) whereas increase with valproic acid (7.8%). Conclusion: These findings emphasize the need for monitoring the serum levels of newer AEDs like LEV considering the various parameters studied here, so as to maintain the therapeutic efficacy by preventing under or over dosage and to generate a broader database of serum levels of LEV in the Indian population to help appropriate prescribing with more confidence.
Abstract. Background: Serum HER2 testing allows the determination of the real-time HER2 status of breast cancer patients. The aim of this investigation was to study (i) whether changes of serum HER2 status occur during the clinicalcourse of breast cancer and (ii) to evaluate the prognostic significance of serum HER2 status, at the time of first diagnosis of primary breast cancer and at the onset of metastatic disease, for survival after relapse (SAR). Materials and Methods: HER2 serum levels were retrospectively measured in 152 breast cancer patients at the time of first diagnosis of breast cancer and at the onset of metastatic disease by enzyme immunoassay. Results: Twenty-seven out of 152 (18%) patients had elevated HER2 serum levels at the time of first diagnosis of breast cancer. In contrast, 56 out of 152 (37%) patients showed elevated serum HER2 levels when metastases were diagnosed. A change of serum HER2 status during clinicalcourse was observed in 43 out of 152 (28%) patients. Serum HER2 status at the time of first diagnosis of breast cancer had no impact on survival after relapse (SAR) (p=0.4). However, the median SAR for serum HER2-positive patients at the onset of metastatic disease was significantly shorter (8 months, 95% CI: 3-12) compared to patients serum HER2-negative at this time (18 months, 95% CI: 14-22) (p<0.01). Conclusion: Serum HER2 status can change during the course of disease. Therefore, the serum HER2 status should be re-evaluated at the time of diagnosis of metastatic disease to optimize treatment decisions. The HER2 proto-oncogene is located on chromosome 17 and encodes a transmembrane tyrosine kinase growth receptor protein (1,2). Gene amplification and overexpression of the HER2 proto-oncogene occurs in 15% to 20% of breast cancer
Limitations of the study are its observational design of FFB and BAL as standard of care in a single centre with- out a randomized control group. Part of the included cases were retrospectively collected. In the assessment of a long term clinicalcourse it might be difficult to differentiate the natural course of the underlying disease from the im- pact of the bronchoscopic intervention. Evidently, FFB and BAL procedures should not be performed in patients in a deplorable clinical condition. Unfortunately, the present study does not allow to define clear-cut clinical criteria for withholding FFB and BAL because the limited number of patients with severe acidosis (pH < 7.25; n = 10), hypercapnia (PaCo2 ≥ 7.5kPa/56 mmHg; n = 9) and hypoxia (PaO2 ≤ 8kPa/60 mmHg; n = 10 or PaO2/FiO2 ra- tio ≤13kPa/100 mmHg; n = 12). Further limitation is the lack of the measurement of respiratory mechanics before, during and after FFB.
Abstract: AIMS OF THE STUDY In daily clinical work, coercion continues to be highly prevalent, with rates differing between countries and sometimes even within countries or between wards of the same hospital. Previous research found inconsistent characteristics of individuals who underwent coercive measures during psychiatric treatment. Furthermore, there continues to be a lack of knowledge on the clinicalcourse of people after being involuntarily committed. This study aimed to describe the rate and duration of different coercive measures and characterise a cohort of involuntarily committed patients regarding sociodemographic and clinical variables. METHODS In this observational cohort study, we analysed clinical data from the patients’ medical files, the use of coercive measures (seclusion, restraint, coercive medication) and other procedural aspects in involuntarily hospitalised patients (n = 612) at the University Hospital of Psychiatry Zurich. For analysis, we used cross-tabulation with chi-square tests for categorical variables and, owing to a non-normal distribution, the Mann-Whitney U-test for interval variables. RESULTS Coercive measures were documented in 170 patients (28% of those who were involuntarily hospitalised). The total number of seclusions was 344, with a mean duration of 9 hours per seclusion. A total of 89 patients (15%) received 159 episodes of coercive medication (oral and intramuscular). Also, 11 episodes of restraint were recorded in 7 patients (1%) with a mean duration of 12 hours per restraint. Patients subjected to coercion were significantly more often male, violent prior to admission, diagnosed with psychosis or personality disorder, and had a history of frequent hospitalisations with long durations of hospitalisation. CONCLUSIONS The prevalence of coercive measures is still high in involuntarily hospitalised patients. Seclusion was the most frequently used coercive measure, which may be based on cultural and clinical aspects and differs from findings in other countries where restraint is more frequently used. Some sociodemographic and clinical characteristics were associated with the use of coercion. This underlines the importance of developing treatment strategies for patients at risk to prevent situations in which the use of coercion is necessary. To enable comparison between different study sites, standardised protocols should be used to document frequency and duration of coercive measures. DOI: https://doi.org/10.4414/smw.2018.14616
Goal of this study was to analyse the clinicalcourse of cystic fibrosis (CF) patients with nontuberculous mycobacteria (NTM) in their respiratory secretions and to investigate the molecular epidemiology of the most prevalent NTM species by multi-locus sequence analysis (MLSA). The respiratory specimen and the clinical parameters forced expiratory volume in one second (FEV1), body-mass-index (BMI), erythrocyte sedimentation rate (ESR) 1 h and immunoglobulin G (IgG) of 357 CF patients, 0 - 52.4 years, mean FEV1 2009 81.5% pred were analysed between 1998 and 2010. In 13 patients NTM were detected. 12 of 13 patients carried M. abscessus, for one patient the NTM species was not charac- terized. 4 patients carried a second NTM species (M. avium, M. chelonae (2x), M. intracellulare). 6 patients exhibited a significant decline in FEV1, however changes in BMI, IgG and ESR were discordant. Molecular genotyping of M. ab- scessus isolates revealed a unique MLSA pattern in 6 patients. 2 patients harboured identical strains, and one patient a closely related strain. Whether the presence of identical strains is attributed to the acquisition of NTM clones from common environmental sources or to patient-to-patient transmission cannot be definitely clarified. Although cross-in- fection of the three patients with identical/closely related strains in the present cohort is highly unlikely, we recommend strict hygiene measures for all CF patients harbouring NTM.
This study used the statistical method of latent class modelling to reveal four distinct clusters of patients with disc-related sciatica. The clusters give further insight into the variability in the characteristics and clinicalcourse of patients within the clear diagnostic classification of imaging confirmed disc-related sciatica, not previously identified in the literature. The clusters are modelled based on their back and leg pain intensity and response to items from clinical assessment. The four identified clusters of sciatica patients are primarily differentiated by the intensity of their back and leg pain and the relationship between back and leg pain intensity. Leg pain intensity was greater than back pain in all clusters except cluster 2 (moderate). Patients with severe back and leg pain (cluster 4) had the most severe profile at baseline, scoring high on measures covering different domains in the biopsychosocial model (physical, psychological and social domains). Cluster 4 also had the least favourable pain and disability outcomes at 2 years and the lowest proportion of people in the cluster reporting improvement.
Methods Study population
To characterise the clinicalcourse of neonatal onset UCDs, we performed a multicentre, retrospective, non- interventional study collecting data on patients affected by symptomatic hyperammonemia in the neonatal period and treated according to local protocols in the years 2001 until 2013. Inclusion criteria were: neonatal onset CPS1, OTC or ASS deficiencies with enzymatic or molecular genetic confirmation, demographic data and medical history, and data until death, orthotopic liver transplantation (OLT), or at least six months of follow- up. Exclusion criteria were: birth before 2001, severe chronic or systemic disease other than UCD, and partici- pation in the liver cell transplantation study SELICA (Safety & Efficacy of Liver Cell Application, Cytonet, Weinheim, Germany). The observation period of pa- tients according to the study protocol was up to five years or until death, but the analysis period was only 550 days. We decided for this shorter analysis period since data was documented beyond 550 days in so few cases, rendering analysis beyond this period uninforma- tive. The decision for this shortened analysis period was made before data evaluation.
The clinicalcourse of patients with MM that relapses after initial therapy is not well documented. We present the outcome of patients followed up and monitored at our institution throughout their disease course to better under- stand the clinicalcourse of the relapsed disease. Selection of patients who had most of their monitoring and follow-up at our institution allows for better follow-up data, and the demographic characteristics of the group are basically the same as those generally described for the disease. This study represents a unique description of the clinicalcourse of patients with relapsed myeloma, which to our knowl- edge has not been previously examined systematically.
Other smaller studies have examined specific dis- ease manifestations in patients with GD who devel- oped parkinsonism. In a study from Israel of 11 patients with both disorders, an earlier AAO of par- kinsonism, more frequent cognitive problems, and more frequent and earlier complications from levo- dopa therapy, including motor fluctuations and dys- kinesias, were noted. In a study of 10 patients with GD and PD from the French national Gaucher dis- ease registry pooled with 49 cases of GD and PD taken from the literature, it was noted that these pa- tients exhibited a poorer response to L -dopa therapy when compared with patients with iPD. 29 However, at this time, no specific phenotypic presentation is unique to patients with parkinsonism who carry GBA1 mutations. A study of 4 patients with both GD and PD identified from a tertiary Parkinson cen- ter described prominent neuropsychiatric problems, anosmia, as well as hyperechogenicity of the substan- tia nigra on ultrasound and presynaptic dopaminergic cell loss on PET, all of which are seen in patients with iPD. 30 Of note, all 4 patients were diagnosed with GD only after the development of PD.
and the vast majority of PMR patients requiring corticosteroid therapy for a minimum of 2 years. 18,28
The mainstay of treatment for polymyalgia is corti- costeroids, usually oral prednisone. The audited initial prednisone dosing of 21.3 mg is in keeping with various recommended guidelines, which suggest a starting dose of 15–25 mg. 16–18 Numerous studies have investigated the effectiveness of steroid-sparing DMARD therapy in PMR and giant cell arteritis. Currently, the exact role of such therapy in the management of PMR is not well established, with conflicting results from various trials. 10,16–18 Although most commonly used as steroid-sparing agents for steroid- dependent patients in whom it is difficult to reduce the prednisone dose, it would be beneficial to investigate further their value when introduced early to induce remission, and whether they are effective in resistant cases of PMR. As such, there are no current guidelines for use of DMARDs
infective cause. This included a full laboratory workup with full blood count, erythrocyte sedimentation rate, urea and electrolytes, liver function tests, C-reactive pro- tein, angiotensin converting enzyme, anti-nuclear anti- body, anti-neutrophil cytoplasmic antibody, syphilis serology and a chest x-ray. Additional investigations, such as toxoplasma antibodies and Mantoux test were undertaken where clinically indicated. Classification and grading of uveitis was undertaken according to the Standardization of Uveitis Nomenclature (SUN) Working Group classification . The clinicalcourse of the uveitis, frequency of recurrence and treatment undertaken were documented. The type of DM, DM treatment, changes in the DM treatment, types of diabetic retinopathy and maculopathy and its course and treatment were noted.
The rate of decline in FEV 1 % predicted has been stud- ied in CF patients to better understand the progression of lung disease, in order to identify high-risk groups in whom aggressive therapy might be indicated and to as- sess therapeutic interventions. Risk factors associated with FEV 1 decline include but are not limited to young age, high lung function, female gender, modifier genes, pancreatic insufficiency, poor nutritional status, viral re- spiratory infections, colonization with P. aeruginosa and BCC, and diabetes mellitus. The Epidemiologic Study of Cystic Fibrosis found that overall rates of FEV 1 % pre- dicted decline were −1.12, −2.39 and −2.34 % per year in 6–8-year-olds, 9–12-year-olds and 13–17-year-olds, re- spectively .
The role of health care utilization, especially ED visits and hospitalizations, in the diagnosis of COPD has not been defined. Patients who were subsequently diagnosed with COPD had more ED visits than those who were previously diagnosed and more than twice as many ED visits as the persistently undiagnosed patients (Figure 3), suggesting a possible role of ED visits in the diagnostic process. Since we could not determine who entered the diagnosis of COPD into the medical record, it was not possible to determine whether there was an increased rate of COPD diagnosis by ED provid- ers or if primary care providers entered a COPD diagnosis after the ED visit. Thus, it is not known which elements of the patient’s clinical history prompt clinicians to establish a COPD diagnosis. ED visits for respiratory complaints may be one stimulus that provokes providers to diagnose COPD.
Quality of life
While the neurologic outcome of PA has been addressed by several case reports and small case series, very little is known about the quality of life of PA patients. In our study, there might be an ascertainment bias because the question- naire could only be filled in by those patients whose cogni- tive impairment was only moderate. Among all categories, family life was the top-ranked aspect with regard to the patients’ quality of life. This may well reflect the significant role of the parents and the family ties that can arise by caring for a child that suffers from a chronic, potentially life-threatening disease. Notably, evaluation of the ques- tionnaire data suggests, that most patients consider their quality of life high. Most patients appeared even to per- ceive themselves as healthy and felt not affected in their daily life. The results of this self-evaluation resemble very much the data of a healthy control group .
The mechanisms of the negative impact of psychoemotional disorders on the QOL of patients with heart failure are multifaceted and have not been fully studied. It is known that anxiety and depression are additional factors in reducing physical, mental and social activity, which is an important component of QOL. In addition, the presence of somatic symptoms directly caused by psycho-emotional disorders (sleep disorder, loss or weight gain, weakness, increased fatigue, etc.) also plays a role in the deterioration of QOL of such patients. It is important to note that the presence of psychoemotional disorders is associated with a decrease in the effectiveness of treatment of heart failure due to the negative attitude of the patient to treatment. It has been shown that such patients have a low commitment to lifestyle modification and drug therapy. The deterioration of QOL of this cohort of patients may also be due to the aggravation of the clinical manifestations of heart failure due to the direct effect of anxiety and depression. The negative impact of psychoemotional disorders on the course and prognosis of heart failure is realized through a variety of pathophysiological mechanisms, among which the activation of the hypothalamic-pituitary-adrenal system, hyperproduction of pro-inflammatory cytokines, endothelial and platelet dysfunctions are distinguished. These pathophysiological disorders accompanying anxiety and depression undoubtedly contribute to the deterioration of the severity of heart failure. On the other hand, the progression of CHF exacerbates the anxiety-depressive disorder present in the patient, closing the vicious circle and contributing to a further deterioration in their quality of life.
By this hypothesis the overall hygiene and socioeconomic status of a country through exposure to microbes, may predispose its citizens to a Th1-dominant immunological response, which favours the development of glomerulonephritis such as mesangiocapillary glomerulonephritis. In contrast, other types of glomerulonephritis such as IgA nephropathy have a predominantly Th2 response, and better public hygiene and fewer infections observed in industrialised nations my lead to a persistence of the Th2 phenotype. Although we cannot completely rule out the possibility that this pattern of glomeulonephritis may not represent an ‘idiopathic’ diagnosis, in all but two patients there was no evidence to support secondary causes such as chronic bacterial and viral infections or autoimmune diseases. In the context of the high incidence of FSGS in this study, the identification of coding region variants in apolipoprotein L1 (APOL1), encoding apolipoprotein L1, may be of note. These variants are restricted to populations of recent African descent and are strongly associated with clinically diagnosed primary renal disease/FSGS/nephrosclerosis in the setting of hypertension.  Although the frequency of these variants may be lower in eastern African, to our knowledge there is no data on the frequency in Sudan. It is also of note that in the group of patients with FSGS in this study, only 50% were hypertensive at presentation, possibly suggesting that there is no association in this cohort, although accepting the small numbers affected.
across the primary pain site diagnosis from that of patients who were classified with non-specific muscular symptoms and limited function. These results are supported by those from cohort studies in the USA, showing anatomical pain sites did not influence the predictive value of psychological factors, such as fear avoidance beliefs and depressive symp- toms, in patients seeking physiotherapy treatment for mus- culoskeletal pain [67, 68]. Traditionally, clinical practice prognosis and treatment has been based on medical diag- noses but the central role of diagnosis has recently been challenged in conditions such as musculoskeletal pain, where other factors have been shown to be more influential on the outcome . In patients with musculoskeletal pain, many symptoms (such as pain, stiffness, and pain interfer- ence with work and daily routine) are common regardless of where the primary pain site is. In musculoskeletal pain conditions, prognosis seems to be less about ‘where you have it’ and more about ‘how much pain and disability you have and your pain perceptions’. Diagnosis is likely to be most relevant in conditions where there is an available treatment that effectively targets the causal pathways of a specific disease. In health conditions such as musculoskel- etal pain, physiotherapy treatment strategies largely depend on the same strategies, such as advice, reassurance, manual therapy and exercise, and therefore are probably better understood and managed within a prognostic framework.