Pub Date : 2018-11-19eCollection Date: 2018-01-01DOI: 10.1155/2018/4210737
HamidReza Naderi, Fereshte Sheybani, Omid Khosravi, Mehdi Jabbari Nooghabi
Objectives: To assess the frequency of different types of diagnostic errors in patients with central nervous system (CNS) infection from the onset of symptoms to admission to the hospital, where the correct diagnosis was made.
Methods: A cross-sectional observational design was used, and the information was collected by interviewing patients and/or their knowledgeable relatives as well as reviewing the accompanying medical record documents and hospital records.
Results: Of 169 adult patients with CNS infection, 129 (76.33%) were subject to diagnostic errors. Failure in ordering tests and hypothesis generation were the most common types of diagnostic errors that accounted for more than 70% of errors. Several contributing factors that were associated with incorrect diagnostic hypotheses included failure in taking a patient's comprehensive history such as detecting relevant epidemiological clues, conducting a full clinical examination, and interpreting diagnostic evidence. The relationship between poor clinical outcome and longer delay from the onset of illness to diagnosis, inappropriate empirical antibiotic therapy, and lower level of consciousness on admission were found to be statistically significant.
Conclusions: Although diagnosis and management of CNS infection in some patients are straightforward, clinical decision making in facing patients with complex scenarios often requires clinical reasoning instead of relying only on intuitive diagnosis. Justification in requesting diagnostic measures and interpretation of their results based on clinical findings and patient information could be a critical factor in preventing a substantial number of diagnostic errors in patients with CNS infection.
{"title":"Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study.","authors":"HamidReza Naderi, Fereshte Sheybani, Omid Khosravi, Mehdi Jabbari Nooghabi","doi":"10.1155/2018/4210737","DOIUrl":"https://doi.org/10.1155/2018/4210737","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the frequency of different types of diagnostic errors in patients with central nervous system (CNS) infection from the onset of symptoms to admission to the hospital, where the correct diagnosis was made.</p><p><strong>Methods: </strong>A cross-sectional observational design was used, and the information was collected by interviewing patients and/or their knowledgeable relatives as well as reviewing the accompanying medical record documents and hospital records.</p><p><strong>Results: </strong>Of 169 adult patients with CNS infection, 129 (76.33%) were subject to diagnostic errors. Failure in ordering tests and hypothesis generation were the most common types of diagnostic errors that accounted for more than 70% of errors. Several contributing factors that were associated with incorrect diagnostic hypotheses included failure in taking a patient's comprehensive history such as detecting relevant epidemiological clues, conducting a full clinical examination, and interpreting diagnostic evidence. The relationship between poor clinical outcome and longer delay from the onset of illness to diagnosis, inappropriate empirical antibiotic therapy, and lower level of consciousness on admission were found to be statistically significant.</p><p><strong>Conclusions: </strong>Although diagnosis and management of CNS infection in some patients are straightforward, clinical decision making in facing patients with complex scenarios often requires clinical reasoning instead of relying only on intuitive diagnosis. Justification in requesting diagnostic measures and interpretation of their results based on clinical findings and patient information could be a critical factor in preventing a substantial number of diagnostic errors in patients with CNS infection.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2018-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/4210737","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36809792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hesperidin, a well-known flavanone glycoside mostly found in citrus fruits, showed neuroprotective and antidepressant activity. Agomelatine, a melatonergic MT1/MT2 agonist and 5-HT2C receptor antagonist, exhibits good antidepressant efficacy. Bupropion has been widely used for the treatment of depression because of its dopamine and norepinephrine reuptake inhibition. The objective of present study was to assess the antidepressant effects of hesperidin combination with agomelatine or bupropion. Male Swiss Albino mice received treatment of saline, vehicle, 'hesperidin alone', 'agomelatine alone', hesperidin+agomelatine, 'bupropion alone', hesperidin+bupropion, and agomelatine+bupropion for 14 days. The immobility period was analysed 30 min after the treatment in forced swim and tail suspension tests. Dopamine and serotonin levels were analysed in hippocampus, cerebral cortex, and whole brain using HPLC with fluorescence detector. Hesperidin plus agomelatine treated group was better in terms of decrease in immobility period and increase in dopamine and serotonin levels when compared to their respective monotherapy treated groups.
{"title":"Potentiation of Antidepressant Effects of Agomelatine and Bupropion by Hesperidin in Mice.","authors":"Jegan Sakthivel Nadar, Pravin Popatrao Kale, Pramod Kerunath Kadu, Kedar Prabhavalkar, Ruchita Dhangar","doi":"10.1155/2018/9828639","DOIUrl":"10.1155/2018/9828639","url":null,"abstract":"<p><p>Hesperidin, a well-known flavanone glycoside mostly found in citrus fruits, showed neuroprotective and antidepressant activity. Agomelatine, a melatonergic MT<sub>1</sub>/MT<sub>2</sub> agonist and 5-HT<sub>2C</sub> receptor antagonist, exhibits good antidepressant efficacy. Bupropion has been widely used for the treatment of depression because of its dopamine and norepinephrine reuptake inhibition. The objective of present study was to assess the antidepressant effects of hesperidin combination with agomelatine or bupropion. Male Swiss Albino mice received treatment of saline, vehicle, 'hesperidin alone', 'agomelatine alone', hesperidin+agomelatine, 'bupropion alone', hesperidin+bupropion, and agomelatine+bupropion for 14 days. The immobility period was analysed 30 min after the treatment in forced swim and tail suspension tests. Dopamine and serotonin levels were analysed in hippocampus, cerebral cortex, and whole brain using HPLC with fluorescence detector. Hesperidin plus agomelatine treated group was better in terms of decrease in immobility period and increase in dopamine and serotonin levels when compared to their respective monotherapy treated groups.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2018-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36748594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-09eCollection Date: 2018-01-01DOI: 10.1155/2018/3172679
Emily R Rosario, Stephanie E Kaplan, Sepehr Khonsari, Garrett Vazquez, Niyant Solanki, Melanie Lane, Hiriam Brownell, Sheila S Rosenberg
Background: While research suggests a benefit of hyperbaric oxygen therapy (HBOT) for neurologic injury, controlled clinical trials have not been able to clearly define the benefits.
Objective: To investigate the effects of HBOT on physical and cognitive impairments resulting from an ischemic stroke.
Methods: Using a within-subject design a baseline for current functional abilities was established over a 3-month period for all subjects (n=7). Each subject then received two 4-week periods of HBOT for a total of 40 90-minute treatments over a 12-week period. Subjects completed a battery of assessments and had blood drawn six times over the 9-month total duration of the study.
Results: We found improvements in cognition and executive function as well as physical abilities, specifically, improved gait. Participants reported improved sleep and quality of life following HBOT treatment. We also saw changes in serum levels of biomarkers for inflammation and neural recovery. In the functional domains where improvement was observed following HBOT treatment, the improvements were maintained up to 3 months following the last treatment. However, the physiological biomarkers showed a pattern of more transient changes following HBOT treatment.
Conclusions: Findings from this study support the idea of HBOT as a potential intervention following stroke.
{"title":"The Effect of Hyperbaric Oxygen Therapy on Functional Impairments Caused by Ischemic Stroke.","authors":"Emily R Rosario, Stephanie E Kaplan, Sepehr Khonsari, Garrett Vazquez, Niyant Solanki, Melanie Lane, Hiriam Brownell, Sheila S Rosenberg","doi":"10.1155/2018/3172679","DOIUrl":"https://doi.org/10.1155/2018/3172679","url":null,"abstract":"<p><strong>Background: </strong>While research suggests a benefit of hyperbaric oxygen therapy (HBOT) for neurologic injury, controlled clinical trials have not been able to clearly define the benefits.</p><p><strong>Objective: </strong>To investigate the effects of HBOT on physical and cognitive impairments resulting from an ischemic stroke.</p><p><strong>Methods: </strong>Using a within-subject design a baseline for current functional abilities was established over a 3-month period for all subjects (n=7). Each subject then received two 4-week periods of HBOT for a total of 40 90-minute treatments over a 12-week period. Subjects completed a battery of assessments and had blood drawn six times over the 9-month total duration of the study.</p><p><strong>Results: </strong>We found improvements in cognition and executive function as well as physical abilities, specifically, improved gait. Participants reported improved sleep and quality of life following HBOT treatment. We also saw changes in serum levels of biomarkers for inflammation and neural recovery. In the functional domains where improvement was observed following HBOT treatment, the improvements were maintained up to 3 months following the last treatment. However, the physiological biomarkers showed a pattern of more transient changes following HBOT treatment.</p><p><strong>Conclusions: </strong>Findings from this study support the idea of HBOT as a potential intervention following stroke.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2018-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/3172679","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36642930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01eCollection Date: 2018-01-01DOI: 10.1155/2018/3050278
Ali M Al Khathaami, Haya Aloraini, S Almudlej, Haifa Al Issa, Nourhan Elshammaa, Sami Alsolamy
Background and objectives: Tissue plasminogen activator (t-PA) within 4.5 hours from onset improves outcome in patients with ischemic stroke and has been recommended by several international guidelines. Since its approval in 1996, the debate among emergency physicians continues particularly around the result interpretation of the first positive randomized controlled trial, the National Institute of Neurological Disorders and Stroke (NINDS) clinical trial. This lack of consensus might negatively affect the delivery of effective stroke care. Here we aimed to assess the knowledge and attitude of Saudi emergency physicians toward t-PA use within 4.5 hours of onset in acute ischemic stroke.
Methods: A web-based, self-administered, locally designed questionnaire was sent to all emergency physicians practicing in the city of Riyadh from January to September 2017.
Results: Out of 450 emergency physicians, 122 from ten hospitals in Riyadh participated in the survey, with a 27% response rate. The majority of participants were men (78%), and their mean age was 40 ± 8 years. Half of the participants were board certified, and 36% were consultants. Half of the participants consider the evidence for t-PA use in stroke within 4.5 hours of stroke onset to be controversial, and 41% recommend against its use due to lack of proven efficacy (37%), the risk of hemorrhagic complications (35%), lack of stroke expertise (21%), and medicolegal liability (9%). Nearly half were willing to administer IV t-PA for ischemic stroke in collaboration with remote stroke neurology consultation if telestroke is implemented.
Conclusion: Our study detected inadequate knowledge and a negative attitude among Saudi emergency physicians toward t-PA use in acute stroke. This might negatively impact patient outcome. Therefore, we recommend developing urgent strategies to improve emergency physicians' knowledge, attitudes, and beliefs in the management of acute stroke.
{"title":"Knowledge and Attitudes of Saudi Emergency Physicians toward t-PA Use in Stroke.","authors":"Ali M Al Khathaami, Haya Aloraini, S Almudlej, Haifa Al Issa, Nourhan Elshammaa, Sami Alsolamy","doi":"10.1155/2018/3050278","DOIUrl":"https://doi.org/10.1155/2018/3050278","url":null,"abstract":"<p><strong>Background and objectives: </strong>Tissue plasminogen activator (t-PA) within 4.5 hours from onset improves outcome in patients with ischemic stroke and has been recommended by several international guidelines. Since its approval in 1996, the debate among emergency physicians continues particularly around the result interpretation of the first positive randomized controlled trial, the National Institute of Neurological Disorders and Stroke (NINDS) clinical trial. This lack of consensus might negatively affect the delivery of effective stroke care. Here we aimed to assess the knowledge and attitude of Saudi emergency physicians toward t-PA use within 4.5 hours of onset in acute ischemic stroke.</p><p><strong>Methods: </strong>A web-based, self-administered, locally designed questionnaire was sent to all emergency physicians practicing in the city of Riyadh from January to September 2017.</p><p><strong>Results: </strong>Out of 450 emergency physicians, 122 from ten hospitals in Riyadh participated in the survey, with a 27% response rate. The majority of participants were men (78%), and their mean age was 40 ± 8 years. Half of the participants were board certified, and 36% were consultants. Half of the participants consider the evidence for t-PA use in stroke within 4.5 hours of stroke onset to be controversial, and 41% recommend against its use due to lack of proven efficacy (37%), the risk of hemorrhagic complications (35%), lack of stroke expertise (21%), and medicolegal liability (9%). Nearly half were willing to administer IV t-PA for ischemic stroke in collaboration with remote stroke neurology consultation if telestroke is implemented.</p><p><strong>Conclusion: </strong>Our study detected inadequate knowledge and a negative attitude among Saudi emergency physicians toward t-PA use in acute stroke. This might negatively impact patient outcome. Therefore, we recommend developing urgent strategies to improve emergency physicians' knowledge, attitudes, and beliefs in the management of acute stroke.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/3050278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36621663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-27eCollection Date: 2018-01-01DOI: 10.1155/2018/1254602
Jean-Baptiste Delmotte, Abdulkarim Tutakhail, Kahina Abdallah, Pauline Reach, Marguerite D'Ussel, Gael Deplanque, Hélène Beaussier, François Coudoré
Purpose: Oxaliplatin is a platinum compound widely used in gastrointestinal cancer treatment but produces dose-limiting peripheral neuropathy. New insights into oxaliplatin-induced peripheral neuropathy (OIPN) assessment are needed to detect more effectively this condition. In this context, we conducted Canaloxa study, a prospective preliminary clinical trial that aimed to investigate how Electrochemical Skin Conductance (ESC), a parameter used in small fiber neuropathy assessment, could be helpful in OIPN diagnosis.
Methods: Cancer patients treated for at least three months with oxaliplatin and suffering from clinically OIPN were included. Electrochemical Skin Conductance, thermal thresholds, and neuropathic pain were assessed in all included patients.
Results: During one year, 36 patients were included. The main result was the correlation between ESC and Neuropathic Pain Symptom Inventory score for hands (rho value = -0.69, p < 0.0001) and feet (rho value = -0.79, p < 0.0001). ESC values were lower in neuropathic patients with painful symptoms than in ones without painful symptoms (p = 0.0003 and p < 0.0001 for hands and feet, respectively). No correlation was observed between ESC and thermal thresholds.
Conclusion: These preliminary data suggest that ESC could be a useful objective marker of painful oxaliplatin-induced neuropathy and could complement the use of subjective clinical scales. This study was prospectively registered on clinicaltrials.gov (NCT02827916) before patient recruitment has begun.
{"title":"Electrochemical Skin Conductance as a Marker of Painful Oxaliplatin-Induced Peripheral Neuropathy.","authors":"Jean-Baptiste Delmotte, Abdulkarim Tutakhail, Kahina Abdallah, Pauline Reach, Marguerite D'Ussel, Gael Deplanque, Hélène Beaussier, François Coudoré","doi":"10.1155/2018/1254602","DOIUrl":"https://doi.org/10.1155/2018/1254602","url":null,"abstract":"<p><strong>Purpose: </strong>Oxaliplatin is a platinum compound widely used in gastrointestinal cancer treatment but produces dose-limiting peripheral neuropathy. New insights into oxaliplatin-induced peripheral neuropathy (OIPN) assessment are needed to detect more effectively this condition. In this context, we conducted Canaloxa study, a prospective preliminary clinical trial that aimed to investigate how Electrochemical Skin Conductance (ESC), a parameter used in small fiber neuropathy assessment, could be helpful in OIPN diagnosis.</p><p><strong>Methods: </strong>Cancer patients treated for at least three months with oxaliplatin and suffering from clinically OIPN were included. Electrochemical Skin Conductance, thermal thresholds, and neuropathic pain were assessed in all included patients.</p><p><strong>Results: </strong>During one year, 36 patients were included. The main result was the correlation between ESC and Neuropathic Pain Symptom Inventory score for hands (rho value = -0.69, <i>p</i> < 0.0001) and feet (rho value = -0.79, <i>p</i> < 0.0001). ESC values were lower in neuropathic patients with painful symptoms than in ones without painful symptoms (<i>p</i> = 0.0003 and <i>p</i> < 0.0001 for hands and feet, respectively). No correlation was observed between ESC and thermal thresholds.</p><p><strong>Conclusion: </strong>These preliminary data suggest that ESC could be a useful objective marker of painful oxaliplatin-induced neuropathy and could complement the use of subjective clinical scales. <i>This study was prospectively registered on clinicaltrials.gov</i> (NCT02827916) <i>before patient recruitment has begun</i>.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2018-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/1254602","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36664790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-16eCollection Date: 2018-01-01DOI: 10.1155/2018/2501835
Mohammed Saeed Alqahtani, Ahmad Ayed Alshbriqe, Ahmed A Awwadh, Turki Ali Alyami, Mohammed Saad Alshomrani, Adel Alhazzani
Objectives: To identify prevalence and risk factors of depression among caregivers of Alzheimer' disease (AD) patients.
Methods: In a cross-sectional study, 110 caregivers of AD patients participated in this study (51 males and 59 females). Patients data were obtained from patients' records at Aseer Central Hospital. Depression among caregivers was assessed by using the Hamilton Rating Scale for Depression.
Results: The age of caregivers ranged from 17 to 85 years (Mean±SD: 41.1±14.0 years). Prevalence of depression among caregivers was 70%. Caregivers were mainly sons/daughters (69.1%) or spouses (11.8%). A total of 33 caregivers (30%) had mild depression while 44 (40%) had moderate depression. Prevalence of depression was significantly higher among caregivers of AD patients who were exposed to repeated falling down (p=0.003), but did not differ significantly among caregivers who were exposed to repeated pneumonia or getting lost. Caregivers' scores of depression positively correlated with duration of caregivers' daily stay with AD patients (r=0.272, p=0.004), but did not correlate significantly with either caregivers' age or patients' age. Moreover, caregivers' depression did not differ significantly according to their marital status, educational status, employment status, or monthly income.
Conclusions: Prevalence of depression among AD caregiver is high. Risk factors for depression include patients' exposure to repeated falls and prolonged stay with patients. Therefore, psychiatric care should be provided to caregivers, home safety should be maintained to avoid falls, and several persons should interchangeably provide care to AD patients.
{"title":"Prevalence and Risk Factors for Depression among Caregivers of Alzheimer's Disease Patients in Saudi Arabia.","authors":"Mohammed Saeed Alqahtani, Ahmad Ayed Alshbriqe, Ahmed A Awwadh, Turki Ali Alyami, Mohammed Saad Alshomrani, Adel Alhazzani","doi":"10.1155/2018/2501835","DOIUrl":"https://doi.org/10.1155/2018/2501835","url":null,"abstract":"<p><strong>Objectives: </strong>To identify prevalence and risk factors of depression among caregivers of Alzheimer' disease (AD) patients.</p><p><strong>Methods: </strong>In a cross-sectional study, 110 caregivers of AD patients participated in this study (51 males and 59 females). Patients data were obtained from patients' records at Aseer Central Hospital. Depression among caregivers was assessed by using the Hamilton Rating Scale for Depression.</p><p><strong>Results: </strong>The age of caregivers ranged from 17 to 85 years (Mean±SD: 41.1±14.0 years). Prevalence of depression among caregivers was 70%. Caregivers were mainly sons/daughters (69.1%) or spouses (11.8%). A total of 33 caregivers (30%) had mild depression while 44 (40%) had moderate depression. Prevalence of depression was significantly higher among caregivers of AD patients who were exposed to repeated falling down (p=0.003), but did not differ significantly among caregivers who were exposed to repeated pneumonia or getting lost. Caregivers' scores of depression positively correlated with duration of caregivers' daily stay with AD patients (r=0.272, p=0.004), but did not correlate significantly with either caregivers' age or patients' age. Moreover, caregivers' depression did not differ significantly according to their marital status, educational status, employment status, or monthly income.</p><p><strong>Conclusions: </strong>Prevalence of depression among AD caregiver is high. Risk factors for depression include patients' exposure to repeated falls and prolonged stay with patients. Therefore, psychiatric care should be provided to caregivers, home safety should be maintained to avoid falls, and several persons should interchangeably provide care to AD patients.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2018-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/2501835","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36572982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An epileptic seizure is a clinical event presumed to result from an abnormal and excessive neuronal discharge. The clinical symptoms are paroxysmal and may include impaired consciousness and motor, sensory, autonomic, or psychic events perceived by the subject or an observer. Epilepsy occurs when 2 or more epileptic seizures occur unprovoked by any immediately identifiable cause. And in the majority of patients with epilepsy, antiepileptic drugs effectively control their illness. However, more than 30% of people with epilepsy do not attain full seizure control, even with the best available treatment regimen. The aim of this study is to assess self-reported adherence in adult patients with epilepsy and to identify potential barriers for nonadherence to antiepileptic drug treatment in Dessie Referral Hospital. A hospital based cross-sectional study was conducted using structured questionnaires including Morisky medication adherence scale and analysis was conducted descriptively using SPSS version 20. The level of nonadherence to antiepileptic medication regimens was 34.1%. The major reason for missing medication was forgetfulness 53.5%. And the most common side effect was sedation 56.2%. Conclusion. Majority of epileptic patients in Dessie Referral Hospital was adherent to their AEDs treatment and among the determinants of adherence assessed the level of education and the side effect of drugs showed statistical significance.
癫痫发作是一种临床事件,被认为是由异常和过度的神经元放电引起的。临床症状是阵发性的,可能包括意识和运动、感觉、自主或精神事件的受损,被受试者或观察者感知。癫痫发生时,癫痫发作2次或更多次发生无任何直接可识别的原因引起的。而在大多数癫痫患者中,抗癫痫药物有效地控制了他们的病情。然而,即使采用现有的最佳治疗方案,30%以上的癫痫患者也不能完全控制癫痫发作。本研究的目的是评估成人癫痫患者自我报告的依从性,并确定Dessie转诊医院抗癫痫药物治疗不依从性的潜在障碍。采用Morisky药物依从性量表等结构化问卷进行基于医院的横断面研究,采用SPSS version 20进行描述性分析。抗癫痫药物治疗方案不依从率为34.1%。健忘是漏服药的主要原因,占53.5%。最常见的副作用是镇静,占56.2%。结论。Dessie转诊医院的大多数癫痫患者坚持接受aed治疗,在评估依从性的决定因素中,受教育程度和药物副作用具有统计学意义。
{"title":"Assessment of Patients' Adherence to Antiepileptic Medications at Dessie Referral Hospital, Chronic Follow-Up, South Wollo, Amhara Region, North East Ethiopia.","authors":"Gizachew Kassahun, Getachew Moges, Yitayew Demessie","doi":"10.1155/2018/5109615","DOIUrl":"https://doi.org/10.1155/2018/5109615","url":null,"abstract":"<p><p>An epileptic seizure is a clinical event presumed to result from an abnormal and excessive neuronal discharge. The clinical symptoms are paroxysmal and may include impaired consciousness and motor, sensory, autonomic, or psychic events perceived by the subject or an observer. Epilepsy occurs when 2 or more epileptic seizures occur unprovoked by any immediately identifiable cause. And in the majority of patients with epilepsy, antiepileptic drugs effectively control their illness. However, more than 30% of people with epilepsy do not attain full seizure control, even with the best available treatment regimen. The aim of this study is to assess self-reported adherence in adult patients with epilepsy and to identify potential barriers for nonadherence to antiepileptic drug treatment in Dessie Referral Hospital. A hospital based cross-sectional study was conducted using structured questionnaires including Morisky medication adherence scale and analysis was conducted descriptively using SPSS version 20. The level of nonadherence to antiepileptic medication regimens was 34.1%. The major reason for missing medication was forgetfulness 53.5%. And the most common side effect was sedation 56.2%. <i>Conclusion.</i> Majority of epileptic patients in Dessie Referral Hospital was adherent to their AEDs treatment and among the determinants of adherence assessed the level of education and the side effect of drugs showed statistical significance.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2018-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5109615","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36539682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-02eCollection Date: 2018-01-01DOI: 10.1155/2018/5179356
Stephen Albano, Blake Berman, Glenn Fischberg, Javed Siddiqi, Bolin Liu, Yasir Khan, Atif Zafar, Syed A Quadri, Mudassir Farooqui
Background: Nosocomial EVD-related ventriculitis is a major complication and a significant cause of morbidity and mortality in critically ill neurological patients. Questions remain about best management of EVDs. The purpose of this study is to compare our incidence of ventriculitis to studies using different catheters and/or antibiotic coverage schemes and determine whether c-EVD with prolonged antibiotics given for the duration of drain placement is inferior to ac-EVD with pp-abx or ac-EVD with prolonged antibiotics for prevention of ventriculitis.
Methods: A retrospective chart review of all patients who had EVDs placed from January 2010 through December 2015 at home institution was performed. Statistical analysis was performed using Fisher's exact test to compare incidence of ventriculitis identified in other studies with that of home institution.
Results: The study included 107 patients, 66 (61.7%) males and 41 (38.3%) females. Average age was 56 years ranging from 18 to 95 years. Average length of drain placement was 7.8 days ranging from 2 to 23 days. Average length of drain placement in infected drains was 13.3 days ranging from 11 to 15 days. There were 3 cases with positive CSF cultures (Staphylococcus haemolyticus and Staphylococcus epidermidis x 2). There were 2 cases with a CSF having a positive gram stain but failed to yield any bacterial growth on culture and did not meet predefined criteria.
Conclusions: The c-EVD with prolonged antibiotics given for the duration of drain placement is not inferior to ac-EVD with pp-abx or ac-EVD with prolonged antibiotics for prevention of ventriculitis. The c-EVD with prolonged antibiotics is superior to c-EVD with pp-abx and conventional EVD without antibiotics for prevention of ventriculitis. Selection should include considerations for antibiotic stewardship and cost effectiveness. Future studies should also utilize clinical and CSF profile criteria in addition to positive CSF cultures for identifying ventriculitis to prevent line colonization from classification as ventriculitis in analysis.
{"title":"Retrospective Analysis of Ventriculitis in External Ventricular Drains.","authors":"Stephen Albano, Blake Berman, Glenn Fischberg, Javed Siddiqi, Bolin Liu, Yasir Khan, Atif Zafar, Syed A Quadri, Mudassir Farooqui","doi":"10.1155/2018/5179356","DOIUrl":"https://doi.org/10.1155/2018/5179356","url":null,"abstract":"<p><strong>Background: </strong>Nosocomial EVD-related ventriculitis is a major complication and a significant cause of morbidity and mortality in critically ill neurological patients. Questions remain about best management of EVDs. The purpose of this study is to compare our incidence of ventriculitis to studies using different catheters and/or antibiotic coverage schemes and determine whether c-EVD with prolonged antibiotics given for the duration of drain placement is inferior to ac-EVD with pp-abx or ac-EVD with prolonged antibiotics for prevention of ventriculitis.</p><p><strong>Methods: </strong>A retrospective chart review of all patients who had EVDs placed from January 2010 through December 2015 at home institution was performed. Statistical analysis was performed using Fisher's exact test to compare incidence of ventriculitis identified in other studies with that of home institution.</p><p><strong>Results: </strong>The study included 107 patients, 66 (61.7%) males and 41 (38.3%) females. Average age was 56 years ranging from 18 to 95 years. Average length of drain placement was 7.8 days ranging from 2 to 23 days. Average length of drain placement in infected drains was 13.3 days ranging from 11 to 15 days. There were 3 cases with positive CSF cultures (<i>Staphylococcus haemolyticus</i> and <i>Staphylococcus epidermidis</i> x 2). There were 2 cases with a CSF having a positive gram stain but failed to yield any bacterial growth on culture and did not meet predefined criteria.</p><p><strong>Conclusions: </strong>The c-EVD with prolonged antibiotics given for the duration of drain placement is not inferior to ac-EVD with pp-abx or ac-EVD with prolonged antibiotics for prevention of ventriculitis. The c-EVD with prolonged antibiotics is superior to c-EVD with pp-abx and conventional EVD without antibiotics for prevention of ventriculitis. Selection should include considerations for antibiotic stewardship and cost effectiveness. Future studies should also utilize clinical and CSF profile criteria in addition to positive CSF cultures for identifying ventriculitis to prevent line colonization from classification as ventriculitis in analysis.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2018-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5179356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36515473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-28eCollection Date: 2018-01-01DOI: 10.1155/2018/7247605
Jocelyn Y Cheng
Purpose: Positive airway pressure remains the gold-standard treatment for OSA, but many are intolerant. The neurotransmitter serotonin is involved in respiratory control. Evidence exists for SRIs in reducing OSA severity in the general population and ictal hypoxemia and seizure-induced respiratory arrest in people with epilepsy (PWE). However, the association between SRIs and OSA severity has not been studied in populations consisting of both groups. This study aims to determine if SRIs are associated with OSA severity in both PWE and people without epilepsy (PWO) and whether differences exist between the two groups.
Methods: A retrospective study of adults with OSA was conducted. Subjects were categorized as PWE or PWO and for the use (+SRI) or absence (-SRI) of an SRI. The primary outcome was OSA severity relative to SRI status. OSA severity as a function of SRI status was also compared between PWE and PWO and within the PWE and PWO cohorts. Oxygen saturation nadir was a secondary outcome measure. Statistical adjustment of pertinent characteristics was performed.
Results: There were 125 subjects (57 PWE, 68 PWO, 80 -SRI, and 45 +SRI). +SRI was associated with reduced odds of severe compared to moderate OSA, in unadjusted and adjusted analysis. Compared to PWO, PWE demonstrated a more robust association between OSA severity and +SRI. When analyzed as separate cohorts, only PWE demonstrated reduced OSA severity, with adjustment for age (OR:0.140, CI:0.021-1.116, and p=0.042). Oxygen saturation nadir was not significant in any model.
Conclusions: SRIs represent a potential treatment option for OSA and may demonstrate a more robust association with reduced OSA severity in PWE compared to PWO.
{"title":"Serotonin Reuptake Inhibitors in Obstructive Sleep Apnea: Associations in People with and without Epilepsy.","authors":"Jocelyn Y Cheng","doi":"10.1155/2018/7247605","DOIUrl":"https://doi.org/10.1155/2018/7247605","url":null,"abstract":"<p><strong>Purpose: </strong>Positive airway pressure remains the gold-standard treatment for OSA, but many are intolerant. The neurotransmitter serotonin is involved in respiratory control. Evidence exists for SRIs in reducing OSA severity in the general population and ictal hypoxemia and seizure-induced respiratory arrest in people with epilepsy (PWE). However, the association between SRIs and OSA severity has not been studied in populations consisting of both groups. This study aims to determine if SRIs are associated with OSA severity in both PWE and people without epilepsy (PWO) and whether differences exist between the two groups.</p><p><strong>Methods: </strong>A retrospective study of adults with OSA was conducted. Subjects were categorized as PWE or PWO and for the use (+SRI) or absence (-SRI) of an SRI. The primary outcome was OSA severity relative to SRI status. OSA severity as a function of SRI status was also compared between PWE and PWO and within the PWE and PWO cohorts. Oxygen saturation nadir was a secondary outcome measure. Statistical adjustment of pertinent characteristics was performed.</p><p><strong>Results: </strong>There were 125 subjects (57 PWE, 68 PWO, 80 -SRI, and 45 +SRI). +SRI was associated with reduced odds of severe compared to moderate OSA, in unadjusted and adjusted analysis. Compared to PWO, PWE demonstrated a more robust association between OSA severity and +SRI. When analyzed as separate cohorts, only PWE demonstrated reduced OSA severity, with adjustment for age (OR:0.140, CI:0.021-1.116, and p=0.042). Oxygen saturation nadir was not significant in any model.</p><p><strong>Conclusions: </strong>SRIs represent a potential treatment option for OSA and may demonstrate a more robust association with reduced OSA severity in PWE compared to PWO.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2018-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/7247605","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36518381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-12eCollection Date: 2018-01-01DOI: 10.1155/2018/6534150
Osama A Khairoalsindi, Ahmad R Abuzinadah
Amyotrophic lateral sclerosis is a neurodegenerative disease that leads to loss of the upper and lower motor neurons. Almost 90% of all cases occur in the sporadic form, with the rest occurring in the familial form. The disease has a poor prognosis, with only two disease-modifying drugs approved by the United States Food and Drug Administration (FDA). The approved drugs for the disease have very limited survival benefits. Edaravone is a new FDA-approved medication that may slow the disease progression by 33% in a selected subgroup of ALS patients. This paper covers the various interventions that may provide survival benefits, such as early diagnosis, medications, gene therapy, stem cell therapy, diet, nutritional supplements, multidisciplinary clinics, and mechanical invasive and noninvasive ventilation. The recent data on masitinib, the role of enteral feeding, gene therapy, and stem cell therapy is discussed.
肌萎缩侧索硬化症是一种导致上下运动神经元丧失的神经退行性疾病。近 90% 的病例为散发性,其余为家族性。这种疾病的预后很差,美国食品和药物管理局(FDA)只批准了两种改变病情的药物。已获批准的治疗该疾病的药物对患者的生存益处非常有限。依达拉奉(Edaravone)是美国食品及药物管理局(FDA)批准的一种新药,可使部分 ALS 患者的病情恶化速度减慢 33%。本文介绍了可能对生存有益的各种干预措施,如早期诊断、药物治疗、基因治疗、干细胞治疗、饮食、营养补充剂、多学科诊所以及机械性有创和无创通气。本文还讨论了有关马西替尼、肠道喂养的作用、基因治疗和干细胞治疗的最新数据。
{"title":"Maximizing the Survival of Amyotrophic Lateral Sclerosis Patients: Current Perspectives.","authors":"Osama A Khairoalsindi, Ahmad R Abuzinadah","doi":"10.1155/2018/6534150","DOIUrl":"10.1155/2018/6534150","url":null,"abstract":"<p><p>Amyotrophic lateral sclerosis is a neurodegenerative disease that leads to loss of the upper and lower motor neurons. Almost 90% of all cases occur in the sporadic form, with the rest occurring in the familial form. The disease has a poor prognosis, with only two disease-modifying drugs approved by the United States Food and Drug Administration (FDA). The approved drugs for the disease have very limited survival benefits. Edaravone is a new FDA-approved medication that may slow the disease progression by 33% in a selected subgroup of ALS patients. This paper covers the various interventions that may provide survival benefits, such as early diagnosis, medications, gene therapy, stem cell therapy, diet, nutritional supplements, multidisciplinary clinics, and mechanical invasive and noninvasive ventilation. The recent data on masitinib, the role of enteral feeding, gene therapy, and stem cell therapy is discussed.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2018-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36443797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}