关键词： Neurosurgical Procedures   Hematology  

关键词： ongoing EEG   spectral composition   human constitution (constitution of the person)   temperament   vertebroneurology   cervical spine   neck pain   cervicalgia   cervicocranialgia  

摘要： Effects of temperament as a constitutional feature of higher nervous activity on the spectral characteristics of ongoing EEG activity were examined in 54 patients with neurological spinal cervical-level disorders (cervicocranialgies, cervicalgies, and cervicobrachialgies). Four types of temperaments were classified in the examined patients, choleric (group ChT, n = 22), sanguine (ST, n = 10), melancholic (MT, n = 19), and phlegmatic (PhT, n = 3). Spectral analysis of EEGs showed that normalized powers of the rhythm in some cortical areas of patients of the PhT group were lower than those in patients of groups ChT, MT, and ST (P < 0.05). The most significant intergroup specificity of the EEG patterns was found in the normalized power of the 1 and 2 subrhythms. In patients of the MT and PhT groups, these indices were noticeably greater than those in ST and ChT subjects (P< 0.05 and P< 0.01, respectively). As was found, the power of oscillations correlated with the temperament-related indices, negatively with the estimates of extra/introversion and positively with the neuroticism level (P < 0.05). Thus, temperament-related specificities are in a certain way reflected in the characteristics of mostly activity and, therefore, are dependent on the level of activity of the cerebral reticular formation.

关键词： Acute stroke therapy   depression   ischemic stroke   long-term outcome   mortality   prognosis   recurrence   stroke   thrombolysis  

摘要： Background Despite improved survival and short-term (90-day) outcomes of ischemic stroke patients, only sparse data exist describing the sustained benefits of acute stroke care interventions and long-term prognosis of stroke survivors. Aim We review the contemporary literature assessing long-term (5 years or more) outcomes after stroke and acute stroke treatment. Summary of review Acute stroke unit care and intravenous thrombolysis have sustained benefits over longer follow-up, but few data exist on the long-term outcome after endovascular thrombectomy (EVT). A large proportion of stroke survivors face challenges of residual disability and neuropsychiatric sequelae (especially affective disorders and epilepsy) which affects their quality of life and is associated with poorer prognosis due to increase in stroke recurrences/mortality. Nearly, a quarter of stroke survivors have a recurrent stroke at 5 years, and nearly double that at 10 years. Mortality after recurrent stroke is high, and half of the stroke survivors are deceased at 5 years after stroke and three fourth at 10 years. Long-term all-cause mortality is largely due to conditions other than stroke. Both stroke recurrence and long-term mortality are affected by several modifiable risk factors, and thus amenable to secondary prevention strategies. Conclusions There is a need for studies reporting longer term effects of acute interventions, especially EVT. Better preventive strategies are warranted to reduce the vascular and non-vascular mortality long after stroke.

关键词： Acute kidney injury   Cardiac arrest   Neurological outcome   Targeted temperature management  

摘要： Background: Acute kidney injury (AKI) may be associated with short- and long-term patient morbidity and mortality. Therefore, the impact of AKI after cardiac arrest on survival and neurological outcome was evaluated. Methods: An observational single center study was conducted and consecutively included all out and in hospital cardiac arrest (OHCA/IHCA) patients treated with therapeutic temperature management between 2006 and 2013. Patient morbidity, mortality and neurological outcome according to the widely used Pittsburgh Cerebral Performance Category (CPC) were assessed. A good neurological outcome was defined as a CPC of 1-2 versus a poor neurological outcome with a CPC of 3-5. AKI was defined by using the KDIGO Guidelines 2012. Results: 503 patients were observed in total. 29.4% (n = 148) developed AKI during their intensive care unit (ICU) stay. 70.6% (n = 355) did not experience AKI. The mean age at admission was 62 years, of those 72.8% were male and 77% experienced an out-of-hospital cardiac arrest (OHCA). AKI occurred with 41.2% more often in the group with poor neurological outcome compared to 17.1% in the group with good neurological outcome. The median survival for patients after cardiac arrest with AKI was 0.07 years compared to 6.5 years for patients without AKI. Conclusion: Our data suggest that AKI is a major risk factor for a poor neurological outcome and a higher mortality after cardiac arrest. Further important risk factors were age, time to ROSC and high NSE. (C) 2018 Elsevier Inc. All rights reserved.

关键词： peripheral IV   phenylephrine   peripheral catheter   vasopressors   neurocritical care   neuro ICU  

摘要： Objective: The traditional approach for infusing vasopressors is to insert central venous catheters, which is associated with several complications. Phenylephrine is a commonly used vasopressor in the neurologic intensive care unit (neuro ICU), and due to its modest potency, the risk of local tissue injury from extravasation may be overestimated. The purpose of this study was to evaluate the safety of phenylephrine infusion through peripheral intravenous catheter (PIV) in the neuro ICU. Patients and Methods: Retrospective review of all consecutive adults admitted to the neuro ICU receiving phenylephrine infusion via PIV at a tertiary academic medical center from September 2012 to November 2015. Results: Two hundred seventy-seven patients with a mean age of 65 years (standard deviation [SD]: 15) were included in the final analysis. The most common indications for phenylephrine use were hemodynamic augmentation (40%) and postoperative hypotension (32%). The most common location of PIV-infusing phenylephrine was proximal upper extremity (50%). The most common PIV gauge was 20 (41%). The mean maximum dose of phenylephrine was 79 g/min (SD: +/- 53, range: 5-200) or 1.04 g/kg/min (SD: +/- 0.74, range: 0.07-3.49) and was continued for a mean duration of 19 hours (SD: +/- 18, range: 1-129). Nine (3%) total episodes of PIV infiltration were noted, none requiring intervention for significant tissue injury or limb ischemia. Conclusion: Infusion of phenylephrine through PIV is safe when used in moderate doses for a short time and can be considered in lieu of placing a central line solely for this purpose.

关键词： Long-term predictors   Pre-symptomatic testing   Neurodegenerative diseases   Psychological impact  

摘要： This longitudinal study aimed at determining predicting variables for middle and long-term psychological disturbance due pre-symptomatic testing (PST) for two late-onset neurological diseases, Huntington disease (HD) and TTR (transthyretin protein) familial amyloid polyneuropathy (FAP) Val30Met (now classified as Val50Met). 196 clinical records of persons who performed PST at least three years ago and answered to the two stages of evaluation (before PST and least 3 years after disclosure of results) were analysed. For this purpose, regression analysis was performed, showing that the Positive Symptom Distress Index (PSDI), psychoticism, somatization and paranoid ideation dimensions assume predictive value in the middle and long-term impact for total anxiety and PSDI. The result of PST was not a relevant predictor. The application of an evaluation instrument of various psychopathological dimensions played a fundamental role in the detection of clinical situations that may arise several years later after PST. Attention should be paid to providing psychological support to persons at-risk who, at the pre-test phase, present some psychopathology indices before pursuing with genetic testing.

关键词： Clinical pharmacists   Drug-related problems   Egypt   Hospitalized patients   Neurology   Patient harm  

摘要： Background Drug-related problems (DRPs) are common in hospitalized patients with neurological diseases. Clinical pharmacy services could minimize drug-related harm and improve patient care. Objective To identify common DRPs in neurology and document clinical pharmacists' medication-related interventions. Setting The wards and intensive care unit of the Department of Neurology at Assiut University Hospital. Method Prospective study of clinical pharmacists' interventions during the routine care work of reviewing patients medical charts over a period of 6months from January to June 2017. Main outcome measure The frequency and severity of DRPs and clinical pharmacists' recommendations. Results Out of 1421 reviewed medications charts, a total of 414 DRPs were detected for 285 admitted patients. The most common DRPs were drug selection problems (36.7%) and dosing errors (27.5%). The majority of DRPs (71.7%) were categorized as causing no patient harm. Clinical pharmacists provided recommendations for the detected problems that ranged from drug monitoring to stop and starting new medicines. About 90% of pharmacists' interventions were accepted by physicians. Poisson regression of factors that may influence the frequency of DRPs revealed significant associations of patient age (p=0.03) and the number of comorbid diseases (p=0.01). Conclusions Prescribing errors in neurology inpatient are likely to occur. Clinical pharmacists' interventions assisted in early detection of drug problems and prevention of the consequent patient harms.

关键词： compassionate use   allocation   investigational drugs   ethics   FDA  

摘要： Patients who suffer from life-threatening illnesses or are stricken with conditions that could result in serious morbidity who have exhausted all appropriate treatments may choose to try, through the Food and Drug Administration's expanded access program, an investigational drug or device in development. The program has succeeded for decades in allowing patients to access potentially helpful but still experimental agents. Nevertheless, the administration of investigational drugs outside of clinical trials raises several ethical issues. Of particular concern are the validity of informed consent and the absence of a framework to ensure that experimental drugs are allocated justly and transparently. Although there are some safeguards to help protect the soundness of consent, little work to date has been done to guarantee that investigational medical products are allocated justly and transparently. We introduce a novel pilot project that seeks to address this issue.

关键词： Functional neurological symptom disorder   Psychogenic non epileptic seizures   Functional weakness   Response inhibition   Dissociation  

摘要： Abnormal response inhibition has been demonstrated in psychogenic movement disorders (PMD) and is a plausible mechanism for other forms of functional neurological symptom disorder (FNSD), in which response inhibition has not yet been investigated. Response inhibition was therefore studied in patients with FNSD, including patients with psychogenic non-epileptic seizures (PNES), functional weakness (FW) or both. Twenty-nine patients with FNSD and 29 age and sex-matched healthy volunteers underwent a go-nogo task, a stop-signal reaction time (SSRT) task, and a negative priming flanker task. The Attentional Resource Allocation Scale, the Beck Depression Inventory and the Spielberger State and Trait Anxiety Inventory were also administered. Mean hit rates on nogo trials, miss rates on go signals and discriminability index were higher and go signal reaction times were significantly longer in the FNSD group than in healthy controls. The presence of FW was associated with increased hit rates on nogo trials, suggesting a bias toward responding to nogo signals rather than missed go signals. SSRT and negative priming were not significantly different from healthy controls. It is unclear whether impaired performance on the go-nogo task reflects dysfunctional inhibitory processes, disordered attention, or impaired ability to discriminate between stimuli. (C) 2018 Elsevier Ltd. All rights reserved.