Chronic immune sensory polyradiculopathy (CISP): First juvenile case description.

In its typical presentation, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) occurs more often in old males as a progressive/recurrent motor and sensory nerve dysfunction with tendon areflexia. However, CIDP has also atypical clinical presentations, including pure sensory neuropathies, among which chronic immune sensory polyradiculopathy (CISP) accounts for only 0.5% of all CIDP, with no juvenile cases reported as yet. A 17-year-old girl presented for a progressive sensory ataxia and hands clumsiness. Diffuse tendon areflexia and hypokinaesthesia were observed. Motor and sensory nerve conduction studies were normal. F-waves were normal in median nerves and elongated in tibial nerves. H-reflex and somatosensory evoked potentials (SSEP) were absent. CSF normal cellularity with hyperproteinorrachia was found. Paraneoplastic, metabolic, and paraproteinemic neuropathies were excluded. A diagnosis of CISP has been made based on the presence of pure sensory symptoms in a polyneuropathic distribution, normal peripheral nerve conduction studies, and two supportive criteria (SSEP and CSF). Our paper describes the first CISP case in the pediatric age. We confirm SSEP and CSF as useful complementary tests for this diagnosis also at this age and suggest that clinicians should consider CISP in the spectrum of sporadic sensory ataxias of the pediatric age. We also suggest that in the presence of normal F-wave and peripheral motor nerve conduction, an absent H-reflex can further substantiate SSEPs in the diagnosis of CISP. Intravenous immunoglobulins were rapidly effective and safe.

Low caffeine dose improves intermittent sprint performance in hot and humid environments.

While the effects of caffeine have been evaluated in relation to endurance exercise, few studies have assessed the ergogenic effects of low caffeine doses on intermittent exercise performance in hot and humid environments. Thus, we aimed to determine the effects of low-dose caffeine supplementation on intermittent exercise performance under these conditions. Eight male soccer players (age, 19.9 ± 0.3 years; height, 173.7 ± 6.3 cm; body mass, 65.1 ± 5.5 kg; V˙O2max, 50.0 ± 3.1 mL ⋅ kg-1⋅ min-1) participated in this double-blind, randomized, cross-over study. Caffeine was orally administered at 60 min before exercise (dosage, 3 mg ⋅ kg-1). The participants completed a 90-min intermittent sprint cycling protocol under two conditions (after receiving caffeine and placebo) at 32 °C and at 70% relative humidity. A significant improvement in the total amount of work was observed in the caffeine condition compared to the placebo condition (155.0 ± 15.8 vs 150.8 ± 14.5 kJ, respectively; p < 0.05, d = 0.28). In contrast, the rectal temperature measured at the end of exercise showed no significant difference between the conditions (38.9 ± 0.4 °C and 38.7 ± 0.5 °C in the caffeine and placebo conditions, respectively; p > 0.05, d = 0.57). Other thermal responses, such as the mean skin temperature, heart rate, or sweat volume, were not significantly different between these conditions. These results suggested that a low caffeine dose improved the intermittent sprint performance and the reasons could be explained by the fact that a low caffeine dose ingestion did not affect the thermoregulatory responses compared to the placebo condition and, thus, did not attenuate its ergogenic effect on exercise in hot and humid environments.

Upper and lower limb tremor in inflammatory neuropathies.

OBJECTIVE: The mechanisms underlying neuropathic tremor remain incompletely understood and a distinction has not been drawn between proximal and distal neuropathies. Lower limb tremor contributes to imbalance in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), but this is unexplored in other neuropathies. We characterized upper and lower limb tremor in chronic immune sensory polyradiculopathy (CISP) and distal acquired demyelinating neuropathy with anti-MAG antibodies (DADS-MAG), contrasted to CIDP. METHODS: This was a cross-sectional study of 38 patients (CIDP [n = 25], CISP [n = 7], DADS-MAG [n = 6]). Clinical assessment, tremor study recordings, nerve conduction studies, and somatosensory evoked potentials were performed. Balance was measured by force platform. RESULTS: Upper limb tremor was prevalent (CIDP 66%, CISP 70%, DADS-MAG 100%). Peak frequencies followed a gradient along the upper limb, unchanged by weight-loading. Lower limb tremor was also present (CIDP 32%, CISP 29%, DADS-MAG 66%) and associated with imbalance. Nerve conduction parameters correlated with upper limb tremor in DADS-MAG and CISP, and imbalance in CISP. CONCLUSIONS: Upper limb tremor is mediated by peripheral and central mechanisms regardless of distal or proximal pathology. Lower limb tremor correlates with peripheral nerve function and contributes to imbalance. SIGNIFICANCE: This study contributes to the understanding of neuropathic tremor. Addressing lower limb tremor may be of therapeutic importance for neuropathy-associated imbalance.

Challenges in the Implementation of Competency-Based Medical Curriculum: Perspectives of Prospective Academicians.

Introduction The medical education system all over the world is witnessing a paradigm shift from traditional methods of teaching to competency-based medical education. With the current curricular change, teachers are supposed to play a catalyst role in terms of moderating the different frameworks of competency-based medical education (CBME). Following the implementation of the new curriculum in India (2019), the present study aims to understand the challenges that medical teachers face in its implementation. Materials and methods This nationwide cross-sectional study was conducted among 297 teaching faculty representing 91 medical colleges across 20 states between February and July 2020. A self-validated structured questionnaire on the views of the newly implemented competency-based medical curriculum was prepared, uploaded as a Google form link, and circulated to medical teachers through an electronic platform across the country The faculty responses were exported and analyzed using Microsoft Excel. Results Around 77.4% opined that making incremental changes to the old curriculum would have been better than the overhaul revision, and 85.6% have opined that input from more faculty must have been taken before implementing the new curriculum. Around 80% felt that the pace at which faculty are getting trained in the nodal/regional center is not adequate, and 75% of them believed that the faculty members are not adequate for preparatory work for CBME implementation. About 74.7% opined that framing specific learning objectives (SLOs) for all competencies is time-consuming. Conclusion It is the need of the hour for the curriculum to incorporate a systematic feedback mechanism built into the system. Despite the fact that many of the suggested changes are progressive, given the time and resource constraints, this can only be accomplished through the concerted and combined efforts of all those involved in medical education.

Development and Evaluation of the POPBL (Patient-Oriented Problem-Based Learning) Module in Pathology: A Comparative Analysis of Performance and Perception Among Second-Year Pathology Students.

Background and objective Employing the POPBL (Patient-Oriented Problem-Based Learning) method to teach students offers a fresh take on the classroom experience. It helps to enhance the motivation of the students, improves knowledge, self-learning behavior, and clinical reasoning, and also helps to promote long-lasting memory. In our medical college, we adopted a newer technology-oriented method with the use of case history, laboratory findings, a gross specimen of the same case, microscopic live sessions via Deca and Penta head microscopes, television, and microscopic camera. In light of this, in this study, we aimed to develop a patient- and technology-oriented new Problem-Based Learning (PBL) method and compare its effectiveness with the traditional tutorial method. Materials and methods A total of 149 second-year MBBS students were enrolled in the study. Consent was taken from all students. A total of eight systems of systemic pathology from the second-year MBBS curriculum were selected. Of the eight systems, four were covered under POPBL with gross and microscopic features associated with the help of newer-generation audiovisual aids, and the other four systems were covered under the traditional tutorial/lecture method. The evaluation was performed using prevalidated objective types of questions after exposure of about one week. The objective was to evaluate and compare the outcomes and students' performance between these two sets of pathology systems. Results Students gave excellent responses. Performance (87.92% of students had scores >75%) and attendance (94.14%) parameters with respect to POPBL gross and microscopic features associated with the help of newer-generation audiovisual aids like Deca and Penta head microscopes were superior compared to the traditional tutorial/lecture method, where 53.02% of students scored more than 75% and the attendance was 76.12%. The difference in attendance was also statistically significant (p=0.05). Conclusion Using POPBL instead of standard tutorial/lecture methods leads to better outcomes. Students also found POPBL more appealing than standard lectures. It is a student-centered method that provides a significant level of motivation and encourages active participation among students. The efficacy of this new way of teaching and demonstrating will attract more students to this method.

Profiling of the essential oil compositions from the flowers and leaves of Tanacetum fisherae Aitch. & Hemsl., an endemic plant in Kerman province, Iran.

Tanacetum fisherae Aitch. & Hemsl. is an endemic plant growing wild in some brackish regions of Iran. Since there are not enough reports concerning the quantitative and qualitative analyses of its essential oil, it was decided to characterise the respective water-distilled oils obtained from the flowers and leaves of this medicinal plant. Characterisation of the corresponding essential oil profiles revealed that in both of the analysed oils, oxygenated monoterpenes constituted most of the chemical profiles. In this sense, the most prevailing natural compounds in the flower oils were cis-p-2-menthen-1-ol (11.2%), trans-p-2-menthen-1-ol (10.7%), trans-piperitol (7.8%), 1,8-cineole (6.1%), cis-piperitol (3.8%), α-terpineol (3.7%) and terpinene-4-ol (2.1%), whereas the main constituent components of the leaves oils were, respectively, 1,8-cineole (16.7%), cis-p-2-menthen-1-ol (14.6%), trans-p-2-menthen-1-ol (10.4%), trans-piperitol (12.8%), α-terpineol (5.4%), cis-piperitol (2.9%), borneol (2.7%), and terpinene-4-ol (2.1%). In addition, the second rank of natural compound constituting groups was due to oxygenated sesquiterpenes, as well.[Formula: see text].