Incidence, timing, and risk factors for development of gastrointestinal bleeding in acute traumatic spinal cord injury: A systematic review.

CONTEXT: Current guidelines recommend four weeks of stress ulcer prophylaxis following traumatic spinal cord injury. OBJECTIVES: Assess the current literature on the incidence, timing, and risk factors for gastrointestinal bleeding/clinically important gastrointestinal bleeding in the acute setting following a traumatic spinal cord injury and whether the use of stress ulcer prophylaxis has been shown to reduce the rates of gastrointestinal bleeding. METHODS: A systematic review was performed in PubMed, Embase, Web of Science, and Cochrane Library following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. RESULTS: A total of 24 articles met the inclusion/exclusion criteria. The average rate of gastrointestinal bleeding among all studies was 5.5% (95% CI = 5.4-5.6%; n = 26,576). The average rate of clinically important gastrointestinal bleeding was 1.8% (95% CI = 1.79-1.82%; n = 3,857). The mean time since injury to when gastrointestinal bleeding occurred ranged from 5 to 22.5 days. For clinically important gastrointestinal bleeding the average time was 16 days or less. Those with cervical injuries had a higher incidence of clinically important gastrointestinal bleeding compared to those with non-cervical injuries (2.7% vs. 0.7%). No study found any difference in the use of stress ulcer prophylaxis in participants with or without gastrointestinal bleeding. CONCLUSIONS: The overall incidence of clinically important gastrointestinal bleeding among studies was found to be low. Individuals with non-cervical injury were not found to be at high risk of clinically important gastrointestinal bleeding. There was also insufficient evidence to indicate that use of stress ulcer prophylaxis reduces the rate of gastrointestinal bleeding in those with traumatic spinal cord injury.

Influence of adaptive video gaming on quality of life and social relationships.

In recent years, the field of adaptive video gaming has been growing rapidly. However, its acceptance as an integral service within the rehabilitation field has been slow to develop and no studies have examined the benefits of providing adaptive gaming services for individuals with disabilities. 110 participants with 6 months or more of adaptive gaming experience took part in a self-administered survey which comprised of questions assessing gaming habits, quality of life, and social relationships. Most participants either Agreed or Strongly Agreed that adaptive gaming has had a significant positive influence on their quality of life (90.9%), satisfaction with life (87.3%), and social relationships (67.2%). Two thirds of participants reported using their adaptive equipment for tasks other than gaming. Individuals who game more often, and with others, had significantly higher Social Relationship scores (p = 0.007; p = 0.044), and gaming frequency had a significant positive correlation with the overall influence of adaptive gaming (p = 0.002). There are possible quality of life and social benefits from participation in adaptive gaming, as well as translation to functional tasks. Furthermore, gaming more frequently, gaming with others, and using adaptive gaming equipment for other tasks seems to correlate with greater benefits from adaptive gaming.

A preliminary study on the respiratory benefits of adaptive video gaming in individuals with cervical spinal cord injuries.

PURPOSE: The purpose of this study was to collect preliminary data to assess whether participation in adaptive video gaming using a pneumatic sip-and-puff video game controller may provide respiratory or health benefits for individuals with cervical-level spinal cord injuries. METHODS: A survey was anonymously distributed to potential participants and consisted of four sections: (1) General Information, (2) Gaming Habits, (3) Respiratory Quality of Life, and (4) Impact of Adaptive Video Gaming on Respiratory Health. RESULTS: The study included 124 individuals with cervical-level spinal cord injuries. Participants had primarily positive self-rated health and good respiratory quality of life. Nearly half of the participants (47.6%) Agreed or Strongly Agreed that their breathing control has improved after using their sip-and-puff gaming controller and 45.2% Agreed or Strongly Agreed that their respiratory health has improved. Individuals who Agreed or Strongly Agreed that adaptive video gaming has improved their breathing control also reported a significantly higher level of exertion while gaming compared to those who did not Agree or Strongly Agree (p = 0.00029). CONCLUSIONS: It is possible that there are respiratory benefits of using sip-and-puff video game controllers for individuals with cervical spinal cord injuries. The benefits reported by users were found to be dependent on their level of exertion while playing video games. Further exploration in this area is needed due to the positive benefits reported by participants.Implications for RehabilitationPneumatic sip-and-puff video game controllers are now available for individuals with cervical spinal cord injuries allowing them to play video games using their respiratory function.For individuals with cervical spinal cord injuries, respiratory function is an important component to overall health and quality of life.This study shows that pneumatic sip-and-puff video game controllers may provide respiratory benefits to participant with cervical spinal cord injuries.

Early antiretroviral therapy in neonates with HIV-1 infection restricts viral reservoir size and induces a distinct innate immune profile.

Neonatal HIV-1 infection is associated with rapidly progressive and frequently fatal immune deficiency if left untreated. Immediate institution of antiretroviral therapy (ART), ideally within hours after birth, may restrict irreversible damage to the developing neonatal immune system and possibly provide opportunities for facilitating drug-free viral control during subsequent treatment interruptions. However, the virological and immunological effects of ART initiation within hours after delivery have not been systematically investigated. We examined a unique cohort of neonates with HIV-1 infection from Botswana who started ART shortly after birth and were followed longitudinally for about 2 years in comparison to control infants started on treatment during the first year after birth. We demonstrate multiple clear benefits of rapid antiretroviral initiation, including an extremely small reservoir of intact proviral sequences, a reduction in abnormal T cell immune activation, a more polyfunctional HIV-1-specific T cell response, and an innate immune profile that displays distinct features of improved antiviral activity and is associated with intact proviral reservoir size. Together, these data offer rare insight into the evolutionary dynamics of viral reservoir establishment in neonates and provide strong empirical evidence supporting the immediate initiation of ART for neonates with HIV-1 infection.