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Background@#and Purpose: Dementia subtypes, including Alzheimer’s dementia (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD), pose diagnostic challenges. This review examines the effectiveness of 18 F-Fluorodeoxyglucose Positron Emission Tomography ( 18 F-FDG PET) in differentiating these subtypes for precise treatment and management. @*Methods@#A systematic review following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines was conducted using databases like PubMed and Embase to identify studies on the diagnostic utility of 18 F-FDG PET in dementia. The search included studies up to November 16, 2022, focusing on peer-reviewed journals and applying the goldstandard clinical diagnosis for dementia subtypes. @*Results@#From 12,815 articles, 14 were selected for final analysis. For AD versus FTD, the sensitivity was 0.96 (95% confidence interval [CI], 0.88–0.98) and specificity was 0.84 (95% CI, 0.70–0.92). In the case of AD versus DLB, 18F-FDG PET showed a sensitivity of 0.93 (95% CI 0.88-0.98) and specificity of 0.92 (95% CI, 0.70–0.92). Lastly, when differentiating AD from non-AD dementias, the sensitivity was 0.86 (95% CI, 0.80–0.91) and the specificity was 0.88 (95% CI, 0.80–0.91). The studies mostly used case-control designs with visual and quantitative assessments. @*Conclusions@#18 F-FDG PET exhibits high sensitivity and specificity in differentiating dementia subtypes, particularly AD, FTD, and DLB. This method, while not a standalone diagnostic tool, significantly enhances diagnostic accuracy in uncertain cases, complementing clinical assessments and structural imaging.
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Carbon monoxide poisoning is common cause of fatal intoxication. When carbon monoxide is absorbed into the blood, it interferes with the oxygen supply to the cells, causing damage to tissues and organs. Delayed neuropsychiatric sequelae (DNS) manifested by cognitive dysfunction, motor disorder, micturition disorder are widely known complication of carbon monoxide intoxication. But neuromuscular complication is a rare DNS of carbon monoxide intoxication. We herein report a 42-year-old patient with multifocal neuropathies, rhabdomyolysis, and dermal change due to carbon monoxide intoxication.
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Background@#We aimed to investigate the factors associated with neurological manifestations of post-coronavirus disease 2019 (COVID-19) conditions. @*Methods@#We retrospectively collected data from 440 patients who visited our post-COVID-19 clinic more than 4 weeks after severe acute respiratory syndrome coronavirus 2 infection. We analyzed the prevalence of different neurological symptoms (brain fog, memory impairment, headache, and dizziness) and assessed the associated factors. @*Results@#Brain fog was the most common symptom, observed in 170 patients (38.6%), followed by headaches (n = 137, 31.1%), dizziness (n = 128, 29%), and memory impairment (n = 104, 23.6%). Brain fog was associated with hyposmia or hypogeusia (odds ratio [OR], 2.54; P < 0.001), Fatigue Severity Scale (FSS) (OR, 1.06; P < 0.001), and Hospital Anxiety and Depression Scale-Anxiety (OR, 1.09; P = 0.037). Memory impairment was associated with sleep problems (OR, 2.83; P < 0.001), FSS (OR, 1.05; P < 0.001), and age (OR, 1.02; P = 0.015). Headache was associated with sleep problems (OR, 2.28; P= 0.001), sex (OR, 1.68; P = 0.042), and FSS (OR, 1.04; P < 0.001). Dizziness was associated with sleep problems (OR, 2.88; P < 0.001), and FSS (OR, 1.04; P < 0.001). The incidence of brain fog ( P < 0.001), memory impairment ( P < 0.001), dizziness (P = 0.007), and headache (P = 0.045) accompanied by hyposmia and hypogeusia was higher in patients with the aforementioned symptoms than in those without. @*Conclusion@#This study suggests that there is a relationship between neurological symptoms and other clinical factors, such as fatigue, depression, anxiety, hyposmia, and hypogeusia.
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Background@#and Purpose: We investigated the correlation between the deep distribution of white matter hyperintensity (WMH) (dWMH: WMH in deep and corticomedullary areas, with minimal periventricular WMH) and a positive agitated saline contrast echocardiography result. @*Methods@#We retrospectively recruited participants with comprehensive dementia evaluations, an agitated saline study, and brain imaging. The participants were classified into two groups according to WMH-distributions: dWMH and dpWMH (mainly periventricular WMH with or without deep WMH.) We hypothesized that dWMH is more likely associated with embolism, whereas dpWMH is associated with small-vessel diseases. We compared the clinical characteristics, WMH-distributions, and positive rate of agitated saline studies between the two groups. @*Results@#Among 90 participants, 27 and 12 met the dWMH and dpWMH criteria, respectively. The dWMH-group was younger (62.2±7.5 vs. 78.9±7.3, p<0.001) and had a lower prevalence of hypertension (29.6% vs. 75%, p=0.008), diabetes mellitus (3.7% vs.25%, p=0.043), and hyperlipidemia (33.3% vs. 83.3%, p=0.043) than the dpWMH-group. Regarding deep white matter lesions, the number of small lesions (<3 mm) was higher in the dWMH-group(10.9±9.7) than in the dpWMH-group (3.1±6.4) (p=0.008), and WMH was predominantly distributed in the border-zones and corticomedullary areas. Most importantly, the positive agitated saline study rate was higher in the dWMH-group than in the dpWMH-group (81.5% vs. 33.3%, p=0.003). @*Conclusions@#The dWMH-group with younger participants had fewer cardiovascular risk factors, showed more border-zone-distributions, and had a higher agitated saline test positivity rate than the dpWMH-group, indicating that corticomedullary or deep WMHdistribution with minimal periventricular WMH suggests embolic etiologies.
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Background@#We aim to compare the clinical characteristics and subjectively reported symptoms of the acute coronavirus disease (COVID) phase and those of the post-acute COVID phase to examine varying factors that affect the number of persistent symptoms and their categories. @*Methods@#We categorized 1,122 patients who visited the post coronavirus disease 2019 (COVID-19) clinic into two groups: “acute group” ( 4 weeks following diagnosis of COVID-19). We statistically compared clinical characteristics between the two groups and determined which factors are associated with the number of persistent symptoms and their categories. @*Results@#The persistent symptoms of post COVID-19 conditions were classified into three categories as follows: Category A (the prevalence of symptoms is higher in the acute-visit group than in the post-acute-visit group), Category B (the prevalence of symptoms is not different between the two groups) and Category C (the prevalence of symptoms is higher in the post-acute-visit group than in the acute-visit group). Category A mainly included respiratory symptoms. Category B had generalized weakness, weight loss, cardiologic symptoms, hypogeusia, hyposmia, anxiety, and various gastrointestinal symptoms. Category C included fatigue, decreased attention, depression, blurred vision, hair loss, and sexual dysfunction.Anxiety, depression, fatigue and age were also associated with the number of symptoms and their categories, and anxiety is the most correlated factor (P < 0.001) among them. @*Conclusion@#The persistent symptoms of post COVID-19 condition involve multi-organ and continue for four weeks or greater. Therefore, long-term observation and multidisciplinary interventions are essential for patients with post COVID-19 conditions.
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Long-lasting coronavirus disease 2019 (COVID-19) symptoms beyond 12 weeks, the so-called ‘long COVID’ have been increasingly reported worldwide. Long COVID can be manifested in various forms, and there is an increasing demand for proper assessment and management.However, it is challenging when trying to determine the best-practice standards of care based on the current evidence because there is no internationally agreed clinical definition or clear treatment pathway. Therefore, the present guidelines have been drafted to provide advice on diagnosis and management based on the latest updated available evidence and the consensus of expert opinion. So far, no standard test and drug treatment can be strongly recommended for patients with long COVID because of a lack of evidence. The present guidelines provide advice based on 12 key questions, including appropriate interventions for long COVID that can be used in clinical practice. Continuous careful observation and studies related to long COVID are needed for the long-term impact of COVID-19 and proper management for long COVID to be determined.
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Purpose@#Muscle relaxation following electrical automatic massage (EAM) has been found to reduce fatigue, depression, stress, anxiety, and pain in individuals with various conditions. However, the effects of EAM have not been extensively explored in patients with Alzheimer’s disease (AD). @*Materials and Methods@#Here, we conducted a randomized controlled study to evaluate the effects of EAM on the cognitive and non-cognitive functions of patients with AD spectrum disorders. @*Results@#We found that EAM attenuated changes in attention-associated cognitive scores and subjective sleep quality relative to those in controls. @*Conclusion@#While further studies in a clinical setting are needed to support our findings, these encouraging results suggest that EAM may be an alternative therapy for the management of associated symptoms in AD (ClinicalTrials.gov ID: NCT03507192, 24/04/2018).
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Purpose@#Muscle relaxation following electrical automatic massage (EAM) has been found to reduce fatigue, depression, stress, anxiety, and pain in individuals with various conditions. However, the effects of EAM have not been extensively explored in patients with Alzheimer’s disease (AD). @*Materials and Methods@#Here, we conducted a randomized controlled study to evaluate the effects of EAM on the cognitive and non-cognitive functions of patients with AD spectrum disorders. @*Results@#We found that EAM attenuated changes in attention-associated cognitive scores and subjective sleep quality relative to those in controls. @*Conclusion@#While further studies in a clinical setting are needed to support our findings, these encouraging results suggest that EAM may be an alternative therapy for the management of associated symptoms in AD (ClinicalTrials.gov ID: NCT03507192, 24/04/2018).
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Purpose@#To report a case of ischemic optic neuropathy caused by iron deficiency anemia (IDA) accompanied by ethambutol-induced toxic optic neuropathy.Case summary: A 64-year-old female patient presented with declining visual acuity. Four months prior, she had been taking ethambutol daily for tuberculosis. Corrected visual acuity was 0.3 in both eyes and a central visual field defect was revealed in visual field tests. In the color vision test, the right eye scored three and the left eye scored two. Ethambutol was stopped immediately under suspicion of toxic optic neuropathy; however, the corrected visual acuity gradually worsened to 0.05 in the right eye and the finger count was 50 cm in the left eye. The patient’s blood test showed signs of IDA. After 5 months of IDA treatment, the blood test results returned to the normal range and corrected visual acuity improved to 0.5 in both eyes. However, focal atrophy of the ganglion cell-inner plexiform layer was observed, requiring close monitoring of optical coherence tomography findings. @*Conclusions@#Ischemic optic neuropathy due to IDA may occur in a short period of time and may be difficult to diagnose if accompanied by ethambutol-induced toxic optic neuropathy. In the case of patients with progressive vision loss, prompt diagnosis and careful monitoring in follow-up evaluations are required.
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Purpose@#To report a case of ischemic optic neuropathy caused by iron deficiency anemia (IDA) accompanied by ethambutol-induced toxic optic neuropathy.Case summary: A 64-year-old female patient presented with declining visual acuity. Four months prior, she had been taking ethambutol daily for tuberculosis. Corrected visual acuity was 0.3 in both eyes and a central visual field defect was revealed in visual field tests. In the color vision test, the right eye scored three and the left eye scored two. Ethambutol was stopped immediately under suspicion of toxic optic neuropathy; however, the corrected visual acuity gradually worsened to 0.05 in the right eye and the finger count was 50 cm in the left eye. The patient’s blood test showed signs of IDA. After 5 months of IDA treatment, the blood test results returned to the normal range and corrected visual acuity improved to 0.5 in both eyes. However, focal atrophy of the ganglion cell-inner plexiform layer was observed, requiring close monitoring of optical coherence tomography findings. @*Conclusions@#Ischemic optic neuropathy due to IDA may occur in a short period of time and may be difficult to diagnose if accompanied by ethambutol-induced toxic optic neuropathy. In the case of patients with progressive vision loss, prompt diagnosis and careful monitoring in follow-up evaluations are required.
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Background@#and Purpose: The effect of the integrated program comprising cognitive training, art therapy, and music therapy has not been extensively studied in patients with Alzheimer's disease (AD). The present study investigated the effect of integrated cognitive intervention therapy on cognition, and activity of daily life (ADL), and mood in patients with mild to moderate AD. @*Methods@#In this study, the data of 59 patients who met the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer disease and Related Disorders Association (NINCDS-ADRDS) criteria of probable AD among those who registered at the Centenarian's Good Memory Program in Goyang from September 2014 to August 2019 were collected. We statistically analyzed the scores of Korean version of a Mini-Mental Status Examination (K-MMSE), Korean Dementia Screening Questionnaire-Cognition (KDSQ-C), Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), and Seoul-Instrumental Activities of Daily Living (S-IADL) of the same patients before and after the use of integrated cognitive intervention therapy. @*Results@#K-MMSE slightly increased from 18.7±4.5 to 19.7±5.0 (p<0.001) and KDSQ-C improved from 14.5±7.6 before therapy to 12.6±7.2 after therapy (p=0.001). Mean S-IADL score improved from 17.6±7.6 before therapy to 15.7±9.5 after therapy (p<0.001). Additionally, mean GDS score before the therapy was 5.6±3.5 that improved to 4.2±3.0 after the therapy (p<0.001).Mean BAI score decreased from 8.4±10.3 before therapy to 5.9±8.4 after therapy (p=0.001). @*Conclusions@#In conclusion, this study demonstrated the possibility that the use of an integrated cognitive therapy improved cognition, ADL, and mood (depression and anxiety) in patients with mild to moderate ADs.
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BACKGROUND AND PURPOSE: In Alzheimer's continuum (a comprehensive of preclinical Alzheimer's disease [AD], mild cognitive impairment [MCI] due to AD, and AD dementia), cognitive dysfunctions are often related to cortical atrophy in specific brain regions. The purpose of this study was to investigate the association between anatomical pattern of cortical atrophy and specific neuropsychological deficits. METHODS: A total of 249 participants with Alzheimer's continuum (125 AD dementia, 103 MCI due to AD, and 21 preclinical AD) who were confirmed to be positive for amyloid deposits were collected from the memory disorder clinic in the department of neurology at Samsung Medical Center in Korea between September 2013 and March 2018. To analyze neuropsychological test-specific neural correlates representing the relationship between cortical atrophy measured by cortical thickness and performance in specific neuropsychological tests, a linear regression analysis was performed. Two neural correlates acquired by 2 different standardized scores in neuropsychological tests were also compared. RESULTS: Cortical atrophy in several specific brain regions was associated with most neuropsychological deficits, including digit span backward, naming, drawing-copying, verbal and visual recall, semantic fluency, phonemic fluency, and response inhibition. There were a few differences between 2 neural correlates obtained by different z-scores. CONCLUSIONS: The poor performance of most neuropsychological tests is closely related to cortical thinning in specific brain areas in Alzheimer's continuum. Therefore, the brain atrophy pattern in patients with Alzheimer's continuum can be predict by an accurate analysis of neuropsychological tests in clinical practice.
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Humanos , Enfermedad de Alzheimer , Atrofia , Encéfalo , Cognición , Demencia , Corea (Geográfico) , Modelos Lineales , Trastornos de la Memoria , Disfunción Cognitiva , Neuroanatomía , Neurología , Pruebas Neuropsicológicas , Placa Amiloide , SemánticaRESUMEN
OBJECTIVE: This study aimed to compare the demographic characteristics and trauma service structures and processes of hospitals in 15 countries across the Asia Pacific, and to provide baseline data for the integrated trauma database: the Pan-Asian Trauma Outcomes Study (PATOS).METHODS: Medical directors and emergency physicians at PATOS-participating hospitals in countries across the Asia Pacific were surveyed through a standardized questionnaire. General information, trauma care system data, and trauma emergency department (ED) outcomes at each hospital were collected by email and analyzed using descriptive statistics.RESULTS: Survey data from 35 hospitals across 15 countries were collected from archived data between June 2014 and July 2015. Designated trauma centers were identified as the highest hospital level for trauma patients in 70% of surveyed countries. Half of the hospitals surveyed had special teams for trauma care, and almost all prepared activation protocol documents for these teams. Most hospitals offered specialized trauma education programs, and 72.7% of hospitals had a hospital-based trauma registry. The total number of trauma patients visiting the ED across 25 of the hospitals was 300,376. The overall survival-to-discharge rate was 97.2%; however, it varied greatly between 85.1% and 99.7%. The difference between survival-to-discharge rates of moderate and severe injury groups was highest in Taiwan (41.8%) and lowest in Thailand (18.6%).CONCLUSION: Trauma care systems and ED outcomes vary widely among surveyed hospitals and countries. This information is useful to build further detailed, systematic platforms for trauma surveillance and evidence-based trauma care policies.
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Humanos , Asia , Pueblo Asiatico , Estudios Transversales , Educación , Correo Electrónico , Urgencias Médicas , Servicio de Urgencia en Hospital , Epidemiología , Ejecutivos Médicos , Taiwán , Tailandia , Centros TraumatológicosRESUMEN
Arterial dissection is an important cause of stroke. We report two cases of isolated posterior inferior cerebellar artery (PICA) dissection diagnosed by high-resolution vessel-wall MRI (HRVW-MRI). One subject complained of abrupt-onset vertigo and headache, and the other subject had headache, vertigo, and Horner syndrome. Conventional MRA showed only focal dilatation of the PICA, but HRVW-MRI revealed intramural hematoma and double-lumen contour in the PICA, suggesting arterial dissection. We suggest that the use of HRVW-MRI should be considered when diagnosing isolated PICA dissection in a PICA infarct with an unknown cause.
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Arterias , Dilatación , Cefalea , Hematoma , Síndrome de Horner , Imagen por Resonancia Magnética , Pica , Accidente Cerebrovascular , VértigoRESUMEN
Methotrexate is often used in patients with systemic lupus erythematosus for effective disease controlsand steroid-sparing, and has been known to involve the development of lymphoproliferative disorders for patients with autoimmune diseases. We report a case of spontaneous regression of Epstein-Barr virus-positive methotrexate-associated Hodgkin's lymphoma in a 24-year-old woman with systemic lupus erythematosus. Following 6 months of treatment with low-dose methotrexate, the patient developed a neck mass in the right submandibular area. A computed tomography scan of the neck, chest and abdomen revealed multiple enlarged lymph nodes. Excisional biopsy of the neck masses confirmed infiltrations of malignant lymphoid cells that were positive for CD15, CD30, and Epstein-Barr virus-encoded RNA. Reduction of the mass was observed 3 weeks after withdrawing from the methotrexate treatment. At 7 months after initial presentation, computed tomography revealed near-complete regression of lymphadenopathy. After 30 months, the patient was still in complete clinical remission.
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Femenino , Humanos , Adulto Joven , Abdomen , Enfermedades Autoinmunes , Biopsia , Enfermedad de Hodgkin , Lupus Eritematoso Sistémico , Ganglios Linfáticos , Enfermedades Linfáticas , Linfocitos , Trastornos Linfoproliferativos , Metotrexato , Cuello , Remisión Espontánea , TóraxRESUMEN
The global emergence and spread of multidrug resistant bacterial infections in communities and hospitals has become an important issue in public health. The resistance rate of gram-positive cocci to vancomycin and the resistance rate of several gram-negative bacilli against cefotaxime and carbapenem have been continuously increasing. Surveillance of antimicrobial resistance is essential for providing information on the magnitude of and trend in multidrug resistance. Therefore, beginning 2011, more robust and effective management is to be legally required for six multidrug-resistant bacteria that have been linked to healthcare-related infections: vancomycin-resistant Staphylococcus aureus (VRSA), vancomycin-resistant enterococci (VRE), methicillin-resistant S. aureus (MRSA), multidrug-resistant Pseudomonas aeruginosa (MRPA), multidrug-resistant Acinetobacter baumannii (MRAB), and carbapenem-resistant Enterobactericeae (CRE). We have also performed laboratory-based sentinel surveillance for VRSA/VISA since 2002 and carbapenemase-producing Enterobacteriaceae since November, 2010. This article reviews the national surveillance programs, and molecular epidemiology of multidrug-resistant bacteria.
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Acinetobacter baumannii , Bacterias , Infecciones Bacterianas , Cefotaxima , Resistencia a Múltiples Medicamentos , Enterobacteriaceae , Cocos Grampositivos , Resistencia a la Meticilina , Epidemiología Molecular , Nitrilos , Pseudomonas aeruginosa , Salud Pública , Piretrinas , Vigilancia de Guardia , Staphylococcus aureus , VancomicinaRESUMEN
Parvimonas micra is frequently associated with periodontal disease as well as respiratory, gastrointestinal, and female genitourinary tract infections, but only rarely has it been reported as a pathogenic agent of infectious spondylodiscitis. We describe the case of a 38-year-old woman with spondylodiscitis caused by P. micra. P. micra was cultured from the patient's blood and vertebral tissue. This case was treated with vertebral corpectomy followed by intravenous ampicillin-sulbactam for four weeks. Her symptoms and vital signs improved, and elevated inflammatory markers were normalized after treatment.
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Adulto , Femenino , Humanos , Ampicilina , Bacterias Anaerobias , Discitis , Enfermedades Periodontales , Espondilitis , Sulbactam , Signos VitalesRESUMEN
Parvimonas micra is frequently associated with periodontal disease as well as respiratory, gastrointestinal, and female genitourinary tract infections, but only rarely has it been reported as a pathogenic agent of infectious spondylodiscitis. We describe the case of a 38-year-old woman with spondylodiscitis caused by P. micra. P. micra was cultured from the patient's blood and vertebral tissue. This case was treated with vertebral corpectomy followed by intravenous ampicillin-sulbactam for four weeks. Her symptoms and vital signs improved, and elevated inflammatory markers were normalized after treatment.
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Adulto , Femenino , Humanos , Ampicilina , Bacterias Anaerobias , Discitis , Enfermedades Periodontales , Espondilitis , Sulbactam , Signos VitalesRESUMEN
A focal radioactive iodine uptake in the pelvis of a patient with differentiated thyroid cancer needs differential diagnosis besides bone metastasis. Struma ovarii is a rare monodermal ovarian teratoma composed predominantly of mature thyroid tissue; 5-10% of these tumors are malignant. As diagnosis and surgery of thyroid cancer have increased recently, incidental cases of struma ovarii, after radioactive iodine treatment, were occasionally reported. Rare cases of ovary metastasis of thyroid cancer were also reported. We report a case of benign struma ovarii incidentally found in a patient with papillary thyroid cancer. The patient showed a sustained high level of thyroglobulin and focal radioactive iodine uptake in the right pelvis, confused with distant metastasis, after total thyroidectomy and radioactive iodine treatment.