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1.
Pan Afr Med J ; 36: 71, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32754298

RESUMO

Introduction: polio eradication initiatives started in 1988, this is almost the past 32 years following the WHA resolution 41.8 of eradicating polio by the year 2000. As of 2019, only 3 countries remained to be polio endemic globally, Afghanistan, Pakistan and Nigeria. The east and southern sub-region countries had shown progressive achievement towards polio eradication and to start with the African regional certification. The availability of sensitive AFP surveillance performance is among important strategies in the achievement of polio eradication. We, therefore, decided to conduct this assessment of AFP performance from 2012 to 2019 in the ESA sub-region have evidence documentation and support the certification process of the WHO AFRO region. Methods: we reviewed all reported acute flaccid paralysis (AFP) cases from 19 countries in the ESA sub region with the date of onset of paralysis from 1 January 2012 to 31 December 2019. The data were run to descriptive analysis based on the personal characteristics and AFP surveillance performance indicators parameters. Results: a total of 46,014 AFP cases were reported from 19 countries in the ESA countries who were paralyzed from 1 January 2012 to 31 December 2019. The most affected age group was children aged 0 to 3 years old where 19,740 children with acute paralysis were reported representing 42.9% of the total reported AFP for the period. The overall assessment of the non-polio AFP rate, there is an increase from a rate of 2.7 in 2012 to 3.5 in 2019 per 100,000 population aged less than 15 years, reflects a significant change with a p-value of 0.040 (95% C.I. ranges from 0.035 to 1.564). Furthermore, the percentage of stool adequacy raised from 86.4% in 2012 to 88.5% in 2019, with an observed 2.1% difference and no significant change over the 8 years. Conclusion: we observed an overall increase in the sensitivity of the AFP surveillance performance for the ESA sub-region countries from 2012 to 2019 using the national performance indicators. The COVID-19 pandemic paused an operational challenge for AFP surveillance performances from 2020. A further subnational surveillance performance analysis is suggested.


Assuntos
Infecções por Coronavirus/epidemiologia , Paralisia/epidemiologia , Pneumonia Viral/epidemiologia , Poliomielite/epidemiologia , Vigilância da População/métodos , Doença Aguda , Adolescente , África Oriental/epidemiologia , África Austral/epidemiologia , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias , Estudos Retrospectivos
2.
BMC Infect Dis ; 20(1): 611, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32811467

RESUMO

BACKGROUND: The poliovirus has been targeted for eradication since 1988. Kenya reported its last case of indigenous Wild Poliovirus (WPV) in 1984 but suffered from an outbreak of circulating Vaccine-derived Poliovirus type 2 (cVDPV2) in 2018. We aimed to describe Kenya's polio surveillance performance 2016-2018 using WHO recommended polio surveillance standards. METHODS: Retrospective secondary data analysis was conducted using Kenyan AFP surveillance case-based database from 2016 to 2018. Analyses were carried out using Epi-Info statistical software (version 7) and mapping was done using Quantum Geographic Information System (GIS) (version 3.4.1). RESULTS: Kenya reported 1706 cases of AFP from 2016 to 2018. None of the cases were confirmed as poliomyelitis. However, 23 (1.35%) were classified as polio compatible. Children under 5 years accounted for 1085 (63.6%) cases, 937 (55.0%) cases were boys, and 1503 (88.1%) cases had received three or more doses of Oral Polio Vaccine (OPV). AFP detection rate substantially increased over the years; however, the prolonged health workers strike in 2017 negatively affected key surveillance activities. The mean Non-Polio (NP-AFP) rate during the study period was 2.87/ 100,000 children under 15 years, and two adequate specimens were collected for 1512 (88.6%) AFP cases. Cumulatively, 31 (66.0%) counties surpassed target for both WHO recommended AFP quality indicators. CONCLUSIONS: The performance of Kenya's AFP surveillance system surpassed the minimum WHO recommended targets for both non-polio AFP rate and stool adequacy during the period studied. In order to strengthen the country's polio free status, health worker's awareness on AFP surveillance and active case search should be strengthened in least performing counties to improve case detection. Similar analyses should be done at the sub-county level to uncover underperformance that might have been hidden by county level analysis.


Assuntos
Surtos de Doenças/prevenção & controle , Monitoramento Epidemiológico , Paralisia/epidemiologia , Poliomielite/epidemiologia , Poliomielite/prevenção & controle , Poliovirus/imunologia , Adolescente , Criança , Pré-Escolar , Fezes/virologia , Feminino , Sistemas de Informação Geográfica , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Masculino , Paralisia/virologia , Vacina Antipólio Oral/efeitos adversos , Vigilância da População , Estudos Retrospectivos , Software
3.
Medicine (Baltimore) ; 99(31): e21298, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756110

RESUMO

Serums were collected from people to assess whether polio immunity level was high enough to satisfy the polio vaccine immunization switch in Chongqing.People in 7 age groups (<1 year, 1-2 years, 3-4 years, 5-6 years, 7-14 years, 15-19 years, ≧20 years) were randomly selected in 3 areas by different geographical features in 2015. Peripheral venous blood samples were obtained and assays to detect poliovirus (PV) -neutralizing antibodies were performed. Acute flaccid paralysis (AFP) data was collected from 2012 to 2016 in Chongqing to evaluate the performance of AFP surveillance system by indicator analysis.A total of 636 people were tested for PV neutralization antibodies (NA). Overall NA seroprevalence for PV1, PV2 and PV3 were 93.40%, 96.38% and 91.82%, and geometric mean titers (GMTs) were 61.14, 66.78 and 21.47, respectively. GMTs and NA seroprevalence for PV1, PV2 and PV3 in older people were lower than young people. There were significant differences in seroprevalences of PV1 and PV3 among geographic areas (P < .05) in Chongqing.High seroprevalence for PV1, PV2, and PV3 and qualified capability for monitoring AFP cases showed that the polio eradication program has made positive achievements in Chongqing and established a stable base for a polio vaccine immunization switch. Nevertheless, GMTs were negatively associated with age in the geographic districts with poor economical features, which will increase the risk of emergence of vaccine-derived PV after polio vaccine switch. More than 1 dose of inactivated polio vaccine should be introduced into the polio vaccine schedule, and the supplementary immunization of polio should still be annually carried out after polio vaccine switch, especially among elder children and the adults.


Assuntos
Anticorpos Antivirais/sangue , Paralisia/epidemiologia , Poliovirus/imunologia , Adolescente , Anticorpos Neutralizantes/sangue , Criança , Pré-Escolar , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Hipotonia Muscular , Paralisia/sangue , Paralisia/etiologia , Estudos Soroepidemiológicos , Adulto Jovem
4.
Rinsho Shinkeigaku ; 60(8): 549-553, 2020 Aug 07.
Artigo em Japonês | MEDLINE | ID: mdl-32641634

RESUMO

A 39-year-old man presented with an 8-month history of pain and paresthesia of the right foot sole and difficulty in the right toe dorsiflexion. A neurological examination revealed weakness in performing both the ankle and right foot toe dorsiflexion, reduced right planta pedis sensation, and absent right Achilles tendon reflex. Tinel's sign was present on the right popliteal fossa and medial part of the right ankle. MRI of the right knee showed multiple cystic lesions in his right tibial nerve. The cystic lesions extended from the popliteal fossa and were thought to be intraneural ganglion cysts. On MRI performed 4 months later, most of the cystic lesions spontaneously vanished. Therefore, intraneural ganglia should be considered when atypical mononeuropathy, such as tibial nerve palsy, is present.


Assuntos
Cistos Glanglionares/complicações , Paralisia/etiologia , Neuropatia Tibial/etiologia , Adulto , Cistos Glanglionares/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Nervo Tibial/diagnóstico por imagem
5.
Medicine (Baltimore) ; 99(27): e20974, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629711

RESUMO

BACKGROUND: Stroke is emerging as a significant health issue that threatens human health worldwide and as a common sequela of stroke spastic paralysis after stroke (SPAS) has received wide attention. Currently, several systematic reviews have suggested that the commonly used acupuncture therapy (electroacupuncture, fire acupuncture, warm acupuncture, and filiform needle acupuncture) has achieved significant efficacy in the treatment of SPAS. In this study, network meta-analysis will be used to analyze the results of different clinical trials and evaluate the differences in the efficacy of different acupuncture treatments for SPAS. METHODS: Only randomized controlled trials will be included and all patients were diagnosed as spastic paralysis after stroke. A computer-based retrieval will be conducted at CNKI, WanFang databases, VIP, Sinoed, Pubmed, Embase, Web of Science, and the Cochrane library. The search period limit is from the time the date of database establishment to April 17, 2020. To avoid omissions, we will manually retrieve relevant references and conference papers. The risk of bias in the final included studies will be evaluated based on the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by Revman5.3, WinBUGS 1.4.3, and Stata14.2. RESULTS: This study quantified the effectiveness of each intervention for different outcome indicators. The primary outcomes include the Fugl-Meyer Assessment score, the modified Ashworth scale for the assessment of spasticity, and Barthel Index. The secondary outcomes include clinical effectiveness and adverse reactions. CONCLUSION: It will provide evidence-based medical evidence for clinicians to choose more effective acupuncture therapy for SPAS.


Assuntos
Terapia por Acupuntura/métodos , Paralisia/terapia , Acidente Vascular Cerebral/complicações , Humanos , Metanálise como Assunto , Espasticidade Muscular/etiologia , Paralisia/etiologia , Revisões Sistemáticas como Assunto
6.
Toxicon ; 185: 64-71, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621838

RESUMO

Crotamine is a cationic polypeptide composed by 42 amino acid residues with several pharmacological and biological properties, including the selective ability to enter and kill actively proliferating tumour cells, which led us to propose its use as a theranostic agent for cancer therapy. At the moment, the improvement of crotamine antitumoral efficacy by association with chemotherapeutic adjuvants is envisioned. In the present work, we evaluated the association of crotamine with the antitumoral adjuvant phenotiazine thioridazine (THD). In spite of the clear efficacy of these both compounds as anticancer agents in long-term in vivo treatment of animal model bearing implanted xenograph melanoma tumor, the expected mutual potentiation of the antitumor effects was not observed here. Moreover, this association revealed for the first time the influence of THD on crotamine ability to trigger the hind limb paralysis in mice, and this discovery may represent the first report suggesting the potential involvement of the CNS in the action of this snake polypeptide on the skeletal muscle paralysis, which was classically believed to be essentially limited to a direct action in peripheral tissues as the skeletal muscle. This is also supported by the observed ability of crotamine to potentiate the sedative effects of THD which action was consistently demonstrated to be based on its central action. The better characterization of crotamine properties in CNS may certainly bring important insights for the knowledge needed to pave the way toward the use of this molecule as a theranostic compound in human diseases as cancer.


Assuntos
Antineoplásicos/uso terapêutico , Venenos de Crotalídeos/toxicidade , Extremidade Inferior , Paralisia/tratamento farmacológico , Tioridazina/uso terapêutico , Animais , Antineoplásicos/farmacologia , Modelos Animais de Doenças , Camundongos , Tioridazina/farmacologia
7.
Chin J Traumatol ; 23(4): 211-215, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32571532

RESUMO

Since December 2019, COVID-19, an acute infectious disease, has gradually become a global threat. We report a case of thoracolumbar fractures (T12 and L1) and incomplete lower limb paralysis in a patient with COVID-19. After a series of conservative treatment which did not work at all, posterior open reduction and pedicle screw internal fixation of the thoracolumbar fracture were performed in Wuhan Union Hospital. Three weeks later, the patient could stand up and the pneumonia is almost cured. We successfully performed a surgery in a COVID-19 patient, and to our knowledge it is the first operation for a COVID-19 patient ever reported.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Vértebras Lombares/lesões , Paralisia/cirurgia , Pneumonia Viral/complicações , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Pandemias , Parafusos Pediculares , Vértebras Torácicas/cirurgia
8.
Ann Afr Med ; 19(2): 147-149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32499473

RESUMO

Sjogren syndrome (SS) is a systemic autoimmune disorder with predominant exocrine gland involvement leading to sicca symptoms. Among extraglandular manifestations, renal disease is the most common. Tubular interstitial nephritis and renal tubular acidosis (RTA) are the common presentations. Mild hypokalemia associated with distal RTA is common in SS, however, severe hypokalemia causing paralysis is unusual. We report the case of a 26-year-old female who presented with hypokalemic paralysis. On evaluation, distal RTA was diagnosed. Further evaluation showed positive SS-a/SS-b antibodies in high titer, which confirms the diagnosis of primary SS. Our report illustrates that SS is a rare but important cause of hypokalemic paralysis.


Assuntos
Acidose Tubular Renal/complicações , Hipopotassemia/diagnóstico , Paralisia/etiologia , Síndrome de Sjogren/diagnóstico , Administração Intravenosa , Administração Oral , Adulto , Anticorpos Antinucleares/sangue , Bicarbonatos/administração & dosagem , Bicarbonatos/uso terapêutico , Feminino , Humanos , Hipopotassemia/tratamento farmacológico , Paralisia Periódica Hiperpotassêmica , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/uso terapêutico , Citrato de Potássio/administração & dosagem , Citrato de Potássio/uso terapêutico , Compostos de Potássio/administração & dosagem , Compostos de Potássio/uso terapêutico , Síndrome de Sjogren/etiologia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(26): e20929, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590805

RESUMO

Retrospective reviewThe degree of spinal cord compression and bony spinal canal stenosis are risk factors for the occurrence of spinal cord injury (SCI) without major fracture or dislocation, but they do not affect the severity of neurological symptoms. However, whether a relatively large spinal cord for the dural sac influences the severity of symptoms in SCI cases is unknown.The purpose of this study was to verify the influence of spinal cord size relative to dural sac on the severity of paralysis in elderly patients with cervical SCI caused by minor trauma.Subjects were 50 elderly patients with SCI caused by falls on flat ground. At 72 hours after injury, neurological assessment was performed using the Japanese Orthopaedic Association (JOA) scoring system. Bony canal anteroposterior diameters (APD) at mid C5 vertebral body were measured with computed tomography. We measured dural sac and spinal cord APD at the injured level and mid C5 with magnetic resonance imaging. Spinal cord compression ratio was calculated by dividing spinal cord at the injured level by spinal cord at mid C5. As the evaluation of spinal cord size relative to the dural sac, spinal cord/dural sac ratio was calculated at the injured level and mid C5. To clarify the factors influencing the severity of paralysis, the relationships between JOA score and those parameters were examined statistically.A significant negative correlation was observed between JOA score and spinal cord/dural sac ratio at mid C5. No clear relationship was observed between JOA score and bony canal APD or spinal cord compression ratio.In elderly patients with SCI caused by minor trauma, a relatively large spinal cord for the dural sac was shown to be a factor that influences the severity of paralysis. This result can be useful for the treatment and prevention of SCI in the elderly.


Assuntos
Vértebras Cervicais/lesões , Paralisia/etiologia , Canal Vertebral/anatomia & histologia , Traumatismos da Medula Espinal/etiologia , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/anatomia & histologia , Feminino , Geriatria/métodos , Humanos , Japão/epidemiologia , Imagem por Ressonância Magnética/métodos , Masculino , Paralisia/epidemiologia , Índice de Gravidade de Doença , Canal Vertebral/patologia , Medula Espinal/anormalidades , Medula Espinal/fisiologia , Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/epidemiologia
10.
MMWR Morb Mortal Wkly Rep ; 69(20): 623-629, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32437342

RESUMO

Since the Global Polio Eradication Initiative (GPEI) was launched in 1988, the number of polio cases worldwide has declined approximately 99.99%; only two countries (Afghanistan and Pakistan) have never interrupted wild poliovirus (WPV) transmission (1). The primary means of detecting poliovirus circulation is through surveillance for acute flaccid paralysis (AFP) among children aged <15 years with testing of stool specimens for WPV and vaccine-derived polioviruses (VDPVs) (genetically reverted strains of the vaccine virus that regain neurovirulence) in World Health Organization (WHO)-accredited laboratories (2,3). In many locations, AFP surveillance is supplemented by environmental surveillance, the regular collection and testing of sewage to provide awareness of the extent and duration of poliovirus circulation (3). This report presents 2018-2019 poliovirus surveillance data, focusing on 40 priority countries* with WPV or VDPV outbreaks or at high risk for importation because of their proximity to a country with an outbreak. The number of priority countries rose from 31 in 2018 to 40 in 2019 because of a substantial increase in the number of VDPV outbreaks† (2,4). In areas with low poliovirus immunity, VDPVs can circulate in the community and cause outbreaks of paralysis; these are known as circulating vaccine derived polioviruses (cVDPVs) (4). In 2019, only 25 (63%) of the 40 designated priority countries met AFP surveillance indicators nationally; subnational surveillance performance varied widely and indicated focal weaknesses. High quality, sensitive surveillance is important to ensure timely detection and response to cVDPV and WPV transmission.


Assuntos
Erradicação de Doenças , Saúde Global/estatística & dados numéricos , Poliomielite/prevenção & controle , Vigilância da População , Monitoramento Ambiental , Humanos , Laboratórios , Paralisia/epidemiologia , Poliomielite/epidemiologia , Poliovirus/isolamento & purificação
12.
Med Sci Monit ; 26: e920751, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32134903

RESUMO

Todd's paralysis, a neurological abnormality characterized by temporary limb weakness or hemiplegia, typically occurs following a seizure, without enduring consequences. Since limb weakness or hemiplegia can also be a common symptom of an acute ischemic stroke, it is often difficult to diagnose Todd's paralysis in individuals experiencing an acute ischemic stroke if they do not have a pre-existing history of epilepsy. Given that there is a limited understanding of Todd's paralysis, this review discusses the history, prevalence, clinical manifestations, duration, etiology, and diagnosis of Todd's paralysis. A few factors that may help clinicians distinguish Todd's paralysis from other clinical indications are as follows: (1) Todd's paralysis is commonly observed after partial seizures or generalized tonic-clonic seizures. (2) The incidence of Todd's paralysis is greater if the epilepsy is associated with old age or stroke history. (3) The duration of Todd's paralysis can range from minutes to days, depending on the type of seizure or whether the patient has experienced cortical structural damage. (4) The etiology of Todd's paralysis is associated with cerebral perfusion abnormality after seizures. Further research is needed to explore factors that distinguish Todd's paralysis from other indications that may lead to limb weakness in order to improve the diagnosis of Todd's paralysis.


Assuntos
Paralisia/fisiopatologia , Convulsões/complicações , Epilepsia/complicações , Humanos , Paralisia/etiologia , Acidente Vascular Cerebral/complicações
13.
PLoS Biol ; 18(3): e3000618, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32182233

RESUMO

Botulinum neurotoxins (BoNTs) are a family of bacterial toxins with seven major serotypes (BoNT/A-G). The ability of these toxins to target and bind to motor nerve terminals is a key factor determining their potency and efficacy. Among these toxins, BoNT/B is one of the two types approved for medical and cosmetic uses. Besides binding to well-established receptors, an extended loop in the C-terminal receptor-binding domain (HC) of BoNT/B (HC/B) has been proposed to also contribute to toxin binding to neurons by interacting with lipid membranes (termed lipid-binding loop [LBL]). Analogous loops exist in the HCs of BoNT/C, D, G, and a chimeric toxin DC. However, it has been challenging to detect and characterize binding of LBLs to lipid membranes. Here, using the nanodisc system and biolayer interferometry assays, we find that HC/DC, C, and G, but not HC/B and HC/D, are capable of binding to receptor-free lipids directly, with HC/DC having the highest level of binding. Mutagenesis studies demonstrate the critical role of consecutive aromatic residues at the tip of the LBL for binding of HC/DC to lipid membranes. Taking advantage of this insight, we then create a "gain-of-function" mutant HC/B by replacing two nonaromatic residues at the tip of its LBL with tryptophan. Cocrystallization studies confirm that these two tryptophan residues do not alter the structure of HC/B or the interactions with its receptors. Such a mutated HC/B gains the ability to bind receptor-free lipid membranes and shows enhanced binding to cultured neurons. Finally, full-length BoNT/B containing two tryptophan mutations in its LBL, together with two additional mutations (E1191M/S1199Y) that increase binding to human receptors, is produced and evaluated in mice in vivo using Digit Abduction Score assays. This mutant toxin shows enhanced efficacy in paralyzing local muscles at the injection site and lower systemic diffusion, thus extending both safety range and duration of paralysis compared with the control BoNT/B. These findings establish a mechanistic understanding of LBL-lipid interactions and create a modified BoNT/B with improved therapeutic efficacy.


Assuntos
Toxinas Botulínicas Tipo A/metabolismo , Toxinas Botulínicas Tipo A/farmacologia , Membrana Celular/metabolismo , Animais , Sítios de Ligação , Toxinas Botulínicas Tipo A/química , Toxinas Botulínicas Tipo A/genética , Células Cultivadas , Cristalografia por Raios X , Feminino , Gangliosídeos/metabolismo , Lipídeos de Membrana/metabolismo , Camundongos , Músculo Esquelético/efeitos dos fármacos , Mutação , Neurônios/citologia , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Paralisia/induzido quimicamente , Engenharia de Proteínas , Ratos Transgênicos , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/farmacologia , Sinaptotagminas/metabolismo , Triptofano/química , Triptofano/metabolismo
14.
Int J Infect Dis ; 95: 157-159, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32220630

RESUMO

Botulism is a form of paralysis caused by a neurotoxin produced by the bacterium Clostridium botulinum. It is well known that natural honey contains Clostridium botulinum spores; controversy arises when a honey-related product is being used for wound care, where the possibility occurs of applying these spores to an open wound. To our knowledge, no reported cases of medical-grade honey have been associated with wound botulism. Given this fact, do we feel secure regarding the safety of this product, and will it be enough to alleviate our concern? We present a case of an infant with an infected umbilical stump, which required a surgical wound debridement. This infant developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care. Even though suspicion of wound botulism is high, confirmation of the diagnosis, detection of neurotoxin, and isolating the organism remains a challenge.


Assuntos
Botulismo/diagnóstico , Botulismo/etiologia , Mel/efeitos adversos , Administração Tópica , Desbridamento , Feminino , Mel/microbiologia , Humanos , Lactente , Paralisia/etiologia , Ferimentos e Lesões/cirurgia
15.
Medicine (Baltimore) ; 99(3): e18817, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011490

RESUMO

RATIONALE: Although C5 palsy is a common complication of cervical spine surgery, its cause has not been confirmed. There are various hypotheses for its mechanism, including spinal cord impairment and nerve involvement. Therefore, prophylactic foraminotomy is one of the methods recommended for preventing C5 palsy. However, we describe a patient who experienced C5 palsy after microendoscopic foraminotomy between the left C5/6 and C6/7 levels. PATIENT CONCERNS: A 43-year-old man presented with a 14-month history of progressive numbness in the left upper limb. We performed microendoscopic left foraminal decompressions at the C5/6/7 levels to treat the left C6 and C7 radiculopathy. On the postoperative day 1, we observed weak motor strength of the left deltoid, left biceps, and left forearm pronator, while the motor strength of the other muscles was normal. DIAGNOSES: C5 palsy following C5/6/7 left foraminotomy. INTERVENTION: Follow-up rehabilitation with muscle strength training and range of motion training. OUTCOME: The patient recovered his motor strength completely within 3 months postoperatively. LESSONS: In this case, the C5 palsy could not be adequately explained by the theory of nerve root impingement or disruption in blood circulation following spinal cord decompression. We hypothesized that the patient had drill heat-induced C5 palsy. Regarding the C5 palsy without C5 nerve root decompression, we hypothesize that the C5 palsy in C5/6/7 foraminotomy could be related to variations in the formation of the brachial plexus. Prophylactic foraminotomy for cervical posterior surgery should be performed with care, limiting its use in patients who are at a risk of developing C5 palsy because the prophylactic procedure can cause C5 palsy. We must also consider that even without decompression at the C4/5 level, there is a possibility of C5 palsy occurring.


Assuntos
Vértebras Cervicais/cirurgia , Foraminotomia , Paralisia/etiologia , Paralisia/reabilitação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/reabilitação , Compressão da Medula Espinal/cirurgia , Adulto , Humanos , Masculino , Recuperação de Função Fisiológica
16.
Mayo Clin Proc ; 95(2): 224-225, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32029081
17.
World Neurosurg ; 138: 637-644, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32001413

RESUMO

The feasibility and efficacy of magnetic resonance imaging molecular probe application and pluripotent stem cell-derived neural stem cell (NSC) transplantation for the treatment of hind limb paralysis in mice with cerebral infarction were studied. A model of middle cerebral artery infarction using adult mice was established to stimulate hind limb reactions. After the model was successfully established, the mice were first divided into an experimental group and a control group, with 25 mice in each group. Cultured neural cells were obtained from the cerebral cortex and hippocampus of a mouse 15 days pregnant to prepare pluripotent stem cells. Pluripotent stem cell-derived NSCs were identified by positive expression of Nestin. The experimental group was injected with 1 µL of NSC suspension through the tail vein, and the control group was injected with 1 µL of saline through the tail vein. The neurologic function of mice in each group was scored 1 day, 3 days, 7 days, 14 days, and 28 days after transplantation according to the Garcia 18 subscale. Finally, the differentiation, migration, and integration of pluripotent stem cell-derived NSCs after transplantation were observed using a magnetic resonance imaging molecular probe method. The results showed that the neurologic function scores of the ischemic transplantation group were significantly higher than those of the control group, and the results were significantly different (P < 0.05). Through research, it was found that after transplantation of pluripotent stem cell-derived NSCs, the transplanted cells migrated and differentiated around the body at 28 days and participated in angiogenesis, and the blood vessels in the infarcted area were obviously proliferated. The NSCs cultured in vitro were transplanted to the small infarction after cerebral infarction. In rats, it plays a positive role in the repair of nerve function in mice with cerebral infarction. NSCs cultured in vitro can survive, migrate, and differentiate in the brain tissue of mouse ischemic models and play a positive role in the repair of neurologic function in mice with cerebral infarction. Magnetic resonance imaging molecular probes have a good adjuvant effect on the use of pluripotent stem cell-derived NSCs to treat hind limb paralysis in mice with cerebral infarction.


Assuntos
Infarto Cerebral/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Técnicas de Sonda Molecular , Células-Tronco Neurais/transplante , Paralisia/diagnóstico por imagem , Células-Tronco Pluripotentes/transplante , Animais , Diferenciação Celular/fisiologia , Células Cultivadas , Infarto Cerebral/terapia , Camundongos , Células-Tronco Neurais/fisiologia , Paralisia/terapia , Células-Tronco Pluripotentes/fisiologia , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento
18.
World Neurosurg ; 136: e393-e397, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931248

RESUMO

OBJECTIVE: During surgery, shoulder traction is often used for better fluoroscopic imaging of the lower cervical spine. Traction on the C5 root has been implicated as a potential cause of C5 palsy after cervical spine surgery. Using magnetic resonance imaging, this study was undertaken to determine the impact of upper extremity traction on the C5 root orientation. METHODS: In this study, 5 subjects underwent coronal magnetic resonance imaging of the cervical spine and left brachial plexus. Using a wrist restraint, sequential traction on the left arm with 10, 20, and 30 lb. was applied. Measurements of the angle between the spinal axis and C5 nerve root and the angle between the C5 nerve root and the upper trunk of the brachial plexus were obtained. The measurements were taken by a trained neuroradiologist and analyzed for significance. RESULTS: The angle between the C5 nerve root and the vertical spinal axis remained within 3 and 4 degrees of the mean and was not found to be associated with increased traction weight (P = 0.753). The angle between the C5 root and the upper trunk increased with increasing weight and was found to be statistically significant (P = 0.003). CONCLUSIONS: While the cause of C5 palsy is likely multifactorial, this study provides evidence that, in the awake volunteer, upper extremity traction leads to C5 root and upper trunk tension. These results suggest that shoulder traction in the anesthetized patient could lead to tension of the C5 nerve root and subsequent injury and palsy.


Assuntos
Cuidados Intraoperatórios/efeitos adversos , Paralisia/etiologia , Tração/efeitos adversos , Adulto , Idoso , Plexo Braquial/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Feminino , Fluoroscopia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paralisia/patologia , Raízes Nervosas Espinhais/patologia
19.
World Neurosurg ; 138: 608-618, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31953096

RESUMO

This paper used magnetic resonance diffusion kurtosis imaging to observe the acute cerebral infarction model of mice, and studied the imaging changes of ischemic penumbra after perfusion of model for rat middle cerebral artery occlusion experiment, and combined with the physiologic changes of mice. The damage of neurons was evaluated by the evolution of N-methyl-D-aspartate receptors to provide a corresponding imaging basis for the diagnosis and treatment of ischemic penumbra. The research shows that the diffusivity value decreases with time, and the diffusion kurtosis increases with time. The difference in diffusivity between different parts of the same time point and the same part of the same point (except the edge relative to the normal area) is statistically different. Learning significance was set at P < 0.05. The expression of N-methyl-D-aspartate receptor 2A in tissue homogenate increased overall, and expression in synaptic membrane, synaptic membrane, and light membrane decreased. The expression of N-methyl-D-aspartate acid receptor 2B in tissue homogenate, synaptic membrane, and light cell membrane decreased, and it increased first and then decreased in the synaptic membrane. The studies confirmed that magnetic resonance imaging has a certain clinical diagnostic value for the penumbra evolution mechanism and neuronal injury of acute cerebral infarction, which deserves further study.


Assuntos
Infarto Cerebral/terapia , Imagem por Ressonância Magnética/métodos , Técnicas de Sonda Molecular , Células-Tronco Neurais/transplante , Paralisia/terapia , Células-Tronco Pluripotentes/transplante , Animais , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/patologia , Membro Posterior/diagnóstico por imagem , Membro Posterior/patologia , Sondas Moleculares , Paralisia/diagnóstico por imagem , Ratos
20.
Trop Doct ; 50(3): 238-239, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31902297

RESUMO

A 30-year-old woman presented as an emergency with a history of snakebite 5 h previously with signs of bulbar palsy, ptosis, respiratory distress and weakness of all four limbs. Mechanical ventilation, anti-snake venom (ASV) and supportive management were immediately instituted. With the third dose of ASV, an early anaphylactic reaction ensued. Subsequent management with corticosteroids and antihistamines over the next few days allowed consciousness to return but muscle power did not improve beyond 2/5. A trial of intravenous neostigmine with glycopyrrolate, however, improved motor power in all four limbs to 3/5. Oral pyridostigmine at 60 mg every 8 h allowed subsequent full motor recovery in all four extremities. We suggest consideration of pyridostigmine to promote motor recovery after an allergic reaction to ASV.


Assuntos
Anafilaxia/induzido quimicamente , Antivenenos/uso terapêutico , Brometo de Piridostigmina/uso terapêutico , Mordeduras de Serpentes/tratamento farmacológico , Venenos de Serpentes/antagonistas & inibidores , Adulto , Antivenenos/efeitos adversos , Feminino , Humanos , Paralisia/tratamento farmacológico , Paralisia/fisiopatologia , Recuperação de Função Fisiológica/efeitos dos fármacos , Mordeduras de Serpentes/fisiopatologia
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