Palliation for catastrophic nonlocalizing epilepsy: a retrospective case series of complete corpus callosotomy at a single institution.

OBJECTIVE: In this study, the authors describe their 10-year single-institution experience with single-step complete corpus callosotomy (CCC) for seizure management in pediatric and adult patients with catastrophic, medically refractory, nonlocalizing epilepsy at Advent Health Orlando. METHODS: The authors conducted a retrospective observational study of patients aged 6 months to 49 years who underwent clinically indicated CCC for drug-resistant nonlocalizing epilepsy at Advent Health Orlando between July 2011 and July 2021. Follow-up ranged from 12 months to 10 years. RESULTS: Of the 101 patients (57% of whom were male) who met eligibility criteria, 81 were pediatric patients and 20 were ≥ 18 years. All patients had seizures that appeared poorly lateralized on both electroencephalograms and clinical semiological studies. Of 54 patients with drop seizures before CCC, 29 (54%) achieved stable freedom from drop seizures after CCC. Of the 101 patients, 14 (13.9%) experienced stable resolution of all types of clinical seizures (International League Against Epilepsy classes 1 and 2). The most common postoperative neurological complication was a transient disconnection syndrome, observed in 50% of patients; of those patients, 73% experienced syndrome resolution within 2 months after surgery, and all resolved by the 2-year follow-up. Formal neuropsychological test results were stable in 13 patients assessed after CCC. CONCLUSIONS: CCC is an effective and well-tolerated palliative surgical technique. In this study, drop attacks were reduced after CCC but could recur for the first time as late as 44 months after surgery. Other seizure types were also reduced postoperatively but could recur for the first time as late as 28 months after surgery. Nearly 14% of patients achieved stable and complete freedom from seizures after CCC. Re-evaluation after CCC can reveal lateralized seizure onset in some patients.

Potential Risk Factors of Drug-Related Problems in Hospital-Based Mental Health Units: A Systematic Review.

INTRODUCTION: Reducing the occurrence of drug-related problems is a global health concern. In mental health hospitals, drug-related problems are common, leading to patient harm, and therefore understanding their potential risk factors is key for guiding future interventions designed to minimise their frequency. OBJECTIVE: The aim of this systematic review was to explore the potential risk factors of drug-related problems in mental health inpatient units. METHODS: Six databases were searched between 2000 and 2021 to identify studies that investigated the potential risk factors of drug-related problems in adults hospitalised in mental health inpatient units. Data extraction was performed by two authors independently and Allan and Barker's criteria were used for study quality assessment. Studies were categorised based on drug-related problem types and potential risk factors were stratified as patient, medication, and hospital related. RESULTS: A total of 22 studies were included. Studies mostly originated in Europe (n = 19/22, 86.4%), and used a multivariable logistic regression to identify potential risk factors (n = 13, 59%). Frequently investigated factors were patient age (n = 14/22), sex (n = 14/22) and the number of prescribed medications (n = 14/22). Of these, increasing the number of prescribed medications was the only factor consistently reported to be significantly associated with the occurrence of most types of drug-related problems (n = 11/14). CONCLUSIONS: A variety of patient, medication and hospital-related potential risk factors of drug-related problems in mental health inpatient units were identified. These factors could guide the development of interventions to reduce drug-related problems such as pharmaceutical screening tools to identify high-risk patients for timely interventions. Future studies could test a wider range of possible factors associated with drug-related problems using standardised approaches. CLINICAL TRIAL REGISTRATION: PROSPERO: CRD42021279946.

Back Pain: A Rare Presentation of Takayasu Arteritis.

Takayasu arteritis (TA) is a chronic inflammatory large-vessel vasculitis of the aorta and its major branches. It is a relatively rare disease, which presents with a wide spectrum of clinical features. Back pain is, however, rarely described to be a presenting symptom of TA. We report a case of a 28-year-old female with no known co-morbidity, who presented with back pain along with intermittent fever, dry cough, and significant weight loss. After an extensive inpatient workup, a computed tomography (CT) scan with contrast of chest and abdomen revealed evidence of vasculitis involving aorta, common carotid arteries, renal arteries, common iliac arteries as well as external and internal iliac arteries. A confirmatory CT abdominal aortography established the diagnosis of TA. The patient was treated with long-term oral corticosteroid therapy. Our case highlights that while assessing nonspecific back pain with elevated inflammatory parameters, particularly in young women, TA should be considered as one of the differential diagnoses.

Study of Carotid Artery Intimomedial Thickness in Patients with Rheumatoid Arthritis and its Co-relation with Severity of the Disease.

INTRODUCTION: RA is a chronic inflammatory state, predisposing for atherosclerosis as it is an immunoinflammatory process. This study focuses on use of Carotid artery intimomedial thickness (CIMT) as a marker for subclinical atherosclerosis. OBJECTIVE: To study the assessment of atherosclerosis by Carotid Intimo-Medial Thickness (CIMT) in patients with rheumatoid arthritis and Correlation of ultrasonographic findings with severity of disease (using DAS-28 score). MATERIAL AND METHODS: A prospective, case-control study involving 50 cases of diagnosed RA cases, and 50 healthy control. Sonological examination of the carotid and the vertebral arteries was done using a L&T SEQUINA color Doppler scanner with a linear band probe of frequency 6.6 to 14 MHz's. RESULTS: This case control study was carried out in 100 subjects (50 cases and 50 controls). Cases comprised of 41 rheumatic women (Mean age 42.08+12.13 yrs) and 9 (mean age 48.4+12.8 years) rheumatic men. Mean CIMT of the study group (0.5996+0.109mm) was significantly greater (p<0.001) than that of control group (0.5290+0.006mm). We observed carotid plaques in 18% subjects of study group compared to 2% in controls (p<0.001). Mean age in the study group was 46.56+12.82 years and that of controls was 46.38+11.69 years (p>0.05). In the study group mean CIMT was significantly increased in RA factor positive patients than in RA factor negative patients. We also calculated the DAS-28 score of the study group subjects and found that 8, 27 and 15 were having Mild, Moderate & severe disease activity respectively. CONCLUSIONS: CIMT has significant correlation with the age, and CIMT increases with age. Mean CIMT was found to be more with RF+(ve) patients indicating acute inflammation also has a role. When compared, the mean CIMT in each DAS sub group the result was found to be statistically insignificant.

Clinical Spectrum of Chikungunya in Bikaner (North Western India) in 2006 and Follow up of Patients for Five Years.

OBJECTIVE: To find out clinical and laboratory profile of patients of chikungunya outbreak in 2006 in Bikaner (North-West Rajasthan) and follow up of chikungunya patients for 5 years. METHODS: Study was conducted among 50 chikungunya patients. For this study the inclusion criteria was clinical presentation consistent with chikungunya virus infection (e.g. abrupt onset of fever and/or polyarthralgia) and laboratory confirmation of chikungunya virus infection by IgM-capture ELISA. All patients were subjected for thorough clinical and general physical examination, investigations like CBC, ESR, CRP, rheumatoid factor, ECG, LFT, RFT, anti-CCP antibody were done in all patients and their follow up was done for 5 years. RESULTS: Among the 50 patients of chikungunya arthritis 34 (68%) patients developed persistent arthritis. Among the patients with persistent arthritis 70.58% were shown positive for anti-ccp antibody. CRP (95.24%) and ESR level were raised (68%) in patient with persistent arthralgia. Level of CRP and ESR was proportionally related to number of partially recovered joints, higher the CRP positivity and raised ESR levels severe were the persistent arthralgias. CONCLUSIONS: Our study shows that chikungunya patients who had persistent arthralgia on 5 year follow up mimicked rheumatological disorder like rheumatoid arthritis in 70.58%. Therefore DMARD can be effective.

Post chikungunya brain stem encephalitis.

Chikungunya is an arthropod born acute febrile arbo viral illness characterized by acute severe polyarthralgia. During last few years there has been scattered out breaks with associated neurological complications in India. Here we report a case of post chikungunya reversible demyelinating encephalitis who presented with vertigo, dysarthria and ataxia. There was complete clinical as well as radiological improvement with steroids.

Musculoskeletal manifestations of diabetes mellitus.

The musculoskeletal conditions most commonly associated with diabetes are discussed below. One or more pathogenic mechanisms may be implicated in an association of a musculoskeletal condition with diabetes. Some rheumatological conditions are exclusive to diabetes whilst others occur more frequently in the diabetic population compared with non-diabetics. Whilst some musculoskeletal conditions may be managed conventionally when associated with diabetes, others may require special considerations. There is a preponderance of rheumatological manifestations of diabetes in the upper limb, although some conditions occur throughout the skeletal system.

A preliminary study of glycosylation of hair in diabetes mellitus.

Glycosylation of hair was studied in 30 diabetic (15 IDDM and 15 NIDDM) patients and in 30 age and sex matched healthy non-diabetic subjects. A positive correlation occurs between glycosylation of proximal portion of hair and the simultaneously measured glycosylated haemoglobin. The hair glycosylation remains stable along the length of hair from scalp to tip in normal subjects and suggests that a sufficiently long hair sample may offer a long term record of degree of hyperglycaemia. This may be useful in the investigation of hyperglycaemia and microvascular complications of diabetes mellitus. The level of glycosylation of hair is independent of duration of the disease, age, sex and race of the patient and colour of the hair, thus providing a universal index of hyperglycaemia in the control of diabetic state. Glycosylation of hair is perhaps the most non-invasive technique readily acceptable to the patients and yet provides a fairly accurate and reliable information regarding hyperglycaemia in the preceding duration in which the hair has been grown.

Incidence of coronary artery disease in asymptomatic uncomplicated essential hypertensive patients--evaluation by treadmill exercise test.

Treadmill exercise test was performed in 100 patients, 50 were hypertensive who were not having any clinical or electrocardiographic manifestation of coronary artery disease and 50 were controls. The test was positive in 28% of hypertensive patients as compared to 6% in controls. This study therefore suggests that hypertension is frequently associated with asymptomatic coronary artery disease as compared to normotension and it is concluded that exercise electrocardiography test is a definite diagnostic tool in diagnosis of coronary artery disease not only in symptomatic but also in asymptomatic patients with one or more risk factors.