Factors associated with venous collaterals in patients with cerebral venous thrombosis.

OBJECTIVES: To identify the factors associated with venous collaterals in Thai patients with cerebral venous thrombosis. MATERIALS AND METHODS: This retrospective 20-year cohort study enrolled patients diagnosed with cerebral venous thrombosis between January 2002 and December 2022. Data was collected from the electronic medical record, and venous collaterals were independently reviewed by two neuroradiologists using the Qureshi classification. Patients with and without venous collaterals were compared. Significant factors (P<0.05) in the univariate analysis were recruited into the multivariate logistic regression analysis to determine independently associated factors. RESULTS: Among 79 patients with cerebral venous thrombosis, the prevalence of venous collaterals at the initial neuroimaging was 25.3%. In the univariate analysis, patients with cerebral venous thrombosis and venous collaterals were significantly younger (37.0±13.9 years vs. 44.9±17.4 years, P = 0.048), more often had occlusion in the superior sagittal sinus (80.0% vs. 54.2%, P = 0.041), and were associated with hormonal exposure (35.0% vs. 6.8%, P = 0.002). Multivariate logistic regression analysis revealed occlusion in the superior sagittal sinus (adjusted odds ratio [aOR] 3.581; 95% confidence interval [95% CI] 1.941-13.626; P = 0.044) and hormonal exposure (aOR 7.276, 95% CI 1.606-32.966, P = 0.010) as independent factors associated with venous collaterals in cerebral venous thrombosis. CONCLUSIONS: In this cohort, the prevalence of venous collaterals was 25.3%. Occlusion in the superior sagittal sinus and hormonal exposure were independently associated with venous collaterals in patients with cerebral venous thrombosis.

The predictors of voluntary participation in pulmonary tuberculosis screening program: a study in a suburban community of southern Thailand.

Background: The health belief model (HBM), baseline health condition, and sociocultural factors impact the decision to participate in a tuberculosis screening program. Methods: This cross-sectional and descriptive study was carried out among the "Kao Taew" community dwellers aged 18 years and above, who voluntarily underwent the provided pulmonary tuberculosis (PTB) screening by chest radiographs (CXRs). The level of individual HBM domain perception, attitudes toward PTB prevention, and regularity of PTB prevention practices by the participants were evaluated. The significantly associated or correlated factors such as demographic characteristics, individual HBM domain perception, and attitudes toward PTB prevention with the regularity of PTB prevention practices from the univariate analysis were further analyzed by multiple linear regression (p < 0.05) to determine the independent significant predictors of PTB prevention practices. Results: Among 311 participants comprising 65% women, 57.9% aged ≥ 65 years and 67.2% had an underlying disease. The study participants had a high level of perception of HBM domains but a low level of perception of the barrier. In addition, a high level of attitudes toward PTB prevention and a high regularity of PTB prevention practices were found. A multiple linear regression analysis revealed that the perceived benefits of PTB screening [Beta = 0.20 (0.04, 0.36) p = 0.016] and acquiring underlying diseases [Beta = 1.06 (0.38, 1.73), p = 0.002] were significant predictors for PTB prevention practices, while belief in Islam was a reverse predictor [Beta = -0.84 (-1.47, -0.21), p = 0.010]. Conclusions: The level of perception of the individual domain of HBM, health status, and religious belief significantly predicted voluntary participation in PTB screening programs. Careful consideration by integration of the relevant health psychology, physical, and sociocultural factors is crucial for planning a health screening program.

Association between Bell's Palsy and Cardiometabolic Risks: An Age- and Sex-Matched Case-Control Study.

BACKGROUND: Bell's palsy is possibly an ischemic cranial neuropathy, although reactivation of herpes virus infection has been proposed. METHODS: This was an age-and sex-matched and 1:2 case-control study enrolling Bell's palsy patients during 2011-2021 in a university hospital to investigate the significant associations of cardiometabolic risks (CMRs) with Bell's palsy. We analyzed the differences in waist circumference (WC), body mass index (BMI), systolic and diastolic blood pressures (SBP and DBP), fasting blood sugar (FBS), and lipid levels at 12 weeks post-Bell's palsy with those of the controls by descriptive statistics (p < 0.05). The differences in means or medians of individual CMR values across the consecutive 10-year age intervals were analyzed by ANOVA F-tests and Kruskal-Wallis tests (p < 0.05). RESULTS: A total of 140 cases and 280 controls were enrolled. Bell's palsy patients had significantly higher WC, BMI, SBP, DBP, FBS, and triglyceride but lower high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Moreover, high WC, elevated FBS (≥100 mg/dL), SBP (≥130 mmHg), and total cholesterol were significantly associated with Bell's palsy cases by multivariable analysis. Only FBS in Bell's palsy patients significantly elevated across consecutive 10-year age intervals. CONCLUSION: Screening and monitoring for CMRs, especially hyperglycemia, in every patient presenting with Bell's palsy is essential despite initial normoglycemia, particularly in older-onset cases.

Factors associated with the initial intracranial hemorrhage occurrence in patients with cerebral venous thrombosis.

OBJECTIVES: Studies focusing on intracranial hemorrhage (ICH) in patients with cerebral venous thrombosis (CVT) are limited; thus, we aimed to identify factors associated with the occurrence of ICH in Thai patients with CVT. METHODS: This retrospective cohort study recruited patients with CVT admitted to a tertiary university-based hospital between 2002 and 2022. The baseline characteristics, clinical presentations, radiographic findings, and etiologies were compared between the ICH and non-ICH groups. The factors with p < 0.2 in the univariate analysis were further analyzed using multivariable logistic regression analysis to identify independent factors associated with ICH in patients with CVT. RESULTS: Of 228 screenings, 202 patients were eligible. The incidence rate of ICH was 36.63%. The ICH group showed a higher prevalence of focal neurological deficits (63.51% vs. 26.56%, p < 0.001), seizures (68.92% vs. 21.88%, p < 0.001), dependency status at admission (60.81% vs. 39.84%, p = 0.004), superior sagittal sinus thrombosis (71.62% vs. 39.07%, p < 0.001), superficial cortical vein thrombosis (36.49% vs. 10.16%, p < 0.001), and hormonal use (17.57% vs. 7.03%, p = 0.021) than the non-ICH group. In contrast, the ICH group showed a lower prevalence of isolated increased intracranial pressure (10.81% vs. 21.88%, p = 0.048) than the non-ICH group. Seizures (adjusted odds ratio [aOR], 4.537; 95% confidence interval [CI], 2.085-9.874; p < 0.001), focal neurological deficits (aOR, 2.431; 95% CI, 1.057-5.593; p = 0.037), and superior sagittal sinus thrombosis (aOR, 1.922; 95% CI, 1.913-4.045; p = 0.045) were independently associated with ICH in the multivariable logistic regression analysis. CONCLUSIONS: Seizures, focal neurological deficits, and superior sagittal sinus thrombosis are associated with ICH in patients with CVT.

The Decline of Cortical Beta Oscillation on the Function of Eye-hand Coordination in the Healthy Elderly.

BACKGROUND/AIM: There seems to be a correlation between changes in movement patterns with aging and brain activation. In the preparation and execution of movements, neural oscillations play an important role. In this study, cortical high frequency brain oscillations were analyzed in 15 healthy young adults and 15 elderly adults who participated in eye-hand coordination tasks. PATIENTS AND METHODS: The brain activities of healthy young and older adults were recorded using electroencephalography (EEG). RESULTS: Elderly participants spent significantly more time completing the task than young participants. During eye-hand coordination in elderly groups, beta power decreased significantly in the central midline and parietal brain regions. The data suggest that healthy elderly subjects had intact cognitive performance, but relatively poor eye-hand coordination associated with loss of beta brain oscillation in the central midline and parietal cortex and reduced ability to attentional movement. CONCLUSION: Beta frequency in the parietal brain sites may contribute to attentional movement. This could be an important method for monitoring cognitive brain function changes as the brain ages.

Teamwork Management and Benefit of Telemedicine in COVID-19 Outbreak Control on an Offshore Vessel in the Gulf of Thailand, Songkhla Province, Thailand: A Case Report.

In May 2021, there was a COVID-19 outbreak on board a construction support ship traveling from India to Thailand. Controlling the outbreak on this offshore vessel from 11 May to 2 June 2021 was applied. This case report describes the teamwork management of COVID-19 control on the vessel in the Gulf of Thailand. We summarized the COVID-19 outbreak control process on board, including active COVID-19-infected cases (CoIC) and close contacts (CoCC) identification, isolation, quarantine, treatment, and clinical monitoring using telemedicine to report their health measurements twice daily, including emergency conditions if they occurred. Active COVID-19 cases were identified by two rounds of reverse transcription polymerase chain reaction (RT-PCR) tests in all crew members, in which 7 of 29 (24.1%) showed positive results. Both the CoIC and CoCC were strictly and absolutely isolated and quarantined on the vessel. No serious medical conditions were reported during the monitoring. The third-round RT-PCR tests were conducted, and all tested negative one week later. Teamwork management in proactive COVID-19 case identification, isolation, comprehensive treatment, and close monitoring of health conditions using telemedicine devices is beneficial for controlling the COVID-19 outbreak on board.

Role of health locus of control in preventing occupational decompression sickness among deep-sea fisherman divers.

Background: Indigenous fisherman divers frequently experience decompression sickness (DCS). This study aimed to evaluate the associations between the level of knowledge of safe diving, beliefs in the health locus of control (HLC), and regular diving practices with DCS among the indigenous fisherman divers on Lipe island. The correlations among the level of beliefs in HLC, knowledge of safe diving and regular diving practices were evaluated also. Method: We enrolled the fisherman divers on Lipe island and collected their demographics, health indices, levels of knowledge of safe diving, beliefs in external and internal HLC (EHLC and IHLC), and regular diving practices to evaluate the associations with the occurrence of DCS by logistic regression analysis. Pearson's correlation was used to test the correlations among the level of beliefs in IHLC and EHLC, knowledge of safe diving, and regular diving practices. Results: Fifty-eight male fisherman divers whose mean age was 40.39 (±10.61) (range 21-57) years were enrolled. Twenty-six (44.8%) participants had experienced DCS. Body mass index (BMI), alcohol consumption, diving depth, duration of time in the sea/dive, level of beliefs in HLC and regular diving practices were significantly associated with DCS (p < 0.05). Level of belief in IHLC had a significantly strong reverse correlation with that in EHLC and a moderate correlation with level of knowledge of safe diving and regular diving practices. By contrast, level of belief in EHLC had a significantly moderate reverse correlation with level of knowledge of safe diving and regular diving practices (p < 0.001). Conclusions: Encouraging the fisherman divers' belief in IHLC could be beneficial for their occupational safety.

Acute Peripheral Facial Paralysis Masquerading as Bell's Palsy Is the First Presentation of COVID-19 Infection.

Although Bell's palsy is a common diagnosis of acute isolated peripheral facial palsy (PFP), acute isolated PFP can be the first presentation of various illnesses, including COVID-19 disease. A female with a known history of well-controlled diabetes mellitus presented initially with acute isolated PFP mimicking Bell's palsy. A course of oral prednisolone was given to treat acute PFP. Severe fifth cervical radicular pain, which is unusual for Bell's palsy followed 3 days later. The COVID-19 infection was finally diagnosed by a real-time polymerase chain reaction (RT-PCR) test 15 days after facial paralysis when typical pulmonary infection symptoms developed. Oral favipiravir was given for the treatment of COVID-19 infection, to which the symptoms completely responded. The COVID-19 infection as a cause of acute isolated PFP should be added to the differential diagnosis of acute isolated PFP, albeit without typical pulmonary infection symptoms, particularly during the global pandemic of the infection.

Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients.

(1) Background: Early thymectomy is suggested in all clinically indicated myasthenia gravis (MG) patients. However, short-term clinical response after thymectomy in MG patients has been limitedly described in the literature. This study aimed to compare the 5-year post-thymectomy outcomes between thymoma (Th) and non-thymoma (non-Th) MG patients. (2) Methods: MG patients aged ≥18 years who underwent transsternal thymectomy and had tissue histopathology reports in Songklanagarind Hospital between 2002 and 2020 were enrolled in a retrospective review. The differences in the baseline demographics and clinical characteristics between ThMG and non-Th MG patients were studied. We compared the time-weighted averages (TWAs) of daily required dosages of pyridostigmine, prednisolone or azathioprine to efficiently maintain daily living activities and earnings between the MG patient groups during 5 consecutive years following thymectomy. Post-thymectomy clinical status, exacerbations or crises were followed. Descriptive statistics were used for analysis with statistical significance set at p < 0.05. (3) Results: ThMG patients had significantly older ages of onset and shorter times from the MG diagnosis to thymectomy. Male gender was the only significant factor associated with ThMG. TWAs of the daily MG treatment drug dosages required showed no differences between the groups. Additionally, the rates of exacerbations and crises were not different, but decremental trends were shown in both groups after the thymectomies. (4) Conclusions: The daily dosage requirements of MG treatment drugs were not different. There was a trend of decreasing adverse event rates despite no statistically significant differences during the first 5 years after thymectomy in ThMG and non-ThMG patients.

Integrative Effects between a Bubble and Seal Program and Workers' Compliance to Health Advice on Successful COVID-19 Transmission Control in a Factory in Southern Thailand.

Applying health measures to prevent COVID-19 transmission caused disruption of businesses. A practical plan to balance public health and business sustainability during the pandemic was needed. Herein, we describe a "Bubble and Seal" (B&S) program implemented in a frozen seafood factory in southern Thailand. We enrolled 1539 workers who lived in the factory dormitories. First, the workers who had a high fatality risk were triaged by RT-PCR tests, quarantined and treated if they had COVID-19. Newly diagnosed or suspected COVID-19 workers underwent the same practices. The non-quarantined workers were regulated to work and live in their groups without contact across the groups. Workers' personal hygiene and preventive measures were strongly stressed. Between the 6th and 9th weeks of the program, the post-COVID-19 infection status (PCIS) of all participants was evaluated by mass COVID-19 antibody or RT-PCR tests. Finally, 91.8% of the workers showed positive PCIS, which was above the number required for program exit. Although no workers had received a vaccination, there was only one case of severe COVID-19 pneumonia, and no evidence of COVID-19 spreading to the surrounding communities. Implementation of the B&S program and workers' adherence to health advice was the key to this success.

Factors associated with acute symptomatic seizure occurrence among patients with posterior reversible encephalopathy syndrome.

OBJECTIVES: We aimed to define the factors associated with acute symptomatic seizure occurrence in posterior reversible encephalopathy syndrome (PRES) in the Thai-Asian population. MATERIALS AND METHODS: We conducted a retrospective cohort study enrolling patients with PRES admitted to the hospital between 2006 and 2019. In addition to seizure characteristics, baseline characteristics, clinical presentations, precipitating factors, neuroimaging characteristics, hospital complications, and hospital outcomes were compared between the seizure and non-seizure groups. Factors with p-value <0.05 in the univariate analysis were entered into the first model of multivariate logistic regression analysis to determine the factors associated with seizure occurrence if the p-value <0.05. The interaction of associated factors was also analyzed in the final multiple logistic regression analysis model. RESULTS: Acute symptomatic seizure, which is mainly based on the clinical documentation without electroencephalography, occurred in 50.0% of 136 patients with PRES. Of these, early seizures within 14 days of PRES occurred in 98.5% which mostly developed at presentation (82.4%) with a single seizure attack (55.9%). Convulsive seizures (77.9%) were the most common seizure semiology. The seizure group was significantly younger (median [interquartile range: IQR] 36.00 years old (21.75-48.50) vs 46.50 years old (31.25-61.00), p = 0.003). In univariate analysis, the seizure group had a higher prevalence of consciousness impairment (61.76% vs 26.47%, p < 0.001), Glasgow coma scale (GCS) score of 0-13 (42.46% vs 13.23%, p < 0.001), preeclampsia (20.58% vs 4.41%, p = 0.004), autoimmune disease (17.65% vs 5.88%, p = 0.033), and frontal lesions (25.00% vs 11.76%, p = 0.046) than those in the non-seizure group. In contrast, the seizure group had a lower prevalence of headache (27.94% vs 61.76%, p < 0.001). In the final multivariate logistic regression analysis which included the interaction terms, the acute symptomatic seizure occurrence directly associated with preeclampsia (adjusted odds ratio (aOR) 6.426, 95% confidence interval (CI) 1.450-27.031, p = 0.016) and autoimmune disease (aOR 4.962, 95% CI 1.283-18.642, p = 0.025), while headache showed a reverse association (aOR 0.310, 95% CI = 0.158-0.721, p = 0.008). CONCLUSIONS: Acute symptomatic seizure occurred in a half of patients with PRES in this cohort. Preeclampsia and autoimmune disease were directly associated with seizure occurrence, while headache showed a reverse association.

Predictors of Hospital Outcomes Among Patients with Posterior Reversible Encephalopathy Syndrome.

OBJECTIVES: We aimed to identify independent predictors of the clinical outcomes of posterior reversible encephalopathy syndrome (PRES) in the Thai-Asian population. MATERIALS AND METHODS: This retrospective cohort study recruited PRES patients admitted in the hospital between 2006 and 2019. The baseline characteristics, clinical presentations, precipitating factors, neuroimaging characteristics, hospital complications, and hospital outcomes were compared between the groups with favourable (modified Rankin scale [mRS] score, 0-2) and unfavourable (mRS score, 3-6) clinical outcomes. Factors presenting with p-values < 0.5 in univariate analysis were analysed in the multiple logistic regression model to determine independent predictors of outcome. RESULTS: Among 136 PRES patients, 22.80% experienced unfavourable outcomes (mRS score, 3-6), and the mortality rate was 7.35%. The common presenting symptoms in the unfavourable clinical outcome group were impairment of consciousness (90.32%) and seizures (67.74%). Sepsis as a hospital complication (adjusted odds ratio [aOR], 32.95; 95% confidence interval [CI], 4.44-244.22, p = 0.001), acute kidney injury as a hospital complication (aOR, 9.94; 95% CI, 1.71-57.66; p = 0.010), and impairment of consciousness (aOR, 10.85; 95% CI, 1.72-68.53, p = 0.011) were independent predictors of unfavourable outcomes. On the other hand, headache was an independent protective factor (aOR, 0.164; 95% CI, 0.03-0.91; p = 0.039). CONCLUSIONS: Impairment of consciousness, sepsis as a hospital complication, and acute kidney injury were independent predictors of unfavourable clinical outcomes, whereas headache showed a preventive effect.

A Single Center Study on the Risks of Peri-Intervention Stroke in Thoracic Endovascular Aortic Repair (TEVAR) and Endovascular Abdominal Aortic Repair (EVAR).

(1) Background: The risk factors of peri-intervention stroke (PIS) in thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR) are different. This study aimed to compare the risks of PIS in both interventions. (2) Methods: Patients who had suffered a PIS related to TEVAR or EVAR from January 2008 to June 2015 in Songklanagarind Hospital were selected as the cases, while patients who had not suffered PIS were randomly selected to create a 1:4 case: control ratio for analysis. The associations between the factors from pre- to post-intervention and PISs in TEVAR or EVAR cases were analyzed by univariable analysis (p < 0.1). The independent risks of PIS were identified by multivariable analysis and presented in odds ratios (p < 0.05). (3) Results: A total of 17 (2.2%) out of 777 patients who had undergone TEVAR or EVAR experienced PIS, of which 9/518 (1.7%) and 8/259 (3.1%) cases were in TEVAR and EVAR groups, respectively. PIS developed within the first 24 h in nine (52.9%) cases. Large vessel ischemic stroke or watershed infarctions were the most common etiologies of PIS. The independent risks of PIS were the volume of intra-intervention blood loss (1.99 (1.88-21.12), p < 0.001) in the TEVAR-related PIS, and intervention time (2.16 (1.95-2.37), p = 0.010) and post-intervention hyperglycemia (18.60 (1.60-216.06), p = 0.001) in the EVAR-related PIS. There were no differences in the rate of PIS among the operators, intervention techniques, and status of the interventions performed. (4) Conclusion: The risks of PIS in TEVAR or EVAR in our center were different and possibly independent of the operator expertise and intervention techniques.

Gestational Bell's Palsy Is Associated with Higher Blood Pressure during Late Pregnancy and Lower Birth Weight: A Retrospective Case-Control Study.

The associations between gestational Bell's palsy (GBP) and late obstetric complications (LOCs), i.e., preeclampsia (PE), eclampsia (EC), gestational hypertension (GHT), and gestational diabetes mellitus (GDM) remain unclear. This study aimed to evaluate these associations and the neonatal health of the newborns born from pregnant women with and without GBP. A retrospective 1:5 case-control study matching exact maternal age and gravidity between pregnant women with and without GBP in Songklanagarind Hospital from 2006 to 2016 was conducted. The associations between GBP and PE, EC, GHT, and GDM, as well as comparison of the newborns' health indices were analyzed by bivariate analysis (p < 0.05). Eight GBP cases out of 8,756 pregnant women were recruited. Six GBP cases were first or second gravid. GBP occurred during the third trimester in five cases. Except for higher median systolic blood pressure (125 (114.2, 127.5) vs. (110 (107.0, 116.0), p = 0.045) and diastolic blood pressures (77 (73.0, 80.8) vs. 70 (65.0, 73.2), p = 0.021) in the GBP cases, associations between GBP and all LOCs could not be concluded due to the lack of power. However, a significantly lower mean birth weight in the newborns of GBP mothers was found (2672.2 (744.0) vs. 3154.8 (464.7), p = 0.016) with statistically significant power. Except for the higher blood pressures and lower birth weights of the newborns of GBP mothers, an association between GBP and LOCs remains inconclusive.

Implementation of Triage System and Shortening Patient Journey Time to Prevent COVID-19 Transmission in a University Hospital during a Pandemic.

To explore the characteristics of the patient under investigation (PUI), and the routes and the patient journey time in our outpatient service, we examined the demographic data, presenting symptoms, risks of contact with COVID-19 cases, and the results of real-time polymerase chain reaction (PCR) tests in PUI cases from March to May 2020. The contact time, transfer time and total journey time of patient journey routes in our hospital were also explored. The results were shown in numbers, percentages and medians (interquartile range, IQR). A total of 334 PUI cases were identified from our triage system. The median (IQR) age was 35 (27, 47) years. Cough was the most common presenting symptom (56.2%), while fever (≥37.5 °C) was found in only 19.8% of the cases. The median (IQR) time of onset of the presenting symptoms was 3 (1, 5) days. The most common risk of contact with COVID-19 cases found during the triage was living in or returning from an outbreak area. Fifteen (4.5%) of the PUI cases had positive real-time PCR tests. The contact time and transfer time were longest in the PUI ward and from the Emergency Department (ED) to the PUI ward, respectively. Plans and actions to shorten the transfer time between the ED and the PUI ward and the total journey time should be developed.

Reversible Severe Rhabdomyolysis Associated with Thyrotoxic Hypokalemic Periodic Paralysis.

We report a case of reversible symptomatic rhabdomyolysis associated with thyrotoxic hypokalemic periodic paralysis. The patient had neither past medical nor family history of either disorder. The presenting neurological symptoms and signs, serum potassium, and creatine kinase levels returned to normal without specific treatment. Based on previous case reports, we attributed the combination of the disorders to a mutation of the calcium-gated channel (CACN) gene and its related encoded proteins.

Angiostrongylosis meningomyelitis without blood eosinophilia.

Angiostrongylus cantonensis and Gnathostoma spinigerum usually cause eosinophilic meningitis with associated peripheral blood eosinophilia. A 44-year-old man developed acute paraplegia with bowel and bladder dysfunction. Spinal magnetic resonance images showed a long T2W hyperintensity signal from the 1st to 8th spinal thoracic level. Cerebrospinal fluid analysis revealed eosinophilia and elevated cerebrospinal fluid protein, whereas differential leucocytes count in peripheral blood was unremarkable. Positive immunoblot tests for A. cantonensis antibody in serum and cerebrospinal fluid were reported. The patient had neither history of recent traveling to the high endemic areas of the parasite in Thailand, nor consumption the parasitic hosts. Immediate treatment with intravenous pulse methylprednisolone and oral albendazole resulted in complete recovery. Despite an unremarkable differential leucocytes count, absence a history of parasitic hosts consumption, and a less common presentation with meningomyelitis, A. cantonensis should be considered when cerebrospinal fluid eosinophilia presents.

Malondialdehyde as a Useful Biomarker of Low Hand Grip Strength in Community-Dwelling Stroke Patients.

The assessment of muscle strength by hand grip strength (HGS) is used to evaluate muscle weakness and wasting among stroke patients. This study aimed to investigate the association of oxidative stress/oxidative damage and inflammatory biomarkers with muscle strength and wasting, as evaluated by HGS, among community-dwelling post-stroke patients. The HGS of both paretic and non-paretic limbs was negatively associated with modified Rankin scale (mRS) values. The serum levels of catalase activity and malondialdehyde (MDA), and plasma tumor necrosis factor (TNF)-α levels were significantly increased in post-stroke patients compared with non-stroke controls. Further analysis highlighted that hydrogen peroxide was positively correlated with HGS in the paretic limbs. Interestingly, an elevated MDA level, excluding advanced age and high mRS, increased the risk of low HGS in the non-paretic limbs of stroke patients. This study suggests that there is a detrimental association between MDA and muscle strength and early muscle wasting among post-stroke patients. Hence, MDA is a potentially useful biomarker of muscle weakness and wasting in post-stroke patients living in the community.

A new and easily used modified myasthenia gravis score.

We developed a new modified quantitative myasthenia gravis (mQMG) score which can be easily used in the condition of limited access to specific equipment.  Substitution peak expiratory flow rate for forced vital capacity, and removal of handgrip strength and speech test items were the major modifications. The new mQMG score was tested for content validity and test-retest reliability. Then 45 Myasthenia Gravis Foundation of America (MGFA) grade II-III outpatients who had been clinically stable ≥ 3 months were enrolled to analyze correlations between the mQMG score and the original quantitative myasthenia gravis (QMG) score, the mQMG score and the previously validated Thai-version myasthenia gravis quality of life score (MGQOL 15-Thai version), and the QMG score and MGQOL15-Thai version score by Spearman correlation (p < 0.05). The positive correlation coefficient between the mQMG and QMG score was very strong (r = 0.96, 95% CI, 0.93-0.98, p < 0.001), between the mQMG and MGQOL15-Thai version score was moderate (r = 0.44, 95% CI, 0.17-0.65, p = 0.003), and between the QMG and MGQOL15-Thai version score was moderate (r = 0.41, 95% CI, 0.14-0.63, p = 0.005). We thus conclude that the new mQMG score is practical for use in research and clinical care.

Anti-Ganglioside Antibody-Negative Miller Fisher and AMSAN Variant Guillain-Barré Overlap Syndrome.

A case of Miller Fisher and acute motor sensory axonal neuropathy (AMSAN) variant Guillain-Barré (MFS/AMSAN-GBS) overlap syndrome is presented. The neurological presentation of the overlap syndrome was preceded by an upper respiratory tract infection. Eventually, severe weakness of bulbar and limb muscles, areflexia, ophthalmoplegia, ataxia, and respiratory insufficiency developed. The electroneuromyography revealed symmetrical axonal polyneuropathy which was dominant in both upper limbs. Although a panel of anti-ganglioside antibodies including anti-GQ1b was negative, immediate treatment with intravenous immunoglobulin resulted in dramatic response.