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1.
Lancet ; 394(10216): 2255-2262, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-31862250

RESUMO

BACKGROUND: More than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients. METHODS: This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918. FINDINGS: We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0%) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5%) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7%] vs 5676 [22·6%]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95% CI 1·24-1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0%] vs 7976 [31·8%]; adjusted OR after propensity score-matching, 1·31 [95% CI 1·13-1·52], p<0·0001). INTERPRETATION: Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community. FUNDING: None.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Cardioversão Elétrica/instrumentação , Doenças do Sistema Nervoso/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/métodos , Desfibriladores , Cardioversão Elétrica/métodos , Serviços Médicos de Emergência , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Razão de Chances , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Pontuação de Propensão , Estudos Prospectivos , Logradouros Públicos , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos
2.
Int J Cancer ; 146(3): 819-828, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30980681

RESUMO

Large, comprehensive studies of the risk for neurologic disorders among long-term survivors of noncentral nervous system (CNS) childhood cancers are lacking. Thus, the aim of our study was to assess the lifetime risk of Nordic non-CNS childhood cancer survivors for neurologic disorders. We identified 15,967 5-year survivors of non-CNS childhood cancer diagnosed in Denmark, Iceland, Finland and Sweden in 1943-2008, and 151,118 matched population comparison subjects. In-patient discharge diagnoses of neurologic disorders were used to calculate relative risks (RRs) and absolute excess risks (AERs). A neurologic disorder was diagnosed in 755 of the survivors while 370 were expected, yielding a RR of 2.0 (95% confidence interval (CI) 1.9-2.2). The highest risks were found among survivors of neuroblastoma (4.1; 95% CI 3.2-5.3) and leukemia (2.8; 95% CI 2.4-3.2). The AER decreased from 331 (278-383) excess neurologic disorders per 100,000 person-years 5-9 years after diagnosis to 82 (46-118) ≥ 20 years after diagnosis. Epilepsy was the most common diagnosis (n = 229, 1.4% of all survivors), and significantly increased risks were seen among survivors of eight out of 12 types of childhood cancer. Survivors of neuroblastoma had remarkably high risks (RR ≥ 10) for hospitalization for paralytic syndromes and hydrocephalus, while survivors of leukemia had additional high risks for dementia and encephalopathy. In conclusion, survivors of non-CNS childhood cancer are at high risk for neurologic disorders, especially within the first decade after diagnosis. Therefore, intensive follow-up to identify those who require close management is needed.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Doenças do Sistema Nervoso/epidemiologia , Neoplasias do Sistema Nervoso/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/terapia , Neoplasias do Sistema Nervoso/mortalidade , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Países Escandinavos e Nórdicos/epidemiologia , Adulto Jovem
3.
West Afr J Med ; 36(2): 183-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385606

RESUMO

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.


Assuntos
Disfunção Cognitiva/diagnóstico , Confusão/diagnóstico , Delírio/diagnóstico , Demência/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Comorbidade , Confusão/psicologia , Delírio/epidemiologia , Delírio/psicologia , Demência/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Hipertensão/epidemiologia , Entrevista Psiquiátrica Padronizada/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos , Nigéria/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Centros de Atenção Terciária
4.
BMC Neurol ; 19(1): 192, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409323

RESUMO

BACKGROUND: Neurological disorders are the most common cause of morbidity and mortality in developing countries. Available evidence on urban-rural differences on neurological diseases is scare in such countries. Our study objective was to determine the prevalence of neurological diseases in urban and rural tertiary care hospitals of Sindh, Pakistan. METHODS: This was a cross sectional study conducted in selected urban and rural region of tertiary care hospitals of Sindh, Pakistan. The outpatients medical records of adults (18 years and above) was obtained from January 1st, 2014 to December 31st, 2014. RESULTS: A total of 10,786 outpatients visit were recorded in this period. Mean age of the participants was 40.6 ± 15 years; majority was females 6104 (56.6%). About three-fourth of the patients were from rural hospital 7828 (72.6%). Common neurological diseases were headache disorders 3613 (33.4%), nerve and root lesion 2928 (27.1%), vascular diseases 1440 (13.3%), epilepsies 566 (5.2%), muscle disorders 424 (3.9%), psychiatric disorders 340 (3.1%) and CNS infection 303 (2.8%). Comparison between the urban and rural samples showed that ischaemic stroke (72.7% vs. 82%) and psychiatric disorders (2.1% vs. 3.5%) were more prevalent in rural area as compared to urban setting. CONCLUSION: Stroke, headache and nerve and root lesion are major causes of neurological disorders in urban and rural settings of Sindh, Pakistan. The policy and planning must be focus on primary care, preventive measures and the promotion of health.


Assuntos
Doenças do Sistema Nervoso/epidemiologia , Adulto , Idoso , Estudos Transversais , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Paquistão/epidemiologia , Prevalência , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
5.
Nord J Psychiatry ; 73(7): 451-461, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31393751

RESUMO

Objective: Neurological soft signs (NSS) are a group of minor non-localizable neurological abnormalities found more often in patients with schizophrenia. The aim of the current study was to investigate their temporal stability and relationship to the overall outcome over a 12-month period. Material and methods: The study sample included 133 stabilized patients suffering from schizophrenia (77 males and 56 females; aged 33.55 ± 11.22 years old). The assessment included the application at baseline and after 12 months of the Neurological Evaluation Scale (NES), and a number of scales assessing the clinical symptoms and adverse effects. The statistical analysis included ANOVA, exploratory t-test and Pearson correlation coefficients with Bonferroni correction. Results: In stabilized patients, NSS are stable over a 12-month period with only the subscale of NES-sensory integration manifesting a significant worsening, while, in contrast, most of the clinical variables improved significantly. There was no relationship of NES scores with the magnitude of improvement. The only significant negative correlation was between NES-motor coordination and Positive and Negative Syndrome Scale-GP change at 1 year. Discussion: The results of the current study suggest that after stabilization of patients with schizophrenia, there are probably two separate components, a 'trait' which is stable over a 12-month period, and a 'degenerative' component with a tendency to worsen probably in parallel with the progression of the illness and in correlation with the worsening of negative symptoms. However, the statistical support of the 'degenerative' component is weak. Significant outcomes Neurological softs signs are stable over a 12-month period, with the exception of 'sensory integration' which manifests significant improvement irrespective of treatment response. They do not respond to treatment with antipsychotics. They do not constitute a prognostic factor to predict improvement over a period of 1 year. Neurological soft signs constitute a trait symptom of schizophrenia which is stable though time. Limitations All the subjects have been previously hospitalized which may represent a more severe form of schizophrenia. Also, all patients were under antipsychotic and some also under benzodiazepine medications. Patients with comorbid somatic disorders were excluded which may decrease generalizability of results.


Assuntos
Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/epidemiologia , Exame Neurológico/tendências , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Adolescente , Adulto , Idoso , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/psicologia , Exame Neurológico/psicologia , Escalas de Graduação Psiquiátrica , Esquizofrenia/tratamento farmacológico , Fatores de Tempo , Adulto Jovem
6.
Int J Mol Sci ; 20(17)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31454921

RESUMO

About 1-4% of children are currently generated by Assisted Reproductive Technologies (ART) in developed countries. These babies show only a slightly increased risk of neonatal malformations. However, follow-up studies have suggested a higher susceptibility to multifactorial, adult onset disorders like obesity, diabetes and cardiovascular diseases in ART offspring. It has been suggested that these conditions could be the consequence of epigenetic, alterations, due to artificial manipulations of gametes and embryos potentially able to alter epigenetic stability during zygote reprogramming. In the last years, epigenetic alterations have been invoked as a possible cause of increased risk of neurological disorders, but at present the link between epigenetic modifications and long-term effects in terms of neurological diseases in ART children remains unclear, due to the short follow up limiting retrospective studies. In this review, we summarize the current knowledge about neurological disorders promoted by epigenetics alterations in ART. Based on data currently available, it is possible to conclude that little, if any, evidence of an increased risk of neurological disorders in ART conceived children is provided. Most important, the large majority of reports appears to be limited to epidemiological studies, not providing any experimental evidence about epigenetic modifications responsible for an increased risk.


Assuntos
Epigênese Genética , Predisposição Genética para Doença , Doenças do Sistema Nervoso/etiologia , Técnicas de Reprodução Assistida , Idade de Início , Animais , Humanos , Doenças do Sistema Nervoso/epidemiologia , Medição de Risco
7.
Scand J Trauma Resusc Emerg Med ; 27(1): 79, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443673

RESUMO

BACKGROUND: Little is known about the associations between the duration of prehospital cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) and outcomes among paediatric patients with out-of-hospital cardiac arrests (OHCAs). We investigated these associations and the optimal prehospital EMS CPR duration by the location of arrests. METHODS: We included paediatric patients aged 0-17 years with OHCAs before EMS arrival who were transported to medical institutions after resuscitation by bystanders or EMS personnel. We excluded paediatric OHCA patients for whom CPR was not performed, who had cardiac arrest after EMS arrival, whose EMS CPR duration were < 0 min or ≥120 min and who had cardiac arrest in healthcare facilities. Prehospital EMS CPR duration was defined as the time from CPR initiation by EMS personnel to the time of prehospital return of spontaneous circulation or to the time of hospital arrival. The primary outcome was 1-month survival with a favourable neurological outcome (cerebral performance category scale 1 or 2). Statistical analysis was performed with Mann-Whitney U tests for numerical variables and chi-squared test for categorical variables. Univariable and multivariable logistic regression analyses were applied to assess the association between prehospital EMS CPR duration and a favourable neurological outcome, and crude and adjusted odds ratios and their 95% confidence intervals were calculated. RESULTS: The proportion of patients with a favourable neurological outcome was lower in residential locations than in public locations (2.3% [66/2865] vs 10.8% [113/1048]; P < .001). In both univariable and multivariable logistic regression analyses, the proportion of patients with a favourable neurological outcome decreased as prehospital EMS CPR duration increased, regardless of the location of arrests (P for trend <.001). However, some patients achieved a favourable neurological outcome after a prolonged prehospital EMS CPR duration (> 30 min) in both groups (1.4% [6/417] in residential locations and 0.6% [1/170] in public locations). CONCLUSIONS: A longer prehospital EMS CPR duration is independently associated with a lower proportion of patients with a favourable neurological outcome. The association between prehospital EMS CPR duration and neurological outcome differed significantly by location of arrests.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Doenças do Sistema Nervoso/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Adolescente , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Japão , Masculino , Razão de Chances , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Sistema de Registros , Fatores de Tempo
8.
Nutr. hosp ; 36(4): 758-763, jul.-ago. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184697

RESUMO

Background and aims: home enteral nutrition (HEN) is an established treatment for clinically stable patients. The objective of this study was to determine the frequency and the situation of patients in HEN, in the capital city in the south of Brazil. Methods: in this retrospective study, we recorded all new cases of HEN in adults in Curitiba, Brazil, from January 2006 to December 2015. Data were collected by a dietitian from medical records of patients attending public health settings. The following data were analyzed: clinical diagnosis, diet prescribed during hospitalization and at discharge, and feeding access types. Kaplan-Meier and Cox regression analyses were used to calculate survival. Results: a total of 1,231 patients were included. There was a 425% increase in the frequency of HEN over the years studied. The mean age was 66.7 years, and 54.4% were men. Neurological diseases were the most prevalent (46.4%), followed by cancer (33.6%). Eight hundred and one patients (65.1%) died during this period. Mean HEN duration was 180 days (95% CI 163.6-193.4), with a significant difference between neurological diseases (median: 180 days) and cancer (median: 210 days) (p < 0.05). Neurological disease was an independent risk factor for mortality in patients on HEN (HR: 1.17; CI: 1.08-1.27). Conclusions: the study shows an increase in HEN. Neurological diseases prevailed and presented a risk of mortality, and more than half of the patients with NED died in this period


Introducción y objetivos: la nutrición enteral domiciliaria (NED) es un tratamiento establecido para pacientes clínicamente estables. El objetivo de este estudio fue determinar la frecuencia y la situación de los pacientes con NED en la capital del sur de Brasil. Métodos: en este estudio retrospectivo se registraron todos los nuevos casos de NED en adultos en Curitiba, Brasil, de enero de 2006 a diciembre de 2015. Los datos fueron recolectados por un nutricionista de historiales clínicos de pacientes que frecuentan establecimientos de salud pública. Se analizaron los siguientes datos: diagnóstico clínico, dieta prescrita durante la estancia hospitalaria y en el momento del alta y acceso alimenticio. Se utilizaron los análisis de Kaplan-Meier y regresión de Cox para calcular la supervivencia. Resultados: fueron incluidos 1.231 pacientes. Hubo un aumento del 425% en la frecuencia de NED a lo largo de los años estudiados. La edad media fue de 66,7 años y el 54,4% eran hombres. Las enfermedades neurológicas fueron las más prevalentes (46,4%), seguidas de las neoplasias (33,6%). Durante este periodo murieron 801 pacientes (65,1%). La duración media de la NED fue de 180 días (IC 95%, 163,6-193,4), con una diferencia significativa entre enfermedades neurológicas (mediana: 180 días) y cáncer (mediana: 210 días) (p < 0,05). La enfermedad neurológica fue un factor de riesgo independiente para la mortalidad en pacientes en NED (HR: 1,17; IC: 1,08-1,27). Conclusiones: el estudio muestra un aumento en la NED. Las enfermedades neurológicas prevalecieron y presentaron riesgo de mortalidad y más de la mitad de los pacientes murieron durante la NED


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Política Pública , Nutrição Parenteral no Domicílio/métodos , Nutrição Parenteral no Domicílio/normas , Registros de Dieta , Fatores de Risco , Doenças do Sistema Nervoso/epidemiologia , Estudos Retrospectivos , Dieta/estatística & dados numéricos , Dietoterapia/estatística & dados numéricos , Estimativa de Kaplan-Meier , Brasil/epidemiologia
9.
Emerg Med J ; 36(9): 541-547, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31326952

RESUMO

OBJECTIVES: To investigate the association of prehospital advanced airway management (AAM) on outcomes of emergency medical service (EMS)-witnessed out-of-hospital cardiac arrest (OHCA) according to the location of arrest. METHODS: We evaluated a Korean national OHCA database from 2012 to 2016. Adults with EMS-witnessed, non-traumatic OHCA were included. Patients were categorised into four groups according to whether prehospital AAM was conducted (yes/no) and location of arrest ('at scene' or 'in the ambulance'). The primary outcome was discharge with good neurological recovery (cerebral performance category 1 or 2). Multivariable logistic regression analysis was conducted to evaluate the association between AAM and outcome according to the location of arrest. RESULTS: Among 6620 cases, 1425 (21.5%) cases of arrest occurred 'at the scene', and 5195 (78.5%) cases of arrest occurred 'in an ambulance'. Prehospital AAM was performed in 272 (19.1%) OHCAs occurring 'at the scene' and 645 (12.4%) OHCAs occurring 'in an ambulance'. Patients with OHCA in the ambulance who had prehospital AAM showed the lowest good neurological recovery rate (6.0%) compared with OHCAs in the ambulance with no AAM (8.9%), OHCA at scene with AAM (10.7%) and OHCA at scene with no AAM (7.7%). For OHCAs occurring in the ambulance, the use of AAM had an adjusted OR of 0.67 (95% CI 0.45 to 0.98) for good neurological recovery. CONCLUSION: Our data show no benefit of AAM in patients with EMS-witnessed OHCA. For patients with OHCA occurring in the ambulance, AAM was associated with worse clinical outcome.


Assuntos
Manuseio das Vias Aéreas/efeitos adversos , Ambulâncias , Doenças do Sistema Nervoso/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Sistema de Registros/estatística & dados numéricos , República da Coreia/epidemiologia , Análise Espaço-Temporal , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
10.
Nurs Clin North Am ; 54(3): 449-456, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31331630

RESUMO

There are roughly 600 million people in the Latin America and the Caribbean region, of whom approximately 36% are living at or below the poverty line. According to this, neurologic injury disorders disproportionately affect this population, which faces not only most risk factors, but also has less developed health systems to deal with illness recovery. Further, most of the risk factors can be attributed to classic preventable cardiovascular risk factors, although there are important differences in demographics, socioeconomic status, and injury mechanisms that may influence the patient's outcome.


Assuntos
Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Pobreza , Fatores Socioeconômicos , Cuidado Transicional/normas , Região do Caribe/epidemiologia , Países em Desenvolvimento , Humanos , Internacionalidade , América Latina/epidemiologia , Doenças do Sistema Nervoso/epidemiologia
11.
Gynecol Endocrinol ; 35(9): 762-766, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266379

RESUMO

Vasomotor symptoms (VMSs) are the most common symptoms affecting women during the menopause. Besides, affective symptoms may share with VMS a common biological pathophysiology. The current multicenter quantitative research was based on an online survey aimed to evaluate the impact of VMS in peri- and post-menopausal Italian women and to identify the main barriers to seeking help. The most frequent bothersome VMSs were hot flashes (41%), night sweats (31%), and over-heating (31%). Almost 87% of women experienced three or more simultaneous symptoms. Emotions verbalized by women indicate how intensely hot flushes and neuro-vegetative symptoms impact life: embarrassment, confusion, depression, impact on social/personal relationships, and guiltiness. Up to 43% of all women suffering from VMS were not treating the symptoms. Although 92% of women reported prior knowledge of the VMS condition, only 12% do something about it straight away after the appearance of VMS. This survey provided real-life observational data from a large population of peri-menopausal women and highlighted the important impact of VMS, its neurovegetative comorbidities and its significant burden effect on social life. Physicians must be more adaptive and inquisitive to evaluate and detect incipient VMS, as this will indicate the vulnerability to severe symptomatology and pathological brain aging.


Assuntos
Doenças do Sistema Nervoso Autônomo/epidemiologia , Menopausa/fisiologia , Doenças do Sistema Nervoso/epidemiologia , Sistema Vasomotor/fisiopatologia , Adulto , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Comorbidade , Depressão/epidemiologia , Depressão/fisiopatologia , Feminino , Fogachos/epidemiologia , Fogachos/fisiopatologia , Humanos , Itália/epidemiologia , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/fisiopatologia , Fatores de Risco , Inquéritos e Questionários , Sudorese/fisiologia
12.
Spine (Phila Pa 1976) ; 44(19): 1364-1370, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31261279

RESUMO

STUDY DESIGN: Multicenter retrospective case series. OBJECTIVE: To report the risks, recovery, and clinical impact of neurological complications (NCs) in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Although recent studies have reported the incidence of NCs in ASD surgery, few have addressed the recovery from and clinical impacts of NC. METHODS: We reviewed records from a multicenter database for 285 consecutive surgically treated ASD patients who had reached a 2-year follow-up. NCs were categorized as sensory only or motor deficit (MD). Recovery was noted as none, partial, or complete, during hospitalization and at every postoperation visit. Uni- and multivariate risk analyses were performed to identify risk factors for MD. RESULTS: NC developed in 29 (10%) patients within 30 days of surgery, of which 11 were permanent deficits (seven no recovery, and four partial recovery). MD developed in 14 (5%) patients, including one spinal cord injury. Seven MD patients required physical assistance at the latest follow-up. While NC patients experienced significant improvements in health-related quality of life at the 2-year follow-up, the health-related quality of life was significantly worse for the NC versus no-NC group at this time point. Univariate analyses revealed that Schwab-SRS types N and L, pelvic tilt, modified frailty index physical function, and an inferior SRS22 function domain at baseline were risk factors for MD. Among them, modified frailty index physical function, which represented a preoperative decline in activities of daily living, was identified as an independent risk factor for MD (OR: 4.0, 95% CI: 1.2-13.5, P = 0.03). CONCLUSIONS: NC developed in 10% of ASD surgery patients, with permanent deficits occurring in 4%. Half of the patients who developed MD required physical assistance, which contributed to the inferior clinical outcomes. Surgical intervention should be considered before severe activities of daily living decline to prevent NCs. LEVEL OF EVIDENCE: 4.


Assuntos
Doenças do Sistema Nervoso , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Adulto , Humanos , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
14.
Artigo em Inglês | MEDLINE | ID: mdl-31208070

RESUMO

A systematic method was used to review the existing epidemiologic literature and determine the state of the scientific evidence for potential adverse health outcomes in populations living near oil and natural gas (ONG) operations in the United States. The review utilized adapted systematic review frameworks from the medical and environmental health fields, such as Grading of Recommendations, Assessment, Development and Evaluations (GRADE), the Navigation Guide, and guidance from the National Toxicology Program's Office of Health Assessment and Translation (OHAT). The review included 20 epidemiologic studies, with 32 different health outcomes. Studies of populations living near ONG operations provide limited evidence (modest scientific findings that support the outcome, but with significant limitations) of harmful health effects including asthma exacerbations and various self-reported symptoms. Study quality has improved over time and the highest rated studies within this assessment have primarily focused on birth outcomes. Additional high-quality studies are needed to confirm or dispute these correlations.


Assuntos
Campos de Petróleo e Gás , Indústria de Petróleo e Gás , Anormalidades Congênitas/epidemiologia , Saúde Ambiental , Humanos , Neoplasias/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Doenças Respiratórias/epidemiologia , Estados Unidos/epidemiologia
15.
East Asian Arch Psychiatry ; 29(2): 66-70, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31237249

RESUMO

OBJECTIVE: To investigate association between major depressive disorder (MDD) and quality of life in patients with neurological disorder. METHODS: This cross-sectional study was carried out at a Malaysian hospital between April 2016 and December 2016 using convenience sampling. Patients aged ≥18 years with intracranial tumour or other brain disorders were invited to participate. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life questionnaire version 3.0; diagnosis of MDD was made using Mini International Neuropsychiatric Interview. RESULTS: Of 122 patients approached, 100 (66 women and 34 men) were included (response rate, 93.5%), with a mean age of 45.3 years. The prevalence of MDD in patients with neurological disorder was 30%. Compared with non-depressed patients, patients with MDD had poorer global health status / quality of life (p = 0.003), and reduced physical (p = 0.003), role (p = 0.021), emotional (p < 0.001), cognitive (p = 0.004), and social (p = 0.007) functioning, as well as more symptoms of fatigue (p = 0.004), pain (p < 0.001), dyspnoea (p = 0.033), insomnia (p < 0.001), appetite loss (p = 0.002), constipation (p = 0.034), diarrhoea (p = 0.021), and financial difficulties (p = 0.039). CONCLUSION: Patients with MDD had reduced quality of life. Fatigue, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea, and financial difficulties were prevalent among patients with MDD.


Assuntos
Transtorno Depressivo Maior , Doenças do Sistema Nervoso , Qualidade de Vida , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/fisiopatologia , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/psicologia , Prevalência , Pesquisa Qualitativa
16.
Pan Afr Med J ; 32: 108, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223398

RESUMO

Neurological disorders secondary to vitamin B12 deficiency are polymorphic and diverse. There have been very few studies conducted in the Moroccan as well as in the African population. This study aims to describe the clinical, paraclinical, evolutionary features of neurological manifestations in patients with vitamin B12 deficiency within the Department of Neurology at the Moulay Ismail Military Hospital, Meknes over a period of 18 years (1999-2017). The study involved 06 women and 23 men, with an average age of 57 years. The mean time between symptom onset and diagnosis was 3 months. Neurological manifestation was indicative of vitamin B12 deficiency in 100% of cases. The average hemoglobin level was 10 g/dl, the mean corpuscular volume was 115 fl. Medullary megaloblastosis and atrophic gastritis were found in 95% and 90% of cases respectively. Regular electromyography (EMG), electroencephalography (EEG) and visual evoked potentials (VEP) showed subclinical peripheral and optic neuropathies. In 20 cases they were caused by Biermer's anemia. All the patients received parenteral Vitamin B12 with good outcome. These results demonstrate the importance of early diagnosis in patients with a potentially serious neuropsychiatric condition as well as of rapid substitution treatment which is the only therapeutic option to secure a good outcome.


Assuntos
Anemia Perniciosa/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Deficiência de Vitamina B 12/complicações , Vitamina B 12/administração & dosagem , Idoso , Anemia Perniciosa/diagnóstico , Anemia Perniciosa/etiologia , Eletroencefalografia/métodos , Eletromiografia/métodos , Potenciais Evocados Visuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/epidemiologia , Doenças do Nervo Óptico/etiologia , Estudos Retrospectivos , Fatores de Tempo , Deficiência de Vitamina B 12/diagnóstico
17.
Zhonghua Er Ke Za Zhi ; 57(6): 452-457, 2019 Jun 02.
Artigo em Chinês | MEDLINE | ID: mdl-31216803

RESUMO

Objective: To explore the clinical features, the risk factors of mortality and drug resistance of the isolates in patients with group B streptococcus (GBS) meningitis. Methods: A retrospective analysis was performed in 96 children with GBS meningitis (46 males and 50 females) at Beijing Children's Hospital Affiliated to Capital Medical University from January 2013 to October 2017. The clinical characteristics, prognosis and drug resistance were reviewed and analyzed. According to the onset time, the patients were divided into early onset disease (EOD, 0-6 days), late onset disease (LOD, 7-89 days) and very late onset disease (VLOD, 90 days-16 years), the clinical features were compared. According to the results of cranial imaging examination, the patients were divided into two groups: those with neurological complications and those without neurological complications. The influencing factors of neurological complications were analyzed. According to the outcome of 28 days after discharge, patients were divided into death group and survival group. The risk factors of mortality were analyzed by multivariate Logistic regression analysis. Non-numeric variables were analyzed with χ(2) test or Fisher's exact test. Numeric variable between groups were compared with nonparametric test. Results: A total of 96 patients were enrolled, including 18 (19%) EOD, 71 (74%) LOD and 7 (7%) VLOD cases. The median age of EOD cases was 2 days, with a range from 0 to 6 days. The median age of LOD cases was 31 days, with a range from 7 to 81 days. The median age of VLOD cases was 153 days, with a range from 95 to 214 days. Before the onset of the disease, the mother had mastitis in 6 cases and premature rupture of membranes in 6 cases. The common clinical manifestations of patients were fever (95%, 91/96), anorexia (65%, 62/96), seizure (56%, 54/96), and consciousness changes (36%, 35/96). The differences were statistically significant in gender (13/18 vs. 28/71 vs. 5/7, χ(2)=7.705, P=0.024), the number of cases who was admitted to intensive care unit (ICU) (5/18 vs. 31/71 vs. 0, χ(2)=6.065, P=0.042) and peripheral blood leukocyte (12(4, 18)×10(9)/L vs. 6(3, 11)×10(9)/L vs. 13(6, 17)×10(9)/L, H=9.885, P=0.007) in EOD group, LOD group and VLOD group. Cranial imaging was performed in 94 patients, 60 patients (64%) developed neurological complications, including subdural effusion (31/94, 33%), followed by intracranial hemorrhage (26/94, 28%), cerebral softening (19/94, 20%), cerebral atrophy (15/94, 16%), ependinitis (8/94, 9%) and hydrocephalus (4/94, 4%). By univariate χ(2) test analysis, seizure (63% (38/60) vs.41% (14/34), χ(2)=4.310, P=0.038) was a risk factor of neurological complications. Within 28 days after discharge, 88 patients survived and 8 patients died, with a fatality rate of 8%. The independent risk factors for the death were septic shock (OR: 9.548, 95% CI 1.439-63.356, P=0.019) and respiratory failure (OR: 7.053, 95% CI 1.160-42.888, P=0.034). All of isolates were susceptible to penicillin (68/68), ceftriaxone (47/47), cefepime (50/50), vancomycin (60/60) and linezolid (54/54), while the rates of resistance to tetracycline, levofloxacin, clindamycin and erythromycin were 5/12, 17/45, 38/46 and 32/37, respectively. Conclusions: The main type of GBS meningitis is late onset cases. The incidence of neurological complications was high. The independent risk factors for death were septic shock and respiratory failure. The strains were severely resistant to clindamycin and erythromycin.


Assuntos
Meningites Bacterianas/diagnóstico , Doenças do Sistema Nervoso/epidemiologia , Infecções Estreptocócicas/diagnóstico , Idade de Início , Antibacterianos/uso terapêutico , Criança , Feminino , Humanos , Incidência , Transtornos de Início Tardio , Masculino , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/mortalidade , Testes de Sensibilidade Microbiana , Doenças do Sistema Nervoso/complicações , Estudos Retrospectivos , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/mortalidade
18.
Transfus Apher Sci ; 58(3): 287-292, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31036516

RESUMO

Therapeutic plasma exchange (TPE) is used to treat more than 60 diseases worldwide and has drawn growing interest. Little is known about the current situation of TPE activity in Turkey, so we developed a survey to obtain information about this timely topic. We collected data on TPE from 28 apheresis units throughout Turkey. We performed a total of 24,912 TPE procedures with 3203 patients over the past decade. Twenty years ago, the majority of procedures were performed for neurological and hematological disorders, and today, most TPE procedures are done for the same reasons. The only historical change has been an increase in TPE procedures in renal conditions. Currently, renal conditions were more frequently an indication for TPE than rheumatic conditions. Fresh frozen plasma was the most frequently used replacement fluid, followed by 5% albumin, used in 57.9% and 34.6% of procedures, respectively. The most frequently used anticoagulants in TPE were ACD-A and heparin/ACD-A, used with 1671 (52.2%) and 1164 (36.4%) patients, respectively. The frequency of adverse events (AEs) was 12.6%. The most common AEs were hypocalcemia-related symptoms, hypotension, and urticaria. We encountered no severe AEs that led to severe morbidity and mortality. Overall, more than two thirds of the patients showed improvement in the underlying disease. Here, we report on a nationwide survey on TPE activity in Turkey. We conclude that there has been a great increase in apheresis science, and the number of TPE procedures conducted in Turkey has increased steadily over time. Finally, we would like to point out that our past experiences and published international guidelines were the most important tools in gaining expertise regarding TPE.


Assuntos
Anticoagulantes/administração & dosagem , Remoção de Componentes Sanguíneos , Doenças Hematológicas , Doenças do Sistema Nervoso , Troca Plasmática , Plasma , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Feminino , Doenças Hematológicas/metabolismo , Doenças Hematológicas/patologia , Doenças Hematológicas/terapia , Humanos , Hipocalcemia/etiologia , Hipocalcemia/mortalidade , Hipotensão/etiologia , Hipotensão/mortalidade , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/mortalidade , Doenças do Sistema Nervoso/terapia , Turquia/epidemiologia , Urticária/etiologia , Urticária/mortalidade
19.
J Vet Med Sci ; 81(6): 879-885, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31061248

RESUMO

Many of the reports summarizing neurological disorders in cats considered only a limited disease group(s). There is only one large-scale survey on neurological disorders in cats based on the histopathological viewpoint. We described the localizations and frequencies of neurological diseases in a large population of cats that were referred to the Kyoto Animal Referral Medical Center between 2009 and 2016. We attempted to determine the localization of lesions at the time of the examination in each case and to classify the disease etiologies of these 276 cats with neurological disorders retrospectively. There were 174 cases with lesions in the brain region, 14 cases with lesions in the cervical cord region, 34 cases with lesions in the thoracolumbar cord region, and 54 cases with lesions in the peripheral neuromuscular region. High morbidity rates were observed in cases of idiopathic epilepsy and intracranial tumor in the brain region, spinal cord infarction in the cervical cord region, spinal cord infarction and spinal cord tumor in the thoracolumbar cord region, and peripheral vestibular dysfunction arising from otitis media/interna in the peripheral neuromuscular region. It was suggested that there is a higher number of brain diseases than spinal cord and peripheral neuromuscular diseases in cats. Idiopathic and neoplastic diseases were common in the brain region, vascular diseases were common in the spinal cord region, and infectious diseases were common in the peripheral neuromuscular region.


Assuntos
Doenças do Gato/epidemiologia , Doenças do Sistema Nervoso/veterinária , Animais , Doenças do Gato/etiologia , Gatos , Incidência , Japão/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Estudos Retrospectivos
20.
N Engl J Med ; 380(19): 1795-1803, 2019 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-31067369

RESUMO

BACKGROUND: The time to initiate intravenous thrombolysis for acute ischemic stroke is generally limited to within 4.5 hours after the onset of symptoms. Some trials have suggested that the treatment window may be extended in patients who are shown to have ischemic but not yet infarcted brain tissue on imaging. METHODS: We conducted a multicenter, randomized, placebo-controlled trial involving patients with ischemic stroke who had hypoperfused but salvageable regions of brain detected on automated perfusion imaging. The patients were randomly assigned to receive intravenous alteplase or placebo between 4.5 and 9.0 hours after the onset of stroke or on awakening with stroke (if within 9 hours from the midpoint of sleep). The primary outcome was a score of 0 or 1 on the modified Rankin scale, on which scores range from 0 (no symptoms) to 6 (death), at 90 days. The risk ratio for the primary outcome was adjusted for age and clinical severity at baseline. RESULTS: After 225 of the planned 310 patients had been enrolled, the trial was terminated because of a loss of equipoise after the publication of positive results from a previous trial. A total of 113 patients were randomly assigned to the alteplase group and 112 to the placebo group. The primary outcome occurred in 40 patients (35.4%) in the alteplase group and in 33 patients (29.5%) in the placebo group (adjusted risk ratio, 1.44; 95% confidence interval [CI], 1.01 to 2.06; P = 0.04). Symptomatic intracerebral hemorrhage occurred in 7 patients (6.2%) in the alteplase group and in 1 patient (0.9%) in the placebo group (adjusted risk ratio, 7.22; 95% CI, 0.97 to 53.5; P = 0.05). A secondary ordinal analysis of the distribution of scores on the modified Rankin scale did not show a significant between-group difference in functional improvement at 90 days. CONCLUSIONS: Among the patients in this trial who had ischemic stroke and salvageable brain tissue, the use of alteplase between 4.5 and 9.0 hours after stroke onset or at the time the patient awoke with stroke symptoms resulted in a higher percentage of patients with no or minor neurologic deficits than the use of placebo. There were more cases of symptomatic cerebral hemorrhage in the alteplase group than in the placebo group. (Funded by the Australian National Health and Medical Research Council and others; EXTEND ClinicalTrials.gov numbers, NCT00887328 and NCT01580839.).


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Fibrinolíticos/uso terapêutico , Imagem de Perfusão , Acidente Vascular Cerebral/tratamento farmacológico , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/tratamento farmacológico , Hemorragia Cerebral/induzido quimicamente , Angiografia por Tomografia Computadorizada , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intravenosas , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/prevenção & controle , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Equipolência Terapêutica , Ativador de Plasminogênio Tecidual/efeitos adversos
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