Targeting a helix-in-groove interaction between E1 and E2 blocks ubiquitin transfer.

The ubiquitin-proteasome system (UPS) is a highly regulated protein disposal process critical to cell survival. Inhibiting the pathway induces proteotoxic stress and can be an effective cancer treatment. The therapeutic window observed upon proteasomal blockade has motivated multiple UPS-targeting strategies, including preventing ubiquitination altogether. E1 initiates the cascade by transferring ubiquitin to E2 enzymes. A small molecule that engages the E1 ATP-binding site and derivatizes ubiquitin disrupts enzymatic activity and kills cancer cells. However, binding-site mutations cause resistance, motivating alternative approaches to block this promising target. We identified an interaction between the E2 N-terminal alpha-1 helix and a pocket within the E1 ubiquitin-fold domain as a potentially druggable site. Stapled peptides modeled after the E2 alpha-1 helix bound to the E1 groove, induced a consequential conformational change and inhibited E1 ubiquitin thiotransfer, disrupting E2 ubiquitin charging and ubiquitination of cellular proteins. Thus, we provide a blueprint for a distinct E1-targeting strategy to treat cancer.

Deductive Reasoning Skills in Children Aged 4-8 Years Old.

Young children possess the fundamental deductive reasoning skills for solving their upcoming problems in their daily lives. These skills are of great importance for their school readiness and academic development. Therefore, this study aimed to explore the age differences and predictive variables of deductive reasoning skills in young Hungarian children aged 4-8 years old who reside in Hungary and Slovakia. Face-to-face data were collected from 3050 participants. The instrument of deductive reasoning skills assessment was extracted from the school readiness test, DIFER (Diagnostic System for Assessing Development). Utilizing various statistical analyses with R, AMOS, and MPlus8 packages, it was found that there were significant differences in young children's deductive reasoning skills across countries and age groups. Parents' education levels had significant positive relationships with children's deductive reasoning skills development. And the variables of country and age were identified as significant predictors of children's deductive reasoning skills. And children's family background variables such as parental education played a significant role in predicting children's deductive reasoning skills in Hungary. The implications of this study emphasize the importance of educational contexts, parental involvement, cross-cultural exchange, and further research, with the potential to enhance young children's educational experiences and prospects in Hungary, Slovakia, and beyond.

The effect of reading strategy use on online reading comprehension.

In the current age, digital technology is rapidly changing daily routines, and young people today spend most of their time using various digital tools. Therefore, traditional reading of the printed page is being transformed into digital reading of online texts among students. Thus, online reading strategies have become crucial for their development in online reading performance. This study aimed to investigate the effects of online reading strategies used by lower secondary students on reading comprehension achievement. It conducted an online survey of reading strategies, involving three types of reading strategies, global, problem-solving, and support. The study recruited 4527 students at the lower secondary school level in Hungary. The study examined the students' attitudes toward literature and grammar in their native language (L1), use of online reading strategies, reading comprehension skills, and language arts achievement as well as examining the relations between them with various methods of analysis (descriptive/inferential, Rasch and path analyses). The findings demonstrated that the students' problem-solving strategies (from among the three reading strategies) exerted significant and positive impacts on reading comprehension. Additionally, the students' attitudes toward L1 had a positively significant effect on their use of online reading strategies and language arts achievement and an indirect effect on reading comprehension skills. The study also found a significant relationship between language arts achievement and reading comprehension achievement. Therefore, this study is beneficial for language teachers in helping students improve reading comprehension skills.

The Relationship among Internet Addiction, Moral Potency, Mindfulness, and Psychological Capital.

This research aimed to contribute to the literature on internet addiction (IA) and moral development among university students. Moral potency (MP) encompasses the interconnected dimensions of moral courage, moral ownership, and moral efficacy. Studies on the relationships between students' problematic behaviors (e.g., IA) and cognitive processes like MP, mindfulness (MI), and psychological capital (PsyCap) are scarce in educational research. Therefore, this study investigated the relationships among IA, MP, MI, and PsyCap in university students. This study included 868 undergraduate students from a state university in Ethiopia, with 526 male students (60.6%) and 342 female students (39.4%). Participants' ages ranged from 21 to 29 years, with a mean age of 22.31 and a standard deviation of 4.03. The findings indicated that IA was negatively correlated with MI, PsyCap, and MP. Both MI and PsyCap showed positive correlations with MP. Importantly, this study revealed that IA had a direct and negative impact on MI, PsyCap, and MP. Further, MI and PsyCap partially mediated and fully mediated the relationship between IA and MP. These findings suggest that cultivating MI and positive PsyCap among university students could be an important strategy to reduce the risks of IA and enhance their moral development. This study contributes to the limited research on the complex relationships between technology use, psychological resources, and moral functioning in emerging adulthood.

Exploring the Accuracy and Consistency of a School Readiness Assessment Tool for Preschoolers: Reliability, Validity and Measurement Invariance Analysis.

This study focuses on examining the psychometric properties of the DIFER test, a widely used assessment tool for measuring school readiness. DIFER, which stands for Diagnostic Assessment Systems for Development, has gained prominence in Hungary and some European countries as an effective means of evaluating children's readiness for school. By investigating the reliability and validity of the DIFER test, this study aims to enhance the understanding of the suitability of the DIFER test for cross-cultural and longitudinal studies in assessing school readiness. Conducted as a survey study, the research involved 3050 Hungarian students from Slovakia and Hungary. Employing Rasch analysis and multi-group confirmatory factor analysis (MG-CFA) aid in verifying the precision of the DIFER test as a valuable assessment instrument for determining school readiness. The results revealed a strong alignment between the difficulty level of the test and students' actual abilities, demonstrating its reliability and validity. Importantly, the analysis found measurement invariance across various factors, including country, gender, and age. This indicates the consistent performance of the DIFER test in assessing school readiness across diverse groups. However, mean differences in latent abilities were observed among different age groups, indicating that older students exhibited notably higher proficiency in pre-mathematical skills compared to their younger counterparts. The findings offer valuable insights to educators, providing a reliable tool for assessing school readiness and identifying areas for improvement.

Subject Specific Mastery Motivation in Moldovan Middle School Students.

Given the crucial role of mastery motivation in the cognitive development of children, the present study investigates subject-specific mastery motivation in the multilingual educational system of the Republic of Moldova. We applied cross-sectional data from fifth, seventh, and ninth graders studying either in the Romanian (n = 583) or Russian (n = 353) language using the Subject Specific Mastery Motivation Questionnaire (SSMMQ). To ensure the validity of the comparison of latent mean differences, the Romanian and Russian versions of SSMMQ were validated and measurement invariance of the constructs across language, grade, and gender was assessed. The full scalar invariance across grades and gender and the partial scalar invariance across language held. Thus, a comparison of latent mean differences across these three groups is plausible. The findings proved that there was no difference between the Romanian and Russian samples, but we found girls self-rated themselves significantly higher than boys in the Reading, Art, and Music mastery motivation scales. Results with respect to the comparison of latent mean differences between the grade levels demonstrated that the Reading mastery motivation of the Moldovan students stayed stable from fifth to ninth grades, whereas Art had a constant declining path.

The Dynamics of Mastery Motivation and Its Relationship with Self-Concept in Music Education.

Musical education hinges on students' mastery motivation and self-concept, which are crucial for effective musical learning. Despite the acknowledgement of their individual importance, the relationship between these factors within music education remains unexplored. Hence, this study aimed to investigate the dynamics of mastery motivation (MM) and its relationship with self-concept (SC) in the context of music education. A survey was administered to 139 Hungarian grade 7 students, employing a musical MM questionnaire, a musical SC inquiry, and the collection of demographic information collection. We employed descriptive statistics (IBM SPSS 23), a Rasch analysis (WINSTEPS), and correlational and regression analyses (R programming and SmartPLS4) for data analysis. The findings demonstrated that the utilized instruments were reliable and valid in measuring students' MM and SC in music education. This study revealed a strong positive correlation (r = 0.778) between students' MM and SC, with moderate to strong inter-relationships among various subfactors. Furthermore, comparisons unveiled significant disparities in musical MM across school levels, with higher MM and SC observed among female students. Furthermore, gender, a musical family background, and awareness of musical lesson usefulness were predictive factors for both students' MM and SC within music education. This study provides valuable insights for professionals and policy makers to enhance music education, nurturing students' musical growth effectively. By understanding the relationship between MM and SC and considering predictive factors, stakeholders can develop strategies that optimize the impact of music education on students' musical development.

Assessment of Mastery Motivation and Neurodevelopment of Young Children at High Risk for Developmental Delays.

Young children's mastery motivation and neurodevelopmental evaluation can contribute to overall early assessment for early intervention evaluation. At present, children born preterm (<37 weeks gestation) and with a low birth weight (LBW; <2500 g) are at increased risk of experiencing developmental delays and more nuanced cognitive and language challenges. The main objective of this exploratory study was to examine the connection between preterm children's mastery motivation and their neurodevelopment, as well as to determine whether assessing mastery motivation can enhance assessment practices for early intervention (EI) programs. Parents of children born preterm completed the revised Dimensions of Mastery Motivation Questionnaire (DMQ18). Neurodevelopment was measured on the Bayley Scales of Infant and Toddler Development (BSID-III). Results revealed significant correlations between DMQ18 and BSID-III measures. Multivariate analysis showed that infants and toddlers born with a very low birth weight (VLBW; <1500 g) scored significantly lower on the infant DMQ18 and the BSID-III measures. Regression analyses revealed that birth weight and home environment were significant predictors of the children's eligibility for EI programs. Infants' social persistence with other children, gross motor persistence, and mastery pleasure, as well as toddlers' objective cognitive persistence, social persistence with adults, gross motor persistence, mastery pleasure, and negative reaction to frustration, were important markers for evidenced-based practices in EI programs. This study demonstrates the utility of the DMQ18 as a contributory assessment measure and the importance of birth weight and home environment in predicting EI enrollment.

Reflection-based questioning: Aspects affecting Myanmar students' reading comprehension.

This study aimed to scrutinize the effects of the reflection-based questioning approach (RBQA) on Myanmar students' achievement in English reading comprehension. The RBQA approach covers Oo et al.'s (2021) reflective teaching model for reading comprehension (based on planning, acting, reflecting, and evaluating) in which the teacher uses a questioning strategy (initiate-response-evaluate model). Employing cluster randomized trials, quasi-experimental research was conducted to investigate RBQA's effectiveness in teaching reading comprehension skills to Grade-9 students. The experimental group (N = 228) received the RBQA intervention; the control group (N = 230) did not receive the intervention but was provided with traditional instruction. During RBQA intervention, teachers used the anonymous student questionnaire and observation scheme as effective reflection tools. After a five-week intervention, both groups completed post-tests to assess their achievement. The study findings revealed that teaching with RBQA had a significant positive effect on students' reading comprehension. Therefore, this study is of immense significance to English language teachers and their students.

Infarct of the right basal ganglia in a male spinal cord injury patient: adverse effect of autonomic dysreflexia.

Autonomic dysreflexia is a clinical emergency that occurs in individuals with spinal cord injury at level T-6 and above. We present a 58-year-old male patient with paraplegia who developed a severe, recurrent, throbbing headache during the night, which was relieved by emptying the urinary bladder by intermittent catheterisation. As this person continued to get episodes of severe headache for more than 6 months, computed tomography (CT) of the brain was performed. CT revealed an infarct measuring 1.2 cm in the right basal ganglia. In order to control involuntary detrusor contractions, the patient was prescribed propiverine hydrochloride 15 mg four times a day. The alpha-adrenoceptor blocking drug doxazosin was used to reduce the severity of autonomic dysreflexia. Following 4 weeks of treatment with propiverine and doxazosin, the headache subsided completely. We learned from this case that bladder spasms in individuals with spinal cord injury can lead to severe, recurrent episodes of autonomic dysreflexia that, in turn, can predispose to vascular complications in the brain. Therefore, it is important to take appropriate steps to control bladder spasms and thereby prevent recurrent episodes of autonomic dysreflexia. Intermittent catheterisations along with an alpha-adrenoceptor blocking drug (doxazosin) and an antimuscarinic drug (propiverine hydrochloride) helped this individual to control autonomic dysreflexia, triggered by bladder spasms during the night.

Barriers to implementing intermittent catheterisation in spinal cord injury patients in Northwest Regional Spinal Injuries Centre, Southport, U.K.

Intermittent catheterisation is the preferred method of managing the neurogenic bladder in patients with spinal cord injury. However, spinal cord physicians experienced problems when trying to implement an intermittent catheterisation regime in some spinal cord injury patients in the northwest of England. We present illustrative cases to describe practical difficulties encountered by patients while trying to adopt an intermittent catheterisation regime. Barriers to intermittent catheterisation are (1) caregivers or nurses are not available to carry out five or six catheterisations a day; (2) lack of time to perform intermittent catheterisations; (3) unavailability of suitable toilet facilities in public places, including restaurants and offices; (4) redundant prepuce in a male patient, which prevents ready access to urethral meatus; (5) urethral false passage; (6) urethral sphincter spasm requiring the use of flexible-tip catheters and á-adrenoceptor-blocking drugs; (7) reluctance to perform intermittent catheterisation in patients >60 years by some health professionals; and (8) difficulty in accessing the urethral meatus for catheterisation while the patient is sitting up, especially in female patients. These cases demonstrate the urgent need for provision of trained caregivers who can perform intermittent catheterisation, and improvement in public facilities that are suitable for performing catheterisation in spinal cord injury patients. Further, vigilance should be exercised during each catheterisation in order to prevent complications, such as urethral trauma and consequent false passages. Health professionals should make additional efforts to implement intermittent catheterisation in female spinal cord injury patients and in those >60 years.

Discitis following urinary tract infection manifesting as recurrent autonomic dysreflexia related to truncal movements in a person with tetraplegia.

A 44-year-old male person with tetraplegia (C-5 AIS-A (American Spinal Cord Injury Association Standard Neurological Classification of Spinal Cord Injury Impairment Scale)) developed urinary tract infection and received appropriate antibiotic. Subsequently, he started sweating and shivering when he was sitting up; these symptoms resolved while lying on his back. Autonomic dysreflexia triggered by truncal movements continued to occur for 3 months. CT of the spine showed L5-S1 discitis. MRI of the spine showed diffuse marrow oedema in L5 and S1 vertebrae and a large abscess at L5/S1 level. Blood culture yielded Serratia marcescens sensitive to meropenem. Meropenem followed by ertapenem was given for 12 weeks. After 11 months, MRI showed resolution of discitis and epidural collection. The patient was able to sit up for 9 hours without developing autonomic dysreflexia. If a person with cervical spinal cord injury develops posture-related autonomic dysreflexia (eg, in sitting position, lying on sides or while hoisted), disco-vertebral pathology should be suspected.

Magnitude and reasons for pre-diagnosis attrition among presumptive multi-drug resistant tuberculosis patients in Bago Region, Myanmar: A mixed methods study.

In Myanmar, Rifampicin resistant tuberculosis (RR-TB, a proxy for Multi-drug resistant TB) case detection is very low. Our study objectives were to assess the proportion of eligible TB patients who had not undergone RR-TB testing (Xpert-MTB/Rif tests) in Bago Region, Myanmar and to understand the reasons and solutions for non-testing. We conducted a mixed-methods study involving analysis of routinely collected programme data followed by key informant interviews (KIIs) with 32 health care providers. From October 2016 to March 2017, of the 2,331 eligible patients, 1,066 (46%) had not undergone Xpert-MTB/Rif testing. Patients from townships without Xpert-MTB/Rif testing facilities, new TB patients, patients whose HIV status was negative or unknown and extra pulmonary TB patients were less likely to undergo Xpert-MTB/Rif testing. From the health care providers' perspective, the most common reasons for non-testing were: (a) lack of awareness of the eligibility criteria; (b) difficulties in collecting sputum and transportation from eligible patients to the testing sites. We conclude that nearly half of eligible patients were not tested for RR-TB. Training of health care providers about the latest eligibility criteria and improvement in sputum collection and transportation systems particularly for townships without Xpert-MTB/Rif testing facilities are required to improve RR-TB testing.

Integrating data from different survey types for population monitoring of an endangered species: the case of the Eld's deer.

Despite its value for conservation decision-making, we lack information on population abundances for most species. Because establishing large-scale monitoring schemes is rarely feasible, statistical methods that combine multiple data sources are promising approaches to maximize use of available information. We built a Bayesian hierarchical model that combined different survey data of the endangered Eld's deer in Shwesettaw Wildlife Sanctuary (SWS) in Myanmar and tested our approach in simulation experiments. We combined spatially-restricted line-transect abundance data with more spatially-extensive camera-trap occupancy data to enable estimation of the total deer abundance. The integrated model comprised an ecological model (common to both survey types, based on the equivalence between cloglog-transformed occurrence probability and log-transformed expected abundance) and separate observation models for each survey type. We estimated that the population size of Eld's deer in SWS is c. 1519 (1061-2114), suggesting it is the world's largest wild population. The simulations indicated that the potential benefits of combining data include increased precision and better sampling of the spatial variation in the environment, compared to separate analysis of each survey. Our analytical approach, which integrates the strengths of different survey methods, has widespread application for estimating species' abundances, especially in information-poor regions of the world.

Recurrent autonomic dysreflexia due to chronic aortic dissection in an adult male with cervical spinal cord injury.

Autonomic dysreflexia is a hypertensive clinical emergency for persons with spinal cord injury at T-6 level or above. Recurrent autonomic dysreflexia is uncommon in spinal cord injury patients and is usually caused by noxious stimuli that cannot be removed promptly, e.g., somatic pain, abdominal distension. A 61-year-old man, who sustained tetraplegia at C-5 (ASIA-A) 38 years ago, was admitted with chest infection. Computerised tomography (CT) of the chest showed the ascending aorta to measure 4 cm in anteroposterior diameter; descending thoracic aorta measured 3.5 cm. No dissection was seen. Normal appearances of abdominal aorta were seen. He was treated with noninvasive ventilation, antibiotics, and diuretics. Nineteen days later, when there was sudden deterioration in his clinical condition, CT of the pulmonary angiogram was performed to rule out pulmonary embolism. This showed no pulmonary embolus, but the upper abdominal aorta showed some dissection with thrombosis of the false lumen. Blood pressure was controlled with perindopril 2 mg, once a day, doxazosin 4 mg, twice a day, and furosemide 20 mg, twice a day. Since this patient did not show clinical features of mesenteric or lower limb ischaemia, the vascular surgeon did not recommend subdiaphragmatic aortic replacement. This patient subsequently developed recurrent episodes of autonomic dysreflexia. Each acute episode of dysreflexia was controlled by nifedipine given sublingually in doses varying from 5 to 20 mg. No inciting cause for autonomic dysreflexia could be found other than chronic aortic dissection. This patient's medication was then changed to doxazosin 8 mg, twice a day, and sustained-release nifedipine 10 mg, twice a day, which helped to prevent recurrent autonomic dysreflexia. Chronic aortic dissection is a very rare cause for recurrent autonomic dysreflexia in ageing spinal cord injury patients. When the inciting cause for dysreflexia is not amenable for treatment, recurrent dysreflexic episodes can be prevented by pharmacotherapy with an alpha-adrenergic blocking agent (doxazosin) and sustained-release nifedipine.

Fatal cerebral hemorrhage in a tetraplegic patient due to autonomic dysreflexia triggered by delay in emptying urinary bladder after unsuccessful intermittent catheterization by carer: lessons learned.

INTRODUCTION: Over-distension of urinary bladder in a high spinal cord injury patient is a triggering factor for autonomic dysreflexia. Removing triggering factors is vital to prevent autonomic dysreflexia. CASE PRESENTATION: A 36-year-old tetraplegic patient, who was managed by intermittent catheterizations performed by caregivers, developed recurrent autonomic dysreflexia during a week due to: 1) carers not performing intermittent catheterizations every night; 2) infrequent catheterizations during the day, leading to distension of urinary bladder. A day before his demise, carer attempted routine catheterization; but was unable to insert the catheter; blood pressure rose to 192/109 mmHg. Nifedipine 10 mg was administered. Thirty minutes later, blood pressure was 181/113 mmHg; second dose of Nifedipine was not given. Forty minutes elapsed before a senior carer came and catheterized successfully. Meanwhile, patient developed pounding headache; became drowsy; was talking incoherently. Four and half hours after unsuccessful catheterization, carers contacted emergency services and the patient was taken to Accident and Emergency; CT of head revealed very large acute intracranial hemorrhage in the right frontal and parietal lobes. The patient expired a day later. The Coroner's verdict: "Patient died of massive intracranial hemorrhage caused by autonomic dysreflexia, a known complication of high spinal cord injury. Emergency protocols to manage autonomic dysreflexia were not followed in the days leading up to his death." CONCLUSION: Failed urethral catheterization is a potentially life-threatening emergency; every patient should have a care plan explicitly describing what should be done when catheterization is not successful. Preventive measures rather than episodic treatment of autonomic dysreflexia should be the guiding principle.

Persistent urine leakage around a suprapubic catheter: the experience of a person with chronic tetraplegia.

INTRODUCTION: Persistent urine leakage after suprapubic cystostomy in tetraplegic subjects occurs due to shrinkage of the urinary bladder and bladder spasms. The patient's social life is adversely affected as clothes become wet, smelly, and require frequent changing, thus increasing the workload of carers. CASE PRESENTATION: A 48-year-old male sustained C-4 complete (AIS:A) tetraplegia while swimming in 2007. Suprapubic cystostomy was performed in 2009. From 2012, this patient had urine leakage around the suprapubic catheter, which became progressively more frequent. Propiverine, then oxybutynin tablets instead of propiverine, oxybutynin transdermal patches, and mirabegron in addition to oxybutynin were tried. An indwelling urethral catheter was used in addition to the suprapubic catheter to alleviate urine leakage when the bladder was undergoing spasms. This patient continued to have leakage around the suprapubic catheter. Leakage of urine was occasionally accompanied by autonomic dysreflexia. Leakage of urine caused huge amounts of extra work for carers, and family. Furthermore, leakage of urine had a significant impact on quality of life, and going out with friends and family. Bladder wall injection of Botox was performed in 2015 and in 2016, which reduced urine leakage. DISCUSSION: Bladder wall injection of Botox to treat persistent urine leakage around the suprapubic catheter in spinal cord injury patients with suprapubic cystostomy has not been mentioned in NICE guidelines or publications indexed in PubMed. While recommending suprapubic cystostomy to subjects with tetraplegia, leakage of urine around the suprapubic catheter, which may occur sometime after suprapubic cystostomy, should be included in the conversation so that patients and carers become aware of this potential complication.

Fatal collapse due to autonomic dysreflexia during manual self-evacuation of bowel in a tetraplegic patient living alone: lessons to learn.

BACKGROUND: To identify areas for improvement, the National Health Service in England mandates the review of case reports of patients who have died, which should be translated into improved care for other patients. CASE REPORT: A 49-year-old Caucasian man sustained C-7 tetraplegia in a motorcycle accident in 1992. In 2009, he developed seizures and collapsed in the lavatory on a number of occasions during manual self-evacuation of his bowel. A 24-hour electrocardiogram recording at that time showed sinus rhythm with a maximum heart rate of 97 and a minimum of 39 beats per minute; there were no significant arrhythmias that could have contributed to his episodes of collapse. In 2015, the patient again collapsed while performing manual evacuation of his bowel; on this occasion, he did not suffer a seizure. He was found unresponsive in the bathroom by his daughter, who contacted the emergency services. He recovered consciousness on arrival at the Accident and Emergency Department. A noncontrast computed tomography scan of his head revealed no acute intracranial pathology. In 2016, he suffered a fatal collapse in the lavatory, again while performing manual bowel evacuation. At autopsy, no other significant disease was found that might have caused death, and given the clinical history, the cause of death was recorded as autonomic dysreflexia. CONCLUSION: There were delays in 1) recognizing that his episodes of collapse in the lavatory were due to autonomic dysreflexia induced by manual bowel evacuation; 2) recommending the prior application of topical 2% lidocaine jelly to prevent or limit autonomic dysreflexia occurring during manual bowel evacuation; and 3) considering alternative bowel management such as stimulant laxatives, transanal irrigation, or colostomy, which could have prevented the occurrence of autonomic dysreflexia caused by manual evacuation.

The risk of intra-urethral Foley catheter balloon inflation in spinal cord-injured patients: Lessons learned from a retrospective case series.

BACKGROUND: Inflating the balloon of Foley catheter in urethra is a complication of urethral catheterisation. We report five patients in whom this complication occurred because of unskilled catheterisation. Due to lack of awareness, the problem was not recognised promptly and patients came to harm. CASE SERIES: A tetraplegic patient developed pain in lower abdomen and became unwell after transurethral catheterisation. CT pelvis revealed full bladder with balloon of Foley catheter in dilated urethra.Routine ultrasound examination in an asymptomatic tetraplegic patient with urethral catheter drainage, revealed Foley balloon in the urethra. He was advised to get catheterisations done by senior health professionals.A paraplegic patient developed bleeding and bypassing after transurethral catheterisation. X-ray revealed Foley balloon in urethra; urethral catheter was changed ensuring its correct placement in urinary bladder. Subsequently, balloon of Foley catheter was inflated in urethra several times by community nurses, which resulted in erosion of bulbous urethra and urinary fistula. Suprapubic cystostomy was performed.A tetraplegic patient developed sweating and increased spasms following urethral catheterisations. CT of abdomen revealed distended bladder with the balloon of Foley catheter located in urethra. Flexible cystoscopy and transurethral catheterisation over a guide-wire were performed. Patient noticed decrease in sweating and spasms.A paraplegic patient developed lower abdominal pain and nausea following catheterisation. CT abdomen revealed bilateral hydronephrosis and hydroureter and Foley balloon located in urethra. Urehral catheterisation was performed over a guide-wire after cystoscopy. Subsequently suprapubic cystostomy was done. CONCLUSION: Spinal cord injury patients are at increased risk for intra-urethral Foley catheter balloon inflation because of lack of sensation in urethra, urethral sphincter spasm, and false passage due to previous urethral trauma. Education and training of doctors and nurses in proper technique of catheterisation in spinal cord injury patients is vital to prevent intra-urethral inflation of Foley catheter balloon. If a spinal cord injury patient develops bypassing or symptoms of autonomic dysreflexia following catheterisation, incorrect placement of urethral catheter should be suspected.

Severe, Protracted Spasm of Urinary Bladder and Autonomic Dysreflexia Caused by Changing the Suprapubic Catheter in a Cervical Spinal Cord Injury Patient: Treatment by a Bolus Dose and Increased Total Daily Dose of Intrathecal Baclofen.

BACKGROUND: Intrathecal administration of baclofen by implanted pump reduces rigidity and muscle spasms. Its use specifically to control bladder spasms has not been reported. CASE REPORT: A tetraplegic patient developed severe, protracted, bladder spasms, abdominal muscles spasms, and high blood pressure after change of suprapubic catheter; nifedipine, diazepam, and paracetamol did not control spasms; bolus dose of baclofen intrathecally produced prompt relief via baclofen pump. CONCLUSION: Severe, protracted bladder spasms, abdominal muscles spasms, and autonomic dysreflexia, induced by change of suprapubic catheter in a spinal cord injury patient, were treated successfully by a bolus dose and increased total daily dose of intrathecal baclofen.