scholarly journals Vasculitic Tibial Mononeuropathy Associated with Inherited Immune Dysregulation: A Review of Tibial Mononeuropathies with Electrodiagnostic Considerations

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
James Liu ◽  
Yue Ding ◽  
Sandra Camelo-Piragua ◽  
James Richardson
Keyword(s):  
Critical Role ◽  
Immunosuppressive Treatment ◽  
Nerve Biopsy ◽  
Immune Dysregulation ◽  
Sural Nerve Biopsy ◽  
Small Vessel Vasculitis ◽  
Tarsal Tunnel ◽  
Electrodiagnostic Testing ◽  
The Right ◽  
The Impact

Compressive tibial mononeuropathies are uncommon and can be caused by conditions including posterior compartment syndrome, soleal sling syndrome, and tarsal tunnel syndrome. Therefore, it is critical to consider noncompressive etiologies when a tibial mononeuropathy is suspected. This is a patient with a history of rare inherited immune dysregulation that presented to the electrodiagnostic laboratory with severe neuropathic pain in the right foot associated with plantarflexion weakness, concerning for a tibial mononeuropathy. However, the patient’s clinical presentation and results on electrodiagnostic testing were not consistent with any of the above entities. Therefore, noncompressive etiologies of tibial mononeuropathies such as vasculitis had to be considered. The patient subsequently underwent sural nerve biopsy which confirmed small-vessel vasculitis as the cause of the tibial mononeuropathy. She was then started on appropriate immunosuppressive treatment which resulted in significant pain relief and was discharged home. This case highlights the importance of considering noncompressive causes of tibial nerve injury. Compressive and vasculitic tibial mononeuropathies along with their electrodiagnostic considerations are reviewed. Furthermore, this case highlights the critical role of the electromyographer and ability to maximize the impact on patient care through a solid foundation in anatomy, pathophysiology, and electrodiagnosis blended with clinical acumen.

scholarly journals The Impact of Transformation Leadership on Employee’s Effectiveness (The Case of Ministry of Higher Education and Scientific Research, Kurdistan Regional Government, Iraq)

2020 ◽  
Vol 7 (11) ◽  
pp. 201
Author(s):  
Hazhar Omer Muhammed ◽  
Abdulla Ibrahim Aziz ◽  
Zana Majed Sadq ◽  
Bestoon Abdulmaged Othman
Keyword(s):  
Higher Education ◽  
Transformational Leadership ◽  
Critical Role ◽  
Scientific Research ◽  
Optimal Level ◽  
Regional Government ◽  
Employee Effectiveness ◽  
The Right ◽  
The Impact ◽  
Ministry Of Higher Education

Leadership plays a critical role in the management of any organization and establishing the right style of leadership is one of the fundamental aspects that cannot be undermined. While there are different modes of leadership, the transformational style has been vastly employed and found to be highly effective. Transformational leadership encompasses the tendency to transform the values and norms of employees as the manager strives to motivate employees in a way that motivates them to deliver performances at an optimal level. It thrives on the interactions that are directed at achieving a collective purpose in a manner that motivates, enhances and transforms the actions and ethical leanings of the subordinates. In this study, the researchers examined the impact of transformational leadership on employee effectiveness at the Ministry of Higher Education and Scientific Research in the Kurdistan Regional Government. The sample size included 76 participants that were made to give their assessment through a 24-item questionnaire that was rated using a Likert scale of 1 – 5. The data obtained from this study were analyzed using SPSS 20, and tests for regression and Pearson's correlation coefficient were run. The result showed that inspirational motivation had the greatest impact on employee effectiveness in our case study.

Workplace incivility as a moderator of the relationships between polychronicity and job outcomes

2018 ◽  
Vol 30 (3) ◽  
pp. 1245-1272 ◽  
Author(s):  
Huseyin Arasli ◽  
Boshra Hejraty Namin ◽  
A. Mohammed Abubakar
Keyword(s):  
Job Performance ◽  
Critical Role ◽  
Hotel Industry ◽  
Monetary Incentives ◽  
Frontline Employees ◽  
Social Stressors ◽  
Content Type ◽  
The Right ◽  
The Impact ◽  
The Relationship

Purpose On the basis of person–job fit theory and conservation of resource theory, this study aims to develop and test a model to examine the impact of polychronicity on frontline employees’ job performance in hotel industry and simultaneously, investigate the moderating effects of supervisor, coworker and customer incivility as stressors in the relationship between polychronicity and employees’ job performance. Design/methodology/approach Data are obtained in North Cyprus from 262 frontline employees working in four- and five-star hotels. Findings The results suggest that polychronicity refers to employees’ performance. Customer incivility negatively and significantly influences job performance, but coworker and supervisor incivilities do not. Unlike coworker incivility, both customer and supervisor incivilities moderate the relationship between polychronicity and job performance; that is, high customer and/or supervisor incivility weaken the positive relationship between polychronicity and job performance. Practical implications Regarding the critical role of polychronic frontline employees, hotel management should recruit the right candidates and endeavor to retain such employees by offering monetary and non-monetary incentives, training and empowering. They may implement a zero-tolerance policy that simultaneously supports both parties (customers and employees). Originality/value The association between employee quality (i.e. polychronicity), job performance and incivility is often overlooked in the hospitality research. This study is the first attempt to consider the joint moderating effect of important social stressors (customer, coworker and supervisor incivility) in the hotel industry.

scholarly journals NCMP-23. PEMBROLIZUMAB-ASSOCIATED CD8+ VASCULITIC MONONEURITIS MULTIPLEX IN A PATIENT WITH MESOTHELIOMA: FIRST CASE REPORT

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii127-ii127
Author(s):  
Michaela Baldauf ◽  
Kapauer Monika ◽  
Jörger Markus ◽  
Flatz Lukas ◽  
Regulo Rodriguez ◽  
...  
Keyword(s):  
Case Report ◽  
Checkpoint Inhibitors ◽  
Axonal Neuropathy ◽  
Immunosuppressive Treatment ◽  
Small Vessel ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Mononeuritis Multiplex ◽  
First Case ◽  
The Right

Abstract INTRODUCTION Immunotherapy, especially with immune checkpoint inhibitors (ICPI), has increasingly become an attractive treatment modality for various types of cancers. However, many patients develop ICPI-associated autoimmune adverse events such as pneumonitis, colitis or rarely neurological syndromes. Large and medium vessel vasculitis haS only occasionally been reported. Here we report the first case of ICPI-associated mononeuritis multiplex in a patient with malignant mesothelioma, caused by a histological proven small vessel vasculitis. CASE REPORT A 61-year old female developed subacute progressive painful and asymmetric sensorimotor deficits on distal extremities. Electrophysiologically, signs of a severe axonal neuropathy of both legs and the right arm were found, and swellings of the corresponding nerves were seen upon nerve ultrasound exam. The clinical and electrophysiological findings were reminiscent of mononeuritis multiplex. Laboratory work up including CSF examination was normal. More than two years prior to developing peripheral nerve deficits, the patient had been diagnosed with malignant pleural mesothelioma and treated with the anti-PD1 monoclonal antibody pembrolizumab on progression after chemotherapy. Biopsy of the right sural nerve revealed a small vessel vasculitis with a lymphocyte predominance of CD8+ T cells over CD4+ T as well as B lymphocytes. Despite discontinuation of pembrolizumab and immunosuppressive treatment (high dose methylprednisone, cyclophosphamide) complemented by opioid therapy, painful allodynia persisted. CONCLUSION ICPI-associated autoimmune disorders also include small vessel vasculitis with rare phenotypes such as mononeuritis multiplex. Further studies are required to improve our understanding of the link between ICPIs, and the pathogenic process leading to vasculitis, as well as to optimize treatment options for those rare diseases.

Progressive Catatonia

1999 ◽  
Vol 84 (1) ◽  
pp. 239-246 ◽  
Author(s):  
James Robert Brasić ◽  
David Zagzag ◽  
S. Kowalik ◽  
Leslie Prichep ◽  
E. Roy John ◽  
...  
Keyword(s):  
Neurodegenerative Disorder ◽  
Neurological Diseases ◽  
Nerve Biopsy ◽  
Sural Nerve Biopsy ◽  
Quantitative Electroencephalography ◽  
Childhood Onset ◽  
Positron Emission ◽  
Brain Degeneration ◽  
The Right ◽  
Treatable Condition

We present the case of a young man with a diagnosis of a childhood-onset pervasive developmental disorder who developed a progressive neurologic deterioration with persistent catatonia and right hemiparesis. On his initial evaluation approximately three years after the onset of mutism, he manifested right hemiparesis and catalepsy. Two years later, although catalepsy had subsided, motor function had deteriorated so that he could not use his hands to feed or dress himself. Oral-facialbuccal dyskinesia manifested by blepharospasm and grimacing were present constantly during waking hours. Quantitative electroencephalography demonstrated markedly decreased amplitude, a finding associated with catatonia. Left sural nerve biopsy indicated large axon cylinder degeneration. Left deltoid biopsy demonstrated perimysial fibrosis and type II fiber predominance. Although magnetic resonance imaging of the head without contrast was normal, positron emission tomography indicated hypometabolism of the right cerebral and the right cerebellar hemispheres. The patient continues to deteriorate despite a course of 25 electroconvulsive treatments. He continues to manifest criteria for catatonia including motoric immobility, mutism, and peculiarities of voluntary movement such as prominent grimacing. We suspect an inherited neurodegenerative disorder. Since catatonia is a treatable condition frequently associated with medical and neurological diseases, examination for the features of catatonia must be included in the assessment of patients with progressive brain degeneration. This report is an attempt to clarify the traits of a serious variant of progressive brain degeneration.

The Laryngeal Epithelium in Reflux

2011 ◽  
Vol 21 (3) ◽  
pp. 112-117 ◽  
Author(s):  
Elizabeth Erickson-Levendoski ◽  
Mahalakshmi Sivasankar
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Critical Role ◽  
Structure And Function ◽  
Laryngeal Disease ◽  
Health And Disease ◽  
And Function ◽  
The Impact

The epithelium plays a critical role in the maintenance of laryngeal health. This is evident in that laryngeal disease may result when the integrity of the epithelium is compromised by insults such as laryngopharyngeal reflux. In this article, we will review the structure and function of the laryngeal epithelium and summarize the impact of laryngopharyngeal reflux on the epithelium. Research investigating the ramifications of reflux on the epithelium has improved our understanding of laryngeal disease associated with laryngopharyngeal reflux. It further highlights the need for continued research on the laryngeal epithelium in health and disease.

Eosinophilic vasculitis: an inhabitual and resistant manifestation of a vasculitis

VASA ◽  
2010 ◽  
Vol 39 (4) ◽  
pp. 344-348 ◽  
Author(s):  
Jandus ◽  
Bianda ◽  
Alerci ◽  
Gallino ◽  
Marone
Keyword(s):  
Skin Biopsy ◽  
Intravenous Iron ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Raynaud Phenomenon ◽  
The Third ◽  
Left Elbow ◽  
Right Hand ◽  
The Right ◽  
Trunk Skin

A 55-year-old woman was referred because of diffuse pruritic erythematous lesions and an ischemic process of the third finger of her right hand. She was known to have anaemia secondary to hypermenorrhea. She presented six months before admission with a cutaneous infiltration on the left cubital cavity after a paravenous leakage of intravenous iron substitution. She then reported a progressive pruritic erythematous swelling of her left arm and lower extremities and trunk. Skin biopsy of a lesion on the right leg revealed a fibrillar, small-vessel vasculitis containing many eosinophils.Two months later she reported Raynaud symptoms in both hands, with a persistent violaceous coloration of the skin and cold sensation of her third digit of the right hand. A round 1.5 cm well-delimited swelling on the medial site of the left elbow was noted. The third digit of her right hand was cold and of violet colour. Eosinophilia (19 % of total leucocytes) was present. Doppler-duplex arterial examination of the upper extremities showed an occlusion of the cubital artery down to the palmar arcade on the right arm. Selective angiography of the right subclavian and brachial arteries showed diffuse alteration of the blood flow in the cubital artery and hand, with fine collateral circulation in the carpal region. Neither secondary causes of hypereosinophilia nor a myeloproliferative process was found. Considering the skin biopsy results and having excluded other causes of eosinophilia, we assumed the diagnosis of an eosinophilic vasculitis. Treatment with tacrolimus and high dose steroids was started, the latter tapered within 12 months and then stopped, but a dramatic flare-up of the vasculitis with Raynaud phenomenon occurred. A new immunosupressive approach with steroids and methotrexate was then introduced. This case of aggressive eosinophilic vasculitis is difficult to classify into the usual forms of vasculitis and constitutes a therapeutic challenge given the resistance to current immunosuppressive regimens.

Emotional Reactivity to Visual Content as Revealed by ERP Component Clustering

2015 ◽  
Vol 29 (4) ◽  
pp. 135-146 ◽  
Author(s):  
Miroslaw Wyczesany ◽  
Szczepan J. Grzybowski ◽  
Jan Kaiser
Keyword(s):  
Emotional Reactivity ◽  
Brain Activity ◽  
Affective State ◽  
Occipital Lobe ◽  
Stimulus Onset ◽  
Emotional States ◽  
Neural Basis ◽  
Temporoparietal Junction ◽  
The Right ◽  
The Impact

Abstract. In the study, the neural basis of emotional reactivity was investigated. Reactivity was operationalized as the impact of emotional pictures on the self-reported ongoing affective state. It was used to divide the subjects into high- and low-responders groups. Independent sources of brain activity were identified, localized with the DIPFIT method, and clustered across subjects to analyse the visual evoked potentials to affective pictures. Four of the identified clusters revealed effects of reactivity. The earliest two started about 120 ms from the stimulus onset and were located in the occipital lobe and the right temporoparietal junction. Another two with a latency of 200 ms were found in the orbitofrontal and the right dorsolateral cortices. Additionally, differences in pre-stimulus alpha level over the visual cortex were observed between the groups. The attentional modulation of perceptual processes is proposed as an early source of emotional reactivity, which forms an automatic mechanism of affective control. The role of top-down processes in affective appraisal and, finally, the experience of ongoing emotional states is also discussed.

The Impact of Internal Work Environment on the Retention of Healthcare Providers at Turaif General Hospital

2019 ◽  
Vol 10 (12) ◽  
pp. 1183-1199
Author(s):  
Mohammed Alrouili ◽  
Keyword(s):  
Work Environment ◽  
General Hospital ◽  
Professional Growth ◽  
Healthcare Providers ◽  
Entire Study ◽  
Internal Work ◽  
Research Findings ◽  
Study Population ◽  
The Right ◽  
The Impact

This study attempted to identify the impact of internal work environment on the retention of healthcare providers at Turaif General Hospital in the Kingdom of Saudi Arabia. In particular, the study aimed to identify the dimensions of work circumstances, compensation, and relationship with colleagues, professional growth, and the level of healthcare providers’ retention. In order to achieve the study goals, the researcher used the descriptive analytical approach. The researcher used the questionnaire as the study tool. The study population comprised all the healthcare providers at Turaif General Hospital. Questionnaires were distributed to the entire study sample that consisted of 220 individuals. The number of questionnaires valid for study was 183 questionnaires. The research findings were as follows: the participants’ estimate of the work circumstances dimension was high (3.64), the participants’ estimate of the compensation dimension was moderate (3.32), the participants’ estimate of the relationship with colleagues dimension was high (3.62), the participants’ estimate of the professional growth dimension was weak (2.39), and the participants’ estimate of healthcare providers’ retention level was intermediate (2.75). Accordingly, the researcher’s major recommendations are: the need to create the right atmosphere for personnel in hospitals, the interest of the hospital to provide the appropriate conditions for the staff in terms of the physical and moral aspects for building the work adjustment in the staff, and conducting training courses and educational lectures for personnel in hospitals on how to cope with the work pressures.

The Right to Housing: Challenges Associated with the ‘Waiting List System’ Ekurhuleni Metropolitan Municipality V Various Occupiers, Eden Park Extension 5 2014 3 SA 23 (SCA)

2017 ◽  
Vol 30 (1) ◽  
pp. 112-121
Author(s):  
Shamier Ebrahim
Keyword(s):  
Supreme Court ◽  
Waiting Lists ◽  
The State ◽  
Waiting List ◽  
Allocation Process ◽  
The Supreme Court ◽  
The Right ◽  
The Impact ◽  
Court Of Appeal

The right to adequate housing is a constitutional imperative which is contained in section 26 of the Constitution. The state is tasked with the progressive realisation of this right. The allocation of housing has been plagued with challenges which impact negatively on the allocation process. This note analyses Ekurhuleni Metropolitan Municipality v Various Occupiers, Eden Park Extension 51 which dealt with a situation where one of the main reasons provided by the Supreme Court of Appeal for refusing the eviction order was because the appellants subjected the unlawful occupiers to defective waiting lists and failed to engage with the community regarding the compilation of the lists and the criteria used to identify beneficiaries. This case brings to the fore the importance of a coherent (reasonable) waiting list in eviction proceedings. This note further analyses the impact of the waiting list system in eviction proceedings and makes recommendations regarding what would constitute a coherent (reasonable) waiting list for the purpose of section 26(2) of the Constitution.

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