Characteristics of COVID and post COVID polyneuropathies in adults and pediatrics: an Egyptian sample

Abstract Background The aim of this study is to describe the different forms of polyneuropathy associated with coronavirus disease 2019 (COVID-19) as a secondary neurological complication for (COVID-19) and the outcome from different therapeutic regimens in adults and pediatrics in first and second waves of the pandemic. Case presentation This study was conducted on 42 patients, they were divided into two groups, group (A) and group (B) in first and second waves respectively. Twenty-five patients presented by ascending weakness preceded by fever, dry cough and respiratory distress, electromyography (EMG) and nerve conduction (NC) studies done and confirmed the clinical diagnosis of demyelinating polyneuropathy. Eight patients presented by acute flaccid quadriparesis, more severe in upper limbs preceded by fever and diarrhea diagnosed as acute axonal polyneuropathy. Five patients presented by severe fatigue and progressive weakness of both lower and upper limbs, they developed fever and cough 10 days after the neurological symptoms. EMG and NC done and confirmed clinical diagnosis of polyneuropathy of demyelinating with secondary axonal picture. Four patients presented 30 to 40 days after their recovery form corona virus infection with gradual progressive weakness of both upper and lower limbs over 2 to 3 months duration, mainly the proximal muscles of lower limbs were affected with areflexia. EMG and NC done and confirmed the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). Conclusion We should gain a better understanding of the underlying pathophysiology and therapeutic options of polyneuropathies related to COVID-19, which will have an impact on the treatment of the COVID related respiratory failure presenting with neuropathy.

Download Full-text

Effects of Swiss ball exercise and Pilates exercise on core muscle strengthening in college cricketers

Biomedicine ◽

10.51248/.v40i3.31 ◽

2020 ◽

Vol 40 (3) ◽

pp. 377-380

Author(s):

K. Kamatchi ◽

B. Arun ◽

G. Tharani ◽

G. Yuvarani ◽

G. Vaishnavi ◽

...

Keyword(s):

Mean Value ◽

Terminal Segment ◽

Core Stability ◽

Lower Limbs ◽

Age Group ◽

Mean Values ◽

Muscle Strengthening ◽

Group A ◽

Group B ◽

Swiss Ball

Introduction and Aim: Cricket is one of the most popular game in India played by men and women of all ages. Core stability is defined as the ability to control the position and movement of the trunk over the pelvis to allow optimum production, transfer and control of force and movement to the terminal segment. Major muscles involved are pelvic floor muscles, Transverse abdominis, multifidus, internal and external obliques, and rectus abdominis. Core is used to stabilize the thorax and the pelvis during dynamic movement. The study helps to compare the effectiveness of Swiss ball exercise and Pilates exercise on gaining core muscle strength. The aim of the study is to compare the effect of Swiss ball exercise and Pilates exercise on core muscle strengthening in college cricketers. Materials and Methods: The design of the study is comparative type. The study was carried out in faculty of Physiotherapy, Dr.M.G.R. Educational and Research Institute. The study sample of 30 male college cricketers between the age group of 18 to 25 years are included in the study. Individuals with associated neuromuscular conditions, any injuries to lower limbs and any spinal injuries have been excluded in the study. Swiss ball and Pilates mat are the materials used. Sphygmomanometer is the outcome measure.30 male individuals between the age group of 18 to 25 years were divided into two groups, group A and group B. Individuals in the group A (n=15) received the Swiss ball exercise and group B (n=15) received Pilates exercise for 4 session/ week for 6 weeks. Results: On comparing the mean values of group A and group B on double leg lowering test (DLLT), it shows significant decrease in the post test mean values but (group B- Pilates exercise) shows (30.60) which has the lower mean value is more effective than (group A- Swiss ball exercise) (46.80) at P ? 0.001. Hence, null hypothesis is rejected. Conclusion: The study concluded that both the group was effective but while comparing Pilates exercise showed the potential treatment option than swiss ball exercise. Hence, Pilates exercise was effective on core muscle strengthening in college cricketers. Keywords: Swiss ball; Pilates mat; core muscle; sphygmomanometer.

Download Full-text

Treatment of Chronic Venous Ulcers Using New Four Layers Compressive Bandage Dressing

Journal of Nepal Medical Association ◽

10.31729/jnma.2782 ◽

2015 ◽

Vol 53 (199) ◽

pp. 156-161 ◽

Cited By ~ 1

Author(s):

Kaushal K Tiwari ◽

Krishna G Shrestha ◽

Bijay Sah ◽

D.Jaypal Reddy

Keyword(s):

Compression Therapy ◽

Venous Ulcer ◽

Term Treatment ◽

Lower Limbs ◽

High Morbidity ◽

Current Standard ◽

Venous Ulcers ◽

Long Term Treatment ◽

Group A ◽

Group B

Introduction: Lower-extremity ulcers represent the largest group of ulcers presenting to an outpatient department. It is a cumbersome, difficult to treat disease, which causes high morbidity and huge cost for the patient and healthcare system. Current standard treatment includes compression therapy. However, majority of patients need long term treatment with minimal efficacy. Aim of our study is to evaluate efficacy of four layers compressive bandages for the management of chronic venous ulcers. Methods: In Group A, we have prospectively included 20 patients with chronic venous ulcers on lower limbs for four layers hosiery bandage using Velfour bandage. Other 15 patients, Group B, were treated with conventional wound dressing. Velfour and crepe bandage were done once weekly for three weeks. Results: DVT was cause of chronic venous ulcer in 70% patient in group A and in 73.3% in Group B. Majority of patients were having left sided chronic venous ulcers. The mean duration of the ulcers was 15.6 vs 10.86 months (group A vs. group B). At the end of 3rd week, in 55% wounds in Group A were healed except few big and deep wounds remained. Most of these wounds also became smaller with minimal discharge. Size of wounds significantly decreased in Group A vs. Group B patients (0.7±0.81 cm vs. 1.73±0.77 cm, p<0.00031). However, cost of treatment in group A remained higher than group B. Conclusions: Our study has shown that four layer compressive bandage using Velfour is an easy, effective, and reproducible method of treatment for the chronic venous ulcer. Keywords: compression bandage; treatment; venous ulcer.

Download Full-text

Analisis Postur Kerja Operator dengan Metode Rula di Area Gas Cutting

Jurnal INTECH Teknik Industri Universitas Serang Raya ◽

10.30656/intech.v3i2.881 ◽

2017 ◽

Vol 3 (2) ◽

pp. 73

Author(s):

Irwan Pegiardi ◽

Firdanis Setyaning Handika ◽

Supriyadi Supriyadi

Keyword(s):

Upper Limb ◽

Research Method ◽

The Body ◽

Sitting Position ◽

Upper Limbs ◽

Work Posture ◽

Long Time ◽

Group A ◽

Group B

The gas cutting area has several jobs that are risky to the operator, such as activities with squatting, bending positions. This study aims to determine the risk of work in the gas cutting area as a basis for improving work posture. The method used is RULA (Rapid Upper Limb Assessment) is a research method for investigating disorders of the upper limbs. By measuring the group A score and group B score. Based on the results of the RULA value in the process of operating the machine with a sitting position with a score 3. clearing the cutting plate with a bent position with a score of 5, and the highest score 6 in the grinding plate cutting. To reduce pain in the neck, torso, and arms, operators should not do work postures that cause pain in the body for a long time.

Download Full-text

VENOGRAPHY (VG) OF THE LOWER LIMBS IN THE MANAGEMENT OF PATIENTS WITH SUSPECTED PULMONARY EMBOLISM (PE)

10.1055/s-0038-1644197 ◽

1987 ◽

Author(s):

W H J Kruit ◽

A K Sing ◽

G J H den Ottolander ◽

A C de Beor ◽

J J C Jonker

Keyword(s):

Pulmonary Embolism ◽

Impedance Plethysmography ◽

Lower Limbs ◽

Surgical Patients ◽

Additional Patient ◽

Suspected Pulmonary Embolism ◽

X Ray ◽

Group A ◽

Group B

In a prospective cohort study, we evaluated X-ray VG in the management of non-surgical patients with clinically suspected PE. Thusfar follow up is available on 131 consecutive patients with suspected PE. In all patients a perfusion lungscan (PS) was carried out within 24 hours. In case of a normal PS (group A, n=32), no anticoagulant (AC) therapy was given. In case of an abnormal PS, AC therapy was started (heparin) and a bilateral ascending VG was carried out within 72 hours. In 46 patients (group C) venous thrombosis (DVT) was demonstrated by VG, and these patients were treated with AC for 6 months. In 53 patients with suspected PE and an abnormal lungscan, bilateral VG did not show DVT (group B). AC therapy was discontinued in these patients These patients were then screened for 14 days with fibrinogen legscanning and impedance plethysmography (IPG), followed by IPG alone every 2 months for at least 1 year. In group B, 6 patients died in the follow up period. None of the patients had signs of PE at autopsy. One additional patient in group B developed DVT documented by repeat VG, 6 months after entry into the trial. According to these preliminary data, it seems safe to base the decision whether or not to treat a patient with suspected PE with AC, on the presence or absence of DVT in the lower limbs as demonstrated by VG

Download Full-text

Residual Vein Thrombosis Improves Screening for Occult Cancer: Results On 537 Patients with Idiopathic Deep Vein Thrombosis.

Blood ◽

10.1182/blood.v114.22.3999.3999 ◽

2009 ◽

Vol 114 (22) ◽

pp. 3999-3999

Author(s):

Sergio Siragusa ◽

Alessandra Malato ◽

Fabio Fulfaro ◽

Giorgia Saccullo ◽

Domenica Caramazza ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Early Detection ◽

Lower Limbs ◽

Vein Thrombosis ◽

Occult Cancer ◽

Group A ◽

Group B ◽

Deep Vein ◽

Related Mortality

Abstract Abstract 3999 Poster Board III-935 Background Clinical advantage of extensive screening for occult cancer in patients with idiopathic Deep Vein Thrombosis (DVT) is unknown. We have demonstrated that the Residual Vein Thrombosis (RVT)-based screening for occult cancer improves early detection as well as cancer-related mortality (Siragusa S et al. Blood 2007;110(699):OC). Here we report on final analysis of 537 patients over a period of 8 years. Objective of the study We conducted a prospective study evaluating whether a RVT-based screening for cancer is sensitive and influences cancer-related mortality. Study design Prospective with two cohorts of DVT patients: the first cohort was monitored for clinical overt cancer only (Group A), while the second (Group B) received complete screening for occult neoplasm and subsequent surveillance. Materials and methods Consecutive patients with a first episode of DVT who presented RVT after 3 month of anticoagulation and without signs and/or symptoms for overt cancer. Screening for occult cancer was based on: ultrasound and/or CT scan of the abdomen and pelvis, gastroscopy, colonoscopy or sigmoidoscopy, hemoccult, sputum cytology and tumor markers. These tests were extended with mammography and Pap smear for women and ultrasound of the prostate and total specific prostatic antigen (PSA) for men. All investigations had to be completed within four-weeks from the assessment of RVT. All patients were followed-up for at least 2 years. Incidence and cancer-related mortality was compared between the two groups by survival curves (Kaplan-Mayer) and related Breslow test for statistics. Results Over a period of 8 years, 537 patients were included in the analysis: first cohort included 346 patients (Group A), second cohort 191 (Group B). Clinical characteristics between groups were homogenous. During the follow-up, 8.3% of patients developed overt cancer in group A; in group B, 7.8% of patients had diagnosed cancer at the moment of extensive screening while 2 new cases (0.7%) occurred during the follow-up (Table). The sensitivity of this approach was 92.1% (95% confidence intervals 75.2-104.2). Cancer-related mortality was 7.5% in group A and 3.6% in group B (p< 0.001). Conclusions The RVT-based screening for occult cancer is highly effective for improving early detection as well as cancer-related mortality in a cohort of 537 patient with DVT of the lower limbs. Disclosures: Off Label Use: Hydroxyurea use in myelofibrosis.

Download Full-text

Correlation of distance from skin to lumbar epidural space with age and height of patients

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20205046 ◽

2020 ◽

Vol 7 (12) ◽

pp. 1846

Author(s):

Manju Bala ◽

Monica Chhikara ◽

Deepika . ◽

Kiranpreet Kaur ◽

Teena Bansal ◽

...

Keyword(s):

Epidural Space ◽

Standard Technique ◽

Epidural Block ◽

Lower Limbs ◽

Correct Identification ◽

Epidural Catheter Placement ◽

Group A ◽

Group B ◽

Lower Lumbar ◽

Group D

Background: Epidural block is a popular and versatile procedure with applications as sole anaesthetic, as an analgesic adjuvant to general anaesthesia and for post-operative analgesia in procedures involving lower limbs, perineum, pelvis, abdomen and thorax. However, success of the epidural technique depends upon the correct identification of epidural space. The knowledge of distance from skin to epidural space can help in better identification of epidural space and epidural catheter placement with fewer incidences of complications. We conducted a study to find the distance from skin to the epidural space and its correlation with patient height and age to improve the success rate. Methods: Seventy-four patients scheduled to undergo lower lumbar surgeries where epidural block was required as anaesthetic or analgesic, were included in the study. These patients were randomly divided into four different groups of 37 patients each according to their age (group A and group B) and height (group C and group D). In these patient’s epidural block was given by standard technique according to the need of surgery and epidural depth measured. Obtained results were compared among group A, B and group C, D depending on their age and height respectively. Results: In group A (age 20-30 years), mean epidural depth was 3.96±0.4 cm while in group B (age 30-40 years) mean epidural depth was 4.05±0.5 centimeters. In group C (height 155-169 cm) mean epidural depth was 3.88±0.4 centimeters while it was 4.13±0.5 centimeters in group D (height 170-184 cm).Conclusions: There was increase in epidural depth with increase in height of patients but there was no correlation between age of patients and epidural depth.

Download Full-text

The Effects of Multi-Slice Helical Computed Tomography and Phlebography on Edema Regression Nursing of Lower Limbs Varicosis

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2020.3142 ◽

2020 ◽

Vol 10 (9) ◽

pp. 2124-2129

Author(s):

Jinmei Zu ◽

Ruyue Chen ◽

Jia Kang ◽

Yaru Han ◽

Gaixin Zhang

Keyword(s):

Computed Tomography ◽

Lower Limb ◽

Statistical Significance ◽

Lower Limbs ◽

Helical Computed Tomography ◽

High Ligation ◽

Gabor Filtering ◽

Operation Rate ◽

Group A ◽

Group B

Objective: To explore the effects of multi-slice helical computed tomography (MSCT) and phlebography on edema regression nursing of lower limbs varicosis, and to analyze the values of MSCT and phlebography on the diagnosis and treatment of lower limb varicosis. Methods: A total of 193 patients with lower limb varicosis treated in the Vascular Surgery Department were included as the research objects. According to different examination methods, the included patients were divided into the MSCT group, and the MSCT combined with the phlebography group, Then, patients in both groups received joint treatment of high ligation and varicectomy. The Gabor filtering-based algorithm and the Mean-Variance Efficient Frontier (MVEF) algorithm were used to smoothen the obtained images. Also, the operation rates and contradiction compositions of patients in both groups were analyzed. Patients who received surgical treatment were followed up for three months to one year; whether the deep vein thrombosis (DVT) occurred in them were observed, as well as the edema regression. Results: As for gender, grading, disease history, duration of disease, and onset age of both groups, no statistical significance was found (P > 0.05). Compared to group A, the positive detection rate of postoperative DVT was lower in group B, so did the operation rate. In group A, 32 cases of edema regressed significantly, and the disease condition was relieved. In group B, 35 cases of edema were regressed. Conclusion: Compared with MSCT, phlebography had a higher screening rate for indications of lower limb varicosis, which could effectively reduce the probability of DVT after operations and relieve the symptoms of edema in patients. In addition, although the sensitivity of MSCT was relatively low, it could be used for the primary screening diagnosis of lower limb varicosis.

Download Full-text

A safe technique for insertion of heel wires for hindfoot external fixation frames

The Bone & Joint Journal ◽

10.1302/0301-620x.100b8.bjj-2017-1427.r1 ◽

2018 ◽

Vol 100-B (8) ◽

pp. 1054-1059 ◽

Cited By ~ 1

Author(s):

C. Kelly ◽

P. J. Harwood ◽

P. R. Loughenbury ◽

J. A. Clancy ◽

S. Britten

Keyword(s):

At Risk ◽

External Fixation ◽

The Body ◽

Lateral Malleolus ◽

Lower Limbs ◽

Coronal Plane ◽

Group A ◽

Safe Technique ◽

Group B ◽

Neurovascular Structures

Aims Anatomical atlases document classical safe corridors for the placement of transosseous fine wires through the calcaneum during circular frame external fixation. During this process, the posterior tibial neurovascular bundle (PTNVB) is placed at risk, though this has not been previously quantified. We describe a cadaveric study to investigate a safe technique for posterolateral to anteromedial fine wire insertion through the body of the calcaneum. Materials and Methods A total of 20 embalmed cadaveric lower limbs were divided into two groups. Wires were inserted using two possible insertion points and at varying angles. In Group A, wires were inserted one-third along a line between the point of the heel and the tip of the lateral malleolus while in Group B, wires were inserted halfway along this line. Standard dissection techniques identified the structures at risk and the distance of wires from neurovascular structures was measured. The results from 19 limbs were subject to analysis. Results In Group A, no wires pierced the PTNVB. Wires were inserted a median 22.3 mm (range 4.7 to 39.6) from the PTNVB; two wires (4%) passed within 5 mm. In Group B, 24 (46%) wires passed within 5 mm of the PTNVB, with 11 wires piercing it. The median distance of wires from the PTNVB was 5.5 mm (range 0 to 30). A Mann–Whitney U test showed that this was significantly closer than in Group A (Hodges–Lehmann shift, 14.06 mm; 95% confidence interval (CI) 10.52 to 16.88; p < 0.0001). In Group B, with an increased angle of insertion there was greater risk to the PTNVB (rs = -0.80; p < 0.01). Conclusion Insertion of wires using an entry point one-third along a line from the point of the heel to the tip of the lateral malleolus (Group A) appears to be the safer technique. An insertion angle of up to 30° to the coronal plane can be used without significant risk to the PTNVB. Insertion of wires halfway along a line from the point of the heel to the tip of the lateral malleolus (Group B) carried a significantly higher risk of injury to neurovascular structures and, if necessary, an angle of insertion parallel to the coronal plane should be used. Cite this article: Bone Joint J 2018;100-B:1054–9.

Download Full-text

Nerve Ultrasound Comparison Between Transthyretin Familial Amyloid Polyneuropathy and Chronic Inflammatory Demyelinating Polyneuropathy

Frontiers in Neurology ◽

10.3389/fneur.2021.632096 ◽

2021 ◽

Vol 12 ◽

Author(s):

Kang Du ◽

Ke Xu ◽

Si Cheng ◽

He Lv ◽

Wei Zhang ◽

...

Keyword(s):

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Compound Muscle Action Potential ◽

Familial Amyloid Polyneuropathy ◽

Demyelinating Polyneuropathy ◽

Lower Limbs ◽

Nerve Ultrasound ◽

Inflammatory Demyelinating Polyneuropathy ◽

Amyloid Polyneuropathy ◽

The Mean ◽

Transthyretin Familial Amyloid Polyneuropathy

Backgrounds: Transthyretin familial amyloid polyneuropathy (TTR-FAP) is frequently misdiagnosed as chronic inflammatory demyelinating polyneuropathy (CIDP) because of similar phenotypes in the two diseases. This study was intended to identify the role of nerve ultrasonography in evaluating TTR-FAP and CIDP.Methods: Eighteen patients with TTR-FAP, 13 patients with CIDP, and 14 healthy controls (HC) were enrolled in this study. Consecutive ultrasonography scanning was performed in six pairs of nerves of bilateral limbs with 30 sites. The cross-sectional areas (CSAs) and CSA variability data of different groups were calculated and compared.Results: Both TTR-FAP and CIDP showed larger CSAs at most sites of both upper and lower limbs than in HC groups. CIDP patients had larger CSAs than TTR-FAP patients at 8/15 of these sites, especially at U1-3, Sci2 sites (p < 0.01). However, the CSAs at above sites were not a credible index to differentiate TTR-FAP from CIDP with a low area under the curve (<0.8). The CSA variability of median nerves was significantly higher in CIDP than in TTR-FAP and HC groups, with high sensitivity (0.692) and specificity (0.833) to differentiate CIDP from TTR-FAP. The CSA variability of ulnar nerves was not significantly different between the three groups. For the TTR-FAP group, mean CSAs at each site were not correlated with different Coutinho stages, modified polyneuropathy disability, course of sensory motor peripheral neuropathy, Neuropathy Impairment Score, or Norfolk Quality of life-diabetic neuropathy score. The mean compound muscle action potential of ulnar nerves was negatively correlated with the mean CSAs of ulnar nerves.Interpretation: TTR-FAP patients had milder nerve enlargement with less variability in CSAs of median nerves than those with CIDP, suggesting that nerve ultrasound can be a potential useful auxiliary tool to help differentiate the two neuropathies.

Download Full-text

A comparative study of primary cellulitis and its local complications in lower limbs in diabetics and non-diabetics through the new Amit Jain’s staging system from India

International Surgery Journal ◽

10.18203/2349-2902.isj20202413 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1962

Author(s):

Sharada P. B. ◽

Rohit Krishnappa ◽

Amit Kumar C. Jain ◽

Hariprasad Taluru Ramachandra

Keyword(s):

Statistical Analysis ◽

Staging System ◽

Lower Limbs ◽

Diabetic Patients ◽

Medical College ◽

Stage 4 ◽

Group A ◽

Group B ◽

A Prospective Study ◽

Stage 1

Background: The objective of the study was to validate Amit Jain’s staging system for cellulitis in diabetic and non-diabetic lower limbs and to predict the outcomes associated with cellulitis and surgical procedures done in them.Methods: We conducted a prospective study in department of surgery at Raja Rajeswari Medical College and Hospital Bengaluru, India. The study period was from December 2018 to November 2019. Statistical analysis was done using SPSS 22 and R environment ver.3.2.2.Results: A total of 36 patients were included in this study of which 21 were diabetics and were in placed in group A and 15 were non diabetics and placed in group B. 83.3% of the patients were males. 73.3% of non-diabetics had stage 1 cellulitis and 33.3% of diabetics had stage 1 and 2 each. 47.2% of patients underwent debridement and it was significantly common in diabetics (p=0.037) and also it was common in higher stages of cellulitis (p=0.001). 8.3% had amputation in this series. All the major amputations were done in stage 4 cellulitis (p=0.002).Conclusions: In this validation study, it can be seen that cellulitis is common in both diabetics and non-diabetics but it is severe in diabetic patients. Stage 3 was more common in diabetics compared to non-diabetics. Amit Jain’s staging system of cellulitis is a simple, easy, practical, focal classification that guides therapy and predicts amputation.

Download Full-text