scholarly journals Evaluation of Relationship Between Laboratory, Electrodiagnostic, and Functional Parameters in Patients With Amyotrophic Lateral Sclerosis; A Cross Sectional Study

Author(s):  
Marjan Zeinali ◽  
◽  
Mostafa Almasi Dooghaee ◽  
Mahsa Ziaee ◽  
Bahram Haghi Ashtiani ◽  
...  

Background: Amyotrophic lateral sclerosis (ALS) is an adult-onset motor neuron disease which leads to limb and/or bulbar muscle degeneration with a poor prognosis. Several demographic and biological factors have prognostic importance, but little data exist on the relationship between clinical, electrodiagnostic, and laboratory markers as predictors of disease progression. We aimed to assess the relationships between different aspects of clinical, electrodiagnostic, and laboratory features of ALS patients with their level of functioning. Methods: We included 27 patients with ALS who were diagnosed within two years before enrolment. Clinical assessment and electrodiagnostic studies were done by a neurology resident. The motor unit number index (MUNIX) and compound motor action potential (CMAP) were used as measures of motor unit loss. Serum creatinine, urea, Albumin, and creatine kinase were measured as laboratory markers. We used the Persian version of ALS functional rating scale (ALS-FRS) as the main outcome measure. Data were analyzed using the SPSS software. Pearson's correlation coefficient was calculated to test for correlations. Results: None of the demographic or laboratory parameters correlated with ALS-FRS. Patients with the onset of disease in the limbs had a higher MUNIX score compared to patients with a bulbar onset. Also, increased body mass index was associated with lower CMAP and MUNIX scores (p-value:0.02). Higher serum creatinine levels were significantly associated with higher lower limb MUNIX (p value:0.04). Higher lower limb MUNIX was in turn associated with higher lower limb functional score (ALS-FRS). Conclusion: Decreased serum creatinine may possibly be an indicator of lower limb motor unit loss in patients with ALS. Also, MUNIX scores may be used as surrogates for ALS-FRS in ALS trials. Further research is needed to elucidate the clinical application of these findings.Methods: We included 27 patients with ALS who were diagnosed within two years before enrolment. Clinical assessment and electrodiagnostic studies were done by a neurology resident. The motor unit number index (MUNIX) and compound motor action potential (CMAP) were used as measures of motor unit loss. Serum creatinine, urea, Albumin, and creatine kinase were measured as laboratory markers. We used the Persian version of ALS functional rating scale (ALS-FRS) as the main outcome measure. Data were analyzed using the SPSS software. Pearson's correlation coefficient was calculated to test for correlations. Results: None of the demographic or laboratory parameters correlated with ALS-FRS. Patients with the onset of disease in the limbs had a higher MUNIX score compared to patients with a bulbar onset. Also, increased body mass index was associated with lower CMAP and MUNIX scores (p-value:0.02). Higher serum creatinine levels were significantly associated with higher lower limb MUNIX (p value:0.04). Higher lower limb MUNIX was in turn associated with higher lower limb functional score (ALS-FRS). Conclusion: Decreased serum creatinine may possibly be an indicator of lower limb motor unit loss in patients with ALS. Also, MUNIX scores may be used as surrogates for ALS-FRS in ALS trials. Further research is needed to elucidate the clinical application of these findings.

Author(s):  
Kamarul Aryffin Baharuddin ◽  
Mohd Hashairi Fauzi ◽  
Mohd Faiz Mohd Shukri ◽  
Normalinda Yaacob ◽  
Mimi Azliha Abu Bakar

Introduction: Pain is the most common chief complaint of patients presenting to Emergency Department (ED). Pain is not simply a signal for tissue injury, but also a signal to seek repair and recuperation. The aim of this study was to determine whether upper limb (UL) or lower limb (LL) fracture has more pain and to evaluate the association between types of fracture (UL vs LL) with adequacy of pain relief. Methodology: A study was conducted from July to October 2005 in ED, Hospital Universiti Sains Malaysia (HUSM). Patients who fulfill the inclusion criteria were selected. Paramedics in charged were the assistants; at the same time became the observer. The paramedics were not involved in the decision making for pain management. Pain severity score was assessed by using Numeric Rating Scale (NRS). Results: 42 patients were enrolled. 85.7% (n=36) were male and 14.3% were female. Mean age is 29.6 years old. Mean NRS on arrival for UL and LL fractures were 6.47 ± 1.70 and 7.80 ± 2.53 respectively. Mean NRS for mixed fractures (both UL and LL) was 7.60 ± 3.36. There was no statistically significant association between fracture sites and analgesic administration (p value=0.300). There were 70.6% and 70.0% of the patients with UL and LL fractures had adequate pain relief whereas 80% of patients with mixed fractures had adequate pain relief (p value= 0.902). Conclusion: LL and mixed fractures had more pain score on arrival but there was no statistically significant association between fracture sites and analgesics administration and no association between fracture sites with adequacy of pain relief.


2020 ◽  
Vol 6 (2) ◽  
pp. 164-170
Author(s):  
Dewi Nurlaela Sari ◽  
Aay Rumhaeni

ABSTRAK Sectio caesarea merupakan tindakan alternatif dalam proses persalinan untuk menyelamatkan ibu dan janin. Ibu Bersalin dengan operasi sectio caesarea dilakukan pembedahan pada dinding abdomen dan dinding rahim. Dampak yang paling sering muncul dirasakan oleh postpartum dengan post operasi sectio caesarea adalah  nyeri. Nyeri akan berdampak pada bounding attachment terganggu, mobilisasi terbatas, Activity Daily Living (ADL) terganggu serta berpengaruh  terhadap Inisiasi Menyusui Dini (IMD). Asuhan yang diberikan terbatas pada terapi farmakologi dibandingkan  non farmakologi. Foot massage adalah salah satu terapi non farmakologi yang dapat membantu menutup gerbang di posterior horns dari sumsum tulang belakang dan memblokir bagian dari nyeri ke sistem saraf pusat. Tujuan penelitian ini untuk mengetahui pengaruh foot massage terhadap skala nyeri pada klien post operasi sectio caesarea di RS AMC. Penelitian ini merupakan penelitian pre eksperimen dengan pendekatan one group pre test post test design. Jumlah sampel yang digunakan berjumlah 27 orang dengan menggunakan teknik purposive sampling. Instrumen yang digunakan adalah Numeric Rating Scale (NRS) dan prosedur kerja foot massage. Responden dilakukan foot massage selama 20 menit selama 2 hari. Data di analisis dengan menggunakan uji wilcoxon. Hasil penelitian menunjukkan lebih dari setengah klien post operasi sectio caesarea berada di skala nyeri 6 sebelum dilakukan foot massage dan hampir setengah memiliki skala nyeri 3 sesudah dilakukan foot massage dan didapatkan nilai p value = 0.000, sehingga disimpulkan ada pengaruh foot massage terhadap skala nyeri pada klien post operasi sectio caesarea. Diharapkan rumah sakit dapat menjadikan foot massage sebagai salah satu alternatif manajemen non farmakologi dalam penanganan nyeri.   Kata kunci: Foot Massage; Post Partum; Nyeri; Sectio Caesarea      


2019 ◽  
Vol 8 (2) ◽  
pp. 152
Author(s):  
Adi Antoni ◽  
Yanna Wari Harahap

Abstrak   Latar belakang: Diabetes mellitus (DM) merupakan penyakit kronik dan menjadi masalah global. Salah satu komplikasi yang ditimbulkan dari DM adalah luka kaki diabetic. Langkah awal dalam perawatan luka kaki diabetic adalah mencuci luka. Tujuan penelitian ini adalah mengetahui keefektifan dari rebusan daun jambu biji sebagai cairan pencuci luka terhadap tingkat malodor pada luka kaki diabetic. Metode: Desain penelitian yang digunakan adalah quasy experiment dengan rancangan one group pretests-posttest only. Teknik sampling yang digunakan adalah consecutive sampling dengan jumlah sampel 16 orang. Kriteria sampel yang digunakan adalah klien luka kaki diabetic, tingkat malodor 1-10 dengan NRS. Alat ukur yang digunakan adalah Numeric Rating Scale (NRS). Analisa data yang digunakan dalam penelitian ini menggunakan uji paired t test. Hasil: tingkat malodor sebelum intervensi pencucuan luka menggunakan rebusan daun jambu biji rata-rata sebesar 4.40 dan sesudah intervensi sebesart 2.44 dengan p value < 0.001. Selisih tingkat malodor antara sebelum dan sesudah intervensi sebesar 1.96. Hasil penelitian ini menunjukkan bahwa daun jambu dapat digunakan sebagai cairan pencuci luka dalam mengatasi tingkat malodor pada luka kaki diabetik. Kesimpulan : daun jambu biji dapat digunakan sebagai cairan pencuci luka pada luka kaki diabetic. Perawat diharapkan dapat memanfaatkan daun jambu biji sebagai salah satu alternatif dalam pencucian luka kronik khususnya luka kaki diabetik.   Kata kunci: Daun Jambu Biji, Tingkat Malodor, Luka Kaki Diabetik   Abstract   Background: Diabetes mellitus (DM) is a chronic disease and a global problem. One of the complications that arise from DM is diabetic foot ulcer. The first step in treating diabetic foot ulcer is washing the wound. The purpose of this study was to determine the effectiveness of guava leaf decoction as a washing fluid for malodor levels in diabetic foot ulcer. Method: The research design used was quasy experiment with one group pretests-posttest only design. The sampling technique used was consecutive sampling with a sample of 16 people. Sample criteria used were diabetic foot ulcer clients, malodor level 1-10 with NRS. The measuring instrument used is the Numeric Rating Scale (NRS). Analysis of the data used in this study used paired t test. Results: the level of malodor before intervening in wound washing using guava leaf decoctions on average was 4.40 and after the intervention was 2.44 with p value <0.001. The difference in the level of malodor between before and after the intervention was 1.96. The results of this study indicate that guava leaves can be used as a washing fluid in dealing with malodor levels in diabetic foot ulcer. Conclusion: Guava leaves can be used as a washing fluid for diabetic foot wounds. Nurses are expected to be able to use guava leaves as an alternative in washing chronic wounds, especially diabetic foot injuries.   Key words: Guava Leaf, Malodor Level, Diabetic foot ulcer.


2019 ◽  
Vol 8 (1) ◽  
pp. 49-53
Author(s):  
Angga Arfina ◽  
Yureya Nita ◽  
Khairiyati Khairiyati

Lanjut usia (lansia) merupakan tahap akhir perkembangan pada daur kehidupan manusia yang telah mencapai usia lebih dari 60 tahun. Pada lansia terjadi proses degeneratif yang akan berdampak terjadinya perubahan-perubahan diri manusia. Perubahan yang terjadi pada lansia mengakibatkan berbagai masalah yang kompleks baik secara fisik maupun psikologis. Kecemasan merupakan salah satu respon yang paling dini dan sering muncul pada lanjut usia. Selain dengan farmakologis, kecemasan juga dapat ditangani secara non farmakologis salah satunya dengan membaca Al-Qur’an. Penelitian ini bertujuan mengetahui pengaruh membaca Al-Qur’an terhadap kecemasan pada lansia di Panti Sosial Tresna Werdha (PSTW) Khusnul Khotimah Pekanbaru. Desain penelitian adalah quasy eksperiment dengan metode penelitian one group pretest & posttest. Sampel penelitian adalah lansia berjumlah 42 orang menggunakan metode probability sampling dengan teknik simple random sampling. Pengumpulan data dilakukan dengan lembar observasi untuk membaca Al-Qur’an dan penilaian kecemasan dengan Hamilton Anxiety Rating  Scale. Data dianalisis secara statistik deskriptif dan Paired Sample T Test. Hasil penelitian menunjukkan bahwa ada pengaruh membaca Al-Qur’an dengan kecemasan pada lanjut usia dengan p value 0.002 < 0.05. Penelitian ini diharapkan dapat meningkatkan asuhan keperawatan gerontik sehingga membaca Al-Qur’an dapat dijadikan salah satu intervensi dalam meningkatkan spiritualitas serta menurunkan kecemasan pada lansia.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 519-520
Author(s):  
Priyanka Shrestha ◽  
Erica Husser ◽  
Diane Berish ◽  
Long Ngo ◽  
Marie Boltz ◽  
...  

Abstract Delirium is a serious and potentially life-threatening problem, but it remains clinically under-recognized. Various factors contribute to this under-recognition, including limited understanding of delirium, insufficient training and application of delirium assessments, potential stigma for the patient and increased workload for the clinician. As a part of an NIH funded study testing a rapid two-step delirium identification protocol at two hospitals in the U.S. (one urban and one rural), clinicians completed a 12-item survey to assess their knowledge and attitudes about delirium and their confidence in preventing and managing delirium. Survey response options followed a 5-point rating scale (strongly disagree, disagree, undecided, agree, strongly agree). The sample for this analysis included 399 clinicians (MDs=53; RNs=235; CNAs=111). Chi-square was used to test for group differences between clinician types. Less than half of the clinicians reported agreeing with the statement, “delirium is largely preventable” (MDs: 47%; RN: 44%; CNA: 41%, p-value=0.021). MDs and RNs indicated a high level of confidence in recognizing delirium while CNAs endorsed lower levels of confidence (MDs: 87%; RN: 81%; CNA: 65%, p-value=0.001). All types of clinicians reported lower confidence in managing delirium (MDs: 29%; RN: 36%; CNA: 44%, p-value=0.117). 47% of CNAs and 37% of RNs agreed there is a need for additional training in caring for persons with delirium while only 21% of MDs agreed (p = 0.031). Understanding how different types of clinicians think and feel about delirium will inform training and communication initiatives, clinical implementation, and research on best practices for delirium identification and management.


2021 ◽  
pp. 219256822097608
Author(s):  
Dinesh Kumarasamy ◽  
Shanmuganathan Rajasekaran ◽  
Sri Vijay Anand K. S ◽  
Dilip Chand Raja Soundararajan ◽  
Ajoy Prasad Shetty T ◽  
...  

Study design: Prospective comparative cohort study. Objectives: The study aims to elucidate the relationship between Modic endplate changes and clinical outcomes after a lumbar microdiscectomy. Methods: Consecutive patients undergoing microdiscectomy for lumbar disc herniation (LDH) were prospectively studied. Pre-operative clinical and radiological parameters were recorded. The pain was assessed by Numeric pain rating scale (NPRS), and functional assessment by Oswestry Disability Index (ODI). Minimal clinically important difference (MCID) in outcome was calculated for both the groups. Complications related to surgery were studied. Follow-up was done at 6 weeks, 3 months, 6 months and 1 year. Mac Nab criteria were used to assess patient satisfaction at 1 year. Results: Out of 309 patients, 86 had Modic changes, and 223 had no Modic changes. Both groups had similar back pain (p-value: 0.07) and functional scores (p-value: 0.85) pre-operatively. Postoperatively patients with Modic changes had poorer back pain and ODI scores in the third month, sixth month and 1 year (p-value: 0.001). However, MCID between the groups were not significant (p-value: 0.18 for back pain and 0.58 for ODI scores). Mac Nab criteria at 1 year were worse in Modic patients (p-value: 0.001). No difference was noted among Modic types in the pre-operative and postoperative pain and functional outcomes. Four patients in Modic group (4.7%) and one patient in the non-Modic group (0.5%) developed postoperative discitis (p-value: 0.009). Conclusions: Preoperative Modic changes in lumbar disc herniation is associated with less favorable back pain, functional scores and patient satisfaction in patients undergoing microdiscectomy.


Genes ◽  
2021 ◽  
Vol 12 (6) ◽  
pp. 825
Author(s):  
Iacopo Ciampa ◽  
Grégory Operto ◽  
Carles Falcon ◽  
Carolina Minguillon ◽  
Manuel Castro de Moura ◽  
...  

This study investigated whether genetic factors involved in Alzheimer’s disease (AD) are associated with enlargement of Perivascular Spaces (ePVS) in the brain. A total of 680 participants with T2-weighted MRI scans and genetic information were acquired from the ALFA study. ePVS in the basal ganglia (BG) and the centrum semiovale (CS) were assessed based on a validated visual rating scale. We used univariate and multivariate logistic regression models to investigate associations between ePVS in BG and CS with BIN1-rs744373, as well as APOE genotypes. We found a significant association of the BIN1-rs744373 polymorphism in the CS subscale (p value = 0.019; OR = 2.564), suggesting that G allele carriers have an increased risk of ePVS in comparison with A allele carriers. In stratified analysis by APOE-ε4 status (carriers vs. non-carriers), these results remained significant only for ε4 carriers (p value = 0.011; OR = 1.429). To our knowledge, the present study is the first suggesting that genetic predisposition for AD is associated with ePVS in CS. These findings provide evidence that underlying biological processes affecting AD may influence CS-ePVS.


2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Karthik Selvaraj ◽  
◽  
Pranjali Bansal ◽  
Akshay Singh ◽  
Sushma Viswanathan ◽  
...  

Background: Contemporary literature focuses on various socio-demographic, clinical profile and psychiatric comorbitidies in patients with first attempt suicide. Aim: 1. To study the socio-demographic factors and the clinical profile of subjects with the first attempt suicide. 2. To assess the severity of depression and severity of stress due to various stressful events in patients with first attempt suicide. 3. To assess the severity of the suicide intent in patients with first attempt suicide. 4. To study the association between socio demographic profile of the patients with severity of depression, severity of suicide intent and severity of stress. Materials and Methods: Hundred fifteen patients were assessed using Hamilton rating scale for depression, becks suicide intent scale, Holmes-Rahe life stress inventory, MINI international neuropsychiatric interview. The data was analysed using the statistical software SPSS version 20. Results: The sample of 115 patients showed mean age to be 29 years, majority of them being males (58%). With most common mode of attempting suicide to be drug overdose and most of the patients had adjustment issues due to various domestic household issues and financial stressors. The severity of depression was mild and suicide intent were low (67%). In our study chi square finding association between various socio demographic variables and severity of depression found to be highly significant. It was strongest among gender at p value 0.009, occupation in which depression was found mostly among employed patients and housewives at p value 0.001. Results also found depression more common among participants with urban background at p value 0.03 and family type being nuclear at p value 0.05. Conclusion: Promoting healthy coping mechanism and reduction in stress is required to reduce self-harm. As is evident from the study, modifying the interpersonal relationship problems in the family might help in preventing many of suicide attempts/intentional self-harm and therefore important to address their various life events that might be stressful for them forcing them to take this step. In a country like India, where formal mental health resources are limited and are attached to a stigma, it is important to provide adequate information also among people hailing from lower economic status.


2017 ◽  
Vol 45 (4) ◽  
pp. 1394-1405 ◽  
Author(s):  
Hai-Tao Long ◽  
Zhen-Han Deng ◽  
Min Zou ◽  
Zhang-Yuan Lin ◽  
Jian-Xi Zhu ◽  
...  

Objective To analyze the effects of the acetabular fracture index (AFI) and other factors on the functional outcome of patients with acetabular fractures involving the posterior wall. Methods Forty-eight patients who underwent surgery in our department were reviewed. According to the AFI, which indicates the percentage of remaining intact posterior acetabular arc, the patients were divided into Group A (AFI ≤ 25%, 11 patients), Group B (25% < AFI ≤ 50%, 23 patients), Group C (50% < AFI ≤ 75%, 7 patients), and Group D (75% < AFI ≤ 100%, 7 patients). The AFI was measured with a computed tomography picture archiving and communication system or calculated with the cosine theorem. A nonparametric test and ordinal regression were used to determine the role of the AFI and other factors on the functional outcome. Perioperative information, including demographic and fracture-related data, reduction quality, physical therapy duration, association with a lower limb fracture and avascular necrosis of the femoral head were prospectively gathered. Results The mean AFIs of A, B, C, and D groups were 14.3%, 35.9%, 59.5%, and 81.2%, respectively. No statistically significant differences were observed among the groups for demographic and fracture-related data. A better reduction quality (OR = 4.21, 95%CI 1.42 ∼ 12.43, χ2 = 6.781, P = 0.009) and a larger value of AFI (OR = 2.56, 95%CI 1.18 ∼ 5.55, χ2 = 5.648, P = 0.017) result in a higher functional score. The functional outcome of a physical therapy duration of more than 12 months (OR = 0.15, 95%CI 0.02 ∼ 0.90, χ2 = 4.324, P = 0.038) was better than that of less than 12 months. Lower limb fracture (OR = 0.13, 95%CI 0.02 ∼ 0.74, χ2 = 5.235, P = 0.022) and avascular necrosis of femoral head (OR = 0.02, 95%CI 0.00 ∼ 0.87, χ2 = 4.127, P = 0.042) were found to correlate with a lower functional score. Conclusion With a greater of AFI, the functional outcome score would be better. Other factors, including reduction quality, physical therapy duration, association with a lower limb fracture, and avascular necrosis of the femoral head, most likely also affect hip functional recovery.


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