scholarly journals Cognitive Impairment in Inpatients with Prurigo Nodularis and Psychiatric Comorbidities

2021 ◽  
Vol 18 (12) ◽  
pp. 6265
Author(s):  
Giuseppe Lanza ◽  
Filomena Irene Ilaria Cosentino ◽  
Raffaele Ferri ◽  
Bartolo Lanuzza ◽  
Maddalena Siragusa ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Psychiatric Comorbidity ◽  
Hospital Admissions ◽  
Combined Treatment ◽  
Retrospective Chart Review ◽  
Cognitive Disorder ◽  
Prurigo Nodularis ◽  
Appropriate Treatment ◽  
Vascular Origin ◽  
Neuroactive Drugs

Background: Prurigo nodularis (PN) is a chronic refractory itchy dermatosis. Although psychiatric comorbidity is known, research in cognitive impairment is lacking. We evaluated the occurrence and types of cognitive impairment in a series of inpatients with PN. Methods: This was a retrospective chart review of all the patients with PN admitted to a referral neurological institute from September 2018 to March 2021. Any neurological and psychiatric disorder, along with neuroactive drugs taken, were concomitantly assessed. Results: A total of 16 patients with PN (median age: 70 years, two males) were selected from a total of 1806 hospital admissions. Most of them had a neurodegenerative cognitive disorder, from mild cognitive impairment (8) to Alzheimer’s disease (1), followed by mixed disorder (degenerative and vascular) in six and vascular dementia in one. Comorbid psychiatric diseases (anxiety and depression) were more common than either individual condition, followed by bipolar disorder, whereas two patients did not show psychiatric manifestations. Most patients were on combined treatment with benzodiazepines and antidepressants. Conclusion: Cognitive impairment can be observed in PN. In addition to screening for psychiatric comorbidity and initiating appropriate treatment or referral, clinicians may also consider the presence of cognitive impairment in PN of both degenerative and vascular origin.

Abdominal Lymphangioma in Children: A Pediatric Retrospective Chart Review of 16 Cases

2021 ◽  
Author(s):  
Stefan Bittmann
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Complete Resection ◽  
Benign Lesions ◽  
Vascular Origin ◽  
Anatomic Locations

Lymphangiomas are benign lesions of vascular origin that show lymphatic differentiation. They occur in many anatomic locations. Complete resection is difficult in some cases and recurrences are common. A pediatric chart review was carried out in 16 cases. The authors summarized their experience of abdominal lymphangiomas in children.

Oral Dexamethasone to Control Wheezing in Children at an Outpatient Clinic

2018 ◽  
Vol 58 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Angela S. Volk ◽  
Stephanie A. Marton ◽  
Brittany S. Richardson ◽  
Luis Rauda ◽  
Heidi L. Schwarzwald ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Acute Asthma ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Office Visit ◽  
Asthma Exacerbations ◽  
Oral Dexamethasone ◽  
Cost Effective Treatment ◽  
Ed Visits ◽  
Acute Asthma Exacerbations

Asthma, a chronic childhood disease, has resulted in increased emergency department (ED) visits with high costs. Many asthma ED visits are nonemergent and could be treated in outpatient clinics. Literature has concluded that a 2-day course of oral dexamethasone has comparable outcomes to a 5-day course of prednisone in the ED and hospital setting. A retrospective chart review was performed on children requiring in-house treatment with a corticosteroid (dexamethasone n = 23, prednisone n = 40) for acute asthma exacerbations at an ambulatory medical home. The rates of hospital admissions, ED visits, and symptom follow-up were similar between the 2 groups ( P > .05). The cost for a course of dexamethasone was US$1.28 versus US$16.20 for prednisolone. The average cost for an asthma exacerbation office visit was US$79.89 compared with US$3113.28 for an ED visit. A 2-day course of oral dexamethasone appears to be a promising clinical and cost-effective treatment for acute asthma exacerbations at the primary care level.

scholarly journals Quality of life in people living with HIV-associated neurocognitive disorder: A scoping review study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251944
Author(s):  
Kate Alford ◽  
Stephanie Daley ◽  
Sube Banerjee ◽  
Jaime H. Vera
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Scoping Review ◽  
Chronic Conditions ◽  
Healthy Aging ◽  
Cognitive Disorder ◽  
World Health ◽  
People Living With Hiv ◽  
Living With Hiv

Quality of life (QoL) is recognized as an essential end point in the disease management of chronic conditions such as HIV with calls to include good QoL as a ‘fourth 90’ in the 90-90-90 testing and treatment targets introduced by World Health Organization in 2016. Cognitive impairments impact a broad spectrum of experiences and are a common issue effecting people living with HIV (PLWH). Despite this, few studies have examined QoL in PLWH who also have a cognitive disorder. This study aimed to synthesize and describe what is known about QoL in those living with HIV-associated neurocognitive disorders (HAND). A scoping review of peer-reviewed literature was conducted to identify how QoL has been investigated and measured in PLWH with HAND, and how PLWH with HAND report and describe their QoL. We searched PsychInfo, Medline, Scopus, and Web of Science along with hand-searching reference lists from relevant studies found. Included studies were those published in English after 1st January 2003 which included PLWH with cognitive impairment not due to other pre-existing conditions. Fifteen articles met criteria for inclusion. Two studies measured QoL as a primary aim, with others including QoL assessment as part of a broader battery of outcomes. The MOS-HIV and SF-36 were the most commonly used measures of overall QoL, with findings generally suggestive of poorer overall QoL in PLWH with HAND, compared to PLWH without cognitive impairment. Studies which examined dimensions of QoL focused exclusively on functionality, level of independence, and psychological QoL domains. There is a considerable dearth of research examining QoL in PLWH with HAND. The initiatives which advocate for healthy aging and improved QoL in PLWH must be extended to include and understand the experiences those also living with cognitive impairment. Research is needed to understand the broad experiential impacts of living with these two complex, chronic conditions, to ensure interventions are meaningful to patients and potential benefits are not missed.

scholarly journals Use and understanding of functional cognitive disorder terminology in United Kingdom clinical practice - a survey

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S277-S277
Author(s):  
Alexandra Nash ◽  
Jon Stone ◽  
Alan Carson ◽  
Craig Ritchie ◽  
Laura McWhirter
Keyword(s):  
United Kingdom ◽  
Cognitive Impairment ◽  
Clinical Practice ◽  
Mild Cognitive Impairment ◽  
Old Age ◽  
Cognitive Disorders ◽  
Cognitive Disorder ◽  
Cognitive Symptoms ◽  
Case Study Methodology ◽  
Case Vignettes

AimsThis study aimed to explore the terms used by old-age psychiatrists and psychologists to describe subjective and mild cognitive impairment and functional cognitive disorders (FCD) in clinical practice.MethodParticipants were selected from across the United Kingdom based on their clinical involvement in the assessment of cognitive complaints. 9 old-age psychiatrists and 4 psychologists were interviewed about their use of terminology in clinical practice and their awareness and understanding of FCD terminology via semi-structured interview questions and case vignettes. Interviews were conducted between December 2020 and February 2021 using online platforms Zoom and Microsoft Teams. Participants were recruited by email and Twitter. All questions were asked verbally; however, the four case vignettes were displayed via screen-share. All discussions and answers were transcribed and transcripts were coded manually using the exploratory case study methodology in order to identify themes in participants’ responses.ResultThis study has highlighted the variable use of terms used to describe and diagnose patients presenting with symptoms of cognitive disorders. The terms ‘mild cognitive impairment’, ‘subjective cognitive decline’ and ‘functional cognitive disorder’ were used most commonly amongst participants, though the terms ‘subjective cognitive impairment’ and ‘pseudodementia’ were also presented. This theme of language discontinuity is underscored by participants’ varying use of terminology when describing or presenting their diagnoses for the case vignettes. The data also reveals a sub-theme of variability in application of the term FCD. Whilst all participants gave similar definitions for this term, the application of FCD as a diagnosis in practice was inconsistent. Six participants described FCD as associated with or secondary to other functional or psychiatric conditions, four participants viewed FCD as an isolated diagnosis, and one participant considered FCD to be either part of another illness or a separate diagnosis. Two participants neither used nor recognised the term FCD.ConclusionIt is evident that there is varied use of terms describing or diagnosing forms of cognitive symptoms. The findings of this study highlight the need for a clear, adoptable definition of FCD in practice as well as implementable management plans for FCD patients. This is critical in order to avoid misdiagnosis and mismanagement, which may have harmful effects on patients living with debilitating cognitive symptoms.

scholarly journals A Case Report of a Patient with Guillain-Barre Syndrome Who Complained of Quadriplegia

2021 ◽  
Vol 42 (5) ◽  
pp. 1009-1019
Author(s):  
Gi-yoon Heo ◽  
Chan Lee ◽  
Im-hak Cho ◽  
Hee-kyung Kang ◽  
Min-hwa Kim ◽  
...  
Keyword(s):  
Muscle Weakness ◽  
Muscle Function ◽  
Hospital Admissions ◽  
Combined Treatment ◽  
Gait Pattern ◽  
Guillain Barre Syndrome ◽  
Poor Prognostic Factor ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Purpose: The aim of this study was to report the improvement of Guillain-Barre syndrome after long-term combination treatment with Korean medicine.Methods: A patient was diagnosed with Guillain-Barre syndrome and treated with herbal medicine, acupuncture, pharmacopuncture, moxibustion, and exercise, including quadruped walking after three hospital admissions. To evaluate muscle strength and weakness, we measured manual muscle function, gait pattern, and the speed of quadruped walking.Results: The patient's muscle weakness in the extremities and gait stance were improved. The speed of quadruped walking was increased.Conclusion: We consider that combined treatment with Korean medicine might be effective for the muscle weakness of Guillain-Barre syndrome with a poor prognostic factor. To verify the effectiveness of this treatment, further research is needed.

scholarly journals How can automated linguistic analysis help to discern functional cognitive disorder from healthy controls and mild cognitive impairment?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S7-S7
Author(s):  
Lizzie Beavis ◽  
Ronan O'Malley ◽  
Bahman Mirheidari ◽  
Heidi Christensen ◽  
Daniel Blackburn
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Delayed Diagnosis ◽  
Age Of Acquisition ◽  
Linguistic Analysis ◽  
Cross Sectional Study ◽  
Cognitive Disorder ◽  
Remote Memory ◽  
Healthy Controls ◽  
Cross Sectional

AimsThe disease burden of cognitive impairment is significant and increasing. The aetiology of cognitive impairment can be structural, such as in mild cognitive impairment (MCI) due to early Alzheimer's disease (AD), or in functional cognitive disorder (FCD), where there is no structural pathology. Many people with FCD receive a delayed diagnosis following invasive or costly investigations. Accurate, timely diagnosis improves outcomes across all patients with cognitive impairment. Research suggests that analysis of linguistic features of speech may provide a non-invasive diagnostic tool. This study aimed to investigate the linguistic differences in conversations between people with early signs of cognitive impairment with and without structural pathology, with a view to developing a screening tool using linguistic analysis of conversations.MethodIn this explorative, cross-sectional study, we recruited 25 people with MCI considered likely due to AD, (diagnosed according to Petersen's criteria and referred to as PwMCI), 25 healthy controls (HCs) and 15 people with FCD (PwFCD). Participants’ responses to a standard questionnaire asked by an interactional virtual agent (Digital Doctor) were quantified using previously identified parameters. This paper presents statistical analyses of the responses and a discussion of the results.ResultPwMCI produced fewer words than PwFCD and HCs. The ratio of pauses to speech was generally lower for PwMCI and PwFCD than for HCs. PwMCI showed a greater pause to speech ratio for recent questions (such as ‘what did you do at the weekend?’) compared with the HCs. Those with FCD showed the greatest pause to speech ratio in remote memory questions (such as ‘what was your first job?’). The average age of acquisition of answers for verbal fluency questions was lower in the MCI group than HCs.ConclusionThe results and qualitative observations support the relative preservation of remote memory compared to recent memory in MCI due to AD and decreased spontaneous elaboration in MCI compared with healthy controls and patients with FCD. Word count, age of acquisition and pause to speech ratio could form part of a diagnostic toolkit in identifying those with structural and functional causes of cognitive impairment. Further investigation is required using a large sample.

scholarly journals A156 LOW COMPLICATION RATE IN THE OUTPATIENT INTRAJEJUNAL LEVODOPA/CARBIDOPA INTESTINAL GEL CLINICAL PROGRAM

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 20-21
Author(s):  
N Al Yatama ◽  
C H Parker ◽  
Y Tse ◽  
T Naranian ◽  
A Fasano ◽  
...  
Keyword(s):  
Data Collection ◽  
Adverse Events ◽  
Hospital Admissions ◽  
Retrospective Chart Review ◽  
Current Method ◽  
Final Analysis ◽  
Outpatient Setting ◽  
Fistula Formation ◽  
Serious Adverse Events

Abstract Background Levodopa/carbidopa intestinal gel (LCIG) is a formulation that is delivered continuously through a percutaneous endoscopy gastro-jejunal tube (PEG-J) for the treatment of patients with advanced Parkinson’s disease (PD). LCIG significantly reduces periods of increased motor symptoms without troublesome dyskinesia. Adverse events related to this treatment have been attributed to PEG-J insertion and the device used for LCIG delivery, rather than to the LCIG preparation itself. To date, the data evaluating long-term efficacy and safety of PEG-J insertion for LCIG administration in the outpatient setting is limited. Aims The aim of this study is to describe short and long-term adverse events (AEs) associated with outpatient PEG-J tube insertion for LCIG administration at our centre. Methods A retrospective chart review was performed of all PD patients who underwent PEG-J insertion for LCIG therapy at Toronto Western Hospital from March 2011 to October 2019. All AEs associated with PEG-J insertion were collected including procedure and tube related complications, hospital admissions, emergency room (ER) visits and deaths. Data was analyzed using descriptive statistics. Results A total of 58 patients were identified and included in the final analysis. 37 (64%) male, with a mean age of 74 years +/-6.17. The mean duration of PD diagnosis prior to PEG-J insertion was 16.5 years +/-2.0. Mean time from PEG-J insertion to data collection was 37.5 months +/- 19.3. 30 (51%) patients had post-procedural abdominal pain or site pain. This pain improved with over the counter analgesics. 9 (16%) had possible site infection; 6 received oral antibiotics and 3 had the tube replaced. 19 (33%) developed granulation tissue, with only 2 patients requiring tube exchange. 32 (55%) had their tube removed or exchanged secondary to PEG-J malfunction. No ER visits related to the PEG-J were recorded. During the data collection period, 12 (21%) patients died for reasons unrelated to PEG-J insertion. There were no reported serious adverse events (SAEs), including post-procedure perforation, bleeding, fistula formation, development of intra-abdominal collections or buried bumper syndrome. Conclusions This study demonstrates the absence of serious AEs associated with outpatient PEG-J insertion for LCIG administration in patients with advanced PD. The most common short-term AE was post-procedural pain. The most common long-term AE was related to PEG-J malfunction requiring replacement. This study supports that the current method of outpatient PEG-J insertion for the administration of LCIG is safe in patients with advanced PD. Funding Agencies None

scholarly journals Cost-Effectiveness of Pediatric Cancer Treatment in Tanzania: An Economic Analysis

2017 ◽  
Vol 3 (2_suppl) ◽  
pp. 33s-33s ◽  
Author(s):  
Anthony T. Saxton ◽  
Manisha Bhattacharya ◽  
Nestory Masalu ◽  
Henry E. Rice ◽  
Kristin Schroeder
Keyword(s):  
Cost Effectiveness ◽  
Cancer Treatment ◽  
Pediatric Cancer ◽  
Economic Benefit ◽  
Hospital Admissions ◽  
Conflicts Of Interest ◽  
Medical Center ◽  
Economic Value ◽  
Retrospective Chart Review ◽  
Cost Effectiveness Ratio

Abstract 52 Background: Despite the high burden of pediatric cancer in low- and middle-income countries, the number of facilities at which children can obtain treatment remains distressingly low. Understanding the costs and economic value of pediatric cancer treatment may assist policy makers to maximize the value of investments in health with informed resource allocation decisions. We examined the direct and indirect costs, cost-effectiveness, and societal economic benefit of diagnosing and treating children with cancer in Tanzania at the Bugando Medical Center, one of only two hospitals in the country with a pediatric oncology unit. Methods: A retrospective chart review of hospital admissions and clinic visits from January 2010 to August 2014 was performed. Costs were recorded for all items that were billed to the patient for laboratory studies, medications, imaging, pathology, surgeries, and hospital stay. Travel costs were estimated for each patient on the basis of a self-reported home address. All costs were converted from Tanzanian shillings to 2016 US dollars. Health outcomes were measured as disability-adjusted life-year (DALY) averted. We calculated the cost-effectiveness ratio of treatment versus performing no intervention as well as the societal economic benefit using a human capital approach and considering the per capita gross national product in Tanzania. Results: We identified costs for a subset of 127 patients, 64% of which were male (n = 81). Mean age at first clinical presentation was 6.9 years. Mean cost for treatment was $218 ± $145, with an average of 10.4 ± 8.9 DALYs averted per patient. Total cost-effectiveness ratio was $21/DALY, and the mean societal economic benefit was $27,118 ± $23,412. Conclusion: Our findings show that pediatric cancer treatment in Tanzania is cost-effective and offers substantial economic value. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

scholarly journals Update on the Neurobiology of Vascular Cognitive Impairment: From Lab to Clinic

2020 ◽  
Vol 21 (8) ◽  
pp. 2977 ◽  
Author(s):  
Luisa Vinciguerra ◽  
Giuseppe Lanza ◽  
Valentina Puglisi ◽  
Francesco Fisicaro ◽  
Manuela Pennisi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Disease Process ◽  
The Elderly ◽  
Vascular Cognitive Impairment ◽  
Cognitive Disorder ◽  
Vascular Lesion ◽  
Adaptive Plasticity ◽  
Disease Modifying Drugs ◽  
Neurophysiological Studies ◽  
Degenerative Dementia

In the last years, there has been a significant growth in the literature exploring the pathophysiology of vascular cognitive impairment (VCI). As an “umbrella term” encompassing any degree of vascular-related cognitive decline, VCI is deemed to be the most common cognitive disorder in the elderly, with a significant impact on social and healthcare expenses. Interestingly, some of the molecular, biochemical, and electrophysiological abnormalities detected in VCI seem to correlate with disease process and progression, eventually promoting an adaptive plasticity in some patients and a maladaptive, dysfunctional response in others. However, the exact relationships between vascular lesion, cognition, and neuroplasticity are not completely understood. Recent findings point out also the possibility to identify a panel of markers able to predict cognitive deterioration in the so-called “brain at risk” for vascular or mixed dementia. This will be of pivotal importance when designing trials of disease-modifying drugs or non-pharmacological approaches, including non-invasive neuromodulatory techniques. Taken together, these advances could make VCI a potentially preventable cause of both vascular and degenerative dementia in late life. This review provides a timely update on the recent serological, cerebrospinal fluid, histopathological, imaging, and neurophysiological studies on this “cutting-edge” topic, including the limitations, future perspectives and translational implications in the diagnosis and management of VCI patients.

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