PERBANDINGAN DOSIS PIRIDOSTIGMIN, PERFORMA FUNGSIONAL, DAN DERAJAT KLINIS PASIEN MIASTENIA GRAVIS SEBELUM DAN SETELAH TIMEKTOMI

COMPARISON BETWEEN PYRIDOSTIGMINE DOSE, FUNCTIONAL PERFORMANCE, AND CLINICAL SEVERITY IN MYASTHENIA GRAVIS PATIENTS BEFORE AND AFTER THYMECTOMYABSTRACTIntroduction: Myasthenia gravis (MG) is highly associated with thymic abnormalities. Most cases, show decreasing dosage of drugs and improving of clinical symptoms after thymectomy. However, in Indonesia, there are only limited number of studies have evaluated it.Aim: To evaluate and compare clinical condition of MG patients in Hasan Sadikin Hospital, Bandung before and after thymectomy.Methods: A retrospective cohort and descriptive analytic study on adult MG patients who had gone through thymectomy in Hasan Sadikin Hospital, Bandung from January 2014 to December 2016. Daily Pyridostigmine dosage comparison, functional performance using Myasthenia Gravis-Activities of Daily Living (MG-ADL) score, and clinical severity using Myasthenia Gravis Foundation of America (MGFA) classification before and six months after thymectomy were assessed.Results: There are 27 subjects, female:male 2.8:1, with a mean age of 36.44±14.46 years. Average daily Pyridostigmine dosage needed pre- and six months post-thymectomy were 240 (180–540)mg and 180 (0–480)mg respectively. The median of MG-ADL scores pre- and six months post-thymectomy were 10 (4–21) and 3 (0–18) respectively. The median of MGFA classification pre-and six months post-thymectomy were grade IVa (IIa–V) and IIb (normal–V) respectively.Discussion: There were significant decrease in daily Pyridostigmine dosage, improvements in functional performance, and improvements in clinical severity six months after thymectomy in MG patients.Keywords: MG-ADL, MGFA classification, pyridostigmine, thymectomy ABSTRAKPendahuluan: Penyakit miastenia gravis (MG) sering berhubungan dengan kelainan kelenjar timus. Pada kebanyakan kasus, timektomi dapat menurunkan kebutuhan dosis obat dan memperbaiki gejala klinis pasien MG. Di Indonesia penelitian mengenai hal ini masih sangat terbatas.Tujuan: Mengetahui perbandingan kondisi klinis pasien MG antara sebelum dan setelah dilakukan timektomi di RSUP Dr. Hasan Sadikin, Bandung.Metode: Penelitian kohort retrospektif, deskriptif analitik pada pasien MG dewasa yang telah dilakukan timektomi di RSUP Dr. Hasan Sadikin, Bandung, antara Januari 2014-Desember 2016. Dilakukan perbandingan dosis Piridostigmin per hari serta penilaian performa fungsional dengan skor Myasthenia Gravis-Activities of Daily Living (MG-ADL) dan derajat klinis berdasarkan klasifikasi Myasthenia Gravis Foundation of America (MGFA) antara sebelum dan 6 bulan setelah timektomi.Hasil: Diperoleh 27 subjek, perempuan:laki-laki 2,8:1, rerata usia 36,4±14,5 tahun. Rerata dosis Piridostigmin per hari sebelum timektomi 240 (rentang 180-540)mg dan 6 bulan setelah timektomi 180 (0-480)mg. Median skor MG-ADL sebelum timektomi adalah 10 (4-21) dan 6 bulan setelah timektomi 3 (0-18). Median klasifikasi MGFA sebelum timektomi adalah IVa (rentang IIa-V) sedangkan 6 bulan setelah timektomi adalah IIb (rentang normal-V).Diskusi: Terdapat penurunan dosis Piridostigmin, serta perbaikan performa fungsional dan derajat klinis yang bermakna antara sebelum dan 6 bulan setelah timektomi pada pasien MG.Kata kunci: Klasifikasi MGFA, MG-ADL, piridostigmin, timektomi

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C3, C5a and anti-acetylcholine receptor antibody as severity biomarkers in myasthenia gravis

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286420935697 ◽

2020 ◽

Vol 13 ◽

pp. 175628642093569

Author(s):

Florencia Aguirre ◽

Analisa Manin ◽

Victoria C. Fernandez ◽

Mariano E. Justo ◽

Juliana Leoni ◽

...

Keyword(s):

Myasthenia Gravis ◽

Activities Of Daily Living ◽

Acetylcholine Receptor ◽

Daily Living ◽

Disease Duration ◽

Prognostic Markers ◽

Clinical Severity ◽

Control Group ◽

Receptor Antibody ◽

Anti Acetylcholine

Background: Although the pathogenesis of myasthenia gravis (MG) is well known, prognostic markers are not yet available. We assessed the utility of anti-acetylcholine receptor (AChR) antibody (AChR-ab) titer and concentration of C3, C4, and C5a as potential severity biomarkers in MG. Methods: Levels of C3, C4, C5a, and AChR-ab were measured in 60 AChR-ab-positive patients with MG. Their relationship with clinical severity was analyzed using the activities of daily living (ADL) and MG composite (MGC) scales. Results: AChR-ab titer correlated with severity of MG according to ADL ( p = 0.002) and MGC scales ( p = 0.001). When patients were classified according to disease duration, a statistically significant correlation between AChR-ab titer and clinical severity was only found in the subgroup of patients with fewer than 5 years from symptoms onset. C5a levels showed a positive correlation with MG severity according to the ADL scale ( p = 0.041; τb = 0.18), although C5a levels were not different from the control group. Discussion: AChR-ab titers and C5a levels could potentially be considered markers of severity in patients with MG.

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Evaluation of Recovery of Activities of Daily Living in Patients with Sequelae from Cerebral Vascular Disease

Journal of Biomedical and Clinical Research ◽

10.1515/jbcr-2015-0113 ◽

2013 ◽

Vol 6 (2) ◽

pp. 125-130

Author(s):

Danelina E. Vacheva ◽

Verjinia K. Simeonova ◽

Boyko St. Stamenov

Keyword(s):

Activities Of Daily Living ◽

Cerebrovascular Disease ◽

Daily Living ◽

Personal Hygiene ◽

Rank Test ◽

Self Assessment ◽

Cerebral Vascular Disease ◽

Before And After ◽

The Right

Summary Bulgaria ranks first in the world in incidence, morbidity and death associated with cerebrovascular disease. The aim of the study was to investigate, follow-up and register recovery of activities of daily living (using the toilet and maintaining personal hygiene) in patients with sequelae from cerebrovascular disease in a subacute stage, who underwent physiotherapy and rehabilitation. Sixty-one patients were included and followed up. They were given tailored physiotherapy and rehabilitation. This included kinesitherapy, occupational therapy and electrotherapy. All the patients filled in self-assessment questionnaires before and after the rehabilitation course. Major parameters were assessed, irrespective of the limb affected -dominant or non-dominant. Results were analyzed using the Wilcoxon rank test. At the end of the rehabilitation course, the Wilcoxon curves were driven to the right, confirming improvement concerning independence, irrespective of involvement of dominant or non-dominant limb.

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Functional performance in activities of daily living of individuals with a dual-diagnosis of schizophrenia and substance-use disorder

European Psychiatry ◽

10.1016/s0924-9338(11)73072-3 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1367-1367

Author(s):

M. Desormeaux-Lefebvre ◽

B. Tallant ◽

I. Gelinas ◽

N. Lariviere

Keyword(s):

Substance Use ◽

Activities Of Daily Living ◽

Substance Use Disorder ◽

Dual Diagnosis ◽

Daily Living ◽

Functional Performance ◽

Cognitive Impairments ◽

Addiction Severity Index ◽

Grocery Shopping ◽

Cross Sectional

IntroductionResearch on functional performance of individuals with schizophrenia and substance use is limited, focusing primarily on cognitive impairments. Research findings are conflicting, making it difficult to understand how these individuals function despite their cognitive impairments. There is a need to use performance-based assessments to understand how individuals with a dual-diagnosis accomplish their daily living activities.AimsTo describe the functional performance of individuals with a dual-diagnosis in two activities of daily living, using a performance-based assessment.ObjectivesTo compare the functional performance of individuals with a dual-diagnosis, in grocery shopping and budgeting.MethodsThis descriptive cross-sectional study included ten participants with a dual-diagnosis of schizophrenia and substance-use disorder, aged 21 to 35, living independently in the community. They were evaluated on two tasks, budgeting and grocery shopping, using the Perceive-Recall-Plan-Perform (PRPP) system of task analysis (Chapparo & Ranka, 2005). The PRPP is a standardized criterion-referenced task-based assessment, and is valuable in describing individuals’ community functioning with regards to information-processing difficulties. Substance use was evaluated with the Addiction Severity Index (McLellan et al., 1989).ResultsPreliminary results indicate lower scores on both tasks, in the planning quadrant of the PRPP, particularly the evaluating sub-quadrant, which involves cognitive monitoring and appraisal processes. This trend occurs despite the participant's prior familiarity with tasks. Conclusions: This study is a first step in describing the functional performance of individuals with a dual diagnosis of schizophrenia and substance use in activities of daily living. This information will lead to improved rehabilitation for these clients.

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Diagnosis of internal carotid artery stenosis in a patient referred to a physiotherapist for dizziness

Journal of Primary Health Care ◽

10.1071/hc19047 ◽

2019 ◽

Vol 11 (4) ◽

pp. 373

Author(s):

Ryan Boggs ◽

Michael Ross ◽

Michael Tall

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Activities Of Daily Living ◽

Daily Living ◽

Clinical Decision Making ◽

Internal Carotid ◽

Clinical Symptoms ◽

Artery Stenosis ◽

Left Internal Carotid Artery ◽

Vascular Compromise

ABSTRACT PURPOSEThe purpose of this report is to describe the diagnostic focus of the clinical decision-making process for a patient referred to a physiotherapist for treatment of persistent dizziness, who was subsequently diagnosed with severe stenosis of the internal carotid arteries. CASE DESCRIPTIONThe patient was a 79-year-old man who was referred to a physiotherapist by his primary care physician for the treatment of persistent intermittent dizziness. The patient’s dizziness began 6 months prior insidiously; it was worsening over time and now interfered with activities of daily living. The patient denied cervical pain or headaches, numbness or tingling in his extremities, difficulty maintaining balance with walking, unsteadiness, muscle weakness, dysphagia, drop attacks, diplopia or dysarthria. At the physiotherapist’s initial evaluation, cervical range of motion was moderately restricted in all motions and his dizziness was elicited with changes in head position. The patient’s neurological examination was unremarkable. Due to positional complaints of dizziness, a Dix–Hallpike test was used to screen for benign paroxysmal positional vertigo, which was positive for symptoms reproduction; however, no nystagmus was noted. The patient also became diaphoretic and exhibited significant discoloration of his face during the test. OUTCOMESDue to concern over vascular compromise, carotid duplex ultrasonography and magnetic resonance angiography were completed and revealed near complete occlusion of the left internal carotid artery at its origin. The patient subsequently underwent a left internal carotid endarterectomy with resolution of symptoms and a return to all activities of daily living. DISCUSSIONCarotid artery stenosis, although frequently asymptomatic until severe, may manifest as complaints of dizziness that mimic peripheral vestibular dysfunction. Appropriate and prudent screening and referral is necessary if clinical symptoms suggestive of vascular compromise are present.

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Reliability and Validity of Turkish Myasthenia Gravis-Activities of Daily Living Scale

OTJR Occupation Participation and Health ◽

10.1177/1539449220961077 ◽

2020 ◽

pp. 153944922096107

Author(s):

Ecem Karanfil ◽

Yeliz Salcı ◽

Ayla Fil-Balkan ◽

Can Ebru Bekircan-Kurt ◽

Sevim Erdem Özdamar ◽

...

Keyword(s):

Construct Validity ◽

Myasthenia Gravis ◽

Activities Of Daily Living ◽

Daily Living ◽

Intraclass Correlation ◽

Reliability And Validity ◽

Life Questionnaire ◽

Good Test ◽

Retest Reliability ◽

Test Retest Reliability

Linguistic, reliable, and valid secondary efficacy measures are important in clinical settings and studies. The aim of the study is to report test–retest reliability and construct validity of Turkish version of Myasthenia Gravis-Activities of Daily Living Scale (MG-ADL-T) in Myasthenia Gravis (MG) patients. Fifty-two ocular and generalized individuals with MG, applying to rehabilitation center, were included in the study. MG-ADL-T, MG quality-of-life questionnaire (MG-QoL), MG composite (MGC), quantitative MG score (QMGS), and pulmonary function test were administered. Reliability was assessed with intraclass correlation coefficient (ICC) and Cronbach’s alpha. Spearman correlation test and receiver operating characteristic (ROC) analysis were performed for construct validity. MG-ADL-T had fair internal consistency (Cronbach’s α = .67), excellent test–retest reliability (ICC = 0.96) and moderate construct validity (MG-QoL, r = 0.59; QMGS, r = .58; MGC, r = .68). MG-ADL, a unique scale that evaluates activities of daily living (ADL), has good test–retest reliability and construct validity in Turkish MG patients.

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Immediate Efficacy of Neuromuscular Exercise in Patients with Severe Osteoarthritis of the Hip or Knee: A Secondary Analysis from a Randomized Controlled Trial

The Journal of Rheumatology ◽

10.3899/jrheum.130642 ◽

2014 ◽

Vol 41 (7) ◽

pp. 1385-1394 ◽

Cited By ~ 43

Author(s):

Allan Villadsen ◽

Søren Overgaard ◽

Anders Holsgaard-Larsen ◽

Robin Christensen ◽

Ewa M. Roos

Keyword(s):

Activities Of Daily Living ◽

Effect Size ◽

Daily Living ◽

Exercise Intervention ◽

Muscle Power ◽

Functional Performance ◽

Knee Oa ◽

Randomized Controlled ◽

Link Type ◽

Outcome Score

Objective.Knowledge about the effects of exercise in severe and endstage osteoarthritis (OA) is limited. The aim was to evaluate the efficacy of a neuromuscular exercise program in patients with clinically severe hip or knee OA.Methods.This was a randomized controlled assessor-blinded trial. Patients received an educational package (care-as-usual) only, or care-as-usual plus an 8-week neuromuscular exercise intervention (NEMEX-TJR). NEMEX-TJR was supervised by a physiotherapist, twice weekly for 1 h. The primary outcome was Activities of Daily Living (ADL) subscale from the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The secondary outcomes were the HOOS/KOOS subscales Pain, Symptoms, Sport and Recreation, and Joint-related Quality of Life. Exploratory outcomes were functional performance measures and lower limb muscle power.Results.Included were 165 patients, 56% female, average age 67 years (SD ± 8), and a body mass index of 30 (SD ± 5), who were scheduled for primary hip or knee replacement. The postintervention difference between mean changes in ADL was 7.2 points (95% CI 3.5 to 10.9, p = 0.0002) in favor of NEMEX-TJR compared with control. Second, there were statistically significant differences between groups in favor of NEMEX-TJR on all self-reported outcomes and most functional performance tests (walk, chair stands, and 1-leg knee bends). Stratified analyses according to joint revealed moderate effect size for ADL for hip patients (0.63, 95% CI 0.26 to 1.00). Corresponding effect size for knee patients was small (0.23 95% CI −0.14 to 0.60).Conclusion.Feasibility of neuromuscular exercise was confirmed in patients about to have total joint replacement. Self-reported activities of daily living and objective performance were improved and pain reduced immediately following 8 weeks of neuromuscular exercise. While the effects were moderate in hip OA, they were only small in knee OA.ClinicalTrials.govIdentifier:NCT01003756.

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Physician- and self-assessed myasthenia gravis activities of daily living score

Muscle & Nerve ◽

10.1002/mus.25764 ◽

2017 ◽

Vol 57 (3) ◽

pp. 419-422

Author(s):

Hye Lim Lee ◽

Ju-Hong Min ◽

Jin Myoung Seok ◽

Eun Bin Cho ◽

Hye Jin Cho ◽

...

Keyword(s):

Myasthenia Gravis ◽

Activities Of Daily Living ◽

Daily Living

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Longitudinal Observations of Low Back Pain Recovery

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193129804201402 ◽

1998 ◽

Vol 42 (14) ◽

pp. 1013-1017

Author(s):

Sue A. Ferguson

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Activities Of Daily Living ◽

Outcome Measures ◽

Discriminant Function ◽

Daily Living ◽

Functional Performance ◽

Function Analysis ◽

Low Back ◽

Personal Factors

Most low back pain recovery studies evaluate one outcome measure at one point in time. Return to work, symptoms, activities of daily living and functional performance have been commonly used outcome measures. The goal of this project was to evaluate all four previously used outcome measures at several points in time. The second goal of the project was to predict outcome as a function of time and recovery measure. The outcome measures of working status, symptoms, and activities of daily living were measured using questionnaires. Functional performance outcome was evaluated using the lumbar motion monitor. These outcome measures were evaluated every two weeks for three months. Psychological factors, psychosocial factors, physical job demands and personal factors that may influence recovery were also evaluated. Discriminant function analysis was used to predict outcome at a specific visit given the confounding factors and any previous conditions. The cross-validation error rate for the discriminant function results ranged from 0–15%. The results showed discrepancies among the four outcome measures in there indication of recovery. This is the first study to compare multiple outcome measures at several point in time after an LBP episode.

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Investigating dizziness symptom in adult cases with Crimean-Congo hemorrhagic fever using various scales

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00163-0 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Adem Bora ◽

Seyit Ali Büyüktuna ◽

Kasım Durmuş ◽

Berat Baturay Demirkıran ◽

Yasin Aslan ◽

...

Keyword(s):

Activities Of Daily Living ◽

Disease Severity ◽

Daily Living ◽

Clinical Symptoms ◽

Hemorrhagic Fever ◽

The Self ◽

Multicenter Studies ◽

Pathophysiological Mechanisms ◽

Crimean Congo Hemorrhagic Fever ◽

Vestibular Symptoms

Abstract Background This study was to investigate the frequency of self-reported dizziness symptom in cases with Crimean-Congo hemorrhagic fever (CCHF) and the severity of dizziness, if any, by using various scales. The frequency and severity of the self-reported dizziness symptom of CCHF patients, level of disability caused by dizziness, and to what extent vestibular symptoms affected activities of daily living were assessed by various scales. The frequency and severity of the self-reported dizziness symptom of CCHF patients, level of disability caused by dizziness, and to what extent vestibular symptoms affected activities of daily living were assessed by various scales. Results The frequency of dizziness in CCHF cases included in the study was 11.11% and all the cases were involved in the mild category in terms of disease severity. When the results of the scales applied to all of the cases were evaluated in general, it was seen that there was no vertigo or dizziness. Conclusion According to the results of the present study, we consider that multicenter studies with large series investigating pathophysiological mechanisms underlying these clinical symptoms are needed in order to evaluate dizziness symptom and to make definitive interpretations in CCHF disease.

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