Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil

Introduction Pure Neural Leprosy (PNL) is a rare clinical form of leprosy in which patients do not present with the classical skin lesions but have a high burden of the disability associated with the disease. Clinical characteristics and follow up of patients in PNL are still poorly described in the literature. Objective This paper aims to describe the clinical, electrophysiological and histopathological characteristics of PNL patients, as well as their evolution after multidrug therapy (MDT). Methods Fifty-two PNL patients were selected. Clinical, nerve conduction studies (NCS), histopathological and anti-PGL-1serology were evaluated. Patients were also assessed monthly during the MDT. At the end of the MDT, all of the patients had a new neurological examination and 44 were submitted to another NCS. Results Paresthesia was the complaint most frequently reported by patients, and in the neurological examination the most common pattern observed was impairment in sensory and motor examination and a mononeuropathy multiplex. Painful nerve enlargement, a classical symptom of leprosy neuropathy, was observed in a minority of patients and in the motor NCS axonal injuries, alone or in combination with demyelinating features, were the most commonly observed. 88% of the patients did not present any leprosy reaction during MDT. There was no statistically significant difference between the neurological examinations, nor the NCS pattern, performed before and after the MDT. Discussion The classical hallmarks of leprosy neuropathy are not always present in PNL making the diagnosis even more challenging. Nerve biopsy is an important tool for PNL diagnosis as it may guide therapeutic decisions. This paper highlights unique characteristics of PNL in the spectrum of leprosy in an attempt to facilitate the diagnosis and management of these patients.

Foot-to-Foot Contact Among Initial Goal-Directed Movements Supports the Prognostic Value of Fidgety Movements in HIE-Cooled Infants

Background: Few studies conducted to date have observed general movements in infants affected by hypoxic–ischemic encephalopathy (HIE) who underwent therapeutic hypothermia. We investigated whether foot-to-foot contact (FF) could support the predictive value of fidgety movements (FMs) in infants affected by HIE and treated with brain cooling.Methods: Spontaneous motility was video recorded for 3–5 min at 12 weeks post-term age in 58 full-term newborn infants affected by perinatal asphyxia who were cooled due to moderate to severe HIE. FF and FMs were blindly scored by three independent observers. At 24 months, each patient underwent a neurological examination by Amiel-Tison and Grenier.Results: At 24 months, 47 infants had developed typically at neurological examination, eight had developed mild motor impairment, and three developed cerebral palsy (CP). At 12 weeks, 34 (58.6%) infants had shown normal FMs, four of whom developed mild motor impairment. Twenty-four infants (41.4%) exhibited abnormal or no FMs, four of whom developed mild motor impairment and three developed CP. FF was present in 20 infants (34.5%), two of whom developed mild motor impairment. FF was absent in 38 infants (65.5%), six of whom developed mild motor impairment and three developed CP. Both FMs and FF, considered separately, were 100% sensitive for predicting CP at 24 months, but only 61 and 36%, respectively, were specific. Summing the two patterns together, the specificity increases to 73%, considering only CP as an abnormal outcome, and increases to 74% when considering CP plus mild motor impairment. Unexpectedly, fidgety movements were absent in 24 infants with typical motor outcomes, 17 of whom showed a typical motor outcome.Conclusions: FF is already part of motor repertoire at 12 weeks and allows a comparison of spontaneous non-voluntary movements (FMs) to pre-voluntary movements (FF). FF supports FMs for both sensitivity and specificity. A second video recording at 16–18 weeks, when pedipulation is present in healthy infants, is suggested: it may better define the presence or absence of goal-directed motility.

Behavioral response and erythrocyte chromophilia of rats in experimental traumatic brain injury

Введение. Патогенетические основы изменения микроциркуляции крови в головном мозге вследствие черепно-мозговой травмы (ЧМТ) изучены не в полной мере по причине высокой инвазивности нейроморфологических методов. Цель исследования - изучение поведенческого статуса и информативности цитохимических критериев хромофилии эритроцитов в качестве маркеров вазореактивности микрососудов головного мозга при черепно-мозговой травме у крыс. Методика. Объектом исследования являлись 3-месячные аутбредные крысы Wistar массой 250-270 г. Легкую и средней тяжести ЧМТ воспроизводили с применением модифицированной модели падающего груза для взрослых крыс. Через 2 ч, 1, 2, 8 и 14 сут после моделирования ЧМТ проводили неврологическое обследование животных по модифицированной шкале Neurological Severity Scores (mNSS), сенсомоторное - по степени тревожности в тесте «свет-темнота», поведение анализировали с использованием теста условной реакции пассивного избегания. С помощью хромаффинной реакции исследовали функциональное состояние эритроцитов. Срезы тканей головного мозга, окрашивали по Нисслю и гематоксилин-эозином, микроскопировали, проводили морфометрию цифровых изображений. Результаты. Неврологическое обследование при среднетяжелой ЧМТ показало очаговую симптоматику, соответствующую выраженным неврологическим расстройствам, тогда как после ЧМТ легкой степени у крыс отмечались незначительные нарушения координации. В тесте условной реакции пассивного избегания на 7-е сут у этих животных выявлено состояние повышенной тревожности. Морфометрический анализ препаратов головного мозга травмированных животных показал уменьшение диаметра просвета капилляров и выявил признаки гипоксии нейронов. Цитохимическая оценка эритроцитов, с привлечением количественного определения степени флуоресценции, выявила особенности окислительного метаболизма в клетках у травмированных крыс. Эти показатели коррелировали с морфологическими признаками гипоксии головного мозга. Заключение. В начальный посттравматический период отмечено уменьшение диаметра просвета капилляров нервной ткани, наличие морфологических признаков компенсации нейронов, что является локальной ответной реакцией клеток на ишемию головного мозга. В капиллярах определяется нарушение гемореологии, что является следствием изменения окислительно-восстановительных процессов вследствие гипоксии при внутричерепной травме. The pathogenetic basis of changes in blood microcirculation in the brain due to traumatic brain injury (TBI) has not been fully studied due to the highly invasive nature of neuromorphological methods. Aim: To study the behavioral status and informative value of cytochemical criteria for erythrocyte chromophilia as markers of cerebral microvessel vasoreactivity in rats with TBI. Methods. The study was conducted on 3-month-old Wistar albino, outbred rats weighing 250-270 g. Mild to moderate TBI was simulated using a modified falling weight model for adult rats. At 2 hrs, 1, 2, 8, and 14 days after TBI, a neurological examination was performed according to the modified Neurological Severity Score (mNSS) modified scale and a sensorimotor examination was performed according to the degree of anxiety in the light-dark test. Behavior was analyzed using the conditioned passive avoidance response test. The functional state of erythrocytes was studied using the chromaffin reaction. Brain tissue samples stained by Nissl and with hematoxylin-eosin were evaluated under a microscope, digital images were obtained, and morphometric processing was performed. Results. Neurological examination after moderate TBI showed focal symptoms corresponding to severe neurological disorders, while after mild TBI, rats had minor coordination disorders. In the conditioned passive avoidance response test on the 7th day, the rats showed a state of increased anxiety. Morphometric analysis of the brains showed a decrease in the diameter of capillary lumen and changes in neurons, indicating signs of hypoxia. The cytochemical assessment of erythrocytes, involving a quantitative determination of the degree of fluorescence, revealed features of cell oxidative metabolism in injured rats. Moreover, these indicators correlated with morphological signs of hypoxia in brain neural tissue. Conclusion. In the initial post-traumatic period, there was a decrease in the capillary lumen diameter of the brain neural tissue and the presence of morphological signs of neuronal compensation, which is a local response of cells to cerebral ischemia. Disorders of hemorheology were found. These changes were a consequence of altered redox processes due to hypoxia after intracranial injury.

Clinical neurological manifestations in patients suffering from peptic ulcer disease in the acute phase and in remission

Objective — to analyze clinical neurological manifestations in patients suffering from peptic ulcer disease in the acute phase and in remission, based on the findings of a comprehensive clinical neurological, neuropsychological and paraclinical study. Methods and subjects. 84 patients suffering from PUD were comprehensively examined while in the acute phase of the disease and then all 84 were reexamined while in remission. The age range of the patients was from 25 to 60 years. The average age of the patient was 39.90 ± 1.29 years. The examined individuals were destributed into two groups based on whether they presented symptoms of an acute phase or remission of the peptic ulcer disease. The comprehensive examination included: interview and complaint analysis, neurological examination focused on the state of the autonomic nervous system, study of the neuropsychological differences (the trait and state anxiety levels monitoring based on the Spielberg‑Khanin scale, depressive state evaluation using Beck Depression Inventory, self‑perceived health assessment, mood and activity monitoring using the SAN questionnaire, cognitive impairment evaluation using the MMSE scale, assessment of the refocusing speeds and performance distribution using Schulte tables), as well as lab tests and procedures. Results. Most often, subjects complained of headache (74 (88.0 %) in the acute stage and 37 (44.0 %) in remission). The second most common was a complaint of pain in the thoracic spine (69 (82.1 %) and 35 (41.6 %), respectively). Complaints of dizziness, pain in the heart, palpitations, «interruptions» in the heart, paresthesia were often recorded. In 11 (12.4 %) patients with duodenal ulcer in the acute stage experienced episodes of syncopal state, while in the remission stage they were absent. Complaints that indicated the presence of psychoemotional disorders were anxiety, decreased memory and attention, and sleep disturbances. In patients with duodenal ulcer disease we revealed lesions of the central and peripheral nervous system. Central nervous system disorders were manifested in the form of vestibulo‑cerebellar syndrome (in 30 (35.7 %) patients in the acute stage and in 14 (16.6 %) in the remission stage), extrapyramidal disorders (respectively in 10 (11.9 %) and 4 (4.76 %)) and signs of pyramidal dysfunction (37 (44.0 %) and 15 (17.8 %)). Clinical and neurological examination of the peripheral nervous system in 68 (80.9 %) patients with peptic ulcer in the acute stage and in 31 (36.9 %) in the remission stage revealed polyneuropathy syndrome of varying degrees. Signs of polyneuropathy were accompanied by complaints of disorders of the peripheral nervous system (45 (53.5 %) and 15 (17.8 %) cases, respectively). In 27.4 % of patients with peptic ulcer disease in the acute stage of the complaint were absent at all, and only a thorough neurological examination revealed signs of polyneuropathy. In 56 (66.6 %) patients with peptic ulcer disease in the acute stage and 28 (33.3 %) in the remission stage, the morbidity of paravertebral points in the lower thoracic spine was revealed. Conclusions. Having analyzed the data obtained through the interviews, as well as the neurological characteristics of patients with peptic ulcer disease of the duodenum in the acute phase and in remission it was concluded that most of the somatic complaints and neurological manifestations were common in both the acute phase and the remission of the disease. However, all of the identified neurological differences were significantly more common in the acute phase of the disease.

Predicting Alzheimer's Disease Progression by Combining Multiple Measures

Alzheimer's disease (AD) is a degenerative brain ailment that affects millions worldwide. It is the most common form of dementia. Patients with an early diagnosis of Alzheimer's disease have a strong chance of preventing additional brain damage by halting nerve cell death. At the same time, it begins to progress several years before any symptoms appear. The variety of data is the biggest problem encountered during diagnosis. Neurological examination, brain imaging, and often asked questions from his connected closed relatives are the three forms of data that a neurologist or geriatrics employs to diagnose patients. One of the biggest questions which need answering is the choice of a convenient feature. The main objective of this paper is to help neurologists or geriatricians diagnose patient conditions. It proposes a new hybrid model for features extracted from medical data. It discusses AD's early diagnosis and progression for all features considered in the diagnosis and their complex interactions. It proves to have the best accuracy when compared with the state-ofthe-art algorithm. Also, it proves to be more accurate against some recent research ideas. It got 95% in all cases, considering this work focused more on increasing the number of instances in comparison.