Tomodensitometric Bone Anatomy of The Intervertebral Foramen of The Lower Cervical Spine: Measurements and Comparison of Foraminal Volume in Healthy Individuals and Patients Suffering from Cervicobrachial Neuralgia Due to Foraminal Stenosis.

Purpose Degenerative foraminal stenosis of the cervical spine can lead to cervicobrachial neuralgias. Computed tomography (CT)-scan assists in the diagnosis and evaluation of foraminal stenosis. The main objective of this study is to determine the bony dimensions of the cervical intervertebral foramen and to identify which foraminal measurements are most affected by degenerative disorders of the cervical spine. These data could be applied to the surgical treatment of this pathology, helping surgeons to focus on specific areas during decompression procedures. Methods A descriptive study was conducted between two groups: an asymptomatic one (young people with no evidence of degenerative cervical spine disorders) and a symptomatic one (experiencing cervicobrachial neuralgia due to degenerative foraminal stenosis). Using CT scans, we determined a method allowing measurements of the following foraminal dimensions: foraminal height (FH), foraminal length (FL), foraminal width in its lateral part ((UWPP, MWPP and IWPP (respectively Upper, Medial and Inferior Width of Pedicle Part)) and medial part (UWMP, MWMP and IWMP (respectively Upper, Medial and Inferior Width of Medial Part)), and disk height (DH). Foraminal volume (FV) was calculated considering the above data. Mean volumes were measured in the asymptomatic group and compared to the values obtained in the symptomatic group. Results Both groups were made up of 10 patients, and a total of 50 intervertebral discs (100 intervertebral foramina) were analyzed in each group. Comparison of C4C5, C5C6 and C6C7 levels between both groups showed several significant decreases in foraminal dimensions (p< 0,05) as well as in foraminal volume (p <0.001) in the symptomatic group. The most affected dimensions were UWPP, MWPP, UWMP, MWMP and FV. The most stenotic foraminal areas were the top of the uncus and the posterior edge of the lower plate of the overlying vertebra. Conclusion Using a new protocol for measuring foraminal volume, the present study refines the current knowledge of the normal and pathological anatomy of the lower cervical spine and allows us to understand the foraminal sites most affected by degenerative stenosis. Those findings can be applied to foraminal stenosis surgeries. According to our results, decompression of the foramen in regard of both uncus osteophytic spurs and inferior plate of the overlying vertebra might be an important step for nerve roots release.

Recovery of the lumbopelvic movement and muscle recruitment patterns using motor control exercise program in people with chronic nonspecific low back pain: A prospective study

This study aims to investigate the dysfunction and recovery of the lumbopelvic movement and motor control of people with chronic nonspecific low back pain after a structured rehabilitation which emphasizes on re-education and training of movement and motor control. The lumbopelvic movement and motor control pattern of 30 adults (15 with chronic low back pain, 15 healthy controls) were assessed using 3D motion and electromyographic analysis during the repeated forward bending test, in additional to the clinical outcome measures. Regional kinematics and muscle recruitment pattern of the symptomatic group was analysed before and after the 6-week rehabilitation, and compared to healthy controls. Significant improvement in back pain, functional capacity and self-efficacy of the symptomatic group was found after the rehabilitation. Patients with chronic nonspecific low back pain were capable to recover to a comparable level of the healthy controls in terms of their lumbopelvic movement and motor control pattern upon completion of a 6-week rehabilitation program, despite their dysfunction displayed at baseline. Phase specific motor control reorganization in which more profound and positive changes shown during the flexion phase. Our findings indicate that the recovery of the movement and motor control pattern in patients with chronic low back pain achieved to a comparable level of the healthy able-bodies. The improvement of both the physical outcome measures suggest that specific rehabilitation program which emphasizes on optimizing motor control during movements would help promoting the functional recovery of this specific low back pain subgroup.

Impairment of motor skills in children with achondroplasia—usefulness of brain and cranio-cervical junction evaluation by quantitative magnetic resonance imaging: a case-control study

Background Most infants and children with achondroplasia show delayed motor skill development; however, some patients may have clinical consequences related to cranio-cervical junction stenosis and compression. Purpose To assess, using brain magnetic resonance imaging (MRI), quantitative variables linked to neuromotor impairment in achondroplasic children. Material and Methods In total, 24 achondroplasic children underwent pediatric neurological assessment and were grouped in two cohorts according to relevant motor skill impairment. Achondroplasic children with (n=12) and without (n=12) motor symptoms were identified, and brain MRI scans were quantitatively evaluated. 3D fast spoiled gradient echo T1-weighted images were used to assess: supratentorial intracranial volumes (SICV); supratentorial intracranial brain volume (SICBV); SICV/SICBV ratio; posterior cranial fossa volume (PCFV); posterior cranial fossa brain volume (PCBFV); PCFV/PCFBV ratio; ventricular and extra-ventricular cerebrospinal fluid (CSF) volumes; foramen magnum (FM) area; and jugular foramina (JF) areas. Results In both groups, SICV/SICBV ratio, supratentorial ventricular and extra-ventricular space volumes were increased while SICBV was increased only in the asymptomatic group ( P < 0.05). PCFV/PCFBV ratio, IV ventricle, infratentorial extra-ventricular spaces volumes were reduced ( P < 0.05) in the symptomatic group while PCFBV was increased only in the asymptomatic group ( P < 0.05). Foramen magnum (FM) area was more reduced in the symptomatic group than the asymptomatic group ( P < 0.05) but no correlation between FM area and ventriculomegaly was found ( P > 0.05). Conclusion Evaluation of the FM area together with infratentorial ventricular and extra-ventricular space volume reduction may be helpful in differentiating patients at risk of developing motor skill impairment. Further investigation is needed to better understand the temporal profile between imaging and motor function in order to propose possible personalized surgical treatment.

Evaluation of the validity of Ag PANBIO-COVID19 in the diagnosis of SARS-CoV-2 infection in asymptomatic or mildly infected patients

Objective. To assess the validity of SARS-CoV-2 Antigen (Ag) detection for the diagnosis of SARS-CoV-2 infection in mildly infected or asymptomatic patients. Material and methods. Observational study to evaluate diagnostic tests. Non-hospitalized patients with indication for diagnostic testing for SARS-CoV-2 infection were included. The diagnostic test to be evaluated was the determination of Ag and as a reference standard to determine the presence of viral RNA the RT-PCR was used. Results. A total of 494 patients were included. Of these 71.5% (353/494) had symptoms and 28.5% (141/494) were asymptomatic (presurgery screening (35/494) and confirmed case-contact (106/494). The overall sensitivity of the Ag test was 61.1% and the specificity was 99.7%. The sensitivity and specificity in the asymptomatic group were 40% and 100% respectively, and in the symptomatic group 63.5% and 99.6% respectively. In turn, the sensitivity and specificity in the group of symptomatic patients varied according to the time of symptom evolution: in patients with recent symptoms, they were 71.4% and 99.6% respectively, while in patients with symptoms of more than 5 days of evolution, they were 26.7% and 100% respectively. In all groups studied, the presence of antigen is associated with a high viral load (Ct<30 cycles). Conclusions. The use of Ag detection test is not indicated for the diagnosis of SARS-CoV-2 infection in asymptomatic patients or with symptoms of more than 5 days of evolution, but it could be useful in patients with symptoms of 1-5 days of evolution.

Clinical Characteristics of Hospitalized COVID-19 in Children: Report From the COVID-19 Registry in Japan

A total of 1038 pediatric patients with COVID-19 were identified. Among these, 308 (30%) had asymptomatic COVID-19. The overall outcome was good, and no patients died. A significant rate of patients aged &lt;24 months and ≥13 years were found in the symptomatic group.

Evaluation of Supranormal Spirometry Values With an Obstructive Ratio for Airway Hyperreactivity

ABSTRACT Background Published guidelines on spirometry interpretation suggest an elevated FVC and FEV1 &gt; 100% of predicted with an obstructive ratio may represent a physiological variant. Further evidence is needed on whether this finding indicates symptomatic airways obstruction and what additional evaluation should be done. Methods Participants were prospectively enrolled to undergo additional testing for a technically adequate spirometry study with an FEV1 &gt; 90% of predicted, and FEV1/FVC below the lower limit of normal, based on 95th percentile confidence intervals. Further testing consisted of full pulmonary function testing, impulse oscillometry (IOS), post-bronchodilator testing, fractional exhaled nitric oxide (FeNO), and methacholine challenge testing (MCT). Results A total of 49 patients meeting entry criteria enrolled and completed testing. Thirty-three were considered symptomatic based on clinical indications for initial testing and 16 were considered asymptomatic. Baseline pulmonary function test values were not different between groups while IOS R5 values (% predicted) were higher in the symptomatic group (126.5 ± 0.37 vs 107.1 ± 0.31). Bronchodilator responsiveness on PFT or IOS was infrequent in both groups. There was a 29% positivity rate for MCT in the symptomatic group compared to one borderline study in asymptomatic participants. FeNO was similar for symptomatic, 26.17 ± 31.3 ppb, compared to asymptomatic, 22.8 ± 13.5 ppb (p = 0.93). The dysanapsis ratio was higher in the symptomatic (0.15 ± 0.03) compared to the asymptomatic (0.13 ± 0.02) (p &lt; 0.05). Conclusion Normal FEV1 &gt; 90% of predicted and obstructive indices may not represent a normal physiological variant in all patients. In symptomatic patients, a positive MCT and elevated baseline IOS values were more common than in asymptomatic patients with similar PFT characteristics. These findings suggest that clinicians should still evaluate for airway hyperresponsiveness in patients with exertional dyspnea with airway obstruction and FEV1 &gt; 90% of predicted and consider alternative diagnoses to include a normal physiologic variant if non-reactive.

Ligaments of the scapho-trapezial-trapezoidal joint: MR anatomy in asymptomatic and symptomatic individuals

Purpose To evaluate the MRI anatomy of the scapho-trapezial-trapezoidal (STT) ligament complex in asymptomatic and symptomatic individuals. Material and methods In this retrospective study, STT ligament complex of 42 (male 69%, median age 37.5 years) asymptomatic (n = 25) and symptomatic (n = 17) (defined as pain described over the STT joint) individuals was examined using a high-resolution 3D proton density-weighted isovoxel sequence (MR arthrogram) with multiplanar reconstructions. Two musculoskeletal radiologists independently assessed visibility, signal intensity (SI), morphology, and thickness of the radiopalmar scapho-trapezial ligament (rpSTL), palmar scapho-capitate capsular ligament (pSCL), palmar STT capsule (pSTTC), and dorsal STT capsule (dSTTC). Results Interreader agreement ranged from fair to good and intraclass correlations were good. The rpSTL was almost always visible (85.7%/80.1%; reader 1/reader 2). The pSCL and dSTTC were visible in all cases. The pSTTC was visible in only 52.4%/42.9%. Mean thickness of the rpSTL, pSCL, pSTTC, and dSTTC was 1.4 ± 0.5 mm/1.3 ± 0.5 mm, 2.8 ± 0.7 mm/2.7 ± 0.6 mm, 0.5 ± 0.5 mm/0.4 ± 0.4 mm, and 0.5 ± 0.3 mm/0.3 ± 0.3 mm. Both readers rated SI of the rpSTL significantly more often as increased in the symptomatic group (increased SI in asymptomatic group: 20%/15%; symptomatic group: 56%/50%) (p-values < 0.005). For all other ligaments, no significant difference was observed for SI between symptomatic and asymptomatic group (p-values ranging between 0.188 and 0.890). For all other ligaments, no significant differences were observed regarding ligament visibility, morphology, and thickness (p-values ranging between 0.274 and 1.000). Conclusion The anatomy of the STT ligament complex can consistently be visualized on high-resolution 3D MRI. Increased signal intensity of rpSTL is significantly more frequent in patients with radial-sided wrist pain.

COVID-19 Disease in Infants Less Than 90 Days: Case Series

The objective of this study is to describe the clinical presentations, radiological and laboratory findings, and outcomes of COVID-19 disease in infants ≤ 90 days of age at presentation. We conducted a retrospective study of infants in this age group who were found to be SARS-CoV-2 positive. Asymptomatic infants who were identified through routine testing following delivery to COVID-19-positive mothers were excluded. We classified infants according to their presentation: asymptomatic, mildly symptomatic, moderately symptomatic, and severely/critically symptomatic. A total of 36 infants were included. Of them, two were asymptomatic and four had severe/critical presentation. Of the severely symptomatic infants, two were considered as multisystem inflammatory syndrome in children (MIS-C) and there was one death. One infant in the severe symptomatic group presented with cardiac failure, with the possibility of congenital infection. Another infant presented with cardiogenic shock. None of these infants received antiviral medication. The study found that infants ≤ 90 days can present with a severe form of COVID-19 disease. Multisystem inflammatory syndrome in children, although rarely reported in infants, is a possible complication of COVID-19 disease and can be associated with significant morbidity and mortality.

Psycho-affective health, cognition, and neurophysiological functioning following sports-related concussion in symptomatic and asymptomatic athletes, and control athletes

Little is known about the neuropsychiatric and neurophysiological differences that characterize abnormal recovery following a concussion. The present study aimed to investigate the psycho-affective, cognitive, and neurophysiological profiles of symptomatic, slow-to-recover, concussed athletes, asymptomatic concussed athletes, and control athletes. Seventy-eight athletes (26 symptomatic, 26 asymptomatic, 26 control) completed the Beck Depression Inventory-II, Profile of Mood States, and 2-Back task. Additionally, event-related brain potentials were recorded during an experimental three-stimulus visual Oddball paradigm. Compared to asymptomatic and control groups, the symptomatic group reported greater depression symptoms and negatively altered mood states. Symptomatic athletes also exhibited poorer cognitive performance on the 2-Back task, indicated by more errors and slower reaction time. ERP analyses indicated prolonged P3b latency for both symptomatic and asymptomatic groups, but symptomatic athletes also exhibited reduced P3b amplitude compared to both asymptomatic and control groups. For the asymptomatic group, correlations were observed between time since last concussion and functioning, but no relations were observed within the symptomatic group for any measure. The current findings provide valuable information regarding the psycho-affective, cognitive, and neurophysiological profiles of athletes with and without persistent symptoms following a concussion and highlight the need to assess and treat symptomatic, slow-to-recover athletes from a multidimensional and integrative perspective.

Immediate and post-COVID complications of symptomatic and asymptomatic COVID-19 patients in Bangladesh: a cross-sectional retrospective study

The COVID-19 pandemic has cost a large number of lives worldwide. Most of the COVID-19 patients recover within two weeks of illness, but many survivors are experiencing different post COVID-19 clinical complications. In this cross-sectional retrospective study, we investigated the immediate and post COVID-19 complications with secondary effects in symptomatic and asymptomatic COVID-19 patients of Bangladesh. A total of 632 patients diagnosed with COVID-19 from December, 2020 to February, 2021 were included in this study. The data were collected by telephone interview with patients consent and reviewing their call records using questionnaire and checklist. Results demonstrate that among the 632 patients, 77.53 % of cases were symptomatic, where fever was the most common symptom (82.24%). The other symptoms were headache (58.16%), sore throat (53.65%), cough (45.51%), weakness (41.22%), breathlessness (40%), loss of smell (37.55%), tastelessness (31.84%), diarrhea (19.39%), and vomiting (14.69%). Comorbidities like asthma, hypertension, diabetes mellitus (DM), cardiovascular disease, and other chronic diseases were pronounced in symptomatic patients. Post COVID-19 complications varied significantly (P<0.05) between the symptomatic and asymptomatic observations. Asthma, hypertension, and diabetes were newly reported in symptomatic patients with the rate of 3.06 %, 2.45 %, and 2.24 %, respectively, while the proportions were 1.41%, 1.41%, and 0.70% for the asymptomatic group. Tiredness, weight loss, hair loss, and insomnia were the most observed post COVID-19 complications found higher in symptomatic patients than in asymptomatic groups. A newly developed visual anomaly was also identified in the symptomatic group (1.42%), which was absent in asymptomatic COVID-19 recovered patients. These findings concluded that post-COVID-19 complications were high in symptomatic and comorbid patients compared with asymptomatic individuals. We hope that this study will contribute in post COVID-19 management and help the concerned authority toward decision making in the treatment of post-COVID-19 complications. Asian J. Med. Biol. Res. 2021, 7 (2), 191-201