Analysis of Connected Speech in Persian Aphasic Patients and its Relationship With Type and Severity of Aphasia

Background and Objectives: There are several tests to determine the type and severity of aphasia, but they take a long time to administer when assessing aphasic patients. In recent years, the analysis of spontaneous speech has gained great attention because it is important to diagnose and follow post-treatment improvement in aphasic patients. This study was done to assess some parameters of connected speech in aphasic patients. In addition, the correlation between connected speech parameters and the type and severity of aphasia was measured. Methods: We compared the connected speech parameters of 27 aphasics (10 fluent and 17 non-fluent), Persian speakers, compared with the control group. There were two groups matched by age, sex, and education. Nest’s bird story pictures were used to elicit a speech sample. In the next step, the connected speech was analyzed to define speech parameters, including speech rate, mean length of utterance, number of utterances, total words, content words, function words, nouns, and verbs. Moreover, the severity of aphasia was measured using a Persian Western Aphasia Battery (WAB). Results: The findings showed significant differences between groups in all parameters of the connected speech (P<0.01). The correlation coefficient between speech parameters and severity of aphasia demonstrated that all parameters were highly correlated (r >0.71) with the severity of aphasia (P<0.01) except for speech rate and the number of function words. There were some typical differences between linguistics grammatical and pragmatical characters of different types of aphasia. Conclusion: Connected speech is one of the most sensitive parts of language in all types of aphasic patients. There are some clinical signs for differential diagnosis of aphasia based on speech measures. According to the findings, the type and severity of aphasia and connected speech were highly correlated. Thus, the use of the connected speech analysis is necessary as an assessment tool for the diagnosis of aphasia.

Efficacy of topical 5% fluorouracil (5%- FU) needling in vitiligo: فعالية الحقن الموضعي بالإبر الدقيقة لـ fluorouracil 5% في علاج البهاق

Objective: The aim of this study is to assess the efficacy of topical 5- fluorouracil (5%- FU) with micro needling in treating stable vitiligo. In addition to, assessment the side effects of the treatment. Patients and Methods: A Prospective study (Before& After) conducted for the period one year (April 2019- April2020)at Tishreen University Hospital in Lattakia- Syria, 31 patients with stable vitiligo who received treatment with micro needling and topical 5- fluorouracil (5%- FU) were included in this study. Results : The median age was 36 years, 67.70% of patients were female. Focal type was found in 61.3%, and most common sites of vitiligo involvement were hand and feet (33.7%), followed by trunk (24.8%)and extremities (24.8%). After 6 months of treatment, improvement was excellent in 63.4%, and very good in 23.8%. The lesions of neck and trunk were responded better to treatment than those in other parts of the body. Regarding of side effects, pain, erythema, and itching were reported in 100% followed by ulceration in (16.1%). Conclusion: Topical 5%- fluorouracil (5%- FU) with needling appears to be an effective and safe method in treating stable vitiligo. Except of pain, erythema, and itching after procedure, significant complications not occurred in most patients.

AA-amyloidosis in autoinflammatory diseases

AA amyloidosis complicates various chronic inflammatory disorders and is characterized by the accumulation of amyloid fibrils composed of serum amyloid A protein, an acute phase reactant. In recent decades, the role of chronic infections and rheumatoid arthritis in the ethiology of AA amyloidosis have decreased significantly as a result of their treatment improvement, whereas both monogenic (familial Meditarranean fever, cryopirin-associated periodic syndrome, etc.) or polygenic (ankylosing spondilitis, psoriatic arthritis, adult onset Still’s disease, etc) autoinflammatory diseases more frequently account for AA-amyloidosis today. Autoinflammatory diseases are a consequence of innate immunity disorders although the latter can contribute to the pathogenesis of autoimmune diseases as well. In patients with autoinflammatory diseases, the suppression of inflammation, even subclinical, is essential to prevent development or progression of AA amyloidosis. The choice of inflammatory agents that can be used to achieve this aim depends on the pathogenesis of autoinflammation, e.g. key mediators that are involved in the activation of inflammatory cascade.

OCT-based biomarkers for predicting treatment response in eyes with centre-involved diabetic macular oedema treated with anti-VEGF injections: a real-life retina clinic-based study

Background/aimsTo determine whether a combination of baseline and change in spectral domain-optical coherence tomography (SD-OCT)-based biomarkers can predict visual outcomes in eyes with diabetic macular oedema (DMO) treated with antivascular endothelial growth factors (VEGF) injections.MethodsThis is a retrospective cohort study conducted in Hong Kong, China. 196 eyes with centre-involving DMO, who received anti-VEGF injections between 1 January 2011 and 30 June 2018 were recruited. Medical records of the participants were retrieved retrospectively, visual acuity (VA) at baseline, 6, 12 and 24 months and SD-OCT before initiation and after completion of anti-VEGF treatment were obtained. The SD-OCT images were evaluated for the morphology of DMO, vitreomacular status, presence of disorganisation of retinal inner layers (DRIL), sizes of intraretinal cysts, visibility of external limiting membrane (ELM), ellipsoid zone (EZ) and cone outer segment tip (COST) and the presence of hyper-reflective foci in retina or the choroid.ResultsThe presence of baseline DRIL, hyper-reflective foci in retina and disruption of ELM/EZ and COST were associated with worse baseline and subsequent VA up to 24 months after treatment. Improvement in DRIL (p=0.048), ELM/EZ (p=0.001) and COST (p=0.002) disruption after treatment was associated with greater improvement in VA at 12 months. Eyes with cystoid macular oedema (p=0.003, OR=8.18) and serous retinal detachment (p=0.011, OR=4.84) morphology were more likely to achieve at least 20% reduction in central subfield thickness.Conclusion and relevanceBaseline SD-OCT biomarkers and their subsequent change predict VA and improvement in vision in eyes with DMO treated with anti-VEGF injections. We proposed an SD-OCT-based system that can be readily used in real-life eye clinics to improve decision making in the management of DMO.

Anastomotic Leakage Following Resection of the Esophagus – Introduction of an Endoscopic Scoring System

Background Malignant tumors of the esophagus are the sixth leading cause of cancer-related deaths worldwide. Postoperative leakage of the esophago-gastrostomy leads to mediastinal sepsis, which is still associated with a high morbidity and mortality rate. The aim of this study was to describe the endoscopic view of the different severity grades of an anastomotic leakage. MethodsPatients Between June 2016 and September 2018, 144 patients were operated upon in the Department of Surgery, University of Munich, Germany. Among these patients, 34 (23.6%) presented with a leakage of the anastomosis. EndoscopyIn this retrospective analysis the focus is to describe different patterns of leakage of the anastomosis.Results We studied 34 patients in whom post-esophagectomy leakage of the anastomosis was detected and treated with an endoluminal vacuum sponge system. The leakage healed in 26 of 29 patients (success rate 89.7%). With increasing severity of leakage, the treatment time and the in-hospital mortality correspondingly increased. Furthermore, the incidence of development of a fistula to the tracheobronchial system increased with higher grades of leakage.ConclusionsExact descriptions of leakage are necessary to compare the cases and to prove post-treatment improvement. This is, to our knowledge, the first publication to present a leakage grading score in patients after esophagectomy including reconstruction with a gastric tube. This new grading system needs to be tested in further analyses, with special focus on prospective analysis.

Case Report on Cerebral Palsy- with Ayurvedic Treatment Protocol

Cerebral palsy is a non-progressive disorder, which arising in early stages of development of child. There are many etiology factors like antenatal, natal and postnatal factors responsible for causing cerebral palsy but exact cause is still unknown. Spasticity is the main feature of cerebral palsy(). Classification of CP is too broad on the basis of physiological and topographic etc. Symptoms of spastic cerebral palsy can be corelated with Jadhata in Ayurveda. In Jadata, there is tightness of muscles occurs. Improvement can be got in children with ayurvedic treatment. Aim- To improve the quality of life of child suffered from spastic CP. Place and duration of study- Study was done in Parul Ayurved Hospital, Vadodara, Gujarat. Method- In this case study, Samavardhan ghrita() orally, snehana() with bala taila() and svedan () with dashmmola kwath () was given to child for 31 days. Results- mild improvement in spasticity and achievement of milestones have observed. Patient got discharged from IPD of hospital due to COVID 19 pandemic. Conclusion- Hence, through Ayurveda treatment, improvement in symptoms of spastic cerebral palsy can achieve and quality of life of child can increase spontaneously.

Secukinumab provides sustained improvement in signs and symptoms and low radiographic progression in patients with psoriatic arthritis: 2-year (end-of-study) results from the FUTURE 5 study

ObjectiveSecukinumab provided sustained efficacy, low radiographic progression and consistent safety over 52 weeks in patients with psoriatic arthritis (PsA) in the FUTURE 5 study. Here, we report 2-year (end-of-study) results from this study.MethodsAdults with active PsA were randomised 2:2:2:3 to receive subcutaneous secukinumab 300 mg load (300 mg), 150 mg load (150 mg), 150 mg no load or placebo at baseline; weeks 1, 2, 3 and 4; and every 4 weeks thereafter. Secukinumab could be escalated from 150 mg to 300 mg starting at week 52, if active signs of disease were observed based on physician’s assessment. Assessments at week 104 (2 years) included clinical end points and radiographic damage (mean change in van der Heijde-modified total Sharp score (vdH-mTSS)). Safety analysis included all patients who received ≥1 dose of study medication.ResultsOf the 996 patients randomised, 783 patients (78.6%) completed 2 years of treatment. Improvement in clinical end points was sustained through 2 years. The vdH-mTSS (mean change (SD)) was 0.10 (1.74; 300 mg), 0.52 (2.66; 150 mg) and 0.41 (2.20; 150 mg no load) at 2 years. The proportion of patients with no radiographic progression (change from baseline in vdH-mTSS ≤0.5) at 2 years was 89.5% (300 mg), 82.3% (150 mg) and 81.1% (150 mg no load).ConclusionSecukinumab with and without loading regimen provided sustained clinical efficacy and low radiographic progression through 2 years in patients with PsA. No new safety findings were reported.Trial registration numberNCT02404350.

Management of chronic Achilles ruptures: a scoping review

Purpose This scoping review aims to systematically map and summarise the available evidence on the management of chronic Achilles ruptures, whilst identifying prognostic factors and areas of future research. Methods A scoping review was performed according to the frameworks of Arksey and O’Malley, Levac and Peters. A computer-based search was performed in PubMed, Embase, EmCare, CINAHL, ISI Web of Science and Scopus, for articles reporting treatment of chronic Achilles ruptures. Two reviewers independently performed title/abstract and full text screening according to pre-defined selection criteria. Results A total of 747 unique articles were identified, of which 73 (9.8%) met all inclusion criteria. A variety of methods are described, with flexor hallucis longus tendon transfer being the most common. The most commonly reported outcome is the American Orthopaedic Foot and Ankle Society (AOFAS) score, although 16 other measures were reported in the literatures. All studies comparing pre- and post-operative outcomes reported significant post-treatment improvement. Complications were reported in 50 studies, with an overall pooled complication rate of 168/1065 (15.8%). Conclusion Although beneficial results were reported following a variety of techniques, comparison between these is challenging due to the low-level study designs used and confounding factors such as treatment delay and tendon gap size. Further research comparing the efficacy of different techniques is required in order to facilitate the development of an evidence-based treatment protocol. Such work would allow clinicians to better understand the suitability of the large variety of reported techniques and select the optimal strategy for each individual patient.