Membership in a kind: Nature, norms, and profound disability

2021 ◽  
Author(s):  
John Vorhaus
Keyword(s):  
Profound Disability

Abstract P525: Endovascular Thrombectomy Outcomes in Transferred Octogenarians: A Multicenter Pooled Analysis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jonathan Greco ◽  
Michael Chen ◽  
Ameer E Hassan ◽  
Nitin Goyal ◽  
Haris Kamal ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Functional Independence ◽  
Pooled Analysis ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Younger Patients ◽  
Profound Disability ◽  
Iv Tpa

Background: Acute ischemic strokes outcomes may be less favorable in elderly patients. Whether transferring octogenarians with large vessel occlusion (LVO) for endovascular thrombectomy (EVT) results in similar outcomes to younger patients is uncertain. Methods: A pooled cohort from 6 centers (Europe, US) from 1/2014 to 5/2020 of pts with (ICA, M1, M2) LVO transferred for EVT ≤ 24 hrs from LKW. Patients were stratified into < 80 vs ≥ 80 years old. We compared 90 day functional independence and safety outcomes and assessed for predictors of good outcome (mRS 0-2) and profound disability (mRS 5-6). Results: Of 1176 pts received EVT as transfers, 216 (18%) were octogenarians. Baseline NIHSS was higher in octogenarians [19 (14, 22) vs 17 (12, 21), p<0.001], while IV tPA (52% vs 54%, p=0.52) and time LKW to EVT center [285 (193, 537) vs 272 (190, 470) min, p=0.15] were similar. Functional independence rates were lower in patients ≥ 80 as compared to < 80 (26% vs 46%, aOR 0.50, 95%CI 0.34-0.75, p=0.001). sICH was similar (8.6 vs 9.9%, p=0.56), but octogenarians had significantly higher 90-day mortality (42% vs 17%, p<0.001). Milder strokes (aOR 0.88, 95%CI 0.86-0.91, p<0.001), earlier presentation (aOR 0.95, 95%CI 0.91-0.98, p=0.004) and IV tPA (aOR 1.34, 95%CI 0.98-1.84, p=0.069) were associated with higher functional independence odds after EVT in octogenarians. Higher stroke severity (12% for each point, aOR=1.12, 95%CI 1.11-1.17-, p<0.001) and delayed reperfusion (3% for each additional hr, aOR 1.03, 95%CI 1.00-1.06, p=0.071) were associated with profound disability following EVT in octogenarians. Conclusion: EVT may be associated with lower independence rates in transferred octogenarians with LVO. Milder stroke severity, earlier presentation and IV thrombolysis increased the odds of good outcomes in octogenarians. Severe strokes and later treatment were associated with profound disability. Optimized selection and workflow is warranted in transferring elderly patients for EVT.

Abstract WMP12: Benefits of Thrombectomy Among Patients Who Did Not Achieve Functional Independence in DEFUSE 3

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amrou Sarraj ◽  
Maarten Lansberg ◽  
Michael P Marks ◽  
Michael Mlynash ◽  
Jeremy J Heit ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Elderly Patients ◽  
Older Patients ◽  
Mortality Rates ◽  
Functional Independence ◽  
Severe Disability ◽  
Endovascular Thrombectomy ◽  
Strong Trend ◽  
Baseline Characteristics ◽  
Profound Disability

Background: While endovascular thrombectomy (EVT) patients may not achieve functional independence, they may avoid devastating outcomes as in profound disability/death. Methods: DEFUSE 3 patients who did not achieve mRS 0-2 were assessed for a shift towards reductions in severe (mRS 4-6) and profound (mRS 5-6) disability, mortality, length of stay (LOS) and increased rates of home/rehabilitation discharges. Results: 126 of the 182 randomized in DEFUSE 3 did not achieve mRS 0-2 (EVT 51, MM 75). Baseline characteristics were similar. EVT was associated with a higher mRS 3 rate (28% vs 18%) and lower rates of severe (72% vs 82%) and profound disability (39% vs. 50%), EVT vs MM respectively, with a trend for a shift towards less disability aOR=1.6 (95%CI=0.9-3.2, P=0.138), figure 1. Mortality rates were numerically lower with EVT (25% vs 31, p=0.528). EVT patients had a trend for shorter LOS (8.6 (6.5-13.7) vs 9.3 (7.1-16.3) days, p=0.156) and increased rates of home/rehabilitation discharges 51% vs. 40%, p=0.224. Older age correlated independently with severe disability aOR=1.04 per year/age, (95%CI=1.01-1.07, p=0.023) as did more severe strokes, aOR per NIHSS point=1.07, 95%CI=0.99-1.15, P=0.096). Larger final infarct volumes had a trend towards severe disability in EVT aOR=1.005, 95%CI=0.996-1.013, p=0.257, but not in MM aOR=1.0 (95% CI 0.993-1.007, p=0.966). Lack of reperfusion (>90% Tmax>6 reduction) had a strong trend for severe disability in MM (83% in non-reperfusers vs. 50% for reperfusers), p=0.056, but not in EVT: 77% vs. 63%, p=0.484. Conclusion: In patients who did not achieve functional independence, EVT resulted in reduced rates of severe and profound disability, decreased length of stay and increased home and rehabilitation discharges. Older patients, more severe strokes and those who did not achieve reperfusion were more likely to have severe disability especially if not treated with EVT. EVT may result in avoiding severe disability in elderly patients.

scholarly journals Hysterectomy of Girls with Intellectual Disabilities in Jordan: A Family Perspective

2018 ◽  
Vol 8 (1) ◽  
pp. 53
Author(s):  
Murad A. Al-Bustanji ◽  
Noor T. Al. Bdour ◽  
Mohammad A. Beirat
Keyword(s):  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Monthly Income ◽  
Severity Level ◽  
Level Of Education ◽  
Family Perspective ◽  
The Family ◽  
Degree Of Acceptance ◽  
Profound Disability ◽  
Different Levels

The current study aimed at determining the Jordanian families’ degree of acceptance of having a hysterectomy performed on their daughters with intellectual disabilities (ID). It also aimed to study the differences based on the age of the girl with intellectual Disability, the type of the Intellectual disability of the girl, the severity level of disability, the gender of surveyed parent, the level of education of surveyed parent, and the level of monthly income of the family. The participants of the study were (329) parents of girls with intellectual disabilities. Each one of the participant completed a questionnaire consisted of (21) items. The study concluded that the overall participants’ degree of acceptance of having a hysterectomy performed on their daughters with intellectual disabilities was low. The findings indicated that the families who had disabled daughters between the ages of 11-20 years had higher degree of acceptance of having their daughters undergo hysterectomy than the families who had disabled daughters between the ages of 5 - 10 years or even the ages of 21-30 years. The results showed that the families did not differ in their degree of acceptance of having a hysterectomy performed on their daughters with intellectual disabilities based on their daughters’ type of disability. The results showed that the families who had daughters with severe or profound disability had higher degree of acceptance of having their daughters undergo hysterectomy than participants who had daughters with mild or moderate disability.The results showed that the degree of acceptance of the mothers of girls with intellectual disabilities to perform hysterectomy on them was higher than the degree of acceptance of the fathers of girls with intellectual disabilities. The results showed that the participant parents (either mother or father in each family) who had no education had higher degree of acceptance of having their daughters undergo hysterectomy than the participant parents who had different levels of education. The results also showed that the families who had higher income had a higher degree of acceptance of having their daughters undergo hysterectomy than the families who had less income.

scholarly journals Early infantile epileptic-dyskinetic encephalopathy due to biallelic PIGP mutations

2020 ◽  
Vol 6 (1) ◽  
pp. e387 ◽  
Author(s):  
Annalisa Vetro ◽  
Tiziana Pisano ◽  
Silvia Chiaro ◽  
Elena Procopio ◽  
Azzurra Guerra ◽  
...  
Keyword(s):  
Neurodevelopmental Disorder ◽  
Brain Mri ◽  
Molecular Genetic ◽  
Genetic Diagnosis ◽  
Premature Death ◽  
Epileptic Encephalopathy ◽  
Whole Exome ◽  
Mri Scans ◽  
Severe Hypotonia ◽  
Profound Disability

ObjectiveTo describe clinical, biochemical, and molecular genetic findings in a large inbred family in which 4 children with a severe early-onset epileptic-dyskinetic encephalopathy, with suppression burst EEG, harbored homozygous mutations of phosphatidylinositol glycan anchor biosynthesis, class P (PIGP), a member of the large glycosylphosphatidylinositol (GPI) anchor biosynthesis gene family.MethodsWe studied clinical features, EEG, brain MRI scans, whole-exome sequencing (WES), and measured the expression of a subset of GPI-anchored proteins (GPI-APs) in circulating granulocytes using flow cytometry.ResultsThe 4 affected children exhibited a severe neurodevelopmental disorder featuring severe hypotonia with early dyskinesia progressing to quadriplegia, associated with infantile spasms, focal, tonic, and tonic-clonic seizures and a burst suppression EEG pattern. Two of the children died prematurely between age 2 and 12 years; the remaining 2 children are aged 2 years 7 months and 7 years 4 months. The homozygous c.384del variant of PIGP, present in the 4 patients, introduces a frame shift 6 codons before the expected stop signal and is predicted to result in the synthesis of a protein longer than the wild type, with impaired functionality. We demonstrated a reduced expression of the GPI-AP CD16 in the granulocytic membrane in affected individuals.ConclusionsPIGP mutations are consistently associated with an epileptic-dyskinetic encephalopathy with the features of early infantile epileptic encephalopathy with profound disability and premature death. CD16 is a valuable marker to support a genetic diagnosis of inherited GPI deficiencies.

scholarly journals Neuroinflammation-Induced Parvalbumin Interneuron and Oscillation Deficits Might Contribute to Neurobehavioral Abnormities in a Two-Hit Model of Depression

2021 ◽  
Author(s):  
Fei Wang ◽  
Jianhua Tong ◽  
Yuzhu Gao ◽  
Shixu Wang ◽  
Muhuo Ji
Keyword(s):  
Gamma Oscillations ◽  
Underlying Mechanism ◽  
Male Mice ◽  
Chronic Unpredictable Stress ◽  
Reduced Body ◽  
Fluoxetine Treatment ◽  
Parvalbumin Interneuron ◽  
Chronic Fluoxetine ◽  
Profound Disability ◽  
And Behavior

Abstract Background: Depression is a common neuropsychiatric disorder that causes profound disability worldwide, yet the underlying mechanism remains unclear. Thus, the present study aimed to evaluate the effects of a two-hit model of depression on glial activation, parvalbumin (PV) interneuron, oscillation activity, and behavior alternations, and whether chronic fluoxetine treatment can reverse these abnormalities. Methods: Male mice were submitted to lipopolysaccharide (LPS) injection, followed by a modified chronic unpredictable stress (CUS) protocol. Results: In our study, we showed that mice exposed to LPS and CUS exhibited reduced body weight, anhedonic-like behavior as well as cognitive and anxiety symptoms. These behavioral alternations were related to enhanced neuroinflammation, as reflected by significantly increased IL-1β and IL-6 levels and microglia activation in the prefrontal cortex (PFC). In addition, mice exposed to LPS and CUS displayed significantly decreased PV expression and disturbance of theta and gamma oscillations in the PFC. However, chronic fluoxetine treatment reversed most of these abnormalities. Conclusion: Our study of this two-hit model of depression is clinically relevant and suggests the combination of different etiological and pathophysiological components of depression may provide with a more translational value.

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