scholarly journals Cognitive performance in distinct groups of children undergoing epilepsy surgery—a single-centre experience

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7790
Author(s):  
Barbora Benova ◽  
Anezka Belohlavkova ◽  
Petr Jezdik ◽  
Alena Jahodová ◽  
Martin Kudr ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Epilepsy Surgery ◽  
Cognitive Outcomes ◽  
Tertiary Centre ◽  
Large Patient ◽  
Significant Difference ◽  
Before And After ◽  
Individual Variables ◽  
One Year ◽  
Paediatric Epilepsy

Background We aimed first to describe trends in cognitive performance over time in a large patient cohort (n = 203) from a single tertiary centre for paediatric epilepsy surgery over the period of 16 years divided in two (developing—pre-2011 vs. established—post-2011). Secondly, we tried to identify subgroups of epilepsy surgery candidates with distinctive epilepsy-related characteristics that associate with their pre- and post-surgical cognitive performance. Thirdly, we analysed variables affecting pre-surgical and post-surgical IQ/DQ and their change (post- vs. pre-surgical). Methods We analysed IQ/DQ data obtained using standardized neuropsychological tests before epilepsy surgery and one year post-surgically, along with details of patient’s epilepsy, epilepsy surgery and outcomes in terms of freedom from seizures. Using regression analysis, we described the trend in post-operative IQ/DQ. Cognitive outcomes and the associated epilepsy- and epilepsy surgery-related variables were compared between periods before and after 2011. Using multivariate analysis we analysed the effect of individual variables on pre- and post-operative IQ/DQ and its change. Results Epilepsy surgery tends to improve post-surgical IQ/DQ, most significantly in patients with lower pre-surgical IQ/DQ, and post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ (Rho = 0.888, p < 0.001). We found no significant difference in pre-, post-surgical IQ/DQ and IQ/DQ change between the periods of pre-2011 and post-2011 (p = 0.7, p = 0.469, p = 0.796, respectively). Patients with temporal or extratemporal epilepsy differed in their pre-surgical IQ/DQ (p = 0.001) and in IQ/DQ change (p = 0.002) from those with hemispheric epilepsy, with no significant difference in post-surgical IQ/DQ (p = 0.888). Groups of patients with different underlying histopathology showed significantly different pre- and post-surgical IQ/DQ (p < 0.001 and p < 0.001 respectively) but not IQ/DQ change (p = 0.345).Variables associated with severe epilepsy showed effect on cognitive performance in multivariate model. Discussion Post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ and greatest IQ/DQ gain occurs in patients with lower pre-surgical IQ/DQ scores. Cognitive performance was not affected by changes in paediatric epilepsy surgery practice. Pre- and post-operative cognitive performances, as well as patients’ potential for cognitive recovery, are highly dependent on the underlying aetiology and epileptic syndrome.

The effect of the COVID-19 pandemic on metabolic control in children with type 1 diabetes: a single-center experience

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Emre Sarıkaya ◽  
Dilek Çiçek ◽  
Ebru Gök ◽  
Leyla Kara ◽  
Uğur Berber ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Metabolic Control ◽  
Glycosylated Hemoglobin ◽  
Emergency Admissions ◽  
Single Center Experience ◽  
Number Of Patients ◽  
Significant Difference ◽  
Before And After ◽  
One Year

Abstract Objectives Coronavirus disease 2019 has caused a major epidemic worldwide, and lockdowns became necessary in all countries to prevent its spread. This study aimed to evaluate the effects of staying-at-home practices on the metabolic control of children and adolescents with type 1 diabetes during the pandemic period. Materials and Methods Eighty-nine patients younger than 18 years old who were diagnosed with type 1 diabetes at least one year before the declaration of the pandemic were included in the study. The last visit data of the patients before and after the declaration of the pandemic, and the frequency of presentation of diabetes-related emergencies from one year after diagnosis of type 1 diabetes to the declaration of the pandemic, and from the declaration of the pandemic to the last visit after the pandemic declaration were compared. Results The total number of patients was 89, and 48 (53.9%) were boys. The mean (± standard deviation [SD]) age at diagnosis was 8.4 ± 3.7 years (boys 7.9 ± 3.6 years; girls 8.9 ± 3.9 years). There was no statistically significant difference when the SD values of the anthropometric measurements, and the glycosylated hemoglobin (HbA1c) and lipid profile tests were compared. However, the frequency of admission to the emergency service related to diabetes was significantly different. Conclusions Although the pandemic did not significantly affect the metabolic and glycemic controls of the children with type 1 diabetes included in this study, an increase in the frequency of diabetes-related emergency admissions was noted.

scholarly journals Effects of Sublingual Duster Mite Drops on Lung Function and Exhaled Nitric Oxide in Children with Multiple and Single Allergic Respiratory Diseases

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Li Wang ◽  
Tao Ai ◽  
Ronghua Luo ◽  
Yinghong Fan ◽  
Huiling Liao ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Symptom Score ◽  
Respiratory Diseases ◽  
Allergic Diseases ◽  
Dermatophagoides Farinae ◽  
Vas Score ◽  
Significant Difference ◽  
Before And After ◽  
Drug Score ◽  
One Year

Objective. To evaluate the efficiency of sublingual immunotherapy with Dermatophagoides Farinae Drops in children with single and multiple respiratory allergic diseases. Methods. Seventy-one children with allergic respiratory diseases who had been treated with Dermatophagoides Farinae Drops for one year or more were divided into a single allergic group (12 cases) and multiple allergic group (59 cases). The rhinitis score, daytime and night symptom score of asthma, VAS score, drug score, pulmonary function, and FeNO level before and after treatment were evaluated and compared between the two groups. Results. The rhinitis score, night symptom score, VAS score, and drug score in the single allergic group after treatment were significantly lower than those before treatment ( p < 0.05 ), but there was no significant difference in the daytime symptom score before and after treatment ( p > 0.05 ). The rhinitis score, VAS score, and drug score in the multiple allergic group after treatment were significantly lower than those before treatment ( p < 0.05 ), but there was no significant difference in the scores of daytime symptoms and nighttime symptoms before and after treatment ( p > 0.05 ). In both the single allergic group and multiple allergic group, the pulmonary function indexes of the patients were significantly improved after treatment, and the FeNO after treatment was significantly lower than that before treatment ( p < 0.05 ). There was no significant difference in scores, pulmonary function, and FeNO between the two groups ( p > 0.05 ). Conclusion. Sublingual specific immunotherapy is effective in treating multiple and single allergic respiratory diseases in children.

scholarly journals Effect of revascularization on cognitive outcomes in intracranial steno-occlusive disease: a systematic review

2019 ◽  
Vol 46 (2) ◽  
pp. E14 ◽  
Author(s):  
Bradley Kolb ◽  
Hassan Fadel ◽  
Gary Rajah ◽  
Hamidreza Saber ◽  
Ali Luqman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Observational Studies ◽  
English Language ◽  
Randomized Trials ◽  
Occlusive Disease ◽  
Cognitive Outcomes ◽  
Thomson Reuters ◽  
Before And After

OBJECTIVESteno-occlusive diseases of the cerebral vasculature have been associated with cognitive decline. The authors performed a systematic review of the existing literature on intracranial steno-occlusive disease, including intracranial atherosclerosis and moyamoya disease (MMD), to determine the extent and quality of evidence for the effect of revascularization on cognitive performance.METHODSA systematic search of PubMed/MEDLINE, the Thomson Reuters Web of Science Core Collection, and the KCI Korean Journal Database was performed to identify randomized controlled trials (RCTs) in the English-language literature and observational studies that compared cognitive outcomes before and after revascularization in patients with steno-occlusive disease of the intracranial vasculature, from which data were extracted and analyzed.RESULTSNine papers were included, consisting of 2 RCTs and 7 observational cohort studies. Results from 2 randomized trials including 142 patients with symptomatic intracranial atherosclerotic steno-occlusion found no additional benefit to revascularization when added to maximal medical therapy. The certainty in the results of these trials was limited by concerns for bias and indirectness. Results from 7 observational trials including 282 patients found some cognitive benefit for revascularization for symptomatic atherosclerotic steno-occlusion and for steno-occlusion related to MMD in children. The certainty of these conclusions was low to very low, due to both inherent limitations in observational studies for inferring causality and concerns for added risk of bias and indirectness in some studies.CONCLUSIONSThe effects of revascularization on cognitive performance in intracranial steno-occlusive disease remain uncertain due to limitations in existing studies. More well-designed randomized trials and observational studies are needed to determine if revascularization can arrest or reverse cognitive decline in these patients.

Diode Laser Trabeculoplasty in Patients with Pseudoexfoliative Glaucoma

2013 ◽  
Vol 07 (01) ◽  
pp. 14
Author(s):  
Nikola Babić ◽  
Aleksandar Miljković ◽  
Veljko Andreić ◽  
◽  
◽  
...  
Keyword(s):  
Diode Laser ◽  
Open Angle Glaucoma ◽  
Spot Size ◽  
Open Angle ◽  
Pseudoexfoliative Glaucoma ◽  
Laser Trabeculoplasty ◽  
Significant Difference ◽  
Before And After ◽  
One Year ◽  
A Prospective Study

Aim:A prospective study was carried out to examine the efficacy of diode laser trabeculoplasty (DLT) in the treatment of pseudoexfoliative glaucoma (XFG).Material and Methods:Laser trabeculoplasty was performed by Zeiss VISULAS 532s diode pumped solid state laser on 69 eyes of 40 patients with XFG and primary open-angle glaucoma. Power of 600–1,200 mW was used, with a spot size of 100 microns and a pulse of 0.10 second. One hour before DLT brimonidine 0.1 % was administered and during seven days after the treatment Dexamethasone 1 % was administered. All patients underwent complete ophthalmic evaluation before and at intervals after treatment (seven days, one, three and six months and one year postoperatively). During the follow-up period, patients were treated with the same topical anti-glaucoma medicaments as before diode laser trabeculoplasty.Results:Before treatment in XFG patients mean intraocular pressure (IOP) was 23.7±2.6 mmHg and seven days after DLT it was 16.8 ± 2.1 mmHg that is 26.9 % decrease from the baseline, on day 30 it was 14.3 ± 2.2 mmHg which is 38.3 % decrease from the baseline, after 3 months 13.9 ± 2.4 mmHg (39.0 % decrease from the baseline), after six months 13.8 ± 2.7 mmHg or 39.9 % decrease from the baseline and after one year 15.1 ± 3.1 mmHg that makes 36.3 % decrease from the baseline. No side effects (either objective or subjective) were present in examined patients.Conclusions:There is statistically significant difference between IOP before and after diode laser trabeculoplasty, so it is concluded that diode laser trabeculoplasty is an effective mode of treatment for eyes with open-angle glaucoma especially in patients with XFG.

scholarly journals Subtidal littering: Indirect effects on soft substratum macrofauna?

2008 ◽  
Vol 9 (2) ◽  
pp. 35 ◽  
Author(s):  
I. AKOUMIANAKI ◽  
P. KONTOLEFAS ◽  
S. KATSANEVAKIS ◽  
A. NICOLAIDOU ◽  
G. VERRIOPOULOS
Keyword(s):  
Community Structure ◽  
Sediment Surface ◽  
Long Run ◽  
Significant Difference ◽  
Before And After ◽  
Soft Substratum ◽  
One Year ◽  
The Impact ◽  
Control Surfaces ◽  
Macrofauna Community

Changes in macrofauna community structure, abundance and species richness were examined both before and one year after the deployment of plastic and glass bottles at littered (litter density: 16 items / 100 m2) and non-littered (control) surfaces at three unimpacted coastal areas of the western Saronikos Gulf (Greece). In parallel, LOI% at the adjacent sediments and changes in the composition of feeding types of the megaepifauna that colonized the litter were examined across treatments. Significant changes in macrofauna community structure were demonstrated between before and after littering. At only one of the sites was there detected a significant difference in macrofauna community structure between control and littered plots after littering. This difference was linked with a significant increase in the abundance of opportunistic polychaete species and LOI% levels in the sediment surface due to the entrapment of macrophytal debris within the littered surface. The study did not show a consistent direct response of macroinfauna community to litter and the associated megafauna. Unlike the megafauna attracted by litter items, soft-substratum macrofauna is less responsive to the addition of novel hard substrates in adjacent sediments. Alternatively, it could be that the impact of littering with small items triggers a macrofauna response detectable in the long-run.

scholarly journals Strategic hospital partnerships: improved access to care and increased epilepsy surgical volume

2018 ◽  
Vol 44 (5) ◽  
pp. E9 ◽  
Author(s):  
Sumeet Vadera ◽  
Alvin Y. Chan ◽  
Lilit Mnatsankanyan ◽  
Mona Sazgar ◽  
Indranil Sen-Gupta ◽  
...  
Keyword(s):  
Access To Care ◽  
Epilepsy Surgery ◽  
Focal Epilepsy ◽  
Surgical Care ◽  
Invasive Monitoring ◽  
Strategic Partnerships ◽  
Significant Difference ◽  
Before And After ◽  
The University ◽  
Improve Patient

OBJECTIVESurgical treatment of patients with medically refractory focal epilepsy is underutilized. Patients may lack access to surgically proficient centers. The University of California, Irvine (UCI) entered strategic partnerships with 2 epilepsy centers with limited surgical capabilities. A formal memorandum of understanding (MOU) was created to provide epilepsy surgery to patients from these centers.METHODSThe authors analyzed UCI surgical and financial data associated with patients undergoing epilepsy surgery between September 2012 and June 2016, before and after institution of the MOU. Variables collected included the length of stay, patient age, seizure semiology, use of invasive monitoring, and site of surgery as well as the monthly number of single-surgery cases, complex cases (i.e., staged surgeries), and overall number of surgery cases.RESULTSOver the 46 months of the study, a total of 104 patients underwent a total of 200 operations; 71 operations were performed in 39 patients during the pre-MOU period (28 months) and 129 operations were performed in 200 patients during the post-MOU period (18 months). There was a significant difference in the use of invasive monitoring, the site of surgery, the final therapy, and the type of insurance. The number of single-surgery cases, complex-surgery cases, and the overall number of cases increased significantly.CONCLUSIONSPartnerships with outside epilepsy centers are a means to increase access to surgical care. These partnerships are likely reproducible, can be mutually beneficial to all centers involved, and ultimately improve patient access to care.

scholarly journals Symptomatic Medial Bone Excrescence in the Distal Phalanx of the Hallux after the First Metatarsophalangeal Joint Arthrodesis: A Case Report and Radiographic Reviews

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yuji Maenohara ◽  
Ryutaro Takeda ◽  
Song Ho Chang ◽  
Yasunori Omata ◽  
Sakae Tanaka ◽  
...  
Keyword(s):  
Case Report ◽  
Metatarsophalangeal Joint ◽  
Distal Phalanx ◽  
First Metatarsophalangeal Joint ◽  
First Case ◽  
Significant Difference ◽  
Before And After ◽  
One Year ◽  
Common Manifestation

Medial bone excrescence at the base of the distal phalanx of the hallux is a common manifestation which is rarely painful. In this case report, we described the first case of the excrescence becoming symptomatic one year after a metatarsophalangeal (MTP) joint arthrodesis of the great toe in a 74-year-old female. The medial bony excrescence which was obscure preoperatively became obvious postoperatively in the anteroposterior foot radiographs. The patient was successfully treated by an excision of the excrescence. In order to clarify the pathology of the excrescence, we reviewed the radiographs with respect to the excrescence before and after hallux surgeries including 97 metatarsal osteotomies and 33 MTP joint arthrodesis. The width of the excrescence measured in the anteroposterior foot radiographs displayed substantial increment one month after the hallux surgeries (osteotomy group: 0.9 ± 0.7 vs. 1.5 ± 0.7   mm , p < 0.01 ; arthrodesis group: 1.3 ± 0.8 vs. 1.8 ± 1.0   mm , p < 0.01 ). However, there was no significant difference in the width of the excrescence between one month after surgery and at the most recent follow-up of around 20 months in average after the surgery (osteotomy group: 1.5 ± 0.7 vs. 1.4 ± 0.7   mm , p = 0.62 ; arthrodesis group: 1.8 ± 1.0 vs. 1.8 ± 0.7   mm , p = 0.37 ). The present case and our radiographic review suggested that the postoperative medial bony excrescence was not the result of change of position of the preexisting excrescence. The correction of pronation deformity through hallux surgeries could emphasize the medial bony excrescence and cause symptomatic irritation upon shoe contact.

Comparison of Hemodynamic and Sedative Effects of Midazolam-Fentanyl and Midazolam-Ketamine Combinations Used in Cardioersion Sedation

2021 ◽  
Author(s):  
Murat Acarel ◽  
Özlem Yıldırımtürk ◽  
Nihan Yapici
Keyword(s):  
Heart Rate ◽  
Intensive Care ◽  
Electrical Cardioversion ◽  
Ramsay Sedation Scale ◽  
Significant Difference ◽  
Sedative Effects ◽  
Before And After ◽  
Blood Pressures ◽  
Adequate Sedation ◽  
One Year

Objective: The aim of the study is to compare the hemodynamic and sedation results of patients who underwent anesthesia for electrical cardioversion (EC) during a one-year period in the coronary intensive care unit, retrospectively. Methods: 60 patients who were administered ketamine or fentanyl in addition to midazolam, which was administered EC for the correction of atrial fibrillation rhythm, were evaluated in terms of the study. According to the sedation applied to the patients, they were divided into two groups as Group F (midazolam-fentanyl) and Group K (midazolam-ketamine). The hemodynamic parameters of the groups before and after the procedure and the sedation data during and after the procedure were compared. Results: The pre-intervention heart rate of the patients was found to be high in Group-F (p<0.05). There was no significant difference between the two groups in terms of systolic and diastolic blood pressures (p>0.05). While heart rate was observed to be statistically higher after the intervention in midazolam-fentanil applied patients, a statistically significant decrease was found in diastolic blood pressures (p<0.05). When Ramsay sedation scale was evaluated; There was no significant difference between the two groups at the 5th, 10th and 15th minutes (p>0.05). Conclusion: It was determined that the combination of midazolam + fentanyl or midzolam + ketamine provided adequate sedation at standard doses and had no adverse effects on hemodynamic and sedation parameters. These results made us think that both protocols can be safely applied for electrical cardioversion sedation in intensive care units.

scholarly journals Cognitive outcomes in meningioma patients undergoing surgery: individual changes over time and predictors of late cognitive functioning

2019 ◽  
Vol 21 (7) ◽  
pp. 911-922 ◽  
Author(s):  
Sophie J M Rijnen ◽  
Ikram Meskal ◽  
Marjan Bakker ◽  
Wouter De Baene ◽  
Geert-Jan M Rutten ◽  
...  
Keyword(s):  
Cognitive Functioning ◽  
Cognitive Performance ◽  
Cognitive Deficits ◽  
Cognitive Rehabilitation ◽  
Cognitive Outcomes ◽  
Cognitive Outcome ◽  
Normative Sample ◽  
Before And After ◽  
Preoperative Predictors ◽  
Over Time

Abstract Background Meningioma patients are known to face cognitive deficits before and after surgery. We examined individual changes in cognitive performance over time and identified preoperative predictors of cognitive functioning 12 months after surgery in a large sample of meningioma patients. Methods Patients underwent neuropsychological assessment (NPA) using CNS Vital Signs 1 day before (T0) and 3 (T3) and 12 (T12) months after surgery. Patients’ sociodemographically corrected scores on 7 cognitive domains were compared with performance of a normative sample using one-sample z tests and chi-square tests of independence. Reliable change indices with correction for practice effects were calculated for individual patients. Linear mixed effects models were used to identify preoperative predictors of performance at T12. Results At T0, 261 patients were assessed, and 229 and 82 patients were retested at T3 and T12, respectively. Patients showed impaired cognitive performance before and after surgery, and although performance improved on the group level, cognitive scores remained significantly lower than in the normative sample up to T12. On the individual level, performance remained stable in the majority of patients. Better preoperative performance, younger age, male sex, and higher educational level predicted better late cognitive performance. Conclusions Meningioma patients face serious and persistent pre- and postsurgical cognitive deficits. A preoperative NPA together with sociodemographic characteristics may provide valuable information on the late cognitive outcome of individual meningioma patients. These results can help to inform patients and clinicians on late cognitive outcomes at an early stage, and emphasizes the importance of presurgical NPA and timely cognitive rehabilitation.

scholarly journals Comparison of Intravitreal Aflibercept and Ranibizumab for Treatment of Myopic Choroidal Neovascularization: One-Year Results—A Retrospective, Comparative Study

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Burak Erden ◽  
Selim Bölükbaşı ◽  
Emine Baş ◽  
Akın Çakır
Keyword(s):  
Choroidal Neovascularization ◽  
Treatment Modalities ◽  
Intravitreal Ranibizumab ◽  
Myopic Choroidal Neovascularization ◽  
Significant Difference ◽  
Intravitreal Aflibercept ◽  
Before And After ◽  
The Mean ◽  
One Year ◽  
Retrospective Comparative Study

Purpose. To compare one-year treatment outcomes of intravitreal aflibercept (IVA) and intravitreal ranibizumab (IVR) for treatment of myopic choroidal neovascularization (mCNV). Methods. The medical records of a total of 30 eyes diagnosed with mCNV and underwent IVA or IVR treatment for a minimum one-year follow-up were studied retrospectively. All the subjects had an axial length >26 mm and received a 1 + PRN (pro re nata) regimen IVA or IVR. Best-corrected visual acuity (BCVA) and central macular thicknesses (CMT) on optical coherence tomography were evaluated before and after treatment. Results. There were 12 eyes in IVA group, with a mean age of 60.0 ± 10.2 years. The mean BCVA significantly improved from baseline 1.54 ± 0.76 to 0.85 ± 0.61 and the mean CMT significantly decreased from baseline 384.3 ± 119.1 μm to 305.9 ± 75.4 μm at Month 12 (p:0.024 and p:0.011, respectively). There were 18 eyes in IVR group, with a mean age of 57.4 ± 13.1 years. The mean BCVA improved from baseline 1.14 ± 0.90 to 1.04 ± 0.93 and the mean CMT significantly decreased from baseline 366.5 ± 102.3 μm to 323.6 ± 103.6 μm at Month 12 after IVR (p:0.345 and p:0.011, respectively). There was no significant difference between the groups in CMT changes in the study period (p:0.178), but IVA resulted in significantly better final visual gain (0.69 versus 0.09; p:0.006). Conclusions. Both IVA and IVR treatment modalities resulted in similar anatomical outcomes but IVA had better visual outcomes in treatment of mCNV.

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