132 research outputs found

    Post Stroke Depression

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    Depression is the most common neuropsychiatric disorder affecting over one third of all stroke patients. The presence of depression after a stroke greatly affects the ability of patients to participate in rehabilitation and can even affect their long-term mortality. Poststroke depression is a well-documented and studied aspect of stroke management because of the implications it has on morbidity, mortality and recovery. Despite post stroke depression being a well-studied phenomenon, it remains underdiagnosed. The development of poststroke depression is multifactorial and has been evaluated from the cellular, genetic, and environmental perspective. Using numerous studies this chapter will review facets of post stroke depression such as epidemiology, etiology and treatment, while evaluating how this phenomena effects patient recovery and rehabilitation

    Randomized double-blind study comparing the efficacy and safety of lamotrigine and amitriptyline in painful diabetic neuropathy

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    WSTĘP. Celem niniejszej pracy było porównanie skuteczności oraz bezpieczeństwa stosowania lamotryginy i amitryptyliny w opanowywaniu przewlekłego bólu spowodowanego obwodową neuropatią u chorych na cukrzycę. MATERIAŁ I METODY. Badanie kliniczne z randomizacją przeprowadzono w układzie naprzemiennym metodą podwójnie ślepej próby, z grupą kontrolną otrzymującą terapię standardową. W badaniu wzięły udział 53 osoby. Zastosowano różne dawki leków. Amitryptylinę stosowano w 3 dawkach doustnie: 10, 25 lub 50 mg, jednorazowo na noc przez 2 tygodnie, a lamotryginę - doustnie, 2 × na dobę, w 3 dawkach: 25, 50 lub 100 mg; każdą z dawek stosowano przez 2 tygodnie. Między zamianą leków zastosowano 2-tygodniową przerwę, podczas której chorzy otrzymywali placebo. Oceniano wpływ terapii na zmniejszenie bólu, ogólne polepszenie stanu zdrowia oraz wystąpienie działań niepożądanych. WYNIKI. W ogólnej ocenie pacjentów zniesienie bólu w dużym, umiarkowanym i małym stopniu zanotowano odpowiednio u 19 (41%), 6 (13%) i 7 (15%) osób przyjmujących lamotryginę oraz u 13 (28%), 5 (11%) i 15 (33%) osób stosujących amitryptylinę. Ogólna ocena przeprowadzona przez pacjentów i lekarzy, kwestionariusz McGilla i skala bólu Likerta nie wykazały różnic istotnych statystycznie. Poprawę obserwowano już po 2 tygodniach stosowania obu leków. Odnotowano 44 przypadki działań niepożądanych, 33 (75%) dotyczyły amitryptyliny, z czego najczęściej stwierdzano działanie nasenne (19 pacjentów, 43%); 11 przypadków (25%) dotyczyło lamotryginy, najczęściej była to wysypka (3 chorych, 7%) i podwyższenie stężenia kreatyniny (4 osoby, 9%). Preferowana dawka lamotryginy to 25 mg 2 × na dobę. WNIOSKI. Mimo że wykazano niewiele różnic w skuteczności obu leków, wybór lamotryginy w dawce 25 mg 2 × na dobę wydaje się lepszy, ze względu na mniejszą liczbę działań niepożądanych wywołanych w badanej populacji.AIMS. To compare the efficacy and safety of lamotrigine and amitriptyline in controlling chronic painful peripheral neuropathy in diabetic patients. METHODS. A randomized, double-blind, crossover, active-control, clinical trial with variable dose titration was carried out (n = 53). Amitriptyline orally, at doses of 10, 25 and 50 mg at night-time, each dose for 2 weeks, and lamotrigine orally, at doses of 25, 50 and 100 mg twice daily, each dose for 2 weeks, by optional titration were used. There was a placebo washout period for 2 weeks between the two drugs. Assessment for pain relief, overall improvement and adverse events were carried out. RESULTS. Good, moderate and mild pain relief were noted in 19 (41%), six (13%) and seven (15%) patients on lamotrigine and 13 (28%), five (11%) and 15 (33%) patients on amitriptyline, respectively, by patient’s global assessment of efficacy and safety. Patient and physicians global assessment, McGill pain questionnaire and Likert pain scale showed no significant difference between the treatments, although improvement with both treatments was seen from 2 weeks. Of the 44 adverse events reported, 33 (75%) were with amitriptyline, sedation being the commonest [in 19 (43%) patients]. Lamotrigine caused adverse events in 11 (25%), of which rash in three (7%) and elevations of creatinine in four (9%) were the most common. The preferred lamotrigine dose was 25 mg twice daily. CONCLUSIONS. As there are few differences between the two treatments in efficacy, lamotrigine 25 mg twice daily might be the first choice as it is associated with fewer adverse effects in our population

    The value of spot urinary creatinine as a marker of muscle wasting in patients with new-onset or worsening heart failure

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    Background: Muscle wasting and unintentional weight loss (cachexia) have been associated with worse outcomes in heart failure (HF), but timely identification of these adverse phenomena is difficult. Spot urinary creatinine may be an easily accessible marker to assess muscle loss and cachexia. This study investigated the association of urinary creatinine with body composition changes and outcomes in patients with new‐onset or worsening HF (WHF). Methods: In BIOSTAT‐CHF, baseline spot urinary creatinine measurements were available in 2315 patients with new‐onset or WHF in an international cohort (index cohort) and a validation cohort of 1431 similar patients from Scotland. Results: Median spot urinary creatinine concentrations were 5.2 [2.7–9.6] mmol/L in the index cohort. Median age was 69 ± 12 years and 73% were men. Lower spot urinary creatinine was associated with older age, lower height and weight, worse renal function, more severe HF, and a higher risk of >5% weight loss from baseline to 9 months (odds ratio = 1.23, 95% CI = 1.09–1.39 per log decrease; P = 0.001). Spot urinary creatinine was associated with Evans criteria of cachexia (OR = 1.26 per log decrease, 95% CI = 1.04–1.49; P = 0.016) and clustered with markers of heart failure severity in hierarchical cluster analyses. Lower urinary creatinine was associated with poorer exercise capacity and quality of life (both P < 0.001) and predicted a higher rate for all‐cause mortality [hazard ratio (HR) = 1.27, 95% CI = 1.17–1.38 per log decrease; P < 0.001] and the combined endpoints HF hospitalization or all‐cause mortality (HR = 1.23, 95% CI = 1.15–1.31 per log decrease; P < 0.001). Significance was lost after addition of the BIOSTAT risk model. Analyses of the validation cohort yielded similar findings. Conclusions: Lower spot urinary creatinine is associated with smaller body dimensions, renal dysfunction, and more severe HF in patients with new‐onset/WHF. Additionally, lower spot urinary creatinine is associated with an increased risk of weight loss and a poorer exercise capacity/quality of life. Urinary creatinine could therefore be a novel, easily obtainable marker to assess (risk of) muscle wasting in HF patients

    Impact of discontinuity in health insurance on resource utilization

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    <p>Abstract</p> <p>Background</p> <p>This study sought to describe the incidence of transitions into and out of Medicaid, characterize the populations that transition and determine if health insurance instability is associated with changes in healthcare utilization.</p> <p>Methods</p> <p>2000-2004 Medical Expenditure Panel Survey (MEPS) was used to identify adults enrolled in Medicaid at any time during the survey period (n = 6,247). We estimate both static and dynamic panel data models to examine the effect of health insurance instability on health care resource utilization.</p> <p>Results</p> <p>We find that, after controlling for observed factors like employment and health status, and after specifying a dynamic model that attempts to capture time-dependent unobserved effects, individuals who have multiple transitions into and out of Medicaid have higher emergency room utilization, more office visits, more hospitalizations, and refill their prescriptions less often.</p> <p>Conclusions</p> <p>Individuals with more than one transition in health insurance status over the study period were likely to have higher health care utilization than individuals with one or fewer transitions. If these effects are causal, in addition to individual benefits, there are potentially large benefits for Medicaid programs from reducing avoidable insurance instability. These results suggest the importance of including provisions to facilitate continuous enrollment in public programs as the United States pursues health reform.</p

    Patterns of perceived barriers to medical care in older adults: a latent class analysis

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    <p>Abstract</p> <p>Background</p> <p>This study examined multiple dimensions of healthcare access in order to develop a typology of perceived barriers to healthcare access in community-dwelling elderly. Secondary aims were to define distinct classes of older adults with similar perceived healthcare access barriers and to examine predictors of class membership to identify risk factors for poor healthcare access.</p> <p>Methods</p> <p>A sample of 5,465 community-dwelling elderly was drawn from the 2004 wave of the Wisconsin Longitudinal Study. Perceived barriers to healthcare access were measured using items from the Group Health Association of America Consumer Satisfaction Survey. We used latent class analysis to assess the constellation of items measuring perceived barriers in access and multinomial logistic regression to estimate how risk factors affected the probability of membership in the latent barrier classes.</p> <p>Results</p> <p>Latent class analysis identified four classes of older adults. Class 1 (75% of sample) consisted of individuals with an overall low level of risk for perceived access problems (No Barriers). Class 2 (5%) perceived problems with the availability/accessibility of healthcare providers such as specialists or mental health providers (Availability/Accessibility Barriers). Class 3 (18%) perceived problems with how well their providers' operations arise organized to accommodate their needs and preferences (Accommodation Barriers). Class 4 (2%) perceived problems with all dimension of access (Severe Barriers). Results also revealed that healthcare affordability is a problem shared by members of all three barrier groups, suggesting that older adults with perceived barriers tend to face multiple, co-occurring problems. Compared to those classified into the No Barriers group, those in the Severe Barrier class were more likely to live in a rural county, have no health insurance, have depressive symptomatology, and speech limitations. Those classified into the Availability/Accessibility Barriers group were more likely to live in rural and micropolitan counties, have depressive symptomatology, more chronic conditions, and hearing limitations. Those in the Accommodation group were more likely to have depressive symptomatology and cognitive limitations.</p> <p>Conclusions</p> <p>The current study identified a typology of perceived barriers in healthcare access in older adults. The identified risk factors for membership in perceived barrier classes could potentially assist healthcare organizations and providers with targeting polices and interventions designed to improve access in their most vulnerable older adult populations, particularly those in rural areas, with functional disabilities, or in poor mental health.</p

    A CHIME/FRB Study of Burst Rate and Morphological Evolution of the Periodically Repeating FRB 20180916B

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    FRB 20180916B is a repeating fast radio burst (FRB) with a 16.3 day periodicity in its activity. In this study, we present morphological properties of 60 FRB 20180916B bursts detected by CHIME/FRB between 2018 August and 2021 December. We recorded raw voltage data for 45 of these bursts, enabling microseconds time resolution in some cases. We studied variation of spectro-temporal properties with time and activity phase. We find that the variation in dispersion measure (DM) is ≲1 pc cm−3 and that there is burst-to-burst variation in scattering time estimates ranging from ∼0.16 to over 2 ms, with no discernible trend with activity phase for either property. Furthermore, we find no DM and scattering variability corresponding to the recent change in rotation measure from the source, which has implications for the immediate environment of the source. We find that FRB 20180916B has thus far shown no epochs of heightened activity as have been seen in other active repeaters by CHIME/FRB, with its burst count consistent with originating from a Poissonian process. We also observe no change in the value of the activity period over the duration of our observations and set a 1σ upper limit of 1.5 × 10−4 day day−1 on the absolute period derivative. Finally, we discuss constraints on progenitor models yielded by our results, noting that our upper limits on changes in scattering and DM as a function of phase do not support models invoking a massive binary companion star as the origin of the 16.3 day periodicity.</p

    T-cell regulation in Erythema Nodosum Leprosum.

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    Leprosy is a disease caused by Mycobacterium leprae where the clinical spectrum correlates with the patient immune response. Erythema Nodosum Leprosum (ENL) is an immune-mediated inflammatory complication, which causes significant morbidity in affected leprosy patients. The underlying cause of ENL is not conclusively known. However, immune-complexes and cell-mediated immunity have been suggested in the pathogenesis of ENL. The aim of this study was to investigate the regulatory T-cells in patients with ENL. Forty-six untreated patients with ENL and 31 non-reactional lepromatous leprosy (LL) patient controls visiting ALERT Hospital, Ethiopia were enrolled to the study. Blood samples were obtained before, during and after prednisolone treatment of ENL cases. Peripheral blood mononuclear cells (PBMCs) were isolated and used for immunophenotyping of regulatory T-cells by flow cytometry. Five markers: CD3, CD4 or CD8, CD25, CD27 and FoxP3 were used to define CD4+ and CD8+ regulatory T-cells. Clinical and histopathological data were obtained as supplementary information. All patients had been followed for 28 weeks. Patients with ENL reactions had a lower percentage of CD4+ regulatory T-cells (1.7%) than LL patient controls (3.8%) at diagnosis of ENL before treatment. After treatment, the percentage of CD4+regulatory T-cells was not significantly different between the two groups. The percentage of CD8+ regulatory T-cells was not significantly different in ENL and LL controls before and after treatment. Furthermore, patients with ENL had higher percentage of CD4+ T-ells and CD4+/CD8+ T-cells ratio than LL patient controls before treatment. The expression of CD25 on CD4+ and CD8+ T-cells was not significantly different in ENL and LL controls suggesting that CD25 expression is not associated with ENL reactions while FoxP3 expression on CD4+ T-cells was significantly lower in patients with ENL than in LL controls. We also found that prednisolone treatment of patients with ENL reactions suppresses CD4+ T-cell but not CD8+ T-cell frequencies. Hence, ENL is associated with lower levels of T regulatory cells and higher CD4+/CD8+ T-cell ratio. We suggest that this loss of regulation is one of the causes of ENL
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