Pulsatility Index in Aortic Coarctation: A Possible Way to Evaluate Factors Affecting Stenting Outcome

Background: The pulsatility index (PI) shows continuous blood flow to the end organs and is a significant factor believed to decrease in aortic coarctation. Correction of this factor is of great importance in the treatment of stenotic lesions of the aorta. However, there are minimal data regarding the trend of changes in the PI after stent implantation. Furthermore, the association between the PI and other echocardiographic indices in patients undergoing stent implantation is unclear. This study was designed to evaluate changes in the PI following stenting and its correlation with other echocardiographic indices. Methods: Twenty-three patients with a diagnosis of aortic coarctation consecutively underwent two-dimensional and Doppler echocardiographic imaging modalities twice (before and after stenting). The patients were divided into two groups based on the percentage of increase in the PI after stenting ( < 50% or ≥ 50%). The relation between the post-stenting PI and the baseline echocardiographic indices was assessed. Results: The PI was increased from 0.89 (SD = 0.30) to 1.75 (SD = 0.51) after stenting (p value < 0.001). Baseline diastolic/systolic velocity (D/S velocity) ratio of the abdominal aorta (p value = 0.013), mean velocity (p value = 0.033), and peak gradient of the descending aorta (p value = 0.033) were significantly higher in the patients with ≥ 50% increase in the PI after stenting. Conclusion: Our findings showed that elevation in the PI after stenting was a predictable criterion in patients with aortic coarctation: it was predicted by some baseline clinical and echocardiographic indices. Baseline D/S ratio velocity of the abdominal aorta, mean velocity and peak gradient of the descending aorta, and baseline systolic blood pressure were the statistically significant indices to predict ≥ 50% increase in the PI in our patients

Sexual dimorphism in Parkinson&rsquo;s disease: differences in clinical manifestations, quality of life and psychosocial functioning between males and females

Farzaneh Farhadi,1 Kia Vosoughi,1 Gholam Ali Shahidi,2 Ahmad Delbari,3,4 Johan L&ouml;kk,3,5 Seyed-Mohammad Fereshtehnejad3,6,7 1Medical Student Research Committee, 2Movement Disorders Clinic, Department of Neurology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran; 3Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden; 4Iranian Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran; 5Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden; 6Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; 7Firoozgar Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran Introduction: Sex-related differences in clinical manifestations and consequences of Parkinson&rsquo;s disease (PD) have been poorly explored. Better understanding of sexual dimorphism in neurologic diseases such as PD has been announced as a research priority. The aim of our study was to determine independent sex differences in clinical manifestations and subtypes, psychosocial functioning, quality of life (QoL) and its domains between male and female individuals with PD.Patients and methods: A comprehensive list of demographics, motor symptoms and subtypes, nonmotor features, health-related quality of life (HRQoL), psychosocial functioning and general aspects of daily life was assessed in 157 individuals (108 males and 49 females) with idiopathic PD. In order to control for potential confounding variables, we applied Orthogonal Partial Least Squares &ndash; Discriminant Analysis (OPLS-DA) to explore the strength of each feature to discriminate male and female patients with PD.Results: While no sex difference was found in the total Unified Parkinson&rsquo;s Disease Rating Scale (UPDRS) score and cumulative daily dose of levodopa, females had significantly more severe anxiety (mean difference&nbsp;=2.2 [95% confidence interval, CI: 0.5&ndash;4.0], P=0.011), worse nutritional status (23.8 [standard deviation, SD&nbsp;=4.2] vs 25.8 [SD&nbsp;=2.6], P=0.003) and poorer QoL (28.3 [SD&nbsp;=15.7] vs 17.9 [SD&nbsp;=14.2], P&lt;0.001). Based on multivariate discriminant analysis, emotional well-being, bodily discomfort, social support, mobility and communication domains of HRQoL, together with anxiety, depression and psychosocial functioning, were the strongest features with more severe/worse status in females after adjustment for potential statistical confounders.Conclusion: Our study provides a comprehensive understanding of sexual dimorphism in PD. Anxiety, depression, specific domains of HRQoL (mobility, emotional well-being, social support and bodily discomfort) and psychosocial functioning were significantly worse in female individuals with PD. Sexual dimorphism in PD highlights the features that are more likely to be affected in each sex and should be specifically targeted when managing male and female individuals with PD. Keywords: Parkinson&rsquo;s disease, sexual dimorphism, male, female, quality of life, psychosocial functionin

Analysis of Being Active Based on Older Adults’ Experience: A Qualitative Study of Active Aging Strategies

Objectives In recent decades, it has become important to approach aging issues from the point of view that can ensure older adults&rsquo; Quality of Life (QoL). As a result, countries have adopted a positive perspective with regard to aging, including active aging. The fact is that indigenous understanding of active aging is an unavoidable necessity for every society. Thus, the current study&rsquo;s aim was to understand active aging strategies based on older adults&rsquo; experience. Methods & Materials This qualitative study, conducted during 2014-2016, used the Grounded theory method. It was initiated with the help of purposeful sampling and continued by way of applying theoretical sampling. The study field was cultural centers, artistic-cultural associations, and parks of Tehran. Data saturation was achieved through semi-structured interviews carried out among 35 elders. Data were analyzed and coded through coding suggested by the Strauss and Corbin method. Reliability of data was fulfilled in accordance with the Schwandt, Lincoln and Guba criteria.&nbsp; Results Based on the experience of elders, active aging strategies consisted of 41 concepts, 7 subcategories, and 5 main categories. The categories and subcategories included primary strategies of isolation avoidance (not staying at home and interactionism), social participation (including continuity of career roles, volunteerism and institutional participation), strategies of active attitude and learning, physical activity and management of home&rsquo;s time and daily life&nbsp; Conclusion Active aging requires applying strategies in 3 areas: elders&rsquo; attitude, home environment, and society. For active aging in the country, practitioners and social planners need to strictly consider these 3 areas.&nbsp

COVID-19 and Integrated Multidisciplinary Care Model in Parkinson&rsquo;s Disease: Literature Review &amp; Future Perspectives

Clinical diversity and multi-systemic manifestations of Parkinson&rsquo;s disease (PD) necessitate the involvement of several healthcare professionals from different disciplines for optimal care. Clinical guidelines recommend that all persons with PD should have access to a broad range of medical and allied health professionals to implement an efficient and effective multidisciplinary care model. This is well supported by growing evidence showing the benefits of multidisciplinary interventions on improving quality of life and disease progression in PD. However, a &ldquo;multidisciplinary&rdquo; approach requires gathering healthcare professionals from different disciplines into an integrative platform for collaborative teamwork. With the Coronavirus Disease 2019 (COVID-19) pandemic, implementation of such a multidisciplinary care model has become increasingly challenging due to social distancing mandates, isolation and quarantine, clinics cancellation, among others. To address this problem, multidisciplinary teams are developing innovate virtual platforms to maintain care of people with PD. In the present review, we cover aspects on how SARS-CoV-2 has affected people with PD, their caregivers, and care team members. We also review current evidence on the importance of maintaining patient-centered care in the era of social distancing, and how can we utilize telehealth and innovative virtual platforms for multidisciplinary care in PD

Serum neurofilament light chain predicts long term clinical outcomes in multiple sclerosis

Abstract Serum neurofilament light chain (NfL) is emerging as an important biomarker in multiple sclerosis (MS). Our objective was to evaluate the prognostic value of serum NfL levels obtained close to the time of MS onset with long-term clinical outcomes. In this prospective cohort study, we identified patients with serum collected within 5 years of first MS symptom onset (baseline) with more than 15 years of routine clinical follow-up. Levels of serum NfL were quantified in patients and matched controls using digital immunoassay (SiMoA HD-1 Analyzer, Quanterix). Sixty-seven patients had a median follow-up of 18.9 years (range 15.0–27.0). The median serum NfL level in patient baseline samples was 10.1 pg/mL, 38.5% higher than median levels in 37 controls (7.26 pg/mL, p = 0.004). Baseline NfL level was most helpful as a sensitive predictive marker to rule out progression; patients with levels less 7.62 pg/mL were 4.3 times less likely to develop an EDSS score of ≥ 4 (p = 0.001) and 7.1 times less likely to develop progressive MS (p = 0.054). Patients with the highest NfL levels (3rd-tertile, > 13.2 pg/mL) progressed most rapidly with an EDSS annual rate of 0.16 (p = 0.004), remaining significant after adjustment for sex, age, and disease-modifying treatment (p = 0.022). This study demonstrates that baseline sNfL is associated with long term clinical disease progression. sNfL may be a sensitive marker of subsequent poor clinical outcomes

Correlation of hepatic vein doppler waveform and hepatic artery resistance index with the severity of nonalcoholic fatty liver disease

Purpose. The study was conducted to evaluate the effect of various degrees of fatty infiltration in patients with nonalcoholic fatty liver disease on hepatic artery resistance index and hepatic vein waveform patterns. Methods. After identification and grading of fatty infiltration, 60 patients and 20 normal healthy subjects were examined using color and spectral Doppler sonography. The level of fatty liver infiltration was ascertained and graded by biopsy in patients and excluded by MRI in controls. The patients were allocated to four study groups consecutively, until the required number was reached, according to infiltration level as follows: normal (group A), mild (group B), moderate (group C), and severe (group D). The hepatic vein waveforms were classified into the three following groups: triphasic, biphasic, and monophasic waveform. The hepatic artery resistance index was calculated as the mean of three different measurements. Results. The incidence of monophasic and biphasic hepatic vein waveform was 2 (10) for group B, 11 (55) for group C, 16 (80) for group D, and none for group A. The difference in the distribution of triphasic Doppler waveform pattern between the patients and the control group was significant (p < 0.001). Hepatic artery resistance index was 0.81 (60.02), 0.78 (60.03), 0.73 (60.03), and 0.68 (60.05), respectively, in groups A, B, C, and D and was significantly different between groups (p < 0.001).Conclusion. As the severity of nonalcoholic fatty infiltration increases, the incidence of abnormal hepatic vein waveforms increases and hepatic artery resistance index decreases. © 2010 Wiley Periodicals, Inc