Fatigue in patients with myasthenia gravis. a systematic review of the literature

Myasthenia Gravis (MG) is a chronic autoimmune disease affecting the neuromuscular junction. Although a hallmark of MG is muscle fatigability due to dysfunction of the neuromuscular junction (peripheral fatigue), a large number of MG patients also report symptoms of central fatigue, defined as an experienced lack of energy, physically and/or mentally. We systematically reviewed the literature on all aspects of central fatigue in MG. Results were categorized in 5 domains: prevalence, diagnosis, pathophysiology, treatment or impact. The prevalence of patient-reported fatigue varies between 42 and 82%, which is significantly higher than in control subjects. Fatigue severity is usually assessed with standardized questionnaires, but the choice of questionnaire varies widely between studies. The pathophysiology of fatigue is unknown, but it is strongly associated with depressive symptoms, female gender and disease severity. Fatigue is also highly prevalent in ocular MG and patients in remission, suggesting a multifactorial origin. Fatigued MG patients have a lower quality of life. Pharmacological treatment of MG is associated with improvement of fatigue and promising results have been found with physical and psychological training programs. Fatigue is a highly prevalent symptom of MG with a severe negative impact on quality of life. Physicians treating patients with MG should be aware of this symptom, as it may be treatable with physical or psychological training programs. (c) 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license. ( http://creativecommons.org/licenses/by/4.0/ )Neurological Motor Disorder

Prevalence and associated factors of fatigue in autoimmune myasthenia gravis

Fatigue is usually defined as a subjective perception of lacking energy, mentally or physically, with a difficulty sustaining voluntary activities. It is a common symptom of many diseases and most likely has a multifactorial cause. In myasthenia gravis (MG), fatigue has a high prevalence and is correlated with female sex and disease severity. However, no large scale studies have been performed. Therefore, we aimed to evaluate fatigue in the Dutch participants (n = 420) of the Dutch-Belgian Myasthenia Patient Registry using an online survey. Additional information was obtained on mood, sleep, coping, quality of life, disease severity, physical activities and medication. Severe fatigue was present in 62% with a mean score of 37.1 +/- 13.2 points. Fatigue severity and prevalence increased significantly with disease severity. A positive correlation was found for female gender, BMI, disease severity and depressive symptoms. A negative correlation was found for strenuous physical activities and older age. The strong association with disease severity suggests that fatigue should be recognized as an element of the symptomatology of MG. The observed association between strenuous activity and fatigue and differences in coping style between fatigued and non-fatigued patients warrant future clinical trials on exercise and cognitive behavioral therapy. (C) 2021 The Authors. Published by Elsevier B.V.Neurological Motor Disorder

Evaluation of some important physicochemical properties of starch free grewia gum

Gums obtained by extraction from the inner bark of stems can be found in association with starch, which must be digested in order to obtain a refined polysaccharide isolate. In the present study, grewia gum obtained from the inner bark of the stems of Grewia mollis was shown to co-exist with starch and the effect of starch digestion on the physicochemical properties of the resultant polysaccharide was evaluated. The gum was extracted by maceration of the inner bark in deionized water and isolated by a combination of filtration, centrifugation and finally precipitation with absolute ethanol to produce the crude grewia gum extract (GG). The presence and content of starch in the gum sample was determined followed by enzymatic digestion of the starch using α-amylase (Termamyl 120L) to give a starch-free extract (GGDS). Physicochemical properties of the extracts such as total carbohydrates, total protein, differential sugar composition, NMR, intrinsic viscosity and rheological behaviour of the samples were evaluated. The GG extract had total carbohydrate content of ∼ 60 % out of which 11.8 % was starch, and a protein content of 2.3 %. Samples also contained galacturonic and glucuronic acid which were highly acetylated. Both samples had a higher proportion of galacturonic acid than glucuronic acid and contained rhamnose, arabinose, galactose, glucose and xylose as neutral sugars in varying proportions. Rheological measurements on 2 %w/w dispersions of the extracts show minor differences between both the original extract and the de-starched material but were influenced by changes in pH

Prediction of disease severity in multiple acyl-CoA dehydrogenase deficiency: A retrospective and laboratory cohort study

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Neural correlates of enhanced working-memory performance in dissociative disorder: a functional MRI study.

De samenhang tussen somatische en psychische (dys)functie

Accuracy of patient-reported data for an online patient registry of autoimmune myasthenia gravis and Lambert-Eaton myasthenic syndrome

Disorders of the neuromuscular junction (NMJ) comprise a spectrum of rare diseases causing muscle fatigability and weakness, leading to life-long effects on quality of life. We established the Dutch-Belgian registry for NMJ disorders, based on a unique combination of patient -and physician-reported information. Information on natural course, disease burden, prevalence of complications and comorbidity is collected through patient-reported standardized questionnaires and verified using medical documentation. Currently, the registry contains information of 565 Myasthenia Gravis (MG) patients and 38 Lambert-Eaton myasthenic syndrome (LEMS) patients, constituting approximately 25% (MG) and 80% (LEMS) of patients in the Netherlands. This is a very large registry, with the highest participation rate per capita. In addition to confirming many disease characteristics previously described in the literature, this registry provides several novel insights. The reported rate of potentially corticosteroid-related comorbidity, including hypertension, heart disease, osteoporosis and type 2 diabetes was high, emphasizing the need to commence corticosteroid-sparing immune suppressive treatment as soon as possible. The reported rate of other auto-immune diseases is far higher than previously expected: 27% of MG and 38% of LEMS patients, and a surprisingly high number of MG patients (47%) is unaware of their antibody status. In conclusion, this registry provides a valuable collection of information regarding MG and LEMS disease course. Continuous collection of annual follow-up data will provide further longitudinal insights in disease burden, course and treatment effect. (c) 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )Neurological Motor Disorder

Life support functies van de bodem: operationalisering t.b.v. het biodiversiteitsbeleid

Ter uitvoering van actiepunt NMW1a uit het Strategisch Plan van Aanpak biodiversiteit (SPA; LNV, VROM, V&W, OCW, EZ, BZ, 1995) en als onderdeel van actie N59 uit het NMP-2, is eerder een studie uitgevoerd naar de mogelijkheden om een indicatorsysteem op te stellen voor biodiversiteit van de bodem in relatie tot Life support functies (LSF). In een pilotproject is het indicatorsysteem vervolgens getest binnen de infrastructuur van het Landelijk Meetnet Bodemkwaliteit (LMB). Het indicatorsysteem, en de daaruit af te leiden bodembiologische indicator, bestaat uit een aantal deelindicatoren. De vragen van het onderzoek waren.- kan de gekozen indicatorset worden toegepast in een meetnet; hebben de deelindicatoren van de set voldoende onderscheidend vermogen; kunnen de resultaten worden ingepast in de huidige diagnostische en prognostische gereedschappen van het RIVM (Natuurplanner en EKI).De resultaten en conclusies uit de pilot zijn in dit beleidsgerichte rapport kort beschreven. Een meer gedetailleerde uitwerking van de onderzoeksresultaten verschijnt in het achtergrond-rapport. De pilot heeft aangetoond dat de geselecteerde deelindicatoren gevoelig en onderscheidend zijn voor verschillende combinaties van bodemtype en landgebruik. Als een mogelijke vorm voor het weergeven van de resultaten behaald met de bodembiologische indicator, is een AMOEBE gemaakt voor graslanden op zeeklei. Hierbij is gebruik gemaakt van een gekozen (voorlopige) referentie. De gegevens zijn verder geaggregeerd tot een Bodemkwaliteitsindex (BKX). Op deze wijze zou aan een ecologische bodembeoordeling vorm gegeven kunnen worden. Door systematisch onderzoek aan LSF-deelindicatoren in het Landelijk Meetnet Bodemkwaliteit (40 locaties per jaar) kan in 5 jaar een database opgebouwd worden waarmee responsrelaties voor bodemeigenschappen, systeemeigen- en systeemvreemde stoffen zijn af te leiden. Hiermee kan een LSF-module (prognostisch instrument) worden opgenomen in een decision support systeem als de Natuurplanne

The Galactose Index measured in fibroblasts of GALT deficient patients distinguishes variant patients detected by newborn screening from patients with classical phenotypes

Background: The high variability in clinical outcome of patients with Classical Galactosemia (CG) is poorly understood and underlines the importance of prognostic biomarkers, which are currently lacking. The aim of this study was to investigate if residual galactose metabolism capacity is associated with clinical and biochemical outcomes in CG patients with varying geno- and phenotypes. Methods: Galactose Metabolite Profiling (GMP) was used to determine residual galactose metabolism in fibroblasts of CG patients. The association between the galactose index (GI) defined as the ratio of the measured metabolites [U13C]Gal-1-P/ [13C6]UDP-galactose, and both intellectual and neurological outcome and galactose-1-phosphate (Gal-1-P) levels was investigated. Results: GMP was performed in fibroblasts of 28 patients and 3 control subjects. The GI of the classical phenotype patients (n = 22) was significantly higher than the GI of four variant patients detected by newborn screening (NBS) (p = .002), two homozygous p.Ser135Leu patients (p = .022) and three controls (p = .006). In the classical phenotype patients, 13/18 (72%) had a poor intellectual outcome (IQ < 85) and 6/12 (50%) had a movement disorder. All the NBS detected variant patients (n = 4) had a normal intellectual outcome (IQ ≥ 85) and none of them has a movement disorder. In the classical phenotype patients, there was no significant difference in GI between patients with a poor and normal clinical outcome. The NBS detected variant patients had significantly lower GI levels and thus higher residual galactose metabolism than patients with classical phenotypes. There was a clear correlation between Gal-1-P levels in erythrocytes and the GI (p = .001). Conclusions: The GI was able to distinguish CG patients with varying geno- and phenotypes and correlated with Gal-1-P. The data of the NBS detected variant patients demonstrated that a higher residual galactose metabolism may result in a more favourable clinical outcome. Further research is needed to enable individual prognostication and treatment in all CG patients

Early surgery versus conservative treatment in patients with traumatic intracerebral hematoma:a CENTER-TBI study

Purpose: Evidence regarding the effect of surgery in traumatic intracerebral hematoma (t-ICH) is limited and relies on the STITCH(Trauma) trial. This study is aimed at comparing the effectiveness of early surgery to conservative treatment in patients with a t-ICH. Methods: In a prospective cohort, we included patients with a large t-ICH (&lt; 48 h of injury). Primary outcome was the Glasgow Outcome Scale Extended (GOSE) at 6 months, analyzed with multivariable proportional odds logistic regression. Subgroups included injury severity and isolated vs. non-isolated t-ICH. Results: A total of 367 patients with a large t-ICH were included, of whom 160 received early surgery and 207 received conservative treatment. Patients receiving early surgery were younger (median age 54 vs. 58 years) and more severely injured (median Glasgow Coma Scale 7 vs. 10) compared to those treated conservatively. In the overall cohort, early surgery was not associated with better functional outcome (adjusted odds ratio (AOR) 1.1, (95% CI, 0.6–1.7)) compared to conservative treatment. Early surgery was associated with better outcome for patients with moderate TBI and isolated t-ICH (AOR 1.5 (95% CI, 1.1–2.0); P value for interaction 0.71, and AOR 1.8 (95% CI, 1.3–2.5); P value for interaction 0.004). Conversely, in mild TBI and those with a smaller t-ICH (&lt; 33 cc), conservative treatment was associated with better outcome (AOR 0.6 (95% CI, 0.4–0.9); P value for interaction 0.71, and AOR 0.8 (95% CI, 0.5–1.0); P value for interaction 0.32). Conclusions: Early surgery in t-ICH might benefit those with moderate TBI and isolated t-ICH, comparable with results of the STITCH(Trauma) trial.</p