Morphological and morphometric features of sacral hiatus and its clinical significance in caudal epidural anesthesia

Background: Caudal epidural block (CEB) failure or complications are not unheard even among experienced anesthesiologists and are usually due to sacral hiatus (SH) anatomy variations. The aim of the present study is to observe, record and analyze important anatomical features of SH and correlate them with potential CEB limitations. Materials and methods: The SH of 155 complete and undamaged Greek adult dry sacra of known sex were included in the study. Three non-metric (shape of SH and location of hiatal apex and base in relation to level of sacral/coccygeal vertebra) and five metric parameters (height of the SH, transverse width of the SH at the base, anteroposterior diameter of the SH at the level of its apex and the distance from the sacral apex and base to the upper border of S2 foramina) were evaluated. Results: Inverted U (34.83%) and inverted V (26.45%) were the commonest shapes. Hiatal apex and base were most commonly related to the level of S4 (78.70%) and S5 vertebra (89.03%), respectively. Mean height, depth and intercornual distance were 19.05±8.65 mm, 5.39±1.84 mm and 12.41±3.16 mm, respectively, whereas mean distance between the upper border of S2 foramen and the apex and base of the sacral hiatus were 46.34 mm and 63.48mm, respectively. Anatomical variations of sacral hiatus that might be responsible for CEB failure, such as elongated SH, absence of SH, complete dorsal wall agenesis of sacral canal and narrowing ( < 3 mm) at the apex of SH were found in 17.43% of sacra (male 10.94% and female 25.22%).  Conclusions: This study suggests a potential risk of failure of CEB in Greek patients, especially in females, which should be kept in mind while giving caudal epidural anesthesia

[Comment] The challenges of planetary mental health in the COVID-19 era.

As the focus of the COVID-19 crisis is gradually taken away from emergency healthcare needs, increased attention is warranted on the psychological impact of the pandemic on a global level. Existing guidance on managing the COVID-19 related distress needs to be better informed by upcoming larger-scale research. Applying e-Health can be useful in dealing with the immediate psychological needs, while developing strategies to identify vulnerable populations and shifting the provision of mental health and social care to community services need to be prioritised when looking at the future. Focusing on global mental health during this universal crisis is an opportunity for promoting a more compassionate and less discriminating society

COVID-19 pandemic and its impact on mental health of healthcare professionals.

In light of the unprecedented public health crisis of the COVID-19 pandemic, it is highly important to acknowledge the psychological impact of this mounting threat on healthcare professionals. Previous experience from smaller scale epidemics and emerging literature around COVID-19 show that the unparalleled amount of stress that healthcare workers are dealing with, is associated with increased psychological morbidities. We have depicted the psychological burden that the COVID-19 pandemic has posed on healthcare professionals in Greece and have reviewed the literature around the effect of previous epidemics on frontline healthcare staff. Moreover, we discuss potential triggers and the need for measures to minimise the psychological pressure on those at the frontline against this biothreat

[Case Report] Stress induced (Takotsubo) cardiomyopathy triggered by the COVID-19 pandemic.

Stress induced (Takotsubo) cardiomyopathy (TC) represents an acute heart failure syndrome triggered by physical or emotional stressors. COVID-19 pandemic has caused an unprecedented health crisis resulting in fear, distress and anxiety, with emerging cardiovascular implications. COVID-19 related stress can act as potential trigger for TC. We present a case of an elderly female who developed TC due to stress surrounding COVID-19

Summarising data and factors associated with COVID-19 related conspiracy theories in the first year of the pandemic: a systematic review and narrative synthesis.

Conspiracy theories can have particularly harmful effects by negatively shaping health-related behaviours. A significant number of COVID-19 specific conspiracy theories emerged in the immediate aftermath of the pandemic outbreak. The aim of this study was to systematically review the literature on conspiracy theories related to COVID-19 during the first year of the pandemic (2020), to identify their prevalence, their determinants and their public health consequences. A comprehensive literature search was carried out in PubMed and PsycINFO to detect all studies examining any conspiracy theory related to COVID-19 between January 1st 2020, and January 10th 2021. Forty-three studies were included with a total of 61,809 participants. Between 0.4 and 82.7% of participants agreed with at least one conspiracy belief. Certain sociodemographic factors (young age, female gender, being non-white, lower socioeconomic status), psychological aspects (pessimism, blaming others, anger) and other qualities (political conservatism, religiosity, mistrust in science and using social media as source of information) were associated with increased acceptance of conspiracy theories. Conspiracy beliefs led to harmful health-related behaviours and posed a serious public health threat. Large-scale collaborations between governments and healthcare organizations are needed to curb the spread of conspiracy theories and their adverse consequences

COVID-19 and its consequences on mental health (Review).

As one year is approaching since the beginning of the Coronavirus disease 2019 (COVID-19) pandemic, it is important to acknowledge the detrimental effect that it is having on mental health at the individual, societal and public health levels. The current review presents the direct and indirect psychological impact of COVID-19 on the general public, as well as on vulnerable groups, including the elderly, the young, healthcare professionals, people with pre-existing mental health issues, those infected by COVID-19, homeless people and refugees. Important findings are discussed in the present review, including the social stigma in older people associated with portraying COVID-19 as the disease of the elderly, and the limited psychological impact of COVID-19 in the severely mentally ill, alongside the response of the mental healthcare systems globally to this unparalleled public health crisis. The important lessons to be learnt so far can help formulate individual mental health recommendations, as well as improved intervention and prevention public health strategies

COVID-19 related stress exacerbates common physical and mental pathologies and affects treatment (Review).

COVID-19 pandemic has caused a global public health emergency resulting in unprecedented individual and societal fear and anxiety. The stress surrounding this biothreat appears to have clinical implications in all aspects of medicine, both in mental and physical health spheres. The impact of COVID-19 related anxiety in Cardiology, Paediatrics, Oncology, Dermatology, Neurology and Mental Health and how it affects treatments is discussed. Moreover, the need for introducing novel communication and therapeutic approaches is highlighted in the new landscape of the COVID-19 era

Association of antipsychotic use with raised eosinophil count.

The current study aimed to assess the possibility of an association between first and second generation antipsychotic medication and raised eosinophil count. A total of 22 in-patients at the psychiatric unit of the University General Hospital 'Attikon', a tertiary hospital, were included in the present study. Patients had received antipsychotic monotherapy and did not have any co-morbidities or require additional treatments. Patients were monitored weekly and their eosinophil count was assessed. One-way ANOVA and summary measures analysis were applied to study the effect of time and medication type on the absolute eosinophil concentration (or relative percentage) for each patient. The differences in mean eosinophil concentrations or relative percentage by patient and time were also assessed. An increase in the absolute concentration and the relative percentage of eosinophils over time was observed in patients receiving Olanzapine, Haloperidol and Aripiprazole. However, there was no difference between individual medications. In conclusion, antipsychotics may be associated with increased eosinophil count over time; however, larger studies involving more patients and a longer follow-up are required to reach a definitive conclusion

Reliability, validity and psychometric properties of the Greek translation of the Major Depression Inventory

BACKGROUND: The Major Depression Inventory (MDI) is a brief self-rating scale for the assessment of depression. It is reported to be valid because it is based on the universe of symptoms of DSM-IV and ICD-10 depression. The aim of the current preliminary study was to assess the reliability, validity and psychometric properties of the Greek translation of the MDI. METHODS: 30 depressed patients of mean age 23.41 (± 5.77) years, and 68 controls patients of mean age 25.08 (± 11.42) years, entered the study. In 18 of them, the instrument was re-applied 1–2 days later and the Translation and Back Translation made. Clinical diagnosis was reached with the use of the SCAN v.2.0 and the International Personality Disorders Examination (IPDE). The Center for Epidemiological Studies-Depression (CES-D) and the Zung Depression Rating Scale (ZDRS) were applied for cross-validation purposes. Statistical analysis included ANOVA, the Spearman Product Moment Correlation Coefficient, Principal Components Analysis and the calculation of Cronbach's α. RESULTS: Sensitivity and specificity were 0.86 and 0.94, respectively, at 26/27. Cronbach's α for the total scale was equal to 0.89. The Spearman's rho between MDI and CES-D was 0.86 and between MDI and ZDRS was 0.76. The factor analysis revealed two factors but the first accounted for 54% of variance while the second only for 9%. The test-retest reliability was excellent (Spearman's rho between 0.53 and 0.96 for individual items and 0.89 for total score). CONCLUSION: The current study provided preliminary evidence concerning the reliability and validity of the Greek translation of the MDI. Its properties are similar to those reported in the international literature, but further research is necessary

Pupillometry in myasthenia gravis

Myasthenia Gravis (MG) is characterized, in its typical form, by autoimmune attack on the postsynaptic nicotinic cholinergic receptors of the skeletal muscles (muscular nicotinic AcetylCholine receptors-mnAChRs). On the other hand, the neuromuscular junctions (NMJ) of the non-striated muscles and the neuronal junctions of the Central Nervous System (CNS) and the Autonomic Nervous System (ANS) are widely considered to remain unaffected in MG. However, a broad range of clinical, neurophysiological, pharmaceutical and serological evidence propose that, apart from the skeletal muscles, the cardiac muscle, the smooth muscles, the CNS and the ANS also participate in the pathophysiology of MG. The aim of the present study that was fully conducted in the Laboratory of Clinical Neurophysiology of the AHEPA University Hospital in Thessaloniki, Greece is to investigate whether or not nonstriated cholinergic junctions are affected in MG. For this purpose the Pupil Light Reflex (PLR) to single and multiple flash stimuli of thirty-four recently diagnosed myasthenic patients, grade II-III according to the MGFA; 2000, was recorded with the assistance of a digital video-camera and the arithmetic values of the PLR parameters were automatically calculated with the aid of a specifically constructed computerized pupillometric program. Furthermore, the estimated arithmetic values were statistically processed and compared with the respective arithmetic values of the PLR parameters to single and multiple flash stimuli of thirty-four non-myasthenic patients, matching age and gender. The study of the PLR is considered ideal for this purpose, due to the broad range of cholinergic junctions that take part in its manifestation, as are the cholinergic junctions of the Edinger-Westphal (EW) nucleus, the preganglionic nicotinic junctions of the ciliary ganglion and the ciliospinal center of Βudge-Waller and the postganglionic muscarinic junctions of the sphincter muscle and the dilator muscle of the iris. The PLR parameters to single flash stimuli of 20 msecs duration and 24.6 candelas/m² intensity that were calculated are: 1. Baseline Pupil Radius after 2 min dark adaptation (R1), 2. Latency for the onset of Constriction (T1), 3. Amplitude of the Reaction (AMP), 4. Maximum Constriction Velocity (VCmax), 5. Maximum Constriction Acceleration (ACmax), 6. Latency of Maximum Constriction (T2), 7. Latency of VCmax (T3), 8. 3.5 secs Percentage Recovery - Redilatation (R%), 9. Constriction Ratio (% AMP) and 10. R2/R1 Ratio (%R2/R1). Likewise, the PLR parameters to multiple flash stimuli of the same intensity and duration that were estimated were the amplitude of the iris radius’ shift to repetitive flash stimuli of: 1. 0.6 Hz, 2. 0.9 Hz, 3. 1.2 Hz, 4. 1.5 Hz, and 5. 1.8 Hz frequency. Furthermore, due to the involvement of the age factor in the Baseline Pupil Radius and the PLR morphology the participants were divided in two age groups, 50 years old, respectively, and the statistical analysis and comparison between myasthenic patients and non-myasthenic volunteers was also conducted for these two age groups. From the statistical comparison it is evidenced that, for the approved level of significance (p=.05), the mean scores of T1, T2, T3 and % R2/R1 variables were significantly increased in the myasthenic subjects compared to the non-myasthenic subjects. Conversely, the mean scores of AMP, VCmax, ACmax, %AMP and all five variables that outline the PLR to multiple flash stimuli were significantly decreased in the myasthenic group compared to the non-myasthenic group. Finally, there was no significant difference between the two groups for R1 and R% variables. Due to the fact that the PLR parameters that differ significantly between the myasthenic and the non-myasthenic subjects correspond to the integrity of the cholinergic part of the PLR, it is assumed that the cholinergic junctions of the PLR are affected in MG. This assumption is amplified by the absence of statistically significant difference between myasthenic and non-myasthenic subjects concerning R1 and %R variables, which correspond to the integrity of the inhibitory noradrenergic impulses that reach the EW nucleus and should remain unaffected in a disease that exclusively affects the cholinergic junctions, such as MG. The aforementioned supposition is further boosted by the strict selection of both the recently diagnosed myasthenic patients and the non-myasthenic volunteers, who did not suffer from any other pathological condition or were under any kind of medication that could interfere with the PLR manifestation. For the same reason all participants had no past history of ocular operations and had unimpaired retina, as evidenced by a normal F-ERG. Likewise, this assumption is bolstered by the correspondence of the applied pupillometric procedure to the standards of the pupillometric investigations used internationally. Furthermore, due to the epidemiological resemblance, concerning age and gender, between the myasthenic patients that were included in this study and those of the general population, the results of this study may describe with great accuracy the PLR to single and multiple flash stimuli of the patients that suffer from MG, generally. It is also proposed that pupillometric measurements to single and multiple flash stimuli may be applied in the diagnosis of MG. More specifically, from the evaluated variables of the PLR, ACmax proved to have the highest sensitivity in discriminating statistically the whole sample into myasthenic and non-myasthenic groups without any misclassifications, in both age groups. Likewise, VCmax and Τ2 could perfectly discriminate statistically the whole sample into myasthenic and non-myasthenic groups without any misclassifications in the age group 50, respectively. This finding suggests that ACmax, especially, VCmax and Τ2 may be extremely useful in the diagnosis of MG. Furthermore, the table formation of the normal values for the PLR parameters can indicate, after a pupillometric test that is applied to an individual that is investigated for MG, whether an arithmetic value of a PLR variable is considered normal or not. Besides that, the chance of the whole PLR test to be considered pathologic is analogous to the estimated quantity of abnormal arithmetic values of the PLR parameters. However, based on the fact that abnormal PLR arithmetic values can be found in a broad range of pathologic conditions and after treatment with various medications, the aforementioned statement does not imply that any patient with abnormal PLR arithmetic values is myasthenic. This being the case it is suggested that pupillometry can be used in the diagnosis of MG, in combination with the widely applied diagnostic tests for MG, having the advantage that it comprises an easily applied, low-cost, non-invasive technique.Η Βαριά Μυασθένεια (ΒΜ) χαρακτηρίζεται από αυτοάνοση προσβολή των µετασυναπτικών νικοτινικών υποδοχέων της Ακετυλοχολίνης των σκελετικών µυών (muscular nicotinic AcetylCholine receptors-mnAChRs), ενώ τόσο οι Νευροµυϊκές Συνάψεις (ΝΜΣ) των µη γραµµωτών µυών όσο και οι νευρωνο-νευρωνικές συνάψεις του Κεντρικού Νευρικού Συστήµατος (ΚΝΣ) και του Αυτόνοµου Νευρικού Συστήµατος (ΑΝΣ) θεωρείται πως παραµένουν ανεπηρέαστες. Παρά ταύτα, κλινικά, νευροφυσιολογικά, φαρµακευτικά και ορολογικά ευρήµατα υποδεικνύουν τη συµµετοχή στην παθοφυσιολογία της συγκεκριµένης νόσου αφενός του καρδιακού µυός και των λείων µυών, αφετέρου του ΚΝΣ και του ΑΝΣ. Στόχο της παρούσας έρευνας, η οποία άρχισε και ολοκληρώθηκε στο Εργαστήριο Κλινικής Νευροφυσιολογίας του Πανεπιστηµιακού Νοσοκοµείου ΑΧΕΠΑ, αποτελεί η διερεύνηση της εµπλοκής µη σκελετικών χολινεργικών συνάψεων στη ΒΜ. Ο σκοπός αυτός πραγµατοποιείται µε δύο τρόπους: Πρώτο, δια της καταγραφής, µε τη χρήση ειδικής ψηφιακής video-κάµερας, του Αντανακλαστικού της Κόρης στο Φως (ΑΚΦ) - σε µονήρη και σε επαναλαµβανόµενα φωτεινά ερεθίσµατα - τριαντατεσσάρων ασθενών µε προσφάτως διαγνωσµένη ΒΜ, κατηγορίας ΙΙ-ΙΙΙ κατά την MGFA; 2000, και δια του ηλεκτρονικού υπολογισµού των αριθµητικών τιµών των παραµέτρων του ΑΚΦ καθενός από τους µυασθενικούς, µε την αρωγή εξειδικευµένου κορηµετρικού ηλεκτρονικού προγράµµατος. ∆εύτερο, αφετέρου δια της στατιστικής ανάλυσης και σύγκρισης των εξαγόµενων αποτελεσµάτων µε τα αντίστοιχα που προκύπτουν από την οµότροπη καταγραφή του ΑΚΦ σε µονήρη και σε επαναλαµβανόµενα φωτεινά ερεθίσµατα ισάριθµων εθελοντών, ανάλογης ηλικίας και φύλου, που συγκροτούν την οµάδα ελέγχου. Η µελέτη του ΑΚΦ θεωρείται ιδανική για τον παραπάνω στόχο, λόγω της πληθώρας των χολινεργικών συνάψεων που συµµετέχουν στην ευόδωση του ΑΚΦ, όπως είναι οι κεντρικές συνάψεις του πυρήνα Edinger-Westphal (EW), οι προγαγγλιακές νικοτινικές συνάψεις του ακτινωτού γαγγλίου και του κέντρου Βudge-Waller και οι µεταγαγγλιακές µουσκαρινικές συνάψεις του σφιγκτήρα και του διαστολέα µυ της κόρης του οφθαλµού. Οι παράµετροι του ΑΚΦ σε µονήρη φωτεινά ερεθίσµατα, έντασης 24.6 candelas/m² και διάρκειας 20 milliseconds, οι οποίες εκτιµήθηκαν στο σύνολο των εξεταζοµένων ήταν: 1. Η Αρχική Ακτίνα της κόρης µετά από δίλεπτη παραµονή στο σκοτάδι (R1), 2. ο Λανθάνοντας Χρόνος Αντίδρασης (Τ1), 3. το Εύρος της Αντίδρασης (AMP), 4. η Μέγιστη Ταχύτητα Μύσης (VCmax), 5. η Μέγιστη Επιτάχυνση Μύσης (ACmax), 6. ο Λανθάνοντας Χρόνος µέχρι τη Μέγιστη Μύση (Τ2), 7. ο Λανθάνοντας Χρόνος µέχρι την επίτευξη της VCmax (Τ3), 8. το Ποσοστό Επαναφοράς-Επαναδιαστολής της κόρης µετά την πάροδο των 3.5 δευτερολέπτων, που διαρκεί η καταγραφή της video-κάµερας (R%), 9. η αναλογία AMP/R1 (%ΑΜΡ) και 10. η αναλογία R2/R1x100 (%R2/R1) Επίσης, οι παράµετροι του ΑΚΦ σε επαναλαµβανόµενα φωτεινά ερεθίσµατα, όµοιας έντασης και διάρκειας µ’ εκείνες της προηγούµενης δοκιµασίας, οι οποίες εκτιµήθηκαν στο σύνολο των εξεταζοµένων ήταν το εύρος της µεταβολής της ακτίνας της κόρης σε φωτεινά ερεθίσµατα συχνότητας: 1. 0,6 Hz, 2. 0,9 Hz, 3. 1,2 Hz, 4. 1,5 Hz, και 5. 1,8 Hz. Η διάρκεια της λήψης της video-κάµερας ήταν 5.5 δευτερόλεπτα για καθεµία από τις επιµέρους συχνότητες ερεθισµάτων. Για την εξαγωγή πιο αξιόπιστων συµπερασµάτων, οι εξεταζόµενοι κατανεµήθηκαν σε δύο ηλικιακές οµάδες, 50 ετών, ενώ συγκρίθηκαν στατιστικά τα αποτελέσµατα των µυασθενικών και των υγιών και στις επιµέρους ηλικιακές οµάδες, ώστε να εξαλειφτεί, κατά το δυνατότερο, η επίδραση του παράγοντα της ηλικίας. Τούτο θα συνέβαινε κατά τη σύγκριση ανόµοιων ηλικιακά πληθυσµών, καθώς ο συγκεκριµένος παράγοντας επηρεάζει τόσο την αρχική διάµετρο όσο και τη µορφολογία του ΑΚΦ. Τα συγκριτικά αποτελέσµατα των παραµέτρων του ΑΚΦ, για το προεπιλεγµένο επίπεδο της στατιστικής σηµαντικότητας (p=.05), υπέδειξαν στατιστικά σηµαντικές διαφορές µεταξύ µυασθενικών και µη µυασθενικών, τόσο συνολικά όσο και στις επιµέρους ηλικιακές οµάδες, όσον αφορά αφενός τις παραµέτρους Τ1, AMP, VCmax, ACmax, Τ2, Τ3, %ΑΜΡ και %R2/R1 - οι οποίες περιγράφουν το ΑΚΦ σε µονήρη φωτεινά ερεθίσµατα - αφετέρου το σύνολο των εξεταζοµένων παραµέτρων που χαρακτηρίζουν το ΑΚΦ σε επαναλαµβανόµενα φωτεινά ερεθίσµατα. Εξάλλου, δεν βρέθηκαν στατιστικά σηµαντικές διαφορές µεταξύ των δύο συγκρινόµενων οµάδων, σχετικά µε τις παραµέτρους R1 και R% του ΑΚΦ σε µονήρη φωτεινά ερεθίσµατα. Λαµβάνοντας υπόψη ότι οι παράµετροι του ΑΚΦ, οι οποίες διαφέρουν µεταξύ µυασθενικών και υγιών, εκφράζουν την ακεραιότητα του χολινεργικού σκέλους του ΑΚΦ, γίνεται αντιληπτό πως τα εξαγόµενα συγκριτικά αποτελέσµατα υποδεικνύουν τη συµµετοχή των χολινεργικών συνάψεων του ΑΚΦ στην παθοφυσιολογία της ΒΜ. Η διαπίστωση αυτή επαληθεύεται από την απουσία στατιστικά ανευρισκόµενων διαφορών µεταξύ µυασθενικών και υγιών όσον αφορά τις παραµέτρους R1 και R%. Οι τελευταίες εκφράζουν την επάρκεια των ανασταλτικών νοραδρενεργικών ώσεων προς τον πυρήνα EW και, για το λόγο αυτό, όπως είναι αναµενόµενο, παραµένουν αµετάβλητες σε ένα νόσηµα που επηρεάζει αποκλειστικά τις χολινεργικές συνάψεις, όπως είναι η ΒΜ. Η πιο πάνω διαπίστωση ενισχύεται από την αυστηρή επιλογή του δείγµατος τόσο των ασθενών µε προσφάτως διαγνωσµένη ΒΜ όσο και των µη µυασθενικών της οµάδας ελέγχου, οι οποίοι δεν έπασχαν από άλλη νευρολογική, οφθαλµολογική, παθολογική ή ψυχική νόσο που θα µπορούσε να επηρεάσει το ΑΚΦ, είχαν οπτική οξύτητα 20/20 και ακέραιο αµφιβληστροειδή, ενώ δε βρίσκονταν υπό φαρµακευτική αγωγή µε φαρµακευτικές ουσίες που επιδρούν στο ΑΚΦ. Η ίδια διαπίστωση ενισχύεται από την αξιοπιστία της πειραµατικής διεργασίας που εφαρµόστηκε, η οποία πληρεί τις προϋποθέσεις των χρησιµοποιούµενων, διεθνώς, κορηµετρικών εξετάσεων. Τέλος, τα αποτελέσµατα της παρούσας έρευνας περιγράφουν µε µεγάλη ακρίβεια την αντίδραση της κόρης του γενικότερου πληθυσµού των µυασθενικών στα εφαρµοζόµενα φωτεινά ερεθίσµατα. Κι αυτό γιατί η στατιστική ποιότητα του εξεταζόµενου δείγµατος των µυασθενικών, όσον αφορά την ηλικιακή και την από άποψη φύλου σύνθεσή του, ήταν ιδιαίτερα υψηλή, καθώς προσεγγίζει τα αντίστοιχα επιδηµιολογικά δεδοµένα που ισχύουν για το γενικότερο πληθυσµό των µυασθενικών. Πέρα από την υπόδειξη της προσβολής του ΑΚΦ στη ΒΜ, προτείνεται η εφαρµογή της δοκιµασίας των µονήρων και των επαναλαµβανόµενων φωτεινών ερεθισµάτων και για τη διάγνωση της συγκεκριµένης νόσου. Ειδικότερα, από τις εκτιµώµενες παραµέτρους του ΑΚΦ, σε αµφότερες τις δοκιµασίες, την υψηλότερη ευαισθησία, όσον αφορά την ικανότητα εντοπισµού των µυασθενικών, παρουσιάζουν οι παράµετροι ACmax, ανεξαρτήτως ηλικιακής οµάδας, VCmax, στην ηλικιακή οµάδα 50 ετών. Τούτο σηµαίνει πως οι συγκεκριµένες παράµετροι είναι δυνατό να χρησιµοποιηθούν στη διάγνωση της ΒΜ. Επιπροσθέτως, µε την κατάρτιση πίνακα φυσιολογικών τιµών των παραµέτρων του ΑΚΦ, είναι δυνατό να εκτιµηθεί - µετά από πραγµατοποίηση κορηµετρικής εξέτασης σε άτοµο που διερευνάται για ΒΜ - κατά πόσο µια εξαγόµενη αριθµητική τιµή, από τις παραµέτρους του ΑΚΦ, είναι φυσιολογική ή παθολογική. Επιπλέον, η πιθανότητα νόσησης του εκάστοτε εξεταζόµενου αυξάνεται αναλογικά µε το συνολικό αριθµό των εξαγόµενων παθολογικών αριθµητικών τιµών των παραµέτρων του ΑΚΦ. Οι παραπάνω διαπιστώσεις δεν σηµαίνουν, πάντως, πως κάθε εξεταζόµενος µε παθολογικές τιµές των παραµέτρων του ΑΚΦ είναι µυασθενικός. Κι αυτό γιατί ανάλογα αποτελέσµατα ανευρίσκονται και σε άλλες ασθένειες καθώς και µετά από χορήγηση φαρµακευτικών σκευασµάτων που επηρεάζουν τις παραµέτρους του ΑΚΦ. Συνεπώς, µόνο επί παρουσίας κλινικής συµπτωµατολογίας ενδεικτικής για ΒΜ, προτείνεται η χρήση της δοκιµασίας των µονήρων και των επαναλαµβανόµενων φωτεινών ερεθισµάτων, στη διαγνωστική προσέγγιση της ΒΜ, σε συνδυασµό µε τις υπάρχουσες διαγνωστικές εξετάσεις. Ας σηµειωθεί ότι οι κορηµετρικές δοκιµασίες πλεονεκτούν στο γεγονός ότι αποτελούν ταχείες, χαµηλού κόστους, µη επεµβατικές εργαστηριακές εξετάσεις