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Pooled basic safety analysis involving zanubrutinib monotherapy in people along with B-cell malignancies.
A computed tomography scan of the head in the acute phase is essential to try to clarify its causation. NMU Calcium emboli are an under-diagnosed cause of stroke and occur spontaneously in a large proportion of cases. If calcium embolism is suspected, a study must be conducted in search of a carotid, valvular or aortic arch pathology. Migration of the arterial hyperdensity towards distal is associated with a better prognosis. This case presented good progress in contrast to the poor prognosis described in the literature in cases of arterial hyperdensity as an early marker of stroke in the acute phase.Introduction Myotonic dystrophy type 1 (MD1), or Steinert's disease, is a multisystemic disorder of autosomal dominant inheritance, whose adult variant usually presents with multidomain cognitive impairment and affects patients' functionality and quality of life. Aim To study the four-year history of cognitive functioning in a sample of patients with the adult variant of MD1. Patients and methods The neurocognitive functions of a sample of 31 patients with MD1 are evaluated, of whom 24 repeat the test administered four years ago in the Neurology Service of the Complejo Hospitalario of Navarra. Data are collected from the cognitive domains that are most related to the deficits that usually present in MD1. Results The follow-up evaluation found that the visuospatial and visuoconstructive functions and alternating attention of the patients who underwent the study were affected, as was their daily functioning reported by the family. These results are in line with those obtained four years earlier, with no significant deterioration observed between the two measurements. A higher incidence of cognitive impairment was also displayed in 2018, with some cases of progression to dementia in Steinert's disease. Conclusion Neurocognitive progression in MD1 seems to respond to a progressive pattern of degeneration, linked to the functions that are most affected from the beginning of the sequelae phase and which usually correspond to the domains of working memory, alternating attention, and visuospatial and visuoconstructive abilities.Aim To systematically review all the literature, focusing on instrumental quantitative assessment of voice in patients with Parkinson's disease (PD). Furthermore, a meta-analysis was performed to identify the main characteristics of voice disturbances in PD. Patients and methods Literature searches with the keywords «Parkinson» and «voice» were conducted in PubMed, EMBASE, Cochrane Library and Web of Science. Main inclusion criteria were clinically confirmed PD and instrumented measurement of voice parameters with acoustic analysis of voice. Results Fourteen publications met the inclusion criteria and were included in the meta-analysis. The data within the meta-analysis revealed that several voice parameters including jitter, shimmer and fundamental frequency variation presented significant variations between patients with EP and healthy controls. Significant variations of fundamental frequency, maximum phonation time, harmonic to noise ratio, standard deviation of fundamental frequency were observed, but with a high heterogeneity between the studies. On the other hand, significant variations of noise to harmonic ratio, s/z ratio, variation of amplitude were not observed. Conclusion Acoustic analysis of voice, using an electronic system, allows the identification of changes in voice parameters for predicting the worsening of disease and for targeting specific intervention. Among the voice parameters, jitter and shimmer significantly increased in patients with PD.Background purpose Moyamoya syndrome is the progressive stenosis of intracranial carotids with secondary collateralization. Whole body cryotherapy (WBC) involves external cooling and is used in holistic and sports medicine, its neurologic effects are unknown. Case report We report a first case of symptoms of moyamoya syndrome presenting following WBC and diagnosed with classic MRI ( "Brush Sign", "Ivy sign") and digital subtracted angiography. Conclusion WBC may provoke symptoms of moyamoya syndrome possibly through hyperventilation or vasoconstriction. Practitioners should be aware of possible consequences of WBC in patients with poor cerebrovascular reserve.Purpose Spontaneous intracranial hypotension (SIH) is suspected in patients presenting orthostatic headache and needs excluding structural or iatrogenic causes. Image studies are required to confirm the diagnosis and define exact locations of cerebrospinal fluid leakage, but currently there is no single study sensitive enough to make identifications among patients with various symptoms. Case report We present a 24-year-old young woman having acute orthostatic headache. She denied having previous headache, head trauma, or neuraxial procedures like lumbar punctures. Brain magnetic resonance image (MRI) with gadolinium enhancement reported normal findings on arrival. She received conservative treatment including analgesics and aggressive intravenous hydration, but her headache improved little. Whole spine MRI with gadolinium enhancement revealed no obvious leakage of cerebrospinal fluid but typical dilated epidural veins with ventral displacement of her thoracic spinal cord. After autologous epidural blood patches therapy, her headache relieved completely. Conclusion We review the typical and uncommon findings of spinal MRI in SIH, which is more sensitive than brain MRI in acute stages. Spinal MRI offers the diagnostic value in SIH especially when cranial images do not respond in time.Purpose To study the role of early serial EEGs in improving seizure freedom rates after initiation of ethosuximide or valproic acid for childhood absence epilepsy. Methods Retrospective data analysis study of AED naive patients with childhood absence epilepsy undergoing treatment at the community-based epilepsy clinic. Due to small sample size Fisher's exact test was used to determine two-tailed p value at less than 0.05 statistical significance.. Results At 2-month study period 71.4% patients in the ethosuximide and 87.5% in the valproic acid group achieved seizure freedom, with EEG normalization in 21.4% and 50% respectively. link2 At 6-month study period, in patients continuing ethosuximide, seizure freedom and EEG normalization rates were 89.5% and 52.6% respectively; while in patients continuing valproic acid, results were 100% and 78.6% respectively. Both at 2-month and 6-month study periods, a trend towards higher seizure freedom was noted in patients with typical versus non-typical epileptiform discharges at baseline with the valproic acid group showing a superior response. Conclusion Although no statistically significant difference in response rates was noted, 1) a shift towards higher seizure freedom with valproic acid; 2) improved response after switching to valproic acid at 2 months, if warranted; and 3) superior response rate in patients with typical EEG epileptiform discharges at baseline were observed. A larger study is needed to define the role of early serial EEGs to delineate higher drug failure probability; and to determine the importance of non-typical EEG characteristics at baseline in relation to the choice of AED and long-term outcome Keywords childhood absence epilepsy, ethosuximide, valproic acid, non-typical epileptiform discharges.Purpose This study was designed to investigate the effect of apilarnil on neuronal damage and related mechanisms in a sepsis model in order to demonstrate whether or not apilarnil has neuroprotective effect. Methods In this study, 64 adult male Sprague-Dawley species rats were randomly divided into eight groups. The rats were administered apilarnil and/or lipopolysaccharide (LPS). Superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), xanthine oxidase (XOD) and testican-1 levels were measured in the brain tissue. Proinflammatory cytokines (tumor necrosis factor alpha [TNF-α], interleukin 1 beta [IL-1β], interleukin 6 [IL-6]) were measured in brain tissue. Histological examinations were performed on hippocampus and cortex tissues in all groups. Apoptotic cell count was estimated using the Tunel method to observe the apilarnil's effect on apoptosis. Purkinje cells were counted in the hippocampus to measure the protective effect of apilarnil on the hippocampus. Results Apilarnil reduced the decrease in SOD and CAT levels in the brain developing sepsis. Apilarnil reduced the increase in MDA, XOD, and testican-1 levels in the septic brain. It was observed that the number of degenerated neurons due to sepsis decreased as apilarnil dose increased. Apilarnil reduced the elevated levels of proinflammatory cytokines (IL-6, TNF-α, IL-1β) induced by sepsis. Apilarnil prevented sepsis-related apoptosis in the brain. Conclusion The neuroprotective potential of apilarnil against brain damage in the sepsis model was demonstrated and suggested that it has the potential to contribute to new therapeutic targets against various neurological disorders.Background The English Malaysian Medication Adherence Scale (MALMAS) has been validated for assessing medication adherence of people with type 2 diabetes. However, Malay is the national language of Malaysia. Objectives The aim of this study was to cross-culturally adapt and validate the Malay MALMAS (M-MALMAS) in Malaysia. Methods Adults with type 2 diabetes, who could understand Malay, were recruited between May 2016 and February 2017 from a primary care clinic in Kuala Lumpur, Malaysia. The M-MALMAS and the Malay version of the Morisky Medication Adherence Scale (MMAS-8) were administered at baseline to test for convergent validity. Four weeks later, the M-MALMAS was re-administered. Predictive validity of the M-MALMAS was assessed by correlating the medication adherence scores with levels of glycated haemoglobin (HbA1c). Results In total, 100 of 104 people agreed to participate (response rate = 96.2%). The overall Cronbach's α and McDonald's Ω for the M-MALMAS was 0.654 and 0.676, respectively (mean = 0.665). At test-retest, no significant difference was found for all items. The median total score interquartile range (IQR) of the M-MALMAS was 7.0 (6.0-8.0) and this was significantly correlated to the median total score of the Malay MMAS-8 [median (IQR) = 7.0 (5.8-8.0), p less then 0.001]. HbA1c levels were significantly lower among participants who were adherent to their medications (score 6-8) versus those who were non-adherent (score less then 6, p = 0.018). The sensitivity and specificity of the M-MALMAS was 92% and 32.8%, respectively. Conclusions The M-MALMAS was found to be a valid and reliable instrument for assessing medication adherence of people with type 2 diabetes in Malaysia. The M-MALMAS had a high sensitivity but its specificity was not as good.Suicidal behavior as a psychological problem with high public health burden is associated with a number of genetically determined risk factors. In the current study, we investigated the association between two polymorphisms within the NINJ2 gene and risk of suicide in an Iranian population. The study included 295 individuals who attempted suicide with soft suicide methods, 234 suicide victims and 410 normal controls. The rs11833579 SNP was associated with death from suicide in a codominant model in that the AG genotype decreased the risk of death from suicide compared with the GG genotype (OR (95% CI) = 0.49 (0.34-0.71), adjusted P value = 4e-04). link3 This SNP was also associated with death from suicide in dominant (AG + AA versus GG OR (95% CI) = 0.63 (0.46-0.87), adjusted P value = 0.011) and overdominant (AG versus GG + AA OR (95% CI) = 0.49 (0.35-0.69), adjusted P value less then 0.0001) models. In addition, this SNP was associated with soft suicide attempts in a codominant model (AG versus AA + GG OR (95% CI) = 0.
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