Objective
Psychoses affecting people with epilepsy increase disease burden and diminish quality of life. We characterized postictal psychosis, which comprises about one quarter of epilepsy‐related ...psychoses, and has unknown causation.
Methods
We conducted a case–control cohort study including patients diagnosed with postictal psychosis, confirmed by psychiatric assessment, with available data regarding epilepsy, treatment, psychiatric history, psychosis profile, and outcomes. After screening 3,288 epilepsy patients, we identified 83 with psychosis; 49 had postictal psychosis. Controls were 98 adults, matched by age and epilepsy type, with no history of psychosis. Logistic regression was used to investigate clinical factors associated with postictal psychosis; univariate associations with a p value < 0.20 were used to build a multivariate model. Polygenic risk scores for schizophrenia were calculated.
Results
Cases were more likely to have seizure clustering (odds ratio OR = 7.59, p < 0.001), seizures with a recollected aura (OR = 2.49, p = 0.013), and a family history of psychiatric disease (OR = 5.17, p = 0.022). Cases showed predominance of right temporal epileptiform discharges (OR = 4.87, p = 0.007). There was no difference in epilepsy duration, neuroimaging findings, or antiseizure treatment between cases and controls. Polygenic risk scores for schizophrenia in an extended cohort of postictal psychosis cases (n = 58) were significantly higher than in 1,366 epilepsy controls (R2 = 3%, p = 6 × 10−3), but not significantly different from 945 independent patients with schizophrenia (R2 = 0.1%, p = 0.775).
Interpretation
Postictal psychosis occurs under particular circumstances in people with epilepsy with a heightened genetic predisposition to schizophrenia, illustrating how disease biology (seizures) and trait susceptibility (schizophrenia) may interact to produce particular outcomes (postictal psychosis) in a common disease. ANN NEUROL 2021;90:464–476
Circulating and cerebrospinal fluid (CSF) neurofilament light chain (NfL) levels represent a reliable indicator of disease activity and axonal damage in different neuroinflammatory conditions. ...Recently, high CSF NfL levels have been detected in active autoimmune encephalitis, as opposed to significant lower levels after clinical improvement. The aim of the present study was to evaluate serum and CSF NfL concentration in patients with autoimmune encephalitis and to analyse the association between NfL levels and clinical, MRI, and CSF data. We retrospectively included 25 patients with neurological syndromes associated with autoantibodies to neuronal cell surface antigens and we collected clinical, MRI, CSF, and follow-up data. Using an ultrasensitive method (Simoa, Quanterix), we measured NfL levels in serum and CSF samples of all patients and in 25 sera of healthy controls. Serum NfL levels were higher in all cases, including 20 patients with inflammatory MRI/CSF features and 5 non-inflammatory cases (median 16.9 pg/ml, range 4.5–90) than in controls (median 6.9 pg/ml, range 2.7–12.8;
p
< 0.001). A correlation between serum and CSF NfL levels was found (
r
= 0.461,
p
= 0.023), whereas no significant association was observed between NfL levels and clinical, MRI/CSF inflammatory burden, and antibody type. In the 13 available follow-up samples, correlation between disease activity and NfL values was also observed. In conclusion, NfL levels are significantly increased in the serum of patients with antibody-mediated encephalitis, independently of the MRI/CSF inflammatory profile. These findings support the presence of ongoing axonal damage and suggest the co-occurrence of different mechanisms for neuronal/axonal involvement in antibody-associated CNS syndromes.
At these doses, patients can show a dose-limiting syndrome similar to Wernicke's encephalopathy.2 A similar encephalopathy that might be prevented or reversed by the administration of thiamine has ...also been observed in about 10% of patients exposed to ifosfamide.2 Because the blood concentrations of thiamine did not change after erbulozole or ifosfamide were given, it has been suggested that these drugs or their metabolites either interfere with thiamine function, or the enzymes of the intermediate carbohydrate metabolism.2 The clinical presentation of Wernicke's encephalopathy can vary, and the classical triad of ocular abnormalities, mental status changes, and gait ataxia is seen in only 16% of patients.2 Roughly 84% of patients with Wernicke's encephalopathy show either at least one component of the triad at presentation, or other uncommon symptoms or signs, which include stupor, hypotension and tachycardia, hypothermia, bilateral visual loss and papilloedema, epileptic seizures, hearing loss, hallucinations, and behavioural disturbances.2 In patients with cancer, the subacute appearance of one of these signs or symptoms, in combination with a clinical setting indicative of a possible thiamine deficiency, or an impaired action of thiamine at a cellular level that may be related to chemotherapy, should prompt clinicians to consider the occurrence of this disorder.2,3 Patients with suspected Wernicke's encephalopathy should be treated with adequate amounts of parenteral thiamine as soon as possible to prevent Korsakoff's syndrome.
Abstract Background and aim Despite an extensive literature on cognitive impairments in focal and generalized epilepsy, only a few number of studies specifically explored social cognition disorders ...in epilepsy syndromes. The aim of our study was to investigate social cognition abilities in patients with temporal lobe epilepsy (TLE) and in patients with idiopathic generalized epilepsy (IGE). Materials and methods Thirty-nine patients (21 patients with TLE and 18 patients with IGE) and 21 matched healthy controls (HCs) were recruited. All subjects underwent a basic neuropsychological battery plus two experimental tasks evaluating emotion recognition from facial expression (Ekman-60-Faces test, Ek-60F) and mental state attribution (Story-based Empathy Task, SET). In particular, the latter is a newly developed task that assesses the ability to infer others' intentions (i.e., intention attribution — IA) and emotions (i.e., emotion attribution — EA) compared with a control condition of physical causality (i.e., causal inferences — CI). Results Compared with HCs, patients with TLE showed significantly lower performances on both social cognition tasks. In particular, all SET subconditions as well as the recognition of negative emotions were significantly impaired in patients with TLE vs. HCs. On the contrary, patients with IGE showed impairments on anger recognition only without any deficit at the SET task. Discussion Emotion recognition deficits occur in patients with epilepsy, possibly because of a global disruption of a pathway involving frontal, temporal, and limbic regions. Impairments of mental state attribution specifically characterize the neuropsychological profile of patients with TLE in the context of the in-depth temporal dysfunction typical of such patients. Conclusion Impairments of socioemotional processing have to be considered as part of the neuropsychological assessment in both TLE and IGE in view of a correct management and for future therapeutic interventions.
Background
Post-prostatectomy urinary incontinence is an adverse event leading to significant distress. Our aim was to evaluate immediate urinary continence (UC) recovery in a single-surgeon ...prospective randomized comparative study between the traditional robot-assisted laparoscopic radical prostatectomy (TR-RALP) and the Retzius-sparing RALP (RS-RALP), for the treatment of the clinically localized prostate cancer (PCa).
Methods
102 consecutive PCa patients were prospectively randomized to TR-RALP (57) or RS-RALP (45). Postoperative continence was defined as patient-reported absence of leakage or use of 0 pads/day. The immediate continence rate and 95% confidence interval (CI 95%) were calculated for each treatment. Univariable and multivariate logistic regressions were used to assess predictors of immediate continence following RALP. Continence rates from 1 to 6 months were calculated by Kaplan–Meier curves; log-rank test was used for the curve comparison. Two analyses were performed, considering a per-protocol (PP) population regarding all randomized patients that received nerve-sparing RALP and an Intention-To-Treat (ITT) population regarding all randomized patients that received RALP.
Results
In the PP analysis, the rates of immediate continence were 12/40 (30%) (CI 95% 17–47%) for the TR-RALP and 20/39 (51.3%) (CI 95% 35–68%) for the RS-RALP (
p
= 0.05). In the ITT analysis, the corresponding rates were 12/57 (21%) (CI 95% 11–34%) for the TR-RALP and 23/45 (51%) (CI 95% 36–66%) for the RS-RALP (
p
= 0.001). Median time to continence was 21 days for the TR-RALP and 1 day for RS-RALP, respectively (
p
= 0.02). The relative Kaplan–Meier curves regarding continence resulted statistically different when compared with the log rank test (
p
= 0.02). In the multivariate analysis, lower age and the Retzius-sparing approach were significantly associated to earlier continence recovery.
Conclusions
The Retzius-sparing approach significantly reduces time to continence following RALP. Further studies are required to confirm the reproducibility of our results and investigate the role of the RS-RALP as an additional “protective” factor for postoperative continence in the elderly population.
Objective
To present a new technique of double‐j stent (DJ) placement during laparoscopic transperitoneal ureterolithotomy (LUL).
Patients and methods
Following the extraction of the stone, a 6 ...French DJ open‐end stent is prepared: two straight‐tip hydrophilic guidewires are inserted into the appropriate lateral holes of the stent, as identified by the preoperative evaluation of the CT scan. Approximately 5 centimeters of each wire protrude from the proximal and distal ends of the stent to straighten its terminal curl, thus resembling the wings of a flying seagull. The remaining proximal portions of both guide wires are left within each guidewire dispenser. The two ends of the stent are grasped together in a U‐fashion and inserted into the abdomen through a 10mm port. Once in the abdomen, the longer segment of the stent is inserted and pushed into the ureterotomy until it reaches the target site. The guide wire is then removed. The same procedure is repeated for the other end of the stent. A brief literature review on the currents techniques of laparoscopic DJ placement is also presented.
Results
Analyzing the outcomes of 21 LUL, the "seagull" technique is time‐saving and safe. No perioperative complications were encountered. There is no risk of enlarging or tearing the ureterotomy and no need for patient replacement, extra cystoscopic or ureteroscopic procedures as well as of using modified guidewires and closed‐tip stents.
Conclusion
We described our step‐by‐step technique for DJ placement during LUL.
Bladder cancer (BC) is common worldwide, and has aggressive features and high rates of relapse despite treatments. Approximately 30% of patients present with muscle invasive disease, and therefore, ...high risk of metastasis. This review provides an overview of the state of the art for the ‘Vesical Imaging Reporting and Data System’ (VI-RADS). This scoring system presents a tool for the local staging of BC and has been validated across several institutions. We discuss the current application and the potential future clinical implications of VI-RADS in BC diagnosis, management and follow-up.
Cardiometabolic disorders may worsen Covid-19 outcomes. We investigated features and Covid-19 outcomes for patients with or without diabetes, and with or without cardiometabolic multimorbidity.
We ...collected and compared data retrospectively from patients hospitalized for Covid-19 with and without diabetes, and with and without cardiometabolic multimorbidity (defined as ≥ two of three risk factors of diabetes, hypertension or dyslipidaemia). Multivariate logistic regression was used to assess the risk of the primary composite outcome (any of mechanical ventilation, admission to an intensive care unit ICU or death) in patients with diabetes and in those with cardiometabolic multimorbidity, adjusting for confounders.
Of 354 patients enrolled, those with diabetes (n = 81), compared with those without diabetes (n = 273), had characteristics associated with the primary composite outcome that included older age, higher prevalence of hypertension and chronic obstructive pulmonary disease (COPD), higher levels of inflammatory markers and a lower PaO2/FIO2 ratio. The risk of the primary composite outcome in the 277 patients who completed the study as of May 15
, 2020, was higher in those with diabetes (Adjusted Odds Ratio (
OR) 2.04, 95%CI 1.12-3.73, p = 0.020), hypertension (
OR 2.31, 95%CI: 1.37-3.92, p = 0.002) and COPD (
OR 2.67, 95%CI 1.23-5.80, p = 0.013). Patients with cardiometabolic multimorbidity were at higher risk compared to patients with no cardiometabolic conditions (
OR 3.19 95%CI 1.61-6.34, p = 0.001). The risk for patients with a single cardiometabolic risk factor did not differ with that for patients with no cardiometabolic risk factors (
OR 1.66, 0.90-3.06,
p = 0.10).
Patients with diabetes hospitalized for Covid-19 present with high-risk features. They are at increased risk of adverse outcomes, likely because diabetes clusters with other cardiometabolic conditions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Pericapsular nerve group (PENG) block, although effective for pain management following total hip arthroplasty (THA), does not cover skin analgesia. In this randomized controlled trial, we compared ...the effectiveness of PENG block combined with lateral femoral cutaneous nerve (LFCN) block or wound infiltration (WI) on postoperative analgesia and functional outcomes.
Fifty patients undergoing posterior-approached THA under spinal anesthesia were randomly allocated to receive LFCN block with 10 mL of 0.5% ropivacaine or WI with 20 mL of 0.5% ropivacaine. In both groups, PENG block was performed by injecting 20 mL of 0.5% ropivacaine. Primary outcomes were static and dynamic pain scores (0-10 numeric rating scale) measured in the first 24 h after surgery. Secondary outcomes included postoperative opioid consumption, functional assessment and length of hospital stay.
Postoperative static NRS of patients receiving LFCN was higher than that of patients receiving WI at 6 h but lower at 24 h, with a median (IQR) of 3 (2-4) vs. 2 (1-2) (
< 0.001) and 2 (2-3) vs. 3 (3-4) (
= 0.02), respectively. Static pain scores at 12 h did not show significant differences, with an NRS of 3 (2-4) for WI vs. 3 (3-4) for LFCN (
= 0.94). Dynamic pain and range of movement followed a similar trend. No significant differences were detected in other outcomes.
LFCN block was not inferior to WI for postoperative analgesia and functional recovery in association with PENG block during the first postoperative day, although it had worse short-term pain scores. Based on these results, it is reasonable to consider LFCN block as a valid alternative to WI or even a complementary technique added to WI to enhance skin analgesia during the first 24 h after THA. Future studies are expected to confirm this hypothesis and find the best combination between PENG block and other techniques to enhance analgesia after THA.
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