Abstract
Antinuclear antibodies (ANA) are a diverse group of autoantibodies found in various systemic autoimmune disorders. They represent a key diagnostic marker in the diagnosis of connective ...tissue disorders (CTD). Although many techniques exist, ANA by indirect immunofluorescence remains the gold standard for diagnosing CTDs. Neurologists should be aware of the type of assay used for detection and the advantages and disadvantages of using each method. Through this article, we aimed to review the methodological aspects of the detection of ANA and its subtypes and their clinical relevance in various neurologic disorders.
Muscle synergy-based functional electrical stimulation had improved movement kinematics instantly and in long-term use in post-stroke patients. However, the therapeutic benefits and efficacy of ...muscle synergy-based functional electrical stimulation patterns over traditional stimulation patterns need exploration. This paper presents the therapeutic benefits of muscle synergy-based functional electrical stimulation compared to traditional stimulation patterns from the perspective of muscular fatigue and kinematic performance produced. Three stimulation waveforms/envelopes: customized rectangular, trapezoidal, and muscle synergy-based FES patterns were administered on six healthy and six post-stroke patients to achieve full elbow flexion. The muscular fatigue was measured through evoked-electromyography, and the kinematic outcome was measured through angular displacement during elbow flexion. The time domain ( peak-to-peak amplitude, mean absolute value, root-mean-square ) and frequency domain ( mean frequency, median frequency ) myoelectric indices of fatigue were calculated from evoked-electromyography. Myoelectric indices of fatigue and peak angular displacements of elbow joint were compared across waveforms. The presented study found that the muscle synergy-based stimulation pattern sustained the kinematic output for longer durations and induced less muscular fatigue followed by trapezoidal and customized rectangular patterns in healthy and post-stroke participants. These findings imply that the therapeutic effect of muscle synergy-based functional electrical stimulation stems from not only being biomimetic but also due to it being efficient in inducing less fatigue. The slope of current injection was a crucial factor in determining the performance of muscle synergy-based FES waveforms. The presented research methodology and outcomes would help researchers and physiotherapists in choosing effective stimulation patterns for maximizing post-stroke rehabilitation benefits.
Agarwal et al discuss their case study of a 61-year-old woman with low back pain associated with radiation to left lower limb since the past 1 year, with left foot drop since the past 1 month. ...Examination revealed wasting of the left lower limb with a foot drop. The remaining neurological examination was normal. Magnetic resonance imaging of the spine revealed diffusely bulky and multi-septated homogenous fluid-filled lesions (with signal intensity similar to cerebrospinal fluid) in the intraspinal compartment from L3 to sacral vertebrae, causing extradural compression, and prevertebral and paravertebral locations.
Bacopa monnieri (BM), a commonly used herb, has shown neuroprotective effects in animal and
studies; but human studies on patients with Alzheimer's Disease (AD) have been inconclusive. Further ...high-quality trials are required to conclusively state the utility of BM in AD and other neurodegenerative dementias.
In the present study, we did a narrative review of the current challenges in designing clinical trials of BM in dementia and their evidence-based recommendations.
Many facets of the BM trials need improvement, especially effect size and sample size estimation. Current assessment and outcomes measures need a more holistic approach and newer scales for diagnosing and monitoring prodromal AD. The stringent guidelines in CONSORT and STROBE are often considered difficult to implement for clinical trials in ayurvedic medications like BM. However, adherence to these guidelines will undoubtedly improve the quality of evidence and go a long way in assessing whether BM is efficacious in treating AD/prodromal AD patients and other neurodegenerative dementias.
Future studies on BM should implement more randomized controlled trials (RCTs) with an appropriate sample size of accurately diagnosed AD/prodromal AD patients, administering a recommended dosage of BM and for a pre-specified time calculated to achieve adequate power for the study. Researchers should also develop and validate more sensitive cognitive scales, especially for prodromal AD. BM should be evaluated in accordance with the same rigorous standards as conventional drugs to generate the best quality evidence.
Background: Coronavirus disease (COVID-19)-related scientific publications have increased exponentially during the present pandemic but their influence on biomedical literature is not known. The ...characteristics of highly cited articles help us to identify important advances and their scientific impact. Objectives: In the present study, we have identified and analyzed the top 100 most highly-cited articles of COVID-19 research published in the year 2020. Methods: A cross-sectional bibliometric analysis was using the search terms "severe acute respiratory syndrome-coronavirus-2," "COVID," "nCoV," "Coronavirus," and "HCoV" querying the Google Scholar database using the program "Publish or Perish." The first 100 English language articles with the maximum number of citations were identified and evaluated in detail. Results: The top 100 COVID-19 articles in 2020 had citations ranging from 1147 to 20,440. The median (interquartile range IQR) number of citations was 1970 (1456-2939). The number of authors ranged from 1 to 79 (median 10; IQR 5.25-19). The majority of first authors was from China (58%), followed by the United States of America (16%) and the United Kingdom (7%). The top three journals in terms of the number of published articles (37%) were the New England Journal of Medicine, Journal of the American Medical Association, and The Lancet. Most of the top-cited COVID-19 literature were descriptive studies focusing on epidemiology (48%) and clinical course (60%) of COVID-19. Conclusion: Clinical course and epidemiology have been the predominant areas of research interest in COVID-19 in 2020. Citation analysis of COVID-19 literature helps us to map out the most important focus for research in this pandemic and to identify gaps in knowledge which would guide further research.
Background and aims
Early neurological deterioration (END) in acute ischemic stroke (AIS), patients is defined as clinical worsening or recurrence during first 72 h after onset of AIS. We have ...conducted this study to determine the association between END and functional outcome at 3 months of onset of AIS along with associated risk factors of END in AIS cases.
Methodology
This study was conducted after approval of Institute Ethics Committee. Two hundred three consecutive patients were admitted from September 2020 to January 2022 at a tertiary care hospital. One hundred ninety patients were included in the study; patients were divided into two groups: (1) early neurological deterioration (END) and (2) non-early neurological deterioration (non-END). Patients were followed-up either telephonically or in person at approximately 3 months using modified Rankin Scale 0–6. All the clinically significant prognostic markers and
p
< 0.10 variables were considered significant in univariate analysis;
P
< 0.05 were considered statistically significant for the multivariate analysis.
Results
Out of 190 cases included in the cohort 34/190 (17.8%) cases showed END with mean age (56.56 (± 16.6)) and males (20/34 (58.8%)). END was independently associated with high blood glucose at admission (OR = 1.015;
P
= 0.002; 95%CI = 1.005–1.024) and low serum albumin (OR = 0.208;
P
= 0.002; 95%CI = 0.077–0.562). Patients with END showed poor functional outcome (mRS > 2) at end of 3 months (32 (94.1%);
P
< 0.001) and death was also statistically significant (22 (64.7%);
P
< 0.001) as compared to AIS cases having non-END.
Conclusion
Our study showed END may be associated with poor functional outcome in AIS patients. Higher blood glucose at admission and low serum albumin may be statistically significant causing END. Future prospective cohort with larger sample size may confirm the findings.
Background: Recent respiratory infection including SARS-CoV-2 is an independent risk factor for acute cerebrovascular disease. Purpose: There have been reports linking haemorrhagic strokes to ...SARS-CoV-2 infection during this pandemic, which lead us to evaluate if SARS-CoV-2 infection could be associated with increased risk of intracerebral haemorrhage (ICH). Methods: A retrospective observational study evaluating all stroke cases admitted in our centre in the past one month. Results: More than half (56%) had ICH, compared to 22% last year. Two patients with ICH were SARS-CoV-2 positive and they had no or mild respiratory symptoms and had higher occurrence of renal dysfunction. Conclusion: There could be possible association between ICH and SARS-CoV-2 infections. However, a prospective study with larger sample size is needed to elucidate the pathogenesis.
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