•Free From Falls (FFF) is an in-person fall prevention program for people with MS.•Free From Falls Online (FFFO) overcomes barriers to in-person FFF participation.•People with MS rated their ...experience with FFFO positively.•FFFO may help prevent falls in people with MS.
Falls are common and impactful in people with multiple sclerosis (MS) but currently there is no accepted standard of care for fall prevention in MS. Evidence supports that the in-person, group-based, Free from Falls (FFF) program is associated with both immediate and six-month sustained improvements in mobility and balance and a reduction in falls, but program attendance is limited by access to the class at a given time and location and by the cost and availability of trained facilitators. Therefore, we developed and evaluated an online, web-based version of FFF, Free from Falls Online (FFFO).
Thirty people with MS who reported falling at least twice in the previous two months were randomized to FFFO or to a control group. FFFO consists of eight weekly sessions, each with an instructional and exercise component. Subjects in the control group were given a brochure on minimizing fall risk, a letter was sent to their treating physician informing them that the subject reported falling, and these subjects were invited to use the FFFO program at study completion. Outcomes included baseline demographics, falls prospectively reported for the eight weeks of intervention and the following three months, and a program satisfaction survey for the active group. Regression models were used to test for associations between treatment group and fall incidence.
Subjects’ mean age was 55.8 years, 70% were female, 73% had progressive MS, median Expanded Disability Status Scale (EDSS) score was 6.0, and subjects reported a median of two falls in the month prior to study enrollment. Although, in general, regression models demonstrated trends that those in the intervention group were less likely to fall than those in the control group, statistical significance was only achieved (p = 0.0038) with a post hoc model evaluating the relationship between the square of days and the probability of not falling. This model supported that those in the intervention group were slightly less likely to fall than those in the control group. This difference was most prominent in the first month of the study, less prominent in the following month, and not sustained three months following the intervention.
User experience with FFFO was overall positive, with over 75% reporting the web-based program easy to learn and to use, 85% reporting the program was easy to follow, 62% reporting the material to be useful, and 77% finding the exercises to be a useful component of the program.
This study supports the viability of online delivery of self-management strategies in MS, suggests that FFFO may help prevent falls in people with MS, and provides the preliminary data needed to verify the findings of this pilot study of FFFO with a fully powered randomized controlled trial in people with MS.
Mitochondrial dysfunctions are known to be responsible for a number of heterogenous clinical presentations with multi-systemic involvement. Impaired oxidative phosphorylation leading to a decrease in ...cellular energy (ATP) production is the most important cause underlying these disorders. Despite significant progress made in the field of mitochondrial medicine during the last two decades, the molecular mechanisms underlying these disorders are not fully understood. Since the identification of first mitochondrial DNA (mtDNA) mutation in 1988, there has been an exponential rise in the identification of mtDNA and nuclear DNA mutations that are responsible for mitochondrial dysfunction and disease. Genetic complexity together with ever widening clinical spectrum associated with mitochondrial dysfunction poses a major challenge in diagnosis and treatment. Effective therapy has remained elusive till date and is mostly efficient in relieving symptoms. In this review, we discuss the important clinical and genetic features of mitochondrials disorders with special emphasis on diagnosis and treatment.
Weakness and sensory changes are common complaints in both the inpatient and the outpatient setting. However, this presentation remains a diagnostic challenge to clinicians due to the many possible ...underlying etiologies. The initial evaluation of weakness and sensory changes starts a thorough history and physical examination to guide the diagnostic process. In this article, we present the case of an elderly woman with complaints of weakness and sensory changes to highlight a step-wise approach to diagnosis and management.
Mutations in human MPV17 have been reported in patients with severe mitochondrial DNA (mtDNA) depletion manifesting as early childhood onset failure to thrive, hypoglycemia, encephalopathy and ...progressive liver failure. We describe an 11 year old girl, born to consanguineous parents, who presented with rapidly progressive weakness of all 4 limbs with symmetrical proximal and distal weakness, gastrointestinal disease and leukoencephalopathy. Genetic analysis of the patient revealed a homozygous pathogenic mutation c.121C>T (p.R41W) in the MPV17 gene. Further, screening for this mutation in the parents revealed the presence of heterozygous mutation in both the parents, suggesting the recessive nature of the disease.
Background: Guillain-Barré syndrome (GBS) has been the most common
cause of flaccid paralysis in children after the decline in the
incidence of poliomyelitis. There are not any published data from ...the
Indian subcontinent documenting electrophysiological patterns and
antiganglioside antibodies in pediatric GBS. Materials and Methods: The
study population included children with GBS referred for
electrodiagnostic evaluation and also children with GBS admitted to our
institute between August 2006 and July 2007. Nerve conduction studies
were done to determine GBS subtypes and serum antiganglioside
antibodies were measured using enzyme-linked immunosorbent assay
(ELISA). Clinical and electrophysiological features were correlated
with antiganglioside antibody results. Results: Of the 43 (male to
female ratio = 2.1:1) children studied, 97.6% had motor weakness, 76.7%
had cranial nerve palsies, 13.9% had autonomic disturbances and
respiratory paralysis was found in 9.3% children. Antecedent illness
was recorded in 69.8% children. The GBS subtype distribution was as
follows: acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
in 21 (48.8%), acute motor axonal neuropathy (AMAN) in 19 (44.2%), and
3 (6.9%) children were unclassified. The severity of illness was
similar in both AMAN and AIDP subtypes and the recovery in both the
subtypes was complete without any significant difference in the
duration of recovery. Preceding diarrheal illness was more common in
AMAN subtype as compared to AIDP subtype (57.9% vs. 4.7%, P = 0.007).
Sensory symptoms were more common in AIDP subtype than in AMAN subtype
(66.6% vs. 21%, P = 0.03}. The commonest ganglioside antibody was IgM
GM2. Anti GM3 antibodies were exclusively seen in children with AMAN
and IgG GD1b was significantly associated with (36.7 vs. 4%; P = 0.007)
AMAN subtype. IgG GT1b was identified in 50% of patients with AIDP as
compared to 22.7% in patients with AMAN. Conclusion: In this study,
AMAN subtype accounted for a significant proportion of pediatric GBS.
AMAN was associated with diarrhea and specific antiganglioside
antibodies. Recovery in children with GBS was complete, irrespective of
the subtype.
Chronic progressive external ophthalmoplegia (CPEO) is caused by defects in both mitochondrial and nuclear genes, however, the causal genetic factors in large number of patients remains undetermined. ...Therefore, our aim was to screen 12 unrelated patients with CPEO for mutation/multiple deletions in mtDNA and mutations in the coding regions of C10orf2, which is essential for mtDNA replication. Histopathological study of muscle biopsy revealed cytochrome c oxidase-deficient fibers and ragged blue fibers in all the patients. Long-range PCR of DNA from skeletal muscle revealed multiple mtDNA deletions in all the 12 patients. Further, sequencing coding regions of C10orf2 revealed three variants in three different patients, of which two were novel (c.1964G>A/p.G655D; c.204G>A/p.G68G) variants and one was reported (c.1052A>G/p. N351S). Sequencing of other nuclear genes that are associated with CPEO and multiple mtDNA deletions, such as; POLG1, POLG2, TK2, ANT1, DGUOK, MPV17 and RRM2B did not reveal any pathogenic mutation in patients with C10orf2 mutation. Since in silico analyses revealed p.G655D could be a potentially pathogenic and it was absent in 200 healthy controls, p.G655D could be the causative factor for CPEO. Therefore, we suggest that C10orf2 gene should be screened in CPEO individuals with multiple mtDNA deletions, which might help in prognosis of this disease and appropriate genetic counseling.
Background:
Cannabis use among youth is increasing; this study aimed to assess college students’ knowledge, attitude, and expectancies toward cannabis use.
Methods:
Cross-sectional survey using ...standardized tools among undergraduate and postgraduate college students in urban Bangalore, India (N = 405).
Results:
Ten percent reported past three-month cannabis use, with 1% reporting daily use. Users were significantly older (median age 21, IQR 22,20 vs. 20, IQR 21,19, p < .001) and belonged to families with higher monthly incomes (p = .02). Use was significantly higher among males than females (65.9% vs. 34.1%, p = .006) and postgraduate students than undergraduates (51.2% vs. 48%, p = .001). Users were also significantly more favorable toward cannabis use (median score 4, IQR 6,2 vs. median 3, IQR 4,2, p = .005) and had more positive expectancies from use (median score 2, IQR 3,2 vs. median 2, IQR 2,0, p = .001). Nearly 30% were unaware that cannabis can affect a person’s ability to drive safely or that it can affect executive functions, including academic performance. Over one-third were unaware of the current legal status of cannabis in India. Overall, 36%, 25%, and 17%, respectively, said that cannabis use is safe when used for recreational purposes, cannabis should be legalized as it helps to relieve stress, and cannabis use among youngsters should be acceptable in society as it is “part of college life.”
Conclusion:
Findings build on existing literature on cannabis use among college youth in India, which can guide preventive interventions and policies for this vulnerable group.
Recent treatments for malignant colon cancer in clinics are not efficacious and often result in deprived patient compliance due to short therapeutic efficacy and sturdy systemic side effects. To ...overcome this issue in the present study, we designed and formulated nanomaterial (PEGylated AuNPs-DOX@Kaempferol) for drug delivery system against colon cancer. The drug release behavior was subsequently studied at different pH. These results showed that the drugs have been released in controlled manner. The current investigation proves that the combination of DOX and Kaempferol are more efficient to induce cytotoxic effect while compared to the each drug alone. On the other hand, AO/EtBr and DAPI staining are confirming the induction of apoptosis in cancer cells. In vivo antitumor efficiency of PEGylated AuNPs-DOX@Kaempferol showed a significant reduction in tumor volume without any severe side effects. Thus, combine drug nanoformulations could be a promising drug delivery system for colon cancer therapy.
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