Coronavirus disease 2019 (COVID‐19), a multi‐organ disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), continues to challenge health and care systems around the globe. The ...pandemic has disrupted acute neurology services and routine patient care and has impacted the clinical course in patients with chronic neurological disease. COVID‐19 appears to have exposed inequalities of societies and healthcare systems and had a disproportionate impact on already vulnerable communities. The next challenge will be to set up initiatives to stop disparities in all aspects related to COVID‐19. From the medical perspective, there is a need to consider inequalities in prevention, treatment and long‐term consequences. Some of the issues of direct relevance to neurologists are summarised. With this appraisal, the European Academy of Neurology NeuroCOVID‐19 Task Force intends to raise awareness of the potential impact of COVID‐19 on inequalities in healthcare and calls for action to prevent disparity at individual, national and supranational levels.
Background and purpose
Rare diseases affect up to 29 million people in the European Union, and almost 50% of them affect the nervous system or muscles. Delays in diagnosis and treatment onset and ...insufficient treatment choices are common. Clinical practice guidelines (CPGs) may improve the diagnosis and treatment of patients and optimize care pathways, delivering the best scientific evidence to all clinicians treating these patients. Recommendations are set for developing and reporting high‐quality CPGs on rare neurological diseases (RNDs) within the European Academy of Neurology (EAN), through a consensus procedure.
Methods
A group of 27 experts generated an initial list of items that were evaluated through a two‐step Delphi consensus procedure and a face‐to‐face meeting. The final list of items was reviewed by an external review group of 58 members.
Results
The consensus procedure yielded 63 final items. Items are listed according to the domains of the AGREE instruments and concern scope and purpose, stakeholder involvement, rigour of development, and applicability. Additional items consider reporting and ethical issues. Recommendations are supported by practical examples derived from published guidelines and are presented in two tables: (1) items specific to RND CPGs, and general guideline items of special importance for RNDs, or often neglected; (2) items for guideline development within the EAN.
Conclusions
This guidance aims to provide solutions to the issues specific to RNDs. This consensus document, produced by many experts in various fields, is considered to serve as a starting point for further harmonization and for increasing the quality of CPGs in the field of RNDs.
To evaluate an updated algorithm in the detection of urinary tract infection (UTI) prior to high-dose corticosteroid treatment in acute relapses in multiple sclerosis (MS). This updated algorithm ...aimed to decrease the unnecessary use of antibiotics, whilst maintaining accuracy and safety.
Prospective cohort study of 471 consecutive patients with MS relapses in a hospital-based outpatient acute relapse clinic. 172 patients met exclusion criteria, leaving 299 patients for analysis. Patients underwent urine dipstick and were treated for UTI if 2 or more of: nitrites, leukocyte esterase and cloudy urine were positive. Patients with confirmed acute MS relapse were treated with high dose intravenous or oral methylprednisolone.
Significant bacteriuria (>105 colony forming units/mL) was present in 33 (11%, 95% CI 8-15) patients. The algorithm sensitivity and specificity was 24% and 94% respectively; the negative predictive value was 91%. The overall accuracy of the algorithm was 87%. No adverse sequelae were identified in 25 patients who received high dose methylprednisolone in the presence of an untreated UTI.
With an improved specificity, this updated algorithm addresses previous issues concerning the unnecessary prescription of antibiotics, whilst improving accuracy and maintaining safety.
•High dose steroids to treat acute MS relapses may be delayed when UTI is suspected.•Accurate urine screening allows early treatment and reduces unnecessary antibiotics.•≥2/3 of positive nitrites, leukocyte esterase and cloudy urine gives 87% accuracy.•Risks of high dose steroids when bacteriuria is present remains to be established.
V splošni javnosti in v raziskavah v raznih strokah pridobivajo ozelenjeni fasadni ovoji stavb vse večjo pozornost. Sistemi vertikalnih ozelenitev imajo pomembno vlogo kot izrazni element stavbe, ...hkrati pa se obravnavajo kot poseben tip zelene infrastrukture z raznovrstnimi pozitivnimi učinki predvsem na gosto pozidanih urbanih območjih. Raziskava se osredotoča na zaznavo ozelenjenih fasad v urbanih ambientih. Poudarek je na vizualnem zaznavanju in dojemanju prijetnosti ali vizualne kakovosti raznovrstnih prostorov glede na to, ali stavba ima ozelenjeno fasado ali ne. Odnos javnosti in vrednotenje urbanega odprtega prostora s proučevanimi zelenimi elementi smo preverjali na Nizozemskem in v Sloveniji. V spletno anketo so bili vključeni prikazi prostorskih situacij, o katerih so anketiranci izrazili mnenje. Ciljni skupini sta bili širša javnost in študenti arhitekturno-urbanističnih smeri. Kljub splošnemu rezultatu o večji prijetnosti bolj zelenega mestnega okolja, ki kaže na to, da večina ljudi tudi vertikalne ozelenitve dojema kot prispevek h kakovosti urbanih ambientov, se med proučevanima skupinama v posamezni državi pojavljajo razlike.
The purpose of this study was to test the hypothesis that subcortical β-amyloid (Aβ) deposition was associated with elevated scores on standardized measures of depressive and anxiety symptoms when ...compared with cortical (Aβ) deposition in persons without dementia.
The authors performed a cross-sectional study, derived from the population-based Mayo Clinic Study of Aging, comprising participants aged ≥70 years (N=1,022; 55% males; 28% apolipoprotein E APOE ε4 carriers; without cognitive impairment, N=842; mild cognitive impairment; N=180). To assess Aβ deposition in cortical and subcortical (the amygdala, striatum, and thalamus) regions, participants underwent Pittsburgh Compound B positron emission tomography (PiB-PET) and completed the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). The investigators ran linear regression models to examine the association between PiB-PET standardized uptake value ratios (SUVRs) in the neocortex and subcortical regions and depressive and anxiety symptoms (BDI-II and BAI total scores). Models were adjusted for age, sex, education level, and APOE ε4 carrier status and stratified by cognitive status (without cognitive impairment, mild cognitive impairment).
Cortical PiB-PET SUVRs were associated with depressive symptoms (β=0.57 SE=0.13, p<0.001) and anxiety symptoms (β=0.34 SE=0.13, p=0.011). PiB-PET SUVRs in the amygdala were associated only with depressive symptoms (β=0.80 SE=0.26, p=0.002). PiB-PET SUVRs in the striatum and thalamus were associated with depressive symptoms (striatum: β=0.69 SE=0.18, p<0.001; thalamus: β=0.61 SE=0.24, p=0.011) and anxiety symptoms (striatum: β=0.56 SE=0.18, p=0.002; thalamus: β=0.65 SE=0.24, p=0.008). In the mild cognitive impairment subsample, Aβ deposition, regardless of neuroanatomic location, was associated with depressive symptoms but not anxiety symptoms.
Elevated amyloid deposition in cortical and subcortical brain regions was associated with higher depressive and anxiety symptoms, although these findings did not significantly differ by cortical versus subcortical Aβ deposition. This cross-sectional observation needs to be confirmed by a longitudinal study.
Current experimental methods for the study of reaching in the MRI environment do not exactly mimic actual reaching, due to constrains in movement which are imposed by the MRI machine itself. We ...tested a haptic robot (HR) as such a tool. Positive results would also be promising for combined use of fMRI and EEG to study reaching. Twenty right-handed subjects performed reaching tasks with their right hand with and without the HR. Reaction time, movement time (MT), accuracy, event-related potentials (ERPs) and event-related desynchronisation/synchronisation (ERD/ERS) were studied. Reaction times and accuracies did not differ significantly between the two tasks, while the MT was significantly longer in HR reaching (959 vs. 447 ms). We identified two positive and two negative ERP peaks across all leads in both tasks. The latencies of the P1 and N2 peaks were significantly longer in HR reaching, while there were no significant differences in the P3 and N4 latencies. ERD/ERS topographies were similar between tasks and similar to other reaching studies. Main difference was in ERS rebound which was observed only in actual reaching. Probable reason was significantly larger MT. We found that reaching with the HR engages similar neural structures as in actual reaching. Although there are some constrains, its use may be superior to other techniques used for reaching studies in the MRI environment, where freedom of movement is limited.
PDF
