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The article presents the discussion on Collagenous gastritis (CG) is an infrequent pathology characterized by the presence of subepithelial gastric collagen deposits. Topics include etiology of CG is unknown, although it could be related to an abnormal inflammatory response of the gastric mucosa; and collagenous gastritis seems to be more frequent in girls and appears to have a bimodal presentation, with a peak in adolescence.

Objective: To study the post-operative evolution of voice quality of patients treated by transoral CO2 laser microsurgery (TLM) according to the age. Methods: Patients treated by type I to VI TLM and post-operative speech therapy were prospectively recruited from our hospital. The voice quality was assessed pre-, 1-, 3- 6- and 12-month posttreatment with voice handicap index (VHI), dysphonia, roughness, breathiness, asthenia, strain (GRBAS), maximal phonation time (MPT), F0, F0 standard deviation (STD), percent jitter, percent shimmer, noise-to-harmonic ratio (NHR), vocal fold vibration assessment and speech fluency. Evolution of voice outcomes was analyzed considering age of patients (< 60 vs. ≥ 60 years). Results: Seventy-five patients completed the evaluations. Thirty-four and forty-one patients were < 60 or ≥ 60 yo, respectively. Subjective and objective voice parameters (VHI, G, R, B), jitter and fluency significantly improved from 1- to 6-month post-TLM in < 60 yo individuals. The voice parameters improved 12-month post-TLM in the ≥ 60 yo group at the exception of VHI that improved 3-month post-TLM. There were positive associations between age and 12-month NHR, G and A parameters. Conclusion: The post-operative evolution of voice quality parameters may vary between patients according to the age. Preoperative VHI is predictive of 12-month subjective and objective voice outcomes. [ABSTRACT FROM AUTHOR]

The main purpose of this study was to examine the relationship between resilience and health-related quality of life in patients following COVID-19 disease among those with and without lingering symptoms. The study design is descriptive and cross-sectional. Participants (n = 97) were adults who had earlier contracted COVID-19 disease and were in post-infection status between July and October 2020. Participants completed the following instruments: Connor-Davidson Resilience Scale, Short-Form 12-item Health Survey, and Hospital Anxiety and Depression Scale. Approximately 35% post-COVID-19 patients had a low level of resilience. The impact on the health status and resilience of those who had reported symptoms after 6 months was also significant. Age and depression had a significant impact on level of resilience. This relationship can affect patient recovery and negatively impact the ability to cope with COVID-19 disease. It is necessary to implement specialized training for clinicians on the effects of long-term COVID-19 to improve patient care. Long COVID symptoms might manifest months after an acute COVID-19 illness; clinicians who can confirm patient reports of these symptoms may help patients recover and become more resilient. [ABSTRACT FROM AUTHOR]

The article describes the case of a 64-year-old patient who underwent bilateral lung transplant in March 2021 due to interstitial lung disease and presented with severe lung infection.

Objective: The purpose of this study was to analyse the effectiveness and safety of first-line treatment of metastatic colorectal cancer (CRCm) in older patients treated in a tertiary hospital. Material and methods: This was an observational and retrospective study, including patients aged 75 years or older, with CRCm, who received chemotherapy treatment in 2017. The main variables studied were type of treatment, Progression-Free Survival (PFS), Overall Survival (OS), dose reductions, and treatment delays due to adverse events. Results: A total of 59 patients (71.2% men) with a median age of 76 years were enrolled in this study. About 70% presented colon cancer, with the left colon being the most frequent location. They were treated with 9 different schemes, in most cases using polychemotherapy and biological agents. The median PFS and OS was 12 and 30 months, respectively. A total of 23/59 of patients started treatment at doses lower than recommended in the clinical practice guidelines. In terms of safety, 34/59 of patients had at least one dose reduction, and 30/59 suffered one treatment delay. The most frequent adverse reactions were asthenia, peripheral neuropathy, diarrhoea, and palmoplantar erythrodysesthesia. Conclusion: Our patients presented baseline clinical characteristics similar to the general adult population, with no tumour characteristics associated with advanced age. The efficacy and toxicity were similar to those in the clinical trials, although our patients had more dose reductions. Considering the heterogeneity of patients and in the absence of clinical trials in the older population, real-life studies can be very useful. [ABSTRACT FROM AUTHOR]

The objectives of this study were to describe the anatomy, histology, and ultrastructure of the equine filum terminale (FT) and to describe the FT in hereditary equine regional dermal asthenia (HERDA), a model of human Ehlers-Danlos syndromes (EDS). Those humans suffer from tethered cord syndrome (TCS) caused by an abnormally structured FT wherein its attachment at the base of the vertebral column leads to long-term stretch-induced injury to the spinal cord. The pathophysiology of TCS in EDS is poorly understood, and there is a need for an animal model of the condition. Histopathologic and ultrastructural examinations were performed on FT from HERDA (n = 4) and control horses (n = 5) and were compared to FT from human TCS patients with and without EDS. Adipose, fibrous tissue, and neuronal elements were assessed. CD3 and CD20 immunohistochemistry was performed to clarify cell types (HERDA n = 2; control n = 5). Collagen fibrils were assessed in cross-section for fibril diameter and shape, and in longitudinal section for fibril disorganization, swelling, and fragmentation. The equine and human FT were similar, with both containing fibrous tissue, ependyma, neuropil, and nerve twigs. Hypervascularity was observed in both HERDA horses and human EDS-TCS patients and was not observed in equine or human controls. Moderate to severe abnormalities in collagen fibril orientation and architecture were observed in all HERDA horses and were similar to those observed in human EDS-TCS patients. [ABSTRACT FROM AUTHOR]

Objective: Cytokines have been the mainstay of treatment in metastatic renal cell cancer (mRCC) for decades before the introduction of tyrosine kinase inhibitors (TKIs), which dramatically changed the therapeutic landscape in these patients. This observational study was designed to evaluate use of TKIs in the treatment of cytokine-intolerant mRCC patients. Methods: A total of 151 cytokine-intolerant mRCC patients who were treated with TKIs (sunitinib, pazopanib and sorafenib) were enrolled in this prospective, non-interventional, multi-center observational study at 16 oncology centers across Turkey. Mean (SD) age was 61.3 (11.1) years and 74.8% were males. Data on duration of TKI treatment was the primary outcome measure. Additionally, overall response rate (ORR), progression free survival (PFS), overall survival (OS) and safety data were recorded. Results: Median duration of treatment was 8.2 months at a median follow up of 17.9 months. ORR and disease control rate were 12.5% and 70.8%, respectively. Median PFS and OS were 7.5 months (95%CI: 6.4–10.4) and 27.3 months (95%CI: 17.6–27.3) with no significant difference among three TKI agents in terms of treatment duration, ORR, PFS and OS. The most common adverse events excluding progression-which was the protocol requirement were diarrhea (13.6%), asthenia (13.6%) and hand-foot syndrome (12.6%). Dose modifications were required in 30.5% of the patients and 15% discontinued TKIs because of toxicity. Conclusions: Our findings confirm the efficacy and safety profile of TKIs in the first-line treatment of mRCC patients intolerant to cytokine treatment. There was no significant difference among three TKI agents in terms of treatment duration, ORR, PFS and OS. Trial registration: TURCOS ClinicalTrials.gov Identifier: NCT01585974. Registered April 25, 2012. [ABSTRACT FROM AUTHOR]

Objective: In the intensive care unit (ICU), prolonged inactivity is common, increasing patients' risk for adverse outcomes, including ICU-acquired weakness. Hence, interventions to minimize inactivity are gaining popularity, highlighting actigraphy, ameasure of activity involving a wristwatch-like accelerometer, as a method to inform these efforts. Therefore, we performed a systematic review of studies that used actigraphy tomeasure patient activity in the ICUsetting. Data Sources: We searched PubMed, EMBASE, CINAHL, Cochrane Library, and ProQuest from inception until December 2016. Study Selection: Two reviewers independently screened studies for inclusion. A study was eligible for inclusion if it was published in a peer-reviewed journal and used actigraphy to measure activity in≥5 ICU patients. Data Extraction: Two reviewers independently performed data abstraction and risk of bias assessment. Abstracted actigraphy-based activity data included total activity time and activity counts. Results: Of 16 studies (607 ICU patients) identified, 14 (88%) were observational, 2 (12%) were randomized control trials, and 5 (31%) were published after 2009. Mean patient activity levels per 15 to 60 second epoch ranged from 25 to 37 daytime and 2 to 19 nighttime movements. Actigraphy was evaluated in the context of ICU and post-ICU outcomes in 11 (69%) and 5 (31%) studies, respectively, and demonstrated potential associations between actigraphy-based activity levels and delirium, sedation, pain, anxiety, time to extubation, and length of stay. Conclusion: Actigraphy has demonstrated that patients are profoundly inactive in the ICU with actigraphy-based activity levels potentially associated with important measures, such as delirium, sedation, and length of stay. Larger and more rigorous studies are needed to further evaluate these associations and the overall utility of actigraphy in the ICU setting. [ABSTRACT FROM AUTHOR]

Laryngopharyngeal reflux (LPR) is an inflammatory condition suspected to be associated with dysphonia. In this study, we investigated multidimensional perceptual, aerodynamic, and acoustic voice changes in patients with clinically diagnosed LPR compared to healthy participants. We prospectively included 80 outpatients with Reflux Finding Score (RFS) >7 and Reflux Symptom Index (RSI) >13 from September 2013 to April 2016 and we compared clinical and voice quality assessments of these patients with 80 healthy participants. Statistically significant differences were found between groups with regard to Voice Handicap Index, perceptual voice quality (grades of dysphonia, roughness, strain, breathiness, asthenia, and instability), phonatory quotient, percentage jitter, percentage shimmer, peak-to-peak amplitude variation, standard deviation of fundamental frequency, and noise to harmonic ratio. Granulation score of RFS was found to affect the highest number of acoustic parameters. We did not identify significant correlation between vocal fold edema and objective voice quality measurements. This study supports that patients with LPR have significant deterioration of both subjective and objective voice quality compared to healthy participants. [ABSTRACT FROM AUTHOR]

Objective: We have been performing glottoplasty using angiolytic laser, including pulsed dye laser (PDL) or potassium titanyl phosphate (KTP) laser, for the treatment of sulcus vocalis. In this study, we retrospectively reviewed the treatment results of sulcus vocalis patients who had undergone glottoplasty using angiolytic laser and evaluated the efficacy and safety of this surgical technique. Methods: From January 2008 to April 2016, 79 patients with sulcus vocalis who underwent angiolytic LASER-assisted glottoplasty were enrolled in the study. Results: Of the 79 patients who participated in this study, 55 were male, and 24 were female. PDL was used for glottoplasty in 68 patients, and KTP was used in the remaining 11 patients. Seventy-seven patients underwent surgery for bilateral vocal cord lesions, and only 2 patients underwent surgery for unilateral vocal cord lesion. After glottoplasty using angiolytic laser, most patients showed continuous improvement of the GRBAS (grade, roughness, breathiness, asthenia, strain) score and Voice Handicap Index score until 6 months after the operation. In addition, we observed improvement of objective voice indices such as noise to harmonic ratio, jitter, shimmer, and maximal phonation time postoperatively. Conclusions: Based on these results, we confirmed the efficacy and safety of glottoplasty using angiolytic laser in sulcus vocalis patients. Further studies are needed to confirm appropriate laser settings such as frequency of treatments and total energy delivered to the lesion. Also, multi-institutional studies are needed to confirm the efficacy and safety of the operation. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to describe common iatrogenic causes of anterior glottic stenosis and to investigate the surgical treatment outcomes of 3 different techniques aimed at repairing stenoses and preventing web reformation. Methods: Clinical information regarding patient demographics, presentation, etiology, treatment, and follow-up outcomes was obtained retrospectively through a review of patients’ records between April 2010 and April 2017. Voice quality was evaluated using grade, roughness, breathiness, asthenia, and strain scale and Voice Handicap Index scores. Objective acoustic parameters were collected using the Kay Elemetrics Multi-Speech program. Results: Twenty patients were included in the study. Causes of glottic web formation included chemoradiation therapy and previous laryngeal surgery for polyps or malignant tumors at the anterior commissure. Web lysis with a CO2 laser, intralaryngeal suturing, and keel placement were used in surgical treatment. Satisfactory results were achieved in 19 patients, and 1 recurrence was observed. Grade, roughness, breathiness, asthenia, and strain scale and Voice Handicap Index scores and objective voice variables for patients with Cohen type I or II webs improved significantly after the surgery. Conclusions: Treatment modalities for anterior glottic stenosis should be carefully chosen according to the etiology of the web, as well as the length and depth of the glottis involved. [ABSTRACT FROM AUTHOR]

Introduction: Raltitrexed is a folate analogue, which selectively inhibits thymidylate synthase, used in the treatment of colorectal carcinoma. Common side effects include asthenia and gastrointestinal and haematological toxicities. Case report: We present the case of a 74-year-old gentleman with incidental mild interstitial lung disease on preoperative staging CT Chest who developed acute breathlessness whilst undergoing adjuvant raltitrexed treatment for a completely excised colorectal adenocarcinoma. Management and outcome: Discontinuation of raltitrexed and a course of steroid therapy resulted in resolution of symptoms, mirrored by an improvement in lung function tests. Discussion: The clinical pattern of rapid progression with steroid response highlights the potential for significant acceleration of interstitial lung disease by raltitrexed. [ABSTRACT FROM AUTHOR]

Objectives: In the EXTREME trial, a combination of cisplatin or carboplatin plus 5-fluorouracil (5-FU) and cetuximab was superior to cisplatin/carboplatin plus 5-FU for first-line treatment of recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). With the aim of improving fluoropyrimidine-related tolerance without decreasing its efficacy, the safety and efficacy of carboplatin plus the oral fluoropyrimidine tegafur and cetuximab were investigated. Methods: A retrospective analysis of 104 patients with recurrent or metastatic HNSCC was conducted. Patients were treated with carboplatin (area under the curve: 5 mg/mL/min) on day 1, oral tegafur (250 mg/m2 twice daily) for 21 consecutive days, and cetuximab (400 mg/m2 as an initial 2-hour intravenous infusion, then 250 mg/m2 as a 1-hour weekly infusion for 3 weeks) for ≤6 cycles. Patients who responded to the therapy then received weekly cetuximab maintenance therapy. Results: Treatment was well tolerated with a high level of compliance (relative dose intensity: 96%, 88%, and 81% for carboplatin, tegafur, and cetuximab, respectively). Grade 3-4 adverse events (AEs) were observed in 38% of patients (skin reactions in 17% of patients, anemia 4%, and neutropenia 3%). Grade 1-2 AEs included skin reactions (52% of patients), hypomagnesemia (20%), asthenia (19%), and anemia (13%). No venous thrombosis related to chemotherapy perfusion was observed. Over a median follow-up of 21 months, the median overall and progression-free survival were 11 and 6 months, respectively, and the overall response rate was 35%. Conclusions: Carboplatin plus oral tegafur and cetuximab is a safe, well-tolerated first-line therapy for recurrent or metastatic HNSCC. [ABSTRACT FROM AUTHOR]

In this contribution, we evaluate the short- and long-term effects of a prepaid cash incentive on young people’s cooperation and response rate in the fourth and fifth wave of a panel with sequential mixed-mode design (online questionnaire, CATI). Analyses are based on a survey experiment of students from randomly selected school classes of equal shares, which have participated in the third wave. Findings show that a monetary incentive has a direct and positive effect on the response rate in the fourth but not in the subsequent wave. However, the effect of the incentive is not persistent, since the effect weakens and fades away during the field phase and cannot be directly transferred to the second survey mode. As emphasized in the tailored design method (TDM), a monetary incentive can contribute to a shorter field phase and hence lower costs, but it is an insufficient instrument against panel attrition and the optimization of the retention rate when other strategies are disregarded. [ABSTRACT FROM AUTHOR]

Background No study dedicated to postdrome symptoms of migraine attacks is available in children and adolescents. Objective To study the resolution phase of the migraine attack in children and adolescents. Methods 100 children and adolescents with ICHD-3 beta migraine without and/or with typical aura were included. Each patient, and one of her/his parents, were interviewed by phone about the postdrome phrase of their last six months’ migraine attacks. They were specifically instructed to distinguish symptoms that had begun before and went on after migraine headache cessation (referred to as persistent symptoms), and symptoms whose onset was strictly after headache cessation (referred to as true postdromes). Results 91% of patients reported persistent symptoms, with a mean of 2.9 and a median of 2; asthenia, cognitive difficulties, pallor, cognitive slowing, anorexia, somnolence, and nausea were the most frequently reported. They lasted less than 12 h in 71% of patients. True postdromes were reported by 82% of patients, with a mean of 2.6 and a median of 2; thirst, somnolence, visual disturbances, food craving, paraesthesias, and ocular pain being the most frequently reported. They lasted less than 12 h in 94% of patients. Conclusions This study showed that children and adolescents with migraine had both frequent persistent symptoms and true postdromes. Both were notably different from those reported in adults. [ABSTRACT FROM AUTHOR]

This paper examines the relations and the tensions between debility and disability in global contexts defined by complex forms of bio-social precarity. My focus is Baan Kamlangchay, in Thailand, a care home providing care for older people with dementia and Alzheimer's disease from the global North. I treat Baan Kamlangchay as one concrete example of emerging circuits of transnational care/reproductive labour in order to investigate the interrelations between disability and wider global bio-political inequalities. Using the concept of 'biolegitimacy', I discuss the power dynamics in the relationships between the racialised and gendered care workers in the centre and (white) disabled residents. I argue that debility, understood as the flexible gradation of dis/ability and in/capacity, allows us to better understand these novel forms of embodied precarity and their political implications in global contexts. [ABSTRACT FROM AUTHOR]

In this article we investigate the way in which viral load assays are used to assess the viruses of Human Immunodeficiency Virus (HIV)-positive pregnant women who are cared for in an HIV-specialist antenatal clinic in London. One of the viral load assays has been made more sensitive to subtypes of the virus that are considered to be local, possibly reading the viruses of those who have 'foreign' subtypes as undetectable. Consequently, the patient might not be offered the kind of care needed to prevent transmission of HIV, as her body is not recognised as sufficiently debilitated. Thus, being identified as a debilitated body in this setting facilitates the prevention of vertical transmission of HIV and the management of the HIV-positive pregnant patient's virus. Further to this, we argue that in our example, having a debilitated body as constructed by the viral load assay is thus a 'privilege' that is accorded to HIV-positive persons depending on the geographic origin of their virus. Using Karen Barad's agential realism, we argue that the manner in which HIV is read through the viral load assay constructs a specific woman/foetus/HIV phenomenon. The specificity of this phenomenon directly impacts on the course of care, opening up or foreclosing the possibility of her child having a future free from HIV. [ABSTRACT FROM AUTHOR]

This paper is an intervention within feminist and queer debates that have re-posed so-called negative states of being as offering productive possibilities for political practice and social transformation. What is sometimes called the politics of negative affect or analyses of political feeling has sought to de-pathologise shame, melancholy, failure, depression, anxieties and other forms of 'feeling bad', to open up new ways of thinking about agency, change and transformation. Ann Cvetkovich's recent memoir explores depression as a public feeling and argues that 'feeling bad might, in fact, be the ground for transformation'. As she suggests, the question, 'how do I feel' could usefully be reframed as 'how does capitalism feel'? This performative staging of political forms of psychosocial reflexivity opens up new strategies for survival, new visions of the future, and importantly de-medicalises feeling beyond an individual expression of psychopathology. The grounds for affective politics might be found within new feminist futures that are attentive to the relations between emotion, affect, feelings and politics. This paper will be situated within these debates and the challenge of thinking about the productive possibilities of negative states of being. However, rather than focus on depression, I will turn my attention to experiences such as psychosis and temporal dissociation, based on my long-standing research with the Hearing Voices Network. In the context of discussions of disability and capability I will discuss the value of concepts such as debility, and 'living in prognosis', and respond to the call to think through what such states might offer for feminist and queer practice. [ABSTRACT FROM AUTHOR]

Some authors in disability studies have identified limits of both the medical and social models of disability. They have developed an alternative model, which I call the 'composite model of disability', to theorise societies' ableist norms and structures along with the subjective/phenomenological experience of disability. This model maintains that ableist oppression is not the only source of suffering for disabled people: impairment can be as well. From a feminist, queer, trans activist, anti-ableist perspective and using an intersectional, autoethnographic methodology, I apply this composite model of disability to trans identities to consider the potentially 'debilitating' aspects of transness. I argue that transness, like disability, has too often been perceived from two perspectives, medical or social, without the benefit of a third option. From a medical perspective, transness is reduced to an individual pathology curable with hormonal/surgical treatments, a conceptualisation that erases structural oppression. From a social point of view, transness is conceptualised as a neutral condition and variation in sex/gender identity. In this model, structural oppression (transphobia/cisgenderism) is seen as the only cause of 'trans suffering'. I argue that, just as the medical and social models of disability provide limited opportunities for reflection on the complex experience of disability, medical and social understandings of transness, respectively, are insufficient to describe the complexity of trans experience. I explore the possibilities presented by the application of a composite model of disability in trans studies. By both problematising cisgenderist oppression and acknowledging trans people's subjective experiences of suffering through some of the debilitating aspects of transness, this composite model avoids the pitfalls of the medical and social models. The application of tools from disability studies to trans issues uncovers cisnormativity in disability movements and denounces ableism in trans movements. This will, I hope, solidify alliances between these communities and fields of study. [ABSTRACT FROM AUTHOR]

The contemporary emergence of the concept 'debility', which pertains to a broad swathe of humanity whose ordinary lives simply persist without ever getting better, shares a time span with an acute critique of neo-liberal biopolitics. Where capital has historically relied on a population that through its labour necessarily becomes debilitated, the newer model of understanding references the intrinsic profitability of debility itself. The two dimensions overlap and co-exist, but what I shall pursue here are the implications of recognising that, at the most fundamental level, it is in the interests of neo-liberalism to produce and sustain bodies as debilitated and therefore susceptible to a range of market commodities that hold out the promise of therapeutic interventions into the relative failures of physical, cognitive and affective embodiment. In previous work, I have argued strongly for the inherent vulnerability of all bodies, but in considering here a more overtly politicised context, it becomes possible to readdress the questions posed by Jasbir Puar: 'which bodies are made to pay for 'progress'? Which debilitated bodies can be reinvigorated for neoliberalism, and which cannot?' And at the present moment, writing at a time of imposed austerity, I would add, what, if anything, is lost in the deployment of the term debility instead of disability? [ABSTRACT FROM AUTHOR]

The author offers her thoughts to the idea of queer theorist J. K. Puar about debility, arguing for an ecology of sensation as a methodology for thinking and feeling. She examines Puar's stance on debility, explaining her very own idea of a political economy of slow life. A slow temporal ecology of sensory aesthetics which is posited by cultures of intellectual disability is proposed.

In this paper I take up a critical position in regard to the theme of debility around which this collection is framed. I argue that theorisations of 'debility' do little to progress theory and policy in regard to disability and share many of the problems inherent to the social model. I also suggest that the theorisation of debility is rooted in and reinforces ablebodied privilege. I begin with a critical analysis of the social model of disability and explore the dualisms by which it either negates the body altogether or can only conceive the disabled body in negative terms. I then go on to explore how Puar's work on debility continues this negation of the disabled body. From this position I use the work of Inahara to excavate the foundations of ablebodied privilege. In Inahara's work gender is the analytic starting point, but for me white privilege is a much more effective mechanism through which to understand the impact and reproduction of ablebodied privilege-what McRuer refers to as 'compulsory ablebodiedness'-which I argue underpins Puar's work. I conclude with some reflections upon how a critical analysis of ablebodied privilege might function and I reiterate its importance for a critical theory that goes beyond the mere repetition of binary structures of ablebodiedness and disability. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including HIV virus in pregnant women, institutional barriers to inclusion, and theorisation of debility.

A case of a latissimus dorsi myotendinous junction strain in an avid CrossFit athlete is presented. The patient developed acute onset right axillary burning and swelling and subsequent palpable pop with weakness while performing a "muscle up." Magnetic resonance imaging examination demonstrated a high-grade tear of the right latissimus dorsi myotendinous junction approximately 9 cm proximal to its intact humeral insertion. There were no other injuries to the adjacent shoulder girdle structures. Isolated strain of the latissimus dorsi myotendinous junction is a very rare injury with a scarcity of information available regarding its imaging appearance and preferred treatment. This patient was treated conservatively and was able to resume active CrossFit training within 3 months. At 6 months postinjury, he had only a mild residual functional deficit compared with his preinjury level. [ABSTRACT FROM AUTHOR]

Neuroglia are represented by several population of cells heterogeneous in structure and function that provide for the homeostasis of the brain and the spinal cord. Neuroglial cells are also central for neuroprotection and defence of the central nervous system against exo- and endogenous insults. At the early stages of neurodegenerative diseases including Alzheimer’s disease neuroglial cells become asthenic and lose some of their homeostatic, neuroprotective, and defensive capabilities. Astroglial reactivity, for example, correlates with preservation of cognitive function in patients with mild cognitive impairment and prodromal Alzheimer’s disease. Here, we overview the experimental data indicating glial paralysis in neurodegeneration and argue that loss of glial function is fundamental for defining the progression of neurodegenerative diseases. [ABSTRACT FROM AUTHOR]

A case study of a 71-year-old woman with a clinical history of hypertension was complaining of asthenia and arthromyalgia, is presented. Topics include case of premature ventricular contractions (PVCs) linked to Hydroxychloroquine (HCQ) use; and diagnosis of COVID-19 disease was confirmed by positive reverse transcription–polymerase chain reaction test result for coronavirus-2 via nasal swab and admitted to the infectious disease department.

Within a 24-hour period, 7 out of 200 three- to four-week-old pastured Katahdin lambs died after showing clinical signs of hemoglobinuria, red-tinged feces, weakness, and recumbency. One of the lambs that was examined clinically before natural death also had abdominal pain, trembling, tachycardia, and severe anemia with a packed cell volume of 4%. Pathologic findings included icterus, hemoglobinuric nephrosis, dark red urine, pulmonary edema, hydrothorax, splenomegaly, and acute centrilobular to midzonal hepatocellular degeneration and necrosis with cholestasis. The differential diagnoses and diagnostic workup to achieve the diagnosis are briefly discussed. [ABSTRACT FROM PUBLISHER]

Weakness and fatigue are captured by the 6-minute walk test, but the relationship between these symptoms is uncertain. Comparison across neuromuscular diseases has not been examined. A cohort study of 114 patients with spinal muscular atrophy, Duchenne/Becker muscular dystrophy, myasthenia gravis, and energy failure syndromes were included. Percent-predicted distance on the 6-minute walk test was computed from normative values to determine weakness. Fatigue was determined by the decrement in distance from the first to sixth minute. Weakness was seen across all groups (61.9%) but significant fatigue was seen only in spinal muscular atrophy (21.0%). Other groups showed little fatigue. Correlation between weakness and fatigue was significant only in spinal muscular atrophy (R = –0.71; P < .001). Longitudinally, distance walked declined only in Duchenne/Becker muscular dystrophy. In spinal muscular atrophy, weakness did not change, but fatigue increased significantly. These findings suggest independent mechanisms underlying weakness and fatigue in diverse neuromuscular conditions. [ABSTRACT FROM PUBLISHER]

The article focuses on taste and smell dysfunction in COVID-19 infected patients. Topics include analysis of patients with Covid-19 and their taste dysfunction namely, ageusia or dysgeusia and anosmia that were present diagnosed by Polymerase chain reaction (PCR) of nasopharyngeal swab samples; and that the virus damages the gustatory and olfactory cells by binding to the ACE2 receptor.

A 10-year-old girl presented with progressive proximal limb muscle weakness without facial, ocular, or bulbar muscle involvement. There was no fatigability or diurnal fluctuation in symptoms. Her weakness worsened with febrile illnesses and recovered with accruing disabilities over a few weeks. Serum creatine kinase levels and muscle biopsy were normal. A significant decrement on repetitive nerve stimulation test and positive response to therapeutic neostigmine challenge test confirmed the diagnosis of limb-girdle myasthenia. She responded well to corticosteroids and thymectomy, demonstrating a likely autoimmune etiology. This case highlights the long-term fluctuations in a case of myasthenia gravis and the need for a high index of suspicion for myasthenia in children presenting with unexplained muscle weakness, even in the absence of typical features such as fatigability, diurnal fluctuation, and oculobulbar weakness. [ABSTRACT FROM PUBLISHER]

Objective: To describe the spatial relationship between relapse and disability in multiple sclerosis (MS).Methods: 141 relapse onset MS patients were studied. For each patient an examination was performed and a relapse history obtained. Multivariate logistic regression examined whether there was an association between localizing clinical signs and a history of relevant relapse in order to explore the spatial relationship between relapse and subsequent disability.Results: The presence of impaired vision or sensation was independently associated with a history of one or more anatomically related relapses. The presence of weakness or cerebellar ataxia in a limb was not associated with a single relevant relapse but was associated with multiple relevant relapses. A history of multiple episodes of weakness or ataxia in the same limb was uncommon.Conclusions: Our data suggest that motor pathways are relatively resistant to chronic impairment from acute relapse, whereas afferent pathways are more susceptible. This, in combination with prominent usage of the Expanded Disability Status Scale, which is dependent on mobility and motor function at higher scores, may explain the paradox between natural history studies that suggest relapses are irrelevant to long-term disability and shorter studies at lower disability levels suggesting relapses are responsible for disability accumulation. [ABSTRACT FROM AUTHOR]

Background: Hip muscle weakness has been proposed to contribute to patellofemoral malalignment and the development of the patellofemoral dysfunction syndrome (PFDS). However, from the retrospective studies that have addressed this issue, it is still unclear if hip muscle weakness is a cause or a consequence of PFDS.Purpose: This study was undertaken to investigate if hip muscle weakness is a predisposing factor for the development of PFDS.Study Design: Cohort study (prognosis); Level of evidence, 2.Methods: Before the start of a 10-week “start to run” program, the isometric strength of the hip flexor, extensor, abductor, adductor, and external and internal rotator muscles was measured in 77 healthy female novice runners. During the 10-week training period, patellofemoral pain was diagnosed and registered by an orthopaedic surgeon.Results: Statistical analysis revealed that there was no significant difference in strength of any of the assessed hip muscle groups between the runners who did and did not develop PFDS. Logistic regression analysis did not identify a deviation in strength of any of the assessed hip muscle groups as a risk factor for PFDS.Conclusion: The findings of this study suggest that isometric hip muscle strength might not be a predisposing factor for the development of PFDS. [ABSTRACT FROM AUTHOR]

Muscular (quadriceps) weakness is a predominant impairment that follows anterior cruciate ligament injury and surgery. This continued weakness impairs activities of daily living and could predispose patients to adverse conditions later in life, such as knee osteoarthritis. Vitamins E and C have potent antioxidant and anti-inflammatory activity. Herein, the authors summarize the state-of-the science and suggest directions for future research endeavors regarding the therapeutic influence of vitamins E and C, or other antioxidants, on the recovery from anterior cruciate ligament injury and surgery. [ABSTRACT FROM PUBLISHER]

A hand-grip dynamometer was used to assess the magnitude and prevalence of grip strength impairments among 41 home-care patients with diverse diagnoses (e.g., stroke, cancer, fracture, osteoarthritis). Based on published reference values, patients (as a whole) were weaker than normal for age and sex. The prevalence of weakness was 85.4% on one or the other side and 70.7% on both sides. Considering the prognostic importance of grip strength, this study emphasized the potential value of its measurement in a home-care population. [ABSTRACT FROM AUTHOR]

The article describes a study which discussed the presence of adenohypophysitis in a dog with polyendocrine disease that is similar to Schmidt syndrome. An overview is given to a four and a half-year-old spayed female Great Pyrenees that was presented to the Ontario Veterinary College Teaching Hospital for marked muscle atrophy of the hind limbs and progressive weakness over two months. It explains the findings of the histologic and immunohistochemical analysis conducted to the subject.

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is 'The trainee consistently demonstrates a knowledge of the pathophysiology of various specific impairments including lower motor neuron weakness' and 'management approaches for specific impairments including lower motor neuron weakness'. This article explores weakness as a lower motor symptom. Weakness as a primary impairment of neuromuscular diseases is addressed, with recognition of the phenomenon of disuse atrophy, and how weakness impacts on the functional abilities of people with myopathy and neuropathy. Interventions to reduce weakness or address the functional consequences of weakness are evaluated with consideration of safety and clinical application. Learning outcomes: This paper will allow readers to: (1) appraise the contribution of research in rehabilitation of lower motor neuron weakness to clinical decision making and (2) engage with the issues that arise when researching rehabilitation interventions for lower motor neuron weakness. Aim of article: Impairments associated with neuromuscular conditions can lead to significant functional difficulties that can impact on a person's daily participation. This article focuses on the primary impairment of weakness and explores the research evidence for rehabilitation interventions that directly influence weakness or address the impact of weakness on function. [ABSTRACT FROM AUTHOR]

A 1-year-old oriental cat was presented with a peracute onset of tetraparesis and vocalisation. Clinical findings were suggestive of multi-site thromboembolic disease, and this was confirmed on post-mortem examination. An echocardiogram showed severe restrictive cardiomyopathy and spontaneous echogenic contrast. To the author''s knowledge, this is the first reported case of tetraparesis secondary to cardiogenic arterial thromboembolic disease. Thromboembolic disease should be included as a differential diagnosis for any cat presented with a peracute onset of paresis or paralysis, even if there is no history of cardiac disease. [Copyright &y& Elsevier]

Radix Pseudostellariae is one of the most popular Traditional Chinese Medicine (TCM) for promoting the immune system, treating asthenia after illnesses with a long history in China and some other Asian countries. Rapid discrimination of R. Pseudostellariae according to geographical origin is crucial to pharmacodynamic action control. FT-NIR spectroscopy and supervised pattern recognition was attempted to discriminate R. Pseudostellariae according to geographical origin in this work. LDA, ANN and SVM were used to construct the discrimination models based on PCA, respectively. The number of PCs and model parameters were optimized by crossvalidation in the constructing model. The performances of three discrimination models were compared. Experimental results showed that the performance of SVM model is the best among three models. The optimal SVM model was achieved when 5 PCs were used, discrimination rates being 100% in the training and 88% in prediction set. The overall results demonstrated that FT-NIR spectroscopy has a high potential to discriminate qualitatively R. Pseudostellariae according to geographical origins by means of an appropriate supervised pattern recognition technique. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 53-year-old Caucasian male who was presented to an outside hospital with generalized weakness after a basketball game. It states that the patient was diagnosed with an acute myocardial infarction (MI) with cardiogenic shock and was given aspirin and started on oxygen, dopamine, and heparin infusions and taken to cardiac catheterization lab. The article discusses ventricular assist device (VAD) placement for his kidney, liver, heart and lung failure.

The purpose of this investigation was to determine the failure rate of in situ decompression for cubital tunnel syndrome as determined by the need for additional surgery. We performed a comprehensive chart review of 56 adult patients who had undergone in situ decompression for cubital tunnel syndrome in 69 extremities with more than 1 year follow-up. The patients completed a comprehensive questionnaire concerning preoperative and postoperative pain, numbness, and weakness. After decompression, symptoms were improved substantially or resolved. Five limbs (7%) with persistent symptoms postoperatively were treated successfully with anterior submuscular transposition. These data suggest that in situ decompression of the ulnar nerve is a reliable treatment for cubital tunnel syndrome and has a low failure rate. The uncommon patient with continued symptoms after decompression can be treated effectively with transposition of the ulnar nerve. [ABSTRACT FROM AUTHOR]

Practical relevance: Weakness is recognized somewhat infrequently in cats, but is an important manifestation of neurological disease. The clinician must perform a complete neurological examination to determine the neuroanatomic basis for the weakness. As for all species, the neuroanatomic diagnosis allows the clinician to generate an appropriate differential diagnosis, to design a diagnostic plan, to prognosticate, and ultimately to develop a treatment plan. Clinical challenges: The cause(s) of neurological weakness in the cat may be difficult to determine without access to advanced imaging modalities, cerebrospinal fluid analysis or electrodiagnostics. However, an accurate neuroanatomic diagnosis allows the clinician to pursue preliminary anomalous (vertebral anomalies), metabolic (eg, diabetes mellitus, electrolyte abnormalities) and neoplastic differentials via blood work, vertebral column and thoracic radiography, and abdominal ultrasound. Subsequently, referral to a specialty veterinary hospital may be warranted to pursue advanced neurodiagnostics. Audience: This review provides a framework for generating a neuroanatomic and differential diagnosis in the weak cat. It also discusses the pathogenesis and clinical signs associated with the most common neurological differentials for feline paresis. As such, it is aimed at both primary health care and specialty veterinarians. Patient group: The neurological conditions discussed in this review cause weakness in cats of all age groups. [Copyright &y& Elsevier]

The article discusses the concept of asthenia which means weakness. Some lexicographers consider asthenia as a synonym of syncope and asphyxia, most clinicians will consider these conditions as functionally different. General asthenia results from general debilitating factors such as coital excess, insomnia, lack of food, living in humid and lowly places. Asthenia can be considered as a pathological state, particularly when it leads to starvation or weakening of movement and mentation.

The article provides information on several cases of adverse drug reactions. A 58-year-old female who had undergone heart transplantation 14 years earlier has suffered proximal limb weakness and general muscle weakness after she undergone a stent procedure and began a clopidogrel treatment. It is said that there were cases of hyponatremia and syndrome of inappropriate antidiuretic hormone associated with duloxetine use.

If treatment-emergent central nervous system (CNS) symptoms following triptan therapy represent direct pharmacological effects of the drug, they should occur independent of response to active drug. However, if they represent unmasking of neurological symptoms of the migraine attack after pain is relieved, they should be more common in responders both to active drug and to placebo. To explore this issue, we evaluated the relationship between the CNS adverse events and treatment response following triptan or placebo treatment. We used pooled data from seven double-blind, placebo-controlled trials involving eletriptan 20 mg (E20, n = 402), eletriptan 40 mg (E40, n = 1870), eletriptan 80 mg (E80, n = 1393), sumatriptan 100 mg (S100, n = 275) and placebo (Pbo, n = 1024). Somnolence was more prevalent among 2 h headache responders than non-responders for all treatments, including E80 (8.8% vs. 5.0%; P < 0.05), E40 (6.4% vs. 5.0%; NS), E20 (4.0% vs. 2.0%; NS), S100 (4.7% vs. 3.2%; NS) and Pbo (7.6% vs. 3.0%; P < 0.05). Similarly, the incidence of asthenia was higher among patients who responded to treatment compared with those who did not respond to E80 (15.2% vs. 7.8%; P < 0.05), E40 (6.5% vs. 3.6%; P < 0.05), E20 (6.5% vs. 1.0%; P < 0.05), S100 (10.1% vs. 4.7%; NS) and Pbo (4.4% vs. 2.7%; NS). The generally higher rates of somnolence and asthenia in patients who respond to treatment suggests that these treatment-emergent neurological symptoms may represent the unmasking of CNS symptoms associated with the natural resolution of a migraine attack, rather than simply representing drug-related side-effects. The rate of somnolence in placebo responders is comparable to that in responders to E40 and E80, indicating that somnolence is related, at least in some important part, to headache relief and not treatment. [ABSTRACT FROM AUTHOR]

Seven children between 2 and 1 5 years of age with cerebral palsy and upper extremity dystonia were enrolled in an open-label, dose-escalation pilot clinical trial of botulinum toxin type B (Myobloc), injected into the biceps and brachioradialis muscles of 1 or both arms. The primary outcome measure was the change in maximum speed of hand movement during attempted forward reaching. Escalating doses of 12.5, 25, and 50 U/kg per muscle were injected at each of 3 visits. Reaching speed improved in response to injection, and dystonia scores on the Burke-Fahn-Marsden dystonia scale, the Unified Dystonia Rating Scale, and the Unified Parkinson's Disease Rating Scale improved. There was not a dose-related effect on efficacy. There were no serious adverse events. Two children reported transient weakness. These results support the use of botulinum toxin type B as a safe and effective treatment for upper extremity dystonia in children with cerebral palsy. Larger controlled trials are needed to confirm these results. [ABSTRACT FROM AUTHOR]

This study was performed to document the frequency, duration and types of symptoms of postdrome in migraine patients. Eight hundred and twenty-seven consecutive headache clinic patients (IHS 1.1, 1.2 and 1.5.1) were evaluated at first visit. Postdrome frequency, duration and characteristics were analysed. Sixty-eight per cent of 827 patients reported postdrome (69.1% females; 56.8% males, P < 0.007). The average duration of the postdrome was 25.2 h. Fifty-six per cent had postdrome for ≤ 12 h, 32% for 12–24 h, 88% for ≤ 24 h, and 12% for > 24 h. The commonest symptoms were tiredness (71.8%), head pain (33.1%), cognitive difficulties (11.7%), ‘hangover’ (10.7%), gastrointestinal symptoms (8.4%), mood change (6.8%), and weakness (6.2%). Patients with postdrome compared with patients without postdrome have more characteristic and more frequent migraine features. This study demonstrated postdrome in 68% of patients, duration ≤ 24 h in most patients, more often associated with a full-blown migraine attack, more common in females, and with commonest symptoms being tiredness and low-grade headache. [ABSTRACT FROM AUTHOR]

We present a 10-year-old boy from nonconsanguineous parents of Libyan (Sephardi) Jewish origin. Mild dysmorphism, hypotonia. and clubfoot deformities were noted at birth. On follow-up, he had borderline intelligence and nonprogressive muscle weakness, predominantly in the upper extremities. Physical examination revealed mild facial weakness, a bell-shaped chest cavity, kyphosis, winging of the scapula, and hypotonia of the shoulder girdle. Muscle biopsy demonstrated prominent variation in fiber size and central nuclei and numerous subsarcolemmal particles on modified Gomori trichrome stains. Electron microscopy depicted areas of disrupted sarcomeres with abnormal aggregates. Brain magnetic resonance imaging showed mild widening of the lateral ventricles and an enlarged cisterna magna, Molecular DNA analysis by polymerase chain reaction (PCR) and direct sequencing revealed a de novo heterozygous missense mutation in the skeletal muscle α-actin gene (ACTAl) changing codon 348 from TCG serine to TTG leucine, (J Child Neurol 2005;20:236-239). [ABSTRACT FROM AUTHOR]

The transition from curative to palliative care for elderly patients with cancer-related asthenia presents complex challenges to oncologists. A result of this complexity is a lack of regard for the maintenance of physical and mental function. This study examined the effects of comprehensive, multidisciplinary, inpatient rehabilitation on the physical and mental function of elderly cancer patients with asthenia. We found that both physical and mental function improved following inpatient rehabilitation. However, it is difficult to predict which patients benefit most from rehabilitation. Nevertheless, functional improvement following rehabilitation may allow medical caregivers to better distribute the type and intensity of care, and reduce the caregiver burden experienced by family members in the home. [ABSTRACT FROM AUTHOR]