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In the general population, the construct of race is associated with disparities in cognitive aging. There are notable racial group disparities and inequities among people living with schizophrenia (PLWSz). Despite the salience of the construct of race in schizophrenia, there remains a knowledge gap about racial disparities in cognitive impairment among older adults in this vulnerable population. Our study uses mediation analysis to examine racial disparities in cognitive impairment among older adults with schizophrenia.We assess global cognition in PLWSz over age 55 with the Measurement and Treatment Research to Improve Cognition in Schizophrenia cognitive test battery in our "all-comer" sample (There was a Black/non-Black group racial disparity in global cognitive score (-2.8, 95% CI: -4.4, -1.3) after adjusting for confounding and interaction. This disparity was significantly mediated by years of education.There are notable racial disparities in cognitive impairment among older adults with schizophrenia; however, differences in cognitive scores between racial groups are mediated by level of education.Social determinants of health, particularly educational attainment, are important risk factors for cognitive impairment in PLWSz and should be considered by clinicians. Early screening and assessment of cognitive symptoms is essential to addressing health disparities/inequalities among older adults living with schizophrenia.Controlled Direct EffectsHIV: Human Immunodeficiency VirusMATRICS: Measurement and Treatment Research to Improve Cognition in SchizophreniaMCCB: MATRICS Consensus Cognitive BatteryMTE: Marginal Total EffectsNDE: Natural Direct EffectsPANSS: Positive and Negative Symptom ScalePLWSz: People with schizophrenia.

The lateral step-down test is used to appraise movement quality in patients with patellofemoral pain (PFP), however, it is unclear if reliability of the test is affected by physical therapist experience.Determine if there is a difference in reliability between 'experienced' and 'novice' physical therapists appraising movement quality of patients with PFP during the lateral step-down test.Three 'experienced' and 3 'novice' physical therapists analyzed movement quality of 22 participants [mean age (SD) 28.25 (6.5) years] with PFP. Physical therapists viewed two-dimensional videos of participants performing the lateral step-down test and appraised the quality with a score (0-1 = 'good'; 2-3 = 'fair', and 4-5 = 'poor') at baseline and 1 week. Inter- and intra-rater reliability were calculated with kappa and percent agreement. Differences between the groups were assessed with the chi-square test with an a priori alpha level of0.05.Inter- and intra-rater reliability ranged from fair to moderate (ĸ = 0.40-0.65). There was no difference in reliability between 'experienced' and 'novice' physical therapists at baseline (There was no difference in reliability between 'experienced' and 'novice' physical therapists using categories to appraise movement quality during the lateral step-down test for patients with chronic PFP.

INTRODUCTION Advances in the treatment of myasthenia gravis (MG) have improved quality of life and prognosis for the majority of patients. However, 10%-20% of patients present refractory MG, with frequent relapses and significant functional limitations. PATIENTS AND METHODS Patients with refractory MG were selected from a cohort of patients diagnosed with MG between January 2008 and June 2019. Refractory MG was defined as lack of response to treatment with prednisone and at least 2 immunosuppressants, inability to withdraw treatment without relapse in the last 12 months, or intolerance to treatment with severe adverse reactions. RESULTS We identified 84 patients with MG, 11 of whom (13%) met criteria for refractory MG. Mean (standard deviation) age was 47 (18) years; 64% of patients with refractory MG had early-onset generalised myasthenia (as compared to 22% in the group of patients with MG; P

We performed a retrospective analysis of the patients assessed at our memory unit for whom Alzheimer disease (AD) cerebrospinal fluid biomarker results were available. We selected patients diagnosed with mild cognitive impairment due to AD (National Institute on Aging-Alzheimer's Association clinical criteria), confirmed neuropsychological deficit, a Global Deterioration Scale score of 3, and an abnormal profile of cerebrospinal fluid biomarkers. Of the 588 cases reviewed, 110 met the inclusion criteria. During follow-up, 50 cases (45.45%) progressed to dementia due to AD. Baseline levels of total and phosphorylated tau were higher in the group of patients that progressed to dementia than in those remaining with mild cognitive impairment. After adjusting for age, sex, history of hypertension, diabetes, and educational level, a 10% increase in total tau protein values was associated with a 7.60% increase in the risk of progression to dementia (hazard ratio: 2.22; 95% confidence interval, 1.28-3.84]; P = .004). Among patients with mild cognitive impairment due to AD and abnormal cerebrospinal fluid biomarker profiles, progressively higher concentrations of total or phosphorylated tau were associated with increased risk of progression to dementia.

Resumen En junio de 2019 se organizo en Sevilla el primer curso de resonancia magnetica (RM) fetal, con el aval de las sociedades espanolas de Radiologia Medica (SERAM) y Radiologia Pediatrica (SERPE), y se fundo el grupo espanol de RM fetal. Para establecer este grupo, se diseno un cuestionario para radiologos que se dediquen a la imagen prenatal en Espana que anuncio la Sociedad Espanola de Radiologia a sus socios. Las preguntas estaban relacionadas con el tipo de hospital, con los estudios de RM (campo magnetico, edad gestacional, uso de sedacion, numero de estudios por ano, proporcion de estudios de neuroimagen fetal) y con la docencia e investigacion de la RM fetal. Recogimos 41 respuestas de 25 provincias (88% hospitales publicos). Muy pocos radiologos realizan ecografia (7%) o tomografia computarizada prenatal en Espana. La RM se realiza en el segundo trimestre (34%) o tercer trimestre (44%). En el 95% de los centros predominan los estudios del cerebro fetal. El 41% de los centros tienen la posibilidad de realizar sus estudios en RM 3 Tesla. La sedacion materna se usa en el 17% de los centros. El numero de estudios de RM fetal por ano es muy variable, siendo mucho mayor en Barcelona y Madrid que en el resto de Espana.

Current research aims at improving early detection and treatment of cognitive impairment (CI), particularly in patients at high risk for progression to dementia. It is important to treat signs and symptoms as early as possible to normalize quality of life. In older cognitively impaired patients, dentists and physicians should consider polypharmacy, uncontrolled cardiovascular risk factors, depression, metabolic or endocrine derangements, delirium due to intercurrent illness, and dementia, all of which may increase risk for CI and other negative outcomes. An interdisciplinary team approach is a necessity for a responsible and safe treatment sequence.

Resumen Introduccion La eficacia de la trombectomia mecanica en territorio carotideo en las primeras 24 horas se ha probado con trabajos publicados recientemente. Metodos Revision retrospectiva a partir de un registro prospectivo en nuestro centro de referencia de ictus para valorar la eficacia y seguridad del tratamiento endovascular realizado mas alla de las 6 horas de evolucion de los sintomas en pacientes con ictus isquemico agudo y oclusion de gran vaso en territorio carotideo, entre noviembre de 2016 y abril de 2019. Resultados Se recopilaron datos de 59 pacientes (55,9% mujeres, mediana de edad 71 anos). Treinta y tres pacientes fueron detectados al despertar. El 57,6% de los casos fueron traslados secundarios. La mediana de NIHSS basal fue 16. La mediana del ASPECTS fue 8 y el 94,9% de los pacientes presento > 50% de tejido salvable. El 88,1% de los pacientes logro una recanalizacion satisfactoria, en 5 pacientes despues de 24 horas de evolucion. El 67,8% de los casos logro la independencia funcional a los 90 dias de seguimiento. Los pacientes que no lograron la independencia funcional presentaban mayor edad, mayor proporcion de fibrilacion auricular, mayor tiempo puncion-recanalizacion y mayor puntuacion NIHSS, tanto basal como al alta. Conclusion En nuestra experiencia la trombectomia mecanica despues de las 6 horas se asocio con buenos resultados de funcionalidad a los 90 dias. La edad, la puntuacion NIHSS, el tiempo puncion-recanalizacion y la prevalencia de fibrilacion auricular fueron factores determinantes en el pronostico funcional. La eficacia de este tratamiento por encima de las 24 horas merece ser estudiada.

Resumen Introduccion Junto con el envejecimiento de la poblacion general, la prevalencia de ancianos con esclerosis multiple (EM) se encuentra en aumento. El sistema inmunologico sufre profundos cambios a lo largo de la vida, por lo que parece imprescindible conocer que diferencias presentan respecto a pacientes mas jovenes. Desarrollo La inmunosenescencia, definida como la alteracion del sistema inmunologico en relacion con el envejecimiento natural, juega un papel esencial en la tolerancia, efectos adversos y respuesta a los tratamientos modificadores de la enfermedad. Entre las principales caracteristicas de este fenomeno, la involucion que sufre el timo es la mas destacable. Este hecho genera una reduccion en la produccion de celulas T virgenes. Ademas, se observa una ratio de linfocitos CD4 + /CD8 + invertido, alteraciones severas en el funcionamiento de las celulas NK o una disminucion en la capacidad de reparacion tisular cerebral. Conclusiones El numero de personas de edad avanzada con EM se encuentra en aumento en coincidencia con el envejecimiento de la poblacion general y gracias al avance en los tratamientos modificadores de la enfermedad, asi como a la mejora en la asistencia sociosanitaria de estos pacientes. El envejecimiento del sistema inmunitario conlleva un mayor riesgo de infecciones, tumores y enfermedades autoinmunes en los ancianos. En la EM, ademas, tiene lugar una aceleracion en la neurodegeneracion por la perdida de capacidad de remielinizacion del sistema nervioso. Conocer los cambios que tienen lugar en el sistema inmunologico de la poblacion de edad avanzada es esencial para mejorar la atencion de este grupo de pacientes cada vez mas prevalente.

Introduction Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. Methods We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. Results Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. Conclusion In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.

Introduction Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of sub-triage in patients attending the Emergency Department due to headache. Material and methods We studied a series of consecutive patients who came to the Emergency Department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. Results We registered a total of 1,120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, two patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and five as not urgent (2%). The percentage of patients under-triaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. Conclusion During the study period, at least one in 10 patients attending the Emergency Department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS under-triaged most patients with warning signs suggesting a potential emergency.

Resumen Introduccion El envejecimiento poblacional implica un desafio para los paises respecto a prevenir y detectar trastornos neurodegenerativos. El Montreal Cognitive Assessment (MoCA), test de cribado breve, de simple aplicacion, valido y confiable, evalua el estado cognitivo general, siendo util en contextos de salud publica. El estudio busca normalizar y estandarizar el test MoCA para poblacion chilena. Metodo Se presenta estudio de validacion para prueba diagnostica de tipo descriptivo y correlacional, se evaluo a 526 sujetos, hombres y mujeres, de entre 18 y 90 anos, sanos, del norte, centro y sur de Chile, analizando: el efecto de la edad, nivel educativo y sexo, para rendimiento de MoCA. Resultados Se demuestra un efecto significativo de la edad y el nivel educativo sobre el rendimiento cognitivo general segun MoCA. La edad, educacion y sexo explican 1-7% de la varianza. El rendimiento cognitivo medio del total de la muestra fue de 24,04 ± 3,22, para un rango definido originalmente por el instrumento de 26 puntos sobre 30. Los adultos mayores con menor educacion formal presentaron bajos resultados y menor rendimiento cognitivo. Se propone protocolo de evaluacion de resultados en percentiles y puntuaciones por rango de edad y puntuacion escalar normalizada individual. Discusion Se presentan datos normativos de MoCA segun las caracteristicas sociodemograficas chilenas y puntos de corte propuestos para discriminar el rendimiento cognitivo normal de trastornos neurocognitivos segun rangos de edad, ajustando los resultados al nivel educacional, la propuesta permitiria facilitar el uso del instrumento y disminuir la aparicion de falsos positivos.

Resumen Introduccion La miastenia gravis ocular (MGo) es la forma de presentacion de la enfermedad mas frecuente. Un porcentaje variable de estos pacientes desarrollan una forma generalizada (MGg), siendo los factores de riesgo de conversion y el efecto protector del tratamiento inmunosupresor objeto de controversia en el momento actual. Pacientes y metodos Disenamos un estudio monocentrico retrospectivo, con el objetivo de describir las caracteristicas demograficas, clinicas y de laboratorio de una cohorte espanola de MGo, a partir de una serie de MG registrada en el Hospital Universitario de Albacete desde enero del 2008 hasta febrero de 2020. Resultados Seleccionamos 62 pacientes con MGo de una cohorte de 91 sujetos con MG (68,1%). La mediana de edad al diagnostico fue de 68 (RIQ 52-75,3), con predominio de MGo de inicio muy tardio (n = 34, 54,8%) y de varones (n = 38, 61,3%). La diplopia binocular fue el sintoma inicial mas frecuente (51,7%). La tasa de conversion a MGg fue del 50% (n = 31), con una mediana de tiempo de seis meses (RIQ 2-12,8). Encontramos asociacion significativa entre ser mujer (OR: 5,46, IC 95% 1,16-25-74, p = 0,03) y tener AcAchR (OR: 8,86, IC 95% 1,15-68,41, p = 0,04), con el riesgo de desarrollar una MGg. Conclusiones La tasa de conversion de MGo en nuestra serie es relativamente elevada. La generalizacion tiene lugar principalmente durante los primeros dos anos de evolucion y esta asociada al sexo femenino y, sobre todo, a la presencia de AcAchR.

Transient loss of consciousness (TLOC) is a frequent cause of referral to an emergency room. In view of the impact on treatment and the patients’ daily life activities (e. g. profession, driving license), an accurate and timely diagnosis is of uttermost importance. This article provides key features and suggests a practical step-by-step approach of how to differentiate syncope, epileptic and psychogenic non-epileptic seizures as the commonest causes of nontraumatic TLOC.

Most oral health care providers encounter older adults in their practices and can play a critical role in supporting independence and quality of life for this aging cohort. Physiologic and structural oral cavity changes associated with normal aging may affect the presentation and oral health care of older adults. This article reviews the normative aging of dentition and oral structures and physiologic changes associated with normal aging, including cardiovascular, metabolic, and musculoskeletal changes, and how they may affect oral health. Oral health providers should be aware of normal aging processes when they plan care or schedule procedures for older adults.

Resumen Introduccion Se denomina sindrome de Terson (ST) a cualquier tipo de hemorragia intraocular (HIO), identificada en pacientes con patologia aguda intracraneal. El ST parece estar relacionado con la gravedad clinica en la hemorragia subaracnoidea (HSA), pero en pacientes con trauma craneoencefalico (TCE) y hemorragia intracerebral (HIC), su asociacion esta por definir. Disenamos este estudio para evaluar el rendimiento de la ecografia ocular (EO) y su utilidad en la practica clinica. Materiales y metodos Realizamos un estudio observacional prospectivo, unicentrico en pacientes neurocriticos. Analizamos los casos con respecto a los controles, identificados con oftalmoscopia indirecta (OI), y por EO. Determinamos las caracteristicas diagnosticas de la EO. Hicimos un analisis multivariante para determinar asociaciones clinicamente relevantes. Resultados Se incluyeron 91 pacientes con diagnosticos de HIC (41,76%), HSA (29,67%) y TCE (28,57%). El ST fue identificado por EO en ocho pacientes (8,79%) y en 24 pacientes (24,37%) por OI. La mortalidad ajustada para los pacientes con ST tuvo una OR 4,15 con IC 95% (1,52 - 11,33). Todos los pacientes con ST identificados por EO presentaron una escala de coma de Glasgow Conclusiones El ST diagnosticado por EO discrimina pacientes neurocriticos de extrema gravedad que pueden requerir el maximo escalon terapeutico y es un factor independiente de mortalidad intrahospitalaria.

Introduction The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. Methods Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. Results Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. Conclusions Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

Introducción: El tiempo sigue siendo una variable determinante para los tratamientos de reper-fusión del ictus isquémico agudo. A pesar de las recomendaciones de las guías clínicas, soloalrededor de la tercera parte de los pacientes con ictus isquémico agudo son fibrinolizadosen = 60 min. El objetivo de este trabajo es describir nuestra experiencia implementando unprotocolo específico de atención del ictus isquémico agudo y evaluar su impacto en nuestrostiempos puerta-aguja. Métodos: A finales del 2015, se implantaron gradualmente unas medidas dise ~nadas para acortarlos tiempos de actuación y optimizar la atención del ictus isquémico agudo incluyendo unaguardia específica de Neurovascular. Se compararon los tiempos de actuación antes (2013-2015)y después (2017-2019) de la introducción de este protocolo. Resultados: Se incluyó a 182 pacientes antes y 249 después de la intervención. Cuando todas lasmedidas fueron introducidas, la mediana global de tiempo puerta-aguja fue de 45 min (previa74 min, 39% menos, p < 0, 001) con un 73, 5% de pacientes tratados en = 60 min (47% más quepreintervención, p < 0, 001). El tiempo global al tratamiento (inicio síntoma-aguja) se redujo en20 min de mediana (p < 0, 001). Conclusiones: Las medidas asociadas en nuestro protocolo han conseguido una disminución deltiempo puerta-aguja de forma significativa y sostenida, aunque todavía nos queda margen demejora, la dinámica establecida de control de resultados y mejora continua hará posible seguiravanzando en este sentido. Introduction: Time continues to be a fundamental variable in reperfusion treatments for acute ischaemic stroke. Despite the recommendations made in clinical guidelines, only around one-third of these patients receive fibrinolysis within 60 minutes. In this study, we describe our experience with the implementation of a specific protocol for patients with acute ischaemic stroke and evaluate its impact on door-to-needle times in our hospital. Methods: Measures were gradually implemented in late 2015 to shorten stroke management times and optimise the care provided to patients with acute ischaemic stroke; these measures included the creation of a specific on-call neurovascular care team. We compare stroke management times before (2013-2015) and after (2017-2019) the introduction of the protocol. Results: The study includes 182 patients attended before implementation of the protocol and 249 attended after. Once all measures were in effect, the overall median door-to-needle time was 45 minutes (vs 74 minutes before, a 39% reduction; P

Resumen Introduccion La variabilidad glucemica (VG) hace referencia a las oscilaciones en los niveles de glucosa en sangre y podria influir en el pronostico del ictus. Objetivo: Analizar el efecto de la VG en la evolucion del infarto cerebral agudo (IC). Metodos Analisis exploratorio del estudio GLIAS-II (multicentrico, prospectivo y observacional). Se midieron los niveles de glucemia capilar cada cuatro horas durante las primeras 48 horas y la VG se definio como la desviacion estandar de los valores medios. Variables principales: mortalidad y muerte o dependencia a los tres meses. Variables secundarias: porcentaje de complicaciones intrahospitalarias y de recurrencia de ictus, e influencia de la via de administracion de insulina sobre la VG. Resultados Se incluyeron 213 pacientes. Los pacientes que fallecieron (N = 16;7,8%) presentaron mayores valores de VG (30,9 mg/dL vs. 23,3 mg/dL; p = 0,05). En el analisis de regresion logistica ajustado por edad y comorbilidad, tanto la VG (OR = 1,03; IC del 95%: 1,003-1,06: p = 0,03) como la gravedad del IC (OR = 1,12; IC del 95%: 1,04-1,2; p = 0,004) se asociaron de forma independiente con la mortalidad a los tres meses. No se encontro asociacion entre la VG y las demas variables de estudio. Los pacientes que recibieron tratamiento con insulina subcutanea mostraron una mayor VG que los tratados con insulina intravenosa (38,9 mg/dL vs. 21,3 mg/dL; p Conclusiones Valores elevados de VG durante las primeras 48 horas tras el IC se asociaron de forma independiente con la mortalidad. La administracion subcutanea de insulina podria condicionar una mayor VG que la via intravenosa.

Resumen Introduccion Comprender las alteraciones en la anatomia y funcion del cerebro en los procesos cognitivos para las enfermedades neurodegenerativas es aun un desafio para la neurociencia actual. Desde la neurociencia experimental algunos test computarizados han sido desarrollados para mejorar nuestro conocimiento de las redes neurales involucradas en la cognicion. El Attention Network Test (ANT) permite medir la activad de las 3 redes atencionales (alerta, orientacion y funcion ejecutiva). Objetivos El principal objetivo de esta revision fue describir todas las alteraciones anatomicas y funcionales encontradas en diversas enfermedades neurologicas usando el ANT. Material y metodos Un protocolo de revision fue aplicado seleccionando estudios desde 2010 en la base de datos PubMed, que involucraban al ATN en diferentes enfermedades neurologicas. Se obtuvieron 32 articulos para esclerosis multiple, epilepsia o Parkinson entre otras enfermedades. Conclusiones Se confirman algunas de las estructuras anatomicas propuestas para el modelo de 3 grandes redes atencionales. Las estructuras mas relevantes para la red de alerta son la corteza prefrontal, las regiones parietales, el talamo y el cerebelo. El talamo es tambien relevante para la red de orientacion, junto a regiones parietales posteriores. Respecto a la red ejecutiva no depende exclusivamente de la corteza prefrontal y corteza cingulada anterior, sino tambien de estructuras subcorticales como los ganglios basales y el cerebelo y sus proyecciones hacia toda la corteza.

Resumen Introduccion El trastorno psicotico compartido se caracteriza por la aparicion de sintomas psicoticos en personas que tienen un vinculo afectivo estrecho con un sujeto que padece un trastorno mental; este caso es el primer reporte de lesiones por quemaduras en el contexto de este trastorno. Caso Se trata de una pareja joven, con un patron similar de quemaduras causadas por el contacto con una plancha. Las lesiones son el resultado de la agresion causada por un familiar de uno de ellos, que presentaba sintomas psicoticos relacionados con el espectro de esquizofrenia no diagnosticado previamente. Conclusiones El impacto de esta afeccion abarca los componentes social, fisico y psicologico y requiere un tratamiento multidisciplinario y un alto indice de sospecha diagnostica.

Resumen Introduccion Los antipsicoticos son medicamentos que pueden producir elevaciones transitorias de las enzimas hepaticas. La clozapina es un antipsicotico atipico usado en el tratamiento de la esquizofrenia refractaria a los antipsicoticos convencionales y existe evidencia que puede producir elevaciones de las transaminasas hepaticas, expresion de dano hepatico con patron hepatocelular. Metodos Reporte de caso y revision no sistematica de la literatura relevante. Presentacion del caso Una mujer de 39 anos con diagnostico de esquizofrenia paranoide acudio a un servicio de urgencias de un hospital general por nauseas, vomitos e ictericia que aparecio tras el inicio de clozapina. No hubo mejoria clinica de la paciente durante la hospitalizacion, que fallecio a los 44 dias de su ingreso. Revision de la literatura La clozapina puede elevar las cifras de funcion hepatica de manera transitoria y asintomatica. Hay criterios clinicos para recomendar la suspension de este antipsicotico. Conclusiones Este caso es el tercero en la literatura que registra un desenlace fatal tras un cuadro de hepatotoxicidad inducido por clozapina.

Introduction Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit. Methods We reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months' follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events. Results Thirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects. Conclusions This is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants.

Several measurement models have been proposed for data from the continuous-reproduction paradigm for studying visual working memory: The original mixture model (Zhang & Luck, 2008) and its extension (Bays, Catalao, & Husain, 2009); the interference measurement model (Oberauer, Stoneking, Wabersich, & Lin, 2017), and the target confusability competition model (Schurgin, Wixted, & Brady, 2020). This article describes a space of possible measurement models in which all existing models can be placed. The space is defined by three dimensions: (1) The choice of a activation function (von-Mises or Laplace), the choice of a response-selection function (variants of Luce’s choice rule or of signal detection theory), and whether or not memory precision is assumed to be a constant over manipulations affecting memory. A factorial combination of these three variables generates all possible models in the model space. Fitting all models to eight data sets revealed a new model as empirically most adequate, which combines a von-Mises activation function with a signal-detection response-selection rule. The precision parameter can be treated as a constant across many experimental manipulations, though it might vary with manipulations not yet explored. All modelling code and the raw data modelled are available on the OSF: osf.io/zwprv

Resumen Introduccion La terapia electroconvulsiva es un procedimiento efectivo y seguro, el cual se indica principalmente a pacientes con episodios depresivos tanto unipolares como bipolares, mania y esquizofrenia, cuando no responden a otros tratamientos. Objetivo Describir las propiedades demograficas, sociales y clinicas de un grupo de pacientes tratados con terapia electroconvulsiva con anestesia y relajacion (TECAR) en la Clinica Universidad de La Sabana por un periodo de 8 anos. Metodos Se revisan las bases de datos y los registros de los procedimientos desde el 1 de enero de 2009 hasta el 31 de diciembre de 2017. Se realiza un analisis con estadistica descriptiva. Resultados En este periodo se realizaron 1.322 procedimientos a 143 pacientes, el 54,5% de ellos mujeres, y con diagnostico asociado de depresion mayor en el 57% de los pacientes. El numero de tratamientos por persona fue 9,2 y en el 3,8% se presentaron complicaciones, sin que se requiriese tratamiento invasivo en ninguna de ellas. Conclusiones La terapia electroconvulsiva se aplica con seguridad a los pacientes y con parametros diversos en cuanto a edad, sexo y diagnostico mas frecuente, en comparacion con otros paises de Latinoamerica y el mundo. Es importante sumar esfuerzos en investigacion que permitan tener un panorama mas completo de las caracteristicas de su aplicacion en el pais.

Resumen Introduccion La esclerosis multiple (EM) es una enfermedad desmielinizante del sistema nervioso central (SNC) que afecta a adultos jovenes, ocasionando una variedad de sintomas (motores, visuales, control de esfinteres, alteraciones de la marcha) que impactan la funcionalidad del paciente; sin embargo, otros sintomas, como la disfuncion sexual (DS), tambien pueden tener un efecto sobre la calidad de vida. Desarrollo La DS puede presentarse en cualquier momento del curso de la enfermedad, su prevalencia varia entre 50 y 90%, puede ser secundaria a lesiones desmielinizantes en medula espinal y/o cerebro, ocasionada por sintomas que no incluyen directamente el sistema nervioso —fatiga, aspectos psicologicos, sociales y culturales—. Si bien se ha logrado establecer su prevalencia y su impacto sobre la calidad de vida, la DS todavia es una condicion frecuentemente subestimada, razon por la cual en este articulo se revisan las diferentes escalas que ayudan a evaluar la presencia o la severidad de esta para dar un manejo multidisciplinario temprano, segun corresponda. Conclusion Cinco cuestionarios han sido evaluados y/o disenados para pacientes con EM, los cuales podrian identificar la presencia de DS, su etiologia y, con esto, determinar posibilidades de tratamiento. La EM debe ser comprendida como una enfermedad compleja que abarca y compromete diferentes aspectos de la salud de los pacientes, y va mas alla de solo medir escalas de discapacidad.

Resumen Objetivos Evaluar la seguridad y la eficacia de la embolizacion de arterias bronquiales y arterias sistemicas no bronquiales con n-butil-cianoacrilato en pacientes con hemoptisis. Metodos Se han analizado un total de 55 pacientes consecutivos con hemoptisis (14 leves, 31 moderadas y 10 masivas) tratados mediante embolizacion de arterias bronquiales y arterias sistemicas no bronquiales con n-butil- cianoacrilato entre noviembre de 2013 y enero de 2020. Las variables principales estudiadas son tasa de exito tecnico, tasa de exito clinico, tasas de recurrencia y complicaciones. Se ha realizado un analisis estadistico descriptivo y un analisis de supervivencia mediante el metodo de Kaplan-Meier. Resultados En 55 (100%) pacientes se ha realizado la embolizacion con exito tecnico y en 54 (98,2%), con exito clinico. Durante el seguimiento (media, 23,8 meses; rango intercuartilico, 9,7-38,2) ha recurrido en 5 de los 54 (9,3%) pacientes. La tasa de no recurrencia al ano ha sido del 91,9%, y a los 2 y 4 anos, del 88,7% despues del procedimiento inicial. Ha habido 6 (10,9%) complicaciones menores relacionadas con el procedimiento y ninguna mayor. Conclusiones La embolizacion de arterias bronquiales y arterias sistemicas no bronquiales con n-butil-cianoacrilato es segura y eficaz para controlar la hemoptisis con tasas de recurrencia bajas.

Resumen Introduccion La miastenia gravis (MG) es un enfermedad autoinmune que afecta a la transmision nerviosa a nivel de la union neuromuscular causando debilidad muscular tipicamente fluctuante. Los estudios epidemiologicos constatan un aumento de las tasas de prevalencia de la MG y es especialmente evidente en la poblacion anciana. Objetivo Realizar un estudio epidemiologico retrospectivo para conocer las tasas de incidencia y prevalencia en la provincia de Ourense (Galicia) caracterizada por el envejecimiento poblacional. Material y metodos Los pacientes fueron reclutados de nuestra base de datos clinica de enfermedades neuromusculares y a traves de la busqueda de pacientes con prescripcion activa de bromuro de piridostigmina. La tasa de incidencia se estimo entre los anos 2009-2018. Se establecio la fecha de prevalencia al 31/12/2018. El censo de la provincia de Ourense al 1/1/2019 era de 307.651 habitantes, de los que 96.544 (31,4%) tenian una edad ≥ de 65 anos. Resultados Se identificaron 80 casos de MG. La prevalencia fue de 260 casos/1.000.000 habitantes (IC95%: 202,7-316,4), y en la poblacion ≥ 65 anos de 517,9/1.000.000 habitantes (IC95%: 363,2-672,9). La incidencia acumulada en el periodo de estudio fue de 15,4 casos/1.000.000 habitantes-ano. El inicio precoz (≤ 50 anos) ocurrio en el 29,1% de los casos. Conclusion La prevalencia de la MG en nuestra area sanitaria es de las mas altas entre las cifras previamente reportadas, y es una enfermedad muy prevalente en la poblacion anciana.

Resumen Introduccion El sindrome opsoclono-mioclono-ataxia es un raro trastorno de inicio pediatrico; de base neuroinflamatoria y origen paraneoplasico, parainfeccioso o idiopatico. Actualmente no hay biomarcadores, siendo el diagnostico clinico. El pronostico cognitivo parece estar relacionado con el inicio temprano de la terapia inmunomoduladora. Metodo Se describen las caracteristicas epidemiologicas, clinicas, terapeuticas y pronosticas a largo plazo de una cohorte de 20 pacientes espanoles. Resultados La edad media de debut fue de 21 meses (2-59 meses). La ataxia y el opsoclonus fueron los sintomas de inicio mas frecuentes y predominantes en la evolucion. El tiempo medio desde los primeros sintomas hasta el diagnostico fue de 1,1 mes. Un tumor de extirpe neuroblastica fue detectado en el 45%, realizandose reseccion quirurgica en siete y quimioterapia en dos pacientes. En el estudio de liquido cefalorraquideo se constato pleocitosis en cuatro (25%), con negatividad de anticuerpos antineuronales y bandas oligoclonales en todos los casos estudiados. En el 100% se emplearon farmacos inmunomoduladores. En nueve pacientes el tratamiento combinado inmunomodulador se inicio desde el momento del diagnostico, y en cinco el tiempo medio de implementacion fue de 2,2 meses. A largo plazo, seis de 10 pacientes con seguimiento superior a cinco anos presentaban secuelas cognitivas leves o moderadas; cuatro pacientes presentaron recaidas, generalmente coincidiendo con el descenso de la corticoterapia. Conclusiones El inicio precoz de la inmunoterapia, asi como de la triple terapia en los casos que lo precisaron, se relaciono con una menor frecuencia de afectacion cognitiva a los dos anos del debut.

Resumen Introduccion La epilepsia es un conjunto de redes de estructuras cerebrales representadas bilateralmente, que estan funcional y anatomicamente conectadas; en la epilepsia, la actividad de cualquier parte del cerebro afecta la actividad de las demas. Esto es relevante para el entendimiento de la fisiopatologia, la etiologia, el diagnostico y la prognosis de esta enfermedad. Objetivo Revisar el estado del arte en cuanto al entendimiento de la vision neurofisiologica de la epilepsia como una enfermedad de redes neuronales. Resultados Se describen los principios basicos y avanzados de la epilepsia como enfermedad de redes neuronales usando distintos metodos clinicos y matematicos con una vision neurofisiologica, indicando las limitaciones de estos hallazgos en el contexto clinico. Conclusiones La epilepsia es una enfermedad de redes neuronales complejas cuyo entendimiento permitira mejorar los tratamientos disponibles y la certeza pronostica.

Resumen Introduccion Las variantes C1236T, G2677T/A y C3435T del gen ABCB1 alteran la funcion de la glicoproteina P y el transporte de sustancias endogenas y exogenas en la barrera hematoencefalica; ademas, actuan como factores de susceptibilidad para algunas enfermedades neurodegenerativas. El objetivo del estudio fue determinar la asociacion de polimorfismos ABCB1 (C1236T, G2677T/A y C3435T), sus haplotipos y sus combinaciones de genotipos con la enfermedad desmielinizante. Metodo Se genotipifico a 199 pacientes con enfermedad desmielinizante y a 200 controles mestizos mexicanos mediante PCR-RFLP y secuenciacion Sanger para comparar las frecuencias de alelos, genotipos, haplotipos y combinaciones de genotipos entre pacientes y controles. El analisis estadistico se realizo con regresion logistica y χ2 de Pearson al 95% de confianza; se calculo la OR y se evaluo la asociacion con enfermedad desmielinizante. Resultados Los haplotipos TTT y CGC fueron los mas frecuentes en pacientes y controles. El alelo G2677 (OR = 1,79; IC 95%: 1,12-2,86; p = 0,015) muestra asociacion con enfermedad desmielinizante, asi como los genotipos GG2677 (OR = 2,72; IC 95% = 1,11-6,68; p = 0,025) y CC3435 (OR = 1,82; IC 95%: 1,15-2,90; p = 0,010) y su combinacion GG2677/CC3435 (OR = 2,02; IC 95%: 1,17-3,48; p = 0,010) y el haplotipo CAT (OR = 0,21; IC 95%: 0,05-0,66; p = 0,001). Los portadores TTTTTT presentaron la edad de inicio mas temprana (23,0 ± 7,7 vs. 31,6 ± 10,7; p = 0,0001). Conclusiones La combinacion de genotipos GG2677/CC3435 esta asociada al desarrollo de enfermedad desmielinizante en esta muestra, principalmente en el sexo masculino, en el cual puede darse acumulacion toxica de sustratos de glicoproteina P. En este estudio, la edad de inicio de la enfermedad desmielinizante podria ser modulada diferencialmente entre sexos por el alelo G2677 del gen ABCB1.

Resumen Introduccion El manejo de la epilepsia durante la gestacion requiere un control optimo de las crisis, evitando los potenciales efectos teratogenicos del tratamiento antiepileptico. Objetivos Describir las caracteristicas clinicas y los resultados perinatales de las pacientes con epilepsia gestantes. Analizar los factores que se asocian a la presencia de crisis durante la gestacion. Describir los farmacos antiepilepticos mas utilizados y analizar los cambios en el regimen terapeutico en dos periodos: de 2000-2010 y 2011-2018. Metodos Se realizo un estudio prospectivo observacional de pacientes con epilepsia que notificaron su gestacion en el periodo de 2000-2018. Se evaluo a las pacientes en el primer y segundo trimestre de gestacion, tras el parto y al ano. Se recogieron variables demograficas, relacionadas con la epilepsia, perinatales y obstetricas. Resultados Se incluyeron 101 gestaciones. La edad media fue de 32,6 anos, el 55,4% tenia una epilepsia focal, el 38,6% una epilepsia generalizada y el 5,9% indeterminada. Se registraron 90 nacidos vivos, nueve abortos espontaneos y cinco malformaciones congenitas, cuatro de ellas en monoterapia con valproato. En 40 gestaciones (39,6%) se registraron crisis, siendo tonico-clonicas generalizadas en 16 (40%). Las variables asociadas con la presencia de crisis durante el embarazo fueron el mal control el ano previo a la gestacion (66,7% vs. 15,1%, p Conclusiones Los factores asociados con la presencia de crisis durante la gestacion fueron el mal control previo, el tratamiento con dos o mas farmacos antiepilepticos y la ausencia de tratamiento. Los farmacos mas utilizados fueron lamotrigina, valproato y levetiracetam, con un incremento de este ultimo y un descenso de valproato en el periodo mas reciente (2011-2018).

Resumen Introduccion La polineuropatia relacionada con el deposito de amiloide por transtiretina (hATTR, por sus siglas en ingles) es una enfermedad poco comun, multisistemica, de inicio en la edad adulta con un pronostico ominoso sin tratamiento. Para reconocer la enfermedad en la etapa mas temprana posible, se ha propuesto un grupo de signos y sintomas, comunmente conocidos como «red flags», y su presencia puede indicar la presencia de una hATTR subyacente en pacientes con polineuropatia sensitivo-motora progresiva. Materiales y metodos Se analizo la frecuencia de «red flags» en el momento del diagnostico en 30 pacientes con hATTR de un area no endemica de Espana, con una mayoria de pacientes de inicio tardio. Resultados Las frecuencias de «red flags» fueron las siguientes: sindrome del tunel carpiano bilateral 15/30 (50%); disautonomia temprana en 17/30 (56%); sintomas gastrointestinales en 14/30 (46,6%); perdida inexplicable de peso en 8/30 (26,6%); enfermedad cardiaca en 12/30 (40%); hallazgos cardiacos asintomaticos en 13/30 (43,3%); enfermedad renal en 1/30 (3,3%); opacidades vitreas en 0/30 (0%); neuropatia familiar en 21/30 (70%); cardiopatia familiar en 15/30 (50%) y antecedentes familiares gastrointestinales en 3/30 (10%). Todos los pacientes presentaron al menos una «red flag» en el momento del diagnostico, con una mediana de 4 «red flags». Conclusion Las «red flags», incluso en los pacientes de inicio tardio, fueron hallazgos comunes en el momento del diagnostico y su presencia en un paciente con polineuropatia sensitivo-motora simetrica deberia alertarnos y conducir el diagnostico a lo largo de la hATTR hasta excluirlo, independientemente de la edad de inicio o de la region endemica.

Resumen Introduccion Dadas las altas tasas de recurrencia, el hematoma subdural cronico (HSDC) es una condicion que supone un reto para el clinico. La embolizacion endovascular de la arteria meningea media (EeAMM) ha surgido como una alternativa para aquellos pacientes con problemas de salud o con varias recurrencias de su HSDC. A pesar de la publicacion de algunos articulos prometedores referentes a esta tecnica, el perfil de seguridad, las indicaciones y las limitaciones no estan claramente establecidas. Desarrollo Nuestro objetivo es evaluar la evidencia actual sobre la EeAMM en el HSDC. Se realizo una revision sistematica de la literatura segun las guias PRISMA. Nuestra busqueda arrojo un total de 6 estudios, en los que 164 pacientes con HSDC se sometieron a EeAMM. La tasa de recurrencia entre todos los estudios fue del 6,7% y se produjeron complicaciones en hasta el 6% de los pacientes. Conclusion La EeAMM es una tecnica factible en el tratamiento del HSDC con una tasa de recurrencia relativamente baja y tasas aceptables de complicaciones. Se necesitan mas estudios prospectivos y aleatorizados para establecer formalmente un perfil de seguridad claro y su efectividad.

Resumen La arteriopatia autosomica dominante cerebral con infartos subcorticales y leucoencefalopatia es una enfermedad autosomica dominante de pequenos vasos causada por mutaciones del gen NOTCH3. Tipicamente se presenta con migrana, eventos isquemicos cerebrales recurrentes y trastornos cognitivos. Las crisis epilepticas son inusuales como manifestacion inicial, pero aun mas infrecuente es su presentacion como status epilepticus no convulsivo 1 . Se presenta una serie familiar de 3 casos con esta arteriopatia, entre los cuales 2 de ellos tuvieron status epilepticus como manifestacion de la enfermedad.

Background: Radial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve transfers for the management of isolated radial nerve injuries. Methods: A retrospective chart review of 30 patients with isolated radial nerve injuries treated with tendon transfers and 16 patients managed with nerve transfers was performed. Fifteen of the 16 patients treated with nerve transfer had concomitant pronator teres to extensor carpi radialis brevis tendon transfer for wrist extension. Preoperative and postoperative strength data, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and quality-of-life (QOL) scores were compared before and after surgery and compared between groups. Results: For the nerve transfer group, patients were significantly younger, time from injury to surgery was significantly shorter, and follow-up time was significantly longer. Both groups demonstrated significant improvements in grip and pinch strength after surgery. Postoperative grip strength was significantly higher in the nerve transfer group. Postoperative pinch strength did not differ between groups. Similarly, both groups showed an improvement in DASH and QOL scores after surgery with no significant differences between the 2 groups. Conclusions: The nerve transfer group demonstrated greater grip strength, but both groups had improved pain, function, and satisfaction postoperatively. Patients who present early and can tolerate longer time to functional recovery would be optimal candidates for nerve transfers. Both tendon transfers and nerve transfers are good options for patients with radial nerve palsy.

Background: Social and demographic factors may influence patient treatment by physicians. This study analyzes the influence of patient sociodemographics on prescription practices among hand surgeons. Methods: We performed a retrospective analysis of all hand surgeries (N = 5278) at a single academic medical center from January 2016 to September 2018. The average morphine milligram equivalent (MME) prescribed following each surgery was calculated and then classified by age, race, sex, type of insurance, and history of substance use or chronic pain. Multivariate linear regression was used to compare MME among groups. Results: Overall, patients with a history of substance abuse were prescribed 31.2 MME more than those without ( P < .0001), and patients with a history of chronic pain were prescribed 36.7 MME more than those without ( P < .0001). After adjusting for these variables and the type of procedure performed, women were prescribed 11.2 MME less than men ( P = .0048), and Hispanics were prescribed 16.6 MME more than whites ( P = .0091) overall. Both Hispanic and black patients were also prescribed more than whites following carpal tunnel release (+19.0 and + 20.0 MME, respectively; P < .001). Patients with private insurance were prescribed 24.5 MME more than those with Medicare ( P < .0001), but 25.0 MME less than those with Medicaid ( P < .0001). There were no differences across age groups. Conclusions: Numerous sociodemographic factors influenced postoperative opioid prescription among hand surgeons at our institution. These findings highlight the importance of establishing more uniform, evidence-based guidelines for postoperative pain management, which may help minimize subjectivity and prevent the overtreatment or undertreatment of pain in certain patient populations.

Previous studies indicate that occupation might affect cognitive functioning in late life. As people in low- and middle-income countries often have to work until late life, we sought to investigate if there are cognitive benefits to working later into life and whether cognitive function deteriorates after exiting the labour force. We analysed longitudinal data from the Mexican Health and Aging Study (MHAS), a nationally representative sample of Mexican adults age 50+ (N = 7,375), that assessed cognitive functioning by verbal learning, delayed recall and visual scanning. Analyses were carried out using mixed-effects modelling corrected for the influence of gender, instrumental activities of daily living, diabetes, stroke, hypertension, depression, income and marital status. Results suggest that working actively, compared to exiting the workforce, was associated with cognitive performance only in context with occupation. Domestic workers had a faster decline in verbal learning (b = −0.02, p = 0.020) and delayed recall (b = −0.02, p = 0.036) if they continued working actively and people working in administration (b = 0.03, p = 0.007), sales (b = 0.02, p = 0.044) and educators (b = 0.03, p = 0.049) had a slower decline in visual scanning if they continued working in old age. Our findings indicate that continued participation in the labour force in old age does not necessarily come with cognitive benefits. Whether or not working actively in later life protects or even harms cognitive functioning is likely to depend on the type of job.

Background Traditional measures of evaluating scholarly output do not capture the impact social media can provide in disseminating and promoting research. We sought to better understand the level of online attention that high-quality hand research received. Methods Scientific manuscripts published from 2017 in Journal of Hand Surgery (American Volume) ( JHS-A), Journal of Hand Surgery ( European Volume) ( JHS-E), and HAND were recorded. Manuscript characteristics were determined, including the number of citations. Altmetric Attention Score (AAS), a measure of a manuscript’s online attention and impact, was determined, as well as Twitter mentions, Facebook mentions, and news outlet mentions. Spearman rho (ρ) correlation coefficient was used to evaluate the relationship between the number of citations and AAS. Multivariable linear regression analysis was performed to determine which manuscript factors were associated with AAS. Results A total of 323 manuscripts were identified. There was a weak positive correlation between the number of citations and AAS; however, this relationship did not exist for each individual journal. Publication in HAND and JHS-E were associated with lower average manuscript AAS when using JHS-A as the reference group. Two additional factors were also associated with increased manuscript AAS: (1) being a clinical study focused on a specific upper extremity anatomical location; and (2) increasing number of institutions on a study. Conclusions Publication in HAND and JHS-E were associated with lower manuscript AAS when using JHS-A as the reference group, suggesting that HAND and JHS-E have room for improvement in using social media to share their high-quality hand surgery scientific articles.

Background High-resolution ultrasound (HRU) has demonstrated utility in the diagnosis and treatment of carpal tunnel syndrome (CTS) by measuring the cross-sectional area (CSA) of the median nerve. We investigated whether HRU could be helpful in evaluating outcomes of carpal tunnel release in patients with severe CTS. Methods Patients greater than 18 years of age with severe CTS on electrodiagnostic (EDX) studies and scheduled to have carpal tunnel release were enrolled. At baseline visit within 6 weeks preoperatively, HRU was used to measure median nerve CSA at the carpal tunnel inlet and forearm, and the wrist/forearm ratio (WFR) was calculated. Patients also completed the Boston Carpal Tunnel Questionnaire (BCTQ). Ultrasound and BCTQ were repeated at 6 weeks and 6 months postoperatively. Results Twelve patients completed the study (average age, 69 years; range, 52-80 years). The WFR improved significantly at 6 weeks and reached normal levels at 6 months. The CSA at the wrist also improved at 6 months, although this did not reach statistical significance ( P = .059). Boston Carpal Tunnel Questionnaire symptoms and function scores improved significantly at 6 weeks and 6 months. Conclusions High-resolution ultrasound provides an objective assessment of surgical outcomes in cases of severe CTS, demonstrating normalization of WFR in our series of successful cases. Future study of poor outcomes may help determine whether improvement in WFR and CSA can provide reassurance and support for observation rather than reoperation. Ultrasound also provides anatomical evaluation and may be helpful in cases with medicolegal or psychosocial issues while potentially being less costly and better tolerated than EDX or magnetic resonance imaging.

Background: In treating occupational hand injuries under workers’ compensation, the 2 most important goals are to maximize patient function, ideally to preinjury levels, and permit a timely return to work (RTW). The purpose of this study was to determine factors affecting total case length, that is, the total time from injury until primary closure of a patient’s claim, and disposition among patients with hand injuries treated under workers’ compensation. Methods: All cases treated under workers’ compensation by a single fellowship-trained hand surgeon within a single year were retrospectively reviewed. A case is defined as the entire management and treatment of a single patient related to a single occupational injury incident. Independent variables included age, sex, body mass index, comorbidity, occupation, injury pattern, and treatment modality. Dependent variables included treatment duration from injury to case closure and final case disposition (RTW, functional capacity evaluation [FCE], or loss to follow-up [LTFU]). Comparison between groups was accomplished with analysis of variance. Multivariate linear and logistic regression analysis was performed to predict case length and disposition. Results: In all, 447 cases involving a workers’ compensation claim were reviewed. Among these, 75 (16.8%) were LTFU, 24 (5.4%) required an FCE, and 346 (77.4%) an RTW. The RTW cases averaged 138.5 days, whereas those requiring FCE averaged 331.5 days. Compared with average case length, crush injuries (76.8 days. P < .001) and fractures (111.8 days, P = .0224) had significantly shorter time to closure. In a multivariate linear model, cases of soft tissue and nerve injury were associated with longer case lengths, remaining open for an additional 56.8 and 347.1 days, respectively ( P < .001). Each treatment modality studied, therapy, injections, and surgery, was associated with an increase in case length. Conclusions: Cases requiring FCE were open significantly longer than those resulting in RTW. In addition, injury pattern and treatment modality were associated with significant variations in total case length. These results imply that a specific subset of patients, namely those with soft tissue and nerve injuries, may experience delayed resolution among patients treated under a workers’ compensation claim.

Partial nerve recovery either after expectant observation following an injury in-continuity or after nerve repair is not an uncommon occurrence. Historically, treatment strategies in these situations—late repair, revision repair, or acceptance of a mediocre result—were unsatisfying. The reverse end-to-side, or supercharging, nerve transfer was conceived to offer a more palatable option. Partially validated primarily through small animal research, supercharging has been rapidly translated to clinical practice. Many have extended the indications beyond the original intent, though the final place of this technique in the peripheral nerve surgeon’s armamentarium is still yet to be determined.

Background Vitamin D deficiency is now recognized as an independent risk factor and is involved in the pathogenesis of carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the effects of vitamin D3 supplementation on functional and symptomatic outcomes in CTS patients with vitamin D deficiency. Methods This was a prospective, single-arm study with a pretreatment or posttreatment quasi-experimental design. Carpal tunnel syndrome patients with vitamin D deficiency were treated with vitamin D3 (60 000 IU/week) plus standard treatment for a period of 3 months. Carpal tunnel syndrome–related pain and functional and symptomatic outcomes were assessed at baseline and at 3 months posttreatment using the Visual Analogue Scale (VAS) and the Boston Carpal Tunnel Questionnaire, respectively, along with serum vitamin D. Results A total of 42 patients were analyzed. At 3 months posttreatment, there was a significant reduction in the severity of pain (VAS score) from baseline ( Z = −5.71, P < .001). Similarly, the functional and symptomatic outcomes (Boston symptoms severity scale [SSS] and Boston functional status scale [FSS] score) at 3 months posttreatment significantly improved in comparison with baseline (Boston SSS: Z = −5.66, P < .001; Boston FSS: Z = −5.68, P < .001). Conclusions Vitamin D3 supplementation was associated with improvement in functional and symptomatic outcomes and CTS-related pain in CTS with vitamin deficiency. However, further robust randomized controlled trials are warranted to validate the results.

OBJECTIVES: Extensive literature has documented the experiences of informal caregivers and their interactions with formal care providers, yet this research is almost entirely limited to caregivers who live near their care-recipients. This study aims to describe long-distance caregivers’ (LDC) experiences (e.g., satisfaction and challenges) with formal care providers. Subgroup differences were examined based on the care-recipient’s (CR) dementia status and residential setting (community versus residential care). METHODS: Data were collected from 296 LDCs (M(age)=56.64, SD=12.40) categorized into four subgroups based on CR dementia status and residential setting. Participants rated their overall satisfaction, satisfaction with communication and information, and described challenges faced in their interactions with formal care providers. RESULTS: Challenges related to formal care providers were significantly greater and satisfaction significantly lower among LDCs of CRs in residential care, irrespective of dementia status, when compared to LDCs of CRs in the community. CONCLUSIONS: This study provides insights into the experiences of a growing segment of the caregiver population managing care from a distance, specifically in their interactions with formal care providers. CLINICAL IMPLICATIONS: The results of this study point to the possible necessity for the development of novel interventions to improve and enhance communication and collaboration between FCPs and informal caregivers.

The perspectives of professionals involved in behavioral health (BH) services with short-stay residents in skilled nursing facilities (SNFs) are rarely captured in the literature. This study examines the real-world experiences of BH clinicians and administrators in post-acute/subacute care units in SNFs.This qualitative study used semi-structured interviews with 18 clinicians (e.g., psychologists and social workers) and five administrators (e.g., directors of social services or BH company executives) involved in BH services with short-stay SNF residents. Interviews were recorded, transcribed, and analyzed by two independent coders using conventional thematic content analysis.Three themes emerged from the data: (1) BH needs are high among short-stay residents and families during post-acute care transitions; (2) BH services offer multiple unique opportunities to enhance post-acute/subacute care in SNFs; and (3) barriers to providing optimal BH care exist at multiple levels and require action from BH clinicians and stakeholders.Variability in clinician roles and barriers to optimized care suggest the need for future research targeting best practices and implementation strategies for BH services with short-stay SNF residents.Results identified multiple ways in which BH services may enhance resident, family, and staff outcomes, as well as the milieu in SNFs.

OBJECTIVE Emotion dysregulation is a transdiagnostic risk factor for many mental health disorders and develops in the context of early trauma exposure. Research suggests intergenerational risk associated with trauma exposure and posttraumatic stress disorder (PTSD), such that maternal trauma experiences and related symptoms can negatively impact child outcomes across development. The goals of the present study were to examine child and mother correlates of child PTSD symptoms and the unique roles of child and maternal emotion dysregulation in understanding child PTSD symptoms. METHOD Subjects included 105 African American mother-child dyads from an urban hospital serving primarily low-income minority individuals. RESULTS Correlational results showed that child trauma exposure, child emotion dysregulation, maternal depressive symptoms, maternal emotion dysregulation, and potential for maternal child abuse all were significantly associated with child PTSD symptoms (ps < 0.05). Hierarchical linear regression models revealed that child trauma exposure, maternal depression, and maternal abuse potential accounted for 29% of the variance in child PTSD symptoms (p < 0.001). Both child emotion dysregulation (Rchange² = 0.14, p < .001) and maternal emotion dysregulation (Rchange² = 0.04, p < .05) were significantly associated with child PTSD symptoms independent of other risk factors and potential for maternal abuse was no longer a significant predictor. CONCLUSIONS These results suggest that maternal emotion dysregulation may be an important factor in influencing their child's PTSD symptoms above and beyond child-specific variables. Both maternal and child emotion dysregulation could be valuable treatment targets for improving maternal mental health and parenting behaviors and bolstering child health outcomes, thus reducing intergenerational transmission of risk associated with trauma. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Wheelchair users often experience prolonged periods of stationary sitting. Such periods are accompanied with increased loading of the ischial tuberosities. This can lead to the development of pressure ulcers which can cause complications such as sepsis. Periodic pressure offloading is recommended to reduce the onset of pressure ulcers. Experts recommend the periodic execution of different movements to provide the needed pressure offloading. Wheelchair users, however, might not remember to perform these recommended movements in terms of both quality and quantity. A system that can detect such movements could provide valuable feedback to both wheelchair users as well as clinicians. The objective of this study was to present and validate the WiSAT - a system for characterizing in-seat activity for wheelchair users. WiSAT is designed to detect two kinds of movements - weight shifts and in-seat movements. Weight shifts are movements that offload pressure on ischial tuberosities by 30% as compared to upright sitting and are maintained for 15 seconds. In-seat movements are shorter transient movements that involve either a change in the center of pressure on the sitting buttocks or a transient reduction in total load by 30%. This study validates the use of WiSAT in manual wheelchairs. WiSAT has a sensor mat which was inserted beneath a wheelchair cushion. Readings from these sensors were used by WiSAT algorithms to predict weight shifts and in-seat movements. These weight shifts and in-seat movements were validated against a high-resolution interface pressure mat in a dataset that resembles real-world usage. The proposed system achieved weight shift precision and recall scores of 81% and 80%, respectively, while in-seat movement scores were predicted with a mean absolute error of 22%. Results showed that WiSAT provides sufficient accuracy in characterizing in-seat activity in terms of weight shifts and in-seat movement.

In-home assessment of everyday activities over many months to years may be useful in predicting cognitive decline in older adulthood. This study examined whether a comparatively brief data collection period (3 months) may yield similar diagnostic information. A total of 91 community-dwelling older adults without dementia underwent baseline neuropsychological testing and completed weekly computer-based surveys assessing health-related events/activities. A subset of participants wore fitness tracker watches assessing daily sleep and physical activity patterns, used a sensor-instrumented pillbox, and had their computer use frequency recorded on a daily basis. Similar patterns in computer use, sleep and medication use were noted in comparison to prior literature with more extensive data collection periods. Greater computer use and sleep, as well as self-reported pain and independence, were also linked to better cognition. These activities and symptoms may be useful correlates of cognitive function even when assessed over a relatively brief monitoring period.

Background Reconstructive surgery for upper extremity manifestations of cerebral palsy (CP) has been demonstrated to be safe and effective, yet many potential candidates are never evaluated for surgery. The purpose of this study was to determine barriers to upper extremity reconstruction for patients with CP in a cohort of upper extremity surgeons and nonsurgeons. Methods We sent a questionnaire to 4167 surgeons and nonsurgeon physicians, aggregated responses, and analyzed for differences in perceptions regarding surgical efficacy, patient candidacy for surgery, compliance with rehabilitation, remuneration, complexity of care, and physician comfort providing care. Results Surgeons and nonsurgeons did not agree on the literature support of surgical efficacy (73% vs 35% agree or strongly agree, respectively). Both surgeons and nonsurgeons felt that many potential candidates exist, yet there was variability in their confidence in identifying them. Most surgeons (59%) and nonsurgeons (61%) felt comfortable performing surgery and directing the associated rehabilitation, respectively. Neither group reported that patient compliance, access to rehabilitation services, and available financial resources were a major barrier, but surgeons were more likely than nonsurgeons to feel that remuneration for services was inadequate (37% vs 13%). Both groups agreed that surgical treatments are complex and should be performed in the setting of a multidisciplinary team. Conclusions Surgeons and nonsurgeons differ in their views regarding upper extremity reconstructive surgery for CP. Barriers to reconstruction may be addressed by performing higher level research, implementing multispecialty educational outreach, developing objective referral criteria, increasing surgical remuneration, improving access to trained upper extremity surgeons, and implementing multidisciplinary CP clinics.