Medical Specialties Commons^™

Musculoskeletal Pain Outcomes Pre- And Post Intrathecal Baclofen Pump Implant In Children With Cerebral Palsy: A Prospective Cohort Study., Chantel C. Barney, Alyssa M. Merbler, Jean Stansbury, Linda E. Krach, Michael D. Partington, Patrick Graupman, Peter D. Kim, Debbie Song, Frank J. Symons

Manuscripts, Articles, Book Chapters and Other Papers

Objective: To characterize musculoskeletal pain intensity, duration, frequency, and interference with activities of daily living in children with cerebral palsy (CP) before and after intrathecal baclofen pump placement.

Design: Prospective cohort study.

Setting: Children's tertiary hospital.

Participants: Participants were children with CP (N=32; 53% male; mean age, 9.9y; age range, 4-17y). The majority of participants had a CP diagnosis of quadriplegia (76%) and relied on wheeled mobility (91%).

Interventions: Assessments were completed pre- and post intrathecal baclofen pump implant.

Main outcome measures: Because of considerable patient heterogeneity, both pain measures (Brief Pain Inventory, Dalhousie Pain Interview) were completed by proxy …

Metastatic Spinal Cord Compression Mimicking Cauda Equina Syndrome Illustrating Importance Of Adequate Diagnostic Imaging, Jonathan L. Holt, Joseph Hill, Farzin Farhandnejad, Karyn Doddy, Se Won Lee

Physical Medicine & Rehabilitation

See additional files.

Rehabilitation Following Valproic Acid-Induced Hyperammonemic Encephalopathy (Vhe) In A Patient With Intractable Epilepsy, Dan Nguyen, Ann Ikonne, Sewon Lee, Mark Steinhauer

Physical Medicine & Rehabilitation

See additional documents.

Worsening Weakness After Posterior Cervical Decompression And Fusion; The Challenge In Diagnosis, Steven D. Kim, Joseph Hill, Farzin Farhandnejad, Karyn Doddy

Physical Medicine & Rehabilitation

See additional files.

Unmasking Severe Hypotension After Intermittent Catheter For Distended Bladder In A Patient With Cervical Spinal Cord Injury, Dennis Nguyen, Neal Ekpoudia, Ellsworth Remson, Farzin Farhandnejad, Se Won Lee

Physical Medicine & Rehabilitation

See additional files.

Cell Type Composition And Circuit Organization Of Clonally Related Excitatory Neurons In The Juvenile Mouse Neocortex, Cathryn R Cadwell, Federico Scala, Paul G Fahey, Dmitry Kobak, Shalaka Mulherkar, Fabian H Sinz, Stelios Papadopoulos, Zheng H Tan, Per Johnsson, Leonard Hartmanis, Shuang Li, Ronald J Cotton, Kimberley F Tolias, Rickard Sandberg, Philipp Berens, Xiaolong Jiang, Andreas Savas Tolias

Faculty, Staff and Students Publications

Clones of excitatory neurons derived from a common progenitor have been proposed to serve as elementary information processing modules in the neocortex. To characterize the cell types and circuit diagram of clonally related excitatory neurons, we performed multi-cell patch clamp recordings and Patch-seq on neurons derived from Nestin-positive progenitors labeled by tamoxifen induction at embryonic day 10.5. The resulting clones are derived from two radial glia on average, span cortical layers 2–6, and are composed of a random sampling of transcriptomic cell types. We find an interaction between shared lineage and connection type: related neurons are more likely to …

Neurological Involvement In Covid-19 Infections; Pathophysiology, Presentation And Outcome., Dureshahwar Kanwar, Muhammad Imran, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Severe acute respiratory syndrome corona virus 2 (SARS CoV 2) seems to display an increasing affinity for the nervous system. The ongoing pandemic has made evident that diverse neurological manifestations may occur with COVID 19. Headache and dizziness remain the most common symptoms however stroke, seizures, encephalopathy, neuropathy and skeletal muscle injury may be seen. An increasing number of patients report initial anosmia and ageusia. Tendency for serious illness is believed to be in the elderly or people with a history of diabetes, high blood pressure and heart disease. Many patients on immunosuppressive therapies such as multiple sclerosis, myasthenia gravis …

Primary Intracranial Malignant Melanoma, Ummey Hani, Dr Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Primary intracranial malignant melanoma (PIMM) are rare brain tumours; more infrequent than melanomas metastasizing to the brain or those extending to the brain from adjacent structures such as the orbit. Complete surgical excision with adjuvant chemotherapy and radiation remains the mainstay of treatment. Herein, we have reviewed the literature to find the treatment modalities for PIMMs that can lead to longer overall survivals and better patient outcomes.

Narcolepsy :A Review Amongst Sleep Disorders., Muhammad Umer Ahmed, Manahil Jeoffrey, Omer Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Narcolepsy is a sleep disorder known and studied about from time to time is a sleep disorder characterized by a combination of myriad of symptoms including excessive day time sleepiness with recurrent irresistible sleep attacks , hypnogogic hallucinations ,hypnopompic hallucinations ,sleep paralysis and cataplexy (sudden and bilateral loss of muscle tone.1 Narcolepsy may present it self long with cataplexy or without cataplexy. The pathogenesis behind narcolepsy is found to be due to degeneration of hypocretin/orexin secreting neurones in the central nervous system due to disorder of human leukocyte antigen DQB1*0602.Narcolepsy is a deblitating disorder which causes intense functional impairment and …

Factors Predicting Need For Post-Operative Ventilation After Microsurgical Clipping Of Cerebral Aneurysms – A Multivariate Analysis, Usman Siddiqui, Muhammad Faheem Khan, Saad Bin Anis, Bushra Ahmad, Muhammad Shahzad Shamim, Rida Mitha, Fouzia Anis Khan, Erfan Hussain

Pakistan Journal of Neurological Sciences (PJNS)

Patients with aneurysmal Subarachnoid Hemorrhage (aSAH) frequently require Intensive Care Unit (ICU) beds, pre-operatively and more often, post-operatively due to the need for ventilatory support and specialized monitoring. We aimed to evaluate the frequency of post-operative ventilatory requirement in patients with aSAH and identify the possible predictive factors that might influence the need of post-operative ventilation in these patients. METHODS: We retrospectively identified a five-year data of all patients with aSAH who underwent surgical clipping using a structured proforma. Aneurysm was confirmed by Digital Subtraction Angiography (DSA) or Computerized Tomographic Angiography (CTA).

Prediction Of Cognitive And Intellectual Competence In Kindergarten Schools Associated With General Measures Of Health: A Study On Children With Age Ranges Between 4 To 7 Years, Abeer Musaddiq, Yusra Saleem, Muhammad Bilal Siddiqui, Shamoon Noushad, Sadaf Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND Stunting refers to the low “height-for-age” measurement. Literature suggests that it is associated with delayed or diminished physical development, cognition and intellectual abilities. OBJECTIVES: This study aimed to estimate the physical growth measures among children under 4 to 7 years of age and to determine its relationship with cognitive deficits & intellectual performances.

Chikungunya Encephalitis: Usual Presentation At An Unusual Time. A Case Report, Muhammad Owais Hashmat, Dureshahwar Kanwar, Iffat Khanum Khanum

Pakistan Journal of Neurological Sciences (PJNS)

CHIK is an arboviral infection caused by chikungunya virus transmitted by Aedes mosquito worldwide. It usually manifests as a self-limiting acute febrile illness with rash, body ache and severe polyarthralgia; in some patients, symptoms persist up to months or even years. Neurological manifestations are relatively uncommon. In recent years Pakistan and other South East Asian countries have been hit several times by its epidemics1. We report a case of a middle-aged male who presented in our hospital with acute febrile illness along with neurological manifestations. Extensive laboratory investigations were done and he was diagnosed with seropositive CHIKV. He was treated …

Patterns Of Eeg(Electroencephalogram) Findings In Patients With Neurological Disorders, Saba Zaidi, Amsa Khan

Pakistan Journal of Neurological Sciences (PJNS)

OBJECTIVE: To study the patterns of EEG in patients with neurological disorders BACKGROUND: EEG is still relevant in the diagnosis and management of patients with seizure disorders and extends to other neurological conditions, however local data is limited

Myotonic Dystrophy In A Pakistani Family: A Case Series And Literature Review, Waleed Shahzad, Muhammad Hassan, Mazhar Badshah, Haris Majid Rajput, Zakir Jan, Tehmina Inayat

Pakistan Journal of Neurological Sciences (PJNS)

Myotonic dystrophy also known as (Steinert's disease) is a clinically and genetically heterogeneous multisystem disorder with a prevalence of 1 in 8000 in the general population. It is inherited as an autosomal dominant trait. It is characterized by myotonia, myopathy of voluntary and involuntary muscles, frontal baldness in men, cardiac conduction abnormalities, cataracts, intellectual deterioration and endocrinopathies. Affected men may have gonadal atrophy and infertility. On the other hand women are generally fertile. We report a case series of three individuals belonging to the same family presenting with characteristic features of myotonic dystrophy. The presentation of these cases depicts that …

Cutaneous Allodynia In Migraine, Dr. Ghulam Shabbir, Dr. Haris Majid Rajput, Dr. Zakir Jan

Pakistan Journal of Neurological Sciences (PJNS)

OBJECTIVE: Objective of this study is to find out the presence and severity of cutaneous allodynia in migraine sufferers. BACKGROUND: Cutaneous allodynia is the perception of pain in response to non noxious stimuli. It occurs due to repeated stimulations that lead to sensitization and abnormal skin response. MATERIALS AND METHODS: It was a descriptive case study and conducted at Neurology department Pakistan Institute of Medical Sciences from June 2017 to May 2018. All patients of both genders above age 13 years of age with migraine diagnosed as having “Migraine without aura” or “Migraine with aura” according to the International Headache …

Distance Learning For Neurology: Experiences From Mini-Fellowship In Movement Disorders., Danish Bhatti, John Bertoni

Pakistan Journal of Neurological Sciences (PJNS)

Sub-speciality training in neurology is not available in Pakistan given lack of trained supervising faculty. Developing trained supervisors by sending faculty abroad for formal fellowships is too slow, resource intense and subject to attrition or brain-drain. Web-based learning methods have been used effectively in training in medicine. Meta-analysis of 201 eligible studies showed large positive effects of E-learning in health professionals compared with no interventions1. There are highly qualified academic neurologists available in developed countries of Pakistani origin providing opportunity to bridge the gap and transfer skills.

Memory And Cognitive Flexibility In Physical Therapy Students Of Karachi, Sonya Arshad, Muhammad Faisal Qureshi, Syed Hasan Abbas Rizvi, Javeria Rizvi, Kanza Imtiaz, Kisa Hussain Rizvi, Khushbakht Ahmed, Khola Noman, Vishal Kumar

Pakistan Journal of Neurological Sciences (PJNS)

Memory allows us to remember the skills that we have learnt and retrieve valuable information stored in the brain. Physical therapy is a multidimensional profession which demands efficient cognitive flexibility and decision-making skills with an excellent memory to help the therapist to multi-task.

Covid-19 Infection; Loss Of Taste, Smell, And Neurogenic Respiratory Failure, Abdul Mannan Baig, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Neurological Signs and Symptoms in COVID-19: Like the rest of the world, Pakistan is been gripped by unprecedented and complex burden of COVID-19. While the diseases got upgraded to a pandemic, the preparedness of even the first world countries to combat COVID-19 is distressing, as there seems to be a lack of clear strategy to tackle the disease spread and treatment.

Amylin As A Potential Link Between Type 2 Diabetes And Alzheimer Disease, Florin Despa, Larry B. Goldstein, Geert Jan Biessels

Pharmacology and Nutritional Sciences Faculty Publications

No abstract provided.

The Bull Or The Horn - What Are Outcomes Data?, James Harrop

Department of Neurosurgery Faculty Papers

No abstract provided.

Management Of Patients With Isolated Acute Cervical Carotid Artery Occlusion And Normal Neurological Exam: Technical Note And Case Series, Joshua H. Weinberg, Nohra Chalouhi, Ahmad Sweid, Stavropoula Tjoumakaris, Michael Reid Gooch, Robert H. Rosenwasswer, Pascal Jabbour, Hekmat Zarzour

Department of Neurosurgery Faculty Papers

Objectives

Limited data exists on the management and outcome of patients with isolated acute cervical internal carotid artery (cICA) occlusion presenting with normal neurologic exam after experiencing a period of neurological deficits. These patients are at risk for progressive neurologic deterioration but have not yet progressed to stroke. Current management is no intervention due to intervention risk of embolization. We aim to determine the optimal management of patients with isolated acute cICA occlusion presenting with a normal neurological exam after experiencing neurological deficits.

Patients and methods

Data was collected on 3 patients with acute cICA occlusion that presented with a …

Bone Marrow Dendritic Cells Deficient For Cd40 And Il-23p19 Are Tolerogenic In Vitro, Tahereh Kalantari, Bogoljub Ciric, Eskandar Kamali-Sarvestani, Abdolmohamad Rostami

Department of Neurology Faculty Papers

Objective(s): In addition to pro-inflammatory role, dendritic cells (DCs) can also be anti-inflammatory when they acquire tolerogenic phenotype. In this study we tested the role of CD40 and IL-23p19 in antigen presenting function of bone marrow-derived DCs (BMDCs) by comparing BMDCs derived from CD40 knockout (CD40KO-DCs) and IL-23p19 (IL-23p19KO-DCs) knockout mice with those from C57BL/6 mice (Cont-DCs). We have focused on CD40 and IL-23, as these molecules have well established pro-inflammatory roles in a number of autoimmune and inflammatory diseases.

Materials and Methods: The expression of maturation markers MHC II and co-stimulatory molecules CD40, CD80, and CD86 was analyzed by …

The Impact Of Diabetic Foot Ulcers And Unilateral Offloading Footwear On Gait In People With Diabetes, Erica Ling, Brian Lepow, He Zhou, Ana Enriquez, Ashley Mullen, Bijan Najafi

Faculty, Staff and Students Publications

BACKGROUND: Unilateral offloading footwear prescribed to patients with diabetic foot ulcers elevates one limb relative to the other, which may lead to limp and abnormal gait. This study investigated whether the unilateral foot ulcer and offloading combination negatively impacts gait function beyond diabetic peripheral neuropathy.

METHODS: Eighty-six participants were recruited in 3 groups: 12 with diabetic peripheral neuropathy and unilateral foot ulcers wearing offloading footwear (offloading group, age = 55.6 ± 9.5 years, BMI = 30.9 ± 4.5 kg/m

FINDINGS: The offloading group exhibited deteriorated gait function compared to the non-diabetic group (p < 0.005, Cohen's effect size d = 0.90-2.61). They also had decreased gait speed (p < 0.001, d = 1.79) and stride length (p < 0.001, d = 1.76), as well as increased gait cycle time (p < 0.001, d = 1.67) and limp (p < 0.050, d = 0.72-1.49) compared to the neuropathy group. The offloading group showed increased gait unsteadiness compared to the neuropathy group, but the difference did not reach statistical significance in our samples.

INTERPRETATION: This study demonstrated that while diabetic …

Hispanics Have Higher Grade Intracerebral Hemorrhage Compared To Non-Hispanics, Jessica Houck Do, Tej Stead, Paul Banerjee, Latha Ganti Md

Emergency Medicine

No abstract provided.

Multi-Domain Cognitive Assessment Of Male Mice Shows Space Radiation Is Not Harmful To High-Level Cognition And Actually Improves Pattern Separation, Cody W. Whoolery, Sanghee Yun, Ryan P. Reynolds, Melanie J. Lucero, Ivan Soler, Fionya H. Tran, Naoki Ito, Rachel L. Redfield, Devon R. Richardson, Hung-Ying Shih, Phillip D. Rivera, Benjamin P. C. Chen, Shari G. Birnbaum, Ann M. Stowe, Amelia J. Eisch

Neurology Faculty Publications

Astronauts on interplanetary missions - such as to Mars - will be exposed to space radiation, a spectrum of highly-charged, fast-moving particles that includes ⁵⁶Fe and ²⁸Si. Earth-based preclinical studies show space radiation decreases rodent performance in low- and some high-level cognitive tasks. Given astronaut use of touchscreen platforms during training and space flight and given the ability of rodent touchscreen tasks to assess functional integrity of brain circuits and multiple cognitive domains in a non-aversive way, here we exposed 6-month-old C57BL/6J male mice to whole-body space radiation and subsequently assessed them on a touchscreen battery. Relative to …

Cost-Effectiveness Model Shows Superiority Of Wireless Spinal Cord Stimulation Implantation Without A Separate Trial., Richard B North, Harish S. Parihar, Shawn D. Spencer, Arthur F Spalding, Jane Shipley

PCOM Scholarly Works

OBJECTIVE: We evaluated the cost-effectiveness of wireless spinal cord stimulation (Wireless SCS) with single stage "direct to permanent" implantation vs. screening with temporary electrodes and an external pulse generator followed by implantation of a system for long-term use (IPG SCS).

MATERIALS AND METHODS: We created a cost model that takes a 2019 United States (U.S.) payer perspective and is based on IPG SCS cost models for subjects with chronic back and/or leg pain. Our six-month decision tree includes the screening trial period (success ≥50% relief) and leads to various levels of pain relief with or without complications for IPG SCS …

Can Treadmill Training With Musical Cueing In Individuals With Progressive Parkinson’S Disease Improve Ambulation?, Kristen Barta, Derrick F. Campbell, Sharon Dunnivan-Mitchell Pt, Dpt

Physical Therapy Collection

The purpose of this study was to measure the effectiveness of a specialized musical composition in combination with treadmill training to impact gait parameters and balance in people with progressive Parkinson’s disease (PD). Incorporation of auditory stimulation, typically via metronome, to improve movement has been successfully used in rehabilitation for decades. Treadmill training, also frequently used in treatment of PD, has shown short- and long-term improvements in stride length, cadence, stance and swing phase. Music assisted therapy utilizing expertly designed musical composition, known as informed composition, has recently become available for use in rehabilitation in collaboration with music therapists. Combination …

B Cells Migrate Into Remote Brain Areas And Support Neurogenesis And Functional Recovery After Focal Stroke In Mice, Sterling B. Ortega, Vanessa O. Torres, Sarah E. Latchney, Cody W. Whoolery, Ibrahim Z. Noorbhai, Katie Poinsatte, Uma M. Selvaraj, Monica A. Benson, Anouk J. M. Meeuwissen, Erik J. Plautz, Xiangmei Kong, Denise M. Ramirez, Apoorva D. Ajay, Julian P. Meeks, Mark P. Goldberg, Nancy L. Monson, Amelia J. Eisch, Ann M. Stowe

Neurology Faculty Publications

Lymphocytes infiltrate the stroke core and penumbra and often exacerbate cellular injury. B cells, however, are lymphocytes that do not contribute to acute pathology but can support recovery. B cell adoptive transfer to mice reduced infarct volumes 3 and 7 d after transient middle cerebral artery occlusion (tMCAo), independent of changing immune populations in recipient mice. Testing a direct neurotrophic effect, B cells cocultured with mixed cortical cells protected neurons and maintained dendritic arborization after oxygen-glucose deprivation. Whole-brain volumetric serial two-photon tomography (STPT) and a custom-developed image analysis pipeline visualized and quantified poststroke B cell diapedesis throughout the brain, including …

Hierarchical Clustering Analyses Of Plasma Proteins In Subjects With Cardiovascular Risk Factors Identify Informative Subsets Based On Differential Levels Of Angiogenic And Inflammatory Biomarkers, Zachary Winder, Tiffany L. Sudduth, David W. Fardo, Qiang Cheng, Larry B. Goldstein, Peter T. Nelson, Frederick A. Schmitt, Gregory A. Jicha, Donna M. Wilcock

Sanders-Brown Center on Aging Faculty Publications

Agglomerative hierarchical clustering analysis (HCA) is a commonly used unsupervised machine learning approach for identifying informative natural clusters of observations. HCA is performed by calculating a pairwise dissimilarity matrix and then clustering similar observations until all observations are grouped within a cluster. Verifying the empirical clusters produced by HCA is complex and not well studied in biomedical applications. Here, we demonstrate the comparability of a novel HCA technique with one that was used in previous biomedical applications while applying both techniques to plasma angiogenic (FGF, FLT, PIGF, Tie-2, VEGF, VEGF-D) and inflammatory (MMP1, MMP3, MMP9, IL8, TNFα) protein data to …

The Effectiveness Of A Mindfulness-Based Intervention: A Neuropsychological Perspective Using An Electroencephalography, Elizabeth Mary Grace

Doctor of Psychology (PsyD)

In recent years, there has been a significant increase in mindfulness-related techniques. The willingness to experience emotions fully, just as they are, is a catalyst for psychological change to occur. Mindfulness has been used to alleviate stress and promote healthy living (Lagopoulos et al., 2009). The clinical utility of mindfulness has grown exponentially; however, the neuropsychological process of mindfulness is still being understood. The present study sought to examine the influence of a brief mindfulness intervention on brain activation in college students. A sample (n = 17) of undergraduate participants were randomly assigned into a prepost mindfulness intervention or control …