Abelfoss7442

Objectives Patients with muscle-specific kinase (MuSK)-positive myasthenia are generally considered to have a grave prognosis. We present our experience of patients with myasthenia with different antibody status. This is followed by a short discourse on previous studies and the current view on MuSK-positive myasthenia, focusing on the associated prejudice. Materials and Methods This study compares 23 patients with MuSK-positive myasthenia with 55 patients with acetylcholine receptor-positive myasthenia and 9 patients with double-seronegative myasthenia at a tertiary level center. Results We did not find any significant difference in terms of clinical characteristics, treatment response to immunosuppressants, long-term prognosis, and quality of life. Conclusion Seropositivity for antibodies should not be used in isolation to guide the management or predict the prognosis. Undue negative prognostication may affect the morale of patient. Clinical features and response to therapy in addition to antibody status must be considered before planning therapy. Copyright © 2006-2019 Annals of Indian Academy of Neurology.Background and Purpose The present study aims to evaluate the role of blood pressure variability (BPV) as a target therapeutic risk factor for poor outcome of ischemic stroke by finding the association between the two and by finding the population attributable risk (PAR) of BPV compared to other baseline outcome predictors. Methods A prospective observational study was carried out at GMCH, Nagpur, India from January to June 2019 in 75 patients diagnosed with acute ischemic stroke. BP was recorded hourly for the first 24 hours of admission and base line factors were collected along with measurement of stroke severity. BPV was measured by index of average real-time variability (ARV) while discharge outcome was measured by Barthel Index. Results 36.5% of patients had poor outcome at discharge. A significant association was found between 24-hr ARV of systolic BP and poor outcome (P = 0.002, 95% CI = 2.22-23.5). Five factors were found to be independent outcome predictors on multiple logistic regression (OR, 95% CI) age (1.07, 1.03-1.10), NIHSS score (1.12, 1.04-1.27), on admission SBP (5.12, 4.01-16.23), on admission RBS (2.23, 1.92-6.49) and 24 Hr ARV-SBP (9.65, 3.02-20.1). The PAR of 24 hr ARV-SBP was 23.6%, second only to NIHSS score (26.4%). Conclusions Reduction in BP variability might have a beneficial impact on the outcome of patients with acute ischemic stroke. There is further scope to explore optimum therapeutic strategies to minimize BPV in the management of acute ischemic stroke. Copyright © 2006-2020 Annals of Indian Academy of Neurology.Background Apomorphine is an option for continuous dopaminergic therapy in Parkinson's disease (PD). P7C3 activator However, its effects in varied populations are limited due to its availability. Objective To assess the efficacy and outcomes of apomorphine in Indian patients. Materials and Methods Retrospective analysis of PD patients who underwent apomorphine response test (ART), along with the subset, who went on to apomorphine pumps. Results Twenty-nine confirmed PD patients underwent ART and all PD patients showed good clinical response. 19 subjects developed adverse events which included nausea (n-15, 51.7%), vomiting (n-10, 34.4%), sleepiness (n-08; 27.5%), yawning (n-07, 24.1%), postural hypotension (n-03, 10.3%), dizziness (n-03, 10.3%), and profuse sweating (n-01, 3.4%). Apomorphine pumps were initiated in six subjects, with significant clinical improvement. Adverse events on pump included subcutaneous nodules, nausea, hypersexuality. Two among them subsequently discontinued the pump primarily due to financial constraints. Conclusions Apomorphine adds up to the armamentarium for treatment of PD patients in India with good clinical responses. Copyright © 2006-2019 Annals of Indian Academy of Neurology.The stroke physician community witnessed a major "breakthrough" in acute stroke therapeutics when the results of the first of the many positive trials, "MR CLEAN," were published showing a significant absolute benefit in favor of mechanical thrombectomy in patients with large vessel occlusion (LVO). Thereafter, the investigators of ESCAPE, SWIFT PRIME, REVASCAT, THRACE, and PISTE concluded the same. Based on the initial studies, the American Stroke Association amended the 2013 guidelines in 2015 to include mechanical thrombectomy as the standard of care in patients with LVO presenting within six hours. In the past year, the horizon was further expanded when two major landmark trials, DAWN and DEFUSE 3, established the benefit of mechanical thrombectomy in the delayed window period in a select group of patients. It further led to the inclusion of the delayed window period treatment strategies in the 2018 guidelines. However, there are many unanswered questions in scenarios like small deficit with LVO, borderline large core, wake-up stroke (WUS), tandem occlusion, imaging of choice, conscious sedation (CS) versus general anesthesia (GA), and choice of technique. In our review, we aim to answer these questions along with a schematic representation of current techniques used in stroke thrombectomy. Copyright © 2006-2019 Annals of Indian Academy of Neurology.The role of thymectomy in thymomatous myasthenia gravis (MG) is unambiguous. However, its role in non-thymomatous MG (NTMG) remains debatable. The evidence till date is not robust. In this short review, we try to see the pros and cons of thymectomy in NTMG and critically appraise the evidence available till date. Copyright © 2006-2019 Annals of Indian Academy of Neurology.A popular distinction in the human and animal learning literature is between deliberate (or willed) and habitual (or automatic) modes of control. Extensive evidence indicates that, after sufficient learning, living organisms develop behavioural habits that permit them saving computational resources. Furthermore, humans and other animals are able to transfer control from deliberate to habitual modes (and vice versa), trading off efficiently flexibility and parsimony - an ability that is currently unparalleled by artificial control systems. Here, we discuss a computational implementation of habit formation, and the transfer of control from deliberate to habitual modes (and vice versa) within Active Inference a computational framework that merges aspects of cybernetic theory and of Bayesian inference. To model habit formation, we endow an Active Inference agent with a mechanism to "cache" (or memorize) policy probabilities from previous trials, and reuse them to skip - in part or in full - the inferential steps ciated with contextual estimation. These schemes are more or less impervious to contextual and contingency changes. © 2019 The Author(s).Copper (Cu) is an unusual micronutrient as it can limit primary production but can also become toxic for growth and cellular functioning under high concentrations. Cu also displays an atypical linear profile, which will modulate its availability to marine microbes across the ocean. Multiple chemical forms of Cu coexist in seawater as dissolved species and understanding the main processes shaping the Cu biogeochemical cycling is hampered by key knowledge gaps. For instance, the drivers of its specific linear profile in seawater are unknown, and the bioavailable form of Cu for marine phytoplankton is debated. Here we developed a global 3-D biogeochemical model of oceanic Cu within the NEMO/PISCES global model, which represents the global distribution of dissolved copper well. Using our model, we find that reversible scavenging of Cu by organic particles drives the dissolved Cu vertical profile and its distribution in the deep ocean. The low modeled inorganic copper (Cu') in the surface ocean means that Cu' cannot maintain phytoplankton cellular copper requirements within observed ranges. The global budget of oceanic Cu from our model suggests that its residence time may be shorter than previously estimated and provides a global perspective on Cu cycling and the main drivers of Cu biogeochemistry in different regions. Cu scavenging within particle microenvironments and uptake by denitrifying bacteria could be a significant component of Cu cycling in oxygen minimum zones. © 2019. The Authors.This study presents a screening-level analysis of the impacts of climate change on electricity transmission and distribution infrastructure of the U.S. In particular, the model identifies changes in performance and longevity of physical infrastructure such as power poles and transformers, and quantifies these impacts in economic terms. This analysis was evaluated for the contiguous U.S, using five general circulation models (GCMs) under two greenhouse gas emission scenarios, to analyze changes in damage and cost from the baseline period to the end of the century with three different adaptation strategies. Total infrastructure costs were found to rise considerably, with annual climate change expenditures increasing by as much as 25%. The results demonstrate that climate impacts will likely be substantial, though this analysis only captures a portion of the total potential impacts. A proactive adaptation strategy resulted in the expected costs of climate change being reduced by as much as 50% by 2090, compared to a scenario without adaptation. Impacts vary across the contiguous U.S. with the highest impacts in parts of the Southeast and Northwest. Improvements and extensions to this analysis would help better inform climate resiliency policies and utility-level planning for the future.Carpet and rugs currently represent about half of the United States flooring market and offer many benefits as a flooring type. How carpets influence our exposure to both microorganisms and chemicals in indoor environments has important health implications but is not well understood. The goal of this manuscript is to consolidate what is known about how carpet impacts indoor chemistry and microbiology, as well as to identify the important research gaps that remain. After describing the current use of carpet indoors, questions focus on five specific areas 1) indoor chemistry, 2) indoor microbiology, 3) resuspension and exposure, 4) current practices and future needs, and 5) sustainability. Overall, it is clear that carpet can influence our exposures to particles and volatile compounds in the indoor environment by acting as a direct source, as a reservoir of environmental contaminants, and as a surface supporting chemical and biological transformations. However, the health implications of these processes are not well known, nor how cleaning practices could be optimized to minimize potential negative impacts. Current standards and recommendations focus largely on carpets as a primary source of chemicals and on limiting moisture that would support microbial growth. Future research should consider enhancing knowledge related to the impact of carpet in the indoor environment and how we might improve the design and maintenance of this common material to reduce our exposure to harmful contaminants while retaining the benefits to consumers.Introduction Blockchain technology is associated with the financial industry, but it can be applied to other industries. The supporting architecture of blockchain has the immense potential to transform the delivery of healthcare, medical, clinical, and life sciences, due to the extended functionality and distinct features of its distributed ledger. The potential scale of impact is comparable to that seen with the introduction of TCP/IP. Blockchain technology has captured the interest of healthcare providers and biomedical scientists within various healthcare domains such as longitudinal healthcare records, automated claims, drug development, interoperability in population health, consumer health, patient portals, medical research, data security, and reducing costs with supply chain management. It is not yet clear if blockchain is going to disrupt healthcare, but healthcare organizations are monitoring its potential closely for prospective concepts like secure patient IDs. Realistically, the adoption and implementation of blockchains will be a gradual evolution over time, but now is the time to take a fresh look at its possibilities in healthcare and biomedical sciences.