Browsing by Subject "Neurology"

Now showing 1 - 3 of 3
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    Open Access
    Clinical prediction scale approach derived from a retrospective study to reduce the number of urgent, low-value cranial CT scans
    (Springer, 2024-07-26) Plasencia Martínez, Juana María; Otón González, Elena; Sánchez Canales, Marta; Ortiz Mayoral, Herminia; Cotillo Ramos, Estefanía; Casado‑Alarcón, Nuria Isabel; Ballesta Ruiz, Mónica; Villaverde González, Ramón; García Santos, José María; Ciencias Sociosanitarias; Facultades de la UMU::Facultad de Enfermería
    Purpose: Fifty percent of cranial CT scans performed achieve no benefit and entail risks. Our aim is to determine the yield of non-traumatic urgent cranial-CT and develop a pretest clinical probability scale approach. Methods: Adult patients seen in our emergency department between 2017–2021 and referred for urgent cranial-CT for non-traumatic reasons were retrospectively recruited and randomly selected. Presenting complaint (PC), demographic variables, Relevant radiological findings (RRF) on the urgent cranial-CT and Relevant clinical-radiological findings (RCRF: admission need or RRF detection on the urgent cranial-CT or cranial CT/MRI in the following three months) were recruited. Results: We recruited 702 patients, with median age 62 [47–76] years, 363 (51.7%) females. RCRF were observed in 404 (57.55%); of these, 352 (50.1%) required admission. RRF were detected in 190 (27.06%): 36 acute ischemic and 27 acute hemorrhagic lesions, 115 masses, 9 edema, and 27 hydrocephalus. Predictive PC for urgent cranial-CT were motor, speech, sensory deficits, sudden alteration of mental status, epileptic seizure, cognitive impairment, neurological symptoms in cancer patients, acute headache without a prior history and with meningeal signs; nausea, vomiting, or hypertensive crisis; visual deficits, and dizziness. This algorithm provided sensitivity, specificity, positive predictive value, and negative predictive value (NPV, 95%CI in brackets) of 92.1% (89–94.5%), 27.5% (22.5–33.0%), 63.3% (59.2–67.2%), and 71.9% (62.7–80.0%), to diagnose RCRF, and 97.4% (93.4–99.1%), 21.3% (17.8–25.1%), 31.5% (27.7–35.4%), and 95.6% (90.1–98.6%), to diagnose RRF. In patients not requiring admission (n = 350), the NPV for RRF was 98.8% (93.6–100%); the negative likelihood ratio 0.08 (0.01–0.57), and sensitivity remained at 97.8% (82.2–99.9%). Applying it would have avoided performing 85/350 urgent cranial-CT (24.29%). To find one RRF, we would have gone from performing 7.8 (350/45) to 5.9 (265/45) CTs, failing to diagnose 1/45 (2.2%) RRF. Conclusions: This proposed clinical scale could potentially decrease 24% of urgent cranial-CT.
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    Open Access
    Effects of neuropilates on functional outcomes in chronic stroke: a randomized clinical trial
    (MDPI, 2024-04-17) García Bravo, Cristina; Delgado Lobete, Laura; Montes Montes, Rebeca; Rodríguez Pérez, María Pilar; Trugeda Pedrajo, Nuria; Fernández Gómez, Gemma; García Bravo, Sara; Atención Sociosanitaria; Facultades de la UMU::Facultad de Ciencias Sociosanitarias (Lorca)
    Neuropilates is an intervention approach that was developed as a modified version of the Pilates Method to be used for neurological rehabilitation. The main objective of this study was to analyze the effectiveness of regular physiotherapy and occupational therapy rehabilitation in comparison to a combination of traditional rehabilitation with Neuropilates in adults with post-stroke motor disabilities. This was a rater- and analyst-blinded randomized clinical trial with a three-month intervention and a one-month follow up. Participants were randomly allocated to either the experimental group (EG, receiving a combination of conventional therapy and Neuropilates; n = 15) or the control group (CG, receiving solely conventional therapy; n = 15). Once adjusted for baseline FIM scores, the results showed significant differences favoring the EG in daily functioning (FIM), static balance (FRT), right-hand manual dexterity (NHPT) and right-upper limb coordination (BBT). Satisfaction with the received treatment as measured with the CSQ-8 was significantly higher for the EG. In conclusion, the incorporation of Neuropilates, facilitated by a single experienced therapist, can be a valuable complement to conventional physical and occupational therapy. However, Neuropilates-based interventions should be supervised and tailored to each individual by a professional specifically trained in the method.
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    Presunta parálisis periódica hipercalémica con miotonía en perros Shi-Tzú y Pastor Alemán
    (Universidad de Murcia. Servicio de publicaciones, 2018) Pellegrino, Fernando Carlos
    En los humanos, las canalopatías del músculo esquelético son entidades de base genética y de incidencia muy baja. En relación al canal de sodio en particular, las diferentes mutaciones SCN4A pueden dar lugar a diversos fenotipos que van desde la parálisis muscular (parálisis periódica hipercalémica, parálisis periódica hipocalémica) a la hiperexcitabilidad muscular (paramiotonía congénita, miotonías agravadas por potasio), pasando por fenotipos combinados de las dos anteriores. Existe una estrecha interrelación entre la parálisis periódica hipercalémica y las miotonías; ambas características pueden coexistir en el mismo paciente.Este trabajo describe un cuadro clínico que afectó a una camada de 7 cachorros Pastor Alemán y a una camada de 4 cachorros Shi-Tzú, con episodios caracterizados por un fenotipo clínico de parálisis muscular combinado con hiperexcitabilidad muscular.De acuerdo a los hallazgos clínicos (fenomenología clínica, edad de aparición, recurrencia de los episo-dios, ausencia de signos clínicos entre los episodios) y de laboratorio (hipercalemia), y a los resultados del tratamiento con acetazolamida, el diagnóstico presuntivo fue parálisis periódica hipercalémica con miotonía/paramiotonía por una canalopatía SCN4A.Destacamos la importancia del diagnóstico clínico para estas raras patologías. En ausencia de diagnóstico genético, los métodos de diagnóstico complementario tiene valor limitado debido al carácter funcional de estos trastornos.Proponemos esta comunicación como la primera de este tipo en perros de raza Pastor Alemán y Shi-Tzú.