Background and Objective. Impaired health-related quality of life (HRQOL) is one of the possible outcomes after discharge from an intensive care unit (ICU). Evaluation of patient health status on discharge from the ICU would help identify factors influencing changes in HRQOL after ICU discharge. The objective of the study was to identify whether health state on discharge from prolonged stay in the ICU has any influence on survivors’ HRQOL 6 months after intensive care. Material and Methods. A prospective study of patients with the prolonged length of stay (exceeding 7 days) in the ICU was conducted. The study covered the impact of organ system dysfunction (SOFA score), number of therapeutic interventions (TISS-28 score), and critical illness neuromuscular abnormalities (CINMA) on discharge from the ICU on HRQOL 6 months following ICU discharge. Results. In total, 137 patients were included in the study. The SOFA score on the last day in the ICU was 2.91 (SD, 1.57); the TISS-28 score on the last day in the ICU was 21.79 (SD, 4.53). Decreased physical functioning (PF) and role physical (RP) were identified. Circulatory impairment on discharge from the ICU had an impact on decreased PF (P=0.016), role physical (P=0.066), and role emotional (P=0.001). Patients with dysfunction in more than one organ system on ICU discharge had decreased role emotional (P=0.016). Severe CINMA was diagnosed in 18 patients. They had decreased PF (P=0.007) and RP (P=0.019). Patients with the TISS-28 score above or equal to 20 points showed lower HRQOL in the PF domain (P=0.077) and general health (P=0.038). Conclusions. HRQOL in patients with prolonged stay in the ICU is particularly impaired in the domains of physical functioning and role physical. It is associated with circulatory impairment, CINMA, and greater number of therapeutic interventions on discharge from the ICU.
Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case fatality, functional outcome, and health-related quality of life (HRQoL) at 90 days. Materials and Methods: A single-center prospective study was carried out for four non-consecutive months between December 2018 and July 2019 in one of the two comprehensive stroke centers in Eastern Lithuania. A telephone-based follow-up was conveyed at 90 days using the modified Rankin Scale (mRS) and EuroQoL five-dimensional three-level descriptive system (EQ-5D-3L) with a self-rated visual analog scale (EQ-VAS). One-year case fatality was investigated. Results: We included 238 AIS patients with a mean age of 71.4 ± 11.9 years of whom 45.0% were female. A striking 97 (40.8%) AIS patients had a concomitant AF, in 68 (70.1%) of whom the AF was pre-existing. The AIS patients with AF were at a significantly higher risk for a large vessel occlusion (LVO; odds ratio 2.72 [95% CI 1.38–5.49], p = 0.004), and had a more severe neurological impairment at presentation (median NIHSS score (interquartile range): 9 (6–16) vs. 6 (3–9), p < 0.001). The LVO status was only detected in those who had received computed tomography angiography. Fifty-five (80.9%) patients with pre-existing AF received insufficient anticoagulation at stroke onset. All patients received a 12-lead ECG, however, in-hospital 24-h Holter monitoring was only performed in 3.4% of AIS patients without pre-existing AF. Although multivariate analyses found no statistically significant difference in one-year stroke patient survival and favorable functional status (mRS 0–2) at 90 days, when adjusted for age, gender, reperfusion treatment, baseline functional status, and baseline NIHSS, stroke patients with AF had a significantly poorer self-perceived HRQoL, indicated by a lower EQ-VAS score (regression coefficient ± standard error: β = −11.776 ± 4.850, p = 0.017). Conclusions: In our single-center prospective observational study in Lithuania, we found that 40.8% of AIS patients had a concomitant AF, were at a higher risk for an LVO, and had a significantly poorer self-perceived HRQoL at 90 days. Despite the high AF prevalence, diagnostic tools for subclinical AF were greatly underutilized.
Vilniaus universitetas, Medicinos fakultetas, Klinikinës medicinos institutas, Neurologijos ir Neurochirurgijos klinika ÁVADASOs mo si në mie li no li zë (OM) yra re tas ir ûmus de mie li nizuo jan tis su sir gi mas. 1959 m. R. D. Ad ams su ko le go mis [1] pir mie ji ap ra ðë cen tri nae til to mie li no li zae (CTM), ku rià diag no za vo al ko ho liu pik tnau dþiau jan tiems ir pras tai be simai ti nan tiems as me nims. Vë liau nu sta ty ta, kad iden tið ki pa to lo gi niai po ky èiai ga li pa si reikð ti taip pat uþ til to ri bø, jie pa va din ti eks tra pon ti ni ne mie li no li ze (EPM). Vyk dant moks li nius ty ri mus, ið aið kin tas ry ðys tarp OM ir grei tos nat rio ko rek ci jos pa cien tams, ser gan tiems hi po nat re mi ja. EPIDEMIOLOGIJATiks lus OM pa pli ti mas në ra þi no mas. Pir mie ji duo me nys apie OM gau ti au to psi jø me tu. M. Vic tor ir R. Lau re no apra ðy to je 3 548 su au gu siø jø au to psi jø ana li zë je OM bû din gi pa þei di mai ras ti 0,25 % at ve jø [2]. Ki ta me moks li nia me dar be bu vo ið ana li zuo ta 3 000 mi ru siø jø sme ge nø, 0,005 % jø nu sta ty ta asimp to më CTM [3]. Au to psi jø ana li zë je didþiau sias OM pa pli ti mas, nu sta ty tas 30-50-ai siais gy ve nimo me tais, dau giau bû din gas vy rams [4], ta èiau pa to lo giniai po ky èiai pa ste bë ti ir vai kams [5,6]. A. Gocht ir ko le gø [7] au to psi jø stu di jo je ið nag ri në ti 58 OM kli ni ki niai at ve - San trau ka. Cen tri në til to mie li no li zë api bû di na ma kaip os mo si nës mie li no li zës sin dro mas, daþ niau siai ið si vys tan tis kaip kom pli ka ci ja po grei tos hi po nat re mi jos ko rek ci jos. Til to mieli no li zë skirs to ma á cen tri nae til to mie li no li zae ir eks tra pon ti ni nae mie li no li zae. Hi po nat re mi ja daþ nai nu sta to ma pa cien tams, ku rie pik tnau dþiau ja al ko ho liu, pras tai mai ti na si, var to jant tam tik rus vais tus, taip pat ser gant ke pe nø li go mis, esant pa ki tu siai an ti diu re zi nio hor mo no sin te zei, ant inks èiø ne pa kan ka mu mui. Yra ke le tas pa to fi zio lo gi niø me cha niz mø, pa aið kinan èiø os mo si nës mie li no li zës ið si vys ty mà. Bû din ga dvi fa zë li gos ei ga. Pir mie ji simp to mai yra en ce fa lo pa ti ja ir (ar) trau ku liø prie puo liai, pa si reið kae dël hi po nat re mi jos, vë liau ste bi mas at si sta ty mas nor mo nat re mi jos me tu ir po ke liø die nø -pa blo gë ji mas, ga lin tis pa si reikð ti þi -di ni ne neu ro lo gi ne simp to ma ti ka, psi chi kos ir el ge sio su tri ki mais. Anks èiau siai bû din gus pa ki ti mus sme ge ny se ga li ma pa ste bë ti mag ne ti nio re zo nan so to mog ra fi jos DWI re þi mu. Patvir tin tø os mo si nës mie li no li zës gy dy mo re ko men da ci jø në ra, ta èiau li te ra tû ro je ap ra ðo mi sëk min gi at ve jai, pa cien tus gy dant ti rot ro pi nà ið ski rian èiu hor mo nu, gy do mo sio mis afe re zë -mis, gliu ko kor ti koi dais, in tra ve ni niu imu nog lo bu li nu. Os mo si nës mie li no li zës ga li ma ið -veng ti, hi po nat re mi jos me tu nat rio kon cen tra ci j...
Lewis-Sumner sindromas (L-SS) – tai daugiažidininė įgyta demielinizuojanti sensorinė ir motorinė neuropatija, asimetrinis lėtinės uždegiminės demielinizuojančios polineuropatijos (LUDP) variantas, kai pažeidžiamos viršutinės ir (ar) apatinės galūnės. Sindromo dažniausios klinikinės išraiškos yra asimetrinis ar daugiažidininis jutimų sutrikimas bei jėgos sumažėjimas ir elektrofiziologiškai nustatomi motorinių nervų laidumo blokai. Straipsnyje aprašomas pacientas, kuriam L-SS pasireiškė tik viršutinių galūnių pažeidimu, nei laboratoriniuose, nei elektrofiziologiniuose tyrimuose pakitimų nebuvo rasta. Lewis-Sumner sindromo diagnozė patvirtinta atlikus peties rezginio magnetinio rezonanso tyrimą. L-SS – retas sindromas, jo diagnostika ir gydymas yra sudėtingi, nes tyrimai atlikti su nedideliu pacientų skaičiumi ir rezultatai neretai yra prieštaringi.
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