Movement disorders associated with neuronal antibodies: a data-driven approach

Journal of Neurology - Movement disorders can be associated with anti-neuronal antibodies. We conducted a systematic review of cases with documented anti-neuronal antibodies in serum and/or...     

Influence of psychiatric and psychosomatic disorders on quality of life

INTRODUCTION AND AIMS: The term 'quality of life' has received a growing highlight in relation to the care of chronically ill people during the past decades. The main goal of the present study has been to analyze patients' quality of life regarding the following diagnoses: headache (tension headache); mood disorders (depression); anxiety, and comorbid states, involving some psychological variables, such as hostility or social support. METHODS: There were 157 patients participating in the study who came from a registered patients' pool in the Neuropsychiatric Rehabilitation Ward, Department of Psychiatry, University of Szeged, during the spring semester of 2005. The final sample size contained 151 patients who might be sorted into five main disease groups: mood disorders (depression); anxiety disorders; mixed psychiatric diagnosis; headache; and comorbid diagnosis (headache and psychiatric disorder together). The mean scores of the scales of patients' quality of life were investigated according to gender and disease groups; in addition, we also analyzed the psychological background of the quality of life. RESULTS: Based on factor analysis, two factors of the quality of life scale were detected: one factor labelled 'everyday activities' factor (including items such as work, financial situation, nutrition, sexual life or self-actualization), and another one labelled 'social activities' factor (e.g., activities with spouse, family, other persons, religious and community activities). According to the disease groups, differences could be detected particularly in the field of everyday activities; especially patients suffering from mood disorders reported higher levels of deterioration of their quality of life, whereas in comparison with them, patients of headache showed less changes. When there was comorbid psychiatric illness besides headache, a more determinant deterioration of the quality of life could be detected. Hostility and psychosomatic/anxiety symptoms contributed mostly to deterioration of the quality of life in the field of everyday activities, moreover, with growing age, the patients experienced a greater level of deterioration of their quality of life. Among the disease groups, the presence of mood disorder lowered mostly the patients' quality of life. In case of the quality of life factor 'social activities', social support was a protective factor. CONCLUSIONS: In this study, we would like to draw the attention to the influences of psychosomatic and psychiatric disorders on patients' quality of life since with this help we may get closer to a deeper understanding of patient behavior. The quality of life study identifies not only the non-beneficial effects but also maps the positive ones. This implies the possibility of effective adaptation.     

Plasmid-mediated quinolone resistance in isolates obtained in german intensive care units

Screening of 703 isolates of Enterobacteriaceae, obtained from 34 German intensive care units (ICUs), revealed qnr-positive, integron-containing isolates of Enterobacter sp. and Citrobacter freundii from four patients in 2 German ICUs. This is one of the first reports of qnr-positive strains obtained from patients in Europe.     

Survival and long-term functional outcome in 1,155 consecutive neurocritical care patients

OBJECTIVE: To analyze survival, mortality, and long-term functional disability outcome and to determine predictors of unfavorable outcome in critically ill patients admitted to a neurologic intensive care unit (neuro-ICU). DESIGN: Retrospective cohort study with post-neuro-ICU health-related evaluation of functional long-term outcome. SETTING: Ten-bed neuro-ICU in a tertiary care university hospital. PATIENTS: A consecutive cohort of 1,155 patients admitted to a neuro-ICU during a 36-month period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 1,155 consecutive patients, of whom 41% were women, were enrolled in the study. The predominant reasons for neuro-ICU care were cerebrovascular diseases, such as intracerebral hemorrhage (20%), subarachnoid hemorrhage (16%), and complicated, malignant ischemic stroke (15%). A total of 213 patients (18%) died in the neuro-ICU. The Glasgow Outcome Scale and modified Rankin scale were dichotomized into two groups determining unfavorable vs. favorable outcome (Glasgow Outcome Scale scores 1-3 vs. 4-5 and modified Rankin scale scores 2-6 vs. 0-1). Factors associated with unfavorable outcome in the unselected cohort according to logistic regression analysis were admission diagnosis, age (p < .01), and a higher score in the simplified Therapeutic Intervention Scoring System (TISS-28) at time of admission (p < .01). Functional long-term outcome was evaluated by telephone interview for 662 patients after a median follow-up of approximately 2.5 yrs by evaluating modified Rankin scale and Glasgow Outcome Scale scores. Factors associated with unfavorable functional long-term outcome were admission diagnosis, sex, age of >70 yrs (odds ratio, 8.45; 95% confidence interval, 4.52-15.83; p < .01), TISS-28 of >40 points at admission (odds ratio, 4.05; 95% confidence interval, 2.54-6.44; p < .01), TISS-28 of >40 points at discharge from the neuro-ICU (odds ratio, 3.50; 95% confidence interval, 1.51-8.09; p < .01), and length of stay (odds ratio, 1.01; 95% confidence interval, 1.00-1.03; p = .02). CONCLUSION: We found admission diagnosis, age, length of stay, and TISS-28 scores at admission and discharge to be independent predictors of unfavorable long-term outcome in an unselected neurocritical care population.