Pain-related psychological issues in hand therapy

Study Design

Literature review.

Biomechanical Properties of the Pelvic Floor and its Relation to Pelvic Floor Disorders

Pelvic organ prolapse and stress urinary incontinence remain a clinical challenge as they have unclear pathophysiology and suboptimal treatments. These common pelvic floor disorders (PFD) are characterized by the weakening of the pelvic floor supportive tissues that are directly related to their biomechanical properties. Characterizing the biomechanical properties of the pelvic floor tissues has been the focus of recent studies and researchers are using tools that are not always well understood by clinicians. Therefore, the aim of this review is to provide an overview of the most used methods to test the passive biomechanical properties of the human pelvic floor tissues. We also summarize recent findings from studies looking into the passive properties of the pelvic floor in pelvic floor disorders using the ex vivo tensile test and emerging in vivo techniques. Together, these studies provide valuable quantitative information about the different biomechanical properties of the supportive tissues of the pelvic floor under normal and pathological conditions. Results from ex vivo tests provide valuable data that needs to be correlated to the in vivo data and the clinical manifestations of the symptoms of the PFD. As more research is conducted we will obtain an enhanced understanding of the effect of age, PFD, and treatments on the biomechanical properties of the pelvic floor. This information can contribute to better identify individuals at risk, improve clinical diagnosis, and develop new treatments to advance clinical practice.     

Treating pediatric neuromuscular disorders: The future is now

Pediatric neuromuscular diseases encompass all disorders with onset in childhood and where the primary area of pathology is in the peripheral nervous system. These conditions are largely genetic in etiology, and only those with a genetic underpinning will be presented in this review. This includes disorders of the anterior horn cell (e.g., spinal muscular atrophy), peripheral nerve (e.g., Charcot–Marie–Tooth disease), the neuromuscular junction (e.g., congenital myasthenic syndrome), and the muscle (myopathies and muscular dystrophies). Historically, pediatric neuromuscular disorders have uniformly been considered to be without treatment possibilities and to have dire prognoses. This perception has gradually changed, starting in part with the discovery and widespread application of corticosteroids for Duchenne muscular dystrophy. At present, several exciting therapeutic avenues are under investigation for a range of conditions, offering the potential for significant improvements in patient morbidities and mortality and, in some cases, curative intervention. In this review, we will present the current state of treatment for the most common pediatric neuromuscular conditions, and detail the treatment strategies with the greatest potential for helping with these devastating diseases.     

Quality of life and neuropsychiatric disorders in patients with Graves' Orbitopathy: Current concepts

Graves' disease (GD) is an autoimmune chronic thyroiditis frequently associated with development of Graves' orbitopathy (GO) characterized by proptosis, strabismus, impairment of visual function, ocular surface inflammation and dry eye. As consequence, patients with GO experience impairment of quality of life and social function and could develop a neurobehavioral syndrome, ranging from anxious to depressive or psychotic disorders. To date, the pathogenic mechanism underlying neuropsychiatric disorders in patients with GD has not been clearly understood. In fact, the development of neuropsychiatric disorders in patients with GO has been associated with both the detrimental effects of the altered circulating thyroid hormones on the nervous system, and with the psychological discomfort caused by poor quality of life, reduced social interactions and relapsing course of the disease. This paper summarizes current evidence on neuropsychiatric abnormalities in Graves' disease focusing on its impact on QoL and psychosocial function. We remark the importance of a multidisciplinary approach and we emphasize the potential benefit of neuropsychiatric approach on disease perception, patient compliance to medical and/or surgical treatment and clinical outcomes.     

Neuromyelitis optica spectrum disorders and systemic lupus erythematosus: A case series from a university center

Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated inflammatory diseases of the central nervous system (CNS), which preferentially affect the optic nerves and the spinal cord. Anti-aquaporin 4 antibody is a specific serological marker. Systemic lupus erythematosus (SLE) is a rheumatologic disease that may affect the CNS. There are several reports about the coexistence of NMOSD and autoimmune diseases, mainly those of rheumatologic origin. We describe three different cases in which SLE and NMOSD subsequently occurred, drawing attention to the clinical heterogeneity, the challenge and the importance of recognizing this possible association.     

Experiencia con tocilizumab en pacientes con espectro de la neuromielitis óptica

IntroductionNeuromyelitis optica spectrum disorders (NMOSD) are immune-mediated inflammatory disorders of the central nervous system involving astrocytes, B lymphocytes, anti-aquaporin 4, and such inflammatory mediators as interleukin-6. Several immunosuppressants are used in their treatment. Tocilizumab, an interleukin-6 receptor antagonist, may be a treatment option.MethodWe performed an observational, retrospective study analysing parameters of effectiveness (annualised relapse rate, disability, and radiological progression) and safety of tocilizumab in patients with NMOSD in whom previous immunosuppressant treatment had failed. We aimed to evaluate the effectiveness and safety of tocilizumab in clinical practice in patients with NMOSD not responding to other immunosuppressants.ResultsFive patients with NMOSD were analysed. Sixty percent of patients were women; mean age at diagnosis was 50 ± 5.3 years and mean progression time was 4.5 ± 3.6 years. Previously administered immunosuppressants were rituximab (in all 5), cyclophosphamide (2), and azathioprine (1). Mean time of exposure to tocilizumab was 2.3 ± 1 years. Mean annualised relapse rate was 1.8 ± 1.3 in the year prior to the introduction of tocilizumab and 0.2 ± 0.4 the year after (P < .05), representing a reduction of 88.9%.ConclusionsIn our experience, tocilizumab is safe and effective in patients with NMOSD showing no response to other immunosuppressants.     

Evaluation of retinal nerve fiber layer thickness in children with autism spectrum disorders

BackgroundThe study compared retinal nerve fiber layer (RNFL) thickness, macular thickness, and macular volume of children with autism spectrum disorder (ASD) to those of healthy control group and correlated the RNFL thickness with symptom severity in children with ASD.MethodForty children between the ages of 7 and 12 with normal intelligence levels and who were diagnosed with ASD as per DSM-5 were included in the ASD group. The control group consisted of healthy children, who were matched with subjects in the ASD group in terms of age and gender. The Autism Behavior Checklist (ABC) and Childhood Autism Rating Scale (CARS) were used to evaluate the severity of the disease in the cases diagnosed with ASD. The RNFL, macular thickness, and macular volume of all participants were measured optical coherence tomography (OCT).ResultsThe temporal, temporal superior, nasal superior, temporal inferior, and global RNFL thicknesses were significantly lower in the ASD group than in the control group. There was no correlation between the RNFL thickness and ASD symptom severity. The macular thickness and volume were not significantly different between the groups.ConclusionOur data suggest that lower RNFL thickness may relate to atypical brain development in the ASD, and this can be measured in the retina.