• Publikační typ
• abstrakt z konference MeSH

Prezentujeme případ 76letého muže v anamnéze s tromboembolickou chorobou a ischemickou chorobou srdeční, který byl přijat do nemocnice pro akutní hypoxemickou respirační insuficienci při oboustranné pneumonii v důsledku onemocnění COVID-19. Vzhledem k tomu, že druhý den hospitalizace poklesla spontánní saturace O2 na 60 %, byl pacient přeložen na jednotku intenzivní péče, kde byla zahájena intenzivní oxygenoterapie (vysokoprůtoková nazální oxygenoterapie a neinvazivní ventilace prostřednictvím CPAP: Continuous Positive Airway Pressure). Saturace O2 postupně stoupala a docházelo ke zlepšení klinické symptomatologie. Po následné dechové rehabilitaci byl pacient po 17 dnech hospitalizace propuštěn do domácí péče. Ve sdělení jsou zvažovány hlavní faktory, které ovlivňují výsledek léčby ARDS (Acute Respiratory Distress Syndrome). Vedle intenzivní oxygenoterapie přispěly velmi pravděpodobně k úspěšnému zvládnutí závažného stavu u tohoto pacienta včasné podání nízkomolekulárního heparinu, remdesiviru a dexamethasonu. Klinické zlepšení doprovázelo zlepšení laboratorních nálezů (CRP, prokalcitonin, D-dimery, kreatinin, hs-troponin, počet lymfocytů). Závěrem je diskutována možná kauzální souvislost koronavirové infekce s herpetiformním exantémem, který se objevil před propuštěním pacienta z nemocnice.

We present a 76-year-old male with a past medical history of thromboembolism and coronary heart disease. He was admitted to the hospital with acute hypoxemic respiratory insufficiency due to bilateral COVID-19 pneumonia. As spontaneous O2 saturation dropped to 60% on the second day of the hospital stay, the patient was transferred to the intensive care unit where an intensive oxygen therapy was initiated (HFNO: High-Flow Nasal Oxygenotherapy and non invasive ventilation via CPAP: Continuous Positive Airway Pressure). His oxygen saturation gradually increased and follow-up showed improvement in symptoms. After 17 days of in-patient treatment, he was discharged to homecare. Main factors affecting the outcome of ARDS (Acute Respiratory Distress Syndrome) are considered. Besides the intensive oxygen therapy, an early administration of low molecular heparin, remdesivir and dexamethasone most probably contributed to reversing the initial serious finding in this patient. Clinical improvement was accompanied by improved laboratory tests (CRP, procalcitonin, d-dimer, creatinine, hs-troponin, lymphocyte count). Finally, we discuss a potential association of coronavirus infection with herpetiform exanthema, which appeared before the patient was discharged from the hospital.

• Klíčová slova
• remdesivir,
• MeSH
• adenosinmonofosfát analogy a deriváty   terapeutické užití   MeSH
• COVID-19 * komplikace   terapie   MeSH
• dexamethason terapeutické užití   MeSH
• heparin nízkomolekulární terapeutické užití   MeSH
• ischemická choroba srdeční MeSH
• kožní manifestace MeSH
• lidé MeSH
• oxygenoterapie MeSH
• pneumonie diagnostické zobrazování   terapie   MeSH
• senioři MeSH
• tromboembolie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

BACKGROUND: Patients with functional movement disorders also typically have functional somatic symptoms, including pain, fatigue, and sensory disturbance. A potentially unifying mechanism for such symptoms is a failure in processing of sensory inputs. Prepulse inhibition is a neurophysiological method that allows for the study of preconscious somatosensory processing. OBJECTIVE: The objective of this study was to assess prepulse inhibition in patients with functional movement disorders and healthy control subjects. METHODS: We analyzed the effect of a weak electrical stimulus to the index finger (prepulse) on the magnitude of the R2 response of the blink reflex induced by electrical stimuli delivered to the supraorbital nerve in 22 patients with clinically established functional movement disorders and 22 matched controls. Pain, depression, anxiety, and obsessive-compulsive symptoms were assessed using self-rated questionnaires. In addition, in patients we assessed motor symptom severity. RESULTS: Prepulses suppressed the R2 response of the blink reflex in both groups, by 36.4% (standard deviation: 25.6) in patients and by 67.3% (standard deviation: 16.4) in controls. This difference was significant (P < 0.001). There was no significant correlation between motor and nonmotor symptom measures and prepulse inhibition size. CONCLUSIONS: Impaired prepulse inhibition of the blink reflex suggests an abnormal preconscious processing of somatosensory inputs, which can be interpreted within predictive coding accounts of both functional movement disorders and functional somatic syndromes. Our results, along with previous findings of a reduced prepulse inhibition in fibromyalgia syndrome, support a possible unified pathophysiology across functional neurological and somatic syndromes with noteworthy implications for diagnostic classification and development of novel biomarkers and treatments. © 2019 International Parkinson and Movement Disorder Society.

• MeSH
• dospělí MeSH
• elektrická stimulace metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mrkání fyziologie   MeSH
• nervový útlum fyziologie   MeSH
• pohybové poruchy patofyziologie   MeSH
• prepulsní inhibice fyziologie   MeSH
• prsty ruky patofyziologie   MeSH
• úleková reakce fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVES: The prevalence of restless legs syndrome (RLS) in functional movement disorders (FMD) is not known. Patients with FMD often present with multiple motor and sensory symptoms. Some of these symptoms might be due to comorbid RLS. Therefore, our objective was to evaluate possible association between FMD and RLS. DESIGN: Case-control study. SETTING: Movement Disorders Center, 1st Faculty of Medicine and General University Hospital in Prague, Czech Republic. PARTICIPANTS: 96 consecutive patients with clinically established FMD (80 females, mean age (SD) 45.0 (13) years), and 76 matched controls. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was prevalence of RLS based on updated International RLS Study Group criteria. Secondary outcome measures included prevalence of periodic limb movements (PLM) using actigraphy; pain, motor and sensory symptoms in lower limbs; organic comorbidities and medication affecting RLS. RESULTS: RLS criteria were fulfilled in 43.8% of patients (95% CI 34 to 54) and in 7.9% of controls (95% CI 3 to 17, p<0.00001). Both RLS and PLM indices (PLMi) ≥22.5/hour were found in 21.2% of patients with FMD and 2.6% of controls. Patients with FMD with RLS had a higher mean PLMi (p<0.001) and a higher proportion of PLMi ≥22.5/hour (p<0.01) than RLS-negative patients. Patients with RLS had higher prevalence of pain and sensory symptoms in lower limbs, no difference was found in medication and prevalence of organic comorbidities in patients with FMD with and without RLS. CONCLUSIONS: We found an increased prevalence of RLS in patients with FMD. Clinical diagnosis of RLS was supported by actigraphic measurement of clinically relevant PLM in a significant proportion of patients with FMD. Although functional motor and sensory symptoms may mimic RLS, RLS may be unrecognised in patients with FMD. This finding may have clinical implications in management of FMD, and it raises the possibility of common pathophysiological mechanisms of FMD and RLS/PLM.

• MeSH
• dospělí MeSH
• dystonie patofyziologie   MeSH
• konverzní poruchy epidemiologie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• myoklonus patofyziologie   MeSH
• neurologické poruchy chůze patofyziologie   MeSH
• pohybové poruchy epidemiologie   patofyziologie   MeSH
• poruchy hybnosti oka patofyziologie   MeSH
• poruchy řeči patofyziologie   MeSH
• prevalence MeSH
• studie případů a kontrol MeSH
• svalová slabost patofyziologie   MeSH
• syndrom neklidných nohou epidemiologie   MeSH
• tremor patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Intramural MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVE: Pain, fatigue, cognitive complaints and psychiatric comorbidities are common in patients with functional movement disorder and may significantly affect their quality of life. The aim of the study was to assess the impact of motor and non-motor symptoms on health-related quality of life in patients with functional movement disorder. METHODS: Sixty-one patients with clinically established functional movement disorder and 61 matched healthy controls completed standardized questionnaires for depression, anxiety, cognitive complaints, fatigue, pain, sleepiness, apathy and health-related quality of life. Motor disorder severity was assessed using The Simplified Functional Movement Disorders Rating Scale. Personality traits were assessed using the 44-Item Big Five Inventory. RESULTS: Compared to controls, patients reported significantly lower health-related quality of life and higher levels of all assessed non-motor symptoms except for apathy. No difference was found in personality traits. In both groups, health-related quality of life scores negatively correlated with depression, anxiety, pain, cognitive complaints, apathy, and neuroticism. No correlation was found between health-related quality of life and motor symptom severity in patients with functional movement disorder. Multiple regression analysis of the predictors of health-related quality of life showed significant impact of trait anxiety and cognitive complaints scores. CONCLUSIONS: Multiple non-motor symptoms but not motor symptom severity correlated with impaired health-related quality of life in patients with functional movement disorder. Impaired health-related quality of life was predicted by anxiety and cognitive complaints. Our results highlight the importance of assessing and treating both motor and non-motor symptoms in patients with functional movement disorder.

• MeSH
• kvalita života psychologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pohybové poruchy diagnóza   psychologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• dospělí MeSH
• dystonie epidemiologie   patofyziologie   MeSH
• incidence MeSH
• komorbidita MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření pohybů očí MeSH
• mladý dospělý MeSH
• neurologické poruchy chůze epidemiologie   patofyziologie   MeSH
• oční konvergence fyziologie   MeSH
• pohyby očí fyziologie   MeSH
• poruchy hybnosti oka epidemiologie   patofyziologie   MeSH
• sakadické oční pohyby fyziologie   MeSH
• tremor epidemiologie   patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• dopisy MeSH
• práce podpořená grantem MeSH