Arrani Senthinathan, Melanie Penner, Karen Tu, Andrew M. Morris, B. Catharine Craven, Susan B. Jaglal
{"title":"Identifying prescribers of antibiotics in a primary care spinal cord injury cohort","authors":"Arrani Senthinathan, Melanie Penner, Karen Tu, Andrew M. Morris, B. Catharine Craven, Susan B. Jaglal","doi":"10.1038/s41394-024-00615-8","DOIUrl":"https://doi.org/10.1038/s41394-024-00615-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Study design</h3><p>A retrospective cross-sectional study.</p><h3 data-test=\"abstract-sub-heading\">Objective</h3><p>To identify who prescribes outpatient antibiotics among a primary care spinal cord injury (SCI) cohort.</p><h3 data-test=\"abstract-sub-heading\">Setting</h3><p>ICES databases in Ontario, Canada.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A cohort of individuals with SCI were retrospectively identified using a tested-algorithm and chart reviews in a primary care electronic medical records database. The cohort was linked to a drug dispensing database to obtain outpatient antibiotic prescribing information, and prescriber details were obtained from a physician database.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Final cohort included three hundred and twenty individuals with SCI. The average annual number of antibiotic courses dispensed for the SCI cohort was 2.0 ± 6.2. For dispensed antibiotics, 58.9% were prescribed by rostered-primary care practice physicians, compared to 17.9% by emergency and non-rostered primary care physicians, 17.4% by specialists and 6.1% by non-physician prescribers. Those who lived in urban areas and rural areas, compared to those who lived in suburban areas, were more likely to receive antibiotics from emergency and non-rostered primary care physicians than from rostered-primary care practice physicians.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Although individuals with SCI received outpatient antibiotic prescriptions from multiple sources, physicians from an individual’s rostered-primary care practice were the main antibiotic prescribers. As such, interventions to optimize antibiotics use in the SCI population should target the primary care practice.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139669423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Franco Alejandro Corvatta, Virginia Margarita Cano Busnelli, Axel Federico Beskow, Susana Gutt, Fernando Gabriel Wright
{"title":"Sleeve gastrectomy as a bridge to maternity in a patient with obesity, infertility and tetraplegia. A case report","authors":"Franco Alejandro Corvatta, Virginia Margarita Cano Busnelli, Axel Federico Beskow, Susana Gutt, Fernando Gabriel Wright","doi":"10.1038/s41394-024-00614-9","DOIUrl":"https://doi.org/10.1038/s41394-024-00614-9","url":null,"abstract":"<p>Traumatic spinal cord injury (SCI) is a major cause of severe and permanent disability in young adults. Overweight and obesity are commonly observed among patients affected with SCI, with reports of a prevalence of over 60 and 30% respectively. Case report: A 34 year-old woman suffering from tetraplegia after sustaining a traumatic injury to C5-C6 at age 23 as a result of a motor vehicle accident was presented to our hospital’s multidisciplinary bariatric team due to class II obesity. At the time of presentation to the team, eleven years after the accident, her BMI was calculated to be 39 Kg/m<sup>2</sup> (weight 97 kg, height 1.57 meters). She was diagnosed with infertility while seeking pregnancy, and referred to our bariatric unit for weight loss. In addition, she had overcome the physical limitations of her injury, had a regular job and was engaged in regular physical activities such as swimming. In May 2017, she underwent laparoscopic sleeve gastrectomy (LSG) without complications and was discharged on postoperative day 2. 17 months following LSG, with a normal BMI, she became naturally pregnant. She had emergency cesarean at 35 weeks due to pneumonia but both patient and child recovered without sequelae. Currently, 4 years after surgery she maintains 37.11% total weight loss (weight 61 kg). She reports having a better quality of life with fewer medical intercurrencies. Conclusions: Patients with SCI and obesity, particularly women seeking to conceive, may be benefited by being referred to bariatric teams for assessment and treatment to improve results associated with sustained weight reduction.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139508689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander M. Tucker, Peter J. Madsen, Shih-Shan Lang, Phillip B. Storm
{"title":"Technical note: Traumatic atlanto-occipital dislocation and severe subaxial cervical distraction injury in an infant","authors":"Alexander M. Tucker, Peter J. Madsen, Shih-Shan Lang, Phillip B. Storm","doi":"10.1038/s41394-023-00612-3","DOIUrl":"https://doi.org/10.1038/s41394-023-00612-3","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Traumatic injuries of the spine requiring surgery are rare in infancy. Fusion procedures in the very young are not well-described at the atlanto-occipital junction or subaxial spine. Here we describe novel segmental posterior instrumentation in a severe spinal column disruption in an infant.</p><h3 data-test=\"abstract-sub-heading\">Case presentation</h3><p>A 13-month-old male with atlanto-occipital dislocation and severe C6-7 distraction (ASIA impairment scale A) presented after a motor vehicle accident. He underwent instrumented fusion (occiput-C2 and C6-7) and halo placement. Postoperative imaging demonstrated reduction of the C6-7 vertebral bodies. Physical examination showed lower limb paraplegia and preserved upper extremity strength except for mild weakness in hand grip (3/5 on the MRC grading scale). Occiput-C2 instrumentation was performed using occipital keel and C2 pedicle screws with sublaminar C1 polyester tape. C6-7 reduction and fixation was performed with laminar hooks. Arthrodesis was promoted with lineage-committed cellular bone matrix allograft and suboccipital autograft. Anterior column stabilization was deferred secondary to a CSF leak. Intraoperative monitoring was performed throughout the procedure. Within 1 month after surgery the patient was able to manipulate objects against gravity. CT imaging revealed bony fusion and spontaneous reduction of C6-7.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>Spinal instrumentation is technically challenging in infants, regardless of injury mechanism, particularly in cases with complete spinal column disruption, but an anterior fusion may be avoided in infants and small children with posterior stabilization and halo placement.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139093590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatment of postprandial hypotension with acarbose in an adult with cervical spinal cord injury: a case report","authors":"Sabrina S. Dieffenbach, Hannah Aura Shoval","doi":"10.1038/s41394-023-00613-2","DOIUrl":"https://doi.org/10.1038/s41394-023-00613-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Postprandial hypotension is a type of autonomic dysfunction where there is a decrease in systolic blood pressure of >20 mm HG within 2 h after eating thought to be due to poor cardiovascular compensation for splanchnic blood pooling that occurs with meals. This form of autonomic dysfunction is underdiagnosed in patients with spinal cord injury, likely in part because it can be asymptomatic.</p><h3 data-test=\"abstract-sub-heading\">Case presentation</h3><p>26-year-old with complete cervical spinal cord injury (SCI) presented with neck pain described as severe 10/10 pain, which felt like “a rope around his neck.” Pain came on during and after meals and was associated with a feeling of pressure behind his eyes, white spots in his vision along with feeling as if he was going to pass out. The caregiver noted a systolic blood pressure drop by about 30–40 points with meals and lost weight due to avoiding eating. A diagnosis of post-prandial hypotension (PPH) was made and Acarbose was started at a low dose 25 mg three times per day with meals. During follow up, the patient reported complete resolution of drops of blood pressure, neck pain, and all associated symptoms. The patient was able to eat comfortably and gained weight.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>There are few case reports on PPH in SCI and none looking at acarbose on a young, nondiabetic person with SCI. Clinicians should be aware that PPH can occur in young otherwise healthy people with SCI. Further research is needed on PPH, including the use of acarbose, in the SCI population.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138715871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The presence of Candida parapsilosis with intrathecal baclofen pump in a person with high cervical spinal cord injury; infection or colonization? A Case Report.","authors":"John Chan, Harminder Singh, Kazuko Shem","doi":"10.1038/s41394-023-00610-5","DOIUrl":"10.1038/s41394-023-00610-5","url":null,"abstract":"<p><strong>Introduction: </strong>Intrathecal baclofen (ITB) therapy is an effective method of treating spasticity in persons with spasticity due to spinal cord injury (SCI), but complications are not rare and can include spinal fluid leaks, infection, and catheter/pump malfunction.</p><p><strong>Case presentation: </strong>This study presents information related to an adult male patient with traumatic SCI and a history of two prior ITB pump pocket infections that required removal due to pump infection. The patient then developed skin erosion over the third pump, and the fluid around the pump grew methicillin-sensitive Staphylococcus aureus, diphtheroids, and Candida parapsilosis. The patient was initially treated with antibiotics and anti-fungal medication without removal of the ITB pump. The ITB pump was eventually removed 27 months later, and the fourth pump was implanted 10 months later.</p><p><strong>Discussion: </strong>ITB pumps can be an effective treatment modality for spasticity in people with SCI; however, complications, including infection, can occur and require pump removal. This case illustrates a case of possible Candida colonization of the ITB pump, which was eventually removed.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138462749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Organophosphorus poisoning induced delayed neurotoxicity: a report of two cases.","authors":"Amrutha Viswanath, Apurba Barman, Jagannatha Sahoo, Souvik Bhattacharjee, Suman Patel","doi":"10.1038/s41394-023-00611-4","DOIUrl":"10.1038/s41394-023-00611-4","url":null,"abstract":"<p><strong>Introduction: </strong>Organophosphorus compounds (OPC) are one of the most commonly used pesticides worldwide and are often misused for suicidal poisoning due to their easy availability. Acute manifestations and management of organophosphorus (OP) poisoning have been reported several times. Organophosphorus-induced delayed neurotoxicity (OPIDN) is a rare delayed presentation of OP poisoning that involves central-peripheral distal axonopathy.</p><p><strong>Case presentation: </strong>In this study, we report two cases of OPIDN developed after a few weeks of OP poisoning. Clinical features, electrodiagnostic study findings, and rehabilitative measures adopted for the patients and their follow-up have been described in the report.</p><p><strong>Discussion: </strong>Organophosphorus (OP) poisoning may rarely produce features of delayed neurotoxicity, which may gradually appear after acute cholinergic symptoms. This report shows the importance of considering the delayed presentation of possible OPC toxicity in patients with neurological symptoms and a history of OPC exposure.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10625613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lumbar spine epidural meningioma: report of a rare case.","authors":"Ghassen Gader, Mourad Masmoudi, Khalil Ghedira, Mohamed Ilyes Krifa, Ines Chelly, Ihsèn Zammel, Mohamed Badri","doi":"10.1038/s41394-023-00608-z","DOIUrl":"10.1038/s41394-023-00608-z","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Spinal meningiomas are typically intradural lesions. Some may infiltrate the dura mater, thus exhibit direct extradural extension. Pure spinal epidural meningiomas are very rare. Here we present a 64 year-old-male with a purely extradural meningioma, and reviewed 15 previously reported cases from the literature.</p><p><strong>Case presentation and clinical discussion: </strong>A 64-year-old male presented with a progressive cauda equine syndrome. When Lumbar spine MRI showed two extradural lesions regarding the L3-L4 level, one was fully removed (i.e., the posterolateral lesion), while the other anterior lesion was left alone (i.e., to avoid potential neurologic sequelae). Pathologically, the lesion was a benign meningioma.</p><p><strong>Conclusions: </strong>Spinal epidural meningiomas are rare and should optimally be fully excised at the index surgery.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10618258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shailesh R Hadgaonkar, Nishad V Situt, Shivan Marya, Siddharth N Aiyer, Parag K Sancheti
{"title":"Cervical Schwannoma camouflaged by cervical intervertebral disc prolapse-A case report.","authors":"Shailesh R Hadgaonkar, Nishad V Situt, Shivan Marya, Siddharth N Aiyer, Parag K Sancheti","doi":"10.1038/s41394-023-00609-y","DOIUrl":"10.1038/s41394-023-00609-y","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical prolapsed intervertebral disc is one of the common conditions causing cervical myeloradiculopathy. Anterior Cervical Discectomy and Fusion (ACDF) is the standard line of management for the same. Intradural neurogenic origin tumors are relatively rare and can present with features of myeloradiculopathy. Radiological imaging plays important role in diagnosis of such pathologies.</p><p><strong>Case report: </strong>We report a patient with C5-6 cervical disc prolapse that presented with radiculopathy symptoms in the right upper limb, which was refractory to conservative care. He underwent a C5-6 ACDF and reported complete relief from symptoms at 4 weeks. He developed deteriorating symptoms over the next 10 weeks and presented at 14 weeks follow-up with severe myeloradiculopathy symptoms on the left upper limb with upper limb weakness. A fresh MRI identified an intradural extramedullary tumor with cystic changes at the index surgery level. This was treated with tumor excision and histopathology confirmed a diagnosis of schwannoma. Simultaneous presence of cord signal changes with disc herniation obscured the cystic schwannoma which became apparent later on contrast enhanced MRI imaging.</p><p><strong>Conclusion: </strong>Careful review of preoperative imaging and contrast MRI study may help in diagnosing cystic schwannomas with concomitant cervical disc herniations that have cord signal changes.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66784333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Differentiating essential hypertension from autonomic dysreflexia: a case report.","authors":"Leon Smith, Gerard Weber","doi":"10.1038/s41394-023-00607-0","DOIUrl":"10.1038/s41394-023-00607-0","url":null,"abstract":"<p><strong>Introduction: </strong>Autonomic dysreflexia (AD), a condition of critically raised blood pressure, is a severe complication of spinal cord injury. Primary (essential) hypertension may present with similar blood pressure levels to AD, though the causes, pathophysiology, presentation and treatment will differ.</p><p><strong>Case presentation: </strong>We report a case of a 74-year-old patient with a C1 spinal injury, who developed primary (essential) hypertension during her rehabilitation phase of care, requiring extensive investigations for autonomic dysreflexia. Despite this, no underlying cause was found; essential hypertension was subsequently confirmed with 24-hour ambulatory blood pressure monitoring. Treatment with an ACE inhibitor was introduced to good effect.</p><p><strong>Discussion: </strong>Essential hypertension can affect patients with spinal injury, even though most patients with higher level injuries (particularly cervical spinal cord injuries) are expected to have low resting baseline hypotension. Relevant features of this are presented within this case; a set of criteria to differentiate essential hypertension from autonomic dysreflexia are also proposed.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10603167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54231026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cross-cultural adaptation, validity and reliability of the Hindi version of the capabilities of upper extremity (CUE-H).","authors":"Ruby Aikat, Somya Prasad","doi":"10.1038/s41394-023-00606-1","DOIUrl":"10.1038/s41394-023-00606-1","url":null,"abstract":"<p><strong>Study design: </strong>Clinimetric Study.</p><p><strong>Objectives: </strong>To translate and cross-cultural adapt the Capabilities of Upper Extremity (CUE) questionnaire into Hindi Language and assess the psychometric properties of the CUE-Hindi (CUE-H).</p><p><strong>Setting: </strong>Indian Spinal Injuries Centre, New Delhi, INDIA.</p><p><strong>Methods: </strong>The CUE-H translation and cross-cultural adaptation followed standardized guidelines. The pre-final version was tested for clarity and comprehensibility. Content Validity Estimation was done using both qualitative and quantitative methods. Cronbach's alpha was used for assessing the internal consistency and Intraclass Correlation Coefficient (ICC) for assessing the test-retest reliability.</p><p><strong>Results: </strong>All steps of the translation process were followed and documented. The CUE-H was found to be comprehensive to patients and easy to administer. Content Validity estimation resulted in the retention of all the questionnaire items. The ICC was 0.99 and Cronbach's alpha for the scale was 0.94.</p><p><strong>Conclusions: </strong>The CUE-H demonstrated acceptable measurement properties, showing that it can be used for assessing upper limb functional limitations in Hindi-speaking people with SCI. It can be used as an assessment tool for clinical management or research.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10603096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54231025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}