Myoclonus-Ataxia Syndrome Associated with COVID-19

Kuldeep Shetty,Atul Manchakrao Jadhav,Ranjith Jayanthakumar,Seema Jamwal,Tejaswini Shanubhogue,Mallepalli Prabhakar Reddy,Gopal Krishna Dash,Radhika Manohar,Vivek Jacob Philip,Vikram Huded 대한파킨슨병및이상운동질환학회 2021 Journal Of Movement Disorders Vol.14 No.2

Neurological manifestations of coronavirus disease (COVID-19) have increasingly been reported since the onset of the pandemic. Herein, we report a relatively new presentation. A patient in the convalescence period following a febrile illness with lower respiratorytract infection (fever, myalgia, nonproductive cough) presented with generalized disabling myoclonus, which is phenotypicallysuggestive of brainstem origin, along with additional truncal cerebellar ataxia. His neurology work-ups, such as brainMRI, electroencephalography, serum autoimmune and paraneoplastic antibody testing, were normal. His CT chest scan revealedright lower lung infiltrates, and serological and other laboratory testing did not show evidence of active infection. COVID-19 titers turned out to be strongly positive, suggestive of post-COVID-19 lung sequelae. He responded partially to antimyoclonicdrugs and fully to a course of steroids, suggesting a para- or postinfectious immune-mediated pathophysiology. Myoclonusataxiasyndrome appears to be a neurological manifestation of COVID-19 infection, and knowledge regarding this phenomenonshould be increased among clinicians for better patient care in a pandemic situation.

The Effect of Sagittal Knee Deformity on Preoperative Measurement of Coronal Mechanical Alignment during Total Knee Arthroplasty

( Gautam M Shetty ),( Arun Mullaji Frcs Mch ),( Ahmed Adel Khalifa ),( Abhik Ray ),( Vivek Nikumbha ) 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.2

Purpose: The purpose of this prospective study was to determine correlation between coronal mechanical alignment measured on preoperative standing full-length radiographs and navigation during total knee arthroplasty (TKA) in the presence of an associated sagittal deformity (hyperextension and flexion deformity). Materials and Methods: Coronal mechanical alignment measured on preoperative, standing, full-length, hip-to-ankle anteroposterior radiographs was compared with intraoperative measurements recorded with computer navigation in 200 primary navigated TKAs. Results: The mean difference in mechanical alignment between the two techniques was significantly greater (p=0.001) in patients with an associated flexion deformity >10° when compared to knees with associated flexion deformity ≤10°; 48% of knees with a flexion deformity >10° had a difference of ≥3° between the full-length radiograph and navigation alignment measurements. There was a strong correlation between the radiographic and navigation measurement techniques. Conclusions: The mean difference in coronal mechanical alignment between the two techniques was significantly higher in patients with an associated flexion deformity >10°. Hence, surgeons should take caution when relying on preoperative full-length radiographs for determining coronal mechanical alignment in patients with an associated flexion deformity >10° where using navigation may be more reliable.

Orofacial Injury Profiles and Patterns of Care in an Inner-City Hospital

Leathers, Richard D.,Vivek Shetty,Black, Edward E.,Kathryn Atchison Korean Academy of Oral Biology and the UCLA Dental 1998 International Journal of Oral Biology Vol.23 No.1

To understand the types of orofacial injuries and determine patterns of surgical care in patients presenting to an inner-city hospital, 203 adult patients seeking treatment at the King/Drew Medical Center in Los Angeles were studied prospectively. Sociodemographic details including race, age, gender and education were collected and the etiology of the injury noted. The nature and severity of injury was categorized using a modified AO classification scheme and related to the type of surgical care provided (maxillomandibular fixation or rigid internal fixation). The majority of the victims were minorities, male (88%), uninsured (86%), and under or unemployed (83%). Interpersonal violence (88%) was the most common etiology of the orofacial injury. The body and angle of the mandible were most commonly involved and approximately 25% of the patients had associated midfacial fractures. While most fractures (83%) with low severity were treated by maxillomandibular fixation, a substantial number (17%) were treated by rigid internal fixation. In contrast, over 65% mandible fractures deemed to be severe were treated exclusively by maxillomandibular fixation. The patterns of injury observed at this inner-city hospital and their antecedents ate distinctly different. The majority of the injuries result from intentional violence and the victims are primarily socially and economically disadvantaged groups without financial resources to pay for treatment. Although women are less involved, they are disproportionally the victims of domestic violence. The large inconsistencies in the treatment methods and the preventable aspect of these injuries emphasizes the need for systematic audit and for developing prevention programs targeting high-risk groups.

Social Support, Well-being and Risk Behaviors among Minority Males Treated at an Urban Orofacial Injury Center

Elliott Brown, Karin A.,Shetty, Vivek,Atchison, Kathryn,Leathers, Richard,Black, Edward,Delrahim, Sandra Korean Academy of Oral Biology and the UCLA Dental 1998 International Journal of Oral Biology Vol.23 No.1

This study examined the relationship between perceived social support and reports of well-being and risky health behaviors among minority males treated at an urban orofacial trauma center. One hundred nineteen African American and 49 Hispanic males, who received orofacial surgery due to a fractured jaw, participated in a structured interview over a six month period. Selected scales from the MOS Short-Form(SF-20) survey were used to obtain self-reports of general health, emotional well-being and the perceived availability of general social support. Patients were also asked about alcohol and street drug use to assess risky health behavior and its relationship to social support. An overwhelming majority of the patients perceived social support to be available to them. However, significantly more Hispanic patients reported "having enough friends and social life" compared to African-American patients. For both groups, perceived availability of social support was found to be positively related to patients reports of general health and emotional well-being. Eighty percent of the patients reported alcohol use as a habit. Alcohol use did not influence perceptions of available social support. More African-American patients (46%) reported habitual street drug use than Hispanics (16%). Habitual street drug use poses a significant risk for poor social support and emotional distress. Social support did not buffer the relationship between street drug use and mental health risk. Perceptions of social support remained consistent when examined across three and six months post-surgery. The positive perceptions of available support reported by the majority of inner-city ethnic-minority males in this study suggests that the potential positive influence of social relationships on their recovery and well-being should not be underestimated. Instead, information on supportive relationships should be elicited and availed of as an adjunct to surgical care.

Mental Health Needs of Inner-City Victims of Orofacial Injury

Asarnow, Joan R.,Shirley Glynn,Robert Asarnow,Vivek Shetty,Richard Leathers,Thomas Belin,Paul Juarez Korean Academy of Oral Biology and the UCLA Dental 1999 International Journal of Oral Biology Vol.24 No.1

To examine the mental health needs of inner-city, minority patients treated for orofacial injury at an urban, tertiary trauma center. Subjects were 187 patients seeking care for orofacial injury at an urban Level 1 trauma center. A structured interview utilizing the Brief Symptom Inventory (BSI) and the Service Use and Adjustment Problem screen (SUAPS) was used to assess the mental health needs. Participants were predominantly male (86.1%) and largely African-American (71.7%) or Hispanic (21.4%). Results underscore the high level of mental health need in this population of orofacial injury victims, with over 57.8% of the sample reporting some lifetime need for mental health services and over 80% of the sample endorsing some need for mental health or social services. Despite this high level of self-reported mental health need, service use was relatively low with only 31.6% of the sample reporting some mental health treatment. This suggests an unmet need for mental health treatment in roughly 26.2% of the sample. The most common problems in this sample included substance use/abuse, arrests/convictions, histories of homelessmess, and school expulsions/suspensions. One or more of these problems were reported by over 25% of the sample during their lifetimes, and by over 15% of the sample during the past year (with the exception of school expulsions/suspensions). Inner-city based, minority victims of orofacial injury have significant mental health needs as well as significant barriers to service utilization. The results of this study underscore the potential utility of screening victims of orofacial injury at urban trauma centers for mental health needs and of developing comprehensive care addressing their psychosocial needs.

The Relationship of Substance Abuse to Orofacial Injuries in an Inner City Population

Black, Edward E.,Kathryn Atchison,Vivek Shetty,Leathers, Richard D.,Shan Bagby,Sandra Delrahim Korean Academy of Oral Biology and the UCLA Dental 1998 International Journal of Oral Biology Vol.23 No.1

The prevalence of drug and alcohol abuse was investigated prospectively in a population of 207 patients with orofacial injuries seeking treatment at the King/Drew Medical Center, Los Angeles. Demographic details were collected, the use of alcohol and street drugs obtained, and a clinical determination made on whether the injuries were related to alcohol or drug intoxication. The prevalence of covert alcoholism was determined by administering the CAGE questionnaire. The majority of victims were young (33.3±9.05 yrs), male (88%), African-American (73%) or Hispanic (25%), unemployed (71%) and had < 12 years of education (73%). About 83% of the African-American patients reported regular use of alcohol and 48% reported regular use of street drugs. Among Hispanic patients, 80% reported use of alcohol and 18% used drugs regularly. Of the 119 patients screened by the CAGE test, 60% of the African-American patients and 46% of the Hispanic patients answered affirmatively for one or more items, which indicates potential for alcoholism. A significantly greater proportion of patients who screened positive had a history of previous head trauma (80% vs. 50%, p=0.01) and a history of orofacial trauma (77% vs. 52%, p=0.03) or both, indicating a high rate of recidivism. We conclude that alcohol and drug abuse is strongly associated with the occurrence of orofacial injury in inner-city populations. The CAGE test appears to be a simple and effective screening mechanism for clinicians to yield valuable information that can affect the treatment provided. Beyond socioeconomic factors, substance abuse in and of itself appears to be an important risk factor of repeat injury.

Orofacial Injury and the Development of Acute PTSD

Glynn, Shirley M.,Asarnow, Joan R.,Robert Asarnow,Vivek Shetty,Elliott Brown, Karin A.,Edward Black,David Forney Korean Academy of Oral Biology and the UCLA Dental 1999 International Journal of Oral Biology Vol.24 No.1

To examine the development of acute post traumatic stress disorder (PTSD) in inner-city, minority patients seeking care for orofacial injury were evaluated. Trained interviewers collected baseline data from one-hundred seventy-two patients seeking care for orofacial injury at an urban trauma center. Follow-up assessments of PTSD (DSM-IV criteria) and perceived impact of the injury on social functioning were repeated at one month post-injury. Patients were predominantly male and largely African-American or Hispanic. At the one month follow-up visit, 52 patients (30%) endorsed symptoms resulting from the facial injury consistent with a PTSD diagnosis. Significant predictors of the development of acute PTSD included older age and perceived life threat at the time of the incident. A substantial subsample of orofacial injury patients presenting to inner-city hospitals has negative psychological outcomes at one-month post-injury. Results underscore the potential utility of screening survivors of orofacial injury at urban trauma centers for PTSD by eliciting responses to a perceived life threat questions and developing systems of care that facilitate referral to appropriate psychological treatment.