No abstract

Type 1 diabetes mellitus (T1DM) has an important impact on morbidity and mortality because it may start early in life. Therefore, the early detection of cardiovascular autonomic neuropathy (DCAN) in T1DM patients is important to intervene quickly and prevent further deterioration. Traditional autonomic function tests detect abnormalities in severely symptomatic patients but they are difficult to be standardized, require the patient’s active participation and their sensitivity to the early disease is limited. In comparison, heart rate variability (HRV) is easier to be measured and standardized. Therefore, we aim to find the HRV indexes that better identify DCAN at an early stage in T1DM patients, and evaluate if HRV is a valid alternative to traditional tests. For this aim, we administered the SCOPA-AUT questionnaire on symptoms of autonomic dysfunction as well as deep breathing, Valsalva, handgrip, head-up tilt (HUT), and cold-pressor tests, to 52 T1DM patients and 27 controls. We calculated HRV indexes during supine rest (SUP) and HUT, assessing differences between groups and postures by a linear mixed-effect model for repeated measures. Receiver Operating Characteristic (ROC) analysis quantified how each HRV index and autonomic test distinguishes between patients and controls. We found that the SCOPA-AUT score was slightly but significantly (p < 0.05) greater in patients, indicating an early DCAN. T1DM patients preserved the HRV response to changing posture but in SUP they showed significantly lower standard deviation and vagal indexes of HRV than controls. The area under the ROC curve of these HRV indexes was not lower than 0.68. By contrast, traditional autonomic tests did not differ between groups. Therefore, early DCAN initially causes an impairment of the cardiac vagal control manifest in conditions of elevated vagal tone, as in SUP. Compensatory adjustments of the sympathetic control might explain the unaltered response to traditional autonomic tests. In conclusion, vagal HRV indexes in SUP help to identify early DCAN better than traditional tests, potentially allowing rapid interventions.

Because of its variable origin and course, the thenar branch of the median nerve is at risk during carpal tunnel release. Transection results in thenar atrophy and non-functioning of the opponens pollicis, abductor pollicis brevis and flexor pollicis brevis muscles. A late neurorrhaphy and hypothenar fat pad flap were performed to restore nerve conduction and thus muscle function after accidental transection of the thenar branch of the median nerve during an open carpal tunnel release 216 days earlier.During the eight months follow-up, we noted progression in daily functioning, muscle strength and a decrease in muscle atrophy. Electromyography confirmed extensive improvement of the thenar motor function.The hypothenar fat pad flap may have an advantage in late nerve repair, providing a tension-free gliding surface, as well as arterial blood supply to the newly repaired nerve branch.

Background YouTube has become an important educational platform. For biomedical students the site is a primary information source for informational and instructional videos on a variety of medical topics.This study examined the educational quality of instructional lumbar puncture procedure videos on YouTube.Methods The search strings “lumbar puncture medical procedure” and “spinal tap medical procedure” were used. The first 100 videos for each search string were assessed for eligibility. Video characteristics were documented. To evaluate the popularity of the videos the Video Power Index was calculated. Four validated checklists were used for video assessment: Lumbar Puncture Assessment Tool, reliability score, Global Quality Score, Attractiveness and Understandability score.Results Lumbar puncture videos had a median ratio of 8,90 views/day, 0,04 likes/day and a video power index of 14,44, which was lower compared to other categories of instructional videos (CPR and cake baking). The mean LumPAT score was 34/55, with only three videos scoring at least 44/55, the pass ratio of this assessment. The median reliability score was 3/4, the median GQS 3/5 (moderate quality) and the median AU score 6,5/8. Significant correlations were found between the LumPAT score and the video length (p = 0,003), the GQS (p < 0,001) and the AU score (p = 0,01).Conclusions In this study, only three out of the 23 videos passed the LumPAT score. The majority of the instructional videos are not suitable for the training of health care professionals and students in performing a lumbar puncture procedure.