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Objective: This study aimed to analyze the prevalence and risk factors of neuromuscular complications after lung transplantation (LT), as well as the association between neuromuscular complications and extracorporeal membrane oxygenation (ECMO) support. Methods: We retrospectively included 201 patients who underwent LT between 2013 and 2020. Patients were classified into three groups based on the presence and the pattern of postoperative leg weakness: no weakness group, asymmetric weakness group, and symmetric weakness group. Comorbidities, duration of ECMO therapy, and postoperative complications were compared between the three groups. Results: Of the 201 recipients, 16 (8.0%) and 29 (14.4%) patients developed asymmetric and symmetric leg weakness, respectively. Foot drop was the main complaint in patients with asymmetric weakness. The presumed site of nerve injury in the asymmetric weakness group was the lumbosacral plexus in 8 (50%), peroneal nerve in 4 (25%), sciatic nerve in 2 (12.5%), and femoral nerve in 2 (12.5%) patients. In multivariate analysis, the use of preoperative ECMO was found to be independently associated with asymmetric weakness (OR, 3.590; 95% CI [1.227–10.502]). Symmetric leg weakness was associated with age at LT (1.062 [1.002–1.125]), diabetes mellitus (2.873 [1.037–7.965]), myositis (13.250 [2.179–80.584]), postoperative continuous renal replacement therapy (4.858 [1.538–15.350]), and duration of stay in the intensive care unit (1.052 [1.015–1.090]). Conclusion: More than 20% of patients developed leg weakness after LT. Early suspicion for peripheral neuropathy is required in patients after LT who used ECMO preoperatively, and who suffered from medical complications after LT. [ABSTRACT FROM AUTHOR]

Abstract Background Obesity is a major global health problem. Kuwait has a very high prevalence of obesity, and consequently, the number of bariatric surgeries is rising. Objectives The aim of this study is to analyze the clinical presentation and electrodiagnostic features of peripheral nerve complications following bariatric surgery. Subjects and methods We retrospectively involved a convenience sample of patients presenting at a tertiary referral center and analyzed the patterns and frequency of peripheral nerve involvement, correlations with operative techniques, perioperative complications, nutritional status, possible risk factors, and functional impairment. Results Among the 58 cases, 23 presented with chronic distal symmetrical sensorimotor neuropathy, 10 suffered from small fiber neuropathy, 22 had mononeuropathies, 2 patients had acute axonal sensorimotor neuropathy, and only 1 patient had lumbar plexopathy. In 22 patients, we observed mononeuropathies (10 cases of carpal tunnel syndrome, 7 cases of peroneal compression at the knee, 4 cases of ulnar neuropathies at the elbow, and 1 case of meralgia paresthetica). Rapid weight loss and protracted postoperative vomiting tended to correlate with generalized neuropathies, while focal compression with loss of the protective subcutaneous tissue pad was associated with mononeuropathies. All patients suffered from a deficiency of at least 1 micronutrient. Compliance with supplementary therapy was poor. Some post-bariatric neuropathies interfere severely with patients’ functional status. Conclusion Prevention by close follow-up, nutritional intervention, and patient education to avoid habitual postures related to nerve compression is appropriate.

Background: Camptocormia is a complication in which the spine bends forward while walking or standing. This axial postural deformity is common in Parkinson's disease (PD), with prevalence ranging from 3 to 18 percent; it is generally associated with a more severe disease and longer duration of symptoms. Camptocormia in PD typically responds poorly to levodopa. Other treatment options are limited and are often not effective. Case Presentation: We describe an unusual case of PD presenting with camptocormia that only emerged during the "off" state of PD. The patient was treated with classical dopaminergic anti-Parkinson's therapy plus a new formulation of palmitoylethanolamide co-ultramicronized with luteolin (Lut) termed um-PEALut. We observed that the addition of um-PEALut to acute treatment with carbidopa/levodopa resulted in improved dyskinesia and reduced camptocormia. The patient continued treatment for four months, resulting in a complete resolution of leg and trunk dyskinesia and a marked reduction in the onset of camptocormia during the "off" states. Conclusion: um-PEALut shows potential as an efficacious adjuvant therapy for patients with PD receiving carbidopa/levodopa to treat both dyskinesia and camptocormia in acute and chronic fashion. [ABSTRACT FROM AUTHOR]

Different mechanisms of neuromuscular complications, their clinical presentation, methods of diagnosis, prognosis and treatment options arepresented. The material is presented according to the level of nervous system damage, with inclusion of different clinical entities. Authors revieweda wide range of disease – disease of the spinal cord, peripheral nerves and plexus, neuromuscular junction and muscle – as a result of chemotherapy and radiation therapy. Systemic effects of drugs on peripheral nervous system, various departments of which can be simultaneously involved in the pathological process, were also highlighted.

Background: A rising number of bariatric surgeries (BS) are associated with a rise in medical complications including protein malnutrition and neuromuscular complications (NM). Although BS were minimized during the COVID-19 pandemic, the number of admissions due to complications continued to increase. Proper outpatient follow-up was negatively affected during the pandemic. We aim to address the rising rate of post-BS admissions during COVID-19 pandemic compared to the previous six years' admissions with a similar diagnosis. Methods: This is a retrospective observational study of 33 patients admitted with malnutrition and/or NM complications post-BS at Hamad General Hospital, Qatar, from 1st Jan 2014-30th Aug 2020. Patients' data were retrieved from the electronic medical records and bariatric patients' database. Malnutrition was evaluated using serum albumin, total protein, minerals, and vitamins. Nerve conduction study/electromyography confirmed NM complications. Risk factors addressed were interval between BS and admission, gastrointestinal symptoms, total weight loss (TWL %), excess weight loss (EWL %), and irregular multivitamins intake. Results: The study included 21 patients, admitted from 1st Jan 2014-31th Dec 2019, compared to 12 patients during the period 1st Jan-30th August 2020. The patients' mean age was 26.90±9.81 years, and females were 18 (59%). The mean pre-operative weight, Body Mass Index (BMI), post-operative weight, BMI were: 123.48 kg, 44.37 kg/m² and 84.61 kg - 30.67 kg/m², respectively. The mean weight loss, EWL% and TWL% was 38.04 kg, 73.26%, and 30.57%, respectively. The time interval between BS and admission was 7.18±8.99 months. Seventeen patients (51.5%) had malnutrition, while 16 (58.5%) had NM complications, 87.9% were off multivitamins, and 66% had gastrointestinal symptoms. All patients showed minerals and vitamins deficiencies, especially for vitamin D (81.8%) and potassium (30.3%). Conclusion: Despite a reduction in the number of BS during the COVID-19 pandemic, an increase in the rate of hospital admissions with medical complications after BS was observed. [ABSTRACT FROM AUTHOR]

This article considers a practical approach to patients presenting with neurological signs and symptoms and highlights possible endocrine causes. It notes that behavioural and cognitive changes are associated with both hyper- and hypothyroidism. It recommends monitoring and therapy in a high dependency environment for those suffering from reduced consciousness due to severe hyperthyroidism. The clinical features of Hashimoto's encephalopathy include coma, seizures, neuropsychiatric changes and/or focal neurological deficits. It points out the importance of decompressive surgery in patients with ophthalmopathy secondary to Graves' disease.

Background: Obesity is a major global health problem. Kuwait has a very high prevalence of obesity, and consequently, the number of bariatric surgeries is rising.Objectives: The aim of this study is to analyze the clinical presentation and electrodiagnostic features of peripheral nerve complications following bariatric surgery.Subjects and methods: We retrospectively involved a convenience sample of patients presenting at a tertiary referral center and analyzed the patterns and frequency of peripheral nerve involvement, correlations with operative techniques, perioperative complications, nutritional status, possible risk factors, and functional impairment.Results: Among the 58 cases, 23 presented with chronic distal symmetrical sensorimotor neuropathy, 10 suffered from small fiber neuropathy, 22 had mononeuropathies, 2 patients had acute axonal sensorimotor neuropathy, and only 1 patient had lumbar plexopathy. In 22 patients, we observed mononeuropathies (10 cases of carpal tunnel syndrome, 7 cases of peroneal compression at the knee, 4 cases of ulnar neuropathies at the elbow, and 1 case of meralgia paresthetica). Rapid weight loss and protracted postoperative vomiting tended to correlate with generalized neuropathies, while focal compression with loss of the protective subcutaneous tissue pad was associated with mononeuropathies. All patients suffered from a deficiency of at least 1 micronutrient. Compliance with supplementary therapy was poor. Some post-bariatric neuropathies interfere severely with patients' functional status.Conclusion: Prevention by close follow-up, nutritional intervention, and patient education to avoid habitual postures related to nerve compression is appropriate. [ABSTRACT FROM AUTHOR]