Treatment of Cognitive Impairment and the Role of Demographic Factors in Disease Progression: The Final Results of the Russian Observational Program “DIAMANT”

2020 ◽  
pp. 1-11
Author(s):  
Vladimir Anatolyevich Parfenov ◽  
Sergey Anatolyevich Zhivolupov ◽  
Irina Evgenyevna Poverennova ◽  
Marina Valentinovna Nesterova ◽  
Svetlana Evgenyevna Ushakova ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Socioeconomic Factors ◽  
Age Groups ◽  
Post Treatment ◽  
Wilcoxon Test ◽  
Cognitive Improvement ◽  
Number Of Patients ◽  
The Mean ◽  
Moca Score

<b><i>Background:</i></b> Chronic cerebral ischemia (CCI) is a form of cerebrovascular disease manifested as a vascular cognitive impairment (VCI). The management of the patients with CCI is determined by a healthy lifestyle and early therapy aimed at correcting and preventing this disease. Divaza is a drug with endothelial protective and nootropic effects. We present the final efficacy and safety analysis of all-Russian, open-label, prospective, observational, multicenter study of Divaza and emphasize the role of demographic and socioeconomic factors in cognitive disorder (CD) progression. <b><i>Methods:</i></b> CCI patients (<i>n</i> = 2,583) with or without CD were enrolled. Patients received Divaza (2 tablets 3 times per day for 12 weeks). Montreal Cognitive Assessment (MoCA) testing was required. The change in the mean MoCA score post-treatment was used as the primary endpoint. As the secondary endpoints, the number of patients with a MoCA &#x3c;26 and ≤17 (dementia); the percentage of patients with a MoCA score improvement in different age groups; the dynamics of mean MoCA score in age groups; and the relationship between CD and sex or regional social/economic factors were assessed. <b><i>Results:</i></b> Divaza therapy led to a significant improvement: the mean MoCA score was up to 20% higher post-treatment (Wilcoxon test, <i>p</i> &#x3c; 0.0001 vs. baseline). The number of participants with MoCA ≥26 increased by 33.6%. The number of patients with dementia was 4.1 times less after therapy (<i>p</i> &#x3c; 0.00001 vs. baseline). Divaza improved cognitive functions of patients in each age group. Findings demonstrate that regional socioeconomic factors contribute to CD development and severity. The observed divergence between sexes was a result of a larger number of women enrolled. The study confirmed the safety of Divaza. <b><i>Conclusions:</i></b> In the study, we observed the efficacy of Divaza for the treatment of CD: a therapy contributed to an increase in the mean MoCA score and the positive dynamics in the number of patients with cognitive improvement.

scholarly journals Role of Patient Sex in Early Recovery from Alcohol-Related Cognitive Impairment: Women Penalized

2019 ◽  
Vol 8 (6) ◽  
pp. 790
Author(s):  
Amandine Luquiens ◽  
Benjamin Rolland ◽  
Stéphanie Pelletier ◽  
Régis Alarcon ◽  
Hélène Donnadieu-Rigole ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Alcohol Use Disorder ◽  
Treatment Center ◽  
Controlled Environment ◽  
Inclusion Criteria ◽  
Early Recovery ◽  
The Mean ◽  
Time Required ◽  
Moca Score

Background: The objective was to explore the role of patient sex in cognitive recovery and to identify predictive factors for non-recovery in alcohol use disorder (AUD). Methods: All patients with AUD admitted to a residential addictions treatment center were systematically assessed at admission and after 6 weeks of abstinence in a controlled environment. The inclusion criteria were that patients were admitted for AUD with baseline alcohol-related cognitive impairment (baseline total Montreal Cognitive Assessment (MoCA) score < 26) and reassessed at 6 weeks (n = 395). A logistic regression model was built to determine the influence of sex on recovery status (MoCA < or ≥ 26) taking into account the interaction effect of sex with alcohol consumption on cognitive function. Results: The mean age was 50.10 years (SD = 9.79), and 27.41% were women. At baseline, the mean MoCA scores were 21.36 (SD = 3.04). Participants who did not achieve recovery (59.3% of women vs 53.8% of men) had lower total MoCA scores at baseline. The 2 factors that was significantly and independently associated with non-recovery and with a non-zero coefficient was being a woman and initial MoCA score (respective adjusted odds ratios (AOR) = 1.5 and 0.96, p-values < 0.05). Conclusions: These results could influence the time required in a controlled environment to maintain abstinence and the duration of in-care for women.

scholarly journals Stereoacuity after Successful Occlusion Therapy in Children with Anisometropic Amblyopia

2021 ◽  
Vol 62 (11) ◽  
pp. 1539-1546
Author(s):  
Sang Wook Lee ◽  
Eun Hye Jung
Keyword(s):  
Patient Characteristics ◽  
Visual Development ◽  
Post Treatment ◽  
Control Group ◽  
Normal Children ◽  
Factors Affecting ◽  
Anisometropic Amblyopia ◽  
Factors Associated ◽  
Number Of Patients ◽  
The Mean

Purpose: To compare the stereoacuity between patients with anisometropic amblyopia who were treated and achieved normal visual acuity (VA) and normal children and evaluate the factors associated with stereoacuity.Methods: We retrospectively reviewed the records of 37 pediatric patients with anisometropic amblyopia who recovered to normal VA with glasses and occlusion treatment (amblyopia group) and 34 normal children (control group). The Worth 4-dot test, Lang II test, Titmus test, and TNO test were performed to measure stereoacuity. Clinical characteristics were compared between the two groups, and factors affecting stereoacuity outcomes were also analyzed in the amblyopic group.Results: The mean age at diagnosis of amblyopia was 5.3 ± 1.4 years, and the mean VAs at diagnosis were 0.41 ± 0.24 and 0.06 ± 0.07 in amblyopic and fellow eyes, respectively. The mean duration of occlusion was 19.00 ± 9.44 months, and VA of amblyopic eyes improved to 0.04 ± 0.04 after occlusion treatment. The patient characteristics did not differ significantly between the two groups, except for the final VA of the amblyopic eye. The final mean logarithm of minimal angle of resolution VA of the amblyopic eye in the amblyopia group was significantly worse than that in the control group. The number of patients with normal stereoacuity was significantly lower in the amblyopia group than in the control group on Lang II, Titmus, and TNO tests. Factors associated with poor stereoacuity were severe amblyopia in the Lang II test and poor post-treatment VA of the amblyopic eye in the Titmus test.Conclusions: Stereoacuity was worse in the amblyopia group than in the control group, despite normal visual development. The depth of amblyopia and post-treatment VA were associated with stereoacuity outcomes. Thus, VA improvement should be closely monitored in the amblyopic eye to obtain good stereoacuity.

scholarly journals Surgical site infection in Laparoscopic versus Open appendicectomy

2018 ◽  
Vol 7 (2) ◽  
pp. 39-43
Author(s):  
Ashok Koirala ◽  
Dipendra Thakur ◽  
Sunit Agrawal ◽  
Bhuwan Lal Chaudhary ◽  
Sagar Poudel
Keyword(s):  
Acute Appendicitis ◽  
Surgical Site Infection ◽  
Age Groups ◽  
Laparoscopic Appendicectomy ◽  
Surgical Removal ◽  
Age Group ◽  
Site Infection ◽  
Open Appendicectomy ◽  
Number Of Patients ◽  
The Mean

 Background: Acute appendicitis is very common surgical cause of acute abdomen and needs surgical removal either by laparoscopic or open appendicectomy. The aim of this study is to compare frequency of surgical site infection (SSI) in patients undergoing laparoscopic and open appendicectomy. Materials and Methods: The study was prospective study conducted in NMCTH, Biratnagar. Total 200 patients with diagnosis of acute appendicitis admitted through the emergency department of our hospital were included in the study. The patients were randomly allocated in two groups: Laparoscopic appendicectomy group (LA) and Open appendicectomy group (OA). Both groups underwent successful emergency appendicectomy. Wound infections in terms of surgical site infection (SSI) if present were recorded. All age groups and both sexes were included.  Results: Two hundred patients underwent appendicectomy, one hundred Laparoscopic appendicectomy (LA) and another hundred open appendicectomy (OA). The mean age of patients with acute appendicitis was 30.63±16.14 years with minimum of 6 years and maximum of 77 years. The highest number of patients were in age group of 10 to 20 years (29.5%). In LA group SSI noted in 3 patients (3%) whereas in OA group it was found in 12 patients (12%). Conclusion: Laparoscopic appendicectomy is better and offers great advantages in terms of SSI as compared to Open appendicectomy.  

scholarly journals DR Knowledge of Cervical Cancer and Its Screening Amongst Female Students of a Tertiary Institution in South-South Nigeria

2020 ◽  
Vol 2 (6) ◽  
Author(s):  
D. O. Allagoa ◽  
O. J. Agbo ◽  
A. O. Eguvbe ◽  
P. W. Alabrah
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Educational Institution ◽  
Age Groups ◽  
Female Students ◽  
Screening Methods ◽  
Tertiary Institution ◽  
Cross Sectional ◽  
The Mean

Background: Cervical cancer is one of the commonest cancers in women. It is the commonest cause of cancer related death in Africa. It is one of the cancers that have well known screening methods. In developed societies with standard protocol for screening, the morbidity and mortality following the disease have been greatly reduced. There is paucity of knowledge of cervical cancer and its screening methods in Yenagoa. Objectives: To determine the knowledge of cervical cancer and its screening methods in female students of a Tertiary educational institution. Methods: This was a cross-sectional descriptive study that was conducted amongst the female students of Federal University Otuoke. Information about their socio-demographic characteristics, knowledge of cervical cancer and the screening methods was obtained using a questionnaire. Results: A total of four hundred and twenty four (424) female students of the Federal University Otuoke were enrolled for the study. The mean age of the respondents was 21.0±3.4 years. The predominant age group was 15-20 years (50.6%). One hundred and eighty three respondents (57.9%) were aware of cervical cancer and the age groups 21-25 years were most aware of cervical cancer. Age was found to influence awareness of cervical cancer. (x2=12.8; df=3; p<0.05). A total of eighty one respondents 26.9% were aware of Pap smear. Age was found to influence the awareness of Pap smear (x2=12.8; df=3; p<0.05). Conclusion: Our study showed that awareness of cervical cancer and the role of Pap smear in the screening of cervical cancer was low amongst the female students of the Federal University Otuoke. Hence the need to make every effort to increase the awareness of this condition and the screening methods amongst these female undergraduates, who are at the prime of their age and at the greatest risk of developing this condition, especially in our societies that lack well organized screening protocols.

scholarly journals Role of dorsal onlay buccal mucosal graft urethroplasty for long anterior urethral strictures

2021 ◽  
Vol 9 (10) ◽  
pp. 3110
Author(s):  
Vedamurthy Reddy Pogula ◽  
Ershad Hussain Galeti ◽  
Venkatesh Velivela ◽  
Bhargava Reddy Kanchi
Keyword(s):  
Statistical Difference ◽  
Age Groups ◽  
Factors Affecting ◽  
Urethral Strictures ◽  
Buccal Mucosal Graft ◽  
Significant Difference ◽  
Dorsal Onlay ◽  
The Mean

Background: Treatment of the urethral strictures is challenging and with appropriate evaluation preoperatively and surgery planning it is possible to achieve good results. The objective of the study was to evaluate the efficacy of dorsal onlay buccal mucosal graft urethroplasty in treating long anterior urethral strictures.Methods: Between August 2018 to July 2019 a total of 25 patients with anterior urethral stricture were treated with dorsal onlay buccal mucosal graft urethroplasty. Age, etiology of the stricture, stricture length (≤ 7 cm, and > 7 cm), and site of the stricture were assessed as the factors affecting the success rate.Results: The clinical outcome as Success was defined as the patient not needing any form of urethral instrumentation postoperatively. The mean follow-up period was 18 months. Of 25 patients, 22 (92%) were successful and 3 (8%) were a failure. There was no statistically significant difference between the age groups, etiology of the stricture and success rate (p=0.21 and p=0.444). The statistical difference was significant for the site and length of the stricture by means of success (p=0.005 and p=0.025).Conclusions: Our results show stricture length and localization are the most important variables for good success. Because of less failure rate, single-stage dorsal onlay buccal mucosal graft urethroplasty may be offered as an alternative to staged urethroplasty in case of long urethral strictures.  

scholarly journals Privacy Concerns Among Older Adults Using Voice Assistant Systems

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 266-267
Author(s):  
Tiffany Driesse ◽  
Robert Roth ◽  
Xiaohui Liang ◽  
David Kotz ◽  
John Batsis ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Daily Activity ◽  
Age Groups ◽  
Future Research ◽  
Privacy Concerns ◽  
Assistant Systems ◽  
Software Platforms ◽  
The Mean ◽  
Ambulatory Practice

Abstract Voice Assistant Systems (VAS) are software platforms that complete various tasks using voice commands (e.g., Amazon Alexa), with increasing usage by older adults. It is unknown whether older adults have significant privacy concerns with VAS. 55 participants were evaluated from ambulatory practice sites for a study on VAS detection of early cognitive decline. The mean age was 73.3±5.6 years, 58% female, 93% white, and 53% had mild cognitive impairment. Privacy concerns were assessed via Likert-based surveys. Participants believed data was used with consent (71%) and stored properly (67%); however, 71% wanted new privacy regulations, 43% were comfortable with daily activity monitoring, and 85% thought the data needs to be highly protected. Qualitative themes included “listening-in”, “tracking”, and unwanted sharing of information. Findings suggest that older adults do not have significant privacy concerns for VAS use, but requested additional regulations. Future research can compare VAS privacy concerns between age groups.

scholarly journals COVID-19 MOST AFFECTED AGE GROUPS AND LETHALITY IN EUROPE

2020 ◽  
Vol 2 (SP1) ◽  
pp. 179-184
Keyword(s):  
Age Groups ◽  
Case Fatality ◽  
Prevention Measures ◽  
Global Epidemic ◽  
Number Of Patients ◽  
The World ◽  
The Mean ◽  
Novel Coronavirus ◽  
Very High ◽  
Age Of Death

Introduction: The outbreak of a novel coronavirus disease (COVID-19; previously known as 2019-nCoV) was the beginning of one of the largest and most critical COVID-19 clusters in the world since late December 2019. Despite intensive prevention measures, the epidemic tends to propagate and the number of patients infected is growing. The case-fatality incidence was very high and is driven by very elderly people. Methods: in this study, we collected data from the (Covidgraph.com) database as the number of infection cases in the world reached 2736188 infections and the number of recovery cases reached 751805 and the number of deaths reached 191423.Results: it turns out that the virus infects older people and the older a person is, the higher the chance of infection with the virus. Results from this analysis the mean age of death is 78 years. Data from 106,399 cases and 12,550 deaths in Italy, to 2 April. In Spain, they are based on 7 April, 88,144 cases, and 3,479 deaths. There were less than 80 deaths in patients younger than 50 years of age. Conclusion: Coronavirus is a global epidemic, and it's hard to control, and it's not enough to prevent people from spreading the virus. The age groups most vulnerable to lethality are shown in this paper, in Italy, the virus destroys people over 75 years of age, In Spain, however, the virus destroys people aged over 85 Taking into account numerous comorbidities, including psychiatric, cerebrovascular, endocrine, metabolic, and respiratory disorders.

scholarly journals Comparative evaluation of levetiracetam and valproic acid as monotherapy on cognitive impairment in patients of epilepsy

2019 ◽  
Vol 8 (4) ◽  
pp. 674
Author(s):  
Shreshth Khanna ◽  
Suman Bala ◽  
Yashpal Singh ◽  
Taruna Sharma ◽  
Juhi Kalra ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
P Value ◽  
Cognitive Improvement ◽  
Institutional Ethics ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
The Impact

Background: Cognitive decline with AEDs (Anti-epileptic drugs) is associated with learning and memory deficits especially in the younger age group. The data regarding the impact of levetiracetam and valproic acid as monotherapy on cognition in epileptic patients is scarce. The present study was done for evaluation of cognitive decline associated with the use of AEDs.Methods: Present study was a prospective study on 60 patients on AEDs for a period of 12 weeks. Patients were enrolled from the Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India and divided into group A (levetiracetam) and group B (valproic acid) with 30 patients in each group. Permission from the institutional ethics committee and written informed consent was taken from all the patients. They were analyzed for cognitive impairment using MMSE and MoCA scales at baseline and 12 weeks.Results: The mean duration of disease was 2.13±1.1 years and 2.08±1.1 years and mean age of the patients was 14.67±1.9 years in group A and 16.20±1.6 years in group B. GTCS was present in 31 patients (52%) followed by partial seizures in 29 patients (48%). The mean change in the MMSE scores from baseline to 12 weeks was significant in group A 1.30±1.1 (p value <0.05) and change group B was -0.20±1.4 not statistically significant. The mean change was observed in MoCA scores from baseline to 12 weeks was significant in both groups A and B by 1.17±1.1 and -0.70±1.1 respectively (P value <0.05).Conclusions: Patients on levetiracetam showed cognitive improvement, whereas patients on valproic acid showed a decline in the MMSE and MoCA scores.

MO227RELATIONSHIP BETWEEN KIDNEY DAMAGE AND COGNITIVE FUNCTIONS IN PATIENTS WITH GLOMERULOPATHIES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Gianmarco Borriello ◽  
Davide Viggiano ◽  
Giovambattista Capasso
Keyword(s):  
Uric Acid ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Functions ◽  
Protective Role ◽  
Dopamine Neurons ◽  
Glomerular Diseases ◽  
Daily Lives ◽  
Moca Score

Abstract Background and Aims Mild Cognitive Impairment (MCI) has been found to be highly prevalent amongst patients with Chronic Kidney Disease (CKD). In this cohort, the prevalence of MCI was estimated to be between 30% and 63%. Mild cognitive impairment is an intermediate state between normal aging and dementia. An individual suffering from MCI has difficulty in remembering, sustaining attention, or decision making which can negatively affect their daily lives. The aim of this study was to verify the role of different glomerular diseases diagnosed by kidney biopsy on the MCI through a retrospective study. Method We recruited 45 patients with bioptic diagnosis of the following glomerular diseases: Focal Segmental Glomerulo Sclerosis (FSGS), minimal change disease (MCD), membranous glomerular disease (MG), IgA nephropathy. The renal function was analyzed using clinical variables, while Cognitive functions using the MoCA test. Patients were divided into two groups based on 24h proteinuria. Results The MoCA score was directly correlated to the uric acid levels (R=0.13; p=0.03). The MoCa score in the group with higher proteinuria levels was significantly lower than those of the group with lower proteinuria levels (p = 0.03). Finally, the MoCA score in subjects with FSGS or MCD is significantly higher compared the other groups (p&lt;0.05). Conclusion Our data suggest that serum uric acid and proteinuria in glomerular diseases influence cognitive functions. Interestingly, uric acid plays a neuroprotective role, as low levels of uric acid reduce the MoCA score. This result agrees with previous observations of a protective role of uric acid on dopamine neurons. Conversely, the extent proteinuria seems to negatively affect cognitive functions, suggesting a role of the endothelial dysfunction. Finally, glomerulopathies with a lower degree of inflammation (FSGS, MCD) have minor impact on cognitive functions.

Initial Experience with 4-Factor PCC for the Reversal of Warfarin: Patterns of Use and Safety Outcomes

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2867-2867
Author(s):  
Colleen T. Morton ◽  
David J Dries ◽  
Fatima Khan
Keyword(s):  
United States ◽  
Atrial Fibrillation ◽  
Vitamin K ◽  
Major Bleeding ◽  
The United States ◽  
Post Treatment ◽  
Factor Vii ◽  
Number Of Patients ◽  
The Mean ◽  
Pre Treatment

Abstract Major bleeding among patients receiving oral anticoagulants is common and is reported to occur in up to 6.5% of patients per year. Vitamin K antagonists (VKA) remain the most frequently prescribed class of anticoagulants for conditions such as atrial fibrillation, mechanical heart valves and venous thromboembolism. The products used for the reversal of VKA-associated coagulopathy include Vitamin K, fresh frozen plasma (FFP), activated recombinant factor VII (rFVIIa), and Prothrombin Complex Concentrates (PCC). Kcentra® (CSL Behring Gmbh, Marburg, Germany) is a 4-factor PCC that contains all of the vitamin K-dependent proteins (Factors II,VII, IX, X, Protein C and S). While Kcentra® has been in use in Europe and other parts of the world for several years, it was only recently approved in the United States for warfarin reversal during acute major bleeding (April, 2013) or when there is a need for an urgent invasive procedure (December 2013). We conducted a retrospective study to evaluate the use of 4-factor PCC in a community-based tertiary care center. The efficacy and safety of PCCs has been established in large multi-center trials. However, there is limited data from outside of carefully conducted clinical trials. In particular, there is a paucity of data regarding the use of 4-factor PCC in the community setting, specifically from the United States. We developed protocols for the reversal of warfarin for life-threatening bleeding and emergent surgery. All patients get vitamin K and they receive Kcentra® if the INR is ≥ 2. If the INR is < 2 they receive plasma. The dose of Kcentra® is based on pre-treatment INR (25 u/kg for INR 2 to < 4, 35 u/kg for INR 4-6 and 50 u/kg for INR >6). We identified 33 patients from July 2013 to April 2014 that were treated with 4-factor PCC (18 males and 15 females). The mean age was 71.06 +/- 14.04 years (Range 42-94). Kcentra® was used appropriately, per our institutional protocol for VKA reversal, in 28/33 (84.35%) cases. Four of the patients, who were treated inappropriately, did not have a drug history on admission and were subsequently found to have an elevated INR due to liver dysfunction. The leading indications for PCC use were intracranial hemorrhage (49%), reversal of elevated INR prior to surgery (21%) and gastrointestinal bleeding (15%). 73% of patients had a pre-reversal INR in the range of 2-4, 12% had INR of 4-6 and15% of patients presented with an INR of >6. The indications for warfarin use included atrial fibrillation (50% patients), prosthetic valve (21.4%) and prior deep vein thrombosis and pulmonary embolism in 18% patients. 40% patients were also receiving concomitant antiplatelet therapy. The mean administered dose of Kcentra® was 2461 +/- 825 units (Range 1375-4715). Among patient treated for reversal of VKA-related coagulopathy, the pre-treatment INR was 4.6 (range 2-17) and mean post-treatment INR was 1.32 (range 1.1-1.9). Post-treatment INR of ≤ 1.5 was attained in 24/33 (73%) patients. Post-treatment INR was not available for one patient. There was only one case of thrombosis within 72 hours of treatment (myocardial infarction). 28/33 patients (85%) were alive at 24 hours. Based on experience from our limited number of patients, we have found Kcentra® to be effective in the rapid reversal of INR in the setting of VKA associated coagulopathy. Kcentra® was successfully used for a wide variety of indications in our patient population. Arterial and venous thromboembolic complications have previously been reported in patients receiving 4-factor PCC. We found a low complication rate in our patients with only one patient developing a thrombotic phenomenon (acute coronary event) within 72 hours of administration of Kcentra®. In conclusion, based on our experience, we have found Kcentra® to be a safe and effective agent for reversal of VKA associated coagulopathy. Disclosures No relevant conflicts of interest to declare.

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