Diagnosis of cognitive function changes in patients with abdominal neoplasms occurring in the early postsurgery period and management of those with neuroprotective drug

Background. The issue of analysis of diagnostic criteria and adequate neuroprotective management of postsurgery cognitive dysfunction in abdominal oncosurgery, depending on the degree and structure of disorders, remains unresolved, determining its relevance. Purpose – assessing the postsurgery cognitive dysfunction in patients with neoplasms of the abdominal cavity and management of possible disorders with citicoline depending on the level of general cognitive deficit. Materials and methods. TThe study was conducted at the premises of departments for patients of surgical profile of Municipal Institution “Kharkov City Clinical Hospital of Ambulance and Emergency Care named after Professor O.I. Meshchaninov”. To achieve the aim of the study, 80 patients with abdominal neoplasms who underwent surgery under general anesthesia using propofol and fentanyl were examined. Results and discussion. Based on the comprehensive clinical study and anal- ysis of the mechanisms of formation of postsurgery cognitive dysfunction in patients of oncosurgical profile after surgery under general anesthesia, we suggested directions and schemes for managing postsurgery cognitive dysfunction by means of the developed clinical diagnostic criterion, which is essential in forming individual scheme of treating patients in postsurgery period. Conclusions. Based on the analysis of data on the state of cognitive function changes, comparing the postsurgery period with the preoperative state, a differentiated approach to intensive neuroprotective therapy of postoperative cognitive dysfunction was developed. The technique of intensive neuroprotective therapy of postsurgery cognitive dysfunction in patients with abdominal neoplasms, undergoing surgery under general anesthesia, was suggested.

Novel Therapeutic Targets and Biomarkers for the Treatment of Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) is a sporadic parkinsonism tauopathy characterised by the deposition of aggregations of abnormal, hyperphosphorylated four-repeat tau (4R-tau). A revised clinical diagnostic criterion for PSP allows early presentations for the full spectrum of clinical phenotypes to be recognised enabling doctors to make a more accurate diagnosis. The major genetic risk factor for sporadic PSP is a common variant in the gene encoding microtubule-associated protein tau (MAPT). Research into the biochemical and pathological pathways of tau is vital to improve the chances of developing an effective diagnostic biomarker to monitor tau pathogenesis. Neuroimaging biomarkers, such as tau PET ligands, are proving the most successful tool in providing a differential diagnosis between neurodegenerative disorders. There are currently no effective treatments for PSP, however tau-directed therapies in the last five years have rapidly advanced. Latest tau therapies are proposed to have disease-modifying effects by reducing toxic aggregations of tau through manipulating tau gene expression. After encouraging results from long awaited trials, additional funding is being injected into this field and with new results expected, this proves an exciting area for scientific discovery. This paper reviews advances in pathophysiology, diagnosis, biomarkers and disease-modifying therapeutic treatments for PSP.

Effect of Topical Nasal Decongestants on Nasal Peak Flow Rates in Adults Suffering from Acute Sinusitis

INTRODUCTION In this research we study the effect of Nasal decongestant Xylometazoline 0.1% solution on Serial measurements of Nasal peak flow rates in a cohort of patients who were suffering from Acute Sinusitis. CASE SERIES A population of 90 patients were chosen from our regular Out-patient clinics who were suffering from Acute Sinusitis based on a Clinical diagnostic criterion. A baseline Nasal peak Flowmetry was done before and this was followed by common Decongestant Xylometazoline 0.1% solution spray application, followed by serial readings of Nasal peak Flowmetry done after 10 minutes, 25 minutes, 60 minutes, 120 minutes,240 minutes and 360 was taken then plotted and analysed. DISCUSSION From the A.U.C Curves it can be inferred that Maximum decongestant action of Xylometazoline 0.1% solution is seen 1 hour after application and the raise in decongestant reaches a plateau by 2 hours. Readings remain elevated from baseline well 6 hours post decongestion. CONCLUSION Patients who are prescribed Xylometazoline 0.1% solution are advised that maximum relief from congestion would be obtained around 1 to 2 hours after application and hence effect would decrease. Surgeons who use Xylometazoline 0.1% solution for nasal packing must proceed with the Surgery within 1 hour of application of the pack to obtain maximum hemostatic and decongestant benefit of this drug.

The cut off of Ferriman Gallwey score for PCOS in Asia and the degree of hyperandrogenism indicator

<p><strong>Objective:</strong> To determine the distribution of the Ferriman–Gallwey score in Asia and to study any association between hirsutism and endocrine markers, and also to find the cut off of F-G score. </p><p><strong>Background: </strong>Hirsutism is the most widely used clinical diagnostic criterion for hyperandrogenism, it is present in approximately 70% of PCOS women. Using the Ferriman- Gallwey (F-G) scoring systems for evaluation of hirsutism, the degrees of hyperandrogenism from different regions are distinct and have different cut off.</p><p><strong>Material and methods: </strong>A descriptive cross-sectional study was carried out at Dr. Cipto Mangunkusumo General Hospital Jakarta in 2015. Reproductive age women who commits with PCOS criteria were included in the study. Clinical data was taken by interview, physical examination and US examination. Patient’s blood was taken for FTI, and testosterone.</p><p><strong>Results: </strong>The data indicated that 32.4% PCOS woman shows clinical signs of hyperandrogenism, with the minimum score of hirsutism 2 and based on laboratory findings 34.3% subjects show high FTI and testosterone level. However not all patient with high androgen level have a high score of hirsutism. </p><p><strong>Conclusion:</strong> Clinical and laboratory finding of hyperandrogenism have a correlation to determine the score of Ferriman–Gallwey (F-G). The cut off is lower than European and west countries.</p>

Abstract 02: American Heart Association (AHA)’s Life’s Simple 7 and Risk of Lower Extremity Peripheral Artery Disease (PAD): The Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Approximately 8.5 million Americans are affected by lower extremity PAD, which is associated with a substantially greater risk of cardiovascular (CV) events, mortality and functional decline. In 2010, the AHA initiated new CV health metrics (Life’s Simple 7) to monitor the goal of significantly improving CV health by the year 2020. The extent to which Life’s Simple 7 may be associated with risk of PAD or change in the ankle brachial index (ABI), the major clinical diagnostic criterion for PAD, has not been established. Methods: MESA is a population-based prospective cohort of 6814 Caucasian, African-American, Hispanic and Chinese men and women from six US field centers. The baseline exam occurred in 2000-02. Life’s Simple 7 at baseline included AHA definitions of poor, intermediate and ideal health behaviors (diet, body mass index, smoking, physical activity) and health factors (blood pressure, glucose, cholesterol), and was modeled continuously on a 0-14 point scale, with a higher score indicating better CV health. The scale was also categorized into overall inadequate (0-7points), average (8-11) and optimum (12-14) CV health. Incident PAD was defined as an ABI≤0.90 at Exam 3 (2004-05) or Exam 5 (2010-12), removing participants both with ABI>1.40 and prevalent PAD at baseline. Cox models were used for incident PAD analyses and change in the ABI over time was assessed using mixed models. All models were adjusted for age, sex and race/ethnicity. Results: The mean±SD Life’s Simple 7 score was 8.4±2.1, with 33.8% of participants classified as inadequate, 59.6% average, and 6.6% classified as having optimum CV health. Adjusted rates of PAD per 1000 person-years were 7.3 for inadequate, 3.2 for average and 1.1 for optimum CV health. Each point higher on the Life’s Simple 7 scale was associated with a 20% lower risk of incident PAD (95% CI (0.76-0.85); p<0.001). Compared to inadequate CV health, participants with average and optimum health had a 55% lower risk (95% CI (0.37-0.56), p<0.001) and an 85% lower risk (95% CI (0.06-0.38); p<0.001) of incident PAD, respectively. Each point higher on the scale was associated with a higher average ABI over a median follow-up time of 9.4 years (0.006 (95% CI (0.005, 0.007), p<0.001). Compared to those with inadequate health, participants with average and optimum health maintained a 0.021 (95% CI (0.016, 0.027, p<0.001) and a 0.030 (95% CI (0.018, 0.041, p<0.001) greater average ABI over the follow-up period, respectively. Conclusions: Maintaining average or optimum CV health results in a substantially reduced risk of incident PAD and also in maintaining a higher average ABI over time, even when accounting for age, sex and race/ethnicity. Encouraging improvement in health behaviors, and treatment to achieve and maintain better levels of CV health metrics, may contribute to decreasing the rate of PAD.

Validation of the Proposed Clinical Diagnostic Criteria of Enteric Fever

Background Enteric fever is very common infectious disease in developing countries like Nepal. Due to lack of resources diagnosis has to be clinical most of the time. Hence a proposal of clinical diagnostic criteria and validation of the same would be very useful. Objective To validate the proposed clinical diagnostic criterion including features characterized as major and minor criteria Methods This study was done in the department of medicine of Kathmandu Medical College Teaching hospital, from June 2009 to January 2012. A total of 114 patients presenting with fever were included in the study. After proposal of clinical diagnostic criteria for enteric fever, by a prior published study, all the fever patients were grouped according to criteria positive or negative. The most significant criteria were validated by calculating sensitivity and specificity along with positive and negative likelihood ratios with blood culture taken as gold standard. Results A total of 114 patients were enrolled. Total patients diagnosed as enteric was 47.3 %. Clinical diagnostic criterion B which included three major (headache, fever and relative bradycardia) and three minor criteria (abdominal pain, vomiting, diarrhea, splenomegaly and chills) was highly significant (p=<.0001) in diagnosing enteric fever and had a sensitivity of 72.2% ( 95% CI 58.1- 83.1) and specificity of 98.3% ( 95% CI 89.8-99-9). The positive likelihood ratio was 43.33 (95 % CI 6.16-304.77) and negative likelihood ratio as 0.28 (95% CI 0.18-0.43). Conclusion Clinical diagnostic criteria can be a very useful tool for diagnosis of enteric fever when culture facility is not available. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10986 Kathmandu Univ Med J 2012;10(4):8-11

Hirsutism

Hirsutism is defined as excess growth of body or facial terminal (coarse) hair in females, in a male-like pattern. The condition has a significant negative impact on a woman’s self-esteem and on her quality of life. Hirsutism affects 5–15% of the women, and is the most commonly used clinical diagnostic criterion of androgen excess or hyperandrogenism (1). Depending on age and race/ethnicity, 80–90% of women with hirsutism will have an androgen excess disorder, most often polycystic ovary syndrome (PCOS), and including idiopathic hirsutism, and non-classic congenital adrenal hyperplasia (NCAH), among the others. This chapter outlines androgen metabolism in women, physiology and pathophysiology of hair growth, epidemiology of and differential diagnosis of hirsutism, other signs of androgen excess including acne, androgenetic alopecia, and virilization, and the clinical investigation, and treatment of the hirsute patient.