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Biocognitive Rehabilitation of Down Syndrome.
No full textImportant progresses in understanding the biology of Down syndrome open new perspectives for cognitive rehabilitation of persons with this genetic condition. Research developments toward specifying a field of cognitive pharmacology for persons with intellectual disability appear promising. The availability of animal models of trisomy 21 allows for the testing of various molecules with the power of modulating the activity of particular genes involved in the causation of Down syndrome. In vitro experiments using induced pluripotent cells offer reasonable hope for removing or silencing overexpressed genes or even an entire chromosome 21. At the same time, cognitive intervention with children with Down syndrome is gaining in efficiency. The article reviews these developments. It is argued that combining biological and neurocognitive rehabilitation will boost the cognitive abilities of persons with Down syndrome to a large extent
Late Development Localized Aneurysmal Ectasia of Stented Coronary Segments after Sirolimus-Eluting Stent Placement, a Case Series
No full textThis case series reviews 3 patients who presented with aneurysmal ectasia, suggestive of pseudoaneurysms, at the site of coronary Cypher drug-eluting stents (DES) with Sirolimus as the eluting agent. We examine risk factors and possible etiologies of DES and Sirolimus related aneurysmal formation, specifically focusing on inhibited vessel healing, increased vascular wall apoptosis, as well as inflammatory and hypersensitivity reactions. We also examine various treatment options, including stenting the lesion with a Jomed covered stent. The clinical value of this report is to foster awareness of aneurysms and pseudoaneurysms as possible complications at stented coronary arteries. The patients described include a 56 year-old male with a Left Anterior Descending (LAD) aneurysmal formation 2 years after a Cypher stent placement, 54 year-old male with multiple areas of LAD ectasia at both Cypher stent sites 1 year after placement, and a 47 year-old female with LAD ectasia at the Cypher stent site 10 months after the intervention
Cardiovascular Risk Factors from Early Life Predict Future Adult Cardiac Structural and Functional Abnormalities: A Systematic Review of the Published Literature
No full textBackground: Clinical practice evaluates cardiovascular risk based on current risk factor (RF) levels [Blood pressure (BP), body mass index (BMI) and glycaemic control] largely disregarding previous risk-factor history over the totality of the life course. RFs are related to contemporaneous echocardiographic measures of cardiac structure and function which in turn are independently related to cardiovascular morbidity and mortality in cross-sectional studies. However, the effect of lifetime or earlier RF history on future echocardiographic changes has never been systematically examined.Methods: A systematic review of the published literature identified 24 studies relating either earlier BP, BMI, glycaemic control or a combination to future cardiac structure and/or function.Results: The majority of studies showed that elevated BP and BMI in earlier life and greater cumulative burden of these factors resulted in worse cardiac structure up to 24 years later. Studies examining glycaemic control as a RF were few, but poorer glycaemic control in young adults was associated with increased future left ventricular mass.While only 5 papers related RFs to future cardiac function, all RFs were positively associated with worse future diastolic function.Conclusions: BP, BMI and glycaemic control measures in childhood, adolescence and early adulthood and subsequent longitudinal trajectories of BP and BMI are predictive of future abnormalities in cardiac structure and function. Lifetime RF history should be used to inform clinical practice. Further research is required to enable the identification of any sensitive periods in the life course to enable prevention when it is most likely to be effective.Â
Impact of HbA1c on Outcomes of Acute Coronary Syndrome in Non-Diabetic Patients
No full textBackground: Elevated glucose levels have been previously shown to be associated with adverse outcomes in patients of acute coronary syndrome. However, admission glucose levels are affected by various factors like meals, circadian cycle and also the stress response. HbA1c is a better marker of long- term glucose status. The value of HbA1c as a predictor of prognosis in acute coronary syndrome has not been extensively studied.Objective: To study the relationship between admission HbA1c levels and short-term outcome in non-diabetic patients admitted with acute coronary syndrome.Material and Methods: This open-label, hospital based, cohort study was conducted on 200 patients without previously known diabetes admitted with acute coronary syndrome. A detailed history and clinical examination were carried out. Admission plasma glucose, fasting glucose and HbA1c levels were recorded. Those presenting with fasting plasma glucose of >126 mg% or HbA1c >6.5% were labeled as “Undiagnosed Diabetic Patientsâ€. Outcome was measured mainly by assessing the left ventricular systolic function. Data were analysed using chi square test, student t-test, ANOVA and partial correlation regression, wherever applicable.Results: Mean age of patients was 56.38 years. Average BMI was 25.1±3.5 kg/m2. Mean HbA1c was 6.3±1.5%. 79 (39.5%) patients had HbA1c between 6 and 6.5. There was a linear correlation between ejection fraction and HbA1c (p value =0.019).Conclusion: HbA1c is a strong predictor of left ventricular dysfunction in non-diabetic patients presenting with acute coronary syndrome, therefore, measurement of HbA1c levels may improve risk assessment in patients presenting with acute coronary syndrome
The Impact of Introducing Inpatient Diabetes Management Protocol on Glycemic Control in a Rural Secondary Care Hospital in the UAE
No full textBackground: Diabetes is one of the most common diagnoses encountered in hospitalized patients. In-hospital hyperglycemia is considered an independent marker of in-hospital poor outcome even in those without prior diagnosis of Diabetes. The purpose of this study is to evaluate the impact of introducing inpatient diabetes management protocol at Madinat Zayed hospital, a rural secondary care hospital in the Western region of Abu Dhabi, UAE.Methods: Adult, non-pregnant Patients admitted to the hospital with diabetes or a blood glucose >7.8 mmol/l (140 mg/dl) were included. The protocol guided physicians to start weight based insulin regimen for all patients with type 1diabetes, insulin dependent type 2 diabetes and all hyperglycemic patients regardless of history of diabetes. All patients who required insulin therapy were treated with basal and bolus insulin. A historical control was randomly selected for comparison.Results: 101 patients were identified in the intervention group and 69 patients in the historical control group. The mean glucose level in the treatment group was 9.2 ±3.1 mmol/l (165.6 ±55.8 mg/dl) and 12.4± 2.7 mmol/l (223±48.6 mg/dl) in the historical control group with a reduction of 26% in the mean glucose level (P<0.05). Patients with episodes of sever hyperglycemia (glucose level >16.6 mmol/l or 300 mg/dl) was significantly lower in the interventional group (23% versus 66%) with p value <0.001). There was no significant difference in the rate of hypoglycemia, length of hospital stay or healthcare associated infection between the groups.Conclusions: Inpatient diabetes management protocol can significantly decrease episodes of severe hyperglycemia and decrease mean glucose level without increasing the incidence of hypoglycemia. Our study shows that evidence-based clinical pathways can impact the quality of care in rural secondary care hospitals
Physiology of the Hypothalamic-Pituitary-Testicular Complex: A View by Stages in the Light of Recent Advances
No full textThe male gonadotropic axis consists of the hypothalamus, pituitary gland and testes. Testosterone is produced by the Leydig cells in the presence of pituitary luteinizing hormone (LH). LH and FSH (follicle stimulating hormone) are themselves regulated by gonadotropin-releasing hormone or GnRH, released in pulses by the anterior hypothalamic neurons.The embryonic migration of GnRH neurons, which is a critical step in this process, is now better understood thanks to the identification of new genes that are involved. The regulation of the gonadotropic function has itself been illuminated by the identification of new peptide regulatory factors which include kisspeptins.This review traces the physiology of male gonadotrope axis based on new knowledge relating to its establishment, its operation and its regulation, allowing a better understanding of the congenital hypogonadotropic hypogonadism
Milk of Camel: Science Edification Urgencies
No full textCamel milk is rich in numerous bioactive substances that function beyond their nutritive value. Camel milk is more similar to goat milk and contains less short-chain fatty acids than cow, sheep and buffalo milks, and about 3 times greater vitamin-C than cow milk. One kg of camel milk meets 100% of daily human requirements for calcium and phosphorus, 57.6% for potassium, 40% for iron, copper, zinc and magnesium, and 24% for sodium. Camel milk helps treat liver problems, lowers bilirubin output, lightens vitamin inadequacy and nutrient deficiency, and boosts immunity. Camel milk reduces allergies caused by cow dairy products. Camel milk has low milk fat made mainly from polyunsaturated fatty acids. It lacks ß-lactoglobulin and is rich in immunoglobulins, compatible with human milk. Persistent systematic education of camel milk science will be an obligation for health implications to be optimally perceived by worldwide human populations
Condom Use and Human Immunodeficiency Virus Transmission during Foreplay with or without Penetrative Sex; Knowledge and Practice in Benin City, Nigeria
No full textAims and Objectives: Foreplay with or without penetrative sex has been documented to transmit Human Immunodeficiency Virus (H.I.V). There is little information on condom use and H.I.V transmission following foreplay with or without penetrative sex, with 2.6 million people newly infected with H.I.V. in 2007 in the world. This study therefore assessed H.I.V. transmission risk following foreplay with or without penetrative sex in a group of Nigerians in Benin City.Patients and Method: Five hundred and sixty-two H.I.V positive patients and five hundred and sixty-two H.I.V negative patients were studied. They were assessed on their knowledge and practice of foreplay with or without penetrative sex and condom use.Results: Mean age for H.I.V. positive and negative patients were 19 ± 6.7 years and 24 ± 8.4 years respectively. 316 H.I.V positive subjects compared with 48 HI.V. Negative subjects as control engaged in foreplay with or without penetrative sex (P<0.05).Conclusion: H.I.V. transmission can occur during foreplay with or without penetrative sex as the condom is just only over the phallus and/or vagina
Use of Cat-Anionic Vesicles as Molecular Vectors for Gene Transfer into Target Cells
No full textWe report on the possibilities to use cat-anionic vesicles as active vectors for transfection technologies. Cat-anionic aggregates are non-stoichiometric mixtures made of oppositely charged surfactants, or lipids. Depending on the relative amounts of two such components, bi- or multi-layered vesicles may be formed. The former ones adsorb bio-polymers on their outer surface, but bi-layers may also contain large amounts of lipophilic species in their interior. The transfection fate depends on the vesicle ability and efficiency in adsorption, which leads, eventually, to fusion with cell membranes. The intra-membrane uptake mechanisms differ significantly, and depend on whether the outer, inner, or bi-layer distribution of the species is considered. The first possibility involves a direct exchange of (supra) molecular entities between fluid surfaces in contact; the second and third, conversely, imply membrane fusion and subsequent transport of material within the cell matrix. A realistic combination of the above possibilities can be envisaged, and would ensure a long term action of the transferred (transfected) formulations. Examples taken from recent literature suggest that a realistic possibility is offered to high-yield molecular penetration: this becomes useful in gene transfer and molecular transfection technologies. Some technological aspects inherent to the above formulations are briefly outlined. The overall effect of penetration across the cell membrane of exogenous material in terms of biocompatibility is quite a formidable task to face with and shall be described in detail
Quantitative Structure-Activity Relationship and Molecular Modeling Studies on a Series of Hydroxamate Analogues Acting as HDAC Inhibitors
No full textIn this communication, a quantitative structure-activity relationship (QSAR) study has been performed on a series of trichostatin A (TSA) and suberanilo hydroxamic acid (SAHA) analogues acting as histone deacetylase (HDAC1) inhibitors to investigate their physicochemical properties that govern their activity. In this study, a significant 2D QSAR model was obtained correlating the activity of the compounds with their parachor and some indicator variables which suggested that molecules may have dispersion interaction with the receptor and that their surface tension may greatly help to this interaction. Further, the indicator parameters suggested that SO2NH moiety present in the molecule may not be conducive to the activity, but the straight chain joining the aromatic rings with hydroxamate moiety and having ≥6 single bonds may be favorable to the activity, provided it has no substituent at any carbon. Using the model, some new compounds in the series have been predicted and docked to see their interaction with the HDAC1. All compounds have been found to have better interaction with the enzyme than TSA and SAHA, the two FDA approved HDAC inhibitors, and all the compounds obey Lipinski’s rule of 5