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Treatment of Depression in Elderly: The Challenge to Success
No full textDepression in the elderly is a major challenge to current Psychiatry and a major mental health problem for several reasons, including its clinical atypicity (hampering a correct diagnosis), its greater severity and risk of suicide. The success of drug treatment will depend on a suitable assessment of the risk-benefit balance. In this review, we will address the antidepressants with a favorable side effect profile, because the elderly have a higher sensitivity to them. Antidepressant treatment in the elderly has a number of peculiarities: it should start with lower doses than those recommended for adults, it is preferable to the use of antidepressants without anticholinergic and sedative effects, to prevent cognitive impairment and risk of cardiotoxicity; it should evaluate possible interactions with other drugs, since the elderly are usually polymedicated patients with different somatic comorbidities; if antidepressant response is obtained, the drug should be kept for long periods, even for lifetime. There is a wide arsenal of antidepressant drugs with mechanisms of action focused on enhancing monoaminergic transmission. An alternative to these classical mechanisms of action is given by agomelatine, a melatoninergic agonist drug. In this paper, we discuss the pharmacodynamic and pharmacokinetic profiles of these agents that may have an influence on the efficacy, tolerability and safety of treatment in the elderly. The use of antidepressants in the elderly should be performed only when necessary, but age should not deprive the patients of medication to improve their health and quality of life
Phonological Development in Bangla: A Normative Study
No full textThis study investigates the various phonological processes operational in the speech of 90 native Bangla spoken children between the age of 3;0 – 3;11 years. The speech of all children was recorded during the administration of the developed word list and was transcribed for analysis. Equality of proportions was used to investigate the observed pattern of variation in speech.Overall this study has established two aspects of speech development: age at which the error patterns were suppressed and the percentage of children exhibiting the obtained phonological processes. Processes like medial consonant deletion, unstressed syllable deletion, /l/ deletion, vowel unrounding, alveolar fronting, denasalization, stopping (except stopping of affricates and fricatives), palatalization and monothongization were eliminated by 3 years 5 months, while nasalization, backing of stops, initial consonant deletion, and coalescence were not found in age beyond 3 years and 9 months. Processes like vowel rising, nasalization, stopping, nasal assimilation, stop assimilation, velar fronting, and deaffrication decreased significantly as the chronological age progressed from 3 to 4 years. Other processes like cluster reduction, epenthesis, final consonant deletion, deaspiration, /r/ deletion, affrication (of fricatives), liquid replacement, and fronting of retroflex were considered to persist beyond 4 years of age. The results however refute the fact that, the mastery of phonological system is completed by 4 years of age. Native Bangla speaking children continues to use simplification for clusters, final consonants, fricatives, liquids, retroflex sounds, and the aspirated counterparts of stops, even after the age of four.The results thus provide a profile of the underlying rules a typically developing child uses, which can be served as a basis for planning remediation. Also information about typical errors helps to delineate the normal course of acquisition; consequently, a child’s atypical phonologic development can be evaluated against normal or typical error patterns
Spoken Language and Literacy Skills in French-Speaking Children with Cochlear Implants: A 5-Year Follow-Up Study
No full textThis paper addresses the question of whether Mean Length of Utterance (MLU), an index of early productive grammar, predicts long-term outcomes of spoken language and literacy skills in French-speaking children with cochlear implants, and how this influence differs according to individual and environmental factors. Twenty-five school-aged children (12 boys and 13 girls), implanted between the ages of 25 and 78 months, were first followed at 3 and 5 years for MLU and then at 8 years after implantation for receptive language, reading and spelling. Univariate analyses of variance indicated that environmental factors (communication mode and SES) were significantly associated to receptive language and to a certain extent to literacy skills. Multivariate and regression analyses revealed that gender and MLU interacted with receptive language and literacy skills at 8 years after implantation. Such findings suggest that MLU at 3 years after implantation is a good predictor of receptive language and literacy skills 5 years later
Stability of Synthetic Single-Strand DNA as a Criterion for the Usage as Marking System
No full textDNA is a carrier of genetic information and can be used as an invisible barcode. For its successful application, stability is one important criterion. This report describes the investigation of synthetic single-strand DNA (ssDNA) damage under several environmental conditions with Real-time PCR. We measured the amplification ratio of amplifiable ssDNA against time and calculated the half-life. Comparing the half-life of all DNA degradations, ultraviolet irradiation leads to the fastest ssDNA decay, followed by ssDNA treatment at 80°C in the presence of water and acidic ssDNA incubation. However, ssDNA is protected against high temperatures by complexation to hydroxyapatite. This study shows for the first time half-life values for ssDNA, which are important for technical applications such as the usage as a marking system. Also this study is of crucial importance for all other applications, in which DNA damage can lead to misinterpretations in PCR results
Wolfram Syndrome: Report of Two New Cases
No full textWolfram Syndrome (WFS) is a rare autosomal recessive disease. It is a progressive neurodegenerative disorder in which patients present with diabetes mellitus, optic atrophy, diabetes insipidus, sensorineural deafness, urologic abnormalities and multiple neurological abnormalities.This study reports two sisters with late diagnosed wolfram syndrome with diabetes insipidus, diabetes mellitus, optic atrophy, deafness and urological abnormalities.The condition should be evaluated in a multidisciplinary attitude and specific tests are necessary to make a precise diagnosis of the syndrome
Pituitary Volumes and Functions in Children with Growth Hormone Deficiency: Volumetric Magnetic Resonance Findings
No full textPurpose: The purpose of the study was to compare pituitary volumes calculated from magnetic resonance imaging (MRI) in patients with idiopathic growth hormone deficiency (GHD) without structural abnormalities in the pituitary gland with clinical and biochemical features.Methods: This study was designed as a retrospective review and the need for informed consent was waived. MRI of the head was performed for 39 male and 17 female patients ranging in age from 10 to 14 years. Pituitary volumes were calculated from sectional area and ellipsoid formula. Pituitary volumes were compared between boys and girls. Pituitary volumes were also compared with measurements of pituitary function, age, and standard deviation scores (SDS) for height.Results: Whole pituitary volumes in patients were 405.1 ± 150.6 mm3 for the male group and 348.6 ± 161.1 mm3 for the female group. No significant difference was identified between mean pituitary volumes of the female and male groups. A weak correlation was found between pituitary volume and height SDS for boys (Ï = 0.34, p = .03). For girls, a moderate correlation was identified between pituitary volume and FSH level (Ï = 0.67, p < .01).Conclusion: Pituitary volumes of GHD patients correlated with height SDS in boys and FSH levels in girls. Brain MRI can be used not only to rule out anatomical abnormalities of the pituitary gland in GHD patients, but also to assess pituitary functions in clinical settings
Specific Thyroid Markers and Auxiliary Diagnostics in Post Pregnancy Woman, Specific and Non-Specific Hypothyreosis-Like Syndromes.
No full textObjective: The signs, symptoms and biochemical criteria in most cases of evident and subclinical hypothyreosis are specific and its diagnosis is rather credible. However, there is a group of patients with goitre, especially post-pregnancy women, where criteria of hypothyreosis are often mistaken.Design: The classic thyroid tests used (CTT): fT4, fT3, TSH, immunology tests(IT): a-TPO, a-TG, CIC, and computer auxiliary diagnostic tests(ADT): BDI, finger photoplethysmography - in 358 patients, divided into groups O(32),CB(38), PH(36), CD(37), PS(41), SH(32), PC(35), DT(34), DN(35), RH(38).Intervention: Answering the following question: Are there any differences or similarities between the data of classic thyroid tests and auxiliary diagnostic tests (ADT) in distinguished patient groups.Results: Patient groups (O, PH, CD,DT), normal thyroid parameters fT3, fT4, TSH, a-TPO, a-TG, CIC, normal profile of ADT (BDI(<15), PT(0,28-0,5), PCT (0,4-0,8)). Patients with hypothyreosis (PS) had normal(a-TPO, a-TG, CIC), increased TSH(7,92), and a different profile of ADT (BDI(24,7), PT(0,66) and PCT(-0,185)). Patients with Hashimoto's disease (RH) had increased a-TPO, a-TG, CIC, TSH, a decreased concentration of fT3, fT4 and similar (PS) ADT profile. Patients in the groups (CB, PC, DN) showed a trend of insignificantly decreased fT3, fT4, a trend of insignificantly increased (a-TPO, a-TG, CIC) and a similar (PS) ADT profile.Conclusions: The biochemical criteria among healthy individuals and patients with no thyroid illness (PH, CD, DT) correlated with the ADT characteristic profile. Patients fulfilling biochemical criteria of evident (PS) and inflammatory-dependant hypothyreosis (RH) had a quite different, characteristic ADT profile. The biochemically uncertain groups (CB, PC, DN) had an ADT profile similar to the group with evident hypothyreosis. These promising initial results prove the method to be a valuable auxiliary diagnostic
Quality of Life in Patients with Fibromyalgia
No full textObjectives: The aim of this review is to provide practicing clinicians with detailed information on the quality of life (QoL) of patients with fibromyalgia, and the medical and non-medical management effects on quality of life in fibromyalgia.Methods: A systematic English language search of the medical literature from January 1980 to January 2013 using PubMed was conducted using the search terms “fibromyalgia†AND “quality of life.†The literature search revealed 1,086 publications; 259 were clinical trials on human patients, 230 were reviews and 20 were case reports. Three authors reached a consensus on selecting the studies based on specific inclusion and exclusion criteria. A total of 95 research studies were included in this review.Results: Overall quality of life is severely impaired in patients with fibromyalgia. Comorbidities have a further negative impact on QoL. Substantial pain reductions resulting in improvement of QoL were observed with medications and non-medication interventions such as exercise, acupuncture, cognitive behavioral therapy, neurofeedback and multidisciplinary approach.Conclusion: Fibromyalgia and its comorbidities including pain have a considerable negative impact on the quality of life of fibromyalgia patients. Substantial or moderate pain reduction seems to improve quality of life. A multidisciplinary approach appears to be most beneficial in management of this multifaceted illness, but more studies are needed to develop specific interventions necessary to alleviate pain and sufferings in these patients
Metabolic Syndrome In Egyptian Patients with Primary Knee Osteoarthritis
No full textIntroduction: Osteoarthritis (OA) is among the most common musculoskeletal disorders affecting millions of people throughout different races in different ages and sexesAim: The aim of the present study was to determine the prevalence of Metabolic Syndrome (MetS) in a group of Egyptian patients with primary knee Osteoarthritis (OA) and to detect its relation to the clinical, functional and radiographic findings.Patients and methods: The present study included 380 patients (150 males, 230 females) diagnosed as having primary knee OA. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess disease specific self-reported disability. X-rays were classified according to the Kellgren–Lawrence (KL) radiographic rating scale. 400 (260females, 140 males) apparently healthy volunteers without knee OA were used as control group.Results: MetS was prevalent in 53.7 % of the studied OA patients, in the control group was 37.3% of (P: <0.001). The prevalence of individual MetS components included 68.7 % for abdominal obesity, 66.8 % for hypertension, 36.1 % for hyperglycemia, 52.1 % for elevated triglycerides and 49.2 % for low high density lipoprotein (HDL). Patients with MetS had significantly higher body mass index (BMI) (P: 0.0013), longer disease duration (P: 0.021), more pain (P: 0.007), more stiffness (P: 0.043), worse functional impairment scores(P: 0.017) and advanced radiological progress (P:0.0001).Conclusions: MetS is prevalent in patients with primary knee OA. It is associated with poor clinical performance and advanced radiological changes. The most common component of MetS in our study is abdominal obesity
Management of Acute Aortic Infective Endocarditis in Pregnancy
No full textThe reported incidence of infective endocarditis during pregnancy is 0,006% and there are no accepted guidelines. Management is individually based according to gestational age and the status of the mother. A multidisciplinary approach is required. Cardiopulmonary bypass, hypothermia and hyperkalemia may be fatal for the foetus due to vasoconstrictive response of the uteroplacental arteries. Herein, we report a case of successful treatment of acute aortic endocarditis during the second trimester of gestation, with a focus on timing of surgery and technical aspects