Information overload?

The use of the Internet for acquiring information on HIV and AIDS and the resulting impact on patient understanding of the disease are examined. Vast amounts of information about HIV and AIDS can be found on the Internet and many patients may have difficulty absorbing information due to the complexities of the disease. The article cautions that problems understanding HIV resources and a patient's desire to know as much as possible about the disease may result in frustration and loss of self esteem. This situation can lead to regressive behavior in the patient and hinder the healing process. Because of information overload, some patients leave all their treatment decisions to their doctors and simply do as they are told.     

Implicit Memory Development in School-Aged Children With Attention Deficit Hyperactivity Disorder (ADHD): Conceptual Priming Deficit?

Previous research has shown that children with attention deficit hyperactivity disorder (ADHD) often demonstrate performance deficits on effortful, strategic memory tasks, whereas relatively rote tasks of memory reveal no such deficit. Thus far, research in this domain has focused primarily on explicit memory. This study examined performance on multiple measures of implicit and explicit memory in children aged 7 to 14 years with and without ADHD. Memory for words and pictures was assessed at 15-min and 24-hr intervals. ADHD and non-ADHD groups performed similarly on tests of explicit memory (category-cued recall and recognition) and on perceptual aspects of implicit memory (word stem completion and picture fragment identification) as a function of age, retention interval, and stimulus format (i.e., picture or word). However, there was no evidence of priming on a conceptual implicit memory test (category exemplar generation) for boys with ADHD. This type of conceptual task, which is likely mediated by frontal systems, may indicate a unique memory deficit associated with ADHD.     

Fetus in fetu or differentiated teratomas?

Two cases of congenital teratoma were operated upon. In view of the high degree of organoid differentiation of the teratomas with rudimentary limbs, intestine, brain-like and pulmonary tissues, it was difficult to distinguish it from fetus-in-fetu. In the light of the data obtained and extensive review of related literature, we consider that fetus-in-fetu and teratoma may not be unrelated entities. Our cases support the view held that fetuses in fetu are highly differentiated teratomas.     

Exercise in Futility or do CART or MEWS Prevent Errors?

How to cite this article: Rao RMG. Exercise in Futility or do CART or MEWS Prevent Errors? Indian J Crit Care Med 2022;26(7):765–766.     

Viruses in therapy--royal road or dead end?

The idea of using viruses as gene vehicles to combat disease is tantalizing for the simplicity of its principle, and for the unlimited perspectives that it raises. Yet the initial enthusiasm gave way to deep skepticism, when the complex challenges became apparent. Issues that hampered clinical successes include the specificity and efficiency of gene delivery; the immune response to viral vectors and targeted cells; standardized and affordable production of vectors; and safety for patients and environment. More recently, some obstacles could be mastered through a better understanding of vector-cell-interactions, vector-induced pathogenesis and principles of vector engineering technologies. First clinical successes became apparent, giving raise to a second waive of effort to exploit viruses in gene therapy. Future challenges include the targeting of stem cells, through receptor tropism and the regulation of gene expression; controlled evasion of host defense; combining the beneficial features of several virus vectors; realistic animal models; and clinical protocols for standardized evaluation of safety and efficacy. Monogenetic disorders were initially regarded as principal targets for gene therapy. However, most clinical trials are now addressing cancer or HIV infection. Cancer gene therapy is aiming at the destruction of malignant cells, whereas 'conventional' gene therapy frequently establishes or restores a long-term function in target cells. Therefore, the requirements for viruses to be used against cancer are fundamentally different from conventional vectors. Host cell death, immune response, and spread of replicating viruses can all contribute to oncolytic efficacy. However, limiting these deleterious effects to tumor cells is mandatory for clinical safety. A number of approaches have been taken to improve the specificity and/or efficacy of cancer virotherapy. Recent studies concerning oncolytic adenoviruses exemplify these strategies.     

Is Neuropsychological Testing Useful in the Management of Sport-Related Concussion?

Objective: Neuropsychological (NP) testing has been used for several years as a way of detecting the effects of sport-related concussion in order to aid in return-to-play determinations. In addition to standard pencil-and-paper tests, computerized NP tests are being commercially marketed for this purpose to professional, collegiate, high school, and elementary school programs. However, a number of important questions regarding the clinical validity and utility of these tests remain unanswered, and these questions present serious challenges to the applicability of NP testing for the management of sport-related concussion. Our purpose is to outline the criteria that should be met in order to establish the utility of NP instruments as a tool in the management of sport-related concussion and to review the degree to which existing tests have met these criteria.Data Sources: A comprehensive literature review of MEDLINE and PsychLit from 1990 to 2004, including all prospective, controlled studies of NP testing in sport-related concussion.Data Synthesis: The effects of concussion on NP test performance are so subtle even during the acute phase of injury (1–3 days postinjury) that they often fail to reach statistical significance in group studies. Thus, this method may lack utility in individual decision making because of a lack of sensitivity. In addition, most of these tests fail to meet other psychometric criteria (eg, adequate reliability) necessary for this purpose. Finally, it is unclear that NP testing can detect impairment in players once concussion-related symptoms (eg, headache) have resolved. Because no current guideline for the management of sport-related concussion allows a symptomatic player to return to sport, the incremental utility of NP testing remains questionable.Conclusions/Recommendations: Despite the theoretic rationale for the use of NP testing in the management of sport-related concussion, no NP tests have met the necessary criteria to support a clinical application at this time. Additional research is necessary to establish the utility of these tests before they can be considered part of a routine standard of care, and concussion recovery should be monitored via the standard clinical examination and subjective symptom checklists until NP testing or other methods are proven effective for this purpose.     

Heading for a fall? Management of head injury in infants

Head injury is one of the commonest reasons for infants (< 1 year) to attend the Emergency Department (ED). Clinical management varies considerably and concern about non accidental injury results in a high admission rate in some hospitals. Information was obtained on 103 children under one year of age presenting to the ED with head injury in a prospective study. The average age was 6.7 months and 57% of patients were male. Twenty eight babies had skull x rays with 1 skull fracture diagnosed. None required CT brain scan. Ninety eight (94%) were discharged home from the ED. There were no unplanned returns, readmissions or adverse events. The incidence of traumatic brain injury in children under one year of age presenting with head injury is low and the majority can be safely discharged home.     

Oesophagitis in children: reflux or allergy?

The prevalence of eosinophilic oesophagitis appears to be increasing in many countries, sometimes rapidly, although this may be partly due to increased disease recognition. Histological methods of assessment and diagnostic criteria vary considerably between major clinical centres. Oesophagitis with over 20 intraepithelial eosinophils per high power field is more likely to be due to allergy than gastro-oesophageal reflux induced acid-peptic mucosal injury. Typical eosinophilic oesophagitis shows involvement of the entire oesophagus, with basal cell proliferation occupying more than 50% of the thickness of the surface epithelium, and high numbers of intraepithelial eosinophils, sometimes concentrated on the surface or as contiguous clusters. Ulceration and prominent neutrophils are atypical and should suggest an alternative or co-existent disease. On endoscopy, the oesophagus may display the typical 'corrugated' mucosal appearance. Clinically, dysphagia or food impaction are the most characteristic symptoms. There is a strong association with other atopic diseases, especially asthma and eczema. To date no evidence has emerged of an increased malignancy risk. Patients with eosinophilic oesophagitis typically fail to respond to acid suppressive medications but respond well to either elemental/elimination diets or aerosolised swallowed corticosteroids. Long-term uncontrolled oesophageal eosinophilic inflammation may lead to progressive subepithelial fibrosis, potentially resulting in strictures or oesophageal narrowing.