A strategy for reducing maternal mortality

A confidential system of enquiry into maternal mortality was introduced in Malaysia in 1991. The methods used and the findings obtained up to 1994 are reported below and an outline is given of the resulting recommendations and actions.     

Catechins as a Potential Dietary Supplementation in Prevention of Comorbidities Linked with Down Syndrome

Plant-derived polyphenols flavonoids are increasingly being recognized for their medicinal potential. These bioactive compounds derived from plants are gaining more interest in ameliorating adverse health risks because of their low toxicity and few side effects. Among them, therapeutic approaches demonstrated the efficacy of catechins, a major group of flavonoids, in reverting several aspects of Down syndrome, the most common genomic disorder that causes intellectual disability. Down syndrome is characterized by increased incidence of developing Alzheimer’s disease, obesity, and subsequent metabolic disorders. In this focused review, we examine the main effects of catechins on comorbidities linked with Down syndrome. We also provide evidence of catechin effects on DYRK1A, a dosage-sensitive gene encoding a protein kinase involved in brain defects and metabolic disease associated with Down syndrome.     

An outbreak of acute conjunctivitis caused by coxsackievirus A24 in Kuala-Lumpur, Malaysia, 1978

An investigation of an outbreak of acute conjunctivitis in Kuala Lumpur from May to August 1978 was made. A total of 2,133 cases was involved, most of whom were adult Malay males of low income status from the surrounding villages and low-cost flats. The majority of cases had bilateral conjunctivitis with clear discharge. Pain and subconjunctival haemorrhage were not common and recovery, mostly without complications, occurred within 1 week. Eye scrapings and paired sera specimens were examined and the causal agent was found to be Coxsackievirus A24 (CA24).     

Dukes C colorectal cancer: is the metastatic lymph node ratio important?

Purpose  

Although the regional lymph node status is essential for staging of colorectal cancer, the importance of the total number of collected nodes remains controversial. Our aim was to examine the impact of the metastatic lymph node ratio (LNR) on the survival of patients with Dukes C colorectal cancer.     

Operability and early outcome in 48 Irish patients with peritoneal malignancy treated by surgery and intraperitoneal chemotherapy in a specialized centre

BackgroundIn selected cases of peritoneal malignancy a novel approach of complete macroscopic tumour removal by extensive surgical cytoreduction, combined with intraperitoneal chemotherapy, provides a possibility of cure. The experience with 48 consecutive Irish cases undergoing laparotomy in a specialized centre is reported.Patients and methodsA subset of 48 Irish patients out of a total of 120 cases with peritoneal malignancy underwent surgery between September 1999 and March 2011 in an English National referral centre. Overall 37/48 (77%) had appendiceal mucinous tumours with pseudomyxoma peritonei type syndrome. The treatment strategy involved macroscopic complete tumour removal (complete cytoreduction) combined with intra-operative, intraperitoneal chemotherapy.ResultsOverall 30/48 (62.5%) had complete cytoreduction, 15/48 (31.3%) had major debulking and 3 (4.2%) had laparotomy and biopsy only. The median (range) operating time in hours was 9.8 (4.8–16) in the 30 who had complete cytoreduction compared with 6.3 (4.5–11) in the 15 who had debulking (p = 0.019). There was no post-operative mortality.Overall five year survival for the complete tumour removal group was 66% compared with 12% for those only amenable to major debulking.ConclusionThis novel strategy of cytoreduction combined with intraperitoneal chemotherapy is effective in selected patients with peritoneal malignancy. The complex surgery is particularly effective for appendiceal tumours and provides the only possibility of cure in this challenging disease.     

Strategies for the use of Ginkgo biloba extract,EGb 761®, in the treatment and management of mild cognitive impairment in Asia: Expert consensus

BackgroundMild cognitive impairment (MCI) is a neurocognitive state between normal cognitive aging and dementia, with evidence of neuropsychological changes but insufficient functional decline to warrant a diagnosis of dementia. Individuals with MCI are at increased risk for progression to dementia; and an appreciable proportion display neuropsychiatric symptoms (NPS), also a known risk factor for dementia. Cerebrovascular disease (CVD) is thought to be an underdiagnosed contributor to MCI/dementia. The Ginkgo biloba extract, EGb 761^®, is increasingly being used for the symptomatic treatment of cognitive disorders with/without CVD, due to its known neuroprotective effects and cerebrovascular benefits.AimsTo present consensus opinion from the ASian Clinical Expert group on Neurocognitive Disorders (ASCEND) regarding the role of EGb 761^® in MCI.Materials & MethodsThe ASCEND Group reconvened in September 2019 to present and critically assess the current evidence on the general management of MCI, including the efficacy and safety of EGb 761^® as a treatment option.ResultsEGb 761^® has demonstrated symptomatic improvement in at least four randomized trials, in terms of cognitive performance, memory, recall and recognition, attention and concentration, anxiety, and NPS. There is also evidence that EGb 761^® may help delay progression from MCI to dementia in some individuals.DiscussionEGb 761^® is currently recommended in multiple guidelines for the symptomatic treatment of MCI. Due to its beneficial effects on cerebrovascular blood flow, it is reasonable to expect that EGb 761^® may benefit MCI patients with underlying CVD.ConclusionAs an expert group, we suggest it is clinically appropriate to incorporate EGb 761^® as part of the multidomain intervention for MCI.     

Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery

Aim Robotic colorectal surgery is an emerging field and may offer a solution to some of the difficulties inherent to conventional laparoscopic surgery. The aim of this review is to provide a comprehensive and critical analysis of the available literature on the use of robotic technology in colorectal surgery. Method Studies reporting outcomes of robotic colorectal surgery were identified by systematic searches of electronic databases. Outcomes examined included operating time, length of stay, blood loss, complications, cost, oncological outcome, and conversion rates. Results Seventeen Studies (nine case series, seven comparative studies, one randomized controlled trial) describing 288 procedures were identified and reviewed. Study heterogeneity precluded a meta‐analysis of the data. Robotic procedures tend to take longer and cost more, but may reduce the length of stay, blood loss, and conversion rates. Complication profiles and short‐term oncological outcomes are similar to laparoscopic surgery. Conclusion Robotic colorectal surgery is a promising field and may provide a powerful additional tool for optimal management of more challenging pathology, including rectal cancer. Further studies are required to better define its role.     

Helical CT evaluation of the perirenal space and its boundaries: a cadaveric study

PURPOSE: To determine whether the perirenal spaces communicate across the midline and with the pelvic extraperitoneal spaces. MATERIALS AND METHODS: Helical CT was used to guide the sequential injection of 100-mL intravenous boluses of dilute contrast medium, up to 300 mL, into the perirenal space of eight embalmed cadavers (three male, five female; mean age at death, 82 years; range, 72-93 years), with four left-sided and four right-sided injections. All images were acquired after the final injection (300 mL total) to facilitate coronal and sagittal reconstruction of relevant images. All images were reviewed to assess the flow pathways of contrast medium from the perirenal space to other retroperitoneal spaces. RESULTS: In three cadavers that received left perirenal space injections and in two cadavers that received right perirenal space injections, communication was seen with the contralateral perirenal space through an area anterior to the aorta and inferior vena cava. In three cadavers that received right perirenal space injections, contrast material flowed from the right perirenal space to outline the bare area of the liver. Communication between the perirenal and pelvic extraperitoneal spaces was seen in all eight cadavers; contrast material extended into the pelvic extraperitoneal and presacral spaces. CONCLUSION: These findings show that the perirenal spaces communicate with each other across the midline and with the pelvic extraperitoneal spaces. Clinical implications are that perinephric collections can potentially flow into the pelvis or across the midline.     

Ethanol modulates BKCa channels by acting as an adjuvant of calcium

Ethanol modulation of calcium- and voltage-gated potassium (slo1) channels alters neuronal excitability, cerebrovascular tone, brain function, and behavior, yet the mechanism of this modulation remains unknown. Using patch-clamp electrophysiology on recombinant BK(Ca) channels cloned from mouse brain and expressed in Xenopus laevis oocytes, we demonstrate that ethanol, even at concentrations maximally effective to modulate BK(Ca) channel function (100 mM), fails to gate the channel in absence of activating calcium. Moreover, ethanol does not modify intrinsic, voltage- or physiological magnesium-driven gating. The alcohol works as an adjuvant of calcium by selectively facilitating calcium-driven gating. This facilitation, however, renders differential ethanol effects on channel activity: potentiation at low (<10 microM) and inhibition at high (>10 microM) calcium, this dual pattern remaining largely unmodified by coexpression of brain slo1 channels with the neuronally abundant BK(Ca) channel beta(4) subunit. Calcium recognition by either of the slo1 high-affinity sensors (calcium bowl and RCK1 Asp362/Asp367) is required for ethanol to amplify channel activation by calcium. The Asp362/Asp367 site, however, is necessary and sufficient to sustain ethanol inhibition. This inhibition also results from ethanol facilitation of calcium action; in this case, ethanol favors channel dwelling in a calcium-driven, low-activity mode. The agonist-adjuvant mechanism that we advance from the calcium-ethanol interaction on slo1 might be applicable to data of ethanol action on a wide variety of ligand-gated channels.     

Creutzfeldt-Jakob disease: Which diffusion-weighted imaging abnormality is associated with periodic EEG complexes?

Background   Clinical diagnosis of CJD remains important due to lack of access to a genetic or histopathological diagnosis. Using current WHO criteria, diagnostic certainty can be increased from “possible” to “probable” CJD if periodic complexes are recorded on EEG. Objective   To study the correlation between patterns of MRI-DWI hyperintensity and typical EEG findings among patients with CJD. Methods   Demographics, clinical findings, MRI-DWI and EEG findings of CJD patients were retrospectively reviewed. Results   A total of 14 patients ranging in age from 35 to 81 years were identified. All had dementia and cerebellar ataxia. Psychiatric manifestations were seen in 5 patients. Seven patients had both cortical and striatal DWI changes, five had isolated cortical DWI changes and two had isolated striatal DWI changes. All twelve patients with cortical DWI changes also had periodic EEG changes. In ten, periodic EEG was recorded within seven days of the DWI. The two patients with isolated striatal DWI changes did not develop periodic EEG complexes despite serial EEG recordings, 40 and 88 days from their respective DWI scans. Conclusions   Serial EEGs are not useful for patients with isolated striatal DWI hyperintensity but will increase diagnostic certainty from “possible” to probable” CJD for patients with cortical DWI hyperintensity.