Acute-on-Chronic Liver Failure: What are the Implications?

Acute-on-chronic liver failure (ACLF) is a clinical entity that is well recognized by those who care for patients with cirrhosis, however in spite of this widespread recognition, there remains little consensus with regard to definition and clinical features. While many similarities exist between ACLF and decompensated cirrhosis, there are also key differences, the implications of which are far reaching for both clinicians and patients alike. Among these differences are the possibility of a reversible component, the presence of a defined insult, prognosis, and outcomes associated with ACLF (see Fig. 1). However, for ACLF to have meaningful clinical implications, it first must be defined. If ACLF can be clearly defined and more easily recognized, then clinicians may be better able to prevent, treat, prognosticate, and counsel such patients.     

Orthodontic anomalies and malocclusions in Late Antique and Early Mediaeval period in Croatia

ObjectiveMalocclusions are relative infrequently analysed in bioarchaeological investigations and if investigated the samples are very small. This research provides analysis of orthodontic anomalies of even 1118 individuals from the Late Antique (LA) and Early Mediaeval (EM) period. Aims were to describe the prevalence of orthodontic anomalies in this historical period and to analyse which orthodontic anomalies are best suitable for bioarchaeological investigations.Methods1118 skulls were examined for anomalies of tooth number, tooth displacement (rotation, malposition, diastema and crowding) as well as for malocclusions.ResultsThe prevalence of hypodontia in the LA was 41.02% and 30.61% in the EM sample. Tooth displacement was noticed in 15.63% individuals from the LA and in 12.42% individuals from EM. About 26% of the LA sample and 7.19% of the EM sample were affected with tooth crowding and the difference was statistically significant.ConclusionOrthodontic anomalies affecting only one tooth or group of teeth are more suitable for examination in bioarchaeological investigations than orthodontic features requiring presence of both jaws and all or almost all teeth. Clinical investigation protocols and methodology should be adopted for bioarchaeological researches and international standards and recommendations should be established for this kind of investigation on skeletal remains.     

Depression and partial epilepsy: Relevance of laterality of the epileptic focus

Abstract

In a prospective study of 50 epileptic patients (20 with a left hemisphere epileptic focus, 20 with a right one and 10 with a cryptogenic generalized epilepsy), the authors show that depression as appreciated by the H.A.R.D. score, is more frequent and severe in partial epilepsy in males, and when the epileptic focus is localized on left hemisphere. This association is related to the duration of epilepsythe number of seizures, but not to age or medication status.. Vulnerability of left hemisphere to depression is analysedand neuro-chemical mechanisms are discussed. [Neurol Res 1993; 15: 136-138]     

Parenting-related stress and psychological distress in mothers of toddlers with autism spectrum disorders

Background:Parents of children with autism spectrum disorders (ASDs) are at risk for higher stress levels than parents of children with other developmental disabilities and typical development. Recent advances in early diagnosis have resulted in younger children being diagnosed with ASDs but factors associated with parent stress in this age group are not well understood. Aims: The present study examined parenting-related stress and psychological distress in mothers of toddlers with ASD, developmental delay without ASD (DD), and typical development. The impact of child problem behavior and daily living skills on parenting-stress and psychological distress were further investigated. Methods: Participants were part of a larger research study on early ASD intervention. Results: Parent self-report of parenting-related stress and psychological distress was utilized. Parents of toddlers with ASD demonstrated increased parenting-related stress compared with parents of toddlers with DD and typical development. However, psychological distress did not differ significantly between the groups. Child behavior problems, but not daily living skills emerged as a significant predictor of parenting-related stress and psychological distress. This was true for both mothers of children with ASD and DD. Conclusions: These finding suggest that parents’ abilities to manage and reduce behavior problems is a critical target for interventions for young children with ASD and DD in order to improve child functioning and decrease parenting-related stress.     

Rehabilitation of spelling in a participant with a graphemic buffer impairment: The role of orthographic neighbourhood in remediating the serial position effect

Graphemic Output Buffer (GOB) disorder is defined as difficulty with the serial output of a sequence of letters in the output stage of the spelling process. In their rehabilitation study with a GOB patient, Sage and Ellis (2006 Sage, K. and Ellis, A. W. 2006. Using orthographic neighbours to treat a case of graphemic buffer disorder. Aphasiology, 20: 851–870. (doi:10.1080/02687030600738945)[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) found that improvement on treated words generalised to untreated words from the same orthographic neighbourhoods as treated items, but not to other unrelated words. GOB patients frequently show a bow-shaped accuracy curve across letter positions, where letters at the middle positions are most error-prone. It may be that consistent letters at these middle letter positions across neighbourhoods modulate this effect. Spelling was treated using an Anagram and Copy Treatment (ACT) and generalisation to three untreated sets was examined: (1) neighbours of treated words with shared middle letters (e.g., clock–block), (2) neighbours with different medial position letters (e.g., clock–click), and (3) unrelated words (e.g., clock–puppy). Improvement was found for untreated neighbours with shared middle letters. There was no effect of training on the unrelated word set, and a negative impact on untreated neighbours with changed middle letters after the treatment. We attribute these results to top-down support from learned lexical representations, which facilitate spelling of untreated neighbours with shared middle letters but impede neighbours with changed middle letters. This latter result is attributed to interference from neighbours in the trained set strengthening competing letter representations at middle positions.     

l-dopa-induced dyskinesias in unilateral 6-hydroxydopamine-lesioned rats are not modified by excitotoxic lesion of the entopeduncular nucleus and substantia nigra pars reticulata

l -Dopa-induced dyskinesias (LIDs) are a troublesome complication in Parkinson's disease after long-term therapy and a major reason for surgical treatment. LIDs are effectively eliminated by surgery. We aimed to reproduce such effect in the 6-hydroxydopamine (6-OHDA)-lesioned rat model. Single or combined lesions with quinolinic acid were caused in the entopeduncular nucleus (EP) and substantia nigra pars reticulata (SNr) on 6-hydroxydopamine (6-OHDA)-lesioned rats treated for 3 weeks with l -Dopa (6 mg/kg plus 15 mg/kg benserazide, i.p.). l -Dopa administration was continued for a further week following the lesion and abnormal involuntary movements (AIMs) scored at the end of treatment. Neither the individual lesions of the EP and SNr nor the combined lesions had any antidyskinetic effect nor decreased the total number of rotations. These results suggest that excitotoxic lesions of neurons bodies of the output nuclei of the basal ganglia, which destroy cell bodies and spare fibers of passage, do not induce a beneficial reduction of dyskinesias in contrast to thermolytic lesions in humans (which provokes a complete tissue destruction), thus supporting the possibility that other nuclei or systems might be involved in the antidyskinetic effect of pallidotomy. Synapse 67:407–414, 2013. © 2013 Wiley Periodicals, Inc.     

Role of dental professional identification and referral of victims of domestic violence

Dental professionals can play an important role in identifying and referring victims of domestic violence. Since most of the injuries sustained by victims occur in the head and neck region, dentists are uniquely positioned to help address this enormous public health issue. Unfortunately, dentists are the least likely of all health professionals to identify and refer victims of abuse. Much of this failure may be attributed to a lack of knowledge. This article provides an overview of the types and indicators of abuse, information about screening and interviewing victims, and referral resources.