Rehabilitation and education are underutilized for mild stroke and TIA sufferers

Purpose: Transient ischemic attack (TIA) and mild stroke represent a large proportion of cerebrovascular events, at high risk of being followed by recurrent, serious events. The importance of early education addressing risk management, secondary prevention and lifestyle modifications is the centerpiece of further stroke prevention. However, delivering education and rehabilitation to this population can be complex and challenging.

Methods: Via synthesis of a narrative review and clinical experience, we explore the unique and inherent complexities of rehabilitation management and education provision for patients following mild stroke and TIA.

Results: A considerable proportion of TIA/mild stroke survivors have ongoing rehabilitation needs that are poorly addressed. The need for rehabilitation in these patients is often overlooked, and available assessment tools lack the sensitivity to identify common subtle impairments in cognition, mood, language and fatigue. Active and accessible education interventions need to be initiated early after the event, and integrated with ongoing rehabilitation management. Priority areas in need of future development in this field are highlighted and discussed.

• Implications for rehabilitation

• Survivors of mild stroke and TIA have ongoing unmet rehabilitation needs and require a unique approach to rehabilitation and education.

• Rehabilitation needs are difficult to assess and poorly addressed in this cohort, where available assessment tools lack the sensitivity required to identify subtle impairments.

• Education needs to be initiated early after the event and involve active engagement of the patient in order to improve stroke knowledge, mood and motivate adherence to lifestyle modifications and secondary prevention.

• Rehabilitation physicians are currently an underutilized resource, who should be more involved in the management of all patients following TIA or mild stroke.

     

Biodistribution and targeting potential assessment of mucoadhesive chitosan nanoparticles designed for ulcerative colitis via scintigraphy

In the present investigation we have prepared and characterized curcumin (CN)-containing chitosan nanoparticles (CS-NPs) coated with Eudragit FS 30D for colon-specific drug delivery for treatment of ulcerative colitis. Methods: CS-NPs were prepared by ionic gelation using tripolyphosphate. To specify pH sensitive delivery, CS–CN-NPs were coated with Eudragit FS 30D by using a solvent evaporation method. Different process parameters were evaluated, and the optimized formulation was characterized by particle size, size distribution, zeta potential and encapsulation efficiency before lyophilization. The lyophilized product was further subjected to Fourier-transform infrared spectroscopy, and particle morphology and in vitro drug release in different media were studied. Results: the kinetics of in vitro drug release from the CS–CN-NPs revealed sustained release behaviour of the developed carriers. In vivo biodistribution study by gamma-scintigraphy showed good accumulation of the developed nanocarriers in the colonic region. Conclusion: sustained and pH stimulated delivery of CN to the colon was successfully attained via coating of CS-NPs with Eudragit FS 30D to circumvent poor absorption and availability of CN.

In the present investigation we have prepared and characterized curcumin (CN)-containing chitosan nanoparticles (CS-NPs) coated with Eudragit FS 30D for colon-specific drug delivery for treatment of ulcerative colitis.     

Ginger and turmeric lipid-solubles attenuate heated oil-induced oxidative stress in the brain via the upregulation of NRF2 and improve cognitive function in rats

In this study, we elucidated the modulatory potentials of lipid-solubles from ginger and turmeric that may migrate to oils during heating on the brain antioxidant defense and cognitive response in rats. Male Wistar rats were fed with control diet [including native canola oil (N-CNO), and native sunflower oil (N-SFO)], or experimental diets [including heated canola oil (H-CNO), heated sunflower oil (H-SFO), heated canola oil with ginger (H-CNO + GI), heated canola oil with turmeric (H-CNO + TU), heated sunflower oil with ginger (H-SFO + GI), heated sunflower oil with turmeric (H-SFO + TU)] for 90 days. Memory parameters [Morris water maze, elevated plus maze, novel object recognition test, T-maze (spontaneous alteration)], locomotor skills (open field test and rotarod test), antioxidant defense enzymes, reactive oxygen species, NOS2, ICAM-1, and NRF-2 level in the brain were assessed. Compared to their respective controls, heated oil-fed rats, but not those fed oils heated with ginger or turmeric, showed significant (p < 0.05) reduction in the memory, motor coordination skills, antioxidant defense enzymes, and NRF-2 activation in the brain. Compared to their respective controls, the brain NOS-2 and ICAM-1 were significantly (p < 0.05) increased in heated oil-fed rats, but not those fed oils heated with ginger or turmeric. Chronic intake of repeatedly heated oil causes brain dysfunction by inducing oxidative stress through NRF-2 downregulation. Lipid-solubles from ginger and turmeric that may migrate to oil during heating prevent the oxidative stress and cognitive dysfunction triggered by heated oils in rats.

     

Bilateral ankle arthritis with mediastinal lymphadenopathy: a clinician's perspective

Aim: This study is a clinician's perspective of the association of bilateral ankle arthritis with mediastinal lymphadenopathy. Method: Forty‐three patients with bilateral ankle arthritis with mediastinal lymphadenopathy were included in a 14‐month prospective follow‐up study in our hospital. Complete history, examination and investigations were carried out. Result: There were 27 female and 16 male patients. Ankle arthritis with tuberculous mediastinal lymphadenopathy was associated in 58.13%, sarcoidosis in 32.5% and 9.3% were non‐specific. The patients were clustered in the spring‐summer months. Erythema nodosum was found in 14.3%, polyarticular presentation in 25%. Thirteen out of 43 patients (28.2%) had biopsy/fine needle aspiration (FNA), of which 69.23% had histopathological evidence of tuberculosis. Conclusion: The aetiology of bilateral ankle arthritis associated with mediastinal lymphadenopathy may be tuberculosis as opposed to sarcoidosis. There is a seasonal clustering of these cases. FNA of mediastinal lymphadenopathy is a fairly safe procedure and should be carried out when feasible, for confirmation of diagnosis.     

The long-term consequence of salivary contamination at various stages of adhesive application and clinically feasible remedies to decontaminate

Clinical Oral Investigations - To analyse the bond quality in dentine post-ageing after salivary contamination and decontamination at different stages of dental adhesive application. A total of...     

Programmed death-1 expression in liver transplant recipients as a prognostic indicator of cytomegalovirus disease

Immunological parameters that distinguish solid-organ transplant (SOT) recipients at risk for life-threatening cytomegalovirus (CMV) disease are being actively pursued to aid posttransplant management. A candidate marker is programmed death (PD)-1 receptor, whose overexpression has been associated with disease progression during persistent viral infections. To determine whether levels of this negative regulator of T cell activity are altered in SOT recipients with symptoms of CMV disease, a comparative PD-1 expression analysis was done in healthy, CMV-positive individuals and in liver transplant recipients. PD-1 levels were measured among the total population of CD8(+) and CD8(+) T cells binding to CMV-specific major histocompatibility complex class I tetramers. Minimal PD-1 expression was found in the healthy, CMV-positive cohort, and symptomatic SOT recipients had significantly higher PD-1 levels. PD-1 up-regulation was significantly associated with incipient and overt CMV disease and with viremia. Our findings suggest that PD-1 could be developed as a prognostic tool to predict CMV disease and guide therapeutic interventions.     

HIV/AIDS and lipodystrophy: Implications for clinical management in resource-limited settings

Introduction

Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings.

Methods

We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n=799), 90 studies were included in this review.

Results and Discussion

Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden.

Conclusions

Lipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.     

Botulinum Toxin in the Treatment of Muscle Specific Oro-Facial Pain: A Literature Review

Facial pain associated with temporomandibular joint (TMJ) and surrounding structures has been a challenge to clinicians as far as diagnosis and management is concerned. Complexity of anatomical structures within a small area, function of teeth and surrounding periodontal ligament, action of muscles, pathologies, lack of diagnostic investigations, all these complicate specific diagnosis of TMJ disorders. Various classifications have been designed and studied to help diagnose and treat TMJ related disorders, of which the simplest one is pain from TMJ proper and surrounding muscles. Many treatment modalities to treat pain arising from muscles around TMJ like splints, mouth restriction exercises, injection of sclerosing agents etc. have been used with various degrees of success. Botulinum toxin has been shown to be effective in the treatment of oro-facial pain due to muscular disorders and the same is discussed in detail in this review literature.