Acetylcholinesterase inhibitors and depressive symptoms in patients with mild to moderate Alzheimer's disease

BACKGROUND AND AIMS: Acetylcholinesterase inhibitor (AChEis) therapy in Alzheimer Disease (AD) has been shown to provide cognitive benefits and to slow progression of the disease. AChEis have also been demonstrated to improve behavioral symptoms, although there seem to be subtle differences in the magnitude of response. The aim of our study was to evaluate the effect of 16 weeks treatment with AChEis on depressive symptoms in a selected sample of AD patients in routine clinical practice. SUBJECTS AND METHODS: A study of 135 patients with Alzheimer's disease. All subjects were assessed at baseline (upon initiation of AChEis therapy) and re-evaluated after 16 weeks. RESULTS: At baseline, "Depressed" and "Not depressed" patients were categorized according to DSM IV criteria for depression in Alzheimer Disease. After 16 weeks of treatment with AchEis, we observed an improvement of mood in the "Depressed" patients. In this group "Mood symptoms", measured with GDS, were independently associated with GDS "Mood symptoms" at baseline, but not with improvement on cognition (mean change of MMSE), age or sex. CONCLUSIONS: In depressed AD subjects, AChEis treatment improves depressive symptoms evaluated by GDS. This improvement is independent of cognition enhancement.     

Radiofrequency modified maze procedure for chronic atrial fibrillation

Background We studied the effectiveness of Radiofrequency (RF) modified maze in early and late restoration of sinus rhythm in patients with rheumatic heart disease (RHD). Methods We studied 84 patients with RHD over 23.6±12.5 months after the RF modified maze and another group of 64 patients over six months after valvular surgery alone (the Non-Maze group). Any thromboembolic episodes and NYHA class of the patient were recorded. The short term survivors in sinus rhythm, underwent stress test and echocardiography for atrial transport function at 3–6 months after surgery. Results In the Maze group, sinus rhythm was restored in 60/70 patients (85.71%) immediately and sustained in 55/70 patients (78.57%) over the follow-up as against an immediate conversion rate of 5.3% (5/53 patients, p<0.001) in the Non-maze group. The additional Cardiopulmonary (CP) bypass time (p=0.13) and cross clamp time (p=0.511) needed for maze is not statistically significant. Left atrial (LA) transport function was preserved in 41/51 patients (80.4%) and Right atrial (RA) transport function in 51/51 patients (100%). Stress test showed good chronotropic response in all the 41 patients in whom it was performed. In the Maze group one patient presented with acute valve thrombosis and subsequently, succumbed to it. In the non maze group 3/55 patients (5.66%) were hospitalized for stroke. No patient needed permanent pacemaker nor was sinus node dysfunction seen. The immediate postoperative morbidity and mortality was comparable in the two groups. Conclusions The RF modified maze is safe, effective and brief without any additional risk. It restores sinus rhythm in the majority, however there is an attrition in some.     

Endoscopic double-blind controlled trial of ranitidine vs placebo in the short-term treatment of duodenal ulcer

The aim of the present study was to investigate the effectiveness of ranitidine in the treatment of duodenal ulcer. Fourty patients with endoscopically proven pyloric or duodenal ulcer were treated with ranitidine 40 mg t.d. with meals and 80 mg nocte, or identical placebo tablets under double-blind conditions. Endoscopy after four weeks of treatment revealed complete healing in 15 out of 18 (83.3%) ranitidine-treated patients and in 5 out of 17 (29.4%) of the placebo patients (P less than 0.01). Ulcer symptoms were significantly less in ranitidine-treated patients, while the difference in antacid consumption between the two groups was found to be only arithmetical. No side effects or significant hematological or biochemical abnormalities were found. Four-week treatment with 200 mg of ranitidine daily seems to correspond to that of 6-8 weeks with 1-1, 6 g of cimetidine.     

Is ethanol metabolism affected by oral administration of cimetidine and ranitidine at therapeutic doses?

The aim of this study was to compare the ethanol serum concentration curve, the area under the curve and subjective response after acute ingestion of ethanol (red wine, 13 degrees proof, at a dose of 0.8 g/kg of ideal weight in 6 healthy volunteers with a mean habitual alcohol intake of 20 g/day. All the subjects underwent the test a total of three times, after pre-treatment with cimetidine (400 mg X 2/day/7 days) and ranitidine (150 mg X 2/day/7 days), respectively, and after receiving no pre-treatment. The wine was taken orally within the space of 15 min, four hours after taking a standard-weight ham sandwich. Blood samples were drawn at the following times: 0, 30, 60, 90, 120, 180, 240 and 360 minutes. The plasma ethanol curve of the subjects pre-treated with cimetidine lies above that of the subjects pre-treated with ranitidine, and largely coincides with the curve obtained in those who received no pre-treatment, with the exception of the initial hour-and-a-half, when the later show a slightly higher mean plasma concentration. The differences between the three treatment groups are merely arithmetical, but not statistical, with respect to peak plasma ethanol concentrations, time elapsing before peaking, and areas under the curves. These results are at variance with some published data suggesting a significant interaction of cimetidine with the metabolism of alcohol by way of interference either with the hepatic oxidative metabolizing enzymes, or with the activity of alcohol dehydrogenase.     

Extensive Mongolian Spots with Autosomal Dominant Inheritance

Background

Mongolian spots are benign skin markings at birth which fade and disappear as the child grows. Often persistent extensive Mongolian spots are associated with inborn error of metabolism. We report thirteen people of the single family manifested with extensive Mongolian spots showing autosomal dominant inheritance.

Case Presentation

A one day old female child, product of second degree consanguineous marriage, born by normal vaginal delivery with history of meconium stained amniotic fluid and birth asphyxia. On examination the child showed extensive bluish discoloration of the body involving trunk and extremities in both anterior and posterior aspects associated with bluish discoloration of the tongue. A detailed family history revealed most of the family members manifested with extensive bluish discoloration of the body soon after birth which faded in the first few years of life and completely disappeared by puberty. Thus it was diagnosed to be extensive Mongolian spots with an autosomal dominant inheritance.

Conclusion

Knowledge about the natural history of extensive Mongolian spots, their inheritance and association with certain metabolic diseases mainly IEM and Mucopolysaccharidosis aids in the diagnosis and in order to improve the patient''s prognosis.