Identification of Resting and Active State EEG Features of Alzheimer’s Disease using Discrete Wavelet Transform

Alzheimer’s disease (AD) is associated with deficits in a number of cognitive processes and executive functions. Moreover, abnormalities in the electroencephalogram (EEG) power spectrum develop with the progression of AD. These features have been traditionally characterized with montage recordings and conventional spectral analysis during resting eyes-closed and resting eyes-open (EO) conditions. In this study, we introduce a single lead dry electrode EEG device which was employed on AD and control subjects during resting and activated battery of cognitive and sensory tasks such as Paced Auditory Serial Addition Test (PASAT) and auditory stimulations. EEG signals were recorded over the left prefrontal cortex (Fp1) from each subject. EEG signals were decomposed into sub-bands approximately corresponding to the major brain frequency bands using several different discrete wavelet transforms and developed statistical features for each band. Decision tree algorithms along with univariate and multivariate statistical analysis were used to identify the most predictive features across resting and active states, separately and collectively. During resting state recordings, we found that the AD patients exhibited elevated D₄ (~4–8 Hz) mean power in EO state as their most distinctive feature. During the active states, however, the majority of AD patients exhibited larger minimum D₃ (~8–12 Hz) values during auditory stimulation (18 Hz) combined with increased kurtosis of D₅ (~2–4 Hz) during PASAT with 2 s interval. When analyzed using EEG recording data across all tasks, the most predictive AD patient features were a combination of the first two feature sets. However, the dominant discriminating feature for the majority of AD patients were still the same features as the active state analysis. The results from this small sample size pilot study indicate that although EEG recordings during resting conditions are able to differentiate AD from control subjects, EEG activity recorded during active engagement in cognitive and auditory tasks provide important distinct features, some of which may be among the most predictive discriminating features.     

Liposuction for highly active antiretroviral therapy (HAART)-associated lipohypertrophy

The aim is to explore satisfaction levels in HIV patients following liposuction for HAART-associated lipodystrophy. Ninety postal questionnaires were sent out, enquiring about regions affected and scoring the improvement in lifestyle, discomfort and time of recurrence. We received 66 replies (73%). All areas showed significant patient satisfaction and improvement of lifestyle as well as decrease in the discomfort previously experienced. The area with the marginally lower score was the abdomen while the interscapular and occipital area that comprised the majority of patients with the same complaint was found to have high scores of satisfaction from the patients treated. Liposuction is beneficial in managing antiretroviral-associated lipohypertrophy. Patients should be warned of variable recurrence rates and satisfaction outcomes for each anatomical region addressed.     

Familial dysbetalipoproteinaemia presenting with cauliflower xanthoma

Familial dysbetalipoproteinaemia (FDL) is an inherited disorder in which both cholesterol and triglycerides are elevated in the plasma, pre-disposing the people to coronary artery disease and peripheral vascular disease. The disease is mostly manifested by xanthomas, which have variable forms according to lipid amounts in the plasma of the blood. Hereby, we report a 43-year-old man with FDL, presenting with a rare form of xanthomas calling “Cauliflower xanthoma” all over the body.     

Impact of Premorbid Malnutrition and Dysphagia on Ischemic Stroke Outcome in Elderly Patients: A Community-Based Study

Objective: The present study was performed to assess nutritional status and its relationship with clinical outcomes in elderly stroke patients.

Method: In this cross-sectional study, 253 stroke patients were studied. Mini Nutritional Assessment (MNA) was used to assign patients to three groups: malnourished, at risk of malnutrition, and well nourished. Northwestern Dysphagia Patient Check Sheet was administered to all patients. Anthropometric measures, including body mass index (BMI), calf circumferences (CC), mid-arm circumferences (MAC), and triceps skinfold thickness were brought out. In addition, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and biochemical tests were performed.

Results: Of 253 patients, 34.4% were malnourished, 42.3% were at risk of malnutrition, and 23.3% were well nourished. The malnourished patients had significantly lower BMI, CC, and MAC (p?<?0.05). The levels of albumin and high-sensitivity C-reactive protein were significantly different among the groups (p?<?0.001). The admission and 3-month follow-up mRS scores, as well as dysphagia, were significantly higher in the malnourished patients and those at risk of malnutrition (p?<?0.001). In addition, mRS scores at admission and 3-month follow-up scores, as well as the length of hospital stay (LOS), were significantly correlated with MNA score, dysphagia, BMI, CC, MAC, albumin, and high-sensitivity C-reactive protein (p?<?0.05). Significant unadjusted associations were observed among MNA scores, BMI, CC, MAC, dysphagia scores, NIHSS scores, length of hospital stay (LOS), albumin, hs-C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR) with a poor outcome. With a multivariate logistic regression analysis, NIHSS scores and MNA scores remained significantly associated with the poor outcome in patients with ischemic stroke.

Conclusions: The findings of the present study underline the importance of nutritional status in elderly stroke patients.     

Protective effect of raisin (currant) against spatial memory impairment and oxidative stress in Alzheimer disease model

Objectives: Alzheimer’s disease (AD) is a neurodegenerative disorder characterized by progressive pathological changes of the brain. A number of studies demonstrated compelling evidence of the importance of oxidative processes in AD pathogenesis. Raisin contains polyphenol, phenolic acid, and tannin compounds, which have antioxidant and anti-inflammatory properties. The present study was aimed to evaluate the protective effect of raisin on neurobehavioral and histological changes in rats with Alzheimer.

Methods: Animal model of AD was induced by intraperitoneal injection of aluminium chloride for 60 days (100?mg/kg body weight). During these 60 days both Alzheimer’s and control rats were given 6?g of raisin per rat. At the end of the treatment, blood was collected for biochemical assessment. We used a Morris water task and passive avoidance test to assess spatial memory.

Results: Our results showed that aluminium exposure significantly decreased the memory in the MWT and passive avoidance test, but in the raisin?+?AlCl₃ group, it significantly increased spatial memory in both tests. Also, Aluminium exposure significantly increased malondialdehyde (MDA) and decreased ferric reducing ability of plasma (ferric reducing/antioxidant power (FRAP)), while treatment with raisin significantly decreased MDA and increased FRAP in plasma of blood.

Discussion: Our findings showed that raisin has a neuroprotective effect and improves the spatial memory in AD animal models.     

Neuroprotective effects of the 17β-estradiol against ethanol-induced neurotoxicity and oxidative stress in the developing male rat cerebellum: biochemical, histological and behavioral changes

During particular periods of central nervous system (CNS) development, exposure to ethanol can decrease regional brain growth and can result in selective loss of neurons. Unfortunately, there are few effective means of attenuating damage in the immature brain. In this study, the possible antioxidant and neuroprotective properties of 17β-estradiol against ethanol-induced neurotoxicity was investigated. 17β-estradiol (600 μg/kg) was injected subcutaneously in postnatal day (PD) 4 and 5, 30 min prior to intraperitoneal injection of ethanol (6 g/kg) in rat pups. Ninety minutes after injection of ethanol, the activities of several antioxidant enzymes including superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (Gpx) in vermis of cerebellum were assayed. Thiobarbituric acid reactive substance (TBARS) levels were also measured as a marker of lipid peroxidation. Behavioral studies, including rotarod and locomotor activity tests were performed in PD 21-23 and histological study was performed after completion of behavioral measurements in postnatal day 23. The results of the present work demonstrated that ethanol could induce lipid peroxidation, increase TBARS levels and decrease glutathione peroxidase levels in pup cerebellum. We also observed that ethanol impaired performance on the rotarod and locomotor activities of rat pups. However, treatment with 17β-estradiol significantly attenuated motoric impairment, the lipid peroxidation process and restored the levels of antioxidants. Histological analysis also indicated that ethanol could decrease vermis Purkinje cell count and 17β-estradiol prevented this toxic effect. These results suggest that ethanol may induce lipid peroxidation in the rat pups cerebellum while treatment with 17β-estradiol improves motor deficits by protecting the cerebellum against ethanol toxicity.     

Short-term results of retrograde pulmonary embolectomy in massive and submassive pulmonary embolism: a single-center study of 30 patients

Objective: Surgical pulmonary embolectomy is usually reserved for critically ill patients with pulmonary embolism. The conventional antegrade technique of embolectomy may miss peripheral clots, rendering the patient amenable to developing pulmonary hypertension. Here, we present our experience with a new retrograde pulmonary embolectomy supplementing the current antegrade technique. Methods: From January 2004 through December 2010, 30 consecutive patients underwent pulmonary embolectomy in our center. The study included 15 men and 15 women whose age ranged from 28 to 80 years, with mean age of 58 ± 15 years. All the patients except one were taken to the operating room with at least one imaging modality confirming the presence of a large thrombus in pulmonary-arterial vasculature. Results: The most common presenting symptoms of patients was dyspnea (n = 27, 90%). The major indications for surgery were severe hemodynamic or respiratory compromise (n = 11, 36%). After performing antegrade embolectomy, retrograde flushing of the pulmonary veins was done. The in-hospital mortality in our study was 6.6% (2/30). Mean intubation time for the patients was 52.7 ± 36.5 h, with a range of 12–120 h. Mean intensive care unit (ICU) admission for the patients was 7 days with a range of 2–60 days. Conclusions: As far as we know, this is the largest series of cases published so far regarding the immediate results of retrograde pulmonary embolectomy. This technique can successfully dislodge the remaining clots in distal pulmonary vasculature not directly visualized. Surgical pulmonary embolectomy is a safe method and should not be used as a last resort for patients with pulmonary embolism.