• Seerup George posted an update 6 months, 2 weeks ago

    In Thailand, almost one-quarter of strokes are related to atrial fibrillation (AF), and many could be prevented if AF were diagnosed and treated prior to the stroke. Therefore, we tested a novel strategy to screen large numbers of community residents using village health volunteers and primary care nurses.

    Local primary care nurses and village health volunteers in Phetchaburi and Lopburi provinces, Thailand were trained to perform AF screening using a blood pressure device with AF algorithm (Microlife A200 AFib). 10% of residents aged≥65years were randomly selected for screening during home-visits. Participants with possible AF were given follow-up appointments for further testing, including 12-lead ECG and echocardiogram.

    Over two-months, 9.7% (13,864/143,478) of the target population were screened mean age 73.2±6.4years, 32.4% male. The estimated AF prevalence (detected by Microlife A200 AFib) was 2.8% (95% CI, 2.6-3.1%) for age≥65years (i.e. 393/13,864 participants). Prevalence increased with age from 1.9% (65-69years) to 5.0% (≥85years) (p<0.001). Only 58% (226/393) of participants with suspected AF attended the follow-up appointment (1-3months after initial screen) mean CHA2DS2-VASc score 3.2±1.2; 86.3% (195/226) had Class-1 oral anticoagulation recommendation, and 33% (75/226) had AF on 12-lead ECG.

    In Thailand, large-scale AF screening in the community is feasible using trained volunteer health workers, allowing screening of large numbers in a short time-period. Further investigation of this strategy is warranted, ensuring mechanisms to obtain a timely rhythm strip or 12-lead ECG locally, and a designated pathway to treatment.

    In Thailand, large-scale AF screening in the community is feasible using trained volunteer health workers, allowing screening of large numbers in a short time-period. Further investigation of this strategy is warranted, ensuring mechanisms to obtain a timely rhythm strip or 12-lead ECG locally, and a designated pathway to treatment.The COVID-19 pandemic has caused tremendous suffering for patients with dementia and their caregivers. We conducted a survey to study the impact of the pandemic on patients with mild frontotemporal dementia (FTD). Our preliminary findings demonstrate that patients with FTD have significant worsening in behavior and social cognition, as well as suffer greater negative consequences from disruption to health-care services compared to patients with AD. The reduced ability to cope with sudden changes to social environments places patients with FTD at increased vulnerability to COVID-19 infection as well as to poorer clinical and social outcomes. Caregivers of FTD patients also demonstrate high burden during crisis situations. A proportion of patients with FTD benefitted from use of web-based interactive platforms. In this article, we outline the priority areas for research as well as a roadmap for future collaborative research to ensure greatest benefit for patients with FTD and their caregivers.

    Adults with Down syndrome (DS) are predisposed to Alzheimer’s disease (AD) and the relationship between cognition and glucose metabolism in this population has yet to be evaluated.

    Adults with DS (N=90; mean age =38.0 years) underwent Pittsburgh compound B (PiB) and fluorodeoxyglucose (FDG) positron emission tomography scans. Associations among amyloid beta (Aβ), FDG, and measures of cognition were explored. Interregional FDG metabolic connectivity was assessed to compare cognitively stable DS and mild cognitive impairment/AD (MCI-DS/AD).

    Negative associations between Aβ and FDG were evident in regions affected in sporadic AD. A positive association was observed in the putamen, which is the brain region showing the earliest increases in Aβ deposition. Both Aβ and FDG were associated with measures of cognition, and metabolic connectivity distinguished cases of MCI-DS/AD from cognitively stable DS.

    Associations among Aβ, FDG, and cognition reveal that neurodegeneration in DS resembles sporadic AD with the exception of the putamen, highlighting the usefulness of FDG in monitoring neurodegeneration in DS.

    Associations among Aβ, FDG, and cognition reveal that neurodegeneration in DS resembles sporadic AD with the exception of the putamen, highlighting the usefulness of FDG in monitoring neurodegeneration in DS.The freshwater snail Indoplanorbis exustus play an important role as the sole intermediate host of several medically- and economically-important trematodes, especially zoonotic schistosomes and echinostomes, which can infect and cause diseases in livestock and people. This study aims to explore the mitochondrial cytochrome c oxidase subunit 1 sequence variation of I. selleck exustus collected from new geographical areas; 459 specimens of I. exustus were collected from 43 localities in South and Southeast Asia. The 42 haplotypes (Ie1 – Ie42) we detected were classified into haplogroups I – V. Phylogenetic analyses revealed five major clades, A – E, in concordance with all previous studies. Clade E contained two subclades, E1 (haplogroup I) and E2 (haplogroup II). The most widespread genetic group was subclade E1. Clade A, clade B (haplogroup V), and clade C (haplogroup IV) were found only in South Asia, whereas clade D (haplogroup III) was specifically found in Southeast Asia. In Thailand, I. exustus showed high genetic divergence with 21 haplotypes. Several isolates showed significant genetic differences from others with unique haplotype(s). Hence, we confidently conclude our findings support all previous studies that I. exustus is a species complex with at least four major lineages and five haplogroups. Our additional analyses of 35 samples from Sri Lanka showed these were indeed an independent genetic group as previously found, but they can now be classified as a unique group forming subclade E2 (haplogroup II) of I. exustus sensu lato.Bone biopsies whether Computed Tomography guided or open, are one of the commonest procedures undertaken. Our literature review proves that bone biopsy needle fracture in a bone is a rare complication with no literature available on a needle fracture in a joint. We report a 7-year-old male who underwent an open needle biopsy. During the procedure, the bone biopsy needle fractured with the distal 2.7 cm fragment being completely embedded in the right sacroiliac joint. Considering the location of the fragment, the standard techniques described in literature for extraction could not be applied due to intra-articular nature of the fragment and the risk of complications. We describe a method using a 2.5 mm drill bit to safely extract the foreign body. We have found that reasonable erosion of adjacent cortex, exposes the needle tip, prevents the needle from shattering and avoids further articular damage. There was an uneventful 15 months follow up. This case highlights the fact that bone biopsy procedure mandates correct technique and supervision and as far as possible a disposable pre-sterilized bone biopsy needle should be used.

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