Heart failure and Dementia: Cardiogenic dementia

Dementia and heart failure both represent growing social, healthcare and economic problems. The most common form of dementia is Alzheimer′s disease, and the major risk factor for its development is increasing age. Other known risk factors include family history, hypertension and hypotension, high cholesterol levels, low levels of physical activity and of education, obesity, genetics and recently heart failure. Decreased cerebral blood flow and neurohormonal activation due to heart failure may contribute to the dysfunction of the neurovascular unit and cause an energy crisis in neurons. The impaired clearance of amyloid beta and hyperphosphorylation of tau protein, results in the formation of amyloid beta plaques and neurofibrillary tangles. An interdisciplinary approach towards elderly patients is needed. Better understanding of such newly understood relationships may result in benefit for elderly patients from appropriate evidence-based treatment. Neuro-cardiology field helps integrates medical knowledge of interactions between chronic degenerative and cardiovascular diseases and applies this knowledge in clinical practice. 

Background: The most important assessment in the neurological examination is to assess the level of consciousness (LOC), which is considered as the first step in neurological examination. Detecting the changes in level of consciousness depends on the accuracy of nursing assessment. The nurses should be knowledgeable, confident, and quick in performing this task.

Purpose: of this study is to assess UAE nurses' knowledge about GCS working in Al Dhafer Hospitals, Abu Dhabi, United Arab Emirates.

Methodology:  This study was carried out in the Dhafra hospitals, Abu Dhabi, United Arab Emirates in April 2018. It is a cross-sectional, descriptive study. Eighty-five nurses met the inclusion criteria, the survey was sent to 165 nurses (Respondent rate 51%). Data collection was carried out using a survey monkey instru­ment called “Glasgow Coma Scale”. Data coding, entry and analysis has been conducted using SPSS 20 software. The difference has been tested at 95% level of significance, and the difference that has P-value < 0.05 was considered significant.

Results: The study revealed that the knowledge percentages mean of correct answers about GCS is 56.1 % {SD: ±11.7; 95% CI: [26.67-100]}. On the other hand, it revealed also that the percentages of nurses who have a good knowledge about GCS was 50.6% and staff whom have poor knowledge were 49.4 %. Moreover, the results revealed significant relation between gender and GCS training with level of GCS knowledge.

Conclusion and recommendations:  The present study showed that the nurses in Al-Dhafra hospitals reflect inadequate knowledge. This finding raises concerns about the importance of knowledge and skill in assessing GCS. Continuing education and practice on the use of the GCS tool are important. A Brochure and booklet should be designated and distributed to all nurses who working in critical care units and dealing with an unconscious patient. Specific and advanced courses about GCS should be conducted in Al-Dhafra hospitals.

First-trimester placenta accreta (PA) is a rare event associated with serious morbidity and mortality due to serious obestetric hemorrhage that is usually necessitating a hysterectomy. There are very few reported cases worldwide. Here we report a case of Cesarean section scar pregnancy with placenta accreta at 10 weeks’ Diagnosed by ultrasound with all criteria of accreation, termination of pregnancy done with preservation of the uterus through the conservative surgical technique of postpartum hemorrhage. The detailed surgical technique is detailed and discussed. Furthermore, we reviewed medical literatures over the past 20 years for case reports of first trimester PA diagnosed after the occurrence of severe bleeding during abortive curettage or in the post-abortive period.

Brain Hemorrhage is an interruption of blood supply to a part of the brain typically by a thrombus or embolus occlusion. It is characterized by oxidative stress, excitotoxicity, neurotransmitter deficits, mitochondrial energy failure and neuronal cell death that lead to behavioral and motor dysfunctions. After cerebral hemorrhage or post-hemorrhagic surgeries, most of the patients suffering from impairment in memory, grip strength, posture and cognitive dysfunction. Mitochondrial complexes enzyme dysfunction increases neuroinflammatory cytokines which may be key pathological hallmarks of cerebral hemorrhage. As a part of the mitochondrial respiratory chain, Coenzyme Q10 can effectively remove free radicals and can prevent damage to biological membranes of neurons. Solanesol is long- chain terpenoid alcohol and is the starting material for many high-value bio-chemicals, including Coenzyme Q9 (CoQ9), Coenzyme Q10 (CoQ10) and vitamin K analogues. Moreover, it prevents the opening of mitochondrial membrane transition pore, thereby counteracting cell death events such as ATP depletion, release of cytochrome c into the cytosol, DNA fragmentation etc. It also exerts an anti-inflammatory effect by influencing the expression of NFkB1 dependent genes thus preventing the neuroinflammation. Therefore, in current investigation, first time we explore the neuroprotective strategies of coenzyme-Q10 precursor Solanesol in combined model of intracerebral and intraventricular hemorrhage using autologous blood-injection in rat brain.

Keywords: Ophthalmo-acromelic syndrome, spina bifida, hydrocephalus, Gaza Strip

NAFLD is characterized by excessive hepatic fat accumulation. NAFLD includes two pathologically distinct conditions: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). The definition of nonalcoholic fatty liver disease (NAFLD) requires that there is evidence of hepatic steatosis and that there are no causes for secondary hepatic fat accumulation.

The prevalence of NAFLD varies by sensitivity of the diagnostics methods used and characteristics of population such as age, sex distribution, duration of diabetes, family history of T2D, BMI and degree of glycaemic control. NAFLD in T1D is characterized by an altered portosystemic gradient of insulin and lower degree of insulin resistance than T1D.

Although the majority of patients with NAFLD are asymptomatic, some may present with nonspecific symptoms. NAFLD remains a diagnosis of exclusion. Liver enzymes may not be elevated in all cases of NAFLD, and the level of aminotransferases does not reliably predict the extent of inflammation and cirrhosis. Hepatic MRI can give insight into the extent of liver involvement in NAFLD. Scores developed to predict steatosis are not accurate enough. Staging of hepatic fibrosis is the strongest predictor of disease-specific mortality. NAFLD has been associated with an increased prevalence of both micro- and macrovascular complications in patients with T1D.

The most commonly accepted goal of treatment is regression of NAFLD, defined as a decrease in steatosis, inflammation, and/or fibrosis. A second accepted goal is resolution of NASH. Medical nutrition therapy lifestyle modification is a safe and effective means of treating and preventing NAFLD. Pharmacological treatment may be required. No currently available medications have been proven to benefit the majority of children with NAFLD. A variety of new drugs are likely to emerge, permitting a more stage-based approach to NAFLD management.

Patients with simple fatty change had no increase in mortality, whereas patients with NASH had reduced survival and more cases died from cardiovascular disease than liver-related disease.

Background:

The STI prevalence is estimated to be 6% in India and a total of 30 million people may be affected out of 340 million world over. The emergence of HIV and identification of STIs as a cofactor have further lent a sense of urgency for formulating a programmatic response to address this important public health problem.

The present study was carried out to assess the Impact of health education intervention on hiv/aids high risk groups.

Methods:

Field visits in ten districts of state of Uttar Pradesh in Northern India were made in 2013 and 2014. Interactive health education sessions were held with the high risk groups (Female sex workers and Intra venous drug users) to know their knowledge about HIV/AIDS and practice of using condoms during sex by the female sex workers. Total of 100 high risk group persons (50 FSW and 50 I.V.D.U.) were included in the study.

Results:

During visit undertaken in 2013, correct knowledge of HIV/AIDS transmission was found in 60.2% of FSW and 25.0% in I.V. Drug users. 56.3% of FSW used condoms during sex with the partners. None of the subjects in both the category knew their HIV status as they did not undergo any test for HIV/AIDS. Correct health education was given to the high risk participants. In 2014, there was marked improvement in their knowledge regarding HIV/ AIDS. Correct knowledge of HIV/AIDS transmission was found in 78.3% of FSW and 44.0% in I.V. Drug users. 76.4% of FSW used condoms during sex with the partners. 13 subjects knew their HIV status.

Conclusions:

HIV remains a social and life-threatening disease, and needs socio-cultural, pragmatic, and inclusive prevention messages – as well as programs which address behavioral, cultural, and institutional barriers to sexual health information and services. Stigma against HIV/AIDS should be removed through counselling and Information, education and Communication (IEC) activities. 

Keywords: High risk group, female sex workers, I.V.drug users