Topical Cellular/Tissue and Molecular Aspects Regarding Nonpharmacological Interventions in Alzheimer's Disease-A Systematic Review

One of the most complex and challenging developments at the beginning of the third millennium is the alarming increase in demographic aging, mainly-but not exclusively-affecting developed countries. This reality results in one of the harsh medical, social, and economic consequences: the continuously increasing number of people with dementia, including Alzheimer's disease (AD), which accounts for up to 80% of all such types of pathology. Its large and progressive disabling potential, which eventually leads to death, therefore represents an important public health matter, especially because there is no known cure for this disease. Consequently, periodic reappraisals of different therapeutic possibilities are necessary. For this purpose, we conducted this systematic literature review investigating nonpharmacological interventions for AD, including their currently known cellular and molecular action bases. This endeavor was based on the PRISMA method, by which we selected 116 eligible articles published during the last year. Because of the unfortunate lack of effective treatments for AD, it is necessary to enhance efforts toward identifying and improving various therapeutic and rehabilitative approaches, as well as related prophylactic measures.

Relation of Polypharmacy to Systemic and Oral Health Related Factors

To assess polypharmacy (i.e., multiple medication use, as synthetic chemical products) and its relationship to general, systemic health and oral health factors in adults over 50 years old. A cross-sectional study was conducted on a convenience sample of adult patients recruited from two medical centers from Bucharest, i.e. from the Clinic of Dental Prosthetics, Carol Davila University of Medicine and Pharmacy, and from Saint Luca Hospital for Chronic Diseases. Study sample included 126 patients, that used a mean of 5.2 drugs. Almost half of patients (43.65%) used more than five prescribed medications. There was a tendency to use a greater number of medications in the case of patients that were hospitalized at Saint Luca Hospital, were less educated, had a lower income, had a greater number of comorbidities, had untreated edentulism in both jaws, were unfrequently wearing removable prosthesis and were using denture adhesives. Both positive and negative effects of polypharmacy should be considered in mutimorbidity patients when establishing prescription medications, along with general and oral factors that may influence treatment conduct and outcome.

Role of comorbidities in caring for chronicly ill elderly patients with and without dementia

Background and aim

The aim of this study is to highlight the presence of co-morbidities and their role in caring for chronicly ill patients with and without dementia.

Patients and methods

The study was performed on a group of 213 chronic patients. We used CIRS-G (Cumulative Illness Rating Scale in Geriatric Population) and IADL (Instrumental Activity Daily Living) scales. We compared the scores of severity and dependency.

Results

The most frequent co-morbidities in the study group were cardiac, vascular, locomotor, sensory organs and metabolic diseases. For the study group, the highest medium score of severity according to the CIRS-G scale was represented by cardiovascular diseases. For patients with dementia, psychiatric, cardiac, vascular, metabolic, genitourinary, sensory organs and locomotion domains had the highest score of severity and dependency.

Conclusions

The health status of chronic patients with and without dementia is characterized by multiple pathologies with various degrees of severity and dependency.

Devastating epileptic encephalopathy in school-aged children (DESC): A pseudo encephalitis

PURPOSE

To describe the characteristics of a previously overlooked devastating epileptic encephalopathy that presents as intractable bilateral perisylvian epilepsy starting with prolonged status epilepticus (SE) in normally developing school-aged children.

METHODS

Retrospective study over 7 years of all normally developing children admitted in our institution for a prolonged SE following non-specific febrile illness with at least one seizure recorded on EEG.

RESULTS

Fourteen children were included at a median age of 7.5 years (4-11) (median follow-up of 4 years (1-7)). Intractable SE lasted 4-60 days (median 30). CSF cell count was normal in five cases and moderately increased in the others. During SE, seizures were recorded in 11 patients and involved temporal lobes in 7; the other 4 patients exhibited perisylvian clinical features with secondary generalization. Intractable epilepsy followed SE in all cases without any latent period. Persisting seizures were recorded in 10 patients and involved temporo-perisylvian regions in 8, frontal regions in 2; 3 others had perisylvian ictal semiology. Spiking was bilateral in 10 cases. MRI showed bilateral hippocampal hypersignal and/or atrophy in 10 cases (extended to the neocortex in 3). All children had major cognitive sequelae. When feasible (six patients), detailed neuropsychology suggested fronto-temporal impairment.

CONCLUSIONS

Among so called grey matter encephalitis patients, we identified a recognizable pattern we propose to call Devastating Epileptic encephalopathy in School-age Children (DESC) that begins with prolonged SE triggered by fever of unknown cause, and persists as intractable perisylvian epilepsy with severe cognitive deterioration.

[Neonatal convulsions: the current concepts and classification]

The authors presented a new classification of the neonatal convulsions, based on prolonged EEG registrations related to concomitant clinical or videorecording of fits. They focussed on the atypical neonatal convulsions and on the differential diagnosis between epileptic and nonepileptic seizures. Finally, they discussed the therapeutical consequences of these new conceptions about the conclusions in the neonate.

[The diagnostic difficulties in a case of a hemorrhagic syndrome in an infant]

The authors present a case of cystic fibrosis in a 3 months old infant. Clinically, the first manifestation was a severe anemia secondary to iron deperdition through a hemorrhage due to an acquired trouble of thrombin formation. The late was explained by the vitamin K malabsorption and by the hepatocellular insufficiency.

[Progress in neonatal screening for genetic diseases of metabolism]

The main inborn errors of metabolism are described and the methods used for their screening. The recent technical progress in the screening tests are envisaged as well as the diagnosis and treatment aspects, insisting upon the fact that the neonatal screening undertaken in this areas are of vital importance, since the treatment of a number of specific inborn errors of metabolism constitutes a main trait of actual preventive pediatrics.

[Antiviral chemotherapy in pediatrics--its present and prospects]

Authors discuss the general aspects of viral infections and the principles of antiviral chemotherapy. First section deals with the stages, the types of viral infections and the basic principles for action of antiviral drugs. Authors review also the up-to-date situation of antiviral therapy in pediatrics, the problem of resistant strains and formulate the expected progress in the field of antiviral chemotherapy.