Dysfunction In Adult Patients Research Articles

Postoperative executive function in adult moyamoya disease: a preliminary study of its functional anatomy and behavioral correlates.

OBJECTIVE Chronic frontal hemodynamic disturbances are associated with executive dysfunction in adult patients with moyamoya disease (MMD). However, the impact of surgical revascularization on executive dysfunction and its underlying mechanism remains unclear. The aim of the present study was to examine the postoperative radiological correlates of cognitive improvement and thereby explore its underlying mechanism. METHODS Fourteen patients who met the inclusion criteria were identified at Huashan Hospital, were operated on, and were successfully followed up for 6 months. Postoperative changes in cortical perfusion and regional amplitude of low-frequency fluctuations (ALFF) were examined by SPECT and resting-state functional MRI, respectively. Executive function was evaluated by 2 tests (Trail Making Test Part B and the summation of executive subtests of Memory and Executive Screening [MES-EX]). Follow-up neuropsychological outcomes were then correlated with radiological changes to identify nodes functioning as leading contributors to postoperative executive outcomes. RESULTS All patients underwent successful unilateral bypass procedures, with some operations performed on the left side and some on the right side. At the 6-month follow-up, the baseline and follow-up test scores for the different sides did not differ significantly. The group with good collaterals (Matsushima Grade A, 9 patients) exhibited significantly increased postoperative perfusion (change in [△] hemodynamics) in bilateral frontal (left, p = 0.009; right, p = 0.003) and left parietal lobe (p = 0.014). The Spearman's correlation test suggested that only the right frontal lobe exhibited significant positive postoperative radiological correlates with cognitive performance (△MES-EX vs △hemodynamics, r = 0.620, p = 0.018; △MES-EX vs △ALFF, r = 0.676, p = 0.008; △hemodynamics vs △ALFF, r = 0.547, p = 0.043). Subsequent regional ALFF analysis revealed that the right dorsolateral prefrontal cortex (DLPFC) was the only node in the responsible hemisphere to exhibit significant postoperative changes. CONCLUSIONS The results not only advance our understanding of pathological interactions of postoperative executive performance in adult MMD, but also indicate that the right DLPFC amplitude might be a quantitative predictor of postoperative executive control improvement.

A Study on Spectrum of Hepatobiliary Dysfunctions and Pattern of Liver Involvement in Dengue Infection.

The most common arthropod-borne viral (arboviral) disease in humans is dengue. It is transmitted by female Aedes mosquitoes. These mosquitoes are widely distributed in subtropical and tropical areas of the world. Study of dengue infection and its complications are rare from countries like India. In this prospective observational cross-sectional study, we intended to assess the frequency and degree of hepatobiliary dysfunction in adult patients with dengue infection presenting to a tertiary-care medical facility. The details of all patients with serologically proved dengue fever admitted to a tertiary care hospital in eastern India from July 2014 to June 2015 were prospectively reviewed. We collected data including routine blood count, Liver Function Test (LFT), Prothrombin Time (PT), Activated Partial Prothrombin Time (APTT), abdominal ultrasonography from 110 patients. The maximum number of cases were seen in the age group between 46 years and 61 years and of all cases 55.5% were male and 44.5% were female. Pain abdomen and vomiting were the commonest presenting complaints next to fever which was present in all the cases. Elevated liver enzymes, abnormal values of PT and APTT, thrombocytopenia were observed more commonly in Dengue Shock Syndrome (DSS). Gall bladder wall thickening, thrombocytopenia were seen more commonly in both DSS and Dengue Haemorrhagic Fever (DHF). Plasma leakage such as ascites and pleural effusion on USG were seen more frequently in patients with DHF (76.9% and 73.1%) followed by DSS (72% and 68%) and DF (33.9% and 32.2%). Hepatobiliary derangement is seen more commonly in severe case of dengue infection. Early recognition of these parameters can also be used as a predictor for assessing the disease severity.

Advanced Parameters of Cardiac Mechanics in Children with CKD: The 4C Study.

Newer parameters of cardiac mechanics provide additional insights on cardiac dysfunction in adult patients with CKD. The aim of this study was to identify prevalence of subclinical abnormalities in cardiac function through the analysis of novel indices of cardiac mechanics in a large population of children with CKD. Between 2009 and 2011, the prospective observational Cardiovascular Comorbidity in Children with CKD Study enrolled patients with CKD ages 6-17 years old with eGFR=10-45 ml/min per 1.73 m(2) in 14 European countries. Cardiac morphology and function were assessed through echocardiography. The analysis presented encompasses global radial, longitudinal, and circumferential strains as well as time to peak analysis. Data were compared with 61 healthy children with comparable age and sex. Data on 272 patients with CKD with complete echocardiographic assessment are reported (age =12.8±3.5 years old; 65% boys). Patients with CKD showed mildly higher office BP values and higher prevalence of left ventricular hypertrophy, but no differences were observed among groups in left ventricular ejection fraction. Strain analysis showed significantly lower global radial strain (29.6%±13.3% versus 35.5%±8.9%) and circumferential strain components (-21.8%±4.8% versus -28.2%±5.0%; both P<0.05) in patients with CKD without significant differences observed in longitudinal strain (-15.9%±3.4% versus -16.2%±3.7%). Lower values of global radial strain were associated with lower circumferential endocardial-to-epicardial gradient (r=0.51; P<0.01). This association remained significant after adjusting for BP, eGFR, and presence of left ventricular hypertrophy. Eventually, patients with CKD also showed higher delay in time to peak cardiac contraction (58±28 versus 37±18 milliseconds; P<0.05). A significant proportion of children with CKD show impaired systolic mechanics. Impaired systolic function is characterized by lower radial strain, transmural circumferential gradient, and mild cardiac dyssynchrony. This study suggests that analysis of cardiac strain is feasible in a large multicenter study in children with CKD and provides additional information on cardiac pathophysiology of this high-risk population.

High-resolution manometry combined with impedance measurements discriminates the cause of dysphagia in children.

Pressure-flow analysis enables differentiation of patients with dysphagia due to weak peristalsis (poor bolus clearance) from abnormal bolus flow resistance (esophageal outflow obstruction). This new dichotomous categorization of esophageal function may help guide the selection of optimal treatment such as pharmacological or endoscopic therapy. • Pressure-flow analysis (PFA) can detect abnormalities in esophageal motility using integrated analysis of bolus propulsion and bolus flow during swallowing. • AIM analysis has recently been reported to be useful in identifying subtle pre-operative esophageal dysfunction in adult patients who developed post-fundoplication dysphagia as well as in patients with non-obstructive dysphagia. • Pressure-flow parameters can distinguish the cause of dysphagia in paediatric patients. • Combined high-resolution manometry and impedance measurements with pressure-flow analysis can differentiate paediatric patients with dysphagia symptoms in relation to either weak peristalsis (poor bolus clearance) or over-pressurization (abnormal bolus flow resistance). HOW MIGHT IT IMPACT ON CLINICAL PRACTICE IN THE FUTURE? • This study supports the use of a novel objective analysis method on recordings that are readily used in paediatric clinical practice. • The pressure-flow approach allows discriminating esophageal dysfunction in relation to dysphagia symptoms in children. This has not been achieved in children with current analysis methods. • The new findings of this study allow a dichotomous categorization of esophageal function, which may help to guide the selection of the most optimal treatment such as pharmacological or endoscopic therapy.

Complications in Surgical Treatment of Cervical Spondylotic Myelopathy: What We Think We Know

Cervical spondyloticmyelopathy(CSM)isthe primarycause of spinal cord dysfunction in adult patients, and is due to a heterogeneous spectrum of etiologies, from degenerative disk disease to ossification of the posterior longitudinal ligament (OPLL). Due to the prevalence of CSM, surgical procedures addressing this pathology comprise a significant proportion of all spinal operations performed worldwide. Recent debate has centered around the superiority of anterior versus posterior approaches in the effectiveness of treating CSM and the risk of complications each confers. Controversy still exists as to the best procedure; however, the diversity of etiologies likely excludes a solitary optimal approach. The technical considerations, as well as the differential anatomy involved with each approach, contribute to potential complications. There is a wide variance in the literature regardingtheincidenceanddistributionofcomplicationsassociated

Pituitary dysfunction in adult patients after cranial irradiation for head and nasopharyngeal tumours

BackgroundPituitary insufficiency after radiotherapy in the hypothalamic pituitary region is a well-known complication. However, endocrine assessments are not incorporated in the follow-up after cranial irradiation for head and neck tumours. Aim of the studyTo evaluate pituitary function in patients cranially irradiated for non-pituitary tumours. Patients and methodsEvaluation of pituitary function in all available patients treated at our centre with cranial radiotherapy for head and neck tumours. ResultsWe included 80 patients. Forty patients were treated for cerebral tumours, 15 for nasopharyngeal tumours, and 25 for different tumours like meningioma or cerebral metastasis. Mean age was 47.5 (18.6–89.7)years. Mean radiation dose delivered at the pituitary region was 56.27Gy (40.0–70.0). Pituitary insufficiency was present in 16 patients within 2years after irradiation 23/49 patients (47%) after 5years and 27/45 (60%) after 10years and 31/35 patients (89%) after 15years. ConclusionPituitary insufficiency is highly prevalent in adult patients treated with cranial radiotherapy for head and nasopharyngeal tumours. These prevalence rates are comparable to those observed after radiotherapy for pituitary tumours. Because hormone replacement of endocrine deficits improves quality of life and prevents potential severe complications, such as Addisonian crises, periodical evaluation of pituitary function is advocated.

Endothelial function in contemporary patients with repaired coarctation of aorta

ObjectivePrevious studies have suggested endothelial dysfunction in adult patients after repair of aortic coarctation (CoA). It has been proposed to play a key role in the pathogenesis of arterial hypertension...

Cognitive Function of Patients with Adult Moyamoya Disease

Neurocognitive impairment is one of several unsolved social issues faced by patients with moyamoya disease. Although efforts have been made to investigate cognitive function using neuropsychologic tasks, generalizability has been limited. Here, in a preliminary study, we used structured neuropsychologic tasks to establish a standardized neuropsychologic assessment for adult moyamoya patients with and without difficulty in social independence. Ten patients with neuroradiologically confirmed adult moyamoya disease (3 male, 7 female) participated. Half of all subjects did not have difficulty with social independence (group 1) and the others had (group 2). Group differences were evaluated after basic cognitive abilities and frontal lobe function were tested. Although the mean age of group 1 was substantially higher than that of group 2, disease duration did not differ significantly between groups. Means scores for intelligence functions including all subtests for basic cognitive abilities were higher in group 1 compared with group 2. Scores from only 2 frontal lobe evaluation tasks (Trail Making Test B and Theory of Mind) were significantly different between groups. This preliminary study provides a profile of neurocognitive dysfunction in adult patients with moyamoya disease using structured neuropsychologic tasks. A broad range of cognitive functions was disrupted particularly in the patients who had difficulty with social independence. To obtain stronger evidence regarding neurocognitive dysfunction in patients with moyamoya disease, a multicenter prospective study is essential.

An efficacy and mechanism evaluation study of Levosimendan for the Prevention of Acute oRgan Dysfunction in Sepsis (LeoPARDS): protocol for a randomized controlled trial.

BackgroundOrgan dysfunction consequent to infection (‘severe sepsis’) is the leading cause of admission to an intensive care unit (ICU). In both animal models and early clinical studies the calcium channel sensitizer levosimendan has been demonstrated to have potentially beneficial effects on organ function. The aims of the Levosimendan for the Prevention of Acute oRgan Dysfunction in Sepsis (LeoPARDS) trial are to identify whether a 24-hour infusion of levosimendan will improve organ dysfunction in adults who have septic shock and to establish the safety profile of levosimendan in this group of patients.Methods/DesignThis is a multicenter, randomized, double-blind, parallel group, placebo-controlled trial. Adults fulfilling the criteria for systemic inflammatory response syndrome due to infection, and requiring vasopressor therapy, will be eligible for inclusion in the trial. Within 24 hours of meeting these inclusion criteria, patients will be randomized in a 1:1 ratio stratified by the ICU to receive either levosimendan (0.05 to 0.2 μg.kg-1.min-1 or placebo for 24 hours in addition to standard care. The primary outcome measure is the mean Sequential Organ Failure Assessment (SOFA) score while in the ICU. Secondary outcomes include: central venous oxygen saturations and cardiac output; incidence and severity of renal failure using the Acute Kidney Injury Network criteria; duration of renal replacement therapy; serum bilirubin; time to liberation from mechanical ventilation; 28-day, hospital, 3 and 6 month survival; ICU and hospital length-of-stay; and days free from catecholamine therapy. Blood and urine samples will be collected on the day of inclusion, at 24 hours, and on days 4 and 6 post-inclusion for investigation of the mechanisms by which levosimendan might improve organ function. Eighty patients will have additional blood samples taken to measure levels of levosimendan and its active metabolites OR-1896 and OR-1855. A total of 516 patients will be recruited from approximately 25 ICUs in the United Kingdom.DiscussionThis trial will test the efficacy of levosimendan to reduce acute organ dysfunction in adult patients who have septic shock and evaluate its biological mechanisms of action.Trial registrationCurrent controlled trials ISRCTN12776039 (19 September 2013)

DI-059 Use, effectiveness and safety of ivabradine in paediatric patients

BackgroundIvabradine is authorised for the treatment of coronary artery disease and chronic heart failure with systolic dysfunction in adult patients, but there is little information on its efficacy and safety...

Predictors of postoperative cognitive dysfunction in adult patients undergoing elective cardiac surgery.

Predictors of postoperative cognitive dysfunction in adult patients undergoing elective cardiac surgery.

P.2.c.002 The visuospatial and executive dysfunction in adult patients with bipolar I disorder type

To present real-world evidence on the differences between long-acting injectable (LAI) and oral antipsychotic maintenance treatment (AMT) in terms of subjective well-being, attitudes towards drug and quality of life in a sample of remitted schizophrenic subjects.Twenty outpatients with remitted schizophrenia treated with either olanzapine or paliperidone and switching from the oral to the LAI formulation of their maintenance treatment were recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral AMT and matching main sociodemographic, clinical and treatment variables made up the control group (oral-AMT group). All participants were assessed in terms of objective (PANSS, YMRS, MADRS) and subjective (SWN-K, DAI-10, SF-36) treatment outcomes at baseline (T0) and after 6 months (T1).Between T0 and T1, general psychopathology of the PANSS, DAI-10, and all but one of the SWN-K dimensions (except for social integration), showed significantly higher percentages of improvement in the LAI-AMT group compared to the oral-AMT group. A generalized expansion of health-related quality of life, with better functioning in almost all areas of daily living, was reported by the LAI-AMT group after the 6-month period. In contrast, the oral-AMT group reported a significant worsening of health-related quality of life in the areas of emotional role and social functioning in the same period.Our study indicates possible advantages of LAI over oral antipsychotic formulation in terms of subjective experience of maintenance treatment in remitted schizophrenic patients. Size and duration of this study need to be expanded in order to produce more solid and generalizable results.

Effectiveness of physical exercise to decrease sexual dysfunction in adults with cardiovascular disease: a systematic review protocol

Review question/objective This systematic review aims to identify, appraise and synthesize the best available evidence on the effectiveness of physical exercise interventions on sexual function in adult patients with cardiovascular disease and sexual dysfunction. More specifically, the review question is: What is the effectiveness of physical exercise intervention compared to usual care or a non-physical exercise intervention in reduction of sexual dysfunction in adult patients with cardiovascular disease and sexual dysfunction? Inclusion criteria Types of participants This review will consider studies that include male and female patients with cardiovascular disease over the age of 18 years, with sexual dysfunction measured by a validated and reliable instrument or by a decrease in the level of sexual activity. Types of intervention This review will consider studies that evaluate the effect of any physical exercise intervention. Physical interventions will include exercise training interventions such as, for example, aerobic exercise, bicycle exercise, running exercise or individually designed exercise interventions or a combination of these. Comparator It is anticipated that the effect of any physical exercise intervention will be compared with a control group that did not receive any physical exercise intervention, or received usual care. Types of outcomes The outcome measure will be change in sexual function measured by validated and reliable instruments such as self-reported questionnaires that cover male or female sexual dysfunction. Additionally, outcome measures such as percentage improvement in sexual activity measured as number of activities before and after the intervention will be considered.

Prediction of Anthracycline-Induced Left Ventricular Dysfunction by Cardiac Troponins

Evidence suggests prognostic utility of troponin (Tn) serum concentrations for a variety of conditions. We sought to determine whether elevated concentrations early after anthracycline chemotherapy predict the development of left ventricular systolic dysfunction in adult patients with cancer. PubMed/MEDLINE searches identified original reports that assessed cardiac TnI or TnT within 5 days of anthracycline chemotherapy and evaluated left ventricular systolic function after treatment for review. Ten reports qualified for review. Four studies indicated a significant relation between elevated Tn and subsequent left ventricular systolic dysfunction. One study that enrolled patients actively receiving anthracyclines and others who had previously received anthracyclines also demonstrated a significant relation. The remaining five reports identified no such relation. Heterogeneity in experimental methods, sampling times, and handling of confounders was significant between positive and negative studies. The present evidence is insufficient to suggest that Tns are reliable predictors of left ventricular dysfunction in patients with cancer. These data suggest, however, that larger prospective studies using frequent scheduled Tn measurement with adjustment for confounding factors could determine the predictive value of Tns in this setting.

The Involvement of the GH/IGF-I Axis in Cognitive Functions of Adult Patients and Healthy Subjects

The growth hormone/insulin-like growth factor I (GH/IGF-I) axis is an important regulator of brain function which view is based on the evidence that 1) GH and IGF-I can cross the blood brain barrier, 2) GH and IGF-I can bind to sites in various brain structures, including the hippocampus, 3) GH can alter the dopamine turnover in the hippocampus and IGF-I the acetylcholine release, and 4) GH and IGF-I can activate the NMDA receptor in the hippocampus. These mechanisms may underlie the relationship between the GH/IGF-I axis and cognitive functioning. A reduced activity of the GH/IGF-I axis seems associated with cognitive dysfunction in adult patients with GH deficiency (GHD), Prader-Willi syndrome, traumatic brain injury (TBI), dementia and also with age-associated cognitive decline in healthy elderly. Moreover, IGF-I deficiency may be involved in the aetiology of schizophrenia. Treatment with GH appears to have a beneficial effect on cognitive functions in patients with GHD, Prader-Willi and TBI. However, as evidence of GH replacement on cognition in distinct groups is limited and diet, exercise, and specific medicines have known effects on the GH/IGF-I axis, future studies on the relationship between GH-, diet-, exercise-, or medication-induced GH/IGF-I increase and cognition are required.

Sympathetic and vascular dysfunction in adult patients with Fontan circulation

BackgroundPatients with Fontan circulation are known to have increased systemic vascular resistance (SVR) however the underlying mechanisms are uncertain. We therefore further investigated the haemodynamic and vascular profile of Fontan patients. MethodsEighteen adult subjects aged 25±1years who had undergone the Fontan procedure in their childhood (at age 6±1years) and not in clinical failure at the time of study were assessed for: 1) autonomic function, including direct muscle sympathetic nerve activity (MSNA) recording and sympathetic and cardiac baroreflex function, 2) endothelial function by means of reactive hyperaemia using the Endopat peripheral arterial tonometry (PAT) technique and plasma endothelin concentration and gene expression, 3) pulse wave reflections (digital and central augmentation index (AI)) and 4) haemodynamic changes to head-up tilt. Data were compared to that obtained in a group of 23 age- and weight-matched healthy subjects. ResultsFontan participants presented with elevated MSNA compared with controls (40±5 vs 27±3 bursts per 100 heartbeats), decreased cardiac baroreflex function (16.0±3.3 versus 30.9±3.7ms·mm Hg−1), normal sympathetic baroreflex function, decreased endothelial function (PAT ratio=0.35±0.09 vs 0.77±0.11), and increased digital (5.9±3.0% vs −9.7±2.3%) and central (1.4±2.7% vs −10.2±3.9%) AI. Ten minute head-up tilt (60°) induced greater reductions in cardiac output (CO) and stroke volume (SV) in Fontan patients (CO: −28% vs −11%, SV: −40% vs −25%). ConclusionAdult Fontan patients have increased MSNA and altered endothelial function that are likely to contribute to their known increased SVR. Therapies aiming at reducing the peripheral resistances should target endothelial function and sympathetic activity.

Low yield of routine screening for thyroid dysfunction in asymptomatic patients with vitiligo

Nonsegmental vitiligo is considered to be an autoimmune disease and is known to be associated with other autoimmune diseases, particularly affecting the thyroid. Screening patients with nonsegmental vitiligo for thyroid function and for the presence of thyroid autoantibodies has been recommended. To investigate the prevalence of thyroid dysfunction and thyroid peroxidase-specific (TPO) antibodies in a large cohort of patients with nonsegmental vitiligo in order to help decide whether routine screening is justified. A total of 434 adults with nonsegmental vitiligo who were referred to our institute were enrolled. Thyroid function and anti-TPO antibody titres were assessed in those patients who had no history of thyroid disease or recent thyroid screening. Forty-three patients had already been diagnosed with thyroid dysfunction, and in 27 patients the general practitioner had performed a thyroid function test with negative results <3months previously. In these patients, thyroid function assessment was not repeated. The remaining 364 patients were screened for thyroid dysfunction. Overt hypothyroidism was newly diagnosed in three (0·8%) patients; subclinical disease was found in 10 (2·7%) patients and increased levels of TPO antibodies, without thyroid disease, were found in 49 (13·5%) patients. An elevated risk for thyroid disease was found among older women and in women with a positive family history of thyroid disease. The overall prevalence of thyroid dysfunction in adult patients with nonsegmental vitiligo was higher than reported in the general population. However, the number of newly diagnosed cases with overt and subclinical thyroid dysfunction in our population was low. Most patients had already been diagnosed by their general practitioner and had symptoms indicative for thyroid disease. Thyroid disease was found predominantly among older women and in subjects with a positive family history of thyroid disease. Thyroid screening including anti-TPO antibodies is advisable in these high-risk subpopulations.

The classical case of the treatment of an adult patient with the salt-losing form of congenital adrenal cortical dysfunction

This case report illustrates peculiarities of the clinical course of congenital adrenal cortical dysfunction in adult patients presenting with the salt-losing form of the disease. Analysis of this case confirmed the necessity of dynamic observation of adults with this pathology in order to avoid complications that are likely to develop in case of inadequate treatment.

Sympathetic, endothelial and arterial dysfunction in adult patients with Fontan circulation

Background: The Fontan procedure, although essential for the survival in patients with a single ventricle, is associated with a risk of suffering gradual decline in functionality with heart failure (HF) being the greatest cause of mid-onset morbidity amongst Fontan patients. The underlying mechanisms responsible for hemodynamic compromise and progression of HF in Fontan patients were investigated.

Pituitary Dysfunction in Adult Patients after Cranial Radiotherapy: Systematic Review and Meta-Analysis

Cranial radiotherapy is an important cause of hypopituitarism. The prevalence of hypopituitarism varies considerably between studies. We conducted a systematic review and meta-analysis of reported prevalences of hypopituitarism in adults radiated for nonpituitary tumors. We searched PubMed, EMBASE, Web of Science, and the Cochrane Library to identify potentially relevant studies. Studies were eligible for inclusion with the following criteria: 1) cranial radiotherapy for nonpituitary tumors and/or total body irradiation for hematological malignancies; 2) adult population (>18 yr old); and 3) report on endocrine evaluation. Data review was done by two independent reviewers. Besides extraction of baseline and treatment characteristics, also endocrine tests, definitions, and cutoff values used to define pituitary insufficiency were extracted. Eighteen studies with a total of 813 patients were included. These included 608 patients treated for nasopharyngeal cancer (75%) and 205 for intracerebral tumors. The total radiation dose ranged from 14 to 83 and 40 to 97 Gy for nasopharyngeal and intracerebral tumors, respectively. The point prevalence of any degree of hypopituitarism was 0.66 [95% confidence interval (CI), 0.55-0.76]. The prevalence of GH deficiency was 0.45 (95% CI, 0.33-0.57); of LH and FSH, 0.3 (95% CI, 0.23-0.37); of TSH, 0.25 (95% CI, 0.16-0.37); and of ACTH, 0.22 (95% CI, 0.15-0.3), respectively. The prevalence of hyperprolactinemia was 0.34 (95% CI, 0.15-0.6). There were no differences between the effects of radiotherapy for nasopharyngeal vs. for intracerebral tumors. Hypopituitarism is prevalent in adult patients after cranial radiotherapy for nonpituitary tumors. Therefore, all patients treated by cranial radiotherapy should have structured periodical assessment of pituitary functions.