Vascular Accident Research Articles

AN OBSERVATIONAL CLINICAL STUDY TO EVALUATE SHIROROGA NIDANA IN CEREBROVASCULAR ACCIDENT

Shiroroga is a broad term encompassing various diseases of the head involving Rakta Dushti due to vitiated Doshas.[1] resulting in different neurovascular presentations, which is comparable with the vascular pathology of stroke. Cerebrovascular diseases include some of the most devastating disorders such as ischemic stroke and haemorrhagic stroke, which result in episodes of brain dysfunction.[2] Currently, the stroke incidents in India is much higher and prevention of stroke is the best option, through control and/or avoiding risk factors such as hypertension. Objectives: This calls for an evaluation of the possible Shiroroga Nidana in the development of Cerebro Vascular Accident (CVA) to identify more risk factors. Methods: In this cross-sectional observational study, 30 subjects diagnosed with the cerebrovascular accident were selected. The probable incidence of Nidana (causes), in patients, were assessed through a questionnaire developed for the study. The recorded data were analysed with descriptive statistics. Results: Nidana, like Vegadharana and Rodana causes Rakta Dushti along with Vata Prakopa. Aharaja Nidanas of Shiroroga are similar to that of Rakta Dushti Nidana and directly causes Dhatu Pradooshana in the body. Manasika Nidana or anxiety and emotional stress acts as Vyanjaka or PrerakaHetu in Samprapti of Shiroroga. Conclusion: Bahya Hetu (external factors) triggers Dosha Kopa or causes Dhatu Pradooshana. In CVA patients, Vata Pradhana Tridosha Kopa and Rakta were vitiated to initiate the disease manifestation. Keywords: Cerebrovascular Accident; Nidana; Shiras; Shiroroga; Stroke.

Assessment of complication rates based on time of feeding initiation in radiologically guided gastrostomy tubes: a retrospective study.

We aimed to assess the association between complication rate and time to feeding in a cohort of patients undergoing radiologically guided placement of gastrostomy tubes. A retrospective study was conducted of all patients receiving pull-type and push-type gastrostomy tubes placed by interventional radiologists between January 1st, 2017 and December 31st, 2018 at a single institution. Primary outcomes included procedural and tube-related complications per medical chart review with a follow-up interval of 30 days. Exclusion criteria were enteral nutrition delayed more than 48 hours, no feeding information, and tubes placed for venting (n=20). Overall, 303 gastrostomy tubes (pull-type, n=184; push-type, n=119) were included. The most common indications for placement included head and neck carcinoma for push-type tubes (n=76, 63.9%) and cerebral vascular accident for pull-type tubes (n=78, 42.4%). In a multiple regression analysis, there was no statistically significant association between complications and time to feeding (p = 0.096), age (p = 0.758), gender (p = 0.127), indication for tube placement (p = 0.206), or type of tube placed (p = 0.437). Average time to initiation of enteral nutrition was 12.3 hours for the pull-type and 21.7 hours for the push-type cohort (p < 0.001). Additional multiple regression analyses of pull-type tubes and push-type tubes separately also did not find any significant association between complications and the above factors (p > 0.05). There was no statistically significant correlation between time to feed and complications, suggesting that there is no clinical difference between early and late feeding following gastrostomy tube placement.

O profissional de educação física na reabilitação com pessoas pós acidente vascular cerebral / The physical education professional in rehabilitation with people after brain vascular accident

O respectivo estudo possui por intencionalidade oferecer significativas reflexões acerca do papel do Profissional de Educação Física no que se refere a reabilitar pessoas no Pós AVC (Acidente Vascular Cerebral). Assim, o objetivo geral desse trabalho culmina em compreender como os exercícios físicos podem melhorar e ajudar as pessoas que tiveram AVC. Partindo dessas considerações, esse estudo se justifica sob a intenção de fomentar a sociedade como um todo, demonstrando como pessoas que foram acometidas por AVC podem contar com o auxílio de um profissional de Educação Física, levando-se em consideração os conhecimentos técnicos que ele poderá propiciar para melhorar a qualidade de vida desses pacientes no Pós AVC. Assim, para auxiliar na metodologia desse trabalho, optou-se por uma pesquisa exploratório-bibliográfica, frente ao amparo das obras de autores que contribuíram para a sustentação desse estudo. Ao término desse estudo, pode-se concluir o quão o profissional de Educação Física, pode contribuir tanto para a reabilitação com pessoas pós-AVC, quanto melhorar sua qualidade de vida.

Hip fractures in elderly patients with non-dialysis dependent chronic kidney disease: Outcomes in a Southeast Asian population.

Chronic kidney disease (CKD) causes bone and mineral disorders and alterations in vitamin D metabolism that contribute to greater skeletal fragility. Hip fracture in elderly is associated with significant morbidity and mortality. The aim of this study was to investigate the outcome of elderly patients with non-dialysis dependent CKD and hip fracture undergoing surgery.Retrospective study with IRB approval of patients above 65 years of age, with hip fractures admitted between June 2014 to June 2016 in a Southeast Asian cohort. Data collected included demographic variables and the haematological and biochemical parameters HBA1c, estimated glomerular filtration rate (eGFR), serum calcium, phosphorous, and 25(OH) Vitamin D. Co-morbidities investigated were ischemic heart disease, congestive heart failure, peripheral vascular disease, malignancy, chronic obstructive pulmonary disease, cerebro vascular accident, hypertension and hyperlipidaemia. All patients were followed up from index date to either death or June 1, 2018.Of the 883 patients, 725 underwent surgery and 334 had CKD. Death rates for CKD patients with hip fractures and those with normal renal function did not differ significantly [8.08% vs 6.54%, (HR= 1.33, 95% CI: 0.95, 1.86; P = .102)], whilst median hospital length of stay was significantly higher in CKD patients [10.5 vs 9.03 days (P = .003)]. Significant risk factors associated with higher risk of mortality in the elderly with hip fracture were male gender, age ≥80 years and serum albumin < 30 g/L (all, P < .0001).In summary, in elderly, non-dialysis dependent CKD patient with hip fracture we found that male gender, age ≥80 years, low serum albumin and eGFR < 30 mL/min/1.73 m2 were associated with higher risk of death. The hospital stay in the CKD group was also longer. Additional studies are needed to validate our findings.

Hitting a Wall: An Ambiguous Case of Wallenberg Syndrome

Wallenberg syndrome is the most common stroke of the posterior circulation. Diagnosis of Wallenberg syndrome is often overlooked as initial MRI may show no visible lesion. We present an atypical case of Wallenberg syndrome in which the initial MRI of the brain was normal.Our patient is a 65-year-old male who was brought in by emergency medical services complaining of right-sided facial droop, slurred speech, and left-sided weakness for one day. Physical examination showed decreased left arm and leg strength compared to the right side, decreased left facial temperature sensations, decreased left arm and leg temperature sensations, and difficulty sitting upright with an associated leaning towards the left side. An initial magnetic resonance imaging (MRI) of the brain with and without contrast revealed no abnormality. In light of such a high suspicion for stroke based on the patient’s neurologic deficits, a repeat MRI of the brain was performed three days later and exposed a small focus of bright signal (hyperintensity) on T2-weighted fluid-attenuated inversion recovery and diffusion-weighted imaging (DWI) in the left posterior medulla.Wallenberg syndrome, also known as lateral medullary syndrome or posterior inferior cerebellar artery syndrome, is a constellation of symptoms caused by posterior vascular accidents. The neurological deficits associated with this disease are due to damage of the lateral medulla, inferior cerebellar peduncle, nucleus of trigeminal nerve, nucleus and fibers of vagus and glossopharyngeal nerves, descending sympathetic tract, spinothalamic tract, and/or vestibular nuclei. MRI with DWI is the gold standard to confirm the diagnosis.Wallenberg syndrome has the potential to leave patients extremely debilitated. Early detection, management, and rehabilitation are critical for improving post-stroke recovery.

Prevalence of Hospital Acquired Pneumonia in Intensive Care Units in Khartoum State (From April 2019 to September 2019)

Objectives: To determine the prevalence of nosocomial infections in intensive care unit (ICU), we performed a hospital-based study. Materials and Methods: Consecutive patients were enrolled and details of risk factors and bacteriological data were obtained. Statistical analyses were performed using spss version 24. Results: seventy six patients were admitted during the study period (minimum 10 years and maximum 91 years, men 69.7%, females 30.3%). Most important comorbidities were renal tubular acidosis (23.7%), cerebro vascular accidents (15.8%), and acute kidney injury (9.2%). Antibiotics were administered in 40.8%. Bacteriological cultures were positive in 42.1% (n=32). Gram negative bacteria were common–Klebsiella pneumoniae (27.6%), pseudomonas aerogenisa (7.95%), and Streptococcus pyogenes (2.6%) Escherichia coli (1.3%), Staphylococcus aurous (1.3%) and candida (1.3%). There a high prevalence of resistance to common antibiotics. Conclusions: There is high prevalence of infections in patients in a medical ICU in Khartoum – Sudan. Gram negative bacteria are the most prevalent and resistance to antibiotics is high. Risk factors are age and multiple comorbidities

Current data about localization of acute ischemic stroke and prognostic factors in diabetic and non-diabetic patients

Introduction. Ischemic stroke accounts for approximately 85% of all vascular accidents and has a high number of identified risk factors, including transient ischemic attack, smoking, metabolic syndrome, alcohol consumption, elevated cholesterol levels and artery stenosis carotid. Diabetes mellitus (DM) is a well-established risk factor for ischemic stroke. Material and method. This prospective longitudinal observational study highlights the importance of localization of ischemic stroke, including 340 patients with acute ischemic stroke with / without diabetes mellitus. The database was collected in a Microsoft Excel document. The correlation analysis was processed in the MedCalc 14.1 program where correlation tests included in the program were used. Results. The predominant localization of ischemic stroke in diabetic patients was the middle cerebral artery followed by the posterior cerebral artery and the double localization compared to the group witness where the same trend is maintained (p = 0.22). The correlation between the localization of the acute ischemic stroke with the age 64.5 for MCA, 64.6 for PCA, and 73.57 for DL (CI 95%, p= 0.02). The correlation of the NIHSS severity score with the location of ischemic strokes was also obtained: average NIHSS score 18.9 points for MCA, 18.5 for PCA, 24 for DL (CI 95, p &lt; 0.0001). The data obtained from the Kaplan-Meier analysis on the survival rate of the patients (divided by the vascular territory involved), provided an expected result difference (statistically significant, p &lt; 0.0001). Conclusions. There is no statistically significant difference between diabetic vs. non-diabetic patients regarding the localization correlated with DM, the double location being statistically insignificant between the two batches. The double location having a higher frequency in elderly patients.

A Comprehensive Review of Intestinal Atresias

A Comprehensive Review of Intestinal Atresias

Optimizing Checkpoint Blockade As a Treatment for Relapsed Hematologic Malignancies after Allogeneic Hematopoietic Cell Transplantation

Optimizing Checkpoint Blockade As a Treatment for Relapsed Hematologic Malignancies after Allogeneic Hematopoietic Cell Transplantation

Effectiveness of Dual Task Exercise on Selected Parameters among Patients with Cerebro Vascular Accident

Effectiveness of Dual Task Exercise on Selected Parameters among Patients with Cerebro Vascular Accident

Preoperative and Intraoperative Blood Pressure Variability Independently Correlate with Outcomes

BackgroundBlood pressure variability (BPV) describes visit-to-visit blood pressure (BP) changes independent of hypertension. Preoperative BPV and intraoperative BPV are associated with increased postoperative outcomes. We investigated the impact of both preoperative BPV and intraoperative BPV on elective surgical outcomes, specifically whether preoperative BPV and intraoperative BPV were independent risk factors for surgical complications. Materials and MethodsWe investigated 600 patients undergoing elective surgery lasting more than two h and who had ≥8 outpatient BP recordings over three preoperative years. Age, sex, ethnicity, BMI, current medical problems, and medications at time of surgery were recorded.BPV was calculated as the standard deviation (SD) of systolic or diastolic BP for the 369 valid patients. Average BPV were compared between adverse outcomes of readmission, wound infection, acute kidney injury, death, myocardial infarction, and cerebral vascular accident. ResultsThree-hundred-sixty-nine (52.6% male, 47.4% female, 98.1% non–Hispanic) patients (mean age 62.5) were included in the study. Preoperative systolic (P = 0.043) and diastolic (P = 0.009) BPV were higher for patients with the combined endpoint of all adverse events. Preoperative systolic BPV was correlated with intraoperative BPV (P = 0.010). Both systolic and diastolic preoperative BPV was found to be independent from intraoperative BPV. Otolaryngology procedures were associated with less adverse outcomes (P = 0.034), whil antimicrobials (P = 0.022), autonomic drugs (P < 0.001), or respiratory drugs (P = 0.032) was associated with an increased likelihood of adverse outcome. ConclusionPreoperative DBPV is associated with increased risk of readmission, wound infection and the combined endpoint of all adverse events. Intraoperative systolic blood pressure variability (SPBV) is associated with increased risk of acute kidney injury and the combined endpoint of all adverse events. Preoperative DBPV and intraoperative SBPV are independent risk factors for ninety-d postoperative outcomes. BPV should be considered in individualized risk assessment when assessing patient eligibility for elective procedures.

Multiple Small Bowel Atresia: Resection or Conservation?

Multiple small bowel atresia is a relatively uncommon cause of intestinal obstruction in neonates. About one-third of the neonatal intestinal obstruction is caused by intestinal atresia. As suggested by Louw and Barnard, the vascular accident in utero is the principal reason, resulting in bowel atresia.1 The condition presents soon after birth, with bilious vomiting and abdominal distension, requiring emergency surgical intervention. A subtype of small bowel atresia (type IV), which presents with involvement of multiple segments, is unique due to the difficulties in management, accompanied by a variety of postoperative morbidities, which are highlighted in this case. The choice lies between resection of all the atretic segments with resultant single anastomosis and conservation with anastomoses of multiple small bowel segments involving meticulous repair by fine sutures, taking care to maintain luminal patency. The dilemma of whether to conserve the atretic segments of bowel, which is a time consuming procedure but preserves the bowel length or to proceed with excision of the atretic bowel segments, accepting the likelihood of short bowel, in order to provide a quick, safe and stable single anastomosis in a timely manner, is a valid challenge. The background of limited resource setting also need to be taken into consideration. Key Words: Atresia, Neonates, Bowel segments, Anastomosis.

The impact of post-operative atrial fibrillation on outcomes in coronary artery bypass graft and combined procedures.

BACKGROUNDPost-operative atrial fibrillation (POAF) is a common yet understudied clinical issue after coronary artery bypass graft (CABG) leading to higher mortality rates and stroke. This systematic review and meta-analysis evaluated the rates of adverse outcomes between patients with and without POAF in patients treated with CABG or combined procedures.METHODSThe search period was from the beginning of PubMed and Embase to May 18th, 2020 with no language restrictions. The inclusion criteria were: (1) studies comparing new onset atrial fibrillation before or after revascularization vs. no new onset AF before or after revascularization. The outcomes assessed included all-cause mortality, cardiac death, cerebral vascular accident (CVA), myocardial infarction (MI), repeated revascularization, major adverse cardiac event (MACE), and major adverse cardiac and cerebrovascular events (MACCEs). RESULTSOf the 7,279 entries screened, 11 studies comprising of 57,384 patients were included. Compared to non-POAF, POAF was significantly associated with higher risk of all-cause mortality (Risk Ratio (RR) = 1.58; 95% Confidence Interval (CI): 1.42−1.76, P < 0.00001) with accompanying high level of heterogeneity ( I2 = 62%). ConclusionsPatients with POAF after CABG or combined procedures are at an increased risk of all-cause mortality or CVAs. Therefore, POAF after such procedures should be closely monitored and treated judiciously to minimize risk of further complications. While there are studies on POAF versus no POAF on outcomes, the heterogeneity suggests that further studies are needed.

The Costs and Cardiovascular Benefits in Patients With Peripheral Artery Disease From a Fourth-Generation Synchronous Telehealth Program: Retrospective Cohort Study

BackgroundPatients with peripheral artery disease (PAD) are at high risk for major cardiovascular events, including myocardial infarction, stroke, and hospitalization for heart failure. We have previously shown the clinical efficacy of a fourth-generation synchronous telehealth program for some patients, but the costs and cardiovascular benefits of the program for PAD patients remain unknown.ObjectiveThe telehealth program is now widely used by higher-risk cardiovascular patients to prevent further cardiovascular events. This study investigated whether patients with PAD would also have better cardiovascular outcomes after participating in the fourth-generation synchronous telehealth program.MethodsThis was a retrospective cohort study. We screened 5062 patients with cardiovascular diseases who were treated at National Taiwan University Hospital and then enrolled 391 patients with a diagnosis of PAD. Of these patients, 162 took part in the telehealth program, while 229 did not and thus served as control patients. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to mitigate possible selection bias. Follow-up outcomes included heart failure hospitalization, acute coronary syndrome, stroke, and all-cause readmission during the 1-year follow-up period and through the last follow-up.ResultsThe mean follow-up duration was 3.1 (SD 1.8) years for the patients who participated in the telehealth program and 3.2 (SD 1.8) for the control group. The telehealth program patients exhibited lower risk of ischemic stroke than did the control group in the first year after IPTW (0.9% vs 3.5%; hazard ratio [HR] 0.24; 95% CI 0.07-0.80). The 1-year composite endpoint of vascular accident, including acute coronary syndrome and stroke, was also significantly lower in the telehealth program group after IPTW (2.4% vs 5.2%; HR 0.46; 95% CI 0.21-0.997). At the end of the follow-up, the telehealth program group continued to exhibit a significantly lower rate of ischemic stroke than did the control group after IPTW (0.9% vs 3.5%; HR 0.52, 95% CI 0.28-0.93). Furthermore, the medical costs of the telehealth program patients were not higher than those of the control group, whether in terms of outpatient, emergency department, hospitalization, or total costs.ConclusionsThe PAD patients who participated in the fourth-generation synchronous telehealth program exhibited lower risk of ischemic stroke events over both mid- and long-term follow-up periods. However, larger-scale and prospective randomized clinical trials are needed to confirm our findings.

Hypercoagulability in ACTH-Dependent Cushing Syndrome

Introduction: ACTH-dependent Cushing syndrome (CS) is associated with hypercoagulability; however, the incidence and timing of thrombosis during evaluation and management of CS is unclear.Objective: To evaluate the incidence and timing of thrombotic events in patients with ACTH-dependent CS following diagnosis and management.Methods: We performed a retrospective, longitudinal study of patients with ACTH-dependent CS seen at Stanford University Health Care from 1998 to 2020. Thrombotic events — deep vein thrombosis (DVT), pulmonary embolism (PE), cerebral vascular accident (CVA), and myocardial infarction (MI) — were recorded between diagnosis and 12 months following therapeutic intervention.Results: Of 108 patients with ACTH-dependent CS, 97 (89.8%) were women, and the mean age at diagnosis was 43.0 years (± 15.7 years). Sixty-eight (63%) patients had hypertension, 38 (35.2%) had diabetes mellitus, and 11 (10.2%) were active smokers. Of the 108 subjects, 97 (89.8%) had Cushing Disease (CD) and 11 (10.2%) had ectopic CS. Of the 97 patients with CD, 38 (39.2%) underwent inferior petrosal sinus sampling (IPSS), 59 (60.8%) underwent transsphenoidal surgery (TSS), 19 required repeat TSS (19.6%), and 15 underwent TSS and bilateral adrenalectomy (BAL) (15.4%). Of the 11 patients with ectopic CS, 3 (27.2%) underwent IPSS, 6 (54.5%) underwent BAL, and 1 (9.1%) underwent TSS and BAL.There were 10 thrombotic events among 7 (7.2%) CD patients, but no thrombotic events among ectopic CS patients. Of the thrombotic events, there were 7 (70%) DVT/PE, 2 (20%) CVA, and 1 (10%) cortical vein thrombosis. Six (60%) occurred within 30 days after TSS (range 3-25 days), 2 (20%) between 31 days and 1 year after TSS (range 59-165 days), 1 (10%) 26 days after IPSS but prior to TSS, and 1 (10%) in a patient who did not undergo IPSS or surgery. No thrombotic events were noted after BAL. Of the 8 postoperative thrombotic events, 5 (62.5%) occurred while patients received supraphysiologic glucocorticoid replacement (defined as >25mg hydrocortisone or equivalent daily) after curative surgery, 1 (12.5%) occurred after a patient was tapered to physiologic glucocorticoid replacement, and 2 (25%) occurred in patients who had persistent disease despite surgery. The degree of hypercortisolism at baseline was not associated with risk of thrombotic events.Conclusions: In this retrospective study, 6.5% of ACTH-dependent CS patients had a thrombotic event, all in patients with CD. The majority had venous thromboembolism with DVT/PE, and the highest incidence occurred up to 30 days after surgery. The degree of hypercortisolism at baseline did not correlate with subsequent thrombotic events. Therefore, it is important to monitor all patients with ACTH-dependent CS following surgical intervention for venous thromboembolism.

Neonatal intestinal obstruction: Type I - Septal atresia of distal small intestine

Congenital Intestinal atresia is common cause of neonatal intestinal obstructions. Small intestinal atresia accounts for majority of cases than colonic atresia. In small intestinal atresia Type I is rare form. The plausible etiology is mainly from intra-uterine mesenteric vascular accident and the extent depends on the time and the site of development of obstruction. A 2-day-old baby with history of maternal antenatal scan suspecting of Hirschsprung’s disease presented with clinical signs of lower intestinal obstruction. Barium enema showed features of distal small intestine obstruction for which baby underwent surgery with resection of obstructed segment with end to end anatomises was done. Type I small intestinal atresia was confirmed on histological examination. Thus intestinal obstruction is an emergency encountered in newborn infants requiring early accurate diagnosis by radio imaging modalities and histopathological evaluation. Keywords: Intestinal obstruction, Small intestine atresia, Histopathology.

Autonomization of pectoralis major flap in head and neck surgery

The pectoralis major flap (PMF) is one of the most used pedicled flaps for reconstructive surgery in head and neck. Basing on previous studies observing that a vascular accident or pedicle ligation not always resulted in necrosis of free flaps, sometimes after a short critical period, we describe the possibility to perform the division of the PMF pedicle. The autonomization of PMF is based on the hypothesis that the flap, after a critical period, develops a neoangiogenesis at the free portion in the recipient site. It represents a possible choice in selected patients with relapse or second tumour of the oral floor and/or mobile tongue, who have been already treated with PMF reconstruction. We provide a step-by-step description of the autonomization and use of the modified PMF. Moreover, we reported advantages and pitfalls. The modified PMF represents a safe reconstructive choice for patients advised against a free flap or a second pedicled flap, with good surgical outcomes.

Study of Physical, Psychological, and Spiritual Impact of Family Caregiver In Home-Based Stroke Treatment: A Systematic Review

BACKGROUND: Family support during stroke treatment at home is crucial. However, post-stroke patients’ long-term care will be a problem for families, reducing the level of life satisfaction and physical burden for caregivers. Furthermore, families may experience depression. AIM: Analyzing family conditions related to physical, psychological, and spiritual conditions that receive home-based health worker interventions. METHODS: Study implemented systematic review design with Prisma guidelines, initially with the identification of article sources, following by article screening, checking the eligibility of studies then appraised the selected articles. Three databases were used, Ebsco, PubMed, and PROQUEST. Only studies using quasi-experimental, pre-experimental, and RCT designs were included in this study. Furthermore, those articles were published between 2014 until 2019, full type article and conducted anykind of home intervention for stroke patients and/or family member. Keywords that were employed “Stroke, Apoplexy, Cerebrovascular Accident, Vascular Accident, Home Care Services, home care, Home Health Care, Domiciliary Care, Physical, Physics, Psychological Factors, Psychological Side Effects, Psychosocial Factors, Spirituality.” Totally, 19,528 articles were obtained. Finally, only six eligible articles met review requirements. RESULTS: Implementation of home-based care lowered the physical fatigue of the family. In psychological responses showed that home-based care could reduce the incidence of depression and anxiety levels. Another impact was that the family felt helped because patients could more independently do their activities. Furthermore, the family always supported to motivate the patients to do their daily tasks. CONCLUSION: Home-based interventions for stroke patients can reduce depression, anxiety, and fatigue for the family caregiver.

Metacognition and Frontal Lobe Functioning.

Objective:The frontal lobes have been reported to play in important role in metacognition. The present study evaluated metacognition in a group of neurological patients.Method:Twenty-one neurological (traumatic brain injury and cerebral vascular accident) patients were administered a metacognitive test and neuropsychological tests including a well-known index of frontal lobe functioning, the Wisconsin Card Sorting Test (WCST). After each trial, the participants were asked to evaluate their own performance on a face recognition test by rating their confidence about their accuracy on a scale of 1 (not very confident) to 3 (very confident).Results:A point biserial correlation between accuracy on each trial and confidence was calculated for each participant as a measure of metacognition, Mcog. Mcog was significantly associated with the index of executive/frontal lobe functioning, WCST number of categories. Mcog was not associated with Full Scale IQ, General Memory Quotient, or Benton Facial Recognition Test score (short form, which did not include the experimental trials).Conclusions:These data add support to the idea that the frontal lobes have a special role in metacognition.

Beneficial Xultophy Treatment from Medical and Social Points of View

The case is a 65-year-old male who has been treated for Type 2 diabetes mellitus (T2DM) for 26 years. He has no previous history of cerebral vascular accident (CVA) or coronary heart disease (CHD). He has been treated on insulin therapy, and recently his glucose variability became worse due to the irregular lifestyle. Then, diabetic treatment was changed to Xultophy, which consists of insulin degludec and liraglutide. Providing 16 units of Xultophy brought him a satisfactory daily profile of blood glucose, which seemed to be lower doses compared with the ordinary standard amount. Treatment of Xultophy seems to be effective and some discussion would be described from several points of view.