cognition

Herpes simplex virus (HSV)-1 encephalitis is the most common infectious cause of sporadic encephalitis. Despite treatment with acyclovir, HSV encephalitis is still associated with severe morbidity characterized by persistent neurological deficits. HSV encephalitis usually follows a monophasic course, however, some patients might develop relapsing symptoms caused by the formation of auto-antibodies directed against the N-methyl-D-aspartate receptor (NMDAR). Here we present an 82-year-old male patient with HSV encephalitis who developed shortly after his hospital discharge a Post-HSV NMDAR encephalitis, characterized by recurrent epileptic seizures and deterioration of his residual aphasia. First-line immunotherapy with intravenous immunoglobulins (IgIV) was administered and the patient returned almost to his baseline residual deficits of HSV encephalitis. Subsequently, he presented with recurrent relapses of NMDAR encephalitis. Since periodic treatment with IgIV has been started the patient is seizure-free and his neuropsychiatric condition is stable. In conclusion, the recognition of Post-HSV NMDAR encephalitis is very important because neurological manifestations can markedly improve with immunotherapy. Interestingly, in some patients cerebral HSV infection seems to trigger a chronic inflammatory disorder with persistent autoimmune activation which requires chronic treatment.

Aim:The work was to perform a comparative study of the neuroprotective and nootropic activities of two pharmaceutical substances, the HLDF-6 peptide and its amide form (HLDF-6-NH2). Materials and Methods: We used in the study healthy adult male Wistar rats aged 180–200 days weighing 280–300 g. We modelled ischemic stroke in rats by chronical occlusion of carotid arteries. Solutions of the HLDF-6-NH2 and HLDF-6 peptides were administered intranasally. Cognitive functions we assessed with Novel object recognition test and Morris maze. Results: The amide form of HLDF-6 peptide is more efficient: the neuroprotective activity of HLDF-6-NH2, evaluated by improvement of cognitive functions in animals, surpassed that of the native HLDF-6 peptide. A dose of 250 µg/kg of HLDF-6-NH2 peptide resulted in practically complete restoration of the disturbed functions. In the model of ischemic stroke, the amide form of the peptide significantly excelled the reference substance mexidol both in the effective dose and biological activity. Conclusion: The results of study of the agent allow hoping for its success in further clinical investigation. In view of high demand for the agent and in case of successful clinical trials, it will surely become widely used in clinical practice in treatment of IS.

Background: Glomerular hyperfiltration (GH) is a common feature of sickle cell nephropathy (SCN) starting at infancy and represents an early marker of incipient glomerular injury and renal dysfunction. Methods: This study aimed to determine the prevalence and correlates of GH among children (≤ 16 years) with sickle cell disease (SCD) at their steady state, recruited over 6 months at the Pediatric Outpatient Clinic in Al-Sadaqa General Teaching Hospital, Aden, Yemen. Glomerular filtration rate (eGFR) was estimated using the Schwartz formula. Data on clinical history, anthropometry, blood pressure (BP) and laboratory investigations were collected. Results: Of 101 children (mean age 7.2 ± 3.9 years), 65 (64.4%) were males. The prevalence of GH was observed in 36 (35.6%) children, who were significantly older (10.7 ± 3.2 vs. 5.2 ± 2.7 years, p < 0.001) and had a lower fetal Hb level (5 ± 3.3 vs. 9 ± 7.1, p = 0.02). All children were normotensive, but hyperfiltrating children showed significantly higher systolic (97.2 ± 7.3 vs. 89.7 ± 5.2 mmHg) and diastolic pressure (55.1 ± 5.0 vs. 49 ± 4.3 mmHg) (all p < 0.001). Among evaluated children, 25.7% had hyperfiltration alone, whereas 9.9% had an associated microalbuminuria (MA), and no significant difference in eGFR between those with and without MA (158.4 ± 33.7 vs. 160.7 ± 29.8 ml/min/173m2, p = 0.84). Conclusion: This study demonstrated a relatively high prevalence of GH in Yemeni children with SCD that increased with age. Recognition of hyperfiltration and other early markers of nephropathy in this population could help to develop renal protective strategies to prevent progressive loss of kidney function.

Marijuana is considered illicit in much of the world, and is classified as a drug for recreational use, in recent decades the medicinal use of Cannabis sativa L. has grown and diversified, being considered the only therapeutic alternative in the control of serious and incurable diseases such as syndrome of Dravet. The world panorama has shown a more liberal position, since in several countries such as the United States of America, Holland, Australia, Italy, and more recently in Canada, the use of medications, or even the recreational use of this plant, have been regulated. In this context, the investigation of the modifying effects on physical activity of empirically used cannabinoids is fundamental nowadays, mainly due to the regulatory recognition of Cannabis sativa L. as a medicinal plant in a large part of the world. Therefore, the objective of this review was to verify the evidence related to the effect of cannabis on physical performance and to identify and highlight the challenges in the interpretation of information regarding the performance of practitioners of physical activity, as well as athletes, presenting new trends in this area of research to be addressed. To carry out the systematic review, a bibliographic survey of case reports was obtained through Pubmed, Science Direct and Google Academic databases. The following keywords were used to perform the research: cannabis, performance, pain, competition. The following filters were used as inclusion criteria a languages used english; species: humans; types of articles: original articles and reviews and period of publication of articles: 1981 to 2021.

Steady-state VEPs, have been used to estimate visual acuity since the 1970s and allow responses to a range of stimulus sizes to be collected rapidly- with particular utility in infants. However, the assessment of children with cortical visual impairment is a bigger challenge that lead to the development of the Step VEP. Its initial evaluation revealed that accuracy and precision were poorer for pediatric patients than for optically degraded normal adults and that it was not necessarily successful in every child. Statistical models generated the equations: VAO = 0.56 VAStep (r2 = 0.75, F = 60.93, p = 0.000) and VAPL = 0.45 VAStep (r2 = 0.82, F = 156.85, p = 0.000), supported by a recent a systematic review of VA comparisons showing that recognition VA (optotypes) agrees more closely than discrimination VA (PL) with VEP VA. In combination, Step VEPS and subjective tests allowed complete assessment in 96% of patients, with incomplete Step VEPS much more likely to be partially successful than not, and more likely to be partially successful than incomplete subjective tests. This supports the rationale that Step VEPs maintain attention by limiting the time spent stimulating away from an individual’s threshold of spatial resolution. For the small number of patients in whom VA cannot be estimated, alternative stimuli and methods of presentation are proposed. 

Background: Hemp seed (Cannabis sativa L.) is an annual herbaceous plant of the Cannabis genus that contains a large amount of protein, iron, and fatty acids, including linoleic, α-linolenic, and γ-linolenic acid. These compounds are involved in a number of biological activities, including immunity enhancement, hyperlipidemia, and inflammation reduction. Here, we investigated the antioxidant effects of hemp seed on human cognitive function.Methods: The test was administered to 34 healthy volunteers aged ≥ 20 years. Participants were selected according to age and sex and were administered 10 g of hemp seed three times daily (30 g/day) for 45 days. The outcome measurements were recorded using a survey, computerized neurocognitive tests, and artificial intelligence.Results: Survey analysis determined that both the Beck Anxiety Inventory and Beck Depression Inventory measurements decreased significantly after hemp seed consumption when compared to measurements taken before consumption (p < 0.05). Additionally, significant results were observed in the Stroop and Tower of London tasks (p < 0.05). The prediction performance for the antidepressant effect was 0.83 for the area under the curve in the random forest algorithm, which was superior to that of other machine learning methods. Conclusion: These results suggest that hemp seeds have a beneficial effect on cognitive impairment.

Pneumopericardium is a rare clinical entity, occurring in the setting of thoracic trauma, malignancies, or mechanical ventilation. Very few cases report pneumopericardium as a complication of gastrointestinal tract surgery. Signs and symptoms may be frustrating, ranging from asymptomatic to chest pain, sepsis, hemodynamic instability, pericarditis, or even cardiac tamponade. Clinical pathognomonic signs of pneumopericardium include pericardial metallic tinkling friction rub and mill wheel murmur. Diagnostic work-up includes electrocardiogram, chest radiography, and, computed tomography imaging. A gastro pericardial fistula should be considered a rare differential diagnosis for acute chest pain in patients with a history of gastroesophageal surgery. Rapid recognition and treatment avoid life-threatening complications. The successful outcome of gastro pericardial fistula treatment depends on both emergency and definitive surgical management. The survival rate with conservative management is poor.We present the case of a 78-year-old patient suffering from pneumopericardium and pericardial infusion, due to a fibrotic fistula between the Nissen’s valve, occurring 10 years after redo antireflux surgery. Treatment included broad-spectrum antibiotics, and emergency surgery for pericardial drainage, biopsy of the valve’s defect, suture, and omentoplasty.

The purpose of this work is to implement methods and develop tools for nonlinear dynamic identification of the Oculomotor System (OMS) “input-output” in the form of Multidimensional Transient Functions (MTF) based on eye tracking data and their use in an information system for diagnosing the psychophysiological state of a person. The object of the study is the process of diagnosing the psychophysiological state of an individual based on innovative eye-tracking technology. The subject of the research is computational algorithms and software for determining diagnostic features based on identification data of compulsory medical insurance in the form of MTF, constructing a Bayesian classifier using machine learning in the established space of the most informative features. A methodology has been developed and implemented for the experimental study of human compulsory mental health using innovative eye-tracking technology to record compulsory mental health responses to test visual stimuli. The obtained empirical data from input-output studies are used for the identification of OMS based on Volterra polynomials. Experimental studies of compulsory medical insurance of respondents were carried out before and after the working day. Based on the data obtained using the Tobii Pro TX300 eye tracker, the transient functions of the first, second, and third orders of the OMS were determined. Variability of second and third order transient functions was revealed for different psychophysiological states of the respondent (normal or fatigue). Thus, it seems appropriate to use MTF in diagnostic studies in the fields of neuroscience and psychology. Information technology for diagnosing human psychophysiological conditions has been further developed through the use of compulsory health insurance information models based on Volterra polynomials as a source of primary data. This allows for an increase in the accuracy of OMS modeling and, consequently, enhances the reliability of diagnosis within the framework of the proposed heuristic features. A set of heuristic features is proposed, which are determined using integral and differential transformations of the MTF OMS. The information content of individual features and all possible combinations of them in pairs was studied using the Probability of Correct Recognition (PCR) indicator. Two-dimensional feature spaces with the maximum PCR value (0.938) were identified during the diagnosis of a person’s psychophysiological state.

Background: Early-onset sarcoidosis is a rare systemic inflammatory granulomatous disease, distinguished by onset before the age of 4 and notably lacking pulmonary involvement. Unfortunately, the condition often shows clinical features similar to juvenile idiopathic arthritis, resulting in the misdiagnosis of numerous patients. This case report delves into the challenges associated with the delayed diagnosis of early-onset sarcoidosis, with a particular focus on the diagnostic methods employed to address this delayed recognition.Case presentation: A 15-year-old girl presented with a history of recurrent fever since infancy, accompanied by rash, arthritis, and joint deformity. Previously misdiagnosed with juvenile idiopathic arthritis, she underwent management with steroids and methotrexate, yielding no improvement. The diagnosis of early-onset sarcoidosis was made during adolescence based on serial examinations, comprehensive laboratory and radiological evaluations, and subsequent histopathology findings. Presently, the patient is receiving treatment with low-dose steroids and biologic therapy (Tocilizumab) and experiencing no disease progression.Conclusion: This case report underscores the importance of considering early-onset sarcoidosis in the differential diagnosis of pediatric patients exhibiting persistent arthritis from an early age. Early detection and treatment are crucial in averting complications and enhancing the overall quality of life. 

Background: Dysgerminomas, account for only 1% - 2% of all malignant ovarian neoplasms.Objective: This case report aims to present a rare occurrence of dysgerminoma in a pediatric patient, highlighting the clinical characteristics, diagnosis, and management.Case presentation: We present a case of dysgerminoma in a 12-year-old girl who presented with a three-week history of pelvic pain and progressive abdominal swelling. Physical examination revealed a distended abdomen with evident suprapubic fullness, and a palpable abdominopelvic mass measuring approximately 20 weeks in size. Imaging studies confirmed the presence of a solid heterogeneous mass originating from the pelvis. The patient underwent a right salpingo-oophorectomy without complications. Histological examination coupled with an immunohistochemical study confirmed the diagnosis of dysgerminoma. The patient had an uneventful postoperative course and was discharged without adjuvant treatment. Regular follow-up visits, physical examinations, ultrasound scans, and lactate dehydrogenase assays were initiated for monitoring. Conclusion: Prompt recognition and appropriate surgical intervention, followed by regular monitoring, are crucial for optimal outcomes in pediatric dysgerminoma cases.

Maternal cardiac arrests are rare but serious events where recognition and prompt initiation of resuscitation are crucial. Obesity is a common risk factor encountered in disorders of pregnancy as well as maternal cardiac arrests. Cardiac arrest algorithms should be followed with some changes to accommodate maternal and fetal health. We present a case of a 32-year-old pregnant patient who had a perimortem caesarean section due to maternal cardiac arrest.

Cells have emerged as highly promising vehicles for delivering drugs due to their unique advantages. They have the ability to bypass immune recognition, navigate biological barriers, and reach difficult-to-access tissues through sensing and active movement. Over the past couple of decades, extensive research has been conducted to understand how cell carriers can overcome biological barriers and influence drug effectiveness. This has resulted in the development of engineered cells for targeted drug delivery to specific tissues. Despite the presence of exciting developments, a comprehensive understanding of the challenges and potential strategies is necessary for the effective clinical application of cell-based drug carriers. This review provides an overview of recent progress and novel concepts in cell-based drug carriers, as well as their potential for translation into clinical practice. Additionally, we delve into important factors and emerging strategies for designing the next generation of cell-based delivery technologies, with a particular emphasis on achieving greater accuracy and targeted drug administration.

This manuscript presents a compelling case of renal tuberculosis in a 15-year-old male, elucidating the intricate diagnostic hurdles and strategic management approaches encountered. The patient initially presented with nonspecific symptoms, including intermittent low-grade fever, weight loss, fatigue, and diffuse skin rashes, which were initially managed as suspected enteric fever. However, as the patient’s condition deteriorated, a comprehensive diagnostic exploration revealed renal tuberculosis. The report meticulously outlines the clinical presentation, diagnostic evaluation, and therapeutic trajectory, emphasizing the enigmatic nature of symptoms and advocating for a multidimensional diagnostic paradigm integrating clinical, radiological, microbiological, and histopathological assessments.Furthermore, this case report provides a comprehensive review of urogenital tuberculosis, discussing its epidemiological underpinnings, clinical manifestations, diagnostic methodologies, and therapeutic tenets. It underscores the paramount significance of early recognition and prompt initiation of treatment in forestalling complications and optimizing patient outcomes.This case report enriches the medical discourse by shedding light on the diagnostic intricacies and therapeutic imperatives pertinent to renal tuberculosis, especially in the younger demographic. We believe that the findings will contribute significantly to the understanding and management of this disease.

This study compares the effect of imipramine and amitriptyline on learning and memory. Thirty-five (35) healthy Swiss white (CD1) mice of both sexes weighing 18 g - 30 g were randomly divided into 5 groups (n = 7). Mice in group 1 (control) were administered 0.9% normal saline orally, while mice in groups 2 and 3 were treated with low (1.8 mg/kg) and high (3.7 mg/kg) doses of imipramine, groups 4 and 5 were treated with low (1.8 mg/kg) and high (3.7 mg/kg) of amitriptyline respectively. Treatment was for 21 days before tests. All animals were tested using the Morris Water Maze (MWM) and Novel Object Recognition Task (NORT) to assess visuospatial learning and memory as well as cognitive learning and memory. The results obtained from the Morris Water Maze during the acquisition training showed that the swim latencies were significantly lower (p < 0.05) in the amitriptyline low-dose group compared to the control group. During the reversal training, the swim latencies were significantly lower (p < 0.05) in the test groups compared to the control group. The result for the retention quadrant in the probe trials showed a significant decrease (p < 0.05) in the northeast quadrant in the test groups compared to the control group, with no significant difference in the visible platform day of the Morris Water Maze in the test groups compared to the control group. In the novel object recognition task, the short-term index of habituation was significantly lower (p < 0.05) in the low-dose imipramine and low-dose amitriptyline compared to the control group, the results also showed a significant increase (p < 0.05) in amitriptyline high dose group compared to imipramine and amitriptyline low dose group and the control group. The index of discrimination showed no significant difference among all groups. The long-term index of habituation and discrimination in the memory test showed a significant decrease (p < 0.05) in all the test groups compared to the control group. The results suggest that imipramine and amitriptyline impaired cognitive memory and enhanced visuospatial learning and memory functions.

A 51-year-old female with a history of multinodular goitre presented with vomiting, abdominal discomfort, and generalized tiredness. Investigations revealed hypercalcemia (ionized calcium 1.41 mmol/L), hypokalaemia, suppressed parathyroid hormone, and significantly elevated free thyroxine (> 7.77 ng/dL) with a suppressed thyroid-stimulating hormone level consistent with hyperthyroidism. Further, the workup confirmed Graves’ disease as the underlying aetiology. Hyperthyroidism is occasionally associated with mild to moderate hypercalcemia, but severe hypercalcemia or hypercalcaemic crisis is an extremely rare complication. Prompt recognition and treatment are crucial to prevent life-threatening complications. The patient was treated with intravenous fluids, a low-calcium diet, zoledronic acid, carbimazole, and a beta-blocker, leading to improvement in her condition. This case highlights a rare occurrence of hypercalcaemic crisis in a patient with thyrotoxicosis due to Graves’ disease. Hyperthyroidism-induced hypercalcemia requires prompt recognition and multidisciplinary management involving endocrinologists, internists, and critical care specialists to prevent potentially life-threatening complications. Healthcare providers should consider the hypercalcaemic crisis in the differential diagnosis of hypercalcemia in the context of hyperthyroidism.

Background: To assess the association between neurocognitive functioning, adaptive functioning, and health-related quality of life (HRQoL), in Children and Young Adults with Severe Chronic Kidney Disease (CKD).Methods: We included patients with severe CKD (stages 4 and 5), aged 8-30 years, on different therapy modalities (pre-dialysis, dialysis, and transplanted) and healthy controls matched on age, sex, and parental education. All patients and healthy controls performed tasks to assess neurocognitive functioning (WISC/WAIS and a comprehensive neuropsychological test battery), and completed questionnaires to assess adaptive functioning (WFIRS or WHODAS) and HRQoL (PedsQL). Group differences were explored using MANCOVA. Mediation analyses were done to explore whether the relation between neurocognitive functioning and HRQoL was mediated by adaptive functioning. Results: 28 patients with severe CKD and 21 healthy matched controls were included. CKD patients had worse HRQoL (p < .001) than healthy controls. Adaptive functioning problems increased with age in the CKD patient group but not in the healthy control group (significant interaction effect: p = .024). Significant mediation effects were found, where impaired adaptive functioning mediated the relation between both low estimated Full Scale Intelligence Quotient (eFSIQ) and worse Processing Speed & Working Memory, and impaired HRQoL (eFSIQ: 95% confidence interval = .01-.58; Processing Speed & Working Memory: 95% confidence interval = 2.31-16.36).Conclusion: We found that impaired neurocognitive functioning is associated with worse HRQoL, which is conditional to impaired adaptive functioning. Especially towards young adulthood problems in adaptive functioning are more likely to be reported than when patients are younger.

Carfilzomib, a highly selective proteasome inhibitor, is commonly used in the treatment of multiple myeloma and AL amyloidosis. While its efficacy is well-established, there is increasing recognition of its association with cardiovascular adverse events, including hypertension, heart failure, and arrhythmias. However, cases of carfilzomib-induced pericardial disease remain rare. Here, we present a case of a 78-year-old female with multiple myeloma who experienced two episodes of hemorrhagic pericardial effusion following carfilzomib therapy, highlighting the importance of vigilant cardiovascular monitoring during treatment.

Introduction: Pneumothorax is a life-threatening condition that requires prompt recognition and therapy to prevent deterioration. Radiologist workload often precludes rapid assessment of the usual diagnostic modality, the chest radiograph, particularly after hours. The aim was to develop a deep learning model using a segmentation-based Deep Convolutional Neural Network (DCNN) to detect pneumothorax on chest radiographs to provide rapid and accurate pneumothorax diagnosis.Methods: This is a retrospective study of spontaneous pneumothorax at a single center, containing 130 positive and 70 negative radiographs. Subsequent manual contour mapping was performed to draw a mask of the pneumothorax. These image pairs were used to train a DCNN model (a modified AlexNet) after pretraining on the ImageNet dataset.Results: The DCNN achieved an accuracy of 0.83, with sensitivity of 98.1%, and specificity of 68.5%.Conclusion: This segmentation-based DCNN accuracy is comparable to previous categorization-based CDNN models, despite using a smaller sample size for training, while including the benefits of visual representation for clinician feedback. Segmentation-based DCNNs show promise in the development of accurate and clinically useful models for medical imaging.

Coronary artery aneurysm is an uncommon condition defined as abnormal dilatation of the coronary artery.We report the case of a man admitted to the Emergency Department for suspected intestinal obstruction. At abdominal/thoracic Computed Tomography (CT) it was reported a suspected pericardial cyst. Contrast echocardiography showed a clear pattern of blood flow inside the mass with a probable origin at a very limited region where it was also possible to sample an ECG-synchronized system-diastolic Pulse-Wave (PW)-Doppler pattern, typical for a coronary artery flow. Our suspicion of a giant coronary artery aneurysm was then confirmed by coronary CT and coronary angiography. The patient was transferred to a Cardiac Surgery center where he underwent surgical treatment for the aneurysm.Most coronary aneurysms are clinically silent and are often incidentally detected. Coronary angiography is the ‘‘gold standard’’ for diagnosis and evaluation of coronary artery aneurysms. Among non-invasive diagnostic techniques, Computed Tomography Coronary Angiography is the best method for coronary artery anatomy and coronary abnormalities. However, echocardiography with the use of a contrast agent, a cost-effective non-radiation nature, and a widespread use method, maybe a reliable method to detect and characterize the masses, allowing a differential diagnosis.Learning objective1.    Recognition and evaluation of cardiac masses require first-line imaging methods such as echocardiography.2.    The use of additional non-invasive (cardiac CT or MRI) and/or invasive imaging methods are often required. 3.    Contrast echocardiography may be helpful, as second-line imaging methods, to better characterize the mass and approach the correct diagnosis.

Introduction: Cognitive impairment is defined as a new deficit in at least two areas of cognitive functioning. These may include disturbances in memory, executive functioning, attention or speed of information processing, perceptual motor abilities, or language. It has been shown that cognitive impairment is associated with the severity of kidney disease. Methods: The study was a descriptive research design, with participants purposively sampled from the general chronic kidney disease population which included haemodialysis and peritoneal dialysis patients at Steve Biko Academic Hospital in Pretoria, Gauteng Province, South Africa. Hundred and fifty-one participants (76 hemodialysis & 75 peritoneal dialysis patients), 58% were males, and 42% were females aged 19-61 years. To establish the prevalence of cognitive impairment by testing the level of cognition the Mini-Mental State Examination was utilized to provide a brief screening test to quantitatively assess the cognitive abilities and cognitive changes of patients while on dialysis. Results: Ninety-nine percent (99%) of the recruited population reported no cognitive impairment, irrespective of dialysis modality, demographic characteristics, and socio-economic status. Conclusion: Despite the findings highlighting that the majority of the chronic kidney disease population at Steve Biko Academic Hospital reported no cognitive impairment, it is crucial to increase awareness of the potential effects of cognitive impairment on daily activities, quality of life, and treatment adherence. Early detection and management of cognitive impairment can significantly impact the quality of life and adherence to treatment among these patients. Further research is needed to understand the prevalence and impact of cognitive impairment in different populations and to develop effective interventions for its prevention and management.