A pilot study of rivastigmine in the treatment of delirium after stroke: A safe alternative

<p>Abstract</p> <p>Background</p> <p>Delirium is a common disorder in the early phase of stroke. Given the presumed cholinergic deficiency in delirium, we tested treatment with the acetylcholinesterase inhibitor rivastigmine.</p> <p>Methods</p> <p>This pilot study was performed within an epidemiological study. In 527 consecutive stroke patients presence of delirium was assessed during the first week with the confusion assessment method. Severity was scored with the delirium rating scale (DRS). Sixty-two patients developed a delirium in the acute phase of stroke. Only patients with a severe and persistent delirium (defined as a DRS of 12 or more for more than 24 hours) were enrolled in the present study. In total 26 fulfilled these criteria of whom 17 were treated with orally administered rivastigmine with a total dose between 3 and 12 mg a day. Eight patients could not be treated because of dysphagia and one because of early discharge.</p> <p>Results</p> <p>No major side effects were recorded. In 16 patients there was a considerable decrease in severity of delirium. The mean DRS declined from 14.8 on day one to 8.5 after therapy and 5.6 after tapering. The mean duration of delirium was 6.7 days (range; 2–17).</p> <p>Conclusion</p> <p>Rivastigmine is safe in stroke patients with delirium even after rapid titration. In the majority of patients the delirium improved after treatment. A randomized controlled trial is needed to establish the usefulness of rivastigmine in delirium after stroke.</p> <p>Trial registration</p> <p>Nederlands Trial Register NTR1395</p

Validating the Time and Change test to screen for dementia in elderly Koreans

BACKGROUND: We assessed the applicability of the T&C test as an accurate and convenient means to screen for dementia in primary care and community settings. METHODS: The study group comprised 59 patients and 405 community participants, all of who were aged 65 years and over. The time component of the T&C test evaluated the ability of a subject to comprehend clock hands that indicated a time of 11:10, while the change component of the T&C test evaluated the ability of a subject to make 1,000 Won from a group of coins with smaller denominations (one 500, seven 100, and seven 50 Won coins). RESULTS: The T&C test had a sensitivity and specificity of 73.0 and 90.9%, respectively, and positive and negative predictive values of 93.1, and 66.7%, respectively. The test-retest and interobserver agreement rates were both 95% (κ = 0.91) (time interval, 24 hours). The association between the T&C test and K-MMSE test was modest, while significant (r = 0.422, p < 0.001). The T&C test scores were not influenced by educational status. CONCLUSIONS: We conclude that the T&C test is useful as supplemental testing of important domains (e.g., calculation, conceptualization, visuospatial) to traditional measures such as the MMSE. However, because T&C test is simple, rapid, and easy to use, it can be applied conveniently to elderly subjects by non-specialist personnel who receive training

Новий підхід до оптимізації лікування хворих на первинну неходжкінську злоякісну лімфому шлунку без хірургічного втручання

Запропоновано схему лікування хворих з первинними неходжкінськими злоякісними лімфомами шлунка (ПНЗЛШ) без хірургічного втручання. Лікування починається з поліхіміотерапії (ПХТ) за схемою СНОР (6 курсів). Перші 4 курси забезпечують повну регресію пухлини і стійку ремісію у 84,2% хворих з І-Е–ІІ-Е стадією захворювання. 5-й і 6-й курси проводять з інтервалом 3 міс для профілактики рецидиву. За відсутності повної регресії ПНЗЛШ після 4 курсів ПХТ застосовують променеву терапію (СВД 30 Гр). Після 1–1,5 міс після досягнення повної регресії проводять курс терапії рекомбінантним інтерфероном альфа-2���b (30 млн од.). Проаналізовано переносимість та віддалені результати проведеного лікування.A schedule is proposed for treating primary non-Hodgkin malignant lymphoma of the stomach (PNHLS) without any surgery intervention. Treatment begins with polychemotherapy (PCT) according to СНОР regime (6 courses). The first 4 courses ensure full regression and stable remission in 84.2% patients at stage І-E–ІІ-Е. The 5th and 6th courses are given at a 3-month interval for relapse prevention. In the absence of a full regression of PNHLS after 4 courses of PCT, radiation therapy (a total local dose of 30 Gy) can be added. Four to six weeks after the full regression, one course of recombinant alpha-2b interferon (30 million IU) is applied. The paper discusses the issues of tolerance and remote results of this therapy

A model of discriminant analysis on the basis of descriptor variables for the ampelography of Vitis sp.

Use of descriptor variables in ampelography is recommended to simplify recording of data and to enable useful comparisons. Parametric assumptions are, however, poorly satisfied especially with regard to statistical interference. In the paper some statistical procedures to improve the discriminant ability of descriptor variables are considered. The use of variances and covariances of variety by year interactions is suggested for the error matrix within a multiple discriminant analysis procedure. The adequacy of this model is verified in a 3-year experiment with Italian wine varieties. The discriminant power, as evaluated on the basis of the estimated distances among varieties, is satisfactory

A surgical study of serological markers such as C-reactive protein and interleukin 6 in response to postoperative infection in patients with open fractures in a tertiary care hospital

To study the response of C-reactive protein (CRP) and interleukin-6 (IL-6) to postoperative infection in patients with open fractures. Thirty patients with open fractures of extremities within 12 hours of injury were included in study. Blood samples were collected for Postoperative infection is a devastating complication of open fractures. The ideal investigation for early diagnosis of infection should be done before surgery and should be accurate, convenient to patient, cause minimal morbidity. Test such as CRP and IL-6 estimation is utilized in this study. CRP and IL 6 estimation on admission, second and fourth post-op day. All patients underwent surgery and reports evaluated. It was observed that CRP peak on post-op day 4 and IL 6 on postoperative day 2 in patients with infection before clinical evidence of infection. This prospective study includes 30 cases, followed up in ward for a week. Various factors regarding clinical presentation, findings of various investigations, operative treatment had been analyzed. The sensitivity of CRP in our study was 100%, and specificity was 42%. The persistent rise of CRP value seen within the infected group was statistically significant (p&lt;0.05). The present clinical study of estimation of CRP and IL 6 to detect postoperative infection in patients after open fractures is an excellent diagnostic test for early detection and management of infection