Hypoxic bradycardia: an enigma in coronavirus disease 2019

Coronavirus disease 2019 varies from asymptomatic to severe acute respiratory syndrome with multiple organ involvement, primarily involving the microvasculature and heart. Acute myocardial injury is the most frequently observed and reported cardiac complication with acute coronary events, acute left ventricular systolic dysfunction, and cardiac arrhythmias, but sinus bradycardia reported only in a few cases. The development of sinus bradycardia can be crucial warning sign of onset of severe cytokine storm. The primary determinant of severity of COVID-19 is aging and co-morbidities such as diabetes and hyperlipidemia with dysregulated immunological status. Patients with pre-existing cardiovascular disease infected with COVID-19 have increased risk of severity and mortality. Literature available regarding the occurrence of bradycardia is limited, and electrophysiology studies in COVID-19 patients have shown sinus bradycardia, heart block, bundle branch block, and intraventricular conduction delay. The pathophysiological mechanism regarding the occurrence of bradycardia is not yet known entirely. Cardiac manifestations could be attributed to multiple clinical etiologies, including direct viral myocardial damage, inflammatory response, hypoxia, hypotension, downregulation of angiotensin-converting enzyme 2 (ACE-2), drug toxicity, and endogenous toxicity of catecholamine adrenergic status, also severe hypoxic damage of lungs by COVID-19 can also act as a trigger. We report one such case of bradycardia due to COVID-19 detected through intensive monitoring and managed successfully in the ICU of tertiary care dedicated COVID-19 hospital. Bradycardia in COVID-19 is a rare clinical phenomenon, could be a worst prognostic marker. If detected early may help in prognostication and, if managed appropriately, will avert a life-threatening complication.

Universal and language-specific connected speech characteristics of bilingual speakers with Alzheimer’s Disease: insights from case studies of structurally distinct languages

Purpose: Connected speech analysis has been effectively utilized for the diagnosis and disease monitoring of individuals with Alzheimer’s Disease (AD). Existing research has been conducted mostly in monolingual English speakers with a noticeable lack of evidence from bilinguals and non-English speakers, particularly in non-European languages. Using a case study approach, we characterized connected speech profiles of two Bengali-English bilingual speakers with AD to: determine the universal features of language impairments in both languages, identify language-specific differences between the languages, and explore language impairment characteristics of the participants with AD in relation to their bilingual language experience. Method: Participants included two Bengali-English bilingual speakers with AD and a group of age-, gender-, education- and language-matched neurologically healthy controls. Connected speech samples were collected in L1 (Bengali) and L2 (English) using a novel storytelling task (i.e., “Frog, where are you?”). These samples were analyzed using an augmented Quantitative Production Analysis and Correct Information Unit analyses for productivity, fluency, syntactic and morpho-syntactic features, lexical and semantic characteristics. Results: Irrespective of the language, AD impacted speech productivity (speech rate and fluency) and semantic characteristics in both languages. Unique language-specific differences were noted on syntactic measures (reduced sentence length in Bengali), lexical distribution (fewer pronouns and absence of reduplication in Bengali) and inflectional properties (no difficulties with noun or verb inflections in Bengali). Among the two participants with AD, the individual who showed lower proficiency and usage in L2 (English) demonstrated reduced syntactic complexity and morpho-syntactic richness in English. Conclusion: Evidence from these case studies suggest that language impairment features in AD are not universal across languages, particularly in comparison to impairments typically associated with language breakdowns in English. This study underscores the importance of establishing connected speech profiles in AD for non-English speaking populations, especially for structurally different languages. This would in turn lead to the development of language-specific markers that can facilitate early detection of language deterioration and aid in improving diagnosis of AD in individuals belonging to underserved linguistically diverse populations

Distinct performance profiles on the Brixton test in frontotemporal dementia

From Wiley via Jisc Publications RouterHistory: received 2020-05-30, rev-recd 2020-09-18, pub-electronic 2020-10-15, pub-print 2021-06Article version: VoRPublication status: PublishedThe Brixton Spatial Anticipation Test is a well‐established test of executive function that evaluates the capacity to abstract, follow, and switch rules. There has been remarkably little systematic analysis of Brixton test performance in the prototypical neurodegenerative disorder of the frontal lobes: behavioural variant frontotemporal dementia (bvFTD) or evaluation of the test’s ability to distinguish frontal from temporal lobe degenerative disease. We carried out a quantitative and qualitative analysis of Brixton performance in 76 patients with bvFTD and 34 with semantic dementia (SD) associated with temporal lobe degeneration. The groups were matched for demographic variables and illness duration. The bvFTD group performed significantly more poorly (U = 348, p < .0001, r = .58), 53% of patients scoring in the poor–impaired range compared with 6% of SD patients. Whereas bvFTD patients showed problems in rule acquisition and switching, SD patients did not, despite their impaired conceptual knowledge. Error analysis revealed more frequent perseverative errors in bvFTD, particularly responses unconnected to the stimulus, as well as random responses. Stimulus‐bound errors were rare. Within the bvFTD group, there was variation in performance profile, which could not be explained by demographic, neurological, or genetic factors. The findings demonstrate sensitivity and specificity of the Brixton test in identifying frontal lobe degenerative disease and highlight the clinical value of qualitative analysis of test performance. From a theoretical perspective, the findings provide evidence that semantic knowledge and the capacity to acquire rules are dissociable. Moreover, they exemplify the separable functional contributions to executive performance

Connected speech characteristics of Bengali speakers with Alzheimer’s Disease: evidence for language-specific diagnostic markers

Background & Aim: Speech and language characteristics of connected speech provide a valuable tool for identifying, diagnosing and monitoring progression in Alzheimer’s Disease (AD). Our knowledge of linguistic features of connected speech in AD is primarily derived from English speakers; very little is known regarding patterns of linguistic deficits in speakers of other languages, such as Bengali. Bengali is a highly inflected pro-drop language from the Indo-Aryan language family. It is the seventh most spoken language in the world, yet to date, no studies have investigated the profile of linguistic impairments in Bengali speakers with AD. The aim of this study was to characterize connected speech production and identify the linguistic features affected in Bengali speakers with AD. Methods: Participants were six Bengali speaking AD patients and eight matched controls from the urban metropolis, Kolkata, India. Narrative samples were elicited in Bengali using the Frog Story. Samples were analyzed using the Quantitative Production Analysis and the Correct Information Unit analyses to quantify six different aspects of speech production: speech rate, structural and syntactic measures, lexical measures, morphological and inflectional measures, semantic measures and measure of spontaneity and fluency disruptions. Results & Conclusions: In line with the extant literature from English speakers, the Bengali AD participants demonstrated decreased speech rate, simplicity of sentence forms and structures, and reduced semantic content. Critically, differences with English speakers’ literature emerged in the domains of Bengali specific linguistic features, such as the pro-drop nature of Bengali and its inflectional properties of nominal and verbal systems. Bengali AD participants produced fewer pronouns, which is in direct contrast with the overuse of pronouns by English AD participants. No obvious difficulty in producing nominal and verbal inflections was evident. However, differences in the type of noun inflections were evident; these were characterized by simpler inflectional features used by AD speakers. This study represents the first of its kind to characterize connected speech production in Bengali AD participants and is a significant step forward towards the development of language-specific clinical markers in AD. It also provides a framework for cross-linguistic comparisons across structurally distinct and under-explored languages

False recognition in behavioral variant frontotemporal dementia and Alzheimer's Disease - Disinhibition or amnesia?

Episodic memory recall processes in Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD) can be similarly impaired, whereas recognition performance is more variable. A potential reason for this variability could be false-positive errors made on recognition trials and whether these errors are due to amnesia per se or a general over-endorsement of recognition items regardless of memory. The current study addressed this issue by analysing recognition performance on the Rey Auditory Verbal Learning Test (RAVLT) in 39 bvFTD, 77 AD and 61 control participants from two centers (India, Australia), as well as disinhibition assessed using the Hayling test. Whereas both AD and bvFTD patients were comparably impaired on delayed recall, bvFTD patients showed intact recognition performance in terms of the number of correct hits. However, both patient groups endorsed significantly more false-positives than controls, and bvFTD and AD patients scored equally poorly on a sensitivity index (correct hits—false-positives). Furthermore, measures of disinhibition were significantly associated with false positives in both groups, with a stronger relationship with false-positives in bvFTD. Voxel-based morphometry analyses revealed similar neural correlates of false positive endorsement across bvFTD and AD, with both patient groups showing involvement of prefrontal and Papez circuitry regions, such as medial temporal and thalamic regions, and a DTI analysis detected an emerging but non-significant trend between false positives and decreased fornix integrity in bvFTD only. These findings suggest that false-positive errors on recognition tests relate to similar mechanisms in bvFTD and AD, reflecting deficits in episodic memory processes and disinhibition. These findings highlight that current memory tests are not sufficient to accurately distinguish between bvFTD and AD patients

Challenges for neuropsychology in the global context

Globally, the demand for culturally appropriate and equitable neuropsychological services is greater than ever before. However, providing culturally competent neuropsychological services is challenging. This chapter provides an understanding of the complex set of interlinked and interdependent challenges that contributes to inequalities in neuropsychological assessment. These challenges are relevant to the ethnic minorities, international migrants, and indigenous groups in countries with well-established neuropsychological services, and also to the national majority and minority groups in countries where neuropsychology is less established. Inequalities in access to neuropsychological services are the first challenge. Second, several socio-cultural and contextual factors relating to clinicians and patients may bias assessment outcomes. Finally, the large majority of neuropsychological tests and norms lack clinical utility for culturally, linguistically, and educationally diverse populations. The available indigenous and locally developed tools have not yet filled the gap. Deviation from standard administration procedures in cross-cultural situations further poses a threat to valid assessment. Failure to address these challenges increases the risk of under- and over-diagnosis, undertreatment and misdiagnosis of cognitive impairment in patients from diverse populations.Fil: Dutt, Aparna. Duttanagar Mental Health Centre. Neuropsychology & Clinical Psychology Unit; IndiaFil: Evans, Jonathan. Institute of Health & Wellbeing, University of Glasgow; Reino Unid

CORRELATION OF N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE (NT PRO BNP) WITH SERUM FERRITIN AND NUMBER OF BLOOD TRANSFUSIONS IN THALASSEMIA PATIENTS-A CROSS-SECTIONAL STUDY

Objective: Thalassemia is a genetic disorder of globin chain production in which there is an imbalance between alpha globin and beta globin chain production. Thalassemia patients require frequent blood transfusions to maintain adequate tissue oxygenation, which can cause a state of iron overload. NT pro BNP is a sensitive biomarker to detect cardiac iron overload. Our objective of this study was to estimate the level of NTproBNP in beta-thalassemia patients and to find out the correlation of NT pro BNP with serum ferritin levels and the number of blood transfusions.Methods: 50 thalassemic patients aged below 18 y with no known cardiac comorbidities were enrolled in this cross-sectional study. The correlation between the levels of NT-pro BNP with serum ferritin and number of blood transfusions and chelation therapy was measured.Results: This study demonstrated that the levels of NT Pro BNP were elevated in thalassemia patients with a positive correlation with serum ferritin values and the number of blood transfusions which the patients received.Conclusion: This Study also concluded that NT Pro BNP can be used as a biochemical marker used to detect early stages of cardiac failure and also to identify patients going for heart failure, especially in resource-limited settings

The future of neuropsychology in a global context

It is argued by some that neuropsychology is in crisis, its viability under threat. This chapter reviews the challenges faced by the field of neuropsychology in our globalized, multi-cultural world. Challenges exist within countries with well-established neuropsychology services that are seeking to better serve all members of the community whatever their cultural and linguistic background. Challenges also exist in countries without an established tradition of neuropsychological science and practice. Solutions to address these challenges are offered in this chapter, including short-term practical changes in practice that will immediately improve the validity of cross-cultural assessments, and long-term changes designed to reduce problems of access to neuropsychological services and improve the precision of neuropsychological assessment of people from all cultural backgrounds.Fil: Evans, Jonathan. University of Glasgow. Institute of Health & Wellbeing; Reino UnidoFil: Dutt, Aparna. Duttanagar Mental Health Centre; IndiaFil: Fernández, Alberto Luis. Universidad Católica de Córdoba. Neuropsychology Department; ArgentinaFil: Fernández, Alberto Luis. Universidad Nacional de Córdoba. Psychometrics Department; Argentin

Risk of Developing Antimicrobial Resistant Listeria monocytogenes in India: A Short Narrative Review

Background and Objective: Rampant application of antimicrobial drugs in food sectors triggered the development of resistance within the microorganisms in the surrounding environment. Due to the reduced susceptibility towards existing drugs, these microo-rganisms have an increased survival rate when treated. The emergence of this complication in the common food-borne pathogens is worrisome. Several antimicrobial-resistant variants of known infectious bacteria have been discovered. Listeria monocytogenes is one among those 'superbugs' bringing such public health challenges to be tackled. This article aims to review India's current situation and stance regarding the progressive issue of antimicrobial resistance and listeriosis. Results and Conclusion: The issue of antimicrobial resistance has been recognized at all food industry and health care domain levels. Solutions are constantly being made to combat the obstacle, but the antibiotic resistance crisis does not seem to retard. Despite the awareness, regulations, and restraints implemented across the globe, researches hint towards rising antimicrobial usage and the ensued more threatening infections. India's step towards curbing antimicrobial resistance is at par with other global policies and intends to lower the resistance development rate among all pathogens. Till now, Indian authorities and the public have shown insouciance towards listeriosis. There are no special rules targeting Listeria monocytogenes in India, as opposed to stringent regulations in many western countries. The Indian government and all associated authorities must study and develop plans to establish standards and statutes to control listeriosis. Above all, set up a surveillance system to monitor the causes of food-related illnesses across the country. Conflict of interest: The authors declare no conflict of interest

Cognition In Parkinsonian Syndromes : A Review

Parkinson&#x2032;s disease is a distinctive progressive disorder characterised clinically by tremor, rigidity, bradykinesia and postural imbalance. Although James Parkinson himself denied the presence of intellectual changes in the parkinsonian Disease, thorough exploration has revealed behavioural and cognitive changes to be explicit in the patients. India, along with its demographic shift and its overwhelming population growth, falls a victim to all old-age degenerative diseases. A large percentage of the elderly Indian population today suffers from Parkinsonian and related disorders. Disturbed cognition and neurobehavioral abnormalities are enough reasons for a falling ADL (activities of daily living) curve, and consequent distress to families of PD patients. Spontaneous involvement of one and all is required to not only intervene with the right pharmacological therapy, but also to empathize and develop the right attitude towards the affected person. Cognitive dysfunction in Parkinson&#x2032;s disease is well established and its affection in the early stage has been reported. In this article. We attempt to review and update the various cognitive impairments that occur in all the Parkinson related disorders which necessitates diagnosis, management and rehabilitation to alleviate patients&#x2032; suffering. It also reviews the role of frontal lobe, dementia and depression with respect to these patients