Recovery of cognitive function in a substance abuse population

Background: Substance abuse is known to cause injury to the brain that may not be fully repaired by sobriety. The most commonly identified impairments are in attention, working memory, and executive functioning. Although research has found that most people do experience some level of cognitive improvement after stopping substance use, it is unclear how quickly this happens and if there is a particular pattern in improvement. This pilot study tested the natural rate of cognitive recovery in early substance abuse treatment.Methods: Participants were 28 adults newly admitted to a residential substance abuse treatment facility. All were post-detox. The majority were in treatment for polysubstance abuse, with 15 having primary opioid abuse. NIH Toolbox cognition battery was administered at intake and 4 weeks later.Results: Regarding cognition, primary weaknesses at baseline were in processing speed (Pattern Comparison mean t- score=41.96), attention and executive function (Flanker mean t- score=43.0) and working memory (List Sorting mean t- score=44.04). Cognitive recovery during the normal course of early inpatient treatment was significant in the areas of processing speed, attention and executive functioning and yielded significant improvement in the Cognitive Function Composite Score (p < .01).Conclusions: Consistent with previous research, this pilot study found that patients commonly enter inpatient treatment with inefficiencies in fluid cognition skills. Over the course of 1-month of inpatient treatment, this sample of patients experienced significant improvement across multiple domains, with significant improvements in composite Fluid and Total Cognition scores. Further study on the pattern of cognitive changes during substance abuse treatment may be used to help better match intervention strategy to cognitive level and possibly develop cognitive rehabilitation protocols to increase treatment engagement and extend abstinence via improvement in cognitive capacity

Cognitive recovery in early substance abuse treatment

Background: Substance abuse is known to cause injury to the brain that may not be fully repaired by sobriety. The most commonly identified impairments are in attention, working memory, and executive functioning. Although research has found that most people do experience some level of cognitive improvement after stopping substance use, it is unclear how quickly this happens and if there is a particular pattern in improvement. This pilot study tested the natural rate of cognitive recovery in early substance abuse treatment.Methods: Participants were 28 adults newly admitted to a residential substance abuse treatment facility. All were post- detox. The majority were in treatment for polysubstance abuse, with 15 having primary opioid abuse. NIH Toolbox cognition battery was administered at intake and 4 weeks later.Results: Regarding cognition, primary weaknesses at baseline were in processing speed (Pattern Comparison mean t- score=41.96), attention and executive function (Flanker mean t- score=43.0) and working memory (List Sorting mean t- score=44.04). Cognitive recovery during the normal course of early inpatient treatment was significant in the areas of processing speed, attention and executive functioning and yielded significant improvement in the Cognitive Function Composite Score (p<.01).Conclusions: Consistent with previous research, this pilot study found that patients commonly enter inpatient treatment with inefficiencies in fluid cognition skills. Over the course of 1-month of inpatient treatment, this sample of patients experienced significant improvement across multiple domains, with significant improvements in composite Fluid and Total Cognition scores. Further study on the pattern of cognitive changes during substance abuse treatment may be used to help better match intervention strategy to cognitive level and possibly develop cognitive rehabilitation protocols to increase treatment engagement and extend abstinence via improvement in cognitive capacity

Transvenous nonfluoroscopic pacemaker implantation during pregnancy guided by 3-dimensional electroanatomic mapping

Patients with congenital heart disease are at ongoing risk of developing both bradyarrhythmias and tachyarrhythmias decades after surgical repair. Rarely, arrhythmias can be exacerbated during pregnancy and require emergent intervention. Here, we report unique experience with nonfluoroscopic pacemaker implantation during pregnancy. Ionizing radiation, even in low doses, is associated with an increased risk of malignancy, and a fetus may be at particularly increased risk.1, 2 Over the past 2 decades, the use of fluoroscopy in cardiac ablation procedures has become nearly obsolete with the development of 3-dimensional (3D) electroanatomic mapping software such as CARTO (Biosense-Webster, Diamond Bar, CA) and NavX or EnSite (St. Jude Medical, Inc., St. Paul, MN).3 However, certain procedures, such as device implants, still commonly use fluoroscopy in most instances.2 Fluoroscopy use in patients with congenital heart disease is of utmost concern because of cumulative radiation exposure from multiple lifetime catheterization, radiographic and computed tomography imaging, and electrophysiological procedures

Enhancing breast milk production with Domperidone in mothers of preterm neonates (EMPOWER trial)

BACKGROUND: The use of mother’s own breast milk during initial hospitalization has a positive impact not only in reducing potential serious neonatal morbidities but also contribute to improvements in neurodevelopmental outcomes. Mothers of very preterm infants struggle to maintain a supply of breast milk during their infants’ prolonged hospitalization. Galactogogues are medications that induce lactation by exerting its effects through oxytocin or prolactin enhancement. Domperidone is a potent dopamine D(2) receptor antagonist which stimulates the release of prolactin. Small trials have established its ability in enhancing breast milk production. EMPOWER was designed to determine the safety and efficacy of domperidone in mothers experiencing an inadequate milk supply. METHODS/DESIGN: EMPOWER is a multicenter, double masked, randomized controlled phase-II trial to evaluate the safety and effectiveness of domperidone in those mothers identified as having difficulty in breast milk production. Eligible mothers will be randomized to one of two allocated groups: Group A: domperidone 10 mg orally three times daily for 28 days; and Group B: identical placebo 10 mg orally three times daily for 14 days followed by domperidone 10 mg orally three times daily for 14 days. The primary outcome will be determined at the completion of the first 2-week period; the second 2-week period will facilitate answering the secondary questions regarding timing and duration of treatment. To detect an estimated 30% change between the two groups (from 40% to 28%, corresponding to an odds ratio of 0.6), a total sample size of 488 mothers would be required at 80% power and alpha = 0.05. To account for a 15% dropout, this number is increased to 560 (280 per group). The duration of the trial is expected to be 36–40 months. DISCUSSION: The use of a galactogogue often becomes the measure of choice for mothers in the presence of insufficient breast milk production, particularly when the other techniques are unsuccessful. EMPOWER is designed to provide valuable information in guiding the practices for this high-risk group of infants and mothers. The results of this trial will also inform both mothers and clinicians about the choices available to increase and maintain sufficient breast milk. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT0151222

Seroprevalence of Toxoplasma gondii IgG antibody in HIV/AIDS-infected individuals in Maputo, Mozambique

OBJETIVO Avaliar a prevalência de anticorpos IgG anti- Toxoplasma gondii em pessoas infectadas pelo HIV/Aids e a associação de variáveis demográficas e sociais. MÉTODOS Estudo transversal que incluiu a análise de dados sociodemográficos e laboratoriais de 200 pessoas infectadas por HIV/Aids, atendidas em unidade laboratorial em 2010 na Província de Maputo, Moçambique. Os dados foram coletados por meio de questionário autopreenchido por todos os participantes. Para a análise de anticorpos, amostras de plasma coletadas foram confirmadas para testagem de IgG anti- T. gondii por hemaglutinação. RESULTADOS A soroprevalência de IgG anti- T. gondii foi de 46,0% (IC95% 39,2;52,9), 39,3% (IC95% 29,5;50,0) em homens e de 50,9% (IC95% 41,9;59,8) em mulheres, sem diferença entre sexo (OR 1.30; IC95% 0.95;1.77; p = 0.12). A idade variou de 10 a 60 anos, com maior prevalência de infecção em grupos etários mais idosos, mas sem haver diferença significativa entre eles. Ter consumo regular de carne de gado bovino (OR 1,74; IC95% 1,04;2,89, p = 0,05), possuir criação de gatos/cães (OR 6,18; IC95% 3,60;10,62, p < 0,000) e ter contato regular com a terra (OR 3,38; IC95% 2,19;5,21, p < 0,000) estiveram significativamente associados ao risco de infecção latente. CONCLUSÕES A infecção por toxoplasmose apresenta alta prevalência na população de Moçambique, cujo risco amplia-se pelos aspectos culturais e comportamentais. A toxoplasmose pode ser responsável pela grande carga de morbimortalidade associada a lesões meningoencefálicas em pessoas com HIV/Aids no país.OBJETIVO Evaluar la prevalencia de anticuerpos IgG anti- Toxoplasma gondii en personas infectadas por VIH/SIDA y la asociación de variables demográficas y sociales. MÉTODOS Estudio transversal que incluyó el análisis de datos sociodemográficos y de laboratorio de 200 personas infectadas por VIH/SIDA, atendidas en unidad de laboratorio en 2010 en la Provincia de Maputo, Mozambique. Los datos fueron colectados por medio de cuestionario auto llenado por todos los participantes. Para el análisis de anticuerpos, las muestras de plasma colectadas fueron confirmadas para evaluación anti- T. gondii por hemaglutinación. RESULTADOS La seroprevalencia de IgG anti- T. gondii fue de 46% (IC95% 39,2;52,9), 39,3% (IC95% 29,5;50,0) en hombres y de 50,9% (41,9-59,8%) en mujeres, sin diferencia entre sexo (OR 1.30; IC95% 0.95;1.77; p = 0.12). La edad varió de 10 a 60 años, con mayor prevalencia de infección en grupos etarios más ancianos, pero sin haber diferencia significativa entre ellos. Consumir carne de ganado bovino regularmente (OR 1,74; IC95% 1,04;2,89, p = 0,05), poseer cria de gatos/perros (OR 6,18; IC95% 3,60;10,62, p < 0,000) y tener contacto regular con la tierra (OR 3,38; IC95% 2,19;5,21, p < 0,000) estuvieron significativamente asociados al riesgo de infección latente. CONCLUSIONES La infección por toxoplasmosis presenta alta prevalencia en la población de Mozambique, cuyo riesgo se amplía por los aspectos culturales y de comportamiento. La toxoplasmosis puede ser responsable por la gran carga de morbi-mortalidad asociada a lesiones meningoencefálicas en personas con VIH/SIDA en el país.OBJECTIVE To analyze the prevalence of IgG antibodies to Toxoplasma gondii in patients infected with HIV/AIDS and the association of demographic and social variables. METHODS Descriptive cross-sectional study that included the analysis of sociodemographic data and laboratory findings of 200 patients infected with HIV/AIDS treated in a laboratory unit in Maputo, Mozambique, in 2010. Individual data for all participants were collected with a self-administered questionnaire. Plasma samples were tested for IgG testing of anti- T. gondii using hemagglutination for the analysis of antibodies. RESULTS The seroprevalence of IgG anti- T. gondii was 46.0% (95%CI 39.2;52.9), 39.3% (95%CI 29.5;50.0) in men and 50.9% (95%CI 41.9;59.8) in women, with no difference between sex (OR 1.30; 95%CI 0.95;1.77; p = 0.12). Ages ranged from 10 to 60 years, with a higher prevalence of infection in older age groups, but with no significant difference between them. Regularly consuming cattle meat (OR 1.74; 95%CI 1.04;2.89, p = 0.05), breeding cats/dogs (OR 6.18; 95%CI 3.60;10.62, p < 0.000) and having regular contact with soil (OR 3.38; 95%CI 2.19;5.21; p < 0.000) were significantly associated with risk of latent infection. CONCLUSIONS Toxoplasmosis is an infection with high prevalence in Mozambique. Cultural and behavioral aspects increase the risk. Toxoplasmosis can be responsible in our environment by the great burden of morbidity and mortality associated with meningoencephalic injuries in patients with HIV/AIDS

Dynamic interaction networks in a hierarchically organized tissue

We have integrated gene expression profiling with database and literature mining, mechanistic modeling, and cell culture experiments to identify intercellular and intracellular networks regulating blood stem cell self-renewal.Blood stem cell fate in vitro is regulated non-autonomously by a coupled positive–negative intercellular feedback circuit, composed of megakaryocyte-derived stimulatory growth factors (VEGF, PDGF, EGF, and serotonin) versus monocyte-derived inhibitory factors (CCL3, CCL4, CXCL10, TGFB2, and TNFSF9).The antagonistic signals converge in a core intracellular network focused around PI3K, Raf, PLC, and Akt.Model simulations enable functional classification of the novel endogenous ligands and signaling molecules

Atividades biológicas e composição química dos extratos brutos de Chresta exsucca

As atividades tripanocida, leishmanicida, antibacteriana e antifungica dos extratos brutos de Chresta exsucca foram investigadas. Formas tripomastigotas do Trypanosoma cruzi, formas amastigotas de Leishmania amazonensis e vinte cepas de microrganismos, incluindo bactérias Gram-positivas, Gram-negativas e leveduras, foram utilizadas nos ensaios biológicos. Os melhores resultados foram obtidos para a atividade leishmanicida. A composição química dos extratos hexânicos e etanólicos dessa espécie foi determinada empregando-se técnicas cromatográficas como HRGC e HPLC-ESI-MS, respectivamente. Esteróides, triterpenos e flavonóides foram identificados.Crude extracts of Chresta exsucca were investigated for their in vitro trypanocidal, leishmanicidal, antibacterial and antifungal activities. Trypomastigote forms of Trypanosoma cruzi, amastigote-like forms of Leishmania amazonensis and twenty strains of microorganisms including Gram-positive and Gram-negative bacteria and yeasts were utilized in the bioassays. The best results were found for the leishmanicidal activity. The chemical composition of hexanic and ethanolic extracts of this species was determinate using chromatographic techniques as HRGC and HPLC-ESI-MS, respectively. Steroids, triterpenes and flavonoids were identified

Views and Experiences of Persons with Chronic Diseases about Strategies that Aim to Integrate and Re-Integrate Them into Work: A Systematic Review of Qualitative Studies

The effectiveness of strategies targeting professional integration and reintegration strongly depends on the experiences of participants. The aim of this systematic literature review is to synthesize European qualitative studies exploring views and experiences of persons with chronic conditions regarding strategies for integration and reintegration into work. The systematic search was conducted in Medline, PsycINFO, CDR-HTA, CDR-DARE and Cochrane Systematic Reviews. Overall, 24 studies published in English between January 2011 and April 2016 were included. Most studies were carried out in Nordic countries or in the UK, and most participants were persons with either mental or musculoskeletal disorders. Ten themes emerged: individual and holistic approach, clarity of strategy and processes, timing of rehabilitation processes, experience with professionals, at the workplace and with peer groups, changes in the understanding of health and work, active involvement in the process, competencies development and motivating aspects of work. Findings highlight, among others, the need to actively involve participants in the return to work process and to provide timely and clearly structured processes and interventions. This review provides stakeholders key information to develop, plan, implement and evaluate interventions to integrate and re-integrate persons with chronic conditions into work in Europe

Transplantation of canine olfactory ensheathing cells producing chondroitinase ABC promotes chondroitin sulphate proteoglycan digestion and axonal sprouting following spinal cord injury

Olfactory ensheathing cell (OEC) transplantation is a promising strategy for treating spinal cord injury (SCI), as has been demonstrated in experimental SCI models and naturally occurring SCI in dogs. However, the presence of chondroitin sulphate proteoglycans within the extracellular matrix of the glial scar can inhibit efficient axonal repair and limit the therapeutic potential of OECs. Here we have used lentiviral vectors to genetically modify canine OECs to continuously deliver mammalian chondroitinase ABC at the lesion site in order to degrade the inhibitory chondroitin sulphate proteoglycans in a rodent model of spinal cord injury. We demonstrate that these chondroitinase producing canine OECs survived at 4 weeks following transplantation into the spinal cord lesion and effectively digested chondroitin sulphate proteoglycans at the site of injury. There was evidence of sprouting within the corticospinal tract rostral to the lesion and an increase in the number of corticospinal axons caudal to the lesion, suggestive of axonal regeneration. Our results indicate that delivery of the chondroitinase enzyme can be achieved with the genetically modified OECs to increase axon growth following SCI. The combination of these two promising approaches is a potential strategy for promoting neural regeneration following SCI in veterinary practice and human patients