Neuroprotection and Recovery in Multiple Sclerosis

Multiple sclerosis is a complex and heterogeneous immune-mediated disease that results in the progressive accumulation of mental and physical symptoms. Currently approved disease-modifying drugs (DMDs) are immunomodulatory or immunosuppressive, but these drugs have little effect on disease progression. In addition to studies that have directly targeted inflammation and immune responses, a large number of studies, most of them experimental, have investigated neuroprotective therapies and remyelination strategies. However, to date, attempts to provide neuroprotection have failed not just in multiple sclerosis but in neurological disorders in general; this situation has emphasized the need to revise the old paradigm of a “magic bullet” with a single mechanism of action. Remyelination strategies involve either promoting endogenous remyelination or replacing lost myelinating cells through exogenous sources. However, several puzzle pieces regarding the physiology of remyelination remain unknown, including feasible treatment monitoring methods, the selection of patients, and the optimal time of treatment initiation. This chapter will describe the direct and indirect neuroprotective effects of DMDs, as suggested by basic research studies and confirmed by clinical studies in some cases. Current knowledge of potential neuroprotective therapies and remyelination strategies is also reviewed

Cerebrolysin and repetitive transcranial magnetic stimulation (rTMS) in patients with traumatic brain injury: a three-arm randomized trial

IntroductionTraumatic brain injury (TBI) is a major public health problem affecting millions worldwide. Despite significant advances in medical care, there are limited effective interventions for improving cognitive and functional outcomes in TBI patients.MethodsThis randomized controlled trial investigated the safety and efficacy of combining repetitive transcranial magnetic stimulation (rTMS) and Cerebrolysin in improving cognitive and functional outcomes in TBI patients. Ninety-three patients with TBI were randomized to receive either Cerebrolysin and rTMS (CRB + rTMS), Cerebrolysin and sham stimulation (CRB + SHM), or placebo and sham stimulation (PLC + SHM). The primary outcome measures were the composite cognitive outcome scores at 3 and 6 months after TBI. Safety and tolerability were also assessed.ResultsThe study results demonstrated that the combined intervention of rTMS and Cerebrolysin was safe and well-tolerated by patients with TBI. Although no statistically significant differences were observed in the primary outcome measures, the descriptive trends in the study support existing literature on the efficacy and safety of rTMS and Cerebrolysin.DiscussionThe findings of this study suggest that rTMS and Cerebrolysin may be effective interventions for improving cognitive and functional outcomes in TBI patients. However, limitations of the study, such as the small sample size and exclusion of specific patient populations, should be considered when interpreting the results. This study provides preliminary evidence for the safety and potential efficacy of combining rTMS and Cerebrolysin in improving cognitive and functional outcomes in TBI patients. The study highlights the importance of multidisciplinary approaches in TBI rehabilitation and the potential for combining neuropsychological measurements and interventions to optimize patient outcomes.ConclusionFurther research is needed to establish these findings’ generalizability and identify the optimal dosages and treatment protocols for rTMS and Cerebrolysin

Catheter ablation of idiopathic ventricular fibrillation using the CARTO 3 mapping system

Ventricular fibrillation in the absence of structural heart disease represents an important mechanism of sudden cardiac death. It is initiated by triggers originating in the distal Purkinje fibers, arising from either the right or the left ventricle. Catheter ablation of these triggers has the potential of terminating the arrhythmia and preventing recurrence. We present the case of an electrical storm in a 39-year old female patient with no cardiac past medical history, with recurrent episodes of idiopathic ventricular fibrillation, who was referred to our hospital for repeated episodes of syncope. The 12-lead ECG showed the presence of frequent ventricular premature beats (VPB), having a left-bundle branch block morphology and superior axis, with an “R on T” phenomenon, initiating non-sustained episodes of ventricular fibrillation. Using a three-dimensional, non-fluoroscopic mapping system (CARTO 3, Biosense Webster), the origin of the ventricular premature beat responsible for the initiation of VFib was identified and successfully ablated. Catheter ablation of idiopathic ventricular fibrillation using a 3-dimensional mapping system is a feasible therapeutic option for patients with this type of arrhythmia

PSEUDOMONAS AERUGINOSA INFECTIONS IN THE “SFÂNTA PARASCHEVA” INFECTIOUS DISEASES HOSPITAL OF IASI CITY

Background. Pseudomonas aeruginosa is a dangerous, hard to treat pathogen, due to an increasing frequency of resistance to multiple antibiotics. This susceptibility pattern is influenced by multiple factors and it frequently has a regional or local character, different for each hospital or intensive care unit. Methods. We analysed and compared the characteristics of 62 patients and their isolated P. aeruginosa strains, treated in the “Sfânta Parascheva” Infectious Diseases Hospital of Iasi City between January and December 2011 (Group 1 – 25c) and between January and December 2016 (Group 2 – 37c). The susceptibility was tested by disk diffusion test; CLSI standards were used. Results. The median age was higher in group 2 (63 years) vs group 1 (52 years, p=0.04), more men were affected in both groups (59.2 vs 57.5%). In group 2 the strains were isolated from urine (50%), sputum (17.5%), wound secretions (15%), blood cultures (10%) or central venous catheters (7.5%); more than half may be of nosocomial origin; the infection mainly occurred in patients with significant comorbidities, long-term hospitalization (median - 15 days), ICU care or mechanical ventilation. We did not find a significant increase in the resistance rates in group 2 for the tested antibiotics; they remain high for almost every drug: 55 vs 60% for imipenem, 70 vs 62% for meropenem, 31 vs 41.7% for ceftazidime, 68 vs 75% for ciprofloxacin, 50 vs 42.8% for gentamicin, 63.6 vs 45.8% for amikacin, 46 vs 30% for piperacillin-tazobactam. All isolates were susceptible to colistin. The share of MDR isolates was slightly higher in group 2 (52 vs 61%, p=0.4). The treatment of these infections was difficult, with an average duration of 15 days; 20% of patients died. Conclusions. In our hospital, P. aeruginosa infections appeared predominantly in elderly patients, often in association with medical care, were associated with multidrug resistance to anti-biotics and sometimes had a guarded prognosis. The antibiotic susceptibility rates did not vary significantly in the two time intervals that we analysed