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Hidden burden of malaria in Indian women
Vinod P Sharma
Malaria Journal , 2009, DOI: 10.1186/1475-2875-8-281
Abstract: A recent article on malaria in pregnancy (MiP) contributed by three prestigious organizations (Indian Council of Medical Research, National Vector Borne Disease Control Programme, World Health Organization), monitoring malaria situation in India has revealed appalling situation of pregnant women contracting malaria infection [1]. In undivided Madhya Pradesh (Madhya Pradesh and Chhattisgarh states of India), the estimated annual MiP was in excess of 220,000 infections; 76,000 abortions; 19,800 stillbirths; and 1,000 maternal deaths. In the past, several studies from India and other countries of the WHO's South East Asia Region have highlighted the tragedy of pregnant women living in malaria endemic regions [2]. Persistent neglect of MiP is widening the gender equity gap of the already skewed gender picture emerging due to social reasons [3]. It is noteworthy to mention that malaria incidence data reported by the NVBDCP is grossly under-reported, and this fact has been highlighted time and again by several independent studies and the NVBDCP's in-depth evaluations [4-7]. Furthermore, NVBDCP's surveillance does not collect data on malaria in pregnant women and children under five years of age (U5), and, principally for this reason, malaria in pregnancy has remained hidden [8]. Wherever and whenever quality surveillance was undertaken it has exposed the real picture of malaria. An account of the prevailing malaria situation of pregnant women, neonates, and U5 in India, and countermeasures to make a difference in the existing malaria situation in high-risk groups (pregnant women and U5), are briefly described in the discussion below.Malaria is endemic in India, distributed throughout the length and breadth of the country, and an estimated >90% population (2001 population 1.13 billion) is at risk of the disease. Malaria surveillance is carried out at fortnightly intervals through a multi-purpose worker (MPWs) scheme at the village level, the active case detection (ACD). Bl
Statins Decrease Neuroinflammation and Prevent Cognitive Impairment after Cerebral Malaria  [PDF]
Patricia A. Reis ,Vanessa Estato,Tathiany I. da Silva,Joana C. d'Avila,Luciana D. Siqueira,Edson F. Assis,Patricia T. Bozza,Fernando A. Bozza,Eduardo V. Tibiri?a,Guy A. Zimmerman,Hugo C. Castro-Faria-Neto
PLOS Pathogens , 2012, DOI: 10.1371/journal.ppat.1003099
Abstract: Cerebral malaria (CM) is the most severe manifestation of Plasmodium falciparum infection in children and non-immune adults. Previous work has documented a persistent cognitive impairment in children who survive an episode of CM that is mimicked in animal models of the disease. Potential therapeutic interventions for this complication have not been investigated, and are urgently needed. HMG-CoA reductase inhibitors (statins) are widely prescribed for cardiovascular diseases. In addition to their effects on the inhibition of cholesterol synthesis, statins have pleiotropic immunomodulatory activities. Here we tested if statins would prevent cognitive impairment in a murine model of cerebral malaria. Six days after infection with Plasmodium berghei ANKA (PbA) mice displayed clear signs of CM and were treated with chloroquine, or chloroquine and lovastatin. Intravital examination of pial vessels of infected animals demonstrated a decrease in functional capillary density and an increase in rolling and adhesion of leukocytes to inflamed endothelium that were reversed by treatment with lovastatin. In addition, oedema, ICAM-1, and CD11b mRNA levels were reduced in lovastatin-treated PbA-infected mice brains. Moreover, HMOX-1 mRNA levels are enhanced in lovastatin-treated healthy and infected brains. Oxidative stress and key inflammatory chemokines and cytokines were reduced to non-infected control levels in animals treated with lovastatin. Fifteen days post-infection cognitive dysfunction was detected by a battery of cognition tests in animals rescued from CM by chloroquine treatment. In contrast, it was absent in animals treated with lovastatin and chloroquine. The outcome was similar in experimental bacterial sepsis, suggesting that statins have neuroprotective effects in severe infectious syndromes in addition to CM. Statin treatment prevents neuroinflammation and blood brain barrier dysfunction in experimental CM and related conditions that are associated with cognitive sequelae, and may be a valuable adjuvant therapeutic agent for prevention of cognitive impairment in patients surviving an episode of CM.
Vascular cognitive impairment: Current concepts and Indian perspective
Alladi Suvarna,Kaul Subhash,Mekala Shailaja
Annals of Indian Academy of Neurology , 2010,
Abstract: Cognitive impairment due to cerebrovascular disease is termed "Vascular Cognitive Impairment" (VCI) and forms a spectrum that includes Vascular Dementia (VaD) and milder forms of cognitive impairment referred to as Vascular Mild Cognitive Impairment (VaMCI). VCI represents a complex neurological disorder that occurs as a result of interaction between vascular risk factors such as hypertension, diabetes, obesity, dyslipidemia, and brain parenchymal changes such as macro and micro infarcts, haemorrhages, white matter changes, and brain atrophy occurring in an ageing brain. Mixed degenerative and vascular pathologies are increasingly being recognised and an interaction between the AD pathology, vascular risk factors, and strokes is now proposed. The high cardiovascular disease burden in India, increasing stroke incidence, and ageing population have contributed to large numbers of patients with VCI in India. Inadequate resources coupled with low awareness make it a problem that needs urgent attention, it is important identify patients at early stages of cognitive impairment, to treat appropriately and prevent progression to frank dementia.
Hyperhomocysteinemia in Patients with Cognitive Impairment
Marcello Ciaccio,Giulia Bivona,Antonino Tuttolomondo,Chiara Bellia,Riccardo Di Sciacca,Gaia Chiarello,Bruna Lo Sasso,Rosa C. Carollo,Domenico Di Raimondo,Antonio Pinto,Giuseppe Licata
Research Journal of Biological Sciences , 2012,
Abstract: Cognitive impairment is common in elderly people and represents clinical feature of neurodegenerative diseases. Not all of patients with Mild Cognitive Impairment (MCI) finally develop dementia and it is interesting to investigate the role of possible markers for early diagnosis. Hyperhomocysteinemia is associated to several pathologies including cognitive impairment; aim of this study is to evaluate the correlation between cognitive performance assessment and homocysteine plasma levels. Total 74 patients and 75 healthy controls were enrolled and MCI were defined by a MMSE score lower than 26 after adjustment for years of schooling. Homocysteine plasma levels were determined. Homocysteine levels significantly raised in patients with cognitive impairment and showed a significant negative association with MMSE score. Finally, our data show that a moderate risk of cognitive impairment could be associated to high homocysteine plasma levels.
Hyperhomocysteinemia in Patients with Cognitive Impairment
Marcello Ciaccio,Giulia Bivona,Antonino Tuttolomondo,Chiara Bellia
Research Journal of Biological Sciences , 2008,
Abstract: Cognitive impairment is common in elderly people and represents clinical feature of neurodegenerative diseases. Not all of patients with Mild Cognitive Impairment (MCI) finally develop dementia and it is interesting to investigate the role of possible markers for early diagnosis. Hyperhomocysteinemia is associated to several pathologies including cognitive impairment; aim of this study is to evaluate the correlation between cognitive performance assessment and homocysteine plasma levels. Total 74 patients and 75 healthy controls were enrolled and MCI were defined by a MMSE score lower than 26 after adjustment for years of schooling. Homocysteine plasma levels were determined. Homocysteine levels significantly raised in patients with cognitive impairment and showed a significant negative association with MMSE score. Finally, our data show that a moderate risk of cognitive impairment could be associated to high homocysteine plasma levels.
What is the global burden of visual impairment?
Lalit Dandona, Rakhi Dandona
BMC Medicine , 2006, DOI: 10.1186/1741-7015-4-6
Abstract: We reviewed data from population-based surveys of visual impairment worldwide published 1996 onwards that included presenting visual acuity, and estimated the proportion of visual impairment caused by uncorrected refractive error in different sub-regions of the world. We then extrapolated these data to estimate the worldwide burden of visual impairment including that caused by uncorrected refractive error.The total number of persons with visual impairment worldwide, including that due to uncorrected refractive error, was estimated as 259 million, 61% higher than the commonly quoted WHO estimate. This includes 42 million persons with blindness defined as presenting visual acuity less than 3/60 in the better eye, and 217 million persons with less severe visual impairment level defined as presenting visual acuity less than 6/18 to 3/60 in the better eye, 14% and 75% higher, respectively, than the WHO estimates based on best-corrected visual acuity. Sensitivity analysis, taking into account the uncertainty of the proportion of visual impairment caused by refractive error, revealed that the number of persons in the world with visual impairment due to uncorrected refractive error could range from 82 to 117 million.The actual burden of visual impairment worldwide, including that caused by uncorrected refractive error, is substantially higher than the commonly quoted WHO estimate that is based on best-corrected visual acuity. We suggest that the indicative estimate of 259 million persons with visual impairment worldwide, which includes 42 million blind with visual acuity less than 3/60 in the better eye, be used for further planning of the VISION 2020 initiative instead of the often quoted 161 million estimate that includes 37 million blind.The World Health Organization (WHO) recently completed an impressive global review of a large number of surveys on visual impairment, and estimated that there were 161 million persons worldwide with visual impairment in the year 2002, in
Profile of Cognitive Complaints in Vascular Mild Cognitive Impairment and Mild Cognitive Impairment  [PDF]
Jenny Gu,Corinne E. Fischer,Gustavo Saposnik,Tom A. Schweizer
ISRN Neurology , 2013, DOI: 10.1155/2013/865827
Abstract: Objective. Vascular mild cognitive impairment (VaMCI) is differentiated from mild cognitive impairment (MCI) by the presence of vascular events such as stroke or small vessel disease. Typically, MCI and VaMCI patients present with subjective complaints regarding cognition; however, little is known about the specific nature of these complaints. We aimed to create a profile of subjective cognitive complaints in MCI and VaMCI patients with similar levels of objective cognitive performance. Methods. Twenty MCI and twenty VaMCI patients were recruited from a Memory Disorders Clinic in Toronto. Subjective cognitive complaints were assessed and categorized using the Neuropsychological Impairment Scale. Results. MCI and VaMCI patients achieved similar scores on measures of objective cognitive function ( ). However, the VaMCI group had more subjective complaints than the MCI group ( ), particularly in the critical items, cognitive efficiency, memory, and verbal learning domains of the Neuropsychological Impairment Scale. Conclusions. Our findings support the idea that VaMCI and MCI differ in their clinical profiles, independent of neuroimaging. VaMCI patients have significantly more subjective cognitive complaints and may be exhibiting particular deficits in memory, verbal learning, and cognitive efficiency. Our findings promote the need for further research into VaMCI-specific cognitive deficits. 1. Introduction As adults age, it is common for cognitive problems to arise. Subjective cognitive complaints (SCC) are quite prevalent among older adults, with some estimates suggesting that between 25% and 50% of all older adults have self-perceived memory impairment [1, 2]. In clinical practice, it is often difficult to assess the veracity and severity of subjective cognitive complaints, primarily because such complaints vary widely from individual to individual. As a result, clinicians and caregivers perhaps do not consider subjective complaints to have the same weight as objective findings. However, studies have shown that subjective complaints may be valid indicators of current and future cognitive impairment. A recent study by Amariglio and colleagues showed that certain subjective complaints, such as “I have trouble finding my way around familiar streets,” are correlated with impairment in delayed recall, naming, and semantic fluency [3]. A review conducted by Jonker and colleagues showed that memory complaints may be predictive of dementia or Alzheimer’s disease onset within two to four years, especially in individuals with a diagnosis of mild cognitive
The Diagnostic Role of Brain MRI in Detection of Multiple Sclerosis Related Cognitive Impairment  [PDF]
Mohamed Saad, Maha Bilal, Wael Gabr, Aymen Abd Elnaby
Journal of Behavioral and Brain Science (JBBS) , 2019, DOI: 10.4236/jbbs.2019.98023
Abstract: Background: Cognitive impairment (CI) is a common manifestation of multiple sclerosis (MS), which can severely affect patients’ and their families’ life. Early suspicion and detection of CI can improve general medical management of MS patients. Objectives: To correlate MS related CI to cortical brain lesions using brain magnetic resonance imaging (MRI). Materials and Methods: Cognitive impairment was detected using mini mental state examination (MMSE); Neurological examination and brain MRI were performed for all patients. Correlation was calculated between disease cortical burden detected by MRI and CI. Results: Fifty-three patients with proven MS were scanned by brain MRI; 69.8% of them had cognitive impairment diagnosed with MMSE. The presence and severity of cognitive impairment was correlated to cortical brain lesion. Cognitive impairment was not correlated with non-cortical brain lesions or neurological physical disability measured by Expanded Disability Status Scale (EDSS). Conclusions: Presence of brain frontal cortical lesions detected by MRI in MS patients can predict subsequent development of MS-related CI.
Mild cognitive impairment: cognitive screening or neuropsychological assessment?
Diniz, Breno Satler;Nunes, Paula Villela;Yassuda, Monica S;Pereira, Fernanda S;Flaks, Mariana K;Viola, Luciane F;Radanovic, Marcia;Abreu, Izabella Dutra de;Borelli, Danilo T;Gattaz, Wagner F;Forlenza, Orestes Vicente;
Revista Brasileira de Psiquiatria , 2008, DOI: 10.1590/S1516-44462008000400003
Abstract: objective: to describe the neuropsychological profile of mild cognitive impairment subtypes (amnestic, non-amnestic and multiple-domain) of a clinical sample. we further address the diagnostic properties of the mini-mental state examination and the cambridge cognitive examination for the identification of the different mild cognitive impairment subtypes in clinical practice. method: cross-sectional clinical and neuropsychological evaluation of 249 elderly patients attending a memory clinic at a university hospital in sao paulo, brazil. results: the performance of patients with mild cognitive impairment was heterogeneous across the different subtests of the neuropsychological battery, with a trend towards an overall worse performance for amnestic (particularly multiple domain) mild cognitive impairment as compared to non-amnestic subtypes. screening tests for dementia (mini-mental state examination and cambridge cognitive examination) adequately discriminated cases of mild alzheimer's disease from controls, but they were not accurate to discriminate patients with mild cognitive impairment (all subtypes) from control subjects. conclusions: the discrimination of mild cognitive impairment subtypes was possible only with the aid of a comprehensive neuropsychological assessment. it is necessary to develop new strategies for mild cognitive impairment screening in clinical practice.
Cognitive Impairment in Heart Failure  [PDF]
Efthimios Dardiotis,Gregory Giamouzis,Dimos Mastrogiannis,Christina Vogiatzi,John Skoularigis,Filippos Triposkiadis,Georgios M. Hadjigeorgiou
Cardiology Research and Practice , 2012, DOI: 10.1155/2012/595821
Abstract: Cognitive impairment (CI) is increasingly recognized as a common adverse consequence of heart failure (HF). Although the exact mechanisms remain unclear, microembolism, chronic or intermittent cerebral hypoperfusion, and/or impaired cerebral vessel reactivity that lead to cerebral hypoxia and ischemic brain damage seem to underlie the development of CI in HF. Cognitive decline in HF is characterized by deficits in one or more cognition domains, including attention, memory, executive function, and psychomotor speed. These deficits may affect patients' decision-making capacity and interfere with their ability to comply with treatment requirements, recognize and self-manage disease worsening symptoms. CI may have fluctuations in severity over time, improve with effective HF treatment or progress to dementia. CI is independently associated with disability, mortality, and decreased quality of life of HF patients. It is essential therefore for health professionals in their routine evaluations of HF patients to become familiar with assessment of cognitive performance using standardized screening instruments. Future studies should focus on elucidating the mechanisms that underlie CI in HF and establishing preventive strategies and treatment approaches. 1. Introduction Heart failure (HF) is a major and growing health problem in the developed world that affects 1-2% of the adult population and 6–10% of people over the age of 65 [1, 2]. HF is associated with frequent hospital admissions, reduced quality of life, significant morbidity, and increased mortality [3–6]. It is estimated that elderly HF patients have high readmission rates ranging from 40 to 50% within 6 months [7]. Significant predictors of HF decompensation and high readmission rates include patients’ poor compliance with therapy and diet restrictions, and their failure to recognize early symptoms of HF deterioration which may be the consequences of cognitive impairment (CI) and poor insight [8]. Several studies have demonstrated that CI is particularly common in HF with 30% to 80% of patients with HF experiencing some degree of cognitive impairment [9, 10]. This wide range in CI prevalence estimates is believed to be the result of diverse study designs, HF severity, age of patients, sample sizes, neuropsychological tests, and diagnostic criteria between different studies. HF adversely affects various aspects of cognitive functioning, including attention, learning ability and delay recall, working memory, executive function, and psychomotor speed [9–11]. Areas of cognition less affected are the
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