The relation between the symbol digit modalities test, fatigue, depression, and anxiety symptoms in a Belgian MS cohort

BACKGROUND

Multiple sclerosis (MS) is associated with high prevalence of cognitive impairment, ranging from 40 to 80%. The purpose of this single-center retrospective study was to examine the relation between cognitive function, as measured by Symbol Digit Modalities Test (SDMT), with fatigue, anxiety, and depression symptoms in a Belgian cohort of patients with MS.

METHODS

Sociodemographic and clinical data were analyzed in 66 (F:40, M:26) Belgian patients with a diagnosis of MS. The cognitive function was assessed with the oral version of SDMT, depression and anxiety symptoms with the Hospital Anxiety and Depression scale (HAD), fatigue symptoms with the French valid version of the Fatigue Impact Scale in MS (EMIF-SEP), which is a scale composed of four dimensions (cognitive, physical, social, and psychological) allowing a multidimensional evaluation of fatigue.

RESULTS

The multivariate linear regression analysis demonstrated that lower SDMT scores were associated with higher EDSS score and psychological dimension of fatigue symptoms. No association were found between SDMT and anxiety or depression symptoms. Conversely, higher depression and anxiety symptoms were associated with higher total fatigue symptoms, but lower physical dimension of fatigue symptoms. Higher anxiety symptoms were also independently associated with higher social dimension of fatigue symptoms.

CONCLUSION

A complex relationship exists between cognitive performance, fatigue, and neuropsychiatric symptoms in Belgian people with MS. The level of disability and fatigue adversely affects the cognitive function in MS, whereas depression and anxiety seem to not have a significant effect. A more complex relationship exists between fatigue and neuropsychiatric symptoms, with a divergent interplay between the different dimensions of fatigue that supports the multidimensional approach to assessing fatigue in MS.

Discromatismo Dental por Tetraciclina: uma Revisão de Literatura

O objetivo deste trabalho foi revisar a literatura sobre os graus de alterações de cores dentárias causadas por tetraciclina. Foi realizada uma busca na literatura nas bases de dados PubMed e Bireme, sendo encontrados 23 artigos no período compreendido entre 2012 a 2017, utilizando os descritores estética dental (dental esthetics), tetraciclina (tetracycline) e pigmentação (pigmentation). Foram selecionados seis artigos com base em título/Resumo. Os dentes que apresentam uma maior alteração de cor provocada pela tetraciclina são os anteriores. Nestes elementos, o terço cervical mostra uma alteração cromática mais intensa. As pigmentações são classificadas em graus I, II, III, IV. O grau I apresenta coloração amarelo claro, castanho ou cinza claro, uniformemente distribuída na coroa dental. O grau II apresenta aspecto amarelo ou cinza em vários tons e não apresenta faixas. O grau III apresenta uma coloração cinza escuro, com formação de bandas principalmente na cervical. O manchamento de grau IV é bastante severo, com faixas escuras. A associação entre diferentes técnicas de clareamento vital deve ser considerada a primeira escolha em tratamentos de discromatismo dental por tetraciclina. Contudo, nem todos os casos são sensíveis a este tratamento, podendo haver o emprego de técnicas restauradoras invasivas para um resultado final satisfatório.Palavras-chave: Pigmentação. Estética Dental. Tetraciclina

Timing of adjuvant chemotherapy in colorectal cancer

AIM

Delay in commencing adjuvant therapy for colorectal cancer seems to impair survival in some retrospective studies. This study was planned to evaluate its impact on survival.

METHODS

This was a retrospective study enrolling patients registered from 2000 to 2012 in two large cancer-dedicated institutions in Brazil. The primary outcome was overall survival according to early vs late chemotherapy initiation. The interval between the primary surgery and the start of adjuvant chemotherapy was calculated. Survival was estimated using the Kaplan-Meier method and the impact of multiple prognostic factors on survival by Cox regression analysis.

RESULTS

By the end of 2012, a total of 1963 Stage II and III colorectal patients were identified and 1318 patients received adjuvant chemotherapy, with 22% and 46% of those starting adjuvant chemotherapy within 6 weeks and 8 weeks of surgery. The median period of follow-up was 41 months. Patients starting chemotherapy within 6-8 weeks of surgery had longer overall survival compared with those who started after (6 weeks vs later, hazard ratio 0.76, 95% CI 0.57-0.99, P = 0.046; 8 weeks vs later, hazard ratio 0.74, 95% CI 0.59-0.93, P = 0.011). In the multivariate analysis, age, stage, histological grade, angiolymphatic invasion, emergency surgery and preoperative therapy were independent prognostic factors, but the interval between surgery and start of adjuvant therapy was not.

CONCLUSION

In this large retrospective study, the standard prognostic factors impacted on survival whereas the timing of adjuvant therapy did not. Patients with delayed adjuvant chemotherapy may have worse prognostic factors which could play a major role in their poor outcome.

Effect of the ketamine/xylazine anesthetic on the auditory brainstem response of adult gerbils

The auditory brainstem response (ABR) is a test widely used to assess the integrity of the brain stem. Although it is considered to be an auditory-evoked potential that is influenced by the physical characteristics of the stimulus, such as rate, polarity and type of stimulus, it may also be influenced by the change in several parameters. The use of anesthetics may adversely influence the value of the ABR wave latency. One of the anesthetics used for e ABR assessment, especially in animal research, is the ketamine/xylazine combination. Our objective was to determine the influence of the ketamine/xylazine anesthetic on the ABR latency values in adult gerbils. The ABRs of 12 adult gerbils injected with the anesthetic were collected on three consecutive days, or a total of six collections, namely: pre-collection and A, B, C, D, and E collections. Before each collection the gerbil was injected with a dose of ketamine (100 mg/kg)/xylazine (4 mg/kg). For the capture of the ABR, 2000 click stimuli were used with rarefaction polarity and 13 stimuli per second, 80 dBnHL intensity and in-ear phones. A statistically significant difference was observed in the latency of the V wave in the ABR of gerbils in the C and D collections compared to the pre-, A and E collections, and no difference was observed between the pre-, A, B, and E collections. We conclude that the use of ketamine/xylazine increases the latency of the V wave of the ABR after several doses injected into adult gerbils; thus clinicians should consider the use of this substance in the assessment of ABR.

Caroli's disease: report of 10 cases in children and adolescents in southern Brazil

PURPOSE

The aim of this study was to describe the authors' experience with Caroli's disease in children and adolescents.

METHODS

The authors reviewed the hospital charts of 10 children and adolescents with Caroli's disease diagnosed between 1968 and 1996.

RESULTS

The median age at the onset of symptoms was 5.5 months and the median age at diagnosis was 12 months, both much lower than those reported in the literature. Clinical symptoms were compatible with the classical findings of Caroli's disease, but jaundice and hepatosplenomegaly occurred more frequently. There was an association with congenital renal malformation in eight cases (80%), congenital hepatic fibrosis in five cases, and choledochal cyst in two cases. One case presented the pure form of the disease.

[Abnormalities of the cystic duct diagnosed by oral cholecystography. Report of a case]

A rare case of septal gallbladder with a long spiral cystic duct crossing the common hepatic duct and joining it at the papilla of Vater is described. These anomalies wer observed by oral cholecystography after a fatty meal.

[Cimetidine in the prevention of upper digestive hemorrhage in fulminating hepatitis]

The value of cimetidine on the prevention of gastric hemorrhage in 8 patients with fulminant hepatic failure was appreciated. The frequency of hemorrhage in this series was about 25% which is significant different from his past experience (52%) or from that of the literature (54%).

[Budd-Chiari syndrome and oral contraceptives. Report of a case and review of the literature]

One case of Budd-Chiari syndrome is described in a woman taking for 10 months oral contraceptive. The diagnosis was established by liver biopsy and inferior cavography. A review of the pertinent literature was made and the causal relationship between Budd-Chiari syndrome and oral contraceptive was considered.

[Anatomy and physiology of the liver secretory apparatus]

Bile secretion by the liver is thoroughly reviewed on its histologic and functional aspects. Regarding biliary flux, it is quantified as dependent or independent from bile acids. The mechanisms of excretion of other compounds like organic anions, cholesterol and phospholipids, are described. Such aspects allow the classification of intrahepatic cholestasis, based on their mechanisms, which can encompass the following: 1) decreased bile acid synthesis; 2) qualitative changes of bile acids; 3) enzymatic changes of the canalicular membrane; 4) changes in the permeability of the canalicular membrane; 5) dysfunction of the contractile microfilaments of the hepatocyte.