Correlation of COVID-19 with Severity of Periodontitis-A Clinical and Biochemical Study

Background: Various conceptual hypotheses have been put forth to link association of COVID?19 with various chronic diseases such as periodontitis. Empirical evidence is still lacking to correlate the severity of COVID?19 with periodontal diseases. Objectives: This study was undertaken with an objective to correlate COVID severity in systemically healthy patients suffering from periodontal diseases. Materials and Methods: 44 systemically healthy patients of both genders with minimum of 20 teeth in their oral cavity in age range of 20 to 50 years suffering from periodontitis were recruited and categorised into four stages as per American Academy of Periodontology (AAP) 2017 classification for periodontitis. Serum C?reactive protein (CRP) levels and periodontal disease parameters of all the patients were measured. Because of COVID?19 and the nationwide lockdown, the dental practice was highly affected. With the help of self?designed online questionnaire information regarding COVID?19 infection and associated symptoms were recorded. Cases were categorized into five groups based on the World Health Organization clinical progression scale of COVID severity. Results: All the patients suffering from COVID disease in moderate and severe forms had increased probing pocket depth, clinical attachment level, and raised serum C?reactive protein levels as compared to patients who were uninfected or suffering from mild COVID disease and the results were statistically significant. Conclusion: Prioritisation and Implementation of periodontal treatment as a preventive measure for COVID?19 should be done. A positive correlation is observed between the severity of periodontitis and COVID?19.

Assessment of Functional Mitral Regurgitation Severity by Proximal Isovelocity Surface Area via 3D Transthoracic Echocardiography

Background: Accurate quantitative evaluation of MR severity remains challenging because limited scan plane orientation of 2D echocardiography does not provide direct measurement of the regurgitant lesion. Three-dimensional echocardiography, which has become a clinically established technique, has been shown to provide useful information for flow quantification and so has the potential to address the major drawbacks of 2D-based approaches. Objectives: To assess the reliability of PISA measurement using real-time 3D color trans-thoracic echocardiographic imaging in clinical practice and to compare its derived EROA, regurgitant volume (Rvol) and regurgitant fraction with that obtained by 2D trans thoracic PISA. Patients and Methods: This cross-sectional study, included 30 patients with at least moderate functional MR came for evaluation on clinical basis indications at Al-Hussein and Bab El-Shaareya University Hospitals during the period from November 2020 to July 2021. Two- and three-dimensional echocardiography was done to asses MR and calculate vena contract width, 2D PISA and derived EORA and regurgitant volume. Also, calculation of 3D EROA using PISA method by 3D probe. Results: There was a significant positive correlation between 2D EPISA and 3D EROA using PISA method and EROA, p value was 0.0001. With higher values for 3D EROA using PISA method when compared with 2D PISA in different degrees of MR as summarized in “the mean value of EROA by 2D PISA in moderate MR was 0.25 ±0.042 cm2, while it was 0.32±0.059 cm2 by 3D EROA using PISA method. While the mean value of EROA by 2D PISA in severe MR was 0.58 ±0.14 cm2, and it was 0.47 ±0.049 cm2 by 3D EROA”. Also showed significant difference in different direction of MR jets especially in eccentric jet as shown by the mean value of EROA by 2D PISA in central MR was 0.41±0.19 cm2, while it was 0.41±0.87 cm2 by 3D method. While the mean value of EROA by 2D PISA in eccentric MR was 0.53 ±0.21 cm2, and it was 0.44 ±0.096 cm2 by 3D EROA using PISA method. Conclusion: The use of 3D EROA using PISA method and simple calculation of a mean systolic regurgitation orifice area proved to be superior to 2D measures (VC, 2D-PISA) for distinguishing moderate from severe MR, evaluation, classification and grading of MR in a routine clinical cardiology setting. 3D EROA reduces assumptions and seemingly improves diagnostic value as compared with 2D-PISA

Relación entre la anemia infantil y el desempeño intelectual en la juventud

Objetivo: Determinar la relación que entre la anemia padecida por una generación cuando eran niños y su rendimiento en la prueba PISA a los 15 años de edad. Material y métodos: Se relacionó el puntaje que los jóvenes de cada país obtuvieron en la prueba PISA 2018 con la prevalencia de anemia infantil en 2005, el Ingreso Nacional Bruto per cápita y los Años Esperados de Escolaridad del Índice de Desarrollo Humano del año 2018. Resultados: El puntaje obtenido en la prueba PISA se relaciona con la anemia cuando niños, el Ingreso Nacional Bruto per cápita y los Años Esperados de Escolaridad (Esfuerzo Educativo) con coeficientes de determinación (r2) de 0.5168, 0.1951 y 0.3536, respectivamente. Conclusión: El puntaje obtenido en la prueba PISA se asocia con más fuerza con la prevalencia de anemia que padeció esa generación cuando eran niños que con cualquier otro factor económico o social actuales.

Cognitive Abilities, Debt, Roads and their Impact on Deaths in Traffic in Brazil / Habilidades Cognitivas, Endividamento, Rodovias e seus Impactos nos Óbitos no Trânsito

Abstract Deaths in traffic represent a global and multicausal problem. We verified, through a linear regression model, that cognitive abilities (CA) and population indebtedness (PI) predict, together, 56% of the variation of death rates in the traffic (DT) of the twenty-seven states of Brazil. CA's are related to a greater control of the attention and, possibly, to a greater compliance with norms for preventing traffic accidents, has a greater impact than PI on DT, since PI associates to only one deficit of people's attention resources. The decrease of PI and the improvement of CA can decrease DT.

Resumo Os óbitos no trânsito representam um problema global e multicausal. Verificamos, por meio de um modelo de regressão linear, que as habilidades cognitivas (HC) e o endividamento populacional (ENDP), predizem, juntos, 56% da variação das taxas de óbitos no trânsito (TOT) das 27 unidades federativas (UF) do Brasil. As HC, por estarem relacionadas a um maior controle da atenção e, possivelmente, a um maior cumprimento de normas de prevenção contra acidentes de trânsito, possuem um impacto maior que o ENDP sobre as TOT, já que o ENDP associa somente a um deficit dos recursos de atenção das pessoas. A diminuição do ENDP e a melhoria das HC podem reduzir as TOT.

Brasil no pisa 2003 e 2012: os estudantes e a matemática / Brazil in pisa 2003 and 2012: students and mathematics / Le brésil au pisa 2003 et 2012: les élèves et les mathématiques / Brasil en el pisa 2003 y 2012: los estudiantes y la matemática

Resumo Este trabalho apresenta uma investigação sobre o desempenho dos estudantes brasileiros em Matemática no Pisa de 2003 e 2012. O objetivo foi verificar em qual conteúdo avaliado os estudantes apresentaram melhor desempenho e dispersão positiva na escala de níveis da avaliação. A estratégia empírica adotada foi descritiva e comparativa. Foram analisados relatórios do Inep (Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira) e da OCDE/Pisa para compor a base de dados para análise comparativa das duas aplicações da prova. Os resultados apontam que os estudantes brasileiros apresentaram melhor desempenho e a mais significativa distribuição na escala Pisa em Indeterminação e Dados ou Probabilidade. Contudo o desempenho dos estudantes brasileiros, influenciado por uma multiplicidade de fatores, ainda está longe de atingir os níveis da OCDE.

Abstract This study presents an investigation on the performance of Brazilian students in Mathematics in Pisa 2003 and 2012. Our goal was to identify the assessed content in which the students had their best performance and most significant dispersion in the scale of assessment levels. Our empirical study consisted of descriptive and comparative analyses. Reports from Inep (Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira) and OECD/Pisa were analyzed to make up the database for comparing the two editions of the test. The results show that Brazilian students had their best performance and most significant distribution on the Pisa scale in Indetermination and Data or Probability. However, the performance of Brazilian students, influenced by innumerous factors, is still far below OECD levels.

Résumé Cet article présente une recherche sur la performance des élèves brésiliens en mathématiques dans au Pisa 2003 et 2012. L'objectif était de vérifier quels étaient les contenus évalués dans lesquels les élèves avaient obtenu une meilleure performance et dispersion positive sur l'échelle des niveaux d'évaluation. La stratégie empirique adoptée a été d'ordre descriptif et comparatif. Des rapports de l'Inep (Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira) et de l' OCDE/Pisa ont été analysés pour composer la base de données de l'analyse comparative des deux épreuves du test. Les résultats indiquent que, sur l'échelle Pisa, les élèves brésiliens ont présenté une meilleure performance et la distribution la plus marquée en Indétermination et en Données et Probabilité. Cependant, dû à une multitude de facteurs, le score des élèves brésiliens est encore loin d'atteindre les niveaux de l'OCDE.

Resumen Este trabajo presenta una investigación sobre el desempeño de los estudiantes brasileños en Matemática en el Pisa de 2003 y 2012. El objetivo fue verificar en cuál contenido evaluado los estudiantes presentaron mejor desempeño y dispersión positiva en la escala de niveles de evaluación. La estrategia empírica adoptada fue descriptiva y comparativa. Fueron analizados informes del Inep (Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira) y de la OCDE/Pisa para componer la base de datos para análisis comparativa de las dos aplicaciones de la prueba. Los resultados apuntan que los estudiantes brasileños presentaron mejor desempeño y la más significativa distribución en la escala Pisa en Indeterminación y Datos o Probabilidad. Aun considerando esto, el desempeño de los estudiantes brasileños, influenciado por una multiplicidad de factores, todavía esta lejos de alcanzar los niveles de la OCDE.

PISA 2012: Inmigración y etapa de llegada al Sistema Educativo Español / PISA 2012: Age at Immigration and the Spanish Education System

Resumen Introducción. Las evidencias empíricas muestran que hay diferencias en el rendimiento entre es colares inmigrantes que puede ser atribuido a diferentes variables, entre ellas la etapa de llegada al Sistema Educativo Español. Objetivo. Analizar el riesgo y/o probabilidad que escolares inmi grantes de la muestra española tienen de tener bajo rendimiento en las competencias evaluadas en PISA 2012, considerando la etapa de llegada al Sistema Educativo como variable predictora del riesgo. Metodología. No experimental o ex-post facto, diseño comparativo - causal. Análisis de datos. Análisis de regresión logística binaria. Resultados. En relación a la etapa de llegada al Sistema Educativo Español, es en la etapa de Educación Infantil donde se registra mayor riesgo de bajo de rendimiento en comparación con Educación Infantil: Lectura, Matemáticas y Ciencias. Respecto a las competencias, es en la competencia matemática donde se registra mayor riesgo en comparación con el resto de competencias evaluadas (Lectura y Ciencias). Conclusiones. El riesgo de tener bajo rendimiento varía según la etapa de llegada al Sistema Educativo. La llega da de escolares inmigrantes en Educación Infantil es un factor de riesgo. Es necesario desarro llar políticas educativas (programas lingüísticos, programas de acogida, por ejemplo) que mini micen el impacto y reduzcan el riesgo con el abandono y fracaso escolar en etapas posteriores.

Abstract Introduction. Immigrants arriving at school at younger ages have lower educational achievement than those who arrive at adolescence. Aims. Analyze risk and / or probability of immigrant students having low performance in skills assessed in PISA 2012, considering their age of arrival into the Education System. Methodology. Non- experimental or ex post facto, comparative design - cau sal. Data Analysis: Binary logistic regression analysis. Outcomes. In relation to the age at entrance into the Spanish Education System, the stage of Early Childhood Education increases the risk of a diminished performance in Reading, Mathematics and Science. With respect to PISA 2012 skills as sessment, it varies in stages: Kindergarten, Primary Education y Secondary Education. Conclusions. The risk of low performance varies with the educational stage at arrival. The arrival of immigrant students at Primary Education is a risk factor. We need to develop educational policies (e.g., language programs, host programs) that minimize the impact and reduce the risk of subsequent abandonment.

Risk low math performance PISA 2012: Impact of assistance to Early Childhood Education and other possible cognitive variables / Rendimiento bajo en matemáticas PISA 2012: impacto de la asistencia en educación infantil temprana y otras posibles variables cognitivas

Abstract: Mathematics competencies are critical in the development of the individual. There are several variables that can predict poor performance in this competition. These variables may be related to self-learner and teacher who instructs. Objective: Analyse the risk of poor performance depending on several variables: attending early childhood education, learning strategies and strategies used by the teacher uses. Method: No experimental or ex post facto. Data: We used the database PISA 2012 for Spain provided by the Ministry of Education, Culture and Sport. The generated data sample consists of 25,313 young Spaniards of both sexes, aged 15 years, belonging to 902 schools that are distributed throughout the national territory of Spain. Dependent or endogenous variable: Performance in mathematics. Independent or exogenous variables: Different variables were considered: attendance and duration of Early Childhood Education, student learning strategies and teaching strategies. Analysis of data: Binary logistic regression. Results: It shows that the factor that has greater predictive capability of risk of underperformance is attending Early Childhood Education [β = −.595; ρ < .001]. It is the variable that has more predictive capability of risk of all analysed. Discussion: There are variables that increase the risk and others that reduce this risk. It is possible to prevent low performance in Mathematics competencies, for example, we need to pursue a teaching of quality Early Childhood Education knowing their long-term benefits and not only ensure access to it for all children.

Resumen: Las competencias matemáticas son críticas en el desarrollo del individuo. Existen diversas variables que pueden predecir el bajo rendimiento en este tipo de competencias. Dichas variables pueden estar relacionadas con el auto-aprendiz o con el maestro que imparte instrucción. Objetivo: Analizar el riesgo de rendimiento bajo según diferentes variables: educación formal desde edad temprana, estrategias de aprendizaje y estrategias que utiliza el maestro. Método: No experimental o ex post facto. Datos: Se utilizó la base de datos PISA 2012 para España, otorgada por el Ministerio de Educación, Cultura y Deporte. La muestra de datos generada consiste en 25313 jóvenes españoles de ambos sexos, de 15 años, pertenecientes a las 902 escuelas distribuidas a lo largo del territorio nacional de España. Variable dependiente: Rendimiento en matemáticas. Variable independiente: Diferentes variables fueron consideradas: asistencia y duración de la educación en edades tempranas, estrategias de aprendizaje del estudiante y estrategias de enseñanza. Análisis de datos: Regresión binaria logística. Resultados: Estos indican que el factor con mayor capacidad predictiva de rendimiento bajo es la educación formal en edades tempranas (B=-.595; p<.001). Es la variable que tiene mayor capacidad predictiva de todas las que se analizaron. Discusión: Existen variables que aumentan el riesgo y otras que lo disminuyen. Es posible prevenir el bajo rendimiento en competencias asociadas a las matemáticas; por ejemplo, se necesita hacer énfasis en la enseñanza de calidad en la educación en edades tempranas sabiendo los beneficios de esto a largo plazo y no solo garantizar el acceso a esta para todos los niños.

'Método de evaluación dinámica automatizado' de competencias lectoras para educación secundaria (EdiLEC) / Method of Automated Dynamic Assessment of reading literacy for Secondary Education (EdilLEC)

Se presenta un nuevo método de evaluación dinámica de la competencia lectora automatizado para educación secundaria (EdiLEC). Su diseño se ajusta al marco teórico propuesto por el Informe PISA-2009 (OCDE, 2010) y los principios de la evaluación dinámica (Sternberg & Grigorenko, 2002). Esta herramienta electrónica proporciona automáticamente mensajes de retroalimentación adaptados a cada individuo sobre el proceso y ejecución a lo largo de la prueba, añadiendo a los resultados de la evaluación tradicional de la competencia lectora la posibilidad de explorar las potencialidades de aprendizaje del estudiante. El método ha sido baremado con una muestra de 1008 estudiantes de entre 11 y 14 años. Los resultados muestran que consta de propiedades psicométricas de fiabilidad, homogeneidad y validez satisfactorias.

A new method to evaluate students' reading literacy, the Method of Dynamic Assessment for Secondary Education (EdilLEC) is presented. EdilLEC is based on PISA assessment framework and the principles of dynamic assessment. In a computer-based environment, automatically provides adaptive intervention elements (feedback and user's aids), in order to add to the reading literacy traditional assessment the possibility to explore the potential of student's learning. The method has been standarized with a sample of 1008 students between 11 and 14 years of aged. Conclusions: The results show satisfactory psychometric properties of reliability, validity and homogeneity.

Risperidone Induced Pisa Syndrome in a Male Adolescent

Pisa syndrome, a rare dystonic reaction resulting from prolonged exposure to antipsychotic medications, is characterized by persistent dystonia of trunk muscles and abnormal posture. It is called Pisa syndrome, because the abnormal posture resembles the Leaning Tower of Pisa. Different from other types of dystonic reactions, Pisa syndrome is more prevalent in females and in older patients with organic brain changes. A 15-year-old male patient with mental retardation was admitted to pediatric neurology clinic for the complaint of abnormal posturing. He had been taking only risperidone for the last four years. Over the last month, the patient gradually developed tonic flexion of trunk and head toward left and was diagnosed with Pisa syndrome. In this paper, we aimed to discuss the association between risperidone use and Pisa syndrome in light of the available literature.

La prueba PISA: una mirada alternativa desde la Teoría del Actor-Red / The PISA test: an Actor-Network Theory alternative approach

En el marco de la proliferación de las evaluaciones estandarizadas, inscritas en lo que ha sido conceptualizado por la literatura como políticas de accountability o de rendición de cuentas, se ofrece por medio de este artículo una línea de pensamiento y discusión alternativa sobre la prueba PISA2. Utilizando como enfoque la Teoría del Actor-Red (TAR) de Bruno Latour, se presentan ejercicios de traslación epistémica de la prueba PISA desde un modelo de pensamiento positivista moderno, a uno materialista pragmático en el que se privilegia una descripción constructivista y analítica de los componentes que la constituyen. En base al seguimiento y análisis de noticias sobre la prueba PISA desplegadas en diarios electrónicos en Chile y Argentina, más la revisión de fuentes secundarias, se exponen algunas de las controversias suscitadas en torno a la evaluación y se discute sobre su posible impacto en nuestras percepciones sobre educación y calidad. También se problematiza el carácter neutral y objetivo de la prueba, y se levanta la pregunta acerca de su posible agencia en la cristalización de las relaciones de centro-periferia entre países que, en el marco del enfoque de la TAR, tiene sentido explorar...

In the context of the proliferation of standardized testing, circumscribed by what has been conceptualized in the literature as “accountability policies”, the aim of this paper is to offer an alternative line of thought and discussion on the PISA test. Using the approach of Bruno Latour’s actor-network theory (ANT), I present exercises on epistemic translation of the PISA test from a modern-positivist model of thought to a materialistic-pragmatic one, in which a constructivist and analytical description of its constituent components is preferred. Based on the monitoring and analysis of news reports about PISA in electronic newspapers in Chile and Argentina, plus the review of secondary sources, I describe some of the controversies surrounding the test and discuss its potential impact on our perceptions of education and quality. Additionally, the allegedly neutral and objective character of the test is problematized, and it is raised the question of its possible agency in the crystallization of centerperiphery relations between countries which, in the framework of the ANT approach, makes sense to explore...

Expresión de citoquinas Th17 y su correlación con periodontopatógenos y el área periodontal inflamada en pacientes con periodontitis crónica / Th17 cytokines expression and its correlation with periodontopathogens and periodontal inflammed surface area (PISA) in patients with chronic periodontitis

Antecedentes: La periodontitis es una enfermedad inflamatoria infecciosa que involucra una respuesta inmune del hospedero y se caracteriza por destrucción del hueso alveolar, el objetivo del estudio es analizar la expresión de citoquinas Th17 y su correlación con periodontopatógenos y el área periodontal inflamada en pacientes con periodontitis crónica. Método: Se realizó un estudio descriptivo exploratorio en el que se reclutaron 23 pacientes con diagnóstico de periodontitis crónica y un grupo control de 10 individuos sano/gingivitis. A todos los sujetos se les realizó un examen periodontal completo. Además, se utilizó el método PISA (Periodontal Inflamed Surface Area) para cuantificar el tamaño de la herida periodontal. Se recolectaron muestras de FGC, plasma y placa bacteriana para su análisis mediante técnica de ELISA de IL-17 A, IL-6, IL-23 y IL-10 y PCR para la determinación de la presencia de: P. gingivalis, T. denticola, T. forsythensis, A. actinomycetemcomitans, F. nucleatum y P. intermedia. Los datos fueron analizados utilizando estadística descriptiva y la asociación entre variables se estimó a través de modelos de regresión logística. Resultados: Se observó una tendencia al aumento, no significativa, de los niveles de IL-17A, IL-6 y IL-23 a nivel de FGC en los sujetos con periodontitis crónica (p=0.716, 0.784, 0.421, respectivamente). Los pacientes con periodontitis crónica presentaron una disminución de la IL-10 (p=0.012) y los niveles de IL-17A se correlacionaron positivamente con el área periodontal inflamada (p=0.004). A nivel de los patógenos periodontales, se observó una asociación entre la presencia de: P. gingivalis, T. denticola, T. forsythensis y los niveles de IL-6 plasmática (p=0.017, 0.033, 0.024, respectivamente).

Objective: Periodontitis is an infectious and inflammatory disease that involves a host immune response and is characterized by alveolar bone destruction. Aim: Analyze the expression of Th17 cytokines and their correlation with periodontopathogens and periodontal inflamed area in patients with chronic periodontitis. Method: A case control study was performed. At the time of delivery, 23 cases of patients with periodontal diagnosis were enrolled in the study and 10 controls with gingivitis. The diagnosis involved a complete periodontal examination with periodontal Florida probe. Also we used the PISA (Periodontal Inflamed Surface Area) index to classify the groups. Plasma and GCF samples were collected and studied for protein expression by ELISA assays for IL17A, Il6, IL23 and IL10. Plaque was analyzed by PCR for the determination of the presence of: P. gingivalis, T. denticola, T. forsythensis, F. nucleatum, P. intermedia and A. actinomycetemcomitans. Data was analyzed using descriptive statistics and the association between variables was estimated through logistic regression models. Results: There is a trend of increased GCF levels of IL17A, IL6, and IL23 with no significance. However there was an association between gingivitis and IL10 plasma and GCF levels (p=0.012). In relation to the periodontal wound size, a correlation was observed between the levels of IL6 and IL10 in GCF. Analysis of periodontal pathogens, showed an association between the presence of: P. gingivalis, T. denticola, T. forsythensis and plasma levels of IL-6 (p=0.017, 0.033 and 0.024, respectively).

Dilación, dilatación e inclinación en hidrocefalia de presión normal / Delay, Dilation, and Bending in Normal Pressure Hydrocephalus

Introducción: La hidrocefalia idiopática de presión normal es una entidad conformada por una triada de signos clínicos que incluyen alteraciones de la marcha, de la cognición y del control de esfínteres urinarios, concomitantes con un aumento de líquido cefalorraquídeo con presión normal, hidrocefalia y atrofia cortical, sin causa identificable. Métodos y resultados: Reporte de caso. Paciente colombiano, de género masculino y 26 años de edad, con un cuadro clínico de tres años de evolución: presentaba los criterios clínicos descritos anteriormente, además de una notoria afectación extrapiramidal, caracterizada por distonía focal, incluyendo pleurotonos. Sumado a lo anterior, presentó labilidad emocional, alteraciones de memoria, personalidad que pasó de introvertida a compulsiva, trastornos del sueño, aislamiento y disminución de la reacción al peligro. Inicialmente se diagnosticó depresión, y luego, esquizofrenia paranoide. Recibió olanzapina sin mejoría de su cuadro neuropsiquiátrico. Algunos de estos signos y síntomas mejoraron luego de punción lumbar, la cual tuvo una presión normal, confirmándose así el diagnóstico clínico, con posibilidades terapéuticas promisorias. Conclusión: La hidrocefalia de presión normal se debe considerar en personas jóvenes, cuya sintomatología y exámenes de neurolaboratorio no cumplan con los fundamentos de la psiquiatría basada en la evidencia.

Introduction: Normal pressure hydrocephalus is a clinical entity characterized by a triad of clinical signs including gait abnormalities, cognitive disorders and sphincter dysfunction. It parallels an increased cerebrospinal fluid pressure, hydrocephalus and brain cortical atrophy. No detectable cause is a must. Methods and results: Case report. This is a Colombian male patient, 26 years-old, who had the clinical findings commented above starting three years before our evaluation. He also presented notorious extrapyramidal involvement, mostly focal dystonia including pleorotonus. Besides this, mood lability, memory disorders, personality changes turning from introverted to compulsive, sleep disorders, isolation and fearlessness were also present. Initially, depression was diagnosed and then paranoid schizophrenia was considered. Olanzapine was given with no benefits on his neuropsychiatric disorder. Some of these signs and symptoms improved after a lumbar puncture which had a normal pressure. It confirmed the diagnosis and offered very promising therapeutic possibilities. Conclusion: Normal pressure hydrocephalus must be considered in young people who have clinical symptoms and neurolaboratory findings out of the range of those commonly considered to be part of evidence-based psychiatry.

Pisa Syndrome in Parkinson's Disease With a Good Response to Dopamine Therapy

No abstract available.

Pisa Syndrome in a Patient with Alzheimer's Disease and Concomitant Normal Pressure Hydrocephalus: A Case Report

Extrapyramidal symptoms are common in patients with advanced Alzheimer's disease and have various etiologies. We report a 65-year-old man with probable Alzheimer's disease (AD) who concomitantly developed Pisa syndrome, ataxic gait, postural instability and voiding difficulty. Pisa syndrome improved after the discontinuation of acetylcholinesterase inhibitor (AchEI) and antipsychotics. However his ataxic gait and voiding symptoms persisted. A ventriculo-peritoneal shunt operation eliminated the symptoms except for cognition. We report Pisa syndrome in a patient with Alzheimer's disease and concomitant normal pressure hydrocephalus.

Quantification of mitral regurgitation using proximal isovelocity surface area method in dogs

The present study was performed to determine the accuracy and reproducibility of calculating the mitral regurgitant orifice area with the proximal isovelocity surface area (PISA) method in dogs with experimental mitral regurgitation and in canine patients with chronic mitral insufficiency and to evaluate the effect of general anesthesia on mitral regurgitation. Eight adult, Beagle dogs for experimental mitral regurgitation and 11 small breed dogs with spontaneous mitral regurgitation were used. In 8 Beagle dogs, mild mitral regurgitation was created by disrupting mitral chordae or leaflets. Effective regurgitant orifice (ERO) area was measured by the PISA method and compared with the measurements simultaneously obtained by quantitative Doppler echocardiography 4 weeks after creation of mitral regurgitation. The same procedure was performed in 11 patients with isolated mitral regurgitation and in 8 Beagle dogs under two different protocols of general anesthesia. ERO and regurgitant stroke volume (RSV) by the PISA method correlated well with values by the quantitative Doppler technique with a small error in experimental dogs (r = 0.914 and r = 0.839) and 11 patients (r = 0.990 and r = 0.996). The isoflurane anesthetic echocardiography demonstrated a significant decrease of RSV, and there was no significant change in fractional shortening (FS), ERO area, LV end-diastolic and LV end-systolic volume. ERO area showed increasing tendency after ketamine-xylazine administration, but not statistically significant. RSV, LV end-systolic and LV end-diastolic volume increased significantly (p < 0.01), whereas FS significantly decreased (p < 0.01). The PISA method is accurate and reproducible in experimental mitral regurgitation model and in a clinical setting. ERO area is considered and preferred as a hemodynamic-nondependent factor than other traditional measurements.

A Case of Metronome Pisa Syndrome in Risperidone Therapy / 신경정신의학

The Pisa syndrome is a rare extrapyramidal side effect caused by neuroleptic treatment and its characteristics are twisting and bending to one side of the upper thorax, the neck and the head. When its chatacteristics show both sides, we call it 'Metronome Pisa syndrome'. We report the case of a 53-year-old woman who suffered Metronome Pisa syndrome following risperidone therapy. Risperidone therapy in old ages should be cautious even if its dosage is minimal.

Four Cases of Pisa Syndrome in Risperidone Therapy

The Pisa syndrome is a rare extrapyramidal side effect caused by neuroleptic treatment. Its characteristics are the twist-ing and bending to one side of the upper thorax, the neck, and the head. To our knowledge, there have been no reports of Pisa syndrome in risperidone therapy. We report four male patients with Pisa syndrome in risperidone therapy. Significant points to be noted here are the absence of any extrapyramidal symptoms prior to risperidone therapy, occur-rence in risperidone therapy with small dosages, and delayed spontaneous recovery on discontinuation of risperidone.

Two Cases of Pisa Syndrome Due to Cholinestrase Inhibitor

The Pisa syndrome is a rare extrapyramidal side effect with twisting and bending characteristics of the upper trunk, neck, and head, usually caused by neuroleptic treatment. However, there have been no reports of Pisa syndrome in cholinesterase inhibitor therapy. We report 2 female patients of Alzheimer's disease with Pisa syndrome after cholinesterase inhibitor ther-apy. The postural disturbance in these patients was completely resolved after the cessation of the cholinesterase inhibitor. Although the pathophysiology of Pisa syndrome appears to be extremely complicated and poorly understood, it may be of importance to consider the relationship between acetylcholine and Pisa syndrome. Therefore, the present cases provide a novel viewpoint on the underlying mechanism of the Pisa syndrome and the role of acetylcholine in the movement disorder.

Assessment of Mitral Valve Area in Patients with Mitral Stenosis Using Color Doppler Proximal Isovelocity Surface Area Method

BACKGROUND: It has been proposed recently that measuring the flow convergence region proximal to an orifice by Doppler flow mapping can provide a means of calculating regurgitant flow rate. And this method also can be used to derive cardiac output or flow rate proximal to stenotic orifices and therefore to calculate their areas by the continuity equation(area=flow rate/velocity). Applying this method in mitral stenosis would provide a unique way of validating the underlying concept because the predicted areas could be compared with those measured directly by planimetry and pressur half-time method. METHOD: We studied 50 patients with mitral stenosis using imaging and Doppler echocardiography. Doppler color flow recordings of mitral inflow were obtained from the apex, and the radius of the proximal flow convergence region was measured at its peak diastolic valve from the orifice to the first color alias along the axis of flow. Flow rate was calculated assuming uniform radial flow convergence toward the orifice, modified by a factor that accounted for the inflow funnel angle formed by the mitral leaflets. Mitral valve area was then calculated as peak flow rate divided by peak velocity by continuous-wave Doppler. RESULTS: The calculated areas agreed well with those from comparative techniques. 1) Cross-sectional area by planimetry(y=0.38×+0.81, r=0.51, p < 0.001). 2) Area derived from the Doppler pressure half-time(y=0.35+0.55, r=0.44, p=0.002). 3) Agreement with planimetry was similar for 26 patients with mitral regurgitation and 24 without it, as well as for 34 in atrial fibrillation. CONCLUSION: These results suggested that the proximal flow convergence concept in the clinical setting demonstrate calculating method of mietral valve area in patients with mitral stenosis.