Insights into the management of Lewy body dementia: a scoping review.

Lewy body dementia (LBD) is situated at the convergence of neurodegenerative disorders, posing an intricate and diverse clinical dilemma. The accumulation of abnormal protein in the brain, namely, the Lewy body causes disturbances in typical neural functioning, leading to a range of cognitive, motor, and mental symptoms that have a substantial influence on the overall well-being and quality of life of affected individuals. There is no definitive cure for the disease; however, several nonpharmacological and pharmacological modalities have been tried with questionable efficacies. The aim of this study is to figure out the role of different interventional strategies in the disease. Donepezil, rivastigmine, memantine, and galantamine were the commonly used drugs for LBD. Together with that, levodopa, antipsychotics, armodafinil, piracetam, and traditional medications like yokukansan were also used, when indicated. Talking about nonpharmacological measures, exercise, physical therapy, multicomponent therapy, occupational therapy, psychobehavioral modification, transcranial stimulation, and deep brain stimulation have been used with variable efficacies. Talking about recent advances in the treatment of LBD, various disease-modifying therapies like ambroxol, neflamapimod, irsenontrine, nilotinib, bosutinib, vodobatinib, clenbuterol, terazosin, elayta, fosgonimeton, and anle138b are emerging out. However, there drugs are still in the different phases of clinical trials and are not commonly used in clinical practice. With the different pharmacological and nonpharmacological modalities we have for treatment of LBD, all of them offer symptomatic relief only. Being a degenerative disease, definite cure of the disease can only be possible with regenerative measures.

Molecular biology of carcinoid heart disease: Seeking therapeutic targets in the era of targeted therapy.

Carcinoid tumors (CT) are among the least studied tumors. It is a relatively rare and slow-growing tumor with good survival in its primary form. However, metastatic carcinoid tumor comes up with many different complications contributing to increased morbidity and mortality. Metastatic form of the disease has a wide spectrum of clinical manifestations and multisystem involvement including cardiovascular manifestations, neurological manifestations, and psychiatric manifestations and so on. In this review, we are centered towards the cardiovascular manifestations of the disease, which, by far, is one of the commonest causes of death in these patients. Being a neuroendocrine tumor, cardiovascular manifestations are mainly because of biologically active substances, produced by the tumor cells, remodeling the heart. Development of targeted therapies against carcinoid heart diseases is currently limited by lack of understanding of pathophysiology of the disease processes. In this review, we aim to figure out the spectrum of carcinoid heart diseases, along with the molecular biology of the changes going on, which, in turn, will not only pave a way to the development of targeted therapies but will also extend opportunities for molecular screening of the tumor and diagnosis at an early stage, thereby, reducing the morbidity and mortality.

Assessment of Implementation of CB-IMNCI Program at Primary Health Care Centers and Health Posts.

BACKGROUND: Community-based integrated management of neonatal and childhood illness (CB-IMNCI) is a government-run priority one program aimed to decrease neonatal and childhood morbidity and mortality. The objective of our study was to identify the CB-IMNCI implementation gap in terms of health care providers' training status, availability of medicines, follow-up visits and clinical outcome at Primary Health Care Centers and Health Posts of Morang district of Nepal. METHODS: We conducted a community based cross-sectional study in Morang district of Nepal from 25 Oct 2021 to 25 Jan 2022. Ethical approval was taken from ethical review board of the Nepal Health Research Council. We enrolled 9 (53%) out of 17 local governments of Morang district of Nepal by simple random sampling. The collected data was entered in MS Excel and analyzed by SPSS version 23. RESULTS: The majority of healthcare workers were in their early age of 26-35 years (57.2%), male (85.7%) and Auxiliary Health Workers (78.6%). The mean duration of practice was 15.1 years. Only 46.5% of healthcare providers were trained for the CB-IMNCI program. The availability of medicine as per CB-IMNCI guideline was 52.9%. There was no record available for total number of required follow up, total number of actual follow up and clinical outcome in last 6 months. CONCLUSIONS: About half of the human resources were trained with the availability of only half of the required medicines. We also found a lack of adequate record-keeping of follow up of patients and their clinical outcomes.