Multidisciplinary Interventions in Motor Neuron Disease.

Motor neuron disease is a neurodegenerative disease characterized by loss of upper motor neuron in the motor cortex and lower motor neurons in the brain stem and spinal cord. Death occurs 2-4 years after the onset of the disease. A complex interplay of cellular processes such as mitochondrial dysfunction, oxidative stress, excitotoxicity, and impaired axonal transport are proposed pathogenetic processes underlying neuronal cell loss. Currently evidence exists for the use of riluzole as a disease modifying drug; multidisciplinary team care approach to patient management; noninvasive ventilation for respiratory management; botulinum toxin B for sialorrhoea treatment; palliative care throughout the course of the disease; and Modafinil use for fatigue treatment. Further research is needed in management of dysphagia, bronchial secretion, pseudobulbar affect, spasticity, cramps, insomnia, cognitive impairment, and communication in motor neuron disease.

Disease Modifying Therapy in Multiple Sclerosis.

Multiple sclerosis is an autoimmune disease of the central nervous system characterized by inflammatory demyelination and axonal degeneration. It is the commonest cause of permanent disability in young adults. Environmental and genetic factors have been suggested in its etiology. Currently available disease modifying drugs are only effective in controlling inflammation but not prevention of neurodegeneration or accumulation of disability. Search for an effective neuroprotective therapy is at the forefront of multiple sclerosis research.

Prevalence and pattern of neurocognitive impairment in nigerians with stages 3 to 5 chronic kidney disease.

Background. Cognitive impairment with its negative effect on quality of life has been reported in chronic kidney disease (CKD). The paucity of the literature on cognitive impairment in Africans with CKD prompted this study. Objectives. To determine the frequency and pattern of cognitive impairment in patients with stages 3 to 5 CKD. Methods. We studied 79 consecutive consenting adults with a National Kidney Foundation (NKF) stage 3 to 5 CKD based on their estimated glomerular filtration rate using the Cockcroft-Gault formula. The controls consisted of healthy demographically matched subjects. Community screening instrument for dementia (CSI'D), trail making test A (TMTA), and trail making test B (TMTB) were used for cognitive assessment. Results. More CKD patients had cognitive impairment compared with controls using CSI'D (51.9% versus 2.5%, P < 0.001); TMTA (53.2% versus 0%, P < 0.001); and TMTB (40% versus 0%, P < 0.001). The odds of having cognitive impairment increased in the presence of CKD when assessed using CSI'D (OR = 2.026; CI = 1.607-2.555); TMTA (OR = 3.13; CI = 2.40-4.09) and TMTB (OR = 3.22; CI = 2.42-4.25). CKD patients performed poorer on tests of executive function TMTA (P < 0.001) and TMTB (P < 0.001) while CSI'D showed significantly lower scores on multiple cognitive domains. Conclusions. Significant cognitive impairment in multiple domains exists among Nigerians with CKD.

The role of radiotherapy and chemotherapy in the treatment of primary adult high grade gliomas: assessment of patients for these treatment approaches and the common immediate side effects.

Gliomas are the commonest primary brain tumours in adults. They are usually classified and graded according to the criteria by the World Health Organisation. High-grade gliomas are the most malignant primary brain tumours. Conventional therapies include surgery, radiotherapy, and chemotherapy. The tumours often demonstrate high levels of resistance to these conventional therapies, and in spite of treatment advances the prognosis remains poor.

Heterogeneity of tracheobronchial lymphatic smooth muscle responses to histamine and 5-hydroxytryptamine.

We assessed the responsiveness of tracheobronchial lymphatic smooth muscle to mediators of inflammation to determine whether homogeneous responses to histamine and 5-hydroxytryptamine (5-HT) are demonstrated among species typically used in studies of lymph vessels. Fresh porcine and bovine tracheobronchial lymph vessels were suspended from force-displacement transducers in baths containing oxygenated Krebs solution. Concentration-response curves were generated by cumulative addition of histamine (10(-7) to 10(-3) M) or 5-HT (10(-7) to 3 x 10(-4) M). Active tension (AT) was expressed in milligrams and as a percentage of initial vessel ring response to 65mM KCl. Histamine elicited concentration-dependent contraction, yielding maximum AT in porcine rings of 1116 +/- 127 mg (n = 39; 129.1 +/- 10.5% of KCl response) and in bovine rings of 733 +/- 106 mg (n = 20; 65.8 +/- 12.9%; P = 0.0005 for percent responses). PD2 values (negative log10 of the concentration at half-maximum effect) were 4.49 +/- 0.08 and 4.82 +/- 0.08; (P = 0.0034). 5-HT elicited concentration-dependent contraction, yielding maximum AT of 560 +/- 50 mg in porcine rings (n = 15; 97.2 +/- 9.7%) and 2892 +/- 454 mg in bovine rings (n = 27; 159.0 +/- 29%; P < 0.0001 for percent responses). PD2 values were 6.25 +/- 0.05 and 5.28 +/- 0.04 (P < 0.0001). The data demonstrate a role for inflammatory mediators in the modulation of tracheobronchial lymphatic smooth muscle tone that is species- and mediator-specific, and support the potential for paracrine regulation of tracheobronchial lymph flow.